A 55-year -old male presents to the

A 55-year -old male presents to the ED after vomiting several hundred milliliters of blood. His stool was dark color. His prior medical history is significant for CAD and HTN. Medications include an ACE inhibitor, a β-blocker, and a daily aspirin tablet. He reports having had “heartburn” for several years but no prior episodes of hematemesis or melena. A nasogastric tube placed in the ED revealed bloody aspirate. Vital signs are as follows: RR = 20, BP = 90/55, pulse = 105. He has a 25 mm Hg orthostatic decrease in BP. The rest of the physical examination is unremarkable. What is the likely diagnosis? What is the etiology of the condition you identified in (i)? A 27-year-old female presents to the nurse practitioner’s office with a history of diarrhea and intermittent abdominal cramping with flatus. She reports having diarrhea very frequently on and off for several years, but her symptoms have been worse for the past 3 weeks. She also has constipation every once in a while. She has no apparent medical problems. Her physical examination reveals mild LLQ tenderness without guarding or rebound. A stool test for occult blood is negative. She is a college student and is studying for her midterm examination. What is the likely diagnosis? Describe the condition that you identified in (i). A 24-year-old male presents to his family physician’s office having had cramping abdominal pain for the past 2 months. He reports having low-volume diarrhea on and off for the past 1 to 2 years. He also reports occasional pain in the rectal region with defecation. He denies any other medical problems and takes no medications. His physical examination reveals mild tenderness in the RLQ with normal bowel sounds. There is a small fissure in the anal region with surrounding erythema. His stool is negative for occult blood. Vital signs are as follows: temperature = 37.0 °C, RR = 15, BP = 122/78, pulse = 65. Laboratory test results (CBC, electrolytes) are within normal limits. What is the likely diagnosis? Support your diagnosis using the information presented in the case. A 35-year-old male presents with complaint of a 6-month history of fatigue and lethargy. His prior medical history is unremarkable. He denies melena and recent trauma or surgery. He reports that he does not drink alcohol, smoke, or take any medications. He appears well nourished. Vital signs are as follows: RR = 16, BP = 130/80 mm Hg, pulse = 70. Laboratory test results are as follows: Hb = 76 mmol/L (7.6 g/dL), Hct = 22.8%, and MCV = 68 fL (normal 80 – 95 fL). The remainder of his laboratory test results are normal. What is the likely diagnosis? A 56-year-old female presents to the ED with a complaint of severe abdominal pain, primarily in the RUQ and epigastric region. She has had two episodes of vomiting in the past 5 hours. She describes the pain as sharp, without radiation to her back. PMH is significant for DM, HTN, alcoholism, asthma, and chronic low back pain. Her current medications include insulin, atenolol, albuterol inhaler, and oxycodone. She has had abdominal pain several times in the past year, but never this severe and never associated with vomiting. On examination, she has tenderness in the epigastric region. There is no guarding or rebound. Physical examination is otherwise unremarkable. Temperature = 39.5 °C, BP = 136/ 88 mm/Hg, pulse = 116. She is alert and oriented and is in obvious distress. What is the likely diagnosis? A 64-year-old male presents with back pain for the past 5 to 6 months. Two days ago he fell while shoveling snow, and he has pain in his right arm as well. Plain X-ray films of the spine show several small lytic lesions in the vertebral bodies at the L3 to L4 level. Right humerus films reveal lytic areas in the metaphysis and diaphysis of the right humerus. There is a fracture line through the abnormal area on the humerus film. Physical examination reveals tenderness on palpation of the low back and right humerus, but is otherwise unremarkable. There is no splenomegaly or lymphadenopathy. CBC results are as follows: Hb = 91 mmol/L (9.1 g/ dL), Hct = 27.6%, MCV = 90 fL, platelet count =150,000/mL. What is the likely diagnosis? A 63-year-old female presents to your office with complaint of mid to low back pain for the last year, which has become worse over the past 3 months. She denies any weakness or radiating pain in her lower extremities. She currently takes oxycodone for her back pain with inadequate relief. She has difficulty sleeping at night because of the backpain. PMH is significant for HTN, for which she takes a β-blocker. Thoracic and lumbar spine radiographs show multiple compression fractures at T8, T11, L3, and L4, as well as diffuse osteopenia. Laboratory studies are as follows: WBC = 11 x 109/L, hemoglobin = 97 mmol/L (9.7 g/dL), hematocrit = 29%, platelets = 189 x 109/L, Na+ = 142 mmol/L, K+ = 4.1 mmol/L, calcium = 4.0 mmol/L. Physical examination reveals tenderness on palpation of thoracic and lumbar spine. She has limited lumbar flexion due to pain. Neurologic examination is normal. What is the likely diagnosis? A 41- year-old male presents to your office with a complaint of heartburn and epigastric pain for the past several months. He takes over-the-counter antacids, but symptoms have been worse over the past month. He denies any weight loss, vomiting, hematemesis, or melena. The discomfort is worse after eating and when he lies flat in bed. He sometimes gets a horrible taste in his mouth. Medical history is noncontributory. He takes no other medications. He smokes half a pack a day of cigarettes and drinks alcohol socially about once per week. Physical examination is unremarkable except for mild epigastric tenderness. What is the likely diagnosis? A 49-year-old female presents to the ED with complaint of severe epigastric and RUQ abdominal pain. Her symptoms started 3 days ago but have progressively worsened over the past 12 hours. Her symptoms are worse with meals. She has had two episodes of vomiting in the past 12 hours and is nauseous currently. PMH is significant for diabetes, osteoarthritis, and HTN. Temperature = 39 °C, BP = 146/80 mm/Hg, pulse = 110, RR = 16. On physical examination, there is tenderness in the RUQ and rebound tenderness. Bowel sounds are diminished. The patient is lying on her side holding an emesis basin. What is the likely diagnosis? A 52- year-old male with a long-standing history of alcohol abuse is brought to the ED by his wife for vomiting blood. He vomited bright red blood at least twice this morning. PMH is significant for cirrhosis, HTN, and arthritis. He has never vomited blood before. On examination, the patient is awake but appears nervous and is in moderate distress. You are able to determine that he has vomited approximately 2 L of blood over the past 6 hours. Vital signs are: Temperature = 38.5 °C, BP = 95/60 mm/Hg, pulse = 134, RR = 20. Pulse oximetry shows 98% oxygenation on room air. What is the likely diagnosis? A 63-year-old male is brought to the ED by his wife for altered mental status. The patient regularly drinks alcohol and has a long-standing history of alcohol use. Over the past 24 hours, he has become more confused and is not “acting like himself” according to his wife. She states that he has never acted like this before. On further questioning, the patient had an episode of massive hematemesis last year that required admission to the hospital, necessitating blood transfusion and other treatment that the wife does not recall. On physical examination, the patient is arousable and is alert to person but not to place or time. He is cachectic, with prominent veins over his abdomen. He has a significant ascites. There are several dilated superficial arterioles scattered throughout his body. What is the likely diagnosis? 12. A 76-year-old male presents to your office with the complaint of fatigue for the past 2 months. He does not abuse alcohol. His medical history is significant for HTN, for which he takes metoprolol. He denies melena, hematochezia, or any other blood loss. His family history is noncontributory. He has no symptoms other than fatigue. He admits he does not have a good diet. Vital signs are: BP = 135/ 85 mm/Hg, pulse = 70. Physical examination is unremarkable except for mild pallor. Stool is negative for occult blood. Laboratory test results are: Hb = 92 mmol/L (9.2 g/dL), Hct = 27.6%, MCV = 117 fL. ECG is normal. What is the likely diagnosis?

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