MKSAP: 32-year-old woman with weight loss, abdominal cramping, and loose stools
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 32-year-old woman is evaluated for a 2-month history of weight loss, abdominal cramping, and loose stools. Her stools are malodorous, but she has not noted any blood associated with her bowel movements. Although her appetite is good, she has lost 3.2 kg (7.0 lb). She has an 8-year history of diffuse cutaneous systemic sclerosis.
On physical examination, temperature is normal, blood pressure is 146/92 mm Hg, pulse rate is 94/min, and respiration rate is 16/min. BMI is 19. Cardiopulmonary examination is normal. The abdomen is soft and nontender with normal bowel sounds. Diffuse skin thickening of the face, anterior chest, and distal extremities is noted as well as sclerodactyly and multiple healed digital pits. There is no rash. Muscle strength and reflexes are normal.
Laboratory studies:
Albumin
2.6 g/dL (26 g/L)
Alanine aminotransferase
Normal
Aspartate aminotransferase
Normal
Total bilirubin
Normal
Lipase
Normal
Urinalysis
Normal
Which of the following is the most appropriate diagnostic test to perform next?
A. Colonoscopy
B. CT of the abdomen and pelvis with contrast
C. Endoscopic retrograde cholangiopancreatography
D. Glucose hydrogen breath test
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Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Gastroenterology Rheumatology Source Type: blogs
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