General Surgery Board Review Case Studies & Practical Application 2

Question 1

A 55-year-old male presents with sudden-onset severe epigastric pain radiating to the back, nausea, and vomiting after a heavy meal. Serum lipase is 1,200 U/L. CT scan shows peripancreatic fat stranding without necrosis. What is the most appropriate initial management?

Accepted Answer

NPO, IV fluids, and analgesics

Answer

Mild acute pancreatitis is managed conservatively with bowel rest, aggressive IV fluid resuscitation, and pain control.

Question 2

A 68-year-old woman undergoes elective sigmoid colectomy. On postoperative day 5, she develops fever, abdominal distension, and CT shows a 4 cm pelvic fluid collection with air-fluid level. What is the best next step?

Accepted Answer

CT-guided percutaneous drainage

Answer

A well-defined postoperative pelvic abscess is best managed with CT-guided percutaneous drainage combined with antibiotics.

Question 3

A 42-year-old male with a BMI of 38 undergoes laparoscopic Roux-en-Y gastric bypass. On postoperative day 2, his heart rate rises to 118 bpm and he complains of left shoulder pain. What complication must be ruled out first?

Accepted Answer

Anastomotic leak

Answer

Tachycardia with left shoulder pain (referred from diaphragmatic irritation) after gastric bypass is a red flag for anastomotic leak until proven otherwise.

Question 4

A 70-year-old man presents with a pulsatile abdominal mass. CT angiography reveals a 6.2 cm infrarenal AAA with no symptoms. He is an active smoker with well-controlled hypertension. What is the recommended management?

Accepted Answer

Endovascular aneurysm repair (EVAR)

Answer

EVAR is preferred over open repair for anatomically suitable infrarenal AAAs ≥5.5 cm due to lower perioperative morbidity.

Question 5

A 35-year-old woman presents with right lower quadrant pain, fever, and leukocytosis. CT scan shows a 10 mm appendix with periappendiceal fat stranding and a 3 cm periappendiceal abscess. What is the best initial management?

Accepted Answer

CT-guided drainage plus IV antibiotics

Answer

A periappendiceal abscess is optimally treated with CT-guided drainage and IV antibiotics, followed by interval appendectomy after resolution.

General Surgery Board Review Practice Test

General Surgery Board Review Practice Test

General Surgery Board Review Case Studies & Practical Application 2