MCQs Mock Exams for General Surgery Board ExamMock Exam 6- 25 MCQs Share from Dr. Muhanad Deeb. Riyadh, King Faisal Hospital (muhanad.deeb.5facebook.com) References: 1. Comprhensive "AIO" Revision on SURGERY by Dr.Adel Abdel Hamid. 2008 2. Lange Q & A 5th Edition. 1. Which of the following statement (s) is/are true concerning the recurrence of breast cancer? a. The majority of patients recur within five years of diagnosis b. More than 70% of breast cancer recurrence involve distant metastases c. Pulmonary metastases are the most common initial site of distant recurrence d. The local recurrence rate following breast-conserving procedures varies from 10% to 40% whether or not radiation was used e. Recurrent disease will be seen in at least 35% of node-negative patients undergoing appropriate primary breast therapy Answer: a, b, d 2. Which of the following statement(s) is/are true concerning mammography? a. Up to 50% of cancers detected mammographically are not palpable b. One third of palpable breast cancers are not detected by mammography c. The sensitivity of mammography increases with age d. The American Cancer Society currently recommends routine screening mammography beginning at age 40 e. Only about 10% of nonpalpable lesions detection mammographically are found to be malignant at biopsy Answer: a, c, d 3. A 35-year-old woman, who is currently breast-feeding her firstborn child, develops an erythematous and inflamed fluctuant area on breast examination. Which of the following statement(s) is/are true concerning her diagnosis and management? a. The most common organism which would expect to be cultured is Staphylococcus aureus b. Open surgical drainage is likely indicated c. Breast-feeding absolutely should be discontinued d. If the inflammatory process does not completely respond, a biopsy may be indicated Answer: a, b, d 4. A partially blind 65-year-old mother presents with a slight change in color of the areola of her left breast. An eczematous rash of the left areola has persisted for the last 3 months. Biopsy of the 5 cm. It presents at a later age than papillary carcinoma. (D) The underlying carcinoma when present is very large. B. Many cases involve small breast cancers. (B) Surgical therapy often fails to cure Paget’s disease. (C) The diagnosis should be made by nipple biopsy when suspected. This is unrelated to Paget’s disease of the bone. 5. Lower overall recurrence rate. It disseminates via hematogenous routes. D. B. Answer: AD . Paget’s disease represents a ductal carcinoma that has grown along the ducts into the nipple/areolar region. In Paget’s disease of the nipple which of the following is TRUE? (A) Carcinoma of the breast is rarely found. Is best treated initially by subtotal parathyroidectomy. E. Lower risk of hypoparathyroidism. Which of the following statements about follicular carcinoma is/are true? A.nipple reveals Paget’s disease. Surgical therapy is often curative. Can have severe effects on bones exacerbated by aluminum contained in phosphate binders and dialysate water. C. Answer: ABC 6. Is caused by increased production of 1. The ability to use thyroglobulin levels as a marker for recurrence. E. (E) Paget’s disease of the bone is commonly encountered. Secondary hyperparathyroidism: A. C. which does not resolve and can be diagnosed with a small incisional biopsy. B. Is a metabolic disease in which the primary abnormality is decreased glomerular filtration rate. Advantages of total thyroidectomy for management of papillary carcinomas of the thyroid larger than 1. which are missed on clinical examination and mammogram. Answer: (C) The diagnosis should be made by nipple biopsy when suspected. Answer: ABD 7. Typically swollenvacuolated Paget’s cells are found on histologicl examination. Is best treated initially by total parathyroidectomy with autotransplantation. Extensive angioinvasion portends a poor prognosis. The lesion often presents with an eczematous rash. D. Possibility of using radioactive iodine postoperatively to identify and treat metastases.25(OH) 2 vitamin D 3. include: A. Follicular carcinomas are frequently multicentric. It is the most common type of well-differentiated thyroid carcinoma. D. C. causing increasing intestinal calcium absorption and hypercalcemia. There is no other evidence of disease. The transversalis fascia is the most important layer of the abdominal wall in preventing hernias. they frequently appear bilaterally. Answer: ABCD 10. The following statement(s) is/are true concerning the indications for treatment of an inguinal hernia. the presence of a solitary nodule on chest x-ray is more likely to represent a primary carcinoma of the lung than a solitary secondary metastasis. 9. What should he be given? (A) Radiotherapy (B) Combination chemotherapy (C) Attempted curative lung resection (D) Exploration of the neck for thyroid recurrence (E) Androgen therapy Answer: (C) Although there is a history of previous thyroid cancer. In metastasis. ACT scan would be helpful in delineating the pulmonary findings. The internal abdominal oblique muscles have fibers that continue into the scrotum as cremasteric muscles. Scarpa's fascia affords little strength in wound closure. Meckel's diverticulum results when the intestinal end of the omphalomesenteric duct persists and represents a true diverticulum. a 56-year-old fisherman underwent thyroidectomy for cancer of the thyroid gland. Most adult hernias will remain stable in size. An umbilical polyp is a small excrescence of omphalomesenteric duct mucosa that is retained in the umbilicus. B. Answer: BCD 11. The herniated viscera associated with omphaloceles are usually covered with a membranous sac. a. Omphalocele represents a defect in the abdominal wall lateral to the umbilical cord. Which of the following congenital abnormalities are correctly defined? A. B. Which of the following statements concerning the abdominal wall layers are correct? A. He is now noted to have a single 4-cm lesion in the upper lobe of the left lung. the lesions are more often multiple. Four years previously. and they more commonly present in the lower area of the lungs.8. C. therefore delay seldom affects the technical aspects of a surgical repair . and he is in excellent health. D. Endobronchial biopsy confirms that the lesion is malignant but the organ of origin cannot be determined. D. C. The lymphatics of the abdominal wall drain into the ipsilateral axillary lymph nodes above the umbilicus and into the ipsilateral superficial inguinal lymph nodes below the umbilicus. B. A truss maintains a hernia in the reduced state. B. the remainder being secondary or tertiary contractions. C. Play an important role in digestion. D. The morbidity and mortality associated with emergent operation due to hernia complications is significantly greater than for elective repair of the identical hernia d. a progressive peristaltic contraction (primary wave) follows 50% of all swallows. tall. minimizing the risk of incarceration and strangulation Answer: b. Typical symptoms include cervical dysphagia. D. 22 to 26 mm. D. Nerve fibers. E. C. The lamina propria between the intestinal epithelium and the muscularis mucosae contains: A. therefore. Secondary peristalsis is initiated when the entire swallowed bolus of food fails to empty from the esophagus into the stomach. Contain trypsinogen. Answer: ACDE . expectoration of saliva. F. F. Produce the brush border appearance. Contain dissacharidases. D. Which of the following statements about esophageal motility is/are true? A. E. and hoarseness. This condition is diagnosed by the characteristic manometric findings of UES spasm. in length so that normal muscle is not damaged. Which of the following statements about UES dysfunction are correct? A. Enterochromaffin cells. Undifferentiated epithelial cells. c 12. which persists until the bolus of food passes the LES. Medical or surgical therapy of gastroesophageal reflux may be curative. There is a direct correlation between the length of time that a hernia is present and the risk of major complications c. exhibit a striated luminal border (brush border). A cervical esophagomyotomy for UES dysfunction should be limited to 2 to 3 cm. E. Connective tissue. C. Increase absorptive area. C. Answer: BCD 14. The classic finding on barium esophagogram is a posterior cricopharyngeal bar. The act of swallowing initiates UES relaxation. The primary peristaltic wave normally propels the swallowed bolus through the esophagus in 4 to 8 seconds. Normally. B. Tertiary esophageal contractions are high-amplitude progressive peristaltic contractions that produce the ―corkscrew‖ appearance of esophageal spasm on barium esophagography.b. Contain amylase. The brush border microvilli: A. The intestinal epithelial cells. B. Macrophages. Answer: ACEF 15. Answer: BD 13. E. Blood and lymph vessels. Anti-inflamatory agents are not indicated in the therapy of . diffuse abdominal tenderness. Physical examination reveals dehydration. and broad spectrum antibiotics (B) Urgent surgical resection (C) Steroids (D) Diverting colostomy (E) Ileostomy Answer:9. The combination of an acute abdomen and an upright chest x-ray with free air under the diaphragm provides enough information to take the patient to the operating room for exploration. Although a CAT scan will show both free fluid and free air. Measurement of C difficile toxin in stool d. and rebound tenderness. Apatients CT scan reveals diverticulitis confined to the sigmoid colon. If antibiotic-associated colitis is suspected. Abdominal examination reveals board-like rigidity. (A) Uncomplicated diverticulitis is treated with broad spectrum antibiotics and bowel rest. A 63-year-old woman is admitted to the hospital with severe abdominal pain of 3-hour duration. IV fluids. what diagnostic study should be performed? (A) Supine abdominal x-rays (B) Upright chest x-ray (C) Gastrograffin swallow (D) Computerized axial tomography (CAT) scan of the abdomen (E) Abdominal sonogram Answer: (B) An upright chest x-ray will demonstrate free air below the diaphragm in about 70–75% of patients presenting with a perforated duodenal ulcer. and cephalothin. guarding. b. Outpatient medications have included digoxin. and crampy abdominal pain. What is best course of treatment? (A) Bowel rest. An abdominal sonogram may demonstrate free fluid. nasogastric suction. Surgery is not indicated—either resection or diversion of the fecal stream by colotomy or ilestomy. fever. it will take longer to perform and may delay the definitive treatment. Computed topography of abdomen Answer: a. propranolol. pluse 110 bpm (beats per minute). and a temperature of 102°F. Barium enema e. 18. and initiation of fluid resuscitation. A 72-year-old man returns to the hospital 2 weeks following right hip arthroplasty with complaints of 48 hours of mucoid diarrhea.16. but not free air. Her blood pressure is 90/50 mm Hg. After a thorough history and physical. c 17. and respiratory rate is 30 breaths per minute. Stool culture for C difficile c. which of the following is/are appropriate diagnostic tests? a. There is no associated pericolic abscess. Fecal leukocyte smear b. reduces when resting. A 72-year-old man develops jaundice and is demonstrated to have a 2. Which of the following statement(s) are true: a. They are rarely encountered in children and women. He complains of recent difficulty with micturition and nocturia. 20. Microscopic tumor cells in perigastric lymph nodes on frozen section c. After a second episode. A 70-year-old cigarette smoker presents with a right inguinal mass that has enlarged and has caused discomfort in recent months. The risk of a second episode is less than 30%. Fine needle aspiration cytology is positive for adenocarcinoma. Lymphatic capillaries are more permeable than blood capillaries. which does not extend to the scrotum. Surgical reconstruction offers a better chance of long-term success than either percutaneous or endoscopic dilatation Answer: b. Inability to develop an avascular plane anterior to the superior mesenteric vein d. 19. This type of hernia does not extend to the scrotum and rarely undergoes strangulation. Which of the following statements about lymphatic capillaries are true? A. Surgical reconstruction is the only option for management of this patient b. Cholelithiasis Answer: b. A 37-year-old female presents with obstructive jaundice due to a mid-bile duct stricture four months after laparoscopic cholecystectomy. B. Excellent long-term results can be expected in approximately 80% of patients following surgical biliary reconstruction c. . The swelling. What is the likely diagnosis? (A) Direct inguinal hernia (B) Strangulated indirect inguinal hernia (C) Hydrocele (D) Aneurysm of the femoral artery (E) Cyst of the cord Answer: (A) Direct hernias are more common in older patients. There is an increased incidence in patients with a chronic cough and prostatic obstruction. the risk is greater than 50% and resection may be advised at this stage. One year follow-up after successful repair is satisfactory regardless of the method of management d. Which of the following intraoperative findings would indicate unresectability? a. These vessels have delicate tricuspid valves every 2 to 3 mm. d 22. c 21. Fibrotic reaction in the body and tail of the pancreas b. There are no signs of unresectability on CT examination.diverticulitis.5 mass in the pancreatic head by computed tomography. Lymphatic capillaries contain gaps large enough to admit particles as large as lymphocytes. The blood pressure rises to 85 mm Hg after 2 L of Ringer’s lactate. and a Foley catheter are inserted. orotracheal intubation may be attempted with in-line stabilization of the neck. D. is not an effective treatment for relief of symptoms of BPH Answer: a. 25. By which method is the immediate need for a definitive airway in this patient best provided? (A) Orotracheal intubation (B) Nasotracheal intubation (C) Percutaneous cricothyroidotomy (D) Intubation over a bronchoscope (E) Needle cricothyroidotomy Answer. Renal failure secondary to obstructive uropathy occurs as bladder pressure rises and is eventually transmitted proximally to the renal pelvis c. Prostatic size has no consistent relationship to urethral obstruction b.C. a nasogastric tube. and respiration rate is 28 breaths per minute. Hormonal treatment for BPH involves treatment with a 5 a-reductase inhibitor which blocks the conversion of testosterone to the dihydrotestosterone d. Upon presentation. the patient has obvious head and extremity injuries. A 32-year-old female falls from the tenth floor of her apartment building in an apparent suicide attempt. Answer: CD 23. Intermittent catheterization. Lymphatic capillaries are less permeable than blood capillaries. (A) In a patient with significant blunt mechanism of injury and head injury. Two large-bore intravenous lines. In an apneic patient with the potential for cervical spine injury. Her abdomen has a stab wound in the anterior axillary line at the right costal margin. Which of the following statement(s) is/are true concerning benign prostatic hypertrophy (BPH)? a. Her blood pressure is 80/0 mm Hg. Hemorrhage control should take . percutaneous cricothyroidotomy is the best definitive step. c 24. A 17-year-old girl presents to the emergency department with a stab wound to the abdomen and a blow to the head that left her groggy. b. the cervical spine should be protected against further injury. The appropriate management is which of the following? (A) Peritoneal lavage (B) Ultrasound of the abdomen (C) Laparoscopic assessment of the peritoneal cavity (D) Exploratory laparotomy (E) CT of the head Answer. Primary survey reveals that the patient is totally apneic. although a temporizing measure. If this is unsuccessful. pulse is 120 bpm. (D) A patient without other sources of blood loss who presents to the emergency department with a stab wound to the abdomen and in shock should have an expeditious exploratory laparotomy. precedence over definitive management of a concomitant head injury. . The other tests will waste precious time and are contraindicated in a patient in shock.