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CCS 401 Genel Cerrahi > ÇIKMIŞ 2 :) > Flashcards

ÇIKMIŞ 2 :) Flashcards

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1
Q

A 42-year-old female patient presents with acute onset epigastric pain. She has serum amylase levels more than 3 times the cut-off value and her total bilirubin level is 6.2 mg/dL. Abdominal ultrasound reveals her gallbladder is filled with multiple millimetric gallstones measuring less than 5 mm each. Her common bile duct measures 10 mm thick.
What is the most appropriate step in the management of this patient?

A) Emergent cholecystectomy
B) ERCP
C) Evaluation of the complications with CT
D) Broad-spectrum antibiotics

A

Correct Answer: B) ERCP

xplanation: The patient likely has acute pancreatitis due to gallstone obstruction in the common bile duct. ERCP is both diagnostic and therapeutic for bile duct stones.

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2
Q

A 69-year-old man is involved in a motor vehicle accident and is brought to the emergency department with a GCS of 5, raccoon eyes, and a scalp laceration.
The next most appropriate step in the management of the patient’s airway is:

A) Cricothyroidotomy
B) 50% oxygen by face mask
C) Orotracheal intubation
D) Placement of an oral airway

A

Correct Answer: C) Orotracheal intubation

Krikotirotomi, acil hava yolu yönetimi sırasında açık bir hava yolu oluş

Explanation: Patients with a GCS ≤ 8 require definitive airway management (orotracheal intubation) to prevent hypoxia.

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3
Q

Which group is not a reversible cause requiring Advanced Cardiac Life Support?

A) Toxins
B) Hypercapnia
C) Hypothermia
D) Hypoxia

A

Correct Answer: B) Hypercapnia

Explanation: Reversible causes in ACLS are summarized as the “H’s and T’s,” which include Hypoxia, Hypovolemia, and Hypothermia, but not Hypercapnia.

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4
Q

Which one is contraindicated in the use of activated charcoal?

A) Quinine intoxication
B) GIS perforation by alkaline caustics
C) Carbamazepine intoxication
D) Dapsone intoxication

A

Correct Answer: B) GIS perforation by alkaline caustics

Explanation: Activated charcoal is contraindicated in cases of known or suspected GI perforation due to the risk of further damage.

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5
Q

A 22-month-old boy presents with paroxysmal abdominal pain and maroon-colored stool. Abdominal radiograph shows dilated loops of small bowel.
What is the best next step in diagnosis?

A) Barium enema
B) Upper gastrointestinal series
C) CT of the abdomen
D) Surgical exploration

A

Correct Answer: A) Barium enema
Explanation: The clinical picture suggests intussusception, and barium enema is both diagnostic and potentially therapeutic.

Intussusception (in-tuh-suh-SEP-shun) is a serious condition in which part of the intestine slides into an adjacent part of the intestine

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6
Q

Which of the following is not a sign of chronic anal fissure?

A) Hypertrophied anal papillae
B) Being in the posterior midline of the anal canal
C) Visualization of internal sphincter muscle fibers
D) Sentinel pile

A

Correct Answer: B) Being in the posterior midline of the anal canal
Explanation: While 90% of anal fissures occur in the posterior midline, this is not exclusive to chronic fissures.

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7
Q

A 73-year-old male with left lower quadrant pain, fever, and leukocytosis is diagnosed with non-complicated acute diverticulitis.
What should be done in management?

A) Inpatient surgical treatment
B) Inpatient medical treatment
C) Outpatient oral antibiotics
D) Outpatient no antibiotics

A

Correct Answer: B) Inpatient medical treatment
Explanation: The patient meets SIRS criteria and is elderly, warranting inpatient care for IV antibiotics and monitoring.

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8
Q

A 49-year-old man has an asymptomatic left groin mass. The greatest consideration for the next step is:

A) Epididymitis
B) Inguinal adenopathy
C) Indirect or direct inguinal hernia
D) Direct inguinal hernia only

A

Correct Answer: C) Indirect or direct inguinal hernia

Explanation: The clinical presentation is most consistent with an inguinal hernia, which cannot be reliably distinguished as direct or indirect on exam alone.

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9
Q

Which process is not involved in the transmission of painful stimuli to the CNS?

A) Perception
B) Transmission
C) Sensitization
D) Modulation

A

Correct Answer: C) Sensitization
Explanation: Sensitization contributes to chronic pain but is not part of the initial transmission pathway.

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10
Q

Which is not used for treating methyl alcohol intoxication?

A) Protamine
B) Fomepizole
C) Thiamine
D) Ethanol

A

Correct Answer: A) Protamine
Explanation: Protamine is used for heparin reversal, not methanol toxicity. Fomepizole, thiamine, and ethanol are standard treatments.

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11
Q

A 60-year-old man with obstipation, abdominal distention, and pencil-thin stools has a nasogastric tube placed. The next step is:

A) Exploratory laparotomy
B) CT of the abdomen
C) Colonoscopy
D) Barium enema

A

Correct Answer: B) CT of the abdomen
Explanation: CT confirms large bowel obstruction and evaluates for complications like ischemia or perforation.

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12
Q

A 25-year-old man with bloody diarrhea and abdominal pain but no fever likely has:

A) Crohn’s disease
B) Adhesive small bowel obstruction
C) Colon cancer
D) Meckel’s diverticulitis

A

**
Correct Answer: A) Crohn’s disease
Explanation: Progressive symptoms and bloody stool in a young adult are classic for Crohn’s disease.

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13
Q

Which strategy is not acceptable to reduce colon cancer surgery wound infection risk?

A) Preoperative bowel prep
B) Preoperative antibiotics
C) Postoperative IV antibiotics for one week
D) Wound irrigation

A

Correct Answer: C) Postoperative IV antibiotics for one week
Explanation: Prolonged antibiotics postoperatively do not reduce infection risk and may select for resistant bacteria.

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14
Q

An 80-year-old nursing home resident presents with 2 days of abdominal distention and obstipation. She has no surgical history. Abdominal X-ray reveals a massively dilated, coffee bean-shaped loop of bowel with haustral markings in the right upper quadrant.
What is the most likely diagnosis?

A) Diverticulitis
B) Gallstone ileus
C) Sigmoid volvulus
D) Ogilvie’s pseudo-obstruction

A

Correct Answer: C) Sigmoid volvulus
Explanation: The “coffee bean” sign on X-ray is pathognomonic for sigmoid volvulus, where the twisted bowel loop appears as a rounded, gas-filled structure. Elderly patients with chronic constipation are at high risk.

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15
Q

A 40-year-old diabetic woman presents with fever, right upper quadrant pain after fatty food ingestion, and elevated WBC/alkaline phosphatase. Ultrasound confirms gallstones. She undergoes laparoscopic cholecystectomy.
Which finding on ultrasound most likely prompted surgical intervention?

A) Gallstones in the gallbladder
B) Obstruction of the right hepatic duct
C) Obstruction of the cystic duct
D) Obstruction of the common bile duct

A

Correct Answer: C) Obstruction of the cystic duct
Explanation: Persistent cystic duct obstruction (vs. transient obstruction in biliary colic) defines acute cholecystitis. This causes gallbladder wall inflammation, requiring cholecystectomy.

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16
Q

A 60-year-old hypertensive patient on diuretics presents with muscle weakness. ECG shows ST depression, inverted T waves, and prominent U waves.
Which electrolyte abnormality best explains these findings?

A) Potassium 2.2 mmol/L
B) Magnesium 2.2 mg/dL
C) Sodium 135 mEq/L
D) Potassium 5.8 mmol/L

A

Correct Answer: A) Potassium 2.2 mmol/L
Explanation: Hypokalemia causes ECG changes (U waves, ST/T changes) due to delayed repolarization. Diuretics (e.g., furosemide) are a common cause of potassium wasting.

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17
Q

A 70-year-old smoker presents with periumbilical pain, right leg pain, and diarrhea. She has an ankle-brachial index of 0.70 in the right leg. Abdominal CT is performed.
What is the most likely CT finding?

A) Bowel wall thickening and pneumatosis intestinalis
B) Saccular abdominal aortic aneurysm
C) Gallbladder wall thickening
D) Large ovarian cyst

A

Correct Answer: A) Bowel wall thickening and pneumatosis intestinalis
Explanation: The triad of abdominal pain, diarrhea, and peripheral vascular disease suggests acute mesenteric ischemia. Pneumatosis (gas in bowel wall) indicates necrosis.

ANKLE BACHİAL İNDEX: Ayak bileği-kol basınç indeksi veya ayak bileği-kol indeksi, ayak bileğindeki kan basıncının üst koldaki kan basıncına oranıdır. Kolla karşılaştırıldığında, bacaktaki düşük kan basıncı, periferik arter hastalığına bağlı tıkanmış arterleri düşündürür.

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18
Q

A trauma patient has a contaminated leg wound with devitalized tissue edges.
Which scenario is NOT an indication for secondary wound healing?

A) Excessive tissue loss
B) Devitalized wound edges
C) Wound age >24 hours
D) Active infection

A

Correct Answer: C) Wound age >24 hours
Explanation: Older wounds may still undergo delayed primary closure. Secondary healing is reserved for non-approximable wounds (e.g., tissue loss, infection).

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19
Q

During wound management, irrigation is performed.
What is the primary purpose of wound irrigation?

A) To decrease bacterial load per gram of tissue
B) To provide pain relief
C) To visualize the wound bed
D) To promote hemostasis

A

Correct Answer: A) To decrease bacterial load per gram of tissue
Explanation: Irrigation reduces bacterial colonization (>10^5 organisms/gram increases infection risk) and removes debris.

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20
Q

During rectal cancer surgery, the presacral nerve plexus is at risk.
Which sequela is most likely if this plexus is injured?

A) Loss of hip flexor strength
B) Ejaculatory dysfunction
C) Fecal incontinence
D) Perineal anesthesia

A

Correct Answer: B) Ejaculatory dysfunction
Explanation: The presacral plexus contains sympathetic fibers controlling ejaculation. Injury causes retrograde ejaculation or anejaculation.

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21
Q

A 52-year-old woman on HRT presents with a 1-cm hard, irregular, mobile breast mass. No lymphadenopathy is noted.
What is the next best step?

A) Core-needle biopsy
B) Diagnostic mammography
C) Excisional biopsy
D) MRI

A

Correct Answer: B) Diagnostic mammography

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22
Q

A 58-year-old diabetic man has bone pain, hyperphosphatemia, and hypocalcemia. Creatinine is 7.8 mg/dL.
What is the underlying condition?

A) Pituitary adenoma
B) Parathyroid hyperplasia
C) Medullary thyroid carcinoma
D) Adrenal adenoma

A

Correct Answer: B) Parathyroid hyperplasia
Explanation: Chronic kidney disease causes secondary hyperparathyroidism (high PTH) due to phosphate retention and low vitamin D activation, leading to renal osteodystrophy.

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23
Q

An asymptomatic 50-year-old man is found to have a small inguinal hernia during a physical. His father had hernia repair at age 52.
What is the recommended management?

A) Elective open repair
B) Laparoscopic repair now
C) Observation
D) Imaging to assess bowel involvement

A

Correct Answer: A) Elective open repair
Explanation: Asymptomatic hernias in healthy patients with life expectancy >5–10 years should be repaired electively to prevent future complications (e.g., incarceration).

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24
Q

A 21-year-old athlete has bilateral reducible inguinal hernias.
What is the best surgical approach?

A) Open repair with mesh
B) Laparoscopic/robotic repair
C) High ligation of sacs
D) Physical therapy

A

Correct Answer: B) Laparoscopic/robotic repair
Explanation: Laparoscopy is preferred for bilateral hernias (single procedure, faster recovery). Mesh reinforces the repair.

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25
A patient reports hemorrhoids that prolapse during bowel movements but reduce spontaneously. What grade is this? A) Grade 1 B) Grade 2 C) Grade 3 D) Grade 4
Correct Answer: B) Grade 2 Explanation: Grade 2 hemorrhoids prolapse with straining but reduce spontaneously; Grade 1 do not prolapse, Grade 3 require manual reduction. Grade 4 is non erducible.
26
A 65-year-old man with pencil-thin stools and rectal mass on exam needs a definitive diagnosis. What is the next step? A) Colonoscopy with biopsy B) CT abdomen C) Barium enema D) PET scan
Correct Answer: A) Colonoscopy with biopsy Explanation: Colonoscopy allows direct visualization and biopsy of the mass for histopathological diagnosis (e.g., adenocarcinoma).
27
A 47-year-old woman with epigastric pain, vomiting, and lipase 2,400 U/L has gallstones on ultrasound. Which statement is true? A) MRCP is always needed to confirm gallstone pancreatitis B) Gallstones + pancreatitis = gallstone pancreatitis C) Biliary sludge excludes pancreatitis D) Ultrasound detects 95% of common bile duct stones
Correct Answer: B) Gallstones + pancreatitis = gallstone pancreatitis Explanation: In the absence of other causes (e.g., alcohol), gallstones + pancreatitis confirm the diagnosis. MRCP is only needed if choledocholithiasis is suspected but not seen on ultrasound.
28
Regarding the use of an automatic external defibrillator (AED), which statement is incorrect? A) Follow voice prompts for proper operation B) Place one pad under the left armpit and the other on the right clavicle C) It cannot be used without 3 rescuers present D) Minimize interruptions in CPR during use
Correct Answer: C) It cannot be used without 3 rescuers present Explanation: AEDs are designed to be used even by a single rescuer. Voice prompts guide the user through pad placement and shock delivery, making additional rescuers helpful but not mandatory. ## Footnote (Response Feedback from PDF: "Follow voice prompts. Place a pad under the left armpit. Apply the other pad to the right clavicle under the sternum. Take a minimal break from CPR.")
29
A patient with acute cholecystitis describes their pain as intermittent and similar to prior episodes of biliary colic. What does this description inaccurately suggest about acute cholecystitis? A) The pain may radiate to the right shoulder or back B) Pain is typically triggered by fatty food ingestion C) Pain is intermittent and resembles biliary colic D) Associated symptoms include fever and nausea
Correct Answer: C) Pain is intermittent and resembles biliary colic Explanation: Acute cholecystitis causes steady, severe pain lasting >4–6 hours due to persistent inflammation. Intermittent pain is characteristic of biliary colic (temporary stone obstruction), not acute cholecystitis.
30
A patient presents with severe epigastric pain radiating to the back and elevated lipase. Which finding is not part of the diagnostic criteria for acute pancreatitis? A) Cullen’s sign (periumbilical ecchymosis) B) Sentinel loop on abdominal X-ray C) Positive Murphy’s sign D) Lipase ≥3× upper limit of normal
Correct Answer: C) Positive Murphy’s sign Explanation: Murphy’s sign (pain on palpation of the RUQ during inspiration) is specific for acute cholecystitis, not pancreatitis. The other options are supportive findings (Cullen’s/Grey Turner signs) or diagnostic criteria (lipase elevation, imaging findings). (Response Feedback from PDF: "A positive Murphy’s sign on physical examination supports the diagnosis of acute cholecystitis, not acute pancreatitis.")
31
A 60-year-old man with chronic constipation presents with 5 days of left lower quadrant pain, fever, and leukocytosis. He has had similar episodes in the past. What is the most likely diagnosis? A) Crohn’s disease B) Sigmoid volvulus C) Diverticulitis D) Colon cancer Correct Answer: C) Diverticulitis Explanation: Left lower quadrant pain, fever, and leukocytosis in an older patient with constipation are classic for diverticulitis. Recurrent episodes further support this diagnosis.
(Response Feedback from PDF: "Diverticulitis often presents with low-grade temperatures, left lower quadrant pain and tenderness, and leukocytosis. The history of previous similar symptoms treated as an outpatient is also consistent.")
32
A 39-year-old man with recent pancreatitis has a 6 cm pancreatic fluid collection on CT. He now complains of early satiety and epigastric pain. The collection is rim-enhancing but uninfected. What is the definitive management? A) Antibiotics alone B) Percutaneous drainage C) Surgical cyst-gastrostomy D) Observation with repeat imaging
Correct Answer: C) Surgical cyst-gastrostomy Explanation: Symptomatic, mature pancreatic pseudocysts require internal drainage (e.g., cyst-gastrostomy). Percutaneous drainage is for infected collections.
33
A 55-year-old female with a T2N0 rectal tumor (7 cm from anal verge) should receive: A) Chemoradiotherapy alone B) Total mesorectal excision (TME) without neoadjuvant therapy C) Neoadjuvant chemoradiotherapy → surgery
Correct Answer: B) TME without neoadjuvant therapy Explanation: TME is standard for T2N0 mid/lower rectal tumors. Neoadjuvant therapy is reserved for T3+ or node-positive disease. (Response Feedback: TME minimizes recurrence risk for localized tumors. Neoadjuvant therapy is unnecessary for T2N0.)
34
What induces the production of C-reactive protein (CRP)?
Interleukin 6 ## Footnote CRP is synthesized by the liver in response to IL-6 released during inflammation.
35
True or False: CRP is a very specific marker of infection.
False ## Footnote CRP is nonspecific and can be elevated in various conditions such as trauma and infection.
36
What is the maximum recommended dose of lidocaine without epinephrine?
4.5 mg/kg ## Footnote This dose is recommended due to the risk of systemic absorption without epinephrine.
37
What is the maximum recommended dose of lidocaine with epinephrine?
7 mg/kg ## Footnote Epinephrine reduces systemic absorption, allowing for a higher safe dose.
38
Which type of hernias are more frequent in women?
Femoral hernias ## Footnote Femoral hernias are notably more common in the female population.
39
True or False: Neoadjuvant therapy is necessary for T2N0 rectal tumors.
False ## Footnote Neoadjuvant therapy is reserved for T3+ or node-positive disease.
40
In hypovolemic shock, which system maintains membrane potential? A) Na+/K+ ATPase B) Lactate dehydrogenase C) Creatine kinase
Correct Answer: A) Na+/K+ ATPase Explanation: This pump maintains electrochemical gradients critical for cellular function but fails during energy depletion. (Response Feedback: Na+/K+ ATPase is essential for cellular homeostasis and is an early indicator of dysfunction in shock.)
41
A type I choledochal cyst is most associated with malignant transformation due to: A) Cyst size >3 cm B) Anomalous pancreaticobiliary ductal union (>15 mm common channel) C) Stones within the cyst
Correct Answer: B) Anomalous pancreaticobiliary ductal union Explanation: Long common channels allow pancreatic enzyme reflux, causing chronic inflammation and malignancy. (Response Feedback: This anatomical anomaly drives malignant transformation via chronic inflammation.)
42
A 35-year-old woman with multiple hepatic adenomas likely has: A) Von Hippel-Lindau disease B) Glycogen storage disease type 1 C) Lynch syndrome
Correct Answer: B) Glycogen storage disease type 1 Explanation: GSD1 causes metabolic derangements leading to adenoma formation in 75% of adults with the condition. (Response Feedback: Hepatic adenomas are a hallmark of GSD1 due to metabolic abnormalities.)
43
Which drug is used for induction of anesthesia? A) Thiopental B) Isoflurane C) Succinylcholine
Correct Answer: A) Thiopental Explanation: Thiopental (a barbiturate) provides rapid induction, while isoflurane is used for maintenance. (Response Feedback: Thiopental is preferred for rapid induction due to its quick onset.)
44
Which is NOT part of the SOFA score for sepsis? A) Bilirubin B) Heart rate C) PaO₂/FiO₂ ratio
Correct Answer: B) Heart rate Explanation: SOFA assesses organ dysfunction (e.g., liver, lung, coagulation) but not heart rate. (Response Feedback: Cardiovascular SOFA components are MAP and vasopressor use, not heart rate.)
45
The BEST test to detect GIS bleeding at 0.3–0.5 mL/min in an unstable ICU patient is: A) CT angiography B) Formal angiogram C) Capsule endoscopy
Correct Answer: A) CT angiography Explanation: CT angiography is rapid, detects bleeding at low rates, and is feasible in unstable patients. (Response Feedback: CT angiography balances speed and sensitivity for slow bleeding in critical patients.)
46
Hepatic encephalopathy severity is graded using: A) West Haven Criteria B) Glasgow Coma Scale C) MELD Score
Correct Answer: A) West Haven Criteria Explanation: West Haven Criteria grades encephalopathy from 0 (no symptoms) to 4 (coma). (Response Feedback: This system evaluates mental status and neuromuscular signs specific to hepatic encephalopathy.)
47
Which is NOT a transcellular fluid? A) Pericardial fluid B) Plasma C) Gastrointestinal secretions
Correct Answer: B) Plasma Explanation: Plasma is intravascular, while transcellular fluids (e.g., CSF, pleural fluid) are secreted by epithelial cells. (Response Feedback: Transcellular fluids include CSF, synovial fluid, etc., but not plasma.)
48
Initial management for sliding hiatal hernia with GERD is: A) Nissen fundoplication B) PPI therapy + lifestyle changes C) H₂ blockers alone
Correct Answer: B) PPI therapy + lifestyle changes Explanation: Surgery is reserved for refractory cases. PPIs and lifestyle modifications are first-line. (Response Feedback: PPIs reduce acid production, while weight loss and meal timing adjustments alleviate symptoms.)
49
A 56-year-old chronic alcoholic has a 1-year history of ascites. He is admitted with a 2-day history of diffuse abdominal pain and fever. Examination reveals scleral icterus, spider angiomas, a distended abdomen with shifting dullness, and diffuse abdominal tenderness. Paracentesis reveals slightly cloudy ascitic fluid with an ascitic fluid PMN cell count of 1000/µL. A cirrhotic patient with SBP (PMN >1000/μL) should receive: A) Albumin + antibiotics B) Multiple antibiotics (polymicrobial coverage) C) No antibiotic
Correct Answer: A) Albumin + antibiotics Explanation: Albumin reduces mortality by preventing renal dysfunction in SBP. (Response Feedback: Albumin counters circulatory dysfunction, improving survival alongside antibiotics.)
50
Tokyo criteria for Grade II cholecystitis include: A) WBC >18,000 + GB wall >4 mm B) Jaundice + mental status changes
Correct Answer: A) WBC >18,000 + GB wall >4 mm Explanation: Grade II requires markers of systemic inflammation without organ failure. ## Footnote SORU 22, kendi sınavım, FEEDBACK KISMINDA AÇIKLAMA VAR
51
Which of the following is a nonproliferative breast lesion? * Galactocel * Fibroadenoma * Intraductal papilloma * Sclerosing adenosis
* Galactocel Explanation: Galactoceles are benign milk-filled cysts, while fibroadenomas are proliferative. (Response Feedback: Nonproliferative lesions lack cellular growth abnormalities.)
52
Which phase of wound healing is characterized by fibroblast proliferation and collagen synthesis? A) Hemostatic phase (Minutes) B) Inflammatory phase (Days 0-3) C) Proliferative phase (Days 4-21) D) Maturation phase (Days 21-365)
Correct Answer: C) Proliferative phase (Days 4-21) Explanation: The proliferative phase involves fibroblast migration, granulation tissue formation, and type III collagen synthesis, peaking around days 4–21. (Response Feedback: This phase is critical for wound strength development. Reference: Sabiston Textbook of Surgery, 2018.)
53
Which is NOT a component of the Berlin definition for ARDS? A) Bilateral pulmonary opacities B) PCWP <18 mmHg C) PaO₂/FiO₂ <200 D) Respiratory failure not fully explained by cardiac failure
Correct Answer: B) PCWP <18 mmHg Explanation: The Berlin definition excludes PCWP measurements, focusing on hypoxemia, timing, and radiographic findings. (Response Feedback: PCWP was part of older definitions but is no longer required.)
54
According to TNM staging, which represents early gastric cancer? A) T1N1 B) T2N0 C) T3N0 D) T4N0
Correct Answer: A) T1N1 Explanation: Early gastric cancer is confined to mucosa/submucosa (T1), regardless of nodal status. (Response Feedback: Lymph node involvement occurs in ~10% of early gastric cancers.)
55
Which breast cancer subtype has the highest pCR (pathological complete response) rates after neoadjuvant therapy? A) ER(+), PR(+), HER2(−), Ki67: 8% B) ER(−), PR(−), HER2(FISH+), Ki67: 22% C) ER(−), PR(−), HER2(−), Ki67: 30%
Correct Answer: B) ER(−), PR(−), HER2(FISH+), Ki67: 22% Explanation: HER2-enriched tumors have pCR rates up to 80% with targeted therapy. *(Response Feedback: Triple-negative and HER2+ subtypes respond best to neoadjuvant treatment.)*
56
Which is NOT a risk factor for incisional hernia? A) Obesity B) Transverse incision C) Wound infection D) Immunosuppression
Correct Answer: B) Transverse incision Explanation: Transverse incisions have a lower hernia risk compared to midline incisions. (Response Feedback: Midline incisions carry a 10.5% hernia risk vs. 7.5% for transverse.)
57
A complication of jejunoileal bypass is: A) Hyperoxaluria B) Hungry bone syndrome C) Pseudohyperparathyroidism
Correct Answer: A) Hyperoxaluria Explanation: Fat malabsorption leads to calcium-soap formation, freeing oxalate for absorption and stone formation. (Response Feedback: Enteric hyperoxaluria is a hallmark of small bowel resection or bypass.)
58
Which is INCORRECT about benign gastric lesions? A) Mallory-Weiss tears are mucosal tears from vomiting B) Acquired gastric diverticula contain all three stomach layers C) Dieulafoy’s lesion involves submucosal arterial erosion
Correct Answer: B) Acquired gastric diverticula contain all three stomach layers Explanation: Acquired diverticula are pseudodiverticula lacking muscular layers. (Response Feedback: Congenital diverticula are true diverticula with all layers.)
59
Free air under the diaphragm on X-ray indicates: A) Perforated viscus B) Diverticulitis C) Small bowel obstruction
Correct Answer: A) Perforated viscus Explanation: Free air is pathognomonic for perforation (e.g., peptic ulcer, colonic perforation). (Response Feedback: Immediate laparotomy is typically required.)
60
A 22-year-old with a midline gluteal fluctuant mass likely has: A) Pilonidal abscess B) Perianal abscess C) Fistula-in-ano
Correct Answer: A) Pilonidal abscess Explanation: Pilonidal cysts/abscesses occur in the natal cleft and are unrelated to anal canals. (Response Feedback: Caused by trapped hair follicles; requires drainage.)
61
A cirrhotic patient with a 2.5 cm arterial-enhancing liver lesion should undergo: A) Liver transplant evaluation B) Percutaneous biopsy C) Systemic chemotherapy
Correct Answer: A) Liver transplant evaluation Explanation: Lesions meeting HCC criteria in cirrhosis may qualify for transplant under Milan criteria. (Response Feedback: Transplantation offers the best long-term survival for eligible patients.)
62
Delaying appendectomy for uncomplicated appendicitis until morning risks: A) Increased perforation B) No difference in outcomes C) Higher abscess rates
Correct Answer: B) No difference in outcomes Explanation: Studies show equivalent perforation/abscess rates with urgent vs. emergent surgery. (Response Feedback: Safe to delay ≤24 hours in stable patients.)
63
Symptomatic cholelithiasis without cholecystitis is best managed with: A) Dietary modification B) Elective cholecystectomy C) Ursodeoxycholic acid
Correct Answer: B) Elective cholecystectomy Explanation: Surgery prevents recurrent biliary colic and complications like pancreatitis. (Response Feedback: Laparoscopic cholecystectomy is the gold standard.)
64
Acute cholecystitis with fever/WBC elevation warrants: A) NPO + IV antibiotics → delayed surgery B) Immediate laparoscopic cholecystectomy C) Percutaneous cholecystostomy
Correct Answer: B) Immediate laparoscopic cholecystectomy Explanation: Early surgery (<72 hours) reduces complications and hospital stay.
65
Q1: What is not part of the chain of survival? A) Calling the relatives of the patient B) Activation of emergency response C) Early recognition and prevention D) Defibrillation E) High-quality CPR
Correct Answer: A) Calling the relatives of the patient Explanation: Relatives are not part of the emergency protocol steps.
66
Q2: A 67-year-old woman has had a 10 kg weight loss over the past 3 months without dieting or trying. On physical examination, she appears anxious and worried. Her hands are warm and tremulous. Vital signs show: Temp 37.2°C, Pulse 112/min, RR 20/min, BP 150/70 mmHg. Serum labs: glucose 90 mg/dL, creatinine 0.9 mg/dL. Which of the following additional lab findings is most likely to be present in this woman? A) Serum total thyroxine of 15 mcg/dL B) Serum ANA of 1:160 C) Plasma cortisol of 5 mcg/dL at 8AM D) Urinary free catecholamines of 1000 mcg/24hr E) Serum gastrin of 800 pg/mL
Correct Answer: A) Serum total thyroxine of 15 mcg/dL Explanation: Symptoms suggest hyperthyroidism, supported by elevated thyroxine.
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What is the primary definitive host in the life cycle of Echinococcus granulosus? A) Humans B) Cattle C) Dogs D) Sheep
Correct Answer: C) Dogs ## Footnote Explanation: Dogs are the definitive hosts where adult tapeworms develop in the intestine. They pass eggs in their feces, which are then ingested by intermediate hosts (sheep, cattle). Humans are accidental intermediate hosts and do not play a role in completing the parasite's life cycle.
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Which genetic mutation is most commonly found in gastrointestinal stromal tumors (GISTs)? A) KIT mutation B) KRAS mutation C) TP53 mutation D) CDH1 mutation
Correct Answer: A) KIT mutation ## Footnote Explanation: KIT (CD117) mutation is the most common genetic alteration in GISTs, leading to constitutive activation of the receptor tyrosine kinase pathway. TP53 is associated with various cancers but is not the most common mutation in GISTs.
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Question 4 What type of agent is Propofol? A) Intravenous anesthetic B) Opioid C) Muscle relaxant D) Local anesthetic
Correct Answer: A) Intravenous anesthetic
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A 68-year-old male presents with 72 hours of worsening right lower quadrant (RLQ) pain, fever (38.7°C), nausea, and anorexia. Ultrasound shows a 12 mm non-compressible appendix with a thickened wall. Which laboratory value is the strongest predictor of appendiceal perforation? A) Serum sodium <130 mmol/L B) WBC count >18,000/mm³ C) Procalcitonin >2.0 ng/mL D) CRP >200 mg/L
Correct Answer: C) Procalcitonin >2.0 ng/mL Explanation: Procalcitonin >2.0 ng/mL is the strongest predictor of perforated appendicitis, as it correlates with systemic bacterial infection and inflammation severity.
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What is the most reliable predictor of postoperative biliary fistula after hydatid cyst surgery? A) Presence of daughter cysts B) Cyst wall calcification C) Preoperative cyst-biliary communication on MRCP D) Cyst size greater than 10 cm
Correct Answer: C) Preoperative cyst-biliary communication on MRCP Explanation: Preoperative identification of cyst-biliary communication on MRCP is the most reliable predictor of postoperative biliary fistula, allowing for appropriate surgical planning.
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Which of the following is the most common cause of metabolic alkalosis in hospitalized patients? A) Hypokalemia B) Nasogastric tube suctioning C) Volume contraction D) Hyperalimentation
Correct Answer: C) Volume contraction Explanation: The most common cause of metabolic alkalosis in hospitalized patients is volume contraction, especially with diuretic use.
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What is the recommended management for a patient experiencing cardiovascular collapse due to local anesthetic systemic toxicity? A) Start CPR immediately and administer intralipid 20% B) Administer propofol 50 mg bolus C) Give diazepam for muscle relaxation D) Administer epinephrine 1 mg every 5 minutes
Correct Answer: A) Start CPR immediately and administer intralipid 20% ## Footnote Explanation: Treatment includes immediate ACLS and administration of intralipid 20%, which sequesters the lipophilic anesthetic. ACLS--> Advanced cardiac life support
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A 45-year-old woman with a history of smoking presents with recurrent subareolar breast infections. The most likely diagnosis is: A) Paget’s disease B) Periductal mastitis C) Mammary duct ectasia D) Granulomatous mastitis
Correct Answer: B) Periductal mastitis Explanation: Periductal mastitis is frequently associated with smoking and recurrent infections, especially in women above 30. ## Footnote | Özellik | Granülomatöz Mastit | Periduktal Mastit | | ------------ | ------------------------------------- | ---------------------------------------------- | | Yaş | 20–40 yaş, doğum yapmış | Daha geniş yaş aralığı | | Risk Faktörü | Emzirme, doğum sonrası dönem | **Sigara kullanımı** | | Lokalizasyon | Meme lobülleri | Subareolar bölge | | Klinik | Sert kitle, apse, fistül, retraksiyon | Areola çevresi kızarıklık, akıntı, retraksiyon | | Histoloji | **Granülom**, dev hücreler | **Plazma hücreleri**, granülom yok | | Tedavi | Steroid ± immünsupresif | Antibiyotik ± cerrahi |
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The primary compensatory mechanism in early hypovolemic shock is: A) Vasodilation B) Increased sympathetic tone with catecholamine release C) Decreased respiratory rate D) Decreased heart rate
Correct Answer: B) Increased sympathetic tone with catecholamine release ## Footnote Explanation: The initial response to hypovolemic shock includes increased sympathetic tone, which increases heart rate, contractility, and peripheral vasoconstriction to maintain tissue perfusion.
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A 58-year-old woman with severe acute pancreatitis develops worsening tachycardia, hypotension, and rising creatinine levels despite aggressive IV fluid resuscitation. What is the most likely cause of her hemodynamic instability? A) Septic shock due to pancreatic infection B) Third-spacing of fluid leading to hypovolemic shock C) Adrenal insufficiency secondary to systemic inflammation D) Cardiogenic shock due to pancreatic enzyme-mediated myocardial suppression
Correct Answer: B) Third-spacing of fluid leading to hypovolemic shock ## Footnote Explanation: In severe acute pancreatitis, inflammation causes massive third-spacing of fluids into the retroperitoneal space, leading to intravascular volume depletion and hypovolemic shock.
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A 52-year-old male presents with 48 hours of RLQ pain, fever (39.2°C), tachycardia, and hypotension. CT shows a ruptured appendix with a 6 cm pericolonic abscess. What is the best next step in management? A) Emergency laparoscopic appendectomy with peritoneal lavage B) Percutaneous abscess drainage followed by interval appendectomy C) Broad-spectrum IV antibiotics and observation D) Immediate right hemicolectomy
Correct Answer: A) Emergency laparoscopic appendectomy with peritoneal lavage | Explanation: The patient meets severe sepsis criteria, and immediate sur ## Footnote SERUM LAKTAT--> hipoperfüzyon gösterir.
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During laparoscopic cholecystectomy, which anatomical landmark should be identified first to prevent bile duct injury? A) Calot's node B) Rouviere's sulcus C) Hartmann's pouch D) Morrison's pouch
Correct Answer: B) Rouviere's sulcus ## Footnote Explanation: Rouviere's sulcus reliably indicates the plane of the common bile duct and is the first step in the Critical View of Safety technique.
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What is the most common presenting symptom of left-sided colorectal cancer? A) Weight loss B) Abdominal pain C) Iron deficiency anemia D) Change in bowel habits with rectal bleeding
Correct Answer: D) Change in bowel habits with rectal bleeding ## Footnote Explanation: Left-sided colorectal cancer commonly presents with change in bowel habits and rectal bleeding due to the smaller luminal diameter and solid stool in the left colon.
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Which of the following findings in upper GI bleeding most strongly predicts the need for surgical intervention? A) Endoscopic finding of erosive esophagitis B) Melena with normal hemoglobin levels C) Presence of Helicobacter pylori D) Rockall score > 8
Correct Answer: D) Rockall score > 8 Explanation: A Rockall score > 8 is a strong predictor of mortality and need for surgical intervention due to its association with high-risk bleeding and hemodynamic instability. | Rockall skoru, üst GI kanamalarda hastanın mortalite ve yeniden kanama r ## Footnote ROCKALL Skor Hesaplama: 0–3 puan: Düşük risk (erken taburcu olabilir) 4–7 puan: Orta risk (yakın takip gerekir) >7 puan: Yüksek mortalite ve yeniden kanama riski
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Which of the following is the most common risk factor for cholelithiasis? A) Female gender over 40 years of age B) Family history C) Rapid weight loss D) High-fiber diet
Correct Answer: A) Female gender over 40 years of age Explanation: Women are twice as likely to develop gallstones due to estrogen’s effect on increasing cholesterol secretion and saturating bile. Age further elevates risk.
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A patient with chronic pancreatitis develops brittle diabetes. What type of diabetes is this classified as? A) Type 1 diabetes B) Type 2 diabetes C) Type 3c diabetes D) Gestational diabetes
Correct Answer: C) Type 3c diabetes Explanation: Diabetes resulting from pancreatic diseases (e.g., chronic pancreatitis) is classified as Type 3c or pancreatogenic diabetes, involving damage to both insulin and glucagon-producing cells. ## Footnote Brittle diabetes, hastanın yaşam kalitesini ve günlük fonksiyonlarını ciddi şekilde bozan, sık hipoglisemi ve hiperglisemi atakları ile seyreden, insülin tedavisine rağmen glisemik kontrolün sağlanamadığı durumdur.
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What is the most common type of hernia in adult males? A) Epigastric hernia B) Inguinal hernia C) Umbilical hernia D) Femoral hernia
Correct Answer: B) Inguinal hernia Explanation: Inguinal hernias account for ~75% of abdominal wall hernias in adult males, with a lifetime risk of 27%. + direkt indirekt sadece inguinal herni için kullanılır. ## Footnote İndirekt = İçeriden gelir, gençte olur, skrotuma iner 👴 Direkt = Duvar zayıflar, yaşlıda olur, skrotuma pek inmez
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İNDİREKT VS DİREKT HERNİ BİLGİ
Özellik İndirekt Herni Direkt Herni Tanım Processus vaginalis'in açık kalması sonucu oluşur (konjenital kökenli) Karın duvarındaki zayıf alandan (Hesselbach üçgeni) fıtıklaşma (edinsel) Sıklık En sık görülen tip Daha nadir Yaş Genellikle gençlerde ve çocuklarda Genellikle erişkinlerde, yaşlı erkeklerde Fıtık Yolu İnguinal kanalın içinden geçer, skrotuma kadar inebilir İnguinal kanalın içine girmez, doğrudan karın duvarından dışarı çıkar Lokalizasyon Inferior epigastrik damarların lateralinden çıkar Inferior epigastrik damarların medialinden çıkar Skrotuma İniş İnebilir (özellikle çocuklarda skrotal şişlik olur) Nadir iner Nedeni Doğumsal – Processus vaginalis'in kapanmaması Edinsel – Karın duvarı zayıflığı Palpasyon Skrotuma doğru parmak sokulduğunda, parmağın ucuna doğru fıtık gelir Parmağın yan tarafından hissedilir Komplikasyon Riski İnkarsere ve strangülasyon riski daha yüksek Genellikle geniş boyunlu, daha düşük riskli
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What is the classic triad of acute cholangitis (Charcot's triad)? A) Right upper quadrant pain, fever, and tachycardia B) Right upper quadrant pain, fever, and jaundice C) Jaundice, fever, and vomiting D) Fever, jaundice, and hypotension
Correct Answer: B) Right upper quadrant pain, fever, and jaundice ## Footnote Explanation: Charcot's triad consists of right upper quadrant pain, fever, and jaundice, though it is present in only 50–70% of cases. Charcot triadı, akut kolanjit (safra yolları enfeksiyonu) tanısında kullanılan klinik bir üçlüdür.
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A pregnant woman in her second trimester presents with acute right-sided abdominal pain. What is most important to consider regarding appendicitis in this case? A) Avoiding imaging studies B) Treating with antibiotics alone C) Waiting for fever before intervention D) Early appendectomy to prevent complications
Correct Answer: D) Early appendectomy to prevent complications Explanation: Delay in appendectomy increases the risk of perforation and peritonitis, which poses greater danger to both mother and fetus.
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Which artery is most commonly involved in a bleeding duodenal ulcer? A) Left gastric artery B) Gastroduodenal artery C) Inferior mesenteric artery D) Splenic artery
**Correct Answer: B) Gastroduodenal artery**
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Which hormone demonstrates the most significant change after sleeve gastrectomy, contributing to weight loss? A) Peptide YY B) Ghrelin C) Cholecystokinin D) Glucagon-like peptide-1
Correct Answer: B) Ghrelin ## Footnote Explanation: Ghrelin levels decrease dramatically after sleeve gastrectomy due to removal of the gastric fundus (primary production site), reducing appetite. Ghrelin, esas olarak mide fundusundan (özellikle oksintik hücrelerden) salgılanan bir iştah artırıcı hormondur.
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Which of the following is an indication for thyroidectomy in the treatment of hyperthyroidism? A) A patient with moderate-to-severe Graves’ orbitopathy B) A patient with subclinical hyperthyroidism and no compressive symptoms C) A woman with Graves’ disease who plans to conceive in 2 years D) A pregnant patient with well-controlled Graves’ disease
Correct Answer: A) A patient with moderate-to-severe Graves’ orbitopathy Explanation: Thyroidectomy is preferred for Graves’ disease with ophthalmopathy, as radioactive iodine may worsen orbitopathy. ## Footnote Graves orbitopathy = Göz + Tiroid + Otoimmün reaksiyon Göz kasları ve dokular şişer, itilir, sertleşir → Ekzoftalmi ve diplopi olur.
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In the ASA classification, which class represents a patient with severe systemic disease that is a constant threat to life, such as sepsis? A) ASA I B) ASA II C) ASA III D) ASA IV
Correct Answer: D) ASA IV
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Which of the following is the most common histological type of esophageal cancer worldwide? A) Small cell carcinoma B) Adenocarcinoma C) Squamous cell carcinoma D) Gastrointestinal stromal tumor (GIST)
Correct Answer: C) Squamous cell carcinoma
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A 28-year-old male with blunt abdominal trauma is hypotensive (85/50 mmHg), tachycardic, and has a positive FAST scan. Despite 2L crystalloid resuscitation, his BP remains low. What is the next best step? A) Perform CT scan for diagnosis B) Immediate exploratory laparotomy while resuscitating with blood products C) Administer 2 more liters of crystalloids D) Correct base deficit
Correct Answer: B) Immediate exploratory laparotomy while resuscitating with blood products Explanation: FAST-positive + hemodynamic instability mandates operative intervention. Blood product resuscitation (1:1:1 ratio) is critical to address hemorrhagic shock.
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Which of the following is the most common cause of anal abscesses? A) Cryptoglandular infection B) Fistula-in-ano C) Viral infection D) Hemorrhoidal thrombosis
Correct Answer: A) Cryptoglandular infection Explanation: Obstruction of anal glands leads to bacterial overgrowth and abscess formation (cryptoglandular theory).
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During right colectomy for cancer, which vessel ligation technique provides the optimal lymph node yield? A) Low ligation of ileocolic vessels B) High ligation at origin of ileocolic vessels with complete mesocolic excision C) Intermediate ligation with preservation of right colic artery D) Sequential ligation after lymph node sampling
Correct Answer: B) High ligation at origin of ileocolic vessels with complete mesocolic excision Explanation: High ligation with complete mesocolic excision maximizes lymph node harvest and oncologic outcomes.
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In mesh repair of inguinal hernias, what is the optimal position for mesh placement? A) Subcutaneous space B) Within the inguinal canal C) Preperitoneal space D) Above external oblique
Correct Answer: C) Preperitoneal space Explanation: Preperitoneal placement allows intra-abdominal pressure to secure the mesh against the posterior wall, reducing recurrence rates.
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Which of the following is not typically part of the preoperative fasting guidelines? A) No clear liquids (water) allowed 2 hours before surgery B) No infant formula allowed 4 hours before surgery C) No solid food allowed 6–8 hours before surgery D) No breast milk 4 hours before surgery
Correct Answer: B) No infant formula allowed 4 hours before surgery Explanation: Infant formula requires a longer fasting period (≥6 hours) due to its higher fat/protein content compared to breast milk or clear liquids.
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CCS 401 Genel Cerrahi (7 decks)

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