GeneralSurgeryEndofRotation
ExamQuestionsexamwithcorrect
answers
An18-year-old patienthasatibia/fibulafracture followingamotorcycle crash.Twelve hourslaterthe
patientpresentswithincreasedpaindespiteadequatedosesofanalgesicsandimmobilization.Which
ofthefollowingisthemostlikelydiagnosis?
Aavascularnecrosis
Bmyositisossificans
Ccompartmentsyndrome
Dreflexsympatheticdystrophy-correct answer✔✔C
Compartmentsyndromeischaracterized byapathologicalincreaseofpressurewithinaclosedspace
andresultsfromedemaorbleedingwithinthecompartment.Itmayoccurasanearlylocalcomplication
offracture.
A38year-oldmalesustainedafractureoftheleftdistaltibiafollowinga25-footfallandistakentothe
operatingroomforanopenreductioninternal fixationofthedistaltibia.Sixteenhourspost-op,the
patientdevelopssustainedpain,whichisnotrelievedwithnarcotics.Onpassiverangeofmotionofthe
toesthepatient"yells"inagony.Thepatientalsostatesthatthetopofhisfoothasdecreasedsensation.
Onphysicalexaminationthephysicianassistantnotesthatthelegisswollenandthefootiscooltotouch.
Baseduponthisinformationwhatdiagnostic testingshouldbedone?
AX-rayofthelowerlegandankle
BDopplerstudies
CBonescan.
DCompartmentpressure-correct answer✔✔D
,Compartmental pressuresshouldbeobtainedassoonaspossible.Iftheyareelevatedthisisasurgical
emergency.
A35year-oldmaleplacedinathumbspicacastforascaphoidfracture presentscomplainingofforearm
andhandpainthatisnotrelievedwithpainmedicationandelevation.Whichofthefollowingisthe
earliestphysicalexamsignforhiscurrentcondition?
ASlowcapillaryrefill
BLossoftwo-pointdiscrimination
CAbsentperipheral pulses
DPainwithpassive stretch.-correct answer✔✔B
Lossoftwo-pointdiscrimination canbetheearliestsignofcompartmentsyndrome.
25year-oldmalepresentstotheEDwithleftcalfpainandcramping, aswell asnauseaandvomiting.He
admitsto"partyingwithcocaineallnight".Hedescribeshisurine asadarkbrowncolor.Serum
creatinine kinase (CK)is1325IU/L(NormalRange32-267IU/L).Whichofthefollowingistheinitial
mainstayoftherapyforthiscondition?
AIVrehydration
BFasciotomy
CToradol(Ketorlac)
DHydrotherapy-correct answer✔✔A
IVrehydrationwithcrystalloids for24to72hoursisthemainstayoftherapyforrhabdomyolysis.
A42year-oldmalepresentscomplainingofasuddenonsetofasevereintermittentpainoriginatingin
theflankandradiatingintotherighttesticle.Healsocomplainsofnauseaandvomiting.Onexamination
thepatientisafebrile,butrestless.Examinationoftheabdomenrevealstendernesstopalpationalong
therightflankwithnoreboundordirecttesticular tenderness.Urinalysis revealsapHof5.4and
microscopichematuria, butisotherwise unremarkable.Whichofthefollowingisthemostlikely
diagnosis?
,ABladdercancer
BNephrolithiasis
CAcuteappendicitis
DAcuteepididymitis-correct answer✔✔B
Asuddenonsetofseverecolickyflankpainassociatedwithnauseaandvomitingaswellastheabsence
ofreboundordirecttesticulartenderness makesnephrolithiasis themostlikelydiagnosis.Thisis
furthersupportedbythepresenceofhematuriaontheurinalysis.
Whichofthefollowingpathophysiological processesisbelievedtoinitiate acuteappendicitis?
AObstruction
BPerforation
CHemorrhage
DVascular compromise-correct answer✔✔A
Obstructionoftheappendiceallumenbylymphoidhyperplasia,afecalithorforeignbodyinitiates
mostcasesofappendicitis
Whatisthetermforbluediscolorationabouttheumbilicus?
ACullen'ssign
BMurphy'ssign
CRovsing'ssign
DTurnersign-correct answer✔✔A
Cullen'ssignisabluediscolorationabouttheumbilicusandcanoccurinhemorrhagic pancreatitis and
resultsfromhemoperitoneum.
, Apatientpresentswithabdominal painintherightlowerquadrant,examinationrevealsincreasedpain
intherightlowerquadrantondeeppalpationoftheleftlowerquadrant.Thiscommonlyknownas
whichofthefollowing?
APsoassign
BMurphy'ssign
CRovsing'ssign
DObturatorsign-correct answer✔✔C
ApositiveRovsing'ssigncanbeelicitedinapatientwithappendicitiswhenincreasedpainoccursinthe
rightlowerquadrantuponpalpationoftheleftlowerquadrant.
A25year-oldfemalepresentswithrightlowerquadrantpain,rightflankpain,nausea,andvomiting.
Hertemperature is39.6degreesC.ThereisrightCVAtendernessandRLQtenderness.Pelvicexamis
unremarkable.UrinalysisrevealspH7.0,traceprotein,negativeglucose,negativeketones,positive
blood,andpositivenitrates.Specific gravityis1.022.Microscopicshows102RBCs/HPF,50-75
WBCs/HPF,rareepithelial cells,andWBCcasts.Themostlikelydiagnosisis
Aacutesalpingitis.
Bnephrolithiasis.
Cacutepyelonephritis.
Dappendicitis.-correct answer✔✔C
Acutepyelonephritispresentswithflankpain,fever,andgeneralizedmuscle tenderness.Urinalysis
showspyuriawithleukocyte casts.
A26year-oldgravida0sexuallyactive femalepresentstotheemergencyroomcomplainingofcolicky
paininherlowerabdomenforthepast12hours.Shepassedoutearlier inthedaywhiletryingtohavea
bowelmovement.Herlastmenstrual periodwas6weeksago.Shehasnotedvaginal spottingoverthe
last24hours.Vital signsshowTemp37degreesC,BP96/60mmHg,P110,R16,OxygenSat.98%.
Abdominalexamispositivefordistensionandtenderness.Bowelsoundsaredecreased.Pelvicexam
showscervical motionandadnexaltenderness.Whichofthefollowingisthemostlikelydiagnosis?
ExamQuestionsexamwithcorrect
answers
An18-year-old patienthasatibia/fibulafracture followingamotorcycle crash.Twelve hourslaterthe
patientpresentswithincreasedpaindespiteadequatedosesofanalgesicsandimmobilization.Which
ofthefollowingisthemostlikelydiagnosis?
Aavascularnecrosis
Bmyositisossificans
Ccompartmentsyndrome
Dreflexsympatheticdystrophy-correct answer✔✔C
Compartmentsyndromeischaracterized byapathologicalincreaseofpressurewithinaclosedspace
andresultsfromedemaorbleedingwithinthecompartment.Itmayoccurasanearlylocalcomplication
offracture.
A38year-oldmalesustainedafractureoftheleftdistaltibiafollowinga25-footfallandistakentothe
operatingroomforanopenreductioninternal fixationofthedistaltibia.Sixteenhourspost-op,the
patientdevelopssustainedpain,whichisnotrelievedwithnarcotics.Onpassiverangeofmotionofthe
toesthepatient"yells"inagony.Thepatientalsostatesthatthetopofhisfoothasdecreasedsensation.
Onphysicalexaminationthephysicianassistantnotesthatthelegisswollenandthefootiscooltotouch.
Baseduponthisinformationwhatdiagnostic testingshouldbedone?
AX-rayofthelowerlegandankle
BDopplerstudies
CBonescan.
DCompartmentpressure-correct answer✔✔D
,Compartmental pressuresshouldbeobtainedassoonaspossible.Iftheyareelevatedthisisasurgical
emergency.
A35year-oldmaleplacedinathumbspicacastforascaphoidfracture presentscomplainingofforearm
andhandpainthatisnotrelievedwithpainmedicationandelevation.Whichofthefollowingisthe
earliestphysicalexamsignforhiscurrentcondition?
ASlowcapillaryrefill
BLossoftwo-pointdiscrimination
CAbsentperipheral pulses
DPainwithpassive stretch.-correct answer✔✔B
Lossoftwo-pointdiscrimination canbetheearliestsignofcompartmentsyndrome.
25year-oldmalepresentstotheEDwithleftcalfpainandcramping, aswell asnauseaandvomiting.He
admitsto"partyingwithcocaineallnight".Hedescribeshisurine asadarkbrowncolor.Serum
creatinine kinase (CK)is1325IU/L(NormalRange32-267IU/L).Whichofthefollowingistheinitial
mainstayoftherapyforthiscondition?
AIVrehydration
BFasciotomy
CToradol(Ketorlac)
DHydrotherapy-correct answer✔✔A
IVrehydrationwithcrystalloids for24to72hoursisthemainstayoftherapyforrhabdomyolysis.
A42year-oldmalepresentscomplainingofasuddenonsetofasevereintermittentpainoriginatingin
theflankandradiatingintotherighttesticle.Healsocomplainsofnauseaandvomiting.Onexamination
thepatientisafebrile,butrestless.Examinationoftheabdomenrevealstendernesstopalpationalong
therightflankwithnoreboundordirecttesticular tenderness.Urinalysis revealsapHof5.4and
microscopichematuria, butisotherwise unremarkable.Whichofthefollowingisthemostlikely
diagnosis?
,ABladdercancer
BNephrolithiasis
CAcuteappendicitis
DAcuteepididymitis-correct answer✔✔B
Asuddenonsetofseverecolickyflankpainassociatedwithnauseaandvomitingaswellastheabsence
ofreboundordirecttesticulartenderness makesnephrolithiasis themostlikelydiagnosis.Thisis
furthersupportedbythepresenceofhematuriaontheurinalysis.
Whichofthefollowingpathophysiological processesisbelievedtoinitiate acuteappendicitis?
AObstruction
BPerforation
CHemorrhage
DVascular compromise-correct answer✔✔A
Obstructionoftheappendiceallumenbylymphoidhyperplasia,afecalithorforeignbodyinitiates
mostcasesofappendicitis
Whatisthetermforbluediscolorationabouttheumbilicus?
ACullen'ssign
BMurphy'ssign
CRovsing'ssign
DTurnersign-correct answer✔✔A
Cullen'ssignisabluediscolorationabouttheumbilicusandcanoccurinhemorrhagic pancreatitis and
resultsfromhemoperitoneum.
, Apatientpresentswithabdominal painintherightlowerquadrant,examinationrevealsincreasedpain
intherightlowerquadrantondeeppalpationoftheleftlowerquadrant.Thiscommonlyknownas
whichofthefollowing?
APsoassign
BMurphy'ssign
CRovsing'ssign
DObturatorsign-correct answer✔✔C
ApositiveRovsing'ssigncanbeelicitedinapatientwithappendicitiswhenincreasedpainoccursinthe
rightlowerquadrantuponpalpationoftheleftlowerquadrant.
A25year-oldfemalepresentswithrightlowerquadrantpain,rightflankpain,nausea,andvomiting.
Hertemperature is39.6degreesC.ThereisrightCVAtendernessandRLQtenderness.Pelvicexamis
unremarkable.UrinalysisrevealspH7.0,traceprotein,negativeglucose,negativeketones,positive
blood,andpositivenitrates.Specific gravityis1.022.Microscopicshows102RBCs/HPF,50-75
WBCs/HPF,rareepithelial cells,andWBCcasts.Themostlikelydiagnosisis
Aacutesalpingitis.
Bnephrolithiasis.
Cacutepyelonephritis.
Dappendicitis.-correct answer✔✔C
Acutepyelonephritispresentswithflankpain,fever,andgeneralizedmuscle tenderness.Urinalysis
showspyuriawithleukocyte casts.
A26year-oldgravida0sexuallyactive femalepresentstotheemergencyroomcomplainingofcolicky
paininherlowerabdomenforthepast12hours.Shepassedoutearlier inthedaywhiletryingtohavea
bowelmovement.Herlastmenstrual periodwas6weeksago.Shehasnotedvaginal spottingoverthe
last24hours.Vital signsshowTemp37degreesC,BP96/60mmHg,P110,R16,OxygenSat.98%.
Abdominalexamispositivefordistensionandtenderness.Bowelsoundsaredecreased.Pelvicexam
showscervical motionandadnexaltenderness.Whichofthefollowingisthemostlikelydiagnosis?
