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

A Duplex ultrasound scan is the next appropriate step to assess venous anatomy and function before considering invasive treatments like ligation or sclerotherapy for varicosities.

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

Oesophagogastroduodenoscopy (OGDS) is the most appropriate initial investigation for progressive dysphagia, as it allows direct visualization of the esophagus to identify any obstructions or lesions causing the symptoms.

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

The patient's symptoms, including weight loss and a persistent mass in the right iliac fossa, suggest a malignancy. Caecal carcinoma is more likely than appendiceal mass or ovarian carcinoma, given her age and presentation.

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

The patient's history of pancreatitis and the presence of a palpable abdominal mass suggest a pancreatic pseudocyst, which can occur after pancreatitis. Mildly elevated serum amylase supports this diagnosis.

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

Fine-needle aspiration cytology (FNAC) is the next best investigation to obtain a definitive diagnosis of the thyroid nodule, as it allows for cytological evaluation of the lesion.

What is the first priority in managing a patient with multiple traumatic injuries?

• Control bleeding

• Fluid resuscitation

• Maintain airway

• Prevent infection

Answer explanation

In managing multiple traumatic injuries, maintaining the airway is the first priority. An obstructed airway can lead to inadequate oxygenation, making it critical to ensure the patient can breathe before addressing other injuries.

A 75-year-old man develops a fever of 39.5°C and abdominal tenderness on post-operative day 5 following anterior resection. What is the most likely diagnosis?

• Pulmonary embolism

• Deep vein thrombosis

• Urinary tract infection

• Anastomotic leak

Answer explanation

On post-operative day 5, fever and abdominal tenderness suggest complications. An anastomotic leak is a common post-surgical issue, especially after bowel surgery, making it the most likely diagnosis in this scenario.

Which of the following is the most important criterion for distinguishing between benign and malignant tumours?

• Size of tumour

• Site of tumour

• Growth rate

• Metastasis

Answer explanation

Metastasis is the key factor that differentiates malignant tumors from benign ones. Malignant tumors can spread to other parts of the body, while benign tumors do not, making metastasis the most critical criterion.

A 30-year-old woman presents with progressive dysphagia for 2 years, associated with retrosternal chest pain. Physical examination is unremarkable. What is the most likely diagnosis?

• Oesophageal carcinoma

• Gastroesophageal reflux disease

• Oesophageal diverticulum

• Achalasia cardia

Answer explanation

The patient's progressive dysphagia and retrosternal chest pain suggest a motility disorder. Achalasia cardia is characterized by difficulty swallowing due to esophageal sphincter dysfunction, making it the most likely diagnosis.

In a patient presenting with lower rectal cancer, what is the most likely clinical finding?

• Low back pain

• Large bowel obstruction

• Anaemia

• Rectal bleeding

Answer explanation

Rectal bleeding is a common clinical finding in lower rectal cancer due to the tumor's location and its effect on the rectal mucosa. Other options like low back pain and anaemia may occur but are less specific to this condition.