Case

A 45-year-old presents with a small lump at their right groin. They indicate a painless lump has occasionally appeared and disappeared at that site in the past year, but the small lump is now continuously present. In the last few days the lump has recently become painful, and the area is very tender to the touch with localized erythema.  The patient has normal bowel movements and bowel sounds are unremarkable. The patient has a temperature of 38.5°C, respiratory rate of 30 breaths/minute, pulse of 110 beats/minute and blood pressure of 80/60mmHg. The patient's response to questions is slow and a few times during interview requires repeating the question.   

Question 3/3 - What further tests would you order to confirm or rule out your diagnosis before proceeding to treatment?

Click on your selected option(s) below  (correct = 1, over-thinking = 2+)

Case Complete

Incorrect. The problem is soft tissue (a hernia) which does not show well on x-ray.

Incorrect. CT shows reasonable soft tissue detail, but the amount of additional information gained by a groin CT in a hernia would be limited.  

Partially correct. Blood work would be part of the sequence of actions taken, but we would not wait on the results of blood work before starting treatment as that could take hours even for stat/rush lab work. 

Incorrect. MRI would provide excellent soft tissue definition to the region, but we have sufficient information from physical examination to move forward with initial treatment. MRI also takes several hours which would not be warranted in this case.

Incorrect. While the patient does have altered mentation, this is due to the sepsis rather than a neurological condition. Thus, a neurology work-up would not be needed at this stage. 

Correct!  The patient has sepsis which can be life threatening. Delay of care for further testing before starting treatment is not warranted.

Urgent to emergent surgery is needed to repair the bowel, which should not be delayed. Additionally, immediate intravenous antibiotics should be administered to combat the sepsis.  Initially this would be a broad spectrum antibiotic while awaiting blood work, followed by more tailored antibiotics once the microorganism has been identified.