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| A 24-year old male complains of severe epigastric pain following an alcoholic binge. There is a bluish discoloration in the flanks and marked tenderness in the epigastric region. CBC shows a leukocytosis with raised neutrophils. His serum amylase is elevated. |
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| A 10-year old child develops periumbilical pain. Fever and vomiting followed the abdominal pain. The periumbilical pain shifts to the right iliac fossa. On examination, there is marked tenderness over McBurney’s point. Rovsing test is positive. However both the Psoas and Obturator internus tests are negative. CBC shows an elevation in the white blood cell count with a neutrophilia |
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| A 61-year old female presents with recurrent epigastric pain. She has been taking NSAIDs for chronic knee pain. She also complains that in the last two days her stool has been very black and she is feeling a little lightheaded. On examination, there is pallor and tenderness in the epigastric tenderness. A rectal examination confirms the melena. CBC shows a microcytic hypochromic anemia. |
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| A 30-year old female presents with a 9-month history of bloating, vomiting and the passage of foul-smelling greasy stools that float. The condition fluctuates and seems to be worse when she eats certain foods. On examination, there is abdominal distension and pale mucous membranes. CBC shows an anemia and she has a positive d-xylose test. |
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| A 43-year old overweight mother of three complains of constant right upper quadrant pain which radiates to the right infrascapular region. There is also nausea and vomiting. On examination, there is fever and marked tenderness in the right upper quadrant. Murphy’s sign is positive. CBC shows elevated WBCs and ultrasound of the abdomen shows numerous gallstones. |
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| A 23-year old white female presents with recurrent abdominal pain in the right iliac fossa and diarrhea. There is mild tenderness in the right iliac fossa. Rovsing, psoas and the obturator internus tests are negative. CBC shows an anemia with an increase in the Mean Corpuscular Volume of the red blood cells. Colonoscopy reveals skip lesions and a cobblestone appearance of the mucosa. |
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| A 65-year old male presents with severe left lower abdominal pain, nausea, vomiting and diarrhea with flecks of red blood in the stool. On examination, there is marked tenderness in the left iliac fossa, with local guarding and rebound tenderness present. CBC shows an marked elevation in the WBCs and raised neutrophils. |
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| A 19-year old sexually active female presents with cramping lower abdominal pain. Her LMP was 6 weeks ago and she is starting to feel faint. On examination, there is tenderness in the right iliac fossa. Her blood pressure is 110/70 and her pulse is 98/minute. HCG is positive and the ultrasound shows a gestational sac outside of the uterine cavity. |
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| A 28-year old sexually active female presents with severe dysmenorrhea, dyspareunia and menorrhagia. She and her husband having been trying to conceive for the past three years without any success. On examination, there are painful nodules in the lateral fornices in the pelvic examination. |
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| A 45-year old male presents with recurrent epigastric pain which is worse when he eats foods and when he is under stress. On examination, there is moderate tenderness in the epigastric region. The urease breath test is positive. |
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| A 23-year old male presents with anorexia, nausea, vomiting and mild discomfort in the right upper quadrant two weeks after a vacation in Costa Rica. On examination, there is jaundice and tender hepatomegaly. CBC shows a mild leukocytosis with raised lymphocytes. CMP reveals raised AST, ALT and Alkaline Phosphatase. |
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| A 21-year old sexually active female presents with lower abdominal pain, fever and a vaginal discharge. On examination, she is febrile and there is tenderness on moving her cervix from side to side in the pelvic examination along with a purulent discharge issuing from the cervical os. CBC shows a marked elevation of her white blood cells and neutrophils. Gram stain of the vaginal discharge reveals numerous Gram negative intracellular diplococci. |
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Definition
| Pelvic Inflammatory Disease |
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| A 65-year old overweight male smoker presents with sudden onset of abdominal pain that has become progressively worse over the past three hours and has had one bout of bloody diarrhea. On examination, there is mild abdominal tenderness in the umbilical region. CBC shows a mild leukocytosis. Selective angiography shows lack of visualization of the superior mesenteric artery and its branches. |
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Definition
| Mesenteric Vascular Occlusion |
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| A 35-year old male presents with sudden onset of severe colicky pain in his left flank. The pain has radiated downwards towards his groin and his urine is red. On examination, there is tenderness over the left costovertebral angle. Urinalysis shows lots of red blood cells. |
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| A 25-year old female presents with recurrent abdominal pains that are relieved by defecation. There is no weight loss, blood in the stool or fever. There are no abnormalities on physical examination. CBC, ESR and CMP are normal. Her FOB is negative. |
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| A 56-year old female complains of colicky abdominal pain and vomiting. She is constipated and has not passed any flatus since yesterday. She had her appendix removed as a teenager. On examination, there is abdominal distention and her bowel sounds are high-pitched and frequent. An erect abdominal x-ray shows multiple air-fluid levels. |
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| A 56-year old male alcoholic presents with chills, fever, pleuritic chest pain and a productive cough for the past 3 days. The sputum looks like red-currant jelly. On examination, there is an elevated temperature. The percussion note is decreased over the right lower chest. Tactile fremitus is increased over the same area and there are crackles and bronchial breathing heard over the same region. CBC shows leukocytosis with raised neutrophils. PA and lateral chest x-rays shows a wedge-shaped area of consolidation in the right middle lobe. |
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Definition
| Pneumonia [most likely Klebsiella] |
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| A 9-year old male presents with recurrent periumbilical pain unrelated to diet or bowel movement. On examination, there is a positive closed eyes sign. CBC, CMP, urinalysis and stool examination are normal. |
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Definition
| Psychogenic Abdominal Pain |
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| A 21-year-old sexually active female complains of lower abdominal pains and vaginal spotting following 8 weeks of amenorrhea. Her cervical os is closed. |
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Definition
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| A 24-year old female presents with recurrent left lower quadrant abdominal pain and bouts of bloody diarrhea. The symptoms seem to be worse whenever she eats spicy foods. On examination, there is mild tenderness in her left iliac fossa. CBC shows a mild microcytic hypochromic anemia. Colonoscopy reveals multiple shallow ulcers in her rectum and sigmoid colon. |
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