SURG2 FINALS Flashcards
Most breast cancers are estimated to have a volume-doubling time of?
A. 1 to 2 years
B. 3 to 5 years
C. 4 to 6 weeks
D. 2 to 12 months
A patient with a 1-cm medullary carcinoma of the right thyroid and no clinically significant adenopathy is best treated with:
A. Total thyroidectomy with central lymph node dissection
B. Right thyroid lobectomy and isthmusectomy
C. Right thyroid lobectomy and subtotal left thyroidectomy
D. Total thyroidectomy
According to the Bismuth-Corlette classification system, perihilar cholangiocarcinomas extending into the right secondary intrahepatic ducts are classified as:
A. Type IV
B. Type IIIa
C. Type IIIb
D. Type I
B. Type Illa
Rationale:
The Bismuth-Corlette classification is used to describe perihilar (Klatskin) cholangiocarcinomas based on how far the tumor extends into the biliary tree:
* Type I: Below the confluence of the right and left hepatic ducts
* Type II: Involves the hepatic duct confluence
* Type Illa: Extends into right secondary intrahepatic ducts
* Type Illb: Extends into left secondary intrahepatic ducts
* Type IV: Involves both right and left second-order ducts (multifocal)
High-Yield Point:
Type Illa involves extension into the right biliary tree, impacting surgical resectability and planning.
At what week of human embryonic development does the appendix appear as an outpouching from the caudal limb of the midgut?
A. 4th week
B. 8th week
C. 5th week
D. 6th week
B. 8th week
Rationale:
The appendix develops as a diverticulum from the caudal limb of the midgut loop during the 8th week of embryonic life. Initially, it appears as a small bud from the cecum, which itself develops earlier (around the 6th week). The appendix elongates as the cecum grows, and its final position varies due to differential growth and rotation of the gut.
High-Yield Point:
The 8th week is a critical period for the formation of many GI tract derivatives, including the appendix.
Based on the Alvarado scoring system, which parameter is given a score of 2 if present?
A. Tenderness at the right iliac fossa
B. Shift to the left of neutrophils
C. Anorexia
D. Fever >36.3°C
What is the most important prognosticating factor in soft tissue sarcoma?
A. Depth of invasion
B. Tumor size
C. Locoregional invasion
D. Histologic grade
Innervation of the appendix is derived from sympathetic elements contributed by the superior mesenteric plexus from which spinal level?
A. T4–T8
B. T12–L3
C. T10–L1
D. T6–T10
Appendiceal perforation usually occurs at what site?
A. Mesenteric border
B. Antimesenteric border
C. Base
D. Tip
Which of the following is a common cause of acute (suppurative) thyroiditis?
A. Escherichia coli
B. Pseudomonas aeruginosa
C. Staphylococcus aureus
D. Streptococcus species
One year after surgery, after several previously normal levels, serum CEA determination now shows elevated values. You should now suggest:
A. Adjuvant chemotherapy
B. Repeat determination after 2 months
C. Exploratory laparotomy
D. Complete work-up for metastasis
Most common true diverticulum of the GIT
A. Ileal diverticulum
B. Jejunal diverticulum
C. Duodenal diverticulum
D. Meckel’s diverticulum
Which segment of the primitive gut develops into the ascending colon and proximal transverse colon?
A. Hindgut
B. Foregut
C. Ectoderm
D. Midgut
Which of the following is NOT included in the Gail model for assessing breast cancer risk?
A. Family history of breast cancer
B. Age at first live birth
C. Age at menarche
D. Previous exposure to radiation therapy
E. Previous biopsy revealing atypical hyperplasia
Small intestine: most common benign tumors found in autopsy series
A. Cyst
B. Adenomas
C. Myoma
D. Leiomyomas
What is the mode of action of alkylating agents?
A. Binding of tubulin in the S phase and blocks polymerization
B. Causes damage by interfering with DNA or RNA synthesis
C. Cross-linking the two strands of DNA or direct DNA damage
D. Substitutes for purines or pyrimidines in nucleic acid synthesis
First diagnostic test to order for a solitary thyroid nodule
A. Radioactive iodine scan
B. Fine needle aspiration (FNA)
C. CT or MRI
D. Core needle biopsy
Relaxation of the sphincter of Oddi in response to a meal is largely controlled by which hormone?
A. Ghrelin
B. Cholecystokinin (CCK)
C. Gastrin
D. Motilin
E. Secretin
What percentage of the bile acid pool is reabsorbed in the ileum via enterohepatic circulation?
A. 50%
B. 75%
C. 95%
D. 25%
E. 90%
What is the only vascularized suspensory ligament of the spleen?
A. Gastrosplenic ligament
B. Splenorenal ligament
C. Phrenosplenic ligament
D. Splenocolic ligament
B. Splenorenal ligament
✅ Rationale (Based on Your Document):
From the [Spleen lecture document], the spleen is held in place by several suspensory ligaments, but only one is vascularized:
🌟 Splenorenal ligament:
🔹 Connects spleen to the posterior abdominal wall (near left kidney)
🔹 Contains the splenic artery and vein
🔹 Only ligament carrying vascular supply to the spleen.
📌 Other Ligaments (Non-vascularized):
A. Gastrosplenic ligament
🔸 Connects spleen to stomach
🔸 Contains short gastric vessels, but not the main splenic vessels
C. Phrenosplenic ligament
🔸 Connects diaphragm to spleen
🔸 Non-vascularized
D. Splenocolic ligament
🔸 Connects spleen to colon
🔸 Non-vascularized
Small intestine: most common benign small bowel lesion that produces symptoms
A. Adenomas
B. Leiomyomas
C. Cyst
D. Cystadenoma
A 50-year-old male with a 3×3 cm preauricular lesion involving the superficial lobe of the parotid, biopsy shows malignancy, no facial nerve symptoms. What is the next step?
A. Enucleation
B. Superficial parotidectomy
C. Radiotherapy
D. Total parotidectomy
Treatment of malignant neoplasms of the small intestines
A. Radiotherapy
B. Wide resection including regional lymph nodes
C. Segmental resection and primary anastomosis
D. Observation
Patient with bilirubin 3 mg/dL, albumin 3 mg/dL, INR 3, minimal ascites, alert and coherent. What is true regarding surgical mortality?
A. Overall surgical mortality is 80%
B. Overall surgical mortality is 30%
C. Overall surgical mortality is 10%
D. None are true
Which of the following does NOT stimulate parietal cells?
A. Gastrin
B. Acetylcholine
C. Somatostatin
D. Histamine
The following statements are true EXCEPT:
A. Common benign liver lesions can often be reliably diagnosed via imaging
B. Ultrasonography is the mainstay for liver imaging
C. Acute variceal bleeding is managed with resuscitation and endoscopy
D. All are true
Acute cholecystitis is considered:
A. A primary infectious process with secondary inflammation
B. A primary autoimmune process
C. A sterile primary inflammatory process
D. A primary inflammatory process with occasional bacterial contamination
G cells are mainly located in which area?
A. Pylorus
B. GE junction
C. 2nd part of the duodenum
D. Antrum
D. Antrum
Rationale:
G cells, which secrete gastrin, are primarily located in the gastric antrum. Gastrin stimulates acid secretion by parietal cells and promotes mucosal growth. Some G cells may also be found in the duodenum, but the antrum is the main site.
High-Yield Point:
G cells = Antrum → Gastrin → Parietal cell stimulation → HCl secretion
A 37-year-old female has a 3 cm palpable breast mass on ultrasound. What is the next best step?
A. Incision biopsy
B. Observe
C. Fine-needle aspiration biopsy
D. Core-needle biopsy
Hesselbach’s triangle includes all EXCEPT:
A. Medial border of the rectus sheath
B. Femoral vein
C. Cooper ligament
D. Inferior epigastric vessels
E. Inguinal ligament
Branches of the facial nerve, EXCEPT:
A. All are branches of the facial nerve
B. Buccal
C. Zygomatic
D. Orbital
Most common symptom of Meckel’s diverticulum in childhood
A. Intestinal obstruction
B. Acute diverticulitis
C. Abdominal pain
D. Bleeding
The solubility of cholesterol in bile is determined by:
A. Cholesterol, bile salts, lecithin
B. Calcium, cholesterol, bile salts
C. Bile salts, cholesterol, bilirubin
D. Cholesterol, calcium, bilirubin
A. Cholesterol, bile salts, lecithin
Rationale:
Cholesterol solubility in bile is determined by the ratio of cholesterol to bile salts and lecithin (a phospholipid). When this balance is disturbed (e.g., increased cholesterol or decreased bile salts/lecithin), bile becomes supersaturated, predisposing to cholesterol gallstone formation.
High-Yield Point:
Cholesterol solubility = cholesterol : bile salts : lecithin ratio — imbalance leads to gallstone risk.
Above the arcuate line, the anterior rectus sheath is formed by:
A. Internal oblique aponeurosis, transverse abdominis aponeurosis
B. External oblique aponeurosis, internal oblique aponeurosis
C. Transversalis fascia
D. Internal oblique aponeurosis
The arterial supply of the common bile duct is derived from:
A. Right hepatic and gastroduodenal arteries
B. Left hepatic and gastroduodenal arteries
C. Right hepatic artery
D. Left hepatic artery
E. Gastroduodenal artery
A newborn has a red/purplish lesion on the cheek growing over the past 2 weeks, otherwise healthy. What is the best management?
A. Observe
B. Photocoagulation
C. Excision
D. Give steroids
The high incidence of inguinal hernias in preterm babies is most often due to:
A. Familial history
B. Developmental dysplasia of the hip
C. Failure of the peritoneum to close
D. Female gender
Which among the following is NOT considered a strong indicator of acute appendicitis?
A. Rebound tenderness
B. Increased WBC
C. Increased CRP
D. Indirect tenderness
The antireflux mechanism in humans is composed of three components EXCEPT:
A. Mechanically effective LES
B. Adequately functioning gastric reservoir
C. Efficient esophageal clearance
D. None of the choices
Which condition is characterized by loss of peristalsis in the esophagus and failure of LES relaxation?
A. Achalasia
B. Hypertensive lower esophageal sphincter
C. Nutcracker esophagus
D. Diffuse esophageal spasm
A rectus sheath hematoma is due to rupture of:
A. Rectus sheath
B. Pararectal vessels
C. Epigastric vessels
D. Hypogastric vessels
What percentage of bile duct injuries are identified intraoperatively?
A. 5%
B. 85%
C. 10%
D. 50%
E. 25%
Painful subacute thyroiditis:
A. Occurs most commonly in women >70 years of age
B. Requires thyroidectomy for relief of symptoms in >50% of patients
C. Is often preceded by an upper respiratory infection
D. Results in hypothyroidism in >80% of patients
Which of the following chemotherapeutic drugs is cell-cycle specific?
A. Alkylating agents
B. Nitrosoureas
C. Antitumor antibiotics
D. Plant alkaloids
The hallmark of acute mesenteric ischemia is:
A. Severe abdominal pain out of proportion to the degree of tenderness on examination
B. Abdominal distention with abdominal pain
C. Passage of bloody stool with abdominal pain
D. Abdominal pain with vomiting
A 1-year-old boy has a 2×2 cm bluish, soft, compressible, non-pulsatile facial lesion that’s present since birth and more prominent when crying. Probable diagnosis:
A. Venous malformation
B. Congenital hemangioma
C. Infantile hemangioma
D. Capillary hemangioma
A 38-year-old female presents with which symptom that warrants mandatory upper GI endoscopy?
A. GERD
B. Dysphagia
C. Heartburn
D. PUD
Head and neck carcinoma associated with HPV:
A. Larynx
B. Hypopharynx
C. Nasopharynx
D. Oropharynx
What is the most common serious complication of an end colostomy?
A. Skin breakdown
B. Colonic perforation during irrigation
C. Bleeding
D. Stomal prolapse
E. Parastomal hernia
A patient with a history of familial polyposis undergoes a diagnostic polypectomy. Which type of polyp is most likely to be found?
A. Pseudopolyp
B. Adenomatous polyp
C. Villous adenoma
D. Hyperplastic polyp
Which liver lesion is typically diagnosed on CT scan due to a central scar?
A. Adenoma
B. Hepatocellular carcinoma
C. Focal nodular hyperplasia
D. Hemangioma
The following are true about ultrasound for liver evaluation EXCEPT:
A. Incomplete visualization of lesion boundaries
B. Incomplete imaging of the liver usually at the dome or beneath ribs
C. Useful initial imaging test because it is inexpensive, widely available, no radiation, and well tolerated by patients
D. Can assess the degree of fibrosis of the liver
Most common type of gallbladder cancer is:
A. Anaplastic
B. Adenosquamous
C. Oat cell
D. Squamous cell
E. Adenocarcinoma
Traction diverticula in the esophagus are the result of:
A. Inflammation
B. Trauma, usually iatrogenic
C. Genetic abnormality
D. Motility disorders
A 50-year-old male smoker has a subcentimeter lower lip lesion. Biopsy: squamous cell carcinoma. Staging: T1N1M0 (Stage III). What is the best management?
A. Resection with lymph node dissection
B. Chemotherapy
C. Resection only
D. Radiotherapy
Anomalies of the hepatic artery and cystic artery are present in what percentage of individuals?
A. 35%
B. 25%
C. 15%
D. 75%
E. 50%
The RET proto-oncogene is associated with:
A. Hirschsprung’s disease
B. Pheochromocytoma
C. Papillary thyroid cancer
D. All of the choices
Which hernia repair method is associated with the lowest recurrence rate?
A. Bassini technique
B. Lichtenstein tension-free repair
C. Shouldice repair
D. Open elective tissue-based repair
Which neck dissection is recommended for a patient with oral cavity cancer?
A. Supraomohyoid neck dissection
B. Posterolateral neck dissection
C. Superoanterior neck dissection
D. Lateral neck dissection
Diverticular disease most commonly affects the:
A. Sigmoid
B. Descending
C. Ascending
D. Transverse
Most common location of a chronic anal fissure is:
A. Left lateral
B. Right lateral
C. Midline anterior
D. Midline posterior
Watermelon stomach is best treated by:
A. Total gastrectomy
B. Antrectomy
C. Beta blockers
D. Acid-reducing agents
Which fracture has mobility of the palate, nasal dorsum, and inferomedial aspect of the orbital rim?
A. Le Fort III
B. Le Fort II
C. Le Fort I
D. Le Fort IV
Best screening procedure for colon carcinoma in the general population:
A. Fecal occult blood test
B. CEA assay
C. Barium enema
D. Sigmoidoscopy
E. Sigmoid colonoscopy
Most common malignant lesion of the liver:
A. Metastatic colorectal cancer
B. Hepatocellular carcinoma
C. Cholangiocarcinoma
D. Metastatic breast cancer
What vessels are ligated in a right hemicolectomy?
A. Ileocolic, right colic, right branch of middle colic artery
B. Ileocolic, right colic, right and left branch of middle colic artery
C. Right colic, middle colic, right and left branch of middle colic artery
D. Right colic, right branch of middle colic artery
The transition from pharynx to esophagus occurs at the level of:
A. Lower border of the 6th cervical vertebra
B. None of the choices
C. Epiglottis
D. Transverse process of 5th cervical vertebra
E. Thyroid cartilage anteriorly
55-year-old male, hepatocellular carcinoma, Child A, 6 cm solitary lesion on right lobe, no metastasis on triphasic CT. Best management?
A. Radiofrequency ablation
B. Resection
C. Transarterial chemoembolization
D. Liver transplantation
Caustic injury of the esophagus due to alkaline ingestion causes:
A. Burns also the oropharynx
B. Deep esophageal burn
C. Coagulative necrosis
D. Liquefaction necrosis
Ideal treatment for uniloculated splenic abscess:
A. Splenectomy
B. Splenic artery embolization
C. Broad-spectrum oral antibiotics
D. Ultrasound-guided percutaneous drainage
Most common position of the RIGHT recurrent laryngeal nerve:
A. Between the branches of the inferior thyroid artery
B. Absent (nonrecurrent laryngeal nerve)
C. Anterior to the inferior thyroid artery
D. Posterior to the inferior thyroid artery
Which of the following is considered to have low malignant potential?
A. Dermatofibrosarcoma protuberans
B. Myxoid liposarcoma
C. Angiosarcoma
D. Clear cell sarcoma
Urgent open laparotomy is the recommended treatment for what minimum Hinchey stage of diverticulitis?
A. Stage IV
B. Any stage
C. Stage II
D. Stage III
Thyroid hormone production is inhibited by:
A. Epinephrine
B. Alpha-fetoprotein
C. Human chorionic gonadotropin
D. Glucocorticoids
Salivary gland with the highest risk of malignancy:
A. Submandibular gland
B. Sublingual gland
C. Minor salivary gland
D. Parotid gland
Common origins of hematogenous spread for splenic abscess EXCEPT:
A. Dengue fever
B. Osteomyelitis
C. Infective endocarditis
D. Malaria
Management of hilar cholangiocarcinoma with primary sclerosing cholangitis:
A. Liver transplantation
B. Resection
C. Palliation
D. Chemoradiation
Risk management strategies for BRCA1 and BRCA2 mutation carriers include:
A. All of the choices are correct
B. Mastectomy ± reconstruction
C. Salpingo-oophorectomy
D. Tamoxifen
Palliation of esophageal cancer is indicated for all EXCEPT:
A. Tumor invading adventitia with >4 enlarged lymph nodes
B. Fistula in the tracheobronchial tree
C. >10% weight loss
D. Endoscopic tumor length >9 cm
Congenital multiple cysts of the intrahepatic ducts:
A. Biliary cystadenoma
B. Polycystic liver disease
C. Congenital cysts
D. Caroli’s disease
The triangle of pain is bordered by all of the following EXCEPT:
A. Reflected peritoneum
B. Ductus deferens
C. Iliopubic tract
D. Gonadal vessels
Ideal site for cervical esophagostomy in a 56-year-old male patient:
A. Left upper portion of the neck
B. Left lower portion of the neck
C. Right lower portion of the neck
D. Right upper portion of the neck
The origin of the superior thyroid artery is:
A. Innominate artery
B. External carotid artery
C. Thyrocervical trunk
D. Internal carotid artery
40-year-old woman with 3 cm smooth, firm upper outer quadrant breast mass. Aspirated fluid is 10 mL cloudy green. What is the appropriate next step?
A. Administration of estrogen
B. Excision of the cyst
C. Cytologic evaluation of the aspirated fluid
D. Administration of tamoxifen
E. Observation only
Internal hemorrhoids are engorged veins proximal to the dentate line. The covering mucosa is:
A. Very sensitive endoderm
B. Very sensitive columnar epithelium
C. Insensate columnar epithelium
D. Insensate anoderm
Most common cause of acute mesenteric ischemia (>50% of cases):
A. Venous thrombosis
B. Arterial thrombosis
C. Arterial embolus
D. Vasospasm
Thyroglossal duct cysts are most commonly located:
A. In the midline at the level of the hyoid
B. On the anterior border of the sternocleidomastoid
C. Over the medial clavicular head
D. In the midline just superior to the thyroid gland
Which of the following is TRUE regarding pancreatic cancer?
A. All of the choices
B. Associated with MEN2 syndrome
C. Neoplasms of the endocrine pancreas are common
D. Endocrine pancreatic tumor has better prognosis
57-year-old woman with 5 cm firm painless arm mass (triceps), present for 3 months. Best next step?
A. Excisional biopsy
B. Incisional biopsy
C. Percutaneous core needle biopsy
D. PET-CT scan
E. Fine-needle aspiration biopsy
Best initial test for suspected postoperative bile leak:
A. Plain film X-ray
B. MRI
C. ERCP
D. Ultrasound (US)
E. PTC
Initial treatment of choice for Riedel’s thyroiditis:
A. Observation
B. Corticosteroids
C. Surgery
D. Antibiotics
Most common liver lesion:
A. Adenoma
B. Hemangioma
C. Carcinoma
D. Cyst
Best management for low-grade gastric lymphoma of the antrum:
A. Wedge resection
B. Antrectomy
C. H. pylori eradication
D. Chemotherapy ± radiation therapy
Patient vomits 500 mL of bright red blood. Endoscopy shows a tear at the GE junction. Best treatment:
A. Observation
B. Placement of Sengstaken-Blakemore tube
C. Administration of antiemetics
D. Surgical gastrostomy and oversewing of tears
Most common cause of urinary retention after hernia repair:
A. Narcotic analgesia
B. Pain
C. General anesthesia
D. Preoperative bladder distention
Which of the following is NOT part of Ranson’s criteria?
A. Systolic blood pressure
B. Serum LDH
C. WBC
D. Age
Which finding does NOT suggest that an esophageal lesion is a sarcoma rather than SCC?
A. Less likely to metastasize to regional lymph nodes
B. Polypoid intraluminal mass on barium swallow
C. Intraluminal necrotic mass on EGD
D. All of the choices
Below the arcuate line (semicircular line of Douglas), the rectus muscle is separated from abdominal organs only by:
A. External oblique aponeurosis
B. Laminae of internal oblique aponeurosis
C. Transversalis fascia
D. Transverse abdominis aponeurosis
Standard treatment for an isolated 3 cm gastrointestinal stromal tumor (GIST) in the body of the stomach:
A. Imatinib
B. Endoscopic ablation
C. Wedge resection
D. Subtotal gastrectomy
True of adenoid cystic carcinoma, EXCEPT:
A. All are true
B. Late recurrences are common
C. Known for perineural invasion
D. Most common salivary gland malignancy
Included in Milan criteria, EXCEPT:
A. 3 lesions <3 cm
B. No metastasis
C. Cirrhotic liver
D. All are part of Milan criteria
