Surgery Flashcards

A 70-year-old patient develops sudden-onset severe abdominal pain, bloody diarrhea, and has atrial fibrillation. CT shows pneumatosis intestinalis and portal venous gas. What is the diagnosis?

Answer: Acute mesenteric ischemia with bowel infarction

Pneumatosis intestinalis and portal venous gas on CT in a patient with A-fib and acute abdominal pain indicate advanced acute mesenteric ischemia with intestinal infarction, requiring emergency surgery.

Which type of shock is characterized by low SVR, high cardiac output, and warm extremities, and is commonly seen in early sepsis?

Answer: Distributive (septic) shock

Distributive/septic shock features vasodilation with low SVR, compensatory high CO, and warm extremities due to profound peripheral vasodilation from inflammatory mediators.

A patient with end-stage renal disease on dialysis requires vascular access. Which is the preferred first-choice access for long-term hemodialysis?

Answer: Arteriovenous fistula (AVF)

Arteriovenous fistula (AVF) is preferred per KDOQI guidelines due to its superior long-term patency, lower infection rate, and fewer complications compared to grafts or catheters.

During an open inguinal hernia repair (Lichtenstein technique), which structure forms the floor of the inguinal canal that is reinforced with mesh?

Answer: Transversalis fascia (posterior wall)

The Lichtenstein tension-free repair places mesh to reinforce the posterior wall of the inguinal canal (transversalis fascia), where direct hernias protrude through Hesselbach's triangle.

Which antibiotic class is recommended for surgical prophylaxis in colorectal surgery to cover both aerobic gram-negative and anaerobic organisms?

Answer: Cefazolin plus metronidazole or cefoxitin

Colorectal prophylaxis requires coverage of both gram-negative aerobes and anaerobes; cefazolin plus metronidazole, or cefoxitin alone, provides appropriate dual coverage.

A 45-year-old woman has a 3 cm adrenal mass found incidentally. It is non-functioning and has imaging characteristics suggesting a lipid-rich adenoma. What is the recommended management?

Answer: Repeat imaging in 6-12 months and reassess

Non-functioning adrenal incidentalomas less than 4 cm with benign imaging features require follow-up CT at 6-12 months and annual hormonal assessment for 4 years per current guidelines.

Which operation is indicated for a patient with Zollinger-Ellison syndrome (ZES) with a sporadic, localized gastrinoma identified on imaging?

Answer: Surgical resection of the gastrinoma

Surgical resection of a sporadic, localized gastrinoma offers the only chance of cure in ZES and is recommended when there is no evidence of unresectable metastatic disease.