A 35-year-old woman presents to the Gastroenterology Clinic with a history of intermittent dysphagia to both solids and liquids for the past 6 months. She reports that food often gets stuck during meals and she has to drink a lot of water to overcome this. The doctor orders a chest X-ray and barium swallow, which reveal a dilated oesophagus, lack of peristalsis, and bird-beak deformity.
What diagnosis is consistent with these symptoms and test results?
A 35-year-old woman presents to the Emergency Department with fever, abdominal pain and bright red, bloody bowel movements for the last 12 hours. She has also had multiple episodes of non-bloody vomiting for the last eight hours. She was diagnosed with ulcerative colitis three years ago and has been non-compliant with her management plan.
Her observations are as follows:
Temperature 38.3°C
Blood pressure 105/59 mmHg
Heart rate 105 bpm
Respiratory rate 24 breaths per minute
SpO2 99% (room air)
Examination demonstrates a diffusely tender and distended abdomen with hypoactive bowel sounds.
Which of the following is the next best diagnostic step?
A 65-year-old man presents to the Emergency Department after several episodes of vomiting bright red blood. He has presented to the same hospital in the past for spontaneous bacterial peritonitis, alcohol intoxication and peptic ulcer disease (PUD). The gastroenterology team review the patient and perform an urgent gastroscopy, which reveals several oesophageal varices.
Which of the following medications should be prescribed to this patient to reduce his chance of future variceal bleeding?
A 42-year-old man presents to A&E with sudden onset of severe epigastric pain and bright red blood in his vomit. He has a long history of heavy alcohol consumption. On examination, he has guarding over the epigastric region and cool extremities. He also has a distended abdomen with ascites and spider naevi on his neck and cheek. The patient is unstable hemodynamically, and fluid resuscitation is initiated. What is the most crucial medication to begin given the probable diagnosis?
A 45-year-old man is admitted to Emergency Department (ED) with haematemesis of bright red blood. He is an alcoholic. He has cool extremities, guarding over the epigastric region, he is ascitic, and has eight spider naevi on his neck and chest. An ABCD management is begun along with fluid resuscitation.
Given the likely diagnosis, what medication is it most important to start?
A 50-year-old male is referred by his GP for an endoscopy due to recurrent indigestion. During the procedure, a small duodenal ulcer is discovered and Helicobacter pylori is found to be present. What is the recommended treatment for this patient?
A 25-year-old woman is seen in the Gastroenterology Clinic with complaints of weight loss, diarrhoea, and a severely itchy rash on her buttocks and upper legs. Upon conducting an endoscopy with small bowel biopsy, villous atrophy is discovered. What is the most crucial step in managing her underlying condition?
A 67-year-old man visits his GP complaining of a mass on his tongue. He has a history of HIV that is not well-controlled, and he does not follow his medication regimen. During the examination, the doctor observes shaggy, poorly-defined, hardened, slightly raised, and rough plaques on the side of the tongue. The plaques cannot be removed with a tongue blade. What is the most probable diagnosis?
A 42-year-old man, who had recently undergone treatment for an inflamed appendix, presented with fever, abdominal pain and diarrhoea. He is diagnosed with Clostridium difficile infection and started on oral vancomycin. However, after 3 days, his diarrhoea continues and his total white cell count (WCC) is 22.7 (4–11 × 109/l). He remembers having a similar illness 2 years ago, after gallbladder surgery which seemed to come back subsequently.
Which of the following treatment options may be tried in his case?
A 32-year-old white man presents to his doctor with concerns about fatigue and changes to his tongue. He reports no other symptoms.
The patient has been following a strict vegan diet for the past six years and has a history of Crohn’s disease. He is currently receiving immunomodulation therapy for his condition. His vital signs are within normal limits.
Upon examination of his mouth, a beefy-red tongue is observed. His neurological exam is unremarkable.
What is the most suitable course of treatment for this patient?