SMLE (Saudi Medical Licensing Exam) · General Surgery and Patient Safety

Clinical Cases

46 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 46 questions

  1. A 25-year-old man has periumbilical pain that has moved to the right iliac fossa with anorexia and low-grade fever. What is the most likely diagnosis?
  2. A 45-year-old obese woman has right upper quadrant pain after fatty meals and a positive Murphy sign. What is the best initial imaging test?
  3. A 60-year-old man has sudden severe epigastric pain, a rigid abdomen and free air under the diaphragm on an erect chest X-ray. What is the diagnosis?
  4. A 55-year-old alcoholic man has epigastric pain radiating to the back and a serum lipase four times the upper limit. What is the diagnosis?
  5. A 70-year-old man has colicky abdominal pain, vomiting, abdominal distension and absolute constipation. He has a scar from a previous laparotomy. What is the most likely cause?
  6. A 75-year-old woman has a tender irreducible lump below and lateral to the pubic tubercle with vomiting. What is the most likely diagnosis?
  7. A 60-year-old man has rectal bleeding, change in bowel habit and weight loss. What is the investigation of choice?
  8. A 30-year-old woman has a painless, smooth, mobile 2 cm breast lump. Which is the most likely diagnosis?
  9. A 55-year-old woman has a hard, fixed breast lump and a bloody nipple discharge. What is the next step in assessment?
  10. A 40-year-old woman has a thyroid nodule. Fine needle aspiration shows follicular cells. What is the next step?
  11. A 20-year-old man has sudden severe scrotal pain with nausea. The testis is high-riding and the cremasteric reflex is absent. What is the management?
  12. A 28-year-old man falls from a motorcycle with a tender pelvis and blood at the urethral meatus. What should be avoided?
  13. A trauma patient has a blood pressure of 80/50, a rapid pulse and a distended abdomen after a road accident. What is the first priority?
  14. A 35-year-old man has a stab wound in the chest, hypotension, distended neck veins and muffled heart sounds. What is the diagnosis?
  15. A burned adult has burns to the whole of the front of the trunk and the entire left arm. By the rule of nines, what is the approximate burned surface area?
  16. A 60-year-old diabetic has a painless foot ulcer under the first metatarsal head. What is the main underlying cause?
  17. A 65-year-old man has cramping calf pain after 200 metres that is relieved by rest. What is the diagnosis?
  18. A 70-year-old man has a pulsatile abdominal mass and sudden severe back pain with hypotension. What is the diagnosis?
  19. A 50-year-old woman has a swollen, tender left calf after hip surgery. Which test is the first line to confirm the diagnosis?
  20. A 28-year-old man has a hot, painful, fluctuant swelling over the buttock. What is the treatment?
  21. A 62-year-old patient has had a hemicolectomy and now has a fever, tachycardia and abdominal tenderness on day 5. What complication should be suspected?
  22. A patient on the surgical ward develops a fever on day 1 after surgery. What is the most likely cause?
  23. Before a major operation, a patient reports that he took aspirin that morning. What is the main concern?
  24. Which is the commonest cause of postoperative wound infection in clean surgery?
  25. What is the correct sequence before an operation to avoid wrong-site surgery?
  26. Which of these is the best way to reduce hospital-acquired infection spread?
  27. A patient is about to receive a drug to which she has a documented anaphylactic reaction. What is the best action?
  28. A patient has anaphylaxis after an injection with stridor and hypotension. What is the first-line drug?
  29. Which is the best definition of informed consent?
  30. A competent adult refuses a blood transfusion for religious reasons, even though it may save his life. What should the doctor do?
  31. A 50-year-old man complains of a hoarse voice for 6 weeks. He smokes heavily. What is the next step?
  32. A patient two days after total thyroidectomy has tingling around the mouth and carpopedal spasm. What is the cause?
  33. A 64-year-old woman has painless haematuria. What is the investigation of choice?
  34. A 68-year-old man has weak urinary stream, hesitancy and nocturia, with a smooth enlarged prostate. What is the first-line medical treatment?
  35. A 30-year-old woman has sudden right flank pain radiating to the groin and haematuria. What is the best initial imaging?
  36. A 25-year-old man has a lump in the neck that moves up on swallowing. Where is it from?
  37. A 45-year-old man has dysphagia to solids and then liquids with weight loss over 3 months. What is the most important investigation?
  38. A patient has a hernia that is firm, tender and cannot be reduced, with vomiting. What is the management?
  39. A 40-year-old man has a lump in the groin that appears on coughing and disappears on lying down, above and medial to the pubic tubercle. What is the most likely diagnosis?
  40. A 55-year-old woman has a painless thyroid nodule and a hard cervical lymph node. What is the most important initial test?
  41. A 30-year-old man has a rectal pain, bleeding on defecation and a tear at the 6 o'clock position. What is the diagnosis?
  42. A 72-year-old woman has a tender, red, hot swelling of her lower leg with fever and spreading erythema. What is the diagnosis?
  43. A patient undergoing surgery receives a drug and develops a high fever, muscle rigidity and a rise in end-tidal carbon dioxide. What is the diagnosis and treatment?
  44. A 50-year-old man has a sudden painful cold pale pulseless leg with paraesthesia. What is the diagnosis and the immediate treatment?
  45. A 25-year-old woman has a swollen painful finger with throbbing pain and tenderness along the flexor tendon sheath. What is the diagnosis?
  46. After the removal of a chest drain in a trauma patient, which complication should be suspected if a patient develops sudden dyspnoea?

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