A 28-year-old woman presents with right lower quadrant pain and nausea/vomiting for the past hour. She is tender at McBurney's point and has pain on passive extension of the right hip. Leukocytosis. What is the next step in management?

• A. Start broad-spectrum antibiotics and observe
• B. Get a beta-hCG
• C. CT abdomen with contrast
• D. Immediate appendectomy

Answer: (B)

In a reproductive-age woman with acute right lower quadrant pain, the first priority is to rule out pregnancy, because ectopic pregnancy can mimic appendicitis and management changes dramatically, plus imaging options (and exposure to radiation) depend on pregnancy status. A beta-hCG test is the quickest, noninvasive way to confirm whether pregnancy is present.

If beta-hCG is positive, you’d proceed with focused pelvic ultrasound to determine intrauterine vs ectopic pregnancy and tailor management accordingly, rather than jumping to CT or immediate surgery. If beta-hCG is negative, you can pursue abdominal imaging (often ultrasound first, then CT if needed) to evaluate for appendicitis. This is why the next best step is to obtain a beta-hCG.