Tubo-ovarian abscess

Ms. Smith is a 23-year-old sexually active female — G0P0, LMP 3 weeks ago on OCPs — who presents with midline suprapubic abdominal pain x 5 days, now with LLQ localization of < 24 hours’ duration. The pain is worse with standing and movement; she reports chills/sweating, poor appetite, nausea, and dizziness; she denies abnormal vaginal bleeding and lower/upper urinary-tract symptoms. PE reveals an ill-appearing, woman: T 101, P 126, BP 88/56, with intermittent tachypnea secondary to pain, pelvic exam demonstrates foul vaginal discharge with purulence draining per cervical os, a normal-size uterus, cervical-motion tenderness, and fullness with marked tenderness of the left adnexa. answer the following questions using the latest evidenced based guidelines: 1. Discuss the questions that would be important to include when interviewing a patient with this issue. 2. Describe the clinical findings that may be present in a patient with this issue. 3. Are there any diagnostic studies that should be ordered on this patient? Why? 4. List the primary diagnosis and three differential diagnoses for this patient. Explain your reasoning for each( Primary dx is Tubo-ovarian abscess (TOA)) 5. Discuss your management plan for this patient, including pharmacologic therapies, tests, patient education, referrals, and follow-ups.