General Surgery Board Review General Surgery Board Review MCQ 4 — Questions and Answers
Question 1: 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?
- Observation and repeat imaging in 6 hours
- CT scan of abdomen and pelvis
- Diagnostic peritoneal lavage
- Immediate exploratory laparotomy (Correct answer)
Correct 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.
Question 2: Which of the following is the most sensitive test for detecting a pheochromocytoma?
- 24-hour urine vanillylmandelic acid (VMA)
- Plasma fractionated metanephrines (Correct answer)
- CT scan of the adrenal glands
- Clonidine suppression test
Correct answer: Plasma fractionated metanephrines
Plasma fractionated metanephrines have sensitivity of approximately 96-99% for pheochromocytoma, making it the preferred first-line biochemical test.
Question 3: 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?
- CT abdomen with IV contrast
- MRI abdomen without contrast (Correct answer)
- Plain X-ray of abdomen
- Repeat ultrasound in 4 hours
Correct 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.
Question 4: Which of the following best describes the Hartmann's procedure?
- Sigmoid resection with primary anastomosis and diverting loop ileostomy
- Anterior resection of the rectum with colorectal anastomosis
- Sigmoid resection with end colostomy and closure of the rectal stump (Correct answer)
- Total colectomy with ileorectal anastomosis
Correct 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.
Question 5: 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?
- Intravesical BCG therapy
- Transurethral resection of bladder tumor (TURBT) alone
- Radical cystectomy with urinary diversion (Correct answer)
- External beam radiation therapy alone
Correct 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.
Question 6: What is the landmark anatomical structure used to distinguish between an indirect and a direct inguinal hernia during surgery?
- Ilioinguinal nerve
- Inferior epigastric vessels (Correct answer)
- Cooper's ligament
- External oblique aponeurosis
Correct 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.
Question 7: 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?
- Immediate arthroscopic repair
- Physical therapy for 3-6 months (Correct answer)
- Open Bankart repair
- Total shoulder arthroplasty
Correct 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.
General Surgery Board Review General Surgery Board Review MCQ 4
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?