Prc Questions

PRC QUESTIONS – SURGERY 1. A patient who sustained multiple injuries was noted after a few days to have lost weight and had increased urinary nitrogen. This patient is in what phase of the metabolic response to injury? a. Ebb phase b. Catabolic phase c. Anabolic phase d. Excretory phase 2. The major neuroendocrine stimuli that would stimulate a response in a patient with vascular injury would most likely be: a. Effective circulating volume change b. Pain c. Energy substrate d. Oxygen, CO2 & H ion change 3. This is a hormone under pituitary control that maintains euglycemia during stressful situations by increasing the availability of gluconeogenic substrates to the liver. a. Cortisol b. Catecholamines c. Growth Hormone d. Insulin 4. The plasma volume which is a component of the extracellular fluid is approximately: a. 20% of TBW b. 10% of TBW c. 15% of TBW d. 5% of TBW 5. A 30 y/o male, working in a steel mill for several hours, was brought to the ER because of weakness .On PE the patient was tachycardic, with dry,sticky mucus membranes & slightly febrile. The patient is most probably: a. Hypokalemic b. Hyponatremic c. Hypercalemic d. Hypernatremic 6. The condition which is aggrevated by either metabolic or respiratory alkalosis is: a. Hypocalcemia b. Hypokalemia c. Hyponatremia d. Hypochloremia 7. A patient who has lost a significant amount of blood and is in shock requires emergency transfusion, which of the following statements is least applicable? a. Type specific blood may be given without crossmatching b. Type O (+) blood may be given if type specific blood is not available c. Crossmatched type specific blood should always be given d. Hemolytic transfusion reaction is possible if more than 4u of O (-) are given

8. The level of platelets in the blood that should be maintained to prevent bleeding problems is: a. 10,000-20,000/cu.mm b. 50,000-100,000/cu.mm c. 150,000-200,000/cu.mm d. 300,000-500,000/cu.mm 9. What is the most common fatal complication of blood transfusion? a. Hemolytic transfusion reactions b. Thrombophlebitis c. Pulmonary edema d. Post-transfusion viral hepatitis 10. This is a mechanism of wound healing whereby keratinocytes migrate and then divide to resurface partial -thickness loss of skin or mucosa. a. Epithelization b. Matrix deposition c. Contraction d. Scar formation 11. The cytokine present in wound healing that stimulates epithelial cell and fibroblast proliferation and granulation tissue formation. a. PDGF (platelet derived growth factor) b. TGF-β (transforming growth factor- beta) c. FGF (fibroblast growth factor) d. EGF (epidermal growth factor) 12. The estimated blood volume of a 3 kg baby is: a. 150 ml b. 300 ml c. 240 ml d. 450 ml 13. A 2-year old baby boy with a history of on and off bulging right scrotal mass, suddenly developed abdominal pain, irritability and vomiting. PE finding revealed a tender mass at the right inguinal area. The most likely diagnosis is: a. Acute testicular torsion b. Testicular carcinoma c. Incarcerated hernia d. Acute inguinal lymphadenitis 14. The most common ectopic mucosa present in Meckel’s diverticulum is: a. Colonic mucosa b. Pancreatic mucosa c. Ovarian mucosa d. Gastric mucosa 15. Which among the abdominal wall defects in the newborn period has the worse prognosis: a. Gastroschisis b. Omphalocele c. Bladder extrophy d. Prune belly syndrome

16. The most common pediatric malignant lesion in the liver is: a. Hepatocarcinoma b. Malignant teratoma c. Hapatoblastoma d. Metastatic lesion from neuroblastoma 17. Vater syndrome is associated with: a. Wilms tumor b. Hirschprungs disease c. Cryptochordism d. Esophageal atresia 18. Organs transplanted between genetically non-identical individuals of the same species are termed: a. Isografts b. Allografts c. Xenografts d. Heterografts 19. A 42-year old female underwent cholecystectomy and 16 hours after the operation she developed fever. This is most probably due to: a. Pneumonia b. UTI c. Atelectasis d. Wound infection 20. The most important aspect in the management of enterocutaneous fistula is: a. Wound care b. Nutrition c. Prevention of abscess formation d. Antibiotic administration 21. In retroperitonial hemorrhage from necrotic pancreatitis the blood can dissect to the periumbilical area. a. Grey-Turner sign b. Cullen’s sign c. Murphy’s sign d. Kehr’s sign 22. Which of the following is not included as criteria for the Ranson’s prognostication for pancreatitis: a. White blood cell count b. Age c. Amylase d. Aspartate transaminase 23. Gram negative organisms are the most common causative agent in septic shock which is frequently from the: a. Genitourinary system b. Respiratory system c. Alimentary system d. Integumentary system

24. True of the compensatory response that occurs during shock? a. Loss of circulating intravascular volume results in decreased vascular tone b. Decrease in intravascular volume stimulate decreased sympathetic activity, which increase vagal inhibition of the rate and force of cardiac contraction c. Loss of circulating intravascular volume leads to decreased capillary hydrostatic pressure d. Arteriolar dilation and loss of circulating volume diminishes renal blood flow 25. Classification of the operative wound in cases of appendectomy? a. Clean b. Clean-contaminated c. Contaminated d. Dirty and infected 26. Tumor associated virus that is implicated in Burkitt’s lymphoma a. Epstein-Barr Virus (EBV) b. Hepatitis BVirus (HBV) c. Human Papilloma Virus (HPV) d. Human Immunodeficiency Virus Type 1 (HIV-1) 27. A 50-year old female sought consult because of a 5 cm tender nodule on the right lobe of the thyroid gland. The most unlikely diagnosis is: a. Thyroid malignancy b. Subacute thyroiditis c. Toxic adenoma d. Bleeding in a benign nodule 28. A 40-year old female sought consult because of a 3 cm “cold” nodule on the right lobe of the thyroid gland. The next best step to do is: a. UTZ b. CT scan c. FNAB d. Diagnostic thyroidectomy 29. A 30-year old male sought consult because of a 2 cm hard nodule on the left lobe of the thyroid gland associated with enlarged cervical lymphadenopathy on the ipsilateral side. His family history showed strong predisposition to Familial Adenoma Polyposis syndrome. If the nodule will turn out to be malignant the most likely histologic type is: a. Papillary Carcinoma b. Follicular Carcinoma c. Medullary Carcinoma d. Anaplatic Carcinoma 30. A 60-year old female underwent total thyroidectomy and RAI therapy for Follicular Thyroid Carcinoma. Aside from clinical surveillance, part of the follow up program to monitor for possible recurrence is regular determination of: a. TSH b. Calcitonin c. CEA d. Thyroglobulin

31. The most common organ secondarily affected by Primary Hyperparathyroidism is the: a. Kidney b. Bone c. GIT d. Pancreas 32. The most common complication of thyroglossal duct cyst is: a. Infection b. Malignant degeneration c. Hypothyroidism d. Airway obstruction 33. A 42-year old female sought consult because of a slow-growing, painless swelling in her right mandible. X-ray showed a multiloculated radiolucency in the body of the mandible with an impacted tooth clearly visualized. This condition is suggestive of: a. Torus mandibularis b. Ameloblastoma c. Gorlin’s cyst d. Osteosarcoma 34. For small (T1) squamous cell carcinoma of the Head and Neck region, this treatment modality offers equal survival rates with that of surgery: a. Radiotherapy b. Chemotherapy c. Cryotherapy d. Immunotherapy 35. The type of neck dissection that removes lymph nodes levels I, II and III is called: a. Supraomohyoid neck dissection b. Lateral neck dissection c. Posterolateral neck dissection d. Central neck dissection 36. Following total parotidectomy for a malignant tumor, the patient was observed to have difficulty in closing the eyelids in the ipsilateral side. Which branch of the Facial Nerve was most likely injured: a. Temporal b. Zygomatic c. Buccal d. Mandibular 37. The most common complication of GERD is: a. Esophagitis b. Esophageal stricture c. Barrett’s esophagus d. Aspiration pneumonia 38. The most frequent cause of primary esophageal motility disorder: a. Achalasia b. Diffuse esophageal spasm c. Nutcracker esophagus d. Hypertensive LES

39. In the initial management of Caustic Injury to the esophagus, this treatment modality may pose more harm than good to the patient if performed: a. Neutralizer b. Gastric lavage c. Endoscopy d. Dilation 40. The most common cause of acute bacterial cystitis: a. E. coli b. Pseudomonas Sp. c. Protens Sp. d. Staphylococcus aureus 41. Imaging procedure of choice in renal trauma: a. Angiography b. Doppler ultrasound c. CT scan d. MRI 42. The most common cause of subarachnoid hemorrhage in general: a. Ruptured aneurysm b. Hypertensive bleed c. Artero-venous malformation d. Head injury 42. Epidural hematoma is associated with: a. Linear fracture b. Tear in the middle meningeal artery c. Lucid interval in 20% of cases d. All are correct 43. Bleeding source of acute subdural hematoma comes from: a. Tear in middle meningeal artery b. Rupture of bridging veins c. Bleeding from the diploic veins d. Tear from internal carotid artery 44. The most specific sign of increase ICP a. Headache b. Vomiting c. Lateral rectus palsy d. Papilledema 45. Which metacarpal bone in the metacarpals is most prone to avascular necrosis due to its peculiar blood supply? a. Lunate b. Scaphoid c. Capitate d. Hamate 46. All of the following are associated with post menopausal osteoporosis, EXCEPT: a. Colle’s fracture b. Femoral neck fracture c. Vertebral compression fracture d. Femoral shaft fracture

47. The safe maneuver to determine a congenitally dislocated hip in the newborn is: a. Barlow’s test b. Ortolani’s test c. Thomas’ test d. Laseque’s test 48. The femoral head is contained more into the acetabulum when the hip is: a. Internally rotated and adducted b. Externally rotated and adducted c. Internally rotated and abducted d. Externally rotated and abducted 49. An 18-year old athlete came into your office because of pain over the middle third of the right leg with slight swelling and tenderness on deep pressure, giving a history of a minimum five (5) kilometer run everyday along Quezon City Circle. X-ray of the tibia shows an incomplete fracture of the anterior cortex, middle third of the tibia. Most likely he is having: a. Pathological fracture b. Stress fracture c. Torus fracture d. Greenstick fracture 50. This is the most common aggressive primary malignant bone tumor in adolescent and occurs in methaphyseal area of long bones with high incidence of pulmonary metastases: a. Chrodrosarcoma b. Osteosarcoma c. Fibrosarcoma d. Adamantinoma 51. Recurrent ulceration after vagotomy is usually due to inadequate dissection of the esophagus and intact criminal nerve of Grassi which arises from the: a. Anterior vagus b. Posterior vagus c. Nerves of Laterjet d. Crow’s foot 52. A 65-year old, male, known COPD case was chronically taking NSAID suddenly experienced severe epigastric pain. 24-hours later fever was noted thus consult. Chest xray upright revealed a crescent shape luscency beneath the diaphragm which can be attributed to: a. Free blood from the stomach which collected underneath the diaphragm b. Escape of air from the lungs c. Pneumoperitoneum secondary to perforated peptic ulcer d. Collection of pus beneath the diaphragm 53. Same patient as # 2. While at the ER, BP went down to 90/60. How will you manage this case? a. Sclerotherapy and blood transfusion b. Closed tube thoracostomy c. Graham’s omental patching d. Explor lap, drainage of pus and antibiotic administration

54. Metastasis of gastric malignancy may be noted in the following sites: a. Krukenberg’s tumor – involvement of the pelvic cul-de-sac b. Blumer’s shelf – involvement of ovaries c. Vichow’s node – ipsilateral axillary node d. Sister Joseph’s nodule – deposit to the umbilicus 55. Gross difference of jejunum from ileum is best described as: a. Jejunum has larger diameter and thicker wall than the ileum b. Jejunum has one or two arterial arcades c. Jejunum has abundant mesenteric fat than the ileum d. Jejunum has few plicae 56. The most common symptomatic benign lesion of the small bowel is: a. Adenoma b. Lipoma c. Leiomyoma d. Hamartoma 57. The most common complication of Meckel’s Diverticulum in adult is: a. Obstruction b. Bleeding c. Acute diverticulitis d. Intussuception 58. True of the evidence for the existence of an adenoma-carcinoma sequence: a. Larger adenomas are found to contain less cancer cells and dysplasia than smaller polyps b. The differentiation between carcinoma in situ and invasive cancer relies on the size of the polyp c. Polypectomy alone has been shown to increase the incidence of cancer d. Patients w/ familial adenomatous polyposis develop cancer 100% of the time if the colon is not removed 59. A 54-year old, male had an executive check up because of pallor, body weakness and 20% weight loss in 2 months time. Occult blood testing is positive. If you are considering a colonic malignancy where is the probable site? a. Right side of the colon b. Left side of the colon c. Sigmoid colon d. Rectum 60. After the operation of a patient with colon cancer, the surgeon told the relatives that colonic mass invades the submucosa with 1 to 3 pericolic lymph nodes. Liver was noted to be smooth and with sharp edge. What is the stage of the disease? a. Stage I b. Stage II c. Stage III d. Stage IV

61. A patient presents with persistent purulent discharge from an external opening posterior to the imaginary line that bisected the anus. If the Goodsal’s rule will be followed the internal opening is located at: a. Posterior midline via a straight tract b. Posterior midline via a curved tract c. Anterior midline via a straight tract d. Anterior midline via a curved tract 62. Characteristic contrast study findings in cases of volvulus: a. Inverted U-shaped, sausage-like loop of bowel in abdominal radiograph b. Bent inner tube sign in plain film of the abdomen c. Coiled spring appearance in upper GI series d. Bird’s beak appearance in barium enema 63. True statement about the diagnosis of breast cancer: a. Doing mammography for all females above 20 years of age is cost effective b. BSE (breast self examination) should be done by women 20 years old and older c. Ultrasound of the breasts can accurately detect microcalfications d. History and breast examination should be done after a screening mammogram 64. Correct statement about the presentation of breast cancer: a. Breast pain (mastalgia) is the most common complaint of patients b. Women do BSE regularly can detect or palpate breast lumps with more than 85% accuracy c. A soft to firm, rounded, movable breast mass in a young female patient should be suspected to be cancer d. Early breast cancer is usually associated with palpable axillary lymph nodes 65. Accurate statement about the anatomy and development of the mammary gland: a. At birth, the female breast is distinctly more prominent and developed than the male baby b. Acquired hypoplasia of the breast tissue can be due to trauma or infection c. Polythelia is not associated with abnormalities of other organ systems d. The upper inner quadrant has the greatest volume of breast tissue 66. Correct statement about the lymphatic drainage of the breast: a. The external mammary group (anterior or pectoral group) drains the majority of lymph from the lateral quadrants b. There are more lymph nodes along the internal thoracic lymphatic route than along the axillary lymphatic drainage pathway c. Level III axillary lymph nodes are those nodes located medial to the pectoralis minor insertion tendon d. Fifty percent of lymph flow drains toward the axillary lymph nodes and the other 50% into the internal mammary lymphatics 67. The breast lesion that has the least risk for degenerating into cancer is: a. Atypical ductal hyperplasia b. Ductal ectasia c. Sclerosing adenosis d. Lobular carcinoma in situ

68. Which of the following vital signs most closely represents a patient with closed head trauma that results in loss of consciousness: a. Increased pulse, increased blood pressure b. Decreased pulse, increased blood pressure c. Increased pulse, decreased blood pressure d. Decreased pulse, decreased blood pressure 69. What would you consider the most appropriate immediate management of a patient admitted with a flail chest, ventilatory failure and a Pa02 on air of 50 mmHg: a. Immediate tracheostomy b. Thoracic epidural anaesthesia c. Endotracheal intubation d. Nitrous oxide/oxygen mixture 70. The most common cause of diaphragmatic injury is: a. Iatrogenic b. A subphrenic inflammatory process c. Dehiscence of a surgical operation d. Blunt trauma 71. A patient is taken to the recovery area after an uncomplicated routine operation. 10 minutes later, it is noticed that she is cyanosed. Which one of the following is the most appropriate first line of management: a. Summon the cardiac arrest team b. Carry out endotracheal intubation and ventilate the patient c. Establish a clear airway and ventilate the patient with a self-intubation bag and mask d. Order a ventimask with 60% oxygen 72. Which one of the following conclusion from the accompanying arterial blood gas values (in which gas tension are given in mmHg) is true: a. PaCO2 40, PaO2 98, pH 7.36 indicates right to left shunt b. PaCO2 60, PaO2 50, pH 7.30 indicates hypoventilation with compensation by increased respiratory drive c. PaCO2 28, PaO2 50, pH 7.48 indicates pulmonary collapse d. None of the above 73. If an incidental appendiceal carcinoid is recognized during simple appendectomy, which of the following statements is/are true: a. If the tumor is >2 cm in size, the mesoappendiceal lymph nodes are negative and the resection margins are clear, no further surgical treatment is necessary b. Right hemicolectomy is routinely indicated regardless of nodal status c. Right hemicolectomy is indicated if tumor is present at the surgical margins or if nodal involvement is present d. If mesoappendiceal lymph nodal metastases are present, surgical cure is unlikely and chemotherapy should be initiated

74. Correct statements concerning acute ligature of blood vessels around the liver include the following, EXCEPT: a. The common hepatic artery can be safely ligated b. Ligation of the left hepatic artery produces parenchymal necrosis c. Ligation of the portal vein must be accompanied by a portal systemic shunt d. Ligation of the inferior vena cava below the liver may or may not have a serious sequelae 75. In the cirrhotic patient with refractory ascites, an appropriate operation is: a. Portacaval shunt (end-to-end) b. Disconnection operation c. Peritoneovenous shunt d. Ligation of the thoracic duct 76. Liver metastasis secondary to colon cancer: a. Almost always occurs within 6 months of the primary resection b. Usually causes facial flushing, dyspnea and diarrhea c. May result in 20% 5-year survival rates if resected d. Should be resected in most cases 77. The following may require splenectomy, EXCEPT: a. Hereditary spherocytosis b. Sickle cell disease (occasionally) c. Idiopathic autoimmune hemolytic anemia when steroids have proven ineffective d. Hashimoto’s autoimmune disease 78. The following conditions require urgent thoracotomy, EXCEPT: a. Complete unilateral atelectasis with a larger air leak b. Penetrating diaphragmatic in jury c. Progressively widening mediastinum d. Persistent chest tube drainage of greater than 100 ml of blood per hour for 6 hours or more 79. A 50-year old construction worker has a chest x-ray because of chest pain and dysnea. He is found to have a large pleural effusion. With his history of exposure to asbestos, a malignant mesothelioma is suspected. The best way to establish a tissue diagnosis is: a. Bronchoscopy b. Needle biopsy of pleura c. Thoracentesis and cell cytology d. Thoracoscopy and biopsy 80. The following conditions contraindicate surgery in the presence of lung malignancy, EXCEPT: a. Malignant pleural effusion b. Contralateral mediastinal lymph node involvement c. Extension of the tumor into the chest wall d. Distant metastases 81. Hoarseness is a clinical manifestation of lung cancer because of the extension of the tumor to: a. Superior laryngeal nerve b. Phrenic nerve c. Recurrent laryngeal nerve

d.

Sympathetic ganglia

82. The most important step in the control of empyema is: a. Decortication of trapped underlying lung b. Obliteration of the empyema space c. Repeated antibiotics irrigation of the cavity d. Systemic therapy with the appropriate antibiotic 83. The most common benign tumor of the lung is: a. Fibroma b. Lipoma c. Papilloma d. Hamartoma 84. Conditions that usually are indication for coronary artery bypass surgery include all the following, EXCEPT: a. Chronic angina of varying degree b. Unstable angina c. Complications of acute myocardial infarction d. Congestive heart failure 85. A premature infant is discovered at birth to have a patent ductus arteriosus with moderate respiratory distress. The infant does not improve after 48 hours of medical management with fluid restriction, diuretics and respiratory support. The next step in management is: a. Acetylsalicylic acid b. Indomethacin c. Surgical correction of the ductus d. Transvenous occlusion of the ductus 86. An asymptomatic 34-year old non-smoker patient is found to have a solitary pulmonary nodule that is 2 cm in diameter. There is no evidence of the lesion on a chest x-ray taken 5 years previously. Tomography reveals a central core of calcium. The correct management for this lesion should consist of: a. Periodic x-ray follow up b. Transbronchial biopsy c. Needle biopsy d. Thoracotomy and resection 87. Which of the following is the best predictor of a significantly increased operative risk for coronary artery bypass surgery: a. Electrocardiography b. Left ventricular end-diastolic pressure c. Ventricular ejection fraction d. History of multiple myocardial infarcts 88. True statement about the anatomy of the gallbladder: a. The fundus is the narrowest part of the gallbladder b. The cystic artery which supplies the gallbladder is usually a branch of the left hepatic artery c. The triangle of Calot is a useful landmark to locate the cystic artery d. The hepatoduodenal ligament is basically avascular

89. Correct statement about gallstone: a. Pigment gallstones are the most common type worldwide b. Cholesterol gallstones are more prevalent in Asian than in Western populations c. Cholesterol gallstones are formed if the relative concentration of cholesterol in the bile is decreased in population to the concentration of bile salts and phospolipids d. Pigment gallstones are formed solely because of biliary tract infection 90. Accurate statement about gallstone disease: a. All asymptomatics gallstones requires cholecystectomy to prevent complications b. Acute cholecystitis is associated with cystic duct obstruction usually due to gallstone impaction in the cystic duct or infundibulum c. Gallstone pancreatitis is caused by stones obstruction the second portion of the duodenum d. Choledocholithiasis occur more commonly than cholecystolithiasis 91. True statement about the groin hernias: a. Direct inguinal hernias are much more common than indirect inguinal hernia b. The etiology of indirect inguinal hernia is closely related to the descent of the testes c. Femoral hernias are indirect hernias occurring below the inguinal ligament d. The larger the hernia orifice or neck the greater the possibility of incarceration 92. The hernial sac of an indirect inguinal hernia is located: a. Antero-lateral to the spermatic cord b. Postero-lateral to the spermatic cord c. Antero-medial to the spermatic cord d. Postero-medial to the spermatic cord 93. Accurate statement regarding the diagnosis of groin hernias: a. Symptoms like groin discomfort are usually worse on waking up and gradually subside at the end of the day b. Testicular pain is a common symptom of groin hernias c. Physical examination while the patient is standing up is usually sufficient to palpate a groin hernias sac d. Hernias not detected on P.E. should undergo immediate inguinal exploration 94. A 30 years old man weighing 154 lbs. was admitted because of flame burns that occurred 2 hours earlier. P.E. showed painful blisters of the whole face and anterior neck area. Painful blisters were noted at the whole anterior trunk, left anterior thigh, left anterior leg and foot. A waxy white area amounting to about 1 palm size was seen at the left anterolateral arm. Patient had singed nasal hair. Vital signs were BP = 130/70 PR -– 105/min. RR- 24/min T – 37.6’C. The total body surface area burned is: a. 41.5% b. 36% c. 32.5% d. 28% 95. Using Parkland Formula, the estimated fluid required for the first 24 hours is: a. 6,000 ml LRS b. 8,960 ml LRS

c. d.

9,100 ml LRS 11,760 ml LRS

96. Patients with Xeroderma Pigmentosa are prone to develop multiple skin malignancies due to an endonuclease deficiency. This is: a. A sex linked recessive genetic defect b. A skin condition that is sensitive to UV radiation c. A defect in the over production of melanin d. A defect in the target cells that easily mutate 97. Which of the following is not a factor in the increase in growth and linear extension for Basal Cell Ca: a. Recurrent lesion b. Tumor size greater than 2cm c. Primary tumor located in the H zone d. Lowered immune status of the patient 98. A day after the burn injury, a patient with 30% burn injury was noted to be tachycardic, BMR is twice normal and is in a state of hypermetabolism. This response is influenced by which of the following hormone? a. Thyroxine b. Cathecholamines c. Glucagons d. Aldosterone 99. A 70 kg patient was brought to the ER was noted on examination to have 30 % major burn injury to the body. How much fluid would you give in the first 8 hours of resuscitation? a. 1.5 liters b. 2.3 liters c. 4.2 liters d. 8.4 liters 100. During fluid resuscitation, one means of assessing adequacy of resuscitation is by measuring: a. Blood pressure b. Heart rate c. Respiratory rate d. Urine pH

Our Lady of Fatima University Department of Surgery CHOOSE THE BEST ANSWER.

C1. The most common organism associated with OPSI is: A. Pseudomonas C. Streptococcus pneumoniae B. Hemophilus influenzae D. Neisseria meningitides D2. The most common indication for surgery in Chronic pancreatitis is: A. Endocrine insufficiency C. Abscess formation

B. Exocrine insufficiency D. Pain A3. Criteria for resectability of Adenocarcinoma of the pancreas are the following except: A. Negative or equivocal FNAB prior to resection C. Involvement of distant lymph node B. Involvement of major vascular structure D. Involvement of the liver B4. The most common type of peritonitis is seen in: A. Patients w/ renal failure undergoing dialysis D. All of the above B. Patient with ruptured appendicitis B C. Postoperative patients on broad spectrum antibiotics C5.The ff. statements regarding movement & accumulation of peritoneal fluid are true, EXCEPT: C A. Clearance of fluid & particulate matter within the peritoneal cavity occurs via the diaphragmatic surface D B. Movement of fluid within the peritoneal cavity is affected by gravity E C. Fluid tends to collect in the subhepatic & subphrenic spaces in the supine position only F D. None of the above B6. The best imaging modality in suspected cases of intra-abdominal abscess: A. Ultrasound B. CT scan C. Plain abdominal X-ray D. Laparoscopy A7. Almost always heralds intraabdominal disease but might not indicate the need for surgical therapy: A.visceral pain B. somatic pain C. parietal pain D. well localized , sharp pain C8. Hyperactive bowel sounds: A. hypokalemia B.ileus C. early small bowel obstruction D. peritonitis D9. Type of somatic stimulation resulting to pain: A. stretching B. distention C. contraction D. inflammation B10. The manometric finding of non-peristalsis, low pressure or absent esophageal contraction can be seen A. Nut cracker esophagus B. achalasia C. Barett esophagus D. none of the above D11. Pre-malignant lesions developing into adeno CA of esophagus: A. Achalasia C. Reflux esophagitis E. Tylosis B. Leiomyoma D. Baretts esophagus D12. In caustic agent injury of the esophagus, the best diagnostic workup to evaluate the injury: A. CT scan B. barium swallow C. Chest X-ray D. esophagoscopy E. ultrasound B13. A condition being felt by a patient who underwent gastric surgery in which after eating a high carbohydrate diet, severe colicky abdominal pain follows: A. Gastric stasis C. Small capacity syndrome E. none of the above B. Dumping synderomeD. Afferent loop syndrome C14. Surgical procedure for peptic ulcer disease with the best result:

A. Truncal vagotomy with drainage procedure D. Subtotal gastrectomy B. Parietal cell vagotomy without drainage procedure E. Total gastrectomy C. Truncal vagotomy and antrectomy B15. A condition with s/s of gastric outlet obstruction and the cause is a conglomeration of undigestible materials: A. Lymphoma B. Bezoar C. Corrosive Gastirits D. Gastric Volulus E. none A16. The single best thyroid function test that can be used in the diagnosis of hyperthyroidism is: A. Serum TSH determination C. Serum T3 B. Radioactive iodine uptake D. Serum T4 A17. A practical and precise diagnostic screening procedure that can differentiate between a benign from a malignant thyroid nodule is: A. Fine needle aspiration cytology C. Thyroid ultrasound B. Radioactive iodine thyroid scan D. Serum TSH determination D18. Immediate and potentially complication of thyroid surgery: A. Hypocalcemia C. Injury to the ansa hypoglossi nerve B. Injury of the recurrent laryngeal nerve D. Bleeding D19. The most common type of primary malignancy encountered in the head and neck area is: A. Adenocarcinoma C. Lymphoma E. papillary carcinoma B. Basal cell carcinoma D. Squamous cell carcinoma C20. In pt diagnosed with nasopharyngeal carcinoma, one of the following statements is Not True: A. Nasal stuffiness is a common complaint E. none of the above B. Upper Jugular and posterior triangle group of nodes are usually involved C. Primary treatment is surgery D. Radiation is the recommend treatment for locoregional disease C21. A 6 y/o male presents with a 3 x 4 cm, non-hard, movable mass located at the midline of the neck. History reveals the intermittent episode of infection in the said mass which was also noted to elevate upon tongue protrution. The most likely diagnosis is: A. 2nd branchial cleft anomaly C. Thyroglossal duct cyst E. Lipoma B. 3rd branchial cleft anomaly D. Epidermal inclusion cyst D22. Which of the following may be used to differentiate acute appendicitis from a gynecologic pathology? A. Laparoscopy C. HBT Ultrasonography E. B & C B. Pregnancy test D. A and B B23. Most common presentation of appendiceal adenocarcinoma A. Intestinal obstruction B. Appendicitis C. Presence of mass D. Anemia B24. A 37 y/o female was brought to your clinic foe a fluctuant mass at the right lower quadrant. On history taking, you elicited that she given a course of antibiotic therapy. Most probably this patient has: A. soft tissue abcess B. phlegmon formation C. Chronic appendicits D. Mucocoele C25. Idiopathic retroperitoneal fibrosis A. Nonsuppurative inflammation of fibroadipose tissue of unknown cause

B. Produce symptom of gradual compression of tubular structure in the retroperitoneum C. Both of the above D. none of the above A26. Most common malignant retroperitoneal tumor A. sarcoma B. squamous cell CA C. adenocarcinoma D. lymphoma D27. Superior and inferior mesenteric arteries are the arterial supply to entire intestinal tract, EXCEPT: A. stomach B. duodenum C. distal rectum D. all of the above C28. Boundaries of the Hesselbach’s triangle, EXCEPT: A. inferior epigastric vessels C. Rectus sheath B. Inguinal ligament D. External oblique m. B29. Anatomically, hernias occuring within the Hesselbach’s triangle is: A. Indirect type B. direct type C. Femoral D. Incarcerated D30. Anterior approaches to hernia repair, EXCEPT: A. Bassini’s B. Shouldice C. Lichtenstein D. TAPP C31. Usual location of tuberculous enteritis: A. Duodenum B. Jejunum C. Ileum D. Colon B32. Most common location of duodenal diverticula: A. superior part B. descending part C. horizontal part D. ascending part C33. Blind loop syndrome: A. steatorrhea B. Vit B12 deficiency C. Both D. none B34. A useful in determining the path of a tract in Fistula-in-ano A. Bradoies Triad B. Goodsall’s rule C. Charcots Triad D. Rule of thum A35. Which paraclinica; exam will be most useful in the diagnosis of colorectal CA? A. Colonoscopy C. Barium swallow B. Abdominal ultrasonography D. Carcinoembryonic antigen A36. Which of the following is true regarding familial adenomatous polyposis? A. Polyps start to occur at a mean age of 16 y/o. Necessitating screening colonoscopy at this age among relatives of patients with FAP. B. Screening by using colonoscopy among relatives of patients with FAP is done at 35 y/o since almost all persons with this gene will exhibit adenoma by this time. C. Genetic screening has no rule in the detection and control of FAP D. Polypectomy is adequate in the treatment of the adenoma in FAP C37. Lymph nodes medial to the medial border of pectoralis minor: A. Level I B. Level II C. Level III D. Level IV A38. Liver metastasis is suspected when there is elevated: A. Alkaline phosphatase C. Prolactin Level B. Carcino embryonic antigen D. BUN and creatinine D39. Contraindication of breast conservation Surgery: A. Large tumor size 70.5 cm B. Gross multifocal disease or diffuse malignant microcalcification C. Retroareolar or nipple & cannot participate in needed follow-up D. All of the above

D40. True regarding the incidence of Imperforate Anus:

A. more common in females B. males have less complex C. females tend to undergo colonostomy more than males D. surgical management is more simple in females in most cases A41. Clinical manifestation of Hirchsprung’s Disease A. Presentation is varied but most had delayed passage of meconium beyond the 1 st 24 hr of life B. Almost always presents as obstruction at birth C. Majority of patients have delayed presentation D. Should be the sole consideration when dealing with chronic constipation in older children

C42. Intestinal Atresia, in contrast to Malrotation, presents with billous vomiting associated with: A. scaphoid abdomen C. abdominal distention B. upper abdominal fulness D. thich blackish meconium D43. The most common cause of esophageal perforation is: A. tumor B. swallowed objects C. caustic injury D. instrumentation B44. Flail chest cause respiratory compromise because of: A. rib fracture B. pulmonary contusionC. pleural effusion D. pneumothorax D45. The most common cause of esophageal perforation is: A. tumor B. swallowed objects C. caustic injury D. instrumentation B46. The normal prostate gland weighs about A. 10 grams b. 20 grams c. 30 grams d. 40 grams A47. The classic triad of symptoms for renal cell cancer are the following EXCEPT: A. weight loss b. flank pain c. gross hematuria d. abdominal mass D48. A 23 y/o female has BP of 240/120. To diagnose of the hypertension is renal origin, one should do: a. KUB-IVP b. Renal ultrasonography c. CT Scan d. Renal arteriography B49. A good color match is an important factor in skin grafting. The best donor site for skin grafting of the face is:

A. antecubital area B. supraclavicular area C. abdomen D. groin D50. A 40 y/o with 2nd degree flame burns involving the entire right upper extremity, whole anterior trunk, perineal area and 50% of the left lower extremity. Approximately what percentage of the total body surface is burned? A. 28% B. 24% C. 45% D. 37% B51. CT scan finding in a head injured man is a crescentic hyper dense mass of the right frontotemporoparietal area. His diagnosis is A. acute epidural hematoma C. chronic subdural hematoma E. subarachnoid B. acute subdural hematoma D. cerebral contusion hemorrhage C52. Epidural hematomas are located between the: A. bone and the galea C. bone and the dura E. scalp and the bone B. cerebral cortex and the dura D. cortex and the ventricle B53. Management of intracerebral hemorrhage include A. antiplatelet and antihypertensive drugs B. ventilatory support and tissue-dehydrating agents C. ventilatory support and antiplatelet medication D. antiplatelet medication and surgery B54. A decrease in femoral neck shaft angle less than 130°: A. Fenu valgus b. Coxa vara c. Coxa valga varum D55. Maximum weight that can be used for skin traction: A. 6-7 lbs. b. 6-7 kgs. c. 15-20 lbs C56. A positive Trendelenberg’s test is secondary to weakness of:

d.

Genu

d. 10 lbs.

A. Hip extensors B. Hip flexors C. hip abductors D. hip adductors B57. Metabolic response to injury includes the following, EXCEPT: A. increase in heart rate C. increased BP E. increased ketones B. decrease in peripheral resistanceD. increased blood glucose A58. Epithelialization stops when: A. Like cells from each side comes in contact with each other B. Platelets have formed a blood clot D. Contraction starts C. Collagen have been deposited by the reparative process C59. The total body fluid of a 70 kg female is: A. 28,000 ml. B. 42 Liters C. 35 liters D. 40 liters E. 35 – 45 liters B60. Statement/s true about the metabolic changes in injured patients: A.There is an obligatory decrease in energy expenditure and nitrogen excretion B.There is a rapid depletion of labile and functional energy stores. C. There is a positive nitrogen balance D. All of the above C61. Majority of body glycogen is stored in what tissue A. Liver B. Kidney C. Skeletal muscle D. Subcutaneous tissue D62. Principle/s of antibiotic prophylaxis therapy: A.Choose antibiotic effective against the pathogens B.Choose an antibiotic with low toxicity C.Administer a second dose of antibiotic if the operation lasts longer than 4 hours D.All of the above D63. Tidal volume that does not participate in gas exchange is called. A. vital capacity

B. tidal vol.

C. minute vol.

D. dead space

B64. With regards to neoplastic disease in general, all of the following statements are true, EXCEPT: A. Neoplasms are a population of cells that have undergone extensive proliferation and have escaped normal control mechanism. B. By definition, all neoplasms are malignant tumors C.Malignant neoplasms are those capable of local tissue invasion and metastatic spread to distant site D. Benign neoplasms do not spread to distant site D65. With regards to cell cycle the following statements are true, except: A. Cell cycle has been analyzed by auto radiography B. Cells synthesizing DNA are measured on their uptake of radioactive labeled thymidine.

C. Knowledge of cell cycle is useful particularly in chemotherapy and radiotherapy D. Lag phase is always a period of inactivity or a period of rest C66. Incidence of anastomotic leak and fistula is increase in the following: EXCEPT A. Poor surgical technique C. Adequate decompression of GIT B. Distal obstruction D. Malnutrition

B67. Which of the following topical anti-microbial agents can penetrate an eschar? A. Silver sulfadiazine C. Aqueous silver nitrate E. None of the above B. Mafenide acetate D. Betadine D68. In patients with a significant burn injury, the greatest loss of fluid occurs in: A. 1st 6 hours of injury D. 1st 8 hours of injury st B. 1 24 hours of injury E. 1st 12-24hours of injury C. 1st 12 hours of injury D69. Rabies travels in the human body through A. Venous blood C. Lymphatics B. Intercellular spaces D. Peripheral nerves A70. Neoplasm with greatest malignant potential is A. villous adenoma B. leiomyoma C. Brunner’s gland D. tubular adenoma D71. 30 y/o female, pregnant manifesting with thyrotoxicosis, management: A. methimazole and betablocker C. RAI E. All of the above B. PTU D. Antithyroid drug for 1 month then surgery C72. This serves as a border, separating carcinoma in situ and invasive carcinoma of the breast: A. Linign epithelium C. Basement membrane B. Lamina propia D. None of the above E73. A condition wherein a calculi becomes impacted in cystic duct or neck of gallbladder producing white bile: the

A. Choledochal cyst

C. Primary sclerosing cholangitis

E. Hydrops of

B. Choledocholithiasis D. Biliary fistula gallbladder B74. Composed of tissues normally present in the liver but arranged in a disorderly fashion: A. Focal nodular hyperplasia C. Hepatic adenoma E. None of the above B. Mesenchymal hamartomas D. Hepatocellular adenoma B75. Terminal branch of the vagus nerve that has important role in the etiology of recurrent ulcer: Crow’s foot C. Zollinger Ellison B. Criminal nerve of Grassi D. Nerve of laterjet B76. A 45 y/o male patients with gastric outlet obstruction 2° to chronic duodenal ulcer complaining of protected vomiting will most likely develop: A. Hyperkalemic hyperchlorhydric alkalosis B. Hypokalemic hypochlorhydric alkalosis C. Hypokalemia metabolic acidosis D. Hyperkalemic metabolic acidosis B77. The following are physical signs of severe peritonitis, except A. Hypertension C. Absent bowel sound

B. Tachypnia

D. Involuntary muscle

guarding C78. Gland infected in hidradenitis suppurativa is: Sweat

A. Sebaceous

B. Mucus secreting

C. Apocrine

D.

D79. Elective Surgery is contraindicated in patients with A. Elevated serum creatinine D. History of Myocardial Infarction 4 weeks ago B. Atrial fibrillation E. History of stroke 6 months ago C. COPD C80. The most common female inguinal hernia is A. Femoral hernia B. Direct inguinal C. Indirect inguinal D. Spigelian D81. Which of the following systemic collagen diseases most frequently involves the esophagus? A. Periarteritis nodosa C. lupus erythematosus B. Rheumatoid arthritis D. scleroderma E. erythema multiforme C82. Neoplasm that mimics PUD is: A. villous adenoma B. leiomyoma C. Brunner’s gland D. true adenoma A83. Treatment for the first episode of uncomplicated diverticulitis is A. liquid diet and antibiotics C. resection with primary anastomosis B. colostomy D. explore lap and drainage C84. Tumor marker for colonic carcinoma is: A. AFP B. calcitonin C. CEA D. CA19-9 D85. Landmark used in identifying main trunk of facial nerve, except: A. Posterior belly of digastric muscle C. External acoustic cartilage E. None B. Stylomastoid process D. Masseter of the above C86. Considered as 1st echelon node in thyroid tumors, EXCEPT: A. Pre-laryngeal C. Upper jugular E. None of the above B. Para-tracheal D. Pre-tracheal C87. The most common clinical presentation of hyperparathyroidism: A. fracture C. Nephrolithiasis E. Dehydration B. Bone pain D. Gastric ulcer C88. The most common cause of a bloody nipple discharge: A. Paget’s disease of the breast C. Intraductal papilloma B. Adenoma of the nipple D. Invasive ductal carcinoma C89. This serves as a border, separating carcinoma in situ and invasive carcinoma of the breast: A. Linign epithelium C. Basement membrane B. Lamina propia D. None of the above

D90. If this LN is positive for malignant cell, the breast lesion is stage IIIB. A. Rotter’s node B. Central LN C. Apical LN D. Internal mammary LN D91. This benign lesion can degenerate into a malignant lesion: A. Fibrocystic disease of the breast C. Fibroadenoma B. Galactocoele D. None of the above C92. This/These can differentiate benign from malignant phyllodes tumor: A. Size of the tumor C. > 3 mitotic figure / HPF B. Consistency of the lesion D. All of the above C93. Breast malignancy with several lymphatic follicles near cancer cells: A. Paget’s disease of the breast C. Medullary CA of the breast B. Colloid carcinoma D. Schirrous Ca of the breast D94. The criteria for diagnosis of Primary Sclerosing Cholangitis are the following, EXCEPT: A. No evidence of primary liver disease D. Presence of choledocholithiasis B. Stenosis of a major portion of biliary duct system E. None of the above C. Absence of history of congenital anomalies C95. The Courvoiseir law described the gallbladder in the following condition: A. Gallbladder is distended due to cholecystitis E. None of the above B. Gallbladder is palpable due to cholithiasis C. Gallbladder is not distended due to inflammation D. Gallbladder is not distended due to neoplasia C96. A complication of cholecystitis which result in enteric fistula revealing air in the biliary tree: A. Emphysematous cholecystitis C. Gallstone ileus E. None of B. Gangrenous cholecystitis D. Perforated cholecystitis the above B97. All are true regarding DM from Chronic pancreatitis except: A. Oral hypoglycemics are the first choice of treatment B. Mild elevation does not require treatment C. Ketoacidosis is rare D. May developed to a profound hypoglycemia even with small amounts of insulin

C98. A 70 y/o male was seen in the ER because of severe abdominal pain of > 24 hrs. History revealed chronic intake of NSAID due to osteoarthritis. He is tachycardic, tachypneic & febrile. PE revealed diffuse tenderness & rigidity of the abdomen. If you were entertaining peritonitis, the most likely cause is: A. Ruptured appendicitis

B. Acute gastroenteritis

C. Perforated duodenal ulcer

D. Perforated diverticulitis

C99. Three months after accidental ingestion of muriatic acid, 30 y/o Female consults for dysphagia. Barium swallow shows a 10 cm structured segment of distal thoracic esophagus and normal looking stomach. What is the preferred treatment for this patient? A. Esophageal dilatation D. Esophagectomy with colonic interposition B. Gastric pull-up E. None of the above C. Esophagectomy with gastric pull-up D100. The venous drainage of the stomach in the lesser curvature near the cardia is: A. Left gastric B. coronary veinC. Right Gastric D. A & B E. B &C References:

1. Principles of Surgery by Schwarts 2. Textbook of Surgery by Sabiston 3. Textbook of Pediatric Surgery by Rowe, latest edition Vol 1 & 2 4. Urology Textbook by Smith 5. Plastic Reconstructive Surgery Book by Mc Carthy

6. Neurological Surgery by Yeomas 7. Neuro Surgery by Williams 8. Shands Handbook of Orthopedic Surgery 9. Surgery of the Chest by Sabistan & Spencer

University of Perpetual Help Rizal JONELTA FOUNDATION SCHOOL OF MEDICINE Department of Surgery – Consortium Test Questions for the February 2005 PLE

Name ________________________________________

Subject: General Surgery 1 Instructions: Multiple Choice : Choose the BEST answer. 1. With regard to keloids and hypertrophic scars, the following statements are true, EXCEPT: a. There are no histologic differences between the two. b. The differences between hypertrophic scar and keloid are clinical, not pathologic. c. Hypertrophic scars outgrow their original borders. d. Hypertrophic scars and keloids have been treated successfully with intalesional injection of steroids. Answer: C Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 1, pp. 515-516

MPL:

0.7

2. True statements regarding melanoma include all of the following, EXCEPT: a. The most common histologic type is superficial spreading. b. Depth of invasion (measured in millimeters), ulceration and patient gender are important prognostic criteria. c. Nodular melanomas carry a poorer prognosis than do superficial spreading melanomas of the same thickness. d. Melanomas in dark-skinned people are frequently subungual or appear on the palms and soles. Answer: C Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 1, pp. 522-527 MPL: 0.6 3. A mass in the midline of the neck just above the tracheal cartilage has been notable for some months in an 8 year-old girl but in the last four days there has been some reddening and discomfort. Which of the following statements is most likely correct? a. It has a high probability of malignancy. b. It would most likely resolve completely with antibiotics. c. It would rise higher in the neck when she protrudes her tongue. d. Incision and drainage is adequate treatment. Answer: C Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 1, pp. 601-602 MPL: 0.6 4. Each of the following factors contributes to the likelihood that a mass in the neck is malignant, EXCEPT: a. The patient is alcoholic. a. The patient had another malignancy outside the neck. b. The patient is quite sure it was not present a week ago. c. The patient was a heavy smoker, but quit two years ago. Answer: C Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 1, pp. 617-620 MPL: 0.6 5. Which of the following statements concerning parotid tumors is true? a. 80% are benign b. Diagnosis is by incisional biopsy c. Facial nerve palsy is a definite sign of malignancy d. Tumors that extend into the deep lobe of the parotid are unresectable Answer: A Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 1, pp. 657 MPL: 0.6

6. The type of hiatal hernia for which operation is indicated based on its demonstrated presence is: a. sliding hiatal hernia

b. para-esophageal hiatal hernia c. “short esophagus” d. Barrett’s esophagitis Answer: B Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 1, pp. 1116 MPL: 0.4 7. Which of the following esophageal abnormalities is premalignant? a. reflux esophagitis b. Barett’s esophagitis c. Presbyesophagus d. Scleroderma Answer: B Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 1, pp.1116 MPL: 0.4 8. Of the anatomic layers of the esophagus, which statement is true for the serosal layer? a. It is effective in temporarily halting the spread of carcinoma. b. It lubricates the esophageal thoracic mobility during swallowing. c. It is useful in suturing anastomoses to the esophageal stump. d. It does not exist. Answer: D Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 1, pp. 1138 MPL: 0.5 9. A 32 year-old woman complains of difficulty swallowing, foul breath, and regurgitation of undigested food. Her most likely diagnosis is: a. esophageal cancer b. achalasia c. Zenker’s diverticulum (pulsion) d. Esophageal stenosis from reflux esophagitis Answer: C Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 1, pp. 1125 MPL: 0.5 10.

Signs of breast cancer include each of the following, EXCEPT: a. bloody nipple discharge b. skin dimpling c. Paget’s disease of the nipple d. breast discomfort Answer: D Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 1, pp. 556-558 MPL: 0.6

11. In a 36 year-old woman with a painless hard dominant breast lump, the next step should be: a. mammography of the lump b. fine needle aspiration cytology c. radiation therapy

d. radical mastectomy Answer: B Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 1, pp. 570-571 MPL: 0.6

12.

Which of the following breast lesions is typically benign? a. cystosarcoma phylloides b. comedocarcinoma c. medullary carcinoma d. lobular carcinoma Answer: A Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 1, pp. 552-553 MPL: 0.6

13. Current adjunctive therapy for a premenopausal 40 year old woman following radical mastectomy with a 2.5 cm ductal carcinoma with a 2 of 15 lymph nodes involved and an estrogen receptor negative tumor includes: a. tamoxifen b. cytotoxic chemotherapy c. androgens d. oophorectomy Answer: B Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 1, pp. 590 MPL: 0.5 14. A 65 year-old farmer presents with a 1.5-cm ulcerated lesion on the middle third of his lower lip. The lesion has been present for 4 months and is not painful. No lymph nodes are palpable in the patient’s neck. The most likely diagnosis is: a. Squamous cell carcinoma b. Basal cell carcinoma c. Herpes simplex d. Keratoacanthoma Answer: A Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 1, 521-522 MPL: 0.6 15. A 65 year-old patient who spends summer in Baguio City presents with a painless, ulcerated lesion on the right cheek. The lesion has been present for one year. Physical examination of the patient’s neck reveals no lymph node enlargement. The most likely diagnosis is: a. pyogenic granuloma b. melanoma

c. basal cell carcinoma d. squamous cell carcinoma Answer: C Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 1, 522 MPL: 0.5 Subject: General Surgery II Instructions: Multiple Choice : Choose the BEST answer. 16. A 60yr.old male underwent operation for a perforated diverticulitis of the descending colon. What would be the most dominant bacteria if the peritoneal fluid was cultured? a. E.coli b. Bacteroides c. H. pylori d. Proteus Answer: B Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 2, pp. 1274 MPL: 0.7 17. A 70yr.old male post-stroke patient with hemiplegia came in at the E.R. complaining of crampy abdominal pain, abdominal distention, vomiting and absence of bowel movement. Physical examination revealed globular abdomen & tender all quadrants. Scout film of the abdomen revealed an “inverted” U shaped, sausage like loop on L abdomen. What would be the likely diagnosis? a. Strangulated Hernia c. Sigmoid Volvulus b. Perforated Diverticulitis d. Completely Obstructing Colonic CA. Answer: C Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 2, pp. 1275 MPL: 0.5 18. What would be the best management for case no.17? a. Observation w/ IV antibiotics c. Barium enema b. Colonoscopy c. Barium enema d. Exploratory Laparotomy Answer: D Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 2, pp. 1275 MPL: 0.6 19. The appropriate surgical procedure for a perforated sigmoid diverticulitis with generalized peritonitis is: a. Sigmoid resection w/ primary anastomosis b. Double barrel transverse colostomy w/ drainage of perforation c. Proximal loop colostomy and drainage of perforation d. Resection of perforated segment w/ end colostomy Answer: D Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 2, pp. 1279-1280 MPL: 0.4

20. A 50yr.old underwent colonoscopy where there is a note of a pedunculated 1.6cm sigmoid polyps and the histopath revealed a tubular adenoma which contained a well-differentiated adenocarcinoma extending to but not beyond the muscularis mucosa. The margin of polypectomy is free of tumor. The best therapeutic option will be: a. Segmental resection of the colon b. Operative colostomy and excision of polypectomy site c. Observation and repeat colonoscopy after 3-6 months d. Intracavitary radiotherapy Answer: C Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 2, pp. 1344 MPL: 0.4 21. A 45y/o F G3P3 came in for consult due to sensation of rectal fullness, mucus discharge and bright red blood dripping into the toilet. Rectal exam revealed a mucosa lined canal mass which is noted to reduce spontaneously. Your primary consideration is internal hemorrhoids. You can further classify this as: a. 1st degree hemorrhoid b. 2nd degree hemorrhoid c. 3rd degree hemorrhoid d. 4th degree hemorrhoid Answer: B Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 2, pp. 1296 MPL: 0.7 22. Assuming this is the 1st consult of the patient in case #21, what would be the appropriate management? a. Medical therapy (i.e increase dietary fiber, stool softer & avoidance of straining) b. Elastic ligation c. Coagulation d. Excessional hemorrhoidectomy Answer: A Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 2, pp. 1296-1297 MPL: 0.6 23. A 30y/o M has persistent purulent drainage from an external anal fistula from abscess few weeks ago. If the external fistula is 2cm anterior to a line transversely drawn in the anus. The internal opening will be noted at: a. curve tract in the posterior midline b. short, direct fistulous trait c. absence of fistulous tract d. beside the external opening Answer: B Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 2, pp. 1306 MPL: 0.6 24. After a L hemicolectomy and an end to end an anastomosis for adenocarcinoma of the descending colon, a 65y/o F was noted to have a fecaloid discharge in the incision site. She is afebrile w/ abdomen soft,

NABS and non-tender. While among the following factors will increase chance of spontaneous closure of fistula. a. distal obstruction b. long fistulous tract c. loss of bowel continuity d. 1000 LC/24hr fistula output Answer: B Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 2, pp. 1296 MPL: 0.5 25. A 55y/old female came in for consult due to intermittent crampy abdominal pain and change in bowel habits of 1month duration. Physical examinations were essentially normal. Barium study with revealed an “apple core” lesion on the L colon. What would be the next appropriate step of management? a. Colonoscopy w/ Biopsy b. CT-scan of the abdomen c. ULTRASOUND of the abdomen d. Sigmoidoscopy w/ Biopsy Answer: A Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 2, pp. 1347 MPL: 0.7 26. Patient in no.10 underwent operation, histology report showed the tumor to invade the muscularis propea w/ 2 pericolic lymph nodes and negative liver metastasis. What is the stage of the patient? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4 Answer: C Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 2, pp. 1350-1351 MPL: 0.5 27.

What is the common mode of spread of colorectal cancer? a. direct extension b. hemotogenosis c. lymphatic d. implantation Answer: C Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 2, pp. 1350-1351 MPL: 0.5

28. Which is the most important prognostic determinant of survival of patient w/ colorectal cancer? a. tumor size b. transmural extension c. DNA content d. Lymph node involvement Answer: D Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 2, pp. 1354-1355

MPL:

0.5

29. Which of the following colorectal polyps have the highest risk of developing colorectal cancer? a. tubular adenoma b. hyperplastic polyp c. tubulo villous adenoma d. villous adenoma Answer: D Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 2, pp. 1342 MPL: 0.5

30. Which among the following statements is not true regarding Familial Adenomatosis Polypsis? a. it has more than 100 adenomatosis polyps in the large bowel b. includes a spectrum of syndromes i.e Gardner’s syndrome and Turcot’s syndrome c. genetic defect is detected in chromosome 5,near g21 locus d. it is an autosomal recessive disorder. Answer: D Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 2, pp. 1275 MPL: 0.5 Subject: Instructions:

General Surgery III Multiple Choice : Choose the BEST answer.

For questions 31 to 39: A 45 year old woman is admitted for a perforated duodenal ulcer 6 hours after onset of symptoms. She has a history of chronic peptic ulcer disease treated medically with minimal symptoms.

31. The patient is assessed to be dehydrated at the emergency room with dry mucous membranes, tachycardia and a blood pressure of 90/60. Her depleted intravascular volume is mainly due to isotonic fluid losses due to: a. Vomiting b. poor intake c. third space loss due to peritonitis d. escape of gastric fluid through the perforated duodenum Answer: C Reference: Principles of Surgery, Schwartz 6th Edition, pp. 1455 MPL: 0.6 32.

Intravenous fluid of choice for resuscitation would be: a. 0.3 Normal Saline b. 0.45 Normal Saline c. D5 Water d. Plain LR solution Answer: D Reference: Principles of Surgery, Schwartz 6th Edition, pp. 1475 MPL: 0.7

33. The most cost- effective method of monitoring adequacy of hydration is through the use ofa/an: a. Foley catheter b. Nasogastric tube c. Swan-Ganz catheter d. Intra-arterial Pressure monitoring. Answer: A Reference: Principles of Surgery, Schwartz 6th Edition, pp. 1475 MPL: 0.5 34. Given an actual body weight of 60 kilograms, an adequate hourly urine output would be: a. 25 cc/ hour b. 60 cc/ hour c. 20 cc/ hour d. 15 cc/ hour Answer: B Reference: Principles of Surgery, Schwartz 6th Edition, pp. 74-78 MPL: 0.5 35. Her pneumoperitoneum would be best documented by which radiologic study: a. Chest Bucky film b. Plain Abdomen c. Chest PA upright d. Holoabdominal ultrasound Answer: C Reference: Principles of Surgery, Schwartz 6th Edition, pp. 1135 MPL: 0.6

36. Appropriate antimicrobial coverage peri-operatively would consist of intravenous: a. Ciprofloxacin b. Cefazolin c. Metronidazole d. Imipenem Answer: B Reference: Principles of Surgery, Schwartz 6th Edition, pp. 1134-1137 MPL: 0.6 37. If the patient exhibits unstable vital signs in the operating theatre, the procedure of choice is: a. Hemigastrectomy b. Simple closure with omental patch c. Antrectomy and truncal vagotomy d. Highly selective Vagotomy

Answer: Reference: 1138 MPL:

B Principles of Surgery, Schwartz 6th Edition, pp. 11370.6

38. It the patient exhibits stable vital signs in the operating theatre and the peritonitis is localized, the procedure of choice is: a. Hemigastrectomy b. Simple closure with omental patch c. Antrectomy and truncal vagotomy d. Highly selective Vagotomy Answer: C Reference: Principles of Surgery, Schwartz 6th Edition, pp. 1137-1138 MPL: 0.5 39.

This microbe has been implicated in the causation of her disease: a. H. influenzae b. H. pylori c. S. pneumoniae d. S. aureus Answer: B Reference: Principles of Surgery, Schwartz 6th Edition, pp. 1134 MPL: 0.6

For questions 40to 42: A 53 year old man is diagnosed to have a bleeding duodenal ulcer on urgent endoscopy after he presented at the emergency room with melena. His vital signs are stable.

40.

The blood vessel most likely involved in the above lesion if the : a. Left Gastric Artery b. Gastroduodenal Artery c. Coronary Vein d. Right Gastroepiploic Artery. Answer: B Reference: Principles of Surgery, Schwartz 6th Edition, pp. 1134-1135 MPL: 0.4

41. The lesion showed evidence of active bleeding on endoscopy, the most appropriate management to arrest the bleeding would be: a. NGT lavage with ice cold saline b. Urgent Laparotomy c. Endoscopic Hemostasis d. Angiographic Hemostasis Answer: C Reference: Principles of Surgery, Schwartz 6th Edition, pp. 1134-1135 MPL: 0.6 42. The most appropriate supportive medication to administer in addition to # 41 would be: a. Antacids b. Intravenous H2 blockers

c. Intravenous Proton Pump Inhibitors d. Oral H2 blockers Answer: C Reference: Principles of Surgery, Schwartz 6th Edition, pp. 1134-1135 MPL: 0.6 For questions 43 to 45. A 50 year old man presents with obstructive jaundice.

43. Additionally, he presented with significant weight loss and mild abdominal discomfort. Ultrasound examination revealed Dilated intrahepatic ducts, gall bladder and common bile duct. The most likely diagnosis is: a. Klatskin Tumor b. Hepatocellular Carcinoma c. Common Duct Stone d. Pancreatic Head Cancer Answer: Reference: MPL:

D Principles of Surgery, Schwartz 6th Edition, pp. 1421-1425 0.5

44. Additionally, he presented with a prior 2 month history of episodic severe, right upper quadrant pain and fever associated with waxing and waning jaundice. The most likely diagnosis is: a. Klatskin Tumor b. Hepatocellular Carcinoma c. Common Duct Stone d. Pancreatic Head Cancer Answer: C Reference: Principles of Surgery, Schwartz 6th Edition, pp. 1382-1383 MPL: 0.4 45. Additionally he presented with significant weight loss and mild abdominal discomfort. Ultrasound examination revealed Dilated intrahepatic ducts with no visualization of the gallbladder and common bile duct. The most likely diagnosis is: a. Klatskin Tumor b. Hepatocellular Carcinoma c. Common Duct Stone d. Pancreatic Head Cancer Answer: A Reference: Principles of Surgery, Schwartz 6th Edition, pp. 13891390 MPL: 0.5 Subject: Trauma Instructions: Multiple Choice : Choose the BEST answer. 46. A 24 year old male was admitted for a Tension Pneumothorax of the Right Lung due to a stab wound in the chest. The intervention of choice would be: a. Tube Thoracostomy b. Subxiphoid Window c. Cricothyroidotomy d. Endotracheal Intubation

Answer: Reference: 675 MPL:

A Principles of Surgery, Schwartz 6th Edition, pp. 6740.6

47. A 30 year old male was admitted for a Flail Chest on the Right Hemithorax cue to injuries sustained in a car crash. The intervention of choice would be: a. Tube Thoracostomy b. Subxiphoid Window c. Cricothyroidotomy d. Endotracheal II:¥Ubation Answer: D Reference: Principles of Surgery, Schwartz 6th Edition, pp. 675 MPL: 0.5 48. A 29-year-old male was admitted for Laryngeal Obstruction due to injuries sustained in a car crash. The intervention of choice would be: a. Tube Thoracostomy b. Subxiphoid Window c. Cricothyroidotomy d. Endotracheal Intubation Answer: C Reference: Principles of Surgery, Schwartz 6th Edition, pp. 673 MPL: 0.6

49. A 22-year-old male was admitted for an Open Pneumothorax due to a gun shot wound. The intervention of choice in the acute setting would be: a. Occlusive Dressing b. Subxiphoid Window c. Cricothyroidotomy d. Endotracheal Intubation Answer: A Reference: Principles of Surgery, Schwartz 6th Edition, pp. 674-675 MPL: 0.5 50. A 19-Year-old Male was admitted for a Pericardial Tamponade caused by an Ice Pick wound to the chest. The intervention of choice would be: a. Tube Thoracostomy b. Subxiphoid Window c. Cricothyroidotomy d. Endotracheal Intubation Answer: B Reference: Principles of Surgery, Schwartz 6th Edition, pp. 887888 MPL: 0.6

For questions 51 and 52: A 19 year old male is kicked in the left flank. Three hours later he develops gross hematuria. His vital signs are stable.

51.

Initial diagnostic test of choice would be: a. Retrograde urethrography b. Retrograde cystography c. Arteriography d. High dose infusion urography Answer: D Reference: Principles of Surgery, Schwartz 6th Edition, pp. 1766-1768 MPL: 0.5

52. The diagnostic tests performed revealed extravasation of contrast into the renal parenchyma. Treatment of choice would be: a. Exploration and suture of laceration. b. Non surgical treatment consisting of serial monitoring of vital signs and increased fluid intake and antibiotics. c. Exploration and Nephrectomy d. Exploration and ligation of the involved Renal artery . Answer: C Reference: Principles of Surgery, Schwartz 6th Edition, pp. 17661768 MPL: 0.6 For questions 53-55. .A 13 year old boy falls from his bicycle and is run over by a passing truck. On arrival in the emergency room he is awake, alert and appears frightened but in no distress. The chest radiograph suggests an air fluid level in the left lower lung field and the nasogastric tube seems to coil upward into the left chest.

53.

The teen aged boy is suffering from: a. Flail chest b. Rupture of the left hemidiaphragm c. Pleural Effusion d. Lung Contusion Answer: B Reference: Principles of Surgery, Schwartz 6th Edition, pp. 675-676 MPL: 0.6

54. On the 45th minute of admission, the patient starts to exhibit tachycardia and hypotension. Rapid fluid resuscitation is significantly enhanced by which of the following? a. Placement of long gauge 18 subclavian catheters. b. Placement of short large bore percutaneous peripheral intravenous catheters. c. Bilateral saphenous vein cut downs. d. Bilateral femoral vein cut downs. Answer: B Reference: Principles of Surgery, Schwartz 6th Edition, pp. 176 MPL: 0.6

55.

The next best step in management is:

a. Non Surgical treatment in the ICU setting. b. Placement of a left chest tube. c. Immediate celiotomy d. Immediate thoracotomy. Answer: C Reference: Principles of Surgery, Schwartz 6th Edition, pp. 675676 MPL: 0.6 56. A 15 year old boy is admitted for a intra peritoneal injury aft'er he is run over by a car. The most commonly injured organ in this case is the: a. Liver b. Spleen c. Kidney d. Pancreas Answer: B Reference: Principles of Surgery, Schwartz 6th Edition, pp. 212214 MPL: 0.5 For questions 57 to 60. A 25 year old woman arrives in the emergency room following an automobile accident. She is very dyspneic with a respiratory rate of 48 breaths per minute. Breath sounds are markedly diminished on the right side and the trachea is deviated to the left.

57.

She is most likely suffering from a: a. Massive Pleural Effusion b. Simple Pneumothorax c. Tension Pneumothorax d. Hemothorax Answer: C Reference: Principles of Surgery, Schwartz 6th Edition, pp. 674676 MPL: 0.6

58.

In this patient there is : a. Collapse of the ipsilateral lung b. Shifting of the mediastinal structures to the ipsilateral side of the injury. c. Shifting of the trachea to the ipsilateral side of the injury d. Increased Cardiac ouput. Answer: A Reference: Principles of Surgery, Schwartz 6th Edition, pp. 674676 MPL: 0.6

59.

The first step in managil1g the patient should be to a. Take a chest X ray b. Draw arterial blood for blood gas studies c. Decompress the Right Pleural space d. Perform Pericardiocentesis. Answer: C Reference: Principles of Surgery, Schwartz 6th Edition, pp. 674676 MPL: 0.6

60.

If left untreated, this woman may succumb due to: a. Pneumonia b. Empyema Thoracis c. Hypoxemia and Hypotension d. Myocardial Infarction Answer: C Reference: Principles of Surgery, Schwartz 6th Edition, pp. 674-676 MPL: 0.6

Subject: Instructions:

Orthopedic Surgery Multiple Choice : Choose the BEST answer.

61.

These are present in a typical Colles fracture except: a. Dorsal angulation (silver fork deformity) c. Ulnar shortening b. Radial angulation d. Involves distal metaphysis of the radius Answer: C Reference: Rockwood and Green’s Fractures in Adults, Vol. 1, pp. 770 MPL: 0.5

62.

A reverse Colles fracture is called a. Barton’s fracture c. Frykmann’s fracture b. Smith’s fracture d. Pouteau’s fracture Answer: B Reference: Rockwood and Green’s Fractures in Adults, Vol 1, pp. 770 MPL: 0.5

63. An open fracture with a very large wound (more than 10cm) caused by a sharp object such as a knife with minimal soft tissue injury is classified as a: a. Type I Open fracture c. Type III Open fracture b. Type II Open fracture d. Type IV Open fracture Answer: B Reference: Rockwood and Green’s Fractures in Adults, Vol 1, pp. 309 MPL: 0.6 64.

The antibiotics of choice for the treatment of open fractures: a. Penicillin c. Cephalosporins b. Streptomycin d. Aminoglycosides Answer: C Reference: Rockwood and Green’s Fractures in Adults, Vol 1, pp. 347 MPL: 0.6

65.

The distal carpal row is formed by the following bones except: a. Triquetrum c. Trapezium b. Capitate d. Hamate Answer: A

Reference: 1, pp. 750 MPL:

Rockwood and Green’s Fractures in Adults, Vol 0.5

66. Its innervation is purest at the palmar skin of the tip of the index finger: a. Ulnar nerve c. Median nerve b. Radial nerve d. Posterior interosseous nerve Answer: C Reference: Physical examination of the Spine and Extremities by Hoppenfeld, pp. 98 MPL: 0.6 67.

This test evaluates the strength of the gluteus medius: a. Thomas test c. Finkelstein’s test b. Allen test d. Trendelenburg test Answer: C Reference: Physical examination of the Spine and Extremities by Hoppenfeld, pp. 164 MPL: 0.5

68. To test for the true leg length, one measures from the __________to the medial malleoli. a. Umbilicus c. Posterior superior iliac spine b. Anterior superior iliac spine d. Greater trochanter Answer: B. Reference: Physical examination of the Spine and Extremities by Hoppenfeld, pp. 165 MPL: 0.6 69.

This is a very common site for gout: a. First metatarsal head c. Elbow b. Ankle d. Knee joint Answer: A Reference: Physical examination of the Spine and Extremities by Hoppenfeld, pp. 209 MPL: 0.5

70.

This area of the bone is most often involved in acute osteomyelitis a. Epiphysis c. Diaphysis b. Metaphysis d. Physis Answer: B Reference: Orthopedics by Turek, pp. 258 MPL: 0.4

Subject: Instructions:

Thoracic Cardio Vascular Surgery Multiple Choice : Choose the BEST answer.

71. In the evaluation of lymph node status of patients with suspected lung cancer, Chamberlaine procedure or parasternal mediastinotomy is used to biopsy what location of lymph nodes? a. cervical lymph nodes c. aortopulmonary window lymph nodes b. paratracheal nodes d. subcarinal lymph nodes Answer: C Reference: Principles of Surgery, pp. 671 MPL: 0.5 72. A 17 y/o, male, sustained a stab wound on the right chest. He was brought to the ER complaining of dyspnea. He was given oxygen support and started with IVF. On physical examination, the following are manifestations of Tension Pneumothorax except: a. dilated neck veins c. absent or distant breath sounds b. dull percussion over the injured hemithorax d. hypotension Answer: B Reference: Principles of Surgery, pp. 684 MPL: 0.6 73. A 35 y/o, male, with gunshot wound over the left chest was brought to the ER. After initial resuscitation, a chest tube was inserted draining bloody pleural effusion. What amount of drainage will warrant an emergency thoracotomy?

a. 1.5 liter c. 50 ml per hour for 3 consecutive hours b. 500 ml d. 700 ml Answer: A Reference: Principles of Surgery, pp. 684 MPL: 0.7 74. A young tall male suddenly complains of chest pain and dyspnea while playing basketball. Chest x-ray showed pneumothorax on the left hemithorax. What is the most likely cause? a. Lung abscess b. PTB c. Bronchiectasis d. Ruptured bleb or bulla Answer: D Reference: Principles of Surgery, pp. 711 MPL: 0.6 75. Myasthenia gravis is associated most commonly with what type of mediastinal tumor? a. Lymphoma b. Teratoma c. Neurogenic tumor d. Thymoma Answer: D Reference: Principles of Surgery, pp. 774 MPL: 0.6

76. Chest x-ray is used initially to evaluate patients with congenital heart disease. What cardiac contour is typical of Tetralogy of Fallot? a. egg – shape b. boot – shape c. snowman appearance d. apple – shape Answer: B Reference: Principles of Surgery, pp. 797 MPL: 0.5 77. A 20 y/o, female, consulted at the ER with complaints of palpitation and dyspnea. She was diagnosed to have Patent Ductus Arteriosus during her childhood. What is the hallmark of this congenital disease? a. wide pulse pressure b. distant heart sounds c. continuous machinery murmur d. engorged neck veins Answer: C Reference: Principles of Surgery, pp. 812 MPL: 0.5 78. In coronary artery bypass grafting, what is the most important vessel used with a long term patency rates exceeding 90%? a. internal mammary artery b. saphenous vein c. radial artery d. tibial artery Answer: A Reference: Principles of Surgery, pp. 859 MPL: 0.4 79. A 35 y/o, male patient complains of exertional dyspnea and fatigue. On P.E., he has a grade 3 apical diastolic murmur and bipedal edema. ECG showed atrial fibrillation. 2D Echocardiography showed a severely stenotic and calcified mitral valve. What is the most likely cause?

a. infection b. trauma c. congenital d. rheumatic Answer: Reference: MPL:

D Principles of Surgery, pp. 876 0.4

80. A 55 y/o, male, smoker, diabetic for 10 years was admitted due to chest pain radiating to the left shoulder. ECG showed ST segment elevations in leads II, AVF, V 1-3. Diagnosis was Unstable Angina. Coronary angiogram showed significant three vessel disease. The surgical treatment of choice is: a. valve replacement b. coronary artery bypass grafting

c. laser therapy d. VATS ( video assisted thoracic surgery ) Answer: B Reference: Principles of Surgery, pp. 861 MPL: 0.4 Subject: Instructions:

Urology Multiple Choice : Choose the BEST answer.

81. A 13 year old boy was brought in at the ER due to blood dripping at the urethral meatus. The following informations is/are necessary to make the proper diagnosis. a. history of acute colicky flank pain b. history of straddle or pelvic crushing injury c. history of instrumentation d. family history of renal disease Answer: B Reference: Smith’s General Urology, pp. 343-345 MPL: 0.5 82.

Injury to the urethra is best diagnosed by means of a. voiding cystourethrogram b. retrograde urethrogram c. cystogram d. retrograde pyelography Answer: B Reference: Smith’s General Urology, pp. 344 MPL: 0.4

83.

The most common cause of ureteral injury is/are a. iatrogenic b. vehicular accident c. penetrating abdominal injury d. self-induced Answer: A Reference: Smith’s General Urology, pp. 329 MPL: 0.4

84.

The classic triad of manifestations of renal cell CA a. hematuria, weight loss, and pain b. hematuria, weight loss, and mass c. hematuria, palpable mass, and flank pain d. hematuria, palpable mass, and weight loss Answer: C Reference: Smith’s General Urology, pp. 383 MPL: 0.4

85.

Stage II renal cell CA is managed by a. chemotherapy b. radiation therapy

c. partial nephrectomy d. radical nephrectomy Answer: D Reference: Smith’s General Urology, pp. 387-388 MPL: 0.5 86. Patient presenting with painless gross hematuria is most likely suffering from a. renal cell carcinoma b. ureteral transitional cell CA c. bladder transitional cell CA d. renal pelvic transitional cell CA Answer: C Reference: Smith’s General Urology, pp. 358 MPL: 0.6 87. On digital rectal exam, a strong 63 year old male sexually active male was found to have a 1.0cm nodule on the right lobe of the prostate gland. However, he was asymptomatic, what will be your next plan of management? a. transrectal prostate ultrasound b. transabdominal KUB prostate ultrasound c. acid phosphatase determination d. prostate specific antigen test Answer: D Reference: Smith’s General Urology, pp. 406-407 MPL: 0.4 88.

Prostatic CA most commonly originates at what zone? a. central zone b. transitional zone c. peripheral zone d. periurethral gland Answer: C Reference: Smith’s General Urology, pp. 406-408 MPL: 0.4

89. On transrectal UTZ guided needle biopsy of prostate gland, result showed adenocarcinoma with a Gleason’s score of 4+5 (9) and PSA value of 42 (NO 0-4). The next step is to determine the stage of the disease. What will be your best choice in staging the disease? a. total body bone scan b. abdominal CT scan c. pelvic lymphangiography d. molecular staging Answer: A Reference: Smith’s General Urology, pp. 411 MPL: 0.4 90. Benign prostatic hyperplasia originates from what portion or zone of the prostatic gland? a. central zone b. transitional zone c. peripheral zone d. periurethral gland

Answer: Reference: MPL:

D Smith’s General Urology, pp. 399-401 0.4

Subject: Neuro Surgery Instructions: Multiple Choice : Choose the BEST answer. 91. Regarding the relationship of ICP and systemic BP, the best conclusion is: a. blood pressure may be high without increased ICP b. ICP may be elevated without change in BP c. BP may increase as ICP is falling d. The relationship is unconstant and measuring BP is not a satisfactory technique for measuring ICP. Answer: D Reference: Youman’s Neurological Surgery, pp. 469 MPL: 0.4 92. The presence of reflexes of spinal origin in brain damaged patients: a. Is prognosis of recovery b. Is compatible with a diagnosis of brain death c. Is incompatible with a diagnosis of brain death d. None of the above Answer: B Reference: Ivan, L.P. Neurology (Minn.), chap. 23 pp. 650, MPL: 0.5 93. In traumatic transection of the spinal cord, “spinal shock” may a. Last from 3 or 4 days to 6 weeks. b. Result in permanent flaccidity of the denerated muscles c. Never be evident d. None of the above Answer: A Reference: Haymakers, W. Bing’s Local Diagnosis in Neurologic Diseases, pp. 85 MPL: 0.6 94. The mesencephalic nucleus of the trigeminal nerve is concerned with: a. Propuoceptive fibers b. Tactile sensaion c. Thermal sensation d. Pain sensation Answer: A Reference: Bloedel, J.R. & Mc Cherry, D.B. Surg. Neurol., chap. 4 pp. 68 MPL: 0.4 95. In civilian practice, an intracranial missile is not ordinarily removed if it is deep in the brain. Periodic radiological observation is indicated for all of the following reasons except: a. The bullet may migrate b. It may move to on accessible area c. The movement may cause neurological damage d. Erosion of vascular structures is frequent complication

Answer: Reference: pp. 129 MPL:

A Lieberkind, A.L. et al. Neuroradiology, chap. 5 0.4

96. Increased morbidity and mortality in patients with epidural hematoma was associated with all of the following except: a. Late development of the hematoma b. Concomitant brain injury c. Unconsciousness at time of operation d. Early development of the hematoma Answer: A Reference: Heiskamen, O. Surgical Neurology, chap. 4 pp. 23 MPL: 0.6

97. There is a question regarding the utility of routine skull x-rays in trauma patients. Recently, authors have suggested all of the following except: a. There is high correlation between physical findings and the detection, location and type of fracture demonstrated by x-ray. b. There’s little correlation between physical findings and the detection, location and type of fracture demonstrated by x-ray. c. Skull fractures are an insignificant manifestation of trauma. d. Skull fractures need not be detected unless there is reasonable possibility of depressed fragments. Answer: A Reference: Bill R.S. & loop, J.W.NEJM and Roberts, F & Shaftner, Radiology 114: 230, 1972, chap. 284 pp. 236 MPL: 0.5 98. All of the following apply to patient with compound depressed skull fractures EXCEPT: a. 1/4 will develop late epilepsy b. 10% have an associated hematoma c. 2/3 of patients were not unconscious d. Dural penetration greatly increased the likelihood of early epilepsy Answer: D Reference: Heiskamen, O. et al Acta Chir Scand, chap. 139 pp. 605 MPL: 0.5 99. Regarding patients with chronic subdural hematoma.: a. History of craniocerebral trauma in 90% of patients.

b. Have a precipitous onset c. History of craniocerebral trauma in 50% of patients d. 90% of patients with a history of craniocerebral trauma were unconscious following the trauma. Answer: C Reference: Figelholm. R. etal. J Neurosurgery, 1975, chap. 42 pp. 43 MPL: 0.6 100. The most important factor in infection as a complication of depressed skull fracture is: a. Delay in treatment c. Failure in antibiotic therapy b. Replacement of bone fragments d. Inadequate debridement Answer: A Reference: Jennett, B.J. Neurosurgery, 1972, chap. 36 pp. 337 MPL: 0.5