LE4 Surgery >:( Flashcards
(98 cards)
1
Q
- Above the arcuate line, the posterior rectus sheath is formed by:
A. Internal oblique aponeurosis, transversalis fascia
B. Internal oblique aponeurosis, transverse abdominis aponeurosis
C. Transverse abdominis aponeurosis, transversalis fascia
D. External oblique aponeurosis, transversalis fascia
A
B. Internal oblique aponeurosis, transverse abdominis aponeurosis
2
Q
- Above the arcuate line, the anterior rectus sheath is formed by:
A. Transversalis fascia
B. Internal oblique aponeurosis, transverse abdominis aponeurosis
C. External oblique aponeurosis, internal oblique aponeurosis
D. Internal oblique aponeurosis
A
C. External oblique aponeurosis, internal oblique aponeurosis
3
Q
- The superior epigastric artery arises from:
A. Axillary artery
B. Internal thoracic artery
C. Vertebral artery
D. Subclavian artery
A
B. Internal thoracic artery
4
Q
- Below the semicircular line of Douglas (arcuate line), the rectus muscle is separated from the abdominal organs only by:
A. External oblique aponeurosis
B. Transversalis fascia
C. Laminae of the internal oblique aponeurosis
D. Transverse abdominis aponeurosis
A
B. Transversalis fascia
5
Q
- The inferior epigastric artery arises from:
A. External iliac artery
B. External pudendal artery
C. Superficial iliac circumflex artery
D. Lateral thoracic artery
A
A. External iliac artery
6
Q
- A palpable abdominal mass that remains unchanged with contraction of the rectus muscles is known as:
A. Rovsing’s sign
B. Father’s sign
C. Murphy’s sign
D. Fothergill’s sign
A
D. Fothergill’s sign
7
Q
- When part of the wall of the hernia sac is formed by the herniating viscus, it is called:
A. Spigelian hernia
B. Sliding hernia
C. Littre’s hernia
D. Richter’s hernia
A
B. Sliding hernia
8
Q
- The surgical treatment for Nyhus Type I hernia is:
A. Bassini
B. McVay
C. Lichtenstein
D. Herniotomy
A
A. Bassini
Clarification:
Nyhus Type I hernia refers to an indirect inguinal hernia with a normal internal ring.
Bassini repair is a non-mesh technique involving sutures to repair the inguinal canal floor. While mesh repairs like Lichtenstein are now preferred, Bassini remains significant for historical and certain clinical settings.
Herniotomy: involves sac excision and is often used in children or cases without significant repair needs.
9
Q
- Which of the following is a retroperitoneal organ?
A. Spleen
B. Liver
C. Pancreas
D. Stomach
A
C. Pancreas
10
Q
- What structure is known as the “wall of infection”?
A. Mesentery
B. Omentum
C. Diaphragm
D. Peritoneum
A
B. Omentum
11
Q
- A mesenteric cyst presents with a mass that is mobile only from the patient’s right to left or left to right. This finding is known as:
A. Kennedy’s sign
B. Tillaux’s sign
C. Fothergill’s sign
D. Ross’s sign
A
B. Tillaux’s sign
12
Q
- Idiopathic retroperitoneal fibrosis is also known as:
A. Ormond’s Disease
B. Meigs’ Disease
C. Whipple’s Disease
D. Budd-Chiari Syndrome
A
A. Ormond’s Disease
13
Q
- The hallmark of mesenteric ischemia is:
A. Abdominal distention with abdominal pain
B. Passage of bloody stool with abdominal pain
C. Abdominal pain with vomiting
D. Severe abdominal pain is out of proportion to the degree of tenderness on examination
A
D. Severe abdominal pain is out of proportion to the degree of tenderness on examination
Clarification:
In acute mesenteric ischemia, severe abdominal pain that is disproportionate to the physical examination findings is the classic hallmark symptom.
14
Q
- Regulation of intestinal absorption and secretion. The agent that stimulates absorption or inhibits the secretion of water is:
A. Aldosterone
B. Secretin
C. Vasopressin
D. All of the above
A
A. Aldosterone
Aldosterone: Enhances sodium and water absorption in the intestines.
15
Q
- Regulation of intestinal absorption and secretion. Agents that stimulate secretion or inhibit absorption of water include:
A. Dopamine
B. Somatostatin
C. Prostaglandins
D. None of the above
A
C. Prostaglandins
Clarification:
Prostaglandins: Stimulate intestinal secretion and inhibit water absorption.
Somatostatin: Inhibits secretion.
Dopamine: Minimal direct role in this process.
16
Q
- A second-look operation for a patient who had bowel resection due to thrombosis of superior mesenteric artery occlusion is usually done after:
A. 2 days
B. 6 days
C. 4 days
D. 8 days
A
A. 2 days
Clarification:
A second-look operation is typically performed within 24-48 hours (2 days) to assess for bowel viability and identify any delayed ischemia.
17
Q
- The strongest layer of the intestinal wall is:
A. Serosa
B. Submucosa
C. Muscularis
D. Lamina propria
A
B. Submucosa
Clarification:
The submucosa is the strongest layer of the intestinal wall due to its dense connective tissue and supportive function, making it crucial in surgical anastomoses.
18
Q
- The most common site of involvement in intestinal tuberculosis is:
A. Ileocecal
B. Duodenum
C. Jejunum
D. Sigmoid colon
A
A. Ileocecal
Clarification:
The ileocecal region is the most common site of intestinal tuberculosis due to the abundance of lymphoid tissue (Peyer’s patches) and stasis of intestinal contents.
19
Q
- The approximate length of the jejunum is:
A. 50–60 cm
B. 80–90 cm
C. 100–110 cm
D. 130–150 cm
A
C. 100–110 cm
Clarification:
The jejunum typically measures 100–110 cm and constitutes the proximal part of the small intestine following the duodenum.
20
Q
- Which of the following lies in the retroperitoneum?
A. Jejunum
B. Ileum
C. Duodenum
D. Sigmoid colon
A
C. Duodenum
Clarification:
The duodenum (except the first part) lies in the retroperitoneum, making it less mobile compared to other parts of the small intestine.
21
Q
- The only type of peritonitis where abdominal pain and tenderness are preceded by a few days of high fever is caused by:
A. Perforated typhoid ulcer
B. Acute appendicitis
C. Perforated peptic ulcer
D. Tuberculous peritonitis
A
A. Perforated typhoid ulcer
Clarification:
In typhoid fever, hyperplasia and necrosis of Peyer’s patches in the terminal ileum can lead to intestinal perforation, presenting with fever followed by abdominal pain and tenderness.
22
Q
- The most common symptom of Meckel’s diverticulum in childhood is:
A. Intestinal obstruction
B. Rectal bleeding
C. Abdominal pain
D. Intussusception
A
B. Rectal bleeding
Clarification:
In children, rectal bleeding is the most common symptom of Meckel’s diverticulum due to ulceration caused by ectopic gastric mucosa.
23
Q
- A common cause of abdominal pain in children and young adults, self-limiting, where spasms of colic are followed by periods when the patient feels well, is:
A. Acute appendicitis
B. Infectious mononucleosis
C. Non-specific mesenteric lymphadenitis
D. Regional enteritis
A
C. Non-specific mesenteric lymphadenitis
Clarification:
Non-specific mesenteric lymphadenitis is a self-limiting condition often caused by viral infections, leading to colicky abdominal pain with intervals of well-being.
24
Q
- The highest preponderance of omental involvement (metastasis) occurs in:
A. Ovarian cancer
B. Gastric cancer
C. Colon cancer
D. Pancreatic cancer
A
A. Ovarian cancer
Clarification:
Omental metastasis is most commonly associated with ovarian cancer due to its peritoneal spread within the abdominal cavity.
25
41. The usual presentation of rectus sheath hematoma is:
A. Unexplained anemia
B. Abdominal mass is prominent
C. Sudden abdominal pain
D. Inability to stand erect
C. Sudden abdominal pain
Clarification:
The most common presentation of rectus sheath hematoma is sudden abdominal pain, often mimicking an acute abdomen.
26
42. Rectus sheath hematoma is:
A. An emergency surgical case
B. A self-limiting condition
C. Will not simulate acute abdomen
D. 3x more common in men
B. A self-limiting condition
Clarification:
Rectus sheath hematoma is often self-limiting and managed conservatively unless there is significant bleeding or hemodynamic instability.
27
45. The most common presentation of Meckel's diverticulum in adults is:
A. Bleeding
B. Perforation
C. Intestinal obstruction
D. Abdominal mass
C. Intestinal obstruction
Clarification:
In adults, the most common presentation of Meckel's diverticulum is intestinal obstruction.
In children, the most common presentation is rectal bleeding due to ectopic gastric mucosa.
(Ref: Schwartz's Principles of Surgery, 11th ed., Chapter 28, p. 1247)
28
46. The length of the jejunum is approximately:
A. 100 cm
B. 200 cm
C. 250 cm
D. 400 cm
C. 250 cm (2.5 meters)
Clarification:
The jejunum measures approximately 2.5 meters (or 250–300 cm) and is distinguished by the presence of plicae circulares and villi, which aid in absorption.
29
49. The second most common site of diverticulum formation after the colon is:
A. Duodenum
B. Jejunum
C. Ileum
D. Sigmoid colon
A. Duodenum
Clarification:
Duodenal diverticula are the second most common after colonic diverticula.
Jejunoileal diverticula are less common.
30
50. Meckel's diverticulum is a relatively wide projection arising from the antimesenteric side of the ileum and is located approximately:
A. 45 to 60 cm proximal to the ileocecal valve
B. 15 to 30 cm proximal to the ileocecal valve
C. 85 to 100 cm proximal to the ileocecal valve
D. 115 to 130 cm proximal to the ileocecal valve
C. 85 to 100 cm proximal to the ileocecal valve
Clarification:
Meckel's diverticulum is a true diverticulum involving all layers of the intestinal wall and is typically located 85–100 cm proximal to the ileocecal valve on the antimesenteric border.
31
51. The blood supply of the small intestine comes from the:
A. Celiac axis
B. Superior mesenteric artery
C. Inferior mesenteric artery
D. Appendicular artery
B. Superior mesenteric artery
Clarification:
The superior mesenteric artery supplies the majority of the small intestine (jejunum and ileum). The celiac trunk supplies the duodenum (proximal portion).
32
52. The most common etiology for rectus sheath hematoma is:
A. Infectious
B. Collagen disease
C. Blood dyscrasia
D. All of the above
D. All of the above
Clarification:
Rectus sheath hematoma is commonly caused by:
Abdominal trauma
Anticoagulation
Coagulation disorders (e.g., blood dyscrasia)
Collagen vascular diseases
33
57. The treatment of malignant neoplasms of the small intestine is:
A. Observation
B. Radiotherapy
C. Segmental resection and primary anastomosis
D. Wide resection including regional lymph nodes
D. Wide resection including regional lymph nodes
Clarification:
For malignant small bowel neoplasms, wide resection of the tumor including regional lymph nodes is the standard treatment to ensure complete removal and to address potential metastasis.
34
58. The treatment of benign neoplasms of the small intestine is:
A. Observation
B. Radiotherapy
C. Segmental resection and primary anastomosis
D. Wide resection including regional lymph nodes
D. Wide resection including regional lymph nodes
35
61. The most common cancer to have omental involvement is:
A. Gastric carcinoma
B. Pancreatic carcinoma
C. Ovarian carcinoma
D. Colorectal carcinoma
C. Ovarian carcinoma
Clarification:
Omental involvement (carcinomatosis) is most commonly associated with ovarian cancer, which spreads intraperitoneally to the omentum.
36
62. A 68-year-old woman presents with vague diffuse abdominal discomfort over the past 3 weeks. On examination, there is mild to moderate subjective tenderness without guarding or peritoneal signs, and she is in sinus rhythm on EKG. The most likely diagnosis is:
A. Nonocclusive mesenteric ischemia
B. Superior mesenteric artery embolus
C. Mesenteric venous thrombosis
D. Superior mesenteric artery thrombosis
C. Mesenteric venous thrombosis
Clarification:
Mesenteric venous thrombosis often presents subacutely or chronically with vague abdominal pain over weeks.
Patients may not have risk factors for embolic events (e.g., sinus rhythm rules out atrial fibrillation).
Tenderness without guarding or peritoneal signs is characteristic in the early phase.
Risk factors can include hypercoagulable states, vitamin supplementation (e.g., vitamin D causing hypercalcemia), and dehydration, which could predispose venous thrombosis.
37
65. A 53-year-old white man presents with a 3-day history of increasing crampy abdominal pain, constipation, and intermittent vomiting. He continues to pass gas. Other than the present complaints, he has been healthy. Examination reveals a distended abdomen with high-pitched bowel sounds. There is no localized tenderness, no rectal masses, and the stool is heme positive. Diagnostically, the first step should be to perform:
A. Total colonoscopy and mesenteric angiography
B. Flat plate & erect abdominal X-rays
C. Upper GI X-rays with small bowel follow-through
D. Barium enema
B. Flat plate & erect abdominal X-rays
Clarification:
A flat plate (KUB) and erect abdominal X-ray are the initial imaging studies to diagnose small bowel obstruction (SBO), which this patient likely has.
Findings such as air-fluid levels and bowel distention confirm the diagnosis.
38
66. The management for small bowel obstruction (SBO) in this case is:
A. Immediate exploratory laparotomy
B. Observation and supportive care
C. Endoscopic decompression
D. Antibiotic therapy only
A. Immediate exploratory laparotomy
Clarification:
In cases of complete bowel obstruction or signs of strangulation (e.g., heme-positive stools, crampy pain), immediate exploratory laparotomy is required to identify and correct the cause.
39
69. Meckel's diverticulum originates from the:
A. Foregut
B. Midgut
C. Hindgut
B. Midgut
Clarification:
Meckel's diverticulum arises from a persistent remnant of the omphalomesenteric duct, which connects the midgut to the yolk sac during fetal development.
40
70. Volume replacement in a patient with small bowel obstruction is probably adequate when:
A. Urine output is established
B. Hematocrit is normalized
C. Bowel sounds return to normal
D. The serum electrolytes are normal
A. Urine output is established
Clarification:
Adequate resuscitation in SBO is best monitored by ensuring urine output (≥ 0.5–1 mL/kg/hr) because it reflects improved renal perfusion and overall fluid status.
41
73. Which of the following structures is used in Marcy repair?
A. Inguinal ligament
B. Internal oblique
C. Iliopectineal ligament
D. Cooper's ligament
E. Transversalis fascia
E. Transversalis fascia
Clarification:
Marcy repair is a nonprosthetic repair for small, indirect inguinal hernias (Nyhus Type I).
The key features include high ligation of the hernia sac and narrowing of the internal ring using the transversalis fascia.
42
74. Which of the following structures is used in McVay repair?
A. Inguinal ligament
B. Internal oblique
C. Iliopectineal ligament
D. Cooper's ligament
E. Transversalis fascia
D. Cooper's ligament
Clarification:
McVay repair (or Cooper's ligament repair) is used to address both inguinal and femoral hernias.
It involves suturing the transversalis fascia and conjoint tendon to Cooper's ligament (not Poupart’s/inguinal ligament).
A relaxing incision is made to reduce tension during the repair.
Comparison of Repairs:
McVay repair: Uses Cooper's ligament.
Bassini repair: Uses Poupart's (inguinal) ligament.
Shouldice repair: Involves the inguinal ligament, Cooper's ligament, and iliopubic tract.
43
85. Below the semicircular line of Douglas, the rectus muscles are separated from the abdominal organs only by:
A. Peritoneum
B. Transversalis fascia
C. Internal oblique aponeurosis
D. Transverse abdominis aponeurosis
B. Transversalis fascia
Clarification:
Below the arcuate line (semicircular line of Douglas), all the aponeuroses of the abdominal wall muscles (external oblique, internal oblique, and transverse abdominis) move anterior to the rectus abdominis muscle. Therefore, only the transversalis fascia separates the rectus muscles from the parietal peritoneum and abdominal organs.
44
86. What type of hernia occurs when the incarcerated viscus is the appendix?
A. Littre's hernia
B. Richter's hernia
C. Amyand's hernia
D. Spigelian hernia
C. Amyand's hernia
Clarification:
Amyand's hernia: A rare type of hernia where the appendix is the content of the hernia sac, often inflamed or incarcerated.
Littre's hernia: Herniation involving a Meckel's diverticulum.
Richter's hernia: Herniation of only the anti-mesenteric wall of the intestine.
Spigelian hernia: Herniation through the Spigelian fascia of the abdominal wall.
45
93. The sac of an indirect hernia passes lateral to the inferior epigastric vessel to the scrotum.
A. TRUE
B. FALSE
A. TRUE
Clarification:
An indirect inguinal hernia occurs when the hernia sac passes lateral to the inferior epigastric vessels through the deep inguinal ring and into the inguinal canal, potentially reaching the scrotum.
46
94. Hoguet's maneuver is performed in the treatment of femoral hernia.
A. TRUE
B. FALSE
A. TRUE
Clarification:
Hoguet's maneuver is a technique used for reducing femoral hernias or medial sliding hernias. The maneuver converts the hernia into a lateral inguinal hernia, facilitating repair.
47
95. The management for sigmoid adenocarcinoma is:
A. Chemotherapy
B. Radiotherapy
C. Surgical resection
D. Observation
C. Surgical resection
Clarification:
The treatment of choice for sigmoid adenocarcinoma is surgical resection to remove the tumor completely and restore bowel continuity when feasible.
48
96. Evaluation of the whole colon is important, except in cases of:
A. Synchronous lesion
B. Diverticulitis
C. Synchronous carcinoma
D. Intercolonic lesion
B. Diverticulitis
Clarification:
While colonoscopy is critical for detecting synchronous carcinomas or lesions, it is not mandatory for simple cases of diverticulitis, which can be diagnosed clinically and with imaging studies.
49
97. Femoral hernia is rarely strangulated.
A. TRUE
B. FALSE
B. FALSE
Clarification:
Femoral hernias are particularly prone to strangulation due to their narrow neck and tight femoral canal. This makes them more likely to compromise blood flow, leading to strangulation.
50
100. Shouldice repair uses transversalis fascia ONLY.
A. TRUE
B. FALSE
B. FALSE
Clarification:
The Shouldice repair involves multiple layers of sutures and uses the transversalis fascia, inguinal ligament (Poupart’s), Cooper's ligament, and iliopubic tract to reinforce the inguinal canal.
51
6. The superior epigastric artery arises from:
A. Axillary artery
B. Internal thoracic artery
C. Vertebral artery
D. Subclavian artery
E. None of the above
B. Internal thoracic artery
52
7. The inferior epigastric artery arises from:
A. External iliac artery
B. External pudendal artery
C. Superior iliac circumflex artery
D. Lateral thoracic artery
E. None of the above
A. External iliac artery
53
8. A palpable abdominal mass that remains unchanged with contraction of the rectus muscles:
A. Rovsing’s sign
B. Father’s sign
C. Murphy’s sign
D. Fothergill’s sign
E. None of the above
D. Fothergill’s sign
54
9. The most definitive study to establish the correct diagnosis and to exclude other disorders from rectus sheath hematoma is:
A. CT scan
B. MRI
C. Ultrasound
D. History and PE
E. None of the above
A. CT scan
55
10. Retroperitoneal structure/s include:
A. Duodenum (D2 & D3)
B. Descending colon
C. Both A and B
D. None of the above
E. None of the above
C. Both A and B
56
21. The hallmark of acute mesenteric ischemia is:
A. Abdominal distention with abdominal pain
B. Passage of bloody stool with abdominal pain
C. Abdominal pain with vomiting
D. Severe abdominal pain out of proportion to the degree of tenderness on examination
D. Severe abdominal pain out of proportion to the degree of tenderness on examination
57
22. Regulation of intestinal absorption and secretion. Agents that stimulate absorption or inhibit secretion of water:
A. Aldosterone
B. Secretin
C. Vasopressin
D. All of the above
A. Aldosterone
58
23. Regulation of intestinal absorption and secretion. Agents that stimulate secretion or inhibit absorption of water:
A. Dopamine
B. Somatostatin
C. Prostaglandins
D. None of the above
C. Prostaglandins
59
24. A second-look operation for a patient who had bowel resection due to thrombosis of superior mesenteric occlusion is usually done after:
A. 2 days
B. 6 days
C. 4 days
D. 8 days
A. 2 days
Clarification:
A second-look procedure is performed 24–48 hours after the initial resection to assess bowel viability.
60
25. The strongest layer of the intestinal wall is:
A. Serosa
B. Submucosa
C. Muscularis
D. Lamina propria
B. Submucosa
Clarification:
The submucosa is the strongest layer of the intestinal wall due to its dense connective tissue, which provides structural integrity.
61
26. The most common site of involvement in intestinal tuberculosis is:
A. Ileocecal
B. Duodenum
C. Jejunum
D. Sigmoid colon
A. Ileocecal
Clarification:
The ileocecal region is the most common site of intestinal tuberculosis due to its high lymphoid tissue content (Peyer’s patches).
62
27. The only type of peritonitis where abdominal pain and tenderness are preceded by a few days of high fever is:
A. Primary peritonitis
B. Tertiary peritonitis
C. Perforated peptic ulcer
D. Perforated typhoid ulcer
D. Perforated typhoid ulcer
Clarification:
In perforated typhoid ulcer, high fever precedes abdominal pain and tenderness due to necrosis and perforation of Peyer’s patches.
63
28. The most common small bowel cancer is:
A. Adenocarcinoma
B. Lymphomas
C. GISTs
D. Carcinoid tumors
A. Adenocarcinoma
Clarification:
Adenocarcinoma is the most common malignancy of the small intestine, often found in the duodenum.
64
29. The treatment of malignant neoplasms of the small intestine is:
A. Observation
B. Radiotherapy
C. Segmental resection and primary anastomosis
D. Wide resection including regional lymph nodes
D. Wide resection including regional lymph nodes
Clarification:
For malignant small bowel neoplasms, the standard treatment is wide resection of the tumor along with regional lymph node dissection to ensure complete removal and address potential metastasis.
65
30. The dimension of the jejunum is:
A. 100–110 cm
B. 150–160 cm
C. 200–210 cm
D. 250–300 cm
A. 100–110 cm
66
31. Peyer’s patches are most commonly found in the:
A. Duodenum
B. Jejunum
C. Ileum
D. Cecum
C. Ileum
Clarification:
Peyer’s patches are lymphoid aggregates found predominantly in the ileum of the small intestine.
67
32. The ileum measures approximately:
A. 100–110 cm
B. 150–160 cm
C. 200–210 cm
D. 300–350 cm
B. 150–160 cm
68
33. Carcinoid tumors originate from:
A. Enterochromaffin cells
B. Kulchitsky cells
C. Goblet cells
D. Paneth cells
B. Kulchitsky cells
Clarification:
Carcinoid tumors arise from Kulchitsky cells (neuroendocrine cells) found in the gastrointestinal tract.
69
34. Gastrointestinal stromal tumors (GISTs) arise from:
A. Smooth muscle cells
B. Interstitial cells of Cajal
C. Enterochromaffin cells
D. Goblet cells
B. Interstitial cells of Cajal
Clarification:
GISTs are mesenchymal tumors that originate from the interstitial cells of Cajal within the myenteric plexus.
70
35. Adenocarcinoma of the small intestine is:
A. The most common benign neoplasm
B. The most common malignant neoplasm
C. Rarely found in the duodenum
D. Related to Meckel's diverticulum
B. The most common malignant neoplasm
Clarification:
Adenocarcinoma is the most common malignant neoplasm of the small intestine, particularly in the duodenum.
71
46. The approximate length of the jejunum is:
A. 20 cm
B. 100–110 cm
C. 150–160 cm
D. 200–210 cm
D. 200–210 cm
72
47. Treatment of rectus sheath hematoma except:
A. Bed rest
B. Discontinue anticoagulants
C. Analgesics
D. Immediate surgery
D. Immediate surgery
Clarification:
The initial management for rectus sheath hematoma is conservative: bed rest, analgesia, fluid resuscitation, and reversal of anticoagulation. Surgery is reserved for hemodynamic instability or complications.
73
48. The strongest layer of the abdominal wall is:
A. Linea alba
B. Transversalis fascia
C. Rectus muscle
D. External and internal oblique muscle
B. Transversalis fascia
Clarification:
The transversalis fascia is considered the strongest layer of the abdominal wall, providing significant structural support.
74
49. The second most common site of diverticulum formation in the colon is:
A. Duodenum
B. Jejunum
C. Ileum
D. Sigmoid colon
A. Duodenum
Clarification:
Duodenal diverticula are the second most common after colonic diverticula and are five times more common than jejunoileal diverticula.
75
50. Meckel's diverticulum is a relatively wide projection arising from the antimesenteric side of the ileum and is located approximately:
A. 45–60 cm proximal to the ileocecal valve
B. 15–30 cm proximal to the ileocecal valve
C. 85–100 cm proximal to the ileocecal valve
D. 115–130 cm proximal to the ileocecal valve
C. 85–100 cm proximal to the ileocecal valve
Clarification:
Most Meckel's diverticula are found within 60–100 cm of the ileocecal valve, commonly on the antimesenteric border of the ileum.
76
51. Treatment for malignant neoplasms of the small intestine:
A. Primary anastomosis
B. Radiation
C. Observation
D. Wide resection including regional lymph nodes
D. Wide resection including regional lymph nodes
Explanation:
For malignant small bowel tumors, the standard treatment involves wide resection of the involved bowel segment along with regional lymph nodes to ensure proper oncologic control.
77
52. Most common symptom of Meckel’s diverticulum in childhood:
A. Intestinal obstruction
B. Acute diverticulitis
C. Abdominal pain
D. Bleeding
D. Bleeding
Explanation:
In children, the most common presentation of Meckel's diverticulum is painless rectal bleeding due to ulceration caused by ectopic gastric mucosa.
78
53. Short bowel syndrome has been arbitrarily defined in adults as having a small intestine of less than what length?
A. 100 cm
B. 300 cm
C. 200 cm
D. 50 cm
A. 100 cm
Explanation:
Short bowel syndrome in adults is defined as having a small intestine length of less than 100 cm, resulting in malabsorption and the need for nutritional support.
79
54. Which of the following is correct with regards to Crohn’s disease?
A. Pathergy is a common finding
B. Mesenteric fat wrapping is considered pathognomonic
B. Mesenteric fat wrapping is considered pathognomonic
Explanation:
Mesenteric fat wrapping or "creeping fat" is considered pathognomonic for Crohn’s disease and involves fat extending along the bowel wall, seen during surgery or imaging.
80
55. Which small bowel tumor has the greatest malignant potential?
A. Brunner’s gland adenoma
B. Villous adenoma
C. Leiomyoma
D. Fibroadenoma
E. Hamartoma
B. Villous adenoma
Explanation:
Villous adenomas have the highest malignant potential among small bowel tumors, especially when they are larger than 1 cm, as they can progress to adenocarcinoma.
81
66. A 63-year-old man presents with a 3-day history of crampy abdominal pain, constipation, and intermittent vomiting. He continues to pass gas. Examination reveals a distended abdomen with high-pitched bowel sounds. There is no localized tenderness, and the stool is heme positive. What should be included in the therapy?
A. IV, NGT, Observe
B. Immediate surgery
C. Bowel rest and antibiotics
D. CT scan for further evaluation
A. IV, NGT, Observe
Explanation:
Initial therapy for suspected partial small bowel obstruction includes:
IV fluids for resuscitation
Nasogastric tube (NGT) for decompression
Observation for 24 hours to assess for resolution.
Surgery is indicated only if there are signs of strangulation or failure to resolve.
82
67. Initial treatment of the patient with acute, complete small bowel obstruction includes which of the following?
A. Immediate operation is warranted as soon as the diagnosis is made.
B. Nasogastric decompression for 24 hours allows spontaneous resolution of complete bowel obstruction in most patients.
C. The presence of fever, tachycardia, localized pain, or leukocytosis suggests strangulation and warrants prompt operation.
D. All patients with complete small bowel obstruction require blood and plasma for resuscitation.
E. If small bowel resection must be performed, a stoma and mucous fistula is necessary as anastomosis.
A. Immediate operation is warranted as soon as the diagnosis is made.
Clarification:
Complete small bowel obstruction requires immediate surgical intervention because the risk of complications, such as bowel strangulation, ischemia, and perforation, is high.
B. Nasogastric decompression may be attempted in partial obstructions but is not appropriate for complete obstruction.
C. Strangulation signs (e.g., fever, tachycardia, localized pain, leukocytosis) further emphasize the need for prompt surgery, but in complete obstruction, immediate surgery is already indicated.
D. Blood and plasma resuscitation is not universally required unless the patient is hemodynamically unstable.
E. A stoma and mucous fistula are not routinely required and are reserved for cases with extensive resection or gross contamination.
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68. With regards to Meckel’s diverticulum, which of the following statements is/are true?
A. They are found in various anatomic forms and clinical presentations in 50% of the population.
B. They are true diverticula.
C. Most complications occur in the elderly.
D. Diverticulitis is the most common complication.
E. None of the above.
B. They are true diverticula.
Clarification:
Meckel's diverticulum is a true diverticulum because it contains all layers of the intestinal wall.
Complications are more common in children, not the elderly.
The most common complication is bleeding, not diverticulitis.
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69. Meckel’s diverticulum originates from the:
A. Foregut
B. Midgut
C. Hindgut
D. Stomach
E. Colon
B. Midgut
Clarification:
Meckel’s diverticulum arises from a persistent omphalomesenteric duct, which originates from the midgut during fetal development.
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70. Volume replacement in a patient with small bowel obstruction is probably adequate when:
A. Urine output is established.
B. The blood urea nitrogen and creatinine values are within the normal range.
C. The urinary sodium concentration exceeds 40 mEq/L.
D. Urinary output exceeds 0.5 mL/kg body weight/hour.
E. The serum electrolytes are normal.
D. Urinary output exceeds 0.5 mL/kg body weight/hour.
Clarification:
Urinary output is the most reliable indicator of adequate fluid resuscitation and reflects proper renal perfusion and intravascular volume status.
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71. Amyand’s hernia involves the:
A. Meckel's Diverticulum
B. Appendix
C. Small Intestine
D. Ovary
B. Appendix
Clarification:
Amyand's hernia is a rare type of inguinal hernia where the vermiform appendix is located within the hernial sac.
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72. The McVay repair involves suturing the:
A. Cooper’s ligament & Conjoint tendon
B. Inguinal ligament & Internal oblique
C. Transversalis fascia & Cooper’s ligament
D. External oblique aponeurosis & Iliopubic tract
A. Cooper’s ligament & Conjoint tendon
Clarification:
In the McVay repair, the conjoined tendon (transversus abdominis and internal oblique) is sutured to Cooper’s ligament to repair inguinal and femoral hernias.
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73. The external oblique aponeurosis gives rise to the:
A. External spermatic fascia
B. Cremasteric muscle
C. Internal spermatic fascia
D. Dartos muscle
A. External spermatic fascia
Clarification:
The external oblique aponeurosis forms the external spermatic fascia, which surrounds the spermatic cord and testis.
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76. Above the arcuate line, the posterior rectus sheath is formed by:
A. Internal oblique aponeurosis, transverse abdominis aponeurosis
B. External oblique aponeurosis, transversalis fascia
C. Transversalis fascia only
D. Internal oblique aponeurosis, external oblique aponeurosis
A. Internal oblique aponeurosis, transverse abdominis aponeurosis
Clarification:
Above the arcuate line, the posterior rectus sheath is formed by the aponeuroses of the internal oblique and transverse abdominis muscles.
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77. The triangle of pain is defined by the following structures:
A. Iliopubic tract, gonadal vessels, femoral nerves
B. Inguinal ligament, rectus sheath, epigastric vessels
C. Iliopubic tract, Cooper's ligament, ilioinguinal nerve
D. Gonadal vessels, transversalis fascia, femoral artery
A. Iliopubic tract, gonadal vessels, femoral nerves
Clarification:
The triangle of pain is a region bounded by the iliopubic tract superiorly, gonadal vessels, and contains important femoral nerves. It is a critical area during hernia repair to avoid nerve injury.
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78. According to the Nyhus Classification System, Type IIIA refers to:
A. Indirect hernia
B. Direct hernia
C. Femoral hernia
D. Recurrent hernia
B. Direct hernia
Clarification:
In the Nyhus Classification System, Type IIIA refers to a direct inguinal hernia associated with a weakened transversalis fascia.
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79. The surgical treatment for Nyhus Type I hernia is:
A. Bassini
B. Marcy Repair
C. Lichtenstein Repair
D. Shouldice Repair
A. Bassini
Clarification:
For Nyhus Type I hernia (small, indirect hernia with a normal internal ring), the Bassini repair is a common surgical option. In children or young adults, a Marcy repair (high ligation of the hernia sac) may also be performed.
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80. When part of the wall of the hernia sac is formed by the herniating viscus, this is called:
A. Sliding inguinal hernia
B. Richter’s hernia
C. Amyand’s hernia
D. Littre’s hernia
A. Sliding inguinal hernia
Clarification:
In a sliding inguinal hernia, part of the hernia sac is formed by a viscus (e.g., colon or bladder wall). This condition is more common in older adults.
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86. Littre’s Hernia involves:
A. Appendix
B. Meckel’s diverticulum
C. Small intestine
D. Epiploic appendage
A. Appendix
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87. Richter’s Hernia involves:
A. Appendix
B. Meckel’s diverticulum
C. Anti-mesenteric bowel wall
D. Bladder
B. Meckel’s diverticulum
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88. Pantaloon Hernia is associated with:
A. Deep inguinal ring
B. Femoral canal
C. External oblique aponeurosis
D. Cooper’s ligament
A. Deep inguinal ring
Clarification:
Pantaloon hernia refers to the coexistence of both a direct and indirect inguinal hernia, often involving the deep inguinal ring on one side and bulging through weakened fascia.
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89. Sliding Hernia occurs when part of the sac is formed by:
A. The omentum
B. The wall of a viscus
C. The transversalis fascia
D. The femoral vein
B. The wall of a viscus
Clarification:
In a sliding hernia, part of the hernia sac is made up of the wall of a viscus such as the colon, bladder, or cecum.
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90. Femoral hernia is the most common inguinal hernia in females:
A. True
B. False
A. True
