This document contains 4 clinical case scenarios presented as structured essay questions. Each case provides some background information about a patient and their presentation. For each case, candidates are asked to:
1) Provide the most likely diagnosis
2) Suggest appropriate investigations to confirm the diagnosis
3) Discuss management options
The cases cover common presentations in urology (enlarged prostate), general surgery (bowel obstruction), and vascular surgery (non-healing leg wound).
This document contains 4 clinical case scenarios presented as structured essay questions. Each case provides some background information about a patient and their presentation. For each case, candidates are asked to:
1) Provide the most likely diagnosis
2) Suggest appropriate investigations to confirm the diagnosis
3) Discuss management options
The cases cover common presentations in urology (enlarged prostate), general surgery (bowel obstruction), and vascular surgery (non-healing leg wound).
This document contains 4 clinical case scenarios presented as structured essay questions. Each case provides some background information about a patient and their presentation. For each case, candidates are asked to:
1) Provide the most likely diagnosis
2) Suggest appropriate investigations to confirm the diagnosis
3) Discuss management options
The cases cover common presentations in urology (enlarged prostate), general surgery (bowel obstruction), and vascular surgery (non-healing leg wound).
This document contains 4 clinical case scenarios presented as structured essay questions. Each case provides some background information about a patient and their presentation. For each case, candidates are asked to:
1) Provide the most likely diagnosis
2) Suggest appropriate investigations to confirm the diagnosis
3) Discuss management options
The cases cover common presentations in urology (enlarged prostate), general surgery (bowel obstruction), and vascular surgery (non-healing leg wound).
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