Early pregnancy: methotrexate in 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: methotrexate in ectopic pregnancy

Sample item

Which woman with a tubal ectopic pregnancy is the best candidate for single-dose methotrexate?

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

The answer and the reasoning

A. Haemodynamically stable, hCG 2500 mIU/mL, mass 2.5 cm, no cardiac activity

Medical therapy suits stable women with an unruptured ectopic pregnancy, hCG below about 5000 mIU/mL, mass below 3.5 to 4 cm and no cardiac activity, with reliable follow-up. Rupture, instability, high hCG or fetal heart activity favour surgery. Folic acid supplements and NSAIDs should be avoided during treatment.

Option by option

  • A. Haemodynamically stable, hCG 2500 mIU/mL, mass 2.5 cm, no cardiac activity (correct)

    Correct. Low hCG, small mass and stability fit medical management.

  • B. Breastfeeding mother with a 5 cm mass

    Breastfeeding and large mass are contraindications.

  • C. Haemodynamically unstable with haemoperitoneum

    Instability or haemoperitoneum needs surgery.

  • D. hCG 9000 mIU/mL with fetal cardiac activity

    High hCG with cardiac activity predicts methotrexate failure.

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 A, Haemodynamically stable, hCG 2500 mIU/mL, mass 2.5 cm, no cardiac activity. Medical therapy suits stable women with an unruptured ectopic pregnancy, hCG below about 5000 mIU/mL, mass below 3.

Why is "Breastfeeding mother with a 5 cm mass" not the answer?

Breastfeeding and large mass are contraindications.

Why is "Haemodynamically unstable with haemoperitoneum" not the answer?

Instability or haemoperitoneum needs surgery.

Why is "hCG 9000 mIU/mL with fetal cardiac activity" not the answer?

High hCG with cardiac activity predicts methotrexate failure.

What concept does this question test?

It tests Early pregnancy: methotrexate in ectopic pregnancy in OBG. 5 to 4 cm and no cardiac activity, with reliable follow-up. Rupture, instability, high hCG or fetal heart activity favour surgery. Folic acid supplements and NSAIDs should be avoided during treatment.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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: methotrexate in 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.