Sample Written Exam – General Surgery

Question 1
A 32-year-old quadriplegic woman presents with abdominal discomfort. Which of the
following signs would be suspicious for an abdominal emergency?
a. *Increasing spasticity (CORRECT ANSWER)
b. Fecal impaction
c. Flaccid abdomen
d. Localized hyperesthesia

Question 2
A 26-year-old man with a history of multiple complications following previous surgeries for Crohn
disease develops persistent vomiting resulting in a 15-kg weight loss. He is afebrile, with a soft non-
tender abdomen. Imaging demonstrates dilatation of the stomach with an extrinsic stricture in the
third portion of the duodenum. An upper GI endoscopy shows no abnormality other than a dilated
stomach with considerable residual fluid. What is the MOST appropriate management?
a. Endoscopic balloon dilatation
b. Laparotomy and stricturoplasty
c. *Continued nutritional support (CORRECT ANSWER)
d. Laparotomy and gastrojejunostomy

Question 3
A mother brings her 16-month-old child to the emergency department with a history of the child
falling down the basement stairs and landing on the cement floor. Which injury sustained by the
child is highly specific for child abuse?
a. Linear parietal skull fracture
b. Periorbital ecchymosis
c. Slightly displaced fracture of the right humerus
d. *Bilateral posterior rib fractures (CORRECT ANSWER)

Question 4
A 68-year-old woman presents with unresectable cholangiocarcinoma. An internal-external
transhepatic biliary drain is placed to palliate her jaundice and pruritus. Three weeks later, she
develops fever and melena. What is the MOST likely diagnosis?
a. Cholangitis
b. *Arteriobiliary fistula (CORRECT ANSWER)
c. Duodenal erosion from the distal end of the drain
d. Coagulation disorder due to vitamin K deficiency
Question 5
A 50-year-old man is involved in a motor vehicle crash and sustains severe head injuries and blunt
abdominal trauma. He remains hemodynamically stable, but his urine output remains low despite
repeated fluid resuscitation. He is hyponatremic, but his urinary sodium level is elevated. What is the
BEST initial treatment?
a. Demeclocycline (Declomycin®)
b. Hypertonic saline
c. Furosemide (Lasix®)
d. *Fluid restriction (CORRECT ANSWER)