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Surgery Flashcards

7 cards from real NBME practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

Read the first 7 Surgery flashcards as text

  1. A 3-week-old male infant presents with non-bilious projectile vomiting after every feeding. He appears hungry after vomiting. Examination reveals a palpable olive-shaped mass in the epigastrium. What is the definitive treatment?

    Answer: Electrolyte correction followed by pyloromyotomy

    Hypertrophic pyloric stenosis requires correction of hypochloremic hypokalemic metabolic alkalosis before surgical pyloromyotomy, which is not an emergency operation.

  2. A 65-year-old man undergoes a low anterior resection for rectal cancer. Three days post-op he develops fever, tachycardia, leukocytosis, and purulent output from a pelvic drain. CT confirms an anastomotic leak with contained pelvic abscess. He is hemodynamically stable. What is the appropriate management?

    Answer: CT-guided drainage, IV antibiotics, and proximal diversion if needed

    A contained anastomotic leak in a stable patient is managed with CT-guided drainage, IV antibiotics, and fecal diversion if the anastomosis cannot be salvaged.

  3. A 50-year-old woman presents with right upper quadrant pain, weight loss, and jaundice. CT scan shows a mass at the hepatic hilum causing biliary dilatation. CA 19-9 is markedly elevated. Biopsy reveals cholangiocarcinoma. The mass is confined to the biliary system without vascular involvement. What is the treatment of choice?

    Answer: Surgical resection with hepaticojejunostomy reconstruction

    Resectable hilar cholangiocarcinoma (Klatskin tumor) without vascular invasion is best treated with surgical resection and biliary reconstruction to achieve R0 margins.

  4. A 44-year-old man presents with a 5-cm retroperitoneal mass found incidentally on CT. It is well-circumscribed with no adjacent organ involvement. Core biopsy reveals a well-differentiated liposarcoma. What is the mainstay of treatment?

    Answer: Wide surgical resection with negative margins

    Wide surgical excision with negative margins is the cornerstone of treatment for retroperitoneal liposarcoma, as it offers the best chance of cure.

  5. A 4-year-old boy presents with a painless right-sided abdominal mass that does not cross the midline. His BP is 140/90 mmHg. Ultrasound shows a 6-cm solid intrarenal mass. What is the most likely diagnosis and next step?

    Answer: Wilms tumor (nephroblastoma); surgical resection and adjuvant therapy

    A solid intrarenal mass in a child aged 3–5 that does not cross the midline is most likely Wilms tumor, treated with nephrectomy plus adjuvant chemotherapy/radiation per stage.

  6. A 60-year-old woman presents with a 4-week history of painless obstructive jaundice, dark urine, and pale stools. CT shows a 2.5-cm mass in the head of the pancreas with no distant metastases and no vascular involvement. CA 19-9 is 450 U/mL. What is the appropriate surgical procedure?

    Answer: Pancreaticoduodenectomy (Whipple procedure)

    Resectable pancreatic head adenocarcinoma is treated with pancreaticoduodenectomy (Whipple procedure), which removes the pancreatic head, duodenum, and bile duct.

  7. A 25-year-old woman undergoes elective laparoscopic appendectomy for recurrent right lower quadrant pain. The appendix appears grossly normal intraoperatively. The surgeon proceeds with removal. Histopathology reveals a 1.2-cm carcinoid tumor with clear margins. What is the recommended follow-up?

    Answer: No additional workup or surgery is required

    Appendiceal carcinoids less than 2 cm with clear margins are cured by appendectomy alone and require no additional surgery or intensive surveillance.