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 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?
A 57-year-old man presents to his general practitioner (GP) with a 2-month history of pain and difficulty swallowing when eating solid foods and now also has trouble swallowing liquids. He states that his trousers now feel looser around his waist and he no longer looks forward to his meals. His past medical history is significant for reflux disease for which he takes over-the-counter Gaviscon. He has a 20-pack-year history of smoking and drinks approximately 15 pints of beer per week. His family medical history is unremarkable.
His observations are shown below:
Temperature 36.4°C
Blood pressure 155/69 mmHg
Heart rate 66 beats per minute
Respiratory rate 13 breaths per minute
Sp(O2) 99% (room air)
Physical examination is normal.
Which of the following is the best next step in management?
A 61-year-old retiree with a history of gallstone disease is scheduled for ERCP to extract a common bile duct stone discovered during an episode of biliary colic.
What is the primary medical condition for which ERCP would be the most beneficial diagnostic procedure?
A 44-year-old woman is scheduled for splenectomy due to an enlarged spleen. The consultant advises the registrar to locate the tail of the pancreas during the procedure to prevent postoperative pancreatic fistula. Where should the tail of the pancreas be identified during the splenectomy?
A 65-year-old man presents with increased satiety, dull abdominal pain and weight loss over the past 6 months. He smokes 20 cigarettes per day and has suffered from indigestion symptoms for some years. On examination, his body mass index is 18 and he looks thin. He has epigastric tenderness and a suspicion of a mass on examination of the abdomen.
Investigations:
Investigation Result Normal value
Haemoglobin 101 g/l 135–175 g/l
White cell count (WCC) 9.2 × 109/l 4–11 × 109/l
Platelets 201 × 109/l 150–400 × 109/l
Sodium (Na+) 139 mmol/l 135–145 mmol/l
Potassium (K+) 4.5 mmol/l 3.5–5.0 mmol/l
Creatinine 110 μmol/l 50–120 µmol/l
Faecal occult blood (FOB) Positive
Upper gastrointestinal endoscopy Yellowish coloured, ulcerating
submucosal mass within the
stomach
Histology Extensive lymphocytes within the biopsy
Which of the following is the most likely diagnosis?
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?
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 35-year-old yoga instructor presents to the General Practitioner (GP) with complaints of feeling constantly fatigued. During the consultation, she also mentions experiencing widespread, non-specific itching.
Upon examination, the GP observes generalised excoriation, but no other significant findings. Blood tests reveal an elevated alkaline phosphatase level, leading to a suspicion of primary biliary cholangitis.
What is the most specific symptom of primary biliary cholangitis?