A 10-Day-Old Boy Is Brought to the Emergency Department by His

question 216

Multiple Choice

A 10-day-old boy is brought to the emergency department by his mother due to persistent bilious vomiting for 10 hours.  The patient has also been more irritable and has refused to feed.  His last bowel movement was 24 hours ago.  The patient was born at term via vaginal delivery with no prenatal or neonatal complications.  Apgar scores were 8 and 9 at 1 and 5 minutes, respectively.  Temperature is 37.9 C (100.2 F) , blood pressure is 68/36 mm Hg, and pulse is 176/min.  The patient appears lethargic.  The fontanelles are open and flat.  The neck is supple.  The abdomen is firm and distended with hypoactive bowel sounds and tenderness to palpation.  Rectal tone is normal, and there is a small amount of stool in the rectal vault.  Stool testing is positive for occult blood.  Plain abdominal x-ray is shown in the exhibit.  Which of the following is the best next step in management of this patient?

• A)Contrast enema
• B)CT scan of the abdomen and pelvis
• C)Exploratory laparotomy
• D)Gastrointestinal endoscopy
• E)Supportive care with serial abdominal examinations
• F)Upper gastrointestinal series with small-bowel follow-through

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Definitions:

Firm Offer

An offer made in writing by a merchant guaranteeing to hold the offer open for a specified period of time without revocation.

UCC

The Uniform Commercial Code, a set of comprehensive statutes designed to unify and standardize sales and commercial transactions in all 50 states.

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A new offer made in response to an offer received, implying rejection of the original offer.

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the total cost, expressed as a monetary amount, of borrowing credit, including interest, fees, and any other charges associated with the transaction.