Finals 1st Sem Flashcards by Marian Emeri Barranco

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

Vision and willingness to

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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

Galen

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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

Angiotensin I is converted to angiotensin II primarily in the kidney

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

Thyrotropin

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

Glycogen synthesis

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

Free fatty acids

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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

Leukotrienes and HETE

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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

Expression is autoregulated in part

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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

Hyperphagia

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

Factor V

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

Factor IX

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

Complete history and physical examination

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

Sex linked recessive

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

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

Viral hepatitis

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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

Donor cell compatible with patient’s serum

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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

Stasis

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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

B. Decreased function of leukocytes

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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

Fasciotomy

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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

Continuous water irrigation

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

cataracts

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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

Treated with running water or saline for 2 hours

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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

Zone of stasis

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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

Lactated Ringer’s solution

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

30%

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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

15 cc

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

Platysma

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

Hepatoduodenal ligament

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

Right ventricle

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

PLRS

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

PRBC

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

Apply sheet compression around the pelvis

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

Septic

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

Cardiogenic

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

Epinephrine

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

Crystalloids

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

Broad spectrum antibiotics

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

Communicate failures or losses

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

Postoperative abscess following perforated viscus repair

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

Patient safety

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

Injury that involves loss of limb or function

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

Strong teamwork

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

To provide optimal documentation in medical record

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

Epidermis

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

Pain

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

Fusiform excision

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

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

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

Pyogenic granuloma

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

Wide excision with 2-4 mm margin

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

Lung

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

Cutaneous horn

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

Fibrocystic disease

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

Simple Mastectomy

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

Core needle biopsy

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

Excision

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

Subcutaneous mastectomy

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

Chemotherapy

Patients who preferred to undergo breast conservation therapy must undergo A. Chemotherapy B. Radiotherapy C. Hormonal therapy D. All of the above

D. All of the above

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

D. Close Surveillance

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

Mammogram

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

Estrogen exposure

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

Tracheoesophageal fistula

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

It usually presents with hoarseness of the voice

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

adenocarcinoma

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

D. Female patients have poor prognosis compared to male patients

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

postpneumonectomy pulmonary edema

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

Lung abcess

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

Thymus gland

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

advice for immediate surgery y

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

Osteochondroma

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

D. Omphalomesenteric Duct Cyst

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

On the lateral border of the rectus abdominis muscle

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

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

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

Herniated bowel is contained within a sac in gastroschisis

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

Found within 2 inches of the ileocecal valve

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

Umbilical artery

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

B. Repair with synthetic mesh

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

Congenital umbilical hernias close spontaneously by 5 years of age

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

Sublay

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

Transverse colon

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

Division of the nerves following surgical procedure

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

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

D. Hernias occur with equal frequency in males and females

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

Prostatitis

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

D. Most close spontaneously

Borders of the Hesselbach Triangle include the ff except A. Inguinal Ligament B. Spermatic cord C. Inferior epigastric artery D. Rectus abdominis muscle

Spermatic cord

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

B. Patent processus vaginalis

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

Collagen disorders

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

Femoral artery

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

McVay

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

Type IIIA

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

Ultrasound

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

C. Adductor magnus

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

Inferior epigastric artery

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

Nociceptive

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

Injury to the pampiniform plexus

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

Shouldice

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

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

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

Inferior epigastric artery

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

Desarda