mid exam 2010 saudi board surgery

Mid 2010 surgery board (UPDATED) 1- 55 y old man with chronic GERD had UGI endoscopy and found 4 cm segment of barret’s esophagus biopsy showed low grade dysplasia; current surveillance recommendation for biopsy a) 3month b) 6month c) 12month d) 9month e) 24month 2- 4 months after laparoscopic gastric bypass, 32 y old female came with severe periumbilical abdominal pain and vomiting, she is febrile, tachycardic, her abdomen pendulous, mild tenderness on examination a) CT abdomen b) UG swallow c) Water soluble enema d) UGI endoscopy e) Abdominal exploration 3- Most common malignant tumor between age 15-25 a) Neuroblastoma b) Wilm’s tumor c) Seminoma d) Osteosarcoma 4- Most common intra-abdominal tumor in children a) Neuroblastoma b) Wilm’s c) lymphoma 5- Colonization of burn wounds a) Staph

6- Which is not a common cause of paralytic ileus a) Pneumonia b) Abdominal surgery c) Hypernatremia d) Spinal cord injury e) Hypothyroid

7- Most common malignancy of small bowel of children a) Carcinoid b) Lymphoma c) Lieomyoma d) Fibrosarcoma 8- 25 y swallowed safety pins a) Several x rays and examinations 9- 50 y with lt. lower quadrant pain and fever a) Colonoscopy b) Sigmoidoscopy c) CT abdomen d) MRI 10- Nutritional status is measured clinically by a) Triceps skin fold b) Albumin c) Globulin d) biceps 11- Injection of 1% lignocain and epinephrine can be used safely with a) Zadiki syndrome

b) Colle’s fracture c) Indirect Inguinal hernia 12- Most important phase of healing a) collagen deposition ??????? b) epithilization c) ? capillary bedding d) Fibroblast e) contraction 13- 70kg patient with 50 % burn the initial fluid management a) 600 b) 875

14- Motor cycle accident, patient is dyspnic inspite oxygen, CXR showed no rib fracture and bilateral infiltrates a) ? ARDS b) ? Lung Contusion c) Pneumonia d) Aspiration pneumonia e) atelectasis 15- most common risk factor of Incisional hernia a) Incision infection b) Morbid obesity c) DM d) Old age 16- 50 y female with 3 cm RT adrenal mass found incidentally on CT for epigastric pain

a) 24h urine catecholamines and metaboilites b) CT guided FNA c) 24 h urine cortisol level d) Determine plasma aldesterone concentration to plasma activity ratio e) Operative excsion 17- 45y women with active chron’s dis proctatitis with symptoms of trans sphinteric anovaginal fistula which is the appropriate management a) Drainage seton b) Fistulectomy c) Fibrin glue d) Cutting seton e) Endorectal advancement flap 18- Distal margin of resection of sigmoid diverticulitis should be a) 2cm distal to colonic inflammation b) Sacral promontory c) Normal rectum d) Peritoneal reflection

19- Use of CT in suspected appendicitis a) Lower incidence of negative appendectomies b) Improved in the last 10 years c) Eliminate the need for reexamination d) Decrease the rate of perforated appendix at e) Detect pelvic abnormalities in female patients

20- Single most effective evaluation of 60 y male with history of 6 months of hoarseness and neck mass a) FNA b) CT neck and chest c) Incisional biopsy d) Excisional biopsy e) Laryngeoscope 21- Most accurate method for detecting and identifying liver metastasis a) Trans abdominal US b) CT c) Laparoscopy d) Intraoperative palpation e) Intraoperative US 22- During a laparatomy for a gunshot wound to the abdomen, patient found to have 4 cm laceration to anterior surface of the sigmoid colon patient is hemodynamically stable after minimal resuscitation, no fecal spillage the treatment is a) Debridement and 1ry closure b) 1ry repair with proximal colostomy c) Resection, end colostomy, and mucus fistula d) Resection, end colostomy, and hartman’s procedure e) Resection, anastomosis, and exteriorization 23- Following crush injury and rhabdomyolysis, most important component to avoid renal failure a) Mannitol b) Furosemide c) Bicarbonate d) Volume replacement

e) Spironolactone

24- Following a side impact MVA of restrained passenger, decrease air entry on the Lt side of the chest, CXR showed NGT curved in the chest , the next step in management a) DPL b) Laparoscopy c) Tube thoracostomy d) Laparotomy e) Thoracotomy 25- 40 y man fall from 15 feet on his feet, he is alert and talking, o/e tenderness over the lumbar spine xray showed L1 fracture, which organ may get injured a) Stomach b) Duodenum c) Pancreas d) Transverse colon e) Rt kidney 26- The best indication for ERCP is a) Obstructive jaundice b) History of jaundice c) Elevated ALP to twice normal d) Gallstone pancreatitis e) 10mm CBD stone seen on US 27- Iodine metabolism a) Thyroid store 50% of iodine b) Iodine transport in to follicular cells via passive diffusion c) TSH stimulate iodine to be transported into the follicular cells

d) Iodine is increased in multinodular goiter e) High levels of iodine causes hypothyroidism 28- 25 y came to ER felt from 15 feet on his Rt side, BP 60 became 110/60 after 2L ringer lactate, vital were normal found to have grade 2 liver injury a) Lapratomy b) Laparoscopy c) DPL d) Observation

29- 54y female underwent colonic resection for adenocarcinoma, which of the following suggest poor prognosis a) Circumferential growth b) Extension to muscularis mucosa c) Extension to serosa d) Polypoidal growth e) Mucosal ulceration 30- 45y female, smoker, found to have 1cm painless nodule in the anterior cervical region, biopsy revealed squamous carcinoma which of the following likely to be the 1ry site a) Tongue b) Tonsil c) Palate d) Pharynx e) Larynx 31- Tamoxifen improves survival in which of the following a) Fibroadenoma b) Fibrocystic disease c) Ductal carcinoma in situ

d) Invasive ductal carcinoma e) Lobular carcinoma in situ 32- 75y female with 3 day history of crampy abdominal pain, distention, obstipation with 2 episodes of emesis in the last 24h, had history of appendectomy during his childhood, abdominal series showed pneumobilia at laparotomy, inflammation Rt hypochondrium and obstruction in the distal ileum 10 cm proximal to iliocecal valve, ttt: a) small bowel resection + iliostomy + cholecystectomy b) iliocecectomy + 1ry anastomosis c) enterotomy + removal of the mass d) enterostomy to bypass the tumor + cholycystectomy 33- 77y lady, cold Lt hand. after embelectomy, next step a) MR angiography of subclavian artery b) Duplex of carotid c) ECHO d) Cardiac Cath e) Adson’s maneuver

34- Which indicates resection of small bowel a) Loss> 20% of bowel wall b) Compromise of blood supply of a segment c) Injury 40 cm from ligament teritz d) Injury 40 cm from ilocecal valve e) 2 injury in a segment 35- Which reduce mortality for patient with sever sepsis a) Activated protein C b) High dose steroid c) Antiendotoxin antibodies

d) TPN e) Erythropioten 36- 56 y female recovery from RT hemicolectomy post op day 2 with SOB saturation 85 on RA, HR 110, next step a) Lasix b) Sublingual nitrate c) ABG and CT spiral d) Start SC heparin e) Initiation of unfractionated heparin 37- 24y male fell from the ladder brought to ER with labored breathing and cyanosis, no breath sound in the RT side, resonant on percussion, the next step: a) Cricothyroidotomy b) Obtain CXR c) Endotracheal intubation d) Tube thoracostomy in ER e) Call OR tube thoracostomy 38- 48 hrs post laparoscopic guided liver biopsy, 65y male complaining of hematemesis, HR 100, BP 120/80, PR  melena, endoscopy revealed blood in the duodenum, the next appropriate study: a) MRCP b) Colonoscopy c) Nuclear bleeding scan d) Dynamic helical CT e) Visceral angio 39- 19y student came to ER with fresh blood PR, he is in good health, not on medication he had similar episode 1 year back, OGD, colonoscopy were normal, his abdomen soft, lax, no masses, Hct 32, most likely source of bleeding a) Angiodysplasia b) Ulcerative colitis

c) Juvenile polyposis d) Meckel’s diverticulum e) Chron’s disease 40- Regarding malignant tumour of appendex : a) RT hemicolectomy is the treatment for all carcinoid b) Carcinoid tumor of the appendex is th 2nd most common malignan c) Liver mets demonstrated in most carcinoid even small carcinoma d) Appendex carcinoid lower 5y survival than none carcinoid e) Apendex goblet carcinoid < 1cm is safely treated with simple appendectomy 41- What is more common after lap roux en y gastric by pass than open: a) Anastomosis leak b) Death c) No weight loss d) Internal hernia e) Wound complication 42- Most important layer in the scalp: a) Sub-apenurosis 43- Most common submandibular malignancy: a) ? Mucoepidermoid b) ? Adenoid cystic carcinoma 44- Post op patient has Na 125 and Glu 500 corrected to 100 what is the treatment: a) It will be corrected 45- Mucocele at the tip of the appendex the treatment is: a) Appendectomy 46- Which of the following may be appropriate initial therapy for a 3cm cancer of the anal canal with invasion of the internal sphincter and no inguinal adenopathy: a) Local excision

b) ? APR c) ? combined Chemoradiotherapy d) Radiotherapy 47- Which part of the cell is thaught to be target of radiation damage; A) Nucleus B) Mitochondria C) Cytoplasm D) Crolgi bodies E) Cell membrane 48- Lapratomy done for liver inj during op transfusion of 12 unit , despite treatment there is persistant bleeding, which is the initially most appropriate: a) Correction of hypothermia 49- Which immunosuppressant cause alopecia: a) Tacrolimus 50- patient with cervical adenopathy ( hodgken lymphoma) with mediastinal widening: a) Chemotherapy b) CT staging 51- ADH: a) Mesenteric vasoconstriction 52- Patient with thyroglossal cyst a) Resection of central part of the hyoid bone 53- Which of the following is not a cancer sign: a) Gray turner sign b) krockenbuerge c) virchow sign d) sister marry joseph

54- Best prognostic sign of gastric cancer : a) histologic type b) L.N. involvement

55- patient has hemoptesis bleeding through tracheostomy: a) tracheoinnominate fistula

56- management of necrotizing pancreatitis with E-coli in the culture: a) lapratomy and debridement

57- Cardiac pt. has necrosis of breast flap after mastectomy: a) necrosis due to dye (methylene blue) b) Compressive dressing c) Hypoperfusion due to cardiac status

58- Cock’s peculear tumor: Infection of sbecious cyst

59- Pt. with DCIS comedo grade 3 with involvement of 2 quadrants should be managed by: Simple mastectomy, sentinel L.N. & immediate reconstruction.

60- Atypical ductal hyperplasia managed by: Excisional biopsy

61- Enteral feeding: Mentains gut barrier

62- Spontaneous rupture of the spleen caused by: Infecious mononucleosis

63- Most common bacteria found in spontaneous bacterial peritonitis is: Gram – ve

64- Primary intension: a) b)

stapler ulcer healing

c) d)

suture by PDS plastic dressing

e)

approximation of the edges can’t be broken down

65- Septic shock is charachterized by: Decreased peripheral resistance

A) B) C) D) E)

66-45 –year- old woman whose mother had breast cancer, under goes stereotactic breast core biopsy. Pathological examination demonstrates lobular carcinoma insitu. Next step should be: Re-excision to obtain clear margins Lumpectomy & sentinel L.N biopsy Lumpectomy & sentinel L.N biopsy & radiation therapy Observation, examination & mammography in 6 months Radiation therapy of Rt. breast

66.During exploratory surgery for presumed appendicitis, cecum & appendix found normal, terminal 50 cm of ileum is beefy red, inflamed, edematous & soft with no proximal ileal distension. Which of the following is the most appropriate operation:

A) B) C) D) E)

Appendectomy Resection of involved ileum & Appendectomy Placement & irrigation catheter & Appendectomy Closure without appendectomy or resection By-pass ileoascending anastemosis

67.patient with BRCA 1 & 2 gene mutation & family history of breast cancer: A) Likely to develop bilateral cancer than a women comparable stage of cancer without BRCA 1 B) Don’t benefit from prophylactic oopherectomy C) Don’t benefit from bilateral mastectomy D) Has low incidence of undetected pre-malignant lesions in prophylactic mastectomy specimen E) Worse prognosis than comparable stage cancer without BRCA 1 68.The most effective treatment of chronic anal fissure is: A) Fissurectomy B) Internal lateral sphenctrectomy

69.In hemodynemically stable patient presented with melena. Upper GI endoscopy & segmoidoscopy are normal, the source of bleeding can be diagnosed by: A) Colonoscopy B) CT angio C) Capsule endoscopy

70- Anatomy of hepatobiliary vasculature : Rt. hepatic artery passes posterior to………???

71- The most serous complication of B.T. is: a) incompatibility b) viral hepatitis

72- Retained hemothorax: Infected empyma

73- Prophylactic mastectomy in pt. with moderate risk for breast ca: Decreases risk of breast ca by 90%

74- 6 hours history of acute pain of lt. leg & foot with coldness till mid leg & no popliteal pulse: a) Femoral artery embolism b) Femoral artery thrombosis c) burger disease

75- prevention of esophageal variceal bleeding by: propanolol

76- Green stick fracture: Fracture of one of the cortex sides

77- Immunosupressive drugs: Cyclosporine is a selective Immunosupressive drug

78- ARDS managed by: Supportive treatment

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