Surgery Ple

University of Perpetual Help Rizal
JONELTA FOUNDATION SCHOOL OF MEDICINE

Department of Surgery Consortium
Test Questions for the February 2005 PLE
Name ________________________________________
Subject:
General Surgery 1
Instructions:
Multiple Choice : Choose the BEST answer.
1. With regard to keloids and hypertrophic scars, the following statements are true,
EXCEPT:
a. There are no histologic differences between the two.
b. The differences between hypertrophic scar and keloid are clinical, not
pathologic.
c. Hypertrophic scars outgrow their original borders.
d. Hypertrophic scars and keloids have been treated successfully with
intalesional injection of
steroids.
Answer:
C
Reference:
PRINCIPLES OF SURGERY by SCHWARTZ, SPENCER, SHIRES 7TH
EDITION, Vol. 1, pp. 515-516
MPL:
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2. True statements regarding melanoma include all of the following, EXCEPT:
a. The most common histologic type is superficial spreading.
b. Depth of invasion (measured in millimeters), ulceration and patient gender
are important prognostic criteria.
c. Nodular melanomas carry a poorer prognosis than do superficial spreading
melanomas of the same thickness.
d. Melanomas in dark-skinned people are frequently subungual or appear on the
palms and soles.
Answer:
C
Reference:
MPL:
0.6
3. A mass in the midline of the neck just above the tracheal cartilage has been notable
for some months in an 8 year-old girl but in the last four days there has been some
reddening and discomfort. Which of the following statements is most likely correct?
a. It has a high probability of malignancy.
b. It would most likely resolve completely with antibiotics.
c. It would rise higher in the neck when she protrudes her tongue.
d. Incision and drainage is adequate treatment.
Answer:
C
Reference:
MPL:
0.6
4. Each of the following factors contributes to the likelihood that a mass in the neck is
malignant, EXCEPT:
a. The patient is alcoholic.
a. The patient had another malignancy outside the neck.
b. The patient is quite sure it was not present a week ago.
c. The patient was a heavy smoker, but quit two years ago.
Answer:
C
Reference:
MPL:
0.6
5. Which of the following statements concerning parotid tumors is true?
a. 80% are benign
b. Diagnosis is by incisional biopsy
c. Facial nerve palsy is a definite sign of malignancy
d. Tumors that extend into the deep lobe of the parotid are unresectable
Answer:
A
Reference:
EDITION, Vol. 1, pp. 657
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6. The type of hiatal hernia for which operation is indicated based on its demonstrated
presence is:
a. sliding hiatal hernia
b. para-esophageal hiatal hernia
c. short esophagus
d. Barretts esophagitis
Answer:
B
Reference:
MPL:
0.4
7. Which of the following esophageal abnormalities is premalignant?
a. reflux esophagitis
b. Baretts esophagitis
c. Presbyesophagus
d. Scleroderma
Answer:
B
Reference:
EDITION, Vol. 1, pp.1116
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8. Of the anatomic layers of the esophagus, which statement is true for the serosal
layer?
a. It is effective in temporarily halting the spread of carcinoma.
b. It lubricates the esophageal thoracic mobility during swallowing.
c. It is useful in suturing anastomoses to the esophageal stump.
d. It does not exist.
Answer:
D
Reference:
MPL:
0.5
9. A 32 year-old woman complains of difficulty swallowing, foul breath, and
regurgitation of undigested food. Her most likely diagnosis is:
a. esophageal cancer
b. achalasia
c. Zenkers diverticulum (pulsion)
d. Esophageal stenosis from reflux esophagitis
Answer:
C
Reference:
MPL:
0.5
10. Signs of breast cancer include each of the following, EXCEPT:
a. bloody nipple discharge
b. skin dimpling
c. Pagets disease of the nipple
d. breast discomfort
Answer:
D
Reference:
MPL:
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11. In a 36 year-old woman with a painless hard dominant breast lump, the next step
should be:
a. mammography of the lump
b. fine needle aspiration cytology
c. radiation therapy
d. radical mastectomy
Answer:
B
Reference:
MPL:
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12. Which of the following breast lesions is typically benign?
a. cystosarcoma phylloides
b. comedocarcinoma
c. medullary carcinoma
d. lobular carcinoma
Answer:
A
Reference:
MPL:
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13. Current adjunctive therapy for a premenopausal 40 year old woman following radical
mastectomy with a 2.5 cm ductal carcinoma with a 2 of 15 lymph nodes involved
and an estrogen receptor negative tumor includes:
a. tamoxifen
b. cytotoxic chemotherapy
c. androgens
d. oophorectomy
Answer:
B
Reference:
MPL:
0.5
14. A 65 year-old farmer presents with a 1.5-cm ulcerated lesion on the middle third of
his lower lip. The lesion has been present for 4 months and is not painful. No lymph
nodes are palpable in the patients neck. The most likely diagnosis is:
a. Squamous cell carcinoma
b. Basal cell carcinoma
c. Herpes simplex
d. Keratoacanthoma
Answer:
A
Reference:
EDITION, Vol. 1, 521-522
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15. A 65 year-old patient who spends summer in Baguio City presents with a painless,
ulcerated lesion on the right cheek. The lesion has been present for one year.
Physical examination of the patients neck reveals no lymph node enlargement. The
most likely diagnosis is:
a. pyogenic granuloma
b. melanoma
c. basal cell carcinoma
d. squamous cell carcinoma
Answer:
C
Reference:
EDITION, Vol. 1, 522
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Subject:
General Surgery II
Instructions:
16. A 60yr.old male underwent operation for a perforated diverticulitis of the descending
colon. What would be the most dominant bacteria if the peritoneal fluid was
cultured?
a. E.coli
b. Bacteroides
c. H. pylori
d. Proteus
Answer:
B
Reference:
MPL:
0.7
17. A 70yr.old male post-stroke patient with hemiplegia came in at the E.R. complaining
of crampy abdominal pain, abdominal distention, vomiting and absence of bowel
movement. Physical examination revealed globular abdomen & tender all
quadrants. Scout film of the abdomen revealed an inverted U shaped, sausage like
loop on L abdomen. What would be the likely diagnosis?
a. Strangulated Hernia
c. Sigmoid Volvulus
b. Perforated Diverticulitis
d. Completely Obstructing Colonic
CA.
Answer:
C
Reference:
MPL:
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18. What would be the best management for case no.17?

a. Observation w/ IV antibioticsc. Barium enema
b. Colonoscopy
c. Barium enema
d. Exploratory Laparotomy
Answer:
D
Reference:
MPL:
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19. The appropriate surgical procedure for a perforated sigmoid diverticulitis with
generalized peritonitis is:
a. Sigmoid resection w/ primary anastomosis
b. Double barrel transverse colostomy w/ drainage of perforation
c. Proximal loop colostomy and drainage of perforation
d. Resection of perforated segment w/ end colostomy
Answer:
D
Reference:
MPL:
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20. A 50yr.old underwent colonoscopy where there is a note of a pedunculated 1.6cm
sigmoid polyps and the histopath revealed a tubular adenoma which contained a
well-differentiated adenocarcinoma extending to but not beyond the muscularis
mucosa. The margin of polypectomy is free of tumor. The best therapeutic option
will be:
a. Segmental resection of the colon
b. Operative colostomy and excision of polypectomy site
c. Observation and repeat colonoscopy after 3-6 months
d. Intracavitary radiotherapy
Answer:
C
Reference:
MPL:
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21. A 45y/o F G3P3 came in for consult due to sensation of rectal fullness, mucus
discharge and bright red blood dripping into the toilet. Rectal exam revealed a
mucosa lined canal mass which is noted to reduce spontaneously. Your primary
consideration is internal hemorrhoids. You can further classify this as:
a. 1st degree hemorrhoid
b. 2nd degree hemorrhoid
c. 3rd degree hemorrhoid
d. 4th degree hemorrhoid
Answer:
B
Reference:
MPL:
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22. Assuming this is the 1st consult of the patient in case #21, what would be the
appropriate management?
a. Medical therapy (i.e increase dietary fiber, stool softer & avoidance of
straining)
b. Elastic ligation
c. Coagulation
d. Excessional hemorrhoidectomy
Answer:
A
Reference:
MPL:
0.6
23. A 30y/o M has persistent purulent drainage from an external anal fistula from
abscess few weeks ago. If the external fistula is 2cm anterior to a line transversely
drawn in the anus. The internal opening will be noted at:
a. curve tract in the posterior midline
b. short, direct fistulous trait
c. absence of fistulous tract
d. beside the external opening
Answer:
B
Reference:
MPL:
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24. After a L hemicolectomy and an end to end an anastomosis for adenocarcinoma of

the descending colon, a 65y/o F was noted to have a fecaloid discharge in the
incision site. She is afebrile w/ abdomen soft, NABS and non-tender. While among
the following factors will increase chance of spontaneous closure of fistula.
a. distal obstruction
b. long fistulous tract
c. loss of bowel continuity
d. 1000 LC/24hr fistula output
Answer:
B
Reference:
MPL:
0.5
25. A 55y/old female came in for consult due to intermittent crampy abdominal pain and
change in bowel habits of 1month duration. Physical examinations were essentially
normal. Barium study with revealed an apple core lesion on the L colon. What
would be the next appropriate step of management?
a. Colonoscopy w/ Biopsy
b. CT-scan of the abdomen
c. ULTRASOUND of the abdomen
d. Sigmoidoscopy w/ Biopsy
Answer:
A
Reference:
MPL:
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26. Patient in no.10 underwent operation, histology report showed the tumor to invade
the muscularis propea w/ 2 pericolic lymph nodes and negative liver metastasis.
What is the stage of the patient?
a. Stage 1
b. Stage 2
c. Stage 3
d. Stage 4
Answer:
C
Reference:
MPL:
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27. What is the common mode of spread of colorectal cancer?
a. direct extension
b. hemotogenosis
c. lymphatic
d. implantation
Answer:
C
Reference:
MPL:
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28. Which is the most important prognostic determinant of survival of patient w/
colorectal cancer?
a. tumor size
b. transmural extension
c. DNA content
d. Lymph node involvement
Answer:
D
Reference:
MPL:
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29. Which of the following colorectal polyps have the highest risk of developing
colorectal cancer?
a. tubular adenoma
b. hyperplastic polyp
c. tubulo villous adenoma
d. villous adenoma
Answer:
D
Reference:
MPL:
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30. Which among the following statements is not true regarding Familial Adenomatosis
Polypsis?
a. it has more than 100 adenomatosis polyps in the large bowel
b. includes a spectrum of syndromes i.e Gardners syndrome and Turcots
syndrome
c. genetic defect is detected in chromosome 5,near g21 locus
d. it is an autosomal recessive disorder.
Answer:
D
Reference:
MPL:
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Subject:
General Surgery III
Instructions:
For questions 31 to 39: A 45 year old woman is admitted for a perforated duodenal ulcer
6 hours after onset of symptoms. She has a history of chronic peptic ulcer disease
treated medically with minimal symptoms.
31. The patient is assessed to be dehydrated at the emergency room with dry mucous
membranes, tachycardia and a blood pressure of 90/60. Her depleted intravascular
volume is mainly due to isotonic fluid losses due to:
a. Vomiting
b. poor intake
c. third space loss due to peritonitis
d. escape of gastric fluid through the perforated duodenum
Answer:
C
Reference:
Principles of Surgery, Schwartz 6th Edition, pp. 1455
MPL:
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32. Intravenous fluid of choice for resuscitation would be:
a. 0.3 Normal Saline
b. 0.45 Normal Saline
c. D5 Water
d. Plain LR solution
Answer:
D
Reference:
MPL:
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33. The most cost- effective method of monitoring adequacy of hydration is
through the use ofa/an:
a. Foley catheter
b. Nasogastric tube
c. Swan-Ganz catheter
d. Intra-arterial Pressure monitoring.
Answer:
A
Reference:
MPL:
0.5
34. Given an actual body weight of 60 kilograms, an adequate hourly urine output would
be:
a. 25 cc/ hour
b. 60 cc/ hour
c. 20 cc/ hour
d. 15 cc/ hour
Answer:
B
Reference:
Principles of Surgery, Schwartz 6th Edition, pp. 74-78
MPL:
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35. Her pneumoperitoneum would be best documented by which radiologic study:
a. Chest Bucky film
b. Plain Abdomen
c. Chest PA upright
d. Holoabdominal ultrasound
Answer:
C
Reference:
MPL:
0.6
36. Appropriate antimicrobial coverage peri-operatively would consist of intravenous:

a. Ciprofloxacin
b. Cefazolin
c. Metronidazole
d. Imipenem
Answer:
B
Reference:
MPL:
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37. If the patient exhibits unstable vital signs in the operating theatre, the procedure of
choice is:
a. Hemigastrectomy
b. Simple closure with omental patch
c. Antrectomy and truncal vagotomy
d. Highly selective Vagotomy
Answer:
B
Reference:
MPL:
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38. It the patient exhibits stable vital signs in the operating theatre and the
peritonitis is localized, the procedure of choice is:
a. Hemigastrectomy
b. Simple closure with omental patch
c. Antrectomy and truncal vagotomy
d. Highly selective Vagotomy
Answer:
C
Reference:
MPL:
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39. This microbe has been implicated in the causation of her disease:
a. H. influenzae
b. H. pylori
c. S. pneumoniae
d. S. aureus
Answer:
B
Reference:
MPL:
0.6
For questions 40to 42: A 53 year old man is diagnosed to have a bleeding duodenal
ulcer on urgent endoscopy after he presented at the emergency room with melena. His
vital signs are stable.
40. The blood vessel most likely involved in the above lesion if the :
a. Left Gastric Artery
b. Gastroduodenal Artery
c. Coronary Vein
d. Right Gastroepiploic Artery.
Answer:
B
Reference:
MPL:
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41. The lesion showed evidence of active bleeding on endoscopy, the most
appropriate management to arrest the bleeding would be:
a. NGT lavage with ice cold saline
b. Urgent Laparotomy
c. Endoscopic Hemostasis
d. Angiographic Hemostasis
Answer:
C
Reference:
MPL:
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42. The most appropriate supportive medication to administer in addition to # 41 would
be:
a. Antacids
b. Intravenous H2 blockers
c. Intravenous Proton Pump Inhibitors
d. Oral H2 blockers
Answer:
C
Reference:
MPL:
0.6
For questions 43 to 45. A 50 year old man presents with obstructive jaundice.
43. Additionally, he presented with significant weight loss and mild abdominal
discomfort. Ultrasound examination revealed Dilated intrahepatic ducts,
gall
bladder and common bile duct. The most likely diagnosis is:
a. Klatskin Tumor
b. Hepatocellular Carcinoma
c. Common Duct Stone
d. Pancreatic Head Cancer
Answer:
D
Reference:
MPL:
0.5
44. Additionally, he presented with a prior 2 month history of episodic severe, right
upper quadrant pain and fever associated with waxing and waning jaundice. The
most likely diagnosis is:
a. Klatskin Tumor
Answer:
C
Reference:
MPL:
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45. Additionally he presented with significant weight loss and mild abdominal
discomfort. Ultrasound examination revealed Dilated intrahepatic ducts
with
no visualization of the gallbladder and common bile duct. The most likely diagnosis
is:
a. Klatskin Tumor
Answer:
A
Reference:
MPL:
0.5
Subject:
Trauma
Instructions:
46. A 24 year old male was admitted for a Tension Pneumothorax of the Right Lung due
to a stab wound in the chest. The intervention of choice would be:
a. Tube Thoracostomy
b. Subxiphoid Window
c. Cricothyroidotomy
d. Endotracheal Intubation
Answer:
A
Reference:
MPL:
0.6
47. A 30 year old male was admitted for a Flail Chest on the Right Hemithorax cue to
injuries sustained in a car crash. The intervention of choice would be:
d. Endotracheal II:Ubation
Answer:
D
Reference:
MPL:
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48. A 29-year-old male was admitted for Laryngeal Obstruction due to injuries sustained
in a car crash. The intervention of choice would be:
Answer:
C
Reference:
MPL:
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49. A 22-year-old male was admitted for an Open Pneumothorax due to a gun shot
wound. The intervention of choice in the acute setting would be:
a. Occlusive Dressing
Answer:
A
Reference:
MPL:
0.5
50. A 19-Year-old Male was admitted for a Pericardial Tamponade caused by an Ice Pick
wound to the chest. The intervention of choice would be:
Answer:
B
Reference:
MPL:
0.6
For questions 51 and 52: A 19 year old male is kicked in the left flank. Three hours later
he develops gross hematuria. His vital signs are stable.
51. Initial diagnostic test of choice would be:
a. Retrograde urethrography
b. Retrograde cystography
c. Arteriography
d. High dose infusion urography
Answer:
D
Reference:
MPL:
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52. The diagnostic tests performed revealed extravasation of contrast into the renal
parenchyma. Treatment of choice would be:
a. Exploration and suture of laceration.
b. Non surgical treatment consisting of serial monitoring of vital signs and
increased fluid intake and antibiotics.
c. Exploration and Nephrectomy
d. Exploration and ligation of the involved Renal artery .
Answer:
C
Reference:
MPL:
0.6
For questions 53-55. .A 13 year old boy falls from his bicycle and is run over by a
passing truck. On arrival in the emergency room he is awake, alert and appears
frightened but in no distress. The chest radiograph suggests an air fluid level in the left
lower lung field and the nasogastric tube seems to coil upward into the left chest.
53. The teen aged boy is suffering from:
a. Flail chest
b. Rupture of the left hemidiaphragm
c. Pleural Effusion
d. Lung Contusion
Answer:
B
Reference:
MPL:
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54. On the 45th minute of admission, the patient starts to exhibit tachycardia and
hypotension. Rapid fluid resuscitation is significantly enhanced by which of the
following?
a. Placement of long gauge 18 subclavian catheters.
b. Placement of short large bore percutaneous peripheral intravenous catheters.
c. Bilateral saphenous vein cut downs.
d. Bilateral femoral vein cut downs.
Answer:
B
Reference:
MPL:
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55. The next best step in management is:
a. Non Surgical treatment in the ICU setting.

b. Placement of a left chest tube.
c. Immediate celiotomy
d. Immediate thoracotomy.
Answer:
C
Reference:
MPL:
0.6
56. A 15 year old boy is admitted for a intra peritoneal injury aft'er he is run
by a car. The most commonly injured organ in this case is the:
a. Liver
b. Spleen
c. Kidney
d. Pancreas
Answer:
B
Reference:
MPL:
0.5
over
For questions 57 to 60. A 25 year old woman arrives in the emergency room following
an automobile accident. She is very dyspneic with a respiratory rate of 48 breaths per
minute. Breath sounds are markedly diminished on the right side and the trachea is
deviated to the left.
57. She is most likely suffering from a:
a. Massive Pleural Effusion
b. Simple Pneumothorax
c. Tension Pneumothorax
d. Hemothorax
Answer:
C
Reference:
MPL:
0.6
58. In this patient there is :
a. Collapse of the ipsilateral lung
b. Shifting of the mediastinal structures to the ipsilateral side of the injury.
c. Shifting of the trachea to the ipsilateral side of the injury
d. Increased Cardiac ouput.
Answer:
A
Reference:
MPL:
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59. The first step in managil1g the patient should be to
a. Take a chest X ray
b. Draw arterial blood for blood gas studies
c. Decompress the Right Pleural space
d. Perform Pericardiocentesis.
Answer:
C
Reference:
MPL:
0.6
60. If left untreated, this woman may succumb due to:
a. Pneumonia
b. Empyema Thoracis
c. Hypoxemia and Hypotension
d. Myocardial Infarction
Answer:
C
Reference: Principles of Surgery, Schwartz 6th Edition, pp. 674-676
MPL:
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Subject:
Orthopedic Surgery
Instructions:
61. These are present in a typical Colles fracture except:
a. Dorsal angulation (silver
fork deformity)
c. Ulnar shortening
b. Radial angulation
d. Involves distal metaphysis of the
radius
Answer:
C
Reference:
Rockwood and Greens Fractures in Adults, Vol. 1, pp. 770
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62. A reverse Colles fracture is called

a. Bartons fracture
c. Frykmanns fracture
b. Smiths fracture
Answer:
B
Reference:
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d. Pouteaus fracture
Rockwood and Greens Fractures in Adults, Vol 1, pp. 770
63. An open fracture with a very large wound (more than 10cm) caused by a sharp
object such as a knife with minimal soft tissue injury is classified as a:
a. Type I Open fracture
c. Type III Open fracture
b. Type II Open fracture
d. Type IV Open fracture
Answer:
B
Reference:
MPL:
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64. The antibiotics of choice for the treatment of open fractures:
a. Penicillin
c. Cephalosporins
b. Streptomycin
d. Aminoglycosides
Answer:
C
Reference:
MPL:
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65. The distal carpal row is formed by the following bones except:
a. Triquetrum
c. Trapezium
b. Capitate
d. Hamate
Answer:
A
Reference:
MPL:
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66. Its innervation is purest at the palmar skin of the tip of the index finger:
a. Ulnar nerve
c. Median nerve
b. Radial nerve
d. Posterior interosseous nerve
Answer:
C
Reference:
Physical examination of the Spine and Extremities by Hoppenfeld,
pp. 98
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67. This test evaluates the strength of the gluteus medius:
a. Thomas test
c. Finkelsteins test
b. Allen test
d. Trendelenburg test
Answer:
C
Reference:
pp. 164
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68. To test for the true leg length, one measures from the __________to the medial
malleoli.
a. Umbilicus
c. Posterior superior iliac spine
b. Anterior superior iliac spine
d. Greater trochanter
Answer:
B.
Reference:
pp. 165
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69. This is a very common site for gout:
a. First metatarsal head
c. Elbow
b. Ankle
d. Knee joint
Answer:
A
Reference: Physical examination of the Spine and Extremities by Hoppenfeld, pp.
209
MPL:
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70. This area of the bone is most often involved in acute osteomyelitis
a. Epiphysis
c. Diaphysis
b. Metaphysis
d. Physis
Answer:
B
Reference:
Orthopedics by Turek, pp. 258
MPL:
0.4
Subject:
Thoracic Cardio Vascular Surgery
Instructions:
71. In the evaluation of lymph node status of patients with suspected lung cancer,
Chamberlaine
procedure or parasternal mediastinotomy is used to biopsy what location of lymph
nodes?
a. cervical lymph nodes
c. aortopulmonary window lymph nodes
b. paratracheal nodes
d. subcarinal lymph nodes
Answer:
C
Reference:
Principles of Surgery, pp. 671
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72. A 17 y/o, male, sustained a stab wound on the right chest. He was brought to the ER
complaining
of dyspnea. He was given oxygen support and started with IVF. On physical
examination, the
following are manifestations of Tension Pneumothorax except:
a. dilated neck veins
c.
absent or distant breath
sounds
b. dull percussion over the injured hemithorax
d. hypotension
Answer:
B
Reference:
MPL:
0.6
73. A 35 y/o, male, with gunshot wound over the left chest was brought to the ER. After
initial
resuscitation, a chest tube was inserted draining bloody pleural effusion. What
amount of drainage will warrant an emergency thoracotomy?
a. 1.5 liter
c. 50 ml per hour for 3 consecutive hours
b. 500 ml
d. 700 ml
Answer:
A
Reference:
MPL:
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74. A young tall male suddenly complains of chest pain and dyspnea while playing
basketball. Chest
x-ray showed pneumothorax on the left hemithorax. What is the most likely cause?
a. Lung abscess
b. PTB
c. Bronchiectasis
d. Ruptured bleb or bulla
Answer:
D
Reference:
MPL:
0.6
75. Myasthenia gravis is associated most commonly with what type of mediastinal
tumor?
a. Lymphoma
b. Teratoma
c. Neurogenic tumor
d. Thymoma
Answer:
D
Reference:
MPL:
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76. Chest x-ray is used initially to evaluate patients with congenital heart disease. What
cardiac contour
is typical of Tetralogy of Fallot?
a. egg shape
b. boot shape
c. snowman appearance
d. apple shape
Answer:
B
Reference:
MPL:
0.5
77. A 20 y/o, female, consulted at the ER with complaints of palpitation and dyspnea.
She was diagnosed to have Patent Ductus Arteriosus during her childhood. What is
the hallmark of this congenital disease?
a. wide pulse pressure
b. distant heart sounds
c. continuous machinery murmur
d. engorged neck veins

Answer:
C
Reference:
MPL:
0.5
78. In coronary artery bypass grafting, what is the most important vessel used with a
long term patency
rates exceeding 90%?
a. internal mammary artery
b. saphenous vein
c. radial artery
d. tibial artery
Answer:
A
Reference:
MPL:
0.4
79. A 35 y/o, male patient complains of exertional dyspnea and fatigue. On P.E., he has a
grade 3 apical
diastolic murmur and bipedal edema. ECG showed atrial fibrillation. 2D
Echocardiography showed a severely stenotic and calcified mitral valve. What is the
most likely cause?
a. infection
b. trauma
c. congenital
d. rheumatic
Answer:
D
Reference:
MPL:
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80. A 55 y/o, male, smoker, diabetic for 10 years was admitted due to chest pain
radiating to the left
shoulder. ECG showed ST segment elevations in leads II, AVF, V 1-3. Diagnosis was
Unstable
Angina. Coronary angiogram showed significant three vessel disease. The surgical
treatment of
choice is:
a. valve replacement
b. coronary artery bypass grafting
c. laser therapy
d. VATS ( video assisted thoracic surgery )
Answer:
B
Reference:
MPL:
0.4
Subject:
Urology
Instructions:
81. A 13 year old boy was brought in at the ER due to blood dripping at the urethral
meatus. The following informations is/are necessary to make the proper diagnosis.
a.
history of acute colicky flank pain
b.
history of straddle or pelvic crushing injury
c.
history of instrumentation
d.
family history of renal disease
Answer:
B
Reference:
Smiths General Urology, pp. 343-345
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82. Injury to the urethra is best diagnosed by means of
a. voiding cystourethrogram
b. retrograde urethrogram
c. cystogram
d. retrograde pyelography
Answer:
B
Reference:
Smiths General Urology, pp. 344
MPL:
0.4
83. The most common cause of ureteral injury is/are
a. iatrogenic
b. vehicular accident
c. penetrating abdominal injury
d. self-induced
Answer:
A
Reference:
MPL:

0.4
84. The classic triad of manifestations of renal cell CA

a. hematuria, weight loss, and pain
b. hematuria, weight loss, and mass
c. hematuria, palpable mass, and flank pain
d. hematuria, palpable mass, and weight loss
Answer:
C
Reference:
MPL:
0.4
85. Stage II renal cell CA is managed by
a. chemotherapy
b. radiation therapy
c. partial nephrectomy
d. radical nephrectomy
Answer:
D
Reference:
MPL:
0.5
86. Patient presenting with painless gross hematuria is most likely suffering from
a. renal cell carcinoma
b. ureteral transitional cell CA
c. bladder transitional cell CA
d. renal pelvic transitional cell CA
Answer:
C
Reference:
MPL:
0.6
87. On digital rectal exam, a strong 63 year old male sexually active male was found to
have a 1.0cm nodule on the right lobe of the prostate gland. However, he was
asymptomatic, what will be your next plan of management?
a. transrectal prostate ultrasound
b. transabdominal KUB prostate ultrasound
c. acid phosphatase determination
d. prostate specific antigen test
Answer:
D
Reference:
MPL:
0.4
88. Prostatic CA most commonly originates at what zone?
a. central zone
b. transitional zone
c. peripheral zone
d. periurethral gland
Answer:
C
Reference:
MPL:
0.4
89. On transrectal UTZ guided needle biopsy of prostate gland, result showed
adenocarcinoma with a Gleasons score of 4+5 (9) and PSA value of 42 (NO 0-4).
The next step is to determine the stage of the disease. What will be your best
choice in staging the disease?
a. total body bone scan
b. abdominal CT scan
c. pelvic lymphangiography
d. molecular staging
Answer:
A
Reference:
MPL:
0.4
90. Benign prostatic hyperplasia originates from what portion or zone of the prostatic
gland?
a. central zone
b. transitional zone
c. peripheral zone
d. periurethral gland
Answer:
D
Reference:
MPL:
0.4
Subject:
Neuro Surgery
Instructions:
91. Regarding the relationship of ICP and systemic BP, the best conclusion is:
a. blood pressure may be high without increased ICP
b. ICP may be elevated without change in BP
c. BP may increase as ICP is falling
d. The relationship is unconstant and measuring BP is not a satisfactory
technique for measuring ICP.
Answer:
D
Reference:
Youmans Neurological Surgery, pp. 469
MPL:
0.4
92. The presence of reflexes of spinal origin in brain damaged patients:
a. Is prognosis of recovery
b. Is compatible with a diagnosis of brain death
c. Is incompatible with a diagnosis of brain death
d. None of the above
Answer:
B
Reference:
Ivan, L.P. Neurology (Minn.), chap. 23 pp. 650,
MPL:
0.5
93. In traumatic transection of the spinal cord, spinal shock may
a. Last from 3 or 4 days to 6 weeks.
b. Result in permanent flaccidity of the denerated muscles
c. Never be evident
d. None of the above
Answer:
A
Reference:
Haymakers, W. Bings Local Diagnosis in Neurologic Diseases, pp.
85
MPL:
0.6
94. The mesencephalic nucleus of the trigeminal nerve is concerned with:
a. Propuoceptive fibers
b. Tactile sensaion
c. Thermal sensation
d. Pain sensation
Answer:
A
Reference:
Bloedel, J.R. & Mc Cherry, D.B. Surg. Neurol., chap. 4 pp. 68
MPL:
0.4
95. In civilian practice, an intracranial missile is not ordinarily removed if it is deep in the
brain. Periodic radiological observation is indicated for all of the following reasons
except:
a. The bullet may migrate
b. It may move to on accessible area
c. The movement may cause neurological damage
d. Erosion of vascular structures is frequent complication
Answer:
A
Reference:
Lieberkind, A.L. et al. Neuroradiology, chap. 5 pp. 129
MPL:
0.4
96. Increased morbidity and mortality in patients with epidural hematoma was
associated with all of the following except:
a. Late development of the hematoma
b. Concomitant brain injury
c. Unconsciousness at time of operation
d. Early development of the hematoma
Answer:
A
Reference:
Heiskamen, O. Surgical Neurology, chap. 4 pp. 23
MPL:
0.6
97. There is a question regarding the utility of routine skull x-rays in trauma patients.
Recently, authors have suggested all of the following except:
a. There is high correlation between physical findings and the detection,
location and type of fracture demonstrated by x-ray.
b. Theres little correlation between physical findings and the detection, location
and type of fracture demonstrated by x-ray.
c. Skull fractures are an insignificant manifestation of trauma.
d. Skull fractures need not be detected unless there is reasonable possibility of
depressed fragments.
Answer:
A
Reference:
Bill R.S. & loop, J.W.NEJM and Roberts, F & Shaftner, Radiology 114:
230, 1972, chap. 284 pp. 236
MPL:
0.5
98. All of the following apply to patient with compound depressed skull fractures
EXCEPT:
a. 1/4 will develop late epilepsy
b. 10% have an associated hematoma
c. 2/3 of patients were not unconscious
d. Dural penetration greatly increased the likelihood of early epilepsy
Answer:
D
Reference:
Heiskamen, O. et al Acta Chir Scand, chap. 139 pp. 605
MPL:
0.5
99. Regarding patients with chronic subdural hematoma.:
a. History of craniocerebral trauma in 90% of patients.
b. Have a precipitous onset
c. History of craniocerebral trauma in 50% of patients
d. 90% of patients with a history of craniocerebral trauma were unconscious
following the trauma.
Answer:
C
Reference:
Figelholm. R. etal. J Neurosurgery, 1975, chap. 42 pp. 43
MPL:
0.6
100.The most important factor in infection as a complication of depressed skull fracture
is:
a. Delay in treatment
c. Failure in antibiotic therapy
b. Replacement of bone fragments
d. Inadequate debridement
Answer:
A
Reference:
Jennett, B.J. Neurosurgery, 1972, chap. 36 pp. 337
MPL:
0.5

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12. Which of the following breast lesions is typically benign?

18. What would be the best management for case no.17?

24. After a L hemicolectomy and an end to end an anastomosis for adenocarcinoma of

36. Appropriate antimicrobial coverage peri-operatively would consist of intravenous:

55. The next best step in management is:

a. Non Surgical treatment in the ICU setting.

62. A reverse Colles fracture is called

d. engorged neck veins

Smiths General Urology, pp. 329

84. The classic triad of manifestations of renal cell CA

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