General Surgery, Trauma & Burns

Topics in this chapter

• Trauma Assessment and Imaging
• Abdominal and Thoracoabdominal Trauma
• Hemorrhagic Shock and Resuscitation
• Burns and Electrical Injuries
• Acute Surgical Abdomen
• General Surgical Procedures and Complications
• Systemic Trauma Complications

Practice questions

1. Question 1Q-E3E8D6

   A 35-year-old male is brought to the emergency department following a high-speed motor vehicle collision. He is hypotensive (BP 80/50 mmHg), tachycardic (heart rate 130/min), and unresponsive. Focused Assessment with Sonography for Trauma (FAST) reveals free fluid in the perihepatic, perisplenic, and pelvic regions. Which of the following is the most appropriate immediate next step in management?

   1. A.Diagnostic peritoneal lavage (DPL)
   2. B.Immediate exploratory laparotomy
   3. C.Contrast-enhanced computed tomography (CECT) of the abdomen and pelvis
   4. D.Aggressive crystalloid resuscitation until normal blood pressure is achieved
   See the answer and solution
2. Question 2Q-000BD3

   A 28-year-old construction worker is brought in after sustaining deep partial-thickness and full-thickness burns involving his entire anterior torso and both entire upper limbs. According to the Rule of Nines, what is the estimated total body surface area (TBSA) affected?

   1. A.27%
   2. B.36%
   3. C.45%
   4. D.54%
   See the answer and solution
3. Question 3Q-6C52D3

   A 45-year-old male is admitted with severe acute pancreatitis. On the third day of admission, he develops acute respiratory distress with tachypnea, hypoxemia refractory to supplemental oxygen via nasal cannula, and bilateral infiltrates on chest radiograph without evidence of cardiogenic pulmonary edema. What is the underlying pathophysiological mechanism of this complication?

   1. A.Increased pulmonary capillary hydrostatic pressure due to fluid overload
   2. B.Systemic release of activated pancreatic enzymes and cytokines leading to increased alveolar-capillary membrane permeability
   3. C.Direct aspiration of gastric contents secondary to paralytic ileus
   4. D.Fat embolization syndrome originating from peripancreatic fat necrosis
   See the answer and solution
4. Question 4Q-3E3E7E

   A 30-year-old male presents with a painful, fluctuant mass in the intergluteal cleft containing hair-containing pits. He gives a history of recurrent purulent discharge from the area. What is the definitive surgical treatment to prevent recurrence of this condition?

   1. A.Daily shaving and antibiotics only
   2. B.Incision and drainage alone
   3. C.Excision of the sinus tract with open packing, marsupialization, or primary/flap closure (e.g., Limberg flap)
   4. D.Sclerotherapy with phenol injection
   See the answer and solution
5. Question 5Q-A70F02

   A 60-year-old male undergoes an elective low anterior resection for rectal adenocarcinoma. On postoperative day 5, he develops severe lower abdominal pain, fever, tachycardia, and feculent discharge from the pelvic drain. Which of the following is the most sensitive and specific imaging modality to confirm anastomotic leakage?

   1. A.Plain abdominal radiograph
   2. B.Contrast-enhanced computed tomography (CECT) of the abdomen and pelvis with rectal and intravenous contrast
   3. C.Ultrasonography of the abdomen
   4. D.Barium enema
   See the answer and solution