Examkin

Soru

Zorluk: KolayOrdering Imaging Studies

A 28-year-old woman, G1P0 at 16 weeks gestation, presents to the emergency department with a 12-hour history of progressively worsening right lower quadrant abdominal pain, nausea, and vomiting. Her temperature is 38.0°C (100.4°F), blood pressure is 112/72 mmHg, and heart rate is 105/min. Physical examination reveals focal tenderness in the right lower quadrant with guarding, but no rebound tenderness. Laboratory studies show a leukocyte count of 14,500/mm³. Which of the following is the most appropriate initial imaging study to establish the diagnosis?

  1. Ultrasound of the right lower quadrantCevap
  2. B
    Computed tomography of the abdomen and pelvis with intravenous contrast
  3. C
    Magnetic resonance imaging of the abdomen and pelvis without contrast
  4. D
    Plain radiography of the abdomen
  5. E
    Diagnostic laparoscopy

Cevap

Ultrasound of the right lower quadrant
The correct answer is ultrasound of the right lower quadrant because it avoids ionizing radiation, making it the safest and most appropriate initial diagnostic step for a pregnant patient with suspected appendicitis.

Adım Adım Çözüm

1
Identify the patient's clinical presentation.
The patient is a pregnant woman at 16 weeks gestation presenting with classic signs and symptoms of acute appendicitis (fever, leukocytosis, right lower quadrant pain, nausea).
Recognizing the likely diagnosis directs the choice of diagnostic imaging.
2
Consider imaging contraindications related to the patient's demographics.
The patient is pregnant, which makes modalities utilizing ionizing radiation (like CT scans and X-rays) relatively or absolutely contraindicated for initial workup to protect the fetus.
Minimizing fetal radiation exposure is a primary concern in the diagnostic workup of pregnant patients.
3
Select the most appropriate initial imaging modality.
Graded compression ultrasound is selected as the initial test because it is safe (no ionizing radiation), widely available, and often diagnostic.
Ultrasound is the standard-of-care first step in pregnant women with suspected appendicitis, followed by MRI if the ultrasound is indeterminate.

Anahtar Kavram

In pregnant patients with suspected acute appendicitis, graded compression ultrasound of the right lower quadrant is the most appropriate initial imaging modality due to its safety profile and lack of ionizing radiation.
Tahmini Süre:50s
Bu soruyu puanla

Konular

Ordering Imaging Studies

Bu konudan daha fazla soru