Surgery 2

1st Long Exam

Recalls
1. One of the ff is a classic symptom of GERD 11. Patients for evaluation of passsive esophagel tumor,
A. DOB what diagnostic modality will be of best use? - BONUS
B. Anorexiaa A. Chest X-ray
C. Heart burn B. Esophagoscopy
D. Vomiting
C. CT scan – can visualize other structures, more lymph
2. What is Hill’s Repair? node visualization
A. Posterior gastroplexy D. Endoscopy – can also visualize depth of tumor

3. Drug for GERD 12. A patient complains of dysphagia. What is the usual
A. Amoxicillin diagnostic test?
B. Steroids A. Chest x-ray
C. Loperamide
D. Metoclopramide 13. A patient complains of dysphagia and reflux
undigested food. On PE, there is a palpable ballotable
4. One of the following is true regarding the lymphatic mass on the left side of the neck What can be the initial
drainage of the esophagus. diagnostic procedure to be done?
A. The course is submucosal A. Barium swallow
B. The course is serosal B. Video esophagogastroscopy
C. It is drained by the mediastinal nodes only C. MRI
D. CT scan
5. One of the following statements is true of the
anatomy of the esophagus. 14. A patient with Zenker’s Diverticulum is scheduled for
A. Originates at the level of C6 vertebra and ends at surgery. A conduct of surgery should include all except:
level of C11 A. Mobilization of esophagus and accompanying
B. Descends in front of the aortic arch diverticulum
C. Enters the abdomen through the esophageal B. Excision of diverticulum and primary repair of
hiatus at the level of T10 esophageal defect
D. Starts at the level of thyroid cartilage C. Cricopharyngeal myotomy
D. Primary closure of esophagus to include the
6. One of the following statements is not true of the serosal layer
muscle layer of the esophagus?
A. Inner layer is circular 15. Bird’s beak appearance upon Barium Swallow
B. Outer layer is longitudinal A. Achalasia
C. Upper third is striated muscle B. Diffuse Esophageal Spasm
D. Lower ⅔ third is striated muscle C. Cricopharyngeal Muscle Dysfunction
D. Zenker’s Diverticulum
7. One of the following is true of the Lower Esophageal
Sphincter. 16. One of the following is true of Achalasia
A. 1-2 cm long A. 10x risk for carcinoma
B. Contracts as peristaltic movement passes through
C. High pressure zone 17. Patient was referred to you diagnosed of
D. None of the above ACHALASIA, you would expect:
A. Difficulty of Breathing
8. The LES pressure can be decreased by which of the ff: B. Weight loss
A. Alkalinization C. Dizziness
B. Gastrin D. Weight gain
C. Vasopressin
D. Glucagon 18. Drawback of Heller Myotomy
A. Reflux of Gastric Contents
9. The LES pressure can be increased by which of the ff: B. Recurrence of dysphagia
A. Acidification of the stomach C. Faster gastric emptying
B. Secretin D. Basta tama yung A. :P
C. Vasopressin
D. Cholinergics 19. Advantage/Limitation of Baloon Dilatation
A. Long term benefit
10. One of the ff is associated with cricopharyngeal B. Low recurrence rate
muscle dysfunction. C. Definitive treatment
A. Due to coordinated relaxation and contraction of D. Need for multiple sessions
cricopharyngeus
B. Will not result to Zenker’s diverticulum 20. If the patient w. achalasia opted to go under surgery
C. Will complain of dysphagia what can you offer?
D. Can’t be treated conservatively A. Total esophagectomy
B. Distal esophagectomy with gastric pull up
C. Total esophagectomy w/ colonic interposition
D. Esophagectomy with or without anitreflux
procedure
21. A patient came in complaining of chest pain that is 32. Which of the following best describes Bilroth II
spontaneous, resolves on its own and is accompanied by procedure?
weight loss. Esophagometry was done revealing diffuse A. Jejunum is anastomosed to stomach
non-peristaltic movement and normal LES relaxation. B. Jejunum is anastomosed to esophagus
What will be your likely diagnosis? C. Jejunum is anastomosed to duodenum
A. Achalasia
B. Zenker’s diverticulum 33. Which of the ff best describes Whipples’ procedure?
C. GERD A. Removal of pancreatic head and duodenum
D. Diffuse esophageal spasm 34. 53 y/o male came to the ER coming from another
hospital. Patient complained of severe abdominal pain
22. Which is true of GERD? couple of hours ago. Patient is non-alcoholic and self-
A. Increased LES pressure medicating of NSAIDs. BP is normal, generalized muscle
B. Treatment is surgery only guarding with hypoactive bowel sounds. Initial xray
C. 24 hr pH monitoring can be done shows pneumoperitoneum. Which of the ff is least
D. Medical treatment will fail appropriate?
A. Infusion ng IV fluid
23. Stimulation of vasovagal reflex upon NGT insertion B. IV PPI
can be possible in what physiologic esophageal C. Open abdomen and do omental patching
constriction when inserting NGT? D. Open abdomen and do antrectomy, pyloroplasty,
A. 1st gastrojejunostomy
B. 3rd
C. 2nd 35. Most significant cause of gastric ulcers?
D. 4th A. Unrelieved hunger
B. Hypersecretion of acid
24. Will warrant surgical intervention for GERD C. Mucosal injury
A. Dysphagia D. Presence of ungested food
B. Esophagitis
C. Heart Burn 36. Which of the following factor is highly associated with
D. Gastric Ulcer development of duodenal ulcer?
A. Hypersecretion of acid
25. Balloon dilatation has the ff benefit:
A. Long term benefit 37. 35 y/o male diagnosed with gastric ulcer for several
B. Low recurrence rate months now with poor compliance to medications,
C. Definitive treatment uncontrolled cigarette smoking and alcohol intake. Which
D. Short term benefit of the ff complications does not need surgical treatment?
A. Perforated ulcer
26. Not a part of gastric vasculature B. Obstructed duodenum
A. Left gastric artery C. Spontaneous bleeding resolved without
B. Right gastric artery hemodynamic instability
C. Middle gastric artery D. Non-healing ulcer even after 3 months of treatment
D. Right gastroepiploic artery
38. Patient with Adenocarcinoma in the
27. Which of the following supplies the fundus of the gastroesophageal junction with Stage II ulcer that is
stomach? highly resectable
A. RGE A. Billroth II Antrectomy with gastrojejunostomy
B. LGE B. Billroth I Antrectomy with gastroduodenostomy
C. SG C. Truncal vagotomy with pyloroplasty
D. RG D. Total Gastrectomy with esophagojejunostomy

28. Which of the following is the nerve supply of the 39. Which of the ff is true of marginal ulcers?
anterior stomach? A. Ulcers found at the periphery of the stomach
A. Left vagus B. Commonly occurs in patients with partial
B. Right vagus gastrectomy and gastrointestinal anastomoses
C. Lateral vagus C. Bile reflux has no contribution
D. Medial vagus D. Vomiting is most common symptom

29. Not part of gastric vasculature 40. Which of the following is the most useful and
A. R gastric preferred diagnostic modality for upper GI bleeding?
B. L gastric A. Esophagogastroscopy
C. Middle gastric
D. R gastroepiploic 41. What is the most common benign neoplasm
originating from the gastric muscle?
30. Which of the following cells in the pyloric region is A. Sarcoma
physiologically most important for acid production? B. Lymphoma
A. G Cells C. Hypertrophic Polyp
D. Leiomyoma
31. Which of the following produces Pepsinogen?
A. Gastric Mucosa of Cardia 42. CASE: “least likely to cause recurrent ulcerations”
B. Gastric Mucosa of Fundus and Body A. Complete Vagotomy
C. Gastric Mucosa of Duodenum B. Retained Antrum
D. Gastric Mucosa of Gastroesophageal Junction C. Persistent H. pylori
D. Zollinger-Ellison Syndrome
43. 47 y/o, F, will undergo subtotal resection of the A. Dumping Syndrome
stomach. She was told that more than half will be B. Afferent Loop Syndrome
removed. What are the possible changes related to C. Both
impaired or inadequate absorption is least likely to D. neither
occur:
A. Vit. B deficiency 51. Overgrowth of bacterial organism B
B. Vit. A deficiency 52. Post prandial pain, bloating diarrhea B
C. Iron deficiency 53. Rapid emptying of hyperosmolar gastric content A
D. Vit. D and calcium deficiency 54. Fluid shift to lumen A
55. Vasomotor response A
44. 54/ female suspected with perforated peptic ulcer
disease, what diagnostic work-up is most appropriate? 56. True or false. After truncal vagotomy, plyloroplasty is
A. Abdominal x-ray, upright recommended. True
B. Abdominal x-ray, supine
C. Chest x-ray, upright 57. Fundus part of stomach is supplied by? Short
D. Chest x-ray, supine gastric artery

45. 35 y/o, underwent endoscopy and was found to have 58. Gastrojejunostomy is also known as: Bilroth II
an ulcer at the duodenum and the lower part of the
lesser curvature of the stomach, what management is 59. Gastric outlet obstruction due to chronic ulceration is
needed? most likely due to:
A. Treat primarily as a duodenal ulcer A. Fibrosis
B. Treat as gastric ulcers B. Bleeding
C. Treat gastric ulcers as separate entity to duodenal
ulcers 60. Most common type of malignancy in stomach?
D. Treats the patient neither as gastric ulcers Adenocarcinoma

46-50
A. Epithelial
B. Sub-epithelial
C. Both
D. Neither

46. Produces Bicarbonate? C

47. Provides restitution and proliferation? B
48. Creates and maintains pH gradient. A
49. Contains microvascular network B
50. Removes toxic metabolite by-products B