SHORT

WRITTEN
MOCK
2021
Question 1

A 55 year old man has a 10-12 cm adenocarcinoma extending from 2 cm above the ileo-caecal
junction to within 6 cm of the hepatic flexure. Imaging studies demonstrate that the mass is
infiltrating posteriorly and is very close to structures behind the colon. There is no evidence of
metastatic disease on CT Scan or PET Scan.

a) What are the anatomical structures that may be associated with a mass in this location?

b) Discuss how damage to each of these structures may be avoided at the time of right
hemicolectomy.
Question 2

A 24 year old male has been involved in a high speed motor vehicle accident. On arrival in the
emergency department he has a GCS of 6 and has been intubated. He has a closed head injury and
open book fracture of the pelvis on pelvic x-ray. A FAST scan is negative. A trauma CT demonstrates
a small intra-cerebral bleed as well as a blush of contrast from a branch of the right internal iliac
artery with associated large pelvic haematoma.

Despite on-going resuscitation his systolic blood pressure has dropped to 80 mmHg and heart rate
increased to 125 beats/min.

Outline the initial management for this patient including the various therapeutic options to control
the pelvic bleeding.
Question 3

A 38-year-old man presents to a peripheral metropolitan hospital with small bowel obstruction. He
has a history of appendicectomy as a child and three subsequent laparotomies for small bowel
obstruction. After conservative treatment fails, he undergoes a further laparotomy.

The operation is prolonged and difficult and two enterotomies were sustained and repaired
primarily without resection during the adhesiolysis.

Six days after surgery, enteric fluid is noticed leaking from the wound. The patient is transferred to
your institution without evidence of peritonitis but is still not able to tolerate enteral nutrition.

Outline your management of this problem.

Question 4

During injection of subcutaneous local anaesthetic you sustain a needlestick injury.

Discuss your management.
Question 5

A patient undergoes a total thyroidectomy for multinodular goitre. 2 hours postoperatively, she
presents with increasing neck swelling.

1. What are the risk factors for bleeding following total thyroidectomy?
2. What is the appropriate management for this complication?
Question 6

A 58yo man presents to the Emergency Department following 16 episodes bloody diarrhoea in the last
24hrs. He has a history of ulcerative colitis.
1. How would you assess the severity of this acute episode of ulcerative colitis?
2. Describe your management over the first 48 hours.
3. What are the indications for surgical management?
Question 7

A 35-year-old male presents with symptoms of gastro-oesophageal reflux. He has an upper

gastrointestinal endoscopy that demonstrates a 4 cm sliding hiatus hernia with grade 3 reflux
oesophagitis.

a) List the indications for surgical management of this condition?

b) What are the surgical alternatives? Outline the advantages and disadvantages of
each.
c) Discuss the important issues to cover in the consent for the procedure
Question 8

A 53yo man has an abdominal wall mass resected. Histological assessment identified the mass as a
desmoid tumour. 2 years later, a new lump becomes evident at the location of the original resection.

What is the natural history of desmoid tumour?

What syndromes are associated with desmoid tumours?
How should the recurrence be managed?