Male Patients 5-14 years old with RLQ Pain and Tenderness with Various Associated Symptoms and Signs
Patient
1A: Sex: Male 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
other associated symptoms/signs |
( ) Appendicitis ( ) Urinary tract infection ( ) Ureteral stone ( ) Gastroenteritis ( ) Nonspecific RLQ pain/tenderness ( ) Others: _____________________________ |
( ) Appendicitis ( ) Urinary tract infection ( ) Ureteral stone ( ) Gastroenteritis ( ) 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 ( ) CT scan Others:_______________________ |
Patient
1B: Sex: Male 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
other associated symptoms/signs |
( ) Appendicitis ( ) Urinary tract infection ( ) Ureteral stone ( ) Gastroenteritis ( ) Nonspecific RLQ pain/tenderness ( ) Others: _____________________________ |
( ) Appendicitis ( ) Urinary tract infection ( ) Ureteral stone ( ) Gastroenteritis ( ) 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 ( ) CT scan Others:______________________ |
Patient
1C: Sex: Male 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
other associated symptoms/signs |
( ) Appendicitis ( ) Urinary tract infection ( ) Ureteral stone ( ) Gastroenteritis ( ) Nonspecific RLQ pain/tenderness ( ) Others: _____________________________ |
( ) Appendicitis ( ) Urinary tract infection ( ) Ureteral stone ( ) Gastroenteritis ( ) 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 ( ) CT scan Others:_______________________ |
Male Patients 5-14 years old
with RLQ Pain and Tenderness with
Various Associated Symptoms and Signs
Patient
2A: Sex: Male 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
other associated symptoms/signs |
( ) Appendicitis ( ) Urinary tract infection ( ) Ureteral stone ( ) Gastroenteritis ( ) Nonspecific RLQ pain/tenderness ( ) Others: _____________________________ |
( ) Appendicitis ( ) Urinary tract infection ( ) Ureteral stone ( ) Gastroenteritis ( ) 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 ( ) CT scan Others:_______________________ |
Patient
2B: Sex: Male 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
other associated symptoms/signs |
( ) Appendicitis ( ) Urinary tract infection ( ) Ureteral stone ( ) Gastroenteritis ( ) Nonspecific RLQ pain/tenderness ( ) Others: _____________________________ |
( ) Appendicitis ( ) Urinary tract infection ( ) Ureteral stone ( ) Gastroenteritis ( ) 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 ( ) CT scan Others:_______________________ |
Patient
2C: Sex: Male 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
other associated symptoms/signs |
( ) Appendicitis ( ) Urinary tract infection ( ) Ureteral stone ( ) Gastroenteritis ( ) Nonspecific RLQ pain/tenderness ( ) Others: _____________________________ |
( ) Appendicitis | ||||