A 26-year-old female presents with 6 weeks of amenorrhea, sharp left lower quadrant pain, and light vaginal spotting. Urine pregnancy test is positive. Transvaginal ultrasound demonstrates an empty uterine cavity and a 3 cm adnexal mass with fluid in the pouch of Douglas. Serum beta-hCG is 2,400 mIU/mL. What is the diagnosis?

Answer and explanation

Correct answer: B. Ectopic pregnancy

  1. Step 1: Serum beta-hCG exceeds the discriminatory zone (typically 1,500 to 2,000 mIU/mL) where a normal intrauterine gestational sac must be visualized on transvaginal ultrasound.
  2. Step 2: An empty uterus accompanied by an adnexal mass and free fluid establishes the diagnosis of tubal ectopic pregnancy.
Answer
Ectopic pregnancy.
Why not the others: 'Normal intrauterine pregnancy' must exhibit an intrauterine gestational sac with yolk sac above the discriminatory zone; 'Corpus luteum cyst rupture' occurs in early luteal phase without positive pregnancy test; 'Hydatidiform mole' displays a characteristic intra-uterine 'snowstorm' pattern with markedly elevated hCG.

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