The patient’s symptoms along with his age indicates a diagnosis of colorectal cancer. Blood test marker CA-19-9 is a prognostic index for colorectal cancer which confirms the suspicion. Celiac disease is not usually associated with bleeding per rectum and it is associated with a reaction to products containing gliadin. Crohn’s disease and UC are inflammatory bowel diseases and on endoscopy, show many other features of inflammation and not just a single ulcer. A patient with IBS will also have bloating and intermittent diarrhoea with constipation.

All of the symptoms observed in this patient are typical of uncoordinated irregular oesophageal peristalsis – this is characteristic of oesophageal spasm. The cork-screw oesophagus is also diagnostic of the condition.

This presentation is suggestive of cocaine toxicity. The major effects of cocaine poisoning include CNS effects such as agitation, seizures and psychosis, and cardiovascular effects such as dysrhythmias, myocardial infarction and cardiovascular collapse. The common route for cocaine ingestion is through the nose, hence the irritated swollen septum.

As this patient seems to be a danger to the safety of staff, police should be called to handle the situation.

At 7 months, children are expected to sit briefly leaning forward on their hands, reach and grasp objects, transfer objects from hand to hand, and babble. Children are usually expected to wave goodbye or grasp objects with their fingers or thumb at around 10 months and older.

Patients with chronic myeloid leukaemia (CML) can initially be asymptomatic but as the disease progresses, they appear to have elevated WBCs with anaemia and a lower than normal platelet count. The blood test results in addition to the profound splenomegaly, which is the most common finding in patients with CML, make CML the most possible diagnosis.

In spinal anaesthesia, the needle parts the dura rather than tears it. In an epidural, however, the needle is meant to inject around the dura but may penetrate it by accident. Maternal hypotension is most likely to be caused by dural penetration during an epidural, as this is the generally intended procedure. Postdural puncture headache appears to be associated higher with a spinal than an epidural.

Maple syrup urine disease (MSUD) is an autosomal recessive metabolic disorder affecting branched-chain amino acids. It is one type of organic academia. The condition gets its name from the distinctive sweet odour of affected infants’ urine, particularly prior to diagnosis, and during times of acute illness. MSUD, also known as branched-chain ketoaciduria, is an aminoacidopathy due to an enzyme defect in the catabolic pathway of the branched-chain amino acids leucine, isoleucine, and valine.

This is a case of Sjogren Syndrome (aka Reiter’s disease). It is characterised by a triad of: seronegative arthritis mostly sacroiliitis (walking on gravel reflects planter fasciitis), urethritis and conjunctivitis. Sjogren Syndrome usually follows gastroenteritis or non specific urethritis. On the other hand gonococcal arthritis usually occurs in patients who are systemically unwell.

Normal pressure hydrocephalus is a form of communicating hydrocephalus characterised by enlarged ventricles with normal opening pressure on lumbar puncture. For diagnostic purposes, a triad of urinary incontinence, gait abnormality and dementia is necessary. It is necessary to diagnose the condition early because it is reversible by placing a ventriculoperitoneal shunt. It is most common in patients aged more than 60 years.

The patient has most probably experienced a transient ischemic attack which should be initially managed with aspirin 300 mg for two weeks.

The most probable diagnosis is Herpes Simplex infection. Topical Acyclovir can be used in early stages.

Due to its cholestatic properties, Flucloxacillin can block bile flow through the liver, leading to the accumulation of bilirubin in the blood, giving rise to jaundice. Dark urine is the result of excessive bilirubin in the blood being filtered by the kidney. As the bile doesn’t move into the small intestine, stools are pale.

Barrett’s oesophagus is characterised by the metaplastic replacement of the normal squamous epithelium of the lower oesophagus by columnar epithelium.

Herpes zoster oticus is a viral infection of the inner, middle, and external ear. It manifests as severe otalgia with associated cutaneous vesicular eruption, usually of the external canal and pinna. When associated with facial paralysis, the infection is called Ramsay Hunt syndrome.

A large prospective study identified hopelessness, higher levels of suicidal ideation, recurrent episodes of depression, presence of personality disorders, previous psychiatric hospitalisation, older age, unemployed status and a family history of suicide as significant markers for suicide. Having one or more previous suicide attempts is a very strong predictor of suicide risk.

This is a case of nephrotic syndrome that can be confirmed by the presence of urinary albumin. It should be further investigated by a tissue sample to confirm the diagnosis.

This a case of autoimmune haemolytic anaemia which is a rare complication of the less used treatment, salazopyrine, used for inflammatory bowel disease (IBD). A direct Coombs’ test looks for erythrocytes already coated with antibody, whereas the indirect test is used to detect potential red cell antibody interactions floating around in the blood.

This temperature is considered to be a mild fever and is most often caused by a minor infection in children of this age. Therefore, an infection screen should be conducted and an IV antibiotic.

Valproate is one of the most prescribed antiepileptic medications and is also commonly associated with tremors. It is the most common neurological adverse event observed with valproate. Approximately 25% of patients taking valproate are found to develop a tremor within 3–12 months of initiating therapy.

Physiological jaundice is the condition in which there is a yellow discolouration of the eyes and the skin of the baby caused by the build up of bilirubin in the blood due to an immature liver. No other symptoms accompany physiological jaundice, thus it will not present with difficulty in feeding. All the other conditions listed can present with feeding problems.

Intrahepatic cholestasis of pregnancy can affect both mother and foetus, however it is more harmful for the foetus. Amongst foetuses, there is an increased risk of perinatal mortality, meconium aspiration, premature delivery and post partum haemorrhage. Exact cause of fetal death cannot be predicted accurately but it is not related to intra uterine growth retardation or placental insufficiency. The liver can be affected in the mother leading to generalized pruritis but no evidence of fetal hepatic dysfunction has been found.

According to NICE guidelines women with type I diabetes, who are expecting a child should aim to keep their HbA1c level[1] below 48 mmol/mol (6.5%) without causing problematic hypoglycaemia. Women with diabetes whose HbA1c level is above 86 mmol/mol (10%) should be strongly advised not to get pregnant because of the associated risks. The risks are higher with chronic diabetes. There is an increased risk to the foetus or mother due to diabetes in pregnancy. Women who are waiting to become pregnant should take folic acid (5 mg/day) until 12 weeks of gestation to reduce the risk of having a baby with a neural tube defect.

Alzheimer’s disease is most often characterized early on by short-term memory loss. The other options in this list are characteristic of the following: normal pressure hydrocephalus (gait ataxia and urinary incontinence); Creutzfeldt-Jakob disease (myoclonic jerks); delirium or Lewy body dementia (visual hallucinations).

Brain tumour symptoms include gradual paralysis on one side of the body, extreme headaches, and seizures. Hyperreflexia is defined as overactive reflexes including twitching or spastic tendencies, which are indicative of upper motor neuron disease.

Schistosoma haematobium characteristically causes urinary tract disease. S.mansoni, S. mekongi, S. intercalatum, and S. japonicum cause intestinal tract and liver disease.

Anti ds-DNA antibodies are very specific for SLE and their presence most often indicates systemic spread of the disease. These antibodies are present in about 30 percent of the total cases of SLE.

Maternal and fetal toxoplasma infection may be avoided by advising pregnant women to wear gloves when gardening or handling cat litter and to cook meat thoroughly. Affected babies are treated with pyrimethamine, sulfadiazine, and folic acid.

Lateral epicondylitis (tennis elbow) is an overuse injury of the hand and finger extensor tendons that originate in the lateral humeral epicondyle that occurs following repeated or excessive pronation/supination and extension of the wrist (e.g., in racquet sports). Clinical features include pain and tenderness over the lateral epicondyle and along extensor muscles, thickening of the tendons. The examiner holds the patient’s hand with the thumb placed over the lateral epicondyle – The patient makes a fist, supinates the forearm, deviates radially, and extends the fist against the examiner’s resistance which results in pain over the lateral epicondyle. Conservative treatment includes rest, physiotherapy and orthotic braces. If this fails corticosteroids and lidocaine injections are employed. Surgery is indicated in patients with persistent symptoms despite 6 months of conservative treatment. Excision of abnormal tendon tissue; longitudinal incisions (tenotomies) in scarred and fibrotic areas to promote healing.

Atenolol is a beta-selective (cardio selective) adrenoceptor blocking drug without partial agonist or membrane stabilising activity. Higher doses of Atenolol causes broncho-constriction.