ROSH REVIEW general surgery
questions and answers passed
Sarcoidosis - correct answer ✔✔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?
Emergent surgical repair - correct answer ✔✔Which of the following options is the best therapy
for an ascending aortic dissection?
To avoid unopposed alpha-adrenergic receptor stimulation - correct answer ✔✔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?
Sacrum (peripheral and periorbital edema are commonly seen in patients with nephrotic
syndrome caused by sodium retention and hypoalbuminemia; lab shows proteinuria > 3.5g/day)
- correct answer ✔✔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?
Metabolic alkalosis - correct answer ✔✔A 78-year-old man undergoes laparoscopic surgery for
a small bowel obstruction. Which metabolic disturbance is he most at risk for postoperatively?
Hypothyroidism - correct answer ✔✔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?
Abdominal CT w/ contrast - correct answer ✔✔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?
Immunosuppressant therapy - correct answer ✔✔Which of the following is appropriate initial
treatment for uncomplicated symptomatic Crohn's disease?
Order transabdominal ultrasound - correct answer ✔✔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?
Angina pectoris - correct answer ✔✔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?
, Venous doppler ultrasound - correct answer ✔✔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?
Murphy's sign - correct answer ✔✔Which of the following is a physical exam finding
characterized by pain and inspiratory arrest during palpation of the right upper quadrant?
Cellulitis - correct answer ✔✔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?
Complete blood count - correct answer ✔✔Which of the following blood analysis tests is
indicated to diagnose anemia?
Fluctuance - correct answer ✔✔Which of the following physical exam findings is more indicative
of skin abscess than cellulitis?
Hemoglobin degradation products (xanthochromia from subarachnoid hemorrhage; tx includes
supportive and nimodipine) - correct answer ✔✔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?
questions and answers passed
Sarcoidosis - correct answer ✔✔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?
Emergent surgical repair - correct answer ✔✔Which of the following options is the best therapy
for an ascending aortic dissection?
To avoid unopposed alpha-adrenergic receptor stimulation - correct answer ✔✔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?
Sacrum (peripheral and periorbital edema are commonly seen in patients with nephrotic
syndrome caused by sodium retention and hypoalbuminemia; lab shows proteinuria > 3.5g/day)
- correct answer ✔✔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?
Metabolic alkalosis - correct answer ✔✔A 78-year-old man undergoes laparoscopic surgery for
a small bowel obstruction. Which metabolic disturbance is he most at risk for postoperatively?
Hypothyroidism - correct answer ✔✔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?
Abdominal CT w/ contrast - correct answer ✔✔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?
Immunosuppressant therapy - correct answer ✔✔Which of the following is appropriate initial
treatment for uncomplicated symptomatic Crohn's disease?
Order transabdominal ultrasound - correct answer ✔✔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?
Angina pectoris - correct answer ✔✔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?
, Venous doppler ultrasound - correct answer ✔✔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?
Murphy's sign - correct answer ✔✔Which of the following is a physical exam finding
characterized by pain and inspiratory arrest during palpation of the right upper quadrant?
Cellulitis - correct answer ✔✔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?
Complete blood count - correct answer ✔✔Which of the following blood analysis tests is
indicated to diagnose anemia?
Fluctuance - correct answer ✔✔Which of the following physical exam findings is more indicative
of skin abscess than cellulitis?
Hemoglobin degradation products (xanthochromia from subarachnoid hemorrhage; tx includes
supportive and nimodipine) - correct answer ✔✔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?
