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:______________________ |
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:_______________________ |
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:_______________________ |
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:_______________________ |
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:_______________________ |
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:_______________________ |