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46 Cards in this Set
- Front
- Back
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A 15-year-old boy is admitted with a history and physical findings consistent with appendicitis. Which finding is most likely to be positive?
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B. Iliopsoas sign
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A 50-year-old man is admitted with massive bright red rectal bleeding. He recently had a barium enema that demonstrated no diverticular or space-occupying lesion. Nasogastric suction reveals no blood but does produce yellow bile. The patient continues to bleed. What is the next diagnostic step?
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D. Mesenteric angiography
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A 15-yr-old boy awakens with sudden onset of right lower quadrant and scrotal tenderness accompanied by nausea and vomiting. Which of the following is the most appropriate diagnosis and represents a surgical emergency?
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C. Torsion of the testicle
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A 47-year-old woman presents with dysphagia to both solids and liquids equally. She has experienced a 10-kg weight loss over the last several months. A barium swallow reveals a birdlike narrowing in the distal esophagus. What is the underlying cause of her symptoms?
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B. Failure of the lower esophageal sphincter to relax
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A 45-year-old executive is seen because he is vomiting bright red blood. There are no previous symptoms. The man admits to one drink a week and has no other significant history. In the hospital, he bleeds five units of blood before endoscopy. What is the most likely diagnosis?
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B. Duodenal ulcer
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Massive bleeding from the lower GI tract is occuring in a 55-yr-old man who is otherwise healthy. After continued bleeding equivalent to one unit of blood, what should be the initial management?
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C. Arteriography to identify the bleeding site after anoscopy and sigmoidoscopy have ruled out a distal site
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A 45-yr-old man is seen in the ER after vomiting bright red blood. He has no previous symptoms. He drinks one alcoholic beverage a day.
What is the most reliable method for locating the lesion responsible for the bleeding? |
C. Upper endoscopy
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A 45-yr-old man is seen in the ER after vomiting bright red blood. He has no previous symptoms. He drinks one alcoholic beverage a day.
After several hours in the hospital, he begins to have recurrent bleeding. He is transferred to a critical care bed and is persistently hypotensive despite transfusion of nine units of packed red blood cells. Which is the most appropriate next step in the management of this patient? |
D. Laparotomy to control bleeding
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A 45-yr-old woman who has had a hysterectomy presents to the ER with abdominal pain and vomiting. A mechanical small bowel obstruction is seen on the abdominal radiograph. Wgat is the most likely cause for this obstruction?
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C. Adhesions
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A 25-yr-old man is admitted with a history of sudden onset of severe midepigrastic abdominal pain. Upright chest radiograph reveals free intraperitoneal air. What is the therapy for this patient?
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E. Laparotomy
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An 80-yr-old male patient is referred for dysphagia with reflux of undigested food. The patient occasionally notices a bulging in his left neck. Which of the following is the most appropriate definitive treatment?
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C. Cricopharyngeal myotomy
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A 42-yr-old female patient is diagnosed with gastroesophageal reflux and is started on medical therapy. Which of the following would be an indication for surgial antireflux procedure.
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A. Development of esophageal stricture(s)
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A 75-year-old male patient presents to the ER 2 hours after developing severe chest pain with repeated episodes of vomiting. He is tachycardic and febrile. A chest radiograph demonstrates a left pleural effusion. Emergent barium smallow reveals extravasation of contrast into the left chest. Proper definitive treatment of this patient would include which of the following?
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B. Emergent surgical intervention
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A 65-year-old patient has been treated with pharmacologic therapy for an antral gastric ulcer for 12 weeks. A repeat upper GI series shows approximately 50% shrinkage of the ulcer.
What further management should the patient undergo at this time? |
C. An upper endoscopy with multiple biopsies
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A 65-year-old patient has been treated with pharmacologic therapy for an antral gastric ulcer for 12 weeks. A repeat upper GI series shows approximately 50% shrinkage of the ulcer.
After further diagnostic work-up, the patient is found to have a gastric adenocarcinoma. Metastatic work-up is negative. Therapy with curative intent would involve which of the following? |
B. Distal gastrectomy followed by adjuvant chemoradiotherapy
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Which of the following statements is true about the performance of a parietal cell vagotomy?
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B. It maintains the innervation of the pylorus so that a drainage procedure is not required
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What innerves the stomach resulting in parietal cell secretion and gastrin release?
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B. Vagus nerve
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Which of the following is true regarding intestinal absorption of nutrients?
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C. Parathormone increases the intestinal absorption of dietary calcium
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A previously health 43-yr-old man presents with a 6-month hx of nonbloody diarrhea, fever, and 10-lb weight loss and now develops urosepsis. On eval, an enterovesical fistula (ileum to bladder) is found. At laparotomy, findings include inflammation and "fat wrapping" of three separate segments of ileum. Each segment is approximately 20 cm in length and is separated by less than 20 cm segments of normal bowel (skip areas). The distal most is more severely inflamed than the others and involves the terminal ileum all the way to the cecum. This segment of ileum is densely adherent to the right superior aspect of the bladder.
Which of the following is true? |
E. Closure of the fistula and resection of the involved bowel are preferred
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A previously health 43-yr-old man presents with a 6-month hx of nonbloody diarrhea, fever, and 10-lb weight loss and now develops urosepsis. On eval, an enterovesical fistula (ileum to bladder) is found. At laparotomy, findings include inflammation and "fat wrapping" of three separate segments of ileum. Each segment is approximately 20 cm in length and is separated by less than 20 cm segments of normal bowel (skip areas). The distal most is more severely inflamed than the others and involves the terminal ileum all the way to the cecum. This segment of ileum is densely adherent to the right superior aspect of the bladder.
The pt. returns 3 yrs later c/o abdominal pain, abdominal distention, bloating after meals, and intermittent constipation interspersed with diarrhea. He has lost 20 lbs in 3 months. An upper GI series with a small bowel follow through reveals one area of tight stricture in the distal small bowel, which appears to be 10 cm in length. Which of the following is true? |
B. Postoperatively, this patient's chance of another recurrence requiring surgery is 50%
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A 32-year-old male executive with long-standing Crohn's disease presents with a complete obstruction of the small bowel. At laparotomy, scarring of the distal ileum and cecum cause an obstruction. A 10-cm segment of mid small bowel shows moderate nonobstructive Crohn's disease.
Which operative procedure should be performed at this time? |
E. Resection of distal ileum and cecum
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A 32-year-old male executive with long-standing Crohn's disease presents with a complete obstruction of the small bowel. At laparotomy, scarring of the distal ileum and cecum cause an obstruction. A 10-cm segment of mid small bowel shows moderate nonobstructive Crohn's disease.
Postoperatively, the patient requires an indwelling bladder catheter for 5 days to treat urinary retention. He does well until the tenth postop day, at which point he develops a fever of 103 F, right lower quadrant pain, and an ileus. The midline wound is not inflamed. Which of the following is most likely to have developed? |
D. Intra-abdominal abscess
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A 32-year-old male executive with long-standing Crohn's disease presents with a complete obstruction of the small bowel. At laparotomy, scarring of the distal ileum and cecum cause an obstruction. A 10-cm segment of mid small bowel shows moderate nonobstructive Crohn's disease.
After successful surgery and discharge from the hospital, which of the following is true? |
C. The recurrence rate is higher than the 50% during the next 5 - 10 years.
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A 63-yr-old man presents with a 3-day history of increasing cramping abdominal pain, constipation, and intermittent vomiting. He continues to pass gas. Other than the present complaints, he has been healthy. Examination reveals a distended abdomen with high-pitched bowel sounds. No localized tenderness and no rectal masses are noted. The stool is heme positive.
Diagnostically, the first step should be to perform which of the following? |
C. Flat plate and erect abdominal radiographs
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A 63-yr-old man presents with a 3-day history of increasing cramping abdominal pain, constipation, and intermittent vomiting. He continues to pass gas. Other than the present complaints, he has been healthy. Examination reveals a distended abdomen with high-pitched bowel sounds. No localized tenderness and no rectal masses are noted. The stool is heme positive.
Therapeutically, the first step should be which of the following? |
C. Intravenous fluids, nasogastric suction, and careful observation
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A 60-yr-old patient who is finishing a course of antibiotic therapy for bacterial pneumonia develops cramping abdominal pain and profuse watery diarrhea. A diagnosis of pseudomembranous or antibiotic-associated colitis is suspected.
Which of the following is the quickest way to establish the diagnosis? |
D. Proctoscopy
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A 60-yr-old patient who is finishing a course of antibiotic therapy for bacterial pneumonia develops cramping abdominal pain and profuse watery diarrhea. A diagnosis of pseudomembranous or antibiotic-associated colitis is suspected.
What would the initial treatment involve? |
A. Metronidazole
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During exploration for a transverse colon tumor, a surgeon incidentally notices a 2-cm diverticulum of the small bowel located 2 ft proximal to the ileocecal valve. Which of teh following statments are NOT true?
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A. This diverticulum should be resected when found due to an associated increased risk of malignancy
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A 55-yr-old man presents with a 24-hr history of increasingly severe left lower quadrant abdominal pain. On examination, he has tenderness localized in the left lower quadrant with rebound. Fever and leuocytosis are present. The clinical suspicion of diverticulitis would be best confirmed by which of the following?
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C. CT scan of the abdomen and pelvis
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30. A 45-yr-old woman with diabetes presents with a 2-day history of acute perirectal pain. On examination, a tender fluctuant mass is present to the left of the anus. What treatment should be administered at this time?
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C. Incision and drainage of the abscess
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A 34-yr-old female patient in previous good health presents in the ER with spontaneous intraperitoneal hemorrhage. Her only medication is an oral contraceptive that she has been taking for the past 5 yrs. During resuscitation, a bedside ultrasound reveals a large amount of intraperitoneal blood and a 3-cm mass in the right lobe of her liver.
What is the likely cause of her hemorrhage? |
D. Hepatic cell adenoma
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A 34-yr-old female patient in previous good health presents in the ER with spontaneous intraperitoneal hemorrhage. Her only medication is an oral contraceptive that she has been taking for the past 5 yrs. During resuscitation, a bedside ultrasound reveals a large amount of intraperitoneal blood and a 3-cm mass in the right lobe of her liver.
The patient continues to bleed and requires a transfusion. What further treatment should be undertaken? |
D. Angiographic embolization of hepatic artery
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A 45 yr old man presents to the ER with 24 hrs of left lower quadrant abdominal pain. Examination reveals fever and focal tenderness in the left lower quadrant but no generalized peritoneal signs. CT scan reveals a collection containing air and fluid. Optimal management of this patient includes which of the following?
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E. CT-guided drainage followed by bowel resection once the patient has fully recovered
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A 52 yr old alcoholic man with known cirrhosis presents to the ER with hematemesis.
After resuscitation and stabilization, which procedure should take place? |
C. Endoscopy
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A 52 yr old alcoholic man with known cirrhosis presents to the ER with hematemesis.
What should the next treatment be? (After dx of esophageal varices) |
D. Sclerotherapy
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A 52 yr old alcoholic man with known cirrhosis presents to the ER with hematemesis.
After appropriate therapy, the bleeding ceases and the patient stabilizes. He is fond to be a Child's C alcoholic cirrhotic who has been abstinent for 1 year. Evaluation for an orthotopic liver transplant has begin. If his variceal bleeding returns, it could be managed by all except which of the following? |
A. Portocaval shunt
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A 73 yr old previously health man presents to the ER with several days of jaundice followed by 12 hours of right upper quadrant pain and fever. He is mildly hypotensive. CT scan of the abdomen reveals dilatation of the biliary tree. The next step in management includes which of the following?
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D. Fluid resuscitation, antibiotics, and ERCP
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A 33 yr old man with no significant past medical history presents to the ER with abdominal pain and nausea. He is afebrile, and labs reveal a serum amylase level of 1200 U/L.
Which of the following would NOT be part of initial management? |
D. ERCP to evaluate pancreatic duct anatomy
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A 33 yr old man with no significant past medical history presents to the ER with abdominal pain and nausea. He is afebrile, and labs reveal a serum amylase level of 1200 U/L.
Ten days into his course of pancreatitis, this patient is found to have a fluid collection measuring 4 cm in diameter near the tail of his pancreas. He had a recurrence of his abdominal pain when he was restarted on a diet 2 days prior but is otherwise asymptomatic. He remains on total parenteral nutrition. Appropriate management of this collection would include which of the following? |
E. Observation alone
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A 59 yr old patient undergoes exploration for a 4 cm mass in the head of the pancreas that has caused obstructive jaundice. The patient had a biliary stent endoscopically placed prior to the procedure with complete resolution of jaundice. At the time of surgery two small liver metastases are noted. Which of the following is NOT part of appropriate management at this point.
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A. Transduodenal pancreatic biopsy
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A 65 yr old patient presents with a history significant for obstructive jaundice and weight loss. A workup reveals a 2.5-cm mass in the head of the pancreas; needle aspiration reveals adenocarcinoma. Which of the following findings on preoperative CT scan would preclude operative exploration for curative resection?
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E. Occlusion of superior mesenteric vein
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Match the portion of the GI tract to the appropriate arterial supply:
Body and tail of pancreas |
C. Splenic artery
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Match the portion of the GI tract to the appropriate arterial supply:
Duodenum and head of pancreas |
E. Superior mesenteric artery
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Match the portion of the GI tract to the appropriate arterial supply:
Proximal lesser curvature of stomach |
A. Left gastric artery
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Match the portion of the GI tract to the appropriate arterial supply:
Distal greater curve of stomach |
B. Right gastroepiploic artery
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Match the portion of the GI tract to the appropriate arterial supply:
Fundus of stomach |
D. Vasa brevia (short gastric arteries)
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