{"generated_at":"2026-10-12T22:59:56+01:00","bank_count":43,"banks":[{"post_type":"gen-surg-questions","bank_name":"General Surgery Question","taxonomy":"mb-question-type","stations":[{"station_name":"Clinical","duration_minutes":null,"questions":[{"scenario_name":"3 urgent patients","scenario_description":"You are the ST3 on-call for General Surgery. You are doing the ward round of all surgical patients on the weekend with two FY1 doctors. The SHO is currently in A&E reviewing two patients. You have seen 3 patients who are unwell and need urgent management: The first patient is a 56-year-old patient receiving IV heparin for an SMV thrombosis who has developed fresh PR bleeding; the second patient is a post-gastric bypass patient (D2) who has developed severe chest pain; the third patient is intubated and ventilated on ICU following a trauma laparotomy, and has developed abdominal distension, high ventilation pressures and renal failure.<\/span>\r\n\r\nWhat would you do?<\/strong>","question_order":1,"question":"Response:","answer":"

The challenges in this scenario are multiple unwell patients and a relatively junior team. The likely differential diagnoses are GI bleeding, PE, and abdominal compartment syndrome, although the differential diagnoses for each case is wide. First, it is important to seek more information about each case to help decide the clinical priority. This could include simple information such as observations, comorbidities, and location (e.g. ward vs ICU). Having decided the clinical priority, the next step is to organise your team effectively (FY1 & nurses) and escalate your concerns to the Consultant on-call early.<\/span><\/p>\n

You were unable to finish the ward round. Later that day you are called to the ward to review a patient who is 6 days following a sigmoid colectomy and has developed abdominal pain. Observations: T 37.7, HR 120, BP 90\/70.<\/strong><\/p>"},{"scenario_name":"3 urgent patients","scenario_description":"You are the ST3 on-call for General Surgery. You are doing the ward round of all surgical patients on the weekend with two FY1 doctors. The SHO is currently in A&E reviewing two patients. You have seen 3 patients who are unwell and need urgent management: The first patient is a 56-year-old patient receiving IV heparin for an SMV thrombosis who has developed fresh PR bleeding; the second patient is a post-gastric bypass patient (D2) who has developed severe chest pain; the third patient is intubated and ventilated on ICU following a trauma laparotomy, and has developed abdominal distension, high ventilation pressures and renal failure.<\/span>\r\n\r\nWhat would you do?<\/strong>","question_order":2,"question":"What would you do?","answer":"

The differential diagnosis includes anastomotic leak, abscess, and perforation. The patient will need to undergo resuscitation according to CCRISP principles (IV fluids, antibiotics, ABG, CT scan). You will need to call for help from the surgical team (FY1, SHO, Consultant), ICU, anaesthetics, and theatres. If a CT confirms a leak, the patient will need a laparotomy and washout.<\/span><\/p>\n

You notice that the patient was tachycardic overnight, but no action was taken. The patient was moved to ICU and has made slow progress over 2 weeks. The patient\u2019s family would like to complain.<\/strong><\/p>"},{"scenario_name":"3 urgent patients","scenario_description":"You are the ST3 on-call for General Surgery. You are doing the ward round of all surgical patients on the weekend with two FY1 doctors. The SHO is currently in A&E reviewing two patients. You have seen 3 patients who are unwell and need urgent management: The first patient is a 56-year-old patient receiving IV heparin for an SMV thrombosis who has developed fresh PR bleeding; the second patient is a post-gastric bypass patient (D2) who has developed severe chest pain; the third patient is intubated and ventilated on ICU following a trauma laparotomy, and has developed abdominal distension, high ventilation pressures and renal failure.<\/span>\r\n\r\nWhat would you do?<\/strong>","question_order":3,"question":"What would you do","answer":"

This is a potential patient safety concern and highlights a failure of escalation pathways. Review the case in detail. Speak to the patient with a nurse present. Ensure the environment is quiet. Explain the facts of the event in a slow, clear manner. Offer the chance for questions and further follow-up. Refer the family to PALS if they still wish to make a complaint.<\/span><\/p>"},{"scenario_name":"72-year-old male patient who has developed fresh PR bleeding","scenario_description":"You are the ST3 on-call for General Surgery. You are called to A&E resus to review a 72-year-old male patient who has developed fresh PR bleeding. The patient had undergone PCI with stenting 1 month ago. Observations: HR 110, BP 90\/70. You go to A&E and are surprised to find that there is no nursing staff with the patient and intravenous access has not been obtained.<\/span>\r\n\r\nWhat would you do?<\/strong>","question_order":1,"question":"Response:","answer":"

The issues in this case are i) a critically unwell patient with lower GI bleeding who will need urgent resuscitation and diagnostic imaging, ii) a lack of trained staff to assist with managing this patient. First, you will need to gather your team (SHO & FY1). If there are no available staff in Resus, speak to the nurse-in-charge to determine whether a nurse from another area of ED could offer assistance. If there are no staff available, you could discuss the situation with the Site Manager, to find appropriately trained nursing staff within the hospital. The initial priority is resuscitation according to CCRISP principles: oxygen, IV access, cross-matching for blood products, discussion with Haematology (the patient is likely receiving dual antiplatelet therapy) and diagnostic imaging (CT angiography). If a contrast blush is identified, catheter-directed embolisation would be recommended.<\/span><\/p>"},{"scenario_name":"72-year-old male patient who has developed fresh PR bleeding","scenario_description":"You are the ST3 on-call for General Surgery. You are called to A&E resus to review a 72-year-old male patient who has developed fresh PR bleeding. The patient had undergone PCI with stenting 1 month ago. Observations: HR 110, BP 90\/70. You go to A&E and are surprised to find that there is no nursing staff with the patient and intravenous access has not been obtained.<\/span>\r\n\r\nWhat would you do?<\/strong>","question_order":2,"question":"Two days later the same patient develops chest pain and tachycardia. What would you do?","answer":"

The differential diagnosis includes MI, PE and arrythmia which requires targeted management according to CCRISP & ALS principles. The important issue to highlight is that many patients on antiplatelet \/ anticoagulant therapy may be admitted with bleeding complications requiring cessation of therapy. However they are then exposed to higher risk of thrombotic complications. The ongoing inpatient and long-term management of antiplatelet \/ anticoagulant therapy should be discussed between the surgical and specialty (e.g. Haematology \/ Cardiology) teams to decide on the optimum management.<\/span><\/p>"},{"scenario_name":"8 patients in A&E","scenario_description":"You are the ST3 on-call for General Surgery. There are 8 patients in A&E waiting to be seen. The A&E co-ordinator has called you and complained that the SHO is not responding to their bleep. What would you do?<\/span>","question_order":1,"question":"Response:","answer":"

You should go to A&E and speak to the A&E coordinator to retrieve details of all referrals. Attempt to call for help from the SHO or FY1 if available. Organise the reviews in order of clinical priority, and attempt to share the reviews between the clinical team, leaving you to prioritise the top priority patients. If you are having difficulty, you should call the on-call Consultant for additional assistance if they are available.<\/span><\/p>\n

Later during the night, you are called from the surgical ward by the nurse in charge. She has noticed that there has been a drug error \u2013 a dose of gentamicin was prescribed by the FY1 for a patient that was five times greater than the maximum dose. The patient had already received two doses of gentamicin in the last 48 hours without monitoring. This was administered by an agency nurse who did not notice the drug error. <\/strong><\/p>"},{"scenario_name":"8 patients in A&E","scenario_description":"You are the ST3 on-call for General Surgery. There are 8 patients in A&E waiting to be seen. The A&E co-ordinator has called you and complained that the SHO is not responding to their bleep. What would you do?<\/span>","question_order":2,"question":"What would you do?","answer":"

The principles in this case are to address the immediate patient harm\/near-harm, followed by actions to prevent repeat episodes and investigations to improve clinical pathways. Begin by reviewing the patient according to CCRISP principles, ensuring they are stable and have up-to-date blood tests and a blood gas. Discuss with the medical team \/ toxicology \/ ICU about mitigating steps. Seek information from the junior medical team about how and why the doses were prescribed. Use this as a teaching opportunity for the junior doctors and encourage reflection. Finally, ensure you submit a detailed DATIX and inform the Consultant in charge of the patient.<\/span><\/p>\n

The patient develops acute kidney injury and needs to go to ICU for haemofiltration. <\/strong><\/p>"},{"scenario_name":"8 patients in A&E","scenario_description":"You are the ST3 on-call for General Surgery. There are 8 patients in A&E waiting to be seen. The A&E co-ordinator has called you and complained that the SHO is not responding to their bleep. What would you do?<\/span>","question_order":3,"question":"Please explain how you would communicate this to the patient \/ relative?","answer":"

Ensure you speak to the patient \/ family with a nurse present in a quiet environment, after reviewing all the facts of the case. Provide the information slowly and clearly, stating facts only. Explain how actions have been taken to prevent the mistake happening again. Explain the possible long-term consequences. If you are uncertain about any part of the case, state that you will attempt to find the information for them. Refer the patient \/ relative to PALS if they still have concerns.<\/span><\/p>"},{"scenario_name":"Abdominal pain","scenario_description":"You are the ST3 on-call for General Surgery at a district general hospital. The Obstetric registrar has called you about a 28-year-old woman who is 25 weeks pregnant and has presented with abdominal pain, worse on the right side. She has some dysuria but the urine dipstick is negative. WCC is 15 and CRP 65. The TVUS shows a normal intrauterine pregnancy.<\/span>\r\n\r\nHow would you manage this situation?<\/b>","question_order":1,"question":"What are the clinical\/organisational issues?","answer":"