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SMARTYPANCE: GENERAL SURGERY QUESTIONS
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SMARTYPANCE: GENERAL SURGERY QUESTIONS
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SMARTYPANCE: GENERAL SURGERY QUESTIONScompartment syndrome - Answers- An 18-year-old patient has a tibia/fibula fracture
following a motorcycle crash. Twelve hours later the patient presents with increased
pain despite adequate doses of analgesics and immobilization. Which of the following is
the most likely diagnosis?
A
avascular necrosis
B
myositis ossificans
C
compartment syndrome
D
reflex sympathetic dystrophy
compartment pressure - Answers- A 38 year-old male sustained a fracture of the left
distal tibia following a 25-foot fall and is taken to the operating room for an open
reduction internal fixation of the distal tibia. Sixteen hours post-op, the patient develops
sustained pain, which is not relieved with narcotics. On passive range of motion of the
toes the patient "yells" in agony. The patient also states that the top of his foot has
decreased sensation. On physical examination the physician assistant notes that the leg
is swollen and the foot is cool to touch. Based upon this information what diagnostic
testing should be done?
A
X-ray of the lower leg and ankle
B
Doppler studies
C
Bone scan.
D
Compartment pressure
fasciotomy
**compartment syndrome - Answers- A 23-year-old patient presents to the emergency
department after a motor vehicle accident. The patient was an unrestrained driver
involved in a head-on collision. The patient is heavily intoxicated on what he claims is
only alcohol. An initial trauma assessment is performed and is notable for significant
bruising of the right forearm. The patient is in the trauma bay and complains of severe
pain in his right forearm. A physical exam is performed and is notable for pallor,
decreased sensation, and cool temperature of the skin of the right forearm. Pain is
elicited upon passive movement of the right forearm and digits. A thready radial pulse is
palpable. A FAST exam is performed and is negative for signs of internal bleeding. The
patient's temperature is 99.5°F (37.5°C), pulse is 100/min, blood pressure is 110/70
mmHg, respirations are 12/min, and oxygen saturation is 98% on room air. Radiography
,of the right forearm is ordered. The patient is still heavily intoxicated. Which of the
following is the best next step in management?
A
Detoxification
B
IV fluids
C
Analgesics
D
Fasciotomy
E
Pressure measurement
obstruction - Answers- Which of the following pathophysiological processes is believed
to initiate acute appendicitis?
A
Obstruction
B
Perforation
C
Hemorrhage
D
Vascular compromise
Cullen's sign - Answers- What is the term for blue discoloration about the umbilicus?
A
Cullen's sign
B
Murphy's sign
C
Rovsing's sign
D
Turner sign
Rovsing's sign - Answers- A patient presents with abdominal pain in the right lower
quadrant, examination reveals increased pain in the right lower quadrant on deep
palpation of the left lower quadrant. This commonly known as which of the following?
A
Psoas sign
B
Murphy's sign
C
Rovsing's sign
D
Obturator sign
,acute pyelonephritis - Answers- A 25 year-old female presents with right lower quadrant
pain, right flank pain, nausea, and vomiting. Her temperature is 39.6 degrees C. There
is right CVA tenderness and RLQ tenderness. Pelvic exam is unremarkable. Urinalysis
reveals pH 7.0, trace protein, negative glucose, negative ketones, positive blood, and
positive nitrates. Specific gravity is 1.022. Microscopic shows 102 RBCs/HPF, 50-75
WBCs/HPF, rare epithelial cells, and WBC casts. The most likely diagnosis is
A
acute salpingitis
B
nephrolithiasis.
C
acute pyelonephritis
D
appendicitis
ectopic pregnancy - Answers- A 26 year-old gravida 0 sexually active female presents
to the emergency room complaining of colicky pain in her lower abdomen for the past
12 hours. She passed out earlier in the day while trying to have a bowel movement. Her
last menstrual period was 6 weeks ago. She has noted vaginal spotting over the last 24
hours. Vital signs show Temp 37 degrees C, BP 96/60mmHg, P 110, R 16, Oxygen Sat.
98%. Abdominal exam is positive for distension and tenderness. Bowel sounds are
decreased. Pelvic exam shows cervical motion and adnexal tenderness. Which of the
following is the most likely diagnosis?
A
Ectopic pregnancy
B
Appendicitis
C
Crohn's disease
D
Pelvic inflammatory disease
IV rehydration - Answers- 25 year-old male presents to the ED with left calf pain and
cramping, as well as nausea and vomiting. He admits to "partying with cocaine all
night". He describes his urine as a dark brown color. Serum creatinine kinase (CK) is
1325 IU/L (Normal Range 32-267 IU/L). Which of the following is the initial mainstay of
therapy for this condition?
A
IV rehydration
B
Fasciotomy
C
Toradol (Ketorlac)
D
Hydrotherapy
, nephrolithiasis - Answers- A 42 year-old male presents complaining of a sudden onset
of a severe intermittent pain originating in the flank and radiating into the right testicle.
He also complains of nausea and vomiting. On examination the patient is afebrile, but
restless. Examination of the abdomen reveals tenderness to palpation along the right
flank with no rebound or direct testicular tenderness. Urinalysis reveals a pH of 5.4 and
microscopic hematuria, but is otherwise unremarkable. Which of the following is the
most likely diagnosis?
A
Bladder cancer
B
Nephrolithiasis
C
Acute appendicitis
D
Acute epididymitis
Prehn's sign - Answers- A 22 year-old male presents to the clinic complaining of scrotal
pain that radiates into the groin. Patient admits to being a weightlifter and was lifting 24
hours prior to this pain developing into the scrotum. The patient admits to being sexually
active with only his male partner. Examination reveals a reddened scrotum and it is
difficult to distinguish the epididymis from the testes on the right side. Elevation of the
right testicle brings relief of the pain. This is known as a positive
A
Prehn's sign.
B
Cullen's sign.
C
Rovsing's sign.
D
Murphy's sign.
abdominal mass
**symptomatic AAA presents with pulsating upper abdominal mass - Answers- Which of
the following conditions is most suggestive of a symptomatic abdominal aortic
aneurysm?
A
abdominal mass
B
hypertension
C
chest pain
D
syncope
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