This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Ecotopic Pregnancy, Subject name: Gynaecology & Obstetrics
A 20-year-old woman complains of sudden onset of right-sided lower abdominal pain and bleeding per vagina. Her last normal menstrual period was 35 days ago. Her blood pressure is 90/70 mmHg and the pulse rate is 100 bpm. There is tenderness and guarding in the right iliac fossa. She denies any sexual intercourse.What is the most appropriate next step in the management? 
Select and explain. 
A. Estimate serum beta hCG levels, B. Obtain a surgical opinion to exclude acute appendicitis, C. Perform a laparoscopic examination, D. Perform a transvaginal ultrasound scan
D: Perform a transvaginal ultrasound scan
Answer: D: Perform a transvaginal ultrasound scan 
Explanation: Ans. is d, i.e. Perform a transvaginal ultrasound scanIn this patient:Rt sided lower abdominal pain with bleeding per vagina and amenorrhea: Indicate ectopic pregnancy. This is further supported by tenderness and guarding of Rt iliac fossaB/P=90/70mmP/R=100bpm ]Vitalsarestable[?] Next step is to do TVS, i.e. transvaginal ultrasound scan to confirm the diagnosis.