General Surgery MCQs (Prometric)

A 27-year-old man sustains blunt left-flank trauma during a collision. After resuscitation, blood pressure is 122/76 mmHg, heart rate is 94/min, and serial hemoglobin measurements remain stable. CT shows a grade IV renal laceration extending into the collecting system with a small urinary extravasation, but no arterial blush or expanding hematoma. The contralateral kidney is normal. He has mild flank pain, no fever, and no enlarging urinoma. What is the most appropriate management?

A 62-year-old man has recurrent urinary infections, pneumaturia, and fecaluria six months after an episode of sigmoid diverticulitis. CT shows air in the bladder and inflammatory adherence between sigmoid colon and bladder, without abscess or malignancy. Cystoscopy excludes a primary bladder tumor, colonoscopy excludes colorectal cancer, and inflammation has settled after antibiotics. He is medically fit. What is the most appropriate definitive treatment?

A 45-year-old woman presents with fever, rigors, right-flank pain, and vomiting. Blood pressure is 86/54 mmHg after initial fluids, lactate is 4.0 mmol/L, and creatinine is twice baseline. Urinalysis shows pyuria, and broad intravenous antibiotics have been started. The displayed noncontrast CT reveals the decisive urinary obstruction. What is the most appropriate next intervention?

A 46-year-old woman initially had a 3-cm HER2-positive breast carcinoma and one biopsy-proven metastatic axillary node marked with a clip. After neoadjuvant systemic therapy, the breast lesion is no longer palpable and axillary examination and ultrasound are normal. Breast MRI shows a good partial response without distant disease. She will undergo breast-conserving surgery. Which axillary operation best stages her response while reducing unnecessary morbidity?

A 44-year-old woman with BMI 39 kg/m² seeks metabolic surgery. She has insulin-treated type 2 diabetes, objectively confirmed severe gastroesophageal reflux, and a 4-cm hiatal hernia. Endoscopy shows erosive esophagitis without dysplasia. She has completed nutritional and psychological assessment, stopped smoking, and has no inflammatory bowel disease or previous gastric surgery. Which bariatric procedure is most appropriate?

A 32-year-old laboratory worker sustains a thermal injury to the dominant hand. The displayed illustration identifies the deepest area. Sensation is absent centrally, capillary refill is not visible within that region, and the injury crosses several finger joints. Doppler signals remain present, there is no circumferential constriction, and total burn size is 3% of body surface area. After cooling, analgesia, and sterile coverage, what is the most appropriate disposition?

A 46-year-old woman reports intermittent epigastric discomfort. She has no pancreatitis history, jaundice, or weight loss. MRI shows a 6.2-cm multilocular cystic lesion in the pancreatic body and tail that does not communicate with the main duct. Endoscopic ultrasound demonstrates a 9-mm enhancing mural nodule. The displayed pathological image represents the suspected lesion type. Serum CA 19-9 is mildly elevated, staging shows no metastases, and she is medically fit. What is the most appropriate management?

A 44-year-old man presents ten weeks after liver transplantation with fatigue, jaundice, and rising aminotransferases. He missed several tacrolimus doses during the preceding week. Doppler confirms patent hepatic artery, portal vein, and hepatic veins; ultrasound shows no biliary dilatation. Cytomegalovirus PCR is negative, blood cultures are sterile, and tacrolimus concentration is subtherapeutic. Liver biopsy demonstrates portal inflammation, bile-duct injury, and venous endothelial inflammation without viral inclusions. What is the most appropriate treatment?

A 79-year-old woman presents with fever and localized lower-abdominal pain. CT demonstrates perforated small-bowel diverticulitis with a 5-cm encapsulated abscess. She is hemodynamically stable, lactate is normal, and there is no free perforation, bowel obstruction, or generalized guarding. The displayed follow-up CT shows the intervention performed through a safe percutaneous route. Cultures are pending. Which ongoing strategy is most appropriate?

A 41-year-old woman has a 1.6-cm solitary right-thyroid nodule. Thyroid function is normal, ultrasound shows no extrathyroidal extension or suspicious cervical nodes, and she has no radiation exposure, familial thyroid cancer, or contralateral nodules. Fine-needle aspiration material is displayed. Staging identifies no distant disease, and she accepts postoperative surveillance. Which operation is most appropriate?