All right to welcome everyone. My name is Devine. This is episode 549 of the

Divine Intervention Podcast and in today's podcast series we're going to be

continuing the 2024 US family step three free one 37 discussion this is going to be part 2

I'm going to be doing questions 11 to 20 and again I'll encourage you if you're

studying for step 2 this stuff is also super helpful for those that are taking

step 2 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

reduced to the pelvic region. She reads the pain as a nine on a 10-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 another medications.

She does not smoke cigarettes or drink alcoholic beverages.

She is not sexually active and her last minister appeared in it four days ago.

The patient is holding her right side and is grimacing in pain.

Her vitals are, she's to keep neck, her blood pressure is not too bad.

O'S2. Exclotition of the chest discloses normal breath sounds a normal less one and S2.

Abdominal examination, discloses normal bowel sounds tenderness with voluntary

guarding on the right side but no probable masses.

Pines elicited on percussion of the over the right cost of a tibral angle and

then we look at the labs right so a neutral field count is a

13,000 so what are the pertinent labs has 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,

...