06-17-2010, 11:40 AM
19. A 27-year-old primigravid woman at 29 weeks' gestation comes to the emergency department because of a 24-hour history of increasingly severe right-sided abdominal pain and no appetite. She has vomited twice over the past 4 hours. She has not had vaginal bleeding. Her temperature is 38.2 C (100.8 F). Examination shows exquisite
tenderness of the right lateral flank and the fundus. There are no peritoneal signs. Bowel
sounds are absent. The fetal heart rate is 144/min.
Laboratory studies show:
Hematocrit 37%
Leukocyte count 16,000/mm3
Serum
Total bilirubin 1.1 mg/dL
Amylase 32 U/L
Lactate dehydrogenase 110 U/L
Urine WBC 3“5/hpf
Which of the following is the most likely diagnosis?
A) Abruptio placentae
B) Appendicitis
C) Cholelithiasis
D) Colitis
E) Pyelonephritis
tenderness of the right lateral flank and the fundus. There are no peritoneal signs. Bowel
sounds are absent. The fetal heart rate is 144/min.
Laboratory studies show:
Hematocrit 37%
Leukocyte count 16,000/mm3
Serum
Total bilirubin 1.1 mg/dL
Amylase 32 U/L
Lactate dehydrogenase 110 U/L
Urine WBC 3“5/hpf
Which of the following is the most likely diagnosis?
A) Abruptio placentae
B) Appendicitis
C) Cholelithiasis
D) Colitis
E) Pyelonephritis