SMLE Surgery 3

Question 1

A 30-year-old male involved in a motor vehicle accident presents with hypotension and a positive FAST examination. Where is the most likely site of fluid accumulation detected by FAST?

Accepted Answer

Morrison's pouch (hepatorenal recess)

Answer

Morrison's pouch (hepatorenal recess) is the most dependent part of the peritoneal cavity in the supine position and is the most common site where free fluid accumulates in blunt abdominal trauma. It is the most sensitive FAST window.

Question 2

A 45-year-old female presents with a thyroid nodule. Fine needle aspiration cytology (FNAC) shows Bethesda category V (suspicious for malignancy). What is the recommended management?

Accepted Answer

Lobectomy or total thyroidectomy

Answer

Bethesda category V carries a malignancy risk of 60-75%. Surgery (lobectomy for diagnostic purposes or total thyroidectomy) is recommended. The extent of surgery depends on risk factors, nodule size, and patient preference.

Question 3

A patient develops deep vein thrombosis (DVT) on postoperative day 5 after a total hip replacement. According to Virchow's triad, which factor is most directly related to this patient's risk?

Accepted Answer

Venous stasis from immobilisation

Answer

While all three components of Virchow's triad (stasis, endothelial injury, hypercoagulability) contribute, venous stasis from postoperative immobilisation is the most significant modifiable risk factor in this setting. Early mobilisation and pharmacological prophylaxis are essential.

Question 4

A 70-year-old male presents with left lower quadrant pain, fever, and leucocytosis. CT shows pericolic fat stranding and a small abscess around the sigmoid colon. What is the initial management?

Accepted Answer

IV antibiotics and CT-guided percutaneous drainage

Answer

Complicated diverticulitis with a small abscess (Hinchey stage I-II) is initially managed with IV antibiotics and CT-guided percutaneous drainage if the abscess is accessible (>3 cm). Surgery is reserved for failed conservative management or complications.

Question 5

During a right hemicolectomy, which vessel is ligated at its origin to achieve adequate lymph node clearance for caecal carcinoma?

Accepted Answer

Ileocolic artery

Answer

For caecal carcinoma, the ileocolic artery is the primary feeding vessel and is ligated at its origin from the superior mesenteric artery to achieve central lymph node clearance, which is essential for adequate oncological resection.

SMLE Practice Test

SMLE Practice Test

SMLE Surgery 3