A man with repeated vomiting & haematemesis

A 50-year-old man presented with haematemesis a few hours ago. He had a few episodes of vomiting before the haematemesis. Before that, he attended a party and claimed that he drank a few cans of beer. However, he did not drink alcohol often, just a social drinker. He was not a smoker. He did not have any diarrhoea but he felt nauseous. There was no abdominal pain, no change in bowel movement. Family and past medical history was not significant. He did not take any drugs or painkiller recently.

On examination, the pulse rate was 90bpm, blood pressure was normal, no fever. Heart and lung examination were normal. There was no stigmata of chronic liver diseases. Abdominal palpation revealed no tenderness or guarding. There was no enlargement of liver and spleen.

1. What is the most likely diagnosis?

(Clue: repeated vomiting)

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Man with bleeding per rectum

A 65-year-old man present to the emergency department with complaint of bleeding per rectum. He did not complain of diarrhoea or abdominal pain. He had a history of chronic constipation. His past medical history was otherwise non-significant.

On examination, he had mild fever of 37.9 degree Celcius. He had no signs of anaemia. Abdominal examination showed mild tenderness at lower abdomen. Rectal examination show maroon-coloured blood. The examination was otherwise normal.

1. Name 2 possible diagnoses.

(Clue: bleeding with no complaint of abdominal pain/diarrhoea)

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Woman with yellow eyes and skin

A 60-year-old woman present to the clinic with yellowish eye and skin. She also complained of itchiness of skin. She also mentioned that her urine was tea-coloured. From her history, there were lost of appetite and weight loss. There was no significant past medical history.

On examination, there were scratch marks on her skin. The nails were noted to be shining. Her heart rate was 58bpm. Examination of the abdomen revealed an enlarged mass at the right upper quadrant. There was no tenderness.

1. What is the clinical diagnosis?

(clue: presentation, heart rate, clinical findings)

2. What is the name of the sign found in abdominal examination?

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