2010 Flashcards
48.A 32 year old woman with 2.5 thyroid nodules. She showed no clinical signs of hyperthyroidism and thyroid function tests were within normal. The nodule was cold and FNA suggested follicular neoplasia of the thyroid. What should you do next? 2010
a. Total thyroidectomy
b. Lobectomy with LN dissection
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While performing a cholecystectomy, the surgeon elaborates on the boundaries of the triangle of Calot in order to safely remove the gallbladder without injuring the surrounding structures. Which of the following structures passes through the triangle of Calot? 2011,
2010
a. Cystic artery
b. Cystic duct
c. Right hepatic artery
d. Left hepatic artery
a. Cystic artery
Note: The triangle of Calot is bounded by the common hepatic duct medially, the cystic duct laterally and the liver edge superiorly according to the modern definition. The cystic artery and Calot’s lymph node being the contents.
24.What are the borders of the Hesselbach’s triangle?
Inguinal ligament, Inferior epigastric artery, and Lateral border of rectus abdominis.
17.What is the best radiological term to describe a fracture of the humeral shaft that is displaced side to side in lateral direction without angulations?
a. Lateral translation
26.An elderly man with a history of resistant helicobacter pylori infection. What malignant tumor is he at highest risk of developing?
a. Gastric lymphoma
b. GIST
c. Gastric adenocarcinoma
a. Gastric lymphoma
20.Patient presented with gallstone pancreatitis. How to manage? 2010
a. ERCP
b. Cholecystectomy on same admission when the pain is relieved
c. Cholecystectomy when amylase normal
a. ERCP
(probably, confirm pls cause you do cholecystectomy for these patients eventually as well, but to prevent recurrence, not treat current situation.)
25.A 70 year old with osteoporosis fell from height, most common type of fracture?
Wedge
Female complaining of mass in the breast. What is the initial imaging?
Ultrasound
When should antibiotics be given in a Clean contaminated surgery? 2013, 2010
a. 4 hours before skin incision
b. 8 hours before skin incision
c. Within 1 hr of skin incision
d. After skin incision
c. Within 1 hr of skin incision
49.A patient after thyroidectomy developed perioral numbness. How to treat it? 2010
a. IV calcium gluconate
b. Oral vit D supplements
a. IV calcium gluconate
Which of the following would be the best method to diagnose prostate cancer? 2013, 2010
a. PSA only
b. CT scan
c. Transrectal ultrasound
d. PSA and transrectal ultrasound biopsy
d. PSA and transrectal ultrasound biopsy
Which of the following is responsible for bone resorption? 2010
a. Osteoclasts
b. Osteoblasts
c. Chondroblasts
d. Fibroblasts
a. Osteoclasts
What is the best imaging modality to detect the earliest abnormalities in AVN?
MRI
28.Diarrhea after broad spectrum antibiotics. How to treat it?
Metronidazol
22.Patient came with a 2 days history of SBO due to adhesions after he had a surgery. What is your management? 2010
a. IV fluid and NGT
b. NPO
c. Lysis of adhesion
c. Lysis of adhesion
12.A patient with septic arthritis developed secondary osteoarthritis. Which of the following is contraindicated?
Total hip replacement
(history of infection is contraindication)
41.Female with solid mass in the breast. How to confirm your diagnosis?
Core biopsy
Hot thyroid nodule, high T4, low TSH. How to treat this patient? 2010
a. Radioactive iodine
b. Surgical removal
a. Radioactive iodine
A 7-year-old child comes to the clinic with his mother complaining of limping. While examining the gait of the child, the doctor notices that his trunk shifts over the hip quickly and then shifts back to the opposite side due to pain in his lower limb. What type of gait is described here?
a. Antalgic gait
b. Waddling gait
c. Ataxic gait
d. Diplegic gait
a. Antalgic gait
Which of the following is associated with the highest risk of transmission with needle stick injury? 2017, 2016, 2013, 2010
a. Epstien-Barr virus
b. Hepatitis A virus
C. Hepatitis B virus
d. Hepatitis C virus
e. HIV
C. Hepatitis B virus
CDC data from most common to least: HBV (6-30%), HCV (1-2%), HIV (0.3%)
10.Diaphyseal fracture treated with open reduction and intramedullary nail. Goal of surgery?
2010
a. Anatomic reduction
b. Restore length and alignment
c. Promote primary healing
d. Formation of callus
e. Maintain absolute stability
b. Restore length and alignment
A 25-year-old man has a history of varicoceles in the right scrotum. Upon lying flat, the dilated veins do not disappear. Which of the following structures is likely to be obstructed?
2013, 2011, 2010
a. Inferior vena cava
b. External iliac artery
c. Internal iliac artery
d. Right renal artery
a. Inferior vena cava
Left-sided varicoceles are more common due to the indirect drainage of the left gonadal vein into the IC via the left renal vein. Right-sided varicoceles, on the other hand, should raise the suspicion of a retroperitoneal mass compressing the IVC and hence, predisposing to varicoceles
Which of the following has the highest malignant potential? 2011, 2010
a. Adenomatous polyp
b. Inflammatory polyp
c. Hamartomatous polyp
d. Hyperplastic polyp
a. Adenomatous polyp
21.What best describes symptoms of BPH? 2010
a. Hesitancy
b. Post void dribbling
c. Dysuria
d. Hematuria
?
17.Patient had an accident and was given blood, later on he became tachycardic, tachypneic and hypotensive. Why is that? 2010
a. Catheter-related infection
b. Disseminated intravascular coagulation
c. Transfusion reaction
c. Transfusion reaction
27.A 23 year old patient complains of a 6 week history of bloody diarrhea with mucus, and tenderness without guarding. Vitals were stable. What is your diagnosis?
Ulcerative Colitis
43.Breast mass found to be infiltrating ductal carcinoma on biopsy but without clinical evidence of lymphadenopathy. What is your management? 2010
a. Wide local excision
b. Wide local excision with axillary lymph node dissection
c. Wide local excision with axillary lymph node radiation
d. Wide local excision with sentinel node biopsy and radiation
d. Wide local excision with sentinel node biopsy and radiation
17.15 hrs history of retention. Immediate action is?
Immediate insertion of a folly’s
10.What do carcinoid tumor cells arise from?
Enterochromaffin cells.
47.Which nerve is commonly injured during a parotidectomy?
Facial nerve
A 72-year-old man after hip replacement surgery presented with abdominal pain, bloating, nausea and vomiting. He was diagnosed with Ogilvie’s syndrome (Acute Colonic Pseudo-Obstruction ACPO). Which of the following drugs is used for treatment?
Neostigmine
A 6-month-old baby was brought by his parents to the urology clinic to get circumcised. On physical examination of the baby, the urethral meatus was on the ventral aspect of his penis. The parents are so willing to have their child circumcised. What advice would be recommended for the parents regarding their child’s circumcision? 2013, 2011, 2010
a. Circumcision is contraindicated in hypospadias
b. They should wait when their son is older
c. It should be performed immediately
a. Circumcision is contraindicated in hypospadias
Hypospadias are an absolute contraindication for circumcision which should be deferred as the foreskin may be utilized in the correction.
16.Supracondylar fracture w/ no palpable radial pulse, what is the management? 2010
a. Urgent surgical exploration
b. Open reduction
c. Closed reduction
d. Call vascular surgeon
a. Urgent surgical exploration
13.MVA with pelvic fracture and bleeding, which is most likely the source of bleeding?
Bone marrow and veins
(80%
Which of the following is a radiological finding in malignant bone tumors?
Wide transition zone
31.A patient with a history of breast cancer that was resected now presented with back pain.
She is diagnosed with a compression fracture. What imaging technique will you perform next? 2012, 2010
a. Bone scan
b. No further imaging is needed
a. Bone scan
24.A 39-year-old man presented to the surgery OPD with a groin swelling that he noticed while taking a shower. The doctor was not able to manually reduce it. However, the mass was not tender to palpation, and no overlying skin changes were present. How should this patient be managed?
a. Elective repair
b. Immediate surgical exploration
a. Elective repair
A patient with left scrotal pain with absent cremasteric reflex and high riding testes. What is your diagnosis?
Testicular torsion
22.Which of the following depicts a correct sequence of the steps done at the emergency room to manage an open fracture?
Intravenous antibiotics for 72 hours -> debridement and irrigation -> external fixation
What is the earliest sign of osteoarthritis? 2010
a. Valgus
b. Varus
c. None of the above
b. Varus
What are the cells of origin in gastrointestinal stromal tumors? 2013, 2011, 2010
a. Cajal cells
b. Kutchinsky cells
c. Paneth cells
a. Cajal cells
18.A patient with moderate retention and residual urine of 30 ml. How to manage? 2010
a. Discharge home with alpha blocker
b. Self-administered catheter
a. Discharge home with alpha blocker
15.A 45-year-old female complains of inability to control her urination while coughing, sneezing or lifting heavy objects. What is the likely diagnosis? 2011, 2010
a. Stress incontinence
b. Urge incontinence
c. Mixed incontinence
a. Stress incontinence
23.A 43-year-old man presents to the hospital with an episode of hematemesis. Upper endoscopy revealed the presence of a bleeding peptic ulcer. The patient was resuscitated and is now stable. Following investigations showed that the patient was positive for Helicobacter pylori. What is the treatment option available for this patient? 2011, 2010
a. Proton pump inhibitors and antibiotics against H. pylori
b. Proton pump inhibitors and H2 receptor antagonists
a. Proton pump inhibitors and antibiotics against H. pylori
What is the imaging modality that has the least exposure to radiation? 2010
a. US
b. Xray
c. CT
a. US
18.A patient with carcinoid syndrome presented with wheezing, flushing, and diarrhea. What organ should the carcinoid tumor invade for carcinoid syndrome to occur? 2013, 2011, 2010
a. Colon
b. Liver
c. Rectum
b. Liver
Note: Hormones released by the tumor are metabolized by the liver and produce no symptoms; however, if hepatic metastases are present, hormones will drain into the systemic circulation without metabolism causing diarrhea, flushing and other symptoms of carcinoid syndrome.
A patient had a car accident, he developed bruises on the left lateral side of his chest below the nipple and he was hypotensive. Which organ is affected? 2010
a. Liver
b. Lungs
c. Pancreas
d. Spleen
d. Spleen
37.A 21-year-old woman complains of a mass in her breast that is causing her discomfort. On physical examination, the mass was mobile and rubbery in consistency. What is the likely diagnosis in this patient?
Fibroadenoma
32.A 20 year old female patient presented with a 4 cm papillary thyroid tumor in the right lobe.
How to manage?
Total thyroidectomy
17.The nerve you encounter during posterior approach open reduction for a distal humeral fracture?
Radial
A 36 year old female came in with bloody nipple discharge. What is the diagnosis? 2017,
2010
a. Abscess
b. Cyst
c. Intraductal papilloma
d. Prolactinoma
c. Intraductal papilloma
25.A patient with an 8 cm wound with segmental fracture and tissue injury with sufficient skin coverage with no vascular injury, which stage is this?
a. Illa
What type of fracture is most likely to occur due to repetitive use?
Stress fracture
12.Sexually transmitted disease with discharge and fever what is a possible LONG TERM complication?
Urethral stricture
Patient presented with signs of SBO, on examination you found an appendectomy scar.
What is the likely cause?
Adhesions
What is true regarding infertility? 2010
a. Azoospermia means no sperms in ejaculation
b. Oligospermia means abnormal motility
a. Azoospermia means no sperms in ejaculation
15.Patient with anal fissure, failed conservative treatment. How to manage next? 2010
a. GTN ointment
b. Lateral internal sphincterotomy
b. Lateral internal sphincterotomy
Patient with post obstructive diuresis. What is the cause?
Release of an outlet obstruction
27.Who is accepted to undergo bariatric surgery? 2010
a. BMI >35 with comorbidities or BMI >40
28.Inheritance for HNPCC?
AD
Which is true regarding hydrocele? 2010
a. Always bilateral
b. Usually painful
c. Require surgery
d. Associated with infections commonly
c. Require surgery
25.Irreducible mass lateral and inferior to the pubic tubercle. What is most likely your diagnosis?
a. Incarcerated femoral hernia
A 26 year old male had a motorcycle accident. The doctor in the ER found blood on his urethral meatus. He also had a severe pelvic injury distending his abdomen. Physical examination revealed a dullness of the suprapubic area on percussion. What is most likely to be injured? 2013, 2010
a. Intraperitoneal bladder rupture
b. Penis crush injury
c. Membranous urethra injury
c. Membranous urethra injury
Virus causing Anal condyloma?
HPV
An 18 years old male with sudden severe left scrotal pain, no history of trauma, on examination there was swelling and tenderness. What is management? 2010
a. Laboratory exploration
b. Admit for further investigation and give iv antibiotic
a. Laboratory exploration
11.Which of the following is an emergency? 2010
a. Gonococcal arthritis
b. Gouty arthritis
c. RA arthritis
a. Gonococcal arthritis
What is your immediate step after transfusion reaction? 2010
a. Give the patient heparin
b. Stop the transfusion
b. Stop the transfusion
20.A patient with BPH with lower urinary tract symptoms. Which of the following is true about management?
Transurethral prostate resection is indicated when there is renal impairment
20.Tension pneumothorax is diagnosed clinically by? 2010
a. Decrease air entry
b. Distended neck vein
c. Mediastinal shift on CXT
d. Sulcus sign
b. Distended neck vein
42.After undergoing thyroidectomy, a 42-year-old lady was found to have difficulty breathing with stridor. Her oxygen saturation in room air was 94%. There was no blood found in her wound. What would be the immediate management for this patient? 2011, 2010
a. Endotracheal intubation
b. Tracheostomy
a. Endotracheal intubation
24.A patient with a previous history of mastectomy is now having back pain?
Cord compression
15.A 42-year-old man had recently undergone a choledochojejunostomy. Few days later, he developed abdominal pain and fever. The drainage bag contained a greenish discharge.
What is the underlying cause of this patient’s presentation? 2011, 2010
a. Abscess
b. Anastomotic leak
c. Ascending cholangitis
d. Digested blood
b. Anastomotic leak
What is the most effective way to decrease the risk of MRSA infection in normal surgical patients? 2016, 2010
a. Hand washing
b. Wearing masks and gloves
c. Isolation in negative pressure rooms
d. Antibiotic administration
a. Hand washing
13.A 29-year-old female presented with jaundice. Laboratory testing revealed an IN of 1.8.
What is most likely to be deficient? 2010
a. Factor Ill
b. Factor VIll
c. Tissue Plasminogen Activator (tPA)
d. Vitamin K
e. Von-Willebrand factor
d. Vitamin K
26.A 65 year old male with HCV presented with liver mass. What is the common primary liver malignancy in his condition? 2010
a. Hepatocellular carcinoma
b. Liver metastasis
a. Hepatocellular carcinoma
A 56-year-old man who has a known history of hypertension, diabetes mellitus, coronary heart disease and epilepsy takes the following drugs: alpha blockers, carbamazepine, metformin and atenolol. He comes to the urology clinic with a complaint of erectile dysfunction. Which of the drugs he takes is likely to have caused his erectile dysfunction?
2013, 2011, 2010
a. Carbamazepine
b. Atenolol
c. Alpha blockers
d. Metformin
a. Carbamazepine
36.What is the mode of inheritance of the BRCA1 gene? 2011, 2010
a. Autosomal dominant
b. Autosomal recessive
c. X-linked dominant
d. X-linked recessive
a. Autosomal dominant
10.A 53 year old lady underwent a modified radical mastectomy to treat her breast cancer.
After the procedure, she was noticed to have a protruding scapula and difficulty abducting her arm. Which nerve has been likely injured? 2016, 2011, 2010
a. Axillary nerve
b. Lateral pectoral nerve
c. Long thoracic nerve
d. Medial pectoral nerve
e. Thoracodorsal nerve
c. Long thoracic nerve
A 34-year-old man presented with severe flank pain and decreased urine output but is allergic to iodine. How should this patient be initially investigated? 2013, 2011, 2010
a. Retrograde urethrogram
b. Ultrasound of the kidney, ureter and urinary bladder
c. CT scan with contrast
b. Ultrasound of the kidney, ureter and urinary bladder
How to test for carcinoid tumors? 2010
a. Serum serotonin
b. Urine 5-HIAA
b. Urine 5-HIAA
What best describes a total thyroidectomy wound? 2012, 2010
a. Clean-contaminated
b. Clean Wound
b. Clean Wound
13.A 1 year old child, limping, painless, can’t abduct his limb. What is most likely to be the diagnosis?
DDH
19.Which drug is used to treat malignant hyperthermia? 2010
a. Dantrolene
b. Halothane
c. Naloxone
d. N-acetylcysteine
e. Protamine
a. Dantrolene
26.A patient with ischemic spinal lesion affecting his corticospinal tract mainly?
Anterior cord syndrome
14.A 70 year old woman tripped on the grass while playing golf and sustained a displaced comminuted femoral neck injury. How to treat it? 2010
a. Total hip replacement
b. Hemiarthroplasty
a. Total hip replacement
(Hemiarthroplasty not good long term outcome)
42.What is the most common site of breast metastasis? 2010
a. Brain
b. Bone
c. Liver
d. Lungs
d. Lungs
28.A patient presented with right upper quadrant pain, fever, and jaundice. What does this indicate?
Acute cholecystitis
Patient was diagnosed with seminoma and removed his testis. What’s next? 2010
a. Retroperitoneal LN radiation
b. Retroperitoneal LN resection
a. Retroperitoneal LN radiation
Transitional cell carcinoma or urothelial cell carcinoma and Squamous cell carcinoma were
NEVER mentioned in the choices
13.You were called by the ICU to assess a 43 year old male 2 hours after inserting an internal jugular vein catheter after uncomplicated partial liver surgery. He has a history of myocardial infarction and bronchial asthma. The patient appears to be short of breath and is unwell. Vital signs are HR 120, BP 95/50, T 37.2, O, sat. 87%. What is the diagnosis or cause?
2012, 2010
a. Atelectasis
b. Aspiration pneumonia
c. Myocardial infarction
d. Pneumothorax
e. Pulmonary embolism
d. Pneumothorax
*Common after inserting a central line, that’s why you might order a CXR
What could be a cause of priapism in a patient from the East Mediterranean region? 2011,
2010
a. Sickle cell disease
b. Hemophilia
c. Peripheral vascular disease
a. Sickle cell disease
A young obese boy with a history of hypothyroidism reports a history of severe hip pain that is causing him to limp as he is unable to bear weight. On flexion of the hip there’s a forced external rotation. What is the likely diagnosis? 2016, 2012, 2011, 2010
a. Juvenile osteoarthritis
b. Development Dysplasia of the Hip (DDH)
c. Limb Length Discrepancy (LLD)
d. Legg-Calve-Perthes Disease (LCPD)
e. Slipped Capital Femoral Epiphysis Disease (SCFE)
e. Slipped Capital Femoral Epiphysis Disease (SCFE)
Patient in ICU after brain trauma developed acalcular cholecystitis. How to manage? 2010
a. Cholecystectomy
b. Percutaneous drainage
b. Percutaneous drainage
11.A 66-year-old patient with painless jaundice. On CT scan, a 3 cm mass in the pancreatic head was found. It was also abutting the portal vein. Which of the following is the most appropriate intervention? 2015, 2010
a. Palliative chemotherapy
b. Palliative dilation
c. Whipple procedure
c. Whipple procedure
(most of us put this, during the exam one of the residents proctoring told a few students it was wrong but it was the best choice within the choices. As far as we know the whipple procedure can be done with adjuvant radiotherapy for minor invasion of the portal vein)
10.A boy playing soccer with a meniscus tear. Which of the following findings will be seen while examining him? 2010
a. Knee giving away
b. Effusion immediately after falling
c. Lateral meniscal tenderness
d. Medial meniscal tenderness
d. Medial meniscal tenderness
12.Malignant primary hyaline cartilage?
Chondrosarcoma
19.After 8 days of admission for acute pancreatitis, a 35 year old patient developed increasing
RUQ pain, US showed 10cm collection. What is the next management? 2010
a. Laparotomy
b. Percutaneous drainage
c. IV antibiotics
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What type of fracture is most likely to occur due to repetitive use?
Stress fracture
26.Which feature is most important to diagnose compartment syndrome? 2010
a. Pallor
b. Pulselessness
c. Paresthesia
d. Increased analgesia
d. Increased analgesia
Which of the following is correct about the knee joint?
ACL is more anterior then PCL
