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  Case #20. To Scan or Not to Scan — That is the Question!

A 33 y/o female presents with dysuria. She noted some spotting yesterday, and her menses is one week late. She denies any pain, passing of tissue, cramping, or dizziness. She has been nauseous, but no vomiting. She has been pregnant twice, one delivery without complications vaginally, and one abortion.

PE: BP:115/70 P: 80 RR:16 Afebrile
HEENT: NL
Heart/Lungs NL
Abd: soft, nontender, normal.
Pelvic: no bleeding now, no cervical motion tenderness, no pain.
Urine: SG 1.015 WBC: 15 RBC: 2 Leukocyte esterase+ UCG +

1.What is the likelihood this patient could have an ectopic without any pain?

2. How does bleeding correlate with likelihood of ectopic? Does spotting increase or decrease the risk she is having an ectopic, compared to heavier bleeding?

3. How does the quantitative HCG factor into the risk of ectopic? Is a higher quantitative HCG more or less likely to point to ectopic?

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