SMLE Surgery 4

Question 1

A 60-year-old male presents with a pulsatile, expansile abdominal mass. CT angiography shows an infrarenal abdominal aortic aneurysm measuring 6.5 cm. What is the recommended management?

Accepted Answer

Elective surgical repair (open or EVAR)

Answer

An abdominal aortic aneurysm ≥5.5 cm carries a significant annual rupture risk and is an indication for elective repair, either open surgical repair or endovascular aneurysm repair (EVAR), depending on anatomy and patient fitness.

Question 2

A patient with a history of peptic ulcer disease presents with massive haematemesis. After initial resuscitation, what is the most appropriate definitive investigation?

Accepted Answer

Upper GI endoscopy (OGD)

Answer

Upper GI endoscopy (oesophagogastroduodenoscopy) is both diagnostic and therapeutic for upper GI bleeding. It allows identification of the bleeding source and endoscopic haemostasis using clips, thermal coagulation, or injection therapy.

Question 3

A 40-year-old male presents with intermittent claudication in the left calf after walking 200 metres. Ankle-brachial index (ABI) is 0.6. What is the initial management?

Accepted Answer

Smoking cessation, supervised exercise, and antiplatelet therapy

Answer

For intermittent claudication (Fontaine stage II), initial management includes risk factor modification (smoking cessation is paramount), supervised exercise programmes, and antiplatelet therapy. Revascularisation is reserved for lifestyle-limiting symptoms despite conservative measures.

Question 4

A child swallows a coin. X-ray shows the coin in the oesophagus at the level of the cricopharyngeus. The child is drooling but not in respiratory distress. What is the management?

Accepted Answer

Endoscopic removal within 24 hours

Answer

An oesophageal foreign body with symptoms (drooling indicates inability to handle secretions) requires endoscopic removal within 24 hours to prevent complications such as perforation, mucosal necrosis, or airway compromise.

Question 5

A 50-year-old female presents with a solitary thyroid nodule. Thyroid function tests are normal. Ultrasound shows microcalcifications and irregular margins. What is the next step?

Accepted Answer

Fine needle aspiration cytology (FNAC)

Answer

Ultrasound features of microcalcifications and irregular margins are suspicious for thyroid malignancy (TI-RADS 4-5). Fine needle aspiration cytology is the next step to obtain a tissue diagnosis and guide further management.

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SMLE Surgery 4