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* nbme-em
 #846094  
  kennychan - 12/05/17 21:13
 
  A 68-year-old man comes to the emergency department because of a 2-week history of abdominal cramps after eating. He has also notice a 2.3-kg (5-lb) weight loss during this time. He has had occasional loose stools but does not report any blood. He has hypertension and congestive heart failure. Medications are metoprolol, digoxin, and amlodipine. His medical records from 6 months ago show left ventricular ejection fraction of 20%. He has no known drug allergies. On arrival, he appears thin and uncomfortable. His temperature is 37C, pulse is 96/min, respirations are 18/min, and blood pressure is 138/72 mm Hg. Pulse oximetry on room air show oxygen saturation of 97%. Cardiopulmonary examination discloses an S3 and bilateral basilar crackles. The abdomen is soft with minimal generalized tenderness to palpation. The remainder of the examination show no abnormalities. Which of the following is the most appropriate step in diagnosis?
a) Abdominal ultrasongotaphy
b) Barium enema
c) CT angiography
d) Esophagogastroduodenoscopy
e) Upper gastrointestinal series with small bowel follow through

I think it is b).
 
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* Re:nbme-em
#3354533
  tchops - 12/07/17 10:05
 
  C)..mesentric ischemia  
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* Re:nbme-em
#3354543
  kennychan - 12/07/17 12:14
 
  Thanks. I though the patient had bowel obstruction. The next thing to do is abdominal x-ray, but it was not the answer lists. Good job!!!  
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