Clinical Scenarios 1-3
1. A 21 year old woman is brought to the emergency department with severe pain in the right iliac fossa, referred to the right shoulder. On examination she is pale, cold and clammy. She has a heart rate of 100 bpm and a blood pressure of 90/70 MM Hg. Abdominal examination revealed diffuse tenderness and guarding throughout the lower abdomen.
2. A 11year old girl is brought to the emergency department with a 2 day history of right sided abdominal pain, fever and vomiting. On examination, she has a temperature of 37.6 C and heart rate of 112 bpm. Abdominal examination revealed tenderness in the right iliac fossa.
3. A 36 year old woman present to the emergency department with sudden onset of pain in the right iliac fossa that awoke her from sleep. She does not have any urinary symptoms or discharge per vagina. On examination, she is in distress. She is afebrile, her heart rate is 120 bpm and there is marked tenderness and guarding in the right iliac fossa. Her last menstrual cycle was 2 weeks ago. Urine examination is negative for β- human chorionic gonadotrophin, RBC and leucocytes.
For each of the scenarios, select the best answer from the list of options given below:
A. Acute appendicitis
B. Carcinoma of the caecum
C. Crohn’s disease
D. Cystitis
E. Diverticulitis
F. Irritable bowel syndrome
G. Mesenteric adenitis
H. Mittelschmerz
I. Pelvic inflammatory disease
J. Rectus sheath haematoma
K. Ruptured ectopic pregnancy
L. Ureteric colic
M. Torsion of the ovary
2. A 11year old girl is brought to the emergency department with a 2 day history of right sided abdominal pain, fever and vomiting. On examination, she has a temperature of 37.6 C and heart rate of 112 bpm. Abdominal examination revealed tenderness in the right iliac fossa.
3. A 36 year old woman present to the emergency department with sudden onset of pain in the right iliac fossa that awoke her from sleep. She does not have any urinary symptoms or discharge per vagina. On examination, she is in distress. She is afebrile, her heart rate is 120 bpm and there is marked tenderness and guarding in the right iliac fossa. Her last menstrual cycle was 2 weeks ago. Urine examination is negative for β- human chorionic gonadotrophin, RBC and leucocytes.
For each of the scenarios, select the best answer from the list of options given below:
A. Acute appendicitis
B. Carcinoma of the caecum
C. Crohn’s disease
D. Cystitis
E. Diverticulitis
F. Irritable bowel syndrome
G. Mesenteric adenitis
H. Mittelschmerz
I. Pelvic inflammatory disease
J. Rectus sheath haematoma
K. Ruptured ectopic pregnancy
L. Ureteric colic
M. Torsion of the ovary