SURGERY EOR FINAL TEST 2026
QUESTIONS WITH CORRECT ANSWERS
GRADED A+
• When accessing cardiac disease prior to surgery, what is the most important
thing to access?.
Answer: aortic stenosis -- crescendo diastolic rumble at apex
• A 63-year-old man presents with sudden-onset severe tearing chest pain
radiating to the back. He is hypertensive, has diminished pulses on the left
arm, and chest X-ray shows a widened mediastinum. What is the next best
diagnostic test?.
Answer: -CTA of chest= gold standard for Aortic dissection
• Guidelines for the use of antibiotics include administration within _______
of surgery and redosing after 4 hours. What is the abx of choice?.
Answer: 1 hour Abx of choice: cefazolin for all except colorectal then
cefazolin/metronidazole
• A 72-year-old woman with a history of atrial fibrillation presents with
sudden onset abdominal pain out of proportion to exam. Lactate is elevated,
and CT abdomen shows pneumatosis intestinalis. What is the most likely
diagnosis?.
Answer: -Acute Mesenteric Ischemia =SMA most commonly
• A 45-year-old man presents with a painful, swollen right leg after long-haul
travel. The limb is warm and erythematous, and Doppler ultrasound shows
non-compressible proximal veins. What is the most appropriate initial
treatment?.
Answer: -Anticoagulation --> LMWH = DVT !!
• A 29-year-old woman presents with a painless breast mass discovered on
self-exam. Ultrasound shows a solid, irregular, hypoechoic lesion. What is
the next best diagnostic step?.
, Answer: -Core Needle Biopsy !! (if over 30 need Mammogram too with US)
• Pre-op -- Metabolic disease/syndrome -- what are the 5 criteria?.
Answer: 3/5 to diagnose: 1 - diabetes 2 - central obesity 3 - HTN 4 - high
serum triglycerrides 5 - low HDL levels
• ______should be monitored before surgery bc it is a stimulant and
vasoconstrictor -- can lead to severe tachycardia.
Answer: Cocaine
• Pre-Op -- What are the indications for EKG and CXR?.
Answer: EKG - men >40, women>50, known CAD, DM, or HTN CXR -
age >50, known cardiac or pulmonary disease
• What are the 5 classic "W's" of post operative fever?.
Answer: W - wind (atelectasis) W - water (UTI) W - wound (wound
infection) W - walking (DVT/thrombophlebitis) W - wonder drugs (drug
fever)
• If the post op fever occurs within the first 24 hours of surgery, what is the
most likely cause?.
Answer: wind/atelectasis
• A 55-year-old man presents with fever, RUQ pain, jaundice, and
hypotension. Labs reveal leukocytosis and elevated alkaline phosphatase.
What is the most appropriate immediate management?.
Answer: EMERGENT ERCP because of acute cholangitis
• A 70-year-old man presents with progressive difficulty swallowing solids
and recent weight loss. Barium swallow shows a "bird beak" tapering of the
distal esophagus. What is the next best diagnostic study?.
Answer: -Achalasia --> GOLD STANDARD (Best) = esophageal
manometry (eval how eso functions) -upper endoscopy is for visual of
esophagus (after barium swallow but not best test!!)
• A 41-year-old man presents after being struck in the abdomen by a steering
wheel. FAST exam shows free fluid, and he is hypotensive despite fluids.
, What is the most appropriate next step in management?.
Answer: -immediate laparotomy (unstable + positive FAST)
• A 39-year-old woman presents with fatigue, heat intolerance, and a rapidly
enlarging thyroid nodule. Ultrasound reveals a hypoechoic lesion with
microcalcifications. TSH is low. What is the next step in evaluation?.
Answer: -since TSH is low next step is a RAIU scan to determine if
hyperfunctioning (hot or cold= hot is good) -if TSH was normal/elevated +
US sus = FNA next -still want to r/o malignancy would get a FNA next after
RAIU
• If the post op fever occurs within days 3-5 post op, what is the most likely
cause?.
Answer: water/UTI, catheter related phlebitis, pneumonia
• If the post op fever occurs within days 5-10 post op, what is the most likely
cause?.
Answer: wound infection, pneumonia, abscess, infected hematoma, C diff
colitis, anastomotic leak, DVT, peritoneal abscess, drug fever, PE, parotitis
• _______is the most common pathogen in wound infections and around
foreign bodies..
Answer: Staph aureus
• _______invades the inner ear and enteric tissues as well as the lung..
Answer: Klebsiella
• A 65-year-old man presents with cramping abdominal pain, distention, and
vomiting. He has a history of multiple abdominal surgeries. CT shows
dilated loops of bowel with air-fluid levels. What is the most appropriate
initial management?.
Answer: -SBO= bowel rest --> NG, IVFs, NPO
• ______organisms are often found together with anaerobes..
Answer: Enteric organisms ie. enterobacteriaceae and enterococci
• Among the anaerobes, ___&___are often present in surgical infections and
, _____species are major pathogens in ischemic tissue..
Answer: Bacteroides & Peptostreptococci; Clostridium
• A 47-year-old woman with obesity presents with sudden severe epigastric
pain radiating to the back after a large meal. She is vomiting and
diaphoretic. Labs show markedly elevated lipase. Leaning forward provides
partial relief..
Answer: -Acute Pancreatitis
• A 34-year-old woman presents with recurrent painful nodules in the axilla
that intermittently drain foul-smelling fluid. There are sinus tracts and
scarring on exam..
Answer: -hidradenitis suppurativa
• ___&___are usually nonpathogenic surface contaminants but may be
opportunistic. Some fungi and yeast cause abscesses in sinus tracts..
Answer: Pseudomonas & Serratia
• History of recent surgery, trauma, cancer, prolonged immobilization, or oral
contraceptive use increases the risk of ____..
Answer: DVT - deep vein thrombosis
• A 77-year-old man on warfarin has multiple episodes of melena and
lightheadedness. He appears pale. Hemoglobin is 7.8 g/dL. NG lavage
returns bright red blood..
Answer: -Upper GI bleed -get IV PPI on board, IVFs, <7 Hbg need PRBCs
• What is Homan's sign?.
Answer: pain on passive dorsiflexion of ankle
• What is the test of choice for DVT?.
Answer: doppler ultrasound
• How is the D-dimer text useful?.
Answer: It is good at ruling a DVT out (if the text is negative) but not rule it
in
• Tx of DVT -- 1. Initiate use of ____or____to what dose? 2. Overlap with the
QUESTIONS WITH CORRECT ANSWERS
GRADED A+
• When accessing cardiac disease prior to surgery, what is the most important
thing to access?.
Answer: aortic stenosis -- crescendo diastolic rumble at apex
• A 63-year-old man presents with sudden-onset severe tearing chest pain
radiating to the back. He is hypertensive, has diminished pulses on the left
arm, and chest X-ray shows a widened mediastinum. What is the next best
diagnostic test?.
Answer: -CTA of chest= gold standard for Aortic dissection
• Guidelines for the use of antibiotics include administration within _______
of surgery and redosing after 4 hours. What is the abx of choice?.
Answer: 1 hour Abx of choice: cefazolin for all except colorectal then
cefazolin/metronidazole
• A 72-year-old woman with a history of atrial fibrillation presents with
sudden onset abdominal pain out of proportion to exam. Lactate is elevated,
and CT abdomen shows pneumatosis intestinalis. What is the most likely
diagnosis?.
Answer: -Acute Mesenteric Ischemia =SMA most commonly
• A 45-year-old man presents with a painful, swollen right leg after long-haul
travel. The limb is warm and erythematous, and Doppler ultrasound shows
non-compressible proximal veins. What is the most appropriate initial
treatment?.
Answer: -Anticoagulation --> LMWH = DVT !!
• A 29-year-old woman presents with a painless breast mass discovered on
self-exam. Ultrasound shows a solid, irregular, hypoechoic lesion. What is
the next best diagnostic step?.
, Answer: -Core Needle Biopsy !! (if over 30 need Mammogram too with US)
• Pre-op -- Metabolic disease/syndrome -- what are the 5 criteria?.
Answer: 3/5 to diagnose: 1 - diabetes 2 - central obesity 3 - HTN 4 - high
serum triglycerrides 5 - low HDL levels
• ______should be monitored before surgery bc it is a stimulant and
vasoconstrictor -- can lead to severe tachycardia.
Answer: Cocaine
• Pre-Op -- What are the indications for EKG and CXR?.
Answer: EKG - men >40, women>50, known CAD, DM, or HTN CXR -
age >50, known cardiac or pulmonary disease
• What are the 5 classic "W's" of post operative fever?.
Answer: W - wind (atelectasis) W - water (UTI) W - wound (wound
infection) W - walking (DVT/thrombophlebitis) W - wonder drugs (drug
fever)
• If the post op fever occurs within the first 24 hours of surgery, what is the
most likely cause?.
Answer: wind/atelectasis
• A 55-year-old man presents with fever, RUQ pain, jaundice, and
hypotension. Labs reveal leukocytosis and elevated alkaline phosphatase.
What is the most appropriate immediate management?.
Answer: EMERGENT ERCP because of acute cholangitis
• A 70-year-old man presents with progressive difficulty swallowing solids
and recent weight loss. Barium swallow shows a "bird beak" tapering of the
distal esophagus. What is the next best diagnostic study?.
Answer: -Achalasia --> GOLD STANDARD (Best) = esophageal
manometry (eval how eso functions) -upper endoscopy is for visual of
esophagus (after barium swallow but not best test!!)
• A 41-year-old man presents after being struck in the abdomen by a steering
wheel. FAST exam shows free fluid, and he is hypotensive despite fluids.
, What is the most appropriate next step in management?.
Answer: -immediate laparotomy (unstable + positive FAST)
• A 39-year-old woman presents with fatigue, heat intolerance, and a rapidly
enlarging thyroid nodule. Ultrasound reveals a hypoechoic lesion with
microcalcifications. TSH is low. What is the next step in evaluation?.
Answer: -since TSH is low next step is a RAIU scan to determine if
hyperfunctioning (hot or cold= hot is good) -if TSH was normal/elevated +
US sus = FNA next -still want to r/o malignancy would get a FNA next after
RAIU
• If the post op fever occurs within days 3-5 post op, what is the most likely
cause?.
Answer: water/UTI, catheter related phlebitis, pneumonia
• If the post op fever occurs within days 5-10 post op, what is the most likely
cause?.
Answer: wound infection, pneumonia, abscess, infected hematoma, C diff
colitis, anastomotic leak, DVT, peritoneal abscess, drug fever, PE, parotitis
• _______is the most common pathogen in wound infections and around
foreign bodies..
Answer: Staph aureus
• _______invades the inner ear and enteric tissues as well as the lung..
Answer: Klebsiella
• A 65-year-old man presents with cramping abdominal pain, distention, and
vomiting. He has a history of multiple abdominal surgeries. CT shows
dilated loops of bowel with air-fluid levels. What is the most appropriate
initial management?.
Answer: -SBO= bowel rest --> NG, IVFs, NPO
• ______organisms are often found together with anaerobes..
Answer: Enteric organisms ie. enterobacteriaceae and enterococci
• Among the anaerobes, ___&___are often present in surgical infections and
, _____species are major pathogens in ischemic tissue..
Answer: Bacteroides & Peptostreptococci; Clostridium
• A 47-year-old woman with obesity presents with sudden severe epigastric
pain radiating to the back after a large meal. She is vomiting and
diaphoretic. Labs show markedly elevated lipase. Leaning forward provides
partial relief..
Answer: -Acute Pancreatitis
• A 34-year-old woman presents with recurrent painful nodules in the axilla
that intermittently drain foul-smelling fluid. There are sinus tracts and
scarring on exam..
Answer: -hidradenitis suppurativa
• ___&___are usually nonpathogenic surface contaminants but may be
opportunistic. Some fungi and yeast cause abscesses in sinus tracts..
Answer: Pseudomonas & Serratia
• History of recent surgery, trauma, cancer, prolonged immobilization, or oral
contraceptive use increases the risk of ____..
Answer: DVT - deep vein thrombosis
• A 77-year-old man on warfarin has multiple episodes of melena and
lightheadedness. He appears pale. Hemoglobin is 7.8 g/dL. NG lavage
returns bright red blood..
Answer: -Upper GI bleed -get IV PPI on board, IVFs, <7 Hbg need PRBCs
• What is Homan's sign?.
Answer: pain on passive dorsiflexion of ankle
• What is the test of choice for DVT?.
Answer: doppler ultrasound
• How is the D-dimer text useful?.
Answer: It is good at ruling a DVT out (if the text is negative) but not rule it
in
• Tx of DVT -- 1. Initiate use of ____or____to what dose? 2. Overlap with the
