Rosh Surgery Exam UPDATED ACTUAL Questions and CORRECT Answers
1. Pt presents for a chronic nonproductive cough, chest Sarcoidosis
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?
2. What is the best therapy for an ascending aortic dis- Emergent open surgical
section? repair
*descending can usually
be treated medically
3. Why must the preoperative preparation for surgical To avoid unopposed al-
resection of a patient with a diagnosed pheochromo- pha-adrenergic stimula-
cytoma involve propranolol initiation after a 10-14 day tion
course of phenoxybenzamine?
4. What type of diet are patients started on during the High-sodium diet
alpha-adrenergic blockade preoperative preparation
for pheochromocytoma resection?
5. A 60-year-old man has been bedridden following a Sacrum (b/c nonambula-
stroke several months ago. Urinalysis shows high lev- tory, otherwise peripheral
els of protein in the urine and nephrotic syndrome and periorbital edema)
is suspected. On physical exam, where would the
provider likely detect edema?
6. A 78-year-old man undergoes laparoscopic surgery Metabolic alkalosis (third
for a small bowel obstruction. Which metabolic distur- spacing of fluid into peri-
bance is he most at risk for postoperatively? toneal cavity and postop
, NG tube decompression
causes acid loss)
7. What is the pathophysiology behind a contraction al- Losses of large volumes of
kalosis? fluids high in sodium and
low in bicarbonate.
8. A 46-year-old man presents to the emergency de- Abdominal CT with con-
partment reporting abdominal pain, bloating, nau- trast
sea, 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?
9. What is the most common cause of large bowel ob- A malignant tumor
struction in adults?
10. Which of the following is appropriate initial treatment Immunosuppressant ther-
for uncomplicated symptomatic Crohn's disease? apy (mesalamine)
11. Parents bring their previously healthy four-week-old Transabdominal ultra-
boy to the ED due to repeated "projectile vomiting" sound (shows thickened
immediately after he nurses for the past 24 hours. pylorus or target sign)
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?
, 12. What is the most common cause of polycythemia, an Hypoxia due to pulmonary
increased red blood cell count? disease
13. A 31-year-old man presents to the emergency depart- Hemoglobin degradation
ment after an episode of syncope following sexual products (xanthochromia)
intercourse. Upon regaining consciousness at home, d/t subarachnoid hemor-
patient began complaining of a severe headache and rhage
started to vomit. Physical examination reveals an un-
comfortable man with positive meningeal signs. Blood
pressure is 162/94 mm Hg. CT scan of the head with-
out contrast reveals no acute pathology. Based on the
most likely diagnosis, what would you expect on the
patient's lumbar puncture?
14. What medication is given in patients with subarach- Nimodipine or Nicardip-
noid hemorrhage to prevent vasospasm and subse- ine
quent mortality?
15. A 54-year-old man presents to the clinic complaining of Upper endoscopy
difficulty swallowing food for the past two years, which (Esophageal or peptic
has been gradually worsening. He has no problem stricture)
swallowing liquids. He has had uncontrolled gastroe-
sophageal 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?
16. Which gastrointestinal procedure is often associated Endoscopic retro-
with the development of acute pancreatitis? grade cholangiopancre-
atography (ERCP).
17. Ecchymosis of the flanks
1. Pt presents for a chronic nonproductive cough, chest Sarcoidosis
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?
2. What is the best therapy for an ascending aortic dis- Emergent open surgical
section? repair
*descending can usually
be treated medically
3. Why must the preoperative preparation for surgical To avoid unopposed al-
resection of a patient with a diagnosed pheochromo- pha-adrenergic stimula-
cytoma involve propranolol initiation after a 10-14 day tion
course of phenoxybenzamine?
4. What type of diet are patients started on during the High-sodium diet
alpha-adrenergic blockade preoperative preparation
for pheochromocytoma resection?
5. A 60-year-old man has been bedridden following a Sacrum (b/c nonambula-
stroke several months ago. Urinalysis shows high lev- tory, otherwise peripheral
els of protein in the urine and nephrotic syndrome and periorbital edema)
is suspected. On physical exam, where would the
provider likely detect edema?
6. A 78-year-old man undergoes laparoscopic surgery Metabolic alkalosis (third
for a small bowel obstruction. Which metabolic distur- spacing of fluid into peri-
bance is he most at risk for postoperatively? toneal cavity and postop
, NG tube decompression
causes acid loss)
7. What is the pathophysiology behind a contraction al- Losses of large volumes of
kalosis? fluids high in sodium and
low in bicarbonate.
8. A 46-year-old man presents to the emergency de- Abdominal CT with con-
partment reporting abdominal pain, bloating, nau- trast
sea, 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?
9. What is the most common cause of large bowel ob- A malignant tumor
struction in adults?
10. Which of the following is appropriate initial treatment Immunosuppressant ther-
for uncomplicated symptomatic Crohn's disease? apy (mesalamine)
11. Parents bring their previously healthy four-week-old Transabdominal ultra-
boy to the ED due to repeated "projectile vomiting" sound (shows thickened
immediately after he nurses for the past 24 hours. pylorus or target sign)
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?
, 12. What is the most common cause of polycythemia, an Hypoxia due to pulmonary
increased red blood cell count? disease
13. A 31-year-old man presents to the emergency depart- Hemoglobin degradation
ment after an episode of syncope following sexual products (xanthochromia)
intercourse. Upon regaining consciousness at home, d/t subarachnoid hemor-
patient began complaining of a severe headache and rhage
started to vomit. Physical examination reveals an un-
comfortable man with positive meningeal signs. Blood
pressure is 162/94 mm Hg. CT scan of the head with-
out contrast reveals no acute pathology. Based on the
most likely diagnosis, what would you expect on the
patient's lumbar puncture?
14. What medication is given in patients with subarach- Nimodipine or Nicardip-
noid hemorrhage to prevent vasospasm and subse- ine
quent mortality?
15. A 54-year-old man presents to the clinic complaining of Upper endoscopy
difficulty swallowing food for the past two years, which (Esophageal or peptic
has been gradually worsening. He has no problem stricture)
swallowing liquids. He has had uncontrolled gastroe-
sophageal 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?
16. Which gastrointestinal procedure is often associated Endoscopic retro-
with the development of acute pancreatitis? grade cholangiopancre-
atography (ERCP).
17. Ecchymosis of the flanks
