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Theme: (Abdominal Pain

)
For Each of the following scenarios please choose the most appropriate options from the list.
A.
B.
C.
D.
E.
F.
G.
H.

Acute appendicitis
Ischaemic bowel
Porphyria
Mesenteric adenitis
Small bowel obstruction
Urinary tract infection
Crohn’s disease
Diverticulitis

Scenario 1
A 20-year-old man presented with a 6 hour history of severe RIF ( right iliac fossa) pain and diarrhoea. He
had been admitted 12 months previously for drainage of a perianal abscess, following which he had
suffered from persistent perianal discharge and has history of significant weight loss.
Correct answer:

G

Scenario 2
An 80-year-old man presented to his general practitioner (GP) complaining of sudden onset of left-sided
abdominal pain. He had recently suffered from a transient ischaemic attack from which he had made a
complete recovery.
Correct answer

B

Scenario 3
A 32-year-old pregnant lady presented to her GP with a history of vague abdominal pain associated with
nausea and loss of appetite. She had a long history of depressive illness to which these symptoms had
been attributed. She had recently noticed
marked reddish discoloration of her urine.
Correct answer

C

The stool was noted to be of liquid consistency. A. Pain was reported to be worse when eating but relieved by bowel movement. Appendicitis Ectopic pregnancy Irritable bowel syndrome Ovarian torsion Perforated duodenal ulcer Ruptured ovarian cyst Terminal ileal Crohn’s disease Ureteric stone Scenario 1 A 28-year-old woman developed sudden onset of pain in the right iliac fossa. Correct answer G Scenario 3 A 22 year old married female came to emergency with severe right lower abdominal pain for 6 hours . Correct answer H Scenario 2 A 28-year-old woman presents with recurrent abdominal pain localised mostly to the right iliac fossa. Pain was improved by walking around the examination room in the Emergency department. tachycardic and hypotensive. She opens her bowels four times a day. F. Correct Answer : A . D. G. A loss of 5 kg in weight was noted. Correct Answer : B Scenario 4 A 22 year old male came to Er with Right lower abdominal pain and non bilious vomintgs for 12 hours. On examination he is tachycardic and febrile with tenderness in the right iliac fossa. C. B. H. On examination was pale. E.Theme: (Right iliac fossa pain) For Each of the following scenarios please choose the most appropriate options from the list.

She is on non-steroidal anti-inflammatoryagents (NSAIDs) for rheumatoid arthritis. C. His BP is 90/60 mmHg and his pulse rate is 110/min. H. A. Correct answer H . E. He presents with upper abdominal distension. There are no other systemic symptoms. Erect chest X-ray shows free gas under the diaphragm. Correct answer G Scenario 4 A 74-year-old man is brought to the Emergency Department with sudden onset of upper abdominal and periumbilical pain radiating to his back.Theme: (Abdominal Pain ) For Each of the following scenarios please choose the most appropriate options from the list. J. He also complains of left shoulder tip pain and his past medical history includes recurrent episodes of malaria. On examination. I. nauseated and feeling faint. B. Correct answer D Scenario 2 A 38-year-old executive of Asian origin is brought to the Emergency Department after his car was involved in a high-speed RTA. guarding and signs of shock. The pain radiates to her back and makes her nauseated. Acute appendicitis Acute cholecystitis Acute pancreatitis Biliary colic Intestinal obstruction F. Correct answer J Scenario 3 A 78-year-old lady presents with severe abdominal pain and signs of peritonitis. D. Perforated peptic ulcer Obstructive jaundice Ruptured abdominal aortic aneurysm Ruptured liver Ruptured spleen Scenario 1 A 43-year-old female complains of severe epigastric/right upper quadrant (RUQ) pain 2 hours after eating a meal of chips and fried chicken. He is sweating. bowel sounds are absent. G.

Theme:( Upper abdominal pain) For Each of the following scenarios please choose the most appropriate options from the list. I. she had a pyrexia 38 oC and a WBC 15 x 109/l. Correct answer I . A. J. D. C. Correct answer D Scenario 3 A 65-year-old man was admitted to the Emergency Department with sudden onset of upper abdominal pain and vomiting. A history of back pain and some bruising was noted in the flanks. K. On examination there is resonance on percussion over the liver. He was also noted to have a raised respiratory rate and low urine output. Biliary colic Bleeding duodenal ulcer Bleeding gastric ulcer Cholecystitis Gastritis Leaking abdominal aortic aneurysm G. E. H. F. B. Correct answer G Scenario 2 A 43-year-old lady presented to the Emergency Department with an 8-week history of epigastric discomfort. There was associated nausea but no vomiting or features of generalised peritonitis. There was some indication of increased pain on ingestion of fatty foods. Pancreatitis Peptic ulcer Perforated duodenal ulcer Perforated gastric ulcer Perforated oesophagus Scenario 1 A 35-year-old man on steroids was admitted to accident and emergency (the Emergency Department) with hypotension and tachycardia. He had drunk 4 pints of beer the night before.

Correct answer C Scenario 3 A 38-year-old obese lady presents to the emergency department department with right upper quadrant pain.THEME: (JAUNDICE) For Each of the following scenarios please choose the most appropriate options from the list. B. D. C. Correct answer E Scenario 2 A 30-year-old female who had an open cholecystectomy presents with obstructive jaundice 48 h after surgery. fever and being generally unwell. Correct answer D . Ultrasound scan shows a stone in the Hartmann’s pouch. A. Cholangiocarcinoma Gall bladder calculi Common bile duct calculus Mucocele of the gall bladder Empyema of the gall bladder Scenario 1 A 34-year-old lady presents to the emergency department with a palpable right upper quadrant mass. E.

X-Ray Chest (Erect) 1. On examnaiton . Past history is significant for taking NSAIDS and Steroids for his knee arthritis. 55 years old male . UGI Endoscopy e. D correct answer 3. 25 years old presents to OPD with heartburn and non-bilious vomiting after taking spicy meals. a. presented with multiple episodes of non-bilious vomiting and severe upper abdominal pain. Xray Abdomen b. nausea and vomiting dating back over the last week.Theme (Vomiting) For Each of the following scenarios please choose the most appropriate options from the list. Ultrasound Abdomen c. B Correct answer 2. C-T Scan Abdomen d. Murphy’s sign is positive. E correct answer . A 45-year-old woman with right upper quadrant pain. She also complains of marked dyspepsia.