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 Female Patients 5-14 years old with RLQ  Pain and Tenderness with Various Associated Symptoms and Signs

Patient 1A: Sex: Female    Age: 5-14 years old

 

Clinical Findings and Data

(With 2 physical exams within 30 min)

Primary Clinical Diagnosis

        (Tick one only)

Secondary Clinical Diagnosis

          (Tick one only)

Degree of Certainty of Clin. Diagnosis

                 (Tick one only)

Ancillary Diagnostic Procedure

              (Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

Started in and confined to RLQ

Direct RLQ tenderness,

     NO rebound, NO guarding

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  ) Others:

_____________________________

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  )  Others: 

_____________________________

(   ) Certain that I will proceed to

          treatment without requesting

          for  any ancillary diagnostic

          procedure.

 (   ) Uncertain that I will request 

        for an ancillary diagnostic

        procedure (observation

        included)

(  ) Observation without lab initially

(  ) CBC

(  ) Urinalysis

(  ) CBC and urinalysis

(  ) Ultrasound of lower abdomen

         and pelvis

(  ) CBC and urinalysis and

       ultrasound, pelvis & lower abd

(  ) CT scan

(  ) Pregnancy test (urine)

Others:_________________

 

Patient 1B: Sex: Female    Age: 5-14 years old

 

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

        (Tick one only)

Secondary Clinical Diagnosis

          (Tick one only)

Degree of Certainty of Clin. Diagnosis

                  (Tick one only)

Ancillary Diagnostic Procedure

              (Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

With shifting pain -  epigastric or  periumbilical to  RLQ

Direct RLQ tenderness,

     NO rebound, NO guarding

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  ) Others:

_____________________________

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  )  Others: 

_____________________________

(   ) Certain that I will proceed to

          treatment without requesting

          for  any ancillary diagnostic

          procedure.

 (   ) Uncertain that I will request 

        for an ancillary diagnostic

        procedure (observation

        included)

(  ) Observation without lab initially

(  ) CBC

(  ) Urinalysis

(  ) CBC and urinalysis

(  ) Ultrasound of lower abdomen

         and pelvis

(  ) CBC and urinalysis and

       ultrasound, pelvis & lower abd

(  ) CT scan

(  ) Pregnancy test (urine)

Others:_______________________

 

Patient 1C: Sex: Female    Age: 5-14 years old

 

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

        (Tick one only)

Secondary Clinical Diagnosis

          (Tick one only)

Degree of Certainty of Clin. Diagnosis

                  (Tick one only)

Ancillary Diagnostic Procedure

              (Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

With shifting pain -  LLQ  to  RLQ

Direct RLQ tenderness,

    NO rebound, NO guarding

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  ) Others:

_____________________________

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  )  Others: 

_____________________________

(   ) Certain that I will proceed to

          treatment without requesting

          for  any ancillary diagnostic

          procedure.

 (   ) Uncertain that I will request 

        for an ancillary diagnostic

        procedure (observation

        included)

(  ) Observation without lab initially

(  ) CBC

(  ) Urinalysis

(  ) CBC and urinalysis

(  ) Ultrasound of lower abdomen

         and pelvis

(  ) CBC and urinalysis and

       ultrasound, pelvis & lower abd

(  ) CT scan

(  ) Pregnancy test (urine)

Others:______________________

 

Female Patients 5-14 years old with RLQ  Pain and Tenderness with Various Associated Symptoms and Signs

Patient 2A:  Sex: Female    Age: 5-14 years old

 

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

        (Tick one only)

Secondary Clinical Diagnosis

          (Tick one only)

Degree of Certainty of Clin. Diagnosis

                  (Tick one only)

Ancillary Diagnostic Procedure

              (Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

Started in and confined to RLQ

Direct and REBOUND RLQ

      tenderness, NO guarding

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  ) Others:

_____________________________

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  )  Others: 

_____________________________

(   ) Certain that I will proceed to

          treatment without requesting

          for  any ancillary diagnostic

          procedure.

 (   ) Uncertain that I will request 

        for an ancillary diagnostic

        procedure (observation

        included)

(  ) Observation without lab initially

(  ) CBC

(  ) Urinalysis

(  ) CBC and urinalysis

 (  ) Ultrasound of lower abdomen

         and pelvis

(  ) CBC and urinalysis and

       ultrasound, pelvis & lower abd

(  ) CT scan

(  ) Pregnancy test (urine)

Others:_______________________

 

Patient 2B:  Sex: Female    Age: 5-14 years old

 

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

        (Tick one only)

Secondary Clinical Diagnosis

          (Tick one only)

Degree of Certainty of Clin. Diagnosis

                  (Tick one only)

Ancillary Diagnostic Procedure

              (Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

With shifting pain -  epigastric or periumbilical to  RLQ

Direct and REBOUND RLQ

      tenderness, NO guarding

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  ) Others:

_____________________________

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  )  Others: 

_____________________________

(   ) Certain that I will proceed to

          treatment without requesting

          for  any ancillary diagnostic

          procedure.

 (   ) Uncertain that I will request 

        for an ancillary diagnostic

        procedure (observation

        included)

(  ) Observation without lab initially

(  ) CBC

(  ) Urinalysis

(  ) CBC and urinalysis

 (  ) Ultrasound of lower abdomen

         and pelvis

(  ) CBC and urinalysis and

       ultrasound, pelvis & lower abd

(  ) CT scan

(  ) Pregnancy test (urine)

Others:_______________________

 

Patient 2C:  Sex: Female    Age: 5-14 years old

 

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

        (Tick one only)

Secondary Clinical Diagnosis

          (Tick one only)

Degree of Certainty of Clin. Diagnosis

                  (Tick one only)

Ancillary Diagnostic Procedure

              (Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

With shifting pain - LLQ  to  RLQ

Direct and REBOUND RLQ

      tenderness, NO guarding

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  ) Others:

_____________________________

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  )  Others: 

_____________________________

(   ) Certain that I will proceed to

          treatment without requesting

          for  any ancillary diagnostic

          procedure.

 (   ) Uncertain that I will request 

        for an ancillary diagnostic

        procedure (observation

        included)

(  ) Observation without lab initially

(  ) CBC

(  ) Urinalysis

(  ) CBC and urinalysis

 (  ) Ultrasound of lower abdomen

         and pelvis

(  ) CBC and urinalysis and

       ultrasound, pelvis & lower abd

(  ) CT scan

(  ) Pregnancy test (urine)

Others:_______________________

 

Female Patients 5-14 years old with RLQ  Pain and Tenderness with Various Associated Symptoms and Signs

Patient 3A:  Sex: Female    Age: 5-14 years old

 

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

        (Tick one only)

Secondary Clinical Diagnosis

          (Tick one only)

Degree of Certainty of Clin. Diagnosis

                  (Tick one only)

Ancillary Diagnostic Procedure

              (Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

Started in and confined to RLQ

Direct and rebound RLQ

      tenderness, WITH guarding

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  ) Others:

_____________________________

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  )  Others: 

_____________________________

(   ) Certain that I will proceed to

          treatment without requesting

          for  any ancillary diagnostic

          procedure.

 (   ) Uncertain that I will request 

        for an ancillary diagnostic

        procedure (observation

        included)

(  ) Observation without lab initially

(  ) CBC

(  ) Urinalysis

(  ) CBC and urinalysis

 (  ) Ultrasound of lower abdomen

         and pelvis

(  ) CBC and urinalysis and

       ultrasound, pelvis & lower abd

(  ) CT scan

(  ) Pregnancy test (urine)

Others:_______________________

 

Patient 3B:  Sex: Female    Age: 5-14 years old

 

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

        (Tick one only)

Secondary Clinical Diagnosis

          (Tick one only)

Degree of Certainty of Clin. Diagnosis

                  (Tick one only)

Ancillary Diagnostic Procedure

              (Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

With shifting pain -  epigastric or periumbilical to  RLQ

Direct and rebound RLQ

      tenderness, WITH guarding

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  ) Others:

_____________________________

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  )  Others: 

_____________________________

(   ) Certain that I will proceed to

          treatment without requesting

          for  any ancillary diagnostic

          procedure.

 (   ) Uncertain that I will request 

        for an ancillary diagnostic

        procedure (observation

        included))

(  ) Observation without lab initially

(  ) CBC

(  ) Urinalysis

(  ) CBC and urinalysis

 (  ) Ultrasound of lower abdomen

         and pelvis

(  ) CBC and urinalysis and

       ultrasound, pelvis & lower abd

(  ) CT scan

(  ) Pregnancy test (urine)

Others:_______________________

 

Patient 3C:  Sex: Female    Age: 5-14 years old

 

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

        (Tick one only)

Secondary Clinical Diagnosis

          (Tick one only)

Degree of Certainty of Clin. Diagnosis

                  (Tick one only)

Ancillary Diagnostic Procedure

              (Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

With shifting pain - LLQ  to  RLQ

Direct and rebound RLQ

      tenderness, WITH guarding

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  ) Others:

_____________________________

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  )  Others: 

_____________________________

(   ) Certain that I will proceed to

          treatment without requesting

          for  any ancillary diagnostic

          procedure.

 (   ) Uncertain that I will request 

        for an ancillary diagnostic

        procedure (observation

        included)

(  ) Observation without lab initially

(  ) CBC

(  ) Urinalysis

(  ) CBC and urinalysis

 (  ) Ultrasound of lower abdomen

         and pelvis

(  ) CBC and urinalysis and

       ultrasound, pelvis & lower abd

(  ) CT scan

(  ) Pregnancy test (urine)

Others:_______________________

 

Female Patients 5-14 years old with RLQ  Pain and Tenderness with Various Associated Symptoms and Signs

Patient 4A:  Sex: Female    Age: 5-14 years old

 

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

        (Tick one only)

Secondary Clinical Diagnosis

          (Tick one only)

Degree of Certainty of Clin. Diagnosis

                  (Tick one only)

Ancillary Diagnostic Procedure

              (Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

Started in and confined to RLQ

Direct RLQ tenderness, WITH

    guarding, NO rebound

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  ) Others:

_____________________________

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  )  Others: 

_____________________________

(   ) Certain that I will proceed to

          treatment without requesting

          for  any ancillary diagnostic

          procedure.

 (   ) Uncertain that I will request 

        for an ancillary diagnostic

        procedure (observation

        included)

(  ) Observation without lab initially

(  ) CBC

(  ) Urinalysis

(  ) CBC and urinalysis

 (  ) Ultrasound of lower abdomen

         and pelvis

(  ) CBC and urinalysis and

       ultrasound, pelvis & lower abd

(  ) CT scan

(  ) Pregnancy test (urine)

Others:_______________________

 

Patient 4B:  Sex: Female    Age: 5-14 years old

 

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

        (Tick one only)

Secondary Clinical Diagnosis

          (Tick one only)

Degree of Certainty of Clin. Diagnosis

                  (Tick one only)

Ancillary Diagnostic Procedure

              (Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

With shifting pain -  epigastric or periumbilical to  RLQ

Direct RLQ tenderness, WITH

 guarding, NO rebound

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  ) Others:

_____________________________

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  )  Others: 

_____________________________

(   ) Certain that I will proceed to

          treatment without requesting

          for  any ancillary diagnostic

          procedure.

 (   ) Uncertain that I will request 

        for an ancillary diagnostic

        procedure (observation

        included)

(  ) Observation without lab initially

(  ) CBC

(  ) Urinalysis

(  ) CBC and urinalysis

 (  ) Ultrasound of lower abdomen

         and pelvis

(  ) CBC and urinalysis and

       ultrasound, pelvis & lower abd

(  ) CT scan

(  ) Pregnancy test (urine)

Others:_______________________

 

Patient 4C:  Sex: Female    Age: 5-14 years old

 

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

        (Tick one only)

Secondary Clinical Diagnosis

          (Tick one only)

Degree of Certainty of Clin. Diagnosis

                  (Tick one only)

Ancillary Diagnostic Procedure

              (Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

With shifting pain - LLQ  to  RLQ

Direct RLQ tenderness, WITH  

  guarding, NO rebound

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  ) Others:

_____________________________

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  )  Others: 

_____________________________

(   ) Certain that I will proceed to

          treatment without requesting

          for  any ancillary diagnostic

          procedure.

 (   ) Uncertain that I will request 

        for an ancillary diagnostic

        procedure (observation

        included)

(  ) Observation without lab initially

(  ) CBC

(  ) Urinalysis

(  ) CBC and urinalysis

 (  ) Ultrasound of lower abdomen

         and pelvis

(  ) CBC and urinalysis and

       ultrasound, pelvis & lower abd

(  ) CT scan

(  ) Pregnancy test (urine)

Others:_______________________

 

Female Patients 5-14 years old with RLQ  Pain and Tenderness with Various Associated Symptoms and Signs

Patient 5A:  Sex: Female    Age: 5-14 years old

 

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

        (Tick one only)

Secondary Clinical Diagnosis

          (Tick one only)

Degree of Certainty of Clin. Diagnosis

                  (Tick one only)

Ancillary Diagnostic Procedure

              (Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

Started in and confined to RLQ

Rebound RLQ tenderness, NO 

  direct tenderness, NO  guarding

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  ) Others:

_____________________________

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  )  Others: 

_____________________________

(   ) Certain that I will proceed to

          treatment without requesting

          for  any ancillary diagnostic

          procedure.

 (   ) Uncertain that I will request 

        for an ancillary diagnostic

        procedure (observation

        included)

(  ) Observation without lab initially

(  ) CBC

(  ) Urinalysis

(  ) CBC and urinalysis

 (  ) Ultrasound of lower abdomen

         and pelvis

(  ) CBC and urinalysis and

       ultrasound, pelvis & lower abd

(  ) CT scan

(  ) Pregnancy test (urine)

Others:_______________________

 

Patient 5B:  Sex: Female    Age: 5-14 years old

 

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

        (Tick one only)

Secondary Clinical Diagnosis

          (Tick one only)

Degree of Certainty of Clin. Diagnosis

                  (Tick one only)

Ancillary Diagnostic Procedure

              (Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

With shifting pain -  epigastric or  periumbilical to  RLQ

 Rebound RLQ tenderness, NO 

  direct tenderness, NO  guarding

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  ) Others:

_____________________________

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  )  Others: 

_____________________________

(   ) Certain that I will proceed to

          treatment without requesting

          for  any ancillary diagnostic

          procedure.

 (   ) Uncertain that I will request 

        for an ancillary diagnostic

        procedure (observation

        included)

(  ) Observation without lab initially

(  ) CBC

(  ) Urinalysis

(  ) CBC and urinalysis

 (  ) Ultrasound of lower abdomen

         and pelvis

(  ) CBC and urinalysis and

       ultrasound, pelvis & lower abd

(  ) CT scan

(  ) Pregnancy test (urine)

Others:_______________________

 

Patient 5C:  Sex: Female    Age: 5-14 years old

 

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

        (Tick one only)

Secondary Clinical Diagnosis

          (Tick one only)

Degree of Certainty of Clin. Diagnosis

                  (Tick one only)

Ancillary Diagnostic Procedure

              (Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

With shifting pain - LLQ  to  RLQ

Rebound RLQ tenderness, NO 

  direct tenderness, NO  guarding

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  ) Others:

_____________________________

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  )  Others: 

_____________________________

(   ) Certain that I will proceed to

          treatment without requesting

          for  any ancillary diagnostic

          procedure.

 (   ) Uncertain that I will request 

        for an ancillary diagnostic

        procedure (observation

        included)

(  ) Observation without lab initially

(  ) CBC

(  ) Urinalysis

(  ) CBC and urinalysis

 (  ) Ultrasound of lower abdomen

         and pelvis

(  ) CBC and urinalysis and

       ultrasound, pelvis & lower abd

(  ) CT scan

(  ) Pregnancy test (urine)

Others:_______________________

 

Female Patients 5-14 years old with RLQ  Pain and Tenderness with Various Associated Symptoms and Signs

 

Patient 6A:  Sex: Female    Age: 5-14 years old

 

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

        (Tick one only)

Secondary Clinical Diagnosis

          (Tick one only)

Degree of Certainty of Clin. Diagnosis

                  (Tick one only)

Ancillary Diagnostic Procedure

              (Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

Started in and confined to RLQ

Direct RLQ tenderness, NO 

  rebound, NO  guarding

No bowel movement disturbance

No urinary disturbance

Yellowish vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  ) Others:

_____________________________

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  )  Others: 

_____________________________

(   ) Certain that I will proceed to

          treatment without requesting

          for  any ancillary diagnostic

          procedure.

 (   ) Uncertain that I will request 

        for an ancillary diagnostic

        procedure (observation

        included)

(  ) Observation without lab initially

(  ) CBC

(  ) Urinalysis

(  ) CBC and urinalysis

 (  ) Ultrasound of lower abdomen

         and pelvis

(  ) CBC and urinalysis and

       ultrasound, pelvis & lower abd

(  ) CT scan

(  ) Pregnancy test (urine)

Others:_______________________

 

Patient 6B:  Sex: Female    Age: 5-14 years old

 

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

        (Tick one only)

Secondary Clinical Diagnosis

          (Tick one only)

Degree of Certainty of Clin. Diagnosis

                  (Tick one only)

Ancillary Diagnostic Procedure

              (Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

Started in and confined to RLQ

Direct and Rebound  RLQ

  tenderness, NO  guarding

No bowel movement disturbance

No urinary disturbance

Yellowish  vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  ) Others:

_____________________________

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  )  Others: 

_____________________________

(   ) Certain that I will proceed to

          treatment without requesting

          for  any ancillary diagnostic

          procedure.

 (   ) Uncertain that I will request 

        for an ancillary diagnostic

        procedure (observation

        included)

(  ) Observation without lab initially

(  ) CBC

(  ) Urinalysis

(  ) CBC and urinalysis

 (  ) Ultrasound of lower abdomen

         and pelvis

(  ) CBC and urinalysis and

       ultrasound, pelvis & lower abd

(  ) CT scan

(  ) Pregnancy test (urine)

Others:_______________________

 

Patient 6C:  Sex: Female    Age: 5-14 years old

 

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

        (Tick one only)

Secondary Clinical Diagnosis

          (Tick one only)

Degree of Certainty of Clin. Diagnosis

                  (Tick one only)

Ancillary Diagnostic Procedure

              (Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

Started in and confined to RLQ

Direct and Rebound RLQ

   tenderness, WITH  guarding

No bowel movement disturbance

No urinary disturbance

Yellowish vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  ) Others:

_____________________________

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  )  Others: 

_____________________________

(   ) Certain that I will proceed to

          treatment without requesting

          for  any ancillary diagnostic

          procedure.

 (   ) Uncertain that I will request 

        for an ancillary diagnostic

        procedure (observation

        included)

(  ) Observation without lab initially

(  ) CBC

(  ) Urinalysis

(  ) CBC and urinalysis

 (  ) Ultrasound of lower abdomen

         and pelvis

(  ) CBC and urinalysis and

       ultrasound, pelvis & lower abd

(  ) CT scan

(  ) Pregnancy test (urine)

Others:_______________________

 

Patient 6D:  Sex: Female    Age: 5-14 years old

 

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

        (Tick one only)

Secondary Clinical Diagnosis

          (Tick one only)

Degree of Certainty of Clin. Diagnosis

                  (Tick one only)

Ancillary Diagnostic Procedure

              (Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

Started in and confined to RLQ

Direct RLQ tenderness, WITH

  guarding, NO rebound

No bowel movement disturbance

No urinary disturbance

Yellowish vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  ) Others:

_____________________________

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  )  Others: 

_____________________________

(   ) Certain that I will proceed to

          treatment without requesting

          for  any ancillary diagnostic

          procedure.

 (   ) Uncertain that I will request 

        for an ancillary diagnostic

        procedure (observation

        included)

(  ) Observation without lab initially

(  ) CBC

(  ) Urinalysis

(  ) CBC and urinalysis

 (  ) Ultrasound of lower abdomen

         and pelvis

(  ) CBC and urinalysis and

       ultrasound, pelvis & lower abd

(  ) CT scan

(  ) Pregnancy test (urine)

Others:_______________________

 

 Female Patients 5-14 years old with RLQ  Pain and Tenderness with Various Associated Symptoms and Signs

Patient 7A:  Sex: Female    Age: 5-14 years old

 

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

        (Tick one only)

Secondary Clinical Diagnosis

          (Tick one only)

Degree of Certainty of Clin. Diagnosis

                  (Tick one only)

Ancillary Diagnostic Procedure

              (Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

Started in and confined to RLQ

Direct RLQ tenderness, NO 

  rebound, NO  guarding

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Pregnant-suspect

No other associated symptoms/signs

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  ) Others:

_____________________________

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  )  Others: 

_____________________________

(   ) Certain that I will proceed to

          treatment without requesting for

          any ancillary diagnostic

          procedure.

(   ) Uncertain that I will request for

       an ancillary diagnostic

       procedure (observation included)

(  ) Observation without lab initially

(  ) CBC

(  ) Urinalysis

(  ) CBC and urinalysis

 (  ) Ultrasound of lower abdomen

         and pelvis

(  ) CBC and urinalysis and

       ultrasound, pelvis & lower abd

(  ) CT scan

(  ) Pregnancy test (urine)

Others:_______________________

 

Patient 7B:  Sex: Female    Age: 5-14 years old

 

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

        (Tick one only)

Secondary Clinical Diagnosis

          (Tick one only)

Degree of Certainty of Clin. Diagnosis

                  (Tick one only)

Ancillary Diagnostic Procedure

              (Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

Started in and confined to RLQ

Direct and Rebound  RLQ

  tenderness, NO  guarding

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Pregnant-suspect

No other associated symptoms/signs

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  ) Others:

_____________________________

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  )  Others: 

_____________________________

(   ) Certain that I will proceed to

          treatment without requesting for

          any ancillary diagnostic

          procedure.

(   ) Uncertain that I will request for

       an ancillary diagnostic

       procedure (observation included)

(  ) Observation without lab initially

(  ) CBC

(  ) Urinalysis

(  ) CBC and urinalysis

 (  ) Ultrasound of lower abdomen

         and pelvis

(  ) CBC and urinalysis and

       ultrasound, pelvis & lower abd

(  ) CT scan

(  ) Pregnancy test (urine)

Others:_______________________

 

Patient 7C:  Sex: Female    Age: 5-14 years old

 

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

        (Tick one only)

Secondary Clinical Diagnosis

          (Tick one only)

Degree of Certainty of Clin. Diagnosis

                  (Tick one only)

Ancillary Diagnostic Procedure

              (Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

Started in and confined to RLQ

Direct and Rebound RLQ

   tenderness, WITH  guarding

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Pregnant-suspect

No other associated symptoms/signs

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  ) Others:

_____________________________

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  )  Others: 

_____________________________

(   ) Certain that I will proceed to

          treatment without requesting for

          any ancillary diagnostic

          procedure.

(   ) Uncertain that I will request for

       an ancillary diagnostic

       procedure (observation included)

(  ) Observation without lab initially

(  ) CBC

(  ) Urinalysis

(  ) CBC and urinalysis

 (  ) Ultrasound of lower abdomen

         and pelvis

(  ) CBC and urinalysis and

       ultrasound, pelvis & lower abd

(  ) CT scan

(  ) Pregnancy test (urine)

Others:_______________________

 

Patient 7D:  Sex: Female    Age: 5-14 years old

 

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

        (Tick one only)

Secondary Clinical Diagnosis

          (Tick one only)

Degree of Certainty of Clin. Diagnosis

                  (Tick one only)

Ancillary Diagnostic Procedure

              (Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

Started in and confined to RLQ

Direct RLQ tenderness, WITH

  guarding, NO rebound

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Pregnant-suspect

No other associated symptoms/signs

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  ) Others:

_____________________________

(  ) Appendicitis

(  ) Urinary tract infection

(  ) Ureteral stone

(  ) Gastroenteritis

(  ) Pelvic inflammatory disease

(  ) Ectopic pregnancy-related pain

(  ) Normal pregnancy-related pain

(  ) Nonspecific RLQ pain/tenderness

(  )  Others: 

_____________________________

(   ) Certain that I will proceed to

          treatment without requesting for

          any ancillary diagnostic

          procedure.

(   ) Uncertain that I will request for

       an ancillary diagnostic

       procedure (observation included)

(  ) Observation without lab initially

(  ) CBC

(  ) Urinalysis

(  ) CBC and urinalysis

 (  ) Ultrasound of lower abdomen

         and pelvis

(  ) CBC and urinalysis and

       ultrasound, pelvis & lower abd

(  ) CT scan

(  ) Pregnancy test (urine)

Others:_______________________