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What physical findings are you looking for to help determine the diagnosis?

These are the actual findings on physical examination:

General survey

Patient is an alert, young woman who is ill appearing. She is sitting quietly on the examination table.

Vital signs

BP 105/75 mm Hg; HR 120 bpm and regular; respiratory rate 18 breaths/min.; temperature 103°F

Cardiovascular

JVP 6 cm above the right atrium; carotid upstrokes brisk without bruits PMI tapping, 7 cm lateral to the midsternal line in the 5th intercostal space.

Good S1, S2 with tachycardia; no S3, S4; no murmurs, or extra sounds

Abdomen

Protuberant with active bowel sounds.

Soft, tender to palpation in the lower abdomen, over the bladder without rebound or guarding; no masses or hepatosplenomegaly Liver span is 7 cm in the right mid-clavicular line; edge is smooth and palpable 1 cm below the right costal margin. Spleen and kidneys not felt. Costovertebral angle tenderness is present on the left side.

Female genitalia

No inguinal adenopathy. External genitalia without erythema or lesions; no lesions or masses. Uterus anterior, midline, smooth, and not enlarged. No cervical motion or adnexal tenderness. Rectovaginal wall intact.

Anus, rectum, prostate

No perirectal lesions or fissures. External sphincter tone intact. Rectal vault without masses. Uterine cervix nontender. Stool brown and hemoccult negative.

Based on this information, what is your differential diagnosis?

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