98.A 59-year-old woman presents to the ED complaining of worsening lower
abdominal pain over the previous 3 days. She describes feeling constipated
recently and some burning when she urinates. Her BP is 135/75 mm Hg, HR
is 89 beats per minute, temperature is 101.2°F, and her RR is 18 breaths per
minute. Her abdomen is mildly distended, tender in the LLQ, and positive for
rebound tenderness. CT scan is consistent with diverticulitis with a 7-cm
abscess. Which of the following is the most appropriate management for this
condition?
a. Reserve the OR for emergent laparotomy.
b. Start treatment with ciprofloxacin and metronidazole and plan for CT-guided
draining of the abscess.
c. Give an IV dose of ciprofloxacin and have the patient follow-up with her primary
physician.
d. Start treatment with ciprofloxacin and metronidazole and plan for an emergent
barium enema.
e. Start treatment with ciprofloxacin and metronidazole and prep for an emergent
colonoscopy.
99.A 29-year-old man presents to the ED complaining of RLQ pain for
24 hours. He states that the pain first began as a dull feeling around his
umbilicus and slowly migrated to his right side. He has no appetite, is nause-
ated, and vomited twice. His BP is 130/75 mm Hg, HR is 95 beats per minute,
temperature is 100.9°F, and his RR is 16 breaths per minute. His WBC is
14,000/μL. As you palpate the LLQ of the patient’s abdomen, he states that his
RLQ is painful. What is the name of this sign?
a. Blumberg sign
b. Psoas sign
c. Obturator sign
d. Raynaud sign
e. Rovsing sign
92 Emergency Medicine