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Adult with abdominal mass

Clinical Discipline(s)/Organ System(s)
Digestive System, Gastroenterology & Hepatology, General Surgery, Oncology, Radiology, General Practice
Progress Test Topic(s)
A 52 year old NZ European woman presents to her GP with bloating of her abdomen, worsening over the last few months associated with intermittent diarrhoea and 5kg weightloss. Her brother and father were diagnosed with bowel cancer in their 40's.
Progress Test-Type Questions:   Question 1 | Question 2 | Question 3 | Question 4
Applied Science for Medicine 
   - Anatomy of the abdomen and pelvis
   - Biochemistry of tumour markers
   - Processes and routes by which malignancies metastasise
   - Outline the pharmacology of commonly used cytotoxic drugs
   - Mechanisms by which gene mutations are involved in the initation and progression of cancer
Clinical and Communication Skills 
   - History from a patient with abdominal distension; include consideration of malignancy
   - Perform and record an examination of the abdomen and lymph nodes. Include checking for ascites, rectal, genital and speculum examinations if indicated. Recognise a distended bladder
   - Perform urinary catheterisation
   - Indications for CT abdomen, MR abdomen, abdominal ultrasound, transvaginal ultrasound, endoscopy, ascitic tap, guided biopsy of mass
   - Interpret abdominal X-ray, full blood count, electrolytes, creatinine, liver function tests, erect chest X-ray, ascitic fluid pathology report
   - Interpret tumour markers (CEA, CA-125, CA19-9)
   - Differential diagnosis of abdominal and pelvic masses
   - Management of intra-abdominal malignancies: surgical, oncological and palliative approaches
   - Genetic testing and cancer screening in families with familial cancers; prophylactic interventions for those with inherited mutation of familial cancers
Personal and Professional Skills 
   - Consent for intimate examination and use of chaperone
   - Delivering life-changing news
   - Interdisciplinary care for patients with known or suspected cancer
   - Role of formal hospital multidisciplinary meeting in facilitating appropriate care for patients with cancer
Hauora Māori 
   - Cater for differential health literacy needs of Māori patients and whānau
   - Awareness of differing risk profiles for cancer between Māori (and other disadvantaged populations) compared with non-Māori in NZ
   - Understanding the role of kaupapa Māori cancer services and research
   - Appreciate unique familial mutations in Māori families for developing cancers such as gastric cancer, and how this information has impacted on cancer research
   - Describe the characteristics that Māori may ascribe to their genome and outline how this might impact on genetic research, diagnosis of genetic disorders and novel gene-based therapies
Population Health 
   - Effectiveness and cost effectiveness of screening tests for bowel cancer and gynaecological cancers in the general population
   - Epidemiology of bowel and gynaecological cancers; identify genetic, environmental and lifestyle risk factors for cancer development
   - Ethical, social, and medical issues around genetic screening
Conditions to be considered relating to this scenario
ovarian carcinoma, uterine cancer, colorectal cancer, gastric cancer, ascites, ovarian cyst, fibroids, hepatosplenomegaly, bladder distension
Less common but 'important not to miss'
lymphoma, abdominal aortic aneurysm, abdominal/pelvic metastases
Crohn's disease