Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Surgery, Trauma, and Transplantation--->Abdominal and Gastrointestinal Surgery
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Question 1# Print Question

A 33-year-old male from South Asian presents with acute abdominal pain and several weeks of constipation. He had undergone cholecystectomy 2 months ago for similar symptoms with some resolution of the pain. He now presents with nausea, vomiting, and pain localized to the epigastrium. His laboratory test results are significant for hemoglobin of 8 µg/dL and white blood cell count of 9 µg/dL. He reports taking Ayurvedic home remedies.

What additional tests should be considered to diagnose the cause of his acute abdomen?

A. Serum heavy metal screen
B. Lipid profile
C. Serum troponin
D. CMV antibody

Question 2# Print Question

A 28-year-old male who is an avid outdoorsman presents approximately 2 weeks after a hike in New Hampshire to the emergency department with severe abdominal pain. He is hypotensive with a distended abdomen. He denies recent trauma or falls. The focused assessment with sonography for trauma (FAST) is positive on the left for free fluid around the spleen. An exploratory laparotomy reveals a ruptured spleen.

What is the MOST likely explanation for his presentation?

A. Trauma
B. Malaria
C. Tuberculosis
D. Babesiosis

Question 3# Print Question

A 34-year-old morbidly obese male with a past medical history of intravenous drug abuse, HCV, lymphedema, and obstructive sleep apnea has now been in the intensive care unit (ICU) for 2 weeks for acute respiratory failure secondary to sepsis from a soft tissue infection. He develops a new fever with associated hypotension requiring vasopressor support. On physical exam he is intubated and sedated, with coarse breath sounds that are unchanged; however, an increase in peak airway pressures are noted, and his abdominal exam is notable only for severe obesity.

What imaging study would you request NEXT?

A. Three-view abdominal radiographs
B. Right upper quadrant ultrasound
D. Chest, abdomen, and pelvis computed tomography (CT)

Question 4# Print Question

A 63-year-old obese female undergoes a robotic low anterior resection for rectal cancer, which goes well. On postoperative day 7, it is noted that she has become somnolent and febrile. You are called bedside to evaluate her for an ICU admission. On examination, she is lethargic and tachypneic with clear breath sounds. Her abdomen is mildly distended with moderate pain on palpation. Her vitals reveal her:

  • temperature is 39°C
  • oxygen saturation is 90%
  • respiratory rate is 45 breaths per minute
  • heart rate is 130 bpm
  • blood pressure of 100 mm Hg systolic

In addition to the standard septic workup including chest radiograph and culture data, you NEXT proceed to: 

A. Transfer to ICU and start IV cefepime and vancomycin to cover for hospital-acquired pneumonia
B. Transfer to ICU, start zosyn and vancomycin, and request urgent CT
C. Transfer to ICU, start Rocephin and vancomycin at meningeal dosing, and request stat lumbar puncture
D. Call the surgeon and prepare the OR for emergent exploratory laparotomy

Question 5# Print Question

Two weeks after a Whipple procedure, a 66-year-old male presents to the emergency department with severe abdominal pain. On evaluation, he is in moderate distress and is obviously uncomfortable. His vitals are notable for tachycardia of 120 bpm and hypotension with systolic blood pressure of 95 mm Hg. He is afebrile. A FAST reveals free fluid in all quadrants. Blood transfusion of blood products are initiated and his blood pressure responds to resuscitation.

The NEXT best management option is:

A. Emergent exploratory laparotomy
B. Stat head, chest, abdomen, and pelvis CT
C. Emergent consultation of interventional radiology
D. Admission to the ICU with emergent consultation for pan-endoscopy

Category: Critical Care Medicine-Surgery, Trauma, and Transplantation--->Abdominal and Gastrointestinal Surgery
Page: 1 of 3