NEET PG / USMLE – MCQ 17

A 25-year-old woman is brought to the emergency department 1 hour after she fainted. She has had mild intermittent vaginal bleeding,sometimes associated with lower abdominal pain, during the past 3 days. She has had severe cramping pain in the right lower abdomen for 12 hours. She has not had a menstrual period for 3 months; previously, menses occurred at regular 28-day intervals. Abdominal examination shows mild tenderness to palpation in the right lower quadrant. Bimanual pelvic examination shows a tender walnut-sized mass in the right parametrium. Which of the following is the most likely diagnosis?
A. Appendicitis
B. Cancer of the ovary
C. Ectopic pregnancy
D. Endometriosis
E. Ovarian cyst
F. Placenta previa

Correct answer : C. Ectopic pregnancy

The history is typical of ruptured ectopic pregnancy. Excluding other options:
-Appendicitis and endometriosis does not cause amenorrhoea
-Torsion of ovarian cyst / tumour in pregnancy can present as a case of acute abodomen, but does not cause bleeding
-Placenta previa causes painless vaginal bleeding