View Answer

C

25. Therapeutically, the first step should be which of the following?

A A Fleet enema, clear liquids by mouth, and careful observation

B Emergency colonoscopy for colonic decompression

C Intravenous fluids, nasogastric suction, and careful observation

D Colonoscopic decompression with use of a rectal tube, if necessary

E Immediate exploratory laparotomy

View Answer

C

Questions 26–27

A 60-year-old patient who is finishing a course of antibiotic therapy for bacterial pneumonia develops cramping abdominal pain and profuse watery diarrhea. A diagnosis of pseudomembranous or antibiotic-associated colitis is suspected.

P.299

26. Which of the following is the quickest way to establish the diagnosis?

A Stool culture

B Barium enema

C Stool titer for Clostridium difficile toxin

D Proctoscopy

E Blood culture

View Answer

D

27. What would the initial treatment involve?

A Metronidazole

B Vancomycin

C Imodium

D Cephalexin

E Total abdominal colectomy

View Answer

A

28. During exploration for a transverse colon tumor, a surgeon incidentally notices a 2-cm diverticulum of the small bowel located 2 ft proximal to the ileocecal valve. Which of the following statements are not true?

A This diverticulum should be resected when found due to an associated increased risk of malignancy

B This is an example of the most common type of diverticulum of the gastrointestinal tract, present in 2% of the population

C It is more commonly found in men than women

D When symptomatic in children, it presents as a source of bleeding

E It can cause obstruction via intussusception

View Answer

A

29. A 55-year-old man presents with a 24-hour history of increasingly severe left lower quadrant abdominal pain. On examination, he has tenderness localized in the left lower quadrant with rebound. Fever and leukocytosis are present. The clinical suspicion of diverticulitis would best be confirmed by which of the following?

A Barium enema

B Colonoscopy

C CT scan of the abdomen and pelvis

D Magnetic resonance imaging of the abdomen and pelvis

E Chest radiograph

View Answer

C

30. A 45-year-old woman with diabetes presents with a 2-day history of acute perirectal pain. On examination, a tender fluctuant mass is present to the left of the anus. What treatment should be administered at this time?

A Broad-spectrum antibiotic therapy

B Abscess drainage and excision of the fistulous tract

C Incision and drainage of the abscess

D Continued observation

E Treatment of Crohn's disease

View Answer

C

Questions 31–32

A 34-year-old female patient in previous good health presents in the emergency department with spontaneous intraperitoneal hemorrhage. Her only medication is an oral contraceptive that she has been taking for the past 5 years. During resuscitation, a bedside ultrasound reveals a large amount of intraperitoneal blood and a 3-cm mass in the right lobe of the liver.

31. What is the likely cause of her hemorrhage?

A Hepatoma

B Hemangioma

C Focal nodular hyperplasia

D Hepatic cell adenoma

E Metastatic neoplasm