Your patient is an 18-year-old woman who is alert and in moderate distress, complaining of abdominal pain and light-headedness. She describes a four-week history of worsening unilateral lower quadrant abdominal pain with onset of malaise, nausea, and vomiting this week. Today, she is experiencing faintness and near-syncope with exertion. She denies pain or difficulty with urination. Her last menstrual period was two weeks ago. She is sexually active and uses oral contraceptives. Physical examination reveals marked tenderness and guarding with palpation of her abdomen. Her skin is cool and diaphoretic. Her vital signs are: heart rate 121, blood pressure 90/58 mmHg, respirations 18. The patient's presentation is most consistent with:

Question

Quizplus · Accepted Answer

The patient’s symptoms of unilateral lower quadrant abdominal pain, malaise, nausea, and vomiting with faintness and near-syncope suggest an ectopic pregnancy, which is a medical emergency. The use of oral contraceptives can decrease the risk of pregnancy, but is not 100% effective in preventing it. The marked tenderness and guarding with cool, diaphoretic skin and tachycardia are indicative of a serious condition requiring immediate intervention. Pelvic inflammatory disease, spontaneous abortion, and pyelonephritis have different clinical presentations and would not be expected to cause the same symptoms.

Your Patient Is an 18-Year-Old Woman Who Is Alert and in Moderate