Male Patients 15-50 years old with RLQ Pain and Tenderness with Various Associated Symptoms and Signs

Patient 1A: Sex: Male Age: 15-50 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: 15-50 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: 15-50 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 15-50 years old with RLQ Pain and Tenderness with Various Associated Symptoms and Signs

Patient 2A: Sex: Male Age: 15-50 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: 15-50 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: 15-50 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

( ) 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 15-50 years old with RLQ Pain and Tenderness with Various Associated Symptoms and Signs

Patient 3A: Sex: Male Age: 15-50 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 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 3B: Sex: Male Age: 15-50 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 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 3C: Sex: Male Age: 15-50 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 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 15-50 years old with RLQ Pain and Tenderness with Various Associated Symptoms and Signs

Patient 4A: Sex: Male Age: 15-50 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 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 4B: Sex: Male Age: 15-50 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 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 4C: Sex: Male Age: 15-50 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 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 15-50 years old with RLQ Pain and Tenderness with Various Associated Symptoms and Signs

Patient 5A: Sex: Male Age: 15-50 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 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 5B: Sex: Male Age: 15-50 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 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 5C: Sex: Male Age: 15-50 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 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 15-50 years old with RLQ Pain and Tenderness with Various Associated Symptoms and Signs

Patient 6A: Sex: Male Age: 15-50 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

Diarrhea synchronous with pain

No urinary disturbance

( ) 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 6B: Sex: Male Age: 15-50 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

Diarrhea synchronous with pain

No urinary disturbance

( ) 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 6C: Sex: Male Age: 15-50 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

Diarrhea synchronous with pain

No urinary disturbance

( ) 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 6D: Sex: Male Age: 15-50 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

Diarrhea synchronous with pain

No urinary disturbance

( ) 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 15-50 years old with RLQ Pain and Tenderness with Various Associated Symptoms and Signs

Patient 7A: Sex: Male Age: 15-50 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

With dysuria

No bowel movement disturbance

( ) 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 7B: Sex: Male Age: 15-50 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

With dysuria

No bowel movement disturbance

( ) 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 7C: Sex: Male Age: 15-50 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

With dysuria

No bowel movement disturbance

( ) 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 7D: Sex: Male Age: 15-50 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

With dysuria

No bowel movement disturbance

( ) 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:______________________