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Surgery Final > 2015 > Flashcards

2015 Flashcards

1
Q

14.A patient was scheduled for an adrenalectomy to treat pheochromocytoma. To optimize his blood pressure and for hemodynamic stability, which drug should be given preoperatively?
2015
a. Alpha adrenergic blocker
b. Norepinephrine
c. Octreotide analogue
d. Serotonin
e. Steroids

A

a. Alpha adrenergic blocker
We must give patients alpha blockers and then beta blockers preoperatively to stop and adrenergic crisis from occurring

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2
Q

Which of the following is a urinary storage symptom? 2015
a. Weak stream.
b. Urgency.
c. Hesitancy.
d. Incomplete emptying of bladder.

A

b. Urgency.

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3
Q

What are the boundaries of Calot’s triangle? 2017, 2016, 2015, 2013
a. Cystic duct, common hepatic duct, inferior liver edge
b. Left hepatic duct, inferior liver edge and CBD
c. Right hepatic artery, cystic duct, and CBD

A

a. Cystic duct, common hepatic duct, inferior liver edge

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4
Q

A 38-year-old male known case of Crohn’s of terminal ileum for 3 years, came in with an 8-day history of abdominal pain and fever. CT showed 3x6 cm psoas abscess. What is most appropriate management? 2015
a. Percutaneous drainage
b. Ileocecal resection
c. Biological therapy

A

a. Percutaneous drainage

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5
Q

A patient presented with comminuted tibial fracture. It had an overlying wound 5 cm in size.
On close inspection, the wound was grossly contaminated. What is his best treatment option? 2015
a. ORIF
b. Cast placement
c. Splint placement
d. External fixator

A

d. External fixator

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6
Q

20.A female patient presenting to the clinic complaining of a mass in her neck which was increasing in size over time. Upon examination it was a midline firm mass, and needle biopsy was done which showed psammoma bodies. What is the likely diagnosis? 2015
a. Hurthle cell carcinoma
b. Medullary carcinoma
c. Papillary carcinoma

A

c. Papillary carcinoma

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7
Q

They gave a scenario of a patient with diabetes. What is the cause of delayed wound healing in this patient? 2015
a. Microorganism
b. Diabetes
c. Nutritional
d. Smoking

A

b. Diabetes

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8
Q

A young patient with IBD presented with a groin pain exacerbated by weight- bearing. The x-ray showed avascular necrosis stage 2. What is the immediate/ best treatment? 2015
a. Core decompression.
b. Total hip replacement.
c. Stop his medications (steroids).

A

a. Core decompression.

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9
Q

What is the most appropriate treatment for a displaced midshaft forearm fracture in an adult? 2015
a. Open reduction with internal fixation (ORIF).
b. Intramedullary nail.
c. Closed reduction with an above elbow cast.
d. Closed reduction with a below elbow cast.
e. K wires.

A

a. Open reduction with internal fixation (ORIF).

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10
Q

Which of the following describes how the BMI can be measured?

A

A person’s weight in kg / their height in m2

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11
Q

A BPH patient developed urinary retention post TURP. What is the most appropriate step in management?

A

Foley’s catheter insertion

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12
Q

10.A patient with chronic pancreatitis recently developed fatty stools that float. What will most likely be deficient if this condition remains untreated? 2015
a. Vitamin D
b. Vitamin B1
c. Vitamin C
d. Vitamin B6
e. Iron

A

a. Vitamin D
(The question was just asking for fat soluble vitamins “ADEK” which would be deficient in chronic pancreatitis)

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13
Q

A patient has testicular cancer. He is positive for B-HCG. What is the name of the tumor?
2015
a. Seminoma.
b. Yolk sac tumor.
c. Embryonal carcinoma.
d. Choriocarcinoma.

A

d. Choriocarcinoma.

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14
Q

13.A female patient has a femoral fracture. She was on parenteral nutrition for the past 6 years following small bowel resection. How would you manage her parenteral nutrition in this case? 2015
a. Decrease amino acid intake.
b. Decrease lipid intake.
c. Increase energy intake.
d. Keep it as it is.

A

c. Increase energy intake.
(Post-trauma, burns, and even surgery, caloric needs will increase as well as protein for wound healing but increased amino acid was not a choice in the exam)

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15
Q

A patient was brought to the casualty with an open book pelvic fracture. After resuscitation, pulse rate was high and blood pressure was low. He is hemodynamically unstable despite applying pelvic binder. Abdominal US (FAST) was negative for any intra abdominal fluid. His BP remained 80/50 with palpable faint pulse despite transfusing 4 units of PRBC. What will be your next step? 2015, 2014
a. Transfuse more blood
b. Exploratory laparotomy
c. Start cardiopulmonary resuscitation
d. Diagnostic angiography
e. Pelvis packing in the operating room

A

d. Diagnostic angiography

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16
Q

What represents the roof of the inguinal canal? 2015
a. External and internal oblique muscles
b. Transverse and conjoint tendon
c. Transverse and internal oblique aponeurosis

A

c. Transverse and internal oblique aponeurosis

Not A because external forms the anterior wall

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17
Q

What is the minimum BMI for bariatric surgery if the patient has no comorbidities? 2015
a. 30
b. 35
c. 40
d. 45

A

c. 40

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18
Q

Which of the following is a tumor marker for pancreatic cancer? 2015, 2011
a. CEA
b. CA 19-9
c. Ca-125
d. Alpha fetoprotein

A

b. CA 19-9

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19
Q

18.A radiologist was called by the surgeon to biopsy a difficult breast lump. However, even he failed to do so. What should be done next?

A

Core needle biopsy with wire localization

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20
Q

Which hormone is responsible for postprandial pain in patients with cholelithiasis?

A

Cholecystokinin

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21
Q

A 72-year-old lady came with abdominal pain, nausea and vomiting. Appropriate investigations were done, and a diagnosis of small bowel obstruction was made. She has never had abdominal surgery before. In the OR, an intussusception of the ileum was found.
The surgeon decided to undo the intussusception manually. What is the most appropriate next step? 2015
a. Do intraoperative gastroscopy
b. Do intraoperative colonoscopy
c. Open the lesser sac and explore the stomach
d. Resect the part with intussusception
e. Close the abdomen

A

d. Resect the part with intussusception

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22
Q

17.A 68-year-old obese female with no other health conditions is planned for large ventral hernia repair. What is the best plan to prevent deep vein thrombosis? 2015
a. Ambulate early with compression devices
b. Give LMWH until ambulatory then discontinue
c. Give LMWH until discharge
d. Give LMWH for 28 days
e. Give LMWH indefinitely

A

c. Give LMWH until discharge

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23
Q

19.A 31-year-old female came to the clinic for an incidental breast mass. She had a mammogram and her BIRAD score was 3. What is the most appropriate management plan?
2015
a. MRI has to be done
b. Neoadjuvant chemotherapy
c. Repeat mammography in 2 years
d. Resect the mass
e. Short-term follow-up in 6 months

A

e. Short-term follow-up in 6 months

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24
Q

A 45-year-old patient presented to the ER after a road traffic accident. On examination, He was disoriented, opened his eyes to painful stimuli, and had a decorticate response. What is his GCS? 2015
a. 7
b. 8
C. 9
d. 10
e. 11

A

C. 9

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25
Q

A 70-year-old female presented with large bowel obstruction. Imaging showed sigmoid volvulus. She was hemodynamically stable. What is appropriate management for this patient? 2015
a. Colonoscopy and Reduction
b. Sigmoid Colectomy
c. Total Proctocolectomy

A

a. Colonoscopy and Reduction

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26
Q

An expert surgeon was performing a surgery to fix the humerus posteriorly. After the surgery, the patient experienced a wrist drop. What is the most likely cause? 2015
a. Radial nerve cut.
b. Traction neuropraxia.

A

b. Traction neuropraxia.

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27
Q

12.A 38 years old male presented with a firm lump on the right side of his neck under the mandible and anterior to the SCM. The size of the lump is 3 cm. It is adherent to the skin with visible punctum. What is the diagnosis? 2016, 2015
a. Branchial cyst
b. Cystic hygroma
c. Epidermal cyst
d. Thyroglossal cyst

A

c. Epidermal cyst

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28
Q

During defecation, a 56-year-old male feels something prolapsing, which he reduces manually. What is the diagnosis? 2016, 2015
a. Grade I hemorrhoids
b. Grade Il hemorrhoids
c. Grade Ill hemorrhoids
d. Grade IV hemorrhoids
e. Rectal prolapse

A

c. Grade Ill hemorrhoids

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29
Q

A 61 years old female presented with 48 hrs of nausea and vomiting and central abdominal pain. She had a history of Hysterectomy. On CT, small bowel obstruction is diagnosed. What is the next appropriate management?
a. NG tube and IV fluid
b. Exploratory laparotomy
c. Total colectomy

A

a. NG tube and IV fluid

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30
Q

A patient has felt some epigastric pain post-surgery. On examination the abdomen was tender in the epigastric area. What is the best next step? 2015
a. Water soluble esophagram
b. Endoscopy

A

b. Endoscopy
(If the scenario depicted esophageal perforation, the answer would be A. Since it’s unlikely to be perforation (patients present with chest crepitations/surgical emphysema and fever/chills and signs of shock) then the best next step would most probably be an endoscopy)

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31
Q

A 32-year-old woman complained of difficulty swallowing. She says that she regurgitates undigested food she ate a couple of days back. Esophageal manometry showed a hypertensive lower esophageal sphincter which fails to relax and peristalsis of the esophageal body. What is the diagnosis? 2015, 2011
a. Achalasia
b. Diffuse Esophageal Spasm
c. Gastroesophageal reflux disease

A

a. Achalasia

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32
Q

15.A patient presented with resistant hypertension and you suspect a diagnosis of Conn’s disease. What lab test would help in confirming your suspicion? 2015
a. Aldosterone renin ratio
b. Dexamethasone suppression test
c. Urine cortisol

A

a. Aldosterone renin ratio

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33
Q

21.A patient with a history of fever/URT signs presented with a tender neck swelling. What would histology show? 2015
a. Lymphoid follicle with multiple germinal centers
b. Lymphocyte infiltration with occasional germinal centers
c. Multinucleated cells and inflammatory infiltrate

A

c. Multinucleated cells and inflammatory infiltrate
(subacute thyroiditis)

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34
Q

A patient with Parkinson disease has recurrent urinary tract infections. What is the most common type of stone in these patients? 2016, 2015
a. Struvite.
b. Cystine.
c. Calcium oxalate.
d. Ammonium oxalate.

A

a. Struvite.

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35
Q

A patient had winging of the scapula post axillary lymph node dissection. Which nerve injury is responsible for such a presentation? 2015
a. Long thoracic
b. Thoracodorsal
c. Medial pectoral
d. Lateral pectoral

A

a. Long thoracic

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36
Q

After falling down, a patient presented with shoulder pain. On examination, he had weakness of elbow extension, wrist flexion, and numbness of the forearm. He also had a decreased triceps reflex. Which nerve root is involved? 2015
a. C5
b. C6
c. C7
d. C8
e. T1

A

c. C7

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37
Q

16.A 45 years old gentleman presented with pain in the inguinal region 3 weeks after an open inguinal hernia repair with mesh and plug. The pain was burning and sharp in sensation along the L1 dermatome. What is the most likely cause? 2015
a. injury to ilioinguinal
b. injury to genitofemoral
c. injury to vas deferens
d. injury to spermatic cord

A

a. injury to ilioinguinal

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38
Q

10.A 61-year old patient with chronic back pain. He has weak plantar reflex and numbness in big toe. Which of the following nerve roots is likely to be affected? 2015
a. L3
b. L4
c. L5
d. S1
e. 52

A

d. S1

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39
Q

A 27 year old male patient came to the outpatient clinic complaining of bleeding per rectum frequently for the past 3 months. He has no pain or fever. Proctoscopy showed grade one hemorrhoids with no bleeding. What is the best initial management? 2016, 2015
a. Colonoscopy to rule out malignancy
b. Hemorrhoidectomy
c. High fiber diet, laxatives, sit bath

A

c. High fiber diet, laxatives, sit bath

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40
Q

A young man had fallen from a building ( vertically resulting in axial load on the body). He had lost sensation in both lower limbs. On investigation, fracture of L2 vertebra was diagnosed. What type of injury/ fracture to the vertebra would you expect in this scenario?
2015
a. Burst fracture with central canal compression
b. Wedge fracture with less than 10% loss of height.

A

a. Burst fracture with central canal compression

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41
Q

What is the most important step in the management of open fractures? 2015
a. Time from injury to debridement
b. Time from injury to antibiotics
c. Time from injury to irrigation

A

b. Time from injury to antibiotics

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42
Q

10.A 58-year-old patient came to the ER with easy fatigue & general weakness. He had no abdominal pain, no vomiting, or blood per rectum. He was treated 1 year ago with iron supplements. Upon presentation, he had HR 89, BP 130/70, Hb 9. What further investigation would you do?
a. Ct angio
b. Colonoscopy
c. Nuclear test
d. Mesenteric angio
e. Capsule endoscopy

A

b. Colonoscopy

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43
Q

16.You are called to assess a 23-year old patient post hemi-thyroidectomy. She is developing respiratory distress. In addition, she is becoming stridorous and more agitated. What should you do? 2015, 2013
a. Arrange for CT to check for collection.
b. Arrange for US to check for collection.
c. Treat with diphenhydramine and epinephrine.
d. Ventolin nebulizer and CXR.
e. Notify on-call team and anesthesia to evacuate hematoma and protect airway.

A

e. Notify on-call team and anesthesia to evacuate hematoma and protect airway.

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44
Q

22.A middle aged female with weight loss, anxiety, and visual problems. On examination of the neck, no mass was felt on palpation, however, on auscultation of the neck, a bruit was heard. What is the diagnosis?

A

Graves disease

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45
Q

A patient had a total thyroidectomy for a large goiter. On the third day, he complained of numbness and his hands contracted in response to increase cuff pressure. The ECG showed prolonged QT. What is the most likely abnormality? 2017, 2015
a. Hypokalemia
b. Hyperkalemia
c. Hypocalcemia
d. Hypercalcemia

A

c. Hypocalcemia
A positive Trousseau’s sign is defined by flexion of the wrist, the thumb, and the joints located between the palm of the hand and the fingers, along with the extension of the fingers.

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46
Q

It is known that a lot of patients in the ICU get infections (something basic like that). What is the best way to avoid infection of patients who spend time in the ICU? 2015
a. Wash hands before seeing every patient
b. Wash patient with hydrochloride
c. Maintain blood glucose of 10 mmol

A

a. Wash hands before seeing every patient
(hand washing is the single most important factor in reducing hospital acquired infection)

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47
Q

10.A 55-year-old man underwent gastrectomy for adenocarcinoma. 5 years later, he had no recurrence, but developed megaloblastic anemia. What’s the reason? 2015
a. Alcohol
b. B1 deficiency
c. Duodenal bypass
d. Folate deficiency
e. Parietal cell deficiency

A

e. Parietal cell deficiency

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48
Q

A 65-year old man on warfarin. For the first time, he is having urinary retention. When checked, the prostate was large without nodules, weighed 100 grams. Diverticula was found in the bladder. His kidney function is normal. What is the appropriate management? 2015
a. TURP.
b. Give Tamsulosin (an alpha-adrenergic blocker) and observe.
c. Suprapubic proctectomy.
d. D-Laser prostatectomy.

A

b. Give Tamsulosin (an alpha-adrenergic blocker) and observe.
Answer: B (There is no absolute indication to do TURP, the patient should have Renal failure or more than one episode of acute retention to be eligible for TURP before trial of medical therapy. Also, the patient is on warfarin so if he DID have renal failure D would be better than A)

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49
Q

12.A patient presented to the ER hypotensive following a 4-floor fall. Two liters of fluids were infused with no response. The FAST examination was positive. There was also pelvic instability and flank ecchymosis. What is the most appropriate next step in management?
2015
a. Infusion of O-ve packed RBC
b. Angioembolization
c. Explorative laparotomy
d. Pelvic wrap

A

a. Infusion of O-ve packed RBC

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50
Q

13.Patient with hernia that is irreducible and also has a fever and tenderness in the abdomen.
The skin overlying the hernia was erythematous. What is the next step? 2015
a. Erect chest X-ray
b. Laparotomy

A

b. Laparotomy

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51
Q

What is the embryological origin of Verumontanum? 2015
a. Mullerian ducts.
b. Wolffian ducts.
c. Urogenital sinus.
d. Allantois.
e. Yolk sac.

A

a. Mullerian ducts.
(utricle is from the mullerian ducts)

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52
Q

What is the most common primary malignant bone tumor around the knee joint in young adults? 2015
a. Osteosarcoma
b. Chondrosarcoma
c. Ewing sarcoma

A

a. Osteosarcoma

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53
Q

Scenario of a patient with gastric varices, what is the definitive treatment knowing that the patient does not have cirrhosis? 2015
a. Band ligation
b. Sclerotherapy
c. Splenectomy

A

c. Splenectomy
(key words are gastric varices, and definitive treatment)

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54
Q

13.A 32-year-old female presented with tachycardia, hypotension, and low blood pressure.
History taking revealed she had undergone a laparoscopic sleeve surgery for morbid obesity, two weeks ago. What could be the reason? 2015
a. Anastomotic leak
b. Bleeding
c. DVT
d. Wound infection
e. Pneumonia

A

a. Anastomotic leak

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55
Q

How long does spermatogenesis take?

A

128 days.

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56
Q

A patient with left testicular cancer with positive lymph nodes. Which of the following lymph nodes are particularly affected? 2017, 2016, 2015
a. Para-aortic
b. Paracaval
c. Pelvic
d. Inguinal

A

a. Para-aortic

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57
Q

A trauma patient arrived at the ER unconscious and required immediate surgical intervention. From whom should the consent be taken? 2017, 2016, 2015
a. Patient
b. Partner
c. Ethics Office
d. Judge
e. Surgeon

A

e. Surgeon

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58
Q

A patient biopsy of his bladder tumor showed invasion of the muscularis mucosa. What is the best management plan? 2015
a. Radical cystectomy
b. TURBT
c. Intravesical chemotherapy

A

a. Radical cystectomy

59
Q

Which of the following is an early sign of xylocaine (lidocaine) toxicity? 2016, 2015, 2013,
2012
a. Cardiac arrhythmia
b. Perioral numbness
c. Seizures

A

b. Perioral numbness
Lidocaine is a class I antiarrhythmic drug, its toxicity can cause both cardiac and CNS manifestations, but CNS is by far the most common. However, early symptoms of its toxicity are circumoral numbness, tongue paresthesia, and dizziness. Sensory complaints may include tinnitus and blurred vision. Excitatory signs, such as restlessness, agitation, nervousness, or paranoia, may progress to muscle twitches and seizures.

60
Q

A 56 Female presented with sudden, severe abdominal pain radiating to the back with vomiting of food mixed with bile. The abdomen is tender. Amylase around 1560, Bilirubin 96, Erect chest X-ray was unremarkable. What is the best modality to do? 2016, 2015
a. Abdominal ultrasound
b. CT of the abdomen
c. CT abdomen\ pelvis
d. MRCP
e. HIDA scan

A

b. CT of the abdomen

61
Q

Following a road traffic accident, the patient presented with clear nasal discharge, discoloration around his eyes, and headache. What is the most likely issue going on in this patient? 2015
a. Allergic rhinitis
b. Basilar fracture
c. Nasal fracture
d. Zygomatic fracture

A

b. Basilar fracture

62
Q

A 60-year-old male came to his GP for a routine checkup. PSA was 10 ng/dl (normal: 2.4-4).
DRE showed a nodule close to the left base of the prostate. The patient has no urinary symptoms. Family history is positive for prostate cancer. What is the best next step in this patient workup? 2015
a. Transurethral biopsy of prostate
b. Transrectal biopsy of prostate.
c. Transabdominal biopsy of prostate.
d. MRI-guided biopsy of prostate.
e. Ultrasound-guided biopsy of prostate.

A

b. Transrectal biopsy of prostate.

63
Q

What is the explanation of the migration of pain from the periumbilical area to the RLQ in appendicitis? 2015
a. (local) Peritoneal irritation
b. Lumen distention

A

a. (local) Peritoneal irritation

64
Q

An 80-year-old male, with restrictive lung disease, requires urethral catheterization. His physician wants to give him chronic prophylaxis to UTI. Which drug will worsen his respiratory condition? 2016, 2015
a. Ciprofloxacin
b. Nitrofurantoin
c. Amoxicillin
d. Cefuroxime
e. Trimethoprim/sulfamethoxazole

A

b. Nitrofurantoin

65
Q

11.A scenario describing symptoms of compartment syndrome. What is the most accurate way to diagnose compartment syndrome? 2015
a. Systolic - intra-compartmental pressure > 35 mmHg.
b. Diastolic - intra-compartmental > 35 mmHg.

A

b. Diastolic - intra-compartmental > 35 mmHg.

66
Q

A 40-year-old asymptomatic male was referred to a urologist as his urinalysis showed 10
RBCs/HPF and the rest of urinalysis was normal. What is the next best step? 2016, 2015
a. Repeat urinalysis
b. Cystoscopy
c. CT urography
d. Flexible cystoscopy.
e. Mig3 lasix.

A

a. Repeat urinalysis
If he had only microscopic, otherwise in macroscopic hematuria a stepwise approach would be lab tests, imaging eg CTU, then more ‘invasive’ but definitive procedures such as cystoscopy

67
Q

A patient presented with persistent and prolonged penile erection even in absence of any sexual desire. What is the diagnosis? 2015
a. Priapism.
b. Peyronie’s disease.
c. Premature ejaculation.
d. Phimosis.

A

a. Priapism.

68
Q

10.A 23-year-old male had an open fracture with wood pieces inside the wound in the recent Beirut explosion. On follow-up, X-ray showed malunion. What is the most probable cause of his complication? 2015
a. Smoking
b. Diabetes
c. Foreign body
d. Malalignment

A

c. Foreign body

69
Q

A 58-year old lady diagnosed with muscle invasive bladder cancer is undergoing radical cystectomy and neobladder reconstruction using the terminal ileum. On the next follow up, she looked pale and was found to have megaloblastic anemia. What is the most likely cause of her anemia? 2015
a. Infection.
b. Renal impairment.
c. Medication toxicity.
d. Vitamin B12 deficiency.
e. Folate deficiency.

A

d. Vitamin B12 deficiency.
(ileal resection caused impaired absorption)

70
Q

11.A 69-year old male is in the ICU for a while because of exacerbation of his COPD. He is fed by TPN. He complains of right upper quadrant pain for the past few weeks. Then he developed fever, high ALP and high bilirubin. Ultrasound revealed acalculous gallbladder.
What is the most probable diagnosis? 2015
a. Acute cholecystitis.
b. Acute pancreatitis.
c. Acute hepatitis.
d. Acalculous cholecystitis.

A

d. Acalculous cholecystitis.

71
Q

What causes a chancroid? 2016, 2015, 2012
a. Haemophilus ducreyi
b. Neisseria gonorrhoeae.
c. Trichomonas vaginalis
d. Treponema pallidum
e. Chlamydia

A

a. Haemophilus ducreyi

72
Q

11.Ringer lactate is contraindicated in which of the following situations? 2015
a. Burn Injury
b. Hypovolemic Shock
c. Enterocutaneous Fistula
d. Hypercalcemic Crisis
e. Small Bowel Obstruction

A

d. Hypercalcemic Crisis

73
Q

Which of the following cancers has raised carbohydrate antigen 19-9 (CA 19-9)? 2016, 2015
a. Ovarian
b. Breast
c. Prostate
d. Colon
e. Pancreas

A

e. Pancreas

74
Q

13.In patients with breast cancer, which of the following is associated with both poorer survival and increased likelihood of recurrence, an effect that persists after adjustment for tumor stage, grade, hormone receptor status, and adjuvant therapy? 2015
a. Age over 50
b. Breastfeeding
c. Early menarche
d. Male breast cancer
e. Obesity

A

e. Obesity

75
Q

A 68-year old smoker male developed dysphagia to solids for the past two months. He can take liquids only and has a severe cough with every oral intake. He lost 12 kg in 2 months. What is the most likely diagnosis? 2015
a. Carcinoma of the esophagus.
b. Diffuse esophageal spasm.
c. Duodenal diverticulum.
d. Pharyngeal diverticulum.

A

a. Carcinoma of the esophagus.
Answer: A (dysphagia is not progressive but the weight loss and time frame fit esophageal carcinoma the most)

76
Q

A 65-year-old hypertensive male and a known case of MI presents with hypotension, tachycardia, and fresh bleeding per rectum. His vitals are BP 85/50, HR 123. What is the appropriate sequence of management? 2015
a. Resuscitate, nasogastric tube insertion, rigid sigmoidoscopy
b. Resuscitate, colonoscopy, CT angiography
C. Resuscitate, mesenteric angiogram, colonoscopy
d. Resuscitate, Nuclear scan, colonoscopy
e. Resuscitate, proctoscopy, surgery

A

a. Resuscitate, nasogastric tube insertion, rigid sigmoidoscopy

(This is most likely the answer because NGT must be done to rule out UGI bleeding and a sigmoidoscopy is done to rule out distal rectal sources. Colonoscopy or CT angiography would be the next step)

77
Q

What kind of mode of fixation provides callus formation? 2015
a. Compression plate.
b. Intramedullary nail.
c. Hemiarthroplasty.
d. Total hip replacement.
e. Compression screw.

A

b. Intramedullary nail.

78
Q

Which of the following fractures has to be fixed considering primary bone healing? 2015
a. Humerus.
b. Femur.
c. Capitulum.

A

c. Capitulum.
As it is part of the elbow joint so absolute stability is a requirement

79
Q

21.A 34-year-old lady presented with redness and breast pain. Patient was not lactating or breastfeeding. What is the most appropriate management plan? 2015
a. Neoadjuvant chemotherapy
b. Simple mastectomy
c. Wide local excision

A

a. Neoadjuvant chemotherapy
Most likely invasive/inflammatory breast carcinoma

80
Q

A 45-year-old obese man presented with left iliac fossa pain. He’s stable and only has mild localized tenderness. WBC high is 16, CRP high (124). CT showed 3.8 cm paracolic collection around diverticulum in the sigmoid colon. What is the best INITIAL management? 2015
a. IV antibiotics
b. Laparoscopic washout AND drainage
c. Radiographic percutaneous drainage
d. Sigmoid colectomy with primary anastomosis
e. Laparoscopic washout WITHOUT drainage

A

a. IV antibiotics

81
Q

A 15-year old lady presented to your clinic with a breast mass. Based on your examination, you think it is either a cyst or fibroadenoma. What would be the best test to differentiate between the two?
a. Chest x-ray (CXR)
b. Compression views of mammography
c. Nuclear medicine scan
d. Ultrasound (U/S)

A

d. Ultrasound (U/S)

82
Q

A 57-year-old patient with end stage renal disease was admitted preoperatively for laparoscopic cholecystectomy. Preoperative ECG showed prolonged P waves and tall T waves. What is the definitive preoperative step? 2015
a. Insulin and glucose
b. IV Bicarbonate
c. IV Calcium Gluconate
d. Hemodialysis

A

d. Hemodialysis
(All patients on hemodialysis should be dialyzed within 24 hours pre-surgery regardless of electrolyte abnormality. Since he is in ESRD this would be the best choice as it is also the definitive treatment of hyperkalemia)

83
Q

A 28-year old male presented 8 hours after the accident with displaced femoral neck fracture. What is the most appropriate management? 2015
a. Open reduction with internal fixation (ORIF).
b. Total hip replacement.
c. Hemiarthroplasty.

A

a. Open reduction with internal fixation (ORIF).

84
Q

A 42-year old diabetic man presented with penile curvature that lasted for 1 year. Now, he also complains of unsuccessful sexual intercourse. What is the likely cause of his presentation? 2015
a. Diabetes.
b. Penile fracture.
c. Peyronie’s disease.
d. Psychogenic.
e. Priapism.

A

c. Peyronie’s disease.

85
Q

14.What other abnormality is found in a patient with hypomagnesemia? 2015
a. Hypernatremia
b. Hyponatremia
c. Hyperkalemia
d. Hypophosphatemia

A

d. Hypophosphatemia

86
Q

Which of the following medical terms describes sperm of low quantity and abnormal forms?
2015, 2013, 2011
a. Oligoteratospermia.
b. Oligoasthenospermia.
c. Asthenoteratospermia.
d. Oligospermia
e. Teratospermia.

A

a. Oligoteratospermia.
Note: Oligospermia implies decreased sperm count; azoospermia means absent sperm in the semen; teratospermia describes abnormal morphology; while asthenospermia refers to abnormal motility.

87
Q

Which of the following is a component of the spermatic cord? 2015
a. Ilioinguinal nerve
b. Pampiniform plexus
c. Femoral branch of the genitofemoral nerve

A

b. Pampiniform plexus

88
Q

A patient’s laboratory showed that his potassium is 6.1. You ordered an ECG, which showed tented T waves. What is the immediate next step? 2016, 2015
a. Dialysis
b. Magnesium
c. Insulin
d. IV calcium gluconate

A

d. IV calcium gluconate

89
Q

A 54-year old woman presented with recurrent flank pain for the past 3 months. She is hypertensive and has type 2 diabetes mellitus. Her BMI is 26.Urinalysis shows pyuria and microscopic hematuria, and negative nitrates. Urine culture shows infection with E. coli.
Kidney ultrasonography shows 15 mm left renal stone at the ureteropelvic junction with mild hydronephrosis. What is the next step? 2015, 2015
a. conservative medical management
b. ESWL
c. PCNL
d. Ureteroscopy and laser fragmentation of the stone
e. Place double J stent and treat the infection

A

e. Place double J stent and treat the infection

90
Q

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

A

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)

91
Q

A mother noticed her child limping 10 days after a sore throat. Ultrasound showed increased joint space/swelling. What is the diagnosis? 2015
a. Legg-Calve-Perthes.
b. Slipped capital femoral epiphysis.
c. Hip transient (toxic) synovitis.
d. Slipped capital femoral epiphysis (SCFE)

A

c. Hip transient (toxic) synovitis.

92
Q

Which of the following structures forms the lateral wall of the femoral canal? 2015, 2011
a. Femoral vein
b. Femoral artery
c. Femoral nerve
d. Lacunar ligament

A

a. Femoral vein

93
Q

A 54-year-old female came to the surgical OPD complaining of a lump in her left breast for several weeks. Physical examination and mammography were done. What is the next investigation to consider? 2016, 2015
a. Core needle biopsy of the lump
b. FNA cytology of left nipple
c. MRI of both breast
d. Reassure and follow annual

A

a. Core needle biopsy of the lump

94
Q

Which zone of the prostate is affected by prostatic adenocarcinoma? 2015
a. Transitional.
b. Peripheral.
c. Periurethral.

A

b. Peripheral.

95
Q

A young boy was playing basketball. He heard a pop when prepared to jump. After that, he could not extend his knee and had ecchymosis. You palpated a gap superior to his patella.
What is the most likely injury? 2015, 2013
a. Patellar fracture.
b. Patellar tendon rupture.
c. Patellar superior dislocation.
d. Quadriceps tendon rupture.

A

d. Quadriceps tendon rupture.

96
Q

A 45-year old woman had a motor vehicle accident. GCS was 14/15, HR was 126, BP 80/60 mmHg. O2 83% on an oxygen mask. The trachea was deviated with a hyperresonant chest and decreased air entry on the right side. Tender abdomen with guarding and unstable pelvis. What is the most appropriate next step in management? 2015
a. Chest tube
b. Tourniquet for the bleed
c. Pelvic wrap

A

a. Chest tube
Start with management of pneumothorax, then pelvis. Follow the ABC’s of ATLS protocol

97
Q

A female with mixed stress and urgency incontinence. She is a smoker and drinks excessive caffeine at night. Her BMI is 35 and suffers from long-standing constipation. Which of the following is a grade A recommendation? 2015
a. Reduce caffeine intake at night.
b. 25% reduction in fluid intake.
c. Moderate weight loss.
d. Treatment for her constipation.

A

?

98
Q

A 55-year old gentleman underwent an elective inguinal hernia repair and spinal anesthesia.
Six hours postoperatively, he experienced difficulty in urination and sensation of incomplete urination. On examination, the bladder was percussible and distended. The amount of residual urine was 200 ml. What is the best management? 2015
a. Insert Foley’s catheter.
b. Insert suprapubic catheter.

A

a. Insert Foley’s catheter.

99
Q

A 30-year-old construction worker was brought to the hospital following a fall from the fourth floor. The patient was intubated due to a low level of consciousness. You noticed a left dilated pupil and a skull fracture on examination. The patient is responding well to fluid resuscitation. What is the most important next step? 2015
a. Decompression craniotomy
b. Hydrocortisone
c. Mannitol
d. Naloxone

A

c. Mannitol

100
Q

What are the signs and symptoms of fat embolism? 2015
a. Petechiae, hypoxia, renal failure.
b. Confusion.
c. Respiratory failure, renal failure, hemolysis.

A

a. Petechiae, hypoxia, renal failure.

101
Q

What is the treatment option for a patient with papillary thyroid carcinoma of 5 cm in size without lymph node involvement? 2015
a. Chemo-radiation
b. Radio-iodine therapy
c. Total thyroidectomy

A

c. Total thyroidectomy

102
Q

male patient with LUTS, presented with 15 hours of acute urinary retention. What is the next step?

A

Folley’s catheter

103
Q

A patient developed cola-colored urine after a long urological procedure. Creatinine kinase levels were high. What is the likely diagnosis?

A

Rhabdomyolysis.

104
Q

A patient with a neurogenic bladder presented with a bladder stone around 5 cm. What is management? 2016, 2015
a. Transurethral cystolitholapaxy
b. Percutaneous cystolitholapaxy

A

b. Percutaneous cystolitholapaxy
Since he has a neurogenic bladder, if he had a normal bladder then it would be A) - confirmed with Dr. Ahmad Al-Kanderi (repeated Q)

105
Q

What is the goal of stable fixation in orthopedics? 2015
a. Restore bone density
b. Early mobilization

A

b. Early mobilization

106
Q

10.A diabetic patient presented with RUQ pain. CT showed gas in the gallbladder wall. What is the likely organism? 2015
a. E. coli
b. Clostridium perfringens

A

b. Clostridium perfringens

107
Q

Which organism is most likely to cause ascending cholangitis? 2016, 2015
a. Salmonella
b. S.aureus
c. E. coli
d. Mycobacterium
e. C. Difficile

A

c. E. coli
According to UpToDate: most common bacteria isolated are of colonic origin, most common to least common are: E.coli, Klebsiella, Enterobacter. The most common gram-positive organism is Enterococcus.

108
Q

An obese female is planned to undergo an elective sleeve gastrectomy, which perioperative prophylactic antibiotics should be given to the patient?

A

Ceftriaxone and metronidazole

109
Q

A 27-year-old lady presented with right flank pain for 2 weeks duration. She underwent
Roux-en-Y gastric bypass for her obesity 4 years ago. Upon examination, her renal ultrasound showed moderate hydro-uretero-nephrosis proximal to a 12 mm stone in the upper ureter. What is the most likely stone composition? 2015
a. Calcium oxalate.
b. Uric acid.
c. Cystine.
d. Magnesium ammonium phosphate.

A

a. Calcium oxalate.
Answer: A (in patients with rapid weight loss, calcium oxalate is the most common type of stone, as it is in IBD patients as well)

110
Q

19.A 36 years old patient was diagnosed with primary hyperparathyroidism. He came to your clinic complaining of abdominal pain, and an upper endoscopy showed GERD and multiple duodenal ulceration. You noticed that the patient also had telangiectasia on his nasolabial folds. Negative family history. What is the most likely diagnosis? 2015
a. Hemorrhagic hereditary telangiectasia
b. Multiple endocrine neoplasia 1
c. Multiple endocrine neoplasia 2
d. NSAIDs use due to bone pain
e. Parathyroid adenoma

A

e. Parathyroid adenoma

111
Q

Which of the following is the most common source of infection after open ilioinguinal hernia repair? 2016, 2015
a. Operation theater temperature
b. Patient’s nasopharynx
c. Patient’s skin
d. Surgical instruments
e. Staff

A

c. Patient’s skin

112
Q

17.A 35-year-old female was found to have a clinically palpable solitary thyroid nodule. Ultrasound showed a solid mass measuring 2.5 cm. What is the next step in management? 2015
a. Biopsy guided by ultrasound
b. CT scan of the neck
c. Fine needle aspiration
d. MRI

A

c. Fine needle aspiration

113
Q

There was a question about a patient with numbness in the lateral 3.5 fingers (median nerve) and wrist fracture distal radial fracture and they asked about the best treatment method. 2015
a. ORIF
b. closed reduction and cast placement

A

a. ORIF

114
Q

22.A lactating patient presented with breast erythema and pain. What organism should be covered with antibiotic treatment? 2015
a. Pseudomonas aeruginosa
b. Staphylococcus aureus
c. Streptococcus pyogenes

A

b. Staphylococcus aureus

115
Q

12.A 30 year old male with a 7-year history of ulcerative colitis complained of jaundice, RUQ
pain and weight loss for the past 6 months. Alkaline phosphatase = 20 (below normal
range). What is the most likely diagnosis? 2015
a. Primary biliary cirrhosis
b. Primary sclerosing cholangitis
c. Cholangiocarcinoma
d. Liver metastasis
e. Ascending cholangitis

A

b. Primary sclerosing cholangitis

116
Q

During a TURP, a 57-year old male appeared to be confused and nauseated. He also had visual disruption. What is the most likely abnormality? 2016, 2015
a. Hypocalcemia.
b. Hypochloremia.
c. Hypokalemia.
d. Hypouricemia.
e. Hyponatremia.

A

e. Hyponatremia.

117
Q

Which of the following is the correct definition of segmental fractures? 2015
a. Fracture line perpendicular to long axis of bone
b. A separate segment of bone bordered by fracture lines
c. Fracture line crosses articular cartilage and enters the joint

A

b. A separate segment of bone bordered by fracture lines

118
Q

A female came to the clinic for an incidental breast mass. She had a mammogram and her BIRAD score was 5. What is the most appropriate management plan? 2015
a. Core needle biopsy
b. MRI has to be done
c. Short-term follow-up in 6 months
d. Repeat mammography in 2 years
e. Resect the mass

A

a. Core needle biopsy

119
Q

12.A patient with a 5 cm mass in the gastric wall. The overlying mucosa appeared to be normal.
What is the most appropriate next step? 2015
a. Core biopsy
b. Imatinib
c. Resection

A

a. Core biopsy

120
Q

Which of the following is a result of delayed primary wound closure?
a. Decreased fibrosis
b. Decreased wound strength
c. Increased angiogenesis
d. Lower collagen content
e. Wider scar

A

c. Increased angiogenesis

121
Q

What is the best way to take a biopsy for osteosarcoma? 2015
a. Application of tourniquet and then en bloc resection biopsy.
b. Longitudinal resection.
c. Core biopsy with transverse incision.

A

?

122
Q

11.A crohn’s patient who recently underwent surgery and is now on TPN and antibiotics. His ABG shows the following: normal PaO2, pH 7.4 (low), PaCO2 normal, AG 10 (normal). What is the most likely cause of these findings? 2015
a. Enteric Fistula
b. Renal Failure
c. DKA

A

a. Enteric Fistula

123
Q

Patient was undergoing a urological surgery. She was given O+ type blood without crossmatch because there was no time. Post-operative creatinine was high. What is the cause? 2015
a. Pre-renal failure
b. Hemolysis
c. Post-renal

A

b. Hemolysis
ABO-incompatible blood transfusion is one of the most common cause of hemolysis-associated acute kidney injury

124
Q

When should prophylactic antibiotics be given for a given surgery? 2016, 2015
a. 30 mins before incision
b. 1 hour before incision
c. Continue for 1 day after surgery
d. Continue for 2 days after surgery

A

b. 1 hour before incision

125
Q

A 56 years old patient with a history of recurrent diverticulitis. He presented with pneumaturia. What is the diagnosis? 2015
a. Colovesical fistula
b. Urinary tract infection

A

a. Colovesical fistula

126
Q

A female with long-term diabetes. She had a previous history of long-term radiation due to cervical cancer, complicated by retroperitoneal fibrosis and hydronephrosis. She had pyelonephritis and acute renal impairment, and IV antibiotics were administered. What is the best next step? 2015
a. Nephrostomy tube
b. PCNL

A

a. Nephrostomy tube

127
Q

A male patient had an open pelvic fracture. Post-operatively, he developed numbness in the anterior scrotum and anterior pubis. Which nerve was affected? 2015
a. Femoral.
b. Obturator.
c. lioinguinal.
d. Genital branch of genitofemoral.
e. liohypogastric.

A

d. Genital branch of genitofemoral.

128
Q

A football player had an accident. This accident caused hyperextension of his neck. He experienced upper and lower limb weakness, which is more prominent in distal muscles (hand and wrist) than proximal muscles (shoulder and arms). What do you think the patient has? 2015
a. Cauda equina syndrome
b. Anterior cord syndrome
c. Posterior cord syndrome
d. Central cord syndrome
e. Brown-squared syndrome

A

d. Central cord syndrome

129
Q

What is the TNM staging of breast mass with a size of 4.5 cm, freely mobile single lymph node group on the same side, and no metastasis? 2015
a. T1N1MO
b. T2N1MO
c. T2N2MO
d. T4N2MO

A

b. T2N1MO

130
Q

The high incidence of radial nerve palsy with humerus shaft fracture is due to its close relation to which anatomical location? 2015
a. Radial groove at mid-shaft humerus.
b. Neck of humerus.
c. Between biceps and triceps muscles.

A

a. Radial groove at mid-shaft humerus.

131
Q

Which hormone is responsible for contraction of gallbladder?

A

Cholecystokinin

132
Q

What is a sign of a benign bone lesion on X-ray? 2015
a. Geographic distribution
b. Periosteal reaction

A

a. Geographic distribution

133
Q

Which of the following is an example of a clean contaminated wound? 2015
a. Elective cholecystectomy
b. Laparoscopic hernia repair
c. Open hernia repair
d. Thyroidectomy

A

a. Elective cholecystectomy

134
Q

An obese patient with bilateral osteoarthritis. What is the best next step? 2015
a. NSAIDS.
b. Weight loss and light exercise.

A

b. Weight loss and light exercise.
Always start with education, weight loss, and exercise/physiotherapy

135
Q

A 31-year-old patient was scheduled for a laparoscopic appendectomy under general anesthesia. Soon after the patient was anesthetized, he developed muscle rigidity, fever, and tachycardia. How should he be managed? 2015
a. Dantrolene sodium
b. IV hydrocortisone
c. Propofol
d. Somatostatin analogue
e. Succinylcholine

A

a. Dantrolene sodium

136
Q

A 38-year-old male, a known case of diabetes mellitus type 2, has 2 cm kidney stone. Urine culture 3 days before was negative. A PCNL was arranged, and pus was aspirated. Which of the following is the next step? 2016, 2015
a. Irrigate pus and continue PCNL.
b. Abort and do ESWL.
c. Abort procedure and keep nephrostomy.
d. Convert to ureteroscopy.
e. Convert to open nephrectomy.
f. Transperineal retrieval of the stone.

A

c. Abort procedure and keep nephrostomy.

137
Q

A patient presented with dinner fork deformity following a fall on an outstretched arm (FOOSH). What is the diagnosis? 2015
a. Galeazzi fracture
b. Monteggia fracture
c. Colles fracture
d. Smith fracture

A

c. Colles fracture

138
Q

A 26-year-old female had a 2.5 cm breast mass that was found to be a phyllodes tumor. No palpable lymph nodes were present. What is the most appropriate management? 2015
a. Adjuvant chemotherapy.
b. Modified radical mastectomy with sentinel lymph node biopsy.
c. Total mastectomy with sentinel lymph node biopsy.
d. Watchful waiting.
e. Wide local excision with 1 cm negative margin.

A

e. Wide local excision with 1 cm negative margin.

139
Q

A patient with ESRD was placed on TP. What component should be adjusted with regards to his medical condition? 2015
a. Fat
b. Carbohydrates
c. Protein
d. Glucose

A

c. Protein

140
Q

17.A 64-year-old woman presented with 1cm mass in her breast. Core biopsy showed DCIS.
What is the most appropriate management? 2015
a. Bilateral mastectomy
b. Follow up in 6 months
c. Modified radical mastectomy
d. Wide local excision
e. Wide local excision with sentinel node

A

d. Wide local excision

141
Q

A 65-year old diabetic man was admitted due to inability to bear weight on his left lower limb. Physical examination showed a swollen, erythematous, tender knee with a painful decreased range of motion. Labs showed elevated ESR & CRP. Knee aspiration showed positive diplococci. What is the most important factor in the management of his knee? 2015
a. Order urgent MRI to know the source.
b. Order 3 phase bone scan.
c. Knee splint and analgesia.
d. 6 -12 weeks parenteral antibiotic.
e. Surgical arthrotomy for drainage and debridement.

A

e. Surgical arthrotomy for drainage and debridement.

142
Q

12.A 27-year-old female presented to ER with acute appendicitis. Before surgery, she was NPO and received IV fluids. Her first bag was a 500 ml of 0.45% normal saline. How much sodium did she receive? 2015
a. 22 mmol
b. 44 mmol
c. 77 mmol
d. 145 mmol

A

c. 77 mmol

143
Q

What is the best thing to reverse heparin in an emergency surgery? 2017, 2015
a. Dantrolene
b. Halothane
c. Naloxone
d. N-acetylcysteine
e. Protamine

A

e. Protamine

Surgery Final (10 decks)

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