Bedside Diagnostic Challenge – 16-year-old girl with lack of bowel movements

Paul Griner, MD, MACPBedside Diagnostic Challenge, Emergency Medicine, Family Medicine, Internal Medicine, Nurse Practitioner, Nursing RN/PN, Pediatric Medicine


Bedside Diagnostic Challenge

A 16-year-old girl with lack of bowel movements.

Test your bedside diagnostic skills with this free clinical case question.

Patient Case:

A 16-year-old girl is brought to her physician because of lack of bowel movements.

The patient states that for the past 3 months, she has had a bowel movement only every other week. She describes them as normal in color and consistency.

She has had no abdominal pain or soreness. She notes some fatigue and infrequent menses which previously were regular.

She has been eating well but has lost a few pounds. She has been urinating a bit more frequently than normal but has no urinary tract symptoms. She complains of cold hands and feet.

She takes no medications and denies using alcohol or illegal drugs. Her mother adds that her daughter is “spending too much time in the bathroom.”

Physical examination reveals a pleasant, slightly thin young woman who does not appear ill.

Vital signs show:

  • Temperature of 96.80F,
  • Blood Pressure of 96/50 mmHg,
  • Pulse of 54 and regular, and
  • Respirations of 12 /minute.

BMI is 17 kg/m2.

Her hands and feet are cold and slightly blue. The skin is otherwise normal. The dental enamel is slightly pitted. The thyroid gland is palpable but without nodules. The abdomen is scaphoid but otherwise normal. Rectal examination reveals an empty ampulla and a palpable, normal sized uterus.


    Based on the diagnostic value of careful examination...

    Which symptom, not asked about in the medical history, would have been most helpful; and what test or tests would be most helpful in supporting a diagnosis?

    Answer Options:

    Vomiting; electrolytes.

    Voice change; gastric analysis.

    Thirst; kidney function studies.

    Night sweats; colonoscopy.

    See the Answer:

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    About The Bedside Diagnostics Blog Series:

    Except for Hospitalists, Emergency Medicine physicians, and Interventional Cardiologists, most physicians will spend the bulk of their professional time with patients in an office setting.

    Here is where finely tuned clinical skills are most important in leading to accurate diagnoses, fewer complications resulting from unnecessary tests and procedures, and lower costs. These Bedside Diagnostic Challenges reinforces the value of these clinical skills and tests users on their knowledge of them.

    Bedside Diagnostic Challenge questions are issued periodically every month as a free benefit of Med-Challenger.

    Subscribe to the Med-Challenger blog for more Diagnostic Challenge blogs and other free clinical content from Med-Challenger.

    About the Author:

    Paul Griner MD, MACP graduated from the University of Rochester School of Medicine and completed his residency at the Massachusetts General Hospital, Boston, MA. He has served the University of Rochester School of Medicine as Chief Resident in Medicine and as Professor, Department of Medicine. He has served as a Senior Lecturer at Harvard Medical School and consultant at the Massachusetts General Hospital where he introduced a mentoring program for the faculty of General Internal Medicine. Dr. Griner is board certified in internal medicine.