PLAB 1 Surgery and Emergencies

Question 1

A 25-year-old man presents to A&E with sudden-onset right iliac fossa pain.
On examination, he has rebound tenderness and guarding.
His temperature is 38.2°C.
Blood tests show WCC 15 x10^9/L and CRP 85 mg/L.
What is the most likely diagnosis?

Accepted Answer

Acute appendicitis

Answer

Mesenteric adenitis

Answer

Right ureteric colic

Answer

Crohn's disease flare

Question 2

A 70-year-old woman presents with sudden-onset severe abdominal pain, bloody diarrhoea, and abdominal distension. She has a history of atrial fibrillation. What is the most likely diagnosis?

Accepted Answer

Acute mesenteric ischaemia

Answer

Diverticulitis

Answer

Gastroenteritis

Answer

Sigmoid volvulus

Question 3

According to ATLS principles, what is the correct sequence of the primary survey?

Accepted Answer

Airway with cervical spine protection, Breathing, Circulation, Disability, Exposure (ABCDE)

Answer

Breathing, Airway, Circulation, Disability, Exposure

Answer

Circulation, Airway, Breathing, Disability, Exposure

Answer

Exposure, Disability, Circulation, Breathing, Airway

Question 4

A 45-year-old woman presents with a 6-hour history of severe colicky right upper quadrant pain radiating to the right shoulder tip, nausea, and vomiting. She is febrile at 38.5°C. Murphy's sign is positive. What is the most likely diagnosis?

Accepted Answer

Acute cholecystitis

Answer

Biliary colic

Answer

Acute pancreatitis

Answer

Hepatitis

Question 5

A patient arrives in A&E after a road traffic collision. They are hypotensive (BP 80/50), tachycardic (HR 130), with a distended abdomen. What class of haemorrhagic shock does this represent according to ATLS?

Accepted Answer

Class III (30-40% blood loss)

Answer

Class I (up to 15% blood loss)

Answer

Class II (15-30% blood loss)

Answer

Class IV (>40% blood loss)

Question 6

A 60-year-old man with a history of heavy alcohol use presents with severe epigastric pain radiating to the back, vomiting, and a serum amylase of 1,200 U/L (normal <100). What is the most appropriate initial management?

Accepted Answer

IV fluids, nil by mouth, analgesia, and monitoring using the Glasgow-Imrie score

Answer

Emergency laparotomy

Answer

Oral antibiotics and discharge

Answer

ERCP within 2 hours