A 50 year old man develops a colocutaneous fistula after having reversal of a loop colostomy fashioned for the defunctioning of an anterior resection. Pre-operative Gastrografin enema showed no distal obstruction or anastomotic stricture. Which of the following is the most appropriate course of action?
A 46 year old man had an upper gastrointestinal endoscopy and biopsies done which were reported by two gastrointestinal pathologists as being ‘indefinite for dysplasia.’ Repeat endoscopy and biopsies were repeated 6 months after completing treatment with proton pump inhibitors. The results revealed no definite evidence of dysplasia. What is the most appropriate management?
A 36 year old female presents to the clinic with a 6 week history of discomfort just below her ribcage which is relieved by eating. She develops haematemesis and undergoes an upper GI endoscopy. An actively bleeding ulcer is noted in the first part of the duodenum. What is the best course of action?
A 39 year old lady presents with a mass in the upper outer quadrant of her left breast. Imaging, histology and clinical examination confirm a 1.4cm malignant mass lesion with no clinical evidence of axillary nodal disease. Which treatment would be the most appropriate?
A 52 year old man undergoes a renal transplant from a living related donor. He is well for the first five months, but on review in the renal clinic, he is noted to have persistent hypertension and a slight deterioration in renal function. What is the best explanation for this?
A 55 year old man undergoes a live donor related renal transplant for end stage renal failure. He had good urine output following surgery but it was noticed while he was on the ward that his urinary catheter is not draining despite the urostomy continuing to drain urine. Which intervention would be appropriate in this case?
A 59 year old woman presents to the hospital with a 2.1cm mobile breast mass. A mammogram is indeterminate (M3), an ultrasound scan shows benign changes (U2), and clinical examination is also indeterminate (P3). What is the next best course of action?
A 40 year old teacher presents with a mass lesion in the upper outer quadrant of the right breast. Tests reveal that she has a 2cm mass lesion which on core biopsy is demonstrated to be invasive ductal carcinoma. A FNA of a bulky axillary lymph node contains malignant cells. What is the best course of action?
A 39 year old woman is admitted with acute cholecystitis which fails to settle. During a laparoscopic cholecystectomy, the gallbladder has evidence of an empyema and Calots triangle is inflamed. The surgeon suspects that a Mirizzi syndrome has occurred. What is the most appropriate course of action?
A 57 year old male is diagnosed with carcinoma of the caecum. A CT scan is performed and it shows a tumour invading the muscularis propria with some regional lymphadenopathy. What is the best initial treatment?