A 21-year-old female complains of dull, aching lower quadrant abdominal pain and has missed her last menstrual period. She becomes faint when standing, with vital signs P 100, R 16, BP 112/84. Which condition should you suspect?

• A. Pelvic disease
• B. Spontaneous abortion
• C. Ruptured ectopic pregnancy
• D. Appendicitis

Answer: (C)

The key idea is recognizing a pregnancy-related emergency in a reproductive-age woman who has lower quadrant pain. When a woman misses a menstrual period and develops abdominal pain, an ectopic pregnancy must be considered. If the ectopic pregnancy ruptures, internal bleeding can occur, leading to dizziness or fainting with standing and a compensatory tachycardia. In this scenario, the patient has amenorrhea, dull lower quadrant pain, and faintness on standing with a somewhat elevated heart rate—together these point toward a ruptured ectopic pregnancy as a life-threatening possibility that requires rapid transport and urgent evaluation.

Pelvic disease is possible with pelvic pain but doesn’t explain the missed period. Spontaneous abortion would more typically present with vaginal bleeding and cramping. Appendicitis usually presents with right lower quadrant pain and does not relate to pregnancy status.