JAWAL-3LMNY

MCQs on IBD

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Matching

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CASE SCENARIO ,,, A 27 year old man comes to the emergency room complaining of 2 days of abdominal pain and diarrhea. He describes his stools as frequent, with 10-12 per day, small volume, sometimes with visible blood and mucus, and proceeded by a sudden urge to defecate. The abdominal pain is crampy, diffuse, and moderately severe, and it is not relieved with defecation. In the past 6-8 months, he has experienced similar episodes of abdominal pain and loose mucoid stools, but the episodes were milder and resolved within 24-48 hours. He has no other medical history and takes no medications. He has neither traveled out of the United States nor had contact with anyone with similar symptoms. He works as an accountant and does not smoke or drink alcohol. No member of his family has gastrointestinal problems.

On examination, his temperature is 99F, heart rate 98 bpm, and blood pressure 118/74 mmHg. He appears uncomfortable, is diaphoretic, and is lying still on the stretcher. His sclerae are clear, and his oral mucosa is pink and clear. His chest is clear, and his heart rhythm is regular, without murmurs. His abdomen is soft and mildy distended, with hypoactive bowel sound and moderate diffuse tenderness but no guarding or rebound tenderness.

Laboratory studies are significant for a white blood cell count of 15,800/mm3 with 82% polymorphonuclear leukocytes, hemoglobin 10.3 g/dL, and platelet count 754,000/mm3. the HIV assay is negative. Renal function and liver function tests are normal. A plain film radiograph of the abdomen shows a mildly dilated air-filled colon with a 4.5 cm diameter and no pneumoperitoneum or air/fluid levels.

• What is the most likely diagnosis?
• What is the next step?

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CASE SCENARIO ,,, A 49 year old woman presents to the emergency room complaining of a 4 week history of progressive abdominal swelling and discomfort. She has no other gastrointestinal symptoms, and she has a normal appetite and normal bowel habits. Her medical history is significant only for three pregnancies, one of which was complicated by excessive blood loss, requiring a blood transfusion. She is happily married for 20 years, exercises, does not smoke, and drinks only occasionally. On pointed questioning, however, she does admit that she was wild in her youth, and she had snorted cocaine once or twice at parties many years ago. She does not use drugs now. She was HIV negative at the time of birth of her last child.

On examination, her temperature is 100.3 F, heart rate 88 bpm, and blood pressure 94/60 mmHg. She is thin, her complexion is sallow, her sclerae are icteric, her chest is clear, and her heart rhythm is regular with no murmur. Her abdomen is distended, with mild diffuse tenderness, hypoactive bowel sounds, shifting dullness to percussion, and a fluid wave. She has no peripheral edema. laboratory studies are normal except for Na 129 mEq/L, albumin 2.8 mg/dL, total bilirubin 4 mg/dL, prothrombin time 15 seconds, hemoglobin 12 g/dL with mean call volume 102fL, and platelet count 78,000/mm3.

• What is the most likely diagnosis?
• What is your next step?

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CASE SCENARIO ,,, A 40 year old man with 2 month history of abdominal pain. The pain is epigastric or central and is  intermittent. He had a similar episode a year ago, took some indigestion pils & went after 10 weeks. The pain lasts for 30 to 60 min. It often occurs at night & wakes him up, and seems to improves after meals, but spicey food seems to bring on pain.  He had Smoked 15 cigarettes per day for 25 years. He is not on any medications & no other medical history. Haemoglobin 10.1 g/dl , RCC 6.4 X 10^12/l , MCV 72 fl , Iron 4 umol/l , Ferritin 7 umol/l. What is the likely diagnosis?

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CASE SCENARIO ,,, A 64 year old woman has a 10 year history of retrosternal pain. The pain it often present in bed at night. Occasionally, the pain comes on after eating & sometimes precipitated by exercise. The pain has been described as having a burning and a tight quality. It has no relation with respiration or position. On examination she is 1.64m tall & weighs 82kg. There is no findings. Chest x-ray is normal, exercise ECG is -ve, What is your diagnosis?

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