Inflammatory Bowel Disease USMLE Step 1 Practice Question
A 34-year-old man with a 6-year history of Crohn disease presents to the emergency department with a 3-day history of progressive right lower quadrant pain, abdominal distension, and nausea. He denies vomiting or passage of stool for the past 24 hours. Vital signs: BP 128/82 mmHg, HR 92 bpm, RR 18/min, temperature 37.2°C, SpO2 98% on room air. On examination, the abdomen is distended with diminished bowel sounds and a tender, palpable right lower quadrant mass. Labs show WBC 11,200/μL, hemoglobin 9.8 g/dL, albumin 2.9 g/dL. CT abdomen/pelvis reveals a 5-cm fibrostenosing stricture of the terminal ileum with proximal small bowel dilation to 4 cm, adjacent mesenteric fat stranding, and a 3-cm phlegmon but no free perforation or abscess. Which of the following is the most appropriate initial management?
Answer choices
- ABowel rest, nasogastric decompression, and total parenteral nutrition with consideration for immunosuppressionCorrect answer
- BImmediate surgical resection of the strictured segment and primary anastomosis
- CEndoscopic balloon dilation of the stricture under fluoroscopic guidance
- DPercutaneous drainage of the phlegmon followed by colonoscopic evaluation and stricture dilation
- EInduction therapy with infliximab and azathioprine without bowel rest
- FInitiation of oral mesalamine and ciprofloxacin with outpatient gastroenterology follow-up
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