The Rosh Reveal: EPISODE 21

Can You Diagnose & Manage This Woman’s Lower Abdominal Pain?

November 24, 2019
Welcome to the next episode of The Reveal where we take you inside the mind of a test-taker to deconstruct and connect the dots of a board-style question so you can become a better student, transform how you learn, and excel not only on high-stakes exams, but also in your general medical knowledge. Let’s get started.

A 22-year-old woman presents with lower abdominal pain that started two days ago. Today, she had three episodes of vomiting but denies any diarrhea or dysuria. On examination, her temperature is 38.8°C, heart rate 105 beats per minute, and blood pressure 128/72 mm Hg. She is ill-appearing with bilateral lower quadrant tenderness. Pelvic examination reveals moderate yellow discharge and uterine tenderness. There are no adnexal masses appreciated. Pregnancy test is negative. What is the next step in the management of this patient?

A) Admission for intravenous cefotetan and doxycycline

B) Admission for intravenous ciprofloxacin and metronidazole

C) Discharge home following intramuscular ceftriaxone and with a 14 day course of oral doxycycline

D) Order a computed tomography scan of the abdomen and pelvis with intravenous and oral contrast

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By Adam Rosh

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