The following symptom(s) in the patient's history should raise ...

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The following symptom(s) in the patient's history should raise the clinician's suspicion of colon cancer:
 
  A. Alternating constipation and diarrhea
  B. Narrowed caliber of stool
  C. Hematochezia
  D. All of the above

Question 2

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

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Answer to Question 1

ANS: D
Colon cancer may be present for several years before symptoms appear. Complaints include fatigue, weakness, weight loss, alternating constipation and diarrhea, a change in the caliber of stool, tenesmus, urgency, and hematochezia. Physical examination is usually normal except in advanced disease, when the tumor can be palpated or hepatomegaly is present, owing to metastatic disease.

Answer to Question 2

ANS: B
Ovarian masses are often asymptomatic, but symptoms may include pressure-type pain, heaviness, aching, and bloating. Masses are typically detected on pelvic examination. In advanced malignancies, ascites is often present. An elevated cancer antigen 125 (CA-125) result indicates the likelihood that the mass is malignant. A transvaginal pelvic ultrasound has a higher diagnostic sensitivity than transabdominal ultrasound. If diagnosis is unclear, CT, MRI, or PET scan can be performed. A laparoscopy or exploratory laparotomy is necessary for staging, tumor debulking, and resection.

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