A 30-Year-Old Woman with Ulcerative Colitis Treated with Mesalamine Is

question 41

Multiple Choice

A 30-year-old woman with ulcerative colitis treated with mesalamine is hospitalized for nausea, abdominal pain, and diarrhea.  She has had 8-10 bloody bowel movements every day for the past week with associated tenesmus, anorexia, and a 2-kg (4.4-lb) weight loss.  The patient reports no recent travel, antibiotic use, or eating anything unusual.  She does not use tobacco, alcohol, or illicit drugs.
Temperature is 37 C (98.6 F) , blood pressure is 110/70 mm Hg, pulse is 92/min, and respirations are 16/min.  Examination shows a mildly distended abdomen.  There is mild diffuse tenderness but no involuntary guarding or rebound tenderness.  Bowel sounds are present in all quadrants.  Stool is positive for occult blood.
Laboratory results are as follows:
Abdominal and upright chest radiographs are unremarkable with no free air or severe colonic dilatation.  Stool testing for Clostridium difficile is negative and stool cultures are sent.
Which of the following is the most appropriate next step in management of this patient?

• A)Anti-tumor necrosis factor therapy
• B)Colonoscopy with biopsy
• C)CT scan of the abdomen and pelvis
• D)Empiric antibiotics until culture results are available
• E)Systemic glucocorticoids

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Definitions:

Groupthink

A psychological phenomenon that occurs within a group of people, in which the desire for harmony or conformity results in an irrational or dysfunctional decision-making outcome.

Cohesiveness

The quality of forming a united whole, often referring to the degree to which members of a group or organization stick together.

Environmental Factors

Aspects of the environment that can affect a person's health, behavior, and ability to function, or the external conditions that influence the outcomes of a business or project.

Unfavorable Public Images

Negative perceptions held by the public about an organization or individual, often due to controversies or mismanaged events.