flection Qu A 67-year-old G3P3 woman with a history of

Portion Name: Exit Exam A 50-year-old woman with a history of hypertension, and hyperlipidemia presents to the primary care clinic with constipation. She states that over the past several months, she has been experiencing a change in bowel movements. She used to have 2-3 bowel movements per day but has only been having a bowel movement every 2 days for the last 3 months. In addition, she reports nausea/vomiting, bloating, and occasional bloody stools. She denies abdominal pain. She eats a normal diet. The patient reports weight loss of 30 pounds over the last 3 months with occasional fever and chills. The patient’s temperature is 99.9 degrees Fahrenheit, MR is 80, RR is 16, and BP is 140/90. Physical exam reveals no tenderness to palpation, decreased bowel sounds, and no dullness to percussion. What is the next best step in management? 1. Surgical referral 2. ASA and steroids 3. Dietary modification 4. Colonoscopy

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