Mid 2010 surgery boared

55 y old man with chronic GERD had UGI endoscopy and found 4 cm segment of barret’s esophagus
biopsy showed low grade dysplasia; current surveillance recommendation for biopsy

a) 3month
b) 6month if high grade
c) 12month
d) 9month
e) 24month

4 month after laparoscopic gastric bypass, 32 y old female came with severe periumbilical abdominal
pain and vomiting, she is febrile, tachycardic, her abdomen pendulous, mild tenderness on examination

a) CT abdomen
b) UG swallow
c) Water soluble enema
d) UGI endoscopy
e) Abdominal exploration

Most common malignant tumor between age 15-25

a) Neuroblastoma
b) Wilm’s tumor
c) Seminoma
d) Osteosarcoma

Most common intra-abdominal tumor in children

a) Neuroblastoma
b) Wilm’s
c) lymphoma

Colonization of burn wounds

a) Staph

Which is not a common cause of paralytic ileus

a) Pneumonia
b) Abdominal surgery
c) Hypernatremia
d) Spinal cord injury
e) Hypothyroid
Most common malignancy of small bowel

a) Carcinoid
b) Lymphoma
c) Lieomyoma
d) Fibrosarcoma

25 y swallowed safety pins

a) Several x rays and examinations

50 y with lt lower quadrant pain and fever

a) Colonoscopy
b) Sigmoidoscopy
c) CT abdomen
d) MRI

Nutritional status is measured clinically by

a) Triceps skin fold

b) Albumin
c) Globulin
d) biceps

Injection of 1% ligocain and epinephrine can be used safely with

a) Zadiki syndrome
b) Colle’s fracture
c) Indirect Inguinal hernia

Most important phase of healing

a) collagen deposition??????????????????
b) epithilization
c) capillary budding

70kg patient with 50 % burn the initial fluid management

a) 600
b) 875
Motor cycle accident, patient is dyspnic inspite oxygen, CXR showed no rib fracture and bilateral
infiltrates

a) ARDS
b) Lung Contusion
c) Pneumonia
d) Aspiration pneumonia
e) atelectasis

most common risk factor of Incisional hernia

a) Incision infection
b) Morbid obesity
c) DM
d) Old age

50 y female with 3 cm RT adrenal mass found incidentally on CT for epigastric pain

a) 24h urine catecholamines and metaboilites

b) CT guided FNA
c) 24 h urine cortisol level
d) Determine plasma aldesterone concentration to plasma activity ratio
e) Operative excsion

45y women with active chron’s dis proctatitis with symptoms of trans sphinteric anovaginal fistula which
is the appropriate management

a) Drainage seton
b) Fistulectomy
c) Fibrin glue
d) Cutting seton
e) Endorectal advancement flap

Distal margin of resection of sigmoid diverticulitis should be

a) 2cm distal to colonic inflammation

b) Sacral promontory
c) Normal rectum
d) Peritoneal reflection
Use of CT in suspected appendicitis

a) Lower incidence of negative appendectomies

b) Improved in the last 10 years
c) Eliminate the need for reexamination
d) Decrease the rate of perforated appendix at
e) Detect pelvic abnormalities in female patients

Single most effective evaluation of 60 y male with history of 6month of hoarseness and neck mass

a) FNA
b) CT neck and chest
c) Incisional biopsy
d) Excisional biopsy
e) Laryngeoscope

Most accurate method for detecting and identifying liver metastasis

a) Trans abdominal US
b) CT
c) Laparoscopy
d) Intraoperative palpation
e) Intraoperative US

During a laparatomy for a gunshot wound to the abdomen, patient found to have 4 cm laceration to
anterior surface of the sigmoid colon patient is hemodynamically stable after minimal resuscitation no
fecal spillage the treatment is

a) Debridement and 1ry closure

b) 1ry repair with proximal colostomy
c) Resection, end colostomy, and mucus fistula
d) Resection, end colostomy, and hartman’s procedure
e) Resection, anastomosis, and exteriorization

Following crush injury and rhabdomyolysis, most important component to avoid renal failure

a) Mannitol
b) Furosemide
c) Bicarbonate
d) Volume replacement
e) Spironolactone
Following a side impact MVA of restrained passenger, decrease air entry on the Lt side of the chest, CXR
showed NGT curved in the chest , the next step in management

a) DPL
b) Laparoscopy
c) Tube thoracostomy
d) Laparotomy
e) Thoracotomy

40 y man fall from 15 feet on his feet, he is alert and talking, o/e tenderness over the lumbar spine xray
showed L1 fracture, which organ may get injured

a) Stomach
b) Duodenum
c) Pancreas
d) Transverse colon
e) Rt kidney

The best indication for ERCP is

a) Obstructive jaundice
b) History of jaundice
c) Elevated ALP to twice normal
d) Gallstone pancreatitis
e) 10mm CBD stone seen on US

Iodine metabolism

a) Thyroid store 50% of iodine

b) Iodine transport in to follicular cells via passive diffusion
c) TSH stimulate iodine to be transported into the follicular cells
d) Iodine is increased in multinodular goiter
e) High levels of iodine causes hypothyroidism

25 y came to ER fell 15 feet on his Rt side BP 60 became 110/60 after 2L ringer lactate, vital were normal
found to have grade 2 liver injury

a) Lapratomy
b) Laparoscopy
c) DPL
d) Observation
54y female underwent colonic resection for adenocarcinoma, which of the following suggest poor
prognosis

a) Circumferential growth
b) Extension to muscularis mucosa
c) Extension to serosa
d) Polypoidal growth
e) Mucosal ulceration

45y female, smoker, found to have 1cm painless nodule in the anterior cervical region, biopsy revealed
squamous carcinoma which of the following likely to be the 1ry site

a) Tongue
b) Tonsil
c) Palate
d) Pharynx
e) Larynx

Tamoxifen improves survival in which of the following

a) Fibroadenoma
b) Fibrocystic disease
c) Ductal carcinoma in situ
d) Invasive ductal carcinoma
e) Lobular carcinoma in situ

75y female with 3 day history of crampy abdominal pain, distention, obstipation with 2 episodes of
emesis in the last 24h, had history of appendectomy during his childhood, abdominal series showed
pneumobilia at laparotomy, inflammation Rt hypochondrium and obstruction in the distal ileum 10 cm
proximal to iliocecal valve, ttt:

a) small bowel resection + iliostomy + cholecystectomy

b) iliocecectomy + 1ry anastomosis
c) enterotomy + removal of the mass
d) enterostomy to bypass the tumor + cholycystectomy

77y lady, cold Lt hand after embelectomy, next step

a) MR angiography of subclavian artery

b) Duplex of carotid
c) ECHO
d) Cardiac Cath
e) Adson’s maneuver
Which indicate resection of small bowel

a) Loss> 20% of bowel wall

b) Compromise of blood supply of a segment
c) Injury 40 cm from ligament teritz
d) Injury 40 cm from ilocecal valve
e) 2 injury in a segment

Which reduce mortality for patient with sever sepsis

a) Activated protein C
b) High dose steroid
c) Antiendotoxin antibodies
d) TPN
e) Erythropioten

56 y female recovery from RT hemicolectomy post op day 2 with SOB saturation 85 on RA, HR 110, next
step

a) Lasix
b) Sublingual nitrate
c) ABG and CT spiral
d) Start SC heparin
e) Initiation of unfractionated heparin

24y male fell from the ladder brought to ER with labored breathing and cyanosis, no breath sound in the
RT side, resonant on percussion, the next step:

a) Cricothyroidotomy
b) Obtain CXR
c) Endotracheal intubation
d) Tube thoracostomy in ER
e) Call OR tube thoracostomy

48 hrs post laparoscopic guided liver biopsy, 65y male complaining of hematemesis, HR 100, BP 120/80,
PR  melena, endoscopy revealed blood in the duodenum, the next appropriate study:

a) MRCP
b) Colonoscopy
c) Nuclear bleeding scan
d) Dynamic helical CT
e) Visceral angio
19y student came to ER with fresh blood PR, he is in good health, not on medication he had similar
episode 1 year back, OGD, colonoscopy were normal, his abdomen soft, lax, no masses, Hct 32, most
likely source of bleeding

a) Angiodysplasia
b) Ulcerative colitis
c) Juvenile polyposis
d) Meckel’s diverticulum
e) Chron’s disease

Regarding malignant tumour of appendex :

a) RT hemicolectomy is the treatment for all carcinoid

b) Carcinoid tumor of the appendex is th 2 nd most common malignan
c) Liver mets demonstrated in most carcinoid even small carcinoma
d) Appendex carcinoid lower 5y survival than none carcinoid
e) Apendex goblet carcinoid < 1cm is safely treated with simple appendectomy

What is more common after lap roux and y than open:

a) Anastomosis leak
b) Death
c) No weight loss
d) Internal hernia
e) Wound complication

Most important layer in the scalp:

a) Sub-apenurosis

Most common submandibular malignancy:

a) Mucoepidermoid
b) Adenoid cystic carcinoma

Post op patient has Na 125 and Glu 500 corrected to 100 what is the treatment:

a) It will be corrected

Mucocele at the tip of the appendex the treatment is:

a) Appendectomy

Which of the following may be appropriate initial therapy for a 3cm cancer of the anal canal with
invasion of the internal sphincter and no inguinal adenopathy:

a) Local excision
 b) APR
c) Chemoradiotherapy
d) Radiotherapy

Which part of the cell is thaught to be target of radiation damage;

A) Nucleus

Lapratomy done for liver inj during op transfusion of 12 unit , despite treatment there is persistant
bleeding, which is the initially most appropriate:

a) Correction of hypothermia

Which immunosuppressant cause alopecia:

a) Tacrolimus

patient with cervical adenopathy with mediastinal widening:

a) Chemotherapy
b) Ct staging

ADH:

a) Mesenteric vasoconstriction

Patient with thyroglossal cyst

a) Resection with part of the hyoid bone

Which of the following is not a cancer sign:

a) Gray turner sign

b) krockenbuerge
c) virchow sign
d) sister marry joseph

bad prognosis of gastric cancer :

a) histologic type

patient has hemoptesis bleeding through tracheostomy:

a) tracheoinnominate fistula

management of pancreatic infection:

a) lapratomy and debridement

pt has necrosis of breast flap after mastectomy:

a) necrosis due to dye(methylene blue)