Surgery 4th Year Final 2020

Surgery 4th Year Final 2020 For the younger generations: The questions may look easier than you think. Both the question stems and the exam conditions make it way more difficult to answer even the simplest questions. So study hard and expect the worst. Plastic Surgery 1- Not determined by the degree of the burn - Systemic management 2- False about cleft palate - Abnormal swallowing 3- False about high-voltage electrical burn - fluid management follows Parkland formula 4- Patient with burns in both upper limbs (one limb with first degree burn and the other with second-degree burn) and one lower limb, 50 kg, how much fluid does he need in the first 8 hours? - 2700 mL (always exclude 1st burns from Parkland formula) 5- Hemangioma in the trunk, measuring 7 x 7 cm in diameter, best management? observation 6- False about FTSG compared to STSG - associated with more successful take 7- Best indicator of fluid management in burn patients - urine output of 0.5 mL/kg/hr 8- Most common cause of burn sepsis is - Pseudomonas 9- True about BCC - the skull forms a barrier that prevents invasion 10 - Most common ear tumor is - SCC 11- The best prognostic factor for soft tissue sarcoma is – grade 12- False about keloid - Is pre-cancerous 13- A patient with contaminated wound of 12 hrs duration, best thing to do? - clean the wound, get rid of devitalized tissue without primary closure 14- type of collagen in tendons – type I collagen 15- when does the wound start to have tensile strength? - after 3-4 days Vascular and Cardiothoracic 1- Most common site of venous ulcer - lower third of the leg and ankle 2- Exercise effect in PAD - improves the collateral circulation 3- Not used for AAA repair - Axillo-bifemoral bypass 4- Cause of early cyanosis - Transposition of the great vessels 5- Not in TOF - ASD 6- Indication for CABG - Patient with unstable angina, three-vessel disease, EF = 35 % 7- MI with occlusion of LCX artery, patient has left-dominant circulation, which parts will be infarcted? - Left lateral ventricle and posterior interventricular septum 8- False about lymphedema - lymphedema praecox is primary and lymphedema tarda is secondary (both of them are primary) 9- False about pneumothorax - tension pneumothorax is diagnosed by CXR 10- Which of the following is associated with the highest relative risk of developing DVT? – Antiphospholipid syndrome (The other choice were heterozygous factor V leiden, prothrombin mutations, heterozygotes protein C deficiency) 11- A question about Pancoast tumor? – 2/3 of the cases are associated with squamous cell carcinoma 12- Which of the following is false about intermittent claudication? – becomes better at night Breast 1. False about duct ectasia - reduced incidence in smokers 2. Not a risk factor of breast cancer - first pregnancy at a young age 3. Breast cancer with worst prognosis - Infiltrating / tubular / mucinous / 4. False about phyllodes tumor - 90 % malignant 5. Which of the following arteries does not supply the breast - superior epigastric artery General surgery 1. A patient lost 15 % of her blood, what fluid management to do? - crystalloids 2. When to start eating after thyroidectomy? – After 1 hour 3. Which type of shock needs vasopressors as an initial management? - Neurogenic shock 4. Which of the following does not need Abx prophylaxis? - Thyroid surgery 5. How much a 70 kg man needs as maintenance fluid in 24hrs - 2800 mL 6. BMI equals - weight in kg / height in m2 7. Which of the following is false about antibiotic prophylaxis before surgery? – Should be continued for 72 hours 8. Most common cause of death after blood transfusion? - TRALI 9. True about TRALI - Can also occur after administration of fresh-frozen plasma 10.One feature that makes TPN better than enteral nutrition - less incidence of diarrhea 11.Patient on NG tube, which is true? - Enteral nutrition activates the biliary pancreatic axis and has trophic effects on the bowel 12.The most common cause of secondary bleeding in the few days postoperative period is – infection 13.A patient with nonhealing ulcer is very likely to have a nutritional deficiency in which of the following? - Zinc 14.Which of the following is false about hypercalcemia: a) breast cancer metastasis is an unusual cause*** b) severely hypercalcemic patient will have signs of extracellular fluid volume deficit c) Volume repletion would result in increased urinary excretion of calcium d) Hypercalcemic patients will have signs and symptoms similar to hyperglycemia 15.which of the following is not used for assessment of nutrition? a) albumin b) Transferrin c) Hemoglobin*** d) Malnutrition by physical examination 16.A patient has pencil-stick injury in his forearm, then he developed a swollen tender and fluctuant mass, what is the most likely diagnosis? – Abscess 17.Which of the following is true about cellulitis? – Can be treated by penicillin (It is nonsuppurative spreading infection of the skin is incorrect as it affects the subcutaneous tissue not the skin). 18.Which of the following is true about body fluids? – It might be affected by wide range of physiological variation 19.Which of the following is true about body fluids? – The concentration of sodium in the intravascular and the interstitial compartment is almost equal. 20.A patient has fever, tachycardia, tachypnea, high blood pressure, and on CT scan he was found to have pelvic abscess, what is the most likely diagnosis? – Sepsis (the other choices where SIRS, severe sepsis, multiple organ failure etc.) 21.Which of the following is not a risk factor of surgical site infections? – Hyperthermia (the other choices were old age, malnutrition, infections at other remote sites) 22.After surgery, a patient was found to have a fractional excretion of sodium of less than 1%, what is the most likely cause? – Pre-renal acute kidney injury (was written as acute renal failure in the exam) GI Surgery 1. Initial investigation in a patient with GERD - barium swallow 2. True about Barrett esophagus - intestinal columnar metaplasia 3. Most common site of lymphoma in the colon - Cecum 4. Which of the following is not part of management of gastric ulcer - NG tube insertion 5. False about diverticular disease - considered pre-cancerous 6. False about rectal anatomy - superior rectal artery arises from the internal iliac artery 7. True about hemorrhoids? - Internal hemorrhoid lies above the dentate line and below the anorectal ring 8. True about inguinal hernia - direct hernia bulges out medial to the inferior epigastric vessels 9. Not a risk factor of colon cancer? - Young age 10.True about FAP - Osteoma is an extra-intestinal manifestation that can be associated with it. 11.Not associated with gastric cancer - blood type O (it’s blood type A). 12.True about the appendix - Contains lymphoid follicles in the submucosa 13.True about pilonidal sinus - Occurs always in the midline (not sure) 14.The least effective bariatric surgery in terms of excessive weight loss – Gastric banding 15.A case of dysphagia and weight loss, Dx? - Esophageal cancer 16.True about fibrolamellar HCC – The rest of the liver is normal (high AFP is not a characteristic of this HCC type). 17.The vascular ligament of the spleen is – lienorenal ligament 18.Which is true about splenic trauma surgery? – Don’t know the answer 19.Which of the following does not increase the risk of colon cancer? - Hyperplastic polyp 20.The type of cholecystitis that mimics gallbladder carcinoma is - Xanthogranulamatous cholecystitis 21.Worst complication of cirrhosis is - Esophageogastric varices 22.What predicts earlier spontaneous closure of enterocutaneous fistula? - long tract 23.in which part of the small intestine does absorption of most nutrients occur? - Jejunum 24.The most common complication of hydatid cyst of the liver is? - Cyst infection / Rupture into the biliary tree*** 25.Which of the following is a risk factor of pancreatic cancer? – Smoking 26.Which of the following is false about G.I. secretions? – Gastric juice is rich in potassium 27.Add 38-year-old female presented with right upper quadrant pain with for 12 hrs and mild tenderness with no rigidity. She used to have a similar pain following fatty meals, what is the most likely diagnosis? – Acute cholecystitis 28.which of the following does not does not pass through the three openings of the day from? – Left phrenic nerve (the other choices were IVC, aorta, left vagus nerve, and eaophagus)/ The left phrenic pierces the diaphragm rather than passing through one of the openings. Pediatric: 1. A cause of atypical neonatal SBO - Intussusception 2. Most common site of CDH- posterolateral 3. Most common findings on CXR with foreign body aspiration- hyperinflation 4. Rt flank palpable mass, the most likely diagnosis - Hydronephorsis. 5. Alkali disc battery ingestion, AXR after 5 hourrs shows it is in the proximal small bowel best next step- admission and run a serial AXR to follow its progress 6. Infant with bilious vomiting and signs of intestinal obstruction, best thing to do is? Upper GI series (other choices were abdominal x-ray, CT scan, abdominal ultrasound) Head and Neck and Endocrine Surgery 1. A man presented with right parotid mass, what is the most likely diagnosis? Pleomorphic adenoma 2. False about Warthin tumor - Becomes malignant in 20 % of cases. 3. Thyroid cancer in parafollicular cells - medullary thyroid cancer 4. Most common thyroid cancer in iodine deficient areas is - follicular thyroid cancer 5. A patient with a mass in the deep cervical lymph nodes, best next step is? - FNA with cytology 6. Best describes hyperparathyroidism - high calcium and high PTH 7. The mechanism of palpitations, sweating, and tremor in insulinoma is - increased catecholeamines 8. Which of the following does not occur in Addison’s disease - generalized edema