EMQs for Medical Students - PasTest

G A S T R O E N T E R O L O G Y
12. THEME: DYSPEPSIA AND PEPTIC ULCER DISEASE
A
B
C
D
E
F
G
H
I
J
Barrett’s oesophagus
Biliary gastritis
Duodenal ulcer
Duodenitis
Gastric ulcer
Gastro-oesophageal reflux disease
Haemorrhagic gastritis
Oesophageal stricture
Pyloric stenosis
Zollinger–Ellison syndrome
The following patients have all presented with dyspepsia or complications of peptic ulcer
disease. Please choose the most appropriate diagnosis from the above list. Each diagnosis
may be used once, more than once or not at all.
1. A 54-year-old man presents in the Emergency Department with two episodes
of fresh haematemesis over the preceding hour. On examination, he is pale but
haemodynamically stable and well perfused. He has no lymphadenopathy or
signs of chronic liver disease and the only significant finding is epigastric
tenderness. Oesophagogastroduodenoscopy (OGD) confirms a lesion in the
first part of the duodenum which requires injection. His Campylobacter-like
organism (CLO) test is strongly positive.
2. A 59-year-old man presents to his GP with severe retrosternal burning pain. On
examination, he is pale but otherwise well, with no significant findings. Upper
gastrointestinal endoscopy reveals long-standing changes of gastrooesophageal
reflux and biopsy confirms ‘metaplastic changes within the
epithelium’.
3. A 34-year-old man with severe peptic ulcer disease is seen in the Emergency
Department with epigastric pain and vomiting. On examination, he looks
unwell and has severe vomiting. Abdominal examination reveals mild,
generalised tenderness and a succussion splash. Initial investigations show:
haemoglobin 10.9 g/dl, MCV 73 fl, WCC 10.9 × 10 9 /l, platelets 342 × 10 9 /l;
Na + 135 mmol/l, K + 2.9 mmol/l, HCO 3–
48 mmol/l, urea 5.9 mmol/l, creatinine
95 mmol/l. An abdominal radiograph shows ‘large gastric bubble, nil else’.
4. A 69-year-old woman with a long history of dyspepsia is seen by her GP with
mid-thoracic dysphagia to solids associated with pain on food reaching the
sticking point. Examination is unremarkable but routine investigations confirm
a microcytic anaemia.
5. A 41-year-old man is referred to the Gastroenterology Out-patient Clinic
with a 3-month history of worsening epigastric pain and dyspepsia. Upper
(GI) endoscopy confirms multiple peptic ulcers in the stomach and
duodenum, with ulceration in the lower oesophagus. His serum gastrin levels
are grossly elevated.
19