inglés

Question 1

a 74 year old man with biopsy-proven rectal adenocarcinoma is undergoing a low anterior resection. which layers must be stapled through when resecting the distal portion o resection specimen?

a) mucosa, submucosa, circular muscle layer and serosa
b) mucosa, submucosa, circulsr muscle layer, and longitudinal muscle layer
c) mucosa, submucosa, longitudinal muscle layer, circular muscle layer and serosa
d) mucosa, submucosa, circular muscle layer, longitudinal muscle layer and serosa

Answer 1

b) mucosa, submucosa, circulsr muscle layer, and longitudinal muscle layer

Question 2

which of the following translocations in known as the philadelphia chromosome?

a) translocation 8:14
b) translocation 9:22
c) translocation 11:14
d) translocation 11:22

Answer 2

b) translocation 9:22

Question 3

which leukemia is most commonly associated with the philadelphia chromosome?

a) acute myeloid leukemia
b) chronic myeloid leukemia
c) acute lymphocytic leukemia
d) chronic lymphocytic leukemia

Answer 3

b) chronic myeloid leukemia

Question 4

52 year-old man with history of obesity was treated with a laparoscopic gastric sleeve procedure 2 years ago. he has lost 56% of his weight, he is currently under no medication for HAS or DM2. The gastric sleeve procedure and RYGB result in similar degrees of resolution of all of the following except:

a) hypertension
b) gastroesophageal reflux
c) obstruction sleep apnea
d) DM2

Answer 4

b) gastroesophageal reflux

Question 5

41 year old female hs been diagnosed wth invasive ductal carcinoma of the breast. The hormonal receptor panel is positive for estrogen and progesterone receptors. Her lesion es 2.4 cm in size and she has 1 + lymph node. She decided to undergo breast conserbing surgery. Which of the following will be the best postsurgical tratment?

a) radiation therapy only
b) anastrazole
c) radiation therapy and tamoxifen
d) chemotherapy, radiation therapy and tamoxifen

Answer 5

d) chemotherapy, radiation therapy and tamoxifen

Question 6

a 68 year old female presents with spontaneus, unilateral, bloody nipple discharge. The rest of her exam in unremarkable. Mammogram doesn´t reveal any abnormality. Ultrasound reveals a ductal papillary lesion. About the probable diagnosis, which of the following fits better:

a) the most common cause of unilateral nipple discharge is a duct cyst
b) the most common cause of unilateral nipple discharge is usually benign but pathology can sometimes show a malignant neoplasm
c) ductography is a very sentitive test for malignancy
d) the treatment of choice will always. be watchfull waiting

Answer 6

b) the most common cause of unilateral nipple discharge is usually benign but pathology can sometimes show a malignant neoplasm

Question 7

a healthy 25 year old female nurse presents with an asymptomatic neck mass found during a practice head and neck examination. Physical exam: 4 cm nontender and firm mass in the inferior pole of the left thyroid lobe. The remaining physical exam is normal. She denies symptoms of thyroid pathologies., exposure to radiation, and family history. Thyroid function tests are normal. What is the optimal diagnostic test for this patient?

a) 18 FDG PET
b) I 123 uptake scan
c) neck ultrasound
d) core needle biopsy

Answer 7

c) neck ultrasound

Question 8

In a cytology report shows a Bethesda V lession. Which of the following is the most accurate sentence?

a) it is the most common cause of hyperfunctioning of the thyroid gland
b) the most common histology is a well diffrentiated carcinoma
c) I 123 scan usually reveals a hot nodule
d) undifferentiades histology should be suspected due to lack of symptoms

Answer 8

b) the most common histology is a well diffrentiated carcinoma

Question 9

What are the treatment options based on pathology por a Bethesda V lession?

a) surgical resection of the affected gland
b) radio iodine ablation
c) repeat core needle biopsy
d) watchful waiting

Answer 9

a) surgical resection of the affected gland

Question 10

a 55 year old postmenopausal woman with osteoporosis has a serum calcium level of 11.2 mg/dl, a serum phosphorus level of 1.8 mg/ dl, and a 24 hr urine calcium excretion of 400 mg. Which of the following tests is most likely to establish the cause of her hypercalcemia?

a) a sestamibi scan
b) intact PTH level
c) thyroglobulin
d) urine calcium clearance

Answer 10

b) intact PTH level

Question 11

a 55 year old postmenopausal woman with osteoporosis has a serum calcium level of 11.2 mg/dl, a serum phosphorus level of 1.8 mg/ dl, and a 24 hr urine calcium excretion of 400 mg. Which is the most common cause of this patients disease?

a) hyperfunctional thyroid adenoma
b) hyperplasia of the parathyroid glands
c) hyperfunctioning of a single parathyroid adenoma
d) hyperfunctioning of C cells

Answer 11

c) hyperfunctioning of a single parathyroid adenoma

Question 12

a 53 year old healthy man with a 8 cm nonfunctioning left adrenal mass presents to the outpatient clinic. He is totally asymptomatic. Which of the following would be the best approach for this patient?

a) watchful waiting, it is a nonfunctioning adrenal mass and the patient is asymptomatic
b) the increased diameter of the lesion is a worrisome characteristic of malignancy, adrenalectomy should be the next step.
c) core needle biopsy in indicated because it is an 8 cm adrenal mss
d) diagnostic laparoscopy and insicional biopsy of the mas

Answer 12

b) the increased diameter of the lesion is a worrisome characteristic of malignancy, adrenalectomy should be the next step.

Question 13

a 3 cm left adrenal mass was discovered incidentally on an abdominal CT scan obatined in a 65 year old woman who was involved in a motor vehicular trauma. Her medical history was notable for a left upper lobe lung resection 5 years previously for a stage I lung adenocarcinoma. She is asymptomatic. Which of the following is the most appropriate step in the evaluation?

a) repeat CT scan in 6 months
b) core needle biopsy of the adrenal mass
c) functional assessment of the adrenal mass
d) laparoscopic adrenalectomy

Answer 13

c) functional assessment of the adrenal mass

Question 14

all of the following patients are good candidates for antirreflux surgery except:

a) 31 year old man with typical GERD with disease becoming resistant to medical therapy
b) 55 year old woman with disease well controlled with PPIs who wishes to discontinue medical therapy
c) 75 year old man wiht new onset heatburn which is not relieved by PPIs
d) 52 year old man with a large paraesophageal hernia

Answer 14

c) 75 year old man wiht new onset heatburn which is not relieved by PPIs

Question 15

a 28 year old male with GERD diagnosis is scheduled for Nissen funduplication. While looking at the esophagram you notice an upward dislocation of both the cardia and gastric fundus. Which is the type of hiatal hernia?

a) I
b) II
c) III
d) IV

Answer 15

c) III

Question 16

preoperative testing for antirreflux surgery typically includes all of the following except:

a) CT scan of the chest and abdomen
b) contrast esophagram
c) 24 hr ph probe
d) esophagueal manometry
e) esophagogastroduodenoscopy

Answer 16

a) CT scan of the chest and abdomen

Question 17

a 25 year old women refers dysphagia and chest pain. Esophagram and manometry are requested. The latter shows simultaneous nonperistaltic contractions of the esophagus and abscense of relaxation in the lower esophageal sphincter. Which of the following disorders is compatible with the previous finding?

a) achalasia
b) gastroesophageal reflux disease
c) hypertensive lower esophagueal sphincter
d) nutcracker esophagua

Answer 17

a) achalasia

Question 18

Which blood group is associated with an increased risk pf gastric cancer?

a) A
b) B
c) AB
d) O

Answer 18

a) A

Question 19

The goals of medical therapy for inflammatory bowel disease are to decrease inflammation and alleviate symptoms, mild to moderate flares are treated in the clinic and more severe symptoms may require hospitalization. what is the first line therapy for inflammatory bowel disease in the outpatient setting?

a) salicylates such as sulfasalazine and 5 acetyl salicylic acid
b) antibiotics, such as metronidazole and fluoroquinolones
c) corticosteroids
d) azathriopine and 6-mercaptoupurine

Answer 19

a) salicylates such as sulfasalazine and 5 acetyl salicylic acid

Question 20

a 63 year old woman presents to ED with a 2 day hystory of left lower quadrant abdominal pain and is found to be febrile to 38.6ºC. Her white blood cell count is 15,000. On CT scan she is found to have colonic inflammation with an associated pericolic abscess. What is her Hinchey stage?

a) I
b) II
c) III
d) IV

Answer 20

a) I

Question 21

a 20 year old male comes into your clinic, he complains of a little blood coming out every time he defecates and diffuse abdominal pain. An endoscopic examination of a patient reveals patchy/skip lesions of inflammation throughout the GI tract. Based on this, what is the most likely diagnosis?

a) chron´s disease
b) ulcerative colitis
c) kidney failure
d) liver failure

Answer 21

a) chron´s disease

Question 22

a 63 year old man with known clostridium diffcile colitis on PO vancomycin develops increasing abdominal distension, severe tachycardia, and hypotension requiring support with vassopressors. An upright x-ray demonstrates a diffusely dilated colon with free air. He is brought to the OR and continues to require pressors throughout the case. What is the best operation to perform at this time?

a) total abdominal clectomy with ileorectal anastomosis
b) total proctocolectomy with end ileostomy
c) total abdominal colectomy with end ileostomy
d) segmental colectomy at area of perforation

Answer 22

c) total abdominal colectomy with end ileostomy

Question 23

a 65 year old male presents with severe lower abdominal pain and nausea for the last 3 days. his pain has worsened and become diffuse pain throughout the abdomen. on exam, he has a HR of 125, BP 100/60, he is writhing in pain and has diffuse peritonitis. he is taken to te OR for diagnostic laparoscopy and found to have severe inflammation of the sigmoid colon with a small perforation and stool in the abdomen. What is the appropriate Hinchey stage?

a) I
b) II
c) III
d) IV

Answer 23

d) IV

Question 24

A 32 year old patient has just been diagnosed with a right colon adenocarcinoma on a colonoscopy which was performed for screening because her mother died of colon cancer at age 40. inmmunohistochemical testing on the tumor biopsy shows abscence os MSH2 and subsequent genetic testing confirms a germline mutation in MSH2. Which of the following would be unnecessary prior to resection of her colon cancer?

a) EGD
b) referral to gynecology
c) referral to genetic counselling
d) repeat colonoscopy
e) CT chest, abdomen and pelvis

Answer 24

d) repeat colonoscopy

Question 25

a 50 year old female presents with hemodynamic stability and a soft abdomen to the emergency department with LLQ pain, low grade fever, leuukocytosis and a finding of contained 1 cm sigmoid mesenteric abscess on CT imaging. The best next step in her care is:

a) discharge with 14 day oral cipro and metro antibiotic course
b) admission for bowel rest with IV broad antibiotic therapy
c) admission for GI consultation and colonoscopy in 24 hr to rule out neoplasm
d) percutaneous drianage of the abscess
e) urgent operative intervention for hartmann´s procedure

Answer 25

b) admission for bowel rest with IV broad antibiotic therapy