Case histories Flashcards
A 28-year-old woman in her second post-partum week presents with recent-onset breast pain and a tender wedge-shaped area in one breast that feels firm, warm, and swollen, and appears erythematous. She has decreased milk output, flu-like symptoms, pyrexia of 38°C, and myalgia, in addition to feeling fatigued.
What do you suspect this woman has?
A. Breast abscess
B. Primary invasive breast cancer
C. Breast fibroadenoma
D. Fibrocystic breast
A.
A 42-year-old woman presents with bilateral breast pain of mild-to-moderate intensity. Pain is worse just before and improves a few days after the start of her menstrual period. Gynaecological history is significant for grava 2 para 2. She does not take an oral contraceptive. Physical examination of the breasts demonstrates diffuse nodularity throughout both breasts.
What do you suspect this woman has?
A. Breast abscess
B. Primary invasive breast cancer
C. Breast fibroadenoma
D. Fibrocystic breast
D.
A 30-year-old woman with a history of mastitis presents with sharp shooting breast pain and an exquisitely tender, swollen, red, and warm fluctuant peri-areolar breast mass.
What do you suspect this woman has?
A. Primary invasive breast cancer
B. Breast fibroadenoma
C. Breast abscess
D. Fibrocystic breast
C.
A 65-year-old white woman presents to her doctor for a routine screening mammogram, which demonstrates a cluster of pleomorphic micro-calcifications that are located in the upper outer quadrant of her left breast. One year ago, her mammogram showed no abnormalities; the patient has been diligent in undergoing annual mammograms because her mother was diagnosed with breast cancer at the age of 50 years.
What do you suspect this woman has?
A. Primary invasive breast cancer
B. Breast fibroadenoma
C. Breast abscess
D. Fibrocystic breast
A.
A 46-year-old obese woman presents with a 6-hour history of moderate steady pain in the right upper quadrant (RUQ) that began after eating dinner and radiates through to her back. This pain gradually increased and became constant over the last few hours. She has had previous episodes of similar pain for which she has not sought medical advice. Her vital signs are normal. The pertinent findings on physical examination are tenderness to palpation in the RUQ without guarding or rebound.
A. Cholecystitis
B. Pancreatitis
C. Renal colic
D. Cholelithiasis
D.
A 58-year-old man with pancreatic adenocarcinoma, who had a plastic stent placed in his common bile duct 6 weeks ago to relieve obstructive jaundice, presents to the emergency department with a 1-week history of progressive nausea and occasional vomiting after eating. He has generalised abdominal pain that is worse in the RUQ. He has experienced subjective fever/chills and states that his bowel movements are pale. Laboratory results show
WBC of 14.0 × 10⁹/L ( 4.8-10.8 × 10⁹/L) PMNs of 77% (35% to 70%) AST is 214 units/L (8-34 units/L) ALT is 181 units/L (7-35 units/L) ALP is 543 units/L (25-100 units/L) total bilirubin is 183.0 micromol/L (3.4 to 22.2 micromol/L ), amylase is 110 units/L (53-123 units/L)
What is his diagnosis?
A) Liver failure
B) Ascending cholangitis
C) Acute cholecystitis
D) Perforated peptic ulcer
B.
C is possible too but usually with acute cholecystitis you have positive Murphy’s sign (more localised pain) whereas with cholangitis the pain is more diffuse
A 43-year-old female with a prior history of open cholecystectomy presents with gradual onset of nausea, vomiting, absolute constipation, and abdominal distention. Physical examination does not demonstrate peritonitis. Abdominal x-rays demonstrate scattered air-fluid levels.
What is her diagnosis?
A) large bowel obstruction and perforation
B) small bowel obstruction and perforation
C) perforated peptic ulcer
D) acute appendicitis
B. adhesions is the most common cause of SBO, whereas tumour is the most common cause of LBO.
A man in his early 70s presents with acute-onset, colicky, lower abdominal pain and distension, failing to pass flatus or faeces in the preceding 12 to 24 hours. He reports a recent change in his bowel habit with increased frequency of defecation, some weight loss, and the passage of blood mixed with his stools. On examination he is generally unwell, is pyrexial, and has a distended tympanic abdomen along the distribution of the large bowel, with tenderness in the right lower quadrant. He has an empty rectum on digital rectal examination.
What is his diagnosis?
A) large bowel obstruction and perforation
B) small bowel obstruction and perforation
C) perforated peptic ulcer
D) acute appendicitis
A. Age + sex + hx of wt loss etc indicate cancer. Most common cause of LBO is colorectal cancer. Tympanic abdomen along distribution of large bowel is huge clue…
