Vignettes Flashcards
A 47 year old male presents to your GP surgery complaining of worsening “heartburn” over the past year. He reports he has had intermittent heartburn over the past five years, but it has been getting progressively worse and more frequent in the past year. The pain increases after eating and when sleeping. Sometimes he notes a “sour” taste in his mouth. He currently smokes cigarettes, with a 10 pack year history. Denies fever, dysphagia, odynophagia, n/v, chest pain, abd pain, melaena, stools w/ frank red blood, unintended weight loss.
Obs: T 37°C, BP 120/76, HR 74, RR 18, SaO2 100%
CV: regular rhythm & rate, HS I + II + 0
Lungs: clear to auscultation
BLGI: non-distended, mild ttp in epigastrium, no rebound or guarding, bowel sounds present.
Oesophagitis
A 43 year old female presents to the A&E after an episode of haematemesis. She reports she got “food poisoning” the day prior, and has been vomiting at least once every hour. One hour ago, she reports vomiting “bright red blood”. She also complains of mild upper back pain. Denies fever, abdominal pain, odynophagia, melaena, coffee-ground emesis, lightheadedness, syncope.
Obs: T 37°C, BP 114/66, HR 96, RR 18, SaO2 98%
HEENT: no pharyngeal oedema or erythema, no oral ulcerations or lesions
Lungs: clear to auscultation bilaterally
CV: regular rate & rhythm, HS I + II + 0
Abd: soft, no abdominal ttp, no rebound/guarding, no abdominal distension, bowel sounds present
Mallory Weiss tear
A 73 year old male patient presents to your GP practice complaining of dysphagia and unintended weight loss x2 months. He reports having difficulty swallowing both solids and liquids, and has lost 7kg in the past two months. The patient admits to a history of heavy alcohol use, typically drinking 3-5 beers nightly for the past 40 years. Denies fever, night sweats, abdominal pain, odynophagia, n/v, melaena, stools w/ frank red blood, chest pain, numbness/tingling, weakness.
Obs: T 37.2°C, BP 138/82, HR 88, RR 16, SaO2 98%
HEENT: no pharyngeal erythema/oedema, no oral ulcerations or lesions
Lymph: no cervical or supraclavicular
LADGI: no distension, no abdominal ttp, no guarding/rebound, bowel sounds +
Oesophageal malignancy
A 48 year old female presents to the GP surgery complaining of increasing dysphagia over the 2 months. She reports “food sticking in my throat” when swallowing solid food. Sometimes this will cause her to regurgitate her food and can cause chest discomfort. She reports having occasional heartburn for “years”. She does not take any medication for her heartburn. Denies fever, weight loss, night sweats, odynophagia, abdominal pain, melaena, haematochezia.
Obs: T 37°C, BP 126/66, HR 80, RR 16, SaO2 100%
HEENT: no pharyngeal oedema, no oral lesions
Neck: no LAD, no thyromegaly or thyroid nodules
Abd: no distension, no abdominal ttp, BS +
Oesophageal stricture
A 50 year old male presents with gradually worsening dysphagia over the past year. He reports noting difficulty swallowing both solids and liquids. This used to not bother him, but now he is beginning to regurgitate food at times.
Denies fever, night sweats, weight loss, odynophagia, heartburn, n/v, abdominal pain, chest pain.
Obs: T 37°C, BP 126/66, HR 80, RR 16, SaO2 100%
HEENT: clear oropharynx, tonsils 1+ bilaterally
Neck: no LAD, no thyromegaly
Abd: no distension, non-tender to palpation, BS +
Achalasia
A 67 year old male patient with chronic HBV infection and liver cirrhosis presents to the A&E with haematemesis that began suddenly one hour ago. He reports the emesis is “bright red”. He did note “black” stools the past two days. The patient denies any trauma or vomiting prior to symptoms beginning. Denies fever, coffee ground emesis, chest/back pain, dysphagia, odynophagia.
Obs: T 37°C, BP 92/60, HR 102, RR 18, SaO2 96%
HEENT: oropharynx clear without lesions
Eyes: slight bilateral scleral icterus, bilateral conjunctival pallor
Lungs: clear to auscultation bilaterally
Abd: non-distended, no abdominal ttp, no ascites, bowel sounds present, no aortic or renal bruits auscultated
Skin: no jaundice
Oesophageal varices
A 28 year old female presents to your GP practice complaining of a burning sensation in her chest intermittently over the past two weeks. She notes that it seems to occur mostly after eating spicy meals or her favourite chocolate bar. She has taken an over-the-counter antacid, which has helped. Denies fever, weight loss, decreased appetite, odynophagia, dysphagia, abdominal pain, melaena, n/v, palpitations, lightheadedness, diaphoresis.
Obs: T 37.1°C, BP 118/64, HR 72, RR 16, SaO2 100%
Resp: clear to auscultation bilaterally
CV: regular rate & rhythm, HS I + II + 0, no peripheral oedema
Abd: mild epigastric ttp, no distension, no hepatosplenomegaly, BS +
GORD
A 24 year old female presents to your office complaining of intermittent epigastric pain x4 months. Pain does not seem to worsen with eating. She reports rarely experiencing nausea with the pain. She has a history of near-daily headaches, and admits to taking ibuprofen regularly, approximately 5 days per week. Denies fever, weight loss, vomiting, dysphagia, odynophagia, diarrhoea, constipation, melaena.
Obs: T 37°C, BP 120/78, HR 68, RR 16, SaO2 100%
Abd: mild ttp of epigastrium, no guarding or rebound, BS +
Gastritis
A 63 year old female presents today complaining of intermittent epigastric abdominal pain x6 months. She describes the pain as “burning” and sometimes sharp. Over the past month, she has also noted early satiety and nausea after eating. The pain increases after eating. She has taken an over-the-counter antacid with no relief. She has bilateral knee OA and takes ibuprofen on a near-daily basis to control the associated pain. Denies fever, weight loss, vomiting, melaena, bright red blood in stool, dysphagia, odynophagia.
Obs: T 37°C, BP 126/72, HR 86, RR 16, SaO2 97%
Abd: moderate epigastric ttp, no guarding or rebound tenderness, BS +
Peptic ulcer disease
A 70 year old male presents to your office complaining of intermittent abdominal pain x6 months. He has difficulty locating the pain. The patient reports he has been gradually losing weight without intending to. He is a current smoker, having smoked approx 0.5 packs per day since age 20. Denies fever, night sweats, n/v, diarrhoea, constipation, melaena, bright red blood per rectum, dysphagia, odynophagia.
Obs: T 37°C, BP 132/88, HR 92, RR 16, SaO2 99%
Neck: single enlarged L supraclavicular lymph node, non-mobile, non-tender, no associated erythema
CV: regular rate & rhythm, HS I + II + 0, no peripheral oedema
Abd: non-distended, mild epigastric & RUQ ttp, bowel sounds +
Gastric malignancy
A 25-year-old woman presents to her GP reporting ongoing lethargy and is concerned about her recent weight loss. She has a history of intermittent diarrhoea with abdominal cramping and generally feels quite bloated. Passing stools does not relieve the discomfort. She does not report any blood or mucus in her stool. She mentions that her brother has Type 1 diabetes.
On examination, she has a soft abdomen. Conjunctival pallor is noted.
Coeliac disease
A 47 year old male presents to your GP surgery complaining of worsening “heartburn”
over the past year. He reports he has had intermittent heartburn over the past five
years, but it has been getting progressively worse and more frequent in the past year.
The pain increases after eating and when sleeping. Sometimes he notes a “sour” taste
in his mouth. He currently smokes cigarettes, with a 10 pack year history.
Denies fever, dysphagia, odynophagia, n/v, chest pain, abd pain, melaena, stools w/
frank red blood, unintended weight loss.
Obs: T 37°C, BP 120/76, HR 74, RR 18, SaO2 100%
CV: regular rhythm & rate, HS I + II + 0
Lungs: clear to auscultation BL
GI: non-distended, mild ttp in epigastrium, no rebound or guarding,
bowel sounds present
Oesophatitis
A 43 year old female presents to the A&E after an episode of haematemesis. She
reports she got “food poisoning” the day prior, and has been vomiting at least once
every hour. One hour ago, she reports vomiting “bright red blood”. She also complains
of mild upper back pain.
Denies fever, abdominal pain, odynophagia, melaena, coffee-ground emesis,
lightheadedness, syncope.
Obs: T 37°C, BP 114/66, HR 96, RR 18, SaO2 98%
HEENT: no pharyngeal oedema or erythema, no oral ulcerations or lesions
Lungs: clear to auscultation bilaterally
CV: regular rate & rhythm, HS I + II + 0
Abd: soft, no abdominal ttp, no rebound/guarding, no abdominal distension, bowel
sounds present
Mallory Weiss tear
A 73 year old male patient presents to your GP practice complaining of dysphagia and
unintended weight loss x2 months. He reports having difficulty swallowing both solids and
liquids, and has lost 7kg in the past two months. The patient admits to a history of heavy alcohol
use, typically drinking 3-5 beers nightly for the past 40 years.
Denies fever, night sweats, abdominal pain, odynophagia, n/v, melaena, stools w/ frank red
blood, chest pain, numbness/tingling, weakness.
Obs: T 37.2°C, BP 138/82, HR 88, RR 16, SaO2 98%
HEENT: no pharyngeal erythema/oedema, no oral ulcerations or lesions
Lymph: no cervical or supraclavicular LAD
GI: no distension, no abdominal ttp, no guarding/rebound, bowel sounds +
Oesophageal malignancy
A 25-year-old female presents to her GP with a 6-month history of non-specific abdominal pain, diarrhoea with occasional mucus, and bloating. Her symptoms seem to worsen upon eating but improve after defaecation. Bloods are unremarkable.
IBS
