A 55-Year-Old Man Comes to the Emergency Department Due to Rectal

question 326

Multiple Choice

A 55-year-old man comes to the emergency department due to rectal pain.  The pain, which is described as excruciating and unrelenting, started abruptly 2 hours ago while the patient was having a bowel movement.  He denies fevers, abdominal pain, hematochezia, or unexpected weight loss.  Medical history is significant for chronic constipation.  Temperature is 37.5 C (99.5 F) , blood pressure is 125/75 mm Hg, pulse is 75/min, and respirations are 12/min.  The abdomen is nontender and nondistended.  Rectal examination reveals an exquisitely tender, purplish bulge just below the dentate line.  Which of the following is the immediate next step in management?

• A)Hemorrhoidectomy under local anesthesia
• B)Infrared coagulation
• C)Rubber band ligation
• D)Stool softeners and antispasmodics alone
• E)Stool softeners, antispasmodics, and antibiotics

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Definitions:

Modified Assembly-Line Job

A variation of traditional assembly-line work, often incorporating more flexibility or ergonomic considerations to improve worker satisfaction and efficiency.

Job Rotation

Increasing task variety by periodically shifting workers between different jobs.

Job Enlargement

Increasing task variety by combining into one job two or more tasks previously done by separate workers.

Horizontal Loading

A job design approach that increases the number of tasks at the same level of responsibility or complexity to enrich a job role.