SPEX Surgery 2 — Questions and Answers
Question 1: A patient undergoes a Whipple procedure (pancreaticoduodenectomy). Which structure is NOT routinely resected during this operation?
- Head of the pancreas
- Duodenum
- Distal stomach
- Splenic flexure of the colon (Correct answer)
Correct answer: Splenic flexure of the colon
The Whipple procedure removes the pancreatic head, duodenum, common bile duct, gallbladder, and often the distal stomach, but the splenic flexure is not part of this resection.
Question 2: Which nerve injury during thyroid surgery results in hoarseness and is the most common laryngeal nerve complication?
- External branch of the superior laryngeal nerve
- Recurrent laryngeal nerve (Correct answer)
- Internal branch of the superior laryngeal nerve
- Glossopharyngeal nerve
Correct answer: Recurrent laryngeal nerve
Recurrent laryngeal nerve injury causes hoarseness (unilateral) or aphonia/airway compromise (bilateral) and is the most feared complication of thyroidectomy.
Question 3: A 65-year-old presents with a pulsatile abdominal mass and abdominal pain radiating to the back. BP is 90/60 mmHg. What is the most appropriate next step?
- CT angiography of the abdomen
- Bedside ultrasound
- Immediate operative intervention (Correct answer)
- Aortography
Correct answer: Immediate operative intervention
A hemodynamically unstable patient with suspected ruptured AAA requires immediate surgical intervention without delay for imaging studies.
Question 4: Which of the following is the preferred initial treatment for acute calculous cholecystitis in a surgically fit patient?
- Antibiotics alone
- Percutaneous cholecystostomy
- Early laparoscopic cholecystectomy (within 72 hours) (Correct answer)
- Delayed cholecystectomy after 6 weeks
Correct answer: Early laparoscopic cholecystectomy (within 72 hours)
Early laparoscopic cholecystectomy within 72 hours of symptom onset is now the preferred treatment for acute calculous cholecystitis in fit patients, with lower morbidity than delayed surgery.
Question 5: In Hartmann's procedure for perforated sigmoid diverticulitis, which of the following best describes the operation?
- Primary anastomosis with protective loop ileostomy
- Sigmoid resection, end colostomy, and oversewn rectal stump (Correct answer)
- Sigmoid resection with primary colorectal anastomosis
- Lavage and drainage without resection
Correct answer: Sigmoid resection, end colostomy, and oversewn rectal stump
Hartmann's procedure involves sigmoid resection, creation of an end colostomy, and closure of the rectal stump, avoiding a primary anastomosis in an unstable, contaminated field.
Question 6: A 40-year-old woman presents with bloody nipple discharge and a retroareolar mass. Core biopsy shows intraductal papilloma. Which statement is correct regarding management?
- Excision is recommended due to risk of concurrent carcinoma (Correct answer)
- Observation alone is sufficient for all intraductal papillomas
- Tamoxifen is first-line treatment
- Total mastectomy is required
Correct answer: Excision is recommended due to risk of concurrent carcinoma
Surgical excision of intraductal papilloma is recommended because of the 10-20% risk of associated carcinoma and to relieve symptoms.
Question 7: Which postoperative complication presents with low-grade fever, leukocytosis, and a wound that opens to reveal a fascial defect with underlying bowel, typically on postoperative day 5-8?
- Surgical site infection
- Wound dehiscence with evisceration (Correct answer)
- Intraabdominal abscess
- Necrotizing fasciitis
Correct answer: Wound dehiscence with evisceration
Wound dehiscence with evisceration classically presents on days 5-8 postoperatively with serosanguineous discharge, fascial separation, and bowel exposure, requiring emergent return to the OR.
SPEX Surgery 2
A patient undergoes a Whipple procedure (pancreaticoduodenectomy).
Which structure is NOT routinely resected during this operation?