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Cracking D’ Boards © Board Review Series ANATOMY & SURGERY EXAMINATION Monday June 25, 2007 7:30 p.m. INSTRUCTIONS: Select The Letter Of The Best Correct Answer For Each Of The Following Questions. Mark Only One Answer For Each Item By Shading The Box Corresponding To The Letter Of Your Choice On The Answer Sheet. Strictly No Erasures Allowed. Use Pencil No. 1 Only. 1.

Ciliary Action Can Be Influenced the following factors, except: a. Humidity b. pH (N.V. 6.8-7.4) c. Air pollution (Nitrogen dioxide, Sulfur dioxide) d. Infection and quality & quantity of mucus e. None of the above

2.

Respiratory Mucosa Of The Nose & Paranasal Sinuses is lined by this type of epithelium a. Simple columnar b. Ciliated pseudostratified columnar c. Simple columnar ciliated d. Stratified squamous e. Simple squamous

3.

The part of the inner ear responsible for balance a. vestibular portion b. pars superior c. cochlear portion d. pars inferior e. A and B

4.

Inner Ear fluids is characterized by the following except: a. endolymph - K+ b. Endolymph- Na+  c. perilymph K+  d. PerilymphNa+ e. None of the above

5.

Otolith organs are characterized by the following except a. Saccule respond to angular acceleration b. Utricle respond to linear acceleration c. Semicircular canal respond to angular acceleration d. A and B e. None of the above

6.

Herpes Zoster Oticus is characterized by the following except: a. Also known as Ramsay Hunt disease b. Viral infection involving the geniculate ganglion c. Facial paralysis d. Otalgia e. Herpetic eruption of the internal ear

7.

A 18 year old female came to the emergency room for complaints of vomiting, anorexia, epigastric and right lower quadrant pain noted 12 hours prior to admission. Digital rectal exam revealed right pararectal wall tenderness. Differential diagnosis would include the following except: a. Acute appendicitis b. Urinary tract infection c. Twisted ovarian cyst d. Ectopic pregnancy e. None of the above

8. A 40 year old man who was an unrestrained passenger in a motor vehicle accident was brought to the emergency room. He was thrown from the car at impact. The patient is unconscious and, on evaluation becomes apneic. Ventilation should be achieved by a. endotracheal intubation b. nasotracheal intubation c. face mask d. tracheostomy e. cricothyroidotomy 9. A patient has lost cutaneous sensation over the tip of the nose. Which nerve is most likely damaged? a. facial nerve b. ophthalmic division of the trigeminal nerve c. greater auricular nerve d. mandibular division of the trigeminal nerve e. maxillary division of the trigeminal nerve 10. Injury to the common peroneal nerve would result in an a. inability to evert the foot b. inability to invert the foot c. inability to plantar flex the ankle d. inability to plantar flex the big toe e. inability to feel sensation on the medial side of the leg 11. A 55 year old man is involved in a motor vehicular accident. Initial resuscitation is carried out. Cervical spine films are normal. A supine anteroposterior (AP) chest film suggests a distorted upper mediastinum. The next study should be a. aortogram b. CT scan of the chest c. MRI of the chest d. upright posteroanterior (PA) chest radiograph e. electrocardiogram 12. A 14 year old boy fell off a wall and fractured his right humerus at midshaft. The wrist joint immediately assumed a flexed position that the patient was unable to correct. Extension and supination of the forearm was weakened but not abolished. Select the peripheral nerve damaged that could cause the symptoms. a. radial nerve b. ulnar nerve c. median nerve d. axillary nerve e. musculocutaneous nerve 13. In a 23 y.o, male coming in with anorexia, right lower quadrant pain and vomiting, peritoneal irritation is indicated by: a. Dunphy’s sign b. Hamburger Sign c. Rovsing’s sign d. Obturator sign e. Psoas sign 14. Blood supply ligated during an appendectomy a. Colonic artery b. branch of celiac artery c. branch of ileocolic artery d. branch of cecal artery e. superior mesenteric artery

15. Most common organisms causing acute appendicitis, except: a. e. coli b. peptostreptococcus sp. c. bacteroides fragilis d. enterobacter aeroginosa 16. Allelic loss at the site of this tumor suppressor gene is responsible for developing 100% risk of colon cancer: a. BRCA 1 b. BRCA 2 c. myc-trans gene d. APC e. fibrillin 17. The following are true of familial adenomatous polyposis except: a. colon becomes covered with polyps after puberty b. autosomal recessive inheritance c. 100% risk of developing colon CA d. May present with weight loss and hematochezia e. common in middle-aged Caucasians 18. Tumor marker for Papillary thyroid Carcinoma: a. free T3 b. free T4 c. Free T3 & T4 d. thyroglobulin e. calcitonin 19. A 67 y.o, female underwent total thyroidectomy. Biopsy findings revealed abundance of parafollicular cells or C cells. She will most likely manifest with increased levels of the following hormone: a. thyroglobulin b. calcitonin c. parathyroid hormone d. tyrosine e. tryptophan 20. The following contribute to the blood supply of the thyroid gland except: a. superior thyroid artery b. inferior thyroid artery c. brachiocephalic artery d. left common carotid artery e. right common carotid artery 21. Gene on chromosome 13 that is associated with early onset breast CA a. fibrillin b. CA-19 c. BRCA1 d. APC e. BRCA 2 22. Most common benign condition of the breast: a. fibrocystic breast disease b. peau d’ orange c. papillary CA d. invasive ductal e. phylloides tumor

23. Most common site of breast CA: a. Lower outer quadrant b. Upper outer quadrant c. Upper inner quadrant d. Lower inner quadrant 24. A 38 y.o, female noted “Winging of the scapula” after undergoing MRM. The most likely injured structure would be: a. axillary artery b. axillary nerve c. pectoralis minor muscle d. long thoracic nerve e. Batson’s plexus 25. The landmark structure used to divide Level I,II, and III in breast surgery a. axillary nerve b. long thoracic nerve c. pectoralis major mm. d. pectoralis minor mm. e. Rotter’s nodes 26. A 56 y.o, woman was diagnosed to have Invasive Ductal CA of the left breast. The following would be the most important factor in prognosis: a. Involvement of the Batson’s plexus b. atypia and proliferative changes on biopsy c. axillary lymph node status d. winging of the scapula e. (+) BRCA 1 gene 27. The following are characteristics of Carpal Tunnel Syndrome, except: a. common in secretaries and computer programmers & dressmakers b. May be confirmed by performing Tinel’s sign c. Entrapment of the median nerve by the flexor retinaculum d. Numbness and pain over the index finger and hypothenar area e. May be confirmed by performing Phalen’s sign 28. The following are Intracranial complications of chronic or recurrent otitis media, except: a. Extradural abscess b. Lateral sinus thrombosis c. Meningitis d. Brain abscess e. Gradenigo’s syndrome or petrositis 29. The following characteristics about skin are true except: a. Largest organ of the body b. Average weight = 4 Kg c. thickest at the palms/soles d. thinnest at the eyelids and genitals e. none of the above 30. The epithelial layers from Surface to base are the following a. Corneum, Lucidum, Granulosum, Spinosum, Basalis b. Corneum, Lucidum, Spinosum, Basalis, Granulosum c. Granulosum, Corneum, Lucidum, Spinosum, Basalis d. Lucidum, Spinosum, Basalis, granulosum, corneum e. Basalis, corneum, lucidum, spinosum, granulosum

31. The dangerous area of the scalp a. skin b. subcutaneous tissue c. loose areolar layer d. periosteum e. galea aponeurotica 32. Muscles of Mastication except: a. temporalis m. b. masseter m. c. medial pterygoid m. d. lateral pterygoid m. e. buccinator m. 34. The following structures arise from the foregut except: a. Pharynx b. Thyroid c. Esophagus d. Lung Alveoli e. none of the above 35. The Anterior Pituitary gland arises from : a. foregut b. midgut c. hindgut d. Rathke’s pouch e. A and D 36. The portal vein is formed by the following vein(s) a. splenic vein b. superior mesenteric vein c. inferior mesenteric vein d. A and B e. A and C 37. Glandular metaplasia in the distal esophagus occurs in the following condition(s): a. chronic GERD d. achalasia b. Barrett’s esophagus e. none of the above c. esophagitis 38. Bowel thickening or “String Sign” on abdominal xray is indicative of this disease entity: a. Crohn’s disease b. Ulcerative colitis c. Irritable bowel syndrome d. Toxic megacolon e. Hirschsprung’s disesase 39. Caroli’s disease and clonorchiasis is strongly associated with the following: a. cholangiocarcinoma b. gallbladder CA c. pancreatic CA d. hepatocellular CA e. Bladder outlet obstruction 40. Urinary metabolite found in patients with pheochromocytoma a. 5-hydroxytryptamine b. vanillymandelic acid c. organs of Zuckerkandl d. urinary metamphetamines e. valine, leucine, isoleucine metabolites

41.Most common type of gastric cancer a. leiomyosarcoma b. adenocarcinoma c. lymphoma d. signet ring adenocarcinoma e. papillary carcinoma 42. Most common type of thyroid carcinoma a. papillary thyroid carcinoma b. medullary thyroid carcinoma c. anaplastic carcinoma d. poorly differentiated carcinoma e. Hurthle cell carcinoma 43. Most common post thyroidectomy complication a. Wound hemorrhage b. Recurrent laryngeal nerve injury c. Hypoparathyroidism d. Thyroid storm e. Winging of the scapula 44. The following are contents of Cubital Fossa except: a. Termination of Brachial Artery b. Radial and ulnar arteries c. Biceps tendon d. Median nerve e. none of the above 45. The superficial membranous fascia which continues as the Colle’s fascia in the perineum a. Camper’s fascia b. Scarpa’s fascia c. Gimbernat’s fascia d. Cooper’s Fascia e. External oblique fascia 46. Collection of para-aortic & paraganglionic cells that may serve as extra adrenal site for chromaffin cell tumor a. Klatskin tumor b. Organs of Zuckerkandl c. Organs of Zuckermann d. Pheochromocytoma e. none of the above 47. Characteristic of barium swallow showing dilated esophagus with area of distal stenosis à ‘BIRD’S BEAK” a. esophagitis b. barrett’s esophagus c. esophageal carcinoma d. tracheo-esophageal fistula e. achalasia 48. The best screening procedure for colon carcinoma is the general population is: A. CEA assay B. Colonoscopy C. Barium enema D. Sigmoidoscopy E. Stool Occult Blood Test.

49. The following is/are indication/s for diagnostic peritoneal lavage: A. Kitchen knife wound across the belly, eviscerating small intestines B. Gunshot wound to the lower abdomen, non-penetrating C. Ice-pick wound at periumbilical area, 8 cm hematoma at left parieto-occipital area, GCS-4 D. Blunt and abdominal trauma, BP 80/40, RR 36, 2 L lactated Ringer’s already given E. none of the above 50. Which of the following is considered pre-malignant A. Pseudopolyp B. Hamartoma C. Villous adenoma D. Pedunculated polyp. E. Tubular polyp 51. A 65 year old female sought consult due to hematochezia and weight loss. Colonoscopy revealed an illdefined fungating mass 15 cm from the anal verge causing obstruction. The treatment of choice is: a. Biopsy b. Low Anterior Resection c. Mile’s procedure d. Insertion of Sump tube attached to low pressure gomco e. Radiation therapy 52. A 45 year old male executive is seen because he is vomiting bright red blood. There are no previous symptoms. The man admits to one drink a week with no other significant history. In the hospital, he bleeds 5 units of blood before endoscopy. The most likely diagnosis is a. gastritis b. duodenal ulcer c. esophagitis d. Mallory-Weiss tear e. esophageal varices 53. Work-up reveals an inflammatory process within the colon with skip areas. The rectum is spared. The most likely diagnosis is a. ischemic colitis d. ulcerative colitis b. amebic dysentery e. Crohn’s Disease c. toxic megacolon 54. An elderly woman is admitted for weakness, weight loss, anemia and a palpable abdominal mass. She has colon carcinoma. The most likely anatomic site is a. rectum d. sigmoid colon b. left colon e. cecum c. transverse colon 55. Meckel’s diverticulum is characterized by the following except: a. 2 % of population b. commonly presents during 1st 2 years of life c. 2 inches long d. 2 feet from the ileocecal valve e. 2 ectopic tissues: duodenal mucosa and pancreatic tissue 56. Common pathogen in surgical implants: A. Klebsiella B. E. coli C. S. epidermidis

D. S. pyogenes

E. Pseudomonas

57. Most common congenital anomaly of the GI tract characterized by persistence of the vitelline duct or yolk stalk a. Cystic hygroma b. Inguinal hernia c. Meckel’s diverticulum d. omphalocoele e. Vitelloma

58. Condition where pupils accommodates when patient follows finger moving towards the nose but does not react to direct light a. Neurosyphilis b. Horner’s syndrome c. Adies pupil d. Argyll-Robertson pupil e. Weber’s syndrome 59. A 24 year old male was in a vehicular accident. He arrived at the ER with raccoon eyes and otorrhea. On the 3rd hospital day he developed high grade fever and nuchal rigidity. The most common meningeal isolate in this patient would be a. Streptococcus pneumoniae b. H. influenzae c. N. meningitides d. S. aureus e. Listeria monocytogenes

60.

A 7-year old boy with a history of swimming complains of pain, tragal tenderness and scanty ear discharge.PE revealed diffuse swelling of the external auditory canal. Probable diagnosis is: a. Acute Circumscribed Otitis Externa b. Otomycosis c. Diffuse Otitis Externa d. Acute Otitis Media 61. Etiologic agent of the above mentioned disease a. S. aureus b. Aspergillus c. Pseudomonas d. S. pneumoniae 62. Most common site of subperiosteal abscess a. Zygomatic or pre-auricular b. Post-auricular c. Intracanal d. Bezold’s 63. It is a complication of otitis media caused by herpes zoster involving CN VII characterized by rash and eruption of vesicles over the External Auditory Canal (EAC) and pinna. a. Gradenigo’s syndrome b. Bell’s Palsy c. Ramsay Hunt Syndrome d. Melkersson’s Syndrome 64. Most common acute infection of the external nose which presents with marked local erythema, swelling and pain which may lead to cavernous sinus thrombosis if left untreated. a. Vestibulitis b. Furunculosis c. Erysipelas d. Impetigo 65. A form of vasomotor rhinitis characterized by worsening rebound congestion following prolonged use of topical decongestants. a. Hormonal Rhinitis b. Infectious Rhinitis c. Rhinitis Medicamentosa d. Atrophic Rhinits

66. A 45-year old male complains of nasal obstruction, epistaxis and rhinorrhea . PE revealed a unilateral nasal mass, non-transluscent. Initial impression is a. Squamous papilloma b. Inverting papilloma c. Nasal Polyp d. Hemangioma 67. Sinuses present at birth a. maxillary & frontal b. maxillary & ethmoid c. frontal & ethmoid d. sphenoid & maxillary 68. At the ER, a 20-year old female came in due to severe dysphagia, ear pain, fever, hot potato voice. PE revealed difficulty opening the mouth & peritonsillar swelling of soft palate w/ uvula pushed to other side. Diagnosis is a. Quinsy abscess b. Vincent’s or Plaut’s Angina c. Exudative tonsillitis d. Acute pharyngitis 69. The anterior group of the triangles of the neck is composed of the following EXCEPT: a. Digastric triangle b. Carotid triangle c. Occipital triangle d. Muscular triangle 70. The primary drainage site of Nasopharyngeal Carcinoma (NPCa): a. jugulodigastric nodes b. jugulo-omohyoid nodes c. post-auricular nodes d. retropharyngeal nodes 71. Most common etiology of Ludwig’s angina: a. tonsillitis b. dental caries c. pharyngitis d. stomatitis 72. A midline cyst that elevates with tongue protrusion is most likely: a. thyroid nodule b. branchial cleft cyst c. thyroglossal duct cyst d. laryngocoele 73. A 30 year old female complains of a 3 x 4 x 3 centimeter anterior neck mass which moves with deglutition. She came with results of normal T4 and TSH. What’s your next step? a. Thyroid scan b. T3 c. Fine Needle Aspiration Biopsy d. Ultrasound 74. A 25 year old female complained of an anterior neck mass of one year duration. She also experienced weight loss despite an increased in appetite, tremors, increased perspiration and irritability. The most useful diagnostic test: a. Fine Needle Aspiration Biopsy b. Ultrasound c. T4 / TSH determination d. Thyroid scan

75. A non-invasive procedure which would indicate that a mass is cystic or solid: a. thyroid scan b. cystogram c. ultrasound d. aspiration 76. A 7 year old boy was brought to the outpatient clinic because of bilateral swelling of the preauricular area of three days duration with fever, chills and anorexia. PE showed clear saliva from the Stensen’s duct. Management should include the following EXCEPT: a. analgesics and antipyretics b. antibiotics c. advise for possible involvement of gonads and pancreas d. advice of possible sensorineural hearingloss e. advice that this illness usually occurs only once 77. Treatment of choice in Nasopharyngeal Carcinoma (NPCa): a. surgery b. radiation c. chemotherapy d. immunotherapy 78. A 35 year old male consulted at the OPD for an anterior midline neck mass. On a previous consult with another doctor, the patient was told to have a thyroid malignancy of which diagnosis was by FNAB. Metastatic work-up was negative. What is the probable histopathology of the malignancy? a. papillary b. follicular c. anaplastic d. medullary 79. What foramen represents a gap in the fusion between the sphenoid, palatine, and ethmoid bones rather than a specific opening a. sphenoethmoid foramen b. incisive foramen c. sphenopalatine foramen d. vidian foramen 80. What nerve passes through the foramen rotundum a. Mandibular division of CN V b. Maxillary division of CN V c. Facial nerve d. None of the above 81. The nasal muscle that elevates the skin over the dorsum of the nose a. Nasalis b. Levator labi superioris alaeque nasi c. Procerus d. Depressor septi 82. The Wharton’s duct opens into what structure in the oral cavity a. papillae opposite the upper 2nd molar b. papillae of the lingual frenulum c. papillae opposite the lower 2nd molar d. papillae on the lateral aspect of the tongue 83. Which structure divides the parotid gland into a superficial and deep lobe a. hypoglossal nerve b. lingual Artery c. buccal Vein d. facial nerve

84. The most common malignant carcinoma of the submandibular gland: a. Adenoid Cystic Ca b. Mucoepidermoid Ca c. Squamous Cell Ca d. Malignant Mixed Cell Tumor 85. Causes coagulation necrosis and thus penetration is limited a. alkali ingestion b. reflux esophagitis c. acid ingestion d. laryngopharyngeal reflux 86. Spiral or corkscrew appearance on barium swallow a. presbyoesophagus b. scleroderma c. diffuse esophageal spasm d. achalasia 87. Most common organism involved in infectious esophagitis a. Staphylococci b. Streptococci c. Candida albicans d. Pseudomonas 88. Most common area of lodgement on the esophagus a. distal third b. middle third c. upper third d. hypopharynx 89. A particular type of salivary gland malignancy that has a high propensity to spread along the neural sheath a. lymphona b. basal cell carcinoma c. malignant fibrous histiocytoma d. adenoid cystic carcinoma 90. The most common tumor to metastasize to the paranasal sinuses a. lung carcinoma b. prostate carcinoma c. hypernephroma d. lymphoma 91. Membrane separating the scala vestibuli & scala media a. Tectorial membrane b. Reissner’s membrane c. Basilar membrane d. Tympanic membrane 92. Most common ototoxic drug causing vertigo a. Diuretics b. Methotrexate c. Antiepileptic d. Aminoglycosides 93. Which nerve innervates the external auditory canal, which upon irrigation causes coughing? a. Nerve to the stapedius muscle b. Auriculotemporal branch of the trigeminal nerve c. Jacobson’s nerve—glossopharyngeal d. Auricular branch of the Vagus nerve, or Arnold’s nerve

94. This is an extracranial complication of otitis media and mastoiditis a. Extradural abscess b. Subdural abscess c. Subperiosteal abscess d. Brain abscess 95.Which is not a layer of the tympanic membrane? a. Squamous epithelial layer b. Fibrous layer c. Mucosal layer d. Endothelial layer 96.The tympanic membrane ruptures at this pressure a. 90 mmHg b. 100 mmHg c. –30 mmHg d. 200-300 mmHg 97. The most common laryngeal tumor in children: a. Laryngeal papilloma b. Laryngocele c. Squamous cell carcinoma d. Lymphoma 98.In the patient who has ingested a caustic material, esophagoscopy a. Is contraindicated b. Should be carried out within 48 hours c. Is unnecessary in the presence of oral burns d. Is indicated if a stricture is apparent by X-ray 99.What is the main advantage of flexible bronchoscopy over rigid bronchoscopy? a. More distal bronchial segments can be examined b. Allows for an airway c. Ability to remove foreign bodies d. Better optics 100. The most common esophageal foreign body found in children is: a. Fish spine b. Meat c. Toy d. Coin e. Candy

 AMDG…Ad Majorem Dei Gloriam