* nbme 4 bl3 q24
		#413948
	unstableangina - 05/27/09 05:33
	24 A hospitalized 37-year-old woman has the sudden onset of fever 7 days after undergoing splenectomy for immune thrombocvtopenic purpura. She has had moderate abdominal pain and mild left shoulder pain for 2 days Her hemoglobin concentration has ranged from 9.5 g”dL to 10 g/dL since the operation Current medications include hydrocodonie and docusate Her temperature is 39 1°C (102 4°F) Abdominal examination shows mild distention and diffuse tenderness without rebound, rigidity, or guarding Bowel sounds are absent Laboratory studies show: Hemoglobin 98 g/dL Leukocyte count 21,3oo1mm3 Segmented neutrophils 50% Bands 17% Eosinophils 3% Lymphocytes 25% Monocytes 5% Platelet count 105,000/mm3 Serum amylase 124 U/L A chest x-ray shows a left pleural effusion. Which of the following is the most likely cause of these findings? O A) Aspiration O B) Gastric perforation O C) Pancreatitis O D) Pneumonia 0 E) Subphrenic abscess
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