It is the first day of your emergency medicine elective rotation and it is a very busy evening. The attending, Dr. Roberts, suggests that you shadow for the first few hours to become oriented to how the emergency department works. She is about to see a patient and is speaking with the nurse outside of the door. The nurse says, “Kayla is a 16-year-old female who was seen just a couple of days ago. Looks like she was diagnosed with pelvic inflammatory disease (PID). Her abdominal pain isn’t getting better, and now she’s vomiting.”
Dr. Roberts says, “I’ve seen lots of cases like this before—the doxycycline can cause a lot of stomach upset, and they can’t keep it down. I’m guessing she’s still in pain because she’s not been adequately treated. Teenagers can be so tough to treat, even for simple things.”
You and Dr. Roberts walk into the room together and introduce yourselves.
• Discuss the questions that would be important to include when interviewing a patient with this issue.
• Describe the clinical findings that may be present in a patient with this issue.
• Are there any diagnostic studies that should be ordered on this patient? Why?
• List the primary diagnosis and three differential diagnoses for this patient. Explain your reasoning for each.
• Discuss your management plan for this patient, including pharmacologic therapies, tests, patient education, referrals, and follow-ups.