Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3017_Библиотеки_им_академика_М_И_Перельмана
.pdf
12 Diagnostic EMQs
M. Small bowel haematoma
N. Small bowel obstruction
O. Ulcerative colitis
For each of the following, what is the MOST likely diagnosis?
1. Bird’s beak sign seen on barium swallow.
2. Coffee bean sign seen on abdominal X-ray.
3. Cottage loaf sign seen on CT of the abdomen.
4. Target sign seen on abdominal ultrasound.
5. Lead pipe sign seen on an erect abdominal X-ray.
See pages 26–27 for answers.
GASTROINTESTINAL IMAGING 3
A. Achalasia
B. Colorectal carcinoma
C. Crohn’s disease
D. Diaphragmatic rupture
E. Diffuse esophageal spasm
F. Duodenal atresia
G. Impending abdominal aortic aneurysm rupture
H. Intraluminal duodenal diverticulum
I. Intussusception
J. Pneumoperitoneum
K. Pyloric stenosis
L. Sigmoid volvulus
M. Small bowel haematoma
N. Small bowel obstruction
O. Ulcerative colitis
For each of the following, what is the MOST likely diagnosis?
1. Stack of coins sign seen on erect abdominal X-ray.
2. Telltale triangle sign seen on plain abdominal X-ray.
3. Corkscrew appearance seen on barium swallow.
4. Ram’s horn sign seen on a barium meal.
See page 27 for answers.
https://t.me/medicina_free
Gastroenterology 13
HEPATOBILIARY DISEASE 1
A. Alcoholic hepatitis
B. Ascending cholangitis
C. Cholecystitis
D. Choledocholithiasis
E. Dubin–Johnson syndrome
F. Gaucher’s disease
G. Gilbert’s syndrome
H. Haemochromatosis
I. Hepatitis A
J. Hepatitis B–acute
K. Hepatitis B–chronic
L. Hepatitis B resolved
M. Pancreatic cancer
N. Pancreatitis
O. Primary biliary cirrhosis
P. Primary sclerosing cholangitis
Q. Rotor disease
R. Wilson’s disease
For each of the following, what is the MOST likely diagnosis?
1. A 39-year-old man presents with a one-day history of right upper quadrant pain. On
examination he has a temperature of 38.1
o
C and he has a positive Murphy’s sign.
2. A 61-year-old male presents with a two-day history of skin colour changes and
itch. He has a history of gall stones. On examination he is afebrile, his observa-
tions are within a normal range and he is jaundiced. Abdominal examination is
unremarkable. ERCP reveals a lling defect in the common bile duct.
3. A 62-year-old male attends your clinic for results of his blood tests, he is asymp-
tomatic today. He has no signicant medical history and takes no medication.
He migrated from Egypt when he was 21years of age and lives with his wife
and two daughters. He has a raised ALT and AST but the remainder of his
bloods are normal. You arrange for follow up bloods which reveal HBsAg posi-
tive, anti-HBc positive, IgM anti-HBc negative and anti-HBs negative.
4. A 68-year-old man presents with a two-week history of generalised itch, choluria
and skin discoloration. On questioning he explains that he has lost 10 kg in the
past six months and has a loss of appetite. On examination he is jaundiced and
you palpate a mass in the epigastric region 2cm below the left costal margin.
5. A 32-year-old hairdresser attends your clinic complaining of fatigue. She tells you
that over the past week she has also been nauseated and has had upper abdomi-
nal pain. On examination she has normal observations but she is jaundiced and
has mild discomfort with palpation of the right upper quadrant. You arrange for
https://t.me/medicina_free
14 Diagnostic EMQs
serology which reveals AST 2234, ALT 2006, ALP 122, Bilirubin 24, HBsAg
positive, anti-HBc positive, IgM anti-HBc positive and anti-HBs negative.
See page 27 for answers.
HEPATOBILIARY DISEASE 2
A. Alcoholic hepatitis
B. Ascending cholangitis
C. Cholecystitis
D. Choledocholithiasis
E. Dubin–Johnson syndrome
F. Gaucher’s disease
G. Gilbert’s syndrome
H. Haemochromatosis
I. Hepatitis A
J. Hepatitis B–acute
K. Hepatitis B–chronic
L. Hepatitis B–resolved
M. Pancreatic cancer
N. Pancreatitis
O. Primary biliary cirrhosis
P. Primary sclerosing cholangitis
Q. Rotor disease
R. Wilson’s disease
For each of the following, what is the MOST likely diagnosis?
1. A 21-year-old presents with a two-day history of fever and nausea. He tells you
that he has also had abdominal cramping and dark urine. He recently returned
from Thailand two weeks ago where he had been on a eld trip with university
visiting various agricultural sites. On examination he has a temperature of 37.9
o
C,
he appears jaundiced, has hepatosplenomegaly and cervical lymphadenopathy.
2. A 45-year-old presents with a one-week history of abdominal swelling and gen-
eralised itch. He has a history of hypertension and uses Captopril to treat this.
He is a non-smoker and drinks eight cans of full-strength beer on most nights,
he has done this for the last 10years. On examination he appears jaundiced, has
decreased chest hair, bilateral gynaecomastia, abdominal distension, multiple
spider naevi and hepatomegaly. His abdomen is non tender on palpation. You
arrange for bloods which reveal AST 153, ALT 68, ALP 197 and Bilirubin 120.
3. A 37-year-old male presents to your GP clinic. He explains that he has been put-
ting off review with you as he has a phobia of doctor’s clinics. He explains that
he was meant to come and see a GP many years ago as there is a family history
https://t.me/medicina_free
Gastroenterology 15
of liver problems and as a young child he was admitted to hospital because he
was jaundiced. You arrange for some blood tests which reveal normal LFT’s,
HBsAg negative, anti-HBc positive and anti-HBs positive.
4. A 43-year-old woman presents to your emergency department with worsening
epigastric pain. She reports that her pain started two hours ago and is severe in
nature, radiating through to her back. She gets some relief with leaning forward.
She has vomited three times as a result of her symptoms. She has a history of
gallstones and takes no regular medication. On examination she is afebrile,
observations are within normal limits and she is very tender in the epigastric
region. Serology reveals a lipase of 312 U/L.
See pages 27–28 for answers.
HEPATOBILIARY DISEASE 3
A. Alcoholic hepatitis
B. Ascending cholangitis
C. Cholecystitis
D. Choledocholithiasis
E. Dubin–Johnson syndrome
F. Gaucher’s disease
G. Gilbert’s syndrome
H. Haemochromatosis
I. Hepatitis A
J. Hepatitis B – acute
K. Hepatitis B – chronic
L. Hepatitis B – resolved
M. Pancreatic cancer
N. Pancreatitis
O. Primary biliary cirrhosis
P. Primary sclerosing cholangitis
Q. Rotor disease
R. Wilson’s disease
For each of the following, what is the MOST likely diagnosis?
1. A 54-year-old woman presents with a long history of fatigue, joint pain, gen-
eralised itch and unexplained bruising. She has a history of osteoporosis and
hypertension. On examination she has xanthelasma and hepatomegaly. Anti-
mitochondrial antibodies are positive.
2. A 38-year-old male presents with fatigue, pruritus and jaundice. He drinks two
to three cans of beer a day on weekends and is a non-smoker. He has a history
of ulcerative colitis. On examination he is jaundiced and has hepatomegaly. You
https://t.me/medicina_free
16 Diagnostic EMQs
arrange for bloods which reveal a signicantly elevated ALP. After specialist
referral an ERCP is performed which reveals beading of the bile ducts within
the liver.
3. A 22-year-old woman presents with recurrent episodes of jaundice for the past
three years. Episodes are usually preceded by upper respiratory tract infec-
tions. She presents today with mild jaundice. You arrange for liver function tests
which reveal normal liver function but a raised bilirubin level.
4. A 56-year-old woman presents with chronic arthralgia and fatigue. She tells you
that the pain mostly affects her hands and particularly the 2nd and 3rd MCP
joints. Recently she has also noticed abdominal discomfort in the right upper
quadrant. On examination you note swelling in all joints of both hands, abdomi-
nal exam reveals hepatomegaly. You arrange for serology which reveals serum
ferritin of 520 μg/L, transferrin saturation 61%.
5. A 52-year-old male presents with a one-day history of abdominal pain and jaundice.
He explains that the pain is severe, in the right upper quadrant and radiating to the
right shoulder tip. He reports dark urine and light-coloured stools. On examination
he is jaundiced, has a temperature of 38.6
o
C and Murphy’s sign is negative.
See page 28 for answers.
LUMPS AND HERNIAS 1
A. Direct inguinal hernia
B. Divarication of recti
C. Epigastric hernia
D. Femoral hernia
E. Indirect inguinal hernia
F. Paraumbilical hernia
G. Richter’s hernia
H. Saphena varix
I. Spigelian hernia
J. Umbilical hernia
For each of the following, what is the MOST likely diagnosis?
1. A 32-year-old multiparous woman presents for her six-week check. She deliv-
ered her daughter at term via caesarean section due to breech position. She
complains of abdominal muscle weakness. On examination the upper midline
bulges when intra-abdominal pressure is increased.
2. A 2-month-old child attends your clinic for the rst time with his mother for a
routine check-up. On examination you note a bulge in the belly button area. His
mother tells you she noticed it a few weeks ago and explains that it swells when
he cries or tries to pass a motion.
https://t.me/medicina_free
Gastroenterology 17
3. A 36-year-old male presents with a four-month history of pain around his belly
button. He tells you he has had a lump there since he was 10years old and it was
pea sized back then. He tells you that four months ago the lump increased to the
size of a walnut all of a sudden which was quite painful at the time. It gets larger
with Valsalva manoeuvre and reduces with lying down.
4. A 23-year-old tradesman presents with a two-year history of left groin lump.
You reduce the lump then apply pressure over the inguinal canal, the patient is
asked to cough which causes a bulge against your hand.
See pages 28–29 for answers.
LUMPS AND HERNIAS 2
A. Direct inguinal hernia
B. Divarication of recti
C. Epigastric hernia
D. Femoral hernia
E. Indirect inguinal hernia
F. Paraumbilical hernia
G. Richter’s hernia
H. Saphena varix
I. Spigelian hernia
J. Umbilical hernia
For each of the following, what is the MOST likely diagnosis?
1. A 26-year-old woman presents to your clinic complaining of a painless lump in
her upper abdomen. She has a past history of endometriosis diagnosed by lapa-
roscopy. On examination you note a small lump measuring 1.5cm in diameter
in the midline between her belly button and her sternum.
2. A 38-year-old man presents to your clinic concerned about a blue tinged lump
in his left groin. He has a history of varicose veins, asthma and uses Ventolin on
occasion. On examination there is a blue tinged, non-tender, uctuant soft lump
in his left groin which displays a cough impulse. The lump disappears on lying
at.
3. A 38-year-old plumber complains of a one-year history of a lump in his right
groin. You reduce the lump then apply pressure over the deep inguinal ring, the
patient is asked to cough and you feel it protrude despite occlusion.
4. A 53-year-old primary school teacher presents to your clinic with a lump in her
right groin which is not reducible. The lump is below and lateral to the pubic
tubercle.
See page 29 for answers.
https://t.me/medicina_free
18 Diagnostic EMQs
PERIANAL CONDITIONS 1
A. Anal ssure
B. Condyloma
C. Internal haemorrhoid
D. Molluscum contagiosum
E. Perianal abscess
F. Perianal haematoma
G. Pilonidal sinus
H. Proctalgia fugax
I. Rectal prolapse
J. Rectal varices
K. Solitary rectal ulcer syndrome
For each of the following, what is the MOST likely diagnosis?
1. A 24-year-old student presents complaining of a one-month history of inter-
mittent tight cramping pain around the rectum above his anus. Episodes last
for about two minutes and spontaneously resolve. He tells you that they occur
mostly at night and cause him to wake up. On examination his abdomen is soft
and non-tender, a rectal examination is unremarkable.
2. A 32-year-old hairdresser attends your GP clinic with a complaint of anal itch,
he reports that on occasion he notices a small amount of PR bleeding on wiping
after defecation. He has had at least three male partners in the past six months.
On examination you nd small pinhead sized growths on the anal verge.
3. A 33-year-old woman presents with a ve-day history of painless rectal bleed-
ing. She describes the blood as bright in colour and occurring after defecation.
She explains that she notices the blood as being separate from the stools and
dripping onto the toilet bowl. No masses protrude from the anus.
4. A 23-year-old university student presents with a two-year history of pain in his
lower back associated with intermittent discharge. On examination you note a
scar measuring 3cm with multiple openings on either end in the middle of the
natal cleft about 5cm from the anal verge.
5. A 26-year-old woman presents with a two-day history of excruciating anal pain
on defecation associated with haematochezia. The pain lasts for some time after
defecation, she also reports that she has been constipated for the past week. She
has no signicant medical history. You gently perform an anal examination
which reveals defect in the skin of the anal canal distal to the dentate line.
6. A 58-year-old obstetrician attends your emergency department complaining of
rectal discomfort. She tells you that she has had some PR bleeding over the
past 24hours after an episode of straining while trying to pass a motion. She
tells you that she has had constipation for the past few days. On examination
you note a rectal mass which gets larger when you ask the patient to perform a
Valsalva manoeuvre.
See pages 29–30 for answers.
https://t.me/medicina_free
Gastroenterology 19
PERIANAL CONDITIONS 2
A. Anal ssure
B. Condyloma
C. Internal haemorrhoid
D. Molluscum contagiosum
E. Perianal abscess
F. Perianal haematoma
G. Pilonidal sinus
H. Proctalgia fugax
I. Rectal prolapse
J. Rectal varices
K. Solitary rectal ulcer syndrome
For each of the following, what is the MOST likely diagnosis?
1. A 36-year-old woman presents with a three-month history of rectal pain. On
examination you note small esh-coloured bumps around her anus and vulva
which are round and dimpled in their centres.
2. A 62-year-old male presents with a two-day history of inability to defecate due
to extreme rectal pain. On examination you observe a dark bluish lump at the
verge of the anal canal.
3. A 54-year-old male presents with a two-month history of rectal bleeding associ-
ated with abdominal swelling. He tells you that the blood is bright coloured and
not associated with pain. He has a history of alcoholism. On examination he has
jaundice, hepatomegaly and ascites.
4. A 58-year-old man presents to your GP clinic with rectal pain associated with
bleeding, He explains that he has had constipation for the past six months and
had been passaging large amounts of mucus with stools. You arrange for colo-
noscopy which reveals a large ulcer at the 6cm distance from the anal verge.
5. A 36-year-old reports that he has noticed anal pain for the past two days, he
explains that it feels like a throbbing sensation. He tells you that he has also had
intermittent sweats and shakes. He tells you his symptoms are worse at the end of
the day when he has to sit on the seat of his Vespa. On examination you note a red
lump under the skin near the anus which is pea sized and very tender to touch.
See page 30 for answers.
PAEDIATRIC JAUNDICE 1
A. ABO incompatibility
B. Biliary atresia
https://t.me/medicina_free
20 Diagnostic EMQs
C. Breast milk jaundice
D. Cephalohaematoma
E. Choledochal cyst
F. Crigler–Najjar syndrome type 1
G. Crigler–Najjar syndrome type 2
H. Cystic brosis
I. Galactosaemia
J. G6PD Deciency
K. Hypothyroidism
L. Physiological jaundice
M. Rhesus incompatibility
For each of the following, what is the MOST likely diagnosis?
1. A 5-day-old child presents with his mother who is concerned about discolor-
ation in his skin which she noticed two days ago. He was born at term via for-
ceps delivery due to prolonged labour. On examination you note that the child
is mildly jaundiced with a large lump at the top of his head.
2. A 2-week-old child attends your emergency department with her concerned
parents. She is breastfed, has been vomiting after most feeds, has had ongoing
diarrhoea and as a result of her symptoms she has not been thriving. Today
her mother explains that she has noticed yellow discoloration of her skin and
that she has been very irritable. She was born at home at 39 weeks’ gestation
via uncomplicated vaginal delivery. Her parents have not registered her birth
with local authorities as yet and she has not been seen by a doctor or nurse. On
examination she has hepatomegaly and obvious jaundice.
3. A 3-day-old child presents to your clinic with his mother who is concerned about a
slight yellow discoloration in his skin which she noticed last night. He is bottle fed
and has been feeding well, has normal stools and is passing urine without concern.
He was born at term via vaginal delivery without any complications and has no sig-
nicant family history. On examination his observations are within normal limits.
4. A female infant is born at 38 weeks via vaginal delivery with a birth weight of
2.9 kg to an otherwise healthy 33-year-old mother. Twelve hours after delivery
she developed jaundice; she was subsequently admitted. You arrange for bloods
which reveal indirect bilirubinaemia and metabolic acidosis. Her parents are
both rhesus negative.
See page 30 for answers.
PAEDIATRIC JAUNDICE 2
A. ABO incompatibility
B. Biliary atresia
https://t.me/medicina_free
Gastroenterology 21
C. Breast milk jaundice
D. Cephalohaematoma
E. Choledochal cyst
F. Crigler–Najjar syndrome type 1
G. Crigler–Najjar syndrome type 2
H. Cystic brosis
I. Galactosaemia
J. G6PD Deciency
K. Hypothyroidism
L. Physiological jaundice
M. Rhesus incompatibility
For each of the following, what is the MOST likely diagnosis?
1. A 1-month-old child presents with a history of jaundice since the fth day of
life. The child has been passing normal coloured stools and urine. Her mother
explains that she has had constipation and has been sleeping excessively. On
examination you note a puffy face, prominent tongue and dry skin.
2. A 2-month-old child presents with worsening jaundice. His parents report that
he has had yellow discoloration and pale stools over the past four weeks, they
did not think much of it. The parents attended their local GP clinic for routine
vaccinations and the duty nurse has asked them to attend the ED as she is con-
cerned. On examination he is jaundiced, and has marked hepatomegaly. You
arrange for bloods which reveal a raised direct bilirubin, raised transaminases,
raised ALP and raised GGT. Ultrasound reveals a positive triangular cord sign
and a gall bladder length of 18mm.
3. A 3-day-old child is brought into your clinic by his mother who is concerned as his
skin has changed colour. He was born at term via normal vaginal delivery and is
exclusively breastfed. You refer him to your local paediatric unit where his jaundice
peaked at day ve and then completely resolved by day 12. Adischarge summary
reveals that when he presented, he had normal LFT’s and indirect bilirubinaemia.
4. A 2-year-old child presents to your clinic with a one-day history of jaundice, he
has also been passing orange coloured urine. His mother has been introducing
new foods for him recently and she recalls that they did go out to a Mexican
restaurant yesterday where he was fed corn for the rst time and fava beans. He
has a history of prolonged neonatal jaundice.
See pages 30–31 for answers
https://t.me/medicina_free
Соседние файлы в папке Библиотека им академика М.И. Перельмана