General Surgery Board Review Surgical Foundation 3 — Questions and Answers
Question 1: Which suture material is contraindicated in contaminated or infected fields?
- Polydioxanone (PDS)
- Poliglecaprone (Monocryl)
- Braided polyester (Ethibond) (Correct answer)
- Polypropylene (Prolene)
Correct answer: Braided polyester (Ethibond)
Braided multifilament sutures like polyester harbor bacteria in their interstices and are contraindicated in contaminated fields.
Question 2: The Shouldice repair for inguinal hernia primarily relies on which tissue layer for reconstruction?
- Scarpa's fascia
- Transversalis fascia (Correct answer)
- External oblique aponeurosis
- Conjoined tendon to Cooper's ligament
Correct answer: Transversalis fascia
The Shouldice repair uses a four-layer imbrication of the transversalis fascia as the primary load-bearing repair.
Question 3: A 55-year-old develops chylous ascites after an aortic aneurysm repair. What is the initial treatment?
- Total parenteral nutrition
- Medium-chain triglyceride diet and octreotide (Correct answer)
- Immediate re-exploration
- Peritoneal-venous shunt
Correct answer: Medium-chain triglyceride diet and octreotide
A medium-chain triglyceride diet reduces chyle flow by bypassing intestinal lymphatics, and octreotide decreases lymphatic output.
Question 4: During thyroidectomy, injury to which nerve causes hoarseness?
- External branch of the superior laryngeal nerve
- Internal branch of the superior laryngeal nerve
- Recurrent laryngeal nerve (Correct answer)
- Hypoglossal nerve
Correct answer: Recurrent laryngeal nerve
The recurrent laryngeal nerve innervates all intrinsic laryngeal muscles (except cricothyroid); injury causes ipsilateral vocal cord paralysis and hoarseness.
Question 5: The Modified Radical Neck Dissection (MRND) preserves which three structures compared to a radical neck dissection?
- Internal jugular vein, sternocleidomastoid, spinal accessory nerve (Correct answer)
- External jugular vein, platysma, vagus nerve
- Common carotid, internal jugular, spinal accessory nerve
- Sternocleidomastoid, omohyoid, phrenic nerve
Correct answer: Internal jugular vein, sternocleidomastoid, spinal accessory nerve
MRND removes cervical lymph nodes while preserving the internal jugular vein, sternocleidomastoid muscle, and spinal accessory nerve.
Question 6: What is the significance of a positive sentinel lymph node biopsy in melanoma staging?
- Mandates immediate systemic chemotherapy
- Upstages the patient to Stage III disease (Correct answer)
- Requires emergent wide local re-excision
- Confirms distant hematogenous spread
Correct answer: Upstages the patient to Stage III disease
A positive sentinel lymph node indicates regional nodal metastasis, upstaging melanoma to Stage III and guiding further management decisions.
Question 7: Which acid-base disturbance is most commonly seen after prolonged nasogastric tube suctioning?
- Metabolic acidosis with hyperchloremia
- Metabolic alkalosis with hypokalemia (Correct answer)
- Respiratory acidosis with CO2 retention
- Hyperchloremic non-anion gap acidosis
Correct answer: Metabolic alkalosis with hypokalemia
Loss of hydrochloric acid and potassium from gastric suctioning causes hypochloremic hypokalemic metabolic alkalosis.
General Surgery Board Review Surgical Foundation 3
Which suture material is contraindicated in contaminated or infected fields?