Theme: (Abdominal Pain)

For Each of the following scenarios please choose the most appropriate options from the list.
A.
B.
C.
D.
E.
F.
G.
H.

Acute appendicitis
Ischaemic bowel
Porphyria
Mesenteric adenitis
Small bowel obstruction
Urinary tract infection
Crohns disease
Diverticulitis

Scenario 1
A 20-year-old man presented with a 6 hour history of severe RIF ( right iliac fossa) pain and diarrhoea. He
had been admitted 12 months previously for drainage of a perianal abscess, following which he had
suffered from persistent perianal discharge and has history of significant weight loss.
Correct answer:

Scenario 2
An 80-year-old man presented to his general practitioner (GP) complaining of sudden onset of left-sided
abdominal pain. He had recently suffered from a transient ischaemic attack from which he had made a
complete recovery.
Correct answer

Scenario 3
A 32-year-old pregnant lady presented to her GP with a history of vague abdominal pain associated with
nausea and loss of appetite. She had a long history of depressive illness to which these symptoms had
been attributed. She had recently noticed
marked reddish discoloration of her urine.
Correct answer

Theme: (Right iliac fossa pain)

For Each of the following scenarios please choose the most appropriate options from the list.
A.
B.
C.
D.
E.
F.
G.
H.

Appendicitis
Ectopic pregnancy
Irritable bowel syndrome
Ovarian torsion
Perforated duodenal ulcer
Ruptured ovarian cyst
Terminal ileal Crohns disease
Ureteric stone

Scenario 1
A 28-year-old woman developed sudden onset of pain in the right iliac fossa. Pain was improved by walking
around the examination room in the Emergency department.
Correct answer

Scenario 2
A 28-year-old woman presents with recurrent abdominal pain localised mostly to the right iliac fossa. She
opens her bowels four times a day. The stool was noted to be of liquid consistency. Pain was reported to be
worse when eating but relieved by bowel movement. A loss of 5 kg in weight was noted.
Correct answer

Scenario 3
A 22 year old married female came to emergency with severe right lower abdominal pain for 6 hours . On
examination was pale, tachycardic and hypotensive.
Correct Answer :

Scenario 4
A 22 year old male came to Er with Right lower abdominal pain and non bilious vomintgs for 12 hours. On
examination he is tachycardic and febrile with tenderness in the right iliac fossa.
Correct Answer :

Theme: (Abdominal Pain )

For Each of the following scenarios please choose the most appropriate options from the list.
A.
B.
C.
D.
E.

Acute appendicitis
Acute cholecystitis
Acute pancreatitis
Biliary colic
Intestinal obstruction

F.
G.
H.
I.
J.

Perforated peptic ulcer

Obstructive jaundice
Ruptured abdominal aortic aneurysm
Ruptured liver
Ruptured spleen

Scenario 1
A 43-year-old female complains of severe epigastric/right upper quadrant (RUQ) pain 2 hours after eating a
meal of chips and fried chicken. The pain radiates to her back and makes her nauseated. There are no
other systemic symptoms.
Correct answer

Scenario 2
A 38-year-old executive of Asian origin is brought to the Emergency Department after his car was involved
in a high-speed RTA. He presents with upper abdominal distension, guarding and signs of shock. He also
complains of left shoulder tip pain and his past medical history includes recurrent episodes of malaria.
Correct answer

Scenario 3
A 78-year-old lady presents with severe abdominal pain and signs of peritonitis. She is on non-steroidal
anti-inflammatoryagents (NSAIDs) for rheumatoid arthritis. On examination, bowel sounds are absent.
Erect chest X-ray shows free gas under the diaphragm.
Correct answer

Scenario 4
A 74-year-old man is brought to the Emergency Department with sudden onset of upper abdominal and
periumbilical pain radiating to his back. He is sweating, nauseated and feeling faint. His BP is 90/60 mmHg
and his pulse rate is 110/min.
Correct answer
H

Theme:( Upper abdominal pain)

For Each of the following scenarios please choose the most appropriate options from the list.
A.
B.
C.
D.
E.
F.

Biliary colic
Bleeding duodenal ulcer
Bleeding gastric ulcer
Cholecystitis
Gastritis
Leaking abdominal aortic aneurysm

G.
H.
I.
J.
K.

Pancreatitis
Peptic ulcer
Perforated duodenal ulcer
Perforated gastric ulcer
Perforated oesophagus

Scenario 1
A 35-year-old man on steroids was admitted to accident and emergency (the Emergency Department) with
hypotension and tachycardia. He was also noted to have a raised respiratory rate and low urine output. A
history of back pain and some bruising was noted in the flanks.
Correct answer

Scenario 2
A 43-year-old lady presented to the Emergency Department with an 8-week history of epigastric discomfort,
she had a pyrexia 38 oC and a WBC 15 x 109/l. There was associated nausea but no vomiting or features
of generalised peritonitis. There was some indication of increased pain on ingestion of fatty foods.
Correct answer
D
Scenario 3
A 65-year-old man was admitted to the Emergency Department with sudden onset of upper abdominal pain
and vomiting. He had drunk 4 pints of beer the night before. On examination there is resonance on
percussion over the liver.
Correct answer

THEME: (JAUNDICE)
For Each of the following scenarios please choose the most appropriate options from the list.
A.
B.
C.
D.
E.

Cholangiocarcinoma
Gall bladder calculi
Common bile duct calculus
Mucocele of the gall bladder
Empyema of the gall bladder

Scenario 1
A 34-year-old lady presents to the emergency department with a palpable right upper quadrant mass, fever
and being generally unwell.
Correct answer
E
Scenario 2
A 30-year-old female who had an open cholecystectomy presents with obstructive jaundice 48 h after
surgery.
Correct answer
C
Scenario 3
A 38-year-old obese lady presents to the emergency department department with right upper quadrant
pain. Ultrasound scan shows a stone in the Hartmanns pouch.
Correct answer
D

Theme (Vomiting)
For Each of the following scenarios please choose the most appropriate options from the list.
a. Xray Abdomen
b. Ultrasound Abdomen
c. C-T Scan Abdomen
d. UGI Endoscopy
e. X-Ray Chest (Erect)

1. A 45-year-old woman with right upper quadrant pain, nausea and vomiting dating back over the last
week. She also complains of marked dyspepsia. On examnaiton , Murphys sign is positive.
B Correct answer

2. 25 years old presents to OPD with heartburn and non-bilious vomiting after taking spicy meals.
D correct answer

3. 55 years old male , presented with multiple episodes of non-bilious vomiting and severe upper abdominal
pain. Past history is significant for taking NSAIDS and Steroids for his knee arthritis.
E correct answer