Surgical Medicine Quiz

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Questions and Answers

What is the minimum predicted postoperative FEV1 required for a patient to undergo an anatomic pulmonary lobectomy if their pre-operative FEV1 is less than 60%?

≥ 60%

35–40% (correct)

≥ 45%

≥ 50%

What is the recommended endoscopic surveillance interval for Barrett's esophagitis without dysplasia?

Every 1 to 2 years

Annual surveillance is recommended

Every 6 months

Every 3 to 5 years (correct)

When is an esophagectomy indicated for esophageal adenocarcinoma?

Only for lesions invading the muscularis propria (cT2N0) with high-risk features

For all resectable lesions

Only for lesions limited to the mucosa (cT1aN0)

For resectable lesions that invade the muscularis propria (cT2N0) in the absence of high-risk features (correct)

Which of the following is NOT a condition associated with Epstein-Barr virus infection?

Hepatitis (D) Signup and view all the answers

What is the normal LES pressure with a food bolus?

0 mmHg (C) Signup and view all the answers

What is the primary indication for splenectomy in the context of a multiloculated splenic abscess?

Splenectomy is the preferred treatment for multiloculated splenic abscesses. (A) Signup and view all the answers

What is the most likely causative organism for an encapsulated bacterial infection following splenectomy?

Streptococcus pneumoniae (D) Signup and view all the answers

Which of the following anatomical structures contains the splenic vessels and tail of the pancreas?

Splenorenal ligament (C) Signup and view all the answers

Which of the following is NOT a risk factor for developing a pyogenic liver abscess?

Alcohol abuse (D) Signup and view all the answers

Which of the following is NOT a surgical option for persistent anal fissures?

Fissurectomy (A) Signup and view all the answers

What is the preferred surgical technique for live donor liver resection for pediatric transplantation?

Left lateral hepatectomy (C) Signup and view all the answers

Which of the following conditions would necessitate a right hemicolectomy for an appendiceal neuroendocrine tumor?

Tumor size greater than 2 cm (D) Signup and view all the answers

Which of the following is a common side effect of octreotide treatment?

Cholelithiasis (C) Signup and view all the answers

Which of the following is NOT a common modality used for the localization of pancreatic neuroendocrine tumors (pNETs)?

Magnetic resonance imaging (MRI) (B) Signup and view all the answers

What is the most common cause of portal hypertension with thrombocytopenia?

Advanced cirrhosis (D) Signup and view all the answers

Which of the following statements is TRUE regarding treatment of variceal bleeding?

Octreotide and terlipressin are effective in controlling bleeding. (A) Signup and view all the answers

What is the recommended treatment for a patient with variceal bleeding who has signs of hepatic encephalopathy?

Liver transplantation. (A) Signup and view all the answers

What is the most common cause of liver cysts in the Middle East?

Echinococcus granulosus (A) Signup and view all the answers

Which condition is NOT indicated for stress ulcer prophylaxis with proton pump inhibitors?

Mild burn injury (less than 20% body surface area) (B) Signup and view all the answers

What type of anemia is likely to occur post-RYGBP due to iron deficiency?

Microcytic anemia (B) Signup and view all the answers

Which of the following statements about GISTs is true?

GISTs are a type of sarcoma. (B) Signup and view all the answers

Which of the following conditions specifically indicates the use of neoadjuvant chemotherapy?

Stage T2 or any N (B) Signup and view all the answers

A patient shows symptoms of neuromuscular issues after gastric surgery, indicating possible hypocalcemia. This is most likely due to:

Bypassing of proximal small bowel (A) Signup and view all the answers

What is the most significant indicator for malignant potential in a GIST?

Mitosis > 5/50 high-power field and size > 5 cm (A) Signup and view all the answers

What procedure should be performed if a large ulcer is found along the greater curvature of the stomach?

Biopsy from both the edge and the core (C) Signup and view all the answers

What is the expected time frame for gastric motility to return post abdominal surgery?

24 to 48 hours (C) Signup and view all the answers

What is the best method for diagnosing proximal small bowel lesions?

Endoscopic submucosal biopsy (B) Signup and view all the answers

What is the recommended treatment for a broad-based Meckel diverticulum during an appendectomy on a child?

Segmental resection of involved small intestine (C) Signup and view all the answers

What is the best management strategy for post-operative ileus?

Correct electrolytes (A) Signup and view all the answers

What type of lymphoma is associated with celiac disease?

Enteropathy-associated T-cell lymphoma (EATL) (C) Signup and view all the answers

What should be done during an EGD for large ulcers regardless of their location?

Biopsy from both the edge and the core of the ulcer (D) Signup and view all the answers

For a patient with intrahepatic cholangiocarcinoma without metastatic disease, what is the preferred treatment option?

R0 resection (B) Signup and view all the answers

What is a contraindication for the resection of paracellular carcinoma?

Main portal vein involvement (A) Signup and view all the answers

Which of the following is the most frequent serious complication following pancreaticoduodenectomy?

Pancreatic fistula (D) Signup and view all the answers

What is the recommended approach to use during necrotizing pancreatitis to minimize operative interventions?

Step up approach (B) Signup and view all the answers

Which finding strongly suggests a pyogenic liver abscess on CT imaging?

Multiloculated, hypodense liver lesion (B) Signup and view all the answers

What is the approximate central venous pressure that should be targeted during liver transection to minimize bleeding?

5 mm Hg (A) Signup and view all the answers

Which type of drainage is recommended for fungal hepatic abscesses?

Percutaneous drainage and caspofungin or micafungin (C) Signup and view all the answers

What is the expected functional liver remnant percentage after resection for a patient with cirrhosis?

40% (C) Signup and view all the answers

Study Notes

Nutrition & Metabolism

Enteral nutrition is preferred over parenteral nutrition within 24-48 hours in critically ill patients.
Tube feeding can be initiated in critically ill patients expected to have mechanical ventilation for at least 72 hours.
Respiratory quotient (RQ) of 1.0 = carbohydrates
RQ of 0.7 = lipids
Kwashiorkor is a condition where kids have fatty liver due to decreased carrier protein synthesis, which is a result of the lack of amino acid availability, making it difficult to transport lipoproteins out of the liver. Kwashiorkor is more severe than marasmus
Copper deficiency can manifest as pancytopenia, neuropathy, and ataxia, often seen after TPN without trace minerals or following a gastric bypass.
Selenium deficiency is linked to cardiomyopathy, hypothyroidism, and neurological changes.
Calcium chloride has a higher concentration of elemental calcium than calcium gluconate, but it's caustic when administered peripherally. It's usually reserved for code situations.
Prealbumin has a half-life of 48 hours, while albumin's half-life is 21 days.
25-30 kcal/kg/day = Basal Energy Expenditure (BEE) for a well-nourished patient undergoing mild stress surgery.
300 kcal/day increase for pregnancy, 500 for lactation

Short Chain Fatty Acids

Short chain fatty acids are absorbed by simple diffusion.
Long chain fatty acids are absorbed by micelles.
Short chain fatty acids are used as substrates for colonocyte nutrition.
Short chain fatty acids are produced in the colon via the action of bacteria on undigested carbohydrates.
Patients with colostomies or distal rectal pouches may develop diversion colitis due to lack of short chain fatty acids, which nourish the mucosa.

Preoperative Nutrition Assessment

Preoperative nutritional support should consider albumin and vitamin D levels.
Albumin < 3 or vitamin D < 20 are qualifiers for nutritional support.

Head & Neck

Surgical excision of the remnant is the management for branchial cleft anomalies in children.

Salivary Duct Carcinoma

Salivary Duct carcinoma is similar to high-grade breast carcinoma.
Salivary Duct carcinoma is responsive to hormonal therapy.
Warthin tumors are common, often associated with smoking. They have a rare malignant potential and can be bilateral or multicentric.
Adenoid cystic carcinoma tends to have a slow onset and distant metastases.

Endocrine

The best surgical treatment for hyperparathyroidism in MEN1 patients is a 3.5-gland or 4-gland resection with autotransplantation and cervical thymectomy.
The optimal surgical approach for hyperparathyroidism in MEN1 is either a 3.5-gland or 4-gland resection with autoimplantation.
This should be accompanied by a prophylactic transcervical thymectomy to reduce the risk of thymic carcinoid tumors.

Imaging

Imaging like ultrasound, 4D CT, and sestamibi are used for surgical planning, but they do not impact diagnosis of primary hyperparathyroidism.

DCIS/LCIS and Breast Cancer

Invasive lobular carcinoma is less inflammatory and commonly presents as a soft mass.
Imaging can underestimate the size of the tumor.

Esophagus

Superficial mucosal injuries (grade 1 & 2) in hemodynamically stable patients can be observed.

Zargar Classification of Esophageal Injuries

Don't use barium if esophageal perforation is suspected; use Gastrografin instead.
The swallowing center is located in the medulla, not the pons.
Barrett esophagitis without dysplasia requires endoscopic surveillance every 3-5 years, not every 6 months.
Normal lower esophageal sphincter (LES) pressure is 10mmHg; with food bolus, it should be 0mmHg.

Chyle Leaks

Low-volume (<1.5 L/day) chyle leaks can often be managed conservatively with a low-fat diet, somatostatin analogs, and drainage.
If conservative management fails, total parenteral nutrition (TPN) may be considered.

Stomach

Epstein-Barr virus is associated with nasopharyngeal cancer, Hodgkin disease, Burkitt lymphoma, gastric cancer, and lymphoproliferative disease in AIDS patients.

Gastric Tumors

Gastrointestinal stromal tumors (GISTs) are most commonly found in the stomach (60%-70%), followed by the small bowel.
GIST prognosis depends on tumor size and mitotic index.

Miscellaneous

Kaposi's sarcoma is associated with HHV-8.
Normal phi angle in gastric band surgery is 4-58 degrees.
Stress ulcer prophylaxis with a proton pump inhibitor is indicated for patients with traumatic brain injury, spinal cord injury, mechanical ventilation for >48 hours, severe burns (>=20% BSA), or coagulopathy (INR > 1.5, PTT > 2x normal).

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Description

Test your knowledge on important surgical concepts. This quiz covers topics such as postoperative requirements, indications for surgical procedures, and associations with infections. Perfect for medical students and professionals preparing for exams.