At consult Doctor: Ms Anderson, Hi nice to meet you. I am Dr.

Smith, I will be the attending doctor taking care of you today. What brought you here? Patient: Abdominal Pain Doctor: Oh sorry to hear that, so we are going to figure out whats going with you today. When did the pain begin? Patient:This morning. Doctor: And how frequently are you having pain? Patient:Is present everytime. Doctor: Is the pain getting worse? Patient:Yes Doctor: How severe is the pain in a scale of 1 to 10? Patient:From seven out of ten. Doctor: Where are you having the pain at? Patient:In the lower right of my belly Doctor: Does the pain radiate anywhere? Patient:No Doctor: Please describe the quality of the pain is it sharp, is it dumb? Patient:Is cramping Doctor: And there is anything that make you feel better? Patient:No Doctor: Is there anything that makes it worse? Patient:Movement Doctor: Ok . Does the pain affects the quality of your daily activities? Patient:Yes Doctor: Did you have pain in the road when you came to the hospital? Patient:Yes Doctor: Do you have any fever or chills? Patient:I felt me too hot this morning but no chills Doctor: Do you have any nassua or vomitting associated? Patient:I felt nassueus so I vomited in the morning Doctor: How was what you vomitted? How did it look like? Patient:A yellowish bright fluid. Doctor: Did you noticed any blood? Patient:No Doctor: Have you evacuated today? Patient: Yes this morning Doctor: Did you notice any blood in there? Patient:No Doctor: Is there any burning during urination? Patient:No Doctor: When was your last period? Patient:Five weeks ago

Doctor: Are you usually so far apart? Patient:Yes usually four to five weeks Doctor: Do you have a common spotting? Patient:Yes Doctor: When did you started to have your periods? Patient:13 years old Doctor: Are you sexually active? Patient:Yes Doctor: Any pregnancies? Patient:Three years ago Doctor: Were there any problems during the pregnancy or the delivery? Patient:No and the baby is healthy Doctor: Have you ever had abortions? Patient:No Doctor: Are you on current medication? Patient:No Doctor: Do you use contraceptives? Patient:I use oral contraceptives Doctor: Do your partners use condoms? Patient:No Doctor: How many sexual partners have you had over the last year? Patient:One that I met in the last two months. And 3 partners in the past. Doctor:Have you had any sexual transmitted infections? Patient:Yes I had one that I do not remember exactly the name, but the doctor send some pills for me. Doctor: And that partner is the same that is with you right now? Patient:Oh No that partner did want to be treated. Doctor: Any surgical history? Patient:No Doctor: What is your occupation? Patient:Waiter Doctor: Do you consume alcohol? Patient:Like to three beers a week Doctor: Do you use drugs? Patient:No Doctor: Do you use tobacco products? Patient:A pack a day for about six years Doctor: Any drug allergies that you know of? Patient:No that I remember Doctor: Ok I am going to examine you. That is ok for you? Patient:Yes no problem Doctor: First let me wash my hands Doctor: You have any further questions for me? Patient: No , only I have a problem with my child that is alone right now

Doctor: Ok first we are going to make sure that you are going to be ok, but here we have a social worker and we can talk to him in order to be sure that your child is going to be save. Patient:Ok but I cannot afford a lot in that Doctor: Ok no problem fisr he is going to be sure about your finnacial situation in order for you to get the chance of affording the cost. Patient:Ok Doctor: But first we have to make sure you are going to be ok. Doctor:Ok first I am going to put this on your leg ok? Doctor: And does it fine that I hear your lungs? Patient:Yes no problem Doctor: Please take some deep breath now Doctor: Good, one more time please Doctor:Ok let me check your tenderness in the back Doctor:Does it hurt you? Patient:No Doctor:How about that? Patient:No Doctor:Ok let me hear you heart Dr: Alright miss Anderson, I want you to lay back, good, it might just hurt a Little bit. Im just gonna examine your bally and push on you bally. I will push down and you will tell me if it hurts Patient: Yes it hurts Dr: Sorry but this way we will know wahts wrong. Ok, another thing i want to check is your legs. Im gonna raise your leg.Does it hurt when I lift it? Patient: yes Dr: where does it hurt? Patient: in the stomach on the right side Dr: ok, I will pull your knee to the other side. How about that? Does it hurt? Patient: Yes Dr: Ok, let me help you sit up, sorry if it hurts you. Mrs Anderson, this may be a problema in your reproductive organs, maybe you ovaries, falopian tubes, it may also be a complication from pncreas, or you may be pregnant as well but we will check does results or you may have apendicitis and that may include a surgery. In order to ensure the diagnosis we need to practice some tests. I need to perform a rectal exam. You need as well to stop smoking and we have several ways to help you do that if you are interested. I will also recomend to use a condom

everytime you have a sexual relations in order to prevent several infections Do you have any other questions? Patient: No Dr: Alright, thank you, will see you later after I get your results.

____________is a 28-year-old woman college student who complained of pain, nausea with vomiting, and tenderness in the right lower quadrant. The pain was first vague and diffuse, then became more severe in the midepigastric region before localizing in the right lower quadrant. The pain was accentuated by movement, deep respiration, coughing, or sneezing. A mild fever of 102.2 F and a moderate leucocytosis (11,500/cu mm) were present. A marked tenderness was noted over the right lower quadrant at McBurney's point (one-third the distance between the anterior superior iliac spine and the umbilicus). The psoas sign (pain on passive hyperxtension of the thigh) was also present. His vitals were: Temperature 102.2 F Pulse BP Respiration 96 140/90 18 b/min and shallow

His abdomen was protuberant with decreased bowel sounds. The abdominal x-ray indicated distended bowel loops. After checking the tests. General practioner Oh! I found you, I am looking for some advice because in the morning while I was in consult A 21 old year old woman came with a terrible pain in the right lower quadrant. I think he may present apendicitis but there are other symptoms that confuse me. Could you please tell me what were his vital signs? Did he told you how the pain was? His vital signs according to the respiration were 18 b/min and shallow. The temperature was around 102.2 F, his pulse was 96 and he had a BP of 140/90. The pain was first vague and diffuse, then became more severe in the midepigastric region before I realized it was localized in the right lower quadrant. A marked tenderness was noted over the right lower quadrant at McBurney's point and the psoas sign was positive. Did you send him to the lab?

Specialist general practitioner

Specialist

general practitioner Specialist

Yes, It was realized and hematocrit and hematic biometry. The results were (11,500/cu mm) of leucocytes and a high level of basophils that make me hesitate about appendictis. Well, Appendicitis can be confound with Crohn disease also when the basophils are high. Crohn disease presents air contrast barium enema in the base of the cecum and nodular, irregular contours of the appendix. So the pain is there but the problem is not the appendix. In order to determine a certain diagnose we have to make a radiography in order to prove appendicitis. Please let me check the radiography in order to make a decision. I have the radiography I took a moment ago and I think it looks completely normal. Ok as you see there is no air contrast in the base of the cecum. And here you can see how the appendix is inflamed, so you must send this patient to surgery as fast as you can. Thank you for your advice.

general practitioner specialist

General practitioner

Doctor: Good afternoon Ms Anderson right now I have the results of your test and I have diagnosed appendicitis, so it is important to take you to the operating room. The surgeon is going to come in a few minutes in order to prepare everything. Do not be afraid about your son is going to be right and the social worker is in charge of him now. Do you have any questions? Patient: No questions, thank you for everything.