ÇIKMIŞ SORULAR Flashcards
In which of the following options, the sequence leading to gastric cancer pathogenesis is in correct order?
A-normal mucosa- chronic active gastritis-atrophic gastritis-metaplasia-dysplasia-cancer
b-normal mucosa-metaplasia-active gastritis-atrophic gastritisdysplasia-cancer
c-normal mucosa- chronic active gastritis-metaplasia-atrophic
gastritis-dysplasia-cancer
d-normal mucosa-atrophic gastritis- chronic active gastritis-metaplasia-dysplasia-cancer
A-normal mucosa- chronic active gastritis-atrophic gastritismetaplasia-dysplasia-cancer
Which of the following cell types first arrive at the site of the injury?
Monocytes
Thrombocytes
Neutrophils
Fibroblasts
Macrophages
Thrombocytes
I- Arteria Colica Media
II- Arteria Colica Sinistra
III- Arteria Sigmoidea
IV- Arteria Rectalis Superior
V- Arteria Ileocolica
Which of the following contains the branches of the inferior mesenteric artery?
II, III and IV
Falciform ligament of the liver divides:
The right lobe into anterior and posterior segments
The left lobe into medial and lateral segments
The liver into right and left lobes
The caudate lobe into medial and lateral segments
The left lobe into medial and lateral segments
Which of the following does not play a role in the pathophysiology of inguinal hernia?
Low birth weight
Causes that increase intraabdominal pressure
Collagen synthesis disorder
Hydrocele
Patency of the processus vaginalis
Hydrocele
A metastatic mass with a diameter of 4 cm in the right liver lobe was detected in the abdominal PET of a 60-year-old male patient with esophageal cancer.
Which of the following is the patient’s stage?
T1N0M0
T0N0M1
T2N2M0
T3N0M0
T3N2M1
T3N2M1
Not: Since there is distant metastasis, it must be M1 independent of T and N. In addition, since there is a tumor of 4 cm in diameter the T stage cannot be zero
A 34-year-old previously healthy male patient notices that his eyes are yellow. He has a history of sleeve gastrectomy due to morbid obesity 16 months ago. On physical examination he has jaundice and scleral icterus along with right upper quadrant tenderness. His temperature is 38.9. Ultrasound of the abdomen demonstrates biliary ductal dilation with gallstones. Which of the following is the most appropriate treatment option for this patient?
1- Surgical Removal of the gallstones
2- Endoscopic retrograde cholangiopancreatography(ERCP) and antibiotics
3- Laparoscopic cholecystectomy
4- Observation with repeat ultrasound examinations
5- Percutaneus drainage of gallbladder
2- Endoscopic retrograde cholangiopancreatography(ERCP) and antibiotics
Not: Koledok taşına bağlı kolanjit nedeniyle ERCP ile taş çıkarılıp, antibiyotik verilmesi gerekir
Which one is not a complication of hydatid disease in humans?
Anaphylaxis
Chronic blood loss and anemia
Liver abscess
Cyst development within the liver or lungs
Chronic blood loss and anemia
Not: Hydatid disease may cause; Anaphylaxis due to rupture of the cyst, liver abscess due to infection of the cyst within the liver and cyst development may ocur anywhere in the body most often within the liver. Taenia type of tapeworm infections may cause gastrointestinal symptoms.
In the context of uncomplicated diverticulitis, what imaging modality is often used for confirmation of diagnosis and evaluation of severity?
Computed tomography (CT) scan
Magnetic resonance imaging (MRI)
Abdominal X-ray
Colonoscopy
Computed tomography (CT) scan
Not: CT imaging can identify signs of inflammation, such
as wall thickening and pericolonic fat stranding
Which of the following conditions is characterized by the presence of dilated, tortuous veins in the submucosa of the rectum and anus, often associated with painless rectal bleeding?
Anal fissure
Anal fistula
Hemorrhoids
Anal abscess
Hemorrhoids
Which of the following is not found in idiopathic granulomatous lobular mastitis pathology?
Epithelioid cell granuloma
Langhans giant cell
Lymphohistiocytic aggregate
Caseous granulomas
Caseous granulomas.
Found in tuberculosis
Which of the following laboratory findings is more suggestive of common bile duct obstruction rather than cholecystitis?
Elevated alkaline phosphatase
Elevated serum lipase
Elevated direct bilirubin
Elevated serum amylase
Elevated direct bilirubin
Which of the following is a key component of the initial management of a patient with suspected intestinal obstruction?
Immediate surgery
Oral fluid intake
Bowel rest and nasogastric decompression
Intravenous antibiotics
Bowel rest and nasogastric decompression
Not: This helps relieve distension, reduce vomiting, and prevent aspiration. Immediate surgery is reserved for cases of strangulation or failure of conservative measures. Oral fluid intake is generally restricted until the obstruction is resolved
What is the primary surgical treatment for early-stage cholangiocarcinoma involving the common bile duct?
Endoscopic stent placement
Whipple procedure
Extrahepatic bile duct resection
Liver transplantation
Extrahepatic bile duct resection
Not: This involves removal of the affected segment of the bile duct along with regional lymph nodes
Which of the following treatment modalities has the highest survival rate for multifocal hepatocellular carcinoma on the basis of chronic viral hepatitis?
Chemoembolisation combined with adjuvant chemotherapy
Antiviral therapy
Liver transplantation
Liver resection surgery
Chemoembolisation combined with adjuvant chemotherapy
Liver transplantation
Which of the following special hernia types is associated with inflamed appendix vermiformis in the hernia sac
Petit
Amyand
Littre
Richter
Maydl
Amyand
Which of the following is not an indication for secondary wound debridement?
Presence of devitalized fat tissue
Aim of achieving cosmetically better results
Presence of tense wound edges
Presence of narrow pedicule skin flaps
Presence of tense wound edges
Loop diuretics exert their effects at which part of the nephron?
Proximal convoluted tubule
ADH receptor
Distal convoluted tubule
Thick ascending limb of the loop of Henle
Collecting ducts
Thick ascending limb of the loop of Henle
What is the classic triad of symptoms associated with chronic pancreatitis?
Hematemesis, melena, and anemia
Abdominal pain, weight loss, and diarrhea
Fever, abdominal distension, and constipation
Jaundice, dark urine, and pale stools
Abdominal pain, weight loss, and diarrhea
Not: The classic triad of symptoms in chronic pancreatitis includes abdominal pain (often epigastric and radiating to the back), weight loss, and diarrhea. These symptoms result from the impaired digestive and endocrine functions of the pancreas.
Which of the following is incorrect for visceral pain?
It is primarily carried by C type nerve fibers.
It is often felt in the midline.
It does not project to cerebral cortex.
It can be reproduced with physical examination.
It can be reproduced with physical examination.
Not: The visceral pain transmission end in thalamus and is carried by central nervous system. Thus visceral pain is constant and can’t be reproduced with physical examination.
Ketamine is used occasionally as an induction anesthetic. Which of the following statements about ketamine is false?
*Ketamine increases the heart rate.
*Upon waking after receiving ketamine, patients may experience emergence phenomena.
*In addition to its induction effects, ketamine acts as a painkiller, so fewer opioids have to be used to prevent
excessive sedation.
*Ketamine decreases blood pressure.
*Ketamine decreases blood pressure.
Which of the following is a proliferative breast lesion without atypia?
Lobular carcinoma in situ
Fat necrosis
Galactocele
Sclerosing adenosis
Sclerosing adenosis
Not: Galactocel is a nonproliferative breast lesion.
Lobular carcinoma in situ is a proliferative breast lesion with atypia. Fat necrosis is another benign breast lesion.
Which of the following is most likely to present with Coruvoisier’s sign?
Distal pancreatic tumor
Gallbladder cancer
Klatskin’s tumor
Periampullary tumor
Periampullary tumor
Courvoisier’s principle (known as Courvoisier’s
sign or Courvoisier–Terrier’s sign, or Courvoisier syndrome)
states that a painless palpably enlarged gallbladder that is
found on physical examination. The mechanism is the slow
and steady enlargement of gallbladder due to chronic
What are the components of the Courvoisier-Terrier finding?
Gallstone diverticulosis hiatus hernia
Melana obstructive icterus biliary colic
Jaundice fever
Non-sensitive hydropic gall bladder and jaundice
None
Non-sensitive hydropic gall bladder and jaundice
What is the primary determinant of plasma osmolality?
Potassium
Sodium
Proteins
Urea
Glucose
Sodium
A child has a panic attack and breathes rapidly. Which of the following should we expect?
Normal acid-base balance
Metabolic alkalosis
Metabolic acidosis
Respiratory alkalosis
Respiratory acidosis
Respiratory alkalosis
Which of the following is not used for the treatment of methyl alcohol intoxication?
Thiamine
Protamine
Hemodialysis
Ethanol
Fomepizole
Protamine
Not: An appropriate approach for the treatment of methyl alcohol intoxication is to administer thiamine, folate, and multivitamin supplements, folinic acid 50 mg iv every 4 - 6 hours for 24 hours, in methanol ingestion to provide the cofactor for formic acid elimination CO2 and H2o, Administer ethanol or fomepizole to inhibit the metabolism of ethylene glycol or methanol, and hemodialysis for visual impairment, renal failure, pulmonary edema, and acidosis
A patient presents with diverticular bleeding, with hematochezia and stable vital signs. What is the appropriate initial management for this patient?
Transcatheter arterial embolization
Sclerotherapy
Observation and supportive care
Emergent surgical intervention
Observation and supportive care
Not: For stable patients with diverticular bleeding and no active hemorrhage, the appropriate initial management is
observation and supportive care. This may include
intravenous fluids and blood transfusion if necessary.
What is the first-line treatment of anaphylaxis?
Epinephrine and IV fluids
Broad-spectrum antibiotics and IV fluids
Corticosteroids and antihistamines
Beta-agonists and IV fluids
Corticosteroids and IV fluids
Epinephrine and IV fluids
A 72-year-old male was admitted with left lower abdominal pain for the past 2 days. He also complains of nausea and vomiting. His past medical history is notable for a history of chronic constipation, however, he takes no medications. His temperature is 38.3°C, blood pressure is 120/75 mmHg, and pulse is 92 beats per minute. He has left lower quadrant tenderness with palpation and no flank tenderness. Labs are collected and WBC: 16,000/mm³; CRP: 8 mg/dL. An abdominal CT scan is performed and reveals acute diverticulitis with a 3 cm sized pelvic abscess. Which of the following should be the initial treatment plan for this patient?
Inpatient treatment with percutaneous drainage
Outpatient treatment with antibiotics
Inpatient treatment with IV antibiotics
Surgery
Inpatient treatment with IV antibiotics
NOT: Antibiotics are the first-line treatment for all diverticular abscesses. Percutaneous drainage may be added, if feasible, for abscesses ≥4 cm, those that do not resolve with antibiotic therapy, or in the presence of clinical deterioration.
What is the most appropriate next step in the management for Echinococcus granulosus positive patients?,
Perform surgical resection of the cyst with a goal of complete excision
Refer the patient for percutaneous drainage and albendazole therapy
Initiate watchful waiting and monitor the cyst by imaging every 6 months
Administer albendazole therapy for 3 months
refer the patient for percutaneous drainage and
albendazole therapy
In acute pancreatitis, which imaging modality is preferred for confirming the diagnosis?
Ultrasound, MRI, X-ray, CT scan, MRI, X-ray
CT scan
Which of the following is not necessarily considered in the initial evaluation of a fresh wound?
Deep tissue damage
Presence of possible foreign bodies
Presence of devitalised tissue
Microbial contamination
Active bleeding
Microbial contamination
Not: Although microbial contamination might be a worrisome issue in the healing process of a wound, it is not considered during the initial evaluation of a fresh wound for many practical reasons:
1. Wound or surgical site infection does not become a clinical issue before 72 hours
2. It is impractical and unnecessary to obtain routine wound
cultures as the wound might probably be contaminated with skin flora and the treatment (or closure) of the wound should not be delayed until culture results arrive.
3. Antibiotics usually suffice to treat uncomplicated wound
infections if need be.
In which of the following diagnostic laparoscopy is not performed?
Adrenal tumor
Appendicitis
Endometriosis
Ectopic pregnancy
Adrenal tumor
Which of the following features belongs to intestinal type gastric cancer?
Familial tendency
Poorly differentiated, signet ring cells
Decreased E-cadherin
Increasing incidence with age
Transmural, lymphatic spread
Increasing incidence with age
Not: The incidence of intestinal type gastric cancer is more
common in older age group, while diffuse type is encountered more in younger age groups.
What blood product has the shortest shelf life?
Cryoprecipitate
Fresh frozen plasma
Packed red cells
Whole blood
Platelets
Platelets
What is the cause of complex regional pain syndrome?
Peripheral sensitization
Autoimmune activity
Genetic predisposition
Inflammatory response
Post-infection complication
Peripheral sensitization
Which of the following is the most common cause of acute mesenteric ischemia?
Acute mesenteric artery embolism
Non-occlusive mesenteric ischemia
Acute mesenteric artery thrombosis
Acute mesenteric vein thrombosis
Acute mesenteric artery embolism
Which of the following interventions is most appropriate in the initial management of a hypovolemic shock patient?
Rapid administration of crystalloid fluids
Blood transfusion to restore oxygen-carrying capacity
Administration of a beta-blocker
Application of warm blankets to maintain normothermia
Rapid administration of crystalloid fluids
Not: In hypovolemic shock, the primary goal is to restore intravascular volume and improve tissue perfusion. Rapid administration of crystalloid fluids, such as normal saline or lactated Ringer’s solution, helps achieve this by replenishing circulating blood.
Which type of the hiatal hernias are not expected to cause gastroesophageal reflux?
type 1 2 3 4 5
type 2
In pure type 2 hiatal hernias, gastroesophageal junction is in
regular position,
Which of the following sign suggests a more severe, potentially ischemic, intestinal obstruction that may require urgent surgical intervention?
Abdominal distension
Rebound tenderness on abdominal examination
Passage of flatus
High-pitched bowel sounds
Abdominal distension
Rebound tenderness on abdominal examination
Not: Abdominal distension, high-pitched bowel sounds, and the passage of flatus are signs that may be present in both simple and severe obstruction.
Pheochromocytoma is known as a “10% tumor”. Which of the following findings support the 10% rule?
- 10% are familial.
- 10% are extra-adrenal.
- 10% are bilateral.
- 10% are malignant.
- 10% occur in children.
All.
Which of the following symptoms for gastric cancer is not true?
Dyspnea may develop in gastric cancer patients with pleural effusions.
Jaundice may be encountered in advanced staged gastric cancer.
Anorexia and weight loss is common in gastric cancer patients.,
Patients usually feel discomfort after meals.
Dysphagia is common in gastric tumors located in pylorus.
Dysphagia is common in gastric tumors located in pylorus.
this statement is incorrect.
Not: Dysphagia is common in cancers located at gastric cardia. The tumors located in pylorus generally cause vomiting secondary to gastric outlet obstruction
A patient with cirrhosis develops spontaneous bacterial peritonitis (SBP). What is the most common organism responsible for SBP in this population?
Streptococcus pneumoniae
Klebsiella pneumoniae
Staphylococcus aureus
Escherichia coli
Escherichia coli
Not: Streptococcus pneumoniae is more commonly associated with community-acquired pneumonia. Klebsiella pneumoniae can cause liver abscesses but is less common in SBP. Staphylococcus aureus is not a typical cause of SBP.
A 32-year-old woman, is brought to the emergency room after a motor vehicle accident. She was the driver and was unrestrained during the collision. On examination, she complains of severe abdominal pain. Vital signs are stable, but there is tenderness and bruising over her abdomen.
As you assess her, you notice her abdomen is distended.
Which option is the most appropriate initial step in the management of this patient’s abdominal trauma?
*Immediately proceed to surgical exploration given the
mechanism of injury and clinical findings.
*Perform a chest X-ray to rule out associated thoracic injuries before deciding on further abdominal imaging.
*Administer analgesics and observe her for a few hours, then repeat the physical examination to assess for any changes.
*Order a focused assessment with sonography for trauma
(FAST) to evaluate for intra-abdominal fluid.
Order a focused assessment with sonography for trauma
(FAST) to evaluate for intra-abdominal fluid.
Not: FAST is a rapid bedside ultrasound examination commonly used in the initial assessment of trauma patients. It can quickly identify the presence of free intra-abdominal fluid, such as blood, which may indicate internal organ injury or bleeding.
A patient with a localized pancreatic adenocarcinoma involving the head of the pancreas and adjacent structures may undergo:
Enucleation
Distal pancreatectomy
Whipple procedure
Total pancreatectomy
Whipple procedure AKA pancreaticoduodenectomy.
This involves the removal of the head of the pancreas, duodenum, and part of the common bile duct.
Papillary thyroid cancer differs from follicular thyroid cancer by:
*Mortality rate is lower in follicular thyroid cancer.
*Recurrence rate is lower in follicular thyroid cancer.
*Lymph node metastasis is more common in papillary thyroid cancer.
*Vascular invasion incidence is lower in papillary thyroid cancer.
Lymph node metastasis is more common in papillary
thyroid cancer.
Which of the following statements is true?
*Thyroglobulin is a commonly used tumor marker in the assessment of thyroid cancer.
*FNA biopsy can be diagnostic for follicular carcinoma.
*Follicular thyroid carcinoma may be associated with flushing and diarrhea.
*Papillary carcinoma is the most common and the most aggressive form of thyroid cancer.
*Anaplastic carcinoma is the least common and the most
aggressive form of thyroid cancer.
Anaplastic carcinoma is the least common and the most
aggressive form of thyroid cancer. This is true.
NOT: Papillary carcinoma is the most common thyroid cancer, approximately 85% of cases, the least aggressive.
Follicular carcinoma is the second most common, accounting for approximately 10% of cases, with a slightly more aggressive course. FNA cytology alone cannot distinguish between follicular adenoma and carcinoma. The diagnosis requires histologic evaluation of a surgical specimen. MTC is a neuroendocrine tumor of the C cells of the thyroid gland. Patients with advanced disease may present with flushing or diarrhea secondary to hormone secretion by the tumor.
Medullary carcinoma is the only thyroid cancer that reliably
expresses a tumor marker, calcitonin. Thyroglobulin levels may be elevated in benign thyroid disease and are not reliably elevated in follicular or papillary carcinomas, and therefore not useful as a tumor marker. Anaplastic carcinoma is the least common but most aggressive form of thyroid cancer with a dismal prognosis
A premenopausal 44-year-old woman undergoes a quadrantectomy and node dissection for a 2-cm infiltrating carcinoma of the left breast. The margins are clear and 5 out of 15 lymph nodes are involved. ER and PR are positive. Recommended adjuvant therapy should include which of the following?
Modified radical mastectomy
Chemotherapy, radiotherapy, and tamoxifen.
Radiotherapy alone
Estrogen therapy alone
Chemotherapy alone
Chemotherapy, radiotherapy, and tamoxifen.
Not: It is advised chemotherapy for all invasive cancers >1 cm as well as for node-positive cancers. Radiotherapy is required whenever breast conserving surgery is undertaken, and tamoxifen should be given for all ER+ and/or PR+ invasive tumors whose patients are premenopausal.
What is the objective finding to tell a wound is in proliferation phase?
Synthesis of Platelet Derived Growth Factor in the wound
Proliferation of fibroblasts in the wound
Synthesis of collagen in the wound
Presence of Macrophages in the wound
Presence of T cells in the wound
Presence of T cells in the wound
Not: T cells appear in the wound about a week after the injury and their presence marks the starting of the proliferation phase of the wound healing.
46-y.o. patient underwent surgery because of a prolapsed intervertebral disk. General anesthesia was induced with propofol and maintained with sevoflurane. When administration of sevoflurane was discontinued, the patient regained consciousness in a few minutes. Which of the following statements best explains why anesthetic recovery is so rapid when sevoflurane administration is stopped?
It is rapidly metabolized within the CNS.
It has a low minimum alveolar concentration (MAC) value.
It has a low blood/gas partition coefficient.
It distributes mainly into the cerebral cortex.
It has a low blood/gas partition coefficient.
A patient is in anaphylactic shock. The patient is given Epinephrine intramuscularly. This medication will have what effect on the body?
It will cause vasoconstriction and decrease the blood pressure.
It will help dilate the airways.
It will help block the effects of histamine in the body.
It will prevent a recurrent attack
It will help dilate the airways.
Not: Epinephrine acts as a vasopressor and will actually dilate the airway. Epinephrine performs vasoconstriction which will INCREASE the blood pressure. It does not prevent a recurrent attack (corticosteroids may help with this), and it does not block the effects of histamine (antihistamine helps with this).
Which of the following is the type of diaphragmatic hernia that occurs more frequently in people around the age of 40 and is sometimes characterized by bleeding, acute gastric dilatation and volvulus?
Paraesophageal Hernia
Sliding Hernia
Morgagni Hernia
Bochdalek Hernia
Traumatic Diaphragmatic Hernia
Paraesophageal Hernia
Not: Paraesophageal hernia is more often asymptomatic but the occurrence of gastric volvulus and bleeding is more frequent than other diaphragmatic hernias
Which of the following is the type of polyp in Peutz Jeghers Syndrome?
Adenomatous
Hamartomatous
Benign Lymhoid
Inflammatory
Hyperplastic
Hamartomatous
Which of the following does not cause Courvoisier’s law ?
Pancreatic cancer
Papilla tumor
Klatskin tumor
Distal bile duct cancer
Cholangiocarcinoma of the distal common bile duct
Carcinoma of the second segment of duodenum
Pancreatic head carcinoma
Klatskin tumor
Not: Klatskin tumor will not cause Courvoisier’s law as the obstruction is above the junction of cystic duct and main hepatic duct
Fastest induction and recovery is seen with -
Enflurane
N2O
Halothane
Desflurane
Desflurane
Not: Due to its low blood gas partition coefficient (0.42), desflurane provides fast induction and recovery in high flow anesthesia.
Which of the following target points is not correct for a trauma patient needing transfusion of blood products?
*Cryoprecipitate should be administered to the patients with less than 100 m g/dL of fibrinogen.
*Fresh frozen plasma should be administered to the patients with INR more than 1.5
*Transfusion of packed red blood cells should be continued until hemoglobin levels reach at least 10 g/dL.
*Packed red blood cells should be administered to the patients with less than 7 g/dL of hemoglobin.
*Thrombocytes should be administered to the patients with platelet counts less than 150,000/µL.
Thrombocytes should be administered to the patients with platelet counts less than 150,000/µL.
NOT: The minimum required amount of platelet count for hemostasis is 50000/µL. 150000/µL. Is more than enough and is not a necessary end point.
The most common cause of an acute hemolytic transfusion reaction is:
Defective blood filter
An error during type and crossmatch
An error during type and screen
Misidentification of the patient, blood specimen, or transfusion unit
Misidentification of the patient, blood specimen, or transfusion unit
Not: Acute hemolytic transfusion reactions are usually due to ABO blood incompatibility, and the most common cause is misidentification of the patient, blood specimen, or transfusion unit (clerical error).
Which of following signs is included in the qSOFA organ failure assessmant?
Tachycardia
Hypertansion
Bradicardia
Altered mental status
Altered mental status
Not:Quick Sequential Organ Failure Assessment (qSOFA) identified hypotension, altered mental status and tachpnea as harbingars of a poor sepsis outcome.
Which of the following are the cells in the gastric epithelium that secrete HCL?
G cells
Chief cells
Parietal cells
Foveolar cells
Mast cells
Parietal cells
Which of the following entities endoscopic ultrasonography (EUS) is incapable of detecting?
Location of the tumor
The depth of the tumor
Local lymph node involvement
Size of the tumor
The presence of distant metastasis
The presence of distant metastasis
Which of the following is not expected to develop in chronic pancreatitis?
Secondary diabetes
Pancreatic duct obstruction
Systemic organ failure
Pseudocyst
Malabsorption
Systemic organ failure
Not: development of systemic organ failure is expected in acute pancreatitis, this risk is absent in chronic pancreatitis.
Which of the following is not observed in acute pancreatitis?
Malabsorption
Acute kidney failure
Pancreatic pseudocyst
Liquid electrolyte imbalance
Pancreatic abscess
Acute kidney failure
A 22 year old woman presents with a painful fluctuant mass in the midline between the gluteal folds. She denies pain on rectal examination. Which of the following is the most likely diagnosis?
Fistula
Perirectal abscess
Anal fissure
Pilonidal abscess
Perianal abscess
Pilonidal abscess
Not: There is absce ss in the intergluteal sulcus and since the anal examination is normal, most likely diagnosis is pilonidal cyst with an abscess
A 28-year-old female presents several weeks after having sustained an injury to her left breast. She has a painful mass in the upper outer quadrant. Skin retraction and ecchymosis is noticed and a hard mass, 3–4 cm in diameter, can easily be palpated. What is the most likely diagnosis?
Fat necrosis and hematoma
Infiltrating carcinoma
Sclerosing adenosis
Breast abscess
Fibroadenoma
Fat necrosis and hematoma
Not: Sclerosing adenosis is a variant of fibrocystic disease
and may present with a hard mass. In a hematoma, evidence of resolving ecchymosis may be present.
Which one of the following is true regarding the hydatid disease of the liver in humans?
The disease occurs by ingesting eggs by eating sheep liver
The disease occurs by ingesting eggs from direct contact to dogs
The disease occurs by ingesting eggs from vegetables which are contaminated by the dogs’ feces
All of the above
The disease occurs by ingesting eggs from vegetables which are contaminated by the dogs’ feces
Galactorrhea, a milky discharge from the nipple in nonpregnant women, is most likely to be associated with which of the following?
Fibroadenoma
Tubular adenoma
Breast abscess
Hyperparathyroidism
Pituitary microadenoma
Pituitary microadenoma
Not: Galactorrhea is fairly common up to old age. The discharge may vary in color from brown to milky. Hormonal causes are associated with elevated prolactin levels or with pituitary or thyroid disorders. Tranquilizers have also been implicated. Simple abscesses do not cause galactorrhea.
A 36-year-old woman complains of a 3-month history of bloody discharge from the nipple. At examination, a small nodule is found, deep to the areola. Careful palpation of the nipple areolar complex results in blood appearing at the 3 O’clock position. Mammogram findings are normal. What is the likeliest diagnosis?
Carcinoma in situ
Fat necrosis
Breast cyst
Intraductal papilloma
Intraductal carcinoma
Intraductal papilloma
NOT: Intraductal papilloma is the most common cause of bloody discharge from the nipple. The lesion is treated by excision and is benign in most cases. Cancer is present in 5% of cases. Preoperative ductography can be used to help locate the offending duct.
Which of the following is one of the goals to be achieved for successful shock therapy?
Central venous oxygen saturation of 50-60%
35-40% mixed venous oxygen saturation
Mean arterial pressure > 65 mmHg
Cardiac index 1.5 TL / minute / m2
lactate level > 4 mMol / L
Mean arterial pressure > 65 mmHg
NOT: All other situations are parameters that show the severity of the shock increased
In which clinical setting urgent appendectomy is not indicated?
Perforated Appendicitis with Localized Peritonitis
Phlegmonous (Plastrone) Appendicitis
Acute Appendicitis
Perforated Appendicitis with Generalized Peritonitis
Acute Appendicitis in 1st Trimester Pregnancy
Phlegmonous (Plastrone) Appendicitis
NOT: Phlegmonous (Plastrone) appendicitis, an appendectomy is performed 4-6 weeks later in a planned manner
A 20-year-old woman is seen in clinic because of a thyroid nodule. She is asymptomatic and her past medical history is unremarkable. She takes no medications. There is a 1-cm firm, solitary, nodule in the lateral aspect of the left lobe of the thyroid. A radionuclide scan showed no uptake of tracer in the nodule. Ultrasonography shows a solid, homogeneous 1-cm mass. FNA cytology shows a follicular neoplasm. What is the next best step in management?
Total thyroidectomy
Thyroid suppression with thyroxine
Left thyroid lobectomy
Incisional biopsy and enucleation if benign
Irradiation (radioactive iodine)
Left thyroid lobectomy
NOT: y. Even though an FNA showing follicular cells is only 5% likely to be a malignancy, most endocrine surgeons would recommend excision because of that concern.
Which one is wrong about rhythms that can cause cardiac arrest?
+Biphasic: 120 – 360 J , monophasic: 360 J shock is applied during Pulse-less VT
+Pulse-less electrical activity is not shockable rhythm
+Amiadarone can be used as post-shock anti-arrhythmic agent during CPR
+Monophasic 360J is used while asystole shock is applied
+Ventricular fibrillation is shockable rhythm
Monophasic 360J is used while asystole shock is applied, this statement is wrong.
Not: 1. Shockable rhythms:
* Ventricular fibrillation (Biphasic: 120 – 360 J , monophasic:
360 J)
* Pulse-less ventricular tachycardia (Biphasic: 120 – 360 J ,
monophasic: 360 J)
2. Non-shockable rhythms:
* ASYSTOLE
* Pulse-less electrical activity
75 yo male admitted to ER due to sudden and very severe epigastric pain felt immediately after eating. He has a
history of oral anticoagulant use due to heart valve insufficiency. Initial physical examination shows no pathological findings except for minimal distention and
tenderness in the abdomen. In the laboratory tests, there is an increase D-Dimer and there are signs of metabolic acidosis. What is your possible pre-diagnosis?
Colon tumor
Acute gastroenteritis
Acute gallstone cholecystitis
Acute appendicitis
Ischemia due to acute mesenteric artery embolism
Ischemia due to acute mesenteric artery embolism
NOT: AMI is characterized by advanced age, valvular diseases, sudden abdominal pain, mild abdominal findings in the initial examination, and increased blood ischemia markers.
Which of the below eponyms is the definition of edema and ecchymosis around the umblical area which can be encountered in acute pancreatitis that was first defined
by a gynecologist in patients with ruptured ectopic pregnancy?
Caput medusa
Cullen’s sign
Grey - Turner’s sign
Murphy’s sign
Clepotage
Cullen’s sign
NOT: Cullen’s sign is superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus.
An 18 yo man is rushed into the ER by his friends who left him immediately before they could interviewed by the staff. He is semiconscious RR=8 /min, BP = 120/70, pulse = 60 bpm. He is noted to have needle track marks on his arms and his pupils are small. What is the single best initial tx?
Methadone
Gastric lavage
Naloxone
Insulin
Naloxone
NOT: The key is naloxone. The diagnosis is opiat overdose. Points in favour are : reduced consiousness, RR 8 /min, hypotension, miosis, needle track marks on his arms
Which of the following is not true for primary peritonitis?
+Acute abdominal findings and positive paracentesis findings are diagnostic.
+In adults, it is most common in patients with liver cirrhosis.
+The treatment of primary peritonitis is medical.
+E.Coli, one of the enteric bacteria, is most frequently encountered pathogen in adults.
+Primary peritonitis is of multibacterial origin
+Primary peritonitis is of multibacterial origin
Note: It is monobacterial in origin.
MHC Class II molecules are a class of major histocompatibility complex (MHC) molecules normally found only in what type of cells?
In immune system cells
In all of the cells
In all of the nucleated cells
In hepatocytes
In immune system cells
NOT: The human major histocompatibility complex (MHC), commonly called the human leukocyte antigens (HLA) are divided into two classes. Class I antigens are expressed by all of the nucleated cells, while class II antigens are expressed by the immune system cells,
A 35-year-old woman is seen in clinic because of weight gain and abnormal hair growth. She has gained 15 kg in 6 months, most notably in her torso. She denies increased appetite and has not changed her daily activity patterns. She has been emotionally labile, and her previously regular menses have become irregular (periods are shorter or missed altogether). On examination, she has truncal obesity and hirsutism. The most likely primary cause of her symptoms is due to hyperfunction of which one of the following?
Pulmonary enterochromaffin (Kulchitsky) cells
Ovarian epithelial cells.
Pituitary basophils
Adrenal cortical cells
Adrenal medullary cells
Pituitary basophils
NOT: This patient has symptoms and signs of hypercortisolism (CS). The most common cause of CS in adults is an ACTH-secreting tumor of the pituitary basophils (CD). Women in the third and fourth decades of life are the typical patients. CD accounts for 70% of cases of CS. Bronchial carcinoid tumors (arising from Kulchitsky cells) are a source of ectopic ACTH production. Ectopic ACTH syndrome causes about 15% of CS in adults. The adrenal medulla does not produce glucocorticoids; tumors of the medulla are PHEOs and produce excess catecholamines. A tumor of ovarian epithelial cells could lead to menstrual irregularities through excess sex steroid production but would not produce hypercortisolism.
Which of the following neurostimulators below have excitatory effect in the modulation processes of pain?
GABA
Acetylcholine
Glutamate
Glysine
Beta endorfine
Glutamate
NOT: Glutamate as a neurotransmitter has excitatory effect in pain modulation processes, both in peripheral and central nervous system, while other options have inhibitory effects.
Which of the following neurostimulators have excitatory effect in the modulation processes of pain?
Beta endorfine
GABA
Glutamate
Glysine
Acetylcholine
GABA
Etiologies associated with hypocalemia may include all of the following except?
Vitamin D deficiency
Metastatic bone lesions
Inadequate intake calcium
Renal failure
Metastatic bone lesions
NOT: Metastatic bone lesions are associated with hyperclcemia due to accelerated bone metabolism and relase of calcium into the serum. Renal failure, inadequate calcium intake, and vitamin D deficiency may cause hypocalcemia.
A young collage student is found in his dorm unconscious. He has tachyarrythmia and high fever. He also seems to be bleeding from his nose ,which on examination shows a perforation of a nasal septum. What is the most likely dx?
Marijuana OD
Heroin OD
Cocaine OD
Alcohol OD
Cocaine OD
NOT: The symptoms of cocain overdose : tachyarrythmia, high fever, perforation of a nasal septum, unconscious, anxiety, paranoia, tachypnoea, increased energy and talking rapidly, dilated pupils.
Also: rabdomyolysis, metabolic acidosis, convulsion.
Adequate of alveolar ventilation is determined by measuring:
The oxygen gradient
Cardiac output
Carbon dioxide tension
Oxygen tension
Oxygen saturation
Carbon dioxide tension
NOT: (Adequate of alveolar ventilation is obtained by measured the carbon
dioxide tension. Oxygen values may be affected by ventilation, but
the measure of ventilation is carbon dioxide.)
An 18-year-old presents with a well circumscribed 2-cm mass in her right breast. The mass is painless and has a rubbery consistency and discrete borders. It appears to move freely through the breast tissue. What is the likeliest diagnosis?
Cystosarcoma phyllodes
Fibroadenoma
Cyst
Intramammary lymph node
Carcinoma
Fibroadenoma
NOT: Fibroadenomas are most often found in teenage girls. They are firm in consistency, clearly defined, and very mobile. The typical feature on palpation is that they appear to move freely through the breast tissue (“breast mouse”).
All of the following are risk factors for obstructive sleep apnea, EXCEPT;
Age>50
Short neck
Female gender
Enlarged tonsils
Obesity
Female gender
NOT: The assessment of preoperative predictability for obstructive sleep apnea can be done by using the “STOP-BANG” questionnaire. (S, snoring; T, tired during daytime; O, observed for apnea during sleep; P, high blood pressure; B, BMI >35 kg/m2 ; A, age >50; N, neck circumference >40 cm; G, male gender). In addition to the questionnaire, upper airway anatomical abnormalities that increase the likelihood of obstruction are tonsillar hypertrophy, tumors of the upper airway, or facio maxillary abnormalities
A 45-year-old male is referred for clinic for a left-sided adrenal mass. Serum metanephrines are markedly elevated and is scheduled for a laparoscopic left adrenalectomy. Prior to proceeding to the operating room, what intervention should be performed?
*Hydration followed by beta-blockade.
*Alpha-blockade and then the addition of beta-blockade 10 days prior to surgery
*Beta-blockade until the patient is not tachycardic and then the addition of an alpha blocker
*Left-sided adrenal biopsy to rule out cancer
*No further intervention is required. Proceed with surgery
*Alpha-blockade and then the addition of beta-blockade 10 days prior to surgery
This patient has been diagnosed with a left-sided PHEO. It is
appropriate to proceed with surgical intervention. However, it is essential to make sure that the patient is adequately prepared for surgery with alpha blockade, usually with either phenoxybenzamine or doxazosin, prior to surgery. Once adequate blockade has been achieved, beta-blockade should be added 10 days prior to surgery along with aggressive hydration
A 40-year-old healthy woman is found to have a serum calcium level of 11 mg/dL during a preventive medicine visit. She is otherwise healthy and takes no medications. There is no family history of endocrine disease. Serum phosphorus is 2.4 mg/dL, and the PTH level is 90 pg/mL. Sestamibi scan shows persistent uptake in the region of the inferior lobe of the thyroid on the right. Cervical ultrasonography demonstrates a 15-mm ovoid hypoechoic solid soft-tissue mass immediately adjacent and lateral to the inferior pole of the right thyroid lobe. Which of the following is the most appropriate treatment recommendation for this patient?
Begin saline and bisphosphonates intravenously
Observation and repeat laboratory studies in 6 months
Begin daily oral furosemide
Targeted parathyroidectomy with ioPTH monitoring
Begin daily cinacalcet
Targeted parathyroidectomy with ioPTH monitoring
NOT: This patient has early sporadic PHP. Although she is asymptomatic, she meets consensus criterion for parathyroid operation of age < 50. She localized preoperatively to an abnormal right inferior parathyroid
gland, so she is a candidate for a targeted approach to
parathyroidectomy using a focal exploration and ioPTH monitoring. Four-gland exploration would also be an appropriate answer if this had been an option and would be the appropriate next step if the ioPTH did not decrease as expected.
Which of the following has the lowest risk of developing colon cancer?
Ulcerative Colitis
Gardner Syndrome
Villous Adenoma
Hamartomatous Polyp
Familial Polyposis
Hamartomatous Polyp
Aldosterone secretion in response to fluid loss will result in which on of the following electrolyte imbalance?
Hyponatremia
Hypokalemia
Hypercalsemia
Hyperkalemia
Hypernatremia
Hypokalemia
NOT: Aldosterone is secreted in response to fluid loss. Aldosterone causes sodium reabsorption and potassium elimination, further exacerbating hypokalemia.
What is the proper maximum amount of crystalloid fluid to be administered for a fluid challenge in a patient with shock?
500 cc
800 cc
1000 cc
1500 cc
2000 cc
2000 cc
What is the least amount of systolic blood pressure required for a palpable pulsation in the radial artery?
60 mmHg
70 mmHg
80 mmHg
90 mmHg
100 mmHg
80 mmHg
At least 80 mmHg of systolic pressure is required to properly
palpate radial pulse, 70 for femoral and 60 for carotid
In which of the following situations, abdominal pain does not show a sudden and sharp onset?
Hollow organ perforation
Acute appendicitis
Ectopic pregnancy rupture
Acute mesenteric ischemia after embolism
Ovarian cyst rupture
Acute appendicitis
NOT: In the development of acute appendicitis, visceral pain is felt first, and therefore the onset of pain is slow and blunt at the beginning
62-y.o. patient undergoes surgery to repair a small bowel closed loop obstruction. Which of the following general anesthetics would be contraindicated in this patient?
Ketamine
Nitrous oxide
Thiopental
Sevoflurane
Nitrous oxide
NOT: In closed loop obstruction, the lumen of the bowel is occluded at two points, thus preventing prograde and retrograde movements of bowel contents. Because nitrous oxide uses into the cavity more rapidly than the air (principally nitrogen) diffuses out, the gas can increase the intraluminal pressure of the obstructed bowel loop, thus
increasing the risk of gut rupture. Examples of conditions in which nitrous oxide might be hazardous include all the closed cavities filled with air, such as pneumothorax, pulmonary air cysts, and pneumocephalus.
You’re providing education to a patient, who has a severe peanut allergy, on how to recognize the signs and symptoms of anaphylactic shock. Select the signs and
symptoms which is NOT associated with anaphylactic shock:
Difficulty speaking
Slow heart rate
Vomiting and Nausea
Feeling dizzy
Itchy
Slow heart rate
NOT: Patients who are in anaphylactic shock will have signs and symptoms associated with the effects of histamine. Remember histamine affects the respiratory, cardiac, GI and skin. The patient can have the following: Respiratory: dyspnea and wheezing (bronchoconstriction), swelling of upper airways due to edema “tightness”…can’t speak, coughing, stuffy nose, watery eyes, Cardiac: tachycardia, hypotension (vasodilation)…loss of consciousness, dizzy, GI: vomiting, nausea, pain, Skin: vasodilation…red, swollen, itchy, hives
Which local anesthetic does not require adrenaline¿
Lignocaine
Cocaine
Procaine
Cocaine
NOT: (The key is cocaine. Cocaine does not require adrenaline)
During the transmission of a painful stimuli to the central nervous system, which of the following processes below is not employed?
Transmission
Sensitization
Perception
Modulation
Transduction
Sensitization
Which of the following factors does not contribute to the acute coagulopathy of trauma (ACOT)?
Acidosis
Hypothermia
Release of tissue factor
Release of heparin sulphate
Activation of protein C
Release of tissue factor
NOT: Releasing of tissue factor contributes to clot formation however remaining factors causes coagulopathy
Which of the following is wrong for pancreatic pseudocyst?
It occurs with the accumulation of fluid that develops after
pancreatitis.
It does not have a complete capsule and is surrounded by tissue and granulation tissue.
It may develop after acute or chronic pancreatitis.
There is a complete epithelial capsule
Persists for more than 4 weeks
There is a complete epithelial capsule, this statement is wrong
NOT: The pseudocyst does not have a complete capsule, it is surrounded by tissue and granulation, therefore it is called false cyst
In what case is a distributive shock (hyper-dynamic, or vasodilatory shock) seen?
Acute myocardial infarction
Sepsis
Renal failure
Pulmonary embolism
Severe gastroenteritis
Sepsis
NOT: Severe gastroenteritis causes hypovolemic shock. In acute myocardial infarction, cardiac shock will be appeared. Pulmonary embolism causes obstructive shock. In renal failure, hypervolemia, acidosis and hyperpotassemia will develop. Cardiac shock will be more prominent. Sepsis causes hyper-dynamic, distributive or vasodilatory shock.
