ROSH General surgery UPDATED ACTUAL Questions and CORRECT
Answers
1. Which of the following medications can be used in the C
treatment of hemodynamically stable atrial fibrillation
with concomitant Wolff-Parkinson-White syndrome?
all of the other options
AAdenosine are all AV nodal block-
B Diltiazem ing agents and should be
C Ibutilide avoided in patients with
DMetoprolol preexcited atrial fibrilla-
tion. Blocking the AV node
can promote and enhance
conduction down the ac-
cessory pathway, which
can deteriorate into an
unstable rhythm such as
ventricular tachycardia or
ventricular fibrillation.
2. Triad for Wolff-parkinson white syndrome (EKG char- 1. Slurred upstroke of QRS
acteristics) (delta wave)
2. shortened PR interval
3. Wide QRS
3. A 45-year-old man with a past medical history sig- C
nificant for obesity, status post partial gastrectomy,
returns to the clinic following a recent barium swal- Paraesophageal hiatal
low study for complaints of abdominal pressure and hernias can be asympto-
fullness. Results from the study show displacement matic, but may also be
of the gastroesophageal junction and herniation of a associated with epigastric
portion of the gastric fundus into the thoracic cavity. or postprandial fullness,
Which of the following is the most likely diagnosis? nausea, and vomiting.
Less commonly, they can
A. Esophageal motility disorder be associated with gas-
, B. Esophagitis troesophageal reflux dis-
C. Paraesophageal hiatus hernia ease (GERD) symptoms
D. Sliding hiatus hernia
Tx: Fundoplication (Nec-
essary if volvulus of stom-
ach occurs)
4. An elderly man with a history of atrial fibrillation pre- C
sents with sudden onset of severe periumbilical pain
that is out of proportion to physical examination. A CT
scan will most likely show lack of flow in which visceral
vessel?
A. Celiac trunk
B. Inferior mesenteric artery
C. Superior mesenteric artery
D. Superior mesenteric vein
5. A 65-year-old man with hypertension presents to the B
clinic complaining of worsening shortness of breath
with physical exertion for the past two weeks. He has
no history of chronic lung disease. He denies chest
discomfort and palpitations. Vital signs include heart
rate 78 beats per minute, blood pressure 134/84 mm
Hg, temperature 98.8°F, pulse oxygenation 93%, and
20 respirations per minute. Exam reveals an obese
man, bibasilar lung crackles, normal heart sounds,
and 1+ pitting edema in both ankles. Which of the
following is the best next step?
a. Duplex ultrasonography of the lower extremities
b. Echocardiogram
, c. Helical chest computed tomography
d. Thoracentesis
6. Aside from infection, what is a serious complication of Malignancy such as squa-
chronic venous ulcers? mous cell carcinoma.
7. An 84-year-old man presents to the clinic with an ulcer A.
on his left medial malleolus. The 1.5 cm ulcer has
an irregular shape and well-defined borders, and no wound care for ve-
purulence is noted. The skin surrounding the ulcer nous ulcers involves a
is firm, dry, and pruritic. He has bilateral peripheral zinc impregnated gauze
edema and hyperpigmentation at his ankles and feet. wrapped around the low-
The hyperpigmentation does not change with leg el- er extremity and then
evation. Aside from venous duplex ultrasonography, wrapped with coband to
which of the following tests is also recommended be- provide compression. this
fore initiating the treatment for this patient's most compression can be detri-
likely condition? mental to those with arte-
rial disease, so ABI is rec-
A. Ankle-brachial index ommended before tx
B. Microcirculation assessment
C. Venous plethysmographyYour Answer
D. Wound biopsy
8. 56-year-old woman with stage IV breast cancer pre- C
sents to the emergency department complaining of
dyspnea and cough that started one hour ago. She
was first diagnosed with breast cancer five years ago
and had a lumpectomy with adjuvant radiation. She
was diagnosed with metastatic disease six months
ago. She also has a history of hypertension, hypothy-
roidism, and gastroesophageal reflux disease. Her
pulse is 102, blood pressure is 115/76 mm Hg, respi-
ratory rate is 16, and temperature is 98.3°F. Which of
, the following is the most likely diagnosis?
a. Community-acquired pneumonia
b. Congestive heart failure
c. Pulmonary embolism
d. Radiation pneumonitis
9. Which of the following is appropriate initial treatment C
for uncomplicated symptomatic Crohn's disease?
A. Antibiotic treatment
B. Chemotherapy
C. Immunosuppressant therapy
D. Watchful waiting
10. A 65-year-old woman presents for her annual physical B
to her primary care physician. She has a history of re-
current urinary tract infections and has a 30 pack-year
smoking history. She has worked in a textile factory
for 40 years. With her increased risk, what is the most
common symptom of bladder cancer that would ne-
cessitate further investigation?
a. Fever
b. Hematuria
c. Suprapubic pain
d. Weight loss
11. What is the gold standard for diagnosing and staging Cystoscopy with biopsy.
of bladder cancer?
12. A 43-year-old woman presents to the clinic with three D
days of severe right upper quadrant pain with radi-
Answers
1. Which of the following medications can be used in the C
treatment of hemodynamically stable atrial fibrillation
with concomitant Wolff-Parkinson-White syndrome?
all of the other options
AAdenosine are all AV nodal block-
B Diltiazem ing agents and should be
C Ibutilide avoided in patients with
DMetoprolol preexcited atrial fibrilla-
tion. Blocking the AV node
can promote and enhance
conduction down the ac-
cessory pathway, which
can deteriorate into an
unstable rhythm such as
ventricular tachycardia or
ventricular fibrillation.
2. Triad for Wolff-parkinson white syndrome (EKG char- 1. Slurred upstroke of QRS
acteristics) (delta wave)
2. shortened PR interval
3. Wide QRS
3. A 45-year-old man with a past medical history sig- C
nificant for obesity, status post partial gastrectomy,
returns to the clinic following a recent barium swal- Paraesophageal hiatal
low study for complaints of abdominal pressure and hernias can be asympto-
fullness. Results from the study show displacement matic, but may also be
of the gastroesophageal junction and herniation of a associated with epigastric
portion of the gastric fundus into the thoracic cavity. or postprandial fullness,
Which of the following is the most likely diagnosis? nausea, and vomiting.
Less commonly, they can
A. Esophageal motility disorder be associated with gas-
, B. Esophagitis troesophageal reflux dis-
C. Paraesophageal hiatus hernia ease (GERD) symptoms
D. Sliding hiatus hernia
Tx: Fundoplication (Nec-
essary if volvulus of stom-
ach occurs)
4. An elderly man with a history of atrial fibrillation pre- C
sents with sudden onset of severe periumbilical pain
that is out of proportion to physical examination. A CT
scan will most likely show lack of flow in which visceral
vessel?
A. Celiac trunk
B. Inferior mesenteric artery
C. Superior mesenteric artery
D. Superior mesenteric vein
5. A 65-year-old man with hypertension presents to the B
clinic complaining of worsening shortness of breath
with physical exertion for the past two weeks. He has
no history of chronic lung disease. He denies chest
discomfort and palpitations. Vital signs include heart
rate 78 beats per minute, blood pressure 134/84 mm
Hg, temperature 98.8°F, pulse oxygenation 93%, and
20 respirations per minute. Exam reveals an obese
man, bibasilar lung crackles, normal heart sounds,
and 1+ pitting edema in both ankles. Which of the
following is the best next step?
a. Duplex ultrasonography of the lower extremities
b. Echocardiogram
, c. Helical chest computed tomography
d. Thoracentesis
6. Aside from infection, what is a serious complication of Malignancy such as squa-
chronic venous ulcers? mous cell carcinoma.
7. An 84-year-old man presents to the clinic with an ulcer A.
on his left medial malleolus. The 1.5 cm ulcer has
an irregular shape and well-defined borders, and no wound care for ve-
purulence is noted. The skin surrounding the ulcer nous ulcers involves a
is firm, dry, and pruritic. He has bilateral peripheral zinc impregnated gauze
edema and hyperpigmentation at his ankles and feet. wrapped around the low-
The hyperpigmentation does not change with leg el- er extremity and then
evation. Aside from venous duplex ultrasonography, wrapped with coband to
which of the following tests is also recommended be- provide compression. this
fore initiating the treatment for this patient's most compression can be detri-
likely condition? mental to those with arte-
rial disease, so ABI is rec-
A. Ankle-brachial index ommended before tx
B. Microcirculation assessment
C. Venous plethysmographyYour Answer
D. Wound biopsy
8. 56-year-old woman with stage IV breast cancer pre- C
sents to the emergency department complaining of
dyspnea and cough that started one hour ago. She
was first diagnosed with breast cancer five years ago
and had a lumpectomy with adjuvant radiation. She
was diagnosed with metastatic disease six months
ago. She also has a history of hypertension, hypothy-
roidism, and gastroesophageal reflux disease. Her
pulse is 102, blood pressure is 115/76 mm Hg, respi-
ratory rate is 16, and temperature is 98.3°F. Which of
, the following is the most likely diagnosis?
a. Community-acquired pneumonia
b. Congestive heart failure
c. Pulmonary embolism
d. Radiation pneumonitis
9. Which of the following is appropriate initial treatment C
for uncomplicated symptomatic Crohn's disease?
A. Antibiotic treatment
B. Chemotherapy
C. Immunosuppressant therapy
D. Watchful waiting
10. A 65-year-old woman presents for her annual physical B
to her primary care physician. She has a history of re-
current urinary tract infections and has a 30 pack-year
smoking history. She has worked in a textile factory
for 40 years. With her increased risk, what is the most
common symptom of bladder cancer that would ne-
cessitate further investigation?
a. Fever
b. Hematuria
c. Suprapubic pain
d. Weight loss
11. What is the gold standard for diagnosing and staging Cystoscopy with biopsy.
of bladder cancer?
12. A 43-year-old woman presents to the clinic with three D
days of severe right upper quadrant pain with radi-
