SMLE Surgery 2

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?

Accepted Answer

Cardiac tamponade

Answer

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?

Accepted Answer

Cystic duct and cystic artery in Calot's triangle

Answer

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?

Accepted Answer

Midgut volvulus

Answer

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?

Accepted Answer

Strangulated inguinal hernia

Answer

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?

Accepted Answer

Ampulla of the fallopian tube

Answer

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.

SMLE Practice Test

SMLE Practice Test

SMLE Surgery 2