1.

A 26-year-old man with a comminuted closed fracture of the femur shaft

undergoes intramedullary nail fixation. Two days postoperatively, he develops a
pyrexia, shortness of breath and a tachycardia.

A. Cardiogenic shock
B. Fat embolism
C. Hypovolaemic shock
D. Thromboembolism

2. A 72-year-old man with an underlying prostate carcinoma sustains a femoral

shaft fracture. He undergoes intramedullary nail fixation. At post-operative day
7, he develops shortness of breath, hypotension and a tachycardia

A. Cardiogenic shock
B. Fat embolism
C. Hypovolaemic shock
D. Thromboembolism

3. A 60-year-old man develops sudden back pain and is brought to the

Emergency Department with a swollen, tense abdomen. He is tachycardic, with
a low-volume pulse and low BP.

A. Cardiogenic shock
B. Fat embolism
C. Hypovolaemic shock
D. Thromboembolism
4. A 45-year-old lady is brought to the Emergency Department with an 18-hour
history of right upper quadrant pain, and a tender mass in this region.
Temperature is 39 ºC and ultrasound demonstrates a distended gallbladder with
pericholecystic fluid. The WBC count is 26 x 109/l. The patient remains pyrexial
and tachycardic after 24 hours of antibiotics.

A. Urgent operation within next 12–24 hours

B. Wait 2 weeks and operate
C. Wait 6 months and operate
D. Wait 6 weeks and operate

5. A 12-year-old boy is brought to the Emergency Department with a 3-day

history of right iliac fossa pain. There is a palpable mass with only localised
tenderness. Temperature and pain respond to intravenous antibiotics

A. Urgent operation within next 12–24 hours

B. Wait 2 weeks and operate
C. Wait 6 months and operate
D. Wait 6 weeks and operate

6. A 79-year-old man is admitted with a sigmoid perforation secondary to

diverticular disease. He had a Hartmann’s procedure and makes a satisfactory
post-operative recovery. He is extremely keen for a reversal and asks when this
procedure might be feasible.

A. Urgent operation within next 12–24 hours

B. Wait 2 weeks and operate
C. Wait 6 months and operate
D. Wait 6 weeks and operate

7. 13. A 30-year-old female undergoes a total pancreatectomy for severe

necrotizing pancreatitis that does not respond to conservative
therapy. Which of the following statements is incorrect regarding the
physiological effects of total pancreatectomy on this patient?

A. Protein malnutrition and negative nitrogen balance ensues from a loss of proteolytic
proenzymes
B. The patient is likely to develop diabetes mellitus
C. Loss of fat emulsification will result in the malabsorption of vitamins A, C, D, and K
D. The patient is at a higher risk of developing iron deficient anaemia
E. The patient has a higher risk of developing osteoporosis

8. A 63-year-old gentleman 4 days post-left hemicolectomy for bowel cancer. He

complains of vague abdominal pain in the suprapubic region, has passed very
little flatus and no stool yet. Bowel sounds are absent.

A. Atelectasis
B. Chest infection
C. Anastomotic leak
D. Urinary tract infection
E. Pulmonary embolism

9. A 75-year-old smoker develops shortness of breath 10 days post-left

hemicolectomy for bowel cancer. On examination he has a respiratory rate of
25/min and decreased air entry to the right lung base. Postoperative mobility
has been slow because of osteoarthritis of his left hip.

A. Atelectasis
B. Chest infection
C. Anastomotic leak
D. Urinary tract infection
E. Pulmonary embolism
10. A 75-year-old grossly obese male presented with sudden onset of low
backache associated with nausea, vomiting, palpitation and feeling clammy and
sweaty. He has a long-standing history of ischaemic heart disease. On
examination you notice pallor, tachycardia and hypotension. Abdominal
examination is difficult due to body habitus

A. Disc herniation
B. Sickle cell disease
C. Tuberculosis
D. Osteoporosis
E. Ruptured abdominal aortic aneurysm

11. A 38-year-old cyclist has been brought in to casualty after being knocked off
his bicycle by a lorry. He was extricated from under one of the wheels, which
was lying across his abdomen. He has bruising to this area and is complaining of
considerable abdominal pain. He is conscious and maintaining a blood pressure
of 120/70 mmHg, pulse rate 110/min and respiratory rate 20
breaths/min. A FAST scan is negative.

A. Abdominal X-ray
B. Angiogram
C. Chest drain
D. Computed tomography scan
E. Diagnostic peritoneal lavage

12 A 45-year-old car driver is seen by the surgical team in the Accident and
Emergency Department, following a high-speed road traffic accident. He was
tender in the right upper quadrant and a CT scan has shown a small, isolated
tear in the right lobe of his liver with some free fluid in the peritoneal cavity. A
secondary survey reveals no other significant injury. He has a pulse of
80 and a blood pressure (BP) of 140/90.

A. Laparotomy
 B. Trial of conservative management
C. Computed tomography (CT) scan of abdomen
D. Laparoscopy
E. Diagnostic peritoneal lavage

13. A 19-year-old man is brought into the Accident and Emergency Department
after been stabbed in the epigastrium. Despite adequate fluid resuscitation he
remains hypotensive (BP 90/45) and tachycardic (pulse 120). A primary survey
suggest he has no other injuries.

A. Laparotomy
B. Trial of conservative management
C. Computed tomography (CT) scan of abdomen
D. Laparoscopy
E. Diagnostic peritoneal lavage

14. A 17-year-old motorcyclist is seen in the resuscitation room following a high-

speed road-traffic accident. Radiology in the resuscitation room has shown a
haemopneumothorax (for which a chest drain has been inserted) and a
fractured right femur. He was hypotensive on arrival but he has responded to
fluid resuscitation. He has some bruising over his lower abdomen but no
peritoneal signs.

A. Laparotomy
B. Trial of conservative management
C. Computed tomography (CT) scan of abdomen
D. Laparoscopy
E. Diagnostic peritoneal lavage

15. A 9-year-old boy has a 70% body surface area (BSA) burn that requires daily
debridement in the Hubbard tank. To ease the pain of this debridement, what is
the best selection?
A. Diazepam
 B. morphine
C. Thiopental
D. Nitrous oxide
E. Ketamine

16. A 56-year-old male is burned while sleeping in his home. His right upper and
lower extremity and the anterior aspect of the upper chest have extensive
second-degree burns. Following initial resuscitation, based upon the Parkland
formula, the patient was resuscitated with Ringer’s lactate solution at 800
mL/h. Further assessment after 6 hours reveals oliguria. What should the next
step in management be?
A. Continue with increased amount of lactated Ringer’s solution
B. Give Plasma
C. Give Diuretics to improve urine flow
D. Colloid solution
E. Continue initial resuscitation with normal saline