SMLE Surgery 6

Question 1

A 70-year-old patient undergoes emergency laparotomy for a perforated duodenal ulcer. Intraoperatively, a large perforation is found. What is the most appropriate surgical procedure?

Accepted Answer

Graham patch (omental patch repair)

Answer

Vagotomy and pyloroplasty

Answer

Billroth I gastrectomy

Answer

Billroth II gastrectomy

Question 2

A 30-year-old male presents with a painless testicular mass. Ultrasound confirms a solid intratesticular lesion. What is the next step?

Accepted Answer

Radical inguinal orchidectomy

Answer

Testicular biopsy

Answer

Trans-scrotal orchidectomy

Answer

CT abdomen and pelvis first

Question 3

A patient develops high-output small bowel fistula postoperatively. What electrolyte abnormality is most likely?

Accepted Answer

Metabolic acidosis with dehydration

Answer

Hyperkalaemia

Answer

Respiratory alkalosis

Answer

Hypercalcaemia

Question 4

A 55-year-old female presents with a 4 cm mass in the right lobe of the liver. AFP is markedly elevated. She has a history of hepatitis B cirrhosis. What is the most likely diagnosis?

Accepted Answer

Hepatocellular carcinoma

Answer

Haemangioma

Answer

Metastatic colorectal cancer

Answer

Focal nodular hyperplasia

Question 5

A 40-year-old male presents with epigastric pain radiating to the back, elevated serum lipase (>3× upper limit of normal), and a history of heavy alcohol use. What is the most important initial management?

Accepted Answer

NPO, IV fluids, and analgesia

Answer

Emergency ERCP

Answer

Immediate cholecystectomy

Answer

Oral pancreatic enzymes

Question 6

A 25-year-old male sustains a penetrating injury to the neck in Zone II. He is haemodynamically stable with an expanding haematoma. What is the recommended approach?

Accepted Answer

Mandatory surgical exploration

Answer

Observation and serial examinations

Answer

CT angiography of the neck

Answer

Endovascular embolisation