EMQs in Clinical Medicine.pdf - Peshawar Medical College

Constipation – answers 189
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A 17-year-old man presents with symptoms of chronic diarrhoea
and smelly stools. He has a history of recurrent chest infections as a
child.
Cystic fibrosis can give rise to pancreatic insufficiency and consequently
steatorrhoea caused by gastrointestinal malabsorption.
A 35-year-old woman with diabetes presents with weight loss,
diarrhoea and angular stomatitis. Blood tests reveal presence of
anti-gliadin antibodies.
Anti-endomysial antibodies (serum IgA) can also be used to diagnose
coeliac disease and in fact show greater sensitivity and specificity.
Jejunal biopsy shows villous atrophy, which is reversible on removal of
gluten from the diet. There are general signs of malabsorption, e.g. folate
deficiency macrocytic anaemia, excessive bleeding resulting from vitamin
K malabsorption, etc. Coeliac disease is associated with an increased
risk of developing gastrointestinal lymphoma.
75 Constipation
Answers: I J A K H
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J
A
An 80-year-old woman presents with thirst, tiredness, depression,
bone pain and constipation.
Hypercalcaemia is also a well-recognized cause of confusion.
Intravenous saline, furosemide (frusemide) and bisphosphonates can be
used to lower serum calcium.
A 65-year-old man presents with a 3-month history of weight loss,
altered bowel habit and bleeding per rectum.
A patient with this history should be referred for colonoscopy as soon as
possible.
A 42-year-old woman complains of weight gain, constipation, cold
intolerance and depression.
Symptoms of hypothyroidism include cold intolerance, weight gain,
hoarse voice, menorrhagia, constipation and depression.
On examination the patient may have the typical coarse facial features.
Signs include bradycardia, goitre, non-pitting oedema, particularly over
the eyelids, peripheral neuropathy and slowly relaxing reflexes.
Hypothyroidism can also present as an emergency with confusion/coma
(myxoedema coma). The patient may be hypothermic and hypoglycaemic
and have chronic cardiac failure. Thyroid replacement therapy should be
initiated gradually to prevent complications.
A 65-year-old woman presents with constipation and colicky
left-sided abdominal pain relieved by defecation.