MEDizzy - A 24-year-old woman presents with severe right lower

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Gynecology (Set -1)

A 24-year-old woman presents with severe right lower quadrant pain. She has a history of multiple sexual partners but has been married and faithful to her husband for the last three years. A urine b-human chorionic gonadotropin test is positive, but no gestational sac is visualized on transvaginal ultrasound imaging of the uterus. During the examination, her pain increases and she is becoming tachycardic. Which of the following best characterizes the organism most likely predisposed this woman to her current clinical picture?

ExplanationThe correct answer is D. The woman is pre-senting with classic signs of ectopic pregnancy. Once the b-human chorionic gonadotropin (b-hCG) is above 1500, and intrauterine pregnancy should be visible on transvaginal ultrasound imaging. If it is not, ectopic pregnancy must be suspected. If embedded in the fallopian tube, the growing fetus will eventually rupture the organ, leading to life-threatening intra-abdominal bleeding or it will die and spontaneously abort. One risk factor for the development of ectopic pregnancy is previous pelvic inflammatory disease (PID) due to its associated damage to fallopian tubes. Scarring of the lining of the tubes renders them unable to propel the fertilized ovum toward the uterus. Organisms associated with PID are Chlamydia trachomatis, an obligate intracellular bacterium, and Neisseria gonorrhoeae, a gram-negative diplococcus. Answer A is incorrect. Escherichia coli, a gram-negative bacillus, is a common cause of urinary tract infections in women, but is not associated with PID or ectopic pregnancy. Answer B is incorrect. Gardnerella vaginalis, a bacillus that has variable Gram staining, is a cause of bacterial vaginosis, which is not associated with an increased risk of PID or ectopic pregnancy. Answer C is incorrect. Treponema pallidum, a spirochete, causes the sexually transmitted dis-ease syphilis, which is not associated with PID or ectopic pregnancy.