VS: BP138/88 mm Hg HR70 beats per minute RR 18 breaths per minute Temp 36.5°C, and oxygen saturation of 99% on room air.
General appearance: writhing around on the stretcher, holding her right side, periodically tearful
Eyes: EOMI, PERRLA, anicteric, no pallor
Mouth: mucosa moist, normal tonsils without erythema, vesicles, or exudates
Neck: supple, no lymphadenopathy, no JVD, no goiter
Respiratory: CTA b/l, no wheezes, rales, or rhonchi
Cardiovascular: no murmurs, rubs, or gallops, 2+ pulses in all extremities
Abdomen: obese, soft, tender in the right upper and lower quadrants, no rebound or guarding, mild CVA tenderness on the right, normal bowel sounds
Pelvic: whitish foul-smelling discharge, os is closed, friable cervix with minimal bleeding when swab taken, no cervical motion tenderness
Extremities: no cyanosis, clubbing, or edema
Musculoskeletal: full range of motion throughout
Skin: warm and dry, no rashes
Neurological: A & O x3, CN II-XII intact, normal sensation and strength throughout
CBC and electrolytes within normal limits
U/A: 2-5 trichomonas, trace leukocyte esterase, no nitrites, no blood, 2+ bacteria
CT Abdomen-Pelvis w/o contrast: 2 cm hypodense mass in left adrenal gland, 4.4 cm cyst in left adnexa, 6.1 cm cyst in right adnexa, gallbladder, kidneys, and appendix all normal in appearance
Pelvic U/S: left ovary is 5x4x3 cm, right ovary is 7x5x5cm containing a 3x4x4cm hypoechoic lesion with no arterial wave form, fluid in the right cul-de-sac
1. What is the most common type of adnexal mass in the reproductive years?
B. tubo-ovarian abscess
D. physiologic cyst
2. What is the first step in management of a woman with pelvic pain and unstable vital signs?
A. consult to Ob/Gyn
B. send to OR
C. wide-bore IV access and volume resuscitation
D. CBC and electrolytes
E. Pelvic ultrasound
3. What is the gold standard for diagnosis of acute pelvic pathology?
C. laboratory tests
D. CT with contrast
E. CT without contrast
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