A 65-Year-Old Man Comes to the Office Due to 4

question 488

Multiple Choice

A 65-year-old man comes to the office due to 4 months of abdominal pain, nausea, and occasional emesis.  The pain is deep, mid-epigastric, persistent, and non-radiating.  There is no consistent relationship between the pain and food intake.  He has no difficulty swallowing, hematemesis, black stools, blood in the stool, or diarrhea.  The patient thinks he may have lost weight recently.  He emigrated to the United States from China 20 years ago but frequently travels to China to visit family.  He has no significant medical or surgical history.  The patient does not use tobacco, alcohol, or illicit drugs.  Temperature is 36.9 C (98.4 F) , blood pressure is 110/78 mm Hg, pulse is 78/min, and respirations are 16/min.  BMI is 20 kg/m².  Heart and lung sounds are normal.  The upper abdomen is mildly tender to palpation but nondistended.  Hepatomegaly is present.  Bowel sounds are normoactive.  Laboratory results are as follows: Laboratory testing last year was normal.  Which of the following is most likely causing this patient's symptoms?

• A)Chronic pancreatitis
• B)Chronic viral hepatitis
• C)Duodenal peptic ulcer
• D)Gastric cancer
• E)Hookworm infection
• F)Pancreatic cancer

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