COMLEX-USA Surgery and Emergency Medicine 1 — Questions and Answers
Question 1: A patient presents with sudden onset of tearing chest pain radiating to the back, with unequal blood pressures in bilateral arms. The most likely diagnosis is:
- Acute MI
- Pulmonary embolism
- Aortic dissection (Correct answer)
- Esophageal rupture
Correct answer: Aortic dissection
Aortic dissection classically presents with sudden severe tearing or ripping chest/back pain and pulse or blood pressure differentials between extremities.
Question 2: In the initial management of an acute burn patient, fluid resuscitation in the first 24 hours is guided by which formula?
- Starling equation
- Parkland formula (Correct answer)
- Henderson-Hasselbalch equation
- APACHE II scoring
Correct answer: Parkland formula
The Parkland formula (4 mL × weight in kg × % TBSA burned) with lactated Ringer's guides IV fluid resuscitation in major burns in the first 24 hours.
Question 3: Beck's triad (hypotension, muffled heart sounds, JVD) is the classic presentation of which emergency?
- Tension pneumothorax
- Cardiac tamponade (Correct answer)
- Hemothorax
- Superior vena cava syndrome
Correct answer: Cardiac tamponade
Beck's triad (hypotension, muffled/distant heart sounds, and JVD) is the hallmark of cardiac tamponade from pericardial fluid compressing the heart.
Question 4: A 35-year-old woman presents with right lower quadrant pain, fever, anorexia, and elevated WBC. Rebound tenderness at McBurney's point is present. Diagnosis is:
- Ovarian cyst
- Ectopic pregnancy
- Acute appendicitis (Correct answer)
- Mesenteric adenitis
Correct answer: Acute appendicitis
Acute appendicitis classically presents with periumbilical pain migrating to the RLQ (McBurney's point), fever, anorexia, and leukocytosis.
Question 5: During ATLS primary survey, which is assessed as part of the 'C' component of ABCDE?
- Cervical spine stabilization
- Circulation and hemorrhage control (Correct answer)
- Consciousness level
- Catheter placement
Correct answer: Circulation and hemorrhage control
In ATLS, C stands for Circulation with hemorrhage control — including assessment of blood pressure, pulses, and control of external bleeding.
Question 6: Which sign, elicited by passive right hip flexion with knee extended while supine, suggests peritoneal irritation from appendicitis?
- Psoas sign (Correct answer)
- Obturator sign
- Rovsing's sign
- Murphy's sign
Correct answer: Psoas sign
The psoas sign is positive when extension of the right hip (or passive flexion against resistance) causes RLQ pain, suggesting a retrocecal appendix irritating the psoas muscle.
COMLEX-USA Surgery and Emergency Medicine 1
A patient presents with sudden onset of tearing chest pain radiating to the back, with unequal blood pressures in bilateral arms.
The most likely diagnosis is: