Colorectal and Abdominal Surgery Final Exam Questions, Exams of General Surgery

Download Colorectal and Abdominal Surgery Final Exam Questions and more Exams General Surgery in PDF only on Docsity! Surgery Final Book Questions A 52 year old woman has never undergone any colorectal cancer screening. Her mother had colon cancer at age 63. What screening test would be most appropriate for this patient? - Colonoscopy A patient with rectal cancer undergoes LAR with primary anastomosis and temporary proximal diverting stoma. The purpose of a temporary proximal diverting stoma is... - To reduce the risk of anastomotic leak A patient undergoes right colectomy for cancer. Pathologic staging reveals T3N1 invasion of the muscularis propria with 2 of 26 lymph nodes positive for cancer. What is the most appropriate next step in treatment? - Chemotherapy A 45 year old man complains of six months of intermittent blood in the stool, fatigue, and vague right sided abdominal pain. The most appropriate next test would be... - Colonoscopy A 38 year old woman undergoes normal spontaneous vaginal delivery. One day later, she notes the acute onset of an excruciatingly painful bump next to the anal opening. Exam of the perineum reveals a tense, blue, tender, two centimeter mass adjacent to the anus. The best treatment would be... - Excision the blood supply to the gallbladder is a branch of the... - Right hepatic artery Bile consists of... - Bile acids, lecithin, cholesterol Which laboratory result would be most consistent with biliary obstruction from choledocholithiasis? - High total bilirubin and high ALP A 60 year old male who is status post open repair of an abdominal aortic aneurysm rupture has been in intensive care unit for the past two weeks since on a ventilator with total parenteral nutrition. He is responsive and able to communicate. He complains of upper abdominal pain that he locates in the right upper quadrant epigastric area. White blood cell count is now 12,500 and the ALP, AST, and ALT are elevated. The total bilirubin is normal. Best test used to diagnose the patient's condition is... - Ultrasound of the right upper quadrant A 72 year old man comes to the clinic because his wife noticed that his eyes are yellow. Recently, he has found that his urine is dark and his stool is light in color. He also has a diminished appetite but is otherwise feeling well without any complaints. His past medical history is unremarkable. He smoked cigarettes for 30 years but quit 15 years ago. On examination, he is afebrile and his vital signs are normal. He is deeply jaundiced and when examining the abdomen, a nontender smooth globular mass is found in the right upper quadrant. The rest of his examination is normal. Which of the following is the most likely diagnosis in this patient? - Bile duct cancer A 20 year old man comes to the emergency department with severe epigastric pain. He has a history of postprandial right upper quadrant discomfort and fatty food intolerance. He has otherwise been healthy. Does not smoke or drink alcohol. Takes no medications. Signs are a temperature of 37C, a blood pressure of 130/80, a pulse of 110 bpm, and respirations of 18. He has severe epigastric tenderness with guarding. There is no scleral icterus. An ultrasound shows gallstones. The bile ducts are not dilated. Laboratory studies show the following: Lipase 20,000 U/L, Amylase 800 U/L, total bilirubin 0.9 mg/dL, alkaline phosphatase 20 mg/dL. Which of the following should be part of his treatment plan? - Supportive treatment and cholecystectomy prior to discharge A 50 year old woman has severe gallstone pancreatitis. She is receiving ivy fluid and is receiving nothing by mouth in an effort to slow pancreatic secretions to reduce the amount of active pancreatic enzymes leaking into the disrupted glandular tissue. Which of the following enzymes is produced by the pancreas and is secreted in its active form? - Amylase A 42 year old man comes to the emergency department with severe abdominal pain. He takes no medications. Drinks a quart of vodka daily and smokes one to two packs of cigarettes daily. His temperature is 38C, his blood pressure is 110/90, his pulse is 20/minute, and his respirations are 24/minute. He has severe epigastric tenderness. Which of the following variables is included in the ransom criteria on admission to predict the severity of the patient's illness? - WBC A 70 year old woman is brought to the clinic by her family because of Jaundice. She also had a 20 pound weight loss over the past few months and has recently noticed very dark urine and light colored stools. Have any pain. Thin. There is a nontender, globular mass in the right upper quadrant. An ultrasound shows dilated intrahepatic and extra hepatic bile ducts with a dilated pancreatic duct and a mass in the head of the pancreas. Mutations in which of the following is most likely associated with this patients diagnosis? - K-ras A 66 year old man presented to the clinic with painless jaundice. Further evaluation with CT imaging and esophageal ultrasound showed a small resectable tumor in the head of the pancreas with no evidence of metastatic disease. EUS-guided biopsy confirmed the diagnosis of pancreatic adenocarcinoma. Pancreatoduodenectomy is planned. Of the following statements regarding the role of adjuvant or neoadjuvant therapy for this patient is true? - Adjuvant and Neoadjuvant strategies can include radiation and/or chemotherapy a 35 year old woman comes to the clinic because of right breast pain for the past three months. The pain is cyclic in nature. Mother and two maternal aunts were all diagnosed with breast cancer in their 30s. No abnormal findings on exam, and a recent diagnostic mammogram and ultrasound are normal. Which of the following would be the most appropriate option for management? - High risk screening and genetic counseling A 35 year old woman comes to the clinic because of a two month history of thickening in the upper outer quadrant of her left breast. The patient's mother had breast cancer at age 48. Physical examination hypodense region. She does not drink alcohol and does not have any history of hepatitis or cirrhosis. Her liver function tests are normal. She does not take oral contraceptive pills. She has no complaints at this time, including no pain, nausea, jaundice, or weight loss. What is your recommendation to this patient? - Repeat imaging, CT or MRI, in 6 to 12 months A 60 year old woman with chronic hepatitis C is brought to an acute care clinic by her family because of increasing confusion. Physical examination identifies jaundice, spider angiomata, and Splenomegaly. Neurologic exam shows the patient to be lethargic, asterixis is present. Which of the following pharmacological agents is most appropriate for the treatment of this condition? - Lactulose A 46 year old man presents to the emergency department with hematemesis. There have been no prior episodes. He admits to drinking a pint of hard liquor daily for more than 10 years. Upper GI endoscopy is performed and shows bleeding esophageal varices. Which of the following is the best management for this patients bleeding? - Endoscopic rubber band ligation A 55 year old man with known cirrhosis presents to the emergency department with severe abdominal pain. He appears ill. His blood pressure is 90/50, his pulse is 110 bpm, his respirations are 24 breaths per minute, and his temperature is 38.8C. The abdomen is distended and tender a fluid wave is present. Blood tests show a hemoglobin of 13 g/dL, a white blood cell count of 16,500/uL, normal electrolytes, a urea nitrogen of 10 mg/dL, and a creatinine of 1.1 mg/dL. A CT scan shows a small shrunken liver, and enlarged spleen, and a large volume of ascites. The ascites is sampled by paracentesis, and the results of the analysis are a white blood cell count of 750 cells/mL with 90% neutrophils, cultures are positive for a single gram negative aerobic organism. Which of the following is the most likely diagnosis? - SBP (spontaneous bacterial peritonitis) For a patient with spontaneous bacterial peritonitis, which of the following is the most appropriate immediate therapy? - IV antibiotics A 68 year old man comes to the office because he noted a pulsating bulge in his abdomen for the past two years, and it is becoming more prominent He has a remote history of MI, and his only risk factors are one pack per day of smoking and hypertension, controlled with a diuretic. His physical exam is normal except for a pulsatile, non tender mass above his umbilicus, which measures 7 centimeters. What is the best initial test for this patient? - CT scan with contrast of the abdomen and pelvis A 70 year old woman responds to an advertisement for cardiovascular screening, which includes an ABI, and EKG and ultrasound for AAA and a carotid duplex ultrasound. She is told that She has a stenosis in her left carotid artery of 50% to 70%, and no significance stenosis in the right carotid bulb. What should your recommendation to her be? - Repeat carotid duplex ultrasound A 50 year old type one diabetic woman has developed an ulcer that penetrates into the fat on the plantar aspect of the left foot, under the ball of her big toe. She has foot swelling so pulses are not palpable, but she has good capillary refill in the toes. The ulcer is not painful and is not clinically infected. What is the next best step for this problem? - Measure ABI and toe pressures A 55 year old man has degenerative hip disease and must undergo a total hip replacement. His BMI is 36.3. To otherwise healthy and has never had an episode of deep venous thrombosis. The most appropriate DVT prophylaxis for him is... - Low molecular weight heparin pre and post op a 35 year old woman comes to the office because of an ulcer on the skin of her left ankle. She developed pigmentation in her left medial ankle several years ago and then developed a superficial, painless ulcer in the center of the pigmented area two months ago. She had been in excellent health prior to that. She works as a school teacher and is on her feet most of the day. She has been unable to heal it with local wound care and comes to see you for treatment. Which of the following diagnostic tests would be most useful? - Venous duplex ultrasound