A patient presents with amenorrhea, a positive pregnancy test (beta HCG 2500 IU), a "doughnut sign" on a 5-week ultrasound, an empty uterus, and a small ovarian cyst. What is the n... A patient presents with amenorrhea, a positive pregnancy test (beta HCG 2500 IU), a "doughnut sign" on a 5-week ultrasound, an empty uterus, and a small ovarian cyst. What is the next step in management? Options: A) Laparoscopy, B) Repeat ultrasound, C) Repeat S. beta HCG, D) Parenteral Methotrexate
Understand the Problem
The question describes a clinical scenario involving a patient with amenorrhea, a positive pregnancy test (beta HCG 2500 IU), a finding of a "doughnut sign" on a 5-week ultrasound (often associated with ectopic pregnancy), an empty uterus, and a small ovarian cyst. The question asks about the most appropriate next step in management.
Answer
Repeat S. beta HCG.
The next step in management is to repeat S. beta HCG.
Answer for screen readers
The next step in management is to repeat S. beta HCG.
More Information
Given the clinical scenario of amenorrhea, a positive pregnancy test, a 'doughnut sign' on ultrasound, an empty uterus, and a small ovarian cyst, the most likely diagnosis is an ectopic pregnancy. However, with a beta HCG of 2500 IU and an empty uterus on ultrasound, it's possible the pregnancy is too early to visualize in the uterus. Repeating the beta HCG level in 48 hours is important to see if it is appropriately increasing, which would suggest a viable intrauterine pregnancy, or if it is not increasing as expected, which would further support the diagnosis of ectopic pregnancy.
Tips
A common mistake to make is proceeding directly to laparoscopy or methotrexate without first confirming the diagnosis and ruling out a viable intrauterine pregnancy.
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