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General Surgery Rotation exam with verified answers
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General Surgery Rotation exam with verified answers
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General Surgery Rotation exam withverified answers
When can a pt eat prior to major surgery? - .......🔷ANSWERS🔶......✔✔ NPO after midnight the
night before or for at least 8 hrs before surgery
Should a patient take their oral hypoglycemic agent the day of surgery? Insulin?
- .......🔷ANSWERS🔶......✔✔ -Hypoglycemic--> do not take if pt is to be NPO on day of surgery
-Insulin--> no, only 1/2 of LA insulin (Glargine, Levemir)
What labs should all women of childbearing age have before entering the OR?
- .......🔷ANSWERS🔶......✔✔ CBC and beta-HCG bc of the possibility of pregnancy and anemia
from menses
What must you always order pre-op for your patient undergoing a major operation?
- .......🔷ANSWERS🔶......✔✔ 1. NPO/IVF
2. Pre-op ABX
3. Type & cross blood (PRBCs)
What electrolyte must you check pre-op if a pt is on hemodialysis? - .......🔷ANSWERS🔶......✔✔ K
Who gets a pre-op EKG? - .......🔷ANSWERS🔶......✔✔ pts >40 y/o
After a primary closure, when should the dressing be removed? When can a pt shower?
- .......🔷ANSWERS🔶......✔✔ -Can be removed POD #2
-Can shower anytime after POD #2 (after the wound epithelializes)
What is the name of the anatomic structure through which a direct inguinal hernia usually
protrudes? - .......🔷ANSWERS🔶......✔✔ Hesselbach triangle--> bordered by the abdominus rectus
muscle, inguinal ligament and inferior epigastric vessels
,What is the classic acid-base finding with significant vomiting or NGT suctioning?
- .......🔷ANSWERS🔶......✔✔ hypokalemic and hypochloremic metabolic alkalosis
4/2/1 Rule - .......🔷ANSWERS🔶......✔✔ maintenance IV fluids for hourly rate:
4mL/kg for the 1st 10kg (4 x 10)
2mL/kg for the next 10kg (2 x 10)
1mL/kg for every kg over 20 (1 x kg)
What is the common adult maintenance fluid? Pediatric? - .......🔷ANSWERS🔶......✔✔ -Adult: D5
1/2 NS with 20 mEq KCl/L
-Peds: D5 1/4 NS with 20 mEq KCl/L
Best way to assess fluid status? - .......🔷ANSWERS🔶......✔✔ UO
Bladder CA - .......🔷ANSWERS🔶......✔✔ -Biggest RF= smoking, 2nd biggest= industrial dye
exposure (leather, dye, hairdressers, painters, textile, tire rubber)
-MC type= urothelial (transitional cell)
-MC presentation= gross, painless hematuria
-GS for dx= cystoscopy w bx
-Tx= endoscopic resection w cystoscopy Q3 mo
Patients with recurrent upper urinary tract infections due to urease-producing organisms are at risk
of developing what type of stone? - .......🔷ANSWERS🔶......✔✔ Struvite
Barrett's Esophagus Tx - .......🔷ANSWERS🔶......✔✔ -No dysplasia--> PPIs + rescope Q3-5 yrs
-Low grade dysplasia--> PPIs + rescope Q6-12 mo
-High grade dysplasia--> ablation w EGD
, 4 Stages of Internal Hemorrhoids - .......🔷ANSWERS🔶......✔✔ based on degree of prolapse from
anal canal:
1. Stage 1: confined to anal canal (does not prolapse)→ +/- bleed w defecation
2. Stage 2: prolapses (protrudes from anal canal) w defecation or straining but spontaneously reduce
3. Stage 3: prolapses w defecation or straining but requires manual reduction after BMs
4. Stage 4: chronically protruding→ irreducible & may strangulate (occlude blood supply)
What are some complications of rubber band ligation? - .......🔷ANSWERS🔶......✔✔ Pelvic sepsis,
pelvic abscess, urinary retention, and bleeding
Indications for Revascularization in PAD - .......🔷ANSWERS🔶......✔✔ limiting claudication,
ischemic rest pain, signif limb ischemia, non-healing wounds/ulcers
-1st line revasc procedure= percutaneous transluminal angioplasty (PTA)
Indications for Revascularization in Carotid Artery Stenosis - .......🔷ANSWERS🔶......✔✔ GS tx of
choice= carotid endarterectomy (CEA)
-60-79% stenosis→ surgery if Sx only (borderline), if ASx then monitor 3-6 mo
*-80-99%→ ALWAYS surgery,* presence of S/Sx doesn't matter
*-100%→ NO SURGERY bc totally blocked*
AAA Tx - .......🔷ANSWERS🔶......✔✔ -3-4cm→ monitor w U/S Q1 yr
-4-4.5 cm→ monitor w U/S Q6 mo
->4.5cm→ vascular surgeon referral
-≥5.5 cm OR >0.5cm expansion in 6 mo (or >1cm in 12 mo) OR 2x size of normal aorta→
IMMEDIATE surgical repair
What is an indicator of unresectability of gastric cancer? - .......🔷ANSWERS🔶......✔✔ dz
encasement of the hepatic a.
In which segment of the colon do the majority of diverticula form? - .......🔷ANSWERS🔶......✔✔
sigmoid colon
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