Question

A 37-year-old G1P1001 woman comes to your office with a 3-day history of progressive pelvic pain. She notes some vaginal spotting but no frank bleeding. She denies any fevers, chills, diarrhea, vaginal discharge, or urinary symptoms. Her last menstrual period was 6 weeks ago. She is married and has been trying to conceive for the past 6 months. She and her husband have one child already, a result of in vitro fertilization (IVF). She is afebrile, and her pulse and blood pressure are normal. On speculum examination, her os appears closed, and there is a small amount of dark brownish red blood pooled in the fornix. There is no mucopurulent discharge or cervical motion tenderness. On bimanual examination, her uterus feels slightly enlarged and boggy, and the left adnexa is tender without any obvious mass. A wet prep is normal except for many red blood cells. What is the most appropriate initial test that should be performed to support your diagnosis?

A. Urine or serum β-human chorionic gonadotropin (β-hCG)
B. Hysterosalpingography
C. Culdocentesis
D. Pelvic/ transvaginal ultrasonography
E. Laparoscopy

Answer 1

The most appropriate test to perform is pelvic/transvaginal ultrasonography (D). This test can assess the structure of the uterus and adnexa and help determine the cause of the patient's symptoms.

Step-by-step explanation:

The most appropriate initial test to perform in this case would be Pelvic/transvaginal ultrasonography (D). This test can help determine the cause of the patient's symptoms by assessing the structure of the uterus and adnexa. It can identify if there are any abnormalities, such as uterine fibroids or ovarian cysts, which could be causing the pelvic pain and spotting. The ultrasound can also help rule out other conditions, such as an ectopic pregnancy, which can present with similar symptoms.