LE4 (Subspec)

Question 1

Which gas has the highest risk of developing an air embolism?

A. Carbon dioxide
B. Nitrous oxide
C. Compressed air
D. Helium
E. Oxygen

Answer 1

D. Helium
Rationale: Helium has the highest risk of air embolism due to its poor solubility in blood, making it more likely to form persistent bubbles if it enters the vascular system.

Question 2

During a laparoscopic appendectomy, the surgeon must stand on the:

A. Right side of the patient
B. Left side of the patient
C. Head of the patient
D. Any of the above

Answer 2

B. Left side of the patient
✅ Explanation:
During a laparoscopic appendectomy, the appendix is located in the right lower quadrant (RLQ) of the abdomen. For optimal visualization and instrument manipulation, the surgeon stands on the left side of the patient, while the camera assistant stands on the contralateral (right) side.

Question 3

What is an advantage of laparoscopic surgery over open surgery?

A. Faster recovery
B. Early ambulation
C. Cosmetically better
D. All of the above

Answer 3

D. All of the above
Rationale: Laparoscopic surgery leads to faster recovery, early ambulation, and better cosmetic outcomes due to smaller incisions compared to open surgery.

Question 4

The following statements regarding aortic coarctation are true EXCEPT:

A. Narrowing is most commonly located proximal to the left subclavian artery
B. Extensive collateral circulation develops, predominantly involving the intercostals and mammary arteries as a direct result of aortic flow obstruction
C. All of the above are true
D. It is defined as a luminal narrowing in the aorta that causes an obstruction to blood flow

Answer 4

A. Narrowing is most commonly located PROXIMAL to the left subclavian artery
Rationale: Aortic coarctation is most commonly located distal to the left subclavian artery, typically at the level of the ductus arteriosus (juxtaductal coarctation).

Question 5

A 37-year-old female was referred for right-sided pneumothorax. The patient claims she was diagnosed and managed for pneumothorax five months ago. Upon history taking, she mentioned that she also has recurrent episodes of abdominal pain and changes in bowel habits, occurring monthly or every other month for almost two years. What is the most probable cause of the pneumothorax?

A. Ruptured bleb
B. Catamenial pneumothorax
C. Cystic fibrosis
D. Metastatic cancer

Answer 5

B. Catamenial Pneumothorax ✅
Key Clinical Clues:
Recurrent Right-Sided Pneumothorax – Occurred twice within five months.
Cyclical Symptoms – The patient reports abdominal pain and bowel habit changes occurring monthly or every other month.
Female Patient in Reproductive Age (37 years old) – Suggests a possible gynecological link.

✅ Primary Pneumothorax = Apical Bleb Rupture (Tall, Thin Males, Smokers)
✅ Secondary Pneumothorax = Underlying Lung Disease (Emphysema, CF, Cancer, AIDS, Asthma)

Question 6

What is the gold standard in detecting the presence of deep vein thrombosis (DVT)?

A. Venography
B. Duplex ultrasound
C. Impedance plethysmography
D. Iodine-125 fibrinogen uptake

Answer 6

B. Duplex ultrasound

Question 7

All of the following are effects of pneumoperitoneum on the cardiovascular system, EXCEPT:

A. Decreased systemic vascular resistance (SVR)
B. Diminished venous return from the lower extremities
C. Decreased stroke volume
D. Decreased cardiac output

Answer 7

A. Decreased systemic vascular resistance (SVR)
Rationale: Pneumoperitoneum increases intra-abdominal pressure, leading to increased systemic vascular resistance (SVR), reduced venous return, decreased stroke volume, and decreased cardiac output.

Question 8

The following abnormalities are included in Tetralogy of Fallot, EXCEPT:

A. Left ventricular hypertrophy
B. Large perimembranous VSD adjacent to the tricuspid valve
C. Overriding aorta
D. Right ventricular outflow tract (RVOT) obstruction

Answer 8

A. Left ventricular hypertrophy
Rationale: Tetralogy of Fallot includes a large VSD, overriding aorta, RVOT obstruction, and right ventricular hypertrophy, not left ventricular hypertrophy.

Question 9

What does MIS stand for?

A. Minimally Invasive Surgery
B. Minimally Invasive Scope
C. Maximum Incision Surgery
D. Multiple Incision Surgery

Answer 9

A. Minimally Invasive Surgery
Rationale: MIS refers to procedures performed using small incisions and specialized instruments to reduce surgical trauma.

Question 10

The laparoscopic tower includes all of the following, EXCEPT:
A. Video recorder
B. Xenon light source
C. HD Camera
D. CO₂ high-flow insufflator
E. Suction machine

Answer 10

E. Suction machine
Rationale: The laparoscopic tower typically consists of a video recorder, xenon light source, HD camera, and CO₂ high-flow insufflator, while the suction machine is a separate device not directly part of the laparoscopic tower.

Question 11

Ischemic rest pain is classified in the Fontaine classification of peripheral artery disease as:
A. Stage I
B. Stage III
C. Stage II
D. Stage IV

Answer 11

B. Stage III
Rationale: The Fontaine classification of PAD includes Stage I (asymptomatic), Stage II (claudication), Stage III (ischemic rest pain), and Stage IV (ulceration or gangrene). Ischemic rest pain indicates severe arterial insufficiency, classified as Stage III.

Question 12

The most commonly injured organ during a laparoscopic cholecystectomy is:
A. Duodenum
B. Portal Vein
C. Stomach
D. Common Bile Duct
E. Large Intestine

Answer 12

D. Common Bile Duct
Rationale: The common bile duct (CBD) is the most frequently injured structure due to misidentification during gallbladder dissection, leading to bile leaks, strictures, or obstruction.

Question 13

A rare autoimmune disease occurring in women aged 10–40 years of Asian descent, presenting as chronic inflammation of large vessels, predominantly the aorta, leading to arterial wall thickening, stenosis, fibrosis, and thrombus formation:
A. Kawasaki disease
B. Polyarteritis nodosa
C. Giant cell arteritis
D. Takayasu’s arteritis

Answer 13

D. Takayasu’s arteritis
Rationale: Takayasu’s arteritis is a large-vessel vasculitis that primarily affects the aorta and its branches, leading to pulseless disease and ischemic complications.

Question 14

The gold standard for the evaluation of venous function is:
A. Venography
B. Plethysmography
C. Iodine-125 fibrinogen uptake
D. Duplex ultrasound

Answer 14

D. Duplex Ultrasound
Explanation:
* Duplex Ultrasound is the gold standard for evaluating venous function because it provides real-time imaging of blood flow, vein structure, and the presence of thrombi or valvular incompetence.
* Venography (Option A) is the gold standard for venous thrombosis, but it is invasive and rarely used.
* Plethysmography (Option B) measures venous volume changes but is not as accurate as duplex ultrasound.
* lodine-125 Fibrinogen Uptake (Option C) was historically used for detecting active clot formation, but it is outdated.

Question 15

The open technique or direct peritoneal access when inserting the first trocar is called the:
A. Hasson technique
B. None of the above
C. Hunter technique
D. Andersen technique
E. Veress technique

Answer 15

A. Hasson technique
Rationale: The Hasson technique involves making a small incision and directly placing a blunt trocar under direct vision, reducing the risk of injury compared to the Veress needle technique, which is blind.

Question 16

True of open abdominal aortic aneurysm (AAA) repair, EXCEPT:
A. Risk of aneurysm recurrence and delayed rupture is significantly decreased
B. Long-term imaging surveillance is not needed after open AAA repair
C. Associated with risk of myocardial infarction or arrhythmias
D. Patients post-open AAA repair have a risk of developing ischemic colitis

Answer 16

B. Long-term imaging surveillance is not needed after open AAA repair
Rationale: Surveillance is still required post-open AAA repair to monitor for anastomotic aneurysms, graft infections, or complications. While risk is lower than in endovascular repair, lifelong follow-up is recommended.

Question 17

True of chronic limb ischemia (CLI), EXCEPT:
A. All are true
B. Ischemic rest pain most commonly occurs below an ankle pressure of 50 mmHg
C. Ulcers are painless, with regular margins and the presence of calluses
D. There is no definite consensus regarding the vascular hemodynamic parameters required to make the diagnosis of CLI

Answer 17

C. Ulcers are painless, with regular margins and the presence of calluses

Chronic Limb Ischemia (CLI)
📌 Mnemonic: “CRIP” – Chronic Rest pain, Ischemic Ulcers, Pallor
✅ Claudication – Pain/cramping with exertion, relieved by rest.
✅ Rest Pain – Persistent ischemic pain even at rest (critical stage).
✅ Ischemic Ulcers & Gangrene – Non-healing ulcers, tissue necrosis.
✅ Pallor & Hair Loss – Thin, shiny skin with absent pulses.

🔹 Additional Signs:

Buerger’s sign – Dependent rubor, limb turns red when lowered.
Ankle-Brachial Index (ABI) <0.4 = Severe ischemia.
📌 Tip: CLI is a progressive disease → If untreated, leads to amputation!

Question 18

A patient is prone to develop a decrease in venous return in which position?
A. Prone
B. Supine
C. Trendelenburg
D. Lateral decubitus
E. Fowler’s

Answer 18

Question 19

A patient is prone to develop poor respiratory compliance in which position?
A. Prone
B. Supine
C. Trendelenburg
D. Lateral decubitus
E. Fowler’s

Answer 19

C. Trendelenburg

🔥 Rationale:
* Trendelenburg position (head-down tilt) reduces lung compliance by shifting abdominal contents upward, compressing the diaphragm and restricting lung expansion.
* This leads to atelectasis, decreased functional residual capacity (FRC), and increased peak airway pressures.
* Patients with pre-existing lung disease (COPD, ARDS) are at higher risk of hypoxia.

❌ Why Not the Other Options?

Position Respiratory Effect Why Not Correct?
A. Prone ✅ Improves lung compliance in ARDS Helps with better oxygenation in critically ill patients.
B. Supine 🟡 Neutral effect Can cause mild diaphragmatic compression but not as severe as Trendelenburg.
D. Lateral Decubitus 🟡 Variable effect Dependent lung gets compressed, but overall compliance is better than Trendelenburg.
E. Fowler’s ✅ Best for lung expansion Upright position maximizes lung capacity and improves oxygenation.

🚀 Key Takeaway:
* Trendelenburg = Worst for lung compliance (diaphragm compression, increased intrathoracic pressure).
* Fowler’s = Best for respiratory function (maximal lung expansion).
* Prone can actually improve lung compliance in certain conditions (ARDS).

📌 Key Takeaway:

Reverse Trendelenburg increases DVT risk but improves lung compliance.
Trendelenburg worsens lung compliance but does not increase DVT risk.

Question 20

True regarding lymphedema:
A. Primary lymphedema is more common than secondary lymphedema
B. Lymphedema praecox is more common in males
C. Axillary node dissection is the most common cause of secondary lymphedema in the arm
D. Congenital lymphedema is the most common form of primary lymphedema

Answer 20

C. Axillary node dissection is the most common cause of secondary lymphedema in the arm
Rationale: Secondary lymphedema occurs most commonly after lymph node dissection (e.g., mastectomy with axillary clearance in breast cancer), leading to chronic swelling of the affected limb.

Question 21

Which gas has the highest risk for developing air embolism?
A. Nitrous oxide
B. Helium
C. Carbon dioxide
D. Oxygen
E. Compressed air

Answer 21

B. Helium
Rationale: Helium has the highest risk of air embolism due to its poor solubility in blood, making it more likely to form persistent bubbles if introduced into the vascular system.

Question 22

TAPP (Transabdominal Preperitoneal) or TEP (Totally Extraperitoneal) is a procedure done for:
A. Appendicitis
B. Morbid obesity
C. Hernia
D. Thyroid enlargement
E. Gallstones

Answer 22

C. Hernia
Rationale: TAPP and TEP are two minimally invasive techniques used in laparoscopic inguinal hernia repair. TAPP involves entering the peritoneal cavity, while TEP avoids it.

Question 23

When performing a laparoscopic cholecystectomy, the patient should be positioned in:
A. Lithotomy
B. Reverse Trendelenburg
C. Trendelenburg
D. Supine
E. Left lateral decubitus

Answer 23

B. Reverse Trendelenburg
Rationale: Reverse Trendelenburg with slight left tilt improves visualization of the gallbladder by shifting abdominal organs downward via gravity.

Question 24

The most common type of atrial septal defect (ASD) is:
A. Ostium secundum
B. Transitional AV canal defect
C. Sinus venosus
D. Partial ostium primum

Answer 24

A. Ostium secundum
Rationale: Ostium secundum ASD is the most common type of ASD, accounting for 70% of cases, and occurs in the central portion of the atrial septum.

Question 25

Which is a nonelectric method of coagulating and dividing tissue with minimal collateral damage? A. Monopolar cautery B. Harmonic scalpel C. Monopolar and bipolar cautery only D. Bipolar cautery E. All of the above

Answer 25

B. Harmonic scalpel Rationale: The Harmonic scalpel uses ultrasonic vibrations to cut and coagulate tissue, minimizing thermal spread and reducing collateral damage compared to monopolar or bipolar electrocautery.

Question 26

Carbon dioxide is the ideal gas used for insufflating the abdominal cavity because: A. It has physiological effects on the body B. It is combustible C. Highly absorbable D. Causes air embolism

Answer 26

C. Highly absorbable Rationale: CO₂ is the preferred gas for laparoscopy because it is rapidly absorbed by the body, reducing the risk of gas embolism and allowing for easier exhalation.

Question 27

Which maneuver is done to decrease the risk of DVT? A. All of the above B. Place the patient in Fowler's position C. Blood transfusion D. Apply compressive stockings to the lower extremities E. Apply spinal anesthesia

Answer 27

Question 28

What is the standard number of trocars inserted when performing a laparoscopic cholecystectomy? A. 5 B. 3 C. 2 D. 1 E. 4

Answer 28

E. 4 Rationale: The standard technique for laparoscopic cholecystectomy typically requires four trocars: one for the camera and three for instruments.

Question 29

Effective thromboprophylaxis, EXCEPT: A. Graduated compression stockings B. Early ambulation C. Vitamin K agonist D. Fondaparinux

Answer 29

C. Vitamin K agonist (should be antagonist) Rationale: Vitamin K antagonists (like warfarin) are used for long-term anticoagulation rather than immediate thromboprophylaxis. Instead, heparin, compression stockings, and early ambulation are used for DVT prevention.

Question 30

Which maneuver is done to decrease the risk of DVT? A. All of the above B. Place the patient in Fowler's position C. Blood transfusion D. Apply compressive stockings to the lower extremities E. Apply spinal anesthesia

Answer 30

D. Apply compressive stockings to the lower extremities Explanation: Compressive stockings (graded compression therapy) help prevent venous stasis and promote venous return, reducing the risk of deep vein thrombosis (DVT). Fowler's position (Option B) does not specifically prevent DVT and may contribute to venous stasis if prolonged. Blood transfusion (Option C) does not prevent DVT and is unrelated to clot formation risk reduction. Spinal anesthesia (Option E) may slightly reduce the risk of DVT compared to general anesthesia but is not a primary preventive maneuver. All of the above (Option A) is incorrect because not all options are effective DVT prevention strategies.

Question 31

When performing a laparoscopic adrenalectomy, the patient's position is usually: A. Reverse Trendelenburg B. Left lateral decubitus C. Supine D. Trendelenburg E. Lithotomy

Answer 31

B. Left lateral decubitus Rationale: The left lateral decubitus position allows for better access to the retroperitoneal space, improving exposure of the adrenal gland during laparoscopic adrenalectomy.

Question 32

34. A 40-year-old male, hypertensive, presents with acute abdominal pain and back pain. On physical examination, BP is 180/100 mmHg, HR is 100 bpm, RR is 24, and T is 37.0°C. A tender, pulsatile mass is palpated in the abdomen. CT scan reveals a 5 cm saccular dilation of the aorta with a high attenuation crescent sign. What is the appropriate management for this patient? A. Admit and direct patient to OR for emergency repair of AAA B. Admit patient for BP control and repair within 24 hours C. Admit patient for BP control and schedule for elective repair after discharge D. Elective repair of AAA once cleared cardiopulmonary-wise

Answer 32

Question 33

35. A 50-year-old female, who underwent a Modified Radical Mastectomy of the left breast for breast cancer and is currently receiving chemotherapy, presents with swelling of her left arm. Which of the following statements regarding her management is FALSE? A. There is no cure for her left arm condition B. Bedrest and leg elevation is recommended C. Monthly IM injections of antibiotics are recommended as prophylaxis for cellulitis D. Excisional procedure has become the definitive management requiring no long-term follow-up

Answer 33

Question 34

36. What is an advantage of laparoscopic surgery over open surgery? A. Less need for analgesics B. All are correct C. Lesser cost D. Shorter hospital stay E. Shorter hospital stay and less need for analgesics only

Answer 34

E. Shorter hospital stay and less need for analgesics only

Question 35

37. What is the standard number of trocars inserted during laparoscopic cholecystectomy? A. 1 B. 3 C. 5 D. 2 E. 4

Answer 35

E. 4 Rationale: The standard laparoscopic cholecystectomy technique typically involves four trocars: one for the camera, two for working instruments, and one for retraction.

Question 36

38. A 70-year-old male undergoes chest tube insertion due to a massive left pleural effusion secondary to pneumonia. During the procedure, approximately 2L of pleural fluid is drained, and as the fluid continues to drain, the patient suddenly develops hypotension. What is the most probable cause of this deterioration? A. Vessel/cardiac injury B. Pulmonary edema C. Inadvertent injury to the lungs D. Subdiaphragmatic entry and damage to the liver causing bleeding and shock

Answer 36

Question 37

39. Indications for surgery in thoracic aneurysms include all of the following EXCEPT: A. Growth rate of >0.5 cm/year when the ascending aorta is <5.0 cm in diameter B. Ascending aortic aneurysm >5.0 cm in diameter C. Ascending aortic aneurysm ≥4.5 cm in patients with Marfan syndrome D. Growth rate of >0.6 cm per year

Answer 37

D. Growth rate of >0.6 cm per year Rationale: Surgery is indicated when the growth rate exceeds 0.5 cm per year in an ascending aortic aneurysm <5 cm. A rate of 0.6 cm per year is an exaggerated threshold. ✔ Indications for Surgery: Ascending Aortic Aneurysm (AA) > 5.5 cm Descending Aortic Aneurysm (DAA) > 6.0 cm Marfan: AA > 5.0 cm Loeys-Dietz: AA 4.4-4.6 cm Rapid growth >0.5 cm/year

Question 38

40. The following congenital heart defects are amenable to complete repair EXCEPT: A. Aortic coarctation B. Cor triatriatum C. Atrial septal defect D. Tricuspid atresia

Answer 38

D. Tricuspid atresia Rationale: Tricuspid atresia requires staged palliation (e.g., Fontan procedure) rather than a single complete repair, unlike ASD, cor triatriatum, and aortic coarctation, which can be fully repaired.

Question 39

41. Direct peritoneal access during insertion of the first trocar is called: A. NOTA B. Hunter technique C. Andersen technique D. Veress technique E. Hasson technique

Answer 39

E. Hasson technique Rationale: The Hasson technique is an open method for inserting the first trocar under direct vision, reducing the risk of visceral or vascular injury.

Question 40

42. The tracheobronchial tree is predominantly lined by: A. Pseudostratified columnar cells B. Goblet cells C. Basal cells D. Ciliated cuboidal cells

Answer 40

A. Pseudostratified columnar cells Rationale: The tracheobronchial epithelium is lined by pseudostratified columnar ciliated epithelium with goblet cells, which aid in mucociliary clearance.

Question 41

45. All of the following are effects of pneumoperitoneum on the cardiovascular system EXCEPT: A. Decreased cardiac output B. Increased systemic vascular resistance C. Increased venous return from the lower extremities D. Decreased stroke volume

Answer 41

C. Increased venous return from the lower extremities Rationale: Pneumoperitoneum decreases venous return due to compression of the inferior vena cava, leading to decreased cardiac output and increased systemic vascular resistance (SVR).

Question 42

46. When establishing abdominal access, the first trocar should be placed in the: A. Right upper quadrant B. Retroperitoneum C. Subxiphoid process D. Linea alba E. Umbilicus

Answer 42

E. Umbilicus Rationale: The umbilicus is the preferred site for the first trocar as it provides central access to the peritoneal cavity and has less subcutaneous fat, making entry easier.

Question 43

47. All of the following are systemic effects of pneumoperitoneum EXCEPT: A. Myocardial stress B. Hypercarbia C. Increased catecholamines D. Vagal reaction E. Acidosis

Answer 43

D. Vagal reaction Rationale: Pneumoperitoneum leads to hypercarbia, myocardial stress, increased catecholamines, and metabolic acidosis. However, vagal reaction (bradycardia, hypotension) occurs only transiently, not as a systemic effect.

Question 44

48. Which of the following devices is used to buttress collapsible vessels and help prevent atherosclerotic restenosis? A. Balloon B. Graft C. Stent D. Sheath

Answer 44

C. Stent Rationale: Stents are used to maintain vessel patency and prevent restenosis after angioplasty. They support weakened or narrowed vessels.

Question 45

49. Exudative pleural effusion is characterized by all of the following EXCEPT: A. Total and differential cell count reveal a predominance of neutrophils B. Pleural fluid to serum ratio of protein >0.6 C. All are exudative pleural effusion D. Absolute pleural LDH level is greater than ⅔ of the normal upper limit for serum

Answer 45

C. All are exudative pleural effusion Rationale: Exudative pleural effusion follows Light’s criteria (pleural protein/serum protein >0.5, pleural LDH >2/3 of normal serum limit, etc.). Answer C is incorrect because some pleural effusions can be transudative (e.g., heart failure). 💡 Mnemonic for Light’s Criteria: "PLEURAL PROTEIN & LDH" 🔹 Protein > 0.5 (pleural/serum) 🔹 LDH > 0.6 (pleural/serum) 🔹 Elevated LDH > 2/3 upper limit

Question 46

50. When performing laparoscopic cholecystectomy, the surgeon should position themselves at the: A. Head part of the patient B. Left side of the patient C. Any of the above D. Right side of the patient

Answer 46

B. Left side of the patient Surgeries Where the Surgeon Stands on the Left Side (Target Organ on the Right Side) 🔹 Cholecystectomy (Gallbladder Removal) 🔹 Appendectomy 🔹 Right-Sided Hernia Repair 🔹 Right Hemicolectomy (Removal of the right colon due to cancer or disease) 📌 Why? Standing on the left side provides direct instrument control over the right upper quadrant (gallbladder) or right lower quadrant (appendix). 📌 Key Takeaways (Based on Your Teaching): ✔️ Laparoscopic Surgery → Surgeon stands OPPOSITE (contralateral) to the organ. ✔️ Open Surgery → Surgeon stands on the SAME side as the organ.

Question 47

51. Which conduit has the highest patency rate? A. Internal thoracic artery B. Greater saphenous vein C. Lesser saphenous vein D. Radial artery

Answer 47

A. Internal thoracic artery Rationale: The internal thoracic artery (ITA) has the highest long-term patency rate in coronary artery bypass grafting (CABG), superior to saphenous vein and radial artery grafts.

Question 48

52. A 50-year-old female, who underwent a Modified Radical Mastectomy of the left breast for breast cancer and is currently receiving chemotherapy, presents with swelling of her left arm. Which of the following statements regarding her condition is FALSE? A. Axillary node dissection from previous surgery is the cause of swelling of her left arm B. Left arm will never completely normalize C. Recurrent cellulitis is a common complication D. Diagnosis cannot be made based on history and physical examination alone

Answer 48

D. Diagnosis cannot be made based on history and physical examination alone Rationale: Lymphedema after axillary node dissection is a clinical diagnosis based on history (prior mastectomy, lymph node removal) and physical exam (non-pitting edema, skin thickening). No further testing is needed unless another cause is suspected.

Question 49

53. Which of the following is the most common type of ventricular septal defect (VSD) requiring surgical intervention? A. Perimembranous B. Supracristal C. Muscular D. Inlet

Answer 49

A. Perimembranous Rationale: Perimembranous VSD is the most common type requiring surgery, as it does not close spontaneously as frequently as muscular VSDs. It is located near the aortic valve and can lead to aortic regurgitation or heart failure.

Question 50

54. Which of the following cardiac murmurs is characteristic of ventricular septal defect (VSD)? A. Late systolic B. Mid systolic C. Pre systolic D. Holosystolic

Answer 50

D. Holosystolic Rationale: A VSD murmur is holosystolic, best heard at the left lower sternal border, due to the continuous left-to-right shunting of blood through the defect.

Question 51

60. What is the most common type of lung cancer? A. Neuroendocrine neoplasms B. Large cell lung carcinoma C. Non-small cell lung carcinoma D. Small cell lung carcinoma

Answer 51

C. Non-small cell lung carcinoma (NSCLC) Rationale: NSCLC accounts for 85% of lung cancer cases, with subtypes including adenocarcinoma, squamous cell carcinoma, and large cell carcinoma.

Question 52

61. Which of the following is TRUE regarding pseudoaneurysms? A. Entire aorta is aneurysmal B. All are true C. Chronic leaks contained by intact aortic tissue D. Can arise from anastomotic leaks

Answer 52

D. Can arise from anastomotic leaks Rationale: Pseudoaneurysms occur when blood leaks outside the arterial wall, forming a contained hematoma. They often arise from anastomotic leaks following vascular surgery or trauma.

Question 53

62. What is the most common site for percutaneous vascular access for endovascular interventions? A. Axillary arterial puncture B. Carotid arterial puncture C. Femoral arterial puncture D. Brachial arterial puncture

Answer 53

C. Femoral arterial puncture Rationale: The femoral artery is the preferred site for percutaneous endovascular access due to its large diameter, easy palpation, and minimal tortuosity.

Question 54

63. Indications for surgery in thoracic aortic aneurysms include all of the following EXCEPT: A. Diameter of ascending aortic aneurysm is >6.0 cm in asymptomatic patients B. Diameter of descending aortic aneurysm is >5.5 cm in asymptomatic patients C. All are correct D. Diameter of 4.0 cm in women considering pregnancy with heritable disorders

Answer 54

C. All are correct (JUST USE AS REVIEWER)

Question 55

64. Which of the following is considered a local effect of pneumoperitoneum? A. Vagal reaction B. Increased catecholamines C. Acidosis D. Myocardial stress E. Hypercarbia

Answer 55

A. Vagal reaction Rationale: Local effects of pneumoperitoneum include vagal-mediated bradycardia and hypotension, often occurring when intra-abdominal pressure rises too quickly.

Question 56

65. When performing a laparoscopic appendectomy, the patient should be in what position? A. Supine B. Lithotomy C. Trendelenburg D. Left Lateral Decubitus

Answer 56

C. Trendelenburg Rationale: The Trendelenburg position (head-down tilt) allows better visualization of the lower abdomen by shifting intestines upward.

Question 57

66. The laparoscopic tower includes all of the following EXCEPT: A. Anesthesia machine B. HD camera C. Video recorder D. Xenon light source E. CO₂ high-flow insufflator

Answer 57

A. Anesthesia machine Rationale: The laparoscopic tower consists of an HD camera, video recorder, xenon light source, and CO₂ high-flow insufflator. The anesthesia machine is separate from the tower.

Question 58

67. Hand instruments used in bariatric surgery are usually ____ than those used in conventional laparoscopic surgery. A. Longer B. Shorter C. Thinner D. Thicker

Answer 58

A. Longer Rationale: Bariatric surgery instruments are longer to accommodate the increased abdominal wall thickness in obese patients.

Question 59

68. The critical pressure for insufflating the abdominal cavity should not exceed: A. 12 mmHg B. 15 mmHg C. 10 mmHg D. 8 mmHg E. 18 mmHg

Answer 59

B. 15 mmHg Rationale: The recommended intra-abdominal pressure for pneumoperitoneum is 12–15 mmHg to avoid excessive cardiovascular and respiratory compromise.

Question 60

69. The ideal gas used for insufflating the abdominal cavity is: A. Oxygen B. Compressed air C. Helium D. Carbon dioxide E. Nitrous oxide

Answer 60

D. Carbon dioxide Rationale: CO₂ is used due to its high solubility, rapid excretion, and non-combustible nature, reducing the risk of air embolism.

Question 61

70. A patient is most prone to develop deep venous thrombosis (DVT) in which position? A. Trendelenburg position B. Fowler's position C. Prone position D. Lateral decubitus position E. Supine position

Answer 61

B. Fowler's position/ Lithotomy Position Rationale: Fowler’s position (semi-upright) promotes venous stasis by reducing venous return, increasing the risk of DVT.

Question 62

73. Which of the following statements is TRUE regarding transposition of the great arteries? A. Pulmonary artery arises posteriorly from the left ventricle (LV) B. Pulmonary artery arises anteriorly from the right ventricle (RV) C. Aorta arises anteriorly from the left ventricle (LV) D. Aorta arises posteriorly from the right ventricle (RV)

Answer 62

B. Pulmonary artery arises anteriorly from the right ventricle (RV) Rationale: In transposition of the great arteries (TGA), the aorta arises from the right ventricle (RV), and the pulmonary artery arises from the left ventricle (LV). The pulmonary artery is positioned anteriorly, while the aorta is positioned posteriorly. Final Takeaways: 🚀 TGA = Pulmonary artery arises from RV (Anterior), Aorta from RV (Posterior). 🚀 Cyanotic at birth due to "Parallel Circulations" (Needs ASD, VSD, or PDA for survival). 🚀 Treatment = PGE1 + Balloon Atrial Septostomy → Surgical Correction (Jatene

Question 63

74. What is the appropriate management for an abdominal aortic aneurysm (AAA) >6 cm saccular dilation in a female patient? A. Emergency repair B. Prescribe analgesics and follow up with CT or ultrasound at 6-month intervals to monitor dilation expansion C. Elective repair D. Prophylactic repair

Answer 63

C. Elective repair Rationale: Elective surgical repair is indicated for an AAA >5.5 cm in males and >5.0 cm in females, or if there is rapid expansion (>0.5 cm/year) or symptoms (e.g., pain or rupture risk). Emergency repair is only needed for a ruptured AAA.

Question 64

75. In which position is a patient most prone to develop deep venous thrombosis (DVT)? A. All of the above B. Fowler's position C. Reverse Trendelenburg D. Reverse Trendelenburg and Fowler's position only E. Trendelenburg

Answer 64

D. Reverse Trendelenburg and Fowler's position only Rationale: Reverse Trendelenburg and Fowler’s position promote venous stasis in the lower extremities, increasing the risk of DVT formation.

Question 65

77. Which of the following statements is TRUE regarding transposition of the great arteries? A. Pulmonary artery arises posteriorly from the left ventricle (LV) B. Aorta arises anteriorly from the left ventricle (LV) C. Pulmonary artery arises anteriorly from the right ventricle (RV) D. Aorta arises posteriorly from the right ventricle (RV)

Answer 65

C. Pulmonary artery arises anteriorly from the right ventricle (RV) Rationale: TGA is a congenital heart defect where the great arteries are switched. The aorta arises from the RV (posteriorly), and the pulmonary artery arises from the LV (anteriorly). Final Takeaways: 🚀 TGA = Pulmonary artery arises from RV (Anterior), Aorta from RV (Posterior). 🚀 Cyanotic at birth due to "Parallel Circulations" (Needs ASD, VSD, or PDA for survival). 🚀 Treatment = PGE1 + Balloon Atrial Septostomy → Surgical Correction (Jatene

Question 66

83. The most widely used robotic surgical system today is the: A. Leonardo robot B. Goleta Robot C. Aesop Robot D. Da Vinci Robot E. None of the above

Answer 66

D. Da Vinci Robot Rationale: The Da Vinci surgical system is the most widely used robotic platform for minimally invasive surgery (MIS), offering high precision, 3D visualization, and improved dexterity.

Question 67

85. What is the most common cause of mitral stenosis? A. Rheumatic fever B. Myxomatous degenerative disease of the mitral valve C. Infective endocarditis D. Previous chest radiation

Answer 67

A. Rheumatic fever Rationale: Rheumatic fever is the leading cause of mitral stenosis worldwide, resulting in progressive fibrosis, thickening, and calcification of the mitral valve.

Question 68

86. Which of the following patients is most likely to have an improved long-term outcome with CABG rather than PCI? A. Diabetic B. Left main coronary artery involvement C. Multivessel coronary artery disease D. All of the above

Answer 68

D. All of the above Rationale: CABG is superior to PCI in patients with diabetes, left main coronary artery disease, and multivessel coronary artery disease, offering better survival and reduced need for repeat revascularization. Final Takeaways: 🚀 CABG > PCI in: Diabetics, Left Main CAD, Multivessel Disease (especially with high SYNTAX scores). 🚀 CABG improves survival and reduces MI risk compared to PCI. 🚀 PCI is preferred for single-vessel disease or low SYNTAX score LM disease.

Question 69

87. A 53-year-old female was referred for chest tube insertion due to pleural effusion. You drained blood-tinged exudative pleural fluid and suspect malignancy. Which of the following statements is TRUE? A. None are true B. Cytologic testing may not be done since gross appearance is diagnostic with thorough history and physical examination for detection of the primary tumor C. For loculated fluid or trapped lung, VATS pleurodesis is recommended D. An effusion in the setting of a malignancy that is managed early has a high survival rate

Answer 69

C. For loculated fluid or trapped lung, VATS pleurodesis is recommended Rationale: Video-assisted thoracoscopic surgery (VATS) pleurodesis is indicated for recurrent malignant pleural effusions or when the lung is trapped due to tumor invasion or pleural fibrosis.

Question 70

88. The critical pressure for insufflating the abdominal cavity should not exceed: A. 5 mmHg B. 12 mmHg C. 10 mmHg D. 8 mmHg E. 18 mmHg

Answer 70

B. 12 mmHg Rationale: 12–15 mmHg is the recommended intra-abdominal pressure for pneumoperitoneum during laparoscopic surgery to optimize visualization while minimizing cardiovascular and respiratory effects.

Question 71

89. What is the most commonly injured organ during laparoscopic cholecystectomy? A. Duodenum B. Common bile duct C. Portal vein D. Large intestine E. Stomach

Answer 71

B. Common bile duct Rationale: The common bile duct (CBD) is the most commonly injured structure due to misidentification during gallbladder dissection, leading to bile leaks, strictures, or obstruction.

Question 72

90. Hand instruments used in pediatric surgery are usually ______ than those used in conventional laparoscopic surgery. A. Thinner B. Shorter C. Longer D. Thicker

Answer 72

B. Shorter Rationale: Pediatric laparoscopic instruments are typically shorter and thinner than standard adult instruments to accommodate the smaller abdominal cavity and finer structures in children.

Question 73

93. What is the most commonly injured organ during laparoscopic cholecystectomy? A. Duodenum B. Common bile duct C. Portal vein D. Large intestine E. Stomach

Answer 73

B. Common bile duct Rationale: The common bile duct (CBD) is the most commonly injured structure during laparoscopic cholecystectomy due to misidentification of the cystic duct and excessive cautery use.

Question 74

95. What is the most common cause of pleural effusion? A. Tuberculosis B. Cancer C. Pneumonia D. Congestive heart failure

Answer 74

D. Congestive heart failure Rationale: Congestive heart failure (CHF) is the most common cause of pleural effusion, leading to transudative effusion due to increased hydrostatic pressure and fluid accumulation in the pleural space.

Question 75

96. When performing a laparoscopic right adrenalectomy, the patient is usually positioned in: A. Left lateral decubitus B. Reverse Trendelenburg C. Lithotomy D. Trendelenburg E. Supine

Answer 75

A. Left lateral decubitus Rationale: For a right adrenalectomy, the patient is placed in the left lateral decubitus position to allow better access to the retroperitoneal space and adrenal gland.

Question 76

97. In establishing abdominal access, the first trocar should be placed in the: A. Linea alba B. Retroperitoneum C. Subxiphoid process D. Umbilicus E. Right upper quadrant

Answer 76

D. Umbilicus Rationale: The umbilicus is the preferred site for the first trocar as it provides central access to the peritoneal cavity and has less subcutaneous fat, making entry easier.

Question 77

98. What is the most common cause of empyema thoracis? A. Hepatic abscess B. Pneumonia C. Penetrating chest injuries D. Postoperative infection

Answer 77

B. Pneumonia Rationale: Empyema thoracis (infected pleural effusion) is most commonly caused by pneumonia, leading to bacterial invasion of the pleural space and the accumulation of purulent fluid.

Question 78

99. Which of the following statements is TRUE regarding tricuspid atresia? A. Tricuspid atresia is the most common form of the single-ventricle complex B. Left heart filling is dependent on an atrial septal defect (ASD) C. The right ventricle is hypoplastic D. All are true

Answer 78

D. All are true Rationale: Tricuspid atresia is a cyanotic congenital heart defect characterized by: Hypoplastic right ventricle Dependence on an atrial septal defect (ASD) for left heart filling It being the most common single-ventricle complex

Question 79

100. Which of the following statements is TRUE regarding aortic stenosis? A. The most common cause is rheumatic heart disease B. It is an age-related disorder C. It has a harsh, crescendo-decrescendo systolic murmur D. All are true

Answer 79

B. It is an age-related disorder ✔ Senile (degenerative) calcific aortic stenosis is the most common cause in elderly patients (>65 years). ✔ Progressive calcification of the valve leads to leaflet thickening and obstruction. Final Takeaways: 🚀 Most common cause of AS in elderly = Degenerative (Senile) Calcification. 🚀 Harsh, crescendo-decrescendo murmur radiating to carotids. 🚀 Classic "SAD" triad = Syncope, Angina, Dyspnea. 🚀 Definitive treatment = Valve replacement (TAVR/SAVR) for severe symptomatic AS.

Question 80

1. Which of the following is the most commonly used access needle in endovascular procedures? A. Chiba needle B. Seldinger needle C. Jamshidi needle D. Touhy needle

Answer 80

B. Seldinger needle 📌 Explanation: The Seldinger needle is the most widely used access needle in endovascular procedures, allowing for safe and efficient vascular access.

Question 81

3. What is the most frequently used direction for catheter access in endovascular procedures? A. Antegrade B. Retrograde C. Transluminal D. Contralateral

Answer 81

B. Retrograde 📌 Explanation: The retrograde approach is the most commonly used method for catheter access, where the catheter is advanced against the direction of blood flow.

Question 82

4. What is the primary function of guidewires in endovascular procedures? A. To puncture the artery for access B. To inject contrast during angiography C. To introduce, position, and exchange catheters inside the vessel D. To directly remove plaques from the artery

Answer 82

C. To introduce, position, and exchange catheters inside the vessel 📌 Explanation: Guidewires facilitate the safe introduction and movement of catheters through the vascular system while maintaining access to the vessel.

Question 83

5. What is the primary purpose of a hemostatic sheath in endovascular procedures? A. To stop bleeding from an arterial puncture B. To serve as a conduit for catheters while protecting the vessel from repeated trauma C. To measure intravascular pressure D. To facilitate stent deployment

Answer 83

B. To serve as a conduit for catheters while protecting the vessel from repeated trauma 📌 Explanation: Hemostatic sheaths are used in endovascular procedures to allow multiple catheter exchanges without additional trauma to the vessel.

Question 84

6. Which of the following is NOT a type of catheter used in endovascular procedures? A. Diagnostic catheter B. Guiding catheter C. Suction catheter D. Interventional catheter

Answer 84

C. Suction catheter 📌 Explanation: Diagnostic catheters (for imaging), guiding catheters (for support), and interventional catheters (for therapeutic procedures) are commonly used in endovascular procedures. Suction catheters are primarily used in pulmonary or airway suctioning, not vascular interventions.

Question 85

7. What is the function of an angioplasty balloon in vascular procedures? A. To remove thrombi from blood vessels B. To compress plaques against the vessel wall, increasing lumen diameter C. To suction out atherosclerotic debris D. To permanently replace a diseased artery

Answer 85

B. To compress plaques against the vessel wall, increasing lumen diameter 📌 Explanation: Angioplasty balloons are used to dilate narrowed vessels by inflating and compressing the plaque against the arterial wall, thereby improving blood flow.

Question 86

8. Which of the following best describes the function of a vascular stent? A. It serves as a temporary scaffold to prevent vessel collapse B. It dissolves plaque within the artery C. It acts as a conduit to redirect blood flow D. It removes emboli from the arterial circulation

Answer 86

A. It serves as a temporary scaffold to prevent vessel collapse 📌 Explanation: Stents are metallic mesh-like tubes placed inside vessels to prevent collapse and reduce restenosis (re-narrowing) post-angioplasty.

Question 87

9. What is the primary function of a stent graft in vascular interventions? A. To permanently replace an occluded artery B. To act as a conduit for bypassing a stenotic segment C. To repair vascular lesions and exclude aneurysms from circulation D. To break down and absorb thrombi in the vessel

Answer 87

C. To repair vascular lesions and exclude aneurysms from circulation 📌 Explanation: Stent grafts are covered metallic stents that provide structural support while excluding aneurysms from circulation, most commonly used in abdominal aortic aneurysm (AAA) repair.

Question 88

10. Which vascular condition is most commonly treated using a stent graft? A. Deep vein thrombosis (DVT) B. Aortic aneurysm C. Peripheral artery disease (PAD) D. Carotid artery stenosis

Answer 88

B. Aortic aneurysm 📌 Explanation: Stent grafts are primarily used for aneurysm exclusion, particularly in endovascular aneurysm repair (EVAR) for AAA and thoracic aortic aneurysms.

Question 89

31. Hypoplasia of the left ventricle (LV) and ascending aorta is characteristic of: A. Tetralogy of Fallot B. Transposition of the great arteries C. Hypoplastic left heart syndrome D. Total anomalous pulmonary venous return

Answer 89

C. Hypoplastic Left Heart Syndrome (HLHS) Explanation: Hypoplastic Left Heart Syndrome (HLHS) is characterized by underdevelopment (hypoplasia) of the left ventricle (LV) and ascending aorta, along with atresia or stenosis of the aortic and/or mitral valve. This leads to severe systemic circulation impairment, as the left side of the heart is unable to effectively pump blood to the body. Survival depends on a patent ductus arteriosus (PDA) to allow blood to bypass the nonfunctional left heart. Defects Requiring Palliation – Tricuspid Atresia Hypoplastic Left Heart Syndrome (HLHS)

Question 90

77. A 54-year-old woman underwent a laparoscopic cholecystectomy with CO₂ insufflation. During the procedure, her heart rate suddenly decreased to 40 bpm. What is the most likely cause of her bradycardia? A. Air embolism B. Pneumoperitoneum C. Pulmonary embolism D. Excessive anesthetic depth

Answer 90

B. Pneumoperitoneum Explanation: CO₂ insufflation increases intra-abdominal pressure, which can stimulate the vagus nerve, leading to bradycardia, hypotension, and arrhythmias. This vagal response is the most common cause of intraoperative bradycardia during laparoscopy. 🚨 Management: ✔️ Stop insufflation temporarily to relieve vagal stimulation. ✔️ Administer atropine if bradycardia persists. ✔️ Monitor hemodynamics closely.

Question 91

78. Which of the following is NOT routinely increased in laparoscopic surgery? A. Intra-abdominal pressure B. Venous return C. Systemic vascular resistance D. End-tidal CO₂

Answer 91

B. Venous return Explanation: Pneumoperitoneum (CO₂ insufflation) compresses the inferior vena cava (IVC), reducing venous return to the heart. This can decrease cardiac output and lead to hypotension, especially in patients with cardiovascular disease. 🚨 What is routinely increased? ✔️ A. Intra-abdominal pressure – CO₂ insufflation increases to 12-15 mmHg to create a working space. ✔️ C. Systemic vascular resistance (SVR) – Increased intra-abdominal pressure leads to elevated SVR and afterload. ✔️ D. End-tidal CO₂ (EtCO₂) – CO₂ is absorbed systemically, causing transient hypercarbia and respiratory acidosis. 📌 Key Takeaway: CO₂ insufflation compresses everything, leading to increased pressures & decreased blood flow. Laparoscopic surgery requires careful ventilation & hemodynamic monitoring.

Question 92

79. Which of the following is NOT routinely recommended after initial trocar placement in laparoscopic surgery? A. Routine peritoneal lavage B. Insertion of additional trocars C. CO₂ insufflation D. Confirmation of peritoneal entry

Answer 92

A. Routine peritoneal lavage Explanation: Routine peritoneal lavage is not a standard step in laparoscopic surgery unless there is contamination (e.g., bile, pus, or blood). CO₂ insufflation (pneumoperitoneum) is performed immediately after confirming trocar placement. 🚨 What is routinely recommended? ✔️ B. Insertion of additional trocars – Needed for instrument access. ✔️ C. CO₂ insufflation – Required to expand the working space. ✔️ D. Confirmation of peritoneal entry – Ensures safe trocar placement before proceeding.

Question 93

13. Which of the following is an absolute contraindication to laparoscopic surgery? A. Morbid obesity B. Severe COPD C. History of multiple abdominal surgeries D. Pregnancy in the second trimester

Answer 93

B. Severe COPD Rationale: Severe COPD is an absolute contraindication because CO₂ pneumoperitoneum can cause hypercapnia, respiratory acidosis, and ventilatory failure. Morbid obesity, prior abdominal surgeries, and pregnancy (2nd trimester) are relative contraindications.

Question 94

12. During laparoscopic surgery, which of the following is a major cardiovascular effect of CO₂ insufflation? A. Increased cardiac output B. Increased systemic vascular resistance C. Decreased systemic vascular resistance D. Increased venous return

Answer 94

B. Increased systemic vascular resistance Rationale: CO₂ insufflation increases intra-abdominal pressure, leading to IVC compression and increased systemic vascular resistance (SVR). This results in reduced venous return and decreased cardiac output.

Question 95

14. What is the most serious complication of CO₂ insufflation during laparoscopy? A. Hypercarbia B. Subcutaneous emphysema C. CO₂ embolism D. Respiratory acidosis

Answer 95

C. CO₂ embolism Rationale: A CO₂ embolism occurs when CO₂ enters the venous system, leading to air trapping in the heart or lungs. Signs: Sudden hypotension, tachycardia, cyanosis, and "mill wheel murmur." Management: Stop insufflation, place patient in left lateral decubitus, and aspirate CO₂ from the heart via central line.

Question 96

17. What is the recommended intra-abdominal pressure for CO₂ pneumoperitoneum in pediatric laparoscopy? A. 5-8 mmHg B. 8-10 mmHg C. 12-15 mmHg D. 18-20 mmHg

Answer 96

A. 5-8 mmHg Rationale: Children require lower insufflation pressures (5-8 mmHg) to prevent cardiovascular and respiratory compromise. Adults use 12-15 mmHg for optimal visualization.