Trial test · General Surgery MCQs (Prometric)

Question 1 of 10

A 70-year-old man becomes hypotensive six hours after femoral arterial catheterization. He reports flank and groin pain, hemoglobin falls from 126 to 78 g/L, and the puncture site has little external swelling. After red-cell transfusion, blood pressure improves transiently. CT angiography shows a large retroperitoneal hematoma with active external-iliac arterial extravasation. There is no abdominal compartment syndrome, limb ischemia, or generalized peritonitis. Interventional radiology is immediately available. What is the most appropriate definitive treatment?

Continue observation after transfusion without controlling the injured artery

Perform urgent endovascular embolization or covered-stent hemorrhage control

Apply prolonged groin compression despite proximal retroperitoneal arterial bleeding

Perform immediate blind laparotomy without attempting targeted vascular treatment

Question 2 of 10

Chest radiograph showing a large right pneumothorax with marked lung collapse and mediastinal displacement.

A 33-year-old man develops sudden pleuritic chest pain and severe dyspnea while awaiting abdominal surgery. Heart rate is 132/min, blood pressure is 78/46 mmHg, oxygen saturation is 84%, and the trachea appears displaced. Breath sounds are absent on the right, and neck veins are distended. The displayed portable chest radiograph was obtained during rapid assessment, but the patient is deteriorating and thoracic surgery is off-site. What is the most appropriate immediate action?

Decompress the right chest immediately

Obtain chest CT before pleural intervention

Begin noninvasive ventilation and reassess

Give high-flow oxygen and await transfer

Question 3 of 10

A 60-year-old man develops chest pain and fever four hours after difficult endoscopic removal of an impacted food bolus. CT with oral contrast shows a 1.2-cm distal esophageal defect with a localized mediastinal collection and limited contrast leakage. He is hemodynamically stable, has no diffuse pleural contamination, and presents before established sepsis. Endoscopic and thoracic surgical expertise are immediately available. What is the most appropriate management?

Observe without closure while continuing oral fluids and routine monitoring

Perform immediate esophagectomy despite localized early iatrogenic injury

Close the defect endoscopically and drain contamination when required

Begin unrestricted oral feeding once initial chest pain improves

Question 4 of 10

A 71-year-old man undergoes emergency laparotomy for extensive small-bowel ischemia caused by profound low-flow shock. After revascularization, two borderline segments improve but remain of uncertain viability. He is acidotic, hypothermic, and requires escalating vasopressors. There is no established perforation, and removing every questionable segment would leave less than 40 cm of small bowel. What is the most appropriate operative strategy?

Close the abdomen definitively without planned bowel reassessment

Use temporary abdominal closure and schedule second-look laparotomy

Resect every questionable segment during the initial operation

Observe clinically without arranging repeat operative exploration

Question 5 of 10

A 39-year-old woman with body mass index of 42 kg/m² has poorly controlled type 2 diabetes, severe knee osteoarthritis, and no clinically important reflux. Endoscopy is normal, psychological evaluation confirms readiness, and she accepts the need for lifelong nutritional monitoring. She prefers an operation without intestinal bypass. The displayed diagram shows the proposed procedure. Which counseling point is most important before proceeding?

Explain that new or worsened reflux may follow this operation

Explain that lifelong micronutrient supplementation will never be required

Explain that the operation is readily reversible to normal anatomy

Explain that internal hernia is the commonest late complication

Question 6 of 10

A 66-year-old man has increasing abdominal distension and nausea on postoperative day 3 after open right hemicolectomy. He has passed no flatus, but pain is mild and diffuse without guarding. Temperature is normal, leukocyte count is falling, potassium is 3.0 mmol/L, and opioid use has been substantial. The displayed abdominal radiograph supplies the principal diagnosis. There is no abrupt transition point, hernia, or clinical deterioration. What is the most appropriate management?

Perform colonoscopic decompression despite diffuse postoperative small-bowel dilation

Perform urgent exploration for presumed complete mechanical bowel obstruction

Correct electrolytes, reduce opioids, mobilize, and provide supportive care

Begin immediate parenteral nutrition without addressing reversible ileus factors

Question 7 of 10

A 46-year-old woman has intermittent epigastric discomfort. MRI shows a 5.4-cm multilocular cyst in the pancreatic body and tail without communication with the main duct. Endoscopic ultrasonography identifies a mural nodule, and cyst fluid has elevated carcinoembryonic antigen with low amylase. The displayed pathological image represents the suspected lesion type. She is fit for surgery and has no metastatic disease. What is the most appropriate treatment?

Perform endoscopic cyst drainage without removing the neoplasm

Continue MRI surveillance despite the mural nodule and size

Perform distal pancreatectomy with oncologically appropriate specimen assessment

Perform pancreaticoduodenectomy for the distal pancreatic cyst

Question 8 of 10

A 29-year-old man presents with 18 hours of worsening central abdominal pain, vomiting, fever, and localized lower-abdominal guarding. CT demonstrates an inflamed blind-ending structure arising from the antimesenteric ileum, containing an enterolith and surrounded by free fluid, while the appendix is normal. There is no diffuse fecal contamination, and he remains stable after fluids and antibiotics. What is the most appropriate operative management?

Perform urgent laparoscopy with diverticulectomy or segmental ileal resection

Perform appendectomy alone despite a normal appendix on imaging

Perform urgent colonoscopy to extract the obstructing ileal enterolith

Continue antibiotic therapy without removing the inflamed small-bowel source

Question 9 of 10

A 72-year-old man is scheduled for elective colectomy for a nonobstructing colon cancer. He reports exertional syncope and progressive breathlessness when walking one block. Examination reveals a harsh systolic murmur radiating to the carotids. Echocardiography shows aortic-valve area of 0.7 cm², mean gradient of 48 mmHg, and preserved ventricular function. There is no bleeding, perforation, or impending obstruction. What is the most appropriate preoperative plan?

Postpone colectomy for urgent specialist valve assessment and treatment

Proceed using regional anesthesia to avoid cardiovascular instability

Proceed with colectomy using invasive monitoring and general anesthesia

Perform coronary angiography and proceed without treating the valve

Question 10 of 10

An 81-year-old woman with atrial fibrillation develops abrupt severe abdominal pain that initially exceeds examination findings. Within four hours she becomes acidotic, lactate rises to 6.7 mmol/L, and diffuse guarding appears. The displayed contrast CT demonstrates advanced intestinal vascular compromise. Broad resuscitation, antibiotics, and intravenous heparin are initiated. What is the most appropriate next intervention?

Perform immediate laparotomy with revascularization and bowel viability assessment

Delay intervention until lactate normalizes after fluid resuscitation

Perform colonoscopy before deciding whether intestinal exploration is required

Continue anticoagulation alone despite new peritonitis and advanced ischemia