Sprint 30: The Story Changes When the Room Changes

Case presentation

Acute intra-abdominal infection requiring immediate escalation

A nonspecific gastrointestinal or stress-associated process remains plausible

Urinary tract infection is the leading explanation

The symptoms are adequately explained by anxiety

There is not enough information to form any working interpretation

Reassure the patient and conclude the visit

Obtain abdominal imaging before gathering additional history

Prescribe treatment for stress-related gastrointestinal symptoms

Continue obtaining history, including speaking with the patient privately

Refer immediately for emergency evaluation

Replace the earlier history because information obtained with a parent present is unreliable

Leave the interpretation largely unchanged because the abdominal examination was reassuring

Expand the working model. New reproductive information adds another plausible explanation for her symptoms.

Treat the discrepancy as evidence that the patient was intentionally misleading you

Evaluate for pregnancy while interpreting the abdominal symptoms in the full clinical context.

Continue with reassurance because there are no peritoneal findings

Refer immediately for emergency evaluation solely because she is sexually active

Ask her mother to return and verify whether the history is accurate

Treat empirically for a gastrointestinal disorder before pursuing reproductive causes