A 66-Year-Old Man Comes to the Office Due to Several

question 753

Multiple Choice

A 66-year-old man comes to the office due to several weeks of severe constipation and increasing back pain.  The patient notes that he has always had regular bowel movements; however, for the last 2 months, he has required over-the-counter laxatives to produce any stool.  During this period, he has also had increasing pain in his lower back.  He has had no trauma to that area.  There is no radiation down the legs, bowel incontinence, or lower extremity weakness.  The patient takes lisinopril for hypertension and ibuprofen as needed for back pain.  He does not use tobacco or alcohol.  Temperature is 36.1 C (97 F) , blood pressure is 134/80 mm Hg, and pulse is 78/min.  Mucosal pallor is present.  He is anicteric.  Cardiopulmonary and abdominal examinations are normal.  Rectal examination reveals a smooth, nonenlarged prostate.  The stool is negative for occult blood.  Strength and reflexes are intact in his lower extremities.  Laboratory results are as follows: Which of the following is the best explanation for this patient's constipation?

• A)Electrolyte disturbance
• B)Hormonal disturbances
• C)Irritable bowel syndrome
• D)Mechanical obstruction
• E)Medication side effect
• F)Neurologic dysfunction

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