NMS Q&A Family Medicine

94 NMS Q&A Family Medicinebowel barium follow-through is a diagnostic tool forhemorrhage but fails in cases of mucosal lesions.20. The answer is D. Dysphagia that is due to an esophagealmotor disorder is characterized by symptoms withboth solids and liquids. Rapidly progressing dysphagiawith weight loss is a cause for suspicion of esophagealcancer. Slowly progressing dysphagia, over months oryears, is suggestive of benign stricture; intermittent acutesymptoms or spasmodic acute obstruction is characteristicof symptomatic esophageal ring (the Schatzki ring, at thelower end of the esophagus ); odynophagia, although it is dueto other causes, when of recent onset, usually indicatesulcerative esophagitis caused by aphthous disease, or if longer,such ulcerative disease could be due to more seriousunderlying causes such as immune compromise emanatingfrom diseases such as cancer, blood dyscrasias, cancer chemotherapy,or acquired immunodeficiency disease.21. The answer is A. Extraintestinal processes of ulcerativecolitis include all of those listed except uveitis.Sclerosing cholangitis, pyoderma gangrenosum, andarthropathies are well known to be associated with ulcerativecolitis, although the bases for these are poorly understood.Similarly, erythema nodosum is associated but lessfrequently than the other entities.ReferencesFlake ZA , Scalley RD , Bailey AG . Practical selection of antiemetics. Am Fam Physician . 2004 ; 69 : 1169 – 1174 , 1176 .Kennedy TM , Rubin G , Jones RH . Clinical evidence: Irritablebowel syndrome . Am Fam Physician . 2005 ; 71 ( 3 ): 525 .Kucik CJ , Martin GL , Sortor BV . Common intestinal parasites .Am Fam Physician . 2004 ; 69 : 1161 – 1168 .Manning-Dimmit LA , Dimmit SG , Wilson GR . Diagnosis ofgastrointestinal bleeding in adults . Am Fam Physician . 2005 ;71 : 1339 – 1346 .Mitchell SH , Schaeffer DC , Dubagunta S . A new view of occultand gastrointestinal bleeding . Am Fam Physician . 2004 ;69 : 875 – 881 .Nidiry JJ . Medical problems of the gastrointestinal tract . In:Rudy DR , Kurowski K , eds. Family Medicine: House OfficerSeries . Baltimore : Williams & Wilkins ; 1997 : 217 – 234 .Rakel RER , Bope EP , eds. Conn’s Current Therapy 2009 . Philadelphia, PA: Saunders-Elsevier; 2009.Schiller L . Malabsorption . In: Rakel RE , Bope EP, eds. Conn’sCurrent Therapy . Philadelphia, PA: Saunders-Elsevier ; 2009.Schroeder MS . Clostridium difficile-associated diarrhea . AmFam Physician . 2005 ; 71 : 921 – 928 .