lower abdo pain in a female pt

Question 1

A 45 year old lady presents at A+E with acute left lower abdominal pain and vomiting.
Clinical examination reveals an 8cm mass in the left iliac fossa. Previously the patient has been fit and well.

Dx?

Answer 1

torsion of ovarian cyst

Question 2

A 24 year old woman experiences very sudden left lower abdominal pain while out shopping. This is
associated with pallor and feeling faint. On arrival at Accident & Emergency her blood pressure is
80/50mmHg and her pulse rate is 130 beats/min. A pregnancy test on admission is positive.

Dx?

Answer 2

ruptured ectopic pregnancy

Question 3

A 35 year old Afro-Caribbean woman at 26 weeks pregnancy presents with severe pain and tenderness over discreet area of the uterus. She is known to have fibroids.

Dx?

Answer 3

red degeneration of a leiomyoma

Question 4

A 19 year old female student attends the Student Health Service because of a nine month history of intermittent lower abdominal pain and diarrhoea. Questioning revealed an approximate weight loss of 4kg over this period. There was a history of mouth ulcers during her A-level exams, but these were not investigated at the time.

Dx?

Answer 4

Crohn’s disease

Question 5

A 22 year old woman is seen by her General Practitioner on account of a one week history of lower abdominal pain, dyspareunia and a vaginal discharge. Clinical examination reveals pyrexia of 38.7°C and
extreme tenderness on bimanual pelvic examination.

Dx?

Answer 5

PID