EMQs in Clinical Medicine.pdf - Peshawar Medical College

Haematemesis 161
73 Haematemesis
A
B
C
D
E
F
oesophageal varices
duodenal ulcer
infectious gastritis
Crohn’s disease
Mallory–Weiss tear
Peutz–Jeghers syndrome
G
H
I
J
K
Osler–Weber–Rendu syndrome
gastric carcinoma
gastric ulcer
Barrett’s oesophagus
aortoenteric fistula
For each clinical scenario below, give the most likely cause for the haematemesis.
Each option may be used only once.
1 A 50-year-old man who is an alcoholic complains of vomiting blood. On
examination he has signs of chronic liver disease.
2 A 55-year-old businessman complains of epigastric pain worse at night which
is relieved by eating. He has started vomiting small amounts of blood.
3 A 60-year-old woman with a several year history of heartburn presents with
occasional haematemesis. Endoscopy reveals intestinal-type metaplasia at the
distal oesophagus.
4 A 40-year-old woman presents with haematemesis after a bout of prolonged
vomiting.
5 A 60-year-old woman with pernicious anaemia presents with a 2-month history
of dyspepsia, weight loss and haematemesis. Examination reveals an enlarged
left supraclavicular node.
Answers: see page 187.