Surgery p8(351-

A 25 year old man who has had a motor bike accident. On arrival at the Emergency Department, his vital signs are heart rate is 130/minute, blood pressure of 90/60 mmHg, respiratory rate of 32/minute, temperature is 36°C. His peripheral oxygen saturation is 97 percent on room air. What would be your initial order for IV fluids?

A 24 year old woman presents with a 3 day history of lower abdominal pain and swinging fever to 39°C. She underwent laparoscopic appendicectomy for perforated appendicitis 5 days ago. The procedure was uncomplicated and she was discharged following 2 days of hospital admission. On physical examination, her temperature is 38.9°C, pulse rate is 120 beats/minute and blood pressure is 140/70 mmHg. Her abdomen is mildly distended and there is mild right iliac fossa tenderness. The laparoscopic wounds are clean. What is the most likely diagnosis?

A man is brought into the Emergency Department after being assaulted. His Glasgow Coma Score (GCS) is 8 and he has a markedly dilated pupil on the right. Which of the following is the most important priority?

A skin flap refers to soft tissue that is characterised by which of the following?

An acute attack of abdominal colic means that the pain:

Regarding analgesic doses of ketamine, which of the following statements is correct?

A 56 year old man is brought into the Emergency Department following a car accident. When you assess his respiratory system you find that he has reduced chest expansion on the right with a midline trachea. The percussion note is dull on the right posteriorly and laterally but resonant on the left. He is very tender in the right axilla. Breath sounds are absent at the right base and generally vesicular with occasional crackles elsewhere. What is the most likely diagnosis based on these findings?

A 45 year old man who presents to the Emergency Department with pain in the lateral aspect of his wrist after a fall on an outstretched hand. On examination he is tender in his anatomical snuffbox. On X-ray he does not have an obvious fracture. Which fracture are you most concerned about?

A 45 year old man, presents to Emergency Department after being knocked off his bicycle by a car. He is talking and has no recollection of the event. Physical examination is unremarkable except for bilateral periorbital brusing. CT scan of the head shows a small amount of air in the cranial cavity. What is the most likely diagnosis?

Mrs Chubb, a 60 year old woman, presents to the Emergency Department following a motor vehicle accident. On primary survey: her airway is intact; she is breathing spontaneously with a respiratory rate of 20 per minute, pulse rate of 90 beats per minute and blood pressure of 140/90 mmHg; Glasgow Coma Score of 15. The secondary survey is unremarkable except for marked tenderness over the mid sternum on palpation. No haemothorax, pneumothorax or fractures are seen on a chest X-ray with a sternal view. What is the most likely diagnosis?

A 65 year old woman, presents to the Emergency Department following a motor vehicle accident. Following initial assessment, she is found to have a minimally displaced fractured left clavicle. What is the most appropriate management following 5 milligrams of intramuscular morphine injection?

A 22 year old man, presents to the Emergency Department after being tackled in rugby. He complains of left arm pain and is unable to move his left shoulder because of pain. X ray shows a minimally displaced fracture of the mid shaft of the humerus. His left arm is warm with good distal pulses. Sensation in the left upper arm is also normal. What is the most appropriate management of this humeral fracture?

A 15 year old girl presents with a 12 hour history of right iiac fossa pain. Which of the following symptoms or signs is usually not associated with a diagnosis of acute appendicitis?

A 35 year old woman presents with a 24 hour history of right iliac fossa pain. She is tender with moderate rebound tenderness in the right iliac fossa. Which of the following is the LEAST likely differential diagnosis?

A 72 year old woman presents with severe abdominal pain. She has been on the waiting list for a laparoscopic cholecystectomy for gallstone disease. She is afebrile,with a normal pulse and blood pressure and is tender in the epigastrium. Aprovisional diagnosis of acute pancreatitis is made and confirmed with an elevated lipase and amylase level. Which of the following is NOT useful in predicting the severity of acute pancreatitis?

In which of the following is topical anaesthesia with lignocaine NOT effective?

A 23 year old man presents with abdominal pain after a single low velocity gunshot wound to the left chest. The entrance wound is 3 cm inferior and lateral to the left nipple and the exit wound 6 cm below the left scapula. A chest tube is inserted and drains 400 ml of blood initially and 50 ml over the next hour. A chest X-ray reveals an expanded lung and no pleural fluid. His initial blood pressure was 70/20 mmHg with a pulse of 120/min. After 2 litres of saline his blood pressure is 85/55 mmHg and pulse is 110/min. An initial FAST (focused abdominal scan in trauma) scan is negative. Which of the following should be the next step in his management?

A 48 year old woman develops sudden onset of right sided abdominal pain while playing tennis. She presents to you with persistent sharp pain in the right lower abdomen with associated nausea. Examination reveals a low grade fever (37.2ºC) and tenderness to the right of the midline below the umbilicus with an impression of a mass in this region. Which of the following is the most likely diagnosis?

A 72 year old man undergoes a right total knee replacement and on the 2nd post operative day is found to have a swollen leg with pain in the calf on movement. Which of the following would be the most likely diagnosis?

A 24 year old man has fallen from his motorbike. He was paraplegic at the scene with a sensory level at T10. You review him in the Emergency Department. His legs appear warm and well perfused but he is tachycardic (105 bpm) and hypotensive (85/40 mmHg). His haemoglobin level is normal (120 g/L). What is the most correct statement?

A 50 year old man was moving house when he felt a twinge in his back that was followed by the sudden onset of severe pain in his left leg. It travelled from the buttock into the posterior thigh and calf. The pain has been present for 2 weeks. He has now noticed that his calf muscles are weak on the left side. He is unable to stand on his toes on the left side. A CT scan of the lumbar spine shows a left lateral disc protrusion compromising the S1 nerve root. Which is the most correct statement?

A 65 year old woman collapsed while standing at the watercooler at work. She was noted to clutch at her head as she fell. She is brought to the Emergency Department and a computed tomography (CT) scan is reported as showing blood in the basal cisterns. What is the most likely diagnosis?