Surgery Final Examination 6th Year 2021

Surgery final examination 6th year medical students 2021 GI Surgery 1. After performing Appendectomy, nurse giving you the tissue you removed, MANS: Carefully label and send to histology. 2. Right iliac fossa pain with anorexia. MANS: Arrange for theatre since surgery is the management. 3. carcinoid what is wrong : - neuroendocrine tumor - can be with MEN1 (medscape) - the syndrome is due to 5-HIAA ? - ....another right choice - sth malignancy with appendix carcinoid 4. Which of the following locations of carcinoid is most likely to mets: - appendix - ilium? - rectum 5. False about endoscopy: - endoscopy associated with high false negative results for esophagitis ? -esophagitis found on >90% of endoscopies ? -60% of GERD pts will have normal mucosa at endoscopy. 6. GERD, False: - manometry is mandatory before surgery? - not all esophageal hernia result in reflux 7. Bleeding artery in duodenal ulcer is: Gastrodudenal artery 8. Anatomy, true: - pancreas is related to medial side of duodenum - liver and GB cover 1st part of duodenum" 9. About gastrin, true: - secreted from G cells, stimulate pariteal cells 10. True about type one benign gastric ulcer: 1) associated with hypergastrinemia 2) increased with increased parital cell activity or sth 3) decreased mucosal defenses *** 11. Pt with BMI above 50, sweet eater, comorbidities, best bariatric surgery is: - laparascopic sleeve gastrectomy? - laparascopic gastric bypass ? 12. 13. 14. 15. 16. 17. 18. 19. - vertical banded gastroplasty - lap adjustable gastric band About GI lymphoma, false: - most common site of extra nodal involvement - most are NHL B cell type - 5 year survival more than 50 % - can't be treated with chemotherapy and radiotherapy ? All may cause pancreatitis except: - hyperthyroidism? - hyperparathyroidism - hyperlipidemia • TG >500 - cardiopulmonary bypass machine Pancreatic pseudocyst,false: - infected cyst must be drained internally? - to drain cyst internally we must wait for maturation of wall - size is no longer an indication of surgery - all symptomatic must be treated - persistent cyst after 6 wks is not an absolute indication for surgery Pancreatic adenocarcinoma, false: 1) 70% in the head 2) 90% ductal 3) in resectable , 20% 5-yr survival 4) p16 mutation is found in more than 90% (this is true) 5) papillary and mucinous cystadenocarcinoma are worse pronosis **** Neonatal jaundice 6 hour after birth can be caused by: - biliary atresia • Appears bw 2-6 wks - neonatal hepatitis - hemorrhagic disease of newborn? Pt with fever, jaundice, and abdominal right upper quadrant pain, all appropriate except - MRCP is contraindicated ? - resuscitation with IV fluids and antibiotics - most probably as sequel of GB stone - most likely direct hyperbilirubinemia All seen with Chron's except: - leap pipe? • UC - serosal involvement - skipped lesions - cobblestone Most common incidental solid liver tumor is: - hemangioma ? - hepatic adenoma 20. 21. 22. 23. 24. 1. 2. 3. 4. 5. - hepatic carcinoma - mets ITP, false: - majority of patients improve after splenectomy - spleen is usually palpable? - most cases resolve with immunosuppressant Most likely to benefit from splenectomy is; - hereditary spherocytosis? - thalassemia major - sickle cell - ITP OPSI, false: - occur in 2% post traumatic splenectomy - 50% due to pneumococcus - majority occur within first 2 years post op - present as non specific flu like - mortality is 80%? Diverticulosis, false: - bleeding most often from right colon -mortality is 10-20% Single most prognostic factor in colon cancer is: - nodal involvement - tumor size - transmural involvement ? - histological type Oncology Not a sign of local invasion: Arm Edema Cystic mass in the breast in a 33 year old woman MANS: - Aspiration & Cytology * - reassurance and reexamine postmenstrual single most important risk factor for Breast Cancer: Age. Gynecomastia, false: - pseudo gynecomastia can be treated with tamoxifen - no increased risk of cancer? - testosterone can be used for gynecomastia secondary to testosterone deficiency - increase incidence with advancing age Elderly Male with lesion on forehead for the last 6 months, nodular with talegectasia and central ulcer, most likely diagnosis: - BCC 6. Sarcomas, wrong: - histology affect prognosis? 7. pseudogynocomastia : is 2ry to obesity , no pharmacological management 8. Pt with family history of colon cancer (his father , uncle , and brother ) the tumor marker in this condition: • FAP APC kras p53 DCC APC BRACA1 BRACA2 Ras oncogen MSH2 Cardio-Thoracic 1. The atrial septal defect (ASD) most commonly associated with partial anomalous pulmonary venous return (PAPVR) is: A. Secundum defect. B. Sinus venosus defect. C. Ostium primum defect. D. Complete atrioventricular (AV) canal defect. E. Coronary sinus defect. Answer: B 2. Which of the following has the greatest impact on the physiology of tetralogy of Fallot? A. The size of the ASD. B. The size of the VSD. C. The degree of pulmonary stenosis. D. The amount of aortic overriding. Answer: C 3. The congenital coronary lesion most likely to cause death in infancy is: A. Coronary artery fistula. B. Origin of the left coronary artery from the pulmonary artery. C. Origin of the right coronary artery from the pulmonary artery. D. Congenital coronary aneurysm. Answer: B 4. Which of the following are the most frequent complications of intra-aortic balloon counterpulsation? A. Stroke. B. Limb ischemia. C. Arrhythmias. D. Aortic thrombosis. Answer: B Vascular Surgery: 1. 2. 3. 4. 5. 6. 7. 8. 9. A 55-year-old woman gives a history of tiredness, aching, and a feeling of heaviness in the left lower leg for the past 3 months. These symptoms are relieved by leg elevation. She is also awakened frequently by calf and foot cramping, which is relieved by leg elevation, walking, or massage. On physical examination there are superficial varicosities, nonpitting edema, and a slightly painful, 2 cm. diameter superficial ulcer 5 cm. above and behind the left medial malleolus. What is the most appropriate diagnosis? A. Isolated symptomatic varicose veins. B. Superficial lymphatic obstruction. C. Deep venous insufficiency. D. Arterial insufficiency. E. Incompetent perforating veins. Answer: C phlegmasia alba dolens, false: - require treatment with LMWH - absent distal pulses • White - limb is blue in color? Revasculirization surgery is indicated in all of the following cases except: - claudication - ischemic neuropathy - rest pain - ulcer - gangrene Which is most lethal coronary anomaly: - left main arising from pulmonary artery (alkapa) ? Most prognostic in TOF: - degree of pulmonary stenosis Most likely ASD type with partial anomalous pulmonary venous return: - coronary sinus venous - septum secondum - septum premium - AV canal malformation Ejection fraction is defined as: Stroke volume ratio to end diastolic volume Most likely sign indicating pneumothorax: - weak lung sounds ? - dull percussion note - shift of mediastinum to same side - crepitations Most common complication with intra aortic balloon pump: - arryhthmias - limb ischemia - hematoma at site of insertion 10. 11. 12. 13. 14. - stroke? - aortic dissection Most feared complication after thoracic aortic repair surgery is: - paraplegia "definitive" to show transection of (forgot the vessel) after trauma? - CT? - CXR -aortogram/angogram Popliteal artery aneurysm, true: - 70% bilateral - most common peripheral anurysm? - likely to present with compression on near nerve and vessels - most commonly present with pregnancy - if pt have abdominal aortic aneurysm he has 50% risk of having popliteal aneurysm Lymphedema, false: - filariasis is the most common cause of lymph edema worldwide - lymphedema praecox is most common primary lymphedema - best viewed by lymphogram - weight loss can help to improve lymphedema in obese pt - all cases must be managed surgically IABP complication : Lower limb ischemia Pediatrics: 1. Hurshsprung whats the wrong ? Decreased ACh-Esterase on biopsy. 2. Tympanic percussion on the left chest w vomiting and scafoid abdomen > left diaphragmatic hernia 3. The treatment of choice for neonates with uncomplicated meconium ileus is: A. Observation. B. Emergency laparotomy, bowel resection, and Bishop-Koop enterostomy. C. Intravenous hydration and a gastrograffin enema. D. Emergency laparotomy, bowel resection, and anastomosis. E. Sweat chloride test and pancreatic enzyme therapy. Answer: C 4. A 2.8-kg. neonate with excessive salivation develops respiratory distress. Attempts to pass an orogastric catheter fail because the catheter coils in the back of the throat. A chest film is obtained and shows right upper lobe atelectasis and a gasless abdomen. The most likely diagnosis is: A. Proximal esophageal atresia without a fistula. B. Proximal esophageal atresia with a distal tracheoesophageal (TE) fistula. C. “H-type” TE fistula. D. Esophageal atresia with both proximal and distal TE fistula. E. Congenital esophageal stricture. Answer: A 5. The most common type of congenital diaphragmatic hernia is caused by: A. A defect in the central tendon. B. Eventration of the diaphragm in the fetus. C. A defect through the space of Larrey. D. An abnormally wide esophageal hiatus. E. A defect through the pleuroperitoneal fold. Answer: E 6. true about pyloric stenosis : 1) can present as Autosomal dominant condition 2) mostly in first week of life 3) leads to bilious vomitting... 4) tumor can be palpated in most cases 5) if left untreated leads to severe complications in childhood 7. Most likely cause of biliary vomitus is: - esophageal atresia - pyloric stenosis - small intestinal volvulus? - diaphragmatic hernia 8. Intussusception, false: - mcc of intestinal obstruction btw age of 6-18 months - palpable sausage abdominal mass in 80% of pts? - ilioceccal is most common type - meckles or pyares patch may act as leading points -In ultrasound appear as doughnut sign General & Misc. 1. Rare hernia in females: - direct inguinal hernia? - indirect inguinal hernia - femoral hernia - incisional hernia - umbilical hernia? 2. All absolute contraindications to insert NGT except: - confirmed esophageal rupture - suspected esophageal rupture - esophageal stricture - foreign body in esophagus? 3. Amino acid most important in improving immunity - glutamine 4. limit for K in peripheral line : 20 mEq 5. False about IV fluids : 1) NaCL has 154 mEq Na & 154 mEq Cl 2) RL is the most physiological 3) hypotonic fluids can increase intracerebral pressure(or edema) 4) colloids can cause volume overload 5)G5W is enough to support nutrition for a fasting patient ** 6. All given for ttt of pseudo membranous colitis except: - metronidazole - vancomycin - steroids* - stop offending antibiotic 7. All risk factors for c.difficle infections except: - vegetarian ? - long course of antibiotics 8. High velocity penetrating trauma, transverse abdomen at mid umbilicus, which is likely to be injured: - small bowel? - liver - kidney - spleen 9. Source of infection after inguinal hernia repair is: - pt skin? - instruments - surgeon 10. Hypermagnisemia, false: - associated with ECG changes consistent with hyperkalemia - DTR are exaggerated * - levels are parallel with postassium levels 11. Pt with crush injury, in respiratory distress, multiple rib fractures, life saving measure is: - intubation and mechanical ventilation * - cricothyrotomy 12. Facial trauma, false: - facial fracture can't wait to stabilize the pt? 13. Hernia, false: - sliding hernia can't be reduced? - if reducibly most likely to have positive cough impulse - becomes irreducible before strangulation - hernia of meckles is called lesser hernia 14. wrong about soft tissue sarcoma : * retroperitoneal and abdominal mostly metastasize to liver (it's to lung) 15. most important factor for wound healing : 1) vit;.D • Intraperut . To liver 2) vit.C 3) carbohydrate 4) caloric intake 5) balanced diet 16. Source of protein in pts with trauma is: - liver? - plasma protein - skeletal muscle Plastic 1. Wrong about Escharotomy for Compartment Syndrome: not usually done when distal pulses are felt. 2. most common type of facial cleft : 1.isolated unilateral incomplete cleft lip .. 2.isolated cleft palate 3. all need good irrigation except :1.sodium metal 2. KOH 3. calcium hydroxide . 4.chromium acid 4. all are true about cleft palate except : late surgical correction leads to facial growth deformities 5. about skin , what is correct 1) skin appendages are mesodermal in origin 2) epidermis is 20% of skin 3) 4) 5) collagen cross-linkage provides tensile strength ** ???? 6. About inhalational injury, false: - best way to diagnose is flexible fiberoptic laryngoscopes ? - in CO poisoning pulse oxymeter is not reliable 7. Electrical burn, wrong: - injury result from thermal and non thermal injury - high voltage is above 1000 V 8. 9. 10. 11. 12. - elevated cr, CPK indicate massive injury ? - PET can be used as a quick measure to accurately estimate tissue injury ? - myoglobinurea result in kidney injury Compartment syndrome is defined when intracompartmental pressure is above: -40 mmhg All true about use of escherectomy and early graft of burn, except: - increase incidence of sepsis* - decrease hospital stay - decrease negative nitrogen balance - less contracture All help to prevent enlargement of zone of ischemia except: - good fluid resuscitation - urine output maintained above .5 ml/kg/hr - leg dependency to improve blood supply? False: - nevus of jadasshon has no malignant potential Vascular malformation, false: - AVM are low flow lesions* - capillary malformation result in seizure in brain Endocrine: 1. Most Common Site of Extra-Adrenal Pheochromocytoma is: Abdomen (Organ of ZuckerLandl) 2. Which of the following is treated with Radioactive Iodine Ablation: Multinodular Goitre 3. Hemithyroidectomy effective for : - papillary ca - follicular ca - medullary ca - an aplastic ca - Graves' disease 4. Pleomorphic adenoma, false - most common salivary gland tumor - increase risk of malignancy with advancing age - ideally treated with total parotidectomy? - recurrence treated with radiotherapy ? 5. pt with conns syndrome and imaging showed bilateral masses on adrenals , next step : 1) FNA 2) bilateral adrenalectomy 3) MIBG 4) venous sampling 5) bilateral radiotherapy 6. All cause hypercalcemia except: - secondary hyperparathyroidism 7. All manifestation of hypercalcemia except: - oligurea 8. all cause hypercalcemia except : 1) sarcoidosis 2) vit. D toxicity 3) metastatic cancer 4) ..sth causes hypercalcemia too 5) medullary thyroid ca ***** 9. Most common pancreatic endocrine tumor: - inslulinoma 10. Neuroblastoma most common mets to: - regional LN? - lung - brain - liver 11. pt with conns syndrome and imaging showed bilateral masses on adrenals , next step : 1) FNA 2) bilateral adrenalectomy 3) MIBG 4) venous sampling 5) bilateral radiotherapy 12. all can be caused by hypermagnisemia except : exaggerated deep tendon reflexes