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1. Rish Sharma

2.  A 70 y/o male presents with
 Severe upper abdo pain, vomiting and
genearalised peritonism
 He is shocked and acidotic with AKI
 How will you manage

3.  CXR- pneumo; CT- DU PERF
 D/D
 Preop optimizatiopn/ risk prediction
 Sepsis / SIRS/ SOFA- Kumar et al
 ELPQUIC- Pearse RM et al
 NELA
 AKI

4.  A 10 year old boy comes in with sudden onset,
severe crampy abdo pain of 12 hrs duration
with rashes and temp 38 degree
 How would you manage?

5.  D/D HS purpura, intusussception, mesenteric
adenitis and bowel obst
 USS vs CT
 Reduction techniques and success rates

8.  39 F, BMI 36, presented with RUQ pain, mild
jaundice and fever
 How would you manage ?

9.  DD – Acute cholecystitis/Perf DU/
pancreatitis/ appendicitis/ ruptured ectopic
 Investigations : Sepsis 6 , urine dip+ HCG, Uss.
 Indication of CT/MRCP
 ?ERCP/ Tokyo Guidelines/ ERCP
complications
 Early vs late LC – evidence- Gurusami/
Davidson et al
 Consent for LC/ complications
 ACDC study and chocolate trails

10.  40 M , Motorbike accident, open fracture right
femur, Spurting from wound, tachy, bp 70/50,
pulse 120, hb 7.
 How will you manage this patient

11.  ATLS : Primary survey- C spine, high flow O2 and
pulse oxim
 DSTS : C-ABC/ splint the limb
 FAST scan/ ABG/ Intensivists input
 Control of arterial bleed – local pressure/ Vascular
surgeon/ massive haemorrhage protocol
 Resuscitations and investigations (?? Too general)
 CT if stable +/- Angioembolisation
 Trauma laparotomy- prereqisites

12.  60 M, alcoholic/ cirrhosis , 2nd post op day
following elective right hemicolectomy for a
caecal tumour, hypotensive, Na 132, k 4.0.
 How would you manage this patient?

13.  CCrISP approach- see next
 Define and list the causes of hyponatremia
 Investigations (need to list them)
 Management of hyponatremia

15.  70 M in the surgical ward
 Post op hypotension 5 days following
emergency AAA repair
 How would you manage this ?

16.  Causes of post op hypotension: Anastomotic
leak/sepsis/MI/PE/ lack of fluid
 Resuscitation/ Sepsis 6/ ECG/ ABG/ 2D Echo
 Back to ITU if sepsis/theatre if leakage
 CT vs USS
 MBL
 Sepsis/ SIRS/ MODS/ Quic Sofa/ Sepsis-3

17.  22 years old male riding a motorbike at a speed
of 60mph was involved in collision with a van.
He was ejected 5 metres from the scene.
Brought in to ED on spinal board, helmet still
on and no sign of head injury. GCS 15 , C/O -
right leg pain. On examination right foot is cold
and impalpable pulse.
 How would you approach this patient?

18.  AMPLE history
 DDs/Pattern of injury: arterial thrombosis/
external compression/arterial dissection
 Approach to vascular injury
 What will you do if no vascular surgeon available
and found to have SFA injury
 CT angio/exploration
 He become suddenly hypotensive with GCS 13 –
what are the probablities
 Decelaration injury – commonly involved organs

19.  45 years old male type 1 DM, h/0 renal
transplant 10 years ago post op rt hydrocele
surgery 7 days ago presented with painful
scrotal sweeling
 O/E: swollen inflamed testis with necrotic skin
 What will be your approach ?

20.  Sepsis 3/6.
 Immunosupression : oral – IV
 Contact regional transplant unit
 Necrotising fasciitis- extent of surgery
 Pathophysiology and microbiology of NF
 AKI – renal replacement therapy,
Haemodialysis/Haemofiltration:transfer to
transplant unit
 Involving critical care team in the management
 Plastic surgeon

21.  76M on Naproxen for OA of right hip attended
ED with sudden onset abdominal pain.
 Vomitted in ED once and collapsed, pulse
130/min, BP 70 systolic
 What will be your approach?

22.  ABCDE approach
 DDs: UGI bleed, DU perf,Ac pancreatitis, leaking
AAA, mesenteric ischaemia
 Investigations: CXR, ECG, Amylase, Ontable OGD,
Abdo CT
 Blood transfusion and MBL
 Urgent OGD
 Interventional radiology
 Clotting INR 1.5 not on any warfarin – Why inr
raised?
 Indication of surgical intervention.

23.  4 years old boy brought in by mum with right
sided abdominal pain. On clinical examination
you found mild RIF tenderness and right sided
undescended testis
 How will you approach this patient.

24.  DDs : acute appendicitis/ mesenteric adenitis/
HSP/strangulated hernia
 Management of acute abdomen.
 Alvarado score for acute appendicitis
 Surgical VS nonsurgical treatment of ac
appendicitis with evidence
 Investigations and management of undescended
testis
 Indication of orchidectomy for undescended testis


26.  19 years old lady 10 weeks pregnant attended
ED with right sided abdominal pain.
 How would you manage this?
 USS: appendix is thickened with fluid around
it? Acute appenditis

27.  Diagnostic challenge of appendicitis in
pregnancy
 Lap vs open surgery
 Risk of miscarriage
 What if the lady is 36 weeks pregnant
 Port placement for laparoscopic surgery
 Role of imaging in the diagnosis USS/CT/MRI
 Consent for appendicectomy

28.  10 weeks old infant with sudden onset right
groin+ scrotum swelling, child is a bit irritable
and refusing feeds .
 How wouldyou manage?

29.  Focussed history: keeping DDs in mind –
hernia/hydrocele/torsion
/trauma/tumour/epididymoorchitis
 Clinical examination:; how to distinguish
hernia from congenital hydrocele
 What is PPV?
 When to rapair hernia ?
 Paed hernia surgery : by whom and timing
 When to repair hydrocele?
 Would you explore contralateral groin??

30.  5 month old boy presented to ED with 48 hours
history of intermittent crying episodes, draws
his legs at the time of crying and lethargic in
between episodes. Abdominal examination
revealed a tender lump in the RUQ
 What is the likely diagnosis?
 How would you manage this?

31.  DDs
 Initial resuscitation
 Aetiology of intussuception
 Investigations
 Methods of reduction and when to use?
 Indication of surgery? Lap/open ?
 Problems after successful reduction?

32.  A 3 year old girl has been referred with a
persistent umbilical swelling since birth
recently increased in size after a chest
infection/cough.
 What is the likely diagnosis?
 How would you manage this?

33.  Anatomy fo umbilical hernia
 When will you repair ?
 Describe the surgery?
 Open vs lap
 What is persistent V I D?
 What is patent urachus?
 How the umbilicus is formed

34.  10 M presented with RIF pain and vomiting ,
O/E: tender RIF, raised wcc 15, CRP 10, what
are the DDs?
 You do a diagnostic laparoscopy with 5mm
scope with a provisional diagnosis of acute
appendicitis but appendix found to be normal.
How would you manage this patient ( you are
still in theatre with this patient)?

35.  DDs
 Meckel’s diverticulitis
 Anatomy of MD, complications of MD, %,
 What will you do if diverticulum is not
inflamed but has a narrow neck
 What is Meckel’s scan ?
 How do you manage incidental normal looking
MD?

36.  6m old boy seen in the clinic with no palpable
right testicle.
 How would you manage?
 Definition of undescended testis ( UDT) ?

37.  Descent of testis
 Aim of surgical treatment in UDT?
 Timimg of surgery and why?
 Exploration of the groin/laparoscopy?
 Dartos pouch for UDT?
 What will you do if testis is intraabdominal?
 Complications of UDT
 Complication of surgery?
 Contralateral testis fixation or not ?
 What is retractile testis?

38.  40 years old alcoholic with BMI 18.2 has been
listed for elective anterior resection. How will
you do a nutritional assessment of this patient?
 What is MUST score?
 What are the anthropometric measurement
 What type of nutritional deficiencies are
common with chronic alcoholism?
 What are the normal resting nutritional
requirement?

39.  How does the nutritional requirement differ
after major surgery or sepsis?
 Indication of TPN?
 Complications of TPN
 Which route preferred ? Enteral parenteral?
 Advantages and disadvantages of enteral
nutrion?
 What is refeeding syndrome?