Surgery Flashcards

A 70-year-old patient undergoes emergency laparotomy for a perforated duodenal ulcer. Intraoperatively, a large perforation is found. What is the most appropriate surgical procedure?

Answer: Graham patch (omental patch repair)

In an emergency setting with a perforated duodenal ulcer, Graham patch (omental patch) repair is the safest and most commonly performed procedure. Definitive ulcer surgery is deferred, and H. pylori eradication and PPI therapy are initiated postoperatively.

A 30-year-old male presents with a painless testicular mass. Ultrasound confirms a solid intratesticular lesion. What is the next step?

Answer: Radical inguinal orchidectomy

A solid intratesticular mass in a young male is testicular cancer until proven otherwise. Radical inguinal orchidectomy (not trans-scrotal to avoid scrotal contamination) is both diagnostic and therapeutic. Tumour markers (AFP, beta-hCG, LDH) should be drawn preoperatively.

A patient develops high-output small bowel fistula postoperatively. What electrolyte abnormality is most likely?

Answer: Metabolic acidosis with dehydration

High-output small bowel fistulas cause significant losses of sodium, potassium, bicarbonate, and water. This leads to dehydration, metabolic acidosis (from bicarbonate loss), and electrolyte depletion requiring aggressive fluid and electrolyte replacement.

A 55-year-old female presents with a 4 cm mass in the right lobe of the liver. AFP is markedly elevated. She has a history of hepatitis B cirrhosis. What is the most likely diagnosis?

Answer: Hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and frequently develops in the setting of hepatitis B cirrhosis. Markedly elevated AFP (>400 ng/mL) in a cirrhotic patient with a liver mass is highly suggestive of HCC.

A 40-year-old male presents with epigastric pain radiating to the back, elevated serum lipase (>3× upper limit of normal), and a history of heavy alcohol use. What is the most important initial management?

Answer: NPO, IV fluids, and analgesia

Acute pancreatitis management is primarily supportive: nil per os (NPO), aggressive IV fluid resuscitation (preferably Ringer's lactate), and adequate analgesia. ERCP is only indicated if there is evidence of choledocholithiasis with cholangitis.

A 25-year-old male sustains a penetrating injury to the neck in Zone II. He is haemodynamically stable with an expanding haematoma. What is the recommended approach?

Answer: Mandatory surgical exploration

Zone II penetrating neck injuries (between the cricoid and angle of mandible) with hard signs (expanding haematoma, active bleeding, airway compromise) require mandatory surgical exploration regardless of imaging. An expanding haematoma is a hard sign indicating vascular injury.