COMLEX-USA Surgery and Emergency Medicine 2 — Questions and Answers
Question 1: Which is the most common cause of small bowel obstruction in adults in the United States?
- Hernia
- Malignancy
- Adhesions from prior surgery (Correct answer)
- Crohn's disease
Correct answer: Adhesions from prior surgery
Adhesions from prior abdominal surgery account for approximately 60–75% of small bowel obstructions in adults.
Question 2: A trauma patient has absent breath sounds on the left, hypotension, and tracheal deviation to the right. Immediate action is:
- Chest X-ray
- CT scan of chest
- Needle decompression of the left chest (Correct answer)
- Intubation
Correct answer: Needle decompression of the left chest
Tension pneumothorax (absent breath sounds, hypotension, tracheal deviation away from the affected side) is a clinical diagnosis requiring immediate needle decompression.
Question 3: Which condition presents with colicky flank pain radiating to the groin, hematuria, and nausea — often described as the worst pain of the patient's life?
- Acute pyelonephritis
- Renal cell carcinoma
- Ureterolithiasis (renal/ureteral stone) (Correct answer)
- Ovarian torsion
Correct answer: Ureterolithiasis (renal/ureteral stone)
Ureteral colic from a kidney stone causes severe colicky flank-to-groin pain, hematuria, and nausea due to ureteral obstruction and spasm.
Question 4: A patient develops fever, purulent wound discharge, and erythema on post-op day 5 from an appendectomy. The most likely cause is:
- DVT
- Atelectasis
- Wound infection (Correct answer)
- Pneumonia
Correct answer: Wound infection
Wound infection typically presents 3–7 days after surgery with fever, erythema, warmth, and purulent discharge at the incision site.
Question 5: In acute cholecystitis, which physical exam finding is pain with palpation of the RUQ that increases with inspiration?
- Cullen's sign
- Grey-Turner's sign
- Murphy's sign (Correct answer)
- Kehr's sign
Correct answer: Murphy's sign
Murphy's sign is cessation of inspiration due to pain when the examiner presses the RUQ and the inflamed gallbladder descends to meet the fingers.
Question 6: Which surgical complication presents with fever, tachycardia, elevated WBC, and rigidity beginning 24–48 hours after bowel surgery?
- Pulmonary embolism
- Anastomotic leak (Correct answer)
- Superficial wound infection
- Urinary retention
Correct answer: Anastomotic leak
Anastomotic leak after bowel surgery presents with fever, tachycardia, leukocytosis, and peritoneal signs due to bowel contents leaking into the peritoneum.
COMLEX-USA Surgery and Emergency Medicine 2
Which is the most common cause of small bowel obstruction in adults in the United States?