General Surgery

1. The following statements regarding primary ca of the tongue is true except:

A. Most primary mesenchymal tunors are leiomyomas, leiomyosarcomas
and rhabdomyosarcomas
B. Involvement of the lingual nerve causes deviation of the tongue to the
contralateral side
C. Commonly affects the lateral and ventral part of the tongue
D. Commonly involve the submandibular and upper cervical nodes
2. Which of the following is also removed when resecting a thyroglossal duct
cyst?
A. Hyoid bone
B. Cricoid cartilage
C. Thyroid cartilage
D. Superior laryngeal cartilage
3. Which of the following is an indication for tonsillectomy in children?
A. At least 5 infections in a year
B. At least 1 week of missed school
C. >3 infections in one year
D. Sleep apnea
4. Type of temporal bone fracture with high incidence of facial nerve injury?
A. Open
B. Longitudinal
C. Comminuted
D. Transverse
5. Which of the following statements regarding recurrent respiratory
papillomatosis is true?
A. Usually due to subtypes 5 and 11
B. Most cases appear during early childhood
C. Can be cured by intralesional injection of cidofovir
D. Manifestation is more severe in adult onset
6. The type of parotid tumor with propensity for neural invasion
A. Adenoid cystic carcinoma
B. Wharton’s tumor
C. Mucoepidormoid carcinoma
D. Pleomorphic adenoma
7. A 45 year old man complained of 4cm fixed hard mass on the anterior border
of the left sternocleidomastoid muscle. CT scan and endoscopic examinations
failed to localize the primary lesion. FNAB showed squamous cell ca, MRI of
the mass showed spread to the sternocleidomastoic muscle. Best option is to
A. Radiotherapy and chemotherapy only
B. Type 1 modified radical neck dissection plus radiotherapy
C. Lateral neck dissection plus radiotherapy
D. Supraomohyoid neck dissection
8. A 60 year old male complained of hoarseness and dysphagia. Fiberoptic
flexible laryngoscopy showed a 3 cm mass on the glottis extending toward
 the arytenoid cartilage. The vocal cord is fixed. Biopsy of the mass showed
squamous cell ca. Multiple lymph nodes are palpable along the midcervical
area. Best treatment is to
A. Partial laryngectomy plus modifined radical neck dissection
B. Radiotherapy
C. Total laryngectomy plus modified radical neck dissection
D. Radiotherapy plus chemotherapy
9. A 50 year old female was diagnosed to have squamous cell ca affecting more
than one third of the lower lip. The common lymphatic spread of malignancy
in this location is
A. Level VI
B. Level I
C. Level V
D. Level 3
10. Recommended treatment for the preceding case is
A. Wide excision plus chemotherapy
B. Wide excision and primary closure
C. Wide excision plus modified neck dissection
D. Wide excision plus Burrow’s flap
11. A 45 year old male with BMI of 35 has been snoring terribly and experiences
day time somnolence. He was diagnosed with Obstructive Sleep Apnea. His
polysomnogram must be
A. >15 episodes of apnea per 12 hours of sleep
B. 10 episodes of apnea per week
C. 10 episodes of apnea per hour of sleep
D. 10 episodes of apnea every night
12. Which of the following treatment most suitable for the patient of the
preceding number?
A. Use of airway appliance and weight reduction
B. Eeight reduction
C. Tonsillectomy
D. Uvulopalatoplasty
13. A 48 year old man was mobbed by a group of men for no apparent reason, he
loss consciousness and was brought to a hospital. CT Scan of the skull
showed separation of the maxilla, nasal bones, zygomas. What type of
midface fracture did the patient have?
A. Le Fort I
B. Le Fort II
C. Le Fort III
D. Le Fort IV
14. The recommended treatment for the above case is
A. Craniotomy
B. Open reduction and internal fixation with miniplates and microplates
C. Closed reduction and internal maxiallry fixation
D. Mannitol through IV
15. A 12 year old boy was brought to the clinic complaining of weakness of the
left side of the face, vertigo and otorrhea. Endoscopic examination showed
hemotympany. 4 days before consultation, a flat iron accidentally fell on the
patients head. CT scan showed transverse fracture of the left temporal bone.
What will you do?
A. Elevate the depressed fracture of the temporal bone
B. Immediate decompression of the facial nerve
C. Drain the hemotympanum ASAP
D. Treat the patient conservatively
16. The most common site of neural spread of malignant parotid gland tumor is
A. Intraperiglandular nodes
B. Level 1 nodes
C. Level 4 nodes
D. Level 2 nodes
17. The following statements regarding salivary gland tumors is correct except:
A. They are rare
B. They are slow growing tumors
C. MRI will differentiate malignant from benign tumors
D. Most are benign tumors
18. A 56 year old male who is being treated from chronic sinusitis complained of
numbness of the face and diplopia. MRI showed a tumor above the Ohngren’s
line. The following statement regarding this patient is true except:
A. Most likely the mass is squamous cell ca
B. The mass is slow growing
C. Treatment is complete maxillectomy with conservative radiotherapy?
D. Regional metastasis is common
19. Numbness of the face and diplopia experienced by the patient on the
preceding number is due to the involvement of
A. Facial and trochlear nerve
B. Mandibular branch of of V nerve and IV nerve
C. Maxillary branch of V nerve and VI nerve
D. Maxillary branch of V nerve and IV nerve
20. Selective neck dissection used in the thyroid gland malignancies
A. Type 3 modified radical neck dissection
B. Lateral neck dissection
C. Anterior compartment neck dissection
D. Radical neck dissection
21. Truncal vagotomy and antrectomy when properly performed will be able to
reduce acid bulk by
A. 50%
B. 65%
C. 85%
D. 90%
E. 100%
22. The main reason for the development of stress ulcer is
A. NSAID use
 B. H.Pylori Infection
C. Decrease mucosal blood flow
D. Decrease bicarbonate production
E. All
23. Cholelithiasis is a complication of what gastric procedure
A. Truncal vagotomy
B. PGV
C. Antrectomy
D. Total gastrectomy
E. Pyloroplasty
24. The earliest sign and symptom of gastic cancer is
A. Satiety
B. Pain
C. Weight loss
D. Bloatedness
E. None
25. A 38 year old male was diagnosed to have PUD via endoscopy. He is positive
for H. Pylori infection. What would be the treatment for this patient?
A. PPI + Clarythromycin 500mg bid for 10 days
B. PPI + Amoxicillin 1000mg bid + clarithromycin 500 mg bid for 14
days
C. PPI + Amoxicillin 1000mg tid for 10 days
D. PPI + Clarithromycin 1000mg bid + amoxicillin 500mg bid for 14 days
E. PPI + metronidazole 500mg bid + Clarithromycin 500mg for 14 days
26. Which of the following tests for Helicobacter pylori has become the standard
test to confirm eradication of H. Pylori following treatment
A. Histologic examination of the antral mucosa
B. Urea breath test
C. Fecal antigen test
D. Serologic test
E. Rapid urease test
27. Regarding the peptic ulcer disease (PUD) which of the following statements
is/are TRUE
A. Perforation is the most common complication of peptic ulcer
B. Gastric outlet obstruction is the most common indication for surgery
in a patient with PUD
C. Type III gastric ulcers tend to have low acid secretion
D. The recurrence rate for duodenal ulcer after Helicobacter pylori
eradication is less than 20%
E. A perforated duodenal ulcer results in a higher mortality rate than
perforated gastric ulcer
28. A 38 year old male was found to have a submucosal gastric lesion. Mutation
of what gene is most commonly associated with this lesion
A. P53
B. RET
C. C-kit
 D. BRCA 1
29. Which of the following statements is/are true regarding duodenal ulcers
(DU)
A. Patients who are in shock or are medically unstable should have a
gastric resection right away
B. Bleeding DU usually has eroded into the gastroduodenal artery
C. All bleeding DUs will require surgical intervention
D. Severe abdominal pain associated with rigidity is typical of bleeding
DUs
E. All of the above
30. The following are known complication of peptic ulcer surgery EXCEPT ONE:
A. Duodenal stump blowout
B. Dumping
C. Diarrhea
D. Delayed gastric emptying
E. Steatorrhea
31. In patients with bleeding duodenal ulcers, the endoscopic finding that is
associated with the highest incidence of rebleeding is
A. Cherry red spot
B. Visible vessels
C. Clean ulcer bed
D. Duodenitis
E. Shallow ulcer measuring 3 cm
32. Which of the following therapeutic measures is/are effective in preventing
the occurrence of stress gastritis bleeding in critically ill patients
A. Improving systemic circulation by correcting hypotension brought
about by sepsis or blood loss
B. Correcting systemic acid-abase imbalance
C. Reducing intragastric acidity by H@ antagonists and proton pump
inhibitors (PPI)
D. All of the above
33. What is the common cause of gastric outlet obstruction in adults
A. Peptic ulcer disease
B. Cancer
C. Extrinsic neoplastic compression
D. Primary lymphoma of stomach
34. Most common premalignant condition of the stomach is
A. Polyps
B. Atrophic gastritis
C. Intestinal metaplasia
D. Benign gastric ulcer
E. Gastric remnant cancer
35. True statements concerning gastric outlet obstruction EXCEPT
A. It may be acute or chronic
B. Pateints typically present with nonbilous vomiting
 C. Profound hypokalemic hyperchloremic alkalosis may be seen with
protracted vomiting
D. A succusion splash may be audible with stethoscope placed in the
epigastrium
E. Cancer must be ruled out because most patients with symptoms of
gastric outlet obstruction will have a pancreatic gastric or duodenal
malignancy
36-40 Matching type: Match the gastric lesion with its corresponding clinical
features

A. Bezoars B. Dieulafoy lesion C. Mallory-Weiss Syndrome D. Menetrier

Disease E. Watermelon Stomach Syndrome

36. Intraoperatively pulsatile bleeding may be seen from what appears to be a

normal gastric mucosa
37. Hypertrophic gastropathy
38. Concretions of indigestible matter accumulates in the stomach
39. Longitudinal tear at the mucosal GE junction on endoscopy
40. Associated with portal hypertension or autoimmune connective tissue
disorder

Multiple Choice

41. A 35 year old man presented with a history of alcoholism. He had

excruciating pain in the precordium followed by vomiting. Which of the
following conditions is most likely the diagnosis
A. Mallory Weiss syndrome
B. Boerheave syndrome
C. Zollinger Ellison syndrome
D. Esophageal cancer with fistula
42. True statements regarding esophageal perforation, EXCEPT
A. It most commonly occurs following diagnostic or therapeutic
procedures
B. A chest radiograph can be reliable in making the correct diagnosis
C. Mediastinal emphysema is a strong indicator of perforation
D. The most common location of iatrogenic injury is at the left lateral
wall of the esophagus just above the GE junction
E. Primary closure of the perforation within 24 hours results in 80-90%
survival
43. The following statement are true regarding leiomyomas of the esophagus
EXCEPT
A. Average age at presentation is 38
B. Most are located in the lower two-thirds of the esophagus
C. Bleeding is the most common presentation
D. A barium swallow is the most useful study
E. They should be removed unless there are specific contraindications
44. When all factors are considered, the order of preference for an esophageal
substitute fpr caustic injury into the esophagus is
A. Stomach, colon, jejenum
B. Colon, stomach, jejenum
C. Stomach, jejenum, colon
D. Colon, jejenum, stomach
E. Jejenum, colon, stomach
45. Which of the following will indicate the need for surgical intervention in a
patient with esophageal stricture
A. Complete stenosis in which all attempts from above or below fail to
establish a lumen
B. Marked irregularity and pocketing on barium swallow
C. Development of mediastinatis with dilatation
D. Presence of fistula
E. All of the above
46. A normal esophageal lumen should be around
A. 80 mm
B. 50 mm
C. 30 mm
D. 20 mm
E. 15 mm
47. Which of the following medical therapies for Gastroesophageal reflux disease
(GERD) has been found to be the most effective
A. Lifetime modifications/antacids
B. H2 receptor antagonists
C. Single dose Proton Pump Inhibitors (PPI)
D. Increased dose PPI
E. None of the above would be effective
48. Which of the following is NOT a typical clinical manifestation of GERD
A. Long standing history of heartburn
B. Caustic or stinging sensation confined to the epigastric and
retrosternal areas
C. It does not radiate to the back
D. Some patient will be unable to bend without experiencing the
unpleasant event
E. Regurgitation of undigested food
49. When the esophageal mucosa has taken a “Cobblestone” appearance, the
degree of esophagitis is considered as
A. Grade I esophagitis
B. Grade II esophagitis
C. Grade III esophagitis
D. Grace IV esophagitis
E. Any of the above
50. Which of the following statements is NOT TRUE regarding structural
evaluation of the esophagus
 A. The full column technique can detect extrinsic lesions by virtue of
displacement
B. The full column technique can reliably show small of superficial
mucosal abnormalities
C. The best means of demonstrating esophageal varices radiographically
is with the use of mucosal relief technique
D. One limitation of the double contrast technique is that the patient
must be able to cooperate and stand unaided
E. Normal esophageal mucosal thickness is about 1-2mm thick in a
completely collapsed esophagus
51. The esophageal hiatus is at the level of
A. T8
B. T12
C. T10
D. T6
E. T4
52. This surgical procedure for esophageal cancer entails limited exposure of the
intrathoracic esophagus and its blood supply and risk of hemorrhage. Two
incisions are made in the cervical area and in the upper abdominal midline
A. Ivor-Lewis procedure
B. Orringer technique
C. Left lateral thoracoabdominal esophagectomy
D. Laryngopharyngesophagectomy
E. None of the above
53. True statement concerning malignant tumors of the esophagus EXCEPT
A. Alcohol consumption and cigarette smoking seem to be the most
consistent risk factor
B. 95% of all esophageal cancers is squamous cell cancer
C. Patients with Barret’s metaplasia are 40 times more likely to develop
squamous cell CA
D. Adenocarcinoma often occur in the distal third of the esophagus
E. Both adenocarcinoma and squamous cell carcinoma has male
predilection
54. A partial fundoplication procedure defined as a 180 degree anterior wrap
which is anchored to the right hiatal pillar in the esophagus
A. Nissen
B. Belsey
C. Hill
D. Allison
E. Dor
55. Factors associated with increases risk of squamous cell carcinoma of the
esophagus EXCEPT
A. Achalasia
B. Barret’s esophagus
C. Corrosive stricture
D. Upper esophageal web
 E. Nitrosamine
56. Criteria for nonoperative management of esophageal perforation EXCEPT
A. Perforation is contained within the mediastinum and drains well back
into the esophagus as seen in barium swallow
B. Symptoms are mild
C. Minimal evidence of clinical sepsis
D. Free perforation into the pleural space
E. None of the above
57. CASE: A 60 year old man came in with complaint of progressive dysphagia,
halitosis and regurgitation of undigested food. Barium esophagogram
showed a diverticulum at the level of the cricothyroid cartilage. Which of the
following is NOT TRUE regarding this disease?
A. It is a false diverticulum
B. It is more commonly seen on the left side of the esophagus
C. It is the most common esophageal diverticulum
D. It is a traction diverticulum
E. It occurs in the Killian triangle
58. CASE: A 28 year old female came in at the emergency room after ingesting lye
alkali in a suicide attempt. Which of these following statements is TRUE?
A. The substance ingested can cause coagulative necrosis
B. Endoscopy should not be performed in the first 72 hours to avoid the
risk of perforation
C. The lye can be neutralized by giving milk or egg whites if the patient is
seen within first hour of ingestion
D. Dilations should be performed before re-epithelialization to decrease
long term stricture rate
E. For long segment interposition of graft, the colon is the preferred
conduit
59. CASE: A 45 year old man has had difficulty swallowing for 2 years and
frequently regurgitates undigested food at night. The barium swallow
showed dilatation of the proximal esophagus and tapered narrowing of the
distal esophagus in normal appearing mucosa. Which of the following is
likely to be present in this patient
A. Barret’s esophagus
B. Reflux of gastric contents
C. Carcinoma of the distal esophagus
D. Stricture of the gastroesophageal junction
E. Absent primary peristalsis
60. Traction diverticula EXCEPT:
A. Acquired
B. Result of granulomatous disease or TB
C. Midesophageal diverticula
D. Surgical treatment is most often needed
E. Predominantly in adults
61. In a 30 year old female with 3cm thyroid nodular without obvious signs of
hyperparathyroidism, the first diagnostic examination should be
 A. T3 T4 determination
B. TSA determination
C. T99
D. Thyroid ultrasounds
E. Fine needle aspiration
62. A 50 year old male present with a 6 cm dominant nodule with a background
of multinodular goiter. FNAB showed colloid goiter. The appropriate
treatment is
A. Iodine solution
B. Anti-thyroid drugs
C. TSH suppression
D. Radioactive iodine
E. Thyroidectomy
63. A 40 year old female presented with a 4cm hard left anterior neck mass with
deglutition. There are no palpable nodes in both sides of the neck. Which of
the following procedures could determine the extent of the surgery
A. CT scan of the neck
B. FNAB
C. Ultrasound
D. Thyroid scan
E. Thyroglobulin level
64. Twelve hours bilateral subtotal thyroidectomy, a 40 year old female
complains of circumoral numbness and tingling sensation. Management
should be
A. Calcium lactate per orm
B. Calcium gluconate
C. Calcium lactate IV plus Vitamin D
D. Vitamin D 50,000 units once a day
E. Draw serum ionized calcium and observe
65. A 35 year old female underwent lobectomy for a 3cm nodule on the left.
Frozen section showed follicular Ca. Which of the following additional
modalities are appropriate in this situation?
A. Performance of near or total thyroidectomy
B. Do neck dissection on involved side
C. TSH suppression postoperatively
D. A & C
E. A, B & C
66. A 25 year old female presented with an anterior neck mass of 2 years. PE
showed a 3x3 cm non hard, solid mass more on the right, that moves with
deglutition. No other complaints. Diagnostic procedure for this patient is?
A. FNAC of the mass
B. Ultrasound studies
C. Thyroid scan
D. Serum T3 and T4
67. Biopsy of the mass in the previous question indicate that it is a malignant
thyroid nodule. The most likely histologic type is?
 A. Papillary thyroid carcinoma
B. Follicular thyroid carcinoma
C. Medullary thyroid carcinoma
D. Anaplastic thyroid carcinoma
E. None of the above
68. On further work up, the patient above was noted to have multiple pulmonary
metastasis. What is the stage of the disease of this patient?
A. Stage I
B. Stage II
C. Stage III
D. Stage IV
69. Advantage of thyroidectomy in Grave’s Disease except:
A. Immediate response and reversal of compression symptoms
B. Indicated in patient with “cold” nodules
C. Effective against toxic multinodular goiters
D. Less risk of hypothyroidism
E. None of the above
70. Indications for thyroid ultrasound, except:
A. If there is overt or subclinical hyperthyroidism
B. Elevated TSH
C. Palpable nodule
D. Detect change in size of thyroid nodule
E. None of the above
71. Indications for calcium supplementation after thyroid or parathyroid surgery
except:
A. Anxiety
B. Circumoral paresthesias
C. (+) Chovstek or Trousseau’s sign
D. Serum calcium < than 7.1 mg/dL
E. None of the above
72. A 35 year old female with a 3.0 cm solitary right thyroid nodule was
diagnosed with metastatic follicular thyroid cancer. The appropriate
management would be?
A. Right thyroid lobectomy plus isthmusectomy
B. Near total thyroidectomy
C. Total thyroidectomy
D. Radioactive iodine
E. TSH supression
73. A 45 year old female patient presents with a 3x3 cm anterior neck mass.
Examination reveals free moveable non tender at the right neck that moves
with deglutition. No palpable masses were noted in the lateral neck. A soft
non tender mass is noted in the parietal area. Skull xray showed lytic lesion
on right parietal area. Most likely diagnosis?
A. Papillary carcinoma
B. Follicular carcinoma
C. Lymphoma
 D. Medullary carcinoma
E. Anaplastic carcinoma
74. Negative prognostic variable for papillary thyroid carcinoma except:
A. Age of <45 years
B. Extrathyroid capsular extension
C. High grade tumor
D. Vascular/Lymphatic tumor invasion
75. A 36 y/o teacher underwent thyroidectomy for multinodular non-toxic
goiter. Postoperatively she experiences voice fatigue and hoarseness. The
most probable cause is:
A. Hypothyroidism
B. Hypocalcemic teatny
C. Wound hematoma
D. Injury to the superior laryngeal nerve
E. Unilateral injury to the recurrent laryngeal nerve
76. Characteristics of papillary thyroid CA include the following except:
A. High likelihood of multicentric disease
B. Most commonly associated with radiation exposure
C. Mortality is caused primarily by metastatic disease
D. Slow growing tumor
E. Well differentiated tumor
77. Biochemical features characteristic of primary hyperparathyroidism include
the following except
A. Elevated serum calcium
B. Elevated PTH level
C. Increased phosphate level
D. Elevated serum chloride
E. None of the above
78. Which of the following clinical situations is thyroidectomy not indicated
A. Papillary thyroid cancer
B. Follicular thyroid cancer
C. Medullary thyroid cancer
D. Anaplastic thyroid cancer
E. Follicular variant of papillary thyroid cancer
79. Indications for I-131 ablation for thyroid CA except:
A. Inoperable cancer
B. Recurrent thyroid CA
C. Invasion of thyroid capsule
D. Distant metastasis
E. None of the above
80. 60-year old man has a 4cm right thyroid nodule. Fine needle aspiration
(FNA) of the nodule is interpreted as papillary cancer. No lymph nodes are
palpable. Management of this patient should include all of the following
except:
A. Total thyroidectomy
B. Radioactive iodine ablation
 C. Suppressive thyroxine
D. Modified radical neck dissection
E. Serum thyroglobulin monitoring
81. A 30 year old male who usually has dripping fresh blood after defecation
suddenly had anal pain, and a smooth, tender 1 cm diameter rounded mass
coming out of the anus. This is most likely:
A. Anal wart
B. 3rd degree internal hemorrhoid
C. Perianal abscess
D. Thrombosed internal hemorrhoids
E. Anal fissure
82. Which of the following is the most effective treatment for chronic anal
fissure?
A. Glycoglycerine ointment
B. Fissurectomy
C. Lateral anal sphinctorectomy
D. Botulinum toxin injection
E. Ointment
83. A 54 year old male has been complaining of hypogastric pain for 6 months.
For almost 3 weeks prior to consult, he had noticed passage of air during
micturition. Most common cause of the above condition is?
A. Carcinoma of the bladder
B. Carcinoma of the sigmoid colon
C. Diverticulitis
D. TB of the urinary tract
E. SBO
84. A 70 year old male presents with history of melena. He is hemodynamically
stable. Upper GI endoscopy and rigid protoscopy did not identify the source
of bleeding. Protoscopy shows melena. The appropriate diagnostic study
should be:
A. Colonoscopy
B. Capsule endoscopy
C. Catheter angiography
D. CT angiography
E. Radionuclide imaging
85. Most common type of fistula in ano
A. Intersphincteric
B. Extrasphincteric
C. Supralevator
D. Suprasphincteric
E. Transphincteric
86. A 19 year old student present to the emergency with bright red blood per
rectum. He is otherwise in good health, takes no medication. He had the
similar episode over a year ago and underwent a diagnostic colonoscopy and
upper GI endoscopy. PE normal. He does not have hemorrhoids. His
 hematocrit is 32mg/dL. Which of the following is the most likely cause of his
bleeding?
A. Angiodysplasia
B. Ulcerative colitis
C. Juvenile polyps
D. Meckel’s Diverticulum
E. Crohn’s Disease
87. A stable patient has abdominal pain, but not peritoneal signs. Abdominal
plain film show markedly distended adnexal loop of air filled colon that is
oriented from the left lower quadrant in the right upper quadrant and
appears like a bent inner tube. Which of the following stamen is true?
A. The condition typically occurs in young women
B. Initial management should be nasogastric decompression and bowel
rest
C. This patient is a candidate for colonic wall stenting
D. Colonoscopy 6 months previously could have detected the
abnormality
E. Patient does not require emergent surgical management
88. A 37 y/o female with grade III internal hemorrhoids will undergo
hemorrhoidectomy. Primary hemorrhoidal plexus to be excised include the
following except:
A. Right anterior
B. Left anterior
C. Right posterior
D. Left lateral
E. None of the above
89. The optimal method for assessing whether surgery or adjuvant
chemoradiation is appropriate in a 50 year old female with rectal cancer:
A. Computed tomography (CT)
B. DRE plus proctoscopy
C. Endorectal ultrasound
D. Positron emission tomography (PET)
E. Endoscopic biopsy
90. When evaluating a patient for anal cancer, the distal margin of the anal canal
is defined by the
A. Anoder,
B. Anal verge
C. Dentate line
D. First valve of Houston
E. Intersphincteric groove
91. Chemotherapeutic drugs used for adjuvant treatment of colorectal cancer
include the following except:
A. 5-FU
B. Leucovorin
C. Oxaplatin
D. Cisplatin
 E. Methotrexate
92. Which of the following diagnostic modalities is used to best assess the depth
of invasion in rectal cancer?
A. Endorectal ultrasound
B. CT scan
C. MRI
D. Colonoscopy
E. PET scan
93. A 75 year old elderly patient with Alzheimer’s disease present with a 24 hour
history of severe abdominal distention, without significant pain or
tenderness. Abdominal xray reveal a large, air filled right colon. What is the
most likely diagnosis?
A. Volvulus
B. Colorectal cancer
C. Diverticulitis
D. Ogilvie’s syndrome
E. Acute appendicitis
94. An 83 year old female present with vomiting and abdominal distention. She
complains of pain in the medial aspect of the right thigh. PE shows a palpable
mass on the right side during rectal examination. The appropriate course of
action is?
A. NGT, IVF and observation
B. Flexible sigmoidoscopy and drainage of the mass
C. Urgent laparotomy
D. Gastrograffin study with SBFT
E. Groin exploration
95. Which of the following colon polyps is associated with the highest malignant
potential?
A. 1 cm tubular adenoma
B. 4 cm hyperplastic polyp
C. 2 cm villous adenoma
D. 3 cm juvenile polyp
96. Which of the following procedures is most appropriate for lesions in the
rectosigmoid area?
A. Anterior resection
B. Low anterior resection
C. Left hemicolectomy
D. Sigmoidectomy
E. Segmental resection with end to end anastomosis
97. Swallowed santol seeds are likely to be impacted in which portion of the
large intestine?
A. Ascending colon
B. Ileocecal area
C. Cecum
D. Sigmoid
E. Transverse colon
98. A 60 year old male is admitted after passing out large amount of maroon
colored stool. At the ER he again passed out more bloody stools as well as
clots. He is pale and tachycardic. NGT aspirate is bilous. After resuscitation,
which of the following is the most appropriate initial test?
A. Barium enema
B. Rigid proctoscopy
C. Colonoscopy
D. RBC tagged scan
E. Virtual colonoscopy
99. A 50 year old female complains of severe left lower quadrant pain associated
with nausea, vomiting and modeate grade fever. On PE she is febrile, PR:
95/min, abdomen is flat with hypoactive bowel sounds and with direct
tenderness over the left lower quadrant. The most probable cause is:
A. Diverticulosis
B. Diverticulitis
C. Obstructed sigmoid carcinoma
D. Small bowel obstruction
E. Colonic tuberculosis
100. Adjuvant treatment is given for stage II rectal cancer when it presents
with the following characteristics except”
A. Obstruction
B. Perforation
C. Poor differentiation
D. Tumor fixation
E. None of the above