GI Surgery MCQs

Surgery · 5 free questions with answers & explanations.

1. A 55-year-old man presents with a 6-month history of progressive dysphagia, initially to solids and now to liquids, with a 10 kg weight loss. Upper GI endoscopy reveals an irregular ulcerative lesion in the mid-oesophagus. Biopsy confirms squamous cell carcinoma. CT staging shows no distant metastases and a tumour confined to the oesophageal wall without involvement of adjacent structures. Which of the following is the most appropriate primary treatment strategy?
2. A 40-year-old woman presents with sudden-onset severe epigastric pain radiating to the back, nausea, and vomiting. Her serum amylase is 1,200 U/L and lipase is 3,400 U/L. CT abdomen shows pancreatic oedema with peripancreatic fat stranding and no necrosis. She is haemodynamically stable. On day 3 of admission her Revised Atlanta criteria suggest mild acute pancreatitis. Which of the following is the single most important intervention in her management?
3. A 68-year-old man with a longstanding history of gastro-oesophageal reflux disease undergoes surveillance endoscopy. Biopsies from the lower oesophagus confirm high-grade dysplasia on a background of Barrett's oesophagus. There is no visible lesion or submucosal invasion on endoscopic ultrasound. What is the most appropriate next step in management?
4. A 72-year-old woman presents with a 4-day history of lower abdominal pain, fever (38.4°C), and leucocytosis. CT abdomen and pelvis shows a 5 cm pericolic abscess adjacent to a segment of sigmoid colon with diverticular disease, with no free gas or free fluid. This is classified as Hinchey stage II diverticular disease. What is the most appropriate initial management?
5. A 45-year-old man presents with sudden-onset severe diffuse abdominal pain. On examination he has board-like rigidity and absent bowel sounds. Erect chest X-ray reveals free gas under the right hemidiaphragm. He has a 2-year history of peptic ulcer disease inadequately treated with over-the-counter antacids. After initial resuscitation, what is the definitive management?