Ectopic pregnancy Test Questions with Correct Answers Already Passed
Ectopic pregnancy - Answers Implantation of a blastocyst in a location other than in the uterine cavity
Classic triad of ectopic symptoms? - Answers Pain
Amenorrhea
Spotting or bleeding
Three categories of ectopic pregnancies? - Answers Intrauterine, extrauterine, heterotopic
Treatment options for ectopic? - Answers Medical
Surgical
Expectant management
Which is preferable, medical or surgical management of ectopic? - Answers Medical management is
preferable to even "conservative" surgical procedures whenever feasible, esp in asymptomatic women
with early unruptured EP
Location might an intrauterine ectopic occur? - Answers Gestation in cervix or cornua
Location might an extrauterine ectopic occur? - Answers Fallopian tube, ovary, abdomen, broad
ligament
Location might an heterotopic pregnancy occur? - Answers Implantation in both uterine cavity and in an
ectopic site (usually tube)
When are heterotopic pregnancies more likely? - Answers With pregnancy resulting from IVF
Which type of ectopic is most common? - Answers Tubal (97%)
How are tubal ectopics classified? - Answers By location: ampullary, isthmic, fimbrial, cornual/insterstital
What type of tubal ectopic is most common? - Answers Ampullary
Why is ampullary ectopic so common? - Answers Because it is where fertilization usually occurs
When will a woman with an isthmic ectopic become symptomatic? - Answers Earlier rather than later (6-
7w?)
Why will a woman with an isthmic ectopic become symptomatic earlier? - Answers Because it that part
of the tube is so narrow
What is the most distal part of the fallopian tube? - Answers Fimbriae
,What can happen to the products of conception in a fimbrial ectopic? - Answers They can be expelled
into the peritoneal cavity
Why do interstitial ectopics generally rupture later rather than earlier? - Answers Thicker portion of the
tube partially surrounded by myometrium
When would rupture generally occur with an interstitial ectopic? - Answers 9-12w
What is a possible etiology of ectopic related to implantation? - Answers Mechanical interference with
implantation: IUC, hormonal dysfunction, sterilization failure
What are some factors considered high risk for ectopic? - Answers Prior ectopic pregnancy
Tubal pathology & surgery
In utero DES exposure
What is the chance of recurrence with prior ectopic pregnancy? - Answers 33%
What kind of infection can result in tubal pathology? - Answers Chlamydia, GC, polymicrobial
What is the relationship between IUDs and ectopic? - Answers Doesn't cause EP but if a pregnancy
occurs there's a greater risk that the pregnancy is EP
What type of infertility is of greatest risk for ectopic? - Answers Patients with primary infertility due to
tubal factors that prohibit or delay ovum transport
What are some surgical risk factors for ectopic? - Answers History of pelvic or abdominal procedures
What lifestyle factor is known to increase risk of ectopic? - Answers Smoking (dose dependent), multiple
partners, early age of 1st intercourse
What percentage of women with ectopic will have NO identifiable risk factors or initial definitive
physical findings? - Answers 50%
What kind of pain is associated with ectopic? - Answers Abdominal usually monitor pelvic, shoulder
What kind of pain suggests rupture? - Answers Sharp, sudden, stabbing
What might exacerbate abdominal pain due to ectopic? - Answers Movement
What does shoulder pain suggest in ectopic? - Answers Phrenic nerve stimulation -> rupture
Why does shoulder pain occur in some ectopic pregnancies? - Answers Intra-peritoneal bleeding with
blood collecting below the diaphragm
How are vital signs affected by ectopic? - Answers Usually normal
, On abdominal exam, how might a woman with ectopic present if she hasn't ruptured? - Answers
Unilateral tenderness in lower abdomen
On abdominal exam, how might a woman with ectopic present if she has ruptured? - Answers Acute
abdomen -- rebound, guarding, rigidity
Decreased bowel sounds
Cullen's sign (Cullen's sign is superficial edema and bruising in the subcutaneous fatty tissue around the
umbilicus. It is named for Thomas Stephen Cullen (1869-1953), gynecologist who first described the sign
in ruptured ectopic pregnancy in 1916.)
On bimanual exam, how might a woman with ectopic present? - Answers - 70% normal size --> IE not
pregnant
- 30% enlarged but S<D
- May be displaced to one side
- CMT in 50-75%
- adnexal tenderness, bilateral or unilater
- ill-defined adnexal mass or feeling of fullness in adnexa
- adnexal mass on side opposite the EP in 20% (usually corpus luteum cyst)
- Doughy mass or bulging sensation palpated in posterior vaginal fornix (pouch of Douglas) due to
accumulation of blood
bleeding from fimbriated end of tube into the cul-de-sac
Differential diagnosis for ectopic? - Answers - Ectopic (which location? ruptured or unruptured?)
- IUP (implantation; incomplete or missed spontaneous
abortion/miscarriage; threatened abortion/miscarriage; painful, normal corpus luteum cyst; ruptured
corpus luteum cyst; follicular cyst)
- PID/Salpingitis
- Appendicitis
- Endometriosis
- Abnormal uterine bleeding
- Ovarian torsion or ruptured cysts
Ectopic pregnancy - Answers Implantation of a blastocyst in a location other than in the uterine cavity
Classic triad of ectopic symptoms? - Answers Pain
Amenorrhea
Spotting or bleeding
Three categories of ectopic pregnancies? - Answers Intrauterine, extrauterine, heterotopic
Treatment options for ectopic? - Answers Medical
Surgical
Expectant management
Which is preferable, medical or surgical management of ectopic? - Answers Medical management is
preferable to even "conservative" surgical procedures whenever feasible, esp in asymptomatic women
with early unruptured EP
Location might an intrauterine ectopic occur? - Answers Gestation in cervix or cornua
Location might an extrauterine ectopic occur? - Answers Fallopian tube, ovary, abdomen, broad
ligament
Location might an heterotopic pregnancy occur? - Answers Implantation in both uterine cavity and in an
ectopic site (usually tube)
When are heterotopic pregnancies more likely? - Answers With pregnancy resulting from IVF
Which type of ectopic is most common? - Answers Tubal (97%)
How are tubal ectopics classified? - Answers By location: ampullary, isthmic, fimbrial, cornual/insterstital
What type of tubal ectopic is most common? - Answers Ampullary
Why is ampullary ectopic so common? - Answers Because it is where fertilization usually occurs
When will a woman with an isthmic ectopic become symptomatic? - Answers Earlier rather than later (6-
7w?)
Why will a woman with an isthmic ectopic become symptomatic earlier? - Answers Because it that part
of the tube is so narrow
What is the most distal part of the fallopian tube? - Answers Fimbriae
,What can happen to the products of conception in a fimbrial ectopic? - Answers They can be expelled
into the peritoneal cavity
Why do interstitial ectopics generally rupture later rather than earlier? - Answers Thicker portion of the
tube partially surrounded by myometrium
When would rupture generally occur with an interstitial ectopic? - Answers 9-12w
What is a possible etiology of ectopic related to implantation? - Answers Mechanical interference with
implantation: IUC, hormonal dysfunction, sterilization failure
What are some factors considered high risk for ectopic? - Answers Prior ectopic pregnancy
Tubal pathology & surgery
In utero DES exposure
What is the chance of recurrence with prior ectopic pregnancy? - Answers 33%
What kind of infection can result in tubal pathology? - Answers Chlamydia, GC, polymicrobial
What is the relationship between IUDs and ectopic? - Answers Doesn't cause EP but if a pregnancy
occurs there's a greater risk that the pregnancy is EP
What type of infertility is of greatest risk for ectopic? - Answers Patients with primary infertility due to
tubal factors that prohibit or delay ovum transport
What are some surgical risk factors for ectopic? - Answers History of pelvic or abdominal procedures
What lifestyle factor is known to increase risk of ectopic? - Answers Smoking (dose dependent), multiple
partners, early age of 1st intercourse
What percentage of women with ectopic will have NO identifiable risk factors or initial definitive
physical findings? - Answers 50%
What kind of pain is associated with ectopic? - Answers Abdominal usually monitor pelvic, shoulder
What kind of pain suggests rupture? - Answers Sharp, sudden, stabbing
What might exacerbate abdominal pain due to ectopic? - Answers Movement
What does shoulder pain suggest in ectopic? - Answers Phrenic nerve stimulation -> rupture
Why does shoulder pain occur in some ectopic pregnancies? - Answers Intra-peritoneal bleeding with
blood collecting below the diaphragm
How are vital signs affected by ectopic? - Answers Usually normal
, On abdominal exam, how might a woman with ectopic present if she hasn't ruptured? - Answers
Unilateral tenderness in lower abdomen
On abdominal exam, how might a woman with ectopic present if she has ruptured? - Answers Acute
abdomen -- rebound, guarding, rigidity
Decreased bowel sounds
Cullen's sign (Cullen's sign is superficial edema and bruising in the subcutaneous fatty tissue around the
umbilicus. It is named for Thomas Stephen Cullen (1869-1953), gynecologist who first described the sign
in ruptured ectopic pregnancy in 1916.)
On bimanual exam, how might a woman with ectopic present? - Answers - 70% normal size --> IE not
pregnant
- 30% enlarged but S<D
- May be displaced to one side
- CMT in 50-75%
- adnexal tenderness, bilateral or unilater
- ill-defined adnexal mass or feeling of fullness in adnexa
- adnexal mass on side opposite the EP in 20% (usually corpus luteum cyst)
- Doughy mass or bulging sensation palpated in posterior vaginal fornix (pouch of Douglas) due to
accumulation of blood
bleeding from fimbriated end of tube into the cul-de-sac
Differential diagnosis for ectopic? - Answers - Ectopic (which location? ruptured or unruptured?)
- IUP (implantation; incomplete or missed spontaneous
abortion/miscarriage; threatened abortion/miscarriage; painful, normal corpus luteum cyst; ruptured
corpus luteum cyst; follicular cyst)
- PID/Salpingitis
- Appendicitis
- Endometriosis
- Abnormal uterine bleeding
- Ovarian torsion or ruptured cysts
