A 28-year-old woman presents to an urgent care clinic reporting a 3-day history of worsening left lower quadrant abdominal pain, which has become sharp and persistent. She notes light vaginal spotting and states her last menstrual period was approximately 7 weeks ago, though her cycles are irregular. She denies nausea or vomiting but has experienced two episodes of feeling faint and reports generalized lightheadedness when standing quickly. Her past medical history is significant for a prior sexually transmitted infection. She mentions inconsistent use of oral contraceptives recently. On examination, her temperature is 37.0°C, blood pressure is 95/55 mmHg, pulse is 115 beats/min, and respirations are 20 breaths/min. Her abdomen is distended with marked tenderness and rebound in the left lower quadrant. Pelvic examination reveals minimal blood in the vaginal canal, left adnexal tenderness, and moderate cervical motion tenderness. A rapid urine pregnancy test is positive. Initial laboratory results indicate a serum beta human chorionic gonadotropin (beta-hCG) of 2,500 mIU/mL. Considering her clinical presentation, what is the most likely diagnosis, and what is the immediate, definitive diagnostic and management approach in this setting?

A 28-year-old woman presents to the outpatient gynecology clinic for a scheduled follow-up. Two days prior, she had presented to the emergency department with mild left lower quadrant abdominal discomfort and a positive pregnancy test. At that time, her serum -hCG was 2,000 mIU/mL, and a transvaginal ultrasound (TVUS) did not identify an intrauterine gestational sac. Today, she reports her abdominal discomfort is still mild, primarily localized to the left lower quadrant, and has not worsened. Her medical history includes a previous episode of pelvic inflammatory disease five years ago. On examination, her vital signs are stable: temperature 37.0 C, blood pressure 118/78 mmHg, pulse 70/min, respirations 16/min, and oxygen saturation 99% on room air. Abdominal palpation reveals mild tenderness in the left lower quadrant, without guarding or rebound. Pelvic examination is remarkable for mild left adnexal tenderness. Repeat laboratory tests and a new transvaginal ultrasound have been completed. What is the most likely diagnosis, and what is the best initial management strategy for this patient?

A 32-year-old woman presents to an urgent care center complaining of worsening lower abdominal pain and scant vaginal spotting for the past 24 hours. Her last menstrual period was approximately 7 weeks ago, and she uses a copper intrauterine device for contraception. She denies any recent trauma or other significant medical history. Upon arrival, she appears pale and diaphoretic. Her vital signs are: temperature 37.0°C, blood pressure 75/45 mmHg, heart rate 140 beats/min, and respiratory rate 22 breaths/min. Abdominal examination reveals severe, diffuse tenderness, more pronounced in the lower quadrants, with rebound tenderness. Pelvic examination is limited by pain but notes cervical motion tenderness and a small amount of dark red blood in the vault. Given her critical status, what is the most likely diagnosis and the most immediate definitive intervention required?

A 28-year-old woman presents to an outpatient women's health clinic complaining of intermittent, dull lower abdominal discomfort for the past week, which has progressively worsened to sharp, localized pain in the right iliac fossa over the last 12 hours. She also reports spotting for the past two days and states her last normal menstrual period was approximately 7 weeks ago. Her past medical history includes a chlamydial infection treated 3 years prior and occasional unprotected intercourse with her long-term partner. She denies fever, chills, or significant gastrointestinal upset. On examination, her vital signs are: temperature 37.20C, blood pressure 118/72 mmHg, pulse 96/min, and respiratory rate 16/min. Abdominal palpation reveals marked tenderness and guarding in the right lower quadrant, with mild rebound tenderness. A pelvic exam is deferred due to significant tenderness. Initial laboratory results indicate a serum beta-hCG level of 3,500 IU/L. Her hemoglobin is 125 g/L, white blood cell count is 9.8 x 10^9/L, and urinalysis is negative for infection. Given these findings, what is the most appropriate initial diagnostic evaluation and subsequent management approach to consider?

A 30-year-old woman, gravida 2 para 1, presents to the outpatient gynecology clinic with a 3-day history of increasing right lower quadrant abdominal pain, described as sharp and intermittent, and radiating to her shoulder. She reports her last menstrual period was 7 weeks ago and she has been experiencing light, dark brown vaginal spotting for the past 2 days, along with intermittent nausea. Her contraception is an intrauterine device (IUD). She denies fever or chills. On examination, her vital signs are: blood pressure 118/72 mmHg, heart rate 88 beats/min, respiratory rate 16 breaths/min, temperature 37.0 degrees Celsius. Abdominal palpation reveals moderate tenderness localized to the right lower quadrant, with mild rebound tenderness. A pelvic exam shows a closed cervix, no cervical motion tenderness, and mild adnexal tenderness on the right. Transvaginal ultrasound reveals an empty uterus with a thickened endometrial stripe and an approximately 3.0 cm adnexal mass in the right fallopian tube, consistent with an ectopic pregnancy. There is no free fluid in the cul-de-sac. Considering her confirmed diagnosis, what is the most appropriate management strategy and what is a potential severe complication of this approach or the underlying condition if not adequately managed?

A 28-year-old woman presents to an urgent care clinic with a 36-hour history of worsening lower abdominal discomfort, predominantly localized to the right iliac fossa. She reports associated nausea, a single episode of vomiting, and mild anorexia. Her last menstrual period was approximately seven weeks ago, and she typically has regular cycles. An initial point-of-care urine pregnancy test is positive. She denies any significant medical history apart from occasional migraines managed with over-the-counter analgesics. On examination, her temperature is 37.80C, blood pressure 105/65 mmHg, pulse 105/min, and respiratory rate 16/min. Abdominal palpation reveals tenderness with guarding in the right lower quadrant and rebound tenderness, with pain exacerbated upon palpation of the left lower quadrant. Pelvic examination is deferred due to significant abdominal pain. Relevant laboratory findings include: - White Blood Cell (WBC) count: 12.8 x 10^9/L - Hemoglobin: 138 g/L - Quantitative beta-hCG: 2500 IU/L - Urinalysis: Negative for leukocyte esterase and nitrites. Considering her presentation and initial findings, what is the most probable diagnosis and the most appropriate immediate diagnostic imaging to confirm it?

A 28-year-old female presents to an urgent care clinic complaining of sudden-onset, sharp left lower abdominal pain that began approximately four hours ago while she was performing light stretching exercises. She describes the pain as intermittent but progressively worsening. Her past medical history includes a treated chlamydial infection two years prior. She is sexually active with a new partner and occasionally uses condoms. Her last menstrual period was 5 days ago, and cycles are typically 28 days, generally regular. Upon examination, her temperature is 37.0°C, blood pressure is 108/70 mmHg, heart rate is 92 beats/min, and respiratory rate is 16 breaths/min. Abdominal palpation reveals moderate tenderness and mild guarding in the left iliac fossa with palpable left adnexal tenderness on pelvic examination. A point-of-care transvaginal ultrasound performed in the clinic shows a small, collapsed left ovarian cyst and a moderate amount of anechoic fluid within the cul-de-sac. Given these findings, what is the most likely diagnosis and the immediate appropriate management strategy?