ROSH General surgery Questions with
100% Correct Answers
Which of the following medications can be used in the treatment of
hemodynamically stable atrial fibrillation with concomitant Wolff-Parkinson-
White syndrome?
AAdenosine
B Diltiazem
C Ibutilide
DMetoprolol Correct Answer: C
all of the other options are all AV nodal blocking agents and should be avoided
in patients with preexcited atrial fibrillation. Blocking the AV node can promote
and enhance conduction down the accessory pathway, which can deteriorate
into an unstable rhythm such as ventricular tachycardia or ventricular fibrillation.
Triad for Wolff-parkinson white syndrome (EKG characteristics) Correct Answer:
1. Slurred upstroke of QRS (delta wave)
2. shortened PR interval
3. Wide QRS
,A 45-year-old man with a past medical history significant for obesity, status post
partial gastrectomy, returns to the clinic following a recent barium swallow study
for complaints of abdominal pressure and fullness. Results from the study show
displacement of the gastroesophageal junction and herniation of a portion of
the gastric fundus into the thoracic cavity. Which of the following is the most
likely diagnosis?
A. Esophageal motility disorder
B. Esophagitis
C. Paraesophageal hiatus hernia
D. Sliding hiatus hernia Correct Answer: C
Paraesophageal hiatal hernias can be asymptomatic, but may also be
associated with epigastric or postprandial fullness, nausea, and vomiting. Less
commonly, they can be associated with gastroesophageal reflux disease
(GERD) symptoms
Tx: Fundoplication (Necessary if volvulus of stomach occurs)
An elderly man with a history of atrial fibrillation presents with sudden onset of
severe periumbilical pain that is out of proportion to physical examination. A CT
scan will most likely show lack of flow in which visceral vessel?
,A. Celiac trunk
B. Inferior mesenteric artery
C. Superior mesenteric artery
D. Superior mesenteric vein Correct Answer: C
A 65-year-old man with hypertension presents to the clinic complaining of
worsening shortness of breath with physical exertion for the past two weeks. He
has no history of chronic lung disease. He denies chest discomfort and
palpitations. Vital signs include heart rate 78 beats per minute, blood pressure
134/84 mm Hg, temperature 98.8°F, pulse oxygenation 93%, and 20 respirations
per minute. Exam reveals an obese man, bibasilar lung crackles, normal heart
sounds, and 1+ pitting edema in both ankles. Which of the following is the best
next step?
a. Duplex ultrasonography of the lower extremities
b. Echocardiogram
c. Helical chest computed tomography
d. Thoracentesis Correct Answer: B
Aside from infection, what is a serious complication of chronic venous ulcers?
Correct Answer: Malignancy such as squamous cell carcinoma.
An 84-year-old man presents to the clinic with an ulcer on his left medial
malleolus. The 1.5 cm ulcer has an irregular shape and well-defined borders,
and no purulence is noted. The skin surrounding the ulcer is firm, dry, and pruritic.
He has bilateral peripheral edema and hyperpigmentation at his ankles and
, feet. The hyperpigmentation does not change with leg elevation. Aside from
venous duplex ultrasonography, which of the following tests is also
recommended before initiating the treatment for this patient's most likely
condition?
A. Ankle-brachial index
B. Microcirculation assessment
C. Venous plethysmographyYour Answer
D. Wound biopsy Correct Answer: A.
wound care for venous ulcers involves a zinc impregnated gauze wrapped
around the lower extremity and then wrapped with coband to provide
compression. this compression can be detrimental to those with arterial disease,
so ABI is recommended before tx
56-year-old woman with stage IV breast cancer presents to the emergency
department complaining of dyspnea and cough that started one hour ago. She
was first diagnosed with breast cancer five years ago and had a lumpectomy
with adjuvant radiation. She was diagnosed with metastatic disease six months
ago. She also has a history of hypertension, hypothyroidism, and
gastroesophageal reflux disease. Her pulse is 102, blood pressure is 115/76 mm
Hg, respiratory rate is 16, and temperature is 98.3°F. Which of the following is the
most likely diagnosis?
a. Community-acquired pneumonia
100% Correct Answers
Which of the following medications can be used in the treatment of
hemodynamically stable atrial fibrillation with concomitant Wolff-Parkinson-
White syndrome?
AAdenosine
B Diltiazem
C Ibutilide
DMetoprolol Correct Answer: C
all of the other options are all AV nodal blocking agents and should be avoided
in patients with preexcited atrial fibrillation. Blocking the AV node can promote
and enhance conduction down the accessory pathway, which can deteriorate
into an unstable rhythm such as ventricular tachycardia or ventricular fibrillation.
Triad for Wolff-parkinson white syndrome (EKG characteristics) Correct Answer:
1. Slurred upstroke of QRS (delta wave)
2. shortened PR interval
3. Wide QRS
,A 45-year-old man with a past medical history significant for obesity, status post
partial gastrectomy, returns to the clinic following a recent barium swallow study
for complaints of abdominal pressure and fullness. Results from the study show
displacement of the gastroesophageal junction and herniation of a portion of
the gastric fundus into the thoracic cavity. Which of the following is the most
likely diagnosis?
A. Esophageal motility disorder
B. Esophagitis
C. Paraesophageal hiatus hernia
D. Sliding hiatus hernia Correct Answer: C
Paraesophageal hiatal hernias can be asymptomatic, but may also be
associated with epigastric or postprandial fullness, nausea, and vomiting. Less
commonly, they can be associated with gastroesophageal reflux disease
(GERD) symptoms
Tx: Fundoplication (Necessary if volvulus of stomach occurs)
An elderly man with a history of atrial fibrillation presents with sudden onset of
severe periumbilical pain that is out of proportion to physical examination. A CT
scan will most likely show lack of flow in which visceral vessel?
,A. Celiac trunk
B. Inferior mesenteric artery
C. Superior mesenteric artery
D. Superior mesenteric vein Correct Answer: C
A 65-year-old man with hypertension presents to the clinic complaining of
worsening shortness of breath with physical exertion for the past two weeks. He
has no history of chronic lung disease. He denies chest discomfort and
palpitations. Vital signs include heart rate 78 beats per minute, blood pressure
134/84 mm Hg, temperature 98.8°F, pulse oxygenation 93%, and 20 respirations
per minute. Exam reveals an obese man, bibasilar lung crackles, normal heart
sounds, and 1+ pitting edema in both ankles. Which of the following is the best
next step?
a. Duplex ultrasonography of the lower extremities
b. Echocardiogram
c. Helical chest computed tomography
d. Thoracentesis Correct Answer: B
Aside from infection, what is a serious complication of chronic venous ulcers?
Correct Answer: Malignancy such as squamous cell carcinoma.
An 84-year-old man presents to the clinic with an ulcer on his left medial
malleolus. The 1.5 cm ulcer has an irregular shape and well-defined borders,
and no purulence is noted. The skin surrounding the ulcer is firm, dry, and pruritic.
He has bilateral peripheral edema and hyperpigmentation at his ankles and
, feet. The hyperpigmentation does not change with leg elevation. Aside from
venous duplex ultrasonography, which of the following tests is also
recommended before initiating the treatment for this patient's most likely
condition?
A. Ankle-brachial index
B. Microcirculation assessment
C. Venous plethysmographyYour Answer
D. Wound biopsy Correct Answer: A.
wound care for venous ulcers involves a zinc impregnated gauze wrapped
around the lower extremity and then wrapped with coband to provide
compression. this compression can be detrimental to those with arterial disease,
so ABI is recommended before tx
56-year-old woman with stage IV breast cancer presents to the emergency
department complaining of dyspnea and cough that started one hour ago. She
was first diagnosed with breast cancer five years ago and had a lumpectomy
with adjuvant radiation. She was diagnosed with metastatic disease six months
ago. She also has a history of hypertension, hypothyroidism, and
gastroesophageal reflux disease. Her pulse is 102, blood pressure is 115/76 mm
Hg, respiratory rate is 16, and temperature is 98.3°F. Which of the following is the
most likely diagnosis?
a. Community-acquired pneumonia
