Gynecology Registrar

Spirit Hospital

South Brisbane

16.02.2013

Dear Doctor

Re: Miss Cathy Jones, aged 20

I request your urgent assessment and management for Miss Jones, a receptionist who has been
suspected with ectopic pregnancy.

Today, Miss Jones condition has deteriorated which manifested in form of worsening pain overnight,
new onset left shoulder-tip pain and having vaginal spotting. Furthermore, she had a fainting like
sensation while waiting at reception. Her examination revealed a marked rebound tenderness over the
right iliac fossa associated with guarding. Additionally, cervical excitement and the right fornix
tenderness were noted while doing PV. She was afebrile and vital signs were normal; however, her
pregnancy test had come positive.

Miss Jones presented yesterday, complaining of an acute onset lower abdomen pain predominantly
over right iliac fossa. She reported that her menses had been irregular for the previous 2 months since
she started taking POP and because of that she was not sure of the LMP. She also informed living with a
new partner for the past two months. Mild right iliac fossa and the right fornix tenderness were
observed on examination; therefore pertinent investigations were requested and a review next morning
was recommended.

I would appreciate your assessment and emergency care for Miss Jones. Please note, this is her first
pregnancy. She also has a family history of DVT.

Should you have any queries, please do not hesitate to contact me.

Yours faithfully

Doctor