Red flags — MCQs

A 28-year-old woman presents with intermittent abdominal pain and diarrhea for 6 months. Recently, she noticed blood in her stool. She reports a 10-pound weight loss and increasing fatigue. Her mother died of colon cancer at age 42. Physical examination reveals pallor and a palpable mass in the right lower quadrant. Hemoglobin is 9.2 g/dL. What should be prioritized in the diagnostic workup?

A 72-year-old man with a history of hypertension and smoking presents with new-onset back pain for 3 weeks. He describes the pain as constant, worse at night, and unrelieved by position changes. He has lost 15 pounds over the past 2 months without trying. On examination, there is tenderness over the lumbar spine. Temperature is 37.8°C (100°F). What is the most critical diagnostic consideration?

A 45-year-old woman presents to the emergency department with sudden onset severe headache that she describes as 'the worst headache of my life.' The headache started 2 hours ago while she was exercising. She has nausea but no focal neurological deficits. Vital signs show BP 165/95 mmHg, pulse 88/min. What is the most appropriate next step in management?

A 53-year-old man is brought to the emergency department by his wife for the evaluation of a progressively generalized headache that started suddenly 2 hours ago. He describes the pain as 10 out of 10 in intensity. The pain radiates to the neck and is aggravated by lying down. The patient has vomited once on his way to the hospital. He had a similar headache 1 week ago that had resolved after a few hours without treatment. The patient has smoked one pack of cigarettes daily for 35 years. He does not drink alcohol or use illicit drugs. He appears lethargic. His temperature is 37.7°C (99.9°F), pulse is 82/min, respirations are 13/min, and blood pressure is 165/89 mm Hg. Pupils are equal and reactive to light and extraocular eye movements are normal. There is no weakness or sensory loss. Reflexes are 2+ throughout. Neck flexion causes worsening of the pain. Which of the following is the most appropriate next step in the management of this patient?

A 36-year-old man is seen in the emergency department for back pain that has been getting progressively worse over the last 4 days. Upon further questioning, he also notes that he has been having a tingling and burning sensation rising up from his feet to his knees bilaterally. The patient states he is having difficulty urinating and having bowel movements over the last several days. His temperature is 97.4°F (36.3°C), blood pressure is 122/80 mmHg, pulse is 85/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam is notable for weak leg flexion bilaterally along with decreased anal sphincter tone. Which of the following is the best next step in management?