122.A 23-year-old woman presents to the ED complaining of pain with uri-
nation. She has no other complaints. Her symptoms started 3 weeks ago.
During this time, she has been to the clinic twice, with negative urine cul-
tures each time. Her condition has not improved with antibiotic therapy with
sulfonamides or quinolones. Physical examination is normal. Which of the
following organisms is most likely responsible for the patient’s symptoms?
a. Staphylococcus aureus
b. Herpes simplex virus
c. Trichomonas vaginalis
d. Escherichia coli
e. Chlamydia trachomatis
123.A 43-year-old man presents to the ED complaining of progressively
worsening abdominal pain over the past 2 days. The pain is constant and
radiates to his back. He also describes nausea and vomiting and states he
usually drinks 6 pack of beer daily, but has not had a drink for 2 days. His
BP is 144/75 mm Hg, HR is 101 beats per minute, temperature is 99.8°F,
and RR is 14 breaths per minute. He is lying on his side with his knees
flexed. Examination shows voluntary guarding and tenderness to palpation
of his epigastrium. Laboratory results reveal WBC 10,500/μL, hematocrit
51%, platelets 225/μL, and lipase 620 IU. An abdominal radiograph reveals
a nonspecific bowel gas pattern. There is no free air under the diaphragm.
Which of the following is the most appropriate next step in management?
a. Observe in the ED
b. Send home with antibiotic therapy
c. Admit to the hospital for endoscopy
d. Admit to the hospital for exploratory laparotomy
e. Admit to the hospital for medical management and supportive care
104 Emergency Medicine