SURGERY EOR CERTIFICATION SCRIPT
2026 QUESTIONS WITH SOLUTIONS
GRADED A+
• a 55-year-old male with a history of blunt chest trauma from a motor vehicle
accident presents to the emergency department with shortness of breath and
chest pain. He reports that the symptoms have gradually worsened over the
past 48 hours. On physical examination, there are decreased breath sounds
over the left lower lung field, and the patient appears mildly tachypneic. A
chest X-ray reveals a left-sided pleural effusion. A thoracentesis is
performed, and the fluid is milky in appearance, with laboratory analysis
showing high triglyceride levels, confirming the diagnosis of.
Answer: chylothorax
• chylothorax.
Answer: accumulation of lymphatic fluid (chyle) in the pleural space,
typically due to damage or obstruction of the thoracic duct
• chyle is rich in.
Answer: triglycerides
• What are hemorrhoids?.
Answer: Swollen and inflamed blood vessels in the anorectal region,
classifed as internal or external based on their location
• Risk factors for hemorrhoids?.
Answer: Increased venous pressure - Straining during defecation
(constipation) - Pregnancy - Obesity - Prolonged sitting - Cirrhosis with
portal HTN - Heavy lifting
• What are the usual causes of hemorrhoids?.
Answer: - Straining during bowel movements - Obesity - Pregnancy
• What are the 3 types of hemorrhoids?.
, Answer: External --> distal to the dentate line Internal --> proximal to the
dentate line Mixed --> located proximal and distal to the dentate line
• Internal Hemorrhoids.
Answer: - PAINLESS - BRIGHT RED BLOOD PER RECTUM
• Internal hemorrhoids originate from the ______ vein..
Answer: Superior hemorrhoid vein
• mcc of chylothorax.
Answer: trauma - esp following thoracic surgery
• Grades of internal hemorrhoids (based on degree of prolapse).
Answer: Grade I --> does not prolapse (confined to anal canal), may bleed
with pooping Grade II --> prolapses with defecation or straining, but
spotaneously reduces Grade III --> prolapses with defacation or straining,
requires manual reduction Grade IV --> Irreducible and may strangulate
• mc malignancies associated with chylothorax.
Answer: lymphomas - particularly non-hodgkins
• the most important RF for chylothorax.
Answer: thoracic or neck surgery
• What are the clinical manifestations of internal hemorrhoids?.
Answer: - Intermittent rectal bleeding (MC) seen on toilet paper or dispersed
in toilet water - Rectal itching, fullness, or mucus discharge - Sensation of
incomplete evacuation - Non palpable unless they are thromboses
• What does rectal pain with internal hemorrhoids suggest?.
Answer: Complication
• in cases of high-output chylothorax, what may happen.
Answer: patients may experience electrolyte imbalances and
immunosuppression due to the loss of immunoglobulins in the chyle
• dx of chylothorax.
Answer: start with a CXR CT is more sensative Thoracentesis* - check for
TAGs, cholesterol, cell count
,• chylous effusion is confirmed by the presence of.
Answer: milky fluid with elevated TAGs > 110 and a positive sudan III stain
• External Hemorrhoids originate from the ____ vein..
Answer: Inferior hemorrhoid vein
• chylothorax - ______ predominate the cell count, distinguishing chylothorax
from other types of effusions.
Answer: lymphocytes
• Clinical manifestations of external hemorrhoids?.
Answer: - Pain, but no bleeding - Perianal pain worse with defecation -
Thrombosed --> painful, purplish swelling - +/- skin tags - Itching
• treatment for chylothorax.
Answer: chest tube to drain it start patient on a low fat diet with
medium-chain tags refractory - initate TPN to reduce instetinal fat
absorption surgical -thoracic duct ligation (via thoracoscopy or open
thoracotomy) indicated for patients with persistent ot high output > 1L/day
-Pleurodesis - refractory cases, obliterates the pleural space -Lymphatic
embolization - block the site of leakage by embolixing the thoracic duct
• indications for surgery - chylothorax.
Answer: persistent despite conservative tx high output > 1L/day for 5-7d
recurrent
• Strangulated hemorrhoids.
Answer: Strangulated hemorrhoids occur when protrusion and constriction
occlude the blood supply. They cause pain that is occasionally followed by
necrosis and ulceration.
• long term tx - chylothorax.
Answer: medium chain TAG diet or low fat diet regular f/u with imaging
• a 64-year-old male with a history of chronic obstructive pulmonary disease
(COPD) presents to the emergency department with fever, pleuritic chest
pain, and shortness of breath. He reports that these symptoms have
, worsened over the past week following a recent pneumonia. On physical
examination, he is febrile and tachypneic, with decreased breath sounds and
dullness to percussion over the right lower lung field. A chest X-ray reveals
a large right-sided pleural effusion. A thoracentesis is performed, yielding
purulent fluid, and laboratory analysis shows low pH, low glucose, and high
lactate dehydrogenase (LDH), confirming the diagnosis of.
Answer: empyema
• empyema.
Answer: collection of pus in the plueral cavity
• mcc of empyema.
Answer: PNA, particulary bacterial
• Diagnosis of hemorrhoids.
Answer: - Inspection - DRE - Anoscopy --> indicated when hemorrhoids are
not detected on physical exam and DRE - Colonoscopy/flex sig--> indicated
in pts > 40 with RF for CRC
• Conservative treatments for hemorrhoids?.
Answer: - High fiber diet - Increased fluids - Warm sitz baths - Topical
rectal steroids If failed, debilitating, pain, or strangulation --> rubber band
ligation (MC), sclerotherapy, infrared coagulation, excision of thrombosed
external hemorrhoids
• Treatment for internal hemorrhoids?.
Answer: Stool softeners, sitz baths, anesthetic ointments, witch hazel
compresses Bleeding internal hemorrhoids --> injection sclerotherapy ,
rubber band ligation for larger, prolapsing ones
• empyema fluid via thoracentesis.
Answer: purulent, cloudy, low pH , 7.2, low glucose < 40, elevated LDH
• When is a hemorrhoidectomy indicated?.
Answer: Stage IV external hemorrhoids or those not responsive to other
therapies
2026 QUESTIONS WITH SOLUTIONS
GRADED A+
• a 55-year-old male with a history of blunt chest trauma from a motor vehicle
accident presents to the emergency department with shortness of breath and
chest pain. He reports that the symptoms have gradually worsened over the
past 48 hours. On physical examination, there are decreased breath sounds
over the left lower lung field, and the patient appears mildly tachypneic. A
chest X-ray reveals a left-sided pleural effusion. A thoracentesis is
performed, and the fluid is milky in appearance, with laboratory analysis
showing high triglyceride levels, confirming the diagnosis of.
Answer: chylothorax
• chylothorax.
Answer: accumulation of lymphatic fluid (chyle) in the pleural space,
typically due to damage or obstruction of the thoracic duct
• chyle is rich in.
Answer: triglycerides
• What are hemorrhoids?.
Answer: Swollen and inflamed blood vessels in the anorectal region,
classifed as internal or external based on their location
• Risk factors for hemorrhoids?.
Answer: Increased venous pressure - Straining during defecation
(constipation) - Pregnancy - Obesity - Prolonged sitting - Cirrhosis with
portal HTN - Heavy lifting
• What are the usual causes of hemorrhoids?.
Answer: - Straining during bowel movements - Obesity - Pregnancy
• What are the 3 types of hemorrhoids?.
, Answer: External --> distal to the dentate line Internal --> proximal to the
dentate line Mixed --> located proximal and distal to the dentate line
• Internal Hemorrhoids.
Answer: - PAINLESS - BRIGHT RED BLOOD PER RECTUM
• Internal hemorrhoids originate from the ______ vein..
Answer: Superior hemorrhoid vein
• mcc of chylothorax.
Answer: trauma - esp following thoracic surgery
• Grades of internal hemorrhoids (based on degree of prolapse).
Answer: Grade I --> does not prolapse (confined to anal canal), may bleed
with pooping Grade II --> prolapses with defecation or straining, but
spotaneously reduces Grade III --> prolapses with defacation or straining,
requires manual reduction Grade IV --> Irreducible and may strangulate
• mc malignancies associated with chylothorax.
Answer: lymphomas - particularly non-hodgkins
• the most important RF for chylothorax.
Answer: thoracic or neck surgery
• What are the clinical manifestations of internal hemorrhoids?.
Answer: - Intermittent rectal bleeding (MC) seen on toilet paper or dispersed
in toilet water - Rectal itching, fullness, or mucus discharge - Sensation of
incomplete evacuation - Non palpable unless they are thromboses
• What does rectal pain with internal hemorrhoids suggest?.
Answer: Complication
• in cases of high-output chylothorax, what may happen.
Answer: patients may experience electrolyte imbalances and
immunosuppression due to the loss of immunoglobulins in the chyle
• dx of chylothorax.
Answer: start with a CXR CT is more sensative Thoracentesis* - check for
TAGs, cholesterol, cell count
,• chylous effusion is confirmed by the presence of.
Answer: milky fluid with elevated TAGs > 110 and a positive sudan III stain
• External Hemorrhoids originate from the ____ vein..
Answer: Inferior hemorrhoid vein
• chylothorax - ______ predominate the cell count, distinguishing chylothorax
from other types of effusions.
Answer: lymphocytes
• Clinical manifestations of external hemorrhoids?.
Answer: - Pain, but no bleeding - Perianal pain worse with defecation -
Thrombosed --> painful, purplish swelling - +/- skin tags - Itching
• treatment for chylothorax.
Answer: chest tube to drain it start patient on a low fat diet with
medium-chain tags refractory - initate TPN to reduce instetinal fat
absorption surgical -thoracic duct ligation (via thoracoscopy or open
thoracotomy) indicated for patients with persistent ot high output > 1L/day
-Pleurodesis - refractory cases, obliterates the pleural space -Lymphatic
embolization - block the site of leakage by embolixing the thoracic duct
• indications for surgery - chylothorax.
Answer: persistent despite conservative tx high output > 1L/day for 5-7d
recurrent
• Strangulated hemorrhoids.
Answer: Strangulated hemorrhoids occur when protrusion and constriction
occlude the blood supply. They cause pain that is occasionally followed by
necrosis and ulceration.
• long term tx - chylothorax.
Answer: medium chain TAG diet or low fat diet regular f/u with imaging
• a 64-year-old male with a history of chronic obstructive pulmonary disease
(COPD) presents to the emergency department with fever, pleuritic chest
pain, and shortness of breath. He reports that these symptoms have
, worsened over the past week following a recent pneumonia. On physical
examination, he is febrile and tachypneic, with decreased breath sounds and
dullness to percussion over the right lower lung field. A chest X-ray reveals
a large right-sided pleural effusion. A thoracentesis is performed, yielding
purulent fluid, and laboratory analysis shows low pH, low glucose, and high
lactate dehydrogenase (LDH), confirming the diagnosis of.
Answer: empyema
• empyema.
Answer: collection of pus in the plueral cavity
• mcc of empyema.
Answer: PNA, particulary bacterial
• Diagnosis of hemorrhoids.
Answer: - Inspection - DRE - Anoscopy --> indicated when hemorrhoids are
not detected on physical exam and DRE - Colonoscopy/flex sig--> indicated
in pts > 40 with RF for CRC
• Conservative treatments for hemorrhoids?.
Answer: - High fiber diet - Increased fluids - Warm sitz baths - Topical
rectal steroids If failed, debilitating, pain, or strangulation --> rubber band
ligation (MC), sclerotherapy, infrared coagulation, excision of thrombosed
external hemorrhoids
• Treatment for internal hemorrhoids?.
Answer: Stool softeners, sitz baths, anesthetic ointments, witch hazel
compresses Bleeding internal hemorrhoids --> injection sclerotherapy ,
rubber band ligation for larger, prolapsing ones
• empyema fluid via thoracentesis.
Answer: purulent, cloudy, low pH , 7.2, low glucose < 40, elevated LDH
• When is a hemorrhoidectomy indicated?.
Answer: Stage IV external hemorrhoids or those not responsive to other
therapies
