Surgical Board Evaluation Exam

1. A right-sided disc herniation at the L5S1 level typically may cause:

a. Weakness of dorsiflexion of the right foot.
b. A diminished or absent right ankle jerk.
c. Diminution of sensation over the medial aspect of the right foot, including the great toe.
d. Weakness of dorsiflexion of the left foot.
2. In the classification of cholangiocarcinoma by site, Type II is
a) Confined to the common hepatic duct
b) Involve the bifurcation without involvement of secondary intrahepatic ducts
c) Tumors extend into either the right or left secondary intrahepatic ducts, respectively.
d) Involve the secondary intrahepatic ducts on both sides.
3. Ideal treatment of alkaline refkux gastritis after after Billroth I and Billroth II gastrectmy is:
a) Conversion of Billroth I to Billroth II
b) Roux en Y gastrojejunostomy
c) Tatal gastrectomy
D) Conservative management

4. All of the following are part of the Child-Pugh scoring system EXCEPT:
A Overall nutritional state.
B Presence of ascites.
C Presence of encephalopathy.
D Serum bilirubin.
E International normalized ratio.

5. The sensitivity of the test is:

(a) the proportion of patients with the disease who have a positive test
(b) the proportion of patients without the disease who have a negative test
(c) the proportion of patients with a positive test who have the disease
(d) the proportion of patients with a negative test who do not have the disease
6,Which is MOST typically associated with a metabolic alkalosis
A Hyperkalaemia, hypochloraemia, raised HCO3
B Hypokalaemia, hypochloraemia, raised HCO3
C Hyperkalaemia, hyperchloraemia, raised HCO3
D Hypokalaemia, , hyperchloraemia, raised HCO3

7-An acute subdural haematoma:

a shows a characteristic hyperdense extra-cerebral mass
b is often associated with only a minor head injury
c virtually never need surgical excision
d can always be managed with diuretic therapy
e usually causes an ipsilateral hemiparesis

8 -The Howship-Romberg sign is associated with which type of hernia?

A. Spigelian hernia
B. Richter hernia
C. Pantaloon hernia
D. Lumbar hernia
E. Obturator hernia

9-Which of the following is true regarding umbilical hernias in adults?

A. Most are congenital.
B. Repair is contraindicated in patients with cirrhosis.
C. Strangulation is less common than in children.
D. Small, asymptomatic hernias can be clinically observed.
E. Primary closure has recurrence rates similar to those of mesh repair.
10. Vascular complications of acute pancreatitis include the following except
(a) Splenic vein thrombosis
(b) Splenic artery aneurysm
(c) Gastroduodenal artery aneurysm
(d) Middle colic artery thrombosis

11- With

regards to the use of HCO-3 in shock, which is FALSE?

A. HCO-3 shifts O2 dissociation curve to the right to allow increased O2 delivery

from Hb at lower tissue pO2
B. HCO-3 improves the myocardial depression associated with shock
C. HCO-3 counteracts the insensitivity to endogenous catecholamines attributed
o acidosis
D. HCO-3 worsens intracellular acidosis

12-Which of the following is NOT a criterion for SIRS?

A- Temperature < 36oC
B -HR > 90
C -RR < 6 or PaCO2 < 23 mmHg
D -WCC with > 10% immature bands

13-The first compensatory response to shock is which of the following?

A An increased Cardiac output
B A fall in O2 content of blood
C A rise in respiratory rate
D A fall in the mixed venous O2 saturation

14. Which of the following is the most effective definitive therapy for both prevention of recurrent
variceal hemorrhage and control of ascites?
A. Endoscopic sclerotherapy.
B. Distal splenorenal shunt.
C. Esophagogastric devascularization (Sugiura procedure).
D. Side-to-side portacaval shunt.
E. End-to-side portacaval shunt.
15. Which of the following statement(s) is/are true concerning tissue sampling techniques for
breast masses?
a. The sensitivity of fine needle aspiration biopsy is such that mastectomy can be performed in
the case of malignant diagnosis
b. The accuracy of mammographic-directed fine needle aspiration biopsy is comparable to that
achieved for that of palpable lesions
c. Core-needle biopsy showing normal breast tissue is an acceptable diagnosis
d. The technique of core-needle biopsy is not applicable to radiographically detected lesions
16. Which of the following statement(s) is correct concerning cystosarcoma phyllodes?
a. The tumor is most commonly seen in post-menopausal women
b. Total mastectomy is necessary for all patients with this diagnosis
c. Axillary lymph node dissection is not necessary for malignant cystosarcoma phyllodes

d. Most patients with the malignant variant of cystosarcoma phyllodes die of metastatic disease

17-Which of the following surgical procedures has the lowest incidence of recurrent jaundice when
used in the context of unresectable carcinoma of the head of the pancreas?
a.Choledochoduodenostomy
b.Cholecystojejunostomy
c.Cholecystoduodenostomy
d. Choledochojejunostomy

18-Regarding a wound created by a surgical incision

a)
b)
c)
d)
e)

Macrophages appear at the wound edge within 24 hours

The initial leucocytic infiltrate has largely cleared by week 2
Epithelial spurs fuse to close the wound at around day 5
Granulation tissue formation occurs as the first step in wound healing
After a week wound strength is approximately 30% of pre-injury

19. Which of the following statements characterize amebic abscess?

A. Mortality is higher than that for similarly located pyogenic abscesses.
B. The diagnosis of amebic abscess may be based on serologic tests and resolution of symptoms.
C. the treatment of amebic abscess is primarily surgical.
D. Patients with amebic abscess tend to be older than those with pyogenic abscess.
20. Axillary lymph node dissection is routinely used for all of the following conditions except:
A. 2-cm. pure comedo-type intraductal carcinoma.
B. 1-cm. infiltrating lobular carcinoma.
C. 8-mm. infiltrating ductal carcinoma.
D. A pure medullary cancer in the upper inner quadrant.
21. The Coeliac Trunk
A.Commences at L1 Vertebral Level
B.Is the main artery supplying the midgut
C.Divides into its branches in the posterior wall of the lesser sac
D.Gives origin to the right gastric artery
E.Lies inferior to the medial arcuate ligament

22.A midline longitudinal incision through the roof of the popliteal fossa will expose as the most
superficial major structure:
A.Popliteal artery
B.Tibial nerve
C.Common peroneal nerve
D.Popliteal vein
E.Popliteus muscle

23. Which of the following breast lesions are noninvasive malignancies?

A. Intraductal carcinoma of the comedo type.
B. Tubular carcinoma and mucinous carcinoma.
C. Infiltrating ductal carcinoma and lobular carcinoma.
D. Medullary carcinoma, including atypical medullary lesions.
24. Which of the following conditions is associated with increased risk of breast cancer?
A. Fibrocystic mastopathy.
B. Severe hyperplasia.
C. Atypical hyperplasia.
D. Papillomatosis.
25.Regarding collagen
a)
b)
c)
d)
e)

Type V, non-fibillar collagen, is seen in basement membranes

Non-fibillar collagen is the most ubiquitous protein in the body
Collagen is formed in cells as long fibrils
Ehlers-Danlos syndrome is due to a genetic increase in collagen breakdown
Collagen is formed in a triple helix structure

26. In a 55-year-old grocery store cashier with an 8-month history of leg edema increasing over
the course of a work day, associated with moderate to severe lower leg bursting pain, the most
appropriate investigative study or studies are:
A. Doppler duplex ultrasound.
B. Brodie-Trendelenburg test.
C. Ascending and descending phlebography.
D. Measurement of ambulatory and resting foot venous pressure.
E. Venous reflux plethysmography.

27. Which of the following statements describes an ideal tumor marker?

A. The ideal tumor marker should be tumor specific; that is, in the normal population or patients with benign
diseases,
false-positive test results are rare.
B. The ideal marker must have a low false-negative rate; that means that all patients with a particular type of
cancer should
test positive.
C. The circulating level of an ideal tumor marker should correlate directly with the amount of viable tumor and
be a
measure of the response to therapy.
D. The ideal tumor marker should act as a prognostic indicator.
E. All of the above.
28. The treatment of choice for neonates with uncomplicated meconium ileus is:
A. Observation.
B. Emergency laparotomy, bowel resection, and Bishop-Koop enterostomy.
C. Intravenous hydration and a gastrograffin enema.
D. Emergency laparotomy, bowel resection, and anastomosis.
E. Sweat chloride test and pancreatic enzyme therapy.

29. In neonates with necrotizing enterocolitis, which of the following findings is an indication of significant bowel
ischemia?
A. Increased gastric residuals.
B. Septic shock.
C. Cardiac failure due to a patent ductus arteriosus.
D. Elevated platelet count.
E. Erythema of the abdominal wall.
30. Renal adenocarcinomas:
A. Are of transitional cell origin.
B. Usually are associated with anemia.
C. Are difficult to diagnose.
D. Are extremely radiosensitive.
E. Frequently are signaled by gross hematuria.

31. Which statements about lymphangiomas are true?

A. Most lesions appear during puberty.
B. These lesions frequently respond to small doses of radiation therapy.
C. The lesions usually grow slowly but may infiltrate local tissues.
D. Malignant transformation is frequent.
32.Which of the following statements about the surgical treatment of carcinoid tumors is false ?
A. Carcinoid tumors should be treated by resection, regardless of the presence of metastases.
B. Appendiceal tumors larger than 1.5 cm. should be treated by ileocolectomy.
C. Local excision with margins is adequate for a rectal carcinoid of any size.
D. Carcinoid tumors are associated with a large percentage of other synchronous or metachronous neoplasms.

33. The most common malignant neoplasm of the kidney is the hypernephroma or renal cell carcinoma. Which
of the following statement(s) are true concerning renal neoplasms?
a. Renal cell carcinomas can produce a variety of hormone or hormone-like substances
b. Bilateral multifocal renal cell cancers can be associated with the multiple endocrine neoplasia syndrome
c. A tumor deformity on IVP is diagnostic of a renal cell carcinoma
d. Patients with renal cell carcinoma in a solitary kidney will inevitably require total nephrectomy and long-term
dialysis for the resultant renal failure

34.A tension haematoma deep to the cervical fascia following thyroid surgery is usually due to
A) bleeding from anterior jugular veins
B) slipping ligature of the superior thyroid artery
C) bleeding from substance of thyroid gland
D) injury to external carotid artery
35. regarding post splenectomy sepsis?
a. The incidence in children is generally reported as less than 5%
b. Haemophilus influenzae, Streptococcus pneumoniae and Neiseria meningitidis are the most common
causative
organisms
c. The mortality rate is now approximately 50%
d. The incidence in adults in approximately 1%
e.all are ture

36.The parathyroid glands:

A. Develop from the second and third pharyngeal pouches, along with the
palatine tonsil and the thymus.
B. Migrate caudally in the neck in normal development but can be found
anywhere from the pharyngeal mucosa to the deep mediastinum.
C. Secrete PTH and calcitonin to manage calcium homeostasis.
D. Usually number four, but frequently number only two or three.
E. Contain enzymes that catalyze the conversion of 25(OH) vitamin D 3 to
1,25(OH) 2 vitamin D 3.
37-Most characteristic histopathologic feature of keratoacanthoma is:
a. elevation of normal epithelium towards the central portion of the lesion with an abrupt
change in normal epithelium as hyperplastic acanthotic epithelium is reached.
b. hyperplastic squamous epithelium growing into underlying connective tissue
c. occasional dysplastic features
d. epithelium appears to be invading into connective tissue at deep leading margin of the
tumor
e. All of the above
38. Which is the least common in anatomic variations of extrahepatic biliary system?

a) Trifurcation of Right anterior, right posterior and left hepatic ducts.

b) Right anterior duct joining the common hepatic duct
c) Right Posterior joining the common hepatic duct
d) Anomalies of the gall bladder
e) Anomalies of the cystic duct

39-Regarding cutaneous wound healing which statement is correct

a)
b)
c)
d)
e)

Insensate skin has little impact on wound healing rates

Complications from wound contraction are most commonly seen on the face and neck
Early movement of wounds can stimulate the process of angiogenesis and healing
Vitamin C deficiency impairs collagen synthesis in healing tissues
Glucocorticoids promote collagen syenthesis and fibrosis of tissues

40-A diabetic patient has an ulcer on their great toe, which statement is false regarding its
healing
a)
b)
c)
d)
e)

It will heal by secondary intention

Substantial scar formation is likely
The amount of acute inflammation is small, slowing the healing
Wound contraction requires actin containing fibroblasts
Large amounts of granulation tissue grow in from the periphery of the wound

41. Which of the following is consistent with syndrome of inappropriate antidiuretic hormone (SIADH)?
(a) hypovolemia
(b) increased urine sodium
(c) hypernatremia
(d) plasma hyperosmolarity
(e) excessive diuresis

42.Which of the following is not a part of superficial perineal pouch in males?

A. Posterior scrotal nerves
B. Sphincter urethrae
C. Ducts of bulbourethral glands
D. Bulbospongiosus muscle
E.All of the above

43.Kidney transplant recipients are at increased risk for:

(a) epidermoid skin cancer
(b) lung cancer
(c) colon cancer
(d) breast cancer
(e) uterine cancer

44. Which of the following is true about small bowel adenocarcinoma?

(A) Most occur in the ileum
(B) Enteroclysis is useful in the diagnosis
(C) Chemotherapy is the first line of therapy
(D) En bloc resection of contiguous involved organs is not indicated
(E) Delayed diagnosis is uncommon

45 . Which of the following is true regarding Crohn disease?

(A) Ileocolic disease is less common than jejunoileal disease
(B) Recurrence is uncommon after resection
(C) Post op chemoprophylaxis can reduce recurrence
(D) Crohn colitis is easily distinguished from ulcerative colitis
(E) Cutaneous manifestations are less common with Crohns colitis than with small bowel
disease

46. Alkaline reflux gastritis:

(A) Is debilitating in 15 17% of postgastrectomy patients
(B) Not present in healthy controls
(C) More common after Billroth II than Billroth I or Vagotomy and pyloroplasty
(D) Symptoms usually start within 6 weeks after surgery
(E) In patients who have vomiting, it is nonbilious

47. A 37-year-old man is involved in a motor vehicle accident. His chest x-ray shows a widened
mediastinum. An aortogram demonstrates a descending thoracic aortic injury. He is also noted to
have a grade II splenic injury. Which of these approaches should not be used to repair the aortic
injury?
a. total cardiopulmonary bypass
b. partial cardiopulmonary bypass using a Gott shunt
c. left atrial to left femoral bypass using a nonheparinized pump
d. clamp and sew without cardiopulmonary bypass
e. none of the above
48. A 17-year-old man is stabbed in the axilla. He is noted to have loss of function of the ulnar
nerve. If nonoperative therapy is used for treatment of this nerve injury, at what rate is the nerve
expected to regenerate?
a. 1 mm/wk

b. 1 mm/mo
c. 1 mm/d
d. 10 mm/mo
e. 1 cm/wk

49.-Which of the following statements regarding the arterial blood supply of the rectum are
correct?
A.the principal blood supply of the rectum is from the inferior rectal artery
B.the superior rectal artery crosses the ureter anterior to the bifurcation of the left common iliac
artery
C.the inferior rectal artery has few anastomoses with the middle and superior rectal arteries
D.the inferior mesenteric artery becomes the superior rectal artery on crossing the pelvic brim
E.the superior rectal artery divides into branches at S1 vertebral level, where the rectum begins

50.. A patient presents after a motor vehicle collision at which he was found ambulatory at the
scene. He is anxious, smells of alcohol, and has a heart rate of 110 beats/min, a blood pressure
of 110/90 mm Hg, a normalcapillary refill, and normal urinary output. This patient is assessed in
which one of the following ways?
A He is intoxicated and an early head computed tomography (CT) scan should be planned to rule
out head injury.
B He may be in class I hemorrhage (up to 15% of blood volume loss).
C He may be in class II hemorrhage (15%30% of blood volume loss).
D He may be in class III hemorrhage (30%40% of blood volume loss).
E He may be in class IV hemorrhage (40% of blood volume loss).