A 19 year old female presents to the emergency room with sudden onset right lower quadrant abdominal pain. Her vital signs show tachycardia (HR 122), hypotension (BP 88/60) and she is afebrile (Temp 98.7). She had a positive pregnancy test about one week ago. What is her most likely diagnosis?
This is an ectopic pregnancy unless proven otherwise. Her positive pregnancy test and the sudden onset of lower abdominal pain is suggestive of this. Other possibilities would include appendicitis and an ovarian torsion.
I listen to my patient's heart with a stethoscope and I hear a sound that isn't supposed to be there. Upon further examination I notice the patient has a large amount of edema in both her feet and she is short of breath. What was the most likely sound that I heard while listening to her heart?
This was likely a third heart sound, or S3, which is caused by rapid filling of the ventricles. This is sometimes noted in patients with severe heart failure.
Round ligament pain in a pregnant woman typically takes which path of distribution? What is round ligament pain and why does it take this path?
The round ligament attaches from the uterine cornua, through the inguinal canal and attaches to the pubic rami. Round ligament pain typically radiates along the inguinal folds anteriorly, and terminates at the pubic bone/labia majora. This causes intense pain, especially with moving from a seated to a standing position.