Surgery Comat Exam Questions And
Answers
/. Bloody discharge in one nipple from one duct in the breast - Answer-✅Intraductal
papilloma (in the large subareolar ducts under the nipple)
/.Hepatobiliary scan - Answer-✅Cholescintigraphy (99mTc-hepatic iminodiacetic acid or
HIDA scan) - radiiolabeled substances upatke by the liver, gallbladder, common bile
duct, and duodenum should be visualized after 1 hour in choledocolithiasis
/.Most common location of Carcinoid tumors - Answer-✅Appendix
Usually asymptomatic, but they could present with abdominal pain or carcinoid
syndrome if it has metastasized
/.Carcinoid Syndrome - Answer-✅caused by serotonin released from the tumor and
patient experience flushing, diarrhea, and bronchoconstriction
dx: 24 hour runie for 5-HIAA and CT scan or scintigraphy can localize it.
/.Tx of appendiceal carcinoids - Answer-✅Right hemicolectomy is indicated if the tumor
is greater than 1.5 cm
If there are no signs of tumor spread and the tumor is less than 1.5 cm, just and
appendectomy can be performed.
Carcinoid syndrome = Octreotide (somatostatin analogue)
/.Hit on the side of the head with blunt object causing weakness arm and leg - Answer-
✅Epidural hematoma resulting from rupture of middle meningeal artery from maxillary
artery)
Symptoms: vomiting, drowiness, confusion, aphasia, seizures, and hemiparesis
Dx: CT scan
/.Direct Hernia - Answer-✅a protrusion medial to the inferior epigastric vessels (lateral
umbilical fold)
Medial umbilical fold contains obliterated umbilical veins.
,Median Umbilical fold contains the urachus
/.Indirect Hernia - Answer-✅most commonly due to a *Patent processus vaginalis*
Most commonly seen in premature males
/.Diastasis recti - Answer-✅a condition in which the abdominal wall separates and the
linea alba is stretched. Presents with a midline bulge that is above the umbilicus. Bulge
will increase with straining and decrease at rest.
tx: PT and abdominal wall exercises
/.Spigelian Hernia - Answer-✅Arise from a defect in Spigel's fascia, the apoeurotic layer
between the rectus abdominis and external oblique muscle along the linea semilunaris
Presents without bulge but has associated pain
/.Amyand Hernia - Answer-✅An inguinal hernia containing the vermiform appendix
(signs and symptoms of appendicitis may be present)
/.Littre Hernia - Answer-✅Hernia that contains a Meckel's diverticulum
/.Pantaloon Hernia - Answer-✅an inguinal hernia that contains elements of both a direct
and an inguinal hernia
/.Richter Hernia - Answer-✅occurs when only the antimesenteric wall of a hollow
abdominal organ becomes incarcerated in and inguinal hernia.
/.Sliding Hernia - Answer-✅A hernia containing a hollow retroperitoneal organ, most
commonly the bladder or colon
/.Treatment of hernias - Answer-✅Conservative/Observation = Diastasis recti (midline
bulge)
Appendectomy = Amyand's hernia
Laparoscopic hernia repair = Ventral, inguinal, hiatal, and incisional hernia
Open hernia repair = most hernias
/.Retroperitoneal Organ - Answer-✅*SAD PUCKER*
S = Suprarenal (adrenal) glands
A = Aorta/IVC
D = Duodenum (2nd & 3rd segments)
, P = Pancreas
U = Ureters
C = Colon
K = Kidneys
E = Esophagus
R = Rectum
/.Peutz-Jeghers syndrome - Answer-✅Autosomal dominant disorder
Two manifestations: Pigmented mucocutaneous macules and multiple hamrtomatous GI
polyps (usu benign)
GI symptom caused by obstruction from *intussusception* or occlusion of bowel
obstruction
/.Paget's Disease of the breast - Answer-✅*Hallmark = scaly, raw, vesicular, or
ulcerated lesion that begins on the nipple and then spreads to the areola*
Symptoms = Pain, burring, and/or pruritus
Mammary Paget cells are malignant epithelial cells derived from underlying ductal
adenocarcinoma of the breast that invade into the skin of nipple and areolar
/.Acute Hemolytic Transfusion Reaction - Answer-✅Classic triad = Fever, flank pain,
and red or brown urine (hemoglobinuria)
The rapid destruction of donor erythrocytes by preformed recipient antibodies. *Due to
ABO incompatibility* > Disseminated Intravascular Coagulation (especially under
anesthesia), shock, and ARF due to Acute tubular necrosis
/.Inflammatory bowel disease (Crohn's disease and ulcerative colitis) - Answer-✅Seen
in second decade of life, more in females
Most commonly affected site Terminal ileum
Symptoms = right lower quadrant pain, weight loss, and diarrhea
Note = Crohn's disease affects the anus and patient will have anal fissures and fistulas.
Colonoscopy: skipped lesions, strictures, and cobblestoning
/.Treatment of Crohn's - Answer-✅Step-wise approach:
1) 1st-line: 5-aminosalicyclic acid (5-ASA): *Sulfasalazine & Mesalamine* for flares
2)Antibiotics: Ciprofloxacin and Metronidazole are good for perianal involvement and
fistulas
3) 2nd-line: Corticosteroids for acute flare ups
Answers
/. Bloody discharge in one nipple from one duct in the breast - Answer-✅Intraductal
papilloma (in the large subareolar ducts under the nipple)
/.Hepatobiliary scan - Answer-✅Cholescintigraphy (99mTc-hepatic iminodiacetic acid or
HIDA scan) - radiiolabeled substances upatke by the liver, gallbladder, common bile
duct, and duodenum should be visualized after 1 hour in choledocolithiasis
/.Most common location of Carcinoid tumors - Answer-✅Appendix
Usually asymptomatic, but they could present with abdominal pain or carcinoid
syndrome if it has metastasized
/.Carcinoid Syndrome - Answer-✅caused by serotonin released from the tumor and
patient experience flushing, diarrhea, and bronchoconstriction
dx: 24 hour runie for 5-HIAA and CT scan or scintigraphy can localize it.
/.Tx of appendiceal carcinoids - Answer-✅Right hemicolectomy is indicated if the tumor
is greater than 1.5 cm
If there are no signs of tumor spread and the tumor is less than 1.5 cm, just and
appendectomy can be performed.
Carcinoid syndrome = Octreotide (somatostatin analogue)
/.Hit on the side of the head with blunt object causing weakness arm and leg - Answer-
✅Epidural hematoma resulting from rupture of middle meningeal artery from maxillary
artery)
Symptoms: vomiting, drowiness, confusion, aphasia, seizures, and hemiparesis
Dx: CT scan
/.Direct Hernia - Answer-✅a protrusion medial to the inferior epigastric vessels (lateral
umbilical fold)
Medial umbilical fold contains obliterated umbilical veins.
,Median Umbilical fold contains the urachus
/.Indirect Hernia - Answer-✅most commonly due to a *Patent processus vaginalis*
Most commonly seen in premature males
/.Diastasis recti - Answer-✅a condition in which the abdominal wall separates and the
linea alba is stretched. Presents with a midline bulge that is above the umbilicus. Bulge
will increase with straining and decrease at rest.
tx: PT and abdominal wall exercises
/.Spigelian Hernia - Answer-✅Arise from a defect in Spigel's fascia, the apoeurotic layer
between the rectus abdominis and external oblique muscle along the linea semilunaris
Presents without bulge but has associated pain
/.Amyand Hernia - Answer-✅An inguinal hernia containing the vermiform appendix
(signs and symptoms of appendicitis may be present)
/.Littre Hernia - Answer-✅Hernia that contains a Meckel's diverticulum
/.Pantaloon Hernia - Answer-✅an inguinal hernia that contains elements of both a direct
and an inguinal hernia
/.Richter Hernia - Answer-✅occurs when only the antimesenteric wall of a hollow
abdominal organ becomes incarcerated in and inguinal hernia.
/.Sliding Hernia - Answer-✅A hernia containing a hollow retroperitoneal organ, most
commonly the bladder or colon
/.Treatment of hernias - Answer-✅Conservative/Observation = Diastasis recti (midline
bulge)
Appendectomy = Amyand's hernia
Laparoscopic hernia repair = Ventral, inguinal, hiatal, and incisional hernia
Open hernia repair = most hernias
/.Retroperitoneal Organ - Answer-✅*SAD PUCKER*
S = Suprarenal (adrenal) glands
A = Aorta/IVC
D = Duodenum (2nd & 3rd segments)
, P = Pancreas
U = Ureters
C = Colon
K = Kidneys
E = Esophagus
R = Rectum
/.Peutz-Jeghers syndrome - Answer-✅Autosomal dominant disorder
Two manifestations: Pigmented mucocutaneous macules and multiple hamrtomatous GI
polyps (usu benign)
GI symptom caused by obstruction from *intussusception* or occlusion of bowel
obstruction
/.Paget's Disease of the breast - Answer-✅*Hallmark = scaly, raw, vesicular, or
ulcerated lesion that begins on the nipple and then spreads to the areola*
Symptoms = Pain, burring, and/or pruritus
Mammary Paget cells are malignant epithelial cells derived from underlying ductal
adenocarcinoma of the breast that invade into the skin of nipple and areolar
/.Acute Hemolytic Transfusion Reaction - Answer-✅Classic triad = Fever, flank pain,
and red or brown urine (hemoglobinuria)
The rapid destruction of donor erythrocytes by preformed recipient antibodies. *Due to
ABO incompatibility* > Disseminated Intravascular Coagulation (especially under
anesthesia), shock, and ARF due to Acute tubular necrosis
/.Inflammatory bowel disease (Crohn's disease and ulcerative colitis) - Answer-✅Seen
in second decade of life, more in females
Most commonly affected site Terminal ileum
Symptoms = right lower quadrant pain, weight loss, and diarrhea
Note = Crohn's disease affects the anus and patient will have anal fissures and fistulas.
Colonoscopy: skipped lesions, strictures, and cobblestoning
/.Treatment of Crohn's - Answer-✅Step-wise approach:
1) 1st-line: 5-aminosalicyclic acid (5-ASA): *Sulfasalazine & Mesalamine* for flares
2)Antibiotics: Ciprofloxacin and Metronidazole are good for perianal involvement and
fistulas
3) 2nd-line: Corticosteroids for acute flare ups
