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Ectopic pregnancy — USMLE Step 2 CK MCQ

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HardObstetrics & GynecologyEctopic pregnancyUSMLE Step 2 CK

A hemodynamically stable 29-year-old at 7 weeks by her last menstrual period has unilateral pelvic pain and light vaginal bleeding. Urine pregnancy testing is positive; the cervix is closed and there are no peritoneal signs. Which diagnostic approach should be used first to determine pregnancy location?

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

Reveal the answer and explanation

Correct answer: D — Use transvaginal ultrasonography with quantitative beta-hCG, repeating either when the location remains uncertain

Explanation lettering: E = shown as B · B = shown as E

D is correct: a stable patient with pain or bleeding in early pregnancy requires localization with transvaginal ultrasonography interpreted alongside quantitative beta-hCG; serial hCG and repeat ultrasound are used when the initial evaluation defines a pregnancy of unknown location. A overstates the certainty of a single discriminatory-level value. B cannot reliably localize the gestation. C exposes the pregnancy to unnecessary ionizing radiation and is inferior for this purpose. E is reserved for instability, rupture, or another clear surgical indication rather than unilateral pain alone.

Reference: ACOG Practice Bulletin: tubal ectopic pregnancy. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2018/03/tubal-ectopic-pregnancy