A 26-Year-Old Man Comes to the Emergency Department Due to 6

question 309

Multiple Choice

A 26-year-old man comes to the emergency department due to 6 weeks of intermittent lower abdominal pain and cramps accompanied by rectal urgency, bloody diarrhea, nausea, and decreased appetite.  His symptoms have become more severe over the past 2 days.  The patient has never traveled outside the country and has not been prescribed antibiotics recently.  Temperature is 38.5 C (101.3 F) , blood pressure is 90/50 mm Hg, pulse is 130/min, and respirations are 15/min.  The patient is ill appearing and lethargic.  Bowel sounds are decreased.  The abdomen is distended, tympanic to percussion, and diffusely tender to palpation; rebound tenderness and muscle rigidity are absent.  Rectal examination shows marked tenderness and mucus mixed with blood in the vault.  Laboratory results are as follows: Intravenous fluids are started, with improvement of blood pressure to 104/58 mm Hg and pulse to 108/min.  Which of the following is the most appropriate next step in management of this patient?

• A)Barium enema
• B)Colonoscopy with biopsies
• C)CT scan of the abdomen
• D)Emergency surgery
• E)Opioid analgesics
• F)Stool sample for ova and parasites
• G)Sulfasalazine

---

Definitions:

Disrupting Effect

An impact that significantly alters the usual function or process of something.

Premenstrual Disorder

A term likely meant to refer to premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD), conditions characterized by emotional and physical symptoms that occur in the one to two weeks before a woman's period.

Menstrual Disturbance

Menstrual disturbance refers to any abnormal condition or disorder in the menstrual cycle, including irregular, missed, or heavy periods.

Menstruation

The monthly process in which the lining of the uterus is shed, resulting in bleeding through the vagina, if pregnancy has not occurred.