SPEX Surgery 5

Question 1

A 50-year-old man sustains blunt abdominal trauma with a grade III splenic laceration and is hemodynamically stable. What is the first-line management?

Accepted Answer

Non-operative management with monitoring in ICU

Answer

Hemodynamically stable patients with blunt splenic injuries, including grade III lacerations, are managed non-operatively with serial abdominal exams and hemodynamic monitoring in an ICU setting.

Question 2

Which test is used intraoperatively to verify bile duct patency and identify retained stones during cholecystectomy?

Accepted Answer

Intraoperative cholangiogram (IOC)

Answer

Intraoperative cholangiogram (IOC) is performed by injecting contrast into the cystic duct under fluoroscopy to visualize bile duct anatomy and detect retained stones or ductal injury.

Question 3

A patient develops a triad of hypotension, distended neck veins, and muffled heart sounds after a stab wound to the chest. Which procedure is immediately indicated?

Accepted Answer

Pericardiocentesis or surgical pericardial window

Answer

Beck's triad (hypotension, JVD, muffled heart sounds) indicates cardiac tamponade; immediate pericardiocentesis or surgical pericardial window is required to relieve the pressure.

Question 4

Which of the following is a contraindication to laparoscopic surgery in the acute abdomen?

Accepted Answer

Hemodynamic instability requiring damage control

Answer

Hemodynamically unstable patients requiring damage control surgery are a contraindication to laparoscopy; pneumoperitoneum can further compromise venous return and cardiac output.

Question 5

What is the most common cause of early postoperative small bowel obstruction within the first 30 days after abdominal surgery?

Accepted Answer

Postoperative ileus evolving into mechanical obstruction from adhesions

Answer

Early postoperative small bowel obstruction is most commonly caused by adhesions from the recent surgery and must be distinguished from prolonged ileus, as most will resolve with nasogastric decompression.

SPEX Exam Practice Test

SPEX Exam Practice Test

SPEX Surgery 5