A 42-year-old florist comes to your office, complaining of chronic
constipation for the last six months. She has had no nausea, vomiting, or
diarrhea, and no abdominal pain or cramping. She denies any recent illnesses
or injuries. She denies any changes to her diet or exercise program. She is on
no new medications. During the review of systems (ROS), you note that she
has felt fatigued, had some weight gain, has irregular periods, and has cold
intolerance. Her past medical history is significant for one vaginal delivery
and two cesarean sections. She is married, has three children, and owns a
flower shop. She denies tobacco, alcohol, or drug use. Her mother has type 2
diabetes and her father has coronary artery disease. There is no family history
of cancers. On examination, she appears her stated age. Her vital signs are
normal. Her head, eyes, ears, nose, throat, and neck examinations are normal.
Her cardiac, lung, and abdominal examinations are also unremarkable. Her
rectal occult blood test is negative. Her deep tendon reflexes are delayed in
response to a blow with the hammer, especially the Achilles tendons.
What is the best choice for the cause of her constipation?
Question 1 options:
Large bowel obstruction
Irritable bowel syndrome
Rectal cancer
Hypothyroidism
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, Question 2 (1 point)
2
A 76-year-old retired farmer comes to your office complaining of abdominal
pain, constipation, and a low-grade fever for about three days. He denies any
nausea, vomiting, or diarrhea. The only unusual thing he remembers eating is
two bags of popcorn at the movies with his grandson, three days before his
symptoms began. He denies any other recent illnesses. His past medical
history is significant for coronary artery disease and high blood pressure. He
has been married for over fifty years. He denies any tobacco, alcohol, or drug
use. His mother died of colon cancer and his father had a stroke. On
examination, he appears his stated age and is in no acute distress. His
temperature is 100.9 degrees and his other vital signs are unremarkable. His
head, cardiac, and pulmonary examinations are normal. He has normal bowel
sounds and is tender over the left lower quadrant. He has no rebound or
guarding. His rectal examination is unremarkable and his fecal occult blood
test is negative. His prostate is slightly enlarged but his testicular, penile, and
inguinal examinations are all normal. Blood work is pending.
What diagnosis for abdominal pain best describes his symptoms and signs?
Question 2 options:
Acute diverticulitis
Acute cholecystitis
Acute appendicitis
Mesenteric ischemia
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Question 3 (1 point)
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