USMLE Forum Archives - USMLE Step 2 CK - Abdominal Pain
Abdominal Pain
laparotomy - 01-06-08 13:27
A 25 year old female presents with severe right lower quadrant pain that started suddenly 5 hours ago. On examination she has severe right lower quadrant pain with guarding, but no rebound tenderness. Her last menstrual period finished yesterday. Her wcc, hct, rbc, ESR, CRP, LFT's and Urea and elerolytes are all within normal limits. Her temperature is 36.5C, Pulse 77/min, Bp 120/80. What is your next step in management? Her HCG is negative.
A. Ultrasound of pelvis and abdomen
B. CT abdomen and pelvis
C. Diagnostic Laparoscopy
D. Laparotomy
E. Admit for observation
laparotomy - 01-06-08 13:27
A 25 year old female presents with severe right lower quadrant pain that started suddenly 5 hours ago. On examination she has severe right lower quadrant pain with guarding, but no rebound tenderness. Her last menstrual period finished yesterday. Her wcc, hct, rbc, ESR, CRP, LFT's and Urea and elerolytes are all within normal limits. Her temperature is 36.5C, Pulse 77/min, Bp 120/80. What is your next step in management? Her HCG is negative.
A. Ultrasound of pelvis and abdomen
B. CT abdomen and pelvis
C. Diagnostic Laparoscopy
D. Laparotomy
E. Admit for observation
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#2
Re: Abdominal Pain
laparotomy - 01-06-08 14:00 What is your differential diagnosis say your first three in order of most probable...
#3
Re: Abdominal Pain 8401glacieres - 01-08-08 10:01 Do USG of abdomen and Pelcvis
D/d are
1-PID- Usually abdominal pain begins after some days of last menstrual period and is of dull aching charecter.
2-Ovarian cyst torsion----is a strong possibility in women of child bearing age group who are not pregnant.
3--Ac Appendicitis.
#4
Re: Abdominal Pain TheOne - 01-08-08 15:47 D/D:
1) Appendicitis.
2) Tosrion/Ruptured Overian Cyst.
I would go for D.
#9
Re: Abdominal Pain laparotomy - 01-26-08 11:06 
posted by TheOne on 01-08-08 15:47
D/D:
1) Appendicitis.
2) Tosrion/Ruptured Overian Cyst.
I would go for D.
D/D:
1) Appendicitis.
2) Tosrion/Ruptured Overian Cyst.
I would go for D.
Would you really do a laparotomy for an appendicitis?
Okay pop quiz, what incision would you do for a patient with acute appendicitis?
#10
Re: Abdominal Pain InSitu - 01-26-08 11:49 posted by laparotomy on 01-26-08 11:06
Would you really do a laparotomy for an appendicitis?
Okay pop quiz, what incision would you do for a patient with acute appendicitis?
Would you really do a laparotomy for an appendicitis?
Okay pop quiz, what incision would you do for a patient with acute appendicitis?
McBurney's incision
A short diagonal incision in the lower right quadrant in which the muscle fibers are separated rather than cut.
#11
Re: Abdominal Pain laparotomy - 01-26-08 13:18 The Lanz incision gives a better cosmetic result and is less invasive. But I believe in the 21st century the least traumatic with shortest post operative stay is the laparoscopic approach.
The future is in scarless surgery where an appendix or even a gallbladder can be removed transvaginaly or transgastric through an endoscope.
#15
Re: Abdominal Pain babbu5508 - 07-07-10 21:53 A. Ultrasound of pelvis and abdomen
could be a renal colic or pelvic inflammatory disease, but torsion of ovarian cyst or acute appendicitis could be possible
#16
Re: Abdominal Pain bingousmle - 07-09-10 02:19 E. Admit for observation as all her vitals are stable and she is not pregnant asthe hcg is negative and had her menses periods just yesterday
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