Mdsc 5555 Exam (1)

UNIVERSITY OF THE WEST INDIESFACULTY OF MEDICAL SCIENCES EXAMINATION OF MAY/JUNE 2016 Code and Name of Course: EXAMINATION Paper: 1 SU 500/MDSC 5555 STAGE Date and Time: THURSDAY, MAY 5, 2016: 9:00 a.m. -12:00 noon hrs. II, PART Duration: IV 3 INSTRUCTIONS TO CANDIDATES: This examination consists of Two Sections, A & B, and has 38 pages, including the cover page. Section A, consist of Two Parts: Part I contains 90 questions which require a Single Best Answer Part II contains 25 questions of the extended matching type DIRECTIONS: For each of the questions, shade the appropriate box on the appropriate answer card. Section B contains 5 questions requiring short written responses YOUR QUESTION PAPER WILL BE COLLECTED ALONG WITH YOUR ANSWER CARD AT THE END OF THE EXAMINATION FAILURE TO RETURN YOUR COMPLETED PAPER WILL INVALIDATE YOUR MARKS POINTS WILL NOT BE DEDUCTED FO INCORRECT ANSWERS GIVEN a) List three (3) precursor lesions of colon cancer b) What other specific investigations would you order if you suspected a rightsided colonic malignancy? c) List four (4) routes of spread of colorectal cancer and give an example of each: . over the same period. Her physical examination is essentially unremarkable. Note that marks vary for each response. Question 1 A 52-year-old woman presented to her primary health care physician in the country with a complaint of feeling weak and fatigued for the past (3) months. Correct precise answers gain full marks. She also experienced unintentional weight loss of 10 lbs.UWI ID Number: ___ -_________ ©The University of the West Indies_______________________________________________________________________ DO NOT WRITE ON THE BACK OF THIS PAPER USE ONE SIDE ONLY SECTION B Structured Answer Essay Questions Instructions: Please write the answer in the space provided only. She was subsequently referred to a tertiary care hospital for further management. Responses that are close may be given partial marks. Blood investigations reveal that she has a microcytic anaemia. d) The patient undergoes an exploratory laparotomy for resection of the affected segment of colon. There was no mention of any visible metastatic deposits. e) Name three (3) pathological staging systems used for colorectal cancer AND using any (1) system of your choice give the appropriate stage for this patient? On routine surveillance imaging one (1) year after surgery.UWI ID Number: ___ -_________ Diagnostic imaging tests revealed a “cauliflower” lesion in the ascending colon. f) What are the options for management of liver metastases from colorectal carcinoma AND list any two (2) criteria that should be fulfilled for this patient to be considered a candidate for hepatic resection? g) If any (3) of her siblings or parents had a history of endometrial. What specific surgical procedure should be done AND list any five (5) early post-operative complications you could expect: Microscopic examination of the specimen by the pathologist reveals tumour invasion through the muscularis propria into peri-colic tissues & evidence of spread to two (2) regional lymph nodes. what familial cancer syndrome would you consider? What genetic defect is responsible? . she is found to have a 2cm lesion in the left lobe of the liver. ovarian or colorectal cancer. ulcerating mass involving the right true and false vocal cords. coughing and unintentional 9 kg weight loss. There is mild biphasic stridor with deep inspiration and expiration. d) What further investigations would you request (give reasons for your choice)? . and extension onto the epiglottis and aryepiglottic folds. and breath sounds are clear. He is known to have chronic obstructive pulmonary disease (COPD).UWI ID Number: ___ -_________ Question 2 A 65-year-old bartender is referred to the clinic with a 6-month history of hoarseness. c) What is the definition of stridor? Flexible fibre-optic laryngoscopy demonstrates a necrotic. but the patient has no increased work of breathing at rest. The right true vocal cord is immobile. Neck examination demonstrates a 2 cm right-sided mass that is firm and fixed a) List three (3) differential diagnoses that could account for his persistent symptoms b) What other important information would you ask about when ascertaining the medical history? Over the past week he has noted progressive difficulty breathing. Cranial nerve examination is normal. The glottic airway is partially obstructed. Repeat radiological test were done and review of the images determined that he was not a candidate for surgical neck dissection due to encasement of a particular structure.UWI ID Number: ___ -_________ e) List two (2) life-saving surgical procedures that are sometimes performed in patients with stridor prior to definitive treatment f) What is the definitive surgical procedure used in the treatment of laryngeal cancer and list any four (4) complications associated with this procedure g) What other modalities are available in the treatment of suspected carcinomas of the larynx: Six months after surgery the patient returns to the clinic with a painless 5 x 5cm firm fixed mass close to the site of the original neck incision. h) What structure is likely to be encased? 1. . presented to the accident and emergency department with severe sternal chest pain radiating to the back and a cold pulseless left leg. a) What important clinical diagnoses should be considered in this patient: b) Name four (4) clinical manifestations associated with further extension or extravasation of blood into the layers of the affected organ or surrounding structures c) What urgent investigations should be requested to aid in the management of this patient? d) Name two (2) classification systems used to describe this condition e) What is the definitive treatment of this condition. and what techniques/ approaches are available to definitively treat this condition if diagnosed early? .UWI ID Number: ___ -_________ Question 3 A 65-year-old woman with a known history of hypertension. Her blood pressure on arrival was 195/90mmHg in the right arm and 160/70 in the left arm. She describes the pain as “tearing” in nature and has no preceding history of trauma. UWI ID Number: ___ -_________ f) List the monitors would you would want to place for the surgical treatment of this condition and give (1) reason why you would want each monitor you have listed g) List four (4) outcomes or complications associated with surgical repair of this condition h) Name any three (3) diseases that may be associated with this condition . He had become trapped under the motorcycle. bleeding left leg after a motorcycle collision. An open 5 cm wound is seen anteriorly in the mid-tibia. with severe burns and a grossly deformed. right upper limb and lower limb. On physical examination he is awake and alert but in excruciating pain.UWI ID Number: ___ -_________ Question 4 A 25-year-old man is brought to the casualty department. Dorsalis pedis and posterior tibial pulses are palpable bilaterally. In addition he has partial and full thickness burns to the chest. which caught on fire. a) List four (4) features on clinical examination that would indicate the need for immediate endotracheal intubation of this patient b) Outline the steps you would take in the initial resuscitation management of this patients injuries in the emergency room c) Name five (5) common complications that are associated with burns and . e) What complication has developed AND how would you manage it? The patient is admitted to the burn unit for further intensive care and wound management.5 ◦C. X-rays reveal non-union of the tibial shaft and areas of involucrum and sequestrum.UWI ID Number: ___ -_________ Plain radiographs of the left leg reveal an angulated and displaced tibial shaft fracture. 6 months later he returns to the orthopedic clinic with a complaint of persistent pain. he becomes increasingly confused and develops a temperature of 38. and fixation of the fracture d) List three (3) benefits of early fixation in this patient? Five (2) hours after the procedure. swelling and a discharging sinus from the left leg. The patient is taken to the operating theater for further debridement. g) What complication has developed and how would you manage this unfortunate complication? . His oxygen saturation falls from 97% to 85% on room air. f) What topical antibacterial agents are commonly used for the treatment of burns? Name one disadvantage of each His wounds heal satisfactorily and she is discharged after 3 months in hospital. UWI ID Number: ___ -_________ . His physical exam was normal and the digital rectal examination revealed a slightly enlarged but benignfeeling prostate. a) What are the criteria necessary to initiate a screening programme for a particular disease? b) List four (4) conditions that may cause to an elevated PSA: c) What voiding or irritable urinary symptoms would you ask this patient if he is experiencing? d) If you were concerned about an advanced prostate malignancy what symptoms might you expect this patient to have? . His past medical history was unremarkable.UWI ID Number: ___ -_________ Question 5 A 66-year-old man who recently attended a prostate screening symposium is referred to the urology clinic after he was found to have a prostatespecific antigen (PSA) level of 8 ng/mL. UWI ID Number: ___ -_________ . UWI ID Number: ___ -_________ e) Name two (3) radiologic imaging tests that could be helpful in this patient f) Briefly outline the steps involved in performing a prostate biopsy Prostatic biopsy revealed a Gleason score 7 (4 + 3) adenocarcinoma in 6 of 12 specimens. g) Would you offer a surgical procedure to this patient and if so what procedure? h) If the patient declined to have surgery done what treatment options are available? .