PAEA GENERAL SURGERY END OF ROTATION EXAM –
800+ REAL QUESTIONS & VERIFIED A+ ANSWERS
WITH RATIONALES
What are the 2 conditions under the inflammatory bowel disease umbrella? -
CORRECT ANSWER ✅✅✅1. ulcerative colitis
2. crohn's dz
in comparing ulcerative colitis and crohn's dz, which is:
-limited to the colon w/ rectum always involved *VS* mouth to anus
-transmural *VS* mucosa/submucosa involved
-LLQ *VS* RLQ pain
-bloody diarrhea *VS* non
-complications of perianal dz, strictures, fistulas & granulomas *VS* colon cancer &
toxic megacolon
-colonoscopy showing "skip lesions" & cobblestoning *VS* ulceration &
pseudopolyps
-barium studies showing "stovepipe sign" (loss of haustral markings) *VS* "string
sign" narrowing through scarred areas
-(+)P-ANCA *VS* (+)ASCA (anti saccharomyces cerevisiae Ab)
-curative *VS* noncurative - CORRECT ANSWER ✅✅✅1. *ulcerative colitis*-
colon/rectum, mucosa/submucosa, LLQ pain, bloody diarrhea, comps of colon
cancer & toxic megacolon, colonoscopy w/ ulcerations & pseudopolyps, "stovepipe
sign" (loss of haustral markings), (+)P-ANCA, curative
2. *crohn's dz*- mouth to anus, transmural, RLQ pain, nonbloody diarrhea, comps of
perianal dz, strictures, fistulas, granulomas, "skip lesions" & "cobblestoning", "string
sign", (+)ASCA, noncurative
what are the best studies of choice for ulcerative colitis vs crohn's dz in acute dz? -
CORRECT ANSWER ✅✅✅-UC: *flex sigmoidoscopy* in acute dz (colonoscopy
and barium enema CONTRAINDICATED in acute dz bc can cause perf or toxic
megacolon)
-crohn's dz: *upper GI series* (barium swallow) in acute dz
what medications are used to treat ulcerative colitis and crohn's dz? - CORRECT
ANSWER ✅✅✅1. 5-aminosalicylic acids (anti-inflammatory) *oral mesalamine*
best for maintenance, topical mesalamine (rectal suppositories & enemas),
*sulfasalzine* (give w/ folic acid); *all of these work best in the colon- so are better
for tx'ing UC*
2. *corticosteroids* in *acute flares* only
3. immune modifying agents: 6-mercaptopurine, azathioprine and MTX
4. anti-TNF agents- adalimumab, infliximab certolizumab
barrett's esophagus (from prolonged/untreated GERD) involves transition of
_________ cells to _________ cells (nml to precancerous); what kind of cancer can
,GERD => barrett's turn into? - CORRECT ANSWER ✅✅✅-*squamous*
epithelium to metaplastic *columnar*
-esophageal *adenocarcinoma*
tx for intermittent/mild vs mod/severe GERD - CORRECT ANSWER
✅✅✅besides lifestyle changes (food/drink avoidance, avoiding recumbency, wt
loss, smoking cessation
-int/mild: OTC antacids (tums, MOM, maalox, mylanta) & H2 receptor
antagonists/blockers (ranitidine, cimetidine, famotidine)
-mod/severe: H2RAs, PPIs (omeprazole, esomeprazole, pantoprazole), & prokinetic
agents (cisapride), nissen fundoplication if refractory
DDx for hematemesis - CORRECT ANSWER ✅✅✅MC is *PUD* (gastric >
duodenal), varices, angiodysplasia, masses (adenocarcinoma, polyps), & mallory-
weiss tears
dx/tx? vomiting blood after a night of heavy drinking or in a bulimic pt; what is seen
on EGD? - CORRECT ANSWER ✅✅✅-dx: mallory-weiss syndrome/tears (d/t
sudden rise in intragastric pressure)
-tx: supportive unless severe bleeding may need epi inj, band ligation or balloon
tamponade
-EGD: superficial longitudinal mucosal erosions/lacerations
dx? dysphagia, esophageal webs, IDA, glossitis, angular cheilitis, koilonychias -
CORRECT ANSWER ✅✅✅plummer-vinson syndrome
test of choice is barium swallow
tx: dilation
dx? lower esophageal webs/constrictions at squamocolumnar junctions MC
associated w/ sliding hiatal hernias but also can be s/p corrosive injury - CORRECT
ANSWER ✅✅✅schatzki ring
test of choice is barium sallow
tx: dilation
esophageal varices are MC d/t? tx to prevent rebleeds? - CORRECT ANSWER
✅✅✅-cirrhosis as a complication of portal venous HTN
-long term tx:
1. nonselective BB: *propranolol, nadolol* 1st line (reduces portal pressure) but not
used in acute bleeds bc pt may already be hypovolemic
2. *isosorbide*: long acting nitrate (vasodilator)
tx of an acute esophageal varices bleed? these have a 30-50% mortality rate w/ 1st
bleed and 70% recurrence rate w/i 1st yr! - CORRECT ANSWER ✅✅✅1. 2 large
bore IV lines, IVF, +/- blood transfusion
2. *endoscopic ligation* is tx of choice
3. pharmacologic vasoconstrictors- *octreotide* 1st line (somatostatin analog),
vasopressin
,4. balloon tamponade
5. surgical decompression *TIPS* (transjugular intrahepatic portosystemic shunt)
connects portal vein to hepatic vein to drain to IVC
what is the tx for type I/sliding hiatal hernia vs type II/rolling hiatal hernias? -
CORRECT ANSWER ✅✅✅-type I/sliding: (MC type 95%) tx: none except
manage GERD it causes
-type II/rolling: (paraesophageal) tx: surgical repair to avoid complications
(strangulation)
in comparing squamous cell vs adenocarcinoma of the esophagus, which is:
-MC worldwide (90%) *VS* MC in the US
-MC in upper 1/3 of esophagus *VS* lower 1/3
-RF of untreated GERD/barrett's *VS* tobacco/EtOH use, exposure to noxious
stimuli, AA - CORRECT ANSWER ✅✅✅-squamous cell: MC worldwide (90%),
upper 1/3, RF: tobacco/EtOH use, exposure to noxious stimuli, AA
-adenocarcinoma: MC in US, lower 1/3, RF: untx'd GERD/barrett's
what are the 2 most common causes of gastritis? how are they diagnosed and
treated? - CORRECT ANSWER ✅✅✅1. H. pylori MC- stool antigen or urea
breath test; tx: triple therapy: "CAP" *clarithromycin + amoxicillin + PPI* or
metronidazole if PCN allergic; if macrolide resistance suspected do quad therapy:
PPI + bismuth subsalicylate + tetracycline + metronidazole
2. NSAIDs/ASA- clinically dx but EGD gold std; tx: acid suppression (PPI, H2RA,
antacids)
is a *gastric* or *duodenal* ulcer more associated with relief of epigastric pain
(dyspepsia) with eating? which type always needs a Bx and endoscopic monitoring
2-3 mos later to r/o malignancy and document healing? - CORRECT ANSWER
✅✅✅-duodenal ulcer (area becomes more basic when you eat in preparation for
acid/food later on); these are 4x more common that GUs
-gastric ulcer bc higher risk of malignancy
PPIs block the _______ pump of the ________ cell reducing acid secretion; taken
_____ min before meals and can result in diarrhea, HA, hypomagnesemia, _____
deficiency, and hypocalcemia; which PPI causes CP450 inhibition? - CORRECT
ANSWER ✅✅✅-H/K ATPase pump
-parietal cells
-30 min
-B12 deficiency
-omeprazole causes CP450 inhibition (can inc levels of theophyllin, warfarin,
phenytoin, etc.)
which H2RA/H2 blocker causes CP450 inhibition (can inc levels of theophyllin,
warfarn, phenytoin, etc.) and can also cause anti-androgen s/e (gynecomastia,
impotence, dec libido)? - CORRECT ANSWER ✅✅✅cimetidine/Tagamet
, what PUD tx is best for treating NSAID induced ulcers because it is a prostaglandin
E1 analog that increases bicarb & mucus secretion? what pts is this drug
contraindicated in? - CORRECT ANSWER ✅✅✅-misoprostol
-CI: premenopausal women bc abortifacent and causes cervical ripening
what PUD treatments are cytoprotective (forms viscous adhesive ulcer coating that
promotes healing and protects stomach mucosa)? what s/e can they have? -
CORRECT ANSWER ✅✅✅-bismuth compounds (pepto-bismol, kaopectate):
also antibacterial; s/e: darkening of stool/tongue, constipation
-sucralfate/Carafate: s/e: may reduce bioavailability of H2RA
what is the MC type of gastric carcinoma? risk factors? s/sx? tx? - CORRECT
ANSWER ✅✅✅-*adenocarcinoma* MC (90%)
-stomach is MC site of extranodal non-hodgkin lymphoma
-RF: *H. pylori*, foods containing nitrites/nitrates
-s/sx: dyspepsia, wt loss, early satiety, IDA, supraclavicular LN (virchows), umbilical
LN (sister mary joseph's)
-tx: gastrectomy, chemo, XRT (prognosis poor)
what are the 5 F's of RF for cholelithiasis? - CORRECT ANSWER ✅✅✅-fat
-fair
-female
-forty
-fertile
what medicine can be used to dissolve gallstones in symptomatic cholelithiasis pts? -
CORRECT ANSWER ✅✅✅ursodeoxycholic acid (Ursodiol) -but elective
cholecystectomy usually done
-in nonsymptomatic pts: observation
choledocholithiasis is a gallstones stuck in the __________ duct whereas
cholelithiasis is stuck in the __________ duct - CORRECT ANSWER ✅✅✅-
choledocholithiasis: common bile duct
-cholelithiasis: cystic duct
what is the tx for choledocholithiasis? - CORRECT ANSWER ✅✅✅-ERCP w/
stone extraction (diagnostic and therapeutic)
what are the s/sx's in charcot's triad and reynold's pentad for acute cholangitis? -
CORRECT ANSWER ✅✅✅charcot's triad:
1. fever/chills
2. RUQ pain
3. jaudice
reynold's pentad:
4. shock/hypotension
5. AMS
800+ REAL QUESTIONS & VERIFIED A+ ANSWERS
WITH RATIONALES
What are the 2 conditions under the inflammatory bowel disease umbrella? -
CORRECT ANSWER ✅✅✅1. ulcerative colitis
2. crohn's dz
in comparing ulcerative colitis and crohn's dz, which is:
-limited to the colon w/ rectum always involved *VS* mouth to anus
-transmural *VS* mucosa/submucosa involved
-LLQ *VS* RLQ pain
-bloody diarrhea *VS* non
-complications of perianal dz, strictures, fistulas & granulomas *VS* colon cancer &
toxic megacolon
-colonoscopy showing "skip lesions" & cobblestoning *VS* ulceration &
pseudopolyps
-barium studies showing "stovepipe sign" (loss of haustral markings) *VS* "string
sign" narrowing through scarred areas
-(+)P-ANCA *VS* (+)ASCA (anti saccharomyces cerevisiae Ab)
-curative *VS* noncurative - CORRECT ANSWER ✅✅✅1. *ulcerative colitis*-
colon/rectum, mucosa/submucosa, LLQ pain, bloody diarrhea, comps of colon
cancer & toxic megacolon, colonoscopy w/ ulcerations & pseudopolyps, "stovepipe
sign" (loss of haustral markings), (+)P-ANCA, curative
2. *crohn's dz*- mouth to anus, transmural, RLQ pain, nonbloody diarrhea, comps of
perianal dz, strictures, fistulas, granulomas, "skip lesions" & "cobblestoning", "string
sign", (+)ASCA, noncurative
what are the best studies of choice for ulcerative colitis vs crohn's dz in acute dz? -
CORRECT ANSWER ✅✅✅-UC: *flex sigmoidoscopy* in acute dz (colonoscopy
and barium enema CONTRAINDICATED in acute dz bc can cause perf or toxic
megacolon)
-crohn's dz: *upper GI series* (barium swallow) in acute dz
what medications are used to treat ulcerative colitis and crohn's dz? - CORRECT
ANSWER ✅✅✅1. 5-aminosalicylic acids (anti-inflammatory) *oral mesalamine*
best for maintenance, topical mesalamine (rectal suppositories & enemas),
*sulfasalzine* (give w/ folic acid); *all of these work best in the colon- so are better
for tx'ing UC*
2. *corticosteroids* in *acute flares* only
3. immune modifying agents: 6-mercaptopurine, azathioprine and MTX
4. anti-TNF agents- adalimumab, infliximab certolizumab
barrett's esophagus (from prolonged/untreated GERD) involves transition of
_________ cells to _________ cells (nml to precancerous); what kind of cancer can
,GERD => barrett's turn into? - CORRECT ANSWER ✅✅✅-*squamous*
epithelium to metaplastic *columnar*
-esophageal *adenocarcinoma*
tx for intermittent/mild vs mod/severe GERD - CORRECT ANSWER
✅✅✅besides lifestyle changes (food/drink avoidance, avoiding recumbency, wt
loss, smoking cessation
-int/mild: OTC antacids (tums, MOM, maalox, mylanta) & H2 receptor
antagonists/blockers (ranitidine, cimetidine, famotidine)
-mod/severe: H2RAs, PPIs (omeprazole, esomeprazole, pantoprazole), & prokinetic
agents (cisapride), nissen fundoplication if refractory
DDx for hematemesis - CORRECT ANSWER ✅✅✅MC is *PUD* (gastric >
duodenal), varices, angiodysplasia, masses (adenocarcinoma, polyps), & mallory-
weiss tears
dx/tx? vomiting blood after a night of heavy drinking or in a bulimic pt; what is seen
on EGD? - CORRECT ANSWER ✅✅✅-dx: mallory-weiss syndrome/tears (d/t
sudden rise in intragastric pressure)
-tx: supportive unless severe bleeding may need epi inj, band ligation or balloon
tamponade
-EGD: superficial longitudinal mucosal erosions/lacerations
dx? dysphagia, esophageal webs, IDA, glossitis, angular cheilitis, koilonychias -
CORRECT ANSWER ✅✅✅plummer-vinson syndrome
test of choice is barium swallow
tx: dilation
dx? lower esophageal webs/constrictions at squamocolumnar junctions MC
associated w/ sliding hiatal hernias but also can be s/p corrosive injury - CORRECT
ANSWER ✅✅✅schatzki ring
test of choice is barium sallow
tx: dilation
esophageal varices are MC d/t? tx to prevent rebleeds? - CORRECT ANSWER
✅✅✅-cirrhosis as a complication of portal venous HTN
-long term tx:
1. nonselective BB: *propranolol, nadolol* 1st line (reduces portal pressure) but not
used in acute bleeds bc pt may already be hypovolemic
2. *isosorbide*: long acting nitrate (vasodilator)
tx of an acute esophageal varices bleed? these have a 30-50% mortality rate w/ 1st
bleed and 70% recurrence rate w/i 1st yr! - CORRECT ANSWER ✅✅✅1. 2 large
bore IV lines, IVF, +/- blood transfusion
2. *endoscopic ligation* is tx of choice
3. pharmacologic vasoconstrictors- *octreotide* 1st line (somatostatin analog),
vasopressin
,4. balloon tamponade
5. surgical decompression *TIPS* (transjugular intrahepatic portosystemic shunt)
connects portal vein to hepatic vein to drain to IVC
what is the tx for type I/sliding hiatal hernia vs type II/rolling hiatal hernias? -
CORRECT ANSWER ✅✅✅-type I/sliding: (MC type 95%) tx: none except
manage GERD it causes
-type II/rolling: (paraesophageal) tx: surgical repair to avoid complications
(strangulation)
in comparing squamous cell vs adenocarcinoma of the esophagus, which is:
-MC worldwide (90%) *VS* MC in the US
-MC in upper 1/3 of esophagus *VS* lower 1/3
-RF of untreated GERD/barrett's *VS* tobacco/EtOH use, exposure to noxious
stimuli, AA - CORRECT ANSWER ✅✅✅-squamous cell: MC worldwide (90%),
upper 1/3, RF: tobacco/EtOH use, exposure to noxious stimuli, AA
-adenocarcinoma: MC in US, lower 1/3, RF: untx'd GERD/barrett's
what are the 2 most common causes of gastritis? how are they diagnosed and
treated? - CORRECT ANSWER ✅✅✅1. H. pylori MC- stool antigen or urea
breath test; tx: triple therapy: "CAP" *clarithromycin + amoxicillin + PPI* or
metronidazole if PCN allergic; if macrolide resistance suspected do quad therapy:
PPI + bismuth subsalicylate + tetracycline + metronidazole
2. NSAIDs/ASA- clinically dx but EGD gold std; tx: acid suppression (PPI, H2RA,
antacids)
is a *gastric* or *duodenal* ulcer more associated with relief of epigastric pain
(dyspepsia) with eating? which type always needs a Bx and endoscopic monitoring
2-3 mos later to r/o malignancy and document healing? - CORRECT ANSWER
✅✅✅-duodenal ulcer (area becomes more basic when you eat in preparation for
acid/food later on); these are 4x more common that GUs
-gastric ulcer bc higher risk of malignancy
PPIs block the _______ pump of the ________ cell reducing acid secretion; taken
_____ min before meals and can result in diarrhea, HA, hypomagnesemia, _____
deficiency, and hypocalcemia; which PPI causes CP450 inhibition? - CORRECT
ANSWER ✅✅✅-H/K ATPase pump
-parietal cells
-30 min
-B12 deficiency
-omeprazole causes CP450 inhibition (can inc levels of theophyllin, warfarin,
phenytoin, etc.)
which H2RA/H2 blocker causes CP450 inhibition (can inc levels of theophyllin,
warfarn, phenytoin, etc.) and can also cause anti-androgen s/e (gynecomastia,
impotence, dec libido)? - CORRECT ANSWER ✅✅✅cimetidine/Tagamet
, what PUD tx is best for treating NSAID induced ulcers because it is a prostaglandin
E1 analog that increases bicarb & mucus secretion? what pts is this drug
contraindicated in? - CORRECT ANSWER ✅✅✅-misoprostol
-CI: premenopausal women bc abortifacent and causes cervical ripening
what PUD treatments are cytoprotective (forms viscous adhesive ulcer coating that
promotes healing and protects stomach mucosa)? what s/e can they have? -
CORRECT ANSWER ✅✅✅-bismuth compounds (pepto-bismol, kaopectate):
also antibacterial; s/e: darkening of stool/tongue, constipation
-sucralfate/Carafate: s/e: may reduce bioavailability of H2RA
what is the MC type of gastric carcinoma? risk factors? s/sx? tx? - CORRECT
ANSWER ✅✅✅-*adenocarcinoma* MC (90%)
-stomach is MC site of extranodal non-hodgkin lymphoma
-RF: *H. pylori*, foods containing nitrites/nitrates
-s/sx: dyspepsia, wt loss, early satiety, IDA, supraclavicular LN (virchows), umbilical
LN (sister mary joseph's)
-tx: gastrectomy, chemo, XRT (prognosis poor)
what are the 5 F's of RF for cholelithiasis? - CORRECT ANSWER ✅✅✅-fat
-fair
-female
-forty
-fertile
what medicine can be used to dissolve gallstones in symptomatic cholelithiasis pts? -
CORRECT ANSWER ✅✅✅ursodeoxycholic acid (Ursodiol) -but elective
cholecystectomy usually done
-in nonsymptomatic pts: observation
choledocholithiasis is a gallstones stuck in the __________ duct whereas
cholelithiasis is stuck in the __________ duct - CORRECT ANSWER ✅✅✅-
choledocholithiasis: common bile duct
-cholelithiasis: cystic duct
what is the tx for choledocholithiasis? - CORRECT ANSWER ✅✅✅-ERCP w/
stone extraction (diagnostic and therapeutic)
what are the s/sx's in charcot's triad and reynold's pentad for acute cholangitis? -
CORRECT ANSWER ✅✅✅charcot's triad:
1. fever/chills
2. RUQ pain
3. jaudice
reynold's pentad:
4. shock/hypotension
5. AMS
