F.D. is a 15 y.o. female who complained of RLQ pain radiating to the back. The pain was intermittent and had resolved before her exam. Her exam at that time was normal and she was dicharged with ibuprofen and a follow up sonogram and adolescent health ap pointments for the next day. The sono revealed a right ovarian cyst 6.7cm x 4.4cm x 6.8cm. She returned to the ED via EMS 2 days later with severe pain and "fainting".

No past medical problems. She had an elective abortion 2 months earlier.

No medicines or allergies

Appearance:	She appeared very ill.
HEENT:	normal
Lungs:	clear bilaterally
Heart:	tachy regular rythmn
Abdomen:	firm, very tender, flat, with rebound tenderness
Extremities:	2+ peripheral pulses.
Neuro:	Awake and alert