84.A 24-year-old man woke up from sleep 1 hour ago with severe pain in
his right testicle. He states that he is sexually active with multiple partners.
On examination, the right scrotum is swollen, tender, and firm. You cannot
elicit a cremasteric reflex. His BP is 145/75 mm Hg, HR is 103 beats per
minute, RR is 14 breaths per minute, temperature is 98.9°F, and oxygen
saturation is 99% on room air. Which of the following is the most appro-
priate next step in management?
a. Administer one dose of ceftriaxone and doxycycline for 10 days and have him
follow-up with a urologist.
b. Swab his urethra, send a culture for gonorrhea and Chlamydia,and treat if
positive.
c. Send a urinalysis and treat for a urinary tract infection (UTI) if positive.
d. Treat the patient for epididymitis and have him return if symptoms persist.
e. Order a statim (STAT) color Doppler ultrasound and urologic consultation.
85.A 28-year-old man presents to the ED complaining of constant vague,
diffuse epigastric pain. He describes having a poor appetite and feeling nause-
ated ever since eating sushi last night. His BP is 125/75 mm Hg, HR is 96 beats
per minute, temperature is 100.5°F, and his RR is 16 breaths per minute. On
examination, his abdomen is soft and moderately tender in the right lower
quadrant (RLQ). Laboratory results reveal a WBC of 12,000/μL. Urinalysis
shows 1+ leukocyte esterase. The patient is convinced that this is food poi-
soning from the sushi and asks for some antacid. Which of the following is the
most appropriate next step in management?
a. Order a plain radiograph to look for dilated bowel loops.
b. Administer 40 cc of Maalox and observe for 1 hour.
c. Send the patient for an abdominal ultrasound.
d. Order an abdominal CT scan.
e. Discharge the patient home with ciprofloxacin.
82 Emergency Medicine