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Flashcards in Midterm Deck (20)
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The following structures are spared in a modified radical neck dissection (MRND), EXCEPT:
A. Submandibular nodes
C. Sternocleidomastoid
D. Internal jugular vein
E. None of the above

A. Submandibular nodes

SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE: The classic radical neck dissection (RND) removes levels I to V of the cervical lymphatics in addition to SCM, IJV and CN XI. Any modification of the RND that preserves nonlymphatic structures (i.e., CN XI, SCM, or IJV) is defined as a modified radical neck dissection (MRND).


A 57-year old male presented at the ER due to nonradiating epigastric pain with 2 episodes of hematemesis, endoscopy was done revealing a mucosal ulceration at the lesser curvature of the stomach near the GEJ. What type of ulcer does he most likely have?
A. I
E. V


SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE: Type I - lesser curve, incisura; Type II - body of stomach, incisura + duodenal ulcer; Type III - Prepyloric; Type IV - High on lesser curve, near gastroesophageal junction; Type V - NSAID-induced, anywhere in the stomach.


A 35-year old man was involved in a motorcycle vehicular accident, on presentation at the ER the patient opens eye and withdraws arm on pain stimulation, he responds to name calling by mumbling incomprehensible words. What is the GCS score?
A. 8
B. 7
C. 9
D. 6
E. 10



A patient who is on long term corticosteroid treatment should be given the following to promote wound healing:
A. Vitamin C
B. Vitamin K
C. Silver sulfadiazine
D. Vitamin A
E. Mupirocin


Steroid-delayed healing of cutaneous wounds can be stimulated to epithelialize by topical application of vitamin A.


The following patients should be immediately referred to a burn center, EXCEPT:
A. A 12 year old with an 11% partial thickness burn
B. A 21 year old with a 9% 3rd degree burn
C. A 29 year old who has been strucked by a lightning
D. A 30 year old with major liver injury and a 12% partial thickness burn
E. A 42 year old with superficial thickness burn with suspected inhalational injury


Guidelines for referral to a burn center: 1) Partial thickness burn >10% TBSA 2) Burns involving the face, hands, feet, genitalia, perineum, or major joints 3) Third degree burns in any age group 4) Electrical burns, including lightning injury 4) Chemical burns 5) Inhalational injury 6) Burn injury in patients with complicated pre-existing medical disorders 7) Patients with burns and concomitant trauma in which the burn is the greater immediate risk. *IF THE TRAUMA IS THE GREATER IMMEDIATE RISK, THE PATIENT MAY BE STABILIZED IN A TRAUMA CENTER BEFORE TRANSFER TO A BURN CENTER 8) Burned children in hospitals without qualified personnel for the care of children 9) Burn injury in patients who will require special social, emotional, or rehabilitative intervention.


The most common complication of mastectomy and axillary lymph node dissection (ALND) is:
A. Injury to long thoracic nerve
B. Seromas
C. Wound dehisence
D. Wound infections
E. Severe hemorrhage


Seromas beneath the skin flaps or in the axilla represent the most frequent complication of mastectomy and ALND. Use of closed-system suction drainage reduces the incidence of this complication. Catheters are retained until wound drainage diminishes to <30ml/day.


The following factors prevent fistula closure, EXCEPT:
A. Foreign body
B. Distal obstruction
C. Infection
D. Fistula tract >2cm
E. Radiation


SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE: Factors that prevent fistula closure: 'FRIENDS' 1) Foreign body 2) Radiation 3) Infection 4) Epithelialization 5) Neoplasia 6) Distal obstruction 7) Short fistula tract (<2cm).


A 38 year old presented with a slow growing preauricular mass, biopsy was done revealing pleomorphic adenoma confined to the lateral lobe. What procedure should the done?
A. Total parotidectomy
B. Radiotherapy
C. Superficial parotidectomy
D. Tumor excision with 2mm margin
E. Tumor enucleation


Treatment of benign neoplasms in the parotid is excision of the superficial/lateral lobe with facial nerve dissection and preservation. Enucleation of the tumor mass is not recommended because of the risk of incomplete excision and tumor spillage


An aortic dissection confined to the ascending aorta, often requiring emergency operation is classified as?
A. DeBakey IIIA
B. DeBakey II
C. Stanford B
D. DeBakey IIIB
E. DeBakey I


DeBakey I - Ascending + Descending aortic dissection;

DeBakey II Ascending aortic dissection;

DeBakey IIIA - Thoracic aorta;

DeBakey IIIB - Thoracic + Abdominal aorta.

Stanford A - Isolated to the ascending aorta;

Stanford B - Ascending and descending dissection.


A hernia involving the inferior lumbar triangle:
A. Amyand's
B. Petit's
C. Grynfeltt's
D. Littre's
E. Petersen's


Amyand's hernia - appendix;
Petit's hernia - inferior lumbar triangle;
Grynfeltt's hernia - superior lumbar triangle;
Littre's - Meckel's diverticulum;
Petersen's hernia - herniation of small bowel through the mesenteric defect from the
Roux-en-Y limb, seen after bariatric gastric bypass.


An elderly male is admitted due to obstipation and abdominal distention, on presentation the patient is febrile, there is generalized abdominal pain and tenderness. WBC revelead leukocytosis, plain x-ray of the abdomen reveals a characteristic coffee bean appearance. What is the initial management?
A. Elective sigmoid colectomy
B. Air enema
C. Endoscopic detorsion
D. Immediate surgical exploration
E. NG suction, bowel rest, and observation

D. Immediate surgical exploration

The symptoms of sigmoid volvulus are those of acute bowel obstruction. Unless there are obvious signs of gangrene or peritonitis, the initial management of sigmoid volvulus is resuscitation followed by endoscopic detorsion. FEVER AND LEUKOCYTOSIS ARE HERALDS OF GANGRENE AND/OR PERFORATION THAT MANDATES IMMEDIATE SURGICAL EXPLORATION WITHOUT AN ATTEMPT AT ENDOSCOPIC DECOMPRESSION.


A 30 year old patient develops a high output fistula following abdominal surgery. The fluid is sent for evaluation with the following composition: Na 90, K 10, Cl 130. What is the most likely source of the fistula?
A. Stomach
B. Pancreas
C. Bile ducts
D. Colon
E. Duodenum

A. Stomach


A newborn infant presents with abdominal distention associated with bilious emesis and failure to pass meconium after 48 hours from birth. The definitive procedure for the diagnosis of this case is:
A. Abdominal ultrasound
B. Rectal biopsy
C. CT-Scan with contrast
D. Emergency laparoscopy
E. Barium enema

B. Rectal biopsy

The definitive diagnosis of Hirschsprung's disease is made by rectal biopsy.
The histopathologic features are the absence of ganglion cells in the myenteric plexuses, increased acetylcholinesterase staining, and the presence of hypertrophied nerve bundles.


An adolescent male presents with sudden onset testicular pain, a swollen, assymetric scrotum with a tender high riding testicle is noted upon examination. Immediate surgical exploration is indicated to salvage an ischemic testis if performed within:
A. 8 hours
B. 12 hours
C. 6 hours
D. 16 hours
E. 10 hours

C. 6 hours

Immediate surgical exploration can salvage an ischemic testes.
More than 80% of testes can be salvaged if surgery is performed within 6 hours, which decreases to 20% or less as time progresses beyond 12 hours.


A 29 year old male was involved in a vehicular accident, he suffered no gross injuries however complained of abdominal pain. At the ER vital signs include BP 120/80, HR: 72, RR: 18, Temp: 36.8, O2 sat: 99%. The surgery resident is considering blunt abdominal injury, initial evaluation should be done is:
C. Abdominal CT scan
D. Laparoscopy
E. Abdominal X-Ray


Blunt abdominal trauma initally is evaluated by FAST examination.
It is used to identify free intraperitoneal fluid in Morison's pouch, the left upper quadrant, and the pelvis.
It is sensitive for detecting intraperitoneal fluid of >250ml, however does not reliably determine the source of hemorrhage nor grade solid organ injuries.


A common complication after repair of esophageal atresia with tracheoesophageal fistula, potentially due to alterations in esophageal motility and the anatomy of GEJ is treated by?
A. Esophagostomy
B. Re-anastomosis
C. Nissen fundoplication
D. Tucker dilators
E. Observation only

C. Nissen fundoplication

Gastroesophageal reflux commonly occurs after repair of EA-TEF.
A loose antireflux procedure, such as Nissen fundoplication, is used to prevent further reflux.


What is the wound classification of a penetrating abdominal trauma presenting early after injury and has an infection rate of 3.4-13.2%?
A. Clean
B. Dirty
C. Dirty/contaminated
D. Clean/contaminated
E. Contaminated

E. Contaminated

Contaminated wounds (Class III) - open accidental wounds encoutered early after injury, those with extensive introduction of bacteria due to major breaks in sterile technique, gross spillage of viscus contents, or incision through inflamed, nonpurulent tissue.


A 56 year old female underwent elective laparoscopic cholecystectomy without complications, histopathologic result revealed an incidental finding of a carcinoma limited to the muscular layer of the gallbladder (T1). The follow-up management of this patient is:
A. Observation only
B. Radiotherapy
C. Chemotherapy + Radiotherapy
D. Neo-adjuvant chemotherapy + lymphadenectomy + bile duct resection
E. Resection of liver segments IVB and V, and lymphadenectomy

A. Observation only

There is universal agreement that simple cholecystectomy is an adequate treatment for T1 lesions and results in a near 100% overall 5-year survival rate.

Beyond stage T1, reoperation with central liver resection, hilar lymphadenectomy, and evaluation of cystic stump is commonly performed.


A cause of renal artery occlusive lesion, frequently encountered in young multiparous women with a characteristic angiographic "string of beads" appearance is:
A. Atherosclerosis
B. Polyarteritis nodosa
C. Takayasu arteritis
D. Aneurysm
E. Fibromuscular dysplasia

E. Fibromuscular dysplasia

Approximately 80% of all renal artery occlusive lesion are caused by atherosclerosis.

The second most common cause of renal artery stenosis is Fibromuscular dysplasia that produces histopathologic changes in the intima, media, or adventitia.


A 4-year old consulted at the OPD because of a well-defined midline neck mass that moves upward with protrusion of the tongue. If a thyroglossal duct cyst is considered, the procedure usually done is:
A. Partial thyroidectomy
B. En bloc cystectomy and excision of the central hyoid bone
C. Simple cystectomy
D. Cystectomy with 2mm margins
E. Ladd procedure

B. En bloc cystectomy and excision of the central hyoid bone

Treatment for thyroglossal duct cyst involves the "Sistrunk operation", which consists of en bloc cystectomy and excision of the central hyoid bone to minimize recurrence.