Inflammatory Bowel Disease USMLE Step 1 Practice Question
A 23-year-old woman with a 4-year history of Crohn disease presents to the emergency department with acute onset severe periumbilical abdominal pain, fever (38.9°C), and persistent vomiting. On examination, she has marked rebound tenderness and rigidity in the right lower quadrant. Vital signs show BP 108/72 mmHg, HR 102 bpm, RR 18/min, SpO2 98% on room air. She denies recent nonsteroidal anti-inflammatory drug use or antimotility agents. Laboratory studies reveal WBC 13,200/μL, hemoglobin 10.2 g/dL, and albumin 2.8 g/dL. Abdominal CT with IV contrast demonstrates free intraperitoneal air, a 6-cm loculated fluid collection adjacent to the ileocecal region, and segmental bowel wall thickening. Which of the following is the most appropriate initial management?
Answer choices
- AAdminister high-dose IV corticosteroids and broad-spectrum antibiotics with close clinical monitoring
- BInitiate NPO status, obtain urgent surgical consultation, and begin fluid resuscitation with broad-spectrum antibioticsCorrect answer
- CPerform percutaneous CT-guided drainage of the collection and continue current immunosuppressive therapy
- DAdminister infliximab to induce remission followed by surgical intervention if clinical deterioration occurs
- EPerform diagnostic colonoscopy with biopsies to confirm diagnosis and assess disease extent
- FStart empiric antifungal therapy pending cultures given immunocompromised status from chronic corticosteroid use
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