SURGERY 4
TH
LE SAMPLEX (2010-2011)
CHOOSE THE BEST ANSWER:
1. A 30 years old male was found to have a posterior mediastinal mass. He must probably has:
a. thymoma b. teratodermoid c. neurogenic tumor
d. lymphoma Ans C
MPL 1.0
2. The most common anterior mediastinal tumor is: a. thymoma
b. teratodermoid c. neurogenic tumor
d. lymphoma Ans A MPL 0.5 3. A 45 year old male was diagnosed to have a thymoma.
Work up should include tests for: a. myasthenia gravis
b. brain metastasis c. red cell aphasia
d. immune deficiency Ans A MPL 0.5 4. During sternotomy for thymoma, the tunor was noted
to have infiltrated the adjacent pleura, pericardium, and the phrenic nerve. The best option is:
a. wide excision to include the nerve b. radiation
c. platinum based chemotherapy
d. supportive treatment Ans A MPL 0.3 5. The so called “ dumbel tumor” is seen in
a. neurogenic tumor b. thymoma
c. Lymphoma
d. thoracic aneurysm Ans A MPL 0.5 6. Endoscopic esophageal punch biopsy should be
avoided in esophageal a. leiomyoma
b. squamos cell CA c. adenocarcinoma
d. diverticulum Ans. B MPL 0.5
7. Cardiovascular collapse in tension pneumothorax is due to:
a. shunt mechanis b. mediastinal shift
c. decreased fraction of inspired oxygen d. hypoventilation Ans B MPL 0.5
8. Pulmonary collapsed and dyspenea is tension pneumothorax is due to
a. shunt mechanism b. mediastinal shift
c. decreased fraction of ispired oxygen d. hypoventilation Ans A MPL 0.5
9. The initial procedure of choice in pleural effusion is: a. thoracentesis
b. pleural biopsy c. thoracoscopy
d. thoracostomy Ans A MPL 0.5
10. To diagnose chylothorax, the pleural fluid is examined for
a. amplase b. triglycerides c. sugar
d. creatinine Ans B MPL 1.0
11. The treatment of TB effusion is: a. anti TB drugs
b. tube thoracostomy c. thoracentesis
d. decortication Ans A MPL 0.5
12. In phythorax, the tube thoracostomy should be placed at
a. 2nd interspace, midclavicular line b. 3rd interspace, anterior axillary line c. 6th interspace, posterior axillary line
d. 8th interspace, mid axillary line Ans C MPL 0.5 13. In chronic TB effusion attention should be given to:
a. nutrition
b. electrolyte imbalance c. adequate antibiotics
d. thoracostomy tube position Ans MPL 0.3 14. The defect in pectus excavatum is in the
a. sternum b. bony rib c. spine
d. chondral cartilage MPL 1.0
15. The most common primary malignancy of the pleura is: a. mesothelioma
b. adenocarcinoma c. lymphoma
d. liposarcoma Ans A MPL 0.5
16. A 9 month old female was brought to the emergency room because of a non reducible inguinal mass of 2 hours duration. The parents noted this mass previously since she was 4 months old but this would spontaneously reduce. Upon your examination the mass is already reduced. Your recommendation should be:
a. Admit the patient and observe
b. Admit the patient and have emergency herniorrhaphy
c. Admit and have elective herniorrhaphy* .33 d. Send the patient home and advised surgery when
she is older
17. A 2 week old was brought to you clinic because of scrotal swelling noticed since the 3rd day of life this does not change in size.. On physical exam the scrotum is enlarge and is positive for transillumination. He is playful and has no episodes of vomiting. You would recommend:
a. Schedule for elective surgery b. Schedule for immediate surgery c. Observe only * .3
d. Request for an Abdominal X-ray
18. A 16 year old female notice a bulge in her Right inguinal area and she went to the emergency room. The resident calls you up and tells you that the bulge seems to be outside the Hasselbach’s triangle. This is most likey a:
a. Direct hernia
b. Indirect Inguinal hernia* .5 c. Femoral hernia
d. Sliding Hernia
19. A newborn with intestines that are matted and leathery, located to the right of the umbilical cord is seen. This patient will definitely need:
a. Ventilatory Support b. Nutritional Support*.3
c. Prosthetic material for closure d. Genetic Examination
20. A 2-week old male neonate has been vomiting for 3 hours with abdominal distention on physical examination. There is a bulge on the right scrotal area. One should:
a. Do x-ray of the abdomen b. Request for a Ultrasound c. Attempt reduction
d. Schedule for emergency surgery* .5
21. The saccular theory of the Patent Processus Vaginalis is the etiologic factor in:
a. Direct Inguinal Hernia b. Indirect Inguinal Hernia* .5 c. Femoral Hernia
d. Umbilical Hernia
22. The appropriate management of an umbilical hernia in a one year old female is:
a. immediate surgery if the defect is 1.0 cm
b. immediate surgery because of its propensity to strangulate
c. conservative management since this may resolve*.3 d. wait until the child is 6 years old then operate 23. The cause of death in patients with Gastroschisis
is usually due to: a. Prematurity
b. The associated anomalies c. Sepsis*.3
d. Hypovolemia
24. 2 year old boy is referred to you because of an inguinal enlargement with abdominal distention and vomiting since 8 hours ago. You would:
a. Do abdominal x-ray b. Try to reduce at bedside c. Check for metabolic status* .3 d. Schedule for immediate surgery
25. A 1 hour old with Omphalocoele the liver can be seen together with the intestines the most likely scenario would be to: .3
a. operate and close the fascial defect b. let the sac granulation
c. apply elastic bandage on the abdominal area d. check for other anomalies
26. Differentiate the abdominal wall defect based on the listed characteristics below.
For numbers 27 to 31; Write : A. if related to Omphalocele B. If related to Gastroschisis C. Related to both
D. Not related to either Ompahocele or Gastroschisis 27. Undescended Testis C .2
28. Intestinal atresia more commonB .2 29. Repair may be staged C .2
30. Respiratory distress may be seen D . 2
31. More common congenital anomalies A . 2
32. An eight week old infant is referred for deepening jaundice which was first noted at the age of 3 weeks. If this is biliary atresia:
a. a liver biopsy will show paucity of bile ducts
b. it is likely to be correctible in type
c. bile duct imaging will show only small amounts of radionuclide passing into the upper GI tract
d. surgery should be performed as soon as possible* (Ana) .5
33. A 2 year old boy is referred to you because of jaundice,abdominal pain and palpable mass. The next step should be :
a. Liver function test b. Abdominal X-ray
c. Ultrasonography*(Recall) .5
d. ERCP (Endoscopic Retrograde Pancreatography) 34. In a 5 week old infant with acholic stool and
deepening jaundice of 4 weeks. The best test to diagnose Biliary atresia reliably would be:
a. Liver Function Test b. Ultrasonography c. Nuclear Scan (DISIDA) d. none of the above*(Rec) .5
35. A 10 year old boy had mild abdominal pain on the Right Upper Quadrant of the abdomen. An ultrasound was done and showed a solitary gallbladder stone. The next step would be:
a. to advise surgical intervention immediately b. to advise no surgery until he is older c. to check for hematologic pathology*
d. to undergo a CT scan for better imaging (Ana) .5 36. A 4 year old boy has jaundice, abdominal pain and
a abdominal mass. If this is a Choledochal cyst this is likely a Type.
a. 1 (saccular or fusiform)* (Rec) .5 b. 2 (diverticulum)
c. 3 (choledococele)
d. 4 (intra and extra hepatic dilatations)
37. A 3 week old neonate is at the Intensive care unit and is on Total Parenteral nutrition for 2 weeks. He has developed deepening jaundice since a week ago. Your assumption would be the jaundice:
a. may still be physiologic
b. is brought about by the Total Parenteral Nutrition*(App) ,33
c. may be due to Biliary Atresia d. may be due to Biliary Hypoplasia
38. A 7 month old has progressive abdominal distention, jaundice, clay colored stool and failure to thrive. On physical examination there is fluid wave on the abdomen. This is likely a:
a. neglected biliary atresia b. neglected choledochal cyst
c. perforated common bile duct*(Rec) .5 d. gallstone perforation
39. Differentiate the Tumors based on the characteristics below:
For numbers 41 to 45; Write: A. Wilms’s Tumor B. Nueroblastoma C. Both
D. Neither
40. Failure to thrive B .2
41. Abdominal tumor frequently does not cross the midline A .2
42. High chance for cure A .2
43. May regress spontaneously B .2 44. Chemotherapy may
be started without definite diagnosis D .2
45. A 1 year old has a abdominal tumor located at the RUQ, has no jaundice nor splenomegaly. Alpha Feto Protein is elevated. The most likely problem is a : a. Hemangioendothelioma
b. Mesenchymal Hamrtoma c. Hepatoblastoma * .5 d. Hepatocellular Carcinoma
46. A boy has a testicular mass on the R. The size is 2 times the left testicle. It is hard and does not transilluminate. The most likely tumor is:
a. Embryonal b. Seminoma c. Teratoma d. Yolk Sac *.5
47. You were called at the nursery by the nurse because a female neonate has a mass at the sacral area measuring about 6 cm. in widest diameter. The next appropriate action would be to do:
a. Digital rectal exam* .5 b. Laboratory examination (AFP) c. Ultrasonography
d. CT scan
48. Pansinusitis, situs inversus universalis and bronchiectasis is a feature of which of the ff:
a. Letterer-Siwe’s Disease b. Adrenal incidentaloma c. Eisenmenber’s syndrome d. Budd-Chiari syndrome e. Kartagener’s syndrome * 1.0
49. Massive hemoptysis is expectoration of blood amounting to what estimated volume in a 24-hour period. a. 100 ml b. 300 ml c. 400 ml d. 600 ml * 1.0 e. 1000 ml
50. Bleeding from bronchiectasis originates from which source
a. pulmonary artery b. pulmonary vein c. bronchial artery * 0.5 d. innominate artery
51. Commonly located in the central region of the lung
a. squamous cell carcinoma * 1.0 b. large cell carcinoma
c. Broncho-alveolar cell carcinoma d. adenocarcinoma
52. Indolent behaviour is often demonstrated by which tumors
a. squamous cell carcinoma b. large cell carcinoma c. small cell carcinoma d. adenocarcinoma
e. typical carcinoid tumors * 1.0
53. Management of massive hemoptysis includes the following modalities except
a. pulmonary artery embolization * 1.0
b. pulmonary resection c. bronchial ligation d. bronchial blockade
e. bronchial artery embolization
54. Demonstration of bleeding source in hemoptysis is best accomplished by which diagnostic modality
a. rbc tagged scan b. CT scan
c. MRI
d. bronchoscopy * 1.0 e. pulmonary angiogram
55. Common causes of hemoptysis are the following conditions except:
a. Tuberculoma * 0.20 b. Aspergilloma
c. Pulmonary arteriovenous malformation d. Bronchiectasis
e. Bronchial adenomas
56. A 60-year old male, chronic smoker, consulted at the OPD for pain in the right shoulder extending to the ulnar distribution in the arm, forearm down to the ring and small fingers noted progressively a month prior to consult. Chest X-ray showed an apical density in the first and second ribs. The most likely diagnosis:
a. Lung abscess with osteomyelitis b. apical tuberculosis
c. Pancoast tumor * 0.25
d. Pott’s disease with paravertebral abscess e. Actinomycosis
57. Confirmation of diagnosis is best performed by which procedure
a. bronchoscopy
b. percutaneous needle biopsy with CT guidance * 0.5 c. rib biopsy
d. mediastinoscopy e. mediastinotomy
58. A 35-year old male, taxi driver, was seen at the ER for sudden bouts of massive hemoptysis 2 hours prior to consult. Past history reveals previous treatment for PTB in the last 2 years. Chest x-ray showed tubular and saccular luscencies in both upper lobes. The most likely diagnosis is: a. tuberculosis b. aspergillosis c. lung abscesses d. pulmonary infarction e. bronchiectasis * 1.0
59. A 20-year old male, student, was being treated at the infirmary for non-resolving pneumonia in the right lower lobe for almost a year. He started to complain of blood streaked sputum a month prior. Sputum AFB and PPD were consistently negative. Most probable diagnosis:
a. Foreign body aspiration b. Bronchioalveolar carcinoma c. Bronchial adenoma
d. Pulmonary atypical tuberculosis e. A and C is appropriate * 0.33
60. Most common cell type of lung cancer a. squamous cell
b. adenocarcinoma * 1.0 c. large cell carcinoma d. small cell carcinoma
e. adenosquamous carcinoma
61. A 60-year old jeepney driver, chronic smoker, consulted at the OPD for an incidental finding of a 2cm nodule in the right upper lobe. CT scan guided needle biopsy showed squamous cell carcinoma with right hilar and paratracheal nodal enlargement. The T status of the disease a. T1a b. T1b * 1.0 c. T2a d. T2b e. T3
62. The following invasive diagnostic procedures will obtain tissue samples from the nodes visualized in the CT scan in the clinical situation previously mentioned except: a. right mediastinotomy b. mediastinoscopy c. video-assisted thoracoscopy d. fiberoptic bronchoscopy * 0.20 e. open thoracotomy
63. Positive nodal samples from the ipsilateral hilar and mediastinal nodes from squamous cell carcinoma in the procedure/s performed will mean what stage of the disease: a. IB b. IIA c. IIB d. IIIA * 1.0 e. IIIB
64. A 45-year old male carpenter was referred to the Surgical department for a 5 cm mass lesion in the superior segment of the right lower lobe noted on chest x-ray (PA) and right lateral view. If a CT guided percutaneous needle lung biopsy were to be performed, the best approach for needle puncture: a. anterior
b. lateral
c. posterior * 0.25
d. none of the above is appropriate
65. Which of the following tumor with pulmonary solitary metastasis has the poorest outcome:
a. soft tissue sarcoma b. bone tumor
c. melanoma * 0.20 d. colon carcinoma e. kidney tumor
66. Paradoxical embolization is possible in the following conditions except:
a. Pulmonary Arteriovenous Malformation (PAVM) b. Ventricularseptal defect (VSD)
c. Deep vein thrombosis (DVT)* 0.25 d. Atrial septal defect (ASD)
e. Tetralogy of Fallot
67. A 30-year old male was referred to the Surgical service for massive hemoptysis. Chest Xray in the PA and lateral view showed a 4 cm mass density in the right upper lobe with a crescent-shaped radioluscency at its upper border. The most likely diagnosis:
a. Tuberculosis with cavitation b. Lung abscess
c. Aspergilloma * 0.20 d. Saccular bronchiectasis
e. Squamous cell carcinoma, cavitary
68. Procedure of choice in the clinical situation: a. Bronchoscopy and bronchial blockade * 0.5 b. CT angiography
c. Magnetic Resonance Imaging Angiography d. Sputum AFB smear and culture
e. Pulmonary arteriogram and embolization
69. Most appropriate treatment for the clinical situation
a. anti-Koch’s therapy for 6 months b. CT guided percutaneous aspiration c. prolonged antibiotic therapy d. pulmonary resection * 1.0 e. amphotericin-b therapy
70. Treatment of choice for small cell carcinoma limited to the chest.
a. surgery
b. chemotherapy * 9 (1.0) c. radiation therapy d. immunotherapy
71. A 70-year old retired employee with a 10cm mass in the right upper lobe diagnosed to be squamous cell carcinoma from bronchial biopsy suddenly developed marked facial edema, engorgement of neck veins and visible venous collaterals in the anterior chest wall and headaches. The clinical condition is compatible with: a. brain metastasis
b. superior venacaval obstruction * 0.5 c. pulmonary embolization
d. paraneoplastic syndrome
72. Appropriate treatment modality for the clinical situation
a. Radiotherapy * 0.5
b. Surgery (Vena Caval Bypass) c. Chemotherapy
d. Steroid administration e. Immunotherapy
73. The T category in the TNM classification of the tumor:
a. T1 b. T2 c. T3 d. T4 * 1.0
74. John Doe was brought to the ER 2 hours after a grocery robbery incident with a 3 cm stab wound at the right 4th intercostals space along the anterior axillary line. Chest xray showed a completely opacified right hemithorax with absent breath sounds and dullness to percussion. Admitting BP- 70/40 mmHg, PR- 100/min, RR-36. Situation is compatible with which of the following
a. severe pulmonary contusion b. tension pneumothorax c. hemothorax * 1.0 d. cardiac tamponade
75. Immediate intervention is appropriate for the clinical situation described above (#75)
a. Blood transfusion b. Thoracentesis
c. Closed Tube Thoracostomy * 0.33 d. Pericardiocentesis
e. Mechanical ventilation
76. A 36-year old female post kidney transplant 6 months ago was brough to the ER for remittent fever and cough productive of blood streaked sputum. Chest xray showed marked pneumonic infiltration of the left lower lobe with cavitation and probable abscess formation. Follow-up chest cxray 3 days later showed progression inspite of antibiotic coverage. CT guided aspiration suspicious for fungal organisms. Most probable diagnosis:
a. Tuberculosis in the immunocompromised host b. Mucormycosis * 0.33
c. Atypical pneumonia d. Aspergilloma e. Histoplasmosis
77. Treatment of choice in the clinical situation
a. Urgent surgery- Thoracotomy and lower lobecotmy * 1.0
b. Amphotericin B c. Itraconazole
d. Quadruple anti Koch’s therapy e. Antibiotics for anaerobic bacteria
78. The congenital heart defect that results to decreased pulmonary blood flow is:
a. PDA b. TOF c. VSD
d. Subvalvar aortic stenosis B. mpl - .5 79. Closure of PDA can be achieved by:
a. ligation or transection of duct
b. administration of indomethacin in premature infants c. transcutaneous catheter closure
d. all of the above D. mpl - .5
80. A 21 year old male construction worker, on routine physical exam, was found to have congenital heart disease. he was asymptomatic. the most likely defect is:
a. VSD b. PDA c. ASD
d. Coarctation of the aorta C. mpl - .5
81. A 14 year old boy was noted to have increased blood pressure on both upper extremities and weak femoral pulses. The most likely diagnosis is:
a. Coarctation of the aorta b. aortic stenosis
c. PDA
d. transposition of great arteries( TGA) A. mpl - .5
82. The boot-shaped heart is usually seen on chest x-ray of children with:
a. VSD b. TGA
c. TOF ( tetralogy of fallot)
d. truncus arteriosus C. mpl - .5 83. The ff. is recommended for repair of VSD's
a. direct suture closure b. use of pericardium c. use of prosthetic graft
d. all of the above. C. mpl - .5
84. The conenital heart disease that generally does not require a cardiopulmonary bypass(CPB) for correction is:
a. TGA b. VSD
c. TOF
d. PDA D. mpl – 1
85. Myocardial protection during open heart surgery can be achieved by:
a. use of systemic hypothermia b. use of systemic anticoagulation c. use of cardioplegia
d. a and c only D. mpl - .5 86. Indications for CABG :
a. chronic angina b. post infarction angina c. unstable angina
d. all of the above D. mpl - 1 87. The best conduit for CABG is:
a. great saphenous vein b. internal mammary art c. gastroepiploic artery
d. radial artery B. mpl . 5
88. Conditions that require mechanical relief of mitral stenosis:
a. worsening pulmonary hypertension b. systemic embolization
c. MVA < 1 cm
d. all of the above D. mpl - 1
89. The treatment of choice for pts with mitral stenosis with pliable leaflets but with thrombus at left atrial appendage is:
a. MVR ( replacement)
b. balloon mitral valvuloplasty
c. OMC ( open mitral commisurotomy ) d. A and C C. mpl - .5
90. Mitral stenosis associated with significant mitral regurgitation is best treated with:
a. balloon mitral valvuloplasty b. open mitral valvuloplasty c. mitral valve replacement
d. B and C C. mpl - .5 a. are highly thrombogenic
b. has excellent durability c. are suited for young pts
d. does not require chronic anticoagulation D. mpl - .5 92. The best diagnostic tool for descending thoracic
dissection and aneurysm is: a. chest x-ray
b. CT with contrast c. MRI
d. transesophageal echocardiogram (TEE) B. mpl - . 5
93. The best diagnostic tool to determine aortic root dissection is:
a. chest x-ray b. CT with contrast c. MRI
d. TEE C. mpl - .5
94. Indications for surgery in acute distal aortic dissection:
a. increasing periaortic fluid b. acute renal failure
c. uncontrolled hypertension
d. all of the above D. mpl - .5
95. The most common cause of thoracic aortic aneurysm:
a. infection b. trauma
c. non specific medial degeneration
d. genetic disorders C. mpl - .5
96. The critical diameter for rupture of descending thoracic aortic aneurysm is:
a. 5 cm b. 6 cm c. 7 cm
d. 8 cm C mpl - .5
97. The most common site of rupture of descending aortic dissection is:
a. proximal 3rd of descending aorta b. middle 3rd
c. distal half
d. distal 3rd A. mpl - .5 98. Embryology of the GIT
a. the 3rd part of the duodenum is to the left of the SMV
b. the DJ loop rotates 270o counterclockwise around the ligament of Treitz
c. the DJ loop rotates 270o counterclockwise around the SMV **
d. the ileocecal segment rotates clockwise around the SMV
99. In Malrotation, the usual location of the cecum is a. RLQ
b. R Upper abdomen ** .33 c. Away from the duodenum d. LLQ
100. Approach in the management of Pediatric tumors a. Best handled by a Pediatric Surgeon
b. Chemotherapy is almost always indicated
c. Staging is important academically but its clinical importance is not yet established
d. Multidisciplinary approach ** .33
