SurgeryEORExamPAEasyexamwith
correctanswers
A54-year-old manpresentstotheemergencydepartmentwithcrampyabdominal pain,nausea,and
vomiting.Thepatienthasnotpassedgasorhadabowelmovementforatleast10hours.On
examination,theabdomenisdistendedandtherearehigh-pitchedbowelsoundswithrushes.Aplain
radiographoftheabdomenrevealscecaldistensionto12cm.Whatisthemostappropriatedefinitive
managementforthispatient?
A
Intravenousfluids
B
Nasogastricsuction
C
Observation
D
Surgicalexploration-correct answer✔✔TheCorrectAnsweris:D
Massive distentionofthececum,asdetectedonplainradiograph,istypicallyseenin"closedloop"
obstructions wheretheileocecalvalveiscompetent.Whendistentionapproaches12cm,thereisan
increasedrisk ofperforationand/organgrene.Expedientsurgical interventionisindicated.Although
observation withintravenousfluidsandnasogastricdecompression areimportantadjunctsto
management,surgical explorationistheonlywaytorapidlyaddressthisemergentsituation.
Whenaboneisfractured, therearethe3stagesofhealing.Whatistheproperorderinwhichthehealing
occurs?
A
Inflammatory,Remodeling,Reparative
B
Inflammatory,Reparative,Remodeling
,C
Remodeling, Inflammatory,Reparative
D
Remodeling, Reparative,Inflammatory
E
Reparative,Inflammatory,Remodeling-correct answer✔✔TheCorrectAnsweris:B
Inflammatorychangeshappenafterfracturesandthisisfollowedbyareparative phaseandultimately,
aremodelingphase.Thehealingfromacuteinjuriesgenerallystartswithinflammation,.Oncethe
integrityofthebonehasbeenrestoredonthemacrolevel,boneremodelingcontinuesuntilfullhealing
hasoccurred.
Whatisthemostcommonembolic sourceofacutearterialocclusioninthelowerextremities?
A
Atrialfibrillation
B
Aorticaneurysm
C
Myocardialinfarction
D
Prostheticcardiacvalve
E
Iliacarterythrombus-correct answer✔✔TheCorrectAnsweris:A
Theheartaccountsfor80%ofallemboli,withatrialfibrillationmakingup70%ofthat.Aortic aneurysms
arefrequentlylinedwiththrombusbutinfrequentlyembolize;aneurysmaldisease onlyaccountsfor
6%ofallacutearterialocclusion.Acutemyocardialinfarction(especiallythoseassociatedwithleft
ventricular thrombus)accountsfor25%ofcardioembolism, withperipheral embolizationoftenthe
firstsignofapreviously"silent"MI.Prostheticcardiacvalvesmakeupastillsmallbutincreasingly
prevalentsourceofemboli.Peripheralarterialthrombi accountforonly3%ofacuteocclusion.
,Followingemergentappendectomy,a58-year-old obesemaledevelopsatemperature of102.4˚F, 18
hourspostoperatively.Hisrespiratoryrateis26andhispulseis116bpm.Aphysicalexamreveals
scatteredfinerales.Whatisthemostlikelydiagnosis?
A
Atelectasis
B
Aspirationpneumonitis
C
Pleural effusion
D
Pneumonia
E
Pulmonaryembolus-correct answer✔✔TheCorrectAnsweris:A
Pulmonaryalveolicollapse,alsoknownasatelectasis, occursduringoperativeproceduresforavariety
ofreasons,includingdecreasedclearance ofsecretionsanddecreasedintra-alveolar pressure.
Postoperatively,oftenduetopain,patientsmaynotmobilize secretionsappropriately,also
contributingtoatelectasis.Atelectasisisthemostcommonpostoperativepulmonarycomplication,
andisoftenassociatedwithemergentandprolongedsurgeries,especiallythoseofthethoraxand
abdomen.Atelectasisisassociatedwithfever,anincreasedrespiratoryrate,anincreasedpulse,and
lungexamfindingsrangingfromnormal toralesanddecreasedbreathsounds.Symptomsusually
presentwithinthefirst48hourspostoperatively.Pulmonaryaspirationpneumonitis,although
possible,islesslikelyduetoappropriatepreoperative andintraoperativemeasuresbeingutilizedto
decreaserisk.Pneumoniaisalsoacommonpostoperative complication,duetothesamecontributing
factorsasatelectasis.Physicalexamfindingsmayalsobesimilar.However,postoperative pneumoniais
likelytobecomeevidentbetween24and96hourspostoperatively.
Duringapre-surgical workup,apatientreportsthatshehadreceivedDesmopressinfollowingthebirth
ofherson.HerCBCiswithinnormal range,aswellasherPTandaPTT.Whatisthemostlikelycauseofher
needingthismedication?
A
Alloimmunizationfollowingvaginaldelivery
, B
Hemolytic anemia
C
Irondeficiencyanemia
D
Thalassemia
E
VonWillebrand's disease -correct answer✔✔TheCorrectAnsweris:E
Desmopressin isthemainstayoftherapyforpeople withvonWillebrand's disease.Hemolytic anemia,
irondeficiencyanemia,andthalassemiawouldallhaveabnormal findingsontheCBC.Allo
immunization doesnotrequiredesmopressin therapy.
Whatabsolutetissuepressure generallyisusedasaguideline fordiagnosingcompartmentsyndrome?
A
10mmHg
B
20mmHg
C
30mmHg
D
40mmHg
E
50mmHg-correct answer✔✔TheCorrectAnsweris:C
Manytraumasurgeryservices useanabsolutetissue pressureofapproximately30mmHgasthe
thresholdfordiagnosingcompartmentsyndrome.Basedontheentireclinicalpicture,patientswith
numbersinthatrangeorhigherwill likelyrequiresurgical decompressionwithafasciotomy,while
lowernumberswillprobablybemanagedwithamoreconservative approach.
correctanswers
A54-year-old manpresentstotheemergencydepartmentwithcrampyabdominal pain,nausea,and
vomiting.Thepatienthasnotpassedgasorhadabowelmovementforatleast10hours.On
examination,theabdomenisdistendedandtherearehigh-pitchedbowelsoundswithrushes.Aplain
radiographoftheabdomenrevealscecaldistensionto12cm.Whatisthemostappropriatedefinitive
managementforthispatient?
A
Intravenousfluids
B
Nasogastricsuction
C
Observation
D
Surgicalexploration-correct answer✔✔TheCorrectAnsweris:D
Massive distentionofthececum,asdetectedonplainradiograph,istypicallyseenin"closedloop"
obstructions wheretheileocecalvalveiscompetent.Whendistentionapproaches12cm,thereisan
increasedrisk ofperforationand/organgrene.Expedientsurgical interventionisindicated.Although
observation withintravenousfluidsandnasogastricdecompression areimportantadjunctsto
management,surgical explorationistheonlywaytorapidlyaddressthisemergentsituation.
Whenaboneisfractured, therearethe3stagesofhealing.Whatistheproperorderinwhichthehealing
occurs?
A
Inflammatory,Remodeling,Reparative
B
Inflammatory,Reparative,Remodeling
,C
Remodeling, Inflammatory,Reparative
D
Remodeling, Reparative,Inflammatory
E
Reparative,Inflammatory,Remodeling-correct answer✔✔TheCorrectAnsweris:B
Inflammatorychangeshappenafterfracturesandthisisfollowedbyareparative phaseandultimately,
aremodelingphase.Thehealingfromacuteinjuriesgenerallystartswithinflammation,.Oncethe
integrityofthebonehasbeenrestoredonthemacrolevel,boneremodelingcontinuesuntilfullhealing
hasoccurred.
Whatisthemostcommonembolic sourceofacutearterialocclusioninthelowerextremities?
A
Atrialfibrillation
B
Aorticaneurysm
C
Myocardialinfarction
D
Prostheticcardiacvalve
E
Iliacarterythrombus-correct answer✔✔TheCorrectAnsweris:A
Theheartaccountsfor80%ofallemboli,withatrialfibrillationmakingup70%ofthat.Aortic aneurysms
arefrequentlylinedwiththrombusbutinfrequentlyembolize;aneurysmaldisease onlyaccountsfor
6%ofallacutearterialocclusion.Acutemyocardialinfarction(especiallythoseassociatedwithleft
ventricular thrombus)accountsfor25%ofcardioembolism, withperipheral embolizationoftenthe
firstsignofapreviously"silent"MI.Prostheticcardiacvalvesmakeupastillsmallbutincreasingly
prevalentsourceofemboli.Peripheralarterialthrombi accountforonly3%ofacuteocclusion.
,Followingemergentappendectomy,a58-year-old obesemaledevelopsatemperature of102.4˚F, 18
hourspostoperatively.Hisrespiratoryrateis26andhispulseis116bpm.Aphysicalexamreveals
scatteredfinerales.Whatisthemostlikelydiagnosis?
A
Atelectasis
B
Aspirationpneumonitis
C
Pleural effusion
D
Pneumonia
E
Pulmonaryembolus-correct answer✔✔TheCorrectAnsweris:A
Pulmonaryalveolicollapse,alsoknownasatelectasis, occursduringoperativeproceduresforavariety
ofreasons,includingdecreasedclearance ofsecretionsanddecreasedintra-alveolar pressure.
Postoperatively,oftenduetopain,patientsmaynotmobilize secretionsappropriately,also
contributingtoatelectasis.Atelectasisisthemostcommonpostoperativepulmonarycomplication,
andisoftenassociatedwithemergentandprolongedsurgeries,especiallythoseofthethoraxand
abdomen.Atelectasisisassociatedwithfever,anincreasedrespiratoryrate,anincreasedpulse,and
lungexamfindingsrangingfromnormal toralesanddecreasedbreathsounds.Symptomsusually
presentwithinthefirst48hourspostoperatively.Pulmonaryaspirationpneumonitis,although
possible,islesslikelyduetoappropriatepreoperative andintraoperativemeasuresbeingutilizedto
decreaserisk.Pneumoniaisalsoacommonpostoperative complication,duetothesamecontributing
factorsasatelectasis.Physicalexamfindingsmayalsobesimilar.However,postoperative pneumoniais
likelytobecomeevidentbetween24and96hourspostoperatively.
Duringapre-surgical workup,apatientreportsthatshehadreceivedDesmopressinfollowingthebirth
ofherson.HerCBCiswithinnormal range,aswellasherPTandaPTT.Whatisthemostlikelycauseofher
needingthismedication?
A
Alloimmunizationfollowingvaginaldelivery
, B
Hemolytic anemia
C
Irondeficiencyanemia
D
Thalassemia
E
VonWillebrand's disease -correct answer✔✔TheCorrectAnsweris:E
Desmopressin isthemainstayoftherapyforpeople withvonWillebrand's disease.Hemolytic anemia,
irondeficiencyanemia,andthalassemiawouldallhaveabnormal findingsontheCBC.Allo
immunization doesnotrequiredesmopressin therapy.
Whatabsolutetissuepressure generallyisusedasaguideline fordiagnosingcompartmentsyndrome?
A
10mmHg
B
20mmHg
C
30mmHg
D
40mmHg
E
50mmHg-correct answer✔✔TheCorrectAnsweris:C
Manytraumasurgeryservices useanabsolutetissue pressureofapproximately30mmHgasthe
thresholdfordiagnosingcompartmentsyndrome.Basedontheentireclinicalpicture,patientswith
numbersinthatrangeorhigherwill likelyrequiresurgical decompressionwithafasciotomy,while
lowernumberswillprobablybemanagedwithamoreconservative approach.
