Aquifer FMCases Quiz at the end of cases 20-29 Questions 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 B. Discussing the patients diet, and educating him about avoiding dairy products C. Performing a CBC, TSH, complete metabolic panel, and stool studies D. Prescribing an antispasmodic E. Scheduling the patient for a CT scan of the abdomen to rule out small bowel obstruction correct answer: 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. 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 after that part is completed D. Give the patient referrals to neurology and orthopedics to evaluate the patients headache and arm pain E. Prescribe Tylenol 650mg po BID to manage the pain, and tell the patient to return in a week if symptoms have not disappeared correct answer: 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