Case 5: 79yr old man admitted under the surgeons with abdominal pain and erythema over right iliac fossa
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Observations & Interpretations
CT: Right sided abdominal wall hernia which contains non-distended loops of small bowel and the appendix. The appendix is slightly thick, with inflammatory change around the tip. Associated collection in the anterior abdominal wall. This collection contains some locules of gas, and may have a tract to the skin surface. There is no bowel obstruction. No free fluid or free intra-abdominal gas. Incidental non-obstructing inguinal hernias. Incidental large non-obstructing gallstone, with no biliary dilatation.Principal Diagnosis
Tip appendicitis within a Right sided abdominal wall hernia (Spigelian hernia). There is an associated collection with a sinus which may communicate with the skin surface.Differential Diagnosis
Post surgical collection in an incisional hernia.Management
Surgical review Antibiotics| Marking Scheme | ||
|---|---|---|
| 3 | Nothing | Nothing Written |
| 4 | Fail | Significant Observations Missed. No Mention of Correct Diagnosis |
| 5 | Borderline | Some Observations Missed. Only 1 of the main diagnoses suggested |
| 6 | Pass | Most observations made. The main diagnoses are made (at least in differential) |
| 7 | Good Pass | Observations made. Principal Diagnoses are all correct, and there is good reasoning. |
| 8 | Perfect Answer | Clear, Concise & Confident. Good Reasoning, and no unrealistic differentials |
You should mark yourself realistically. Some cases will be hard, and just making the relevant observations and sensible observations will give you a pass. Some cases will seem easy, and it is these cases you need to be scoring 7 or 8. In the exam if you write something very incorrect, or if you put down too many obscure differentials, then half marks can be deducted from your score. Make sure you include relevant negatives. If you think there is only 1 differential then be confident, and don't put down unlikely diagnoses. Make sure your handwriting is clear, and use bullet-points to make it more readable. Timing is crucial, and don't spend too long on a single case. As you will note from the mark scheme, if you put nothing down you get a 3. So simply writing a single observation gives you a point
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