Ectopic pregnancy in an IUD user — MCCQE Part 1 MCQ

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HardAbdominal PainEctopic pregnancy in an IUD userMCCQE Part 1

A 37-year-old with a levonorgestrel IUD has pelvic pain, light bleeding, adnexal tenderness and a positive pregnancy test. Which of the following is the most appropriate next step?

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Correct answer: D — Evaluate urgently for ectopic pregnancy

Evaluate urgently for ectopic pregnancy is the single best answer because the age, timing, examination findings and investigations in the vignette fit Ectopic pregnancy in an IUD user better than the alternatives. The most tempting distractor is less appropriate because it either treats a neighbouring presentation, delays a time-critical intervention, or ignores a key discriminator in the stem. The remaining options are suboptimal because they would miss the diagnosis, use an investigation or treatment in the wrong sequence, or fail to address safety and follow-up. Canadian practice should be anchored to SOGC ectopic pregnancy guidance, with attention to acuity, safety-netting and local provincial pathways.

Reference: SOGC ectopic pregnancy guidance