ROSH REVIEW General Surgery Exam Questions With Verified Answers.

ROSH REVIEW General Surgery Exam Questions With Verified Answers. A 24-year-old woman presents to the clinic for preoperative evaluation for a scheduled right anterior cruciate ligament repair. Preoperative clearance was requested by the surgeon secondary to the patient complaining of chest pain. Review of systems is positive 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. Which of the following is the most likely diagnosis? - answerSarcoidosis Which of the following options is the best therapy for an ascending aortic dissection? - answerEmergent surgical repair 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? - answerTo avoid unopposed alpha-adrenergic receptor stimulation 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? - answerSacrum (peripheral and periorbital edema are commonly seen in patients with nephrotic syndrome caused by sodium retention and hypoalbuminemia; lab shows proteinuria > 3.5g/day) A 78-year-old man undergoes laparoscopic surgery for a small bowel obstruction. Which metabolic disturbance is he most at risk for postoperatively? - answerMetabolic alkalosis A 30-year-old woman presents to the outpatient clinic for follow-up on her total thyroidectomy performed six weeks ago. Her incision is well-healed, and there are no signs of infection. The patient does complain of feeling cold, despite others around her being warm, fatigue, and weight gain. She has remained on levothyroxine 100 mcg by mouth once daily. Serum thyroid- stimulating hormone was performed prior to the appointment and was found to be elevated. Which of the following is the most likely diagnosis? - answerHypothyroidism 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. Which of the following tests has the highest sensitivity for confirming the most likely diagnosis? - answerAbdominal CT w/ contrast Which of the following is appropriate initial treatment for uncomplicated symptomatic Crohn's disease? - answerImmunosuppressant therapy 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. Which of the following choices is the best next step for this patient? - answerOrder transabdominal ultrasound A 66-year-old man with hypertension and type II diabetes mellitus presents to the ED complaining of chest tightness, dyspnea, and dizziness while mowing his lawn earlier that day. He had similar symptoms two weeks ago. His symptoms resolved within a couple of minutes of sitting to rest. He is currently pain-free. Vital signs are pulse 88 beats per minute, blood pressure 134/88 mm Hg, temperature 98.8°F, oxygen saturation 97%, and 20 respirations per minute. Exam reveals an obese man in no acute distress and is otherwise unremarkable. Electrocardiogram is obtained and shown above. Which of the following is the most likely diagnosis? - answerAngina pectoris You are evaluating a 48-year-old woman with right lower extremity swelling, pain, and redness. She is eight days status-post open cholecystectomy. She was on lovenox for two days postoperatively but is not currently taking any medications except oxycodone for pain. What is the test of choice to confirm your suspected diagnosis? - answerVenous doppler ultrasound Which of the following is a physical exam finding characterized by pain and inspiratory arrest during palpation of the right upper quadrant? - answerMurphy's sign A 66-year-old woman with a past medical history of uncontrolled diabetes mellitus, obesity, and rheumatoid arthritis who is on methotrexate presents to the emergency department complaining of redness, drainage, and pain at her incision site. She had an umbilical hernia repair approximately six days prior. On exam, you note the patient has a fever of 100.6°F and the incision site is erythematous and warm with a small amount of purulent drainage noted. There are no signs of wound dehiscence and no areas of fluctuance noted. Which of the following is the most likely diagnosis? - answerCellulitis Which of the following blood analysis tests is indicated to diagnose anemia? - answerComplete blood count Which of the following physical exam findings is more indicative of skin abscess than cellulitis? - answerFluctuance 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? - answerHemoglobin degradation products (xanthochromia from subarachnoid hemorrhage; tx includes supportive and nimodipine) 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. Which of the following is the best initial test for this patient? - answerUpper endoscopy (esophageal strictures) A 32-year-old man presents to the outpatient clinic for follow-up regarding his hypertension. Despite the use of three antihypertensive agents, he remains hypertensive. He also has episodes of nonexertional palpitations, diaphoresis, and headache. He recently completed a 24-hour urinary fractionated metanephrines test, which was positive. A computed tomography of the abdomen and pelvis is done and reveals a 5 cm tumor of the right adrenal gland. Which of the following is the most appropriate next step in management? - answerPhenoxybenzamine Which of the following is a confirmatory test for cholecystitis? - answerCholescintigraphy scan (aka HIDA scan) 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, which of the following findings would be consistent with his most likely diagnosis? - answerEcchymosis of the flanks (Grey Turner sign) An obese 68-year-old woman with hypertension is admitted to the hospital due to acute hypoxia. She is a lifelong nonsmoker with no history of lung disease. A chest radiograph reveals a moderate pleural effusion. Which of the following is the best next step in the management of this patient? - answerThoracentesis (pleural effusion, decreased breath sounds, dullness to percussion, decreased tactile fremitus) A 20-year-old man presents to the clinic with a chief complaint of dyspnea and chest pain that began spontaneously six hours ago while playing basketball. He has never smoked, takes no medications, and has no family history of cardiovascular or pulmonary diseases. His vital signs are as follows: heart rate 112 beats per minute, respiratory rate 24 breaths per minute, blood pressure 114/68 mm Hg. He is six feet tall and weighs 165 pounds. On physical exam, the left upper lung field has diminished breath sounds and is hyperresonant to percussion. There are no other abnormalities noted. What is the best initial test to confirm the diagnosis? - answerChest XR (pneumothorax, will show absence of lung markings along perophery) A 64-year-old man presents to the clinic complaining of worsening fatigue over the past six months despite no change in his sleep habits. He