EMQs for Medical Students - PasTest

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E M Q s F O R M E D I C A L S T U D E N T S – V O L U M E 2 10. THEME: DYSPHAGIA A B C D E F G H I J K Achalasia Bulbar palsy Chagas’ disease Gastro-oesophageal reflux disease Myasthenia gravis Oesophageal candidiasis Oesophageal carcinoma Pharyngeal pouch Pharyngeal web Pseudobulbar palsy Scleroderma The patients below have all presented with difficulty swallowing (dysphagia). Please select the most appropriate diagnosis from the above list. Each diagnosis may be used once, more than once or not at all. 1. A 72-year-old man presents with a 6-month history of progressive difficulty swallowing. He is now only able to swallow small quantities of fluids and has lost 10 kg in weight. Examination is unremarkable apart from his wasted appearance. Liver function tests (LFTs) show: bilirubin 20 mmol/l, total protein 58 g/l, albumin 28 g/l, alkaline phosphatase 96 IU/l. 2. A 45-year-old man presents with a 6-month history of progressive difficulty with speech and swallowing. On examination, there is some weakness of facial muscles bilaterally, with drooling. The tongue is flaccid and shows fasciculation and the jaw jerk is absent. Eye movements are normal. 3. A 50-year-old woman presents with a history of chest pain associated with regurgitation of solids and liquids equally, both occurring shortly after swallowing. Radiological investigation reveals a dilated oesophagus with a tapering lower oesophageal segment. Oesophageal manometry demonstrates failure of relaxation of the lower oesophageal sphincter. 4. A 26-year-old man who has undergone a renal transplant presents with a 3-day history of severe odynophagia and difficulty swallowing. Barium swallow and endoscopy demonstrate generalised ulceration of the oesophagus. His medications include oral prednisolone and ciclosporin. 5. A 30–year-old man presents with a long history of epigastric burning pain which is worse at night. He also suffers from severe burning pain in the chest when drinking hot liquids. Recently he has noted some difficulty swallowing solids. Endoscopy reveals confluent circumferential erosions and stricturing in the lower oesophagus. Twenty-four-hour ambulatory oesophageal pH measurement demonstrates a pH of
G A S T R O E N T E R O L O G Y 11. THEME: DISEASES OF THE STOMACH A B C D E F G H I J K L Active chronic gastritis Acute erosive gastritis Adenocarcinoma Adenoma Carcinoid tumour Chronic peptic ulcer Gastrointestinal stromal tumour Kaposi’s sarcoma Lymphoma of mucosa-associated lymphoid tissue (MALT) Ménétrier’s disease Pyloric stenosis Reflux gastropathy For each of the patients below, select the gastric disease that they are most likely to have from the above list. Each disease may be used once, more than once or not at all. 1. A 63-year-old woman presents with a 2-month history of anorexia, weight loss and epigastric pain. Blood tests done by her GP reveal an iron-deficiency anaemia. Endoscopy shows a thickened and rigid gastric wall without an obvious mass lesion. Biopsies show numerous signet-ring cells diffusely infiltrating the mucosa. 2. A 42-year-old woman with rheumatoid arthritis presents with two episodes of melaena. She has recently started taking a new non-steroidal antiinflammatory drug (NSAID). Endoscopy shows numerous superficial mucosal defects throughout the stomach, some of which are bleeding. 3. A 51-year-old man presents with a 3-month history of dyspepsia and weight loss. Endoscopy reveals thickened mucosal folds and a 2-cm antral ulcer. Biopsies show a heavy infiltrate of atypical lymphocytes with clusters of intraepithelial lymphocytes. 4. A 26-year-old, HIV-positive man presents with a 2-week history of dyspepsia and epigastric pain. Endoscopy shows a purple, plaque-like lesion in the fundus. Biopsies of the lesion show slit-like vascular spaces surrounded by proliferating spindle cells. 5. A 42-year-old man presents with a long history of epigastric discom<strong>for</strong>t related to meals. Endoscopy shows diffuse erythema in the antrum without obvious ulceration. Antral biopsies show an infiltrate of lymphocytes, plasma cells and neutrophils in the gastric mucosa. None of the lymphocytes are atypical. A special stain reveals numerous Helicobacter pylori organisms lining the mucosal surface. 17
Page 1 and 2: EMQs for Medical Students Volume 2
Page 3: CHAPTER 1 Gastroenterology 1. Anato
Page 6 and 7: E M Q s F O R M E D I C A L S T U D
Page 20 and 21: ANSWERS TO CHAPTER - GASTROENTEROLO
Page 22 and 23: A N S W E R S - G A S T R O E N T E
Page 30: A N S W E R S - G A S T R O E N T E

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