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?
A man is having his preoperative assessment for a hernia repair. His body mass index (BMI) is calculated at 38.
Which definition correctly describes his BMI value?
A study is designed to statistically test the hypothesis that a particular drug lowers blood pressure. A group of elderly volunteers enrolled in the study. Each participant’s blood pressure is measured prior to administration of the drug. One hour after the drug, the blood pressure for each participant is rechecked.
Which of the following statistical tests is most appropriate for testing the hypothesis that the drug lowers blood pressure in elderly individuals?
A 60-year-old man comes to the Emergency Department with sudden onset compressive chest pain radiating to the left upper limb. He has a medical history of obesity, hypertension and hyperlipidaemia, and is a smoker. Based on the initial assessment, you determine that there is a 40% likelihood that he is having an acute myocardial infarction. You order an ECG and cardiac enzymes for further evaluation.
What is the significance of the 40% estimate in this scenario?
A 60-year-old man with a past medical history of obesity, hypertension and hyperlipidaemia presents to the Emergency Department complaining of sudden-onset chest pain. After your initial history and examination, you conclude that there is a 40% chance that this patient is experiencing an acute myocardial infarction. An electrocardiogram (ECG) and cardiac enzymes are performed to further evaluate his condition.
This estimate (40%) is defined as which of the following?
An 85 kg 40-year-old man who is normally fit and well is scheduled for an appendectomy today. He has been made nil by mouth, and surgeons expect him to continue to be nil by mouth for approximately 24 hours. The man has a past medical history of childhood asthma. He has been taking paracetamol for pain but takes no other regular medication. On examination, the man’s blood pressure (BP) is 110/80 mmHg and heart rate 65 bpm. His lungs are clear. Jugular venous pressure (JVP) is not raised, and he has no peripheral oedema. Skin turgor is normal.
What is the appropriate fluid prescription for this man for the 24 hours while he is nil by mouth?
A 65 kg 30-year-old woman who is normally fit and well is scheduled for appendectomy today. She has been made nil by mouth, and surgeons expect her to continue nil by mouth for approximately 24 h. The woman has a past medical history of childhood asthma. She has been taking paracetamol for pain, but takes no other regular medication. On examination, the woman’s blood pressure (BP) is 110/80 mmHg, heart rate 65 beats per minute (bpm). Her lungs are clear. Jugular venous pressure (JVP) is not raised and she has no peripheral oedema. Skin turgor is normal.
What is the appropriate fluid prescription for this woman for the 24 h while she is nil by mouth?
A 70-year-old woman is being discharged from the Surgical Ward following a midline laparotomy for a perforated duodenal ulcer. She has several surgical staples in situ.
How many days post-surgery should the staples be removed?
A 36-year-old man is one day postoperative, following an inguinal hernia repair. He has become extremely nauseated and is vomiting. He is complaining of general malaise and lethargy. His past medical history includes type 1 diabetes mellitus; you perform a capillary blood glucose which is 24 mmol/l and capillary ketone level is 4 mmol/l. A venous blood gas demonstrates a pH of 7.28 and a potassium level of 5.7 mmol/l.
Given the likely diagnosis, what is the best initial immediate management in this patient?
This 70-year-old man is in atrial fibrillation, which was confirmed on a 24-hour tape during a pre-operative assessment clinic. He reports no prior heart issues but has experienced temporary loss of vision in his right eye over the past two months. He has type II diabetes and COPD but takes no other medications. His blood pressure is normal, and an echocardiogram shows an ejection fraction greater than 65%. What is his CHA2DS2-VASC score?