11-01-2009, 10:54 AM
1. A 70-year-old woman has had increasing abdominal pain over the past 2 days. She has renal
failure and has been receiving peritoneal dialysis for 18 months; her last treatment was 2 hours
ago. She appears toxic. Her temperature is 39 C (102.2 F), and blood pressure is 140/90 mm Hg.
Her abdomen is distended and diffusely tender to deep palpation with rebound tenderness.
Leukocyte count is 18,000/mm3. Which of the following is the most appropriate next step?
A ) X-ray films of the abdomen
B ) Comparison of abdominal fluid amylase with serum amylase activity
C ) Gram's stain of abdominal fluid
D ) Ultrasonography of the abdomen
E ) CT scan of the abdomen and pelvis
failure and has been receiving peritoneal dialysis for 18 months; her last treatment was 2 hours
ago. She appears toxic. Her temperature is 39 C (102.2 F), and blood pressure is 140/90 mm Hg.
Her abdomen is distended and diffusely tender to deep palpation with rebound tenderness.
Leukocyte count is 18,000/mm3. Which of the following is the most appropriate next step?
A ) X-ray films of the abdomen
B ) Comparison of abdominal fluid amylase with serum amylase activity
C ) Gram's stain of abdominal fluid
D ) Ultrasonography of the abdomen
E ) CT scan of the abdomen and pelvis