pls help me w this q? - satirolx

[ArchivalUser]

A 21-year-old married woman comes to the emergency department because of a 1-week history of severe, worsening pelvic pain and a 24-hour history of nausea, fever, and chills. She has not had dysuria but she did have one loose stool earlier today, and she has noted a malodorous vaginal discharge. She has been unable to have intercourse due to the pain. Medical history is unremarkable and she takes no medications. Her last menstrual period was 3 weeks ago. She does not use contraception regularly. She does not smoke cigarettes or drink alcoholic beverages. The patient appears ill and is lying supine on the examination table. Vital signs are temperature 38.3°C (100.9°F), pulse 108/min, respirations 18/min, and blood pressure 110/72 mm Hg. The abdomen is nondistended with tenderness in the right lower quadrant without rebound. Pelvic examination discloses cervical motion tenderness and a tender 4-cm right adnexal mass. Results of laboratory studies are shown:
Serum Blood 3-hCG negative Hematocrit 36.8% Hemoglobin 13.9 g/dL WBC 15000/mm3
Pelvic ultrasonography shows a right adnexal, complex, 4.5-cm mass with air-fluid level; blood flow to the ovary is normal. Which of the following is the most appropriate next step?
A) CT-guided percutaneous drainage
B) Culdocentesis
C) Intravenous antibiotic therapy
D) Laparoscopy ?
E) Ultrasonography-guided placement of a vaginal drain

[ArchivalUser]

A 98-year-old female resident of an assisted-living facility is brought to the office by her daughter because of a 6-month history of weight loss. The patient says, "I've felt okay but have had to buy a whole new wardrobe because all of my old clothes are too big now." She has not had abdominal pain, nausea, vomiting, constipation, or diarrhea. Her appetite is unchanged and she has no problems with her diet. She eats all her meals in her own room. Medical history is significant for osteoarthritis. Medications include acetaminophen as needed for pain. BMI is 22 kg/m2. She has lost 11 kg (25 lb) since her last office visit 6 months ago. Vital signs are temperature 36.6°C (97.8°F), pulse 78/min, respirations 16/min, and blood pressure 126/88 mm Hg. Physical examination discloses interosseous wasting bilaterally, but muscle tone and strength are normal. The remainder of the physical examination discloses no abnormalities. The patient's total daily caloric intake is recorded and shows that she eats 60% of her meals and consumes 1000 calories daily. Which of the following is the most appropriate next step?
A) Begin enteral feedings via nasogastric tube B) Prescribe megestrol therapy C) Recommend eating meals in the facility dining hall D) No intervention is indicated

[ArchivalUser]

C for both

[ArchivalUser]

question 1 looks like abscess. wudnt u do drainage A

[ArchivalUser]

An abscess must be drained but the first patient is already showing signs of infection. You'd want to treat the symptoms before definitive treatment.

[ArchivalUser]

thanks both
agree with the second, lady most eat supervise
in the first the q said: Which of the following is the most appropriate next step?
it is an abscess, we need drain and culture,
so most probably A.

[ArchivalUser]

For the first question the answer is C

TOA, a complication of her PID. Size less tx IV antibiotics

Second question, I again agree with saad182, it's C

[ArchivalUser]

Sorry...It should say, size less than 9 cm is treated with IV antibiotics

[ArchivalUser]

totally correct!!! page 127 Crash USMLE step 3. Pelvic abscess usually resolve with antibiotics.
C is the answer