Surgery Finals 2011 (1)

SURGERY 2 FINALS EXAM 2011 1. Sarcomas arise predominantly from this embryonic layer. a. ectoderm b. endoderm c. mesoderm d. a and c

a. has an axillary tail which runs posterior to the pectoralis minor muscle b. receives its principal blood supply from the mammary artery c. involutes during menopause d. is always removed if it has cancer e. is innervated by the 2nd-4th intercostal nerves. 9. The following are true of acute mastitis except

2. What is the most common histologic type of soft tissue sarcomas in adults? a. Rhabdomyosarcoma b. MFH c. Leiomyosarcoma d. malignant peripheral nerve sheath tumors 3. Most of sarcomas metastasize thru what route? a. Hematogenous b. Lymphatics c. Both a & b d. NOTA 4. All of these metastasize thru the lymph node except a. EWing's sarcoma b. Rhabdomyosarcoma c. Angiosarcoma d. Clear cell sarcoma 5. 21 year old male with a large mass on the posterior left leg. He complained of shooting pain on the said extremity. There were palpable masses on the left inguinal area. What is the most probable diagnosis? a. Ewing's sarcoma b. Rhabdomyosarcoma c. Angiosarcoma d. Clear cell sarcoma

a. occurs most often in nursing women b. usually treated by mastectomy c. it is extremely painful d. staph.aureus is the most common causative organism e. more common in hot weather 10. The following are changes the breast undergoes during pregnancy except: a. Mammary blood flow increases and myoepithelial cells hypertrophy b. the breast enlarges and areola darkens c. colostrum fills the alveoli during the 3rd trimester d. Lobuloalveolar formation is initiated as ducts branch to form multiple alveoli. e. colloid accumulates in the alveoli during the 3rd trimester 11. A 32 yr old nursing mother was kicked in her left breast accidentally by her baby. There was an area of ecchymosis and now with... retraction over the affected are. The most likely diagnosis is a. hematoma b. fat necrosis c. thromboplebitis d. sclerosing adenosis 12. Not true about melanomas

a. may cause hemmorrhage and tumor dissemination b. mandatory c. needed if there is doubt in diagnosis d. may not do if tumor is easily resectable

a. develop by malignant transformation of the histiocyte, a cell of neural crest origin that produces melanin pigment b. arises in the skin but is also found as a primary melanoma in the uveal tract (choroid, iris, ciliary body), upper aerodigestive tract, anal canal, rectum and vagina c. patients with an organ transplant is highly susceptible d. individuals with an inability to tan may be at risk

7. All of the following have high metastatic potential except

13. The best treatment for perianal abscess:

a. Leiomyosarcoma b. Dermatofibrosarcoma c. Alveolar soft part sarcoma d. malignant schwannoma

a. intravenous antibiotics b. hot sitz bath c. observation d. incision and drainage e. hyperbaric oxygen therapy

6. Biopsy of GIST

8. The breast: 14. The most common cause of perianal abscess:

a. trauma to the rectum b. malignancy c. anal warts d. cryptitis e. diarrhea

c. perforated duodenal ulcer d. Meckel's diverticulum e. TB enteritis

15. Hyperbaric oxygen therapy may be used in the following except:

a. anti-TB drugs b. small bowel resection c. antrectony with truncal vagotomy d. ulcer biopsy with closure of perforation and truncal vagotomy e. enterostomy

a. diabetic wounds b. osteomyelitis c. necrotizing soft tissue infection d. skin grafts and flaps e. all kinds of burns 16. A 65yr old male complaint of progressive dysphagia. He can only tolerate liquids. He has lost 20 lbs in 2 months. What is the functional grade ofr dysphagia? a. grade 3 b. grade 4 c. grade 5 d. grade 6 17. What is the narrowest anatomic constriction of the esophagus a. bronchoaortic constriction b. Cricopharyngeal constriction c. gastroesophageal sphincter d. hiatus of the diaphragm 18. The normal esophagus in the adult is about: a. 5cm b. 10 cm c. 25 cm d. 50 cm e. 80 cm 19. A 65 year old patient has difficulty of swallowing,weight loss and passage of black stools, the most important initial diagnostic test for this patient is:

21. The best treatment for the patient above is:

22. The following are the different muscular layers of the stomach except: a. circular b. transverse c. longitudinal d. oblique e. NOTA 23. What is the largest blood supply of the stomach which is a direct branch of the...? Left Gastric Artery 24. The ascending colon is supplied by blood coming from the artery? a. Ileocolic artery b. Right colic artery c. Middle colic artery d. left colic artery e. NOTA 25. The levator ani muscle of the pelvic floor is comprised by the following muscle EXCEPT a. pubococcygeus b. Iliococcygeus c. Puborectalis d. superficial external sphincter e. NOTA 26. The most common site of volvulus is the:

a. chest ultrasound b. PET/CT scan c. MRI of chest and abdomen d. Abdominal CT scan with IV contrast e. endoscopy 20. A 45-year of female has on and off right upper quadrant pain for 8 months associated with eating fatty foods. The pain was severe in the last 7 days. He was then admitted due to abdominal distention. constipation and vomiting of bile, Most likely diagnosis is: a. gallstone ileus b. perforated gastric ulcer

a. cecum b. sigmoid colon c. transverse colon d. splenic flexure e. hepatic flexure 27. The recommended screening test for detecting colon cancer in asymptomatics, average risk individuals is/are the following: a.Carcinoembryonic antigen (CEA) b. Genetic testing for adenomatous polyposis (APC) c. fecal occult blood test (FOBT)

d. A & C are correct e. AOTA 28. True statement regarding supportive measures in critically ill surgical patients a. Are designed for treatment of postoperative patients only b. are meant to sustain patients to survive surgery and allow infection control measures to exert their effects c. are limited to specific organ function support such as mechanical ventillation, hemodialysis and vasopressor therapy d. are uniformly successful in improving survival for all patients e. include putting patients on prolonged NPO. 29. Prolonged ventilation can be adequately delivered in the apneic patient by: a.bag-mask ventilation b. mouth to mouth breathing c.endotracheal intubation d. oxygen by nasal cannula e. mechanical ventilation via endotracheal tube 30. Central venous pressure monitoring provides a quantitative measurement of which of the following parameters a. cardiac contractility b. preload c. systemic vascular resistance d. afterload e. cardiac output 31. Systemic vascular resistance (SVR) is calculated by dividing mean arterial pressure (MAP) by: a. Heart rate b. stroke volume c. Mean arterial blood pressure d. Central venous pressure e. cardiac output 32. Which of the following is the least common shape of the spleen: a. polyhedral b. wedge c. elliptical d. tetrahedral e. pentagonal 33.Term used for autotransplanted splenic tissue arising from splenic injury: a. splenic implantation b. spleniosis

c. splenosis d. splenites e. splenetration 34. Which of the following is not a splenic function during adult life: a. Filtration b. storage reservior of blood components c. immune response d. NOTA 35. The average capacity of the gallbladder is : a. 50-70 ml b. 100 ml c. 30-50 ml d. ...25 something un? 38. What is the blood supply of the GB a. right hepatic artery b. Cystic artery c. left hepatic artery d. common hepatic artery 39. The triangle of Calot is formed by the following except: a. cystic duct b. common hepatic duct c. liver margin d. right hepatic artery 40. Function of the anterior abdominal wall except: a. protect abdominal viscera b. assist bending c. assist standing d. accessory muscles of respiration e. increase abdominal pressure for urination and defecation 41. Blood supply of anterior abdominal wall: a. superior and inferior epigastric artery and vein b. lower intercostal artery c. lumbar and iliac circumflex arteries d. A and C only e. AOTA 42.True about rectus sheath hematoma: a. Three times greater than male than female b. sudden onset does not include pain c. (+) fothergill's sign: mass present even if rectus muscle is tensed d. cannot be diagnosed by CT scan and ultrasound 43. Least likely to produce hypocalcemia:

a. surgery for Grave's disease b. surgery for multinodular goiter c. full thyroidectomy, rather than a lobectomy d. posterior neck dissection for thyroid cancer, which involves removing lymph nodes and lymph tissue in level-V e. a repeat thyroid surgery 44. Unusual in patients with severe peptic ulcer disease a. hypotension b. nausea and vomiting c. hematemesis d. bloating e. stool positive for occult blood (melena) 45. Not usually done in postoperative ileus: a. Intravenous hydration b. correction of electrolytes abnormalitites c. early oral feeding to improve ileus d. insertion of an NGT to relieve distention e. NOTA 46. Penetrating abdominal injuries may present with the following except: a. hypotension b. pain and tenderness c. dyspnea d. blood loss e. NOTA

52. The first step in doing an orthopedic physical examination a. Palpation b. inspection c. range of motion tests d. testing the neurovascular status 53. The most important part of the history of the orthopedic trauma patient a. Past medical history b. Last meal c. Family history d. DOI, TOI, POI, MOI 54. The Ankle Rules which has been developed to determine whether doing an xray in an injured ankle is necessary. a. Owatta Ankle Rules b. Ottawa Ankle Rules c. Patawa Ankle Rules d. NOTA 55. Known as the "laughing gas" a. Zinc Oxide b. Oxygen c. Nitrous Oxide d. Carbon Dioxide e. AOTA 56. Popularly known as the first anesthesiologist

47. What is the most important prognostic factor for patients with sarcoma? a. histologic grade b. tumor size c. nodal metastasis d. distant metastasis 48. What is the tumor size of deep lesion measuring 5cm? a. T1a b. T2a c. T1b d. T2b

a. Willian Morton b. Crawford LOng c. John Snow d. Horace Wells 57. Included in .... ?basta parang classification un a. Complete history b. ... classification c. Laboratory work up d. ASA classification e. AOTA 58. ASA classification:

51. The most common orthopedic complaint seen is: a. Pain b. deformity c. weakness d. mass e. AOTA

a. healthy patient b. Mild to moderate systemic disease c. severe systemic disease d. incapacitating systemic disease 59. The most common type of esophageal atresia is: a. without a fistula or isolated type

b. with a proximal trachea-esophageal fistula c. with a distal trachea-esophageal fistula d. ... of fistula 60. A 3 month old previously healthy male is referred for non-bilious vomiting. On PE, you see a prominence of the upper abdomen olive shaped in the upper quadrant. What would be your diagnosis? a. ... Pyloric stenosis ito….dont know the letter of choice b. ... c. ... d. ... 64. How should skin incisions be designed in relation to the lines of minimal tension in order to produce narrow or inconspicious... a. parallel to the lines b. perpendicular to the lines c. at a 45 degree angle to the lines d. no relation 65. The donor site of a split thickness skin graft would heal by a process known as a. contraction b. scarring c. reepthelialization d. granulation 66. A split thickness skin graft would derive nutrition form its recipient bed in the first 48 hours through which process? a. neovascularization b. plasmatic inhibition c. inosculation d. nutrient dissipation 67. What is the classification used to classify the divisions and segments of the liver. a. Trousseau b. Couinaud c. Reynaud d. Charcot e. Trenaud 68. The liver being the largest soild orgn in the body is prone to injuries especially blunt abdominal trauma. Various methods have been control liver injuries involve the following except. a. perihepatic compression b. Pringle's maneuver c. liver packing with omentum/laparotomy packs d. hemostatic felt/gelatin sponges/collagen sponges e. mass closure

69. The liver has a remarkable ability to regenerate itself. However, this can happen in a haphazard manner as seen in: a. Hepatitis A b. Hepatitis B c. Hepatoma d. cirrhosis e. fatty liver 70. In the Philippines, there are areas where parasitism still thrive well. Which of the following parasites has a profound effect on the liver. a. Ascariasis b. Helminthiasis c. Schistosomiasis d. Filariasis e. Trichomoniasis 71. Pyogenic liver abscess is oftentimes underdiagnosed and underestimated. which of the following diagnostics is not helpful in the clinical diagnosis: a. ultrasounf b. CT scan c. MRI scan d. chest Xray e. Positron Emision Tomography scan 72. The pancreas is known to produce a lot of digestive enzymes. It normally produces a. 100% of required enzymes for digestion b. 100% of required enzymes for digestion d. None during fasting e. None during sleep 73. Which hormone is not produced by the islets of Langerhans. a. insulin b. glucagon c. secretin d. somatostatin e. polypeptide 74. Acute pancreatitis may lead autodigestion of the retroperitoneal structures causing blood to pool around the a. Umbilicus (Corey turner sign) b. Flanks (Cullen sign) c. Flanks (Corey Turner sign) d. C and D

75. Elements of Ranson's criteria include the following except:

d. a small gram-negative spore-forming bacterium in cluster e. a small gram-positive flagellated anaerobic bacterium

a. serum calcium 350 IU/L c. serum ALT >250 IU/dL d. serum AST >250 IU/dL e. serum base deficit >4 mEq/L

82. Arterial claudication is associated with which of the following conditions?

76. Differential diagnoses for acute pancreatitis include the following except a. mesenteric ischemia b. gangrenous cholescystits c. acute intestinal obstruction d. myocardial infarction e. pulmonary embolism 77. Part of burn syndrome except: a. fluid and electrolye imbalance b. metabolic disturbances c. bacterial contamination of tissues d. respiratory alkalosis e. complications from vital organs

a. smoking b. nocturnal resting pain c. normal lower extremity pulses d. persistent, constant pain is the forefoot and toes e. non-bleeding foot ulcers 83. Which of the following statement regarding deep venous thrombosis is TRUE? a. The most common source is a large thrombus in the left atrium b. Subcutaneous low molecular weight heparin is the initial treatment of choice c. immediate anticoagulation with warfarin is indicated d. For increased efficacy, aspirin is combined with-warfarin as treatment e. streptokinase is the preferred drug of choice for patients with history of recent stroke

78. Release form eschar formation

84. Venous ulceration of the lower extremity is associated with:

a. Eschotomy b. Esharotolysis c. Escharotomy d. Escharlysis e. Escharotony

a. Superficial varices b. Post-thrombotic syndrome c. Superficial thrombophlebitis d. long standing edema e. Diabetes mellitus

79. Not necessary to be referred to a burn facility:

85. Lower extremity atherosclerotic arterial disease is NOT typical of a patient whose history includes

a. presence of psychiatric illness-suicide attempt b. extensive burns >15% BSA in adults c. inhalation injury d. full thickness burns >5cm in diameter e. patients more than 35 years old with burn injury to the back 80. In parkland formula, what is the initial fluid for a resuscitation? a. lactated ringer's solution b. plain normal saline solution c. albumin solution d. D5W e. parenteral Vitrimix solution 81. Clostridiom tetani: a. a large gram-negative spore-forming anaerobic bacterium in chain b. a small gram-positive spore-forming aerobic bacillus c. a large gram-positive spore-forming anaerobic bacillus

a. Cigarette smoking b. Hypertension c. Diabetes mellitus d. Raynaud's phenomenon e. Dyslipidemia 86. An 85 year old man is found to have on routing physical exam a pulsatile midabdominal mass, but is otherwise asymptomatic. What is the appropriate next step: a. Observation and repeated monthly examination b. Abdominal ultrasonography c. Abdominal CT scan d. Urgent surgery 87. A 2cm solitary pulmonary nodule in the apex of the right lung of a 17 year old documented disease is best approaches by: a. percutaneous needle lung biopsy b. CT scan-guided biopsy

c. mediastinotomy d. VATS e. Serial chest x-ray 88. Small cell CA of the lung is best managed by" a. Lobectomy b. Pneumonectomy c. En bloc resection d. Segmentectomy e. nonsurgical treatment 89. A 65 year old male has chronic cough and hoarseness. On work-up he is found to have a 6cm adenocarcinoma abutting the hilum of the right lung with enlarged mediastinal lymph node probably best managed by: a. Lobectomy b. Pneumonectomy c. Lobectomy followed by chemotherapy d. Chemotherapy with or without radiotherapy e. Radiotherapy 90. Which of the following is associated with increased photosensitivity, severe extensive ulcerations and mutilation just from sunlight (tip: vampire reaction to sunlight). a. elliptocytosis b. G6PD deficiency c. Glucose phosphate isomerase deficiency d. Congenital erythropoietic porphyria e. NOTA 91. Thrombotic thromcytopenic purpura (TTP) is characterized by the following except: a. schistocytes in peripheral blood smear b. microvascular thrombosis c. vascular endothelial damage is small vessels d. short of splenectomy, plasmapheresis, dialysis, steroids, ASA and dipyridamole are used. e. NOTA

a. sertoli cells b. Leydigs cells c. both d. NOTA 95. Classic presentation of bladder CA a. dysuria b. bladder mass c. painless hematuria d. urinary frequency 96. Abnormal PSA a. >4ng/ml b. >6ng/ml c. >8ng/ml d. >10ng/ml 97. True of abdominal trauma except: a. most common among trauma injuries b. first most common indication for surgery in the philippines c. Top 10 cause of admission. locally d. consists of 2 basics mechanism 98. What are the priorities in the initial management of abdominal trauma patients? a. Assess ABCDE's b. determine organ injury c. determine the need for operation d. AOTA 99. Penetrating injuries as compared to bliunt mechanism generally affects: a. hollow organs b. solid organs c. Head and neck d. extremities

92. Forms the muscular wall of the bladder 100.TRUE of the penetrating injuries EXCEPT a. muscularis propria b. bladder detrusor c. both d. NOTA

a. traverses the anterior fascia b. not a problematic as blunt injury c. usually associated with genitourinary tract perforation d. NOTA

93. maintains the urinary continence in males a. internal sphincter b. external sphincter c. both d. NOTA 94. Produces testosterone

BONUS: Signs of peritoneal irritation from adbominal injury EXCEPT: a. Presence of blood b. Direct and rebound tenderness c. Board like rigidity d. NOTA