A 65 year old man arrives at the emergency department complaining of abdominal pain and distension. He reports not having a bowel movement in 4 days and is now experiencing vomiting. An abdominal X-ray reveals enlarged loops of the large intestine. The patient has no history of surgery and a physical examination shows a soft, tender abdomen without palpable masses. A rectal exam reveals an empty rectum. What is the probable cause of the obstruction?
A 50-year-old man presents to the Emergency Department (ED) complaining of fever and a painful lump near his anus. Upon examination, a 4 cm peri-anal swelling is observed, accompanied by surrounding erythema. The swelling is very tender and fluctuant.
What is the most effective treatment option?
A 35-year-old man visits his General Practitioner complaining of painless rectal bleeding that has been occurring for the past 5 days. The patient reports experiencing bright red bleeding during bowel movements, which appears as streaks on the toilet paper and in the toilet bowl. The blood is not mixed in with the stool. This has been happening every time he has a bowel movement since the symptoms began. He does not feel any pain during these episodes, but he does experience some itching and irritation around the anal area afterwards. He is otherwise healthy, without changes in bowel habits or weight loss.
During a rectal examination, the doctor observes a fleshy protrusion at the 7 o’clock position that appears when the patient strains but recedes into the anus when he stops straining.
Which of the following management options would be appropriate in this case?
A 78-year-old man presents with weight loss and blood in his stool. During rectal examination, a suspicious lesion is found below the pectinate line, raising concern for malignancy. You proceed to palpate for lymphadenopathy.
Where might you anticipate discovering enlarged lymph nodes?
A 67-year-old man presents with severe left lower abdominal pain, his third attack in the past 2 years. He admits to intermittent dark red blood loss per rectum (PR) and diarrhoea. He generally has a poor diet and dislikes fruit and vegetables. On examination, he has a temperature of 38.2 °C and a tachycardia of 95 bpm, with a blood pressure of 110/70 mmHg; his body mass index is 32. There is well-localised left iliac fossa tenderness.
Investigations:
Investigation Result Normal value
Haemoglobin 110 g/l 135–175 g/l
White cell count (WCC) 14.5 × 109/l (N 11.0) 4–11 × 109/l
Platelets 280 × 109/l 150–400 × 109/l
Sodium (Na+) 141 mmol/l 135–145 mmol/l
Potassium (K+) 4.9 mmol/l 3.5–5.0 mmol/l
Urea 10.0 mmol/l 2.5–6.5 mmol/l
Creatinine 145 μmol/l 50–120 µmol/l
C-reactive protein (CRP) 64 mg/l 0–10 mg/l
Which of the following is the most likely diagnosis?
A 56-year-old man comes in with a fistula in ano. During the anal examination, the Consultant mentions that he is searching for the location of the fistula in relation to a specific anatomical landmark.
What is the landmark he is referring to?
A 23-year-old male patient visits the clinic with a complaint of loss of smell. He mentions that he enjoys playing rugby and has suffered some nose injuries in the past. Despite this, he can still detect strong odors like ammonia. Can you identify the location of the olfactory neuroepithelium?
A 25-year-old man has been referred for investigation of Peutz-Jegher syndrome due to his family history. His grandmother passed away at the age of 30 from colonic carcinoma associated with the syndrome. What is the most probable mode of inheritance for Peutz-Jegher syndrome?
What is the inheritance pattern of Osler-Weber-Rendu syndrome?
A 25-year-old female patient presents at the outpatient clinic with an androgen-secreting tumor. She is curious about the most probable location of the tumor.
Can you identify the site where androgens are primarily produced?