300 Essential SBAs in Surgery

With Explanatory Answers

Kaji Sritharan, Samia Ijaz, Neil Russel

• Publisher: CRC Press
• Year: 2017
• eBook ISBN:
  9781315346755
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Medical education and the tools used for assessment are continually evolving. Single Best Answer (SBA) questions are a relatively new method of assessment commonly encountered in final surgical exams. The key to success in any SBA-style examination is practice, practice and more practice. With nearly 300 structured questions, this book comprehensively covers the surgical curriculum. Each specialty-specific chapter contains a combination of clinical vignettes and knowledge-based questions of varying degrees of difficulty, both challenging the more able candidates as well as giving a realistic appreciation of the standard required to pass. Each question gives a detailed explanation of the correct answer to aid reflection and reinforce understanding. This book is the ideal revision aid for all undergraduate medical students preparing for their final examination in surgery. In addition, doctors studying for the Membership of the Royal College of Surgeons (MRCS) and the Professional and Linguistic Assessment Board (PLAB) examinations will also find this book extremely useful.

1

General Surgery

Questions

1.1 Which of the following conditions is NOT associated with dysphagia?

1. Myasthenia gravis
2. Achalasia
3. Plummer-Vinson syndrome
4. Hypothyroidism
5. Thoracic aortic aneurysm

1.2 A 75-year-old man presents to the gastroenterology clinic with a three-month history of progressive dysphagia and a hoarse voice. Which of the following investigations would you carry out first?

1. Chest X-ray
2. Oesophagoscopy
3. Barium swallow
4. CT scan of the thorax and abdomen
5. Endoscopic ultrasound

1.3 A three-week-old male infant presents to A&E with non-bilious projectile vomiting and failure to thrive. The most likely diagnosis is:

1. Duodenal atresia
2. Overfeeding
3. Gastroenteritis
4. Intracranial birth injury
5. Congenital hypertrophic pyloric stenosis

1.4 Helicobacter pylori is a:

1. Gram-positive, non-motile coccus
2. Gram-positive, motile coccus
3. Gram-negative, motile rod
4. Gram-negative, non-motile rod
5. Spirochaete

1.5 An 82-year-old woman presents to A&E with a short history of sudden-onset, severe epigastric pain that is aggravated by movement. She has a long history of osteoarthritis, for which she takes regular Voltarol. The most likely diagnosis is:

1. Perforated appendicitis
2. Acute pancreatitis
3. Perforated peptic ulcer
4. Myocardial infarction
5. Acute cholecystitis

1.6 Which of the following conditions is NOT associated with gastrointestinal haemorrhage?

1. Peptic ulcer disease
2. Meckel’s diverticulum
3. Angiodysplasia
4. Mallory-Weiss syndrome
5. Pernicious anaemia

1.7 Risk factors for gastric carcinoma do NOT include:

1. Previous gastric surgery
2. Chronic peptic ulcer disease
3. Blood group B
4. Smoking
5. Low socio-economic status

1.8 Which of the following symptoms generally occurs first in small-bowel obstruction?

1. Colicky abdominal pain
2. Vomiting
3. Absolute constipation
4. Abdominal distension
5. Pyrexia

1.9 Which of the following is NOT a luminal cause of bowel obstruction?

1. Gallstone
2. Faeces
3. Intussusception
4. Diverticulitis
5. Parasitic infection

1.10 An 85-year-old man presents to A&E with acute-onset colicky abdominal pain and has had some passage of altered blood per rectum. On examination, he is shocked, in atrial fibrillation and generally tender on abdominal palpation. The most likely diagnosis is:

1. Ischaemic bowel
2. Peptic ulcer disease
3. Diverticulitis
4. Sigmoid volvulus
5. Acute appendicitis

1.11 Hirschsprung’s disease is produced by abnormal development of the:

1. Sympathetic innervation of the proximal bowel
2. Parasympathetic innervation of the proximal bowel
3. Sympathetic innervation of the distal bowel
4. Parasympathetic innervation of the distal bowel
5. Cholinergic innervation of the proximal bowel

1.12 Intussusception in children is usually secondary to:

1. A polyp
2. A carcinoma
3. Meckel’s diverticulum
4. A lymphoma
5. No obvious cause

1.13 A 25-year-old male patient presents to his GP with a several-day history of lower-abdominal pain followed by loose motions and fevers. Which of following is the best course of management?

1. The patient should be referred to the gastroenterologists for management of Crohn’s disease.
2. The patient should be reassured and sent home with advice to drink plenty of fluids.
3. The patient should be sent home with a course of ciprofloxacin.
4. The patient should be referred to the surgeons, as this is likely to be acute appendicitis.
5. The patient should be urged to return to the surgery in one week for reassessment.

1.14 A middle-aged woman presents to her GP with a short history of abdominal distension and weight loss, along with an everted umbilicus. The most likely diagnosis is:

1. Pancreatic cancer
2. Ovarian cancer
3. Colon cancer
4. Gastric cancer
5. Hepatoma

1.15 A 70-year-old woman is admitted to hospital deeply jaundiced. She denies having any abdominal pain but has a history of weight loss and itching. On examination, she is cachexic and has a palpable gall bladder, but her abdomen is otherwise non-tender. The most likely diagnosis is:

1. Lymphoma
2. Hepatitis
3. Cholangitis
4. Carcinoma of the head of the pancreas
5. Chronic cholecystitis

1.16 Which of the following is NOT associated with constipation?

1. Diverticular disease
2. Myxoedema
3. Dyschezia
4. Hirschsprung’s disease
5. Digitalis

1.17 A 65-year-old male patient presents to the outpatient clinic with a long history of constipation only. Which of the following is the most appropriate investigation for him?

1. Colonoscopy
2. Barium enema
3. CT scan of the abdomen and pelvis
4. Rigid sigmoidoscopy
5. Flexible sigmoidoscopy

1.18 Angiodysplasia commonly affects the:

1. Duodenum
2. Jejunum
3. Caecum
4. Transverse colon
5. Rectum

1.19 Which of the following is only associated with Crohn’s disease?

1. Granulomas on microscopy
2. Fistulae
3. Gastrointestinal haemorrhage
4. Strictures
5. Pyoderma gangrenosum

1.20 What percentage of large-bowel tumours are synchronous (multiple)?

1. 1%
2. 2%
3. 5%
4. 10%
5. 15%

1.21 Hereditary non-polyposis colon cancer is likely if:

1. At least four family members have been diagnosed with colon cancer, spanning two generations, with one before the age of 60
2. At least three family members have been diagnosed with colon cancer, spanning two generations, with one before the age of 55
3. At least three family members have been diagnosed with colon cancer, spanning two generations, with one before the age of 60
4. At least four family members have been diagnosed with colon cancer, spanning two generations, with one before the age of 50
5. At least three family members have been diagnosed with colon cancer, spanning two generations, with one before the age of 50

1.22 In familial adenomatous polyposis (FAP), the polyps first appear in:

1. Infancy
2. Adolescence
3. Early adulthood
4. Middle age
5. Old age

1.23 What is the five-year survival for a Dukes’ A adenocarcinoma of the colon?

1. 65%
2. 70%
3. 80%
4. 90%
5. 100%

1.24 What is the most common cause of bright-red rectal bleeding?

1. Anal fissure
2. Diverticular disease
3. Trauma
4. Haemorrhoids
5. Tumours of the colon and rectum

1.25 Acute perianal pain is associated with:

1. Anal fissure
2. Thrombosed haemorrhoids
3. Perianal abscess
4. Proctalgia fugax
5. All of the above

1.26 Which of the following statements is true regarding anal fistulae?

1. Goodsall’s rule states that anterior anal fistulae open radially (directly), whereas posterior anal fistulae open into the midline.
2. Goodsall’s rule states that anterior anal fistulae open into the midline, whereas posterior anal fistulae open radially.
3. Goodsall’s rule states that anterior anal fistulae open laterally, wh...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Table of Contents
• Foreword
• Preface
• About the authors
• 1 General Surgery
• 2 Vascular Surgery
• 3 Urology
• 4 Breast and Endocrine Surgery
• 5 Orthopaedics and Trauma, including Neurosurgery
• 6 Perioperative and Critical Care
• 7 Transplant Surgery
• 8 Ear, Nose and Throat (ENT) and Head and Neck
• 9 Lumps and Bumps
• Index