Case 2 number 2

Working impression: suppurative appendicitis

Basis: Periumbilical pain that shifted to the right lower quardrant, anorexia, vomiting, fever, increased
vital signs, positive rovsing’s sign, direct rebound tenderness on the right lower quadrant

Differentials:

Ectopic pregnancy: ruled in due to the location of the abdominal pain however ruled out due to a
negative pregnancy test.

Pelvic inflammatory disease: this is ruled in due to the presence of lower abdominal pain, nausea and
vomiting but ruled out due to absence of abnormal vaginal discharge

Ovarian cyst: this is ruled in due to the presence of lower abdominal pain, nausea and vomiting but
ruled out due to the absence of findings in ultrasound and no difficulty in urinating.

UTI: this is ruled in due to the presence of abdominal pain but is ruled out due to the absence of findings
in urinalysis, absence of strong smelling cloudy urine, burning sensation when urinating and persistent
urge to urinate.