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History :
hpi: 25 yo F comes to ED -sexually and physically assaulted. Incident took place 3hrs ago- 2 men- not
reported to police- happened outside the bar- pleuritic, sharp, rt sided chest pain-8/10, constant, nonradiating. Did not use any foreign objects- used fist to beat-no oral/anal intercourse- no condoms. pt
has nausea, depressed, SOB, fatigue, palpitation, pain in the wrist. there was no ejaculation. Pt.
denies any LOC, headache, urinary/ bowel changes.
ros: negative except as above
pmh: nil
psh: nil
nkda
medications: nil
fh: NC
sh: student, lives alone, no smoking, illicit drugs, but etoh occasionally.
Physical Examination :
ga: anxious
vs: wnl
heent: no pallor, icterus, cyanosis, nc/at, eomi.
neck: no lad,thyroid normal, supple
chest: decreased breath sounds on right side, tenderness on rt. side, TVF equal on both side.
percussion hyperresonant on the rt. side
heart: s1s2 normal, no M/R/G, rrr
Extremities: wrist tenderness, ROM normal, no edema, dtrs+2 symmetric, sensation and motor
strength normal (5/5).
Diagnosis 1 :
rib fracture

History Findings
1) chest pain
2) trauma to chest
3) SOB

Physical Exam Findings

Diagnosis 2 :
Pneumothorax

History Findings
1) chest pain
2) trauma to chest

Physical Exam Findings

3) SOB
4) pleuritic pain

Diagnosis 3 :
pregnancy

History Findings
1) unprotected sexual assault

Diagnostic Study/Studies - Labs

1) CBC with diff esr
2) urine hcg
3) CXR
4) TVS
5) vaginal culture

Physical Exam Findings