Advanced Health Assessment and Clinical Diagnosis in Primary Care 5th Edition Dains Test Bank by rnstudent

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Chapter 1: Clinical reasoning, differential diagnosis, evidence-based practice, and symptom ana Multiple Choice Identify the choice that best completes the statement or answers the question.

____

1. A . B. C. D .

Which type of clinical decision-making is most reliable? Intuitive

2. A . B. C. D .

Which of the following is false? To obtain adequate history, health-care providers must be: Methodical and systematic

3. A . B. C. D .

Essential parts of a health history include all of the following except: Chief complaint

4. A . B. C. D .

Which of the following is false? While performing the physical examination, the examiner must be able to: Differentiate between normal and abnormal findings

5. A . B. C. D .

The following is the least reliable source of information for diagnostic statistics: Evidence-based investigations

____

6. A. B. C. D.

The following can be used to assist in sound clinical decision-making: Algorithm published in a peer-reviewed journal article Clinical practice guidelines Evidence-based research All of the above

____

7. A . B. C. D .

If a diagnostic study has high sensitivity, this indicates a: High percentage of persons with the given condition will have an abnormal result

8. A

If a diagnostic study has high specificity, this indicates a: Low percentage of healthy individuals will show a normal result

____

Analytical Experiential Augenblick

Attentive to the patient’s verbal and nonverbal language Able to accurately interpret the patient’s responses Adept at reading into the patient’s statements

History of the present illness Current vital signs All of the above are essential history components

Recall knowledge of a range of conditions and their associated signs and symptoms Recognize how certain conditions affect the response to other conditions Foresee unpredictable findings

Primary reports of research Estimation based on a provider’s experience Published meta-analyses

Low percentage of persons with the given condition will have an abnormal result Low likelihood of normal result in persons without a given condition None of the above

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. B. High percentage of healthy individuals will show a normal result C. High percentage of individuals with a disorder will show a normal result D Low percentage of individuals with a disorder will show an abnormal result . ____

9. A. B. C. D.

A likelihood ratio above 1 indicates that a diagnostic test showing a: Positive result is strongly associated with the disease Negative result is strongly associated with absence of the disease Positive result is weakly associated with the disease Negative result is weakly associated with absence of the disease

____

10. Which of the following clinical reasoning tools is defined as evidence-based resource based on mathematical modeling to express the likelihood of a condition in select situations, settings, and/or patients? A Clinical practice guideline . B. Clinical decision rule C. Clinical algorithm

Chapter 1: Clinical reasoning, differential diagnosis, evidence-based practice, and symptom ana Answer Section MULTIPLE CHOICE 1. ANS: B Croskerry (2009) describes two major types of clinical diagnostic decision-making: intuitive and analytical. Intuitive decisionmaking (similar to Augenblink decision-making) is based on the experience and intuition of the clinician and is less reliable and paired with fairly common errors. In contrast, analytical decision-making is based on careful consideration and has greater reliability with rare errors. PTS: 1 2. ANS: D To obtain adequate history, providers must be well organized, attentive to the patient’s verbal and nonverbal language, and able to accurately interpret the patient’s responses to questions. Rather than reading into the patient’s statements, they clarify any areas of uncertainty. PTS: 1 3. ANS: C Vital signs are part of the physical examination portion of patient assessment, not part of the health history. PTS: 1 4. ANS: D While performing the physical examination, the examiner must be able to differentiate between normal and abnormal findings, recall knowledge of a range of conditions, including their associated signs and symptoms, recognize how certain conditions affect the response to other conditions, and distinguish the relevance of varied abnormal findings. PTS: 1 5. ANS: C Sources for diagnostic statistics include textbooks, primary reports of research, and published meta-analyses. Another source of statistics, the one that has been most widely used and available for application to the reasoning process, is the estimation based on a provider’s experience, although these are rarely accurate. Over the past decade, the availability of evidence on which to base clinical reasoning is improving, and there is an increasing expectation that clinical reasoning be based on scientific evidence. Evidence-based statistics are also increasingly being used to develop resources to facilitate clinical decision-making. PTS: 1 6. ANS: D To assist in clinical decision-making, a number of evidence-based resources have been developed to assist the clinician. Resources, such as algorithms and clinical practice guidelines, assist in clinical reasoning when properly applied. PTS: 7.

1 ANS:

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The sensitivity of a diagnostic study is the percentage of individuals with the target condition who show an abnormal, or positive, result. A high sensitivity indicates that a greater percentage of persons with the given condition will have an abnormal result. PTS: 1 8. ANS: B The specificity of a diagnostic study is the percentage of normal, healthy individuals who have a normal result. The greater the specificity, the greater the percentage of individuals who will have negative, or normal, results if they do not have the target condition. PTS: 1 9. ANS: A The likelihood ratio is the probability that a positive test result will be associated with a person who has the target condition and a negative result will be associated with a healthy person. A likelihood ratio above 1 indicates that a positive result is associated with the disease; a likelihood ratio less than 1 indicates that a negative result is associated with an absence of the disease. PTS: 1 10. ANS: B Clinical decision (or prediction) rules provide another support for clinical reasoning. Clinical decision rules are evidence-based resources that provide probabilistic statements regarding the likelihood that a condition exists if certain variables are met with regard to the prognosis of patients with specific findings. Decision rules use mathematical models and are specific to certain situations, settings, and/or patient characteristics. PTS:

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Chapter 2. Evidence-based health screening

Multiple Choice Identify the choice that best completes the statement or answers the question.

____

1. A . B. C. D .

The first step in the genomic assessment of a patient is obtaining information regarding: Family history Environmental exposures Lifestyle and behaviors Current medications

____

2. An affected individual who manifests symptoms of a particular condition through whom a family with a genetic disorder is ascertained is called a(n): A Consultand . B. Consulband C. Index patient D Proband .

____

3. A . B. C. D .

An autosomal dominant disorder involves the: X chromosome

4. A . B. C. D .

To illustrate a union between two second cousin family members in a pedigree, draw: Arrows pointing to the male and female

5. A . B. C. D .

To illustrate two family members in an adoptive relationship in a pedigree: Arrows are drawn pointing to the male and female

____

6. A. B. C. D.

When analyzing the pedigree for autosomal dominant disorders, it is common to see: Several generations of affected members Many consanguineous relationships More members of the maternal lineage affected than paternal More members of the paternal lineage affected than maternal

____

7. A . B. C. D

In autosomal recessive (AR) disorders, individuals need: Only one mutated gene on the sex chromosomes to acquire the disease

____

Y chromosome Mitochondrial DNA Non-sex chromosomes

Brackets around the male and female Double horizontal lines between the male and female Circles around the male and female

Brackets are drawn around the male and female Double horizontal lines are drawn between the male and female Circles are drawn around the male and female

Only one mutated gene to acquire the disease Two mutated genes to acquire the disease Two mutated genes to become carriers

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. ____

8. A . B. C. D .

In autosomal recessive disorders, carriers have: Two mutated genes; one from each parent that cause disease A mutation on a sex chromosome that causes a disease A single gene mutation that causes the disease One copy of a gene mutation but not the disease

____

9. With an autosomal recessive disorder, it is important that parents understand that if they both carry a mutation, the following are the risks to each of their offspring (each pregnancy): A 50% chance that offspring will carry the disease . B. 10% chance of offspring affected by disease C. 25% chance children will carry the disease D 10% chance children will be disease free .

____

10. A . B. C. D .

A woman with an X-linked dominant disorder will: Not be affected by the disorder herself Transmit the disorder to 50 % of her offspring (male or female) Not transmit the disorder to her daughters Transmit the disorder to only her daughters

____

11. In creating your female patient’s pedigree, you note that she and both of her sisters were affected by the same genetic disorder. Although neither of her parents had indications of the disorder, her paternal grandmother and her paternal grandmother’s two sisters were affected by the same condition. This pattern suggests: A Autosomal dominant disorder . B. Chromosomal disorder C. Mitochondrial DNA disorder D X-linked dominant disorder .

____

12. A . B. C. D .

A woman affected with an X-linked recessive disorder: Has one X chromosome affected by the mutation

13. A . B. C. D .

Which of the following are found in an individual with aneuploidy? An abnormal number of chromosomes

14. A . B. C. D .

The pedigree of a family with a mitochondrial DNA disorder is unique in that: None of the female offspring will have the disease

____

15.

Will transmit the disorder to all of her children Will transmit the disorder to all of her sons Will not transmit the mutation to any of her daughters

An X-linked disorder Select cells containing abnormal-appearing chromosomes An autosomal recessive disorder

All offspring from an affected female will have disease None of the offspring of an affected female will have the disease All the offspring from an affected male will have disease Which population is at highest risk for the occurrence of aneuploidy in offspring?

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A . B. C. D .

Mothers younger than 18 Fathers younger than 18 Mothers over age 35 Fathers over age 35

____

16. A. B. C. D.

Approximately what percentage of cancers is due to a single-gene mutation? 50% to 70% 30% to 40% 20% to 25% 5% to 10%

____

17. A . B. C. D .

According to the Genetic Information Nondiscrimination Act (GINA): NPs should keep all genetic information of patients confidential

18. A . B. C. D .

The leading causes of death in the United States are due to: Multifactorial inheritance

19. A . B. C. D .

Which of the following would be considered a “red flag” that requires more investigation in a patient assessment? Colon cancer in family member at age 70

20. A . B. C. D .

When patients express variable forms of the same hereditary disorder, this is due to: Penetrance

____

NPs must obtain informed consent prior to genetic testing of all patients Employers cannot inquire about an employee’s genetic information All of the above

Single gene mutations X-linked disorders Aneuploidy

Breast cancer in family member at age 75 Myocardial infarction in family member at age 35 All of the above

Aneuploidy De novo mutation Sporadic inheritance

____

21. Your 2-year-old patient shows facial features, such as epicanthal folds, up-slanted palpebral fissures, single transverse palmar crease, and a low nasal bridge. These are referred to as: A Variable expressivity related to inherited disease . B. Dysmorphic features related to genetic disease C. De novo mutations of genetic disease D Different penetrant signs of genetic disease .

____

22. A . B. C. D .

In order to provide a comprehensive genetic history of a patient, the NP should: Ask patients to complete a family history worksheet Seek out pathology reports related to the patient’s disorder Interview family members regarding genetic disorders All of the above

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1. 2. Evidence-based health screening

Answer Section MULTIPLE CHOICE 1. ANS: A A critical first step in genomic assessment, including assessment of risk, is the use of family history. Family history is considered the first genetic screen (Berry & Shooner 2004) and is a critical component of care because it reflects shared genetic susceptibilities, shared environment, and common behaviors (Yoon, Scheuner, & Khoury 2003). PTS: 1 2. ANS: D A proband is defined as the affected individual who manifests symptoms of a particular condition through whom a family with a genetic disorder is ascertained (Pagon et al. 1993–2013). The proband is the affected individual that brings the family to medical attention. PTS: 1 3. ANS: D Autosomal dominant (AD) inheritance is a result of a gene mutation in one of the 22 autosomes. PTS: 1 4. ANS: C A consanguineous family is related by descent from a common ancestry and is defined as a “union between two individuals who are related as second cousins or closer” (Hamamy 2012). Consanguinity, if present in the family history, is portrayed using two horizontal lines to establish the relationship between the male and female partners. PTS: 1 5. ANS: B For adopted members of the family, use brackets as the appropriate standardized pedigree symbol ([e.g., brackets]). PTS: 1 6. ANS: A Pedigrees associated with autosomal dominant (AD) disorders typically reveal multiple affected family members with the disease or syndrome. When analyzing the pedigree for AD disorders or syndromes, it is common to see a “vertical” pattern denoting several generations of affected members. PTS: 1 7. ANS: C In autosomal recessive (AR) disorders, the offspring inherits the condition by receiving one copy of the gene mutation from each of the parents. Autosomal recessive disorders must be inherited through both parents (Nussbaum et al. 2007). Individuals who have an AR disorder have two mutated genes, one on each locus of the chromosome. Parents of an affected person are called carriers because each carries one copy of the mutation on one chromosome and a normal gene on the other chromosome. Carriers typically are not affected by the disease. PTS: 1 8. ANS: D Individuals who have an AR disorder have two mutated genes, one on each allele of the chromosome. Parents of an affected person are called carriers because each parent carries one copy of the mutation on one chromosome and a normal gene on the other chromosome. Carriers typically are not affected by the disease. In pedigrees with an AR inheritance patterns, males and females will be equally affected because the gene mutation is on an autosome. PTS: 1 9. ANS: A It is important that parents understand that if they both carry a mutation, the risk to each of their offspring (each pregnancy) is an independent event: 25% disease free, 25% affected, and 50% carrier.

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PTS: 1 10. ANS: B Everyone born with an X-linked dominant disorder will be affected with the disease. Transmission of the disorder to the next generation varies by gender, however. A woman will transmit the mutation to 50% of all her offspring (male or female). PTS: 1 11. ANS: D A man with an X-linked dominant disorder will transmit the mutation to 100% of his daughters (they receive his X chromosome) and none of his sons (they receive his Y chromosome). The pedigree of a family with an X-linked dominant disorder would reveal all the daughters and none of the sons affected with the disorder if the father has an X-linked disorder. PTS: 1 12. ANS: C An X-linked recessive disorder means that in a woman, both X chromosomes must have the mutation if she is to be affected. Because males have only one copy of the X chromosome, they will be affected if their X chromosome carries the mutation. PTS: 1 13. ANS: A An individual with an abnormal number of chromosomes has a condition called aneuploidy, which is frequently associated with mental problems or physical problems or both (Jorde, Carey, & Bamshad 2010; Nussbaum et al. 2007). PTS: 1 14. ANS: B Mitochondrial DNA is inherited from the ovum and, therefore, from the mother. The pedigree of a family with a mitochondrial DNA disorder is unique in that all offspring (regardless of gender) of an affected female will have the disease, and none of the offspring from an affected male will have the disease. PTS: 1 15. ANS: C Some individuals or couples have unique identifiable risks that should be discussed prior to conception whenever possible. For example, women who will be 35 years of age or older at delivery (advanced maternal age) are at increased risk for aneuploidy. PTS: 1 16. ANS: D The majority of cancers are sporadic or multifactorial due to a combination of genetic and environmental factors; however, approximately 5% to 10% of all cancers are due to a single-gene mutation (Garber & Offit 2005). PTS: 1 17. ANS: D On May 21, 2008, President George W. Bush signed the Genetic Information Nondiscrimination Act (GINA) to protect Americans against discrimination based upon their genetic information when it comes to health insurance and employment, paving the way for patient personalized genetic medicine without fear of discrimination (National Human Genome Research Institute 2012). PTS: 1 18. ANS: A Most disease-causing conditions are not due to a single-gene disorder but are due to multifactorial inheritance, a result of genomics and environmental or behavioral influences. In fact, the leading causes of mortality in the United States—heart disease, cerebrovascular disease, diabetes, and cancer—are all multifactorial. Most congenital malformation, hypertension, arthritis, asthma, obesity, epilepsy, Alzheimer’s, and mental health disorders are also multifactorial. PTS: 1 19. ANS: C Early onset cancer syndromes, heart disease, or dementia are red flags that warrant further investigation regarding hereditary disorders. PTS: 1 20. ANS: A Some disorders have a range of expression from mild to severe. This variability is referred to as the penetrance of genetic disease. For example, patients with neurofibromatosis (NF1), an AD disorder of the nervous system, may manifest with many forms of the disease. For instance, some patients with NF1 may have mild symptoms, like café-au-lait spots or freckling on the axillary or

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skin, while others may have life-threatening spinal cord tumors or malignancy (Jorde, Carey, & Bamshad 2010; Nussbaum et al. 2007). PTS: 1 21. ANS: B Assessing for dysmorphic features may enable identification of certain syndromes or genetic or chromosomal disorders (Jorde, Carey, & Bamshad 2010; Prichard & Korf 2008). Dysmorphology is defined as “the study of abnormal physical development” (Jorde, Carey, & Bamshad 2010, 302). PTS: 1 22. ANS: D Asking the patient to complete a family history worksheet prior to the appointment saves time in the visit while offering the patient an opportunity to contribute to the collection of an accurate family history. Reviewing the family information can also help establish family rapport while verifying medical conditions in individual family members. If a hereditary condition is being considered but family medical information is unclear or unknown, requesting medical records and pathology or autopsy reports may be warranted. PTS:

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Chapter 3. Abdomen Multiple Choice Identify the choice that best completes the statement or answers the question.

____

1. A . B. C. D .

When performing abdominal assessment, the clinician should perform examination techniques in the following order: Inspection, palpation, percussion, and auscultation

2. A . B. C. D .

The clinician should auscultate the abdomen to listen for possible bruits of the: Aorta

3. A . B. C. D .

On abdominal examination, which of the following is assessed using percussion? Liver

4. A . B. C. D .

In abdominal assessment, a digital rectal examination is performed to assess for: Hemorrhoids

5. A . B. C. D .

Rebound tenderness of the abdomen is a sign of: Constipation

Inspection, percussion, palpation, and auscultation Inspection, auscultation, percussion, and palpation Auscultation, palpation, percussion, and inspection

Renal artery Iliac artery All of the above

Kidneys Pancreas Esophagus

Prostate size Blood in stool Ureteral stenosis

Peritoneal inflammation Elevated venous pressure Peritoneal edema

____

6. While assessing the abdomen, the clinician deeply palpates the left lower quadrant of the abdomen, and this causes pain in the patient’s right lower abdomen. This is most commonly indicative of: A Constipation . B. Diverticulitis C. Appendicitis D Hepatitis .

____

7. Your patient complains of severe right lower quadrant abdominal pain. To assess the patient for peritoneal inflammation, the examiner should: A. Percuss the right lower quadrant of the abdomen B. Deeply palpate the right lower quadrant of the abdomen C. Auscultate the right lower quadrant for hyperactive bowel sounds D. Strike the plantar surface of the patient’s heel while the patient is supine

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____

8. Your patient is lying supine and you ask him to raise his leg while you place resistance against the thigh. The examiner is testing the patient for: A Psoas sign . B. Obturator sign C. Rovsing’s sign D Murphys’ sign .

____

9. A patient is lying supine and the clinician deeply palpates the right upper quadrant of the abdomen while the patient inhales. The examiner is testing the patient for: A Psoas sign . B. Obturator sign C. Rovsing’s sign D Murphys’ sign .

____

10. Your patient has abdominal pain, and it is worsened when the examiner rotates the patient’s right hip inward with the knee bent and the obturator internus muscle is stretched. This is a sign of: A Diverticulitis . B. Cholecystitis C. Appendicitis D Mesenteric adenitis .

____

11. On abdominal examination as the clinician presses on the right upper quadrant to assess liver size, jugular vein distension becomes obvious. Hepatojugular reflux is indicative of: A Acute hepatitis . B. Right ventricular failure C. Cholecystitis D Left ventricular failure .

____

12. A . B. C. D .

Your patient demonstrates positive shifting dullness on percussion of the abdomen. This is indicative of: Cholecystitis Appendicitis Ascites Hepatitis

____

13. Your 44-year-old female patient complains of right upper quadrant pain. Her skin and sclera are yellow, and she has hyperbilirubinemia and elevated liver enzymes. The clinician should suspect: A Acute pancreatitis . B. Biliary duct obstruction C. Acute hepatitis D Atypical appendicitis .

____

14. A . B. C. D .

____

15.

The most common cause of acute pancreatitis is: Trauma Hepatitis virus A Hyperlipidemia Alcohol abuse Your patient with pancreatitis has a Ranson rule score of 8. The clinician should recognize that this is a risk of:

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A . B. C. D .

Pleural involvement Alcoholism High mortality Bile duct obstruction

____

16. Your patient complains of left upper quadrant pain, fever, extreme fatigue, and spontaneous bruising. The clinician should recognize that these symptoms are often related to: A Hematopoetic disorders . B. Hepatomegaly C. Esophageal varices D Pleural effusion .

____

17. A 16-year-old patient presents with sore throat, cervical lymphadenopathy, fever, extreme fatigue, and left upper quadrant pain. The physical examination reveals splenomegaly. The clinician should recognize the probability of: A Bacterial endocarditis . B. Infectious mononucleosis C. Pneumonia with pleural effusion D Pancreatic cancer .

____

18. Your patient complains of lower abdominal pain, anorexia, extreme fatigue, unintentional weight loss of 10 pounds in last 3 weeks, and you find a positive hemoccult on digital rectal examination. Laboratory tests show iron deficiency anemia. The clinician needs to consider: A Diverticulitis . B. Appendicitis C. Colon cancer D Peptic ulcer disease .

____

19. A . B. C. D .

Which of the following is the most common cause of heartburn-type epigastric pain? Decreased lower esophageal sphincter tone Helicobacteria pylori infection of stomach Esophageal spasm Excess use of NSAIDs

____

20. A 22-year-old female enters the emergency room with complaints of right lower quadrant abdominal pain, which has been worsening over the last 24 hours. On examination of the abdomen, there is a palpable mass and rebound tenderness over the right lower quadrant. The clinician should recognize the importance of: A Digital rectal examination . B. Endoscopy C. Ultrasound D Pelvic examination .

____

21. A. B. C. D.

____

22. When ruptured ectopic pregnancy is suspected, the following procedure is most important: A Culdocentesis

The major sign of ectopic pregnancy is: Sudden onset of severe epigastric pain Amenorrhea with unilateral lower quadrant pain Lower back and rectal pain Palpable abdominal mass

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. B. CT scan C. Abdominal x-ray D Digital rectal examination . ____

____

23. A . B. C. D .

The majority of colon cancers are located in the: Transverse colon

24. A . B. C. D .

The following symptom(s) in the patient’s history should raise the clinician’s suspicion of colon cancer: Alternating constipation and diarrhea

Cecum Rectosigmoid region Ascending colon

Narrowed caliber of stool Hematochezia All of the above

____

25. A patient presents to the emergency department with nausea and severe, colicky back pain that radiates into the groin. When asked to locate the pain, he points to the right costovertebral angle region. His physical examination is unremarkable. Which of the following lab tests is most important for the diagnosis? A Urinalysis . B. Serum electrolyte levels C. Digital rectal exam D Lumbar x-ray .

____

26. Your 34-year-old female patient complains of a feeling of “heaviness” in the right lower quadrant, achiness, and bloating. On pelvic examination, there is a palpable mass in the right lower quadrant. Urine and serum pregnancy tests are negative. The diagnostic tool that would be most helpful is: A Digital rectal exam . B. Transvaginal ultrasound C. Pap smear D Urinalysis .

____

27. Your 54-year-old male patient complains of a painless “lump” in his lower left abdomen that comes and goes for the past couple of weeks. When examining the abdomen, you should have the patient: A Lie flat and take a deep breath . B. Stand and bear down against your hand C. Prepare for a digital rectal examination D Lie in a left lateral recumbent position .

____

28. A nurse practitioner reports that your patient’s abdominal x-ray demonstrates multiple air-fluid levels in the bowel. This is a diagnostic finding found in: A Appendicitis . B. Cholecystitis C. Bowel obstruction D Diverticulitis .

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____

29. A 76-year-old patient presents to the emergency department with severe left lower quadrant abdominal pain, diarrhea, and fever. On physical examination, you note the patient has a positive heel strike, and left lower abdominal rebound tenderness. These are typical signs and symptoms of which of the following conditions? A Diverticulitis . B. Salpingitis C. Inflammatory bowel disease D Irritable bowel syndrome .

____

30. A . B. C. D .

Which of the following conditions is the most common cause of nausea, vomiting, and diarrhea? Viral gastroenteritis Staphylococcal food poisoning Acute hepatitis A E.coli gastroenteritis

____

31. A patient presents to the emergency department with complaints of vomiting and abdominal pain. You note that the emesis contains bile. On physical examination, there is diffuse tenderness, abdominal distension, and rushing, high-pitched bowel sounds. Which of the following diagnoses would be most likely? A Gastric outlet obstruction . B. Small bowel obstruction C. Distal intestinal blockage D Colonic obstruction .

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32. Your 5-year-old female patient presents to the emergency department with sore throat, vomiting, ear ache, 103 degree fever, photophobia, and nuchal rigidity. She has an episode of projectile vomiting while you are examining her. The clinician should recognize that the following should be done: A Abdominal x-ray . B. Fundoscopic examination C. Lumbar puncture D Analysis of vomitus .

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33. A 9-year-old boy accompanied by his mother reports that since he came home from summer camp, he has had fever, nausea, vomiting, severe abdominal cramps and watery stools that contain blood and mucus. The clinician should recognize the importance of: A. Stool for ova and parasites B. Abdominal x-ray C. Stool for clostridium D. Fecal occult blood test

____

34. A 56-year-old male complains of anorexia, changes in bowel habits, extreme fatigue, and unintentional weight loss. At times he is constipated and other times he has episodes of diarrhea. His physical examination is unremarkable. It is important for the clinician to recognize the importance of: A CBC with differential . B. Stool culture and sensitivity C. Abdominal x-ray D Colonoscopy .

____

35. A 20-year-old engineering student complains of episodes of abdominal discomfort, bloating, and episodes of diarrhea. The symptoms usually occur after eating, and pain is frequently relieved with bowel movement. She is on a “celiac diet” and the episodic symptoms persist. Physical examination and diagnostic tests are negative. Colonoscopy is negative for any abnormalities. This is a history and physical consistent with: A Inflammatory bowel disease

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