A 65-year-old man presents to the clinic with a complaint of losing 1 stone in weight over the past three months. Apart from this, he has no significant medical history. During the physical examination, his abdomen is soft, and no palpable masses are detected. A normal PR examination is also observed. The patient’s blood tests reveal a haemoglobin level of 80 g/L (120-160) and an MCV of 70 fL (80-96). What is the most appropriate initial investigation for this patient?
A 42-year-old man comes in after being found unconscious. He smells strongly of alcohol.
When considering withdrawal from this substance, which of the following statements is correct?
A homeless alcoholic woman was brought to the Emergency Department by the police when she was found disoriented in the street. The Emergency Department recognises her as she has been brought in numerous times before. She appears malnourished and smells of alcohol. On examination, she is confused and ataxic. On eye examination, she has normal pupillary responses and a horizontal nystagmus on lateral gaze.
Which one of the following vitamin deficiencies is likely responsible for the patient’s condition?
A 49-year-old man is brought to the Emergency Department by ambulance after a witnessed fall. He struck his head on the pavement. He is known to the nursing staff, having been brought in on numerous occasions for the management of alcohol intoxication. On examination, his vital signs are within normal limits, but he is minimally responsive to verbal commands and has slurred speech. He has an elevated serum alcohol level. A computed tomography (CT) brain is reported as normal. He is admitted for overnight observation, hydrated with intravenous dextrose and given acetaminophen for pain relief.
By day 2 of his admission, he remains confused and inappropriate. He appears at times indifferent and does not pay attention to questioning. When he does respond, his answers are tangential and he does not appear to know his own name. On morning ward rounds, you notice that he has a bilateral rectus palsy which was not present at the time of admission. A repeat CT of his brain is normal.
To which one of the following vitamin deficiencies is this presentation is most likely due?
A 35-year-old woman with known alcohol dependence is admitted to the Emergency Department following a 32-hour history of worsening confusion. She complains of excessive sweating and feeling hot; she is also distressed as she says that ants are crawling on her body – although nothing is visible on her skin. She states that over the last few days she has completely stopped drinking alcohol in an attempt to become sober.
On examination she is clearly agitated, with a coarse tremor. Her temperature is 38.2°C, blood pressure is 134/76 mmHg and pulse is 87 beats per minute. She has no focal neurological deficit. A full blood count and urinalysis is taken which reveals the following:
Full blood count:
Investigation Result Normal value
Haemoglobin 144 g/l 135–175 g/l
Mean corpuscular volume (MCV) 105 fl 76–98 fl
White cell count (WCC) 6.8 × 109/l 4–11 × 109/l
Platelets 220 × 109/l 150–400 × 109/l
There are no abnormalities detected on urine and electrolytes (U&Es) and liver function tests (LFTs).
Urinalysis:
Investigations Results
Leukocytes Negative
Nitrites Negative
Protein Negative
Blood Negative
Glucose Negative
Which of the following is the most likely diagnosis?
A 35-year-old patient presents with an abdominal mass that is primarily located around the caecum and also involves the terminal ileum. There are no signs of weight loss or lymphadenopathy. The patient has a history of multiple oral ulcers and severe perianal disease, including fissures, fistulae, and previous abscesses that have required draining.
What is the probable diagnosis?
A 20-year-old man presents to his doctor with a yellowish tinge to his skin and eyes and a tremor in his right hand. He mentions that his family has noticed a change in his speech and have been teasing him about sounding drunk. Upon examination, the doctor notes the presence of hepatomegaly, Kayser-Fleischer rings, and the tremor. What is the probable reason for the man’s jaundice?
A 65-year-old man presents to Gastroenterology with haematemesis and is found to have oesophageal varices on endoscopy. He denies any history of alcohol consumption. On examination, he has a small liver with splenomegaly. His blood pressure is 130/90 mmHg and heart rate is 88 beats per minute. Laboratory investigations reveal low albumin levels, elevated bilirubin, ALT, AST, and ALP levels, and high ferritin levels. What is the most likely diagnosis?
A 50-year-old woman presents with a few months history of abdominal pain and diarrhoea. Further questioning reveals increasing episodes of facial flushing and occasional wheeze. Clinical examination reveals irregular, craggy hepatomegaly. Abdominal CT is performed which revealed nonspecific thickening of a terminal small bowel loop, a large calcified lesion in the small bowel mesentery and innumerable lesions in the liver.
What is the most likely diagnosis?
A 38-year-old woman is brought to the Emergency Department by her partner due to increasing confusion and abdominal distension. Collateral history indicates increasing forgetfulness over the last 12 months and that other members of the family have had similar symptoms although further details are not available. Examination identifies hepatomegaly and ascites. The patient is noted to have a shuffling gait and tremor. Ultrasound of the liver confirms the presence of cirrhosis.
Which one of the following tests would most likely confirm the suspected diagnosis?