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 EMQ 20



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EMQ: 20

Abdominal pain


a)      Acute appendicitis


b)      Diverticular disease


c)      Abdominal aortic aneurysm


d)      Perforated peptic ulcer


e)      Crohn's disease


f)        Ulcerative colitis


g)      Acute pancreatitis


h)     Diverticulitis


i)        Acute viral hepatitis


j)        Acute cholecystitis


Match one of the options above to the most likely scenario given below:


1) A 55-year-old male who has been taking antacids for long standing dyspepsia, presents with severe upper abdominal pain that has subsequently spread and become generalised. For the week prior to admission he had used ibuprofen to ease pain in his right knee

On examination he is afebrile, pulse rate 120 beats per minute, BP 110/60. His abdomen does not move with respiration, it is rigid. Percussion note over the right lower ribs is resonant and bowel sounds are absent


2) A   76-year-old female presents with colicky pain in the left iliac fossa. She also complains of rectal bleeding and diarrhoea. She is febrile. A thickened mass is palpable in the left iliac fossa. It is tender. The white cell count shows a neutrophilia.


3) A 27-year-old male presents with anorexia, nausea, vomiting and fever of a few days duration. He has recently returned from a holiday in the Far East. On examination he is febrile, has icteric sclera and has tender hepatomegaly.

4) A 35-year old male presents with sudden onset of epigastric pain radiating to the back. The pain is severe and characterized as deep and boring. Eating food worsens the pain and bending forward relieves the pain. On examination the patient is febrile he has a tachycardia, and hypotension. Abdominal examination reveals flank ecchymosis and umbilical ecchymosis. On palpation there is epigastric tenderness with localized guarding and rebound, Bowel sounds are sluggish.

5) A 75-year-old male presents with central abdominal pain radiating through to his back. On examination he is tachycardic and hypotensive and has a pulsatile mass in the central abdomen with a systolic bruit audible over it 


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