Surgery Past Year Questions 2016 PDF

"Surgery prev year questions 2016 1. Concentration of mannitol used in elevated ICP: a. 0.1 b. 0.2 c.0.3 d.0.4 e 0.5 2. Nerve responsible for dilation of affected pupil in uncal herniation: a. V b. VI c. VII d. III e.IV 3. preferred method of examination of biliary diseases a.MRI b. abdominal...

"Surgery prev year questions 2016 1. Concentration of mannitol used in elevated ICP: a. 0.1 b. 0.2 c.0.3 d.0.4 e 0.5 2. Nerve responsible for dilation of affected pupil in uncal herniation: a. V b. VI c. VII d. III e.IV 3. preferred method of examination of biliary diseases a.MRI b. abdominal USG c. CT d. Plain radiography e. None of the above 4.Normal ICP in adults is less than a. 5-10 mmhg b.10-15 c.15-20 d. 5-15 e.10-20 5. Young female+unclear breast lumps+obvious pain during menstruation a. Breast cancer b. Cyclomastopathy c. Mammitis d. Mastopathia e. Fibroadenoma of Breast 6. Patient localized to painful stimuli. GCS score a. 2 b.3 c. 4 d. 5 e. 6 7. most common clincal manifestation of pancreatic head cancer a. Abd. pain, jaundice, vomiting b. Abd. pain, jaundice, abd. mass c. Abd. pain, jaundice, wt. loss d. jaundice, wt. loss, abd. mass e. jaundice, abd. distension, weight loss 8. complications of subtotal gastrectomy with Billroth | or Billroth Il reconstruction a. Dumping syndrome b. Anemia c. Metabolic bone diseases d. Reactive hypoglycemia e. hypothyroidism 9. Basic construction and functional unit a. Sinusoids b. kuffper cells c. hepatic cell d. hepatic lobules e. bile duct 10. First muscle group usually gets affected in tetanus a. Masticatory muscles b. Facial expressions muscles c. Dorsal and abdominal muscles d. Diaphragm e. none 11. 25 yr man + recurrent indolent fistula in ano+ wt. loss+ recurrent attacks of diarrhea with blood mixed with stools & tenesmus. on proctoscopy normal appearing rectum. Diagnosis? a. Ulcerative colitis b. Amoebic colitis c. Ischemic colitis d. Crohn’s colitis e. colitis with immune deficiency syndrome (AIDS) 12. First line therapy for prolactinoma a. Octreotide b. Lanreotide c. cabergoline d. bromocriptine e. Aminogluethimide 13. Commonest presentation of Meckels diverticulum a. Fever b. Nausea & vomiting c. Diarrhea d. Constipation e. GI bleeding 14. 34 yr male+ acute appendicitis+ loaclized peritonitis+5 days after appendectomy+ abd pain , abd distension, body temp 38 degree Celsius, 3 to 5 times stool, sense of falling. for diagnosis first check a. portal pyemia b. pelvic abscess c. sub phrenic abscess d. incision infection e. coexisting enteritis or dysentery 15. Which of the following is not identified as predisposing factors for stress ulceration a. Hemorrhagic shock b. Intraperitoneal sepsis c. ARDS d. Isolated tibial fracture e. 50% Total surface area second degree burn 16. Characteristics of Gastrinoma a. Benign lesion b. peptic ulcer is common c. stomach is a multiple site d. 75% multiple lesions e. Low gastric acid secretion 17. Reliable way to diagnose early gastric cancer a. USG b. X-ray barium meal GI angiography c. Fiber gastroscopy d. Tetracycline fluorescence experiment e. Exfoliated cell examination 18. Complication of Portal hypertension which often requires surgical intervention a. Ascites b. Variceal hemorrhage c. Encephalopathy d. Portal hypertensive gastropathy 19. Quicker, safer way for uncooperative patient & Safer for environmental issues for loose ferromagnetic materials near ? a. MR b. X ray c. USG d. DSA e. CT 20. Most common benign tumor of Small intestine a. Hemangioma b. Leiomyoma c. lymphoma d. Fibrosarcoma e. Adenoma 21. Patient with which GSC score should be considered as severe TBI a. 6 or less b. 7 or less c. 8 or less d. 9 or less e. 10 or less 22. simple way to further clarify the inspection a. Blood amylase assay b. Urine amylase assay c. WBC count and classification d. Peritoneal puncture fluid to check the amount of amylase e. X ray plain abdominal film 23. After portal vein blood flow is blocked what appears first a. Hepatic encephalopathy b. Hypersplenism c. Congestive Splenomegaly d. Portal hypertensive gastropathy e. Ascites 24. Thoracic spinal injury, complete paralysis of both limbs, muscle strength at this time a. Level 0 b. level 1 c. level 2 d. level 4 e. level 5 25. Most important treatment before operation of splenic rupture a. Supplement nutrition b. Supplement blood volume c. control infection d. Analgesia e. Application of hemostatic 26. Which type of polyps associated with highest incidence of malignant degeneration a. Tubular adenoma b. villous adenoma c. Tubovillous adenoma d. Hamartomous polyps e. inflammatory polyps 27. Main cause of portal hypertension a. Cirrhosis of liver b. hepatic venous thrombosis and stenosis c. congenital malformations of portal vein d. obstruction of hepatic segmental IVC e. excessive blood flow in splenic vein for a variety of reasons 28. which part of neck mass should be considered in thyroid adenoma a. Lateral part of neck b. lumps are particularly large c. submaxillary region d. In front middle part of neck, and goes up and down with swallowing activities e. In front middle part of neck, and moves with the tongue activity 29. order of repairing stomach, jejunum, ileum perforation caused by closed abdominal injury ? a. stomach, jejunum, ileum b. jejunum, ileum, stomach c. jejunum, stomach, ileum d. ileum, stomach, jejunum e. ileum, jejunum, stomach 30. Correct about Crohn’s disease a. improved by smoking b. tends to occur in families c. caused by mycobacterium paratuberculosis d. less frequent in temperate climates than tropical ones e. Common in Asians than jews 31. Most common pathological type of pancreatic head cancer a. duct cell carcinoma b. papillary carcinoma c. acinar cell carcinoma d. mucinous adenocarcinoma e. undifferentiated carcinoma 32. diagnostic criteria for prolactinoma a. >50 ng/ml b.>100 ng/ml c.>150 ng/ml d.>200 ng/ml e.>250 ng/ml 33. blood supply of liver coming from portal vein accounts for a. 70-75% b. 60-65% c. 40-45% d.30-35% e. 50-55% 34. Space of rectum and anal canal does not include a. ischiorectal space b.pelvirectal space c. retrorectal space d. anal canal space e. none 35. Commonest complication after appendectomy a. bleeding b. adhesive ileus c. fecal fistula d. intra abdominal abscess e. incision infection 36. 36 yr female + nipple discharge+ small mass with pain under nipple + bloody discharge from nipple during compression a. Paget disease b. Breast abscess c. Breast fibrocyst d. intraductal papillary adenoma e. intraductal hyperplasia 37.All contribute to Peptic ulcer disease except a. Gastrinoma b. spicy foods c. NSAIDs d. smoking e.H.pylori 38. Main clinical manifestations of pancreatic head cancer a. abdominal pain b. abdominal mass c. weight loss, anemia d. decrease appetite e. painless obstructive jaundice In HW without in last year paper 55-year-old man had a previous hemicolectomy for a carcinoma of the right colon. 3 years later after primary resection a CT shows a solitary lesion in the right lobe of the liver. What is the next step in Mx? A. Laser cauterization B. Radiotherapy C. Hepatic Artery catheterization and local chemotherapy D. Symptomatic Tx with analgesics, because the colon disease is now stage IV E. Exploratory laparotomy and resection of the tumor Acute subdural hematoma involves emergent operative removal by craniotomy for lesions more than A. 3 cm thick B. 2 cm thick C. 1.5 cm thick D. 1 cm thick E. 0.5 cm thick The length of the rectum is A. 5-15 cm B. 12-15 cm C. 10-20 cm D. 15-25 cm E. 25-30 cm Male 30 years old, 3 days ago there was a perianal mass after drinking alcohol, pain, discomfort, the mass skin temperature increased, fluctuation. Dx is most likely A. Multiple purulent hidradenitis B. Thrombosed hemorrhoid C. Perianal abscess D. Perianal epifolliculitis E. Internal hemorrhoids  From Internal Med paper A 12-year-old girl has a mass in her neck. Physical Physical examination examination reveals reveals a thyroid nodule, but the rest of the gland is not palpable. A technetium scan reveals a “cold” nodule. The child appears to be euthyroid. Which of the following diagnoses is the least likely? E Simple adenoma b Follicular carcinoma c. Papillary carcinoma d. Cyst e. Dysgenetic thyroid gland The most common cancer of the pancreatic head can be revealed by the following symptoms and signs, EXCEPT: a. Weight loss b. Jaundice c. Esophageal varices d. Abdominal pain e. Palpable gallbladder c Most serious complication of a large abdominal aortic aneurysm is: A a. Rupture b. Infection c. Embolization to tibial Embolization to tibial artery d. Compression of neighboring organs e. All are serious Concerning arterial intermittent claudication of lower limbs: a. Numbness of lower limbs relieved by rest b. Cramps relieved by rest c. Patients cannot walk more than 10 meters d. Is always associated with a limited toe gangrene e. Is always due to diabetic arteriopathy b Hypertrophic pyloric stenosis: a. Is often revealed by regurgitations starting on 3rd month of life b. Can be accompanied with conjugated bilirubin jaundice c. Is diagnosed by abdominal ultrasound d. Needs anti-reflux treatment before operation e. Provokes hypocalcemia c Which of the following children is a good candidate for a tousillectomy? D a. A 13-year-old male who snores every night b. A 3-month old female with a history of failure to thrive. c. A 7-yr old male with frequent upper respiratory tract infections d. A 6 year old male with five sorethroats per year for two years. You are examining a 2-week-old baby and detect hip Instability. Ultrasound shows a partially dislocated femoral head epiphysis that relocates on abduction. What is the next step in the management of this patient? D a. Surgery b. Increase iron in milk c Encourage early ambulation d. None of the above D Concerning orthostatic proteinuria, which proposition is true? C a. Occurs in obese adolescents b. Proteinuria is present in the first morning sample c. Has a good prognosis  d. Is accompanied with hypertension During an acute cholecystitis which of the following clinical signs, is the only one allowing, to suspect lithiasis of the main bile duct? C a. Gallbladder distension b. Fever c. Jaundice d. Pain in right hypochondria e. Pain with scapular irradiation What examination do you ask for suspicion of cholangitis? C a. Abdominal ultrasound b. Endoscopic retrograde cholangiography (ERCP) c Cholangio MRI (MRCP) d. Laparoscopy e. Oral cholecystography During cholangitis what is the sign of severity among the following signs? D a.Temperature b. Right scapular irradiation of pain c. Elevation of blood sugar d. Oliguria e. Increase of alkaline phosphatase Cancer of the head of the pancreas can be treated by all the following procedures, EXCEPT: B a. Cephalic duodeno-pancreatectomy (Whipple) b. Pancreatectomy without duodenectomy C. Gastrojejunal and choledocojejunal anastomosis d. -Gastrojejunal and choledoco-duodenal anastomosis e. Placement of an endoscopic prosthesis What is the curative treatment of a large cancer of the lower rectum located 2 centimeters from the anal margin? D a. Sigmoid resection b. Rectal resection with colo-anal anastomosis с. Left iliac colostomy d. Abdomino-perineal amputation e. Radiotherapy In the context of acute generalized peritonitis of the young subject, which observation on clinical examination is itself a formal indication of surgery? C a. Abdominal meteorism b. Sensitive digital rectal examination C. Abdominal contracture d. Flushed face (red and puffy) e. Pain in the right iliac fossa True about colonic carcinoma is: B a. Left side present with anemia b. Solitary liver metastasis is not a contraindication to surgery c. Most common site is ascending colon d. Right side are usually stenosing variety The most common nerve injured in humeral shaft fracture is the: C a. Median nerve b. Ulnar nerve c Radial nerve d. Anterior interosseous nerve e Musculocutaneous nerve A patient of 75-year-old underwent major abnormal surgery. Nasogastric tube was used to drain gastric secretions. 48 hours after surgery she complained of right side swelling of the cheek painful and inflamed area of the parotid. Select the most probable diagnosis: A a. Acute post-surgical parotids b. Lithiasis of the parotid! c. Sjogren syndrome d. Mumps e. None of the above The clinical sign of a patient with malar bone fracture is: E a Pain b. Epistaxis c. Edema d. Bone deformation e. All of the above A 70-year-old man comes to your office complaining of urinary hesitancy, poor urinary stream, and the need to get up to urinate at least six times a night. You are worried about BPH (benign prostate hypertrophy). Your next steps include all the following EXCEPT: B a. Urinalysis with culture b. CT scan c. Ultrasound d. Digital rectal exam A 55-year-old diabetic, who is status post renal transplantation and coronary artery bypass surgery presents to the ER with rectal pain, the patient's medical history is notable for hypertension, hyperlipidemia, and congestive heart failure. The pain has been present and getting worse for 36h. Physical exam reveals: T-37.0, HR-85, BP-155/90, RR-14. The abdomen is soft, nontender, fluctuant mass is palpated. The most appropriate therapy for this problem is: C a. Oral antibiotics and follow-up in 24h b. Admission for IV antibiotics c. Incision and drainage in the operating room and IV antibiotics d. None of the above For which of the following malignancies does histologic grade best correlate with prognosis? E a. Lung cancer b. Melanoma c. colonic adenocarcinoma d. hepatocellular carcinoma e. Soft tissue sarcoma Which of the following agents causes hemorrhagic cystitis? E a. Bleomycin b. 5-fluorouracil C. Cisplatin d. Vincristine e. Cyclophosphamide When to suspect a prostatic bleeding in a patient presenting for macroscopic hematuria? C a. Initial hematuria b. Mid-stream hematuria c. Terminal hematuria d. Total hematuria For fill in the blanks Intracranial components  Brain  CSF  Blood Felty’s syndrome  Rheumatoid arthritis  Splenomegaly  Neutropenia 3 factors regulate bile flow  Hepatic secretions  Gallbladder contractions  Choledochal sphincteric resistance Bile juice primarily consists of  Bile salts  Lecithin  Cholesterol 2 primary bile salts Produced in - Liver  Cholate  Chenodeoxycholate 2 secondary bile salts Produced by – gut bacteria  Deoxycholate  Lithocholate Charcot’s triad - Cholangitis  Biliary colic  Jaundice  Fever/ chills Reynoid’s pentad – Suppurative cholangitis  Jaundice  Fever/ chills  Abdominal pain  mental confusion/ lethargy  Shock Intracranial hematoma  Epidural   Subdural  Intracerebral Cerebral hernia  Tonsillar  Transtentorial  Subfalcine Pancreas parts  Head  Neck  Body  Tail  Uncinate process Whipple triad (Insulinoma)  Hypoglycemia when fasting  Blood glucose < 50 during symptomatic episodes  Relief of symptoms by IV glucose WDHA syndrome (Pancreatic cholera)  Watery diarrhea  Hypokalemia  Achlorhydria (Absent HCl in gastric secretion) GI tract wall layers  Mucosa  Submucosa  Muscularis  Serosa Virchow’s triad  Venous stasis  Injury to intima  Change in coagulation properties Peripheral artery disease characterized by  Claudication  Critical limb ischemia Locations of the appendix  Retrocecal (63%)  Pelvic (30%)  Subcecal (2%)  Preiilial (1%)  Postilial AAA locations  Suprarenal  Infrarenal  Juxta renal  Thoracic abdominal  "Surgery prev year questions 2016 1. Concentration of mannitol used in elevated ICP : a. 0.1 b. 0.2 c.0.3 d.0.4 e 0.5 Ans: B: 0.2 Pg867 2. Nerve responsible for dilation of affected pupil in uncal herniation: pg86 a. V b. VI c. VII d. III contralateralHemi paresis e.IV Ans.D: III 3. preferred method of examination of biliary diseases a.MRI b. abdominal USG c. CT d. Plain radiography e. None of the above Ans:B abdominal USG 4.Normal ICP in adults is less than a. 5-10 mmhg b.10-15 c.15-20 d. 5-15 e.10-20 Ans: B: 10-15mmHg 5. Young female+unclear breast lumps+obvious pain during menstruation a.Breast cancer b.Cyclomastopathy c. Mammitis d. Mastopathia e. Fibroadenoma of Breast Ans: D Mastopathia 6. Patient localized to painful stimuli. GCS score a. 2 b.3 c. 4 d. 5 e. 6 Ans: D: 5 7. most common clincal manifestation of pancreatic head cancer a. Abd. pain, jaundice, vomitting b. Abd. pain, jaundice, abd. mass c. Abd. pain, jaundice, wt. loss d. jaundice, wt. loss, abd. mass e. jaundice, abd. distension, weight loss Ans: C. Abd. pain, jaundice, wt. loss 8. complications of subtotal gastrectomy with Billroth | or Billroth Il reconstruction except a. Dumping syndrome b. Anemia c. Metabolic bone diseases d. Reactive hypoglycemia e. hypothyroidism Ans: E Hypothyroidism 9. Basic construction and functional unit a. Sinusoids b. kuffper cells c.hepatic cell d. hepatic lobules e. bile duct Ans: D Hepatic lobules 10. First muscle group usually gets affected in tetanus a. Masticatory muscles b.Facial expressions muscles c. Dorsal and abdominal muscles d. Diaphragm e. none Ans. A Masticatory Muscles 11. 25 yr man + recurrent indolent fistual in ano+ wt. loss+ recurrent attacks of diarrhea with blood mixed with stools & tenusmus. on proctoscopy normal appearing rectum. Diagnosis? a. Ulcerative colitis b. Amoebic colitis c. Ischemic colitis d. crohn's colitis e. colitis with immune deficiency syndrome (AIDS) Ans: A. Ulcerative colitis 12. First line therapy therapy for prolactinoma a. Octreotide b. Lanreotide c. cabergoline d. bromocriptine e. Aminogluethimide Ans: C cabergoline 13. Commonest presentation of Meckels diverticulum a. Fever b.Nausea & vomiting c. Diarrhea d. Constipation e. GI bleeding Ans: E GI bleeding 14. 34 yr male+ acute appendicitis+ loaclized peritonitis+5 days after appendectomy+ abd pain , abd distension, body temp 38 degree Celsius, 3 to 5 times stool, sense of falling. for diagnosis first check a. portal pyemia b. pelvic abscess c. sub phrenic abscess d. incision infection e. coexisting enteritis or dysentery Ans: C Subphrenic abscess 15. Which of the following is not identified as predisposing factors for stress ulceration a. Hemorrhagic shock b. Intraperitoneal sepsis c. ARDS d. Isolated tibial fracture e. 50% Total surface area second degree burn Ans: D. Isolated tibial fracture 16. Characteristics of Gastrinoma a. Benign leison b. peptic ulcer is common c. stomach is a multiple site d. 75% multiple leisons e. Low gastric acid secretion Ans: B Peptic ulcer is common 17. Reliable way to diagnose early gastric cancer a. USG b. X-ray barium meal GI angiography c. Fiber gastroscopy d. Tetracycline flurooscence experiment e. Exfoliated cell examination Ans: E Exfoliated cell examination 18. Complication of Portal hypertension which often requires surgical intervention a. Ascites b. Variceal hemorrhage c. Encephalopathy d. Portal hypertensive gastropathy Ans: B Variceal hemorrhage 19. Quicker, safer way for uncooperative patient & Safer for environmental issues for loose ferromagnetic materials near ? a. MR b. X ray c. USG d. DSA e. CT Ans: E: CT scan 20. Most common benign tumor of Small intestine a. Hemangioma b. Leiomyoma c. lymphoma d. Fibrosarcoma e. Adenoma Ans: E Adenomas 21. Patient with which GSC score should be considered as severe TBI a. 6 or less b. 7 or less c. 8 or less d. 9 or less e. 10 or less Ans: 8 or less 22. simple way to further clarify the inspection a. Blood amylase assay b. Urine amylase assay c. WBC count and classification d. Peritoneal puncture fluid to check the amount of amylase e. X ray plain abdominal film Ans: E X-ray plain abdominal film 23. After portal vein blood flow is blocked what appears first a. Hepatic encephalopathy b. Hypersplenism c. Congestive Splenomegaly d. Portal hypertensive gastropathy e. Ascites Ans: C Congestive Splenomegaly 24. Thoracic spinal injury, complete paralysis of both limbs, muscle strength at this time a. Level 0 b.level 1 c. level 2 d. level 4 e. level 5 Ans: A. Level 0 25. Most important treatment before operation of splenic rupture a. Supplement nutrition b. Supplement blood volume c. control infection d. Analgesia e. Application of hemostatic Ans: B Supplement blood volume 26. Which type of polyps associated with highest incidence of malignant degeneration a. Tubular adenoma b. villous adenoma c. Tubovillous adenoma d. Hamartomous polyps e. inflammatory polyps Ans: B Villous Adenoma 27. Main cause of portal hypertension a. Cirrhosis of liver b. hepatic venous thrombosis and stenosis c. congenital malformations of portal vein d. obstruction of hepatic segmental IVC e. excessive blood flow in splenic vein for a variety of reasons Ans: A Cirrhosis of liver 28. which part of neck mass should be considered in thyroid adenoma a. Lateral part of neck b. lumps are particularly large c. submaxillary region d. In front middle part of neck, and goes up and down with swallowing activities e. In front middle part of neck, and movee with the tonguee activity Ans:D :In front middle part of neck, and goes up and down with swallowing activities 29. order of repairing stomach, jejunum, ileum perforation caused by closed abdominal injury ? a. stomach, jejunum, ileum b. jejunum, ileum , stomach c. jejunum, stomach, ileum d. ileum,stomach, jejunum e. ileum, jejunum, stomach Ans: E ileum, jejunum, stomach 30. Correct about crohn's disease a. improved by smoking b. tends to occur in families c.caused by mycobacterium paratuberculosis d. less frequent in temperate climates than tropical ones e.common in asians than jews Ans: C Caused by Mycobacterium paratuberculosis 31. Most common pathological type of pancreatic head cancer a. duct cell carcinoma b. papillary carcinoma c. acinar cell carcinoma d. mucinous adenocarcinoma e. undifferentiated carcinoma Ans. A Duct cell carcinoma 32. diagnostic criteria for prolactinoma a. >50 ng/ml b.>100 ng/ml c.>150 ng/ml d.>200 ng/ml e.>250 ng/ml Ans: D >200ng/ml 33. blood supply of liver coming from portal vein accounts for a. 70-75% b. 60-65% c. 40-45% d.30-35% e. 50-55% Ans: A 70-75% 34. Space of rectum and anale canal does not include a. ischiorectal space b.pelvirectal space c. retrorectal space d. anal canal space e. none Ans: D Anal canal space 35. Commonest complication after appendectomy a. bleeding b. adhesive ileus c. fecal fistula d. intra abdominal abscess e. incision infection Ans: E. Incision infection 36. 36 yr female + nipple discharge+ small mass with pain under nipple + bloody discharge from nipple during compression a. Paget disease b. Breast abscess c. Breast fibrocyst d. intraductal papillary adenoma e. intraductal hyperplasia Ans: D Intraductal papillary adenoma 37.All contribute to Peptic ulcer disease except a. Gastrinoma b. spicy foods c. NSAIDs d. smoking e.H.pylori Ans:. B Spicy foods y38. Main clinical manifestations of pancreatic head cancer a. abd. pain b. abd. mass c. wt. loss , anemia d. decrease appetite e. painless obstructive jaundice Ans: C Weight loss and anemia 39. Length of rectum is a. 5-15 cm b.12-15 cm c.10-20 cm d. 15-25 cm e. 25-30 cm Ans: 12-15 cm  SURGERY 5.1 ONLINE EXAMINATION (2017 MBBS) (Mandhari Fernando, Batch 2017, MBBS) aTH 1. What is the main cause of increased pulse pressure in pts with hyperthyroidism? a. Diastolic bp decreased b. Increased HR c. Increased peripheral vascular resistance d. Emotional stress e. Increased systolic pressure w 2. Space of the rectum and anal canal does notPelvirectal include a. Retrorectal space Ano space r ectal space Ischia rectalspace b. Pelvirectal space Perianaispace c. Anal canal space Marginal space d. Ischiorectal space sub mucusspace inter muscular space e. None of the above 3. Which of the following tumors belong to low-grade gliomas? a. Gangliomoas cancers thatdevelopinbrain tendtobeslowgrowingRarelycured b. Glioblastomabmultiforme mostaggressive c. Olidodendroglioma d. Gliosarcoma iatypeofGlioblastomamultiforme e. Anaplastic astrocytoma Highgrade 4. Axial twisting of the right colon or cecal volvulus has been shown to be associated with each of the following except: a. IBD b. Hx of abdominal operation c. Obstructing lesion in the transverse or left colon M d. Mobile cecum e. None of the above 5. What is the most common content of abdominal hernia? a. Cecum b. SI c. Omentum d. Sigmoid colon e. Bladder v Male, 30 yo, 3 days ago there was a perianal mass after drinking alcohol, pain, discomfort, mass 6. skin temp increases and a sense of fluctuation. The diagnosis is most likely to be. a. Perianal epifolliculitis b. Thrombosed hemorrhoids c. Internal hemorrhoids d. Multiple purulent hydradentitis e. Perianal abscess 7. Female, 32 yo, constipation for 3 years, 7 days ago began to have anal knife-like pain during defecation, long-time poain after defecation, paper rubbed with blood, small amount, bright red colour, the diagnosis is most likely: a. Mixed hemorrhoids b. Internal hemorrhoids c. Anal fissure d. Rectal cancer e. Anal fistula 8. A 45 yo man presents with symptoms of epigastric pain, worsened with ingestion of food. Physical examination is normal. Contrast radiography reveals a 2cm ulcer in the gastric fundus along the lesser curvature. Therapy with omeprazole 20mg per day is begun but symptoms persist 3 weeks later. Appropriate management includes the following? a. Endoscopy with biopsy of ulceration b. Addition of cimetidine 200mg b.i.d. c. Observation d. Increase omeprazole dose to 40mg per day e. Addition of sucralfate 1g every 8 hours 9. The 1st choice to judge the blood supply for a mass in the breast is: a. CT b. MRI c. US d. PET-CT e. None of the above 10. What will appear when one side of the recurrent laryngeal nerve injury after thyroid surgery? a. Dysphagia b. Tone decreased c. Hoarseness d. Drinking water choking e. None of the above 11. 13 yo male, develops diarrhea and colicky abdominal pain. Ulcerative colitis is dx on colonoscopy. Which of the following findings are consistent with the dx? a. The disease is confluent, no skip lesions in the colon and rectum involved b. Incidence of colorectal cancer s equal to that of the general population c. Microscopic exam of the mucosa reveals normal cells without evidence of dysplasia d. Full thickness of the bowel wall is involved e. Rectum is not involved 12. Female, 39 yo, 1 day of hematemesis and black stool., with HX of hepatitis for 20 years. PE reveals anemic appearance, scleral mild yellow staining, abdominal distention, the spleen can be touched by 8cm below the ribs, ascites sign +. What measure doesn’t have to be implemented immediately? a. Transfusion and infusion b. Intravenous vasopressin IAntidiureticHormone c. Laparotomy for hemostasis d. Emergency gastroscopy and hemostasis  e. IV somatostatin 13. Which if the following is not an early manifestation of peptic ulcer perforation? a. Hypoactive bowel sounds b. Chills and fever W c. Nauseas and vomiting d. Guarding e. Local tenderness and rebound tenderness 14. The following statements i/are true concerning umbilical hernias in adults a. Most umbilical hernias in adults are the result of a congenital defect carried into adulthood b. Incarceration is uncommon with umbilical hernias c. Presence of ascites is a contraindication to elective umbilical hernia repair d. A Para umbilical hernia typically has no relationship with multiparous females e. A Para umbilical hernia typically occurs un multiparous females 15. The most common site of metastasis in the development of breast cancer lesions is a. Liver b. Lung c. Axillary lymph nodes d. Brain e. Deltopectoral LN 16. The main risk that can occur after liver and spleen injury is: a. Systemic infection b. Intestinal paralysis c. GI bleeding d. Peritonitis e. Intraperitoneal hemorrhage 17. What is the most important imaging method for acute pancreatitis? a. Abdominal US b. Abdominal x-ray c. MRI d. Enhanced CT e. None EW 18. The most easily damaged substantive organ in closed abdominal injury is: a. Adrenal glad b. Pancreas c. Kidney d. Liver e. Spleen 19. The gold standard for diagnosing GH secreting tumors is: a. MRI b. CT c. GH level d. IGF1 level e. X-ray 20. Main basis for diagnosing internal hemorrhoids is:  a. There is an anal prolapse when toilet b. Enlarged hemorrhoids in the anoscope c. Dropping blood after toiler d. There is anal pain when toilet e. Skin is seen outside the anus 21. An elderly nursing home pt is brought to the hospital with a recent onset of colicky abdominal pain, distention and obstipation. on examination the abdomen is found to be markedly distended and tympanitic. There’s no marked tenderness. Plain abdominal x-ray shows marked distended loop located mainly in the upper quadrant. Likely dx is a. LBO b. SBO c. Gallstone ileus d. Mesenteric vascular occlusion e. Sigmoid volvulus 22. A 55 yo man with rectal bleeding and freckles on the lips. He has + FHx of bowel surgery. Most likely dx is a. ulcerative colitis b. Peutz-jegher syndrome inheritedcondition thatputspeople increasedriskof hamar developing tomatouspolypsin c. IBD tract digestive d. CD BIgene Mutationinsik11ILK e. Familial adenomatous polyposis 23. The main cause of portal hypertension is a. Excessive blood flow In the splenic vein for a variety of reasons b. Hepatic venous thrombosis and stenosis c. Cirrhosis of the liver d. Congenital malformation of the main portal vein e. Obstruction of the hepatic segmental inferior vena cava 24. Which of the following regarding pancreatic carcinoma is true? a. Majority of the cases present with jaundice alone N b. 99% of pts with pancreatic cancer have metastatic disease at the time of dx c. CT scan, angiography and laparoscopy have been unsuccessful in predicting respectability d. The 5-year survival rate after a whipple procedure performed for cure is 30-40% 25. The most dangerous complication of portal HTN is: a. Bleeding of esophageal gastric varices and rupture b. Hepatic encephalopathy c. Congestive splenomegaly d. Thrombocytopenia e. Refractory ascites period after orlunch dinner 26. 32 yo male, presents with post prandial intolerable pain on the upper abdomen for 2 hours. PE: tenderness, rebound tenderness on whole abdomen. He has a hx of periodic abdominal pain of empty stomach, which could be released by oral acid inhibitors. Which if the following is the most likely sign this pt could have? a. Succusion splash positive b. Tenderness at vertebrocostal point  c. Border of dullness disappear Md. Murphy’s sign + e. Hyperactive bowel sounds 27. which if the following regarding amylase changes in acute pancreatitis is wrong? a. Amylase can also be elevated in the hydrothorax and ascites b. Level of serum amylase is proportional to the severity of the disease c. The duration of urine amylase increase is longer than that of blood amylase d. The disease can be diagnosed by 3 times of the normal value of serum amylase e. Serum amylase rises earlier than urine amylase & 28. A 30yo pt presents with increasing headache, which she describes as being a dull aching feeling at the top of her head. She describes having suffered uncontrollable jerking movements yesterday, subsiding only after 30 seconds. She states that the worse aspect of the headache is that it reaches a crescendo in the morning, making it difficult for her to get to work on time. What is the likely dx? a. Cluster headache e. ra n t mor b. Epidural hemorrhage c. Subdural hemorrhage d. Migraine headache 29. Which if the following nerve is responsible for the dilatation of the affected pupil uncal herniation? a. V b. III c. VI d. VII e. IV 30. Which of the following is true about benign lesions of the liver? a. Hemangiomas are the most common benign lesions of the liver that comes to the surgeon’s attention b. Nodular regenerative hyperplasia does not usually accompany cirrhosis c. Adenomas are true neoplasm with a redisposition for complications and should be usually resected At d. Focal nodular hyperplasia (FNP) is a neoplasm related to birth control pills and usually requires resection theopposite e. Adenomas are not really neoplasms and don't have to be resected 31. The diagnostic criteria of prolactin levels for prolactinoma is: a. >200ng/ml b. >100 ng/ml c. >250 ng/ml d. >150 ng/ml e. >50 ng/ml 32. What is the most common complication enteral nutrition? a. Asphyxia b. Hyperglycemia c. Hypoglycemia d. Vomiting, diarrhea  K e. Pipe blockage 33. The formation of the superficial inguinal ring is a. Subcutaneously fascia superficialis b. Musculus tranversus abdominis c. None of the above d. Internal oblique muscle of the abdomen e. External oblique muscle tendon of abdomen 34. The basic construction and functional unit is a. Hepatic sinusoids b. Hepatic lobules c. Bile duct d. Hepatic cell e. kupffer cell 35. extraction of non coagulable blood from diagnostic abdominal paracentesis: the most likely diagnosis is: M a. cavity viscera rupture b. anterior abdominal hematoma c. retro peritoneal hematoma d. intraperitoneal vessels mistakenly penetrated e. parenchyma organ rupture 36. the most commonly uses chemotherapeutic agent for malignant gliomas is a. procarbizine b. vincristine c. cisplastin d. carmustine e. temozolamide 37. A 48 yo woman presents with several hours of acute RUQ pain, low grade fever and nausea and vomiting. Which of the following statement if true concerning her dx and management? a. A positive bile culture can be expected in virtually 100% of patients with this scenario b. A mild elevation of bilirubin (lesser than 3mg/dl), would strongly suggest a CBD stone c. Appropriate antibiotics should be used d. Laparoscopic cholecystectomy is clearly contradicted e. None of the above w 38. What is the order of repairing the stomach, jejunum and ileum perforation cause by closed abdominal injury? a. Jejunum, stomach, ileum b. Ileum, jejunum, stomach c. Jejunum. ilium, stomach d. Stomach, jejunum, ileum e. Ileum, stomach, jejunum 39. When a patient can open eyes spontaneously, how many points does the pt score on a Glasgow scale? a. 6 b. 4  c. 3 d. 2 e. 5 40. The contraindication of liver puncture is a. Post hepatitis cirrhosis b. Hepatic cyst c. Primary hepatic carcinoma d. Bacterial hepatic abscess e. Hepatic echinococcosis 41. 1st line therapy for routine peptic duodenal ulcer disease include a. Serum gastrin determination b. Cream or milk based “sippy diet” c. Vagotomy and antrectomy d. Evaluation of H. pylori e. Upper endoscopy and biopsy to rule out tumor 42. The cystic artery mainly comes from a. Right hepatic artery b. Hepatic artery proper c. Common hepatic artery d. Gastroduodenal artery e. Left hepatic artery 43. Axillary LN dissection is routinely used for all the following except a. A pure medullary cancer in the Upper inner quadrant b. Above all c. 2cm pure comedo type intraductal carcinoma d. 8mm infiltration ductal carcinoma e. 1cm infiltrating lobular carcinoma 44. The main clinical manifestation of pancreatic head cancer is a. Abdominal mass weight loss b. Abdominal pain obstructivejaundice c. Painless obstructive jaundice deep seated abdominalpain Ismailtumorslesspaint d. Decreased appetite e. LOW, anemia 45. What is the most reliable evidence for the dx of colon cancer a. CEA b. X-ray barium enema c. CT d. Colonoscopy and pathological examination e. B-US 46. The infection path of bacterial hepatic abscess is a. Portal vein b. Bile duct c. Trauma d. Lymphatic vessel  e. Hepatic artery 47. Indications for surgical removal of polypoid lesions of the gallbladder include a. Size greater than 0.5cm b. Pt age over 25yo c. Presence of multiple small lesions d. Presence of clinical symptoms e. Absence if shadowing on US 48. Which of the following is the most common cause of obstructive jaundice, in pts with chronic pancreatitis? a. Fibrotic stricture of CBD common bileduct b. None of the above c. Adenocarcinoma of the head of the pancreas d. Choledocholithiasis e. Pancreatic pseudo cyst formation 49. Important spontaneous portosystemic collaterals which developed in the face of portal HTN include a. Hemorrhoidal veins b. Para umbilical venous plexus c. Coronary short gastric and paraesophagal veins d. All of the above e. Left renal vein protudes 50. The following description of a straight inguinal hernia is correct a. The inguinal ring was compressed after reinstatement, and the hernia was no longer protruding b. The hernia sac is lateral to the inferior epigastric artery c. Incarceration is extremely rare n i otprotudel d. Most of them go into the scrotum e. Most common in children and young adults 51. Normal ICP in adults is less than blood exertedby tissuecsf brain and a. 10-15mmHg Definition Pressurethatis b. 15-20 mmHg Normaltop c. 10-20 mmHg Adults loismmHg d. 5-15 mmHg iinfantsascommit e. 5-10 mmHg 52. Which arts of the breast often occurs with breast cancer? a. Inner upper quadrant b. Outer lower quadrant c. No difference d. Inner lower quadrant e. Outer upper quadrant 53. According to the hunt-hess grading scale, a pts with the following clinical conditions should be classified to grade V a. Drowsiness, confusion, mild focal neurologic deficit g i rade31  b. Moderate to severe headache, nuchal rigidity, no neurologic deficit other than cranial nerve palsy grade 21 c. Coma, decerebration posturing d. Stupor, moderate to severe hemiparesis igrade Nl e. Asymptomatic, mild headache, slight nuchal rigidity igradel 54. What is true reference to small bowel physiology migrating motor complexes (MMC)? a. They may explain diarrhea that occurs following vagatomy b. They continue throughout laparotomy c. They inhibit nutrient absorption d. They occur once every 10mins e. They are increased after feeding 55. What is the most common complication of acute pancreatitis? a. Pancreatic pseudo cyst b. Upper GI bleeding c. Pancreatic encephalopathy d. Acute kidney failure e. Thrombophlebitis 56. With regard to the clinical course of appendicitis, which f he following statements are true? a. Gross hematuria and pyuria are quite common b. Most pts present with obstipation c. Typical history so vague abdominal pain, followed by periumbilical pain and, later, right lower quadrant pain d. All of the above e. Nausea and vomiting usually precedes with pain 57. 5 days after an uneventful cholecystectomy, an asymptomatic middle-aged woman is found to have a serum sodium level of 120meq/L. proper management would be: Na135145 megll a. Administration of hypertonic saline solution b. Aggressive diuresis with furosemide c. Restriction of free water d. Plasma ultrafiltration e. Hemodialysis 58. What’s the most common site for pancreatic cancer? a. Tail of pancreas b. Head of pancreas c. Entire pancreas d. Body of pancreas e. Body and tail of pancreas 59. The skin of the anal canal is special, it is “three without” skin, what does this “three without” refer to? a. No hair follicles, sweat glands, blood vessels i b. No sweat glands, sebaceous glands, lymphatics c. No hair follicles, sebaceous glands, lymphatics d. No sweat glands, hair follicles, lymphatics e. No sebaceous glands, sweat glands, lymphatics Ans Nosweatglands sebaceousglandshairfollicles 60. Which of the following is the advantage of minimally invasive surgery? a. Shorter hospital stays b. Less blood loss c. Decreased pain d. Less scarring e. All of the above 61. All of the following are contraindications for highly selective vagatomy except a. Cigarette chain smoking b. Perforated peptic ulcer disease with more than 24 hours soilage c. Fundic peptic ulceration d. Peptic ulcer disease causing gastric outlet obstruction e. Intractable duodenal ulcer disease 62. A patient presents with abdominal pain and vomiting. She has a mass in the right lower quadrant and hyperactive bowel sounds. A segment of resected bowel is shown in the photograph. Which of the following is the most likely diagnosis? a. Necrotizing enterocolitis b. Strangulated hernia c. Meckel diverticulum Md. Intussusception e. Appendicitis 63. The first line therapy for prolactinomas is: a. Octreotide b. Lanreotide c. Cabergoline m sideeffect i oreeffective tless d. Aminoglutethimide e. Bromocriptine txalso 64. A 55yo man who is extremely obese, reports of weakness, sweating, tachycardia, confusion and headache whenever he fasts for more than a few hours. He has prompt relief of symptoms when he eats. These symptoms are most suggestive of which of the following disorders? a. Insulinoma b. Multiple endocrine neoplasia type II c. Carcinoid syndrome d. Diabetes mellitus e. Zollinger-ellison syndrome 65. The main treatment for abscess caused by acute mastitis is a. Incision and drainage Alsocontinuebreastfeeding b. Anti-inflammatory c. Stop breastfeeding d. Physical therapy e. Surgery 66. Entamoeba histolytica primarily invades the a. Lungs b. Stomach c. Liver  d. SI smallintestine e. LI largeintestine 67. All of the following are metabolic complications of subtotal gastrectomy with Billroth I or Billroth II reconstruction except: a. Dumping syndrome b. Anemia c. Reactive hypoglycemia d. Hypothyroidism e. Metabolic bone disease 68. Which of the following statements is wrong regarding gallstone? a. Large single stones are not easy to incarceration b. Stones incarcerated in the gallbladder ampulla would cause acute cholecystitis c. All pts with gallstones would have symptoms d. Symptoms would aggravate after eating greasy food e. Biliary colic radiation to the right shoulder 69. The abdominopelvic cavity contains all but a. Pancreas b. Stomach c. Lungs d. Bladder e. Liver 70. Which of the following statement regarding post splenectomy sepsis is false? a. Auto transplantation techniques eliminates this risk b. The incidence in children is generally reported as less than 5% c. The mortality rate is now approximately 50% d. Heamophilus influenza, streptococcus pneumonia and Neisseria meningitidis are the most common causative organisms e. Incidence in adults is about 1% 71. Ducts not wrapped in the sheath of the liver Glisson a. Hepatic duct b. Hepatic artery c. Hepatic vein d. Hepatic portal vein e. All of the above are not wrapped in 72. The most common auxiliary diagnosis and follow-up items for pancreatic cancer is a. CEA b. CA50 c. CA199 d. AFP e. PSA 73. The most common functional pituitary tumors a. Growth hormone secreting tumor b. Prolactinomas c. Gonadotrophic adenomas  d. Thyrotrophic adenomas e. Corticotropic adenomas 74. What will not happen after radical thyroidectomy? a. Hypocalcemia w I illhappen G b. Hypercalcemia c. Tetany d. Hypercalcemia Me. All of the above 75. What is the depth of the epidural hematoma considered for surgical removal? a. 0.5-1.5cm to anoccurwithaskullfracturethatlaceratesanarteryinthedura b. 0.5cm eglacerationofmiddlemeningealarterybytemporalbone epidural theoutsideofdura collectsin expandsthepotential space c. 0.5-1cm occurson Bleeding d. 1cm btwbone dura e. 1-1.5cm u 76. After the portal vein blood flow is blocked, what appears first is a. Congestive splenomegaly b. Hypersplenism c. Portal hypertensive gastropathy d. Ascites x e. Hepatic encephalopathy 77. What is the preferred method of examination for biliary disease? a. Plain abdominal radiograph b. CT c. mri d. abdominal US e. none of the above 78. the most common benign tumor if the small intestine is a. leiomyoma b. adenoma c. lymphoma d. fibro sarcoma e. hemangioma 79. which sign supports the diagnosis of severe acute pancreatitis? cholecystitis t a. A Percussion pain in the hepatic region Loareyturnersigntsullensyndrome b. Positive Courvoisier sign cI arcinomaofheadofpancreas c. Positive Grey-Turner sign d. Positive Murphy's sign inflammationofgallbladder e. Border of liver dullness disappeared signofperforatedviscus freeairinabdominalspace 80. Which of the following tumor is the most common intracranial tumor in adults? a. Medulloblastoma b. Metastatic brain tumors c. Glioma d. Cerebral lymphoma e. Ependymoma 81. What is characteristic of gastrinoma a. It is benign lesion b. Stomach is a multiple site c. 75% multiple lesions d. Low gastric acid secretion e. Peptic ulcer is common 82. The correct one for the role of combined use of glutamine in nutritional support is: a. Protect the liver and the barrier function of intestinal mucosa b. Reduce the viscosity of blood c. Enhanced phagocytic cell viability d. Supply energy for colonic mucosal e. All of the above 83. Which of the following tumor belongs to low-grade gliomas? a. Glioblastoma multiforme b. Gangliomas c. Oligodendroglioma d. Gliosarcoma e. Anaplastic astrocytoma  pressure1.272.35hPa Normaportal item aonra portal 1. The most dangerous complication of portal hypertension is: A. Congestive splenomegaly B. Thrombocytopenia C. Refractory Ascites D. Hepatic encephalopathy E. Bleeding of esophageal gastric varices rapture autosomaldominant 2. Which of the following statements about familial adenomatous polyposis (FAP) is true? A. The phenotypic expression of the disease depends mostly on the genotype B. Appropriate surgical therapy includes total abdominal colectomy with ileorectal anastomosis and ileoanal pull-through with rectal mucosectomy C. Panproctocolectomy with ileostomy is not appropriate therapy for this disease D. Some patients having only a few polyps whereas others develop thousands E. Pharmacologic management of this disease may be appropriate in all instances 3. What is the common cause of diffuse axonal injury? A. Missile craniocerebral injury B. Whiplash injury C. Craniocerebral crush injury D. Deceleration craniocerebral injury E. Acceleration craniocerebral injury benign small tumorsofthe intestinemostly toAmpullaovfater duodenum 1 4. With regard to benign neoplasms of the small intestine, which of the following are true statements? A. Villous adenomas occur most commonly in the part of duodenal bulb B. Adenomas are the most common symptomatic benign neoplasm and may present with gastrointestinal bleeding C. All of the above D. Many are asymptomatic and onlyfoundasincidentalfindings E. Peutz-Jegher Syndrome is associated with multiple adenomatous polyps throughout the small intestine LamultiplehamartomasintheattractelevatedriskofGIbreastpancreaticcervicalovarianandtesticularcancers 5. A 55-year-old woman undergoes cholecystectomy for symptomatic gallstones. The final pathology indicates gallbladder carcinoma. Which of the following statement is not true concerning this patient's prognosis and management?) A. If a full thickness tumor had been recognized at the time of cholecystectomy, an "extended cholecystectomy" may have been appropriate. B. All of the above. C. If the gallbladder carcinoma is limited to the mucosa and/or submucosa, D. If the carcinoma involves deeper layers of the gallbladder wall, the prognosis will be significantly worse E. Reoperation should be conducted in any condition. 6. What is the most common serious complication of an end colostomy? A. Parastomal hernia B. Bleeding C. Skin breakdown D. Stomal prolapse E. Colonic perforation during irrigation 7. A 25-year-old male develops diarrhea and colicky abdominal pain. Ulcerative colitis is diagnosed on colonoscopy. Which of the following findings is consistent with the diagnosis? A. The rectum is not involved. B. The incidence of colorectal cancer is equal to that of the general population. C. Microscopic examination of the mucosa reveals normal cells without evidence of dysplasia. D. The disease is confluent, there are no skip areas in the colon and the rectum is involved. E. The full thickness of the bowel wall is involved. 8. An 88-year-ole man with a history of end-stage renal failure, severe coronary artery disease, and brain metastases form lung cancer presents with acute cholecystitis. His family wants "everything done." The best management option in this patient would be A. Tube cholecystostomy B. Lithotripsy followed by long-term bile acid therapy C. Laparoscopic cholecystectomy D. Intravenous antibiotics followed by E. Open cholecystectomy 9. In addition to its absorptive and digestive roles, the small bowel also plays a significant role in the body's immune system. Gut-associated lymphoid tissue (GALT) represents a major division of the immune system. Which of the following statement(s) is true concerning the immunologic functions of the small intestine? A. IgA produced by the intestinal immune system produces the classic Fc-mediated inflammatory reactions to antigen stimulus B. The major immunoglobulin of the intestinal immune system is IgM C. Peyer's patches, an example of an aggregated cellular portion of the gut-associated lymphoid system tissue, are large collections of lymphoid follicles found on the antimesenteric border of the ileum D. All of the above E. The B lymphocytes of the small intestine do not produce immunoglobulin A 10. A 55-year-old man has had previous hemicolectomy for a carcinoma of the right colon. At this time, 3 years after the primary resection, a CT scan shows a solitary lesion in the right lobe of the liver. What is the next step in management? () A. Laser cauterization B. Hepatic artery catheterization and local chemotherapy C. Symptomatic treatment with analgesics, because the colon disease is now stage IV D. Radiotherapy E. Exploratory laparotomy and resection of the tumor 11. Which of the following statement(s) is/are true about benign lesions of the liver? A. Focal nodular hyperplasia (FNH) is a neoplasm related to birth control pills (BPs) and usually requires resection B. Adenomas are not really neoplasms and do not have to be resected C. Nodular regenerative hyperplasia does not usually accompany cirrhosis D. Adenomas are true neoplasms with a predisposition for complications and should usually be resected E. Hemangiomas are the most common benign lesions of the liver that come to the surgeon's attention 12. Male, 46-year-old. Seeking for treatment for 3 years of recurrent dizziness and nasal bleeding. Physical examination: sclera without yellow staining, liver cannot be touched, the spleen can be touched by 8cm below the ribs, ascites sign (-). The liver function is normal. Bone marrow examination shows hyperplasia of bone marrow. Examination of esophagus barium fluoroscopy shows no esophageal varicosis. The most effective treatment is: A. Application of hemostatic drugs B. Portal shunt C. Application of blood supplementing drugs D. Splenectomy E. Transfusion 13. The most common hernia content in the oblique inguinal hernia is A. Small intestine B. Caul C. Hystera D. Bladder E. Blind gut 14. All of the following are contraindications for highly selective vagotomy except: MA. Fundic peptic ulceration B. Perforated peptic ulcer disease with more than 24 hours' soilage C. Peptic ulcer disease causing gastric outlet obstruction D. Intractable duodenal ulcer disease E. Cigarette chain smoking 15. The structure contained in the hepatic pedicle is not included A. Nerve B. Hepatic portal vein C. Hepatic vein D. Hepatic artery E. Lymph-vessel 16. The first choice to judge the blood supply for the mass of breast is A. CT B. PET-CT C. Ultrasound D. none of above E. MRI 17. A pedunculated polyp, discovered incidentally at colonoscopy, is removed by snare polypectomy from the ascending colon. Invasive cancer to the level of the submucosa is identified histologically within the polyp. The lesion is well-differentiated. No lymphatic or vascular invasion is noted. The cauterized margin is negative for neoplasm. Appropriate subsequent management includes which of the following? A. Repeat endoscopy at 6 months µ B. Repeat endoscopy with fulguration of the polypectomy site C. None of the above is right D. Subtotal colectomy E. Right hemicolectomy 18. Male, 30 years old, 3 days ago there was a perianal mass after drinking alcohol, pain, discomfort, the mass skin temperature increased. a sense of fluctuation, the diagnosis is most likely A. Perianal epifolliculitis B. Multiple purulent hydradenitis C. Internal hemorrhoid D. Perianal abscess E. Thrombosed hemorrhoid 19. Which one is the most common complication of residual infection in acute pancreatitis? A. Pancreatic pseudocysts B. Shock C. Pancreatic encephalopathy D. Systemic bacterial infection E. Malnutrition and gastrointestinal fistula 20. After the portal vein blood flow is blocked, what appears first is A. Hepatic encephalopathy tf B. Congestive splenomegaly C. Portal hypertensive gastropathy D. Ascites E. Hypersplenism 21. Patients who score between () are categorized as moderate brain injury. A. 3--9 B. 3—8 C. 9—12 D. 10—13 E. 13-15 22. Living-related right lobe liver transplantation can be justified currently for: A. any patient requiring re- transplantation for chronic rejection B. children C. any patient with cirrhosis who has an identical twin D. non-urgent adults with cirrhosis and poor quality of life on a waiting list for a liver transplant E. any patient with an urgent need for transplant such as fulminant hepatic failure or hepatocellular carcinoma (HCC) 1. What is the concentration of mannitol used in elevated ICP: A. 0.5 B. 0.4 C. 0.3 D. 0.2 E. 0.1 2. Acute subdural hematoma involves emergent operative removal by craniotomy for lesions more than A. 3-cm thick B. 2-cm thick C. 1.5-cm thick D. 1-cm thick E. 0.5-cm thick 3. Which part of the brain is incarcerated in subfalcine herniation: A. Cingulate gyrus mostcommonform underfatxcerebvi B. Precentral gyrus occurswhen braintissuedisplace C. Transverse temporal gyri cingulategurus D. Uncinate gyrus E. Cerebellar tonsil 4. Which of the following are liver waste products? A. Bilirubin B. Bile salts C. Cholesterol D. Electrolytes E. Vitamins 5. The blood supply of the liver coming from the portal vein accounts for A. 30-35% B. 40-45% C. 50-55% D. 60-65% E. 70-75% 6. The most serious consequence recorded so far in living-related liver donors is: ( A. Small-bowel obstruction B. Infection C. Requirement for liver transplantation D. Death E. Nile-leak 1. What is the simple way to further clarify the inspection? A. Blood amylase assay B. White blood cell count and classification C. X-ray abdominal plain film D. Urine amylase assay E. Peritoneal puncture fluid to check the amount of amylase 2. Which is quicker, safer for management of uncooperative patients, and safer for the environmental issues of loose ferromagnetic materials near? A. MR B. DSA C. CT D. X ray E. Ultrasound 3. Young female patients have unclear breast lumps and there is obvious pain during menstruation. What is the possible diagnosis? A. Breast cancer B. Mammitis C. Mastopathia D. Fibroadenoma of breast E. Cyclomastopathy 4. Which of the following complications of portal hypertension often requires surgical intervention (for more than 25% of patients) A. Hyposplenia. B. Variceal hemorrhage. C. Ascites. D. Encephalopathy. E. Portal hypertensive gastropathy 5. Patient with which GSC score should be considered as severe TBI. A. 6 or less B. 7 or less C. 8 or less D. 9 or less E. 10 or less 6. The length of the rectum is A. 5~15 cm B. 12~15 cm C. 10~20 cm D. 15~25 cm E. 25~30 cm 7. Which part of the neck mass should consider thyroid adenoma A. Lateral part of the neck B. Submaxillary region C. ln front middle area of the neck, and goes up and down with swallowing activities D. In front middle area of the neck, and move with the tongue activity E. Lumps are particularly huge 8. Which of the following types of colonic polyps is associated with the highest incidence of malignant degeneration? A. Tubular adenoma B. Tubulovillous adenoma C. Villous adenoma D. Hamartomatous polyp E. Inflammatory polyp  Sheena -16500219 Surgery 1 SINGLE CHOICE QUESTIONS 1. Presumptive diagnosis of appendicitis; 60 cm mass proximal to ileocecal valve? Merkel? Intestinal duplication? Ilioilleal intussception? 2. Most common non-obstetric surgical emergency that happens in pregnancy, right abdominal pain. Acute fatty liver? Appendicitis? Cholecystitis 3. Oral contraceptive-6cm hepatic adenoma formation. What is your management? Stop oral drugs then CT scan, resection? 4. Most common benign tumor of brain (Meningiomas) 5. CNIX is which one? (Glossopharyngeal) 6. Acute cholangitis symptoms- Charcot’s triad 7. Which is not part of essential diagnosis of intestinal obstruction? 8. Big gallstone in common bile duct, plus polypoid mass in fundus of gallbladder. What is the indication for cholecystectomy? Mass>0.5, symptoms, absence of shadowing on x-ray 9. Which is not used for viewing gallstones? CT, ERCP, MRCP? 10. Which is not a causative factor of acute pancreatitis? Hyperglycemia 11. In splenectomy for ITP, what is most likely going to give long term remission? High reticulocyte count? Enlarged spleen? CRP? 12. Which is not part of child pugh score? Serum sodium 13. What determines TBI severity? Mechanism? Acute symptoms? Number and size of lesion on scans? 14. A 70-year-old man presents with reducible inguinal mass, what is not a causative factor? Congenital? Smoking? Age? 15. An elderly man complains of no bowel movement for a few days; no other major symptoms. What is your management? Laxative and enema? Abdominal CT? Digital examination? 16. Gastric cancer, last year T1N0M0, cramping pain, relieves in supine position and on right side, extreme pain on examination. What is the diagnostic test you would do? X-ray? Abdomen with IV contrast? Contrast abdominal CT? Gastroscopy 17. Right hemicolectomy done, develops dilation, pain, tenderness, dilated loops on X-ray, late vomiting. What is the cause? Distal small bowel obstruction? Proximal small bowel obstruction? Closed loop bowel obstruction? 18. Underwent a surgery recently, develops leg edema, what is the cause? Deep vein thrombosis 19. Best test for gallstones diagnosis? Sonography? CT? ERCP? 20. Anatomy of the peritoneal surface? Semipermeable or permeable with visceral like surface or cutaneous like surface 21. Best imaging technique for pancreatic cancer? CE-CT 22. Diabetic patient, pulsating abdominal mass? What is the probable diagnosis? AAA, abdominal tumor 23. Most important complication of deep vein thrombosis? Pulmonary embolism (PE) 24. Which are used to treat hepatocellular carcinoma? Resection, liver transplantation, TACE 25. Screening tool for breast cancer? Mammography 26. What is the best screening for early gastric cancer? Gastroscopy? Gastric acid tests? 27. Most important clinical manifestation of liver abscess? Pain-fevers-, brown pus aspirate 28. Which one is not benign breast disease? Paget’s disease 29. Pregnant woman, enlarged thyroid, shaking, what management? Anti-thyroid drugs? Surgery? Radioiodine 30. Main peritoneal lymphatic drainage? Left thoracic duct? 31. Biomarker of breast cancer (BRC1 and BRC2) 32. Nerves 33. Most common anal fissure (tearing) 34. T2N1M0 tumor size of breast cancer (2 to 5cm) 35. Most common peritonitis (Acute Bacterial Secondary Peritonitis)  Sheena -16500219 36. TBI 37. Cholestitis 38. Gastroduodenal perforation causes mild peritonitis 39. The protubent part of the human breast is generally described as overlying ____ (A) the 2nd to 6th ribs (B) the 2nd to 7th ribs (C) the 1st to 6th ribs (D) the 1st to 7th ribs TERMS 1. Calot’s triangle 2. Sentinel pile 3. Early gastric carcinoma 4. Hesselbach’s triangle 5. Charcot’s triad 6. Virchow’s triad 7. Recto-anal ring 8. if Main syndrome of increased ICP 9. Late dumping syndrome 10. Wallerian degeneration 11. Ankle brachial index (ABI) 12. Mirrize’s Disease 13. Pancreatic pseudocyst 14. Lucid interval 15. Familiar Adenomatous Polyposis (FAP) 16. 5 P Signs 17. Subclavian Steal Syndrome (SSS) 18. OPSI 19. Primary brain injury 20. McBurney Point 21. Remnant gastric carcinoma 22. Anorectal ring 23. Claudication SHORT ANSWER QUESTIONS 1. Management of increased ICP 2. Most likely cause of massive upper gastrointestinal hemorrhage and its management. 3. Damage control surgery 4. Evaluation of arterial occlusion of limb 5. Causes of pancreatitis toga 6. Pathology of abdominal hernia 7. Describe the types of gastric reconstruction after distal gastrectomy 8. Clinical features of strangulated intestinal obstruction 9. Complications of Thyroid surgery 10. What are the investigative ways of the biliary tract? 11. Blood supply of the stomach 12. Investigations of Thyroid cancer 13. Treatment of intestinal obstructions 14. Investigations of thyroid nodules 15. Significance of dentate line 16. DAI: diffuse axonal injury 17. Symptoms of rectal prolapse 18. What is the intracranial contents? What are the 3 main symptoms for increased ICP?  Surgery 1 MBBS 2018 (50 MCQs) 1. What is the order of repairing the stomach jejunum, and ileum perforation caused by closed abdominal injury? A. stomach, jejunum, and ileum B. ileum, jejunum, stomach C. jejunum, ileum, stomach D. Ileum, stomach, jejunum 2. Which of the following treatments most effectively preserves hepatic portal perfusion? A. Side-to-side portacaval shunt. B. End-to-side portacaval shunt. C. Conventional splenorenal shunt D. Distal splenorenal shunt 3. The most common functional pituitary tumoris: A. Growth hormone-secreting tumor B. Gonadotrophic adenomas C. Corticotrophic adenomas D. Thyrotrophic adenomas E. Prolactinomas 4. Which of the following is not a surgical contraindication for hyperthyroidism A. Late pregnancy B. midtrimester of pregnancy, basal metabolic rate: +60% C. adolescent D. Symptom is lighter 5. Which of the following is an essential drug preparation for patients with hyperthyroidism before surgery? A. iodine B. carbimazole C. temperantia D. propylthiouracil E. inderal 6. Which of the following statements about upper extremity edema is/are true? A. Distal venous obstructions are more likely than proximal venous obstructions to cause symptoms in the upper extremity B. All of the above C. Lymphedema is more common than venous edema D. All patients with symptomatic upper extremity venous thrombosis should receive fibrinolytic therapy E. Lymphoedema is less common than venous edema 7. Which is not a reliable indication for surgical exploration after abdominal injury? A. Abdominal pain B. Pulse increases, temperature rises C. Free gas under the diaphragm D. Disappearance of bowel sounds E. Blood pressure tends to drop 8. The formation of the superficial inguinal ring A. Subcutaneously fascia superficialis B. Musculus transversus abdominis C. None of above D. Internal oblique muscle of abdomen E. External oblique muscle tendon of abdomen 9. What is the concentration of mannitol used in elevated ICP. A. 20% B. 50% C. 10% D. 30% E. 40% 10. When a patient can only make incomprehensible sounds, how many points can this patient score in Glasgow Coma Scale A. 2 B. 4 C. 6 11. Which statement regarding adenocarcinoma of the pancreas is true? A. It is nonresectable if it presents as painless jaudice B. It can usually be resected if it presents in the body or tail of the pancreas and does not involve the common bile duct C. It is associated with diabetes insipidus D. It occurs most frequently in the body of the gland E. It carries a 1-2% b year survival rate 12. The most common site of metastasis in the development of breast cancer lesions is: A. Axillary lymph nodes B. Brain C. Lung D. Liver E. Deltopectoral lymph nodes 13. What is the most common content of abdominal hernia A. cecum B. Omentum C. Small intestine D. bladder E. sigmoid colon 14. The contraindication of liver puncture A. posthepatitis cirrhosis B. primary hepatic carcinoma C. bacterial hepatic abscess D. hepatic cyte 15. The common location of ganglioglioma is A. Cerebellum B. Internal capsule C. Pons D. Occipital lobe E. Temporal lobe 16. A 48-year-old woman presents with several hours of acute right upper quadrant pain, low grade fever, and nausea and vomiting. Which of the following statement is true concerning her diagnosis and management? A. Laparoscopic cholecystectomy is clearly contraindicated f G B. None of the above C. Appropriate antibiotic should be used. D. A positive bile culture can be expected in virtually 100% of patients with this scenario X E. A mild elevation of her bilirubin (< 3mg/dI) would strongly suggest a… 2 17. What is the cause of postoperative crisis in hyperthyroidism? EA. Intraoperative fluid insufficiency B. infection C. Inadequate preoperative preparation D. psychentonia E. Postoperative bleeding 18. Five days after an uneventful cholecystectomy, an asymptomatic middle- aged woman is found to have a serum sodium level of 120 meg/L. Proper management would be: 6A. Administration of hypertonic saline solution - B. Aggressive diuresis with furosemide C. Hemodialysis D. Plasma ultrafiltration E. Restriction of free water 19. Which should be the first to be explored when exploratory laparotomy is performed during abdominal closed injury A. pancreas B. colon GC. liver and spleen D. Stomach and duodenum 20. Which of the following tumor belongs to high-grade gliomas: A. Oligodendroglioma - B. Medulloblastoma C. Mixed Gliomas OD. Gliosarcoma E. Astrocytes 21. The main risk that may occur after liver and spleen injury is: A. Systemic infection B. Gastrointestinal bleeding C. peritonitis D. Intestinal paralysis & E. Intraperitoneal haemorrhage - 22. Which does not support the diagnosis that abdominal visceral has been injured in abdominal closed - injuries A. Early shock O - B. Active bowel sounds C. Signs of peritoneal irritation D. Shifting dullness(+) E. Signs of pneumoperitoneum 23. What is the goal of PaCO2 for hyperventilation A. 22-26 mm Hg B. 18-22 mm Hq C. 18-26 mm Hg D. 16-32 mm Hg E. 26-30 mm Hg 24. For patients with abdominal closed injuries suspected of ruptured abdominal cavity organs, the wrong treatment during the observation period is A. Use broad-spectrum antibiotics B. Gastrointestinal decompression C. Prohibition of diet D. Supplement the blood volume E. Injecting analgesic 25. The treatment principle of blunt abdominal trauma combined with shock is A. Blood transfusion and administration of antibiotics B. Emergency laparotomy C. Anti-shock and simultaneous laparotomy D. Blood transfusion and administration of hemostat E. Active anti-shock treatment and surgical exploration after shock correction 26. Patients who score between() are categorized as moderate brain injury. A. 10--13 B. 3--9 C. 9--12 D. 13--15 27. What is the most valuable sign of closed abdominal injury? A. Reduced bowel sounds B. Increased bowel sounds C. abdominal tenderness D. nausea and vomiting E. Signs of peritoneal irritation 28. Which of the following conditions is associated with increased risk of breast cancer? A. Atypical hyperplasia. B. Fibrocvstic mastopathy. C. Acute mastitis D. Papillomatosis. E. Severe hyperplasia. 29. A 55-year-old man who is extremely obese reports weakness, sweating, tachycardia, confusion, and headache whenever he fasts for more than a few hours. He has prompt relief of symptoms when he eats. These symptoms are most suggestive of which of the following disorders? A. Zollinger-Ellison syndrome B. Diabetes mellitus C. Carcinoid syndrome D. Multiple endocrine neoplasia,type Il E. Insulinoma 30. The most dangerous complication of portal hypertension is: A. Congestive splenomegaly B. Thrombocytopenia C. Hepatic encephalopathy D. Refractory Ascites E. Bleeding of esophageal gastric varices rapture 31. The main risk that may occur after liver and spleen injury is A. Intraperitoneal hemorrhage B. Systemic infection C. Gastrointestinal bleeding D. Intestinal paralysis E. peritonitis 32. The main cause of increased pulse pressure in patients with hyperthyroidism A. emotional stress B. decreased increased heart rate C. Diastolic blood pressure D. Increased systolic pressure 33. The main treatment for abscess caused by acute mastitis is A. Incision and drainage B. Physical therapy C. Anti-inflammatory D. Stop breastfeeding 34. Which statement concerning cholangitis is A. The most common infecting organism is Staphylococcus aureus 35. Main anatomic and pathological basis of inguinal hernia A. Weak inquinal ligament B. Abdominal oblique muscle weakness C. Abdominal fascia weak D. Intra-abdominal muscle bow lower edge position is low E. Weak ligament 36. Which is not the three main components in bile? A. Bile salts B. Phospholipids C. Bile pigment D. All above are not 37. What structure likely was injured in Epidural Hematoma? A. Superior sagittal sinus B. Basilar arterv C. Vertebral artery D. Middle meningeal artery E. Dural venous sinus 38. The most easily damaged substantive organ in closed abdominal injury is: A. Pancreas B. Spleen 39. What is true with reference to small bowel physiology migrating motor complexes (MMC)? A. They are increased after feeding. B. The occur once every 10 minutes C. They inhibit nutrient absorption. D. They continue througnout laparotomy. 40. Which of the following is incorrect about intestinal obstruction? A. Obstructed bowel with obstruction of blood flow is strangulated intestinal obstruction B. Stranguated intestinal obstruction is necessarily a complete intestinal obstruction C. Obstruction of the ileum is a high obstruction of intestine D. Obstruction of intestine often occurs in patients with history of surgery E. Incomplete intestinal obstruction is mostly simple intestinal obstruction 41. Most patients with lymphedema can be managed by A. Lymphatic bypass using an autogenous vein graft B. Elevation, elastic support garments, and massage therapy or mechanical pneumatic compression C. All of the above D. Pedicle transfer of lymphatic bearing tissue into the affected area E. Excision of hypertrophic scarred fibrotic skin and subcutaneous tissue down to muscle fascia and coverage with split-thickness skin grafts 42. Pineal tumors occurs mainly in A. Young adults B. Female C. Children D. The elderly 43. The structure contained in the hepatic pedicle is not included A. Lymph-vessel B. Hepatic artery C. Hepatic portal vein D. Nerve E. Hepatic vein 44. which is quicker, safer for management of uncooperative patients, and safer for the environmental issues of loose ferromagnetic materials near A. X ray B. Ultrasound C. CT D. MR E. DSA 45. The diagnostic criteria of prolactin levels for prolactinoma is A. >50 ng/mL B. >100 ng/mL C. >200 ng/mL D. >150ng/ml E. > 250 ng/mL 46. The most common incarcerated abdominal hernia A. direct hernia B. Sliding hernia C. irreducible hernia D. femoral hernia E. Incisional defect 47. The most easily damaged substantive organ in closed abdominal injury is A. Liver B. Pancreas C. Adrenal gland D. Spleen E. Kidney 48. Which of the following comments does not describe hypersplenism? A. It is associated with immune response B. It requires evaluation of the myeloproliferation. C. It may occur without underlying disease identification. D. It may be secondary to many hematologic illnesses. 49. Useful methods for detection of splenic injury is A. Diagnostic peritoneal lavage B. Isotope scan C. Magnetic resonance imaging (MRI) D. CT E. Ultrasonography