2025 COMPREHENSIVE SURGERY
EOR COMPLETE QUESTIONS WITH
VERIFIED ANSWERS ALREADY
GRADED A+ BY EXPERTS
Immediate smoking cessation is recommended (time) prior to surgery? - CORRECT
ANSWER>>>>4-8 weeks prior to surgery
Airway inflammation and increased bronchial mucus production induced by smoking require
some time to improve
Patients with acute opioid intoxication develop what acid/base disturbance? - CORRECT
ANSWER>>>Respiratory acidosis due to hypoventilation from a decreased central respiratory
drive. Labs would show low pH and high PaCO2
Excessive infusion of normal saline (NaCl) causes what acid/base disturbance? - CORRECT
ANSWER>>>Hyperchloremic Metabolic Acidosis
Because Cl & bicarb are the most abundant anions in blood, an increase in Cl drives bicarb
intracellularly, causing non-anion gap metabolic acidosis
Sepsis commonly causes what acid/base disturbance? - CORRECT ANSWER>>>Anion gap
metabolic acidosis due to lactic acidosis
Inadequate pain control causes what acid/base disturbance? - CORRECT
ANSWER>>>respiratory alkalosis due to hyperventilation
Urethral Stricture Dx and Tx - CORRECT ANSWER>>>Dx: Postvoid residual, uroflowmetry
Urethrography, Cystourethroscopy
Tx: Dilation or Urethroplasty
Causes of Urethral Strictures - CORRECT ANSWER>>>urethral trauma (pelvic fx, iatrogenic
instrumentation), infection, radiotherapy
Patient Education for Fibrocystic Breast Changes - CORRECT ANSWER>>>Well-fitting
supportive bra
Avoid caffeine
Apply heat to the breasts
Over-the-counter pain relievers
For what cancer, in addition to breast cancer, are men with mutations in BRCA1 or BRCA2 at
risk? - CORRECT ANSWER>>>Prostate Cancer
hypoechoic vs hyperechoic - CORRECT ANSWER>>>
1
,Screening pts w/ mutations in BRCA1 or BRCA2 - CORRECT ANSWER>>>Breast MRI q 12
mo starting at 25
Mammogram q 12m starting at 30 (alternating q 6m w/ MRI)
Note: BRCA1/BRCA2 mutations cause hereditary breast, ovarian, pancreatic, & prostate cancers
Irregularly irregular rhythm with no distinct P waves. Complication of suspected dx? -
CORRECT ANSWER>>>Atrial fibrillation
Complication: stroke if AF for > 48h
RF's for atrial fibrillation - CORRECT ANSWER>>>Alcohol
Drugs
Hypothermia
Mitral stenosis
Coronary artery disease
Congenital heart disease
Tx for atrial fibrillation (stable vs unstable) - CORRECT ANSWER>>>Rate control, rhythm
conversion, and anticoagulation
Unstable: Emergent therapy w/ ϲаrԁiοvеrsioո
Stable: BB +/- anticoagulation
(CHA2DS2-VASc score)
+/- cardioversion later
if onset > 48h: anticoagulate for 21 days prior to cardioversion due to risk of stroke
Anorexia, nausea, vomiting, fever, or periumbilical or epigastric pain that migrates to the right
lower quadrant. Dx? Tx? - CORRECT ANSWER>>>Appendicitis
Common ages: 13 - 40 y/o
Labs: leukocytosis (high neutrophils)
Dx: CT, US (peds or preg)
May show appendiceal dilation, rupture, abscess, phlegmon
Tx: Appendectomy + antibx
Complicated appendicitis with a contained perforation (contained by an abscess or phlegmon)
may initially be managed... - CORRECT ANSWER>>>NPO, IV fluids, antibx, serial imaging,
percutaneous drainage. Appendectomy later.
Within how many hours from dx should surgery occur for acute nonperforated appendicitis? -
CORRECT ANSWER>>>12 h
Complicated appendicitis antibiotics - CORRECT ANSWER>>>Nonperforated: 1st/2nd gen
cephalosporin + metronidazole
Complicated: Pip-tazo. (Zosyn) or amp-sulbactam (Unasyn)
2
,All patients w/ hemodynamic instability need blood cultures, IV fluids, and empiric antibiotics
What type of anesthesia is required for a core-needle biopsy? - CORRECT ANSWER>>>Local
anesthesia.
What finding on abdominal x-ray should make you think of bowel obstruction? - CORRECT
ANSWER>>>Air fluid levels
Preferred technique used to biopsy most breast lesions that are suspicious for malignancy -
CORRECT ANSWER>>>Core-needle biopsy:
A 14-gauge needle is used to retrieve cellular material from the suspicious area
Advantages: minimal scarring, lower cost, quicker recovery
Most common type of breast cancer - CORRECT ANSWER>>>Invasive ductal carcinoma
(IDC)
Can spread beyond the ducts into surrounding breast tissue and metastasize to lymph nodes or
distant organs
Screening pts w/ average risk of breast cancer - CORRECT ANSWER>>>Mammogram every 2
yrs starting at 40-74 y/o
Breast self-exam should NOT be routinely encouraged
RF's for Squamous cell carcinoma and characteristics of the lesion - CORRECT
ANSWER>>>fair skin, light hair, and light eyes, excessive sun exposure, smoking hx, actinic
keratosis precursor
Persistent, rough, scaly hyperkeratotic papule, nodule, or patch that bleeds if scratched. May
evolve to a raised, reddish nodule. On sun-exposed areas
Pearly papule with telangiectasia and a rolled border that may ulcerate or crust. Painless and
slow-growing. Dx? Tx? - CORRECT ANSWER>>>BCC (MC skin cancer)
Risk of mets is < SCC
Dx: clinical exam, dermoscopy, shave, punch, or excisional biopsy
Tx: surgical excision (<10 mm on noncritical areas of the face) vs Mohs surgery (high-risk areas
of the face)
MC type of BCC - CORRECT ANSWER>>>Nodular basal cell carcinoma
Superficial basal cell carcinomas - CORRECT ANSWER>>>Common in men and occur on the
trunk (non sun exposed areas)
Scaly macules, patches, or plaques that are light red to pink in color
Pigmented basal cell carcinoma - CORRECT ANSWER>>>Similar to nodular BCC, but w/ dark
brown pigment. Seen in individuals w/ darker skin
3
, RF's for Hemorrhoids? Dx? - CORRECT ANSWER>>>RF: constipation, straining, preg,
obesity, prolonged sitting, portal HTN, anal intercourse, low fiber diet
PE: rectal exam; @ rest & bearing dwn;
Anoscopy if not detected on PE
42 y/o male w/ painless rectal bleeding during BM for 1 wk. Hx of chronic constipation. On PE,
no visible perianal abnormality. DRE is unremarkable, besides bright red blood on the glove.
Dx? Tx? - CORRECT ANSWER>>>Internal hemorrhoids
Tx: increase fiber intake & hydration, hemorrhoid cream, prevent straining
35 y/o female w/ anal pain & itching, especially during sitting and following BMs. Recently
gave birth. On PE, swollen, blue, tender lumps around anal verge. Dx? - CORRECT
ANSWER>>>External Hemorrhoids
Painful, but no bleeding
Tx: sitz bath, fiber, NSAIDs, stool softener, excision if no relief
What is the recommended age to start screening for colorectal cancer according to the U.S.
Preventive Services Task Force? - CORRECT ANSWER>>>50 years grade A recommendation.
45 years grade B recommendation.
Indications for Surgery on hemorrhoids? Surgical options? - CORRECT ANSWER>>>Persistent
bleeding, thrombosed hemorrhoids, severe pain, or failure of conservative treatment.
Minimally Invasive: Rubber band ligation (1st line for internal), sclerotherapy, infrared
coagulation if less severe. If severe, hemorrhoidectomy, stapled Hemorrhoidopexy
Morpheaform basal cell carcinoma - CORRECT ANSWER>>>Smooth, flesh-colored or light
pink papule or plaque w/ ill-defined borders
why would a DRE be performed? - CORRECT ANSWER>>>
ECG finding for a pt with a pulmonary embolism - CORRECT ANSWER>>>S1Q3T3 pattern
(large S wave in lead I, Q wave in lead III, inverted T wave in lead III)
Nonspecific sign of acute right heart strain
common risk factors for developing thrombi - CORRECT ANSWER>>>Virchow triad:
venous stasis
vascular wall injury
hypercoagulable state
Wells criteria for PE - CORRECT ANSWER>>>A score of 0-4 is "PE unlikely," and a negative
D-dimer can be used to rule out a PE
A score of > 4 points is "PE likely" and warrants further testing.
Dx: ECG & CXR
4
EOR COMPLETE QUESTIONS WITH
VERIFIED ANSWERS ALREADY
GRADED A+ BY EXPERTS
Immediate smoking cessation is recommended (time) prior to surgery? - CORRECT
ANSWER>>>>4-8 weeks prior to surgery
Airway inflammation and increased bronchial mucus production induced by smoking require
some time to improve
Patients with acute opioid intoxication develop what acid/base disturbance? - CORRECT
ANSWER>>>Respiratory acidosis due to hypoventilation from a decreased central respiratory
drive. Labs would show low pH and high PaCO2
Excessive infusion of normal saline (NaCl) causes what acid/base disturbance? - CORRECT
ANSWER>>>Hyperchloremic Metabolic Acidosis
Because Cl & bicarb are the most abundant anions in blood, an increase in Cl drives bicarb
intracellularly, causing non-anion gap metabolic acidosis
Sepsis commonly causes what acid/base disturbance? - CORRECT ANSWER>>>Anion gap
metabolic acidosis due to lactic acidosis
Inadequate pain control causes what acid/base disturbance? - CORRECT
ANSWER>>>respiratory alkalosis due to hyperventilation
Urethral Stricture Dx and Tx - CORRECT ANSWER>>>Dx: Postvoid residual, uroflowmetry
Urethrography, Cystourethroscopy
Tx: Dilation or Urethroplasty
Causes of Urethral Strictures - CORRECT ANSWER>>>urethral trauma (pelvic fx, iatrogenic
instrumentation), infection, radiotherapy
Patient Education for Fibrocystic Breast Changes - CORRECT ANSWER>>>Well-fitting
supportive bra
Avoid caffeine
Apply heat to the breasts
Over-the-counter pain relievers
For what cancer, in addition to breast cancer, are men with mutations in BRCA1 or BRCA2 at
risk? - CORRECT ANSWER>>>Prostate Cancer
hypoechoic vs hyperechoic - CORRECT ANSWER>>>
1
,Screening pts w/ mutations in BRCA1 or BRCA2 - CORRECT ANSWER>>>Breast MRI q 12
mo starting at 25
Mammogram q 12m starting at 30 (alternating q 6m w/ MRI)
Note: BRCA1/BRCA2 mutations cause hereditary breast, ovarian, pancreatic, & prostate cancers
Irregularly irregular rhythm with no distinct P waves. Complication of suspected dx? -
CORRECT ANSWER>>>Atrial fibrillation
Complication: stroke if AF for > 48h
RF's for atrial fibrillation - CORRECT ANSWER>>>Alcohol
Drugs
Hypothermia
Mitral stenosis
Coronary artery disease
Congenital heart disease
Tx for atrial fibrillation (stable vs unstable) - CORRECT ANSWER>>>Rate control, rhythm
conversion, and anticoagulation
Unstable: Emergent therapy w/ ϲаrԁiοvеrsioո
Stable: BB +/- anticoagulation
(CHA2DS2-VASc score)
+/- cardioversion later
if onset > 48h: anticoagulate for 21 days prior to cardioversion due to risk of stroke
Anorexia, nausea, vomiting, fever, or periumbilical or epigastric pain that migrates to the right
lower quadrant. Dx? Tx? - CORRECT ANSWER>>>Appendicitis
Common ages: 13 - 40 y/o
Labs: leukocytosis (high neutrophils)
Dx: CT, US (peds or preg)
May show appendiceal dilation, rupture, abscess, phlegmon
Tx: Appendectomy + antibx
Complicated appendicitis with a contained perforation (contained by an abscess or phlegmon)
may initially be managed... - CORRECT ANSWER>>>NPO, IV fluids, antibx, serial imaging,
percutaneous drainage. Appendectomy later.
Within how many hours from dx should surgery occur for acute nonperforated appendicitis? -
CORRECT ANSWER>>>12 h
Complicated appendicitis antibiotics - CORRECT ANSWER>>>Nonperforated: 1st/2nd gen
cephalosporin + metronidazole
Complicated: Pip-tazo. (Zosyn) or amp-sulbactam (Unasyn)
2
,All patients w/ hemodynamic instability need blood cultures, IV fluids, and empiric antibiotics
What type of anesthesia is required for a core-needle biopsy? - CORRECT ANSWER>>>Local
anesthesia.
What finding on abdominal x-ray should make you think of bowel obstruction? - CORRECT
ANSWER>>>Air fluid levels
Preferred technique used to biopsy most breast lesions that are suspicious for malignancy -
CORRECT ANSWER>>>Core-needle biopsy:
A 14-gauge needle is used to retrieve cellular material from the suspicious area
Advantages: minimal scarring, lower cost, quicker recovery
Most common type of breast cancer - CORRECT ANSWER>>>Invasive ductal carcinoma
(IDC)
Can spread beyond the ducts into surrounding breast tissue and metastasize to lymph nodes or
distant organs
Screening pts w/ average risk of breast cancer - CORRECT ANSWER>>>Mammogram every 2
yrs starting at 40-74 y/o
Breast self-exam should NOT be routinely encouraged
RF's for Squamous cell carcinoma and characteristics of the lesion - CORRECT
ANSWER>>>fair skin, light hair, and light eyes, excessive sun exposure, smoking hx, actinic
keratosis precursor
Persistent, rough, scaly hyperkeratotic papule, nodule, or patch that bleeds if scratched. May
evolve to a raised, reddish nodule. On sun-exposed areas
Pearly papule with telangiectasia and a rolled border that may ulcerate or crust. Painless and
slow-growing. Dx? Tx? - CORRECT ANSWER>>>BCC (MC skin cancer)
Risk of mets is < SCC
Dx: clinical exam, dermoscopy, shave, punch, or excisional biopsy
Tx: surgical excision (<10 mm on noncritical areas of the face) vs Mohs surgery (high-risk areas
of the face)
MC type of BCC - CORRECT ANSWER>>>Nodular basal cell carcinoma
Superficial basal cell carcinomas - CORRECT ANSWER>>>Common in men and occur on the
trunk (non sun exposed areas)
Scaly macules, patches, or plaques that are light red to pink in color
Pigmented basal cell carcinoma - CORRECT ANSWER>>>Similar to nodular BCC, but w/ dark
brown pigment. Seen in individuals w/ darker skin
3
, RF's for Hemorrhoids? Dx? - CORRECT ANSWER>>>RF: constipation, straining, preg,
obesity, prolonged sitting, portal HTN, anal intercourse, low fiber diet
PE: rectal exam; @ rest & bearing dwn;
Anoscopy if not detected on PE
42 y/o male w/ painless rectal bleeding during BM for 1 wk. Hx of chronic constipation. On PE,
no visible perianal abnormality. DRE is unremarkable, besides bright red blood on the glove.
Dx? Tx? - CORRECT ANSWER>>>Internal hemorrhoids
Tx: increase fiber intake & hydration, hemorrhoid cream, prevent straining
35 y/o female w/ anal pain & itching, especially during sitting and following BMs. Recently
gave birth. On PE, swollen, blue, tender lumps around anal verge. Dx? - CORRECT
ANSWER>>>External Hemorrhoids
Painful, but no bleeding
Tx: sitz bath, fiber, NSAIDs, stool softener, excision if no relief
What is the recommended age to start screening for colorectal cancer according to the U.S.
Preventive Services Task Force? - CORRECT ANSWER>>>50 years grade A recommendation.
45 years grade B recommendation.
Indications for Surgery on hemorrhoids? Surgical options? - CORRECT ANSWER>>>Persistent
bleeding, thrombosed hemorrhoids, severe pain, or failure of conservative treatment.
Minimally Invasive: Rubber band ligation (1st line for internal), sclerotherapy, infrared
coagulation if less severe. If severe, hemorrhoidectomy, stapled Hemorrhoidopexy
Morpheaform basal cell carcinoma - CORRECT ANSWER>>>Smooth, flesh-colored or light
pink papule or plaque w/ ill-defined borders
why would a DRE be performed? - CORRECT ANSWER>>>
ECG finding for a pt with a pulmonary embolism - CORRECT ANSWER>>>S1Q3T3 pattern
(large S wave in lead I, Q wave in lead III, inverted T wave in lead III)
Nonspecific sign of acute right heart strain
common risk factors for developing thrombi - CORRECT ANSWER>>>Virchow triad:
venous stasis
vascular wall injury
hypercoagulable state
Wells criteria for PE - CORRECT ANSWER>>>A score of 0-4 is "PE unlikely," and a negative
D-dimer can be used to rule out a PE
A score of > 4 points is "PE likely" and warrants further testing.
Dx: ECG & CXR
4
