Surgery Board Review Practice Questions

The Surgery Board Exam can be very difficult, with a pass rate dipping as low as 75%. It’s also a very lengthy exam, lasting approximately eight hours. Drilling large question blocks will help the applicant prepare for the length and pacing of the exam. Below are sample Surgery Board Questions.

Sample Surgery Board Questions

Question 1. Ethics, End-of-Life, and Organ Retrieval QID 4603

A 45-year-old man suffers a massive intracranial hemorrhage from a previously undiagnosed aneurysm and despite aggressive medical and surgical management, is deemed unsalvageable. The surgical critical care fellow has been taking care of this patient and is very involved in the discussions with the family. The family eventually decides to withdraw care and consents to organ donation. At the time of organ harvest, the transplant surgeon invites the fellow to join them in the operating room since this is a good “teaching opportunity.” The fellow should do which of the following?

A. Accepting this could be seen as a conflict of interest, and he should therefore decline
B. Accept this because as a trainee, there is no conflict of interest, and this would be an educational opportunity
C. Accept this but as an observer only since he is a critical care fellow and not a transplant fellow
D. Accept but go to the operating room only with the written consent of the family
E. Accept and participate in the procedure since it is educational, but without informing the family

Answer: A. Accepting this could be seen as a conflict of interest, and he should therefore decline.

Explanation:

Perceived conflict of interest can occur when there is overlap or confusion between the treating team and the transplantation team. Indeed, consent rates have been shown to be up to three times greater when an optimal request pattern was pursued, including clear separation between the treatment team and the donation requester. The surgical critical care fellow is a member of the treatment care team, and although he may not be involved in the discussion of organ donation and obtaining consent for transplantation, is at risk of appearing to have conflicting motivations.

References: Siminoff LA, Arnold RM, Hewlett J (2001) The process of organ donation and its effect on consent. Clinical Transplantation 15, 39–47.

Copyright 2012 Surgical Critical Care and Emergency Surgery: Clinical Questions and Answers

 

Question 2. Neurocritical Care QID 4152

An 80-year-old man with a Glasgow Coma Scale score of 15 is admitted to the intensive care unit three hours following a fall from ground level. Bilateral proximal humerus fractures have been splinted. CT scans of the brain and cervical spine show a 1cm left frontal lobe intracerebral contusion and chronic degenerative changes to the cervical spine without acute fracture. Neurological assessment show good motor strength and reflexes in the lower extremities. Motor strength in the upper extremities is difficult to fully assess due to the fractures, but the patient appears to have bilateral loss of fine motor movement in the fingers and weakness with wrist flexion and extension. These findings are most consistent with:

A. Conus medullaris syndrome
B. The findings on the brain CT scan
C. Anterior spinal cord syndrome
D. Brown-Sequard syndrome
E. Central cord syndrome

Answer: E. Central cord syndrome.

Explanation:

Central cord syndrome is commonly associated with falls in the elderly. The injury affects motor strength in the upper extremities more severely than the lower extremities. These patients frequently have spinal stenosis and the mechanism of injury is usually a hyperextension injury resulting in vascular compromise to the central portion of the cervical spinal cord. Since the cervical fibers controlling motor function to the upper extremities are located more medially than the lower motor fibers, the effects are more prominent in the upper extremity motor neurons. Sensory findings are variable and sphincter control may also be affected.

Copyright 2012 Surgical Critical Care and Emergency Surgery: Clinical Questions and Answers

References: Cowan Jr. JA, Thompson BG (2010) Neurosurgery. In: Doherty GM, Thompson NW (eds) Current Diagnosis and Treatment Surgery, 13th edn, McGraw-Hill, New York, p. 829.

 

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