USMLE Forum Archives - USMLE Step 2 CK - 16 year old femal with abdo pain
16 year old femal with abdo pain
laparotomy - 02-25-08 09:01
A 16 year old female presents to you in the emergency departmentl with severe left lower abdominal pain. A pain of 9 out of 10. She is very pale. Her blood pressure is 120/70 pulse 76. Physical examination reveals left lower quadrant pain, no guarding or rebound. You took down bloods and are waitin for results. She states she is not sexually active and her urine HCG is negative. Urine dipstick shows 3+ for leukocytes. She has no flank pain.
What is your diagnosis?
What is your next step in management?
laparotomy - 02-25-08 09:01
A 16 year old female presents to you in the emergency departmentl with severe left lower abdominal pain. A pain of 9 out of 10. She is very pale. Her blood pressure is 120/70 pulse 76. Physical examination reveals left lower quadrant pain, no guarding or rebound. You took down bloods and are waitin for results. She states she is not sexually active and her urine HCG is negative. Urine dipstick shows 3+ for leukocytes. She has no flank pain.
What is your diagnosis?
What is your next step in management?
Page 1
#1
Re: 16 year old femal with abdo pain radhamesramos - 02-25-08 10:05 It could be:
-PID
-left ovarian torsion
-UTI complicated
-rupture of a left ovarian cyst
-and still an ectopic pregnancy...in that case we send for blood HCG
Next step in diagnosis is a pelvic ultrasound
#2
Re: 16 year old femal with abdo pain TheOne - 02-25-08 12:34 
posted by radhamesramos on 02-25-08 10:05
It could be:
-PID
-left ovarian torsion
-UTI complicated
-rupture of a left ovarian cyst
-and still an ectopic pregnancy...in that case we send for blood HCG
Next step in diagnosis is a pelvic ultrasound
It could be:
-PID
-left ovarian torsion
-UTI complicated
-rupture of a left ovarian cyst
-and still an ectopic pregnancy...in that case we send for blood HCG
Next step in diagnosis is a pelvic ultrasound
Agree with radha, and add Appendicitis for the D/D and Abd. CT for the Mx.
#5
Re: 16 year old femal with abdo pain
laparotomy - 02-26-08 02:52 posted by agamamber on 02-25-08 12:36
APPENDICITIS
APPENDICITIS
With left sided abdominal pain?
#6
Re: 16 year old femal with abdo pain laparotomy - 02-26-08 02:53 posted by laparotomy on 02-25-08 09:01
A 16 year old female presents to you in the emergency departmentl with severe left lower abdominal pain. A pain of 9 out of 10. She is very pale. Her blood pressure is 120/70 pulse 76. Physical examination reveals left lower quadrant pain, no guarding or rebound. You took down bloods and are waitin for results. She states she is not sexually active and her urine HCG is negative. Urine dipstick shows 3+ for leukocytes. She has no flank pain.
What is your diagnosis?
What is your next step in management?
A 16 year old female presents to you in the emergency departmentl with severe left lower abdominal pain. A pain of 9 out of 10. She is very pale. Her blood pressure is 120/70 pulse 76. Physical examination reveals left lower quadrant pain, no guarding or rebound. You took down bloods and are waitin for results. She states she is not sexually active and her urine HCG is negative. Urine dipstick shows 3+ for leukocytes. She has no flank pain.
What is your diagnosis?
What is your next step in management?
Follow up:
Her labs/ bloods came back to be normal (including CBC) now what is your diagnosis and next step in management?
#7
Re: 16 year old femal with abdo pain agamamber - 02-26-08 04:38 sorry, i didnt see left...
then it can be left ovarian torsion.
#8
Re: 16 year old femal with abdo pain laparotomy - 02-26-08 04:54 posted by agamamber on 02-26-08 04:38
sorry, i didnt see left...
then it can be left ovarian torsion.
sorry, i didnt see left...
then it can be left ovarian torsion.
So what will you do? Laparotomy?
#9
Re: 16 year old femal with abdo pain radhamesramos - 02-26-08 13:05 You do an abdominal ultrasound
#10
Re: 16 year old femal with abdo pain laparotomy - 02-26-08 16:13 posted by radhamesramos on 02-26-08 13:05
You do an abdominal ultrasound
You do an abdominal ultrasound
Exactly!!!
#11
Re: 16 year old femal with abdo pain ammulufy - 06-28-10 21:17 Well my D/D goes in favour of gynaecological origin disrdrs like PID or Endometriosis or Dysmenorrhea......However d frst two r ruled out bcos PID usually follows only after prolonged IUD use n as for endometriosis,it is associated wid such severe n crampy abdominal pain dat d patnt will not be in a position to even converse n give d appropriate history.....even d disorders of intestinal disorders are ruled out in v/o no guarding or rigidity or tenderness in dat area......HAVING SAID DAT I DONT KNOW D REASON FOR 3+ LEUCOCYTES IN D URINE......well in support of my answr I would like to proceed further wid PV exmn n US abdomen to rule out other secondary causes for dysmenorrhea.
#12
Re: 16 year old femal with abdo pain bingousmle - 06-30-10 17:14 left sided lower quadrant pain in a sexually inactive woman.. the possibilites are ovarian torsion, or a complicated UTI or ureteral stone... proceed with an ultrasound
Page 1