ROSH REVIEW general surgery | Questions & Answers (100 %Score) Latest Updated
2024/2025 Comprehensive Questions A+ Graded Answers | With Expert Solutions
A 24-year-old woman presents to the clinic for preoperative evaluation for a scheduled
right anterior cruciate ligament repair. Preoperative clearance was requested by the
surgeon secondary to the patient complaining of chest pain. Review of systems is
positive for a chronic nonproductive cough, chest pain, fatigue, and weight loss. She
denies any history of tobacco use. A chest radiograph reveals bilateral hilar adenopathy
with symmetric enlargement of the hila. Serum angiotensin-converting enzyme levels
are ordered and found to be elevated. Which of the following is the most likely
diagnosis? - Sarcoidosis
Which of the following options is the best therapy for an ascending aortic dissection? -
Emergent surgical repair
Why must the preoperative preparation for surgical resection of a patient with a
diagnosed pheochromocytoma involve propranolol initiation after a 10-14 day course of
phenoxybenzamine? - To avoid unopposed alpha-adrenergic receptor stimulation
A 60-year-old man has been bedridden following a stroke several months ago.
Urinalysis shows high levels of protein in the urine and nephrotic syndrome is
suspected. On physical exam, where would the provider likely detect edema? - Sacrum
(peripheral and periorbital edema are commonly seen in patients with nephrotic
syndrome caused by sodium retention and hypoalbuminemia; lab shows proteinuria >
3.5g/day)
A 78-year-old man undergoes laparoscopic surgery for a small bowel obstruction.
Which metabolic disturbance is he most at risk for postoperatively? - Metabolic alkalosis
A 30-year-old woman presents to the outpatient clinic for follow-up on her total
thyroidectomy performed six weeks ago. Her incision is well-healed, and there are no
signs of infection. The patient does complain of feeling cold, despite others around her
being warm, fatigue, and weight gain. She has remained on levothyroxine 100 mcg by
mouth once daily. Serum thyroid-stimulating hormone was performed prior to the
appointment and was found to be elevated. Which of the following is the most likely
diagnosis? - Hypothyroidism
A 46-year-old man presents to the emergency department reporting abdominal pain,
bloating, nausea, anorexia, and vomiting. His symptoms have been worsening since
onset three days ago. His last bowel movement was four days ago, but he continues to
pass flatus. Which of the following tests has the highest sensitivity for confirming the
most likely diagnosis? - Abdominal CT w/ contrast
Which of the following is appropriate initial treatment for uncomplicated symptomatic
Crohn's disease? - Immunosuppressant therapy
,Parents bring their previously healthy four-week-old boy to the ED due to repeated
"projectile vomiting" immediately after he nurses for the past 24 hours. The parents
report the emesis looks just like breast milk. He has had a normal pattern of wet
diapers. The parents deny any rectal bleeding. He has not had any difficulty nursing
before, and attempts at burping him have not brought any relief. Vital signs include a
temperature of 98.8°F. Physical exam reveals an alert, crying infant with a small, firm
right upper quadrant mass. Blood analysis is within normal limits. Which of the following
choices is the best next step for this patient? - Order transabdominal ultrasound
A 66-year-old man with hypertension and type II diabetes mellitus presents to the ED
complaining of chest tightness, dyspnea, and dizziness while mowing his lawn earlier
that day. He had similar symptoms two weeks ago. His symptoms resolved within a
couple of minutes of sitting to rest. He is currently pain-free. Vital signs are pulse 88
beats per minute, blood pressure 134/88 mm Hg, temperature 98.8°F, oxygen
saturation 97%, and 20 respirations per minute. Exam reveals an obese man in no
acute distress and is otherwise unremarkable. Electrocardiogram is obtained and shown
above. Which of the following is the most likely diagnosis? - Angina pectoris
You are evaluating a 48-year-old woman with right lower extremity swelling, pain, and
redness. She is eight days status-post open cholecystectomy. She was on lovenox for
two days postoperatively but is not currently taking any medications except oxycodone
for pain. What is the test of choice to confirm your suspected diagnosis? - Venous
doppler ultrasound
Which of the following is a physical exam finding characterized by pain and inspiratory
arrest during palpation of the right upper quadrant? - Murphy's sign
A 66-year-old woman with a past medical history of uncontrolled diabetes mellitus,
obesity, and rheumatoid arthritis who is on methotrexate presents to the emergency
department complaining of redness, drainage, and pain at her incision site. She had an
umbilical hernia repair approximately six days prior. On exam, you note the patient has
a fever of 100.6°F and the incision site is erythematous and warm with a small amount
of purulent drainage noted. There are no signs of wound dehiscence and no areas of
fluctuance noted. Which of the following is the most likely diagnosis? - Cellulitis
Which of the following blood analysis tests is indicated to diagnose anemia? - Complete
blood count
Which of the following physical exam findings is more indicative of skin abscess than
cellulitis? - Fluctuance
A 31-year-old man presents to the emergency department after an episode of syncope
following sexual intercourse. Upon regaining consciousness at home, patient began
complaining of a severe headache and started to vomit. Physical examination reveals
an uncomfortable man with positive meningeal signs. Blood pressure is 162/94 mm Hg.
, CT scan of the head without contrast reveals no acute pathology. Based on the most
likely diagnosis, what would you expect on the patient's lumbar puncture? - Hemoglobin
degradation products (xanthochromia from subarachnoid hemorrhage; tx includes
supportive and nimodipine)
A 54-year-old man presents to the clinic complaining of difficulty swallowing food for the
past two years, which has been gradually worsening. He has no problem swallowing
liquids. He has had uncontrolled gastroesophageal reflux for several years. He has no
history of tobacco use and has not had any head or neck radiation therapy. Which of the
following is the best initial test for this patient? - Upper endoscopy (esophageal
strictures)
A 32-year-old man presents to the outpatient clinic for follow-up regarding his
hypertension. Despite the use of three antihypertensive agents, he remains
hypertensive. He also has episodes of nonexertional palpitations, diaphoresis, and
headache. He recently completed a 24-hour urinary fractionated metanephrines test,
which was positive. A computed tomography of the abdomen and pelvis is done and
reveals a 5 cm tumor of the right adrenal gland. Which of the following is the most
appropriate next step in management? - Phenoxybenzamine
Which of the following is a confirmatory test for cholecystitis? - Cholescintigraphy scan
(aka HIDA scan)
A 76-year-old man with a history of diabetes mellitus and hyperlipidemia presents to the
emergency room with a sudden onset of epigastric pain 48 hours ago. Now he is
experiencing intractable nausea, vomiting, and fever beginning 12 hours prior to arrival.
Physical examination reveals marked tenderness and guarding in the epigastrium, poor
turgor, hypotension, tachycardia, and a temperature of 101.3°F. Laboratory results
show amylase of 301 U/L and lipase of 1186 U/L. CT scan of the abdomen is pending.
Based on the patient's expected diagnosis, which of the following findings would be
consistent with his most likely diagnosis? - Ecchymosis of the flanks (Grey Turner sign)
An obese 68-year-old woman with hypertension is admitted to the hospital due to acute
hypoxia. She is a lifelong nonsmoker with no history of lung disease. A chest radiograph
reveals a moderate pleural effusion. Which of the following is the best next step in the
management of this patient? - Thoracentesis (pleural effusion, decreased breath
sounds, dullness to percussion, decreased tactile fremitus)
A 20-year-old man presents to the clinic with a chief complaint of dyspnea and chest
pain that began spontaneously six hours ago while playing basketball. He has never
smoked, takes no medications, and has no family history of cardiovascular or
pulmonary diseases. His vital signs are as follows: heart rate 112 beats per minute,
respiratory rate 24 breaths per minute, blood pressure 114/68 mm Hg. He is six feet tall
and weighs 165 pounds. On physical exam, the left upper lung field has diminished
breath sounds and is hyperresonant to percussion. There are no other abnormalities
2024/2025 Comprehensive Questions A+ Graded Answers | With Expert Solutions
A 24-year-old woman presents to the clinic for preoperative evaluation for a scheduled
right anterior cruciate ligament repair. Preoperative clearance was requested by the
surgeon secondary to the patient complaining of chest pain. Review of systems is
positive for a chronic nonproductive cough, chest pain, fatigue, and weight loss. She
denies any history of tobacco use. A chest radiograph reveals bilateral hilar adenopathy
with symmetric enlargement of the hila. Serum angiotensin-converting enzyme levels
are ordered and found to be elevated. Which of the following is the most likely
diagnosis? - Sarcoidosis
Which of the following options is the best therapy for an ascending aortic dissection? -
Emergent surgical repair
Why must the preoperative preparation for surgical resection of a patient with a
diagnosed pheochromocytoma involve propranolol initiation after a 10-14 day course of
phenoxybenzamine? - To avoid unopposed alpha-adrenergic receptor stimulation
A 60-year-old man has been bedridden following a stroke several months ago.
Urinalysis shows high levels of protein in the urine and nephrotic syndrome is
suspected. On physical exam, where would the provider likely detect edema? - Sacrum
(peripheral and periorbital edema are commonly seen in patients with nephrotic
syndrome caused by sodium retention and hypoalbuminemia; lab shows proteinuria >
3.5g/day)
A 78-year-old man undergoes laparoscopic surgery for a small bowel obstruction.
Which metabolic disturbance is he most at risk for postoperatively? - Metabolic alkalosis
A 30-year-old woman presents to the outpatient clinic for follow-up on her total
thyroidectomy performed six weeks ago. Her incision is well-healed, and there are no
signs of infection. The patient does complain of feeling cold, despite others around her
being warm, fatigue, and weight gain. She has remained on levothyroxine 100 mcg by
mouth once daily. Serum thyroid-stimulating hormone was performed prior to the
appointment and was found to be elevated. Which of the following is the most likely
diagnosis? - Hypothyroidism
A 46-year-old man presents to the emergency department reporting abdominal pain,
bloating, nausea, anorexia, and vomiting. His symptoms have been worsening since
onset three days ago. His last bowel movement was four days ago, but he continues to
pass flatus. Which of the following tests has the highest sensitivity for confirming the
most likely diagnosis? - Abdominal CT w/ contrast
Which of the following is appropriate initial treatment for uncomplicated symptomatic
Crohn's disease? - Immunosuppressant therapy
,Parents bring their previously healthy four-week-old boy to the ED due to repeated
"projectile vomiting" immediately after he nurses for the past 24 hours. The parents
report the emesis looks just like breast milk. He has had a normal pattern of wet
diapers. The parents deny any rectal bleeding. He has not had any difficulty nursing
before, and attempts at burping him have not brought any relief. Vital signs include a
temperature of 98.8°F. Physical exam reveals an alert, crying infant with a small, firm
right upper quadrant mass. Blood analysis is within normal limits. Which of the following
choices is the best next step for this patient? - Order transabdominal ultrasound
A 66-year-old man with hypertension and type II diabetes mellitus presents to the ED
complaining of chest tightness, dyspnea, and dizziness while mowing his lawn earlier
that day. He had similar symptoms two weeks ago. His symptoms resolved within a
couple of minutes of sitting to rest. He is currently pain-free. Vital signs are pulse 88
beats per minute, blood pressure 134/88 mm Hg, temperature 98.8°F, oxygen
saturation 97%, and 20 respirations per minute. Exam reveals an obese man in no
acute distress and is otherwise unremarkable. Electrocardiogram is obtained and shown
above. Which of the following is the most likely diagnosis? - Angina pectoris
You are evaluating a 48-year-old woman with right lower extremity swelling, pain, and
redness. She is eight days status-post open cholecystectomy. She was on lovenox for
two days postoperatively but is not currently taking any medications except oxycodone
for pain. What is the test of choice to confirm your suspected diagnosis? - Venous
doppler ultrasound
Which of the following is a physical exam finding characterized by pain and inspiratory
arrest during palpation of the right upper quadrant? - Murphy's sign
A 66-year-old woman with a past medical history of uncontrolled diabetes mellitus,
obesity, and rheumatoid arthritis who is on methotrexate presents to the emergency
department complaining of redness, drainage, and pain at her incision site. She had an
umbilical hernia repair approximately six days prior. On exam, you note the patient has
a fever of 100.6°F and the incision site is erythematous and warm with a small amount
of purulent drainage noted. There are no signs of wound dehiscence and no areas of
fluctuance noted. Which of the following is the most likely diagnosis? - Cellulitis
Which of the following blood analysis tests is indicated to diagnose anemia? - Complete
blood count
Which of the following physical exam findings is more indicative of skin abscess than
cellulitis? - Fluctuance
A 31-year-old man presents to the emergency department after an episode of syncope
following sexual intercourse. Upon regaining consciousness at home, patient began
complaining of a severe headache and started to vomit. Physical examination reveals
an uncomfortable man with positive meningeal signs. Blood pressure is 162/94 mm Hg.
, CT scan of the head without contrast reveals no acute pathology. Based on the most
likely diagnosis, what would you expect on the patient's lumbar puncture? - Hemoglobin
degradation products (xanthochromia from subarachnoid hemorrhage; tx includes
supportive and nimodipine)
A 54-year-old man presents to the clinic complaining of difficulty swallowing food for the
past two years, which has been gradually worsening. He has no problem swallowing
liquids. He has had uncontrolled gastroesophageal reflux for several years. He has no
history of tobacco use and has not had any head or neck radiation therapy. Which of the
following is the best initial test for this patient? - Upper endoscopy (esophageal
strictures)
A 32-year-old man presents to the outpatient clinic for follow-up regarding his
hypertension. Despite the use of three antihypertensive agents, he remains
hypertensive. He also has episodes of nonexertional palpitations, diaphoresis, and
headache. He recently completed a 24-hour urinary fractionated metanephrines test,
which was positive. A computed tomography of the abdomen and pelvis is done and
reveals a 5 cm tumor of the right adrenal gland. Which of the following is the most
appropriate next step in management? - Phenoxybenzamine
Which of the following is a confirmatory test for cholecystitis? - Cholescintigraphy scan
(aka HIDA scan)
A 76-year-old man with a history of diabetes mellitus and hyperlipidemia presents to the
emergency room with a sudden onset of epigastric pain 48 hours ago. Now he is
experiencing intractable nausea, vomiting, and fever beginning 12 hours prior to arrival.
Physical examination reveals marked tenderness and guarding in the epigastrium, poor
turgor, hypotension, tachycardia, and a temperature of 101.3°F. Laboratory results
show amylase of 301 U/L and lipase of 1186 U/L. CT scan of the abdomen is pending.
Based on the patient's expected diagnosis, which of the following findings would be
consistent with his most likely diagnosis? - Ecchymosis of the flanks (Grey Turner sign)
An obese 68-year-old woman with hypertension is admitted to the hospital due to acute
hypoxia. She is a lifelong nonsmoker with no history of lung disease. A chest radiograph
reveals a moderate pleural effusion. Which of the following is the best next step in the
management of this patient? - Thoracentesis (pleural effusion, decreased breath
sounds, dullness to percussion, decreased tactile fremitus)
A 20-year-old man presents to the clinic with a chief complaint of dyspnea and chest
pain that began spontaneously six hours ago while playing basketball. He has never
smoked, takes no medications, and has no family history of cardiovascular or
pulmonary diseases. His vital signs are as follows: heart rate 112 beats per minute,
respiratory rate 24 breaths per minute, blood pressure 114/68 mm Hg. He is six feet tall
and weighs 165 pounds. On physical exam, the left upper lung field has diminished
breath sounds and is hyperresonant to percussion. There are no other abnormalities
