Abdominal Clinic: Extended Matching Questions Formative Self Assessment

A 27-year-old female presents with episodic bilateral loin pain. She does not have symptoms of a urinary tract infection. You are able to balote the kidneys bilaterally and they each have an irregular surface. The remainder of her abdominal examination is unremarkable, although you do appreciate that she has a 3rd-cranial nerve palsy.

A 37-year-old woman presents to you complaining of the development of additional body hair. Her blood pressure is 170/93 mmHg. Other aspects of her abdominal examination are unremarkable. She has three children and her blood glucose is recorded as 5.2 mmol/L

A 40-year-old woman presents with vomiting. She has pain which is present in here right hypochondrium and epigastric region. The pain is made worse when you attempt to palpate her liver and this precipitates vomiting. You are not able to detect any jaundice. The spleen is not palpable.

A 33-year-old woman presents with a long history of constipation interspaced with episodes of frequency and diarrhoea which can contain bloody mucus. You note that she has active ulcerations in her mouth and evidence of scaring. There is also some evidence of scaring around her anus when you perform a per rectal examination.

A 53-year-old man presents with bilateral groin swellings. You are able to reduce each mass when you are applying pressure over the deep inguinal ring and when the patient performs a Valsalva manoeuvre the mass represents. You further test the mass again by reducing it and, by palpating the superficial inguinal ring as the patient performs a second Valsalva manoeuvre, you do not feel a hernia impulse but the mass represents.

A 61-year-old man presents with a swelling in his left groin. You are able to reduce the mass. After reduction when you are applying pressure over the deep inguinal ring and the patient performs a Valsalva manoeuvre the mass does not re-appear. You further test the mass again by reducing it and, by palpating the superficial inguinal ring as the patient performs a second Valsalva manoeuvre, feel your finger being met by a loop of bowel within a lack superficial inguinal ring.

A woman presents with a groin swelling. She says that the swelling is painful and the overlying skin is erythematous. The mass is approximately 7. 6 cm in length by 3 cm. You are not able to reduce the mass and attempts to do this only worsen pain. The fixed portion of the mass originates below the inguinal ligament.

A 19-year-old female present with abdominal pain she tells you that the pains have “come on today” and that she has vomited twice. The vomit had the appearance of undigested food. She describes the pains as cramping. The pains started around the umbilicus, it is now worse in her right iliac fossa. There is no tenderness present in the umbilical region although there is rebound tenderness present in both iliac fossa. The right iliac fossa is involuntarily guarded.

A 53-year-old man present with epigastric pain. His pain is worse at night but does occasionally occur during the day. His abdominal examination is unremarkable but it is limited by his body mass index of 34. You are not able to detect shifting dullness or a fluid thrill.

A 26-year-old woman presents having vomited blood. Here abdominal examination is otherwise unremarkable. She reports vomiting the blood after an [alcohol] drinking binge. She does not normally drink alcohol but did so to celebrate her flatmate’s new job. She vomited whilst drunk several times and noticed that her vomit contained blood this morning.

A 44-year-old man presents with a slightly distended abdomen. His abdomen is soft and non-tender, his liver is palpable 3 cm below the costal margin. There is evidence of shifting dullness present.

A 61-year-old man presents with caput medusae?

A 53-year-old woman presents three days after taking a paracetamol overdose. She has marked hepatosplenomegaly and she is quite confused. There is asterixis present and her skin and sclera have a yellow hue.

A 55-year-old man presents with an unwell appearance. He is jaundiced. You are able to palpate an irregular mass in his epigastrium. There is also a fluctuant mass present below his liver with regular borders.

An 83-year-old lady previously diagnosed with atrial fibrillation presents in an unwell state. She complains of pains in her abdomen which have progressively worsened over a period of hours. Her abdomen has a board-like rigidity and the lady is lying flat on her back slightly confused. Her blood pressure is 94/38 mmHg and her pulse is 107.