Answer and Explanation 25

25.  The correct answer is B.  This patient need admitted for observation.  His age is a significant co-morbid condition, and is not appropriate to treat him as an outpatient because it has been shown to increase mortality and morbidity.  A colonoscopy acutely is not indicated.  A barium enema could make the inflammation worse and could potentially cause perforation and should be avoided.  The diagnosis is already made.

Question 25

25.  Your patient is an 85 year old male that presents with LLQ pain, fever, and diarrhea.  His fever is 101, and the remainder of his vitals are normal.  His WBC count is 8.4.  The remainder of his lab data including chemistries are normal.  His CT scan reveals mild sigmoid diverticulitis without abscess.  His pain is controlled with Vicodin you gave him in the ER.  Which of the following is the best management option?


A.  Discharge the patient home on cipro, flagyl, and vicodin and follow up in 1 week

B.  Admit the patient to the hospital for IV antibiotics and observation

C.  Refer the patient for a colonoscopy to make sure this inflammatory process is not an occult malignancy.

D.  Send the patient for a barium enema

Answer and Explanation 24

24.  C is the correct answer.  This patient clinically has acute cholecystitis.  She needs admitted for IV antibiotics and general surgery consult.  Acutely, a cholecystectomy is not performed because of increase in complications.  It is better to let the infection and inflammation resolve then perform the procedure electively.  This patient should not be managed as an outpatient.

Question 24

24.  Your patient is a 45 year old female who presents with right upper quadrant abdominal pain, fever of 102, and nausea and vomiting.  The patient has normal liver function tests and lipase.  WBC count was 13.9.  Remainder of vitals are normal.  Gall bladder ultrasound reveals gallstones with a thickened gall bladder wall.  What is the best management option?

A.  Discharge the patient home with analgesics and referral to a general surgeon.

B.  Send the patient home with oral antibiotics and analgesics and referral to a general surgeon

C. Admit the patient for IV antibiotics, surgery consult, and further management

D.  Take the patient to the OR for an emergent cholecystectomy

Answer and Explanation 23

23.  D is correct.  Surgery is not curative for crohns disease but it is for ulcerative colitis.  Ulcerative colitis is not transmural and crohns is.  That is why crohns patients are prone to abscess and perforation.  Smoking is actually shown to be protective in ulcerative colitis but not in crohns.  

Question 23

23.  Which of the following statements regarding Crohns and Ulcerative Colitis is incorrect?

A.  Ulcerative Colitis does not involve the entire wall of the colon and Crohns does

B.   Crohns patients are prone to abscesses.

C.  Smoking seems to be protective in patients with ulcerative colitis

D.  Surgery cures Crohns disease if it is resected.