General Surgery Exam 6 /6/2020: Email Address Name and Number (English)

GENERAL SURGERY EXAM 6 /6/2020
GENERAL SURGERY EXAM

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NAME AND NUMBER ( ENGLISH )
1. In the workup on a patient for possible appendicitis, CT scanning should be

performed:
2 points
A. Before consulting the surgeon, by the emergency physician

B. In patients with equivocal physical findings
C. Routinely, in all patients with right lower quadrant pain
D. With equal frequency in men and women
E. Never
2. Overwhelming postsplenectomy infection (OPSI)

2 points
a) Occurs more frequently after resection for trauma than hematologic disease
b) Occurs with equal frequency in children and adults
c) Is most frequently caused by Strep¬tococcus pneumoniae
d) Usually occurs within 2 years after splenectomy
e) Generally has an identifiable site of infection
3. Radiation enteritis
2 points
a) Usually presents with perforation

b) Is caused by thrombosis of mucosal vessels
c) Occurs after 3,000 cGy of abdominal radiation
d) Routinely requires operative therapy
e) Is likely in patients who have undergone laparotomy
4. In surgical patients, adrenal insufficiency

2 points
a) Is generally due to pituitary failure

b) Presents with unexplained perioperative hypotension
c) Causes hypokalemia
d) Can be successfully treated with prednisone alone
e) Responds to catecholamine infusion
5. All of the following statements about carcinoma of the gallbladder are correct
Except :
2 points
A. The neoplasm usually starts in the cystic duct and neck of the gallbladder.
B. It is found more commonly in women than men.
C. It is associated with the presence of gallstones in > 85% of cases.
D. Prognosis is generally poor with < 1 year survival with local invasion.
E. Chemotherapy and radiotherapy do not alter disease progression.
6. The most reliable measurement for diagnosing malnutrition is a

2 points
a. Serum albumin of 2.6 g/mL

b. Ratio of exchangeable sodium (Na) to exchangeable potassium (K) of 0.9
c. Respiratory quotient on indirect ca¬l¬orimetry of 1.0
d. Daily calorie intake that meets < 40% of total energy needs
e. Loss of 7% of total body weight
7. Wound dehiscence
2 points
a. Occurs after 6% of laparotomies

b. Is most commonly due to suture breakage
c. Increases in frequency with advancing age
d. Is not increased by corticosteroid therapy
e. Is unrelated to wound infection
8. The hemodynamic value characteristic of septic shock is

2 points
a. Cardiac index, 2.8 L/min/m2

b. Systemic vascular resistance index, 350 dynes cm-5 sec/m2
c. Oxygen consumption, 135 mL/min/m2
d. Oxygen delivery, 700 mL/min/m2
e. Pulmonary capillary wedge pressure, 6.0 mm Hg
9. Decompression for abdominal compartment syndrome should be performed

2 points
a. If the urine output falls to 30 mL/hour

b. When the patient's respiratory rate increases to 24 breaths per minute
c. Based purely on physical findings
d. When bladder pressure exceeds 35 mm Hg
e. If the patient becomes hypoxemic
10. In laparoscopic surgery, the vessel most likely to be punctured during trochar
placement is the
2 points
a. Aorta
b. Right common iliac artery
c. Vena cava
d. Left common iliac artery
e. Right common iliac vein
11. A walled-off pelvic abscess secondary to sigmoid diverticulitis is Hinchey stage

2 points
a. I
b. II
c. III
d. IV
e. V
12. About chronic pancreatitis all are true except?

2 points
a) Parlington Rochelle operation is longitudanal Pancreaticojejunostomy

b) Whipple Pancreaticoduodenectomy removes 60% of pancreatic parenchyma and has 25%
incidence of Diabetes
c) Frey's operation is Duodenal Presereving Pancreatectomy
d) Beger's operation is Duodenal Preserving Pancreatectomy
e) is a different disease entity from acute pancreatitis
13. Which of the following about Pancreatic Ascites is not true

2 points
a) Conservative treatment effective in only 1/4th of patients

b) ERCP should be done before surgery
c) It is exudative
d) Metaplastic cells are present
e) Pancreatic fluid has high amylase and high albumin
14. Tetanus all are true except?

2 points
a. Is due to an infection with a gram-negative spore forming rod

b. The organism produces a powerful exotoxin
c. The toxin prevents the release of inhibitory neurotransmitter
d. Clostridium tetani is sensitive to penicillin
e. Risus sardonicus is the typical facial spasm
15. Regarding gas gangrene

2 points
a. It is due to Clostridium botulinum infection

b. Clostridial species are gram-negative spore forming anaerobes
c. The clinical features are due to the release of protein endotoxin
d. Gas is invariably present in the muscle compartments
e. antibiotics alone are the main stay of treatment
16. The initial goal of therapy for acute toxic cholangitis is to:
2 points
A. Prevent cholangiovenous reflux by decompressing the duct system.

B. Remove the obstructing stone, if one is present.
C. Alleviate jaundice and prevent permanent liver damage.
D. Prevent the development of gallstone pancreatitis.
E. Prepare the patient for urgent cholangiography.
17. Which of the following statements about chronic pancreatitis is/are correct?
2 points
A. Chronic pancreatitis is the inevitable result after repeated episodes of acute pancreatitis.
B. Patients with chronic pancreatitis commonly present with jaundice, pruritus, and fever.
C. Mesenteric angiography is useful in the evaluation of many patients w ith chronic pancreatitis.
D. Total pancreatectomy usually offers the best outcome in patients with chronic pancreatitis.
E. For patients with disabling chronic pancreatitis and a dilated pancreatic duct with associated
stricture formation, a longitudinal pancreaticojejunostomy (Peustow procedure) is an appropriate
surgical option.
18. Standard supportive measures for patients with mild pancreatitis includes which of
the following:
2 points
A. Intravenous fluid and electrolyte therapy.

B. Withholding of analgesics to allow serial abdominal examinations.
C. Subcutaneous octreotide therapy.
D. Nasogastric decompression.
E. Prophylactic antibiotics.
19. A 65-year-old man presents with obstructive jaundice. The patient’s workup begins
with a CT scan. Which of the following statement(s) is NOT true concerning his
diagnosis?
2 points
A. A CT scan demonstrating intrahepatic biliary obstruction with a decompressed gallbladder and

a nondilated extrahepatic biliary tree will be consistent with a Klatskin tumor
B. The presence of biliary obstruction seen on the CT scan requires further eval uation with
invasive cholangiography either percutaneously or endoscopically
C. Percutaneous transhepatic cholangiography would be the preferred technique for a suspected
proximal cholangiocarcinoma in that it will better visualize the proximal extent of t he tumor in the
biliary tree
D. The placement of a transhepatic biliary catheter can prove useful in surgical management of
proximal bile duct cancers
E. There is little role for cholangiography in the evaluation of a patient with suspected
cholangiocarcinoma
20. Which of the following is not considered a risk factor for gall bladder cancer?
2 points
a-Gall stones>3cm in size.

b-Multiple small gall stones.
c-porcelain gall bladder
d-Biliary salmonella typhi infection.
e-Gall bladder adenoma.
21. The following Nyhus classification of hernias is correct except for:

2 points
A. Recurrent direct inguinal hernia—Type IVa.

B. Indirect inguinal hernia with a normal internal inguinal ring—Type I.
C. Femoral hernia—Type IIIc.
D. Direct inguinal hernia—Type IIIa.
E. Indirect inguinal hernia with destruction of the transversalis fascia of Hesselbach's triangle —
Type II.
22. Regarding Hailar Cholangiocarcinoma which is INCORRECT:

2 points
A. Typically presents as stricture of the proximal hepatic ducts

B. Often involving the periductal lymphatic with frequent LN metastases
C. 10% of patients with Hailar Cholangiocarcinoma have Primary Sclerosing Cholangitis PSC
D. In setting of PSC, Hailar Cholangiocarcinoma is usually unicentric
E. Resection is the only chance for cure
23. A patient with an open wound inquires about the best option to provide the best
aesthetic result. One of the following is TRUE:
2 points
A. Nothing can be done, continuing dressing changes and preventing wound dehydration will
result in the best result
B. Applying a vacuum dressing will almost result in a scar-less wound
C. Placing retention sutures is the best option
D. Placement of silver dressing will produce the smallest scar
E. Delayed primary closure or skin graft will be the best result
24. What is the most common form of renal sarcoma

2 points
A. Liposarcoma
B. Rhabdosarcoma
C. Fibrosarcoma
D. Leiomyosarcoma
E. Angiosarcoma
25. 70 y old man with caecal carcinoma undergoing right hemicolectomy through
transverse incision. The procedure is difficult and the incision extended medially by
divided rectus sheath. Brisk arterial hemorrhage ensues. From which of the damaged
vessel originate?
2 points
A. External iliac artery

B. Femoral artery
C. Common iliac artery
D. Internal iliac artery
E. Superior vesical artery
26. A ten year old boy has a perineal “butterfly" hematoma fallowing a straddle injury.
The suggest rupture of the:
2 points
A. Tunica albogenea
B. Corpus spongiosum
C. Corpus cavernosum
D. Posterior urethra
E. Colle's fascia
27. A 21 year old male is brought to the trauma room after sustaining a superficial stab
wound to the left shoulder. He reports that he received his full series of shots as a
child and received his last tetanus booster shot when he was 15. What should he
receive for his tetanus prophylaxis?
2 points
A. Amoxicillin 500-mg PO TID

B. Nothing
C. Tetanus immune globulin (TIG) 250 units IM
D. Tetanus toxoid (dT) 0.5 ml IM
E. Tetanus toxoid (dT) 0.5 ml IM and TIG 250 units IM
28. Which one of the following statements about duodenal atresia and stenosis in the
newborn is NOT true?
2 points
A. Prenatal detection of duodenal atresia has remained constant over the past three decades.
B. A mucosal web with a normal muscular wall is the most common duodenal abnormality.
C. The double-bubble sign on plain films is the classic x-Ray finding.
D. Down’s syndrome is identified in up to 25% of infants.
E. Cardiac abnormalities are commonly associated with duodenal atresia.
29. The most important factor in the development of ulcers in a spinal cord injury
patient is:
2 points
A. Malnutrition.
B. Septic episodes.
C. Anemia.
D. Local pressure.
E. Diminished sensation
30. During the third trimester of pregnancy, the most common changes in renal
function are:
2 points
A. Elevated BUN; decreased creatinine

B. Elevated BUN; elevated creatinine
C. Decreased BUN; decreased creatinine
D. Decreased BUN; elevated creatinine
E. Unchanged BUN and creatinine
31. Pancreatic acini secrete enzymes that play an important role in the digestion of
proteins. What is the most potent stimulant of pancreatic acinar cells?
2 points
A. Acetylcholine
B. Cholecystokinin (CCK)
C. Peptide YY
D. Secretin
E. Trypsinogen
32. Which among the following statements concerning primary hyperaldosteronism is

INCORRECT?
2 points
A. It results from an adenoma of the adrenal cortex in the majority of cases

B. It leads to sodium retention
C. It may result in hypertension
D. It may suppress plasma renin activity
E. It leads to metabolic acidosis
33. Calcium metabolism: All are true, Except:

2 points
Its main function is neuromuscular stability

Asymptomatic hypercalcemia may occur with hypoproteinemia
Metastatic breast cancer can be a cause of hypercalcemia
Calcium is given routinely in massive blood transfusion
Corticosteroids decrease resorption of calcium from bone
34. Crystalloid solutions: All of the following types of intravenous fluids are
crystalloids, Except:
2 points
A. Normal saline
B. Dextran 70
C. Hypertonic saline
D. Ringer lactate
E. 5% dextrose water
35. Hypernatremia (postoperative): All are true, Except:

2 points
A. May indicate a deficit of total body water

B. May be caused by a high protein intake
C. May diagnose extra cellular fluid volume depletion
D. A common cause is excessive extrarenal water loss
E. Replacement of lost water with isotonic salt solutions can produce hypernatremia
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GENERAL SURGERY EXAM 6 /6/2020

GENERAL SURGERY EXAM

NAME AND NUMBER ( ENGLISH )

1. In the workup on a patient for possible appendicitis, CT scanning should be

A. Before consulting the surgeon, by the emergency physician

2. Overwhelming postsplenectomy infection (OPSI)

a) Usually presents with perforation

4. In surgical patients, adrenal insufficiency

a) Is generally due to pituitary failure

6. The most reliable measurement for diagnosing malnutrition is a

a. Serum albumin of 2.6 g/mL

a. Occurs after 6% of laparotomies

8. The hemodynamic value characteristic of septic shock is

a. Cardiac index, 2.8 L/min/m2

9. Decompression for abdominal compartment syndrome should be performed

a. If the urine output falls to 30 mL/hour

11. A walled-off pelvic abscess secondary to sigmoid diverticulitis is Hinchey stage

12. About chronic pancreatitis all are true except?

a) Parlington Rochelle operation is longitudanal Pancreaticojejunostomy

13. Which of the following about Pancreatic Ascites is not true

a) Conservative treatment effective in only 1/4th of patients

14. Tetanus all are true except?

a. Is due to an infection with a gram-negative spore forming rod

15. Regarding gas gangrene

a. It is due to Clostridium botulinum infection

A. Prevent cholangiovenous reflux by decompressing the duct system.

A. Intravenous fluid and electrolyte therapy.

A. A CT scan demonstrating intrahepatic biliary obstruction with a decompressed gallbladder and

a-Gall stones>3cm in size.

21. The following Nyhus classification of hernias is correct except for:

A. Recurrent direct inguinal hernia—Type IVa.

22. Regarding Hailar Cholangiocarcinoma which is INCORRECT:

A. Typically presents as stricture of the proximal hepatic ducts

24. What is the most common form of renal sarcoma

A. External iliac artery

A. Amoxicillin 500-mg PO TID

A. Elevated BUN; decreased creatinine

32. Which among the following statements concerning primary hyperaldosteronism is

A. It results from an adenoma of the adrenal cortex in the majority of cases

33. Calcium metabolism: All are true, Except:

Its main function is neuromuscular stability

35. Hypernatremia (postoperative): All are true, Except:

A. May indicate a deficit of total body water

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