gastroenterology q13 diverticulitis - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 3 Forum

USMLE Step 3 Forum USMLE Step 3 Discussion Forum: Let's talk about anything related to USMLE Step 3 exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 05-20-2013
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 720
Threads: 217
Thanked 551 Times in 308 Posts
Reputation: 561
Default gastroenterology q13 diverticulitis

A 37-year-old woman presents with abdominal pain, anorexia, and fever of 4 days’ duration. The abdo* minal pain is mostly in the left lower quadrant. Her past medical history is significant for irritable bowel syndromediverticulitis treated 6 months ago, and status post-appen-dectomy. Since her last bout of diverticulitis she has increased her fiber intake and avoids nuts and popcorn. Review of sys-tems is positive for weight loss, daily chills and sweats, and “bubbles” in her urinary stream. Her temperature is 39.6°C.
A limited CT scan shows thickened colonic wall (5 mm) and inflammation with pericolic fat stranding. She is admitted with a presumptive diagnosis of diverticulitis. What is the most appropriate management for this patient?

A. A trial of rifaximin and a high-fiber diet
B. Bowel rest, ciprofloxacin, metronidazole, and ampicillin
C. Examination of the urine sediment
D. Measurement of 24-hour urine protein
E. Surgical removal of the affected colon and exploration
Reply With Quote Quick reply to this message



  #2  
Old 05-20-2013
XpaezX's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,216
Threads: 41
Thanked 1,316 Times in 706 Posts
Reputation: 1331
Default

Quote:
Originally Posted by cingulate.gyrus View Post
A 37-year-old woman presents with abdominal pain, anorexia, and fever of 4 days’ duration. The abdo* minal pain is mostly in the left lower quadrant. Her past medical history is significant for irritable bowel syndromediverticulitis treated 6 months ago, and status post-appen-dectomy. Since her last bout of diverticulitis she has increased her fiber intake and avoids nuts and popcorn. Review of sys-tems is positive for weight loss, daily chills and sweats, and “bubbles” in her urinary stream. Her temperature is 39.6°C.
A limited CT scan shows thickened colonic wall (5 mm) and inflammation with pericolic fat stranding. She is admitted with a presumptive diagnosis of diverticulitis. What is the most appropriate management for this patient?

A. A trial of rifaximin and a high-fiber diet
B. Bowel rest, ciprofloxacin, metronidazole, and ampicillin
C. Examination of the urine sediment
D. Measurement of 24-hour urine protein
E. Surgical removal of the affected colon and exploration
This is her second attack of Diverticulitis... and this vignette shows she is starting to be septic.. and also she is YOUNG ... in these patients the best approach is to remove the affected colonic area... the odds of ANOTHER attack are too high.. so just take the colon out
Reply With Quote Quick reply to this message
The above post was thanked by:
cingulate.gyrus (05-21-2013)
  #3  
Old 05-21-2013
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 720
Threads: 217
Thanked 551 Times in 308 Posts
Reputation: 561
Default

Quote:
Originally Posted by XpaezX View Post
This is her second attack of Diverticulitis... and this vignette shows she is starting to be septic.. and also she is YOUNG ... in these patients the best approach is to remove the affected colonic area... the odds of ANOTHER attack are too high.. so just take the colon out
Yes
e answer is E. Surgical therapy is indicated in all low-risk surgical patients with complicated diverticular disease. Patients with at least two episodes of diverticuli-tis requiring hospitalization, with disease that does not respond to medical therapy, or who develop intra-abdominal complications are considered to have complicated disease.
Complicating this patient’s relapse of diverticulitis is probably an enterovesicular fistula causing pneumaturia. Studies indicate that younger patients (<50 years) may experience a more aggressive form of the disease than older patients, and therefore waiting for more than two attacks before considering surgery is not recommended. Rifaximin is a poorly absorbed broad-spectrum antibiotic that, when combined with a fiber-rich diet, is asso-ciated with less frequent symptoms in patients with uncomplicated diverticular disease.
Pneumaturia represents a potential surgical urgency and should not be confused with proteinuria.
Reply With Quote Quick reply to this message



Reply

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Gastroenterology q6 cingulate.gyrus USMLE Step 3 Forum 6 05-26-2013 01:42 AM
gastroenterology q4 cingulate.gyrus USMLE Step 3 Forum 10 05-19-2013 01:08 PM
acute diverticulitis CT scan tyagee USMLE Step 2 CK Forum 4 11-10-2012 04:24 PM
Treating Diverticulitis on CCS DRFP USMLE Step 3 Forum 4 08-18-2012 06:51 PM
CT and acute diverticulitis tyagee USMLE Step 2 CK Forum 4 04-27-2012 10:20 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)