Surgery p2
Surgical Emergency Quiz
Test your knowledge with this comprehensive quiz on surgical emergencies. Designed for medical students and professionals, it covers essential concepts in trauma care, including mechanisms of injury, diagnosis, and treatment options.
Key topics include:
- Head trauma and intracranial pressure
- Chest injuries and management
- Vascular injuries and surgical interventions
- Management of burns and lacerations
A 28-year-old man is brought to the emergency room for a severe head injury after a fall. Initially lethargic, he becomes comatose and does not move his right side. His left pupil is dilated and responds only sluggishly. The most common initial manifestation of increasing intra-cranial pressure in the victim of head trauma is
A. Change in level of consciousness
B. Ipsilateral (side of hemorrhage) pupillary dilation
C. Contralateral pupillary dilation
D. Hemiparesis
E. Hypertension
A 28-year-old man is brought to the emergency room for a severe head injury after a fall. Initially lethargic, he becomes comatose and does not move his right side. His left pupil is dilated and responds only sluggishly. Initial emergency reduction of intracranial pressure is most rapidly accomplished by
A. Saline-furosemide (Lasix) infusion
B. Urea infusion
C. Mannitol infusion
D. Intravenous dexamethasone (Decadron)
E. Hyperventilation
A 31-year-old man is brought to the emergency room following an automobile accident in which his chest struck the steering wheel. Examination reveals stable vital signs, but the patient exhibits multiple palpable rib fractures and paradoxical movement of the right side of the chest. Chest x-ray shows no evidence of pneumothorax or hemothorax, but a large pulmonary contusion is developing. Proper treatment would consist of which of the following?
A. Tracheostomy, mechanical ventilation, and positive end-expiratory pressure
B. Stabilization of the chest wall with sandbags
C. Stabilization with towel clips
D. Immediate operative stabilization
E. No treatment unless signs of respiratory distress develop
A 30-year-old man is stabbed in the arm. There is no evidence of vascular injury, but he cannot flex his three radial digits. He has injured the
A. Flexor pollicis longus and flexor digitus medius tendons
B. Radial nerve
C. Median nerve
D. Thenar and digital nerves at the wrist
E. Ulnar nerve
Following a 2-h fire-fighting episode, a 36-year-old fireman begins complaining of a throbbing headache, nausea, dizziness, and visual disturbances. He is taken to the emergency room where his carboxyhemoglobin (COHb) level is found to be 31%. Appropriate treatment would be to
A. Begin an immediate exchange transfusion
B. Transfer the patient to a hyperbaric oxygen chamber
C. Begin bicarbonate infusion and give 250mg acetazolamide (Diamox) intravenously
D. Administer 100% oxygen by mask
E. Perform flexible bronchoscopy with further therapy determined byfindings
An elderly pedestrian collides with a bicycle-riding pizza delivery man and suffers a unilateral fracture of his pelvis through the obturator foramen. You would manage this injury by
A. External pelvic fixation
B. Angiographic visualization of the obturator artery with surgical exploration if the artery is injured or constricted
C. Direct surgical approach with internal fixation of the ischia ramus
D. Short-term bed rest with gradual ambulation as pain allows after 3 days
E. Hip spica
Regarding high-voltage electrical burns to an extremity
A. Injuries are generally more superficial than those of thermal burns
B. Intravenous fluid replacement is based on the percentage of body surface area burned
C. Antibiotic prophylaxis is not required
D. Evaluation for fracture of the other extremities and visceral injury is indicated
E. Cardiac conduction abnormalities are unlikely
Which of the following fractures or dislocations of the extremities induced by blunt trauma is associated with significant vascular injuries?
A. Knee dislocation
B. Closed posterior elbow dislocation
C. Midclavicular fracture
D. Supracondylar femur fracture
E. Tibial plateau fracture
A patient is brought to the emergency room after a motor vehicle accident. He is unconscious and has a deep scalp laceration and one dilated pupil. His heart rate is 120 beats/min, blood pressure is 80/40 mm Hg, and respiratory rate is 35 breaths/min. Despite rapid administration of 2 L normal saline, the patient’s vital signs do not change significantly. The injury likely to explain this patient’s hypotension is
A. Epidural hematoma
B. Subdural hematoma
C. Intraparenchymal brain hemorrhage
D. Basilar skull fracture
E. None of the above
When operating to repair civilian colon injuries
A. A colostomy should be performed for colonic injury in the presence of gross fecal contamination
B. The presence of shock on admission or more than two associated intraabdominal injuries is an absolute contraindication to primary colonic repair
C. Distal sigmoidal injuries should not be repaired primarily
D. Right-sided colonic wounds should not be repaired primarily
E. Administration of intravenous antibiotics with aerobic and anaerobic coverage has not been shown to decrease the incidence of wound infections after repair of colonic injuries
If injury to a major artery in an extremity is suspected, surgical exploration should be carried out regardless of the presence of palpa- ble pulses distal to the injury. The rationale is that the presence of pal- pable distal pulses does not reliably exclude
A. Significant arterial injury
B. Significant injury to adjacent motor nerve trunks
C. Significant injury to adjacent long bones
D. Significant injury to adjacent veins
E. Subsequent development of a compartment syndrome and the need for fasciotomy
Animal and clinical studies have shown that administration of lactated Ringer’s solution to patients with hypovolemic shock may
A. Increase serum lactate concentration
B. Impair liver function
C. Improve hemodynamics by alleviating the deficit in the interstitial fluid compartment
D. Increase metabolic acidosis
E. Increase the need for blood transfusion
An 18-year-old high school football player is kicked in the left flank. Three hours later he develops hematuria. His vital signs are stable. The diagnostic tests performed reveal extravasation of contrast into the renal parenchyma. Treatment should consist of
A. Resumption of normal daily activity excluding sports
B. Exploration and suture of the laceration
C. Exploration and wedge resection of the left kidney
D. Nephrostomy
E. Antibiotics and serial monitoring of blood count and vital signs
An 18-year-old high school football player is kicked in the left flank. Three hours later he develops hematuria. His vital signs are stable. Initial diagnostic tests in the emergency room should include which of the following?
A. Retrograde urethrography
B. Retrograde cystography
C. Arteriography
D. Intravenous pyelogram
E. Diagnostic peritoneal lavage
True statements concerning penetrating pancreatic trauma include
A. Most injuries do not involve adjacent organs
B. Management of a ductal injury to the left of the mesenteric vessels is Rouxen-Y pancreaticojejunostomy
C. Management of a ductal injury in the head of the pancreas is pancreaticoduodenectomy
D. Small peripancreatic hematomas need not be explored to search for pancreatic injury
E. The major cause of death is exsanguination from associated vascular injuries
Rapid fluid resuscitation of the hypovolemic patient after abdominal trauma is significantly enhanced by which of the following?
A. Placement of long 18-gauge subclavian vein catheters
B. Placement of percutaneous femoral vein catheters
C. Bilateral saphenous vein cutdowns
D. Placement of short, largebore percutaneous peripheral intravenous catheters
E. Infusion of cold whole blood
Which of the following situa- tions would be an indication for performance of a thoracotomy in the emergency room?
A. Massive hemothorax following blunt trauma to the chest
B. Blunt trauma to multiple organ systems with obtainable vital signs in the field but none on arrival in the emergency room
C. Rapidly deteriorating patient with cardiac tamponade from penetrating thoracic trauma
D. Penetrating thoracic trauma and no signs of life in the field
E. Penetrating abdominal trauma and no signs of life in the field
A 26-year-old man sustains a gunshot wound to the left thigh. Exploration reveals that a 5-cm portion of superficial femoral artery is destroyed. Appropriate management includes
A. Debridement and end-to-end anas- tomosis
B. Debridement and repair with an interposition prosthetic graft
C. Debridement and repair with an interposition arterial graft
D. Debridement and repair with an interposition vein graft
E. Ligation and observation
Laryngeal obstruction. Select the proper intervention for each of the immediately life-threatening injuries of the chest listed below:
A. Endotracheal intubation
B. Cricothyroidotomy
C. Subxiphoid window
D. Tube thoracostomy
E. Occlusive dressing
Open pneumothorax. Select the proper intervention for each of the immediately life-threatening injuries of the chest listed below:
A. Endotracheal intubation
B. Cricothyroidotomy
C. Subxiphoid window
D. Tube thoracostomy
E. Occlusive dressing
Flail chest. Select the proper intervention for each of the immediately life-threatening injuries of the chest listed below:
A. Endotracheal intubation
B. Cricothyroidotomy
C. Subxiphoid window
D. Tube thoracostomy
E. Occlusive dressing
Tension pneumothorax. Select the proper intervention for each of the immediately life-threatening injuries of the chest listed below:
A. Endotracheal intubation
B. Cricothyroidotomy
C. Subxiphoid window
D. Tube thoracostomy
E. Occlusive dressing
Pericardial tamponade. Select the proper intervention for each of the immediately life-threatening injuries of the chest listed below:
A. Endotracheal intubation
B. Cricothyroidotomy
C. Subxiphoid window
D. Tube thoracostomy
E. Occlusive dressing
For which of the following malignancies does histologic grade best correlate with prognosis?
A. Lung cancer
B. Melanoma
C. Colonic adenocarcinoma
D. Hepatocellular carcinoma
E. Soft tissue sarcoma
The mass appears to be fixed to the underlying muscle, but the overly- ing skin is movable. The next most appropriate step in management is
A. Above-knee amputation
B. Excisional biopsy
C. Incisional biopsy
D. Bone scan
E. Abdominal CT scan
A 50-year-old man is incidentally discovered to have non- Hodgkin’s lymphoma confined to the submucosa of the stomach during sophagogastroduodenoscopy for dyspepsia. Which of the following statements is true regarding his condition?
A. Surgery alone cannot be considered adequate treatment
B. Combined chemotherapy and radiation therapy, without prior resecton, are not effective
C. Combined chemotherapy and radiation therapy, without prior resection, result in a high risk of severe hemorrhage and perforation
D. Outcome (freedom from progression and overall survival) is related to the histological grade of the tumor
E. The stomach is the most common site for non-Hodgkin’s lymphoma of the gastrointestinal tract
Which of the following statements regarding malignant parotid tumors is correct?
A. Acinar carcinoma is a highly aggressive malignant tumor of the parotid gland
B. Squamous carcinoma of the parotid gland exhibits only moderately malignant behavior
C. Regional node dissection for occult metastases is not indicated for malignant parotid tumors because of their low incidence and the morbidity of lymphadenectomy
D. Facial nerve preservation should be attempted when the surgical margins of resection are free of tumor
E. Total parotidectomy (superficial and deep portions of the gland) is indicated for malignant tumors
Which of the following statements regarding testicular cancer is true?
A. Lymph node dissection after radical orchiectomy is useful for staging but does not increase survival
B. Seminomas and choriocarcinomas are best treated with orchiectomy and retroperitoneal lymph node dissection
C. Seminomas are extremely resistant to radiotherapy
D. Orchiectomy for a testicular mass is approached via the scrotum
E. Cryptorchidism is associated with an increased risk of testicular cancer
Regarding the risk of breast cancer, which of the following statements is true?
A. Breast cancer occurs more com- monly among women of the lower social classes
B. A history of breast cancer in a first- degree family relative is associated with a fourfold increase in risk
C. Women with a first birth after age 30 years have approximately twice the risk of those with a first birth before age 18
D. Cigarette smoking increases the risk of breast cancer
E. Hair dyes have been shown to increase the risk of breast cancer
Human immunodeficiency virus (HIV) has been isolated from many body fluids. Which of the following is a major source of transmission?
A. Tears
B. Sweat
C. Semen
D. Urine
E. Breast milk
What is the most common cause of cancer death among women?
A. Breast cancer
B. Ovarian cancer
C. Colon cancer
D. Endometrial cancer
E. Lung cancer
Which of the following statements regarding adrenal cortical insufficiency is true?
A. Treatment with exogenous steroids is usually ineffective
B. It is commonly seen as a consequence of metastasis of distant cancers, such as lung or breast, to the adrenal glands
C. Chronic adrenal insufficiency (Addison’s disease) in the preoperative patient should be recognizable by a constellation of findings, including hyperglycemia, hypernatremia, and hypokalemia
D. Death from untreated chronic adrenal insufficiency may occur within hours of surgery
E. The most common underlying cause today is infection with resis- tant tuberculosis
A 35-year-old woman under- goes her first screening mammogram. Which of the following mammographic findings would require a breast biopsy?
A. Breast calcifications larger than 2 mm in diameter
B. Five or more clustered breast microcalcifications per square centimeter
C. A density that effaces with compression
D. Saucer-shaped microcalcifications
E. Multiple round well-circumscribed breast densities
The diagnosis of primary hy- perparathyroidism is most strongly suggested by
A. Serum acid phosphatase above 120 IU/L
B. Serum alkaline phosphatase above 120 IU/L
C. Serum calcium above 11 mg/dL
D. Urinary calcium below 100 mg/day
E. Parathyroid hormone levels below 5 pmol/L
Somatostatin contributes to which of the following processes?
A. Inhibition of adrenocortical cells
B. Inhibition of pancreatic α cells
C. Stimulation of antral gastrin cells
D. Stimulation of secretin-producing cells in the duodenum
E. Stimulation of GI motility
Which of the following statements concerning Cushing syndrome secondary to adrenal adenoma is true?
A. Adrenal adenomas cause 40–60% of all cases of Cushing syndrome
B. Biochemical and x-ray procedures are generally unsuccessful in lateralizing the tumors preoperatively
C. Exploration of both adrenal glands is indicated
D. For uncomplicated tumors, an open transperitoneal surgical approach is usually employed
E. Postoperative corticoid therapy is required to prevent hypoadrenalism
A 40-year-old woman is found to have a 1- to 2-cm, slightly tender cystic mass in her breast; she has no perceptible axillary adenopa- thy. What course would you follow?
A. Reassurance and reexamination in the immediate postmenstrual period
B. Immediate excisional biopsy
C. Aspiration of the mass with cytologic analysis
D. Fluoroscopically guided needle localization biopsy
E. Mammography and reevaluation of options with new information
The course of papillary carci- noma of the thyroid is best described by which of the following statements?
A. Metastases are rare; local growth is rapid; erosion into the trachea and large blood vessels is frequent
B. Local invasion and metastases almost never occur, which makes the term carcinoma misleading
C. Bony metastases are frequent and produce an osteolytic pattern par- ticularly in vertebrae
D. Metastases frequently occur to cervical lymph nodes; distant metas- tases and local invasion are rare
E. Rapid, widespread metastatic involvement of the liver, lungs, and bone marrow results in a 5-year survival rate of approximately 10%
As an incidental finding dur- ing an upper abdominal CT scan, a 3-cm mass in the adrenal gland is noted. The appropriate next step in analysis and management of this finding would be
A. Observation
B. CT-guided needle biopsy
C. Excision of the mass
D. Measurement of urine catecholamine excretion
E. Cortisol provocation test
A woman sustains an injury to her chest after striking the steer- ing wheel of her automobile during a collision. Which of the following statements concerning fat necrosis of the breast is true?
A. Most patients report a history of trauma
B. The lesion is usually nontender and diffuse
C. It predisposes patients to the development of breast cancer
D. It is difficult to distinguish from breast cancer
E. Excision exacerbates the process
The most likely diagnosis in a patient with hypertension, hypo kalemia, and a 7-cm suprarenal mass is
A. Hypernephroma
B. Cushing’s disease
C. Adrenocortical carcinoma
D. Pheochromocytoma
E. Carcinoid
True statements regarding Paget’s disease of the breast include that it
A. Usually precedes development of Paget’s disease of bone
B. Presents with nipple-areolar ecze- matous changes
C. Does not involve axillary lymph nodes because it is a manifestation of intraductal carcinoma only
D. Accounts for 10–15% of all newly diagnosed breast cancers
E. Is adequately treated with wide excision when it presents as a mass
A 40-year-old man who has a long history of peptic ulcer disease that has not responded to medical therapy is admitted to the hospital. His serum gastrin levels are markedly elevated; at celiotomy, a small, firm mass is palpated in the tail of the pancreas. Correct statements concerning this patient’s condition include which of the following?
A. Histamine or a protein meal will markedly increase basal acid secretion
B. Secretin administration will suppress acid secretion
C. The pancreatic mass will probably be benign
D. Distal pancreatectomy is the treatment of choice
E. H2 receptor antagonists have not been beneficial in the treatment of this condition
Of the common complications of thyroidectomy, the one that may be avoided through prophy- laxis is
A. Injury to the recurrent laryngeal nerve
B. Injury to the superior laryngeal nerve
C. Symptomatic hypocalcemia
D. Thyroid storm
E. Postoperative hemorrhage and wound hematoma
Following correction of the patient’s hypercalcemia with hydration and gentle diuresis with furosemide, the most likely therapeutic approach would be
A. Administration of maintenance doses of steroids
B. Radiation treatment for bony metastases
C. Neck exploration and resection of three out of four parathyroid glands
D. Neck exploration and resection of a parathyroid adenoma
E. Avoidance of sunlight, vitamin D, and calcium-containing dairy prod- ucts
99. A 36-year-old woman, 20 wk pregnant, presents with a 1.5-cm right thyroid mass. Fine-needle aspiration is consistent with a pap- illary neoplasm. The mass is “cold” by scan and solid by ultrasound. Which method of treatment would be contraindicated?
A. Right thyroid lobectomy
B. Subtotal thyroidectomy
C. Total thyroidectomy
D. Total thyroidectomy with lymph node dissection
E. 131I radioactive ablation of the thyroid gland
True statements about discharge from the nipple include
A. Intermittent thin or milky dis- charge can be physiologic
B. Expressible nipple discharge is an indication for open biopsy
C. Bloody discharge is indicative of an underlying malignancy
D. Galactorrhea is indicative of an underlying malignancy
E. Pathologic discharge is usually bi- lateral
True statements regarding Cushing’s disease and Cushing syndrome include which of the following?
A. Adrenocortical hyperplasia is the most common cause of Cushing’s disease
B. Overproduction of ACTH is pathognomonic of Cushing syndrome
C. Clinical manifestations of Cushing’s disease and Cushing syndrome are identical
D. Cushing syndrome is caused only by neoplasms of either the pituitary or adrenal glands
E. Cushing’s disease is incurable
A 34-year-old woman has recurrent fainting spells induced by fasting. Her serum insulin levels during these episodes are markedly elevated. Correct statements regarding this patient’s condition include which of the following?
A. The underlying lesion is probably an α-cell tumor of the pancreas
B. The underlying lesion is usually multifocal
C. These lesions are usually malignant
D. Serum calcium levels may be elevated
E. She should be screened for a coexistent pheochromocytoma
The incidence of breast cancer
A. Increases with increasing age
B. Has declined since the 1940s
C. Is related to dietary fat intake
D. Is related to coffee intake
E. Is related to vitamin C intake
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