EMQs for Medical Students - PasTest

More documents

Recommendations

Info

E M Q s F O R M E D I C A L S T U D E N T S – V O L U M E 2 8. THEME: ABDOMINAL PAIN II A B C D E F G H I J Diabetes mellitus Dissecting aortic aneurysm Large-bowel obstruction Myocardial infarction Oesophageal reflux disease Perforated diverticular disease Perforated duodenal ulcer Ruptured abdominal aortic aneurysm Sickle-cell disease Small-bowel obstruction The patients below have all presented with abdominal pain. Please select the most appropriate diagnosis from the above list. Each diagnosis may be used once, more than once or not at all. 1. A 92-year-old man presents with a 1-day history of upper abdominal pain and nausea. On general examination he is sweaty and breathless. He has no gastrointestinal symptoms and a normal abdominal examination. Investigations reveal: haemoglobin 11.2 g/dl, WCC 10.8 × 10 9 /1; troponin I 20.6 IU/l, creatine kinase 2000 IU/l. 2. A 36-year-old woman who underwent an operation for perforated appendix 1 year ago presents with a 3-day history of increasing, central, colicky abdominal pain. She has been vomiting today and feels distended. She opened her bowels normally yesterday. Investigations reveal: haemoglobin 13.2 g/dl, WCC 9.8 × 10 9 /l; K + 3.4 mmol/l. 3. A 72-year-old man, who is a known hypertensive, presents with sudden-onset (30 minutes ago), very severe epigastric pain radiating to the back. On examination he is shocked, with a pulse of 120 bpm and BP of 90/55 mmHg. The femoral pulses are present but weak. There is generalised abdominal tenderness and guarding. 4. A 76-year-old woman presents with a 3-day history of intermittent lower abdominal pain. She has not opened her bowels or passed wind for 2 days and has noticed that she has become very distended today. Abdominal examination reveals a distended, hyper-resonant but non-tender abdomen. 5. A 40-year-old man presents with a rapid onset of severe, constant epigastric pain. On examination, he is lying still and appears very distressed, pulse 118 bpm, BP 120/70 mmHg, respiratory rate 30/minute. The abdomen is tender and there is intense guarding with rigidity. The abdomen is silent to auscultation. 14
G A S T R O E N T E R O L O G Y 9. THEME: ABDOMINAL MASS A B C D E F G H I J Appendix mass Carcinoma of the head of the pancreas Carcinoma of the kidney Carcinoma of the sigmoid colon Carcinoma of the stomach Cirrhosis of the liver Diverticular mass Gallstone disease Pancreatic pseudocyst Splenomegaly The patients below have all presented with a palpable abdominal mass. Please select the most appropriate diagnosis from the above list. Each diagnosis may be used once, more than once or not at all. 1. A 35-year-old alcoholic presents with a 1-month history of epigastric pain, fullness and nausea. He has previously had two or three episodes of severe epigastric pain associated with vomiting. Examination reveals a large, slightly tender, rather indistinct mass in the upper abdomen with no other specific features. 2. A 56-year-old woman presents with a 2-week history of increasing jaundice and pruritus. Direct questioning reveals that over the past few months she has had some upper abdominal pain, radiating to the left side of the back, and has lost approximately 10 kg in weight. A smooth hemi-ovoid mass is palpable in the right upper quadrant which moves with respiration. It is dull to percussion. 3. A 53-year-old man presents with a 10-day history of increasing jaundice and pruritus. Direct questioning reveals that he has become increasingly constipated over the past year with some loss of appetite and weight. Examination reveals a large, hard, irregular mass in the right upper quadrant and epigastrium which moves on respiration and is dull to percussion, and a further mass in the left iliac fossa. 4. A 58-year-old woman presents with an acute haematemesis. On examination she is slightly jaundiced and confused. The abdomen is generally distended with shifting dullness. A large mass is palpable in the right upper quadrant and epigastrium which moves on respiration and is dull to percussion. 5. A 46-year-old woman presents with a 5-day history of severe right upper quadrant pain, nausea and vomiting. On examination, she is febrile and a very tender mass is palpable in the right upper quadrant that moves with respiration and is dull to percussion. She is not jaundiced. 15
Page 1 and 2: EMQs for Medical Students Volume 2
Page 3: CHAPTER 1 Gastroenterology 1. Anato
Page 6 and 7: E M Q s F O R M E D I C A L S T U D
Page 20 and 21: ANSWERS TO CHAPTER - GASTROENTEROLO
Page 22 and 23: A N S W E R S - G A S T R O E N T E
Page 30: A N S W E R S - G A S T R O E N T E

EMQs for Medical Students - PasTest

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?