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SURGERY NEETPG PRACTICE QUESTIONS
1)22y/o man with blunt thoracic trauma remains tachypneic & hypotensive despite aggressive fluid resuscitation. Most likely diagnosis? - ✔✔Flail chest with multiple rib fractures & lung contusion 2)23y/o man with GSW to RUQ is in hemorrhagic shock with distended abdomen. What is the next step in management? - ✔✔Emergent exploratory laparotomy, without waiting for FAST or CT scan 3)27y/o basketball player jumps to block a shot with his right hand. As his hand contacts the ball, he feels severe pain in his right shoulder. He holds his right arm slightly abducted and externally rotated. What is the diagnosis? What are the two main complications? - ✔✔ Diagnosis: anterior dislocation of the humeral head - ✔✔ Main complications: axillary nerve damage with paralysis of the deltoid & teres minor muscle as well as loss of sensation over lateral upper arm; axillary artery damage - ✔✔ 4)29y/o woman with full-thickness burn below her right elbow has circumferential eschar over right arm on day 3 & complains of pain & paresthesia in her right hand. What are the next steps in management? - ✔✔
- Doppler ultrasound to document peripheral pulses & estimate tissue compartment pressure - ✔✔
- Escharotomy (cut only through eschar layer) if pressure is 25-40mmHg - ✔✔
- Fasciotomy if escharotomy does not improve perfusion - ✔✔ 5)31y/o male was hit by a car after attending a party where he drank a lot of fuice. He complains of diffuse abdominal pain that refers to his left shoulder. Which part of the bladder is most likely injured? - ✔✔
Bladder dome: only region covered by peritoneum, allowing leakage of urine into the peritoneum and producing Kehr's sign; the dome is also most susceptible to rupture because the bladder wall is weaker there - ✔✔ 6)31y/o man has acute pain & swelling of the midline sacrococcygeal skin & subQ tissues. what is it? - ✔✔ Infection of a pilonidal cyst - ✔✔ 7)31y/o trauma victim is in hemorrhagic shock with decreased breath sounds on the left, dullness to percussion on the left and slight tracheal deviation to the right. What is the diagnosis? - ✔✔ Hemothorax - ✔✔ 8)34y/o man from Mexico with ongoing massive hemoptysis has dense opacity in right upper lobe on CXR. What do you do (5)? - ✔✔
- Intubate patient to protect his airway & prevent asphyxiation - ✔✔
- Place bleeding lung in dependent position (lateral decubitus on side of affected lung) - ✔✔
- IV fluids - ✔✔
- Bedside bronchoscopy to visualize the lesion & control the bleeding - ✔✔
- Pulmonary artery catheterization with embolization if bronchoscopy doesn't stop the bleeding - ✔✔ 9)34y/o man from Mexico with recent history of massive hemoptysis has dense opacity in right upper lobe on CXR. What is the diagnosis? What is the next step (3)? - ✔✔
Calcium stones <1-3mm - ✔✔ Obstruction of ureter by blood clot or tumor - ✔✔ 14)62y/o man presents with 1hr of severe epigastric pain, history of epigastric pain exacerbated by eating, and free air between the liver & diaphragm on CXR. What is the diagnosis? What is the next step in management? - ✔✔ Diagnosis: perforated peptic ulcer - ✔✔ Management: immediate surgical evaluation - ✔✔ 15)68y/o male on post-op day 1 for diverticulosis resection has oliguria, BP 110/70, HR 90, BUN/Cr 36, Hb 9.5. What is the next step? - ✔✔ Suspect hypovolemia as the cause of the patient's oliguria. Change the Foley to make sure it's not clogged, then IV fluid challenge. - ✔✔ 16)73y/o with advanced dementia has fever, pain & swelling on left angle of jaw on POD8 s/p laparotomy for intestinal obstruction. What is the diagnosis? What could have prevented this? Risk factors? - ✔✔ Diagnosis: acute bacterial parotitis - ✔✔ Prevention: adequate fluid intake & oral hygiene - ✔✔ Risk factors: dehydrated post-op patients, elderly - ✔✔ 17)Acid-base disturbance caused by aspirin toxicity - ✔✔
Metabolic acidosis (accumulation of salicylate) + respiratory alkalosis (increased respiratory drive) - ✔✔ 18)Acid-base disturbance caused by excessive diuresis - ✔✔ Volume contraction metabolic alkalosis - ✔✔ 19)Actinic keratosis - ✔✔ Thick, scaly or crusty patches of skin in sun-exposed areas. May progress to squamous cell carcinoma. - ✔✔ 20)Acute adrenal insufficiency - ✔✔ Acute onset of N/V, abd pain, hypoglycemia, hypotension after a stressful event in a patient who is steroid-dependent. - ✔✔ 21)Acute febrile non-hemolytic transfusion reaction: timing, manifestations (3), treatment (2) - ✔✔ Timing: during or a few hours after transfusion - ✔✔ Manifestations: increased temperature, rigors, self-limited - ✔✔ Treatment: antipyretics + stop transfusion - ✔✔ 22)Acute interstitial nephritis: causes (9), manifestations (4), UA (3) - ✔✔ Causes: NSAIDs, penicillins, rifampin, sulfa drugs, quinolones, diuretics, allopurinol, phenytoin, pyelonephritis - ✔✔
Immediate signs: flaccid paralysis, bowel/bladder dysfunction, sexual dysfunction, hypotension, loss of DTRs, preserved vibratory and proprioceptive sensation - ✔✔ 26)Anterior urethral injury: causes (2), signs (5) - ✔✔ Cause: blunt trauma to perineum (straddle injury), instrumentation of the urethra - ✔✔ Signs: perineal tenderness, perineal hematoma, normal prostate, bleeding from the urethra, extravasation of urine into scrotum / perineum / abd wall - ✔✔ 27)Appearance of basal cell carcionma - ✔✔ Pearly telangiectatic papules with a central 'rodent' ulceration - ✔✔ 28)Arterial occlusion of a lower extremity: three major causes and their characteristics - ✔✔ Embolus: sudden severe pain; clot comes from ventricles (recent MI) or atria (a-fib) - ✔✔ Thrombosis: slow progressive onset of pain; usually bilateral - ✔✔ Trauma - ✔✔ 29)AST/ALT ratio - ✔✔ <1.0: viral hepatitis - ✔✔
2.0: alcoholic hepatitis, hepatocellular carcinoma - ✔✔ 30)At what Hb level does tissue oxygen delivery become deficient? - ✔✔
7g/dL - ✔✔ 31)Atrial fibrillation post-CABG: timing & treatment - ✔✔ Timing: usually occurs within a few days of CABG & resolves on its own within <24hrs - ✔✔ Treatment: rate control with beta-blockers or amiodarone; anticoagulation and/or cardioversion if it lasts
24hrs - ✔✔ 32)Best antibiotic for infectious diarrhea - ✔✔ Ciprofloxacin - ✔✔ 33)Best diagnostic test for assessing soft tissue injury to the knee - ✔✔ MRI - ✔✔ 34)Best diagnostic test for suspected esophageal perforation - ✔✔ Gastrografin-contrast esophagography - ✔✔ 35)Best diagnostic test for suspected splenic injury - ✔✔ Abdominal CT scan with IV contrast - ✔✔ 36)Best diagnostic tests for stress fracture (3) - ✔✔
Ischemia-reperfusion - ✔✔ 42)Causes of esophageal perforation (6) - ✔✔ Medical instrumentation: esophageal dilation procedures, surgery around the esophagus, endoscopy - ✔✔ Persistent vomiting - ✔✔ Pill esophagitis (e.g. KCl pills) - ✔✔ Caustic ingestion - ✔✔ Esophageal ulcer due to Barrett's esophagus - ✔✔ Infectious esophageal ulcer in AIDS patients - ✔✔ 43)Causes of nephrotic syndrome - ✔✔ Diabetes - ✔✔ Amyloidosis - ✔✔ Focal segmental glomerulosclerosis (adults) - ✔✔ Membranous glomerulonephritis (adults, HBV) - ✔✔
Minimal change disease (children) - ✔✔ 44)Causes of pain in the forefoot involving the tarsal bones (4) - ✔✔ Stress fracture - ✔✔ Arthritis - ✔✔ Bursitis - ✔✔ Morton neuroma - ✔✔ 45)Causes of pseudomembranous colitis (5) - ✔✔ Antibiotics: clindamycin, cephalosporins, ampicillin - ✔✔ Malignancy - ✔✔ COPD - ✔✔ Immunosuppressive therapy - ✔✔ Renal failure - ✔✔ 46)Causes of septal perforation (7) - ✔✔ Trauma (nose picking) - ✔✔
No calcification - ✔✔ Cavitation with thick walls - ✔✔ Rapid increase in size over time - ✔✔ 49)Classic CXR findings of flail chest - ✔✔ Multiple rib fractures + lung contusion - ✔✔ 50)Classic presentation of cancer of the head of the pancreas (4) - ✔✔ Constant epigastric pain radiating to the back - ✔✔ Weight loss - ✔✔ Jaundice - ✔✔ Migratory thrombophlebitis (hypercoagulability) - ✔✔ 51)Classic presentation of intraductal papilloma (4) - ✔✔ Intermittent bloody discharge from one nipple - ✔✔ Difficult to palpate - ✔✔ Small size <2mm - ✔✔
Soft consistency - ✔✔ 52)Classic presentation of peptic duodenal ulcer disease - ✔✔ Epigastric burning pain that is periodic and relieved by meals - ✔✔ 53)Clavicle fracture: presentation, evaluation, treatment - ✔✔ Presentation: shoulder is displaced inferiorly & posteriorly - ✔✔ Evaluation: x-ray and careful neurovascular exam, due to proximity to subclavian artery and brachial plexus; angiogram if there is suspicion of vessel injury - ✔✔ Treatment: brace + rest + ice for fx of middle third; open reduction + internal fixation for fx of distal third
- ✔✔ 54)Common cause of acute rotator cuff tear - ✔✔ Fall on outstretched hands - ✔✔ 55)Common cause of central cord syndrome - ✔✔ Forced hyperextension injury to the neck, especially in elderly people who have degenerative changes in the cervical spine - ✔✔ 56)Common causes of fall in elderly patients (6) - ✔✔ Syncope - ✔✔
IBD (most common, esp. ulcerative colitis) - ✔✔ Ischemic colitis - ✔✔ Volvulus - ✔✔ Diverticulitis - ✔✔ Infection - ✔✔ Obstructive colon cancer - ✔✔ 60)Common complication of supracondylar fracture - ✔✔ Brachial artery injury - ✔✔ 61)Common complications of severe burns (3) - ✔✔ Sepsis due to pneumonia or wound infection (staph, pseudomonas) - ✔✔ MI - ✔✔ Acute renal failure - ✔✔ 62)Common manifestations of hypophosphatemia (4) - ✔✔ Weakness - ✔✔
Rhabdomyolysis - ✔✔ Paresthesias - ✔✔ Respiratory failure - ✔✔ 63)Common presentations of peripheral artery disease (4) - ✔✔ Claudication - ✔✔ Erectile dysfunction - ✔✔ Atypical leg pain - ✔✔ Asymptomatic (esp. older people) - ✔✔ 64)Common side effect of rifampin - ✔✔ Red-orange discoloration of urine, saliva, sweat, tears - ✔✔ 65)Common side effects of erythropoietin therapy (4) - ✔✔ Worsening of HTN (esp. IV EPO) - ✔✔ Headache - ✔✔ Flu-like syndrome - ✔✔
Hematoma at access site (femoral artery -- can extend into retroperitoneal space & cause significant bleeding) - ✔✔ Arteriovenous fistula - ✔✔ Arterial thrombosis - ✔✔ Perforation of heart or great vessels - ✔✔ Acute kidney injury - ✔✔ Contrast allergy - ✔✔ 70)Complications of central venous catheters (8) - ✔✔ Arterial puncture - ✔✔ Pneumothorax - ✔✔ Hemothorax - ✔✔ Thrombosis - ✔✔ Air embolism - ✔✔ Sepsis - ✔✔ Vascular perforation - ✔✔
Myocradial perforation leading to tamponade - ✔✔ 71)Complications of rhinoplasty (4) - ✔✔ Patient dissatisfaction - ✔✔ Nasal obstruction - ✔✔ Epistaxis - ✔✔ Septal perforation (due to poor blood supply) associated with septal hematoma or abscess - ✔✔ 72)Complications of uremia in patients with chronic renal failure (8) - ✔✔ Peripheral neuropathy - ✔✔ Encephalopathy - ✔✔ Seizures - ✔✔ Coma - ✔✔ Hyperparathyroidism - ✔✔ Insulin resistance - ✔✔ Sexual dysfunction - ✔✔
