Surgery

Our Lady of Fatima University Department of Surgery CHOOSE THE BEST ANSWER. C1. The most common organism associated with OPSI is: A. Pseudomonas C. Streptococcus pneumoniae B. Hemophilus influenzae D. Neisseria meningitides D2. The most common indication for surgery in Chronic pancreatitis is: A. Endocrine insufficiency C. Abscess formation B. Exocrine insufficiency D. Pain A3. Criteria for resectability of Adenocarcinoma of the pancreas are the following except: A. Negative or equivocal FNAB prior to resection C. Involvement of distant lymph node B. Involvement of major vascular structure D. Involvement of the liver B4. The most common type of peritonitis is seen in: A. Patients w/ renal failure undergoing dialysis D. All of the above B. Patient with ruptured appendicitis B C. Postoperative patients on broad spectrum antibiotics C5.The ff. statements regarding movement & accumulation of peritoneal fluid are true, EXCEPT: C A. Clearance of fluid & particulate matter within the peritoneal cavity occurs via the diaphragmatic surface D B. Movement of fluid within the peritoneal cavity is affected by gravity E C. Fluid tends to collect in the subhepatic & subphrenic spaces in the supine position only F D. None of the above B6. The best imaging modality in suspected cases of intra-abdominal abscess: A. Ultrasound B. CT scan C. Plain abdominal X-ray D. Laparoscopy A7. Almost always heralds intraabdominal disease but might not indicate the need for surgical therapy: A.visceral pain B. somatic pain C. parietal pain D. well localized , sharp pain C8. Hyperactive bowel sounds: A. hypokalemia B.ileus C. early small bowel obstruction D. peritonitis D9. Type of somatic stimulation resulting to pain: A. stretching B. distention C. contraction D. inflammation B10. The manometric finding of non-peristalsis, low pressure or absent esophageal contraction can be seen A. Nut cracker esophagus B. achalasia C. Barett esophagus D. none of the above D11. Pre-malignant lesions developing into adeno CA of esophagus: A. Achalasia C. Reflux esophagitis E. Tylosis B. Leiomyoma D. Baretts esophagus D12. In caustic agent injury of the esophagus, the best diagnostic work-up to evaluate the injury: A. CT scan B. barium swallow C. Chest X-ray D. esophagoscopy E. ultrasound B13. A condition being felt by a patient who underwent gastric surgery in which after eating a high carbohydrate diet, severe colicky abdominal pain follows: A. Gastric stasis C. Small capacity syndrome E. none of the above B. Dumping synderome D. Afferent loop syndrome C14. Surgical procedure for peptic ulcer disease with the best result: A. Truncal vagotomy with drainage procedure D. Subtotal gastrectomy B. Parietal cell vagotomy without drainage procedure E. Total gastrectomy C. Truncal vagotomy and antrectomy B15. A condition with s/s of gastric outlet obstruction and the cause is a conglomeration of undigestible materials: A. Lymphoma B. Bezoar C. Corrosive Gastirits D. Gastric Volulus E. none A16. The single best thyroid function test that can be used in the diagnosis of hyperthyroidism is: A. Serum TSH determination C. Serum T3 B. Radioactive iodine uptake D. Serum T4 A17. A practical and precise diagnostic screening procedure that can differentiate between a benign from a malignant thyroid nodule is: A. Fine needle aspiration cytology C. Thyroid ultrasound B. Radioactive iodine thyroid scan D. Serum TSH determination D18. Immediate and potentially complication of thyroid surgery: A. Hypocalcemia C. Injury to the ansa hypoglossi nerve B. Injury of the recurrent laryngeal nerve D. Bleeding D19. The most common type of primary malignancy encountered in the head and neck area is: A. Adenocarcinoma C. Lymphoma E. papillary carcinoma

B. Basal cell carcinoma

D. Squamous cell carcinoma

C20. In pt diagnosed with nasopharyngeal carcinoma, one of the following statements is Not True: A. Nasal stuffiness is a common complaint E. none of the above B. Upper Jugular and posterior triangle group of nodes are usually involved C. Primary treatment is surgery D. Radiation is the recommend treatment for locoregional disease C21. A 6 y/o male presents with a 3 x 4 cm, non-hard, movable mass located at the midline of the neck. History reveals the intermittent episode of infection in the said mass which was also noted to elevate upon tongue protrution. The most likely diagnosis is: A. 2nd branchial cleft anomaly C. Thyroglossal duct cyst E. Lipoma B. 3rd branchial cleft anomaly D. Epidermal inclusion cyst D22. Which of the following may be used to differentiate acute appendicitis from a gynecologic pathology? A. Laparoscopy C. HBT Ultrasonography E. B & C B. Pregnancy test D. A and B B23. Most common presentation of appendiceal adenocarcinoma A. Intestinal obstruction B. Appendicitis C. Presence of mass D. Anemia B24. A 37 y/o female was brought to your clinic foe a fluctuant mass at the right lower quadrant. On history taking, you elicited that she given a course of antibiotic therapy. Most probably this patient has: A. soft tissue abcess B. phlegmon formation C. Chronic appendicits D. Mucocoele C25. Idiopathic retroperitoneal fibrosis A. Nonsuppurative inflammation of fibroadipose tissue of unknown cause B. Produce symptom of gradual compression of tubular structure in the retroperitoneum C. Both of the above D. none of the above A26. Most common malignant retroperitoneal tumor A. sarcoma B. squamous cell CA C. adenocarcinoma D. lymphoma D27. Superior and inferior mesenteric arteries are the arterial supply to entire intestinal tract, EXCEPT: A. stomach B. duodenum C. distal rectum D. all of the above C28. Boundaries of the Hesselbach’s triangle, EXCEPT: A. inferior epigastric vessels C. Rectus sheath B. Inguinal ligament D. External oblique m. B29. Anatomically, hernias occuring within the Hesselbach’s triangle is: A. Indirect type B. direct type C. Femoral D. Incarcerated D30. Anterior approaches to hernia repair, EXCEPT: A. Bassini’s B. Shouldice C. Lichtenstein D. TAPP C31. Usual location of tuberculous enteritis: A. Duodenum B. Jejunum C. Ileum D. Colon B32. Most common location of duodenal diverticula: A. superior part B. descending part C. horizontal part D. ascending part C33. Blind loop syndrome: A. steatorrhea B. Vit B12 deficiency C. Both D. none B34. A useful in determining the path of a tract in Fistula-in-ano A. Bradoies Triad B. Goodsall’s rule C. Charcots Triad D. Rule of thum A35. Which paraclinica; exam will be most useful in the diagnosis of colorectal CA? A. Colonoscopy C. Barium swallow B. Abdominal ultrasonography D. Carcinoembryonic antigen A36. Which of the following is true regarding familial adenomatous polyposis? A. Polyps start to occur at a mean age of 16 y/o. Necessitating screening colonoscopy at this age among relatives of patients with FAP. B. Screening by using colonoscopy among relatives of patients with FAP is done at 35 y/o since almost all persons with this gene will exhibit adenoma by this time. C. Genetic screening has no rule in the detection and control of FAP D. Polypectomy is adequate in the treatment of the adenoma in FAP C37. Lymph nodes medial to the medial border of pectoralis minor: A. Level I B. Level II C. Level III D. Level IV A38. Liver metastasis is suspected when there is elevated: A. Alkaline phosphatase C. Prolactin Level B. Carcino embryonic antigen D. BUN and creatinine D39. Contraindication of breast conservation Surgery: A. Large tumor size 70.5 cm B. Gross multifocal disease or diffuse malignant microcalcification C. Retroareolar or nipple & cannot participate in needed follow-up D. All of the above

D40. True regarding the incidence of Imperforate Anus: A. more common in females B. males have less complex C. females tend to undergo colonostomy more than males D. surgical management is more simple in females in most cases A41. Clinical manifestation of Hirchsprung’s Disease A. Presentation is varied but most had delayed passage of meconium beyond the 1st 24 hr of life B. Almost always presents as obstruction at birth C. Majority of patients have delayed presentation D. Should be the sole consideration when dealing with chronic constipation in older children C42. Intestinal Atresia, in contrast to Malrotation, presents with billous vomiting associated with: A. scaphoid abdomen C. abdominal distention B. upper abdominal fulness D. thich blackish meconium D43. The most common cause of esophageal perforation is: A. tumor B. swallowed objects C. caustic injury D. instrumentation B44. Flail chest cause respiratory compromise because of: A. rib fracture B. pulmonary contusion C. pleural effusion D. pneumothorax D45. The most common cause of esophageal perforation is: A. tumor B. swallowed objects C. caustic injury D. instrumentation B46. The normal prostate gland weighs about A. 10 grams b. 20 grams c. 30 grams d. 40 grams A47. The classic triad of symptoms for renal cell cancer are the following EXCEPT: A. weight loss b. flank pain c. gross hematuria d. abdominal mass D48. A 23 y/o female has BP of 240/120. To diagnose of the hypertension is renal origin, one should do: a. KUB-IVP b. Renal ultrasonography c. CT Scan d. Renal arteriography B49. A good color match is an important factor in skin grafting. The best donor site for skin grafting of the face is: A. antecubital area B. supraclavicular area C. abdomen D. groin D50. A 40 y/o with 2nd degree flame burns involving the entire right upper extremity, whole anterior trunk, perineal area and 50% of the left lower extremity. Approximately what percentage of the total body surface is burned? A. 28% B. 24% C. 45% D. 37% B51. CT scan finding in a head injured man is a crescentic hyper dense mass of the right frontotemporoparietal area. His diagnosis is A. acute epidural hematoma C. chronic subdural hematoma E. subarachnoid B. acute subdural hematoma D. cerebral contusion hemorrhage C52. Epidural hematomas are located between the: A. bone and the galea C. bone and the dura E. scalp and the bone B. cerebral cortex and the dura D. cortex and the ventricle B53. Management of intracerebral hemorrhage include A. antiplatelet and antihypertensive drugs B. ventilatory support and tissue-dehydrating agents C. ventilatory support and antiplatelet medication D. antiplatelet medication and surgery B54. A decrease in femoral neck shaft angle less than 130°: A. Fenu valgus b. Coxa vara c. Coxa valga d. Genu varum D55. Maximum weight that can be used for skin traction: A. 6-7 lbs. b. 6-7 kgs. c. 15-20 lbs d. 10 lbs. C56. A positive Trendelenberg’s test is secondary to weakness of: A. Hip extensors B. Hip flexors C. hip abductors D. hip adductors B57. Metabolic response to injury includes the following, EXCEPT: A A. increase in heart rate C. increased BP E. increased ketones B B. decrease in peripheral resistance D. increased blood glucose A58. Epithelialization stops when: A. Like cells from each side comes in contact with each other B. Platelets have formed a blood clot D. Contraction starts C. Collagen have been deposited by the reparative process C59. The total body fluid of a 70 kg female is: A. 28,000 ml. B. 42 Liters C. 35 liters D. 40 liters E. 35 – 45 liters B60. Statement/s true about the metabolic changes in injured patients: A.There is an obligatory decrease in energy expenditure and nitrogen excretion

B.There is a rapid depletion of labile and functional energy stores. C. There is a positive nitrogen balance D. All of the above C61. Majority of body glycogen is stored in what tissue A. Liver B. Kidney C. Skeletal muscle D. Subcutaneous tissue D62. Principle/s of antibiotic prophylaxis therapy: A.Choose antibiotic effective against the pathogens B.Choose an antibiotic with low toxicity C.Administer a second dose of antibiotic if the operation lasts longer than 4 hours D.All of the above D63. Tidal volume that does not participate in gas exchange is called. A. vital capacity

B. tidal vol.

C. minute vol.

D. dead space

B64. With regards to neoplastic disease in general, all of the following statements are true, EXCEPT: A. Neoplasms are a population of cells that have undergone extensive proliferation and have escaped normal control mechanism. B. By definition, all neoplasms are malignant tumors C.Malignant neoplasms are those capable of local tissue invasion and metastatic spread to distant site D. Benign neoplasms do not spread to distant site D65. With regards to cell cycle the following statements are true, except: A. Cell cycle has been analyzed by auto radiography B. Cells synthesizing DNA are measured on their uptake of radioactive labeled thymidine. C. Knowledge of cell cycle is useful particularly in chemotherapy and radiotherapy D. Lag phase is always a period of inactivity or a period of rest C66. Incidence of anastomotic leak and fistula is increase in the following: EXCEPT A. Poor surgical technique C. Adequate decompression of GIT B. Distal obstruction D. Malnutrition B67. Which of the following topical anti-microbial agents can penetrate an eschar? A. Silver sulfadiazine C. Aqueous silver nitrate E. None of the above B. Mafenide acetate D. Betadine D68. In patients with a significant burn injury, the greatest loss of fluid occurs in: A. 1st 6 hours of injury D. 1st 8 hours of injury st B. 1 24 hours of injury E. 1st 12-24hours of injury st C. 1 12 hours of injury D69. Rabies travels in the human body through A. Venous blood C. Lymphatics B. Intercellular spaces D. Peripheral nerves A70. Neoplasm with greatest malignant potential is A. villous adenoma B. leiomyoma C. Brunner’s gland D. tubular adenoma D71. 30 y/o female, pregnant manifesting with thyrotoxicosis, management: A. methimazole and betablocker C. RAI E. All of the above B. PTU D. Antithyroid drug for 1 month then surgery C72. This serves as a border, separating carcinoma in situ and invasive carcinoma of the breast: A. Linign epithelium C. Basement membrane B. Lamina propia D. None of the above E73. A condition wherein a calculi becomes impacted in cystic duct or neck of gallbladder producing white bile: A. Choledochal cyst C. Primary sclerosing cholangitis E. Hydrops of the B. Choledocholithiasis D. Biliary fistula gallbladder B74. Composed of tissues normally present in the liver but arranged in a disorderly fashion: A. Focal nodular hyperplasia C. Hepatic adenoma E. None of the above B. Mesenchymal hamartomas D. Hepatocellular adenoma B75. Terminal branch of the vagus nerve that has important role in the etiology of recurrent ulcer: A. Crow’s foot C. Zollinger Ellison B. Criminal nerve of Grassi D. Nerve of laterjet B76. A 45 y/o male patients with gastric outlet obstruction 2° to chronic duodenal ulcer complaining of protected vomiting will most likely develop: A. Hyperkalemic hyperchlorhydric alkalosis B. Hypokalemic hypochlorhydric alkalosis C. Hypokalemia metabolic acidosis D. Hyperkalemic metabolic acidosis B77. The following are physical signs of severe peritonitis, except

A. Hypertension B. Tachypnia

C. Absent bowel sound D. Involuntary muscle guarding

C78. Gland infected in hidradenitis suppurativa is: A. Sebaceous B. Mucus secreting C. Apocrine D. Sweat D79. Elective Surgery is contraindicated in patients with A. Elevated serum creatinine D. History of Myocardial Infarction 4 weeks ago B. Atrial fibrillation E. History of stroke 6 months ago C. COPD C80. The most common female inguinal hernia is A. Femoral hernia B. Direct inguinal C. Indirect inguinal D. Spigelian D81. Which of the following systemic collagen diseases most frequently involves the esophagus? A. Periarteritis nodosa C. lupus erythematosus B. Rheumatoid arthritis D. scleroderma E. erythema multiforme C82. Neoplasm that mimics PUD is: A. villous adenoma B. leiomyoma C. Brunner’s gland D. true adenoma A83. Treatment for the first episode of uncomplicated diverticulitis is A. liquid diet and antibiotics C. resection with primary anastomosis B. colostomy D. explore lap and drainage C84. Tumor marker for colonic carcinoma is: A. AFP B. calcitonin C. CEA D. CA19-9 D85. Landmark used in identifying main trunk of facial nerve, except: A. Posterior belly of digastric muscle C. External acoustic cartilage E. None B. Stylomastoid process D. Masseter of the above C86. Considered as 1st echelon node in thyroid tumors, EXCEPT: A. Pre-laryngeal C. Upper jugular E. None of the above B. Para-tracheal D. Pre-tracheal C87. The most common clinical presentation of hyperparathyroidism: A. fracture C. Nephrolithiasis E. Dehydration B. Bone pain D. Gastric ulcer C88. The most common cause of a bloody nipple discharge: A. Paget’s disease of the breast C. Intraductal papilloma B. Adenoma of the nipple D. Invasive ductal carcinoma C89. This serves as a border, separating carcinoma in situ and invasive carcinoma of the breast: A. Linign epithelium C. Basement membrane B. Lamina propia D. None of the above D90. If this LN is positive for malignant cell, the breast lesion is stage IIIB. A. Rotter’s node B. Central LN C. Apical LN D. Internal mammary LN D91. This benign lesion can degenerate into a malignant lesion: A. Fibrocystic disease of the breast C. Fibroadenoma B. Galactocoele D. None of the above C92. This/These can differentiate benign from malignant phyllodes tumor: A. Size of the tumor C. > 3 mitotic figure / HPF B. Consistency of the lesion D. All of the above C93. Breast malignancy with several lymphatic follicles near cancer cells: A. Paget’s disease of the breast C. Medullary CA of the breast B. Colloid carcinoma D. Schirrous Ca of the breast D94. The criteria for diagnosis of Primary Sclerosing Cholangitis are the following, EXCEPT: A. No evidence of primary liver disease D. Presence of choledocholithiasis B. Stenosis of a major portion of biliary duct system E. None of the above C C. Absence of history of congenital anomalies C95. The Courvoiseir law described the gallbladder in the following condition: A. Gallbladder is distended due to cholecystitis E. None of the above B. Gallbladder is palpable due to cholithiasis C. Gallbladder is not distended due to inflammation D. Gallbladder is not distended due to neoplasia C96. A complication of cholecystitis which result in enteric fistula revealing air in the biliary tree: A. Emphysematous cholecystitis C. Gallstone ileus E. None of B. Gangrenous cholecystitis D. Perforated cholecystitis the above B97. All are true regarding DM from Chronic pancreatitis except: A. Oral hypoglycemics are the first choice of treatment B. Mild elevation does not require treatment C. Ketoacidosis is rare D. May developed to a profound hypoglycemia even with small amounts of insulin

C98. A 70 y/o male was seen in the ER because of severe abdominal pain of > 24 hrs. History revealed chronic intake of NSAID due to osteoarthritis. He is tachycardic, tachypneic & febrile. PE revealed diffuse tenderness & rigidity of the abdomen. If you were entertaining peritonitis, the most likely cause is: A. Ruptured appendicitis C. Perforated duodenal ulcer B. Acute gastroenteritis D. Perforated diverticulitis C99. Three months after accidental ingestion of muriatic acid, 30 y/o Female consults for dysphagia. Barium swallow shows a 10 cm structured segment of distal thoracic esophagus and normal looking stomach. What is the preferred treatment for this patient? A. Esophageal dilatation D. Esophagectomy with colonic interposition B. Gastric pull-up E. None of the above C. Esophagectomy with gastric pull-up D100. The venous drainage of the stomach in the lesser curvature near the cardia is: A. Left gastric B. coronary vein C. Right Gastric D. A & B E. B & C

References: 1. Principles of Surgery by Schwarts 2. Textbook of Surgery by Sabiston 3. Textbook of Pediatric Surgery by Rowe, latest edition Vol 1 & 2 4. Urology Textbook by Smith 5. Plastic Reconstructive Surgery Book by Mc Carthy 6. Neurological Surgery by Yeomas 7. Neuro Surgery by Williams 8. Shands Handbook of Orthopedic Surgery 9. Surgery of the Chest by Sabistan & Spencer