Early pregnancy: ectopic pregnancy: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Early pregnancy: ectopic pregnancy

Sample item

A haemodynamically stable woman at 6 weeks has a 2.5 cm unruptured tubal ectopic pregnancy without fetal cardiac activity. Her serum beta-hCG is 2,500 IU/L. She is reliable for follow-up. What is the most appropriate management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Intramuscular methotrexate with weekly beta-hCG follow-up

Medical management with methotrexate (folate antagonist) is suitable for stable women with an unruptured ectopic, low and preferably falling hCG (below about 5,000 IU/L), a small mass (under 3.5 to 4 cm), no cardiac activity and reliable follow-up. Surgery is needed for instability, rupture, high hCG, or a fetal heartbeat. Folic acid-containing supplements should be avoided during treatment.

Option by option

  • A. Dilatation and curettage

    Curettage removes intrauterine tissue and does not treat a tubal pregnancy.

  • B. Immediate laparotomy with salpingectomy

    Laparotomy is for rupture or instability.

  • C. Expectant management without follow-up

    Expectant management requires very low and falling hCG, with close follow-up.

  • D. Intramuscular methotrexate with weekly beta-hCG follow-up (correct)

    Correct. She meets the criteria for medical treatment with methotrexate.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this OBG question

What is the answer to this OBG question?

The best answer is D, Intramuscular methotrexate with weekly beta-hCG follow-up. Medical management with methotrexate (folate antagonist) is suitable for stable women with an unruptured ectopic, low and preferably falling hCG (below about 5,000 IU/L), a small mass (under 3.

Why is "Dilatation and curettage" not the answer?

Curettage removes intrauterine tissue and does not treat a tubal pregnancy.

Why is "Immediate laparotomy with salpingectomy" not the answer?

Laparotomy is for rupture or instability.

Why is "Expectant management without follow-up" not the answer?

Expectant management requires very low and falling hCG, with close follow-up.

What concept does this question test?

It tests Early pregnancy: ectopic pregnancy in OBG. 5 to 4 cm), no cardiac activity and reliable follow-up. Surgery is needed for instability, rupture, high hCG, or a fetal heartbeat. Folic acid-containing supplements should be avoided during treatment.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Early pregnancy: ectopic pregnancy?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.