Question

A 75-year-old man presents to the emergency department for abdominal pain. The patient states the pain started this morning and has been worsening steadily. He decided to come to the emergency department when he began vomiting. The patient has a past medical history of obesity, diabetes, alcohol abuse, and hypertension. His current medications include captopril, insulin, metformin, sodium docusate, and ibuprofen. His temperature is 104.0°F (40°C), blood pressure is 160/97 mmHg, pulse is 90/min, respirations are 15/min, and oxygen saturation is 98% on room air. Abdominal exam reveals left lower quadrant tenderness. Cardiac exam reveals a crescendo systolic murmur heard best by the right upper sternal border. Lab values are ordered and return as below.

Hemoglobin: 15 g/dL
Hematocrit: 42%
Leukocyte count: 19,500 cells/mm^3 with normal differential
Platelet count: 226,000/mm^3

Serum:
Na+: 139 mEq/L
Cl-: 101 mEq/L
K+: 4.4 mEq/L
HCO3-: 24 mEq/L
BUN: 22 mg/dL
Glucose: 144 mg/dL
Creatinine: 1.2 mg/dL
Ca2+: 9.8 mg/dL

Which of the following is the most accurate test for this patient's condition?

a. Amylase and lipase levels
b. Barium enema
c. Colonoscopy
d. CT scan
e. Sigmoidoscopy

Answer 1

A CT scan is the most accurate test for the described patient to quickly visualize the abdominal organs and identify potential causes of the symptoms, such as inflammation or infection.

Step-by-step explanation:

The most accurate test for this patient's condition would be a CT scan.

Based on the patient's history of abdominal pain, vomiting, obesity, and tenderness on abdominal exam, along with the presence of a systolic heart murmur, there is concern for diverticulitis with possible diverticular abscess or perforation.

A CT scan of the abdomen would be the most appropriate test to evaluate for diverticulitis, as it can help identify the presence of inflammation, abscess, or free air in the abdomen.

The most accurate test for a 75-year-old man presenting to the emergency department with abdominal pain, a history of obesity, diabetes, alcohol abuse, and hypertension, and symptoms including vomiting and left lower quadrant tenderness is a CT scan. Given his symptoms and the crescendo systolic murmur heard best by the right upper sternal border, it is essential to rule out potential abdominal pathological conditions such as diverticulitis, abscess, or ischemic bowel. Considering the patient's elevated temperature of 104.0°F (40°C) and leukocytosis (elevated white blood cell count), the CT scan is the quickest and most efficient way to visualize the abdominal organs and look for signs of infection, inflammation, or other abnormalities.