All right, welcome everyone. My name is Divine. This is episode 549 of the Divine Intervention Podcasts.

And in today's podcast series, we're going to be continuing the 2024 USFLE step three, free 137 discussion.

This is going to be part two. I'm going to be doing questions 11 to 20.

And again, I will encourage you if you're studying for step two.

This stuff is also super helpful for those that are taking step two. All right. So, we're just going to jump right into it. So, question 11. A 37-year-old woman comes to the emergency department because of a four-hour history of severe right-sided abdominal pain. She describes the pain as sharp and says it relates to the pelvic region. She reads the pain as a nine on a ten point scale.

She has had associated nausea but has not vomited. She has not had any recent trauma fever,

chills, changes in bowel habits or urinary symptoms. She took ibuprofen three hours ago but has

had no relief of her current symptoms. Medical history is otherwise unremarkable and she takes

no other medications. She does not smoke cigarettes or drink alcoholic beverages. She is not sexually active and her last menstrual period ended four days ago. The patient is holding her right side and is grimacing in pain. Her vitals are she's tekeptnic. Her blood pressure is not too bad. Oskotation of the chest discloses normal breath sounds and normal S1 and S2 abdominal examination

discloses normal bowel sounds tenderness with voluntary guarding on the

right side but no palpable masses penis elicited on percussion of the

over the right cost of vertebral angle and then we look at the labs right so a

neutral field count is 13 thousand so what are the pertinent labs has a bunch of

labs here but again you can see the white count is just,000. So what are the pertinent labs? There's a bunch of labs here, but again, you can see the white count is pretty high.

And there's barely any blood in your urine.

And then we're told that, you know, there's intravenous fluids and analgesic therapies are initiated.

Which of the following is the most appropriate next step in evaluation, right?

So we see this person.

This person has had like very severe, you know, right-sided pain and, you know, has cost of vertebral tenderness, has like a mild leukocytosis.

We can see some, you know, trace positive. and has cost of vertebral tenderness, has like a mild leukocytosis.

We can see some, you know, trace positive blood in her urine.

But this woman's labs and vitals are otherwise fine.

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