VOMITING AND DYSPHAGIA ||ANSWERS 100% RATED
CORRECT.
A 66-year-old man presents to surgical outpatients with a 6-week history of increasing
dysphagia. Initially this involved only solids, but he is now also having difficultly with liquids
also and describes food as sticking in the middle of his chest. He has also lost 4kg in weight and
his appetite is poor. He is not taking any medication apart from an antacid suspension from the
local pharmacy. He is a retired publican and he smokes 10-15 cigarettes per day and drinks 2-3
pints of beer most days.
Clinical examination does not reveal significant abnormality.
What diagnosis is most important to exclude on initial presentation? correct answers oesophageal
carcinoma
In this patient, staging investigations revealed enlarged nodes in the mediastinum and an
enlarged supraclavicular node, likely to be metastatic. Which three of the following treatments
may appropriate for this patient? correct answers palliative chemo
stent
laser treatment for the lesion
Which three of the following statements regarding oesophageal carcinoma are true? correct
answers Tumours are most common in the lower oesophagus
1. Barrett's oesophagus is a potential complication of gastro-oesophageal reflux disease and
significantly increases the risk of adenocarcinoma of the oesophagus.
2. Stents are used for severe dysphagia. Smoking is a particular risk factor for GI squamous cell
cancers.
3.Alcohol has not been linked to increasing the risk of adenocarcinomas
A 46-year-old man presents to the ED with a two day history of epigastric pain and vomiting. He
has a history of alcohol binging and has consumed approximately 30 units of alcohol in the last
three days. He admits to similar such episode of abdominal pain in the past, however he has
never been hospitalised for these symptoms before.
, On examination, his temperature is 37.1°C, pulse 88 bpm and BP is 156/84 mmHg. He is
markedly tender over his epigastrium. His BMI is 28 kg/m2. Urinalysis normal
Blood results:
Hb 143135-180 g/LWCC 14.44-11 x109/LUr 10.41.7-8.3 mMol/LBili 130-21 µMALT 580-41
IU/L correct answers alcoholic gastritis
acute pancreatitis
perforated duodenal ulcer
His serum amylase comes back at 4000 IU/L. The patient has a contrast CT scan which confirms
the diagnosis of acute pancreatitis. An ultrasound scan does not show evidence of obstructive
gallstones. Which four of the following should be the next steps in management? correct answers
oral feeding
iv fluids
iv analgesia
blood gas analysis
Pancreatic pseudocysts can often be dealt with conservatively. However, if they cause
complications such as infection or obstruction they can be drained. Which of the following
techniques would be the first line methods for draining a pseudocyst? correct answers
endoscopic ultrasound
An ERCP reveals a leak in the pancreatic duct and a temporary stent is placed in the pancreatic
duct to help seal the leak. The patient settles clinically and radiologically and repeat imaging 4
months later shows almost complete resolution of the pseudocyst. The patient is unfortunately
lost to follow up and re-presents 10 years later, again with severe abdominal pain, weight loss
and loose stools. He started drinking alcohol again 5 years ago and is currently drinking about 4-
5 units/day. On examination he is cachetic. There are no stigmata of chronic liver disease. Initial
lab work reveals: Blood glucose 12 mmol/l Amylase 45 IU/L Bilirubin 21 mmol/L Alkaline
phosphatase 150 IU/L An abdominal x-ray shows calcification in the upper abdomen. What is the
most likely cause of the elevated blood glucose and loose stools? correct answers pancreatic
insufficiency
CORRECT.
A 66-year-old man presents to surgical outpatients with a 6-week history of increasing
dysphagia. Initially this involved only solids, but he is now also having difficultly with liquids
also and describes food as sticking in the middle of his chest. He has also lost 4kg in weight and
his appetite is poor. He is not taking any medication apart from an antacid suspension from the
local pharmacy. He is a retired publican and he smokes 10-15 cigarettes per day and drinks 2-3
pints of beer most days.
Clinical examination does not reveal significant abnormality.
What diagnosis is most important to exclude on initial presentation? correct answers oesophageal
carcinoma
In this patient, staging investigations revealed enlarged nodes in the mediastinum and an
enlarged supraclavicular node, likely to be metastatic. Which three of the following treatments
may appropriate for this patient? correct answers palliative chemo
stent
laser treatment for the lesion
Which three of the following statements regarding oesophageal carcinoma are true? correct
answers Tumours are most common in the lower oesophagus
1. Barrett's oesophagus is a potential complication of gastro-oesophageal reflux disease and
significantly increases the risk of adenocarcinoma of the oesophagus.
2. Stents are used for severe dysphagia. Smoking is a particular risk factor for GI squamous cell
cancers.
3.Alcohol has not been linked to increasing the risk of adenocarcinomas
A 46-year-old man presents to the ED with a two day history of epigastric pain and vomiting. He
has a history of alcohol binging and has consumed approximately 30 units of alcohol in the last
three days. He admits to similar such episode of abdominal pain in the past, however he has
never been hospitalised for these symptoms before.
, On examination, his temperature is 37.1°C, pulse 88 bpm and BP is 156/84 mmHg. He is
markedly tender over his epigastrium. His BMI is 28 kg/m2. Urinalysis normal
Blood results:
Hb 143135-180 g/LWCC 14.44-11 x109/LUr 10.41.7-8.3 mMol/LBili 130-21 µMALT 580-41
IU/L correct answers alcoholic gastritis
acute pancreatitis
perforated duodenal ulcer
His serum amylase comes back at 4000 IU/L. The patient has a contrast CT scan which confirms
the diagnosis of acute pancreatitis. An ultrasound scan does not show evidence of obstructive
gallstones. Which four of the following should be the next steps in management? correct answers
oral feeding
iv fluids
iv analgesia
blood gas analysis
Pancreatic pseudocysts can often be dealt with conservatively. However, if they cause
complications such as infection or obstruction they can be drained. Which of the following
techniques would be the first line methods for draining a pseudocyst? correct answers
endoscopic ultrasound
An ERCP reveals a leak in the pancreatic duct and a temporary stent is placed in the pancreatic
duct to help seal the leak. The patient settles clinically and radiologically and repeat imaging 4
months later shows almost complete resolution of the pseudocyst. The patient is unfortunately
lost to follow up and re-presents 10 years later, again with severe abdominal pain, weight loss
and loose stools. He started drinking alcohol again 5 years ago and is currently drinking about 4-
5 units/day. On examination he is cachetic. There are no stigmata of chronic liver disease. Initial
lab work reveals: Blood glucose 12 mmol/l Amylase 45 IU/L Bilirubin 21 mmol/L Alkaline
phosphatase 150 IU/L An abdominal x-ray shows calcification in the upper abdomen. What is the
most likely cause of the elevated blood glucose and loose stools? correct answers pancreatic
insufficiency
