Mrs. A, a 32-year-old G2, P2 arrives at the office for a focus visit complaining of right lower quadrant pain for two days that is increasing in intensity. Her height is 5’2”; weight is 110 lbs; BP is 130/80.
The pain began approximately 72 hours ago and has steadily increased. Mrs. A notes no fever, change in bowel habits, or nausea. Her last menstrual period was “normal.” Her menses are “sort of” regular with her last period being “sometime last month.” She and her husband use condoms for contraception.
Mrs. A is well dressed and well groomed. She states that she is in mild to moderate pain and rates the pain as a 4 out of 10. Upon physical examination:
Vagina: Small amount of white discharge; no “heat” appreciated in pelvis
Cervix: Clear, no discharge
Uterus: Anteverted, non-tender
Adnexa: Left ovary palpable. Right ovary not palpated secondary to guarding.
ASSESSMENT AND TREATMENT PLAN
Mrs. A’s pelvic pain may be due to a possible ectopic pregnancy or appendicitis. A transvaginal ultrasound is scheduled to rule out ectopic pregnancy, and a CBC and quantitative BHCG (stat) are ordered.