MCCQE Acute Surgical Presentations 2

Question 1

A 45-year-old man presents with sudden onset severe epigastric pain radiating to the back, nausea, and vomiting after a heavy meal. Serum lipase is 1200 U/L. CT shows peripancreatic fat stranding but no necrosis. What is the Ranson criterion at admission that most strongly predicts severity?

Accepted Answer

Serum glucose > 11 mmol/L

Answer

Serum glucose > 11 mmol/L (200 mg/dL) at admission is one of the five Ranson criteria assessed on presentation and is a key predictor of severe pancreatitis.

Question 2

A 68-year-old woman with atrial fibrillation presents with sudden severe periumbilical pain out of proportion to physical exam findings, followed by bloody diarrhea 6 hours later. CT angiography shows filling defect in the superior mesenteric artery. What is the priority management?

Accepted Answer

IV heparin anticoagulation and urgent surgical or endovascular revascularization

Answer

Acute mesenteric ischemia from embolic occlusion requires immediate anticoagulation with heparin and urgent revascularization (surgical embolectomy or endovascular therapy) to prevent bowel infarction.

Question 3

A 55-year-old man undergoes elective right hemicolectomy. On post-operative day 3 he develops fever, tachycardia, and worsening abdominal pain with peritoneal signs. CT shows free air and fluid. What is the most likely diagnosis and appropriate next step?

Accepted Answer

Anastomotic leak — return to OR for washout and stoma creation

Answer

Post-operative peritonitis with free air on POD 3 after bowel resection is anastomotic leak until proven otherwise, requiring urgent surgical re-exploration, washout, and fecal diversion.

Question 4

A 30-year-old woman presents with right lower quadrant pain, low-grade fever, and elevated WBC. Ultrasound is non-diagnostic. CT with contrast shows a 9 mm appendix with periappendiceal fat stranding. She has no perforation or abscess. What is standard of care?

Accepted Answer

Laparoscopic appendectomy

Answer

Uncomplicated acute appendicitis confirmed on CT is treated with laparoscopic appendectomy, which is the current standard of care offering lower morbidity and faster recovery than open surgery.

Question 5

A 72-year-old man with a known 5.5 cm abdominal aortic aneurysm presents with sudden onset severe back and flank pain, hypotension, and a pulsatile abdominal mass. BP is 80/50. What is the immediate management priority?

Accepted Answer

Permissive hypotension targeting SBP 50-70 mmHg and emergent surgical repair

Answer

Ruptured AAA is a surgical emergency; permissive hypotension (SBP 50–70 mmHg) is maintained to reduce further hemorrhage while rushing the patient to the OR for open or endovascular repair.

(MCCQE) Medical Council of Canada Qualifying Examination Practice Test

(MCCQE) Medical Council of Canada Qualifying Examination Practice Test

MCCQE Acute Surgical Presentations 2