ROSH QBank General Surgery EOR UPDATED ACTUAL Questions and
CORRECT Answers
1. A 35-year-old man presents to the emergency depart- D immediate fasciotomy
ment today complaining of severe pain to his left fore-
arm. The patient was seen by an orthopedic surgeon
yesterday and had a short-arm cast placed after he
fractured his ulna. The patient's left hand appears
extremely pale, and his cast is immediately removed.
He has absent radial pulses to his left arm and 2 ra-
dial pulses on his right arm. The dorsal compartment
pressure measures 36 mm Hg. What is the most ap-
propriate next step in this patient's management?
A Admission for hourly monitoring
B Discharge with prescription for oxycodone
C Follow-up with orthopedic surgery in 12-24 hours
D immediate fasciotomy
2. A 64-year-old man presents for a bulge in the groin most likely
area that he noticed over the last week. It is not painful to be found
or tender. In the morning upon waking, he feels it is in the
smaller, and as the day progresses and he is on his primary
feet for long hours at work, it gets larger. On physical form of
exam, you notice a bulge in the left inguinal area that chole-
is soft and increases with Valsalva maneuver. There
is no overlying erythema or warmth. Which of the
following risk factors is associated with the most likely
diagnosis?
AAlcohol use disorder
BMale sex
CSubstance use disorder
DYounger age
3. Which of the following types of bile duct stones is
,B male sex
D pigmented stone
, docholithiasis?
A Calcium oxalate stone
B Cholesterol stone
C Mixed stone
D Pigmented stone
4. A 32-year-old G1A0P1 woman presents with two days B colonic dilation without
of worsening abdominal pain. She has not passed mechanical obstruction
stool or flatus since an uncomplicated spontaneous
vaginal delivery with epidural anesthesia two days
ago. Her medical and surgical history is otherwise un-
remarkable. On examination, her abdomen is distend-
ed, tympanic to percussion, and diffusely tender. The
remainder of her physical exam and vitals are normal.
Which of the following would most likely be seen on a
CT abdomen and pelvis with IV contrast?
A Acute appendicitis
B Colonic dilation without mechanical obstruction
C Intraluminal colorectal mass
D Small bowel obstruction with adhesions
5. A 65-year-old man with myasthenia gravis presents A pH 7.20, PaCO2
with severe headache and drowsiness and is diag- 50mmHG, and bicarbon-
nosed with respiratory acidosis. Which of the follow- ate 23 mEq/L
ing arterial blood gas findings would you expect to see
in this patient?
ApH 7.20, PaCO2 50 mm Hg, and bicarbonate 23
mEq/L
BpH 7.25, PaCO2 40 mm Hg, and bicarbonate 20
mEq/L
CpH 7.55, PaCO2 30 mm Hg, and bicarbonate 24
mEq/L
, DpH 7.60, PaCO2 40 mm Hg, and bicarbonate 28
mEq/L
6. A 32-year-old man is admitted to the hospital for fever A metabolic acidosis
and severe pain in his right finger. The patient cut his
finger with a hedge trimmer 4 days ago and did not
seek medical treatment. He has been taking ibuprofen
at home. Vital signs are T 39.1°C (102.4°F), BP 88/58
mm Hg, HR 110 bpm, RR 26 breaths per minute, and
pulse oximetry 97% on room air. Physical examination
is significant for a 2 cm laceration over the distal in-
terphalangeal joint of the right index finger. Hand ra-
diographs are significant for a nondisplaced, oblique
fracture of the distal phalanx of the right index finger.
Arterial blood gas values are as follows:
pH: 7.15
pCO2: 36 mm Hg
HCO3: 12 mmol/L
Anion gap: 32 mEq/L
Which of the following acid-base disorders best de-
scribes the patient's condition?
AMetabolic acidosis
BMetabolic alkalosis
CRespiratory acidosis
DRespiratory alkalosis
7. What is the most appropriate IV fluid for a preopera- C lactated ringer solution
tive patient who is NPO?
A5% dextrose in water
BHalf-normal saline
CORRECT Answers
1. A 35-year-old man presents to the emergency depart- D immediate fasciotomy
ment today complaining of severe pain to his left fore-
arm. The patient was seen by an orthopedic surgeon
yesterday and had a short-arm cast placed after he
fractured his ulna. The patient's left hand appears
extremely pale, and his cast is immediately removed.
He has absent radial pulses to his left arm and 2 ra-
dial pulses on his right arm. The dorsal compartment
pressure measures 36 mm Hg. What is the most ap-
propriate next step in this patient's management?
A Admission for hourly monitoring
B Discharge with prescription for oxycodone
C Follow-up with orthopedic surgery in 12-24 hours
D immediate fasciotomy
2. A 64-year-old man presents for a bulge in the groin most likely
area that he noticed over the last week. It is not painful to be found
or tender. In the morning upon waking, he feels it is in the
smaller, and as the day progresses and he is on his primary
feet for long hours at work, it gets larger. On physical form of
exam, you notice a bulge in the left inguinal area that chole-
is soft and increases with Valsalva maneuver. There
is no overlying erythema or warmth. Which of the
following risk factors is associated with the most likely
diagnosis?
AAlcohol use disorder
BMale sex
CSubstance use disorder
DYounger age
3. Which of the following types of bile duct stones is
,B male sex
D pigmented stone
, docholithiasis?
A Calcium oxalate stone
B Cholesterol stone
C Mixed stone
D Pigmented stone
4. A 32-year-old G1A0P1 woman presents with two days B colonic dilation without
of worsening abdominal pain. She has not passed mechanical obstruction
stool or flatus since an uncomplicated spontaneous
vaginal delivery with epidural anesthesia two days
ago. Her medical and surgical history is otherwise un-
remarkable. On examination, her abdomen is distend-
ed, tympanic to percussion, and diffusely tender. The
remainder of her physical exam and vitals are normal.
Which of the following would most likely be seen on a
CT abdomen and pelvis with IV contrast?
A Acute appendicitis
B Colonic dilation without mechanical obstruction
C Intraluminal colorectal mass
D Small bowel obstruction with adhesions
5. A 65-year-old man with myasthenia gravis presents A pH 7.20, PaCO2
with severe headache and drowsiness and is diag- 50mmHG, and bicarbon-
nosed with respiratory acidosis. Which of the follow- ate 23 mEq/L
ing arterial blood gas findings would you expect to see
in this patient?
ApH 7.20, PaCO2 50 mm Hg, and bicarbonate 23
mEq/L
BpH 7.25, PaCO2 40 mm Hg, and bicarbonate 20
mEq/L
CpH 7.55, PaCO2 30 mm Hg, and bicarbonate 24
mEq/L
, DpH 7.60, PaCO2 40 mm Hg, and bicarbonate 28
mEq/L
6. A 32-year-old man is admitted to the hospital for fever A metabolic acidosis
and severe pain in his right finger. The patient cut his
finger with a hedge trimmer 4 days ago and did not
seek medical treatment. He has been taking ibuprofen
at home. Vital signs are T 39.1°C (102.4°F), BP 88/58
mm Hg, HR 110 bpm, RR 26 breaths per minute, and
pulse oximetry 97% on room air. Physical examination
is significant for a 2 cm laceration over the distal in-
terphalangeal joint of the right index finger. Hand ra-
diographs are significant for a nondisplaced, oblique
fracture of the distal phalanx of the right index finger.
Arterial blood gas values are as follows:
pH: 7.15
pCO2: 36 mm Hg
HCO3: 12 mmol/L
Anion gap: 32 mEq/L
Which of the following acid-base disorders best de-
scribes the patient's condition?
AMetabolic acidosis
BMetabolic alkalosis
CRespiratory acidosis
DRespiratory alkalosis
7. What is the most appropriate IV fluid for a preopera- C lactated ringer solution
tive patient who is NPO?
A5% dextrose in water
BHalf-normal saline
