108.A 27-year-old man is seen in the ED for a leak around a surgical
G-tubethat was placed 2 weeks ago and has been used for enteral feeding for
1 week. Inspection reveals the tube is pulled out from the stoma, but is still
in the cutaneous tissue. The abdomen is soft and nondistended and there
are no signs of skin infection. Which of the following is the most appropri-
ate next step in management?
a. Insert a Foley catheter into the tract and aspirate. If gastric contents are aspi-
rated the tube can be used for feeding.
b. Insert a Foley catheter into the tract, instill water-soluble contrast, and obtain
an abdominal radiograph prior to using for feeding.
c. Remove the tube and admit the patient for observation.
d. Remove the tube and immediately obtain a CT scan of the abdomen.
e. Return to the OR for closure of gastrotomy and placement of a new tube.
109.A 30-year-old man presents to the ED complaining of sudden onset of
abdominal bloating and back pain lasting for 2 days. The pain woke him up
from sleep 2 nights ago. It radiates from his back to his abdomen and down
toward his scrotum. He is in severe pain and is vomiting. His temperature is
101.2°F and HR is 107 beats per minute. A CT scan reveals a 9-mm
obstructing stone of the left ureter with hydronephrosis. Urinalysis is posi-
tive for 2+ blood, 2+ leukocytes, 2+ nitrites, 40 to 50 WBCs, and many bac-
teria. You administer pain medicine, antiemetics, and antibiotics. Which of
the following is the most appropriate next step in management?
a. Admit for IV antibiotics and possible surgical removal of stone.
b. Observe in ED for another 6 hours to see if stone passes.
c. Discharge with antibiotics and pain medicine.
d. Discharge patient with instructions to consume large amounts of water.
e. Discharge patient with antibiotics, pain medicine, and instructions to drink
large amounts of water and cranberry juice.
110.For which of the following patients is an abdominal CT scan
contraindicated?
a. A 52-year-old man with abdominal pain after blunt trauma, negative focused
assessment with sonography for trauma (FAST) examination, BP 125/78 mm Hg,
and HR 109 beats per minute
b. A 22-year-old female with RLQ pain, negative β-hCG, temperature 100.6°F
c. A 45-year-old man with abdominal pain, temperature 100.5°F, WBC 11,200/μL,
BP 110/70 mm Hg, HR 110 beats per minute, and lipase 250 IU
d. A 70-year-old man with abdominal pain, an 11-cm pulsatile mass in the epi-
gastrium, BP of 70/50 mm Hg, and HR of 110 beats per minute
e. A 65-year-old woman with right flank pain that radiates to her groin, microhe-
maturia, BP 165/85 mm Hg, and HR 105 beats per minute
Abdominal and Pelvic Pain 97