Rosh Surgery Exam questions and
answers graded A+
Pt presents for a chronic nonproductive cough, chest pain, fatigue, and weight loss. She denies
any history of tobacco use. A chest radiograph reveals bilateral hilar adenopathy with symmetric
enlargement of the hila. Serum angiotensin-converting enzyme levels are ordered and found to
be elevated. What is the most likely diagnosis? - correct answer ✔✔Sarcoidosis
What is the best therapy for an ascending aortic dissection? - correct answer ✔✔Emergent
open surgical repair
*descending can usually be treated medically
Why must the preoperative preparation for surgical resection of a patient with a diagnosed
pheochromocytoma involve propranolol initiation after a 10-14 day course of
phenoxybenzamine? - correct answer ✔✔To avoid unopposed alpha-adrenergic stimulation
What type of diet are patients started on during the alpha-adrenergic blockade preoperative
preparation for pheochromocytoma resection? - correct answer ✔✔High-sodium diet
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? - correct answer ✔✔Sacrum (b/c
nonambulatory, otherwise peripheral and periorbital edema)
A 78-year-old man undergoes laparoscopic surgery for a small bowel obstruction. Which
metabolic disturbance is he most at risk for postoperatively? - correct answer ✔✔Metabolic
alkalosis (third spacing of fluid into peritoneal cavity and postop NG tube decompression causes
acid loss)
,What is the pathophysiology behind a contraction alkalosis? - correct answer ✔✔Losses of large
volumes of fluids high in sodium and low in bicarbonate.
A 46-year-old man presents to the emergency department reporting abdominal pain, bloating,
nausea, anorexia, and vomiting. His symptoms have been worsening since onset three days ago.
His last bowel movement was four days ago, but he continues to pass flatus. What test has the
highest sensitivity for confirming the most likely diagnosis? - correct answer ✔✔Abdominal CT
with contrast
What is the most common cause of large bowel obstruction in adults? - correct answer ✔✔A
malignant tumor
Which of the following is appropriate initial treatment for uncomplicated symptomatic Crohn's
disease? - correct answer ✔✔Immunosuppressant therapy (mesalamine)
Parents bring their previously healthy four-week-old boy to the ED due to repeated "projectile
vomiting" immediately after he nurses for the past 24 hours. The parents report the emesis
looks just like breast milk. He has had a normal pattern of wet diapers. The parents deny any
rectal bleeding. He has not had any difficulty nursing before, and attempts at burping him have
not brought any relief. Vital signs include a temperature of 98.8°F. Physical exam reveals an
alert, crying infant with a small, firm right upper quadrant mass. Blood analysis is within normal
limits. What is the best dx imaging for this patient? - correct answer ✔✔Transabdominal
ultrasound (shows thickened pylorus or target sign)
What is the most common cause of polycythemia, an increased red blood cell count? - correct
answer ✔✔Hypoxia due to pulmonary disease
A 31-year-old man presents to the emergency department after an episode of syncope
following sexual intercourse. Upon regaining consciousness at home, patient began complaining
of a severe headache and started to vomit. Physical examination reveals an uncomfortable man
with positive meningeal signs. Blood pressure is 162/94 mm Hg. CT scan of the head without
, contrast reveals no acute pathology. Based on the most likely diagnosis, what would you expect
on the patient's lumbar puncture? - correct answer ✔✔Hemoglobin degradation products
(xanthochromia) d/t subarachnoid hemorrhage
What medication is given in patients with subarachnoid hemorrhage to prevent vasospasm and
subsequent mortality? - correct answer ✔✔Nimodipine or Nicardipine
A 54-year-old man presents to the clinic complaining of difficulty swallowing food for the past
two years, which has been gradually worsening. He has no problem swallowing liquids. He has
had uncontrolled gastroesophageal reflux for several years. He has no history of tobacco use
and has not had any head or neck radiation therapy. What is the best initial test for this patient?
- correct answer ✔✔Upper endoscopy (Esophageal or peptic stricture)
Which gastrointestinal procedure is often associated with the development of acute
pancreatitis? - correct answer ✔✔Endoscopic retrograde cholangiopancreatography (ERCP).
A 76-year-old man with a history of diabetes mellitus and hyperlipidemia presents to the
emergency room with a sudden onset of epigastric pain 48 hours ago. Now he is experiencing
intractable nausea, vomiting, and fever beginning 12 hours prior to arrival. Physical examination
reveals marked tenderness and guarding in the epigastrium, poor turgor, hypotension,
tachycardia, and a temperature of 101.3°F. Laboratory results show amylase of 301 U/L and
lipase of 1186 U/L. CT scan of the abdomen is pending. Based on the patient's expected
diagnosis, what findings would be consistent with his most likely diagnosis? - correct answer
✔✔Ecchymosis of the flanks
What two pleural and serum laboratory values are part of Light's criteria? - correct answer
✔✔Lactate dehydrogenase and protein:
Exudative if:
- pleural:serum protein > 0.5
- pleural:serum LDH > 0.6
- pleural fluid LDH > 2/3 UNL
answers graded A+
Pt presents for a chronic nonproductive cough, chest pain, fatigue, and weight loss. She denies
any history of tobacco use. A chest radiograph reveals bilateral hilar adenopathy with symmetric
enlargement of the hila. Serum angiotensin-converting enzyme levels are ordered and found to
be elevated. What is the most likely diagnosis? - correct answer ✔✔Sarcoidosis
What is the best therapy for an ascending aortic dissection? - correct answer ✔✔Emergent
open surgical repair
*descending can usually be treated medically
Why must the preoperative preparation for surgical resection of a patient with a diagnosed
pheochromocytoma involve propranolol initiation after a 10-14 day course of
phenoxybenzamine? - correct answer ✔✔To avoid unopposed alpha-adrenergic stimulation
What type of diet are patients started on during the alpha-adrenergic blockade preoperative
preparation for pheochromocytoma resection? - correct answer ✔✔High-sodium diet
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? - correct answer ✔✔Sacrum (b/c
nonambulatory, otherwise peripheral and periorbital edema)
A 78-year-old man undergoes laparoscopic surgery for a small bowel obstruction. Which
metabolic disturbance is he most at risk for postoperatively? - correct answer ✔✔Metabolic
alkalosis (third spacing of fluid into peritoneal cavity and postop NG tube decompression causes
acid loss)
,What is the pathophysiology behind a contraction alkalosis? - correct answer ✔✔Losses of large
volumes of fluids high in sodium and low in bicarbonate.
A 46-year-old man presents to the emergency department reporting abdominal pain, bloating,
nausea, anorexia, and vomiting. His symptoms have been worsening since onset three days ago.
His last bowel movement was four days ago, but he continues to pass flatus. What test has the
highest sensitivity for confirming the most likely diagnosis? - correct answer ✔✔Abdominal CT
with contrast
What is the most common cause of large bowel obstruction in adults? - correct answer ✔✔A
malignant tumor
Which of the following is appropriate initial treatment for uncomplicated symptomatic Crohn's
disease? - correct answer ✔✔Immunosuppressant therapy (mesalamine)
Parents bring their previously healthy four-week-old boy to the ED due to repeated "projectile
vomiting" immediately after he nurses for the past 24 hours. The parents report the emesis
looks just like breast milk. He has had a normal pattern of wet diapers. The parents deny any
rectal bleeding. He has not had any difficulty nursing before, and attempts at burping him have
not brought any relief. Vital signs include a temperature of 98.8°F. Physical exam reveals an
alert, crying infant with a small, firm right upper quadrant mass. Blood analysis is within normal
limits. What is the best dx imaging for this patient? - correct answer ✔✔Transabdominal
ultrasound (shows thickened pylorus or target sign)
What is the most common cause of polycythemia, an increased red blood cell count? - correct
answer ✔✔Hypoxia due to pulmonary disease
A 31-year-old man presents to the emergency department after an episode of syncope
following sexual intercourse. Upon regaining consciousness at home, patient began complaining
of a severe headache and started to vomit. Physical examination reveals an uncomfortable man
with positive meningeal signs. Blood pressure is 162/94 mm Hg. CT scan of the head without
, contrast reveals no acute pathology. Based on the most likely diagnosis, what would you expect
on the patient's lumbar puncture? - correct answer ✔✔Hemoglobin degradation products
(xanthochromia) d/t subarachnoid hemorrhage
What medication is given in patients with subarachnoid hemorrhage to prevent vasospasm and
subsequent mortality? - correct answer ✔✔Nimodipine or Nicardipine
A 54-year-old man presents to the clinic complaining of difficulty swallowing food for the past
two years, which has been gradually worsening. He has no problem swallowing liquids. He has
had uncontrolled gastroesophageal reflux for several years. He has no history of tobacco use
and has not had any head or neck radiation therapy. What is the best initial test for this patient?
- correct answer ✔✔Upper endoscopy (Esophageal or peptic stricture)
Which gastrointestinal procedure is often associated with the development of acute
pancreatitis? - correct answer ✔✔Endoscopic retrograde cholangiopancreatography (ERCP).
A 76-year-old man with a history of diabetes mellitus and hyperlipidemia presents to the
emergency room with a sudden onset of epigastric pain 48 hours ago. Now he is experiencing
intractable nausea, vomiting, and fever beginning 12 hours prior to arrival. Physical examination
reveals marked tenderness and guarding in the epigastrium, poor turgor, hypotension,
tachycardia, and a temperature of 101.3°F. Laboratory results show amylase of 301 U/L and
lipase of 1186 U/L. CT scan of the abdomen is pending. Based on the patient's expected
diagnosis, what findings would be consistent with his most likely diagnosis? - correct answer
✔✔Ecchymosis of the flanks
What two pleural and serum laboratory values are part of Light's criteria? - correct answer
✔✔Lactate dehydrogenase and protein:
Exudative if:
- pleural:serum protein > 0.5
- pleural:serum LDH > 0.6
- pleural fluid LDH > 2/3 UNL
