H & P:

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Acute MI

Chest pressure, radiates, dyspnea, nausea, diaphoresis, CVD risk factors 

GEN: Pallor, diaphoresis / CVS: Murmur, peripheral edema 

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Aortic dissection 

Tearing pain, radiates, dyspnea, paresthesia, CVD risk factors 

CVS: ↑BP, asymmetric BP, murmur / PVS: Limb ischemia, asymmetric pulses 

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Appendicitis 

Colicky central pain radiated to sharp RLQ pain, nausea, anorexia, fever 

ABDO: ↓gut sounds, rebound, McBurney's point, Rovsing's sign, cough/bump sign 

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Bowel obstruction, Volvulus 

Diffuse crampy pain, constipation, nausea, vomiting, fever, Hx surgery 

ABDO: Distended, high pitch or ↓gut sounds, ↑percussion, localized tenderness, rebound 

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Cholangitis, Cholecyst 

Hx gallstones, Hx bile duct stones, nausea 

GEN: Jaundice, fever, ↓BP / ABDO: RUQ tender, Murphy's sign 

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Ectopic pregnancy 

Crampy pain, sexual Hx, LMP, vaginal bleeding, Hx tubal abnormality 

ABDO: Tender, rebound, cough/bump sign GYN: Adnexal mass 

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Ischemic bowel 

Diffuse crampy pain, pain > findings, NVD, hematochezia, CVD risk factors 

GEN: ↓BP / ABDO: Diffusely tender, blood per rectum 

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Pancreatitis 

Epigastric pain, radiates, worse with meals, nausea, Hx EtOH or gallstones 

GEN: Jaundice, fever, ↓BP / ABDO: Grey-Turner's sign, diffusely tender 

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Perf viscus, Liver/spleen injury 

Hx trauma, Hx instrumentation 

GEN: ↓BP / ABDO: Distended, tender, cough/bump sign 

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Ruptured AAA 

Radiates, CVD risk factors, family Hx 

GEN: ↓BP / ABDO: Pulsatile mass 

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Testicular torsion 

Scrotal pain, acute onset, nausea 

URO: Tender, swollen, elevated testicle; absent cremasteric reflex 

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Investigation:

 

CBC, Lytes, Cr, LFT, Lipase, BhCG, Trop, ECG, CXR, U/S, CT

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