MCQs Mock Exams for General Surgery Board Exam

Mock Exam 2- 25 MCQs

Share from Dr. Muhanad Deeb. Riyadh, King Faisal Hospital (muhanad.deeb.5facebook.com)

References:

1. Comprhensive "AIO" Revision on SURGERY by Dr.Adel Abdel Hamid. 2008

2. Lange Q & A 5th Edition.

1. Which of the following are the most important and clinically useful risk
factors for breast cancer?
A. Fibrocystic disease, age, and gender.
B. Cysts, family history in immediate relatives, and gender.
C. Age, gender, and family history in immediate relatives.
D. Obesity, nulliparity, and alcohol use.
Answer: C
2. Which of the following pathologic findings is the strongest contraindication
to breast preservation (lumpectomy with breast radiation) as primary
treatment for a newly diagnosed breast cancer?
A. Grade 3, poorly differentiated, infiltrating ductal carcinoma.
B. Extensive intraductal cancer around the invasive lesion.
C. Tumor size greater than 3 cm.
D. Positive surgical margin for invasive cancer.
Answer: D
3. Axillary lymph node dissection is routinely used for all of the following
conditions except:
A. 2-cm. pure comedo-type intraductal carcinoma.
B. 1-cm. infiltrating lobular carcinoma.
C. 8-mm. infiltrating ductal carcinoma.
D. A pure medullary cancer in the upper inner quadrant.
Answer: A
4. A 35-year-old premenopausal woman whose mother had breast cancer
comes into your office
and has been told that she has fibrocystic breasts. On examination she has
multiple areas of thickening but no discrete mass. Of the following diagnostic
tests, which should be performed?
(A) Re-examination in 6 months
(B) Bilateral breast ultrasound
(C) Thermography
(D) Bilateral breast magnetic resonance imaging (MRI) with gadolinium

(E) Spot compression views if an area of discrete asymmetry or concerning

calcifications is seen
Answer: (D) Patients who present with fibrocystic mastopathy
at this age should undergo routine screening mammography, either regular
film or digital, and ultrasound if no obvious benign etiology is seen on
mammography. Spot compression mammography is done for any
questionable abnormality. Routine use of screening MRI is not indicated at
this time.
5. A familial form of medullary thyroid carcinoma (MTC) should be suspected
whenever:
A. The tumor is multifocal.
B. The tumor is bilateral (foci of tumor are present in both thyroid lobes).
C. Pathologic examination of the resected thyroid gland reveals the presence
of C-cell hyperplasia in areas of the gland adjacent to foci of MTC.
D. All of the above.
Answer: D
6. All of the following are components of the MEN type 2B syndrome except:
A. Multiple neuromas on the lips, tongue, and oral mucosa.
B. Hyperparathyroidism.
C. MTC.
D. Pheochromocytoma.
Answer: B
8. MEN 2A and MEN 2B syndromes are associated with germline mutations
in:
A. The p53 tumor suppressor gene.
B. The H-ras gene.
C. The N-myc gene.
D. The RET proto-oncogene.
Answer: D
7. Surgery is indicated in the initial management of lung cancer in the
presence of which of the
following?
(A) Hypercalcemia
(B) Vocal cord paralysis
(C) Superior vena cava syndrome
(D) Small-cell anaplastic carcinoma
(E) Chest wall and anterior abdominal wall metastasis
Answer: Answer: (A) Hypercalcemia is attributed to the secretion of
parahormone from a localized squamous cell carcinoma (paraneoplastic
effect); as such, improvement may be seen after surgical

resection. Following extension of the tumor into the chest wall, radiotherapy
and subsequent extensive resection carried out in selected cases may
occasionally be indicated. Small-cell carcinoma (also known as oat-cell
carcinoma) accounts for 2025% of cases of bronchogenic
carcinoma, arises centrally and tends to metastasize widely. The initial
treatment is combination
chemotherapy followed by radiotherapy in those whose cancer responds.
8. The following Nyhus classification of hernias is correct except for:
A. Recurrent direct inguinal herniaType IVa.
B. Indirect inguinal hernia with a normal internal inguinal ringType I.
C. Femoral herniaType IIIc.
D. Direct inguinal herniaType IIIa.
E. Indirect inguinal hernia with destruction of the transversalis fascia of
Hesselbach's triangleType II.
Answer: E
9. Which of the following statements about the causes of inguinal hernia is
correct?
A. Excessive hydroxyproline has been demonstrated in the aponeuroses of
hernia patients.
B. Obliteration of the processus vaginalis is a contributing factor for the
development of an indirect inguinal hernia.
C. Physical activity and athletics have been shown to have a protective effect
toward the development of inguinal hernias.
D. Elevated levels of circulating serum elastalytic activity have been
demonstrated in patients with direct herniation who smoke.
E. The majority of inguinal hernias are acquired.
Answer: D
10. The following statements about the repair of inguinal hernias are true
except:
A. The conjoined tendon is sutured to Cooper's ligament in the Bassini hernia
repair.
B. The McVay repair is a suitable option for the repair of femoral hernias.
C. The Shouldice repair involves a multilayer, imbricated repair of the floor of
the inguinal canal.
D. The Lichtenstein repair is accomplished by prosthetic mesh repair of the
inguinal canal floor in a tension-free manner.
E. The laparoscopic transabdominal preperitoneal (TAPP) and totally
extraperitoneal approach (TEPA) repairs are based on the preperitoneal
repairs of Cheattle, Henry, Nyhus, and Stoppa.
Answer: A 7.

11. Which of the following statements about achalasia is/are correct?

A. In most cases in North America the cause is a parasitic infestation by
Trypanosoma cruzi.
B. Chest pain and regurgitation are the usual symptoms.
C. Distal-third esophageal adenocarcinomas may occur in as many as 20%
of patients within 10 years of diagnosis.
D. Manometry demonstrates failure of LES relaxation on swallowing and
absent or weak simultaneous contractions in the esophageal body after
swallowing.
E. Endoscopic botulinum toxin injection of the LES, pneumatic dilatation, and
esophagomyotomy provide highly effective curative therapy for achalasia.
Answer: D
12. Which of the following statements about epiphrenic diverticula of the
esophagus is/are correct? A. They are traction diverticula that arise close to
the tracheobronchial tree.
B. They characteristically arise proximal to an esophageal reflux stricture.
C. The degree of dysphagia correlates with the size of the pouch.
D. They are best approached surgically through a right thoracotomy.
E. The operation of choice is a stapled diverticulectomy, long
esophagomyotomy, and partial fundoplication.
Answer: E
13. Which of the following statements about Schatzki's ring is correct?
A. The ring represents a panmural fibrotic stricture resulting from
gastroesophageal reflux.
B. Dysphagia occurs when the ring diameter is 13 mm. or less.
C. The ring occurs within 1 to 2 cm. of the squamocolumnar epithelial
junction.
D. Schatzki's ring indicates reflux esophagitis.
E. Schatzki's ring signifies the need for an antireflux operation.
Answer: B
14. A 52-year-old woman is involved in an automobile accident and sustains
an open fracture of the fight femur, compression fractures of the 10th and
11th thoracic vertebrae and right pulmonary contusion. On the fourth day
after injury, her abdomen is noted to be distended, tympanitic and diffusely
tender. Abdominal radiographs reveal gaseous distension of the ascending
and transverse segments of the colon. The cecum is 13 cm in greatest
diameter. Appropriate management includes which of the following as the
next step?
a. Right hemicolectomy
b. Operative cecostomy
c. Colonoscopy

d. Contrast enema
e. Observation
Answer: c
15. For which of the following consequences of radiation injury of the
intestine is urgent laparotomy required?
A. Small bowel obstruction.
B. Colonic perforation.
C. Rectovaginal fistula.
D. Malabsorption and diarrhea.
E. Rectal stenosis.
Answer: B
16. In addition to its absorptive and digestive roles, the small bowel also
plays a significant role in the bodys immune system. Gut-associated
lymphoid tissue (GALT) represents a major division of the immune system.
Which of the following statement(s) is/are true concerning the immunologic
functions of the small intestine?
a. The B lymphocytes of the small intestine do not produce immunoglobulin
A (IgA)
b. Peyers patches, an example of an aggregated cellular portion of the gutassociated lymphoid system tissue, are large collections of lymphoid follicles
found on the antimesenteric border of the ileum
c. The major immunoglobulin of the intestinal immune system is IgM
d. IgA produced by the intestinal immune system produces the classic Fcmediated inflammatory reactions to antigen stimulus
Answer: b
17. A64-year-old woman with arthritis is a chronic NSAID user. She develops
severe epigastric
pain and undergoes an upper endoscopy. She is told that she has an ulcer
adjacent to the pylorus. Which of the following is TRUE about the pylorus?
(A) It cannot be palpated at laparaotomy.
(B) It is not covered completely by omentum.
(C) It is a distinct anatomic entity that can
be distinguished during laparotomy.
(D) It is a true physiologic sphincter.
(E) It is a site where cancer is rarely found.
Answer: (C) The pylorus is palpable but it is not a true physiologic
sphincter. It does not demonstrate reciprocal contraction when the stomach
relaxes, nor does it relax when the stomach
contracts. The pylorus is normally in tonic contraction It is partially covered
by omentum and cancer is commonly found there.
18. A 35-year-old man has known ulcerative colitis. Which of the following is
an indication for total proctocolectomy?

(A) Occasional bouts of colic and diarrhea

(B) Sclerosing cholangitis
(C) Toxic megacolon
(D) Arthritides
(E) Iron deficiency anemia
Answer: (C) Toxic megacolon is a fulminant exacerbation of ulcerative
colitis, causing massive dilatation of the colon with perforation, fecal
peritonitis, and death. Emergency total colectomy is indicated.
19. A 60-year-old alcoholic is admitted to the hospital with a diagnosis of
acute pancreatitis.
Upon admission, his white blood cell (WBC) count is 21,000. His lipase is
500, blood glucose
is 180 mg/dL, lactate dehydrogenase (LDH) is 400 IU/L, and aspartate
aminotransferase (AST)
is 240 IU/dL. Which of the following is TRUE?
(A) This patient is expected to have a mortality rate of less than 5%.
(B) The patients lipase level is an important indication of prognosis.
(C) This patient requires immediate surgery.
(D) A venous blood gas would be helpful in assessing the severity of illness
in this patient.
(E) A serum calcium level of 6.5 mg/dL on the second hospital day is a bad
prognostic sign.
Answer: (E) The patient has three Ransons criteria at the time of
admission. The expected mortality rate is 15% with 34 Ransons criteria.
Amylase and lipase levels are not prognostic factors in acute pancreatitis.
Calcium level <8 mg/dL within the first 48 hours is one of Ransons criteria,
asis arterial PO2 <60 mm Hg.
20 A 35-year-old woman presents with episodes of obtundation,
somnolence, and tachycardia. An insulinoma is suspected based on a
random serum glucose test value of 38 mg. per dl. Which of the following
statements is/are true?
A. The most important diagnostic study for insulinoma is an oral glucose
tolerance test.
B. It may be helpful to perform ERCP in an effort to localize the tumor.
C. Most patients with insulinoma present with extensive disease, rendering
them only rarely resectable or curable.
D. An important component of the preoperative evaluation in patients with
presumed insulinoma involves confirming elevated C-peptide or proinsulin
levels and screening for anti-insulin antibodies.
Answer: D
21. The management of a suspected bile duct injury depends on a number of
factors, most importantly the mode and timing of presentation. Which of the

following statement(s) is/are true concerning a patient presenting with a

suspected bile leak after laparoscopic cholecystectomy?
a. Laparotomy should be performed immediately
b. Cholangiography should be performed to determine the nature of the
injury
c. Operatively-placed drains should be removed to allow the fistula to close
d. The patient should be discharged to home to allow the leak to close
spontaneously
Answer: b
22. Hyposplenism is a potentially lethal syndrome. Which of the following
statements is incorrect?
A. It is confirmed by isotope scan.
B. It is always associated with an atrophic spleen.
C. It may be associated with overwhelming post-splenectomy sepsis
syndrome (OPSS).
D. It is associated with thyrotoxicosis, corticosteroid administration, and
some contrast agents.
E. It may be associated with ulcerative colitis or sickle cell anemia.
Answer: B
23. Stress urinary incontinence:
A. Is principally a disease of young females.
B. Occurs only in males.
C. Is associated with urinary frequency and urgency.
D. May be corrected by surgically increasing the volume of the bladder.
E. Is a disease of aging produced by shortening of the urethra.
Answer: E
24. A30-year-old restrained driver was involved in a motor-vehicle crash. He
is hemodynamically stable and has a large seat belt sign on the abdomen.
His abdomen is tender to palpation. In this patient one should be most
concerned about:
(A) Liver and spleen injury
(B) Transection of the head of the pancreas
(C) Renal pedicle avulsion
(D) Hollow-viscus injuries
(E) Pelvic fracture
Answer. (D) While all the injuries listed are potential problems in this
patient, the most severe is blunt hollow viscus injury. A delay in diagnosis
beyond 12 hours is associated with increased morbidity and mortality. There
may be very few physical signs of a viscus perforation and CT findings may
be subtle and not definitive. A seat belt sign across the abdomen should

raise suspicion of this injury and prompt an aggressive pursuit of diagnosis

by serial examination and a consideration of a peritoneal lavage or repeat CT
scan.
25. A 45-year-old man skidded from the road at high speed and hit a tree.
Examples of deceleration injuries in this patient include:
(A) Aortic valve rupture
(B) Kidney injury
(C) Posterior dislocation of shoulder
(D) Mesenteric avulsion
(E) Stomach rupture
Answer. (E) Deceleration injuries occur when the body is subjected to a
sudden stop when traveling at a high speed (e.g., high-speed automobile
hitting a tree, fall from a height). As the impacting part of the body comes to
a sudden halt, the organs behind continue to travel forward, thus causing
shearing injuries at the junction of mobile and fixed parts; such as
mesenteric avulsion. The other choices are possible but much less common.