Page 1 of 184
SURGERY COMAT EXAM ALL 550 QUESTIONS AND
CORRECT ANSWERS LATEST UPDATE JUST
RELEASED THIS YEAR
Question: Esophageal perforation - ANSWER✔✔TQ: pt w/ CP post vomiting + pleural effusion
w/ high amylase content
Boerhaave syndrome = specific form of esophageal perforation, transmural tearing of distal
esophagus, d/t vomiting
- chest , back, or epigastric pain
- crunching sound on exam = Hamman sign
- systemic inflammation = fever, tachycardia, tachypnea, hypotension
- tx: emergent surgical intervention, NPO, IV antibx, PPI
Question: surveillance following surgical resection of colon cancer - ANSWER✔✔stage 1 =
colonoscopy in 1 yr + repeat every 3-5 yrs
stage 2 and 3 = colonscopy in 1 yr + repeat every 3-5 yrs
- annual CT imaging of chest and abd +/- pelvis
, Page 2 of 184
- periodic tumor marker evaluation (CEA)
Stage 4 = individualized, unlikely to be on exam
Question: Peutz-Jeghers syndrome - ANSWER✔✔Patients with Peutz-Jeghers syndrome have
pigmented mucocutaneous macules and hamartomatous polyps of the gastrointestinal tract.
Nearly half of all these patients will have an intussusception during their lifetime.
AD disorder
2 manifestation
1. pigmented mucocutaneous macules 2. multiple hamartomatous GI polyps, usually benign but
may become malignant
Question: acute infectious lymphanginitis - ANSWER✔✔TQ: pt fell, got abrasions, developed
red streaks extending proximally from a wound + tender lymphadenopathy + infxn signs
Acute infectious lymphangitis typically develops following a cutaneous invasion and is most
commonly caused by Streptococcus pyogenes and methicillin-sensitive Staphylococcus aureus.
Patients typically present within days of the initial wound and examination commonly reveals
fever, tender and erythematous streaks proximal to the wound, and tender lymphadenopathy
within regional lymph nodes. In most cases, empiric cephalexin is used as first-line treatment.
, Page 3 of 184
** DO NOT give Penicillin V, resistance is common in MSSA so do not use to treat skin and soft
tissue infections
Question: Primary Mitral Regurgitation - ANSWER✔✔MR = holosystolic murmur, best heard at
cardiac apex
- usually occurs d/t myxomatous valvular degeneration and mitral valve prolapse
surgical indications for PMR
- LVEF 30-60% regardless of symptoms
- valve repair is preferred to valve replacements
Question: pancreaticopleural fistula - ANSWER✔✔Definition
-Fistula between pancreatic duct and pleural space
Etiology
-Acute or Chronic Pancreatitis
DX:
History/symptoms
Pleural fluid analysis
, Page 4 of 184
-Amylase-rich
-Exudate
(See Light Criteria, meet at least one)
1. Pleural protein / serum protein > 0.5
2. Pleural LDH / Serum LDH > 0.6
3. Pleural LDH > 2.3 * serum LDH upper limit of normal
Management
-Bowel rest to promote fistula closure, NPO + NG tube
-conservative treatment
- ERCP is symptoms or fluid collection persists
Question: impaired distal perfusion (loss of pulses) after circumferential burn -
ANSWER✔✔perform an escharotomy
Circumferential burns can develop into eschars that restrict blood flow. Emergent escharotomy
is required to restore blood flow and prevent tissue death distal to the eschar.
SURGERY COMAT EXAM ALL 550 QUESTIONS AND
CORRECT ANSWERS LATEST UPDATE JUST
RELEASED THIS YEAR
Question: Esophageal perforation - ANSWER✔✔TQ: pt w/ CP post vomiting + pleural effusion
w/ high amylase content
Boerhaave syndrome = specific form of esophageal perforation, transmural tearing of distal
esophagus, d/t vomiting
- chest , back, or epigastric pain
- crunching sound on exam = Hamman sign
- systemic inflammation = fever, tachycardia, tachypnea, hypotension
- tx: emergent surgical intervention, NPO, IV antibx, PPI
Question: surveillance following surgical resection of colon cancer - ANSWER✔✔stage 1 =
colonoscopy in 1 yr + repeat every 3-5 yrs
stage 2 and 3 = colonscopy in 1 yr + repeat every 3-5 yrs
- annual CT imaging of chest and abd +/- pelvis
, Page 2 of 184
- periodic tumor marker evaluation (CEA)
Stage 4 = individualized, unlikely to be on exam
Question: Peutz-Jeghers syndrome - ANSWER✔✔Patients with Peutz-Jeghers syndrome have
pigmented mucocutaneous macules and hamartomatous polyps of the gastrointestinal tract.
Nearly half of all these patients will have an intussusception during their lifetime.
AD disorder
2 manifestation
1. pigmented mucocutaneous macules 2. multiple hamartomatous GI polyps, usually benign but
may become malignant
Question: acute infectious lymphanginitis - ANSWER✔✔TQ: pt fell, got abrasions, developed
red streaks extending proximally from a wound + tender lymphadenopathy + infxn signs
Acute infectious lymphangitis typically develops following a cutaneous invasion and is most
commonly caused by Streptococcus pyogenes and methicillin-sensitive Staphylococcus aureus.
Patients typically present within days of the initial wound and examination commonly reveals
fever, tender and erythematous streaks proximal to the wound, and tender lymphadenopathy
within regional lymph nodes. In most cases, empiric cephalexin is used as first-line treatment.
, Page 3 of 184
** DO NOT give Penicillin V, resistance is common in MSSA so do not use to treat skin and soft
tissue infections
Question: Primary Mitral Regurgitation - ANSWER✔✔MR = holosystolic murmur, best heard at
cardiac apex
- usually occurs d/t myxomatous valvular degeneration and mitral valve prolapse
surgical indications for PMR
- LVEF 30-60% regardless of symptoms
- valve repair is preferred to valve replacements
Question: pancreaticopleural fistula - ANSWER✔✔Definition
-Fistula between pancreatic duct and pleural space
Etiology
-Acute or Chronic Pancreatitis
DX:
History/symptoms
Pleural fluid analysis
, Page 4 of 184
-Amylase-rich
-Exudate
(See Light Criteria, meet at least one)
1. Pleural protein / serum protein > 0.5
2. Pleural LDH / Serum LDH > 0.6
3. Pleural LDH > 2.3 * serum LDH upper limit of normal
Management
-Bowel rest to promote fistula closure, NPO + NG tube
-conservative treatment
- ERCP is symptoms or fluid collection persists
Question: impaired distal perfusion (loss of pulses) after circumferential burn -
ANSWER✔✔perform an escharotomy
Circumferential burns can develop into eschars that restrict blood flow. Emergent escharotomy
is required to restore blood flow and prevent tissue death distal to the eschar.
