A 34-Year-Old Man Comes to the Emergency Department for Evaluation

question 181

Multiple Choice

A 34-year-old man comes to the emergency department for evaluation of abdominal pain.  He reports severe pain unrelated to meals that is sharp, stabbing, and 10 out of 10 in severity.  The patient has been hospitalized twice in the past year for similar symptoms and states that a diagnosis was never found.  He declines when asked to sign a release of information to obtain his prior medical records.  Vital signs are within normal limits.  On physical examination, heart and lung sounds are normal.  Abdomen is soft and nondistended with normoactive bowel sounds.  The patient grimaces and moans in pain throughout the evaluation.  Laboratory evaluation and abdominal CT scan show no abnormalities.  After hearing the results, the patient asks for a note to excuse him from work so that he can recover at home for a few days.  Which of the following additional features is most likely to be present in this patient?

• A)Chronic feelings of helplessness
• B)Excessive anxiety about unexplained physical symptoms
• C)Preoccupation with having a serious illness
• D)Recurrent suicidal gestures or attempts
• E)Refusal of invasive medical procedures

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