A 71-Year-Old Man Is Brought to the Emergency Department Because

question 118

Multiple Choice

A 71-year-old man is brought to the emergency department because of a 2-day history of excruciating left thigh pain, weakness, and nausea.  His medical problems include type 2 diabetes mellitus, hypertension, and benign prostatic hyperplasia.  He is a lifetime non-smoker.
His blood pressure is 85/40 mm Hg and pulse is 114/min and regular.  Mucous membranes are dry.  Examination reveals magenta-bronze discoloration, crepitus, tenderness, and significant swelling over the left thigh.
Laboratory results are as follows:

A Foley catheter was placed and 200 mL of concentrated urine was drained.  Intravenous antibiotics, analgesics, and bolus fluids were administered.  CT scan of the thigh showed gas gangrene.  He was emergently taken to the operating room for debridement.  Four days later, the patient feels better.  The Foley catheter is removed and he urinates without difficulty.  Two sets of blood cultures sent on admission grow Clostridium septicum.
Which of the following additional studies would be indicated in this patient?

• A)Colonoscopy
• B)CT scan of the chest
• C)Cystoscopy
• D)Transesophageal echocardiography
• E)Transrectal prostate biopsy

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Definitions:

Nuclease

An enzyme that helps in breaking down nucleic acids by cleaving the phosphodiester bonds between nucleotides.

Origins Of Replication

Specific sequences in the genome where DNA replication begins, necessary for the duplication of chromosomes.

Linear DNA Molecules

describe the structure of DNA when it is in a straight line, as opposed to being circular, typically found in eukaryotic chromosomes.

Bidirectionally

In a manner that involves or capable of moving in two opposite directions.