Week 6 discussion 16 y/o F with left lower and mid pelvic pain, moderate, start
Week 6 discussion
16 y/o F with left
lower and mid pelvic pain, moderate, started this a.m. Came on suddenly, sharp,
some intermittent relief but no clear relieving or exacerbating factors. Tried
ibuprofen and heat packs, no change. Non-bilious non-bloody vomiting x 2. +Vaginal
discharge, white, no pruritis. No prior episodes. No known prior sexually
transmitted infections. No sick contacts.
Sexually active, 4
lifetime partners male and female, last intercourse 5 d ago with male partner,
consensual, no condom, positive occasional EtOH and marijuana use, no other
illicit drugs, no history of sexual abuse, no history of depressive symptoms.
Lives w/ both parents and sister, 10th grade, does well in school.
Physical exam negative
except
Abdomen
Soft, TTP in suprapubic and left pelvic region
otherwise NT elsewhere, +BS, non-distended, no hepatosplenomegaly, neg psoas,
no guarding/rebound, neg Murphy’s.
Pelvic:
Normal external Tanner 5 female, moderate thin
white/yellow discharge in vaginal vault, no cervical discharge. There is
discomfort with movement of cervix and during left bimanual adnexal exam, no
pain on right during bimanual examination.
Labs
Negative HCG, negative wet mount, GC/chlamydia sent
and pending, UA pH 5, SG 1.020, neg nitrites, neg LE, trace heme, trace
protein, neg ketones, neg bili, neg glucose.
IMAGING
Abdominal radiograph read as normal loops of bowel, no
air fluid levels, scant stool throughout colon, overall unremarkable.
Presumptive dx : PID patient admitted and treated with
IV abx
Patient had a wrong diagnosis
After three days you review patient´s chart and found
out that
Kayla was started on IV antibiotics, and two days later
when her severe pain and vomiting continued, the gynecologists were consulted.
After seeing Kayla, the gynecology team discussed with the pediatrics team that
maybe PID wasn’t the correct diagnosis after all. They thought that ovarian
torsion was possible and decided to take Kayla to the operating room for a
laparoscopy. During the operation, they found that her ovary was necrotic and
could not be salvaged and needed to be removed.
Please
answer these questions using
the latest evidenced based guidelines:
Please answer each question
1• Discuss the questions that would
be important to include when interviewing a patient with this issue.
2• Describe the clinical findings that may be present in a
patient with this issue.
3• Are there any diagnostic studies that should be ordered on
this patient? Why?
4• List the primary diagnosis and three differential
diagnoses for this patient. Explain your reasoning for each.
5• Discuss your management plan for this patient, including
pharmacologic therapies, tests, patient education, referrals, and follow-ups.
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16 y/o F with left
lower and mid pelvic pain, moderate, start appeared first on blitzarchive.com.