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early satiety

Practice targeted AMC-style multiple-choice questions on early satiety.

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Giant hiatal hernia, CT image. 63 year old man.
Image by Jmarchn CC BY 4.0 · Source

A 63-year-old man presents with dysphagia and early satiety. His BMI is 21. A CT scan is performed. Based on the image, and assuming conservative measures have failed, what surgical approach is MOST appropriate?

A. Partial gastrectomy
B. Esophagectomy
C. Endoscopic dilation
D. Laparoscopic Nissen fundoplication with hiatal hernia repair
E. Heller myotomy
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Hepatic metastases from a gastric mixed adenoneuroendocrine carcinoma (MANEC).
Image by Hellerhoff CC BY-SA 3.0 · Source

A 65-year-old male presents with a 3-month history of unintentional weight loss and early satiety. Gastroscopy and biopsy confirmed a gastric mixed adenoneuroendocrine carcinoma. Staging CT imaging is shown. Considering the clinical presentation and the findings on the provided imaging, what is the most appropriate initial management strategy?

A. Commence somatostatin analogue therapy.
B. Proceed with surgical resection of hepatic lesions.
C. Monitor with serial CT scans and symptomatic management.
D. Initiate systemic chemotherapy.
E. Plan for palliative external beam radiotherapy to the liver.
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Giant hiatal hernia, CT image. 63 year old man.
Image by Jmarchn CC BY 4.0 · Source

A 63-year-old man presents with increasing postprandial fullness. The provided image was obtained. What is the MOST appropriate next step in management?

A. Barium swallow study
B. Surgical repair
C. PPI therapy
D. Endoscopic surveillance
E. H. pylori testing
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Giant hiatal hernia, CT image. 63 year old man.
Image by Jmarchn CC BY 4.0 · Source

A 68-year-old male presents to his general practitioner with a three-month history of progressive dysphagia to both solids and liquids, accompanied by postprandial regurgitation. He also reports experiencing early satiety and occasional episodes of nocturnal coughing. His past medical history is significant for well-controlled hypertension and a remote history of smoking (quit 20 years ago). Physical examination reveals mild epigastric fullness, but is otherwise unremarkable. His vital signs are within normal limits. An abdominal CT scan with contrast was performed, and a representative image is shown. Given the clinical presentation and the findings on the image, which of the following is the MOST appropriate next step in the management of this patient?

A. Referral to a gastroenterologist for surgical evaluation
B. Esophageal manometry to evaluate esophageal motility
C. Empiric treatment with antibiotics for possible aspiration pneumonia
D. Initiation of a proton pump inhibitor and lifestyle modifications
E. Barium swallow study to further delineate the anatomy
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Giant hiatal hernia, CT image. 63 year old man.
Image by Jmarchn CC BY 4.0 · Source

A 63-year-old male presents with postprandial vomiting and persistent retrosternal discomfort. He reports feeling full quickly after eating only small amounts. An abdominal CT scan is performed, the axial view is shown. What is the MOST likely underlying mechanism contributing to this patient's symptoms?

A. Gastric malignancy
B. Pyloric stenosis
C. Esophageal dysmotility
D. Mechanical obstruction of the gastric outflow
E. Increased gastric acid production
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Ovarian Cyst
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 55-year-old woman presents to her general practitioner with a 3-month history of increasing abdominal bloating, early satiety, and a vague, intermittent dull ache in her lower abdomen. She reports a 5 kg weight loss over the same period, which she attributes to reduced appetite. Her last menstrual period was 5 years ago. She has a past medical history of well-controlled hypertension and osteoarthritis. She is on perindopril and paracetamol as needed. On physical examination, her vital signs are stable (BP 130/80 mmHg, HR 72 bpm, RR 16/min, Temp 36.8°C). Abdominal examination reveals mild distension and a firm, non-tender mass palpable in the suprapubic and left iliac fossa regions, estimated to be about 8 cm in size. Bowel sounds are normal. Pelvic examination is deferred due to patient discomfort and preference for imaging first. Routine blood tests, including full blood examination, urea and electrolytes, liver function tests, and C-reactive protein, are all within normal reference ranges. A CT scan of the abdomen and pelvis is performed to investigate her symptoms, an axial image from which is shown. Considering the clinical presentation and the findings on the image, what is the most appropriate immediate next step in the management of this patient?

A. Prescribe a proton pump inhibitor for presumed dyspepsia and review in 4 weeks.
B. Reassure the patient that the mass is likely benign and manage symptomatically.
C. Arrange for a diagnostic laparoscopy by a general surgeon.
D. Referral to a gynaecological oncologist for further assessment.
E. Order serum CA-125 and arrange a repeat CT scan in 3 months.
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Hepatic metastases from a gastric mixed adenoneuroendocrine carcinoma (MANEC).
Image by Hellerhoff CC BY-SA 3.0 · Source

A 58-year-old male presents with a 3-month history of dyspepsia, early satiety, and unintentional weight loss. Upper endoscopy revealed a large, ulcerated mass in the gastric antrum. Biopsy confirmed adenocarcinoma. Staging investigations were performed, including the provided imaging. His ECOG performance status is 1. Blood tests show mild anaemia and normal liver function tests. Given the clinical presentation and the findings on the provided imaging, which of the following is the most appropriate primary goal of management for this patient?

A. Curative surgical resection of the primary gastric tumour
B. Radiation therapy to the gastric mass
C. Palliation of symptoms and improvement of quality of life
D. Neoadjuvant chemotherapy followed by reassessment for surgery
E. Liver transplantation
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A 50-year-old woman presents with increasing abdominal swelling and early satiety. Examination reveals ascites. Which investigation is most crucial to guide initial management?

A. Diagnostic paracentesis
B. Complete blood count
C. Abdominal ultrasound
D. Liver function tests
E. Serum albumin and ascitic fluid protein
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Ovarian Cyst
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 55-year-old woman presents to her general practitioner with a 3-month history of increasing abdominal bloating, early satiety, and a vague, intermittent dull ache in her lower abdomen. She reports a 5 kg weight loss over the same period, which she attributes to reduced appetite. Her last menstrual period was 5 years ago. She has a past medical history of well-controlled hypertension and osteoarthritis. She is on perindopril and paracetamol as needed. On physical examination, her vital signs are stable (BP 130/80 mmHg, HR 72 bpm, RR 16/min, Temp 36.8°C). Abdominal examination reveals mild distension and a firm, non-tender mass palpable in the suprapubic and left iliac fossa regions, estimated to be about 8 cm in size. Bowel sounds are normal. Pelvic examination is deferred due to patient discomfort and preference for imaging first. Routine blood tests, including full blood examination, urea and electrolytes, liver function tests, and C-reactive protein, are all within normal reference ranges. A CT scan of the abdomen and pelvis is performed to investigate her symptoms, an axial image from which is shown. Considering the clinical presentation and the findings on the image, what is the most appropriate immediate next step in the management of this patient?

A. Prescribe a course of antibiotics for presumed pelvic inflammatory disease.
B. Arrange for a repeat CT scan in 6 weeks to monitor for changes.
C. Referral to a gynaecological oncologist for further assessment and management.
D. Reassure the patient that this is likely a benign finding and manage symptomatically.
E. Perform an urgent diagnostic laparoscopy to confirm the diagnosis.
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