A 26-Year-Old Man Comes to the Clinic Due to a 2-Week

question 612

Multiple Choice

A 26-year-old man comes to the clinic due to a 2-week history of persistent abdominal pain in the right upper quadrant, low-grade fever, and anorexia.  The patient recently immigrated to the United States from Mexico, where he worked as a mechanic.  Several months ago, he had bloody diarrhea for several days, which resolved spontaneously.  He takes no medications or herbal preparations.  The patient has had no other travel, exposure to animals, or sick contacts.  Temperature is 38.7 C (101.7 F) , blood pressure is 122/80 mm Hg, pulse is 82/min, and respirations are 14/min.  Physical examination shows tenderness to palpation in the right upper quadrant but is otherwise unremarkable.  Laboratory results are as follows: Blood cultures are sterile through 48 hours.  CT scan of the abdomen reveals a 2x3 cm abscess in the right lobe of the liver.  In addition to confirmatory testing, which of the following is the most appropriate next step in management?

• A)Intravenous ceftriaxone therapy
• B)Oral metronidazole therapy
• C)Percutaneous aspiration or drainage
• D)Reassurance and reimaging in 3 months
• E)Surgical lobe resection

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Definitions:

Fetus

A prenatal human between the embryonic state and birth.

Ectoderm

The outermost layer of cells in the early embryo, giving rise to structures such as the skin, nails, and hair, as well as the nervous system.

Inner Cell Mass

A group of cells inside the early embryo that will eventually develop into the body of the organism.

Digestive System

The complex series of organs and glands responsible for the breakdown, digestion, and absorption of nutrients from food into the body.