Surgery – AMBOSS UPDATED ACTUAL
Exam Questions and CORRECT Answers
How treat new sclerotic lesion at L5 vertebral body in pt w bilateral orchiectomy after prostate
cancer dx - CORRECT ANSWER - local radiation
Pt has RUQ abdominal pain plus XR showing air in biliary tree and dilated transverse colon - dx
- CORRECT ANSWER - cholecystoenteric fistula
Pt has hoarse voice, sore throat, difficulty opening mouth. Swelling of R tonsillar pillar w uvula
deviation to L - dx, tx - CORRECT ANSWER - Peritonsillar abscess
- treat with incision and drainage w IV ampicillin-sulbactam
After stab wound, pt has hypotension, muffled heart sounds, JVD. Dx, what other exam findings
will see - CORRECT ANSWER - cardiac tamponade
- also see pulsus paradoxus (drop in SBP by 10 mmHg during inspiration)
40 yo pt has watery diarrhea, episodic crampy abdominal pain, WL, episodic cutaneous flushing,
asthma, systolic murmur at LSB 4th intercostal - dx? What at risk for, why - CORRECT
ANSWER - carcinoid syndrome
- at risk for dementia from pellagra (dermatitis, diarrhea, glossitis) from niacin deficiency from
decreased tryptophan
Pt has enlarged bluish veins above dentate line, mass that prolapses but reduces when breathes
normally. Dx? what tx - CORRECT ANSWER - internal hemorrhoids; docusate therapy
How dx Zenker diverticulum - CORRECT ANSWER - barium esophagram w continuous
fluoroscopy
Pt has retrosternal chest pain, single punched out ulcer seen on endoscopy w normal mucosa at
GE junction. Takes a bunch of meds including insulin, amlodipine, ASA, metformin,
,beclomethasone, albuterol, alendronate. Dx. What next step? - CORRECT ANSWER - Drug
induced esophagitis, discontinue alendronate
Why discontinue alendronate in pt w drug induced esophagitis - CORRECT ANSWER -
Alendronate can cause drug-induced esophagitis
- other meds that can cause it include abx, NSAIDs, KCl
After ORIF of LS femur fracture after MVA, pt has pain and paresthesia in arm. Has decreased
brachial and radial pulses, pale and cold skin. Platelets are 60k, PTT is 55s. Doppler shows
occlusion of R brachial artery. Dx? - CORRECT ANSWER - arterial thrombosis from HIT
Pt has fever, chills, plus indurated tender, warm, erythematous skin lesion w sharply demarcated
margins. Also has toe web intertrigo. Dx? what do - CORRECT ANSWER - Erysipelas; treat
w IV cefazolin
3 yo has cough, SOB for 12 hrs. Repeat asthma exacerbations. Decreased breath sounds,
expiratory wheezing, hyperlucency of R lung field w decreased pulm markings. What do, why -
CORRECT ANSWER - Bronchoscopy to remove foreign body
37 yo male has itching in genitals for 7 days, atrophic white papules on glans and prepuce w
erythema. Narrowed, sclerotic urinary meatus. Dx, what do - CORRECT ANSWER - biopsy
lesion; lichen sclerosus but may become SCC
7 mo boy has palpable testicle in R hemiscrotum w palpable mass in L inguinal canal. What do,
why - CORRECT ANSWER - Orchidopexy - spontaneous descent is unlikely as boy is
already 4-6 mo of age
By when do you want to perform orchidopexy - CORRECT ANSWER - before 1 year of age
After AAA repaid, pt has absent bowel sounds, TTP in 4 quads. Dx - CORRECT ANSWER -
ischemic colitis
,Homeless pt, IVDU has warmth, erythema neck pain. Palpation causes pain. inflammation on
MRI. Dx, what do, why - CORRECT ANSWER - osteomyelitis
- must cover for MRSA, strep, gram negatives (Pseudomonas)
- give vancomycin and fluoroquinolone (cipro) or cephalosporin (cefepime)
Pt has diarrhea for 2 weeks, urge to defecate 15 min after meal plus palpitations, sweating after
eating. Had distal gastrectomy performed. What do, dx - CORRECT ANSWER - dietary
modifications - early dumping syndrome
4 week old girl has yellowing of eyes, skin for 2 weeks. Can palpate liver 2 cm below margin.
Has very high direct bilirubin and alkaline phosphatase. Dx? - CORRECT ANSWER - biliary
atresia
What are signs of biliary atresia - CORRECT ANSWER - elevated direct hyperbilirubinemia,
ALP levels w post-hepatic jaundice
22 yo has pain of L knee. L tibia is displaced posteriorly when force applied to proximal tibia
after flexing knee. Dx - CORRECT ANSWER - PCL injury
42 yo has 2 episodes of LoC, SOB, palpitations, chest tightness, JVD, pitting edema. From India.
Has diastolic murmur in 5th L intercostal space at midclavicular line. Dx? What is mechanism of
findings? - CORRECT ANSWER - Increased LA pressure from mitral stenosis (rheumatic
fever)
68 yo M has sclerotic lesions in thoracic and lumbar vertebra. Normal DRE. Dx? - CORRECT
ANSWER - prostate cancer mets
- can have normal prostate exam
Describe lesions that occur from prostate cancer v RCC - CORRECT ANSWER - osteoblastic
bone mets (sclerotic lesions)
- not osteolytic lesions (RCC)
, Pt has pulsatile abdominal mass w severe abdominal pain radiating to flank for 30 min. Low BP,
high pulse. What do - CORRECT ANSWER - ruptured AAA - open emergency surgery
19 yo M has blood-speckled stools, protruding rectal mass w 4 cm pedunculated polyp w
superficial excoriations. Colonoscopy shows 14 polyps dx as hamartomatous polyps. What dx,
what associated with - CORRECT ANSWER - Peutz-Jeghers syndrome - increased risk of
pancreatic, breast, ovarian cancer
How treat communicating hydrocele in 6 mo old baby - CORRECT ANSWER - reassurance -
should resolve within 1 year
79 yo W has non-productive cough, fatigue, WL. Worked as seamstress in textile factory plus
smoked for 47 years. Has exudative pleural effusion w nodular pleural lesions on R side. Dx -
CORRECT ANSWER - Mesothelioma
23 yo W has R adnexal tenderness after N/V develop suddenly after sex. Dx, what findings -
CORRECT ANSWER - ovarian torsion - see decreased ovarian blood flow on doppler
68 yo W loses control of bladder when walking or standing. Failed Kegel exercises, continence
pessary. What tx - CORRECT ANSWER - urethral sling - 1st line for stress incontinence if
Kegel, pessary, lifestyle changes fail
52 yo M has 3 mo of upper abdominal pain after eating w improvement w eating. Dark stools.
Epigastric tenderness. Normal vitals. How prevent further cx of disease - CORRECT
ANSWER - Triple therapy for H pylori - amoxicillin, clarithromycin, omeprazole
Pt scheduled for cholecystectomy tomorrow but has elevated K+ of 6.1. How manage, why -
CORRECT ANSWER - administer IV saline w furosemide - not emergency
What are ways to decrease potassium emergently - CORRECT ANSWER - IV calcium
gluconate, hemodialysis, insulin and glucose
Exam Questions and CORRECT Answers
How treat new sclerotic lesion at L5 vertebral body in pt w bilateral orchiectomy after prostate
cancer dx - CORRECT ANSWER - local radiation
Pt has RUQ abdominal pain plus XR showing air in biliary tree and dilated transverse colon - dx
- CORRECT ANSWER - cholecystoenteric fistula
Pt has hoarse voice, sore throat, difficulty opening mouth. Swelling of R tonsillar pillar w uvula
deviation to L - dx, tx - CORRECT ANSWER - Peritonsillar abscess
- treat with incision and drainage w IV ampicillin-sulbactam
After stab wound, pt has hypotension, muffled heart sounds, JVD. Dx, what other exam findings
will see - CORRECT ANSWER - cardiac tamponade
- also see pulsus paradoxus (drop in SBP by 10 mmHg during inspiration)
40 yo pt has watery diarrhea, episodic crampy abdominal pain, WL, episodic cutaneous flushing,
asthma, systolic murmur at LSB 4th intercostal - dx? What at risk for, why - CORRECT
ANSWER - carcinoid syndrome
- at risk for dementia from pellagra (dermatitis, diarrhea, glossitis) from niacin deficiency from
decreased tryptophan
Pt has enlarged bluish veins above dentate line, mass that prolapses but reduces when breathes
normally. Dx? what tx - CORRECT ANSWER - internal hemorrhoids; docusate therapy
How dx Zenker diverticulum - CORRECT ANSWER - barium esophagram w continuous
fluoroscopy
Pt has retrosternal chest pain, single punched out ulcer seen on endoscopy w normal mucosa at
GE junction. Takes a bunch of meds including insulin, amlodipine, ASA, metformin,
,beclomethasone, albuterol, alendronate. Dx. What next step? - CORRECT ANSWER - Drug
induced esophagitis, discontinue alendronate
Why discontinue alendronate in pt w drug induced esophagitis - CORRECT ANSWER -
Alendronate can cause drug-induced esophagitis
- other meds that can cause it include abx, NSAIDs, KCl
After ORIF of LS femur fracture after MVA, pt has pain and paresthesia in arm. Has decreased
brachial and radial pulses, pale and cold skin. Platelets are 60k, PTT is 55s. Doppler shows
occlusion of R brachial artery. Dx? - CORRECT ANSWER - arterial thrombosis from HIT
Pt has fever, chills, plus indurated tender, warm, erythematous skin lesion w sharply demarcated
margins. Also has toe web intertrigo. Dx? what do - CORRECT ANSWER - Erysipelas; treat
w IV cefazolin
3 yo has cough, SOB for 12 hrs. Repeat asthma exacerbations. Decreased breath sounds,
expiratory wheezing, hyperlucency of R lung field w decreased pulm markings. What do, why -
CORRECT ANSWER - Bronchoscopy to remove foreign body
37 yo male has itching in genitals for 7 days, atrophic white papules on glans and prepuce w
erythema. Narrowed, sclerotic urinary meatus. Dx, what do - CORRECT ANSWER - biopsy
lesion; lichen sclerosus but may become SCC
7 mo boy has palpable testicle in R hemiscrotum w palpable mass in L inguinal canal. What do,
why - CORRECT ANSWER - Orchidopexy - spontaneous descent is unlikely as boy is
already 4-6 mo of age
By when do you want to perform orchidopexy - CORRECT ANSWER - before 1 year of age
After AAA repaid, pt has absent bowel sounds, TTP in 4 quads. Dx - CORRECT ANSWER -
ischemic colitis
,Homeless pt, IVDU has warmth, erythema neck pain. Palpation causes pain. inflammation on
MRI. Dx, what do, why - CORRECT ANSWER - osteomyelitis
- must cover for MRSA, strep, gram negatives (Pseudomonas)
- give vancomycin and fluoroquinolone (cipro) or cephalosporin (cefepime)
Pt has diarrhea for 2 weeks, urge to defecate 15 min after meal plus palpitations, sweating after
eating. Had distal gastrectomy performed. What do, dx - CORRECT ANSWER - dietary
modifications - early dumping syndrome
4 week old girl has yellowing of eyes, skin for 2 weeks. Can palpate liver 2 cm below margin.
Has very high direct bilirubin and alkaline phosphatase. Dx? - CORRECT ANSWER - biliary
atresia
What are signs of biliary atresia - CORRECT ANSWER - elevated direct hyperbilirubinemia,
ALP levels w post-hepatic jaundice
22 yo has pain of L knee. L tibia is displaced posteriorly when force applied to proximal tibia
after flexing knee. Dx - CORRECT ANSWER - PCL injury
42 yo has 2 episodes of LoC, SOB, palpitations, chest tightness, JVD, pitting edema. From India.
Has diastolic murmur in 5th L intercostal space at midclavicular line. Dx? What is mechanism of
findings? - CORRECT ANSWER - Increased LA pressure from mitral stenosis (rheumatic
fever)
68 yo M has sclerotic lesions in thoracic and lumbar vertebra. Normal DRE. Dx? - CORRECT
ANSWER - prostate cancer mets
- can have normal prostate exam
Describe lesions that occur from prostate cancer v RCC - CORRECT ANSWER - osteoblastic
bone mets (sclerotic lesions)
- not osteolytic lesions (RCC)
, Pt has pulsatile abdominal mass w severe abdominal pain radiating to flank for 30 min. Low BP,
high pulse. What do - CORRECT ANSWER - ruptured AAA - open emergency surgery
19 yo M has blood-speckled stools, protruding rectal mass w 4 cm pedunculated polyp w
superficial excoriations. Colonoscopy shows 14 polyps dx as hamartomatous polyps. What dx,
what associated with - CORRECT ANSWER - Peutz-Jeghers syndrome - increased risk of
pancreatic, breast, ovarian cancer
How treat communicating hydrocele in 6 mo old baby - CORRECT ANSWER - reassurance -
should resolve within 1 year
79 yo W has non-productive cough, fatigue, WL. Worked as seamstress in textile factory plus
smoked for 47 years. Has exudative pleural effusion w nodular pleural lesions on R side. Dx -
CORRECT ANSWER - Mesothelioma
23 yo W has R adnexal tenderness after N/V develop suddenly after sex. Dx, what findings -
CORRECT ANSWER - ovarian torsion - see decreased ovarian blood flow on doppler
68 yo W loses control of bladder when walking or standing. Failed Kegel exercises, continence
pessary. What tx - CORRECT ANSWER - urethral sling - 1st line for stress incontinence if
Kegel, pessary, lifestyle changes fail
52 yo M has 3 mo of upper abdominal pain after eating w improvement w eating. Dark stools.
Epigastric tenderness. Normal vitals. How prevent further cx of disease - CORRECT
ANSWER - Triple therapy for H pylori - amoxicillin, clarithromycin, omeprazole
Pt scheduled for cholecystectomy tomorrow but has elevated K+ of 6.1. How manage, why -
CORRECT ANSWER - administer IV saline w furosemide - not emergency
What are ways to decrease potassium emergently - CORRECT ANSWER - IV calcium
gluconate, hemodialysis, insulin and glucose
