06-07-2004, 05:29 AM
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.
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.