Surg Dz Exam 3 Review Questions
well answered
A 55 y/o WF is brought to the ER for recurrent episodes of severe RUQ pain that lasts for hours.
US has failed to show any abnormality on previous evaluations. She has a fever of 103.5 F and
appears jaundiced. She is morbidly obese at 295lbs. Which of the following would be the most
appropriate next step? - correct answer ✔✔ERCP
A 60-year-old woman with diabetes, severe congestive heart failure, and emphysema presented
to clinic complaining of occasional right upper quadrant pain, flatulence, and heartburn. She
had been experiencing these symptoms for a year. At the time, her physical examination was
normal, as was her laboratory evaluation. After undergoing an abdominal ultrasound, she was
diagnosed as having chronic cholecystitis, with gallbladder stones and a thickened gallbladder
wall. She was referred to surgery, however, the surgeon determined that she was a poor surgical
candidate. Today she presents to your clinic with the same persistent complaints. What is the
best possible treatment option for this patient? - correct answer ✔✔Ursodeoxycholic acid
A 44 y/o overweight female presents with acute, sharp epigastric pain 2 hours after a large
meal. She vomited once. Which of the following examination finding will most likely be found
on this patient? - correct answer ✔✔Arrested inspiration with deep palpation of the RUQ
(Murphy's sign)
A 54 y/o M with diabetes and PVD presents to ED with c/o RUQ pain for 2 days. On P/E, pt
appears ill. He has hypotension, fever and RUQ pain. Laboratory evaluation reveals leukocytosis
and a bilirubin of 3.0 mg/dl. In addition, AST and ALT levels are 3x ULN. US reveals gas in the
gallbladder. You make a dx of emphysematous cholecystitis? Which of the following is the most
likely infectious agent in this pt? - correct answer ✔✔Clostridium perfringens
What is the most common cause of portal HTN in the US? - correct answer ✔✔Cirrhosis
, What is the endoscopic treatment of choice for esophageal varices? - correct answer
✔✔Banding
EGD of a 65 y/o WM with history of cirrhosis reveals medium sized varices, ~5mm in diameter.
Which of of the following medications is the mainstay of therapy in prevention of primary
variceal bleeding? - correct answer ✔✔Propranolol
The initial diagnosis of cholelithiasis is best made with which of the following imaging
techniques? - correct answer ✔✔US of abdomen
A pt presents with a fever and RUQ pain that has become progressively worse over the last 12
hours. Labs show leukocytosis as well as elevated Bilirubin, AST, ALT and ALP. Abdominal
ultrasound reveals no abnormalities. What would be the next best step? - correct answer
✔✔HIDA scan
A pt presents with a fever and RUQ pain that has become progressively worse of the last 12
hours. Lab show leukocytosis as well as elevated bilirubin, AST, ALT and ALP. Abdominal
ultrasound reveals gallstones, percholecystic fluid and intrahepatic duct dilation. What would be
the definitive treatment for this patient? - correct answer ✔✔Urgent cholecystectomy
Which of the following is the most common presenting symptom of esophageal cancer? -
correct answer ✔✔Dysphagia
An 80 y/o pt presents with a 1-year history of constipation. Workup has been negative. What
management option should be recommended to this patient? - correct answer ✔✔Increased
fluid intake and high fiber diet
Hepatocellular carcinoma has a higher incidence of occurrence when associated with which of
the following disorders? - correct answer ✔✔Cirrhosis
well answered
A 55 y/o WF is brought to the ER for recurrent episodes of severe RUQ pain that lasts for hours.
US has failed to show any abnormality on previous evaluations. She has a fever of 103.5 F and
appears jaundiced. She is morbidly obese at 295lbs. Which of the following would be the most
appropriate next step? - correct answer ✔✔ERCP
A 60-year-old woman with diabetes, severe congestive heart failure, and emphysema presented
to clinic complaining of occasional right upper quadrant pain, flatulence, and heartburn. She
had been experiencing these symptoms for a year. At the time, her physical examination was
normal, as was her laboratory evaluation. After undergoing an abdominal ultrasound, she was
diagnosed as having chronic cholecystitis, with gallbladder stones and a thickened gallbladder
wall. She was referred to surgery, however, the surgeon determined that she was a poor surgical
candidate. Today she presents to your clinic with the same persistent complaints. What is the
best possible treatment option for this patient? - correct answer ✔✔Ursodeoxycholic acid
A 44 y/o overweight female presents with acute, sharp epigastric pain 2 hours after a large
meal. She vomited once. Which of the following examination finding will most likely be found
on this patient? - correct answer ✔✔Arrested inspiration with deep palpation of the RUQ
(Murphy's sign)
A 54 y/o M with diabetes and PVD presents to ED with c/o RUQ pain for 2 days. On P/E, pt
appears ill. He has hypotension, fever and RUQ pain. Laboratory evaluation reveals leukocytosis
and a bilirubin of 3.0 mg/dl. In addition, AST and ALT levels are 3x ULN. US reveals gas in the
gallbladder. You make a dx of emphysematous cholecystitis? Which of the following is the most
likely infectious agent in this pt? - correct answer ✔✔Clostridium perfringens
What is the most common cause of portal HTN in the US? - correct answer ✔✔Cirrhosis
, What is the endoscopic treatment of choice for esophageal varices? - correct answer
✔✔Banding
EGD of a 65 y/o WM with history of cirrhosis reveals medium sized varices, ~5mm in diameter.
Which of of the following medications is the mainstay of therapy in prevention of primary
variceal bleeding? - correct answer ✔✔Propranolol
The initial diagnosis of cholelithiasis is best made with which of the following imaging
techniques? - correct answer ✔✔US of abdomen
A pt presents with a fever and RUQ pain that has become progressively worse over the last 12
hours. Labs show leukocytosis as well as elevated Bilirubin, AST, ALT and ALP. Abdominal
ultrasound reveals no abnormalities. What would be the next best step? - correct answer
✔✔HIDA scan
A pt presents with a fever and RUQ pain that has become progressively worse of the last 12
hours. Lab show leukocytosis as well as elevated bilirubin, AST, ALT and ALP. Abdominal
ultrasound reveals gallstones, percholecystic fluid and intrahepatic duct dilation. What would be
the definitive treatment for this patient? - correct answer ✔✔Urgent cholecystectomy
Which of the following is the most common presenting symptom of esophageal cancer? -
correct answer ✔✔Dysphagia
An 80 y/o pt presents with a 1-year history of constipation. Workup has been negative. What
management option should be recommended to this patient? - correct answer ✔✔Increased
fluid intake and high fiber diet
Hepatocellular carcinoma has a higher incidence of occurrence when associated with which of
the following disorders? - correct answer ✔✔Cirrhosis
