Multiple choice questions: general surgery

B is the correct answer. Risk factors for bladder cancer include:

What is the most likely diagnosis?

A 45 year old man presented to the emergency department with colicky abdominal pain, vomiting, and a painful groin lump. On examination he had a pulse of 110 beats/min and temperature of 37.8°C. There was marked abdominal distension, high pitched bowel sounds, and an erythematous, tender mass in the left groin above and medial to the pubic tubercle (fig 1). A plain abdominal radiograph was taken in the emergency department. What is the next step in management?

Bowel obstruction is initially managed by a “drip and suck” approach. A nasogastric tube is placed to remove the stomach contents and prevent vomiting. Intravenous fluids are prescribed to make up the deficit from losses and provide maintenance requirements. Patients are allowed nil by mouth to prevent vomiting and to prepare them for surgery.

Ideally, patients