09-25-2005, 12:17 PM
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A 42-year-old homeless man with no history of prior surgery presents with frequent vomiting and no passage of stool or flatus in the past 24 hours. His temperature is 100.8F. Physical exam reveals a tympanitic abdomen and a tender erythematous mass in the right groin. WBC count is 21,000, and an x-ray shows multiple air-fluid levels with no air visualized in the colon. Which of the following is the most appropriate next step in the management of this patient?
(A) Colonoscopy to rule out obstructing carcinoma of ileocecal valve
(B) Incision and drainage of the groin mass
© Nasogastric suction and observation
(D) Passage of a nasogastric tube and schedule for immediate surgery
(E) Sedation and manual reduction of incarcerated hernia followed by observation