EMQs in Clinical Medicine.pdf - Peshawar Medical College

Abdominal pain 143
55 Abdominal pain
A
B
C
D
E
F
G
hepatitis
irritable bowel syndrome
umbilical hernia
primary sclerosing cholangitis
perforated duodenal ulcer
small bowel obstruction
ulcerative colitis
H
I
J
K
L
M
Crohn’s disease
primary biliary cirrhosis
carcinoma of sigmoid colon
acute appendicitis
gastric ulcer
pneumothorax
For each clinical scenario below, give the most likely cause for the clinical findings.
Each option may be used only once.
1 A 21-year-old student presents with a cramping diffuse abdominal pain associated
with alternating constipation and diarrhoea. Investigations are normal.
2 A 55-year-old smoker presents with severe epigastric pain. The chest radiograph
reveals air under the diaphragm.
3 A 9-year-old girl presents with fever, nausea and right iliac fossa pain. She says
that the pain ‘was around my belly-button before’.
4 A 35-year-old man presents with weight loss, diarrhoea and abdominal pain. On
examination, he has aphthous ulcers in the mouth and a mass is palpable in the
right iliac fossa. Blood tests reveal low serum vitamin B 12 and folate.
5 A 45-year-old woman on treatment for TB presents with abdominal pain and
malaise. On examination she is jaundiced.
Answers: see page 167.