24 25 - showman

[ArchivalUser]

A 59-year-old woman comes to the office because of pain in the left lower quadrant of her abdomen for the past 48 hours. The pain
is associated with tenesmus, loss of appetite and a sensation of being febrile. She has a history of long-standing irritable bowel
symptoms and has not taken any pharmacotherapy. Vital signs are: temperature 37.3EC (99.2EF), pulse 84/min and regular and
respirations 12/min. On physical examination the abdomen is tender in the left lower quadrant; there is no rebound tenderness and
bowel sounds are normal. Leukocyte count is 10,200/mm3 with 71% segmented neutrophils and 3% band forms. The patient is sent
home on a liquid diet and tetracycline therapy. Three days later she returns because the pain has become worse and she is now
having chills.
24. Which of the following is the most appropriate next step?
(A) Admit her to the hospital and begin cefoxitin therapy, intravenously
(B) Admit her to the hospital and prepare her for an immediate operation
© Change to ciprofloxacin therapy, orally, and send her home
(D) Continue the present course of therapy
(E) Do colonoscopy
25. Following the patient's recovery from the acute phase of this illness, which of the following is the most appropriate
long-term management?
(A) Annual endoscopic examination for neoplasia
(B) High-fiber diet
© Low-residue diet
(D) Reassurance only
(E) Use of prophylactic antibiotic therapy for 1 week each month

[ArchivalUser]

a,e

[ArchivalUser]

a,e

[ArchivalUser]

b,e

[ArchivalUser]

24. The correct answer is A. The patient described has diverticulosis leading to diverticulitis. You must start antibiotics that cover the gram-positive cocci, gram-negative bacilli and anaerobes found in the abdomen. Cefoxitin fits the bill.
Immediate surgery (choice B) is too aggressive, particularly without even an attempt at antibiotic therapy.
Ciprofloxacin (choice C) is inappropriate as it has poor gram-positive coverage and no anaerobic coverage.
Continuing the present therapy (choice D) is incorrect because the worsening pain and chills imply infection.
Colonoscopy (choice E) is dangerous in diverticulitis because it can lead to perforation.
25. The correct answer is B. A high fiber diet is the appropriate therapy to try to prevent the formation of further diverticula.
Annual endoscopy (choice A), a low-residue diet (choice C), reassurance (choice D), and prophylactic antibiotics are not indicated.