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Ectopic pregnancy abdominal pain — ABEM Board MCQ

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ModerateGI/Abdominal emergenciesEctopic pregnancy abdominal painABEM Board

A 29-year-old woman arrives with pelvic pain and light vaginal bleeding. Triage acuity is ESI 2; BP 92/56 mm Hg, HR 124/min. Pregnancy test is positive, and transvaginal ultrasound shows no intrauterine pregnancy with free pelvic fluid. She has right adnexal tenderness. Which of the following is the most likely diagnosis?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Ruptured ectopic pregnancy

Hemodynamic instability, positive pregnancy test, empty uterus, adnexal pain, and free fluid indicate ruptured ectopic pregnancy.

Reference: ACEP Early Pregnancy clinical policy; ACOG ectopic pregnancy guidance