40-year-old man comes to the emergency department due to worsening right lower abdominal pain that radiates to the right groin
area. He has had the pain for the past 7 days, and it is slowly increasing. He also describes lever and anorexia. Two weeks ago, he
was treated lor lurunculosis or the right thigh. The patient has a history of type 1 diabetes mellitus and takes insulin. His temperature
is 38.8 C ( 101.9 FJ. Abdominal examination shows tenderness on deep palpation in the right lower quadrant without rebound or
guarding. No masses are palpated. Bowel sounds are present. Extension ol lhe right hip increases pain, and f texion decreases
pain. Rectal examination shows no abnorm alities, and skin is normal. Laboratory results are as follows:
Hemoglobin 10.9 g/dL
Leukocytes 13,500imm3
Platelets 450,000/mm’
Which of the following is the best next step in management of this patient?
- 0 A. Abdominal ultrasonogram
- 0 8. Abdominal x-ray
- 0 C . Colonoscopy
- 0 0. CT scan or abdomen and pelvis
- 0 E. Laparoscopic appendectomy
- 0 F. Right hip joint aspiration
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