Surgery COMAT Questions and answers latest update
/. What is the size guideline for treatment of a spontaneous pneumothorax? - Answer-
✅Spontaneous pneumothorax:
<2 cm observe
>2 cm large and stable = needle aspiration or chest tube
/.5 W's of Post-op surgery? - 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? - Answer-✅MRM includes:
• Includes axillary dissection
• Level I and Level II axillary dissection being the standard procedure
/.altnernate name for hidradenitis suppurative - Answer-✅acnes inversa
/.What is hidradenitis suppurativa? - 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? - Answer-✅Paraphimosis is considered a urological
emergency and occurs when the retracted foreskin develops a fixed constriction
proximal to the glans
/.Treatment of parphimosis? - 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 - 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? - 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 - 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 - 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? - 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? - 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? - 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 - Answer-✅• Embolus
• Hypoperfusion from any cause
• Bowel obstruction
/.Clinical findings of ischemic colitis? - 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? - 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? - 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 - Answer-✅Arises from the end of the SMA and supplies the cecum,
appendix, and terminal ileum
/.Marginal artery (artery of Drummond) - 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 - 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 - 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
/.Schatzki ring - Answer-✅narrowing of the lower esophagus that can cause difficulty
swallowing (dysphagia). The narrowing is caused by a ring of mucosal tissue (which
lines the esophagus) or muscular tissue.
/.Heller myotomy is treatment for? - Answer-✅Treatment of achalasia
/.Treatment for schatzki rings? - Answer-✅• Initial treatment is dilation with a bougie or
balloon to fracture the ring
• If symptoms recur repeat dilation can be done
• Persistent symptoms can be treated with endoscopic electrocautery incision
• Because GERD is possible cause for esophageal ring aggressive treatment of reflux
should also be done
/.fundoplication? - Answer-✅Treatment for persistent GERD
It can be done if persistent esophageal ring is thought to be caused by refractory GERD
but only after dilation has been attempted
/.zenker's diverticulum presentation? - Answer-✅○ Months to years of dysphagia
○ Halitosis
○ Heartburn
○ Regurgitation
○ Physical examination can reveal borborygmi in the neck
/.Diagnosis of Zenker's Diverticulum - Answer-✅• Barium swallow which will show an
outpouching
• Esophagoscopy should be done prior to surgical management to assess the
diverticulum and look for any signs of squamous cell carcinoma or carcinoma in situ
• If a rigid scope is used there is risk of perforation
/.Indications for treatment of Zenker's diverticulum and treatment? - Answer-✅•
Diverticulum is greater than 2 cm
• Patient can tolerate
Treatment is diverticulectomy and cricopharyngeal myotomy
/.Sliding versus paraesophageal hernias? - Answer-✅
/.Treatment of sliding and paraesophageal hernias respectively? - Answer-✅Sliding
hernias can be treated with controlling reflux
/. What is the size guideline for treatment of a spontaneous pneumothorax? - Answer-
✅Spontaneous pneumothorax:
<2 cm observe
>2 cm large and stable = needle aspiration or chest tube
/.5 W's of Post-op surgery? - 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? - Answer-✅MRM includes:
• Includes axillary dissection
• Level I and Level II axillary dissection being the standard procedure
/.altnernate name for hidradenitis suppurative - Answer-✅acnes inversa
/.What is hidradenitis suppurativa? - 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? - Answer-✅Paraphimosis is considered a urological
emergency and occurs when the retracted foreskin develops a fixed constriction
proximal to the glans
/.Treatment of parphimosis? - 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 - 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? - 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 - 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 - 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? - 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? - 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? - 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 - Answer-✅• Embolus
• Hypoperfusion from any cause
• Bowel obstruction
/.Clinical findings of ischemic colitis? - 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? - 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? - 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 - Answer-✅Arises from the end of the SMA and supplies the cecum,
appendix, and terminal ileum
/.Marginal artery (artery of Drummond) - 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 - 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 - 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
/.Schatzki ring - Answer-✅narrowing of the lower esophagus that can cause difficulty
swallowing (dysphagia). The narrowing is caused by a ring of mucosal tissue (which
lines the esophagus) or muscular tissue.
/.Heller myotomy is treatment for? - Answer-✅Treatment of achalasia
/.Treatment for schatzki rings? - Answer-✅• Initial treatment is dilation with a bougie or
balloon to fracture the ring
• If symptoms recur repeat dilation can be done
• Persistent symptoms can be treated with endoscopic electrocautery incision
• Because GERD is possible cause for esophageal ring aggressive treatment of reflux
should also be done
/.fundoplication? - Answer-✅Treatment for persistent GERD
It can be done if persistent esophageal ring is thought to be caused by refractory GERD
but only after dilation has been attempted
/.zenker's diverticulum presentation? - Answer-✅○ Months to years of dysphagia
○ Halitosis
○ Heartburn
○ Regurgitation
○ Physical examination can reveal borborygmi in the neck
/.Diagnosis of Zenker's Diverticulum - Answer-✅• Barium swallow which will show an
outpouching
• Esophagoscopy should be done prior to surgical management to assess the
diverticulum and look for any signs of squamous cell carcinoma or carcinoma in situ
• If a rigid scope is used there is risk of perforation
/.Indications for treatment of Zenker's diverticulum and treatment? - Answer-✅•
Diverticulum is greater than 2 cm
• Patient can tolerate
Treatment is diverticulectomy and cricopharyngeal myotomy
/.Sliding versus paraesophageal hernias? - Answer-✅
/.Treatment of sliding and paraesophageal hernias respectively? - Answer-✅Sliding
hernias can be treated with controlling reflux
