A 76-year-old man is being assessed on the ward following abdominal surgery. He is alert and at ease. During the examination, you notice a stoma protruding from the skin on the midline of his lower abdominal wall. His vital signs are stable, with a heart rate of 57/min, respiratory rate of 15/min, blood pressure of 126/92 mmHg, and temperature of 36.6 ºC. The stoma is functioning well, and there is no skin irritation in the surrounding area. What type of stoma is most likely being described?
MSFinals-6377
A 36-year-old man presents to the emergency department following a fall from a ladder of approximately 2.5 meters. According to his wife, he lost consciousness for around 30 seconds before regaining it. The paramedics who attended the scene noted that he had vomited once and had a GCS of 14 due to confused speech, which remains the same. Upon examination, he has a laceration on his head, multiple lacerations on his body, and a visibly broken arm. However, his cranial nerve, upper limb, and lower limb neurological examinations are normal. What aspect of his current condition warrants a head CT?
MSFinals-6378
A 75-year-old patient with prostate cancer is initiated on goserelin therapy. After a week of starting the treatment, he visits a nearby emergency department with complaints of aggravated lower urinary tract symptoms and newly developed back pain. What could have been done to prevent this deterioration?
MSFinals-6379
A 32-year-old female presents to the emergency department with abdominal pain and inability to urinate for the past 3 days. She has been taking antibiotics prescribed by her primary care physician for a urinary tract infection. She has been able to eat, drink, and have a bowel movement today. Her medical history includes irritable bowel syndrome and depression, which is managed with sertraline. She had her last menstrual period a week ago, and she does not experience heavy menstrual bleeding. What is the most probable cause of her symptoms?
MSFinals-6380
A 55-year-old woman arrives at the emergency department complaining of a severe headache that has been ongoing for 2 hours. Despite taking paracetamol, she has not experienced any relief. She also reports experiencing photophobia, neck stiffness, and nausea. The patient has a medical history of hypertension and polycystic kidney disease. She has a 30-year history of smoking and drinks 2 standard drinks per night. What initial investigation would be most appropriate?
MSFinals-6384
A 65-year-old male presents to the emergency department with a 2-day history of worsening upper abdominal pain, accompanied by nausea and vomiting. The pain is exacerbated by meals, and he is unable to tolerate oral intake. Upon examination, the patient appears distressed and in pain. His vital signs are as follows: Temperature: 38.2 ℃ Heart rate: 110 beats/minute Respiratory rate: 20/min Blood pressure: 130/90 mmHg Oxygen saturation: 98% on room air There is tenderness in the right upper quadrant of his abdomen, but no distension, guarding, or rigidity on light palpation. Murphy’s sign is negative. The sclera of his eyes has a yellow tinge. Blood lab results are as follows: Hb 130 g/L Male: (135-180) Female: (115 – 160) Platelets 180 * 109/L (150 – 400) WBC 15 * 109/L (4.0 – 11.0) Bilirubin 30 µmol/L (3 – 17) ALP 360 u/L (30 – 100) ALT 40 u/L (3 – 40) γGT 50 u/L (8 – 60) Albumin 38 g/L (35 – 50) An ultrasound of the right upper quadrant reveals dilated intrahepatic and extrahepatic bile ducts and multiple hyperechoic spheres within the gallbladder. The patient is started on IV antibiotics and fluid resuscitation, but his condition remains critical. What is the most appropriate next step in management?
MSFinals-6385
A 36-year-old woman presents to the Emergency Department complaining of central, tearing chest pain that is not radiating. She reports having food poisoning and vomiting every hour for the past day. She describes the vomit as liquid without blood. The patient is alert, appears thin, and has dry mucous membranes. She has no relevant medical or family history, is a non-smoker, drinks 8 units of alcohol per week, and works as a cleaner. During ECG placement, the doctor notices crepitus over her chest wall, and the ECG reveals sinus tachycardia. What is the most likely cause of her symptoms?
MSFinals-6386
A 50-year-old man arrives at the emergency department with a friend. The man appears drowsy and has a strong smell of alcohol. According to his friend, he complained of sudden, severe retrosternal pain that worsened when swallowing. The patient has a history of alcoholic liver disease. His vital signs include a heart rate of 130/min, respiratory rate of 24/min, temperature of 37.7ºC, oxygen saturation of 98%, and blood pressure of 100/74 mmHg. Upon examination, there are crackles heard on auscultation of his chest wall, and dried vomit is present around his mouth. An ECG shows sinus rhythm. What is the most likely diagnosis?
MSFinals-6387
A father on the pediatric ward tells the doctor that his 2-year-old child has been having trouble with their feeds and has been vomiting a green substance. The child was born at term via vaginal delivery. On examination, the abdomen is soft but appears to be distended. An abdominal x-ray is ordered, which shows a ‘double bubble’ sign. What is the most probable diagnosis?
MSFinals-6388
A 55-year-old woman comes to the clinic with a complaint of bloody discharge from her left nipple. She is also a perimenopausal woman who has two grown children that were born after normal labour and delivery and breastfed. She is not currently taking hormone replacement therapy. Upon physical examination, there are no signs of lumps, asymmetry, or dimpling of the skin or nipple. When pressure is applied to the nipple, a small amount of bloody fluid is expressed. What is the probable cause of her presenting symptom?