A 70-year-old female presents to breast clinic following a left total mastectomy and sentinel lymph node biopsy for breast cancer. The histological analysis reveals complete excision of the tumour and clear malignancy in all 3 lymph nodes. The tumour is an invasive ductal carcinoma of grade 1, with ER and PR positivity and HER2 negativity. What additional treatment options should be considered for this patient?
A 35-year-old woman has been diagnosed with breast cancer and has undergone surgery and radiotherapy. Despite being HER2 -ve and ER -ve, her TNM stage is T2N2M0. Given her node positivity, what is the most suitable course of action for her management?
A 49-year-old woman has been newly diagnosed with breast cancer. She receives a wide-local excision and subsequently undergoes whole-breast radiotherapy. The pathology report reveals that the tumour is negative for HER2 but positive for oestrogen receptor. She has a medical history of hypertension and premature ovarian failure. What adjuvant treatment is she expected to receive?
A 67-year-old woman with multiple comorbidities complains of acute left leg pain that has been affecting her mobility for the past two days. Upon examination, you observe a cold, pulseless left lower leg with reduced sensation. No visible ulcers are present on examination of her lower limbs. She typically consumes approximately 7 units of alcohol per week and has a medical history of well-controlled type 2 diabetes mellitus (latest HbA1c 49 mmol/mol), asthma, and atrial fibrillation. Recently, she began hormone replacement therapy (HRT) to alleviate vasomotor symptoms associated with menopause. What is the most likely cause of this patient’s presentation based on her risk factors?
A 70-year-old man presents with perianal pain, bleeding and a palpable mass that is not consistent with a haemorrhoid. He reports having multiple male sexual partners and engaging in unprotected anal sex. An anoscopic examination with biopsy is performed, and the histology confirms a squamous cell carcinoma. The cancer is staged at T3 based on its size. What is the most significant risk factor for this patient’s diagnosis?
You are an FY1 doctor working in colorectal surgery. You are looking after a patient following an lower anterior resection of the patients rectum with a defunctioning loop ileostomy to remove a large adenocarcinoma in the proximal third of the rectum. The patient is now 65 years old and is nearly ready for discharge. Your consultant says they will review the patient in three weeks following discharge. They would like you to organise an investigation in two weeks time to ensure that the anastomosis performed to join the colon to the remaining portion of rectum has healed and is not leaking, prior to reversing the ileostomy. Please choose the most appropriate investigation from the options below.
MRI
11%
Transrectal ultrasound scan
6%
Gastrografin enema
30%
CT colon
25%
Barium enema
28%
A gastrografin enema involves passing a water soluble radiopaque liquid into the rectum, then taking radiographs to assess the rectum. If there are any leaks in a colorectal anastomosis, the radiopaque liquid should show up as free fluid in the abdomen. As this is a possibility gastrografin is preferred over barium as it is less toxic if it leaks into the abdominal cavity.
A 50-year-old woman visits her GP with a complaint of sudden anal pain. During the examination, the doctor notices a tender, oedematous, purplish subcutaneous perianal lump. What is the probable diagnosis?
A 67-year-old male undergoes a Hartmann’s procedure for a sigmoid cancer. On day 2 post-op, nurses are concerned as his colostomy has not passed any wind or stool yet and he is complaining of increasing bloatedness. You review the patient and witness him vomit profusely.
What is the appropriate management for this common postoperative complication?
A 56-year-old man, who is a known alcoholic, is admitted to the surgical assessment unit with acute pancreatitis. What is the most appropriate scoring system for this patient?
A 75-year-old man is scheduled for an elective knee replacement surgery the following day. He has type 2 diabetes and is the first patient on the surgery list. His doctor has advised him to continue taking his once-daily dose of metformin and his new anti-diabetic medication on the day of the operation. The patient’s physician recently changed his diabetes medication due to hypoglycemic episodes with his previous medication. What is the most probable new antidiabetic medication he is taking?