A 35-year-old man visited a medical clinic for the first time. He had been experiencing recurrent abdominal pain that improved with defecation, and mushy stools up to three times a day for the past 5 months. He denied any weight loss, rectal bleeding, or a family history of colorectal cancer. Stool microscopy, culture and sensitivity tests were negative for ova, cysts, and parasites.
What is the most suitable next step in investigating this patient’s condition?
You are requested to assess a 67-year-old female patient who has been admitted to the ward. The nursing staff is concerned about her constipation as she has not had a bowel movement in four days. The patient has a medical history of hypertension and is currently hospitalized due to a urinary tract infection. During the examination, you notice that her abdomen is distended and there is mild tenderness in the lower abdomen. However, the patient reports passing flatus regularly.
The blood test results are as follows:
Hb 120 g/l Na+ 138 mmol/l
Platelets 290 * 109/l K+ 3.2 mmol/l
WBC 11.8 * 109/l Urea 11.5 mmol/l
Neuts 9.5 * 109/l Creatinine 130 µmol/l
Lymphs 2.3 * 109/l CRP 135 mg/l
You order an abdominal x-ray which shows dilated small loops of bowel with no visible transition point. There is visible gas in the rectum.
What is the most appropriate antiemetic for this patient?
A 56-year-old female nurse experiences a needlestick injury while administering medication to a patient. The patient has a history of blood transfusions, but there is no known history of infectious diseases. The nurse has a past medical history of hypertension and diabetes. She recently moved from Mexico and is uncertain if she has been vaccinated for hepatitis B.
The results of her hepatitis B tests are:
HBsAg Negative
Anti-HBs Positive
Anti-HBc IgG Positive
What is her hepatitis B status?
A 36-year-old ex intravenous drug user has been diagnosed with HBe-Ag positive Hepatitis B. Her investigation results are as follows:
– HBV DNA 2100 IU/ml
– ALT 60 IU/L
The patient’s ALT was last checked 3 months ago and was found to be 60 IU/L. What is the recommended initial treatment for this individual?
A 54-year-old man has undergone a colonoscopy due to per rectal bleeding and was found to have two small adenomas measuring less than 10mm. He has no significant medical history and no family history of colorectal cancer. What is the most appropriate approach for colonoscopic monitoring in this individual?
A 72-year-old patient presents to the emergency department with a four-day history of diffuse diarrhoea. The patient has a medical history of hypertension and type 2 diabetes and is currently taking amlodipine and metformin. The patient was recently treated with co-amoxiclav for a lower respiratory tract infection. On examination, there is mild generalized abdominal tenderness without peritonism. The patient’s observations are heart rate 105 beats per minute, blood pressure 88/62 mmHg, respiratory rate 19/minute, oxygen saturations 97% on room air, and temperature 38.2.
The patient is started on intravenous fluids and the following results are obtained: Hb 138 g/L (Male: 135-180, Female: 115-160), platelets 412 * 109/L (150-400), WBC 15.4 * 109/L (4.0-11.0), Na+ 131 mmol/L (135-145), K+ 4.2 mmol/L (3.5-5.0), urea 8.2 mmol/L (2.0-7.0), creatinine 88 µmol/L (55-120), and CRP 44 mg/L (<5). A CT abdomen and pelvis is arranged, which shows severe colitis with a transverse colon diameter of 4cm. A stool sample demonstrates Clostridium difficile toxin. What is the appropriate management for this patient?
A 56-year-old man visits the general medical clinic complaining of bloating, acid reflux, and pain during meals. Upon endoscopy, he is diagnosed with a peptic ulcer and further testing reveals the presence of Helicobacter pylori. The patient has a history of depression but is not currently taking any medications. He denies using NSAIDs and has a childhood allergy to penicillin that caused a systemic rash. What is the recommended treatment plan for this patient?
A 32-year-old woman, who is 16 weeks pregnant, has been referred for an opinion by the obstetricians due to recurrent vomiting. Despite treatment with anti-emetics, she has not been able to stop vomiting since the beginning of her pregnancy. As a result, she has lost 5 kg of weight. Nasogastric and nasojejunal feeding were unsuccessful due to recurrent regurgitation of the tubes. Therefore, she has been started on total parenteral nutrition (TPN) and requires supplemental intravenous fluids due to recurrent vomiting. Her blood tests were checked 72 hours after initiating TPN and the results are as follows:
What is the most likely explanation for these results?
An 80-year-old woman presents with melaena, passing dark, black tarry stools for the last 36 hours. She has a medical history of chronic renal failure, angina, and is taking aspirin, isosorbide mononitrate, ramipril, calcium carbonate, alfacalcidol, and erythropoietin. On examination, she is sweaty and clammy with a pulse rate of 102 beats per minute and blood pressure of 102/43 mmHg. Her blood tests show low haemoglobin, high urea and creatinine, and a normal INR. Upper GI endoscopy reveals a gastric ulcer with a visible, non-bleeding vessel and no blood in the stomach. What is the most significant risk factor for mortality based on her clinical history?
A 65-year-old man presents to gastroenterology outpatients to discuss his gastroscopy results. He underwent endoscopy due to a six-week history of dyspeptic symptoms and weight loss, and has a past medical history of osteoarthritis treated with ibuprofen. The gastroscopy report reveals a 3 cm ulcer with flat edges in the gastric antrum, which tested positive for rapid urease (Campylobacter-like organism). He is curious about the impact of Helicobacter pylori eradication therapy and acid suppression on his peptic ulcer disease.
What advice should he be given regarding the effects of Helicobacter pylori eradication therapy and acid suppression on his peptic ulcer disease?