A 72-Year-Old Man with End-Stage Renal Disease Comes to the Emergency

question 133

Multiple Choice

A 72-year-old man with end-stage renal disease comes to the emergency department due to abdominal pain for the past 6 hours.  The pain started in the lower left abdomen at the end of the hemodialysis session and has remained steady in intensity.  The pain does not radiate and is unchanged with movement.  The patient rushed to the hospital after noticing bright red blood in the bowel movement 30 minutes ago.  He has had mild nausea but no vomiting, back pain, fever, or urinary symptoms.  Medical problems include hypertension, type 2 diabetes mellitus, hyperlipidemia, depression, and gastritis.  The patient developed anuric end-stage renal disease due to hypertensive and diabetic nephropathy and has been receiving maintenance hemodialysis for the past several years.  He reports no recent antibiotic use or travel and has not eaten anything out of the ordinary.  The patient is a former smoker with a 30-pack-year history and does not use alcohol or illicit drugs.
Temperature is 37.4 C (99.3 F) , blood pressure is 110/80 mm Hg, pulse is 88/min and regular, and respirations are 16/min.  Abdominal examination shows tenderness in the left lower quadrant with decreased bowel sounds, but there is no rebound tenderness or rigidity.  Rectal examination reveals stool mixed with bright red blood.
Laboratory results are as follows:
Which of the following is the best next step in management of this patient?

• A)Bowel preparation followed by colonoscopy
• B)Contrast-enhanced CT scan of the abdomen and pelvis
• C)MR angiography of the abdomen with gadolinium
• D)Stool culture and Clostridium difficile PCR
• E)Upper gastrointestinal endoscopy

Evaluate make or buy decisions using relevant costing.

Assess the financial implications of discontinuing a product or department.

Apply the concept of contribution margin in decision-making.

Understand the importance of fixed and variable costs in profit planning.

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Definitions:

Continental Crust

The thick part of the Earth's crust that forms the continents, characterized by a composition that is different from oceanic crust.

Rocks

Solid mineral material forming part of the surface of the earth and other similar planets, exposed on the surface or underlying the soil or oceans.

Wooden Pillar

A structural element made of wood, serving as a support in buildings, bridges, or other structures.

Stone Weight

A unit of weight commonly used in some countries, equivalent to 14 pounds or about 6.35 kilograms.