CASE 31 - Abdominal Pain

Question 1

My child is in the house alone. I must leave now.

I can’t afford to stay in the hospital. Please give me a prescription for abx so that I can leave.

Answer 1

Ms. Anderson, I understand your concern for your child’s safety. However, it is most important that we make sure your illness isn’t life threatening.

Our social worker would be happy to work with you to ensure that your child is taken care of, as well as to address any financial concerns you may have.

Question 2

Specific Qs:

Answer 2

1. Pain with ride to the hospital?
2. Gyn Qs ==> LMP + Vag spotting + Color of spotting + Vag discharge + Frequency of menstrual periods + menarche.
3. Sexual History ==> sexual activity + contraception + sexual partners + Hx of STDs + Tx of partner + HIV.

Question 3

PEx:

Answer 3

1. CV ==> A.
2. Chest ==> A.
3. Abdo ==> I + A + P + P, psoas sign, obturator sign, Rovsign sign, CVA tenderness.

Question 4

DDx:

8

Answer 4

1. Appendicitis.
2. PID.
3. Ruptured ectopic pregnancy.
4. Ruptured ovarian cyst.
5. Adnexal torsion.
6. Gastroenteritis.
7. Abortion .
8. Endometriosis.

Question 5

Workup:

Answer 5

1. Urine hCG.
2. Pelvic exam.
3. Cervical cultures.
4. U/S abdo/pelvis.
5. CT abdo/pelvis.
6. CBC.
7. UA.
8. Laparoscopy.