A patient in the clinic reports frequent episodes of bloating, ...

[charchew]

A patient in the clinic reports frequent episodes of bloating, abdominal pain, and loose stools to the primary care nurse practitioner (NP). An important question the NP should ask about the abdominal pain is:
 
  a. the relation of the pain to stools.
  b. what time of day the pain occurs.
  c. whether the pain is sharp or diffuse.
  d. the age of the patient when the pain began.

Question 2

A 30-year-old white woman has a BMI of 26 and weighs 150 lb. At an annual physical examination, the patient's fasting plasma glucose is 130 mg/dL. The patient walks 1 mile three or four times weekly.
 
  She has had two children who weighed 7 lb and 8 lb at birth. Her personal and family histories are noncontributory. The primary care NP should: a. order metformin (Glucophage).
  b. order a lipid profile, complete blood count, and liver function tests (LFTs).
  c. order an oral glucose tolerance test.
  d. set a weight loss goal of 10 to 15 lb.

[Meganchabluk]

Answer to Question 1

A
The new Rome II guidelines maintain that irritable bowel syndrome (IBS) of any subtype is characterized by a strong relationship between abdominal pain and defecation because of visceral hypersensitivity to gut-related events. The other characteristics of pain may be assessed to help guide management of IBS, but the first is necessary for a correct diagnosis.

Answer to Question 2

D
To prevent or delay onset of diabetes, patients with impaired glucose should be advised to lose 5 to 10 of body weight. Metformin should be considered in patients with high risk of developing diabetes. This woman does not have risk factors. Other tests are not indicated.

[charchew]

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