COMAT Surgery Examination
Questions And Correct Answers
(Verified Answers) Plus Rationales
2026 Q&A | Instant Download Pdf
1. A 68-year-old man presents with sudden severe abdominal pain
that began 2 hours ago. He has a history of atrial fibrillation and is
not taking anticoagulation. Examination reveals diffuse abdominal
tenderness with guarding and rebound. Serum lactate is elevated.
CT angiography demonstrates an occlusion of the superior
mesenteric artery. Which intervention is most appropriate?
A. Colonoscopic decompression
B. Observation with serial abdominal examinations
C. Urgent revascularization with exploratory laparotomy as
indicated
D. Elective mesenteric angioplasty after stabilization
Answer: C. Urgent revascularization with exploratory laparotomy
as indicated
Rationale: Acute mesenteric ischemia caused by superior mesenteric
artery embolism is a surgical emergency. Revascularization should be
performed promptly, with laparotomy when peritonitis or suspected
bowel necrosis is present. Delay increases mortality because
irreversible intestinal ischemia can develop rapidly.
2. A 24-year-old woman presents with right lower-quadrant
abdominal pain, anorexia, nausea, and low-grade fever.
Examination reveals McBurney point tenderness and a positive
, psoas sign. CT demonstrates an enlarged appendix with
periappendiceal inflammatory changes but no abscess or
perforation. What is the definitive treatment?
A. Laparoscopic appendectomy
B. Right hemicolectomy
C. Percutaneous drainage
D. Total parenteral nutrition
Answer: A. Laparoscopic appendectomy
Rationale: In uncomplicated acute appendicitis, laparoscopic
appendectomy is a standard definitive treatment. Antibiotics may be
used in selected patients, but operative management provides definitive
source control and prevents recurrent appendicitis.
3. A 72-year-old woman presents with progressive abdominal
distention, vomiting, and constipation. She has undergone multiple
previous abdominal surgeries. CT shows dilated small-bowel loops
with a transition point but no evidence of bowel ischemia or
perforation. What is the initial management?
A. Immediate total colectomy
B. Nasogastric decompression, IV fluids, electrolyte correction, and
close observation
C. Colonoscopy with biopsy
D. Immediate laparotomy in every case
Answer: B. Nasogastric decompression, IV fluids, electrolyte
correction, and close observation
Rationale: Adhesive small-bowel obstruction without signs of
strangulation, ischemia, perforation, or peritonitis can initially be
managed nonoperatively. Treatment includes bowel rest, nasogastric
,decompression, intravenous fluid replacement, electrolyte correction,
and serial examinations. Surgery is required if conservative
management fails or complications develop.
4. A 56-year-old man develops fever, left lower-quadrant pain, and
leukocytosis. CT demonstrates sigmoid diverticulitis with a 5-cm
pericolic abscess. He is hemodynamically stable without
generalized peritonitis. What is the preferred management?
A. Immediate total colectomy
B. Oral laxatives alone
C. Emergency colonoscopy
D. Percutaneous drainage with appropriate antibiotics
Answer: D. Percutaneous drainage with appropriate antibiotics
Rationale: A sizable diverticular abscess, particularly one greater than
approximately 3–4 cm, is generally treated with image-guided
percutaneous drainage combined with antibiotics when technically
feasible. Generalized peritonitis or failure of nonoperative
management requires operative source control.
5. A 45-year-old woman undergoes elective laparoscopic
cholecystectomy for symptomatic gallstones. During surgery, the
surgeon identifies Calot triangle anatomy. Which structure is
normally clipped and divided as part of the procedure?
A. Common hepatic artery
B. Cystic duct
C. Portal vein
D. Common hepatic duct
Answer: B. Cystic duct
, Rationale: During laparoscopic cholecystectomy, the cystic duct and
cystic artery are identified within the hepatocystic triangle and divided
after the critical view of safety is established. Injury to the common
bile duct or major vascular structures is a serious complication that
must be avoided.
6. A 39-year-old woman presents with episodic right-upper-quadrant
pain after fatty meals. Ultrasound demonstrates multiple gallstones
without gallbladder wall thickening or pericholecystic fluid. She
has no fever or leukocytosis. What is the most appropriate
treatment?
A. Elective laparoscopic cholecystectomy
B. Emergent laparotomy
C. Endoscopic sphincterotomy alone
D. Long-term nasogastric suction
Answer: A. Elective laparoscopic cholecystectomy
Rationale: This patient has symptomatic cholelithiasis causing biliary
colic. Definitive treatment is elective laparoscopic cholecystectomy.
Asymptomatic gallstones generally do not require surgery, but
recurrent biliary symptoms are an indication for elective removal.
7. A 63-year-old man presents with fever, jaundice, and right-upper-
quadrant abdominal pain. Laboratory studies reveal leukocytosis
and elevated bilirubin. Ultrasound demonstrates common bile duct
dilation and gallstones. He becomes hypotensive despite initial
fluid resuscitation. What is the most appropriate next step for
biliary decompression?
A. Elective cholecystectomy several weeks later without drainage
B. Observation until bilirubin normalizes
Questions And Correct Answers
(Verified Answers) Plus Rationales
2026 Q&A | Instant Download Pdf
1. A 68-year-old man presents with sudden severe abdominal pain
that began 2 hours ago. He has a history of atrial fibrillation and is
not taking anticoagulation. Examination reveals diffuse abdominal
tenderness with guarding and rebound. Serum lactate is elevated.
CT angiography demonstrates an occlusion of the superior
mesenteric artery. Which intervention is most appropriate?
A. Colonoscopic decompression
B. Observation with serial abdominal examinations
C. Urgent revascularization with exploratory laparotomy as
indicated
D. Elective mesenteric angioplasty after stabilization
Answer: C. Urgent revascularization with exploratory laparotomy
as indicated
Rationale: Acute mesenteric ischemia caused by superior mesenteric
artery embolism is a surgical emergency. Revascularization should be
performed promptly, with laparotomy when peritonitis or suspected
bowel necrosis is present. Delay increases mortality because
irreversible intestinal ischemia can develop rapidly.
2. A 24-year-old woman presents with right lower-quadrant
abdominal pain, anorexia, nausea, and low-grade fever.
Examination reveals McBurney point tenderness and a positive
, psoas sign. CT demonstrates an enlarged appendix with
periappendiceal inflammatory changes but no abscess or
perforation. What is the definitive treatment?
A. Laparoscopic appendectomy
B. Right hemicolectomy
C. Percutaneous drainage
D. Total parenteral nutrition
Answer: A. Laparoscopic appendectomy
Rationale: In uncomplicated acute appendicitis, laparoscopic
appendectomy is a standard definitive treatment. Antibiotics may be
used in selected patients, but operative management provides definitive
source control and prevents recurrent appendicitis.
3. A 72-year-old woman presents with progressive abdominal
distention, vomiting, and constipation. She has undergone multiple
previous abdominal surgeries. CT shows dilated small-bowel loops
with a transition point but no evidence of bowel ischemia or
perforation. What is the initial management?
A. Immediate total colectomy
B. Nasogastric decompression, IV fluids, electrolyte correction, and
close observation
C. Colonoscopy with biopsy
D. Immediate laparotomy in every case
Answer: B. Nasogastric decompression, IV fluids, electrolyte
correction, and close observation
Rationale: Adhesive small-bowel obstruction without signs of
strangulation, ischemia, perforation, or peritonitis can initially be
managed nonoperatively. Treatment includes bowel rest, nasogastric
,decompression, intravenous fluid replacement, electrolyte correction,
and serial examinations. Surgery is required if conservative
management fails or complications develop.
4. A 56-year-old man develops fever, left lower-quadrant pain, and
leukocytosis. CT demonstrates sigmoid diverticulitis with a 5-cm
pericolic abscess. He is hemodynamically stable without
generalized peritonitis. What is the preferred management?
A. Immediate total colectomy
B. Oral laxatives alone
C. Emergency colonoscopy
D. Percutaneous drainage with appropriate antibiotics
Answer: D. Percutaneous drainage with appropriate antibiotics
Rationale: A sizable diverticular abscess, particularly one greater than
approximately 3–4 cm, is generally treated with image-guided
percutaneous drainage combined with antibiotics when technically
feasible. Generalized peritonitis or failure of nonoperative
management requires operative source control.
5. A 45-year-old woman undergoes elective laparoscopic
cholecystectomy for symptomatic gallstones. During surgery, the
surgeon identifies Calot triangle anatomy. Which structure is
normally clipped and divided as part of the procedure?
A. Common hepatic artery
B. Cystic duct
C. Portal vein
D. Common hepatic duct
Answer: B. Cystic duct
, Rationale: During laparoscopic cholecystectomy, the cystic duct and
cystic artery are identified within the hepatocystic triangle and divided
after the critical view of safety is established. Injury to the common
bile duct or major vascular structures is a serious complication that
must be avoided.
6. A 39-year-old woman presents with episodic right-upper-quadrant
pain after fatty meals. Ultrasound demonstrates multiple gallstones
without gallbladder wall thickening or pericholecystic fluid. She
has no fever or leukocytosis. What is the most appropriate
treatment?
A. Elective laparoscopic cholecystectomy
B. Emergent laparotomy
C. Endoscopic sphincterotomy alone
D. Long-term nasogastric suction
Answer: A. Elective laparoscopic cholecystectomy
Rationale: This patient has symptomatic cholelithiasis causing biliary
colic. Definitive treatment is elective laparoscopic cholecystectomy.
Asymptomatic gallstones generally do not require surgery, but
recurrent biliary symptoms are an indication for elective removal.
7. A 63-year-old man presents with fever, jaundice, and right-upper-
quadrant abdominal pain. Laboratory studies reveal leukocytosis
and elevated bilirubin. Ultrasound demonstrates common bile duct
dilation and gallstones. He becomes hypotensive despite initial
fluid resuscitation. What is the most appropriate next step for
biliary decompression?
A. Elective cholecystectomy several weeks later without drainage
B. Observation until bilirubin normalizes
