Minimally Invasive Surgery Practice Questions

Question 1

A 36-year-old woman is brought to the emergency department 20 minutes after being involved in a high-speed motor vehicle collision. On arrival, she is unconscious. Her pulse is 140/min, respirations are 12/min and shallow, and blood pressure is 76/55 mm Hg. 0.9% saline infusion is begun. A focused assessment with sonography shows blood in the left upper quadrant of the abdomen. Her hemoglobin concentration is 7.6 g/dL and hematocrit is 22%. The surgeon decided to move the patient to the operating room for an emergent explorative laparotomy. Packed red blood cell transfusion is ordered prior to surgery. However, a friend of the patient asks for the transfusion to be held as the patient is a Jehovah's Witness. The patient has no advance directive and there is no documentation showing her refusal of blood transfusions. The patient's husband and children cannot be contacted. Which of the following is the most appropriate next best step in management?

Accepted Answer

Transfusion of packed red blood cells

Answer

Administer hydroxyethyl starch

Answer

Consult hospital ethics committee

Answer

Administer high-dose iron dextran

Question 2

During a surgical procedure to repair an abdominal aortic aneurysm, the surgeon must be careful to avoid injury to which of the following arterial structures that originates near the level of the renal vessels?

Accepted Answer

Left renal artery

Answer

Celiac trunk

Answer

Right renal artery

Answer

Superior mesenteric artery

Question 3

A research team develops a new monoclonal antibody checkpoint inhibitor for advanced melanoma that has shown promise in animal studies as well as high efficacy and low toxicity in early phase human clinical trials. The research team would now like to compare this drug to existing standard of care immunotherapy for advanced melanoma. The research team decides to conduct a non-randomized study where the novel drug will be offered to patients who are deemed to be at risk for toxicity with the current standard of care immunotherapy, while patients without such risk factors will receive the standard treatment. Which of the following best describes the level of evidence that this study can offer?

Accepted Answer

Level 3

Answer

Level 1

Answer

Level 5

Answer

Level 4

Answer

Level 2

Question 4

A pharmaceutical company conducts a randomized clinical trial to demonstrate that their new anticoagulant drug, Aclotsaban, prevents more thrombotic events following total knee arthroplasty than the current standard of care. A significant number of patients are lost to follow-up, and many fail to complete treatment according to the study arm to which they were assigned. Despite these protocol deviations, the results for the patients who completed the course of Aclotsaban are encouraging. Which of the following analytical approaches is most appropriate for the primary analysis to establish the efficacy of Aclotsaban?

Accepted Answer

Intention-to-treat analysis

Answer

Sub-group analysis

Answer

Per-protocol analysis

Answer

As-treated analysis

Answer

Non-inferiority analysis

Question 5

A 27-year-old man presents to the emergency department after being stabbed. The patient was robbed at a local pizza parlor and was stabbed over 10 times with a large kitchen knife with an estimated 7 inch blade in the ventral abdomen. His temperature is 97.6°F (36.4°C), blood pressure is 74/54 mmHg, pulse is 180/min, respirations are 19/min, and oxygen saturation is 98% on room air. The patient is intubated and given blood products and vasopressors. Physical exam is notable for multiple stab wounds over the patient's abdomen inferior to the nipple line. Which of the following is the best next step in management?

Accepted Answer

Exploratory laparotomy

Answer

Diagnostic peritoneal lavage

Answer

CT scan of the abdomen and pelvis

Answer

Exploratory laparoscopy

Answer

FAST exam

Question 6

A 32-year-old woman comes to the physician for a screening health examination that is required for scuba diving certification. The physician asks her to perform a breathing technique: following deep inspiration, she is instructed to forcefully exhale against a closed airway and contract her abdominal muscles while different cardiovascular parameters are evaluated. Which of the following effects is most likely after 10 seconds in this position?

Accepted Answer

Decreased left ventricular stroke volume

Answer

Decreased intra-abdominal pressure

Answer

Decreased pulse rate

Answer

Decreased systemic vascular resistance

Answer

Increased venous return to left atrium

Question 7

An orthopaedic surgeon at a local community hospital has noticed that turnover times in the operating room have been unnecessarily long. She believes that the long wait times may be due to inefficient communication between the surgical nursing staff, the staff in the pre-operative area, and the staff in the post-operative receiving area. She believes a secure communication mobile phone app would help to streamline communication between providers and improve efficiency in turnover times. Which of the following methods is most appropriate to evaluate the impact of this intervention in the clinical setting?

Accepted Answer

Plan-Do-Study-Act cycle

Answer

Failure modes and effects analysis

Answer

Standardization

Answer

Forcing function

Answer

Root cause analysis

Question 8

A CT scan of the abdomen reveals a mass in the pancreatic uncinate process. Which of the following structures is most likely to be compressed by this mass?

Accepted Answer

Superior mesenteric vein

Answer

Common bile duct

Answer

Portal vein

Answer

Splenic vein

Question 9

A 39-year-old woman presents to the emergency department with right upper quadrant abdominal discomfort for the past couple of hours. She says that the pain is dull in nature and denies any radiation. She admits to having similar episodes of pain in the past which subsided on its own. Her temperature is 37°C (99.6°F), respirations are 16/min, pulse is 78/min, and blood pressure is 122/98 mm Hg. Physical examination is normal except for diffuse tenderness of her abdomen. She undergoes a limited abdominal ultrasound which reveals a 1.4 cm gallbladder polyp. What is the next best step in the management of this patient?

Accepted Answer

Cholecystectomy

Answer

Barium swallow study

Answer

Magnetic resonance cholangiopancreatography (MRCP)

Answer

Endoscopic retrograde cholangiopancreatography (ERCP)

Answer

No further treatment required

Question 10

A 45-year-old woman comes to the emergency department complaining of abdominal pain for the past day. The pain is situated in the right upper quadrant, colicky, 8/10, and radiates to the tip of the right shoulder with no aggravating or relieving factors. The pain is associated with nausea but no vomiting. She tried to take over-the-counter antacids which relieved her pain to a certain extent, but not entirely. She does not smoke cigarettes or drink alcohol. She has no past medical illness. Her father died of pancreatic cancer at the age of 75, and her mother has diabetes controlled with medications. Temperature is 38°C (100.4°F), blood pressure is 125/89 mm Hg, pulse is 104/min, respiratory rate is 20/min, and BMI is 29 kg/m2. On abdominal examination, her abdomen is tender to shallow and deep palpation of the right upper quadrant.
Laboratory test
Complete blood count
Hemoglobin 13 g/dL
WBC 15,500/mm3
Platelets 145,000/mm3
Basic metabolic panel
Serum Na+   137 mEq/L
Serum K+ 3.6 mEq/L
Serum Cl-   95 mEq/L
Serum HCO3- 25 mEq/L
BUN   10 mg/dL
Serum creatinine        0.8 mg/dL
Liver function test
Total bilirubin   1.3 mg/dL
AST   52 U/L
ALT 60 U/L
Ultrasonography of the abdomen shows normal findings. What is the best next step in management of this patient?

Accepted Answer

Cholescintigraphy

Answer

Emergency cholecystectomy

Answer

CT scan

Answer

Reassurance and close follow up

Answer

Percutaneous cholecystostomy

Minimally Invasive Surgery

Study Resources

Lessons

Questions

Flashcards

Lessons

CO2 insufflation physiology

Complications of minimally invasive surgery

Conversion to open surgery criteria

Cost-effectiveness of minimally invasive surgery

Endoscopic procedures overview

Laparoscopic instrumentation

Laparoscopic surgery principles

Learning curve considerations

Natural orifice transluminal surgery

Patient selection for minimally invasive approaches

Robotic surgery principles

Single-incision laparoscopic surgery

Trocar placement and port sites

Practice Questions

Flashcards

About Minimally Invasive Surgery for USMLE

Lessons in Minimally Invasive Surgery

Master Minimally Invasive Surgery