Archives: MSRA

MSRA-0821

A 44-year-old woman presents to the emergency department with sudden onset abdominal pain and vomiting for the past 5 days. She feels nauseated and cannot tolerate any food and only minimal liquid. She denies diarrhoea and has not had a bowel movement for 4 days.

Her past medical history includes chronic lower back pain for which she takes regular co-codamol. The last time she was in hospital was for her cesarean section 10 years ago.

Upon examination, she appears clammy and dehydrated. Her abdomen is distended and tender throughout. Bowel sounds are inaudible.

What is the most probable underlying cause of this patient’s presentation?

MSRA-0822

Samantha, 72, has a confirmed sigmoid colon tumor graded as T3N0M0. Surgery was recommended as the primary treatment and scheduled for next week. However, she was rushed to the emergency department with severe abdominal pain, which was diagnosed as a perforation. What is the most suitable surgical procedure for Samantha?

MSRA-0823

Samantha, 74, has been diagnosed with a mid-rectal tumour. After undergoing a CT scan and other tests, it has been determined that the tumour is graded as T2N0M0 and is suitable for surgical intervention. What is the recommended surgery for Samantha?

MSRA-0824

As a foundation year two doctor on the surgical admissions unit, you encounter a thirty-year-old patient complaining of right upper abdominal pain and anorexia. Upon examination, you find an overweight Caucasian female with a soft abdomen that is tender in the right upper quadrant. Her observations indicate fever and mild tachycardia. Blood tests reveal a significantly elevated bilirubin level (87 umol/L). What is the probable diagnosis?

MSRA-0825

A 50-year-old man with a history of gallstone disease comes to the clinic complaining of pain in the right upper quadrant for the past two days. He reports feeling like he has the flu and his wife mentions that he has had a fever for the past day. During the examination, his temperature is recorded as 38.1ºC, blood pressure at 100/60 mmHg, and pulse at 102/min. He experiences tenderness in the right upper quadrant and his sclera have a yellowish tint. What is the most probable diagnosis?

MSRA-0826

A 56-year-old male patient presents to the emergency department with a 3-day history of severe right upper quadrant pain preceded by a 2-month history of intermittent ache in the right upper quadrant. His basic observations include heart rate 115 beats/minute, respiratory rate 28 breaths/minute, blood pressure 90/55 mmHg, temperature 38.9°C, oxygen saturation 93% on air. His past medical history includes hypertension and type 2 diabetes mellitus.

WCC 14 x 109cells/L
Bilirubin 80 mg/dL
Alkaline phosphatase 377 IU/L
Alanine aminotransferase 70 U/L
Amylase 300 U/L

What is the most likely diagnosis?

MSRA-0827

A 50-year-old woman visits your clinic to ask about the national screening programme for colorectal cancer. What is the correct statement regarding this?

MSRA-0828

A 29-year-old man comes in for follow-up. He was diagnosed with an anal fissure approximately 8 weeks ago and has attempted dietary changes, laxatives, and topical anesthetics with minimal improvement. What would be the most suitable course of action to take next?

MSRA-0829

A 58-year-old man is recuperating on the ward after an emergency laparotomy and ileocolic resection for Crohn’s disease. The nursing staff has raised concerns about his abdominal wound on the fifth day post-operation. Upon review, you observe a clear wound dehiscence in the central area of his laparotomy incision, with a small portion of the bowel visible.

What are the initial steps that should be taken in this situation?

MSRA-0830

A 68-year-old male presents with a 2-day history of feeling unwell and abdominal pain. Upon examination, you note a distended abdomen with guarding and absent bowel sounds. The patient’s blood pressure is 88/42 mmHg, and heart rate is 120 bpm. A CT scan reveals a perforation of the sigmoid colon due to a large lesion causing bowel obstruction. The patient undergoes emergency laparotomy. What surgical procedure is most likely to have been performed?