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Surgery Final > 2016 > Flashcards

2016 Flashcards

1
Q

A patient with trauma of the left leg complains of pain on passive movement (dorsiflexion) of the left foot, the pedal pulse is diminished. What is the most appropriate next step in the management? 2016
a. Leg elevation and IV heparin
b. Femoral Angiogram
c. Escharotomy
d. Fasciotomy
e. Groin exploration and femoral embolectomy

A

d. Fasciotomy

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2
Q

A patient has multiple pulmonary embolisms and is not responsive to anticoagulation. What do you do next? 2016
a. IVC filter
b. Switch to direct oral anticoagulants
c. Embolectomy
d. Give thrombolytics

A

a. IVC filter

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3
Q

What is the single most important risk factor in urothelial cancer of the bladder? 2016
a. Smoking
b. Advanced age
c. Family history
d. Radiation therapy

A

a. Smoking

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4
Q

Which of the following is true regards the healing process of bridging plate use for diaphyseal fracture? 2016
a. Provides stable environment
b. Primary bone healing
c. No callus
d. Endochondral ossification

A

d. Endochondral ossification

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5
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

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6
Q

Which of the following structures runs within the spermatic cord? 2016
a. Pampiniform plexus
b. Genital branch of the genitofemoral nerve
c. lioinguinal nerve

A

a. Pampiniform plexus
b. Genital branch of the genitofemoral nerve

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7
Q
  1. Which of the following is a way to determine end organ perfusion? 2016
    a. Base deficit and lactic acid
    b. Hemoglobin level
    c. Pulse oximetry and respiratory rate
    d. Systolic blood pressure
    e. Urine pH and osmolality
A

a. Base deficit and lactic acid

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8
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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9
Q

A 25-year-old woman is admitted to the hospital with anorexia, abdominal pain and diarrhea for 24 hours. She vomited and has low grade fever. She is tender in the lower abdomen and in rectal examination. What is the likely diagnosis? 2016
a. Nonbacterial food poisoning
b. Carcinoma of the anus
c. Acute appendicitis
d. Amoebic dysentery
e. Typhoid fever

A

c. Acute appendicitis

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10
Q

An 81 year old male with inoperable cancer of the pancreatic head presented with jaundice and pruritus. Imaging showed dilated CBD. What is the most effective palliative procedure?
2016
a. ERCP with stent placement
b. Percutaneous transhepatic cholangiography
c. Choledocojejunostomy

A

a. ERCP with stent placement

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11
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

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12
Q

What procedure removes bacteria spores, fungi, and viruses from an object? 2017, 2016
a. Sterilization
b. Pasteurization
c. Boiling
d. Antisepsis
e. Disinfection

A

a. Sterilization

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13
Q

12.A middle aged female presented with a hernia after picking up heavy objects. Swelling was irreducible and seen under an imaginary line between superior iliac spine and pubis. Which of the following should be cut first intraoperatively to relieve the pressure? 2016
a. Inguinal ligament
b. Lacunar ligament
c. Pectinate
d. Reflected inguinal ligament
e. Transversalis fascia

A

a. Inguinal ligament

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14
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
The answer could be A (branchial cyst) bcz of typical location + can also have punctum

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15
Q

A diabetic patient had a small abrasion in his big toe with erythema and crepitus, X-ray showed subcutaneous gas. Which specimen will help to confirm the diagnosis? 2016
a. Swab of the abrasion
b. Skin
c. Facia
d. Bone
e. Blood culture

A

c. Facia
This case is necrotizing soft tissue infection (necrotizing cellulitis/ necrotizing fasciitis), the specimen should be obtained from deep tissue since skin and superficial tissue is not accurate and may not contain the infected tissue. The answer is not A because many bacteria may be present that are not the cause of the infection.
Resource: Amboss, Medscape, uptodate.

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16
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.

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17
Q

Where are the chief cells found? 2016, 2013
a. Antrum
b. Body
c. Fundus
d. Incisura
e. Pylorus

A

b. Body
c. Fundus

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18
Q

A middle aged male came to the outpatient clinic with a painless mass of the left lower side of the face near the angle of the mandible which has an insidious onset and increasing in size. On examination the mass was oval, soft, 3x6 cm in size. He is a heavy smoker (in the exam the pack year was provided). What is the most likely diagnosis? 2016
a. Acute Bacterial Parotitis
b. Adenoid cystic carcinoma
c. Mucoepidermoid carcinoma
d. Pleomorphic adenoma
e. Warthin tumor

A

e. Warthin tumor
The character is not the typical pleomorphic description and warthin tumor has a strong association with smoking. Resource: uptodate

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19
Q

How would you investigate an epidural abscess causing cauda equina? 2016
a. CT scan
b. MRI
c. Bone scan

A

b. MRI

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20
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

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21
Q

Which radiological finding indicates pelvic instability? 2017, 2016, 2011
a. Symphysis diastasis 5 mm
b. Sacroiliac impaction
c. Sacroiliac diastasis 1cm
d. Fracture of superior pubic rami
e. Fracture of inferior pubic ram

A

c. Sacroiliac diastasis 1cm

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22
Q

Warfarin inhibits vitamin K activation, which is a cofactor for the synthesis of coagulation factors. What clotting factors does warfarin inhibit? 2016
a. I
b. II, VII
c. II, VII, IX, X
d. II, VII, IX, X, Protein C, Protein S

A

c. II, VII, IX, X

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23
Q

A young female presented to the clinic with anterior knee pain. On examination, she had a positive J sign and a positive tilt test. What is the likely diagnosis? 2016
a. Patellofemoral instability
b. Patellar dislocation
c. Medial meniscus tear
d. Lateral meniscus tear

A

a. Patellofemoral instability

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24
Q

A young female athlete with clavicular fracture, which of the following is an absolute indication for fixation? 2016
a. Bone fragments 1 cm overlap
b. Tenting of the skin
c. Fracture of the contralateral humerus

A

a. Bone fragments 1 cm overlap
b. Tenting of the skin

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25
Q

11.A patient with thyroid cancer has undergone a total thyroidectomy. His calcium level is 3.5 (serum: 8.6-10.3 mg/dL, ionized: 4.4-5.5 mg/dL). What do you expect to see in his ECG?
2016
a. Long QT
b. Short QT
c. U wave

A

a. Long QT

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26
Q

A 63-year-old man underwent left hemicolectomy. Two days later, he still has not passed stool or flats. Otherwise he is well, and his creatinine, sodium, potassium and urea are normal. What is the most likely cause? 2016
a. Adhesions
b. Anastomotic leak
c. Hypercalcemia
d. Hypoalbuminemia
e. Hypomagnesemia

A

e. Hypomagnesemia

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27
Q

A 28 year old male had a new onset of erectile dysfunction at the night of his wedding. He had a normal morning erection. He is a non-smoker and does not have chronic illnesses.
What is most likely the cause? 2016
a. Hormonal
b. Vascular
c. Neurologic
d. Psychologic

A

d. Psychologic

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28
Q

A patient with shoulder dislocation, the humerus is displaced medially, which nerve will likely be injured? 2016
a. Axillary nerve
b. Radial nerve

A

a. Axillary nerve

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29
Q

A 45 year old female underwent small bowel resection then TPN was administered through a central IV catheter, after which she developed non-productive cough and mild abdominal pain with swinging pyrexia 38.5, what is the cause of these symptoms? 2016
a. Pneumonia
b. Central Line Infection
c. Deep vein thrombosis
d. Congestive heart failure
e. Acute respiratory distress syndrome

A

b. Central Line Infection

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30
Q

11.A 28 year old male with right breast cancer due to BRCA2 mutation. Which of the following types of cancer is associated with this mutation? 2016
a. Melanoma
b. Parotid
c. Prostate
d. Squamous cell carcinoma
e. Thyroid

A

a. Melanoma

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31
Q

A patient was stabbed in the arm and could not feel the lateral 3 and a half fingers. There was no vascular injury. What was injured? 2016
a. Radial nerve
b. Ulnar nerve
c. Median nerve
d. Flexor pollicis longus and medius
e. Thenar and digit nerves at the wrist

A

c. Median nerve

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32
Q

A 31-year-old male athlete presents to the orthopedic clinic with foot pain that increases on walking. Foot x-ray shows a transverse fracture in the fifth metatarsal with cortical thickening. What is this patient likely to have?

A

Metatarsal stress fracture

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33
Q

A 45 year old male with a history of abdominal pain following meals presented with chest pain following an episode of forceful vomiting. On examination he had subcutaneous emphysema in the cervical area, x-ray showed a left sided pleural effusion and pneumomediastinum. What is the likely diagnosis? 2016
a. Perforated duodenal ulcer
b. Spontaneous perforation of the esophagus

A

b. Spontaneous perforation of the esophagus

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34
Q

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

A

Rhabdomyolysis.

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35
Q

Which of the following defines Murphy sign? 2016
a. Cessation of respiration during palpation
b. Cessation of respiration during inhalation
c. Cessation of respiration during when exhalation

A

a. Cessation of respiration during palpation

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36
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

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37
Q

A patient with disc herniation at L2-L3 level. What would you expect on a physical examination? 2016
a. Weakness of knee extension and absent knee reflex
b. Weakness of hip flexion and absent knee reflex
c. Weakness of knee flexion and absent achilles reflex

A

a. Weakness of knee extension and absent knee reflex

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38
Q

Which of the following structures forms the floor of the inguinal canal? 2016, 2011
a. Inguinal ligament
b. Transversalis fascia
c. External oblique aponeurosis
d. Conjoint tendon
e. Femoral vein

A

a. Inguinal ligament

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39
Q

A 45-year-old active lady presented to the clinic with hip pain that radiates to the lateral left thigh. The pain increases with rest and is relieved by walking for 20 minutes. What is the most likely diagnosis? 2016
a. L4/L5 hernia
b. 15/S1 hernia
c. Sacroiliitis
d. Greater trochanter bursitis
e. Avascular necrosis

A

d. Greater trochanter bursitis

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40
Q

Patient had a proximal forearm fracture. Can’t extend fingers but can extend wrist? 2016
a. Posterior interosseous nerve
b. Anterior interosseous nerve of the median
c. Radial Nerve
d. Ulnar nerve
e. Median nerve

A

a. Posterior interosseous nerve

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41
Q

A 36-year-old female had a resection of the distal pancreas, she developed a high output pancreatic fistula. What is the acid base deficit that is expected? 2016
a. Normal AG metabolic acidosis
b. High AG metabolic acidosis
c. Normal AG metabolic alkalosis
d. High AG metabolic alkalosis

A

a. Normal AG metabolic acidosis

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42
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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43
Q

Which hormone is responsible for contraction of gallbladder?

A

Cholecystokinin

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44
Q

A 34-year-old female in a motorcycle accident, laparotomy and splenectomy was done. What should be given to her before discharge? 2017, 2016, 2014, 2012
a. Meningococcal, H. influenza, pneumococcal
b. Pneumococcal and tetanus
c. Varicella zoster, meningococcal and tetanus
d. Meningococcal and hepatitis B
e. Tetanus only

A

a. Meningococcal, H. influenza, pneumococcal

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45
Q

A 55-year-old male with a family history of colon cancer but has no symptoms. What would you offer?
a. Colonoscopy
b. Fecal occult blood test
c. Reassurance

A

a. Colonoscopy

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46
Q

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

A

C. Hepatitis B virus
CDC data from most common to least: HBV (6-30%), HCV (1-2%), HIV (0.3%)

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47
Q

A 55 year old diabetic female developed febrile urinary tract infection. Imaging was significant for severely inflamed enlarged left kidney with gas within it, contralateral kidney is normal. What is the diagnosis? 2016
a. TB pyelonephritis
b. Acute Pyelonephritis
c. Chronic Pyelonephritis
d. Reflux pyelonephritis
e. Xanthogranulomatous pyelonephritis

A

b. Acute Pyelonephritis

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48
Q

Which of the following is least involved in rheumatoid arthritis? 2016
a. Proximal interphalangeal
b. Distal interphalangeal
c. Knee
d. Metacarpal
e. Atlantoaxial

A

b. Distal interphalangeal
c. Knee

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49
Q

A wound is left open for weeks until it completely heals. What is the type of wound healing? 2016
a. First intention
b. Secondary intention
c. Third intention

A

b. Secondary intention

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50
Q

A patient scheduled for elective cholecystectomy found to have a positive COVID PCR test.
What is the appropriate management? 2016
a. Proceed with the surgery
b. Proceed when the patient tests negative
c. Postpone for 1-2 months
d. Admit and give IV antibiotics

A

b. Proceed when the patient tests negative

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51
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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52
Q

A patient presenting with fatigue and other anemia symptoms post ileal conduit urinary diversion surgery. What could be the cause?

A

a. Vitamin B12 deficiency

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53
Q

A patient was told that she had a T2 tumor in the breast and wants you to explain what that means? 2016
a. The tumor is 2 cm
b. The tumor is 4 cm
c. The tumor is between 2-5 cm
d. She has a tumor in 2 quadrants

A

c. The tumor is between 2-5 cm

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54
Q

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

a. Hand washing

55
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)

56
Q

A young male patient was brought to the casualty with a lower limb fracture. A splint was applied until further management was decided. What is an advantage of applying a splint over a cast? 2016, 2013, 2011
a. It allows soft tissue swelling
b. Minimizes the need for surgical intervention
c. It gives better stabilization
d. Facilitates healing
e. Decreases the risk of infection

A

a. It allows soft tissue swelling

57
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.

58
Q

What is the most common complication of Meckel’s diverticulum in adults? 2016, 2012
a. Ulceration
b. Bleeding
c. Perforation
d. Small Bowel Obstruction

A

d. Small Bowel Obstruction

59
Q

Following laparoscopic hernia repair for indirect right inguinal hernia, a 60-year-old male patient presents with pain and burning sensation that radiates to the lateral aspect of the ipsilateral thigh. The likely cause is injury to which of the following? 2017, 2016
a. loinguinal nerve
b. Iliohypogastric nerve
c. Femoral nerve
d. Genitofemoral nerve
e. Lateral Cutaneous nerve

A

e. Lateral Cutaneous nerve

60
Q

What is the medical treatment of uric acid stone?
a. Urine alkalization
b. Urine acidification
c. Allopurinol

A

Urine alkalization

61
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

62
Q

Spurling test is used for which condition? 2016
a. Myelopathy
b. Radiculopathy
c. Impingement
d. Encephalitis
e. Meningitis

A

b. Radiculopathy

63
Q

A 24-year-old female, who is nil per mouth, was given 1L normal saline. How much sodium does this bag contain? 2017, 2016
a. 77 mEq/L
b. 130 mEq/L
c. 140 mEg/L
d. 154 mEq/L

A

d. 154 mEq/L

64
Q

A 68 year old admitted with acute urinary retention for the first time. DRE showed enlarged prostate with no nodules. Bladder was hypertrophied with diverticula, US showed prostate size of 100 cc, foley catheter was inserted. What is the next best step after removing the foley’s catheter? 2016
a. Tamsulosin
b. TURP
c. Reassure
d. Open prostatectomy

A

a. Tamsulosin

65
Q

A patient underwent transurethral resection of bladder tumor, which showed muscle invasion but no lymph node involvement. What is the best management plan? 2016
a. Radical cystectomy with urinary diversion
b. Intravesical chemotherapy

A

a. Radical cystectomy with urinary diversion

66
Q

A 57-year-old male smoker with a history of diabetes mellitus had a recent fracture in his lower limb which he was treated for. Follow-up x-rays show inability of the fracture to heal despite appropriate management. What type of fracture nonunion does this patient have?
2016, 2013, 2011
a. Atrophic non-union
b. Hypertrophic non-union
c. Oligotrophic non-union

A

a. Atrophic non-union
Note: Atrophic non-union occurs in states of decreased blood supply to the bone, resulting in no callus formation and inability of the fracture to heal. Factors like smoking and diabetes promote this reduction in blood supply.

67
Q

A patient with peptic ulcer disease, he had a proton pump inhibitor. What additional antibiotics would you prescribe for this patient? 2016, 2013
a. Amoxicillin & ciprofloxacin
b. Amoxicillin & clarithromycin
c. Amoxicillin & clindamycin
d. Metronidazole & ciprofloxacin
e. Metronidazole & clindamycin

A

b. Amoxicillin & clarithromycin
Triple therapy (PPI + clarithromycin + amoxicillin)
Quadruple therapy (PPI + Bismuth + metronidazole + tetracycline)

68
Q

What term describes abnormal sperm motility? 2016
a. Oligospermia
b. Teratospermia
c. Asthenospermia
d. Azoospermia

A

c. Asthenospermia

69
Q

Which mutation is implicated in the formation of GIST?

A

C-kit

70
Q

A 30-year old postpartum female is complaining of pain upon extending and abducting the thumb. What is the diagnosis? 2016
a. De quervain’s tenosynovitis
b. Ganglion
c. Trigger finger
d. Pseudogout of MCP
e. Gout of MCP

A

a. De quervain’s tenosynovitis

71
Q

A patient with chronic liver disease presented with bleeding varices, esophago-gastro-duodenoscopy was done after resuscitation and banding did not control the bleeding. What is the next step in management?
a. Beta blockers
b. Glue injection
c. Splenectomy
d. Splenorenal shunt
e. TIPS

A

e. TIPS

72
Q

Innervation of the pubis and anterior scrotum? 2016
a. Ilioinguinal nerve
b. Obturator nerve
c. Femoral branch of the genitofemoral

A

a. Ilioinguinal nerve

73
Q

10.A 49 year old lady underwent a total thyroidectomy 7 months back. Presented with persistent hoarseness of the voice. What is the most likely injured nerve? 2016
a. External Laryngeal Nerve
b. Internal laryngeal nerve
c. Recurrent laryngeal nerve
d. Vagus nerve

A

c. Recurrent laryngeal nerve

74
Q

A 70-year Old female was undergoing colonoscopy, her weight is 44 kg and was given 5 mg midazolam. Suddenly she was hypotensive, tachycardic, and oxygen saturation was 77%. What is the most appropriate action? 2016

a. Give oxygen and fluids and continue the procedure
b. Stop the procedure and consult the on-call anesthesia
C. Stop the procedure and give flumazenil
d. Stop the procedure and give naloxone

A

C. Stop the procedure and give flumazenil

75
Q

Which of the following is the most appropriate fluid for resuscitation of acute pancreatitis?
2016, 2012
a. Ringer’s lactate
b. Normal saline
c. Dextrose 5%
d. Albumin

A

a. Ringer’s lactate

76
Q

A young patient presented with appendicitis. What is an obturator sign? 2016
a. Flexing the right hip and knee, followed by internal rotation of the right hip, this elicits right lower quadrant pain
b. Pain in the right lower quadrant with palpation of the left lower quadrant.
c. Right lower quadrant pain with passive right hip extension.
d. Maximal tenderness at 1.5 to 2 inches from the anterior superior iliac spine (ASIS) on a straight line from the ASIS to the umbilicus

A

a. Flexing the right hip and knee, followed by internal rotation of the right hip, this elicits right lower quadrant pain

B: Rovesing
C: Psoas
D: Mcmurry

77
Q

What statement accurately describes Monteggia fracture? 2016
a. Fracture of the proximal ulna with proximal radioulnar joint dislocation
b. Fracture of the distal ulna with distal radioulnar joint dislocation
c. Fracture of the proximal radius with proximal radioulnar joint dislocation

A

a. Fracture of the proximal ulna with proximal radioulnar joint dislocation

78
Q

A patient presented with right upper quadrant abdominal pain, radiating to the back, the pain increases after food. He had leukocytosis, normal liver enzymes and high amylase.
What is the diagnosis? 2016
a. Acute cholecystitis
b. Acute pancreatitis
c. Perforated peptic ulcer

A

a. Acute cholecystitis

79
Q

An elderly female with a history of recurrent urinary tract infections had a bladder stone.
What is most likely the type of stone? 2016
a. Struvite
b. Cystine
c. Calcium Oxalate
d. Ammonium oxalate

A

a. Struvite

80
Q

A 20-year-old male presented with right bone pain and growing mass. Radiologist suggested a malignant mass. What are radiological features for malignant mass? 2016
a. Geographic
b. Lytic lesion
c. Codman triangle and periosteal reaction
d. Narrow transitional zone

A

c. Codman triangle and periosteal reaction

81
Q

A 35-year old male had difficulty voiding shortly after inguinal hernia repair surgery. Total voided volume is 200 ml and post void residual was 150 ml. What is the appropriate management? 2016
a. Wait until he voids
b. Insert foleys

A

b. Insert foleys

82
Q

When treating erectile dysfunction with Viagra (sildenafil), which of the following medications is an absolute contraindication to be used in combination with it? 2016
a. Beta blocker
b. Diuretics
c. Anxiolytics
d. Nitrates
e. Statins

A

d. Nitrates

83
Q

A 33-year-old lady with a history of SLE on prednisolone and immunosuppressive medication. She complains of bilateral groin pain for the past six months. She says she cannot bear weight on them which has limited her movement dramatically. What is most likely the diagnosis? 2016, 2011
a. Lupus reactive arthritis
b. Osteoarthritis
c. Avascular necrosis
d. Gout
e. Osteoporosis secondary to steroids

A

c. Avascular necrosis
Note: Hip pain in a patient on steroids is avascular necrosis until proven otherwise.

84
Q

A young male came to the emergency room following a ski accident, on examination he had a high riding prostate and X-ray of the pelvis showed bilateral fracture of the pubic rami. He has not urinated since the accident. What would you do next? 2016
a. Wait for the patient to pass urine
b. Perform urethrogram before attempting the insertion of intraurethral catheter
c. Insert suprapubic cystostomy tube

A

b. Perform urethrogram before attempting the insertion of intraurethral catheter

85
Q

What is the age in which ultrasound is the best screening modality for DDH? 2016
a. 1-3 months
b. Directly after birth
c. Prenatal

A

a. 1-3 months

86
Q

Female singer underwent a total thyroidectomy for thyroid malignancy, now her voice is low pitched, and she cannot reach high notes; her vocal cords were normal. What nerve could have been possibly injured? 2017, 2016
a. Internal laryngeal nerve
b. Recurrent laryngeal nerve
c. Superior laryngeal nerve
d. Vocal cords

A

c. Superior laryngeal nerve

87
Q

A child with septic arthritis, the doctor noticed that his trunk shifts over the hip quickly and shifts back to the opposite side due to pain in his lower limb. What type of gait is described here? 2016, 2011
a. Antalgic gait
b. Waddling gait
c. Shuffling gait
d. Trendelenburg gait

A

a. Antalgic gait

88
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

89
Q
  1. Which hormone is responsible for postprandial pain in patients with cholelithiasis?
A

Cholecystokinin

90
Q

A patient had jaundice, imaging showed obstruction at the ampulla of Vater with dilated CBD and pancreatic duct. Which of the following will be absent in the urine of this patient?

A

Urobilinogen

91
Q

A 45-year-old male, who was admitted for an acute flare of ulcerative colitis, does not respond to steroids. He has 12 bowel movements per day with moderate blood mixed with stool, and his Hb is 95. What is true regarding his deep vein thrombosis prophylaxis? 2016
a. Rivaroxaban
b. Prophylactic dose LMWH
c. Therapeutic dose LMWH
d. Warfarin
e. Nothing since he is actively bleeding

A

b. Prophylactic dose LMWH

92
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

93
Q

Which electrolyte is higher in pancreatic secretions compared to plasma? 2016, 2011
a. Sodium
b. Bicarbonate
c. Potassium
d. Magnesium

A

b. Bicarbonate

94
Q

A 19-year-old female presented to the clinic with a well-defined lump in the upper outer quadrant of the right breast. The lump does not change in size with the cycle but increases in tenderness. What is the best investigation at this stage? 2016
a. Core needle biopsy
b. FNAC
c. Mammography
d. MRI
e. Ultrasound

A

e. Ultrasound

95
Q

A 45-year-old female with mixed urge and stress incontinence symptoms. She is a heavy smoker, with a BMI of 35 kg/m, she consumes a large amount of caffeine especially at night.
She also has chronic constipation. What is considered grade A recommendation on patient management 2016
a. Moderate weight reduction
b. Exercise
c. Management of constipation
d. 25% reduction in daily fluid intake
e. Decrease caffeine intake

A

a. Moderate weight reduction
Other grade A recommendations: pelvic floor muscle training (PFMT) and bladder training.

96
Q

A 21-year-old male, known case of sickle cell anemia presented with knee pain. On examination the knee was red, warm, and swollen. Synovial fluid aspiration yielded Gram positive diplococci. What is the causative organism? 2016
a. Streptococcus
b. Staphylococcus aureus
c. Salmonella

A

a. Streptococcus

97
Q

A patient with diabetes had an ulcer on the left foot, on examination he also had bilateral loss of sensation up to the calf, decreased ankle jerk reflex, pulses of both limbs were intact.
What is the diagnosis? 2016
a. Chronic sensory neuropathy
b. Charcot joint
c. Autonomic neuropathy
d. Multiple sclerosis

A

a. Chronic sensory neuropathy

98
Q

A 55-year-old lady has been treated for acute pancreatitis for 3 weeks in the hospital. At the morning round, the patient was noted to have swelling of the left knee, and a mild fever. On palpation it was tender posteriorly, but not warm. Which of the following conditions best explains what she has? 2016
a. Cellulitis
b. Deep vein thrombosis
c. Lower limb ischemia
d. CHF and dependent edema

A

b. Deep vein thrombosis

99
Q

A 65-year-old female driver endured a car crash that resulted in displaced femoral neck fracture. What is the most appropriate definitive treatment? 2016
a. Total hip replacement
b. Hemiarthroplasty
c. Gammanail

A

a. Total hip replacement
Hemiarthroplasty is done for immobile patients or age > 65

100
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

101
Q

Which of the following is a contraindication for the use of a C-spine collar? 2016, 2011
a. Atlanto-occipital dissociation
b. Post disc removal operation
c. Stable cervical spine injury

A

a. Atlanto-occipital dissociation

102
Q

A 45-year-old male presented to the emergency room with an upper Gl bleed. Endoscopy showed multiple duodenal ulcers and an enlarged stomach. Which of the following is most likely the diagnosis? 2016
a. Gastrinoma
b. Glucagonoma
c. Insulinoma
d. Somatostatinoma
e. VIPoma

A

a. Gastrinoma

103
Q

A motorcyclist presented to ER with leg pain, swelling, and deformity. O/E lower tibial fracture. Open wound 3 cm with no pulses felt. Vascular surgeon decided to do a bypass. What is the grade of fracture according to Gustilo-Anderson classification? 2016
a. 1
b. 2
C. 3A
d. 3B
e. 3C

A

е. 3C

104
Q

A 50-year-old male presented with left lower quadrant pain, constipation, and bleeding per rectum. He also had signs of infection. What is the next step in management? 2016, 2012
a. Barium enema
b. CT abdomen
c. Colonoscopy

A

b. CT abdomen
The scenario is suggestive of diverticulitis

105
Q

A patient had anterior dislocation of the hip joint, which nerve is likely to be injured? 2016
a. Femoral
b. Obturator
c. lioinguinal
d. Sciatic
e. Peroneal

A

a. Femoral

106
Q

A young patient fell from 7 meter height, X-ray showed bilateral fracture of the calcaneus.
What other associated injuries might this patient present with? 2016
a. Vertical shear of the pelvis and lumbar spine fracture
b. Vertical shear of the pelvis and lumbar and cervical spine fracture
c. Fracture of the talus, vertical shear of the pelvis, lumbar spine fracture, femoral fracture

A

a. Vertical shear of the pelvis and lumbar spine fracture

107
Q

A patient had a motor vehicle accident. On arrival at the ER, he had a heart rate of 160 and BP 80/50, C- collar was placed due to an unstable cervical spine. Chest x-ray was done, which showed pulmonary contusions. He also had pubic diastasis of 5 cm. What type of shock does this patient likely have? 2016
a. Anaphylactic shock
b. Cardiogenic shock
c. Hypovolemic shock
d. Neurogenic shock
e. Septic shock

A

c. Hypovolemic shock

108
Q

During a routine screening mammogram, a 62 year old teacher was informed that she has changes on mammogram and she should consult her physician. Which of the following indicates benign finding? 2017, 2016
a. Clearly defined mass with irregular borders
b. Coarse calcifications
c. Discrete non-palpable mass that has increased in size compared to a previous mammogram
d. Linear branching calcifications
e. Solid, clearly defined mass with irregular edges

A

b. Coarse calcifications

109
Q

A 30 year old male patient came after a motorcycle accident with a GCS score of 15, heart rate was 120 beats per minute, blood pressure was 80/50 mHg. C-collar was placed. Chest exam was normal. FAST was negative. Pelvic exam revealed pelvic instability. What should be done next? 2017, 2016
a. Pelvic wrapping
b. Pelvic packing
c. External fixation
d. Internal fixation
e. Angioembolization

A

a. Pelvic wrapping

110
Q

What is the most important step in managing acute pancreatitis? 2016
a. IV fluids
b. IV antibiotics

A

a. IV fluids

111
Q

Which nerve supplies pectoralis minor muscle? 2017, 2016, 2013
a. Medial pectoral nerve
b. Lateral pectoral nerve
c. Long thoracic
d. Thoracodorsal nerve

A

a. Medial pectoral nerve

112
Q

What drug will you use in a patient with hepatic encephalopathy? 2016
a. Thalidomide
b. Lactulose

A

b. Lactulose

113
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

114
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? 2017, 2016
a. Calcium oxalate
b. Uric acid
c. Cystine
d. Magnesium ammonium phosphate

A

a. Calcium oxalate
Explanation: in this case there is decreased absorption of fat, so calcium binds to fat and the absorption of oxalate is increased leading to hyperoxaluria, which facilitates calcium oxalate stones formation. same reason of increased calcium oxalate stone formation in inflammatory bowel disease)

115
Q

A 30 year old male with 7 year history of ulcerative colitis presented with jaundice and history of weight loss for the past 6 months. Alkaline phosphatase was 20 (44-147 IU/L).
What is most likely the diagnosis? 2016
a. Primary sclerosing cholangitis
b. Cholangiocarcinoma
c. Liver metastasis
d. Ascending cholangitis

A

a. Primary sclerosing cholangitis

116
Q

A 53 year old lady underwent a modified radical mastectomy to treat her breast cancer. After the procedure, she noticed having 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

A

c. Long thoracic nerve

117
Q

A 23 year old male came to the outpatient clinic concerned about his risk of developing thyroid cancer, his father died at the age of 40 from a thyroid carcinoma and his 27 year old brother has recently been diagnosed with medullary carcinoma of the thyroid. Ultrasound of the thyroid was unremarkable with no evidence of nodules. What is the most appropriate course of action? 2016
a. Check calcium levels on regular bases
b. List for total thyroidectomy
c. Measure stimulated calcitonin level
d. Perform FNAC to look for absence of amyloid
e. Test for RET proto-oncogene mutation

A

e. Test for RET proto-oncogene mutation

118
Q

A 25-year-old male presented with a mass in the midline of his neck. The mass moved with swallowing and also upon protrusion of the tongue. What is the most likely diagnosis? 2016,
2014, 2013, 2012
a. Branchial cleft cyst
b. Follicular nodule
c. Lipoma
d. Thyroglossal duct cyst

A

d. Thyroglossal duct cyst

119
Q

The previous patient remained febrile with leukocytosis despite treatment with dual antibiotics (can’t remember their names) and a MAG3 renogram showed 5% function of the left kidney. What is the next step? 2016
a. Add metronidazole IV
b. Add amikacin
c. Place nephrostomy tube
d. Place double J stent
e. Left nephrectomy
(55 year old diabetic female developed febrile urinary tract infection. Imaging was significant for severely inflamed enlarged left kidney with gas in it, contralateral kidney is normal.)

A

e. Left nephrectomy

120
Q

Which of the following markers is elevated in hepatocellular carcinoma? 2016, 2013, 2012
a. AFP
b. B-HCG
C. CA19-9
d. CA25

A

a. AFP

121
Q

A 29-year-old female undergoing radical cystectomy, was given ceftriaxone as prophylactic. During surgery she developed massive bleeding that couldn’t be controlled. No cross match was available, thus two units of O group were given. Postoperatively her urine output was decreased, hematocrit decreased, and creatinine elevated. What is the cause? 2016
a. Medical (antibiotic)
b. Prerenal (hypovolemia)
c. Post renal (obstruction)
d. Hemolysis (transfusion)
e. Sepsis

A

d. Hemolysis (transfusion)

122
Q

A patient has undergone EGD. After 8 hours, he developed severe substernal chest pain and chest X-ray showed pleural effusion. What is the next step? 2016
a. Barium swallow
b. CT scan
c. Repeat EGD
d. Thoracostomy

A

b. CT scan

123
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.

124
Q

12.A 35-year-old woman developed whitish discharge from both of her breasts. Physical examination of the breast is otherwise normal. What is the appropriate next step in investigating this patient? 2016
a. Check her prolactin level
b. Order a breast ultrasound

A

a. Check her prolactin level

125
Q

What do you give to reduce the risk of bleeding from aspirin if an emergency surgery is needed? 2016
a. Activated factor 7
b. Cryoprecipitate
c. Fresh frozen plasma
d. Platelets

A

d. Platelets

(In practice, infusion of 2-3 adult doses of donor platelets is usually effective for emergency reversal of the effect of aspirin in adults. There are no specific reversal agents for aspirin.)

126
Q

10.A 56 year old male smoker presented with a bulge in the groin area that extends to the scrotum and disappears upon lying flat. What is the diagnosis? 2016
a. Incarcerated indirect inguinal hernia
b. Strangulated indirect inguinal hernia
c. Direct hernia
d. Lymph node
e. Hydrocele

A

c. Direct hernia
Rarely direct inguinal hernia reaches the scrotum, that’s the point of the question.
Resource: Clinical surgery third edition

127
Q

What’s used to wash hands preoperatively?
(a question about washing hands preoperatively)

A

Chlorhexidine

128
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

129
Q

11.A 72 year old man is going for surgery of an incarcerated hernia, in the operating theater the cecum was inseparable from the sac. What is the diagnosis? 2016
a. Richter hernia
b. Sliding hernia
c. Amyand hernia
d. Littre hernia
e. Pantaloon hernia

A

b. Sliding hernia

130
Q

A young healthy male worker presented with a bulge in the groin and was diagnosed with inguinal hernia, he will undergo an elective open hernia mesh repair. What is the most common complication of the surgery in this patient? 2016
a. Ischemic orchitis
b. Recurrence
c. Chronic pain
d. Urinary retention
e. Decreased fertility

A

d. Urinary retention

131
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

132
Q

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)

A

e. Slipped Capital Femoral Epiphysis Disease (SCFE)

133
Q

An incidental liver mass was found on abdominal CT. What is the most common benign liver tumor? 2016
a. Hemangioma
b. Hepatic adenoma
c. Hydatid cyst

A

a. Hemangioma

134
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

Surgery Final (10 decks)

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