Ectopic pregnancy

Ms. Parrish is a 24-year-old woman who presents to the emergency department with a 24-hour history of acute vaginal bleeding associated with severe, crampy, constant left pelvic pain exacerbated by movement. She is sexually active, uses condoms inconsistently and uncertain of her last menstrual period. She has none of her usual perimenstrual symptoms; the amount of bleeding is similar to a heavy period. She is G0P0; history of chlamydial cervicitis 3 years ago; no prior PID or IUD use; ruptured appendix (age 16). Physical exam is significant for tachycardia, LLQ tenderness with guarding, and absence of rebound tenderness. Obstetric ultrasound showed highly probability of left fallopian tube ectopic pregnancy. • Discuss the questions that would be important to include when interviewing a patient with this issue. • Describe the clinical findings that may be present in a patient with this issue. • Are there any diagnostic studies that should be ordered on this patient? Why? • List the primary diagnosis and three differential diagnoses for this patient. Explain your reasoning for each. • Discuss your management plan for this patient, including pharmacologic therapies, tests, patient education, referrals, and follow-ups