SURGERY COMAT EXAM SCRIPT TEST BANK
FULL SOLUTION 2026 VIEW AHEAD EXAM.
⫸ GERD management. Answer: Diagnose:
*PPI trial*
Prior to surgery:
1. Endoscopy
2. Manometry - ID aperistalsis = partial fundoplication)
3. 24 hr pH monitoring or Nuclear scintigraphy- correlates symptoms
to acid reflux
4. Barium swallow - evaluate for hernia
Treatment:
- High dose PPIs
- Surgery if medical management fails (Nissen fundoplication or
Endoscopic radiotherapy to GE junction)
Physiology:
- dec LES tone, gastroparesis/delayed emptying, excess acid, dec
barrier function to acid, hiatal hernia
⫸ Boerhaave Syndrome. Answer: Diagnosis:
,*Gastrograffin esophagogram* (water soluble unlike Barium) -
although Barium is most sensitive
or CT of abdomen and chest
Treamtent:
ABCs
ABx
1. Score < 5 = Drainage of contents and esophageal stent by
endoscope...or...
2. Score >5 = repair of esophagectomy for malignancies
* most common cause = Iatrogenic
⫸ Metastatic Melanoma. Answer: Patients seem to always benefit
from SLNB
*Surgery* is primary therapy with nodal involvement.
Interferon A and vemurafenib (and others) are for stage III, IV.
*Superficial spreading* most common overall.
,*Nodular Sclerosis* 2nd most common - poor
*Acral Lentiginous* more common for African American, Asian,
Hispanics).
*Lentiginous Maligna* - 5-15 yr radial phase
⫸ Blunt Abdominal Trauma. Answer: If hemodynamically *stable*...
1. FAST
- Diagnostic peritoneal lavage if unable to FAST
2. if +, *or* '-' but high risk (anemia, guarding) -> CT abdomen
3. If + -> Ex Lap
If hemodynamically *unstable*...
1. FAST
2. If + -> Ex Lap
If *altered mental status*, even if stable, go directly to CT
⫸ Prolonged QT. Answer: Hypocalcemia - Ca channels stay open
longer because voltage is not hit, so Qt prolonged
(Parathyroidectomy)
Hypomagnesemia
, ⫸ Anasarca. Answer: "Third spacing of fluid" - extreme generalized
edema
Due to liver failure, hypoalbuminemia, renal failure, right-sided heart
failure, IV fluids, and capillary leak syndrome from docetaxel
⫸ Hinchey Classification. Answer: Diverticulitis perforation staging
process...
I. Localized abscess (para-colonic).
II. Pelvic or retroperitoneal Abscess.
III. Purulent peritonitis.
IV. Feculent peritonitis.
ABx and percutaneous drainage for I or II.
- < 3 cm = IV ABx and observation
- > 3 cm = CT-guided drainage
- if not resolved -> surgical drainage and debridement
III-IV better outcomes with primary resection w/ anastamosis.
⫸ Diverticulitis. Answer: Medical management outpatient
FULL SOLUTION 2026 VIEW AHEAD EXAM.
⫸ GERD management. Answer: Diagnose:
*PPI trial*
Prior to surgery:
1. Endoscopy
2. Manometry - ID aperistalsis = partial fundoplication)
3. 24 hr pH monitoring or Nuclear scintigraphy- correlates symptoms
to acid reflux
4. Barium swallow - evaluate for hernia
Treatment:
- High dose PPIs
- Surgery if medical management fails (Nissen fundoplication or
Endoscopic radiotherapy to GE junction)
Physiology:
- dec LES tone, gastroparesis/delayed emptying, excess acid, dec
barrier function to acid, hiatal hernia
⫸ Boerhaave Syndrome. Answer: Diagnosis:
,*Gastrograffin esophagogram* (water soluble unlike Barium) -
although Barium is most sensitive
or CT of abdomen and chest
Treamtent:
ABCs
ABx
1. Score < 5 = Drainage of contents and esophageal stent by
endoscope...or...
2. Score >5 = repair of esophagectomy for malignancies
* most common cause = Iatrogenic
⫸ Metastatic Melanoma. Answer: Patients seem to always benefit
from SLNB
*Surgery* is primary therapy with nodal involvement.
Interferon A and vemurafenib (and others) are for stage III, IV.
*Superficial spreading* most common overall.
,*Nodular Sclerosis* 2nd most common - poor
*Acral Lentiginous* more common for African American, Asian,
Hispanics).
*Lentiginous Maligna* - 5-15 yr radial phase
⫸ Blunt Abdominal Trauma. Answer: If hemodynamically *stable*...
1. FAST
- Diagnostic peritoneal lavage if unable to FAST
2. if +, *or* '-' but high risk (anemia, guarding) -> CT abdomen
3. If + -> Ex Lap
If hemodynamically *unstable*...
1. FAST
2. If + -> Ex Lap
If *altered mental status*, even if stable, go directly to CT
⫸ Prolonged QT. Answer: Hypocalcemia - Ca channels stay open
longer because voltage is not hit, so Qt prolonged
(Parathyroidectomy)
Hypomagnesemia
, ⫸ Anasarca. Answer: "Third spacing of fluid" - extreme generalized
edema
Due to liver failure, hypoalbuminemia, renal failure, right-sided heart
failure, IV fluids, and capillary leak syndrome from docetaxel
⫸ Hinchey Classification. Answer: Diverticulitis perforation staging
process...
I. Localized abscess (para-colonic).
II. Pelvic or retroperitoneal Abscess.
III. Purulent peritonitis.
IV. Feculent peritonitis.
ABx and percutaneous drainage for I or II.
- < 3 cm = IV ABx and observation
- > 3 cm = CT-guided drainage
- if not resolved -> surgical drainage and debridement
III-IV better outcomes with primary resection w/ anastamosis.
⫸ Diverticulitis. Answer: Medical management outpatient
