SMLE Surgery 1 — Questions and Answers
Question 1: A 25-year-old male presents to the emergency department with right iliac fossa pain, anorexia, and rebound tenderness. His Alvarado score is 8. What is the most appropriate next step?
- Abdominal ultrasound
- CT abdomen with contrast
- Immediate appendicectomy (Correct answer)
- Conservative management with antibiotics
Correct answer: Immediate appendicectomy
An Alvarado score of 7-10 indicates a high probability of acute appendicitis. In a young male with classic presentation and high Alvarado score, immediate appendicectomy (laparoscopic preferred) is the standard of care without need for further imaging.
Question 2: A 40-year-old female presents with a painless, mobile, well-circumscribed 2 cm breast lump. Ultrasound shows a solid, homogeneous mass. What is the most likely diagnosis?
- Breast carcinoma
- Fibroadenoma (Correct answer)
- Breast cyst
- Phyllodes tumour
Correct answer: Fibroadenoma
Fibroadenoma is the most common benign breast tumour in women under 40. It presents as a painless, mobile, well-circumscribed mass often described as a 'breast mouse' due to its mobility.
Question 3: A patient undergoes thyroidectomy and develops numbness around the mouth and carpopedal spasm 24 hours postoperatively. What is the most likely cause?
- Recurrent laryngeal nerve injury
- Hypocalcaemia from parathyroid damage (Correct answer)
- Wound haematoma
- Thyroid storm
Correct answer: Hypocalcaemia from parathyroid damage
Post-thyroidectomy hypocalcaemia due to inadvertent parathyroid gland damage or devascularisation is a well-known complication. Perioral numbness, Chvostek sign, Trousseau sign, and carpopedal spasm are classic manifestations.
Question 4: A 60-year-old male presents with painless obstructive jaundice, weight loss, and a palpable non-tender gallbladder. What is the most likely diagnosis?
- Gallstone in the common bile duct
- Pancreatic head carcinoma (Correct answer)
- Hepatocellular carcinoma
- Acute cholangitis
Correct answer: Pancreatic head carcinoma
Courvoisier's law states that painless obstructive jaundice with a palpable gallbladder is unlikely to be due to gallstones. The most likely diagnosis is carcinoma of the head of the pancreas compressing the common bile duct.
Question 5: What is the most appropriate initial fluid resuscitation for a 70 kg adult with a 40% total body surface area (TBSA) burn according to the Parkland formula?
- 5,600 mL Ringer's lactate in 24 hours
- 11,200 mL Ringer's lactate in 24 hours (Correct answer)
- 5,600 mL normal saline in 24 hours
- 2,800 mL Ringer's lactate in 24 hours
Correct answer: 11,200 mL Ringer's lactate in 24 hours
The Parkland formula: 4 mL × body weight (kg) × %TBSA = 4 × 70 × 40 = 11,200 mL of Ringer's lactate in the first 24 hours, with half given in the first 8 hours and the remainder over the next 16 hours.
Question 6: A 50-year-old man presents with sudden severe abdominal pain. Examination reveals a rigid, board-like abdomen with absent bowel sounds. Erect chest X-ray shows free air under the diaphragm. What is the most likely diagnosis?
- Acute pancreatitis
- Perforated peptic ulcer (Correct answer)
- Acute intestinal obstruction
- Mesenteric ischaemia
Correct answer: Perforated peptic ulcer
Free air under the diaphragm (pneumoperitoneum) on erect chest X-ray, combined with a rigid abdomen and peritonitis, is classic for a perforated hollow viscus, most commonly a perforated peptic ulcer.
SMLE Surgery 1
A 25-year-old male presents to the emergency department with right iliac fossa pain, anorexia, and rebound tenderness.
His Alvarado score is 8.
What is the most appropriate next step?