6th Year Surgery Final 2022

6th year surgery final 1. Not a cause of hypercalcemia A) Primary hyper PTH B) Secondary Hyper PTW' C) Tertiary Hyper PTH D) Ectopic E) Vii D intoxications 2. A case of female having pancreatitis was found to have high PTH .. Normal urinary excretion of Ca++ ... She had a sestamibi scan showing a hyperactivity below the right thyroid lobe, what to do next: A) Exploration of all 4 parathyroid glands B) Excision of the single adenoma?? C) Hemithyroidectomy with exploration D) Total thyroidectomy with right parathyroidectomy 3. How to differentiate malignant from benign thyroid nodules: A) FNA biopsy" B) U/S 4. All consistent with familial medullary thyroid carcinoma except: A)bilateral B) Multifocal C) C-cell hyperplasia D) Ret proto oncogene mutation E) Raf mutation" 5. All are indications for surgery in an asymptomatic pt with hyper PTH except: A) Nephrolithiasis B) Decline in renal function C) Age>65 .. D) Depression E) Osteoporosis 6. Most common malignancy of submandibular gland: A) Adenoid cystic adenoma.. B) Mucoepidermoid carcinoma C) Acinar cell tumor 7. Tumor that only involves the parotid: A) Warth in's tumor.. B) Mucoepidermoid 8. Parotid tumor with history consistent of facial nerve palsy since 6 months, next step: A)CT B) MRI to localize the facial nerve C) FNA?? D) lncisional biopsy 9. Female with history of recurrent submandibular swelling upon eating for 5 months, tender on examination, dx: A) Sialolithiasis .. B) Acute sial adenitis 10. Patient with recurrent swelling upon eating, after imaging was found to have submandibular Stone 0.5 em, 1 em away from the opening of the Wharton, management is: A) Intra-oral removal .. B) Shock wave Lithotripsy C) Antibiotics for 2 weeks D) Advise good oral hygiene 11. Conn's syndrome all true except: A) High plasma renin .. B) Hypernatremia C) Hypokalemia 12. Adrenal insufficiency (addisonian crisis) wrong: A) Hypertension .. B) Dehydration C) Fever D) Nausea E) Vomiting 13. Drug used for treatment of Conn's in pts with bilateral hyperplasia: A} Spironolactone .. B) Mitotane C) Prednisolone D) Ketoconazole E) Metyrapone 14. What is true regarding embolic lower limb ischemia? A) Embolectomy by a Fogarty catheter should be done?? B) No need for pre-op anticoagulation C) Dark blood after revascularization indicates success (Eshi zy heik) 15. Chronic mesenteric ischemia wrong: A) Female more than male? B) Pts with venous ischemia require lifelong anticoagulation?? C) MCC of non-occlusive is IHD D) MC source of emboli is from the heart 16. Giant cell arthritis false: A) Might involve visceral vessels B) More common in elderly females C) Presents with jaw claudications D) The most common form of vasculitis?? E) Temporal artery biopsy is Essential for diagnosis?? 17. The most common cause of poor graft take: A) Vascular degeneration?? B) Infection C) Hematoma formation .. (according to Washington manual, but in the dossier the Dr, mentions that the most imp cause is poor vascularity) D) Sheering forces 18. Regarding total body water content, true: A) Decrease steadily with age .. B) More in females and obese C) Less water content with increased muscle bulk D) Wide physiological variation in water content in the single person 19. Twelve years old male, presented to the ER complaining of testicular pain that started during soccer practice. He denied trauma. On examination the right testicle is tender, red, and edematous. The patient had vomited once. Ox: A) Right testicular torsion .. B) Acute epididymoorchitis C) Idiopathic testicular edema 20. Doesn't need evaluation for intersex: A) Bilateral scrotal testes with small penis .. B) Phenotypically female with fused labia C) Male phenotype with bilateral impalpable testes D) Proximal hypospadias with perineoscrotal fusion 21. SPECIFIC complication of Neonatal circumcision: A) Meatal stenosis.. (not sure) B) Excessive skin removal C) Inadequate skin removal D) Bleeding E) Infection 22. Gastroschesis wrong: A) Can be closed primarily (usually need a flap) .. B) 80-90% good prognosis C) Associated with less anomalies D) Defect is to the right of umbilicus E) Caesarean section delivery is mandatory? 23. Anterior thigh mass 6 em fixed to underlying tissue but the skin above it is mobile, next step: A) Excisional biopsy?? B) lncisional biopsy?? C) Amputation!!! 24. Volvulus wrong: A) Ischemia occurs with 180 degree rotation?? B) Is a common cause of intestinal obstruction in Jordan??? C) You should attempt sigmoidoscopic derotation if no signs of bowel necrosis D) If bowel necrosis or gangrene immediate laparotomy 25. Gastric cancer a, what is wrong: A) CEA and some other tumor marker are used as diagnostic tests•• B) Stage 3 is potentially resectable C) Proximal gastric tumor might present with dysphasia 26. Case of acute cholangitis, which is wrong: A) Hematogenous spread of the organism via portal vein••• B) Classical presentation is abdominal pain, fever and jaundice C) Treat by antibiotics, monitoring sepsis, and biliary drainage D) If suppurative could also present with hypotension and altered mental status E) Most commonly caused by biliary stasis and obstruction 27. Oral cancer all are risk factors except A) Smoking B) Alcohol C) Asbestos?? D) Sun exposure?? E) Tobacco chewing 28. Snake bite does all of the following except: A) IV Antibiotics .. B) Anti-tetanus toxoid C) Remove necrotic skin D) Anti venom to all patients 29. Pseudomembranous colitis, all are risk factors except: A) Broad spectrum antibiotics B) Steroids C) PPI .. D) Cigar smoking E) Malnutrition 30. Question about UC and crohn's, which is wrong: A) Crohn's 50% associated with caseating granuloma.. B) Cryptitis and crypt abscess is pathognomonic for UC 31. Pancreatic ca tumor marker: A) CA 19·9·· B)HCG C) ca 125 32. Hepatocellular carcinoma tumor marker: A) AFP •• 33. Female taking OCP presenting with RUQ, US shows 4 em adenoma, what is your next step: A) Stop OCPs and observe .. 34. In achalasia, most sensitive test: A) Bird peak on Barium swallow B) Manometry showing failure of complete relaxation of LES with swallowing .. C) Biopsy D) Aperistalsis of cervical esophagus 35. Bariatric surgery, Band ligation, what is wrong: A) Banding shows comparable results with bypass in relation to the extent of weight loss.. B) Dumping syndrome is not a significant complication C) Poor choice for sweet eaters D) Results in less leak complications E) Something about recurrence 36. Best indicator to anticipate hungry bone syndrome after parathyroidectomy is: A) Alkaline phosphatase?? B) Preoperative Ca levels C) Preoperative phosphorus levels D)ESR E) CRP 37. Indications for surgery in UC EXCEPT: A) Toxic megacolon B) Massive bleeding C) Obstruction D) Primary sclerosing cholangitis (PSC) •• E) Sepsis related colitis 38. In regard to surgical prophylactic antibiotics what is wrong: A) Should be given before anesthesia B) Occasionally another dose can be administered during the operation C) Can be given for 2-3 days post-op. •• D) We can use more than one antibiotic E) Choice depends on the type of surgery being performed 39. Wound infections, what is wrong: A) Infection in 1st 24 hours is caused by staph .. (only strept and clostridia can present in first day) B) Fresh clean wound is a good indicator of hospital aseptic techniques 40. Associated with HIV: A) Kaposi sarcoma.. 41. Necrotizing fasciitis what is true: A) Mortality reaches 50%?? B) Often polymicrobial?? C) Muscles can be involved?? D) Most important step in management is antibiotics 42. Child Pugh score contains all EXCEPT: A) Ascites B)PTT.. C) Total bilirubin D) Encephalopathy E) Albumin 43. Protein not synthesized in the liver A) Factor II B) Transferrin C) Ferritin D) Von Willebrand factor.. 44. Case of complete transposition of great vessel, what is wrong: A) Aorta originated from R1ght ventricle B) Pulmonary Artery originated from left ventricle C) Two separated circles D) Surgical correction at preschool age •• 45. Most common cardiac anomaly associated with Down syndrome A)VSD B)ASD C) AV septal defects .. (another name of endocardial cushion defect) 46. Popliteal artery aneurysm, true: A) Mostly bilateral .. B) More in females C) Commonly ruptures 47. Diabetic pt with diabetic foot suddenly develops hotness and redness in mid foot: A) Acute charco! joint .. B) Gout C) Bone fracture 48. Most common stimulus for ulcer in the foot of a diabetic: A) Repetitive trauma due to loss of sensation •• 49. lnsulinoma all true except: A) Improves upon giving glucose B) Most rule out sulfonylurea C) Hypoglycemic symptoms with fasting or exercise D) Low C·peptide" 50. All are actions of cytokines except: A) Hypoferntinemia •• B) Septic shock C) Trigger CNS to cause fever D) Cellular proliferation in wounds healing 51. TNF-{], all are true except: A) It acts as an anticoagulant when present inside the circulation?? B) Acts as angiogenic factor during wound healing?? C) Secreted by inflammatory cells and cancer cells D) Release is stimulated by IL 1 52. All are needed for cadaveric renal transplantation except: A) ABO compatibility B) Reversible brain injury.. C) Adequate renal function for Age D) Negative cross match E) Absence of transmissible diseases in the donor 53. Infra renal abdominal aortic aneurysm false: A) Concomitant thoracic artery aneurysm is found in 60% of cases .. b) Risk of rupture is more than 60% when it exceeds 8 em 54. Question about ABI, which is false: A) In non diabetic patient, sensitivity 97% and specificity 100% B) In diabetic specificity is down to 40% due to non compressibility C) Exercise ABI is a good diagnostic modality or something D) When taking the right ankle ABI, you should take the right brachial BP regardless of BP in left arm .. (you take the higher BP) 55. A case of a 55 years old man with persistence medial venous ulcer since a year, next step: A) Biopsy it B) Venography C) Doppler of deep system and superficial one ••• D) Venography of pelvic veins 56. All of the following are side effects of radiation exposure except: A) Lymphocytosis" B) Telangiectasia C) Tissue necrosis D) Increased risk of skin SCC 57. Most common condition that makes you change your mind about using chemotherapy: A) Hematological suppression B) Pulmonary fibrosis C) Renal injury D) Hepatotoxicity E) Gl ulceration 58. All are important initial management in a patient with flame burn to restore the borderline area of ischemia except: A) Keep urine output above 2cc/kg/hr" B) Put the legs in dependant position?? C) You need good fluid replacement to maintain perfusion D) Good oxygenation should be provided to the patient 59. Necrotizing enterocolitis is associated with all of the following except: A) High vitamin A?? B) Premature baby C) Milk formula instead of breast feeding D) Sepsis E) Umbilical catheterization 60. The lifetime risk of foot ulceration in persons with diabetes is: A) 1·2% B) 5·10% C) 15·25%.. D) 25·50% E) >50% 61. Most common cause of death after renal transplant: A) Atherosclerotic complications .. B) Operative technique C) Graft rejection D) Infection 62. Regarding CABG, true: A) Increased mortality with increased number of stenosed arteries?? B) Females have less mortality rate after CABG than males C) 10 year survival after CABG is 75% D) Should be done within 1 week after the acute coronary event?? 63. Gallbladder function all true except: A) Absorption of water B) Absorption of H?? C) Absorption of Na D) Absorption of Cl E) Secretion of glycoprotein?? 64. to compensate Gastric loss, we use: A) Ringer lactates B) Normal saline C) Half saline with K?? D) Half saline?? E) D5W 65. DNA viruses associated all except: A) Burkitt's B) Cervical C) Testicular .. D) Nasopharyngeal E) HCC 66. Patient came after RTA he complains of SOB but patent airway. On examination he had hyper-resonance on the right lung, tachycardia and hypotension also, best next step is: A) Urgent CXR B) Needle thoracostomy .. • C) IV fluids 67. All are boundaries of the femoral ring except: A} Femoral vein B) Femoral artery .. C) Lacunar ligament D) Arcuate ligament E) Inguinal ligament 68. FB aspiration, all are possible CXR findings except: A} Normal CXR B) Unilateral hyperinflation C) Unilateral atelectasis D) Increased AP diameter.. E) Pulmonary infiltrates 69. More associated with breast malignancy?? A} Atypical ductal hyperplasia .. B) Sclerosing adenosis C) Duct ectasia D) Fibroadenoma 70. Wilms tumor most common presentation: A) Abdominal mass.. B) Hypertension C) Hematuria 71. Test for ulnar nerve injury: A) Abduction of fingers .. B) Extension of fingers C) Flexion of fingers D) Flexion of wrist E) Extension of wrist 72. Patient on TPN suddenly became glucose intolerant: A) DM B) Sepsis?? C) Low zinc D) Addisonian crisis 73. Suppurative hidradenitis, which is wrong: A) Eccrine origin?? B) Rare before puberty C) More in blacks D) Potential for malignancy?? E) If extensive it might need surgical excision 74. Behcet disease, which is wrong: A) 50% with vasculitis B) Hemoptysis C) No pathognomonic test for it D) Arterial thrombosis more common than venous .. 75. Popliteal aneurysm, true: A) Most common peripheral aneurysm •• 76. Best to confirm diagnosis of dissecting aneurysm A) Wide mediastinum on CXR B) Chest CT C) +Ve Aortogram?? D) Fracture of 151 rib 77. A 22 years old boy with a submandibular and axillary enlarged L.N, plus splenomegaly, best next step: A) CT abdomen B)FNA C) Open tissue biopsy• .. 78. Compartment syndrome pressure to do fasciotomy: A)5 B) 10 C) 15 D)40 .. E)60 79. wrong about colonoscopy: A) Withdrawal time between 6 and 10 minutes?? B) Can be used with or without sedation?? C) Comparable results with virtual colonoscopy?? D) Perforation is an absolute C/1 E) Incidence of perforation is higher after polypectomy 80. Surgical repair of undescended testicle done at A) 1 year.. 81. Hypertrophic scar, false: A) More common in females?? B) Can't be differentiated from keloid scar by histology?? C) Follows a natural course of growth followed by spontaneous regression D) Could be Resolved with surgery when done at proper time?? E) Occurs on flexor surtaces?? 82. Woman with breast cancer, presented with altered sensorium, upon lab investigations Calcium was 15 mg/dl, which of the following is LEAST appropriate: A) Dexamethasone and call for Oncology consult B) IV inorganic phosphate C) Oral phosphate?? D) IV hydration E)furosemide IV 83. Massive blood transfusion, false: A) More than 10 bags within 24 hours B) More than 2 blood volumes within 24 hours?? C) Dilutional thrombocytopenia D) Dilutional coagulopathy 84. Platelet transfusion, false: A) Benefits ITP patients .. B) When less than 50,000 bleeding complications are increased C) Spontaneous bleeding can occur when less than 10,000 D) Each unit raises the platelet count by 10,000 85. Torticollis, which muscle is involved: A) Sternocleidomastoid•• B) Trapezius C) Platysma 86. Patient with acute appendicitis, the least possible ddx: A) Acute pancreatitis'' B) Ovarian cyst C) IBD D) Meckel's diverticulitis E) Ectopic pregnancy 87. Cleft palate, wrong: A) Swallowing is normal B) Hearing loss due to infections C) Delayed repair leads to facial deformity .. D) due to failure of fusion of palatine shelves 88. Pyloric stenosis, which is wrong: A) Equal loss of both sodium and chloride •• B) Patient has hypochloremic hypokalemic metabolic alkalosis C) Clinical exam and labs is the best way to assess dehydration D) Before surgery you first correct the electrolyte abnormalities E) Paradoxical aciduria occurs with severe dehydration 89. Not a finding in locally advanced breast CA: A) Arm edema .. B) Skin dimpling C) Nipple inversion 90. Colon cancer, chemotherapy given in all except: A) Lymph node +Ve B) T4 C) Tumor size> 4cm .. D) Lymphovascular invasion E) Liver mets 91. about skin, true: A) Collagen imparts tensile strength .. B) Epidermis is vascular C) Skin appendages are mesodermal D) Epidermis is more than 20% 92. Not a hard sign of extremity vascular injury: A) Absent dorsalis pedis pulse B) Pulsatile hematoma C) External bleeding D) Ischemia signs and symptoms E) Neurological deficits ... 93. Woman with melanoma, which indicates prognosis A) Depth of invasion .. 94. Qs about gastric outlet obstruction, what is wrong A) Digital gastric cancer causes 35% of cases?? B) Nowadays more commonly caused by benign lesions C) Succussion splash should be elicited D) Endoscopy should be used to diagnose it and find the underlying cause E) Pancreatic related GOO can be treated medically?? 95. Qs about lipase and amylase, what is wrong A) Serum amylase starts to rise 2 hours after pancreatitis? B) Increased amylase can be from other sources than pancreatitis C) If uncomplicated, amylase starts to disappear 3-5 days after D) Hyperlipidemia can affect the assay of lipase E) Lipase is more sensitive to alcoholic pancreatic than amylase?? 96. Qs about meckel's diverticulum, which is wrong: A) Fresh bleeding B) Causes Painful hemalemesis" C) Contains gastric mucosa D) Contains pancreatic mucosa 97. Qs about congenital heart problem, the one that most commonly causes death in infancy : A) Left coronary from the pulmonary B) Right coronary from the pulmonary C) Congenital coronary aneurysm D) Coronary fistula E) Right coronary from left coronary 98. About acute pancreatitis what is wrong: A) Gall bladder stones including microlithiasis is MCC worldwide B) Alcohol is responsible for 30% of cases in Jordan ... C) Incidence following ERCP is 6%