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LU5 COMPRE > Surg E1 > Flashcards

Surg E1 Flashcards

1
Q 
A 20/M was hacked on the arm with a butcher’s knife, the ideal suture used to approximate the
wound would be
A. Nylon
B. Vicryl
C. Chromic
D. Cotton
A

A

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2
Q 
Dirty wounds are usually closed by
A. Simple interrupted
B. Continuous
C. Vertical mattress
D. Horizontal mattress
A

A
In case the wound gets infected and needs debridement, simple interrupted sutures are the
easiest to remove

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3
Q

A 50/M consulted at the clinic due to an infected cut over the right arm. He was injured while
doing farming. On inspection, the wound has purulent discharge with some granulation tissue.
The best way to treat the wound is
A. Close the wound primarily
B. Advise the patient on wound care and close the wound at a later date
C. Daily wound care and allow the wound to heal by secondary intention
D. Wash and clean the wound well and close it primarily

A

C

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4
Q

A 28 year old consults at the ER for a 3 cm bleeding wrist wound. While preparing the
materials needed for suturing, the best mechanical method of halting bleeding is
A. Digital pressure
B. Application of an extremity tourniquet
C. Pringle maneuver
D. NOTA

A

A

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5
Q

The mainstay of treatment of septic shock is
A. Fluid resuscitation
B. Initiation of appropriate antibiotic therapy
C. Control of the source of infection
D. AOTA

A

D

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6
Q 
Most common cause of shock in the surgical or trauma patient
A. Cardiogenic shock
B. Septic shock
C. Hypovolemic shock
D. Neurogenic shock
A

C

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7
Q 
A 23/M came in at the ER with a 8 cm chest wound, anxious, BP 90 palp, HR 110, RR 20.
Class of hemorrhagic shock would be
A. I
B. II
C. III
D. IV
A

C

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8
Q 
Water constitutes approximately
A. 60% of total body weight
B. 40% of total body weight
C. 90% of total body weight
D. 30% of total body weight
A

A

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9
Q 
deally, sutures to the facial are removed after how many days? This step lessens scar
formation
A. 1-2 days
B. 6-9 days
C. 3-5 days
D. 2 weeks
A

C

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10
Q 
A 30/M who is admitted at Ward 2 for calculous cholecystitis. Hemoglobin was 80, hematocrit
40, with no bleeding. You
A. Transfuse 3 units packed RBC
B. Transfuse 3 units fresh whole blood
C. Do nothing
D. Transfuse 2 units packed RBC
A

A
Normal hemoglobin for this patient would be 120. Since each unit of blood raises hemoglobin by
10, you go with the amount that would most closely achieve your goal. Packed RBC is more
routinely given rather than fresh whole blood

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11
Q 
In wound healing, the first type of cell that will infiltrate after injury is
A. Lymphocytes
B. Neutrophils
C. Fibroblasts
D. Macrophages
A

B

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12
Q

The primary role of neutrophils is
A. Phagocytosis of bacteria and tissue debris
B. Oxygen radical and nitric oxide synthesis
C. Modulation of the wound environment
D. Regulates angiogenesis and matrix deposition

A

A

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13
Q

One of the general phases of SIRS
A. An acute proinflammatory state resulting from innate immune system recognition of ligands
B. A proinflammatory phase that may serve to modulate the inflammatory phase
C. An inflammatory phase that aggravates the migration of neutrophils
D. AOTA

A

D

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14
Q 
A normal response to surgery/trauma is
A. There is no such thing
B. Predominantly anabolic
C. Predominantly catabolic
D. Transmitted thru the efferent limb of the autonomic nervous system
A

C

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15
Q

Which of the following pharmacologic agents has been proven to reduce myocardial ischemic
events and cardiac mortality in patients at risk for cardiac events who undergo high-risk
noncardiac surgery?
A. Metoprolol
B. Isosorbide dinitrate
C. Digoxin
D. Aspirin

A

A

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16
Q

The injured or postoperative patient has increased metabolic needs owing to the
immune/stress response. Which statement best summarizes the approach one must take when
dealing with such patients?
A. Pharmacologic interventions can restore normal homeostatic mechanisms in these patients
B. Applying basic knowledge of the pathophysiology of this altered metabolic state will provide a
basis for combined interventions
C. Meticulous surgical techniques to minimize injury to tissues will reduce this response and lead
to faster recovery
D. This self-limited response will undergo resolution within 2-3 days in more than 95% of patients
and no special monitoring or intervention is needed

A

B

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17
Q

Wound dehiscence is one of the surgical complications surgeons are wary about. By
definition, wound dehiscence involves separation of which layer
A. Skin
B. Muscle
C. Fascia
D. Peritoneum

A

A

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18
Q

Your post-mitral valve replacement patient is to undergo elective excision of benign breast
mass. She is on anti-coagulant (warfarin) to prevent thrombus formation at her artificial valve. To
prepare her for OR and prevent much bleeding, you ordered your patient to stop warfarin 2 weeks
prior to the procedure. To reverse the effect of warfarin further, you also give your patient
A. Protamine
B. Vitamin K
C. Calcium
D. Albumin

A

B

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19
Q 
Ideally, sutures to the facial area are removed after how many days? This step lessens scar
formation
A. 1-2 days
B. 3-5 days
C. 6-9 days
D. 2 weeks
A

B

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20
Q

The following are criteria for SIRS EXCEPT
A. Temperature > 38 C
B. Heart rate > 90 bpm
C. Respiratory rate > 20 breaths per minute
D. PaCO2 40 mmHg

A

D

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21
Q

Compensatory response to shock includes the following EXCEPT
A. Increased vascular tone
B. Tissue extraction of oxygen which is enhanced by decreased levels of erythrocyte 2,3-
diphosphoglycerate
C. Decreased insulin secretion
D. Increased antidiuretic hormone

A

C

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22
Q 
Major physiologic events that participate in the hemostatic process are the following EXCEPT
A. Vascular constriction
B. Platelet plug formation
C. Defibrination
D. Fibrinolysis
A

D

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23
Q 
The initial response to vessel injury
A. Vasodilation
B. Fibrinolysis
C. Vascular constriction
D. NOTA
A

C

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24
Q

The incidence of surgical site infections can be reduced by the following EXCEPT
A. Appropriate patient preparation
B. Timely perioperative antibiotic administration
C. Maintenance of perioperative normothermia and normoglycemia
D. Vitamin A supplements

A

D

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25
Q

Principles relevant to appropriate antibiotic prophylaxis for surgery are the following EXCEPT
A. Select an agent with activity against common organisms at the site of surgery
B. The initial dose of the antibiotic should be given within 30 minutes of incision
C. Antibiotics should be redosed every 1 to 2 half-lives during surgery to ensure adequate tissue
levels
D. Antibiotics should not be continued for more than 24 hours after surgery for routine prophylaxis
E. NOTA

A

E

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26
Q 
Cholecystectomy is classified as:
A. Clean wound
B. Clean contaminated wound
C. Contaminated wound
D. Dirty wound
A

B

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27
Q 
An 24/F will undergo emergency exploratory laparotomy for perforated diverticulitis. The
operation will be classified as
A. Clean
B. Contaminated
C. Clean contaminated
D. Dirty
A

D (although the RIC answered B, perforated diverticulitis was the example given for a
dirty wound in Schwartz [see Table 6-7 on page 148])

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28
Q 
A 40/M patient will undergo hernia repair, the operation will be classified as
A. Clean
B. Contaminated
C. Clean contaminated
D. Dirty
A

A

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29
Q 
Problem with platelets, either quantitative or qualitative, is reflected in which lab test?
A. Prolonged PT
B. Prolonged APTT
C. Prolonged bleeding time
D. Anemia
A

C
A reflects the extrinsic pathway of the coagulation cascade, while B the intrinsic pathway. D is
measured thru RBC, Hb, Hct, etc. in your CBC.

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30
Q

Normal wound healing follows a predictable pattern that can be divided into overlapping
phases defined by characteristic cellular populations and biochemical activities. Which among the
following statements is true?
A. Exposure of subendothelial collagen to platelets results in platelet aggregation, degranulation,
and activation of the coagulation cascade
B. The neutrophil’s most pivotal function is activation and recruitment of other cells via cytokines
and growth factors
C. Fibronectin and collagen type I constitute the early matrix scaffolding, GAGs and
proteoglycans represent the next significant matrix components, and collagen III is the final matrix
D. VEGF and TNF-beta are the strongest chemotactic factors for fibroblasts

A

A

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31
Q

This substance accumulates during proliferation and is a potent regulator of collagen
synthesis thru a mechanism involving adenosine-5-diphosphate-ribosylation
A. Nitric oxide
B. Lactate
C. Prostaglandin
D. Reactive oxygen species

A

C

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32
Q

Low oxygen tension has deleterious effects on all aspects of wound healing. At what
hematocrit level will anemia adversely affect oxygen tension and synthesis?
A.

A

C

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33
Q 
Which of the following layer of the intestine has the greatest tensile strength?
A. Serosa
B. Muscularis
C. Submucosa
D. Mucosa
A

C

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34
Q

The importance of nutrition in the recovery of the traumatic or surgical injury patient has been
recognized by clinicians since the time of Hippocrates. The possible role of single amino acids in
enhanced wound healing has been studied for the last several decades. Which amino acid
appears most active in terms of enhancing wound fibroplasia?
A. Arginine
B. Glutamine
C. Glycine
D. Lysine

A

A

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35
Q 
Which of the following organs would be the least perfused during shock?
A. Brain
B. Heart
C. Adrenals
D. Kidney
A

D
That’s why AKI secondary to prerenal azotemia is most commonly caused by hypoperfusion
secondary to hypovolemia

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36
Q

A 29/F came in to the ER hypotensive (BP 80/60), tachycardic (HR 125), tachypneic (RR 24),
and febrile (Tmax 39). There is also note of jaundice and right upper quadrant tenderness which
leads to your diagnosis of cholangitis. What is the cause of the shock of the patient?
A. Vasodilatory shock
B. Cardiogenic shock
C. Traumatic shock
D. Hypovolemic shock

A

A

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37
Q

A 26 year old patient fell from a height of 4 meters. The patient came in at the ER hypotensive
with normal heart and respiratory rate. On PE, there is no note of fractures and bleeding. The
patient has decreased sensation and movement on his bilateral lower extremities. What is the
cause of shock for the patient?
A. Vasoconstriction due to loss of sympathetic regulation
B. Disrupted endothelium function
C. Loss of vasomotor tone in peripheral arterial beds
D. NOTA

A

C – patient is probably in spinal shock

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38
Q

The breast receives its principal blood supply from the following EXCEPT
A. Perforating branches of the internal mammary artery
B. Lateral branches of the posterior intercostal arteries
C. Branches from the axillary artery and thoracoacromial artery
D. Branches of the internal thoracic artery

A

D

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39
Q

A 30/M presents with a 3 cm well-circumscribed mass between the angle of the jaw and the
tragus on the L side. He is otherwise asymptomatic except for the mass. The rest of the PE is
normal. The next step in the management will be
A. Request for a CT scan of the head
B. Do FNAB of the mass
C. Do core needle biopsy of the mass
D. Schedule for L parotidectomy

A

D

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40
Q

One year after excision for fibroadenoma, a 30/F consults back at the clinic for a 3 x 3 cm
moveable mass located beneath the previous scar at her left breast. You advise her to
A. Have a mammography
B. Undergo core needle biopsy
C. Undergo excision of the mass
D. Undergo wide excision of the mass

A

C – the fibroadenoma probably recurred. Just excise it again

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41
Q

Which of the following findings on core needle biopsy will a bilateral mastectomy be a valid
option for risk reduction in a 35/F without a strong family history of breast cancer
A. Atypical ductal hyperplasia
B. Ductal carcinoma in situ
C. Lobular carcinoma in situ
D. Invasive carcinoma

A

D

42
Q

Which of the following has no survival benefit as an adjuvant treatment for a 35/F who
underwent breast conservation treatment for Stage IIA T2N0M1 breast cancer with ER (+) PR (-)
tumor
A. Radiotherapy
B. Chemotherapy
C. Tamoxifen
D. Letrozol

A

D

43
Q

A 25/F G1P0 in her first trimester of pregnancy consults at the clinic for an anterior neck mass
associated with palpitations and opthalmopathy. What is the best management for this case?
A. Anti-thyroid drugs
B. Exogenous thyroid hormones
C. Radioactive iodine ablation
D. Subtotal thyroidectomy

A

D – while Schwartz says that pregnancy is a relative contraindication for surgical
intervention for thyroid disease, and that anti-thyroid drugs specifically PTU is recommended for
treatment of hyperthyroid preggies, the RIC said that PGH guidelines recommend the surgery
over the medical management. The fact that she’s only in her first trimester also increases the
risk of abnormalities arising from the use of anti-thyroid meds.

44
Q

25/F came into your clinic and noted a 6 month history of a gradually enlarging right breast
mass. On PE, the mass is 2 x 2 cm moveable, nontender, and has well-circumscribed borders.
She wants to know how you will manage her case. Which of the following can you do for the
patient?
A. Perform ultrasound on the breast
B. Do a core needle biopsy on the breast
C. Reassure and monitor the patient closely
D. Perform a modified radical mastectomy
E. AOTA

A

C – given the patient’s age and the characteristics of the mass, this is probably
fibroadenoma

45
Q

A 23 year old breastfeeding mother complains of pain on her left nipple. There is note of
erythema, warmth, and tenderness on the perioareolar area upon PE. She worries that she may
have to discontinue breastfeeding her infant because of the pain. How will you manage the
patient?
A. May start on antibiotics
B. May give pain medications
C. Apply warm compress
D. AOTA
E. A and B only

A

D

46
Q 
Which of the following is the most common histopathologic type of breast cancer?
A. Medullary carcinoma
B. Mucinous carcinoma
C. Invasive ductal carcinoma
D. Papillary carcinoma
E. Tubular carcinoma
A

C

47
Q 
Which of the following DOES NOT increase the risk for developing breast cancer?
A. Early menarche
B. Obesity
C. Nulliparity
D. Longer lactation period
A

D
A to C refer to greater estrogen exposure as a risk factor for developing breast CA. The most
important risk factor, however, is being female, followed by age.

48
Q 
This structure provides structural support and mobility to the breast. It inserts perpendicularly
to the superficial layers of the dermis
A. Treitz ligament
B. Cooper ligament
C. Cardinal ligament
D. Puopart ligament
A

B

49
Q

The American Cancer Society recommends the following EXCEPT
A. All females do self breast examination at 20 years of age
B. Do baseline mammography at 35 years old
C. Regular mammography screening between 40-50 years old, then annually thereafter
D. Do excision biopsy for all breast masses less than 2 cm

A

D

50
Q

This type of malignant breast mass is histologically characterized by very large, pale
vacuolated cells at the rete pegs of the epithelium
A. Medullary carcinoma
B. Mucinous carcinoma
C. Paget’s disease
D. Tubular carcinoma

A

C

51
Q 
The most important facial x-ray view to order in cases of suspected facial fractures
A. Occipitomental view
B. Towne’s
C. Submentovertical
D. Skull APL
A

A

52
Q 
The following are techniques that result in a fine line scar EXCEPT
A. Gentle tissue handling
B. Adequate wound debridement
C. Proper wound orientation
D. Delayed removal of sutures
A

D

53
Q 
This cannot be used to alkalinize the urine
A. Potassium citrate
B. Sodium bicarbonate
C. Piperazine
D. Calcium carbonate
A

D

54
Q

The following is true of the IPSS
A. The IPSS stands for International Prostate Severity Score
B. The IPSS has a maximum score of 30
C. Both irritative and obstructive symptoms are included in the scoring
D. Each symptom is graded from 1 to 5

A

C

55
Q 
In observation for undescended testes, descent may still occur within a span of
A. 6 months
B. 1 year
C. 2 years
D. Until adolescence
A

B

56
Q 
The definitive treatment for Hirschsprung’s Disease
A. Posterior sagittal anorectoplasty
B. Bowel pullthrough
C. Serial anal dilatation
D. Bowel diversion or colostomy
A

B

57
Q 
Leg pain at rest is most indicative of
A. Peripheral arterial occlusive disease
B. Chronic venous insufficiency
C. Neurogenic or neuropathic pain
D. Musculoskeletal disease
A

B

58
Q 
Neurogenic tumors are most common in this anatomic division of the mediastinum
A. Anterior mediastinum
B. Middle mediastinum
C. Posterior mediastinum
D. Equally common in all divisions
A

C

59
Q

You encounter a 34/F at the breast clinic presenting with a 4 x 3 cm firm breast mass in her
right breast. You recommend this diagnostic procedure, as it has the most point-of-care utility in
our hospital setting
A. Fine-needle aspiration biopsy
B. Core-needle biopsy
C. Wide excision and biopsy
D. Bilateral breast mammography

A

B

60
Q

The following are benefits of breast ultrasound EXCEPT
A. It is efficient for routine use as a screening tool in women above 50 years old
B. It is helpful as an adjunct diagnostic procedure in dense breasts
C. It can differentiate between cystic and solid masses
D. It can be used to guide biopsies of non-palpable breast masses

A

A – you don’t routinely use UTZ for screening. Mammography is the way to go

61
Q

The following is true about breast mammography
A. It is the diagnostic procedure of choice in patients presenting with a solitary breast mass
B. It is operator dependent
C. Annual screening with a mammogram should be done in all patients 50 years old and above
D. It is most useful in clinically-evident breast disease

A

C
A is wrong because that would be core needle biopsy, if you have indications for doing so. B
refers to UTZ. D is wrong because mammography is most useful in detecting small non-palpable
masses and revealing the microcalcifications that are usually associated with malignant conditons

62
Q

The PGH consensus on colorectal cancer screening includes
A. Complete colonscopy for all patients 50 and above
B. Complete colonoscopy for all patients above 50
C. Complete colonscopy for all patients above 50 presenting with lower GI bleeding
D. Flexible sigmoidscopy for all symptomatic patients 40 years old and above

A

A

63
Q 
This smooth muscle supports the hemorrhoidal cushions within the anal canal
A. Puborectalis
B. Internal anal sphincter
C. External anal sphincter
D. Treitz muscle
A

D

64
Q 
Which of the following may indicate a chronic anal fissure
A. Hypertrophied hemorrhoidal cushion
B. Sentinel skin tag
C. Pain upon defecation
D. Peristent rectal bleeding
A

B

65
Q 
A 40/M will undergo hernia repair, the operation will be classified as
A. Clean
B. Clean contaminated
C. Contaminated
D. Dirty
A

A

66
Q 
A 45/F presents with obstructive jaundice and abdominal UTZ noted stones in the common
bile duct. The next step is to do
A. Common bile duct exploration
B. ERCP
C. MRCP
D. IV antibiotic therapy
A

B

67
Q

A 35/M went to the OPD due to a scrotal swelling. On PE there was note of a swollen and
erythematous left scrotum which was negative on transillumination and acutely tender. The
following 2 differential diagnoses should be foremost in your mind
A. Strangulated indirect inguinal hernia and testicular torsion
B. Varicocoele and strangulated indirect inguinal hernia
C. Incarcerated indirect inguinal hernia and testicular torsion
D. Varicocoele and testicular torsion

A

A

68
Q

An example of a clean wound
A. Surgical wound from a modified radical mastectomy
B. Surgical wound from an appendectomy
C. Surgical wound from a lung biopsy
D. Surgical wound from a reduction of an incarcerated hernia

A

A

69
Q 
Which of the following is an absorbable suture
A. Polypropylene
B. Polydioxanone
C. Cotton
D. Silk
A

B

70
Q 
The tensile strength of the healing skin approaches 70% of the original in how many months
A. 1-2 months
B. 2-3 months
C. 3-4 months
D. 4-5 months
A

C

71
Q

Eicosanoids are set of substances stored within cells that are generated as a response to
various stimuli. These substances originate from which membrane phospholipid
A. Sphingomyelin
B. Arachidonic acid
C. Phosphatidylcholine
D. Phosphatidylinositol

A

B

72
Q 
Cellular responder most abundant in the GI and respiratory tracts whose primary function is
anti-helminthic
A. Neutrophils
B. Basophils
C. Eosinophils
D. Macrophages
A

C

73
Q

Resting energy expenditure or REE is increased during stress states. Which of the following
circumstances precipitate the greatest rise in REE?
A. Prolonged starvation
B. Elective surgery
C. Skeletal trauma
D. Major burns

A

D

74
Q

Which of the following is TRUE of nutrition in critically-ill surgical patients?
A. Enteral nutrition is preferred over parenteral nutrition
B. 20 kcal/kg/day is adequate to meet nutritional requirements of post-surgical patients
C. In the absence of severe renal or hepatic dysfunction 1.0 to 1.25 g of nitrogen/kg body weight
should be provided daily
D. Short-term use of parenteral nutrition in critically ill patients is defined as

A

A

75
Q

Which of the following is true of indicators for increased risk of complications during critical
illness
A. Hyperglycemia during critical illness is predictive of increased mortality in critically ill patients
B. Hypoglycemia during critical illness is predictive of increased mortality in critically ill patients
C. Hyperglycemia during critical illness is predictive of decreased mortality in critically ill patients
D. Hypoglycemia during critical illness is predictive of decreased mortality in critically ill patients

A

A

76
Q 
This is the most common fluid disorder in surgical patients
A. Extracellular volume deficit
B. Extracellular volume excess
C. Intracellular volume deficit
D. Intracellular volume excess
A

A

77
Q 
For every 100 mg/dl rise in plasma glucose, the plasma sodium is affected in this manner
A. 1.6 mEq/L increase
B. 2.3 mEq/L decrease
C. 1.6 mEq/L decrease
D. 2.3 mEq/L decrease
A

C

78
Q

The following is an alternative resuscitative fluid for patients with closed head injuries as it
has been shown to increase cerebral perfusion and decrease intracranial pressure, thus
decreasing brain edema
A. Hypotonic saline
B. Hypertonic saline
C. Albumin
D. Dextran

A

B

79
Q

Which of the following is TRUE of resuscitative fluids used in surgical patients in need of
resuscitation
A. Lactated Ringer’s is slightly hypertonic to extracellular fluid
B. Sodium chloride is slightly hypotonic to ECF
C. Colloids, due to their molecular weight, are confined to the intracellular space, and their
infusion results in more efficient volume expansion
D. Dextrans, a type of colloid, may be used to lower blood viscosity

A

D

80
Q 
Fibroblast migration into the wound bed reaches its peak during this phase of wound healing
A. Inflammation
B. Proliferation
C. Maturation
D. Degradation
A

B

81
Q 
Type III collagen is deposited during this phase of wound healing
A. Inflammation
B. Proliferation
C. Maturation
D. Degradation
A

A

82
Q 
Tissue continuity is re-established during this phase of wound healing
A. Inflammation
B. Proliferation
C. Maturation
D. Degradation
A

B

83
Q

The following is a chronic wound, EXCEPT
A. A wound that has not healed in 3 months
B. A wound that has not healed in 6 months
C. A wound that has failed to proceed through the orderly process of wound healing
D. A wound that has failed to reach adequate anatomic and functional restoration

A

B

84
Q

The following is false about the similarities and differences of hypertrophic scars and keloids
A. Both represent an over-abundance of fibroplasia in the dermal healing process
B. Hypertrophic scars rise above the skin level but stay within the confines of the original wound
and often regress over time
C. Hypertrophic scars rise above the skin level but stay within the confines of the original wound
D. Hypertrophic scars rarely spontaneously regress over time

A

D

85
Q

Routine screening mammography has been found to reduce mortality of breast cancer by
25%. In which scenarios would it be prudent to order a screening mammography?
A. Patients >= 40 years old
B. Patients >= 50 years old
C. Patients with a solitary palpable breast mass
D. Patients with multiple palpable breast masses

A

B (although you’d order earlier screening for patients with risk factors)
Kapag C and D, it depends on the characteristics of the breast mass involved. If you’re
suspecting CA, go ahead and do the biopsy

86
Q

Breast conservation surgery is now offered routinely to all early-stage breast cancer patients.
Which of the following is not a component of breast conservation surgery?
A. Resection of the primary breast CA
B. Adjuvant radiation therapy
C. Adjuvant chemotherapy
D. Assessment of regional lymph node status

A

C

87
Q 
It is the single most important test in the evaluation of thyroid masses
A. TSH
B. FNAB
C. Thyroid UTZ
D. Thyroid scan using radioactive iodine
A

B

88
Q

Patients with salivary gland tumors may present with trismus in the advanced stages of the
disease. Trismus, or difficulty or pain on mouth opening, most commonly represents invasion of
which structures
A. Facial nerve
B. Muscles of mastication
C. Superficial facial muscles
D. Zygomatic bone

A

B

89
Q 
The usual presentation of the most prevalent congenital anomaly of the GI tract is
A. Bleeding
B. Obstruction
C. Abdominal pain
D. Asymptomatic
A

D (referring to Meckel’s diverticulum, which is commonly asymptomatic)

90
Q

Which of the following accurately describes the different terms used to characterize lower GI
bleeding
A. Obscure GI bleeding refers to GI bleeding for which no source has been identified by routine
endoscopic studies (EGD and colonoscopy)
B. Overt GI bleeding refers to the presence of hematemesis, melena, or hematochezia
C. Occult GI bleedings occurs in the absence of overt bleeding and is identified on lab tests
D. All statements are true

A

D

91
Q

Persistent bleeding from first, second, and selected third-degree hemorrhoids may be treated
by rubber band ligation
A. True
B. False
C. The treatment of choice depends most on the location of the hemorrhoidal pile
D. The treatment of choice depends most on patient continence

A

A

92
Q

A 51/M with no signs and symptoms of colorectal cancer, consults at the outpatient clinic. He
is concerned because his father was diagnosed with colorectal cancer at the age of 50 years old.
No syndromic associations were noted in his father’s diagnosis. Which of the following stands
true of screening for this patient
A. He should undergo colonoscopy at a frequency of every 10 years
B. Annual fecal occult-blood testing is sufficient for testing
C. His screening should have started at 40 years old
D. His screening should have started at 30 years old

A

C

93
Q

Having an Alvarado score of 7, you diagnose your patient to have appendicitis, and
subsequently the patient undergoes an appendectomy. Your intraoperative findings, however,
show an appendix of normal caliber, non-inflamed, and on follow-up, the results of the final
histopathology show no inflammation of the appendix. Which of the following is the most common
pathology for a patient who is erroneously diagnosed with appendicitis pre-operatively?
A. Acute gastroenteritis
B. Acute mesenteric adenitis
C. Ovarian cyst, in torsion
D. Pelvic inflammatory disease

A

B

94
Q 
Which diagnostic tool has the highest sensitivity and specificity for acute appendicitis?
A. History and PE alone
B. Graded compression ultrasound
C. Computed tomography scanning
D. Magnetic resonance imaging
A

C

95
Q 
The following are proven major risk factors for hepatocellular carcinoma EXCEPT
A. Hepatitis C
B. Non-alcoholic steatohepatitis
C. Fulminant hepatitis A
D. Hemochromatosis
A

C

96
Q

You are asked to advise a patient at the OPD newly-diagnosed with cholangiocarcinoma. The
patient asks you about his chances of cure. Knowing the data on the various treatment modalities
for cholangiocarcinoma, you advise that the only chance of cure is afforded by
A. Chemotherapy, in combination with external beam radiotherapy
B. TACE or trans-arterial chemoembolization
C. Stereotactic radiosurgery
D. Surgical resection

A

D

97
Q

A patient presents with RUQ pain and tenderness. The most useful diagnostic test to order is
A. CBC
B. Liver function tests, including AST and ALT
C. Abdominal ultrasound
D. Triphasic upper abdominal CT scan

A

C

98
Q

A patient presents with RUQ pain and tenderness, fever, and leukocytosis. You assess the
patient to be manifesting signs and symptoms of acute cholecystitis. Upon ultrasound, findings
include a distended gallbladder with thickened wall, biliary sludge, pericholecystic fluid, but no
gallbladder stone visible. Your patient is a
A. 34/M basketball player experiencing the symptoms for the first time
B. 29/F pregnant housewife
C. 42/M admitted for complications of DM
D. 60/F on chronic parenteral nutrition

A

A

99
Q 
The cardinal symptom of acute pancreatitis is
A. Jaundice
B. Massive hematemesis
C. Pain
D. Elevation of liver enzymes
A

C

100
Q

The Ranson’s criteria includes prognostic or predictive markers that accurately stratify the
risk of complications in the setting of acute pancreatitis. Which among the following points to a
more severe course of disease
A. Age > 70 years old
B. A fall in hematocrit > 10 points in the initial 48 hours
C. Age > 60 years old
D. A fall in hematocrit > 10 points in the initial 24 hours

A

A

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