PRC Questions

PRC QUESTIONS SURGERY
1. A patient who sustained multiple injuries was noted after a few days to have lost weight
and had increased urinary nitrogen. This patient is in what phase of the metabolic
response to injury?
a.
Ebb phase
b.
Catabolic phase
c.
Anabolic phase
d.
Excretory phase
2. The major neuroendocrine stimuli that would stimulate a response in a patient with
vascular injury would most likely be:
a.
Effective circulating volume change
b.
Pain
c.
Energy substrate
d.
Oxygen, CO2 & H ion change
3. This is a hormone under pituitary control that maintains euglycemia during stressful
situations by increasing the availability of gluconeogenic substrates to the liver.
a.
Cortisol
b.
Catecholamines
c.
Growth Hormone
d.
Insulin
4. The plasma volume which is a component of the extracellular fluid is approximately:
a.
20% of TBW
b.
10% of TBW
c.
15% of TBW
d.
5% of TBW
5. A 30 y/o male, working in a steel mill for several hours, was brought to the ER because
of weakness .On PE the patient was tachycardic, with dry,sticky mucus membranes &
slightly febrile. The patient is most probably:
a.
Hypokalemic
b.
Hyponatremic
c.
Hypercalemic
d.
Hypernatremic
6. The condition which is aggrevated by either metabolic or respiratory alkalosis is:
a.
Hypocalcemia
b.
Hypokalemia
c.
Hyponatremia
d.
Hypochloremia
7. A patient who has lost a significant amount of blood and is in shock requires emergency
transfusion, which of the following statements is least applicable?
a.
Type specific blood may be given without crossmatching
b.
Type O (+) blood may be given if type specific blood is not available
c.
Crossmatched type specific blood should always be given
d.
Hemolytic transfusion reaction is possible if more than 4u of O (-) are given
8. The level of platelets in the blood that should be maintained to prevent bleeding problems
is:
a.
10,000-20,000/cu.mm
b.
50,000-100,000/cu.mm
c.
150,000-200,000/cu.mm
d.
300,000-500,000/cu.mm
9. What is the most common fatal complication of blood transfusion?
a.
Hemolytic transfusion reactions
b.
Thrombophlebitis
c.
Pulmonary edema
d.
Post-transfusion viral hepatitis
10. This is a mechanism of wound healing whereby keratinocytes migrate and then divide to
resurface partial -thickness loss of skin or mucosa.
a.
Epithelization
b.
Matrix deposition
c.
Contraction
d.
Scar formation
11. The cytokine present in wound healing that stimulates epithelial cell and fibroblast
proliferation and granulation tissue formation.
a.
PDGF (platelet derived growth factor)
b.
TGF- (transforming growth factor- beta)
c.
FGF (fibroblast growth factor)
d.
EGF (epidermal growth factor)
12. The estimated blood volume of a 3 kg baby is:
a.
150 ml
b.
300 ml
c.
240 ml
d.
450 ml
13. A 2-year old baby boy with a history of on and off bulging right scrotal mass, suddenly
developed abdominal pain, irritability and vomiting. PE finding revealed a tender mass
at the right inguinal area. The most likely diagnosis is:
a.
Acute testicular torsion
b.
Testicular carcinoma
c.
Incarcerated hernia
d.
Acute inguinal lymphadenitis
14. The most common ectopic mucosa present in Meckels diverticulum is:
a.
Colonic mucosa
b.
Pancreatic mucosa
c.
Ovarian mucosa
d.
Gastric mucosa
15. Which among the abdominal wall defects in the newborn period has the worse prognosis:
a.
Gastroschisis
b.
Omphalocele
c.
Bladder extrophy
d.
Prune belly syndrome
16. The most common pediatric malignant lesion in the liver is:
a.
Hepatocarcinoma
b.
Malignant teratoma
c.
Hapatoblastoma
d.
Metastatic lesion from neuroblastoma
17. Vater syndrome is associated with:
a.
Wilms tumor
b.
Hirschprungs disease
c.
Cryptochordism
d.
Esophageal atresia
18. Organs transplanted between genetically non-identical individuals of the same species are
termed:
a.
Isografts
b.
Allografts
c.
Xenografts
d.
Heterografts
19. A 42-year old female underwent cholecystectomy and 16 hours after the operation she
developed fever. This is most probably due to:
a.
Pneumonia
b.
UTI
c.
Atelectasis
d.
Wound infection
20. The most important aspect in the management of enterocutaneous fistula is:
a.
Wound care
b.
Nutrition
c.
Prevention of abscess formation
d.
Antibiotic administration
21. In retroperitonial hemorrhage from necrotic pancreatitis the blood can dissect to the
periumbilical area.
a.
Grey-Turner sign
b.
Cullens sign
c.
Murphys sign
d.
Kehrs sign
22. Which of the following is not included as criteria for the Ransons prognostication for
pancreatitis:
a.
White blood cell count
b.
Age
c.
Amylase
d.
Aspartate transaminase
23. Gram negative organisms are the most common causative agent in septic shock which is
frequently from the:
a.
Genitourinary system
b.
Respiratory system
c.
Alimentary system
d.
Integumentary system
24. True of the compensatory response that occurs during shock?

a.
Loss of circulating intravascular volume results in decreased vascular tone
b.
Decrease in intravascular volume stimulate decreased sympathetic activity,
which increase vagal inhibition of the rate and force of cardiac contraction
c.
Loss of circulating intravascular volume leads to decreased capillary
hydrostatic pressure
d.
Arteriolar dilation and loss of circulating volume diminishes renal blood flow
25. Classification of the operative wound in cases of appendectomy?
a.
Clean
b.
Clean-contaminated
c.
Contaminated
d.
Dirty and infected
26. Tumor associated virus that is implicated in Burkitts lymphoma
a.
Epstein-Barr Virus (EBV)
b.
Hepatitis BVirus (HBV)
c.
Human Papilloma Virus (HPV)
d.
Human Immunodeficiency Virus Type 1 (HIV-1)
27. A 50-year old female sought consult because of a 5 cm tender nodule on the right lobe of
the thyroid gland. The most unlikely diagnosis is:
a.
Thyroid malignancy
b.
Subacute thyroiditis
c.
Toxic adenoma
d.
Bleeding in a benign nodule
28. A 40-year old female sought consult because of a 3 cm cold nodule on the right lobe of
the thyroid gland. The next best step to do is:
a.
UTZ
b.
CT scan
c.
FNAB
d.
Diagnostic thyroidectomy
29. A 30-year old male sought consult because of a 2 cm hard nodule on the left lobe of the
thyroid gland associated with enlarged cervical lymphadenopathy on the ipsilateral side.
His family history showed strong predisposition to Familial Adenoma Polyposis
syndrome. If the nodule will turn out to be malignant the most likely histologic type is:
a.
Papillary Carcinoma
b.
Follicular Carcinoma
c.
Medullary Carcinoma
d.
Anaplatic Carcinoma
30. A 60-year old female underwent total thyroidectomy and RAI therapy for Follicular
Thyroid Carcinoma. Aside from clinical surveillance, part of the follow up program to
monitor for possible recurrence is regular determination of:
a.
TSH
b.
Calcitonin
c.
CEA
d.
Thyroglobulin
31. The most common organ secondarily affected by Primary Hyperparathyroidism is the:
a.
Kidney
b.
Bone
c.
GIT
d.
Pancreas
32. The most common complication of thyroglossal duct cyst is:
a.
Infection
b.
Malignant degeneration
c.
Hypothyroidism
d.
Airway obstruction
33. A 42-year old female sought consult because of a slow-growing, painless swelling in her
right mandible. X-ray showed a multiloculated radiolucency in the body of the mandible
with an impacted tooth clearly visualized. This condition is suggestive of:
a.
Torus mandibularis
b.
Ameloblastoma
c.
Gorlins cyst
d.
Osteosarcoma
34. For small (T1) squamous cell carcinoma of the Head and Neck region, this treatment
modality offers equal survival rates with that of surgery:
a.
Radiotherapy
b.
Chemotherapy
c.
Cryotherapy
d.
Immunotherapy
35. The type of neck dissection that removes lymph nodes levels I, II and III is called:
a.
Supraomohyoid neck dissection
b.
Lateral neck dissection
c.
Posterolateral neck dissection
d.
Central neck dissection
36. Following total parotidectomy for a malignant tumor, the patient was observed to have
difficulty in closing the eyelids in the ipsilateral side. Which branch of the Facial Nerve
was most likely injured:
a.
Temporal
b.
Zygomatic
c.
Buccal
d.
Mandibular
37. The most common complication of GERD is:
a.
Esophagitis
b.
Esophageal stricture
c.
Barretts esophagus
d.
Aspiration pneumonia
38. The most frequent cause of primary esophageal motility disorder:
a.
Achalasia
b.
Diffuse esophageal spasm
c.
Nutcracker esophagus
d.
Hypertensive LES
39. In the initial management of Caustic Injury to the esophagus, this treatment modality may
pose more harm than good to the patient if performed:
a.
Neutralizer
b.
Gastric lavage
c.
Endoscopy
d.
Dilation
40. The most common cause of acute bacterial cystitis:
a.
E. coli
b.
Pseudomonas Sp.
c.
Protens Sp.
d.
Staphylococcus aureus
41. Imaging procedure of choice in renal trauma:
a.
Angiography
b.
Doppler ultrasound
c.
CT scan
d.
MRI
42. The most common cause of subarachnoid hemorrhage in general:
a.
Ruptured aneurysm
b.
Hypertensive bleed
c.
Artero-venous malformation
d.
Head injury
42. Epidural hematoma is associated with:
a.
Linear fracture
b.
Tear in the middle meningeal artery
c.
Lucid interval in 20% of cases
d.
All are correct
43. Bleeding source of acute subdural hematoma comes from:
a.
Tear in middle meningeal artery
b.
Rupture of bridging veins
c.
Bleeding from the diploic veins
d.
Tear from internal carotid artery
44. The most specific sign of increase ICP
a.
Headache
b.
Vomiting
c.
Lateral rectus palsy
d.
Papilledema
45. Which metacarpal bone in the metacarpals is most prone to avascular necrosis due to its
peculiar blood supply?
a.
Lunate
b.
Scaphoid
c.
Capitate
d.
Hamate
46. All of the following are associated with post menopausal osteoporosis, EXCEPT:
a.
Colles fracture
b.
Femoral neck fracture
c.
Vertebral compression fracture
d.
Femoral shaft fracture
47. The safe maneuver to determine a congenitally dislocated hip in the newborn is:
a.
Barlows test
b.
Ortolanis test
c.
Thomas test
d.
Laseques test
48. The femoral head is contained more into the acetabulum when the hip is:
a.
Internally rotated and adducted
b.
Externally rotated and adducted
c.
Internally rotated and abducted
d.
Externally rotated and abducted
49. An 18-year old athlete came into your office because of pain over the middle third of the
right leg with slight swelling and tenderness on deep pressure, giving a history of a
minimum five (5) kilometer run everyday along Quezon City Circle. X-ray of the tibia
shows an incomplete fracture of the anterior cortex, middle third of the tibia. Most likely
he is having:
a.
Pathological fracture
b.
Stress fracture
c.
Torus fracture
d.
Greenstick fracture
50. This is the most common aggressive primary malignant bone tumor in adolescent and
occurs in methaphyseal area of long bones with high incidence of pulmonary metastases:
a.
Chrodrosarcoma
b.
Osteosarcoma
c.
Fibrosarcoma
d.
Adamantinoma
51. Recurrent ulceration after vagotomy is usually due to inadequate dissection of the
esophagus and intact criminal nerve of Grassi which arises from the:
a.
Anterior vagus
b.
Posterior vagus
c.
Nerves of Laterjet
d.
Crows foot
52. A 65-year old, male, known COPD case was chronically taking NSAID suddenly
experienced severe epigastric pain. 24-hours later fever was noted thus consult. Chest xray upright revealed a crescent shape luscency beneath the diaphragm which can be
attributed to:
a.
Free blood from the stomach which collected underneath the diaphragm
b.
Escape of air from the lungs
c.
Pneumoperitoneum secondary to perforated peptic ulcer
d.
Collection of pus beneath the diaphragm
53. Same patient as # 2. While at the ER, BP went down to 90/60. How will you manage
this case?
a.
Sclerotherapy and blood transfusion
b.
Closed tube thoracostomy
c.
Grahams omental patching
d.
Explor lap, drainage of pus and antibiotic administration
54. Metastasis of gastric malignancy may be noted in the following sites:

a.
Krukenbergs tumor involvement of the pelvic cul-de-sac
b.
Blumers shelf involvement of ovaries
c.
Vichows node ipsilateral axillary node
d.
Sister Josephs nodule deposit to the umbilicus
55. Gross difference of jejunum from ileum is best described as:
a.
Jejunum has larger diameter and thicker wall than the ileum
b.
Jejunum has one or two arterial arcades
c.
Jejunum has abundant mesenteric fat than the ileum
d.
Jejunum has few plicae
56. The most common symptomatic benign lesion of the small bowel is:
a.
Adenoma
b.
Lipoma
c.
Leiomyoma
d.
Hamartoma
57. The most common complication of Meckels Diverticulum in adult is:
a.
Obstruction
b.
Bleeding
c.
Acute diverticulitis
d.
Intussuception
58. True of the evidence for the existence of an adenoma-carcinoma sequence:
a.
Larger adenomas are found to contain less cancer cells and dysplasia than
smaller polyps
b.
The differentiation between carcinoma in situ and invasive cancer relies on the
size of the polyp
c.
Polypectomy alone has been shown to increase the incidence of cancer
d.
Patients w/ familial adenomatous polyposis develop cancer 100% of the time
if the colon is not removed
59. A 54-year old, male had an executive check up because of pallor, body weakness and
20% weight loss in 2 months time. Occult blood testing is positive. If you are
considering a colonic malignancy where is the probable site?
a.
Right side of the colon
b.
Left side of the colon
c.
Sigmoid colon
d.
Rectum
60. After the operation of a patient with colon cancer, the surgeon told the relatives that
colonic mass invades the submucosa with 1 to 3 pericolic lymph nodes. Liver was noted
to be smooth and with sharp edge. What is the stage of the disease?
a.
Stage I
b.
Stage II
c.
Stage III
d.
Stage IV
61. A patient presents with persistent purulent discharge from an external opening posterior
to the imaginary line that bisected the anus. If the Goodsals rule will be followed the
internal opening is located at:
a.
Posterior midline via a straight tract
b.
Posterior midline via a curved tract
c.
Anterior midline via a straight tract
d.
Anterior midline via a curved tract
62. Characteristic contrast study findings in cases of volvulus:
a.
Inverted U-shaped, sausage-like loop of bowel in abdominal radiograph
b.
Bent inner tube sign in plain film of the abdomen
c.
Coiled spring appearance in upper GI series
d.
Birds beak appearance in barium enema
63. True statement about the diagnosis of breast cancer:
a.
Doing mammography for all females above 20 years of age is cost effective
b.
BSE (breast self examination) should be done by women 20 years old and
older
c.
Ultrasound of the breasts can accurately detect microcalfications
d.
History and breast examination should be done after a screening mammogram
64. Correct statement about the presentation of breast cancer:
a.
Breast pain (mastalgia) is the most common complaint of patients
b.
Women do BSE regularly can detect or palpate breast lumps with more than
85% accuracy
c.
A soft to firm, rounded, movable breast mass in a young female patient should
be suspected to be cancer
d.
Early breast cancer is usually associated with palpable axillary lymph nodes
65. Accurate statement about the anatomy and development of the mammary gland:
a.
At birth, the female breast is distinctly more prominent and developed than the
male baby
b.
Acquired hypoplasia of the breast tissue can be due to trauma or infection
c.
Polythelia is not associated with abnormalities of other organ systems
d.
The upper inner quadrant has the greatest volume of breast tissue
66. Correct statement about the lymphatic drainage of the breast:
a.
The external mammary group (anterior or pectoral group) drains the majority
of lymph from the lateral quadrants
b.
There are more lymph nodes along the internal thoracic lymphatic route than
along the axillary lymphatic drainage pathway
c.
Level III axillary lymph nodes are those nodes located medial to the pectoralis
minor insertion tendon
d.
Fifty percent of lymph flow drains toward the axillary lymph nodes and the
other 50% into the internal mammary lymphatics
67. The breast lesion that has the least risk for degenerating into cancer is:
a.
Atypical ductal hyperplasia
b.
Ductal ectasia
c.
Sclerosing adenosis
d.
Lobular carcinoma in situ
68. Which of the following vital signs most closely represents a patient with closed head
trauma that results in loss of consciousness:
a.
Increased pulse, increased blood pressure
b.
Decreased pulse, increased blood pressure
c.
Increased pulse, decreased blood pressure
d.
Decreased pulse, decreased blood pressure
69. What would you consider the most appropriate immediate management of a patient
admitted with a flail chest, ventilatory failure and a Pa02 on air of 50 mmHg:
a.
Immediate tracheostomy
b.
Thoracic epidural anaesthesia
c.
Endotracheal intubation
d.
Nitrous oxide/oxygen mixture
70. The most common cause of diaphragmatic injury is:
a.
Iatrogenic
b.
A subphrenic inflammatory process
c.
Dehiscence of a surgical operation
d.
Blunt trauma
71. A patient is taken to the recovery area after an uncomplicated routine operation. 10
minutes later, it is noticed that she is cyanosed. Which one of the following is the most
appropriate first line of management:
a.
Summon the cardiac arrest team
b.
Carry out endotracheal intubation and ventilate the patient
c.
Establish a clear airway and ventilate the patient with a self-intubation bag and
mask
d.
Order a ventimask with 60% oxygen
72. Which one of the following conclusion from the accompanying arterial blood gas values
(in which gas tension are given in mmHg) is true:
a.
PaCO2 40, PaO2 98, pH 7.36 indicates right to left shunt
b.
PaCO2 60, PaO2 50, pH 7.30 indicates hypoventilation with compensation by
increased respiratory drive
c.
PaCO2 28, PaO2 50, pH 7.48 indicates pulmonary collapse
d.
None of the above
73. If an incidental appendiceal carcinoid is recognized during simple appendectomy, which
of the following statements is/are true:
a.
If the tumor is >2 cm in size, the mesoappendiceal lymph nodes are negative
and the resection margins are clear, no further surgical treatment is necessary
b.
Right hemicolectomy is routinely indicated regardless of nodal status
c.
Right hemicolectomy is indicated if tumor is present at the surgical margins or
if nodal involvement is present
d.
If mesoappendiceal lymph nodal metastases are present, surgical cure is
unlikely and chemotherapy should be initiated
74. Correct statements concerning acute ligature of blood vessels around the liver include the
following, EXCEPT:
a.
The common hepatic artery can be safely ligated
b.
Ligation of the left hepatic artery produces parenchymal necrosis
c.
Ligation of the portal vein must be accompanied by a portal systemic shunt
d.
Ligation of the inferior vena cava below the liver may or may not have a
serious sequelae
75. In the cirrhotic patient with refractory ascites, an appropriate operation is:
a.
Portacaval shunt (end-to-end)
b.
Disconnection operation
c.
Peritoneovenous shunt
d.
Ligation of the thoracic duct
76. Liver metastasis secondary to colon cancer:
a.
Almost always occurs within 6 months of the primary resection
b.
Usually causes facial flushing, dyspnea and diarrhea
c.
May result in 20% 5-year survival rates if resected
d.
Should be resected in most cases
77. The following may require splenectomy, EXCEPT:
a.
Hereditary spherocytosis
b.
Sickle cell disease (occasionally)
c.
Idiopathic autoimmune hemolytic anemia when steroids have proven
ineffective
d.
Hashimotos autoimmune disease
78. The following conditions require urgent thoracotomy, EXCEPT:
a.
Complete unilateral atelectasis with a larger air leak
b.
Penetrating diaphragmatic in jury
c.
Progressively widening mediastinum
d.
Persistent chest tube drainage of greater than 100 ml of blood per hour for 6
hours or more
79. A 50-year old construction worker has a chest x-ray because of chest pain and dysnea.
He is found to have a large pleural effusion. With his history of exposure to asbestos, a
malignant mesothelioma is suspected. The best way to establish a tissue diagnosis is:
a.
Bronchoscopy
b.
Needle biopsy of pleura
c.
Thoracentesis and cell cytology
d.
Thoracoscopy and biopsy
80. The following conditions contraindicate surgery in the presence of lung malignancy,
EXCEPT:
a.
Malignant pleural effusion
b.
Contralateral mediastinal lymph node involvement
c.
Extension of the tumor into the chest wall
d.
Distant metastases
81. Hoarseness is a clinical manifestation of lung cancer because of the extension of the
tumor to:
a.
Superior laryngeal nerve
b.
Phrenic nerve
c.
Recurrent laryngeal nerve
d.
Sympathetic ganglia
82. The most important step in the control of empyema is:

a.
Decortication of trapped underlying lung
b.
Obliteration of the empyema space
c.
Repeated antibiotics irrigation of the cavity
d.
Systemic therapy with the appropriate antibiotic
83. The most common benign tumor of the lung is:
a.
Fibroma
b.
Lipoma
c.
Papilloma
d.
Hamartoma
84. Conditions that usually are indication for coronary artery bypass surgery include all the
following, EXCEPT:
a.
Chronic angina of varying degree
b.
Unstable angina
c.
Complications of acute myocardial infarction
d.
Congestive heart failure
85. A premature infant is discovered at birth to have a patent ductus arteriosus with moderate
respiratory distress. The infant does not improve after 48 hours of medical management
with fluid restriction, diuretics and respiratory support. The next step in management is:
a.
Acetylsalicylic acid
b.
Indomethacin
c.
Surgical correction of the ductus
d.
Transvenous occlusion of the ductus
86. An asymptomatic 34-year old non-smoker patient is found to have a solitary pulmonary
nodule that is 2 cm in diameter. There is no evidence of the lesion on a chest x-ray taken
5 years previously. Tomography reveals a central core of calcium. The correct
management for this lesion should consist of:
a.
Periodic x-ray follow up
b.
Transbronchial biopsy
c.
Needle biopsy
d.
Thoracotomy and resection
87. Which of the following is the best predictor of a significantly increased operative risk for
coronary artery bypass surgery:
a.
Electrocardiography
b.
Left ventricular end-diastolic pressure
c.
Ventricular ejection fraction
d.
History of multiple myocardial infarcts
88. True statement about the anatomy of the gallbladder:
a.
The fundus is the narrowest part of the gallbladder
b.
The cystic artery which supplies the gallbladder is usually a branch of the left
hepatic artery
c.
The triangle of Calot is a useful landmark to locate the cystic artery
d.
The hepatoduodenal ligament is basically avascular
89. Correct statement about gallstone:

a.
Pigment gallstones are the most common type worldwide
b.
Cholesterol gallstones are more prevalent in Asian than in Western populations
c.
Cholesterol gallstones are formed if the relative concentration of cholesterol in
the bile is decreased in population to the concentration of bile salts and
phospolipids
d.
Pigment gallstones are formed solely because of biliary tract infection
90. Accurate statement about gallstone disease:
a.
All asymptomatics gallstones requires cholecystectomy to prevent
complications
b.
Acute cholecystitis is associated with cystic duct obstruction usually due to
gallstone impaction in the cystic duct or infundibulum
c.
Gallstone pancreatitis is caused by stones obstruction the second portion of the
duodenum
d.
Choledocholithiasis occur more commonly than cholecystolithiasis
91. True statement about the groin hernias:
a.
Direct inguinal hernias are much more common than indirect inguinal hernia
b.
The etiology of indirect inguinal hernia is closely related to the descent of the
testes
c.
Femoral hernias are indirect hernias occurring below the inguinal ligament
d.
The larger the hernia orifice or neck the greater the possibility of incarceration
92. The hernial sac of an indirect inguinal hernia is located:
a.
Antero-lateral to the spermatic cord
b.
Postero-lateral to the spermatic cord
c.
Antero-medial to the spermatic cord
d.
Postero-medial to the spermatic cord
93. Accurate statement regarding the diagnosis of groin hernias:
a.
Symptoms like groin discomfort are usually worse on waking up and gradually
subside at the end of the day
b.
Testicular pain is a common symptom of groin hernias
c.
Physical examination while the patient is standing up is usually sufficient to
palpate a groin hernias sac
d.
Hernias not detected on P.E. should undergo immediate inguinal exploration
94. A 30 years old man weighing 154 lbs. was admitted because of flame burns that occurred
2 hours earlier. P.E. showed painful blisters of the whole face and anterior neck area.
Painful blisters were noted at the whole anterior trunk, left anterior thigh, left anterior leg
and foot. A waxy white area amounting to about 1 palm size was seen at the left
anterolateral arm. Patient had singed nasal hair. Vital signs were BP = 130/70 PR -
105/min. RR- 24/min T 37.6C. The total body surface area burned is:
a.
41.5%
b.
36%
c.
32.5%
d.
28%
95. Using Parkland Formula, the estimated fluid required for the first 24 hours is:
a.
6,000 ml LRS
b.
8,960 ml LRS
c.
d.
9,100 ml LRS
11,760 ml LRS
96. Patients with Xeroderma Pigmentosa are prone to develop multiple skin malignancies
due to an endonuclease deficiency. This is:
a.
A sex linked recessive genetic defect
b.
A skin condition that is sensitive to UV radiation
c.
A defect in the over production of melanin
d. A defect in the target cells that easily mutate
97. Which of the following is not a factor in the increase in growth and linear extension for
Basal Cell Ca:
a.
Recurrent lesion
b.
Tumor size greater than 2cm
c.
Primary tumor located in the H zone
d.
Lowered immune status of the patient
98. A day after the burn injury, a patient with 30% burn injury was noted to be tachycardic,
BMR is twice normal and is in a state of hypermetabolism. This response is influenced
by which of the following hormone?
a.
Thyroxine
b.
Cathecholamines
c.
Glucagons
d.
Aldosterone
99. A 70 kg patient was brought to the ER was noted on examination to have 30 % major
burn injury to the body. How much fluid would you give in the first 8 hours of
resuscitation?
a.
1.5 liters
b.
2.3 liters
c.
4.2 liters
d.
8.4 liters
100. During fluid resuscitation, one means of assessing adequacy of resuscitation is by
measuring:
a.
Blood pressure
b.
Heart rate
c.
Respiratory rate
d.
Urine pH
Our Lady of Fatima University

Department of Surgery
CHOOSE THE BEST ANSWER.
C1. The most common organism associated with OPSI is:

A. Pseudomonas
C. Streptococcus pneumoniae
B. Hemophilus influenzae
D. Neisseria
meningitides
D2. The most common indication for surgery in Chronic pancreatitis is:
A. Endocrine insufficiency
C. Abscess formation
B. Exocrine insufficiency
D. Pain
A3. Criteria for resectability of Adenocarcinoma of the pancreas are the
following except:
A. Negative or equivocal FNAB prior to resection
C. Involvement
of distant lymph node
B. Involvement of major vascular structure
D. Involvement of the
liver
B4. The most common type of peritonitis is seen in:
A. Patients w/ renal failure undergoing dialysis
D. All of the
above
B. Patient with ruptured appendicitis
B C. Postoperative patients on broad spectrum antibiotics
C5.The ff. statements regarding movement & accumulation of peritoneal
fluid are true,
EXCEPT:
C A. Clearance of fluid & particulate matter within the peritoneal cavity
occurs via the diaphragmatic surface
D B. Movement of fluid within the peritoneal cavity is affected by gravity
E C. Fluid tends to collect in the subhepatic & subphrenic spaces in the
supine position only
F D. None of the above
B6. The best imaging modality in suspected cases of intra-abdominal
abscess:
A. Ultrasound
B. CT scan C. Plain abdominal X-ray
D. Laparoscopy
A7. Almost always heralds intraabdominal disease but might not indicate
the need for surgical therapy:
A.visceral pain
B. somatic pain C. parietal pain
D. well localized ,
sharp pain
C8. Hyperactive bowel sounds:
A. hypokalemia B.ileus
C. early small bowel obstruction
D. peritonitis
D9. Type of somatic stimulation resulting to pain:
A. stretching
B. distention
C. contraction
D. inflammation
B10. The manometric finding of non-peristalsis, low pressure or absent
esophageal contraction can be seen
A. Nut cracker esophagus
B. achalasia
C. Barett esophagus
D. none of the above
D11. Pre-malignant lesions developing into adeno CA of esophagus:
A. Achalasia
C. Reflux esophagitis
E. Tylosis
B. Leiomyoma
D. Baretts esophagus
D12. In caustic agent injury of the esophagus, the best diagnostic workup to evaluate the injury:
A. CT scan B. barium swallow
C. Chest X-ray D. esophagoscopy
E. ultrasound
B13. A condition being felt by a patient who underwent gastric surgery in
which after eating a high carbohydrate diet, severe colicky abdominal
pain follows:
A. Gastric stasis
C. Small capacity syndrome
E. none of
the above
B. Dumping synderomeD. Afferent loop syndrome
C14. Surgical procedure for peptic ulcer disease with the best result:
A. Truncal vagotomy with drainage procedure

D. Subtotal
gastrectomy
B. Parietal cell vagotomy without drainage procedure
E. Total
gastrectomy
C. Truncal vagotomy and antrectomy
B15. A condition with s/s of gastric outlet obstruction and the cause is a
conglomeration of undigestible materials:
A. Lymphoma B. Bezoar
C. Corrosive Gastirits
D. Gastric
Volulus
E. none
A16. The single best thyroid function test that can be used in the
diagnosis of hyperthyroidism is:
A. Serum TSH determination
C. Serum T3
B. Radioactive iodine uptake
D. Serum T4
A17. A practical and precise diagnostic screening procedure that can
differentiate between a benign from a malignant thyroid nodule is:
A. Fine needle aspiration cytology
C. Thyroid ultrasound
B. Radioactive iodine thyroid scan
D. Serum TSH
determination
D18. Immediate and potentially complication of thyroid surgery:
A. Hypocalcemia
C. Injury to the ansa
hypoglossi nerve
B. Injury of the recurrent laryngeal nerve
D. Bleeding
D19. The most common type of primary malignancy encountered in the
head and neck area is: A. Adenocarcinoma
C. Lymphoma
E. papillary carcinoma
B. Basal cell carcinoma
D. Squamous cell carcinoma
C20. In pt diagnosed with nasopharyngeal carcinoma, one of the following
statements is Not True:
A. Nasal stuffiness is a common complaint
E. none of the
above
B. Upper Jugular and posterior triangle group of nodes are usually
involved
C. Primary treatment is surgery
D. Radiation is the recommend treatment for locoregional disease
C21. A 6 y/o male presents with a 3 x 4 cm, non-hard, movable mass
located at the midline of the neck. History reveals the intermittent
episode of infection in the said mass which was also noted to elevate
upon tongue protrution. The most likely diagnosis is:
A. 2nd branchial cleft anomaly C. Thyroglossal duct cyst
E.
Lipoma
B. 3rd branchial cleft anomaly
D. Epidermal inclusion cyst
D22. Which of the following may be used to differentiate acute appendicitis from a
gynecologic pathology?
A. Laparoscopy
C. HBT Ultrasonography
E. B & C
B. Pregnancy test
D. A and B
B23. Most common presentation of appendiceal adenocarcinoma
A. Intestinal obstruction
B. Appendicitis
C. Presence of mass D. Anemia
B24. A 37 y/o female was brought to your clinic foe a fluctuant mass at the right lower
quadrant. On history taking, you elicited that she given a course of antibiotic therapy.
Most probably this patient has:
A. soft tissue abcess
B. phlegmon formation C. Chronic appendicits D.
Mucocoele
C25. Idiopathic retroperitoneal fibrosis
A. Nonsuppurative inflammation of fibroadipose tissue of unknown cause
B. Produce symptom of gradual compression of tubular structure in the

retroperitoneum
C. Both of the above
D. none of the above
A26. Most common malignant retroperitoneal tumor
A. sarcoma
B. squamous cell CA
C. adenocarcinoma D. lymphoma
D27. Superior and inferior mesenteric arteries are the arterial supply to entire intestinal
tract, EXCEPT:
A. stomach
B. duodenum
C. distal rectum
D. all of the
above
C28. Boundaries of the Hesselbachs triangle, EXCEPT:
A. inferior epigastric vessels
C. Rectus sheath
B. Inguinal ligament
D. External oblique m.
B29. Anatomically, hernias occuring within the Hesselbachs triangle is:
A. Indirect type
B. direct type
C. Femoral
D.
Incarcerated
D30. Anterior approaches to hernia repair, EXCEPT:
A. Bassinis
B. Shouldice
C. Lichtenstein
D. TAPP
C31. Usual location of tuberculous enteritis:
A. Duodenum
B. Jejunum
C. Ileum
D. Colon
B32. Most common location of duodenal diverticula:
A. superior part
B. descending part
C. horizontal part
D. ascending
part
C33. Blind loop syndrome:
A. steatorrhea
B. Vit B12 deficiency
C. Both
D. none
B34. A useful in determining the path of a tract in Fistula-in-ano
A. Bradoies Triad
B. Goodsalls rule
C. Charcots Triad
D. Rule of
thum
A35. Which paraclinica; exam will be most useful in the diagnosis of colorectal CA?
A. Colonoscopy
C. Barium swallow
B. Abdominal ultrasonography
D. Carcinoembryonic antigen
A36. Which of the following is true regarding familial adenomatous polyposis?
A. Polyps start to occur at a mean age of 16 y/o. Necessitating screening
colonoscopy at this age among relatives of patients with FAP.
B. Screening by using colonoscopy among relatives of patients with FAP is done at
35 y/o since almost all persons with this gene will exhibit adenoma by this time.
C. Genetic screening has no rule in the detection and control of FAP
D. Polypectomy is adequate in the treatment of the adenoma in FAP
C37. Lymph nodes medial to the medial border of pectoralis minor:
A. Level I
B. Level II
C. Level III
D. Level IV
A38. Liver metastasis is suspected when there is elevated:
A. Alkaline phosphatase
C. Prolactin Level
B. Carcino embryonic antigen
D. BUN and creatinine
D39. Contraindication of breast conservation Surgery:
A. Large tumor size 70.5 cm
B. Gross multifocal disease or diffuse malignant microcalcification
C. Retroareolar or nipple & cannot participate in needed follow-up
D. All of the above
D40. True regarding the incidence of Imperforate Anus:
A. more common in females

B. males have less complex
C. females tend to undergo colonostomy more than males
D. surgical management is more simple in females in most cases
A41. Clinical manifestation of Hirchsprungs Disease
A. Presentation is varied but most had delayed passage of meconium beyond the 1 st
24 hr
of life
B. Almost always presents as obstruction at birth
C. Majority of patients have delayed presentation
D. Should be the sole consideration when dealing with chronic constipation in older
children
C42. Intestinal Atresia, in contrast to Malrotation, presents with billous

vomiting associated with:
A. scaphoid abdomen
C. abdominal distention
B. upper abdominal fulness
D. thich blackish meconium
D43. The most common cause of esophageal perforation is:
A. tumor
B. swallowed objects
C. caustic injury D.
instrumentation
B44. Flail chest cause respiratory compromise because of:
A. rib fracture
B. pulmonary contusionC. pleural effusion
D. pneumothorax
D45. The most common cause of esophageal perforation is:
A. tumor
B. swallowed objects
C. caustic injury D.
instrumentation
B46. The normal prostate gland weighs about
A. 10 grams
b. 20 grams
c. 30 grams
d. 40 grams
A47. The classic triad of symptoms for renal cell cancer are the following
EXCEPT:
A. weight loss
b. flank pain
c.
gross
hematuria
d. abdominal mass
D48. A 23 y/o female has BP of 240/120. To diagnose of the hypertension
is renal origin, one should do:
a. KUB-IVP
b. Renal ultrasonography
c. CT Scan
d. Renal
arteriography
B49. A good color match is an important factor in skin grafting. The best donor site for
skin grafting of the face is:
A. antecubital area
B. supraclavicular area C. abdomen
D. groin
D50. A 40 y/o with 2nd degree flame burns involving the entire right upper
extremity, whole anterior trunk, perineal area and 50% of the left lower
extremity. Approximately what percentage of the total body surface is
burned?
A. 28%
B. 24%
C. 45%
D. 37%
B51. CT scan finding in a head injured man is a crescentic hyper dense
mass of the right
frontotemporoparietal area. His diagnosis is
A. acute epidural hematoma C. chronic subdural hematoma
E.
subarachnoid
B. acute subdural hematoma D. cerebral contusion
hemorrhage
C52. Epidural hematomas are located between the:
A. bone and the galea
C. bone and the dura E. scalp and the
bone
B. cerebral cortex and the dura
D. cortex and the ventricle
B53. Management of intracerebral hemorrhage include
A. antiplatelet and antihypertensive drugs
B. ventilatory support and tissue-dehydrating agents
C. ventilatory support and antiplatelet medication
D. antiplatelet medication and surgery
B54. A decrease in femoral neck shaft angle less than 130:
A. Fenu valgus
b. Coxa vara
c. Coxa valga
varum
D55. Maximum weight that can be used for skin traction:
A. 6-7 lbs.
b. 6-7 kgs.
c. 15-20 lbs
C56. A positive Trendelenbergs test is secondary to weakness of:
d.
Genu
d. 10 lbs.
A. Hip extensors B. Hip flexors

C. hip abductors D. hip
adductors
B57. Metabolic response to injury includes the following, EXCEPT:
A. increase in heart rate
C. increased BP E.
increased ketones
B. decrease in peripheral resistanceD. increased blood glucose
A58. Epithelialization stops when:
A. Like cells from each side comes in contact with each other
B. Platelets have formed a blood clot
D.
Contraction starts
C. Collagen have been deposited by the reparative process
C59. The total body fluid of a 70 kg female is:
A. 28,000 ml.
B. 42 Liters C. 35 liters
D. 40 liters
E. 35 45 liters
B60. Statement/s true about the metabolic changes in injured patients:
A.There is an obligatory decrease in energy expenditure and nitrogen
excretion
B.There is a rapid depletion of labile and functional energy stores.
C. There is a positive nitrogen balance
D. All of the
above
C61. Majority of body glycogen is stored in what tissue
A. Liver
B. Kidney
C. Skeletal muscle
D.
Subcutaneous tissue
D62. Principle/s of antibiotic prophylaxis therapy:
A.Choose antibiotic effective against the pathogens
B.Choose an antibiotic with low toxicity
C.Administer a second dose of antibiotic if the operation lasts longer
than 4 hours
D.All of the above
D63. Tidal volume that does not participate in gas exchange is called.
A. vital capacity
B. tidal vol.
C. minute vol.
D. dead space
B64. With regards to neoplastic disease in general, all of the following

statements are true,
EXCEPT:
A. Neoplasms are a population of cells that have undergone extensive
proliferation and
have escaped normal control mechanism.
B. By definition, all neoplasms are malignant tumors
C.Malignant neoplasms are those capable of local tissue invasion and metastatic
spread to
distant site
D. Benign neoplasms do not spread to distant site
D65. With regards to cell cycle the following statements are true, except:
A. Cell cycle has been analyzed by auto radiography
B. Cells synthesizing DNA are measured on their uptake of radioactive labeled
thymidine.
C. Knowledge of cell cycle is useful particularly in chemotherapy and

radiotherapy
D. Lag phase is always a period of inactivity or a period of rest
C66. Incidence of anastomotic leak and fistula is increase in the following:
EXCEPT
A. Poor surgical technique
C. Adequate decompression
of GIT
B. Distal obstruction
D. Malnutrition
B67. Which of the following topical anti-microbial agents can penetrate an

eschar?
A. Silver sulfadiazine C. Aqueous silver nitrate
E. None of the
above
B. Mafenide acetate D. Betadine
D68. In patients with a significant burn injury, the greatest loss of fluid
occurs in:
A. 1st 6 hours of injury
D. 1st 8 hours of injury
st
B. 1 24 hours of injury
E. 1st 12-24hours of injury
C. 1st 12 hours of injury
D69. Rabies travels in the human body through
A. Venous blood
C. Lymphatics
B. Intercellular spaces
D. Peripheral nerves
A70. Neoplasm with greatest malignant potential is
A. villous adenoma
B. leiomyoma C. Brunners gland D.
tubular adenoma
D71. 30 y/o female, pregnant manifesting with thyrotoxicosis,
management:
A. methimazole and betablocker
C. RAI
E. All of the
above
B. PTU
D. Antithyroid drug for 1 month
then surgery
C72. This serves as a border, separating carcinoma in situ and invasive
carcinoma of
the breast:
A. Linign epithelium
C. Basement
membrane
B. Lamina propia
D. None of the above
E73. A condition wherein a calculi becomes impacted in cystic duct or neck
of gallbladder
producing white bile:
the
A. Choledochal cyst
C. Primary sclerosing cholangitis
E. Hydrops of
B. Choledocholithiasis D. Biliary fistula

gallbladder
B74. Composed of tissues normally present in the liver but arranged in a
disorderly fashion:
A. Focal nodular hyperplasia
C. Hepatic adenoma
E.
None of the above
B. Mesenchymal hamartomas D. Hepatocellular adenoma
B75. Terminal branch of the vagus nerve that has important role in the
etiology of recurrent
ulcer:
Crows foot
C. Zollinger Ellison
B. Criminal nerve of Grassi
D. Nerve of laterjet
B76. A 45 y/o male patients with gastric outlet obstruction 2 to chronic
duodenal
ulcer complaining of protected vomiting will most likely develop:
A. Hyperkalemic hyperchlorhydric alkalosis
B. Hypokalemic hypochlorhydric alkalosis
C. Hypokalemia metabolic acidosis
D. Hyperkalemic metabolic acidosis
B77. The following are physical signs of severe peritonitis, except
A. Hypertension
C. Absent bowel sound
B. Tachypnia
D. Involuntary muscle
guarding
C78. Gland infected in hidradenitis suppurativa is:
Sweat
A. Sebaceous
B. Mucus secreting
C. Apocrine
D.
D79. Elective Surgery is contraindicated in patients with

A. Elevated serum creatinine D. History of Myocardial Infarction
4 weeks ago
B. Atrial fibrillation
E. History of stroke 6 months
ago
C. COPD
C80. The most common female inguinal hernia is
A. Femoral hernia
B. Direct inguinal
C. Indirect
inguinal
D. Spigelian
D81. Which of the following systemic collagen diseases most frequently
involves the esophagus?
A. Periarteritis nodosa
C. lupus erythematosus
B. Rheumatoid arthritis
D. scleroderma E. erythema
multiforme
C82. Neoplasm that mimics PUD is:
A. villous adenoma
B. leiomyoma
C. Brunners
gland
D. true adenoma
A83. Treatment for the first episode of uncomplicated diverticulitis is
A. liquid diet and antibiotics
C. resection with
primary anastomosis
B. colostomy
D. explore lap and
drainage
C84. Tumor marker for colonic carcinoma is:
A. AFP
B. calcitonin
C. CEA
D. CA19-9
D85. Landmark used in identifying main trunk of facial nerve, except:
A. Posterior belly of digastric muscle
C. External acoustic cartilage
E. None
B. Stylomastoid process
D. Masseter
of
the above
C86. Considered as 1st echelon node in thyroid tumors, EXCEPT:
A. Pre-laryngeal
C. Upper jugular
E. None of the
above
B. Para-tracheal
D. Pre-tracheal
C87. The most common clinical presentation of hyperparathyroidism:
A. fracture
C. Nephrolithiasis
E.
Dehydration
B. Bone pain
D. Gastric ulcer
C88. The most common cause of a bloody nipple discharge:
A. Pagets disease of the breast
C. Intraductal
papilloma
B. Adenoma of the nipple
D. Invasive ductal
carcinoma
C89. This serves as a border, separating carcinoma in situ and invasive
carcinoma of the breast:
A. Linign epithelium
C. Basement membrane
B. Lamina propia
D90. If this LN is positive for malignant cell, the breast lesion is stage
IIIB.
A. Rotters node
B. Central LN
C. Apical LN
D. Internal mammary LN
D91. This benign lesion can degenerate into a malignant lesion:
A. Fibrocystic disease of the breast
C. Fibroadenoma
B. Galactocoele
C92. This/These can differentiate benign from malignant phyllodes tumor:
A. Size of the tumor
C. > 3 mitotic figure / HPF
B. Consistency of the lesion
D. All of the above
C93. Breast malignancy with several lymphatic follicles near cancer cells:
A. Pagets disease of the breast
C. Medullary CA of the
breast
B. Colloid carcinoma
D. Schirrous Ca of the
breast
D94. The criteria for diagnosis of Primary Sclerosing Cholangitis are the
following, EXCEPT:
A. No evidence of primary liver disease
D. Presence
of choledocholithiasis
B. Stenosis of a major portion of biliary duct system
E. None of
the above
C. Absence of history of congenital anomalies
C95. The Courvoiseir law described the gallbladder in the following
condition:
A. Gallbladder is distended due to cholecystitis
E. None of the
above
B. Gallbladder is palpable due to cholithiasis
C. Gallbladder is not distended due to inflammation
D. Gallbladder is not distended due to neoplasia
C96. A complication of cholecystitis which result in enteric fistula
revealing air in the biliary tree:
A. Emphysematous cholecystitis
C. Gallstone ileus
E.
None of
B. Gangrenous cholecystitis
D. Perforated cholecystitis
the above
B97. All are true regarding DM from Chronic pancreatitis except:
A. Oral hypoglycemics are the first choice of treatment
B. Mild elevation does not require treatment
C. Ketoacidosis is rare
D. May developed to a profound hypoglycemia even with small
amounts of insulin
C98. A 70 y/o male was seen in the ER because of severe abdominal pain
of > 24 hrs. History revealed chronic intake of NSAID due to
osteoarthritis. He is tachycardic, tachypneic & febrile. PE revealed diffuse
tenderness & rigidity of the abdomen. If you were entertaining peritonitis,
the most likely cause is:
A. Ruptured appendicitis
B. Acute gastroenteritis
C. Perforated duodenal ulcer
D. Perforated diverticulitis
C99. Three months after accidental ingestion of muriatic acid, 30 y/o

Female consults for dysphagia. Barium swallow shows a 10 cm structured
segment of distal thoracic esophagus and normal looking stomach. What
is the preferred treatment for this patient?
A. Esophageal dilatation
D. Esophagectomy with
colonic interposition
B. Gastric pull-up
E. None of the above
C. Esophagectomy with gastric pull-up
D100. The venous drainage of the stomach in the lesser curvature near
the cardia is:
A. Left gastric
B. coronary veinC. Right Gastric D. A & B
E. B
&C
References:
1. Principles of Surgery by Schwarts

2. Textbook of Surgery by Sabiston
3. Textbook of Pediatric Surgery by Rowe, latest edition Vol 1 & 2
4. Urology Textbook by Smith
5. Plastic Reconstructive Surgery Book by Mc Carthy
6. Neurological Surgery by Yeomas

7. Neuro Surgery by Williams
8. Shands Handbook of Orthopedic Surgery
9. Surgery of the Chest by Sabistan & Spencer
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:
0.7
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:
SHIRES 7TH EDITION, Vol. 1, pp. 657
MPL:
0.6
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:
SHIRES 7TH EDITION, Vol. 1, pp.1116
MPL:
0.4
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:
0.6
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:
0.6
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:
0.6
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:
SHIRES 7TH EDITION, Vol. 1, 521-522
MPL:
0.6
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:
SHIRES 7TH EDITION, Vol. 1, 522
MPL:
0.5
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:
0.5
18.
What would be the best management for case no.17?
a. Observation w/ IV antibiotics c. Barium enema
b. Colonoscopy
c. Barium enema
d. Exploratory Laparotomy
Answer:
D
Reference:
MPL:
0.6
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:
0.4
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:
0.4
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:
0.7
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:
0.6
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:
0.7
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:
0.5
27.
What is the common mode of spread of colorectal cancer?

a. direct extension
b. hemotogenosis
c. lymphatic
d. implantation
Answer:
C
Reference:
MPL:
0.5
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:
0.5
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:
0.5
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:
0.5
Subject:
Instructions:
General Surgery III

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:
0.6
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:
Principles of Surgery, Schwartz 6th Edition, pp.
1475
MPL:
0.7
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:
0.5
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:
1134-1137
MPL:
0.6
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:
Reference:
1138
MPL:
B
Principles of Surgery, Schwartz 6th Edition, pp. 11370.6
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:
1137-1138
MPL:
0.5
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:
1134
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:
1134-1135
MPL:
0.4
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:
1134-1135
MPL:
0.6
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:
1134-1135
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:
Reference:
MPL:
D
Principles of Surgery, Schwartz 6th Edition, pp. 1421-1425
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:
1382-1383
MPL:
0.4
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:
Reference:
675
MPL:
A
Principles of Surgery, Schwartz 6th Edition, pp. 6740.6
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:
675
MPL:
0.5
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:
0.6
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:
674-675
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:
1766-1768
MPL:
0.5
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:
675-676
MPL:
0.6
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:
176
MPL:
0.6
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
over 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
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:
0.6
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:
0.6
Subject:
Instructions:
Orthopedic Surgery
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
MPL:
0.5
62.
A reverse Colles fracture is called

a. Bartons fracture
c. Frykmanns fracture
b. Smiths fracture
d. Pouteaus fracture
Answer:
B
Reference:
Rockwood and Greens Fractures in Adults, Vol
1, pp. 770
MPL:
0.5
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:
Rockwood and Greens Fractures in Adults, Vol 1, pp.
309
MPL:
0.6
64.
The antibiotics of choice for the treatment of open fractures:

a. Penicillin
c. Cephalosporins
b. Streptomycin
d. Aminoglycosides
Answer:
C
Reference:
Rockwood and Greens Fractures in Adults, Vol 1, pp.
347
MPL:
0.6
65.
The distal carpal row is formed by the following bones except:

a. Triquetrum
c. Trapezium
b. Capitate
d. Hamate
Answer:
A
Reference:
1, pp. 750
MPL:
Rockwood and Greens Fractures in Adults, Vol

0.5
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
MPL:
0.6
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:
Physical examination of the Spine and Extremities by
Hoppenfeld, pp. 164
MPL:
0.5
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:
Physical examination of the Spine and
Extremities by Hoppenfeld, pp. 165
MPL:
0.6
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:
0.5
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:
Instructions:
Thoracic Cardio Vascular Surgery

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
MPL:
0.5
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:
0.7
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:
0.6
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:
Reference:
MPL:
D
0.4
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:
Instructions:
Urology
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
MPL:
0.5
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:
Reference:
MPL:
D
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:
Reference:
pp. 129
MPL:
A
Lieberkind, A.L. et al. Neuroradiology, chap. 5
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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