Ultimate Finals List - Abdominal Stations

Abdominal

• GI: multiple abdo scars // Abdo - This guy was strange. He had a long midline scar that was a bit strange (didn't look much like a laparotomy scar and yet did as well) and an incisional hernia in the scar. He also had a midline sternotomy scar (which I missed and looked like a complete idiot when I said "there are no scars in the chest." It's okay though because I passed and apparently some people also missed the hernia and they still passed! It was quite subtle). The examiner was really very nice and asked me why this man had a midline sternotomy scar (abdo station no?) and then why his laparotomy scar looked a bit strange. Apparently it was because it was the old fashioned way of performing a laparotomy. I also thought this guy had hepatomegaly, but I completely forgot to mention this when I was presenting. I was then told this man had a congenital problem. The only thing I could think of at the time was Marfan’s, with a valve replacement and aortic repair

• Gentleman with splenomegaly and anaemia, although I couldn't feel the spleen as the abdo was pretty distended! This examiner was a bit mean and told me I was digging myself a hole by examining the JVP! // Splenomegaly in a young afrocarribean girl // Abdo: Felty's RA and spleen got asked to present my findings, how I could differentiate the mass, is spleen from kidney

• Abdo - PCKD with transplant, av fistula, cushingoid from steroids & hydrocoele - Fx of Cushings // rather large woman I thought I felt fullness in flanks, I was happy with myself for noticing little scar in bellybutton, however as I presented the examiner separated a role of her fat to reveal a large flank scar! oops. asked me what I thought had gone on I said possibly kidney transplant due to pcos, he said - why else may she have this scar if she was well but her family member was ill...it was cos she had donated a kidney. this was a little mean.

• Hepatomegaly secondary to CLD, with spider naevi // Abdo - the yellowest man I've ever seen! He glowed! He also looked far too ill to be a patient for our exams and I hated moving him. No other signs apart from hepatomegaly. I think diagnosis was pancreatic cancer. // Oh and my abdominal examination pt was a gentleman with telangiectasia and a MASSIVE liver. Examiner asked for differentials, I said the 3cs : cirrhosis, congestive cardiac failure, carcinoma..then I talked about other causes: hepatitis, lymphoproliferative, myeloproliferative, endocrine etc. and time was up // Very long gentleman with pectus excavatum and palmar erythema and a whopping Mercedes scar across the abdomen – oh and two Medicalert bracelets with ‘liver transplant’ written on the back... // Guy with most of the classic liver disease signs: jaundice and yellow sclera, palmar erythema, bilateral Dupuytren's, mild ascites, spider naevi, venous engorgement, hepatomegaly. I said Alcoholic Liver Disease (alcoholic cos of the Dupytren's) and examiner was impressed. Patient also had a upper paramedian surgical scar. // Abdo - Amazing alcoholic liver disease from the ward. Ascites with old tap wound, jaundice, FLAP!!!! Hepatomegaly.

• Elderly man with anaemia. He had hepatosplenomegaly. We were expected to discuss the likely diagnosis which I think was a myeloproliferative disorder. I was asked why a person with PRV would be cyanotic and didn't have time to think about my answer and give it – really annoying as I’m sure it was a point-scorer // Abdo station - patient with bronze discolouration, duypytren's contracture and apparently hepatosplenomegaly, which I couldn't feel. I did not get the diagnosis in the exam, although when I write this all down now I can see that it was haemochromatosis, but it didn't matter anyway.

• Abdo: incisional hernia, urostomy. questions about what stoma was and why, what kind of metabolic abnormalities happen in a patient with a urostomy... i gave retroperitoneal fibrosis as a reason for needing a urostomy and was quizzed as to the potential drug causes of retroperitoneal fibrosis

• Abdo - guidance said patient had long term lyphoma but I could find no abnormailty on examination apart from subcutaneous lipomas.

• suprapubic mass - spoke about the bladder and uterus // differential, so I said fibroids, a mass in the bladder, and I would like o rule out pregnancy even though the lady was over 50... he was very impressed when I said that, he then said how would u manage someone with a fibroid, I said if it wasn’t causing any symptoms you could leave it alone, if there were symptom, there was medical management to control menorrhagia and pain, or surgical management was to remove it, and then we sat in silence, I think the examiner was very bored!// n a 50-ish year old woman with a hard pelvic mass - which really confused me, at first but just carried on my examination, presented my findings and we discussed some differentials for pelvic masses - I said fibroids, pregnancy (unlikely in a woman her age), calcified bladder, tumour and discussed how I would manage this patient (full history, basic bloods, tumour markers, dip the urine etc etc, maybe a pelvic ultrasound), then the bell went!

• Gastro-divarification of recti and a sebaceous cyst, also Dupuytren’s contracture which I missed. Asked about causes of Dupuytren’s and management. Also asked to describe the seb cyst and why I thought it was one etc.