EMQs in Clinical Medicine.pdf - Peshawar Medical College

184 The abdomen and surgery
The prognosis in young children is excellent and renal biopsy is not
usually necessary.
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A 30-year-old man presents with a colicky loin pain that radiates to
the groin area, which is associated with nausea and vomiting.
Renal calculi are more common in men. Risk factors include urinary tract
infection, dehydration and conditions associated with hypercalcaemia.
The pain of ureteric colic is severe and it is important to provide
adequate analgesia for the patient.
A 75-year-old woman presents with frequency, pain on micturition
and haematuria.
These are symptoms of acute cystitis. Acute pyelonephritis gives more
severe symptoms of fever, rigors, vomiting and loin pain.
70 Weight loss
Answers: I C F G K
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A 26-year-old woman complains of weight loss associated with
diarrhoea and palpitations. Her pulse is irregular.
Thyrotoxicosis is a well-recognized cause of atrial fibrillation and so
thyroid function tests should always be carried out on first presentation.
A 30-year-old Asian man complains of fever, weight loss, night
sweats and persistent cough.
Haemoptysis may also occur and can be profound, e.g. cupfuls of blood.
In the UK there is a much higher incidence of TB among immigrants
from Asia and Africa than in the native population.
A 55-year-old woman presents with abdominal pain, weight loss and
fatty stools. She also complains of extremely uncomfortable itchy
blisters on her knees and elbows.
Coeliac disease is also known as gluten-sensitive enteropathy and is
characterized by villous atrophy, giving rise to malabsorption in the
small bowel; this reverses with a gluten-free diet. There is a particularly
strong association with the HLA-DR3 and -DQ2 haplotypes.
Dermatitis herpetiformis (DH) is an immune-complex-mediated (IgA)
bullous skin disease that is associated with coeliac disease. DH can be
treated with oral dapsone in the acute setting, but can usually be
managed without medication by maintaining a gluten-free diet.
Anti-endomysial antibodies have a high sensitivity and specificity for
coeliac disease.
Jejunal biopsy to detect villous atrophy, reversible on gluten removal
from the diet, is the diagnostic investigation of choice.