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Erect chest X-ray shows free air under the diaphragm. What is the most likely diagnosis?

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Intestinal obstruction

Perforated peptic ulcer (hollow viscus perforation)

Acute pancreatitis

Acute cholecystitis

None

This abdominal radiograph shows a classic “coffee-bean sign”. What is the diagnosis?

Caecal volvulus

Sigmoid volvulus

Toxic megacolon

Colonic tumour obstruction

None

CT abdomen shows a dilated, inflamed tubular structure in the right iliac fossa. What is the most likely diagnosis?

Meckel’s diverticulitis

Acute appendicitis

Crohn’s ileitis

Right ureteric colic

None

RUQ ultrasound shows the WES sign (Wall–Echo–Shadow). What does it indicate?

Acute hepatitis

Gallstones (packed gallbladder)

Liver abscess

Renal stone

None

Abdominal X-ray is suggestive of small bowel obstruction. What is the best initial management in a stable patient?

Oral feeding

Nasogastric decompression + IV fluids/electrolyte correction

Laxatives

Immediate colostomy

None

Groin swelling as shown. What is the most likely diagnosis?

Femoral hernia

Direct inguinal hernia

Indirect inguinal hernia

Saphena varix

None

Painful irreducible groin swelling with skin changes suggests a strangulated hernia. What is the next best step?

Manual reduction

Emergency surgery

Antibiotics only

Elective repair later

None

This is a diabetic foot ulcer with necrotic/infected tissue. Best management option is:

Oral antifungals

Urgent debridement + IV antibiotics (and glycemic control)

Topical steroid ointment

No intervention

None

Using the adult rule of nines, what percentage of total body surface area (TBSA) is ONE upper limb?

18%

27%

36%

None

Neck swelling consistent with a thyroid mass. Most likely diagnosis:

Thyroglossal cyst

Thyroid nodule/goitre

Branchial cyst

Carotid body tumour

None

Scrotal ultrasound (color Doppler) is consistent with testicular torsion. Best management is:

Antibiotics only

Immediate surgical exploration and detorsion (orchiopexy)

Elective surgery later

Needle aspiration

None

Non-contrast CT demonstrates a renal/ureteric calculus. First-line symptomatic treatment in the ED is:

NSAIDs (analgesia) +/- antiemetic

Steroids

Antacids

Anticoagulation

None

Unilateral lateral neck swelling. Most likely diagnosis:

Thyroglossal cyst

Thyroid nodule

Branchial cleft cyst

Carotid body tumour

None

Endoscopic image shows an actively bleeding peptic ulcer. Best endoscopic hemostasis is:

Biopsy only

Injection (e.g., adrenaline) + clip/thermal therapy

PPI only

Surgery now (without endoscopy)

None

Peau d’orange appearance of the breast is most concerning for inflammatory breast cancer. Best next step is:

Mammogram/ultrasound + biopsy

CA-125 test

Thyroid FNAC

Barium study

None

Surgery Image‑Based Challenge Quiz (MBBS Level)

Instructions: For each question, review the image and choose the single best answer (A–D).

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