inward, the tear is in the lateral meniscus. (e)McBurney sign represents
maximum tenderness and rigidity over McBurney point (two-third the dis-
tance from the umbilicus to the anterior superior iliac spine), which may be
indicative of appendicitis.
121.The answer is c.(Tintinalli, pp 1547-1551.)Crohn diseaseis charac-
terized by chronic inflammation extending through all layers of the bowel
wall.Onset is generally between the ages of 15 and 40 years. Crohn disease
should be suspected in any patient whose symptoms show a picture consis-
tent with chronic inflammatory colitis. Extraintestinal manifestations are seen
in 25% to 30% of patients. The incidence is similar for Crohn disease and
ulcerative colitis. They include aphthous ulcers, erythema nodosum, iritis or
episcleritis, arthritis, and gallstones. Nephrolithiasisis seen as a result of
hyperoxaluria because of increased oxalate absorption in patients with ileal
disease. Because ulcerative colitis affects only the large bowel, this extrain-
testinal manifestation is seen only in patients with Crohn disease.
122.The answer is e.(Tintinalli, pp 606-611.) Chlamydia trachomatis
urethritisaccounts for 5% to 20% of cases of dysuria, and its presence may
besuspected when urine cultures are sterile.If clinical symptoms and
urinalysis point to a UTI, urine cultures are sterile, and standard antibiotic
regimens effective against most urinary pathogens fail, consider Chlamydia
urethritis.
(a)Although group A streptococcus is a possible pathogen, it would
be very rare and would be susceptible in most cases to the antibiotics that
the patient has taken. (b)Initial episodes of herpes simplex virus can result
in symptoms that mimic true dysuria secondary to sensitivity of lesions on
the external genital surface or near the urethra. Generally, these episodes
are accompanied by fever, chills, and systemic symptoms, in addition to
extremely painful and tender lesions. Also, urinary frequency would not be
common.(c)AlthoughT vaginaliswould not respond to the previous
antibiotic therapy, trichomoniasis presents with a copious frothy vaginal
discharge and would have been seen on wet mount preparation of the vagi-
nal secretions. (d)Escherichia coliaccounts for 70% to 90% of community-
acquired UTIs in women. In a woman without recurrent UTIs, the
antibiotics taken by this patient would be appropriate. In a patient with
recurrent UTIs, it is more likely that the E coliwould be resistant to stan-
dard antimicrobial regimens. This pathogen should have also been grown
on the standard culture medium.
Abdominal and Pelvic Pain Answers 127