2016 - 7th Flashcards
- Screening mammogram revealed retro-areolar microcalcifications. Nothing was palpable clinically. Next step?
A) Follow up
B) FNA
C) Core needle biopsy
D) Image guided biopsy
E) Mastectomy
D) Image guided biopsy
Microcalcifications, a spiculated mass, irregular border are all high risk features.
- 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?
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) Vertical shear of the pelvis and lumbar spine fracture
- For the patient in the previous question, when should CT chest abdomen and pelvis be performed?
A. 3 months
B. 6 months
C. 12 months
D. 24 months
(50 years old patient just underwent colectomy for colon cancer and will be followed up in a surveillance program. How many years should he be followed up for/what’s the minimum number of years?)
C. 12 months
- 53-year-old female with history of open cholecystectomy 2 years back presents with a painful bulge over surgical scar area. On examination bulge was reducible. Dx?
A. Incisional hernia
B. Abdominal abscess
C. Recurrent gallbladder disease
D. Skin abscess
A. Incisional hernia
In which of the following zones is prostatic adenocarcinoma located?
A. Peripheral
B. Central
C. Transitional
D. Periurethral
A. Peripheral
- What is the most important treatment in acute pancreatis?
A) Blood transfusion
B) IV fluid resuscitation
C) IV antibiotics
B) IV fluid resuscitation
- 34-year-old pregnant lady in her 2nd trimester presents to the casualty with persistent biliary colic w/nausea and vomiting. She’s afebrile. US revealed gallbladder stones. This is her 3rd admission to the emergency department. What do you recommend?
A) Low fat diet until the end of her pregnancy then laparoscopic cholecystectomy
B) Ursodeoxycholic acid
C) Percutaneous cholecystostomy
D) Laparoscopic cholecystectomy during this admission
E) Open cholecystectomy during this admission
D) Laparoscopic cholecystectomy during this admission
- Otherwise healthy 35 year old male presents with infertility. Which of the following is the most common cause?
A) Varicocele
B) Spermatocele
C) Hydrocele
A) Varicocele
- Young female patient with hypertension. She has episodes of headache. Imaging revealed adrenal mass. Dx?
A. Pheochromocytoma
B. Conn’s disease
A. Pheochromocytoma
- Which of the following constitutes the medial border of femoral canal?
A. Inguinal ligament
B. Lacunar ligament
C. Cooper ligament
B. Lacunar ligament
Review anatomy of femoral canal
- 80-year-old presents with abdominal distention and obstipation. He is hemodynamically stable. Abdominal exam showed distention with mild tenderness. CT revealed cecal volvulus. Management?
A) Detorsion with cecopexy
B) Cecostomy tube
C) Ileocecal resection with ileocolic anastomosis
D) Hartman procedure
C) Ileocecal resection with ileocolic anastomosis
Patient was stable without any mentioned signs of strangulation or high surgical risk in the vignette.
Patient on Warfarin has prolonged PT. Which of the following factors are likely involved?
II, VII, IX, X
- Patient with large bowel obstruction. Abdominal x ray revealed coffee bean sign. What’s the initial step in management?
A. Flexible sigmoidoscopy
B. DRE with tube
C. Colectomy with anastomoses
D. Colectomy with colostomy
E. Neostigmine
A. Flexible sigmoidoscopy
- 50 years old patient just underwent colectomy for colon cancer and will be followed up in a surveillance program. How many years should he be followed up for/what’s the minimum number of years?
A. 1 year
B. 2 years
C. 3 years
D. 4 years
E. 5 years
E. 5 years
- Male patient presents with abdominal pain, distention, and vomiting. On examination, patient was febrile with a distended abdomen an erythematous inguinal mass that is irreducible. Management?
A) Keep NPO with NGT and observation
B) Manually reduce the hernia
C) Surgical exploration
C) Surgical exploration
Not the exact wording from the exam but you get the point.
- 32 years old male underwent CT scan after sustaining minor trauma. CT did not show any traumatic injuries but a 3 cm left adrenal mass was incidentally found. What’s the most appropriate next step?
A. Serum cortisol levels
B. Early morning salivary cortisol levels
C. 24 hour urine catecholamines
D. Fine needle aspiration of the mass
E. Adrenalectomy
C. 24 hour urine catecholamines
- How is anterior stability of the knee assessed?
A) Posterior drawer test
B) Anterior drawer test
C) McMurry
D) Valgus stress test
B) Anterior drawer test
- 56-year-old male patient presents with slowly growing mass at the angle of the mandible. He now has difficulty opening his mouth. US revealed parotid mass. Next step?
A. Fine needle aspiration
B. MRI/CT neck
C. Excision of the mass/excisional biopsy
A. Fine needle aspiration
- A 40-year-old male presented with left iliac fossa pain. CT scan of the pelvis showed sigmoid diverticulitis with 5-cm pericolic abscess. In addition to antibiotics, what would you do to manage his condition?
A. Continue parenteral antibiotics
B. Percutaneous CT guided drainage of the abscesses
C. Laparoscopic drainage
B. Percutaneous CT guided drainage of the abscesses
- A patient presented with epigastric pain that increases when leaning forward, he has hyperkalemia, high lipase, and leukocytosis? which of the following is the most appropriate resussetation fluid
A- Normal saline
B- 5% dextrose 0.45 sodium chloride
C- TPN
D- Dextrose
A- Normal saline
There was no ringer’s lactate this time
- 7 y/o complaining of red swollen painful left knee. He is refusing to walk using his left lower limb. No recent trauma, weight loss or comorbidities. He can’t move his left leg actively or passively because of the pain. Next step?
A) Knee X-ray
B) Knee CT
C) Knee MRI
D) Bone biopsy
E) Synovial fluid aspiration
E) Synovial fluid aspiration
- 55-year-old female presents w/classic symptoms of biliary colic. US revealed a 1 cm polyp in the gallbladder but no gallbladder stones. What is your management?
A) Observe
B) Cholecystectomy
C) Biopsy
B) Cholecystectomy
- A patient with neurogenic bladder presented with a bladder stone 5x4 cm. What is the management?
A) Transurethral cystolitholapaxy
B) Percutaneous cystolitholapaxy
B) Percutaneous cystolitholapaxy
- Colorectal cancer case. Which gene involved in the progression of cancer?
A) Adenomatous polyposis coli gene (APC)
B) Carcinoembryonic antigen gene (CEA)
C) CA19-9
A) Adenomatous polyposis coli gene (APC)
- 45 year old male admitted for an acute flare of ulcerative colitis, does not respond to steroids, he has 12 bowel opening per day with moderate blood mixed with stool, his Hb is 95. What is true regarding his deep vein thrombosis prophylaxis?
A) Nothing since he is actively bleeding
B) Warfarin
C) Therapeutic dose LMWH
D) Prophylactic dose LMWH
E) Rivaroxaban
D) Prophylactic dose LMWH
- Elderly male with PAINLESS jaundice. How to investigate?
A) CT
B) PET
A) CT
Painless obstructive jaundice is malignant until proven otherwise. CT is investigation of choice.
- Which of the following is a common complication of incision and drainage of perianal abscess?
A) Fistula
B) Fissure
C) Anal strictures
A) Fistula
- 65 yo male presents the casualty with LLQ pain and fever. This is his 4th episode of diverticulitis this year. He is now treated and stabilized. However, CT showed persistent luminal narrowing of the sigmoid colon along with fat stranding. What to do next?
A. Colonoscopy and sigmoidectomy during the same admission
B. Colonoscopy now followed by sigmoidectomy after 6 weeks
C. Colonoscopy after 6 weeks followed by sigmoidectomy
D. Sigmoid stent
C. Colonoscopy after 6 weeks followed by sigmoidectomy
- Which of the following is the most common metabolic complication in primary hyperparathyroidism?
A. Kidney stones
B. Osteitis Fibrosa cystica
C. Pancreatitis
D. Gout
E. Hyperthyroid
A. Kidney stones
- A 53-year-old lady underwent a modified radical mastectomy to treat her breast cancer. After the procedure, she noticed a protruding scapula and difficulty abducting her arm. Which nerve has been likely injured?
A. Axillary nerve
B. Lateral pectoral nerve
C. Long thoracic nerve
D. Medial pectoral nerve
E. Thoracodorsal nerve
C. Long thoracic nerve
- Which hernia passes through the linea semilunaris?
A. Spigelian hernia
B. Umbilical hernia
C. Inguinal hernia
A. Spigelian hernia
- Patient had a history of colon cancer that was removed and treated. Which tumour marker is most useful for monitoring after three years?
A) CEA
B) CA 19-9
C) CA 15–3
D) CA 125
A) CEA
- Patient with severe comminated fracture of the left tibia and fibula. He is complaining of pain in his limb out of proportion to the exam finding. Best next step?
A) Measure intercompartmental pressure
B) Perform fasciotomy
B) Perform fasciotomy
- Lady with type 2 diabetes, PCOS, BMI is 45, and inability to conceive. What is the best modality to reduce her weight?
A. Ketogenic diet
B. Bariatric surgery
C. Exercise
B. Bariatric surgery
- Which of the following structures passes through the deep inguinal ring?
A. Round ligament of uterus
B. Ilioinguinal N
C. Genitofemoral N
D. Broad ligament
A. Round ligament of uterus (correct)
B. Ilioinguinal N (only travels through part of the canal, exiting via the superficial ring, but doesn’t pass through the deep ring)
C. Genitofemoral N (genital branch)
- 80-year-old male patient presents with epigastric pain. O/e he had jaundice. Abdominal exam revealed a palpable RUQ mass. Most likely diagnosis?
A) Gallbladder cancer
B) Pancreatic cancer
B) Pancreatic cancer
- 55 year old female under investigation for breast lump. Mammogram report shows BIRAD 4?
A) Follow up/monitoring
B) FNA
C) Core biopsy
D) Surgical excisional biopsy
B) FNA
(It’s probably Core biopsy?)
- Mechanism of action of Silodosin?
A. Phosphodiesterase inhibitor
B. Alpha blocker
B. Alpha blocker
- A 15-year-old female patient discovered to have type 1 choledochal cyst incidentally. She is at risk of which of the following?
A) Hepatocellular carcinoma
B) Primary sclerosing cholangitis
C) Cholecystitis
D) Portal vein thrombosis
E) Cholangiocarcinoma
E) Cholangiocarcinoma
- Middle-age female presents with episodic epigastric pain radiating to the back associated with nausea. Pain exacerbated by fatty meals. Labs revealed high direct bilirubin and mildly elevated liver enzymes. US revealed stones in the gallbladder w/o wall thickening or edema. CBD was dilated. What is your management plan?
A) MRCP and cholecystectomy
B) ERCP and cholecystectomy
B) ERCP and cholecystectomy
- Middle aged male patient k/c/o hypertension and adrenal mass presents to the casualty with nausea, vomiting, and abdominal tenderness. O/e he was hypotensive and tachycardic. Labs revealed high K and low Na. Dx?
A. Conn’s disease
B. Addisonian crisis
C. Pheochromocytoma
D. Cushing syyndrome
A. Conn’s disease
- 30 y/o lady presents to OPD with left retroareolar breast lump. It was tender, smooth, 3 cm in diameter. Nipple areolar complex is intact w/o palpable lymph nodes. What is the best next step in management?
A. FNA
B. Breast U/S
C. Incision & drainage
D. MRI/CT Chest
E. Empiric antibiotics
B. Breast U/S
- 34 year old obese female comes to your clinic regarding weight loss advice. On routine examination of the neck and ultrasound, multiple solid and fluid filled nodules were found in both lobes of the thyroid. The largest measured 0.5 cm in size. Lab results were normal and TSH was within the normal range. Which of the is the most appropriate management?
A. Observation
B. Thyroid scintillagraphy
C. Aspiration of the fluid filled nodules
D. Fine needle aspiration of the solid nodules
E. Total thyroidectomy
A. Observation
- Asymptomatic 45-year-old male. Routine testing revealed elevated serum calcium and low phosphate. PTH was elevated confirming primary hyperparathyroidism. Which test is important for guiding management?
A. US neck
B. CT neck
C. MRI neck
D. Sestamibi test
E. Elective neck vein sample for PTH level
D. Sestamibi test
- Appendectomy is protective from which of the following conditions?
A) Crohn’s disease
B) Ulcerative colitis
C) Familia adenomatous polyposis (FAP)
B) Ulcerative colitis
45-year-old man suffered from 6-month history of dysphagia for solid and liquids. Manometry showed hypertension of lower esophageal sphincter and absent peristalsis. Dx?
A) Diffuse esophageal spasm
B) Achalasia
B) Achalasia
- Crohn’s disease patient with perianal disease. Imaging modality of choice to delineate anatomy of the fistulas?
A) MRI pelvis
B) Fistulogram
A) MRI pelvis
- A patient had periumbilical abdominal pain. Then, the pain was localized to the right lower quadrant area few hours later. What is the reason behind this?
A. Lumen distension
B. Peritoneal irritation
B. Peritoneal irritation
- 27-year-old male patient present with rectal bleeding after bowel movements. Physical examination revealed Grade I internal haemorrhoids. Next step?
A. High fibre diet and sitz bat
B. Colonoscopy
C. Haemorrhoidectomy
D. Band ligation
A. High fibre diet and sitz bat
- Male with recurrent biliary coli, on exam he has RUQ pain and tenderness, labs were normal and imaging revealed GB stones. What’s the diagnosis?
A) Cholecystitis
B) Cholelithiasis
C) Choledocholithiasis
D) Gallbladder cancer
B) Cholelithiasis
- 25 year old male presents with slowly growing parotid mass. Imaging revealed superficial mass in the parotid. FNA revealed pleomorphic adenoma. Management?
A. Intracapsular removal/Enucleation
B. Superficial parotidectomy
C. Total parotidectomy/En block resection along w/facial nerve
A. Intracapsular removal/Enucleation
- Which of the following reverses the risk of bleeding from aspirin in an emergency setting?
A. Cryoprecipitate
B. Platelets
C. Factor VIII
D. FFP
E. Vitamin K
B. Platelets
A 44-year-old obese female, who is otherwise healthy, underwent large central hernia repair. Which of the following is the most appropriate measures to avoid venous thromboembolic events?
A. Post-operative LMWH for 28 days
B. Post-operative LMWH until discharge
C. Post-operative LMWH until ambulatory then discontinue
D. Aspirin for 28 days
E. Early ambulation and compression device
B. Post-operative LMWH until discharge
- 44 yo female patient diagnosed with left breast cancer, size 2.5 cm, Stage T2N0M0, ER/PR positive but HER2 negative. Management?
A) Lumpectomy, lymph node clearance and hormone therapy
B) Neoadjuvant chemo and lumpectomy
C) Neoadjuvant chemo and mastectomy
D) Lumpectomy, sentinel LN biopsy, and radiotherapy
E) Lumpectomy, sentinel LN biopsy, radiotherapy, and hormonal therapy
E) Lumpectomy, sentinel LN biopsy, radiotherapy, and hormonal therapy
- 34 yo male patient comes to the OPD with anal pain. He was diagnosed with anal fissure 7 weeks ago and was treated conservatively. Physical examination revealed a posterior anal fissure and skin tags. Proctoscopy revealed anal papillae. Management?
A. Anal dilatation
B. Fissurectomy
C. Lateral partial internal sphincterotomy
D. Botox injection
E. Continue conservative
C. Lateral partial internal sphincterotomy
A 51-year-old patient with history of cirrhosis (Child-Pugh B) was brought to the emergency room due to hematemesis. He was immediately resuscitated and given IV somatostatinand referred for urgent upper endoscopy. Despite endoscopic measures taken with increasing doses of epinephrine, the patient continued to bleed. What is the best NEXT STEP management for DEFENITVE LONG-TERM prophylaxis of bleeding?
A) Sensgtaken-Blackmore Tube
B) Procedure to decrease portal pressure
C) Liver transplant
B) Procedure to decrease portal pressure
TIPS would be contraindicated in Child-Pugh C.
- in term of public health prevention , Colonoscopy is considered:
A) Primary
B) Secondary
C) Tertiary
D) Quaternary
B) Secondary
- A patient presented with right upper quadrant pain. On further workup, a fusiform dilation of the extrahepatic billiary system was discovered. What is his diagnosis?
A) Cholangiocarcinoma
B) Choledochal cyst
B) Choledochal cyst
- A patient, known case of duodenal ulcer, came with hematochezia and hematemesis. Two units of blood were given, and he was taken for endoscopy. At endoscopy, the artery was clipped and bleeding stopped. Overnight, he developed hematochezia again. He was given four units of blood, but he remained hemodynamically unstable. What is your next step?
A) Repeat endoscopy
B) Radio-embolization
C) Oversewing of ulcer with truncal vagotomy and pyloroplasty
D) Duodenotomy and oversewing of bleeding vessel
E) Antrectomy
C) Oversewing of ulcer with truncal vagotomy and pyloroplasty
- A 50-year-old male with history of superficial parotidectomy 9 months ago presents with a 6-month history of gustatory sweating. In a normal healthy patient what normally carries the parasympathetic paraganglionic innervation to the parotid gland?
A. Auriculotemporal
B. Facial nerve
C. Marginal mandibular
A. Auriculotemporal
Which of the following cells contribute to the development of gastrointestinal stromal tumor (GIST)?
A) Cajal cells
B) Neuro-endocrine cells
C) Intestinal epithelial cells
Cajal cells
- 55 years old female, discovered to have a rectal tumour on surveillance colonoscopy, biopsy showed adenocarcinoma. Pelvic CT showed a low rectal tumour. What is the most appropriate investigation for the management?
A. Chest x ray
B. Barium enema
C. CT brain
D. MRI pelvis
E. PET scan
D. MRI pelvis
Essential for staging rectal cancer and guide management
- Which of the following is the posterior boundary of inguinal canal?
A. Transversus abdominis
B. Inguinal ligament
C. Transversalis fascia
D. External oblique
C. Transversalis fascia
(Review anatomy of inguinal canal)
- Which of the following is a risk factor for gallbladder stones?
A) Rapid weight loss
B) Active lifestyle
C) Smoking
D) Post-menopause
E) Male gender
A) Rapid weight loss
- What’s the most common abdominal wall hernia in infants and young children?
A. Inguinal hernia
B. Incisional hernia
C. Umbilical hernia
D. Femoral hernia
E. Lumbar hernia
A. Inguinal hernia
- How is BMI calculated?
A) Weight in kg divided by height in meters squared
B) Weight in kg divided by height in centimetres squared
A) Weight in kg divided by height in meters squared
- Most common cause of failure of internal fixation?
A. Infection
B. Corrosion
A. Infection
- 32-year-old female with unilateral serosanguinous nipple discharge. No masses palpable on physical examination. What’s the most appropriate next step?
A. Breast U/S
B. Breast MRI
C. Discharge occult blood test
D. Discharge cytology
A. Breast U/S
- A clinical scenario about an open fracture involving the tibia and fibula. Management ?
A) Full thickness skin graft
B) Partial thickness skin graft
C) Soft tissue flap
D) Dermal matrix
E) Negative pressure wound therapy
C) Soft tissue flap?
Question didn’t even mention extent of tissue loss.
35 year old male presented with epigastric pain and dark stool for 2 weeks, he is hypotensive and tachycardic. Rectal examination shows melena, and blood investigations show severe anemia. What is the initial management?
A) Administration 2 units pRBC
B) Sengstaken-blackmore tube
C) TIPS
D) IV octeroid and decrease it until the bleed pressure restored
A) Administration 2 units pRBC
- In which of the following locations are fractures likely to result in radial nerve injury?
A) Midshaft of humerus
B) Midshaft and distal third of humerus
C) Proximal/head humerus
D) Forearm/ulnar
B) Midshaft and distal third of humerus
- Adult female presents with dinner fork deformity after falling on an outstretched hand. Management?
A. ORIF
B. Closed reduction and splint
C. External fixation
Closed reduction and splint
Case was brief w/o any clear indications for ORIF. Review indications for ORIF just in case.
Female with history of PUD presented with hematemesis after taking NSAIDs. What is an important part of her management?
A) IV PPI
B) IV Octreotide/somatostatin
A) IV PPI
- Patient presents with knee injury after being tackled form the side while playing football. He cannot bear wight on the leg. Lachman was positive. What other test would be positive
A. Varus stress
B. Valgus stress
C. Posterior drawer
D. Wilson test
B. Valgus stress
A pregnant lady in her 1st trimester of pregnancy presents with an episode of hematemesis. Over the past couple of days, she has had repetitive episodes of vomiting and severe retching. Dx?
A. Mallory Weiss tear
B. Esophageal rupture
A. Mallory Weiss tear
- Which type of collagen is produced during the proliferative phase of wound healing?
A. Type 1
B. Type 2
C. Type 3
D. Type 4
C. Type 3
- 63-year-old man underwent left hemicolectomy, 2 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?
A) Adhesions
B) Hypoalbuminemia
C) Hypomagnesemia
D) Hypercalcemia
E) Anastomotic leak
C) Hypomagnesemia
- Young healthy female presents with persistent RUQ pain, nausea and vomiting. She was febrile and had Murphy’s sign. Labs revealed leukocytosis. US showed GB stone. Management?
A. IV Antibiotics and cholecystectomy
B. IV antibiotics and interval cholecystectomy after 6-8 weeks
C. Discharge on oral abx
A. IV Antibiotics and cholecystectomy
Not the exact wording but case was straightforward acute cholecystitis.
- Male patient complains of mass prolapsing from his anus with defecation. He can manually reduce it. Dx?
A) Grade I internal haemorrhoids
B) Grade II internal haemorrhoids
C) Grade III internal haemorrhoids
D) Grade IV internal haemorrhoids
E) Rectal prolapse
C) Grade III internal haemorrhoids
Young patient with grade 2 haemorrhoids. Complains of persistent rectal bleeding with defecation and discomfort not responsive to conservative management with high fibre diet and regular sitz bath over the past 6 weeks. Next step?
A. Continue high fibre diet and add sea salt to sitz for 6 weeks
B. Local anaesthetic/steroid suppository twice a day for 2 months
C. Colonoscopy in 6 weeks
D. Banding
E. Surgical haemorrhoidectomy
D. Banding
- 70-year-old male in the ICU. He is on TPN and has a complicated/prolonged clinical course. Regular blood results revealed increasing WBC and alkaline phosphatase levels. What is the investigation method of choice?
A. US
B. HIDA scan
C. MRI abdomen and pelvis
D. CT scan abdomen and pelvis
B. HIDA scan
While US is usually used initially for cholecystitis, HIDA is the gold standard
- In the previous question, what is the best management option?
A. Antibiotics therapy
B. Incision and drainage
C. T-tube insertion
D. Hernia repair with synthetic mesh
(53-year-old female with history of open cholecystectomy 2 years back presents with a painful bulge over surgical scar area. On examination bulge was reducible.)
D. Hernia repair with synthetic mesh
- A 37-year-old female presenting with thyroid pain and tenderness, with flu-like illness of one month duration. Her labs showed high ESR and T4. What is your diagnosis?
A. Subacute thyroiditis
B. Hashimoto’s disease
C. Grave’s disease
D. Thyroid lymphoma
E. Heirdle thyroiditis
A. Subacute thyroiditis
- Which electrolyte is higher in pancreatic secretions compared to plasma?
a) Sodium
b) Bicarbonate
c) Potassium
d) Magnesium
b) Bicarbonate
