07-22-2009, 01:11 PM
26. A 27-year-old woman is brought to the emergency
department by
her mother who found her comatose 30 minutes ago. Her
mother says that
her daughter had been having lower abdominal pain and
vaginal bleeding
over the past week. The patient had an ectopic
pregnancy 2 years ago
and was also treated with doxycycline for pelvic
inflammatory disease at
that time. Her blood pressure is 40/20 mm Hg, pulse
is 160/min, and
respirations are 24/min. The abdomen is distended and
rigid with
decreased bowel sounds. Hemoglobin level is 4.2 g/dL,
and leukocyte count is
12,500/mm3. Culdocentesis is positive. Which of the
following is the
most appropriate next step in management?
A
) Bromocriptine therapy
B
) Clomiphene therapy
C
) Conjugated estrogen therapy
D
) Ergot derivative therapy
E
) Hysteroscopy
F
) Laparoscopy
G
) Dilatation and curettage
H
) Endometrial ablation
I
) Exploratory laparotomy
J
) Total abdominal hysterectomy
department by
her mother who found her comatose 30 minutes ago. Her
mother says that
her daughter had been having lower abdominal pain and
vaginal bleeding
over the past week. The patient had an ectopic
pregnancy 2 years ago
and was also treated with doxycycline for pelvic
inflammatory disease at
that time. Her blood pressure is 40/20 mm Hg, pulse
is 160/min, and
respirations are 24/min. The abdomen is distended and
rigid with
decreased bowel sounds. Hemoglobin level is 4.2 g/dL,
and leukocyte count is
12,500/mm3. Culdocentesis is positive. Which of the
following is the
most appropriate next step in management?
A
) Bromocriptine therapy
B
) Clomiphene therapy
C
) Conjugated estrogen therapy
D
) Ergot derivative therapy
E
) Hysteroscopy
F
) Laparoscopy
G
) Dilatation and curettage
H
) Endometrial ablation
I
) Exploratory laparotomy
J
) Total abdominal hysterectomy