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L3 (1ST BMEX) > SURG 5 > Flashcards

SURG 5 Flashcards

1
Q

Which anatomic segment/s make up the anterior sector of the right lobe of the liver?

A. Segments II and III
B. Segment IV
C. Segment V and VI
D. Segment V and VIII

A

D. Segment V and VIII

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2
Q

Which of the following statements about the anatomy of the hepatic vein is/are true?

A. The left hepatic vein drains the entire left lobe
B. Veins from the caudate lobe drain directly into the inferior vena cava
C. The middle hepatic vein drains into the right hepatic vein
D. The hepatic veins parallel the hepatic arterial system intrahepatically

A

B. Veins from the caudate lobe drain directly into the inferior vena cava

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3
Q

The reticuloendothelial function of the liver is primarily dependent on which of the following cells?

A. Hepatocytes
B. Sinusoidal endothelial cells
C. Kupffer cells
D. Ito cells

A

C. Kupffer cells

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4
Q

A 50-year-old patient came in with a 4-cm hepatic cyst with no internal echo on ultrasonography. Which of the following would be the appropriate management?

A. Observation if asymptomatic
B. Tamoxifen to prevent enlargement
C. Resection because it’s premalignant
D. Percutaneous aspiration for cytology

A

A. Observation if asymptomatic

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5
Q

Which of the following is clearly associated with oral contraceptive use and has a malignant potential?

A. Hepatic adenoma
B. Focal nodular hyperplasia
C. Both
D. Neither

A

A. Hepatic adenoma

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6
Q

A 25-year-old woman on oral contraceptives developed right upper quadrant abdominal pain. CT scan demonstrates hypodense 6-cm mass on the right side of the liver. Technetium-99 shows defects in the area of mass. Angiography showed a hypervascular tumor with a peripheral blood supply. What is the appropriate management?

A. Discontinuation of oral contraceptive and observe with serial CT scan
B. Percutaneous needle biopsy
C. Hepatic resection
D. Arterial embolization

A

C. Hepatic resection

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7
Q

Which of the following is true of pyogenic liver abscess?

A. Organisms most commonly reach liver via portal vein
B. Cultures of percutaneous aspirate usually sterile
C. Primary treatment is pharmacological
D. Primary treatment is drainage

A

D. Primary treatment is drainage

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8
Q

What is the main chemical component of pigment bile stone?

A. Cholesterol
B. Calcium bilirubinate
C. Calcium carbonate
D. Calcium phosphate

A

B. Calcium bilirubinate

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9
Q

What is preferred treatment for acute calculous cholecystitis?

A. Early laparoscopic cholecystectomy
B. Delayed laparoscopic cholecystectomy
C. Early open cholecystectomy
D. Delayed open cholecystectomy

A

A. Early laparoscopic cholecystectomy

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10
Q

Which of the following is the best indication for ERCP in a patient with gallstones?

A. Obstructive jaundice
B. Gallstone pancreatitis
C. History of jaundice
D. Elevated alkaline phosphatase to twice the normal values

A

A. Obstructive jaundice

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11
Q

Which of the following organisms is/are commonly isolated from bile? (Maybe except?)

A. E. coli
B. Clostridium species
C. Bacteroides fragilis
D. Enterobacter species

A

B. Clostridium species

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12
Q

Which of the following is/are necessary in the initial treatment of patients with acute cholangitis?

A. Endoscopic sphincterotomy and drainage
B. Percutaneous transhepatic drainage
C. Choledochoduodenostomy
D. Intravenous antibiotics

A

D. Intravenous antibiotics

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13
Q

Which of the following is the preferred management of type 1 choledochal cyst?

A. Cyst excision
B. Cyst duodenostomy
C. Cyst jejunostomy
D. External drainage

A

A. Cyst excision

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14
Q

A 40-year-old man presents with fluctuating jaundice, pruritus, and fatigue. Liver enzymes demonstrate cholestasis. Ultrasonography does not show gallstones or bile duct dilatation. What diagnostic test should be obtained next?

A. Liver biopsy
B. HIDA scan
C. CT scan
D. ERCP

A

D. ERCP

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15
Q

Adenocarcinoma of the gallbladder extending into the subserosal is discovered incidentally during cholecystectomy. Recommended treatment includes which of the following?

A. Nothing further at this time
B. External beam radiation
C. Irradiation and chemotherapy
D. Reoperation for liver resection and lymphadenectomy

A

D. Reoperation for liver resection and lymphadenectomy

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16
Q

Ultrasonography demonstrates a 15-mm polyploid lesion in the gallbladder of an asymptomatic 60-year- old patient. Which of the following best describes the recommended treatment?

A. Observation with repeat ultrasonography in 6 months
B. Cholecystectomy if the patient is female
C. Cholecystectomy only if symptoms develop
D. Cholecystectomy

A

D. Cholecystectomy (even asymptomatic)

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17
Q

CT scan demonstrates a 5-cm peripancreatic fluid collection in a patient 3 weeks after an episode of acute pancreatitis. The patient is eating and does not have clinical signs of infection. What is the recommended treatment?

A. Expectant management without intervention
B. NPO and total parenteral nutrition
C. Percutaneous catheter drainage of fluid collection
D. Operation for external drainage of fluid collection

A

A. Expectant management without intervention

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18
Q

Which of the following is the most important determinant of the need for drainage of a pancreatic pseudocyst?

A. Pseudocyst size
B. Pseudocyst duration
C. Pseudocyst symptoms
D. Associated chronic pancreatitis

A

C. Pseudocyst symptoms

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19
Q

When should gastrojejunostomy be performed at the time of biliary bypass in a patient with unresectable pancreatic cancer?

A. Always
B. Never
C. Only if asymptomatic obstruction is present at the time of operation
D. Selectively based on tumor extent and anticipated life expectancy

A

D. Selectively based on tumor extent and anticipated life expectancy

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20
Q

ERCP reveals a periampullary cancer on a 64-year-old patient admitted for jaundice. No metastasis detected; no comorbidities are identified. How is the patient managed?

A. Radical excision of the head of the pancreas and duodenum
B. Local excision and chemotherapy
C. External beam radiation
D. Stenting and chemotherapy

A

A. Radical excision of the head of the pancreas and duodenum

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21
Q

A patient who underwent cholecystectomy and common bile duct exploration with T tube choledochostomy shows distal CBD stone on T tube cholangiography. What management is recommended?

A. Daily irrigation with NSS
B. ERCP
C. Choledochoscopy and basket extraction of stone
D. Repeat explore laparotomy and CBDE

A

C. Choledochoscopy and basket extraction of stone

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22
Q

The strongest evidence for the presence of gallstones in using ultrasound is

A. edema and thickened gallbladder wall
B. contracted gallbladder
C. dilated extrahepatic bile duct
D. high level echoes with posterior acoustic shadowing

A

D. high level echoes with posterior acoustic shadowing

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23
Q

What is the most likely diagnosis in a 70-year-old male presenting with significant weight loss accompanied by progressive jaundice, anorexia, pruritus, and tea-colored urine? Physical examination revealed a palpable nontender gallbladder.

A. Hepatoma
B. Gallbladder cancer
C. Pancreatic head cancer
D. Gallbladder emphysema

A

C. Pancreatic head cancer

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24
Q

A 22-year-old woman develops fullness of RUQ but otherwise feels well. Results in PE are normal. She has no history of liver disease. She takes proton pump inhibitors for GERD and oral contraceptives. CT scan revealed a 6-cm lesion at the right hepatic lobe that is initially hypodense but becomes irregularly enhancing with contrast administration. Which of the following is most likely this lesion?

A. Ampullary cancer
B. Cholangiocarcinoma
C. Gallbladder cancer
D. Hepatic adenoma

A

D. Hepatic adenoma

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25
Q

Which of the following risk factors is most strongly associated with ductal adenocarcinoma of the pancreas?

A. Alcohol consumption
B. Diabetes mellitus
C. Cigarette smoking
D. Chronic pancreatitis

A

C. Cigarette smoking

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26
Q

Which of the following findings on exploration during pancreatic surgery is a contraindication for resection?

A. Involvement of hepatic hilar nodes
B. Involvement of peripancreatic lymph nodes
C. Involvement of stomach and proximal duodenum
D. Involvement of porta hepatic which can be swept off with the specimen

A

A. Involvement of hepatic hilar nodes

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27
Q

Which of the following is TRUE of bile duct carcinoma?

A. Both choices are correct
B. None of the choices are correct
C. Most patients with unresectable disease die within 1 year of diagnosis
D. Patients are unlikely to present with jaundice

A

C. Most patients with unresectable disease die within 1 year of diagnosis

28
Q

Which of the following is also known as recurrent pyogenic cholangitis?

A. Biliary pancreatitis
B. Amoebic abscess
C. Cholangiohepatitis
D. Cholangiosarcoma

A

C. Cholangiohepatitis

29
Q

What is a stimulus to gastric emptying that is released endogenously from the duodenal mucosa in response to a meal? When stimulated, the gallbladder empties 50-70% of its content within 30-40 minutes.

A. Somatostatin
B. CCK
C. VIP
D. Glycoproteins

A

B. CCK

30
Q

What is the definitive diagnostic test for the cause of obstruction in a jaundiced patient?

A. Ultrasound
B. Oral cholecystography
C. HIDA scan
D. ERCP

A

D. ERCP

31
Q

Hepatocellular carcinoma is often associated with Hepatitis B especially in the Philippines. It complicates cirrhosis in most patients. Which of the following is TRUE regarding HCC?

A. Large tumors should not be managed aggressively because symptomatic treatment has the same treatment outcome
B. Liver biopsy should be done routinely to confirm the diagnostic prior to surgical management
C. Preoperative bilirubin level is an important predictor of liver failure after liver resection
D. Hepatoma often complicate cirrhosis and the size of the tumor is the most important marker for prognosis since most of these patients die due to tumor progression and metastasis

A

C. Preoperative bilirubin level is an important predictor of liver failure after liver resection

32
Q

A 65-year-old woman underwent cholecystectomy for adenomyomatosis of gallbladder. What is this condition?

A. A chronic gallstone disease
B. A form of gallbladder polyposis
C. A premalignant condition
D. A type of cholecystosis

A

D. A type of cholecystosis

33
Q

The superior mesenteric artery communicates with the celiac artery via the

A. pancreatic-duodenal artery
B. splenic artery
C. hepatic artery
D. dorsal pancreatic artery

A

A. pancreatic-duodenal artery

34
Q

What is the most common cause of acute cholecystitis?

A. Cystic duct obstruction
B. Escherichia coli infection
C. Gallbladder polyp near the neck
D. Multiple gallstones

A

A. Cystic duct obstruction

35
Q

What is the commonly injured intra-abdominal organ following blunt abdominal trauma?

A. Pancreas
B. Spleen
C. Small intestine
D. Colon

A

B. Spleen

36
Q

The initial diagnostic tool in assessing biliary duct obstruction

A. Alkaline phosphatase
B. ERCP
C. Ultrasonography
D. CT scan

A

A. Alkaline phosphatase

37
Q

This type of intrahepatic cholangiocarcinoma shows stronger association with HBV and HCV infections and most patients with this type lack symptoms

A. Introduction growth type
B. Periductal infiltrating type
C. Mass-forming type
D. MF + PI type

A

C. Mass-forming type

38
Q

Which is true of intrahepatic cholangiocarcinoma?

A. A positive resection margin is highly associated with recurrence
B. Liver transplantation is the gold standard treatment of ICC
C. Lymph node metastasis is a positive prognostic factor for patients undergoing
D. Surgery is the only treatment that offers a long term survival in patients with ICC

A

D. Surgery is the only treatment that offers a long term survival in patients with ICC

39
Q

A triple phase CT scan of a 62-year-old male patient with jaundice, steatorrhea, and weight loss revealed 4-cm mass at the head of the pancreas which extends beyond but NOT on the celiac axis of mesenteric artery. No enlarged lymph nodes were seen. Elevated liver function tests. Elevated CA19-9. Endoscopic ultrasound revealed Pancreatic Adenocarcinoma. What is the preoperative stage of the patient?

A. Stage I
B. Stage IIA
C. Stage IIB
D. Stage III

A

B. Stage IIA

40
Q

A 30-year-old woman was admitted due to abdominal pain for a day and high fever. Vital signs showed tachycardia. Her lab results reveal a total bilirubin of 4g/dl and ALT of 500. MRCP showed gallstones in CBD. What is the next best management after fluid resuscitation?

A. Observation
B. Broad spectrum antibiotics
C. ERCP
D. PTC

A

B. Broad spectrum antibiotics

41
Q

The following are true in Gallstone Carcinoma, EXCEPT

A. It has a good prognosis
B. 32% of cases are incidental
C. Sclerosis cholangitis is a risk
D. Larger stone of 3 cm is associated with 10-fold increased risk of cancer

A

A. It has a good prognosis

42
Q

Which of the following is a primary bile acid in humans?

A. Cholic acid
B. Deoxycholic acid
C. Urodeoxycholic acid
D. Lithocholic acid

A

A. Cholic acid

43
Q

Which of the following is not part of the process of cholesterol gallstone formation?

A. Cholesterol supersaturation of bile
B. Bilirubin deconjugation
C. Crystal nucleation
D. Stone growth

A

B. Bilirubin deconjugation

44
Q

Proper exposure of this structure is a key to avoiding common bile duct injuries during cholecystectomy

A. Common hepatic duct
B. Cystic duct
C. Calot’s triangle
D. Calot’s node

A

C. Calot’s triangle

45
Q

What process involves inserting chemotherapy drugs and embolization particles into the hepatic artery supplying a tumor via a percutaneous, transfemoral approach?

A. Ethanol ablation
B. Microwave ablation
C. Radiofrequency ablation
D. Transarterial chemoembolization

A

D. Transarterial chemoembolization

46
Q

What is the gold standard and treatment of choice for primary liver cancers or metastatic liver

A. Liver transplant
B. Hepatic resection
C. Systemic chemotherapy
D. External beam radiation therapy

A

B. Hepatic resection

47
Q

Which of the following is the best indication for preoperative ERCP in a patient with gallstones?

A. History of jaundice
B. Elevated Alkaline phosphatase to twice normal
C. Obstructive Jaundice
D. Gallstone Pancreatitis

A

C. Obstructive Jaundice

48
Q

What is the surgical option for a patient with Pancreatic pseudocyst located at the head of the pancreas?

A. Cystogastrostomy
B. Enucleation of pseudocyst
C. Cystojejunostomy
D. Cystoduodenostomy

A

D. Cystoduodenostomy

49
Q

KI, a 45-year-old female came in with fever, jaundice, RUQ pain, septic shock, and mental status changes. What disease is described by her signs and symptoms?

A. Cholangitis
B. Pancreatitis
C. Cholecystitis
D. Hepatitis

A

A. Cholangitis

50
Q

What is the actual determinant in selection of an operative approach for hepatic metastatic colorectal cancer?

A. Number of hepatic lesions
B. Age of patient
C. Size of hepatic tumor
D. Volume of future liver remnant

A

D. Volume of future liver remnant

51
Q

CD, a 55-year-old female underwent cholecystectomy which was uneventful. Upon return of the specimen, the histopathologic report revealed adenocarcinoma of the gallbladder extending to the biliary tree. What is the recommended treatment for this patient?

A. Nothing further currently
B. Reoperation for liver resection and lymphadenectomy
C. External beam radiation
D. Irradiation and chemotherapy

A

B. Reoperation for liver resection and lymphadenectomy

52
Q

A 30-year-old female presents with acute RUQ abdominal pain for a day and high-grade fever. Vital signs show tachycardia. Labs reveal total bilirubin of 4g/dl along with ALT of 500. An MRCP show stones in the CBD. Which of the following is the next BEST step in managing this patient after fluid resuscitation?

A. PTC
B. ERCP
C. Ciprofloxacin
D. Piperacillin tazobactam

A

D. Piperacillin tazobactam

53
Q

Which of the following is an indication of an urgent ERCP in pancreatitis?

A. Chronic calcific Pancreatitis with pseudocyst
B. Acute Alcoholic Pancreatitis
C. Acute Necrotizing Pancreatitis
D. Acute Biliary Pancreatitis with Cholangitis

A

D. Acute Biliary Pancreatitis with Cholangitis

54
Q

What is the indication for surgical resection of a 6 cm hepatic adenoma in a 35-year-old female?

A. Malignant transformation is one of its characteristics.
B. This can cause liver failure.
C. Pregnancy can cause spontaneous rupture.
D. There is high risk of cholangitis.

A

A. Malignant transformation is one of its characteristics.

55
Q

Which of the following tests show hepatobiliary tract infection caused by choledocholithiasis?

A. Normal WBC count, normal bilirubin, low alkaline phosphatase and normal SGPT
B. Normal WBC count, elevated bilirubin, high alkaline phosphatase and elevated SGPT
C. Elevated WBC count, normal bilirubin, low alkaline phosphatase and elevated SGPT
D. Elevated WBC count, elevated bilirubin, high alkaline phosphatase and normal SGPT

A

D. Elevated WBC count, elevated bilirubin, high alkaline phosphatase and normal SGPT

56
Q

With regards to Choledocholithiasis, which of the following statements is/are TRUE?

A. Common duct stones are present in one-third of patients undergoing cholecystectomy.
B. Common duct stones are found more frequently when cholecystectomy is performed for chronic cholecystitis than for acute cholecystitis.
C. Most common duct stones are composed of calcium bilirubinate.
D. The incidence of common bile duct stones is highest in elderly patients.

A

D. The incidence of common bile duct stones is highest in elderly patients.

57
Q

What is the preferred imaging modality for precise evaluation of biliary duct and pancreatic duct pathology?

A. MRCP
B. Endoscopic ultrasound
C. ERCP
D. Hepatobiliary scintigrapy

A

A. MRCP

58
Q

TB, a 46-year-old female presented with a history of epigastric pain radiating to the back for three days. Laboratory tests revealed normal serum amylase levels and ultrasonography showed cholelithiasis and an enlarged pancreas. CT scan was requested to confirm the diagnosis. Which of the following is the most likely underlying pathology?

A. Acute Appendicitis
B. Acute Cholecystitis
C. Acute Pancreatitis
D. Acute Peritonitis

A

C. Acute Pancreatitis

59
Q

Which of the following liver malignancy is an adenocarcinoma?

A. Metastatic tumor lesions from the breast malignancy
B. Hepatocellular carcinoma
C. Hepatic adenoma malignant transformation
D. Klatskin’s tumor

A

D. Klatskin’s tumor

60
Q

Which statement describes focal nodular hyperplasia?

A. There is average risk of malignancy.
B. Surgical resection is the treatment of choice.
C. More common in males
D. CT scan findings show a well circumscribed lesion with typical central scar.

A

D. CT scan findings show a well circumscribed lesion with typical central scar.

61
Q

What is the definitive treatment for a patient with Sclerosing Cholangitis and Biliary cirrhosis?

A. Liver transplantation
B. Endoscopic balloon dilatation and stenting
C. Ursodeoxycholic acid
D. Corticosteroids

A

A. Liver transplantation

62
Q

A 40-year-old woman with Diabetes and Chronic Kidney Disease was referred to the Surgical service because of the incidental finding of cholelithiasis without inflammation on abdominal sonogram. There were two (2) stones less than half a centimeter in diameter each. The patient is asymptomatic, and her kidney’s functioning are at baseline. Of the following choices, which is the best step to take in the management of this patient?

A. ERCP
B. PTC
C. Observation
D. Cholecystectomy

A

C. Observation

63
Q

Which among the following clinical conditions does not warrant an Endoscopic Retrograde Cholangiopancreatography (ERCP)?

A. Ascaris in the common bile duct
B. Ampullary mass
C. Cholecystolithiasis with biliary colic
D. Distal common bile duct stone

A

C. Cholecystolithiasis with biliary colic

64
Q

KL, a 45-year-old banker came in for consult because of on and off jaundice, pruritus, and body malaise for several months. Initial laboratory results showed elevated direct bilirubin. Ultrasonography does not show gallstones or bile duct dilatation. What diagnostic test should be obtained next?
A. CT scan
B. HIDA scan
C. ERCP
D. PTC

A

C. ERCP

65
Q

Which of the following is not true regarding gallbladder cancer following cholecystectomy?

A. Subsequent treatment depends on many factors including stage of disease, surgical margins, spillage, etc.
B. Common bile duct excision is not required in all cases.
C. For T1 and T2 lesions cholecystectomy is sufficient.
D. The term extended cholecystectomy is preferred to radical cholecystectomy.

A

C. For T1 and T2 lesions cholecystectomy is sufficient.

66
Q

In which clinical situation is Percutaneous transhepatic cholangiography best indicated?

A. Complete transection of the common bile duct
B. Morbidly obese patients
C. Obstructive jaundice secondary to Mirizzi’s syndrome
D. Ascending cholangitis due to distal common bile duct stone

A

C. Obstructive jaundice secondary to Mirizzi’s syndrome

L3 (1ST BMEX) (18 decks)

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