A 60 year old comes to the emergency department with worries of feeling nauseated and vomiting blood. The patient shows you a tissue paper with mostly coffee ground vomit and a few specks of fresh red blood. The patient mentions experiencing on-and-off abdominal pain for a few weeks. You suspect that the patient is experiencing an upper gastrointestinal bleed. What is the primary cause of upper gastrointestinal bleeding in adults?
A 48-year-old male presents to the emergency department complaining of abdominal pain and noticeable abdominal distension. Upon examination, you discover that the patient has a longstanding history of alcohol abuse. After conducting a thorough clinical assessment, you diagnose the patient with significant ascites, most likely caused by alcoholic liver disease. In terms of liver damage resulting from alcohol abuse, which of the following enzymes is primarily responsible for the oxidative metabolism of alcohol (ethanol) in the liver?
A 45 year old patient presents to the emergency department with a head laceration sustained following a fall while under the influence of alcohol. You determine to evaluate the patient’s alcohol consumption. Which screening tool does NICE (National Institute for Health and Care Excellence) recommend for assessing risky drinking?
A 35-year-old patient arrives at the emergency department with a 2-hour history of sporadic coffee ground vomiting. You determine that a formal risk assessment is necessary. Which tool would be the most suitable for the initial evaluation?
A 68-year-old woman presents with severe diarrhea one week after a hip replacement surgery. The diarrhea has a foul odor and is yellow in color. You suspect a diagnosis of Clostridium difficile associated diarrhea (CDAD).
What is the SINGLE most appropriate initial test to investigate this condition?
A 25-year-old man has been experiencing severe, bloody diarrhea for the past week. A stool sample has been sent for analysis, which has cultured Campylobacter jejuni.
Which of the following antibacterial medications would be the most suitable to prescribe in this situation?
A 68-year-old man with asthma has been experiencing persistent diarrhea for the past week. A stool sample has been sent for analysis, which has cultured Salmonella enteritidis. He currently takes a daily maintenance dose of prednisolone for control of his asthma.
Which of the following antibacterial agents would be most suitable to prescribe in this situation?
A 62 year old male presents to the emergency department due to worsening abdominal distension over the past few weeks. You note the patient has a history of heavy alcohol use and continues to drink 50-100 units per week. On clinical assessment the patient’s abdomen is visibly distended, nontender to palpation with shifting dullness on percussion. The patient’s observations are shown below:
Blood pressure 118/78 mmHg
Pulse 86 bpm
Respiration rate 16 bpm
Temperature 36.6ºC
Which of the following medications would be most appropriate to use first line to treat this patient’s condition?
A 65 year old female presents to the emergency department complaining of severe abdominal pain. You note previous attendances with alcohol related injuries. On taking the history the patient admits to being a heavy drinker and estimates her weekly alcohol consumption at 80-100 units. She tells you her abdomen feels more swollen than usual and she feels nauseated. On examination of the abdomen you note it is visibly distended, tender to palpate and shifting dullness is detected on percussion. The patient’s observations are shown below:
Blood pressure 112/74 mmHg
Pulse 102 bpm
Respiration rate 22 bpm
Temperature 38.6ºC
What is the most likely diagnosis?
A 52 year old male presents to the emergency department complaining of worsening chest pain associated with shortness of breath and dizziness over the past 24 hours. You note the patient has a long history of smoking and has been diagnosed with chronic obstructive pulmonary disease (COPD). On examination you note decreased breath sounds on the left side and dullness to percussion. The patient’s observations are shown below:
Blood pressure 120/80 mmHg
Pulse 92 bpm
Respiration rate 20 bpm
Temperature 37.2ºC
Which of the following is the most appropriate initial treatment for this patient?