his head, eyes, ears, throat, neck, cardiac, and pulmonary examinations are normal. His abdomenis soft and nondistended. His bowel sounds are active and he has no tenderness, no enlargedorgans, and no rebound or guarding. His rectal examination is nontender with no blood on theglove. You collect a stool sample for further study.What is the most likely explanation for this patient's chronic diarrhea?A)Malabsorption syndromeB)Osmotic diarrheaC)Secretory diarrheaAns:BChapter: 11Feedback:Usually related to lactose intolerance, watery diarrhea often follows meal ingestion.Crampy abdominal pain, distension, and gas often accompany symptoms. Diarrhea is oftenprovoked by pizza, milkshakes, yogurt, and other lactose-containing foods. This condition ismore common in African-Americans, Latinos, Native Americans, and Asians.10.A 27-year-old policewoman comes to your clinic, complaining of severe left-sided backpain radiating down into her groin. It began in the middle of the night and woke her up suddenly.It hurts in her bladder to urinate but she has no burning on the outside. She has had no frequencyor urgency with urination but she has seen blood in her urine. She has had nausea with the painbut no vomiting or fever. She denies any other recent illness or injuries. Her past medical historyis unremarkable. She denies tobacco or drug use and drinks alcohol rarely. Her mother has highblood pressure and her father is healthy. On examination she looks her stated age and is inobvious pain. She is lying on her left side trying to remain very still. Her cardiac, pulmonary, andabdominal examinations are unremarkable. She has tenderness just inferior to the leftcostovertebral angle. Her urine pregnancy test is negative and her urine analysis shows red bloodcells.What type of urinary tract pain is she most likely to have?A)Kidney pain (from pyelonephritis)B)Ureteral pain (from a kidney stone)C)Musculoskeletal pain106This file was downloaded from StudyLast.com. It is not allowed to publish it elsewhere. Only the buyer can use this file.
D)Ischemic bowel painAns:BChapter:11Feedback:The pain from a kidney stone causes dramatic, severe, colicky pain at thecostovertebral angle that radiates across the flank and down into the groin.11.Chris is a 20-year-old college student who has had abdominal pain for 3 days. It started athis umbilicus and was associated with nausea and vomiting. He was unable to find a comfortableposition. Yesterday, the pain became more severe and constant. Now, he hesitates to walk,because any motion makes the pain much worse. It is localized just medial and inferior to hisiliac crest on the right. Which of the following is most likely?A)Peptic ulcerB)CholecystitisC)PancreatitisD)AppendicitisAns:DChapter:11Feedback:This is a classic history for appendicitis. Notice that the pain has changed fromvisceral to parietal. It is well localized to the right lower quadrant, making appendicitis a strongconsideration.
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