Your patient is an 18-year-old woman who is alert and in moderate distress, complaining of abdominal pain and light-headedness. She describes a four-week history of worsening unilateral lower quadrant abdominal pain with onset of malaise, nausea, and vomiting this week. Today, she is experiencing faintness and near-syncope with exertion. She denies pain or difficulty with urination. Her last

menstrual period was two weeks ago. She is sexually active and uses oral contraceptives. Physical examination reveals marked tenderness and guarding with palpation of her abdomen. Her skin is cool and diaphoretic. Her vital signs are: heart rate 121, blood pressure 90/58 mmHg, respirations 18. The patient's presentation is most consistent with:

A) ectopic pregnancy.
B) pelvic inflammatory disease.
C) spontaneous abortion.
D) pyelonephritis.

A

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