Surgery Ple

8/18/2019 Surgery Ple

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University of Perpetual Help Rizal JONELTA FOUNDATION SHOOL OF !EDIINE

Depart"ent of Sur#ery $ onsortiu" Test %uestions for t&e Fe'ruary ())* PLE

Name ________________________________________Su'+e,t- .eneral Sur#ery /

Instructions: Multiple Choice : Choose the 0EST answer.1. With regard to keloids and hypertrophic scars, the following statements are true,

!C"#:a. #here are no histologic di$erences %etween the two.%. #he di$erences %etween hypertrophic scar and keloid are clinical, not

pathologic.c. &ypertrophic scars outgrow their original %orders.d. &ypertrophic scars and keloids ha'e %een treated successfully with

intalesional in(ection ofsteroids.

)nswer: C*eference: "*INCI"+ - /*0* %y C&W)*#2, "NC*, &I* 3 #&

4I#I-N, 5ol. 1, pp. 6167618

M"+: 9.3

. #rue statements regarding melanoma include all of the following, !C"#:a. #he most common histologic type is super;cial spreading.%. 4epth of in'asion uently su%ungual or appear on the

palms and soles.)nswer: C*eference: "*INCI"+ - /*0* %y C&W)*#2, "NC*, &I* 3 #&

4I#I-N, 5ol. 1, pp. 6763

M"+: 9.8

?. ) mass in the midline of the neck (ust a%o'e the tracheal cartilage has %een nota%lefor some months in an @ year7old girl %ut in the last four days there has %een somereddening and discomfort. Which of the following statements is most likely correctA

a. It has a high pro%a%ility of malignancy.%. It would most likely resol'e completely with anti%iotics.c. It would rise higher in the neck when she protrudes her tongue.d. Incision and drainage is ade>uate treatment.)nswer: C*eference: "*INCI"+ - /*0* %y C&W)*#2, "NC*, &I* 3 #&

4I#I-N, 5ol. 1, pp. 891789M"+: 9.8

B. ach of the following factors contri%utes to the likelihood that a mass in the neck ismalignant, E1EPT:

a. #he patient is alcoholic.a. #he patient had another malignancy outside the neck. b. #he patient is >uite sure it was not present a week ago.c. #he patient was a hea'y smoker, %ut >uit two years ago.)nswer: C*eference: "*INCI"+ - /*0* %y C&W)*#2, "NC*, &I* 3 #&

4I#I-N, 5ol. 1, pp. 813789M"+: 9.8

6. Which of the following statements concerning parotid tumors is trueA

a. @9 are %enign%. 4iagnosis is %y incisional %iopsyc. acial ner'e palsy is a de;nite sign of malignancyd. #umors that eDtend into the deep lo%e of the parotid are unresecta%le)nswer: )*eference: "*INCI"+ - /*0* %y C&W)*#2, "NC*, &I* 3 #&

4I#I-N, 5ol. 1, pp. 863M"+: 9.8


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8. #he type of hiatal hernia for which operation is indicated %ased on its demonstratedpresence is:

a. sliding hiatal hernia%. para7esophageal hiatal herniac. Eshort esophagusFd. GarrettHs esophagitis)nswer: G*eference: "*INCI"+ - /*0* %y C&W)*#2, "NC*, &I* 3 #&

4I#I-N, 5ol. 1, pp. 1118M"+: 9.B

3. Which of the following esophageal a%normalities is premalignantAa. reuD esophagitis%. GarettHs esophagitisc. "res%yesophagusd. cleroderma)nswer: G*eference: "*INCI"+ - /*0* %y C&W)*#2, "NC*, &I* 3 #&

4I#I-N, 5ol. 1, pp.1118M"+: 9.B

@. -f the anatomic layers of the esophagus, which statement is true for the serosallayerA

a. It is e$ecti'e in temporarily halting the spread of carcinoma.%. It lu%ricates the esophageal thoracic mo%ility during swallowing.c. It is useful in suturing anastomoses to the esophageal stump.d. It does not eDist.)nswer: 4*eference: "*INCI"+ - /*0* %y C&W)*#2, "NC*, &I* 3 #&

4I#I-N, 5ol. 1, pp. 11?@M"+: 9.6

J. ) ? year7old woman complains of diKculty swallowing, foul %reath, andregurgitation of undigested food. &er most likely diagnosis is:

a. esophageal cancer%. achalasiac. 2enkerHs di'erticulum


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a. cystosarcoma phylloides%. comedocarcinomac. medullary carcinomad. lo%ular carcinoma)nswer: )*eference: "*INCI"+ - /*0* %y C&W)*#2, "NC*, &I* 3 #&

4I#I-N, 5ol. 1, pp. 66766?M"+: 9.8

1?. Current ad(uncti'e therapy for a premenopausal B9 year old woman following radicalmastectomy with a .6 cm ductal carcinoma with a of 16 lymph nodes in'ol'edand an estrogen receptor negati'e tumor includes:

a. tamoDifen%. cytotoDic chemotherapyc. androgensd. oophorectomy)nswer: G*eference: "*INCI"+ - /*0* %y C&W)*#2, "NC*, &I* 3 #&

4I#I-N, 5ol. 1, pp. 6J9M"+: 9.6

1B. ) 86 year7old farmer presents with a 1.67cm ulcerated lesion on the middle third ofhis lower lip. #he lesion has %een present for B months and is not painful. No lymphnodes are palpa%le in the patientHs neck. #he most likely diagnosis is:

a. >uamous cell carcinoma b. Gasal cell carcinomac. &erpes simpleDd. Leratoacanthoma)nswer: )*eference: "*INCI"+ - /*0* %y C&W)*#2, "NC*, &I* 3 #&

4I#I-N, 5ol. 1, 6176M"+: 9.8

16. ) 86 year7old patient who spends summer in Gaguio City presents with a painless,

ulcerated lesion on the right cheek. #he lesion has %een present for one year."hysical eDamination of the patientHs neck re'eals no lymph node enlargement. #hemost likely diagnosis is:

a. pyogenic granuloma%. melanomac. %asal cell carcinomad. s>uamous cell carcinoma)nswer: C*eference: "*INCI"+ - /*0* %y C&W)*#2, "NC*, &I* 3 #&

4I#I-N, 5ol. 1, 6M"+: 9.6

Su'+e,t- .eneral Sur#ery II

Instructions: Multiple Choice : Choose the 0EST answer.18. ) 89yr.old male underwent operation for a perforated di'erticulitis of the descending

colon. What would %e the most dominant %acteria if the peritoneal uid wasculturedA

a. .coli%. Gacteroidesc. &. pylorid. "roteus)nswer: G*eference: "*INCI"+ - /*0* %y C&W)*#2, "NC*, &I* 3 #&

4I#I-N, 5ol. , pp. 13BM"+: 9.3

13. ) 39yr.old male post7stroke patient with hemiplegia came in at the .*. complainingof crampy a%dominal pain, a%dominal distention, 'omiting and a%sence of %owelmo'ement. "hysical eDamination re'ealed glo%ular a%domen tender all>uadrants. cout ;lm of the a%domen re'ealed an Ein'ertedF / shaped, sausage likeloop on + a%domen. What would %e the likely diagnosisA

a. trangulated &ernia c. igmoid 5ol'ulus%. "erforated 4i'erticulitis d. Completely -%structing Colonic

C).)nswer: C*eference: "*INCI"+ - /*0* %y C&W)*#2, "NC*, &I* 3 #&

4I#I-N, 5ol. , pp. 136M"+: 9.6


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1@. What would %e the %est management for case no.13Aa. -%ser'ation w I5 anti%ioticsc. Garium enema%. Colonoscopyc. Garium enemad. Dploratory +aparotomy)nswer: 4*eference: "*INCI"+ - /*0* %y C&W)*#2, "NC*, &I* 3 #&

4I#I-N, 5ol. , pp. 136M"+: 9.8

1J. #he appropriate surgical procedure for a perforated sigmoid di'erticulitis withgeneraliOed peritonitis is:

a. igmoid resection w primary anastomosis%. 4ou%le %arrel trans'erse colostomy w drainage of perforationc. "roDimal loop colostomy and drainage of perforationd. *esection of perforated segment w end colostomy)nswer: 4*eference: "*INCI"+ - /*0* %y C&W)*#2, "NC*, &I* 3 #&

4I#I-N, 5ol. , pp. 13J71@9M"+: 9.B

9. ) 69yr.old underwent colonoscopy where there is a note of a pedunculated 1.8cmsigmoid polyps and the histopath re'ealed a tu%ular adenoma which contained awell7di$erentiated adenocarcinoma eDtending to %ut not %eyond the muscularismucosa. #he margin of polypectomy is free of tumor. #he %est therapeutic optionwill %e:

a. egmental resection of the colon%. -perati'e colostomy and eDcision of polypectomy sitec. -%ser'ation and repeat colonoscopy after ?78 monthsd. Intraca'itary radiotherapy)nswer: C*eference: "*INCI"+ - /*0* %y C&W)*#2, "NC*, &I* 3 #&

4I#I-N, 5ol. , pp. 1?BBM"+: 9.B

1. ) B6yo 0?"? came in for consult due to sensation of rectal fullness, mucusdischarge and %right red %lood dripping into the toilet. *ectal eDam re'ealed amucosa lined canal mass which is noted to reduce spontaneously. our primaryconsideration is internal hemorrhoids. ou can further classify this as:

a. 1st degree hemorrhoid%. nd degree hemorrhoidc. ?rd degree hemorrhoidd. Bth degree hemorrhoid)nswer: G*eference: "*INCI"+ - /*0* %y C&W)*#2, "NC*, &I* 3 #&

4I#I-N, 5ol. , pp. 1J8M"+: 9.3

. )ssuming this is the 1st consult of the patient in case P1, what would %e theappropriate managementA

a. Medical therapy


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B. )fter a + hemicolectomy and an end to end an anastomosis for adenocarcinoma ofthe descending colon, a 86yo was noted to ha'e a fecaloid discharge in theincision site. he is afe%rile w a%domen soft, N)G and non7tender. While amongthe following factors will increase chance of spontaneous closure of ;stula.

a. distal o%struction%. long ;stulous tractc. loss of %owel continuityd. 1999 +CBhr ;stula output)nswer: G*eference: "*INCI"+ - /*0* %y C&W)*#2, "NC*, &I* 3 #&

4I#I-N, 5ol. , pp. 1J8M"+: 9.6

6. ) 66yold female came in for consult due to intermittent crampy a%dominal pain andchange in %owel ha%its of 1month duration. "hysical eDaminations were essentiallynormal. Garium study with re'ealed an Eapple coreF lesion on the + colon. Whatwould %e the neDt appropriate step of managementA

a. Colonoscopy w Giopsy%. C#7scan of the a%domenc. /+#*)-/N4 of the a%domend. igmoidoscopy w Giopsy)nswer: )*eference: "*INCI"+ - /*0* %y C&W)*#2, "NC*, &I* 3 #&

4I#I-N, 5ol. , pp. 1?B3M"+: 9.3

8. "atient in no.19 underwent operation, histology report showed the tumor to in'adethe muscularis propea w pericolic lymph nodes and negati'e li'er metastasis.What is the stage of the patientA

a. tage 1%. tage c. tage ?d. tage B)nswer: C

*eference: "*INCI"+ - /*0* %y C&W)*#2, "NC*, &I* 3 #& 4I#I-N, 5ol. , pp. 1?6971?61

M"+: 9.6

3. What is the common mode of spread of colorectal cancerAa. direct eDtension%. hemotogenosisc. lymphaticd. implantation)nswer: C*eference: "*INCI"+ - /*0* %y C&W)*#2, "NC*, &I* 3 #&

4I#I-N, 5ol. , pp. 1?6971?61M"+: 9.6

@. Which is the most important prognostic determinant of sur'i'al of patient wcolorectal cancerA

a. tumor siOe%. transmural eDtensionc. 4N) contentd. +ymph node in'ol'ement)nswer: 4*eference: "*INCI"+ - /*0* %y C&W)*#2, "NC*, &I* 3 #&

4I#I-N, 5ol. , pp. 1?6B71?66M"+: 9.6

J. Which of the following colorectal polyps ha'e the highest risk of de'eloping

colorectal cancerAa. tu%ular adenoma%. hyperplastic polypc. tu%ulo 'illous adenomad. 'illous adenoma)nswer: 4*eference: "*INCI"+ - /*0* %y C&W)*#2, "NC*, &I* 3 #&

4I#I-N, 5ol. , pp. 1?BM"+: 9.6


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?9. Which among the following statements is not true regarding amilial )denomatosis"olypsisA

a. it has more than 199 adenomatosis polyps in the large %owel%. includes a spectrum of syndromes i.e 0ardnerHs syndrome and #urcotHs

syndromec. genetic defect is detected in chromosome 6,near g1 locusd. it is an autosomal recessi'e disorder.)nswer: 4*eference: "*INCI"+ - /*0* %y C&W)*#2, "NC*, &I* 3 #&

4I#I-N, 5ol. , pp. 136M"+: 9.6

Su'+e,t- .eneral Sur#ery IIIInstructions: Multiple Choice : Choose the 0EST answer. or >uestions ?1 to ?J: ) B6 year old woman is admitted for a perforated duodenal ulcer8 hours after onset of symptoms. he has a history of chronic peptic ulcer diseasetreated medically with minimal symptoms.?1. #he patient is assessed to %e dehydrated at the emergency room with dry mucous

mem%ranes, tachycardia and a %lood pressure of J989. &er depleted intra'ascular'olume is mainly due to isotonic uid losses due to:

a. 5omiting%. poor intakec. third space loss due to peritonitisd. escape of gastric uid through the perforated duodenum)nswer: C*eference: "rinciples of urgery, chwartO 8th dition, pp. 1B66M"+: 9.8

?. Intra'enous uid of choice for resuscitation would %e:a. 9.? Normal aline%. 9.B6 Normal alinec. 46 Waterd. "lain +* solution

)nswer: 4*eference: "rinciples of urgery, chwartO 8th dition, pp. 1B36M"+: 9.3

??. #he most cost7 e$ecti'e method of monitoring ade>uacy of hydration isthrough the use ofaan:

a. oley catheter%. Nasogastric tu%ec. wan70anO catheterd. Intra7arterial "ressure monitoring.)nswer: )*eference: "rinciples of urgery, chwartO 8th dition, pp. 1B36M"+: 9.6

?B. 0i'en an actual %ody weight of 89 kilograms, an ade>uate hourly urine output would%e:

a. 6 cc hour%. 89 cc hourc. 9 cc hourd. 16 cc hour)nswer: G*eference: "rinciples of urgery, chwartO 8th dition, pp. 3B73@M"+: 9.6

?6. &er pneumoperitoneum would %e %est documented %y which radiologic study:a. Chest Gucky ;lm

%. "lain )%domenc. Chest ") uprightd. &oloa%dominal ultrasound)nswer: C*eference: "rinciples of urgery, chwartO 8th dition, pp. 11?6M"+: 9.8


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?8. )ppropriate antimicro%ial co'erage peri7operati'ely would consist of intra'enous:a. CiprooDacin%. CefaOolinc. MetronidaOoled. Imipenem)nswer: G*eference: "rinciples of urgery, chwartO 8th dition, pp. 11?B711?3M"+: 9.8

?3. If the patient eDhi%its unsta%le 'ital signs in the operating theatre, the procedure ofchoice is:

a. &emigastrectomy%. imple closure with omental patchc. )ntrectomy and truncal 'agotomyd. &ighly selecti'e 5agotomy)nswer: G*eference: "rinciples of urgery, chwartO 8th dition, pp. 11?3711?@M"+: 9.8

?@. It the patient eDhi%its sta%le 'ital signs in the operating theatre and theperitonitis is localiOed, the procedure of choice is:

a. &emigastrectomy%. imple closure with omental patchc. )ntrectomy and truncal 'agotomyd. &ighly selecti'e 5agotomy)nswer: C*eference: "rinciples of urgery, chwartO 8th dition, pp. 11?3711?@M"+: 9.6

?J. #his micro%e has %een implicated in the causation of her disease:a. &. inuenOae%. &. pylori

c. . pneumoniaed. . aureus)nswer: G*eference: "rinciples of urgery, chwartO 8th dition, pp. 11?BM"+: 9.8

or >uestions B9to B: ) 6? year old man is diagnosed to ha'e a %leeding duodenalulcer on urgent endoscopy after he presented at the emergency room with melena. &is'ital signs are sta%le.B9. #he %lood 'essel most likely in'ol'ed in the a%o'e lesion if the :

a. +eft 0astric )rtery%. 0astroduodenal )rteryc. Coronary 5ein

d. *ight 0astroepiploic )rtery.)nswer: G*eference: "rinciples of urgery, chwartO 8th dition, pp. 11?B711?6M"+: 9.B

B1. #he lesion showed e'idence of acti'e %leeding on endoscopy, the mostappropriate management to arrest the %leeding would %e:

a. N0# la'age with ice cold saline%. /rgent +aparotomyc. ndoscopic &emostasisd. )ngiographic &emostasis)nswer: C*eference: "rinciples of urgery, chwartO 8th dition, pp. 11?B711?6

M"+: 9.8

B. #he most appropriate supporti'e medication to administer in addition to P B1 would%e:

a. )ntacids%. Intra'enous & %lockersc. Intra'enous "roton "ump Inhi%itorsd. -ral & %lockers)nswer: C*eference: "rinciples of urgery, chwartO 8th dition, pp. 11?B711?6M"+: 9.8


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or >uestions B? to B6. ) 69 year old man presents with o%structi'e (aundice.B?. )dditionally, he presented with signi;cant weight loss and mild a%dominal

discomfort. /ltrasound eDamination re'ealed 4ilated intrahepatic ducts, gall%ladder and common %ile duct. #he most likely diagnosis is:

a. Llatskin #umor%. &epatocellular Carcinomac. Common 4uct toned. "ancreatic &ead Cancer)nswer: 4*eference: "rinciples of urgery, chwartO 8th dition, pp. 1B171B6M"+: 9.6

BB. )dditionally, he presented with a prior month history of episodic se'ere, rightupper >uadrant pain and fe'er associated with waDing and waning (aundice. #hemost likely diagnosis is:

a. Llatskin #umor%. &epatocellular Carcinomac. Common 4uct toned. "ancreatic &ead Cancer)nswer: C*eference: "rinciples of urgery, chwartO 8th dition, pp. 1?@71?@?M"+: 9.B

B6. )dditionally he presented with signi;cant weight loss and mild a%dominaldiscomfort. /ltrasound eDamination re'ealed 4ilated intrahepatic ducts withno 'isualiOation of the gall%ladder and common %ile duct. #he most likely diagnosisis:

a. Llatskin #umor%. &epatocellular Carcinomac. Common 4uct toned. "ancreatic &ead Cancer)nswer: )

*eference: "rinciples of urgery, chwartO 8th dition, pp. 1?@J71?J9M"+: 9.6

Su'+e,t- Trau"aInstructions: Multiple Choice : Choose the 0EST answer.B8. ) B year old male was admitted for a #ension "neumothoraD of the *ight +ung due

to a sta% wound in the chest. #he inter'ention of choice would %e:a. #u%e #horacostomy%. u%Diphoid Windowc. Cricothyroidotomyd. ndotracheal Intu%ation)nswer: )*eference: "rinciples of urgery, chwartO 8th dition, pp. 83B7836

M"+: 9.8

B3. ) ?9 year old male was admitted for a lail Chest on the *ight &emithoraD cue toin(uries sustained in a car crash. #he inter'ention of choice would %e:

a. #u%e #horacostomy%. u%Diphoid Windowc. Cricothyroidotomyd. ndotracheal II:Q/%ation)nswer: 4*eference: "rinciples of urgery, chwartO 8th dition, pp. 836M"+: 9.6

B@. ) J7year7old male was admitted for +aryngeal -%struction due to in(uries sustained

in a car crash. #he inter'ention of choice would %e:a. #u%e #horacostomy%. u%Diphoid Windowc. Cricothyroidotomyd. ndotracheal Intu%ation)nswer: C*eference: "rinciples of urgery, chwartO 8th dition, pp. 83?M"+: 9.8


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BJ. ) 7year7old male was admitted for an -pen "neumothoraD due to a gun shotwound. #he inter'ention of choice in the acute setting would %e:

a. -cclusi'e 4ressing%. u%Diphoid Windowc. Cricothyroidotomyd. ndotracheal Intu%ation)nswer: )*eference: "rinciples of urgery, chwartO 8th dition, pp. 83B7836M"+: 9.6

69. ) 1J7ear7old Male was admitted for a "ericardial #amponade caused %y an Ice "ickwound to the chest. #he inter'ention of choice would %e:

a. #u%e #horacostomy%. u%Diphoid Windowc. Cricothyroidotomyd. ndotracheal Intu%ation)nswer: G*eference: "rinciples of urgery, chwartO 8th dition, pp. @@37@@@M"+: 9.8

or >uestions 61 and 6: ) 1J year old male is kicked in the left ank. #hree hours laterhe de'elops gross hematuria. &is 'ital signs are sta%le.61. Initial diagnostic test of choice would %e:

a. *etrograde urethrography%. *etrograde cystographyc. )rteriographyd. &igh dose infusion urography)nswer: 4*eference: "rinciples of urgery, chwartO 8th dition, pp. 13887138@M"+: 9.6

6. #he diagnostic tests performed re'ealed eDtra'asation of contrast into the renalparenchyma. #reatment of choice would %e:

a. Dploration and suture of laceration.%. Non surgical treatment consisting of serial monitoring of 'ital signs and

increased uid intake and anti%iotics.c. Dploration and Nephrectomyd. Dploration and ligation of the in'ol'ed *enal artery .)nswer: C*eference: "rinciples of urgery, chwartO 8th dition, pp. 13887138@M"+: 9.8

or >uestions 6?766. .) 1? year old %oy falls from his %icycle and is run o'er %y apassing truck. -n arri'al in the emergency room he is awake, alert and appearsfrightened %ut in no distress. #he chest radiograph suggests an air uid le'el in the leftlower lung ;eld and the nasogastric tu%e seems to coil upward into the left chest.

6?. #he teen aged %oy is su$ering from:a. lail chest%. *upture of the left hemidiaphragmc. "leural $usiond. +ung Contusion)nswer: G*eference: "rinciples of urgery, chwartO 8th dition, pp. 8367838M"+: 9.8

6B. -n the B6th minute of admission, the patient starts to eDhi%it tachycardia andhypotension. *apid uid resuscitation is signi;cantly enhanced %y which of thefollowingA

a. "lacement of long gauge 1@ su%cla'ian catheters.

%. "lacement of short large %ore percutaneous peripheral intra'enous catheters.c. Gilateral saphenous 'ein cut downs.d. Gilateral femoral 'ein cut downs.)nswer: G*eference: "rinciples of urgery, chwartO 8th dition, pp. 138M"+: 9.8

66. #he neDt %est step in management is:


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a. Non urgical treatment in the IC/ setting.%. "lacement of a left chest tu%e.c. Immediate celiotomyd. Immediate thoracotomy.)nswer: C*eference: "rinciples of urgery, chwartO 8th dition, pp. 8367838M"+: 9.8

68. ) 16 year old %oy is admitted for a intra peritoneal in(ury aftRer he is run o'er%y a car. #he most commonly in(ured organ in this case is the:

a. +i'er%. pleenc. Lidneyd. "ancreas)nswer: G*eference: "rinciples of urgery, chwartO 8th dition, pp. 171BM"+: 9.6

or >uestions 63 to 89. ) 6 year old woman arri'es in the emergency room followingan automo%ile accident. he is 'ery dyspneic with a respiratory rate of B@ %reaths perminute. Greath sounds are markedly diminished on the right side and the trachea isde'iated to the left.63. he is most likely su$ering from a:

a. Massi'e "leural $usion%. imple "neumothoraDc. #ension "neumothoraDd. &emothoraD)nswer: C*eference: "rinciples of urgery, chwartO 8th dition, pp. 83B7838M"+: 9.8

6@. In this patient there is :a. Collapse of the ipsilateral lung%. hifting of the mediastinal structures to the ipsilateral side of the in(ury.

c. hifting of the trachea to the ipsilateral side of the in(uryd. Increased Cardiac ouput.)nswer: )*eference: "rinciples of urgery, chwartO 8th dition, pp. 83B7838M"+: 9.8

6J. #he ;rst step in managil1g the patient should %e toa. #ake a chest ! ray%. 4raw arterial %lood for %lood gas studiesc. 4ecompress the *ight "leural spaced. "erform "ericardiocentesis.)nswer: C*eference: "rinciples of urgery, chwartO 8th dition, pp. 83B7838

M"+: 9.8

89. If left untreated, this woman may succum% due to:a. "neumonia%. mpyema #horacisc. &ypoDemia and &ypotensiond. Myocardial Infarction)nswer: C*eference: "rinciples of urgery, chwartO 8th dition, pp. 83B7838M"+: 9.8

Su'+e,t- Ort&ope2i, Sur#eryInstructions: Multiple Choice : Choose the 0EST answer.

81. #hese are present in a typical Colles fracture eDcept:a. 4orsal angulation


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%. mithHs fracture d. "outeauHs fracture)nswer: G*eference: *ockwood and 0reenHs ractures in )dults, 5ol 1, pp. 339M"+: 9.6

8?. )n open fracture with a 'ery large wound


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Su'+e,t- T&ora,i, ar2io 3as,ular Sur#eryInstructions: Multiple Choice : Choose the 0EST answer.

31. In the e'aluation of lymph node status of patients with suspected lung cancer,Cham%erlaineprocedure or parasternal mediastinotomy is used to %iopsy what location of lymphnodesA

a. cer'ical lymph nodes c. aortopulmonary window lymph nodes%. paratracheal nodes d. su%carinal lymph nodes

)nswer: C *eference: "rinciples of urgery, pp. 831

M"+: 9.6

3. ) 13 yo, male, sustained a sta% wound on the right chest. &e was %rought to the *complaining

of dyspnea. &e was gi'en oDygen support and started with I5. -n physicaleDamination, thefollowing are manifestations of #ension "neumothoraD eDcept:

a. dilated neck 'eins c. a%sent or distant %reathsounds

%. dull percussion o'er the in(ured hemithoraD d. hypotension)nswer: G*eference: "rinciples of urgery, pp. 8@BM"+: 9.8

3?. ) ?6 yo, male, with gunshot wound o'er the left chest was %rought to the *. )fterinitialresuscitation, a chest tu%e was inserted draining %loody pleural e$usion. Whatamount of drainage will warrant an emergency thoracotomyA

a. 1.6 liter c. 69 ml per hour for ? consecuti'e hours%. 699 ml d. 399 ml)nswer: )*eference: "rinciples of urgery, pp. 8@BM"+: 9.3

3B. ) young tall male suddenly complains of chest pain and dyspnea while playing%asket%all. ChestD7ray showed pneumothoraD on the left hemithoraD. What is the most likely causeA

a. +ung a%scess%. "#Gc. Gronchiectasisd. *uptured %le% or %ulla)nswer: 4*eference: "rinciples of urgery, pp. 311M"+: 9.8

36. Myasthenia gra'is is associated most commonly with what type of mediastinaltumorA

a. +ymphoma%. #eratomac. Neurogenic tumord. #hymoma)nswer: 4*eference: "rinciples of urgery, pp. 33BM"+: 9.8

38. Chest D7ray is used initially to e'aluate patients with congenital heart disease. Whatcardiac contouris typical of #etralogy of allotA

a. egg S shape%. %oot S shape

c. snowman appearanced. apple S shape

)nswer: G *eference: "rinciples of urgery, pp. 3J3 M"+: 9.6

33. ) 9 yo, female, consulted at the * with complaints of palpitation and dyspnea.he was diagnosed to ha'e "atent 4uctus )rteriosus during her childhood. What isthe hallmark of this congenital diseaseA

a. wide pulse pressure%. distant heart soundsc. continuous machinery murmur


13/16

d. engorged neck 'eins)nswer: C*eference: "rinciples of urgery, pp. @1M"+: 9.6

3@. In coronary artery %ypass grafting, what is the most important 'essel used with a

long term patencyrates eDceeding J9A

a. internal mammary artery%. saphenous 'einc. radial arteryd. ti%ial artery)nswer: )*eference: "rinciples of urgery, pp. @6JM"+: 9.B

3J. ) ?6 yo, male patient complains of eDertional dyspnea and fatigue. -n ".., he has agrade ? apicaldiastolic murmur and %ipedal edema. C0 showed atrial ;%rillation. 4chocardiography showed a se'erely stenotic and calci;ed mitral 'al'e. What is themost likely causeA

a. infection%. traumac. congenitald. rheumatic)nswer: 4*eference: "rinciples of urgery, pp. @38M"+: 9.B

@9. ) 66 yo, male, smoker, dia%etic for 19 years was admitted due to chest painradiating to the leftshoulder. C0 showed # segment ele'ations in leads II, )5, 5 17?. 4iagnosis was/nsta%le

)ngina. Coronary angiogram showed signi;cant three 'essel disease. #he surgicaltreatment ofchoice is:

a. 'al'e replacement%. coronary artery %ypass graftingc. laser therapyd. 5)# < 'ideo assisted thoracic surgery =)nswer: G*eference: "rinciples of urgery, pp. @81M"+: 9.B

Su'+e,t- Urolo#yInstructions: Multiple Choice : Choose the 0EST answer. @1. ) 1? year old %oy was %rought in at the * due to %lood dripping at the urethral

meatus. #he following informations isare necessary to make the proper diagnosis.a. history of acute colicky ank pain%. history of straddle or pel'ic crushing in(uryc. history of instrumentationd. family history of renal disease)nswer: G*eference: mithHs 0eneral /rology, pp. ?B?7?B6M"+: 9.6

@. In(ury to the urethra is %est diagnosed %y means of a. 'oiding cystourethrogram%. retrograde urethrogram

c. cystogramd. retrograde pyelography)nswer: G*eference: mithHs 0eneral /rology, pp. ?BBM"+: 9.B

@?. #he most common cause of ureteral in(ury isarea. iatrogenic%. 'ehicular accidentc. penetrating a%dominal in(uryd. self7induced)nswer: )


14/16

*eference: mithHs 0eneral /rology, pp. ?JM"+: 9.B

@B. #he classic triad of manifestations of renal cell C)a. hematuria, weight loss, and pain%. hematuria, weight loss, and massc. hematuria, palpa%le mass, and ank paind. hematuria, palpa%le mass, and weight loss)nswer: C*eference: mithHs 0eneral /rology, pp. ?@?M"+: 9.B

@6. tage II renal cell C) is managed %ya. chemotherapy%. radiation therapyc. partial nephrectomyd. radical nephrectomy)nswer: 4*eference: mithHs 0eneral /rology, pp. ?@37?@@M"+: 9.6

@8. "atient presenting with painless gross hematuria is most likely su$ering froma. renal cell carcinoma%. ureteral transitional cell C)c. %ladder transitional cell C)d. renal pel'ic transitional cell C))nswer: C*eference: mithHs 0eneral /rology, pp. ?6@

M"+: 9.8

@3. -n digital rectal eDam, a strong 8? year old male seDually acti'e male was found toha'e a 1.9cm nodule on the right lo%e of the prostate gland. &owe'er, he wasasymptomatic, what will %e your neDt plan of managementA

a. transrectal prostate ultrasound%. transa%dominal L/G prostate ultrasoundc. acid phosphatase determinationd. prostate speci;c antigen test)nswer: 4*eference: mithHs 0eneral /rology, pp. B987B93M"+: 9.B

@@. "rostatic C) most commonly originates at what OoneAa. central Oone%. transitional Oonec. peripheral Ooned. periurethral gland)nswer: C*eference: mithHs 0eneral /rology, pp. B987B9@M"+: 9.B

@J. -n transrectal /#2 guided needle %iopsy of prostate gland, result showedadenocarcinoma with a 0leasonHs score of BT6


15/16

c. peripheral Ooned. periurethral gland)nswer: 4*eference: mithHs 0eneral /rology, pp. ?JJ7B91M"+: 9.B

Su'+e,t- Neuro Sur#eryInstructions: Multiple Choice : Choose the 0EST answer. J1. *egarding the relationship of IC" and systemic G", the %est conclusion is:

a. %lood pressure may %e high without increased IC"%. IC" may %e ele'ated without change in G"c. G" may increase as IC" is fallingd. #he relationship is unconstant and measuring G" is not a satisfactory

techni>ue for measuring IC".)nswer: 4*eference: oumanHs Neurological urgery, pp. B8JM"+: 9.B

J. #he presence of reeDes of spinal origin in %rain damaged patients:a. Is prognosis of reco'ery%. Is compati%le with a diagnosis of %rain deathc. Is incompati%le with a diagnosis of %rain deathd. None of the a%o'e)nswer: G*eference: I'an, +.". Neurology


16/16

J3. #here is a >uestion regarding the utility of routine skull D7rays in trauma patients.*ecently, authors ha'e suggested all of the following eDcept:

a. #here is high correlation %etween physical ;ndings and the detection,location and type of fracture demonstrated %y D7ray.

%. #hereHs little correlation %etween physical ;ndings and the detection, locationand type of fracture demonstrated %y D7ray.

c. kull fractures are an insigni;cant manifestation of trauma.d. kull fractures need not %e detected unless there is reasona%le possi%ility of

depressed fragments.)nswer: )*eference: Gill *.. loop, U.W.NUM and *o%erts, haftner, *adiology 11B:

?9, 1J3, chap. @B pp. ?8M"+: 9.6

J@. )ll of the following apply to patient with compound depressed skull fracturesE1EPT:

a. 1B will de'elop late epilepsy%. 19 ha'e an associated hematomac. ? of patients were not unconsciousd. 4ural penetration greatly increased the likelihood of early epilepsy)nswer: 4*eference: &eiskamen, -. et al )cta Chir cand, chap. 1?J pp. 896M"+: 9.6

JJ. *egarding patients with chronic su%dural hematoma.:a. &istory of craniocere%ral trauma in J9 of patients.%. &a'e a precipitous onset

c. &istory of craniocere%ral trauma in 69 of patientsd. J9 of patients with a history of craniocere%ral trauma were unconscious

following the trauma.)nswer: C*eference: igelholm. *. etal. U Neurosurgery, 1J36, chap. B pp. B?M"+: 9.8

199.#he most important factor in infection as a complication of depressed skull fractureis:

a. 4elay in treatment c. ailure in anti%iotic therapy%. *eplacement of %one fragments d. Inade>uate de%ridement)nswer: )*eference: Uennett, G.U. Neurosurgery, 1J3, chap. ?8 pp. ??3

M"+: 9.6

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