A sexually active 22-year-old woman with amenorrhea and vaginal spotting, left adnexal tenderness, and cervical motion tenderness should be initially evaluated with which test?

A sexually active 22-year-old woman with amenorrhea and vaginal spotting, left adnexal tenderness, and cervical motion tenderness should be initially evaluated with which test?

• A. β-hCG pregnancy test
• B. Pelvic ultrasound
• C. CBC
• D. Serum progesterone

Answer: (A)

In a reproductive-age woman with amenorrhea, vaginal spotting, and pelvic tenderness, the most important first step is to determine whether pregnancy is present. A β-hCG pregnancy test is the best initial test because it rapidly confirms or rules out pregnancy, which has immediate implications for management, especially with the concern for ectopic pregnancy. If the test is positive, it directs urgent follow-up with imaging to locate the pregnancy and assess for ectopic implantation; if negative, it shifts the evaluation toward non-pregnancy causes of bleeding while still guiding broader workup. Other tests like pelvic ultrasound, CBC, or serum progesterone are helpful in the overall assessment but do not establish whether pregnancy exists, which is why the β-hCG test is performed first.

In a reproductive-age woman with amenorrhea, vaginal spotting, and pelvic tenderness, the most important first step is to determine whether pregnancy is present. A β-hCG pregnancy test is the best initial test because it rapidly confirms or rules out pregnancy, which has immediate implications for management, especially with the concern for ectopic pregnancy. If the test is positive, it directs urgent follow-up with imaging to locate the pregnancy and assess for ectopic implantation; if negative, it shifts the evaluation toward non-pregnancy causes of bleeding while still guiding broader workup. Other tests like pelvic ultrasound, CBC, or serum progesterone are helpful in the overall assessment but do not establish whether pregnancy exists, which is why the β-hCG test is performed first.