QUESTION AND CORRECT SOLUTIONS WITH DETAILED RATIONALES
1. A 35-year-old female patient is seen in the clinic complaining of abdominal pain. Which of the
following should be included in the history and physical?
A. Past surgical history only
B. Diet history only
C. Nature of the pain, timing of the pain, palliative and provocative aspects, associated symptoms
(nausea/vomiting)
D. Only family history
Answer: C
Rationale: A thorough history and physical for abdominal pain should include characteristics of the pain,
timing, aggravating and relieving factors, and associated symptoms to guide diagnosis.
2. A patient comes to the office complaining of constipation. The patient lists all of the following
medications. Which drug could be responsible for the constipation?
A. Ibuprofen
B. Pepto-Bismol
C. Acetaminophen
D. Amoxicillin
Answer: B
Rationale: Bismuth subsalicylate (Pepto-Bismol) can cause constipation as a side effect.
3. A patient is seen with complaints of diarrhea. Which of the following should be included in the
patient's differential diagnosis?
A. Blood pressure monitoring
B. Electrocardiogram
C. Frequency, amount and fluidity, color and characteristics; diet history; recent travel; medication
use; source of drinking water
D. Hearing test
Answer: C
Rationale: Proper assessment of diarrhea includes stool characteristics, diet, recent travel, medication
use, and water source to determine the etiology.
4. A 29-year-old Englishman is seen in the office with complaints of pain in his chest and belly. He has
been suffering the pain for 2 weeks and gets temporary relief from Alka-Seltzer. The burning wakes
him at night and radiates up to his chest. Which factor favors a diagnosis of gastric ulcer?
A. Pain relief with antacids only during the day
B. His use of Alka-Seltzer
, C. Nocturnal pain unrelated to meals
D. Pain improvement with meals
Answer: B
Rationale: Use of antacids that temporarily relieve pain may indicate a gastric ulcer rather than GERD.
5. Which of the following is most effective in diagnosing appendicitis?
A. CT scan alone
B. Abdominal X-ray
C. History and physical
D. MRI
Answer: C
Rationale: A detailed history and physical exam, including localized tenderness and rebound, remain the
primary method for diagnosing appendicitis.
6. A 46-year-old patient is seen in the clinic with abdominal pain. Which of the following tests is
essential for this patient?
A. Complete blood count only
B. Urine human chorionic gonadotropin (hCG)
C. Lipid panel
D. Stool culture
Answer: B
Rationale: In females of reproductive age, hCG is necessary to rule out pregnancy as a cause of
abdominal pain.
7. A 25-year-old accountant is seen in the clinic complaining of crampy abdominal pain after meals.
She is often constipated and takes laxatives, followed by a couple of days of diarrhea. She temporarily
feels better after a bowel movement. She states she is embarrassed by flatulence and abdominal
distension. She has had no weight loss or blood in her stool. This problem has gone on for about 6
months. What should the next step be?
A. Colonoscopy
B. Obtain a complete history
C. Immediate surgery
D. Prescribe antibiotics
Answer: B
Rationale: The pattern of alternating constipation and diarrhea with abdominal relief suggests irritable
bowel syndrome; obtaining a complete history is the next step.
8. A 28-year-old patient is seen in the clinic with colicky abdominal pain, particularly with meals. She
has frequent constipation, flatulence, and abdominal distension. Which of the data make a diagnosis
of diverticulitis unlikely?