General Surgery Board Review MCQ Flashcards

A patient with a penetrating abdominal injury is found to have free air under the diaphragm on plain X-ray and is hemodynamically stable. What is the next best step?

Answer: Immediate exploratory laparotomy

Free air under the diaphragm following penetrating abdominal trauma is an absolute indication for immediate exploratory laparotomy regardless of hemodynamic status.

Which of the following is the most sensitive test for detecting a pheochromocytoma?

Answer: Plasma fractionated metanephrines

Plasma fractionated metanephrines have sensitivity of approximately 96-99% for pheochromocytoma, making it the preferred first-line biochemical test.

A 30-year-old woman presents 2 days postpartum with right lower quadrant pain and fever. Ultrasound is equivocal. What imaging modality is preferred to evaluate for appendicitis?

Answer: MRI abdomen without contrast

MRI is the preferred imaging for suspected appendicitis in postpartum patients when ultrasound is inconclusive, avoiding ionizing radiation while providing excellent soft tissue detail.

Which of the following best describes the Hartmann's procedure?

Answer: Sigmoid resection with end colostomy and closure of the rectal stump

Hartmann's procedure involves resection of the rectosigmoid colon with creation of an end colostomy and closure of the rectal stump, used in emergencies when primary anastomosis is unsafe.

A 55-year-old man presents with painless hematuria. Cystoscopy reveals a sessile bladder mass. Biopsy confirms transitional cell carcinoma invading the muscularis propria. What is the appropriate treatment?

Answer: Radical cystectomy with urinary diversion

Muscle-invasive bladder cancer (T2 or higher) is treated with radical cystectomy with urinary diversion, often preceded by neoadjuvant cisplatin-based chemotherapy.

What is the landmark anatomical structure used to distinguish between an indirect and a direct inguinal hernia during surgery?

Answer: Inferior epigastric vessels

The inferior epigastric vessels serve as the landmark: indirect hernias pass lateral to these vessels through the internal ring, while direct hernias pass medial to them through Hesselbach's triangle.

Which of the following is the most appropriate initial management for a stable patient with a Type II SLAP (superior labrum anterior-to-posterior) tear?

Answer: Physical therapy for 3-6 months

Initial management of a Type II SLAP tear in a stable, non-overhead athlete typically involves physical therapy; surgery is reserved for those who fail conservative treatment.