Capsule Case Round 1 - Change in Bowel Habit

Question 1

You are a GP Registrar in general practice. A 54-year-old man comes to the surgery with a history of passing bright red blood at defecation which is painless. He has also noticed blood in his stool and on the toilet paper intermittently for the past 6 weeks. He is otherwise well, his weight is stable and his bowel habits have not altered.

Does this patient require further investigation at this stage?

Answer 1

=YES

Question 2

Question 2

He does need investigating. What is in your differential diagnosis? (You may tick more than one)

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Question 3

The patient tells you that his older sister died from carcinoma of the rectum four years ago. Is this relevant?

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Question 7

General Practice 531

A 23-year-old post graduate student complains of several months of intermittent abdominal pain and episodes of constipation. There is no significant previous medical history, and she reports suffering with stress as a result of her studies. There are no positive clinical signs on examination. You suspect a diagnosis of irritable bowel syndrome (IBS).

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Question 27

Which of these lifestyle factors would most reduce the risk of a further relapse?

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