Comprehensive General Surgery (EOR) End of Rotation Exam - Questions, Answers and Rationales

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Comprehensive General Surgery (EOR) End of Rotation Exam - Questions, Answers and Rationales An 18-year-old patient has a tibia/fibula fracture following a motorcycle crash. Twelve hours later the p... atient 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 syndrome is characterized by a pathological increase of pressure within a closed space and results from edema or bleeding within the compartment. It may occur as an early local complication of fracture. 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. Compartmental pressures should be obtained as soon as possible. If they are elevated this is a surgical emergency. A 35 year-old male placed in a thumb Spica cast for a scaphoid fracture presents complaining of forearm and hand pain that is not relieved with pain medication and elevation. Which of the following is the earliest physical exam sign for his current condition? A Slow capillary refill B Loss of two-point discrimination C Absent peripheral pulses D Pain with passive stretch. Loss of two-point discrimination can be the earliest sign of compartment syndrome. 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 IV rehydration with crystalloids for 24 to 72 hours is the mainstay of therapy for rhabdomyolysis. 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 A sudden onset of severe colicky flank pain associated with nausea and vomiting as well as the absence of rebound or direct testicular tenderness makes nephrolithiasis the most likely diagnosis. This is further supported by the presence of hematuria on the urinalysis. Which of the following pathophysiological processes is believed to initiate acute appendicitis? A Obstruction B Perforation C Hemorrhage D Vascular compromise Obstruction of the appendiceal lumen by lymphoid hyperplasia, a fecalith or foreign body initiates most cases of appendicitis [Show More]

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