NCCPA Surgical Principles 3 — Questions and Answers
Question 1: Which sign is MOST indicative of bowel ischemia in a postoperative patient?
- Mild abdominal distension
- Lactic acidosis with peritoneal signs (Correct answer)
- Low-grade fever with nausea
- Decreased bowel sounds on auscultation
Correct answer: Lactic acidosis with peritoneal signs
Lactic acidosis combined with peritoneal signs suggests bowel ischemia with impending necrosis requiring urgent surgical intervention.
Question 2: In a patient undergoing general anesthesia, the MOST dangerous complication of succinylcholine administration is:
- Bradycardia
- Malignant hyperthermia (Correct answer)
- Hypotension
- Bronchospasm
Correct answer: Malignant hyperthermia
Succinylcholine can trigger malignant hyperthermia in susceptible individuals, causing life-threatening hypermetabolic crisis treated with dantrolene.
Question 3: The MOST appropriate management for a 2-cm incidental adrenal mass found on CT in a normotensive patient is:
- Immediate adrenalectomy
- Biochemical evaluation for hormone excess and follow-up imaging (Correct answer)
- Biopsy to rule out malignancy
- No further workup needed
Correct answer: Biochemical evaluation for hormone excess and follow-up imaging
Incidental adrenal masses require hormonal evaluation (cortisol, metanephrines, aldosterone) and imaging follow-up per established incidentaloma guidelines.
Question 4: Which of the following BEST describes the principle of a tension-free anastomosis?
- Using absorbable suture only
- Ensuring adequate blood supply and no tension at the anastomotic site (Correct answer)
- Performing hand-sewn rather than stapled technique
- Using large bites of tissue to prevent leakage
Correct answer: Ensuring adequate blood supply and no tension at the anastomotic site
Adequate blood supply and absence of tension at the anastomosis are the two most critical factors preventing anastomotic leak.
Question 5: A patient presents with abdominal rigidity, free air under the diaphragm, and hemodynamic instability after blunt trauma. The NEXT step is:
- CT scan of abdomen and pelvis
- Diagnostic peritoneal lavage
- Emergent exploratory laparotomy (Correct answer)
- Bedside ultrasound (FAST exam)
Correct answer: Emergent exploratory laparotomy
Hemodynamic instability with peritoneal signs and free air indicates hollow viscus perforation requiring immediate operative intervention without delay for imaging.
Question 6: Virchow's triad, predisposing to deep vein thrombosis, includes all of the following EXCEPT:
- Venous stasis
- Endothelial injury
- Hypercoagulability
- Arterial vasospasm (Correct answer)
Correct answer: Arterial vasospasm
Virchow's triad consists of venous stasis, endothelial injury, and hypercoagulability; arterial vasospasm is not a component.
Question 7: Which anastomotic technique is MOST associated with a reduced leak rate in colorectal surgery?
- Single-layer absorbable suture
- Double-layer technique with inner absorbable and outer permanent suture
- Stapled technique with adequate blood supply and no tension (Correct answer)
- Fibrin glue reinforcement
Correct answer: Stapled technique with adequate blood supply and no tension
Stapled anastomoses with adequate perfusion and tension-free technique have equivalent or lower leak rates and are widely used in colorectal surgery.
NCCPA Surgical Principles 3
Which sign is MOST indicative of bowel ischemia in a postoperative patient?