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2/5/12 12:00 AM

case1 Scenario


30 Yr. O/F Complaining of Abdominal Pain Vitals Pulse--98/min B.P--120/75 mm of Hg Temp-101.3 R.rate--22/min Make a mental checklist of Differential Diagnosis Pelvic inflammatory disease Pelvic abscess Endometriosis Urinary tract infection Appendicitis Rupture/torsion of ovarian cyst Acute cholecystitis Renal colic Ectopic pregnancy Abortion Acute gastroenteritis Inflammatory bowel disease
This copy of the material is licensed to Elsa Arocho. Copyright © 2012 All Rights Reserved www.usmleworld.com


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progressively increasing 6-7/10 in severity Right below the umbilicus It's a type of sharp pain All over your lower abdomen Began after eating a large meal Moving around makes it worse No alleviating factors Associated with nausea and vomiting Passing urine more number of times and have burning urination No bowel problems Last menstrual period was 3 weeks ago No discharge from vagina/no bleeding from vagina Have fever since yesterday associated with chills and rigors Have one episode of urinary tract infections (UTI) in the past No allergies Once hospitalized for evaluation of UTI Have multiple sexual partners Using oral contraceptive pills Familie's health is normal Smoking .No Alcohol .No Occupation: Working as a receptionist Appetite and wt is normal No illicit drug intake Ask this qt . You are Mrs.Doc is it an appendicitis? This copy of the material is licensed to Elsa Arocho.aspx?ID=49 Page 1 of 2 . age: 30yrs Have abdominal pain since 12 hrs Started slowly.com/Step2CS/cs/showcontent. Mary.usmleworld. https://www.Untitled Page 2/5/12 12:01 AM case1 SP Print If the doctor asks you anything other than these just say 'no' (or) say things that are normal in daily routine life.No Recreational drugs.

urinary tract infections) Asked about previous hospitalizations (surgery) Asked about family health. diabetes. kidney problems.Untitled Page 1/28/12 3:53 PM case1 checklist History Taking (General Proforma) Asked about the location of pain Asked about the intensity of pain Asked about the quality of pain Asked about the origin and duration of pain Asked about the progression of pain Asked about any radiation of pain Asked about the aggravating factors. Asked about the relieving factors Asked about any vomiting Asked about fever Asked about urinary problems Asked about bowel problems. Asked about appetite and changes in weight Asked about smoking Asked about alcohol https://www. Asked about last menstrual period Asked about vaginal discharge Asked about vaginal bleeding Past History Asked about similar episodes in the past Asked about history of allergies Asked about past medical problems (high blood pressure.com/Step2CS/cs/showcontent.usmleworld.aspx?ID=50 Page 1 of 3 .

usmleworld. abdomen x ray) Explained the importance of safe sexual practices and use of condoms. urinalysis. ultrasound.aspx?ID=50 Page 2 of 3 .com/Step2CS/cs/showcontent.Untitled Page 1/28/12 3:53 PM Asked about Obg/gyn history (in detail) Asked about sexual history (in detail including contraception) Asked about medications Asked about occupation Examination Examinee washed hands Auscultated abdomen Palpated abdomen superficially Palpated abdomen deeply Checked rebound tenderness Looked for CVA tenderness Performed Psoas sign and obturator sign Examined without gown not through the gown Counseling Explained the physical findings and diagnosis Explained further work up (Blood tests. Asked to perform rectal and vaginal examination Communication Skills Knocked before entering the room Introduced himself and greeted warmly Used my name to address me Paid attention to what I said and maintained good eye contact Asked few open ended questions Asked non leading questions https://www.

Copyright © 2012 All Rights Reserved www.com https://www.usmleworld. made appropriate reassurances Asked whether I have any concerns/ questions.com/Step2CS/cs/showcontent.aspx?ID=50 Page 3 of 3 . D.D for this Case Pelvic inflammatory disease Pelvic abscess Urinary tract infection Appendicitis Rupture/torsion of ovarian cyst Investigations Rectal and vaginal examination CBC with differential count Urinalysis Pregnancy test Abdomen x ray Ultrasound abdomen This copy of the material is licensed to Elsa Arocho.usmleworld.Untitled Page 1/28/12 3:53 PM Asked one question at a time Listened to what ever I said with out interrupting me in between Used lay man's language Used appropriate transition sentences Used appropriate draping techniques Summarized the history and explained physical findings Expressed empathy.

No priors STD's.com/Step2CS/cs/showcontent. PMH: UTI one episode. The pain started after having a heavy meal. Copyright © 2012 All Rights Reserved www. S2 heard. She describes the pain as sharp. her partner doesn't use condoms. HPI: A 30 Y/O WF who has a H/O UTI.usmleworld. Tenderness is present in periumbilical. Hospitalized once for evaluation of possible pyelonephritis. Lungs: CTA B/L (Clear to auscultation bilateral) Abdomen: Flat. Psoas and obturator signs are D/D: Pelvic Inflammatory disease Pelvic abscess Urinary tract Infection Appendicitis Rupture or Torsion of ovarian cyst Investigations: Rectal and pelvic examination CBC with differential Urinalysis including C/S Pregnancy test Ultrasound Abdomen This copy of the material is licensed to Elsa Arocho. B. Not distended.30F AAOx3 (Alert. R. 6-7/10 in severity. CVA tenderness is negative.aspx?ID=51 Page 1 of 1 . She is also C/O having frequent burning urination. SxH: Multiple sexual partners.usmleworld. She never smoked nor had alcohol. RLQ and LLQ regions. gradual in onset and progressively increasing. She denies recent change in appetite and weight. no scars and pigmentations. Temp 101.C: A 30 Y/O WF with abdominal pain. Never been tested for STDs.22/min. BS are + in all 4 quadrants. Moving around makes the pain worse. S1. Rest is unremarkable. Awake and oriented to time place and person).R . pyelonephrtis who is in her usual state of health until yesterday started to have abdominal pain right below the umbilicus. All: NKA SH: Working as a receptionist.P -120/75 mm of Hg. uses oral contraceptive pills. no diarrhea/constipation. No thrills/murmurs /gallops/rubs. ROS: She has regular bowel movements. which started at more or less same time. denies any alleviating factors. No rebound/guarding/organomegaly.Untitled Page 2/5/12 12:01 AM case1 Pt Notes Print C. The pain is associated with nausea and 2 episodes of non-bloody vomitings.com https://www. No H/o vaginal discharge PE: Vitals: Gen: Heart: Pulse 98/min. in mild to moderate pain. Later on. FH: Both parents are alive and healthy Ob & Gyn: LMP 3 weeks ago. the pain moved to the lower abdomen. She also has fever associated with chills and rigors.

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