A 68-Year-Old Woman Is Brought to the Emergency Department Due

question 77

Multiple Choice

A 68-year-old woman is brought to the emergency department due to worsening diarrhea and abdominal pain.  The patient has had watery diarrhea every 3-4 hours for the past 2 days, and today she also had mild nausea but has been tolerating oral fluids.  The patient was discharged from the hospital 10 days ago after treatment for an Escherichia coli urinary tract infection.  Other medical conditions include hypertension, type 2 diabetes mellitus, hyperlipidemia, and chronic kidney disease.
Temperature is 39.3 C (102.7 F) , blood pressure is 90/60 mm Hg, and pulse is 120/min.  On examination, the patient appears lethargic.  There is moderate abdominal distension and diffuse tenderness but no rebound tenderness or rigidity.
Laboratory results are as follows:
CT scan of the abdomen reveals an 8-cm dilation of the ascending and transverse colon with mucosal thickening.  Stool samples for analysis are obtained.
In addition to IV fluids, which of the following is the most appropriate next step in management of this patient?

• A)High-dose oral vancomycin, IV metronidazole, and urgent surgical evaluation
• B)High-dose oral vancomycin, rectal tube, and admission to the intensive care unit
• C)IV corticosteroids, oral vancomycin, and serial abdominal radiographs
• D)IV metronidazole, oral fidaxomicin, and monitoring in the intensive care unit
• E)Vancomycin enema, IV metronidazole, and serial examinations

---

Definitions:

Encroached Land

Land that is illegally occupied or used by someone else without the owner's permission.

Talking Heads

Headings that are detailed enough to provide an overview of the material in the sections they introduce.

Non-Parallel

Lacking uniformity or consistency in structure, direction, or comparison between different elements or aspects.

Subhead

A secondary headline in a text that divides content into sections, making it easier to read and understand.