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A 71-year-old female presents to her primary care physician with a four-day history of left lower quadrant abdominal pain. The patient also complains of diarrhea and mild nausea. She continues to tolerate a diet, though reduced in quantity. On exam, her vitals are T 101F HR 86, BP 130/92, RR 15, and SaO2 100%. Abdominal exam is notable for left lower quadrant tenderness to palpation without rebound or guarding. Urine dipstick is normal and complete blood count shows a minor leukocytosis with a left shift. A screening colonoscopy from a year ago is shown in Figure A. What is the next best step in management?
Trimethoprim-sulfamethoxazole and a liquid diet
Abdominal CT with IV contrast
CT angioplasty of mesenteric vessels
Laparotomy and surgical management
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A 65-year-old man with a history of constipation is admitted to your floor with left lower quadrant pain. The patient states that he has been previously admitted with similar pain. He denies any medical history, but states that he does not like to eat vegetables. His wife states that he has had increasing pain over the last few days and that this time, the pain is more intense and that the patient has had higher fevers of up to 102°F (38.9°C). On exam, the patient's vitals are HR 102, T 101.9°F (38.8°C), BP 140/60, and RR 14. The patient has tenderness to palpation along with rebounding and guarding. Figure A shows a CT scan of the patient's abdomen and pelvis. What is the definitive treatment for this patient?
Antibiotics and surveillance
Emergent operative treatment
A 70-year-old man with a history of chronic constipation presents to the emergency department with a two-day history of left lower quadrant abdominal pain. He is found to have a temperature of 100.8F, BP 140/90, HR 85, and RR 16. On physical examination, he is tender to light palpation in the left lower quadrant and exhibits voluntary guarding. Rectal examination reveals heme-positive stool. Laboratory values are unremarkable except for a WBC count of 12,500 with a left shift. Which of the following tests would be most useful in the diagnosis of this patient's disease?
Left lower quadrant ultrasound
A 68-year-old man presents to the emergency department with left lower quadrant abdominal pain and fever for 1 day. He states during this time frame he has had a decreased appetite. The patient had surgery for a ruptured Achilles tendon 1 month ago and is still recovering but is otherwise generally healthy. His temperature is 102°F (38.9°C), blood pressure is 154/94 mmHg, pulse is 90/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam is remarkable for an uncomfortable man with left lower quadrant abdominal tenderness without rebound findings. Fecal occult test for blood is positive. Laboratory studies are ordered as seen below. Hemoglobin: 10 g/dLHematocrit: 30%Leukocyte count: 13,500/mm^3Platelet count: 157,000/mm^3Which of the following is the most appropriate next step in management?
Ceftriaxone and metronidazole
Ciprofloxacin and metronidazole
A 67-year-old woman presents to the emergency department with diffuse abdominal pain. She states that it started yesterday and has been gradually worsening. She endorses subjective fevers and diarrhea that she believes to be worsening. She has a history of obesity and diabetes. Her temperature is 102°F (38.9°C), blood pressure is 110/80 mmHg, pulse is 122/min, and respirations are 16/min. Physical exam reveals a fast, regular heart rate and left lower quadrant abdominal tenderness. A CT scan demonstrates fat stranding and edema surrounding the colon with a small amount of intraperitoneal free air. Which of the following is the most appropriate antibiotic regimen for this patient?
Daptomycin and clindamycin
Linezolid and clindamycin
Vancomycin and cefepime
Vancomycin and metronidazole