A 20-Year-Old Previously Healthy Woman Comes to the Office Due

question 397

Multiple Choice

A 20-year-old previously healthy woman comes to the office due to intermittent diarrhea and abdominal pain over the past several months.  The patient has had bouts of diarrhea alternating with normal bowel movements, but lately the diarrhea has become more persistent.  She reports 4-6 loose brown stools each day, which frequently awaken her at night.  The diarrhea is associated with crampy abdominal pain in both lower quadrants that subsides after a bowel movement.  Both the pain and the diarrhea frequently occur after eating.  There are also days when she feels constipated and passes a small amount of mucus only.  The patient has not had hematochezia, melena, or weight changes.  There is no family history of gastrointestinal diseases.  She does not use tobacco, alcohol, or illicit drugs.  Vital signs are within normal limits.  Physical examination, including abdominal and rectal examination, shows no abnormalities.  Stool testing for occult blood is negative, and blood cell counts and serum chemistry studies are within normal limits.  C-reactive protein is normal.  Serologic testing for celiac disease is negative.  Further testing may be indicated in this patient due to which of the following findings?

• A)Early age of symptom onset
• B)Episodic nature of the symptoms
• C)Frequent alteration of bowel habits
• D)Nocturnal diarrhea
• E)Postprandial symptoms

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Definitions:

Time Factor

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Calculating Interest

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amounts owed to a business by its customers for goods or services sold on credit.

Accounts Receivable

Amounts owed to a business by its customers for goods or services delivered on credit, expected to be collected in cash.