Level 3: Abdominal Pain – Contrasting Case #1: Patient Information

Given these changes from the original case, what is your diagnosis?

What is your diagnostic explanation?

As compared to the long case, this patient is a 23 year old female who presents to the ED with abdominal pain.

HPI: The patient reports that the pain started a couple of days ago and is located low down. The pain is constant and dull in quality. It has not gotten worse. Nothing alleviates or aggravates the pain. She denies any vaginal discharge or bleeding. Her LMP was 1 week ago. She normally has irregular menstrual cycles with occasional spotting between periods. She just recently became sexually active with her boyfriend. She is not on any form of birth control. She has had 2 previous partners. She has never had an abnormal pap smear or any history of STIs. She denies fever/chills, nausea, vomiting, diarrhea/constipation, hematochezia, dysuria, or increased frequency/urgency. She has not had any sick contacts nor has she eaten anything unusual in the past few days. She has never had pain like this before.

ROS: Noncontributory

VS- Temp 98.6, HR 72, BP 116/78, RR 14, Height 5’6”, Weight 165, BMI 26.6
General- Alert and oriented. No acute distress.
Cardiac- RRR. Normal S1 and S2. No murmurs.
Lungs- Clear to auscultation.
Abdomen- Bowel sounds decreased Tenderness to light palpation in lower quadrants. Positive rebound tenderness. Negative McBurneys. No CVA tenderness.
Genital- Normal appearing external genitalia. Cervix appears smooth without any lesions or masses. Small amount of mucopurulent discharge from cervix. Vaginal vault is pink without lesions or masses. Adnexal and cervical motion tenderness on bimanual exam.