A 24-vear-old lady with 24 hrs comes with complains of pain in the right iliac fossa, vomiting, central dyspareunia, rebound tenderness and with a temperature of 37degC. Pregnancy test negative. The probable diagnosis is
**Core Concept**
The patient's symptoms - pain in the right iliac fossa, vomiting, central dyspareunia, rebound tenderness, and normal temperature - suggest an acute abdominal condition, likely involving the appendix, given the location of the pain. The absence of fever and a negative pregnancy test helps rule out pregnancy-related complications.
**Why the Correct Answer is Right**
The patient's symptoms are consistent with acute appendicitis, which typically presents with pain in the right lower quadrant, followed by nausea and vomiting. Central dyspareunia (pain during intercourse) can occur due to the inflammation of the appendix causing irritation of the surrounding tissues. Rebound tenderness is a classic sign of peritoneal irritation, often seen in conditions like appendicitis. The absence of fever suggests that the condition may not have progressed to a severe, perforated state.
**Why Each Wrong Option is Incorrect**
**Option A:** Ovarian torsion is a possibility in a young woman with acute abdominal pain, but it typically presents with sudden, severe pain, often accompanied by nausea and vomiting, and is usually not associated with rebound tenderness.
**Option B:** Ectopic pregnancy is unlikely given the negative pregnancy test, but could still be a consideration if the patient's symptoms persisted or worsened.
**Option C:** Crohn's disease or ulcerative colitis can cause abdominal pain and tenderness, but are typically associated with diarrhea, blood in the stool, and weight loss, which are not mentioned in this case.
**Clinical Pearl / High-Yield Fact**
In cases of suspected appendicitis, the "Rovsing's sign" can be used to help diagnose: pressing on the left lower quadrant of the abdomen can cause pain in the right lower quadrant, indicating peritoneal irritation.
**Correct Answer: C. Acute appendicitis**