A 56-year-old man presents with progressively worsening dysphagia, which is worse for food than liquid. He has lost several stones in weight and, on examination, he is cachexia. An oesophagogastroduodenoscopy (OGD) confirms oesophageal cancer.
Which of the following is the strongest risk factor for oesophageal adenocarcinoma?
A 43-year-old man presents to his General Practitioner (GP) with four months of difficulty swallowing both liquids and solid food. He also complains of regurgitation of undigested food and retrosternal chest pain when this happens. He no longer looks forward to his meals and thinks he may be starting to lose weight. He has no other medical problems. He has never smoked or drank alcohol and denies drug use. He presented two months ago with similar symptoms and a different GP treated the patient with a proton-pump inhibitor (PPI), which his symptoms did not respond to.
Physical examination is normal. A recent chest radiograph appears to be normal. His electrocardiogram (ECG) does not show any ischaemic changes.
His observations and blood tests results are shown below:
Temperature 36.9 °C
Blood pressure 125/59 mmHg
Heart rate 65 beats per minute
Respiratory rate 14 breaths per minute
Sp(O2) 96% (room air)
Which of the following is the most likely diagnosis?
A 86-year-old patient arrives at the Emergency Department complaining of epigastric pain and difficulty breathing. Upon examination, there is decreased airflow in the left base. A chest X-ray shows an air-fluid level located behind the mediastinum. What is the probable diagnosis?
A 35-year-old woman is found to have gallstones during an abdominal ultrasound. The surgeon informs her that one of the stones is quite large and is currently lodged in the bile duct, about 5 cm above the transpyloric plane. The surgeon explains that this plane is a significant anatomical landmark for several abdominal structures.
What structure is located at the level of the transpyloric plane?
An 80-year-old man presented with progressive dyspepsia and weight loss. Endoscopy revealed a stenosing lesion that bled easily. A biopsy and histopathological examination revealed adenocarcinoma of the oesophagus.
Which of the following is the most likely aetiological factor?
A 3-day-old baby born at term is brought to the Neonatal Unit with green fluid vomiting and a swollen belly. The baby was doing fine after birth and was being breastfed. The parents mention that the baby has urinated but has not yet passed meconium. During the examination, the baby seems weak, pale, and breathing rapidly.
What could be the probable reason for the baby’s deteriorating condition?
A 45-year-old woman, with a body mass index of 30, presents to the Emergency Department with colicky right upper quadrant pain and shoulder discomfort. She has also suffered two episodes of nausea and vomiting. Her blood pressure is 110/70, pulse rate 110 and respiratory rate 20. There is pain on inspiration and an increase in pain when palpating the right upper quadrant. The patient is confirmed as having cholecystitis due to impaction of a gallstone in the gallbladder neck. A laparoscopic cholecystectomy is recommended, and the patient is consented for surgery. The dissection begins by incising peritoneum along the edge of the gallbladder on both sides to open up the cystohepatic triangle of calot.
What are the borders of this triangle?
During a cholecystectomy, the consultant ligates the cystic artery. Which vessel is the cystic artery typically a branch of, supplying the gallbladder?
A 65-year-old man was admitted to hospital for a work-up of a suspected cholangiocarcinoma. He underwent a magnetic resonance cholangiopancreatography (MRCP). After this, he complains of chills, nausea, vomiting and upper-right abdominal pain. He has also spiked a fever of 38.9 °C.
What is the most likely diagnosis?
A geriatric patient is admitted with right upper quadrant pain and jaundice. The following investigation results are obtained:
Investigation Result Normal range
Bilirubin 154 µmol/l 3–17 µmol/l
Conjugated bilirubin 110 mmol/l 3 mmol/l
Alanine aminotransferase (ALT) 10 IU/l 1–21 IU/l
Alkaline phosphatase 200 IU/l 50–160 IU/l
Prothrombin time 55 s 25–41 s
Ultrasound report: ‘A dilated bile duct is noted, no other abnormality seen’
Urine: bilirubin +++
What is the most likely cause of the jaundice?