General Surgery Clinical Rotation Exam
Are you preparing for your general surgery clerkship End of Rotation™ (EOR) Exam?
I am excited to announce this 140 Question General Surgery Rotation Practice Exam available to PA students and members of Smarty PANCE.
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The general surgery exam follows the format of the PAEA General Surgery End of Rotation Exam™ Blueprint and is ideal as preparation for your clinical rotation exam and as preparation for the boards. Smarty PANCE is not sponsored or endorsed by, or affiliated with, the Physician Assistant Education Association. All trademarks are the property of their respective owners.
- Gastrointestinal/nutritional (50%)
- Preoperative/postoperative care (12%)
- Cardiovascular (9%)
- Endocrinology (8%)
- Dermatology (5%)
- Neurology (5%)
- Urology/renal (5%)
- Hematology (3%)
- Pulmonology (3%)
Here is a five-question sample from the Smarty PANCE General Surgery Rotation Exam:
General Surgery Clinical Rotation Sample Exam
Question 1 |
A patient presents with abdominal pain in the right lower quadrant, examination reveals increased pain in the right lower quadrant on deep palpation of the left lower quadrant. This commonly known as which of the following?
Psoas sign Hint: Psoas sign is right lower quadrant pain with right leg extension. | |
Murphy's sign Hint: Murphy's sign is seen in liver and gallbladder disease in which the patient abruptly halts deep inspiration due to discomfort as the examiner's hand applies pressure to the right upper quadrant. | |
Rovsing's sign | |
Obturator sign Hint: Obturator sign is right lower quadrant pain with internal rotation of the hip. |
Question 1 Explanation:
A positive Rovsing's sign can be elicited in a patient with appendicitis when increased pain occurs in the right lower quadrant upon palpation of the left lower quadrant. Psoas sign is right lower quadrant pain with right leg extension. Murphy's sign is seen in liver and gallbladder disease in which the patient abruptly halts deep inspiration due to discomfort as the examiner's hand applies pressure to the right upper quadrant. Obturator sign is right lower quadrant pain with internal rotation of the hip.
Question 2 |
A 26 year-old gravida 0 sexually active female presents to the emergency room complaining of colicky pain in her lower abdomen for the past 12 hours. She passed out earlier in the day while trying to have a bowel movement. Her last menstrual period was 6 weeks ago. She has noted vaginal spotting over the last 24 hours. Vital signs show Temp 37 degrees C, BP 96/60mmHg, P 110, R 16, Oxygen Sat. 98%. Abdominal exam is positive for distension and tenderness. Bowel sounds are decreased. Pelvic exam shows cervical motion and adnexal tenderness. Which of the following is the most likely diagnosis?
Ectopic pregnancy | |
Appendicitis Hint: Appendicitis presents with nausea, vomiting and periumbilical pain that moves to the right lower quadrant of the abdomen. | |
Crohn's disease Hint: Crohn's disease is more common in women and may present with an acute abdomen. However, the pelvic examination would be normal. | |
Pelvic inflammatory disease Hint: In pelvic inflammatory disease the temperature is usually above 38 degrees C and pelvic pain usually follows the onset of cessation of menses |
Question 2 Explanation:
High suspicion for ectopic pregnancy should be maintained when any possible pregnant woman presents with vaginal bleeding or abdominal pain.
Question 3 |
Which of the following is the selected method for the prevention of venous thromboembolism in a 38-year-old male undergoing an inguinal hernia repair?
early ambulation | |
elastic stockings Hint: Elastic stockings are indicated for patients at moderate risk of venous thromboembolism in ages 40-60 with minor procedures with additional thrombosis risk factor, or major operations for patients under age 40 without additional clinical risk factors. | |
intermittent pneumatic compression Hint: Intermittent pneumatic compression is indicated in patients undergoing a major operation plus an increased risk of bleeding. | |
low-molecular weight heparin Hint: Low molecular weight heparin is indicated in patients undergoing orthopedic surgery, neurosurgery, or trauma with an identifiable risk factor for thromboembolism. |
Question 3 Explanation:
Early ambulation is recommended for prophylaxis of venous thromboembolism in low-risk, minor procedures when the patient is under 40 years of age and there are no clinical risk factors.
Question 4 |
A 20-year-old male presents with a mass in the groin. On inspection with the patient standing a symmetric, round swelling is noted at the external ring. When the patient lies down the mass disappears. The patient denies any trauma. The most likely diagnosis is
an indirect inguinal hernia Hint: An indirect inguinal hernia is typically elliptic that does not reduce easily. | |
a direct inguinal hernia | |
an obturator hernia Hint: An obturator hernia is more commonly seen in elderly women and are rarely palpable in the groin. | |
a femoral hernia Hint: Femoral hernias are rare in males and do not typically reduce with lying down. |
Question 4 Explanation:
A direct inguinal hernia is symmetrical, round and disappears easily with the patient lying down. An indirect inguinal hernia is typically elliptic that does not reduce easily. An obturator hernia is more commonly seen in elderly women and are rarely palpable in the groin. Femoral hernias are rare in males and do not typically reduce with lying down.
Question 5 |
A 60-year-old male is brought to the ED complaining of severe onset of chest pain and intrascapular pain. The patient states that the pain feels as though "something is ripping and tearing." The patient appears shocky; the skin is cool and clammy. The patient has an impaired sensorium. Physical examination reveals a loud diastolic murmur and variation in blood pressure between the right and left arm. Based upon this presentation what is the most likely diagnosis?
Aortic dissection | |
Acute myocardial infarction Hint: The scenario presented here is typical of an ascending aortic dissection. In an acute myocardial infarction the pain builds up gradually. Cardiac tamponade may occur with a dissection into the pericardial space; syncope is usually seen with this occurrence. Pulmonary embolism is usually associated with dyspnea along with chest pain. | |
Cardiac tamponade Hint: The scenario presented here is typical of an ascending aortic dissection. In an acute myocardial infarction the pain builds up gradually. Cardiac tamponade may occur with a dissection into the pericardial space; syncope is usually seen with this occurrence. Pulmonary embolism is usually associated with dyspnea along with chest pain. | |
Pulmonary embolism Hint: The scenario presented here is typical of an ascending aortic dissection. In an acute myocardial infarction the pain builds up gradually. Cardiac tamponade may occur with a dissection into the pericardial space; syncope is usually seen with this occurrence. Pulmonary embolism is usually associated with dyspnea along with chest pain. |
Question 5 Explanation:
The scenario presented here is typical of an ascending aortic dissection. In an acute myocardial infarction the pain builds up gradually. Cardiac tamponade may occur with a dissection into the pericardial space; syncope is usually seen with this occurrence. Pulmonary embolism is usually associated with dyspnea along with chest pain.
There are 5 questions to complete.
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Smarty PANCE Clinical Rotation Exams
We're excited to add this general surgery rotation exam to a growing list of clinical clerkship exams available exclusively to Smarty PANCE members. Every exam is included with all membership levels and does not need to be purchased individually.
Other exams include 13 Topic Specific Practice Exams, two full-length PANCE/PANRE Mock Practice Exams, five 250 Question Comprehensive Exams, and many, many more!
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Study on!
Stephen Pasquini PA-C
