fireflymedic Posted June 21, 2008 Share Posted June 21, 2008 You are called to a well kept home of a twenty two year old female complaining of severe pain in the LLQ. Pt states it has a cramping quality and is intense at times rating it up to a 9 out of 10. She states she has not had any nausea or vomiting, and denies breast tenderness. Pt states she is sexually active, though is currently on the pill (seasonique so she only has 4 periods a year). Pt stated earlier in the day she had a syncopal episode and still feels lightheaded. Vitals: BP : 90/62 pulse: 104, regular, strong resp: 18 pt AxOx3 able to answer all questions appropriately, speech is clear and fluid What would you like to do or know? Link to comment Share on other sites More sharing options...
Chief1C Posted June 21, 2008 Share Posted June 21, 2008 Bleeding from anywhere one shouldn't bleed from? Link to comment Share on other sites More sharing options...
ERDoc Posted June 21, 2008 Share Posted June 21, 2008 As I stated in another thread, she is pregnant until proven otherwise. Any vaginal discharge, urinary symptoms, history of STDs? What do we find on physical exam? Temp? Link to comment Share on other sites More sharing options...
fireflymedic Posted June 21, 2008 Author Share Posted June 21, 2008 Pt states she has been urinating more frequently than normal. Also, she has temp of 99.4. No history of STD's - is currently married and is only contact ever (or at least that is what claims). No bleeding noted. Other than pain in lower abdomen, pt does not complain of any pain. As previously mentioned, pt had syncopal episode earlier. Doc - I like your thinking lol. You are knocking on the door but haven't opened it yet. Link to comment Share on other sites More sharing options...
firedoc5 Posted June 21, 2008 Share Posted June 21, 2008 Tubal pregnancy. Ovarian cyst, even possible rupture. At what age did she start menstruating? At any time did she have any interruption of her cycle with no pregnancy, and for how long? Was she regular before being on her current BCP? How has her stools been? Passing gas? Spastic colon. Ulcerative Colitis. History of any ulcers? Has she been more stressed lately? When was the last she had intercourse? Was it painful? Any anal penetration? (you gotta ask) Pain in either groin, femoral tenderness? Link to comment Share on other sites More sharing options...
fireflymedic Posted June 21, 2008 Author Share Posted June 21, 2008 BINGO ! You are the winner fire doc - tubal pregnancy ! Link to comment Share on other sites More sharing options...
Kaisu Posted June 21, 2008 Share Posted June 21, 2008 I was thrown off by the description of the pain as "cramping" quality. I always thought that ectopic pregnancies were asymptomatic until they ruptured, then producing sharp pain with abdominal distension and rigidity. I was under the impression that cramping type pains were associated with uterine issues (premature contractions, menstrual cramping, etc.) Thanks for the scenario. Link to comment Share on other sites More sharing options...
firedoc5 Posted June 22, 2008 Share Posted June 22, 2008 I was thrown off by the description of the pain as "cramping" quality. I always thought that ectopic pregnancies were asymptomatic until they ruptured, then producing sharp pain with abdominal distension and rigidity. I was under the impression that cramping type pains were associated with uterine issues (premature contractions, menstrual cramping, etc.) Thanks for the scenario. I worked with a nurse that had an ectopic pregnancy. She said she missed a period, but not uncommon for her. The next month she started cramping and she thought she was about to start. But after a day the pain was excruciating. They did the ultra sound and found it. That's always stuck in my head, so I thought that was the best guess. Link to comment Share on other sites More sharing options...
Kaisu Posted June 22, 2008 Share Posted June 22, 2008 I stand corrected - and once again, I have learned something. It's a good day. Link to comment Share on other sites More sharing options...
firedoc5 Posted June 22, 2008 Share Posted June 22, 2008 I stand corrected - and once again, I have learned something. It's a good day. That's what we're here for. :wink: Link to comment Share on other sites More sharing options...
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