Question

A previously healthy 55 yo man is referred to you for recent onset of fatigue and a 5 lb weight loss. He has no other symptoms and hisotry is negative

PE shows two positive findigns are evident: pale conjunctiva and black, guaiac positive stool

dx
next step

Answer 1

A 55-year-old man with pale conjunctiva and guaiac positive stool likely has gastrointestinal bleeding, requiring diagnostic testing like endoscopy and blood tests.

Step-by-step explanation:

The subject is a 55-year-old man experiencing fatigue and unintentional weight loss. The physical examination reveals pale conjunctiva and black, guaiac positive stool, indicating potential gastrointestinal bleeding. Given these symptoms, the next immediate step should involve more detailed diagnostic testing to determine the source of the bleeding. This can include a referral for gastrointestinal endoscopy, such as a colonoscopy or an upper endoscopy, which will allow direct visualization of the gastrointestinal tract to identify potential bleeding sources, such as ulcers, tumors, or varices. In addition, blood tests, including a complete blood count (CBC), will likely be necessary to evaluate for anemia that could result from chronic blood loss. Further investigations might also include iron studies to check for iron-deficiency anemia.