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Surgery Finals 1st And 2nd Sem > Finals 1st Sem > Flashcards

Finals 1st Sem Flashcards

1
Q

The fundamental principles of leadership are
A. Vision and willingness
B. Command and control
C. Time management and mentoring
D. Coaching, pacesetting and democracy

A

Vision and willingness to

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2
Q

The physician during the 2nd Century AD whose teachings were accepted as a dogma by his followers so that no advances in medicine were made for the next 1,500 years is
A. Hippocrates
B. Galen
C. Celsus
D. Paracelsus

A

Galen

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3
Q

Which of the following is NOT true regarding the renin-angiotensin system?
A. Rennin is an enzyme origination from the juxtaglomerular apparatus of the kidney
B. Angiotensin I is converted to
angiotensin II primarily in the kidney
C. Angiotensin II stimulates aldosterone release from the adrenal cortex
D. Aldosterone increase sodium resorption in the
distal renal tubule

A

Angiotensin I is converted to angiotensin II primarily in the kidney

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4
Q

Immediately after wound healing, which of the following is NOT stimulated?
A. Blood catecholamine level
B. Aldosterone
C. Antidiuretic hormone
D. Thyrotropin

A

Thyrotropin

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5
Q

Metabolic effects of neuroendocrine response to injury does NOT include
A. Gluconeogenesis
B. Glycogen synthesis
C. Lipolysis
D. Proteolysis

A

Glycogen synthesis

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6
Q

During starvation, the body’s major source of fuel is
A. Free fatty acids
B. Protein
C. Glucose
D. Glycerol

A

Free fatty acids

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7
Q

The oxidative derivative of arachidonic acid via the lipoxygenase pathway eventually produce:
A. Leukotrienes and prostaglandins
B. Leukotrienes and HETE
C. Prostaglandin and thromboxanes
D. Leukotrienes and thromboxanes

A

Leukotrienes and HETE

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8
Q

Which of the following statements is correct regarding IL1?
a. IL-1 appears to be more potent than tumor necrosis alpha
b. Expression is autoregulated in part
c. Inhibits prostaglandin production
d. The ability to regulate endothelial cell
neutrophil adhesion molecules s relatively limited

A

Expression is autoregulated in part

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9
Q

A medical student was operated on
because of rupture appendicitis under general anesthesia. He would exhibit the following changes except
A. Hypermetabolism
B. Fever
C. Tachypnea
D. Hyperphagia

A

Hyperphagia

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10
Q

The clotting factor which is not present in stored plasma is
A. Factor II
B. Factor VII
C. Factor X
D. Factor V

A

Factor V

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11
Q

Prothrombin time could not be used to evaluate the following clotting factor
A. Factor II
B. Factor V
C. Factor VII
D. Factor IX

A

Factor IX

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12
Q

A potential bleeder is best identified by
A. Complete history and physical examination
B. Bleeding time
C. Clotting time
D. Prothrombin time

A

Complete history and physical examination

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13
Q

The mode of inheritance of Hemophilia A is
A. Autosomal dominant
B. Autosomal recessive
C. Sex linked recessive
D. Sex linked dominant

A

Sex linked recessive

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14
Q

Which of the following is most likely
to be transmitted by blood transfusion

A. Viral hepatitis
B. Syphilis
C. Megaloblastic anemia
D. Scurvy

A

Viral hepatitis

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15
Q

The important aspect of blood
compatibility is
A. Crossmatch with anti A and Anti B sera
B. Donor serum compatible with patient’s cells
C. Rh blocking antibodies
D. Donor cell compatible with patient’s serum

A

Donor cell compatible with patient’s serum

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16
Q

In the classic model of burn wound
cytology, the intermediate zone of damaged but potentially salvageable cells is called the zone of
A. coagulation
B. hyperemia
C. necrosis
D. stasis

A

Stasis

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17
Q

An otherwise healthy 35-year old
man receives second and third degree burns over 40% of the total body surface area. Which of the following immunologic reactions will occur?

A. Decreased complement activation
B. Decreased function of leukocytes
C. Decreased function of suppressor T lymphocytes
D. Increased function of suppressor T lymphocytes

A

B. Decreased function of leukocytes

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18
Q

A 30-year-old man who repairs
electrical lines for a utility company is brought to the emergency department for treatment of an electrical injury to the right upper extremity. Examination shows limited full-thickness burns of the flexor creases of the palm, wrist and elbow. Doppler flowmetry shows patent palmar arch pulses. Passive motion of the fingers produces an intrinsic minus hand posture with pain. The most appropriate initial step in management is

A. continued observation
B. escharotomy
C. fasciotomy
D. burn excision and grafting

A

Fasciotomy

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19
Q

Which of the following is the most
appropriate immediate treatment of chemical burns caused by white phosphorus?
A. Application of calcium alginate emulsion
B. Continuous water irrigation
C. Irrigation with copper sulfate solution
D. Irrigation with potassium manganese solution

A

Continuous water irrigation

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20
Q

Which of the following is a common sequelae of electrical injury?
A. cardiac arrhythmias
B. paralysis
C. brain damage
D. cataracts

A

cataracts

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21
Q

Following caustic injury to the skin
with an alkaline agent, the affected area should initially be
A. Treated with running water or saline for 30
minutes
B. Treated with running water or saline for 2
hours
C. Treated with neutralizing agent
D. Treated with topical emollients and oral
analgesics

A

Treated with running water or saline for 2 hours

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22
Q

The area most amenable to salvage
by resuscitative and wound management techniques following thermal injury is called
A. Zone of stasis
B. Zone of coagulation
C. Zone of hyperemia
D. Zone of scalding

A

Zone of stasis

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23
Q

Parkland’s formula recommends this for burn fluid management
A. Lactated Ringer’s solution
B. Plain normal saline solution
C. Hypertonic saline solution
D. Dextran

A

Lactated Ringer’s solution

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24
Q

How much percentage of blood is
lost in trauma patients before they present with hypotension?
A. 10%
B. 20%
C. 30%
D. 40%

A

30%

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25
Q

You are monitoring the urine output
of a 8-year old male with a weight of 15 kg after a laparotomy for traumatic injuries. What is the ideal urine output per hour?
A. 45 cc
B. 30 cc
C. 15 cc
D. 7.5 cc

A

15 cc

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26
Q

In penetrating injury to the neck, what
structure delineates deep penetration that warrants possible cervical operative exploration
A. Digastric
B. Sternocleidomastoid
C. Ansa cervicalis
D. Platysma

A

Platysma

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27
Q

What is the structure that is
controlled when a Pringle Maneuver is used for hepatic bleeding injuries?
A. Gastrocolic ligament
B. Hepatoduodenal ligament
C. Renocolic ligament
D. Falciform ligament

A

Hepatoduodenal ligament

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28
Q

A 22-year old male patient sustained
a single stab wound to the chest at the 4th intercostal space left parasternal area. On echocardiography, there was a note of pericardial fluid. What region of the heart is most probably injured?
A. Right ventricle
B. Left ventricle
C. Right atrium
D. Left atrium

A

Right ventricle

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29
Q

Recommended IV fluid for
resuscitation is
A. PLRS
B. PNSS
C. D5LRS
D. D5NSS

A

PLRS

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30
Q

A 30-year old male sustained stab
wounds on the chest and abdomen. He is anxious, incoherent and diaphoretic with pale palpebral conjunctiva. To increase his chances of survival he should be started immediately on
A. FWB
B. Crystalloids
C. FFP
D. PRBC

A

PRBC

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31
Q

A 15-year old male victim of a hit and
run brought to the emergency room pale with unstable vital signs. Primary and secondary surveys only revealed pain on both hips, with bruising on the hypogastric area and highs and a high flying prostate. After initiating resuscitation, best way to control the bleeding is
A. do an emergency abdominal exploration
B. Apply sheet compression around the pelvis
C. place a long leg cast
D. do embolization

A

Apply sheet compression around the pelvis

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32
Q

Two days postoperatively after
undergoing damage control surgery for multiple organ injuries secondary to trauma, patient developed high grade fever, tachycardia and hypotension. Patient is going into what type of shock
A. Septic
B. Vasogenic
C. Traumatic
D. Hypovolemic

A

Septic

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33
Q

In which type of shock will the
systemic vascular resistance be markedly increased
A. Hypovolemic
B. Septic
C. Neurogenic
D. Cardiogenic

A

Cardiogenic

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34
Q

During the compensatory phase of
shock, blood glucose increase is due to what hormone
A. Cortisol
B. Glucagon
C. Insulin
D. Epinephrine

A

Epinephrine

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35
Q

On the fifth post-operative day after a major abdominal surgery and still on mechanical ventilator, the 70 year old, pale, diabetic, hypertensive female suddenly developed hypotension, arrhythmia and diaphoresis. You should start
A. Crystalloids
B. Norepinephrine
C. Epinephrine
D. Blood transfusion

A

Crystalloids

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36
Q

On the seventh post-operative day
for ruptured appendicitis, patient became febrile with tachycardia and normal blood pressure. Repeat CBC showed Hgb 12 WBC 18. You immediately recommend
A. operation
B. ultrasound
C. CT Scan
D. Broad spectrum antibiotics

A

Broad spectrum antibiotics

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37
Q

The most important component when
errors and complications occur in health care
A. Communicate failures or losses
B. Less organized surgeons
C. Chaotic environment
D. Poor quality improvement

A

Communicate failures or losses

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38
Q

An example of a patient’s disease and its complication is
A. Delay in diagnosis of intestinal obstruction
B. Treatment failure following debridement of infected wound
C. Postoperative abscess following perforated viscus
repair
D. Delay in discharge following appendectomy

A

Postoperative abscess following perforated viscus
repair

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39
Q

Science that promotes the use of
evidence-based medicine to minimize the impact of human error on delivery of services
A. Surgical institutions
B. Medical Science
C. Patient safety
D. Legal Medicine

A

Patient safety

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40
Q

Sentinel Event
A. Injury that falls below a standard of care
B. Injury that involves loss of limb or function
C. Injury that is preventable or unpreventable
D. Injury that does not result in patient’s harm

A

Injury that involves loss of limb or function

41
Q

The core of any effective
organization and is the key element to ensuring patient’s safety in operating room
A. Culture
B. Strong communication
C. Quality of surgery
D. Strong teamwork

A

Strong teamwork

42
Q

Patient contacts for all types of interaction should be recorded

A. For complications recorded
B. For the office charts need to show
C. To provide optimal documentation in medical record
D. To check lost medical
records

A

To provide optimal documentation in medical record

43
Q

A 54-year old woman undergoes
surgical replacement of a fully inflated tissue expander with a mammary prosthesis. The surgical scar and a portion of surrounding expanded tissue are excised. Histopathologic examination shows no malignant cells. The most likely additional finding is thickening of which of the following tissues
A. Dermis
B. Epidermis
C. Muscle
D. Subcutaneous tissue

A

Epidermis

44
Q

Following placement of a split-thickness skin graft, which of the following sensations returns first
A. Cold
B. Heat
C. Light touch
D. Pain

A

Pain

45
Q

A 42-year old man has a 3-cm scar
on the forehead parallel to the resting lines of skin tension. Which of the following is the most appropriate surgical technique for scar revision

A. Fusiform excision
B. Serial excision
C. W-plasty
D. Z-plasty

A

Fusiform excision

46
Q

Which of the following best characterizes a stage III pressure ulcer
A. Partial-thickness skin loss involving the
epidermis and or dermis
B. Full-thickness skin loss involving damage or
destruction of the subcutaneous tissue that does not involve the underlying fascia
C. Full thickness skin loss involving damage or destruction of the subcutaneous tissue fascia and underlying muscle but sparing the underlying bone
D. Full thickness skin loss involving damage or destruction of tissue including underlying bone or supporting structures

A

Full thickness skin loss involving damage or destruction of the subcutaneous tissue fascia and underlying muscle but sparing the underlying bone

47
Q

An 8-month old girl has a 1-cm
pedunculated lesion arising from a capillary vascular malformation (port-wine stain) on her cheek. Which of the following is the most likely diagnosis?
A. Angiosarcoma
B. Arteriovenous fistula
C. Pyogenic granuloma
D. Infected abscess

A

Pyogenic granuloma

48
Q

A 3 cm basal cell carcinoma of the skin should be treated with
A. Biopsy and gross total excision
B. Dermatologic laser vaporization
C. Wide excision with 2-4 mm margin
D. Electrodessication

A

Wide excision with 2-4 mm margin

49
Q

The most common distant metastasis
for melanoma is
A. Brain
B. Lung
C. GIT
D. Liver

A

Lung

50
Q

Which of the following lesions is most
likely malignant cells?
A. Acrochordons
B. Cutaneous horn
C. Dermatofibroma
D. Molluscum contagiosum

A

Cutaneous horn

51
Q

A 25-year old complained of a three
day history of an 8-cm non-erythematous, solid and fluctuant mass, your diagnosis is
A. Fibrocystic disease
B. Fibroadenoma
C. Blue dome cyst
D. Abscess

A

Fibrocystic disease

52
Q

A 50-year old man diagnosed with a Stage I Invasive Ductal Carcinoma, you do
A. Wide excision
B. Modified Radical Mastectomy
C. Simple Mastectomy
D. Close Monitoring

A

Simple Mastectomy

53
Q

A 32-year old female with a 2 cm well defined firm mass on the breast, mammogram revealed solitary
macrocalcification, you recommend
A. Ultrasound
B. Core needle biopsy
C. Excision biopsy
D. Close observation

A

Core needle biopsy

54
Q

What will you recommend for a 2 cm Phyllodes tumor
A. Simple Mastectomy
B. Modified Radical Mastectomy
C. Quadrantectomy
D. Excision

A

Excision

55
Q

A 24 year old male complained of a
10 cm tender 10 cm sub-areolar mass, what surgery will you do if necessary
A. Subcutaneous mastectomy
B. Simple mastectomy
C. Excision
D. Wide excision

A

Subcutaneous mastectomy

56
Q

What will be recommended for a
patient with a 4 cm Invasive Lobular Carcinoma with lung metastases?
A. Modified Radical Mastectomy
B. Simple Mastectomy
C. Radiotherapy
D. Chemotherapy

A

Chemotherapy

57
Q

Patients who preferred to undergo
breast conservation therapy must undergo

A. Chemotherapy
B. Radiotherapy
C. Hormonal therapy
D. All of the above

A

D. All of the above

58
Q

Patient is diagnosed with Lobular Carcinoma in situ, you recommend

A. Simple Mastectomy, left
B. Bilateral Simple Mastectomy
C. Modified Radical Mastectomy
D. Close Surveillance

A

D. Close Surveillance

59
Q

50-year old man with a hard mass initially noted on the Upper Outer Quadrant, you initially recommend:
A. Ultrasound
B. Mammogram
C. Needle biopsy
D. Excision biopsy

A

Mammogram

60
Q

What is the common denominator in
the risk factors for the development of breast cancer
A. Age
B. Family history
C. Estrogen exposure
D. Smoking

A

Estrogen exposure

61
Q

A 35-year old male at the intensive
care unit with tracheostomy and nasogastric tube was referred because of suctioning of tracheostomy tube the nurse aspirated a previously given osterized mixture. Most likely, the patient has

A. Tracheal stenosis
B. Aspiration pneumonia
C. Tracheoesophageal fistula
D. Tracheoinominate artery fistula

A

Tracheoesophageal fistula

62
Q

All of the following are true of Pancoast tumor, except:
A. It usually presents with hoarseness of the voice
B. The tumor originates in the superior sulcus
C. It manifest as apical chest and/or shoulder
pain
D. There is unilateral exophthalmos, miosis and ptosis

A

It usually presents with hoarseness of the voice

63
Q

Most common lung cancer
A. squamous cell carcinoma
B. adenocarcinoma
C. adenomatous hyperplasia
D. elevated ACTH

A

adenocarcinoma

64
Q

All of the following are true of the
epidemiology of lung cancer EXCEPT
A. Associated with smoking
B. The main chemical carcinogens are polycyclic aromatic hydrocarbons
C. Patients with secondary scar formation related
to history of TB have higher risk of primary
tumor
D. Female patients have poor prognosis
compared to male patients

A

D. Female patients have poor prognosis
compared to male patients

65
Q

The most devastating complication after pulmonary resection is
A. bronchopleural fistula
B. bleeding
C. postpneumonectomy pulmonary edema
D. atelectasis

A

postpneumonectomy pulmonary edema

66
Q

A 37-year old was referred because
of the ff findings: fever(39C), chills, leukocytosis, weight loss. Chest x-ray showed mass with a thin-walled cavity. This is consistent with:
A. tuberculosis
B. Cavitary malignancy
C. Lung abscess
D. bronchiectasis

A

Lung abcess

67
Q

A one-year old child was brought to
consult because of an incidental finding of an anterior mediastinal mass on chest x-ray. Physical examination findings are essentially normal. The mass most probably is
A. Pericardial cyst
B. Lymph node
C. Thymus gland
D. Thyroid gland

A

Thymus gland

68
Q

A patient known to have COPD was
referred because of hemoptysis occurring three times a day amounting to 30 cc of blood per episode for two days. The last episode was at the emergency amounting to 50 cc. All are indicated EXCEPT
A. advice for immediate surgery
B. Flexible bronchoscopy
C. insert an IV line
D. nebulized oxygen

A

advice for immediate surgery y

69
Q

The most common benign chest wall
neoplasm is
A. Osteochondroma
B. Desmoid tumor
C. Eosinophilic granuloma
D. Osteosarcoma

A

Osteochondroma

70
Q

Persistence of the vitelline duct can lead to which of the following
A. Colonic diverticulum
B. Urachal Cyst
C. Umbilical Cord Hernia
D. Omphalomesenteric Duct Cyst

A

D. Omphalomesenteric Duct Cyst

71
Q

Spigelian Hernias usually occur

A. On the lateral border of the rectus abdominis
muscle
B. In the linea alba
C. In the medial wall of the inguinal canal
D. In the posterior costovertebral angle

A

On the lateral border of the rectus abdominis
muscle

72
Q

Which of the ff is true

A. As the midgut develops, outside the
abdomen, it undergoes a 270 degree counterclockwise rotation
B. As the midgut develops outside the abdomen, it
undergoes a 270 degree clockwise rotation
C. The midgut remains within the abdominal
cavity throughout gestation
D. None of the above

A

As the midgut develops, outside the
abdomen, it undergoes a 270 degree counterclockwise rotation

73
Q

All of the ff are true except
A. An omphalocele protrudes via a defect in the umbilicus
B. Gastroschisis protrudes via a defect in the umbilicus
C. Herniated bowel is contained within a sac in gastroschisis
D. All are true

A

Herniated bowel is contained within a sac in gastroschisis

74
Q

The rule of 2’s include all of the ff
except
A. Occur in 2% of the population
B. Commonly present in 2 years of age
C. Found within 2 inches of the ileocecal valve
D. Contains 2 types of ectopic mucosa

A

Found within 2 inches of the ileocecal valve

75
Q

The medial umbilical ligament is the
remnant of which of the following structures
A. Umbilical artery
B. Urachus
C. Umbilical vein
D. round ligament

A

Umbilical artery

76
Q

Repair of a new 5-cm midline
postoperative ventral hernia in an otherwise healthy patient is best accomplished with
A. primary suture repair
B. Repair with synthetic mesh
C. repair with transposition of rectus muscle
D. lateral component separation with mesh overlay

A

B. Repair with synthetic mesh

77
Q

Which of the following statements
regarding umbilical hernias is true
A. Congenital umbilical hernias close spontaneously by 5 years of age
B. Umbilical hernias should be repaired as soon as they are diagnosed
C. Adults with small, non incarcerated umbilical hernias should undergo repair
D. Umbilical hernias are associated with disseminated carcinomatosis

A

Congenital umbilical hernias close spontaneously by 5 years of age

78
Q

Mesh repair where mesh is placed underneath the fascia
A. Overlay
B. Interlay
C. Sublay
D. Underlay

A

Sublay

79
Q

The Greater omentum originates in
the greater curvature of the stomach and fold back on itself to attach to which structure
A. Lesser curvature of the stomach
B. Liver
C. 2nd part of the duodenum
D. Transverse colon

A

Transverse colon

80
Q

Chronic groin pain following inguinal
hernia repair may be the result of
A. Division of the nerves following surgical procedure
B. Postoperative scar tissue
C. use of a mesh
D. injury from the use of tacks or staples

A

Division of the nerves following surgical procedure

81
Q

Which of the ff statements is true
regarding surgical technique
A. Bassini repair can be used for femoral hernia
B. A total extraperitoneal repair is a laparoscopic approach that stays in the preoperational space by using a balloon dissector
C. A Bassini repair used a piece of mesh to reinforce the floor of the inguinal canal and recreate the internal ring in a tension free manner
D. A McVay repair may never be used for femoral hernia

A

A total extraperitoneal repair is a laparoscopic approach that stays in the preoperational space by using a balloon dissector

82
Q

Which of the ff statements is false
regarding the incidence of abdominal wall hernias

A. Majority of all inguinal hernias are indirect
B. Premature infants have a higher incidence of inguinal hernia
C. Inguinal hernias are more common in males than in females
D. Hernias occur with equal frequency in males and females

A

D. Hernias occur with equal frequency in males and females

83
Q

Which of the following complications
does NOT occur with hernia repair
A. Ischemic orchitis
B. Transection of the vas deferens
C. Prostatitis
D. Testicular atrophy

A

Prostatitis

84
Q

Which of the ff describes umbilical
hernia in children
A. Repair should be performed only if the
child is symptomatic
B. Repair is indicated once an umbilical hernia is
diagnosed
C. Repair should be performed if the hernia persists beyond 6 months of age
D. Most close spontaneously

A

D. Most close spontaneously

85
Q

Borders of the Hesselbach Triangle
include the ff except

A. Inguinal Ligament
B. Spermatic cord
C. Inferior epigastric artery
D. Rectus abdominis muscle

A

Spermatic cord

86
Q

Congenital inguinal hernia are caused by

A. Increased intra-abdominal pressure during fetal
development
B. Patent processus vaginalis
C. Chronic cough
D. Poor development of abdominal wall

A

B. Patent processus vaginalis

87
Q

All of the following are risk factors of inguinal hernias in adults EXCEPT
A. Ascites
B. Collagen disorders
C. Smoking
D. Diabetes insipidus

A

Collagen disorders

88
Q

Borders of the femoral ring include
the following EXCEPT
A. Inguinal ligament
B. Lacunar ligament
C. cooper’s ligament
D. Femoral artery

A

Femoral artery

89
Q

Which type of repair is indicated for
femoral hernias
A. Bassini
B. Shouldice
C. McVay
D. Lichtenstein

A

McVay

90
Q

According to the Nyhus classification,
direct hernias are what type
A. Type I
B. Type II
C. Type IIIA
D. Type IIIB

A

Type IIIA

91
Q

After proper history and physical examination, what initial diagnostic procedure do you request in a patient with inguinal hernia
A. CT Scan
B. CT Scan with contrast
C. Abdominal xray
D. Ultrasound

A

Ultrasound

92
Q

The borders of the femoral triangle
include all of the following except
A. Sartorius
B. Inguinal ligament
C. Adductor magnus
D. Adductor longus

A

C. Adductor magnus

93
Q

The circle of death is composed of
the ff except

A. Inferior epigastric artery
B. External iliac artery
C. Obturator artery
D. Internal iliac artery

A

Inferior epigastric artery

94
Q

The most common type of pain seen after inguinal hernia repair is
A. Neuropathic
B. Visceral
C. Nociceptive
D. Parietal

A

Nociceptive

95
Q

Postoperative ischemic orchitis is
caused by which of the ff

A. Accidental injury to the testicular artery which
causes necrosis of the testis
B. Neuropathic pain due to injury of the genital
branch of the genitofemoral nerve
C. Accumulation of hematoma within the inguinal area
D. Injury to the pampiniform plexus

A

Injury to the pampiniform plexus

96
Q

Among tissue repairs, which of the ff has the lowest recurrence rate
A. McVay
B. Lichtenstein
C. Shouldice
D. Bassini

A

Shouldice

97
Q

All of the following are true regarding
Taxis except

A. Taxis should be performed while the patient is in a Trendelenburg position
B. Taxis can be done in both incarcerated and strangulated hernias
C. Elective surgical repair is scheduled once taxis is successful
D. Patients are sedated and given analgesics prior to performing taxis

A

B. Taxis can be done in both incarcerated and strangulated hernias

98
Q

Direct hernias are found medial to
which structure
A. Rectus abdominis muscle
B. Inguinal ligament
C. Femoral artery
D. Inferior epigastric artery

A

Inferior epigastric artery

99
Q

Which type of repair makes use of a
strip of External Oblique Aponeurosis
A. Lichtenstein
B. Desarda
C. Bassini
D. Shouldice

A

Desarda

Surgery Finals 1st And 2nd Sem (3 decks)

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