Category: Gastroenterology & Hepatology

FCEM2-0748

A 62 year old female is brought to the emergency department by her husband who is concerned that the patient has been experiencing abdominal pain and also appears slightly confused. He informs you that the patient is a heavy drinker and you observe that the patient was diagnosed with liver cirrhosis 8 months ago. The patient has difficulty focusing during the Abbreviated Mental Test Score (AMTS) but scores 7/10. Upon examination, you notice mild ascites. You suspect the patient has moderate (grade 2) hepatic encephalopathy secondary to liver cirrhosis. The patient’s initial blood tests are as follows:

Bilirubin 45 µmol/l
ALP 210 u/l
ALT 300 u/l
γGT 160 u/l
Albumin 27 g/l
INR 1.9

What is this patient’s Child Pugh score?

FCEM2-0749

A 4-year-old girl is brought to the Emergency Department by her parents. She is typically healthy but has been experiencing abdominal pain for the past two days. She has vomited once, but there have been no loose stools. Her temperature has been elevated throughout the day. She has been producing urine with a strong odor. Upon examination, her abdomen is soft and nontender. Bowel sounds are normal. Urine dipstick reveals the presence of leukocytes and is positive for nitrites.

What is the SINGLE most likely diagnosis?

FCEM2-0750

A 60-year-old man presents with visible jaundice, fatigue, and intense itching. He has noticed that his stools float and that they have become pale, foul-smelling, and oily in appearance. He has no history of abdominal pain. He has a past medical history of Crohn’s disease, which has been controlled with mesalazine. On examination, you notice yellowish pigmentation of the skin, sclerae, and mucous membranes. His abdomen is soft but can palpate a firm liver edge 5 cm below the costal margin. He also has numerous scratch marks covering his abdomen and upper thighs. His liver function tests are shown below:
Bilirubin 102 mmol (3-20)
ALT 235 IU/L (5-40)
ALP: 1501 IU/L (20-140)
pANCA: positive
cANCA: negative
ANA: negative
SMA: negative
What is the SINGLE most likely diagnosis?

FCEM2-0751

A 30-year-old doctor that works in your department has recently come back from a visit to India and has been having diarrhea 5-10 times per day for the past week. They are also experiencing mild stomach cramps and occasional fevers but have not vomited.

What is the SINGLE most probable causative organism?

FCEM2-0752

A 22-year-old woman comes in with bloody diarrhea that has been persisting for a few days. She has recently returned from a backpacking adventure across various Middle Eastern and African nations.
What is the SINGLE most probable causative organism?

FCEM2-0753

A 32-year-old man with a long-standing history of ulcerative colitis presents with a complication of his illness.
What is the SINGLE least likely complication that he has developed?

FCEM2-0754

A 25-year-old woman with inflammatory bowel disease (IBD) presents with a condition associated with IBD.
Which of the following conditions is NOT linked to ulcerative colitis disease?

FCEM2-0755

A 67 year old male is brought into the emergency department by concerned neighbors. They inform you that the patient is frequently intoxicated, but this morning they discovered him wandering in the street and he appeared extremely disoriented and unstable, which is out of character for him. Upon reviewing the patient’s medical records, you observe that he has been experiencing abnormal liver function tests for several years and a history of alcohol abuse has been documented. You suspect that the underlying cause of his condition is Wernicke’s encephalopathy.

FCEM2-0756

A 62 year old male is brought into the emergency department by concerned bystanders who witnessed the patient vomit blood outside a local bar. The patient is familiar to the department due to multiple alcohol-related visits in the past and has a previous diagnosis of alcohol-related liver cirrhosis. The patient experiences another episode of large volume bright red hematemesis shortly after arriving in the emergency department and is transferred to resus. The patient’s initial vital signs are as follows:

Blood pressure: 98/70 mmHg
Pulse: 126 bpm
Respiration rate: 24 bpm
Temperature: 36.4ºC

Which of the following treatments should be administered as a priority?

FCEM2-0741

A 45-year-old man is brought to the resuscitation area of your Emergency Department by ambulance. He has become increasingly unwell over the past few days with vomiting and diarrhea. His wife tells you that he was started on a medication by his GP six months ago for pain and stiffness around his shoulders, upper arms, and hips. She describes this medication as being ‘6 small blue tablets.’ He has been unable to take these tablets for the past few days. On examination, he is pale and sweaty and appears confused. His observations are as follows: temperature 36.9°C, HR 140 bpm, BP 83/42, RR 24, SaO2 98% on 2 L oxygen, GCS 14. He has intravenous access in situ, and his BM stick glucose is 2.1.
Which rheumatological condition is it most likely that his GP is treating?