Surge 4th Le Samplex

SURGERY 4TH LE SAMPLEX (2010-2011) CHOOSE THE BEST ANSWER: 11. The treatment of TB effusion is: 1. A 30 years old male was found to have a posterior a. anti TB drugs mediastinal mass. He must probably has: b. tube thoracostomy a. thymoma c. thoracentesis b. teratodermoid d. decortication Ans A MPL 0.5 c. neurogenic tumor 12. In phythorax, the tube thoracostomy should be placed d. lymphoma Ans C at MPL 1.0 a. 2nd interspace, midclavicular line 2. The most common anterior mediastinal tumor is: b. 3rd interspace, anterior axillary line a. thymoma c. 6th interspace, posterior axillary line b. teratodermoid d. 8th interspace, mid axillary line Ans C MPL 0.5 c. neurogenic tumor 13. In chronic TB effusion attention should be given to: d. lymphoma Ans A MPL 0.5 a. nutrition 3. A 45 year old male was diagnosed to have a thymoma. b. electrolyte imbalance Work up should include tests for: c. adequate antibiotics a. myasthenia gravis d. thoracostomy tube position Ans MPL 0.3 b. brain metastasis 14. The defect in pectus excavatum is in the c. red cell aphasia a. sternum d. immune deficiency Ans A MPL 0.5 b. bony rib 4. During sternotomy for thymoma, the tunor was noted c. spine to have infiltrated the adjacent pleura, pericardium, d. chondral cartilage MPL 1.0 and the phrenic nerve. The best option is: 15. The most common primary malignancy of the pleura is: a. wide excision to include the nerve a. mesothelioma b. radiation b. adenocarcinoma c. platinum based chemotherapy c. lymphoma d. supportive treatment Ans A MPL 0.3 d. liposarcoma Ans A MPL 0.5 5. The so called “ dumbel tumor” is seen in 16. A 9 month old female was brought to the emergency a. neurogenic tumor room because of a non reducible inguinal mass of 2 b. thymoma hours duration. The parents noted this mass previously c. Lymphoma since she was 4 months old but this would d. thoracic aneurysm Ans A MPL 0.5 spontaneously reduce. Upon your examination the 6. Endoscopic esophageal punch biopsy should be mass is already reduced. Your recommendation should avoided in esophageal be: a. leiomyoma a. Admit the patient and observe b. squamos cell CA b. Admit the patient and have emergency c. adenocarcinoma herniorrhaphy d. diverticulum Ans. B MPL 0.5 c. Admit and have elective herniorrhaphy* .33 d. Send the patient home and advised surgery when 7. Cardiovascular collapse in tension pneumothorax is due she is older to: a. shunt mechanis 17. A 2 week old was brought to you clinic because of b. mediastinal shift scrotal swelling noticed since the 3rd day of life this c. decreased fraction of inspired oxygen does not change in size.. On physical exam the scrotum d. hypoventilation Ans B MPL 0.5 is enlarge and is positive for transillumination. He is playful and has no episodes of vomiting. You would 8. Pulmonary collapsed and dyspenea is tension recommend: pneumothorax is due to a. Schedule for elective surgery a. shunt mechanism b. Schedule for immediate surgery b. mediastinal shift c. Observe only * .3 c. decreased fraction of ispired oxygen d. Request for an Abdominal X-ray d. hypoventilation Ans A MPL 0.5 18. A 16 year old female notice a bulge in her Right 9. The initial procedure of choice in pleural effusion is: inguinal area and she went to the emergency room. a. thoracentesis The resident calls you up and tells you that the bulge b. pleural biopsy seems to be outside the Hasselbach’s triangle. This is c. thoracoscopy most likey a: d. thoracostomy Ans A MPL 0.5 a. Direct hernia b. Indirect Inguinal hernia* .5 10. To diagnose chylothorax, the pleural fluid is examined c. Femoral hernia for d. Sliding Hernia a. amplase b. triglycerides 19. A newborn with intestines that are matted and c. sugar leathery, located to the right of the umbilical cord is d. creatinine Ans B MPL 1.0 seen. This patient will definitely need:

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a. b. c. d.

Ventilatory Support Nutritional Support*.3 Prosthetic material for closure Genetic Examination

b. it is likely to be correctible in type c. bile duct imaging will show only small amounts of radionuclide passing into the upper GI tract d. surgery should be performed as soon as possible* (Ana) .5

20. A 2-week old male neonate has been vomiting for 3 hours with abdominal distention on physical examination. There is a bulge on the right scrotal area. One should: 33. A 2 year old boy is referred to you because of a. Do x-ray of the abdomen jaundice,abdominal pain and palpable mass. The next b. Request for a Ultrasound step should be : c. Attempt reduction a. Liver function test d. Schedule for emergency surgery* .5 b. Abdominal X-ray c. Ultrasonography*(Recall) .5 21. The saccular theory of the Patent Processus d. ERCP (Endoscopic Retrograde Pancreatography) Vaginalis is the etiologic factor in: a. b. c. d.

Direct Inguinal Hernia Indirect Inguinal Hernia* .5 Femoral Hernia Umbilical Hernia

34. In a 5 week old infant with acholic stool and deepening jaundice of 4 weeks. The best test to diagnose Biliary atresia reliably would be: a. Liver Function Test b. Ultrasonography 22. The appropriate management of an umbilical c. Nuclear Scan (DISIDA) hernia in a one year old female is: d. none of the above*(Rec) .5 a. immediate surgery if the defect is 1.0 cm b. immediate surgery because of its propensity to 35. A 10 year old boy had mild abdominal pain on the strangulate Right Upper Quadrant of the abdomen. An ultrasound c. conservative management since this may resolve*.3 was done and showed a solitary gallbladder stone. The d. wait until the child is 6 years old then operate next step would be: a. to advise surgical intervention immediately 23. The cause of death in patients with Gastroschisis b. to advise no surgery until he is older is usually due to: c. to check for hematologic pathology* a. Prematurity d. to undergo a CT scan for better imaging (Ana) .5 b. The associated anomalies c. Sepsis*.3 d. Hypovolemia

36. A 4 year old boy has jaundice, abdominal pain and a abdominal mass. If this is a Choledochal cyst this is likely a Type. 24. 2 year old boy is referred to you because of an a. 1 (saccular or fusiform)* (Rec) .5 inguinal enlargement with abdominal distention and b. 2 (diverticulum) vomiting since 8 hours ago. You would: c. 3 (choledococele) a. Do abdominal x-ray d. 4 (intra and extra hepatic dilatations) b. Try to reduce at bedside c. Check for metabolic status* .3 d. Schedule for immediate surgery

37. A 3 week old neonate is at the Intensive care unit and is on Total Parenteral nutrition for 2 weeks. He has developed deepening jaundice since a week ago. Your 25. A 1 hour old with Omphalocoele the liver can be assumption would be the jaundice: seen together with the intestines the most likely a. may still be physiologic scenario would be to: .3 b. is brought about by the Total Parenteral a. operate and close the fascial defect Nutrition*(App) ,33 b. let the sac granulation c. may be due to Biliary Atresia c. apply elastic bandage on the abdominal area d. may be due to Biliary Hypoplasia d. check for other anomalies A 7 month old has progressive abdominal 26. Differentiate the abdominal wall defect based on 38. distention, jaundice, clay colored stool and failure to the listed characteristics below. thrive. On physical examination there is fluid wave on For numbers 27 to 31; Write : the abdomen. This is likely a: A. if related to Omphalocele a. neglected biliary atresia B. If related to Gastroschisis b. neglected choledochal cyst C. Related to both c. perforated common bile duct*(Rec) .5 D. Not related to either Ompahocele or Gastroschisis d. gallstone perforation 27. 28. 29. 30. 2 31. 2

Undescended Testis C .2 Intestinal atresia more commonB .2 Repair may be staged C .2 Respiratory distress may be seen More common congenital anomalies

39. Differentiate the Tumors characteristics below: For numbers 41 to 45; Write: D . A. Wilms’s Tumor B. Nueroblastoma A . C. Both D. Neither

based

on

the

32. An eight week old infant is referred for deepening 40. Failure to thrive B .2 jaundice which was first noted at the age of 3 weeks. If 41. Abdominal tumor frequently does not cross the this is biliary atresia: midline A .2 a. a liver biopsy will show paucity of bile ducts

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42. High chance for cure A .2 43. May regress spontaneously 44. Chemotherapy may be started without definite diagnosis

B .2 D .2

b. c. d. e.

pulmonary resection bronchial ligation bronchial blockade bronchial artery embolization

45. A 1 year old has a abdominal tumor located at the 54. Demonstration of bleeding source in hemoptysis is RUQ, has no jaundice nor splenomegaly. Alpha Feto best accomplished by which diagnostic modality Protein is elevated. The most likely problem is a : a. rbc tagged scan a. Hemangioendothelioma b. CT scan b. Mesenchymal Hamrtoma c. MRI c. Hepatoblastoma * .5 d. bronchoscopy * 1.0 d. Hepatocellular Carcinoma e. pulmonary angiogram 46. A boy has a testicular mass on the R. The size is 2 times the left testicle. It is hard and does not 55. Common causes of hemoptysis are the following transilluminate. The most likely tumor is: conditions except: a. Embryonal a. Tuberculoma * 0.20 b. Seminoma b. Aspergilloma c. Teratoma c. Pulmonary arteriovenous malformation d. Yolk Sac *.5 d. Bronchiectasis 47. You were called at the nursery by the nurse e. Bronchial adenomas because a female neonate has a mass at the sacral A 60-year old male, chronic smoker, consulted at area measuring about 6 cm. in widest diameter. The 56. the OPD for pain in the right shoulder extending to the next appropriate action would be to do: ulnar distribution in the arm, forearm down to the ring a. Digital rectal exam* .5 and small fingers noted progressively a month prior to b. Laboratory examination (AFP) consult. Chest X-ray showed an apical density in the c. Ultrasonography first and second ribs. The most likely diagnosis: d. CT scan a. Lung abscess with osteomyelitis 48. Pansinusitis, situs inversus universalis and b. apical tuberculosis bronchiectasis is a feature of which of the ff: c. Pancoast tumor * 0.25 a. Letterer-Siwe’s Disease d. Pott’s disease with paravertebral abscess b. Adrenal incidentaloma e. Actinomycosis c. Eisenmenber’s syndrome 57. Confirmation of diagnosis is best performed by d. Budd-Chiari syndrome which procedure e. Kartagener’s syndrome * 1.0 a. bronchoscopy 49. Massive hemoptysis is expectoration of blood b. percutaneous needle biopsy with CT guidance * 0.5 amounting to what estimated volume in a 24-hour c. rib biopsy period. d. mediastinoscopy a. 100 ml e. mediastinotomy b. 300 ml 58. A 35-year old male, taxi driver, was seen at the ER c. 400 ml for sudden bouts of massive hemoptysis 2 hours prior d. 600 ml * 1.0 to consult. Past history reveals previous treatment for e. 1000 ml PTB in the last 2 years. Chest x-ray showed tubular and 50. Bleeding from bronchiectasis originates from saccular luscencies in both upper lobes. The most likely which source diagnosis is: a. pulmonary artery a. tuberculosis b. pulmonary vein b. aspergillosis c. bronchial artery * 0.5 c. lung abscesses d. innominate artery d. pulmonary infarction e. bronchiectasis * 1.0 51. Commonly located in the central region of the lung 59. A 20-year old male, student, was being treated at a. squamous cell carcinoma * 1.0 the infirmary for non-resolving pneumonia in the right b. large cell carcinoma lower lobe for almost a year. He started to complain of c. Broncho-alveolar cell carcinoma blood streaked sputum a month prior. Sputum AFB and d. adenocarcinoma PPD were consistently negative. Most probable diagnosis: 52. Indolent behaviour is often demonstrated by a. Foreign body aspiration which tumors b. Bronchioalveolar carcinoma a. squamous cell carcinoma c. Bronchial adenoma b. large cell carcinoma d. Pulmonary atypical tuberculosis c. small cell carcinoma e. A and C is appropriate * 0.33 d. adenocarcinoma e. typical carcinoid tumors * 1.0 60. Most common cell type of lung cancer a. squamous cell 53. Management of massive hemoptysis includes the b. adenocarcinoma * 1.0 following modalities except c. large cell carcinoma a. pulmonary artery embolization * 1.0 d. small cell carcinoma

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e. adenosquamous carcinoma

e. Squamous cell carcinoma, cavitary

61. A 60-year old jeepney driver, chronic smoker, 68. Procedure of choice in the clinical situation: consulted at the OPD for an incidental finding of a 2cm a. Bronchoscopy and bronchial blockade * 0.5 nodule in the right upper lobe. CT scan guided needle b. CT angiography biopsy showed squamous cell carcinoma with right hilar c. Magnetic Resonance Imaging Angiography and paratracheal nodal enlargement. The T status of d. Sputum AFB smear and culture the disease e. Pulmonary arteriogram and embolization a. T1a 69. Most appropriate treatment for the clinical b. T1b * 1.0 situation c. T2a a. anti-Koch’s therapy for 6 months d. T2b b. CT guided percutaneous aspiration e. T3 c. prolonged antibiotic therapy d. pulmonary resection * 1.0 e. amphotericin-b therapy 62. The following invasive diagnostic procedures will obtain tissue samples from the nodes visualized in the 70. Treatment of choice for small cell carcinoma CT scan in the clinical situation previously mentioned limited to the chest. except: a. surgery a. right mediastinotomy b. chemotherapy * 9 (1.0) b. mediastinoscopy c. radiation therapy c. video-assisted thoracoscopy d. immunotherapy d. fiberoptic bronchoscopy * 0.20 e. open thoracotomy 71. A 70-year old retired employee with a 10cm mass in the right upper lobe diagnosed to be squamous cell 63. Positive nodal samples from the ipsilateral hilar carcinoma from bronchial biopsy suddenly developed and mediastinal nodes from squamous cell carcinoma marked facial edema, engorgement of neck veins and in the procedure/s performed will mean what stage of visible venous collaterals in the anterior chest wall and the disease: headaches. The clinical condition is compatible with: a. IB a. brain metastasis b. IIA b. superior venacaval obstruction * 0.5 c. IIB c. pulmonary embolization d. IIIA * 1.0 d. paraneoplastic syndrome e. IIIB 72. Appropriate treatment modality for the clinical 64. A 45-year old male carpenter was referred to the situation Surgical department for a 5 cm mass lesion in the a. Radiotherapy * 0.5 superior segment of the right lower lobe noted on chest b. Surgery (Vena Caval Bypass) x-ray (PA) and right lateral view. If a CT guided c. Chemotherapy percutaneous needle lung biopsy were to be d. Steroid administration performed, the best approach for needle puncture: e. Immunotherapy a. anterior b. lateral 73. The T category in the TNM classification of the c. posterior * 0.25 tumor: d. none of the above is appropriate a. T1 b. T2 65. Which of the following tumor with pulmonary c. T3 solitary metastasis has the poorest outcome: d. T4 * 1.0 a. soft tissue sarcoma b. bone tumor 74. John Doe was brought to the ER 2 hours after a c. melanoma * 0.20 grocery robbery incident with a 3 cm stab wound at the d. colon carcinoma right 4th intercostals space along the anterior axillary e. kidney tumor line. Chest xray showed a completely opacified right hemithorax with absent breath sounds and dullness to 66. Paradoxical embolization is possible in the percussion. Admitting BP- 70/40 mmHg, PR- 100/min, following conditions except: RR-36. Situation is compatible with which of the a. Pulmonary Arteriovenous Malformation (PAVM) following b. Ventricularseptal defect (VSD) a. severe pulmonary contusion c. Deep vein thrombosis (DVT)* 0.25 b. tension pneumothorax d. Atrial septal defect (ASD) c. hemothorax * 1.0 e. Tetralogy of Fallot d. cardiac tamponade 67. A 30-year old male was referred to the Surgical 75. Immediate intervention is appropriate for the service for massive hemoptysis. Chest Xray in the PA clinical situation described above (#75) and lateral view showed a 4 cm mass density in the a. Blood transfusion right upper lobe with a crescent-shaped radioluscency b. Thoracentesis at its upper border. The most likely diagnosis: c. Closed Tube Thoracostomy * 0.33 a. Tuberculosis with cavitation d. Pericardiocentesis b. Lung abscess e. Mechanical ventilation c. Aspergilloma * 0.20 d. Saccular bronchiectasis

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76. A 36-year old female post kidney transplant 6 c. TOF months ago was brough to the ER for remittent fever d. PDA D. mpl – 1 and cough productive of blood streaked sputum. Chest 85. Myocardial protection during open heart surgery xray showed marked pneumonic infiltration of the left can be achieved by: lower lobe with cavitation and probable abscess a. use of systemic hypothermia formation. Follow-up chest cxray 3 days later showed b. use of systemic anticoagulation progression inspite of antibiotic coverage. CT guided c. use of cardioplegia aspiration suspicious for fungal organisms. Most d. a and c only D. mpl - .5 probable diagnosis: a. Tuberculosis in the immunocompromised host 86. Indications for CABG : b. Mucormycosis * 0.33 a. chronic angina c. Atypical pneumonia b. post infarction angina d. Aspergilloma c. unstable angina e. Histoplasmosis d. all of the above D. mpl - 1 77. Treatment of choice in the clinical situation 87. The best conduit for CABG is: a. Urgent surgery- Thoracotomy and lower lobecotmy * a. great saphenous vein 1.0 b. internal mammary art b. Amphotericin B c. gastroepiploic artery c. Itraconazole d. radial artery B. mpl .5 d. Quadruple anti Koch’s therapy e. Antibiotics for anaerobic bacteria 88. Conditions that require mechanical relief of mitral 78. The congenital heart defect that results to stenosis: decreased pulmonary blood flow is: a. worsening pulmonary hypertension a. PDA b. systemic embolization b. TOF c. MVA < 1 cm c. VSD d. all of the above D. mpl -1 d. Subvalvar aortic stenosis B. mpl - .5 89. The treatment of choice for pts with mitral 79. Closure of PDA can be achieved by: stenosis with pliable leaflets but with thrombus at left a. ligation or transection of duct atrial appendage is: b. administration of indomethacin in premature infants a. MVR ( replacement) c. transcutaneous catheter closure b. balloon mitral valvuloplasty d. all of the above D. mpl - .5 c. OMC ( open mitral commisurotomy ) d. A and C C. mpl - .5 80. A 21 year old male construction worker, on routine physical exam, was found to have congenital heart 90. Mitral stenosis associated with significant mitral disease. he was asymptomatic. the most likely defect regurgitation is best treated with: is: a. balloon mitral valvuloplasty a. VSD b. open mitral valvuloplasty b. PDA c. mitral valve replacement c. ASD d. B and C C. mpl - .5 d. Coarctation of the aorta C. mpl - .5 a. are highly thrombogenic 81. A 14 year old boy was noted to have increased b. has excellent durability blood pressure on both upper extremities and weak c. are suited for young pts femoral pulses. The most likely diagnosis is: d. does not require chronic anticoagulation D. mpl - .5 a. Coarctation of the aorta 92. The best diagnostic tool for descending thoracic b. aortic stenosis dissection and aneurysm is: c. PDA a. chest x-ray d. transposition of great arteries( TGA) A. b. CT with contrast mpl - .5 c. MRI 82. The boot-shaped heart is usually seen on chest xd. transesophageal echocardiogram (TEE) B. mpl - . ray of children with: 5 a. VSD 93. The best diagnostic tool to determine aortic root b. TGA dissection is: c. TOF ( tetralogy of fallot) a. chest x-ray d. truncus arteriosus C. mpl - .5 b. CT with contrast 83. The ff. is recommended for repair of VSD's c. MRI a. direct suture closure d. TEE C. mpl - .5 b. use of pericardium 94. Indications for surgery in acute distal aortic c. use of prosthetic graft dissection: d. all of the above. C. mpl - .5 a. increasing periaortic fluid 84. The conenital heart disease that generally does b. acute renal failure not require a cardiopulmonary bypass(CPB) for c. uncontrolled hypertension correction is: d. all of the above D. mpl - .5 a. TGA b. VSD

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95. The most common cause of thoracic aneurysm: a. infection b. trauma c. non specific medial degeneration d. genetic disorders C. mpl - .5

aortic

a. the 3rd part of the duodenum is to the left of the SMV b. the DJ loop rotates 270o counterclockwise around the ligament of Treitz c. the DJ loop rotates 270o counterclockwise around the SMV ** d. the ileocecal segment rotates clockwise around the SMV

96. The critical diameter for rupture of descending thoracic aortic aneurysm is: a. 5 cm 99. b. 6 cm a. c. 7 cm b. d. 8 cm C mpl - .5 c. d. 97. The most common site of rupture of descending aortic dissection is: 100. a. proximal 3rd of descending aorta a. b. middle 3rd b. c. distal half c. d. distal 3rd A. mpl - .5 d. 98. Embryology of the GIT

In Malrotation, the usual location of the cecum is RLQ R Upper abdomen ** .33 Away from the duodenum LLQ Approach in the management of Pediatric tumors Best handled by a Pediatric Surgeon Chemotherapy is almost always indicated Staging is important academically but its clinical importance is not yet established Multidisciplinary approach ** .33

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