ENAM Practice (Peru National Medical Examination) · Surgery and Emergency Medicine

Surgery and Emergency Medicine

39 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 39 questions

  1. A 19-year-old has abdominal pain that began around the umbilicus and moved to the right iliac fossa over twelve hours, with anorexia. What is the most likely diagnosis?
  2. McBurney's point lies at which position?
  3. Which investigation is first line for suspected acute cholecystitis?
  4. A man has fever, jaundice and right upper quadrant pain (Charcot triad). What is the most likely diagnosis?
  5. A 66-year-old has right upper quadrant pain, fever, jaundice, blood pressure 85/50 mmHg and new confusion. What is the best management plan?
  6. What is the commonest cause of small bowel obstruction in an adult who had previous abdominal surgery?
  7. What does an upright chest radiograph typically show in a perforated peptic ulcer?
  8. In the ATLS primary survey, what is the correct order of assessment?
  9. A trauma patient has severe dyspnoea, absent breath sounds on the right, distended neck veins and tracheal deviation to the left. What is the next step?
  10. A man loses about 35 percent of his blood volume. Which ATLS class of haemorrhage is this?
  11. A 70 kg man has an adult burn covering 40 percent of the body surface. Using the Parkland formula, how much fluid is given in the first 8 hours?
  12. In an adult, using the rule of nines, what percentage of the body surface does one entire lower limb represent?
  13. A man pulled from a house fire has facial burns, singed nasal hairs, soot in the mouth and a hoarse voice. What is the priority?
  14. Which fluid strategy is recommended for a patient in haemorrhagic shock with ongoing bleeding?
  15. A patient opens the eyes only to pain, speaks inappropriate words and withdraws from pain. What is the Glasgow Coma Scale score?
  16. After a blow to the temple a patient is briefly unconscious, then lucid, then deteriorates. CT shows a lens-shaped collection. Which vessel is torn?
  17. What is the typical posture of the leg after a displaced fracture of the neck of the femur in an elderly person?
  18. A child with a supracondylar fracture of the humerus has a cold, pulseless hand. Which complication is feared?
  19. Which feature best suggests compartment syndrome after a tibial fracture?
  20. A hernia that cannot be reduced and has a tender, red overlying skin with vomiting suggests which complication?
  21. An inguinal hernia that passes lateral to the inferior epigastric vessels and through the deep ring is classified as which type?
  22. During anaesthesia a patient develops a rising temperature, muscle rigidity and a raised end-tidal carbon dioxide after succinylcholine and a volatile agent. What is the treatment?
  23. A patient develops seizures and arrhythmia after a nerve block with bupivacaine. What specific treatment is used for local anaesthetic systemic toxicity?
  24. In the ASA physical status system, which patient is class II?
  25. A patient has fever, abdominal pain and tachycardia on day 7 after bowel resection. What is the most likely cause and the best investigation?
  26. A patient has a cold, pale, pulseless leg with sudden pain. What is the first drug given while awaiting the vascular surgeons?
  27. Which triad suggests a ruptured abdominal aortic aneurysm?
  28. A teenager has sudden severe testicular pain, a high-riding testis and no cremasteric reflex. What is the management?
  29. What is the best initial imaging for suspected renal colic in an adult?
  30. A 45-year-old woman finds a breast lump. Which approach is used to assess it?
  31. What is the main use of carcinoembryonic antigen (CEA) in colorectal cancer?
  32. A patient has a solitary thyroid nodule and a normal TSH. Which test comes next?
  33. A patient has painless jaundice, weight loss and a palpable, non-tender gallbladder. Which sign and diagnosis fit?
  34. A 65-year-old has left iliac fossa pain, fever and raised inflammatory markers. Which investigation confirms diverticulitis?
  35. What is the first-line treatment of anaphylaxis in an adult?
  36. A young man with blunt abdominal trauma is hypotensive at 80/50 mmHg after 2 litres of crystalloid. The FAST scan shows free fluid in the abdomen. What is next?
  37. A 70 kg adult has a blood volume of about 70 mL per kg. After a bleed of about 1.7 litres, which ATLS class is this closest to?
  38. A man is freed after six hours under a collapsed wall. His urine is dark, the potassium is 6.9 mmol/L and the ECG has peaked T waves. What is the best plan?
  39. A 2-day-old newborn has green (bilious) vomiting and a distended upper abdomen. What is the priority?

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