Ascending

Female Reproductive System & Breast


{"ops":[{"insert":"Diagnosis and reasoning"},{"insert":"\n","attributes":{"header":1}},{"insert":"This patient has presented with a perplexing combination of symptoms : pain in the right upper quadrant AND the pelvis.\n\nExamination shows her to be markedly febrile, with right hypochondriac (RHC) tenderness but no hepatomegaly.\n\nMore importantly though, it also reveals cervical motion tenderness and bilateral adnexal tenderness - a pair of signs found in only a few conditions : pelvic inflammatory disease (PID), endometriosis and very rarely, ectopic pregnancy (in which unilateral adnexal tenderness is more usual).\n\nEctopic pregnancy can be excluded by virtue of her history. While endometriosis can cause right upper quadrant pain (due to diaphragmatic endometriosis), this is rare - and does not explain her fever. Note also that the pain "}]}

Want to continue playing?

Open your Clinical Odyssey account today.


Enjoy unlimited access to 600+ simulations.
Safely improve your skills, anytime and anywhere.
Get answers to your follow-up questions from practicing physicians.