FREE General Surgery Board Review MCQ Question and Answer
Grade 2 hemorrhoids disease with prolapse and sporadic bleeding are present in a 45-year-old female with a known history of ileocolic Crohn's disease. Which of the following should be carried out before suggesting office-based or surgical treatment?
Explanation:
Before implementing procedural or surgical correction for hemorrhoidal illness, any patient with Crohn's or Crohn's-like symptoms should be addressed with extreme caution. In addition to the patient's underlying wound healing difficulties from perianal Crohn's disease, these patients may be using immune-modulating treatments, including steroids and anti-TNF-alpha therapies that can compromise wound healing.
Despite surgical hemostasis and weaning from cardiopulmonary bypass, a patient continues to hemorrhage. After bypass, a thromboelastograph trace demonstrates a prolonged r-time (reaction time).
Which of the following fits this result the best?
Explanation:
Thromboelastography offers a quick evaluation of clot development and clot breakdown. While a decreased maximal amplitude (MA) is typically observed with platelet dysfunction of deficiency, a prolonged reaction time (R time) indicates coagulation factor insufficiency.
After being injured in a car accident, a 37-year-old woman who is on high-dose (32 mg daily) buprenorphine maintenance therapy (BMT) for a history of opioid use disorder (OUD) presents to the trauma bay. She has a T6-L1 spinal fusion after a computed tomography (CT) scan reveals multiple fractures in the thoracic spine.
How should her perioperative BMT be handled?
Explanation:
Non-opioid analgesic techniques should be used as much as possible during surgery since management advice for this patient population is based on pharmacology and contradictory clinical data. As a result, this article emphasizes perioperative methods created especially for the management of these patients.
A 45-year-old male with HIV has a septoplasty to correct a deviated nasal septum. Which exposure method entails the highest risk of occupational HIV exposure?
Explanation:
The average risk of HIV transmission of 0.32% for needlesticks and 0.03% after exposure to mucosal membranes are indicated by pooled prospective data. Although damage from suture needles has been hypothesized as a potential source of occupational exposure to HIV, prospective investigations have not verified it as a route of transmission.
A male patient, 48 years old, is getting a kidney transplant. After the new kidney has been connected to the patient's vascular supply and implanted, the surgeon immediately notices that the organ is not receiving adequate blood flow. The blood type of the donor is B-negative. in contrast to the O-positive receiver.
What is causing the ischemia event, out of the following?
Explanation:
Hyperacute rejection, which develops minutes after transplantation and is caused by pre-existing recipient antibodies, is affecting this patient.
Which of the following can happen if carbon dioxide (CO2) is quickly inhaled into the abdomen?
Explanation:
A pneumoperitoneum is made by inflating gas into the abdomen during laparoscopic surgery to clear a path for vision and manipulation. It's common to use CO2. With the use of a Veres needle and direct vision provided by a port inserted through a small sub umbilical incision, insufflation can be carried out either blindly or visually. The atrial refract and heart rate may increase as a result of a reflexive rise in vagal tone brought on by sudden stretching of the peritoneum.
A 25-year-old guy who has mixed internal and exterior hemorrhoids that are refractory to medical therapy has a 3 column excisional hemorrhoidectomy. He experiences suprapubic soreness and the inability to urinate later that evening.
Which of the following factors most likely caused this complication?
Explanation:
After anorectal and pelvic surgeries, postoperative urine retention is very typical. The side effects of anesthesia, opioids, anticholinergic drugs, and bed rest may exacerbate this.