Surgery p7(301-350)

A 25 year old male falls onto his outstretched hand. Upon examination, he is tender in the anatomical snuffbox. Which carpal bone is he most likely to have fractured?

George Ramonez, a 55 year old man, presents to the Emergency Department with haematemesis. He looks unwell and pale. He has a pulse rate of 130/min and blood pressure of 80/50 mmHg. His Glasgow Coma Score is 9. Physical examination shows a jaundiced patient with multiple spider naevi on his chest, gynaecomastia and an enlarged liver. What is the most appropriate initial step in managing this patient?

A 25 year old motorcyclist, presents with severe central chest pain to the Emergency Department following a motor vehicle accident. His pulse rate is 130/min and blood pressure is 90/60 mmHg. A chest X-ray shows multiple fractured ribs on the right and a widened superior mediastinum. His abdomen is soft and non-tender with no sign of external injuries. Abdominal Focused Assessment with Sonography for Trauma (FAST) was negative. Which of the following is the most appropriate management of this patient?

A 20 year old bystander outside a pub, presents to the Emergency Department with hypotension and stab wounds to the abdomen. Her pulse rate is 140/min and blood pressure is 80/50 mmHg on arrival. She has already had 3L of normal saline intravenous fluid resuscitation. Physical examination shows two 2cm long stab wounds in the epigastric region of the abdomen. Following resuscitation, which of the following is the most appropriate management of this patient?

A 12 year old boy, sustains a penetrating wound of the thigh while trail bike riding. He is taken to the Emergency Department where the wound is debrided. When questioned, his mother is certain that he received the usual childhood immunisations during the first year of life and again before attending school at the age of 5 years.Which of the following is the most appropriate management?

A 56 year old man who asks you, his GP, whether he should undergo prostate cancer testing. Which of the following statements regarding prostate cancer screening is true?

How is an "open" fracture defined?

Which of the following accelerates the natural process of fracture healing?

Which of the following is NOT a stage in normal soft tissue wound healing?

An 18 year old motorcyclist who is brought to hospital by ambulance following a single-vehicle crash. He has a compound fracture of the right femur and is agitated and disorientated. Which of the following is NOT an immediate priority?

A 57 year old man who attends your surgery complaining that he has noticed bright blood on the toilet paper several times over the last two months. He has a past history of haemorrhoids, diagnosed in his 30s. On examination his perianal area looks normal and he has a normal rectal examination. Which of the following is the most appropriate next action?

A patient is having an epidural inserted for postoperative analgesia. He is having a laparotomy, with a midline incision from xiphisternum to pubic symphysis. Where would be a suitable vertebral interspace to insert the epidural catheter?

What is the most likely cause of hypotension in a patient with an epidural infusion of local anaesthetic?

What is the most likely cause of upper airway obstruction in an unconscious patient?

Which of the following compounds can be used as a part of a bowel preparation regimen for a patient prior to large intestinal surgery?

A 25 year old male patient is recovering from a laparotomy he underwent earlier in the day. His vital signs show a blood pressure of 120/80 mmHg and a pulse rate of 120 per min. His in-dwelling catheter has drained 100 mls since coming back from the operating theatre ten hours ago. He has a wound drain which has drained 450 mls of blood looking fluid. Which of the following would be the most appropriate course of action?

An obese 65 year old female with renal failure has had a laparotomy. On day five post operative she develops copious serous ooze from her midline abdominal wound. She is afebrile. This is likely to be due to which of the following?

Which of the following best describes a compound that can be applied topically to human tissue to inhibit or kill micro-organisms with the aim of reducing the risk of sepsis?

A 78 year old female presents febrile, tachycardic and with abdominal pain. On examination, you note a tender mass in the left iliac fossa. After initial resuscitation and routine blood tests, what would be the most appropriate investigation?

A trauma patient with a suspected cervical spine injury requires intubation. Which of the following statements is true regarding the intubation?

A 15 year old male presents with central periumbilical pain, a low grade temperature and nausea. Over the next couple of hours, the pain shifts to the right iliac fossa. Which of the following is the most likely diagnosis?

What is an important difference between sedation and general anaesthesia?

A 58 year old male presents with severe pain and bright red bleeding on defaecation. On examination, there is a tear associated with a small inflammatory skin tag in the posterior midline of the anus. This lesion is typical of which of the following?

A hirsute 20 year old male presents with severe pain in the internatal cleft. He has a low grade temperature and on examination there is a red tender lump in that region. What is the most likely diagnosis?

Graduated compressive stockings are applied to patients recovering from surgery to prevent which of the following?

A patient with a suspected intra-abdominal abscess would have the following pattern to their temperature chart?

A healthy 36 year old patient is having an elective operation under generalanaesthesia. Eight minutes after endotracheal intubation, the pulse oximeter saturation drops from 98 percent to 88 percent. What is the most likely cause of this?

What is the mechanism of action of local anaesthetics on nerve cells?

What is an advantage of tramadol over morphine?

A 75 year old woman is brought into the Emergency Department by ambulance after a fall at home. She is unable to walk and complains of severe groin pain when she moves her left leg. On examination she is lying in bed with her left leg externally rotated. The left leg is 3 cm shorter than the right leg. She is usually well and takes no medications. What is the most appropriate investigation?

A four year old boy is brought to the Emergency Department. His mother states that he has fallen from the backyard trampoline. He has a swollen and obviously deformed right elbow. The radial pulse is absent and the hand is white. The child says that his hand "feels funny". What is the most likely diagnosis?

A four year old boy is brought to the Emergency Department. His mother states that he has fallen from the backyard trampoline. He has a swollen and obviously deformed right elbow. The radial pulse is absent and the hand is white. The child says that his hand "feels funny". What is the appropriate initial management?

A 21 year old man is brought to the Emergency Department. He has been drinking heavily and fell while attempting to avoid arrest. His ankle is very swollen and obviously deformed. Foot pulses are present and the skin is unbroken but tightly stretched over the medial side of the ankle. What is the most likely diagnosis?

A 35 year old woman is brought into the Emergency Department by ambulance after being found lying in the gutter. She is able to speak but is unable to give coherent answers to questions. Her initial vital signs are as follows: heart rate 120 bpm, blood pressure 80/40 mmHg, temperature 38ºC and respiratory rate 28 bpm. What would be your first step on reaching her bedside?

A 22 year old man who was out drinking last night comes into the Emergency Department complaining of a sore right hand. When asked how this might have happened he is evasive. On examination, he is tender over the ulnar aspect of the hand and wrist and has a swollen lip and a bruise around his right eye. What is your provisional diagnosis of his hand injury?

A 78 year old woman presents with diffuse abdominal pain, worsening over the past 2 days. She is nauseated and anorexic. She has not defecated in two days. Herbackground is notable for chronic atrial fibrillation and hypertension. On examination, she looks very unwell and has a generally tender abdomen on palpation. What diagnosis do you need to rule out?

A previously well 65 year old woman is brought in by ambulance after a collapse at home. She is unconscious but breathing spontaneously. She does not open her eyes to a painful stimulus but has an abnormal flexion response in her limbs. Her only vocal response is intermittent groans. What is her Glasgow Coma Score?

A 45 year old man underwent open right inguinal hernia repair with mesh for a large right inguinoscrotal hernia 3 days ago. He presents to the Emergency Department with worsening right testicular pain since the surgery. On physical examination,there is no groin swelling seen but marked swelling and tenderness in his right scrotum. What is the most likely diagnosis?

A 65 year old man, presents with a 2 day history of colicky abdominal pain and vomiting. He has a background history of open anterior resection for rectal cancer 3 years ago. On physical examination, his abdomen is firm and distended. There is a midline laparotomy scar and a 6cm lump in the middle of the scar, which is tender to palpate and not reducible. X-ray of the abdomen shows multiple central bowel loops with air-fluid levels. What is the most appropriate treatment plan?

A thin, 85 year old woman who presents with a left groin lump. She complains of nausea and vomiting and has a background history of hypertension and varicose veins. Physical examination reveals a 1.5cm firm lump below and lateral to the left pubic tubercle. The lump is not reducible and she does not have a cough impulse.What is the most likely diagnosis?

A 40 year old woman, presents with right upper quadrant pain having been the front seat passenger in a high speed head-on motor vehicle collision. On arrival at the Emergency Department, her heart rate is 100 beats per minute and blood pressure is 110/60 mmHg. She is alert and orientated. Her abdomen is mildly distended and there is mild right upper quadrant tenderness. CT scan of the abdomen and pelvis show moderate size liver laceration with surrounding fluid. What is the most appropriate treatment plan?

You are called to see a confused patient on the surgical wards, who is currently receiving oxygen via facemask at 4L/min. Which of the following observations would suggest that the patient is critically ill?

You are asked to review a 73 year old man who had a partial gastrectomy 4 days ago. He has a history of ischaemic heart disease and chronic obstructive airway disease. On examination he has a temperature of 38.3°C, a heart rate of 124/min, blood pressure of 80/40 mmHg, warm peripheries and the jugular venous wave-form is not visible. What is the most likely cause for this scenario?

A 45 year old morbidly obese male presents with a two day history of pain in the left calf and swelling of the ankle. Which of the following is the correct management?

Which of the following is NOT a symptom or a sign of acute lower limb ischaemia?

The highest risk for post-operative deep vein thrombosis (DVT) is associated with which of the following types of surgery?

What is the most effective modality for prevention of post-operative deep vein thrombosis (DVT) following laparoscopic anterior resection for sigmoid colon cancer?

On discharge from hospital following Total Hip Arthroplasty (THA), patients should receive which of the following for 4 weeks for venous thromboembolism (VTE) prophylaxis?

A 24 year old man admitted to the Emergency Department following a motor vehicle accident. He has a contused chest wall and is in respiratory distress. His left chest is resonant on percussion and no breath sounds can be heard on auscultation. His trachea is deviated to the right. What is the most likely diagnosis?

A 25 year old man who has had a motor bike accident. On arrival at the Emergency Department, his vital signs are heart rate 130/minute, blood pressure 90/60 mmHg, respiratory rate 32/minute, temperature 36ºC and his peripheral oxygen saturation is 97 percent. What should be your initial response?