Surgery Exam 2021–4th Year

Surgery exam 2021 – 4th year 1. True about medullary thyroid carcinoma: - 75% are sporadic ** - Related to irradiation 2. Hurthle cell carcinoma. All true except: - Also called oxyphilic cell carcinoma - More aggressive than papillary and follicular - Considered a variant of follicular carcinoma - Eosinophils on microscope 3. Psammoma bodies: - papillary carcinoma 4. Wrong about parathyroid adenoma: - 2nd most common cause of 1ry hyperparathyroidism 5. The most common pancreatic endocrine tumor in MEN1: - Gastrinoma 6. To differentiate between benign and malignant thyroid nodules: - FNA biopsy 7. Most of blood supply of parathyroid is from: - Inferior thyroid artery 8. True about parathyroid gland: - Secrets PTH to control calcium levels 9. Activation of trypsinogen as an initial step in acute pancreatitis is conducted by: - Lipase - Amylase - Enteropeptidase** - Phospholipase 10. Pseudo-obstruction syndrome (ogilvie's), all true except: - Increased sympathetic tone and decreased parasympathetic tone. - More on the left side** - Risk of perforation is 15% 11. All of following can cause gynecomastia except: - Cimetidine - Digoxin - Spironolactone - Tricyclic antidepressants - Cefuroxime** 12. Most common congenital heart defect: - Membranous VSD 13. Closure of foramen primum by union of: - Septum primum with AV cushions 14. GIST arise from: - Cells of Cajal 15. Wrong about GERD: - 90% will have esophagitis on endoscopy due to reflux ** (60% will show normal mucosa on endoscopy). - Not all types of reflux are diagnosed by PH monitoring - Barium swallow > hiatal hernia 16. Wrong about diverticulitis: - Endoscopy is the test of choice to diagnose acute diverticulitis. (it is CT) 17. Wrong about CHD: - TOF is due to aorticopulmonary membrane defect *?? (It is due to anterior and superior deviation of the outlet septum. - In TOF: pulmonary artery stenosis and overriding aorta. - In TOF: VSD and RVH 18. Not associated with polyhydramnios: - Esophageal atresia - Duodenal atresia - Colon atresia** - Congenital hiatal hernia 19. Wrong about bariatric surgery: - Banding is good for pediatric age group. - Bypass is good choice for sweet eaters. - Bypass is mainly restrictive** 20. 2 year-old child has swallowed a 2 cm coin, he has drooling of saliva but no respiratory distress. what is the most likely site to find the coin: - LES - At the level of cricopharyngeous muscle** - At jejunoileal junction - At level of crura of diaphragm 21. Genetic defect ass with HNPCC: - APC• FAP - MLH1/MSH2** - P53 • Li Fraumeni sx 22. Wrong about hemorrhoids: - 2 right hemorrhoid quadrants and 1 left - Mainly in young adult - Grade III > surgery - Grade II refractory to medical treatment >> banding - ……. 23. True about colon cancer: - It is rare for right colon cancer to present as anemia - 75% from polyps ?? 24. Wrong about anal fissures: - Anterior fissures are more common than posterior fissures** - Sentinel pile >> chronic fissure - Usually hyperactive internal sphincter 25. Wrong about fistula: - Intersphincteric > most common - Seton is associated with negligible incontinence** 26. Zone 1 in penetrating neck injuries: - Cricoid cartilage to angle of mandible - Clavicle to cricoid cartilage** 27. Most common cause of death at site of accident is: - CNS injury - Thoracic injury - Vascular injury** 28. True about neuropathy in DM patient with diabetic foot: - Ulcer in normal weight bearing parts. - Cold skin*? 29. Which factor is the most associated with symptomatic PVD: - HTN - DM** 30. Diabetic patient presented with redness and swelling on plantar aspect of the foot: - Acute Charcot 31. Sepsis with organ failure and persistent hypotension is the definition of: • SIRS - Septic shock** • Sepsis - SIRS • Severe sep. org. Fx - Severe sepsis • Septic shock hypotension - MODS 32. Not part of the SIRS criteria: - Temperature < 36 - HR >90 - WBC > 12000 or < 4000 - RR>8 or PaCO2 >23mmHg** - Cell bands > 10% 33. Patient lost 1700 ml of blood: - Class III shock (lost 30 – 40 % of blood volume) 34. Pt has inappropriate words, open eyes in response to painful stimulus, flex limbs in response to painful stimulus. Find his GCS: - 9 ** - 8 - 7 35. P50 for a male with normal [Hb]: - 15 mmHg - 25** - 35 - 40 36. Wrong about compartment syndrome: - Fasciotomy of all affected compartments - Absent pulse is an early sign** (it is very late) 37. Female with DVT. Wrong about treatment: - admission - she may have PE without signs - level of DVT determination would affect the management - need to determine whether it is provoked or unprovoked - good treatment reduce recurrence and post thrombotic syndrome 38. wrong about critical limb ischemia: - mostly are revascularized - worse prognosis than intermittent claudication - amputation is occasionally the only choice - Majority ends with amputation, or become severely diseased in 12 months follow up*?? 39. Antibiotic prophylaxis for inguinal hernia repair with mesh: - Vancomycin - 1st generation cephalosporin** - 2nd generation cephalosporin - 3rd generation cephalosporin 40. Factor that increases the risk of cholangiocarcinoma the most is: - PSC (primary sclerosing cholangitis) 41. Wrong about cholecystitis: - Emphysematous cholecystitis is treated conservatively 42. Wrong about necrotizing fasciitis: - High mortality - Caused by single microbe in 80% of patients** 43. Best test for diagnosis of gastrinoma is: - 24 hour urine gastrin - Acidity of the stomach 44. Clinical picture of pneumothorax (RTA, SOB, patent airway, hyper resonance and decreased breath sounds on right). What is the most appropriate next step? - Needle thoracotomy** - Intubation and ventilation - IV access - CXR - Lavage 45. all are risk factors for C. difficile infection except: - smoking** - PPI - Prolonged broad spectrum antibiotics use - Severely ill patient 46. Wrong about appendicitis: - Mainly in pediatrics 47. All are contents of the spermatic cord except: - Genital branch of genitofemoral nerve - Inferior epigastric artery** 48. Not part of MILAN criteria for liver transplantation: - 4 small tumors < 4 cm** • Single mass up to 5 cm - No extrahepatic manifestations • 2-3 mass not more than 3 cm • No vasc. Invx - No vascular invasion • No extrahep, manifestation 49. Not a cause of hyperkalemia: - Alkalosis** - Renal failure - Thrombocytopenia 50. Associated with high risk of breast cancer: - Atypical hyperplasia 51. The least invasive carcinoma: - Comedo carcinoma** - Tubular carcinoma - Medullary carcinoma - Mucinous carcinoma 52. Wrong about mammography: - 1/3 of palpable CA nodules are missed on mammography • 10% 53. Wrong about fibroadenoma: - Mostly at 3rd to 4th decades** (it is 2nd to 3rd) 54. Wrong about melanoma: - Ocular melanomas metastasize to cervical lymph nodes** - Acral lentiginous melanoma is the most common type in blacks 55. Wrong about breast cancer: • Mc ductsl - Mucinous (colloid) carcinoma is the most common type of invasive breast carcinomas 56. About burns, all are true except: - 2nd degree burns usually treated by skin grafts ** - 3rd degree burn causes loss of the tissue elasticity 57. Wrong about electrical burns: - Hypokalemia is common** - High voltage >> severe damage - Damage is proportional to tissue resistance 58. Wrong about early escharotomy: - Removed by bacteria** 59. Wrong about cleft palate: - Hearing loss is congenital** 60. Wrong about hirschsprung disease: - More in females** 61. Atypical cause of neonatal obstruction: - Intussusception 62. 8 month old baby with hemangioma on his upper eyelid obstructing the eye, management? - Laser - Steroids** - Surgery - Observation - Embolization 63. True about wound healing: - Activation of coagulation cascade 64. Wrong about excessive wound healing: - Keloid doesn't improve with time - number of fibroblast in keloid and hypertrophic is more than normal ulcers** 65. most malignant feature in lung cancer: - no change on CXR after 5 months - speculated appearance** 66. serous pleural effusion: - congestive heart failure 67. most common lung cancer: - metastases • Stage 3b and - peripheral adenocarcinomas in non-smokers more we dont - small cell carcinoma in smokers go for sx - squamous cell carcinoma in smokers - bronchogenic adenoma 68. wrong about gastroschisis: - ?? 69. Not in neuroblastoma: - Diarrhea** - Splenomegaly 70. Most common cause of hydronephrosis: - congenital ureteropelvic junction stenosis 71. the complication with worst prognosis of aortic stenosis: - congestive heart failure** - syncope - angina 72. wrong about undescended testis: - high risk of malignancy - orchidopexy in neonatal period** 73. wrong about testicular torsion: - radiologic investigation and isotope scan should be done before surgery - may present with vomiting ? 74. sternal angle is at level of - 2nd costal cartilage 75. Not complication of TPN: - Hypoglycemia 76. Wrong about IBD: - granulomas are seen in more than 50% of cases 77. Blood transfusion least likely to cause: - Hypercalcemia** - Hypothermia - Hyperkalemia 78. Trauma patient presented to the ER first step? - Secure airways