determine
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A 25-year-old woman presents with an 8-hour history of right lower quadrant pain of sudden onset. The pain is continuous in character. At the time of being seen, she also has pain in the right shoulder. From this history alone, which one of the following is the most likely diagnosis?<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />
1) salpingitis
2) ruptured ovarian cyst
3) ruptured ectopic pregnancy
4) acute cholecystitis
5) ruptured appendix
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| alphahmed
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it is sudden in onset and with right shoulder pain... it goes with 2) ruptured ovarian cyst.
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| achilles
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3-ruptured ectopic ?
Edited by achilles on 04/29/06 - 07:34 AM
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| srf
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3
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| cyra
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3
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| amit_k_m
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explanation pls...
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| Rasul
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iF IT'S 3, THEN WHY IS SHE HAVING PAIN IN HER SHOULDER?
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| achilles
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shoulder pain is reffered pain which is due to the bleeding ( irritates the abdominal side of the diaphragm ) which occured during rupture of ectopic pregnancy.
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| Rasul
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THX, Achilles
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| determine
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Great! I had no clue. Thanks guys!
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| chemamr
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i'd say 3, too.
(that referred pain is some uncommon but i guess it's the most likely Dx).
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| srf
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irritation of diapharm by blood cause referred pain. ectopic causes massive intraabdominal bleeding if not diagnosed early.
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| AAAAA
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I have seen so many cases, real cases and I never forget
A woman with sudden acute right lower quadrant pain and right shoudler pain: ectopic
Operate operate , operate
I remembered the days of opening up the patient with blood shooting up the ceiling
This is emergency
Think this is a 2 million dollar question
why NBME asks you this question WHY WHY WHY?
Because this question will cost you 2 million dollars ?
The patient will die if you don't do anything
The patient has acute event, the rutpured of the ectopic sac and caused chemical irritation to the peritoneum and referred pain to the right should
Remember, call the OBGYN
I did a lot of salpingectomy on these women with my professors in med school
This is OBGYN emergency ! remember 2 million dollar question
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| AAAAA
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The right shoulder pain means what ?
it means peritonitis, it is NOT uncommon !!!!!!!!!!!!!!!!!
It means rutpured of some organs !!!!
I have been burned, burned in hell by ruptured appendix, so I never forgot the patient returned to ER 24 hours later. It is not an acute event ! It takes 8, 12, 16, 24 hours for the patient to return to complain of severe pain of ruptured appendix
Then you got a letter from the Chief why you discharged the patient from ER with gastroenteritis ! O MY GOD
You can miss a ruptured appendix, but not ectopic pregnancy. Actually not really on ruptured appendix
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| AAAAA
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The most important thing is hypotension, hemodynamic shock and the patient dies ! It only cost you 2 million dollars and 2 year of time to 4 years to fight this case in court.
The husband wants all your money, his wife died !
think ectopic
Now you know you will never waste your time here
Now you know why you study for USMLE National Board of medical Examiners
I never understand why I have to know a 17 year old with left testicular pain, sudden onset so importanmt, well if you miss in a 4 hour window, you will lose a patient, a testicule, a lawsuit and kick out of the program and more.......
Study, study, and think like a real situation
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| d_raza1
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Bleeding into peritoneal cavity or rupture of some viscus (for example perforated duodenal ulcer) can cause pain in right shoulder (what about the left shoulder? this is my question as it can also cause same thing on left) due to irritation of right dome of diaphragm.
I have another question, do we give antibiotics too in case of ruptured ectopic pregnancy? do we start them right away even before surgery?
my questions are in bold.
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| d_raza1
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and perhaps same is the reason of pain in rt. shoulder in acute cholecystitis.
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