Mehl + UW ectopic pregnancy 12-13 (1)

Question 1

Mehl. definition?

Answer 1

Implantation of conceptus outside the uterus, including the parametrium of the uterus and cervix.

Question 2

Mehl. what beta-hCG levels?

Answer 2

b-hCG levels will be much lower than expected for the gestational age. You don’t have to be an obstetrician and know exact values.

Question 3

Mehl. how normally increases levels of b-hCG?

Answer 3

b-hCG should double approximately every 2-3 days in early pregnancy, so the Q can also mention something about poor rate of change of increase.

Question 4

Mehl. HY point. in what pathology ectopic occurs?

Answer 4

Highest yield point for USMLE is that ectopic risk is ­­in women who have Hx of PID.

As discussed earlier, this is due to scarring of the Fallopian tubes and disruption of the cilia. Ectopic implantation most frequently occurs in the ampulla (70-80%).

Question 5

Mehl. when is given methotrexate?

Answer 5

Methotrexate is given for Tx (asked once on 2CK form) for “small, stable ectopics” – i.e., mother is hemodynamically stable, there is no evidence of tubal rupture / fluid in the peritoneal cavity, the ectopic is <3.5 cm, and b-hCG is <5000 mIU/mL.
For your Obgyn rotation, I would know those criteria.

Question 6

Mehl. when Tx is surgical?

Answer 6

Laparoscopic salpingostomy/salpingectomy is done if methotrexate cannot be given.

Question 7

Mehl. if HD unstable, Tx?

Answer 7

If the female is hemodynamically unstable (i.e., low BP), the answer is LAPAROTOMY!!!, not laparoscopy.

Question 8

UW table risk factors? 3

Answer 8

PID
Previouls pelvic/tubal surgery
Previous ectopic pregnancy

Question 9

UW notes. Risk factors for cornual/interstitial ectopic pregnancy include? 2

Answer 9

a. Uterine anomalies i. Bicornuate “heart-shaped” uterus
b. In vitro fertilization

Question 10

UW table. CP?

Answer 10

Abdominal pain, amenorrhea, vaginal bleeding
Hypovolemic shock in ruptured ectopic pregnancy
Cervical motion, adnexal and/or abdominal tenderness
+/- palpable adnexal mass

Question 11

UW table. Dx? 2

Answer 11

positive b-hCG
transvaginal ultrasound revealing adnexal mass, empty uterus

Question 12

UW table. Tx? stable

Answer 12

methotrexate

Question 13

UW table. Tx? unstable

Answer 13

surgery (laparotomy)

Question 14

UW notes. extrauteral CP? 2

Answer 14

Shoulder pain (referred pain from diaphragm);
Urge to defecate (blood in posterior cul-de-sac)