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1 | |
A 52-year-old woman complains of abdominal pain, bloating, and constipation. Her symptoms started about 5 years ago and became more bothersome within the last 6 months. She describes a dull pain in the left lower abdomen. This pain is alleviated by passing gas or having a bowel movement. The pain is generally related to eating and she has had intermittent diarrhea and constipation, with constipation predominating. Two years ago, she underwent a screening colonoscopy, which was completely normal. Her review of systems is notable for a weight gain of about 1.5 kg within the last 3 years. She is taking only a multivitamin daily. Her physical examination is normal.
Which is the best next step? |
| | A) | Defecogram. |
| | B) | Barium enema. |
| | C) | Anorectal manometry. |
| | D) | Obtain TSH level. |
| | E) | Colonoscopy. |
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2 | |
The patient is euthyroid. Hypercalcemia and other electrolyte abnormalities have been ruled out. Since she does not use medications other than the multivitamin, you decide to initiate treatment for irritable bowel syndrome. Based on available evidence, you suggest using fiber supplements. |
| | A) | Complete resolution of her symptoms. |
| | B) | Increase in stool frequency and stool volume with less need for straining. |
| | C) | Increase in stool frequency but worsened abdominal pain. |
| | D) | Decrease in abdominal pain and bloating. |
| | E) | Enlightenment and absolute bliss. |
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3 | |
The patient returns to your office. Her constipation did indeed improve. However, she continues to have pain as described above. The character and localization of her pain have not changed.
What do you suggest? |
| | A) | Docusate sodium 100 mg, 3 times daily. |
| | B) | Treatment with sertraline, beginning with 50 mg daily. |
| | C) | Use of hyoscyamine at 0.125 mg every 6 hours as needed. |
| | D) | Nifedipine 10 mg, 3 times daily. |
| | E) | Lorazepam 0.5 mg every 8 hours as needed. |
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