UoS Year 4 Surgery - Introduction Quiz

You have assessed a patient in A&E with abdominal pain. Your top differential is Pancreatitis.

What serum investigation finding would be diagnostic of this condition?

List four differential diagnoses for acute right upper quadrant pain.

Answer explanation

Gastrointestinal:

- Biliary colic.

- Cholecystitis.

- Cholangitis.

- Appendicitis.

- Liver abscess.

- Peptic ulcer disease.

- Indigestion.

- Pancreatitis.

- Irritable bowel syndrome.

Respiratory:

- Pneumonia.

- Pulmonary embolism.

Cardiovascular:

- Acute coronary syndrome.

- Abdominal aortic aneurysm.

Renal:

- Renal colic.

- Pyelonephritis.

Endocrine:

- Addisonian crisis.

Dermatological:

- Shingles.

Obstetric:

- Ectopic pregnancy.

You are examining a patient with abdominal pain. When you palpate their left iliac fossa they experience pain in their right iliac fossa.

What condition is this patient most likely to have?

• Cholecystitis

• Large Bowel Perforation

• Appendicitis

• Abdominal Aortic Aneurysm

You suspect a patient has gallstones, however the trans-abdominal ultrasound is inconclusive.

What is the gold standard investigation for identifying gallstones in this situation?

List three differences between an ilieostomy and a colostomy.

Answer explanation

Ileostomy:

- Often right lower quadrant.

- Higher output.

- Stool is looser.

- Alkaline output.

- Raised off the skin.

Colostomy:

- Flush with the skin.

- Often left lower quadrant.

- Stool is more formed.

You are performing a lower limb vascular examination. Your patient has a painful ulcer with a punched out, necrotic appearance and minimal exudate.

Which type of ulcer is most likely?

• Arterial

• Venous

• Neuropathic

In England and Wales 2-yearly bowel cancer screening with faecal immunochemistry testing is performed for which group of patients?

• Ages 45-70 years

• Ages 50-80 years

• Ages 60-75 years

• Ages 70-80 years

Name two causes of extramural bowel obstruction.

You are reviewing a patient who has presented with acute lower abdominal pain and rectal bleeding. Their venous blood gas has a lactate of 7.

Give your top differential.

Answer explanation

Ischaemic bowel.

A patient with known gallstones presents with right upper quadrant pain and fever. Their laboratory results show hyperbilirubinaemia and raised inflammatory markers.

Name two procedures that could be used as curative management for this condition?