Question

A 27 year-old G2P1 at 18 weeks gestation presents to the emergency room complaining of fever, nausea, vomiting, and mid-abdominal pain for the last 24 hours. For the last 12 hours, she has had no appetite. She has been healthy, but reports that her 3 year-old son has had diarrhea for 2 days. Physical examination reveals a blood pressure of 100/60, pulse 88, respiratory rate 18, and temperature 102.0°F (38.9°C). Abdominal examination reveals decreased bowel sounds and tenderness more pronounced on the right than the left. Which of the following is the next best step in the management of this patient?

A. Check a complete blood count
B. Abdominal and pelvic ultrasound
C. Plain abdominal radiograph
D. Helical computed tomography
E. Graded compression ultrasound

Answer 1

The next best step in the management of this patient is Abdominal and pelvic ultrasound. The patient's symptoms, including abdominal pain, tenderness, decreased bowel sounds, and right-sided predominance, suggest the possibility of appendicitis or pelvic inflammatory disease (PID). Ultrasound can be used to evaluate the appendix for signs of inflammation or fluid collection, as well as assess the uterus and adnexa for any abnormalities associated with PID.

Step-by-step explanation:

The next best step in the management of this patient is Abdominal and pelvic ultrasound. The patient's symptoms, including abdominal pain, tenderness, decreased bowel sounds, and right-sided predominance, along with her history of fever and exposure to a child with diarrhea, suggest the possibility of appendicitis or pelvic inflammatory disease (PID). Ultrasound can be used to evaluate the appendix for signs of inflammation or fluid collection, as well as assess the uterus and adnexa for any abnormalities associated with PID.