(MCQS 334-336):A 68 year old female patient complains of continous diarrhoea at night

Question:334
Correct Answer: C
Explanation:
Autonomic neuropathy may result in nocturnal diarrhea. Codeine, loperamide, or diphenoxylate in high doses may help.

Question:335
Correct Answer: A
Explanation:
A probable diagnosis is: a) Chronic Lymphocytic Leukemia Chronic lymphocytic leukemia (CLL) is the most common (2.7/100,000 incidence) of the chronic lymphoproliferative disorders, representing about 30% of all leukemia. CLL is a disease of adults. Most patients are > 60 years of age and asymptomatic (essentially normal physical examination) at diagnosis. Definition: CLL is a proliferation of mature appearing, but functionally incompetent lymphocytes, in the marrow, peripheral blood, and various organs. The most characteristic feature of CLL is a peripheral blood absolute lymphocytosis (>5.0 x109/L, but usually >15.0 x109/L and sometimes > 100.0 x109/L). Clinical Features: Lymphadenopathy and splenomegaly are common especially late in the disease because small lymphocytes accumulate in the marrow, spleen, lymph nodes and liver. Hypogammaglobulinemia is also common late in the disease course with an associated increased susceptibility to infection. Ten percent of patients have an IgM monoclonal gammopathy. Anemia and thrombocytosis may indicate marrow replacement or autoimmune destruction. The clinical course is highly variable with survival ranging from 1-20 years. The Rai staging system (1975;1987) is used to assess the leukemic "burden" in CLL and to accurately predict the clinical course.

Question:336
Correct Answer: C
Explanation:
Gastrointestinal Manifestations of reflux esophagitis include chest pain (heartburn [pyrosis]) dysphagia (difficult swallowing) hallitosis (refluxate in mouth) odynophagia (painful swallowing) waterbrush (flow of salty saliva into mouth) hematemesis and anemia (iron-deficient) . Respiratory Manifestations include recurrent or chronic pneumonias recurrent wheeze chronic cough stridor and hoarseness The best established technique for diagnosing gastroesophageal reflux in children is the 24 hr esophageal pH probe test. This involves placement of a pH probe into the distal esophagus to moniter the total time that there is acid (pH <4) in the distal esophagus. It is considered the gold standard for the diagnosis of pathogenic reflux quantifies the frequency and duration of acid reflux for prolonged periods. it may detect a temporal relationship between episodes of reflux and discrete signs and symptoms (neurobehavioural manifestations) , identifies at risk conditions, i.e., sleeping, coughing. The limitations: are : it cannot detect nonacid reflux 24 hours in duration limited availability. You may also use 99mTc-sulfur colloid in liquid form (dextrose, milk, or other fluid) in the detection of gastroesophageal reflux and/or aspiration, and to measure gastric emptying time. The procedure may be performed in conjunction with a pH probe and/or a GTT (Glucose Tolerance Test). The test is carried out for one hour following ingestion of the material.


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