A 17-year-old man presents to the Emergency Department with a lump in his groin that he noticed while lifting weights. Upon examination, a soft palpable mass is found in the scrotum that can be reduced with gentle massage. What structure is most likely ascending along the deep inguinal ring through which this mass has passed?
A 76-year-old woman who has recently seen her GP for a change in bowel habit towards constipation arrives in the Emergency Department with a tender, distended abdomen. She has also been suffering with a chest infection recently and has known chronic kidney disease (CKD) stage 4. Bowel sounds are absent. The rectum is empty on examination. Abdominal X-ray reveals distended loops of large bowel, consistent with large bowel obstruction.
Which one of these investigations should be performed next?
A teenager makes an uneventful recovery post-appendicectomy, and three months later is back at school when he gets a sharp pain in the right inguinal region and notices a bulge just above his groin on the right. His GP diagnoses an inguinal hernia.
Which nerve is most likely to have been damaged during the teenager’s appendicectomy?
A 59-year-old librarian has been experiencing more frequent episodes of intermittent abdominal discomfort and bloating. She also reports having episodes of diarrhea with mucous in her stool, but no blood. The pain tends to worsen after meals and improve after having a bowel movement. Despite her symptoms, she has not experienced any weight loss and maintains a healthy appetite. She has undergone surgery for osteoarthritis in her hip, but has no other significant medical history.
Upon investigation, the patient has been diagnosed with diverticular disease. What is the most likely complication this patient may develop?
A 20-year-old man presents with a 3-week history of left groin pain, associated with a lump that seems to come and go.
Following examination, the clinician deduces that the swelling is most likely to be an indirect inguinal hernia.
Indirect inguinal hernias can be controlled at:
You are asked to see an elderly patient who has not opened their bowels for several days. Their abdomen is distended, and they describe cramping abdominal pain that comes and goes. A supine abdominal X-ray is performed to identify features of bowel obstruction and suggest the location of the obstruction.
Which of the following is more characteristic of the large bowel, rather than the small bowel, on an abdominal X-ray?
A 43-year-old man comes to the clinic complaining of colicky abdominal pain and vomiting. His medical history shows that he has had previous abdominal surgery. During the examination, you notice that his abdomen is distended, and upon auscultation, you hear ‘tinkling’ bowel sounds. An abdominal radiograph reveals multiple loops of dilated bowel centrally, with valvulae conniventes present. What is the most probable cause of his symptoms?
A 55-year-old woman arrives at the Emergency Department complaining of intense abdominal pain. She is currently receiving peritoneal dialysis, and the physician suspects that she may be suffering from peritonitis.
What is the most indicative sign or symptom of peritonitis in this patient?
A junior resident performing his first appendectomy was unable to locate the base of the appendix due to extensive adhesions in the peritoneal cavity. The senior physician recommended identifying the caecum first and then locating the base of the appendix.
What anatomical feature(s) on the caecum would have been utilized to locate the base of the appendix?
A 20-year-old woman has come in with acute appendicitis and is currently undergoing surgery to have her appendix removed. The peritoneal cavity has been opened using the appropriate approach and the caecum is visible. What would be the most appropriate feature to follow in order to locate the appendix?