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Suspected appendicitis — PARA MCQ

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HardSurgery - Acute abdomenSuspected appendicitisPARA

A haemodynamically stable woman at approximately 6 weeks has mild unilateral pelvic pain and light bleeding. Transvaginal ultrasound shows no intrauterine or extrauterine pregnancy; serum hCG is 1,200 IU/L. Symptoms are unchanged. What should the early-pregnancy team arrange next?

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

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Correct answer: C — Repeat serum hCG after 48 hours with ectopic-pregnancy safety-netting

Explanation lettering: D = shown as A · A = shown as B · B = shown as C · C = shown as D

B is correct. This is a pregnancy of unknown location, which may still be ectopic. NICE uses 2 serum hCG measurements as close as possible to 48 hours apart to guide subsequent management, while clinical symptoms take priority and require 24-hour access advice. A treats without a definitive ectopic diagnosis. C should not be used to diagnose location. D uses the wrong interval and interpretation. E risks rupture while waiting for a numerical threshold.

Reference: NICE NG126: pregnancy of unknown location and ectopic pregnancy diagnosis: https://www.nice.org.uk/guidance/ng126/chapter/diagnosis-of-viable-intrauterine-pregnancy-and-of-tubal-ectopic-pregnancy GMC: PA registration assessment content map: https://www.gmc-uk.org/education/standards-guidance-and-curricula/standards-and-outcomes/pa-and-aa-prequalification-education-framework/pa-registration-assessment-content-map