TEST EXAM

A 65-year-old male is diagnosed with gastric carcinoma on endoscopy performed due to weight loss. Heavy smoker. Which of the following findings on examination will raise the suspicion for metastatic disease?

Enlarged supraclavicular node (Virchow node)

Correct Incorrect Correct answer

Enlarged umbilical node (Sister Mary Joseph node)

Correct Incorrect Correct answer

Ovarian mass (Krukenberg tumor)

Correct Incorrect Correct answer

All of the above

Correct Incorrect Correct answer

All of the following fit peptic ulcer disease, except:

Pallor

Correct Incorrect Correct answer

Jaundice

Correct Incorrect Correct answer

Multiple vomiting

Correct Incorrect Correct answer

Upper abdominal pain

Correct Incorrect Correct answer

Which of the following can cause intrinsic cardiogenic shock?

Cardiac tamponade

Correct Incorrect Correct answer

Sepsis

Correct Incorrect Correct answer

Tension pneumothorax

Correct Incorrect Correct answer

Myocardial infarction

Correct Incorrect Correct answer

Which of the following is the most common etiology of small bowel obstruction?

Tumors of the small bowel

Correct Incorrect Correct answer

Adhesions following bariatric surgery

Correct Incorrect Correct answer

Intestinal malrotation

Correct Incorrect Correct answer

Adhesions following abdominal or pelvic surgery

Correct Incorrect Correct answer

A 30-year-old healthy female is diagnosed with left breast mass. Ultrasound demonstrates a simple 3 cm cyst. Which of the following is correct?

A breast mass larger than 2 cm necessitates surgical removal

Correct Incorrect Correct answer

Cancerous tumors are very common in breasr cysts and therefore surgical removal is warranted

Correct Incorrect Correct answer

Patients with breast cysts are at an increased risk for developing breast cancer and therefore should be invited for follow-up every 3 months

Correct Incorrect Correct answer

The cyst should be surgically removed with wide margins if cyst aspiration produces green or yellow fluid

Correct Incorrect Correct answer

No further treatment is warranted if ultrasound demonstrates simple cyst and aspiration produces straw-colored fluid

Correct Incorrect Correct answer

A 60-year-old female undergoes routine mammography and biopsy of right breast suspicious clustered calcifications. DCIS is diagnosed. What is the most appropriate management?

Mastectomy is indicated but immediate reconstruction should be avoided due to high local recurrence rates in the first few years

Correct Incorrect Correct answer

Mastectomy is preferred over breast conserving surgery in DCIS due to high local recurrence rates, even if breast conserving surgery can be technically performed

Correct Incorrect Correct answer

Mastectomy is preferred due to increased long term survival in comparison to breast conserving surgery

Correct Incorrect Correct answer

Adding Tamoxifen to patients with DCIS decreases local recurrence rates mainly in young patients

Correct Incorrect Correct answer

There is no indication for adjuvant Tamoxifen treatment in this patient if she will be treated with breast conserving surgery and radiation

Correct Incorrect Correct answer

A 65-year-old male is diagnosed with 3 cm breast mass. On biopsy – breast carcinoma. Which of the following is correct?

Repeat biopsy is recommended due to the rarity of breast cancer in males

Correct Incorrect Correct answer

This is most probably lobular breast carcinoma

Correct Incorrect Correct answer

Most male patients report a long course of gynecomastia before the diagnosis of breast cancer

Correct Incorrect Correct answer

Local and systemic spread will determine the extent of surgery

Correct Incorrect Correct answer

In most cases there is no role for antihormonal therapy since ER/PR positive tumors are rare in male patients

Correct Incorrect Correct answer

A 60-year-old male with Crohn’s disease is a candidate for Whipple surgery due to pancreatic tumor. Four months prior to his current admission he was admitted with Crohn’s disease exacerbation and was treated with 40 mg prednisone per day that was later tapered after his discharge.

Which of the following steroid dose is recommended prior to anesthesia induction?

300 mg hydrocortisone

Correct Incorrect Correct answer

200 mg hydrocortisone

Correct Incorrect Correct answer

100 mg hydrocortisone

Correct Incorrect Correct answer

50 mg hydrocortisone

Correct Incorrect Correct answer

500 mg hydrocortisone

Correct Incorrect Correct answer

An 80-year-old male has hypertension and diabetes that are medically controlled. He is a smoker, independent, and active (swims 45 minutes twice a week). He is a candidate for left inguinal hernia repair. Which of the following preoperative tests is recommended?

Mini-Cog evaluation

Correct Incorrect Correct answer

Echocardiography

Correct Incorrect Correct answer

Carotid arteries Doppler

Correct Incorrect Correct answer

Glucose tolerance test

Correct Incorrect Correct answer

Pulmonary function tes

Correct Incorrect Correct answer

A 50-year-old male with cirrhosis is clear minded, oriented to time and place, and coherent. He is a candidate to an elective surgery due to colon cancer. On examination – no ascites. Labs – bilirubin 2.4, albumin 3, PT 18 seconds, INR 2. Which of the following is recommended?

Start diuretics

Correct Incorrect Correct answer

Correct coagulopathy

Correct Incorrect Correct answer

Start beta blockers, lactulose, and sandostatin

Correct Incorrect Correct answer

Improve serum albumin level

Correct Incorrect Correct answer

Liver biopsy

Correct Incorrect Correct answer

A 58-year-old male is a candidate for elective inguinal hernia repair. He is treated with apixaban (Eliquis) doe to chronic atrial fibrillation. How long before surgery this medication should be stopped to avoid surgical bleeding?

6 hours prior to surgery

Correct Incorrect Correct answer

12 hours prior to surgery

Correct Incorrect Correct answer

24 hours prior to surgery

Correct Incorrect Correct answer

2-3 days prior to surgery

Correct Incorrect Correct answer

1 week prior to surgery

Correct Incorrect Correct answer

All of the following are associated with developing incisional hernia, except:

Morbid obesity

Correct Incorrect Correct answer

Chronic lung disease

Correct Incorrect Correct answer

Hypertension and renal failure

Correct Incorrect Correct answer

Surgical site infection

Correct Incorrect Correct answer

Which of the following is the most common incarcerated hernia?

Femoral

Correct Incorrect Correct answer

Umbilical

Correct Incorrect Correct answer

Inguinal

Correct Incorrect Correct answer

Incisional

Correct Incorrect Correct answer

A 60-year-old healthy female with no prior surgeries is admitted to the ER due to diffuse abdominal pain and vomiting in the past several hours. On examination – tender, distended abdomen. Abdominal X-ray – air fluid levels compatible with small bowel obstruction. Which of the following is the most likely diagnosis?

Duodenal ulcer perforation

Correct Incorrect Correct answer

Incarcerated femoral hernia

Correct Incorrect Correct answer

Acute cholecystitis

Correct Incorrect Correct answer

Perforated appendicitis

Correct Incorrect Correct answer

A 70-year-old male with no past medical history is evaluated for right inguinal pain in the past 6 hours. On examination – a tender 6 cm mass. What is the next step in management?

Abdominal CT

Correct Incorrect Correct answer

Mass aspiration

Correct Incorrect Correct answer

Urgent surgery

Correct Incorrect Correct answer

Inguinal ultrasound

Correct Incorrect Correct answer

An 80-year-old male is admitted to the ER due to severe inguinal pain in the past 2 hours. On examination – a 5 cm rigid, tender, right inguinal mass. Surgery is decided with the diagnosis of incarcerated inguinal hernia. The patient is on Plavix due to atrial fibrillation. While waiting for surgery the patient reports improvement in pain and on repeat examination the mass is gone. What is the most recommended approach?

Patient can be discharged with planned elective hernia repair

Correct Incorrect Correct answer

Proceed with the original surgical plan

Correct Incorrect Correct answer

Admit the patient for observation, discharge after 24 hours with follow-up by his primary physician

Correct Incorrect Correct answer

Admit the patient for observation and operate within the same admission after Plavix discontinuation

Correct Incorrect Correct answer

Which of the following is the most common wound healing inhibitor?

Hypocalcemia

Correct Incorrect Correct answer

Infection

Correct Incorrect Correct answer

Vitamin B6 deficiency

Correct Incorrect Correct answer

Aspirin treatment

Correct Incorrect Correct answer

Ringer lactate solution contains all of the following, except:

Sodium

Correct Incorrect Correct answer

Potassium

Correct Incorrect Correct answer

Calcium

Correct Incorrect Correct answer

Magnesium

Correct Incorrect Correct answer

Wound healing has several stages. Which of the following blood cells is the most dominant in the first two days of wound healing (inflammation phase)?

Lymphocytes

Correct Incorrect Correct answer

Macrophages

Correct Incorrect Correct answer

Fibroblasts

Correct Incorrect Correct answer

Neutrophils

Correct Incorrect Correct answer

A 30-year-old male is operated for right lower abdominal pain and tenderness and suspected appendicitis. Upon scope insertion the following terminal ileum finding is demonstrated (photo). The appendix is normal.

Which of the following is suspected?

Lymphoma

Correct Incorrect Correct answer

Crohn’s disease

Correct Incorrect Correct answer

Perforated adenocarcinoma

Correct Incorrect Correct answer

Typhoid enteritis

Correct Incorrect Correct answer

A 73-year-old male presents with acute lower gastrointestinal bleeding. Which of the following is the most common etiology?

Hemorrhoids

Correct Incorrect Correct answer

Inflammatory bowel disease

Correct Incorrect Correct answer

Arteriovenous malformation (AVM)

Correct Incorrect Correct answer

Diverticulosis

Correct Incorrect Correct answer

A 57-year-old male, psychiatric patient, is admitted due to abdominal distention and lack of bowel movements for the past two days. On examination – blood pressure 130/85, pulse 92/min, T 37.6C. Abdomen – very distended, no significant tenderness, empty ampulla on rectal examination. Abdominal X-ray is given below.

Which of the following is the most appropriate next step?

Laxatives and polyethylene glycol

Correct Incorrect Correct answer

Endoscopic decompression

Correct Incorrect Correct answer

Laxatives and enemas

Correct Incorrect Correct answer

Diagnostic laparoscopy

Correct Incorrect Correct answer

A 50-year-old female is brought to the ER after being hit by a car as a pedestrian. On admission – blood pressure 110/70, pulse 110/min, no free fluid on focused assessment with sonography in trauma (FAST). Pelvic X-ray – multiple pelvic fractures consistent with open book formation. All of the

following may assist in stabilizing this patient, except:

Pelvic sheet wrap

Correct Incorrect Correct answer

Angiography

Correct Incorrect Correct answer

Extraperitoneal packing

Correct Incorrect Correct answer

Exploratory laparotomy

Correct Incorrect Correct answer

A 25-year-old male is admitted to the ER following a knife stab to the abdomen. On admission – fully conscious, no distress, hemodynamically stable. Abdomen – stab wound under the umbilicus approximately 10 cm to

the left of the midline, omentum outside the skin, no peritonitis.

Which of the following is the next step in management?

Abdominal CT

Correct Incorrect Correct answer

Exploratory laparotomy

Correct Incorrect Correct answer

Local wound exploration

Correct Incorrect Correct answer

Focused assessment with sonography in trauma (FAST)

Correct Incorrect Correct answer

A 49-year-old male with previous abdominal surgeries is admitted to the ER due to abdominal pain and vomiting. Abdominal X-ray is below.

Which of the following is the most likely diagnosis?

Colitis

Correct Incorrect Correct answer

Small bowel obstruction

Correct Incorrect Correct answer

Diverticulitis

Correct Incorrect Correct answer

Large bowel obstruction

Correct Incorrect Correct answer

A 70-year-old male is admitted with fever, chills, right upper quadrant pain, and scleral jaundice. Abdominal ultrasound – cholelithiasis and bile duct dilation. Which of the following is the most recommended next step?

Hepatic iminodiacetic acid (HIDA) scan

Correct Incorrect Correct answer

Triphasic abdominal CT

Correct Incorrect Correct answer

Endoscopic retrograde cholangiopancreatography (ERCP)

Correct Incorrect Correct answer

Percutaneous transhepatic cholangiography (PTC)

Correct Incorrect Correct answer

A 65-year-old healthy female undergoes routine virtual colonoscopy (abdominal CT) that demonstrates cholelithiasis and later confirmed by ultrasound. No past medical history of abdominal pain, jaundice, or pancreatitis. The patient reports heartburn associated with certain foods that responds to oral antacids. Which of the following is recommended?

Laparoscopic cholecystectomy

Correct Incorrect Correct answer

Oral medical treatment to dissolve the stones

Correct Incorrect Correct answer

Direct injection of substance to the gallbladder to dissolve the stones

Correct Incorrect Correct answer

Observation only

Correct Incorrect Correct answer

All of the following imaging findings support the diagnosis of gallstone ileus, except:

Calcified mass at the right lower quadrant

Correct Incorrect Correct answer

Air in the bile system

Correct Incorrect Correct answer

Distended loops of small bowel with air-fluid levels

Correct Incorrect Correct answer

Distended gallbladder on US

Correct Incorrect Correct answer

A 53-year-old male is POD1 after cholecystectomy and complains of right upper quadrant severe pain, fever, chills, and large amount of bile in the drain that was left at the gallbladder bed. He also complains of fullness and lack of appetite. Which of the following is correct?

The etiology is bile leak form the cystic duct due to a clip that “fell” off the cystic duct stump

Correct Incorrect Correct answer

This is a very rare phenomena after surgery for acute cholecystitis and will self-resolve

Correct Incorrect Correct answer

The treatment should include Antipyretics, and analgesics only

Correct Incorrect Correct answer

ERCP is contraindicated due to his severe condition

Correct Incorrect Correct answer

Which of the following is the most common etiology for portal vein pyelophlebitis?

Bile duct obstruction by a stone or tumor

Correct Incorrect Correct answer

Diverticulitis, appendicitis

Correct Incorrect Correct answer

Caroli disease

Correct Incorrect Correct answer

Obstruction by ascariasis

Correct Incorrect Correct answer

All of the following are consistent with primary hyperparathyroidism, except:

A single adenoma will be found in most patients

Correct Incorrect Correct answer

Patients complain of bone pain and frequent urination

Correct Incorrect Correct answer

Fatigue and memory loss are common

Correct Incorrect Correct answer

Increased appetite

Correct Incorrect Correct answer

Which of the following is considered a negative prognostic factor in thyroid cancer?

Age below 40

Correct Incorrect Correct answer

3 cm tumor size

Correct Incorrect Correct answer

Tumor without capsular invasion

Correct Incorrect Correct answer

Male gender

Correct Incorrect Correct answer

Which of the following is considered a positive prognostic factor on CT in adrenal incidentaloma?

Relatively large amount of lipomatous content

Correct Incorrect Correct answer

Irregular borders

Correct Incorrect Correct answer

High vascularity

Correct Incorrect Correct answer

Slow contrast washout

Correct Incorrect Correct answer

A 27-year-old male is brought to the ER following a stab wound to the left flank below the rib cage. The knife is still stuck to his flank. Initial evaluation – hypovolemic shock. Which of the following is the most suitable approach?

Retrieve the knife so it will not interfere with the patient’s examination

Correct Incorrect Correct answer

Abdominal CT to rule out other injuries

Correct Incorrect Correct answer

Fluid resuscitation, quick survey for bleeding source, initiate blood products, quick transfer to the operating room

Correct Incorrect Correct answer

Intubation, transfer to ICU until stabilized with fluids and antibiotics, and then transfer to the operating room

Correct Incorrect Correct answer

A 58-year-old male is evaluated for mild epigastric pain and discomfort that started a week ago. He also complains of significant weight loss in the past several months. Which of the following is correct regarding suspected gastric tumor?

Gastroscopy, lesion biopsies, and endoscopic ultrasound (EUS) should be performed to determine the type and stage of tumor

Correct Incorrect Correct answer

Gastrectomy with wide margins should be performed regardless of the tumor location

Correct Incorrect Correct answer

Gastric cancer is usually not aggressive and survival is over 5 years

Correct Incorrect Correct answer

Neoadjuvant chemoradiotherapy followed by surgery can achieve good results in cases of locally advanced gastric cancer

Correct Incorrect Correct answer

An 80-year-old male complains of solid dysphagia, weight loss, and new hoarseness. He has reflux for many years and is treated with antacids. Upper GI Tract Barium X-ray – mid esophagus stricture. Which of the following is the most likely diagnosis?

Achalasia

Correct Incorrect Correct answer

Esophageal malignancy

Correct Incorrect Correct answer

Esophageal stricture secondary to reflux

Correct Incorrect Correct answer

Schatzki’s ring

Correct Incorrect Correct answer

Below are two photos of two patients with dysphagia. Which of the following is correct?

Patient A has a tumor of the gastroesophageal junction

Correct Incorrect Correct answer

Patient B has mid esophagus diverticulum

Correct Incorrect Correct answer

Patient A has achalasia

Correct Incorrect Correct answer

Patient B has reflux

Correct Incorrect Correct answer

A 60-year-old male with ischemic heart disease is treated with antiplatelet therapy due to catheterization last year. He arrives to the ER with malaise, cold diaphoresis, melena, low blood pressure ( 100/70 ), and tachycardia 110/min. What is the first step in management?

ER urgent gastroscopy due to upper gastrointestinal bleeding

Correct Incorrect Correct answer

Rapid fluid resuscitation, blood, and blood products as needed

Correct Incorrect Correct answer

IV antacids and helicobacter pylori eradication with antibiotics

Correct Incorrect Correct answer

Urgent surgery to stop the bleeding – the patient is unstable

Correct Incorrect Correct answer

Which of the following is correct with regards to diagnostic laparoscopy for suspected acute abdomen?

The main advantage is high diagnostic rate (over 80%)

Correct Incorrect Correct answer

It is diagnostic in 50% of the cases

Correct Incorrect Correct answer

The main advantage is diagnosis of retroperitoneal pathologies

Correct Incorrect Correct answer

Its use is decreasing

Correct Incorrect Correct answer

A 73-year-old male arrives to the ER with vomiting, acute abdominal pain, and suspected acute abdomen on physical examination. Labs – lactic acidosis. Which of the following is the next step at the ER?

Abdominal CT

Correct Incorrect Correct answer

Supine and upright or left lateral decubitus abdominal X-ray

Correct Incorrect Correct answer

Abdominal ultrasound

Correct Incorrect Correct answer

Abdominal angiography

Correct Incorrect Correct answer

A 45-year-old female is diagnosed with 4.5 cm right breast carcinoma, HER2NEU (+), ER/PR (-), and axillary lymph node involvement. She undergoes mastectomy with axillary lymph node dissection, 5 positive lymph nodes. Which of the following is correct regarding the adjuvant therapy?

Despite undergoing mastectomy there is an indication for radiation therapy

Correct Incorrect Correct answer

Radiation of the surgical field will only decrease local recurrences but will not affect survival

Correct Incorrect Correct answer

There is no role for radiation therapy if the patient will be treated with chemotherapy

Correct Incorrect Correct answer

Since the patient has positive lymph nodes then radiation should be limited to the axilla alone

Correct Incorrect Correct answer

A 55-year-old female is referred for evaluation due to suspected inflammatory breast carcinoma. Which of the following is likely to be found on examination?

Fever above 38°C at diagnosis

Correct Incorrect Correct answer

Retraction of the breast skin with ulceration

Correct Incorrect Correct answer

Thickening of the breast skin will be the only finding on mammography

Correct Incorrect Correct answer

Axillary lymph node involvement is unlikely

Correct Incorrect Correct answer

Which of the following patients will require prophylactic treatment for venous thrombo-embolism?

A 35-year-old male, a candidate for proctectomy due to malignancy

Correct Incorrect Correct answer

A 30-year-old healthy male, a candidate for laparoscopic hernia repair

Correct Incorrect Correct answer

A 35-year-old healthy male, a candidate for hemorrhoidectomy

Correct Incorrect Correct answer

A 30-year-old female, a candidate for planned cesarean section

Correct Incorrect Correct answer

A 75-year-old male is referred to the ER due to skin and scleral jaundice for the past week. On examination – skin and scleral jaundice, cachectic, right upper quadrant smooth non-tender mass. Rectal examination – acholic stool. Labs – elevated bilirubin and CA 19-9 levels. Which of the following is the correct name for this finding?

Courvoisier gallbladder

Correct Incorrect Correct answer

Positive Rovsing sign

Correct Incorrect Correct answer

Virchow node

Correct Incorrect Correct answer

Positive Murphy sign

Correct Incorrect Correct answer

Which of the following is correct regarding cancer in humans?

Cancer incidence increases in people over the age of 80 years

Correct Incorrect Correct answer

There is significant phenotype similarity between sporadic and inherited cancer

Correct Incorrect Correct answer

Approximately 5-10% of breast cancers are inherited and two genes were identified – BRCA1 and BRCA2

Correct Incorrect Correct answer

Ultraviolet radiation is the only radiation that causes malignant changes in humans

Correct Incorrect Correct answer

A 22-year-old male arrives to the ER following a gunshot wound to the pelvis. He rapidly deteriorates and one of your colleagues is worried that he will develop the lethal triad of trauma. Which of the following correctly describes this triad?

Acidosis, hypothermia, coagulopathy

Correct Incorrect Correct answer

Acidosis, hyperthermia, hyper coagulopathy

Correct Incorrect Correct answer

Alkalosis, hypothermia, coagulopathy

Correct Incorrect Correct answer

Alkalosis, hypothermia, hyper coagulopathy

Correct Incorrect Correct answer

A 69-year-old healthy male is diagnosed with rectal tumor, 7 cm from the anal verge. Total body CT and pelvic MRI demonstrate the tumor invading all the muscle layers (T3) and involved lymph nodes next to it. No distant metastases. What it the recommended step on his treatment?

Abdominoperineal resection

Correct Incorrect Correct answer

Low anterior resection

Correct Incorrect Correct answer

Transanal endoscopic microsurgery

Correct Incorrect Correct answer

Neoadjuvant chemoradiotherapy

Correct Incorrect Correct answer

Which of the following is the most common location of the base of the appendix in acute appendicitis?

Plevis (61%)

Correct Incorrect Correct answer

Where the three taeniae coli merge

Correct Incorrect Correct answer

Along the Toldt line

Correct Incorrect Correct answer

Next to the right colic artery that supplies the appendix

Correct Incorrect Correct answer

A 20-year-old male complains of severe anal pain that increase during defecation as if “knives are cutting him” and accompanied by fresh blood. This started after an episode of constipation. The patient refuses rectal examination because every contact causes pain and there are no masses outside the anus. Which of the following is recommended on top of stool softeners and analgesics?

Topical ointment based on calcium channel blockers or nitrates

Correct Incorrect Correct answer

Incision over the hemorrhoid and clot evacuation

Correct Incorrect Correct answer

Surgical resection of internal hemorrhoids

Correct Incorrect Correct answer

Anal dilatation

Correct Incorrect Correct answer

Which of the following bariatric procedures is considered restrictive only?

Band (LAGB)

Correct Incorrect Correct answer

Biliopancreatic diversion (BPD)

Correct Incorrect Correct answer

Roux-en-Y gastric bypass

Correct Incorrect Correct answer

Duodenal switch (DS)

Correct Incorrect Correct answer

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