General Surgery MCQs (Prometric)

A 68-year-old man presents with painless jaundice, weight loss, and dark urine. CT pancreatic protocol shows a 2.4-cm pancreatic-head adenocarcinoma without arterial encasement, venous occlusion, metastases, or ascites. Bilirubin is 126 µmol/L, renal function is normal, and there is no fever, cholangitis, severe pruritus, or anticipated delay before surgery. He is nutritionally supported and fit for resection. What is the most appropriate next step?

A 63-year-old liver-transplant recipient develops fever, night sweats, weight loss, and abdominal fullness eighteen months after transplantation. Epstein-Barr virus DNA is markedly elevated, and the displayed CT demonstrates the decisive pattern of disease. Core biopsy confirms CD20-positive monomorphic post-transplant lymphoproliferative disorder. The graft is functioning, and there is no perforation, hemorrhage, or intestinal obstruction. What is the most appropriate initial management?

A 30-year-old man sustains high-speed blunt trauma with a C2 fracture extending through the transverse foramen. He is neurologically intact, and head CT shows no intracranial hemorrhage. CT angiography identifies a nonocclusive vertebral-artery dissection with approximately 40% luminal narrowing and preserved distal flow. No operation is planned within the next 24 hours. What is the most appropriate initial management?

A 72-year-old man undergoes emergency surgery for a strangulated incisional hernia. A 20-cm necrotic small-bowel segment is resected, and enteric contents contaminate the operative field. After anastomosis and washout, he is stable, and the fascial defect can be closed without tension. There is no loss of abdominal-wall domain, but permanent synthetic mesh would directly contact the contaminated field. What is the most appropriate abdominal-wall strategy?

A 44-year-old man is postoperative day 2 after sleeve gastrectomy. He develops persistent tachycardia of 124/min, left shoulder pain, fever, and increasing oxygen requirement. Blood pressure is 102/64 mmHg, lactate is 3.1 mmol/L, and abdominal tenderness is mild. A water-soluble contrast study is negative, but clinical concern remains high. What is the most appropriate next investigation and management sequence?

A 27-year-old man undergoes massive transfusion for pelvic hemorrhage. After operative packing, core temperature is 32.8°C, pH is 7.18, ionized calcium is 0.86 mmol/L, and diffuse microvascular bleeding persists. The displayed ECG provides the temperature-related manifestation. Blood products are still being administered through an unwarmed rapid infuser. What is the most appropriate immediate resuscitation adjustment?

A 60-year-old man has persistent nonbilious vomiting, early satiety, and a succussion splash. He uses nonsteroidal anti-inflammatory drugs daily and has lost 8 kg. Sodium is 132 mmol/L, potassium is 2.7 mmol/L, chloride is 82 mmol/L, and bicarbonate is 39 mmol/L. Nasogastric decompression returns 2.4 L of retained material. The displayed abdominal radiograph is obtained, and CT shows no perforation. What is the most appropriate next step after initial fluid and electrolyte correction?

A 51-year-old man is in intensive care after damage-control laparotomy for intra-abdominal hemorrhage. The abdomen was temporarily closed. He now has peak airway pressures rising from 25 to 41 cm H₂O, urine output below 10 mL/hour, tense abdominal distension, and escalating vasopressor requirements. Bladder pressure is repeatedly 29 mmHg despite sedation, neuromuscular blockade, nasogastric decompression, and drainage of accessible fluid. What is the most appropriate next intervention?

A 49-year-old woman with BMI 44 kg/m² seeks metabolic surgery. She has insulin-treated diabetes, severe reflux despite maximal medication, a 5-cm hiatal hernia, and biopsy-confirmed nondysplastic Barrett esophagus. Gastric emptying is normal, and she has no Crohn disease or previous intestinal resection. She accepts lifelong nutritional monitoring. Which primary bariatric procedure is most appropriate?

A 56-year-old man has chronic groin pain 14 months after open mesh repair of a right inguinal hernia. There is no recurrent bulge, infection, testicular abnormality, or radiological recurrence. Pain is burning, radiates to the upper scrotum, and is reproduced by palpation near the superficial ring. Oral analgesia and physiotherapy have failed, but targeted ilioinguinal nerve block provides near-complete temporary relief. What is the most appropriate next management step?