Surgery Ple

University of Perpetual Help Rizal JONELTA FOUNDATION SCHOOL OF MEDICINE Department of Surgery – Consortium Test Questions for the February 2005 PLE

Name ________________________________________ Subject: General Surgery 1 Instructions: Multiple Choice : Choose the BEST answer. 1. With regard to keloids and hypertrophic scars, the following statements are true, EXCEPT: a. There are no histologic differences between the two. b. The differences between hypertrophic scar and keloid are clinical, not pathologic. c. Hypertrophic scars outgrow their original borders. d. Hypertrophic scars and keloids have been treated successfully with intalesional injection of steroids. Answer: C Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 1, pp. 515-516 MPL: 0.7 2. True statements regarding melanoma include all of the following, EXCEPT: a. The most common histologic type is superficial spreading. b. Depth of invasion (measured in millimeters), ulceration and patient gender are important prognostic criteria. c. Nodular melanomas carry a poorer prognosis than do superficial spreading melanomas of the same thickness. d. Melanomas in dark-skinned people are frequently subungual or appear on the palms and soles. Answer: C Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 1, pp. 522-527 MPL: 0.6 3. A mass in the midline of the neck just above the tracheal cartilage has been notable for some months in an 8 year-old girl but in the last four days there has been some reddening and discomfort. Which of the following statements is most likely correct? a. It has a high probability of malignancy. b. It would most likely resolve completely with antibiotics. c. It would rise higher in the neck when she protrudes her tongue. d. Incision and drainage is adequate treatment. Answer: C Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 1, pp. 601-602 MPL: 0.6 4. Each of the following factors contributes to the likelihood that a mass in the neck is malignant, EXCEPT: a. The patient is alcoholic. a. The patient had another malignancy outside the neck. b. The patient is quite sure it was not present a week ago. c. The patient was a heavy smoker, but quit two years ago. Answer: C Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 1, pp. 617-620 MPL: 0.6 5. Which of the following statements concerning parotid tumors is true? a. 80% are benign b. Diagnosis is by incisional biopsy c. Facial nerve palsy is a definite sign of malignancy d. Tumors that extend into the deep lobe of the parotid are unresectable Answer: A Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 1, pp. 657 MPL: 0.6

6. The type of hiatal hernia for which operation is indicated based on its demonstrated presence is: a. sliding hiatal hernia b. para-esophageal hiatal hernia c. “short esophagus” d. Barrett’s esophagitis Answer: B Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 1, pp. 1116 MPL: 0.4 7. Which of the following esophageal abnormalities is premalignant? a. reflux esophagitis b. Barett’s esophagitis c. Presbyesophagus d. Scleroderma Answer: B Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 1, pp.1116 MPL: 0.4 8. Of the anatomic layers of the esophagus, which statement is true for the serosal layer? a. It is effective in temporarily halting the spread of carcinoma. b. It lubricates the esophageal thoracic mobility during swallowing. c. It is useful in suturing anastomoses to the esophageal stump. d. It does not exist. Answer: D Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 1, pp. 1138 MPL: 0.5 9. A 32 year-old woman complains of difficulty swallowing, foul breath, and regurgitation of undigested food. Her most likely diagnosis is: a. esophageal cancer b. achalasia c. Zenker’s diverticulum (pulsion) d. Esophageal stenosis from reflux esophagitis Answer: C Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 1, pp. 1125 MPL: 0.5 10. Signs of breast cancer include each of the following, EXCEPT: a. bloody nipple discharge b. skin dimpling c. Paget’s disease of the nipple d. breast discomfort Answer: D Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 1, pp. 556-558 MPL: 0.6 11. In a 36 year-old woman with a painless hard dominant breast lump, the next step should be: a. mammography of the lump b. fine needle aspiration cytology c. radiation therapy d. radical mastectomy Answer: B Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 1, pp. 570-571 MPL: 0.6

12. Which of the following breast lesions is typically benign?

a. cystosarcoma phylloides b. comedocarcinoma c. medullary carcinoma d. lobular carcinoma Answer: A Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 1, pp. 552-553 MPL: 0.6 13. Current adjunctive therapy for a premenopausal 40 year old woman following radical mastectomy with a 2.5 cm ductal carcinoma with a 2 of 15 lymph nodes involved and an estrogen receptor negative tumor includes: a. tamoxifen b. cytotoxic chemotherapy c. androgens d. oophorectomy Answer: B Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 1, pp. 590 MPL: 0.5 14. A 65 year-old farmer presents with a 1.5-cm ulcerated lesion on the middle third of his lower lip. The lesion has been present for 4 months and is not painful. No lymph nodes are palpable in the patient’s neck. The most likely diagnosis is: a. Squamous cell carcinoma b. Basal cell carcinoma c. Herpes simplex d. Keratoacanthoma Answer: A Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 1, 521-522 MPL: 0.6 15. A 65 year-old patient who spends summer in Baguio City presents with a painless, ulcerated lesion on the right cheek. The lesion has been present for one year. Physical examination of the patient’s neck reveals no lymph node enlargement. The most likely diagnosis is: a. pyogenic granuloma b. melanoma c. basal cell carcinoma d. squamous cell carcinoma Answer: C Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 1, 522 MPL: 0.5 Subject: General Surgery II Instructions: Multiple Choice : Choose the BEST answer. 16. A 60yr.old male underwent operation for a perforated diverticulitis of the descending colon. What would be the most dominant bacteria if the peritoneal fluid was cultured? a. E.coli b. Bacteroides c. H. pylori d. Proteus Answer: B Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 2, pp. 1274 MPL: 0.7 17. A 70yr.old male post-stroke patient with hemiplegia came in at the E.R. complaining of crampy abdominal pain, abdominal distention, vomiting and absence of bowel movement. Physical examination revealed globular abdomen & tender all quadrants. Scout film of the abdomen revealed an “inverted” U shaped, sausage like loop on L abdomen. What would be the likely diagnosis? a. Strangulated Hernia c. Sigmoid Volvulus b. Perforated Diverticulitis d. Completely Obstructing Colonic CA. Answer: C Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 2, pp. 1275 MPL: 0.5

18. What would be the best management for case no.17? a. Observation w/ IV antibioticsc. Barium enema b. Colonoscopy c. Barium enema d. Exploratory Laparotomy Answer: D Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 2, pp. 1275 MPL: 0.6 19. The appropriate surgical procedure for a perforated sigmoid diverticulitis with generalized peritonitis is: a. Sigmoid resection w/ primary anastomosis b. Double barrel transverse colostomy w/ drainage of perforation c. Proximal loop colostomy and drainage of perforation d. Resection of perforated segment w/ end colostomy Answer: D Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 2, pp. 1279-1280 MPL: 0.4 20. A 50yr.old underwent colonoscopy where there is a note of a pedunculated 1.6cm sigmoid polyps and the histopath revealed a tubular adenoma which contained a well-differentiated adenocarcinoma extending to but not beyond the muscularis mucosa. The margin of polypectomy is free of tumor. The best therapeutic option will be: a. Segmental resection of the colon b. Operative colostomy and excision of polypectomy site c. Observation and repeat colonoscopy after 3-6 months d. Intracavitary radiotherapy Answer: C Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 2, pp. 1344 MPL: 0.4 21. A 45y/o F G3P3 came in for consult due to sensation of rectal fullness, mucus discharge and bright red blood dripping into the toilet. Rectal exam revealed a mucosa lined canal mass which is noted to reduce spontaneously. Your primary consideration is internal hemorrhoids. You can further classify this as: a. 1st degree hemorrhoid b. 2nd degree hemorrhoid c. 3rd degree hemorrhoid d. 4th degree hemorrhoid Answer: B Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 2, pp. 1296 MPL: 0.7 22. Assuming this is the 1st consult of the patient in case #21, what would be the appropriate management? a. Medical therapy (i.e increase dietary fiber, stool softer & avoidance of straining) b. Elastic ligation c. Coagulation d. Excessional hemorrhoidectomy Answer: A Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 2, pp. 1296-1297 MPL: 0.6 23. A 30y/o M has persistent purulent drainage from an external anal fistula from abscess few weeks ago. If the external fistula is 2cm anterior to a line transversely drawn in the anus. The internal opening will be noted at: a. curve tract in the posterior midline b. short, direct fistulous trait c. absence of fistulous tract d. beside the external opening Answer: B Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 2, pp. 1306 MPL: 0.6

24. After a L hemicolectomy and an end to end an anastomosis for adenocarcinoma of the descending colon, a 65y/o F was noted to have a fecaloid discharge in the incision site. She is afebrile w/ abdomen soft, NABS and non-tender. While among the following factors will increase chance of spontaneous closure of fistula. a. distal obstruction b. long fistulous tract c. loss of bowel continuity d. 1000 LC/24hr fistula output Answer: B Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 2, pp. 1296 MPL: 0.5 25. A 55y/old female came in for consult due to intermittent crampy abdominal pain and change in bowel habits of 1month duration. Physical examinations were essentially normal. Barium study with revealed an “apple core” lesion on the L colon. What would be the next appropriate step of management? a. Colonoscopy w/ Biopsy b. CT-scan of the abdomen c. ULTRASOUND of the abdomen d. Sigmoidoscopy w/ Biopsy Answer: A Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 2, pp. 1347 MPL: 0.7 26. Patient in no.10 underwent operation, histology report showed the tumor to invade the muscularis propea w/ 2 pericolic lymph nodes and negative liver metastasis. What is the stage of the patient? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4 Answer: C Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 2, pp. 1350-1351 MPL: 0.5 27. What is the common mode of spread of colorectal cancer? a. direct extension b. hemotogenosis c. lymphatic d. implantation Answer: C Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 2, pp. 1350-1351 MPL: 0.5 28. Which is the most important prognostic determinant of survival of patient w/ colorectal cancer? a. tumor size b. transmural extension c. DNA content d. Lymph node involvement Answer: D Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 2, pp. 1354-1355 MPL: 0.5 29. Which of the following colorectal polyps have the highest risk of developing colorectal cancer? a. tubular adenoma b. hyperplastic polyp c. tubulo villous adenoma d. villous adenoma Answer: D Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 2, pp. 1342 MPL: 0.5

30. Which among the following statements is not true regarding Familial Adenomatosis Polypsis? a. it has more than 100 adenomatosis polyps in the large bowel b. includes a spectrum of syndromes i.e Gardner’s syndrome and Turcot’s syndrome c. genetic defect is detected in chromosome 5,near g21 locus d. it is an autosomal recessive disorder. Answer: D Reference: PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH EDITION, Vol. 2, pp. 1275 MPL: 0.5 Subject: General Surgery III Instructions: Multiple Choice : Choose the BEST answer. For questions 31 to 39: A 45 year old woman is admitted for a perforated duodenal ulcer 6 hours after onset of symptoms. She has a history of chronic peptic ulcer disease treated medically with minimal symptoms. 31. The patient is assessed to be dehydrated at the emergency room with dry mucous membranes, tachycardia and a blood pressure of 90/60. Her depleted intravascular volume is mainly due to isotonic fluid losses due to: a. Vomiting b. poor intake c. third space loss due to peritonitis d. escape of gastric fluid through the perforated duodenum Answer: C Reference: Principles of Surgery, Schwartz 6th Edition, pp. 1455 MPL: 0.6 32. Intravenous fluid of choice for resuscitation would be: a. 0.3 Normal Saline b. 0.45 Normal Saline c. D5 Water d. Plain LR solution Answer: D Reference: Principles of Surgery, Schwartz 6th Edition, pp. 1475 MPL: 0.7 33. The most cost- effective method of monitoring adequacy of hydration is through the use ofa/an: a. Foley catheter b. Nasogastric tube c. Swan-Ganz catheter d. Intra-arterial Pressure monitoring. Answer: A Reference: Principles of Surgery, Schwartz 6th Edition, pp. 1475 MPL: 0.5 34. Given an actual body weight of 60 kilograms, an adequate hourly urine output would be: a. 25 cc/ hour b. 60 cc/ hour c. 20 cc/ hour d. 15 cc/ hour Answer: B Reference: Principles of Surgery, Schwartz 6th Edition, pp. 74-78 MPL: 0.5 35. Her pneumoperitoneum would be best documented by which radiologic study: a. Chest Bucky film b. Plain Abdomen c. Chest PA upright d. Holoabdominal ultrasound Answer: C Reference: Principles of Surgery, Schwartz 6th Edition, pp. 1135 MPL: 0.6

36. Appropriate antimicrobial coverage peri-operatively would consist of intravenous: a. Ciprofloxacin b. Cefazolin c. Metronidazole d. Imipenem Answer: B Reference: Principles of Surgery, Schwartz 6th Edition, pp. 1134-1137 MPL: 0.6 37. If the patient exhibits unstable vital signs in the operating theatre, the procedure of choice is: a. Hemigastrectomy b. Simple closure with omental patch c. Antrectomy and truncal vagotomy d. Highly selective Vagotomy Answer: B Reference: Principles of Surgery, Schwartz 6th Edition, pp. 1137-1138 MPL: 0.6 38. It the patient exhibits stable vital signs in the operating theatre and the peritonitis is localized, the procedure of choice is: a. Hemigastrectomy b. Simple closure with omental patch c. Antrectomy and truncal vagotomy d. Highly selective Vagotomy Answer: C Reference: Principles of Surgery, Schwartz 6th Edition, pp. 1137-1138 MPL: 0.5 39. This microbe has been implicated in the causation of her disease: a. H. influenzae b. H. pylori c. S. pneumoniae d. S. aureus Answer: B Reference: Principles of Surgery, Schwartz 6th Edition, pp. 1134 MPL: 0.6 For questions 40to 42: A 53 year old man is diagnosed to have a bleeding duodenal ulcer on urgent endoscopy after he presented at the emergency room with melena. His vital signs are stable. 40. The blood vessel most likely involved in the above lesion if the : a. Left Gastric Artery b. Gastroduodenal Artery c. Coronary Vein d. Right Gastroepiploic Artery. Answer: B Reference: Principles of Surgery, Schwartz 6th Edition, pp. 1134-1135 MPL: 0.4 41. The lesion showed evidence of active bleeding on endoscopy, the most appropriate management to arrest the bleeding would be: a. NGT lavage with ice cold saline b. Urgent Laparotomy c. Endoscopic Hemostasis d. Angiographic Hemostasis Answer: C Reference: Principles of Surgery, Schwartz 6th Edition, pp. 1134-1135 MPL: 0.6 42. The most appropriate supportive medication to administer in addition to # 41 would be: a. Antacids b. Intravenous H2 blockers c. Intravenous Proton Pump Inhibitors d. Oral H2 blockers Answer: C Reference: Principles of Surgery, Schwartz 6th Edition, pp. 1134-1135 MPL: 0.6

For questions 43 to 45. A 50 year old man presents with obstructive jaundice. 43. Additionally, he presented with significant weight loss and mild abdominal discomfort. Ultrasound examination revealed Dilated intrahepatic ducts, gall bladder and common bile duct. The most likely diagnosis is: a. Klatskin Tumor b. Hepatocellular Carcinoma c. Common Duct Stone d. Pancreatic Head Cancer Answer: D Reference: Principles of Surgery, Schwartz 6th Edition, pp. 1421-1425 MPL: 0.5 44. Additionally, he presented with a prior 2 month history of episodic severe, right upper quadrant pain and fever associated with waxing and waning jaundice. The most likely diagnosis is: a. Klatskin Tumor b. Hepatocellular Carcinoma c. Common Duct Stone d. Pancreatic Head Cancer Answer: C Reference: Principles of Surgery, Schwartz 6th Edition, pp. 1382-1383 MPL: 0.4 45. Additionally he presented with significant weight loss and mild abdominal discomfort. Ultrasound examination revealed Dilated intrahepatic ducts with no visualization of the gallbladder and common bile duct. The most likely diagnosis is: a. Klatskin Tumor b. Hepatocellular Carcinoma c. Common Duct Stone d. Pancreatic Head Cancer Answer: A Reference: Principles of Surgery, Schwartz 6th Edition, pp. 1389-1390 MPL: 0.5 Subject: Trauma Instructions: Multiple Choice : Choose the BEST answer. 46. A 24 year old male was admitted for a Tension Pneumothorax of the Right Lung due to a stab wound in the chest. The intervention of choice would be: a. Tube Thoracostomy b. Subxiphoid Window c. Cricothyroidotomy d. Endotracheal Intubation Answer: A Reference: Principles of Surgery, Schwartz 6th Edition, pp. 674-675 MPL: 0.6 47. A 30 year old male was admitted for a Flail Chest on the Right Hemithorax cue to injuries sustained in a car crash. The intervention of choice would be: a. Tube Thoracostomy b. Subxiphoid Window c. Cricothyroidotomy d. Endotracheal II:¥Ubation Answer: D Reference: Principles of Surgery, Schwartz 6th Edition, pp. 675 MPL: 0.5 48. A 29-year-old male was admitted for Laryngeal Obstruction due to injuries sustained in a car crash. The intervention of choice would be: a. Tube Thoracostomy b. Subxiphoid Window c. Cricothyroidotomy d. Endotracheal Intubation Answer: C Reference: Principles of Surgery, Schwartz 6th Edition, pp. 673 MPL: 0.6

49. A 22-year-old male was admitted for an Open Pneumothorax due to a gun shot wound. The intervention of choice in the acute setting would be: a. Occlusive Dressing b. Subxiphoid Window c. Cricothyroidotomy d. Endotracheal Intubation Answer: A Reference: Principles of Surgery, Schwartz 6th Edition, pp. 674-675 MPL: 0.5 50. A 19-Year-old Male was admitted for a Pericardial Tamponade caused by an Ice Pick wound to the chest. The intervention of choice would be: a. Tube Thoracostomy b. Subxiphoid Window c. Cricothyroidotomy d. Endotracheal Intubation Answer: B Reference: Principles of Surgery, Schwartz 6th Edition, pp. 887-888 MPL: 0.6 For questions 51 and 52: A 19 year old male is kicked in the left flank. Three hours later he develops gross hematuria. His vital signs are stable. 51. Initial diagnostic test of choice would be: a. Retrograde urethrography b. Retrograde cystography c. Arteriography d. High dose infusion urography Answer: D Reference: Principles of Surgery, Schwartz 6th Edition, pp. 1766-1768 MPL: 0.5 52. The diagnostic tests performed revealed extravasation of contrast into the renal parenchyma. Treatment of choice would be: a. Exploration and suture of laceration. b. Non surgical treatment consisting of serial monitoring of vital signs and increased fluid intake and antibiotics. c. Exploration and Nephrectomy d. Exploration and ligation of the involved Renal artery . Answer: C Reference: Principles of Surgery, Schwartz 6th Edition, pp. 1766-1768 MPL: 0.6 For questions 53-55. .A 13 year old boy falls from his bicycle and is run over by a passing truck. On arrival in the emergency room he is awake, alert and appears frightened but in no distress. The chest radiograph suggests an air fluid level in the left lower lung field and the nasogastric tube seems to coil upward into the left chest. 53. The teen aged boy is suffering from: a. Flail chest b. Rupture of the left hemidiaphragm c. Pleural Effusion d. Lung Contusion Answer: B Reference: Principles of Surgery, Schwartz 6th Edition, pp. 675-676 MPL: 0.6 54. On the 45th minute of admission, the patient starts to exhibit tachycardia and hypotension. Rapid fluid resuscitation is significantly enhanced by which of the following? a. Placement of long gauge 18 subclavian catheters. b. Placement of short large bore percutaneous peripheral intravenous catheters. c. Bilateral saphenous vein cut downs. d. Bilateral femoral vein cut downs. Answer: B Reference: Principles of Surgery, Schwartz 6th Edition, pp. 176 MPL: 0.6

55. The next best step in management is:

a. Non Surgical treatment in the ICU setting. b. Placement of a left chest tube. c. Immediate celiotomy d. Immediate thoracotomy. Answer: C Reference: Principles of Surgery, Schwartz 6th Edition, pp. 675-676 MPL: 0.6 56. A 15 year old boy is admitted for a intra peritoneal injury aft'er he is run by a car. The most commonly injured organ in this case is the: a. Liver b. Spleen c. Kidney d. Pancreas Answer: B Reference: Principles of Surgery, Schwartz 6th Edition, pp. 212-214 MPL: 0.5

over

For questions 57 to 60. A 25 year old woman arrives in the emergency room following an automobile accident. She is very dyspneic with a respiratory rate of 48 breaths per minute. Breath sounds are markedly diminished on the right side and the trachea is deviated to the left. 57. She is most likely suffering from a: a. Massive Pleural Effusion b. Simple Pneumothorax c. Tension Pneumothorax d. Hemothorax Answer: C Reference: Principles of Surgery, Schwartz 6th Edition, pp. 674-676 MPL: 0.6 58. In this patient there is : a. Collapse of the ipsilateral lung b. Shifting of the mediastinal structures to the ipsilateral side of the injury. c. Shifting of the trachea to the ipsilateral side of the injury d. Increased Cardiac ouput. Answer: A Reference: Principles of Surgery, Schwartz 6th Edition, pp. 674-676 MPL: 0.6 59. The first step in managil1g the patient should be to a. Take a chest X ray b. Draw arterial blood for blood gas studies c. Decompress the Right Pleural space d. Perform Pericardiocentesis. Answer: C Reference: Principles of Surgery, Schwartz 6th Edition, pp. 674-676 MPL: 0.6 60. If left untreated, this woman may succumb due to: a. Pneumonia b. Empyema Thoracis c. Hypoxemia and Hypotension d. Myocardial Infarction Answer: C Reference: Principles of Surgery, Schwartz 6th Edition, pp. 674-676 MPL: 0.6 Subject: Orthopedic Surgery Instructions: Multiple Choice : Choose the BEST answer. 61. These are present in a typical Colles fracture except: a. Dorsal angulation (silver fork deformity) c. Ulnar shortening b. Radial angulation d. Involves distal metaphysis of the radius Answer: C Reference: Rockwood and Green’s Fractures in Adults, Vol. 1, pp. 770 MPL: 0.5

62. A reverse Colles fracture is called a. Barton’s fracture

c. Frykmann’s fracture

b. Smith’s fracture Answer: B Reference: MPL: 0.5

d. Pouteau’s fracture Rockwood and Green’s Fractures in Adults, Vol 1, pp. 770

63. An open fracture with a very large wound (more than 10cm) caused by a sharp object such as a knife with minimal soft tissue injury is classified as a: a. Type I Open fracture c. Type III Open fracture b. Type II Open fracture d. Type IV Open fracture Answer: B Reference: Rockwood and Green’s Fractures in Adults, Vol 1, pp. 309 MPL: 0.6 64. The antibiotics of choice for the treatment of open fractures: a. Penicillin c. Cephalosporins b. Streptomycin d. Aminoglycosides Answer: C Reference: Rockwood and Green’s Fractures in Adults, Vol 1, pp. 347 MPL: 0.6 65. The distal carpal row is formed by the following bones except: a. Triquetrum c. Trapezium b. Capitate d. Hamate Answer: A Reference: Rockwood and Green’s Fractures in Adults, Vol 1, pp. 750 MPL: 0.5 66. Its innervation is purest at the palmar skin of the tip of the index finger: a. Ulnar nerve c. Median nerve b. Radial nerve d. Posterior interosseous nerve Answer: C Reference: Physical examination of the Spine and Extremities by Hoppenfeld, pp. 98 MPL: 0.6 67. This test evaluates the strength of the gluteus medius: a. Thomas test c. Finkelstein’s test b. Allen test d. Trendelenburg test Answer: C Reference: Physical examination of the Spine and Extremities by Hoppenfeld, pp. 164 MPL: 0.5 68. To test for the true leg length, one measures from the __________to the medial malleoli. a. Umbilicus c. Posterior superior iliac spine b. Anterior superior iliac spine d. Greater trochanter Answer: B. Reference: Physical examination of the Spine and Extremities by Hoppenfeld, pp. 165 MPL: 0.6 69. This is a very common site for gout: a. First metatarsal head c. Elbow b. Ankle d. Knee joint Answer: A Reference: Physical examination of the Spine and Extremities by Hoppenfeld, pp. 209 MPL: 0.5 70. This area of the bone is most often involved in acute osteomyelitis a. Epiphysis c. Diaphysis b. Metaphysis d. Physis Answer: B Reference: Orthopedics by Turek, pp. 258 MPL: 0.4

Subject: Thoracic Cardio Vascular Surgery Instructions: Multiple Choice : Choose the BEST answer. 71. In the evaluation of lymph node status of patients with suspected lung cancer, Chamberlaine procedure or parasternal mediastinotomy is used to biopsy what location of lymph nodes? a. cervical lymph nodes c. aortopulmonary window lymph nodes b. paratracheal nodes d. subcarinal lymph nodes Answer: C Reference: Principles of Surgery, pp. 671 MPL: 0.5 72. A 17 y/o, male, sustained a stab wound on the right chest. He was brought to the ER complaining of dyspnea. He was given oxygen support and started with IVF. On physical examination, the following are manifestations of Tension Pneumothorax except: a. dilated neck veins c. absent or distant breath sounds b. dull percussion over the injured hemithorax d. hypotension Answer: B Reference: Principles of Surgery, pp. 684 MPL: 0.6 73. A 35 y/o, male, with gunshot wound over the left chest was brought to the ER. After initial resuscitation, a chest tube was inserted draining bloody pleural effusion. What amount of drainage will warrant an emergency thoracotomy? a. 1.5 liter c. 50 ml per hour for 3 consecutive hours b. 500 ml d. 700 ml Answer: A Reference: Principles of Surgery, pp. 684 MPL: 0.7 74. A young tall male suddenly complains of chest pain and dyspnea while playing basketball. Chest x-ray showed pneumothorax on the left hemithorax. What is the most likely cause? a. Lung abscess b. PTB c. Bronchiectasis d. Ruptured bleb or bulla Answer: D Reference: Principles of Surgery, pp. 711 MPL: 0.6 75. Myasthenia gravis is associated most commonly with what type of mediastinal tumor? a. Lymphoma b. Teratoma c. Neurogenic tumor d. Thymoma Answer: D Reference: Principles of Surgery, pp. 774 MPL: 0.6 76. Chest x-ray is used initially to evaluate patients with congenital heart disease. What cardiac contour is typical of Tetralogy of Fallot? a. egg – shape b. boot – shape c. snowman appearance d. apple – shape Answer: B Reference: Principles of Surgery, pp. 797 MPL: 0.5 77. A 20 y/o, female, consulted at the ER with complaints of palpitation and dyspnea. She was diagnosed to have Patent Ductus Arteriosus during her childhood. What is the hallmark of this congenital disease? a. wide pulse pressure b. distant heart sounds c. continuous machinery murmur

d. engorged neck veins Answer: C Reference: Principles of Surgery, pp. 812 MPL: 0.5 78. In coronary artery bypass grafting, what is the most important vessel used with a long term patency rates exceeding 90%? a. internal mammary artery b. saphenous vein c. radial artery d. tibial artery Answer: A Reference: Principles of Surgery, pp. 859 MPL: 0.4 79. A 35 y/o, male patient complains of exertional dyspnea and fatigue. On P.E., he has a grade 3 apical diastolic murmur and bipedal edema. ECG showed atrial fibrillation. 2D Echocardiography showed a severely stenotic and calcified mitral valve. What is the most likely cause? a. infection b. trauma c. congenital d. rheumatic Answer: D Reference: Principles of Surgery, pp. 876 MPL: 0.4 80. A 55 y/o, male, smoker, diabetic for 10 years was admitted due to chest pain radiating to the left shoulder. ECG showed ST segment elevations in leads II, AVF, V 1-3. Diagnosis was Unstable Angina. Coronary angiogram showed significant three vessel disease. The surgical treatment of choice is: a. valve replacement b. coronary artery bypass grafting c. laser therapy d. VATS ( video assisted thoracic surgery ) Answer: B Reference: Principles of Surgery, pp. 861 MPL: 0.4 Subject: Urology Instructions: Multiple Choice : Choose the BEST answer. 81. A 13 year old boy was brought in at the ER due to blood dripping at the urethral meatus. The following informations is/are necessary to make the proper diagnosis. a. history of acute colicky flank pain b. history of straddle or pelvic crushing injury c. history of instrumentation d. family history of renal disease Answer: B Reference: Smith’s General Urology, pp. 343-345 MPL: 0.5 82. Injury to the urethra is best diagnosed by means of a. voiding cystourethrogram b. retrograde urethrogram c. cystogram d. retrograde pyelography Answer: B Reference: Smith’s General Urology, pp. 344 MPL: 0.4 83. The most common cause of ureteral injury is/are a. iatrogenic b. vehicular accident c. penetrating abdominal injury d. self-induced Answer: A

Reference: MPL:

Smith’s General Urology, pp. 329 0.4

84. The classic triad of manifestations of renal cell CA a. hematuria, weight loss, and pain b. hematuria, weight loss, and mass c. hematuria, palpable mass, and flank pain d. hematuria, palpable mass, and weight loss Answer: C Reference: Smith’s General Urology, pp. 383 MPL: 0.4 85. Stage II renal cell CA is managed by a. chemotherapy b. radiation therapy c. partial nephrectomy d. radical nephrectomy Answer: D Reference: Smith’s General Urology, pp. 387-388 MPL: 0.5 86. Patient presenting with painless gross hematuria is most likely suffering from a. renal cell carcinoma b. ureteral transitional cell CA c. bladder transitional cell CA d. renal pelvic transitional cell CA Answer: C Reference: Smith’s General Urology, pp. 358 MPL: 0.6 87. On digital rectal exam, a strong 63 year old male sexually active male was found to have a 1.0cm nodule on the right lobe of the prostate gland. However, he was asymptomatic, what will be your next plan of management? a. transrectal prostate ultrasound b. transabdominal KUB prostate ultrasound c. acid phosphatase determination d. prostate specific antigen test Answer: D Reference: Smith’s General Urology, pp. 406-407 MPL: 0.4 88. Prostatic CA most commonly originates at what zone? a. central zone b. transitional zone c. peripheral zone d. periurethral gland Answer: C Reference: Smith’s General Urology, pp. 406-408 MPL: 0.4 89. On transrectal UTZ guided needle biopsy of prostate gland, result showed adenocarcinoma with a Gleason’s score of 4+5 (9) and PSA value of 42 (NO 0-4). The next step is to determine the stage of the disease. What will be your best choice in staging the disease? a. total body bone scan b. abdominal CT scan c. pelvic lymphangiography d. molecular staging Answer: A Reference: Smith’s General Urology, pp. 411 MPL: 0.4 90. Benign prostatic hyperplasia originates from what portion or zone of the prostatic gland? a. central zone b. transitional zone

c. peripheral zone d. periurethral gland Answer: D Reference: Smith’s General Urology, pp. 399-401 MPL: 0.4

Subject: Neuro Surgery Instructions: Multiple Choice : Choose the BEST answer. 91. Regarding the relationship of ICP and systemic BP, the best conclusion is: a. blood pressure may be high without increased ICP b. ICP may be elevated without change in BP c. BP may increase as ICP is falling d. The relationship is unconstant and measuring BP is not a satisfactory technique for measuring ICP. Answer: D Reference: Youman’s Neurological Surgery, pp. 469 MPL: 0.4 92. The presence of reflexes of spinal origin in brain damaged patients: a. Is prognosis of recovery b. Is compatible with a diagnosis of brain death c. Is incompatible with a diagnosis of brain death d. None of the above Answer: B Reference: Ivan, L.P. Neurology (Minn.), chap. 23 pp. 650, MPL: 0.5 93. In traumatic transection of the spinal cord, “spinal shock” may a. Last from 3 or 4 days to 6 weeks. b. Result in permanent flaccidity of the denerated muscles c. Never be evident d. None of the above Answer: A Reference: Haymakers, W. Bing’s Local Diagnosis in Neurologic Diseases, pp. 85 MPL: 0.6 94. The mesencephalic nucleus of the trigeminal nerve is concerned with: a. Propuoceptive fibers b. Tactile sensaion c. Thermal sensation d. Pain sensation Answer: A Reference: Bloedel, J.R. & Mc Cherry, D.B. Surg. Neurol., chap. 4 pp. 68 MPL: 0.4 95. In civilian practice, an intracranial missile is not ordinarily removed if it is deep in the brain. Periodic radiological observation is indicated for all of the following reasons except: a. The bullet may migrate b. It may move to on accessible area c. The movement may cause neurological damage d. Erosion of vascular structures is frequent complication Answer: A Reference: Lieberkind, A.L. et al. Neuroradiology, chap. 5 pp. 129 MPL: 0.4 96. Increased morbidity and mortality in patients with epidural hematoma was associated with all of the following except: a. Late development of the hematoma b. Concomitant brain injury c. Unconsciousness at time of operation d. Early development of the hematoma Answer: A Reference: Heiskamen, O. Surgical Neurology, chap. 4 pp. 23 MPL: 0.6

97. There is a question regarding the utility of routine skull x-rays in trauma patients. Recently, authors have suggested all of the following except: a. There is high correlation between physical findings and the detection, location and type of fracture demonstrated by x-ray. b. There’s little correlation between physical findings and the detection, location and type of fracture demonstrated by x-ray. c. Skull fractures are an insignificant manifestation of trauma. d. Skull fractures need not be detected unless there is reasonable possibility of depressed fragments. Answer: A Reference: Bill R.S. & loop, J.W.NEJM and Roberts, F & Shaftner, Radiology 114: 230, 1972, chap. 284 pp. 236 MPL: 0.5 98. All of the following apply to patient with compound depressed skull fractures EXCEPT: a. 1/4 will develop late epilepsy b. 10% have an associated hematoma c. 2/3 of patients were not unconscious d. Dural penetration greatly increased the likelihood of early epilepsy Answer: D Reference: Heiskamen, O. et al Acta Chir Scand, chap. 139 pp. 605 MPL: 0.5 99. Regarding patients with chronic subdural hematoma.: a. History of craniocerebral trauma in 90% of patients. b. Have a precipitous onset c. History of craniocerebral trauma in 50% of patients d. 90% of patients with a history of craniocerebral trauma were unconscious following the trauma. Answer: C Reference: Figelholm. R. etal. J Neurosurgery, 1975, chap. 42 pp. 43 MPL: 0.6 100.The most important factor in infection as a complication of depressed skull fracture is: a. Delay in treatment c. Failure in antibiotic therapy b. Replacement of bone fragments d. Inadequate debridement Answer: A Reference: Jennett, B.J. Neurosurgery, 1972, chap. 36 pp. 337 MPL: 0.5