A 32-year-old woman presents with sudden hematemesis following multiple episodes of vomiting due to viral gastroenteritis. She denies alcohol use or a history of liver disease. Her vital signs show tachycardia with mild hypotension. Endoscopy reveals a longitudinal mucosal tear at the gastroesophageal junction with no active bleeding. What is the next best step in management?
A 40-year-old man presents to the emergency department with hematemesis after a night of heavy alcohol consumption. He reports several episodes of non-bloody vomiting before noticing blood in his vomit. On examination, he appears pale, his blood pressure is 100/65 mmHg, and his heart rate is 110 bpm. Laboratory tests reveal a hemoglobin level of 10.5 g/dL. What is the most likely diagnosis?
A 42-year-old man presents to the emergency department with severe epigastric pain radiating to his back. The pain began 12 hours ago and is associated with nausea and vomiting. He has a history of chronic alcohol use and was hospitalized twice in the past year for similar symptoms. His temperature is 38.5°C (101.3°F), and he is tachycardic. Laboratory tests show: Serum lipase: Elevated (5x the upper limit of normal) Gamma-glutamyl transpeptidase (GGT): Elevated (3x the upper limit of normal) AST/ALT ratio >2:1 What is the most likely diagnosis?
A 50-year-old woman presents with a 3-month history of burning chest discomfort after meals and an occasional sour taste in her mouth. The symptoms worsen when she lies down after eating. They happen at least once a week. She denies weight loss, difficulty swallowing, or any other concerning symptoms. Physical examination is unremarkable. Which of the following is the most appropriate initial step in management?
A 32-year-old female with a BMI of 35, presents with chronic cough for the past year. She mentions that her cough is worse at night and after meals. She has no history of smoking or lung disease.What is the most likely cause of this patient’s chronic cough?
A 45-year-old male patient presents with complaints of frequent heartburn, especially after meals, and nocturnal regurgitation. He has been experiencing these symptoms for the last three months. He also mentions occasional difficulty swallowing. He does not smoke but admits to drinking alcohol occasionally. Which of the following is the most appropriate first-line treatment for this patient’s symptoms?
Case: A 50-year-old obese man presents with chronic heartburn and regurgitation unresponsive to a 3-month course of proton pump inhibitors (PPIs). He experiences coughing and hoarseness, especially at night. He denies dysphagia or weight loss but has occasional wheezing. Question: Which diagnostic test would best confirm the diagnosis of GERD in this patient?
Case: A 60-year-old woman presents with a 3-month history of heartburn and regurgitation that has progressively worsened. She reports difficulty swallowing solids and a 5-kg (11-lb) unintentional weight loss during this period. She denies vomiting or gastrointestinal bleeding. She has a history of obesity and hypertension, for which she takes lisinopril. Question: Which of the following is the most appropriate next step in the evaluation of this patient?
Case: A 45-year-old man presents to the clinic with a 6-month history of burning chest pain, particularly after eating spicy foods or lying down at night. He frequently experiences a sour taste in his mouth and occasional regurgitation of undigested food. He denies any weight loss, difficulty swallowing, or blood in stool. His medical history is unremarkable, and he takes no medications. Question: Which of the following is the most appropriate initial management for this patient?
A 23-year-old male presents with complaints of exercise-induced muscle cramps, early fatigue, and dark urine after intense workouts. He reports that within a few minutes of exercise, he experiences severe muscle pain, but after a short rest, he is able to continue with improved endurance (“second-wind” phenomenon).
