QUESTION 35

 

A 29-year-old woman with ulcerative colitis is brought to the emergency department after a syncopal episode while getting out of bed.
Yesterday she developed right-sided abdominal pain which has spread across the lower abdomen over the past few hours. She also
noticed a blood stain on her underwear after the syncopal episode. The patient was diagnosed with ulcerative colitis 3 years ago and
is in remission with oral mesalamine therapy. She takes no other medications and has no allergies. Her last menstrual period was 8
weeks ago The patient uses condoms intermittently for contraception Her temperature is 37 C (98 F), blood pressure is 90/60 mm
Hg, and pulse is 125/min. She has diffuse lower abdominal pain with rebound tenderness and voluntary guarding. Pelvic examination
shows cervical motion tenderness and right-sided adnexal tenderness; no masses are palpated Which of the following is the most
likely diagnosis for this patient?
QA Appendicitis
0 B. Colonic perforation
0 C. Ovarian torsion
0 D. Pelvic inflammatory disease
0 E. Ruptured ectopic pregnancy
0 F. Ruptured ovarian cyst
0 G. Tuba-ovarian abscess