PAEA GENERAL SURGERY EOR TEST PAPERS 2025/2026
QUESTIONS WITH SOLUTIONS GRADED A+
✔✔name the sign: bruising of the flanks between the last rib and the top of the hip that
is a sign of retroperitoneal hemorrhage (*hemorrhagic pancreatitis*) - ✔✔Grey Turner's
sign
✔✔name the sign: periumbilical bruising due to pancreatitis - ✔✔Cullen's sign
✔✔what are the 2 types of anorexia nervosa patients seen? - ✔✔1. restrictive type-
reduced calorie intake, dieting, fasting, excessive exercise, diet pills
2. purging type- primarily engages in self-induced vomiting, diuretic/laxative/enema
abuse
✔✔Dx of anorexia nervosa is a BMI ≤_____ kg/m2 or body weight <____% of ideal
weight - ✔✔BMI ≤ 17.5 or <85% ideal body wt
✔✔what will be seen on PE and labs of an anorexia nervosa pt? - ✔✔-*PE*:
emaciation, hypotensions, bradycardia, skin/hair changes (lanugo- blonde peach fuzz),
dry skin, salivary gland hypertrophy, ameorrhea, arrhythmias, osteoporosis
-*labs*: leukocytosis, leukopenia, anemia, hypokalemia, inc BUN (dehydration),
hypothyroidism
✔✔what is the tx for anorexia? - ✔✔hospitalization if <75% ideal body wt or w/
electrolyte imbalances (risk of arrhythmias), psychotherapy, supervised meals, wt
monitoring, pharmacotherapy- SSRIs if depressed, SGAs help w/ wt gain (metabolic
side effects)
✔✔etiologies of anorexia (unintentional weight loss)? - ✔✔-malignancy
-PUD
-IBD
-celiac dz
-gallbladder dz
-depression
-eating d/o
-hyperthyroidism
-new onset DM
-HIV
-TB
-Hep C
-helminthic infxns
-COPD
-CHF
-neurologic diseases
,✔✔the most common cause of prehepatic jaundice= - ✔✔hemolysis (increased
production of bilirubin)
✔✔what are the causes of intrahepatic jaundice? - ✔✔genetic (Dubin Johnson, Crigler-
Najjar) or hepatitis
labs: elevations of MIXED indirect and direct bilirubin
✔✔extrahepatic jaundice most often results from biliary obstruction from - ✔✔-malignant
tumors (pancreatic ca, cholangiocarcinoma, ampulla of vater cancer)
-choledocholithiasis (common bile duct obstruction)
-biliary strictures (stent them)
✔✔what are things you should ask patient of hepatic jaundice? - ✔✔-drug use
-alcohol intake
-high risk behaviors
-age
✔✔jaundice, clay colored stools, wt loss, distended *nonpainful* gallbladder are all
signs of? - ✔✔obstructive jaundice; order CT;
Ddx:
-pancreatic cancer
-cholangioncainoma
-ampulla of vater cancer (if nothing shows up on CT)
-strictures
✔✔what are the genetic causes of the jaundice for the following corresponding
labs/pathophys:
1. asx jaundice, inc indirect bili, nml LFTs from *deficiency of GT*
2. symptomatic jaundice (kernicterus), inc indirect bili from *absence of GT*
3. asx jaundice, nml LFTs, inc direct bili, due to impaired hepatocyte excretion of conj.
bili into bile - ✔✔1. gilbert syndrome
2. crigler-najjar syndrome
3. dubin-johnson syndrome
✔✔causes of melena vs hematochezia? - ✔✔-melena: bleeding (usually) above
ligament of Treitz: PUD, varices, gastric carcinoma
-hematochezia: diverticulitis, colon cancer, hemorrhoids
✔✔Dx? infant <6 mos old, non-bilous vomiting/regurgitation that becomes projectile
vomiting after feeding, dehydration, malnutrition, jaundice, olive-shaped non-tender
mobile hard nodule in epigastric area, string sign on upper GI contrast; tx? - ✔✔dx:
pyloric stenosis
tx: rehydration and electrolyte replenishment & pyloromyotomy
,✔✔what is the diagnostic test of choice for pyloric stenosis? - ✔✔US showing
thickening of pylorus
-can also do an upper GI contrast which will show string sign (dye through narrowed
channel)
✔✔what type of acid-base disturbance will you see with pyloric stenosis? -
✔✔hypochloremic metabolic alkalosis
✔✔what are the contents of a pancreatic pseudocyst? complications? - ✔✔fluid
collections of pancreatic enzymes; can become infected and turn into an abscess, can
rupture, can bleed, can cause bowel obstruction on duodenum
✔✔pancreatic pseudocyst tx - ✔✔-internal drainage (tube to stomach or anastomosed
to jejunum) *if >6 cm or >6 wks*
-external drainage (through skin) if critically ill
complications: infection, rupture, hemorrhage, bowel obstruction
✔✔Ddx/tx? pt presents s/p acute pancreatitis 2 weeks ago with pain, fever,
leukocytosis, elevated lipase/amylase, and a palpable mass over the epigastric/LUQ
area - ✔✔-DDx: pancreatic pseudocyst vs pancreatic abscess; diagnose w/ CT scan
✔✔a pt w/ severe acute pancreatitis that fails to improve a develops rising fever or
recurrent symptoms after a period of recovery should be worked up for - ✔✔a
pancreatic abscess
*mortality rate of 20%
✔✔tx of pancreatic abscess - ✔✔-drainage
-Cx
-broad spectrum abx
-surgical debridement of necrotic tissues if necessary
✔✔new onset DM in an older (50-60 y/o) pt who does not appear to be diabetic (not
obese) should be worked up for - ✔✔pancreactic cancer
✔✔what is the most common type of pancreatic cancer? - ✔✔ductal adenocarcinoma
(>90%)- poorly differentiated (worse)
✔✔migratory thrombophlebitis associated with malignancy is called? - ✔✔Trousseau
syndrome/Trousseau's sign of malignancy (i.e. w/ pancreatic cancer)
✔✔in what part of the pancreas is cancer normally located? - ✔✔head
, ✔✔a palpable, nontender gallbladder in a jaundiced pt is called a ______ sign and is
most often due to pancreatic cancer (or biliary cancer) - ✔✔Courvoisier sign
✔✔what labs/PE findings may show up in a pancreatic ca. pt? - ✔✔elevated direct
bilirubin, elevated alk phos, CEA, CA19-9, gray-clay colored stools, painless jaundice,
pruritis, anorexia, Courvoisier's sign (palpable, nontender, distended GB),
abdominal/back pain
✔✔what is a great test to check for pancreatic ca. when nothing shows up on CT/US
but you are really suspicious? - ✔✔ERCP (inj contrast directly into pancreatic duct)
✔✔pancreaticoduodenectomy aka ? is very surgeon dependent when it comes to
mortality rates - ✔✔whipple procedure
✔✔what areas must be free of tumor for pancreatic cancer to be considered
resectable? - ✔✔1. hepatic a near origin of gastroduodenal a
2. SMA (under body of pancreas)
3. liver and regional LNs
✔✔Dx? anorexia, periumbilical/epigastric pain followed by RLQ pain, nausea, vomiting,
rebound tenderness, rigidity, guarding, pain when leg is raised against resistant;
workup? tx? - ✔✔dx: appendicitis
workup: US, CT, CBC w/ leukocytosis
tx: appendectomy & sometimes broad spectrum abx if caught early and uncomplicated
-other signs; Rovsings (RLQ pain from LLQ palpation), Obturator sign (RLQ pain w/ hip
rotation), McBurney's pt tenderness (1/3 distance from ASIS to umbilicus), Psoas sign
(described in scenario)
✔✔while malignancies involving the small intestine are rare, they most commonly are
what type? - ✔✔1. adenocarcinoma (mostly in duodenum)
2. carcinoid (mostly in ileum)
3. lymphoma
4. sarcoma
*increased risk if pt has HNPCC, Peutz-Jeghers syndrome, FAP, IBD- Crohn's dz, CF
✔✔dx? nonobstructive colon dilation *>6* cm + signs of systemic toxicity; causes? tx? -
✔✔-toxic megacolon
-causes: UC, Crohn's, C. diff (pseudomembranous colitis), infectious, radiation,
ischemic
-tx: decompression
QUESTIONS WITH SOLUTIONS GRADED A+
✔✔name the sign: bruising of the flanks between the last rib and the top of the hip that
is a sign of retroperitoneal hemorrhage (*hemorrhagic pancreatitis*) - ✔✔Grey Turner's
sign
✔✔name the sign: periumbilical bruising due to pancreatitis - ✔✔Cullen's sign
✔✔what are the 2 types of anorexia nervosa patients seen? - ✔✔1. restrictive type-
reduced calorie intake, dieting, fasting, excessive exercise, diet pills
2. purging type- primarily engages in self-induced vomiting, diuretic/laxative/enema
abuse
✔✔Dx of anorexia nervosa is a BMI ≤_____ kg/m2 or body weight <____% of ideal
weight - ✔✔BMI ≤ 17.5 or <85% ideal body wt
✔✔what will be seen on PE and labs of an anorexia nervosa pt? - ✔✔-*PE*:
emaciation, hypotensions, bradycardia, skin/hair changes (lanugo- blonde peach fuzz),
dry skin, salivary gland hypertrophy, ameorrhea, arrhythmias, osteoporosis
-*labs*: leukocytosis, leukopenia, anemia, hypokalemia, inc BUN (dehydration),
hypothyroidism
✔✔what is the tx for anorexia? - ✔✔hospitalization if <75% ideal body wt or w/
electrolyte imbalances (risk of arrhythmias), psychotherapy, supervised meals, wt
monitoring, pharmacotherapy- SSRIs if depressed, SGAs help w/ wt gain (metabolic
side effects)
✔✔etiologies of anorexia (unintentional weight loss)? - ✔✔-malignancy
-PUD
-IBD
-celiac dz
-gallbladder dz
-depression
-eating d/o
-hyperthyroidism
-new onset DM
-HIV
-TB
-Hep C
-helminthic infxns
-COPD
-CHF
-neurologic diseases
,✔✔the most common cause of prehepatic jaundice= - ✔✔hemolysis (increased
production of bilirubin)
✔✔what are the causes of intrahepatic jaundice? - ✔✔genetic (Dubin Johnson, Crigler-
Najjar) or hepatitis
labs: elevations of MIXED indirect and direct bilirubin
✔✔extrahepatic jaundice most often results from biliary obstruction from - ✔✔-malignant
tumors (pancreatic ca, cholangiocarcinoma, ampulla of vater cancer)
-choledocholithiasis (common bile duct obstruction)
-biliary strictures (stent them)
✔✔what are things you should ask patient of hepatic jaundice? - ✔✔-drug use
-alcohol intake
-high risk behaviors
-age
✔✔jaundice, clay colored stools, wt loss, distended *nonpainful* gallbladder are all
signs of? - ✔✔obstructive jaundice; order CT;
Ddx:
-pancreatic cancer
-cholangioncainoma
-ampulla of vater cancer (if nothing shows up on CT)
-strictures
✔✔what are the genetic causes of the jaundice for the following corresponding
labs/pathophys:
1. asx jaundice, inc indirect bili, nml LFTs from *deficiency of GT*
2. symptomatic jaundice (kernicterus), inc indirect bili from *absence of GT*
3. asx jaundice, nml LFTs, inc direct bili, due to impaired hepatocyte excretion of conj.
bili into bile - ✔✔1. gilbert syndrome
2. crigler-najjar syndrome
3. dubin-johnson syndrome
✔✔causes of melena vs hematochezia? - ✔✔-melena: bleeding (usually) above
ligament of Treitz: PUD, varices, gastric carcinoma
-hematochezia: diverticulitis, colon cancer, hemorrhoids
✔✔Dx? infant <6 mos old, non-bilous vomiting/regurgitation that becomes projectile
vomiting after feeding, dehydration, malnutrition, jaundice, olive-shaped non-tender
mobile hard nodule in epigastric area, string sign on upper GI contrast; tx? - ✔✔dx:
pyloric stenosis
tx: rehydration and electrolyte replenishment & pyloromyotomy
,✔✔what is the diagnostic test of choice for pyloric stenosis? - ✔✔US showing
thickening of pylorus
-can also do an upper GI contrast which will show string sign (dye through narrowed
channel)
✔✔what type of acid-base disturbance will you see with pyloric stenosis? -
✔✔hypochloremic metabolic alkalosis
✔✔what are the contents of a pancreatic pseudocyst? complications? - ✔✔fluid
collections of pancreatic enzymes; can become infected and turn into an abscess, can
rupture, can bleed, can cause bowel obstruction on duodenum
✔✔pancreatic pseudocyst tx - ✔✔-internal drainage (tube to stomach or anastomosed
to jejunum) *if >6 cm or >6 wks*
-external drainage (through skin) if critically ill
complications: infection, rupture, hemorrhage, bowel obstruction
✔✔Ddx/tx? pt presents s/p acute pancreatitis 2 weeks ago with pain, fever,
leukocytosis, elevated lipase/amylase, and a palpable mass over the epigastric/LUQ
area - ✔✔-DDx: pancreatic pseudocyst vs pancreatic abscess; diagnose w/ CT scan
✔✔a pt w/ severe acute pancreatitis that fails to improve a develops rising fever or
recurrent symptoms after a period of recovery should be worked up for - ✔✔a
pancreatic abscess
*mortality rate of 20%
✔✔tx of pancreatic abscess - ✔✔-drainage
-Cx
-broad spectrum abx
-surgical debridement of necrotic tissues if necessary
✔✔new onset DM in an older (50-60 y/o) pt who does not appear to be diabetic (not
obese) should be worked up for - ✔✔pancreactic cancer
✔✔what is the most common type of pancreatic cancer? - ✔✔ductal adenocarcinoma
(>90%)- poorly differentiated (worse)
✔✔migratory thrombophlebitis associated with malignancy is called? - ✔✔Trousseau
syndrome/Trousseau's sign of malignancy (i.e. w/ pancreatic cancer)
✔✔in what part of the pancreas is cancer normally located? - ✔✔head
, ✔✔a palpable, nontender gallbladder in a jaundiced pt is called a ______ sign and is
most often due to pancreatic cancer (or biliary cancer) - ✔✔Courvoisier sign
✔✔what labs/PE findings may show up in a pancreatic ca. pt? - ✔✔elevated direct
bilirubin, elevated alk phos, CEA, CA19-9, gray-clay colored stools, painless jaundice,
pruritis, anorexia, Courvoisier's sign (palpable, nontender, distended GB),
abdominal/back pain
✔✔what is a great test to check for pancreatic ca. when nothing shows up on CT/US
but you are really suspicious? - ✔✔ERCP (inj contrast directly into pancreatic duct)
✔✔pancreaticoduodenectomy aka ? is very surgeon dependent when it comes to
mortality rates - ✔✔whipple procedure
✔✔what areas must be free of tumor for pancreatic cancer to be considered
resectable? - ✔✔1. hepatic a near origin of gastroduodenal a
2. SMA (under body of pancreas)
3. liver and regional LNs
✔✔Dx? anorexia, periumbilical/epigastric pain followed by RLQ pain, nausea, vomiting,
rebound tenderness, rigidity, guarding, pain when leg is raised against resistant;
workup? tx? - ✔✔dx: appendicitis
workup: US, CT, CBC w/ leukocytosis
tx: appendectomy & sometimes broad spectrum abx if caught early and uncomplicated
-other signs; Rovsings (RLQ pain from LLQ palpation), Obturator sign (RLQ pain w/ hip
rotation), McBurney's pt tenderness (1/3 distance from ASIS to umbilicus), Psoas sign
(described in scenario)
✔✔while malignancies involving the small intestine are rare, they most commonly are
what type? - ✔✔1. adenocarcinoma (mostly in duodenum)
2. carcinoid (mostly in ileum)
3. lymphoma
4. sarcoma
*increased risk if pt has HNPCC, Peutz-Jeghers syndrome, FAP, IBD- Crohn's dz, CF
✔✔dx? nonobstructive colon dilation *>6* cm + signs of systemic toxicity; causes? tx? -
✔✔-toxic megacolon
-causes: UC, Crohn's, C. diff (pseudomembranous colitis), infectious, radiation,
ischemic
-tx: decompression
