Hello, med students. My name is Zach Olson, and thank you for downloading this week's

episode of the EM Clerkship Podcast. Dr. Olson, I have a 30-year-old female with no surgical

history and no significant past medical history who presents with abdominal pain. She describes it

as a severe, sudden onset pain that started about

three hours ago, actually woke her up from sleep. She denies dysuria, hematuria, fevers, vomiting,

or any other symptoms at this time. Her vitals are within normal limits, but she does appear

to be in pain. On exam, she has tenderness of the right lower quadrant

in the right kind of side of her pelvis with voluntary guarding, no rebound. She has no

CVA tenderness or upper abdominal pain. I think she might have an ovarian cysts, but we need to

rule out the diagnoses of ectopic pregnancy, ovarian torsion, urinary tract infection,

and kidney stone.

I don't think it's appendicitis because of how suddenly it started.

I would like to get a CBC, a BMP, a urine, a urine pregnancy, and a pelvic ultrasound,

and we should probably do a pelvic exam to feel for masses and cervical motion tenderness. I would like to get her

four milligrams of IV morphine and four milligrams of IV Zofrin for the pain and nausea.

And then I'll check back on her and see if she needs any more.

All right. So we've been going through our critical abdominal pain diagnoses.

And we've been focusing recently on the GU genital urinary causes of abdominal pain.

And so far we've covered ectopic pregnancy.

That was kind of the queen of abdominal pain.

And we also talked about urinary tract infections of very, very common diagnosis,

but also frequently misdiagnosed, but very common. So you obviously have to cover it.

...