111.A 71-year-old woman presents to the ED with 12-hours of emesis
and abdominal pain. Her temperature is 101.2°F, BP is 100/79 mm Hg, and
HR is 104 beats per minute. Physical examination reveals a tender (2 ×2)-cm
bulge with erythema below the inguinal ligament and abdominal disten-
sion. An occasional high-pitched bowel sound is heard. After placing an IV
line and nasogastric tube, which of the following is the most appropriate
course of management?
a. Administer broad-spectrum antibiotics and then obtain a CT scan of abdomen
b. Administer broad-spectrum antibiotics and attempt reduction
c. Administer broad-spectrum antibiotics and prepare the patient for the OR
d. Administer broad-spectrum antibiotics and obtain a plain radiograph
e. Administer broad-spectrum antibiotics and observe
112.You are working in the ED on a Sunday afternoon when four people
present with acute onset vomiting and crampy abdominal pain. They were
all at the same picnic and ate most of the same foods. The vomiting began
approximately 4 hours into the picnic. They deny having any diarrhea. You
believe they may have “food poisoning” so you place IV lines, administer IV
fluids, and observe. Over the next few hours, the patients begin to improve,
the vomiting stops and their abdominal pain resolves. Which of the follow-
ing is the most likely cause of their presentation?
a. Scombroid fish poisoning
b. Staphylococcal food poisoning
c. Clostridium perfringensfood poisoning
d. Campylobacter
e. Salmonellosis
98 Emergency Medicine