Question bank

A 58-year-old man with a history of chronic liver disease attends with a bilateral fixed Oexion deformity of the ring and little fingers, left worse than right. What is the most likely diagnosis?

A patient is admitted following a motorcycle accident. He has fractured his left femur, tibia, fibula and pelvis. His blood pressure is 70/35 rnmHg, pulse is 140beats/min, respiratory rate is 35breaths/min and the Glasgow Coma Scale score is 9/15. You wish to resuscitate the patient. Which one of the following procedures may be contraindicated in such a patient?

You are asked to assist in theatre during an emergency appendicectomy. The consultant asks you to locate McBurney's point. From the list below, which answer best describes the location of McBurney's point?

A 57-year-old male is day 1 post femoral-femoral (left to right) bypass graft insertion for left external iliac stenosis. You are asked to see him because he is complaining of chest pain and difficulty breathing. You alert your seniors and the on-call Intensive Care Registrar who suspects that the patient may be in cardiogenic shock. You are asked to review the patient's chest radiograph. Which one of the following chest radiograph signs is not a characteristic change seen in cardiogenic shock?

A fit 30-year-old woman while gardening suddenly became very short of breath, had intense itching with rash and complained of a painful red spot on her arm. She has been brought to the A&E department and is hypotensive, hypoxic with warm peripheries. The diagnostic of this patient is?

A fit 25-year-old man fell from a height of 40 feet at a building site. He has been brought in unconscious with a GCS of 13 and flaccid limbs. He has been immobilised in a spinal frame and has an intravenous line. The diagnostic of this patient is?

A 60-year-old woman has been admitted as an emergency with a 4-day history of severe right upper quadrant pain, vomiting, jaundice and intense pruritus and is very toxic - high temperature with rigors and hyperdynamic circulation. The diagnostic of this patient is?

A 45-year-old woman with a long history of intermittent right abdominal pain presents with acute onset of severe abdominal pain and distension. Examination reveals a tense tympanic lump in the left upper abdomen. What is the diagnosis for this patient?

A 65-year-old woman has been admitted through the Accident and Emergency Department (A&E) with abdominal pain, abdominal distension, faeculent vomiting and constipation. She has lost 20 kg in weight in 4 months. Examination reveals a patient with features of acute distal small bowel obstruction and Hb of 8 g/dL. She has never had an operation in the past. What is the diagnosis for this patient?

A 90-year-old man from the local care home was referred to A&E with abdominal pain and persistent diarrhoea. Abdominal examination reveals multiple 'masses', and rectal examination revealed a loaded rectum. What is the diagnosis for this patient?

You are asked to assist the lead surgeon with a midline laparotomy in theatre. The patient has small bowel obstruction confirmed by CT imaging. Before the start of the operation, you are asked what layers, from superficial to deep, would be cut through during a midline laparotomy incision. Which of the foilowing is the most likely answer?

You are asked to review a 45-year-old man on the surgical ward by the nursing staff. Checking through the notes, you observe that be is 1 day following an open anterior resection for rectal carcinoma. He describes severe central abdominal pain associated with dyspnoea. The abdomen is soft but generally tender throughout. His symptoms have occurred despite an epidural that was inserted prior to surgery. What is the most effective form of analgesia in this setting?

A 64-year-old man undergoes a laparoscopic gastric bypass for obesity. His baseline blood pressure is 150/80 mm.Hg. Intraoperatively, there was a small serosal tear which was sutured laparoscopically. The patient had some bleeding during the dissection of the lesser omentum, which was controlled with diathermy. The patient did not require intraoperative transfusion. Postoperatively on return to the high dependency unit, the patient is mechanically ventilated and his blood pressure is 80/40 mmHg. His urine output is 15 ml,/h. Which of the following is the best means of improving his urine output?

You are called urgently to see a 67-year-old man who is 24 hours following uncomplicated laparoscopic cholecystectomy. The patient is human immunodeficiency virus-positive and has a past history of thrombocytopenia and at pre-assessment his platelet count was 60 x 109/L. He is complaining of chest pain and breathlessness and his abdomen is noticeably more distended than in the initial postoperati.ve period with significant peri-umbilical tenderness. His postoperative electrocardiogram shows lateral ischaemia and his current haemoglobin level is USMLE Surgery2e/Management 7.5 g/dL. He is tachycardic and his blood pressure is 115/75 mmHg. The next appropriate step is?

You are told that a 45-year-old woman, who presented to the vascular surgery clinic, has a positive tourniquet test in the left leg. On the basis of the information conveyed to you, choose the most likely diagnosis that is associated with a positive tourniquet test?

A 62-year-old man is about to undergo an elective abdominoperineal resection for a low rectal carcinoma. He usually takes 5 mg warfarin per day for atrial fibrillation. His most recent international normalized ratio (INR) is 2.9. Which of the following is the best preoperative strategy?

A 62-year-old man is awaiting an elective femoropopliteal bypass for peripheral vascular disease. He is a smoker of 60 pack years and is being treated for hypertension and hypercholesterolaemia with ramipril 5 mg each morning and simvastatin 10 mg orally at night. Three weeks ago he was admitted foilowing an ST elevation myocardial infarction. His current blood pressure is 170/110 mmHg. Which of the following best describes the preoperative strategy?

A man presents after a game of squash with pain in the back of the calf and heel that was of sudden onset and difficulty weight bearing. On calf-squeeze test, the ankle does not dorsiflexion. What is the best next step in management of this patient?

A patient is intubated on ITU 48 hours after sustaining a severe TBI. Urine output has been 800 mL over 3 hours and the serum sodium level is 151 mEq/L. What is the most likely diagnosis of this patient?

A 26-year-old woman arrives at the emergency department with unbearable intense right iliac fossa pain. Earlier that day, she was experiencing 'on and off' moderate pain in the umbilical area which gradually moved over to the right iliac fossa. Associated symptoms include anorexia, nausea and vomiting. On examination, the patient is pyrexial and there is rebound tenderness and guarding over the right iliac fossa. A beta-human chorionic gonadotrophin test is negative. What should you do next?