General Surgery Board Review Surgical Foundation 2 — Questions and Answers
Question 1: A patient on warfarin requires emergency appendectomy. INR is 2.8. Which reversal agent acts fastest?
- Fresh frozen plasma
- Vitamin K IV
- 4-factor PCC (Kcentra) (Correct answer)
- Protamine sulfate
Correct answer: 4-factor PCC (Kcentra)
4-factor PCC provides immediate reversal of warfarin within minutes and is preferred over FFP for emergent surgery.
Question 2: During laparoscopic cholecystectomy, the critical view of safety requires identification of which two structures entering the gallbladder?
- Cystic duct and cystic artery (Correct answer)
- Common bile duct and hepatic artery
- Cystic duct and common hepatic duct
- Cystic artery and right hepatic artery
Correct answer: Cystic duct and cystic artery
The critical view of safety requires clearing Calot's triangle fat so only the cystic duct and cystic artery are seen entering the gallbladder.
Question 3: Which parameter is most accurate for guiding fluid resuscitation in a critically ill surgical patient?
- Central venous pressure
- Mean arterial pressure
- Urine output alone
- Pulse pressure variation on mechanical ventilation (Correct answer)
Correct answer: Pulse pressure variation on mechanical ventilation
Pulse pressure variation >13% on controlled mechanical ventilation reliably predicts fluid responsiveness and guides resuscitation.
Question 4: A Richter hernia is defined as herniation of which portion of the bowel?
- The entire bowel circumference
- The antimesenteric wall only (Correct answer)
- The mesenteric wall only
- A Meckel's diverticulum
Correct answer: The antimesenteric wall only
A Richter hernia involves only the antimesenteric portion of the bowel wall, so obstruction may be absent despite strangulation.
Question 5: In Whipple's procedure (pancreaticoduodenectomy), which structure is preserved in the pylorus-preserving variant?
- The duodenal bulb and pylorus (Correct answer)
- The gallbladder
- The distal common bile duct
- The head of the pancreas
Correct answer: The duodenal bulb and pylorus
The pylorus-preserving Whipple retains the pylorus and proximal duodenum (~2 cm), reducing dumping syndrome and marginal ulceration.
Question 6: Which type of surgical wound has the highest infection rate?
- Clean (Class I)
- Clean-contaminated (Class II)
- Contaminated (Class III)
- Dirty-infected (Class IV) (Correct answer)
Correct answer: Dirty-infected (Class IV)
Dirty-infected (Class IV) wounds, which involve pre-existing infection or perforated viscus, carry the highest surgical site infection rate (>40%).
Question 7: A trauma patient arrives with Beck's triad (hypotension, muffled heart sounds, JVD). Immediate treatment is?
- Chest tube insertion
- Pericardiocentesis (Correct answer)
- Pericardial window in the OR
- Emergent thoracotomy with pericardiotomy
Correct answer: Pericardiocentesis
Beck's triad indicates cardiac tamponade; emergent pericardiocentesis is the immediate life-saving intervention while preparing for definitive surgical drainage.
General Surgery Board Review Surgical Foundation 2
A patient on warfarin requires emergency appendectomy.
INR is 2.8.
Which reversal agent acts fastest?