EMQs in Clinical Medicine.pdf - Peshawar Medical College

146 The abdomen and surgery
58 Causes of splenomegaly
A
B
C
D
E
F
malaria
pernicious anaemia
sarcoidosis
idiopathic thrombocytopenic
purpura
Gaucher’s disease
infective endocarditis
G
H
I
J
K
L
M
Weil’s disease
infectious mononucleosis
cutaneous leishmaniasis
Budd–Chiari syndrome
myeloma
Felty’s syndrome
acute lymphoblastic leukaemia
For each clinical scenario below, give the most likely cause for the clinical findings.
Each option may be used only once.
1 A 75-year-old woman with long-standing rheumatoid arthritis is seen to have
splenomegaly on abdominal examination. Her full blood count shows anaemia
and a low white cell count.
2 A 35-year-old man presents with an insidious onset of hepatosplenomegaly
with marked pigmentation on the forehead and hands. He is anaemic and has a
history of pathological fractures.
3 A 23-year-old man presents with a week’s history of fever and sore throat.
He developed a macular rash after being prescribed ampicillin by his GP.
On examination he has enlarged posterior cervical nodes, palatal petechiae and
splenomegaly.
4 A 21-year-old female backpacker returning from India presents with flu-like
symptoms followed by a periodic fever. She is anaemic, jaundiced and has
moderate splenomegaly.
5 A 28-year-old woman presents with abdominal pain, vomiting and jaundice.
On examination she has tender hepatomegaly and ascites. She has a history of
recurrent miscarriages.
Answers: see page 171.