Surgical SBAs for Finals with Explanatory Answers

Thomas Hester, Iain MacGarrow

• Publisher: CRC Press
• Year: 2018
• ISBN:
  9781315357829
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Single best answer (SBA) questions are increasingly popular in medical examinations, and can be challenging: more than one answer may at first appear correct, creating pitfalls for the unwary. This book has been written for medical students throughout their clinical years, including a mixture of clinical and basic science questions that cover the essential topics of surgery. The questions test and reaffirm knowledge through clinical scenarios, making the subject matter engaging, enjoyable and memorable. Explanatory answers both aid learning and help candidates identify areas where further revision is needed.

Questions

1 An 11-year-old boy presents to A&E with a five-hour history of vague abdominal pain. On examination he is noted to have a temperature of 38°C, pulse rate of 110 beats per minute, a runny nose and generalised abdominal tenderness that is worse in the right iliac fossa.

What would be the differentiating feature of this condition?

a Raised neutrophils

b Raised lymphocytes

c Raised CRP

d Raised temperature

e Raised white cell count

What bacteria is the most common bacterial cause of this condition?

a Yersinia enterocolitica

b Helicobacter jejuni

c Campylobacter jejuni

d Salmonella

e Shigella

What radiological investigation would be most appropriate?

a Nil

b Ultrasound

c Computed tomography (appendix protocol)

d MRI

e Abdominal X-ray

The imaging shows some enlarged lymph nodes but is otherwise unremarkable, the patient is currently stable. What is the most appropriate treatment?

a Laparoscopy

b Paracetamol

c Appendicectomy

d Antibiotics

e Watch and wait

2 A 43-year-old lady is referred to A&E by her GP with a 3-day history of ‘green’ vomit and her stoma is not working. Her past surgical history is significant for a laparotomy 3 years ago for ulcerative colitis complicated by adenocarcinoma of the large bowel that she says was done as an emergency. On examination her temperature is 36.8°C. Pulse is 100 beats per minute regular, BP 120/80. There is midline laparotomy scar, a stoma on the right side with an empty appliance and associated swelling upon lifting head of the bed, the abdomen is soft, non-tender, with no audible bowel sounds.

What is the most likely stoma?

a End ileostomy

b Loop ileostomy

c Urostomy

d End colostomy

e Loop colostomy

What is the most likely cause of her symptoms?

a Recurrence of the tumour

b Strangulated hernia

c Adhesions

d Gastroenteritis

e Pancreatitis

Most appropriate management:

a Laparotomy +/− proceed

b Nasogastric tube placement and intravenous fluids

c Laparoscopy +/− proceed

d Intravenous antibiotics

e CT staging

What is the most likely content of the mass next to the stoma?

a Blood

b Omentum

c Small bowel

d Large bowel

e Bladder

3 A 54-year-old publican presents to A&E with epigastric nonradiating abdominal pain. Past medical history is significant for knee arthritis for which he has been taking voltarol for the past 3 months and has increased his dose in the last 2 weeks. He is overweight but does not smoke. His observations are stable, and the blood results are notable for raised amylase. An admission ECG reveals sinus rhythm, with T wave inversion in leads II, III a...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Preface
• About the authors
• Questions
• Answers
• Index