General Surgery Rosh Review Questions And Answers Complete Study Solutions

A 14-year-old girl presents for evaluation of suspected appendicitis. She experiences pain in the right lower quadrant with palpation of the left lower quadrant. What is this called? - Answer-Rovsing's sign A 21-year-old woman presents for evaluation of bloody emesis. She admits to drinking several alcoholic beverages to celebrate her birthday. Just prior to vomiting, she noted severe retching. Which of the following is the most likely diagnosis? - Answer-Mallory-Weiss Syndrome A 32-year-old woman presents to the office with a concerning skin lesion. The lesion is biopsied and she is diagnosed with melanoma that is less than 1 mm in thickness. Which of the following is the next best step in caring for this patient? - Answer-a. Wide excision with a 1 cm margin of normal tissue b. If melanoma is >1mm thick then needs wide excision with 2cm margin of normal A 35-year-old woman is having a preoperative evaluation in clinic. Preoperative blood analysis reveals a hemoglobin 6.2 g/dL, hematocrit 18%, platelets 210 x 109/L. The patient mentions that she has been anemic on and off for several years which was always attributed to her heavy menstrual periods. She has no previous surgical history. She does not take any medications. A few of her male and female family members have required blood transfusions after routine surgery. Which of the following tests is most likely to reveal the correct diagnosis? - Answer-Von Willebrand factor antigen (common heritable disorder) A 35-year-old woman presents to the clinic with palpitations, tremors, and diffuse sweating. Which of the following is used in the diagnosis of hyperthyroidism? - Answer-TSH level A 50-year-old man presents to the emergency department with diffuse abdominal pain and obstipation. Imaging reveals high-grade small bowel obstruction. The patient is admitted to the hospital, however, fails to improve with medical management. He is taken to the operating room for exploratory laparotomy with lysis of adhesions. Postoperatively, the patient is tachycardic and hypotensive with low urine output. Hemoglobin is 12 g/dL. Lactic acid is 4 mmol/L. Which of the following is the most likely diagnosis? - Answer-Hypovolemic shock A 50-year-old woman presents to the emergency department with sudden onset of a pruritic rash located on her back and arms. She denies associated symptoms or recent illnesses. Physical exam reveals several dry, raised erythematous lesions with central clearing. Lesions vary in size and shape. Which of the following is the most likely diagnosis? - Answer-Urticaria (same characteristics)A 53-year-old overweight man presents to the outpatient clinic with recurrent burning abdominal pain that occurs two to three hours after a meal. Which of the following would be the most frequent physical examination finding in this patient? - Answer-Epigastric tenderness A 55-year-old with an abdominal mass is diagnosed with a cortisol-secreting adrenocortical carcinoma. He is immediately referred for surgical resection. Which of the following medications is the best choice to be administered immediately after surgery to prevent hypotension? - Answer-Hydrocortisone (prevents sudden drop in serum cortisol levels that causes low BP) A 60-year-old man has been bedridden following a stroke several months ago. Urinalysis shows high levels of protein in the urine and nephrotic syndrome is suspected. On physical exam, where would the provider likely detect edema? - Answer-Sacrum (patient has been bedridden) A 60-year-old man presents to his primary care provider with the complaint of feeling lightheaded and dizzy when he stands. The patient is currently prescribed hydrocortisone and fludrocortisone for treatment of adrenal insufficiency, doxazosin for treatment of urinary symptoms from enlarged prostate, and erythropoietin for anemia due to renal failure. What is the most appropriate treatment to decrease his orthostatic hypotension symptoms? - Answer-Discontinue doxazosin (alpha-adrenergic antagonist can cause orthostatic hypotension) A 64-year-old man presents to the clinic complaining of worsening fatigue over the past six months despite no change in his sleep habits. He denies diet changes and states he has been well-hydrated from all the ice that he eats. Physical exam reveals skin pallor and koilonychia. Which of the following is the most likely diagnosis? - Answer-Iron-deficiency anemia