General Surgery Board Review Case Studies & Practical Application 3

Question 1

A 28-year-old unrestrained driver is brought in after a high-speed MVA. BP is 88/60, HR 124. FAST exam shows free fluid in the abdomen. Despite 2L IV crystalloid, BP remains 90/62. What is the next step?

Accepted Answer

Emergent exploratory laparotomy

Answer

Hemodynamically unstable blunt abdominal trauma with positive FAST and failure to respond to resuscitation mandates emergent exploratory laparotomy.

Question 2

A 65-year-old male diabetic presents with a 3-day history of scrotal swelling, pain, and fever. Exam reveals crepitus and skin necrosis of the perineum. WBC is 22,000. What is the definitive treatment?

Accepted Answer

Emergent surgical debridement plus IV antibiotics

Answer

Fournier's gangrene requires emergent wide surgical debridement of all necrotic tissue plus broad-spectrum IV antibiotics; delay increases mortality dramatically.

Question 3

A 72-year-old woman with atrial fibrillation on warfarin presents with sudden severe periumbilical pain out of proportion to exam. CT angiography shows SMA thromboembolism with bowel ischemia. INR is 3.2. What is the most appropriate management?

Accepted Answer

Emergent exploratory laparotomy

Answer

Acute mesenteric ischemia with signs of bowel infarction (peritoneal signs) requires emergent surgical exploration for bowel resection and revascularization.

Question 4

A 45-year-old male presents to the ED after a stab wound to the left chest below the nipple line. He is hemodynamically stable with BP 110/70, HR 94. FAST exam is negative. What diagnostic study is most critical?

Accepted Answer

CT chest/abdomen/pelvis with contrast

Answer

A stable patient with thoracoabdominal stab wound requires CT imaging to evaluate for pneumothorax, hemothorax, and occult intra-abdominal injury.

Question 5

A 58-year-old male with Crohn's disease presents with a 1-week history of RLQ pain, low-grade fever, and a tender palpable mass. CT shows a 5 cm abscess adjacent to the terminal ileum. What is the best initial management?

Accepted Answer

CT-guided drainage plus IV antibiotics and bowel rest

Answer

An intra-abdominal abscess from Crohn's disease is best initially treated with CT-guided drainage and antibiotics to allow elective resection under optimized conditions.

General Surgery Board Review Practice Test

General Surgery Board Review Practice Test

General Surgery Board Review Case Studies & Practical Application 3