What is the most likely diagnosis for Mandy given her symptoms and examination findings?

The most likely diagnosis of a ruptured ectopic pregnancy is often suggested by specific symptoms and examination findings that align with this condition. In females of reproductive age, a ruptured ectopic pregnancy typically presents with unilateral abdominal pain, which can be sharp or crampy, as well as additional symptoms like vaginal bleeding and signs of internal bleeding, such as faintness or dizziness due to blood loss.

Upon physical examination, signs such as tenderness in the lower abdomen, especially on one side, and potentially a palpable adnexal mass can be indicators of this diagnosis. The acute presentation may coincide with features such as shoulder pain, which can occur if there is significant internal bleeding irritating the diaphragm.

In contrast, other possible diagnoses such as ovarian cyst rupture typically present with unilateral pain but usually do not cause the same degree of internal hemorrhage or systemic symptoms. Appendicitis generally presents with right lower quadrant pain and potential fever, which are less consistent with the symptoms of a ruptured ectopic pregnancy. Pneumonia, while possible, usually presents with respiratory symptoms and fever, which are not typically associated with acute abdominal pain related to a gynecological issue. Thus, the clinical picture painted by Mandy's symptoms aligns most closely with a ruptured ectopic