SPEX Surgery 3

Question 1

Which scoring system is used to predict the severity of acute pancreatitis and assess the risk of mortality within 48 hours of admission?

Accepted Answer

APACHE II score and Ranson's criteria

Answer

APACHE II score and Ranson's criteria are both used to stratify severity of acute pancreatitis; Ranson's uses 11 criteria assessed at admission and 48 hours.

Question 2

A 55-year-old man undergoes right hemicolectomy. On postoperative day 3, he develops fever, tachycardia, and oliguria. CT shows a fluid collection near the anastomosis. What is the most likely diagnosis?

Accepted Answer

Anastomotic leak

Answer

Anastomotic leak after colorectal surgery typically presents on days 3-7 with fever, tachycardia, ileus, and peritoneal signs, often confirmed with CT showing extraluminal air or fluid.

Question 3

Which hernias are more common in women and have the highest risk of incarceration and strangulation?

Accepted Answer

Femoral hernias

Answer

Femoral hernias are more prevalent in women, pass below the inguinal ligament through the femoral canal, and have the highest rate of strangulation among common hernias due to the narrow neck.

Question 4

During laparoscopic appendectomy, the appendix appears normal. What is the most important next intraoperative step?

Accepted Answer

Inspect the terminal ileum for Meckel's diverticulum or Crohn's disease

Answer

When the appendix is normal, careful inspection of at least 60-80 cm of terminal ileum for alternative pathology (Meckel's diverticulum, Crohn's disease, mesenteric adenitis) is essential.

Question 5

Which intraoperative finding in a patient undergoing cholecystectomy mandates conversion from laparoscopic to open technique?

Accepted Answer

Inability to clearly delineate the critical view of safety

Answer

The critical view of safety requires clear identification of the cystic duct and cystic artery; inability to achieve this mandates conversion to open surgery to prevent bile duct injury.

SPEX Exam Practice Test

SPEX Exam Practice Test

SPEX Surgery 3