A 56-year-old man comes to the Emergency Department with haematemesis. His friends report that he drank a large amount of alcohol earlier and had prolonged vomiting because he is not used to drinking so much. During the examination, his vital signs are: pulse 110 bpm, blood pressure 100/60 mmHg. There are no notable findings during systemic examination.
What is the most likely cause of the haematemesis in this case?
A 55-year-old man presents to the Emergency Department after vomiting bright red blood multiple times over the past four hours. He has a history of alcohol abuse and has been diagnosed with spontaneous bacterial peritonitis in the past. He currently consumes 4-5 pints of beer daily and has a poor compliance with his medication regimen, resulting in missed appointments and discharge from outpatient follow-up. On examination, he has dry mucous membranes, palmar erythema, and hepatomegaly. His vital signs are as follows: temperature 36.6°C, blood pressure 113/67 mmHg, respiratory rate 21 breaths per minute, heart rate 100 beats per minute, and SpO2 99% on room air. The patient is resuscitated with aggressive intravenous fluids, and the gastroenterology team is consulted. They suspect bleeding oesophageal varices and perform an upper gastrointestinal endoscopy, which confirms the diagnosis. The varices are banded, and bleeding is significantly reduced.
Which medication is most likely to prevent further episodes of oesophageal varices in this 55-year-old patient?
A 45-year-old woman comes to the Surgical Admissions Unit complaining of colicky abdominal pain and vomiting in the right upper quadrant. The pain started while eating but is now easing. During the examination, she appears restless and sweaty, with a pulse rate of 100 bpm and blood pressure of 125/86. An abdominal ultrasound reveals the presence of gallstones.
What is the most frequent type of gallstone composition?
A 50-year-old man presents to the upper gastrointestinal surgeon with a 9-month history of difficulty swallowing both liquids and solid foods. He also complains of regurgitating food. He has been eating smaller and smaller meals given the above symptoms. He has a past medical history of depression for which he takes citalopram. He has never smoked or drank alcohol. He has trialled over-the-counter proton-pump inhibitor (PPI) medication without any symptom relief.
Physical examination is normal. A recent chest radiograph also appears to be normal. His electrocardiogram (ECG) is also normal.
His observations are shown below:
Temperature 36.8 °C
Blood pressure 127/79 mmHg
Heart rate 75 beats per minute
Respiratory rate 16 breaths per minute
Sp(O2) 98% (room air)
A diagnosis of achalasia is likely.
Which of the following is the most appropriate definitive management for this condition?
A 42-year-old mechanic visits his GP complaining of intermittent jaundice that has been occurring for the past 5 months. He has been feeling fatigued lately and occasionally experiences mild itching on his arms. He denies any pain or weight loss. The patient has a history of ulcerative colitis, which was diagnosed 13 years ago and has been managed with mesalazine, anti-diarrhoeals, and steroids. The GP orders liver function tests, which reveal the following results:
total bilirubin 38 mmol/l
aspartate aminotransferase (AST) 32 iu/l
alanine aminotransferase (ALT) 34 iu/l
alkaline phosphatase 310 u/l.
What is the most probable diagnosis?
In a 30-year-old patient with chronic obstructive pulmonary disease (COPD) and hepatic dysfunction, a liver biopsy revealed the presence of eosinophilic, round globules within the periportal hepatocytes. These globules ranged in size from 5 to 40 µm and were surrounded by a halo. Additionally, they were found to be periodic acid-Schiff (PAS)-positive and diastase-resistant. What is the most probable substance that makes up these globules?
A 45-year-old alcoholic presents to the Emergency Department with retrosternal chest pain, shortness of breath and pain on swallowing after a heavy drinking session the night before. He reports having vomited several times this morning, after which the pain started. He denies any blood in the vomit and has no melaena. On examination, he is febrile and tachypnoeic and has a heart rate of 110 bpm. A chest X-ray reveals a left-sided pneumothorax and air within the mediastinum.
Given the likely diagnosis, what is the most appropriate management to treat the underlying cause of his symptoms?
A 67-year-old Indian woman presents to the Emergency Department with vomiting and central abdominal pain. She has vomited eight times over the last 24 hours. The vomit is non-bilious and non-bloody. She also reports that she has not moved her bowels for the last four days and is not passing flatus. She reports that she had some form of radiation therapy to her abdomen ten years ago in India for ‘stomach cancer’. There is no urinary urgency or burning on urination. She migrated from India to England two months ago. She reports no other past medical or surgical history.
Her observations and blood tests results are shown below:
Investigation Result Normal value
Temperature 36.9 °C
Blood pressure 155/59 mmHg
Heart rate 85 beats per minute
Respiratory rate 19 breaths per minute
Sp(O2) 96% (room air)
White cell count 8.9 × 109/l 4–11 × 109/l
C-reactive protein 36 mg/l 0–10 mg/l
The patient’s urine dipstick is negative for leukocytes and nitrites. Physical examination reveals a soft but distended abdomen. No abdominal scars are visible. There is mild tenderness throughout the abdomen. Bowel sounds are hyperactive. Rectal examination reveals no stool in the rectal vault, and no blood or melaena.
Which of the following is the most likely diagnosis?
A 55-year-old librarian presents with a 4-month history of abdominal discomfort and pain after consuming fatty meals. She undergoes an ultrasound of her gallbladder, which shows multiple stones.
What is the most frequent observation in an individual with gallstones?
A 54-year-old man with persistent dyspepsia was being evaluated at the nearby medical center. While performing oesophago-gastro-duodenoscopy (OGD), the endoscopist inserted the endoscope until it reached the oesophageal hiatus of the diaphragm.
At which vertebral level is it probable that the endoscope tip reached?