A 37 year old WF presents to your clinic with CC of RLQ abd pain that has been present/persistent for 3-4 days; today she says it's so bad that she can't stand up straight and she is guarding her RLQ. 

When she walks into the clinic, her hips are flexed and she is bent over, holding her RLQ. She has had fever for a couple days, she says, and tylenol and ibuprofen aren't helping with the pain or with the fever. She says she has been vomiting persistently since yesterday, hasn't been able to keep anything down and now is vomiting a greenish thin clear liquid that "tastes really bad." NKDA, no medical problems, no daily medications.

G9T5P0A4L5. Unsure when she had her last normal menstrual period, states that "I don't really keep up with that anymore." Refuses to answer many questions about her sexual history. States, "I just want you to do something about this pain!" No previous surgical history, unsure when she had her last pelvic exam/Pap smear, denies that she has ever had a mammogram. She smokes 2 ppd cigarettes and has since she was 13 years old. Admits to regular marijuana use and methamphetamines "only on the weekends," admits to ETOH on the weekends too, usually about 12 beers/weekend.

1. What other information do you want from this patient to aid in putting together a differential diagnosis/illness script?

2. What are the risk factors for abdominal and/or genitourinary disease that this patient has?

3. What are the Guidelines for Treatment recommendations for the top diagnosis on your differential diagnosis/illness script?

4. What do you expect to find on physical exam of this patient on a physical evaluation?

5. Describe the diagnostic workup you would order for this patient and the rationale behind each test/study you would order.

6. What treatment if any do you want to order now, after your exam and before results are back, and why?