A 62-Year-Old Man Comes to the Emergency Department Due to Acute-Onset

question 200

Multiple Choice

A 62-year-old man comes to the emergency department due to acute-onset constipation.  His last bowel movement was 4 days ago; before that time, his stools were always regular.  Review of systems is positive for dry cough, increasing low back pain, a 9-kg (20-lb) weight loss in the past month, and increasing difficulty with urination.  He has smoked 2 packs of cigarettes daily for 30 years.  Vital signs are within normal limits.  Point tenderness is elicited with palpation over the lower spine.  Bilateral lower extremity weakness is present, and sensation is impaired in the perineal region.  Chest x-ray reveals a right lung mass.  Dysfunction of which of the following nerves best explains this patient's constipation?

• A)Greater splanchnic nerve
• B)Ilioinguinal nerve
• C)Lesser splanchnic nerve
• D)Pelvic splanchnic nerves
• E)Vagus nerve

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