Ectopic Pregnancy Case Study – Jean Simmons |
2026/2027 Final Exam Study Guide – Correct Clinical
Solutions
This guide offers a detailed case study on ectopic pregnancy, focusing on the clinical aspects,
diagnosis, and management of this medical condition. It includes accurate solutions to ensure
understanding for the final exam.
Key Words: Ectopic Pregnancy, Case Study, Clinical Solutions, Diagnosis, Management
Section 1: Initial Assessment & Diagnosis
1. What is the most critical initial action in evaluating a suspected ectopic pregnancy?
A) Schedule an outpatient ultrasound
B) Obtain a detailed sexual history
C) Assess hemodynamic stability ✓
D) Perform a Pap smear
2. Which triad of symptoms is classic for ectopic pregnancy?
A) Pelvic pain, vaginal bleeding, amenorrhea ✓
B) Nausea, fever, diarrhea
C) Back pain, urinary frequency, constipation
D) Headache, dizziness, fatigue
3. Jean's serum hCG is 2,500 mIU/mL. Transvaginal ultrasound shows no intrauterine
gestational sac. What is the most likely diagnosis?
A) Normal intrauterine pregnancy (too early)
B) Ectopic pregnancy ✓
C) Complete miscarriage
D) Molar pregnancy
, 4. What is the discriminatory zone for hCG with transvaginal ultrasound?
A) 1,000–2,000 mIU/mL ✓
B) 5,000–6,000 mIU/mL
C) 10,000–15,000 mIU/mL
D) 20,000–30,000 mIU/mL
5. Jean's vital signs: BP 100/65, HR 110, RR 18, temp 37.1°C. What is your immediate
concern?
A) Sepsis
B) Hypovolemic shock ✓
C) Pulmonary embolism
D) Hyperthyroidism
Section 2: Risk Factors & Pathophysiology
6. Which is the STRONGEST risk factor for ectopic pregnancy?
A) Maternal age >35
B) Previous ectopic pregnancy ✓
C) Smoking
D) ART (IVF)
7. Jean's history of PID increases her risk due to:
A) Endometrial hyperplasia
B) Tubal scarring and dysfunction ✓
C) Ovarian cyst formation
D) Uterine fibroids
8. The most common site for ectopic implantation is:
A) Ampulla of fallopian tube ✓
B) Isthmus of fallopian tube
C) Fimbriae
D) Cervix
9. Previous cesarean section increases risk for which type of ectopic?
A) Tubal
B) Ovarian
C) Cesarean scar ectopic ✓
D) Abdominal
, 10. Smoking increases ectopic risk by affecting:
A) Oocyte quality
B) Tubal motility and ciliary function ✓
C) Sperm count
D) Uterine receptivity
Section 3: Diagnostic Evaluation
11. For diagnosis, serial hCG monitoring is essential. In a normal intrauterine pregnancy,
hCG should:
A) Double every 24-48 hours ✓
B) Remain stable
C) Decrease by 50% weekly
D) Show no predictable pattern
12. Jean's hCG fails to double appropriately (rises only 35% in 48 hours). This suggests:
A) Normal pregnancy
B) Non-viable pregnancy (ectopic or miscarriage) ✓
C) Twin pregnancy
D) Miscalculated dates
13. Transvaginal ultrasound findings diagnostic of ectopic include:
A) Empty uterus with adnexal mass containing yolk sac/fetal pole ✓
B) Thin endometrial lining
C) Corpus luteum cyst
D) Free fluid in cul-de-sac only
14. "Bagel sign" on ultrasound refers to:
A) Ectopic ring in fallopian tube ✓
B) Gestational sac in uterus
C) Ovarian cyst
D) Uterine fibroid
15. If ultrasound is inconclusive and patient stable, next step is:
A) Discharge with follow-up in 1 week
B) Diagnostic laparoscopy ✓
C) Methotrexate empirically
D) D&C for endometrial curettings
, 16. Progesterone level <5 ng/mL suggests:
A) Viable intrauterine pregnancy
B) Non-viable pregnancy ✓
C) Twin pregnancy
D) Ovarian hyperstimulation
17. Culdocentesis showing non-clotting blood indicates:
A) Ruptured ectopic ✓
B) Ovulation
C) Menstruation
D) Traumatic tap
Section 4: Medical Management
18. Criteria for methotrexate treatment includes all EXCEPT:
A) Hemodynamically stable ✓
B) No fetal cardiac activity
C) hCG <5,000 mIU/mL
D) Ectopic size <4 cm
E) Patient compliance with follow-up
19. Methotrexate works by:
A) Causing tubal spasm
B) Inhibiting DNA synthesis in trophoblasts ✓
C) Promoting progesterone breakdown
D) Inducing uterine contractions
20. Standard single-dose methotrexate regimen is:
A) 20 mg PO daily for 5 days
B) 50 mg/m² IM single dose ✓
C) 100 mg IV push
D) 25 mg subcutaneous weekly
21. Day 4 and 7 post-methotrexate hCG levels are compared. Success is indicated by:
A) ≥15% decrease between days 4-7 ✓
B) Stable levels
C) ≥15% increase
D) Any decrease
2026/2027 Final Exam Study Guide – Correct Clinical
Solutions
This guide offers a detailed case study on ectopic pregnancy, focusing on the clinical aspects,
diagnosis, and management of this medical condition. It includes accurate solutions to ensure
understanding for the final exam.
Key Words: Ectopic Pregnancy, Case Study, Clinical Solutions, Diagnosis, Management
Section 1: Initial Assessment & Diagnosis
1. What is the most critical initial action in evaluating a suspected ectopic pregnancy?
A) Schedule an outpatient ultrasound
B) Obtain a detailed sexual history
C) Assess hemodynamic stability ✓
D) Perform a Pap smear
2. Which triad of symptoms is classic for ectopic pregnancy?
A) Pelvic pain, vaginal bleeding, amenorrhea ✓
B) Nausea, fever, diarrhea
C) Back pain, urinary frequency, constipation
D) Headache, dizziness, fatigue
3. Jean's serum hCG is 2,500 mIU/mL. Transvaginal ultrasound shows no intrauterine
gestational sac. What is the most likely diagnosis?
A) Normal intrauterine pregnancy (too early)
B) Ectopic pregnancy ✓
C) Complete miscarriage
D) Molar pregnancy
, 4. What is the discriminatory zone for hCG with transvaginal ultrasound?
A) 1,000–2,000 mIU/mL ✓
B) 5,000–6,000 mIU/mL
C) 10,000–15,000 mIU/mL
D) 20,000–30,000 mIU/mL
5. Jean's vital signs: BP 100/65, HR 110, RR 18, temp 37.1°C. What is your immediate
concern?
A) Sepsis
B) Hypovolemic shock ✓
C) Pulmonary embolism
D) Hyperthyroidism
Section 2: Risk Factors & Pathophysiology
6. Which is the STRONGEST risk factor for ectopic pregnancy?
A) Maternal age >35
B) Previous ectopic pregnancy ✓
C) Smoking
D) ART (IVF)
7. Jean's history of PID increases her risk due to:
A) Endometrial hyperplasia
B) Tubal scarring and dysfunction ✓
C) Ovarian cyst formation
D) Uterine fibroids
8. The most common site for ectopic implantation is:
A) Ampulla of fallopian tube ✓
B) Isthmus of fallopian tube
C) Fimbriae
D) Cervix
9. Previous cesarean section increases risk for which type of ectopic?
A) Tubal
B) Ovarian
C) Cesarean scar ectopic ✓
D) Abdominal
, 10. Smoking increases ectopic risk by affecting:
A) Oocyte quality
B) Tubal motility and ciliary function ✓
C) Sperm count
D) Uterine receptivity
Section 3: Diagnostic Evaluation
11. For diagnosis, serial hCG monitoring is essential. In a normal intrauterine pregnancy,
hCG should:
A) Double every 24-48 hours ✓
B) Remain stable
C) Decrease by 50% weekly
D) Show no predictable pattern
12. Jean's hCG fails to double appropriately (rises only 35% in 48 hours). This suggests:
A) Normal pregnancy
B) Non-viable pregnancy (ectopic or miscarriage) ✓
C) Twin pregnancy
D) Miscalculated dates
13. Transvaginal ultrasound findings diagnostic of ectopic include:
A) Empty uterus with adnexal mass containing yolk sac/fetal pole ✓
B) Thin endometrial lining
C) Corpus luteum cyst
D) Free fluid in cul-de-sac only
14. "Bagel sign" on ultrasound refers to:
A) Ectopic ring in fallopian tube ✓
B) Gestational sac in uterus
C) Ovarian cyst
D) Uterine fibroid
15. If ultrasound is inconclusive and patient stable, next step is:
A) Discharge with follow-up in 1 week
B) Diagnostic laparoscopy ✓
C) Methotrexate empirically
D) D&C for endometrial curettings
, 16. Progesterone level <5 ng/mL suggests:
A) Viable intrauterine pregnancy
B) Non-viable pregnancy ✓
C) Twin pregnancy
D) Ovarian hyperstimulation
17. Culdocentesis showing non-clotting blood indicates:
A) Ruptured ectopic ✓
B) Ovulation
C) Menstruation
D) Traumatic tap
Section 4: Medical Management
18. Criteria for methotrexate treatment includes all EXCEPT:
A) Hemodynamically stable ✓
B) No fetal cardiac activity
C) hCG <5,000 mIU/mL
D) Ectopic size <4 cm
E) Patient compliance with follow-up
19. Methotrexate works by:
A) Causing tubal spasm
B) Inhibiting DNA synthesis in trophoblasts ✓
C) Promoting progesterone breakdown
D) Inducing uterine contractions
20. Standard single-dose methotrexate regimen is:
A) 20 mg PO daily for 5 days
B) 50 mg/m² IM single dose ✓
C) 100 mg IV push
D) 25 mg subcutaneous weekly
21. Day 4 and 7 post-methotrexate hCG levels are compared. Success is indicated by:
A) ≥15% decrease between days 4-7 ✓
B) Stable levels
C) ≥15% increase
D) Any decrease
