08-20-2007, 08:10 PM
16. A 22-year-old woman is in her 5th hospital day following admission for evaluation of severe right lower quadrant abdominal pain. During the previous 8 months, she has had episodes of abdominal pain with associated recurrent diarrhea, which sometimes contained blood. The pain and diarrhea became increasingly severe during the 5 days prior to admission. During that time, she lost 2 kg (5 lb) and had a temperature to 39.0°C (102.0°F). Abdominal examination on admission disclosed a right lower quadrant mass. Blood hemoglobin concentration was 15.5 g/dL and leukocyte count was 24,000/mm3. Colonoscopy showed linear ulcerations with discontinuous areas of inflammation. Biopsy of the lower intestine disclosed noncaseating granulomas. Serum antibody test to Saccharomyces cerevisiae was positive. Treatment with intravenous hydrocortisone therapy was begun. Today, the patient's abdominal pain and diarrhea are resolved. Vital signs are temperature 37.0°C (98.6°F), pulse 76/min, respirations 12/min, and blood pressure 122/74 mm Hg. The abdomen is soft and nontender to palpation; bowel sounds are normal. Which of the following is the most appropriate pharmacotherapy for this patient?
A
) Azathioprine
B
) Mesalamine
C
) Metronidazole
D
) Prednisone
E
) Ranitidine
A
) Azathioprine
B
) Mesalamine
C
) Metronidazole
D
) Prednisone
E
) Ranitidine