GEN SURGERY
Youttobtainttanttarterialttbloodttgasttonttattpatientttinttthettintensivettcarettunit.ttT
hettresultsttshowttattpHtt7.32,ttPaCO2tt50ttmmttHg,ttandttbicarbonatett24ttmmol/
L.ttWhichttofttthettfollowingttisttthettmostttlikelyttcausettofttthisttacid-
basettdisorder?tt-ttcorrectttanswer✔✔Hypoventilation
Hypoventilationttisttthettmostttlikelyttcausettoutttofttthettabovettchoicesttforttpri
maryttrespiratoryttacidosis.ttHypoventilation,ttwithttresultanttthypercapnia,ttc
anttbettsecondarytttottbrainttstemttinjury,ttneuromuscularttdisease,ttopiates,ttortt
ventilatorttdysfunction.
Attthree-week-
old,ttotherwisetthealthy,ttboyttpresentsttforttevaluationttofttprojectilettvomitingt
timmediatelyttafterttbreastfeeding.ttThettpatient'sttmotherttnotesttthattthetttypic
allyttwantstttottbettre-
fedttsoonttafterttvomiting.ttPhysicalttexaminationttrevealsttattfirmttolive-
shapedttmassttinttthettrightttupperttquadrant.ttWhatttisttthettdiagnosticttstudyttoftt
choicettforttyourttsuspectedttdiagnosis?tt-
ttcorrectttanswer✔✔Abdominalttultrasound
PyloricttStenosis
Patientttwillttbett2-8ttweeksttofttage
Nonbiliousttprojectilettvomitingttafterttfeedingttandttearlyttsatiety
PEttwillttshowttRUQttolive-likettmasstt(hypertrophiedttpylorus)
Labsttwillttshowtthypochloremictthypokalemicttmetabolicttalkalosis
,DiagnosisttisttmadettbyttultrasoundttorttUGIttseriestt(stringttsign)
Treatmentttisttsurgical
Att21-year-
oldttwomanttpresentsttforttevaluationttofttbloodyttemesis.ttShettreportsttdrinkin
gttseveralttalcoholicttbeveragestttottcelebratettherttbirthday.ttJustttpriortttottvomi
ting,ttshettnotedttseverettretching.ttWhichttofttthettfollowingttisttthettmostttlikelyt
tdiagnosis?tt-ttcorrectttanswer✔✔Mallory-Weissttsyndrome
Mallory-WeissttSyndrome
Historyttofttdrinkingttalcoholttandttforcefulttvomiting
Hematemesis
Diagnosisttisttmadettbyttupperttendoscopy
Causedttbyttanttincompletetttearttinttthettesophagusttmucosattandttproximalttsto
mach
Followingttanttappendectomy,ttatt20-year-
oldttwomanttdevelopsttwidespreadtturticariattandttpruritusttwithoutttanyttrespir
atory,ttgastrointestinal,ttorttcardiovascularttsymptoms.ttThettlesionsttaretttrans
ientttandttappeartttottmovetttottdifferentttlocationsttonttherttskin.ttShettdeniesttan
yttknownttdrugttallergies.ttShetthadttreceivedttpreoperativettantibioticttprophyl
axisttwithttcefotetanttapproximatelyttonetthourttearlier.ttWhichttofttthettfollowi
ngttisttthettmostttlikelyttexplanationttforttthetturticariattandttpruritus?tt-
ttcorrectttanswer✔✔Allergicttreactiontttottcefotetan
,Urticaria
PE:tttransientttblanching,ttedematousttpapules,ttandttplaques
Etiology:ttIgE-mediatedttreactiontttottanttallergen
Treatment:ttsupportivettcare,ttantihistamines,ttglucocorticoidstt(ifttassociated
ttwithttangioedema)
Whichttofttthettfollowingttisttthettmostttappropriatettnextttinterventionttforttattpa
tientttwithttvaricosettveinsttwhotthasttfailedtttottimprovettwithttconservativetttre
atment?tt-ttcorrectttanswer✔✔Veinttablation
VaricosettVeins
Patientttwillttbettattwoman
Dullttachettinttlegsttafterttprolongedttstanding
PEttwillttshowttdilated,ttelongatedttsubcutaneousttveins
Diagnosisttisttmadettbyttdetailedtthistoryttandttphysicalttexam
Treatmentttisttlegttelevationttandttcompressionttstockings
Att33-year-
oldttwomanttwhottisttobesettpresentsttwithttsuddenttonsetttofttfeverttandttabdomi
nalttpain.ttOnttphysicalttexamttshettisttfoundtttottbettjaundicedttandttherttbloodttpr
essurettistt88/58ttmmttHg.ttShetthasttepigastricttpainttwithttpalpation.ttShettisttfo
undtttotthavettelevatedttliverttenzymesttandttleukocytosis.ttInttadditiontttottadmi
nisteringttbroad-
spectrumttparenteralttantibiotics,ttwhichttofttthettfollowingttinterventionsttisttt
, hettbestttchoicettforttthettsuspectedttdiagnosis?tt-
ttcorrectttanswer✔✔Endoscopicttretrogradettcholangiopancreatography
AcutettCholangitis
Patientttpresentsttwithttrightttupperttquadrantttpain,ttjaundice,ttfevertt(Charcottt
triad)
DiagnosisttisttmadettbyttRUQttultrasound,ttCTttscan,ttorttERCPtt(goldttstandard
)
Mostttcommonlyttcausedttbyttcholedocholithiasisttthatttleadstttottbacterialttinf
ection,ttE.ttcoli
Treatmentttisttantibiotics,ttdefinitivetttreatmentttisttERCPttwithttantibioticsttty
picallyttanttadjunct
Charcottttriadtt+tthypotensionttandttAMStt=ttReynoldsttpentad,ttacutettobstruct
ion
Whichttofttthettfollowingttisttanttindicatorttofttunresectabilityttofttgastricttcance
r?tt-ttcorrectttanswer✔✔Diseasettencasementttofttthetthepaticttartery
Diseasettencasementttofttthetthepaticttarteryttisttconsideredttanttindicatorttofttun
resectabilityttofttgastricttcancer.
Indicatorsttofttunresectabilityttincludettvascularttinvolvementttofttthettaorta,tth
epaticttartery,ttorttproximalttsplenicttartery.
Youttobtainttanttarterialttbloodttgasttonttattpatientttinttthettintensivettcarettunit.ttT
hettresultsttshowttattpHtt7.32,ttPaCO2tt50ttmmttHg,ttandttbicarbonatett24ttmmol/
L.ttWhichttofttthettfollowingttisttthettmostttlikelyttcausettofttthisttacid-
basettdisorder?tt-ttcorrectttanswer✔✔Hypoventilation
Hypoventilationttisttthettmostttlikelyttcausettoutttofttthettabovettchoicesttforttpri
maryttrespiratoryttacidosis.ttHypoventilation,ttwithttresultanttthypercapnia,ttc
anttbettsecondarytttottbrainttstemttinjury,ttneuromuscularttdisease,ttopiates,ttortt
ventilatorttdysfunction.
Attthree-week-
old,ttotherwisetthealthy,ttboyttpresentsttforttevaluationttofttprojectilettvomitingt
timmediatelyttafterttbreastfeeding.ttThettpatient'sttmotherttnotesttthattthetttypic
allyttwantstttottbettre-
fedttsoonttafterttvomiting.ttPhysicalttexaminationttrevealsttattfirmttolive-
shapedttmassttinttthettrightttupperttquadrant.ttWhatttisttthettdiagnosticttstudyttoftt
choicettforttyourttsuspectedttdiagnosis?tt-
ttcorrectttanswer✔✔Abdominalttultrasound
PyloricttStenosis
Patientttwillttbett2-8ttweeksttofttage
Nonbiliousttprojectilettvomitingttafterttfeedingttandttearlyttsatiety
PEttwillttshowttRUQttolive-likettmasstt(hypertrophiedttpylorus)
Labsttwillttshowtthypochloremictthypokalemicttmetabolicttalkalosis
,DiagnosisttisttmadettbyttultrasoundttorttUGIttseriestt(stringttsign)
Treatmentttisttsurgical
Att21-year-
oldttwomanttpresentsttforttevaluationttofttbloodyttemesis.ttShettreportsttdrinkin
gttseveralttalcoholicttbeveragestttottcelebratettherttbirthday.ttJustttpriortttottvomi
ting,ttshettnotedttseverettretching.ttWhichttofttthettfollowingttisttthettmostttlikelyt
tdiagnosis?tt-ttcorrectttanswer✔✔Mallory-Weissttsyndrome
Mallory-WeissttSyndrome
Historyttofttdrinkingttalcoholttandttforcefulttvomiting
Hematemesis
Diagnosisttisttmadettbyttupperttendoscopy
Causedttbyttanttincompletetttearttinttthettesophagusttmucosattandttproximalttsto
mach
Followingttanttappendectomy,ttatt20-year-
oldttwomanttdevelopsttwidespreadtturticariattandttpruritusttwithoutttanyttrespir
atory,ttgastrointestinal,ttorttcardiovascularttsymptoms.ttThettlesionsttaretttrans
ientttandttappeartttottmovetttottdifferentttlocationsttonttherttskin.ttShettdeniesttan
yttknownttdrugttallergies.ttShetthadttreceivedttpreoperativettantibioticttprophyl
axisttwithttcefotetanttapproximatelyttonetthourttearlier.ttWhichttofttthettfollowi
ngttisttthettmostttlikelyttexplanationttforttthetturticariattandttpruritus?tt-
ttcorrectttanswer✔✔Allergicttreactiontttottcefotetan
,Urticaria
PE:tttransientttblanching,ttedematousttpapules,ttandttplaques
Etiology:ttIgE-mediatedttreactiontttottanttallergen
Treatment:ttsupportivettcare,ttantihistamines,ttglucocorticoidstt(ifttassociated
ttwithttangioedema)
Whichttofttthettfollowingttisttthettmostttappropriatettnextttinterventionttforttattpa
tientttwithttvaricosettveinsttwhotthasttfailedtttottimprovettwithttconservativetttre
atment?tt-ttcorrectttanswer✔✔Veinttablation
VaricosettVeins
Patientttwillttbettattwoman
Dullttachettinttlegsttafterttprolongedttstanding
PEttwillttshowttdilated,ttelongatedttsubcutaneousttveins
Diagnosisttisttmadettbyttdetailedtthistoryttandttphysicalttexam
Treatmentttisttlegttelevationttandttcompressionttstockings
Att33-year-
oldttwomanttwhottisttobesettpresentsttwithttsuddenttonsetttofttfeverttandttabdomi
nalttpain.ttOnttphysicalttexamttshettisttfoundtttottbettjaundicedttandttherttbloodttpr
essurettistt88/58ttmmttHg.ttShetthasttepigastricttpainttwithttpalpation.ttShettisttfo
undtttotthavettelevatedttliverttenzymesttandttleukocytosis.ttInttadditiontttottadmi
nisteringttbroad-
spectrumttparenteralttantibiotics,ttwhichttofttthettfollowingttinterventionsttisttt
, hettbestttchoicettforttthettsuspectedttdiagnosis?tt-
ttcorrectttanswer✔✔Endoscopicttretrogradettcholangiopancreatography
AcutettCholangitis
Patientttpresentsttwithttrightttupperttquadrantttpain,ttjaundice,ttfevertt(Charcottt
triad)
DiagnosisttisttmadettbyttRUQttultrasound,ttCTttscan,ttorttERCPtt(goldttstandard
)
Mostttcommonlyttcausedttbyttcholedocholithiasisttthatttleadstttottbacterialttinf
ection,ttE.ttcoli
Treatmentttisttantibiotics,ttdefinitivetttreatmentttisttERCPttwithttantibioticsttty
picallyttanttadjunct
Charcottttriadtt+tthypotensionttandttAMStt=ttReynoldsttpentad,ttacutettobstruct
ion
Whichttofttthettfollowingttisttanttindicatorttofttunresectabilityttofttgastricttcance
r?tt-ttcorrectttanswer✔✔Diseasettencasementttofttthetthepaticttartery
Diseasettencasementttofttthetthepaticttarteryttisttconsideredttanttindicatorttofttun
resectabilityttofttgastricttcancer.
Indicatorsttofttunresectabilityttincludettvascularttinvolvementttofttthettaorta,tth
epaticttartery,ttorttproximalttsplenicttartery.
