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A 23-year-old college student presents to the emergency room with severe abdominal pain, nausea, vomiting, and anorexia for the last 24 hours. She reports that she was in her usual state of health, until yesterday when she began to have abdominal pain which she describes near her belly button. This morning, she woke up with her pain much increased, and shifted to the right lower quadrant. Vitals are T 102.0 F HR 98 bpm BP 138/94 mmHg RR 18 Sat 100%. Exam is notable for exquisite right lower quadrant pain that is worse with rebound. When the examiner presses on the left lower quadrant, the patient complains of pain in the right lower quadrant. Psoas signs is present, with a negative obturator sign. Lab studies show a white blood cell count of 15.3, beta HCG is negative. Abdominal CT with contrast is shown in Figure A. Which of the follow pathophysiologies most likely lead to this patient's condition?
Telescoping of hollow viscus into adjacent segment due to a lead point resulting in vascular compromise
Rotation of adnexa about ligamentous structures leading to venous and arterial compromise
Implantation of zygote within the fallopian tubes leading to tubular dilation and rupture
Luminal obstruction of hollow viscus by fecolith or lymphoid tissue leading to venous outflow obstruction
Viral infection with hyperplasia of lymphoid tissue, and inflammation of mesenteric nodes
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A 12-year-old boy is brought in by his mother to the emergency department. He has had abdominal pain, fever, nausea, vomiting, and loss of appetite since yesterday. At first, the mother believed it was just a "stomach flu," but she is growing concerned about his progressive decline. Vitals include: T 102.3 F, HR 110 bpm, BP 120/89 mmHg, RR 16, O2 Sat 100%. Abdominal exam is notable for pain over the right lower quadrant. What is the next best step in management in addition to IV hydration and analgesia?
Abdominal CT scan with IV and PO contrast
Abdominal CT scan with IV contrast
Upright and supine abdominal radiographs
Right lower quadrant ultrasound
Abdominal MRI with gadolinium contrast