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Cedrick
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06/20/06 - 05:49 PM       #1

A 30 year old woman has a 12 hrs history of chills and abdominal pain
her last menstrual period was two weeks ago
her temperature is 38C{101F}
pulse is 120/min,respirations are 18/min and blood pressure is 132/82 mmHg
Abdominal and pelvic examination shows tenderness on palpitation of the right lower quadrant,pain in the right lower quadrant after pressure is quickly released from the left lower quadrant pain in the right lower quadrant when the right hip is flexed against resistence
and tenderness in the right recat wall,bowell sounds are absent
test of stool for occult blood is negative
Which of the following is the msot likely diagnosis ?

a.-appendicitis
b.-cystitis
c.-diverticulitis
d.-ectopic pregnancy
e.-pelvic inflamatory disease

rolling eyes

robin082006
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06/20/06 - 06:41 PM       #2

E

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sridevibandaru24
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06/20/06 - 06:48 PM       #3

A?

Cedrick
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06/20/06 - 07:17 PM       #4

A
sticking out tongue

star1
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06/20/06 - 07:58 PM       #5

Is this showing rebound tenderness? and if yes then does it only be present in appendicitis?

second does appendicitis has fever associated with it?


robin082006
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06/20/06 - 08:22 PM       #6

Yes A is better choice, the question is written without comma, making me have alexia and not understand. English is not my native language.

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Cedrick
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06/20/06 - 08:24 PM       #7

not worry
I still like you
my spelling is bad
you should see my hand writing "like a Doctor "
hahaha !!!

nadiabarati

06/21/06 - 07:09 AM       #8

A

shilahk
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06/21/06 - 07:39 AM       #9

i think it's A...i am not 100% sure

if it is not written "chills", "absent bowel sound"...i would be sooo sure it's A


rman
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06/21/06 - 07:09 PM       #10

How do you differentiate appendicitis from ectopic??

mjl1717
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06/21/06 - 07:19 PM       #11

star1 wrote:
Is this showing rebound tenderness? and if yes then does it only be present in appendicitis?

second does appendicitis has fever associated with it?

answer to q #1 is yes, rebound tenderness can occur with any ruptured viscus that goes on to peritonitis.
#2 yes appendicitis can have a fever associated with it.


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C5a
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07/30/06 - 05:09 AM       #12

the question shows that the psoas maneuver was a positive, fever, plus tenderness to the right rectal wall on DRE (it'll be hot too). usually they will also say something about leukocytosis & left shift.

plastic_girl
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07/30/06 - 05:57 AM       #13

My 2 cents :

I would go with D, ectopic pregnancy. The first sentence mentions her last menstrual period was 2 weeks ago, shes in her reproductive years and she has with all the signs of acute abdomen, I think the other stuff is to throw us off course.

In every woman in her reproductive years with abdominal pain "Think ectopic!". Thats what I was taught.

black
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08/06/06 - 10:46 PM       #14

Two weeks ago menses.....mmm too early to be pregnant and have symptoms already.
I go with A.


Dragonfly
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08/07/06 - 06:20 AM       #15

hey guys LMP is a distractor. otherwise how could someone buy their other options? wink she could be well in mid-cycle!!

these are classic "Psoas sign" and "Rebound tenderness" which is routinely done to check for Appendicitis. they indicate inflammatory peritonitis.
Right side -- Appendicitis
Left side -- Diverticulitis

could be Ectopic but :
BP is in 130s. no way for at least a ruptured Ectopic.
and there is no mention of high b-HCG

and for PID, there is no discharge or sexual contact history mentioned.

not to meniton that bowel sounds are absent ? ?

Left shift , Leukocytosis, N/V, etc. are common but not essential signs for Appi.


Edited by Dragonfly on 08/07/06 - 06:28 AM

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plastic_girl
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08/07/06 - 11:25 AM       #16

Agreed, thanks for clearing it up. smiling face I think I was looking too much into this, expecting every question to be a bluff. rolling eyes

Answer is A. Appendicitis.



Dragonfly
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08/07/06 - 01:23 PM       #17

smiling face

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fox
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08/21/06 - 01:16 PM       #18

Rovsing's sign (pain in rt iliac fossa when the left iliac fossa is pressed) is present . Hence clearly a case of appendicitis

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