PLAB Surgery & Emergency Medicine — Questions and Answers
Question 1: What is the most common cause of acute appendicitis?
- Obstruction of the appendiceal lumen, often by a fecalith (Correct answer)
- Bacterial infection from contaminated food
- Viral infection spreading from the respiratory tract
- Allergic reaction to certain foods
Correct answer: Obstruction of the appendiceal lumen, often by a fecalith
Acute appendicitis most commonly results from obstruction of the appendiceal lumen by a fecalith (hardened stool), lymphoid hyperplasia, or rarely a foreign body, leading to inflammation and infection.
Question 2: In trauma assessment, what does the primary survey (ABCDE) stand for?
- Airway, Breathing, Circulation, Disability, Exposure (Correct answer)
- Assessment, Blood pressure, Chest, Diagnosis, Evaluation
- Abdomen, Back, Chest, Digits, Eyes
- Anatomy, Biology, Chemistry, Drugs, Emergency
Correct answer: Airway, Breathing, Circulation, Disability, Exposure
The ABCDE primary survey systematically assesses life-threatening conditions: Airway (with cervical spine protection), Breathing, Circulation (hemorrhage control), Disability (neurological status), and Exposure (undress and examine).
Question 3: What is the Glasgow Coma Scale (GCS) used to assess?
- Level of consciousness based on eye opening, verbal response, and motor response (Correct answer)
- The severity of chronic pain
- Blood glucose levels in diabetic patients
- The degree of bone fracture displacement
Correct answer: Level of consciousness based on eye opening, verbal response, and motor response
The GCS scores three components — eye opening (1-4), verbal response (1-5), and motor response (1-6) — with a total range of 3-15, where lower scores indicate deeper impairment of consciousness.
Question 4: A patient presents with right upper quadrant pain, fever, and jaundice. What is this triad known as?
- Charcot's triad, suggesting ascending cholangitis (Correct answer)
- Beck's triad, suggesting cardiac tamponade
- Virchow's triad, suggesting deep vein thrombosis
- Cushing's triad, suggesting raised intracranial pressure
Correct answer: Charcot's triad, suggesting ascending cholangitis
Charcot's triad (right upper quadrant pain, fever, and jaundice) classically indicates ascending cholangitis — infection of the bile duct system requiring urgent drainage.
Question 5: What is the initial management for a tension pneumothorax?
- Needle decompression followed by chest tube insertion (Correct answer)
- Observation and serial chest X-rays
- Oral antibiotics and rest
- Emergency thoracotomy in the operating room
Correct answer: Needle decompression followed by chest tube insertion
Tension pneumothorax is a clinical diagnosis requiring immediate needle decompression (2nd intercostal space, midclavicular line) to relieve the life-threatening pressure, followed by definitive chest tube placement.
Question 6: What are the signs of peritonitis on abdominal examination?
- Board-like rigidity, rebound tenderness, and guarding (Correct answer)
- Soft, non-tender abdomen with active bowel sounds
- Localized swelling without tenderness
- Normal abdominal examination with groin pain
Correct answer: Board-like rigidity, rebound tenderness, and guarding
Peritonitis presents with a rigid, board-like abdomen, rebound tenderness (pain on release of pressure), involuntary guarding, and absent bowel sounds, indicating peritoneal inflammation.
PLAB Surgery & Emergency Medicine
What is the most common cause of acute appendicitis?