The correct answer is C
Order an abdominal radiograph
A 29-year-old man comes to the office because of a 6-month history of "bloating," and diffuse abdominal pain. He constantly feels like he has to loosen his belt, and he has gotten all the waists on his pants let out, despite no change in weight. He usually has 5-6 soft, non-bloody bowel movements throughout the day, but every few days he feels very constipated. His abdominal pain is often relieved by defecation. He does not think that he ever had a fever, does not take any medications, has no recent travel history, and is never awoken from sleep because of abdominal pain or the need to defecate. His temperature is 37.0 C (98.6 F). Physical examination and rectal examination are normal. Fecal occult blood testing is negative. You order a biochemical profile, thyroid function tests, complete blood count, and stool for ova and parasites. You perform a sigmoidoscopy and send him for a small bowel series, and a barium enema. He returns to the office after a 3-week lactose free diet to review the results of the studies, which were all unremarkable. At this time the most correct statement is:
A. A high-fiber diet is the mainstay of treatment for this disorder
B. His risk of colon cancer increases significantly after 10 years with this condition
C. Microperforations, obstruction, peritonitis, fistula formation are complications of this condition
D. Surgical resection is indicated if symptoms do not resolve with medical management
E. Therapy with metronidazole should be initiated immediately
A 37-year-old woman comes to the emergency department because of a 30-minute history of vomiting reddish-brown material. She informs you that she suffers from fibromyalgia syndrome and uses a number of "pain killers" to control her pain. Her blood pressure is 120/70 mm Hg and pulse is 110/min, no orthostasis. Physical examination is unremarkable. Her extremities are cool and her capillary refill is less than 2 seconds. A nasogastric tube is passed and returns 200 cc of coffee ground material that eventually clears with normal saline lavage. The patient is then sent for endoscopy. The most likely cause of this patient's gastrointestinal bleeding is
A. esophageal varices
B. esophagitis
C. gastric neoplasm
D. gastric ulcers
E. Mallory Weiss tears
A 54-year-old man with end-stage liver disease secondary to hepatitis C comes to the emergency department with fevers and mental status changes over the last 4 days. His wife reports that he has been compliant with his medications, which include furosemide, spironolactone, and lactulose up until today when he refused to take them. His temperature is 38.0 C (100.7 F), blood pressure is 100/70 mmHg, pulse is 103/min, and respirations are 19/min. Physical examination reveals a confused and slightly combative male with scleral icterus. His abdomen is distended with bulging flanks, shifting dullness, and a fluid wave. He has asterixis. There is no nuchal rigidity or photophobia. He is oriented to person but not place or time. The most appropriate next step in this patient's management is to
A. determine his ammonia level
B. order a CT scan of the head
C. perform a lumbar puncture
D. perform paracentesis
E. send a urine culture and sensitivity