General Surgery Board Review Surgical Foundation 2

Question 1

A patient on warfarin requires emergency appendectomy. INR is 2.8. Which reversal agent acts fastest?

Accepted Answer

4-factor PCC (Kcentra)

Answer

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?

Accepted Answer

Cystic duct and cystic artery

Answer

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?

Accepted Answer

Pulse pressure variation on mechanical ventilation

Answer

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?

Accepted Answer

The antimesenteric wall only

Answer

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?

Accepted Answer

The duodenal bulb and pylorus

Answer

The pylorus-preserving Whipple retains the pylorus and proximal duodenum (~2 cm), reducing dumping syndrome and marginal ulceration.

General Surgery Board Review Practice Test