12-30-2008, 11:15 AM
A 27-year-old female police officer comes into the emergency department where you are working. She is complaining of a 2-day history of nausea, and vomiting and some mild left lower quadrant pain. Her vital signs are stable. Physical examination shows mild tenderness to palpation in the left lower quadrant. Prior to performing the pelvic examination, the patient informs you that she is menstruating. The examination is significant only for blood in the vault. Routine laboratory studies are sent and a beta hCG returns as 2700. You order a pelvic ultrasound, which identifies nothing in the uterus. However, there is a fetal pole in the left fallopian tube. You inform the patient that she has an ectopic pregnancy and discuss the option of surgery versus methotrexate therapy. The patient decides that she would like to try methotrexate. Appropriate follow-up care for this patient will include
A. another dose of methotrexate on day 4 of therapy if blood levels of hCG have not fallen by 15%
B. checking beta HCG on day 3 and 7 of methotrexate therapy
C. immediate laparotomy if methotrexate therapy is found to fail by day 7 of treatment
D. repeating beta hCG 2 weeks after diagnosis if beta hCG is found to have fallen greater than 15% from day 4 to day 7 of treatment
E. repeating pelvic ultrasound in 1 week
A. another dose of methotrexate on day 4 of therapy if blood levels of hCG have not fallen by 15%
B. checking beta HCG on day 3 and 7 of methotrexate therapy
C. immediate laparotomy if methotrexate therapy is found to fail by day 7 of treatment
D. repeating beta hCG 2 weeks after diagnosis if beta hCG is found to have fallen greater than 15% from day 4 to day 7 of treatment
E. repeating pelvic ultrasound in 1 week