A 69-Year-Old Man Has Had 3 Days of Pain in the Lower

question 258

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A 69-year-old man has had 3 days of pain in the lower left abdomen. The pain was intermittent but has been constant over the past day. He has had nausea and fever for the past 2 days and is urinating more frequently than usual. The patient has a history of chronic constipation and right inguinal hernia repair 20 years ago. He currently takes no medications. His temperature is 38.6 C (101.3 F), blood pressure is 122/80 mm Hg, pulse is 98/min, and respirations are 16/min. His abdomen is soft but tender to palpation in the lower left quadrant. Deep palpation is difficult and reveals no masses or organomegaly. Bowel sounds are present. Rectal examination reveals normal prostate without nodules or enlargement. Costovertebral angle tenderness is absent. Laboratory results are as follows: Which of the following is the most appropriate next test to diagnose this patient's condition?
A)Abdominal CT scan with contrast
B)Barium contrast enema
C)Sigmoidoscopy
D)Small bowel follow-through
E)Upright abdominal film
F)Urine culture

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