This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Gynaecology & Obstetrics
[{'content': 'Basanti, a 28 yrs aged female with a history of 6 weeks of amenorrhoea presents with pain in abdomen; USG shows fluid in pouch of douglas. Aspiration yields dark color blood that fails to clot.Most probable diagnosis is: \nSelect and explain. \nA. Ruptured ovarian cyst, B. Ruptured ectopic pregnancy, C. Red degeneration of fibroid, D. Pelvic abscess', 'role': 'user'}, {'content': 'Answer: B \nExplanation: The picture given in the question classically represents a case of ruptured ectopics pregnancy.\nSymptoms – In Ectopic pregnancy triad of:\n\nAmenorrhea (seen in 75% cases) followed by:\nAbdominal pain (seen in 100% cases, it is the most consistent symptom of ectopic pregnancy).\nAppearance of vaginal bleeding are seen:\nThe above triad may be accompanied by nausea, vomiting, fainting attacks or syncope.\nPatient may present in shock with pallor, tachycardia, hypotension and cold clammy extremities, if ectopic pregnancy has ruptured\n\nExamination:\nGeneral examination: In case of rupture—\n\nP/R ↑\nPallor +nt\nBP ↓\nSlight intermittent pyrexia due to absorption of products of degeneration.\n\nPer Abdomen - Abdomen is tense, tender and distended.\n\nShifting dullness may be present (depending on the amount of hemorrhage in ruptured ectopic).\nRigidity/muscle guarding +/–,\nCullen’s sign - bluish discolouration around the umbilicus may be present.\n\nOn Bimanual examination\n\nVaginal mucosa appears blanched.\nUterus: normal size/slightly bulky.\nExtreme tenderness on cervical movement\nFornices-tender (Remember - tenderness in pelvis is the most constant sign of Ectopic pregnancy).\nU/L adnexal mass: is palpable in one third to half of patient.\n\nCuldocentesis:\n\nIt is a simple technique used to identify hemoperitoneum.\nFluid is aspirated from cul-de-sac via posterior fornix with the help of a needle.\nIf non clotting blood is obtained, it is indicative of an intraperitoneal bleed and probably a ruptured ectopic.', 'role': 'assistant'}]