Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
QUESTIONS
Select one answer.
1. The three findings in achalasia are:
a)
b)
c)
d)
Increased LES resting pressure', decreased LES relaxation, increased esophageal peristaltic activity.
Decreased LES resting pressure, increased LES relaxation, decreased esophageal peristaltic activity.
Increased LES resting pressure, decreased LES relaxation, decreased esophageal peristaltic activity.
Decreased LES resting pressure, increased LES relaxation, increased esophageal peristaltic activity.
1 hour daily.
2 hours daily.
1.5 hours daily.
2.5 hours daily.
Laser debulking.
Prosthetic tube insertion.
Local resection.
Subtotal esophagectomy.
Left chest.
Right chest.
Abdomen and right chest.
Abdomen and neck.
Both c and d.
Lack of coordination between contraction of the inferior constrictor of the pharynx and relaxation of the
cricopharyngeus.
GE reflux.
Development of Zenkers diverticulum.
Decreased primary peristaltic waves.
Esophageal carcinoma.
Hiatus hernia.
Diffuse esophageal spasm.
Scleroderma.
QUESTIONS
2. Which of the following does not stimulate histamine release by the stomach
a.
b.
c.
d.
e.
Gastrin
Acetylcholine
Epinephine
Somatostatin
Caffeine
Gastrin
Cholecystokinin
Secretin
Somatostatin
All the above
6. the most appropriate operation of a 30-year old patient with a history of peptic ulcer disease who presents with a
perforated duodenal ulcer is
a)
b)
c)
d)
e)
8. Which of the following modalities is not indicated in the treatment of a bleeding Mallory-Weiss tear
a.
b.
c.
d.
e.
Band ligation
Heater-probe application
Angiography and embolization
Injection of epinephrine
Near-total gastrectomy
9. Which of the following is not true regarding alkaline reflux gastritis following gastrectomy
a.
b.
c.
d.
e.
10. Which of the following is true regarding GISTS (gastrointestinal stromal tumors)
a.
b.
c.
d.
e.
QUESTIONS
Select one answer.
1. which of the following dose not contribute to the digestion of the fats in the small intestine?
a.
b.
c.
d.
Perianal disease.
Rectal bleeding.
Diarrhea.
Abdominal pain.
20%
50%
75%
90%
5. A patient is taken to the operating room for appendicitis and is found to have ileitis. What is the correct management?
a.
b.
c.
d.
Biopsy Of Ileum.
Heal resection with ileocolic anastomosis.
Appendectomy.
Ileostomy
6. Which of the following can most reliably distin- guish simple from strangulation small intestinal obstruction?
a.
b.
c.
d.
7. Which of the following is true of nonoperative management of patients with small obstruction (SBO)?
a.
b.
c.
d.
Idiopathic.
Lymphoma of the small bowel.
Carcinoid.
Adhesions.
9. Which is true of the lesions responsible for the symptoms in patients with Peutz-Jeghers Syndrome?
a.
b.
c.
d.
10. A patient is found to have a small bowel carcinoma 2 cm in diameter in the distal ileum Which of the following is the
operation of choice?
a.
b.
c.
d.
3. Patients who have suffered a penetrating colon injury involving more than 50% of the rectal wall should undergo which of
the Following:
a.
b.
c.
d.
e.
A diverting colostomy
Exteriorization of the injured segment
Primary repair of the injury
Segmental resection and anastomosis
Hartmann's procedure and drainage
4. Which of the following may he appropriate initial therapy for a 4 cm anal cancer involving the internal sphincter
a.
b.
c.
d.
e.
Abdominoperineal resection
Wide local excision
Radiotherapy and chemotherapy
Interstitial radiotherapy
Wide excision with bilateral groin dissection
5. The Extraintestinal manifestation of ulcerative colitis least likely to improve after total proctocolectomy is
a.
b.
c.
d.
e.
uveitis
Sclerosing cholangitis
pyoderma gangrenosum
erythema nodosum
Iritis
6. A patient with longstanding Crohns disease develops a colonic stricture. Which of the following is the best treatment
option.
a.
b.
c.
d.
e.
7. Which of the following is the most important determinant of survival after treatment of colorectal cancer.
a.
b.
c.
d.
e.
8. An 80-year old patient undergoes an elective colonoscopic polypectomy Six hours later he is noted to be distended and is
found to have a pneumo-peritoneum. Which is ofthe following is the best treatment plan.
a.
b.
c.
d.
e.
Steroid administration
Antibiotics
Nasogastric intubation
Early colectomy
Opiates
10. A sixty-old patient with two bouts of Hinchey Stage II diverticular disease should be treated with
a.
b.
c.
d.
e.
The cystic duct, common hepatic duct, and cystic artery form the triangle of Calot.
The venous drainage of the gallbladder does not empty into the portal circulation
In most cases, the hepatic artery passes cephalad within the hepatoduodenal ligament to the right
of the bile duct and anterior to the portal vein.
In 20% of patients the cystic artery originates Common hepatic artery.
all of the above
3. Primary sclerosing cholangitis is most often associated with which of the following disorders:
a.
b.
c.
d.
e.
Crohns disease.
Diabetes mellitus.
Rheumatoid arthritis.
Ulcerative colitis.
Chronic pancreatitis.
Porcelain gallbladder.
Gallbladder polyp measuring greater than 10 mm.
Asymptomatic cholelithiasis.
a and b.
b and c.
a. In the setting of acute cholecystitis early cholecystectomy has a higher complication rate than does delayed
cholecystectomy.
EUS is less sensitive than ERCP for the detection of choledocholithiasis.
The sensitivity of HIDA scan decreases with elevated bilirubin of greater than 7 mg/dL.
None of the above.
Ail of the above.
Cholecystokinin.
Bile salts.
Vagal stimulation.
Splanchnic stimulation.
Secretin.
Choledochal cyst.
Liver fluke infection
Caroli s disease.
Dioxins.
History of gallstones for less than 10 years.
10. A 55-year-old man presents with hematemesis associated with abdominal pain and melena. His past medical history is
significant for asthma pancreatitis, and previous motor vehicle accident. Laboratory values are significant for hematocrit 23,
WBC 8.0 k/UL, platelets 450.0 k/UL, total bilirubin 3.5 mg/dL, direct bilirubin 1.5 mg/dL, alkaline phosphatase 180U/L, AST 45
U/L, ALT 34 U/L. Ultrasonography revealed a distended gallblad der with sludge. The most likely diagnosis is:
a.
b.
c.
d.
e.
Acute cholecystitis.
Peptic ulcer disease.
Hemobilia.
Portal gastropathy.
Mallory-Weiss tear.
2. which of the following is not an indication for operation in a patient with a pancreatic cystic lesion:
a.
b.
c.
d.
e.
Abdominal pain
Lesion is 2.0 cm in diameter
Elevated CEA level
Mucin in cyst
Ultrasound showing septations
4. patients who develop gallstone pancreatitis should have the following interventions prior or during cholestectomy
a.
b.
c.
d.
e.
ERCP
eus
UGI
MRCP
Cholangiography
5. Most patients with gallstone pancreatitis should be managed by which of the protocols
a.
b.
c.
d.
e.
6. Enlarging or symptomatic pancreatic pseudocysts are best treated by which of the following modalities except:
a.
b.
c.
d.
e.
Cystogastrostomy
endoscopic drainage
TPN and bowel rest
Cystojejunostomy
Cystoduodenostomy
7. Which of the following is the risk factor most closely associated with increased incidence or pancreatic adenocarcinoma
a.
b.
c.
d.
e.
Chronic pancreatitis
Diabetes mellitus
Coffee consumption
Alcohol consumption
Cigarette smoking
Antithrombin III.
Protein c.
ProteinS.
Anticardiolipin antibody.
All of the above.
Eversion endarterectomy results in a higher incidence of recurrent stenosis than CEA with ^atch angioplasty
Routine shunting is necessary when CEA is performed under regional anesthesia.
The glossopharyngeal nerve is the most frequently injured cranial nerve during the performance of CEA.
It is preferable to carotid angioplasty and stent in the treatment of carotid stenosis in patients with previous
neck irradiation.
It is preferable to medical therapy in patients with symptomatic high-grade carotid stenosis.
Surgery is indicated for most visceral aneurysms associated with polyarteritis nodosa.
taKayasu's arteritis most commonly involves the distal arm and hand arteries in middle aged men.
Patients with fibromuscular dysplasia of the carotid artery may have associated intracranial aneurysms.
Most patients with Raynauds disease require sympathectomy.
Popliteal entrapment syndrome usually results in lateral displacement of the popliteal artery.
8. Which of the following is true regarding endovascular abdominal aortic aneurysm repair.
a.
b.
c.
d.
e.
D-dimer.
Venous plethysmography.
Phlebography,
Venography.
Venous duplex scan.
2. A 33 female is upset by the appearance of her legs. On examination, she has extensive varicose veins but there is no
discoloration or swelling. A venous duplex scan demonstrates reux throughout a dilated saphenous vein. The deep veins
are competent. Suitable therapy for improving the cosmetic nature of her legs would include:
a.
b.
c.
d.
e.
3. A 50-year-old woman suddenly develops painful swelling in her left; leg. Duplex scan demonstrates occlusion of the left
iliac and femoral veins. What statement is not true?
a.
b.
c.
d.
e.
A probable cause is compression of the iliac vein by the left iliac artery.
She may harbor a hypercoagulable condition such as factor V Leiden.
Treatment could include lytic therapy.
A vena caval filter may be required.
Treatment could include a venous stent.
4. A 55-year-old male requires bariatric surgery for obesity. He has a maternal family history of DVT and he has had a
superficial phlebitis in his varicose veins twice before. Management should include all except
a.
b.
c.
d.
e.
A 55 year old male geavy smoker who like the lift weights develops a swollen left arm prior to this he has noted tingling in
his hand along the ulnar distribution. Management should include all except
a.
b.
c.
d.
e.
QUESTIONS
Select one answer.
1. A 31 -year-old woman presents with a 2-cm mass in the upper outer quadrant of the right breast. It is well defined and has
been present by history for 2 months. Your initial approach to this problem is to:
a.
b.
c.
d.
2. An 11-year-old girl is brought by her parents with a unilateral 1.5-cm mass underneath the areola on the right. Your
approach to this problem should be:
a.
b.
c.
5. Mammography:
a.
b.
c.
d.
Has resulted in major improvement in mortality and morbidity figures associated with this disease.
Has resulted in durable survival data comparable to those for mastectomy for certain breast cancers.
Should be recommended to all women suffering from breast carcinoma.
Has resulted in a high incidence of serious radiation-related complications.
Has resulted in diminution of the need for adjuvant chemotherapy and hormonal therapy.
7. In a patient with breast carcinoma, the clinical finding portending the worst prognosis is:
a.
b.
c.
d.
10. A 33-year-old woman pregnant for the third time presents at 3 months with a 2cm mass in the inner aspect of the left
breast. A needle aspiration reveals no fluid. You would:
a.
b.
c.
d.
Arrange for a mammogram because multicentre lesions are common during pregnancy.
Consider termination of pregnancy because chemotherapy has been shown to be useful in node-negative
premenopausal patients.
Expeditiously obtain a histologic diagnosis of the mass.
Wait until the third trimester because surgery is safer at that time.
QUESTIONS
1. Which of the following cancer mass screening programs has been effective in reducing cancer specific mortality?
a.
b.
c.
d.
e.
Breast cancer.
Colo-rectal cancer.
Lung cancer.
Cervical cancer.
Thyroid cancer.
2. Which of the following tumor markers is effective as a screening tool for cancer?
a.
b.
c.
d.
e.
CEA
AFP
Cal25
HCG
Calcitonin.
3. Fine needle aspiration biopsies are not useful for which of the following entities?
a.
b.
c.
d.
e.
Thyroid nodules.
Breast masses.
Liver masses.
Lymphadenopathy.
Lung masses.
4. A patient presents with a 2 cm breast mass. Which of the following is the preferred method of diagnosis?
a.
b.
c.
d.
e.
FNAB
Core biopsy.
Excisional biopsy.
Incisional biopsy.
Excisional biopsy with normal margins.
5. A patient who had a colon adenocarcinoma resected 2 years prior now has a solitary pulmonary nodule in the periphery of
the right lung. Which is the best next step in management?
a.
b.
c.
d.
e.
Bronchoscopy.
Thoracentesis.
Wedge resection.
PET scan.
FNA biopsy.
6. A patient being treated for ALL with ARA-C develops right lower quadrant pain with guard ing and rebound. Which of the
following should be the next steps in the management protocol?
a.
b.
c.
d.
e.
CT scan.
Broad spectrum antibiotics.
Bowel rest.
Laparoscopic exploration
Appendectomy.
7. Which of the following is the treatment of choice for squamous carcinoma of the anus?
a.
b.
c.
d.
e.
Proctocolectomy.
Radiotherapy alone.
Local resection.
Adjuvant chemotherapy
Radiotherapy with chemotherapy.
1. Risk factors for the development of melanoma include all of the following except
a.
b.
c.
d.
fair hair
Light complexion
Green eyes.
Multiple nevi
2.The classic triad of the dysplastic nevi syndrome Includes all of the following except:
a.
b.
c.
d.
3. True statements with respect to melanoma include all of the following except
a.
b.
c.
d.
4. true statements with respect to superficial spreading melanoma include all of the following except
a.
b.
c.
d.
6. True statements with respect to the prognosis of SMs include all of the following except.
a.
b.
c.
d.
7. Acceptable biopsy methods for a pigmented lesion include all of the following except
a.
b.
c.
d.
Excisional biopsy.
Punch biopsy.
Shave biopsy.
Incisional biopsy.
8. Optimal resection for melanomas of various ites include all of the following except:
a.
b.
c.
d.
9. The following are true statements with respect to clinical stage 11 melanoma except
a.
b.
c.
d.
10. Adequate local therapy for an STS includes all of the following except
a.
b.
c.
d.
11.True statements with respect to STSs include all of the following except
a.
b.
c.
d.
12. Prognostic factors influencing survival include all of the following except
a.
b.
c.
d.
Size.
Grade.
Location.
Histology.
QUESTIONS
Select one answer.
1. A newborn infant begins having bilious vomiting on day 2 of life. Which of the following investigations is most likely to
give the proper diagnosis?
a.
b.
c.
d.
e.
Sonogram.
HI DA scan.
Upper GI series.
Barium enema.
CT scan.
2. Which of the following is likely to be found in 6 -week-old with a 4-day history of nonbilious projectile vomiting?
a.
b.
c.
d.
e.
Cl = 110.
pH = 7.30.
HC03= 30.
K = 4.8.
P02 = 70.
3. A full-term infant fails to pass meconium at 48 hours of age. Which is the most likely diagnosis?
a.
b.
c.
d.
e.
Duodenal atresia.
Jejunal atresia.
Hirschsprung disease.
Esophageal atresia.
Colonic atresia.
5. Which of the following is not true of babies who have duodenal atresia?
a.
b.
c.
d.
e.
6. Which of the following techniques should be used to reduce an incarcerated inguinal hernia in a 6 -month - old infant?
a.
b.
c.
d.
Sedation.
Traction.
Elevation.
All of the above.
7. A 2-year-old girl has an umbilical hernia. Which of the following is the recommended plan of treatment?
a.
b.
c.
d.
e.
8. An 1,800-g premature infant presents with abdominal distension, lethargy, and stools positive or occult blood. Which of
the following investigations needs to be done?
a.
b.
c.
d.
e.
9. A 2,000-g infant with necrotizing enterocolitis is found to have portal venous gas. Which of the following procedures is in
order?
a.
b.
c.
d.
e.
10. A 2-week-old infant is found to have a hydrocele. Which is the best course of treatment?
a.
b.
c.
d.
e.
Chapter 14 Traum
QUESTIONS
.Select one answer
1. A 25 year old man arrives after sustaining a GSW to the right lower quadrant. He is explored and found to have laceration
to the right colon encompassing 75% of the circumference . he is hemodynamically stable. and there is minimal local
contamination The correct procedure would be to
a.
b.
c.
d.
e.
2. A complete cervical spine evaluation after a motor vehicle accident should include
a.
b.
c.
d.
e.
3. The first priority during evaluation of a multi- ply injured patient who is hypotensive is to
a.
b.
c.
d.
e.
4. A 36-year-old woman arrives with stable vital signs after sustaining a SW to the neck just lateral to above the cricoid
cartilage. There is slowly expanding hematoma lateral to the wound. The next step in management would be
a.
b.
c.
d.
e.
Observation.
Angiography to better define bleeding source.
Neck exploration
Esophagography and observation.
CT scan.
5. A 34-year-old man arrives at the ED hypotensive after being involved in a motorcycle accident. He has an angulated right
femur, facial trauma, and a tender abdomen. Init^ films revealed an unremarkable chest radiograph, normal lateral cervical
spinej and an open-book pelvic fracture. Despite 2 L of Ctystalloid, he remains hypotensive . The next step in management is
a.
b.
c.
d.
e.
Exploratory laparotomy.
CT scan of the abdomen.
C. FAST or DPL.
Angiography.
None of the above.
6. The preferred fluid for a patient who arrives at The ED hypotensive after sustaining a GSW to the chest is
a.
b.
c.
d.
e.
7.The most important determinant for the need for Aortography in a patient at risk for blunt aortic injury is
a.
b.
c.
d.
e.
Clinical suspicion.
First rib fracture.
Morphology of aortic knob.
Sternal fracture.
Myocardial contusion.
8.A 52-year-old woman is involved in a high-speed motor vehicle crash . she is initially Hypotensive but normalizes with
volume. A CT scan of the abdomen is performed and shows free fluid around the spleen and a 2 cm hyperdense area in the
lower pole of the spleen. The most appropriate management of this finding would be
a.
b.
c.
d.
e.
Splenectomy.
Angiographic embolization.
Admit and observe in ICU setting.
Repeat CT scan in 24 hours.
Factor VII.
9. A 68-year-old man is involved in a high-speed motor vehicle accident. He is unconscious and hypotensive with systolic
pressure of 80 mm Hg on arrival at the ED with a distended abdomen. Initial radiographs reveal a minimally displaced pelvic
fracture and normal cervical spine; the chest radiograph shows a widened mediastinum, loss of aortic contour, and deviated
nasogastric tube. Despite blood transfusion, he remains Hypotensive. FAST shows free fluid in the subhepatic and pelvic
areas. The next step in management is a
a.
b.
c.
d.
e.
Head CT scan.
Pelvic angiogram.
Aortogram.
Emergency thoracotomy.
Exploratory laparotomy.
10.A 48-year-old man is stabbed in the right upper quadrant. He arrives in the ED hypotensive and with abdominal
tenderness. He is taken emergently to the OR for laparotomy. At exploration, he is found to have a 5-cm laceration to the
dome of the liver that is no longer bleeding. No other injuries are found. The next step in managing this injury would be
a.
b.
c.
d.
e.
Pringle maneuver.
Pringle maneuver and finger fracture exploration of the injury.
Exploration of the injury.
Drain injury and close the abdomen.
Close the abdomen and get an angiogram.
15
QUESTIONS
Select one answer.
1. Seven days after cadaver renal transplantation a patient develops a fever to 101F, pain, and tenderness over the
incisional area, and oliguria. Serum creatinne has risen from 1.5 mg/dLto 1-9 mg/dL. Likely possibilities include:
a.
b.
c.
d.
e.
Acute rejection.
Wound infection.
Urinary leak.
Wound dehiscence.
All of the above.
IL-2
Tnterferon-2.
T-helper cells.
T cytotoxic cells.
B cells.
3.
4.
Stimulated by antigen or other cells, these cells ultimately produce antibody that causes graft destruction.
5.
6.
Normally resting, these cells are stimulated by antigens and macrophages to initiate the immune response.
7.
For a through e, below, choose the best option from i through V (choice may be repeated).
a.
Blocks IL-1.
b.
Blocks IL-2.
c.
d.
e.
Ne^roto^Gty is a problem.
i.
Cyclosporine.
ii.
Azathioprine.
iii- Corticosteroids,
iv. Tacrolimus
Mycophenolate mofetil.
.
16. THYROID DISEASE QUESTIONS
Select one answer.
1. Which one of the following is true about MTC?
a.
b.
c.
Lung.
Liver.
Bone.
Brain.
Adrenal.
Adenoma.
Carcinoma.
Hyperplasia.
Chronic renal insufciency.
2. All of the following are appropriate treatment options for secondary hyperparathyroidism except
a.
b.
c.
d.
3. What percentage reduction in the pTH value from baseline indicates a successful operation?
a.
b.
c.
d.
40.
50.
60
Depends on the size of the resected parathyroid gland
4. If the abnormal parathyroid glands are not found during blateral neck exploration, all of the following measures are
appropriate except:
a.
b.
c.
d.
2. All of the following are true regarding the adrenal gland except
a.
b.
c.
d.
e.
4. All of the following are true regarding the Dexamethasone Suppression Test except
a.
b.
c.
d.
e.
5. All of the following are expected laboratory results in a patient with primary hyperaldosteronism except
a.
b.
c.
d.
8. All of the following are genetic syndromes which include pheochromocytoma except
a.
b.
c.
d.
e.
MEN 2b.
von Recklinghausen
MEN 2a.
von Hippie Lindau
von Gierke.
Urinary vma
Urinary metanephrines.
17 - OH corticosteroids
Urinary fractionated catecolamines
10. Which of the following statements is true about surgery for pheochromocytoma ?
a.
b.
c.
d.
e.
Larynx
Hypopharynx
Oral cavity
Oropharynx
2. The landmark Veterans Affairs paper regarding larynx cancer established what treatment paradigm?
a.
b.
c.
d.
3. Primary Tumors of what site the aerodigestive tract arc most consistently treated surgically
a.
b.
c.
d.
Nasopharynx
oral cavity
Oropharynx
Larynx
5. In HNSCC, even if no cervical lymph nodes are clinically or radiographically evident, prior to treatment one must consider
the presence of
a.
b.
c.
d.
Distant metastasis
Occult cervical metastasis
Wrong diagnosis
Radioresistant primary tumor
2. The malignant salivary tumor most likely to invade surrounding nerve tissue is:
a.
b.
c.
d.
Mucoepidermoid carcinoma
Acinic cell carcinoma
Adenoid cystic carcinoma
Squamous cell carcinoma
3. The following lesion(s) has potential for distant metastasis to the lungs and bones:
a.
b.
c.
d.
4.A plunging ranula occurs when the mucocele herniates beneath which muscle into the submental space?
a.
b.
c.
d.
Genioglossus
Mylohyoid
Geniohyoid
Platysma
The auriculotemporal segment of the trigeminal nerve lies in close proximity to the superior aspect of the parotid
and is generally not visible at surgery.
The facial nerve should always be sacrificed during parotidectomy for malignant lesions.
The tympanomastoid fissure is a reliable landmark in locating the main trunk of the facial nerve.
Within the parotid, the facial nerve divides into the temporofacial and cervicofacial branches.
Above 0.8 L.
Below 0-ft I
Above 1.2 L.
Below 1.2 L
2. Seven days after insertion of a chest tube for a spontaneous pneumothorax, several attempts to reposition the chest tube
did not decrease the air leak. What is the next step?
a.
b.
c.
d.
3. The initial workup of a newly found lung mass in a 30yearold man does not include
a.
b.
c.
d.
Sputum cytology,
Bronchoscopy.
Review of old films,
Open lung biopsy.
4. A 50 year-old female cigarette smoker was found to have a 3-cm lung mass not present 1 year before. Cytologic and
bronchoscopic examination results were negative. The next step should be
a.
b.
c.
d.
Radiotherapy alone.
Radiotherapy and chemotherapy.
Resection.
Follow-up after 3 months.
5. A lung abscess measuring 4 cm in the superior segment of the right lower lobe is best treated with
a.
b.
c.
d.
It is always incurable.
It is not seen in female subjects.
it is has a predilection for early spread to other organs.
it is not responsive no chemotherapy
radiotherapy.
Surgery.
Radiotherapy and chemotherapy followed by surgery
Radiotherapy and chemotherapy alone.
10. The initial treatment for a patient with multiple bilateral rib fracturesand flail chest with CO, retention is
a.
b.
c.
d.
Fatigue.
Headache.
Disorientation.
Lethargy.
e. All the above.
3. Hydrofluoric acid burns are typically treated with topical, intra-arterial, and/or subcutaneous administration of:
a.
b.
c.
d.
e.
Calcium carbonate.
Sodium bicarbonate.
Calcium gluconate.
Calcium phosphate.
Potassium gluconate.
4. Burns to ears are best treated with what medication to prevent chondritis:
a.
b.
c.
d.
e.
Silver sulfadiazine.
Mafenide acetate.
Bacitracin.
Silver nitrate.
Chlorhexidine.
5. Split-thickness skin grafts typically are defined as mature after what period of time:
a.
b.
c.
d.
e.
1 month.
3 months.
6 months.
9 months.
12 months or longer.
QUESTIONS
1. The net result of aerobic metabolism of 1 mol of glucose is
a.
b.
c.
d.
Class I hemorrhage.
Class II hemorrhage.
Class III hemorrhage
Class IV hemorrhage.
3. Swan ganz parameters include a PCWP of 12 mm Hg a cardiac index of 2.7 l/min/m The patient is
a.
b.
c.
d.
Normal.
Hyperdynamic.
Hypodynamic
Requires more information to determine
Septic shock.
Cardiogenic shock.
Hemorrhagic shock.
Spinal shock.
Contractility
Heart rate
Hemoglobin
Afterload
6. A patient in being mechanically ventilated on assist/control mode. His arterial blood gases are: pH 7.55, Pco2 24, P02 79,
saturation 92%. The set rate is 12 breaths per minute; the patient is breathing 20 times per minute. What should be done?
a.
b.
c.
d.
Fluid resuscitation.
Narrow spectrum antibiotics.
Appropriate cultures.
early institution of goal directed therapy.
9. A patient has ARDS with an Fio2 of 75% on 10 cm H2o PEEP, the Po2 is only 50 mm Hg, Pc02 is 39 mm Hg, and pH is 7.28.
What would you do?
a.
b.
c.
d.
10. a postoperative patient has a platelet count of 50,000/mm* and no clinically apparent bleeding. You would
a.
b.
c.
d.
Chaptar22 Neurosurgarv
QUESTIONS
Select one answer.
1. The lesion most likely to cause neurologic injury and permanent sequelae is
a.
b.
c.
d.
2. Subdural hygromas:
a.
b.
c.
d.
odontoid process
Ring of Cl.
Pedicle of C2
Pars interarticularis of C3.
ependymoma.
low - grade astrocytoma.
Glioblastoma multiforme.
pituitary adenomas.
Somatostatin.
ACTH.
TSH.
GnRH.
Odontoid process.
Ring of Cl.
Pedicle of C2.
Pars interarticularis of C3.
Encephalocele.
Dermal sinus tracts.
Myelomeningocele.
Meningocele.
QUESTIONS
Select one answer.
1.Early fracture stabilization of long bone and pelvic fractures in polytrauma patients reduces the risk of all of die following
Except:
a.
b.
c.
d.
e.
Sepsis
Negative nitrogen balance
ARDS
Fat embolism
Malunion or nonunion
2. Principles for managing high-grade complex open fractures include all of the following EXCEPT
a.
b.
c.
d.
e.
Intravenous antibiotics.
Thorough irrigation and debridement.
Cast immobilization.
Meticulous soft tissue care.
Careful assessment of compartment pressures.
Suprascapular nerve.
Ulnar nerve.
Median nerve,
Axillary nerve.
Long thoracic nerve.
Femoral nerve.
Obturator nerve.
Sciatic nerve.
Peroneal nerve.
Interosseous nerve.
5. Vascular compromise has been associated with all of the following injuries EXCEPT
a.
b.
c.
d.
e.
Clavicle fracture.
Knee dislocation.
Patella fracture.
Sternoclavicular joint dislocation.
Supracondylar fracture of the humerus.
6. Which of the following scenarios warrants operative exploration of the radial nerve after closed manipulation of a fracture
of the shaft of the humerus?
a.
b.
c.
d.
e.
7. A 23-year-old male motorcyclist presents to the emergency department with bilateral closed femoral fractures. He is
placed in bilateral traction and admitted. Twenty-four hours later, he is confused and tachypneic. The most likely diagnosis is
a.
b.
c.
d.
e.
Pulmonary embolism.
Myocardial infarction.
Fat embolism.
Urinary tract infection.
Stroke.
Osccosarcuma.
Synovial sarcoma.
Multiple mycloma.
Malignan brous hisniocymm
Chondrosarcorna.
9. The position in which a patient with a posterior dislocation ofthe hip holds the affected extrem. ity is
a.
b.
c.
d.
e.
10. Which of the following types of childhood Salter fractures of long bones is associated wkh the highest likelihood of
subsequent growth arrest?
a.
b.
c.
d.
e.
Type l.
Type Il.
Type Ill.
Type IV.
Type V.
11. The most important diagnostic test in an adolescent with knee pain and normal knee radiographs is
a.
b.
c.
d.
e.
12. A young female patient presents with pain with an L5 radiculopathy and weakness of the extensor hallucis longus on the
right. The level of the herniated disc most likely is
a.
b.
c.
d.
L2-3.
L3-4.
L4-5.
L5-S1.
13. An osteosarcoma of the distal femur that has been shown by MRI to have broken through into the surrounding muscle
would be classified as a
a.
b.
c.
d.
IB
II A
II B
III B
Uncommon injuries.
May be associated with additional ipsilateral fractures.
Are associated with pneumothorax pulmonary contusions. And spine fractures.
Ofter treated nonoperatively.
All of the above.
15. All of the following are indications to surgically fix midshaft humerus fractures except:
a.
b.
c.
d.
e.
Open fracture.
Polytrauma.
Young patient.
Segmental fracture.
Floating elbow.
19.A 13-month-old boy is seen in the emergency department with a complaint Of redness and swelling of his right leg. The
child appears in Pain. He is not yet walking as per the parents, and they did not observe any trauma He has a spiral fracture
of his right femur on radiographs you should:
a.
b.
c.
d.
e.
2. A 32-year-old healthy pregnant female comes to your office complaining of tingling In her fingers and wrist pain .You
expect the patient to have:
a.
b.
c.
d.
A positive tinel's sing --- symptoms when her hands are held in flexion for 1 minute.
A positive tinel's sing --- electric shock sensetoms when the wrist is tapped.
A positive phalen's sign --- resolution of symptoms when her hand is held in flexion for 1 minute.
A positive phalens sign --- electric shoch sensation when the wrist is tapped.
3. You are asked to evaluate a 16-year-old male with an abscess on the dorsum of his hand. During the medical history
interview he tells you that his cat bit him there 1 week ago. what Is the most likely organism causing this infection?
a.
b.
c.
d.
bacteroides
Eikenella
Streptococcus
P. multocida
4.Which finger is most crucial in a replant for the patient to have good hand function?
a.
b.
c.
d.
Thumb.
Ring finger
Index finger
They are all equally important
Bacteroides
pasteurella
Staphylococcus.
Eikenella.
6. The patency of the radial and ulnar arteries and collateral circulation to the hand can be evaluated by:
a.
b.
c.
d.
Finkelstein maneuver.
Addison maneuver.
Allens test.
Phalen's test.
7. Rupture of the extensor tendon at its insertion at the distal phalanx may result in:
a.
b.
c.
d.
8. Two days following a puncture wound :0 Lhc right ring nger a 45-year-old healthy male comes to the emergcncy
department for care.His nger is swollen and exed and he has severe pain with passive extension. Which statement is
true?
a.
b.
c.
d.
Examination is consistent with a Felon and surgical drainage and antibiotics are indicated.
Examination is consistent with acute suppurative tenosynovitis and surgical drainage and antibiotics are indicated.
. S. viridians is the most likely causative bacteria.
intravenenous antibiotics alone are adequate treatment.
25
Urologic Surgery
QUESTIONS
The following questions may have more than one answer.
1. The most common renal mass is a:
a.
b.
c.
d.
2. During a routine right hemicolectomy a right renal mass is noted one should:
a.
b.
c.
d.
e.
3. Which of the following modalities is not useful of maximizing early direction of prostate Cancer.
a.
b.
c.
d.
e.
prostate-specific antigen.
prostatic acid phosphatase.
Transrectal ultrasonography.
digital rectal examination.
Clinical symptomatology.
5. What percentage of patients with stage I testicular carcinoma eventually progress without further treatment after radical
orchiectomy?
a.
b.
c.
d.
e.
10.
20.
30.
40.
50.
6. Symptoms and signs related to benign prostatic hyperplasia can be successfully treated pharmacologically.
a.
True.
b.
False.
Seminoma.
Embryonal carcinoma.
Yolk Cac tumor.
Choriocarcinoma.
Teratocarcinoma.
8. which of the following parameters necessitate radiographic imaging of the urinary tract in the Patient with blunt trauma?
a.
b.
c.
d.
e.
Adult patient.
Microscopic hematuria.
Systolic blood pressure higher than 90 mm Hg.
Fracture of a lumbar transverse process.
History of renal cysts.
9. proper ureteral repair in after trauma requires all of the following except:
a.
b.
c.
d.
e.
Tension-free anastomosis.
Adequate urinary diversion.
Adequate wound drainage.
Watertight closure.
Use of absorbable suture.
10. Which of the following findings obviate the need for scrotal exploration in a Patient with suspected testicular torsion?
a.
b.
c.
d.
e.
QUESTIONS
1. Which of the following is not an indication for open cholecystectomy
a.
b.
c.
d.
e.
4. Laparoscopy for blunt abdominal trauma is contraindicated in which of the following scenarios
a.
b.
c.
d.
e.
5. Which of the following approaches can be used to performed a minimally invasive inguinal hernia repair
a.
b.
c.
d.
1. The optimal management of most postoperative leaks after gastric bypass is:
a.
b.
c.
d.
3. the initial resuscitation of a postoperative bariatric patient with hypotension and suspected sepsis is
a.
b.
c.
d.
4. Two years after lap banding a patient presents to the emergency department with severe epigastric pain and nausea. The
white blood cell (WBC) count is 20,000 and UGI shows a complete obstruction. Which of the following is true:
a.
b.
c.
d.
Remove all fluid in the band, if the pain is not alleviated go to the OR to access the band and the pouch,
Place the patient on IV antibiotics for a gastric erosion.
Endoscope the patient to make sure that there is no erosion.
Anterior slippages are rarely emergencies, remove the fluid and discharge die poulenc ,for follow-up with their
bariatric surgeon.
5. three months after lrygbp a patient presents with hematemesis .the patient is on clopidogrel and acetylsalicylic acid for
cardiac stent .which of the following is the most appropriate management of this patient
a.
b.
c.
d.
transfuse as needed with blood and platelets and observe in the icu
endoscope the patient after stopping the asa and plavix
endoscope the patient when stable to diagnose and treat a marginal ulcer
empirically start the patient on proton pump inhibitors
A 35 year old man with well controlled diabetes would be considered an asa classification of
a.
b.
c.
d.
e.
Particulate antacids.
Infant formula for more than 4 hours.
High gastric volume.
High pH.
2. A 60 -year-old woman with hypertension is taking care of a foal cat that became pregnant. ch became more aggressive and
bit the an when she was leaving out the hood. Animal control personnel were contacted and succeeded at capturing the cat.
The following day, the woman developed swelling of the right wrist and hand as weil as erythema and never. What should
the next step be
a.
b.
c.
d.
e.
rabies inuminogiobuhn
amoxicillin clavulan acid.
Treat for Cat-scratch disease.
Euthanize the cat.
Cefazolin.
3. A 72-year-old woman with hypothyroidism, diabetes meliitus. and osteoporosis fell and sustained a right intertrochanteric
hip fracture. She was taken for open reduction and internal fixation (ORJF) of the hip the following day perioperative
prophylactic cefazolin was administered for 24 bouts. rMopcrattvr day 3. she ud a louse bowel movement. The following
day. she has fever to 10TF. leukocytosis of 23,400 WBC/HPF and 10% bandemia. Blood pressure is stable. Blood and unne
cultures arc sent. CXR showed right lower lobe atelectasis. What is the most appropriate treatment?
a.
b.
c.
d.
e.
4. A 23-year-old man was involved in a motor vehicle accident. On arrival to the emergency department, he became
hypotensive. A CT of the abdomen showed a lacerated spleen. He was emetgently taken to the operating room for
splenectomy. There are no major complications and he is ready for discharge. In addition to educating him about his
increased risk of infection especially with encapsulated bacteria, what steps should you take to minimize the risk?
a.
b.
c.
d.
e.
5. A 43-yearold woman with irritable bowel syndrome was in her usual state of health until approximately 2 months ago.
She complained of intermittent abdominal pain with nausea, vomiting, and diarrhea. No fever. Last night her pain became
more severe and she presented to the emergency department with fever 103.5 F with rigors. In the emergency department,
she had rigors and sclera icterus. Direct bilirubin 2.4, alkaline phosphatase 400, WBC 18,500, AST 20, and ALT 21. Ultrasound
revealed a common bile duct stone.
What is the next step?
a.
b.
c.
d.
6. A 35yearold woman underwent laparoscopic resection of a perforated appendix. The patient was given ciprofloxacin
and metronidazole perioperatively. The patient returned 1 week later with fever, chills, and abdominal pain. CT of the
abdomen revealed a collection in the right lower quadrant. The fluid was aspirated and 200 cc of purulent should be
initiated?
a.
b.
c.
d.
e.
cefotetan.
ceftriaxone/metronidazole.
daptomycin.
aztreonam/clindamycin.
ampicillin/sulbactam.