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

question 520

Multiple Choice

A 65-year-old man comes to the office due to 4 weeks of persistent epigastric pain and nausea.  The pain is constant and does not improve or worsen with activities, position, or diet.  The patient lost approximately 4.5 kg (9.9 lb) over this period.  He has no fever, vomiting, constipation, or diarrhea.  He was diagnosed with type 2 diabetes mellitus 6 months ago, which is controlled with a low-carbohydrate diet.  The patient has never had surgery and has no other chronic medical conditions.  He has a 45-pack-year history of smoking.  He does not use alcohol or illicit drugs.  Temperature is 36.5 C (97.7 F) , blood pressure is 122/72 mm Hg, pulse is 68/min, and respirations are 16/min.  BMI is 24 kg/m².  Mucous membranes are moist.  No lymphadenopathy is present in the cervical or axillary chains.  Bowel sounds are present, and the abdomen is soft with mild epigastric tenderness to deep palpation.  No hepatosplenomegaly or shifting dullness is present.  The remainder of the examination is normal.  Complete blood count, serum chemistry, and liver function studies is all normal except a fasting blood sugar of 130 mg/dL.  Which of the following is the most appropriate next step in management of this patient?

• A)Abdominal ultrasound
• B)CT scan of the abdomen
• C)Helicobacter pylori stool antigen
• D)Nuclear gastric emptying scan
• E)Upper gastrointestinal endoscopy

---

Definitions:

Closing Message

The final part of a communication that summarizes the main points or objective, often with a call to action or conclusion.

Refusal

The act of declining to accept, agree to, or comply with something.

Refusing An Important Request

The act of denying or not granting a significant or consequential request, often requiring careful communication.

Goodwill Comment

A goodwill comment is a positive statement made to build a friendly relationship or to express kindness and good intentions.