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0% found this document useful (0 votes)
153 views42 pagesSurgery Q Bank
Uploaded by
pronoobgaming818Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF or read online on Scribd
/ 42
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1
972020 FINAL EXAM
1. A 36-year old former intravenous drug user with a prior history of oft
Pneumocystis cariniipneumonia is seen for a complaint of diffuse abdominal
pain and peritonitis. An abdominal X-ray reveals free intraperitoneal air. The
most likely etiology for pneumoperitoneum in thispatient is *
BmOPTEMEGalovirus colitis with perforation
Diverticulitis
Necrotic bowel in a hernia
© Perforated peptic ulcer
Perforated cecal carcinoma
2. A patient with a history of familial polyposis undergoes a diagnostic ava
polypectomy. Which of the following types of polyps is most likely to be
found? *
Villous adenoma
Hyperplastic polyp
©@ Adenomatous polyp
Retention polyp
Pseudopolyp
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09/2020 FINAL EXAM 7
3. What is the most common serious complication of an end colostomy? * 1
Bleeding
Skin breakdown
@ Parastomal hernia
Colonic perforation during irrigation
Stomal prolapse
4. Regarding regional enteritis, all the following are true statements, EXCEPT 0/1
that: *
Regional enteritis may involve any segment of the gastrointestinal tract
The most frequent site of involvement is the terminal ileum
Massive hemorrhage per rectum is common
© Adenocarcinoma of the small bowel associated with the disease has a poor
prognosis
The actual cause of the disease is unknown
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2020 FINAL EXAM
5. An active 80-year old who has never before been hospitalized is admitted 0/1
with signs and symptoms typical of a small bowel obstruction. Which of the
following clinical findings would give most help in ascertaining the diagnosis?
©@ Coffee-grounds aspirate from the stomach
Trerobili
A leukocyte count of 40,000/mm3
A pH of 7.5 Pco2 50 torr, and paradoxically acid urine
A palpable mass in the pelvis
6. A70-year-old woman has nausea, vomiting, abdominal distention, and Oo”
episodic, crampy midabdominal pain. She has no history of previous surgery
but has a long history of cholelithiasis for which she has refused surgery. Her
abdominal radiograph reveals spherical density in the right lower quadrant.
Correct treatment should consist of: *
lleocolectomy
©@ Cholecystectomy
lleotomy and extraction
Nasogastric tube decompression
Intravenous antibiotics
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72020
4
FINAL EXAM
7. A 48-year-old woman develops pain of the right lower quadrant while on
playing tennis. The pain progresses and she presents to the emergency room
later that day with a low-grade fever, a white blood cell count of 13,000 and
complains of anorexia and nausea as well as persistent, sharp pain of the right
lower quadrant. On examination she is tender in the right lower quadrant with
muscular spasm and there is a suggestion of a mass effect. An ultrasound is
ordered and shows an apparent mass in the abdominal wall. Which of the
following is the most likely diagnosis? *
@ Acute appendicitis
Cecal carcinoma
Hematoma of the rectus sheath
Torsion of an ovarian cyst
Cholecystitis
8. All the following statements regarding the etiology of obstructive jaundice 0/1
are true EXCEPT: *
A markedly elevated alkaline phosphatase is usually associated with obstructive
jaundice
When extrahepatic biliary obstruction is suspected, the first test should be
endoscopic retrograde cholangiopancreatography (ERCP)
© Aklatskin tumor will result in intrahepatic ductal dilation only
A liver-spleen scan will add little to the diagnostic work up for obstructive jaundice
Carcinoma of the head of the pancreas can cause deep epigastric or back pain in as
many as 30 percent of patients
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2020
5
FINAL EXAM.
9. A previously healthy 15-year-old boy is brought to the emergency room 0/1
with complaints of about 12 hours of progressive anorexia, nausea, and pain
of the right lower quadrant. On physical examination, he is found to have a
rectal temperature of 38.1 degrees centigrade and has direct and rebound
abdominal tenderness localizing to Mc Burney’s point as well as involuntary
guarding in the right lower quadrant. At operation through a McBurney-type
incision, his appendix and cecum are found to be normal, but the surgeon is
impressed with the marked edema of the terminal ileum, which also has an
overlying fibrinopurulent exudate. The correct procedure is to: *
© Close the abdomen after culturing the exudate
Perform a standard appendectomy
Resect the involved terminal ileum
Perform the ileocecal resection
Perform an ileocolostomy to bypass the involved terminal ileum
10. Which of the following would be expected to stimulate intestinal motility? *0/1
Fear
Gastrin
Secretin
Acetylcholine
© Cholecystokinin
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6
20 FINAL EXAM
11. Each of the following statements regarding appendicitis during pregnancy 0/1
is correct, EXCEPT: *
Appendicitis is the most prevalent extrauterine indication for celiotomy during
pregnancy.
Appendicitis occurs in pregnant and nonpregnant women of comparable age with
equal frequency.
© Suspected appendicitis in a pregnant woman necessitates prompt surgical
intervention
Noncomplicated appendicitis results in 20 percent fetal mortality and 10 percent
premature labor rate.
General anesthesia for appendectomy causes no increase in fetal damage or loss.
12. On Monday morning, a 75-year-old man has a moderate-sized abdominal 1/1
aneurysm resected. On Friday, he is noted to be markedly distended with an
abdominal radiograph on which the cecum is measured as 12 cm across.
Proper management at this time would be: *
A decompression of the large bowel via colonoscopy
Replacement of the nasogastric tube and administration of low-dose cholinergic
drugs
Continued nothing by mouth orders, administration of a gentle saline enema, and
encouragement of ambulation
Immediate return to the operating room for operative decompression by transverse
colostomy
© Right hemicolectomy
C 3 Se
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2020 FINAL EXAM
13. A 55-year-old man has CT evidence of complicated appendicitis with a Ww
contained abscess in the right lower quadrant. He is mildly tachycardic,
afebrile, and normotensive with focal right lower quadrant tenderness but nc
peritonitis. What is the optimal approach to this patient? *
Immediate laparotomy
Laparoscopic exploration and abscess drainage
@ Percutaneous drainage, intravenous (IV) fluids, bowel rest, and broad spectrum
antibiotics
IV fluids, bowel rest, and broad spectrum antibiotics
14. A 23-year-old woman who is 28 weeks pregnant presents with right-sided 0/1
abdominal pain, leukocytosis, and an abdominal ultrasound that does not
visualize the appendix. What intervention would you recommend? *
Exploratory laparoscopy
Abdominal CT scan
Abdominal magnetic resonance imaging (MRI) scan
© Serial clinical observations.
15. A 34-year-old man presents to your clinic asking about an elective Ww
appendectomy. He has no history of appendicitis. What are possible
indications for appendectomy in this patient? *
Planned travel to a remote place with no surgical care.
Patients with Crohn's Disease where the cecum is free of gross disease
As part of Ladd procedure
© Allof the above
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FINAL EXAM
16. Diverticulosis of the colon is associated with all of the following WW
complications EXCEPT: *
Perforation
Fistula 8
Obstruction
Hemorrhage
©@ Carcinoma
17. The proper operative management of a perforated diverticulum with fecal 1/1
soilage is: *
Transverse loop colostomy
Sigmoid colon resection with primary anastomosis
© Sigmoid colon resection, diverting colostomy, and Hartmann's pouch
Nasogastric suction, laparotomy, and drainage
Intravenous antibiotics and hydration
18. The initial therapy for a sigmoid volvulus is: * wW
Nasogastric suction and intravenous hydration
Immediate laparotomy with loop colostomy
Placement of a Cantor tube and intravenous hydration
Subtotal colectomy
© Sigmoidoscopic decompression
FINAL EXAM.
= ra a 2020 FINAL EXAM
19. The radiologic “bird’s beak” on barium enema is associated with: * Ww
Ulcerative colitis
Crohn's disease
Diverticular disease 9
Carcinoma
© volvulus
20. Biliary colic is caused by: * Ww
©@ Astone obstructing the cystic duct
Passage of a stone through the ampulla of Vater
Acute infection within the bile ducts
Inflammation of the pancreas
Inflammation of the gallbladder
BREATH IN, BREATH OUT!!!
PATIENT: DOG, MY,NAME'S NOT,
LITA S UCC AUIS,
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2020 FINAL EXAM
21. A 4x3 cm solitary nodule in a 47/M is best managed by * m
Thyroid ultrasonography
Thyroid scan
@ Fine needle aspiration biopsy 10
Thyroid hormone suppression
22. This type of thyroid cancer is associated to MEN syndrome * TA)
Anaplastic thyroid cancer
Follicular thyroid cancer
@ Medullary thyroid cancer
Papillary thyroid cancer
23, The recurrent laryngeal nerve is closely associated with this artery * aw"
© Inferior thyroid artery
Internal carotid artery
External carotid artery
Superior thyroid artery
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0/2020
FINAL EXAM,
24. 55/M complaining of a 2x3 cm left thyroid nodule with associated o/1
hoarseness and hemoptysis. There are positive 1x1.5 cm lymph nodes in the
left sternocleidomastoid muscle with negative Chest x-ray. If the biopsy is
Papillary cancer, what is the most likely stage of the patient? *
Stage 1 11
@ Stage 2
Stage 3
Stage 4
25. The same patient in number 4, based on the stage what wouldbe the 1/1
most appropriate treatment? *
Total Thyroidectomy
Total Thyroidectomy with Neck Dissection
© Total Thyroidectomy with Neck Dissection and RAl post op
Total Thyroidectomy with RAI post op
Total thyroidectomy with post op chemotherapy and RAI
26. Which of the following diagnostic tool that has low sensitivity during WW
pregnancy? *
Ultrasound
Biopsy
@ Mammography
MRI
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FINAL EXAM
27, is a rare and aggressive form of breast cancer that often Ww
appears as a rash or an irritated area of skin. It blocks the lymph vessels in the
skin of your breast. *
Invasive Ductal CA
Invasive Lobular CA
© Inflammatory breast CA
12
Ductal Carcinoma In Situ
28. After a patient underwent modified radical mastectomy, he developed Ww
winging of the scapula with shoulder weakness. What is the possible cause? *
Injury to the radial nerve
Injury to the vagus nerve
© Injury to the long thoracic nerve
Injury to the axillary nerve
29. A 49/F diagnosed case of Invasive ductal cancer of the right breast came 0/1
to your clinic with a breast mass on the RUOQ 4x4cm in size. There are note
of multiple matted lymph nodes on the axilla and matted supraclavicular
lymph nodes. What is the stage of the patient? *
©@ Stage 28
Stage 3A
Stage 3B
Stage 3C
Stage 4
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FINAL EXAM
30. What would be the most appropriate treatment for patient in No. 29? * o1
Simple Mastectomy
© Modified Radical Mastectomy
Neoadjuvant Chemotherapy
Radiotherapy
is
Chemotherapy and Radiotherapy
31. Locations of anatomic narrowing of the esophagus seen on an ”
esophagogram include all of the following EXCEPT: *
LES
Crossing of the left mainstem bronchus and aortic arch
© Thoracic Outlet
Cricopharyngeal muscle
32. The cervical esophagus receives its blood supply from the * Ww
Internal carotid artery
© inferior thyroid artery
Superior thyroid artery
Inferior cervical artery
Facial artery
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9/2020 FINAL EXAM
33. Medical management for GERD * "1
@® ppl
Antacid
Antibiotic
Antireflux surgery 14
34. A 40ylo M is diagnosed with GERD. Cigarette smoking is thought to NM
contribute to GERD by *
© decreasing LES pressure and impairing contractility
increasing acid production
decreasing the esophageal clearance of acid
increasing secondary peristalsis
increasing saliva production
35. A 45y/o F is diagnosed with GERD. Which of the following findings will be a 1/1
contraindication to her anti reflux surgery. *
presence of severe esophagitis on endoscopy
Type Ill hiatal hernia in esophagogram
© Barrett,s esophagus with high grade dysplasia
shortened esophagus 19/2020
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FINAL EXAM
36. Which segment of the colon and rectum has the highest incidence of of
malignancy? *
Ascending colon
Transverse colon
Descending colon
© Sigmoid colon
15
Rectum
37. Which segment of the colon and rectum has the highest rate of volvulus 1
because of its length and mobility? *
‘1
Ascending colon
Transverse colon
Descending colon
© Sigmoid colon
Rectum (does. google com/forms/die! [FAIpQLSU67UDsGLmB2ZyI_Fw]qMN-Py9OMGEXBYIZ3CQelav4, HCA Wiewseore viewseare=AEO2A gAwgWGMY?.
2020
FINAL EXAM
38. (For No. 38-40) A 58 y/o F menopausal is referred to your clinic for painless 1/1
hematochezia which has been noted for 9 months. She noted easy fatigability
but otherwise asymptomatic and has no other past medical or surgical
history. On PE she has a BMI of 20kg/mz2. His rectal and anoscopic exam show
no lesions. His FIT test is positive. The next step in the management should
be?*
CT sean
MRI 16
Barium Enema
© Colonoscopy
Capsule endoscopy
39. If the findings revealed a 2 cm friable mass at the ascending colonanda 0/1
moderately differentiated adenocarcinoma on histopath, what should be
done to the patient? *
Observe and repeat the tests after 3 months
‘S=Whole abdominal CT scan
Segmental resection of the descending colon
©@ Left hemicolectomy
Chemo and radiotherapy
C a 09/2020 FINAL EXAM
40. What would be the adjuvant treatment of the patient if postoperatively 0/1
she is Stage 3? *
(S—ehemotherapy
@ Chemotherapy and radiotherapy
(©) Radiotherapy
© Close monitoring
KEEP GOING!!! 17
IT NEVER
ETS EAS
41, Amelanoma that has a primary depth of >2mm requires this margin for Ww
excision *
O Smm
© 2cm
© 4m
O 6m
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0/2020 FINAL EXAM
42. Squamous cell carcinoma may arise from these burn scars * WW
Bowen's disease
© Marjolin’s ulcers
Leukoplakia
Cutaneous horn
43. Congenital lesions that result when epithelium is trapped during fetal Ww
midline closure *
© Dermoid cysts 19
Trichilemmal eysts
Epidermal cysts
) Lipoma
44. A 42 ylo male suffered burns on his right leg (circumferential), right upper 1/1
extremity (circumferential) and the genitalia. Compute for TBSA of injury *
32%
@© 28%
37%
19%
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FINAL EXAM
45. A 54 y/o male presented with a suspicious lesion on his right cheek, with 1/1
ulceration and crusting, and with the typical “rolled” border appearance.
Clinical suspicion will point to: *
Squamous cell CA
Bowen's disease
Melanoma
©@ Basal Cell CA
46. The preferred method for diagnosis of palpable or nonpalpable breast o/1
abnormalities *
20
©@ Fine needle aspiration biopsy
Tore needle biopsy
Excision biopsy
Incision biopy
47. The axillary lymph node groups are assigned levels according to their Ww"
anatomic relationship to the *
Internal mammary artery
Latissumus dorsi
Axillary vein
©@ Pectoralis minor
FINAL EXAM
C a <
2020 FINAL EXAM
48. Risk factors for development of breast cancer except * Ww
Nulliparity
©@ Late menarche
Late menopause
Early menarche
49. A 45 yo female is complaining of a unilateral bloody nipple discharge, o/1
spontaneous and localized to a single duct. This is suggestive of *
©@ Periductal mastitis
Intraductal papilloma 21
es Falactocele
Prolactin-secreting adenoma
50. A 38 y/o pregnant is being investigated for a palpable breast mass. The o/1
following is contraindicated: *
© Ultrasound
Mammogram
MRI
None
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FINAL EXAM
51. Hernia that protrudes lateral to the inferior epigastric vessels are * WW
Direct Inguinal hernia
© indirect inguinal hernia
Femoral hernia
Umbilical hernia
52. Palpation of a mass that does not change during contraction of the rectus 1/1
muscle *
Phren's sign
, Zl
McBurney's sign
Rovsing’s sign
© Fothergill’s sign
53. In indirect inguinal hernia, the sac is commonly situated at the 0/1
of the spermatic cord *
Posteromedial
© Arnterolateral
Anteromedial
Superolateral 9/2020
sHidocs
9/2020
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FINAL EXAM
54. A 43 ylo female complains of a painful mass on the right side of her Ww”
abdomen. On history, she is on chronic warfarin therapy and suffered a fall in
the bathroom. On exam, she has a tender, firm mass on the right side of the
umbilicus, non-reducible. The best diagnostic test would be: *
Ultrasound of the abdomen
@ CT scan of the abdomen
Abdominal x-ray
MRI of the abdomen
55. A 55 ylo man complains of an enlarging inguino-scrotal bulge associated 0/1
with abdominal pain and vomiting. On PE, the mass cannot be reduced.
Management would be: *
23
@ Elective hemia repair
Emergency hernia repair
Manual reduction of hernia
Give anti-emetic
56. This reflex is absent in testicular torsion, to differentiate it from orchitis* 1/1
Bulbocavernosus reflex
@ Cremasteric reflex
lliohypogastric reflex
Tendon reflex
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2020 FINAL EXAM
57, Tissue folds located in the prostatic urethra which can cause bladder aA
outlet obstruction and a damaging cause of bilateral hydronephrosis in a
newborn boy *
Vesicoureteral reflux (VUR)
Ureteral stricture
Ureterocoele
© Posterior urethral valves (PUV)
58. This type of testicular cancer is highly responsive to radiotherapy * ”M
©@ Pure seminoma
23
Mixed
Nonseminatous
Leydig cell tumor
59. A 56 y/o male came in due to painless gross hematuria. KUB ultrasound ol
revealed a 4-cm mass in the right lateral bladder wall. The next step is *
TURP.
TURBT
Percutaneous biopsy
© Suprapubic cystostomy
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FINAL EXAM
60. A 35 y/o male complains of left-sided flank pain, intermittent, colicky. Plain 0/1
CT of the abdomen revealed a 2cm stone located at the left proximal ureter.
Plain abdominal xray however revealed no abnormal calcifications.
Consideration is: *
Artifact only in CT scan
Uric acid stone
© Calcium containing stone
Struvite stone
24 <€ BAS:
FINAL EXAM
KEEP MOVING FORWARD!!!
When you're ready
to quit just remember
ow good you'll look in
that white coat
no @ yourstudymate
61. A 35 year old male, working as a teacher came in due to hoarseness of o/1
voice. No lymph nodes palpated on the neck area. You decided to do
laryngoscopy and was able to note a unilateral exophytic lesion on the glottis.
vocal fold nodule
vocal fold polyp
@© vocal fold cyst
fibrous mass of the vocal fold
florms/d/e/1FAlpQLSd674DsGLmB2Zy1_FwqMN-Py9OMGeXB9IZ3CQelavg_IICyA/viewscore view
2020 FINAL EXAM 020
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FINAL EXAM
62. Most common parotid gland tumor * WW
©@ Pleomorphic adenoma
Mucoepidermoid Carcinoma
Adenoid cystic carcinoma
Squamous cell carcinoma
63. A 45 year old male, chronic smoker came in due to 2 months history of o/1
anosmia, and nasal obstruction. Patient also has history of serious otitis media
recently. Upon physical examination, there is also a mass in the posterolateral
neck. What is your next step? *
RT-PCR swab for Covid 19, 14 day quarantine, re swab after quarantine
Do endoscopy for further evaluation
Excise mass on the neck
26
@ Réquest for CT or MRI
64. A 23 year old patient came in due to a mass on his right temporal area. The 0/1
patient claimed the mass appeared after he was involved in a brawl a week
ago. On physical examination, you thought the mass to be pulsating. What is
your next step? *
© Lbserve since the mass is most likely to be a hematoma and the pulsation is the
artery beneath the mass
Do needle biopsy due to the possibility of malignancy
Request imaging studies to further investigate
Give antibiotics since it may be due to infection he might have sustained during the
brawl. Se
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020 FINAL EXAM.
65. A 20 year old female came in due to an anterior neck mass. She claimed 0/1
she started noticing the mass since she was a child but a few days prior to
consult, mass became slightly enlarged and tender after having a cough for a
couple of days. On physical examination you noted a tender and swollen mass
approximately 2cm on the upper area of the midline of the neck. The mass
does not move upon swallowing but does so upon tongue protrusion. What is
your next best step? *
© Observe but request for a neck ultrasound
Antibiotic + Neck ultrasound
Advise surgery
Reassure the patient since this might be just a lymph node secondary to the URTI she
had
66. A50 year old male came in due to a perianal mass. He noted that the mass1/1
has been intermittently present whenever he defecates and sometimes has
bleeding. Although he has had this for a while, he was not worried because it
usually goes away on its own. However, a day prior to consult, other than the 27
bleeding, the mass stayed and won't go back in and is painful. What is the
most probable stage of this patient *
Grade |
Grade II
Grade III
©@ Grade iv
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