90.A 78-year-old woman is brought to the ED by EMS complaining of
vomiting and abdominal pain that began during the night. EMS reports
that her BP is 90/50 mm Hg, HR is 110 beats per minute, temperature is
101.2°F, and RR is 18 breaths per minute. After giving her a 500-mL bolus
of NS, her BP is 115/70 mm Hg. During the examination, you notice that
her face and chest appear jaundiced. Her lungs are clear to auscultation
and you do not appreciate a murmur on cardiac examination. She winces
when you palpate her RUQ. An ultrasound reveals dilation of the common
bile duct and stones in the gallbladder. What is the most likely diagnosis?
a. Cholecystitis
b. Acute hepatitis
c. Cholangitis
d. Pancreatic cancer
e. Bowel obstruction
91.A 23-year-old woman presents to the ED complaining of lower abdom-
inal pain and vaginal spotting for 2 days. Her menstrual cycle is irregular. She
has a history of ovarian cysts and is sexually active but always uses condoms.
Her BP is 115/75 mm Hg, HR is 75 beats per minute, temperature is 98.9°F,
and RR is 16 breaths per minute. Which of the following tests should be
obtained next?
a. Chlamydiaantigen test
b. β-Human chorionic gonadotropin (β-hCG)
c. Transvaginal ultrasound
d. Abdominal radiograph
e. Observe her abdominal pain, if it resolves discharge her with a diagnosis of
menstruation
Abdominal and Pelvic Pain 87