Surgery Final (Part 1) Flashcards by Gerald Libranda

A man sustained severe blunt injuries in a car crash twelve hours ago. The activity of this hormone is now expected to be decreased in this patient:

A. insulin

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A young woman is debilitated by pruritus and burning sensation from her presternal keloid. The recommended initial treatment is:

B. intralesional corticosteroid injection

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A patient is placed on NPO in preparation for an elective major abdominal surgery. The body’s preferred initial fuel source during the fasting state is:

A. hepatic glycogen

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A 48-year-old woman has prolonged ileus after surgery for an obstructed duodenal ulcer. The problem is probably due to:

D. hypokalemia

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A man with chronic prepyloric ulcer appears weak after repeated bouts of non-bilious vomiting over the past 3 days. Fluid therapy should be started using:

C. Normal saline solution

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A multiply injured patient has persistently low urine output. The oliguria is most likely due to prerenal failure rather than acute tubular necrosis if the tests reveal:

B. low urinary excretion of sodium

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A woman admitted to the ICU for severe acute pancreatitis begins to manifest paresthesia of the face and extremities, muscle cramps, and a positive Chvostek’s sign. These are probably due to:

A. hypocalcemia

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Increased nutritional support appears to aggravate tachypnea in a septic patient with respiratory failure. Lessening the amount of this substrate may alleviate the problem:

A. carbohydrate

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Administration of this amino acid is expected to be beneficial to a patient suffering from damage to intestinal mucosa due to adjuvant chemotherapy for esophageal cancer:

D. glutamine

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Early supplementation of this vitamin is recommended to promote wound repair in a patient with extensive second-degree flame burns:

B. C

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A diabetic 41-year-old man is admitted for necrotizing fasciitis in the perineum. A high dose of this antibiotic is generally included in the initial antimicrobial therapy because of concern for clostridial pathogens:

C. penicillin G

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Transfusion of properly cross matched blood is begun on a man admitted for massive bleeding from erosive gastritis and thirty minutes later, he develops urticaria and fever. This should be administered to the patient:

A. antihistamine

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A patient under anticoagulation therapy using warfarin, who is set to undergo surgery for acute cholecystitis, has decreased prothrombin concentration. Warfarin can be reversed by parenteral dose of:

B. vitamin K

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Arterial blood gas analysis is performed on a patient just admitted with a diagnosis of severe acute pancreatitis. This reveals a pH of 7.30 and low levels of bicarbonate and pCO2. The most urgent part of management is:

A. volume resuscitation

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Seven days after surgery for a perforated appendicitis, the primarily closed incision is noted to be erythematous, slightly swollen and tender. The appropriate treatment is:

D. incision and drainage

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A man is brought to the E.R. with blood spurting from a hacking wound in the in the distal right thigh. He is alert and has a systolic BP of 100 mmHg. What is the initial management step?

A. apply direct pressure on the wound with sterile gauze

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A young man presents to the E.R. with a stab wound in the left chest. Examination reveals subcutaneous emphysema and absent breath sounds on the left chest; the trachea is shifted to the right. What is the probable diagnosis?

B. tension pneumothorax

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A 58-year-old woman on NSAID therapy for arthritis has a 6-hour history of epigastric pain that has progressively become severe. Her abdomen is distended, rigid and diffusely tender. This diagnostic test should be done first:

A. upright chest x-ray

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After aggressive fluid therapy, a trauma victim shows a systolic BP of 110 mm Hg, cold extremities, rapid but strong peripheral pulse, and a central venous pressure of 12 cmH2O. The patient has:

A. increased systemic vascular resistance

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An elderly man admitted with a diagnosis of sigmoid volvulus has a markedly distended, non-tender abdomen and hyperactive bowel sounds. The initial treatment is:

A. endoscopic detorsion

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Pancreatic necrosis is suspected in a 49-year-old woman who has not improved despite 3 days of intensive care for acute pancreatitis. The diagnosis is best established through:

C. contrast-enhanced CT scan

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A chronically constipated 67-year-old woman presents with acute left lower quadrant (LLQ) abdominal pain, LLQ direct and rebound tenderness, and fever. The appropriate diagnostic examination is:

B. abdominal CT scan

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After an elective hemicolectomy for colon cancer, a 78-year-old man remains hypotensive and tachycardic. He has distended neck veins, cold skin, oliguria, and elevated central venous pressure. He apparently is suffering from this type of shock:

B. cardiogenic

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For the past 6 weeks, a 67-year-old man has been asymptomatic except for constipation after a course of antibiotic therapy for left lower quadrant abdominal pain. He should undergo:

C. colonoscopy

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A 32-year-old-man with a week’s history of fever presently has right lower quadrant abdominal pain and tenderness and bloody diarrhea. The most probable diagnosis is:

A. typhoid ileitis

A 75 year old woman in the ICU after undergoing cholecystectomy for acute Cholecystitis is hypotensive and tachycardic. Pulmonary capillary wedge pressure (PCWP) is elevated to 18 mmHg, and cardiac output is 3 L/min. she is shock best described as which o

C. cardiogenic shock

A 19 year old man is brought to the emergency department with a stab wound at the base of the neck (zone I) The most important concern for patients with such injuries is which of the following?

C. exsanguinating hemorrhage

In septic shock, which of the following is true?

C. the majority of patients are elderly

The injury most often missed by selective nonoperative management of abdominal stabwounds is to which of the following?

D. diaphragm

A 63-year-old male tobacco smoker has a 1.5 cm non-healing ulcer in his lower lip. A nodular lesion is palpable deep to the ulcer. The most likely diagnosis is:

A. squamous cell carcinoma

A 43-year-old-man presents with nasal obstruction and occasional epistaxis. Imaging studies combined with endoscopic biopsy have led to the diagnosis of nasopharyngeal cancer. The standard treatment is:

C. combined chemotherapy and radiation

Biopsy of a slow growing infraauricular mass reveals a benign pleomorphic adenoma that is confined to the superficial lobe of the parotid gland. The standard treatment is:

C. superficial parotidectomy

A 58 year old woman undergoes excision biopsy of a tumor in the left posterior triangle of her neck. Histology suggests that this is a metastatic cancer. What is the most likely site of the primary tumor?

D. piriform fossa

A 59 year old woman has discomfort in the posterior part of her tongue. A biopsy confirms that the lesion is a carcinoma. What is true in carcinoma of the posterior third of the tongue?

B. lymph gland spread is often encountered

A 60-year-old man has a 3 cm nodular lesion with central ulceration in his left cheek. Section biopsy proves this to be basal cell carcinoma. This is best managed with:

D. excision with 2-4 mm margin

This is the most common aggressive primary malignant bone tumor in adolescent and occurs in methaphyseal area of long bones with high incidence of pulmonary metastases:

b. Osteosarcoma

A 65 year-old farmer presents with a 1.5-cm ulcerated lesion on the middle third of his lower lip. The lesion has been present for 4 months and is not painful. No lymph nodes are palpable in the patient’s neck. The most likely diagnosis is:

a. Squamous cell carcinoma

A 65 year-old patient who spends summer in Baguio City presents with a painless, ulcerated lesion on the right cheek. The lesion has been present for one year. Physical examination of the patient’s neck reveals no lymph node enlargement. The most likel

c. basal cell carcinoma

A 60-year-old woman has a 10-day history of cough and fever. Imaging studies show multiple fluid loculations in the right chest cavity with an estimated volume of 500 ml. Thoracentesis draws purulent material. The best treatment strategy now is:

B. video assisted thoracoscopic drainage with deloculation

A-50-year-old woman presents with a 3 cm solitary pulmonary nodule in the left upper lobe. She has a history of total thyroidectomy for papillary cancer at the age of 38 years. The main consideration is:

C. primary lung cancer

A 45-year-old woman presents with weakness towards the afternoon, shortness of breath, and ptosis. CT scan reveals an anterior mediastinal mass. The most likely diagnosis is:

D. thymoma

A man with malignant pleural effusion in association with an inoperable lung cancer may benefit from the instillation of sclerosing agent into the pleural cavity, once the lungs are almost fully expanded. An accepted sclerosant is:

A. talc

A 20-year-old woman consults for a 2-cm mass in her left breast. The mass is movable, non-tender and has a rubbery consistency and smooth borders. The probable diagnosis is:

A. fibroadenoma

A 16-year-old girl is bothered by cyclical premenstrual pain in her breasts. She has 0.5-1.0 cm nodularities in the upper outer quadrant of both breasts. What management advice should be given to her?

A. Observation

An asymptomatic 40-year-old woman with no palpable breast mass undergoes mammography. This reveals clustered microcalcifications in the lower outer quadrant of her left breast. The probable diagnosis is:

D. ductal carcinoma in situ

A 45-year-old woman with “lumpy” breasts undergoes mammography. Mammographic findings are suggestive of high-grade ductal carcinoma in situ confined to the upper outer quadrant of her right breast. How should she be managed?

B. lumpectomy and radiotherapy

A 45-year-old woman has a recent onset bloody nipple discharge from her right breast. No palpable breast mass is noted. What diagnostic test is indicated?

B. mammography

A premenopausal woman undergoes modified radical mastectomy for a 3-cm breast cancer. No axillary node and distant metastases are detected. Test for this biomarker is currently recommended to facilitate the selection of adjuvant chemotherapy:

D.AHER2/neu

A 63-year-old man with chronic atrial fibrillation has sudden onset of pain, weakness, and paresthesia in his left leg, which appears cool, cyanotic, and without femoral and distal pulses. The right leg has normal pulses. The most likely diagnosis is:

A. arterial embolism

Coronary angiogram reveals a triple-vessel disease in a diabetic 55-year-old man presenting with unstable angina. The recommended treatment is:

C. coronary artery bypass grafting

A 41-year-old male chronic smoker has a 2-year history of bilateral foot claudication. He now has ulceration of the tip of the right 3rd toe and left 2nd and 4th toes. Popliteal pulses are palpable but the posterior tibial and dorsalis pedis pulses are bi

A. cessation of smoking

A premature infant with progressive dyspnea without cyanosis since birth has machinery murmur in the pulmonic area. A diagnosis of patent ductus arteriosus (PDA) is made. The indicated treatment is:

A. administration of indomethacin

A 3-year-old girl presents with cyanotic spells that have increased in severity and frequency since birth. X-ray shows a boot-shaped heart; ECG reveals right ventricular hypertrophy. The most probable diagnosis is:

B. tetralogy of Fallot

A 54-year-old man presents with hematemesis after a bout of vomiting and retching. Endoscopy shows linear mucosal tears at the gastroesophageal junction. The diagnosis is:

A. Mallory-Weiss syndrome

After truncal vagotomy and antrectomy with gastrojejunostomy for an obstructed duodenal ulcer, the patient complains of diaphoresis, weakness, and abdominal discomfort followed by diarrhea several minutes after meals. The symptoms are suggestive of:

D. dumping syndrome

A woman undergoes total gastrectomy for a huge proximal gastric carcinoma. To protect her from developing anemia, she must be given a regular parenteral dose of:

C. vitamin B12

A few weeks after recovering from severe pancreatitis, a 34-year-old man has developed a pancreatic pseudocyst with mature wall that is pressing on his stomach. Aspiration fails to relieve the pressure symptoms. The indicated treatment is:

B. internal drainage (cystogastrostomy)

ERCP reveals a periampullary cancer in a 64-year-old man admitted for jaundice. No metastasis is detected; no co-morbid conditions are identified. How should he b managed?

A. radical excision of the head of pancreas and duodenum

A 60 year old man with no previous operation has a 5-day history of inability to pass flatus or feces, cramping abdominal pain, and progressive abdominal distention. The principal diagnostic consideration is:

B. colorectal cancer

A 65 year old male who underwent a colon resection of carcinoma 2 years prior to consult is found to have 3 solid nodules approximately 2 cms each in the right and left lobes of the liver. There is no extrahepatic disease detected. The preferred treatment

D. surgical resection of metastatic nodules

A 35 year old female with a prolonged intake of contraceptive pills develops right upper quadrant pains. Ultrasound shows an isodense 5 cm mass in the right lobe of the liver. Sulfur-colloid scan done showed a cold lesion. This patient should undergo.

B. resection

A man who has an obstructed rectosigmoid cancer in association with a competent ileocecal valve is liable to develop perforation of:

D. cecum

The presence of tenesmus, decrease in caliber of stools and occasional bloody-mucoid diarrrrhea in a 67-year-old man is suggestive of:

A. rectal carcinoma

Diagnostic tests show an ileocolic intussusception in a 38-year-old man, who has no signs of strangulation. What is recommended for this patient?

A. expectant treatment B. endoscopic decompression C. hydrostatic reduction D. exploratory laparotomy

A 63-year-old man is presently asymptomatic after medical treatment for LLQ pain and tenderness. He should undergo:

B. Colonoscopy

A 56-year-old woman taking NSAID for chronic arthritis experienced severe epigastric pain 6 hours ago. Her abdomen is now diffusely tender with board-like rigidity. The appropriate initial diagnostic test is:

A. chest upright x-ray B. plain abdomen supine x-ray C. abdominal ultrasound D. abdominal CT scan

Despite 3 months of medical treatment for posterior midline anal fissure, the man’s fissure-related anal pain during and after defecation has become excruciating. The appropriate treatment is:

D. internal sphincterotomy

During surgery for a large right indirect inguinal hernia, the cecum is noted to form part of the wall of the hernia sac. The patient has this type of hernia:

A. sliding

A previously asymptomatic 45-year-old obese woman consults for a non-tender swelling below her right inguinal ligament just lateral to the pubic tubercle. A warranted diagnostic procedure for this patient is:

B. ultrasound

A 54 year old male taking anticoagulant for the fast 4 weeks developed 3 day history of abdominal pain. On physical examination there was a palpable mass at the supraumbilical area with direct tenderness. Fothergill sign way positive. What is your impres

B. rectus sheath Hematoma

A 12 year old female complain of 1 day history of epigastric pain which shifted to the right lower quadrant associated with anorexia and vomiting. Physical examination revealed direct and rebound tenderness on the right lowerquadrant. With the preoperat

B. omental torsion

A 45-year-old is discovered to have a solitary 2-cm firm nodule in his right thyroid lobe. No associated symptoms are noted; family history is negative for thyroid cancer. Diagnostic work-up should start with:

D. fine needle aspiration biopsy

A 59-year-old man presents with 4-cm firm mass in the left lobe of the thyroid associated with a firm occipital mass that is 6 cm in its widest diameter, which he has neglected for the past 9 months. Family history is negative for thyroid malignancy. He p

B. follicular

A 49-year-old woman complains of central obesity with moonlike facies and hirsutism. Her ACTH is markedly elevated, which is suppressed by large dose of dexamethasone. The probable pathology is:

D. pituitary adenoma

A 42-year-old man presents with headache, palpitations, and diaphoresis. His urinary metanephrines are elevated. Imaging studies reveal a 3-cm mass in his right adrenal gland. The treatment of choice is:

A. adrenalectomy

A 67-year-old man is bleeding excessively following a transurethral prostatectomy. The bleeding is assessed to be due to local plasminogen activation leading to increased fibrinolysis on the raw wound surface. Administration of this drug may be beneficial

D. EACA

A 60-year-old man presents with slight urinary urgency, frequency, and a decrease in the force of micturition. Digital rectal examination detects no mass in the prostate. The indicated diagnostic test is:

B. prostate-specific antigen

A 35-year-old man presents with right flank pain and microscopic hematuria. Intravenous pyelography reveals a 4 mm radiolucent stone in the distal right ureter. The recommended treatment is:

A. alkalinization of the urine

A 55-year-old man is admitted for gross hematuria associated with left flank pain and anemia. CT scan detects a solid, enhancing mass in the left kidney. The likely diagnosis is:

A. renal cell carcinoma

A 23-year-old woman sustained blunt head trauma to her right frontoparietal area in a car crash, which caused he to be unconscious for several minutes. Upon arrival at the E.R., she is alert and has no neurologic deficit. X-ray shows a linear non-depresse

C. acute epidural hematoma

A 54-year-old woman with no previous neurologic disorder has new onset seizures without associated gross neurologic deficit. She was treated for breast cancer 10 years ago. If brain metastasis is the main consideration, this is

C. MRI of the brain with intravenous contrast

A 55-year-old man with a history of lung cancer presents with frequent severe headache, occasional vomiting, and weakness of the right upper extremity. What is the recommended treatment in addition to corticosteroids?

C. stereotactic radiosurgery (gamma knife)

A young man just admitted for blunt injuries from a car accident is stuporous. CT scan shows cerebral contusion. What should be avoided as it can cause secondary brain injury to this patient through its deleterious effect on in tracranial pressure?

B. respiratory acidosis

As a basketball player falls hard on his extended right arm, he feels immediate severe pain with subsequent inability to move his right arm. Swelling and tenderness about the shoulder with loss of deltoid contour are noted. The likely diagnosis is:

B. shoulder dislocation

A 10-week-old baby with cleft lip and palate has undergone a successful cleft lip repair. It is recommended that cleft pate repair be done before the baby reaches this age:

B. 12 months

A bedridden 61-year-old woman has a significant neurologic recovery from a previous stroke. She has an infected deep pressure ulcer in her sacrum. Once the infection has been controlled by debridement and supportive treatment, the pressure ulcer can be ma

C. gluteus maximus flap

A small thick antecubital scar from a 2nd degree flame burn is constricting movement. To relieve the constriction, the appropriate procedure to refashion the scar is:

A. Z-plasty

Resection of a sarcoma results in a significant lateral chest wall defect. To minimize pulmonary dysfunction, chest wall reconstruction may utilize:

D. Marlex mesh

A 4-week-old baby boy presents with frequent non-bilious vomiting. During feeding, peristaltic waves are seen in the upper abdomen in association with a palpable mass in the right upper quadrant. The diagnosis is:

A. hypertrophic pyloric stenosis

A newborn infant has excessive drooling followed by coughing immediately after feeding. The main diagnostic consideration is esophageal atresia. This can be readily confirmed by:

A. inability to pass orogastric tube into the stomach

A diagnosis of intussusception is made in an infant with paroxysms of crampy abdominal pain and vomiting. The infant has no peritoneal signs and remains hemodynamically stable. The initial treatment of choice is:

C. pneumatic reduction

A 3-day old infant who has not passed meconium presents with abdominal distention and bilious vomiting. The most likely diagnosis is:

D. Hirschprung’s disease

A 3-week-old infant is noted to have jaundice in association with acholic stools shortly after birth. A radionuclide scan demonstrates presence of radioisotope in the intestine. This finding rules out the diagnosis of:

B. biliary atresia

A 67 y/o man has an intraabdominal abscess caused by perforated sigmoid diverticulitis. The most common isolated microorganism is__?

B. Bacteroides

One of the most common complication of central venous access is_____.

B. pneumothorax

Early postoperative small bowel obstruction is a rare finding and occurs less than 1 % of the time. When it does, the most common cause is_____.

B. post-operative adhesions

Which of the ff statements is true concerning corrosive injury to the esophagus?

C. Alkaline injury is more destructive than acid injury.

A 27 year old female was brought to the ER with history of suicidal ingestion of household muriatic acid. This patient is best managed by---

B. Start with milk, egg white or antacids

Which of the following statements is true regarding the arterial blood supply of the stomach?

B. Because of the rich intramural collateral vessels, gastric viability may be preserved after ligation of at least two of the four named gastric arteries

At a cellular level, the major stimulants of acid secretion by the gastric parietal cell are the following, except:

B. prostaglandinE2

A patient with gastric adenocarcinoma underwent subtotal gastrectomy. Histopath revealed tumor penetrating the serosa, regional lymph nodes are not involved and distant metastatic lesions are not detected. What is the correct tumor stage on TNM staging

B. Stage II

A 5-month old baby boy was seen at the ER with complaints of non-bilous vomiting that became increasingly projectile over several days to weeks and cannot tolerate liquid intake. Abdominal examination revealed palpation of typical “olives” in the right up

C. Hypertrophic pyloric stenosis

Which of the following is the most common malignant liver tumor in childhood?

B. Hepatoblastoma

What is the appropriate treatment for an incidental 3 cm liver hemangioma found on abdominal CT scan of 37 year old woman?

A. No treatment

A 35 y/o male presents with 1 year history of early satiety and right upper abdominal discomfort. CT scan shows a 6 x 8 cm cystic lesion in the right lobe of the liver. Ultrasound of cyst show no internal echoes. The appropriate management is:

C. unroofing of the cyst

An imaginary line that divides the liver into right and left lobe that runs from the inferior vena cava to the tip of the gallbladder fossa:

C. Cantlie’s line

The diagnostic tool important in evaluating liver injury in a stable blunt trauma patient is:

C. CT scan

The local factor affecting wound healing:

C. Low oxygen tension

The characteristic of Keloid scars:

C. Extend beyond the border of original wound and rarely regress spontaneously

A 55 y/o male diagnosed to have chronic pancreatitis, developed epigastric mass measuring about 6 cm accompanied by pain and fullness. The diagnosis is:

C. Pseudocyt of the pancreas

Type of benign solitary pancreatic neoplasm consisting of symptomatic fasting hypoglycemia and profound syncopal episodez:

A. Insulinoma

The most common indication for splenectomy:

C. Trauma to spleen

The best time to repair of cleft lip is:

B. 10 weeks

A 36 y/o female complain of an acute pain at the lateral aspect of her left breast. A tender firm cord is found on the same site on physical examination. It was diagnosed as a Mondors disease. This lesion is best managed with:

B. Anti-inflammatory medication, warm compress and rest of ipsilateral extremity

Breast lesion that can be treated with close observation with or without tamoxifen:

lobular carcinoma in situ

The best screening imaging technique for breast cancer is:

D. Mammography

A 46 y/o female who underwent a total thyroidectomy for stage II papillary carcinoma developed 3 weeks later with Chvostek’s and Trouseau’s sign. This could be due to:

C. Hypoparathyroidism

This is considered as a single most important test in the evaluation of patients with thyroid masses:

C. Fine needle aspiration cytology

Lymph node in the posterior triangle of the neck is within what level:

C. Level V

This form of shock has a low blood pressure, low urine output but has an elevated central venous pressure:

B. Obstructive shock

55 y/o male who has been in the ward for the past 4 days and is receiving IV fluid of D5W is complaining on his 5th hospital day of headache, nausea, vomiting, anorexia, body malaie and watery diarrhea. Give the most probable electrolyte imbalance the pat

C. Hyponatremia

The most important part of the treatment of severe metabolic acidosis among trauma patient is:

E. Restore perfusion with volume resuscitation

The most common primary bone malignancy:

A. Osteosarcoma

The most potent stimulant for aldosterone release is:

A. ACTH

The most biologically active and potent vasoconstrictor is

endothelins

In trauma patients significant reduction in infectious complications were noted in patients given early enteral nutrition as compared to those given who are unfed or given parenteral nutrition except for what type of trauma patients?

C. head trauma

Branched chain amino acids are used in parenteral nutrition for what specific type of patients?

D. hepatic failure patients

In what type of parenteral feeding is fat increased to 50% of total calories?

B. pulmonary failure formulas

The appendeceal flora remains constant throughout life with the exception of what bacteria, which appears only in adults?

A. Porphyromonas gingivalis

The most significant factor associated with both fetal and maternal deaths in pregnant patients with acute appendicitis is

B. appendeceal perforation

Which of the ff. is true of the superior mesenteric artery syndrome? C

C. Compression is over the third portion of the duodenum.

Which of the following factors present in a entero-cutaneous fistula increases the possibility of closure of the tract?

A. non-epithelialization of the tract

What is the single most important factor in predicting burn related morbidity and mortality?

A. size of burn

What type of shock is caused by the interference of the balance of vasolidator and vasoconstrictor influences to arterioles and venules?

D. neurogenic shock

A 50 y/o female consulted to you and complaints of fatigue, polydypsia, polyuria, nocturia, joint pains and constipation. Her laboratory exams shows normal FBS, elevated serum calcium, and elevated intact PTH. What would be the most likely diagnosis?

D. Hyperparathyroidism

A 35 y/o male presents with a long standing severe hypertension with associated muscle weaknes, headache, polyuria and polydypsia. Blood exams revealed an elevated aldesterone level and elevated serum potassium. What is the most likely diagnosis?

C. conn’s syndrome

Which of the following is the most commonly inured organ in blunt abdominal injury?

D. spleen

In the initial management of an acutely and seriously injured patient, the first and most important emergency measure to be taken care of is:

D. ensuring an adequate airway

Diagnostic peritoneal lavage (DPL) remains the most sensitive test available for determining the presence of intraabdominal injury. The result of DPL is considered grossly positive if;

D. 15 ml of blood is aspirated

Which of the following constitute an immediate threat to life because of inadequate ventilation

A. flail chest

While undergoing exploratory laparotomy for blunt abdominal injury, to the patients BPwas noted to be 70 palpatory while bleeding was noted coming from the splenic hilum. Appropriate management for the injured spleen should be;

A. splenectomy

During the initial resuscitation of a hypovolemic patient secondary to a vehicular accident external bleeding is best controlled by;

B. direct finger pressure

In penetrating neck injuries zone II is referred to an area between;

B. cricoid cartilage and angle of mandible

In assessing the extent of hepatic injury following blunt injury to the abdomen, bleeding from the liver is best controlled by;

C. pringle maneuver

Stable patients at risk of urethral injury, manifestating as presence of blood at the matus, necessitates an immediate;

B. urethrography

Type of healing in which the wound is allowed to heal by granulation tissues formation and contraction:

B. secondary intention

Partial thickness wound such as seen in superficial second degree burns heal by which of the following process:

B. epithelization

Equilibrium between collagen synthesis and collagen degradation occurred during the stage of;

D. remodeling

Delayed primary wound closure is indicated in which of the following type of wound;

C. contaminated traumatic wound

Cytokines that are produced by one cell and affect an adjacent cell such as transforming growth factor beta (TGF-B) are called;

B. paracrine factors

The major component of the extracellular matrix that provide strength, support and structure of all soft tissues, tendons, ligaments and bones is;

A. collagen

The genetic disorder arising from mutations in the genes for type I collagen causing increase propensity for the bones to break under minimal stress is;

B. osteogenesis imperfecta

Lesion of the gastrointestinal tract that result in comlete regeneration and recovery;

D. gastric erosions

Skin lesions that extend beyond the boundaries of the original wound, do not regress with time and recur after excision;

B. keloids

Kehr’s sign is a classic example of;

D. referred parietal pain

The bleeding in Mallory-Weiss syndrome is secondary to;

B. linear tears of the gastroesophageal junction

The most common cause of intestinal obstruction for all age group combined is;

c. adhesive bands

The most obvious route of fuid and electrolyte loss in patients with intestinal obstruction from leocecal TB is through;

vomiting

Occlusion of the blood supply to a segment of bowel in addition to obstruction of the lumen is referred to as;

C. strangulated obstruction

Which of the following diagnostic modalities consistently localizes the site of bleeding in cases of lower GI bleeding;

C. Angiography

The most common cause of massive lower GI bleeding is;

B. diverticulosis

A 50 y/o male with history of alcoholism was admitted because of history of progressive jaundice, associated with tea-colored urine, achlic stools, weight loss and mild epigastric pain. The simplest and most non-invasive method in the diagnosis of this p

C. Ultrasonography

Relative to the ileum, the jejunum has;

C. longer vasa recta

The most common malignant neoplasm of the small bowel is;

adenocarcnoma

The presence of a Meckels diverticulum in a hernial sac is called;

C. littre’s hernia

Rovsings’ sign is elicited by;

A. pain the right lower quadrant when palpatory pressure is exerted in the left lower quadrant

In children with history of URTI 3 days prior to development of RLQ pain, the differential diagnosis most often confused with appendicitis is;

D. acute mesenteric adenitis

The recommended treatment for patients with adenocarcinoma of the appendix is;

B. right hemicolectomy

The precipitating factor in secondary omental torsion is;

D. foci of intraabdominal inflammation

The most common solid tumor of the omentum is;

D. metastatic carcinoma

The most common anaerobic bacteria that is isolated in intraabdominal infection is;

C. bacteroides specios

A 45 year old female came in because of right upper quadrant pain, colicky aggravated by fatty food intake 4 hours ptc. Physical exam showed a palpable mass at the right subcostal margin non-movable tender, midinspiratory arrest was illicited while the pa

B. acute cholecystitis

The laboratory examination of a 45 year old female came in with the following results ; sgpt was elevated, direct bilirubin increased, alkaline phosphatase increased, protime prolonged . utz showed a hyperechoic mass at he neck of the gallbladder with po

C. acute calculous cholecystitis

The treatment of choice for the above condition ( no.4) is

C. cholecystectomy

A patient s/p cholecystectomy and cbde with t-tube choledochostomy showed a distal cbd stone on t-tube cholangiography , management would be

C. choledococopy and basket extraction of the stone

A 25 year old male came in with chronic draining lesion at the perianal area of 2 years duration. Physical exam showed a draining lesion about 4 cm from the anal verge at the 3:00 position. The internal opening is probably

B. posterior midline

30 year old female came in because of painfull perianal mass 2 days ptc, physical exam showed a tender mass at the right lateral position w/c precludes rectal exam with a bulging tender mass adjacent to it. The most likely condition is

C. perianal abscess

A 50 year old male came in because of loss of weight about 30% of his previous body weight. Associated with on and off colicky abdominal pain. He also noticed that his stools have diminish in caliber just like a goat stool,the single most important examin

C. colonoscopy w/ biopsy

A 25 year old female came in with a palpable breast mass noted 2 weeks ptc, the mass is about 2.5 cm well delineated border, movable, non-tender at the right upper outer quadrant, no familial history of ca.the most likely diagnosis would be

A. fibroadenoma

Seromas are fluid collections coming from the:

C. Lymph

A patient was discharged 3 days after appendectomy (suppurative). After 5 days, he came back at the OPD for follow up complaining of tenderness at the operative site. The incision site was nonerythematous. What is your diagnosis?

B. Surgical site infection

A patient was operated on for acute cholecystitis. After 24h postop, the patient developed fever. What is the most likely cause of his fever?

D. Atelectasis

The basic problem in poor wound healing regardless of the underlying factor is:

C. Low 02 tension

Ileus following abdominal surgery is expected to last for at least how many days?

C. 5

For every degree rise in temperature, the insensible water loss in cm3 per day is approximately:

D. 250

Which ion if altered determines the shift of fluid from one compartment to another?

A. Sodium

Which of the following cytokines may help control keloids and hypertrophic scars?

D. TGB-B

Which part of the GIT provides strength in the anastomosis

C. Submucosa

Which amino acid provide energy source in the GIT

C. Glutamine

A 54yo male patient with 3rd degree burn approximately 40%TBSAdeveloped abdominal pain on the 4th hospital day. What is the least likely cause of the abdominal pain?

D. Renal colic

Convulsions if present during the resucitative phase of burn injury may be due to

B. Hyponatremia

The offending organism in surgical site infection is;

A. Staph aureus

Earliest manifestations of catheter related complication following parenteral nutrition.

A. Tachycardia B. Fever C. Glucose intolerance D. Changes in sensorium

Which of the following statements is not a sound principle in the fluid and electrolyte therapy post operatively?

B. Urine volume is replaced on a mililiter to mililiter basis

The average potassium (in meq/l) content of the bile per day is

B. 10

Which cranial nerve is involved in the act of swallowing

A. Xi

Primary reason for staging esophageal cancer is

A. Determine its resectability

Most common benign esophageal tumor is

A. Leiomyomas

Blood supply of lesser curvature is

B. Right gastric

Manifestation of acute gastric dilatation

D. Hypotension

A patient underwent upper gastrointestinal endoscopy for gastric outlet obstruction. The endoscopist noted a lesion at the antrum and took biopsy. It turned out to be gastric cancer. What type of gastric cancer has favorable prognosis?

B. Polypoid

A patient diagnosed to have perforated peptic ulcer disease had his symptoms 8 hours prior to admission. He was prepared for surgery. Which of the following best describes the required operation?

D. Omental patch

After truncal vagotomy for peptic ulcer disease, the patient may develop the following except:

B. Megaloblastic anemia

Most common neoplasm of the stomach

A. Adenocarcinoma

A 77 year old, male, chronic smoker on NSAIDs for arthritis presents with an acute abdomen and pneumoperitoneum. What could be the most likely cause of this?

A. Severe abdominal pain due to chronic gastritis

Increased venous pressure , decreased pulse pressure and decrease heart sound are pathognomonic of:

C. Cardiac tamponade

“Bird’s beak” deformity is a radiologic sign of

A. Sigmoid volvolus

A 32 yo male was brought to the ER because of blunt abdominal trauma due to fall. The patient had hematoma and abrasions on his RUQ and R flank. Your resident assessed that the patient has surgical abdomen and needs immediate surgery. He requested one-sho

C. Determine function of either kidneys

A 23 yo female, medical student, was brought to the ER because of VA. Patient was GCS 13-14 with blunt abdominal trauma following a motor vehicular accident. Diagnostic peritoneal lavage was done & showed negative results. The assessment of negative resul

D. Does not rule out abdominal organ injury

The most important factor in the management of contaminated wounds is

C. Adequate debridement

Whether it’s diverticulization or exclusion, the principle behind these procedures for the doudenal injuries is to

B. To rest or isolate the injure doudenum

Sphincterotomy for anal fissures is usually done at the

B. Posterolateral

Surgical management of familial adenomatous polyposis depends on the

A. Number of polyps seen

Elective colorectal cancer operation is classified as

C. Clean contaminated

Which of the following is the most important prognostic determination of survival after treatment of colorectal cancer

D. Histologic differentiation

A 60 y.o. male is admitted to the hospital after passing out large amount of maroon-colored stools. At the ER, he again passed out more bloody stools as well as clots. He is pale and tachycardic, NGT aspirate is bilious. After resuscitation, which of the

D. RBC tag scan

Which is the most important stimulus for triggering endocrine response to injury

D. Local wound factors

Which is not true regarding gastrostomy tube feeding?

D. preferably delivered in a constant flow

Pellagra, dermatitis, glossitis, & peripheral paresthesias with spinal cord symptoms are due to deficiency of

A. Folic acid

The primary source of energy following trauma is

A. Glycogen

Eicosanoids are cell mediators derived from

C. Arachidonic acid

The reason why approximately one half of breast cancer are located at the upper outer quadrant is

C. The larger volume of breast tissue

Which structures demarcates the node levels in breast cancer:

D. Pectoralis minor

Carcinoma of the breast among the elderly presenting as a bulky, colloid tumor is

A. Mucinous

Management of inflammatory breast carcinoma with the best response

A. Neoadjuvant chemo + MRM+ irradiation

Which of the following structures which when encroached by cancer gives rise to the “orange-peel” appearance of the breast?

D. Subdermal lymphatics

A 34 female patient came at the OPD with 2cm palpable mass, moveable, nontender. No axillary nodes noted. Patient has an elder sibling who died of breast ca last 2 years ago. What will be your initial diagnostic procedure?

A. Needle or open biopsy

Collagen synthesis is at its peak at around how many days?

C. 5-7

Formation of collagen fibers by cross-linking is enhanced by lysyl oxidase together with

B. Copper

Which of the following steroids useful in the treatment of scars and keloids

B. Triamcinolone

Most common cause of hospital acquired infections are coming from the

C. Urinary tract

45 male came in to the ER with a 3 cm lacerated wound at the left leg after he was bitten by a pig. He has received tetanus toxoid and tetanus immunoglobulin 10 1/2 years ago. What would be the appropraite management at the ER?

C. Debridement, leave wound open + tetanus immunoglobulin +toxoid+antibiotics

Superior vena caval obstruction is commonly caused by

B. Bronchogenic carcinoma

The average length of the adult trachea is

D. 11 cm

Squamous cell ca of the lung is usually associated with

A. Hypercalcemia

The initial diagnostic tool in assessing biliary ductal obstruction

A. Alkaline phosphatase

Progressive painless jaundice with positive “ Courvoisier’s sign” suggest

C. Pancreatic head or peri ampullary neoplasm

The initial diagnostic procedure in patients presenting with lower GI bleed

B. Proctosigmoidoscopy

The main parameter for determining the clinical stage of head and neck tumors is

B. Lymph node involvement

Malignancy of the tongue usually occurs at the

B. Midlateral

The second most frequent benign salivary gland neoplasm is

C. Papillary cystadenoma lymphomatosum

The acidosis in hypovolemic shock is due to

B. Lactic acid

Substance associated with increased incidence of mesothelioma

C. Asbestos

Prostatic carcinoma usually metastasizes to the

D. Bone

The earliest visible evidence of neoplastic transformation is

C. Dysplasia

Epstein-barr virus is associated with the following tumors, except

D. Hepatocellular carcinoma

A normal to low CVP that does not rise with rapid administration of crystalloids indicates:

A. Inadequate rate of infusion

Recurrent laryngeal nerve is preserved in thyroid surgery. What is false with regards to this nerve:

B. Injury to the ipsilateral nerve cause disability of phonation

Among the types of thyroid cancer, which one is the most aggressive?

D. Anaplastic

A 45yo female patient underwent total thyroidectomy for follicular ca. 24 H after surgery, the patient developed numbness around the lips and fingers. What could have caused this?

B. Ischemia to the parathyroids

True regarding hernia:

D. Repair of umbilical hernia is indicated in infants with hernia > 2cm

A 23yo male patient came in at ER with irreducible inguinal hernia of >16hours duration. Patient complained of abdominal pain with BP of 100/70, CR 120, & RR 30. The appropriate management is:

D. Schedule patient for surgery

At the ER, a patient complained of renal colic. The following are the minimal laboratory evaluation you would request except:

A. CBC and electrolytes

In the medical treatment of BPH, which among the drugs acts by reducing the intraprostatic dihydrotestosterone levels without lowering the plasma testosterone level?

B. Finasteride

A 48hour old baby boy was brought to the ER due to vomiting of bilious vomitus, abdominal distention, and failure to pass out meconium. What is the most likely cause?

Ileal atresia

A 28 kg child with ruptured appendicitis has the following laboratory results: BP=90/60; PR=110; RR=25; Na=125; Cl=95; K=3; ph=7.35; pCO2=35; pO2=100; HCO3=24. Which of the following is TRUE?

C. actual Na deficit is 250 mEq

Interpret the above ABG results:

C. compensated metabolic acidosis

In the above patient, which of the following is TRUE?

initial fluid resuscitation is 560 cc given as fast drip

In the same patient, which abnormality is he liable to manifest?

A. increased intracranial pressure

Extracellular fluid deficit results in:

B. increased hematocrit

A 70-kg is admitted because of abdominal colic followed by vomiting of previously ingested food. Initial assessment is an Intestinal Obstruction probably from adhesions. On examination, the patient has weak and rapid pulse, depressed eyeballs, and dry ton

B. isotonic dehydration

TRUE statements regarding fluid and electrolyte losses in this patient:

B. can go into hypovolemic shock anytime

Fluid replacement in this patient should begin with:

C. Crystalloids

Which of the following is an expected cellular change/s in hypovolemic shock?

D. increase in transmembrane potential

A patient has a blood pressure of 70/50 mmHg and a serum lactate level of 30-mg/100 ml (normal: 6 to 16). His cardiac output is 1.9 L/min, and his central venous pressure is 2 cmH2O. The most likely diagnosis is:

C. hypovolemic shock

During compensation for hypovolemic shock, blood flow to which of the following area/s is under sympathetic nervous system control?

B. C. small bowel

This hemodynamic monitor is valuable to differentiate a pericardial tamponade from hypovolemia:

A. CVP

In a multiply injured patient with acute blood loss, adequate preload to the heart is maintained initially by the:

A. increase in systemic vascular resistance

An example of neurogenic shock:

B. syncope

Coagulation factors tested by prothrombin time (PT):

A. VII

The initial hemostatic response to injury is:

C. vascular constriction

All are major events in the hemostatic process:

B. platelet plug formation

The following are suggestive of DIC:

B. increased fibrin split products

Injury to the intima of blood vessels exposes the subendothelial collagen which initiates:

B. platelet aggregation

A 77-year old man is scheduled to undergo sigmoid colectomy. He denies any history of prolonged bleeding. Preoperative evaluation of hemostasis should include:

D. platelet count, PT, and PTT

The total caloric requirement of a malnourished patient is calculated using his:

A. Actual weight

In prescribing the nutrition therapy, micronutrients are given at what % of RDA:

A. 100

Nitrogen excretion is less in:

A. starvation

At the initial stages of septic shock it is normally expected to have a:

A. normal blood volume

A 38-year-old male had abdominal exploration for multiple gunshot wounds. He is febrile T 38.5 C on the 2nd post-op day; HR is 98 bpm, BP 100/80. WBC count is 13000. The patient is hooked to a ventilator. The patient is developing what condition;

A. SIRS

On the 5th day post-op the patient in addition to the above findings now shows erythema and draining pus from the abdominal incision site. The patient now is developing;

B. sepsis

On the 10th day post-op, the patient is persistently febrile with increase in WBC count (18000) and this time with oliguria that is unresponsive to fluid resuscitation. The patient now is developing;

D. Septic shock

The above patient was given pressor agents to improve his condition, despite this he remains oliguric. The patient now has:

D. Septic shock

Immediately after mastectomy your patient asks if any of the following promotes wound healing, which one wills you advise your patient?

A. Vitamin C

Severe cases of hidradenitis suppurativa in the groin area are best managed by excision of the involved area and:

A. closure by secondary intention

An elderly cancer patient fell and sustained a deep lacerated wound over the right forehead about 9 cm length. If wound infection later develops in this patient. The major cause of impaired wound healing is:

A. anemia B. local wound infection C. DM D. All of the above

What technique of wound closure is recommended in a patient with ruptured appendix with spreading peritonitis?

B. delayed primary

If the lacerated wound is sutured closed, this healing is known as;

A. primary

Wound healing in this patient may be impaired because of his;

A. age

Infection in the above wound is partly controlled by the presence of what cells;

A. macrophages

Important activities of macrophages during wound healing;

A. wound debridement

The ABC’s of resuscitation includes the following:

A. establish adequate airway

A 25-year-old male is brought to the ER after he sustained a stab wound to the 5th intercostals space. PE: conscious, stretcher-borne, vitals are as follows: blood pressure 90/50, pulse 110/min and respiratory rate 30/min. Which of the following stat

C. large-bore IV lines should be inserted

An 8-year old boy has a closed angulated deformity of his right forearm. VS: BP = 99 mm Hg systolic and PR = 110 Identify the most emergent problem of the victim. Write any of the following:

D. Disability or Neurologic Injury

A 7-year old boy is gasping for breath. He can speak clearly, but complains of chest pain and an inability to get his breath. He is becoming increasingly anxious. VS: BP = 100 mm Hg systolic and PR = 110 Identify the most emergent problem of t

B. Breathing

A 25-year-old man is unconscious, withdraws from painful stimuli, eyes are closed, but they open in response to pain, and he is making unintelligible sounds. His pupils are equal, and both react sluggishly to light. His Glasgow coma scale score is:

B. 8

After control of this patient's airway is achieved, the first diagnostic study to obtain is:

C. x-rays of the cervical spine

A 19-year-old woman presents with a non-bleeding stab wound, 1 cm long, in the anterior triangle of her neck, 3 cm above her left clavicle. Examination of the neck reveals that the wound has penetrated the platysma muscle, and that the left carotid pulse

D. formal neck exploration under general anesthesia

Following an automobile accident, a 30-year-old woman is discovered to have a posterior pelvic fracture. Hypotension and tachycardia respond marginally to volume replacement. Once it is evident that her major problem is free intraperitoneal bleeding and a

C. exploratory laparotomy and possible bilateral internal iliac artery ligation

Large amount of free intraperitoneal blood is seen in a patient with penetrating abdominal injury after an abdominal ultrasound, the next best step is to:

C. exploratory laparotomy

A 6-year-old is having episodes of watery diarrhea for the past three days. She is lethargic, irritable and restless. The heartbeat is rapid but the pulses are weak. The child should:

C. proceed to the nearest hospital emergency room

Over-enthusiastic fluid resuscitation should be avoided in this child because of:

D. potential cerebral injury

A study on ruptured appendicitis will be conducted in a tertiary university hospital that includes all age groups and all genders on the rate of SSI between primary vs. delayed primary closure. What is the possible confounder in this study?

A. all age groups

The most common type of inguinal hernia in both males and females is:

A. Indirect

The Cooper’s ligament repair for direct or femoral hernia is popularized by:

B. McVay

A 22 year old female consulted a physician because of a 2x2x2 cms, movable, well circumscribed, non tender mass, noted accidentally while taking a bath. Physical examination was consistent with the findings above. Most likely diagnosis is:

C. Fibroadenoma

The next thing to do on the above patient is:

A. Reassurance and observation

Ivory an 18 year old female consulted because of breast tenderness becoming more severe just before menses. PE – showed asymmetric nodularities on the upper outer quadrant of both breasts with no dominant mass . Menstrual cycle is monthly and regula

C. Fibrocystic change

Sarah Jane a 35 year old female consulted because of an intermittent bloody nipple discharge on the right breast PPE- no mass noted on the right breast Most likely diagnosis is:

D. Intraductral papilloma

Chemotherapy in breast carcinoma is:

B. usually a combination of multiple agents

Breast malignancy that is known to have the highest incidence of bilaterality and multicentricity:

D. Medullary carcinoma

The next appropriate thing to do in managing the above case will be:

A. Local wound exploration

Fifteen minutes later the BP became 60 palpatory, PR-120/min accompanied by abdominal distention. You will recommend:

D. Immediate surgery

The most commonly injured intraabdominal organ following a blunt abdominal trauma;

B. spleen

A 55 y/o male, smoker underwent FNAB for a 4cm preauricular mass. Results showed (+) for malignant cells .The patient is most probably suffering from:

C. mucoepidermoid carcinoma

The appropriate treatment for a benign parotid neoplasm is:

B. superficial parotidectomy

Most common histology of head-neck cancers is:

C. squamous cell carcinoma

The most common causative agent being implicated in head-neck cancers is:

B. Tobacco

The site of injury corresponds to which zone of the neck?

A. Zone I

A 60 year old woman with chronic renal failure and undergoing hemodialysis 2-3x/week develops tumoral calcinosis. Her parathyroid hormone is markedly elevated while her Ionized Calcium is normal. The diagnosis of the above is:

B. Secondary Hyperparathyroidism

The course of papillary thyroid cancer is best described by which of the following

C. Metastases frequently occur to cervical lymph nodes, distant metastases and local invasion are rare

The most important prognosticating factor in thyroid cancer is:

B. patient’s age

43 years old female present with diffuse enlargement of the thyroid gland accompanied by palpitation, heat intolerance and weight loss. She is most probably suffering from :

C. Grave’s disease

A 50 years old male has just undergone a total thyroidectomy for follicular cancer of the thyroid. On the third hour post-op, he experienced circumoral numbness. He is probably suffering from

C. hypocalcemia

A 16 year old high school student came to you with a complaint that her friends took notice of an anterior neck enlargement since she started on her weight reduction program. You were indecisive as to whether there really was a thyromegaly. The rest o

C. Thyroid Scanning

A 72-year old male consults because of change in bowel habits for the last 2 weeks. On rectal exam, a hard, irregular mass was noted at 6 cm from the anal verge The most likely diagnosis here is:

B. Rectal carcinoma

The most appropriate initial diagnostic procedure to be done is:

B. Proctosigmoidoscopy

Majority of peptic ulcer patients are successfully managed medically or conservatively. Which of the following complications is the most common indication for surgical intervention?

B. Massive GI bleeding

A 48 year old company manager who has been taking proton pump inhibitor irregularly for the past 2 years because of on & off epigastric discomfort presents in the emergency room with hematemesis and melena. This patient should be:

A. Aggressively resuscitated with fluids and measures to localize site of bleeding should be done in preparation for possible surgery

A 43 year old male patient with on & off epigastric pain during the past 15 months complains of sudden severe epigastric pain later on becoming generalized. An upright chest file taken at the ER shows a strip of lucency underneath the right hemidiaphra

D. Perforated peptic ulcer.

Above patient is best managed by:

B. Laparotomy after resuscitation / IV antibiotics

A 30 y/o male who usually has dripping fresh blood after defecation suddenly had anal pain and a smooth, tender, 1 cm diameter rounded mass coming out of the anus. This is most likely:

D. thrombosed internal hemorrhoids

A 65 y/o female was referred for surgical consult because of abdominal pain and distention. Findings in the scout film of the abdomen that will be highly suggestive of intestinal obstruction:

D. step ladder abnormality

A 75 y/o female is being worked up for paralytic ileus The electrolyte that is usually below normal is:

A. Potassium

A significant and independent influence on the prognosis of a patient who had an esophageal resection for cancer is:

A. Tumor penetration of the esophageal wall

Hepatic resection should be considered for localized metastatic spread from which of the following primary site?

A. colorectal

The standard of treatment for patient with biliary colic and cholecystolthiasis by ultrasound is

A. Cholecystectomy

In an infected obstructed common bile duct producing cholangitis which of the following is the best option for drainage in a very poor risk patient ?

C. ERCP and stenting

CT scan finding that is highly indicative of infected pancreatic necrosis;

D. gas bubbles in the retroperitoneum

When gallstone ileus occurs , obstruction is most frequent in :

C. distal ileum

The most common cause of Acute Cholecystitis is :

A. cystic duct obstruction

The strongest evidence of presence of gallstones by ultrasound is :

D. High level echoes with posterior acoustic shadowing.

A 45 year old jaundiced patient who has been diagnosed to have gallbladder and common bile duct stones by ultrasound 6 months ago is brought to the ER because of abdominal pain , chills, high grade fever and hypotension. PE: icteric sclerae , abdomen sl

C. Acute suppurative obstructive cholangitis

The problem of patient in the previous number is best managed by:

C.surgical/endoscopic decompression of biliary tree after resuscitation and antibiotics

The most likely diagnosis in a 70 y/o male presenting with significant weight loss accompanied by progressive jaundice, anorexia, pruritus and tea colored urine. PPE showed a palpable non tender gallbladder?

C. pancreatic head cancer

The severity of pancreatitis, particularly in those patient who is not improving after 24 hours of medical management can be assessed using:

A. Angiography B. Scout film of the abdomen C. Dynamic CT Scan D. MRICP

Which of the following clinical clues is a reliable symptoms of arteriosclerosis

D. Intermittent claudication.

What is the Most Common symptom of acute aortic dissection?

B. Severe pain

This is the BEST procedure for a patient with acute head injury secondary to a vehicular accident:

A. CT scan

Abrasion wounds on the face are best treated with:

A. wound cleansing and debridement with normal saline

Essential elements in the survival of a skin graft:

C. Vascularity

Most common cause of UTI in children:

A. E. coli

A massively bleeding posterior duodenal ulcer, which of the following is most likely involved:

B. Gastroduodenal artery

Which of the following would inhibit parietal cell acid secretions?

D. Prostaglandins

The most common symptom associated with a Meckel’s diverticulum is:

C. Blood per rectum

The typical visual field deficit caused by a pituitary adenoma with suprasellar extension is:

C. Superior quadrantanopsia

The evaluation of a comatose patient with a head injury begins with:

C. Establishment of an airway

The radial nerve is at greatest risk for injury with which fracture:

B. Fracture of the shaft of the humerus

An early sign of compartment syndrome in the hand includes:

A. Pain with passive stretch at the digits

The most common site of involvement for skeletal tuberculosis is the:

D. Spine

A 65-year old woman with a history of chronic constipation is transferred from a nursing home because of abdominal pain and marked abdominal distention. On examination, her abdomen is found to be distended and tender in the left lower quadrant. The most l

C. Volvulus of the sigmoid colon

A 68-year old man presents with crampy abdominal pain and distention vomiting. Findings on PE are positive for healed abdominal scars. X-ray reveals multiple gas fluid levels. The WBC count is 12,000. The most likely diagnosis is:

A. Small bowel obstruction due to adhesions

A 56-year old man has suffered from intermittent claudication for 5 years. He has recently developed cramping abdominal pain that is made worse by eating. He has a history of a 15-lb weight loss. The most likely diagnosis is:

B. Chronic intestinal ischemia

A 28-year old man with a history of emotional disturbance enters the hospital with a history of weight loss and regurgitation of food. Regurgitation is worse when he lies down. The most likely diagnosis is:

A. Hiatal hernia

A 38-year old man with a history of fever associated with abdominal pain of several weeks duration presents now with a sudden onset of explosive abdominal pain and vomiting. Flat plate x-rays reveals air under the diaphragm. CT scan shows mesenteric lymph

B. Typhoid enteritis

Splenectomy is often indicated in the management of:

A. Hereditary spherocytosis

A painless distended gallbladder palpable on PE of a jaundiced patient is strongly suggestive of:

D. Pancreatic carcinoma

Which of the following suggest unresectability of a left upper lobe lung cancer:

B. Malignant pleural effusion

Which of the following studies is contraindicated in a drowsy patient with papilledema whom one suspects of having acute closed head trauma:

B. Lumbar puncture

The appropriate antibiotic for a patient with a cellulitis of a leg due to streptococcus is:

A. Penicillin

Massive bleeding from the lower GI tract (beyond the ligament of Treitz) is most often due to:

A. Diverticulosis

A 54-year old male has been complaining of recurrent hypogastric pain for almost 6 months. For almost 3 weeks prior to consult, he had noticed that he is passing air during micturition. The most common cause of the above condition is:

D. diverticulitis of the colon

A 42-year old woman has been complaining of intermittent gross hematuria. On urinalysis, she has significant pyuria but without bacilluria. The condition is most commonly due to:

D. tuberculosis of the kidney

A 25-year old male had episodes of severe vomiting due to a gastric outlet obstruction. He appears pale and dehydrated. The likely metabolic abnormality the patient would have is:

C. hypochloremic alkalosis

A 1week old infant presents with moderate respiratory distress and tympany in only one hemithorax. The most likely diagnosis is:

C. Bochdalek hernia

A little boy aspirated a peanut. He is cyanotic. On expiration, his mediastinum shifts to the right. The peanut most likely is lodged in the:

B. left main stem bronchus

A 40-year old man is hit by a car and sustains an injury to the pelvis. Which of the following is most indicative of a urethral injury:

B. high-riding prostate on rectal examination

A 64-year old man has mild upper abdominal pain. On contrast CT-scan, a 5 cm lesion in the left lobe of the liver enhances and then decreases over a 10-minute period from without to within. The most likely lesion is a:

D. carvernous hemangioma

A 28-year old male has had a nonseminomatous testicular cancer treated. In following this patient for possible recurrent tumor, the most useful serum marker would be:

B. alpha fetoprotein

The most common cause of esophageal rupture or perforation:

A. Endoscopic injury

The superior mesenteric artery communicates with the celiac artery via the:

A. Pancreatico-duodenal artery

The most common offending organism in pyogenic osteomyelitis is:

B. Staphylococcus aereus

In patients who developed a documented episode of deep vein thrombosis, the most frequent and significant long term sequela is:

Development of stasis ulcer

In an arterial stenosis, the most critical factor is:

B. The cross-sectional area of the stenosis

A 60-yr old man with a history of atrial fibrillation is found to have a cyanotic cold right lower extremity. The embolus most probably originated from:

D. Heart

Which of the following elements is not a component of venous thrombogenesis:

A. Incompetent valves in perforating vein

In a patient suffering from an acute arterial embolic phenomenon, if the ischemia is not relieved, which of these following tissues is the first to be irreversibly damaged:

A. muscle

Which of the following clinical manifestation may suggest tentorial herniation:

C. contralateral hemiparesis

The most common complication of lung abscess is:

A. Empyema

The most common posterior-superior sulcus chest tumor in a 6-month old child is:

A. Neuroblastoma

The most common cause of spontaneous pneumothorax is:

B. emphysematous blebs

What substance is released by macrophages in order to activate T helper/inducer (CD4+) lymphocytes:

A. Interleukin 1

A 27-year old hypertensive, diabetic woman is admitted for cadaveric renal transplantation. She is blood type B and has had four transfusions of packed cells over the preceding 6 months. Which of the following factors would preclude transplantation:

B. Positive crossmatch

The primary mechanism of action of cyclosporine A is inhibition of:

D. Interleukin 2 production

Which of the following malignancy exhibits a slow growing, late metastasizing characteristic:

B. Basal cell carcinoma

Following the Goodsall-Salmon’s rule in fistula in ano, an anteriorly located opening less than 3 cm from the anal opening follows:

A. Straight tract

One of the following statements is correct regarding hyponatremia:

C. Management could either be water restriction or replacement depending on the cause

A 60 kg lean male would normally have this amount of body water:

A. 36 liters

A practical but useful clinical parameter that can be used to assess the adequacy of volume replacement in patients suffering from hypovolemia is:

B. Urine output

A 42-year old man who has been on prolonged total parenteral nutrition (TPN) administration was noted to have scaly, hyperpigmented lesions over the acral surface of elbows and knees and alopecia. The most likely cause of the condition is:

D. Zinc deficiency

A 40-year old man is found to have severe metabolic acidosis with a high anion gap. 50-57. The most likely cause is:

A. Diarrhea B. Renal tubular acidosis C. Ureterosigmoidostomy D. Methanol ingestion

A 60-year old female, post mastectomy for breast cancer, presents with headache backache and frequent vomiting. She is extremely thirsty and stuporous. The test most likely to identify the cause is:

A. Serum calcium determination

The Trendelenburg’s (head down) position is beneficial in the initial management of which type of shock:

D. Neurogenic shock

The most common form of burn is:

A. scald burns

A 20 year old man has lymphadenopathy behind and inferior to his right ear. Biopsy shows the lesion to be a lymphosarcoma. The most likely site of the primary tumor is:

B. Nasopharynx

The most frequent organism in highest density that can be isolated from contamination following colon perforation are:

D. Gram negative anaerobes

The most clinically significant early physiologic abnormality in post traumatic pulmonary insufficiency is:

A. Increased physiologic shunt

Overall bone mass increases up to what age afterwhich there is an overall decrease in bone mass:

D. 30 to 35 years of age

After multiple myeloma, the most common primary malignant bone tumor is:

A. Osteosarcoma

The best treatment for septic arthritis of the hip is:

C. Surgical drainage/Arthrotomy with antibiotic therapy

The most common form of inflammatory arthritis:

B. Rheumatoid Arthritis

The gold standard of treatment of femoral shaft fractures in adults is:

C. Closed locked antegrade intramedullary nailing

Initial treatment of Talipesequinovarus (clubfoot) is:

A. Serial Casting immediately after birth/time of diagnosis

A unique feature of immature bone is the capacity to undergo plastic deformation without breaking and to sustain an incomplete fracture also called:

D. Greenstick fracture

Inflammation of the tendons in the first dorsal compartment containing the Abductor pollicis brevis and extensor pollicis brevis tendons is called:

C. De Quervain’s Tenosynovitis

In doing an otoscopic examination of an adult , the ear is pulled

a. upward and backwards

This is a clinical hearing test using tunning fork , that compares the bone conduction of the examinaer from that of the patient.

c. Swabach Test

This nerve controls the muscle of facial expression which is easily observe during face and neck examination

a. facial nerve ( CN VII)

The nasolacrimal duct empties into the:

b. inferior meatus

A 3 year old boy was brought to the ER due to recurrent epistaxis. On flexible nasal endoscopy, there was a bulging mass at the nasopharyngeal area. What is the possible diagnosis of the patient

a. Juvenile angiofibroma

This is a autosomal recessive trait characterized by situs invesus, bronchiectasis, sinusitis:

b. kartagener syndrome

This is a cellulitis or phlegmonous inflammation of the superior compartment of the suprahyoid space . The most common cause is odontogenic in origin

b. Ludwigs angina

the cricothyroid muscle is innervated by :

b. external br. of superior laryngeal nerve

The most common benign gland tumor of children of parotid gland is:

b. hemangioma

A 22 year old construction worker comes for consult because an unknown liquid got into his eyes. The very first thing to do is:

b) do copious water irrigation

A 65 year old filipino male comes in for bilateral insidious painless progressive visual deterioration. The most likely diagnosis would be:

a) cataracts

A 55 year old male known diabetic with moderately severe non proliferative retinopathy comes in for 6 months blurring of vision not corrected with pinhole. The most likely diagnosis is:

a) macular edema

A 41 year old female complains of slightly congested eyes with headache after prolonged near work, relieved by rest. She may need

b) convex lenses

A patient complains of poor vision at distance, good vision at near. She may need

c) concave lenses

A chronic granulomatous inflammation of the meibomian gland is a

c) chalazion

Following Goodsall’s rule, a fistula in-ano with an external opening located 4 cm from the anal verge would have its internal opening located :

B. in the posterior midline

In patients with rectal cancer, Computed Tomography scanning best evaluates:

A. The presence or absence of hepatic metastases.

Ultrasonography incidentally revealed a single 1 cm gallstone in an asymptomatic 55 year old. Which of the following is the recommended treatment?

A. Observation and follow-up

70-90% of primary gastrinomas are located in the area defined by a triangle with points located at the junction of the cystic duct and common bile duct, the second and third portion of the duodenum, and the neck and body of the pancreas. This area is know

C. Passaro

Histologic examination of a thyroid gland tumor reveals psammoma bodies. This finding indicates that the lesion is:

C. Papillary Carcinoma

A 40 year old female was diagnosed with Papillary Thyroid Carcinoma. She presents with a hard thyroid mass, cervical lymphadenopathies, and several coin lesions on chest x-ray. Clinical staging for this patient would be:

B. Stage II

A 45 year old woman has a mobile lump in the upper outer quadrant of her right breast. An open excisional biopsy reveals a 1.5 cm lobular carcinoma in situ with negative margins. With regards to further management, which of the following statements is t

A. Careful clinical follow-up without further surgical intervention is sufficient at this time.

During the initial assessment of the multiply injured patient, the main goal and objective of the Primary Survey Is to:

C. detect and treat immediately life-threatening injuries

In performing maneuvers to ensure airway patency, it is most critical to:

C. stabilize the cervical spine

Respiratory distress in cases of congenital diaphragmatic hernia is a result of

D. incomplete development of the lung resulting in inadequate area for gas exchange

Patients with either external or middle ear lesions usually have:

B. Sensorineural hearing loss

Oral or systemic antibiotics are indicated in Otitis Externa when:

D. The infection extends beyond the limits of the canal

The most common etiology of acute otitis media in all age group

B. Streptococcus

Which layer is missing when a tympanic membrane perforation heals

B. Fibrous layer

The most common intracranial complication from supurative Otitis Media is:

D. meningitis

Most accurate test in detecting deafness in neonates and in children

C. Auditory Brainstem Evoked Response

The most common complaint of patients with otomycosis:

C. Itchy ear

Sudden hearing loss with concurrent dizziness while scuba diving suggests:

B. Barotrauma

Conditions predisposing to the development of otitis media

A. Upper respiratory tract infection B. Allergic rhinitis C. Breastfeeding D. Cleft palate

A 3 year old boy was refered to the ENT service due to edema of the eyelids. Pertinent physical examination: normal visual acuity, (-) chemosis, (-) proptosis, full extraocular muscles, (+) profuse purulent nasal discharge. What is your assessment?

A. Periorbital cellulitis

The most common cause of epistaxis in the elderly

B. Atherosclerosis and hypertension

Which of the following best describe a patient with allergic rhinitis?

C. c. Presence of watery nasal discharge with obstruction

Which of the following best describe vasomotor rhinitis

A. A lady dentist with nasal obstruction throughout her pregnancy

Rhinitis medicamentosa is due to overuse of

D. Local decongestants

Which of the following best describe a patient with juvenile angiofibroma

C. A 14 y/o boy, with profuse epistaxis

Which is the most critical aspect of management in odontogenic infection:

C. Remove the offending tooth

A 50-year old female presents clinically with globus hystericus. This is usually

A. A normal PE and barium swallow

A 20-year old sailor has a persistent sorethroat and is found to have a pharyngitis with enlarged tonsils and cervical adenophaty . Gram stain of pharyngeal secretions shows gram- negative diplococci. These findings support a diagnosis of:

B. Gonococcal pharyngitis

A 25y/o male consulted at the OPD due to dysphagia of 2 days duration. PPE: (+) trismus, increased salivation, peritonsillar swelling (left) pushing uvula across midline. What is your working diagnosis?

D. Peritonsillar abscess

This lymphoid tissue may be completely removed because of the presence of a capsule:

C. Palatine tonsils

A 50 year-old male had barium swallow with the report of aperistalsis, esophageal dilatation, and failure of the lower esophageal spinchter to relax. Which of the following is your primary consideration?

C. Achalasia

Tonsillectomy should be considered for all of the following except:

C. Asymptomatic tonsillar hyperplasia

Complication of a retropharyngeal abscess may involve:

A. Mediastinitis

The region of the pharynx that extends from the base of the skull to the level of hard palate:

A. Epipharynx

Majority of FB coins will be trapped in the:

C. Cricopharyngeal constriction

A 1 1/2 month-old baby girl was brought to your clinic because of stridor. There was no associated cough. The patient was delivered to a G8P7 40 year old laundrywoman from payatas via NSD. Birthweight was 6.5lbs with APGAR score of 9 and 10. She was s

D. Laryngomalacia

The best thing to do in this patient for your initial evaluation is/are:

D. Direct laryngoscopy

A 6 year-old boy was brought in to the clinic because of cough associated with moderate-grade fever and sorethroat characterized by painful swallowing few days PTC. The patient was sent home with antibiotics, cough syrup and antipyretics. The following

B. Acute epiglottitis

The best thing to do in this patient as your initial evaluation and management is/are:

D. Antibiotics

A 62 year old farmer from Iriga City came in because of dyspnea. His condition started 10 months PTC as hoarseness associated with hemoptysis. One month PTC, he developed persistent dyspnea accompanied by a lump on the right side of the neck. Patient i

D. Laryngeal CA

The patient requires:

C. Direct laryngoscopy and biopsy

A 3 year-old girl was taken to the ER because of stridor and cyanosis. Few hours PTC, patient was playing in the sala while her daddy was eating peanut while watching world meeting of families. The patient was restless with audible slap and palpable thu

B. Tracheal foreign body

Your initial diagnostic procedure is:

A. Chest X-ray

The only bony structure in the laryngeal skeleton is the

A. hyoid

The best way to examine the larynx in the OPD is by

C. indirect laryngoscopy

The most common congenital laryngeal anomaly is

D. laryngomalacia

The primary structure preventing laryngeal aspiration is:

A. True vocal cords

Symptoms of mandibular fracture include

A. malocclusion

X-ray evidence of unilateral haziness of the maxillary sinus in a trauma case indicates

C. blood in the sinus

The treatment of choice for depressed zygomatic arch fracture is

B. Gillie's Operation

Procedure of choice for neglected nasal bone fracture

B. Septorhinoplasty

Tear drop” sign indicative of blow-out fracture is seen best on:

B. Water’s view

A simple depressed fracture of the nose is best treated by:

C. Closed reduction

The second most common fracture in the face is:

B. Mandibular fracture

The Le Fort II fracture is also known as

B. Pyramidal fracture

The Le Fort I fracture is also known as

A. Guerin fracture

Repair of a cleft palate is best done

C. before speech develops

The operation for prominent ear lobe deformity is called:

C. otoplasty

Scar tissue formation may be delayed by using

C. steroids

A free flap derives its blood supply from:

B. The capillaries in the recipient site

In wound healing, during the stage of injury, which of the following occurs:

D. formation of hemostatic plug composed of fibrin and platelet

The most usual donor site for split thickness skin graft

B. thigh

Which of the following grafts has a better chance of “take”(survival of the graft) ?

B. Split thickness skin graft

A 54-year-old patient presented with a midline mass that moves with deglutition.

B. Thyroid nodule, probably benign

The most logical question to ask when probing whether the mass is congenital, would be:

A. What is the age of the patient?

A 30 year old female comes in with fever, pains in the right pre-auricular area. On examination, you see a swollen, tender, erythematous right parotid area. The orifice of the stensen’s duct is also swollen with minimal purulent material coming out. What

C. Acute bacterial sialadenitis

A 40 year old male presents with a 3 X 3 cm right pre-auricular mass. FNAB showed pleomorphic adenoma. Which of the following statements is incorrect?

D. Recurrence is not a problem in such a case.

A 20 y/o male came to the clinic with a mass at the left submandibular area. Primary consideration as to the nature of the mass would probably be:

D. Inflammatory

A 60 y/o female teacher from Iriga City came in for a right pre-auricular mass of 2 months duration. Initially the patient palpated a tender 1 X 0.5 cm mass which progressively enlarged to its present size. On P.E there is 3 X 4 X 2 cm tender, movable,

D. The age of the patient and duration of the mass

Surgical treatment of choice for thyroglossal duct cyst is

B. Excision of cyst tract and portion of hyoid bone