Q.1 A 45-year-old male presents with sudden, severe abdominal pain radiating to the back and hypotension. Which surgical emergency is most likely?
Acute appendicitis
Perforated peptic ulcer
Ruptured abdominal aortic aneurysm
Acute cholecystitis
Explanation - Sudden severe abdominal pain radiating to the back with hypotension is characteristic of a ruptured abdominal aortic aneurysm, which is a life-threatening surgical emergency.
Correct answer is: Ruptured abdominal aortic aneurysm
Q.2 Which of the following is the most common cause of acute small bowel obstruction in adults?
Volvulus
Hernia
Adhesions
Intussusception
Explanation - Postoperative adhesions are the most common cause of acute small bowel obstruction in adults.
Correct answer is: Adhesions
Q.3 A 25-year-old male presents with right lower quadrant pain, fever, and leukocytosis. The most likely diagnosis is:
Acute appendicitis
Diverticulitis
Acute pancreatitis
Peptic ulcer perforation
Explanation - Right lower quadrant pain with fever and leukocytosis in a young adult is classic for acute appendicitis.
Correct answer is: Acute appendicitis
Q.4 Which sign indicates perforation in a patient with acute abdominal pain?
Murphy’s sign
Rovsing’s sign
Rigidity and rebound tenderness
McBurney’s point tenderness
Explanation - Abdominal rigidity and rebound tenderness are clinical signs of peritonitis, which often indicates gastrointestinal perforation.
Correct answer is: Rigidity and rebound tenderness
Q.5 A patient presents with massive hematemesis and hypotension. The first step in management is:
Endoscopy immediately
Fluid resuscitation and stabilization
CT scan of the abdomen
Administration of proton pump inhibitors
Explanation - In any patient with massive upper gastrointestinal bleeding, initial management focuses on airway protection, fluid resuscitation, and hemodynamic stabilization before definitive therapy.
Correct answer is: Fluid resuscitation and stabilization
Q.6 Which of the following is a classic triad of acute cholangitis?
Fever, jaundice, right upper quadrant pain
Fever, hypotension, abdominal rigidity
Right lower quadrant pain, vomiting, fever
Severe epigastric pain, vomiting, hypotension
Explanation - Charcot’s triad (fever, jaundice, and right upper quadrant pain) is characteristic of acute cholangitis, a surgical emergency requiring biliary drainage.
Correct answer is: Fever, jaundice, right upper quadrant pain
Q.7 A 60-year-old male presents with sudden, severe epigastric pain radiating to the back and hypotension. Serum amylase is markedly elevated. The most likely cause is:
Acute pancreatitis due to gallstones
Perforated peptic ulcer
Acute mesenteric ischemia
Myocardial infarction
Explanation - Sudden severe epigastric pain radiating to the back with elevated amylase suggests acute pancreatitis, with gallstones being a common cause.
Correct answer is: Acute pancreatitis due to gallstones
Q.8 In trauma patients, the 'golden hour' refers to:
First hour after injury for optimal surgical intervention
First hour of resuscitation only
Time taken to reach the hospital
Duration of anesthesia during surgery
Explanation - The 'golden hour' in trauma medicine refers to the first hour after injury when prompt surgical intervention or resuscitation significantly improves survival.
Correct answer is: First hour after injury for optimal surgical intervention
Q.9 Which type of shock is most commonly associated with massive hemorrhage?
Cardiogenic shock
Hypovolemic shock
Septic shock
Neurogenic shock
Explanation - Massive hemorrhage reduces circulating blood volume, leading to hypovolemic shock, a life-threatening surgical emergency.
Correct answer is: Hypovolemic shock
Q.10 Which of the following is the first-line imaging modality for suspected tension pneumothorax in an emergency setting?
Chest X-ray
Ultrasound
CT scan
MRI
Explanation - Point-of-care ultrasound can rapidly detect pneumothorax and is especially useful in unstable patients where X-ray may delay intervention.
Correct answer is: Ultrasound
Q.11 A patient presents with sudden onset of severe scrotal pain. The most urgent surgical emergency to rule out is:
Epididymitis
Testicular torsion
Inguinal hernia
Hydrocele
Explanation - Testicular torsion causes ischemia of the testis and requires immediate surgical intervention to salvage the testicle.
Correct answer is: Testicular torsion
Q.12 Which of the following is the hallmark sign of acute compartment syndrome?
Pallor of the limb
Pain out of proportion to injury
Loss of distal pulses
Swelling only
Explanation - Severe pain disproportionate to the injury, especially on passive stretching, is an early and critical sign of acute compartment syndrome.
Correct answer is: Pain out of proportion to injury
Q.13 The most common cause of upper gastrointestinal perforation is:
Peptic ulcer disease
Crohn’s disease
Appendicitis
Diverticulitis
Explanation - Perforation of a peptic ulcer, especially in the duodenum, is the most common cause of upper GI perforation requiring emergency surgery.
Correct answer is: Peptic ulcer disease
Q.14 Which of the following is the most common cause of small bowel ischemia?
Mesenteric arterial embolism
Mesenteric venous thrombosis
Strangulated hernia
Intussusception
Explanation - Acute mesenteric ischemia is most often caused by embolism to the superior mesenteric artery, leading to bowel necrosis if untreated.
Correct answer is: Mesenteric arterial embolism
Q.15 In a patient with penetrating abdominal trauma, which organ is most commonly injured?
Spleen
Liver
Small intestine
Kidney
Explanation - Penetrating abdominal trauma often injures the small intestine due to its large surface area and central location.
Correct answer is: Small intestine
Q.16 A 55-year-old male presents with sudden, severe abdominal pain and vomiting. He has a history of atrial fibrillation. The most likely cause is:
Acute appendicitis
Acute mesenteric ischemia
Gastroenteritis
Peptic ulcer disease
Explanation - Patients with atrial fibrillation are at risk of emboli, which can cause acute mesenteric ischemia presenting with sudden severe abdominal pain and vomiting.
Correct answer is: Acute mesenteric ischemia
Q.17 Which of the following is the most reliable clinical feature of perforated peptic ulcer?
Epigastric tenderness
Guarding and rigidity
Vomiting
Melaena
Explanation - Generalized peritonitis with guarding and rigidity is a hallmark of gastrointestinal perforation, including perforated peptic ulcer.
Correct answer is: Guarding and rigidity
Q.18 A patient with severe trauma is in shock. Which class of hemorrhagic shock involves 750–1500 mL blood loss?
Class I
Class II
Class III
Class IV
Explanation - Class II hemorrhagic shock corresponds to 15–30% blood loss (750–1500 mL in adults), presenting with tachycardia and mild hypotension.
Correct answer is: Class II
Q.19 Which type of hernia is considered a surgical emergency due to high risk of strangulation?
Inguinal hernia
Femoral hernia
Umbilical hernia
Incisional hernia
Explanation - Femoral hernias have a narrow neck and high risk of incarceration and strangulation, requiring urgent surgical repair.
Correct answer is: Femoral hernia
Q.20 Which is the most common cause of acute scrotum in children?
Epididymitis
Testicular torsion
Hydrocele
Inguinal hernia
Explanation - Testicular torsion is the most common cause of acute scrotum in children and adolescents and requires immediate surgical intervention.
Correct answer is: Testicular torsion
Q.21 In abdominal trauma, a positive FAST (Focused Assessment with Sonography in Trauma) exam detects:
Pneumothorax
Intra-abdominal free fluid
Bone fractures
Vascular injury
Explanation - FAST ultrasound is used in trauma to quickly detect intra-abdominal free fluid, suggesting bleeding requiring urgent intervention.
Correct answer is: Intra-abdominal free fluid
Q.22 A 30-year-old male presents with severe epigastric pain and hypotension after a motorcycle accident. FAST scan shows free fluid. The next best step is:
CT abdomen
Immediate laparotomy
Observation
Endoscopy
Explanation - Hemodynamically unstable trauma patients with intra-abdominal free fluid require urgent surgical exploration (laparotomy).
Correct answer is: Immediate laparotomy
Q.23 Which of the following signs indicates peritonitis?
Positive Murphy’s sign
Rebound tenderness and rigidity
Positive Psoas sign
Positive Rovsing’s sign only
Explanation - Peritonitis is characterized by generalized abdominal tenderness, guarding, and rebound tenderness, indicating inflammation of the peritoneum.
Correct answer is: Rebound tenderness and rigidity
Q.24 Which is the preferred initial management for a patient with incarcerated but viable bowel in a hernia?
Immediate surgery
Observation only
Manual reduction if possible
Administration of antibiotics only
Explanation - If the bowel is viable and no signs of strangulation exist, gentle manual reduction may be attempted; otherwise, urgent surgery is indicated.
Correct answer is: Manual reduction if possible