Surgery - Surgery of the breast

Question 1

SUR - 5.1
Method used for taking biopsy and exposure of paratracheal and praetracheal lymph nodes:

A) Stemmer (Chamberlain)-biopsy
B) Klassen-biopsy
C) Carlens-biopsy
D) Scalenus lymph node biopsy

Answer 1

ANSWER
C) Carlens-biopsy

Question 2

SUR - 5.2
Most frequently used treatment method of the spontaneous, primary pneumothorax:

A) bed rest
B) emergency thoracotomy and surgery
C) needle aspiration
D) thoracic drainage and suction therapy

Answer 2

ANSWER
D) thoracic drainage and suction therapy

Question 3

SUR - 5.3
Usually effective treatment of the pleural empyema:

A) bed rest, antibiotics and pain killers
B) early thoracotomy, decortication
C) thoracic drainage, suction therapy
D) fenestration
E) VATS suctions and drainage

Answer 3

ANSWER
C) thoracic drainage, suction therapy

Question 4

SUR - 5.5
Which type of the primary lung cancer is the most suitable for lung resection?

A) squamocellular cancer
B) adenocarcinoma
C) small cell lung cancer
D) large cell lung cancer
E) bronchioloalveolar

Answer 4

ANSWER
A) squamocellular cancer

Question 5

SUR - 5.6
Which type of the primary lung cancer is the „worst” from early dissemination point of view, thinking of not suitable for surgical treatment by many experts?

A) squamocellular cancer
B) adenocarcinoma
C) small cell lung cancer
D) large cell lung cancer
E) bronchioloalveolar carcinoma

Answer 5

ANSWER
C) small cell lung cancer

Question 6

SUR - 5.7
Which one is an important factor in the development of the mesotehlioma according to our knowledge?

A) specific (TB) pleurisy in the younghood
B) smoking
C) asbestos inhalation
D) repetiting chest wall traumas
E) inhalation of tetra-chlore-ethilene

Answer 6

ANSWER
C) asbestos inhalation

Question 7

SUR - 5.8
Left upper lobe adenocarcinoma with ipsilateral mediastinal lymph node metastasis. How would you proceed?

A) This tumor is inoperable, because not only the lung but the mediastinum is also affected. Primery radio-chemotherapy is recommended.
B) Left upper lobectomy with radical mediastinal lymphadenectomy is recommended.
C) Induction (neoadjuvant) chemo (-radio) therapy is recommended with lobectomy and radical mediastinal lymphadenectomy later on.
D) Lobectomy, lympahedenectomy followed by adjuvant oncological therapy is recommended.

Answer 7

ANSWER
C) Induction (neoadjuvant) chemo (-radio) therapy is recommended with lobectomy and radical mediastinal lymphadenectomy later on.

Question 8

SUR - 5.12
When are most of the chest deformity cases (excavated and carinated pectus) discovered?

A) at birth
B) in babyhood
C) in the teenagers
D) in adulthood

Answer 8

ANSWER
C) in the teenagers

Question 9

SUR - 5.15
Find the examination what is not included in the normal preoperative examinations list of the lung cancer patients.

A) chest X-ray
B) chest CT and MRI
C) bronchoscopy
D) pulmonary angiography
E) sputum cytology
F) spirometry, blood gas analysis

Answer 9

ANSWER
D) pulmonary angiography

Question 10

SUR - 5.18
Which parameter shows decompensated respiratory insufficiency?

A) pH
B) PCO2
C) PO2
D) BE
E) standard HCO3

Answer 10

ANSWER
A) pH

Question 11

SUR - 5.21
Which is the best dynamic lung function parameter for examining the obstructive lung diseases?

A) FEV1
B) Tiff%
C) MEF50
D) flow-volume loop

Answer 11

ANSWER
D) flow-volume loop

Question 12

SUR - 5.25
True for lung cancer, except:

A) never symptom-free
B) can be solitary pulmonary nodule
C) haemoptysis is very common
D) dry, improductive cough can be the only one symptom
E) the endobronchial spread of the tumor can lead to secondary inflammation

Answer 12

ANSWER
A) never symptom-free

Question 13

SUR - 5.26
The most common malignant tumor of the chest wall bones:

A) single bone metastasis
B) osteosarcoma
C) multiple myeloma
D) Ewing-sarcoma
E) chondrosarcoma

Answer 13

ANSWER
E) chondrosarcoma

Question 14

SUR - 5.27
Haemoptysis can be caused by the followings, except:

A) malignant bronchial tumor
B) asthma bronchiale
C) bronchiectasis
D) pulmonary infarction
E) tuberculosis

Answer 14

ANSWER
B) asthma bronchiale

Question 15

SUR - 5.28
The most common cause of vena cava superior syndrome is:

A) advanced cancer of the right upper lobe
B) thymic tumor
C) thyroid cancer
D) mediastinal fibrosis
E) goiter

Answer 15

ANSWER
A) advanced cancer of the right upper lobe

Question 16

SUR - 5.29
Thoracic outlet syndrome can be caused by the followings, except:

A) cervical rib
B) scalene anterior syndrome
C) costoclavicular compression
D) Raynaud-disease
E) hyperabduction syndrome

Answer 16

ANSWER
D) Raynaud-disease

Question 17

SUR - 5.30
Symptoms of the thoracic outlet syndrome are the followings, except:

A) paraesthesia of the ulnar side of the arm
B) atrophy of thenar muscles
C) pain in the neck and the shoulder
D) weakening pulsation of the radial artery during abduction of the arm
E) ischaemic gangraena of the fingers

Answer 17

ANSWER
B) atrophy of thenar muscles

Question 18

SUR - 5.31
A 48-year-old lady had total abdominoperineal rectal resection for adenocarcinoma 2 years ago. The patient is symptom-free, has elevated tumor marker levels and the check up revealed a round laesion 2cm in size on the right side peripherally and an other one on the left side in the same size. The tranthoracal needle biopsy makes adenocarcinoma likely. What would you recommend?

A) The patient obviously has biletarel lung metastasis and urgent oncological treatment (at least 6 cycles of chemotherapy) is recommended.
B) Both metastasis must be resected via median sternotomy and the adjuvant radiotherapy of the affected area may improve the outcome.
C) After excluding other distant metastasis and a negative colonoscopy single stage (sternotomy) or 2 staged (axillary thoracotomy) and metastasectomy is indicated. If histology is positive, adjuvant chemotherapy is indicated.
D) Urgent bilateral thoracotomy is recommended, because the laesions are very likely resectable. Even these are metastastic or primary lung cancers, chemotherapy is indicated.

Answer 18

ANSWER
C) After excluding other distant metastasis and a negative colonoscopy single stage (sternotomy) or 2 staged (axillary thoracotomy) and metastasectomy is indicated. If histology is positive, adjuvant chemotherapy is indicated.

Question 19

SUR - 5.36
What are the most common symptoms of the spontaneous primary pneumothorax?

1) fever
2) sputum
3) dyspnoe
4) high red blood cell sedimentation
5) sharp chest pain
6) dullness during percussion
7) tympanic percussion

A) the 1st and 4th answers are correct
B) the 2nd and 6th answers are correct
C) the 4th and 6th answers are correct
D) the 3rd, 5th and 7th answers are correct
E) the 2nd, 5th and 6th answers are correct

Answer 19

ANSWER
D) the 3rd, 5th and 7th answers are correct

Question 20

SUR - 5.39
The most important steps of the treatment of simple rib fracture:

1) fixation with adhesive plaster
2) pain control with local methods at the level of the affected intercostal nerve and pain killers iv. and/or orally
3) urgent operation, fixation of the fractured ends
4) breathing exercises to avoid respiratory complications

A) the 1st and 4th answers are correct
B) the 2nd and 4th answers are correct
C) the 3rd and 4th answers are correct
D) the 1st and 2nd answers are correct
E) all of the answers are correct

Answer 20

ANSWER
B) the 2nd and 4th answers are correct

Question 21

SUR - 5.40
The rib fracture patient has pneumothorax on the chest X-ray. Recommended treatment:

1) bed rest, fixation with adhesive plasters
2) pain control, breathing exercises
3) aspiration of the pneumothorax with aspiration syringe
4) chest drainage and suction

A) the 1st and 4th answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 3rd answers are correct
D) the 2nd and 4th answers are correct
E) all of the answers are correct

Answer 21

ANSWER
D) the 2nd and 4th answers are correct

Question 22

SUR - 5.42
You can see haemothorax on the chest X-ray in a blunt chest trauma, rib fracture patient. What would you do?

A) thoracotomy, evacuation of the blood
B) needle aspiration
C) wait and see policy
D) thoracic drainage, suction

Answer 22

ANSWER
D) thoracic drainage, suction