Category: Gastroenterology & Hepatology

FCEM2-0742

A 72-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 37.2°C, HR 130 bpm, BP 90/50, RR 22, SaO2 97% on 2 L oxygen, GCS 13. He has intravenous access in situ, and his BM stick glucose is 2.5.
Which of the following medications are the ‘small blue tablets’ most likely to be?

FCEM2-0743

A 75-year-old man is brought to the resuscitation area of your Emergency Department by ambulance. He has become increasingly unwell over the past few weeks 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 37.2°C, HR 130 bpm, BP 90/50, RR 22, SaO2 97% on 2 L oxygen, GCS 13. He has intravenous access in situ, and his BM stick glucose is 2.5.
What is the SINGLE most likely diagnosis?

FCEM2-0744

A 45-year-old male smoker presents with unintentional weight loss and difficulty swallowing along with occasional vomiting. During the examination, you observe a lump in the left lower abdomen and can also feel a swelling in the right lower abdomen. An ultrasound scan is scheduled, which reveals bilateral, solid masses in the ovaries, displaying distinct and well-defined boundaries.

What is the MOST PROBABLE single underlying diagnosis?

FCEM2-0745

A 35-year-old woman presents with watery diarrhea that has been present since her return from a hiking trip in Peru 8 weeks ago. She has also experienced abdominal cramping and bloating and excessive gas. Stool cultures were done, which came back negative. She was referred to a gastroenterologist and had a small bowel tissue biopsy, which showed subtotal villous atrophy.

What is the SINGLE most likely diagnosis?

FCEM2-0746

A 35-year-old woman presents with watery diarrhea that has been present since her return from a hiking trip in Peru 8 weeks ago. She has also experienced abdominal cramps and bloating and excessive gas. Stool cultures were done, which came back negative. She was referred to a gastroenterologist and had a small bowel tissue biopsy, which showed subtotal villous atrophy.

What is the SINGLE most suitable next step in management?

FCEM2-0747

A 62-year-old woman presents, confused and trembling. She has a strong smell of alcohol and her appearance is unkempt. She informs you that she typically consumes large amounts of alcohol (>1 L vodka per day) but has not had any since yesterday. Upon examination, you observe that she has jaundice and abdominal distension. There are numerous spider naevi on her abdomen. Her initial blood results are as follows:

AST: 492 IU/L (5-40)
ALT: 398 IU/L (5-40)
ALP: 320 IU/L (20-140)
Gamma GT: 712 IU/L (5-40)
Bilirubin: 104 mmol (3-20)

What is the SINGLE most likely diagnosis?

FCEM2-0734

A 52-year-old individual is brought into the emergency department after being discovered unresponsive on a park bench. The patient is a familiar face to the department, having had numerous previous visits related to alcohol abuse. Upon reviewing the patient’s medical history, you observe a diagnosis of liver cirrhosis, which prompts a conversation with your consultant about the underlying mechanisms by which alcohol affects the liver. In terms of alcohol metabolism by the liver, what is the resulting product of acetaldehyde oxidation?

FCEM2-0735

A 35-year-old individual presents to the emergency department complaining of abdominal pain that started approximately 30 minutes after consuming a spicy meal. The patient reports not taking any regular or over-the-counter medications and denies any recreational drug use. They mention experiencing abdominal pain after eating for a few weeks and recently visited their general practitioner (GP) who requested a stool sample for testing. The patient states that the pain has worsened since then and they are also experiencing nausea. Upon reviewing the pathology results, it is noted that the stool sample tested positive for helicobacter pylori. The suspicion is that the patient has an h.pylori associated peptic ulcer. According to NICE guidelines, what is the recommended first-line treatment for this condition?

FCEM2-0736

A 28 year old male presents to the emergency department after experiencing 4 days of severe vomiting and diarrhea. A peripheral cannula is inserted, and blood samples are taken, revealing the following results:

Na+ 135 mmol/L
K+ 2.3 mmol/L
Ur 8.8 mmol/L
Cr 123 umol/L

The medical team decides to administer intravenous fluids. They plan to infuse a 1 liter bag of 0.9% saline with 40 mmol of potassium chloride. What would be the most appropriate duration for this infusion?

FCEM2-0737

A 45 year old female visits the emergency department complaining of abdominal cramps and bloating that are alleviated by defecation. Blood tests and an abdominal X-ray are conducted, all of which come back normal. It is observed that the patient has visited the hospital twice in the past 4 months with similar symptoms and has also consulted her primary care physician regarding these recurring issues. The suspicion is that the patient may be suffering from irritable bowel syndrome (IBS). What diagnostic criteria would be most suitable for diagnosing IBS?