A 24-year-old male victim of an acid attack has been brought to the resus department. He has sustained burns on approximately 25% of his body surface area and weighs 60kg. The medical team needs to determine the amount of fluid resuscitation required for the next 24 hours using the Parkland formula based on his weight and the extent of burns. What is the volume of fluid resuscitation that should be administered to this patient over the next 24 hours?
An 80-year-old man is brought to the hospital following a fall. He reports feeling increasingly dizzy when moving around his apartment, but denies losing consciousness. He has a medical history of heart failure, hypertension, and type 2 diabetes. His medications were recently adjusted by the hospital clinic and include bendroflumethiazide, aspirin, ramipril, gliclazide, furosemide, simvastatin, and a newly prescribed doxazosin. What single observation would aid in establishing his diagnosis?
A 50-year-old ex-footballer undergoes a right hip hemi-arthroplasty. He is an ex-smoker. He is admitted to the ward.
Which of the following statements is correct regarding his deep venous thrombosis (DVT) thromboprophylaxis?
A 38-year-old woman is scheduled for a Caesarean section due to fetal distress. She expresses concern about the healing of her wound, as she had a previous surgical incision that became infected and resulted in abscess formation.
Which of the following underlying medical conditions places her at the highest risk for poor wound healing?
A 55-year-old woman is one day post-anterior resection for rectal cancer. During the morning ward round, she complains of severe abdominal pain, refractory to IV paracetamol, which the patient is currently prescribed. The consultant examines the patient and feels that the pain is due to the procedure and that there are no signs of any acute complications. The patient reports that she is allergic to morphine. What is the most suitable course of action for managing her pain?
A 50-year-old man is five days post-laparotomy for subacute intestinal obstruction secondary to underlying Crohn’s disease. He has suddenly become breathless and complains of pleuritic chest pain. On examination, the patient is confused and his chest is clear to auscultation. However, he is tachypnoeic and has a mildly raised jugular venous pressure (JVP).
Observations:
Blood pressure 97/70 mmHg
Heart rate 126 bpm
Respiratory rate 25 breaths per minute
Oxygen saturations 92% on room air
Arterial blood gas:
Investigation Result Normal value
pH 7.53 7.35–7.45
Pa(CO2) 3.1 kPa 4.6–6.0 kPa
Pa(O2) 8.3 kPa 10.5–13.5 kPa
An electrocardiogram (ECG) shows sinus tachycardia and right bundle branch block.
Computed tomography pulmonary angiogram (CTPA) confirms the diagnosis of pulmonary embolism.
Which is the most appropriate immediate management for this patient?
A 49-year-old woman, who had undergone a right-sided mastectomy for breast carcinoma, reports difficulty reaching forward and notices that the vertebral border of her scapula is closer to the midline on the side of surgery during a follow-up visit to the Surgical Outpatient Clinic. Which nerve is likely to have been injured to cause these symptoms?
A 55-year-old man is scheduled to undergo an elective laparoscopic cholecystectomy next week under general anaesthesia, due to recurring episodes of biliary colic. He has no known allergies or co-morbidities. What advice should he be given regarding eating and drinking before the surgery?
A 35-year-old woman experiences nausea and vomiting after a laparoscopic cholecystectomy, resulting in an extended hospital stay.
Which of the following is a risk factor for postoperative nausea and vomiting (PONV) in adults?
A 50-year-old man with a caecal carcinoma undergoes a laparotomy with right hemicolectomy. Four weeks later, he presents to the Surgical Outpatient Clinic with a persistent sinus in his midline laparotomy scar.
Which of the following conditions is most likely to be associated with poor wound healing?