Surgery COMAT review Exam UPDATED
QUESTIONS AND CORRECT ANSWERS
Epidural hematoma
-shape
-artery
-presentation - CORRECT ANSWER lens shape
Due to damage to the middle meningeal artery. Usually the patient experiences loss of consciousness
with the trauma, then has a lucid interval, and then becomes lethargic and comatose.
Subdural hematoma
-shape
-which vessels are bleeding? - CORRECT ANSWER crescent shaped on CT scan. Due to
damage to the bridging veins. Can be acute (trauma) or chronic (brain shrinkage due to alcohol or
aging).
Subarachnoid hemorrhage - CORRECT ANSWER bleeding into the subarachnoid space.
Described as the "worst headache ever". Lumbar puncture will reveal blood in CSF. CT will show
accumulating mass of blood.
"worst headache of my life" - CORRECT ANSWER Subarachnoid hemorrhage
management of increased intracranial pressure - CORRECT ANSWER elevation of head,
hyperventilation, and IV mannitol
cushing's triad - CORRECT ANSWER Signs of increased intracranial pressure:
1. hypertension
2. bradycardia
3. irregular respirations
Schwannoma affects which cranial nerve? How does it present? - CORRECT ANSWER Arises
from Schwann cells. Commonly affects vestibulocochlear (VIII)
,Causes unilateral sensorineural hearing loss and disruption of balance.
Presentation of intracerebral hemorrhage - CORRECT ANSWER headache, nausea, vomiting,
and focal neurological deficits
greatest risk factor for intracerebral hemorrhage - CORRECT ANSWER hypertension
Suspected carotid dissection -- best next step? - CORRECT ANSWER MRI
suspected brain metastasis -- best next step? - CORRECT ANSWER MRI
Presentation, diagnostic imaging and treatment of lumbar spinal stenosis - CORRECT
ANSWER neurogenic claudication that is relieved with sitting or hunching forward. Exam will
potentially reveal decreased DTRs potentially
dx: confirmed with MRI
Tx: NSAIDs, corticosteroid injections, PT, or surgery.
most common intra-abdominal malignancy of childhood - CORRECT
ANSWER Neuroblastoma
Neuroblastoma - CORRECT ANSWER MC intra-abdominal malignancy of childhood. It is a
neuroendocrine tumor that arises from neural crest tissue of the adrenal medulla or paraspinal
sympathetic ganglia. Presents as abdominal pain, hypertension, diarrhea, and fixed abdominal mass.
presentation of angle closure glaucoma - CORRECT ANSWER due to impaired drainage of
aqueous humor
- hyperopia
- N+V
- headache
,- Halos around lights
- ↓ visual acuity
- red eye
- fixed mid-dilated pupil if iris ischaemia
"seeing halos around lights" - CORRECT ANSWER associated with narrow-angle glaucoma
presentation of open angle glaucoma - CORRECT ANSWER often asymptomatic and
incidentally discovered with elevated intraocular pressure
what things trigger acute angle closure glaucoma - CORRECT ANSWER triggered by pupillary
dilation (low ambient light) or certain medications --> decongestants, anticholinergic drugs
Pulmonary nodules larger than ______ mm have a high likelihood of malignancy and should be
surgically resected - CORRECT ANSWER 30
Pulmonary nodule management based on size - CORRECT ANSWER >30 mm --> surgical
resection due to high likelihood for malignancy
4-8 mm (small) --> followed with serial CT scanning
intermediate risk/size --> biopsy
Tension pneumothorax
-presentation and management - CORRECT ANSWER the progression of a pneumothorax that
results in cardiovascular collapse. PE shows absent breath sounds on the affected side.
Tracheal/mediastinal deviation away from the affected side on chest x-ray may be present.
management: urgent needle decompression or chest tube placement
management of spontaneous pneumothorax vs tension pneumothorax - CORRECT
ANSWER Spontaneous:
-if ≤2 cm --> observation and oxygen
, -large and stable --> need aspiration or chest tube
tension: urgent needle decompression or chest tube
how does a tension pneumothorax present differently than a spontaneous pneumothorax - CORRECT
ANSWER In a tension pneumo the patient will be hemodynamically unstable and there will be
tracheal deviation *away* from affected side
-may see ipsilateral hemidiaphragm flattening on imaging
Squamous cell carcinoma of the larynx - CORRECT ANSWER Most common malignancy of
the larynx
Strong association with smoking, alcohol, and HPV
appears friable and erythematous on both vocal folds.
Hoarseness >2 weeks, persistent throat/ear pain, neck mass, hemoptysis, stridor
CT or MRI for imaging
Biopsy
Tx: radiation therapy, partial or full laryngectomy, chemo
benign vocal fold nodule - CORRECT ANSWER smooth lesion that develop on the vocal folds
following vocal abuse
Management of abdominal aortic aneurysm (surgery vs watchful waiting) - CORRECT
ANSWER Elective surgery if > 5.5 cm or rapid expansion >1 cm/year
Management of small to moderately sized AAA (3-5.5 cm) → surveillance with serial abdominal
ultrasound and lifestyle modification (smoking) to limit progression
Screening for abdominal aortic aneurysm - CORRECT ANSWER one time abdominal
ultrasound recommended in men 65-75 who have ever smoked
Strongest overall risk factor for aortic dissection - CORRECT ANSWER chronic HTN
QUESTIONS AND CORRECT ANSWERS
Epidural hematoma
-shape
-artery
-presentation - CORRECT ANSWER lens shape
Due to damage to the middle meningeal artery. Usually the patient experiences loss of consciousness
with the trauma, then has a lucid interval, and then becomes lethargic and comatose.
Subdural hematoma
-shape
-which vessels are bleeding? - CORRECT ANSWER crescent shaped on CT scan. Due to
damage to the bridging veins. Can be acute (trauma) or chronic (brain shrinkage due to alcohol or
aging).
Subarachnoid hemorrhage - CORRECT ANSWER bleeding into the subarachnoid space.
Described as the "worst headache ever". Lumbar puncture will reveal blood in CSF. CT will show
accumulating mass of blood.
"worst headache of my life" - CORRECT ANSWER Subarachnoid hemorrhage
management of increased intracranial pressure - CORRECT ANSWER elevation of head,
hyperventilation, and IV mannitol
cushing's triad - CORRECT ANSWER Signs of increased intracranial pressure:
1. hypertension
2. bradycardia
3. irregular respirations
Schwannoma affects which cranial nerve? How does it present? - CORRECT ANSWER Arises
from Schwann cells. Commonly affects vestibulocochlear (VIII)
,Causes unilateral sensorineural hearing loss and disruption of balance.
Presentation of intracerebral hemorrhage - CORRECT ANSWER headache, nausea, vomiting,
and focal neurological deficits
greatest risk factor for intracerebral hemorrhage - CORRECT ANSWER hypertension
Suspected carotid dissection -- best next step? - CORRECT ANSWER MRI
suspected brain metastasis -- best next step? - CORRECT ANSWER MRI
Presentation, diagnostic imaging and treatment of lumbar spinal stenosis - CORRECT
ANSWER neurogenic claudication that is relieved with sitting or hunching forward. Exam will
potentially reveal decreased DTRs potentially
dx: confirmed with MRI
Tx: NSAIDs, corticosteroid injections, PT, or surgery.
most common intra-abdominal malignancy of childhood - CORRECT
ANSWER Neuroblastoma
Neuroblastoma - CORRECT ANSWER MC intra-abdominal malignancy of childhood. It is a
neuroendocrine tumor that arises from neural crest tissue of the adrenal medulla or paraspinal
sympathetic ganglia. Presents as abdominal pain, hypertension, diarrhea, and fixed abdominal mass.
presentation of angle closure glaucoma - CORRECT ANSWER due to impaired drainage of
aqueous humor
- hyperopia
- N+V
- headache
,- Halos around lights
- ↓ visual acuity
- red eye
- fixed mid-dilated pupil if iris ischaemia
"seeing halos around lights" - CORRECT ANSWER associated with narrow-angle glaucoma
presentation of open angle glaucoma - CORRECT ANSWER often asymptomatic and
incidentally discovered with elevated intraocular pressure
what things trigger acute angle closure glaucoma - CORRECT ANSWER triggered by pupillary
dilation (low ambient light) or certain medications --> decongestants, anticholinergic drugs
Pulmonary nodules larger than ______ mm have a high likelihood of malignancy and should be
surgically resected - CORRECT ANSWER 30
Pulmonary nodule management based on size - CORRECT ANSWER >30 mm --> surgical
resection due to high likelihood for malignancy
4-8 mm (small) --> followed with serial CT scanning
intermediate risk/size --> biopsy
Tension pneumothorax
-presentation and management - CORRECT ANSWER the progression of a pneumothorax that
results in cardiovascular collapse. PE shows absent breath sounds on the affected side.
Tracheal/mediastinal deviation away from the affected side on chest x-ray may be present.
management: urgent needle decompression or chest tube placement
management of spontaneous pneumothorax vs tension pneumothorax - CORRECT
ANSWER Spontaneous:
-if ≤2 cm --> observation and oxygen
, -large and stable --> need aspiration or chest tube
tension: urgent needle decompression or chest tube
how does a tension pneumothorax present differently than a spontaneous pneumothorax - CORRECT
ANSWER In a tension pneumo the patient will be hemodynamically unstable and there will be
tracheal deviation *away* from affected side
-may see ipsilateral hemidiaphragm flattening on imaging
Squamous cell carcinoma of the larynx - CORRECT ANSWER Most common malignancy of
the larynx
Strong association with smoking, alcohol, and HPV
appears friable and erythematous on both vocal folds.
Hoarseness >2 weeks, persistent throat/ear pain, neck mass, hemoptysis, stridor
CT or MRI for imaging
Biopsy
Tx: radiation therapy, partial or full laryngectomy, chemo
benign vocal fold nodule - CORRECT ANSWER smooth lesion that develop on the vocal folds
following vocal abuse
Management of abdominal aortic aneurysm (surgery vs watchful waiting) - CORRECT
ANSWER Elective surgery if > 5.5 cm or rapid expansion >1 cm/year
Management of small to moderately sized AAA (3-5.5 cm) → surveillance with serial abdominal
ultrasound and lifestyle modification (smoking) to limit progression
Screening for abdominal aortic aneurysm - CORRECT ANSWER one time abdominal
ultrasound recommended in men 65-75 who have ever smoked
Strongest overall risk factor for aortic dissection - CORRECT ANSWER chronic HTN
