General Surgery Board Review Surgical Foundation 4 — Questions and Answers
Question 1: A patient with a known splenic artery aneurysm is 28 weeks pregnant. What is the threshold for repair?
- Any detected aneurysm regardless of size
- Diameter ≥ 2 cm (Correct answer)
- Diameter ≥ 4 cm
- Only if symptomatic
Correct answer: Diameter ≥ 2 cm
Splenic artery aneurysms ≥2 cm in women of childbearing age or pregnant patients warrant repair due to high rupture risk during pregnancy.
Question 2: Which condition is characterized by right lower quadrant pain, CT showing fat stranding at the terminal ileum, and no bowel wall thickening?
- Crohn's disease
- Acute appendicitis
- Epiploic appendagitis
- Mesenteric adenitis (Correct answer)
Correct answer: Mesenteric adenitis
Mesenteric adenitis presents with RLQ pain, mesenteric lymph node enlargement on CT, and normal bowel wall, often associated with viral illness.
Question 3: The Hartmann's procedure is defined as?
- End colostomy with oversewn rectal stump (Correct answer)
- Loop colostomy with mucous fistula
- Total colectomy with ileorectal anastomosis
- Abdominoperineal resection with permanent colostomy
Correct answer: End colostomy with oversewn rectal stump
Hartmann's procedure resects the sigmoid colon, creates an end colostomy, and oversews the rectal stump — used when primary anastomosis is unsafe.
Question 4: Which electrolyte abnormality is most commonly associated with massive blood transfusion?
- Hyperkalemia and hypocalcemia (Correct answer)
- Hypokalemia and hypernatremia
- Hypomagnesemia and hypophosphatemia
- Hypercalcemia and hyponatremia
Correct answer: Hyperkalemia and hypocalcemia
Massive transfusion causes hyperkalemia from RBC lysis and hypocalcemia from citrate chelation in stored blood.
Question 5: A 70-year-old develops fever, tachycardia, and right upper quadrant pain 5 days after laparoscopic cholecystectomy. CT shows a 4 cm fluid collection in the gallbladder fossa. Best next step?
- Broad-spectrum antibiotics alone
- Immediate re-exploration
- Percutaneous CT-guided drainage (Correct answer)
- ERCP with biliary stent placement
Correct answer: Percutaneous CT-guided drainage
A postoperative biloma or abscess in the gallbladder fossa is best managed with percutaneous image-guided drainage and antibiotics.
Question 6: Which scoring system is used to predict severity and mortality in acute pancreatitis at 48 hours?
- Child-Pugh score
- Ranson's criteria (Correct answer)
- APACHE II score only
- Glasgow-Blatchford score
Correct answer: Ranson's criteria
Ranson's criteria uses 5 admission factors and 6 factors at 48 hours to stratify acute pancreatitis severity and predict mortality.
Question 7: What is the most common cause of early postoperative small bowel obstruction (within 4 weeks of surgery)?
- Adhesions (Correct answer)
- Internal hernia
- Anastomotic stricture
- Ileus
Correct answer: Adhesions
Adhesions from the prior surgery are the most common cause of small bowel obstruction, even in the early postoperative period.
General Surgery Board Review Surgical Foundation 4
A patient with a known splenic artery aneurysm is 28 weeks pregnant.
What is the threshold for repair?