Acute appendicitis

Question 1

Basic multiple choice Remembering understanding

A 65-year-old female patient presents with severe abdominal pain and signs of shock after a recent laparoscopic cholecystectomy. Imaging shows free fluid in the abdominal cavity but no clear source of bleeding. What should be the next step in the management of this patient?

Administer intravenous fluids and monitor closely for 24 hours.

Perform an urgent exploratory laparotomy to identify the source of the bleeding.

Correct

Schedule a repeat ultrasound to reassess for potential complications.

Initiate blood transfusions and delay intervention until the morning.

Explanation

The urgent exploratory laparotomy is indicated due to the signs of shock and the presence of free fluid, which suggest potential internal bleeding. Monitoring alone does not address the likely need for immediate surgical intervention.

Question 2

Basic multiple choice Remembering understanding

A surgical resident has been tasked with assisting in a complex cardiac surgery involving CABG. The attending surgeon's instructions include using both arterial and venous grafts. What should the resident prioritize during the procedure to ensure successful grafting?

Focus solely on the venous grafts as they are easier to harvest.

Ensure proper hemostasis before graft placement to reduce complications.

Correct

Use the arterial graft without considering the patient's anatomy.

Prepare for excessive blood loss rather than optimizing graft technique.

Explanation

Ensuring proper hemostasis is critical in preventing complications such as graft failure or perioperative bleeding. All grafts must be carefully considered according to the patient's anatomy and condition.

Question 3

Basic multiple choice Remembering understanding

During a routine orthopedic surgery, the anesthesiologist notices that the patient's blood pressure has dropped significantly and the heart rate has increased, indicating possible acute hypotension. Which immediate action should be taken to address this potential crisis?

Administer a bolus of intravenous fluid and monitor vital signs.

Correct

Increase the depth of anesthesia to sedate the patient further.

Consult the surgical team to discuss changing the surgical approach.

Wait for the surgeon to finish the procedure before taking action.

Explanation

Administering a bolus of IV fluid is the correct immediate response to acute hypotension, as it helps to stabilize the patient before further investigation or interventions.

Question 4

Basic multiple choice Remembering understanding

A patient with a history of multiple abdominal surgeries presents for a laparoscopic hernia repair. Pre-operative imaging reveals extensive adhesions, complicating the procedure. What approach should the surgical team consider in this case?

Proceed with the laparoscopic approach regardless of the adhesions.

Switch to an open repair approach to facilitate safer dissection.

Correct

Use laparoscopic tools to break down adhesions without changing the surgical method.

Postpone the surgery and refer the patient to a specialist in adhesion management.

Explanation

Switching to an open repair is recommended when significant adhesions are present, as it allows for better visualization and management of potential complications.

Question 5

Basic multiple choice Remembering understanding

During a post-operative check for a patient who underwent a total knee arthroplasty, the nurse notes warmth, redness, and swelling around the incision site along with fever. Which of the following actions is the most critical for the surgical team to take?

Provide ice packs to reduce swelling and wait for 48 hours.

Document findings and schedule a follow-up appointment in a week.

Administer broad-spectrum antibiotics and order a laboratory work-up.

Correct

Advise the patient to increase mobility and apply a compression bandage.

Explanation

The combination of symptoms suggests a potential infection; thus, immediate administration of antibiotics and further evaluation are crucial to prevent sepsis.

Question 6

Basic multiple choice Remembering understanding

A 30-year-old male with a traumatic brain injury requires emergent craniotomy for hematoma evacuation. In considering post-operative management, which strategy would best enhance the patient's recovery and minimize complications?

Limit all physical activity for at least one month.

Ensure regular neurological assessments and manage intracranial pressure carefully.

Correct

Encourage the patient to use pain medication as needed without monitoring side effects.

Discharge the patient as soon as stable to prevent hospital-acquired infections.

Explanation

Regular neurological assessments and careful management of intracranial pressure are crucial to monitor for complications that may arise following craniotomy.

Question 7

Basic multiple choice Remembering understanding

A surgical team is preparing for a complex liver resection. The patient has a history of liver cirrhosis and portal hypertension. What is the most critical factor to consider during the operation to prevent intraoperative complications?

Aggressively manage the patient's blood pressure throughout the surgery.

Monitor and control bleeding by applying meticulous surgical technique.

Correct

Prioritize rapid pacing of the procedure to reduce anesthetic time.

Limit the use of fluid resuscitation to avoid fluid overload.

Explanation

Patients with liver cirrhosis are at increased risk for bleeding, making meticulous surgical technique and bleeding control crucial to prevent intraoperative complications.

Question 8

Basic multiple choice Remembering understanding

During a retroperitoneal lymph node dissection for testicular cancer, the surgeon encounters unexpected vascular anatomy, complicating the dissection. What is the best approach for successfully addressing this complication?

Continue with the dissection while applying blind dissection techniques.

Consult intraoperative imaging or anatomical references before proceeding.

Correct

Immediately abandon the surgery and refer the patient to a specialist.

Proceed with cauterization of all vessels to minimize surgical time.

Explanation

Consulting imaging or anatomical references allows the surgeon to understand the altered vascular anatomy and proceed safely, without risking major vascular injury.

Question 9

Basic multiple choice Remembering understanding

A patient presenting for a scheduled elective appendectomy has a positive rapid COVID-19 test result, but is asymptomatic. Which is the most appropriate course of action regarding the surgery?

Proceed with the surgery as scheduled since the patient is asymptomatic.

Postpone the surgery until the patient recovers from COVID-19.

Correct

Conduct the surgery using standard precautions without any further testing.

Perform the appendectomy using a fully closed room with minimal staff present.

Explanation

Postponing the surgery is crucial to ensure safety for both the patient and surgical staff, as elective surgeries on COVID-19 positive patients can pose significant risks.

Question 10

Basic multiple choice Remembering understanding

A 45-year-old patient with a history of gout requires a total hip replacement. Pre-operatively, which factor should the surgical team most closely monitor to ensure optimal surgical outcomes?

Blood glucose levels, given the patient's sedentary lifestyle.

Serum uric acid levels to manage gout flares post-operatively.

Correct

The patient's weight as it impacts joint loads.

Heart rate variability during anesthesia induction.

Explanation

Monitoring serum uric acid levels is critical for managing potential gout flares that could complicate recovery after total hip replacement.

Question 11

Basic multiple choice Remembering understanding

In the context of breast cancer management, a patient is considering neoadjuvant chemotherapy before undergoing a lumpectomy. What should the surgical team emphasize when discussing the risks and benefits?

The risk of severe hair loss associated with chemotherapy.

The potential for tumor size reduction, allowing for less extensive surgery.

Correct

The requirement for lifelong follow-up appointments regardless of outcomes.

The unlikelihood of achieving clear margins during surgery.

Explanation

Neoadjuvant chemotherapy is primarily used to shrink tumors, which can facilitate less extensive surgery or the possibility of breast-conserving options.

Question 12

Basic multiple choice Remembering understanding

During laparoscopic bariatric surgery, the surgical team encounters unexpected anatomical variations in the stomach. How should they adjust their strategy to effectively manage this complication?

Proceed with standard techniques to avoid prolonging the procedure.

Utilize alternative laparoscopic techniques tailored to the new variations.

Correct

Consult with the patient’s previous surgeon before making any adjustments.

Switch to open surgery regardless of the circumstances.

Explanation

Adapting techniques to account for anatomical variations ensures patient safety and increases the likelihood of successful outcomes during surgery.

Question 13

Basic multiple choice Remembering understanding

A 50-year-old patient with a severe penicillin allergy requires orthopedic surgery. Which medication alternatives should be used to prevent post-operative infection?

Use vancomycin as the sole prophylaxis even though the patient has risk factors for infection.

Select clindamycin or cefazolin as alternatives to minimize the risk of allergic reactions.

Correct

Administer high doses of penicillin under close monitoring.

Only provide prophylaxis if the patient shows signs of infection.

Explanation

Clindamycin or cefazolin are effective alternatives for patients with penicillin allergies to prevent post-operative infections.

Question 14

Basic multiple choice Remembering understanding

A revision knee arthroplasty case presents a unique challenge where extensive bone loss has occurred. What strategy should the surgical team incorporate to ensure stability of the implant?

Opt for cemented fixation only and avoid any grafting materials.

Employ the use of bone grafts or augments to restore bone integrity.

Correct

Insert the new implant directly into the existing bone without further adjustments.

Delay the revision until the bone density improves naturally.

Explanation

Using bone grafts or augments is essential for providing stability of the implant in cases of significant bone loss during revision knee arthroplasty.

Question 15

Basic multiple choice Remembering understanding

A young female athlete presents with a suspected anterior cruciate ligament (ACL) tear after an injury. Given her active lifestyle, what pre-operative management aspect is key to her recovery after reconstructive surgery?

Strictly limit all physical activity until surgery.

Implement a rigorous prehabilitation program to strengthen surrounding muscles.

Correct

Avoid all forms of physical therapy until the post-operative stage.

Focus solely on pain management instead of functional recovery.

Explanation

A rigorous prehabilitation program is crucial as it prepares the knee for surgery, reduces recovery time, and enhances rehabilitation outcomes post-operatively.

Question 16

Basic multiple choice Remembering understanding

During a complex laparoscopic cholecystectomy, you encounter excessive bleeding due to a hepatobiliary injury. The patient is stable, but the bleeding is significant. What is the best immediate action to address this problem?

Continue the procedure and apply electrocoagulation to control the bleeding.

Convert to an open surgery to better visualize and control the hemorrhage.

Correct

Administer intravenous fluids and wait for a minute to see if the bleeding subsides.

Apply direct pressure through the laparoscope to minimize visual obstruction.

Explanation

Converting to open surgery is indicated in cases where laparoscopic approaches fail to control significant bleeding, as it allows for better visualization and definitive management of the injury. Electrocoagulation may not adequately address a serious vascular injury, while waiting or applying pressure may lead to further complications.

Question 17

Basic multiple choice Remembering understanding

A 70-year-old male patient presents with an abdominal mass and elevated liver function tests. Imaging reveals a suspected liver neoplasm. Which diagnostic approach would be most effective in assessing the likelihood of malignancy?

Obtain a CT scan of the abdomen with contrast.

Correct

Request an ultrasound-guided biopsy immediately.

Perform a laparoscopy for direct visualization of the liver.

Conduct a comprehensive blood panel to look for tumor markers.

Explanation

A CT scan with contrast is the preferred diagnostic tool for assessing liver lesions, as it provides detailed imaging that can indicate characteristics suggestive of malignancy and help guide treatment options. Biopsy may be premature without proper imaging, while blood tests alone are not definitive.

Question 18

Basic multiple choice Remembering understanding

You are leading a surgical team in preparing for an elective vascular surgery on a patient with complex comorbidities. What is the most effective strategy to ensure optimal surgical outcomes?

Focus on surgeon experience and technical skills alone.

Form a multidisciplinary team including anesthesiology, nutrition, and rehabilitation specialists.

Correct

Utilize advanced surgical technology as the primary means of improving outcomes.

Wait until the patient shows signs of complications before strategizing.

Explanation

A multidisciplinary approach allows for comprehensive preoperative assessment and optimization of the patient’s health conditions, which is critical in ensuring positive surgical outcomes, especially in patients with comorbidities. Relying solely on surgeon experience or technology does not address the multifactorial aspects of surgical success.

Question 19

Basic multiple choice Remembering understanding

In preparation for a complex liver transplant, your surgical team is evaluating the donor's health and history. Which factor is most significant in impacting the success rates of organ transplantation?

The age of the donor alone.

The presence of coexisting medical conditions in the donor.

Correct

The surgical technique of the transplant alone.

The postoperative care regimen of the recipient.

Explanation

The presence of coexisting medical conditions in the donor can significantly impact the viability of the transplant and the success rate of the procedure. Simply relying on donor age or the transplant surgical technique alone does not encompass all variables affecting transplant outcomes.

Question 20

Basic multiple choice Remembering understanding

A patient recovering from abdominal surgery begins to exhibit signs of a developing infection, including fever and tachycardia on the second postoperative day. What should be the first action taken to manage this potential complication?

Immediately start broad-spectrum antibiotics.

Perform a physical examination and consider imaging studies to assess for abscess formation.

Correct

Initiate fluid resuscitation to stabilize the patient.

Schedule a follow-up appointment for review in one week.

Explanation

A thorough physical examination, along with imaging studies, is crucial to assess the cause of the infection signs and determine the correct course of action, such as whether antibiotics or further surgical intervention are necessary. Starting antibiotics without a clear assessment is inappropriate as not all infections require immediate antibiotic treatment.

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