11-27-2008, 06:48 PM
16. A 22-year-old woman is in her 5th hospital day following
admission for evaluation of severe right lower quadrant
abdominal pain. During the previous 8 months, she has had
episodes of abdominal pain with associated recurrent diarrhea,
which sometimes contained blood. The pain and diarrhea became
increasingly severe during the 5 days prior to admission.
During that time, she lost 2 kg (5 lb) and had a temperature
to 39.0°C (102.0°F). Abdominal examination on admission
disclosed a right lower quadrant mass. Blood hemoglobin
concentration was 15.5 g/dL and leukocyte count was
24,000/mm3. Colonoscopy showed linear ulcerations with
discontinuous areas of inflammation. Biopsy of the lower
intestine disclosed noncaseating granulomas. Serum antibody
test to Saccharomyces cerevisiae was positive. Treatment with
intravenous hydrocortisone therapy was begun. Today, the
patient's abdominal pain and diarrhea are resolved. Vital
signs are temperature 37.0°C (98.6°F), pulse 76/min,
respirations 12/min, and blood pressure 122/74 mm Hg. The
abdomen is soft and nontender to palpation; bowel sounds are
normal. Which of the following is the most appropriate
pharmacotherapy for this patient?
A) Azathioprine(immune suppressant)
B) Mesalamine
C) Metronidazole
D) Prednisone
E) Ranitidine
D?????
admission for evaluation of severe right lower quadrant
abdominal pain. During the previous 8 months, she has had
episodes of abdominal pain with associated recurrent diarrhea,
which sometimes contained blood. The pain and diarrhea became
increasingly severe during the 5 days prior to admission.
During that time, she lost 2 kg (5 lb) and had a temperature
to 39.0°C (102.0°F). Abdominal examination on admission
disclosed a right lower quadrant mass. Blood hemoglobin
concentration was 15.5 g/dL and leukocyte count was
24,000/mm3. Colonoscopy showed linear ulcerations with
discontinuous areas of inflammation. Biopsy of the lower
intestine disclosed noncaseating granulomas. Serum antibody
test to Saccharomyces cerevisiae was positive. Treatment with
intravenous hydrocortisone therapy was begun. Today, the
patient's abdominal pain and diarrhea are resolved. Vital
signs are temperature 37.0°C (98.6°F), pulse 76/min,
respirations 12/min, and blood pressure 122/74 mm Hg. The
abdomen is soft and nontender to palpation; bowel sounds are
normal. Which of the following is the most appropriate
pharmacotherapy for this patient?
A) Azathioprine(immune suppressant)
B) Mesalamine
C) Metronidazole
D) Prednisone
E) Ranitidine
D?????