102.A 25-year-old G3P1011 presents to the ED with a 6-hour history of
worsening lower abdominal pain, mostly in the RLQ. She also noticed some
vaginal spotting this morning. She is nauseated, but did not vomit. Her last
menstrual period was 2 months ago, but her cycles are irregular. She is sex-
ually active and has a history of pelvic inflammatory disease. Her BP is
120/75 mm Hg, HR is 95 beats per minute, temperature is 99.2°F, and RR
is 16 breaths per minute. Her abdomen is tender in the RLQ. Pelvic exami-
nation reveals right adnexal tenderness. Her WBC count is slightly elevated
and her β-hCG is positive. After establishing IV access, which of the follow-
ing is the most appropriate next step in management?
a. Call the OR to prepare for laparoscopy
b. Order an emergent CT scan of the abdomen
c. Perform a transvaginal ultrasound
d. Order a urinalysis
e. Swab her cervix and treat for gonorrhea and Chlamydia
103.A 59-year-old man presents to the ED complaining of vomiting and
sharp abdominal pain in the epigastric area that began abruptly this after-
noon. He describes feeling nauseated and has no appetite. Laboratory results
reveal WBC 18,000/μL, hematocrit 48%, platelets 110/μL, AST 275 U/L,
ALT 125 U/L, alkaline phosphatase 75 U/L, amylase 1150 U/L, lipase 1450 IU,
LDH 400 U/L, sodium 135 mEq/L, potassium 3.5 mEq/L, chloride 110 mEq/L,
bicarbonate 20 mEq/L, BUN 20 mg/dL, creatinine 1.5 mg/dL, and glucose
250 mg/dL. Which of the following laboratory results correlate with the poor-
est prognosis?
a. Amylase 950, lipase 1250, LDH 400
b. Lipase 1250, LDH 400, bicarbonate 20
c. Lipase 1250, creatinine 1.5, potassium 3.5
d. WBC 18,000, LDH 400, glucose 250
e. WBC 18,000, amylase 950, lipase 1250
94 Emergency Medicine