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Old 05-04-2015
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A 23 year-old woman presents to the emergency room with severe lower right abdominal pain for the last six hours. a female doctorShe had intermittent lower abdominal pain for three days but never been severe like this time. Her last menstrual period was three months ago and before that she had regular 28 day periods. On physical examination, her vital signs are within normal limits and she has a local tenderness on the lower abdomen with no rebound. On pelvic examination, there is a tender small-sized mass felt in the right vaginal fornix.

What is the most likely diagnosis ?

A- Acute appendicitis

B- Ovarian cyst

C- Ectopic pregnancy

D- Endometriosis

E- Pelvic abscess
http://medical-usmle.com/?p=723
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Old 05-05-2015
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Originally Posted by sohag100 View Post
A 23 year-old woman presents to the emergency room with severe lower right abdominal pain for the last six hours. a female doctorShe had intermittent lower abdominal pain for three days but never been severe like this time. Her last menstrual period was three months ago and before that she had regular 28 day periods. On physical examination, her vital signs are within normal limits and she has a local tenderness on the lower abdomen with no rebound. On pelvic examination, there is a tender small-sized mass felt in the right vaginal fornix.

What is the most likely diagnosis ?

A- Acute appendicitis

B- Ovarian cyst

C- Ectopic pregnancy

D- Endometriosis

E- Pelvic abscess
http://medical-usmle.com/?p=723
Most likely an ectopic. This is far too simplistic a question and lacks many of the elements that CK will give such as vitals to assess hemodynamic stability. The real deal would ask:

What is your next step? - urine HCG

If that's positive? - quantitative serum HCG

If they give a serum HCG and it's >1500, next step? U/S

If they give HCG and positive US with extrauterine pregnancy, next step? ....depends on clinical picture. Will need to decide methotrexate versus surgery. In general, stable patient, smaller fetus --> MTX; unstable patient with larger ectopic --> surgery. There are nuances, but that's a general idea and good enough for CK.
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