A 68-year-old man tells his general practitioner that, for the past two months, he has been passing urine more often than usual and getting up at night to urinate. Given the man’s age, you suspect he might have symptoms related to an enlarged prostate.
Which of the following should be done first to confirm the first impression?
A 30-year-old woman presents to the Emergency Department with acute abdominal pain which started about six hours ago. She claims the pain is in the lower abdomen and has been worsening gradually. She has not been able to pass urine since before the pain started.
Upon examination, vital signs are stable and suprapubic tenderness is present. There is no rebound tenderness, and the examining doctor does not find any signs of peritonitis. In addition, the doctor finds a large solid abdominal mass in the right lower quadrant. The patient said this mass had been there for a few years and has made it difficult to get pregnant. The patient also claims that she has heavy periods. She is due to have an operation for it in two months. A serum pregnancy test is negative.
Which of the following is the most likely diagnosis requiring immediate treatment and admission?
A 63-year-old man reported experiencing trouble initiating and ending urination. He had no prior history of urinary issues. The physician used a gloved index finger to examine the patient’s prostate gland, most likely by palpating it through the wall of which of the following structures?
A 55-year-old man has been experiencing pain with urination for the past week. His temperature is 37.5 °C. On digital rectal examination, his prostate is slightly enlarged and mildly tender to palpation. Laboratory studies show his white blood cell count to be 13 000 mL. Urine culture grows > 100 000 Escherichia coli organisms. His serum prostate-specific antigen (PSA) is 6 ng/ml (normal < 5ng/ml). He receives antibiotic therapy and his clinical condition initially improves. However, his symptoms recur six times over the next 12 months.
What is the most likely diagnosis for this patient?
A 22-year-old man discovered a painless enlargement of his left testicle during his shower. He is sexually active, but he reports no recent sexual encounters. What would be the most suitable serological test to assist in diagnosing his condition?
A 32-year-old obese man presents to Accident and Emergency with a 2-day history of nausea, frank haematuria and sharp, persistent left-sided flank pain, radiating from the loin to the groin. On examination, he has left renal angle tenderness.
Urine dip shows:
frank haematuria
blood 2+
protein 2+.
He has a history of hypertension, appendicitis 10 years ago and gout. You order a non-contrast computerised tomography (CT) for the kidney–ureter–bladder (KUB), which shows a 2.2 cm calculus in the proximal left (LT) ureter.
Which of the following is the definitive treatment for this patient’s stone?
A 50-year-old man presents with sudden onset of upper abdominal pain and vomiting. His vital signs are stable upon triage.
During the physical examination, he appears to be in significant distress and has a tense abdomen upon palpation.
What initial test should be performed to confirm a perforation?
A 70-year-old man with a history of hypertension presents to his general practitioner after discovering a mass in his scrotum. He reported feeling a heavy, dragging sensation in his scrotum for approximately 2 weeks before noticing the mass during self-examination. Upon examination, the patient had a palpable, non-tender mass on the right side of the scrotum, seemingly associated with the right testicle. Ultrasound of the scrotum revealed dilation of the right pampiniform plexus.
What is the most probable cause of this patient’s condition?
A 40-year-old woman has been receiving treatment for ulcerative colitis (UC) for the past 2 years. She is currently in remission and has no bowel complaints. However, she has recently been experiencing increased fatigue and loss of appetite. During her examination, she appears mildly jaundiced and her nails are shiny. Her blood test results are as follows:
– Hemoglobin: 112g/L (normal range: 135-175 g/L)
– C-reactive protein (CRP): 5.2 mg/L (normal range: 0-10 mg/L)
– Bilirubin: 62 µmol/L (normal range: 2-17 µmol/L)
– Aspartate aminotransferase (AST): 54 IU/L (normal range: 10-40 IU/L)
– Alanine aminotransferase (ALT): 47 IU/L (normal range: 5-30 IU/L)
– Alkaline phosphatase (ALP): 1850 IU/L (normal range: 30-130 IU/L)
– Albumin: 32 g/L (normal range: 35-55 g/L)
What is the recommended treatment for this condition?
A 42-year-old man presents to his General Practitioner with a 6-month history of erectile dysfunction. He also reports that he has noticed galactorrhoea and is experiencing headaches, usually upon waking in the morning. He has no significant past medical history. His blood test results are as follows:
Investigation(s) Result Normal range
Haemoglobin (Hb) 142 g/l 130–180 g/l
White cell count (WCC) 5.0 × 109/l 3.5–11 × 109/l
Sodium (Na+) 138 mmol/l 135–145 mmol/l
Potassium (K+) 4.1 mmol/l 3.5–5.3 mmol/l
Thyroid-stimulating hormone (TSH) 3.8 mU/l 0.27-4.2 mU/l
Prolactin 5234 mU/l 86-324 mU/l
Which of the following further investigations should be requested?