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[SEM2] SURGERY Flashcards

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1
Q

Which of the following statements regarding tuberculous enteritis is incorrect?

Choices:
A. Primary infection usually results from ingestion of non-pasteurized milk contaminated with Mycobacterium bovis.
B. Secondary infection results from ingestion of bacilli contained in contaminated sputum.
C. The duodenum is the site of involvement in 85% of patients.
D. Infection may be indistinguishable from Crohn’s disease or cancer.
E. Approximately one-half of patients with colonic or ileocecal disease may be treated medically without surgery.

A
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2
Q

What percentage of bile duct injuries are identified intraoperatively?

Choices:
A. 85%
B. 5%
C. 25%
D. 50%
E. 10%

A
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3
Q

Thyroid hormone production is inhibited by:

Choices:
A. Epinephrine
B. Glucocorticoids
C. Human chorionic gonadotropin
D. Alpha-fetoprotein

A
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4
Q

A 40-year-old female, status post (S/P) modified radical mastectomy (MRM), chemotherapy, and radiation therapy, was given a SERM. Which of the following examinations must be done for monitoring?

Choices:
A. CBC every 6 months
B. Pelvic ultrasound annually
C. Chest X-ray (CXR)
D. Breast MRI

A
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5
Q

Thyroglossal duct cysts are most commonly located:

Choices:
A. On the anterior border of the sternocleidomastoid muscle
B. In the midline at the level of the hyoid
C. Over the medial clavicular head
D. In the midline just superior to the thyroid gland

A
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6
Q

A 20-year-old college student recovers from a bout of severe pancreatitis. He has mild epigastric discomfort, bloating, and loss of appetite. Ultrasound shows a cystic mass around the stomach that increased in size over 3 weeks. What should be the next step in management?

Choices:
A. Percutaneous drainage of the cyst
B. Laparotomy and internal drainage of the cyst
C. Excision of cyst
D. Total pancreatectomy
E. Administration of pancreatic enzymes

A
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7
Q

A 60-year-old woman presents with abdominal pain. A CT scan reveals an omental mass. The most likely diagnosis is:

Choices:
A. Desmoid tumor
B. Liposarcoma of the omentum
C. Omental infarction
D. Metastatic carcinoma

A
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8
Q

True about SILS (Single-Incision Laparoscopic Surgery) except:

Choices:
A. Umbilical scar incision
B. Conventional tools employed
C. Accessible extraction site
D. All are true

A
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9
Q

The major deterrent to the use of adjuvant chemotherapy is:

Choices:
A. Risk of infection
B. High cost of chemotherapeutic drug
C. Response rate is less than 20%
D. Thrombocytopenia

A
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10
Q

A 56-year-old man presents with a 2-day history of fever, nausea, and left lower quadrant pain. His WBC count is 14,000 cells/µL. CT shows a thickened sigmoid colon with fat stranding and a 5-cm pelvic abscess. What is the optimal management?

Choices:
A. Immediate sigmoid colectomy and drainage of abscess
B. CT-guided drainage followed in 6 weeks by colectomy and sigmoidectomy
C. CT-guided drainage alone
D. IV antibiotics followed in 6 weeks by colectomy and sigmoidectomy

A
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11
Q

A 50-year-old male with a history of peptic ulcer disease presents with hematemesis and melena. After aggressive resuscitation (3L crystalloids + 3L blood) over 6-8 hours, he remains hypotensive (BP 80/60, PR 140). What is the next best step?

Choices:
A. Emergency upper endoscopy
B. Emergency angiography
C. Prepare for emergency laparotomy
D. Continue volume replacement

A
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12
Q

On abdominal exploration for a suspected carcinoid tumor, a 2-cm mass is found in the terminal ileum. No liver lesions are detected preoperatively or intraoperatively. What is the best treatment?

Choices:
A. Local excision of the tumor
B. Right hemicolectomy
C. Ileal resection only
D. Liver biopsy to rule out micrometastasis

A
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13
Q

Which type of head and neck cancer is associated with Epstein-Barr Virus (EBV)?

Choices:
A. Squamous cell carcinoma
B. Nasopharyngeal carcinoma
C. Oropharyngeal carcinoma
D. Laryngeal carcinoma

A
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14
Q

Mutations in the tumor suppressor gene p53 are strongly associated (up to 70%) with which malignancy?

Choices:
A. Colon cancer
B. Breast cancer
C. Esophageal cancer
D. Thyroid cancer

A

B. Breast cancer

⸻

High-Yield Rationale:
• p53 (TP53 gene) mutations are most famously linked to Li-Fraumeni syndrome, a hereditary cancer syndrome.
• In Li-Fraumeni, breast cancer is the most common malignancy, especially in young women, and p53 mutations are seen in up to 70% of cases.
• While p53 is involved in many other cancers (including colon and esophageal), none have as strong or consistent an association as breast cancer.

⸻

Why Others Are Incorrect:
• A. Colon cancer: Often involves APC and KRAS mutations early; p53 mutations occur later in adenoma-carcinoma sequence.
• C. Esophageal cancer: p53 is involved but not with a 70% prevalence; environmental risk factors play a larger role.
• D. Thyroid cancer: Most often linked to RET/PTC rearrangements, BRAF, and RAS mutations — not p53.

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15
Q

Which gas is poorly soluble in blood?

Choices:
A. Nitrous oxide
B. Carbon dioxide
C. Oxygen
D. Nitrogen

A
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16
Q

A 54-year-old man presents with 2 months of abdominal pain and weight loss. Imaging reveals a carcinoid tumor in the mid-ileum confirmed by frozen section. Which statement about this tumor is true?

Choices:
A. Carcinoid tumors rarely metastasize
B. Midgut carcinoid tumors often metastasize to the liver
C. Carcinoid tumors never produce hormone-related symptoms
D. Surgery is not indicated unless symptomatic

A
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17
Q

The inferior adrenal artery originates from:

Choices:
A. Aorta
B. Renal artery
C. Inferior phrenic artery
D. Celiac artery

A
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18
Q

A 38-year-old woman presents with nausea, vomiting, distention, and obstipation. Imaging shows a markedly dilated, kidney-shaped loop of bowel extending from the right lower quadrant to the left upper quadrant. What is the best treatment?

Choices:
A. Immediate surgical resection
B. Flexible sigmoidoscopy with decompression
C. IV antibiotics and observation
D. Emergency colectomy

A
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19
Q

What is the imaging of choice for a 7-cm painless mass on the upper thigh?

Choices:
A. Plain X-ray
B. Ultrasound
C. CT scan
D. MRI

A
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20
Q

Which statement is true regarding appendiceal carcinoid tumors?

Choices:
A. Tumors smaller than 2 cm are typically benign
B. All appendiceal carcinoids require right hemicolectomy
C. Appendiceal carcinoids frequently cause carcinoid syndrome
D. Appendectomy is insufficient treatment for any carcinoid tumor

A
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21
Q

A 30-year-old woman at 28 weeks of gestation presents with a 24-hour history of right upper quadrant pain. WBC is 18,000/µL. Ultrasound shows a normal gallbladder and viable fetus; appendix is not visualized. What is the next best step?

Choices:
A. Repeat ultrasound in 6 hours
B. Start antibiotics and observe
C. Obtain magnetic resonance imaging (MRI) and proceed with appendectomy if positive
D. Immediate exploratory laparotomy

A
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22
Q

Which of the following is NOT part of standard follow-up care for head and neck tumor patients?

Choices:
A. Annual follow-up on year 4
B. Close follow-up during the first 2 years
C. Chest imaging annually for smokers
D. Thyroid function tests after radiation to the neck

A
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23
Q

A 44-year-old man was diagnosed with colon cancer involving the sigmoid and transverse colon. His father, paternal uncle, and sister also had colon cancer. No adenomatous polyps were seen on pathology. What is the most likely diagnosis?

Choices:
A. Familial adenomatous polyposis (FAP)
B. Lynch syndrome I
C. Peutz-Jeghers syndrome
D. Juvenile polyposis

A

B. Lynch syndrome I

Rationale:

◓Lynch Syndrome (Hereditary Nonpolyposis Colorectal Cancer, HNPCC):
🔵 Autosomal dominant
🔵 No polyposis
🔵 Proximal colon preference (but can be multiple)
🔵 Early age of onset

◓FAP involves hundreds to thousands of polyps
◓Peutz-Jeghers and Juvenile Polyposis are hamartomatous polyposis syndromes, typically with visible polyps.

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24
Q

What is the best prognostic indicator for breast cancer?

Choices:
A. Tumor size
B. Estrogen receptor status
C. Lymph node involvement
D. Histologic grade

A
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25
What is the standard surgical management of a pleomorphic adenoma of the parotid gland? Choices: A. Simple enucleation B. En bloc resection including adjacent structures C. Superficial parotidectomy D. Total parotidectomy
26
Which lesion is the least likely differential diagnosis for retroperitoneal sarcoma? Choices: A. Liposarcoma B. Lymphoma C. Leiomyosarcoma D. Hepatoma
27
At which site is esophageal perforation least likely to occur during upper GI endoscopy? Choices: A. Cervical esophagus (cricopharyngeus) B. Mid-esophagus (aortic arch level) C. Level of diaphragmatic hiatus D. Gastroesophageal junction
28
What is the pathologic hallmark of Paget’s disease of the breast? Choices: A. Keratin pearls B. Large vacuolated cells in the rete pegs C. Dense lymphocytic infiltration D. Loss of E-cadherin expression
29
Which of the following is the poorest determinant of the clinical behavior of sarcomas? Choices: A. Tumor grade B. Tumor size C. Histologic subtype D. Time of diagnosis
30
A 55-year-old woman who underwent modified radical mastectomy is noted to have winging of the scapula. This is most likely due to: Choices: A. Denervation of the serratus anterior muscle B. Injury to the trapezius muscle C. Axillary nerve injury D. Thoracodorsal nerve injury
31
Acute cholecystitis is: Choices: A. Inflammation of the gallbladder unrelated to gallstones B. Infection of the gallbladder associated with gallstones in 90% of cases C. Always caused by bacterial infection alone D. Primarily a consequence of bile duct strictures
32
What is the most appropriate preoperative imaging for evaluation of the lungs in a patient with a pleomorphic liposarcoma of the thigh? Choices: A. Chest X-ray B. Chest CT scan C. PET scan D. MRI of the chest
33
Which of the following statements regarding typhoid enteritis is true? Choices: A. Diagnosis is made clinically without any cultures B. Blood or stool culture for Salmonella typhi confirms the diagnosis C. Typhoid enteritis is caused by E. coli D. Imaging studies are preferred over cultures for diagnosis
34
A 48-year-old man presents with upper abdominal postprandial pain, regurgitation, heartburn, bloating, and early satiety relieved by vomiting. What is the most appropriate test to confirm the diagnosis? Choices: A. Abdominal ultrasound B. CT scan of the abdomen C. Upper GI series with contrast D. Esophagogastroduodenoscopy (EGD)
35
Which of the following statements about thoracoscopy is NOT true? Choices: A. Creates working space by collapsing lung using a standard endotracheal tube B. Is used for lung biopsy and pleural disease diagnosis C. Involves single-lung ventilation typically D. Minimally invasive compared to thoracotomy
36
Which of the following is NOT true regarding hepatic hemangioma? Choices: A. Usually asymptomatic and discovered incidentally B. May require surgical resection if symptomatic C. Malignant transformation is common D. Diagnosed primarily by imaging studies
37
What is the primary treatment for retroperitoneal fibrosis? Choices: A. Surgery B. Chemotherapy C. Corticosteroids D. Radiation therapy
38
What is the appropriate surgical procedure for a gastrointestinal stromal tumor (GIST)? Choices: A. Wide local excision B. Wedge excision C. Radical resection with lymph node dissection D. Total gastrectomy
39
A patient developed redness, warmth, tenderness, and edema of the abdominal wall, indicating a superficial spreading skin infection. What is the most likely diagnosis? Choices: A. Cellulitis B. Erysipelas C. Abscess D. Necrotizing fasciitis
40
Which of the following statements regarding vascular malformations is NOT true? Choices: A. Present at birth and grow proportionally with the child B. Characterized by continuous low-flow without spontaneous spurt C. Typically require urgent surgical intervention due to hemorrhage D. Managed conservatively unless symptomatic
41
A 26-year-old man with ulcerative colitis presents with fever, chills, severe abdominal pain, and a rigid abdomen. During assessment, which findings would favor stoma creation over primary anastomosis? Choices: A. Albumin level of 6.0 g/dL B. History of corticosteroid use C. Blood glucose level of 300 mg/dL D. All of the above
42
A 50-year-old male is diagnosed with esophageal cancer located 34 cm from the incisors. Where is the most likely site of lymph node metastasis? Choices: A. Cervical nodes B. Subcarinal nodes and inferior pulmonary ligament nodes C. Left gastric nodes D. Celiac nodes
43
Lichtenstein repair for hernia is best described as: Choices: A. Tension repair B. Tension-free repair C. Open abdominal repair D. Purely laparoscopic repair
44
During laparotomy for small bowel obstruction, mucinous ascites and a cystic appendiceal mass are found. What is the most likely diagnosis? Choices: A. Peritoneal carcinomatosis B. Mucinous cystadenocarcinoma C. Pseudomyxoma peritonei D. Appendiceal abscess
45
Which of the following statements about tuberculous enteritis is incorrect? Choices: A. Primary infection results from ingestion of contaminated milk B. Secondary infection results from swallowed sputum C. The duodenum is the site of involvement in 85% of patients D. It may mimic Crohn’s disease clinically
46
Peyer's patches are primarily responsible for local synthesis of: Choices: A. IgG B. IgM C. IgA D. IgE
47
Thalassemia patients post-splenectomy are at high risk for overwhelming post-splenectomy infection (OPSI). Which strategy reduces mortality? Choices: A. Full splenectomy B. Antibiotic prophylaxis alone C. Partial splenectomy D. Early vaccination alone
48
Which of the following statements regarding head and neck cancers is NOT true? Choices: A. Squamous cell carcinoma accounts for >90% of malignancies of the upper aerodigestive tract B. Human papillomavirus (HPV) is associated with oropharyngeal cancers C. Head and neck cancers are more common in non-smokers D. Early-stage head and neck cancers may be curable
49
Which of the following ligaments is derived from the external oblique aponeurosis? Choices: A. Round ligament B. Falciform ligament C. Lacunar ligament D. Suspensory ligament of the ovary
50
Which of the following is NOT true regarding hepatocellular carcinoma (HCC)? Choices: A. Commonly associated with cirrhosis B. Alpha-fetoprotein (AFP) is used as a tumor marker C. Surgery is not indicated in localized disease D. Screening is recommended in high-risk patients
51
What is the most common pattern of metastasis for retroperitoneal soft tissue sarcomas? Choices: A. Hematogenous spread to liver B. Lymphatic spread to retroperitoneal nodes C. Direct extension to kidneys D. Hematogenous spread to lungs
52
Which of the following is NOT true regarding carbon dioxide (CO₂) gas used for insufflation in laparoscopy? Choices: A. Rapidly absorbed B. Non-flammable C. May cause hypercapnia D. Poorly soluble in blood
53
A 60-year-old female undergoing screening colonoscopy briefly becomes unresponsive. Post-procedure chest X-ray shows free air under the diaphragm but no consolidation. She is asymptomatic except for tachycardia. What is the next best step? Choices: A. Admit to hospital, IV antibiotics, and bowel rest B. Immediate exploratory laparotomy C. Discharge with follow-up in 24 hours D. Repeat colonoscopy to localize perforation
54
What is the best treatment for an indirect inguinal hernia in a 5-year-old boy? Choices: A. Laparoscopic mesh repair B. Bassini repair C. Marcy repair D. Watchful waiting
55
Which of the following statements regarding hepatitis is NOT true? Choices: A. Hepatitis B can lead to chronic infection B. Hepatitis A is commonly transmitted via the fecal-oral route C. Hepatitis C has an effective vaccine D. Hepatitis E is more severe in pregnant women
56
The high incidence of sarcomas in Li-Fraumeni syndrome is due to: Choices: A. Mutation in p53 tumor suppressor gene B. Mutation in BRCA1 C. Mutation in NF-1 gene D. Mutation in APC gene
57
What is the first-choice palliative treatment for dysphagia in disseminated gastroesophageal (GE) junction cancer? Choices: A. Esophageal stent B. Chemotherapy C. Palliative radiation D. Feeding jejunostomy
58
What is the best initial test for a suspected postoperative bile leak? Choices: A. Ultrasound (US) B. HIDA scan C. CT scan D. ERCP
59
Which of the following statements about umbilical hernias is true? Choices: A. All umbilical hernias in children must be surgically repaired immediately B. Most umbilical hernias resolve spontaneously by age 2 C. Umbilical hernias are never congenital D. Umbilical hernias do not recur after repair
60
Which of the following describes a key principle of sentinel lymph node biopsy? Choices: A. All regional lymph nodes must be dissected B. The sentinel node is always in the axilla C. Sentinel node biopsy can help avoid full lymphadenectomy D. Sentinel node biopsy is contraindicated in breast cancer
61
A 20-year-old woman undergoes surgery for presumed appendicitis via a right lower quadrant incision. The appendix appears normal. What is the most appropriate next step? Choices: A. Close and observe B. Perform an appendectomy only if a fecalith is present C. Perform exploration and appendectomy if no other pathology is found D. Convert to midline laparotomy
62
What is the initial treatment of choice for Riedel’s thyroiditis? Choices: A. Surgery B. Levothyroxine C. Methimazole D. Observation
63
What is the best imaging modality to assess tumor recurrence after surgery for extremity sarcoma? Choices: A. CT scan of the limb B. PET scan C. Bone scan D. MRI of the involved extremity
64
Which of the following may be seen in the ophthalmopathy of Graves’ disease? Choices: A. Chemosis B. Proptosis C. Blindness D. All of the above
65
The adrenal cortex arises from which embryologic layer? Choices: A. Ectoderm B. Mesoderm C. Endoderm D. Neural crest
66
A 48-year-old man presents with postprandial pain, regurgitation, heartburn, bloating, and early satiety relieved by vomiting. What is the most appropriate test to confirm the diagnosis? Choices: A. EGD B. Barium swallow C. 24-hour pH monitoring D. Manometry
67
Which of the following statements regarding hepatocellular carcinoma is NOT true? Choices: A. Fifth most common malignancy worldwide B. HCC can occur before cirrhosis in HCV patients C. Predominantly supplied by the hepatic artery D. Portal vein thrombus rules out HCC
68
A patient presents after vomiting 500 mL of bright red blood. Endoscopy shows a tear at the gastroesophageal (GE) junction. What is the most appropriate treatment? Choices: A. Observation B. Placement of Sengstaken-Blakemore tube C. Surgical gastrostomy and oversewing D. Administration of antiemetics
69
Which of the following statements about omental infarction is true? Choices: A. Patients usually present with fever and lassitude B. Most cases are diagnosed on imaging C. All cases require surgery D. Surgical resection is always indicated
70
The high incidence of sarcoma in Li-Fraumeni syndrome is due to mutations in: Choices: A. NF-1 tumor suppressor gene B. Rb tumor suppressor gene C. p53 tumor suppressor gene D. BRCA1 gene
71
A patient has a bilirubin of 3.5 mg/dL, albumin of 3.5 g/dL, and INR of 2.2. What is the associated overall surgical mortality rate based on the Child-Pugh score? Choices: A. 10% overall surgical mortality rate B. 30% overall surgical mortality rate C. 50% overall surgical mortality rate D. 80% overall surgical mortality rate
B. 30% overall surgical mortality rate BILIRUBIN - 3PTS ALBUMIN- 2PTS INR - 2PTS = 7PTS (CLASS B- 30% MORTALITY)
72
Which head and neck cancer is most associated with Epstein-Barr Virus (EBV)? Choices: A. Nasopharynx B. Oropharynx C. Hypopharynx D. Larynx
73
Which of the following is not a determinant of resectability in metastatic colorectal cancer to the liver? Choices: A. Determined by volume of future liver remnant B. Determined by the health of the background liver C. Determined by the actual tumor number D. All are true
74
The inferior adrenal artery most commonly originates from the: Choices: A. Phrenic artery B. Splenic artery C. Renal artery D. Aorta
75
Which of the following statements about umbilical hernias is true? Choices: A. Umbilical hernias are present in 10% of all newborns B. Umbilical hernias should be repaired as soon as diagnosed C. Adults with small, non-incarcerated umbilical hernias should undergo repair D. Umbilical hernias are associated with disseminated carcinomatosis
76
What is the pathologic hallmark of Paget’s disease of the breast? Choices: A. Papillary fronds in the dermal layer B. Large vacuolated cells in the rete peg C. Hypermitotic cells D. None of the above
77
Which of the following statements regarding tuberculous enteritis is incorrect? Choices: A. Primary infection usually results from the ingestion of non-pasteurized milk contaminated with Mycobacterium bovis B. Secondary infection results from ingestion of bacilli in contaminated sputum C. The duodenum is the site of involvement in 85% of patients D. Infection may mimic Crohn’s disease or cancer E. Half of patients with colonic/ileocolonic disease may be treated medically
78
Which of the following ligaments is derived from the external oblique aponeurosis? Choices: A. Cooper’s ligament B. Iliopubic tract C. Lacunar ligament D. None of the above
79
What is the imaging modality of choice for a 7 cm painless mass on the upper thigh? Choices: A. X-ray of the thigh, AP and lateral view B. CT scan of the thigh C. MRI of the thigh D. Whole-body PET scan
80
A 50-year-old male has esophageal cancer located 34 cm from the incisor. Where is the most likely site of lymph node metastasis? Choices: A. Deep cervical and paracervical lymph nodes B. Paracervical and subcarinal lymph nodes C. Subcarinal nodes and inferior pulmonary ligament nodes D. Perihiatal and left gastric artery nodes
81
Which of the following is the poorest determinant of the clinical behavior of sarcoma? Choices: A. Time of diagnosis B. Depth of tumor C. Histologic grading D. Tumor size
82
What is the first diagnostic test to order in a patient with a solitary thyroid nodule? Choices: A. Radioactive iodine scan B. CT or MRI C. Fine needle aspiration (FNA) D. Core needle biopsy
83
Thyroid hormone production is inhibited by: Choices: A. Epinephrine B. Glucocorticoids C. Human chorionic gonadotropin D. Alpha-fetoprotein
84
What is the imaging modality of choice to assess tumor recurrence after surgery of an extremity sarcoma? Choices: A. Ultrasound evaluation B. Radiographs of the involved extremity C. MRI of the involved extremity D. PET scan
85
Which of the following statements about typhoid enteritis is true? Choices: A. Culturing Salmonella typhi from blood or stool can confirm diagnosis B. Chloramphenicol remains the drug of choice C. Bleeding needing surgery occurs in 10–20% of patients D. Steroids are contraindicated in typhoid fever E. Peyer’s patch hyperplasia and lymphadenopathy are rare
86
What is the appropriate surgical treatment for a patient with an early perforated peptic ulcer and stable vital signs? Choices: A. Subtotal gastrectomy B. Vagotomy with drainage C. Ulcer repair with omental patch D. Antrectomy with drainage
87
Which tumor marker is recommended for cancer screening? Choices: A. AFP and PSA B. CEA C. CA 19-9 D. CA 15-3
88
Which of the following is NOT a correct MIS term? Choices: A. SILS – Single Incision Laparoscopic Surgery B. NOTES – Natural Orifice Transluminal Endoscopic Surgery C. POEM – Perorifice Endoscopic Myotomy D. All are correct
89
A 35-year-old male had a laparoscopic appendectomy. Pathology revealed a 1.4-cm carcinoid tumor in the mid-appendix with mesoappendiceal extension, negative margins, and no lymphovascular invasion. What is the best next step? Choices: A. No further treatment needed B. Ileocecectomy C. Right hemicolectomy D. Octreotide therapy E. Chemotherapy
90
Where are thyroglossal duct cysts most commonly located? Choices: A. On the anterior border of the sternocleidomastoid muscle B. In the midline at the level of the hyoid C. Over the medial clavicular head D. In the midline just superior to the thyroid gland
91
Overwhelming post-splenectomy infection (OPSI) is common in thalassemia due to immune deficiency. Which strategy has been shown to reduce mortality? Choices: A. Partial splenectomy B. Delaying splenectomy until after 2 years of age C. Prophylactic antibiotics D. Maintenance of hemoglobin > 9 g/dL
92
Which of the following statements about vascular malformations is NOT true? Choices: A. Always present at birth B. Arteriovenous malformations are common C. No proliferative phase D. Do not undergo hormonal growth spurts
93
Which of the following is NOT true about thoracoscopy? Choices: A. Insufflation is unnecessary B. There are disadvantages with positive pressure C. Creates working space by collapsing lung using a standard endotracheal tube D. All are correct
94
What is the Child-Pugh score and class for a patient with Bilirubin 3.5 mg/dL, Albumin 3.5 g/dL, and INR 2.2? Choices: A. Score 6 – Class A B. Score 7 – Class B C. Score 8 – Class B D. Score 9 – Class C
B. Score 7 – Class B Bilirubin 3.5 mg/dL = 3 Albumin 3.5 g/dL = 2 INR 2.2 = 2
95
On inguinal exam using the occlusion test, a bulge is noted medial to the occluding finger. What is the most likely diagnosis? Choices: A. Indirect inguinal hernia B. Femoral hernia C. Direct inguinal hernia D. Pantaloon hernia
96
What is the pathologic hallmark of Paget’s disease of the breast? Choices: A. Papillary fronds in the dermal layer B. Large vacuolated cells in the rete pegs C. Hypermitotic cells D. None of the above
97
What is the most appropriate preoperative imaging for lung evaluation in a patient with a pleomorphic liposarcoma of the thigh? Choices: A. Chest radiograph B. Chest ultrasound C. Chest MRI D. Chest CT scan
98
What best describes Lichtenstein hernia repair? Choices: A. Involves approximation of the Poupart’s ligament and conjoined tendon B. Involves Cooper’s ligament and conjoined tendon C. Layered repair of transversalis fascia, Cooper’s ligament, and Poupart’s ligament D. Tension-free repair
99
Which head and neck cancer is associated with Epstein-Barr Virus (EBV)? Choices: A. Nasopharynx B. Oropharynx C. Hypopharynx D. Larynx
100
Which site is least likely for esophageal perforation during upper GI endoscopy? Choices: A. Cricoid cartilage B. Pharyngoesophageal segment C. Area of indentation of right main bronchus and aortic arch D. Level of diaphragmatic hiatus
101
Mutations in the tumor suppressor gene p53 are strongly associated (up to 70%) with which type of malignancy? Choices: A. Breast cancer and sarcoma B. Gastric cancer C. Rectal cancer D. Melanoma
102
A 65-year-old male presents with a rectal mass extending to the anus. Biopsy shows adenocarcinoma. Which lymph node involvement carries the poorest prognosis? Choices: A. Inguinal B. Perirectal C. Inferior mesenteric D. Para-aortic
103
What level of neck lymph nodes is located in the submuscular recess? Choices: A. Level Ia B. Level I C. Level III D. Level II
✅ Correct Answer: D. Level lI ✅ Rationale: * Level Il nodes are located: * Upper jugular chain * Beneath the sternocleidomastoid, in the submuscular recess * Common drainage site for oropharynx, nasopharynx, and oral cavity * Level I = submental/submandibular * Level III = mid-jugular
104
What is an advantage of radiotherapy compared to other cancer treatments? Choices: A. Kills cells in all phases of the cell cycle B. Does not delay wound healing C. Preserves anatomy D. Risk of tracture or edema is rare
105
Which of the following can be seen in ophthalmopathy associated with Graves’ disease? Choices: A. Chemosis B. Proptosis C. Blindness D. All of the above
106
A 30-year-old woman, 28 weeks pregnant, has RUQ pain, WBC 18,000, and normal ultrasound (viable fetus, gallbladder normal, appendix not visualized). What is the next best step? Choices: A. Obtain CT abdomen/pelvis B. Proceed with laparoscopy after delivery C. Admit for serial exams and repeat labs D. Treat with antibiotics to avoid surgery E. Obtain MRI and proceed to appendectomy if positive
107
A 38-year-old woman with no surgical history presents with bowel obstruction symptoms. Imaging shows a large, kidney-shaped loop of bowel. What is the best initial treatment? Choices: A. Cecostomy B. Operative detorsion with cecopexy C. Right hemicolectomy with ileostomy and mucus fistula D. Right hemicolectomy with primary anastomosis E. Initial endoscopic detorsion followed by elective right hemicolectomy
108
What is the best treatment for a recurrent inguinal hernia after previous herniorrhaphy? Choices: A. Bassini repair B. McVay repair C. Laparoscopic repair D. Shouldice repair
109
Which statement correctly reflects the principle of sentinel lymph node biopsy? Choices: A. Lymphadenectomy is avoided B. Remove only hot and blue nodes C. Remove all hot, blue, and palpable nodes D. Lymphadenectomy only if nodes are biopsy-negative
110
Which of the following MIS terminologies is incorrect? Choices: A. SILS – Single Incision Laparoscopic Surgery B. NOTES – Natural Orifice Transluminal Endoscopic Surgery C. POEM – Perorifice Endoscopic Myotomy D. All are correct
111
Which of the following is a common cause of acute (suppurative) thyroiditis? Choices: A. Escherichia coli B. Streptococcus species C. Pseudomonas aeruginosa D. Staphylococcus aureus
112
Failure of fixation of the small intestinal and right colonic mesentery during gestation can result in: Choices: A. Chronic constipation B. Intestinal malrotation C. Umbilical hernia D. Intussusception
113
Which of the following ligaments is derived from the external oblique aponeurosis? Choices: A. Cooper’s ligament B. Iliopubic tract C. Lacunar ligament D. None of the above
114
What is the preferred surgical management for pleomorphic adenoma? Choices: A. Enucleation of the adenoma B. Total parotidectomy C. Superficial parotidectomy D. En bloc resection
115
Which of the following is true regarding radiotherapy for soft tissue sarcoma? Choices: A. Adjuvant to surgery in all high-grade soft tissue sarcoma patients B. Optimal margin is at least 15 cm C. Recommended only for tumors < 5 cm D. Best administered postoperatively rather than preoperatively
116
Which of the following statements about head and neck cancers is NOT true? Choices: A. Ideal treatment protocol varies by subsite, stage, comorbidities, and center B. >90% of upper aerodigestive tract cancers are squamous cell carcinoma C. Early-stage disease is treated with surgery + adjuvant therapy D. All are true
117
Which of the following statements about hepatic hemangiomas is NOT true? Choices: A. Predominantly seen in women B. Enucleation or resection is done for symptomatic lesions C. High risk of spontaneous rupture D. All are true
C. High risk of spontaneous rupture ⸻ High-Yield Rationale: • Hepatic hemangiomas are the most common benign liver tumors, often found incidentally. • More common in women, likely due to estrogen sensitivity. • Most are asymptomatic and require no treatment. • Surgery (enucleation or resection) is reserved for: • Symptomatic lesions • Rapid growth • Compression of adjacent structures • Spontaneous rupture is extremely rare, making C the false statement.
118
What is the most important prognostic indicator in melanoma staging? Choices: A. Breslow tumor thickness B. Clark’s level C. Sentinel lymph node biopsy result D. Histologic type
119
What is the best treatment for an indirect inguinal hernia in a 5-year-old boy? Choices: A. Bassini repair B. Shouldice repair C. McVay repair D. Marcy repair
120
Thyroid hormone production is inhibited by: Choices: A. Epinephrine B. Human chorionic gonadotropin C. Glucocorticoids D. Alpha-fetoprotein

SURG 2 (21 decks)

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