Surgery IV

Question 1

What head and neck infection is characterized by trismus, muffled voice, and deviation of the uvula on physical exam?

Answer 1

Peritonsillar abscess (quinsy)

other symptoms include fever, pharyngeal pain, and earache

Question 2

What hip movement (flexion or extension) worsens the pain associated with a hip septic arthritis?

Answer 2

Hip flexion

Question 3

What hip movement (flexion or extension) worsens the pain associated with a psoas abscess?

Answer 3

Hip extension

i.e. the psoas sign

Question 4

What imaging modality can confirm the diagnosis of diaphragmatic rupture in patients with suggestive X-ray findings?

Answer 4

CT scan (chest, abdomen)

Question 5

What imaging modality is best for confirming a meniscal tear?

Answer 5

MRI

Question 6

What imaging modality is preferred for diagnosis of acute mesenteric ischemia?

Answer 6

CT angiography

Question 7

What imaging modality is typically used to diagnose acute cholecystitis?

Answer 7

Ultrasound

CT scan also be used but is less sensitive; HIDA scan is useful when US findings are indeterminate

Question 8

What imaging modality is used for diagnosis of a psoas abscess?

Answer 8

CT scan of abdomen/pelvis

Question 9

What imaging modality is used for the definitive diagnosis of syringomyelia?

Answer 9

MRI

Question 10

What imaging modality is used to confirm a diagnosis of duodenal hematoma?

Answer 10

Abdominal CT

Question 11

What imaging modality is used to confirm a rotator cuff tear?

Answer 11

MRI

Question 12

What imaging modality is used to determine the need for urgent surgical intervention in patients with ischemic colitis (e.g. extensive bowel damage, perforation)?

Answer 12

CT scan

Question 13

What imaging modality is used to diagnose urethral injury?

Answer 13

Retrograde urethrogram

Question 14

What imaging modality is useful for hemodynamically stable patients with blunt abdominal trauma and a positive FAST exam?

Answer 14

CT scan of the abdomen

helps distinguish blood from urine or ascites and can help quantify the amount of intraperitoneal blood

Question 15

What imaging modality should be used to confirm placement of a central venous catheter tip?

Answer 15

Chest X-ray

this step may be omitted in the setting of an uncomplicated ultrasound-guided CVC placement

Question 16

What imaging modality should be used to evaluate a suspected urethral injury (e.g. patient with a penile fracture)?

Answer 16

Retrograde urethrogram

symptoms may include blood at the meatus, dysuria, urinary retention

Question 17

What imaging test can confirm the diagnosis of ischemic colitis after a CT scan has been obtained?

Answer 17

Colonoscopy

Question 18

What initial imaging modality is used to diagnose GI perforation?

Answer 18

Upright X-ray of chest and abdomen

Question 19

What is a common early clinical feature of compartment syndrome?

Answer 19

Paresthesia

due to sensory nerve ischemia

Question 20

What is next step for blunt abdominal trauma with GI perforation identified on CT?

Answer 20

Exploratory laparotomy

Question 21

What is the best initial step in the management of a hemodynamically stable patient with hemoptysis and a high clinical suspicion for tuberculosis?

Answer 21

Respiratory isolation

Question 22

What is the emergency treatment of choice for acalculous cholecystitis in a critically ill patient?

Answer 22

antibiotics and percutaneous cholecystostomy

followed by cholecystectomy when the medical condition stabilizes

Question 23

What is the first step in the management of a necrotizing surgical site infection?

Answer 23

Surgical exploration and debridement

adjunctive therapies including broad-spectrum antibiotics, adequate hydation, and tight glycemic control are also important

Question 24

What is the first step in the management of cervical spinal trauma?

Answer 24

Spine immobilization

Question 25

What is the first step in the treatment of acute upper GI bleed (e.g. variceal hemorrhage) in a patient with a normal airway/breathing?

Answer 25

Vascular access with 2 large-bore IV catheters

Question 26

What is the first test used to evaluate splenic injury in a hemodynamically stable and alert patient?

Answer 26

Focused Assessment with Sonography for Trauma (FAST)

Question 27

What is the first test used to evaluate splenic injury in a hemodynamically stable patient with altered mental status?

Answer 27

CT scan of abdomen in stable patients with AMS, the FAST exam is often skipped

Question 28

What is the fluid of choice to restore volume quickly in the management of septic shock?

Answer 28

IV 0.9% saline (crystalloid) equally effective as albumin, but less costly and easier to acquire

Question 29

What is the gold standard for diagnosis of sphincter of Oddi dysfunction?

Answer 29

sphincter of Oddi manometry

Question 30

What is the ideal placement for a central venous catheter tip?

Answer 30

Lower superior vena cava

Question 31

What is the initial intervention for the management of stress fractures of the 2nd, 3rd, or 4th metatarsals?

Answer 31

rest and simple analgesics (e.g. acetaminophen) non-union is uncommon

Question 32

What is the initial management for a large pneumothorax in a hemodynamically stable patient?

Answer 32

Needle decompression

Question 33

What is the initial management for a small (\< 2 cm), spontaneous pneumothorax?

Answer 33

observation and supplemental O2 most common in tall, thin, men in their early 20s

Question 34

What is the initial management for a tension pneumothorax in a hemodynamically unstable patient?

Answer 34

Urgent tube thoracostomy or needle decompression

Question 35

What is the initial management for hemodynamically stable patients with an appendiceal abscess?

Answer 35

IV hydration, antibiotics, and bowel rest appendectomy should not be performed right away (may return in 6-8 weeks for elective appendectomy, "interval appendectomy"); abscess formation should be suspected in patients who present \> 5 days after the onset of symptoms

Question 36

What is the initial screening test for blunt aortic trauma?

Answer 36

Chest X-ray should be ruled out in patients with blunt deceleration trauma (MVA or fall from \> 10 feet)

Question 37

What is the initial step in management of dumping syndrome?

Answer 37

Dietary modification

Question 38

What is the initial step in the management of small-bowel obstruction that is complicated by fever, hypotension, and tachycardia?

Answer 38

Urgent surgical exploration

Question 39

What is the initial treatment for prerenal acute kidney injury in patients with evidence of hypovolemia?

Answer 39

IV fluid bolus

Question 40

What is the likely cause of gastric outlet obstruction in a patient with a history of acid ingestion?

Answer 40

Pyloric stricture characterized by early satiety, nausea, non-bilious vomiting, weight loss, and abdominal succussion splash

Question 41

What is the management for a young patient with persistent symptoms due to a meniscal tear?

Answer 41

Surgery (after evaluation by MRI)

Question 42

What is the management for older and/or mildly symptomatic patients with meniscal tears?

Answer 42

rest/activity modification

Question 43

What is the most common blood transfusion reaction?

Answer 43

Febrile non-hemolytic reaction

Question 44

What is the most common cause of lower extremity edema?

Answer 44

Venous insufficiency (valvular incompetence) classically worsens throughout the day and resolves overnight

Question 45

What is the most common cause of primary hypoparathyroidism?

Answer 45

Post-surgical

Question 46

What is the most common cause of small-bowel obstruction (SBO) in the U.S?

Answer 46

Adhesions typically result from abdominal operations or inflammatory processes; other common causes include hernias (#1 cause in developing countries) and malignancy

Question 47

What is the most common location for anal fissures?

Answer 47

Posterior midline