The Rational Clinical Examination
David L. Simel, Drummond Rennie
Jim Wagner, Kaveh Shojania
"A 24-year-old woman presents with abdominal pain, nausea, and
vomiting. She describes the pain as beginning in her midabdomen
3 days ago, and it has gotten progressively worse. Her last menstrual
period was 3 weeks ago and was normal; she is not sexually active.
The pain has stayed in the midabdomen and not moved to other locations.
On examination, she has a fever and right lower quadrant (RLQ) and
rebound tenderness; her pelvic and rectal examination results are
unremarkable. Laboratory evaluation reveals a left shift without
leukocytosis and ketonuria...."
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