A 45-year-old woman, with a history of gallstones, arrives at the emergency department complaining of central abdominal pain that radiates to her back. Upon conducting blood tests, you observe the following result:
Amylase 480 U/L (30 – 110). The patient is diagnosed with acute pancreatitis and inquires about the severity of her condition. What is the primary factor in determining the clinical severity of acute pancreatitis?
A 24-year-old woman presents to the emergency department with a 3-day history of vomiting. She is unable to take any fluids orally and complains of feeling dizzy and lethargic. There is no past medical history of note and she takes no regular medications. She is 12 weeks pregnant.
On examination, she has a temperature of 36.5ºC with a heart rate of 110 beats/min and a blood pressure of 100/60 mmHg. She has dry mucous membranes. Her abdomen is soft and nontender.
What is the most appropriate initial anti-emetic for this patient, given the likely diagnosis?
A 28-year-old woman is in week 32 of her pregnancy. She has been experiencing itching for two weeks and is worried. She now has mild jaundice. Her total bilirubin level is elevated at around 85 μmol/l (reference range <20 μmol/), and her alanine aminotransferase (ALT) level is elevated at 78 iu/l (reference range 20–60 iu/l); her alkaline phosphatase (ALP) level is significantly elevated. What is the most appropriate diagnosis for this clinical presentation?
A 32-year-old male presents with vomiting and central abdominal pain that radiates to the back. The following laboratory result is obtained:
Amylase 1,245 u/dl. Which medication is the most probable cause of these symptoms?
A 26-year-old man complains of rectal bleeding and a sharp, stinging pain during bowel movements. He has been experiencing these symptoms for the past two weeks. The patient reports a history of constipation and notes fresh blood on the toilet paper when wiping. Although rectal examination is challenging due to pain, no external abnormalities are observed. What is the probable diagnosis?
A 70-year-old man presents with unexplained weight loss and episodes of passing blood in his stool for the past 3 months. Upon investigation, a CT scan reveals a T2N0M0 tumour just below the rectosigmoid junction. The patient has no significant medical history and is considered fit for surgery. What is the best course of action for management?
Which one of the following can be utilized for monitoring patients with colorectal cancer?
A 50 year old woman arrives at the Emergency Department complaining of cramp-like abdominal pain, nausea, and vomiting that started 4 hours ago. She describes the pain as intermittent and has experienced similar pain before, but not as severe as this time. The patient has a history of chronic obstructive pulmonary disease, which is well-controlled with inhalers, and has been a smoker for 25 pack years.
Her vital signs are heart rate 110/min, respiratory rate 20/min, blood pressure 130/84 mmHg, temperature 38.6ºC, and oxygen saturation of 99% on room air. Upon examination, the patient appears very ill and sweaty, with some yellowing of the eyes. Palpation of the abdomen reveals tenderness in the right upper quadrant.
What is the most likely cause of this woman’s symptoms?
A 65-year-old woman presents to the emergency department with central abdominal pain. She has vomited twice since the onset of the pain and has not passed any wind or faeces in the last twelve hours. Her medical history includes a partial small bowel resection due to traumatic perforation. On examination, her abdomen appears distended and there is generalised tenderness on palpation. Her blood tests reveal a Hb level of 153 g/L (115 – 160), platelets of 312 * 109/L (150 – 400), WBC count of 10.8 * 109/L (4.0 – 11.0), bilirubin of 17 µmol/L (3 – 17), ALP of 78 u/L (30 – 100), ALT of 29 u/L (3 – 40), and amylase of 880 U/L (70 – 300). What is the most likely diagnosis?
A 28-year-old man presents to the colorectal surgeons with recurrent episodes of bright red rectal bleeding over the past 5 months. During examination, a muco-epithelial defect is observed in the posterior midline of the anus. However, a complete digital rectal exam (DRE) could not be performed due to severe pain. Despite trying bulk-forming laxatives, lubricants, and topical glyceryl trinitrate (GTN), the patient has experienced little relief. What is the recommended next step in managing this likely diagnosis?