EMQs in Clinical Medicine.pdf - Peshawar Medical College

Haematuria – answers 183
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A 46-year-old man with a history of bowel surgery presents with
abdominal pain and vomiting. On examination there is some
tenderness on palpation. Bowel sounds are tinkling. His abdominal
radiograph shows dilated loops of small bowel.
Adhesions are fibrous bands that connect tissue surfaces that are normally
separated. Formation of adhesions after bowel surgery can lead to
bowel obstruction later. The patient may need to have another operation
to cut the adhesions.
69 Haematuria
Answers: I L F G C
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A 55-year-old smoker presents with painless haematuria and weight
loss. Ultrasonography of the kidneys is normal.
Carcinoma of the bladder usually presents with total painless haematuria.
Smoking and exposure to aniline dyes are risk factors for development of
transitional cell carcinoma of the bladder. Treatment depends on the
stage of disease. Most present with early disease that can be managed
with diathermy. Other treatments include cystectomy, chemotherapy,
radiotherapy and immunotherapy with intravesical BCG.
Carcinoma of the prostate usually presents with symptoms of poor
stream, urinary obstruction and nocturia.
A 6-year-old boy presents with a 2-week history of non-blanching
rash over the buttocks and macroscopic haematuria. He complains of
pain in both knees.
Henoch–Schönlein purpura (HSP) usually occurs in young children and
initially presents with a classic purpuric rash over the buttocks and extensor
surfaces. Full blood count should reveal normal platelet count. There
is joint involvement in around two-thirds of patients with the presence of
periarticular oedema. Renal involvement is common with the presence of
a focal segmental proliferative glomerulonephritis. IgA nephropathy may
occur as a part of HSP. Abdominal pain is a common symptom and there
is an increased incidence of intussusception in children with HSP.
Children usually make a complete recovery.
A 9-year-old boy presents with periorbital oedema and microscopic
haematuria plus proteinuria. ASOT is positive and serum C3 is
reduced. Apart from a sore throat 2 weeks ago, he has no previous
medical history of note.
Look out for the history of preceding pharyngitis, upper respiratory tract
infection, etc., particularly in young men and children. There is a diffuse
proliferative glomerulonephritis that is caused by the appearance of
immune complexes after infection by group A -haemolytic streptococci.