General surgery

Question 1

Paraesophageal hiatal hernia: gastric fundus/ entire stomach pass into mediastinum at the side of the esophagus, while the cardia remains fixed in its position. constitutes 8-10% of all hiatal hernias. SX: gastric volvulus. No esophagitis

Answer 1

Esophagitis is present in brachioesophagus hiatal hernia and sliding hiatal hernia.

Question 2

What is the most frequent location of colorectal cancer?

Answer 2

recto sigmoid colon

Question 3

At what level does colorectal cancer metastasize most?

Answer 3

at the liver

Question 4

What is the most common type of anorectal fistula?

Answer 4

Intersphincteric fistulas, i.e. those that make their way between the external anal sphincter and the internal anal sphincter, are the most frequent.

Question 5

What is revascularization syndrome

Answer 5

Revascularization syndrome or myonephropathic metabolic syndrome is the set of multiorgan harmful effects that occurs after restoring arterial flow in an area of ​​tissue affected by acute ischemia.
SX: characterized by the release and diffusion of toxic metabolites, such as myoglobin, potassium and acid radicals coming for example from an ischemic limb after revascularization.

Question 6

What is the gold standard for the diagnosis of choledocholithiasis?

Answer 6

cholangio MRI

Question 7

Acute cholangitis is initially treated with fasting, fluid therapy, analgesics and broad-spectrum antibiotics.
Subsequently, except in very mild cases that resolve with medical therapy, bile drainage is indicated.
The treatment of choice for this purpose is ERCP.
Percutaneous transhepatic cholangiography is the second line of treatment
Urgent cholecystectomy and cholecystostomy are treatment options for cholecystitis.
Cholecystectomy with exploration of the biliary tract is performed in the treatment of choledocholithiasis

Answer 7

t

Question 8

most serious complication post splenectomy

Answer 8

overwhelming infection

Question 9

tamoxifen MOA

Answer 9

Selective estrogen receptor modulator

Question 10

breast cancer screening compulsory between which ages

Answer 10

50-70

Question 11

Which nerve is most likely to have been damaged during appendicectomy?

Answer 11

ilio inguinal

Question 12

When cutting the submandibular duct, which of the following needs the most care to avoid damage?

Answer 12

lingual nerve

Question 13

What does the concept of “FAST TRACK” or “ERAS” in surgery consist of?

Answer 13

A perioperative approach aimed at reducing hospital stay

Question 14

In which cases is it recommended to investigate the presence of microsatellite instability due to suspicion of Lynch syndrome?

Answer 14

Patient of any age with synchronous colorectal tumors.
B) Patient aged <50 diagnosed with colorectal or uterine cancer.
C) Diagnosis of colorectal cancer in first-degree relatives without familial polyposis syndromes; at least one diagnosis made before the age of 50.
D) Diagnosis of colorectal cancer in first or second degree relatives with familial polyposis syndromes regardless of age at diagnosis.

Question 15

What is the first-line diagnostic test for ulcerative colitis?

Answer 15

X RAY

Question 16

In symptomatic cholelithiasis, an indication is generally already given for early cholecystectomy, possibly within a week of diagnosis. It is possible to add ERCP to remove stones before or during laparoscopic cholecystectomy, in case of concomitant lithiasis of the main bile duct. In fact, in all patients with choledocholithiasis, symptomatic and asymptomatic, an endoscopic clearance of the common bile duct and a laparoscopic cholecystectomy are performed. ERCP is also indicated in jaundice of an extra-hepatic nature and in acute pancreatitis of biliary origin.

Answer 16

t

Question 17

What is meant by urgency 0 when we talk about liver transplantation?

Answer 17

In Italy, liver transplant candidates are placed on the waiting list according to two methods: emergency 0 and elective transplant. By urgency 0 we mean that group of patients with acute liver failure or waiting for another transplant 7 days after the previous one due to rejection. Urgency 0 implies national priority, the first available organ with the same blood type will be assigned to that patient

Question 18

A young 28-year-old woman comes to your clinic and, following a self-examination, she detects a small mass by touch which she defines as hard and not very mobile, but not painful. Which diagnostic hypotheses should be excluded in the first instance?

Answer 18

ductal neoplasia

Question 19

Milan criteria for transplant

Answer 19

Has a single lesion smaller than or equal to 5 cm or up to three lesions, each smaller than or equal to 3 cm, in the absence of distant metastases and macrovascular infiltration.

Question 20

Mirizzi syndrome refers to a picture of cholestasis resulting from the wedging of a stone at the level of the infundibulum of the gallbladder or the cystic duct with consequent obstruction of the main bile duct.

Answer 20

T

Question 21

The main complications of acute pancreatitis are

Answer 21

formation of abscesses and pancreatic pseudocysts.

Question 22

What is the correct definition of “Littré’s hernia”?

Answer 22

Littrè’s hernia constitutes the herniation of Meckel’s diverticulum through a wall defect. Meckel’s diverticulum is the partially obliterated remnant of the omphalomesenteric duct, which in fetal life connects the primitive intestine with the yolk sac. It is a pathological condition that occurs in 1-2% of the population.

Question 23

Ménétrier’s disease can be most commonly thought of as:

Answer 23

Ménétrier’s disease or giant hypertrophic gastritis is a rare gastropathy characterized by a giant hypertrophy of the folds of the gastric mucosa resulting from a hypertrophy and hyperplasia of the mucus-secreting cells.

Question 24

What is the most frequently mutated gene in GIST?

Answer 24

c-KIT

Question 25

In the case of a thyroid nodule, which test aims to obtain a definitive diagnosis?

Answer 25

FNAB

Question 26

The prevalent localization of gastric adenocarcinoma is:

Answer 26

Gastric adenocarcinoma is generally localized at the: -anthropyloric level 50% (answer B correct) -cardial 25% -small curvature 20% -large curvature 5%

Question 27

When we talk about right enlarged hepatectomy we mean the resection of the following liver segments:

Answer 27

It consists in the removal of the right hemiliver and the 4th segment (therefore, the so-called right “anatomical lobe”). It is one of the most destructive interventions in liver surgery. It finds its most frequent application in cases of tumors of the biliary tract or gallbladder. It is often associated with preventive embolization of the right branch of the portal vein to reduce the risk of postoperative liver failure.

Question 28

What is the most serious complication in gangrenous appendicitis?

Answer 28

The most relevant complications in the case of acute appendicitis are indicated as “the 4 Ps”, i.e. perforation, focal peritonitis, diffuse peritonitis and pelphlebitis, of which the latter, although very rare, represents the most serious, in cases of gangrenous appendicitis ; consists in the development of septic emboli up to the liver, which give rise to septic thrombophlebitis, which rises from the portal vein and can form liver abscesses.

Question 29

What is the diagnostic technique of choice in malignant gastric tumors?

Answer 29

EGDS with biopsy