Past Year Surgical BAQ

A 31-year-old woman presents with multiple lower limb varicosities, predominantly along the distribution of the long saphenous vein. What is the next appropriate step in management?

• Ligation and stripping

• Ligation of both long and short saphenous veins

• Sclerotherapy

• Duplex ultrasound scan

Answer explanation

Answer: D. Duplex ultrasound scan
Justification: Duplex ultrasound is the first-line investigation to assess venous reflux and plan treatment. It allows detailed evaluation of the anatomy and function of superficial and deep veins

A 55-year-old man presents with a 7-week history of progressive dysphagia, initially noticed when eating meat, with food getting stuck retrosternally. What is the most appropriate initial investigation?

• Barium swallow

• Chest X-ray

• Oesophagogastroduodenoscopy (OGDS)

• CT scan of the chest

Answer explanation

Answer: C. Oesophagogastroduodenoscopy (OGDS)
Justification: OGDS is the gold standard to directly visualize the esophagus, exclude malignancy, and allow biopsy. It is preferred over barium swallow in adults with red flags (e.g. weight loss, progressive symptoms)

A 52-year-old obese woman presents with jaundice, fever with chills, and right hypochondriac pain. What is the most likely diagnosis?

• Empyema of the gallbladder

• Viral hepatitis

• Acute cholecystitis

• Cholangitis

Answer explanation

Answer: D. Cholangitis
Justification: The classical Charcot triad (fever, jaundice, RUQ pain) is diagnostic for acute cholangitis, commonly due to biliary obstruction by stones.

What is the most sensitive imaging modality for detecting urinary tract calculi?

• KUB X-ray

• Intravenous urogram (IVU)

• Non-contrast CT scan

• Ultrasound

Answer explanation

Answer: C. Non-contrast CT scan
Justification: Non-contrast CT is the imaging modality of choice due to high sensitivity and ability to detect both radiopaque and radiolucent stones

A 50-year-old woman presents with a right iliac fossa mass persisting for 4 months. She reports lethargy, poor appetite, and a 3 kg weight loss. What is the most likely diagnosis?

• Appendiceal mass

• Caecal carcinoma

• Right ovarian carcinoma

• Diverticulitis

Answer explanation

Answer: B. Caecal carcinoma
Justification: A chronic right iliac fossa mass with systemic features (weight loss, anorexia) suggests malignancy. Caecal carcinoma is a common cause in this age group

In a patient with multiple traumatic injuries, what is the first priority in management?

• Control of bleeding

• Prevention of infection

• Maintenance of airway

• Fluid resuscitation

• Pain control

Answer explanation

Answer: C. Maintenance of airway
Justification: In trauma management (ATLS), securing the airway is the first priority, followed by breathing and circulation (ABC).

Which of the following is a characteristic feature of a fibroadenoma of the breast?

• Small size

• Freely mobile lump

• Firm consistency

• Common in young women

Answer explanation

Answer: B. Freely mobile lump
Justification: Fibroadenoma is a benign breast tumor, typically firm, mobile ("breast mouse"), and common in young women.

A 42-year-old alcoholic male with a recent history of pancreatitis presents with a palpable abdominal mass and mildly elevated serum amylase. What is the most likely diagnosis?

• Pancreatic carcinoma

• Pancreatic abscess

• Hepatocellular carcinoma

• Pancreatic pseudocyst

• Empyema of the gallbladder

Answer explanation

Answer: D. Pancreatic pseudocyst
Justification: A pseudocyst is a common sequela of pancreatitis. It presents weeks after acute pancreatitis with a palpable mass and persistent enzyme elevation

A 52-year-old man presents with a 1 cm thyroid nodule on the left lobe, confirmed as a solid lesion on ultrasound. What is the next best investigation to establish a definitive diagnosis?

• Thyroid scan

• Fine-needle aspiration cytology (FNAC)

• Thyroid function test

• CT scan of the thyroid

Answer explanation

Answer: B. Fine-needle aspiration cytology (FNAC)
Justification: FNAC is the investigation of choice to determine malignancy risk in solid thyroid nodules.

A 75-year-old man on post-operative day 5 following bowel resection develops abdominal tenderness. What is the most likely diagnosis?

• Pulmonary embolism

• Deep vein thrombosis (DVT)

• Urinary tract infection (UTI)

• Anastomotic leak

Answer explanation

Answer: D. Anastomotic leak
Justification: On postoperative day 5, new abdominal tenderness raises suspicion of an anastomotic leak, a serious complication needing urgent evaluation.