Acute Surgical Presentations Flashcards

A 40-year-old woman presents with colicky right flank pain radiating to the groin, hematuria, and nausea. CT KUB shows a 7 mm stone at the ureterovesical junction with mild hydronephrosis. She is afebrile and pain-controlled. What is the management?

Answer: Medical expulsive therapy with tamsulosin and close follow-up

A 7 mm ureteral stone without infection or renal failure can be managed conservatively with medical expulsive therapy (alpha-blocker) and analgesia, as spontaneous passage is likely with close monitoring.

A 30-year-old man presents 3 days after a cat bite to the right hand with fever, ascending lymphangitis, and purulent wound discharge. He is penicillin-allergic (anaphylaxis). Blood cultures are pending. Which antibiotic covers Pasteurella multocida in a penicillin-anaphylaxis patient?

Answer: Doxycycline or a fluoroquinolone (e.g., ciprofloxacin)

Pasteurella multocida, the key pathogen in cat bites, is resistant to clindamycin; doxycycline or a fluoroquinolone (ciprofloxacin) provides coverage in true penicillin-allergic patients.

A 65-year-old man presents with painless obstructive jaundice, a palpable non-tender gallbladder, and 15 kg weight loss over 3 months. CT shows a mass in the head of the pancreas with dilated biliary and pancreatic ducts. What eponymous sign describes the palpable gallbladder?

Answer: Courvoisier's sign

Courvoisier's sign is a palpable non-tender gallbladder in the setting of painless jaundice, classically indicating malignant biliary obstruction (pancreatic head carcinoma) rather than gallstone disease.

A 55-year-old man with a history of alcoholism presents with hematemesis. Endoscopy reveals bleeding esophageal varices. After band ligation, he remains hemodynamically unstable. What is the appropriate next intervention?

Answer: Sengstaken-Blakemore tube placement as a bridge to TIPS

Persistent variceal hemorrhage uncontrolled by endoscopy requires balloon tamponade (Sengstaken-Blakemore tube) as a temporary bridge while arranging TIPS (transjugular intrahepatic portosystemic shunt).

A 25-year-old woman presents with acute right lower quadrant pain and a positive pregnancy test (beta-hCG 2500 IU/L). Transvaginal ultrasound shows no intrauterine pregnancy and free fluid in the pelvis. She is hemodynamically stable. What is the next step?

Answer: Diagnostic laparoscopy to confirm and treat ectopic pregnancy

Free fluid with no IUP and a positive beta-hCG is ectopic pregnancy until proven otherwise; diagnostic and therapeutic laparoscopy is indicated even in stable patients when the tube cannot be visualized as intact.

A 60-year-old man presents with left lower quadrant pain, fever, and leukocytosis. CT shows pericolic fat stranding and a small extraluminal air bubble adjacent to the sigmoid colon (Hinchey Stage II). He is stable. What is the standard management?

Answer: IV antibiotics and CT-guided drainage of any abscess, with elective sigmoid resection later

Hinchey II diverticulitis (pericolic or pelvic abscess without free perforation) is managed with IV antibiotics and percutaneous drainage if the abscess is ≥3 cm, followed by elective resection.

A 45-year-old man is brought to the ER after a high-speed MVC. He is hemodynamically stable. CT scan shows a grade III splenic laceration with a small perisplenic hematoma but no active extravasation. What is the appropriate management?

Answer: Non-operative management with admission, serial abdominal exams, and bed rest

Hemodynamically stable patients with grade I–III splenic lacerations and no active extravasation are candidates for non-operative management with ICU admission, serial exams, and serial hemoglobin monitoring.