General Surgery Board Review Surgical Foundation 5 — Questions and Answers
Question 1: Which phase of wound healing is characterized by collagen synthesis and fibroblast proliferation?
- Hemostasis phase
- Inflammatory phase
- Proliferative phase (Correct answer)
- Remodeling phase
Correct answer: Proliferative phase
The proliferative phase (days 4–21) features fibroblast migration, collagen deposition, angiogenesis, and epithelialization.
Question 2: A patient with a pulsatile abdominal mass and hypotension arrives to the ER. CT confirms a 7 cm ruptured AAA. Next step?
- Immediate resuscitation with 4L crystalloid then CT
- Emergent transfer to operating room (Correct answer)
- EVAR in the interventional suite
- Aortogram to plan repair
Correct answer: Emergent transfer to operating room
Hemodynamically unstable ruptured AAA requires immediate OR transfer; delaying for imaging in an unstable patient is lethal.
Question 3: Which intraoperative finding mandates conversion from laparoscopic to open cholecystectomy?
- Mild inflammation of Calot's triangle
- Inability to achieve the critical view of safety (Correct answer)
- Cholelithiasis with a large stone
- Mild adhesions from prior surgery
Correct answer: Inability to achieve the critical view of safety
Failure to achieve the critical view of safety is the definitive indication to convert, because proceeding without it risks misidentification and bile duct injury.
Question 4: A 45-year-old presents with fever, jaundice, and RUQ pain (Charcot's triad). Blood cultures grow gram-negative rods. The addition of altered mental status and hypotension describes which condition?
- Acute cholecystitis
- Courvoisier's sign
- Reynolds' pentad (acute suppurative cholangitis) (Correct answer)
- Mirizzi syndrome
Correct answer: Reynolds' pentad (acute suppurative cholangitis)
Reynolds' pentad adds hypotension and altered mental status to Charcot's triad and indicates severe suppurative cholangitis requiring urgent biliary decompression.
Question 5: During a right hemicolectomy, which structure is at highest risk of inadvertent injury when dividing the mesentery at the base?
- Right ureter (Correct answer)
- Right gonadal vessels
- Superior mesenteric vein
- Right common iliac artery
Correct answer: Right ureter
The right ureter crosses the iliac vessels and runs medially toward the pelvis; it must be identified and protected during right colon mesenteric dissection.
Question 6: Which type of skin graft provides the best long-term durability and least contracture but requires longer donor-site healing?
- Split-thickness skin graft (STSG)
- Full-thickness skin graft (FTSG) (Correct answer)
- Cultured epithelial autograft
- Xenograft
Correct answer: Full-thickness skin graft (FTSG)
Full-thickness skin grafts include the dermis, which resists contracture and provides superior cosmesis but requires primary closure or small donor sites.
Question 7: Which maneuver allows assessment of the pancreatic head and duodenum by reflecting the duodenum and head medially?
- Pringle maneuver
- Cattell-Braasch maneuver
- Kocher maneuver (Correct answer)
- Mattox maneuver
Correct answer: Kocher maneuver
The Kocher maneuver mobilizes the duodenum and pancreatic head from the retroperitoneum, exposing the IVC and aorta posterior to them.
General Surgery Board Review Surgical Foundation 5
Which phase of wound healing is characterized by collagen synthesis and fibroblast proliferation?