A 29-year-old man was involved in a motorcycle race accident where a rod pierced his abdomen. He underwent emergency surgery and survived. After a year, he complains of abdominal pain and frequent stools, and is diagnosed with anemia. His blood tests show a vitamin B12 level of 41 (160–900 pmol/l) and serum folate of 35 ug/l (4.20 – 18.70 ug/l). He denies any dietary intolerance or rectal bleeding. What is the gold standard test for diagnosing this condition?
A 23-year-old plumber is admitted to the Surgical Ward after undergoing an appendicectomy. A medical student conducts a thorough examination and takes a detailed medical history of the patient. The student observes that the patient is exhibiting jaundice but does not display any other symptoms of liver dysfunction. The liver function tests reveal the following results: total bilirubin of 52 mmol/l, aspartate aminotransferase (AST) 37 iu/l, alanine aminotransferase (ALT) 32 iu/l, and alkaline phosphatase 70 u/l. What is the likely condition affecting this patient?
A 21-year-old woman is brought to the Emergency Department by her flatmates who claim that she has vomited up blood. Apparently she had consumed far too much alcohol over the course of the night, had vomited on multiple occasions, and then began to dry-retch. After a period of retching, she vomited a minimal amount of bright red blood. On examination, she is intoxicated and has marked epigastric tenderness; her blood pressure is 135/75 mmHg, with a heart rate of 70 bpm, regular.
Investigations:
Investigation
Result
Normal value
Haemoglobin 145 g/l 115–155 g/l
White cell count (WCC) 5.4 × 109/l 4–11 × 109/l
Platelets 301 × 109/l 150–400 × 109/l
Sodium (Na+) 142 mmol/l 135–145 mmol/l
Potassium (K+) 3.8 mmol/l 3.5–5.0 mmol/l
Creatinine 75 μmol/l 50–120 µmol/l
Which of the following is the most appropriate treatment for her?
A 42-year-old female patient complains of a slow onset of difficulty swallowing both solids and liquids. An upper GI endoscopy shows no abnormalities, and there is no visible swelling in the neck. A preliminary psychiatric evaluation reveals no issues. The on-call junior doctor suspects a psychological or functional cause. What signs would indicate an organic origin for the dysphagia?
A 20-year old man presents to the Surgical Assessment Unit complaining of sudden onset abdominal pain. What physical examination finding is most indicative of a possible diagnosis of appendicitis?
A 45-year-old woman presents with sudden onset of constant abdominal pain. She tells you she has a history of peptic ulcers. The pain is worse with inspiration and movement.
On examination, there is rebound tenderness and guarding. There are absent bowel sounds. A chest X-ray shows free air under the diaphragm.
What clinical sign tells you that the peritonitis involves the whole abdomen and is not localised?
A 63-year-old woman is concerned about the possibility of having bowel cancer. She has been experiencing bloating and abdominal discomfort for the past 6 months, as well as unintentional weight loss. Her cousin was recently diagnosed with colorectal cancer, which has prompted her to seek medical attention.
What is a red flag symptom for colorectal cancer?
A 21-year-old anatomy student presents with diarrhoea and weight loss. The patient complains of increased frequency of loose motions associated with cramping abdominal pain for six weeks, with an accompanying 5 kg weight loss. He opens his bowels anywhere from three to six times daily, the stool frequently has mucous in it, but no blood. The patient has no recent history of foreign travel and has had no ill contacts. He is a non-smoker and does not drink alcohol. The patient is referred to Gastroenterology for further investigation. A colonoscopy and biopsy of an affected area of bowel reveals ulcerative colitis.
Which of the following is an extra-intestinal clinical feature associated with inflammatory bowel disease?
An 80-year-old woman has been referred to a Gastroenterologist by her General Practitioner due to epigastric discomfort and the development of jaundice over several months. The patient reports no pain but has experienced unintentional weight loss. During examination, no abdominal tenderness or mass is detected. Serology results indicate that the patient has recently been diagnosed with diabetes. What is the most probable diagnosis?
A 30-year-old man has arrived at the Emergency Department complaining of fever, jaundice and malaise over the last three days. His initial lab results indicate elevated liver enzymes and a decreased platelet count. He has not traveled recently. The possibility of autoimmune hepatitis is being evaluated. What antibodies are the most specific for this condition?