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Worksheets4th Year Surgery End of Block
Total questions: 40
Worksheet time: 16mins
12-year-old boy is admitted to the emergency department with sudden onset of severe right testicular and lower abdominal pain during athletic training. He has had one episode of vomiting and constantly feels nauseous. On examination, the patient is sweating and in unbearable pain. There is marked tenderness and swelling of the right testicle which is observed to be lying horizontally. What is the most appropriate next step in this patient’s management?
Order a Doppler ultrasound of the testicular arteries
Send the patient immediately for emergency surgical exploration of the scrotum
Perform urine dipstick
Manage the patient with analgesia and observe
A 44-year-old woman presents to the emergency department with acute onset of right upper quadrant pain and fever. On examination, the patient is lying still and has a tachycardia. The abdomen is tender in the right upper quadrant with guarding in that area. Murphy’s sign is positive. What is the most useful investigation for the likely diagnosis?
Ultrasound
Colonoscopy
Serum amylase
Abdominal X-ray
In scrubbing, which of the following statements are false?
If the surgeon has a suspected infected lesion, it is sprayed with iodine and covered with a sterile dressing before gloving.
The first scrub of the day should take about 5 min from start to drying.
After applying disinfectant, the arms are washed from distal to proximal with hands up and elbows flexed.
Drying, using a towel for each side, should start with the fingers and work across the hand and up the arm.
Which of the following statements regarding otitis externa are true?
It can be distinguished from otitis media by pain on movement of the pinna or tragus
It is best treated initially with oral antibiotics.
It should be treated with irrigation and washout
It should not be treated with steroids, due to the risk of overwhelming sepsis.
The pharynx extends from the level of the skull base to which vertebra?
Fourth cervical vertebra.
Fifth cervical vertebra.
Sixth cervical vertebra.
Seventh cervical vertebra.
Which of the following is not true in relation to strangulated hernias?
They present with local and then generalised abdominal pain and vomiting.
A normal hernia can strangulate at any time.
This is more common in inguinal.
They can be reliably excluded from irreducible hernias on clinical examination.
Which of the following is not part of the anaesthetic triad used during surgery?
Unconsciousness
Analgesia
Amnesia
Muscle Relaxation
Which virus is associated with nasopharyngeal carcinoma?
Epstein–Barr virus
Varicella zoster
Human papillomavirus (HPV) 6 and 11
Rhinovirus
Which of the following are not indications for tracheostomy?
Acute upper airway obstruction.
Potential upper airway obstruction.
Tension pneumothorax.
Prolonged artificial ventilation.
Which of the following is not a predisposing factor for a hernia?
COPD
Obesity
Simple Urinary Stones
Pregnancy
What are the typical presenting symptoms associated with chronic otitis media?
Otorrhoea and hearing loss
Pain and otorrhoea
dizziness and hearing loss
Tinnitus and dizziness
Which of the following are important in the causation of gastric cancer?
H. pylori infection
Gastric atrophy
Pernicious anaemia
All of the above
What is the most reliable way to ascertain correct placement of an endotracheal tube?
Recording sats >94%
Measurement of end-tidal carbon dioxide concentration
Direct visualization
Detection of breath sounds on auscultation
A 64-year-old woman complains of right calf pain and swelling. She recently underwent an uncomplicated left hemicolectomy for diverticular disease. A duplex ultrasound confirms the presence of deep vein thrombosis (DVT) of the calf. Which of the following is the most appropriate initial management of this patient?
Pneumatic compression stockings
Warfarin
Heparin
Thrombolysis
What nerve does not supply sensation to the external ear?
CN V
CN VII
CN VIII
CN X
Which of the following statements are true?
A Pain of renal origin is a deep-seated, sickening ache.
Pain from a ureteric stone is colicky and the patient rolls around in agony.
Perineal pain is a penetrating ache and can occur in both sexes.
All of the above.
In benign prostatic hypertrophy (BPH) which of the following statements are false?
It is the commonest cause of bladder outflow obstruction (BOO) in men >70 years of age.
Decrease in serum testosterone levels and therefore relative increase in serum oestrogens cause BPH.
The condition affects the transitional zone and the central zone.
All lower urinary tract symptoms (LUTS) in men >70 years are due to BPH.
On postoperative day 5, an otherwise healthy 55-year-old man recovering from a partial hepatectomy is noted to have a fever of 38.6°C. Which of the following is the most common nosocomial infection postoperatively?
Wound infection
Pneumonia
UTI
Intra-abdominal collection
A 56-year-old woman is referred to you about 3 months after a colostomy subsequent to a sigmoid resection for cancer. She complains that her stoma is not functioning properly. Which of the following is the most common serious complication of an end colostomy?
Bleeding
Skin breakdown
Parastomal hernia
Stomal prolapse
A 42-year-old man with no history of use of NSAIDs presents with recurrent gastritis. The patient was diagnosed and treated for Helicobacter pylori 6 months ago. Which of the following tests provides the least invasive method to document eradication of the infection?
Serology testing for H pylori
Carbon-labeled urea breath test
Rapid urease assay
Histologic evaluation of gastric mucosa
Which of the following regarding the management of acoustic neuroma are true?
Hearing will be lost during treatment for this condition.
Predictable tumour growth allows for appropriately timed treatment.
Treatment options are complex and involve factors including tumour size and hearing levels.
Following diagnosis, treatment is mandatory.
A 22-year-old student notices a bulge in his right groin. It is accentuated with coughing, but is easily reducible. Which of the following hernias follows the path of the spermatic cord within the cremaster muscle?
Femoral
Direct inguinal
Indirect inguinal
Spigelian
A 74-year-old woman is admitted with upper gastrointestinal (GI) bleeding. She is started on H2 blockers, but experiences another bleeding episode. Endoscopy documents diffuse gastric ulcerations. Omeprazole is added to the H2 antagonists as a therapeutic approach to the management of acute gastric and duodenal ulcers. Which of the following is the mechanism of action of omeprazole?
Blockage of the breakdown of mucosa-damaging metabolites of nonsteroidal anti-inflammatory drugs (NSAIDs)
Provision of a direct cytoprotective effect
Buffering of gastric acids
Inhibition of parietal cell hydrogen potassium ATPase (adenosine triphosphatase)
A 45-year-old businessman experiences increasingly painful retrosternal heartburn, especially at night. He has been chewing antacid tablets. An esophagogram shows a hiatal hernia. In determining the proper treatment for a sliding hiatal hernia, which of the following is the most useful modality?
Barium swallow
Endoscopy
Assessment of the patient’s smoking and drinking history
Twenty-four-hour monitoring of esophageal pH
A 22-year-old woman presents with a painful fluctuant mass in the midline between the gluteal folds. She denies pain on rectal examination. Which of the following is the most likely diagnosis?
Pilonidal abscess
Perianal abscess
Perirectal abscess
Anal fissure
What is a cholesteatoma?
A benign condition which is self-limiting.
A benign condition which can be locally destructive
A malignant ear condition without metastasis
A malignant condition with metastasis
55-year-old man, with a 2-year history of dyspepsia, is brought to the emergency department following a sudden onset of severe epigastric pain. The pain is made worse on movement and the patient has also experienced one episode of haematemesis. On examination, the patient is cold, sweating profusely and taking shallow breaths. The abdomen is rigid and bowel sounds are absent. A plain film chest radiograph reveals free air under the diaphragm. The most likely diagnosis is
Perforated appendicitis
Perforated peptic ulcer
Acute cholecystitis
Acute pancreatitis
A patient is admitted following a road traffic accident. He has a suspected liver laceration and is taken to theatre for a laparotomy. The surgeon performing the procedure asks you to name the other intraperitoneal organs within the abdomen. Which of the following abdominal organs is not classified as intraperitoneal?
Ureters
Transverse colon
Stomach
Gallbladder
what is the most common type of pancreatic cancer
adenocarcinoma
insulinoma
glucagonoma
gastrinoma
65 year old presents with 3 week history of jaundince, weight loss, and nausea. on examination you can feel fullness in the RUQ, no tenderness. Given the likely diagnosis, what imaging modality would you consider in the first instance?
CT abdomen pelvis
xray abdomen
ultrasound abdomen
endoscopy with ERCP
35 year old present with right sided colicky loin to groin pain and vomiting. Urine dip is positive for blood and protein. WCC and CRP are within normal ranges. How will you investigate this patient?
US KUB
CT KUB
Xray abdomen
flexible cystoscopy
35 year old present with right sided colicky loin to groin pain and vomiting. Urine dip is positive for blood and protein. WCC and CRP are within normal ranges. Given the likely diagnosis, what is the the most effective analgesia of choice
IV Morphine
inhaled entonox
fascia iliaca block
PR diclofenec
56-year-old presents with retrosternal chest pain. He has tried antacids and lifestyle modifications. He has been on Esomeprazole for the last 3 months with little benefit. What is the most appropriate next step in his care?
begin tripple therapy immediately
non-urgent referral for endoscopy
dual acid suppresison therapy with H2 receptor antagonist and PPI
referral for Nissen fundoplication
List the key red flags for back pain
A 34 year old man presents with pain in his lower back which is worse in the morning. He has previously had issues with a painful red eye. An XR of his lumbar spine shows a 'bamboo appearance'. What is the most likely diagnosis?
Ankylosing Spondylitis
Rheumatoid Arthritis
Osteoarthritis
Herniated Disc
A 45 year old patient presents with acute lower back pain radiating down the back of both legs after a bending injury. She describes difficulty in ability to pass urine. On examination she has a positive bilateral sciatic stress test and reduced peri-anal sensation. What is the most appropriate first line investigation?
CT thorax abdomen pelvis
MRI Lumbar spine
US Bladder scan
No acute imaging required
Which of the following cancers have the biggest association with development of MSCC?
Breast, brain, stomach, myeloma
Brain, prostate, myeloma, pancreatic
Adrenal, breast, prostate, myeloma
Breast, lung, prostate, myeloma
Arrange the following into voiding and storage symptoms
Urgency
Day time urinary frequency
Nocturia
Urinary incontinence
Slow stream
Straining
Intermittency
Hesitancy
Terminal dribbling
A 60 year old presents with new problems with swallowing. What is the most appropriate first line investigation?
Barium Swallow
CT CAP
ECG
FBC
OGD
A sixty-year-old male presents with worsening retrosternal chest pain over the past six months which comes on after drinking coffee. He hasn’t lost any weight and otherwise feels well in himself. What is the most likely cause for his symptoms?
Achalasia
Gastric cancer
GORD
Ischaemic heart disease
Oesophageal cancer
