A.) C-reactive protein
B.) CT abdomen with angiogram
C.) CT abdomen with oral and IV contrast
D.) Erect and supine AXR
E.) Full blood count
G.) Liver function tests
H.) Ultrasound abdomen
I.) Ultrasound abdomen with graded compression
J.) Urea and electrolytes
For each clinical scenario pick the most appropriate investigation
1.) A 54 year old man presents with acute onset of severe, constant epigastric pain radiating to his back. He is also nauseous and vomiting. He is tender in his epigastrium. He has a background of biliary disease. His HR is 128, BP 154/88, O2 sats 95% RA, RR 20 bpm, temp 37.8°C
2.) A 67 year old man presents with acute onset severe central constant abdominal pain. He is extremely tender throughout his abdomen. His vitals are HR 88-94 in atrial fibrillation, BP 138/78, O2 sats 96% RA, RR 14 bpm, temp 36.6°C
3.) A 48 year old man presents with a few days of colicky left lower quadrant pain which today has become severe and sharp. He has localised peritonism in his left lower quadrant. His vitals are HP 96 bpm, BP 138/72, Rr 16, Sats 96% RA, temp 38.2°C
4.) A 78 year old man presents with central colicky abdominal pain, vomiting and distention. He has a background of previous colon cancer treated surgically. His vitals are HR 102, BP 146/75, O2 sats 96% RA, RR 20, temp 37.6°C
Author: J Haire
Ref: Tintinalli p. 523-524
A.) Appendageal torsion
B.) Testicular torsion
E.) Haemorrhage into testicular malignancy
H.) Testicular malignancy
For each clinical scenario select the most likely diagnosis.
- A 16 year old boy presents with acute onset of severe pain in the left groin, nausea and vomiting. On examination his left testis is firm, tender and the cremasteric reflex on that side is absent.
- A 21 year old man presents with acute onset of severe left testicular pain. ON exam he is tender in the upper pole of his testicle with an area of blue discolouration visible.
- A 25 year old man presents with onset of the pain and swelling in the left testicle which has progressed over the last few days and is associated with dysuria. He is tender throughout the testicle but the pain is partially relieved by elevation.
- A 35 year old man presents with acute pain in the left testicle. On exam he has one testicle larger than the other with a tender firm mass.
Author: J Haire
Ref: Tintinalli p. 649-50