Category: Gastroenterology & Hepatology

FCEM2-0671

A 40-year-old woman presents with symptoms of chronic heartburn, difficulty swallowing, and occasional food blockage. She was recently given a short course of omeprazole but has not experienced any improvement in her symptoms. Her medical history includes asthma and seasonal allergies, for which she uses a salbutamol inhaler and steroid creams. She has not noticed any weight loss, has not experienced any episodes of vomiting blood, and overall feels healthy.

What is the most probable diagnosis in this scenario?

FCEM2-0672

A 5 year old girl is brought into the emergency department by worried parents. The child mentioned having stomach pain and feeling nauseous yesterday but began vomiting this morning and now appears sleepy. After evaluating her, you examine the results of the venous blood gas and glucose (provided below):

pH 7.25
Bicarbonate 13 mmol/l
Glucose 28 mmol/l

The girl weighs 20kg. What is the calculated fluid deficit for this patient?

FCEM2-0673

You evaluate a 7-year-old boy with a 4-month history of recurring episodes of abdominal pain. The pain has typically occurred 2-3 days per week during that time. There have been no changes in bowel movements or episodes of vomiting. He has missed some school days, but his parents note that the pain has also occurred on weekends. His physical examination is unremarkable, and a colleague recently ordered a series of blood tests, which were all normal. Upon reviewing his growth chart, you observe that his weight has remained consistent on the 50th percentile.

What is the MOST likely diagnosis in this case?

FCEM2-0674

A 42-year-old woman presents with fatigue and nausea following a recent viral illness. She experienced flu-like symptoms for four days and had difficulty eating during that time. She visited the Emergency Department with these symptoms but was discharged with instructions to rest in bed and take regular paracetamol. Her blood tests today reveal the following results:
– Bilirubin: 50 mmol (3-20)
– ALT: 34 IU/L (5-40)
– ALP: 103 IU/L (20-140)
– LDH: 150 IU/L (100-330)

How is the condition typically inherited in this patient?

FCEM2-0675

A 42-year-old woman presents with fatigue and vomiting following a recent viral illness. She experienced flu-like symptoms for four days and had difficulty eating during that time. She visited the Emergency Department with these symptoms but was discharged with advice to rest in bed and take regular acetaminophen. Her blood tests today are as follows:
Bilirubin 50 mmol (3-20)
ALT 34 IU/L (5-40)
ALP: 103 IU/L (20-140)
LDH: 150 IU/L (100-330)
What is the SINGLE most likely diagnosis?

FCEM2-0676

A 62 year old male with a history of alcohol dependence is brought into the emergency department by a social worker who is concerned that the patient appears to be growing more confused and drowsy in recent days. The social worker informs you that the patient had been behaving normally but had mentioned intending to visit his primary care physician regarding obtaining medication for his constipation. You suspect hepatic encephalopathy. Which of the following medications would be the most suitable to administer?

FCEM2-0661

A 60-year-old man who has recently finished a round of antibiotics comes in with excessive, foul-smelling diarrhea. After further examination, he is diagnosed with Clostridium Difficile diarrhea.
Which of the following antibiotics carries the highest risk of causing Clostridium Difficile diarrhea?

FCEM2-0662

A 60-year-old man who has recently finished a course of antibiotics for a respiratory infection comes in with excessive, foul-smelling diarrhea. After conducting tests, the patient is diagnosed with Clostridium Difficile diarrhea.
What is the most effective measure to minimize transmission to other patients?

FCEM2-0663

A 32 year old male presents to the emergency department with worsening abdominal pain and diarrhea. The patient had previously been referred to a gastroenterologist by his primary care physician for recurrent episodes of abdominal pain and diarrhea accompanied by anemia. Barium contrast studies were performed last week, and the report indicates the presence of ‘cobblestoning’ and ‘rose thorn ulcers’ in the terminal ileum and colon.

What is the probable diagnosis?

FCEM2-0664

A 35-year-old female presents to the emergency department complaining of abdominal pain accompanied by diarrhea. She states that she has experienced several similar episodes over the past year, with the diarrhea often being watery and bloody. The patient also reports feeling constantly fatigued recently. Upon examination, tenderness is noted upon deep palpation in both lower quadrants, but there is no guarding or rigidity. Bowel sounds are audible. The patient’s vital signs and initial blood test results are as follows:

Blood pressure: 140/82 mmHg
Pulse: 93 bpm
Respiration rate: 16 bpm
Oxygen saturations: 98% on room air
Temperature: 37.3ºC

Hemoglobin: 111 g/l
Platelets: 324 * 109/l
White blood cells: 11.2 * 109/l
Mean corpuscular volume: 78 fL
Ferritin: 21 ng/mL

The patient has not traveled abroad in years due to COVID-19 and rarely consumes alcohol. Which of the following tests would be most helpful in confirming the suspected diagnosis?