TEALE FENNING

Nick Raine-Fenning

The following are recognised causes of abdominal pain in pregnancy

Select the single best option from the following list that fits the clinical description.

A Abruption
B Cholecystitis
C Urinary tract infection
D Labour
E Uterine rupture
F Fibroid degeneration
G Ureteric colic
H Adnexal torsion
I Constipation
J Crohns disease
K Pre-eclampsia
L Round ligament pain
M Pyelonephritis
N Pancreatitis
O Gastroenteritis
P HELLP syndrome
Q Symphysial pubis dysfunction
R Mesenteric vein thrombosis
S Hepatitis
T Appendicitis
U Chorioamnionitis
V Uterine contractions
W Domestic violence
X No cause
Y Pyschosomatic
Z Drug related
_________________
"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 921

Scenario 1

29 y old G1 P0 at 35 weeks gestation with fever, diffuse abdominal pain , and nausea of a duration of 2 days. Examination reveals a diffusely tender abdomen.
WBC count-14,000/mm3. Urinalysis shows mild pyuria.

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 921

Scenario 2

31 y old obese female at 9 weeks gestation presents with RUQ pain
radiating to the back, and severe vomiting.

Labs show Leukocytosis(14000/mm3 , raised serum alkaline phosphatase (1.5 times normal) , amylase 580 IU/L

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 921

Scenario 3

26 G3 P2 in 14th week singleton gestation presents with intractable nausea, vomiting, and dehydration. No history of travel in the past year, and does not take any medications. examiantion- dry mucus membranes, and a gravid uterus. Moderate upper abdominal pain.

Labs-reveals elevations in serum aminotransferases ALT (175 IU/L), AST (122 IU/L), serum total bilirubin (2.1 mg/dL). The albumin is slightly decreased from normal values.

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 921

Scenario 4

37 year old 11 weeks pregnant with sudden onset of midepigastric pain, left upper quadrant pain radiating to the left flank, anorexia, nausea, vomiting. She has a history of gall stones.
On examination- Mild jaundice,Rales in lower lung fileds.
Epigastric tenderness, decreased bowel sounds, low-grade fever.

Hb- 14, WBC- 15000, Amylase - 900 IU/L, Lipase- 600

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 921

scenario 4

31 year old with a previous uncomplicated cesarean delivery presents at 36 weeks gestation with abrupt onset of periodic crampy abdominal pain radiating to flank, vomiting, constipation. She gives history of endometriosis. She has been treated for Chlamydial PID.

Examination reveals -Mild dehydration, distended tender abdomen with high-pitched bowel sounds , uterine tenderness. An appendicectomy scar is seen in the right lower quadrant.

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 921

scenario 5

29y multiparous woman in 16th week of pregnancy with severe, unremitting right loin pain. She had intermittent back pain for the previous week. Past 3 days -increasing nausea. Urinary frequency incraesed 10-11 times/day. Previous pregnancies -uncomplicated. Afebrile. Labs-WBC ount of 18×109/l, Urea 8 mmol/l, Creatinine 90 μmol/l. Urinalysis - microscopic haematuria in isolation

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 921

scenario6

33 y old G1 in the 10th week of a twin pregnancy following IVF; with left flank and lower abdominal pain, an episode of nausea and vomiting prior to admission, afebrile (36.4°C) ,urinary frequency with dysuria. No vaginal bleeding nor any bowel symptoms.
On examination-PA- Tenderness on palpation of the left flank. Deep palpation provoked abdominal guarding.

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 921

Scenario 7

39 y old obese multiparous woman in the 32nd week of her 4th pregnancy complains of continuous disabling pelvic pain, especially when turning in bed, walking, climbing stairs. On a visual analogue scale her pain is 7 out of 10 for intensity. She has difficulty walking, ascending or descending stairs, rising from a chair, impaired weight bearing activities, turning in bed. Her 3rd pregnancy was complicated by an instrumental delivery and shoulder dystocia.

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 921

scenario 8

A healthy 28-week pregnant woman presents to emergency department with with an 8-hour complaint of severe generalized abdominal pain. Pian is sharp, constant, and nonradiating severe left lower quadrant abdominal pain (scale 10/10) of sudden onset. The pain is associated with nausea and multiple episodes of nonbloody, nonbilious vomitus.
She denies any change in bowel movements or hematochezia. No history of any recent surgical procedures, or recent trauma or period of immobilization.
Clinical examination reveals a 28-week gravid uterus and a mildly distended and tender abdomen with absent bowel sounds. Left costovertebral angle tenderness present. Pelvic examination is unremarkable, with no cervical changes.
The fetal heart tracing is reactive and no contractions.
Sonographic findings unremarkable.

farha · Century Club Joined: 18 May 2007 Posts: 156

For scenario 1 option is pyelonephritis(M)

Reason is because pyuria urinalysis and and pyelonephritis in pregnency occurs most commonly in second or third trimester with fever , nausea and vomitting.

2)Answer is cholecystitis(B)

Clue hereis obese and raised alkaline phosphatase. Although alkaline phosphatase is raised in pregnency but mostly in third trimester ecause of placental production.Right upper quadrent pain is typical of cholecystitis

farha · Century Club Joined: 18 May 2007 Posts: 156

3) Third option is gastroenterits ? I m not sure

farha · Century Club Joined: 18 May 2007 Posts: 156

4)Answer is pancreatitis

Reason because serum amylase is raised and because she has history of gall stones which is also favouring pancreatitis.

Nick Raine-Fenning · Posted: Tue Jun 26, 2007 8:26 pm Post subject:

Hi guys.

Sorry - never had time to make a post to explain what I wanted you to do. It no longer seems necessary as cspeeed has done exactly what I was going to ask for!

Basically the idea is to generate a series of lists that you can consider and make up various clinical scenarios. Jointly we can come up with some 'gold standard' descriptions for each option and that is the key to EMQs - both in writing and answering them.

I'll make a series of posts with option lists and you guys can look at them and add other options you feel should be included.
_________________
"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997

Shinelkimo · Joined: 25 Apr 2007 Posts: 55

I meet a patient with appendicular mass, is it necessary to do operation urgently?

Nick Raine-Fenning · Posted: Thu Aug 02, 2007 4:09 am Post subject: