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A 37 year old WF presents to your clinic with CC of RLQ abd pain that...

A 37 year old WF presents to your clinic with CC of RLQ abd pain that has been present/persistent for 3-4 days; today she says it's so bad that she can't stand up straight and she is guarding her RLQ. When she walks into the clinic, her hips are flexed and she is bent over, holding her RLQ. She has had fever for a couple days, she says, and tylenol and ibuprofen aren't helping with the pain or with the fever. She says she has been vomiting persistently since yesterday, hasn't been able to keep anything down and now is vomiting a greenish thin clear liquid that "tastes really bad." NKDA, no medical problems, no daily medications. G9T5P0A4L5. Unsure when she had her last normal menstrual period, states that "I don't really keep up with that anymore." Refuses to answer many questions about her sexual history. States, "I just want you to do something about this pain!" No previous surgical history, unsure when she had her last pelvic exam/Pap smear, denies that she has ever had a mammogram. She smokes 2 ppd cigarettes and has since she was 13 years old. Admits to regular marijuana use and methamphetamines "only on the weekends," admits to ETOH on the weekends too, usually about 12 beers/weekend.

What are the Guidelines for Treatment recommendations for the top diagnosis on your differential diagnosis/illness script?

What do you expect to find on physical assessment of this patient?

Solutions

Expert Solution

Answer:

From the given information, patient is having appendicitis( which is characterised by right lower quadrant pain, pain may worsen with walk,fever, nausea, vomiting).

Treatment recommendations for appendicitis:

Appendectomy( laporoscopic or open lapaorotomy) is the standard treatment for appenditis.

Antibiotics before and after surgery is needed to subside the infection, also analgesics are to be prescribed.

Advice to avoid strenous activities for two weeks  after surgey.

On physical examination, we can expect:

Mc burney's sign:Tenderness on deep palpation at mcburney's point( midway between the umbilicus and right anterior ileac spine)

Psoas sign: Extentending right hip causes pain on posteriolateral back and hip suggesting retrocecal appendicitis.

Obturator sign: Increased pain in hypogastrium on passive flexion and interanal rotation of the right hip.

Rovsing's sign: Right lower quadrant pain upon palpating left lower quadrant.

Heel drop sign: Right lower quadrant pain upon dropping heels on the ground or forcrfully striking the patient's heel.

Nightingale answered 1 year ago
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