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Aquifer FM Cases Quiz at the end of
cases 20-29 With Complete Solutions.
*Case 20: Question 1*
A 34-year-old male comes to the clinic complaining of abdominal pain. He says the pain
has been bothering him for the past two weeks. He reports episodes of diarrhea and
constipation, with more episodes of constipation. He states he has noticed an increase in
flatulence. He denies any nausea or vomiting. He has noticed mucus in his stools, but
no blood. He states that he cannot recall if anything aggravates the pain, but admits to
being under more stress than usual, due to his mother-in-law moving in with him and
his wife. Vital signs show a blood pressure of 124/76 mmHg, pulse of 74, respirations of
16, a temperature of 97.9, and oxygen saturation of 98% on room air. Physical exam is
unremarkable.
The most appropriate initial step in management is:
A. Scheduling the patient for a colonoscopy to look for colon cancer
Katelyn Whitman© 2025, All Rights Reserved.
,2|Page
B. Discussing the patients diet, and educating him about avoiding dairy produ - ✔✔The
correct answer is C.
Performing a CBC, TSH, complete metabolic panel, and stool studies
The patient most likely has a diagnosis of irritable bowel syndrome. When a patient
presents with abdominal pain, mucus in stool, episodes of diarrhea and/or
constipation, it is appropriate to perform lab studies to rule out other etiologies, such as
infection, autoimmune disease, or an obstruction. Since IBS is a diagnosis of exclusion,
the diagnosis can be made once other sources of abdominal pain have been ruled out by
appropriate studies.
*Case 20: Question 2*
A 24-year-old female presents to the clinic complaining of a headache and arm pain.
She is accompanied by her boyfriend, who insists on staying in the room with her
during the visit. When asked to describe when she noticed the pain and how it
occurred, the boyfriend states that the patient hit her head on the bathroom cabinet two
days ago, and fell on her side afterwards, hitting her arm. The patient nods in
agreement, while looking down at the floor.
Katelyn Whitman© 2025, All Rights Reserved.
,3|Page
The next best step in obtaining an accurate history and physical exam is to:
A. Direct all questions to the boyfriend, since it appears the patient does not want to
discuss her situation with you
B. Accuse the boyfriend of domestic abuse and call the police to report him
C. Ask the boyfriend to leave the room so you can perform the physical exam, and
explain that you always do that part of the exam with just the patient, and that he may
join you - ✔✔The correct answer is C.
Ask the boyfriend to leave the room so you can perform the physical exam, and explain
that you always do that part of the exam with just the patient, and that he may join you
after that part is completed
When domestic violence is suspected and the partner is present for the visit, the best
step in obtaining an accurate history and physical from the patient is to politely but
firmly ask the partner to leave the room. To aid you in asking the partner to leave, it is
suitable to tell them that the next part of the exam is done with the patient
independently, and the partner may rejoin you and the patient after the exam is
Katelyn Whitman© 2025, All Rights Reserved.
, 4|Page
performed. ** If the partner still insists on staying, use other tactics, such as a test
performed outside of the exam room or by taking the patient to get a urine sample.
*Case 20: Question 3*
A 22-year-old female comes to the clinic complaining of frequent urination. She states
she has noticed some increased frequency for the past week. She denies itching or pain
in the vaginal area, but reports a burning sensation during urination that began a week
ago. When asked if she has noticed blood in her urine, she admits to not paying
attention to its color. She states that she has some abdominal pain in her pelvic area. She
admits to being inconsistent with her birth control pills, and states she is sexually active.
She does not recall the date of her last menstrual period. Urine hCG test is negative.
Physical exam reveals suprapubic tenderness. She exhibits no costovertebral angle
tenderness. Vital signs show a blood pressure of 126/78 mmHg, temperature of 98.2,
respirations of 18, heart rate of 82, and oxygen saturation of 97%.
The most likely diagnosis is:
A. Pyelonephritis
B. Urosep - ✔✔The correct answer is D.
Katelyn Whitman© 2025, All Rights Reserved.
Aquifer FM Cases Quiz at the end of
cases 20-29 With Complete Solutions.
*Case 20: Question 1*
A 34-year-old male comes to the clinic complaining of abdominal pain. He says the pain
has been bothering him for the past two weeks. He reports episodes of diarrhea and
constipation, with more episodes of constipation. He states he has noticed an increase in
flatulence. He denies any nausea or vomiting. He has noticed mucus in his stools, but
no blood. He states that he cannot recall if anything aggravates the pain, but admits to
being under more stress than usual, due to his mother-in-law moving in with him and
his wife. Vital signs show a blood pressure of 124/76 mmHg, pulse of 74, respirations of
16, a temperature of 97.9, and oxygen saturation of 98% on room air. Physical exam is
unremarkable.
The most appropriate initial step in management is:
A. Scheduling the patient for a colonoscopy to look for colon cancer
Katelyn Whitman© 2025, All Rights Reserved.
,2|Page
B. Discussing the patients diet, and educating him about avoiding dairy produ - ✔✔The
correct answer is C.
Performing a CBC, TSH, complete metabolic panel, and stool studies
The patient most likely has a diagnosis of irritable bowel syndrome. When a patient
presents with abdominal pain, mucus in stool, episodes of diarrhea and/or
constipation, it is appropriate to perform lab studies to rule out other etiologies, such as
infection, autoimmune disease, or an obstruction. Since IBS is a diagnosis of exclusion,
the diagnosis can be made once other sources of abdominal pain have been ruled out by
appropriate studies.
*Case 20: Question 2*
A 24-year-old female presents to the clinic complaining of a headache and arm pain.
She is accompanied by her boyfriend, who insists on staying in the room with her
during the visit. When asked to describe when she noticed the pain and how it
occurred, the boyfriend states that the patient hit her head on the bathroom cabinet two
days ago, and fell on her side afterwards, hitting her arm. The patient nods in
agreement, while looking down at the floor.
Katelyn Whitman© 2025, All Rights Reserved.
,3|Page
The next best step in obtaining an accurate history and physical exam is to:
A. Direct all questions to the boyfriend, since it appears the patient does not want to
discuss her situation with you
B. Accuse the boyfriend of domestic abuse and call the police to report him
C. Ask the boyfriend to leave the room so you can perform the physical exam, and
explain that you always do that part of the exam with just the patient, and that he may
join you - ✔✔The correct answer is C.
Ask the boyfriend to leave the room so you can perform the physical exam, and explain
that you always do that part of the exam with just the patient, and that he may join you
after that part is completed
When domestic violence is suspected and the partner is present for the visit, the best
step in obtaining an accurate history and physical from the patient is to politely but
firmly ask the partner to leave the room. To aid you in asking the partner to leave, it is
suitable to tell them that the next part of the exam is done with the patient
independently, and the partner may rejoin you and the patient after the exam is
Katelyn Whitman© 2025, All Rights Reserved.
, 4|Page
performed. ** If the partner still insists on staying, use other tactics, such as a test
performed outside of the exam room or by taking the patient to get a urine sample.
*Case 20: Question 3*
A 22-year-old female comes to the clinic complaining of frequent urination. She states
she has noticed some increased frequency for the past week. She denies itching or pain
in the vaginal area, but reports a burning sensation during urination that began a week
ago. When asked if she has noticed blood in her urine, she admits to not paying
attention to its color. She states that she has some abdominal pain in her pelvic area. She
admits to being inconsistent with her birth control pills, and states she is sexually active.
She does not recall the date of her last menstrual period. Urine hCG test is negative.
Physical exam reveals suprapubic tenderness. She exhibits no costovertebral angle
tenderness. Vital signs show a blood pressure of 126/78 mmHg, temperature of 98.2,
respirations of 18, heart rate of 82, and oxygen saturation of 97%.
The most likely diagnosis is:
A. Pyelonephritis
B. Urosep - ✔✔The correct answer is D.
Katelyn Whitman© 2025, All Rights Reserved.
