EMQs in Clinical Medicine.pdf - Peshawar Medical College

160 The abdomen and surgery
72 Lower gastrointestinal bleeding
A
B
C
D
E
F
ulcerative colitis
Crohn’s disease
Mallory–Weiss tear
haemophilia
diverticulosis
Meyer–Betz syndrome
G
H
I
J
K
L
Peutz–Jeghers syndrome
anal fissure
infectious diarrhoea
colonic carcinoma
haemorrhoids
intussusception
For each clinical scenario below, give the most likely cause for the bleeding. Each
option may be used only once.
1 A 62-year-old man presents with rectal bleeding and a year’s history of left iliac
fossa pain and change in bowel habit. There is no weight loss.
2 An 8-month-old baby presents with inconsolable crying, colic and bleeding per
rectum. A sausage-shaped abdominal mass is palpable.
3 A 35-year-old man returns from holiday with a 2-week history of fever, cramping
abdominal pain and bloody diarrhoea.
4 A 60-year-old man complains of tiredness and significant weight loss. He notes
episodes of rectal bleeding with blood mixed in with the stool over the last few
weeks. There is no diarrhoea.
5 A 21-year-old man presents with a history of constipation and rectal bleeding.
On examination there are numerous dark freckles on the palm, lips and oral
mucosa.
Answers: see page 186.