SMLE Surgery 2 — Questions and Answers
Question 1: A 35-year-old male sustains a stab wound to the left chest at the 5th intercostal space, midclavicular line. He has distended neck veins, muffled heart sounds, and hypotension. What is the most likely diagnosis?
- Tension pneumothorax
- Cardiac tamponade (Correct answer)
- Haemothorax
- Flail chest
Correct answer: Cardiac tamponade
Beck's triad (distended neck veins, muffled heart sounds, hypotension) is classic for cardiac tamponade. A stab wound at the 5th intercostal space, midclavicular line overlies the heart, making penetrating cardiac injury likely.
Question 2: During laparoscopic cholecystectomy, which structure must be clearly identified in the critical view of safety before clipping?
- Common bile duct
- Cystic duct and cystic artery in Calot's triangle (Correct answer)
- Hepatic artery proper
- Portal vein
Correct answer: Cystic duct and cystic artery in Calot's triangle
The critical view of safety requires identification of two structures (cystic duct and cystic artery) entering the gallbladder through Calot's triangle, with the hepatocystic triangle cleared of fat and fibrous tissue. This prevents bile duct injury.
Question 3: A newborn presents with bilious vomiting within the first 24 hours of life. An upper GI series shows a 'corkscrew' pattern. What is the most likely diagnosis?
- Pyloric stenosis
- Midgut volvulus (Correct answer)
- Duodenal atresia
- Hirschsprung disease
Correct answer: Midgut volvulus
Bilious vomiting in a neonate is a surgical emergency until proven otherwise. A corkscrew or bird's beak pattern on upper GI series is diagnostic of midgut volvulus, which occurs secondary to malrotation and requires emergent Ladd procedure.
Question 4: A 65-year-old male presents with an irreducible, tender inguinal swelling with vomiting and abdominal distension. What is the diagnosis?
- Direct inguinal hernia
- Strangulated inguinal hernia (Correct answer)
- Femoral hernia
- Inguinal lymphadenopathy
Correct answer: Strangulated inguinal hernia
An irreducible, tender inguinal hernia with signs of intestinal obstruction (vomiting, distension) indicates strangulation — a surgical emergency requiring urgent exploration to assess bowel viability and perform repair.
Question 5: Which of the following is the most common site for ectopic pregnancy?
- Ovary
- Ampulla of the fallopian tube (Correct answer)
- Isthmus of the fallopian tube
- Cervix
Correct answer: Ampulla of the fallopian tube
The ampulla of the fallopian tube is the most common site for ectopic pregnancy, accounting for approximately 70-80% of all ectopic pregnancies. This is where fertilisation normally occurs and where the embryo may implant abnormally.
Question 6: A 55-year-old male with a 30-pack-year smoking history presents with painless gross haematuria. Cystoscopy reveals a papillary mass in the bladder. What is the most likely histological type?
- Squamous cell carcinoma
- Transitional cell carcinoma (urothelial) (Correct answer)
- Adenocarcinoma
- Small cell carcinoma
Correct answer: Transitional cell carcinoma (urothelial)
Transitional cell carcinoma (urothelial carcinoma) is the most common type of bladder cancer, strongly associated with cigarette smoking. It typically presents as a papillary lesion on cystoscopy.
SMLE Surgery 2
A 35-year-old male sustains a stab wound to the left chest at the 5th intercostal space, midclavicular line.
He has distended neck veins, muffled heart sounds, and hypotension.
What is the most likely diagnosis?