Surgery pretests questions II
330. A 73-year-old woman presents to the emergency room complaining of severe epigastric
pain radiating to her back, nausea, and vomiting. CT scan of the abdomen demonstrates
inflammation and edema of the pancreas. A right upper quadrant ultrasound demonstrates the
presence of gallstones in the gallbladder. Which of the following is an important prognostic sign
in acute pancreatitis according to Ranson’s criteria?
a. Amylase level
b. Age
c. Total bilirubin level
d. Albumin level
e. Lipase level
331. A 55-year-old man who is extremely obese reports weakness, sweating, tachycardia,
confusion, and headache whenever he fasts for more than a few hours. He has prompt relief of
symptoms when he eats. Labarotory examination reveals an inappropriately high level of serum
insulin during the episodes of fasting. Which of the following is the most appropriate treatment
for this condition?
a. Diet modification to include frequent meals
b. Long-acting somatostatin analogue octreotide
c. Simple excision of the tumor
d. Total pancreatectomy
e. Chemotherapy and radiation
333. An 80-year-old man is admitted to the hospital complaining of nausea, abdominal pain,
distention, and diarrhea. A cautiously performed transanal contrast study reveals an apple-core
configuration in the rectosigmoid area. Which of the following is the most appropriate next step
in his management?
a. Colonoscopic decompression and rectal tube placement
b. Saline enemas and digital disimpaction of fecal matter from the rectum
c. Colon resection and proximal colostomy
d. Oral administration of metronidazole and checking a Clostridium difficile titer
e. Evaluation of an electrocardiogram and obtaining an angiogram to evaluate for colonic
mesenteric ischemia
336. A septuagenarian woman undergoes an uncomplicated resection of an abdominal aneurysm.
Four days after surgery the patient presents with sudden onset of abdominal pain and distention.
1
An abdominal radiograph demonstrates an air-filled, kidney-bean–shaped structure in the left
upper quadrant. Which of the following is the most appropriate management at this time?
a. Decompression of the large bowel via colonoscopy
b. Placement of the NG tube and administration of low-dose cholinergic drugs
c. Administration of a gentle saline enema and encouragement of ambulation
d. Operative decompression with transverse colostomy
e. Right hemicolectomy
337. A 45-year-old man presents with right upper quadrant abdominal pain and fever. CT scan
shows a large, calcified cystic mass in the right lobe of the liver. Echinococcus is suggested by
the CT findings. Which of the following is the most appropriate management of echinococcal
liver cysts?
a. Percutaneous catheter drainage.
b. Medical treatment with albendazole.
c. Medical treatment with steroids.
d. Medical treatment with metronidazole.
e. Total pericystectomy.
338. A 28-year-old woman who is 15 weeks pregnant has new onset of nausea, vomiting, and
right sided abdominal pain. She has been free of nausea since early in her first trimester. The
pain has become worse over the past 6 hours. Which of the following is the most common
nonobstetric surgical disease of the abdomen during pregnancy?
a. Appendicitis
b. Cholecystitis
c. Pancreatitis
d. Intestinal obstruction
e. Acute fatty liver of pregnancy
355. During an appendectomy for acute appendicitis, a 4-cm mass is found in the midportion of
the appendix. Frozen section reveals this lesion to be a carcinoid tumor. Which of the following
is the most appropriate management of this patient?
a. Appendectomy
b. Appendectomy followed by a colonoscopy
c. Appendectomy followed by a PET scan
d. Right hemicolectomy
e. Total proctocolectomy
2
356. A 45-year-old man is examined for a yearly executive physical. A mass is palpated in the
rectum, and a biopsy suggests carcinoid. Which of the following findings is most likely to be
associated with the carcinoid syndrome?
a. Tumor < 2 cm
b. Tumor < 2 cm with ulceration
c. Tumor > 2 cm
d. Involvement of regional lymph nodes
e. Hepatic metastases
357. An ultrasound is performed on a patient with right upper quadrant pain. It demonstrates a
large gallstone in the cystic duct but also a polypoid mass in the fundus. Which of the following
is an indication for cholecystectomy for a polypoid gallbladder lesion?
a. Size greater than 0.5 cm
b. Presence of clinical symptoms
c. Patient age of older than 25 years
d. Presence of multiple small lesions
e. Absence of shadowing on ultrasound
358. An alcoholic man has been suffering excruciating pain from chronic pancreatitis recalcitrant
to analgesics and splanchnic block. A surgeon recommends total pancreatectomy. A patient who
has a total pancreatectomy might be expected to develop which of the following complications?
a. Diabetes mellitus and steatorrhea
b. Diabetes mellitus and constipation
c. Hypoglycemia
d. Hypoglycemia and steatorrhea
e. Hypoglycemia and constipation
359. A 45-year-old woman has an incidental finding of a liver mass on a CT scan. Magnetic
resonance imaging (MRI) is suggestive of a hemangioma. Which of the following is the most
appropriate management strategy for this patient?
a. Observation
b. Discontinuation of oral contraceptive pills
c. Percutaneous biopsy of the lesion to confirm the diagnosis
d. Resection of the hemangioma
e. Liver transplantation
3
360. A 57-year-old woman presents with adenocarcinoma of the right colon. Laboratory
evaluation demonstrates an elevation of carcinoembryonic antigen (CEA) to 123 ng/mL. Which
of the following is the most appropriate use of CEA testing in patients with colorectal cancer?
a. As a screening test for colorectal cancer
b. To determine which patients should receive adjuvant therapy
c. To determine which patients should receive neoadjuvant therapy
d. To monitor for postoperative recurrence
e. To monitor for preoperative metastatic disease
Questions 366 to 369
Select the most appropriate surgical procedure for each patient. Each lettered option may be used
once, more than once, or not at all.
a. Low anterior resection
b. Abdominoperineal resection
c. Subtotal colectomy with end ileostomy
d. Total proctocolectomy with ileoanal J-pouch
e. Sigmoid resection with end colostomy (Hartmann procedure)
f. Transanal excision
g. Diverting colostomy
366. A 37-year-old man with a 10-year history of ulcerative colitis who has a sessile polyp 10 cm
from the anal verge with high-grade dysplasia.
367. A 60-year-old woman with recurrent squamous cell carcinoma of the anus after
chemoradiation.
368. A 68-year-old woman with fecal incontinence who presents with a large fixed
adenocarcinoma 3 cm from the anal verge
369. A 33-year-old man with a history of Crohn disease presents with severe abdominal pain and
fever. On examination, his heart rate is 130 beats per minute, blood pressure 105/62 mm Hg, and
temperature 38.9°C (102°F). Workup reveals a leukocytosis of 32,000/mm 3. Plain films reveal a
markedly dilated large colon.
