Surgery Final (Part 1) Flashcards
A man sustained severe blunt injuries in a car crash twelve hours ago. The activity of this hormone is now expected to be decreased in this patient:
A. insulin
A young woman is debilitated by pruritus and burning sensation from her presternal keloid. The recommended initial treatment is:
B. intralesional corticosteroid injection
A patient is placed on NPO in preparation for an elective major abdominal surgery. The body’s preferred initial fuel source during the fasting state is:
A. hepatic glycogen
A 48-year-old woman has prolonged ileus after surgery for an obstructed duodenal ulcer. The problem is probably due to:
D. hypokalemia
A man with chronic prepyloric ulcer appears weak after repeated bouts of non-bilious vomiting over the past 3 days. Fluid therapy should be started using:
C. Normal saline solution
A multiply injured patient has persistently low urine output. The oliguria is most likely due to prerenal failure rather than acute tubular necrosis if the tests reveal:
B. low urinary excretion of sodium
A woman admitted to the ICU for severe acute pancreatitis begins to manifest paresthesia of the face and extremities, muscle cramps, and a positive Chvostek’s sign. These are probably due to:
A. hypocalcemia
Increased nutritional support appears to aggravate tachypnea in a septic patient with respiratory failure. Lessening the amount of this substrate may alleviate the problem:
A. carbohydrate
Administration of this amino acid is expected to be beneficial to a patient suffering from damage to intestinal mucosa due to adjuvant chemotherapy for esophageal cancer:
D. glutamine
Early supplementation of this vitamin is recommended to promote wound repair in a patient with extensive second-degree flame burns:
B. C
A diabetic 41-year-old man is admitted for necrotizing fasciitis in the perineum. A high dose of this antibiotic is generally included in the initial antimicrobial therapy because of concern for clostridial pathogens:
C. penicillin G
Transfusion of properly cross matched blood is begun on a man admitted for massive bleeding from erosive gastritis and thirty minutes later, he develops urticaria and fever. This should be administered to the patient:
A. antihistamine
A patient under anticoagulation therapy using warfarin, who is set to undergo surgery for acute cholecystitis, has decreased prothrombin concentration. Warfarin can be reversed by parenteral dose of:
B. vitamin K
Arterial blood gas analysis is performed on a patient just admitted with a diagnosis of severe acute pancreatitis. This reveals a pH of 7.30 and low levels of bicarbonate and pCO2. The most urgent part of management is:
A. volume resuscitation
Seven days after surgery for a perforated appendicitis, the primarily closed incision is noted to be erythematous, slightly swollen and tender. The appropriate treatment is:
D. incision and drainage
A man is brought to the E.R. with blood spurting from a hacking wound in the in the distal right thigh. He is alert and has a systolic BP of 100 mmHg. What is the initial management step?
A. apply direct pressure on the wound with sterile gauze
A young man presents to the E.R. with a stab wound in the left chest. Examination reveals subcutaneous emphysema and absent breath sounds on the left chest; the trachea is shifted to the right. What is the probable diagnosis?
B. tension pneumothorax
A 58-year-old woman on NSAID therapy for arthritis has a 6-hour history of epigastric pain that has progressively become severe. Her abdomen is distended, rigid and diffusely tender. This diagnostic test should be done first:
A. upright chest x-ray
After aggressive fluid therapy, a trauma victim shows a systolic BP of 110 mm Hg, cold extremities, rapid but strong peripheral pulse, and a central venous pressure of 12 cmH2O. The patient has:
A. increased systemic vascular resistance
An elderly man admitted with a diagnosis of sigmoid volvulus has a markedly distended, non-tender abdomen and hyperactive bowel sounds. The initial treatment is:
A. endoscopic detorsion
Pancreatic necrosis is suspected in a 49-year-old woman who has not improved despite 3 days of intensive care for acute pancreatitis. The diagnosis is best established through:
C. contrast-enhanced CT scan
A chronically constipated 67-year-old woman presents with acute left lower quadrant (LLQ) abdominal pain, LLQ direct and rebound tenderness, and fever. The appropriate diagnostic examination is:
B. abdominal CT scan
After an elective hemicolectomy for colon cancer, a 78-year-old man remains hypotensive and tachycardic. He has distended neck veins, cold skin, oliguria, and elevated central venous pressure. He apparently is suffering from this type of shock:
B. cardiogenic
For the past 6 weeks, a 67-year-old man has been asymptomatic except for constipation after a course of antibiotic therapy for left lower quadrant abdominal pain. He should undergo:
C. colonoscopy
A 32-year-old-man with a week’s history of fever presently has right lower quadrant abdominal pain and tenderness and bloody diarrhea. The most probable diagnosis is:
A. typhoid ileitis
A 75 year old woman in the ICU after undergoing cholecystectomy for acute Cholecystitis is hypotensive and tachycardic. Pulmonary capillary wedge pressure (PCWP) is elevated to 18 mmHg, and cardiac output is 3 L/min. she is shock best described as which o
C. cardiogenic shock
A 19 year old man is brought to the emergency department with a stab wound at the base of the neck (zone I) The most important concern for patients with such injuries is which of the following?
C. exsanguinating hemorrhage
In septic shock, which of the following is true?
C. the majority of patients are elderly
The injury most often missed by selective nonoperative management of abdominal stabwounds is to which of the following?
D. diaphragm
A 63-year-old male tobacco smoker has a 1.5 cm non-healing ulcer in his lower lip. A nodular lesion is palpable deep to the ulcer. The most likely diagnosis is:
A. squamous cell carcinoma
A 43-year-old-man presents with nasal obstruction and occasional epistaxis. Imaging studies combined with endoscopic biopsy have led to the diagnosis of nasopharyngeal cancer. The standard treatment is:
C. combined chemotherapy and radiation
Biopsy of a slow growing infraauricular mass reveals a benign pleomorphic adenoma that is confined to the superficial lobe of the parotid gland. The standard treatment is:
C. superficial parotidectomy
A 58 year old woman undergoes excision biopsy of a tumor in the left posterior triangle of her neck. Histology suggests that this is a metastatic cancer. What is the most likely site of the primary tumor?
D. piriform fossa
A 59 year old woman has discomfort in the posterior part of her tongue. A biopsy confirms that the lesion is a carcinoma. What is true in carcinoma of the posterior third of the tongue?
B. lymph gland spread is often encountered
A 60-year-old man has a 3 cm nodular lesion with central ulceration in his left cheek. Section biopsy proves this to be basal cell carcinoma. This is best managed with:
D. excision with 2-4 mm margin
This is the most common aggressive primary malignant bone tumor in adolescent and occurs in methaphyseal area of long bones with high incidence of pulmonary metastases:
b. Osteosarcoma
A 65 year-old farmer presents with a 1.5-cm ulcerated lesion on the middle third of his lower lip. The lesion has been present for 4 months and is not painful. No lymph nodes are palpable in the patient’s neck. The most likely diagnosis is:
a. Squamous cell carcinoma
A 65 year-old patient who spends summer in Baguio City presents with a painless, ulcerated lesion on the right cheek. The lesion has been present for one year. Physical examination of the patient’s neck reveals no lymph node enlargement. The most likel
c. basal cell carcinoma
A 60-year-old woman has a 10-day history of cough and fever. Imaging studies show multiple fluid loculations in the right chest cavity with an estimated volume of 500 ml. Thoracentesis draws purulent material. The best treatment strategy now is:
B. video assisted thoracoscopic drainage with deloculation
A-50-year-old woman presents with a 3 cm solitary pulmonary nodule in the left upper lobe. She has a history of total thyroidectomy for papillary cancer at the age of 38 years. The main consideration is:
C. primary lung cancer
A 45-year-old woman presents with weakness towards the afternoon, shortness of breath, and ptosis. CT scan reveals an anterior mediastinal mass. The most likely diagnosis is:
D. thymoma
A man with malignant pleural effusion in association with an inoperable lung cancer may benefit from the instillation of sclerosing agent into the pleural cavity, once the lungs are almost fully expanded. An accepted sclerosant is:
A. talc
A 20-year-old woman consults for a 2-cm mass in her left breast. The mass is movable, non-tender and has a rubbery consistency and smooth borders. The probable diagnosis is:
A. fibroadenoma
A 16-year-old girl is bothered by cyclical premenstrual pain in her breasts. She has 0.5-1.0 cm nodularities in the upper outer quadrant of both breasts. What management advice should be given to her?
A. Observation
An asymptomatic 40-year-old woman with no palpable breast mass undergoes mammography. This reveals clustered microcalcifications in the lower outer quadrant of her left breast. The probable diagnosis is:
D. ductal carcinoma in situ
A 45-year-old woman with “lumpy” breasts undergoes mammography. Mammographic findings are suggestive of high-grade ductal carcinoma in situ confined to the upper outer quadrant of her right breast. How should she be managed?
B. lumpectomy and radiotherapy
A 45-year-old woman has a recent onset bloody nipple discharge from her right breast. No palpable breast mass is noted. What diagnostic test is indicated?
B. mammography
A premenopausal woman undergoes modified radical mastectomy for a 3-cm breast cancer. No axillary node and distant metastases are detected. Test for this biomarker is currently recommended to facilitate the selection of adjuvant chemotherapy:
D.AHER2/neu
A 63-year-old man with chronic atrial fibrillation has sudden onset of pain, weakness, and paresthesia in his left leg, which appears cool, cyanotic, and without femoral and distal pulses. The right leg has normal pulses. The most likely diagnosis is:
A. arterial embolism
Coronary angiogram reveals a triple-vessel disease in a diabetic 55-year-old man presenting with unstable angina. The recommended treatment is:
C. coronary artery bypass grafting
A 41-year-old male chronic smoker has a 2-year history of bilateral foot claudication. He now has ulceration of the tip of the right 3rd toe and left 2nd and 4th toes. Popliteal pulses are palpable but the posterior tibial and dorsalis pedis pulses are bi
A. cessation of smoking
A premature infant with progressive dyspnea without cyanosis since birth has machinery murmur in the pulmonic area. A diagnosis of patent ductus arteriosus (PDA) is made. The indicated treatment is:
A. administration of indomethacin
A 3-year-old girl presents with cyanotic spells that have increased in severity and frequency since birth. X-ray shows a boot-shaped heart; ECG reveals right ventricular hypertrophy. The most probable diagnosis is:
B. tetralogy of Fallot
A 54-year-old man presents with hematemesis after a bout of vomiting and retching. Endoscopy shows linear mucosal tears at the gastroesophageal junction. The diagnosis is:
A. Mallory-Weiss syndrome
After truncal vagotomy and antrectomy with gastrojejunostomy for an obstructed duodenal ulcer, the patient complains of diaphoresis, weakness, and abdominal discomfort followed by diarrhea several minutes after meals. The symptoms are suggestive of:
D. dumping syndrome
A woman undergoes total gastrectomy for a huge proximal gastric carcinoma. To protect her from developing anemia, she must be given a regular parenteral dose of:
C. vitamin B12
A few weeks after recovering from severe pancreatitis, a 34-year-old man has developed a pancreatic pseudocyst with mature wall that is pressing on his stomach. Aspiration fails to relieve the pressure symptoms. The indicated treatment is:
B. internal drainage (cystogastrostomy)
ERCP reveals a periampullary cancer in a 64-year-old man admitted for jaundice. No metastasis is detected; no co-morbid conditions are identified. How should he b managed?
A. radical excision of the head of pancreas and duodenum
A 60 year old man with no previous operation has a 5-day history of inability to pass flatus or feces, cramping abdominal pain, and progressive abdominal distention. The principal diagnostic consideration is:
B. colorectal cancer
A 65 year old male who underwent a colon resection of carcinoma 2 years prior to consult is found to have 3 solid nodules approximately 2 cms each in the right and left lobes of the liver. There is no extrahepatic disease detected. The preferred treatment
D. surgical resection of metastatic nodules
A 35 year old female with a prolonged intake of contraceptive pills develops right upper quadrant pains. Ultrasound shows an isodense 5 cm mass in the right lobe of the liver. Sulfur-colloid scan done showed a cold lesion. This patient should undergo.
B. resection
A man who has an obstructed rectosigmoid cancer in association with a competent ileocecal valve is liable to develop perforation of:
D. cecum
The presence of tenesmus, decrease in caliber of stools and occasional bloody-mucoid diarrrrhea in a 67-year-old man is suggestive of:
A. rectal carcinoma
Diagnostic tests show an ileocolic intussusception in a 38-year-old man, who has no signs of strangulation. What is recommended for this patient?
A. expectant treatment B. endoscopic decompression C. hydrostatic reduction D. exploratory laparotomy
A 63-year-old man is presently asymptomatic after medical treatment for LLQ pain and tenderness. He should undergo:
B. Colonoscopy
A 56-year-old woman taking NSAID for chronic arthritis experienced severe epigastric pain 6 hours ago. Her abdomen is now diffusely tender with board-like rigidity. The appropriate initial diagnostic test is:
A. chest upright x-ray B. plain abdomen supine x-ray C. abdominal ultrasound D. abdominal CT scan
Despite 3 months of medical treatment for posterior midline anal fissure, the man’s fissure-related anal pain during and after defecation has become excruciating. The appropriate treatment is:
D. internal sphincterotomy
During surgery for a large right indirect inguinal hernia, the cecum is noted to form part of the wall of the hernia sac. The patient has this type of hernia:
A. sliding
A previously asymptomatic 45-year-old obese woman consults for a non-tender swelling below her right inguinal ligament just lateral to the pubic tubercle. A warranted diagnostic procedure for this patient is:
B. ultrasound
A 54 year old male taking anticoagulant for the fast 4 weeks developed 3 day history of abdominal pain. On physical examination there was a palpable mass at the supraumbilical area with direct tenderness. Fothergill sign way positive. What is your impres
B. rectus sheath Hematoma
A 12 year old female complain of 1 day history of epigastric pain which shifted to the right lower quadrant associated with anorexia and vomiting. Physical examination revealed direct and rebound tenderness on the right lowerquadrant. With the preoperat
B. omental torsion
A 45-year-old is discovered to have a solitary 2-cm firm nodule in his right thyroid lobe. No associated symptoms are noted; family history is negative for thyroid cancer. Diagnostic work-up should start with:
D. fine needle aspiration biopsy
A 59-year-old man presents with 4-cm firm mass in the left lobe of the thyroid associated with a firm occipital mass that is 6 cm in its widest diameter, which he has neglected for the past 9 months. Family history is negative for thyroid malignancy. He p
B. follicular
A 49-year-old woman complains of central obesity with moonlike facies and hirsutism. Her ACTH is markedly elevated, which is suppressed by large dose of dexamethasone. The probable pathology is:
D. pituitary adenoma
A 42-year-old man presents with headache, palpitations, and diaphoresis. His urinary metanephrines are elevated. Imaging studies reveal a 3-cm mass in his right adrenal gland. The treatment of choice is:
A. adrenalectomy
A 67-year-old man is bleeding excessively following a transurethral prostatectomy. The bleeding is assessed to be due to local plasminogen activation leading to increased fibrinolysis on the raw wound surface. Administration of this drug may be beneficial
D. EACA
A 60-year-old man presents with slight urinary urgency, frequency, and a decrease in the force of micturition. Digital rectal examination detects no mass in the prostate. The indicated diagnostic test is:
B. prostate-specific antigen
A 35-year-old man presents with right flank pain and microscopic hematuria. Intravenous pyelography reveals a 4 mm radiolucent stone in the distal right ureter. The recommended treatment is:
A. alkalinization of the urine
A 55-year-old man is admitted for gross hematuria associated with left flank pain and anemia. CT scan detects a solid, enhancing mass in the left kidney. The likely diagnosis is:
A. renal cell carcinoma
A 23-year-old woman sustained blunt head trauma to her right frontoparietal area in a car crash, which caused he to be unconscious for several minutes. Upon arrival at the E.R., she is alert and has no neurologic deficit. X-ray shows a linear non-depresse
C. acute epidural hematoma
A 54-year-old woman with no previous neurologic disorder has new onset seizures without associated gross neurologic deficit. She was treated for breast cancer 10 years ago. If brain metastasis is the main consideration, this is
C. MRI of the brain with intravenous contrast
A 55-year-old man with a history of lung cancer presents with frequent severe headache, occasional vomiting, and weakness of the right upper extremity. What is the recommended treatment in addition to corticosteroids?
C. stereotactic radiosurgery (gamma knife)
A young man just admitted for blunt injuries from a car accident is stuporous. CT scan shows cerebral contusion. What should be avoided as it can cause secondary brain injury to this patient through its deleterious effect on in tracranial pressure?
B. respiratory acidosis
As a basketball player falls hard on his extended right arm, he feels immediate severe pain with subsequent inability to move his right arm. Swelling and tenderness about the shoulder with loss of deltoid contour are noted. The likely diagnosis is:
B. shoulder dislocation
A 10-week-old baby with cleft lip and palate has undergone a successful cleft lip repair. It is recommended that cleft pate repair be done before the baby reaches this age:
B. 12 months
A bedridden 61-year-old woman has a significant neurologic recovery from a previous stroke. She has an infected deep pressure ulcer in her sacrum. Once the infection has been controlled by debridement and supportive treatment, the pressure ulcer can be ma
C. gluteus maximus flap
A small thick antecubital scar from a 2nd degree flame burn is constricting movement. To relieve the constriction, the appropriate procedure to refashion the scar is:
A. Z-plasty
Resection of a sarcoma results in a significant lateral chest wall defect. To minimize pulmonary dysfunction, chest wall reconstruction may utilize:
D. Marlex mesh
A 4-week-old baby boy presents with frequent non-bilious vomiting. During feeding, peristaltic waves are seen in the upper abdomen in association with a palpable mass in the right upper quadrant. The diagnosis is:
A. hypertrophic pyloric stenosis
A newborn infant has excessive drooling followed by coughing immediately after feeding. The main diagnostic consideration is esophageal atresia. This can be readily confirmed by:
A. inability to pass orogastric tube into the stomach
A diagnosis of intussusception is made in an infant with paroxysms of crampy abdominal pain and vomiting. The infant has no peritoneal signs and remains hemodynamically stable. The initial treatment of choice is:
C. pneumatic reduction
A 3-day old infant who has not passed meconium presents with abdominal distention and bilious vomiting. The most likely diagnosis is:
D. Hirschprung’s disease
A 3-week-old infant is noted to have jaundice in association with acholic stools shortly after birth. A radionuclide scan demonstrates presence of radioisotope in the intestine. This finding rules out the diagnosis of:
B. biliary atresia
A 67 y/o man has an intraabdominal abscess caused by perforated sigmoid diverticulitis. The most common isolated microorganism is__?
B. Bacteroides
One of the most common complication of central venous access is_____.
B. pneumothorax
Early postoperative small bowel obstruction is a rare finding and occurs less than 1 % of the time. When it does, the most common cause is_____.
B. post-operative adhesions
Which of the ff statements is true concerning corrosive injury to the esophagus?
C. Alkaline injury is more destructive than acid injury.
A 27 year old female was brought to the ER with history of suicidal ingestion of household muriatic acid. This patient is best managed by—
B. Start with milk, egg white or antacids
Which of the following statements is true regarding the arterial blood supply of the stomach?
B. Because of the rich intramural collateral vessels, gastric viability may be preserved after ligation of at least two of the four named gastric arteries
At a cellular level, the major stimulants of acid secretion by the gastric parietal cell are the following, except:
B. prostaglandinE2
A patient with gastric adenocarcinoma underwent subtotal gastrectomy. Histopath revealed tumor penetrating the serosa, regional lymph nodes are not involved and distant metastatic lesions are not detected. What is the correct tumor stage on TNM staging
B. Stage II
A 5-month old baby boy was seen at the ER with complaints of non-bilous vomiting that became increasingly projectile over several days to weeks and cannot tolerate liquid intake. Abdominal examination revealed palpation of typical “olives” in the right up
C. Hypertrophic pyloric stenosis
Which of the following is the most common malignant liver tumor in childhood?
B. Hepatoblastoma
What is the appropriate treatment for an incidental 3 cm liver hemangioma found on abdominal CT scan of 37 year old woman?
A. No treatment
A 35 y/o male presents with 1 year history of early satiety and right upper abdominal discomfort. CT scan shows a 6 x 8 cm cystic lesion in the right lobe of the liver. Ultrasound of cyst show no internal echoes. The appropriate management is:
C. unroofing of the cyst
An imaginary line that divides the liver into right and left lobe that runs from the inferior vena cava to the tip of the gallbladder fossa:
C. Cantlie’s line
The diagnostic tool important in evaluating liver injury in a stable blunt trauma patient is:
C. CT scan
The local factor affecting wound healing:
C. Low oxygen tension
The characteristic of Keloid scars:
C. Extend beyond the border of original wound and rarely regress spontaneously
A 55 y/o male diagnosed to have chronic pancreatitis, developed epigastric mass measuring about 6 cm accompanied by pain and fullness. The diagnosis is:
C. Pseudocyt of the pancreas
Type of benign solitary pancreatic neoplasm consisting of symptomatic fasting hypoglycemia and profound syncopal episodez:
A. Insulinoma
The most common indication for splenectomy:
C. Trauma to spleen
The best time to repair of cleft lip is:
B. 10 weeks
A 36 y/o female complain of an acute pain at the lateral aspect of her left breast. A tender firm cord is found on the same site on physical examination. It was diagnosed as a Mondors disease. This lesion is best managed with:
B. Anti-inflammatory medication, warm compress and rest of ipsilateral extremity
Breast lesion that can be treated with close observation with or without tamoxifen:
lobular carcinoma in situ
The best screening imaging technique for breast cancer is:
D. Mammography
A 46 y/o female who underwent a total thyroidectomy for stage II papillary carcinoma developed 3 weeks later with Chvostek’s and Trouseau’s sign. This could be due to:
C. Hypoparathyroidism
This is considered as a single most important test in the evaluation of patients with thyroid masses:
C. Fine needle aspiration cytology
Lymph node in the posterior triangle of the neck is within what level:
C. Level V
This form of shock has a low blood pressure, low urine output but has an elevated central venous pressure:
B. Obstructive shock
55 y/o male who has been in the ward for the past 4 days and is receiving IV fluid of D5W is complaining on his 5th hospital day of headache, nausea, vomiting, anorexia, body malaie and watery diarrhea. Give the most probable electrolyte imbalance the pat
C. Hyponatremia
The most important part of the treatment of severe metabolic acidosis among trauma patient is:
E. Restore perfusion with volume resuscitation
The most common primary bone malignancy:
A. Osteosarcoma
The most potent stimulant for aldosterone release is:
A. ACTH
The most biologically active and potent vasoconstrictor is
endothelins
In trauma patients significant reduction in infectious complications were noted in patients given early enteral nutrition as compared to those given who are unfed or given parenteral nutrition except for what type of trauma patients?
C. head trauma
Branched chain amino acids are used in parenteral nutrition for what specific type of patients?
D. hepatic failure patients
In what type of parenteral feeding is fat increased to 50% of total calories?
B. pulmonary failure formulas
The appendeceal flora remains constant throughout life with the exception of what bacteria, which appears only in adults?
A. Porphyromonas gingivalis
The most significant factor associated with both fetal and maternal deaths in pregnant patients with acute appendicitis is
B. appendeceal perforation
Which of the ff. is true of the superior mesenteric artery syndrome? C
C. Compression is over the third portion of the duodenum.
Which of the following factors present in a entero-cutaneous fistula increases the possibility of closure of the tract?
A. non-epithelialization of the tract
What is the single most important factor in predicting burn related morbidity and mortality?
A. size of burn
What type of shock is caused by the interference of the balance of vasolidator and vasoconstrictor influences to arterioles and venules?
D. neurogenic shock
A 50 y/o female consulted to you and complaints of fatigue, polydypsia, polyuria, nocturia, joint pains and constipation. Her laboratory exams shows normal FBS, elevated serum calcium, and elevated intact PTH. What would be the most likely diagnosis?
D. Hyperparathyroidism
A 35 y/o male presents with a long standing severe hypertension with associated muscle weaknes, headache, polyuria and polydypsia. Blood exams revealed an elevated aldesterone level and elevated serum potassium. What is the most likely diagnosis?
C. conn’s syndrome
Which of the following is the most commonly inured organ in blunt abdominal injury?
D. spleen
In the initial management of an acutely and seriously injured patient, the first and most important emergency measure to be taken care of is:
D. ensuring an adequate airway
Diagnostic peritoneal lavage (DPL) remains the most sensitive test available for determining the presence of intraabdominal injury. The result of DPL is considered grossly positive if;
D. 15 ml of blood is aspirated
Which of the following constitute an immediate threat to life because of inadequate ventilation
A. flail chest
While undergoing exploratory laparotomy for blunt abdominal injury, to the patients BPwas noted to be 70 palpatory while bleeding was noted coming from the splenic hilum. Appropriate management for the injured spleen should be;
A. splenectomy
During the initial resuscitation of a hypovolemic patient secondary to a vehicular accident external bleeding is best controlled by;
B. direct finger pressure
In penetrating neck injuries zone II is referred to an area between;
B. cricoid cartilage and angle of mandible
In assessing the extent of hepatic injury following blunt injury to the abdomen, bleeding from the liver is best controlled by;
C. pringle maneuver
Stable patients at risk of urethral injury, manifestating as presence of blood at the matus, necessitates an immediate;
B. urethrography
Type of healing in which the wound is allowed to heal by granulation tissues formation and contraction:
B. secondary intention
Partial thickness wound such as seen in superficial second degree burns heal by which of the following process:
B. epithelization
Equilibrium between collagen synthesis and collagen degradation occurred during the stage of;
D. remodeling
Delayed primary wound closure is indicated in which of the following type of wound;
C. contaminated traumatic wound
Cytokines that are produced by one cell and affect an adjacent cell such as transforming growth factor beta (TGF-B) are called;
B. paracrine factors
The major component of the extracellular matrix that provide strength, support and structure of all soft tissues, tendons, ligaments and bones is;
A. collagen
The genetic disorder arising from mutations in the genes for type I collagen causing increase propensity for the bones to break under minimal stress is;
B. osteogenesis imperfecta
Lesion of the gastrointestinal tract that result in comlete regeneration and recovery;
D. gastric erosions
Skin lesions that extend beyond the boundaries of the original wound, do not regress with time and recur after excision;
B. keloids
Kehr’s sign is a classic example of;
D. referred parietal pain
The bleeding in Mallory-Weiss syndrome is secondary to;
B. linear tears of the gastroesophageal junction
The most common cause of intestinal obstruction for all age group combined is;
c. adhesive bands
The most obvious route of fuid and electrolyte loss in patients with intestinal obstruction from leocecal TB is through;
vomiting
Occlusion of the blood supply to a segment of bowel in addition to obstruction of the lumen is referred to as;
C. strangulated obstruction
Which of the following diagnostic modalities consistently localizes the site of bleeding in cases of lower GI bleeding;
C. Angiography
The most common cause of massive lower GI bleeding is;
B. diverticulosis
A 50 y/o male with history of alcoholism was admitted because of history of progressive jaundice, associated with tea-colored urine, achlic stools, weight loss and mild epigastric pain. The simplest and most non-invasive method in the diagnosis of this p
C. Ultrasonography
Relative to the ileum, the jejunum has;
C. longer vasa recta
The most common malignant neoplasm of the small bowel is;
adenocarcnoma
The presence of a Meckels diverticulum in a hernial sac is called;
C. littre’s hernia
Rovsings’ sign is elicited by;
A. pain the right lower quadrant when palpatory pressure is exerted in the left lower quadrant
In children with history of URTI 3 days prior to development of RLQ pain, the differential diagnosis most often confused with appendicitis is;
D. acute mesenteric adenitis
The recommended treatment for patients with adenocarcinoma of the appendix is;
B. right hemicolectomy
The precipitating factor in secondary omental torsion is;
D. foci of intraabdominal inflammation
The most common solid tumor of the omentum is;
D. metastatic carcinoma
The most common anaerobic bacteria that is isolated in intraabdominal infection is;
C. bacteroides specios
A 45 year old female came in because of right upper quadrant pain, colicky aggravated by fatty food intake 4 hours ptc. Physical exam showed a palpable mass at the right subcostal margin non-movable tender, midinspiratory arrest was illicited while the pa
B. acute cholecystitis
The laboratory examination of a 45 year old female came in with the following results ; sgpt was elevated, direct bilirubin increased, alkaline phosphatase increased, protime prolonged . utz showed a hyperechoic mass at he neck of the gallbladder with po
C. acute calculous cholecystitis
The treatment of choice for the above condition ( no.4) is
C. cholecystectomy
A patient s/p cholecystectomy and cbde with t-tube choledochostomy showed a distal cbd stone on t-tube cholangiography , management would be
C. choledococopy and basket extraction of the stone
A 25 year old male came in with chronic draining lesion at the perianal area of 2 years duration. Physical exam showed a draining lesion about 4 cm from the anal verge at the 3:00 position. The internal opening is probably
B. posterior midline
30 year old female came in because of painfull perianal mass 2 days ptc, physical exam showed a tender mass at the right lateral position w/c precludes rectal exam with a bulging tender mass adjacent to it. The most likely condition is
C. perianal abscess
A 50 year old male came in because of loss of weight about 30% of his previous body weight. Associated with on and off colicky abdominal pain. He also noticed that his stools have diminish in caliber just like a goat stool,the single most important examin
C. colonoscopy w/ biopsy
A 25 year old female came in with a palpable breast mass noted 2 weeks ptc, the mass is about 2.5 cm well delineated border, movable, non-tender at the right upper outer quadrant, no familial history of ca.the most likely diagnosis would be
A. fibroadenoma
Seromas are fluid collections coming from the:
C. Lymph
A patient was discharged 3 days after appendectomy (suppurative). After 5 days, he came back at the OPD for follow up complaining of tenderness at the operative site. The incision site was nonerythematous. What is your diagnosis?
B. Surgical site infection
A patient was operated on for acute cholecystitis. After 24h postop, the patient developed fever. What is the most likely cause of his fever?
D. Atelectasis
The basic problem in poor wound healing regardless of the underlying factor is:
C. Low 02 tension
Ileus following abdominal surgery is expected to last for at least how many days?
C. 5
For every degree rise in temperature, the insensible water loss in cm3 per day is approximately:
D. 250
Which ion if altered determines the shift of fluid from one compartment to another?
A. Sodium
Which of the following cytokines may help control keloids and hypertrophic scars?
D. TGB-B
Which part of the GIT provides strength in the anastomosis
C. Submucosa
Which amino acid provide energy source in the GIT
C. Glutamine
A 54yo male patient with 3rd degree burn approximately 40%TBSAdeveloped abdominal pain on the 4th hospital day. What is the least likely cause of the abdominal pain?
D. Renal colic
Convulsions if present during the resucitative phase of burn injury may be due to
B. Hyponatremia
The offending organism in surgical site infection is;
A. Staph aureus
Earliest manifestations of catheter related complication following parenteral nutrition.
A. Tachycardia B. Fever C. Glucose intolerance D. Changes in sensorium
Which of the following statements is not a sound principle in the fluid and electrolyte therapy post operatively?
B. Urine volume is replaced on a mililiter to mililiter basis
The average potassium (in meq/l) content of the bile per day is
B. 10
Which cranial nerve is involved in the act of swallowing
A. Xi
Primary reason for staging esophageal cancer is
A. Determine its resectability
Most common benign esophageal tumor is
A. Leiomyomas
Blood supply of lesser curvature is
B. Right gastric
Manifestation of acute gastric dilatation
D. Hypotension
