General Surgery Board Review General Surgery Board Review MCQ 2 — Questions and Answers
Question 1: A 55-year-old male presents with painless jaundice, weight loss, and a palpable gallbladder. Which of the following is the most likely diagnosis?
- Choledocholithiasis
- Pancreatic head carcinoma (Correct answer)
- Primary sclerosing cholangitis
- Acute cholecystitis
Correct 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.
Question 2: Which artery is most commonly injured during laparoscopic cholecystectomy leading to a major vascular complication?
- Hepatic artery proper
- Right hepatic artery (Correct answer)
- Cystic artery
- Gastroduodenal artery
Correct 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.
Question 3: 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?
- Broad-spectrum IV antibiotics alone
- CT scan of the abdomen and pelvis
- Immediate surgical debridement (Correct answer)
- Wound culture and oral antibiotics
Correct 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.
Question 4: In a trauma patient with a liver laceration and hemodynamic instability, which damage control surgery maneuver is most appropriate?
- Formal hepatic resection
- Perihepatic packing and abdominal closure (Correct answer)
- Pringle maneuver and definitive repair
- Angioembolization
Correct 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.
Question 5: A 70-year-old woman presents with a 6 cm abdominal aortic aneurysm that is symptomatic. What is the best management?
- Watchful waiting with repeat ultrasound in 6 months
- Endovascular aneurysm repair (EVAR)
- Open surgical repair
- Prompt surgical or endovascular repair based on anatomy (Correct answer)
Correct 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.
Question 6: Which of the following is the most common cause of small bowel obstruction in adults in the United States?
- Neoplasm
- Adhesions (Correct answer)
- Incarcerated hernia
- Crohn's disease
Correct answer: Adhesions
Adhesions from prior abdominal surgery account for approximately 60-75% of small bowel obstructions in adults in the US.
Question 7: 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?
- Anastomotic leak (Correct answer)
- Duodenal injury
- Enterocutaneous fistula from the terminal ileum
- Biliary injury
Correct answer: Anastomotic leak
Bilious drain output on POD 5 after right hemicolectomy most commonly indicates an anastomotic leak at the ileocolic anastomosis.
General Surgery Board Review General Surgery Board Review MCQ 2
A 55-year-old male presents with painless jaundice, weight loss, and a palpable gallbladder.
Which of the following is the most likely diagnosis?