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a 24yr old female states that her LMP was 7 weeks back.she has regular menstural cycle in the past but now has vaginal spotting and mild lower abd pain.on physical exam she has a normal sized uterus and mild tenderness in rt lower quadrant.beta hcg level is 1000 miu/ml from the day before the examination. the physician should do which of the following
a recommend diagnostic laproscopy.
b perform an abdominal ultrasound exam
c repeat bhcg measurment in24 hrs
d repeat bhcg measurment after a week
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What about b perform an abdominal ultrasound exam?
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Both b and c sound fine to me. and in real life I would do both. but for this q, I will go for c, because it is cheaper than US, I presume. If hcg is dropping, I will worry much less. Nooo, B will not work because it is abd US not vaginal.
C.
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A. I believe the pt has ectopic pregnancy. Abd. sono would not disclose anything at this stage. What is the point repeating the measurement?
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alibi,
My dear friend, it is so good to see you.
Repeating hcg will tell whether the embryo is still alive. If it is dead, heg drops, you do not have to worry about it anymore and relax, the get 99.
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I am lost.
Elevated beta hCG in the absence of an intrauterine pregnancy on U/S is suspicious for an ectopic pregnancy, isn't it? At 7 weeks, abodominal U/S can't disclose anything? Then when?
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Calendar,
I just remember (fresh memory) that you need hcg 1500 for US to find the embryonic sac, if it is below that, US is pointless. If 7 wks is correct, then the embryo is dying or dead already to have hcg 1000, so no need for US, but you need to confirm the viability of the embryo by time lapse of hcg. if hcg is going up, the embryo is alive or partially there, then the timing of pregnancy can be wrong and think of the next steps. I am not an expert on this, I use more logic and common sense than knowledge I guess.
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yeah ericz you need 1500 to see a sac by vaginal usg for abdominal you need above 5000 so we have to do c ie repeat hcg
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ericz, you said repeating the HCG is to know if the embryo is alive or not. It is of no use. There is no embryo in the uterus. Laparoscopy tells you more. It is an ectopic pregnancy. Abd. sono and HCG will not help. You don't need to check for HCG level. it is a waste of time. Laparoscopis diagnosis is the answer.
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