A 35-year-old recently arrived female with several skin blisters comes in for assessment. A few of the blisters have burst, resulting in a sore, exposed region. The base of one of the erosive lesions is scraped for Tzanck test. Upon examination, acantholytic keratinocytes with significant hyperchromatic nuclei are detected under the microscope.
What is the probable diagnosis?
An 82-year-old retired landscape gardener presents to clinic with his daughter, who is concerned about a lesion on his scalp.
The lesion is 45 mm × 30 mm, irregular, and she feels it has changed colour to become darker over recent months. He states it has occasionally bled and is more raised than before. He has a history of travel with the armed forces in South-East Asia.
You suspect malignant melanoma.
Which of the following features is most likely to be associated with a poor prognosis in this patient?
A 60-year-old bus driver is referred by his general practitioner with a change in bowel habit and bleeding per rectum. He reports no further symptoms, and an abdominal and digital rectal examination are unremarkable. However, colonoscopy shows a high rectal tumour, encompassing approximately two-thirds of the diameter of the colon. He is booked to have an operation.
Which of the following is he most likely to be listed for?
You are a Foundation Year 2 (FY2) doctor on your general surgical rotation, and the consultant has asked you to scrub in to help assist. He informs you that it will be a fantastic learning opportunity and will ask you questions throughout. He goes to commence the operation and the questions begin.
When making a midline abdominal incision, what would be the correct order of layers through the abdominal wall?
A 70-year-old man comes to the clinic complaining of gradual onset of constant abdominal pain in the left iliac fossa. Upon examination, local peritonitis is observed. Blood tests reveal an elevated white cell count. He has no prior history of abdominal disease, but he does have a history of atrial fibrillation. Pain worsens after eating and is alleviated by defecation. What is the probable diagnosis?
A 28-year-old gardener who is typically healthy and in good shape visits his doctor complaining of worsening abdominal pain that has been present for two days. He also reports feeling nauseous and experiencing loose bowel movements. During the examination, the patient’s temperature is found to be 37.9 °C, and he has a heart rate of 90 bpm and a blood pressure of 118/75 mmHg. The doctor notes that the patient’s abdomen is tender to the touch and that he has a positive Rovsing sign. What is the most probable diagnosis for this patient?
A 76-year-old man has been diagnosed with colon cancer and is a candidate for an extended left hemicolectomy. The tumour is located in the descending colon and the surgery will involve ligating the blood vessel that supplies it. What is the name of the artery that provides the primary blood supply to the descending colon?
A 32-year-old man comes to the Emergency Department complaining of lower abdominal pain. He reports that the pain began 6 hours ago as a vague discomfort around his belly button, but has since become a sharp pain in the right iliac fossa, which worsens when he walks or coughs. He has lost his appetite and has vomited twice. The examining surgeon suspects that he may have appendicitis.
Which dermatome level in the spinal cord receives afferent signals from the periumbilical pain in this condition?
You are observing the repair of an inguinal hernia as a medical student. The consultant asks you what structures form the roof of the inguinal canal.
What forms the roof of the inguinal canal?
A 40-year-old man with a chronic bowel condition presents with severe pain on defecation, which has lasted over two months despite increasing fluid intake and stool softeners. He has had anal fissures in the past, as well as a previous perianal abscess. On examination, the anal area is inflamed, with evidence of a deep anal fissure with an associated large sentinel tag.
The doctor explains that this is a symptom of active perianal disease secondary to this patient’s chronic bowel condition.
With which of the following conditions is perianal disease most commonly associated?