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| * nbme 1 |
| | #175589 |
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1. A 70-year-old woman has had increasing abdominal pain over the past 2 days. She has renal failure and has been receiving peritoneal dialysis for 18 months; her last treatment was 2 hours ago. She appears toxic. Her temperature is 39 C (102.2 F), and blood pressure is 140/90 mm Hg. Her abdomen is distended and diffusely tender to deep palpation with rebound tenderness. Leukocyte count is 18,000/mm3. Which of the following is the most appropriate next step?
A ) X-ray films of the abdomen
B ) Comparison of abdominal fluid amylase with serum amylase activity
C ) Gram's stain of abdominal fluid
D ) Ultrasonography of the abdomen
E ) CT scan of the abdomen and pelvis
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| * Re:nbme 1 |
| #726641 |
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neither A D or E will tell you much about her condition
Since she has ascites the 1st evaluation will have to be to Tap and take sample for Gstain & Culure , to Id Infection |
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| * Re:nbme 1 |
| #727506 |
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SBP , get her ascitic fluid tap for Gm stain and Culture . However , shouldn't we start empiric antibiotics before that even ?
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| * Re:nbme 1 |
| #740587 |
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C..
.one more thing its most of the time negative for Grma stain and culture in SBP....so never exculde it if gram stain and culture are Negative...Big time Fact |
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