SECTION B-DAY 2

SECTION B – COLON RECTUM and ANUS/ SOFT TISSUE SARCOMA/ BREAST/ APPENDIX

COLON RECTUM and ANUS COLON RECTUM and ANUS 1.

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28 year old male juvenile diabetic suddenly developed intolerable pain at the perianal area aggravated by movement. He is febrile with temp of 38.8 deg. Cent. Patient was then diagnosed to have perianal abscess. A graver sequel would develop in the form of a. Fistula in ano b. Rectal prolapsed c. Fournier’s gangrene d. Fissure in ano Carcinoma of the distal anal canal is almost always a. Epidermoid cancer b. Adenocarcinoma c. Melanoma d. Basal cell cancer True statement regarding hemorrhoids a. They aid in the continence mechanism of the anorectal area b. Hemorrhoidal cushions are primarily located in left anterior, right anterior, right posterior positions c. These are submucosal tissues containing venules, arterioles, and smooth muscle fibers located in the rectum d. Hemorrhoids are a normal part of anorectal anatomy, treated by excision when encountered in routine anorectal examination Treatment of uncomplicated acute sigmoid volvulus should begin with a. Colonoscopy or proctogigmoidoscopy b. Laparotomy and detorsion c. Sigmoid colostomy d. High pressure barium enema A 78 y/o male patient recovered from uneventful acute attack of sigmoid diverticulitis and is now asymptomatic. This patient should be treated this time with a. High fiber diet b. Regular 3 month colonoscopy c. Elective anterior resection d. Emergency total colectomy Correct statement/s regarding patients with anal/ perianal symptoms a. Careful and adequate history usually clinches a diagnosis b. Digital rectal examination is imperative c. Use of other diagnostic ancillaries sometimes necessary d. A and B only e. All are correct statements For serum CEA determination to be useful in the management of colorectal cancer, you would suggest a. Before any form of treatment is begun b. Before surgery c. Immediately after surgery d. 3 months after surgery On rectal examination of a 58 y/o male patient with a history of bleeding per rectum on defecation and a hard mass irregular and friable 4cm from anal verge occupying ¾ of the circumference. The most likely diagnosis is a. Rectal carcinoma b. Rectal adenoma c. Anal epidermoid carcinoma d. Anal adenocarcinoma In the same case as mentioned above, the best diagnostic procedure would be a. Colonoscopy with biopsy b. CEA determination c. Anoscopy with biopsy

d. A and C only e. All of the above 10. In the same case as mentioned above, the appropriate initial management would be a. Low anterior resection b. Abdominoperineal resection c. Trans anal excision d. Chemotherapy and radiation (nigro protocol) e. 11. The most acceptable method of treatment for the first episode of uncomplicated acute colonic diverticulitis is: a. Diverting transverse colonoscopy c. NPO and Intravenous antibiotic b. Primary resection and anastomosis d. Colonoscopic decompression

12. Amoebic colitis is best diagnosed by: a. Colonoscopy with biopsy b. History and physical exam c. Proctosigmoidoscopic aspirate exam

d. e.

Fecalysis Barium enema

13. An inflammatory bowel disease that involves mainly the colon is a. Ulcerative colitis d. Bowens disease b. Chron’s disease e. Ischemic colitis c. Tuberculosis

14. Most common indication for surgical intervention in recurrent diverticulitis of the colon is: a. Intractability b. Bleeding c. Obstruction d. Perforation e. Fistula formation

15. Fascia that separates the rectum from the prostate and seminal vesicles in men and from the vagina in women a. DenonViller’s fascia c. Rectus sheat fascia b. Presacral fascia d. Retrosacral fascia

16. True of colon anatomy EXCEPT a. The cecum, transverse and sigmoid colon are located retroperitoneally b. Cecum has the largest diameter c. Cecum is the first to rapture in the presence of obstruction d. Sigmoid is the narrowest portion with 2.5 cm e. Omentum is attached to the anterior superior edge of the transverse colon

17. Subacute presentation of patient with colonic CA EXCEPT a. 90% complete obstruction b. dark tarry stool c. Change in bowel habit not usual in right sided colonic CA d. Weight loss and fever e. Iron deficiency anemia

18. 65 year old male patient diagnosed with colon CA, with TNM class of TANT… 3, month. The test for survival rate is: a. 0 – 16% b. 70 – 95% c. 54 – 65% d. 39 – 60% e. 5%

19. correct statement regarding fistula in ano. EXCEPT a. about 50% develop a persistent fistula in ano b. Fistula usually originates in the infected crypt (internal opening) and tracingto the external opening usually the site of prior damage c. The course of the fistula can often be predicted by the anatomy of the previous abcess d. Damage of an anorectal abscess results in the cure for about 10% of patients e.

20. True statement regarding DIVERTICULITIS, except: a. Common site is the sigmoid colon b. It is known to be a true diverticulum c. Located at the mesenteric side of the Anterior mesenteric teniae d. Hemorrhage and infection are the common complication e. Present with left lower quadrant pain COLON 1.

following organs have mesentery, EXCEPT: a. DUODENUM b. Ileum c. Jejunum d. transverse colon 2. What major artery arising from the aorta is found in the mesentery of the transverse colon? a. right colic b. MIDDLE COLIC c. left colics d. igmoidal 3. The ligament of Treitz is: a. Found at the level of T2 b. Very vascular c. DEMARCATES THE ILEUM AND THE JEJUNUM d. Entrance of the duodenum 4. A 65 y/o male with cardiac arrythmias suddenly develops sever abdominal pain, unrelieved by IV analgesics. PE exam is unremarkable except for absent bowel. Most probable etiology of the problem is: a. Thrombus b. Embolus c.A mass d.An infectious process 5. Definitive diagnostic is by: a. Venogram b. Ultrasound c. CT scan d. arteriogram 6. The most probable diagnosis is: a. Embolic occlusion of the of the superior mesenteric artery B. MESENTERIC VEIN OCCLUSION c Intestinal obstruction secondary to Adenocarcinoma 7. The first branch of the superior mesenteric artery is the A. MIDDLE COLIC b. Right colic c. Ileocolic d. Left colic 8. Collateral circulation between the superior and inferior mesenteric artery thru the marginal artery of: A. DRUMMOND b. Daniel’s c. Riolan d. Peter 9. Which of the following is NOT a branch of the inferior mesenteric artery? a. Left colic b. Sigmoidal artery C. INFERIOR RECTAL ARTERY d. Superior rectal artery 10. The following causes omental torsionEXCEPT: a. venous redundancy b. metastatic CA c. obesity d. accessory omentum 11. The best way to diagnose omental torsion is by: A. EXPLORE LAPAROTOMY b. CT scan c. Ultrasound d. Barium enema 12. Idiopathic segmental infarction is usually caused by: a. embolus B. THROMBUS

c. cyst d. lymph node 13. Diagnosis showing a smudged appearance is by: a. ultrasound b. x-ray c. MRI D. CT SCAN 14. Cysts are commonly caused by blocked: a. veins b. arteries C. LYMPHATIC CHANNELS d. apocrine glands 15.A cyst that can be diagnosed by x-ray is a ________ cyst: A. DERMOID b. sebaceous c. lymphatics d. ………… 16. The most common solid tumor of the omentum: a. dermoid B. METASTATIC TUMOR c. sarcoma d. lymphoma 17. Most common site of volvulus: A. SIGMOID b. descending colon c. cecum d. ascending colon\ 18. Layers of the colon, EXCEPT: A. OUTER CIRCULAR b. inner circular c. mucosa d. submucosa 19. Most common cause of life-threatening colonic bleeding: a. polyps B. DIVERTICULOSIS c. cancer d. Crohn’s disease 20. Serum marker for colonic CA: a. AFP B. CEA c. CAL-90 d. CA 125 21. Most common histopath for colonic CA a. Clear cell CA b. Transitional CA c. Squamous cell CA D. ADENOSARCOMA 22. Most common site of colonic malignancy: a. ascending colon b. Coden’s disease C. RECTOSIGMOID d. splenic flexure 23. Non-polyposis inherited colon CA is also known as: A. LYNCH SYNDROME b. Coden’s disease c. Gardner’s syndrome d. Peutz-Jegher syndrome 24. Blood supply of the small intestines comes from: a. celiac artery B. SUPERIOR MESENTERIC ARTERY c. inferior mesenteric artery d. internal iliac artery 25. Neoplasm that mimic PUD is: a. Villous adenoma b. Leiomyoma C. BRUNNER’S GLAND d. Adenoma 26. Blood supply to the colon include the following EXCEPT:

A. CELIAC ARTERY b. superior mesenteric artery c. inferior mesenteric artery d. artery of Drummond

SOFT TISSUE SARCOMA (C B D C A C E A B A)

SOFT TISSUE SARCOMA 1. It is the most reliable of the diagnostic methods, providing accurate histologic diagnosis and grading in more than 95% of soft tissue sarcoma: a. FNAB

c. Open Biopsy

b. Core Needle Biopsy

d. FNAB with ultrasound guided

2. Highly aggressive tumor that have substantial metastatic potential: a. Myxoid liposarcoma

c. Well differentiated liposarcoma

b. Rhabdomyosarcoma

d. Hemangiopericytoma

3. A 57 y/o male was admitted due to a deep 12 cm soft tissue tumor on his left deltoid. Open biopsy revealed positive for poorly differentiated rhabdomyosarcoma. No other palpable mass was noted on further examination. The present clinical staging is: a. Stage IB

d. Stage III

b. Stage IIA

e. Stage IV

c. Stage IIB 4. The 5-year survival rate of this patient based on the tumor size (Q no. 3) is estimated to be: a. 84%

c. 50%

b. 70%

d. 33%

5. The most important prognostic factor for patients with sarcomas: a. Histologic grade

c. Nodal metastasis

b. Tumor size

d. Distant metastasis

6. The metastatic potential for high grade sarcomas: a. 5% to 10%

c. 50% to 60%

b. 25% to 30%

d. 70% to 80%

7. Histologic subtypes of soft tissue sarcoma with higher incidence of nodal involvement: a. Rhabdomyosarcoma

d. A and C only

b. Epitheloid sarcoma

e. All of the above

c. Malignant fibrous histiocytoma

8. True statement regarding general considerations in treating soft tissue sarcoma: a. Accurate preoperative histologic diagnosis is critical in choosing a primary treatment strategy b. Extremity soft tissue sarcoma is treated with margin negative resection plus chemotherapy has resulted in 90% control rate c. Abdominal sarcomas continue to have low rates of recurrence and good overall survival d. Small (< 5cm) primary tumors with evidence of distant metastasis is managed by surgery alone

9. It is an alternative treatment using TNF and melphalan as limb sparing for patients with locally advanced soft tissue sarcoma or as a palliative treatment to achieve local control for patients with distant metastasis:

a. Radiation therapy

c. Brachytherapy

b. Isolated regional perfusion

d. Systemic therapy

10. Correct statement/s regarding retroperitoneal sarcomas: a. Generally present as large masses, nearly 50% are larger than 20cm at the time of diagnosis b. Overall prognosis is better than that for patients with extremity sarcoma c. Survival rates at 5 years are reported to be 90% d. B and C only e. All are correct statements

BREAST (Dec. 2013)

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Most common histologic type of breast malignancy is C. Sarcoma of the breast A. Adenocarcinoma B. Squamous cell carcinoma D. Lymphoma of the breast Breast malignancy that has lymphocytes and /or lymphatic follicles around the cancer cells A. Colloid carcinoma of the breast C. Tubular carcinoma of the breast B. Paget’s disease of the breast D. Medullary carcinoma of the breast Give the stage T2N0M0 A. Stage I B. Stage IIB C. Stage IIIA D. Stage IIA Inheritance of this germline mutation has the highest chance of having hereditary breast cancers A. STK11/LKB1 C. BRCA – 2 D. p53 B. BRCA – 1 Yearly mammography is startd at what age, as being recommended at present A. 50 y/o B. 55 y/o D. 45 y/o C. 40 y/o The following are breast carcinoma except A. Inflammatory breast CA B. Invasive lobular carcinoma C. DCIS D. LCIS In classical radical mastectomy there is an en bloc resection of the following, except A. Internal mammary group LN C. axillary lymphatic B. Breast and its overlying skin D. Pectoralis major and minor Type of mastectomy that preserve both pectoralis major and minor A. Modified radical mastectomy C. Quadranectomy B. Radical mastectomy D. Lumpectomy Axillary lymph nodes located behind the pectoralis minor are: C. Posterior axillary LN A. Central axillary LN B. Lateral axillary LN D. Apical axillary LN Considered as a screening procedure used to evaluate lesions if the female breast A. Mammography C. Ultrasonography B. CT scan of the breast D. MRI

Case (for #11 - #13) 25-year-old medical student consulted for a painful lump on her left breast. Said mass was noted 12 months ago and usually appears a week before her menstrual period and decreases its size during her ovarian follicular phase. No significant family history and past medical history. On PE, there is a doughy tender mass at left upper quadrant measuring 1x2cm, movable, (–) nipple discharge 11. What will you suggest to the patient A. Request for mammography C. Consult back during her ovarian follicular phase B. Suggest excision biopsy of said mass D. Suggest fine needle aspiration of the mass 12. Give the most probable breast lesion the patient has that present above sign and symptom A. Intraductal papilloma C. Fat necrosis D. Fibroadenoma B. Fibrocystic disease 13. Give your management A. Total mastectomy C. Reassurance and observe B. Give tamoxifen D. Suggest partial mastectomy 14. Give the most common cause of bloody nipple A. Phyllodes tumor of the breast C. Mammary duct ectasia B. Fibrocystic disease of the breast D. None of the above 15. Risk factor in breast malignancy A. multiple pregnancy C. (-) family history for breast tumors B. Late menarche D. Ovarian malignancy BREAST 1.

Group of axillary lymph node that are immediately posterior to the pectoralis minor muscle: a. Subscapular LN B. CENTRAL AXILLARY LN c. External mammary LN

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d. Apical group LN Most common cause of bloody nipple discharge a. Paget’s disease of the nipple b. Adenoma of the nipple C. INTRADUCTAL PAPILLOMA d. Invasive duvtal CA Due to obstruction of a mammary duct results to distention of mmamry lobule with milk: A. GALACTOCEOLE b. Plasma cell mastitis c. Comedomastitis d. Fibrocystic disease The most common cause of cold abscess of the breast is: a. Fungi B. M. TUBERCULOSIS c. Adenocarcinoma d. None This structure serves as a border between carcinoma in situ from invasive CA of the breast a. Lining epithelium b. Lamina propia C. BASEMENT MEMBRANE d. None Breast CA with desmoplastic response to invading CA cell is A. SCIRROUS CA b. Medullary CA c. Colloid CA d. Tubular CA The primary therapy of inflammatory breast CA is: a. Mastectomy B. CHEMOTHERAPHY c. Hormonal therapy d. MRI Adenocarcinoma of the breast a. Papillary breast CA b. Scirrous breast CA c. Colloid breast CA D. MEDULLARY BREAST CA These are the axillary LN in zone 1 EXCEPT: a. Subscapular LN b. Anterior LN C. CENTRAL LN d. Lateral LN Risk factors for breast CA EXCEPT a. Lobular carcinoma in situ b. Mammary duct anaplasia C. TUBULAR CARCINOMA IN SITU d. Mother and sister with breast CA The most common histologic type of breast CA; a. Epidermoid B. ADENOCARCINOMA c. Lymphoma d. NOTA Subtotal parathyroidectomy means a. Removal of 2 of the 4 glands, contralateral b. Removal of 3 of the 4 glands c. Removal of 3.5 of 4 glands d. Removal of 2 of 4 glands ipsilateral e. Removal of all 4 glands Called infraclavicular LN a. Rotton’s LN b. Central LN

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C. APICAL LN d. Subscapular LN Gives the cytologic impression of the specimen submitted A. FNAB b. Excision biopsy c. Incision biopsy d. Core biopsy The most common cause of blood nipple discharge a. Paget’s disease of the breast b. Adenoma of the nipple C. INTRADUCTAL PAPILLOMA d. Invasive ductal carcinoma Most common cancer occurring in the breast a. Intraductal papilloma b. Squamous or epidermoud CA c. Malignant cystosarcomaphyllodes D. ADENOCARCINOMA This has the worst prognosis a. Lymphoma b. Scirrous breast CA c. Squamous cell CA D. INFLAMMATORY BREAST CA Accepted form of management of lobular carcinoma in situ a. closed follow up b. bilateral mastectomy c. tamoxifen for 5 years D. ALL OF THE ABOVE indications for conservative breast surgery a. breast CA >4 cm B. ADEQUATE BREAST SIZE TO ALLOW UNIFORM DOSAGE OF IRRADIATION c. axillary (+) LN for CA d. AOTA Chemotherapeutic drugs used for breast CA a. Cyclophosphamide b. Adriamycin c. Vincristin D. AOTA The primary therapy for inflammatory breast CA; a. Mastectomy B. CHEMOTHERAPY c. Hormonal treatment d. MRM These are breast CA in male EXCEPT: a. Invasive lobula CA b. Lymphoma of the breast c. Epidermoid carcinoma of the breast D. AOTA If this LN is positive for malignant cell, the breast is stage III B a. Rotter’s LN b. Central LN c. Apical LN D. INTERNAL MAMMARY LN Breast malignancy with several lymphatic follicles a. Paget’s disease of the breast b. Colloid CA C. MEDULLARY CA d. Schiroous CA The following structures are… in classical radical mastectomy, EXCET: a. Axillary lymphoarleolar tissues B. SERRATUS ANTERIOR

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c. Pectoral major d. Pectoralis minor Predominant breast carcinoma that presents concurrently with fibroadenoma a. Medullary CA b. Schirrous CA C. LOBULAR CARCINOMA INN SITU d. Tubular carcinoma The most common distant metastatsis of breast CA a. Lungs b. Liver C. BONE d. Brain Considered as the most important diagnostic aid in evaluating breast lesions a. Biopsy B. MRI C. CLINICAL HX AND PE d. Ultrasound Breast malignancy in male EXCET: a. Invasive lobular CAR of the breast b. Lymphoma of the breast c. Epidermal CA of the breast D. INVASIVE DUCTAL CA OF THE BREAST Adenocarcinoma of the breast that has the highest axillary LN involvement is; a. Papillary breast CA B. SCHIRROUS BREAST CA c. Colloid breast d. Medullary breast CA Management of male breast CA: a. MRM b. Orichectomy c. Chemotherapy D. AOTA Breast CA can bypass the lungs and metastasize directly to the CNS due to: a. Axillary vein B. BATSON’S PLEXUS c. Internal mammary vein d. Rotter’s node The best screening procedure for breast lesion is: A. MAMMOGRAPHY b. MRI c. CT scan d. Ultrasonography Interventional technique used in detecting the location of non-palpable intraductal papilloma a. Ultrasound b. MRI C. DUCTORAPHY d. CTscan Malignant tumor of the breast that is made up of large round cells with abundant cytoplasm arranged in broad plexiform mass surrounded by lymphocytes and lymphatic follicles a. Mucimous CA b. Fibrinocarcinoma C. MEDUALLRY CA d. Papillary Ca Characteristic of chronic cystic mastitis a. Unencapsulated b. Most common breast tumor c. Can co-exist with breast CA D. AOTA The most common erroneous preoperative diagnosis of acute appendicitis is: a. UTI

b. C. d.

Acute gastroenteritis ACUTE MESENTERIC ADENITIS Ruptured graafian follicle

APPENDIX 1.

The most common erroneous preoperative diagnosis of acute appendicitis is: a. UTI b. Acute gastroenteritis C. ACUTE MESENTERIC ADENITIS d. Ruptured grafian follicle 2. Abdominal condition that is misdiagnosed for appendicitis, but needs surgical intervention is: a. Torsion of the testis B. MECKEL’S DIVERTICULITIS c. Acute mesenteric adenitis d. Pelvic inflammatory disease 3. The most common gynecological disorder that is misdiagnosed for appendicitis but needs surgical intervention is: a. Ruptured graafian follicle b. Twisted ovarian cyst C. PID d. Endometriosis 4. Part of the management of acute appendicitis: a. We have to feel the patient orally to provide the necessary energy for surgery b. Steroids C. ANTIBIOTICS FOR GM (-), GM(+) AND ANAEROBES d. AOTA 5. Statement/s true regarding appendicitis during preganancy: a. Most frequent during 3rd tri b. Abdominal wall sign are more prominent C. APPENDICEAL PERFORATION IS A SIGN. FACTOR ASSOCIATED WITH FETAL AND MATERNAL DEATH d. AOTA 6. This patient who had appendectomy could have a 15% mortality a. Appendectomy for suppurative appendicitis in a 40 y/o female b. Appendectomy for ruptured appendicitis in 15 y/o male C. APPENDECTOMY IN 60 Y/O MALE WITH OPERATIVE FINDING OF A PHLEGMON d. Appendectomy in a 8thmos pregnant 7. The most common cause of mortality in post-appendectomy is: a. Cardiac/pulmo insufficiency b. Pulmonary embolism c. Aspiration D. UNCONTROLLED SEPSIS 8. The most common tumor of the appendix; a. Adenocarcinoma B. CARCINOID c. Mucocoele d. Sarcoma 9. On exploration laparotomy, an incidental finding of a 1 cm mass at distal 1/3 of the appendix was noted. Appendectomy was done. A week later the said mass was read as carcinoid a. Reoperation should be done to do a right hemicolectomy B. APPENDECTOMIES ARE ENOUGH AND ADVISE PATIENT CLOSE FOLLOW UP c. Start chemothereaphy immediately d. NOTA 10. The following are late complication of appendectomy, EXCEPT: A. WOUND ABBSECESS b. Adhesive band c. Inguinal hernia d. Incisional hernia 11. Statement ture about the anatomical and physiological features of the appendix

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a. The location of the tip of this organ is constant\ b. It’s lumen is lined by pseudocolumnar epithelium with goblet cells c. E. coli is the most common bacteria isolated in the lumen D. NOTA The most common cause of luminal obstruction causing appendicitis is: a. Hypertrophy of lymphoid tissue B. FECALITH c. Intestinal worm d. Vegetables and seeds The rapid distention of the appendix after its luminal obstruction is due to: a. Presence of bacteriodesfragilis B. GOBLET CELLS c. Increase permeability of its blood vessel wall d. AOTA Tue about appendicitis a. More common in female than males b. Peak incidence about 50 y/o C. THIS CONDITION IS INEVITABLEAND THE PROCESS NEVER SUBSIDE SPONTANEOUSLY d. AOTA The most common earliest symptoms of appendicitis is: A. ANOREXIA b. Abdominal pain c. n/V d. fever The best guide used by surgeons in the diagnosis of appendicitis is: a. Graded compression sonograph B. CLINICAL HISTORY AND PE c. Laparoscopy d. CT scan The ff. are the abdominal signs for appendicitis, EXCEPT: A. MURPHY’S SIGN b. Rovsing’s sign c. Psoas sign d. Obturator sign The most important findings in the urinalysis that favor UTI than appendicitis is: a. Pyuria b. Hematuria c. Acidic pH d. Bacteriuria This can produce a false (+) preoperative diagnosis of acute appendicitis using a graded compression sonogram: a. Obese patient b. Perforated appendix c. Appendicitis confined at the tip d. Retrocecal position of the appendix Sign/s suggestive of appendiceal rupture a. Direct and rebound tenderness b. Ill-defined tenderness at right iliac region c. WC of 14,000/mm3 d. AOTA The appendicular artery is a direct branch of what vessel: A. ILEOCOLIC ARTERY b. Ileal branch of ileocolic c. Ascending branch of ileocolic artery d. Supererior mesenteric artery The dominant causal factor for the development of acute appendicitis a. Infection b. Autoiimune disease C. LUMINAL OBSTRUCTION d. Congenital lesion The most common pathogen of acute appendicitis:

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a. E. coli B. B. FRAGILIS c. Proteus sp. d. P. aeriginosa The ff. are symptoms of acute appendicitis in congestive stage, EXCEPT: a. N/V b. Anorexia C. HIGH GRADE FEVER d. Abdominal pain Distinguishing character of intussusceptions from acute appendicitis: a. Age of the patient b. Sausage shape mass at RLQ c. Bloody mucus stool D. AOTA Part of the wall of the large bowel used by surgeon to locate appendix; a. Haustration B. TAENIA COLI c. Marginal artery of Drummond d. Appendages epiplocae True about appendix a. Lined by simple columnar epithelium B. INTRAPERITONEAL ORGAN c. No mesentery d. NOTA Adenocarcinoma of the appendix is/are: A. MANAGE WITH RIGHT HEMICOLECTOMY b. Has good prognosis c. Common malignant CA of GIT d. AOTA A complicated appendicitis a. Suppurative appendicitis B. GANGRENOUS APPENDICITIS C. RUPTURED APPENDICITIS d. B &C Pseudomyxoma peritonitis is/are: A. ASSOCIATED BY CYSTADENOMA CA OF THE OVARY OR APPENDIX b. it is best managed with appendectomy if it rise in the appendix c. … is usually to pulmonary failiure d. AOTA Statement true about the anatomical and physiological features of the appendix: a. The location of the tip of this organ is constant b. It’s lumen is lined by pseudocolumnar epithelium with goblet cells c. E. coli is the most common bacteria isolated in it’s lumen D. NOTA True statements regarding blood supply to the head of the pancreas a. Supplied by superior pancreaticoduodenal artery which is a branch of the superior mesenteric artery B. SUPPLIED BY SUPERIOR PANCREATICODUODENAL ARTRY WHICH A BRANCH OF THE GASTRODUODENAL ARTERY c. Both are correct d. Neither This benign lesion can degenerate into a malignant lesion a. Fibrocystic disease of the breast b. Galactoceole c. Fibroadenoma D. NOTA This/these can differentiate benign from malignant phyllodes tumor: a. Size of the tumor b. Consistency of the lesion C. > 3 MITOTIC FIGURE/HPF d. AOTA

35. Breast malignancy with several lymphatic follicles near cancer cells a. Paget’s disease of the breast b. Colloid carcinoma C. MEDULLARY CA IN THE BREAST d. Schirrous Ca of the breast 36. The following structures are excised in classical radical mastectomy, EXCEPT: a. Axillary lymphoalviolar tissues B. SERRATUS ANTERIOR c. Pectoralis major d. Mectoralis minor 37. The most common distant metastases of breast carcinoma is: a. Lungs B. BONE c. Brain d. Liver 38. Considered as the most important diagnostic aid in evaluating a breast lesion is: a. Biopsy b. MRI c. CT scan D. CLINICAL HISTORY AND PE e. Ultrasonography

APPENDIX 39. The most common erroneous preoperative diagnosis of acute appendicitis is: e. UTI f. Acute gastroenteritis G. ACUTE MESENTERIC ADENITIS h. Ruptured grafian follicle 40. Abdominal condition that is misdiagnosed for appendicitis, but needs surgical intervention is: e. Torsion of the testis F. MECKEL’S DIVERTICULITIS g. Acute mesenteric adenitis h. Pelvic inflammatory disease 41. The most common gynecological disorder that is misdiagnosed for appendicitis but needs surgical intervention is: e. Ruptured graafian follicle f. Twisted ovarian cyst G. PID h. Endometriosis 42. Part of the management of acute appendicitis: e. We have to feel the patient orally to provide the necessary energy for surgery f. Steroids G. ANTIBIOTICS FOR GM (-), GM(+) AND ANAEROBES h. AOTA 43. Statement/s true regarding appendicitis during preganancy: e. Most frequent during 3rd tri f. Abdominal wall sign are more prominent G. APPENDICEAL PERFORATION IS A SIGN. FACTOR ASSOCIATED WITH FETAL AND MATERNAL DEATH h. AOTA 44. This patient who had appendectomy could have a 15% mortality e. Appendectomy for suppurative appendicitis in a 40 y/o female f. Appendectomy for ruptured appendicitis in 15 y/o male G. APPENDECTOMY IN 60 Y/O MALE WITH OPERATIVE FINDING OF A PHLEGMON h. Appendectomy in a 8thmos pregnant 45. The most common cause of mortality in post-appendectomy is: e. Cardiac/pulmo insufficiency f. Pulmonary embolism g. Aspiration H. UNCONTROLLED SEPSIS

46. The most common tumor of the appendix; e. Adenocarcinoma F. CARCINOID g. Mucocoele h. Sarcoma 47. On exploration laparotomy, an incidental finding of a 1 cm mass at distal 1/3 of the appendix was noted. Appendectomy was done. A week later the said mass was read as carcinoid e. Reoperation should be done to do a right hemicolectomy F. APPENDECTOMIES ARE ENOUGH AND ADVISE PATIENT CLOSE FOLLOW UP g. Start chemothereaphy immediately h. NOTA 48. The following are late complication of appendectomy, EXCEPT: E. WOUND ABBSECESS f. Adhesive band g. Inguinal hernia h. Incisional hernia 49. Statement ture about the anatomical and physiological features of the appendix e. The location of the tip of this organ is constant\ f. It’s lumen is lined by pseudocolumnar epithelium with goblet cells g. E. coli is the most common bacteria isolated in the lumen H. NOTA 50. The most common cause of luminal obstruction causing appendicitis is: e. Hypertrophy of lymphoid tissue F. FECALITH g. Intestinal worm h. Vegetables and seeds 51. The rapid distention of the appendix after its luminal obstruction is due to: e. Presence of bacteriodesfragilis F. GOBLET CELLS g. Increase permeability of its blood vessel wall h. AOTA 52. Tue about appendicitis e. More common in female than males f. Peak incidence about 50 y/o G. THIS CONDITION IS INEVITABLEAND THE PROCESS NEVER SUBSIDE SPONTANEOUSLY h. AOTA 53. The most common earliest symptoms of appendicitis is: E. ANOREXIA f. Abdominal pain g. n/V h. fever 54. The best guide used by surgeons in the diagnosis of appendicitis is: e. Graded compression sonograph F. CLINICAL HISTORY AND PE g. Laparoscopy h. CT scan 55. The ff. are the abdominal signs for appendicitis, EXCEPT: E. MURPHY’S SIGN f. Rovsing’s sign g. Psoas sign h. Obturator sign 56. The most important findings in the urinalysis that favor UTI than appendicitis is: e. Pyuria f. Hematuria g. Acidic pH h. Bacteriuria 57. This can produce a false (+) preoperative diagnosis of acute appendicitis using a graded compression sonogram: e. Obese patient f. Perforated appendix g. Appendicitis confined at the tip

h. Retrocecal position of the appendix 58. Sign/s suggestive of appendiceal rupture e. Direct and rebound tenderness f. Ill-defined tenderness at right iliac region g. WC of 14,000/mm3 h. AOTA 59. The appendicular artery is a direct branch of what vessel: E. ILEOCOLIC ARTERY f. Ileal branch of ileocolic g. Ascending branch of ileocolic artery h. Supererior mesenteric artery 60. The dominant causal factor for the development of acute appendicitis e. Infection f. Autoiimune disease G. LUMINAL OBSTRUCTION h. Congenital lesion 61. The most common pathogen of acute appendicitis: e. E. coli F. B. FRAGILIS g. Proteus sp. h. P. aeriginosa 62. The ff. are symptoms of acute appendicitis in congestive stage, EXCEPT: e. N/V f. Anorexia G. HIGH GRADE FEVER h. Abdominal pain 63. Distinguishing character of intussusceptions from acute appendicitis: e. Age of the patient f. Sausage shape mass at RLQ g. Bloody mucus stool H. AOTA 64. Part of the wall of the large bowel used by surgeon to locate appendix; e. Haustration F. TAENIA COLI g. Marginal artery of Drummond h. Appendages epiplocae 65. True about appendix e. Lined by simple columnar epithelium F. INTRAPERITONEAL ORGAN g. No mesentery h. NOTA 66. Adenocarcinoma of the appendix is/are: E. MANAGE WITH RIGHT HEMICOLECTOMY f. Has good prognosis g. Common malignant CA of GIT h. AOTA 67. A complicated appendicitis e. Suppurative appendicitis F. GANGRENOUS APPENDICITIS G. RUPTURED APPENDICITIS h. B &C 68. Pseudomyxoma peritonitis is/are: E. ASSOCIATED BY CYSTADENOMA CA OF THE OVARY OR APPENDIX f. it is best managed with appendectomy if it rise in the appendix g. … is usually to pulmonary failiure h. AOTA 69. Statement true about the anatomical and physiological features of the appendix: e. The location of the tip of this organ is constant f. It’s lumen is lined by pseudocolumnar epithelium with goblet cells g. E. coli is the most common bacteria isolated in it’s lumen

H. NOTA 70. True statements regarding blood supply to the head of the pancreas e. Supplied by superior pancreaticoduodenal artery which is a branch of the superior mesenteric artery F. SUPPLIED BY SUPERIOR PANCREATICODUODENAL ARTRY WHICH A BRANCH OF THE GASTRODUODENAL ARTERY g. Both are correct h. Neither 71. This benign lesion can degenerate into a malignant lesion e. Fibrocystic disease of the breast f. Galactoceole g. Fibroadenoma H. NOTA 72. This/these can differentiate benign from malignant phyllodes tumor: e. Size of the tumor f. Consistency of the lesion G. > 3 MITOTIC FIGURE/HPF h. AOTA 73. Breast malignancy with several lymphatic follicles near cancer cells e. Paget’s disease of the breast f. Colloid carcinoma G. MEDULLARY CA IN THE BREAST h. Schirrous Ca of the breast 74. The following structures are excised in classical radical mastectomy, EXCEPT: e. Axillary lymphoalviolar tissues F. SERRATUS ANTERIOR g. Pectoralis major h. Mectoralis minor 75. The most common distant metastases of breast carcinoma is: e. Lungs F. BONE g. Brain h. Liver 76. Considered as the most important diagnostic aid in evaluating a breast lesion is: f. Biopsy g. MRI h. CT scan I. CLINICAL HISTORY AND PE j. Ultrasonography