General Surgery Board Review MCQ Flashcards

A 55-year-old male presents with painless jaundice, weight loss, and a palpable gallbladder. Which of the following is the most likely diagnosis?

Answer: Pancreatic head carcinoma

Painless jaundice with a palpable, nontender gallbladder (Courvoisier's sign) in the setting of weight loss is classic for pancreatic head carcinoma obstructing the bile duct.

Which artery is most commonly injured during laparoscopic cholecystectomy leading to a major vascular complication?

Answer: Right hepatic artery

The right hepatic artery is the most commonly injured major artery during laparoscopic cholecystectomy, often misidentified as the cystic artery in a short cystic duct scenario.

A patient develops a wound infection 48 hours after bowel resection with fever, severe pain, and skin crepitus. What is the most appropriate next step?

Answer: Immediate surgical debridement

Crepitus with early onset fever and wound pain after bowel surgery indicates necrotizing fasciitis, which requires immediate surgical debridement — imaging should not delay treatment.

In a trauma patient with a liver laceration and hemodynamic instability, which damage control surgery maneuver is most appropriate?

Answer: Perihepatic packing and abdominal closure

Damage control surgery for hemodynamically unstable liver trauma involves perihepatic packing to achieve temporary hemorrhage control, allowing resuscitation before definitive repair.

A 70-year-old woman presents with a 6 cm abdominal aortic aneurysm that is symptomatic. What is the best management?

Answer: Prompt surgical or endovascular repair based on anatomy

A symptomatic AAA carries a high risk of rupture regardless of size and requires urgent repair; the approach (EVAR vs. open) depends on patient anatomy and comorbidities.

Which of the following is the most common cause of small bowel obstruction in adults in the United States?

Answer: Adhesions

Adhesions from prior abdominal surgery account for approximately 60-75% of small bowel obstructions in adults in the US.

A patient undergoes right hemicolectomy. On post-operative day 5, output from the drain is 500 mL of bilious fluid. What is the most likely source?

Answer: Anastomotic leak

Bilious drain output on POD 5 after right hemicolectomy most commonly indicates an anastomotic leak at the ileocolic anastomosis.