General Surgery Board Review MCQ Flashcards

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?

Answer: Needle stick

Needle stick injuries carry the highest risk of occupational HIV exposure because they involve direct percutaneous inoculation of blood. This allows for efficient transfer of the virus into the bloodstream, bypassing the protective barriers of intact skin or mucous membranes. Other exposure routes, while carrying some risk, are generally less efficient in transmitting the virus.

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?

Answer: Type II hypersensitivity reaction

This scenario describes an ABO incompatibility, where an O-positive recipient (who has anti-A and anti-B antibodies) receives a B-negative kidney. The recipient's pre-existing antibodies immediately attack the donor kidney's B antigens, leading to hyperacute rejection. This rapid, antibody-mediated destruction of the graft is a classic example of a Type II hypersensitivity reaction.

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?

Answer: Performing 3 quadrant hemorrhoidectomy instead of 2

Postoperative urinary retention is a common complication after hemorrhoidectomy, often exacerbated by the extent of surgical trauma. Performing a 3-quadrant hemorrhoidectomy involves more extensive dissection and tissue manipulation compared to a 2-quadrant procedure. This increased surgical insult can lead to greater pain, inflammation, and reflex spasm of the pelvic floor muscles, thereby increasing the risk of urinary retention.

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?

Answer: Coagulation factor deficiency

A prolonged r-time (reaction time) on a thromboelastograph (TEG) indicates a delay in the initial formation of the clot. This parameter specifically reflects the activity and availability of coagulation factors. Therefore, a prolonged r-time strongly suggests a deficiency or impaired function of these essential factors, which are necessary for initiating the coagulation cascade.

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?

Answer: Flexible proctosigmoidoscopy

In a patient with Crohn's disease presenting with hemorrhoidal symptoms, it is crucial to first rule out other perianal manifestations of Crohn's, such as fissures, fistulas, or proctitis. Flexible proctosigmoidoscopy allows for direct visualization of the distal colon and rectum, enabling accurate diagnosis. This prevents misdiagnosis and avoids potentially harmful surgical interventions for hemorrhoids that could complicate underlying inflammatory bowel disease.

Which of the following can happen if carbon dioxide (CO2) is quickly inhaled into the abdomen?

Answer: Bradycardia

Rapid insufflation of carbon dioxide (CO2) into the abdomen during laparoscopy can lead to increased vagal tone. This stimulation of the vagus nerve, often due to peritoneal stretching and CO2 absorption causing hypercapnia and acidosis, can result in bradycardia (slowing of the heart rate). This is a known physiological response during laparoscopic procedures.

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?

Answer: Buprenorphine should be continued and supplemented with non-opiate adjuncts.

For patients on buprenorphine maintenance therapy (BMT), it is generally recommended to continue buprenorphine perioperatively to prevent withdrawal symptoms and maintain treatment for opioid use disorder. Abrupt discontinuation can precipitate withdrawal and increase the risk of relapse. Instead, pain management should be supplemented with non-opioid analgesics and regional anesthesia, as buprenorphine's high receptor affinity can block the effects of exogenous opioids.