1. Explain the significance of the following in the protocol that my have a bearing to this patient's chief complaint..  Answer

History

• Normal bowel movements

• Constipation alternating with diarrhea

• Stool caliber

• Stool with streaks of blood on surface

• Weight loss

• Low blood 6 months back

Physical

• Pale conjunctiva

Lab

• Stool positive for occult blood

• Type of anemia

• Alkaline phosphatase

2. What is/are the major clinical problem/s (not the diagnosis)?  Answer

3. What type of anemia does this patient have?     Answer

4. What are the most common causes for this type of anemia. What is the most likely etiology in this patient and why?  Answer

5. Is this the result of acute bleeding or chronic bleeding?  Answer

6. What are the type of lesions that can cause chronic bleeding in GI tract?  Answer

7. Let us next address the next major problem. Develop a differential diagnosis for constipation.   Answer

8. What is the most likely reason in this patient and why? Cite data from protocol to support your diagnosis.  Answer

9. What is the significance of the laboratory in this case? How would you proceed to investigate the significance for elevated alkaline  Answer

10. How would you confirm your clinical suspicion? What procedures will you request?  Answer

11. What do you think the liver CT will show?  Answer

12. What would you have done 6 months ago when the anemia was first discovered? Was there a malpractice?   Answer

13. How would you treat this patient?  Answer