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What are the obstetric and gynecologic differential diagnoses for acute pelvic pain Pelvic inflammatory disease Adnexal cysts/masses/abscesses with bleeding, torsion, or rupture Ectopic pregnancy Spontaneous abortion Endometritis Degeneration, infarction, or torsion of leiomyomas (fibroids) What are non-gynecologic differential diagnoses for acute pelvic pain Appendicitis Diverticulitis Urinary tract infection or obstruction Renal colic Which of these diagnoses are life threatening and must be ruled out quickly Ectopic pregnancy Tubo-ovarian abscess Ruptured ovarian cyst Appendicitis On what additional points should the history taking focus to determine a pelvic etiology The regularity and timing of menstrual periods, possibility of pregnancy, presence of vaginal discharge or bleeding, and a recent history of dyspareunia or dysmenorrhea Ectopic pregnancy: unruptured pregnancy leads to localized unilateral pain because of fallopian tube dilatation If it ruptures, the pain becomes generalized because of peritoneal irritation A pelvic examination may reveal cervical motion tenderness that is exaggerated on the side of the tubal pregnancy Tubo-ovarian abscess: patients present with generalized abdominal pain and rebound tenderness caused by peritoneal inflammation Bilateral, palpable, fixed, and tender masses are commonly found on examination
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Designing and creating sound and sound environments This Core Topic includes a range of theoretical and practical audio-related areas, such as music theory and history; music composition; aesthetic analysis of music; recording studio skills; and electronic sound generation Audio relating specifically to digital game technologies, such as 3-D sound processing and generative audio structures are also included Throughout, special emphasis is placed on the role of audio
What findings on physical examination may lead you to the appropriate gynecologic/obstetric etiology for acute pelvic pain
Acute PID: lower abdominal tenderness, cervical motion tenderness, adnexal tenderness Ovarian torsion/rupture: severe unilateral, lower abdominal pain, adnexal mass, nausea and vomiting Uterine infection or pathology (torsion, degeneration, infarction): irregular enlargement and painful uterus on palpation Endometriosis: localized pain in the cul-de-sac or uterosacral ligaments, palpable tender nodules in the culde-sac, uterosacral ligaments, or rectovaginal septum, possible fixation of adnexa or uterus in a retroverted position What labs or tests should be considered in the workup of acute pelvic pain CBC; urinary analysis (UA); pregnancy test; tests for Chlamydia and gonorrhea in women with suspected PID; microscopic examination of (wet mount) of any abnormal vaginal discharge; culdocentesis; vaginal ultrasound; laparoscopy See Table 41
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experience within the larger context of a game As with Visual Design, the emphasis is on design fundamentals rather than on specific technical knowledge
An entire "fortune cookie" program is shown here It uses rand( ) to generate a random number It then uses the modulus operator to obtain a number between 0 and 4, which it uses to index the array
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Traditional storytelling and the challenges of interactive narrative Writers and designers of interactive works need a solid understanding of traditional narrative theory, character development, plot, dialogue, backstory and world creation, as well as experimental approaches to storytelling in literature, theatre and film with relevance to games In addition, interactive storytelling requires familiarity with new tools and techniques, including the technical aspects of writing for this new medium, algorithmic storytelling and collaborative story construction In this Core Topic, these approaches are applied to the unique context of interactive storytelling in games
It is recurrent acute midcycle abdominal pain because of leakage of prostaglandin-containing follicular fluid at the time of ovulation The pain associated is typically mild, unilateral, midway between menstrual periods, and lasts for a few hours to a couple of days
Practical challenges of managing the development of games Games are among the most complex forms of software to create and game development and publishing are complex collaborative efforts Along with all the technical challenges of software development, issues of design documentation, content creation, team roles, group dynamics, risk assessment, people management and process management are addressed in this Core Topic While there is growing literature on Game Production, there are also rich traditions in software engineering and project management from which to draw for this Core Topic
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