Surgery

​Surgery

By Megan Persenaire

Multiple Choice

A 29 y/o man underwent an ex lap and lysis of adhesions for recurrent adhesive SBO 14days ago. His hispital course was unremarkable, and he was discharged from thehospital on POD 6. The pt was doing well, but he returns to the ER with abdominal painand vomiting. A CT scan of the abdomen reveals that a loop of small bowel hasherniated through a mid-abdominal fascia defect. There is CT evidence of contrsictionof the herniated small bowel at the fascial defect with closed loop obstruction of theherniated small bowel segment. Which of the following is the best treatment option?

• Provide non-operate management of SBO for 7 days and surgery if not improved.

• Attempt to reduce the hernia and obstruction by manipulation of the abdomen.

• Provide IV sedation and muscle relaxants and attempt to manually reduce the hernia.

• Take the pt to surgery to reduce the herniated intestine and revise the fascial closure

• Attempt non-operative management for 14 days while providing the patient with TPN and NG tube. If the process does not resolve, then operate.

Multiple Choice

A 48 y/o woman underwent a laparotomy for a sigmoid colon obstruction from a diverticular stricture. The pt developed a deep surgical site infection on POD 4. She remained in the hospital for close observation and wound care with frequent dressing changes. 6 days later, she is noted to have a significant amount of purulent fluid draining into her wound through a 1 cm fascia defect in the lower aspect of her surgical incision. Which of the following is the best treatment plan for this patient?

• CT scan, broad-spectrum abx, wound care

• CT scan and surgery for abdominal re-exploration

• Broad-spectrum abx and wound care

• Extension of the fascial defect to assess the contents within the abdominal cavity.

• Wound care and patient reassurance.

Multiple Choice

A 53 y/o woman had an ex-lap for possible ruptured diverticulitis and underwent a sigmoid resection and re-anastomosis. On POD 2she began having fever and cough with yellow sputum. On examination, her temp is elevated at 100.8. HR is tachycardic at 100 bpm, BP WNL. She is noted to have dullness on percussion of bilateral lung bases and decreased breath sounds in both lung bases. O2 is 92% on RA. Which of the following is the most likely diagnosis?​

​

• Atelectasis​

• DVT

• PE

• PNA

Multiple Choice

A 34 y/o woman is hospitalized for septic shock caused by toxic shock syndrome after a MVC. She is treated with IV nafcillin and noted to have hypoxemia. A CXR reveals diffuse infiltrates in bilateral lung fields. Which of the following would most likely differentiate acute respiratory distress syndrome from cardiogenic pulmonary edema?

• Pulmonary artery catheter

• Serum colloid osmotic pressure

• Urinary electrolytes and partial excretion of sodium

• Pulmonary ventilation/perfusion scan

• Bronchoscopy and bronchoalveolar lavage

Multiple Choice

A 34 y/o man slipped and fell in the bathroom at home and struck his anterior neck on the edge of some shelves. When he arrived at the ER he had significant anterior neck pain, soft tissue crepitus, and stridor. The patient was successfully intubated after several difficult attempts. His initial CXR following intubation revealed a properly positioned ET tube, diffuse bilateral nonsegmental infiltrates, and no evidence of a pneumothorax or pleural effusion. Which of the following is the most appropriate treatment option at this time?

• Bronchoscopy to assess the tracheobronchial tress

• Mechanical ventilation and fluid administration

• Broad spectrum antibiotics for aspiration pneumonia

• Chest tube placement

Multiple Choice

A 26 y/o man with a gunshot wound to the abdomen underwent ex lap and repair of several small bowel and colon injuries. Post-op, he is slow to have return of bowel function and has persistent low urine output. On POD 9, he is noted to have a fever of100.8, tachypnea, tachycardia, and O2 of 92% on RA. During the valuation, he complains of difficulty breathing and is noted to have diminished breath sounds bilaterally. His abdomen is distended with absence of bowel sounds. His WBC is elevated at 18000. Which of the following is the best management?

• CT angiography of the chest and empiric heparin

• Abx and CT of the abdomen

• Abx and heparin

• Blood cultures, monitor

• Abx and re-exploration of the abdomen

Multiple Choice

A 62 y/o male presents to the ER for abdominal pain and jaundice. He does not have a PCP. He reports 1 month of worsening abdominal pain and bloating, over the last week the pain has started radiating through his abdomen to his back. Social history is noted for cigarette smoking and heavy alcohol use for many years. GI family history is insignificant, mother and sister did have breast cancer. You notice that his clothing is baggy and ask if he has lost weight recently, he says he's unsure since he doesn't ever go to the doctor, but he admits his clothes have been fitting differently​

​

Which of the following is the most likely diagnosis?

• Acute pancreatitis

• Pancreatic cancer

• Chronic pancreatitis

• Gastric cancer

Multiple Choice

A 57 y/o male presents to their PCP for an annual physical. The PCP notes a 30 lb weight loss over the last year. Upon further interview, the patient admits to early satiety, intermittent upper abdominal pain, and decreased appetite. He has a history of H. Pylori with a gastric ulcer, but this was treated successfully. He has not noticed any fever, chills, constipation diarrhea. The PCP orders an endoscopy, and the biopsies return positive for gastric adenocarcinoma. Which of the following is not a risk factor for gastric cancer?

• Chronic NSAID use

• Smoking

• Heavy alcohol use

• Blood type A

Multiple Choice

Which of the following is the test of choice in patients with a suspected AAA who are unstable? ​

• CT scan with IV contrast

• CT scan without IV contrast

• Ultrasound

• Xray

Multiple Choice

A 36 y/o male has been admitted to surgery service for acute pancreatitis. On his 2nd day of admission, he develops worsening hypocalcemia. Which of the following would not be a finding you would expect to see? ​

• Increased muscular contractions

• Diarrhea

• Chvostek sign

• Trousseau's sign

• Polyuria

Multiple Choice

Which of the following is not true regarding the skin lesions shown on the previous screen?​

• They are the most common type of skin cancer in the US.

• They tend to be slow growing.

• They are associated with the human papilloma virus.

• It is common to occur on the upper lip.