Lebanese Medical Colloquium (Colloquium Liban) · Surgery and Obstetrics & Gynecology

General Surgery and Perioperative Care

78 practice questions, each with the answer and an explanation.

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Random questions from this topic, one at a time. You see the answer and the explanation straight after each one.

All 78 questions

  1. A 22-year-old male presents with 12 hours of periumbilical pain that migrated to the right lower quadrant, accompanied by anorexia and low-grade fever. Physical examination reveals tenderness at McBur…
  2. A 45-year-old female presents with postprandial right upper quadrant pain radiating to the right scapula, nausea, and vomiting after fatty meals. Abdominal ultrasound demonstrates acoustic shadowing w…
  3. A 65-year-old male with a history of prior open appendectomy presents with obstipation, vomiting, abdominal distension, and high-pitched 'tinkling' bowel sounds. Plain abdominal radiography shows mult…
  4. A 70-year-old male presents with severe tearing back pain, hypotension (BP 80/50 mmHg), and a pulsatile expansile epigastric mass. What is the immediate definitive management?
  5. A 28-year-old unrestrained driver involved in a high-speed motor vehicle crash presents with left upper quadrant pain and left shoulder pain (Kehr sign). Blood pressure is 85/55 mmHg and pulse is 125…
  6. In the Advanced Trauma Life Support (ATLS) initial assessment protocol, what is the first and most critical component of the primary survey?
  7. A 50-year-old male presents with acute lower gastrointestinal bleeding. On physical examination, there are painful, swollen, thrombosed masses protruding below the dentate (pectinate) line covered by…
  8. A 35-year-old male presents with a tender, irreducible bulge in the right groin with severe local pain, erythema, and vomiting. What surgical emergency is present?
  9. A 55-year-old female presents with a hard, painless, non-mobile 2.5 cm solitary mass in the upper outer quadrant of the left breast with skin retraction. What is the standard diagnostic algorithm ('tr…
  10. On postoperative day 3 following open colectomy, a 68-year-old male develops a temperature of 38.8°C, productive cough, and tachypnea. Chest auscultation reveals right lower lobe crackles and bronchia…
  11. A 60-year-old male presents with painless progressive dysphagia initially for solids and now for liquids, accompanied by a 10 kg weight loss. Barium swallow shows an irregular, 'apple-core' narrowing…
  12. A 75-year-old female presents with a painless bulge in the groin located inferolateral to the pubic tubercle and below the inguinal ligament. What type of hernia is present?
  13. A 40-year-old male undergoes total thyroidectomy for multinodular goiter. Six hours postoperatively, he develops progressive neck swelling, stridor, and respiratory distress. What is the immediate lif…
  14. A 30-year-old male presents with recurrent perianal discharge and pain. Examination reveals an external cutaneous opening 2 cm from the anal verge at the 5 o'clock position. According to Goodsall's ru…
  15. A 52-year-old female presents with acute severe right upper quadrant pain and fever. On examination, deep palpation beneath the right costal margin causes abrupt inspiratory arrest as the gallbladder…
  16. A 65-year-old male smoker with bilateral intermittent calf claudication presents with pain in the toes at rest that improves when hanging his feet over the edge of the bed. What is the clinical stage…
  17. Which intravenous anesthetic agent is classic for causing acute malignant hyperthermia in genetically susceptible individuals with ryanodine receptor (RYR1) gene mutations?
  18. A 45-year-old female presents with episodic flushing, watery diarrhea, and bronchospasm. Echocardiography reveals tricuspid regurgitation. Urinary 24-hour excretion of 5-hydroxyindoleacetic acid (5-HI…
  19. A 25-year-old male sustains a stab wound to the left 5th intercostal space anteriorly. He is in shock with BP 70/40 mmHg, distended neck veins, and muffled distant heart sounds (Beck's triad). What is…
  20. A 60-year-old male undergoing routine screening colonoscopy has a 1.5 cm pedunculated polyp completely excised from the descending colon. Histology demonstrates tubular architecture with low-grade dys…
  21. What is the most common histological subtype of thyroid carcinoma, typically characterized by psammoma bodies and ground-glass 'Orphan Annie eye' nuclei?
  22. A 50-year-old male presents with severe burns over his entire anterior torso (18%) and both entire upper extremities (9% + 9% = 18%), totaling 36% total body surface area (TBSA). Weight is 70 kg. Acco…
  23. A 35-year-old male with ulcerative colitis presents with persistent fever, severe abdominal distension, and signs of peritonitis. Abdominal radiograph shows marked non-obstructive colonic dilatation w…
  24. A 72-year-old female presents with acute severe colicky left lower quadrant abdominal pain, fever, and leukocytosis. Abdominal CT confirms pericolic fat stranding and localized sigmoid wall thickening…
  25. A 40-year-old male presents with recurrent peptic ulcer disease and recurrent calcium nephrolithiasis. Serum calcium is 11.2 mg/dL with inappropriately elevated parathyroid hormone (PTH). Multiple End…
  26. A 25-year-old male presents with sudden, exquisite right scrotal pain and swelling of 2 hours' duration. On physical examination, the right testis is elevated, horizontally oriented, and lifting the t…
  27. After major surgery, a 70 kg patient should pass at least 0.5 mL/kg/hour of urine. What is the minimum urine volume over 24 hours?
  28. After major surgery, a 80 kg patient should pass at least 0.5 mL/kg/hour of urine. What is the minimum urine volume over 24 hours?
  29. After major surgery, a 60 kg patient should pass at least 0.5 mL/kg/hour of urine. What is the minimum urine volume over 12 hours?
  30. After major surgery, a 90 kg patient should pass at least 0.5 mL/kg/hour of urine. What is the minimum urine volume over 8 hours?
  31. After major surgery, a 50 kg patient should pass at least 0.5 mL/kg/hour of urine. What is the minimum urine volume over 6 hours?
  32. Estimate the blood loss, using a blood volume of 70 mL/kg, for a 70 kg adult who has lost 20% of blood volume.
  33. Estimate the blood loss, using a blood volume of 70 mL/kg, for a 80 kg adult who has lost 15% of blood volume.
  34. Estimate the blood loss, using a blood volume of 70 mL/kg, for a 90 kg adult who has lost 10% of blood volume.
  35. Estimate the blood loss, using a blood volume of 70 mL/kg, for a 50 kg adult who has lost 30% of blood volume.
  36. A patient has migration of pain (1), anorexia (1), nausea (1), tenderness in the right iliac fossa (2), rebound (1), fever (1), leukocytosis (2) and left shift (1). These are Alvarado score points. Wh…
  37. A patient has migration of pain (1), anorexia (0), nausea (1), tenderness in the right iliac fossa (2), rebound (0), fever (0), leukocytosis (2) and left shift (1). These are Alvarado score points. Wh…
  38. A patient has migration of pain (0), anorexia (1), nausea (1), tenderness in the right iliac fossa (2), rebound (1), fever (1), leukocytosis (2) and left shift (0). These are Alvarado score points. Wh…
  39. Which ASA physical status class describes a normal healthy patient?
  40. Which ASA physical status class describes a patient with mild systemic disease such as well-controlled hypertension?
  41. Which ASA physical status class describes a patient with severe systemic disease such as poorly controlled diabetes?
  42. Which ASA physical status class describes a patient with severe systemic disease that is a constant threat to life?
  43. Which ASA physical status class describes a moribund patient not expected to survive without the operation?
  44. A patient has a thyroid nodule and fine needle aspiration shows Bethesda VI (malignant) cytology of papillary type. What is the standard management?
  45. Which drug is most important to give before surgery in a patient with hyperthyroidism to prevent thyroid storm?
  46. Which procedure is the standard treatment of achalasia in a fit patient?
  47. Which histological change defines Barrett oesophagus?
  48. What is the most common type of oesophageal cancer in the lower third of the oesophagus in Western countries?
  49. A patient has painless jaundice, weight loss and a palpable gallbladder. What is the most likely diagnosis?
  50. Which operation is used for a resectable tumour of the head of the pancreas?
  51. Which finding on barium enema suggests colorectal cancer?
  52. What is the most important prognostic factor in colorectal cancer?
  53. Which anal condition is characterised by severe pain on defecation and bright red blood on the paper, with a midline tear?
  54. A patient has a painful, fluctuant perianal swelling with fever. What is the treatment?
  55. Which management is first-line for symptomatic gallstones in a fit patient after an episode of biliary colic?
  56. Which symptom is typical of intermittent claudication?
  57. Which treatment is first-line for intermittent claudication?
  58. Which investigation is first-line for suspected deep vein thrombosis with a low clinical probability?
  59. Which drug class is first-line for treating established deep vein thrombosis in most patients?
  60. What is the recommended screening for abdominal aortic aneurysm in many countries for men aged 65?
  61. Which skin cancer has the worst prognosis and is staged by Breslow thickness?
  62. Which fracture is classically missed on initial wrist radiographs after a fall on an outstretched hand with snuffbox tenderness?
  63. Which complication is feared after a supracondylar fracture of the humerus in a child?
  64. What is the standard treatment for most displaced intracapsular hip fractures in an older patient?
  65. Which organism most commonly causes acute osteomyelitis in children?
  66. Which sign is classic for Achilles tendon rupture?
  67. Which phase of wound healing involves fibroblast proliferation and collagen deposition?
  68. Which nutrient deficiency impairs wound healing by reducing collagen cross-linking?
  69. Which blood transfusion reaction occurs within minutes with fever, back pain and haemoglobinuria?
  70. What is the first step if an acute transfusion reaction is suspected?
  71. Which pain relief step follows non-opioid analgesics on the WHO analgesic ladder?
  72. What is the most common cause of fever on day 1-2 after major abdominal surgery?
  73. What is the main risk of an anastomotic leak after bowel surgery?
  74. Which investigation is most useful for suspected anastomotic leak?
  75. Which type of hernia lies lateral to the inferior epigastric vessels and passes through the deep inguinal ring?
  76. Which hernia carries the highest risk of strangulation?
  77. What is the usual treatment of a pilonidal abscess?
  78. Which prophylaxis reduces venous thromboembolism after major surgery?

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