Pathology EMQ template.

Name:

Candidate number:

Theme: Malabsorption

 

OPTION LIST

 

A

Abetalipoproteinaemia

I

Tropical Sprue

B

Bacterial Overgrowth

J

Tuberculous Terminal Iletis

C

Chronic Pancreatitis

K

 

D

Coeliac Disease

L

 

E

Crohn’s Disease

M

 

F

Cystic Fibrosis

N

 

G

Giardiasis

O

 

H

Short Bowel Syndrome

P

 

 

 

For each scenario below, choose the most appropriate answer from the list above. Each option may be used once, more than once or not at all.

 

1.   A 31-year-old Vietnamese man is referred to the Gastroenterology clinic with a 2-month history of weight loss and loose, offensive stools. Initial investigations reveal a macrocytic anaemia and hypoalbuminaemia. U&Es, LFTs, random blood glucose and TFTs are all normal. CXR shows apical calcification and hilar lymphadenopathy. An upper endoscopy and small-bowel biopsy are unremarkable.

 

 

2.   A 24-year-old woman is referred to the Gastroenterology clinic with a 3-month history of weight loss, mouth ulceration, loose stools and lethargy. Initial investigations show: Hb 10.4 g/dl, MCV 102 fl, WCC 9.2 x 109/l, platelets 399 x 109/l; Na+ 132 mmol/l, K+ 4.1 mmol/l, urea 4.1 mmol/l, creatinine 76 µmol/l; random blood glucose 4.9 mmol/l; total bilirubin 12 µmol/l, ALT 23 IU/l, AST 31 IU/l, alkaline phosphotase 56 IU/l, albumin 32 g/l; TSH 1.07 mU/l, fT4 23 pmol/l; anti-endomysial and anti-tissue glutaminase antibodies both highly positive.

 

 

3.   A 49-year-old man with a previous history of a Polya gastrectomy for gastric ulceration presents to his GP with a 3-month history of abdominal bloating, nausea, weight loss and steatorrhoea. He is referred to the local gastroenterologist and the diagnosis is subsequently confirmed by a positive 14C breath test. He improves with a course of oral clarithromycin.

 

 

4.   An 18-year-old student returns from a 4-month trip around South-East Asia with a 6-week history of weight loss, diarrhoea, lethargy and malaise. O/E, he has obvious weight loss and is clinically anaemic. Abdominal examination is unremarkable. Stool microscopy and culture are negative for organisms, parasites, ova and cysts. A small-bowel biopsy confirms early villous stunting with increased crypt depth. No organisms are seen or cultured. He improves with a course of folate, vitamin B12 and tetracycline.

 

 

5.   A 41-year-old chronic alcohol abuser presents to his GP with abdominal pain, lethargy and malaise associated with steatorrhoea. Initial investigations show: Hb 9.1 g/dl, MCV 107 fl, WCC 4.2 x 109/l, platelets 79 x 109/l; Na+ 129 mmol/l, K+ 4.1 mmol/l, urea 3.1 mmol/l, creatinine 88 µmol/l; random blood glucose 12.9 mmol/l; total bilirubin 32 µmol/l, ALT 323 IU/l, AST 231 IU/l, alkaline phosphotase 356 IU/l, albumin 27 g/l; corrected Ca2+ 1.98 mmol/l, PO43- 0.34 mmol/l. An abdominal radiograph shows speckled calcification across the upper abdomen.

 

 

 

ANSWERS

1. J

2. D

3. B

4. I

5. C