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Right lower quadrant pain -
#1
bill

Q) A 40-year-old woman G2P2, 2 years post-tubal ligation, has a sudden onset of right lower quadrant pain. For the last year, her menses have come at irregular intervals, and her last normal period was three months ago. She has no GI or GU complaints, and her surgical history is only positive for her sterilization operation. Vital signs are within normal limits. Pertinent physical findings are limited to the abdomen and pelvis. Examination of the abdomen reveals a well-healed small midline scar between pubis and umbilicus. There is no palpable organopathy, but there is diffuse tenderness in both lower abdominal quadrants. On pelvic examination, the vulva and vagina are within normal limits. There is a small amount of dark brown discharge in the vagina, coming from a closed cervical os. The uterus is normal in size, shape, and position. There is diffuse tenderness in both adnexal regions and voluntary guarding prevents a complete examination. A hemoglobin is 12gm/dL and urinalysis is negative for glucose, albumin, acetone, and formed elements. Pelvic ultrasound examination reveals an empty uterus, a complex mass on the right measuring 5 cm in length, and a small amount of fluid in the cul-de-sac. Which of the following is the most likely diagnosis?

A. Acute appendicitis.
B. Adnexal torsion.
C. Ectopic pregnancy.
D. Tubo-ovarian abscess.
E. Ureteral calculus.

Kindly substantiate your answers.
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#2
regulator

I would say its classic signs for an ectopic pregnancy.. empty uterus, complete mass, small amount of fluid in the cul de sac.. next to the rectum in other words.. well acute appendicitis would be visceral to somatic pain localized RLQ pain, TOA would have a fever, I think that the best option in this case is an ectopic pregnancy.. great question thanks.. what does anyone else think????
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#3
TAC

Looks like ectopic pregnancy to me.. In fact, tube ligation is a risk factor for tubarial pregnancy.

TAC
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#4
hooch !@!@


C )
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#5
Sunny

why not B. Adnexal torsion.
the option says ectopic preg, not ruptured ectopic, and h/o sudden pain, with some complex mass.
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#6
bill

Y not adnexal torsion?
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#7
RAJ

Is 5cm mass a very huge mass to undergo torsion?
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#8
bill

Is mass itself necessary for undergoing torsion?
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#9
aditi

I would think of an ovarian tumour which has undergone torsion and also is the cause of amerrhoea..so my ans is B.
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#10
aditi

Also it mentions that the uterus is normal in size and shape..whereas in ectopic pregnancy it will be enlarged to 6 wks size and soft.
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