Set of clinical case Qs taken from MRCS part A exam

[AlmondEye]

Hello,

I have been trying out some questions I found that had recently been in the BMJ, taken from the OnExamination revision website for the MRCS part A paper, but the answers are not there any more so I am in need of answers from YOU to compare it to! It is also an excellent opportunity for you to have that extra bit of practise before the exam. You might have even tried them already from the October '09 issue.

Obviously, I would appreciate answers that are not by complete guess work.

Perhaps you could also provide short explanations of why you have come to the conclusion to your answers too..?

Well anyway, here are the questions and the answers you must choose from: (you can apparently put the same answer to more than one presentation)

Presentation 1

A 48 year old woman is referred as an emergency with severe right upper quadrant pain. On examination she has a fever and a tender, palpable right subcostal mass with local peritonism.

Presentation 2

A 43 year old obese, multiparous woman seen in the emergency department reports a first episode of right upper quadrant pain and nausea. The pain settled completely by the time the casualty officer has her blood results back. She does not have a fever and has only minimal right subcostal tenderness.

Presentation 3

A 54 year old woman is admitted with severe epigastric pain and vomiting. She has a long history of recurrent right upper quadrant pain. An upper abdominal ultrasound arranged by her general practitioner had shown gallstones but the patient had not been referred. On examination she has marked epigastric tenderness.

Presentation 4

A 47 year old woman has had recurrent episodes of biliary colic. She is admitted with severe right upper quadrant pain associated with a fever of 38°C and localised tenderness in the right hypochondrium.

Presentation 5

An 82 year old man with heart failure is referred from the cardiology ward with sudden onset of severe abdominal pain and vomiting. On examination he has tachycardia of 110 beats a minute, is hypotensive (85/60 mm Hg), and his abdomen is rigid.

For each of these presentations, choose the single most likely cause from the list of options below. Each option may be used once, more than once, or not at all.

Answers to choose from:

A Acute cholecystitis
B Acute pancreatitis
C Ascending cholangitis
D Biliary colic
E Biliary peritonitis
F Choledocholithiasis
G Empyema
H Gallstone ileus
I Mirizzi syndrome
J Mucocele