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Scenario 2, The 25-year-old woman presents with acute left sided lower…
Scenario 2
Relevant History Points
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Character
Sharp, dull, crampy and its intensity
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Associated Symptoms
Nausea, vomiting, fever, urinary symptoms, vaginal discharge or abnormal vaginal bleeding
Menstrual History
LMP, regularity of cycles, dysmenorrhea, intermenstrual bleeding
Sexual History
Recent sexual activity, contraceptive use (adherence and type), history of STIs and condom use
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Relevant Examinations
Vitals: Temp, pulse, BP, RR
Abdominal: Inspection for any visible abnormalities, palpation for tenderness or masses, percussion for abnormal tympany, and auscultation for bowel sounds
Pelvic: Inspection of external genitalia for abnormalities, speculum examination to assess vaginal discharge or bleeding, bimanual examination to assess pelvic organs for tenderness, masses, or organ enlargement
Rectal: If indicated, to assess for rectal tenderness, masses, or occult blood.
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Ovarian cyst rupture: Sudden-onset unilateral pelvic pain, often associated with physical activity or intercourse
Pelvic inflammatory disease (PID): Lower abdominal pain, cervical motion tenderness, and adnexal tenderness, often associated with vaginal discharge and fever.
Ectopic pregnancy: Unilateral pelvic pain, vaginal bleeding, and a positive pregnancy test, especially in women of reproductive age with risk factors such as previous ectopic pregnancy or tubal surgery.
Endometriosis: Chronic pelvic pain, dysmenorrhea, dyspareunia, and infertility, often associated with cyclic symptoms
Acute appendicitis: Periumbilical pain migrating to the right lower quadrant, associated with anorexia, nausea, vomiting, and localized tenderness on examination
Renal colic: Flank pain radiating to the groin, associated with hematuria and urinary symptoms
Gastrointestinal causes: Various gastrointestinal conditions such as diverticulitis, inflammatory bowel disease, or gastroenteritis can present with lower abdominal pain, often associated with altered bowel habits, bloating, or rectal bleeding.
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