Mr. Doctor

02/08/2026

A 26-year-old man presents with a 6-month history of intermittent abdominal pain, chronic diarrhea, and a 7-kg weight loss. He also reports painful oral ulcers and recurrent perianal fistulas. Colonoscopy shows skip lesions with areas of normal mucosa between inflamed segments. Biopsy demonstrates transmural inflammation with noncaseating granulomas.

Which of the following is the most likely complication of this disease?

28/07/2026

A 58-year-old man presents with progressive dysphagia. Initially, he had difficulty swallowing solid foods, but over the past 3 months he has also developed difficulty swallowing liquids. He has unintentionally lost 10 kg and has a 40-pack-year smoking history. Upper GI endoscopy reveals an ulcerative mass in the middle third of the esophagus. Biopsy confirms squamous cell carcinoma.

Which of the following is the most likely risk factor responsible for this patient's malignancy?

27/07/2026

A 67-year-old man presents with progressive jaundice, generalized itching, dark urine, pale stools, and a 12-kg weight loss over the last 4 months. He denies abdominal pain. On examination, he has a palpable, non-tender gallbladder. Laboratory investigations show:
Total bilirubin: 15 mg/dL

ALP: Markedly elevated

AST/ALT: Mildly elevated

Ultrasound

demonstrates dilatation of both the common bile duct and pancreatic duct (double-duct sign).

What is the most likely diagnosis?

25/07/2026

21/07/2026

A 48-year-old woman comes to the emergency department with vomiting of fresh blood (hematemesis) and black tarry stools (melena) for the past 6 hours. She has a history of NSAID use for chronic knee pain. Her blood pressure is 90/60 mmHg, pulse is 120/min, and she appears pale.

What is the most appropriate initial management?

18/07/2026

A 68-year-old man presents with abdominal distension, vomiting, constipation, and inability to pass flatus for the past 2 days. On examination, his abdomen is distended with high-pitched bowel sounds. An abdominal X-ray shows multiple air-fluid levels and dilated loops of small bowel.

What is the most likely diagnosis?

17/07/2026

A 56-year-old man presents to the emergency department with sudden severe epigastric pain radiating to the back. He has had repeated vomiting since the pain began. He has a history of chronic alcohol consumption. On examination, his pulse is 110/min, BP is 95/60 mmHg, and he has epigastric tenderness. Serum lipase is markedly elevated.

What is the most likely diagnosis?

10/07/2026

A 56-year-old man presents with fatigue and epigastric discomfort. Endoscopy reveals a gastric ulcer. Biopsy of the ulcer margin demonstrates signet ring cells infiltrating the stomach wall. Which of the following genetic mutations is most commonly associated with this type of gastric cancer?

08/07/2026

A 48-year-old man presents with recurrent episodes of severe epigastric pain radiating to the back. The pain improves when he leans forward. He has a long history of alcohol use. CT scan shows pancreatic calcifications. Which of the following is the most likely long-term complication of this disease?

07/07/2026

A 68-year-old man presents with fatigue, weight loss, and a change in bowel habits. Laboratory studies show iron deficiency anemia. Colonoscopy reveals a mass in the ascending (right) colon. Which of the following is the most likely clinical presentation of right-sided colon cancer?