EMQs in Clinical Medicine.pdf - Peshawar Medical College

Dysphagia – answers 185
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A 10-year-old boy presents with a history of weight loss and
excessive thirst.
Type 1 diabetes mellitus is usually of juvenile onset and is characterized
by insulin deficiency. Common early symptoms include polydipsia,
polyuria and weight loss. The patient may also present as a medical emergency
with diabetic ketoacidosis. Signs of diabetic ketoacidosis include
hyperventilation, dehydration, drowsiness, abdominal pain and vomiting.
A 24-year-old woman complains of tiredness and difficulty in
concentrating at university. On examination she has marked weight
loss and lanugo hair. Blood tests reveal a mild hypokalaemia.
Anorexia nervosa is characterized by a morbid fear of fatness and a
desire to be thinner that is associated with a body mass index (BMI) less
than 17.5 kg/m 2 (more than 15 per cent below standard weight).
Lanugo hair is soft downy hair found particularly on the face and forearms,
which is a feature of advanced anorexia. Hypokalaemia and alkalosis are
sometimes found when blood tests are carried out to investigate weight
loss, and result from self-induced vomiting and laxative and diuretic abuse.
71 Dysphagia
Answers: G I L K A
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A 35-year-old woman presents with dysphagia for solid and liquids
associated with regurgitation and weight loss. Barium swallow shows
a dilated tapering oesophagus.
Oesophageal achalasia involves a failure of relaxation of the lower
oesophageal sphincter on the initiation of swallowing. There are degenerative
changes in both the myenteric plexus and the vagus nerve. It is
important to perform a oesophagoscopy to exclude the possibility of carcinoma
at the lower end of the oesophagus. First-line treatment involves
endoscopic balloon dilatation of the sphincter. Surgical treatment
involves dividing the muscle at the lower end of the oesophagus –
known as a Heller’s cardiomyotomy.
A 65-year-old smoker presents with a history of severe oesophagitis
and gradually worsening dysphagia.
This history is highly suggestive of carcinoma. Smoking is a risk factor.
A 28-year-old woman presents with a feeling of a lump in her throat
that causes some discomfort on swallowing. Examination and imaging
of the pharynx and oesophagus reveal no abnormality.
Globus hystericus involves a classic description of a constant ‘lump in
my throat’ sensation, but no abnormality can be found. Some patients
describe a difficulty in swallowing whereas others claim that swallowing