Surgery FinalA

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SURGERY

1. A man sustained severe blunt injuries in a car crash twelve hours ago. The activity of this hormone is now expected to be decreased in this patient:

A. insulin

B. cortisol C. epinephrine D. aldosterone

(Classification - Application; Source – Schwartz’s Textbook of Surgery (8th edition): pp. 25-29)

2. A young woman is debilitated by pruritus and burning sensation from her presternal keloid. The recommended initial treatment is:

A. topical application of silicone sheets

B. intralesional corticosteroid injection

C. surgical excision D. low-dose radiation

(Classification - Recall; Source – Schwartz’s Textbook of Surgery (8th_edition): pp. 241-242)

3. A patient is placed on NPO in preparation for an elective major abdominal surgery. The body’s preferred initial fuel source during the fasting state is:

A. hepatic glycogen

B. skeletal muscle glycogen C. muscle protein

D. body fat

(Classification - Recall; Source – Schwartz’s Textbook of Surgery (8th_{edition): p.} 24)

4. A 48-year-old woman has prolonged ileus after surgery for an obstructed duodenal ulcer. The problem is probably due to:

A. hypochloremia B. hypocalcemia C. hypomagnesemia

D. hypokalemia

5. A man with chronic prepyloric ulcer appears weak after repeated bouts of non-bilious vomiting over the past 3 days. Fluid therapy should be started using:

A. Normosol M

B. Lactated Ringer’s solution

C. Normal saline solution

D. Hypertonic saline solution

6. A multiply injured patient has persistently low urine output. The oliguria is most likely due to prerenal failure rather than acute tubular necrosis if the tests reveal:

A. low urine specific gravity

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C. low BUN/creatinine ratio D. low creatinine clearance

7. A woman admitted to the ICU for severe acute pancreatitis begins to manifest paresthesia of the face and extremities, muscle cramps, and a positive Chvostek’s sign. These are probably due to:

A. hypocalcemia

B. hypokalemia C. hypomagnesemia D. hypophosphatemia

(Classification - Application; Source – Schwartz’s Textbook of Surgery (8th edition): p. 50)

8. Increased nutritional support appears to aggravate tachypnea in a septic patient with respiratory failure. Lessening the amount of this substrate may alleviate the problem:

A. carbohydrate

B. fat emulsion

C. essential amino acids D. non-essential amino acids

9. Administration of this amino acid is expected to be beneficial to a patient suffering from damage to intestinal mucosa due to adjuvant chemotherapy for esophageal cancer:

A. arginine B. valine C. leucine

D. glutamine

10. Early supplementation of this vitamin is recommended to promote wound repair in a patient with extensive second-degree flame burns:

A. A

B. C

C. D D. E

11. A diabetic 41-year-old man is admitted for necrotizing fasciitis in the perineum. A high dose of this antibiotic is generally included in the initial antimicrobial therapy because of concern for clostridial pathogens: A. metronidazole

B. vancomycin

C. penicillin G

D. aminoglycoside

12. Transfusion of properly cross matched blood is begun on a man admitted for massive bleeding from erosive gastritis and thirty minutes later, he develops urticaria and fever. This should be administered to the patient:

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B. mannitol C. furosemide

D. sodium bicarbonate

13. A patient under anticoagulation therapy using warfarin, who is set to undergo surgery for acute cholecystitis, has decreased prothrombin concentration. Warfarin can be reversed by parenteral dose of:

A. protamine sulfate

B. vitamin K

C. EACA D. hydroxyurea

14. Arterial blood gas analysis is performed on a patient just admitted with a diagnosis of severe acute pancreatitis. This reveals a pH of 7.30 and low levels of bicarbonate and pCO2. The most urgent part of management is:

A. volume resuscitation

B. intravenous bicarbonate C. calcium infusion

D. mechanical ventilation

15. Seven days after surgery for a perforated appendicitis, the primarily closed incision is noted to be erythematous, slightly swollen and tender. The appropriate treatment is:

A. local heat therapy B. topical antibiotics

C. new systemic antibiotics

D. incision and drainage

16. A man is brought to the E.R. with blood spurting from a hacking wound in the in the distal right thigh. He is alert and has a systolic BP of 100 mmHg. What is the initial management step?

A. apply direct pressure on the wound with sterile gauze

B. apply digital pressure on proximal femoral artery C. apply a thigh tourniquet above the wound

D. open the wound and clamp the bleeders

17. A young man presents to the E.R. with a stab wound in the left chest. Examination reveals subcutaneous emphysema and absent breath sounds on the left chest; the trachea is shifted to the right. What is the probable diagnosis?

A. massive hemothorax

B. tension pneumothorax

C. cardiac tamponade D. flail chest

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18. A 58-year-old woman on NSAID therapy for arthritis has a 6-hour history of epigastric pain that has progressively become severe. Her abdomen is distended, rigid and diffusely tender. This diagnostic test should be done first:

A. upright chest x-ray

B. esophagogastroduodenoscopy C. abdominal ultrasound

D. abdominal CT scan

19. After aggressive fluid therapy, a trauma victim shows a systolic BP of 110 mm Hg, cold extremities, rapid but strong peripheral pulse, and a central venous pressure of 12 cmH2O. The patient has:

A. increased systemic vascular resistance

B. decreased stroke volume index C. decreased cardiac index

D. excessive cardiac preload

20. An elderly man admitted with a diagnosis of sigmoid volvulus has a

markedly distended, non-tender abdomen and hyperactive bowel sounds. The initial treatment is:

A. endoscopic detorsion

B. detorsion via laparotomy

C. decompressing transverse loop colostomy D. Re section of involved segment of colon

21. Pancreatic necrosis is suspected in a 49-year-old woman who has not improved despite 3 days of intensive care for acute pancreatitis. The diagnosis is best established through:

A. C-reactive protein measurement B. abdominal ultrasound

C. contrast-enhanced CT scan

D. CT-guided percutaneous biopsy

22. A chronically constipated 67-year-old woman presents with acute left lower quadrant (LLQ) abdominal pain, LLQ direct and rebound

tenderness, and fever. The appropriate diagnostic examination is: A. transvaginal ultrasound

B. abdominal CT scan

C. proctosigmoidoscopy D. barium enema

23. After an elective hemicolectomy for colon cancer, a 78-year-old man remains hypotensive and tachycardic. He has distended neck veins, cold skin, oliguria, and elevated central venous pressure. He apparently is suffering from this type of shock:

A. hypovolemic

B. cardiogenic

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D. neurogenic

24. For the past 6 weeks, a 67-year-old man has been asymptomatic except for constipation after a course of antibiotic therapy for left lower quadrant abdominal pain. He should undergo:

A. CEA determination B. barium enema

C. colonoscopy

D. abdominal CT scan

25. A 32-year-old-man with a week’s history of fever presently has right lower quadrant abdominal pain and tenderness and bloody diarrhea. The most probable diagnosis is:

A. typhoid ileitis

B. amebic colitis C. ileocecal TB D. intussusception

26. A 75 year old woman in the ICU after undergoing cholecystectomy for acute Cholecystitis is hypotensive and tachycardic. Pulmonary capillary wedge pressure (PCWP) is elevated to 18 mmHg, and cardiac output is 3 L/min. she is shock best described as which of the following?

A. hypovolemic shock B. septic shock

C. cardiogenic shock

D. anaphylactic shock

(Classification -Recall; Source – Schwartz’s Textbook of Surgery (8th_edition):

pp.)

27. A 19 year old man is brought to the emergency department with a stab wound at the base of the neck (zone I) The most important concern for patients with such injuries is which of the following?

A. upper extremity ischemia B. cerebral infarction

C. exsanguinating hemorrhage

D. mediastinitis

(Classification -Recall; Source – Schwartz’s Textbook of Surgery (8th_edition):

pp.)

28. In septic shock, which of the following is true? A. the mortality rate is beteeen 10& and 20%

B. gram-negative organisms are involved exclusively

C. the majority of patients are elderly

D. the most common source of infection is the alimentary tract.

(Classification - Recall; Source – Schwartz’s Textbook of Surgery (8th_edition):

pp.)

29. The injury most often missed by selective nonoperative management of abdominal stabwounds is to which of the following?

A. colon B. spleen

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C. ureter

D. diaphragm

pp. )

30. A 63-year-old male tobacco smoker has a 1.5 cm non-healing ulcer in his lower lip. A nodular lesion is palpable deep to the ulcer. The most likely diagnosis is:

A. squamous cell carcinoma

B. keratoacanthoma

C. malignant fibrous histiocytoma D. verrucous carcinoma

31. A 43-year-old-man presents with nasal obstruction and occasional epistaxis. Imaging studies combined with endoscopic biopsy have led to the diagnosis of nasopharyngeal cancer. The standard treatment is: A. intracavitary radiation

B. external beam radiation

C. combined chemotherapy and radiation

D. surgical resection

32. Biopsy of a slow growing infraauricular mass reveals a benign

pleomorphic adenoma that is confined to the superficial lobe of the parotid gland. The standard treatment is:

A. tumor enucleation

B. tumor excision with 2 mm margin

C. superficial parotidectomy

D. total parotidectomy

33. A 58 year old woman undergoes excision biopsy of a tumor in the left posterior triangle of her neck. Histology suggests that this is a metastatic cancer. What is the most likely site of the primary tumor?

A. ovary

B. adrenal gland C. kidney

D. piriform fossa

pp.)

34. A 59 year old woman has discomfort in the posterior part of her tongue. A biopsy confirms that the lesion is a carcinoma. What is true in carcinoma of the posterior third of the tongue?

A. lymphoid tissue is absent

B. lymph gland spread is often encountered

C. there is an excellent prognosis D. the tissue is well differentiated

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35. A 60-year-old man has a 3 cm nodular lesion with central ulceration in his left cheek. Section biopsy proves this to be basal cell carcinoma. This is best managed with:

A. external beam radiation B. topical 5-fluouracil C. electrodessication

D. excision with 2-4 mm margin

36. This is the most common aggressive primary malignant bone tumor in adolescent and occurs in methaphyseal area of long bones with high incidence of pulmonary metastases:

A. Chrodrosarcoma

B. Osteosarcoma

C. Fibrosarcoma D. Adamantinoma

(Classification -Recall; Source – Schwartz’s Textbook of Surgery (8th_edition): pp.)

37. A 65 year-old farmer presents with a 1.5-cm ulcerated lesion on the middle third of his lower lip. The lesion has been present for 4 months and is not painful. No lymph nodes are palpable in the patient’s neck. The most likely diagnosis is:

A. Squamous cell carcinoma

B. Basal cell carcinoma C. Herpes simplex D. Keratoacanthoma

(Classification – Application; Source - PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH_{EDITION, Vol. 1, 521-522)}

38. A 65 year-old patient who spends summer in Baguio City presents with a painless, ulcerated lesion on the right cheek. The lesion has been present for one year. Physical examination of the patient’s neck reveals no lymph node enlargement. The most likely diagnosis is:

A. pyogenic granuloma B. melanoma

C. basal cell carcinoma

D. squamous cell carcinoma

(Classification – Application; Source - PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH_{EDITION, Vol. 1, p.522)}

39. A 60-year-old woman has a 10-day history of cough and fever. Imaging studies show multiple fluid loculations in the right chest cavity with an estimated volume of 500 ml. Thoracentesis draws purulent material. The best treatment strategy now is:

A. pigtail catheter drainage of the empyema

B. video assisted thoracoscopic drainage with deloculation

C. insertion of multiple thoracostomy tubes D. early thoracotomy and drainage

40. A-50-year-old woman presents with a 3 cm solitary pulmonary nodule in the left upper lobe. She has a history of total thyroidectomy for papillary cancer at the age of 38 years. The main consideration is:

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B. hamartoma

C. primary lung cancer

D. metastatic thyroid cancer

41. A 45-year-old woman presents with weakness towards the afternoon, shortness of breath, and ptosis. CT scan reveals an anterior mediastinal mass. The most likely diagnosis is:

A. intrathoracic goiter

B. non-Hodgkin’s lymphoma

C. non-seminomatous germ cell tumor

D. thymoma

42. A man with malignant pleural effusion in association with an inoperable lung cancer may benefit from the instillation of sclerosing agent into the pleural cavity, once the lungs are almost fully expanded. An accepted sclerosant is:

A. talc

B. gentamicin C. penicillin G D. Vitamin C

43. A 20-year-old woman consults for a 2-cm mass in her left breast. The mass is movable, non-tender and has a rubbery consistency and smooth borders. The probable diagnosis is:

A. fibroadenoma

B. fibrocystic disease C. carcinoma

D. cystosarcoma phyllodes

44. A 16-year-old girl is bothered by cyclical premenstrual pain in her breasts. She has 0.5-1.0 cm nodularities in the upper outer quadrant of both

breasts. What management advice should be given to her?

A. Observation

B. breast ultrasound C. mammography D. aspiration biopsy

45. An asymptomatic 40-year-old woman with no palpable breast mass undergoes mammography. This reveals clustered microcalcifications in the lower outer quadrant of her left breast. The probable diagnosis is: A. florid hyperplasia

B. sclerosing adenosis

C. atypical ductal hyperplasia

D. ductal carcinoma in situ

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46. A 45-year-old woman with “lumpy” breasts undergoes mammography. Mammographic findings are suggestive of high-grade ductal carcinoma in situ confined to the upper outer quadrant of her right breast. How should she be managed?

A. lumpectomy alone

B. lumpectomy and radiotherapy

C. mastectomy

D. mastectomy and axillary node sampling

47. A 45-year-old woman has a recent onset bloody nipple discharge from her right breast. No palpable breast mass is noted. What diagnostic test is indicated?

A. breast ultrasound

B. mammography

C. ductography

D. cytology of discharge

48. A premenopausal woman undergoes modified radical mastectomy for a 3-cm breast cancer. No axillary node and distant metastases are detected. Test for this biomarker is currently recommended to facilitate the selection of adjuvant chemotherapy:

A. c-fos B. c-myc C. p53

D.AHER2/neu

49. A 63-year-old man with chronic atrial fibrillation has sudden onset of pain, weakness, and paresthesia in his left leg, which appears cool, cyanotic, and without femoral and distal pulses. The right leg has normal pulses. The most likely diagnosis is:

A. arterial embolism

B. aortoiliac thrombosis C. Buerger’s disease D. Raynaud’s disease

50. Coronary angiogram reveals a triple-vessel disease in a diabetic 55-year-old man presenting with unstable angina. The recommended treatment is: A. catheter-directed thrombolysis

B. balloon angioplasty

C. coronary artery bypass grafting

D. Transmyocardial revascularization

(Class;ification - Application; Source – Schwartz’s Textbook of Surgery (8th edition): pp. 652-653)

51. A 41-year-old male chronic smoker has a 2-year history of bilateral foot claudication. He now has ulceration of the tip of the right 3rd_{toe and left} 2nd_{and 4}th_{toes. Popliteal pulses are palpable but the posterior tibial and} dorsalis pedis pulses are bilaterally absent. The most important step in management is:

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A. cessation of smoking

B. long-term anticoagulant therapy C. multiple toe amputations

D. angiography followed by bypass surgery

52. A premature infant with progressive dyspnea without cyanosis since birth has machinery murmur in the pulmonic area. A diagnosis of patent ductus arteriosus (PDA) is made. The indicated treatment is:

A. administration of indomethacin

B. infusion of prostaglandin C. administration of indomethacin

D. immediate surgical correction of PDA

53. A 3-year-old girl presents with cyanotic spells that have increased in

severity and frequency since birth. X-ray shows a boot-shaped heart; ECG reveals right ventricular hypertrophy. The most probable diagnosis is: A. truncus arteriosus

B. tetralogy of Fallot

C. transposition of the great arteries D. Ebstein’s anomaly

54. A 54-year-old man presents with hematemesis after a bout of vomiting and retching. Endoscopy shows linear mucosal tears at the

gastroesophageal junction. The diagnosis is:

A. Mallory-Weiss syndrome

B. Boerhaave’s syndrome C. Menetrier’s disease D. Dieulafoy’s lesion

55. After truncal vagotomy and antrectomy with gastrojejunostomy for an obstructed duodenal ulcer, the patient complains of diaphoresis,

weakness, and abdominal discomfort followed by diarrhea several minutes after meals. The symptoms are suggestive of:

A. post-vagotomy diarrhea B. bile reflux gastritis C. afferent loop syndrome

D. dumping syndrome

56. A woman undergoes total gastrectomy for a huge proximal gastric carcinoma. To protect her from developing anemia, she must be given a regular parenteral dose of:

A. folic acid B. ferrous sulfate

C. vitamin B12

D. transferrin

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57. A few weeks after recovering from severe pancreatitis, a 34-year-old man has developed a pancreatic pseudocyst with mature wall that is pressing on his stomach. Aspiration fails to relieve the pressure symptoms. The indicated treatment is:

A. administration of somatostatin

B. internal drainage (cystogastrostomy)

C. external drainage D. excision of pseudocyst

58. ERCP reveals a periampullary cancer in a 64-year-old man admitted for jaundice. No metastasis is detected; no co-morbid conditions are

identified. How should he b managed?

A. radical excision of the head of pancreas and duodenum

B. local excision and adjuvant chemotherapy C. external beam radiation

D. stenting and chemotherapy

59. A 60 year old man with no previous operation has a 5-day history of inability to pass flatus or feces, cramping abdominal pain, and progressive abdominal distention. The principal diagnostic consideration is:

A. midgut volvulus B. sigmoid volvulus

C. colorectal cancer

D. ileocecal tuberculosis

(Classification - Application; Source – Schwartz’s Textbook of Surgery (8th edition): pp.)

1. A 65 year old male who underwent a colon resection of carcinoma 2 years prior to consult is found to have 3 solid nodules approximately 2 cms each in the right and left lobes of the liver. There is no extrahepatic disease detected. The preferred treatment is:

A. systemic chemotherapy B. radiofrequency ablation

C. microwave coagulation therapy

D. surgical resection of metastatic nodules

(Classification – Application; Source – Schwartz’s Textbook of Surgery (8th edition): pp.)

2. A 35 year old female with a prolonged intake of contraceptive pills

develops right upper quadrant pains. Ultrasound shows an isodense 5 cm mass in the right lobe of the liver. Sulfur-colloid scan done showed a cold lesion. This patient should undergo.

A. conservative treatment

B. resection

C. enucleation

D. liver transplantation

(Classification - Application; Source – Schwartz’s Textbook of Surgery (8th edition): pp. 119-120)

60. A man who has an obstructed rectosigmoid cancer in association with a competent ileocecal valve is liable to develop perforation of:

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B. splenic flexure C. hepatic flexure

D. cecum

61. The presence of tenesmus, decrease in caliber of stools and occasional bloody-mucoid diarrrrhea in a 67-year-old man is suggestive of:

A. rectal carcinoma

B. amebic colitis C. intussusception D. ileocecal tuberculosis

62. Diagnostic tests show an ileocolic intussusception in a 38-year-old man, who has no signs of strangulation. What is recommended for this patient? A. expectant treatment

B. endoscopic decompression C. hydrostatic reduction

D. exploratory laparotomy

63. A 63-year-old man is presently asymptomatic after medical treatment for LLQ pain and tenderness. He should undergo:

A. CEA determination B. Colonoscopy C. barium enema D. abdominal CT scan

64. A 56-year-old woman taking NSAID for chronic arthritis experienced severe epigastric pain 6 hours ago. Her abdomen is now diffusely tender with board-like rigidity. The appropriate initial diagnostic test is:

A. chest upright x-ray

B. plain abdomen supine x-ray C. abdominal ultrasound D. abdominal CT scan

65. Despite 3 months of medical treatment for posterior midline anal fissure, the man’s fissure-related anal pain during and after defecation has become excruciating. The appropriate treatment is:

A. excision of fissure B. botulinum toxin injection C. anal divulsion

D. internal sphincterotomy

66. During surgery for a large right indirect inguinal hernia, the cecum is noted to form part of the wall of the hernia sac. The patient has this type of hernia:

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B. Richter’s C. interstitial D. Spigelian

67. A previously asymptomatic 45-year-old obese woman consults for a non-tender swelling below her right inguinal ligament just lateral to the pubic tubercle. A warranted diagnostic procedure for this patient is:

A. fine needle aspiration

B. ultrasound

C. MRI

D. herniography

68. A 54 year old male taking anticoagulant for the fast 4 weeks developed 3 day history of abdominal pain. On physical examination there was a palpable mass at the supraumbilical area with direct tenderness. Fothergill sign way positive. What is your impression?

A. desmoid tumor

B. rectus sheath Hematoma

C. omental torsion D. omental infarction

69. A 12 year old female complain of 1 day history of epigastric pain which shifted to the right lower quadrant associated with anorexia and vomiting. Physical examination revealed direct and rebound tenderness on the right lower quadrant. With the preoperative diagnosis of acute appendicitis, she was operated on. However, intraoperatively there was blood tinged

peritoneal fluid and appendix was noted to be normal. The most probable cause of the patient condition is:

A. mesenteric cyst

B. omental torsion

C. ruptured rectus sheath Hematoma D. mesenteric adenitis

70. A 45-year-old is discovered to have a solitary 2-cm firm nodule in his right thyroid lobe. No associated symptoms are noted; family history is negative for thyroid cancer. Diagnostic work-up should start with:

A. thyroid function tests B. thyroid ultrasound C. thyroid scan

D. fine needle aspiration biopsy

71. A 59-year-old man presents with 4-cm firm mass in the left lobe of the thyroid associated with a firm occipital mass that is 6 cm in its widest diameter, which he has neglected for the past 9 months. Family history is negative for thyroid malignancy. He probably has this type of thyroid cancer:

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B. follicular

C. medullary D. anaplastic

72. A 49-year-old woman complains of central obesity with moonlike facies and hirsutism. Her ACTH is markedly elevated, which is suppressed by large dose of dexamethasone. The probable pathology is:

A. adrenal adenoma B. adrenal carcinoma C. pheochromocytoma

D. pituitary adenoma

73. A 42-year-old man presents with headache, palpitations, and diaphoresis. His urinary metanephrines are elevated. Imaging studies reveal a 3-cm mass in his right adrenal gland. The treatment of choice is:

A. adrenalectomy

B. radiotherapy

C. tumor embolization D. chemoradiation

74. A 67-year-old man is bleeding excessively following a transurethral prostatectomy. The bleeding is assessed to be due to local plasminogen activation leading to increased fibrinolysis on the raw wound surface. Administration of this drug may be beneficial:

A. vitamin K B. heparin C. warfarin

D. EACA

75. A 60-year-old man presents with slight urinary urgency, frequency, and a decrease in the force of micturition. Digital rectal examination detects no mass in the prostate. The indicated diagnostic test is:

A. prostatic acid phosphatase

B. prostate-specific antigen

C. pelvic ultrasound

D. needle biopsy of prostate

76. A 35-year-old man presents with right flank pain and microscopic

hematuria. Intravenous pyelography reveals a 4 mm radiolucent stone in the distal right ureter. The recommended treatment is:

A. alkalinization of the urine

B. extracorporeal shock wave lithotripsy C. stone extraction via ureteroscope D. open ureterolithotomy

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77. A 55-year-old man is admitted for gross hematuria associated with left flank pain and anemia. CT scan detects a solid, enhancing mass in the left kidney. The likely diagnosis is:

A. renal cell carcinoma

B. renal tuberculosis C. renal sarcoma D. renal oncocytoma

78. A 23-year-old woman sustained blunt head trauma to her right

frontoparietal area in a car crash, which caused he to be unconscious for several minutes. Upon arrival at the E.R., she is alert and has no

neurologic deficit. X-ray shows a linear non-depressed right frontoparietal fracture. An hour after admission, vomiting followed by progressive

neurologic deterioration are noted. A. diffuse axonal injury

B. cerebral contusion

C. acute epidural hematoma

D. acute subdural hematoma

79. A 54-year-old woman with no previous neurologic disorder has new onset seizures without associated gross neurologic deficit. She was treated for breast cancer 10 years ago. If brain metastasis is the main consideration, this is best confirmed by means of:

A. electroencephalography

B. CT scan of the brain with intravenous contrast

C. MRI of the brain with intravenous contrast

D. Doppler ultrasound

80. A 55-year-old man with a history of lung cancer presents with frequent severe headache, occasional vomiting, and weakness of the right upper extremity. What is the recommended treatment in addition to

corticosteroids?

A. intrathecal chemotherapy B. whole-brain radiotherapy

C. stereotactic radiosurgery (gamma knife) D. resection of lesion causing arm weakness

81. A young man just admitted for blunt injuries from a car accident is

stuporous. CT scan shows cerebral contusion. What should be avoided as it can cause secondary brain injury to this patient through its deleterious effect on intracranial pressure?

A. elevation of the head B. respiratory acidosis

C. hypovolemia even of mild degree D. sedation of agitated patient

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82. As a basketball player falls hard on his extended right arm, he feels immediate severe pain with subsequent inability to move his right arm. Swelling and tenderness about the shoulder with loss of deltoid contour are noted. The likely diagnosis is:

A. deltoid muscle rupture

B. shoulder dislocation

C. fracture of proximal humerus D. brachial plexus injury

83. A 10-week-old baby with cleft lip and palate has undergone a successful cleft lip repair. It is recommended that cleft pate repair be done before the baby reaches this age:

A. 6 months

B. 12 months

C. 2 years D. 4 years

84. A bedridden 61-year-old woman has a significant neurologic recovery from a previous stroke. She has an infected deep pressure ulcer in her sacrum. Once the infection has been controlled by debridement and supportive treatment, the pressure ulcer can be managed with:

A. skin graft

B. rotation skin flap

C. gluteus maximus flap

D. microsurgery free flap

(Classification - Recall; Source – Schwartz’s Textbook of Surgery (8th_edition): pp. 1825-1826))

85. A small thick antecubital scar from a 2nd_{degree flame burn is constricting} movement. To relieve the constriction, the appropriate procedure to refashion the scar is:

A. Z-plasty

B. advancement flap

C. scar excision and skin graft D. deltopectoral flap

86. Resection of a sarcoma results in a significant lateral chest wall defect. To minimize pulmonary dysfunction, chest wall reconstruction may utilize:

A. rectus abdominis muscle flap B. omental flap

C. tensor fascia lata graft

D. Marlex mesh

87. A 4-week-old baby boy presents with frequent non-bilious vomiting. During feeding, peristaltic waves are seen in the upper abdomen in association with a palpable mass in the right upper quadrant. The diagnosis is:

A. hypertrophic pyloric stenosis

B. duodenal atresia C. jejunal atresia

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D. volvulus neonatorum

88. A newborn infant has excessive drooling followed by coughing immediately after feeding. The main diagnostic consideration is esophageal atresia. This can be readily confirmed by:

A. inability to pass orogastric tube into the stomach

B. water-soluble contrast study (esophagram) C. transesophageal ultrasound

D. plain abdominal radiograph

(Classification - Application; Source – Schwartz’s Textbook of Surgery (8th edition): pp. 1481-1482))

89. A diagnosis of intussusception is made in an infant with paroxysms of crampy abdominal pain and vomiting. The infant has no peritoneal signs and remains hemodynamically stable. The initial treatment of choice is:

A. nasogastric decompression B. endoscopic reduction

C. pneumatic reduction

D. hydrostatic reduction with barium

90. A 3-day old infant who has not passed meconium presents with abdominal distention and bilious vomiting. The most likely diagnosis is:

A. duodenal atresia B. malrotation C. midgut volvulus

D. Hirschprung’s disease

91. A 3-week-old infant is noted to have jaundice in association with acholic stools shortly after birth. A radionuclide scan demonstrates presence of radioisotope in the intestine. This finding rules out the diagnosis of: A. neonatal hepatitis

B. biliary atresia

C. inspissated bile syndrome D. choledochal cyst

92. A 67 y/o man has an intraabdominal abscess caused by perforated sigmoid diverticulitis. The most common isolated microorganism is__? A. Escherichia coli

B. Bacteroides

C. K. pneumoniae

D. Staphylococcus epidremides Schwartz’s: surgical infection pp 121

93. One of the most common complication of central venous access is_____. A. hemorrhage

B. pneumothorax

C. wound infection D. air embolus

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94. Early postoperative small bowel obstruction is a rare finding and occurs less than 1 % of the time. When it does, the most common cause is_____.

A. internal hernias

B. post-operative adhesions

C. infections or abscess D. technical errors

Schwartz’s: surgical complications p. 347

95. Which of the ff statements is true concerning corrosive injury to the esophagus?

A. Acid ingestion is not injurious to the stomach because of its non-acidic pH.

B. Ingested caustic agents rapidly pass through the esophagus and stomach into the small intestines.

C. Alkaline injury is more destructive than acid injury. D. Acid injury is more destructive than alkaline injury. Schwartz’s: Esophagus p. 909

96. A 27 year old female was brought to the ER with history of suicidal ingestion of household muriatic acid. This patient is best managed by--- A. Give half strength vinegar, lemon juice or orange juice

B. Start with milk, egg white or antacids

C. Give emetics to induce vomiting

D. Sodium bicarbonate is one of the treatment option. Schwartz’s: Esophagus p. 910

97. Which of the following statements is true regarding the arterial blood supply of the stomach?

A. The right gastric artery, a branch of the superior mesenteric artery supplies the gastric antrum

B. Because of the rich intramural collateral vessels, gastric viability may be preserved after ligation of at least two of the four named gastric arteries

C. The largest artery supplying the stomach is the right gastric artery. D. The left gastroepiploic artery is a branch of the celiac trunk.

Schwartz’s: Stomach pp. 935-937

98. At a cellular level, the major stimulants of acid secretion by the gastric parietal cell are the following, except:

A. histamine

B. prostaglandinE2 C. acetylcholine

D. gastrin

Schwartz’s: Stomach p. 943

99. A patient with gastric adenocarcinoma underwent subtotal gastrectomy. Histopath revealed tumor penetrating the serosa, regional lymph nodes are not involved and distant metastatic lesions are not detected. What is the correct tumor stage on TNM staging? B

A. Stage I

B. Stage II

C. Stage III-A D. Stage III-B

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100. A 5-month old baby boy was seen at the ER with complaints of non-bilous vomiting that became increasingly projectile over several days to weeks and cannot tolerate liquid intake. Abdominal examination revealed

palpation of typical “olives” in the right upper quadrant with visible gastric waves. What is the correct diagnosis?

A. Meconium ileus C. Hypertrophic pyloric stenosis

Hirschprung’s disease D. Intussusception Schwartz’s: Pediatric Surgery p.1486

101. Which of the following is the most common malignant liver tumor in childhood?

A. Hemangioma C. Hepatocellular carcinoma

B. Hepatoblastoma D. Mesenchymal hamartoma

Schwartz’s: Pediatric Surgery p.1512

102. What is the appropriate treatment for an incidental 3 cm liver hemangioma found on abdominal CT scan of 37 year old woman?

A. No treatment C. Selective embolization of left hepatic artery B. Cryoablation D. Left hepatic lobectomy

Schwartz’s: pp. 1162 – 1163

103. A 35 y/o male presents with 1 year history of early satiety and right upper abdominal discomfort. CT scan shows a 6 x 8 cm cystic lesion in the right lobe of the liver. Ultrasound of cyst show no internal echoes. The

appropriate management is:

A. cryoablation of cyst C. unroofing of the cyst

B. right hepatic lobectomy D. percutaneous aspiration of cyst Schwartz’s: p. 1159

104. An imaginary line that divides the liver into right and left lobe that runs from the inferior vena cava to the tip of the gallbladder fossa: C A. Catlie line

B. Calot’s line

C. Cantlie’s line

D. Charcot’s line Schwartz’s: p. 1140

105. The diagnostic tool important in evaluating liver injury in a stable blunt trauma patient is:

A. Ultrasound C. CT scan

B. Abdominal x-ray D. Peritoneal lavage Schwartz’s: p. 142

106. The local factor affecting wound healing:

A. Age C. Low oxygen tension

B. Smoking D. Trauma

Schwartz’s: p. 235

107. The characteristic of Keloid scars:

A. Arise above the skin level and stay in the confine of the original wound B. Develop within 4 weeks after trauma

C. Extend beyond the border of original wound and rarely regress spontaneously

D. Occur in areas of flexion and extension Schwartz’s: p. 240

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108. A 55 y/o male diagnosed to have chronic pancreatitis, developed

epigastric mass measuring about 6 cm accompanied by pain and fullness. The diagnosis is:

A. Gastric carcinoma C. Pseudocyt of the pancreas

B. Pancreatic carcinoma D. Acute pancreatitis Schwartz’s: p. 1256

109. Type of benign solitary pancreatic neoplasm consisting of symptomatic fasting hypoglycemia and profound syncopal episodez:

A. Insulinoma C. Gastrinoma

B. Glucagoma D. VIPoma

110. The most common indication for splenectomy:

A. Staging of Hodgkin’s disease C. Trauma to spleen

B. Hereditary spherocytosis D. Thalassemia Schwartz’s: p. 1301

111. The best time to repair of cleft lip is:

A. 10 months C. 6 months

B. 10 weeks D. 16 weeks

Schwartz’s: p 1797

112. A 36 y/o female complain of an acute pain at the lateral aspect of her left breast. A tender firm cord is found on the same site on physical

examination. It was diagnosed as a Mondors disease. This lesion is best managed with:

A. Radiotherapy

B. Anti-inflammatory medication, warm compress and rest of ipsilateral extremity

C. Immediate excision of the lesion is needed D. Total mastectomy

113. Breast lesion that can be treated with close observation with or without tamoxifen:

early invasive breast carcinoma

lobular carcinoma in situ

ductal carcinoma in situ

inflammatory carcinoma of the breast Schwartz’s: p.481

114. The best screening imaging technique for breast cancer is: D A. Magnetic resonance imaging

B. Ultrasonography C. Ductography

D. Mammography

Schwartz’s: pp. 476-477

115. A 46 y/o female who underwent a total thyroidectomy for stage II papillary carcinoma developed 3 weeks later with Chvostek’s and Trouseau’s sign. This could be due to:

A. Recurrence of papillary thyroid carcinoma B. Injury to cervical sympathetic trunk

C. Hypoparathyroidism

D. Injury to recurrent laryngeal nerve Schwartz’s: pp. 1429-1448

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116. This is considered as a single most important test in the evaluation of patients with thyroid masses:

A. Thyroid ultrasound B. CT and MRI

C. Fine needle aspiration cytology

D. Thyroid scanning Schwartz’s: p. 1415

117. Lymph node in the posterior triangle of the neck is within what level: A. Level II

B. Level IV

C. Level V

D. Level VI Schwartz’s: p. 534

118. This form of shock has a low blood pressure, low urine output but has an elevated central venous pressure:

A.Vasodilatory shock

B. Obstructive shock

C. Neurogenic shock D. Traumatic shock Schwartz’s: p. 95-102

119. 55 y/o male who has been in the ward for the past 4 days and is receiving IV fluid of D5W is complaining on his 5th_{hospital day of headache,}

nausea, vomiting, anorexia, body malaie and watery diarrhea. Give the most probable electrolyte imbalance the patient might have:

A. Hypernatremia B. Hyperkalemia

C. Hyponatremia

D. Hypokalemia Schwartz’s: p. 48

120. The most important part of the treatment of severe metabolic acidosis among trauma patient is:

A .Correct abnormality with exogenous bicarbonate B. High oxygenation

E. Restore perfusion with volume resuscitation

F. D. Give colloid solution Schwartz’s: p. 50-51

121. The most common primary bone malignancy:

A. Osteosarcoma

B. Ewing’s sarcoma C. Ostoblastoma D. Chondrosarcoma Schwartz’s: p. 1665

122. The most potent stimulant for aldosterone release is:

A. ACTH

B. rennin

C. angiotensin I D. angiotensin II Schwartz’s: p. 9

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angiotensin II

endothelins

epinephrine serotonin Schwartz’s: p. 23

124. In trauma patients significant reduction in infectious complications were noted in patients given early enteral nutrition as compared to those given who are unfed or given parenteral nutrition except for what type of trauma patients?

A. renal trauma

B. long bone fractures

C. head trauma

D. liver trauma Schwartz’s: p. 31

125. Branched chain amino acids are used in parenteral nutrition for what specific type of patients?

A. renal failure patients B. diabetic patients

C. pulmonary failure patients

D. hepatic failure patients

Schwartz’s: p.33

126. In what type of parenteral feeding is fat increased to 50% of total calories? A. Heart failure formulas

B. pulmonary failure formulas

C. renal failure formulas D. calorie-dense formulas Schwartz’s: p. 33

127. The appendeceal flora remains constant throughout life with the exception of what bacteria, which appears only in adults?

A. Porphyromonas gingivalis

B. Pseudomonas aeruginosa C. Peptostreptococci

D. Streptococcus anginosus Swhartz’s: p. 1121

128. The most significant factor associated with both fetal and maternal deaths in pregnant patients with acute appendicitis is

A. formation of a phlegmon

B. appendeceal perforation

C. appendeceal tip near the uterus D. retrocecal appendix

129. Which of the ff. is true of the superior mesenteric artery syndrome? C A. It is often seen in obese individuals.

B. It usually affects patients over 70 yrs. old.

C. Compression is over the third portion of the duodenum.

D. It is a surgical emergency. Swhartz’s: p. 1027

130. Which of the following factors present in a entero-cutaneous fistula increases the possibility of closure of the tract?

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B. high output fistula C. malnutrition

D. sepsis Swhartz’s: p. 1037

131. What is the single most important factor in predicting burn related morbidity and mortality?

A. size of burn

B. type of burn C. etiology of burn

D. associated medical condition Schwartz 7th_{ed., p. 228-232 / Ans. A}

132. What type of shock is caused by the interference of the balance of vasolidator and vasoconstrictor influences to arterioles and venules? A. cardiogenic shock

B. hypovolemic shock C. septic shock

D. neurogenic shock

Shwartz 7th_{ed., p. 113-115 / Ans. D}

133. A 50 y/o female consulted to you and complaints of fatigue, polydypsia, polyuria, nocturia, joint pains and constipation. Her laboratory exams shows normal FBS, elevated serum calcium, and elevated intact PTH. What would be the most likely diagnosis?

A. NIDDM

B. Metastatic breast ca C. Hyperthyroidism

D. Hyperparathyroidism

Shwartz 7th_{ed., p. 1434-1439 / Ans. D}

134. A 35 y/o male presents with a long standing severe hypertension with associated muscle weaknes, headache, polyuria and polydypsia. Blood exams revealed an elevated aldesterone level and elevated serum potassium. What is the most likely diagnosis?

A. cushing’s syndrome B. pheochromocytoma

C. conn’s syndrome

D. waterhouse-friderichsen syndrome Shwartz 7th_{ed., p. 1453-1458 / Ans. C}

135. Which of the following is the most commonly inured organ in blunt abdominal injury?

A. small intestine B. large intestine C. pancreas

D. spleen

Schwartz 7th_{ed., p. 187 / Ans. D}

136. In the initial management of an acutely and seriously injured patient, the first and most important emergency measure to be taken care of is: A. splinting of fracture

B. control of bleeding

C. restoration of blood volume

D. ensuring an adequate airway

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137. Diagnostic peritoneal lavage (DPL) remains the most sensitive test

available for determining the presence of intraabdominal injury. The result of DPL is considered grossly positive if;

A. 1 ml of blood is aspirated B. 5 ml of blood is aspirated C. 8 ml of blood is aspiarated

D. 15 ml of blood is aspirated

138. Which of the following constitute an immediate threat to life because of inadequate ventilation

A. flail chest

B. hemothorax

C. stabbed wound involving the diaphragm D. pulmonary hematoma

Schwartz 7th_{ed., p.156-157 / Ans. A}

139. While undergoing exploratory laparotomy for blunt abdominal injury, to the patients BPwas noted to be 70 palpatory while bleeding was noted coming from the splenic hilum. Appropriate management for the injured spleen should be;

A. splenectomy

B. splenorrhapy

C. debridement and repair

D. packing, immediate closure of abdominal lesion and volume replacement

Schwartz 7th_{ed., p. 193 / Ans. A}

140. During the initial resuscitation of a hypovolemic patient secondary to a vehicular accident external bleeding is best controlled by;

A. suturing

B. direct finger pressure

C. application of tourniquet D. blood transfusion

Schwartz 7thed., p. 157 / Ans. B

141. In penetrating neck injuries zone II is referred to an area between; A. clavicle and cricoid cartilage

B. cricoid cartilage and angle of mandible

C. above the angle of the mandible D. below the clavicle

Schwartz 7th_{ed., p. 165 / Ans. B}

142. In assessing the extent of hepatic injury following blunt injury to the abdomen, bleeding from the liver is best controlled by;

A. manual cmpression of liver parenchyma B. using figure of 8 - suture

C. pringle maneuver

D. liver resection

Schwartz 7th_{ed., p. 188-189 / Ans. C}

143. Stable patients at risk of urethral injury, manifestating as presence of blood at the matus, necessitates an immediate;

A. urethral catheterization

B. urethrography

C. cystoscopy D. KUB-IVP

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Schwartz 7th_{ed., p. 161-162 / Ans. B}

144. Type of healing in which the wound is allowed to heal by granulation tissues formation and contraction:

A. primary intention

B. secondary intention

C. tertiary intention D. quarternary intention Schwartz 8th_{ed., p. 234 / Ans. B}

145. Partial thickness wound such as seen in superficial second degree burns heal by which of the following process:

A. wound contraction

B. epithelization

C. granulation tissue formation D. maturation and remodeling Schwartz 8th_{ed., p. 228 / Ans. B}

146. Equilibrium between collagen synthesis and collagen degradation occurred during the stage of;

A. hemostasis and inflammation B. proliferative stage

C. matrix synthesis

D. remodeling

147. Delayed primary wound closure is indicated in which of the following type of wound;

A. diabetic ulcer B. decubitus ulcer

C. contaminated traumatic wound

D. surgical incision following simple appendectomy Schwartz 7th_{ed., p. 264 / Ans. C}

148. Cytokines that are produced by one cell and affect an adjacent cell such as transforming growth factor beta (TGF-B) are called;

A. endocrine factors

B. paracrine factors

C. autocrine factors D. intacrine factors Schwartz 7th_{ed., p. 266 / Ans. B}

149. The major component of the extracellular matrix that provide strength, support and structure of all soft tissues, tendons, ligaments and bones is;

A. collagen

B. elastin C. fibronectin D. hyaluronic acid

Schwartz 7th_{ed., p. 270-271 / Ans. A}

150. The genetic disorder arising from mutations in the genes for type I

collagen causing increase propensity for the bones to break under minimal stress is;

A. ehlers-danlos syndrome

B. osteogenesis imperfecta

C. marfan’s syndrome D. epidermolysis bullosa

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Schwartz 7th_{ed., p. 278} _{/ Ans. B}

151. Lesion of the gastrointestinal tract that result in comlete regeneration and recovery;

A. peptic ulcer disease B. crohns disease C. radiation colitis

D. gastric erosions

Schwartz 7th_{ed., p. 280-281 / Ans. D}

152. Skin lesions that extend beyond the boundaries of the original wound, do not regress with time and recur after excision;

A. hypertrophic scars

B. keloids

C. diabetic ulcers D. decubitus ulcers

Schwartz 7th_{ed., p. 281-282 / Ans. B} 153. Kehr’s sign is a classic example of;

A. unreferred visceral pain B. referred visceral pain C. unreferred parietal pain

D. referred parietal pain

Scwratz 7th_{ed., p. 1034-1035 / Ans. D}

154. The bleeding in Mallory-Weiss syndrome is secondary to; A. penetration of ulcer affecting the gastroduodenal artery

B. linear tears of the gastroesophageal junction

C. gastric erosions D. hematobilia

Schwartz 7th_{ed., p. 1062-1063 / Ans. B}

155. The most common cause of intestinal obstruction for all age group combined is;

A. strangulated hernia B. volvulus

C. adhesive bands

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Schwartz 7th_{ed., p. 1054 / ans. C}

156. The most obvious route of fuid and electrolyte loss in patients with intestinal obstruction from leocecal TB is through;

the edematous bowel wall the intestinal lumen

vomiting

the peritoneal cavity Schwartz 7th_{ed., p . 1056 / Ans. C}

157. Occlusion of the blood supply to a segment of bowel in addition to obstruction of the lumen is referred to as;

A. complete intestinal obstruction B. closed-loop obstruction

C. strangulated obstruction D. ileus

Schwartz 7th_{ed., p. 1057 / Ans. C}

158. Which of the following diagnostic modalities consistently localizes the site of bleeding in cases of lower GI bleeding;

A. colonoscopy B. CT scan C. Angiography D. Barium enema Schwartz 7th_{ed., p. 1066 / Ans. C}

159. The most common cause of massive lower GI bleeding is; A. colonic malignancy

B. diverticulosis C. adenamatous polyps D. ulcerative colitis Schwartz 7th_{ed., p. 1065 / Ans. B}

160. A 50 y/o male with history of alcoholism was admitted because of history of progressive jaundice, associated with tea-colored urine, achlic stools, weight loss and mild

epigastric pain. The simplest and most non-invasive method in the diagnosis of this patient is;

A. percutaneous transhepatic cholangiography (PTC) B. ERCP

C. Ultrasonography D. HIDA scan

Schwartz 7th_{ed., p. 1071 / Ans. C}

161. Relative to the ileum, the jejunum has; A. more fatly mesentery

B. less prominent plicae circularis C. longer vasa recta

D. lesser in diameter Schwatz 8th_{ed., p . 1018 / Ans. C}

162. The most common malignant neoplasm of the small bowel is;

adenocarcnoma

carcinoids sarcomas lymphomas

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A. spingelian hernia B. femoral hernia C. littre’s hernia D. richter’s hernia Schwartz th ed., p. 1249 / ans. C

164. Rovsings’ sign is elicited by;

A. pain the right lower quadrant when palpatory pressure is exerted in the left lower quadrant

B. pain in the right lower quadrant when palpatory pressure is exerted directly over the pont of tenderness

C. flexion-extension of the right lower extremity D. asking the patient to cough

165. In children with history of URTI 3 days prior to development of RLQ pain, the differential diagnosis most often confused with appendicitis is;

A. meckel’s diverticulitis B. perforated peptic ulcer C. acute gastroenteritis

D. acute mesenteric adenitis Schwartz 7th_{ed., p. 1387 / Ans. D}

166. The recommended treatment for patients with adenocarcinoma of the appendix is; A. appendectomy

B. right hemicolectomy C. total colectomy

D. subtotal colectomy Schwartz 7ht ed., p. 1392 / Ans. B

167. The precipitating factor in secondary omental torsion is; A. bifid omentum

B. accessory omentum C. obesity

D. foci of intraabdominal inflammation Schwartz 7th_{ed., p. 1556 / Ans. D}

168. The most common solid tumor of the omentum is; A. lymphoma

B. liposarcoma C. leiomyosacoma

D. metastatic carcinoma Schwartz 7h ed., p. 1558 / Ans. D

169. The most common anaerobic bacteria that is isolated in intraabdominal infection is; A. clostridium specios

B. peptococcus specios C. bacteroides specios D. fusobacterium specios Schwartz 7th_{ed., p. 1524-1525 / Ans. C}

170. A 45 year old female came in because of right upper quadrant pain, colicky aggravated by fatty food intake 4 hours ptc. Physical exam showed a palpable mass at the right

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subcostal margin non-movable tender, midinspiratory arrest was illicited while the palpating hand was on the right subcostal area . the most likely condition is/are

A. acute appendicitis B. acute cholecystitis C. perforated peptic ulcer D. acute ascending cholangitis Schwartz / Ans. B

171. The laboratory examination of a 45 year old female came in with the following results ; sgpt was elevated, direct bilirubin increased, alkaline phosphatase increased, protime prolonged . utz showed a hyperechoic mass at he neck of the gallbladder with posterior shadowing. The most likely diagnosis is

A. acute appendicitis

B. acute infectious hepatitis

C. acute calculous cholecystitis D. ascending cholangitis

Schwartz / Ans. C

172. The treatment of choice for the above condition ( no.4) is A. appendectomy

B. medical management C. cholecystectomy D. ercp

Schwartz / Ans. C

173. A patient s/p cholecystectomy and cbde with t-tube choledochostomy showed a distal cbd stone on t-tube cholangiography , management would be

A. daily irrigation with nss B. ercp

C. choledococopy and basket extraction of the stone

D. repeart explore lap and cbde Schwartz / Ans. C

174. A 25 year old male came in with chronic draining lesion at the perianal area of 2 years duration. Physical exam showed a draining lesion about 4 cm from the anal verge at the 3:00 position. The internal opening is probably

A. anterior midline

B. posterior midline

C. radially directly opposite D. variable

Schwartz / Ans. B

175. 30 year old female came in because of painfull perianal mass 2 days ptc, physical exam showed a tender mass at the right lateral position w/c precludes rectal exam with a bulging tender mass adjacent to it. The most likely condition is

A. thrombosed external hemorrhoids B. prolapsed internal hemorrhoid

C. perianal abscess

D. rectal polyp Schwartz / Ans. C

176. A 50 year old male came in because of loss of weight about 30% of his previous body weight. Associated with on and off colicky abdominal pain. He also noticed that his stools have diminish in caliber just like a goat stool,the single most important examination would be

A. fecalysis B. ba enema

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C. colonoscopy w/ biopsy

D. ct scan Schwartz / Ans. C

177. A 25 year old female came in with a palpable breast mass noted 2 weeks ptc, the mass is about 2.5 cm well delineated border, movable, non-tender at the right upper outer quadrant, no familial history of ca.the most likely diagnosis would be

A. fibroadenoma

B. fibrocystic disease C. breast ca

D. galactocoele Schwartz / Ans. A

178. Seromas are fluid collections coming from the: A. Plasma

B. Interstitium

C. Lymph

D. Capillary oozing

179. A patient was discharged 3 days after appendectomy (suppurative). After 5 days, he came back at the OPD for follow up complaining of tenderness at the operative site. The incision site was nonerythematous. What is your diagnosis?

A. Hyperesthesia

B. Surgical site infection

C. Foreign body reaction to suture D. Urinary tract infection

180. A patient was operated on for acute cholecystitis. After 24h postop, the patient developed fever. What is the most likely cause of his fever?

A. Cathether sepsis

B. Drug-related conditions C. Aspiration pneumonia

D. Atelectasis

181. The basic problem in poor wound healing regardless of the underlying factor is: A. Poor local hemostasis

B. Anemia

C. Low 02 tension

D. Impaired inflammatory response

182. Ileus following abdominal surgery is expected to last for at least how many days? A. 3

B. 4

C. 5

D. 6

183. For every degree rise in temperature, the insensible water loss in cm3_{per day is} approximately:

A. 100 B. 150 C. 200

D. 250

184. Which ion if altered determines the shift of fluid from one compartment to another?

A. Sodium

B. Potasium C. Chloride

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D. Bicarbonate

185. Which of the following cytokines may help control keloids and hypertrophic scars? A. Pdgf

B. Egf C. TNF

D. TGB-B

186. Which part of the GIT provides strength in the anastomosis A. Serosa

B. Muscularis

C. Submucosa

D. Mucosa

187. Which amino acid provide energy source in the GIT A. Alanine

B. Valine

C. Glutamine

D. Tryptophan

188. A 54yo male patient with 3rd_{degree burn approximately 40%TBSAdeveloped abdominal} pain on the 4th_{hospital day. What is the least likely cause of the abdominal pain?}

A. Acalculous cholecystitis B. Acute pancreatitis

C. Superior mesenteric artery syndrome

D. Renal colic

189. Convulsions if present during the resucitative phase of burn injury may be due to A. Hypoxemia

B. Hyponatremia

C. Infection D. Hypokalemia

190. The offending organism in surgical site infection is;

A. Staph aureus

B. Pseudomonas C. E. Coli

D. Bacteroides

191. Earliest manifestations of catheter related complication following parenteral nutrition. A. Tachycardia

B. Fever

C. Glucose intolerance D. Changes in sensorium

192. Which of the following statements is not a sound principle in the fluid and electrolyte therapy post operatively?

A. Thorough evaluation of the pre and intra-op fluid status

B. Urine volume is replaced on a mililiter to mililiter basis

C. It is not necessary to give potassium with in the first 24 hour D. Insensible water loss is considered in the fluid therapy 193. The average potassium (in meq/l) content of the bile per day is

A. 5

B. 10

C. 15 D. 18

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194. Which cranial nerve is involved in the act of swallowing

A. Xi

B. X C. Xi D. Viii

195. Primary reason for staging esophageal cancer is

A. Determine its resectability

B. Prognostication

C. To assess whether the procedure is for cure or palliation D. Whether pre-op chemotherapy is indicated

196. Most common benign esophageal tumor is

A. Leiomyomas

B. Fibromas C. Myomas D. Fibromyomas

197. Blood supply of lesser curvature is A. Left gastric

B. Right gastric

C. Gastroepiploic D. Splenic

198. Manifestation of acute gastric dilatation A. Pallor

B. Rapid respiration C. Changes in sensorium

D. Hypotension

199. A patient underwent upper gastrointestinal endoscopy for gastric outlet obstruction. The endoscopist noted a lesion at the antrum and took biopsy. It turned out to be gastric cancer. What type of gastric cancer has favorable prognosis?

A. Superficial spreading

B. Polypoid

C. Ulcerative D. Linitis plastica

200. A patient diagnosed to have perforated peptic ulcer disease had his symptoms 8 hours prior to admission. He was prepared for surgery. Which of the following best describes the required operation?

A. Repair of perforation and selective vagotomy B. Repair of perforation and truncal vagotomy C. Suture of perforation

D. Omental patch

201. After truncal vagotomy for peptic ulcer disease, the patient may develop the following except:

A. Gastric stasis

B. Megaloblastic anemia

C. Diarrhea

D. Gallstone formation

202. Most common neoplasm of the stomach

A. Adenocarcinoma