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