Review Questions for Surgery
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REVIEW QUESTIONS FOR SURGERY MD3 2017-‐2018 Plastic Surgery, Head and Neck 1. Early signs & symptoms of life-‐ threatening smoke inhalation injury include: a. stridor b. wheezes c. progressive hoarseness of voice d. laryngeal edema 2. Silver sulfadiazine the gold standard for topical management of wounds: a. has a broad spectrum antimicrobial coverage against both gram (+) and gram (-‐) bacteria including Pseudomonas spp, E. coli, P. vulgaris b. may cause leukocytosis as a reversible side effect c. penetrates burn eschar effectively to reach the surface of wound d. delays wound epithelialization 3. Cleft palate repair is done: a. under local anesthesia b. simultaneously with cleft lip repair at 3 months of age c. between ages 18 months to 15 yrs of age d. as early as possible in order to maximize the recovery 4. Thin split-‐ thickness skin grafts are characterized as: a. containing epidermis and the upper half of the dermis b. ranging between .008-‐.020 inch in thickness c. more prone to primary & secondary contaction d. with cosmetic appearance better than thicker grafts
5. Full thickness skin grafts are indicated for coverage in which of these situations? a. lower eyelid defect following ablation of BCC b. full thickness V-‐shaped defect of the lower lip post excision of capillary hemangioma c. wound defect due to deep partial thickness burns over the R cheek d. full thickness scalp defect with exposure of calvarium 6. abdominal dermolipectomy is a cosmetic surgical procedure that involves a. removal of excess localized fat from the ant abdomen through liposuction b. excision of skin +fat on the ant abdominal wall from below the umbilicus down to the suprapubic area c. repositioning of the umbilicus downwards through the new skin drape d. thinning out of the fascia and repair of the linea alba on the ant abdominal wall 7. lab exam included in the systemic prep of Px w/ wound defects requiring coverage: a. wound biopsy & culture b. total CHON determination c. FBS determination d. 2D-‐echocardiography 8. The “rule of tens” used as criteria for timing of repair of cleft lip deformities prescribes surgery at: a. 10 months of age b. Hgb level at least 10gm/dl c. WBC count of at least 10,000 d. Weight of at least 10kg
9. A tripod facial bone fracture involves which of these bones? a. mandible b. orbit c. nasal d. ethmoid 10. Primary survey of the Px w/ traumatic injuries entails: a. ensuring a patent airway free of foreign materials b. local wound management c. nutritional support d. infection control 11. Deterrents of wound healing include: a. chemotherapeutic agents b. zinc c. ascorbic acid d. corticosteroids 12. Alginates, hydrogels & hydrocolloids are considered ideal dressing materials for wounds because they a. prevent maceration of the periwound area b. maintain enough moisture on the wound surface c. prevent punctate hemorrhages on the wound bed d. have broad spectrum antibacterial coverage 13. in which of the following chemical processes does the action of Vit C or ascorbic acid become important in wound healing? a. hydroxylation of AA b. prevention of bacterial translocation c. collagen fiber re-‐alignment d. blocking the adverse effects of steroids 14. Which among these materials has the same action as Vit C in wound healing? a. Zn
b. Mn c. Fe d. Cu 15. The MC cause of skin graft failure is: a. infection b. seroma formation c. necrosis d. hematoma 16. Recommended management of a fresh mandibular condyle fracture without dislocation is a. conservative non-‐surgical approach b. intermaxillary fixation alone c. open reduction + interosseous plate fixation d. open reduction + interosseous plate fixation + intermaxillary fixation 17. Valid statement regarding management of facial bone fractures: a. conservative non surgical approach is reserved for unstable fractures b. open reduction + interosseous plate fixation + intermaxillary fixation is surgical procedure for Lefort II fractures c. generally, mandibular fractures heal faster than maxillary fractures d. “pure blowout” orbital fractures present with orbital rim and floor involvement 18. Rhytidoplasty is a cosmetic surgical procedure to remove: a. eye bags b. facial wrinkles c. witch’s chin d. crows feet 19. Which of the ff statements regarding SIRS the MC cause of mortality among burn Px is/ are valid? a. Langhans cells and keratinocytes in skin lose their immune function due
to coagulation of CHONs on the surface of the burn wounds b. Burn wound infection and pneumonia often progressing into sepsis usher in SIRS c. Clinical S/S of SIRS like fever, tachycardia, changes in sensorium & restlessness usually manifest w/in the 1st 72 hrs ff burn injuries d. Use of systemic broad spectrum antibiotics together w/ topical antibacterial like silver sulfadiazine prevent SIRS 20. The most preferred dressing materials for wounds are those that: a. Are both bacteriostatic and bactericidal b. Don’t require frequent change thus cost effective c. Lessen the pain on the wound area such that the Px doesn’t need analgesics d. Maintain moisture on the surface of wound 21. The goals of reconstruction include a. Provision of cosmetically superior coverage b. Restoration of form and function c. Primary closure of wide defects d. Use of grafts or flaps depending on the nature and extent of defect 22. Random pattern flaps are characterized as a. Having better vascular supply than axial pattern flaps b. Dependent on the cutaneous blood supply c. Subject to width and length ratio of 1:3 d. Always pedicled 23. Advantages of meshed split thickness skin grafts include: a. Superior cosmetic appearance b. Easier revascularization
c. Better drainage of seroma/ hematoma d. Lower failure rates 24. Sequelae of burn injuries: a. Sepsis b. Marjolin’s ulcer c. Burn scar contractures d. Loss of limbs (post amputation) 25. Among the ff burn Px, who will need to be admitted to hospital for Tx? a. Middle aged housewife w/ multiple small scalding burn lesions both upper extremities sustained while frying milkfish b. Grade school pupil w/ a 5cm bulla at the R calf area from contact w/ motorcycle muffler c. 20 yr old coed w/ extensive sunburn over the whole back extending from the nape down to the lumbar area then the back of both thighs d. electrician w/ a .3cm point of contact burn on the palm of the R hand & no point of grounding evident elsewhere 26. Which of the ff fat soluble Vit reverses the effects of glucocorticoids which in turn delay wound healing? a. A b. D c. E d. K 27. Among the ff wound defects which should be covered w/ a skin graft? a. Full thickness scalp loss b. Partial avulsion of the nasal tip c. Complete defect of the oral cavity wall ff wide excision of SCC d. Full thickness burn injuries A 16 month old baby boy is admitted due to scalding injuries over the ant chest, abdomen & thighs after accidental spillage of hot water from dispenser sustained about 15 min prior
to consultation at ER. Based on the Lund-‐ Browder chart TBSA amounted to 15% 28. Using the Parkland formula, how much fluid should be ordered in the 1st 8 hrs? a. 250-‐300 ml b. 500-‐600ml c. 800-‐1000 cc d. 1,200-‐ 1500cc 29. Primary survey in this patient includes which of the following measures? a. local wound care b. NGT insertion c. tracheostomy d. warm blankets Physical examination revelaed a well-‐ nourished, well developed male infant, crying uncontrollably, afebrile, with stable VS. Chest auscultation revealed occasional respiratory wheezes, R basal rales, tachycardia, with normal heart rhythm. Multiple bullous lesions admixed with pale skin patches are scattered all over the anterior chest, abdomen, and anteriror thighs. 30. Considering the offending agent and the manner of the injury, the burns are most probably; a. superficial b. superficial + deep partial thickness c. deep partial thickness d. full thickness 31. Monitoring parameters useful during the first 48 hrs include: a. conversion of burn depth b. body temperature c. bipedal edema d. hourly urine output 32. Prevention of SIRS entails institution of which therapeutic course; a. emergency escharectomy in the first 8 hours after burn injury b. systemic broad spectrum antibiotics starting on admission
c. topical SSD+ cerium nitrate over burn wounds d. enteral feedings instead of parenteral hyperalimentation 33. Recommended timing of debridement of burns in this case must be: a. as soon as patients vital signs stabilize b. within the first 48-‐72 hours c. after 5-‐7 days post burn d. direct to OR from ER 34. Which of the following statements regarding hypospadias is /are valid? a. Recommended timing of surgical repair is at pre-‐school age to spare the child some psychosocial problems. b. Multistage repair procedures present less risk for fistula formation c. Creation of a neo-‐urethra on the ventral aspect of the penis is done on stage II repair. d. Circumcision is recommended during the neonatal period ensure proper urination. 35. Nasal bone fractures; a. if without accompanying dislocation, are usually managed conservatively with analgesics and alternating cold & hot nasal compress. b. may not be shown on skull x-‐rays but usually diagnosed on proper & thorough physical examination c. will usually heal externally with 2-‐3weeks d. are ideally managed with open reduction, interosseous plate fixation and application of nasal splint for 1-‐2 weeks. 36. How long will the maturation of scar generally require? a. 4-‐6 weeks after injury b. 3-‐6 months in children c. 9-‐12 months-‐ beyond 12 y.0 d. 12-‐18 months between 0-‐12 y.o
37. Radiologic signs of facial bone fractures. a. enophthalmos b. malocclusion c. diplopia d. periorbital ecchymoses 38. Which of the following statements regarding hemangiomas is/are valid? a. Carvenous heamangiomas are generally superficial and grow alarmingly in the first year of life. b. Strawberry type of hemangiomas appear reddish, with skin tags and do not resolve with age if mucosal tissues are involved. c. Port wine nevus requires surgery because of its predilection for malignant degeneration later in life. d. Scharotics and iiradiation are effective modalities for treatment of small hemangiomas. 39. Biologic dressings maintain moisture on the surface of the wound, thereby enhancing wound healing. What other statement is about them is/are true? a. irradiated frozen cadaver skin can acts as skin graft substitute. Wounds heal underneath them since the skin is revascularized within 4-‐6 weeks. b. Amnion taken from healthy placentas can be used directly over wounds with less pain and better scar formation. c. Porcine xenografts work like human cadaver grafts in hastening and being subsequently revascularized and become definitive coverage. d. Honey impreganated on gauze and applied over the wounds hasten wound healing by nourishing the bacteria on the wound surface. 40. The pectorlais major mm. myocutaneous flap is:
a. A random-‐pattern flap, dependent on the cutaneous blood supply of overlying skin. b. The coverage of choice for composite defects over the upper half of the face and neck. c. Difficult to delineate with a skin paddle in female patients with big breasts. d. Used as an osteomyocutaneous flap, using the 7th or 8th rib to cover complex oral cavity lesions in conjunction segmental mandibulectomy. 41. The most common site for squamous cell carcinoma over the face is the; a. lower lip b. eyelids c. nose d. upper lip 42. The Lund-‐Browder chart measures which characteristics of the burn wounds? a. depth b. severity c. body surface area involved d. infection 43. Forces or pressure applied anteriorly to the chin, as when a patient fails facedown on a concrete pavement with the chin jutting out, commonly results in fracture over the; a. shaft of the mandible b. mandibular condyle c. angles of the mandible d. parasymphyseal area A 64 y.o traffic policeman presents with a 5cm lesion on R nasolabial area, characterized as a central ulcer, with hyperpigmented borders, which easily come off when washing the face, with resultant minimal bleeding. 44. What’s the most possible diagnosis?
a. b. c. d.
Squamous cell Carcinoma Basal Cell Carcinoma Malignant Hematoma Soft Tissue Carcinoma
45. Diagnosis is confirmed using which procedure? a. FNAC b. Incisional Biopsy c. Excisional biopsy d. Wide exclusion 46. The recommended margins of resection during definitive surgical ablation for this conditionare: a. 0.1-‐0.2 cm b. 0.5-‐ 1.5 cm c. 1.5-‐3.0 cm d. 3.0-‐ 5 cm 47. Using the reconstructive ladder-‐elevator principle, the best form of coverage of the ensuing defect in this case would be; a. a random-‐pattern, advancement flap b. full-‐thickness skin graft c. median forehead flap d. rhomboid flap 48. Cleft lip deformities are; a. More common among females than in males. b. Mostly heredofamilial than environmental etiology c. Associated with short stature in about 1/3 of cases. d. More common on the right than on the left. 49. These are all major factors associated with a history of rhinosinusitis, except? a. Facial Congestion b. Facial pain c. Maxillary dental pain
d. Post nasal Drip 50. A 45 y.o. Man brought to the ED due to MVA. On P.E patient able to open his eyes with painful stimuli, confused and able to localized pain. What is his GCS? a. 13 b. 12 c. 11 d. 10 51. A 28yo male sustained a sucking chest (R) wound secondary to stab wound. What would be the most initial treatment for the patient? a. Suture the wound do a needle thoracotomy b. CTT (R) c. Do an immediate Chest x-‐ray d. Occlusive Dressing on 3 out 4 sides 52. Which trauma patient that cricothyroidotomy is contraindicated? a. a 43yo male with facial fractures b. a 78yo female with GSW to the neck c. a 15yo male with stab wound to the neck d. a 5yo female with blunt neck trauma 53. A 4yo female patient brought to the ED due to fall from a height of 10feet. On PE, patient able to open his eyes with painful stimuli, persistently irritable and shows abnormal flexion. What is the GCS of the patient? a. 10 b. 8 c. 6 d. 4 54. All are life-‐threatening injuires to be identified during the primary survey under Breathing except? a. Massive Hemothorax
b. Tension Pneumothorax c. Open Pneumothorax d. Flail Chest with underlying pulmonary contusion 55. A 36yo male sustained a stab wound above the angle of the mandible, brought to the ED. The patient is hemodynamically stable and asymptomatic. All of the following are correct management except? a. Mandatory neck exploration b. CT Angiography c. Esophagoscopic examination d. Observation 56. All of the following are soft sign in penetrating neck injuries, except? a. Subcutaneous Emphysema b. Stridor c. Chest pain d. Odynophagia 57. A 32yo male was brought to the ED with a GSW below the angle of the mandible, with unstable vital sign a have a massive hemoptysis, what is the most appropriate management to the patient? a. Mandatory neck exploration b. Request for a CT Angiography c. Flexible Esophagoscopic Examination d. Observation 58. A 24yo male patient with a stab wound on the left anterior thorax was brought to the ED with the following VS BP-‐80/60, HR 115bpm, RR 35 cpm. Upon PE decrease breath sounds on the affected side, subcutaneous emphysema. What would be your diagnosis? a. Cardiac tamponade b. Tension Pneumothorax c. Open Pneumothorax d. Sucking Chest Wound
59. In the above case, what would be your initial management? a. Occlusive Dressing on 3 of sides b. CTT left c. Needle Thoracotomy d. Observation 60. In Otitis Externa, the most common causative organism is? a. Streptococcus pneumonia b. Staphylococcus aureus c. Pseudomonas aeruginosa d. Viruses 61 . The following statement are true about Ramsay Hunt Syndrome, except? a. Full recovery in all patients b. The causative agent is Varicella zoster virus c. Patient has severe otalgia d. Treatment is similar to Bell’s Palsy 62 . Which of the following statement do not describes the anatomy of the oral activity? a. Superiorly, hard-‐palate/soft-‐palate junction b. Laterally; anterior tonsillar pillars c. Extends from the posterior nasal septum and choana to the skull base d. Regional metastatic spreads to the submandibular and the upper jugular region. 63. These are the major sites within the oropharynx, except? a. Hard palate b. Soft palate c. Tonsillar region d. Base of the tongue
64. Which of the following Statements about Recurrent Respiratory Papillomatosis (RRP) is true? a. Infected with HPV subtype 16 & 18 b. Pharynx is the most frequently involved site c. Present in early childhood secondary to viral acquisition during vaginal delivery d. Can be treated and be cured if diagnosed early 65. A 52yo male smoker has a painless 1 cm nodule in her right anterior cervical triangle found to be SCC. On examination of the head and neck is unremarkable. The most likely source for the primary tumor is? a. tonsil b. tongue c. palate d. pharynx 66. A 55yo male diagnose to have thyroglossal duct cyst, underwent a systrunk procedure to a 2 cm midline neck mass, the thyroid is normal and there is no palpable adenopathy. Final pathologic report showed a 0.5cm well-‐ differentiated papillary carcinoma within the wall of the cyst, negative margins. The next step in management should be? a. Observation b. Subtotal thyroidectomy with central neck dissection c. Total thyroidectomy d. MRND 67. A 60yo female consulted for a 2cm painless nodule on the anterior border of the sternocleidomastoid inferior to the angle of the mandible. Which is the most appropriate next step? a. FNA b. Core needle Biopsy c. Incisional Biopsy d. Endoscopic Biopsy
68. Factors associated with increased incidence of the head and neck cancers include all of the following, except? a. Long term use of the betel nut quid b. Reflux esophagus c. Ultraviolet light exposure d. Plummer-‐Vinson Syndrome 69. Most common site of mandibular fracture is? a. Condylar process b. Angle of the mandible c. Body of the mandible d. Ramus of the mandible 70. All of the following are included in the supraglottic larynx, except? a. False Vocal cords b. Epiglottis c. Medial surface of the aryepiglottic folds d. Floor of the laryngeal ventricle 71. A 64yo man with history of chronic smoking with a biopsy result showed SCC from a 3cm ulcerating located at the right anterior portion of the tongue. CT of the neck showed an enlarged 2cm lymph node in the level II region on the right side. Chest X-‐ray are negative, what is the TNM score of the patient? a. T1, N1, M0 b. T2, N2a, M0 c. T2, N1, M0 d. T2, N2c, M0 72. In the above case, what is the stage of the patient? a. Stage I b. Stage II c. Stage III d. Stage IV 73. Which of the major salivary gland have a higher incidence of malignancy? a. Parotid Gland b. Submandibular gland c. Sublingual Gland d. None of the above
74. All of the statements are true about the salivary glands, except? a. All major salivary glands are paired b. 2/3 of malignant tumors occur in the parotid c. Benign parotid tumors are common in the superficial lobe d. 70% of all malignant salivary tumor occur in the submandibular gland 75. A 56yo female have a SCC of the midline of the upper lip, primary lymphatic drainage of the midline of the upper lip? a. Preauricular nodes b. Submandibular Nodes c. Submental Nodes d. Level IV 76. Nodes located in the inferior to the hyoid, superior to the suprasternal notch, medial to the lateral extent of the strap muscles bilaterally is? a. Level IV b. Level V c. Level VI d. Level VII 77. A 64yo man with a history of chronic smoking with a biopsy result showed SCC from a 3cm ulcerating located at the right anterior portion of the tongue. CT of the neck showed an enlarged 2cm lymph node in the level II region on the left side. Chest Xray are negative, what is the TNM score of the patient? a. T1, N1, M0 b. T2, N2a, M0 C. T2, N2b, M0 d. T2, N2c, M0 78. In the above case, what is the stage of the patient? a. Stage I
b. Stage II c. Stage III d. Stage IV Matching Type Patterns of Lymph Node Metastasis a. Level I b. Level II c. Level III d. Level IV e. Level V C 79. Middle jugular chain nodes; inferior to the hyoid, superior to the level of the cricoid, deep to SCM muscle from posterior border of the muscle to the strap muscles medially. E 80. Posterior triangle Nodes A 81. The submental and submandibular nodes D 82. Lower jugular chain nodes B 83. Submuscular recess; superior to spinal accessory nerve to the level of the skull base Primary site for metastatic disease of cervical lymph nodes. A. Level I B. Level II C. Level III D. Level IV E. Level V E 84. Breast A 85. Floor of the mouth B 86. Parotid gland D 87. Virchow’s Node A 88. Anterior Tongue Matching Type A 89. The Palatal vault is mobile while the nasal pyramid and orbital ruins are stable. A 90. Involve the inferior nasal aperture C 91. Also known as craniofacial disjunction
B 92. Fracture arch passes through posterior alveolar ridge, lateral walls of maxillary sinuses, inferior orbital rim and nasal bones B 93. The nasal dorsum, palate and medial part of the infraorbital rim are mobile. Matching Type A. Supraomohyoid Neck Dissection B. Jugular Neck Dissection C. Central Compartment Neck Dissection D. Posterolateral Neck Dissection E. Classical radical Neck Dissection E 94. Includes removal of the SCM, UV and SAN A 95. Levels I, II, I& III D 96. Nodes at the posterior and occipital triangles B 97. Also called anterolateral neck Dissection C 98. Usually done in thyroid cancer. Liver, Mesentery and Omentum 1. What ligament of the liver separates the left lateral from the left medial segment? a. Coronary b. Round c. Triangular d. Falciform 2. The caudate lobe corresponds to what specific segment of the liver? a. Segment II b. Segment I c. Segment III d. Segment IV 3. Segment IV is also known as what lobe of the liver? a. Caudate lobe b. Right lobe c. Quadrate lobe d. Left lobe 4. Segments V and VIII are located on which side of the right lobe? a. Anterior
b. Medial c. Posterior d. Lateral 5. In the functional anatomy of the liver, what structure is located in the main scissura and separates the right and left lobes? a. Left hepatic vein b. Common bile duct c. Common hepatic artery d. Middle hepatic vein 6. What is the origin of the common hepatic artery? a. Direct from the abdominal aorta b. Gastroduodenal artery c. Celiac axis d. Splenic artery 7. What main veins formed the portal vein? a. Inferior mesenteric and splenic veins b. Superior and inferior mesenteric veins c. Hepatic and splenic veins d. Splenic and superior mesenteric veins 8. What ligament of the liver is the ligamentum teres found? a. Coronary b. Falciform c. Right triangular d. Left triangular 9. The left portal vein divides which particular segments of the liver? a. II, III, and IV b. IV, V, and VI c. I, II, and III d. VI, VII, and VIII 10. What is the normal pressure of the portal vein? a. 4-‐8 mmHg b. 0-‐3 mmHg
c. 2-‐5 mmHg d. 5-‐10 mmHg
c. Serum albumin and PT d. ALT and Alkaline phosphatase
11. Which particular segments of the liver drain into the middle hepatic vein? a. II and III b. V to VIII c. IV, V, and VIII d. III to VII
17. Prothrombin time is a test used to determine or measure which of the following clotting factors produced in the liver? a. II, V, VII, and X b. II, VII, IX, and X c. V, VII, VIII, and IX d. V, VIII, IX, and X
12. What biliary duct has a longer extrahepatic course and divides into segmental branches? a. Cystic duct b. Common hepatic duct c. Pancreatic duct d. Common bile duct
18. How much is the bilirubin blood level if one presents with hyperbilirubinemia in the test and jaundice clinically? a. >1-‐1.5 mg/dL b. >1.5-‐2.0 mg/dL c. >2.0-‐2.5 mg/dL d. >2.5-‐3.0 mg/dL 19. What radiologic procedure of the liver can be used intra-‐operatively and is the standard for detecting lesion of the liver? a. Ultrasound b. Computed tomography c. Magnetic resonance imaging d. Positron emission tomography
13. The Calot’s triangle node are described as enlarged lymph nodes found primarily where? a. Common bile duct b. Retropancreatic area c. Celiac area d. Hilar cystic duct 14. Ammonia is produced in the liver coming what process? a. Protein metabolism b. Gluconeogenesis c. Lipid metabolism d. Glycogenolysis
20. In the classification of acute liver failure, which type does jaundice and encephalopathy occur 29 days – 12 weeks with infrequent cerebral edema and has a poor prognosis? a. Hyper-‐acute b. Acute c. Sub-‐acute d. Late onset
15. Of the following enzymes requested in the liver function test, which of the following is found more in the liver but non-‐specific? a. Aspartate transaminases b. Alkaline phosphatase c. Alpha-‐glutaryl transpeptidase d. Alanine transaminases
21. What is the particular stage of hepatic encephalopathy wherein one feels drowsy, disoriented, agitated and with the presence of asterixis? a. Stage I b. Stage II c. Stage III d. Stage IV
16. Among the following liver function test, which is considered as the best test to indicate hepatic synthesis function? a. AST:ALT ratio b. Prothrombin time and INR
22. How do you call a liver described as a final sequelae of chronic hepatic insult with the presence of fibrous septa throughout? a. Chronic liver failure b. Hepatic encephalopathy c. Hepatic steatosis d. Liver cirrhosis
b. Hydatid disease c. Ascariasis d. Amebic liver abscess 28. Which condition produces a liver mass which is hereditary in nature and causes intra-‐cystic haemorrhage, infection and post-‐traumatic rupture? a. Biliary cystadenoma b. Congenital cyst c. Hydatid cyst d. Polycystic liver disease
23. Which of the following imaging procedures is considered the most accurate in detecting portal hypertension? a. Ultrasound abdomen b. Doppler ultrasound c. Hepatic venography d. CT arteriography
29. What liver disease or condition is considered a syndrome wherein there is a malformation of the intrahepatic bile ducts? a. Polycystic liver disease b. Hemangioma c. Caroli’s disease d. Biliary cystadenoma
24. What major group in portal hypertension does the schistosomiasis belong to? a. Pre-‐sinusoidal b. Intra-‐hepatic sinusoidal c. Intra-‐hepatic post-‐sinusoidal d. Post-‐hepatic post-‐sinusoidal
30. Which among the benign liver diseases is described as solid, common in women, do not rupture spontaneously nor undergo malignant transformation? a. Focal nodular hyperplasia b. Adenoma c. Hemangioma d. Bile duct hamartoma
25. The gastro-‐esophageal varices gets its major blood supply from which of the following veins? a. Right gastric vein b. Left gastroepiploic vein c. Left gastric vein d. Right gastroepiploic vein
31. The presence of the Klatskin’s tumor is associated with what type of malignant liver tumor? a. Metastatic liver disease b. Hepatocellular carcinoma c. Cholangiocarcinoma d. Gallbladder cancer
26. The “caput medusa” are collaterals and dilated veins formed by which vein? a. Inferior hemorrhoidal veins b. Superior epigastric veins c. Umbilical veins d. Inferior epigastric veins
32. From where is the most common primary source of cancer that cause liver metastasis? a. Lung b. Gastric c. Small bowel d. Colorectal
27. Which of the following infections of the liver produces anaphylactic reactions and usually involves the anterior or posterior inferior segments of the right lobe? a. Pyogenic liver abscess
33. Which one of the following descriptions best describes the mesentery? a. Single layer of peritoneum that walls the abdomino-‐pelvic cavities b. Double layer of visceral peritoneum c. Double layer of parietal peritoneum d. Single layer of peritoneum that walls the abdominal cavity only
37. Which of the following is not true about the epithelial cells of the stomach? a. Chief cell – production of pepsinogens I and II, and of lipase b. Mucous neck cell – Heterogeneous granules 1-‐2 µm in diameter dispersed throughout the cytoplasm c. Surface-‐foveolar mucous cells – Apical stippled granules up to 1 µm in diameter d. Oxyntic (parietal) cell – production of pepsinogen II
34. Among the ligaments found in the lesser omentum, which of them contains the common bile duct, hepatic proper artery, and portal vein? a. Hepatoduodenal b. Hepatoesophageal c. Hepatogastric d. Hepatosplenic
38. An incidental findings on a chest x-‐ray PA of a 35 y/o male showed an air-‐ fluid level behind the cardiac shadow, what is your diagnosis? a. Paraesophageal hernia b. GERD c. Schatzki’s ring d. Zenker diverticulum
35. Upper respiratory tract infection is considered as a common precedence for this particular condition which may not be surgical in nature. What is this called? a. Tabes mesenterica b. Mesenteric cyst c. Omental adhesions d. Mesenteric lymphadenitis
39. True about the thoracic portion of the esophagus? a. Approximately 5cm long b. Recurrent laryngeal nerves lie in the right and left grooves c. Crosses both the bifurcation of the trachea and the left main stem bronchus d. Descends between the trachea and the vertebral column
36. Which of the following is true regarding the anatomy of the stomach? a. The left and right gastric arteries form an anastomotic arcade along the greater curvature. b. Right gastric artery arises directly from the celiac trunk. c. The veins draining the stomach generally parallel the arteries. d. Left gastroepiploic artery, which arises consistently from the gastroduodenal artery.
40. A 45 y/o male consulted at the ER due to dysphagia, associated …. characteristic “wet voice”. What is your initial diagnosis? a. Paraesophageal hernia b. GERD c. Schatzki’s ring d. Zenker’s diverticulum 41. In the above patient, what is the best diagnostic modality to be requested? a. Manometry b. Contrast esophagogram
c. Endoscopy d. Plain chest x-‐ray
motility disorder that the patient have? a. Achalasia b. DES c. Nutcracker esophagus d. Hypertensive lower esophageal sphincter
42. The most appropriate treatment for the above patient? a. Observe b. Acid suppression c. Partial fundoplication (Toupet) d. Diverticulectomy with primary repair and cricopharyngeal myotomy
47. Surgical option in the treatment in patient with intractability/nonhealing duodenal ulcer, except? a. Highly selective vagotomy b. Gastrojejunostomy c. Vagotomy and drainage d. Vagotomy and antrectomy
43. A 48 y/o male come in due to chest pain and dysphagia. A barium swallow was requested and revealed a ringed esophagus? The most appropriate management would be, except? a. Proton pump inhibitors b. Corticosteroids c. Elimination of food allergies d. Rigid dilators
48. Which of the following gastric cells secrete intrinsic factor? a. Chief cells b. Parietal cells c. G cells d. D cells
44. Most of the parietal cells are located in the? a. Fundus b. Cardia c. Body d. Antrum
45. All of the following statements are true about left gastric artery to the stomach, except? a. Largest artery to the stomach b. Arises directly from the celiac trunk c. Divides into an ascending and descending branch along the greater gastric curvature d. Supplies the aberrant vessel that travels in the gastrohepatic ligament
49. Which of the following gastric ulcer is associated with acid hypersecretion? a. Cardia b. Fundus c. Angularis Incisiura d. Pylorus
50. Procedure of choice in low-‐risk patient with perforated duodenal ulcer? a. Graham patch with HSV b. Distal gastrectomy c. Truncal vagotomy with antrectomy d. Vagotomy and drainage 51. All of the following stimulate gastric acid secretion except? a. Acetylcholine b. Gastric distention c. Intraluminal protein d. Somatostatin
46. Patient’s manometric study showed an incomplete lower esophageal sphincter (LES) relaxation and aperistalsis in the esophageal body, what type of primary of primary
52. What is the stage of the patient with SCC that invades muscularis propria,
with no regional lymph node metastasis nor distant metastasis? a. Stage I b. Stage II c. Stage IIIA d. Stage IIIB 53. Which of the following is not true about Mallory-‐Weiss Syndrome? a. Presents with upper GI bleeding, often with hematemesis b. Endoscopy confirms the diagnosis and may be useful in controlling the bleeding c. A congenital arteriovenous malformation d. Use of balloon tamponade to control bleeding 54. Indication to an antireflux procedure in patients with GERD, except? a. Extraesophageal atypical reflux symptoms b. Ulceration c. Barrett’s mucosa with high-‐grade dysplasia d. Noncompliance with medical therapy 55. Three normal areas of esophageal narrowing, except? a. Level of the cricopharyngeal muscle b. Level of the aortic arch c. Level of the carina d. Level of the diaphragm Matching type: Manometry in primary esophageal motility disorder a. Achalasia b. DES c. Nutcracker esophagus d. Hypertensive lower esophageal sphincter e. Ineffective esophageal motility disorder
56. Repetitive and multipeaked contractions with intermittent normal peristalsis 57. Incomplete lower esophageal sphincter (LES) relaxation (70% c. Sensitivity and specificity of >80% d. Sensitivity and specificity of >90%
c. 30% chance of metastasis d. 40% chance of metastasis e. 50% chance of metastasis 3. The following belong to the translocation-‐associated sarcomas, except: a. Ewing’s sarcoma b. Dermatofibrosarcoma protuberance c. Pleomorphic sarcoma d. Synovial sarcoma e. Myxoid liposarcoma
28. Indicative of chronic cholecystitis as seen on U/S? a. Contracted, thin-‐walled gallbladder b. Contracted, thick-‐walled gallbladder c. Contracted, thick-‐walled gallbladder 2 hours after meal d. Thick-‐walled gallbladder
4. Most common site of Gastro-‐ intestinal Stromal Tumors: a. Esophagus b. Stomach c. Small intestine d. Large intestine e. Anus
29. Biliary leaks as a complication of surgery of the gallbladder or the biliary tree can be confirmed and frequently localized by? a. MRCP b. ERCP c. HIDA scan d. UTZ
5. The gold standard for histologically documenting sarcomas: a. Fine needle aspiration cytology b. Core needle biopsy c. Incisional biopsy d. Excisional biopsy e. Frozen section biopsy
30. What is your important tool in staging carcinoma of the gallbladder? a. UTZ b. ERCP c. HIDA d. CT scan Urology, small and large intestines, soft tissue sarcomas and appendix 1. The following sarcoma has very low propensity for lymph node metastasis: a. Liposarcoma b. Pediatric rhabdomyosarcoma c. Angiosarcoma d. Clear cell sarcoma e. Synovial sarcoma 2. Intermediate grade sarcomas, generally have: a. 10% chance of metastasis b. 20% chance of metastasis
6. Non-‐operative management may be an option for this sarcoma: a. Leiomyosarcoma b. Fibroids c. Rhabdomyosarcoma d. Synovial sarcoma e. Desmoid 7. Which is not a chronic effect of radiation therapy: a. Osteitis b. Lymphedema c. Contractures d. Stomatitis e. Fractures
8. The technique whereby radio-‐active beads are embedded in the tumor site is: a. Adjuvant chemotherapy b. Induction chemotherapy c. Neo-‐adjuvant irradiation d. Isolated limb perfusion e. Brachytherapy
d. Commonly found in the lower extremities e. Can metastasize 14. The grading system which provides the best prognostic capability is the: a. AJCC b. NCCN c. FFCC d. NCI e. ACS
9. Sarcomas most commonly metastasize to the: a. Other extremity b. Lungs c. Liver d. Bone e. Brain
15. In Dermatofibrosarcoma protuberance, the gene involved in the mutation is the: a. JAZFI-‐JJAZI b. PDFGB-‐COL1A1 c. FUS-‐CREB312 d. FUS-‐ATFI e. EWS-‐ATFI
10. The following are endodermal derivatives except: a. Lung b. Liver c. Stomach d. Kidneys e. Pancreas
16. A marine derived alkaloid which shows benefit for advanced leiomyosarcoma: a. Ifosfamide b. Sorafenib c. Dasatinib d. Imatinib e. Trabectedin
11. According to FNCLCC, Grade 2 tumors have a 5-‐year survival rate of: a. 40% b. 50% c. 60% d. 70% e. 80%
17. The recommended number of cycles pre-‐operative chemotherapy is given: a. Two b. Three c. Four d. Five e. Six
12. The oncogenes associated with sarcomas are the following, except: a. C-‐erbB2 b. MDM2 c. PDGFRA d. N-‐myc e. RAS
18. The most important prognostic factor for sarcomas is: a. Tumor size b. Patient’s age c. Patient’s sex d. Nodal status e. Histologic grade
13. The following characteristics of the myxoid type of liposarcoma are true, except: a. Peaks at old age b. Low grade c. Deep tumors
19. One of the following is linked to radiation exposure as a risk factor:
a. Malignant Fibrous Histiocytoma b. Malignant Mixed Muellerian tumor c. Dermatofibrosarcoma protuberance d. Rhabdomyosarcoma e. Myxoid liposarcoma
e. 8 cm 25. From the time of diagnosis, without intervention, sarcomas metastasize to the lungs in: a. 6 months b. 12 months c. 18 months d. 24 months e. 48 months
20. Neo-‐adjuvant imatinib allows surgery to be performed in patients with large GIST: a. 1 month after b. 2 months after c. 3 months after d. 5 months after e. 6 months after
26. Also known as Lobstein’s cancer: a. Gastrointestinal Stromal Tumor b. Gastro intestinal Sarcoma c. Cystosarcoma phyllodes d. Desmoids e. Retroperitoneal sarcomas
21. Rhadomyosarcomas have a disease free survival rate of: a. 55% b. 60% c. 65% d. 70% e. 75%
22. Generally not considered a sarcoma: a. Cystosarcoma Phyllodes b. Ewing’s sarcoma c. Desmoid d. Dermatofibrosarcoma protuberans e. Malignant Mixed Mullerian Tumor
23. The retroperitoneal space is bordered by the following, except: a. Diaphragm b. Peritoneum c. Psoas d. Spine e. Pelvic diaphragm
24. The following are acceptable radiation margins, except: a. 4 cm b. 5 cm c. 6 cm d. 7 cm
27. Most common presenting sign of Gastrointestinal sarcoma is: a. Abdominal pain b. Abdominal mass c. Abdominal distension d. Gastrointestinal colic e. Gastrointestinal bleeding
28. The following cancer syndromes are associated with pediatric sarcomas, except: a. Retinoblastoma b. Werner’s syndrome c. Familial adenomatous polyposis d. Neurofibromatosis e. Wernicke’s syndrome
29. Primary resistance to imatinib usually occurs in: a. 6 months b. 9 months c. 12 months d. 24 months e. 36 months
30. In FNCLLC grading, Grade 2 has a score of: a. 1 b. 3 c. 5
d. 7 e. 9 31. Trauma is a risk factor in developing which of the following sarcomas: a. Fibrosarcoma b. Ewing’s sarcoma c. Synovial sarcoma d. Angiosarcoma e. None of the above
b.
c.
32. Radiation is usually associated with sarcomas with mutations in: a. KIT b. P53 c. cErb d. N-‐myc e. MDM2
d. e.
37. True about the adrenal glands except: a. The adrenal glands lie superomedially to the kidneys within Gerota’s fascia b. The arterial supply of the adrenals derives from the inferior phrenic, aorta, and small branches from the renal arteries c. The venous drainage on the left is mainly through the inferior phrenic vein and through the left renal vein via the inferior adrenal vein d. All of the above e. None of the above
33. Sarcoma common at the reproductive age: a. Leiomyosarcoma b. Endometrial Stromal Sarcoma c. Malignant Mixed Mullerian Tumor d. Undifferentiated Endometrial Sarcoma e. Desmoid
invested in a fibro-‐fatty layer: fascia of Zuckerkandl posteriorly and Gerota’s fascia anteriorly. Posterolaterally, the kidneys are bordered by the quadratus lumborum and posteromedially by the psoas muscle. Anteriorly, they are confined by the posterior layer of the peritoneum. All of the above None of the above
34. … tumors are tumors that are: a. 5 cms in size b. More than 5 cms in size c. 15 cms in size d. More than 15 cms in size e. None of the above
38. Which of the following is/are true of the ureters a. The blood supply of the proximal ureter derives from the aorta and renal artery and comes mainly from the lateral direction. b. Distally, it derives its blood supply medially from branches from the iliac arteries. c. Mobilizing the distal ureter for anastomosis requires releasing its medial attachments, which results in ischemia. d. All of the above e. None of the above
35. The following includes features that define the grade of the tumor, except: a. Pleomorphism b. Mitoses c. Necrosis d. Cellularity e. No exception
36. True about the kidneys except: a. The kidneys are paired intraperitoneal organs that are
39. True about the anatomy of the urinary bladder, except:
a. Urinary bladder is situated in the retropubic space in an extraperitoneal position. b. A portion of the bladder dome is adjacent to the peritoneum, so ruptures at this point can result in intraperitoneal urine leakage. c. At physiologic volumes (200-‐400 mL), the bladder projects modestly into the abdomen. d. All of the above e. None of the above
function as two separate compartment. d. The sinusoidal tissue is innervated by the cavernosal nerves, which are autonomic nerves that originate in the hypogastric plexus and play a critical role in erection. e. The tip of the penis, called the glans, is in continuity with the corpus spongiosum
40. Which of the following statements is/are true of the prostate: a. The prostate has a significant component of smooth muscle and can provide urinary continence even in the absence of the external striated sphincter. b. The puboprostatic ligaments connect the prostate to the pubic symphysis, and pelvic fractures often result in proximal urethral injuries due to the traction that these ligaments provide. c. Between the prostate and the rectum lies Denonvilliers’ fascia, which is the main anatomic barrier that prevents prostate cancer from regularly penetrating into the rectum. d. All of the above e. None of the above
42. A 27y/o patient was rushed into the ER after a vehicular accident. Kidney injury is suspected. As the ER resident on duty, you know that several structures would be compromised should the left renal vein be injured as it receives drainage from the following, except? a. Left gonadal vein b. Left inferior phrenic vein c. Left internal pudendal vein d. Left suprarenal gland 43. Which of the following is/are true of the ureters a. The blood supply of the proximal ureter derives from the aorta and renal artery and comes mainly from the lateral direction. b. Distally, it derives its blood supply medially from branches from the iliac arteries. c. Mobilizing the distal ureter for anastomosis requires releasing its medial attachments, which results in ischemia. d. All of the above e. None of the above
41. True about the penis, except: a. The corpora cavernosum are the paired, cylinder-‐like structures that are the main erectile bodies of the penis. b. The corpora cavernosum consist of a tough outer layer called the tunica albuginea and spongy, sinusoidal tissue inside that fills with blood to result in erection. c. The two corpora cavernosum have no vascular interconnections, so they
44. On physical examination, which technique is better for diagnosing a distended bladder? a. Inspection b. Auscultation c. Palpation d. Percussion
d. Category III 45. All of the following statements about the physical examination are true, except: a. The left kidney is generally palpable in men b. Transillumination of the kidney may be helpful in children younger than 1 year of age c. The adult bladder cannot usually be palpated or percussed until there is 150 mL of urine in it d. Bimanual examination of the bladder to assess tumour extent is best done under anaesthetic e. A lower ureteric calculus may be palpable per vagina
49. Following documentation of a firm mass in the testes by ultrasound in a 32 year old male, tissue sample for biopsy should be obtained for diagnosis by a. Fine needle aspiration b. Core needle biopsy c. Open scrotal biopsy d. Inguinal orchiectomy 50. A 28-‐year-‐old white male presents with asymptomatic testicular enlargement. Which of the following statement(s) is/are true concerning his diagnosis and management? a. Tumor markers, α-‐fetoprotein (AFP) and β-‐human chorionic gonadotropin (HCG) will both be of value in the patient regardless of his ultimate tissue type b. Orchiectomy should be performed via scrotal approach c. The diagnosis of seminoma should be followed by postoperative radiation therapy d. With current adjuvant chemotherapy regimens, retroperitoneal lymphadenectomy is no longer indicated for non-‐seminomatous testicular tumors
46. A 60 year old male patient with a PSA of >100ng/mL, is suspected for a metastatic prostate cancer. Biopsy confirmed your suspicion. The most common site of spread of prostate cancer is: a. Kidney and liver b. Testes and urinary bladder c. Lungs and Mediastinum d. Pelvic lymph nodes and bones 47. Diagnostic imaging to demonstrate the site of metastasis in this pt (#46) except: a. CT scan of the abdomen b. Bone scan c. Both A & B d. None of the above
51. A 23-‐year-‐old man has a solid mass in his left testis about 10 cm in size. Which of the following is an appropriate work-‐up for the patient: a. Request for tumor markers – AFP, BHCG and LDH b. Obtain a complete history and physical examination c. Scrotal US d. All of the above
48. A 52 year old patient was suspected as having kidney CA and was submitted for CT scan for classification. Upon imaging, the scan showed homogeneously, hyperdense cysts measuring about 7 cm, and few hairline septa. What would be the intern’s answer? a. Category II b. Category II F c. Category VII
52. If the serum levels of alpha fetoprotein is elevated in this patient (#51) with a firm testicular mass,
which of the following diagnoses most likely? a. Seminomatous germ cell tumor b. Nonseminomatous germ cell tumor c. Leydig cell tumor d. Sertoli cell tumor
d. Surgical resection with radiotherapy 56. A 68 year old man with a history of radical prostatectomy 4 years earlier for Prostatic CA, but was subsequently … to follow-‐up, came to your office for pain on the ribs. If you are the physician, the next best step in managing this patient is to: a. Tell him it’s normal b. Perform a rib biopsy c. Give medications that lower serum testosterone d. Order for PSA testing e. Perform orchiectomy
53. After radical orchiectomy (#51), the pathology reveals an embryonal carcinoma with a teratoma. Which additional tests is appropriate? a. Repeat the serum tumor markers b. Chest CT scan c. Abdominal CT scan d. All of the above e. None of the above
57. Which of the following statement is false concerning the detection and diagnosis of prostatic cancer? a. An elevation of prostate specific antigen (PSA) is highly sensitive and specific for prostatic carcinoma b. American blacks have an increased risk of prostatic carcinoma c. Autopsy series would suggest that 10% of men in their 50s will have small latent prostatic cancers d. Transrectal prostatic biopsy is indicated for a palpable 1 cm prostate nodule e. Serum prostatic acid phosphatase remains the most useful tumor marker for prostatic carcinoma
54. The CT scan of the abdomen (#51) reveals 8cm of lymphadenopathy in the periaortic nodes. What is the recommended treatment? a. Modified nerve-‐sparing retroperitoneal lymph node dissection b. Full bilateral retroperitoneal lymph node dissection c. Chemotherapy with Paclitaxel (Taxol), Gemcitabine and Cisplatin d. Chemotherapy with Cisplatin, Etoposide, and Bleomycin e. Chemotherapy plus retroperitoneal radiation 55. A 59 year old Filipino man is told by his primary care physician that his prostatic specific antigen (PSA) has gone up significantly since his last visit. He has no palpable abnormalities in his prostate by rectal exam. What’s the initial management? a. Transrectal needle biopsy b. Transrectal needle biopsy guided by finger c. Transrectal needle biopsy guided by sonogram or MRI
58. A 70-‐year-‐old man with a long smoking history presents with painless gross hematuria. A CT urogram is performed as part of the diagnostic evaluation. CT urogram shows nonvisualization of the left kidney. There is a filling defect in the bladder, in addition, the right kidney has a standing column of contrast to the middle third of the ureter and early hydronephrosis evidenced by
blunting of the forniceal angles. Which of the following statements are true: a. The likely diagnosis is muscle invasive transitional cell carcinoma of the bladder b. Obstruction of the left ureter can cause nonfunction of the left kidney c. The findings on the right are suspicious for transitional cell cancer of the ureter d. All are true e. None
examination. The most appropriate initial diagnostic test is: a. IVP b. Retrograde urethrogram c. Cystogram d. Pelvic CT scan e. Peritoneal lavage 62. A 26 y/o male patient goes to the ER with a complaint of hematuria after a motor vehicle accident which happened 3 days prior. You suspect an isolated urinary system injury and would suggest imaging studies. What is the gold standard for genitourinary imaging in renal trauma? a. Retrograde pyelogram b. Radiographic imaging c. Contrast-‐enhanced computed tomography d. MRI
59. A 20 y/o, male patient came in due to a blunt trauma on the flank, secondary to motor vehicular accident. What is/are the finding/s on CT that will raise suspicion for major renal injury? a. Medial hematoma b. Medial urinary intravasation c. Lack of contrast enhancement of the parenchyma d. Both A and C
63. A 55-‐year-‐old male patient is admitted @ ED due to severe scrotal and perineal pain. Upon history and physical examination, the patient is diagnosed with Fournier’s Gangrene. Which of the following is LEAST likely the anticipated management in this case? a. Prompt debridement of the nonviable tissue b. Broad antibiotics should be administered c. Damage to external anal sphincter requires colostomy d. Testes are usually threatened and need to be removed
60. If a patient with documented uncomplicated extraperitoneal bladder rupture, what is your initial management? a. Cystoscopy is necessary to verify the rupture b. Urethral catheter drainage alone c. Schedule the patient for surgery immediately d. None of the above 61. A 25-‐year-‐old pedestrian is struck by an automobile. On arrival in the emergency room, a plain film of the pelvis reveals a left superior and inferior pubic ramus fracture as well as a fracture of the sacroiliac joint. Examination of the patient reveals a suprapubic mass. Blood is noted at the meatus and the prostate is in the normal position on digital
64. A patient came in for penile swelling. Patient reported hearing an audible “pop” during sexual intercourse with his partner. Upon inspection of the perineum, you noticed a “butterfly” sign. What is your initial diagnosis? a. Penile fracture only b. Penile fracture, with disrupted tunica albuginea
c. Penile fracture, with disrupted Buck’s fascia d. Penile fracture, with disrupted Dartos fascia
a. It is useful to apply firm pressure to the edematous distal penis for several minutes to reduce the glans b. Reduction in penile edema can be the key to success c. If the foreskin cannot be manually reduced, surgical intervention is required d. None of the above e. All of the above
65. A 12-‐year-‐old boy presents in the emergency room with very severe pain of sudden onset in his right testicle. There is no fever, pyuria, or history of recent mumps. Testis is swollen, tender, exquisitely painful, and high-‐riding. What is your diagnosis? a. Testicular cancer b. Acute epididymitis c. Testicular torsion d. Epididymo-‐orchitis
69. A 45-‐year-‐old male patient presented with complaints of high grade fever and fairly rapid onset unilateral painful swelling of the testis. Upon inspection, the scrotum was also erythematous. Blood work shows elevated WBC. What is your management for this condition? a. Continue observation b. Oral antibiotics c. Hospitalization and parenteral antibiotics d. Penile block
66. Patricio, 37-‐year-‐old taxi driver came in for persistent penile erection that lasted for 4 hours. On examination, the penis is very tender and both cavernosal bodies are rigid while the glans are flaccid. What is the most likely diagnosis? a. Testicular torsion b. Paraphimosis c. Fournier’s gangrene d. Priapism
70. Patient in #69 was observed and the next day you noted pus coming out from the scrotum with areas of necrosis. Fever persisted despite the antibiotics. On examination, you noted crepitations on the scrotum. Your impression at this time is: a. Acute epididymitis b. Acute orchitis c. Fournier’s gangrene d. Scrotal abscess
67. A 5 y/o male child was brought to your office for a possible “tuli”. On examination, you forcedly retracted the prepuce to visualize the glans. However, several hours later, the patient was rushed to the ER. On examination, the prepuce is edematous and engorged distal to the phemotic ring. In this patient, the most likely problem is: a. Acute urinary retention b. Testicular torsion c. Fournier’s gangrene d. Priapism e. Paraphimosis 68. True about paraphimosis:
71. A 25 y/o woman is 40 weeks pregnant, consulted at the ER for right-‐sided abdominal pain, associated with nausea and vomiting, fever with leucocytosis. What is the best management of this patient? a. Antibiotics alone b. Perform an abdominal ultrasound c. Schedule for laparoscopic surgery d. Schedule for “E” explor lap
72. A 32 y/o male, consulted at the ER for a hx of 6 hours of migratory right quadrant pain, associated with nausea and vomiting, anorexia at PE, positive for direct and rebound tenderness and laboratory showed leucocytosis. What is your Alvarado score to this patient? a. 6 b. 7 c. 8 d. 9
b. Arterial supply of the appendix is from the appendicular branch of the ileocolic a. c. Immunologic organ that secretes immunoglobulin A d. Lymphoid aggregates occur in the submucosal layer 77. A 27-‐year-‐old male consulted at the ER due to abdominal pain associated with vomiting and fever. PE revealed equivocal findings at the abdomen, what would be the preferred management for this patient? a. Discharged and prescribed analgesic b. Abdominal ultrasound c. CT scan of the abdomen d. Schedule for “E” appendectomy
73. In the above patient, what would be the best management? a. Request for UA b. Do abdominal ultrasound c. Schedule for “E” appendectomy d. Discharge the patient
78. The following statement are true about the anorectal vascular supply, except? a. Superior rectal a. – upper rectum b. Inferior rectal vein drains into the internal pudendal vein c. Inferior rectal artery arises from the internal pudendal artery d. Middle rectal artery arises from the terminal branch of the inferior mesenteric artery
74. A 32 y/o male diagnosed as acute abdomen prob secondary to ruptured viscus most prob sec to ruptured acute appendicitis, what is the recommended antibiotics to this patient? a. Cefoxitin b. Enapenem c. Ampicillin-‐sulbactam d. Gentamicin + clindamycin
75. Differential diagnosis of acute appendicitis depends on four major factors, except? a. Patient’s age b. Gender c. Timing of the pain d. Anatomic location of the inflamed appendix
79. Type of adenomatous polyp that have a higher risk for malignant degeneration? a. Tubular b. Villous c. Tubulovillous d. Hamartomatous
80. Patient with colorectal cancer with TNM scoring of T3, N0, M0. What is the stage of the patient? a. Stage IIa b. Stage IIb c. Stage IIIa d. Stage IIIc
76. The following statement are true about the appendix, except? a. The tip of the appendix is located at the confluence of the 3 tenia coli
81. A 45 y/o male consulted for hematochezia and pain with defecation. Pt. is diagnosed as acute anal fissure. What is the treatment of choice for this patient? a. Lateral internal sphincterotomy b. Botulinum injection c. Laxatives and warm sitz baths d. Observe
d. Cigarette smoking is protective 87. Which of the following pathology warrants APR? a. Circumferential adenocarcinoma just above the dentate line b. Intraluminal mass at the rectosigmoid c. Intraluminal adenocarcinoma 12 cm from the anal verge d. Upper rectal mass
82. An internal haemorrhoid that prolapses past the dentate line with straining is a a. First-‐degree haemorrhoid b. Second-‐degree haemorrhoid c. Third-‐degree haemorrhoid d. Fourth-‐degree haemorrhoid
88. A disorder in which patients develop gastrointestinal polyposis in association with … cutaneous pigmentation, and atrophy of the fingernails and toenails? a. Peutz-‐Jehgers syndrome b. Cronkite-‐Canada syndrome c. Cowden’s syndrome d. Familial juvenile polyposis
83. The treatment of choice for first-‐ degree internal haemorrhoids is? a. PPH b. Infrared coagulation c. Dietary and lifestyle changes d. Surgical procedure
89. True about Goodsall’s rule, except? a. Used as a guide in determining the location of the external opening b. Fistulas with an external opening posteriorly track in a curvilinear fashion to the posterior midline c. Anteriorly based fistulas typically have a radial course to the internal opening d. External opening is greater than 3 cm from the anal margin, usually track to the posterior midline
84. All are characteristics of ulcerative colitis, except? a. Bimodal age distribution b. Involves the small bowel c. Backwash ileitis d. Cigarette smoking is protective 85. A disorder in which patient manifest hamartomas of the colon and rectum associated with melanin spots on the buccal mucosa and lips of the patient? a. Peutz-‐Jeghers syndrome b. Cronkite-‐Canada syndrome c. Cowden’s syndrome d. Familial juvenile polyposis 86. All of the following statements are true about Crohn’s colitis, except? a. Complex anal fistulae and/or abscesses b. Creeping fat c. Cobble stone
90. A 1 cm appendiceal carcinoid located at the base of the appendix. What is the appropriate management? a. Observe b. Appendectomy alone c. Right hemicolectomy d. Total colectomy Matching type a. Somatostatin b. Cholecystokinin
c. Motilin d. Neurotensin e. Secretin 91. Inhibits gastrointestinal secretion, motility, and splanchnic perfusion (A) 92. Stimulates exocrine pancreatic secretion, stimulates intestinal secretion (E) 93. Stimulates intestinal motility (C) 94. Stimulates pancreatic exocrine secretion, stimulates gallbladder emptying, inhibits sphincter of Oddi contraction (B) 95. Stimulates intestinal mucosal growth (D) a. b. c. d. e.
Right colectomy Extended right colectomy Total and subtotal colectomy Low anterior resection Abdominoperineal resection
96. Removal of the entire rectum, anal canal, and anus with construction of a permanent colostomy from the descending or sigmoid colon. 97. Required for patients with fulminant colitis 98. Most appropriate operation for curative intent resection of proximal colon carcinoma 99. Used for curative intent resection of lesions located at the hepatic flexure or proximal transverse colon 100. Used to remove lesions in the upper and mid rectum Breast, Thyroid, Parathyroid, Venous and Lymphatics 1. A 45-‐year-‐old poerter develops a direct inguinal hernia. If the hernia extended through the superficial inguinal ring, it would be surrounder by all of the abdominal layers EXCEPT the: a. External spermatic fascia
b. Internal spermatic fascia c. Peritoneum and extraperitoneal connective tissue d. Weak fascia of the transversus abdominis muscle lateral to the falx 2. During explorative surgery, the incidental finding is herniation between the lateral edge of rectus muscle, the inguinal ligament and the inferior epigastric vessels. Based on the boundaries, the type of hermia is a. Congenital inguinal hernia b. Direct inguinal hernia c. Femoral inguinal hernia d. Indirect inguinal hernia e. Incisional inguinal hernia 3. The processus vaginalis regresses to form what structure? A. Tunica vaginalis B. Canal of nuck C. Spermatic cord D. Falx inguinalis 4. Most common inguinal hernia in women A. Direct B. Femoral C. Indirect D. Umbilical 5. Where does protrusion occur in indirect (congenital) hernia? A. Deep inguinal ring B. Superficial inguinal ring C. ? D. Canal of nuck E. Falx inguinalis 6. Virchows triad except: A. Endothelial Injury B. Stasis of blood flow C. Hypercoagulability D. Hypersensitivity 7. A 35-‐year old professional dancer presents with a well-‐defines, tense,
b. c. d.
smooth mass in the upper outer quadrant of the left breast. She states that the mass becomes larger just before onset of her periods. Aspiration yeilds a clear yellow fluid and the mass disappears. The most likely diagnosis is: Fibroadenoma in a cyst Fibrocystic disease of the breast Carcinoma in a cyst Lipoma Galactocele Varicose veins are common and are present in atleast 10% of the general population. Findings may include: Dilated and tortuous veins b.Telangiectasias fine reticular varicoses all of the above none of the above
9. A. B. C. D. E.
Risk factors for varicose veins: Malignancy Obesity Female Inactivity Family history
A. B. C. D. E.
8.
a.
13.
A. B. C. D. E. 14. All is true about the anatomy of the thyroid. Review lg guys. Choices are in long statements. 15. Which of the following is "produced?" by the thyroid follicle?
16.
A. 10. A.) B.) C.) D.)
Primary varicose veins results from Deep venous insufficiency Supeficial venous insufficiency Intrinsic abnormalities of venous wall DVT
B. C.
D. 11. Patient with varicose may complain of A.) Aching B.) Heaviness C.) Pruritus D.) All of the above 12. 27 y/o woman Left sided neck mass 2.5 cm FNA -‐ papillary thyroid neoplasm No palpable Lymph Node A. Left thyroid lobectomy w/ radical neck dissection B. Total thyroidectomy w/ bilateral modified radical neck dissection
C. Left thyroid lobectomy w/ postop I-‐ 131 D. Total thyroidectomy w/ postop I-‐ 131 E. Total thyroidectomy alone 17 y.o. with right cervical node. positive calcitonin serum calcium elevated. What is the diagnosis? Familial mtc FTC Men1 Men2a Men2b
A. Triiodothyronine B. Calcitonin C. Iodine D. Nakalimot ko huhu Which of the ff is correct in the thyroid hormone Formation of thyroif hormone depends on endogenous Iodine converted to iodide in diodenum Iodine is pass through ....... blablabla ATP Iodine is linked .... blablabla g something blablabla
17. Thyroid-‐stimulating antibodies stimulate the thyrocytes to grow and synthesize excess thyroid hormone. Nakalimut ko sa choices guys ug sa answer haha sorry 18. 20 yr-‐old college student. Fatigability, Irritibality, weight loss. PROMINENCE OF THE EYES. choices:
A. GRAVE's disease B. Hashimotos C. Plummers disease D. Subacute thyroiditis 19. The management/treatment at this moment is: A. Anti thyroid drugs B. Surgery C. Radioactive ablation D. Iodone 20. 45 yr old woman had a thyrodectomy. But the nurse reported 6 packs of dressing was already in use due ro bleesding. What shpuld the doctor do. A . CT, BT and PTT B. K drip Mao ra ako madumduman taas au ang case 21. A 30 years old patient post total thyroidectomy complain of fatigue and numbness in her finger. What's your immediate management? A. Check ionized calcium level B. Give O2 per cannula C. Start IV Ca immediately D. Check serum Na and K level 22. The ff drugs that may help relieve pain in Px with severe mastalgia except: a. danozol b. tamoxifen
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