SECTION B

Structured Answer Essay Questions

Instructions: Please write the answer in the space provided only. Note that marks
vary for each response. Correct precise answers gain full marks. Responses that are
close may be given partial marks.
1. A 60 year old man presents to the urology outpatient clinic with a history
of urinary frequency, nocturia and post micturition dribbling. He has no
findings on general or abdominal examination. Digital rectal examination
revealed an enlarged smooth prostate with mobile overlying rectal
mucosa. His (PSA) is 7 ng/ml (normal <6.5 ng/ml for this age).
a) What is the MOST likely diagnosis?

b) What investigations would you order to confirm your suspected diagnosis?

c) How would you manage this patient if he had no complications?

Despite conservative management he fails to have any relief of his urinary

symptoms.
d) What are the surgical options available to this patient?

2. A 75- year old man transferred from a nursing home complains of

intermittent sharp abdominal pain, he has passed no stool or flatus for 5
days and has a history of chronic constipation. On examination his
temperature is 38 C, pulse 100 bpm. There is gross abdominal distension
and tenderness most marked in the left iliac fossa.
a) What is your clinical diagnosis?

b) What imaging test(s) would you order AND what findings would you expect?

On palpation his abdomen is rigid with generalized guarding and rebound

tenderness. You do not think he would be a candidate for conservative
management.
c) How would you prepare this patient preoperatively?

d) What surgical operation(s) should be offered?

e) If the patient had presented earlier with obstipation but no signs of

peritonitis, what conservative treatment option would you consider?

3. A 50 year old man presents to the emergency room complaining of a severely

painful non-healing wound to the right leg. The wound as made by minor trauma
and has since been enlarging. A 4 cmx5 cm punched out ulcer is seen overlying
the tibia. The right leg also appears cooler than the left and distal pulses are
difficult to appreciate on the right.
a) What is the most likely diagnosis?

b) What points in the history would you consider asking about?

c) What investigations would you request?

d) In addition to the investigations outlined above explain how you would

manage this patient