General Surgery - ROSH Review UPDATED ACTUAL Questions and
CORRECT Answers
1. what is an ERCP used for? this procedure is diagnostic
and therapeutic for choledo-
cholithiasis, which refers to
the presence of gallstones in
the common bile duct.
2. wha to is the initial test for acute cholecystitis? Initial: U/S
Gold standard: HIDA
what is the gold standard?
3. when is a percutaneous cholecystostomy used? when critically ill or if have co-
morbidities and do not im-
prove on antibiotics
4. how does an epidural hematoma present on CT? lenticular or lens-shaped col-
lection of blood
does not cross suture lines
5. what does an epidural hematoma originate from? arterial bleed, most common-
ly coming from the middle
meningeal artery following
trauma to the skull
6. classic presentation of an epidural hematoma? have a history of loss of con-
sciousness at the time of the
trauma following by a lucid
interval and then progres-
sive neurological deteriora-
, tion as the artery continues
, to bleed. Patients may ex-
perience headache, vomiting,
confusion, seizures, and focal
neurological deficits.
7. what will patients with an epidural hematoma pre- may display a dilated pupil
sent with if they are herniating? and Cushing's triad (hyper-
tension, bradycardia, irregu-
lar respirations)
8. what is contraindicated in an epidural heamtoma? Lumbar puncture
risk of brain herniation
9. tx for an epidural hematoma? craniotomy
10. who is a subdural hematoma common in? older patients and typically
have a crescent shaped col-
lection of blood on CT scan
11. triple therapy for H.pylori? CAP
Clarithromycin
Amoxicillin (metro iif PCN al-
lergic)
PPI - Omeprazole
12. two options for quadruple therapy for H.pylori?
13. what two classes of medication are used in the treat- PPIs and histamine antago-
ment of peptic ulcer disease? nists (H2-blockers).
14. how can H.pylori be diagnosed? Noninvasive testing (e.g.,
stool antigen, urea breath
, test)
Can be diagnosed during
EGD (e.g., by biopsy histology
or urease test) if indicated
15. where is an indirect inguinal hernia vs. a direct? MDs don't LIe
Medial to IEA: direct
Lateral to IEA: indirect
16. what is more common, indirect or direct inguinal indirect
hernia?
17. what is the initial test for carotid artery stenosis? initial = Carotid artery duplex
ultrasound
what is the gold standard?
gold standard = Contrast dig-
ital subtraction arteriography
(but this is invasive)
18. tx of carotid artery stenosis <50% stenosis and asympto-
matic = mediactions
- <50% stenosis and asymptomatic - antithrombotic medica-
- > 50% stenosis and symptomatic or >70% stenosis tions, high-dose statin ther-
apy, blood pressure control,
glucose control, smoking ces-
sation, and other lifestyle
modifications, including diet
and exercise
> 50% stenosis and symp-
tomatic or >70% stenosis =
CORRECT Answers
1. what is an ERCP used for? this procedure is diagnostic
and therapeutic for choledo-
cholithiasis, which refers to
the presence of gallstones in
the common bile duct.
2. wha to is the initial test for acute cholecystitis? Initial: U/S
Gold standard: HIDA
what is the gold standard?
3. when is a percutaneous cholecystostomy used? when critically ill or if have co-
morbidities and do not im-
prove on antibiotics
4. how does an epidural hematoma present on CT? lenticular or lens-shaped col-
lection of blood
does not cross suture lines
5. what does an epidural hematoma originate from? arterial bleed, most common-
ly coming from the middle
meningeal artery following
trauma to the skull
6. classic presentation of an epidural hematoma? have a history of loss of con-
sciousness at the time of the
trauma following by a lucid
interval and then progres-
sive neurological deteriora-
, tion as the artery continues
, to bleed. Patients may ex-
perience headache, vomiting,
confusion, seizures, and focal
neurological deficits.
7. what will patients with an epidural hematoma pre- may display a dilated pupil
sent with if they are herniating? and Cushing's triad (hyper-
tension, bradycardia, irregu-
lar respirations)
8. what is contraindicated in an epidural heamtoma? Lumbar puncture
risk of brain herniation
9. tx for an epidural hematoma? craniotomy
10. who is a subdural hematoma common in? older patients and typically
have a crescent shaped col-
lection of blood on CT scan
11. triple therapy for H.pylori? CAP
Clarithromycin
Amoxicillin (metro iif PCN al-
lergic)
PPI - Omeprazole
12. two options for quadruple therapy for H.pylori?
13. what two classes of medication are used in the treat- PPIs and histamine antago-
ment of peptic ulcer disease? nists (H2-blockers).
14. how can H.pylori be diagnosed? Noninvasive testing (e.g.,
stool antigen, urea breath
, test)
Can be diagnosed during
EGD (e.g., by biopsy histology
or urease test) if indicated
15. where is an indirect inguinal hernia vs. a direct? MDs don't LIe
Medial to IEA: direct
Lateral to IEA: indirect
16. what is more common, indirect or direct inguinal indirect
hernia?
17. what is the initial test for carotid artery stenosis? initial = Carotid artery duplex
ultrasound
what is the gold standard?
gold standard = Contrast dig-
ital subtraction arteriography
(but this is invasive)
18. tx of carotid artery stenosis <50% stenosis and asympto-
matic = mediactions
- <50% stenosis and asymptomatic - antithrombotic medica-
- > 50% stenosis and symptomatic or >70% stenosis tions, high-dose statin ther-
apy, blood pressure control,
glucose control, smoking ces-
sation, and other lifestyle
modifications, including diet
and exercise
> 50% stenosis and symp-
tomatic or >70% stenosis =
