PLAB 1 Surgery and Emergencies 2

Question 1

A 35-year-old man sustains a stab wound to the left chest at the 5th intercostal space, midclavicular line. He is hypotensive with muffled heart sounds and distended neck veins. What is the most likely diagnosis?

Accepted Answer

Cardiac tamponade

Answer

Beck's triad — hypotension, muffled heart sounds, and distended neck veins (raised JVP) — is classic for cardiac tamponade. Penetrating trauma at this location can injure the heart. Emergency management includes pericardiocentesis or emergency thoracotomy.

Question 2

A 75-year-old man presents with absolute constipation (no flatus or faeces for 3 days), colicky abdominal pain, and vomiting. Abdominal X-ray shows dilated large bowel with a 'coffee bean' sign. What is the most likely diagnosis?

Accepted Answer

Sigmoid volvulus

Answer

The 'coffee bean' sign on abdominal X-ray is pathognomonic for sigmoid volvulus — a twisting of the sigmoid colon on its mesentery. It is more common in elderly, institutionalised, or psychiatric patients. Initial management is sigmoidoscopic decompression with a flatus tube.

Question 3

A 50-year-old woman presents with a painless, progressively enlarging lump in her right breast. On examination, there is skin tethering and peau d'orange. What is the most appropriate next step?

Accepted Answer

Urgent 2-week wait referral for triple assessment (clinical examination, imaging, and tissue sampling)

Answer

A painless breast lump with skin tethering and peau d'orange is highly suspicious for breast cancer. NICE guidelines mandate urgent 2-week wait referral for triple assessment: clinical examination, imaging (mammography/ultrasound), and tissue sampling (core biopsy).

Question 4

A 20-year-old male cyclist is brought to A&E after being hit by a car. He has a GCS of 8. According to ATLS, what is the most important immediate airway intervention?

Accepted Answer

Perform endotracheal intubation with in-line cervical spine stabilisation

Answer

A GCS of 8 or below indicates the patient cannot protect their own airway. ATLS guidelines recommend definitive airway management with endotracheal intubation, maintaining in-line cervical spine stabilisation until injury is excluded. A GCS ≤8 is a key threshold for intubation.

Question 5

A 55-year-old man presents with a pulsatile, expansile abdominal mass. He is haemodynamically stable. An ultrasound shows a 5.8 cm infrarenal abdominal aortic aneurysm. What is the recommended management?

Accepted Answer

Urgent referral to vascular surgery for consideration of elective repair

Answer

NICE guidelines recommend referral for consideration of elective repair for AAA ≥5.5 cm due to the significant risk of rupture. Aneurysms 3.0-4.4 cm are monitored annually, and 4.5-5.4 cm are monitored 3-monthly. At 5.8 cm, the benefit of elective repair outweighs surgical risk.

PLAB 1 Practice Test

PLAB 1 Practice Test

PLAB 1 Surgery and Emergencies 2