Approach to acute abdominal pain (pediatrics) Quiz: Ace Your Exams
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A 17-year-old girl presents to the emergency department for evaluation of right sided lower abdominal pain. The patient reports that she has felt pressure in her right lower abdomen over the last month but that the pain became intermittent and severe pain over the last 24 hours. The patient reports nausea and two episodes of emesis. The patient reports urinary frequency but denies dysuria or hematuria. The patient is not sexually active. Menses began at age 13 yo and her Periods are regular. She has no history of dysmenorrhea or menorrhagia. Last menstrual period was two weeks ago. The patient has no new vaginal discharge or dysuria or frequency. Temperature is 37.2°C (99°F), pulse is 108/min, blood pressure is 111/66 mm Hg, respirations are 14/min, and oxygen saturation is 100% on room air. On physical examination, the patient is alert and appears uncomfortable. Cardiopulmonary examinations are within normal limits. The abdomen is soft with tenderness to palpation in the right pelvic area. Adnexal tenderness on the right. No rebound or guarding are present. Psoas and obturator signs are negative. Which of the following is the best next step in management?
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