119.A 22-year-old woman is brought to the ED by ambulance complaining
of sudden onset of severe abdominal pain for 1 hour. The pain is in the RLQ
and is not associated with nausea, vomiting, fever, or diarrhea. On the pelvic
examination you palpate a tender right adnexal mass. The patient’s last men-
strual period was 6 weeks ago. Her BP is 95/65 mm Hg, HR is 124 beats per
minute, temperature is 99.8°F, and RR is 20 breaths per minute. Which of
the following are the most appropriate next steps in management?
a. Provide her oxygen via face mask and administer morphine sulfate.
b. Administer morphine sulfate, order an abdominal CT with contrast, and call an
emergent surgery consult.
c. Send the patient’s urine for analysis and order an abdominal CT.
d. Bolus 2-L NS, order a type and crossmatch and β-hCG, and call gynecology for
possible surgery.
e. Provide oxygen via face mask, give morphine sulfate, and order a transvaginal
ultrasound.
120.A 33-year-old woman presents to the ED complaining of fever, vom-
iting, and gradually worsening RUQ pain. She states that her pain radiates
to her back. Her BP is 130/75 mm Hg, HR is 90 beats per minute, temper-
ature is 100.9°F, and RR is 17 breaths per minute. While examining her
abdomen you palpate her RUQ and notice that she momentarily stops her
inspiration. What is the name of this classic sign?
a. Grey-Turner sign
b. Kernig sign
c. McMurray sign
d. Murphy sign
e. McBurney sign
121.A 21-year-old girl presents to the ED complaining of diarrhea, abdominal
cramps, fever, anorexia, and weight loss for 3 days. Her BP is 127/75 mm Hg,
HR is 91 beats per minute, and temperature is 100.8°F. Her abdomen is soft
and nontender without rebound or guarding. WBC is 9200/μL,β-hCG is
negative, urinalysis is unremarkable, and stool is guaiac positive. She tells you
that she has had this similar presentation four times over the past 2 months.
Which of the following extraintestinal manifestations is associated with Crohn
disease but not ulcerative colitis?
a. Ankylosing spondylitis
b. Erythema nodosum
c. Nephrolithiasis
d. Thromboembolic disease
e. Uveitis
Abdominal and Pelvic Pain 103