Surgery Flashcards

A 35-year-old male presents with a non-healing ulcer on the sole of the foot. He has loss of pain sensation and a warm, well-perfused foot. What is the most likely underlying condition?

Answer: Diabetic neuropathic ulcer

A non-healing plantar ulcer with loss of pain sensation in a warm, well-perfused foot is characteristic of a neuropathic ulcer, most commonly caused by diabetic peripheral neuropathy. The preserved pulses and warmth distinguish it from arterial ulcers.

A 45-year-old woman presents with a breast lump. Mammography shows a spiculated mass with architectural distortion. What does this most likely represent?

Answer: Invasive breast carcinoma

A spiculated mass with architectural distortion on mammography is highly suspicious for invasive breast carcinoma (BI-RADS 5). This requires tissue biopsy (core needle biopsy) for histological confirmation before treatment planning.

In the primary survey of a trauma patient (ATLS), what is the correct sequence?

Answer: Airway, Breathing, Circulation, Disability, Exposure

The ATLS primary survey follows the ABCDE approach: Airway (with cervical spine protection), Breathing, Circulation (with haemorrhage control), Disability (neurological status), and Exposure (with environmental control). This sequence addresses the most lethal threats first.

A 55-year-old male presents with a change in bowel habit, rectal bleeding, and a palpable mass on digital rectal examination at 6 cm from the anal verge. What is the most likely diagnosis?

Answer: Rectal carcinoma

A palpable rectal mass with change in bowel habit and rectal bleeding in a patient over 50 is rectal carcinoma until proven otherwise. Digital rectal examination can detect low rectal tumours, and further assessment with rigid sigmoidoscopy and biopsy is essential.

A patient is scheduled for elective surgery. He is on warfarin for a mechanical heart valve. What is the recommended perioperative anticoagulation strategy?

Answer: Stop warfarin 5 days before surgery and bridge with LMWH

For high-risk patients on warfarin (mechanical heart valves), the recommended strategy is to stop warfarin 5 days preoperatively, bridge with therapeutic-dose LMWH, hold LMWH 24 hours before surgery, and resume postoperatively when haemostasis is achieved.

A 20-year-old male sustains a fracture of the shaft of the humerus. On examination, there is wrist drop. Which nerve is most likely injured?

Answer: Radial nerve

The radial nerve runs in the spiral groove of the humerus and is vulnerable to injury in midshaft humeral fractures. Radial nerve injury causes wrist drop (inability to extend the wrist and fingers) and loss of sensation over the anatomical snuffbox.