Quiz 22: Abdominal Pain

Front 1

Ovarian torsion

Back 1

• post-menopausal
• can present at any age group
• stabbing pain in lower abdo or pelvis
• N/V

Front 2

PID

Back 2

• sexual history
• lack of STI screen
• adnexal pain
• mucopurulent discharge
• cervical motion tenderness
• RUQ pain
• fever

Front 3

Ectopic pregnancy

Back 3

• crampy, pelvic pain
• nausea
• diffuse abdo pain (if rupture and intraperitoneal bleed)

Front 4

Appendicitis

Back 4

• lack of migration of pain to RLQ
• negative Rovsing's sign
• involuntary guarding and fever without perforation
• pain with movement or coughing (cat eye sign)
• rebound tenderness
• adnexal pain, atypical sign

Front 5

Cholecystitis

Back 5

• steady pain
  
• present in RUQ
• radiate to right shoulder
• worsen with ingestion of fat rich food
• causes anorexia with N/V

Front 6

Pancreatitis

Back 6

• continous abdo pain
• localize to right and left upper quadrants, "band like pain"
• N/V nearly always present
• LIPASE

Front 7

UTI

Back 7

• painful urination with frequency and urgency
  
• suprapubic tenderness
  
• flank pain (kidney)
  
• more often in females
  
• fever and vomiting (pyelo)
  

Front 8

Ectopic pregnancy

Back 8

• sexually active female
  
• abdo pain
  
• lower abdo pain
  

Front 9

Appendicitis

Back 9

• starts as periumbilical pain
  
• migrates to McBurney's point
  

Front 10

Ovarian torsion

Back 10

• stabbing
  
• localized to lower abdomen and pelvis
  
• N/V
  

Front 11

PID

Back 11

• sexual history
  
• cervical motion tenderness
• lower abdo or pelvic pain
• vaginal discharge
• fever
• fatigue
• n/v
• diarrhea
• dysuria
• dyspareunia

Front 12

Ruptured ectopic pregnancy

Back 12

positive preg test

hemodynamic instability

Front 13

Fitz-Hugh Curtis Syndrome

Back 13

• possible complication of PID
  
• sexual history
  
• abdo pain RUQ, may refer to right shoulder if peritoneum irritated
  

Front 14

Acute hepatitis

Back 14

• anorexia
  
• n/v, fatigue, malaise, fever
  
• Lab studies: high AST and ALT
  
• IV drug use
  
• immigrant asian mother
  
• travel
  
• RUQ pain, refer to sholder if peritoneum irritated
  

Front 15

A 16-year-old female presents with acute onset of diffuse abdominal pain with periodic sharpness in the right upper quadrant that radiates to her back. She has had some episodes of vomiting and has a fever. She is sexually active and has used alcohol in the past. Which of the following is most likely to present with right upper quadrant pain?

Back 15

Pancreatitis

Front 16

A 16-year-old obese Caucasian female with a history of irregular menses presents to the ED with severe abdominal pain and altered mental status. She uses intravenous drugs weekly. She has regular unprotected sexual intercourse with multiple male sexual partners. She has experienced fevers, nausea, vomiting, and right shoulder pain and reports no vaginal bleeding. She has not regularly seen a physician for years. Only bedside studies are performed. Vitals are T 38.0 C, BP 90/60 mmHg, P 120 bpm, R 20 bpm. Qualitative B-hCG is positive, and hemoglobin is 7 g/dL. On exam, she is in apparent distress and has difficulty answering questions. Auscultation of the chest is clear. The abdomen is somewhat rigid with tenderness in the right lower quadrant as well as guarding and rebound tenderness. On pelvic exam, there is cervical motion tenderness but no bleeding or masses noted. What is the most likely diagnosis?

Back 16

Ruptured ectopic pregnancy

Front 17

A 16-year old female presents to the ED with abdominal pain. Upon questioning, the patient notes that the pain is pretty consistently in the RLQ without radiation. She denies dysuria, hematuria, or blood in the stool. She has a history of multiple sexual partners and inconsistent condom use. She does not use any other contraceptive measures. She believes her last menstrual period was 3 weeks ago, but she is unsure. She has no history of abdominal or pelvic surgeries. Her temperature is 100.8 F, heart rate is 85 bpm, respiratory rate is 12 bpm, and blood pressure is 110/70 mmHg. Her abdominal exam is notable for involuntary guarding, tenderness to palpation in the RLQ without rebound tenderness, and no CVA tenderness. Her pelvic exam is notable for cervical motion tenderness with some discharge. What is the best NEXT step in management?

Back 17

Pregnancy test

Front 18

Luanne is a 15-year-old female who presents with three hours of abdominal pain and two episodes of non-bilious, non-bloody vomiting. She rates her pain at 8/10 and describes it as constant, located mainly in the middle of her belly but somewhat present throughout her abdomen. It is worse with coughing and moving. She has never had pain like this before, and has had no appetite since the pain started. She is sexually active with her boyfriend of three months, always uses condoms, and has not been tested for STIs. She is due to start her period next week. Vitals: 37.9 C, HR 100 bpm, BP 120/85 mmHg, RR 14 bpm. On exam, she exhibits involuntary guarding, mild rebound tenderness, and tenderness to palpation between her right anterior superior iliac spine and umbilicus. On pelvic exam, she reports tenderness when attempting to palpate her right adnexa, but no masses are appreciated and there is no cervical motion tenderness. Her WBC and CRP are within normal limits. Based on the information above, what is the most likely diagnosis?

Back 18

Appendicitis

Front 19

A 16-year-old homeless female presents with low-grade fever and abdominal pain. The patient reports recent unprotected sex. Abdominal examination reveals tenderness to palpation in the lower abdominal region, but no masses are appreciated. Pelvic examination reveals whitish cervical discharge and cervical motion tenderness. The discharge is sent for culture, and a pregnancy test is negative. What is the next best step in management?

Back 19

Arrange for hospitalization