General Surgery MCQs for NEET PG
985 worked General Surgery questions across 106 areas. Each one has its own page with the reasoning for every option.
What this set is
Surgery questions test diagnosis, the best investigation and the right operation or first step. It is a large subject spanning gastrointestinal, endocrine, vascular and trauma surgery.
This page lists the 985 General Surgery questions that have a full worked page: 700 application questions that put a fact to use on a patient or a finding, and 285 multi-step questions that combine two or more ideas. Plain one-fact recall items are left out here on purpose. The General Surgery practice bank in the app is larger, with 3,420 questions in all, and is where timed tests and daily practice draw from.
How to use it
- Pick an area you are weak in, below.
- Answer first, then read why each wrong option fails.
- Write a three-line note for every miss, and revisit it in a week.
- Move to a timed General Surgery test once an area feels steady.
These are original practice items, not recalled exam questions, and they are not yet reviewed by independent faculty. Confirm important facts in a standard textbook.
What General Surgery covers in the exam
- Gastrointestinal surgery
- Hepatobiliary and pancreatic surgery
- Breast and endocrine surgery
- Vascular surgery
- Urology
- Trauma and burns
- Hernia and abdominal wall
- Paediatric surgery
- Perioperative care
A study map from the standard curriculum; the NBEMS bulletin is the authority. See the General Surgery study guide.
Worked questions by area
106 areas, largest first. Open an area to see its questions.
Urology91
- Urology · ApplicationA 14-year-old boy wakes with sudden severe pain in the left scrotum and vomiting. The left testis is high-riding and horizontal, and the cremasteric reflex is absent. W…
- Urology · ApplicationA 65-year-old man has hesitancy, weak stream and nocturia, with a smooth enlarged prostate of 70 grams. Which drug combination reduces the risk of progression and need…
- Urology · ApplicationA 28-year-old man has a painless hard testicular mass. Ultrasound shows a hypoechoic intratesticular lesion, and serum AFP is markedly elevated. What is the best next s…
- Urology: renal cell carcinoma · ApplicationA 58-year-old smoker has painless haematuria and a left flank mass. He also has a left varicocele that does not empty when he lies down. What is the explanation for the…
- Urology: haematuria work-up · ApplicationA 64-year-old man who smokes has had one episode of painless gross haematuria. Urine culture is sterile and ultrasound shows normal kidneys. What is the most appropriat…
- Urology: non-muscle-invasive bladder cancer · Multi-stepA 66-year-old man has a complete transurethral resection of a high-grade pTa urothelial carcinoma with carcinoma in situ. The specimen contains detrusor muscle without…
- Urology: androgen deprivation therapy · Multi-stepA 70-year-old man with metastatic prostate cancer and bone pain is to start a GnRH agonist, leuprolide. What should be added at the start to prevent a tumour flare?
- Urology: struvite calculi · ApplicationA 45-year-old woman with recurrent urinary infections has a staghorn calculus on imaging, and her urine pH is 8.0. Which stone and organism are most likely?
- Urology: uric acid calculi · ApplicationA 55-year-old man with gout has a stone that is not seen on plain radiography but is visible on CT. His urine pH is 5.0. Which measure helps dissolve it?
- Urology: obstructed infected kidney · Multi-stepA 35-year-old woman has left renal colic, temperature 39.2 degrees Celsius, pulse 124 per minute and blood pressure 90/60 mmHg. CT shows an 8 mm proximal ureteric stone…
- Urology: TURP syndrome · ApplicationA 68-year-old man has a 90-minute transurethral resection of the prostate under spinal anaesthesia with glycine irrigation. In recovery he becomes confused and nauseate…
- Urology: priapism · Multi-stepA 22-year-old man with sickle cell disease has had a painful rigid erection for 8 hours. The glans is soft. Cavernosal blood gas shows a dark blood with pH 7.0 and low…
- Urology: bladder injury · Multi-stepA 30-year-old man with a pelvic fracture after a road accident has lower abdominal pain, cannot void, and has gross haematuria. A retrograde cystogram shows contrast ou…
- Urology: post-obstructive diuresis · ApplicationA 72-year-old man with chronic urinary retention has 2.5 litres drained after catheterisation. Next morning his urine output is 400 mL per hour, and he is thirsty, with…
- Urology: medical expulsive therapy · ApplicationA patient with an uncomplicated 6 mm distal ureteric stone has controlled pain, normal renal function and no infection. What is a reasonable management?
- Urology: staghorn calculus · ApplicationA woman with recurrent UTIs has a large branched stone filling the renal pelvis and calyces. What is the preferred treatment?
- Urology: varicocele · ApplicationA 20-year-old has a left scrotal swelling described as a bag of worms that increases on standing and reduces on lying down. Why is it more common on the left?
- Urology: epididymo-orchitis · ApplicationA 25-year-old sexually active man has gradual scrotal pain and fever. Elevation of the scrotum relieves the pain and urinalysis shows pyuria. Which sign is this?
- Urology: Fournier gangrene · Multi-stepA diabetic man has severe scrotal pain, crepitus, dusky skin, fever and hypotension. What is the correct treatment?
- Urology: renal tuberculosis · ApplicationA young man has frequency, sterile pyuria with acidic urine and a contracted bladder. Cultures for routine bacteria are negative. What is the diagnosis?
- Urology: schistosomal bladder cancer · ApplicationA farmer from an area endemic for Schistosoma haematobium has painless haematuria and a bladder tumour. Which histological type is typical in this setting?
- Urology: cystine stones · ApplicationUrine microscopy shows hexagonal crystals and the sodium nitroprusside test is positive. What treatment helps prevent recurrence?
- Urology: calcium oxalate stone prevention · Multi-stepA recurrent stone former has calcium oxalate stones, low urinary citrate and normal urinary calcium. Which agent is most appropriate?
- Urology: IPSS and surgical indications in BPH · ApplicationWhich is an absolute indication for surgery in benign prostatic hyperplasia?
- Urology: prostate cancer diagnosis · Multi-stepA 66-year-old has a PSA of 14 ng/mL. What is the best next step to diagnose prostate cancer?
- Urology: prostate cancer bone metastases · ApplicationA man with prostate cancer has back pain and raised alkaline phosphatase. Which statement describes the likely metastatic pattern?
- Urology: testicular torsion · Multi-stepA 14-year-old boy has sudden severe scrotal pain with vomiting for 3 hours. The testis is high-riding with a transverse lie, and the cremasteric reflex is absent. What…
- Urology: hydrocele surgery · ApplicationA 50-year-old man has a large, tense, painless primary vaginal hydrocele. Which procedures are used for its repair?
- Urology: penile carcinoma · ApplicationAn uncircumcised man with poor hygiene has a non-healing fungating lesion on the glans. Which statement is correct?
- Urology: urethral stricture · ApplicationA man has a poor stream and recurrent UTIs after a straddle injury. A retrograde urethrogram shows a 3 cm bulbar stricture. What is the best definitive treatment?
- Urology: posterior urethral injury in pelvic fracture · Multi-stepAfter a road traffic accident with pelvic fracture, a man has blood at the meatus, inability to void and a high-riding prostate. What should be done initially?
- Urology: renal trauma · ApplicationA stable man with blunt flank trauma and haematuria has a grade III renal laceration on contrast CT without active extravasation. What is the best management?
- Urology: pelviureteric junction obstruction · Multi-stepA 6-year-old has intermittent loin pain and antenatally detected hydronephrosis. Diuretic renography (MAG3) shows delayed drainage with split function of 35 percent on…
- Urology: vesicoureteric reflux · ApplicationA child with recurrent febrile UTIs has grade III reflux on voiding cystourethrography. What is the usual initial management?
- Urology: neurogenic bladder · ApplicationA paraplegic patient with a neurogenic bladder has high residual volumes and hydronephrosis. Which management protects the upper tract?
- Urology: recurrent UTI and asymptomatic bacteriuria · ApplicationIn which situation is asymptomatic bacteriuria treated?
- Urology: Peyronie disease · ApplicationA 55-year-old has painful erections with a new penile curvature and a palpable dorsal plaque for 6 months. Which agent is licensed for stable disease?
- Urology: upper tract urothelial carcinoma · Multi-stepA 65-year-old man has painless haematuria. CT urography shows a filling defect in the renal pelvis, and ureteroscopic biopsy shows high-grade urothelial carcinoma. What…
- Urology: renal cell carcinoma with caval thrombus · Multi-stepA 60-year-old man has a 9 cm right renal mass with tumour extending as a thrombus up the right renal vein into the inferior vena cava. There are no distant metastases.…
- Urology: ureteric stone in pregnancy · Multi-stepA woman in the second trimester has right loin pain, haematuria and mild hydronephrosis on ultrasound. She is afebrile with normal renal function. Which approach is mos…
- Urology: clot retention · ApplicationA man has gross haematuria after TURP and now has severe suprapubic pain, a palpable bladder and inability to void. What is the immediate management?
- Urology: PSA after radical prostatectomy · ApplicationTwo years after radical prostatectomy for localised prostate cancer, a man's PSA, undetectable since surgery, is now rising on serial tests. What does this indicate?
- Urology: renal cell carcinoma · ApplicationA 55-year-old has an incidentally found 3 cm enhancing solid mass confined to the upper pole of the right kidney, and the other kidney is normal. Which operation is pre…
- Urology: adult polycystic kidney disease · ApplicationA 40-year-old has hypertension, bilateral flank masses and haematuria, and his father died of a stroke. Ultrasound shows enlarged kidneys with multiple cysts. Which ext…
- Urology: renal angiomyolipoma · Multi-stepA woman with tuberous sclerosis has sudden flank pain and hypotension. CT shows a 6 cm fat-containing renal mass with a large perirenal haematoma. After resuscitation,…
- Urology: emphysematous pyelonephritis · Multi-stepA diabetic woman with fever, flank pain and vomiting has non-contrast CT showing gas within the renal parenchyma. What is the best management?
- Urology: xanthogranulomatous pyelonephritis · Multi-stepA middle-aged woman with recurrent Proteus urinary infections and a staghorn calculus has a non-functioning enlarged kidney. Histology shows lipid-laden foamy macrophag…
- Urology: balanitis xerotica obliterans · ApplicationA 9-year-old boy has a white, scarred, non-retractile foreskin with narrowing of the urethral meatus. Which condition is this?
- Urology: torsion of the appendix testis · ApplicationA 10-year-old has one day of pain at the upper pole of the testis. A small tender bluish dot is seen through the scrotal skin and the cremasteric reflex is present. Wha…
- Urology: spermatocele · ApplicationA 35-year-old has a painless cystic swelling in the scrotum lying above and behind the testis, separate from it. It transilluminates and aspiration gives a milky fluid.…
- Urology: contraindications to ESWL · ApplicationA urologist plans extracorporeal shock wave lithotripsy for a 1 cm renal pelvic stone. Which patient feature is an absolute contraindication?
- Urology: posterior urethral valves management · ApplicationA newborn boy has a weak urinary stream and a palpable bladder. Antenatal ultrasound had shown bilateral hydronephrosis, a thick-walled bladder and a keyhole sign. Crea…
- Urology: bladder pain syndrome · ApplicationA 45-year-old woman has chronic suprapubic pain relieved by voiding, urgency and nocturia, with sterile urine cultures. Cystoscopy under hydrodistension shows petechial…
- Urology: ureterosigmoidostomy complications · Multi-stepA 30-year-old man had ureterosigmoidostomy for bladder exstrophy in infancy. Besides hyperchloraemic acidosis, for which late complication does he need surveillance col…
- Urology: PSA interpretation on a 5-alpha reductase inhibitor · Multi-stepA 64-year-old man has taken finasteride for his prostate for 18 months. His PSA is now 3.0 ng/mL. How should this value be interpreted?
- Urology: ejaculatory side effect of alpha-blockers · ApplicationA 62-year-old man starting tamsulosin for lower urinary tract symptoms reports that orgasm is preserved but he now produces very little ejaculate. What explains this?
- Urology: overactive bladder drug choice · ApplicationAn 80-year-old woman with overactive bladder develops constipation, dry mouth and confusion on oxybutynin. Which alternative drug acts through a different mechanism and…
- Urology: surgery for stress urinary incontinence · ApplicationA 48-year-old woman leaks urine only on coughing and lifting. Urodynamics show urethral hypermobility with no detrusor overactivity, and pelvic floor exercises have fai…
- Urology: histology of seminoma · ApplicationA 33-year-old man has a painless testicular mass. After orchidectomy, histology shows sheets of uniform polygonal cells with clear cytoplasm separated by fibrous septa…
- Urology: genetics of hereditary renal cell carcinoma · ApplicationA 28-year-old man has bilateral clear cell renal carcinomas, retinal haemangioblastomas and a cerebellar haemangioblastoma. Which gene is affected?
- Urology: radiolucent stone on CT · Multi-stepAn HIV-positive man on antiretroviral therapy has severe renal colic. Non-contrast CT shows hydronephrosis and perinephric stranding but no calculus at any level, and u…
- Urology: prevention of recurrent calcium stones with hypercalciuria · ApplicationA man with recurrent calcium oxalate stones has high 24-hour urinary calcium and normal serum calcium and PTH. Which measure helps prevent recurrence?
- Urology: enteric hyperoxaluria · Multi-stepA man who had an extensive ileal resection for Crohn disease develops recurrent calcium oxalate stones. What is the underlying mechanism?
- Urology: medullary sponge kidney · Multi-stepA 35-year-old woman with recurrent calcium stones and normal renal function has an intravenous urogram showing a linear brush-like blush in the papillae with small cyst…
- Urology: nerve-sparing radical prostatectomy · ApplicationA surgeon performs a nerve-sparing radical prostatectomy to try to preserve erectile function. Which structure is being preserved?
- Urology: acute bacterial prostatitis · ApplicationA 40-year-old man has fever, perineal pain, dysuria and a tender, swollen, warm prostate on rectal examination. Which of the following should be avoided?
- Urology: ectopic ureter in a duplex system · Multi-stepA 4-year-old girl has been constantly damp since toilet training although she voids normally. Ultrasound shows a duplex left kidney with a hydronephrotic upper moiety.…
- Urology: nitrates and phosphodiesterase-5 inhibitors · ApplicationA 62-year-old man with angina taking isosorbide mononitrate asks his surgeon for sildenafil for erectile dysfunction. Why is the combination contraindicated?
- Urology: penile fracture · ApplicationDuring vigorous intercourse a man hears a snap, feels sudden pain and loses his erection. The penis is swollen, bruised and deviated to one side. What is the best manag…
- Urology: testicular rupture · Multi-stepA footballer is kicked in the scrotum and has severe pain with a large tender scrotum. Ultrasound shows a heterogeneous testis with an interrupted tunica albuginea and…
- Urology: obstructing stone in a solitary kidney · Multi-stepA man with a single functioning kidney has 12 hours of anuria and loin pain. CT shows a 7 mm stone at the lower ureter with hydronephrosis, and creatinine has risen fro…
- Urology: torsion · ApplicationAbrupt severe scrotal pain with high-riding testis suggests what?
- Urology: retention · ApplicationPainful inability to void with distended bladder needs what?
- Urology · ApplicationColicky flank-to-groin pain with hematuria suggests what?
- Urology · ApplicationPainless hematuria needs exclusion of what?
- Urology · ApplicationPainful prolonged erection requires what urgency?
- Urology · ApplicationAbrupt painful high-riding testis suggests what?
- Urology · ApplicationPainful retention with bladder distension needs what?
- Urology · ApplicationWhich symptom requires urgent assessment for testicular torsion in an adolescent?
- Urology · ApplicationWhich feature suggests urinary retention requiring prompt bladder assessment?
- Urology · ApplicationWhich presentation is typical of testicular torsion?
- Urology · ApplicationWhat is a key initial step in suspected urinary retention with painful suprapubic distension?
- Urology: obstructed infected kidney · Multi-stepA patient has fever, rigors, flank pain, hydronephrosis, and a ureteric stone on CT. What is the crucial management principle?
- Urology: Fournier gangrene · Multi-stepA patient with diabetes has severe perineal pain, rapidly spreading erythema, crepitus, fever, and hypotension. What is the most appropriate management?
- Urology: testicular torsion · ApplicationAn adolescent with sudden severe unilateral scrotal pain and a high-riding testis needs what?
- Urology: urinary retention · ApplicationA man with painful inability to pass urine and a palpable suprapubic bladder requires what immediate intervention?
- Urology: testicular torsion · Multi-stepAn adolescent has sudden severe unilateral scrotal pain, vomiting, high-riding horizontal testis, and absent cremasteric reflex. What is the next step?
- Urology: renal cell carcinoma · ApplicationA patient has intermittent painless hematuria, flank mass, weight loss, and varicocele that does not decompress when supine. What diagnosis is most likely?
- Urology: posterior urethral injury · Multi-stepAfter pelvic fracture, a patient has blood at the urethral meatus and cannot void. What should be done before attempting urethral catheterization?
- Urology: bladder cancer · ApplicationA smoker has painless visible hematuria without infection. What serious diagnosis must be excluded?
- Urology: renal trauma · ApplicationAfter blunt flank trauma, a stable patient has gross hematuria and flank tenderness. Which imaging is generally used to assess renal injury?
Vascular surgery83
- Vascular surgery · ApplicationA 70-year-old man with atrial fibrillation has sudden severe pain, pallor, coldness and absent pulses in the left leg for three hours. What is the immediate management?
- Vascular surgery · ApplicationA 28-year-old heavy smoker has calf claudication, ulcers on his toes and a history of migratory superficial thrombophlebitis. Which intervention is the most important t…
- Vascular surgery · ApplicationA 72-year-old hypertensive man collapses with sudden severe abdominal and back pain. He is pale, with a blood pressure of 80/50 mmHg and a pulsatile abdominal mass. Wha…
- Vascular surgery · ApplicationA 60-year-old woman has a shallow, irregular ulcer above the medial malleolus with surrounding pigmentation and lipodermatosclerosis. Pulses are palpable. Before compre…
- Vascular surgery · ApplicationA 68-year-old man with atrial fibrillation not on anticoagulation has sudden severe central abdominal pain, but the abdomen is soft with only minimal tenderness. Lactat…
- Vascular surgery: varicose veins · ApplicationA 40-year-old woman has long saphenous varicose veins. With the leg elevated and emptied, a tourniquet is placed at the saphenofemoral junction. On standing, the veins…
- Vascular surgery: aortoiliac occlusion · ApplicationA 55-year-old male smoker has buttock and thigh claudication and erectile dysfunction. Both femoral pulses are absent and the legs are pale on exertion. What is the mos…
- Vascular surgery: claudication pharmacotherapy · ApplicationA 62-year-old man with stable intermittent claudication, on aspirin and a statin, is considered for a drug to lengthen walking distance. Which condition would contraind…
- Vascular surgery: popliteal aneurysm · ApplicationA 64-year-old man has a pulsatile swelling in the left popliteal fossa. Ultrasound shows a 2.4 cm aneurysm with mural thrombus. Which is the most common serious complic…
- Vascular surgery: AAA elective repair · ApplicationA 70-year-old man has an incidental asymptomatic infrarenal aortic aneurysm measuring 5.8 cm on ultrasound. He is fit with no major comorbidity. What is the most approp…
- Vascular surgery: carotid stenosis · ApplicationA 67-year-old man had an episode of transient loss of vision in the right eye lasting 5 minutes, followed by full recovery. Carotid duplex shows 80% stenosis of the rig…
- Vascular surgery: subclavian steal syndrome · ApplicationA 60-year-old man has episodes of dizziness and diplopia when he exercises his left arm. Blood pressure is 100/60 mmHg in the left arm and 150/85 mmHg in the right, wit…
- Vascular surgery: effort thrombosis of the subclavian vein · Multi-stepA 24-year-old competitive swimmer has sudden swelling, heaviness and bluish discolouration of the right arm with prominent chest wall veins. Duplex confirms axillosubcl…
- Vascular surgery: reperfusion compartment syndrome · Multi-stepA 68-year-old man has an embolectomy for acute leg ischaemia after 9 hours. Six hours later the calf is tense and swollen with severe pain on passive dorsiflexion of th…
- Vascular surgery: warfarin-induced skin necrosis · ApplicationOn day 4 of starting warfarin without heparin cover, a woman develops painful, well-demarcated red patches on the thighs that become haemorrhagic and necrotic. What is…
- Vascular surgery: phlegmasia cerulea dolens · ApplicationA 45-year-old woman after pelvic surgery develops sudden massive swelling of the entire left leg that is painful and deeply blue, with blistering. Arterial pulses are f…
- Vascular surgery: complicated type B dissection · Multi-stepA 52-year-old man with a Stanford type B aortic dissection has a cold, pulseless left leg and rising creatinine despite blood pressure control. What is the preferred de…
- Vascular surgery: endoleak after EVAR · Multi-stepSurveillance CT angiography one month after endovascular aneurysm repair shows contrast filling the sac through retrograde flow from a lumbar artery. The sac diameter i…
- Vascular surgery: IVC filter indication · ApplicationA 58-year-old man with acute proximal deep vein thrombosis and pulmonary embolism then develops a major intracranial haemorrhage, making anticoagulation unsafe. What is…
- Vascular surgery: dialysis access steal · ApplicationA diabetic man 3 weeks after a brachiocephalic arteriovenous fistula for dialysis develops a cold, painful, pale hand with rest pain in the fingers, though the fistula…
- Vascular surgery: Takayasu arteritis · Multi-stepA 24-year-old woman has fatigue, arm claudication and low-grade fever for 2 months. The left radial pulse is absent, the arm blood pressures differ by 40 mmHg, there is…
- Vascular surgery: ABPI interpretation · Multi-stepA 68-year-old man with diabetes and chronic kidney disease has a foot ulcer. The brachial systolic pressure is 100 mmHg and the ankle pressure cannot be compressed unti…
- Vascular surgery: splenic artery aneurysm · ApplicationA 30-year-old woman in the third trimester of her third pregnancy collapses with sudden epigastric pain and shock. There is initial transient improvement, then deterior…
- Vascular surgery: DVT probability · ApplicationA patient with a swollen calf has a low pretest probability score for deep vein thrombosis. Which strategy safely excludes DVT?
- Vascular surgery: DVT treatment · ApplicationA 40-year-old has a confirmed popliteal vein DVT after a long flight and no cancer. What is the standard treatment?
- Vascular surgery: diabetic foot · ApplicationA diabetic man has a painless punched-out plantar ulcer under the first metatarsal head. The foot is warm with palpable pulses and reduced sensation. What is the most i…
- Vascular surgery: cervical rib · ApplicationA young woman has wasting of the small hand muscles and numbness on the medial forearm, aggravated by carrying loads. X-ray shows a cervical rib. Which neural structure…
- Vascular surgery: arteriovenous fistula for dialysis · ApplicationA patient with end-stage renal disease needs permanent haemodialysis access. Which fistula is created first, if vessels are suitable?
- Vascular surgery: pseudoaneurysm · ApplicationA man develops a painful pulsatile groin swelling with a systolic bruit two days after cardiac catheterisation via the femoral artery. Duplex shows a neck connecting th…
- Vascular surgery: massive pulmonary embolism · Multi-stepA postoperative patient develops sudden dyspnoea, collapse and BP of 70/40 mmHg. Echo shows a dilated right ventricle and CT confirms a central pulmonary embolus. What…
- Vascular surgery: critical limb ischaemia · ApplicationA diabetic patient has rest pain in the forefoot at night and a non-healing toe ulcer. Ankle systolic pressure is 40 mmHg. What is the appropriate step?
- Vascular surgery: acute limb ischaemia · Multi-stepA patient with atrial fibrillation presents with a cold, pale, painful leg with paraesthesia and no pulses for 4 hours but with preserved motor function. After starting…
- Vascular surgery: ruptured AAA · Multi-stepA 72-year-old with sudden severe back pain, collapse and a pulsatile abdominal mass has a systolic BP of 80 mmHg. What is the best initial approach?
- Vascular surgery: post-thrombotic syndrome · ApplicationTwo years after an iliofemoral DVT, a patient has chronic leg heaviness, swelling and pigmentation. What is the mechanism and mainstay of care?
- Vascular surgery: filarial lymphoedema · ApplicationA man from an endemic area has gross non-pitting leg swelling with thickened skin and recurrent cellulitis. What is the commonest cause of lymphoedema in India?
- Vascular surgery: vascular trauma hard signs · Multi-stepAfter a stab wound to the thigh, a patient has an expanding haematoma, absent distal pulses and a cold foot. What is the next step?
- Vascular surgery: aortoenteric fistula · Multi-stepA man with a previous aortic graft has a small self-limiting haematemesis followed by massive bleeding a few days later. Which diagnosis must be considered?
- Vascular surgery: mycotic aneurysm · ApplicationA patient with Salmonella bacteraemia has a saccular infected aortic aneurysm. What is the principle of treatment?
- Vascular surgery: vascular malformations and tumours · ApplicationA child has a port-wine stain over the trigeminal V1 area, seizures and glaucoma. Which syndrome is this, in contrast to the limb overgrowth syndrome with port-wine sta…
- Vascular surgery: renal artery stenosis · Multi-stepA 28-year-old woman has new severe hypertension with an abdominal bruit. Angiography shows a string-of-beads appearance in the renal arteries. What is the preferred tre…
- Vascular surgery: Leriche syndrome · ApplicationA 55-year-old smoker has fatigue and cramping in both buttocks and thighs on walking, difficulty maintaining erections and absent femoral pulses on both sides. What is…
- Vascular surgery: dry gangrene · Multi-stepA 70-year-old man with atherosclerosis has a shrivelled, black, painless toe with a clear line of demarcation, no pus, and no spreading cellulitis. Which is the most ap…
- Vascular surgery: mesenteric venous thrombosis · Multi-stepA 30-year-old woman on oral contraceptives has two days of worsening abdominal pain out of proportion to examination and a mildly raised lactate. Contrast CT shows a th…
- Vascular surgery: duplex scan in varicose veins · ApplicationA woman with symptomatic varicose veins and aching legs is considering endovenous ablation. Which investigation is essential before intervention?
- Vascular surgery: iliofemoral venous thrombosis · Multi-stepA 28-year-old woman has sudden swelling of the left leg only. Duplex shows thrombosis from the common iliac to the femoral vein, and CT venography shows compression of…
- Vascular surgery: atheroembolism · Multi-stepAfter cardiac catheterisation, a 70-year-old man has painful bluish toes with palpable pedal pulses, eosinophilia and worsening renal function. What is the mechanism?
- Vascular surgery: diabetic foot · ApplicationA diabetic man has a foot ulcer with a deep plantar abscess and osteomyelitis but no gangrene. According to the Wagner classification, which grade is this?
- Vascular surgery: superficial thrombophlebitis · Multi-stepA man has a tender cord along the thigh, and duplex shows thrombus in the great saphenous vein extending right up to the saphenofemoral junction. What is the appropriat…
- Vascular surgery: recognition · ApplicationA man with Marfan syndrome has chest pain, hoarseness, dysphagia, a widened mediastinum on X-ray and an ascending aorta of 5.8 cm on CT, with no tearing pain or intimal…
- Vascular surgery: Adson test · ApplicationA 28-year-old woman has tingling over the medial forearm and hand when she raises her arm. When she extends the neck, rotates the head to the affected side and inhales…
- Vascular surgery: perforating veins · Multi-stepA man has a venous ulcer just above the medial malleolus, and the surgeon plans subfascial endoscopic perforator surgery. Which perforating veins are the usual targets…
- Vascular surgery: thoracoscopic sympathectomy · ApplicationA 20-year-old with severe palmar hyperhidrosis undergoes thoracoscopic sympathectomy at the T2 and T3 levels. Which is the most common troublesome late complication?
- Vascular surgery: nerve injury after vein stripping · ApplicationA 45-year-old woman has varicose vein stripping carried down to the ankle. Afterwards she notices numbness along the medial border of the lower leg and foot. Which nerv…
- Vascular surgery: tumescent anaesthesia in endovenous ablation · ApplicationDuring endovenous laser ablation of a varicose long vein, dilute local anaesthetic is infiltrated along the vein under ultrasound guidance. Apart from anaesthesia, what…
- Vascular surgery: nerve injury in carotid endarterectomy · ApplicationAfter a right carotid endarterectomy, a man's tongue deviates to the right when he protrudes it, and he has difficulty moving food around his mouth. Which nerve was inj…
- Vascular surgery: cerebral hyperperfusion after endarterectomy · Multi-stepThree days after endarterectomy for a tight symptomatic carotid stenosis, a hypertensive man develops severe ipsilateral headache and a focal seizure but no new limb we…
- Vascular surgery: popliteal artery entrapment · ApplicationA 24-year-old marathon runner has calf cramps after a few kilometres. His foot pulses are normal at rest but the pedal pulses disappear when he actively plantar-flexes…
- Vascular surgery: arterial injury after knee dislocation · Multi-stepA motorcyclist has a posterior knee dislocation that is reduced in the emergency department. The foot is warm with palpable pulses, but the ankle-brachial index in that…
- Vascular surgery: drug treatment in acute aortic dissection · ApplicationA 58-year-old man has sudden tearing interscapular pain. CT confirms an acute aortic dissection. His blood pressure is 190/105 mmHg and his heart rate is 110 per minute…
- Vascular surgery: inflammatory aortic aneurysm · Multi-stepA 62-year-old smoker has back pain, weight loss and an ESR of 90 mm/h. CT shows a 5.5 cm infrarenal aortic aneurysm with a markedly thickened enhancing wall, dense peri…
- Vascular surgery: management of chronic lymphoedema · ApplicationA woman has chronic non-pitting lymphoedema of the left leg after pelvic radiotherapy, with recurrent cellulitis. Which is the mainstay of conservative management?
- Vascular surgery: acute Charcot neuro-osteoarthropathy · Multi-stepA diabetic man with peripheral neuropathy has a warm, red, swollen foot for two weeks without any ulcer. Pulses are palpable, inflammatory markers are only mildly raise…
- Vascular surgery: retroperitoneal haemorrhage after femoral puncture · Multi-stepA day after coronary angiography through the right femoral artery, a woman is hypotensive with right flank pain and a falling haemoglobin. The groin is soft, with no sw…
- Vascular surgery: non-viable acute limb ischaemia · Multi-stepAn elderly man presents 24 hours after sudden onset of leg pain. The foot is cold with fixed mottling that does not blanch. There is anaesthesia of the foot, paralysis…
- Vascular surgery: why aneurysms favour the infrarenal aorta · ApplicationThe infrarenal segment of the abdominal aorta is the most common site of atherosclerotic aneurysm. Which feature of this segment contributes most?
- Vascular surgery · ApplicationWhat symptom may suggest acute limb ischemia?
- Vascular surgery · ApplicationWhat is a common risk factor for peripheral arterial disease?
- Vascular surgery · ApplicationWhat is a key symptom of an abdominal aortic aneurysm rupture?
- Vascular surgery · ApplicationWhat initial imaging may be used for suspected abdominal aortic aneurysm in a stable patient?
- Vascular surgery · ApplicationImaging shows a focal enlargement of an arterial lumen caused by wall weakening; which vascular lesion is present?
- Vascular surgery · ApplicationWhich symptom pattern is most consistent with acute limb ischemia?
- Vascular surgery · ApplicationWhat is the priority when a known abdominal aortic aneurysm patient develops sudden abdominal and back pain with collapse?
- Vascular surgery · ApplicationWhich symptom is typical of acute limb ischaemia?
- Vascular surgery · ApplicationWhich measure helps prevent venous thromboembolism after surgery when appropriate?
- Vascular surgery: chronic limb-threatening ischemia · ApplicationA patient with diabetes has rest pain in the forefoot relieved by dangling the leg and a nonhealing toe ulcer. Which vascular syndrome is most likely?
- Vascular surgery: compartment syndrome · Multi-stepAfter tibial fracture fixation, a patient has escalating pain despite opioids and severe pain on passive toe extension. Pulses remain palpable. What is the next best ac…
- Vascular surgery: acute limb ischaemia · ApplicationWhich sign is part of the classic acute limb ischaemia 'six Ps'?
- Vascular surgery: chronic venous disease · ApplicationA venous leg ulcer is most commonly located where?
- Vascular surgery: ruptured aneurysm · Multi-stepA patient with known abdominal aortic aneurysm has sudden back pain, collapse, and hypotension. What is the correct management principle?
- Vascular surgery: carotid disease · ApplicationA patient has transient unilateral weakness and carotid ultrasound shows symptomatic severe internal carotid stenosis. Which management may reduce future stroke risk in…
- Vascular surgery: acute limb ischemia · Multi-stepA patient with atrial fibrillation develops sudden painful cold pale leg with absent pulses and sensory loss. What is the immediate management principle?
- Vascular surgery: chronic venous disease · ApplicationA patient has ankle edema, hemosiderin staining in the gaiter area, and a shallow irregular ulcer above the medial malleolus. What is the likely ulcer type?
- Vascular surgery: varicose vein bleeding · ApplicationA patient with varicose veins has brisk bleeding after minor trauma to the lower leg. What first-aid measure is most appropriate?
Gastrointestinal surgery65
- Gastrointestinal surgery: Lauren classification and D2 gastrectomy · ApplicationWhich statement about gastric cancer is correct?
- Gastrointestinal surgery: perforated duodenal ulcer · Multi-stepA 45-year-old NSAID user has sudden severe epigastric pain with a board-like abdomen. Erect chest film shows gas under the right hemidiaphragm. He is resuscitated and c…
- Gastrointestinal surgery: Gastrografin in small bowel obstruction · Multi-stepA 60-year-old with previous laparotomy has adhesive small bowel obstruction with no peritonism and stable vitals after 48 hours of nasogastric decompression. Water-solu…
- Gastrointestinal surgery: Alvarado score · ApplicationWhich component carries the highest weight (2 points) in the Alvarado score for appendicitis?
- Gastrointestinal surgery: pseudomyxoma peritonei · ApplicationA woman has progressive abdominal distension with jelly-like mucinous ascites and a mucinous lesion of the appendix. What is the recommended treatment for fit patients?
- Gastrointestinal surgery: Hartmann procedure · Multi-stepA 72-year-old with ischaemic heart disease has faecal peritonitis from perforated sigmoid diverticulitis and is in septic shock. Which operation is generally safest?
- Gastrointestinal surgery: short bowel syndrome · ApplicationA patient after massive small bowel resection has 80 cm of jejunum left with an end jejunostomy and high-volume output. What is the key long-term support?
- Gastrointestinal surgery: intestinal tuberculosis surgery · Multi-stepA young patient from an endemic area has recurrent subacute obstruction with a thickened ileocaecal mass and caseating granulomas on biopsy. After antitubercular therap…
- Gastrointestinal surgery: anastomotic leak risk factors · Multi-stepOn day 5 after low anterior resection, a malnourished steroid-treated patient develops fever, tachycardia, and faeculent drain output. Which factor is least likely to h…
- Gastrointestinal surgery: faecal peritonitis management · Multi-stepA patient has diffuse peritonitis from a perforated sigmoid colon with faecal contamination. Which management bundle is correct?
- Gastrointestinal surgery: abdominal compartment syndrome · Multi-stepAfter massive resuscitation for pancreatitis, a patient has a tense abdomen, oliguria and rising airway pressures. Bladder pressure is 28 mmHg. What is the next best st…
- Gastrointestinal surgery: adult intussusception · Multi-stepA 55-year-old has recurrent colicky abdominal pain and CT shows a target sign in the ileocaecal region. What is the key difference from childhood intussusception?
- Gastrointestinal surgery: pilonidal sinus · ApplicationA young hirsute man has recurrent discharge from midline pits in the natal cleft. Which is the best surgical principle for chronic disease?
- Gastrointestinal surgery: ileosigmoid knotting · Multi-stepA young farmer breaks a long fast with a heavy meal and within hours has severe colicky abdominal pain, vomiting and rapid distension. Films show dilated small bowel lo…
- Gastrointestinal surgery: pseudoachalasia · Multi-stepA 68-year-old man has had three months of progressive dysphagia and an 8 kg weight loss. Barium swallow shows a smooth bird-beak tapering at the lower oesophagus. What…
- Gastrointestinal surgery: gastric antral vascular ectasia · Multi-stepAn elderly woman has chronic iron deficiency anaemia needing repeated transfusion. Endoscopy shows red longitudinal stripes converging on the pylorus, with no varices o…
- Gastrointestinal surgery: tuberculous peritonitis · Multi-stepA 24-year-old woman from a rural area has two months of low-grade fever, weight loss and ascites. Ascitic fluid is a lymphocytic exudate with a serum-ascites albumin gr…
- Gastrointestinal surgery: malignant colonic polyp · Multi-stepColonoscopy finds a pedunculated polyp that is removed completely with a long stalk. Histology shows invasive adenocarcinoma confined to the head and upper stalk, well…
- Gastrointestinal surgery: nerve injury in rectal cancer surgery · Multi-stepAfter anterior resection with high ligation of the inferior mesenteric artery for rectal cancer, a man reports that semen no longer emerges at climax, though he still g…
- Gastrointestinal surgery: staging laparoscopy in gastric cancer · Multi-stepA 60-year-old man has biopsy-proven gastric adenocarcinoma. CT shows a resectable-looking antral tumour with no obvious distant disease, but the radiologist notes a sma…
- Gastrointestinal surgery: palliation of oesophageal cancer · ApplicationA 72-year-old with unresectable squamous carcinoma of the mid-oesophagus cannot swallow saliva and has a life expectancy of a few months. Which measure gives the quicke…
- Gastrointestinal surgery: pouchitis · ApplicationEight months after restorative proctocolectomy with an ileal pouch for ulcerative colitis, a man has increased stool frequency, urgency, abdominal cramps and low-grade…
- Gastrointestinal surgery: haemorrhoids grading · ApplicationA 45-year-old man has bright red bleeding after defecation and a lump that comes down on straining and has to be pushed back in by hand. Proctoscopy confirms internal p…
- Gastrointestinal surgery: post-gastrectomy syndromes · Multi-stepSome months after a Billroth II gastrectomy, a man has postprandial epigastric fullness and pain that is relieved by sudden projectile vomiting of bile-stained fluid co…
- Gastrointestinal surgery: retroperitoneal fibrosis · Multi-stepA 55-year-old man has dull back pain, a raised ESR and rising creatinine. CT shows a plaque of soft tissue around the aorta, and imaging shows both ureters pulled media…
- Gastrointestinal surgery: spontaneous bacterial peritonitis · ApplicationA cirrhotic patient with ascites has fever and diffuse abdominal tenderness. Diagnostic paracentesis shows an ascitic neutrophil count of 400 per cubic mm. What is the…
- Gastrointestinal surgery: oesophagectomy complications · Multi-stepOn day 5 after a transthoracic oesophagectomy, a patient on enteral feeds drains 1.2 litres a day of milky fluid from the chest tube. The fluid has a high triglyceride…
- Gastrointestinal surgery: hidradenitis suppurativa · ApplicationA 25-year-old obese smoker has recurrent painful nodules, discharging sinuses and scarring in both axillae and groins. What is the underlying pathology?
- Gastrointestinal surgery: actinomycosis · ApplicationA man with poor dental hygiene has a chronic indurated swelling at the angle of the jaw with multiple discharging sinuses. The discharge contains yellow granules, and G…
- Gastrointestinal surgery: animal bite management · Multi-stepA 6-year-old is bitten on the forearm by a stray dog in India, and the bite is bleeding. The dog cannot be traced. What is the correct management?
- Gastrointestinal surgery: marginal ulcer · Multi-stepEight months after a gastrojejunostomy for duodenal ulcer, a man has epigastric pain and bleeding. Endoscopy shows an ulcer on the jejunal side of the anastomosis. What…
- Gastrointestinal surgery: appendicitis in pregnancy · ApplicationA woman at 30 weeks of pregnancy has fever and right abdominal pain with maximal tenderness in the right flank above the iliac crest. What best explains the site of pain?
- Gastrointestinal surgery: stercoral perforation · Multi-stepA bedridden 80-year-old with chronic constipation has generalised peritonitis. CT shows a dilated sigmoid colon packed with faeces and free air. What is the likely mech…
- Gastrointestinal surgery: perihepatitis · Multi-stepA 24-year-old sexually active woman with pelvic inflammatory disease has sharp right upper quadrant pain worse on breathing. Liver tests and ultrasound are normal, and…
- Gastrointestinal surgery: post-vagotomy diarrhoea · Multi-stepA man who had truncal vagotomy and drainage years ago has episodic explosive watery diarrhoea. Which drug often helps?
- Gastrointestinal surgery: umbilical metastasis · ApplicationA 62-year-old woman with weight loss and ascites has a hard, irregular 2 cm nodule at the umbilicus. CT shows a thickened gastric wall with omental caking. What is the…
- Gastrointestinal surgery: Krukenberg tumour · ApplicationA 38-year-old woman has abdominal distension. Imaging shows bilateral solid ovarian masses that preserve the ovarian shape. Histology shows mucin-filled signet-ring cel…
- Gastrointestinal surgery: Cushing ulcer mechanism · Multi-stepA 28-year-old man on a ventilator after a severe head injury with raised intracranial pressure vomits blood on day 4. Endoscopy shows a deep solitary duodenal ulcer. Wh…
- Gastrointestinal surgery: Hinchey classification · Multi-stepA 67-year-old man with left iliac fossa pain and fever has signs of generalised peritonitis. At laparotomy there is purulent fluid throughout the peritoneal cavity from…
- Gastrointestinal surgery: Menetrier disease · Multi-stepA 50-year-old man has epigastric pain, vomiting and pedal oedema. Endoscopy shows giant convoluted folds in the gastric fundus and body with sparing of the antrum. Seru…
- Gastrointestinal surgery: gastric MALT lymphoma · ApplicationA 55-year-old man with dyspepsia has an ulcerated gastric lesion. Biopsy shows lymphoepithelial lesions of marginal zone B cells, Helicobacter pylori is positive, and s…
- Gastrointestinal surgery: Forrest classification · ApplicationA man with melaena has urgent endoscopy that shows a duodenal ulcer with a pulsatile spurt of blood from the ulcer base. Which Forrest class is this?
- Gastrointestinal surgery: diffuse oesophageal spasm · ApplicationA 45-year-old has intermittent chest pain and dysphagia for both solids and liquids. Barium swallow shows a corkscrew oesophagus, and manometry shows simultaneous contr…
- Gastrointestinal surgery: Schatzki ring · ApplicationA 55-year-old man has recurrent episodes of sudden dysphagia when eating meat, relieved by regurgitation. He has no weight loss. Barium swallow shows a thin ring at the…
- Gastrointestinal surgery: antibiotic-associated colitis treatment · ApplicationA 68-year-old woman develops profuse watery diarrhoea, fever and leucocytosis nine days after a course of clindamycin. Stool toxin assay is positive and colonoscopy sho…
- Gastrointestinal surgery: neutropenic enterocolitis · Multi-stepA 34-year-old with acute leukaemia on induction chemotherapy has an absolute neutrophil count of 200 per microlitre, fever and right lower quadrant pain. CT shows a thi…
- Gastrointestinal surgery: appendiceal mucocele · ApplicationDuring laparoscopy for a right iliac fossa mass, a surgeon finds a 4 cm distended, mucus-filled appendix with an intact wall and no free mucin in the peritoneal cavity.…
- Gastrointestinal surgery: alkaline reflux gastritis · Multi-stepTwo years after a Billroth II gastrectomy for ulcer disease, a man has constant epigastric burning pain, bilious vomiting that does not relieve the pain, weight loss an…
- Gastrointestinal surgery: investigation before antireflux surgery · ApplicationA 40-year-old man has typical heartburn that has not responded to a full course of proton pump inhibitors. Upper gastrointestinal endoscopy is normal. Before considerin…
- Gastrointestinal surgery: gas-bloat after fundoplication · Multi-stepThree weeks after a laparoscopic total fundoplication, a woman is unable to belch or vomit and has distressing abdominal bloating. Dysphagia is minimal. Which mechanism…
- Gastrointestinal surgery: complex fistula-in-ano · Multi-stepA man has a recurrent perianal fistula. MRI shows a high transsphincteric tract passing through a substantial part of the external sphincter. Which approach best preser…
- Gastrointestinal surgery: chylous ascites · ApplicationA woman with abdominal lymphoma has progressive abdominal distension. Paracentesis yields opaque, milky fluid that does not clear on centrifugation. Which finding on fl…
- Gastrointestinal surgery: Gardner syndrome · ApplicationA 22-year-old man has hundreds of colonic adenomas, a mandibular osteoma and multiple epidermoid cysts of the skin. His father had a similar picture. Which syndrome is…
- Gastrointestinal surgery: epiphrenic diverticulum · Multi-stepA 62-year-old man has dysphagia and regurgitation. Barium swallow shows a 5 cm pouch arising from the lower oesophagus a few centimetres above the diaphragm. What is th…
- Gastrointestinal surgery: Barrett oesophagus with high-grade dysplasia · Multi-stepA 55-year-old man with a 4 cm segment of Barrett oesophagus has biopsies, confirmed by two pathologists, showing high-grade dysplasia in a flat area without any visible…
- Gastrointestinal surgery: staging of oesophageal cancer · ApplicationA 60-year-old man has biopsy-proven adenocarcinoma of the lower oesophagus and CT shows no distant disease. Which investigation best defines depth of tumour invasion an…
- Gastrointestinal surgery: appendiceal neuroendocrine tumour size · ApplicationAfter appendicectomy for appendicitis, histology shows a 2.5 cm well-differentiated neuroendocrine tumour at the base of the appendix with extension into the caecum. Wh…
- Gastrointestinal surgery: diverticular haemorrhage · Multi-stepA 72-year-old man passes a large volume of fresh red blood per rectum. After resuscitation his pulse and blood pressure are stable, but bleeding continues and an urgent…
- Gastrointestinal surgery: adjuvant therapy for node-positive colon cancer · ApplicationA 58-year-old man has a curative right hemicolectomy for adenocarcinoma. Histology shows invasion through the muscularis propria with metastasis in 3 of 14 regional nod…
- Gastrointestinal surgery: low anterior resection syndrome · ApplicationSix months after an ultra-low anterior resection with a coloanal anastomosis, a man has urgency, clustering of stools within an hour and frequent passage of small amoun…
- Gastrointestinal surgery: hereditary diffuse gastric cancer · ApplicationA 28-year-old woman carries a germline CDH1 mutation and her mother and aunt died of diffuse-type gastric cancer. Endoscopy and random biopsies are normal. What is the…
- Gastrointestinal surgery: stagnant loop syndrome · Multi-stepA man had a side-to-side jejunal anastomosis with a long defunctioned segment. Years later he has weight loss, steatorrhoea, abdominal bloating and macrocytic anaemia w…
- Gastrointestinal surgery: solitary rectal ulcer syndrome · Multi-stepA 30-year-old man with years of straining at stool and feelings of incomplete evacuation has rectal bleeding and mucus. Sigmoidoscopy shows a shallow ulcer on the anter…
- Gastrointestinal surgery: perforated diverticulitis · Multi-stepA patient with sigmoid diverticulitis has generalized peritonitis and free intraperitoneal air. What is the surgical principle?
- Gastrointestinal surgery: short bowel syndrome · ApplicationAfter extensive small-bowel resection, a patient has chronic diarrhea, weight loss, electrolyte losses, and malabsorption. What syndrome is present?
Hepatobiliary and pancreatic surgery52
- Hepatobiliary and pancreatic surgery: acute cholangitis management · Multi-stepA patient with gallstones has fever with rigors, jaundice, right upper quadrant pain, confusion and a blood pressure of 80/50 mmHg. Which is the best definitive step af…
- Hepatobiliary and pancreatic surgery: Klatskin tumour and Bismuth-Corlette · ApplicationA hilar cholangiocarcinoma extends to involve the confluence and both the right and left hepatic ducts up to secondary radicles. What is the Bismuth-Corlette type?
- Hepatobiliary and pancreatic surgery: Strasberg classification · Multi-stepAfter laparoscopic cholecystectomy a patient has bile in the drain from a leak at the cystic duct stump with the common bile duct intact. Which Strasberg type is this?
- Hepatobiliary and pancreatic surgery: post-cholecystectomy bile leak · Multi-stepOn day 3 after cholecystectomy, a patient has abdominal pain, fever and a collection on ultrasound. A drain yields bile and HIDA scan shows tracer in the collection wit…
- Hepatobiliary and pancreatic surgery: periampullary carcinoma · Multi-stepA patient has intermittent jaundice, silver-coloured stools, and a polypoid mass at the ampulla on duodenoscopy with biopsy-proven adenocarcinoma. Why is the outlook ge…
- Hepatobiliary and pancreatic surgery: IPMN management · Multi-stepMRCP in a 65-year-old shows a main pancreatic duct dilated to 12 mm with a cystic lesion communicating with it. What is the best management?
- Hepatobiliary and pancreatic surgery: HCC treatment by stage · Multi-stepA cirrhotic Child-Pugh A patient without portal hypertension has a solitary 4 cm hepatocellular carcinoma without vascular invasion. Which treatment gives the best chan…
- Hepatobiliary and pancreatic surgery: colorectal liver metastases · Multi-stepA patient with resected colon cancer has two metastases confined to the right lobe. What determines resectability?
- Hepatobiliary and pancreatic surgery: hepatic adenoma · ApplicationA young woman on long-term oral contraceptives has a 6 cm hepatic adenoma. What is the most appropriate management?
- Hepatobiliary and pancreatic surgery: surgery in portal hypertension · Multi-stepA Child A cirrhotic patient has recurrent variceal bleeding despite beta-blockers and band ligation. Which procedure selectively decompresses the varices while preservi…
- Hepatobiliary and pancreatic surgery: extrahepatic portal venous obstruction · ApplicationA 10-year-old boy has massive haematemesis, splenomegaly, normal liver function tests and normal liver on ultrasound with portal cavernoma. Which diagnosis is most like…
- Hepatobiliary and pancreatic surgery: pancreatic trauma · Multi-stepAfter a handlebar injury to the epigastrium, a boy has persistent pain, raised amylase, and CT shows transection of the pancreatic body with a disrupted main duct. What…
- Hepatobiliary and pancreatic surgery: somatostatinoma · Multi-stepA 55-year-old woman has gallstones found at cholecystectomy, new mild diabetes mellitus and pale bulky greasy stools. A large pancreatic head mass is seen on CT. Which…
- Hepatobiliary and pancreatic surgery: biliary dyskinesia · ApplicationA 30-year-old woman has recurrent post-prandial right upper quadrant pain. Ultrasound shows no gallstones, liver tests are normal and endoscopy is normal. A cholecystok…
- Hepatobiliary and pancreatic surgery: acute liver failure prognosis · Multi-stepA 24-year-old woman presents 3 days after a deliberate paracetamol overdose with encephalopathy, rising INR and jaundice. Despite full fluid resuscitation and acetylcys…
- Hepatobiliary and pancreatic surgery: symptomatic simple liver cyst · ApplicationA 50-year-old woman with early satiety and dull right upper quadrant pain has a 10 cm thin-walled unilocular liver cyst without septa or calcified wall, and hydatid ser…
- Hepatobiliary and pancreatic surgery: albumin with large-volume paracentesis · ApplicationA man with cirrhosis and tense ascites undergoes removal of 8 litres of ascitic fluid in one session. Which measure best prevents post-paracentesis circulatory dysfunct…
- Hepatobiliary and pancreatic surgery: gallstone disease in pregnancy · ApplicationA woman in the second trimester has recurrent attacks of biliary colic and one episode of acute cholecystitis. What is the best management for recurrent symptomatic gal…
- Hepatobiliary and pancreatic surgery: amoebic abscess aspiration · Multi-stepA man with an 8 cm amoebic liver abscess in the left lobe is on metronidazole but still has pain and fever on day 5. Ultrasound shows the abscess approaching the perica…
- Hepatobiliary and pancreatic surgery: porcelain gallbladder · ApplicationAn asymptomatic 60-year-old woman has a calcified gallbladder wall on CT. What is advised?
- Hepatobiliary and pancreatic surgery: acalculous cholecystitis · ApplicationA critically ill burns patient on parenteral nutrition for three weeks develops fever and right upper quadrant tenderness. Ultrasound shows a distended gallbladder with…
- Hepatobiliary and pancreatic surgery: hepatocellular carcinoma · ApplicationA patient with hepatitis B cirrhosis, Child-Pugh B, has a solitary 2 cm hepatocellular carcinoma and is unfit for resection or transplant. Which local treatment can ach…
- Hepatobiliary and pancreatic surgery: post-ERCP pancreatitis · ApplicationA patient with a common bile duct stone is about to have ERCP and is at high risk of post-procedure pancreatitis. Which simple measure reduces its incidence?
- Hepatobiliary and pancreatic surgery: liver trauma · ApplicationA 20-year-old after a road traffic accident has a grade III liver laceration on contrast CT. His blood pressure is 120/80 mmHg, his pulse is 84 per minute and he has no…
- Hepatobiliary and pancreatic surgery: pancreaticoduodenectomy complications · Multi-stepFive days after a pancreaticoduodenectomy, a patient has fever and a drain output of amylase-rich fluid, with no peritonitis. Which complication is this?
- Hepatobiliary and pancreatic surgery: delayed gastric emptying · Multi-stepAfter pancreaticoduodenectomy, a patient cannot tolerate diet from day 8 and has high nasogastric aspirates. A contrast study shows no leak and CT is normal. What is th…
- Hepatobiliary and pancreatic surgery: CT severity index · ApplicationA radiologist reports the CT severity index in a patient with acute pancreatitis. Which two CT findings are combined to calculate it?
- Hepatobiliary and pancreatic surgery: Pringle manoeuvre · Multi-stepDuring laparotomy for blunt liver trauma, the surgeon clamps the hepatoduodenal ligament, but dark, steady bleeding continues from behind the liver. Which injury is mos…
- Hepatobiliary and pancreatic surgery: Bouveret syndrome · Multi-stepA 74-year-old woman with previous gallstones has repeated vomiting of undigested food for four days. CT shows a distended stomach, air in the biliary tree and a 3 cm ca…
- Hepatobiliary and pancreatic surgery: focal nodular hyperplasia · ApplicationA 29-year-old woman has an incidental 4 cm liver lesion on ultrasound. MRI shows a well-circumscribed lesion with bright arterial enhancement and a central stellate sca…
- Hepatobiliary and pancreatic surgery: hepatic haemangioma · ApplicationA 45-year-old woman has an asymptomatic 3 cm liver lesion found on ultrasound. Multiphase CT shows peripheral nodular enhancement in the arterial phase with progressive…
- Hepatobiliary and pancreatic surgery: hepatorenal syndrome · Multi-stepA 52-year-old man with alcoholic cirrhosis and ascites has a creatinine rise from 1.0 to 2.6 mg/dL over a week. Diuretics were stopped and albumin was given for two day…
- Hepatobiliary and pancreatic surgery: Caroli disease · Multi-stepA 20-year-old has recurrent episodes of fever, jaundice and right upper quadrant pain. MRCP shows saccular dilatations of the intrahepatic bile ducts that communicate w…
- Hepatobiliary and pancreatic surgery: sinistral portal hypertension · Multi-stepA man with a history of chronic pancreatitis has isolated gastric fundal varices with no oesophageal varices. Liver function is normal and he has splenomegaly. What are…
- Hepatobiliary and pancreatic surgery: amoebic liver abscess treatment · ApplicationA man with a solitary right-lobe amoebic liver abscess has improved clinically after a ten-day course of metronidazole. Which drug should follow to clear the intestinal…
- Hepatobiliary and pancreatic surgery: exocrine insufficiency in chronic pancreatitis · ApplicationA 45-year-old man with long-standing alcohol-related chronic pancreatitis passes pale, bulky, foul-smelling stools that float and has lost weight. What is the most appr…
- Hepatobiliary and pancreatic surgery: autoimmune pancreatitis · Multi-stepA 60-year-old man has obstructive jaundice, weight loss and diffuse sausage-shaped pancreatic enlargement on CT with a featureless duct. Serum IgG4 is raised, and chola…
- Hepatobiliary and pancreatic surgery: unresectable pancreatic head cancer · Multi-stepA 62-year-old man with a pancreatic head adenocarcinoma undergoes multiphase CT for staging. Which finding indicates locally advanced, unresectable disease?
- Hepatobiliary and pancreatic surgery: bleeding gastric varices · Multi-stepA cirrhotic patient with portal hypertension has acute bleeding from isolated fundal gastric varices extending from the cardia. What is the preferred endoscopic treatme…
- Hepatobiliary and pancreatic surgery: primary biliary cholangitis · ApplicationA 48-year-old woman has fatigue, itching and a raised alkaline phosphatase. Ultrasound shows normal bile ducts and she is positive for antimitochondrial antibodies. Whi…
- Hepatobiliary and pancreatic surgery: critical view of safety · ApplicationA trainee is taught the criteria to be met before clipping and dividing any structure during laparoscopic cholecystectomy. Which description fits the critical view of s…
- Hepatobiliary and pancreatic surgery: emphysematous cholecystitis · ApplicationA 65-year-old man with diabetes has right upper quadrant pain and sepsis. CT shows gas within the gallbladder wall and lumen. Which gas-forming anaerobe is characterist…
- Hepatobiliary and pancreatic surgery: non-invasive diagnosis of HCC · Multi-stepA 55-year-old man with hepatitis B cirrhosis has a 3 cm nodule found on surveillance ultrasound. Multiphase CT shows arterial-phase hyperenhancement with washout in the…
- Hepatobiliary and pancreatic surgery: fibrolamellar carcinoma · Multi-stepA 22-year-old woman with no liver disease has a 12 cm liver mass with a central scar and calcification. Alpha-fetoprotein is normal. Histology shows large polygonal eos…
- Hepatobiliary and pancreatic surgery: hydatid cyst percutaneous treatment · Multi-stepPercutaneous puncture, aspiration, injection and re-aspiration (PAIR) is being considered for a hepatic hydatid cyst. Which finding is a contraindication?
- Hepatobiliary and pancreatic surgery: serous cystadenoma · ApplicationA 55-year-old woman has an incidental 4 cm pancreatic cyst. CT shows a cluster of many tiny cysts with a central stellate scar and calcification. Cyst fluid is low in C…
- Hepatobiliary and pancreatic surgery: hypocalcaemia in acute pancreatitis · ApplicationOn day 3 of severe acute pancreatitis, a patient has a serum calcium of 1.8 mmol/L despite normal albumin. Which mechanism contributes to this finding?
- Hepatobiliary and pancreatic surgery: adenomyomatosis of the gallbladder · Multi-stepUltrasound of a 50-year-old woman with vague dyspepsia shows focal thickening of the gallbladder fundal wall with small intramural cystic spaces and bright comet-tail e…
- Hepatobiliary and pancreatic surgery: mucocele of the gallbladder · ApplicationA 70-year-old woman has a smooth, non-tender, palpable gallbladder with no fever or jaundice. Ultrasound shows a distended gallbladder filled with clear mucoid fluid an…
- Hepatobiliary and pancreatic surgery: recurrent pyogenic cholangitis · Multi-stepA 40-year-old woman from East Asia has repeated episodes of cholangitis. Imaging shows dilated intrahepatic ducts of the left lateral segment and right posterior sector…
- Hepatobiliary and pancreatic surgery: bleeding pancreatic pseudocyst · Multi-stepA man with a known pancreatic pseudocyst has sudden upper gastrointestinal bleeding with blood coming through the ampulla at endoscopy. CT angiography shows an arterial…
- Hepatobiliary and pancreatic surgery: location of gastrinoma · ApplicationA patient with recurrent ulcers and a confirmed gastrinoma needs imaging. In which location are most sporadic gastrinomas found?
Paediatric surgery51
- Paediatric surgery: infantile hypertrophic pyloric stenosis · Multi-stepA 5-week-old first-born boy has projectile non-bilious vomiting after every feed and an olive-sized mass in the epigastrium. He is dehydrated with serum sodium 132, chl…
- Paediatric surgery: intussusception reduction · ApplicationA 9-month-old boy has episodic screaming with drawing up of the legs and passes red currant jelly stool. He is haemodynamically stable with no peritonitis, and ultrasou…
- Paediatric surgery: oesophageal atresia anatomy · ApplicationA newborn has frothing at the mouth and chokes with the first feed. A nasogastric tube coils in the upper chest, and the abdominal radiograph shows gas in the stomach.…
- Paediatric surgery: congenital diaphragmatic hernia · Multi-stepA term newborn has severe respiratory distress at birth, a scaphoid abdomen and heart sounds displaced to the right, and bowel loops are seen in the left chest on radio…
- Paediatric surgery: gastroschisis initial care · ApplicationA newborn has loops of thickened bowel outside the abdomen through a defect to the right of the umbilical cord, with no covering membrane. What is the best immediate ma…
- Paediatric surgery: Beckwith-Wiedemann syndrome · ApplicationA newborn has an omphalocele, macroglossia and a large birth weight. Which complication needs early monitoring in the first days of life?
- Paediatric surgery: anorectal malformation · Multi-stepA newborn boy has no visible anal opening, a flat perineum and meconium passing in the urine. What is the most appropriate initial management?
- Paediatric surgery: necrotising enterocolitis surgery · ApplicationA preterm infant of 1.2 kg on day 9 has abdominal distension and bloody stools, and radiography showed pneumatosis intestinalis. Now there is free air under the diaphra…
- Paediatric surgery: neuroblastoma · ApplicationA 2-year-old child has a firm irregular abdominal mass that crosses the midline, periorbital ecchymoses and bone pain. Calcification is seen on radiograph. Which test b…
- Paediatric surgery: sacrococcygeal teratoma · ApplicationA newborn has a large mass protruding from the sacral region. Imaging shows a predominantly solid tumour with a pelvic component, and alpha-fetoprotein is elevated. Whi…
- Paediatric surgery: cystic hygroma · ApplicationA newborn has a soft, fluctuant, brilliantly transilluminant swelling in the posterior triangle of the neck, not moving with swallowing. What is the lesion?
- Paediatric surgery: infantile haemangioma · ApplicationA 3-month-old girl has a rapidly enlarging bright red raised lesion on the upper eyelid that is starting to close the eye. What is the preferred treatment?
- Paediatric surgery: malrotation with volvulus · Multi-stepA 5-day-old, previously well, haemodynamically stable neonate has sudden bilious vomiting. The abdomen is soft and not distended. Which investigation should be done urg…
- Paediatric surgery: duodenal atresia · ApplicationA newborn with upslanting palpebral fissures and a single palmar crease vomits bilious fluid on day one. Radiograph shows a double bubble with no distal gas. What is th…
- Paediatric surgery: button battery ingestion · ApplicationA 2-year-old child is brought 1 hour after swallowing a flat 20 mm lithium coin cell battery. Radiograph shows a double-contour disc at the level of the clavicles. He i…
- Paediatric surgery: exomphalos · ApplicationA newborn has a midline abdominal wall defect at the umbilicus covered by a translucent membrane containing the liver. Which statement is true?
- Paediatric surgery: meconium ileus · ApplicationA newborn has bilious vomiting, abdominal distension and failure to pass meconium. Abdominal film shows a ground-glass appearance with soap-bubble opacity. Which underl…
- Paediatric surgery: jejunoileal atresia · Multi-stepA newborn with bilious vomiting is found to have a jejunoileal atresia in which the distal ileum spirals around a single mesenteric vessel in an apple-peel pattern. Wha…
- Paediatric surgery: sternomastoid tumour · ApplicationA 3-week-old infant has a firm, non-tender, olive-shaped lump in the neck and head tilt toward the side of the lump with the chin turned to the opposite side. What is t…
- Paediatric surgery: Hirschsprung enterocolitis · Multi-stepA neonate with Hirschsprung disease develops fever, explosive foul-smelling diarrhoea and abdominal distension with lethargy. What is the diagnosis and treatment?
- Paediatric surgery: impalpable undescended testis · ApplicationA 9-month-old has a unilateral impalpable testis on repeated examination. What is the best next step?
- Paediatric surgery: bladder exstrophy · ApplicationA newborn has an exposed bladder mucosa on the lower abdominal wall with a widened pubic symphysis and epispadias. What is the management principle?
- Paediatric surgery: rectal prolapse in children · ApplicationA 3-year-old has repeated mucosal rectal prolapse during defecation. Which condition should be excluded, and what is the usual outcome?
- Paediatric surgery: appendicitis in young children · ApplicationA 3-year-old has fever, vomiting and diffuse abdominal pain for 2 days. Which statement about appendicitis in this age group is correct?
- Paediatric surgery: hepatoblastoma · Multi-stepA 1-year-old has an enlarging upper abdominal mass, with serum alpha-fetoprotein markedly raised and a solitary liver lesion on CT. What is the treatment plan?
- Paediatric surgery: rhabdomyosarcoma · Multi-stepA 3-year-old girl has grape-like polypoid masses protruding from the vagina. Biopsy shows small round blue cells with strong desmin positivity. What is the diagnosis?
- Paediatric surgery: congenital pulmonary airway malformation · Multi-stepA 6-month-old has recurrent chest infections at the same site. Chest CT shows a multicystic mass in the right lower lobe with a normal systemic blood supply. What is th…
- Paediatric surgery: juvenile polyp · ApplicationA 4-year-old child passes bright red blood with stools without pain or systemic upset. A smooth rounded reddish rectal polyp is felt. What is the usual diagnosis and tr…
- Paediatric surgery: trichobezoar · ApplicationA 14-year-old girl who eats her own hair has early satiety, vomiting and a palpable epigastric mass. CT shows a mottled gastric mass that moulds to the stomach and exte…
- Paediatric surgery: mesenteric adenitis · ApplicationA 7-year-old with a recent sore throat has fever and right iliac fossa pain. Ultrasound shows enlarged ileocaecal lymph nodes and a normal appendix. What is the diagnos…
- Paediatric surgery: Hirschsprung pull-through procedures · Multi-stepAn infant with biopsy-proven Hirschsprung disease has a pull-through in which the aganglionic rectal stump is left in place behind the ganglionic colon, and the two are…
- Paediatric surgery: congenital lobar emphysema · ApplicationA 3-week-old infant has progressive tachypnoea and wheeze. A chest radiograph shows a hyperlucent left upper zone with attenuated vascular markings, compression of the…
- Paediatric surgery: lead point in older child intussusception · Multi-stepAn 8-year-old boy has a second episode of ileocolic intussusception three weeks after a successful air enema reduction. What should be sought as the cause?
- Paediatric surgery: complication after Kasai operation · ApplicationTwo weeks after a Kasai portoenterostomy, an infant has fever, a rising bilirubin and return of pale stools. What is the most likely complication?
- Paediatric surgery: contrast enema in Hirschsprung disease · Multi-stepA contrast enema in a constipated neonate shows a narrow rectum with a conical transition to a dilated sigmoid colon, and contrast is still retained on a film at 24 hou…
- Paediatric surgery: tracheomalacia after oesophageal atresia repair · Multi-stepA 6-month-old who had repair of oesophageal atresia with a distal tracheo-oesophageal fistula has a barking cough and episodes of cyanosis, especially with feeds. Which…
- Paediatric surgery: neuroblastoma prognostic marker · ApplicationA 2-year-old with neuroblastoma has a biopsy sent for molecular testing. Which finding indicates the worst prognosis?
- Paediatric surgery: retractile testis · ApplicationA 4-year-old boy has testes not seen in the scrotum when he is cold and anxious, but in a warm room they are easily brought down and stay there without tension. What is…
- Paediatric surgery: phimosis in a child · ApplicationA 6-year-old boy has a non-retractile foreskin with ballooning during micturition and a narrow tip, with no white scarring and no infections. What is the first-line tre…
- Paediatric surgery: prune belly syndrome · ApplicationA newborn boy has a wrinkled, flaccid abdominal wall, bilateral impalpable testes and dilated tortuous ureters on ultrasound. What is the diagnosis?
- Paediatric surgery: stricture after necrotising enterocolitis · Multi-stepSix weeks after medical treatment of necrotising enterocolitis, a preterm infant develops vomiting and abdominal distension. A contrast study shows a short narrowed seg…
- Paediatric surgery: cloaca · Multi-stepA newborn girl has only a single perineal opening, an abdominal swelling from hydrocolpos and a small phallus-like clitoris. What is the diagnosis?
- Paediatric surgery: bronchial foreign body · Multi-stepA 2-year-old choked on peanuts and now has unilateral wheeze. An expiratory chest radiograph shows the right lung remaining hyperinflated, with the mediastinum shifting…
- Paediatric surgery: multiple magnet ingestion · ApplicationWhy are multiple ingested magnets in a child dangerous?
- Paediatric surgery: pulmonary sequestration · Multi-stepA 5-year-old has recurrent infection of the left lower lobe. CT angiography shows a lung mass supplied by an artery from the descending thoracic aorta, with no connecti…
- Paediatric surgery: meconium plug syndrome · Multi-stepA term infant of a diabetic mother has delayed passage of meconium and abdominal distension. A water-soluble contrast enema shows a narrow descending colon with a dilat…
- Paediatric surgery: oesophageal atresia work-up · ApplicationA newborn with oesophageal atresia is being prepared for repair. Which investigation is essential before operation because it influences the surgical approach?
- Paediatric surgery: annular pancreas · ApplicationAt laparotomy in a neonate with duodenal obstruction, a ring of pancreatic tissue completely encircles the second part of the duodenum. What is the appropriate operation?
- Paediatric surgery · ApplicationWhich feature is most characteristic of intussusception in an infant?
- Paediatric surgery · ApplicationWhich vomiting pattern in a young infant suggests hypertrophic pyloric stenosis?
- Paediatric surgery: pyloric stenosis · ApplicationA 4-week-old infant has non-bilious projectile vomiting and an olive-shaped epigastric mass. Which metabolic disturbance is expected?
Perioperative care51
- Perioperative care: complications of parenteral nutrition · Multi-stepA patient on long-term total parenteral nutrition via a central line develops fever and rigors with no other source. What is the most likely cause, and what is the firs…
- Perioperative care: laparoscopic pneumoperitoneum · ApplicationDuring laparoscopic cholecystectomy, the anaesthetist notes a sudden drop in end-tidal CO2, hypotension and a mill-wheel murmur. What is the complication and immediate…
- Perioperative care: Frey syndrome after parotidectomy · ApplicationAfter superficial parotidectomy, a patient sweats and flushes over the cheek while eating. What is this and what is its mechanism?
- Perioperative care: hand infections · Multi-stepA man has a swollen flexed finger with fusiform swelling and severe pain on passive extension along the flexor sheath. Which diagnosis and urgent treatment?
- Perioperative care: informed consent and duty of care · ApplicationA surgeon is about to operate on a competent adult. Which statement about valid consent is correct?
- Perioperative care: open laparoscopic entry · Multi-stepA woman with previous midline laparotomies for peritonitis is scheduled for laparoscopic cholecystectomy. Which method of first entry lowers the risk of bowel injury?
- Perioperative care: postoperative urinary retention · ApplicationA man has not passed urine 8 hours after inguinal hernia repair under spinal anaesthesia and has lower abdominal discomfort. What is the first step?
- Perioperative care: emergency transfusion · Multi-stepA young woman in haemorrhagic shock needs blood immediately, and her blood group is unknown. Which product is given?
- Perioperative care: intraoperative hypothermia · ApplicationDuring a long open abdominal operation a patient's core temperature falls to 34 degrees Celsius. Which complication is more likely?
- Perioperative care: irradiated blood · ApplicationA patient who has had a stem cell transplant needs a transfusion. Which modification of cellular blood products prevents transfusion-associated graft-versus-host disease?
- Perioperative care: early postoperative jaundice · Multi-stepOn the second day after major trauma surgery requiring massive transfusion and a large retroperitoneal haematoma, a patient is mildly jaundiced. Liver enzymes and ALP a…
- Perioperative care: hypomagnesaemia · Multi-stepA patient with a high-output ileostomy has persistent hypokalaemia and hypocalcaemia despite repeated potassium and calcium replacement. Which additional measure is mos…
- Perioperative care: postoperative hyponatraemia · ApplicationTwo days after lobectomy for lung cancer, a patient is confused with serum sodium 122 mmol/L, low plasma osmolality, high urine osmolality and normal volume status. Wha…
- Perioperative care: human bite of the hand · Multi-stepA man has a swollen painful third metacarpophalangeal joint with a small laceration over the knuckle after punching someone in the mouth two days ago. What is the manag…
- Perioperative care: keratoacanthoma · ApplicationA 60-year-old has a dome-shaped nodule with a central keratin plug that grew over six weeks on sun-exposed facial skin. Histology resembles a well-differentiated squamo…
- Perioperative care: erysipelas · ApplicationA woman has a sharply demarcated, raised, shiny red plaque on the cheek with fever and a palpable edge. Which organism is typical?
- Perioperative care: oral leukoplakia · ApplicationA 48-year-old tobacco chewer has a persistent white patch on the buccal mucosa that cannot be scraped off. What is the most appropriate next step?
- Perioperative care: suture materials · ApplicationWhich suture material is degraded by hydrolysis rather than by enzymatic proteolysis?
- Perioperative care: dermatofibrosarcoma protuberans · ApplicationA 35-year-old man has a slowly growing firm plaque on the trunk that has recurred twice after simple excision. Histology shows spindle cells in a storiform pattern infi…
- Perioperative care: Merkel cell carcinoma · ApplicationA 78-year-old man has a rapidly growing, painless violaceous nodule on the sun-exposed cheek. Histology shows small round blue cells with paranuclear dot-like staining…
- Perioperative care: Revised Cardiac Risk Index · ApplicationWhich of the following is NOT a component of the Revised Cardiac Risk Index for non-cardiac surgery?
- Perioperative care: Apfel score · ApplicationUsing the Apfel score for postoperative nausea and vomiting, which patient has the highest risk?
- Perioperative care: choice of skin antiseptic · ApplicationTrials in clean-contaminated surgery have compared skin preparations to reduce surgical site infection. Which preparation gave fewer infections?
- Perioperative care: biological indicator for steam sterilisation · ApplicationA theatre sterilisation unit places spore strips in each autoclave load to confirm that steam sterilisation has worked. Which organism's spores are used as the indicator?
- Perioperative care: transfusion-related acute lung injury · Multi-stepTwo hours after transfusion of fresh frozen plasma, a patient has sudden dyspnoea, fever, hypotension and bilateral pulmonary infiltrates. The jugular venous pressure i…
- Perioperative care: postoperative oliguria · Multi-stepOn the first day after bowel resection, a patient has urine output of 15 mL/h, a heart rate of 120, low blood pressure, dry mucosa, concentrated urine and a urinary sod…
- Perioperative care: spinal epidural haematoma · Multi-stepA patient on prophylactic anticoagulation has an epidural catheter removed after surgery. Hours later he has severe back pain, progressive leg weakness and urinary rete…
- Perioperative care: hypotension after spinal anaesthesia · Multi-stepTen minutes after a subarachnoid block for a groin operation, with a sensory level to T4, a patient has a blood pressure of 78/40 and a heart rate of 46. What is the be…
- Perioperative care: induction agent in hypovolaemia · ApplicationA bronchial asthmatic patient with hypovolaemia from intestinal obstruction needs a rapid sequence induction. Which induction agent is most suitable?
- Perioperative care: prolonged apnoea after suxamethonium · Multi-stepA patient remains paralysed and apnoeic for three hours after a single dose of suxamethonium at induction. There is no history of muscle disease. What is the likely cau…
- Perioperative care: opioid-induced respiratory depression · ApplicationAn hour after a morphine bolus on a patient-controlled analgesia pump, a patient is drowsy with a respiratory rate of 6 and pinpoint pupils. After supporting the airway…
- Perioperative care: perioperative needle-stick injury · Multi-stepA surgeon who has never been vaccinated against hepatitis B sustains a deep needle-stick injury from a needle used on an HBsAg-positive patient. What is the most approp…
- Perioperative care: intraoperative anaphylaxis · ApplicationWithin minutes of induction, a patient develops bronchospasm, hypotension, tachycardia and a widespread rash. After stopping the suspected trigger and calling for help,…
- Perioperative care: positioning nerve injury · ApplicationAfter a 5-hour operation in the lithotomy position with leg supports pressing at the lateral side of the knee, a patient has foot drop and loss of sensation over the do…
- Perioperative care: emergency treatment of hyperkalaemia · ApplicationA patient with postoperative acute kidney injury has a potassium of 7.2 mmol/L with peaked T waves and a widened QRS complex. Which drug is given first?
- Perioperative care: postoperative ileus · Multi-stepOn day 3 after a colectomy, a patient has abdominal distension, no flatus and absent bowel sounds. Radiographs show gas in dilated small and large bowel, with a serum p…
- Perioperative care: postoperative delirium · Multi-stepA 76-year-old man on day 2 after hip surgery has fluctuating confusion, visual hallucinations and inattention, worse at night. What is the best initial approach?
- Perioperative care: refusal of blood by a competent patient · Multi-stepA competent adult Jehovah's Witness, who has refused blood products in writing, needs elective major surgery. What is the correct approach?
- Perioperative care: cardiac conditions that delay elective surgery · ApplicationWhich finding in a patient scheduled for elective major surgery should make the team postpone the operation?
- Perioperative care: neuraxial block after low molecular weight heparin · Multi-stepA patient received enoxaparin 40 mg subcutaneously for thromboprophylaxis at 8 pm. The anaesthetist plans to insert an epidural catheter the next day. What is the minim…
- Perioperative care: beta-blockers before surgery · ApplicationA 62-year-old man takes atenolol long term for hypertension and is listed for elective hernia repair. What is the correct perioperative advice?
- Perioperative care · ApplicationWhy is venous thromboembolism prophylaxis considered after surgery?
- Perioperative care · ApplicationWhat is an important postoperative observation?
- Perioperative care · ApplicationWhat is the purpose of timely prophylactic antibiotic administration before selected operations?
- Perioperative care · ApplicationWhich component of the ABCDE assessment addresses life-threatening external haemorrhage first?
- Perioperative care · ApplicationWhy are patients kept nil by mouth before many operations?
- Perioperative care · ApplicationWhat is the purpose of informed consent before an elective operation?
- Perioperative care: venous thromboembolism · ApplicationWhich measure reduces postoperative venous thromboembolism risk in an immobilised high-risk surgical patient?
- Perioperative care: postoperative ileus · ApplicationAfter abdominal surgery, diffuse distension, absent bowel sounds and no transition point on imaging most likely represent what?
- Perioperative care: postoperative urinary retention · ApplicationA patient after spinal anesthesia has suprapubic discomfort, inability to void, and a palpable distended bladder. What is the immediate management?
- Perioperative care: postoperative ileus · ApplicationAfter laparotomy, a patient has abdominal distension, nausea, absent bowel sounds, and diffuse gaseous bowel dilatation without a transition point. What is most likely?
Breast and endocrine surgery40
- Breast and endocrine surgery: breast cancer histology · ApplicationWhich feature is typical of invasive lobular carcinoma compared with ductal carcinoma NST?
- Breast and endocrine surgery: sentinel node biopsy and axillary management · Multi-stepA woman with a 2 cm clinically node-negative breast cancer undergoes breast-conserving surgery with sentinel lymph node biopsy that shows 1 micrometastatic node and she…
- Breast and endocrine surgery: modified radical mastectomy types · ApplicationIn the Patey modified radical mastectomy, which muscle is removed?
- Breast and endocrine surgery: Paget disease of the nipple · ApplicationA woman has a unilateral scaly, eczematous nipple lesion not responding to topical steroids for 3 months. What is the next step?
- Breast and endocrine surgery: DCIS management · Multi-stepScreening mammography shows pleomorphic microcalcification, and biopsy shows high-grade comedo-type DCIS in a 2 cm area. What is the standard management?
- Breast and endocrine surgery: radioiodine after thyroidectomy · ApplicationA 35-year-old has a total thyroidectomy for a 3 cm papillary carcinoma with lymph node metastases. What is the usual adjuvant plan?
- Breast and endocrine surgery: Conn syndrome · ApplicationA 45-year-old with resistant hypertension, hypokalaemia and a high aldosterone-renin ratio has a 1.5 cm left adrenal adenoma on CT. What should be done before surgery t…
- Breast and endocrine surgery: adrenocortical carcinoma · ApplicationA 9 cm adrenal mass with heterogeneous enhancement causes Cushing syndrome with virilisation. What is the main treatment?
- Breast and endocrine surgery: implant-associated lymphoma · ApplicationSix years after cosmetic breast augmentation with a textured implant, a woman has a sudden swelling of one breast. Ultrasound shows a large peri-implant fluid collectio…
- Breast and endocrine surgery: core biopsy before neoadjuvant therapy · ApplicationA woman has a 5 cm clinically malignant breast mass and the team plans neoadjuvant chemotherapy to downstage it. FNAC shows malignant cells. What should be done before…
- Breast and endocrine surgery: parathyroid autotransplantation · ApplicationDuring total thyroidectomy a parathyroid gland is found to be devascularised and dusky. What is the recommended action?
- Breast and endocrine surgery: papillary carcinoma with lateral nodes · Multi-stepA 35-year-old man has a 2 cm papillary thyroid carcinoma and FNAC-proven metastasis in an enlarged node in the lower jugular chain (level IV). Which operation is most a…
- Breast and endocrine surgery: radial scar · Multi-stepA screening mammogram shows a stellate lesion with radiating spicules and a lucent centre in a woman with no history of surgery or trauma. Core biopsy shows a radial sc…
- Breast and endocrine surgery: Zuska disease · Multi-stepA 35-year-old smoker has recurrent subareolar abscesses with a chronic fistula tracking to the edge of the areola. What is the underlying pathology?
- Breast and endocrine surgery: hyperparathyroidism · Multi-stepA man with chronic kidney disease for 12 years had a renal transplant, but his serum calcium remains high with elevated PTH despite a well-functioning graft. Which diag…
- Breast and endocrine surgery: toxic multinodular goitre · ApplicationA 60-year-old woman with a long-standing nodular goitre develops tachycardia, weight loss and a suppressed TSH. A radioiodine scan shows multiple hot nodules with suppr…
- Breast and endocrine surgery: Cowden syndrome · ApplicationA 34-year-old woman with macrocephaly has facial trichilemmomas, multiple hamartomatous gastrointestinal polyps and follicular thyroid carcinoma. Her mother had breast…
- Breast and endocrine surgery: Hurthle cell carcinoma · Multi-stepA 55-year-old woman has a thyroid nodule reported as a Hurthle cell neoplasm on cytology. Lobectomy shows capsular and vascular invasion. Which statement about this tum…
- Breast and endocrine surgery: lateral aberrant thyroid · Multi-stepA 30-year-old woman has a firm 2 cm swelling in the lateral neck. Cytology shows papillary carcinoma cells with thyroid follicular elements. What is the swelling most l…
- Breast and endocrine surgery: lingual thyroid · ApplicationA 12-year-old girl has a smooth reddish 2 cm mass at the base of the tongue with dysphagia and a muffled voice. No thyroid gland can be felt in the neck. Which investig…
- Breast and endocrine surgery: prophylactic thyroidectomy in MEN 2B · ApplicationA 6-month-old infant is found by genetic testing to carry the RET M918T mutation of multiple endocrine neoplasia type 2B. According to the American Thyroid Association,…
- Breast and endocrine surgery: Nelson syndrome · Multi-stepA woman who underwent bilateral adrenalectomy for Cushing disease develops progressive skin hyperpigmentation, headaches and bitemporal hemianopia. What is the cause?
- Breast and endocrine surgery: intercostobrachial nerve · ApplicationAfter a level II axillary clearance, a woman has numbness and tingling over the skin of the axilla and the medial upper arm, with no weakness. Which nerve has been divi…
- Breast and endocrine surgery: thoracodorsal nerve injury · ApplicationAfter an axillary clearance, a woman finds weakness when she adducts and internally rotates her arm, for example while pulling herself up from a chair. The scapula does…
- Breast and endocrine surgery: thyrotoxicosis in early pregnancy · ApplicationA woman at 7 weeks of pregnancy is diagnosed with Graves disease and is thyrotoxic. Which antithyroid drug is preferred in the first trimester?
- Breast and endocrine surgery: Graves orbitopathy and radioiodine · Multi-stepA 35-year-old smoker with Graves disease has active moderate thyroid eye disease. Which definitive treatment is most likely to worsen the eye disease unless steroid cov…
- Breast and endocrine surgery: intraoperative PTH monitoring · Multi-stepA surgeon performing a focused parathyroidectomy uses the Miami criterion for intraoperative PTH assay. Which result indicates a successful operation?
- Breast and endocrine surgery: parathyroid carcinoma · Multi-stepA 55-year-old man has serum calcium of 15 mg/dL, a markedly raised PTH, nephrolithiasis and bone disease. He has a palpable firm neck mass and hoarseness. Which operati…
- Breast and endocrine surgery: hypotension after adrenal vein ligation · Multi-stepDuring laparoscopic adrenalectomy for a phaeochromocytoma in a patient prepared with phenoxybenzamine, blood pressure falls to 70/40 mmHg within minutes of ligating the…
- Breast and endocrine surgery: paraganglioma genetics · Multi-stepA 30-year-old man has a large retroperitoneal paraganglioma with liver metastases. Mutation in which gene is most strongly associated with malignant behaviour in these…
- Breast and endocrine surgery: lymphangiosarcoma · Multi-stepTen years after a radical mastectomy with axillary clearance, a woman with a chronically swollen arm develops violaceous nodules on the skin of the forearm that coalesc…
- Breast and endocrine surgery: cyclical mastalgia · ApplicationA 32-year-old woman has bilateral breast pain and lumpiness that worsen before menstruation. Examination, ultrasound and mammography are normal. What is the most approp…
- Breast and endocrine surgery: accessory breast tissue · ApplicationA woman has soft, tender swellings in both axillae that appear in late pregnancy and enlarge after delivery while she breastfeeds. They settle after weaning. Examinatio…
- Breast and endocrine surgery: BRCA1 tumour phenotype · ApplicationA 32-year-old BRCA1 mutation carrier is diagnosed with breast cancer. Which phenotype is she most likely to have?
- Breast and endocrine surgery: aromatase inhibitors in premenopausal women · Multi-stepWhy are aromatase inhibitors alone ineffective as adjuvant endocrine therapy in a woman with intact ovarian function?
- Breast and endocrine surgery: mucinous breast carcinoma · ApplicationA 70-year-old woman has a soft, well-circumscribed breast mass. Pathology shows tumour cell clusters floating in extracellular mucin, oestrogen receptor-positive, with…
- Breast and endocrine surgery: hypercalcaemic crisis · ApplicationA 65-year-old man with primary hyperparathyroidism has confusion, vomiting, dehydration and a serum calcium of 16 mg/dL. What is the first step in management?
- Breast and endocrine surgery: adrenal myelolipoma · ApplicationA 4.5 cm right adrenal mass is found incidentally on CT. It is well circumscribed with attenuation of minus 80 Hounsfield units in most areas, and hormonal screening is…
- Breast and endocrine surgery: galactorrhoea · ApplicationA 28-year-old woman has bilateral milky nipple discharge and secondary amenorrhoea. Breast examination and ultrasound are normal. What is the most appropriate initial i…
- Breast and endocrine surgery: idiopathic granulomatous mastitis · Multi-stepA 32-year-old parous woman has a tender, firm breast mass with overlying erythema and no fever. Needle biopsy shows non-caseating granulomas centred on lobules with neu…
Trauma40
- Trauma · ApplicationAfter blunt chest trauma, a man is hypotensive and tachycardic with distended neck veins, absent breath sounds on the right and tracheal deviation to the left. What is…
- Trauma · Multi-stepA driver in a road accident has blunt abdominal trauma, blood pressure 80/50 mmHg that does not respond to initial fluid resuscitation, and a positive FAST scan with fr…
- Trauma · Multi-stepA motorcyclist has an unstable pelvic fracture after a crash, with blood pressure 75/40 mmHg and a distended, tender pelvic region. FAST scan is negative. Which immedia…
- Trauma · ApplicationA 20-year-old man with a grade III splenic laceration after a bicycle fall is haemodynamically stable on repeated assessment, with a CT showing a small haemoperitoneum…
- Trauma · ApplicationAfter a fall astride a bar, a man has blood at the external urethral meatus, a high-riding prostate and a perineal haematoma, and cannot pass urine. What should be done…
- Trauma: haemorrhagic shock · ApplicationA trauma patient has a heart rate of 128 per minute, a respiratory rate of 32, a systolic blood pressure of 88 mmHg, and is confused. By ATLS classification, what is th…
- Trauma: head injury assessment · ApplicationA man after a road traffic accident opens his eyes to pain, speaks in confused sentences and localises pain with his hand. What is his Glasgow Coma Scale score?
- Trauma: airway in children · ApplicationA 7-year-old boy has severe facial trauma with upper airway obstruction. Bag-mask ventilation and two attempts at orotracheal intubation fail, and saturation is falling…
- Trauma: damage control surgery · Multi-stepDuring laparotomy for multiple gunshot injuries, a 28-year-old man has received 12 units of packed red cells. His core temperature is 33 degrees Celsius, arterial pH 7.…
- Trauma: cardiac tamponade · Multi-stepA 26-year-old man with a stab wound in the left parasternal fourth intercostal space is hypotensive with distended neck veins and muffled heart sounds. FAST shows peric…
- Trauma: massive haemothorax · Multi-stepAfter blunt chest trauma, a 35-year-old man is tachycardic and hypotensive. A chest drain is inserted and 1700 mL of blood drains immediately, with continued brisk drai…
- Trauma: Chance fracture · ApplicationA 30-year-old woman wearing a lap-only seat belt in a head-on collision has abdominal wall bruising across the lower abdomen and back pain. Lateral spine radiograph sho…
- Trauma: duodenal haematoma · ApplicationA 6-year-old boy struck his upper abdomen on a bicycle handlebar and has persistent vomiting 2 days later. CT shows a thickened duodenal wall with intramural haematoma…
- Trauma: liver injury · Multi-stepA 32-year-old man with a grade IV blunt liver laceration is haemodynamically stable after 1 litre of crystalloid. CT shows active contrast extravasation (blush) within…
- Trauma: extradural haematoma · ApplicationA 19-year-old cricketer struck on the temple by a ball loses consciousness briefly, recovers and talks normally, then becomes drowsy 3 hours later with a dilated right…
- Trauma: neurogenic shock · ApplicationA 25-year-old man falls from a height and has a cervical spinal cord injury. His blood pressure is 80/50 mmHg, heart rate 48 per minute, and his skin is warm and dry. T…
- Trauma: compartment syndrome · ApplicationA 22-year-old man with a tibial shaft fracture treated in a cast has severe, increasing leg pain not relieved by opioids and pain on passive stretching of the toes. Pul…
- Trauma: crush injury · Multi-stepA man is extricated after 8 hours under a collapsed building. He is hypotensive, his limbs are swollen, urine is dark brown, and the ECG shows tall peaked T waves and a…
- Trauma: flail chest · ApplicationA patient has paradoxical movement of a segment of the right chest wall after multiple rib fractures and is hypoxic. What is the main cause of hypoxia?
- Trauma: open pneumothorax · ApplicationA stab wound leaves a 3 cm sucking chest wound with air hissing in and out. What is the immediate treatment?
- Trauma: diaphragmatic rupture · Multi-stepAfter a high-speed crash a patient has respiratory distress, and the chest film shows a nasogastric tube coiled in the left hemithorax with loss of the left hemidiaphra…
- Trauma: seat belt injury · Multi-stepA driver has a transverse band of bruising across the lower abdomen, abdominal tenderness and free fluid on CT without solid organ injury. What injury should be suspect…
- Trauma: raised intracranial pressure · ApplicationA patient with a head injury develops hypertension, bradycardia and irregular respiration. Which immediate measure is appropriate?
- Trauma: primary survey · ApplicationWhat comes first in trauma primary survey?
- Trauma: tension pneumothorax · ApplicationHypotension and absent unilateral breath sounds after trauma need what?
- Trauma · ApplicationExternal arterial bleeding needs what first?
- Trauma · ApplicationUnstable pelvic fracture risks what?
- Trauma · ApplicationPrimary survey first priority is what?
- Trauma · ApplicationAbsent breath sounds with shock after trauma needs what?
- Trauma · ApplicationWhat is the main purpose of the primary survey in trauma?
- Trauma · ApplicationWhat modality is used for rapid detection of free fluid in unstable abdominal trauma?
- Trauma · ApplicationWhat is the purpose of a trauma secondary survey?
- Trauma · ApplicationWhat is the purpose of the primary trauma survey?
- Trauma · ApplicationWhat is FAST ultrasound used to detect in unstable trauma?
- Trauma · ApplicationIn blunt abdominal trauma, which finding most strongly indicates possible intra-abdominal bleeding?
- Trauma: ATLS · ApplicationIn the primary survey of trauma care, what is assessed first?
- Trauma: tension pneumothorax · ApplicationHypotension, unilateral absent breath sounds and tracheal deviation after chest trauma require what immediate action?
- Trauma: splenic injury · ApplicationA haemodynamically stable patient with blunt splenic injury and no peritonitis is commonly managed how?
- Trauma: spinal injury · Multi-stepA trauma patient has hypotension, bradycardia, warm dry skin, and a high cervical spinal injury. What type of shock is most likely?
- Trauma: splenic injury · ApplicationAfter blunt left-upper-quadrant trauma, a patient has left shoulder-tip pain and hypotension. Which organ injury is most likely?
Trauma and burns36
- Trauma and burns: surgical airway · Multi-stepA man with severe facial trauma cannot be intubated and cannot be ventilated by bag-mask. What is the next step?
- Trauma and burns: tension pneumothorax · ApplicationAfter a stab wound, a patient has severe dyspnoea, hypotension, distended neck veins, tracheal deviation and absent breath sounds on the right. What is the immediate ac…
- Trauma and burns: diffuse axonal injury · Multi-stepAfter a high-speed deceleration injury, a patient remains deeply unconscious but the initial CT head is normal. MRI is likely to show:
- Trauma and burns: penetrating neck injury zones · Multi-stepA man with a stab wound in zone II of the neck has an expanding haematoma and active bleeding. What is the appropriate management?
- Trauma and burns: open fracture management · Multi-stepA farmer has an open tibial fracture with a 12 cm wound, extensive soft tissue damage and a contaminated field. Distal pulses are intact. Which Gustilo-Anderson type an…
- Trauma and burns: modified Brooke formula and urine output · ApplicationWhich statement about fluid resuscitation in adult burns is correct?
- Trauma and burns: frostbite rewarming · ApplicationA mountaineer arrives with frozen, white, hard toes that are not at risk of refreezing. What is the correct treatment?
- Trauma and burns: snake bite surgical considerations · Multi-stepA man bitten by a viper has swelling, bleeding gums and a positive 20-minute whole blood clotting test. His leg compartments are soft. What is the recommended management?
- Trauma and burns: flaps and microvascular surgery · ApplicationWhich statement about flaps is correct?
- Trauma and burns: pressure ulcer staging · ApplicationA bedridden patient has a sacral pressure ulcer with full-thickness skin loss exposing subcutaneous fat but no muscle or bone. Which NPUAP stage is this?
- Trauma and burns: necrotising fasciitis · Multi-stepA diabetic has a swollen thigh with severe pain out of proportion, bullae and a LRINEC score of 9. What is the best management?
- Trauma and burns: resuscitative thoracotomy · Multi-stepA man is stabbed in the left chest. In the emergency department he suddenly loses his pulse after having been alert on arrival. A pericardial collection is seen on ultr…
- Trauma and burns: antibiotics in burns · ApplicationA previously well adult has 25% total body surface area partial-thickness burns, treated with resuscitation and dressings on day 1. She is afebrile with a clean wound.…
- Trauma and burns: burn scar contracture · ApplicationA child has a tight linear scar band after an axillary burn that limits shoulder abduction. Which plastic technique lengthens the contracted band?
- Trauma and burns: retained haemothorax · ApplicationA man had a chest drain for traumatic haemothorax. After a week he has fever, and chest CT shows a persistent loculated collection with partial lung entrapment. What is…
- Trauma and burns: cervical spine clearance · ApplicationWhich finding stops a trauma patient from being cleared of cervical spine injury on clinical grounds under the NEXUS criteria?
- Trauma and burns: spinal shock · ApplicationA man with a cervical spine fracture has flaccid paralysis, absent reflexes and hypotension. Which finding marks the end of spinal shock?
- Trauma and burns: basal skull fracture · ApplicationA man with a head injury has bilateral periorbital ecchymosis and clear fluid dripping from the nose. Which procedure should be avoided?
- Trauma and burns: shock in children · ApplicationA 6-year-old child after a road accident has a heart rate of 150/min, cold peripheries and a capillary refill of 4 seconds, but a normal blood pressure. What does the n…
- Trauma and burns: blunt cardiac injury · ApplicationA restrained driver has sternal bruising and chest tenderness after a head-on collision. He is haemodynamically stable. Which initial investigations screen for blunt ca…
- Trauma and burns: cyanide poisoning in smoke inhalation · Multi-stepA man is rescued unconscious from a closed-room fire. His pulse oximeter reads 98 percent, carboxyhaemoglobin is 8 percent, and arterial lactate is 12 mmol/L with sever…
- Trauma and burns: silver sulfadiazine · ApplicationA surgeon applies silver sulfadiazine to a large partial-thickness burn. Which adverse effect is characteristic of this agent?
- Trauma and burns: timing of burn wound excision · ApplicationA 30-year-old man has a 10 percent total body surface area full-thickness flame burn of the thigh. What is the best timing of definitive wound management?
- Trauma and burns: nutrition after major burns · ApplicationA 35-year-old man has 40 percent total body surface area burns and is intubated. What is the best approach to nutrition?
- Trauma and burns: invasive burn wound infection · Multi-stepOn day 8 after a 40 percent burn, a patient develops fever, hypotension and ileus. The wound shows focal dark discolouration, haemorrhagic areas and early eschar separa…
- Trauma and burns: scald pattern suggesting non-accidental injury · ApplicationA 2-year-old child is brought with scalds. Which pattern most strongly suggests a non-accidental injury?
- Trauma and burns: venous air embolism · Multi-stepA man with a stab wound to the base of the neck suddenly becomes hypotensive, cyanosed and breathless. A hissing sound is heard from the wound and a mill-wheel murmur i…
- Trauma and burns: positioning of the pregnant trauma patient · ApplicationA woman at 32 weeks of gestation is brought after a road accident. Lying supine on the trolley, she is pale with a blood pressure of 85/50 mmHg that improves when the t…
- Trauma and burns: fetomaternal haemorrhage test · ApplicationA 28-year-old Rh-negative woman at 30 weeks of pregnancy is monitored after minor blunt abdominal trauma. Which test is used to estimate the volume of fetomaternal haem…
- Trauma and burns: central cord syndrome · ApplicationA 65-year-old man with cervical spondylosis falls forward and hyperextends his neck. Afterwards both arms are much weaker than his legs, with a patchy sensory loss and…
- Trauma and burns: Brown-Sequard syndrome · Multi-stepA man is stabbed on the right side of the back at the T10 level. He has weakness and loss of joint position sense in the right leg and loss of pain and temperature sens…
- Trauma and burns: midfacial fracture pattern · ApplicationAfter a road accident a man has facial swelling, epistaxis and a step deformity at both infraorbital margins. When the upper teeth are gripped and pushed, the central m…
- Trauma and burns: primary blast injury · ApplicationA man survives a bomb explosion with no external wounds, but later has ear pain, haemoptysis and breathlessness. Which feature of primary blast injury explains this?
- Trauma and burns: retroperitoneal haematoma at laparotomy · Multi-stepAt laparotomy for blunt trauma, a stable patient is found to have a lateral perinephric retroperitoneal haematoma that is not expanding or pulsatile, and preoperative C…
- Trauma and burns: compartment pressure threshold · Multi-stepA man with a tibial fracture has a tense swollen calf and pain on passive stretch. His diastolic blood pressure is 70 mmHg and the measured compartment pressure is 55 m…
- Trauma and burns: traumatic asphyxia · Multi-stepA worker is crushed between a lorry and a wall. He has deep blue-purple discolouration and petechiae of the face and neck, bilateral subconjunctival haemorrhages, and a…
Hernia and abdominal wall26
- Hernia and abdominal wall: Shouldice repair · ApplicationWhich tissue repair has the lowest recurrence for inguinal hernia when mesh is not used?
- Hernia and abdominal wall: strangulated hernia · Multi-stepAn elderly woman has a tender, irreducible swelling below and lateral to the pubic tubercle with vomiting and absolute constipation. What is the best management?
- Hernia and abdominal wall: Maydl hernia · Multi-stepAt operation for a strangulated inguinal hernia, two viable loops lie in the sac but the connecting loop in the abdomen is gangrenous. This pattern is called:
- Hernia and abdominal wall: chronic post-herniorrhaphy groin pain · Multi-stepSix months after open mesh repair, a man has burning pain in the groin radiating to the scrotum, worse on standing. Which nerve is most commonly implicated?
- Hernia and abdominal wall: sportsman's groin · Multi-stepA 24-year-old footballer has several months of exertional groin pain that spreads to the adductor region and is worse on sprinting, with no palpable hernia or cough imp…
- Hernia and abdominal wall: minimally symptomatic inguinal hernia · ApplicationA 72-year-old man has a small reducible inguinal hernia that causes almost no symptoms and does not interfere with his activities. What is a reasonable approach?
- Hernia and abdominal wall: viability of strangulated bowel · ApplicationDuring repair of a strangulated hernia, the loop of small bowel is dusky. After warm saline packs and oxygen, which finding indicates that it is viable and can be retur…
- Hernia and abdominal wall: eponymous hernias · Multi-stepAn elderly woman has a tender irreducible swelling below and lateral to the pubic tubercle. At operation the sac contains an inflamed appendix. What is this called?
- Hernia and abdominal wall: pantaloon hernia · ApplicationAt operation for a groin hernia, two separate sacs are found, one lateral and one medial to the inferior epigastric vessels, straddling the vessels. What is this called?
- Hernia and abdominal wall: lipoma of the cord · ApplicationDuring open repair of a right indirect inguinal hernia, the sac is dissected and ligated, but a lobulated mass of fat remains lying along the spermatic cord structures.…
- Hernia and abdominal wall: deep ring occlusion test · ApplicationA man has a reducible swelling in the right groin. After he lies down and the swelling is reduced, the examiner presses firmly over the deep inguinal ring and asks him…
- Hernia and abdominal wall: ischaemic orchitis · Multi-stepOn the third day after open repair of a large inguinal hernia that extended into the scrotum, a man has a painful, firm, enlarged testis with low-grade fever. The wound…
- Hernia and abdominal wall: reduction en masse · Multi-stepA 70-year-old man with a painful irreducible inguinal hernia is treated by forceful manipulation elsewhere and the lump disappears. Severe pain, vomiting and obstructio…
- Hernia and abdominal wall: umbilical hernia with ascites · Multi-stepA cirrhotic patient with tense ascites has a symptomatic, reducible swelling at the umbilicus with thin shiny skin over it, but no leak or tenderness. How should it be…
- Hernia and abdominal wall: TEP versus TAPP · ApplicationBoth TEP and TAPP are laparoscopic mesh repairs for groin hernias. What is the principal feature of the TEP approach compared with TAPP?
- Hernia and abdominal wall: corona mortis · ApplicationDuring dissection of Cooper's ligament in a laparoscopic hernia repair, brisk bleeding arises from a vessel crossing the superior pubic ramus that connects the external…
- Hernia and abdominal wall: triangle of doom · ApplicationIn laparoscopic groin anatomy, the triangle bounded medially by the vas deferens and laterally by the gonadal vessels is avoided when placing staples. Which structures…
- Hernia and abdominal wall: incarcerated infant inguinal hernia · Multi-stepA 2-month-old boy has a tense, tender swelling in the right groin and irritability. He has no abdominal distension, peritonitis or skin discolouration. What is the best…
- Hernia and abdominal wall: communicating hydrocele in infants · ApplicationA 10-month-old boy has a painless scrotal swelling that is smaller in the morning and larger by evening. It transilluminates brilliantly and the examiner can get above…
- Hernia and abdominal wall: gastroschisis association · ApplicationA newborn has loops of bowel without any covering sac protruding through a small defect to the right of a normal umbilical cord. Which associated problem is most charac…
- Hernia and abdominal wall: mesh choice for intraperitoneal repair · ApplicationA laparoscopic ventral hernia repair will place the mesh on the peritoneal surface in direct contact with bowel. Which mesh is appropriate?
- Hernia and abdominal wall: open abdomen after damage control · ApplicationAfter a damage control laparotomy for severe haemorrhage, the bowel is grossly swollen and the fascia cannot be approximated without high tension. What is the best appr…
- Hernia and abdominal wall: approach to strangulated femoral hernia · Multi-stepAn elderly woman has a tender irreducible femoral swelling with vomiting and suspected gangrenous bowel needing resection. Which operative approach gives the best acces…
- Hernia and abdominal wall: patent urachus · Multi-stepA 2-week-old boy has a wet umbilicus with clear fluid leaking that increases when he cries or strains. The fluid has a creatinine concentration similar to urine. What i…
- Hernia and abdominal wall: patent vitellointestinal duct · Multi-stepA 10-day-old infant has a bright red moist mucosal nodule at the umbilicus that intermittently discharges bile-stained fluid and gas. What is the likely diagnosis?
- Hernia and abdominal wall: port-site hernia prevention · ApplicationThree weeks after laparoscopic cholecystectomy, a patient has colicky pain and vomiting with a tender small swelling at the umbilical port site. Which measure would bes…
Breast20
- Breast · ApplicationA 55-year-old woman has a unilateral scaly, eczema-like rash of the nipple and areola that has not responded to topical steroids for two months. What is the next best s…
- Breast · ApplicationA 32-year-old woman whose mother and sister had breast and ovarian cancer is found to have a 2 cm breast cancer that is ER, PR and HER2 negative with a high grade. A mu…
- Breast: infection · ApplicationA breastfeeding woman has a painful, red, fluctuant 4 cm lump in the breast with fever, 3 weeks after delivery. What is the best management?
- Breast: phyllodes tumour · ApplicationA 46-year-old woman has an 8 cm smooth, firm, mobile breast lump that has doubled in size over 3 months. There are no palpable axillary nodes. Core biopsy shows a cellu…
- Breast: breast conservation · ApplicationA 40-year-old woman has a 2 cm invasive ductal carcinoma in the upper outer quadrant of the left breast. At 19 years of age she received mantle field radiotherapy for H…
- Breast: adjuvant targeted therapy · ApplicationA 52-year-old woman with HER2-positive breast cancer is to receive adjuvant trastuzumab after anthracycline chemotherapy. Which adverse effect requires baseline and per…
- Breast: lobular carcinoma in situ · ApplicationA 45-year-old woman has a core biopsy of screening-detected calcification that shows classic lobular carcinoma in situ as an incidental finding, with no atypical featur…
- Breast: nipple discharge · ApplicationA 38-year-old woman has spontaneous blood-stained discharge from a single duct of the right nipple. There is no palpable lump and ultrasound is normal. What is the most…
- Breast: Mondor disease · ApplicationA 34-year-old woman notices a tender, cord-like subcutaneous induration running from the lateral breast to the upper abdomen, with a groove on raising the arm. There is…
- Breast: imaging categories · Multi-stepA 48-year-old woman has a screening mammogram showing a new cluster of fine pleomorphic microcalcifications and no mass. It is reported as BI-RADS 4. What is the next s…
- Breast: inflammatory carcinoma · Multi-stepA 35-year-old woman has a red, swollen, warm breast with peau d'orange covering more than a third of the skin for 3 weeks, with no response to two weeks of antibiotics.…
- Breast: axillary surgery complications · ApplicationAfter a level III axillary clearance, a woman finds that the medial border of her scapula lifts away from the chest wall when she pushes against a wall. Which nerve has…
- Breast: periductal mastitis · ApplicationA 35-year-old smoker has recurrent subareolar abscesses with nipple retraction and a fistula at the areolar margin. What is the underlying condition?
- Breast: BRCA mutation carrier · ApplicationA 35-year-old BRCA1 carrier with a strong family history asks about risk-reduction. Which statement is accurate?
- Breast: breast cyst aspiration · ApplicationA 45-year-old woman has a palpable 3 cm breast lump. Ultrasound shows a simple cyst. At aspiration the fluid is blood-stained. What should be done?
- Breast: T staging · ApplicationA breast carcinoma measures 3.5 cm in greatest dimension with no chest wall or skin involvement. What is the T category?
- Breast: fat necrosis · ApplicationA 50-year-old woman has a firm, irregular breast lump with skin tethering three months after a blow to the breast. Imaging looks suspicious. What does biopsy most likel…
- Breast: suspicious mass · ApplicationHard fixed breast lump with axillary node needs what?
- Breast · ApplicationFluctuant painful breast mass with fever suggests what?
- Breast · ApplicationHard fixed breast lump needs what?
Thyroid19
- Thyroid · Multi-stepA thyroid nodule has FNAC showing medullary carcinoma and the patient's mother had episodic hypertension and thyroid cancer. Which test must be done before thyroidectomy?
- Thyroid: follicular neoplasm · ApplicationFine-needle aspiration of a solitary thyroid nodule in a 40-year-old woman reports a 'follicular neoplasm'. What is the most appropriate next step?
- Thyroid: post-operative haematoma · Multi-stepThree hours after total thyroidectomy, a 40-year-old woman has progressive neck swelling, stridor and a muffled voice. Oxygen saturation is falling. What is the immedia…
- Thyroid: nerve injury · ApplicationAfter thyroidectomy, a professional singer finds that she cannot reach high notes and her voice tires easily, though her voice is otherwise normal and there is no strid…
- Thyroid: bilateral nerve palsy · Multi-stepImmediately after extubation following total thyroidectomy, a woman develops inspiratory stridor and respiratory distress. Laryngoscopy shows both cords fixed near the…
- Thyroid: hypocalcaemia · ApplicationOn the second day after total thyroidectomy for a multinodular goitre, a woman has perioral tingling and carpopedal spasm. Serum calcium is 6.8 mg/dL. What is the immed…
- Thyroid: Graves disease preparation · ApplicationA 30-year-old woman with Graves disease is rendered euthyroid with carbimazole and is scheduled for total thyroidectomy. Why is Lugol's iodine given for 10 days before…
- Thyroid: lymphoma · Multi-stepA 62-year-old woman with long-standing Hashimoto thyroiditis develops rapid enlargement of the thyroid over 6 weeks, with dysphagia. FNAC suggests a lymphoid infiltrate…
- Thyroid: follow-up of cancer · ApplicationA patient has had total thyroidectomy and radioiodine ablation for papillary thyroid carcinoma. Which marker is most useful in long-term surveillance for recurrence?
- Thyroid: nodule evaluation · Multi-stepA 45-year-old woman has a solitary 2.5 cm thyroid nodule. TSH is 0.05 mIU/L with a raised free T4. What is the most appropriate next investigation?
- Thyroid: MEN2 prophylaxis · Multi-stepA 3-year-old child is found by family screening to carry a RET codon 634 mutation (MEN2A). Calcitonin is normal and the neck is clinically normal. What is the recommend…
- Thyroid: medullary carcinoma · ApplicationA patient has a firm thyroid nodule, diarrhoea and a raised serum calcitonin. Biopsy shows polygonal cells in an amyloid stroma. Which cells give rise to this tumour?
- Thyroid: anaplastic carcinoma · ApplicationA 75-year-old has a rapidly enlarging, hard fixed neck mass with hoarseness and stridor over four weeks. Biopsy shows undifferentiated spindle and giant cells. What is…
- Thyroid: Riedel thyroiditis · ApplicationA woman has a woody-hard, fixed thyroid with dysphagia and dyspnoea that mimics anaplastic carcinoma. Biopsy shows dense fibrosis without malignant cells. Which diagnos…
- Thyroid: subacute thyroiditis · ApplicationA woman has fever, a painful tender thyroid after a viral illness, raised ESR and low radioiodine uptake. What is the best treatment?
- Thyroid: retrosternal goitre · ApplicationA patient with a large goitre has facial flushing and distended neck veins when she raises both arms above her head. What is this sign?
- Thyroid: thyroid storm · Multi-stepA thyrotoxic patient develops fever of 40 C, agitation, tachycardia and vomiting after emergency surgery. Which treatment sequence is correct?
- Thyroid: RLN injury · ApplicationHoarseness after thyroid surgery suggests injury to what?
- Thyroid · ApplicationTingling after thyroidectomy suggests what?
Colorectal17
- Colorectal: rectal cancer · Multi-stepA 60-year-old man has a rectal adenocarcinoma 3 cm from the anal verge that invades the sphincter complex. MRI shows threatened mesorectal fascia. Which treatment appro…
- Colorectal: ulcerative colitis surgery · ApplicationA 28-year-old woman with extensive ulcerative colitis has relapsed repeatedly despite maximal medical therapy and is steroid-dependent. Biopsies show no dysplasia and t…
- Colorectal: familial adenomatous polyposis · ApplicationA 17-year-old boy has rectal bleeding. Colonoscopy shows more than 200 adenomatous polyps throughout the colon. His father had a colectomy for colon cancer at the age o…
- Colorectal: Lynch syndrome · Multi-stepA 38-year-old man has a right-sided colon adenocarcinoma. His mother had endometrial cancer and a maternal uncle had colon cancer, both before 50. Immunohistochemistry…
- Colorectal: complicated diverticulitis · Multi-stepA 55-year-old man has 4 days of left iliac fossa pain and fever. He is haemodynamically stable with localised tenderness and no peritonism. CT shows sigmoid diverticuli…
- Colorectal: adjuvant chemotherapy · ApplicationA patient has a resected sigmoid carcinoma with metastasis in 3 of 14 regional lymph nodes and no distant disease. Which statement is correct?
- Colorectal: rectal cancer staging with MRI · Multi-stepIn a patient with mid-rectal cancer, which MRI finding is most important for deciding on neoadjuvant chemoradiotherapy?
- Colorectal: adenoma-carcinoma sequence · ApplicationIn the classic adenoma-carcinoma sequence of sporadic colorectal cancer, which genetic event is usually the earliest?
- Colorectal: ischaemic colitis · ApplicationAn elderly woman after aortic surgery has left-sided abdominal pain and bloody diarrhoea. Colonoscopy shows a well-demarcated segment of oedematous, bluish mucosa at th…
- Colorectal: closed loop obstruction · ApplicationA patient with a left colon carcinoma has massive caecal distension of 12 cm on film. Why is the caecum at highest risk of perforation?
- Colorectal: stoma complication · ApplicationWhich is the most common long-term complication of an end colostomy?
- Colorectal: diverticulitis · ApplicationLeft-lower-quadrant pain with fever in older adult suggests what?
- Colorectal: fissure · ApplicationTearing pain on defecation with posterior midline tear suggests what?
- Colorectal · ApplicationPainless rectal bleeding with prolapse suggests what?
- Colorectal · ApplicationPainful posterior anal tear suggests what?
- Colorectal · ApplicationLLQ pain fever in older patient suggests what?
- Colorectal · ApplicationBright painless blood with prolapse suggests what?
Pancreas17
- Pancreas · ApplicationA 66-year-old man has progressive painless jaundice, weight loss and a palpable, non-tender gallbladder. What is the most likely diagnosis?
- Pancreas: pseudocyst · ApplicationA man recovering from acute pancreatitis has persistent abdominal fullness and early satiety 7 weeks later. CT shows a 9 cm well-defined fluid collection with a thick f…
- Pancreas: infected necrosis · Multi-stepA 45-year-old man recovering from severe necrotising pancreatitis develops fever, leucocytosis and sepsis in week 4. CT shows a walled-off collection with gas bubbles.…
- Pancreas: gallstone pancreatitis timing · ApplicationA 44-year-old woman is admitted with mild acute gallstone pancreatitis. She improves in 3 days, tolerates a diet, and has no necrosis or collections on imaging. When sh…
- Pancreas: nutrition in severe pancreatitis · ApplicationA 50-year-old man with severe acute pancreatitis has been fasting for 3 days and is unable to eat. Which nutritional strategy is preferred?
- Pancreas: carcinoma tumour marker · ApplicationA 62-year-old man has painless jaundice and a 3 cm pancreatic head mass on CT. Biopsy confirms ductal adenocarcinoma, yet serum CA 19-9 is undetectable. What is the lik…
- Pancreas: chronic pancreatitis surgery · ApplicationA 41-year-old man with chronic alcoholic pancreatitis has intractable pain despite analgesics. CT and MRCP show a main pancreatic duct of 10 mm with multiple intraducta…
- Pancreas: insulinoma diagnosis · ApplicationA 40-year-old woman has recurrent early-morning confusion and sweating relieved by eating. During a supervised 72-hour fast she becomes symptomatic with glucose 38 mg/d…
- Pancreas: mucinous cystic neoplasm · ApplicationA 44-year-old woman has an incidental 5 cm septated cyst in the tail of the pancreas, with no history of pancreatitis, no communication with the main duct, high cyst fl…
- Pancreas: glucagonoma · ApplicationA 58-year-old woman has weight loss, new diabetes, anaemia and a migratory erythematous rash with blistering around the groin and perineum. CT shows a 4 cm tumour in th…
- Pancreas: Whipple procedure · ApplicationWhich structures are removed in a classical pancreaticoduodenectomy (Whipple procedure)?
- Pancreas: Ranson criteria · Multi-stepWhich of the following is an admission (zero hour) Ranson criterion for non-gallstone pancreatitis?
- Pancreas: revised Atlanta classification · Multi-stepAccording to the revised Atlanta classification, which feature defines severe acute pancreatitis?
- Pancreas: acute pancreatitis · ApplicationEpigastric pain radiating to back with high lipase suggests what?
- Pancreas · ApplicationWhat symptom is typical of acute pancreatitis?
- Pancreas · ApplicationWhat laboratory test is often elevated in acute pancreatitis?
- Pancreas · ApplicationWhat symptom is typical of acute pancreatitis?
Burns16
- Burns · Multi-stepA 70 kg adult has burns over 40% of the body surface. By the Parkland formula, what total volume of Ringer's lactate is needed in the first 24 hours?
- Burns · Multi-stepA man has circumferential full-thickness burns of the forearm and hand. Two hours later the fingers are cold and tense, capillary refill is poor and the radial pulse ha…
- Burns: inhalation injury · ApplicationA 30-year-old man is rescued from a house fire in an enclosed room with burns to the face and neck. He has a hoarse voice, singed nasal hair and soot in the oropharynx,…
- Burns: carbon monoxide poisoning · ApplicationA 24-year-old woman from a smoke-filled kitchen fire has headache, confusion and nausea. Pulse oximetry reads 99% on room air, and the carboxyhaemoglobin is 30%. What i…
- Burns: depth assessment · ApplicationA child has a scald where the skin is mottled pink-white, does not blanch on pressure and has reduced sensation to pin-prick, with ruptured blisters. Which burn depth i…
- Burns: electrical injury · ApplicationA 35-year-old lineman has a high-voltage electrical injury, with a small entry wound on the hand and exit wound on the foot. Urine is dark red-brown, the dipstick is po…
- Burns: hydrofluoric acid · ApplicationA laboratory worker splashes concentrated hydrofluoric acid on her hand and develops severe pain out of proportion to the minimal skin change. After copious irrigation,…
- Burns: Marjolin ulcer · ApplicationA 55-year-old man has a non-healing, raised, ulcerated lesion with an everted edge within a burn scar on his thigh sustained 30 years ago. Which diagnosis must be exclu…
- Burns: resuscitation endpoint · ApplicationDuring burn resuscitation of an adult, which parameter is the most useful guide to adequacy of fluid replacement?
- Burns: Curling ulcer · ApplicationA patient with 45 percent burns develops painless upper gastrointestinal bleeding on day 5. Which ulcer is typically associated with major burns?
- Burns: circumferential · ApplicationCold pale hand distal to a circumferential burn suggests need for what?
- Burns · ApplicationCircumferential burn with poor distal perfusion needs what?
- Burns · ApplicationWhich burn feature means the patient should be assessed urgently by a specialist burns service?
- Burns: fluid resuscitation · ApplicationThe Parkland formula estimates initial burn-resuscitation fluid using which measure?
- Burns: fluid resuscitation · ApplicationIn a major burn, which clinical parameter is commonly used to judge adequacy of initial fluid resuscitation in an adult?
- Burns: inhalation injury · Multi-stepA patient rescued from an enclosed-space fire has facial burns, soot in the mouth, hoarse voice, and increasing stridor. What is the airway principle?
Colorectal surgery16
- Colorectal surgery · ApplicationWhat is a red-flag symptom requiring assessment for colorectal pathology?
- Colorectal surgery · ApplicationWhat symptom may suggest diverticulitis?
- Colorectal surgery · ApplicationWhat is a potential complication of diverticulitis?
- Colorectal surgery · ApplicationWhat symptom is a red flag for colorectal pathology?
- Colorectal surgery · ApplicationWhich symptom is an alarm feature that should prompt investigation for colorectal cancer in an older adult?
- Colorectal surgery · ApplicationWhat is the immediate management priority for a prolapsed rectum that appears dusky and painful?
- Colorectal surgery · ApplicationWhich symptom is a red flag for colorectal cancer assessment?
- Colorectal surgery · ApplicationWhat is the main purpose of a stoma appliance?
- Colorectal surgery: large bowel obstruction · Multi-stepAn older patient has progressive abdominal distension, colicky pain, obstipation, and a markedly dilated colon proximal to an obstructing sigmoid lesion. Which complica…
- Colorectal surgery: volvulus · ApplicationAn elderly institutionalized patient presents with progressive distension and constipation. Abdominal radiography shows a coffee-bean shaped loop arising from the pelvi…
- Colorectal surgery: diverticulitis · ApplicationLeft-lower-quadrant pain, fever and raised inflammatory markers in an older adult most commonly suggest what?
- Colorectal surgery: colorectal cancer · ApplicationA right-sided colon cancer is more likely than a left-sided lesion to present with what?
- Colorectal surgery: rectal cancer · ApplicationA patient has rectal bleeding, altered bowel habit, tenesmus, and iron-deficiency anemia. What is the appropriate diagnostic principle?
- Colorectal surgery: toxic megacolon · Multi-stepA patient with severe colitis develops fever, tachycardia, abdominal distension, tenderness, and marked colonic dilatation on imaging. What is the diagnosis?
- Colorectal surgery: volvulus · Multi-stepA patient with sigmoid volvulus has peritonitis, shock, and endoscopic evidence of ischemic mucosa. What is the next management principle?
- Colorectal surgery: anal fistula · ApplicationA patient has recurrent perianal abscesses and persistent purulent drainage from a small opening near the anus. What diagnosis is likely?
Hernia16
- Hernia · ApplicationA groin hernia that passes medial to the inferior epigastric vessels through Hesselbach's triangle is a:
- Hernia · ApplicationA hernia that enters the inguinal canal through the deep ring, lateral to the inferior epigastric vessels, is:
- Hernia: Richter hernia · ApplicationAn elderly woman has a tender, irreducible, red swelling below and lateral to the pubic tubercle. She is passing flatus and stool and has no vomiting or distension. At…
- Hernia: Spigelian hernia · ApplicationA 60-year-old woman has localised pain and a small tender swelling lateral to the rectus sheath, below the umbilicus. It is visible only on straining and the external o…
- Hernia: obturator hernia · ApplicationAn emaciated 82-year-old woman presents with small bowel obstruction and pain in the medial thigh that increases on extension and medial rotation of the hip. What is th…
- Hernia: paediatric inguinal hernia · ApplicationA 6-month-old boy has a reducible right inguinal hernia that appears on crying. What is the appropriate operation?
- Hernia: sliding hernia · ApplicationDuring repair of a long-standing left inguinal hernia in an elderly man, the surgeon finds that part of the posterior wall of the sac is formed by a viscus. Which struc…
- Hernia: Hesselbach triangle · ApplicationWhich structure forms the lateral boundary of Hesselbach triangle?
- Hernia: laparoscopic repair · ApplicationIn which patient is a laparoscopic totally extraperitoneal (TEP) repair particularly advantageous?
- Hernia: strangulation risk · ApplicationWhich type of hernia is least likely to strangulate?
- Hernia: triangles of the groin · Multi-stepDuring laparoscopic inguinal hernia repair, mesh fixation with tacks should be avoided in the triangle of pain. Which nerve is at risk there?
- Hernia: strangulation · ApplicationPainful irreducible hernia with vomiting suggests what?
- Hernia · ApplicationGroin mass below pubic tubercle is what?
- Hernia · ApplicationIrreducible painful groin mass with vomiting suggests what?
- Hernia: femoral hernia · ApplicationA woman has a painful groin lump located below and lateral to the pubic tubercle. Which hernia is most likely?
- Hernia: strangulation · Multi-stepA patient with a longstanding groin hernia develops constant severe pain, vomiting, fever, and an irreducible tender lump with skin erythema. What is the priority?
Acute abdomen15
- Acute abdomen: appendicitis · ApplicationMigratory periumbilical to right-lower-quadrant pain suggests what?
- Acute abdomen · ApplicationWhat symptom is classically associated with appendicitis?
- Acute abdomen · ApplicationWhat is an important sign of peritonitis?
- Acute abdomen · ApplicationWhat presentation can suggest a perforated viscus?
- Acute abdomen · ApplicationWhat may be seen on upright chest radiograph with a perforated hollow viscus?
- Acute abdomen · ApplicationWhat symptom pattern is typical of appendicitis?
- Acute abdomen · ApplicationWhat sign suggests peritonitis?
- Acute abdomen · ApplicationWhich clinical migration of pain is classically described in acute appendicitis?
- Acute abdomen · ApplicationA patient has migrating pain from the periumbilical region to the right lower quadrant with anorexia. Which diagnosis is most likely?
- Acute abdomen · ApplicationWhich sign supports peritonitis on abdominal examination?
- Acute abdomen: mesenteric ischemia · Multi-stepAn older patient with atrial fibrillation develops sudden severe abdominal pain but has minimal tenderness on early examination. Which diagnosis should be strongly susp…
- Acute abdomen: perforated ulcer · Multi-stepA patient has abrupt severe epigastric pain, a rigid board-like abdomen, and free air under the diaphragm on an erect chest radiograph. What is the most likely diagnosis?
- Acute abdomen: appendicitis · ApplicationPain that begins peri-umbilically and later localises to the right iliac fossa is typical of what condition?
- Acute abdomen: ischemic colitis · ApplicationAn older patient with vascular disease develops crampy left-sided abdominal pain followed by bloody diarrhea. What diagnosis is most likely?
- Acute abdomen: abdominal compartment syndrome · Multi-stepA critically ill patient with massive fluid resuscitation has tense abdominal distension, oliguria, rising ventilatory pressures, and shock. What syndrome should be con…
Perioperative14
- Perioperative: anticoagulant management · ApplicationA 68-year-old man with atrial fibrillation and no prior stroke takes warfarin and has an INR of 2.6. He is scheduled for an elective colectomy. What is the appropriate…
- Perioperative: diabetic drugs · ApplicationA 55-year-old man with type 2 diabetes on dapagliflozin and metformin is booked for major elective surgery. Dapagliflozin is advised to be stopped at least 3 days befor…
- Perioperative: adrenal suppression · Multi-stepA 52-year-old woman with rheumatoid arthritis has taken prednisolone 10 mg daily for 2 years and is undergoing right hemicolectomy. Under anaesthesia she develops hypot…
- Perioperative: anastomotic leak · Multi-stepOn the sixth day after an anterior resection, a man has fever of 38.8 degrees Celsius, tachycardia of 118 per minute, lower abdominal pain, and a raised CRP and white c…
- Perioperative: refeeding syndrome · ApplicationA 30-year-old woman with anorexia nervosa (BMI 13) starts aggressive enteral feeding before surgery. On day 4 she develops weakness, peripheral oedema, arrhythmia and r…
- Perioperative: heparin-induced thrombocytopenia · Multi-stepA 60-year-old man receiving enoxaparin after colectomy has a platelet count that falls from 280 to 90 x 10^9/L on day 8, with a new calf deep vein thrombosis and necrot…
- Perioperative: massive transfusion · ApplicationA trauma patient receives 12 units of red cells over 2 hours. He develops hypotension, perioral tingling and a prolonged QT interval. Ionised calcium is low. What is th…
- Perioperative: transfusion reaction · Multi-stepTwenty minutes into a red cell transfusion, a patient develops fever, rigors, loin pain, hypotension and passes red urine. What is the first action?
- Perioperative: post-dural puncture headache · ApplicationA 28-year-old man has a spinal anaesthetic for hernia repair. On day 2 he has a severe headache that is worse sitting and relieved lying flat, with no fever. It persist…
- Perioperative: local anaesthetic toxicity · ApplicationAfter an axillary brachial plexus block with bupivacaine, a patient has perioral numbness, tinnitus, then a seizure and ventricular arrhythmia. Which specific therapy s…
- Perioperative: surgical site infection prophylaxis · ApplicationA 50-year-old woman is having elective colorectal resection. When should intravenous cefazolin with metronidazole be given for surgical prophylaxis?
- Perioperative: timing of wound infection · ApplicationA patient develops fever with a red, tender, discharging laparotomy wound. When do surgical site infections most typically declare themselves?
- Perioperative: diathermy safety · ApplicationWhy should monopolar diathermy be avoided during circumcision or surgery on a digit?
- Perioperative: venous thromboembolism prophylaxis · ApplicationA 65-year-old undergoes major abdominal surgery for colon cancer. What is the best thromboprophylaxis strategy?
Biliary12
- Biliary: haemobilia · Multi-stepTwo days after a percutaneous transhepatic biliary drainage, a 55-year-old man develops right upper quadrant colic, new jaundice and melaena, with blood seen draining t…
- Biliary: bile duct injury repair · Multi-stepDuring laparoscopic cholecystectomy for acute cholecystitis, the surgeon realises that the common bile duct has been completely transected (Strasberg E injury) and bile…
- Biliary: incidental gallbladder carcinoma · Multi-stepAfter routine laparoscopic cholecystectomy for stones in a 58-year-old woman in the Gangetic belt, histology shows adenocarcinoma invading the perimuscular connective t…
- Biliary: primary sclerosing cholangitis · ApplicationA 32-year-old man with long-standing ulcerative colitis has fatigue, pruritus and a raised alkaline phosphatase. MRCP shows multifocal strictures and dilatations of int…
- Biliary: gallbladder polyp · ApplicationA 52-year-old asymptomatic man has a solitary 12 mm sessile polyp in the gallbladder on routine ultrasound, with no stones. What is the best management?
- Biliary: risk stratification for duct stones · Multi-stepA 38-year-old woman with symptomatic gallstones has ALT 130 U/L, total bilirubin 2.8 mg/dL and a common bile duct of 7 mm on ultrasound with no stone seen. She has no f…
- Biliary: choledochal cyst · ApplicationAn infant has jaundice and an abdominal mass, and MRCP shows fusiform dilatation of the common bile duct. What is the treatment of choice?
- Biliary: cholecystitis · ApplicationRUQ pain, fever, and positive Murphy sign suggest what?
- Biliary: cholangitis · ApplicationFever, jaundice, and RUQ pain suggest what?
- Biliary · ApplicationPainless jaundice with weight loss suggests what concern?
- Biliary · ApplicationRUQ pain with Murphy sign suggests what?
- Biliary · ApplicationFever jaundice RUQ pain suggests what?
Wound healing12
- Wound healing: role of macrophages · ApplicationWhich cell is considered the key orchestrator that bridges the inflammatory and proliferative phases of wound healing?
- Wound healing: collagen maturation · ApplicationWhich statement about collagen in a healing wound is correct?
- Wound healing: delayed primary closure · ApplicationA contaminated laparotomy wound after faecal peritonitis is left open after thorough washout. After about four days it looks clean and is sutured. What is this called?
- Wound healing: skin graft take · Multi-stepIn the first 48 hours after application, how does a split-thickness skin graft survive?
- Wound healing: impairing factors · ApplicationA patient is on long-term high-dose prednisolone and has a delayed healing wound. Which supplement can partly reverse this steroid effect?
- Wound healing · ApplicationWhat phase of wound healing involves collagen deposition?
- Wound healing · ApplicationWhat is a common sign of a surgical-site infection?
- Wound healing · ApplicationWhat phase of wound healing includes collagen deposition?
- Wound healing · ApplicationWhat sign suggests a surgical-site infection?
- Wound healing · ApplicationWhich vitamin deficiency most directly impairs collagen hydroxylation and can delay wound healing?
- Wound healing · ApplicationWhich nutrient deficiency particularly impairs collagen hydroxylation and wound healing?
- Wound healing: dehiscence · ApplicationOn postoperative day 7 after laparotomy, a patient has a sudden gush of pink serosanguinous fluid from the incision. What complication is suggested?
Breast surgery11
- Breast surgery · ApplicationWhat finding in a breast lump warrants further urgent assessment?
- Breast surgery · ApplicationWhat is the purpose of triple assessment for a breast lump?
- Breast surgery · ApplicationWhat finding in a breast lump warrants urgent assessment?
- Breast surgery · ApplicationWhich breast lump feature warrants urgent specialist assessment for possible malignancy?
- Breast surgery · ApplicationWhich breast symptom requires timely specialist assessment?
- Breast surgery · ApplicationWhat does triple assessment for a suspicious breast lump include?
- Breast surgery: nipple discharge · ApplicationA patient has spontaneous unilateral bloody nipple discharge from a single duct, without a palpable mass. Which benign lesion is a common cause but still warrants speci…
- Breast surgery: malignancy · ApplicationWhich breast finding is most concerning for carcinoma?
- Breast surgery: sentinel node · ApplicationWhat is the main purpose of sentinel lymph-node biopsy in clinically node-negative breast cancer?
- Breast surgery: inflammatory breast cancer · ApplicationA patient has rapidly developing breast enlargement, erythema, peau d'orange, and axillary nodes without improvement on antibiotics. What diagnosis must be considered?
- Breast surgery: nipple discharge · ApplicationWhich nipple discharge pattern is most concerning and warrants breast assessment?
Bowel obstruction10
- Bowel obstruction · ApplicationVomiting, distension, and obstipation suggest what?
- Bowel obstruction · ApplicationWhat symptom constellation suggests bowel obstruction?
- Bowel obstruction · ApplicationWhat is an important initial management element for significant bowel obstruction?
- Bowel obstruction · ApplicationWhat feature is especially common in large-bowel obstruction?
- Bowel obstruction · ApplicationWhat is an important initial management element for significant obstruction?
- Bowel obstruction · ApplicationWhich combination is most typical of mechanical small-bowel obstruction?
- Bowel obstruction · ApplicationWhich feature in a patient with bowel obstruction suggests strangulation and mandates urgent surgical assessment?
- Bowel obstruction · ApplicationWhich symptom combination is typical of mechanical small bowel obstruction?
- Bowel obstruction · ApplicationWhat is an important initial management step in suspected bowel obstruction?
- Bowel obstruction · ApplicationWhich feature favours small-bowel obstruction rather than large-bowel obstruction?
Endocrine surgery9
- Endocrine surgery · Multi-stepA patient with severe primary hyperparathyroidism and osteitis fibrosa cystica undergoes successful parathyroidectomy. On postoperative day 3 he has perioral numbness,…
- Endocrine surgery · ApplicationA 48-year-old woman has recurrent renal stones and bone pain. Serum calcium is 11.8 mg/dL, phosphate is low and PTH is elevated. After biochemical confirmation, which i…
- Endocrine surgery · ApplicationHoarseness after thyroid surgery suggests what nerve injury?
- Endocrine surgery · ApplicationWhat electrolyte problem may occur after thyroidectomy due to parathyroid injury?
- Endocrine surgery · ApplicationWhich nerve injury can cause hoarseness after thyroidectomy?
- Endocrine surgery: thyroid · Multi-stepSeveral hours after total thyroidectomy, a patient develops neck swelling, stridor, and respiratory distress. What is the immediate priority?
- Endocrine surgery: parathyroid · ApplicationAfter parathyroid surgery, a patient has perioral tingling, carpopedal spasm, and a prolonged QT interval. What is the most likely metabolic disturbance?
- Endocrine surgery: pheochromocytoma · Multi-stepBefore adrenalectomy for pheochromocytoma, which preoperative medication sequence is essential?
- Endocrine surgery: adrenal insufficiency · ApplicationA patient taking chronic high-dose steroids undergoes major surgery. Why may perioperative stress-dose glucocorticoids be needed?
Hepatobiliary surgery9
- Hepatobiliary surgery · ApplicationWhat condition may cause fever, jaundice, and right upper-quadrant pain?
- Hepatobiliary surgery: acute cholangitis · Multi-stepA patient with fever, jaundice, right-upper-quadrant pain, hypotension, and confusion has a dilated common bile duct on imaging. What is the definitive urgent principle…
- Hepatobiliary surgery: gallstone pancreatitis · ApplicationA patient with acute pancreatitis has jaundice and a dilated common bile duct. Which associated cause should be suspected?
- Hepatobiliary surgery: cholecystitis · ApplicationWhich sign supports acute cholecystitis on examination?
- Hepatobiliary surgery: cholangitis · ApplicationFever, jaundice and right-upper-quadrant pain form which syndrome?
- Hepatobiliary surgery: gallstone ileus · ApplicationAn older patient has small-bowel obstruction, pneumobilia, and an ectopic gallstone on imaging. Which diagnosis is most likely?
- Hepatobiliary surgery: Mirizzi syndrome · ApplicationA patient with an impacted stone in the cystic duct or gallbladder neck develops obstructive jaundice from external compression of the common hepatic duct. What syndrom…
- Hepatobiliary surgery: acute cholecystitis · ApplicationA patient with right-upper-quadrant pain has fever, leukocytosis, and an ultrasound showing gallstones, wall thickening, and pericholecystic fluid. What is the diagnosis?
- Hepatobiliary surgery: bile leak · ApplicationAfter laparoscopic cholecystectomy, a patient has increasing abdominal pain, fever, jaundice, and bilious output from a drain. What complication should be suspected?
Small bowel9
- Small bowel: short bowel and ileal resection · ApplicationA 40-year-old man had 120 cm of terminal ileum resected for Crohn disease. Two years later he has macrocytic anaemia, paraesthesia and watery diarrhoea that improves wi…
- Small bowel: carcinoid syndrome · ApplicationA man with episodic flushing, diarrhoea and wheeze has a small ileal mass and multiple liver metastases. Which investigation is the best biochemical marker?
- Small bowel: Crohn disease surgery · Multi-stepA patient with Crohn disease has several short fibrotic strictures in the jejunum and a history of ileal resection. Which operation conserves bowel length?
- Small bowel: intestinal tuberculosis · ApplicationA young man from an endemic area has chronic right iliac fossa pain, low-grade fever and subacute obstruction. Barium shows a contracted caecum with a patulous ileocaec…
- Small bowel: Peutz-Jeghers syndrome · ApplicationA child with brown perioral macules presents with colicky pain from intussusception. Polyps in the small bowel are removed. What is the nature of the polyps and the und…
- Small bowel: enterocutaneous fistula closure · Multi-stepWhich factor is most likely to prevent spontaneous closure of an enterocutaneous fistula?
- Small bowel: enterocutaneous fistula management · ApplicationA patient develops a high-output enterocutaneous fistula on postoperative day 6, with 1.5 L per day output and dehydration. What is the first priority?
- Small bowel: SMA syndrome · ApplicationA young woman with rapid weight loss after scoliosis surgery has postprandial vomiting and relief when lying on her left side. Contrast study shows abrupt cut-off of th…
- Small bowel · ApplicationWhat symptom is common in small bowel obstruction?
Head and neck8
- Head and neck · Multi-stepA 6-year-old girl has a painless midline neck swelling at the level of the hyoid that rises on protrusion of the tongue. What is the definitive treatment?
- Head and neck: oral premalignant lesions · ApplicationAmong oral premalignant lesions, which has the highest rate of malignant transformation?
- Head and neck: carcinoma tongue · ApplicationA 55-year-old smoker has an ulcerated lesion on the lateral border of the tongue, 2.5 cm in size and 6 mm deep, with no palpable nodes. What is the best treatment?
- Head and neck: neck levels · ApplicationWhich nodal group belongs to level IB of the neck?
- Head and neck: Ludwig angina · ApplicationA diabetic man with a dental infection has a woody, tender swelling of the floor of the mouth and submandibular spaces, with a raised tongue and drooling. What is the p…
- Head and neck: nasopharyngeal carcinoma · ApplicationA 35-year-old has a painless upper neck lymph node, unilateral hearing loss from serous otitis media, and epistaxis. Which virus is linked with the suspected tumour?
- Head and neck: laryngeal carcinoma · ApplicationA heavy smoker has persistent hoarseness for 8 weeks. Laryngoscopy shows a lesion on the true vocal cord. Why does glottic cancer have a good prognosis?
- Head and neck: tuberculous lymphadenitis · ApplicationA young adult from an endemic area has a chronic matted cervical lymph node mass with a cold abscess that tracks through deep fascia, forming a collar-stud abscess. Wha…
Pediatric surgery8
- Pediatric surgery: Hirschsprung · ApplicationDelayed meconium and abdominal distension suggest what?
- Pediatric surgery: volvulus · ApplicationBilious vomiting in a newborn requires exclusion of what?
- Pediatric surgery · ApplicationCurrant-jelly stool suggests what?
- Pediatric surgery · ApplicationProjectile nonbilious vomiting in young infant suggests what?
- Pediatric surgery · ApplicationA newborn has delayed passage of meconium and a transition zone on contrast enema. Which diagnosis is most likely?
- Pediatric surgery · ApplicationBilious neonatal vomiting needs exclusion of what?
- Pediatric surgery: intussusception · ApplicationA 10-month-old has episodic colicky crying, vomits, draws the knees up, and passes red currant-jelly stool. Which diagnosis is most likely?
- Pediatric surgery: pyloric stenosis · ApplicationA 5-week-old infant has progressively forceful nonbilious vomiting after feeds, remains hungry, and has a palpable epigastric olive. Which acid-base disturbance is most…
Oesophagus7
- Oesophagus · Multi-stepA 35-year-old man has dysphagia to both solids and liquids since onset, regurgitation of undigested food at night and weight loss. A barium swallow shows a dilated oeso…
- Oesophagus · ApplicationA man develops severe retrosternal chest pain and subcutaneous emphysema in the neck after forceful vomiting following binge drinking. Which investigation is most appro…
- Oesophagus: achalasia treatment · ApplicationA fit 28-year-old with confirmed achalasia cardia asks for the most durable surgical treatment. Which operation is the classical choice?
- Oesophagus: corrosive ingestion · ApplicationA child is brought one hour after drinking toilet cleaner containing a strong acid. He is drooling but breathing comfortably. Which step should be avoided?
- Oesophagus: Plummer-Vinson syndrome · ApplicationA middle-aged woman has dysphagia for solids, koilonychia and glossitis. Barium swallow shows a thin web in the post-cricoid region and her haemoglobin is low. Which co…
- Oesophagus: Zenker diverticulum · ApplicationAn elderly man has halitosis, regurgitation of undigested food eaten the day before and a gurgling swelling in the left neck. Where does this pouch arise?
- Oesophagus: staging of carcinoma · ApplicationA patient with biopsy-proven oesophageal carcinoma and no distant disease on CT needs assessment of depth of invasion and regional nodes. Which investigation is the mos…
Anorectal6
- Anorectal: second degree haemorrhoids · ApplicationA 40-year-old has painless bright red bleeding after defaecation, and piles that prolapse on straining and reduce spontaneously. What is a suitable office treatment?
- Anorectal: perianal haematoma · ApplicationA patient has sudden severe perianal pain with a tense, bluish, tender lump at the anal verge, seen within 24 hours of onset. What is the best management?
- Anorectal: atypical fissure · Multi-stepA patient has a painless, broad anal fissure situated laterally with undermined edges. Which underlying conditions should be considered?
- Anorectal: Parks classification · ApplicationAccording to Parks classification of anal fistulae, which type is the commonest?
- Anorectal: rectal prolapse surgery · ApplicationA fit 45-year-old woman has full-thickness rectal prolapse. Which operation gives the lowest recurrence?
- Anorectal: anal canal carcinoma · ApplicationA patient with HIV has a biopsy-proven squamous cell carcinoma of the anal canal. What is the primary treatment?
Hernias6
- Hernias · ApplicationWhat is an incarcerated hernia?
- Hernias · ApplicationWhat complication of hernia threatens bowel viability?
- Hernias · ApplicationWhere is a femoral hernia typically felt?
- Hernias · ApplicationWhat complication of a hernia threatens bowel viability?
- Hernias · ApplicationWhat distinguishes a strangulated hernia from a reducible uncomplicated hernia?
- Hernias · ApplicationWhich feature makes an inguinal hernia concerning for strangulation?
Liver6
- Liver: hydatid cyst imaging · ApplicationA 35-year-old farmer from a sheep-rearing region has vague right upper quadrant discomfort. Ultrasound shows a 9 cm cystic lesion in the right lobe with a floating, wav…
- Liver: pyogenic abscess organism · ApplicationA 54-year-old diabetic man has fever and a solitary 6 cm right lobe liver abscess. Aspirated pus is thick and yellow, and culture grows a mucoid lactose-fermenting Gram…
- Liver: transplant criteria for HCC · Multi-stepFour cirrhotic patients with hepatocellular carcinoma and no vascular invasion or extrahepatic spread are assessed for liver transplantation. Which tumour burden falls…
- Liver: portal vein embolisation · Multi-stepA 62-year-old man with colorectal liver metastases confined to the right lobe needs a right hepatectomy. He has a normal background liver and CT volumetry shows a futur…
- Liver: Budd-Chiari syndrome · ApplicationA 29-year-old woman has abdominal pain, tender hepatomegaly and rapidly developing ascites over 2 weeks. Ultrasound shows an enlarged caudate lobe, and she has a raised…
- Liver: Child-Pugh scoring · Multi-stepA cirrhotic patient has total bilirubin 2.5 mg/dL, albumin 2.9 g/dL, INR 1.5, mild controlled ascites and no encephalopathy. What is his Child-Pugh class?
Stomach6
- Stomach: dumping syndrome · ApplicationSix months after a gastric bypass, a woman has sweating, tremor and palpitations about 2 hours after sugary meals. Symptoms settle with food. What is the mechanism?
- Stomach: bleeding duodenal ulcer · ApplicationA man with a known duodenal ulcer develops massive haematemesis and shock. At surgery a posterior wall ulcer has eroded into an artery. Which vessel is most likely invo…
- Stomach: Zollinger-Ellison syndrome · ApplicationA patient has recurrent ulcers in the distal duodenum and jejunum with chronic diarrhoea. Fasting gastrin is only mildly raised and the gastric pH is below 2. Which tes…
- Stomach: GIST · ApplicationA 60-year-old has anaemia and a 6 cm submucosal gastric mass with central ulceration. Histology shows spindle cells positive for CD117 (KIT) and DOG1. What drug is used…
- Stomach: gastric volvulus · Multi-stepAn elderly woman with a large paraoesophageal hiatus hernia has sudden severe epigastric pain, retching without vomiting, and inability to pass a nasogastric tube. What…
- Stomach: Dieulafoy lesion · ApplicationA man has recurrent massive upper GI bleeding. At endoscopy a small mucosal defect with a spurting vessel is seen in the proximal stomach without a surrounding ulcer. W…
Surgical oncology6
- Surgical oncology · ApplicationWhat is the purpose of a tissue biopsy?
- Surgical oncology · ApplicationWhat does a positive surgical margin mean after cancer resection?
- Surgical oncology · ApplicationWhich principle is central to obtaining informed consent for an elective operation?
- Surgical oncology · ApplicationWhy is histological tissue diagnosis important before many cancer operations?
- Surgical oncology: sentinel lymph node biopsy · ApplicationIn clinically node-negative early breast cancer, what is the principal purpose of sentinel lymph node biopsy?
- Surgical oncology: melanoma · ApplicationWhich feature of a pigmented skin lesion is included in the ABCDE warning rule for melanoma?
Trauma surgery6
- Trauma surgery · ApplicationWhat is the first priority when assessing a major trauma patient?
- Trauma surgery: hemorrhagic shock · Multi-stepA trauma patient is hypotensive, tachycardic, cold, and has a positive focused abdominal sonography for trauma (FAST) examination. What is the most likely source catego…
- Trauma surgery: pelvic fracture · Multi-stepAfter high-energy trauma, a patient with an unstable pelvic fracture becomes hypotensive. What early mechanical maneuver can reduce pelvic volume and tamponade bleeding?
- Trauma surgery: flail chest · ApplicationAfter blunt thoracic trauma, a patient has a segment of chest wall moving inward on inspiration and outward on expiration. What is the diagnosis?
- Trauma surgery: diaphragmatic rupture · ApplicationAfter high-energy left thoracoabdominal trauma, a chest radiograph shows bowel loops in the left hemithorax. What injury is most likely?
- Trauma surgery: damage control · Multi-stepA massively bleeding trauma patient is hypothermic, acidotic, and coagulopathic in the operating room. What operative strategy is most appropriate?
Abdominal wall5
- Abdominal wall: incisional hernia repair · ApplicationA surgeon repairs a large midline incisional hernia using mesh. Which mesh position is associated with the lowest recurrence?
- Abdominal wall: umbilical hernia in children · ApplicationA 14-month-old girl has a reducible 1 cm umbilical hernia that is asymptomatic. What is the best management?
- Abdominal wall: rectus sheath haematoma · ApplicationA 70-year-old man taking warfarin develops sudden pain and a tender, firm swelling in the right lower abdomen after a bout of coughing. The mass does not cross the midl…
- Abdominal wall: desmoid tumour · ApplicationA 28-year-old woman has a firm, painless, non-tender mass within the rectus abdominis 8 months after delivery. Biopsy shows bland spindle cells infiltrating muscle with…
- Abdominal wall: burst abdomen · Multi-stepOn the 8th day after emergency laparotomy for perforation, a patient has a copious salmon-pink serous discharge from the midline wound, with the skin still intact. What…
Hepatobiliary5
- Hepatobiliary · Multi-stepA man with gallstones presents with fever, jaundice, right upper quadrant pain, hypotension and confusion. Which step is most important after starting antibiotics and f…
- Hepatobiliary · ApplicationA young man from an endemic region has fever, right upper quadrant pain and a solitary abscess in the right lobe of the liver on ultrasound. Serology for Entamoeba hist…
- Hepatobiliary · ApplicationAn elderly woman has small bowel obstruction. Abdominal radiograph shows dilated small bowel loops, air in the biliary tree and an ectopic gallstone in the right iliac…
- Hepatobiliary: acute cholecystitis · ApplicationA 45-year-old woman has 36 hours of right upper quadrant pain, fever and a positive Murphy sign. Ultrasound shows gallstones, a thickened gallbladder wall and perichole…
- Hepatobiliary: Mirizzi syndrome · ApplicationA 60-year-old woman has jaundice and right upper quadrant pain. Ultrasound shows a large stone impacted in the neck of the gallbladder, dilated intrahepatic ducts and c…
Intestinal obstruction5
- Intestinal obstruction · ApplicationWhat is the commonest cause of small bowel obstruction in adults?
- Intestinal obstruction · ApplicationAn elderly bedridden man has abdominal distension and constipation. The abdominal radiograph shows a massively dilated, inverted U-shaped (coffee bean) loop from the pe…
- Intestinal obstruction: adhesive obstruction · ApplicationA 45-year-old with a prior laparotomy has colicky pain, vomiting and distension. He has no fever, the abdomen is soft, and CT shows a transition point without ischaemia…
- Intestinal obstruction: strangulation · ApplicationIn a patient with small bowel obstruction, which finding most suggests strangulation?
- Intestinal obstruction: caecal volvulus · Multi-stepA 35-year-old woman has small bowel obstruction. Abdominal film shows a comma-shaped dilated loop in the left upper quadrant with a displaced caecal pole. Colonoscopic…
Oncology5
- Oncology: tumour suppressor genes · ApplicationWhich gene, often called the guardian of the genome, is the most frequently mutated tumour suppressor gene in human cancers?
- Oncology: soft tissue sarcoma · ApplicationA 50-year-old has a deep 8 cm thigh mass diagnosed as high-grade soft tissue sarcoma. Which statement is correct?
- Oncology: lymph node biopsy · ApplicationA young man has a 3 cm firm rubbery cervical node with night sweats and weight loss. FNAC was inconclusive. What is the best next step?
- Oncology · ApplicationCancer surgery increases risk of what?
- Oncology · ApplicationMajor cancer surgery raises risk of what?
Postoperative care5
- Postoperative care · ApplicationWhat symptom can suggest postoperative deep-vein thrombosis?
- Postoperative care · ApplicationWhy is early mobilization encouraged after many operations?
- Postoperative care · ApplicationWhich discharge symptom after abdominal surgery should prompt urgent review?
- Postoperative care · ApplicationA patient becomes suddenly short of breath and tachycardic on postoperative day three. Which diagnosis must be considered urgently?
- Postoperative care: pulmonary embolism · Multi-stepFive days after major pelvic surgery, a patient develops sudden dyspnea, pleuritic pain, tachycardia, and syncope. What diagnosis must be urgently considered?
Surgical infections5
- Surgical infections · Multi-stepA 58-year-old diabetic man has a swollen thigh with dusky skin, bullae, crepitus and pain out of proportion to the findings. He is tachycardic and hypotensive. What is…
- Surgical infections: wound classification · ApplicationA patient has an elective laparoscopic cholecystectomy in which the gallbladder is opened without gross spillage. How is this wound classified, and when is antibiotic p…
- Surgical infections: tetanus prophylaxis · ApplicationA farmer has a contaminated, deep puncture wound from a rusty nail and has never been vaccinated against tetanus. What is the correct prophylaxis?
- Surgical infections: gas gangrene · ApplicationA man with a crush injury develops severe pain, a foul-smelling brown discharge, crepitus and rapidly spreading muscle necrosis. Which organism and toxin are responsible?
- Surgical infections: tetanus prophylaxis · ApplicationA patient with a heavily contaminated wound has an uncertain vaccination history. Which preventive principle is correct?
Thyroid surgery5
- Thyroid surgery · ApplicationWhat complication should be considered after thyroid surgery with stridor?
- Thyroid surgery · ApplicationWhich postoperative symptom after thyroidectomy should prompt immediate concern for neck haematoma compromising the airway?
- Thyroid surgery · ApplicationWhich postoperative symptom after thyroidectomy may indicate hypocalcaemia?
- Thyroid surgery: recurrent laryngeal nerve · ApplicationHoarseness after thyroidectomy most suggests injury to which nerve?
- Thyroid surgery: hypocalcaemia · ApplicationPerioral tingling and carpopedal spasm after thyroid surgery should prompt concern for what?
Transplantation5
- Transplantation: hyperacute rejection · ApplicationWithin minutes of reperfusion, a transplanted kidney turns blue and mottled, and fails. What is the mechanism?
- Transplantation: acute cellular rejection · ApplicationTwo weeks after renal transplantation, a patient has fever, graft tenderness and a rising creatinine. Biopsy shows lymphocytic tubulitis. What is the first-line treatme…
- Transplantation: cyclosporin adverse effects · ApplicationA renal transplant recipient on cyclosporin develops gum hypertrophy, hirsutism and hypertension with rising creatinine. Which drug class does cyclosporin belong to?
- Transplantation: HLA matching · ApplicationFor renal transplantation, which HLA locus match has the greatest effect on graft survival?
- Transplantation: brainstem death testing · Multi-stepBefore declaring brainstem death in a potential organ donor, which condition must be excluded?
Vascular5
- Vascular: acute limb ischemia · ApplicationSudden painful pale pulseless leg indicates what?
- Vascular · ApplicationRest pain with toe ulcer and weak pulses suggests what?
- Vascular · ApplicationPainful swollen calf after surgery suggests what?
- Vascular · ApplicationSudden cold pulseless limb suggests what?
- Vascular · ApplicationShock with pulsatile abdominal mass suggests what?
Adrenal4
- Adrenal: phaeochromocytoma · ApplicationA 40-year-old man with biochemically confirmed phaeochromocytoma is being prepared for adrenalectomy. What is the correct pharmacological preparation?
- Adrenal: primary aldosteronism · ApplicationA 38-year-old woman has hypertension resistant to three drugs, serum potassium 2.9 mmol/L and metabolic alkalosis. Which is the best screening test for the suspected di…
- Adrenal: incidentaloma · ApplicationA CT performed for renal colic in a 55-year-old man shows a homogeneous 3 cm right adrenal mass with an unenhanced attenuation of 6 Hounsfield units. Which interpretati…
- Adrenal: Cushing syndrome surgery · ApplicationA 35-year-old woman with a cortisol-secreting right adrenal adenoma is scheduled for laparoscopic adrenalectomy. Which perioperative measure is essential?
Biliary disease4
- Biliary disease · ApplicationWhat is a common symptom of acute cholecystitis?
- Biliary disease · ApplicationWhat is the usual first imaging test for suspected gallbladder stones?
- Biliary disease · ApplicationWhat is the usual first imaging test for suspected gallstones?
- Biliary disease · ApplicationWhat pain location is common in acute cholecystitis?
Biliary surgery4
- Biliary surgery · ApplicationWhich ultrasound finding supports acute cholecystitis in a patient with right-upper-quadrant pain and fever?
- Biliary surgery · ApplicationWhich symptom is most suggestive of obstructive jaundice rather than isolated haemolysis?
- Biliary surgery · ApplicationWhich presentation is typical of acute cholecystitis?
- Biliary surgery · ApplicationWhat imaging study is commonly used first for suspected gallstones?
Parathyroid4
- Parathyroid: indications for surgery · Multi-stepFour patients have asymptomatic primary hyperparathyroidism. Which one meets a standard criterion for parathyroidectomy?
- Parathyroid: MEN1 · ApplicationA 30-year-old man with a pituitary adenoma and a family history of pancreatic tumours has hypercalcaemia with raised PTH. Imaging suggests several enlarged glands. What…
- Parathyroid: secondary hyperparathyroidism · ApplicationA haemodialysis patient has persistently raised PTH, high phosphate and low-normal calcium despite phosphate binders and vitamin D analogues. Cinacalcet is added. What…
- Parathyroid: differential of hypercalcaemia · Multi-stepA 35-year-old woman has asymptomatic serum calcium 11.0 mg/dL, normal PTH, and a 24-hour urinary calcium to creatinine clearance ratio below 0.01. Her father and sister…
Spleen4
- Spleen · ApplicationA patient is scheduled for elective splenectomy for immune thrombocytopenia. Which perioperative measure is most appropriate?
- Spleen: management of splenic injury · ApplicationA 22-year-old after a road accident has a grade III splenic laceration on CT, with stable vital signs and no peritonitis. What is the management?
- Spleen: hereditary spherocytosis · ApplicationA 7-year-old child with hereditary spherocytosis has persistent haemolysis and transfusion requirements. What is the treatment of choice?
- Spleen: ITP surgery · ApplicationA young woman with chronic immune thrombocytopenia relapses after steroid therapy and has bleeding symptoms. What surgical option is considered?
Surgical infection4
- Surgical infection · ApplicationWhat is source control in surgical sepsis?
- Surgical infection · ApplicationWhat does source control mean in surgical sepsis?
- Surgical infection: necrotising fasciitis · Multi-stepRapidly progressive severe pain out of proportion to skin findings with systemic toxicity should raise concern for what?
- Surgical infection: clostridial myonecrosis · Multi-stepA patient with a contaminated crush injury develops severe pain, rapidly spreading edema, crepitus, systemic toxicity, and gas in muscle. What is the diagnosis?
Wounds4
Appendix3
- Appendix: neuroendocrine tumour · ApplicationA 28-year-old woman has an appendicectomy for acute appendicitis. Histology shows an incidental 8 mm well-differentiated neuroendocrine tumour at the tip, with no mesoa…
- Appendix: appendicular mass · ApplicationA 25-year-old presents on day 5 of right iliac fossa pain with a tender, ill-defined mass, mild fever and no peritonitis. What is the preferred management?
- Appendix · ApplicationMigratory pain to RIF suggests what?
Bowel3
Esophageal surgery3
- Esophageal surgery · ApplicationWhat symptom is a red flag for esophageal pathology?
- Esophageal surgery: Boerhaave syndrome · Multi-stepAfter forceful vomiting, a patient develops severe chest pain, subcutaneous emphysema, and systemic toxicity. What diagnosis is most likely?
- Esophageal surgery: achalasia treatment · ApplicationWhich procedure directly divides the lower-esophageal sphincter muscle to treat achalasia?
Fluids3
- Fluids: normal saline complication · ApplicationA patient receives several litres of 0.9 percent saline during major surgery. Which acid-base disturbance can develop?
- Fluids: maintenance requirement · ApplicationUsing the 4-2-1 rule, what is the hourly maintenance fluid requirement of a 70 kg adult?
- Fluids: correction of hyponatraemia · Multi-stepA patient with chronic symptomatic hyponatraemia of 112 mmol/L is given hypertonic saline. What is the maximum safe rate of correction in 24 hours?
Nutrition3
- Nutrition · ApplicationWhich postoperative patient is most likely to need early dietitian and nutrition-team input?
- Nutrition: refeeding syndrome · Multi-stepA severely malnourished patient is started on high-calorie nutrition and then develops weakness, arrhythmia, and a sharp fall in serum phosphate. What syndrome is most…
- Nutrition: enteral feeding · ApplicationIn a patient with a functioning gastrointestinal tract who cannot meet nutritional needs orally after surgery, which route is generally preferred?
Paediatric urology3
- Paediatric urology: Wilms tumour · ApplicationA 3-year-old child has a large smooth flank mass that does not cross the midline, hypertension and haematuria. He has aniridia. Which gene is implicated in this associa…
- Paediatric urology: posterior urethral valves · ApplicationA 2-month-old boy has a poor urinary stream and a palpable bladder. Ultrasound shows bilateral hydroureteronephrosis and a thick-walled bladder. Which investigation con…
- Paediatric urology: undescended testis · ApplicationA 14-month-old boy has a left testis that is palpable in the superficial inguinal pouch and cannot be manipulated into the scrotum. The testis has not descended on repe…
Perforation3
Salivary glands3
- Salivary glands: Warthin tumour · ApplicationAn elderly male smoker has a soft, cystic, bilateral parotid swelling in the tail of the gland. Histology shows oncocytic epithelium with a lymphoid stroma. Which tumou…
- Salivary glands: adenoid cystic carcinoma · ApplicationA patient with a parotid tumour has facial weakness. Histology shows cribriform pattern and tumour surrounding nerves. Which feature is typical of this tumour?
- Salivary glands: parotidectomy anatomy · ApplicationDuring superficial parotidectomy, which structure divides the parotid into superficial and deep parts?
Shock3
- Shock: septic shock management · ApplicationA patient with pneumonia has fever, a pulse of 120 per minute and BP of 80/50 mmHg and lactate 4 mmol/L. After the first litre of fluid, which is the first-line vasopre…
- Shock: haemodynamic profiles · ApplicationWhich haemodynamic profile is characteristic of hypovolaemic haemorrhagic shock?
- Shock: markers of resuscitation · ApplicationIn a trauma patient who has stable vital signs after initial resuscitation, which laboratory parameter best identifies ongoing occult hypoperfusion?
Surgical assessment3
- Surgical assessment · ApplicationWhat is a first priority when evaluating an acutely unwell surgical patient?
- Surgical assessment · ApplicationWhat finding suggests hypovolemic shock in a bleeding surgical patient?
- Surgical assessment · ApplicationWhy is serial abdominal examination useful in acute abdominal pain?
Wound care3
Anorectal conditions2
Burn2
Colon2
- Colon: toxic megacolon · Multi-stepA patient with severe ulcerative colitis has fever, tachycardia, and a transverse colon diameter of 7 cm on abdominal film. After 48 hours of intravenous steroids, flui…
- Colon: Ogilvie syndrome · Multi-stepA bedridden patient after hip surgery has massive caecal dilatation of 11 cm with no mechanical obstruction on CT and no peritonitis. Conservative measures fail. Which…
Critical care2
Fluid management2
Gastrointestinal bleeding2
GI bleeding2
- GI bleeding: variceal bleed · ApplicationA cirrhotic patient has massive haematemesis. After resuscitation, which pharmacological therapy should be started immediately along with antibiotics?
- GI bleeding: Heyde syndrome · Multi-stepAn elderly man with calcific aortic stenosis has recurrent lower GI bleeding and iron deficiency. Colonoscopy shows right-sided angiodysplasia. Which pathophysiology ex…
Mesenteric ischaemia2
- Mesenteric ischaemia: acute embolus · ApplicationA 70-year-old with atrial fibrillation develops sudden severe abdominal pain with a soft abdomen and no peritonism. Lactate is raised. After resuscitation and heparin,…
- Mesenteric ischaemia: chronic · ApplicationA 62-year-old smoker has postprandial abdominal pain, fear of eating and a 10 kg weight loss. Colonoscopy and gastroscopy are normal. What is the likely diagnosis?
Neck swellings2
- Neck swellings: branchial cyst · ApplicationA 22-year-old has a soft, fluctuant, painless swelling at the anterior border of the upper third of the sternocleidomastoid. Aspirate contains cholesterol crystals. Wha…
- Neck swellings: carotid body tumour · ApplicationA 45-year-old has a firm pulsatile neck mass at the carotid bifurcation that moves from side to side but not vertically. Angiography shows splaying of the carotid bifur…
Paediatric GI surgery2
- Paediatric GI surgery: Hirschsprung disease · ApplicationA full-term neonate has not passed meconium for 3 days and has abdominal distension and bilious vomiting. A digital rectal examination is followed by an explosive gush…
- Paediatric GI surgery: Meckel diverticulum · ApplicationA 3-year-old boy passes a large volume of painless maroon stool. He is pale, but the abdomen is soft and haemodynamically he is stable. Endoscopy of the upper and lower…
Pancreatic surgery2
- Pancreatic surgery: pancreatic cancer · ApplicationAn older patient has painless jaundice, weight loss, pale stools, dark urine, and a palpable nontender gallbladder. What diagnosis is most likely?
- Pancreatic surgery: pseudocyst · ApplicationSeveral weeks after acute pancreatitis, a patient has persistent epigastric fullness and a well-circumscribed fluid collection without epithelial lining. What is most l…
Peptic ulcer disease2
- Peptic ulcer disease · ApplicationA 50-year-old man has sudden severe epigastric pain, a board-like rigid abdomen and absent bowel sounds. He has long used NSAIDs. What is the most appropriate initial i…
- Peptic ulcer disease · Multi-stepA man with a long history of duodenal ulcer has persistent vomiting of food eaten the previous day and a succussion splash. Which acid-base and electrolyte profile is e…
Postoperative complications2
- Postoperative complications: anastomotic leak · Multi-stepOn postoperative day 4 after low anterior resection, a patient develops tachycardia, fever, increasing abdominal pain, and purulent pelvic drain output. Which complicat…
- Postoperative complications: atelectasis · ApplicationOn the first postoperative day after upper abdominal surgery, a patient has low-grade fever, reduced basal breath sounds, and mild hypoxemia but no focal crackles or pu…
Preoperative care2
Skin2
- Skin: melanoma prognosis · ApplicationAfter excision biopsy of a pigmented lesion, which histological feature is the most important prognostic factor in localised melanoma?
- Skin: melanoma wide excision margins · Multi-stepAfter diagnostic biopsy a melanoma has Breslow thickness of 3 mm. What wide excision margin is recommended?
Surgical ethics2
- Surgical ethics: consent · Multi-stepBefore elective colectomy, a patient asks about the risk of an anastomotic leak and possibility of stoma formation. What is the surgeon's obligation?
- Surgical ethics: capacity · Multi-stepA patient with bowel obstruction refuses surgery after demonstrating that they understand the risks, alternatives, and likely outcome, and can explain their reasoning c…
Transplant2
Transplant surgery2
- Transplant surgery: rejection · ApplicationA kidney transplant recipient develops rising creatinine and graft tenderness several weeks after transplantation. Which process should be urgently investigated?
- Transplant surgery: immunosuppression · ApplicationWhich complication is increased by long-term immunosuppression after organ transplantation?
Venous disease2
Anaesthesia and perioperative care1
Colorectal and anal surgery1
Informed consent1
Paediatric hepatobiliary1
Pancreatic and splenic surgery1
Perforated viscus1
Postoperative bowel care1
Stomach and duodenum1
Surgical complications1
Surgical emergencies1
Upper gastrointestinal surgery1
Common questions
How many General Surgery questions are there?
985 original questions across 813 topics, and the bank grows over time.
Which General Surgery topics are covered?
Hernia, Burns, Intestinal obstruction, Trauma, Peptic ulcer disease, Anorectal disorders, Pancreas, Urology, Surgical infections, Anaesthesia and perioperative care, Oesophagus, Head and neck, and more.
How difficult are these General Surgery questions?
0 are recall, 700 are application and 285 are multi-step. The tags are our own editorial judgement, not an official difficulty rating.
Are these General Surgery questions from past papers?
No. They are original practice items. NBEMS does not publish its paper or an official key, and we do not use recalled or leaked questions.
Can I practise General Surgery for free?
Yes. The free plan includes 20 practice questions a day across all subjects, and the free 20-question assessment covers every subject. A paid term removes the daily limit.
Is there a timed General Surgery test?
Yes. The General Surgery subject test is included with a paid term, with a countdown and a question palette.
How should I use these General Surgery questions?
Answer before you look, read the reason for every option, and write a three-line note for each mistake. A few questions you fully review are worth more than many you skim.
Have these General Surgery questions been reviewed by faculty?
Not yet. They are original and drafted with AI assistance, then edited by our team. Independent faculty review is planned, and each item shows its status. Confirm important facts in a standard textbook.