Acute Surgical Presentations Practice Questions

Question 1

A 31-year-old man presents with acute severe testicular pain. The pain started suddenly 4 hours ago. Doppler ultrasound shows absent blood flow. What is the expected salvage rate for this condition if treated at this time?

Accepted Answer

80-90%

Answer

>95%

Answer

60-70%

Answer

40-50%

Answer

<20%

Question 2

A 46-year-old man presents with acute severe epigastric pain and vomiting. His amylase (1800 U/L). He has a history of alcohol excess. What is the most important initial assessment?

Accepted Answer

Severity scoring

Answer

CT abdomen

Answer

ERCP

Answer

Nutritional assessment

Answer

Psychiatric evaluation

Question 3

A 28-year-old man presents with sudden onset severe headache described as "worst headache of my life." He is photophobic and has neck stiffness. CT head is normal. What is the next most appropriate investigation?

Accepted Answer

Lumbar puncture

Answer

MRI brain

Answer

CT angiogram

Answer

Carotid Doppler

Answer

EEG

Question 4

A 39-year-old man presents with acute onset severe headache during sexual intercourse. CT head is normal. What is the most appropriate next investigation?

Accepted Answer

Lumbar puncture

Answer

MRI brain

Answer

CT angiogram

Answer

Carotid Doppler

Answer

EEG

Question 5

A 38-year-old man presents with acute onset severe lower back pain and bilateral leg weakness. He has saddle anesthesia and cannot urinate. What is the most appropriate immediate management?

Accepted Answer

Emergency surgical decompression

Answer

MRI lumbar spine

Answer

High-dose steroids

Answer

Catheter insertion

Answer

Pain relief

Question 6

A 27-year-old man presents with acute onset severe chest pain and dyspnea. He is tall and thin with a marfanoid habitus. Chest X-ray shows a large left-sided pneumothorax. What is the most appropriate management?

Accepted Answer

Chest drain insertion

Answer

Observation

Answer

Needle aspiration

Answer

Thoracotomy

Answer

VATS procedure

Question 7

A 46-year-old man presents with sudden onset severe "tearing" chest pain radiating to his back. His blood pressure is 180/100 mmHg in the right arm and 120/80 mmHg in the left arm. What is the most likely diagnosis?

Accepted Answer

Aortic dissection

Answer

Myocardial infarction

Answer

Pulmonary embolism

Answer

Pericarditis

Answer

Pneumothorax

Question 8

A 44-year-old woman presents with sudden onset severe right upper quadrant pain radiating to the right shoulder tip. She has had previous episodes of biliary colic. Ultrasound shows gallstones with gallbladder wall thickening (6 mm), pericholecystic fluid, and a positive sonographic Murphy's sign. Blood tests show WBC 15.3×10⁹/L, CRP 78 mg/L. What is the optimal timing for cholecystectomy?

Accepted Answer

Early laparoscopic cholecystectomy within 72 hours of symptom onset

Answer

Immediate emergency cholecystectomy within 6 hours

Answer

Conservative management with antibiotics followed by interval cholecystectomy at 6-8 weeks

Answer

Percutaneous cholecystostomy followed by delayed cholecystectomy after 3 months

Answer

Urgent ERCP within 24 hours followed by cholecystectomy during same admission

Question 9

A 76-year-old man with known colorectal adenocarcinoma presents with a 72-hour history of absolute constipation and abdominal distension. CT shows dilated colon up to 11 cm in diameter at the caecum with an obstructing sigmoid tumour. The caecal wall appears thinned. He has multiple comorbidities including severe COPD and recent myocardial infarction 8 weeks ago. What is the most appropriate management strategy?

Accepted Answer

Hartmann's procedure with sigmoid resection and end colostomy

Answer

Emergency subtotal colectomy with end ileostomy

Answer

Endoscopic stent placement across obstructing tumour as bridge to surgery

Answer

Proximal defunctioning transverse loop colostomy without tumour resection

Answer

On-table lavage with primary resection and anastomosis

Acute Surgical Presentations

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