Samplex surg

General Surgery Prelims 2013 1. All are potential to be malignant potential except a. Hereditary Pancreatitis b. Junctional nevus c. COMPOUND NEVUS d. Atypical Nevus 2. The following inhibit insulin release except a. CCK b. Amylin c. Somatostatin d. Pancreastatin 3. The major stimulant for the secretion of somatostatin a. Acetylcholine b. Decreased pH of the gastric or duodenal mucosa c. INTRALUMINAL FAT d. Intraluminal protein 4. The following are effects of pancreatic polypeptide except a. Inhibits bile secretion b. Inhibits gallbladder contraction c. Glucose regulation d. Stimulates exocrine secretion 5. The following stimulates glucagon release except a. Glucose b. Arginine c. Alanine d. Beta synaptic fibers 6. Which of the following events occur in Acute pancreatitis a. Accelerated extrusion of zymogen granules b. Imparied extrusion of zymogen granules c. Impaired protein synthesis d. Destruction of beta cells 7.

8.

9.

A 5 yr old boy was brought to a hospital because of vomiting and abdominal pain 2weeks PTA to consultation the boy fell in his bike the handle bar hitting his mid abdomen. On examination boy is looking pale there was an ecchymosis on the left upper quadrant and positive for Kehr’s sign. Scan showed 15% subcapsular hematoma on the spleen with 2 cm laceration noted on the pole of spleen. There was a minimal amount of fluid in the left paracolic gutter. Patient is hypotensive and tachycardic BEST MANAGEMENT WOULD BE: a. Explore-lap, evaluation of hematoma , suturing the laceration b. Observation, Blood transfusion, CT scan monitoring of splenic injury c. Explore-lap, splenectomy d. Explore-lap, partial splenectomy In order to prevent overwhelming post splenectomy sepsis the best thing for the above patient a. Give prophylactic antibiotic b. Annual vaccination c. Vaccination 7 days after surgery d. Preserve splenic tissue as possible

A 43 yr old man had been having episodes of watery diarrhea of 2 yrs in duration. This accompanied by epigastric pain, feeling bloated and weight loss. The proton pump inhibitor has been taking seems to have no beneficial effect. Diagnostic test that is done will be. a. Serum gastrin determination b. Esophagogastroduodenoscopy c. Secretin provocative test d. Maximal output determination 10. A serum gastrin determination done on the patient on the preceding number was 200/pgml next logical procedure is a. Secretin provocative test b. Get the BAO to MAO c. Esophagogastroduodenoscopy d. Re-Test serum gastrin level

11. This patient was diagnosed to have Zollinger-Ellison syndrome you expect his BAO to MAO ratio a. 30% c. >60% d. >40% 12. The same patient was advised to undergo surgery. The best way to localize the lesion is to do a. MRI b. Explore the passaros triangle c. CT scan with contrast d. Endoscopic UTZ with octreotide scinti scan 13. +pruritus, jaundice = ADENOCARCINOMA 14. Initial diagnosis for the case above = CT SCAN =90-95% sensitivity 15. Best Treatment for the case above = WHIPPLES PROCEDURE 16. Increase protein and amylase = PANCREATIC ASCITES 17. Treatment of above patient = OCREOTIDE CITRATE MATCHING TYPE 18. E Locally reccurent lymphatic invading melanoma 19. A Level 2 Lentigo Maligna (0.3mm depth) 20. B Level 4 Acral lentigenous, (-) regional LN, (2mm depth) 21. D Level 3 Superficial Spread (-) LN, (2mm depth) 22. C Level 4 Superfical Spread (+) LN, (1.5mm depth) a. b. c. d. e.

Wide excision with 1 cm margin Wide excision with 2 cm margin with Regional LN Wide excision with 2 cm Sentinel LN Wide excision with 2 cm margin With Melphalan

23. Light Brown, Greasy Mass = ACTINIC KERATOSES 24. Treatment above = ELECTRODESSICATION 25. Painless lesion on the Right Cheek = PYOGENIC GRANULOMA 26. Treatment of above case with 1.5cm mass = EXCISION WITH 1CM MARGIN 27. 3 YR OLD WITH HEMANGIOMA = PREDNISONE 28. Cranial nerve V = Capillary malformation / Portwine stain 29. Melanoma (3mm depth) involves reticular dermis = CLARKS LEVEL 4 30. Treatment of above case = EXCISION 2CM + SLN Biopsy 31. Incision Site is Fresh = HYPERTROPHIC SCAR 32. Treatment of above case = Triamclinolone 33. 1 yr old Baby = CAVERNOUS HEMANGIOMA 34. Treatment of above case = OBSERVE cause it resolves 35. Painfull mass on index finger = GLOMUS TUMOR 36. Acute AP = REBOUND TENDERNESS 37. Atelectasis except = CLOSURE OF BRONCHIOLES 38. Intraperitoneal abscess = CT SCAN 39. GI bleed and pain after meals = GASTRIC ULCER 40. Mass on Culdesac = RUPTURED ECTOPIC PREGNANCY 41. Signs (+) except = FOTHERGILL SIGN 42. 43. Dypneic, fever and decrease breath sounds = PNEUMONIA 44. Treatment above = ANTIBIOTICS 45. Sausage mass = INTUSSUSCEPTION 46. Intussusception = (+) DANCE SIGN 47. True of GI bleed except = Approximately 500ml (50-60) to produce melena 48. Constipation except = MARKED ASCITES 49. Pathophysiologic cause about diarrhea = AOTA 50.

51. 52. 53. 54. 55.

MATCHING TYPE E Choledocholithiasis B Ruptured spleen D Rebound tenderness C Ruptured Common Bile Duct A Acute hemorrhagic pancreatitis

Surgery Block | T&T Club

1

56. 57. 58. 59. 60. 61. 62. 63. 64. 65.

a. Grey Turner b. Balance c. Ransohoff d. Bloomberg e. Charcot Peritoneal adhesion except = PRECISE/ GENTLE Primary Peritonitis differs from secondary Peritonitis = SINGLE ORGANISM Lesser Sac Abscess = PERCUTANEOUS Pancreatic ascites + antibiotics = OPERATIVE EXTERNAL DRAINAGE Subphrenic Abscess = AOTA True of Intraperitoneal Abscess = AOTA Site of localization factors = AOTA Not true in ACUTE abdomen = Appendectomy is well tolerated in pregnancy True of Peritoneal =FIBRIN True about Peritoneal Cavity = GREATER/ LESSER SAC MATCHING TYPE

66. 67. 68. 69. 70.

D E A C B a. b. c. d. e.

71. 72. 73. 74. 75.

76. 77. 78. 79. 80. 81. 82. 83.

Urgency, Dysuria Drainage of upper abdominal abscess Secondary rupture of hepatic abscess Multiple Kehr Right Subphrenic Abscess Left Subprenic Abscess Interloop Pelvic Lesser Sac

D C A B E

Repeated irrigation until clear Tenkhoff catheter Rayon Cloth Merlex mesh Exploration a. Abdominal wall pack b. STAR c. Continuous post op d. Intraop e. Open Correct about anatomy of appendix except = MUCOSA IS IRREGULAR LEAST common position of Appendix = PELVIC Common about bacteria except = INCREASE ANAEROBES Common about Pathophysiologic of appendicitis = IMPACTED FECALITH CONSTANT Finding in an adult with APPENDICITIS = ANOREXIA Least common finding = FEVER INCIDENCE of APPENDICITIS in WOMEN = 75% RISK of APPENDICTIS in WOMEN = 25%

Surgery Block | T&T Club

2