General Surgery End of Rotation Exam
Questions With Complete Solutions
An nn18-year-old nnpatient nnhas nna nntibia/fibula nnfracture nnfollowing nna nnmotorcycle nncrash. nnTwelve nnhours
nnlater nnthe nnpatient nnpresents nnwith nnincreased nnpain nndespite nnadequate nndoses nnof nnanalgesics nnand
nnimmobilization. nnWhich nnof nnthe nnfollowing nnis nnthe nnmost nnlikely nndiagnosis?
A nnavascular nnnecrosis
B nnmyositis nnossificans
C nncompartment nnsyndrome
D nnreflex nnsympathetic nndystrophy nn- nnANSWER: nn✔ nnC
Compartment nnsyndrome nnis nncharacterized nnby nna nnpathological nnincrease nnof nnpressure nnwithin nna nnclosed
nnspace nnand nnresults nnfrom nnedema nnor nnbleeding nnwithin nnthe nncompartment. nnIt nnmay nnoccur nnas nnan
nnearly nnlocal nncomplication nnof nnfracture.
A nn38 nnyear-old nnmale nnsustained nna nnfracture nnof nnthe nnleft nndistal nntibia nnfollowing nna nn25-foot nnfall nnand nnis
nntaken nnto nnthe nnoperating nnroom nnfor nnan nnopen nnreduction nninternal nnfixation nnof nnthe nndistal nntibia.
nnSixteen nnhours nnpost-op, nnthe nnpatient nndevelops nnsustained nnpain, nnwhich nnis nnnot nnrelieved nnwith
nnnarcotics. nnOn nnpassive nnrange nnof nnmotion nnof nnthe nntoes nnthe nnpatient nn"yells" nnin nnagony. nnThe nnpatient
nnalso nnstates nnthat nnthe nntop nnof nnhis nnfoot nnhas nndecreased nnsensation. nnOn nnphysical nnexamination nnthe
nnphysician nnassistant nnnotes nnthat nnthe nnleg nnis nnswollen nnand nnthe nnfoot nnis nncool nnto nntouch. nnBased nnupon
nnthis nninformation nnwhat nndiagnostic nntesting nnshould nnbe nndone?
A nnX-ray nnof nnthe nnlower nnleg nnand nnankle
B nnDoppler nnstudies
C nnBone nnscan.
D nnCompartment nnpressure nn- nnANSWER: nn✔ nnD
Compartmental nnpressures nnshould nnbe nnobtained nnas nnsoon nnas nnpossible. nnIf nnthey nnare nnelevated nnthis nnis
nna nnsurgical nnemergency.
,A nn35 nnyear-old nnmale nnplaced nnin nna nnthumb nnspica nncast nnfor nna nnscaphoid nnfracture nnpresents
nncomplaining nnof nnforearm nnand nnhand nnpain nnthat nnis nnnot nnrelieved nnwith nnpain nnmedication nnand
nnelevation. nnWhich nnof nnthe nnfollowing nnis nnthe nnearliest nnphysical nnexam nnsign nnfor nnhis nncurrent
nncondition?
A nnSlow nncapillary nnrefill
B nnLoss nnof nntwo-point nndiscrimination
C nnAbsent nnperipheral nnpulses
D nnPain nnwith nnpassive nnstretch. nn- nnANSWER: nn✔ nnB
Loss nnof nntwo-point nndiscrimination nncan nnbe nnthe nnearliest nnsign nnof nncompartment nnsyndrome.
25 nnyear-old nnmale nnpresents nnto nnthe nnED nnwith nnleft nncalf nnpain nnand nncramping, nnas nnwell nnas nnnausea
nnand nnvomiting. nnHe nnadmits nnto nn"partying nnwith nncocaine nnall nnnight". nnHe nndescribes nnhis nnurine nnas nna
nndark nnbrown nncolor. nnSerum nncreatinine nnkinase nn(CK) nnis nn1325 nnIU/L nn(Normal nnRange nn32-267 nnIU/L).
nnWhich nnof nnthe nnfollowing nnis nnthe nninitial nnmainstay nnof nntherapy nnfor nnthis nncondition?
A nnIV nnrehydration
B nnFasciotomy
C nnToradol nn(Ketorlac)
D nnHydrotherapy nn- nnANSWER: nn✔ nnA
IV nnrehydration nnwith nncrystalloids nnfor nn24 nnto nn72 nnhours nnis nnthe nnmainstay nnof nntherapy nnfor
nnrhabdomyolysis.
A nn42 nnyear-old nnmale nnpresents nncomplaining nnof nna nnsudden nnonset nnof nna nnsevere nnintermittent nnpain
nnoriginating nnin nnthe nnflank nnand nnradiating nninto nnthe nnright nntesticle. nnHe nnalso nncomplains nnof nnnausea
nnand nnvomiting. nnOn nnexamination nnthe nnpatient nnis nnafebrile, nnbut nnrestless. nnExamination nnof nnthe
nnabdomen nnreveals nntenderness nnto nnpalpation nnalong nnthe nnright nnflank nnwith nnno nnrebound nnor nndirect
nntesticular nntenderness. nnUrinalysis nnreveals nna nnpH nnof nn5.4 nnand nnmicroscopic nnhematuria, nnbut nnis
nnotherwise nnunremarkable. nnWhich nnof nnthe nnfollowing nnis nnthe nnmost nnlikely nndiagnosis?
A nnBladder nncancer
B nnNephrolithiasis
C nnAcute nnappendicitis
D nnAcute nnepididymitis nn- nnANSWER: nn✔ nnB
,A nnsudden nnonset nnof nnsevere nncolicky nnflank nnpain nnassociated nnwith nnnausea nnand nnvomiting nnas nnwell nnas
nnthe nnabsence nnof nnrebound nnor nndirect nntesticular nntenderness nnmakes nnnephrolithiasis nnthe nnmost nnlikely
nndiagnosis. nnThis nnis nnfurther nnsupported nnby nnthe nnpresence nnof nnhematuria nnon nnthe nnurinalysis.
Which nnof nnthe nnfollowing nnpathophysiological nnprocesses nnis nnbelieved nnto nninitiate nnacute nnappendicitis?
A nnObstruction
B nnPerforation
C nnHemorrhage
D nnVascular nncompromise nn- nnANSWER: nn✔ nnA
Obstruction nnof nnthe nnappendiceal nnlumen nnby nnlymphoid nnhyperplasia, nna nnfecalith nnor nnforeign nnbody
nninitiates nnmost nncases nnof nnappendicitis
What nnis nnthe nnterm nnfor nnblue nndiscoloration nnabout nnthe nnumbilicus?
A nnCullen's nnsign
B nnMurphy's nnsign
C nnRovsing's nnsign
D nnTurner nnsign nn- nnANSWER: nn✔ nnA
Cullen's nnsign nnis nna nnblue nndiscoloration nnabout nnthe nnumbilicus nnand nncan nnoccur nnin nnhemorrhagic
nnpancreatitis nnand nnresults nnfrom nnhemoperitoneum.
A nnpatient nnpresents nnwith nnabdominal nnpain nnin nnthe nnright nnlower nnquadrant, nnexamination nnreveals
nnincreased nnpain nnin nnthe nnright nnlower nnquadrant nnon nndeep nnpalpation nnof nnthe nnleft nnlower nnquadrant.
nnThis nncommonly nnknown nnas nnwhich nnof nnthe nnfollowing?
A nnPsoas nnsign
B nnMurphy's nnsign
C nnRovsing's nnsign
D nnObturator nnsign nn- nnANSWER: nn✔ nnC
, A nnpositive nnRovsing's nnsign nncan nnbe nnelicited nnin nna nnpatient nnwith nnappendicitis nnwhen nnincreased nnpain
nnoccurs nnin nnthe nnright nnlower nnquadrant nnupon nnpalpation nnof nnthe nnleft nnlower nnquadrant.
A nn25 nnyear-old nnfemale nnpresents nnwith nnright nnlower nnquadrant nnpain, nnright nnflank nnpain, nnnausea, nnand
nnvomiting. nnHer nntemperature nnis nn39.6 nndegrees nnC. nnThere nnis nnright nnCVA nntenderness nnand nnRLQ
nntenderness. nnPelvic nnexam nnis nnunremarkable. nnUrinalysis nnreveals nnpH nn7.0, nntrace nnprotein, nnnegative
nnglucose, nnnegative nnketones, nnpositive nnblood, nnand nnpositive nnnitrates. nnSpecific nngravity nnis nn1.022.
nnMicroscopic nnshows nn102 nnRBCs/HPF, nn50-75 nnWBCs/HPF, nnrare nnepithelial nncells, nnand nnWBC nncasts. nnThe
nnmost nnlikely nndiagnosis nnis
A nnacute nnsalpingitis.
B nnnephrolithiasis.
C nnacute nnpyelonephritis.
D nnappendicitis. nn- nnANSWER: nn✔ nnC
Acute nnpyelonephritis nnpresents nnwith nnflank nnpain, nnfever, nnand nngeneralized nnmuscle nntenderness.
nnUrinalysis nnshows nnpyuria nnwith nnleukocyte nncasts.
A nn26 nnyear-old nngravida nn0 nnsexually nnactive nnfemale nnpresents nnto nnthe nnemergency nnroom nncomplaining
nnof nncolicky nnpain nnin nnher nnlower nnabdomen nnfor nnthe nnpast nn12 nnhours. nnShe nnpassed nnout nnearlier nnin nnthe
nnday nnwhile nntrying nnto nnhave nna nnbowel nnmovement. nnHer nnlast nnmenstrual nnperiod nnwas nn6 nnweeks nnago.
nnShe nnhas nnnoted nnvaginal nnspotting nnover nnthe nnlast nn24 nnhours. nnVital nnsigns nnshow nnTemp nn37 nndegrees
nnC, nnBP nn96/60mmHg, nnP nn110, nnR nn16, nnOxygen nnSat. nn98%. nnAbdominal nnexam nnis nnpositive nnfor
nndistension nnand nntenderness. nnBowel nnsounds nnare nndecreased. nnPelvic nnexam nnshows nncervical nnmotion
nnand nnadnexal nntenderness. nnWhich nnof nnthe nnfollowing nnis nnthe nnmost nnlikely nndiagnosis?
A nnEctopic nnpregnancy
B nnAppendicitis
C nnCrohn's nndisease
D nnPelvic nninflammatory nndisease nn- nnANSWER: nn✔ nnA
High nnsuspicion nnfor nnectopic nnpregnancy nnshould nnbe nnmaintained nnwhen nnany nnpossible nnpregnant
nnwoman nnpresents nnwith nnvaginal nnbleeding nnor nnabdominal nnpain.
A nn22 nnyear-old nnmale nnpresents nnto nnthe nnclinic nncomplaining nnof nnscrotal nnpain nnthat nnradiates nninto nnthe
nngroin. nnPatient nnadmits nnto nnbeing nna nnweightlifter nnand nnwas nnlifting nn24 nnhours nnprior nnto nnthis nnpain
Questions With Complete Solutions
An nn18-year-old nnpatient nnhas nna nntibia/fibula nnfracture nnfollowing nna nnmotorcycle nncrash. nnTwelve nnhours
nnlater nnthe nnpatient nnpresents nnwith nnincreased nnpain nndespite nnadequate nndoses nnof nnanalgesics nnand
nnimmobilization. nnWhich nnof nnthe nnfollowing nnis nnthe nnmost nnlikely nndiagnosis?
A nnavascular nnnecrosis
B nnmyositis nnossificans
C nncompartment nnsyndrome
D nnreflex nnsympathetic nndystrophy nn- nnANSWER: nn✔ nnC
Compartment nnsyndrome nnis nncharacterized nnby nna nnpathological nnincrease nnof nnpressure nnwithin nna nnclosed
nnspace nnand nnresults nnfrom nnedema nnor nnbleeding nnwithin nnthe nncompartment. nnIt nnmay nnoccur nnas nnan
nnearly nnlocal nncomplication nnof nnfracture.
A nn38 nnyear-old nnmale nnsustained nna nnfracture nnof nnthe nnleft nndistal nntibia nnfollowing nna nn25-foot nnfall nnand nnis
nntaken nnto nnthe nnoperating nnroom nnfor nnan nnopen nnreduction nninternal nnfixation nnof nnthe nndistal nntibia.
nnSixteen nnhours nnpost-op, nnthe nnpatient nndevelops nnsustained nnpain, nnwhich nnis nnnot nnrelieved nnwith
nnnarcotics. nnOn nnpassive nnrange nnof nnmotion nnof nnthe nntoes nnthe nnpatient nn"yells" nnin nnagony. nnThe nnpatient
nnalso nnstates nnthat nnthe nntop nnof nnhis nnfoot nnhas nndecreased nnsensation. nnOn nnphysical nnexamination nnthe
nnphysician nnassistant nnnotes nnthat nnthe nnleg nnis nnswollen nnand nnthe nnfoot nnis nncool nnto nntouch. nnBased nnupon
nnthis nninformation nnwhat nndiagnostic nntesting nnshould nnbe nndone?
A nnX-ray nnof nnthe nnlower nnleg nnand nnankle
B nnDoppler nnstudies
C nnBone nnscan.
D nnCompartment nnpressure nn- nnANSWER: nn✔ nnD
Compartmental nnpressures nnshould nnbe nnobtained nnas nnsoon nnas nnpossible. nnIf nnthey nnare nnelevated nnthis nnis
nna nnsurgical nnemergency.
,A nn35 nnyear-old nnmale nnplaced nnin nna nnthumb nnspica nncast nnfor nna nnscaphoid nnfracture nnpresents
nncomplaining nnof nnforearm nnand nnhand nnpain nnthat nnis nnnot nnrelieved nnwith nnpain nnmedication nnand
nnelevation. nnWhich nnof nnthe nnfollowing nnis nnthe nnearliest nnphysical nnexam nnsign nnfor nnhis nncurrent
nncondition?
A nnSlow nncapillary nnrefill
B nnLoss nnof nntwo-point nndiscrimination
C nnAbsent nnperipheral nnpulses
D nnPain nnwith nnpassive nnstretch. nn- nnANSWER: nn✔ nnB
Loss nnof nntwo-point nndiscrimination nncan nnbe nnthe nnearliest nnsign nnof nncompartment nnsyndrome.
25 nnyear-old nnmale nnpresents nnto nnthe nnED nnwith nnleft nncalf nnpain nnand nncramping, nnas nnwell nnas nnnausea
nnand nnvomiting. nnHe nnadmits nnto nn"partying nnwith nncocaine nnall nnnight". nnHe nndescribes nnhis nnurine nnas nna
nndark nnbrown nncolor. nnSerum nncreatinine nnkinase nn(CK) nnis nn1325 nnIU/L nn(Normal nnRange nn32-267 nnIU/L).
nnWhich nnof nnthe nnfollowing nnis nnthe nninitial nnmainstay nnof nntherapy nnfor nnthis nncondition?
A nnIV nnrehydration
B nnFasciotomy
C nnToradol nn(Ketorlac)
D nnHydrotherapy nn- nnANSWER: nn✔ nnA
IV nnrehydration nnwith nncrystalloids nnfor nn24 nnto nn72 nnhours nnis nnthe nnmainstay nnof nntherapy nnfor
nnrhabdomyolysis.
A nn42 nnyear-old nnmale nnpresents nncomplaining nnof nna nnsudden nnonset nnof nna nnsevere nnintermittent nnpain
nnoriginating nnin nnthe nnflank nnand nnradiating nninto nnthe nnright nntesticle. nnHe nnalso nncomplains nnof nnnausea
nnand nnvomiting. nnOn nnexamination nnthe nnpatient nnis nnafebrile, nnbut nnrestless. nnExamination nnof nnthe
nnabdomen nnreveals nntenderness nnto nnpalpation nnalong nnthe nnright nnflank nnwith nnno nnrebound nnor nndirect
nntesticular nntenderness. nnUrinalysis nnreveals nna nnpH nnof nn5.4 nnand nnmicroscopic nnhematuria, nnbut nnis
nnotherwise nnunremarkable. nnWhich nnof nnthe nnfollowing nnis nnthe nnmost nnlikely nndiagnosis?
A nnBladder nncancer
B nnNephrolithiasis
C nnAcute nnappendicitis
D nnAcute nnepididymitis nn- nnANSWER: nn✔ nnB
,A nnsudden nnonset nnof nnsevere nncolicky nnflank nnpain nnassociated nnwith nnnausea nnand nnvomiting nnas nnwell nnas
nnthe nnabsence nnof nnrebound nnor nndirect nntesticular nntenderness nnmakes nnnephrolithiasis nnthe nnmost nnlikely
nndiagnosis. nnThis nnis nnfurther nnsupported nnby nnthe nnpresence nnof nnhematuria nnon nnthe nnurinalysis.
Which nnof nnthe nnfollowing nnpathophysiological nnprocesses nnis nnbelieved nnto nninitiate nnacute nnappendicitis?
A nnObstruction
B nnPerforation
C nnHemorrhage
D nnVascular nncompromise nn- nnANSWER: nn✔ nnA
Obstruction nnof nnthe nnappendiceal nnlumen nnby nnlymphoid nnhyperplasia, nna nnfecalith nnor nnforeign nnbody
nninitiates nnmost nncases nnof nnappendicitis
What nnis nnthe nnterm nnfor nnblue nndiscoloration nnabout nnthe nnumbilicus?
A nnCullen's nnsign
B nnMurphy's nnsign
C nnRovsing's nnsign
D nnTurner nnsign nn- nnANSWER: nn✔ nnA
Cullen's nnsign nnis nna nnblue nndiscoloration nnabout nnthe nnumbilicus nnand nncan nnoccur nnin nnhemorrhagic
nnpancreatitis nnand nnresults nnfrom nnhemoperitoneum.
A nnpatient nnpresents nnwith nnabdominal nnpain nnin nnthe nnright nnlower nnquadrant, nnexamination nnreveals
nnincreased nnpain nnin nnthe nnright nnlower nnquadrant nnon nndeep nnpalpation nnof nnthe nnleft nnlower nnquadrant.
nnThis nncommonly nnknown nnas nnwhich nnof nnthe nnfollowing?
A nnPsoas nnsign
B nnMurphy's nnsign
C nnRovsing's nnsign
D nnObturator nnsign nn- nnANSWER: nn✔ nnC
, A nnpositive nnRovsing's nnsign nncan nnbe nnelicited nnin nna nnpatient nnwith nnappendicitis nnwhen nnincreased nnpain
nnoccurs nnin nnthe nnright nnlower nnquadrant nnupon nnpalpation nnof nnthe nnleft nnlower nnquadrant.
A nn25 nnyear-old nnfemale nnpresents nnwith nnright nnlower nnquadrant nnpain, nnright nnflank nnpain, nnnausea, nnand
nnvomiting. nnHer nntemperature nnis nn39.6 nndegrees nnC. nnThere nnis nnright nnCVA nntenderness nnand nnRLQ
nntenderness. nnPelvic nnexam nnis nnunremarkable. nnUrinalysis nnreveals nnpH nn7.0, nntrace nnprotein, nnnegative
nnglucose, nnnegative nnketones, nnpositive nnblood, nnand nnpositive nnnitrates. nnSpecific nngravity nnis nn1.022.
nnMicroscopic nnshows nn102 nnRBCs/HPF, nn50-75 nnWBCs/HPF, nnrare nnepithelial nncells, nnand nnWBC nncasts. nnThe
nnmost nnlikely nndiagnosis nnis
A nnacute nnsalpingitis.
B nnnephrolithiasis.
C nnacute nnpyelonephritis.
D nnappendicitis. nn- nnANSWER: nn✔ nnC
Acute nnpyelonephritis nnpresents nnwith nnflank nnpain, nnfever, nnand nngeneralized nnmuscle nntenderness.
nnUrinalysis nnshows nnpyuria nnwith nnleukocyte nncasts.
A nn26 nnyear-old nngravida nn0 nnsexually nnactive nnfemale nnpresents nnto nnthe nnemergency nnroom nncomplaining
nnof nncolicky nnpain nnin nnher nnlower nnabdomen nnfor nnthe nnpast nn12 nnhours. nnShe nnpassed nnout nnearlier nnin nnthe
nnday nnwhile nntrying nnto nnhave nna nnbowel nnmovement. nnHer nnlast nnmenstrual nnperiod nnwas nn6 nnweeks nnago.
nnShe nnhas nnnoted nnvaginal nnspotting nnover nnthe nnlast nn24 nnhours. nnVital nnsigns nnshow nnTemp nn37 nndegrees
nnC, nnBP nn96/60mmHg, nnP nn110, nnR nn16, nnOxygen nnSat. nn98%. nnAbdominal nnexam nnis nnpositive nnfor
nndistension nnand nntenderness. nnBowel nnsounds nnare nndecreased. nnPelvic nnexam nnshows nncervical nnmotion
nnand nnadnexal nntenderness. nnWhich nnof nnthe nnfollowing nnis nnthe nnmost nnlikely nndiagnosis?
A nnEctopic nnpregnancy
B nnAppendicitis
C nnCrohn's nndisease
D nnPelvic nninflammatory nndisease nn- nnANSWER: nn✔ nnA
High nnsuspicion nnfor nnectopic nnpregnancy nnshould nnbe nnmaintained nnwhen nnany nnpossible nnpregnant
nnwoman nnpresents nnwith nnvaginal nnbleeding nnor nnabdominal nnpain.
A nn22 nnyear-old nnmale nnpresents nnto nnthe nnclinic nncomplaining nnof nnscrotal nnpain nnthat nnradiates nninto nnthe
nngroin. nnPatient nnadmits nnto nnbeing nna nnweightlifter nnand nnwas nnlifting nn24 nnhours nnprior nnto nnthis nnpain
