1.
Diseases of the Esophagus
QUESTIONS Select one answer. 1. The three findings in achalasia are: a) b) c) d)
Increased LES resting pressure', decreased LES relaxation, increased esophageal peristaltic activity. Decreased LES resting pressure, increased LES relaxation, decreased esophageal peristaltic activity. Increased LES resting pressure, decreased LES relaxation, decreased esophageal peristaltic activity. Decreased LES resting pressure, increased LES relaxation, increased esophageal peristaltic activity.
2. Esophageal precancerous conditions are: a) b) c) d)
Cricopharyngeal dysphagia, epiphrenic diverticulum, achalasia. Achalasia , hiatus hernia, Zenker’s diverticulum. Chemical burns of the esophagus, achalasia, Barrett’s esophagus. Barretts esophagus, hiatus hernia, achalasia.
3. Acidic pH in the lower esophagus should not exceed: a) b) c) d)
1 hour daily. 2 hours daily. 1.5 hours daily. 2.5 hours daily.
4. An anti reflux procedure may be unsuccessful because of: a) b) c) d)
Gastric outlet obstruction not previously identified. Well-dilated previous stricture. Decreased saliva production. Transthoracic fundoplasty.
5. The most common etiology of esophageal perforations is: a) b) c) d)
Spontaneous rupture (Boerhaave’s syndrome). Instrumental perforation. Foreign bodies in esophagus. Barrett’s esophagus.
6. Esophageal carcinoma confined to the esophagus is best treated by: a) b) c) d)
Laser debulking. Prosthetic tube insertion. Local resection. Subtotal esophagectomy.
7.Middle-third esophageal carcinoma confined to the esophagus may be approached via: a. b. c. d. e.
Left chest. Right chest. Abdomen and right chest. Abdomen and neck. Both c and d.
8. Cricopharyngeal dysphagia is associated with all but a. b. c. d.
Lack of coordination between contraction of the inferior constrictor of the pharynx and relaxation of the cricopharyngeus. GE reflux. Development of Zenker’s diverticulum. Decreased primary peristaltic waves.
9. Esophageal tertiary waves are prevalent in: a. b. c. d.
Esophageal carcinoma. Hiatus hernia. Diffuse esophageal spasm. Scleroderma.
2 Stomach and Duodenum
QUESTIONS
Select one answer. 1. Which of the following is the primary stimulus for gastric somatostatin release a. b. c. d. e.
Distension of the stomach Release of acetylcholine by the vagus Acidification of the antrum Release of cholecystokinin Cephalic phase of digestion
2. Which of the following does not stimulate histamine release by the stomach a. b. c. d. e.
Gastrin Acetylcholine Epinephine Somatostatin Caffeine
3. Which of the following hormones are produced by the duodenum a. b. c. d. e.
Gastrin Cholecystokinin Secretin Somatostatin All the above
4. Which of the following statements is not true a. b. c. d. e.
Type I gastric ulcers are associated with normal acid output Type II gastric ulcers are associated with increased acid output Type III ulcers are located in the prepyloric region of the stomach Type IV ulcers are located on the greater curvature of the stomach close to the antrum Duodenal ulcers are often associated with increased nocturnal acid production
5.The operation most appropriate for severe stress ulcer bleeding is a. b. c. d. e.
Vagotomy and pyloroplasty Highly selective vagotomy Near-total or total gastrectomy Ligation of the bleeding sites Antrectomy with Billroth II reconstruction
6. the most appropriate operation of a 30-year old patient with a history of peptic ulcer disease who presents with a perforated duodenal ulcer is a) b) c) d) e)
Patch closure with a highly selective vagotomy Gastrectomy with a Billroth I reconstruction Gastrectomy with a Billroth II reconstruction Vagotomy and pyloroplasty Gastrojejunostomy and Omeprazol
7. Which of the following is true regarding post-vagotomy diarrhea a. b. c. d. e.
It is a common condition occurring about 30% of cases Most cases of the diarrhea is self-limiting and resolves in 4-6 months Cholestyramine can be effective in severe Severe, refractory diarrhea can be treated by a jejunal interposition All the above
8. Which of the following modalities is not indicated in the treatment of a bleeding Mallory-Weiss tear a. b. c. d. e.
Band ligation Heater-probe application Angiography and embolization Injection of epinephrine Near-total gastrectomy
9. Which of the following is not true regarding alkaline reflux gastritis following gastrectomy a. b. c. d. e.
It usually does not respond to medical therapy It is uncommon following a Billroth II reconstruction HIDA scan can be diagnostic It may require a Roux-en-Y gastrojejunostomy The vomiting may occur day or night
10. Which of the following is true regarding GISTS (gastrointestinal stromal tumors) a. b. c. d. e.
Surgery is the mainstay of treatment Most GISTS are found in the stomach GISTS respond well to imatinib mesvlate (Gleevec) GISTS usually present with upper gastrointestinal bleeding All the above
3. Diseases of the Small Bowel
QUESTIONS Select one answer. 1. which of the following dose not contribute to the digestion of the fats in the small intestine? a. b. c. d.
brush border enzymes Pancreatic lipases. Bile salts. Lacteals.
2. Which of the following is not characteristic of Crohn’s disease? a. b. c. d.
Perianal disease. Rectal bleeding. Diarrhea. Abdominal pain.
3. Which of the following complications of Crohn’s disease is least common? a. b. c. d.
entero enteral fistulas Enterocutaneous fistulas. Free perforation. Strictures.
4. What percentage of patients with Crohn’s disease eventually needs surgery? a. b. c. d.
20% 50% 75% 90%
5. A patient is taken to the operating room for appendicitis and is found to have ileitis. What is the correct management? a. b. c. d.
Biopsy Of Ileum. Heal resection with ileocolic anastomosis. Appendectomy. Ileostomy
6. Which of the following can most reliably distin- guish simple from strangulation small intestinal obstruction? a. b. c. d.
High nasogastric output. Fever over 101®F. Tachycardia. None of the above.
7. Which of the following is true of nonoperative management of patients with small obstruction (SBO)? a. b. c. d.
It is most likely to be successful in patients who have from adhesions. Long-tube decompression is superior to It is most useful For the younger patient It is successful in cases of complete Sbo.
8. Which is the most likely cause of intussusception in a 20-year-old man? a. b. c. d.
Idiopathic. Lymphoma of the small bowel. Carcinoid. Adhesions.
9. Which is true of the lesions responsible for the symptoms in patients with Peutz-Jeghers Syndrome? a. b. c. d.
They are sessile adenomas. They tend to cluster in the duodenum. They are hamartomas. The syndrome is inherited as an autosomal recessive trait.
10. A patient is found to have a small bowel carcinoma 2 cm in diameter in the distal ileum Which of the following is the operation of choice? a. b. c. d.
Wedge resection with 2-cm margins. Biopsy and chemotherapy. Right hemicolectomy. Wedge resection with 5־cm margins.
Chapter 4 ٠ Colon, Rectum, and Anus QUESTIONS
Select one answer. 1. Which of the following is NOT true of colonic diverticular bleeding. a. b. c. d. e.
Most bleeding stops spontaneously Recurrent bleeding is very common Few patients will need a colon resection angiography is the most sensitive test to localize rectal bleeding Patients who bleed often need blood transfusions
2. Which of the following is true regarding adenomatous colonic polyps. a. b. c. d. e.
Polyps less than 1 cm in diameter are unlikely to be malignant Villous adenomas most commonly occur in the cecum FAP (familial adenomatous polyposis; is an autosomal recessive condition Hamartomatous polyps have a high incidence of malignant transformation Fecal occult blood testing has not changed the mortality from colon cancer
3. Patients who have suffered a penetrating colon injury involving more than 50% of the rectal wall should undergo which of the Following: a. b. c. d. e.
A diverting colostomy Exteriorization of the injured segment Primary repair of the injury Segmental resection and anastomosis Hartmann's procedure and drainage
4. Which of the following may he appropriate initial therapy for a 4 cm anal cancer involving the internal sphincter a. b. c. d. e.
Abdominoperineal resection Wide local excision Radiotherapy and chemotherapy Interstitial radiotherapy Wide excision with bilateral groin dissection
5. The Extraintestinal manifestation of ulcerative colitis least likely to improve after total proctocolectomy is a. b. c. d. e.
uveitis Sclerosing cholangitis pyoderma gangrenosum erythema nodosum Iritis
6. A patient with longstanding Crohn’s disease develops a colonic stricture. Which of the following is the best treatment option. a. b. c. d. e.
A short course of infliximab Segmental resection and primary anastomosis Bowel rest A proximal diverting colostomy and mucous fistula Strictureplasty
7. Which of the following is the most important determinant of survival after treatment of colorectal cancer. a. b. c. d. e.
Lymph node involvement Transmural extension Tumor size Histologic differentiation DNA content
8. An 80-year old patient undergoes an elective colonoscopic polypectomy Six hours later he is noted to be distended and is found to have a pneumo-peritoneum. Which is ofthe following is the best treatment plan. a. b. c. d. e.
Colonic resection and primary anastomosis Exteriorization of the injury Simple repair of the injury Bowel rest, observation and antibiotics Colostomy with mucous fistula
9. Treatment of toxic megacolon should all of the following except a. b. c. d. e.
Steroid administration Antibiotics Nasogastric intubation Early colectomy Opiates
10. A sixty-old patient with two bouts of Hinchey Stage II diverticular disease should be treated with a. b. c. d. e.
Sigmoid colectomy and anastomosis Transverse colostomy Sigmoid resection, end colostomy and mucous fistula Bowel rest, IV antibiotics Total abdominal colectomy
5. Diseases of the Biliary Tract QUESTIONS Select one answer. 1. Which of the following is true? a. b. c. d. e.
The cystic duct, common hepatic duct, and cystic artery form the triangle of Calot. The venous drainage of the gallbladder does not empty into the portal circulation In most cases, the hepatic artery passes cephalad within the hepatoduodenal ligament to the right of the bile duct and anterior to the portal vein. In 20% of patients the cystic artery originates Common hepatic artery. all of the above
3. Primary sclerosing cholangitis is most often associated with which of the following disorders: a. b. c. d. e.
Crohns disease. Diabetes mellitus. Rheumatoid arthritis. Ulcerative colitis. Chronic pancreatitis.
4. Which of the following are accepted indications for cholecystectomy ? a. b. c. d. e.
Porcelain gallbladder. Gallbladder polyp measuring greater than 10 mm. Asymptomatic cholelithiasis. a and b. b and c.
5. Which of the following statements are true? a. b. c. d. e.
a. In the setting of acute cholecystitis early cholecystectomy has a higher complication rate than does delayed cholecystectomy. EUS is less sensitive than ERCP for the detection of choledocholithiasis. The sensitivity of HIDA scan decreases with elevated bilirubin of greater than 7 mg/dL. None of the above. Ail of the above.
6. Which of the following does not stimulate bile flow? a. b. c. d. e.
Cholecystokinin. Bile salts. Vagal stimulation. Splanchnic stimulation. Secretin.
7. Which of the following statements regarding choledochal cysts is not true? a. b. c. d.
The most common type of cholechochal cyst is type III Cholangiocarcinoma risk is increased in the presence of a choledochal cyst. most adult choledochal are diagnosed incidentally. The best surgical procedure for the management of choledochal cysts is resection andr Reconstruction with a Roux-en-Y biliary enteric anastomosis.
8. All of the following increase the risk for cholangiocarcinoma except a. b. c. d. e.
Choledochal cyst. Liver fluke infection Caroli s disease. Dioxins. History of gallstones for less than 10 years.
9. Which of the following is the most common type of gallstone: a. b. c. d.
Pure cholesterol stones. Mixed cholesterol stones. Brown pigment stones. Black pigment stones.
10. A 55-year-old man presents with hematemesis associated with abdominal pain and melena. His past medical history is significant for asthma pancreatitis, and previous motor vehicle accident. Laboratory values are significant for hematocrit 23, WBC 8.0 k/UL, platelets 450.0 k/UL, total bilirubin 3.5 mg/dL, direct bilirubin 1.5 mg/dL, alkaline phosphatase 180U/L, AST 45 U/L, ALT 34 U/L. Ultrasonography revealed a distended gallblad der with sludge. The most likely diagnosis is: a. b. c. d. e.
Acute cholecystitis. Peptic ulcer disease. Hemobilia. Portal gastropathy. Mallory-Weiss tear.
Chapter 6 The Pancreas ؛QUESTIONS Select one answer. 1. All of the following are indicative of poor prognosis in acute pancreatitis except. a. b. c. d. e.
Serum calcium less than 8.0 mg/d؛ Hyperglycemia Serum amylase more than five times normal on admission Arterial oxygen tension less than 60 mm Hg. Serum lactic dehydrogenase more than three times normal
2. which of the following is not an indication for operation in a patient with a pancreatic cystic lesion: a. b. c. d. e.
Abdominal pain Lesion is 2.0 cm in diameter Elevated CEA level Mucin in cyst Ultrasound showing septations
3. Infected pancreatic necrosis can be diagnosed using which of the following: a. b. c. d. e.
Fine needle aspiration CT scan Clinical course Clinical deterioration All of the above
4. patients who develop gallstone pancreatitis should have the following interventions prior or during cholestectomy a. b. c. d. e.
ERCP eus UGI MRCP Cholangiography
5. Most patients with gallstone pancreatitis should be managed by which of the protocols a. b. c. d. e.
Cholecystectomy with common duct exploration within 24 hours of admission Urgent eRCP followed by laparoscopic cholecystectomy Stabilization with cholecystectomy on the same admission Stabilization followed by elective cholecystectomy 6 weeks later Nonoperative therapy with cholecystectomy at a later time if symptoms recur
6. Enlarging or symptomatic pancreatic pseudocysts are best treated by which of the following modalities except: a. b. c. d. e.
Cystogastrostomy endoscopic drainage TPN and bowel rest Cystojejunostomy Cystoduodenostomy
7. Which of the following is the risk factor most closely associated with increased incidence or pancreatic adenocarcinoma a. b. c. d. e.
Chronic pancreatitis Diabetes mellitus Coffee consumption Alcohol consumption Cigarette smoking
8. Delayed gastric emptying following a pancreaticodudenectomy is best managed by a. b. c. d. e.
Reoperation and revision of the gastrojejunostomy PEG placement Promotility agents and acid suppression Parenteral nutrition Roux־en־y gastrojejunostomy
9. Which of the following is true regarding insulinomas a. b. c. d. e.
The vast majority are benign Diazoxide can be used to treat the severe hypoglycemia associated with this lesion Most insulinomas can be treated by simple enucleation They are not associated with MEA-I syndrome All the above
10. Which of the following is true regarding pancreas divisum a. b. c. d. e.
It may be associated with pancreatitis It is associated with intestinal malrotation It is common cause of acute pancreatitis It results from abnormal rotation of the ven¬tral pancreas It is usually diagnosed by CT scan
7. Peripheral Arterial Disease QUESTIONS 1. Acute ischemia of the lower extremity: a. b. c. d. e.
Is most often the result of Femoral artery thrombosis. Can never occur as a consequence of deep venous thrombosis. Is never amenable to treatment with thrombolytic therapy. Is most often the result of a cardiac embolic event. Rarely results in limb threatening ischemia.
2. Evaluation for states should include measurement of: a. b. c. d. e.
Antithrombin III. Protein c. ProteinS. Anticardiolipin antibody. All of the above.
3. Regarding carotid endarterectomy (CEA): a. b. c. d. e.
Eversion endarterectomy results in a higher incidence of recurrent stenosis than CEA with ^atch angioplasty Routine shunting is necessary when CEA is performed under regional anesthesia. The glossopharyngeal nerve is the most frequently injured cranial nerve during the performance of CEA. It is preferable to carotid angioplasty and stent in the treatment of carotid stenosis in patients with previous neck irradiation. It is preferable to medical therapy in patients with symptomatic high-grade carotid stenosis.
4. Which of the following is true regarding diabetic foot infections? a. b. c. d. e.
They are usually caused by infection with appositive organisms only. Surgical debridement is unnecessary when Pedal pulses are present. oral antibiotics are adequate treatment in most cases. Neuropathy is rarely a contributing Factor in their development. Revascularization may be required even if adequate surgical debridement is done and appropriate antibiotics are used
5. Which of the Following statements regarding aneurysms IS true? a. b. c. d. e.
Inflammatory aneurysms of the aorta rarely rupture. Splenic artery aneurysms are usually atherosclerotic in origin Thrombosis of popliteal artery ilfltlurysrns may be rrcarcd with thrombolysis only. infected aneurysms of the aorta usually require complete exclusion and extra anatomic revascularization. Aneurysms of rhc hepatic artery are the most Cummnfl visceral aneurysms.
6. Which of the following is true? a. b. c. d. e.
Surgery is indicated for most visceral aneurysms associated with polyarteritis nodosa. taKayasu's arteritis most commonly involves the distal arm and hand arteries in middle aged men. Patients with fibromuscular dysplasia of the carotid artery may have associated intracranial aneurysms. Most patients with Raynaud’s disease require sympathectomy. Popliteal entrapment syndrome usually results in lateral displacement of the popliteal artery.
7. Which of the following is true about patients with intermittent claudication? a. b. c. d. e.
Lumbar sympathectomy effectively relieves symptoms in most patients. A graded exercise program improves the walking capacity of most of the patients. Arteriography should be performed as part of the initial clinical assessment. Pentoxifylline is more effective than cilostazol in improving walking distance. Amputation is required in up to one-third of patients if left untreated.
8. Which of the following is true regarding endovascular abdominal aortic aneurysm repair. a. b. c. d. e.
Most Type I endoleaks can be safely observed without treatment. Endovascular repair should never be considered for treatment of ruptured aneurysms. Endovascular repair is indicated for treatment of aneurysms less than 5 cm in diameter. Type II endoleaks associated with aneurysm growth should be treated. Endovascular repair is suitable for most juxtarcnal aneurysms.
9. Subclavian steal syndrome: a. b. c. d. e.
May be treated with endovascular or surgical techniques. Require ؟treatment in asymptomatic patients. Can be diagnosed by visualizing retrograde blood flow in the subclavian artery. May cause amaurosis fugax. Is more common on the left side.
10. Ischemic complications of hemodialysis access: a. b. c. d. e.
Rarely require access ligation for ischemic monomelic neuropathy. Are clinically manifest in up to 15% of patients. May be successfully treated with a distal revascularization and interval ligation procedure for steal syndrome. Are most frequent after radio cephalic AV fistulas. Are usually caused by intimal hyperplasia.
8 Venous and Lymphatic Disease QUESTIONS Select one answer. 1.A 58-year old male undergoes bariatric surgery. Two days later, he complains of pain in his right leg. On examination, it is not swollen but The best screening test for detecting DVT of the lower extremities is: a. b. c. d. e.
D-dimer. Venous plethysmography. Phlebography, Venography. Venous duplex scan.
2. A 33 female is upset by the appearance of her legs. On examination, she has extensive varicose veins but there is no discoloration or swelling. A venous duplex scan demonstrates reflux throughout a dilated saphenous vein. The deep veins are competent. Suitable therapy for improving the cosmetic nature of her legs would include: a. b. c. d. e.
Stab avulsion phlebectomy alone. Stab avulsion and laser or radiofrequency ablation of the saphenous vein. Compression stockings Foam sclerotherapy. SEPS procedure.
3. A 50-year-old woman suddenly develops painful swelling in her left; leg. Duplex scan demonstrates occlusion of the left iliac and femoral veins. What statement is not true? a. b. c. d. e.
A probable cause is compression of the iliac vein by the left iliac artery. She may harbor a hypercoagulable condition such as factor V Leiden. Treatment could include lytic therapy. A vena caval filter may be required. Treatment could include a venous stent.
4. A 55-year-old male requires bariatric surgery for obesity. He has a maternal family history of DVT and he has had a superficial phlebitis in his varicose veins twice before. Management should include all except a. b. c. d. e.
Intermittent pneumatic compression during surgery possible low - molecular-weight prophylaxis possible use of a removable vena caval filter preoperative blood tests to evaluate possible hypercoagulable tendency. Cancel surgery.
A 55 year old male geavy smoker who like the lift weights develops a swollen left arm prior to this he has noted tingling in his hand along the ulnar distribution. Management should include all except a. b. c. d. e.
Lytic therapy to open the cephalic vein. Lytic therapy to open the axillary vein. Possible first rib resection. Possible placement of a venous stent. X-ray of his neck and chest.
Chapter 9 ٠ Diseases of the Breast
QUESTIONS Select one answer. 1. A 31 -year-old woman presents with a 2-cm mass in the upper outer quadrant of the right breast. It is well defined and has been present by history for 2 months. Your initial approach to this problem is to: a. b. c. d.
Order a mammogram followed by a sonogram. Insert a needle to aspirate any fluid. Schedule an open biopsy. Reschedule an appointment in 6 weeks to reevaluate the problem clinically.
2. An 11-year-old girl is brought by her parents with a unilateral 1.5-cm mass underneath the areola on the right. Your approach to this problem should be: a. b. c.
Observation only, as it is a “breast bud” which frequently develops asymmetrically. Excision, because with growth of the child the scar becomes less noticeable. Biopsy, as lymphomas occur in this age group.
3. The long thoracic nerve: a. b. c. d.
Innervates the serratus anterior muscle. Courses down posterior to the axillary artery and vein because it arises from the roots of the brachial plexus. Section of the nerve result ؛in ipsilateral scapular prominence and shoulder pain. Both. Neither.
4. The incidence of breast carcinoma is lower: a. b. c. d.
In the contralateral breasts of patients receiving tamoxifen. In young women. In women with no family history of breast carcinoma. All of the above.
5. Mammography: a. b. c. d.
Is the most effective means of screening for breast carcinoma. Is more effective in detecting breast carcinomas in postmenopausal women. When normal, should not exclude biopsy of a palpable suspicious breast mass. All of the above.
6. Breast conservation surgery in breast carcinoma: a. b. c. d. e.
Has resulted in major improvement in mortality and morbidity figures associated with this disease. Has resulted in durable survival data comparable to those for mastectomy for certain breast cancers. Should be recommended to all women suffering from breast carcinoma. Has resulted in a high incidence of serious radiation-related complications. Has resulted in diminution of the need for adjuvant chemotherapy and hormonal therapy.
7. In a patient with breast carcinoma, the clinical finding portending the worst prognosis is: a. b. c. d.
Eczematous changes around the nipple areolar complex. Skin dimpling in the area of the tumor. The presence of a palpable l־cm node in the axilla. Peau d’orange.
8. Statistically, the most powerEil predictor of prognosis is: a. b. c. d. e.
The presence of intramammary lymphatic involvement. The grad of differentiation of the tumor. The presence ot marked intraductal carcinoma around the primary tumor. The size of the primary tumor. The number of axillary lymph nodes involved with metastatic tumor.
9. ductal carcinoma in situ of the breast: a. b. c. d.
Is almost always bilateral. Has become more frequently diagnosed as a result of mammography. Cannot present as a palpable mass. Is frequently associated with microscopic lymph node metastases.
10. A 33-year-old woman pregnant for the third time presents at 3 months with a 2־cm mass in the inner aspect of the left breast. A needle aspiration reveals no fluid. You would: a. b. c. d.
Arrange for a mammogram because multicentre lesions are common during pregnancy. Consider termination of pregnancy because chemotherapy has been shown to be useful in node-negative premenopausal patients. Expeditiously obtain a histologic diagnosis of the mass. Wait until the third trimester because surgery is safer at that time.
10 Principles of Surgical Oncology
QUESTIONS 1. Which of the following cancer mass screening programs has been effective in reducing cancer specific mortality? a. b. c. d. e.
Breast cancer. Colo-rectal cancer. Lung cancer. Cervical cancer. Thyroid cancer.
2. Which of the following tumor markers is effective as a screening tool for cancer? a. b. c. d. e.
CEA AFP Cal25 HCG Calcitonin.
3. Fine needle aspiration biopsies are not useful for which of the following entities? a. b. c. d. e.
Thyroid nodules. Breast masses. Liver masses. Lymphadenopathy. Lung masses.
4. A patient presents with a 2 cm breast mass. Which of the following is the preferred method of diagnosis? a. b. c. d. e.
FNAB Core biopsy. Excisional biopsy. Incisional biopsy. Excisional biopsy with normal margins.
5. A patient who had a colon adenocarcinoma resected 2 years prior now has a solitary pulmonary nodule in the periphery of the right lung. Which is the best next step in management? a. b. c. d. e.
Bronchoscopy. Thoracentesis. Wedge resection. PET scan. FNA biopsy.
6. A patient being treated for ALL with ARA-C develops right lower quadrant pain with guard ing and rebound. Which of the following should be the next steps in the management protocol? a. b. c. d. e.
CT scan. Broad spectrum antibiotics. Bowel rest. Laparoscopic exploration• Appendectomy.
7. Which of the following is the treatment of choice for squamous carcinoma of the anus? a. b. c. d. e.
Proctocolectomy. Radiotherapy alone. Local resection. Adjuvant chemotherapy Radiotherapy with chemotherapy.
11. Melanoma, Sarcoma, and Lymphoma QUESTIONS one answer.
1. Risk factors for the development of melanoma include all of the following except a. b. c. d.
fair hair Light complexion Green eyes. Multiple nevi
2.The classic triad of the dysplastic nevi syndrome Includes all of the following except: a. b. c. d.
Patient with more than 100 moles. One mole larger than 8 mm. Superficial spreading melanoma of one of the moles. One mole with atypical histologic features.
3. True statements with respect to melanoma include all of the following except a. b. c. d.
Melanoma is increasing at a rapid rate. Most melanomas arc more common in out door laborers than office workers. Melanoma has become less virulent. Melanoma is associated with xeroderma pig mentosum.
4. true statements with respect to superficial spreading melanoma include all of the following except a. b. c. d.
SSM is the most common from of melanoma. Approximately half of the lesions are ulcerated at presentation. SSMs arise from or near a preexisting nevus. SSM has an immediate prognosis.
5. True statements with respect to NM include all of the following except: a. b. c. d.
NM is more common in females. Ulceration is common. Most amelanotic melanomas are of the nodular type. The lesions are raised and generally darker than the SSM counterparts.
6. True statements with respect to the prognosis of SMs include all of the following except. a. b. c. d.
Prognosis is related to destruction of the nail bed. Prognosis is related to the thickness of the tumor. Prognosis is related to bony invasion. Prognosis is related to the location of the lack of pigmentation.
7. Acceptable biopsy methods for a pigmented lesion include all of the following except a. b. c. d.
Excisional biopsy. Punch biopsy. Shave biopsy. Incisional biopsy.
8. Optimal resection for melanomas of various ؟ites include all of the following except: a. b. c. d.
SM of the thumb: interphalangeal amputation. SM of the third digit: distal interphalangeal amputation. Melanoma on the female breast: mastectomy. Melanoma of the thigh, 3 mm deep: wide local excision with 3־cm margins.
9. The following are true statements with respect to clinical stage 11 melanoma except a. b. c. d.
If no primary is found, the patient should receive chemotherapy. Therapeutic node dissection is not indicated. Common sites of metastases include regional nodes, lung, liver, brain, and bones. About 20% of patients with positive regional nodes survive 5 years.
10. Adequate local therapy for an STS includes all of the following except a. b. c. d.
Neoadjuvant radiation therapy followed by excision. Wide margin resection. Limited margin resection. Amputation.
11.True statements with respect to STSs include all of the following except a. b. c. d.
Lymphatic metastases are common and require lymphadenectomy when present. Hematogenous spread is most common. The pseudocapsule is made up of fibrous tissue and no tumor. Lung metastases are the most common sites of initial failure.
12. Prognostic factors influencing survival include all of the following except a. b. c. d.
Size. Grade. Location. Histology.
13. Pediatric Surgery
QUESTIONS Select one answer.
1. A newborn infant begins having bilious vomiting on day 2 of life. Which of the following investigations is most likely to give the proper diagnosis? a. b. c. d. e.
Sonogram. HI DA scan. Upper GI series. Barium enema. CT scan.
2. Which of the following is likely to be found in 6 ؛-week-old with a 4-day history of nonbilious projectile vomiting? a. b. c. d. e.
Cl = 110. pH = 7.30. HC03= 30. K = 4.8. P02 = 70.
3. A full-term infant fails to pass meconium at 48 hours of age. Which is the most likely diagnosis? a. b. c. d. e.
Duodenal atresia. Jejunal atresia. Hirschsprung disease. Esophageal atresia. Colonic atresia.
4. Which of the following anomalies is the most common? a. b. c. d. e.
Proximal esophageal atresia with a tracheoesophageal fistula to the distal pouch. H-type tracheoesophageal fistula. Isolated esophageal atresia without a fistula. Esophageal atresia with tracheoesophageal fistulas to the proximal and distal pouches. Esophageal atresia with a tracheoesophageal fistula to the upper pouch.
5. Which of the following is not true of babies who have duodenal atresia? a. b. c. d. e.
About 30% have Down syndrome. Most of the atresias are distal to the ampulla of Vater. There is a strong likelihood that other atresias will be found. The correct operation to repair the anomaly is duodenoduodenostomy. The mother may have had polyhydramnios.
6. Which of the following techniques should be used to reduce an incarcerated inguinal hernia in a 6 -month - old infant? a. b. c. d.
Sedation. Traction. Elevation. All of the above.
7. A 2-year-old girl has an umbilical hernia. Which of the following is the recommended plan of treatment? a. b. c. d. e.
Surgery within the next few months. Surgery at the age of 5 years. Strapping the umbilical defect. Surgery only if the hernia becomes incarcerated. Surgery at the age of 12 years.
8. An 1,800-g premature infant presents with abdominal distension, lethargy, and stools positive or occult blood. Which of the following investigations needs to be done? a. b. c. d. e.
Radiography of kidneys and upper bladder. CT scan. Sonogram. HIDA scan. Barium enema.
9. A 2,000-g infant with necrotizing enterocolitis is found to have portal venous gas. Which of the following procedures is in order? a. b. c. d. e.
Continued medical therapy. Abdominal paracentesis. HIDA scan. Immediate surgery. Adding Cipro to the antibiotic regimen.
10. A 2-week-old infant is found to have a hydrocele. Which is the best course of treatment? a. b. c. d. e.
Surgery at the age of 6 months. Surgery at the age of 2 years. Aspiration of the hydrocele. Transscrotal hydrocelectomy at the age of 2 years. None of the above.
Chapter 14 ٠ Traum
QUESTIONS .Select one answer 1. A 25 year old man arrives after sustaining a GSW to the right lower quadrant. He is explored and found to have laceration to the right colon encompassing 75% of the circumference . he is hemodynamically stable. and there is minimal local contamination The correct procedure would be to a. b. c. d. e.
Perform an ascending loop colostomy Resect the injury and buring up an endcolostomy and mucous fistula Exteriorize te repair and drop th back in after 5 to 7 days if intact Perform a primary repair. Perform a resection and anastomosis.
2. A complete cervical spine evaluation after a motor vehicle accident should include a. b. c. d. e.
Careful clinical examination, Lateral radiograph including the top of T1. Anteroposterior view. Odontoid view. all of the above-
3. The first priority during evaluation of a multi- ply injured patient who is hypotensive is to a. b. c. d. e.
Establish intravenous access. Obtain blood for crossmatch. Perform a mini-neurologic examination. Assess the airway. Search for occult bleeding.
4. A 36-year-old woman arrives with stable vital signs after sustaining a SW to the neck just lateral to above the cricoid cartilage. There is slowly expanding hematoma lateral to the wound. The next step in management would be a. b. c. d. e.
Observation. Angiography to better define bleeding source. Neck exploration Esophagography and observation. CT scan.
5. A 34-year-old man arrives at the ED hypotensive after being involved in a motorcycle accident. He has an angulated right femur, facial trauma, and a tender abdomen. Init^ films revealed an unremarkable chest radiograph, normal lateral cervical spinej and an open-book pelvic fracture. Despite 2 L of Ctystalloid, he remains hypotensive . The next step in management is a. b. c. d. e.
Exploratory laparotomy. CT scan of the abdomen. C. FAST or DPL. Angiography. None of the above.
6. The preferred fluid for a patient who arrives at The ED hypotensive after sustaining a GSW to the chest is a. b. c. d. e.
Normal saline 0.9%. Ringers lactate solution. 5%Hetastarch. Blood. 5% Hetastarch.
7.The most important determinant for the need for Aortography in a patient at risk for blunt aortic injury is a. b. c. d. e.
Clinical suspicion. First rib fracture. Morphology of aortic knob. Sternal fracture. Myocardial contusion.
8.A 52-year-old woman is involved in a high-speed motor vehicle crash . she is initially Hypotensive but normalizes with volume. A CT scan of the abdomen is performed and shows free fluid around the spleen and a 2 cm hyperdense area in the lower pole of the spleen. The most appropriate management of this finding would be a. b. c. d. e.
Splenectomy. Angiographic embolization. Admit and observe in ICU setting. Repeat CT scan in 24 hours. Factor VII.
9. A 68-year-old man is involved in a high-speed motor vehicle accident. He is unconscious and hypotensive with systolic pressure of 80 mm Hg on arrival at the ED with a distended abdomen. Initial radiographs reveal a minimally displaced pelvic fracture and normal cervical spine; the chest radiograph shows a widened mediastinum, loss of aortic contour, and deviated nasogastric tube. Despite blood transfusion, he remains Hypotensive. FAST shows free fluid in the subhepatic and pelvic areas. The next step in management is a a. b. c. d. e.
Head CT scan. Pelvic angiogram. Aortogram. Emergency thoracotomy. Exploratory laparotomy.
10.A 48-year-old man is stabbed in the right upper quadrant. He arrives in the ED hypotensive and with abdominal tenderness. He is taken emergently to the OR for laparotomy. At exploration, he is found to have a 5-cm laceration to the dome of the liver that is no longer bleeding. No other injuries are found. The next step in managing this injury would be a. b. c. d. e.
Pringle maneuver. Pringle maneuver and finger fracture exploration of the injury. Exploration of the injury. Drain injury and close the abdomen. Close the abdomen and get an angiogram.
15 QUESTIONS Select one answer. 1. Seven days after cadaver renal transplantation a patient develops a fever to 101°F, pain, and tenderness over the incisional area, and oliguria. Serum creatin؛ne has risen from 1.5 mg/dLto 1-9 mg/dL. Likely possibilities include: a. b. c. d. e.
Acute rejection. Wound infection. Urinary leak. Wound dehiscence. All of the above.
2. The patient in Question l should: a. b. c. d. e.
Be rushed to the operating room, Receive high closes of steroids mediated Be investigated using ultrasonography, nuclear scan, or both. Receive broad-spectrum antibiotic coverage None of Lhc above.
Possible answers for Questions 3 through 6: a. b. c. d. e.
IL-2 Tnterferon-2. T-helper cells. T cytotoxic cells. B cells.
3.
These cells are usually CD8+ and recognize class I molecules.
4.
Stimulated by antigen or other cells, these cells ultimately produce antibody that causes graft destruction.
5.
Secretion that stimulates various antigen- activated cells to proliferate.
6.
Normally resting, these cells are stimulated by antigens and macrophages to initiate the immune response.
7.
For a through e, below, choose the best option from i through V (choice may be repeated).
a.
Blocks IL-1.
b.
Blocks IL-2.
c.
Inhibits cell division.
d.
Can depress bone marrow.
e.
Ne^roto^Gty is a problem.
i.
Cyclosporine.
ii.
Azathioprine.
iii- Corticosteroids, iv. Tacrolimus
V
Mycophenolate mofetil.
9. In regard to transplant rejection: a. b. c. d. e.
Acute rejection is irreversible and leads to loss of the kidney. There is no treatment for chronic rejection Hyperacute rejection is precipitated by circulating humoral antibodies. a, b, and c are correct. b and c are correct.
10. The following statements are true except -. a. b. c. d. e.
Deep hypothermia sharply reduces cell metabolism. Oxygen-derived free radicals may be responsible for reperfusion injury. Cell swelling can be minimized by the addition of impermeable osmotic agents to the preservation/perfusion solution. Hypothermia prevents anaerobic metabolism With the use of UW solution, preservation of abdominal organs more than 24 hours an can be regularly achieved.
. 16. THYROID DISEASE QUESTIONS Select one answer. 1. Which one of the following is true about MTC? a. b. c.
70% :0 80% of MTC cases are familial in origin. 70% no 80% of MTC cases are sporadic in nature. RRAI (radioactive iodine remnant ablation) is used to treat micrometastatic disease in MTC.
2. The following is not true about papillary thyroid cancer? a. b. c. d. e.
Most common malignancy of thyroid gland. More common in men than women. Most commonly metastasizes by lymphatics. Lymphatic metastases have no effect on survival rate. True (pure) papillary cancer is rare.
3. The most common site for follicular carcinoma metastases is: a. b. c. d. e.
Lung. Liver. Bone. Brain. Adrenal.
4. The following is not a characteristic feature of familial MTC: a. b. c. d.
RET proto-oncogene mutation. Unilateral. Histopathology shows amyloid deposits. Serum calcitonin is used as a tumor marker.
5. Which of the following are true? a. b. c. d.
5% to 8% of cold nodules of the thyroid gland on iodine scintigraphy are malignant. 15% to 30% of incidentalomas of the thyroid gland on PET scan are malignant. Both are true. Neither one is true.
PARATHYROID DISEASE QUESTIONS Select one answer. 1. What is the most common cause of primary hyperparathyroidism? a. b. c. d.
Adenoma. Carcinoma. Hyperplasia. Chronic renal insufficiency.
2. All of the following are appropriate treatment options for secondary hyperparathyroidism except a. b. c. d.
Vitamin D replacement and phosphorus- binding drugs, Subtotal parathyroidectomy. Total parathyroidectomy with autotransplantation. Minimally invasive parathyroidectomy with preoperative technetium-99m sestamibi scan,
3. What percentage reduction in the pTH value from baseline indicates a successful operation? a. b. c. d.
40. 50. 60 Depends on the size of the resected parathyroid gland
4. If the abnormal parathyroid glands are not found during b،lateral neck exploration, all of the following measures are appropriate except: a. b. c. d.
Inspect both thyroid lobes. Remove normal-appearing parathyroid glands. Remove the thymic tissue on the side of the missing gland. Explore common ectopic sites.
5. MEN I is associated with: a. b. c. d.
A mutation in the RET proto-oncogene. Medullary thyroid carcinoma. Only one standard surgical treatment. Multiglandular parathyroid disease.
Chapter 17 ٠ Adrenal Surgery QUESTIONS Select one answer. 1. Which of the following statements is incorrect a. b. c. d. e.
The right superior adrenal artery of the superior phrenic artery. The left middle adrenal artery is a direct branch or the aorta. The left adrenal vein drains into the renal vein The right adrenal vein drains into the vena The right inferior adrenal artery is a branch of the renal artery.
2. All of the following are true regarding the adrenal gland except a. b. c. d. e.
The zona glomerulosa is responsible for mineralocorticoid production. The outer cortex comprises 90% of the gland The inner medulla contains chromaffin cells of mesodermal origin. The inner medulla is the site of catecholamine synthesis, storage, and production. Cortisol is produced in the zona fasciculata and zona reticularis.
3. Which of the following statements about Cushings disease is true? a. b. c. d. e.
Treatment involves unilateral adrenalectomy. High-dose dexamethasone will cause suppression of cortisol production. It is often associated with a malignancy. Unlike in other forms of Cushing's syndrome, patients demonstrate diurnal secretion of cortisol. Pituitary irradiation is contraindicated in Cushings disease.
4. All of the following are true regarding the Dexamethasone Suppression Test except a. b. c. d. e.
It involves measuring 17-hydroxysteroids in 24-hour urine samples for 6 days. Low-dose dexamethasone is 2 mg. A normal individual will have suppression of cortisol production by low-dose dexamethasone. Cortisol production by a cortical neoplasm will not be suppressed by either low- or high- dose dexamethasone. Cortisol production by a pituitary adenoma will be suppressed by only high-dose dexamethasone.
5. All of the following are expected laboratory results in a patient with primary hyperaldosteronism except a. b. c. d.
Elevated plasma aldosterone/renin ratio. hypokalemia. Elevated plasma renin level Plasma aldosterone level of more then 15 ng/dl
6. which of the following is true adrenocortical carcinoma a. b. c. d. e.
it is common in adrenal masses 4 cm in size. it is the most common malignant tumor found in the adrenal gland. It spreads by both hematogenous and lymphatic routes. Only 20% of patients demonstrate metastatic disease at the time of presentation. The 5־year survival of stage I disease is 90%.
7. All of the following are true regarding pheochromocytomas except a. b. c. d. e.
10% are malignant. 10% are seen in children. 10% are hereditary. 10% are seen in females. 10% are extra-adrenal.
8. All of the following are genetic syndromes which include pheochromocytoma except a. b. c. d. e.
MEN 2b. von Recklinghausen MEN 2a. von Hippie Lindau von Gierke.
9-All of the following are elevated in a patient with pheochromocytoma except a. b. c. d.
Urinary vma Urinary metanephrines. 17 - OH corticosteroids Urinary fractionated catecolamines
10. Which of the following statements is true about surgery for pheochromocytoma ? a. b. c. d. e.
Patients should receive preoperative a-blockade for 1 to 4 weeks prior to surgery, The adrenal vein should be taken only after the arterial supply is isolated and ligated. Intravenous fluids should be restricted until the tumor is removed. Preoperative b־blockade ،should precede any a-blockers to avoid the precipitation of malignant hypertension. Bilateral adrenalectomy should be performed for patients with MEN2a
18.HEAD AND NECK CANCER QUESTIONS 1. What upper aerodigestive site has the highest association between see and HPV? a. b. c. d.
Larynx Hypopharynx Oral cavity Oropharynx
2. The landmark Veterans Affairs paper regarding larynx cancer established what treatment paradigm? a. b. c. d.
Advanced stage larynx cancer should mainly be treated with surgery. Chemotherapy and radiation result in a low should replace surgery for treatment of most advanced larynx cancers. Failure of chemotherapy and radiation leaves patients with no options Chemotherapy and radiation result a owcr quality of life than surgical treatment tor advanced stage larynx cancer
3. Primary Tumors of what site the aerodigestive tract arc most consistently treated surgically a. b. c. d.
Nasopharynx oral cavity Oropharynx Larynx
4. The most common cutaneous malignancy of the head and neck is a. b. c. d.
Squamous cell carcinoma Basal cell carcinoma Melanoma Merkel cell carcinoma
5. In HNSCC, even if no cervical lymph nodes are clinically or radiographically evident, prior to treatment one must consider the presence of a. b. c. d.
Distant metastasis Occult cervical metastasis Wrong diagnosis Radioresistant primary tumor
SALIVARY DISEASE QUESTIONS Select one answer. 1. The following statements are true EXCEPT a. b. c. d.
Pleomorphic adenomas have a very small risk of malignant transformation. Warthin's tumor is also known as papillary cystadenoma lymphomatosum. Basal cell and canalicular adenomas arc varieties of pleomorphic adenoma. Oncocytoma is also known as oxyphilic adenoma.
2. The malignant salivary tumor most likely to invade surrounding nerve tissue is: a. b. c. d.
Mucoepidermoid carcinoma Acinic cell carcinoma Adenoid cystic carcinoma Squamous cell carcinoma
3. The following lesion(s) has potential for distant metastasis to the lungs and bones: a. b. c. d.
Polymorphous low-grade adenocarcinoma Adenoid cystic carcinoma Acinic cell carcinoma All of the above
4.A plunging ranula occurs when the mucocele herniates beneath which muscle into the submental space? a. b. c. d.
Genioglossus Mylohyoid Geniohyoid Platysma
5. All of the following statements are TRUE except a. b. c. d.
The auriculotemporal segment of the trigeminal nerve lies in close proximity to the superior aspect of the parotid and is generally not visible at surgery. The facial nerve should always be sacrificed during parotidectomy for malignant lesions. The tympanomastoid fissure is a reliable landmark in locating the main trunk of the facial nerve. Within the parotid, the facial nerve divides into the temporofacial and cervicofacial branches.
19. Thoracic Surgery QUESTIONS Select one answer. 1. Which predicted FEV1 value contraindicate pulmonary resection? a. b. c. d.
Above 0.8 L. Below 0-ft I Above 1.2 L. Below 1.2 L
2. Seven days after insertion of a chest tube for a spontaneous pneumothorax, several attempts to reposition the chest tube did not decrease the air leak. What is the next step? a. b. c. d.
Insert a new chest tube. Reposition the chest tube. Chemical pleurodesis. Surgically close the air leak plus pleurodesis
3. The initial workup of a newly found lung mass in a 30־year־old man does not include a. b. c. d.
Sputum cytology, Bronchoscopy. Review of old films, Open lung biopsy.
4. A 50 ־year-old female cigarette smoker was found to have a 3-cm lung mass not present 1 year before. Cytologic and bronchoscopic examination results were negative. The next step should be a. b. c. d.
Radiotherapy alone. Radiotherapy and chemotherapy. Resection. Follow-up after 3 months.
5. A lung abscess measuring 4 cm in the superior segment of the right lower lobe is best treated with a. b. c. d.
Antibiotics and physiotherapy. Percutaneous drainage. Resection. Chest tube drainage.
6. A postpneumonic empyema is best treated with a. b. c. d.
Antibiotics and physiotherapy. Chest tube drainage and antibiotics. Decortication if more than 7 days old. Thoracentesis and pleural injection of streptokinase.
7. Small cell carcinoma is different from other bronchogenic carcinomas in that a. b. c. d.
It is always incurable. It is not seen in female subjects. it is has a predilection for early spread to other organs. it is not responsive no chemotherapy
8. The presence of a thymoma a. b. c. d.
ls always associated with myasthenia gravis ls never associated with myasthenia gravis Is indication for resection Can he diagnosed by radiographic appearance only.
9. treatment of an apical tumor with horner syndrome is a. b. c. d.
radiotherapy. Surgery. Radiotherapy and chemotherapy followed by surgery Radiotherapy and chemotherapy alone.
10. The initial treatment for a patient with multiple bilateral rib fracturesand flail chest with CO, retention is a. b. c. d.
Endotracheal intubation and positive- pressure ventilation. Surgical fixation of ribs. Chest wall immobilization with sand bags. Intercostal nerve blocks.
20. Management of Burns 1. Burns characterized by painful blistering are best characterized as a. b. c. d.
First degree burns. Second degree burns. Third- degree burns. Fourth- degree burns.
2. the initial symptoms of carbon monoxide poisoning include: a. b. c. d. e.
Fatigue. Headache. Disorientation. Lethargy. e. All the above.
3. Hydrofluoric acid burns are typically treated with topical, intra-arterial, and/or subcutaneous administration of: a. b. c. d. e.
Calcium carbonate. Sodium bicarbonate. Calcium gluconate. Calcium phosphate. Potassium gluconate.
4. Burns to ears are best treated with what medication to prevent chondritis: a. b. c. d. e.
Silver sulfadiazine. Mafenide acetate. Bacitracin. Silver nitrate. Chlorhexidine.
5. Split-thickness skin grafts typically are defined as “mature” after what period of time: a. b. c. d. e.
1 month. 3 months. 6 months. 9 months. 12 months or longer.
21. Surgical critical care
QUESTIONS 1. The net result of aerobic metabolism of 1 mol of glucose is a. b. c. d.
ATP (18 mol), lactate, ATP (38 mol), carbon dioxide, and water, ATP (38 mol), lactate, ATP (2 mol), lactate.
2. An estimated blood loss of 35% of blood • olume reflects a. b. c. d.
Class I hemorrhage. Class II hemorrhage. Class III hemorrhage Class IV hemorrhage.
3. Swan ganz parameters include a PCWP of 12 mm Hg a cardiac index of 2.7 l/min/m The patient is a. b. c. d.
Normal. Hyperdynamic. Hypodynamic Requires more information to determine
4. An arteriovenous difference of 2.0 mL is most consistent with a. b. c. d.
Septic shock. Cardiogenic shock. Hemorrhagic shock. Spinal shock.
5. Cardiac output is Not affected by a. b. c. d.
Contractility Heart rate Hemoglobin Afterload
6. A patient in being mechanically ventilated on assist/control mode. His arterial blood gases are: pH 7.55, Pco2 24, P02 79, saturation 92%. The set rate is 12 breaths per minute; the patient is breathing 20 times per minute. What should be done? a. b. c. d.
Increase the Fio2 Sedate the patient. Add dead space to the circuit. Increase the rate of ventilation.
7. low levels of erythrocyte 2,3-DPG a. b. c. d.
Increase oxygen affinity. Decrease oxygen affinity. Increase acidosis. Increase alkalosis.
8. Appropriate treatment of a septic patient includes the following except a. b. c. d.
Fluid resuscitation. Narrow spectrum antibiotics. Appropriate cultures. early institution of goal directed therapy.
9. A patient has ARDS with an Fio2 of 75% on 10 cm H2o PEEP, the Po2 is only 50 mm Hg, Pc02 is 39 mm Hg, and pH is 7.28. What would you do? a. b. c. d.
Increase the Fi02 to 100%. Increase the PEEP. Increase the ventilatory rate. Give bicarbonate.
10. a postoperative patient has a platelet count of 50,000/mm* and no clinically apparent bleeding. You would a. b. c. d.
Transfuse 6 units Hla matched platelets. Transfuse 6 units of banked platelets. do not transfuse unless the platelet count falls to 20,000/mm3 administer cryoprecipitate
Chaptar22 ٠ Neurosurgarv QUESTIONS Select one answer. 1. The lesion most likely to cause neurologic injury and permanent sequelae is a. b. c. d.
Basilar skull fracture. Subdural hematoma. Epidural hematoma. Brain stem shear injury.
2. Subdural hygromas: a. b. c. d.
Are common following head injury. Are made up of a blood collection. Show as hyperdense lesions in a CT scan. treated with burr holes or twist drill trephination.
3. A complete spinal cord lesion is seen in which or the following? a. b. c. d.
Anterior spinal syndrome. central cord syndrome, Brown - Sequard syndrome. spinal shock.
4. Jefferson fracture is a fracture of the a. b. c. d.
odontoid process Ring of Cl. Pedicle of C2 Pars interarticularis of C3.
5. which of the following is the most common brain tumor in an adult? a. b. c. d.
ependymoma. ٠ low - grade astrocytoma. Glioblastoma multiforme. pituitary adenomas.
6. Cushing’s disease is associated with an increase of which of the following hormones? . a. b. c. d.
Somatostatin. ACTH. TSH. GnRH.
7. Hangman’s fracture refers to a fracture of which of the following? a. b. c. d.
Odontoid process. Ring of Cl. Pedicle of C2. Pars interarticularis of C3.
8. Which of the following is the most common type of myelodysplasia? a. b. c. d.
Encephalocele. Dermal sinus tracts. Myelomeningocele. Meningocele.
23 ؛Chapter Orthopedic Surgery
QUESTIONS Select one answer. 1.Early fracture stabilization of long bone and pelvic fractures in polytrauma patients reduces the risk of all of die following Except: a. b. c. d. e.
Sepsis Negative nitrogen balance ARDS Fat embolism Malunion or nonunion
2. Principles for managing high-grade complex open fractures include all of the following EXCEPT a. b. c. d. e.
Intravenous antibiotics. Thorough irrigation and debridement. Cast immobilization. Meticulous soft tissue care. Careful assessment of compartment pressures.
3.The nerve most commonly injured in anterior shoulder dislocations is the a. b. c. d. e.
Suprascapular nerve. Ulnar nerve. Median nerve, Axillary nerve. Long thoracic nerve.
4.Posterior dislocations of the hip most commonly injure which nerve? a. b. c. d. e.
Femoral nerve. Obturator nerve. Sciatic nerve. Peroneal nerve. Interosseous nerve.
5. Vascular compromise has been associated with all of the following injuries EXCEPT a. b. c. d. e.
Clavicle fracture. Knee dislocation. Patella fracture. Sternoclavicular joint dislocation. Supracondylar fracture of the humerus.
6. Which of the following scenarios warrants operative exploration of the radial nerve after closed manipulation of a fracture of the shaft of the humerus? a. b. c. d. e.
No radial nerve function at the time of the initial physical examination. No radial nerve function on presentation and without improvement after closed manipulation. Intact radial nerve function at presentation and after closed reduction, but no function at the initial office visit 1 week after the fracture. Intact radial nerve function on presentation but no function after closed reduction. Intact radial nerve function on presentation, after manipulation, and at subsequent office visits.
7. A 23-year-old male motorcyclist presents to the emergency department with bilateral closed femoral fractures. He is placed in bilateral traction and admitted. Twenty-four hours later, he is confused and tachypneic. The most likely diagnosis is a. b. c. d. e.
Pulmonary embolism. Myocardial infarction. Fat embolism. Urinary tract infection. Stroke.
8. The most common primary bone malignqn a. b. c. d. e.
Osccosarcuma. Synovial sarcoma. Multiple mycloma. Malignan fibrous hisniocymm Chondrosarcorna.
9. The position in which a patient with a posterior dislocation ofthe hip holds the affected extrem. ity is a. b. c. d. e.
Abducted, flexed, and externally rotated, Abducted, flexed, and internally rotated, Adducted, flexed, and internally rotated, Adducteti, flexed, and extcrna y rotated. Abducted, extended, and internally rorated
10. Which of the following types of childhood Salter fractures of long bones is associated wkh the highest likelihood of subsequent growth arrest? a. b. c. d. e.
Type l. Type Il. Type Ill. Type IV. Type V.
11. The most important diagnostic test in an adolescent with knee pain and normal knee radiographs is a. b. c. d. e.
Ipsilateral hip radiographs. Ipsilateral femur radiographs. AP pelvis. Bilateral hip radiographs. Ipsilateral tibia radiographs.
12. A young female patient presents with pain with an L5 radiculopathy and weakness of the extensor hallucis longus on the right. The level of the herniated disc most likely is a. b. c. d.
L2-3. L3-4. L4-5. L5-S1.
13. An osteosarcoma of the distal femur that has been shown by MRI to have broken through into the surrounding muscle would be classified as a a. b. c. d.
IB II A II B III B
14.the following regarding scapular fractures are true: a. b. c. d. e.
Uncommon injuries. May be associated with additional ipsilateral fractures. Are associated with pneumothorax pulmonary contusions. And spine fractures. Ofter treated nonoperatively. All of the above.
15. All of the following are indications to surgically fix midshaft humerus fractures except: a. b. c. d. e.
Open fracture. Polytrauma. Young patient. Segmental fracture. Floating elbow.
16. All of the following regarding hip fracture true EXCEPT a. b. c. d. e.
More common in women. Often occur from low-energy trauma in the elderly. Patients arc able to bear weight as tolerated postoperatively with modern implants. Is defined as a fracture of the proximal femur. Later stabilization of the fracture has the same 1-year mortality as early fracture stabilization (<48 hours).
17. the following are true regarding intra-articular fractures: a. b. c. d. e.
Require surgical fixation if more than minimally displaced, Have low morbidity. Heal well with prolonged immobilization of die involved joint. Patients can be weight bearing as tolerated immediately. All of the above.
18. Of the following regarding knee dislocations are true EXCEPT a. b. c. d. e.
They are often undiagnosed an estimated , 50% to 60% of the time. Require amputation. associated with multiple ligament May be associated with peroneal nerve injury uP to 25%. Are a devastating injury.
19.A 13-month-old boy is seen in the emergency department with a complaint Of redness and swelling of his right leg. The child appears in Pain. He is not yet walking as per the parents, and they did not observe any trauma He has a spiral fracture of his right femur on radiographs you should: a. b. c. d. e.
Indicate the child for surgery. Apply a splint and instruct the parents to Follow-up with an orthopaedic surgeon. Perform a skeletal survey Obtain a more detailed account of the occurernce and consult orthopaedics and child services. Apply a hip spica cast.
20. Patients diagnosed with slipped capital femoral epiphysis: a. b. c. d. e.
Arc often obese. Present with inability to ambulate and complain of knee pain. May often have bilateral disease. Usually treated surgically All of the above.
24. Selected Principles of Plastic Surgery 1.A 50-year -old female presents to the emergency department with a felon. She can flex and extend her finger without pain. What is the most appropriate treatment? a. b. c. d.
IV antibiotics and hand elevation A hockey stick incision for drainage at fingertip and IV antibiotics warm soaks and IV antibiotics Close observation and acyclovir
2. A 32-year-old healthy pregnant female comes to your office complaining of tingling In her fingers and wrist pain .You expect the patient to have: a. b. c. d.
A positive tinel's sing --- symptoms when her hands are held in flexion for 1 minute. A positive tinel's sing --- electric shock sensetoms when the wrist is tapped. A positive phalen's sign --- resolution of symptoms when her hand is held in flexion for 1 minute. A positive phalens sign --- electric shoch sensation when the wrist is tapped.
3. You are asked to evaluate a 16-year-old male with an abscess on the dorsum of his hand. During the medical history interview he tells you that his cat bit him there 1 week ago. what Is the most likely organism causing this infection? a. b. c. d.
bacteroides Eikenella Streptococcus P. multocida
4.Which finger is most crucial in a replant for the patient to have good hand function? a. b. c. d.
Thumb. Ring finger Index finger They are all equally important
5. What are the most common bacteria found in hand infections? a. b. c. d.
Bacteroides pasteurella Staphylococcus. Eikenella.
6. The patency of the radial and ulnar arteries and collateral circulation to the hand can be evaluated by: a. b. c. d.
Finkelstein maneuver. Addison maneuver. Allens test. Phalen's test.
7. Rupture of the extensor tendon at its insertion at the distal phalanx may result in: a. b. c. d.
Mallet finger deformity. Swan-neck deformity. Both of the above. Neither of the above.
8. Two days following a puncture wound :0 Lhc right ring finger a 45-year-old healthy male comes to the emergcncy department for care.His finger is swollen and flexed and he has severe pain with passive extension. Which statement is true? a. b. c. d.
Examination is consistent with a Felon and surgical drainage and antibiotics are indicated. Examination is consistent with acute suppurative tenosynovitis and surgical drainage and antibiotics are indicated. . S. viridians is the most likely causative bacteria. intravenenous antibiotics alone are adequate treatment.
9. Contraindications to replantation of amputated digits include: a. b. c. d. e.
A thumb in a young patient. A thumb in a 20-year-old manual laborer. A complete amputation of the hand at the level of the wrist. A complete amputation of the index finger at the level of the proximal phalanx. A gunshot wound to the hand.
10. Dupuytren contracture: a. b. c. d.
occurs most frequently in the ring and little finger. is frequently thought to be a work-related condition. is frequently quite painful. prevents the patient from making a full fist.
25
•
Urologic Surgery
QUESTIONS The following questions may have more than one answer. 1. The most common renal mass is a: a. b. c. d.
Renal cell carcinoma. Adenoma. Benign cyst. Angiomyolipoma.
2. During a routine right hemicolectomy a right renal mass is noted one should: a. b. c. d. e.
Expose the mass and perform a wedge biopsy. Needle-aspirate the mass. Perform a nephrectomy. palpate carefully and then Work up postoperatively.. Excise the mass with adequate margin.
3. Which of the following modalities is not useful of maximizing early direction of prostate Cancer. a. b. c. d. e.
prostate-specific antigen. prostatic acid phosphatase. Transrectal ultrasonography. digital rectal examination. Clinical symptomatology.
4. BCG bladder instillations are useful in patients with: a. b. c. d. e.
Solitary, superficial urothelial bladder card- noma. Squamous cell carcinoma of the bladder. Superficial, recurrent urothelial bladder carcinoma. Carcinoma in situ. Recurrent urothelial bladder carcinoma with superficial muscle invasion.
5. What percentage of patients with stage I testicular carcinoma eventually progress without further treatment after radical orchiectomy? a. b. c. d. e.
10. 20. 30. 40. 50.
6. Symptoms and signs related to benign prostatic hyperplasia can be successfully treated pharmacologically. a.
True.
b.
False.
7. Which testicular tumor has the worse prognosis? a. b. c. d. e.
Seminoma. Embryonal carcinoma. Yolk Cac tumor. Choriocarcinoma. Teratocarcinoma.
8. which of the following parameters necessitate radiographic imaging of the urinary tract in the Patient with blunt trauma? a. b. c. d. e.
Adult patient. Microscopic hematuria. Systolic blood pressure higher than 90 mm Hg. Fracture of a lumbar transverse process. History of renal cysts.
9. proper ureteral repair in after trauma requires all of the following except: a. b. c. d. e.
Tension-free anastomosis. Adequate urinary diversion. Adequate wound drainage. Watertight closure. Use of absorbable suture.
10. Which of the following findings obviate the need for scrotal exploration in a Patient with suspected testicular torsion? a. b. c. d. e.
Positive prehn's sign. Normal urinalysis. Normal color Doppler ultrasound. No history of scrotal trauma. Shortened spermatic cord.
27 Minimally Invasive Surgery
QUESTIONS 1. Which of the following is not an indication for open cholecystectomy a. b. c. d. e.
Poor pulmonary or cardiac reserve Third-trimester gestation Childs's class C liver disease Suspected gall bladder cancer Previous gastric bypass procedure
2. Which of the following regarding laparoscopic appendectomy is true a. b. c. d. e.
It is contraindicated in the face of diffuse peritonitis It is less likely to result in post-operative small bowel obstruction It is contraindicated in the elderly or immunocompromised The conversion rate to open appendectomy is over 50% Compared to open approaches, the laparoscopic approach has a higher rate of hospital morbidity
3. Indications for intra-operative cholangiogram include which of the following a. b. c. d. e.
Poor visualization of the anatomy Pre-operative jaundice Dilated common bile duct Biliary pancreatitis All the above
4. Laparoscopy for blunt abdominal trauma is contraindicated in which of the following scenarios a. b. c. d. e.
Suspicion for pancreatic injury A positive FAST study Pneumoperitoneum Previous abdominal surgery Suspicion for a diaphragmatic injury
5. Which of the following approaches can be used to performed a minimally invasive inguinal her¬nia repair a. b. c. d.
Totally extraperitoneal approach Intraperitoneal approach Transabdominal preperitoneal approach All the above
Chapter 28 •Bariatric Surgery QUESTIONS .Select one answer
1. The optimal management of most postoperative leaks after gastric bypass is: a. b. c. d.
npo , hyperalimentation, iv antibiotic. ugi to determine site of leak and operate can be clearly identified IV antibiotics, CT-guided pigtail placement near the gastrojejunostomy anastomosis ngt placement. Operative exploration, endoscopic NGT placement, good drainage of anastomotic .site g tube placement, IV antibiotics
2. All of the following are false EXCEPT; a. b. c. d. e.
Ghrelin is secreted from adipocytes. Ghrelin is high in the obese. Leptin comes from the stomach. Leptin is high in the obese. PYY and GLIM decrease after gastric bypass.
3. the initial resuscitation of a postoperative bariatric patient with hypotension and suspected sepsis is a. b. c. d.
transfuse blood followed by vasopressor usually dopamine at 5 mg/kg/ min fluid bolus of 1000 cc of crystalloid or colloid over 30 min elevate the foot of the bed and position left side down to increase venous return stat blood cultures followed by blood transfusion followed by broad spectrum antibiotics
4. Two years after lap banding a patient presents to the emergency department with severe epigastric pain and nausea. The white blood cell (WBC) count is 20,000 and UGI shows a complete obstruction. Which of the following is true: a. b. c. d.
Remove all fluid in the band, if the pain is not alleviated go to the OR to access the band and the pouch, Place the patient on IV antibiotics for a gastric erosion. Endoscope the patient to make sure that there is no erosion. Anterior slippages are rarely emergencies, remove the fluid and discharge die poulenc ,for follow-up with their bariatric surgeon.
5. three months after lrygbp a patient presents with hematemesis .the patient is on clopidogrel and acetylsalicylic acid for cardiac stent .which of the following is the most appropriate management of this patient a. b. c. d.
transfuse as needed with blood and platelets and observe in the icu endoscope the patient after stopping the asa and plavix endoscope the patient when stable to diagnose and treat a marginal ulcer empirically start the patient on proton pump inhibitors
29. Anesthesia for the General Surgeon 1.
A 35 year old man with well controlled diabetes would be considered an asa classification of a. b. c. d. e.
P1 a normal healthy patient P2 a mild systemic disease P3 a severe systemic disease P4 incapacitated P5 a moribund
2. Triggering agents for malignant hyperthermia include a. b. c. d.
All inhalation agents Succinylcholine Benzodiazepines Potassium salts
3. Recommendations for reducing the risk of pulmonary aspiration include: a. b. c. d.
Particulate antacids. Infant formula for more than 4 hours. High gastric volume. High pH.
4. True statements concerning flumazenil include: a. b. c. d.
It reverses the effects of some opioids. It reverses only the respiratory and amnestic effects of benzodiazepines. It is a benzodiazepine antagonist. ft has a relatively long half-life (prevents resedation by benzodiazepines).
30. Surgical Infections and Principles of Antibiotic Use
2. A 60 -year-old woman with hypertension is taking care of a foal cat that became pregnant. ch became more aggressive and bit the an when she was leaving out the hood. Animal control personnel were contacted and succeeded at capturing the cat. The following day, the woman developed swelling of the right wrist and hand as weil as erythema and never. What should the next step be؛ a. b. c. d. e.
rabies inuminogiobuhn amoxicillin clavulan acid. Treat for Cat-scratch disease. Euthanize the cat. Cefazolin.
3. A 72-year-old woman with hypothyroidism, diabetes meliitus. and osteoporosis fell and sustained a right intertrochanteric hip fracture. She was taken for open reduction and internal fixation (ORJF) of the hip the following day perioperative prophylactic cefazolin was administered for 24 bouts. r؛M،opcrattvr day 3. she ،ud a louse bowel movement. The following day. she has fever to 10TF. leukocytosis of 23,400 WBC/HPF and 10% bandemia. Blood pressure is stable. Blood and unne cultures arc sent. CXR showed right lower lobe atelectasis. What is the most appropri¬ate treatment? a. b. c. d. e.
Stan empiric intravenous vancomycin. Encourage incentive spirometer use. Begin lactobacillus. Observe off antibiotics while awaiting cultures. Begin oral vancomycin.
4. A 23-year-old man was involved in a motor vehicle accident. On arrival to the emergency department, he became hypotensive. A CT of the abdomen showed a lacerated spleen. He was emetgently taken to the operating room for splenectomy. There are no major complications and he is ready for discharge. In addition to educating him about his increased risk of infection especially with encapsulated bacteria, what steps should you take to minimize the risk? a. b. c. d. e.
Prophylactic penicillin daily. Pneumovax . hib. and meningococcal vaccines every 5 years. Pneumovax , hib, and meningococcal vaccines once. Pneumovax every 5 years; hib and meningococcal vaccines once. Pneumovax every 5 years; hib and meningococcal vaccines every 10 years.
5. A 43-year־old woman with irritable bowel syndrome was in her usual state of health until approximately 2 months ago. She complained of intermittent abdominal pain with nausea, vomiting, and diarrhea. No fever. Last night her pain became more severe and she presented to the emergency department with fever 103.5° F with rigors. In the emergency department, she had rigors and sclera icterus. Direct bilirubin 2.4, alkaline phosphatase 400, WBC 18,500, AST 20, and ALT 21. Ultrasound revealed a common bile duct stone. What is the next step? a. b. c. d.
Antibiotics and urgent surgical biliary decompression. Antibiotics and endoscopic biliary decompression. Antibiotics and percutaneous transhepatic biliary decompression. Antibiotics, surgical decompression, and cholecystectomy.
6. A 35־year־old woman underwent laparoscopic resection of a perforated appendix. The patient was given ciprofloxacin and metronidazole perioperatively. The patient returned 1 week later with fever, chills, and abdominal pain. CT of the abdomen revealed a collection in the right lower quadrant. The fluid was aspirated and 200 cc of purulent should be initiated? a. b. c. d. e.
cefotetan. ceftriaxone/metronidazole. daptomycin. aztreonam/clindamycin. ampicillin/sulbactam.
