EMQs in Clinical Medicine.pdf - Peshawar Medical College

144 The abdomen and surgery
56 Abdominal masses
A
B
C
D
E
F
renal cell carcinoma
ovarian carcinoma
gastric carcinoma
sigmoid carcinoma
fibroids
pancreatic pseudocyst
G
H
I
J
K
L
diverticulosis
hepatocellular carcinoma
caecal carcinoma
psoas abscess
abdominal aortic aneurysm
ovarian cyst
For each clinical scenario below, give the most likely cause for the clinical findings.
Each option may be used only once.
1 A 65-year-old man collapses in the street. On examination he has an umbilical
mass that is expansile and pulsatile.
2 A 75-year-old man with a 3-month history of dyspepsia presents with weight
loss and abdominal distension. On examination a 3.5 cm, hard, irregular, tender
epigastric mass can be felt which moves on respiration. Percussion of the
distended abdomen reveals shifting dullness. The left supraclavicular node is
palpable.
3 A 70-year-old woman presents with a mass in the right iliac fossa and severe
microcytic anaemia. On examination the mass is firm, irregular and 4 cm in
diameter. The lower edge is palpable.
4 A 35-year-old woman is worried about an abdominal mass that has grown over
the last 6 months and a similar length history of very heavy menstrual bleeding
with no intermenstrual bleeding. On examination a knobbly mass can be felt in
the middle lower quadrant that is dull to percussion. The lower edge is not
palpable. She is otherwise well.
5 A 70 year old with alcohol problems presents with a tender upper abdominal
mass. Computed tomography (CT) shows a thick-walled, rounded, fluid-filled
mass adjacent to the pancreas.
Answers: see page 168.