QUESTION 16

 

A 15-year-old girl is brought to the emergency department due to a severe headache, abdominal pain, nausea, and vomiting. The
patient reports an occipital headache that began 4 days ago and has increased in severity despite treatment with acetaminophen.
The nausea and vomiting began a day ago, and now the patient is unable to tolerate liquids. The abdominal pain is constant but
worsens with vomiting She has no chills, photophobia, changes in vision, or dizziness. The patient is sexually active. Her last
menstrual period was 4 months ago She does not use tobacco, alcohol, or illicit drugs. Temperature is 37.2 C (99 F), blood pressure
is 150/90 mm Hg, and pulse is 90/min. Cardiopulmonary examination is normal. Abdominal examination shows right upper quadrant
tenderness without rebound or rigidity. There is a nontender, palpable mass that extends from the suprapubic bone up to the
umbilicus. Neurologic examination shows intact cranial nerves, no nystagmus, and no pain with neck flexion. Bilateral lower
extremities have 3+ deep tendon reflexes and sustained ankle clonus. Serum 13-hCG is elevated. Which of the following is the most
likely diagnosis in this patient?
QA Acute cholecystitis
0 B. Bacterial meningitis
0 C. Embryonal carcinoma
0 D. Fitz-Hugh Curtis syndrome
0 E. Hydatidiform mole
0 F Viral encephalitis