Surgery Flashcards

A 25-year-old male presents to the emergency department with right iliac fossa pain, anorexia, and rebound tenderness. His Alvarado score is 8. What is the most appropriate next step?

Answer: Immediate appendicectomy

An Alvarado score of 7-10 indicates a high probability of acute appendicitis. In a young male with classic presentation and high Alvarado score, immediate appendicectomy (laparoscopic preferred) is the standard of care without need for further imaging.

A 40-year-old female presents with a painless, mobile, well-circumscribed 2 cm breast lump. Ultrasound shows a solid, homogeneous mass. What is the most likely diagnosis?

Answer: Fibroadenoma

Fibroadenoma is the most common benign breast tumour in women under 40. It presents as a painless, mobile, well-circumscribed mass often described as a 'breast mouse' due to its mobility.

A patient undergoes thyroidectomy and develops numbness around the mouth and carpopedal spasm 24 hours postoperatively. What is the most likely cause?

Answer: Hypocalcaemia from parathyroid damage

Post-thyroidectomy hypocalcaemia due to inadvertent parathyroid gland damage or devascularisation is a well-known complication. Perioral numbness, Chvostek sign, Trousseau sign, and carpopedal spasm are classic manifestations.

A 60-year-old male presents with painless obstructive jaundice, weight loss, and a palpable non-tender gallbladder. What is the most likely diagnosis?

Answer: Pancreatic head carcinoma

Courvoisier's law states that painless obstructive jaundice with a palpable gallbladder is unlikely to be due to gallstones. The most likely diagnosis is carcinoma of the head of the pancreas compressing the common bile duct.

What is the most appropriate initial fluid resuscitation for a 70 kg adult with a 40% total body surface area (TBSA) burn according to the Parkland formula?

Answer: 11,200 mL Ringer's lactate in 24 hours

The Parkland formula: 4 mL × body weight (kg) × %TBSA = 4 × 70 × 40 = 11,200 mL of Ringer's lactate in the first 24 hours, with half given in the first 8 hours and the remainder over the next 16 hours.

A 50-year-old man presents with sudden severe abdominal pain. Examination reveals a rigid, board-like abdomen with absent bowel sounds. Erect chest X-ray shows free air under the diaphragm. What is the most likely diagnosis?

Answer: Perforated peptic ulcer

Free air under the diaphragm (pneumoperitoneum) on erect chest X-ray, combined with a rigid abdomen and peritonitis, is classic for a perforated hollow viscus, most commonly a perforated peptic ulcer.