Category: Gastroenterology & Hepatology

FCEM2-0738

A 47 year old female presents to the emergency department complaining of worsening abdominal pain and distension over the past 2 weeks. The patient has a history of alcohol dependence with multiple alcohol related visits to the hospital over the past 8 years. On examination, you observe a significantly swollen abdomen consistent with tense ascites which you suspect is due to liver cirrhosis. Which scoring system is utilized to evaluate the severity of liver cirrhosis and predict mortality?

FCEM2-0739

A 35 year old female presents to the emergency department complaining of sudden abdominal pain. She mentions that she has been consuming alcohol excessively for the past 48 hours and suspects it may be the cause of her discomfort. After a thorough evaluation and necessary tests, the patient is deemed stable enough to be discharged. You counsel her on the importance of consuming alcohol within safe limits.

According to the department of health, what is the recommended maximum number of units per week for women in order to minimize health risks?

FCEM2-0740

You evaluate a 42-year-old woman with a history of Sjögren’s syndrome. She has undergone a series of liver function tests, and the results are as follows:

Bilirubin: 18 mmol (3-20)
ALT: 38 IU/L (5-40)
ALP: 356 IU/L (20-140)
IgM: 4.0 g/L (0.5-2.5)
pANCA: negative
cANCA: negative
ANA: positive
SMA: negative
Antimitochondrial antibodies: positive

Currently, she is asymptomatic, and her Sjögren’s syndrome is well managed with hydroxychloroquine.

What is the most likely diagnosis in this case?

FCEM2-0725

You are reviewing a 35-year-old man after receiving his most recent blood results. He is currently taking ramipril for his blood pressure, which is well controlled. He used to consume 30 units of alcohol per week until three months ago when he was advised to reduce his intake following his last set of blood tests. He has since remained completely abstinent. He has no identifiable risk factors for chronic liver disease. On examination, you can palpate a 1 cm liver edge below the right costal margin. His most recent two sets of blood results are provided below.

Blood results today:
Bilirubin: 19 µmol/L (3-20)
ALT: 98 IU/L (5-40)
AST: 46 IU/L (5-40)
ALP: 126 IU/L (20-140)
GGT: 225 IU/L (5-40)

Blood results 3 months ago:
Bilirubin: 19 µmol/L (3-20)
ALT: 126 IU/L (5-40)
AST: 39 IU/L (5-40)
ALP: 118 IU/L (20-140)
GGT: 35 IU/L (5-40)

What is the SINGLE most likely diagnosis?

FCEM2-0726

You evaluate a 60-year-old patient with hepatomegaly. He was recently diagnosed with type 2 diabetes mellitus and is currently taking metformin 500 mg twice daily. He consumes approximately 25 units of alcohol per week and has a BMI of 30. His liver function tests are as follows:
– Bilirubin: 18 mmol (3-20)
– ALT: 320 IU/L (5-40)
– AST: 85 IU/L (5-40)
– ALP: 110 IU/L (20-40)
– GGT: 120 (5-40)
– ANA: positive

What is the MOST LIKELY diagnosis for this patient?

FCEM2-0727

A 68-year-old man is brought into the Emergency Department by his wife. He has been experiencing excessive watery diarrhea for the past nine days and feels extremely weak.

What type of acid-base imbalance would you anticipate in a patient with severe and prolonged diarrhea?

FCEM2-0728

A 60-year-old woman presents to the Emergency Department following an episode of hematemesis. You assess her risk using a scoring system to determine whether or not she can be discharged.

Which of the following scoring systems is most suitable to use in this scenario?

FCEM2-0729

A 35 year old female presents to the emergency department complaining of abdominal pain associated with increased abdominal swelling, fever and vomiting. You note the patient has a long history of drug abuse and is well known to the local gastroenterology team who have diagnosed her with liver cirrhosis. You are concerned the patient may have developed spontaneous bacterial peritonitis (SBP).

What is the most commonly identified causative pathogen in patients with spontaneous bacterial peritonitis?

FCEM2-0730

A 10-year-old girl is brought into the Emergency Department with stomach pain and throwing up. Her mom tells you that she has been losing weight lately and seems to be drinking a lot and peeing a lot. During the examination, she appears tired and you notice that she is dehydrated. She is breathing deeply and quickly. Her blood sugar levels are found to be very high when her blood is tested.
Which of the following tests will be most useful in confirming the diagnosis?

FCEM2-0731

You evaluate a 42-year-old woman with a history of increasing fatigue and overall discomfort. Her blood test results are as follows:
Bilirubin 19 mmol (3-20)
ALT 338 IU/L (5-40)
ALP: 256 IU/L (20-140)
IgM: 2.4 g/L (0.5-2.5)
IgG: 28 g/L (7.5-15)
IgA: 1.5 g/L (1-4)
ANA: positive
SMA: positive
What is the MOST likely diagnosis?