Exam Surgery Finals 2012

Surgery finals

March 22nd2A12

1. What is the narowest anatomic constriction a. Bronchoaortic constriction

of the esophagus?

./ A. Cricopharyngeal c. Gastroesophageal d. Hiatus of the diaphragm

2. The most common cause of upper Gl bleeding a. Mallory- weiss tears b. Varices

exclude:

c. AV malformation ,r' d. Meckel's diverticulam 3. Histologic type of mucosal lining of the stomach -..a.

Columnar

b. Stratified squamous

c. d. e. 4.

Transistional Psuedostratified

The most common site of volvulus is the

a.

{ !.c. d. e. 5.

Cuboidal

Caecum

z

Sigmoid colon Transverse colon Splenic flexure Hepatic fiexure

A 65 year old female was admitted because of active intestinal bleeding, some test was

requested. ln order to detect that source of bleeding the rate of bleeding should be l mUhr

a. b.

0.5 mUhr

c.

0.1m#hr 0.05 mt/hr .'"

-d. e.

NOTA

6. The intestinal polyp with the greatest malignant potential is a. Tubular adenomatous polyp

-h Villous adenomatous polyp c. Tubulo-villousadenomatous d. Hamartomous polyp e. Hyperplastic polyp 7.

potyp

Chronically dilated, hypertrophied proximal large bowel resulting from failure of migration of

neural crest cells to the distal large bowel is a condition known as:

a.

Chaga's disease

b.

c. d. e. 8.

Ogilvie's syndrome

Pseudomembranouscolitis Hirschprung'sdisease None

Using the Goodsall's rule as guide for identifying the internal opening of a fistula-in-ano, an

externalopening located 3cm at left posterolateral area would: a. Have a short radical tract anteriorly b. Have a short radicaltract posteriorly

c. Have a curvilinear tract to the anterior midline d. Have a curvilinear tract to the posterior midline e. None 9.

A 65 year old male complaint of progressive dysphagia. He can only tolerate liquids. He has lost 20 lbs in 2 months. What is the functional grade of dysphagia?

a. b.

Grade 3 Grade 4

c. Grade 5 d. Grade 6 10. A 65 year old patient had difficutty of swallowing, weight loss and passage og black stools, the most important initial diagnostic test for this patient is:

a. Chest UTZ b. PET/CTscan c. MRI of chest and abdomen d. Endoscopy 11. Corkscrew esophagus

a. Nutcrackeresophagus b. Diffuse esophageal spasm c. Gastroesophageal reflux d. Achalasia e. Zenker'sdiverticulum 12. Not true of Barret's esophagus: a. Ulceration in the columnar-lined segment b. Stricture formation in the lower esophagus c- Not associated with cancer

d. Severe stage ofGERD e. Presence of columnar mucosa extending at least 3cm into the esophagus 13. Most common sites for intussusception do not include: a. lleocolic

b. c. d. e.

Rectocolic Colocolic

lleoileocolic lleoical

14. The following are complications of colostomy except

a. Necrosis b. Spontaneous c. Hernia d. Prolapse e. Retraction

closure

15. Procedure of choice for a 20 yr old male patient who has ingested a i00 ml of some dangerous chemical

a. lnduce emesis b. Upper Gl series with barium c. Upper Gl endoscopy d. Chest xray e. Gastric lavage 16. Mallory weiss tear:

a. Typical longitudinal mucosal tear with overlying fibrous ......esophagus to the gastric cardia b. Associated with severe smoking

c. Very mych associated with development of malignancy d. e.

Sucralfate is contraindicated Can be treated with endoscopic band ligation

17. A small 2 cm esophageal cancer is best treated with Band ligation

a. b. Esophageai resection c. Chemotherapy d. Modified siguira procedure e. Distalsplenorenalshunt

18. A 65 yr old female has on and off right upper quadrant pain for 5 monthsaggravated after eating fatty food. The pain was severe in the last 7 days. She was then admitted due to abdominal distention and vomitting of bile. The most likely diagnosis is:

a. Gallstone ileus b. Perforated gastric ulcer

c. d.

Perforated duodenal ulcer

Meckel'sdiverticulum e. TB enteritis 19. What is the largest blood suplly of the stomach which is a direct branch of celiac artery? a. Right gastric

b. Rightgastroepiploic c. Left gastric d. Left gastroepiploic e. NOTA 20. Sarcomas arise predominantly from this embryonic layer

a. b.

Ectoderm Endoderm

f.--j.

d. Aandc 21.

Alt

of the following are oncogenes associated with soft tissue tumor except

a.

N-myc

b.

C0erb32

c.

Ras

9,,,,F.53

22.

All of these metastasize through

the lymph node except

a: Ewing's sarcoma b. Rhabdomyosarcoma c. Angiosarcoma d.

Clear cell sarcoma

23. Most of sarcomas metastasize through what route?

a. b. c. d.

Hematogenous

Lymphatic Both None

24- What is the preferred imaging tool for retroperitoneal sarcomas?

a.

MRI

$,'., ff:SCdlt

c.

UIZ

d.

X-ray

25. For lesion smaller than 3 cm not involving hands and feet, what a. lncisionalbiopsy

b. FNAB c. Core needle biopsy d. ExcisionalBi"pty 26. When is radiotherapy indicated a. Post operative with margin 2 cm

b.

Tumor of size 5 cm

c.

Deep tumors

d.:.j.F,Ur{}sr.s, >5,qtE 27. What is the primary treatment for 5 cm mass

i..

-SurgPry

b.

Chemotherapy

c.

Radiotherapy

d.

AOTA

28. For unresectable retroperitoneal tumors except a. Radiotherapy and or chemotherapy

b.,.:.Sompiete.**ligi renra

c. d.

Biopsy Palliative care

is

the biopsy of choice?

29. What

a. b. c. d.

is

the most common histologic type of soft tissue sarcomas in adults?

Rhabdomyosarcoma MFH Leiomyosarcoma

Malignant peripheral nerve sheath tumors 30. A 32 yr old nursing mother was kicked in her left breast accidentally by her baby. She developed echhymosis and now with skin retraction over the affected area. The most likely diagnosis is

a. Hematoma b. Fat necrosis c. Cancer d. Thrombophebilis 31. Which of the following has successfully reduced the mortality from breast cancer? a. Radicalsurgery b. Screeningmammography c. Radiotherapy d. Hormonaltherapy e. ehemotherapy 32- Which of the following biopsy result has the greatest risk for later carcinoma? a. Apocrine metaplasia

b. Duct ectasia c. Atypical ductal hyperplasia d. lntraductal papilloma e. Fibrocystic changes 33. A 52 yr old female presented with 4 cm right breast mass with peau o' orange extending to axillary nodes. Metastatic workup was clear. What is her stage?

a. Stage b. Stage iiA c. Stage lltA d. Stage lllB I

34. The following lesions must be excised except

a. DCIS b. Lcrs c. Sclerosing adenosls d. Atypicalductal hyperplasia e. Radial scar 35. Which of the folloing carcinomas of breast has the best prognosis?

a. Tubular CA b. lnflitrating papillary CA

c.

lnflitrating ductal CA d. Colloid CA e. Medullary CA 36. The ff are true about fibrocystic changes of the breast except

a. Usually characterised by multiple cysts most evident during menstruation b. lf the dx is entertained a biopsy should NOT be carried out c. lt is a benign condition with no premalignant potential d. Commonly associated with mastalgia e. Mammography should be done to evaluate breast with fibrocystic change. 37. ScreeninB mammography may reveal a suspicious lesion if there is a. Microcalcifications

b. Macrocalcifications c. Vascularabnormalities d. Free air e. Axillary gland calcification 38. Ductal CA in situ is non malignant lesion. The ff are true except a. lt is treated with a wide excision or mastectomy b. Usually presents as microcalcifications as mammography c. Adjuvant chemotherapy is an integral part of its management d. lt is a premalignant lesion

e.

Lymphadenectomy is NOT indicated unless .....

39. Major risk factors for breast cancer except a. Fibrocystic changes ofthe breast b. Three maternal aunts with breast cancer c. Ductal CA in situ d. Personal history of breast CA e. Personal history of invasive ovarian CA 40. The best management of necrotic skin: a. lnvasiveantibiotics b. Debridement c. lntravenousinjection

d. landD e. Getting a sample of the necrotic tissue and gram staining

41. The hallmark of fournier gangrene is

a. Foul smelling wound discharge b. lntense pain and tenderness c- Occurence in an immunocompromised d. Decreased WBC count in the blood e. Fever accompanied by scrotal pain 42. The best management of perianal abscess: a. lnvasiveantibiotics b. Debridement c. lntravenousinjection

d. landD e. Hyperbaric

oxygen therapy

43. The most common cause of perianal abcess

HIV + patient

a. Trauma to the rectum b. Analwarts

c. d. e.

Cryptitis Malignancy Diarrhea

44. The hallmark of fournier gangrene is a. Foul smelling wound discharge b. lntense pain andtenderness

c. Occurence in an immunocompromised d. Decreased WBC count in the blood e. Fever accompanied by scrotal pain

45. Major BS of

HIV + patient

GB

a. Right hepatic artery b. Left hepatic artery c. Cystic artery d. Common hepatic artery 46. The triangle of ealot is formed by the following except a. Cystic duct

b. Liver margin c. Common hepatic duct d. Right hepatic artery 47. The CBD enters which part of the duodenum?

a. 1st portion b. 2nd portion c, 3rd portion d. Doesnt enter the duodenum 48. A 45 yr old female consulted at the emergency room due to epigastric pain after a meal. She had several episodes of vomitting. Your differential diagnoses include the following except a. Acute appendicitis b. Acute cholecystitis

c. d. e. 49. On

a. b.

Peptic ulcer disease

Acute Mi NOTA

there was direct tenderness on RUQ, what is the best thing to do? CBC and U]*Z

PE,

Endoscopy

c. eT scan of the whole abdomen d. Observe the patient 50. Splenic trauma is frequently a result of blunt abdominal trauma, usually manifesting as left upper quadrant pain of flank pain, but oftentimes ignored by both patient and doctor. Therefore a CT scan scoring is needed along with high intex of suspicion. What is the cut off score when surgery is indicated?

a. 1 b. 1.5 c,2 d. 2.5 e.3 51. Which is not a common complication of splenic abscess treatment? a. Atelectais b. R-sided pleural effusion

c. Subphrenic abscess d. Pancreateic injury with fistula or pseudocyst formation e.

Thrombocytosis

52. Treatment of splenic abscess include the following except

a. Broad spectrum Ab coverage b. Percutaneous drainage of a solitary unilocualte abscess c. Splenectomy, open or laparoscopic d. Partialsplenectomy e. Polyvalen pneumococcal vaccine preferably given 2 weeks in advance 53- When is splenectomy not lndicated?

a. b.

When spleen destroys so many

RBC

thus resulting in anemia

When WBC are so depleted that infection and bleeding occur

c. When it is causing pain and/or pressure on adjacent organs/ structures d. When it has grown so iarge that part of it bleedsl dies e. NOTA 54. What is hypersplenism? a. Overactive function resulting in overproduction of Ab b. Overactive function resulting in premature release of platelets c. Overactive function resulting in accelerated maturation of blood components. d. Overactive function resulting in increased sequestratio n of any/all blood elements e. Overactive function promoting accelerated apoptosis of blood elements 55. Which of the following benign liver tumors is needle biopsy contraindicated? a. Hamartoma b. Hepatocellularadenoma

c. d, e.

Hemangioma Fouclar nodular hyperplasia NOTA

56. Which of the following benign liver tumors are contraceptives and related synthetic steroids in pathogenesist?

a. b. c. d. e.

Hamartoma Hepatocellularadenoma Hemangioma Fouclar nodular hyperplasia NOTA

57. Pyogenic liver abscess is often deceptive with similar presentation as amoebic liver abscess albeit more toxic lookoing thus complicating management. Which of the following is not associated with it? a. Solitary b. Elevated hemidiaphragm on affected side c. Liver enzymes elevated

d. e.

Ab

Soccasionallysurgical drainage

58. Amoebic abscess is manifested by tender hepatomegaly accompanied by liver pain, fever and chills, sweating. Which of the following options is not typically part of management?

a. Use of amebicidal drugs b. Aspiration c. Closed drainage d. Open drainage e. Surgical resection 59. Because of the high morbidity and complication rate of shunts, other options include surgery on the esophageal varices directly. Which of the following procedure is not part of Siguira operation for esophageal varices?

b. Esophageal transection and subsequent anastomosis c. Paraesophageal devascularization d. Splenectomy e. Vagotomy with or without drainage 50. ln the event of esophageal variceal bleeding, the following are non-operative options which of the following is risky with high failure rate? a. Propanolol IV b. Endoscopicvariceal sclerotherapy c- Variceal rubber band ligation

d. e.

Vasopressin lV Ballon tamponade

51. The liver has a remarkable ability to regenerate itself. However this can be haphazard like in Hepatitis A

a. b. Hepatitis B c. Hepatoma d. Cirrhosis e. Fatty layer

60a.

The development of portal hypertension in various liver diseases is a sign chronically. Which of

the following entities does it arise acutely:

a. Cirrhosis b. Schistosomiasis

d. e.

61a. a. b.

Hepatic vein thrombosis NOTA

"anchovy sauce" appearance is often given to describe: Contents of simple cyst Contents of hydatid cyst

c. Contents of rystadenoma d. e.

Contents of amebic abscess Contents of pyogenic abscess.

52. Physical signs that can be found in idiopathic retroperitoneal fibrosis is/are a. Palpable abdominal mass

b. Fever c. Oliguria d. AOTA e. NOTA 63. ldiopathic retroperitoneal fibrosis is described as a. Non specific suppurative inflammation of fibroadipose tissue b. Produces symptoms by gradual compression of tubular structures c. Not considered to be of any systemic d/o

d. e.

AOTA NOTA

64. The liver being the largest solid organ in the body is prone to injuries esp blunt abdominal

trauma. Variuos methods have been described to control liver injuries involve the following except:

a. Perihepaticcompression b. Pringle's maneuver c. Liver packing with omentum/ lapartomy packs d. Hemostatic felt/ gelatin sponges/ collagen sponges 65. Diagnosis of retroperitoneal injury includes the following except

a. High index of suspicion b. Use of an organised diagnostic approach c. Pre-operative use of available procedures such as ct scan, DPI etc d. AOTA e. NOTA 55. lnvasive procedures in the diagnosis of traumatic retroperitoneal injuries are the following

except

b.

DPL

d.

Absolute density

75. The earliest sign of local anesthetic toxicity

a. Tachycardia b. Dizziness

c. Tonic clonic seizures d. Lossofconsciousness 76. The priamry mechanism by which the action of tetracaine is terminated when using for spinal anesthesia

b. c. d.

Uptake of neurons Hydrolysis by nonspecific esterase Sensorineural degradation

77. A 75 yr old man is scheduled for orchiectomy (prostatic CA) under spinal anesthesia. What is

the appropriate dermatomal level for this operation?

a. T1 b. 14

ffi d.

L3

78. Which of the following intravenous anesthetics is contraindicated in patients with ...

W b.

Diazepam

c.

Propofii

d.

Midazolam

79. The most common reason for admitting out patients to the hospital following general anesthesia is

a. Hypotension b. Respiratorycomplications c. Surgicalpain 80. Which of the following volatile anesthetics have MAC value of 6l

a. Halothane b. lsoflurane c. Sevoflurane d. Desflurane 81. You are called

to see your patient in the recovery room because of elevated

BP readings, your

immediate approach would be

a. Treat the BP with small doses of an antiHPN drug b. Wait to see if the HPN is transient and associated with emergence

d.

checkthe BPyourself 82. What is the normal luminal capacity of the appendix? a. 0.05 ml Re

of anesthesia

b. 0.1mI

c.

1.0 ml

d.

0,01m1

83. Obturator sign is pain elicited by a. Passive internal rotation on an extended thigh b. Active internal rotation on a flexed thigh c. Passive internal rotation on an flexed thigh d. Active internal rotation on a extended thigh 84. All are histologic type of adenoCA of appendix except a. Mucinous adenoCA

b.

Colonic adenoCA

c. Adenocarcinoid d. NOTA 85. What diagnostic test will you request to aid you in confirming you diagnosis?

a. Urinalysis b. UTz

c. eBe

d.

AOTA

86. A 53 yr old female who presented with 6 yr history of vague abdominal pain, nausea and vomitting self medicated with buscopan without relief hence consult at E.R. What PE will you elicit to arrive at a diagnosis? a- Palpation of the abdomen b. Psoas and obturator sign

c.

DRE

d.

AOTA

87. True of UTZ in appendicitis except:

a. b. c. d.

Non-compressible appendixwith.. Presence of appendicolith

Non-visualization of the appendix is occlusive none

88. Pathogenesis of acute appendicitis a. Luminal obstruction) distension) vascular congestion) infarct) perforation b. vascular congestion) distension) Luminal obstruction) perforation c. infart) Luminal obstruction) distension) vascular congestion)perforation

d.

NOTA

89. The base ofthe appendix can be located at the a. Various location on the cecum b. Convergence of taenia coli c. Near the ileocecal valve

d.

NOTA

90. True of Alvarado's Scale except

a.

Scoring design for diagnosis of appendicitis

b.

Symptoms include migration of

c. Signs include RLQ tenderness and fever d. Leukopenia with shif to the left 91. Pain on the right quadrant is elicited by hyperextending the right thigh at hip joint. This is called a. Obturator sign

b.

c. d.

Psoas sign Rovsing's sign NOTA

92. JC 25 yr old male with a large mass on the left leg comes to your clinic. He complained of shooting pain on the said extremity. There were also palpable masses on the left inguinal area. What

is

your diagnosis?

a. Ewing's sarcoma b. Angiosarcoma c. Clear cellsarcoma d. Rhabdomyosarcoma 93. Sarcomas arise predominantly from this embryonic layer

a. Ectoderm b. Endoderm c. Mesoderm d. Aandc 94. For lesion smaller than 3 cm NOT involving the hands and feet. What is the biopsy procedure of choice?

a. b. c. d.

Excisionalbiopsy lncisional biospy FNA biopsy

Core needle biopsy

95. All of the following are risk factor in developing soft tissue sarcoma

a. Trauma b. Genetics

c.

Radiation exposure

d.

AOTA

96. Of the components of AJeC staging of soft tissue sarcoma is an important prognostic factor? a. Histologic grade

b. Tumor size

c. Nodalmetastasis d. Distant metastasis 97. When is radio therapy indicated? a. Post operative with margin 2 cm b. Tumor of size 5 cm d. Deep tumors 98. Modality used to evaluate primary tumor of retropertoneal sarcomas

a. Chest CT scan b. abdominalMRl c. Abdominal Ct scan d. Chest MRI 99. The miller laryngoscope blade

a. Has a curved spatula b. Has no flange c. Has a sharp tip d. Has a straight blade 100. The purpose of premedication is primarily for control at a. Vomiting b. Secretions c. Apprehension d. Pain 101. The trimodal pattern of death in injury, the moratlity at first phase can be decreased by a. Preventive measures b. Trauma system c. Criticalcare d. Rehabilitation LOz. lnjury will result when the body interacts with forces: a. Mechanical

103.

b.

Thermal

c.

Radiation

d.

AOTA

The following trauma concept is true

a. Treat the most obvious injury b. A diagnostic workup is neceassary before starting the treatment

104.

c.

A detailed history is not essential to....

d.

Always perform a detailed

first ln the primary survey, cervical spine control comes under PE

a. Arrway b. Breathing

c. Circulation d. Disability 105.

The simplest way to assess the patients airway is

a. Talk to the patient b. Auscultate the chest

106.

c.

Perform chin

d.

Sweep the mouth for foriegn body

lift

The following are airway risk factors except

a. Maxillofacialtrauma b. Thermalinhalationalinjury

c.

Neck hematoma

d,' ..6f.as8p*.toma.+Eo:r,esf, 707.

:ji

The following maneuver is part of breathing

a.

lntubation E;.l$itre,ory, gn

c. Pack the bleeding d. EPR 108.

What is the highest FiO2 that can be delivered by O2 canula?

a. b.

c.

24 28 35

d:..',.4I 109.

What is the higest oxygen setting for a patient...?

a.

4,

b.6 c.8 d. 10 110.

The best way to treat a patient with tension peymothorax is to fi ,;..'.ll1sgft:*'ctrest'tuhe

b. c. d. 777-

Open the chest

Dopericardiocentesis

What is the best riray to adress a patient suffering from a cardiac tamponade?

a. b. c. L12.

Perform needling

lnsert a chesttube Perform needling Open the chest

d;t,.tro:,pE@ Vital signs determination is considered a part of a. Airway

b.

Breathing

a....,,G-,aii +l$rr

d. 173.

Disability

What is the earliest sign of circulatory collapse?

a-:.,+a,

*ai it

b. Hypotesnion c. Cold clammy d. L14.

Hypotension usually occurs when the patient loses how much percent of blood volume?

a.5 b. 10 c. 20 di'.- $g

What is the sign/ symptom of a patient suffering from a class I shock?

115.

a. Tachycardia b. Hypotension

c.

Oliguria

d;,,,.NOTA

The following symptom characterises a patient in class ll shock

116.

a.,.:Taehyeardia

b. Hypotension c. 0liguria d. Confusion What

LL7.

is

the average time needed to consume a liter of crystalloids using a gauge 14

needle?

a.5 b".. 7

c.9 d. L2 Sugar containing fluid should be avoided in resuscitating a trauma patient because

i.18.

causes......?

a.

Hyperglycemia

$.,,.],:piUf€siS

The following procedure is part of trauma resuscitation?

119.

a.

c.

Performingexploratory laparatomy Chest tube insertion lntravenous fluid infusion

d..

AOTA

b-

Often missed injuries are located at the....?

a. b.

Face

Neck

C::::::r-:EA€k

d. tzt- Lz5 1I1-,.-

Legs

please provide the correct sequence in teh approach of severly injured patient ' .,,,

F;irna'ry.str+ey

tl2;,,,-, . ,Re$ulfitaticlt 133;=,::

,

Seeoada ys{lH,Ey

i74.....,,.

Definitive management

f,t$,':;r:' "".Tertia*'au*€y

126-t3O what is the acronym A.'.,aller$i:es

AMPLE stands

for

it

M

Medications

P

Past medical history

L

last mealtaken

E

Events preciding the injury.