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 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 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?
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?
You have a geriatric patient who presents with massive haematemesis. He is agitated with a pulse of 110 bpm and a blood pressure of 130/90 mmHg. He is a known alcoholic.
What is the best step in the management for this elderly patient?
A 55-year-old man presents to the general practitioner (GP) with a 6-month history of increasing difficulty with swallowing solid foods. He does not have any problems with swallowing liquids. He has always been overweight but has lost 5 kg in the past few months. He attributes this eating a little less due to his swallowing difficulties. He has a past history of long-term heartburn and indigestion, which he has been self-treating with over-the-counter antacids. The GP is concerned that the patient may have oesophageal cancer.
Which one of the following statements with regard to oesophageal cancer is correct?