After picking up the large medipack on the rock outcrop...
...follow the ramp downward (away from the doorway where Ahmed went) and continue straight on toward the cave wall.
The pit where the fourth scorpion was is now on Lara's right. Climb onto the stone block to the left of the pit.
Turn and jump up into the concealed alcove. Congratulations! You've found SECRET #1 (9/70): a small medipack.
Or, if you prefer, you can pull up from the cave floor directly into the secret alcove.
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