S.B. is a 57-year-old African American man with newly diagnosed late-stage small-cell lung cancer. He has undergone radiation therapy to the brain for his metastases and is to start chemotherapy next week. His past medical history includes hypertension. He has no known drug allergies. A combination chemotherapy regimen has been chosen: cisplatin 100 mg/m2 for one dose on the first day and etoposide 100 mg/m2 IV every day for 3 days. He has experienced nausea and vomiting.
J.C. is a 42-year-old white man presenting with a 2-month history of intermittent mid-epigastric pain. The pain sometimes wakes him up at night and seems to get better after he eats a meal. J.G. informs you that he was told by his doctor 6 months ago that he had an infection in his stomach. He never followed up and has been taking over-the-counter Zantac for 2 weeks without relief. He is concerned because the pain is continuing. He has no other significant history except he is a 20 pack-year smoker and he drinks 5 cups of coffee a day. He eats late at night and goes to bed about 30 minutes after dinner. He also takes Motrin twice a day for shoulder pain. He is allergic to penicillin.
C.J. is a 71-year-old woman who presents for follow-up. She complains of hard, dry stools over the past week. She remembers reading an educational brochure she picked up in her pharmacy that suggested increasing her fiber and fluid intake, but this has not alleviated her problem. C.J.’s past medical conditions include hypertension and chronic renal insufficiency. She had a stroke 1 year ago with little or no residual. Her medications include verapamil SR 240 mg daily, lisinopril 10 mg orally once daily, calcium carbonate 1,250 mg twice daily orally, and aspirin 325 mg orally once daily.
T. is a 34-year-old white man who presents with diarrhea of 2 days’ duration. His other symptoms are nausea with vomiting and blood stools for 1 day. The history reveals that the patient has just returned from a 3-day honeymoon in Mexico. He was careful to eat steaming hot foods and beverages but did have a frozen drink the last night of the trip.
S.C. is a 38-year-old woman who presents with intermittent diarrhea with camping that is relieved by defecation. The diarrhea is not blood or accompanied by nausea and vomiting. Review of past medical history includes some childhood “problems with my stomach,” hypertension, and a recent cholecystectomy. She works as a housekeeper in a local inn and does not drink alcohol or smoke cigarettes.
B.F., age 28, presents with diarrhea and abdominal pain. He says he feels weak and feverish. His symptoms have persisted for 5 days. He tells you he has 8 to 10 bowel movements each day, although the volume of stool is only about “half a cupful.” Each stool is watery and contains bright-red blood. Before this episode, he had noticed a gradual increase in the frequency of his bowel movements, which he attributed to a new vitamin regimen. He has not traveled anywhere in the past 4 months and has taken no antibiotics recently. His medical history is significant for UC; his most recent exacerbation was 2 years ago. He is taking no medications except vitamins.
Examination findings include a tender, slightly distended abdomen. His BP is 122/84 sitting, 110/78 standing; HR 96 bpm; and temperature of 100°F. Otherwise, physical findings are unremarkable. Laboratory study results reveal hemoglobin 12 g/dL; hematocrit 38%; white blood cell count 12,000/mm3; platelet count 242k; sodium 132; potassium 3.6. All other study results are within normal limits. The most recent colonoscopy findings (4 years ago) revealed granular, edematous, friable mucosa with continuous ulcerations extending throughout the descending colon.
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