PAEA GENERAL SURGERY EOR FINAL PAPER 2025/2026
QUESTIONS WITH SOLUTIONS GRADED A+
✔✔The most common cause of SIRS (systemic inflammatory response syndrome) is
sepsis. What are the criteria for dx of SIRS? - ✔✔At least 2 of the following:
1. temp >38C or <36C
2. tachy >90
3. tachypnea > 20 breaths/minute
4. PCO2 <32mmHg
5. WBC > 12,000/uL or <4000/uL
✔✔After sepsis, what are the next two most common causes of SIRS? - ✔✔pancreatitis
and drugs
✔✔What is the difference between hypovolemia and dehydration? - ✔✔hypovolemia is
loss of both water and sodium while dehydration is loss of intracellular water or deficit
with hypernatremia -- dehydration occurs when patient can not adjust water intake for
water loss
✔✔What are the clinical signs of dehydration and hypovolemia? - ✔✔tachycardia,
hypotension, pale skin, increased capillary refill time, dizziness, faintness, nausea,
thirst, decreased urine output -- in hypovolemia, urine will demonstrate low sodium
concentration
✔✔What are 2 common conditions with dehydration? - ✔✔diabetes insipidus (lack of
ADH or unable to respond to ADH), fever with increased water loss
✔✔Hyponatremia Causes
_______ = cirrhosis, CHF, nephrotic syndrome, massive edema
_______=states of severe pain or nausea, trauma, brain damage, SIADH
_______=prolonged vomiting, decreased oral intake, severe diarrhea, diuretic use
Misc causes = factitious hyponatremia, hypothyroidism, adrenal insufficiency,
malnourished states, primary polydipsia - ✔✔Hypervolemic, Euvolemic, Hypovolemic
✔✔What are the two most common treatments for hyponatremia?
Other less common treatment? - ✔✔salt tabs and fluid restriction; vasopressin receptor
antagonist in SIADH, CHF, and cirrhosis
✔✔Hypernatremia is almost always due to _______. Therefore, what is the treatment? -
✔✔dehydration; rehydrate!
✔✔What s/s can result in a hyperkalemic patient? - ✔✔cardiac arrhythmias (tall peaked
T waves) and weakness
,✔✔If the potassium level is above 6meq/L or the patient has EKG changes, what
treatments can lower K temporarily? - ✔✔calcium gluconate, sodium bicarbonate,
insulin and glucose, kayexalate (takes longer to be effective)
✔✔______&______ is extremely effective in decreasing potassium. - ✔✔Dialysis and
furosemide
✔✔Hypokalemia is usually due to ________, hypomagnesemia, alkalosis, high
aldosterone levels. How is it treated? - ✔✔potassium loss; replacement must be slow!!!
Mild loss: oral KCl supplements or K containing foods
Severe loss: IV supplementation - rate 10mEg/hr
✔✔Causes of ________are VITAMIN D METABOLIC DISORDERS, abnormal PTH
function, primary hyperparathyroidism, Lithium, malignancy, disorders related to high
bone turnover rates (hyperthyroidism, prolonged immobilization, thiazide use, vit A
intoxication, Pagets dz of bone, multiple myeloma), renal failure - ✔✔hypercalcemia
✔✔How should hypercalcemia be treated? - ✔✔fluid and diuretics, bisphosphonates,
and calcitonin
✔✔_______is usually caused by ineffective PTH (chronic renal failure, absent active vit
D, ineffective active vit D, pseudohypoparathyroidism), deficient PTH. -
✔✔Hypocalcemia
✔✔How should hypocalcemia be treated? - ✔✔intravenous calcium gluconate, Tums
✔✔Increased CO2, hypoventilation, or decreased pH is aka ___. - ✔✔respiratory
acidosis
✔✔Decreased CO2, hyperventilation, or increased pH is aka ___. - ✔✔respiratory
alkalosis
✔✔Increased H+ or HCO3 loss, DKA, lactic acidosis is aka ___. - ✔✔metabolic acidosis
✔✔Loss of H+ is aka ________. - ✔✔metabolic alkalosis
✔✔The d/d of post op ___________can be MI, atelectasis, pneumonia, pleurisy,
esophageal reflux, PE, musculoskeletal pain, subphrenic abscess, aortic dissection,
pneumo/chyle/hemothorax, or gastritis. - ✔✔chest pain
✔✔Who classically gets silent MI's? - ✔✔diabetics
,✔✔How should syncope be initially evaluated? - ✔✔It is important to distinguish
syncope from cardiac arrest from other nonsyncopal conditions causing LOC
✔✔Syncope d/d: Prodrome or aura usually associated with ____. - ✔✔seizures (as is
loss of continence)
✔✔Cardiac syncope's onset is usually ____without a prodrome. Monitor vitals regularly,
EKG, orthostatic challenge, neuro exam etc. - ✔✔sudden
✔✔In a surgery patient with dyspnea on exertion, what should be ruled out? - ✔✔PE or
pneumothorax
✔✔What are some chronic dyspnea on exertion causes? - ✔✔asthma, COPD,
interstitial lung disease, myocardial dysfunction, obesity
✔✔What are some acute dyspnea on exertion causes? - ✔✔angioedema, anaphylaxis,
foreign objects, airway trauma, pulmonary infection, pleural effusion, peritonitis/ruptured
viscous, bowel obstruction
✔✔__________is pain, cramping, or both of the lower extremity (usually calf muscle)
after walking a specific distance; then resolves for a specific amount of time while
standing. - ✔✔Claudication
✔✔What is claudication associated with? - ✔✔peripheral vascular occlusion
✔✔D/D of lower extremity claudication? - ✔✔neurogenic/nerve entrapment/discs,
arthritis, coartation of the aorta, popliteal artery syndrome, neuromas, anemia, diabetic
neuropathy pain
✔✔A _________is an abnormal dilation of an artery. Involve all layers of the arterial
wall. - ✔✔aneurysm
✔✔At what size is surgical repair of aneurysm recommended? - ✔✔5.5 cm
✔✔95% of aneurysms are associated with ___________. - ✔✔atheroschlerosis -- other
causes are trauma, infection, syphilis, & Marfan's syndrome
✔✔What is the classic triad of s/s related to ruptured AAA? - ✔✔abdominal pain,
pulsatile abdominal mass, hypotension
✔✔Where does the aorta bifurcate? - ✔✔At the level of umbilicus
, ✔✔Because the ________is often sacrificed during AAA repair, colonic ischemia can
occur. - ✔✔IMA - inferior mesenteric artery
✔✔_______is a separation of the walls of the aorta from an intimal tear and disease of
the tunica media; a false lumen is formed and a "reentry" tear may occur, resulting in a
"double barrel" aorta. - ✔✔Aortic dissection
✔✔Explain the DeBakey classifications (Type 1,2, & 3) of aortic dissections. -
✔✔DeBakey Type 1 - ascending & descending aorta
DeBakey Type 2 - ascending aorta
DeBakey Type 3 - descending aorta
✔✔Explain the Stanford classifications of aortic dissections. - ✔✔Type A -- ascending
+/- descending aorta
Type B - descending aorta
✔✔What is the most common cause of aortic dissection. - ✔✔HTN!
✔✔What are the s/s of aortic dissection. - ✔✔abrupt tearing pain/sensation
✔✔What are 3 other sequelae of aorta dissection? - ✔✔cardiac tamponade, aortic
insufficiency, aortic arterial branch occlusion/shearing
✔✔What is Beck's triad of cardiac tamponade? - ✔✔muffled heart sounds, JVD,
hypotension
✔✔What does CXR show with aortic dissection? - ✔✔widened mediastinum
✔✔What is the gold standard but time consuming test of choice with aortic
dissection/aneurysm? - ✔✔aortagraphy
✔✔Which type of aortic dissection should be treated with surgical repair? -
✔✔Involvement of ascending aorta -- Type A or Type I
✔✔Type III or B aortic dissections can be treated with what meds? - ✔✔blood pressure
meds
✔✔_______is a diffuse disease process in arteries; artheromas containing cholesterol
and lipid form within the intima and inner media, often accompanied by ulcerations and
smooth muscle hyperplasia. Risk factors: HTN, smoking, DM, FH,
hypercholesterolemia, high LDL, obesity, & sedentary lifestyle. - ✔✔Atherosclerosis
QUESTIONS WITH SOLUTIONS GRADED A+
✔✔The most common cause of SIRS (systemic inflammatory response syndrome) is
sepsis. What are the criteria for dx of SIRS? - ✔✔At least 2 of the following:
1. temp >38C or <36C
2. tachy >90
3. tachypnea > 20 breaths/minute
4. PCO2 <32mmHg
5. WBC > 12,000/uL or <4000/uL
✔✔After sepsis, what are the next two most common causes of SIRS? - ✔✔pancreatitis
and drugs
✔✔What is the difference between hypovolemia and dehydration? - ✔✔hypovolemia is
loss of both water and sodium while dehydration is loss of intracellular water or deficit
with hypernatremia -- dehydration occurs when patient can not adjust water intake for
water loss
✔✔What are the clinical signs of dehydration and hypovolemia? - ✔✔tachycardia,
hypotension, pale skin, increased capillary refill time, dizziness, faintness, nausea,
thirst, decreased urine output -- in hypovolemia, urine will demonstrate low sodium
concentration
✔✔What are 2 common conditions with dehydration? - ✔✔diabetes insipidus (lack of
ADH or unable to respond to ADH), fever with increased water loss
✔✔Hyponatremia Causes
_______ = cirrhosis, CHF, nephrotic syndrome, massive edema
_______=states of severe pain or nausea, trauma, brain damage, SIADH
_______=prolonged vomiting, decreased oral intake, severe diarrhea, diuretic use
Misc causes = factitious hyponatremia, hypothyroidism, adrenal insufficiency,
malnourished states, primary polydipsia - ✔✔Hypervolemic, Euvolemic, Hypovolemic
✔✔What are the two most common treatments for hyponatremia?
Other less common treatment? - ✔✔salt tabs and fluid restriction; vasopressin receptor
antagonist in SIADH, CHF, and cirrhosis
✔✔Hypernatremia is almost always due to _______. Therefore, what is the treatment? -
✔✔dehydration; rehydrate!
✔✔What s/s can result in a hyperkalemic patient? - ✔✔cardiac arrhythmias (tall peaked
T waves) and weakness
,✔✔If the potassium level is above 6meq/L or the patient has EKG changes, what
treatments can lower K temporarily? - ✔✔calcium gluconate, sodium bicarbonate,
insulin and glucose, kayexalate (takes longer to be effective)
✔✔______&______ is extremely effective in decreasing potassium. - ✔✔Dialysis and
furosemide
✔✔Hypokalemia is usually due to ________, hypomagnesemia, alkalosis, high
aldosterone levels. How is it treated? - ✔✔potassium loss; replacement must be slow!!!
Mild loss: oral KCl supplements or K containing foods
Severe loss: IV supplementation - rate 10mEg/hr
✔✔Causes of ________are VITAMIN D METABOLIC DISORDERS, abnormal PTH
function, primary hyperparathyroidism, Lithium, malignancy, disorders related to high
bone turnover rates (hyperthyroidism, prolonged immobilization, thiazide use, vit A
intoxication, Pagets dz of bone, multiple myeloma), renal failure - ✔✔hypercalcemia
✔✔How should hypercalcemia be treated? - ✔✔fluid and diuretics, bisphosphonates,
and calcitonin
✔✔_______is usually caused by ineffective PTH (chronic renal failure, absent active vit
D, ineffective active vit D, pseudohypoparathyroidism), deficient PTH. -
✔✔Hypocalcemia
✔✔How should hypocalcemia be treated? - ✔✔intravenous calcium gluconate, Tums
✔✔Increased CO2, hypoventilation, or decreased pH is aka ___. - ✔✔respiratory
acidosis
✔✔Decreased CO2, hyperventilation, or increased pH is aka ___. - ✔✔respiratory
alkalosis
✔✔Increased H+ or HCO3 loss, DKA, lactic acidosis is aka ___. - ✔✔metabolic acidosis
✔✔Loss of H+ is aka ________. - ✔✔metabolic alkalosis
✔✔The d/d of post op ___________can be MI, atelectasis, pneumonia, pleurisy,
esophageal reflux, PE, musculoskeletal pain, subphrenic abscess, aortic dissection,
pneumo/chyle/hemothorax, or gastritis. - ✔✔chest pain
✔✔Who classically gets silent MI's? - ✔✔diabetics
,✔✔How should syncope be initially evaluated? - ✔✔It is important to distinguish
syncope from cardiac arrest from other nonsyncopal conditions causing LOC
✔✔Syncope d/d: Prodrome or aura usually associated with ____. - ✔✔seizures (as is
loss of continence)
✔✔Cardiac syncope's onset is usually ____without a prodrome. Monitor vitals regularly,
EKG, orthostatic challenge, neuro exam etc. - ✔✔sudden
✔✔In a surgery patient with dyspnea on exertion, what should be ruled out? - ✔✔PE or
pneumothorax
✔✔What are some chronic dyspnea on exertion causes? - ✔✔asthma, COPD,
interstitial lung disease, myocardial dysfunction, obesity
✔✔What are some acute dyspnea on exertion causes? - ✔✔angioedema, anaphylaxis,
foreign objects, airway trauma, pulmonary infection, pleural effusion, peritonitis/ruptured
viscous, bowel obstruction
✔✔__________is pain, cramping, or both of the lower extremity (usually calf muscle)
after walking a specific distance; then resolves for a specific amount of time while
standing. - ✔✔Claudication
✔✔What is claudication associated with? - ✔✔peripheral vascular occlusion
✔✔D/D of lower extremity claudication? - ✔✔neurogenic/nerve entrapment/discs,
arthritis, coartation of the aorta, popliteal artery syndrome, neuromas, anemia, diabetic
neuropathy pain
✔✔A _________is an abnormal dilation of an artery. Involve all layers of the arterial
wall. - ✔✔aneurysm
✔✔At what size is surgical repair of aneurysm recommended? - ✔✔5.5 cm
✔✔95% of aneurysms are associated with ___________. - ✔✔atheroschlerosis -- other
causes are trauma, infection, syphilis, & Marfan's syndrome
✔✔What is the classic triad of s/s related to ruptured AAA? - ✔✔abdominal pain,
pulsatile abdominal mass, hypotension
✔✔Where does the aorta bifurcate? - ✔✔At the level of umbilicus
, ✔✔Because the ________is often sacrificed during AAA repair, colonic ischemia can
occur. - ✔✔IMA - inferior mesenteric artery
✔✔_______is a separation of the walls of the aorta from an intimal tear and disease of
the tunica media; a false lumen is formed and a "reentry" tear may occur, resulting in a
"double barrel" aorta. - ✔✔Aortic dissection
✔✔Explain the DeBakey classifications (Type 1,2, & 3) of aortic dissections. -
✔✔DeBakey Type 1 - ascending & descending aorta
DeBakey Type 2 - ascending aorta
DeBakey Type 3 - descending aorta
✔✔Explain the Stanford classifications of aortic dissections. - ✔✔Type A -- ascending
+/- descending aorta
Type B - descending aorta
✔✔What is the most common cause of aortic dissection. - ✔✔HTN!
✔✔What are the s/s of aortic dissection. - ✔✔abrupt tearing pain/sensation
✔✔What are 3 other sequelae of aorta dissection? - ✔✔cardiac tamponade, aortic
insufficiency, aortic arterial branch occlusion/shearing
✔✔What is Beck's triad of cardiac tamponade? - ✔✔muffled heart sounds, JVD,
hypotension
✔✔What does CXR show with aortic dissection? - ✔✔widened mediastinum
✔✔What is the gold standard but time consuming test of choice with aortic
dissection/aneurysm? - ✔✔aortagraphy
✔✔Which type of aortic dissection should be treated with surgical repair? -
✔✔Involvement of ascending aorta -- Type A or Type I
✔✔Type III or B aortic dissections can be treated with what meds? - ✔✔blood pressure
meds
✔✔_______is a diffuse disease process in arteries; artheromas containing cholesterol
and lipid form within the intima and inner media, often accompanied by ulcerations and
smooth muscle hyperplasia. Risk factors: HTN, smoking, DM, FH,
hypercholesterolemia, high LDL, obesity, & sedentary lifestyle. - ✔✔Atherosclerosis
