Surgery COMAT Exam UPDATED
QUESTIONS AND CORRECT ANSWERS
What is the size guideline for treatment of a spontaneous pneumothorax? - CORRECT
ANSWER Spontaneous pneumothorax:
<2 cm observe
>2 cm large and stable = needle aspiration or chest tube
5 W's of Post-op surgery? - CORRECT ANSWER 5 W's
• Wind
○ Pneumonia, PE, Aspiration
• Wound
○ Surgical site infections
• Water
○ Urinary tract infections
§ Increased risk due to indwelling catheters
§ Associated with enteric organisms ie. E. coli, Klebsiella, Proteus mirabillis
• Walk
○ Deep vein thrombosis
• Wonder Drugs
○ Drug fever, blood products, IV lines
○ Drug fever: diagnosis of exclusion
§ Usually associated with anticonvulsants, antibiotics (beta-lactams, sulfonamides) and allopurinol
§ Occurs within 1-2 weeks of drug initiation
Modified Radial Mastectomy vs. Simple mastectomy? - CORRECT ANSWER MRM includes:
• Includes axillary dissection
• Level I and Level II axillary dissection being the standard procedure
altnernate name for hidradenitis suppurative - CORRECT ANSWER acnes inversa
,What is hidradenitis suppurativa? - CORRECT ANSWER hronic skin inflammatory condition
that is associated with:
• Induration
• Abscess
• Sinus tracts
It is similar in character and location as many other conditions but can be differentiated by careful
history and identifying presence of hyperkeratosis induced follicular occlusion (family history and
reccurrence)
What is Paraphimosis? - CORRECT ANSWER Paraphimosis is considered a urological
emergency and occurs when the retracted foreskin develops a fixed constriction proximal to the glans
Treatment of parphimosis? - CORRECT ANSWER The glans is first compressed for several
minutes to decrease edema
Followed by application of ice and attempting to push the prepuce distally while the glans is pushed
proximally
Balanoposthitis - CORRECT ANSWER is an inflammation secondary to an infection of the
glans penis and the surrounding foreskin
The majority of cases are due to poor hygiene or external irritation with subsequent colonization by a
fungus
Treatment of Balanoposthitis? - CORRECT ANSWER Cleaning the region with soap and
water, adequate hygiene, avoiding moist environment and application of antifungal creams such as
nystatin or clotrimazole
Peyronie's disease - CORRECT ANSWER Peyronie's disease is a rare condition also known as
chronic inflammation of the tunica albuginea
Associated with abnormal growth of the fibrous plaques and scar formation in the sheath of tissue
surrounding the corpora cavernosa (tunica albuginea) of the penis
,Phimosis - CORRECT ANSWER Phimosis is the inability to retract the foreskin proximally to
the glans penis
• Can be a result of normal development or may be due to infection or poor hygiene
Priapism? - CORRECT ANSWER Priapism is another urological emergency but is not involved
with foreskin constriction or retraction difficulties
• Priapism is a urological emergency and is defined as painful, involntary and persistent erection in
which both corpora cavernosa are engorged with stagnant blood
• Impotence can result with sustained erection, thus urgent action is imperative when faced with this
condition
Treatment of priapism? - CORRECT ANSWER adequate analgesia, hydration, stopping the
offending agent, administration of terbutaline (beta2-mimetic), application of ice packs and corporal
aspiration of blood
A-fib complication and acute abdomen? - CORRECT ANSWER The patient in the vignette has
A-fib as seen in the exhibit and is reportedly non-compliant with medical therapy predisposing him to
atrial clot formatiom which can subsequently embolize and cause ischemic colitis. These patients
present with:
• Acute abdominal pain
• Bloody diarrhea
• Vomiting
• Abdominal tenderness
Other causes of ischemic colitis - CORRECT ANSWER • Embolus
• Hypoperfusion from any cause
• Bowel obstruction
Clinical findings of ischemic colitis? - CORRECT ANSWER • Labs show characteristically
elevated WBC count and elevated lactic acid level because of ischemia
• Imaging techniques:
○ CT scan can show bowel wall thickening
○ Barium enema may show a "thumb printing"
, ○ Sigmoidoscopy can reveal bloody and edematous tissue
Treatment of ischemic colitis? - CORRECT ANSWER • Aimed at the cause, in this case
embolization is a possibility
• If treatment is delayed the bowel necroses then surgical resection is indicated
• Patients should get IV fluids, bowel rest, and ab to cover for normal gastrointestinal bacteria
• The left side of the colon is invlved most of the time in ischemic colitis
what part of the colon is most commonly involved in ischemic colitis? - CORRECT
ANSWER • The left colon is most commonly involved in ischemic colitis
• This portion of the colon is supplied by the IMA
• The IMA supplies the descending colon, the sigmoid colon, and the upper rectum
ileocolic artery - CORRECT ANSWER Arises from the end of the SMA and supplies the
cecum, appendix, and terminal ileum
Marginal artery (artery of Drummond) - CORRECT ANSWER Marginal artery (artery of
Drummond)
Is the connection between the SMA and the IMA found at the splenic flexure
It is considered a watershed area and an area often involved in ischemic colitis
Middle colic artery - CORRECT ANSWER Branch of the SMA that supplies the transverse
colon
It anastamoses with the L. colic artery of the IMA to form the marginal artery
SMA - CORRECT ANSWER Arises from the anterior portion of the abdominal aorta just
inferior to the celiac artery
It supplies a portion of the duodenum, the small bowel, the right colon, and 2/3 of the transverse colon
QUESTIONS AND CORRECT ANSWERS
What is the size guideline for treatment of a spontaneous pneumothorax? - CORRECT
ANSWER Spontaneous pneumothorax:
<2 cm observe
>2 cm large and stable = needle aspiration or chest tube
5 W's of Post-op surgery? - CORRECT ANSWER 5 W's
• Wind
○ Pneumonia, PE, Aspiration
• Wound
○ Surgical site infections
• Water
○ Urinary tract infections
§ Increased risk due to indwelling catheters
§ Associated with enteric organisms ie. E. coli, Klebsiella, Proteus mirabillis
• Walk
○ Deep vein thrombosis
• Wonder Drugs
○ Drug fever, blood products, IV lines
○ Drug fever: diagnosis of exclusion
§ Usually associated with anticonvulsants, antibiotics (beta-lactams, sulfonamides) and allopurinol
§ Occurs within 1-2 weeks of drug initiation
Modified Radial Mastectomy vs. Simple mastectomy? - CORRECT ANSWER MRM includes:
• Includes axillary dissection
• Level I and Level II axillary dissection being the standard procedure
altnernate name for hidradenitis suppurative - CORRECT ANSWER acnes inversa
,What is hidradenitis suppurativa? - CORRECT ANSWER hronic skin inflammatory condition
that is associated with:
• Induration
• Abscess
• Sinus tracts
It is similar in character and location as many other conditions but can be differentiated by careful
history and identifying presence of hyperkeratosis induced follicular occlusion (family history and
reccurrence)
What is Paraphimosis? - CORRECT ANSWER Paraphimosis is considered a urological
emergency and occurs when the retracted foreskin develops a fixed constriction proximal to the glans
Treatment of parphimosis? - CORRECT ANSWER The glans is first compressed for several
minutes to decrease edema
Followed by application of ice and attempting to push the prepuce distally while the glans is pushed
proximally
Balanoposthitis - CORRECT ANSWER is an inflammation secondary to an infection of the
glans penis and the surrounding foreskin
The majority of cases are due to poor hygiene or external irritation with subsequent colonization by a
fungus
Treatment of Balanoposthitis? - CORRECT ANSWER Cleaning the region with soap and
water, adequate hygiene, avoiding moist environment and application of antifungal creams such as
nystatin or clotrimazole
Peyronie's disease - CORRECT ANSWER Peyronie's disease is a rare condition also known as
chronic inflammation of the tunica albuginea
Associated with abnormal growth of the fibrous plaques and scar formation in the sheath of tissue
surrounding the corpora cavernosa (tunica albuginea) of the penis
,Phimosis - CORRECT ANSWER Phimosis is the inability to retract the foreskin proximally to
the glans penis
• Can be a result of normal development or may be due to infection or poor hygiene
Priapism? - CORRECT ANSWER Priapism is another urological emergency but is not involved
with foreskin constriction or retraction difficulties
• Priapism is a urological emergency and is defined as painful, involntary and persistent erection in
which both corpora cavernosa are engorged with stagnant blood
• Impotence can result with sustained erection, thus urgent action is imperative when faced with this
condition
Treatment of priapism? - CORRECT ANSWER adequate analgesia, hydration, stopping the
offending agent, administration of terbutaline (beta2-mimetic), application of ice packs and corporal
aspiration of blood
A-fib complication and acute abdomen? - CORRECT ANSWER The patient in the vignette has
A-fib as seen in the exhibit and is reportedly non-compliant with medical therapy predisposing him to
atrial clot formatiom which can subsequently embolize and cause ischemic colitis. These patients
present with:
• Acute abdominal pain
• Bloody diarrhea
• Vomiting
• Abdominal tenderness
Other causes of ischemic colitis - CORRECT ANSWER • Embolus
• Hypoperfusion from any cause
• Bowel obstruction
Clinical findings of ischemic colitis? - CORRECT ANSWER • Labs show characteristically
elevated WBC count and elevated lactic acid level because of ischemia
• Imaging techniques:
○ CT scan can show bowel wall thickening
○ Barium enema may show a "thumb printing"
, ○ Sigmoidoscopy can reveal bloody and edematous tissue
Treatment of ischemic colitis? - CORRECT ANSWER • Aimed at the cause, in this case
embolization is a possibility
• If treatment is delayed the bowel necroses then surgical resection is indicated
• Patients should get IV fluids, bowel rest, and ab to cover for normal gastrointestinal bacteria
• The left side of the colon is invlved most of the time in ischemic colitis
what part of the colon is most commonly involved in ischemic colitis? - CORRECT
ANSWER • The left colon is most commonly involved in ischemic colitis
• This portion of the colon is supplied by the IMA
• The IMA supplies the descending colon, the sigmoid colon, and the upper rectum
ileocolic artery - CORRECT ANSWER Arises from the end of the SMA and supplies the
cecum, appendix, and terminal ileum
Marginal artery (artery of Drummond) - CORRECT ANSWER Marginal artery (artery of
Drummond)
Is the connection between the SMA and the IMA found at the splenic flexure
It is considered a watershed area and an area often involved in ischemic colitis
Middle colic artery - CORRECT ANSWER Branch of the SMA that supplies the transverse
colon
It anastamoses with the L. colic artery of the IMA to form the marginal artery
SMA - CORRECT ANSWER Arises from the anterior portion of the abdominal aorta just
inferior to the celiac artery
It supplies a portion of the duodenum, the small bowel, the right colon, and 2/3 of the transverse colon
