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SURGERY [SAGARALIAS11] EDITION
- What is the main complications after tension hernia repair? a) Strangulations b) Prosthetic material intolerance c) Local tissue ischemia and necroses d) Less chronic pain after surgery
- The method of choice for esophageal foreign body removal is: a) Esophagoscopy b) Partial esophagectomy c) X-ray investigation d) Computed tomography
- All of the following symptoms and signs are indicative of a tension pneumothorax EXCEPT a) Chest pain b) Shortness of breath c) Absent breath sounds unilaterally d) Shifting of the trachea toward the pneumothorax
- The wall of inguinal canal consists with these units, except a) Transversus abdominis b) Internal oblique c) Inguinal ligament d) Rectus abdominis
- Portal venous pressure normally ranges from a) 1 to 4 mm Hg b) 4 to 4 mm Hg
c) 7 to 10 mm Hg d) 10 to 15 mm Hg
- A 24-yaer-old man involved in a motor vehicle accident present with blood pressure 80/60, heart rate 135, and respirations 45 and labored. Physical examination reveals agitation, sternal flail, and absent breath sounds in the left hemithorax, which is crepitant to palpation and resonant to percussion. The initial maneuver should be: a) A chest radiographs b) Intubation c) Insertion of a tube in the left chest (Place a left chest tube) d) Start-up two large-bore intravenous needles
- Which of the following statement is true for incisional hernia? a) Most incisional hernia will occur with 2 years of the surgery b) Transverse abdominal incisions are less likely herniate than vertical incisions c) Non-absorbable meshes placed at initial surgery will reduce the risk of subsequent incisional herniation d) Open mesh repair of incisional hernia has a higher wound infection rate but lower recurrence rate when compared with laparoscopic mesh repair
- Massive bleeding from the lower gastrointestinal tract is occurring in a 55- year-old man who is otherwise healthy. After continued bleeding equivalent to one unit of blood, what should the initial management be? a) Emergency laparotomy and total colectomy and ileoproctostomy b) Emergency laparotomy and colostomy with operative endoscopy c) Arteriography to identify the bleeding site after anoscopy and sigmoidoscopy have ruled out a distal site d) Infusion of vitamin K and fresh frozen plasma
a) Tracheostomy might be performed under local anesthetic b) Tracheostomy increases the work of breathing c) Tracheostomy increases the anatomical dead space by appro.50% d) Alveolar ventilation is decreased
- Complications of the hemorrhoid disease are a) Pain b) Laceration c) Thrombosis and entrapping of the hemorrhoids d) Swelling of the anal canal
- All of the following statements about achalasia are true EXCEPT: a) in most affected individuals, ganglion cells in the body of the esophagus either are absent or have degenerated b) pressure in the body of the esophagus is lower than normal c) it occurs most commonly in individuals between 30 and 50 years d) affected individuals usually experience more difficulty swallowing cold food than warm food
- What is the main treatment for infants umbilical herniation? a) Immediately open hernia repair using mesh to prevent the complications b) Do not open hernia repair without mesh c) Infantile umbilical hernias resolve spontaneously, and no surgical treatment is indicated under the age of 2 years unless complications occur d) Using laparoscopic hernia repair technique
- What is the most reliable method for precisely locating an upper gastrointestinal lesion that is responsible for a bleed? a) Upper GI series
b) Exploratory laparotomy c) Upper gastrointestinal endoscopy d) Arteriography
- Patient complains long-standing dysphagia about 2 years, occasionally he has regurgitation of foul- smelling state food and frothy sputum. This condition is closely match: a) Diffuse esophageal spasm b) Achalasia cardia c) Rolling hiatus hernia d) Pharyngeal diverticulum
- Gastric acid production is altered by all of the following hormones or actions EXCEPT a) Cholecystokinin b) Gastrin c) Vagal stimulation d) Glucagon
- Hartmann’s Procedure means: a) Resection of the small intestine b) Right hemicolectomy with ileotransverso anastomosis c) Resection of recto-sogmoid colon with colostomy d) Partial gastrectomy with gastro-jejuno anastomosis
- A 45-year-old man is seen in the emergency department after vomiting bright red blood. he has no previous symptoms. He drinks one alcoholic beverage a day. What is the most reliable method for locating the lesion responsible for the bleeding? a) Upper Gastrointestinal series b) Exploratory laparotomy
d) Diarrhea 26.Traumatic rupture of the esophagus as a complication might be developed after: a) Esophagoscopy, bujiing, mediastinal or esophageal surgery b) Sonography c) Colonoscopy d) Irrigoscopy 27.What is the main X-ray sign for rolling hiatus hernia? a) Foreign bodies in the chest b) Gas bubble and fluid level behind the hart c) Air fluid levels (Kloiber’s cups) d) Gastro-esophageal reflux
- Main symptom of the hemorrhoid disease is: a) Bleeding b) Constipation c) Diarrhea d) Dysbacteriosis 29.Which of the following statements concerning a femoral hernia are trye a) It results from a defect in the transversalis fascia in Hesselbach’s triangle b) It may be confused with inguinal lymphadenopathy c) It may cause strangulation obstruction with no premonitory symptoms d) All of them are true
- All of the following problems commonly occur with the use of balloon tamponade for control of variceal bleeding EXCEPT a) Pneumonia
b) Aspiration of nasopharyngeal secretions c) Rebleeding fillowing removal of the tube d) Gastritis
- The most frequent complication after hernia mesh repair is a) Bowel obstruction b) Due to the migration of the mesh, it can make adhesions with intestine c) Peritonitis d) It does not have any complications
- The delta (D) cells of the pancreatic islets are now known to produse a) Insulin b) Glucagons c) Somatostatins d) Gastrin
- Which of the following statement is true? a) In case of hernia repair mesh should not be used in the presence of infection b) Mesh is mainly used to induce fibrosis, thus making a strong repair c) Mesh benefits include: tension free repair and induction of fibrosis d) Simple polypropylene mesh is an ideal choice for intra-peritoneal repair
- Empyema of the gallbladder is defined as: a) Phlegmona of all layers of the gallbladder b) Septic inflammation around the gallbladder c) Accumulation of the pus in the obstructed gallbladder d) Pus under the diaphragm alongside gallbladder
d) Resection of the tumor of sigmoid colon and transverso-rectostomy
- All of the following findings are indications for exploration of the common bile duct at the time of cholecystectomy EXCEPT a) Dilations of the duct b) Hydrops of the gallbladder c) Multiple small stones in the gallbladder d) Pancreatitis 41.Which of the following findings in acute pancreatitis is not well visualized with ultrasonography? a) Cullen’s sign b) Biliary obstruction c) Pancreatic pseudocyst d) Pancreatic calcification 42.The drug most useful for controlling massive bleeding from erosive gastritis is a) Epinephrine b) J dopamine c) Vasopressin d) Norepinephrine 43.In case of bowel obstruction, the indication for early surgical intervention is: a) Complete obstruction in a ‘virgin’ abdomen b) Incomplete obstruction in a previously operated patient c) Intensive colicky pain in the lower abdomen d) Fever, constipation, colicky pain
- Paraesophageal (rolling) type herniation means a) When esophagus with stomach migrates up into the chest b) When cardiac part of the stomach is fixed up to the diaphragm c) When the gastro-esophageal junction stays on its place and only fundus migrates up into the chest d) Hernia sack content is bowel 45.Which of the following statement is true for Ramirez technique? a) Ramirez technique is most common for inguinal hernia repair b) This operation is being replaced by the use of non-absorbable mesh c) This is an open pre-peritoneal placing a large mesh over the posterior aspect of the inguino/femoral canal area d) Lateral – releasing incisions allow the separation of the three muscle layers so that rectus muscles can be moved medially to close a central defect
- Which of the following disease leads to the massive lower intestinal bleeding? a) Diverticulitis b) Colon cancer c) Ulcerative colitis d) Crohn’s disease 47.Which of the following statements about melena (black, tarry stools) is NOT true? a) As little as 50 ml of blood may produse this sighn b) Melena usually indicates upper gastrointestinal bleeding c) The terry color is atributeble to the production of acid hematin by the action of gastric acid on hemoglobin d) Blood is the only substance proven capable of producing black stools
53.Which segment of the liver is frequently injured after liver blunt trauma? a) 2 nd segment of the left lobe b) 2 nd^ and 3rd^ segments of the left lobe c) Right half and 4 th segment of the liver d) 5 th^ segment of the right lobe
- All of the following disorders are pre- or intrahepatic (sinusoidal) causes of portal hypertension EXCEPT: a) Alcoholic cirrhosis b) Hemochromatosis c) Schistosomiasis d) Budd-Chiari syndrome 55.A 50-year-old patient is resolving from an episode of acute pancreatitis. Two weeks later he complains of persistent epigastric pain. Part of his evaluation is an ultrasound, which reveals a 4-sm cystic structure situated in the lesser sac posterior to the stomach. Treatment at this time should include which of the following? a) External drainage b) Internal drainage to the stomach c) Internal drainage into the jejunum d) Continued observation
- Which symptoms include Charcot’s triad? a) Right upper quadrant pain, jaundice, fever b) Abdominal rigidity, fever, vomiting c) Dolor, color, tumor d) Jaundice, erythema, vomiting 57.Acute severe pain in the belly (Dieulafoy sign), rebound tenderness, and X- ray presence of air under the diaphragm is typical for:
a) Perforated peptic ulcer b) Gastric malignancy c) Bowel’s obstruction d) Acute pancreatitis 58.In case of mechanical jaundice there is evidence of: a) Nonconjugated hyperbilirubinemia b) Conjugated hyperbilirubinemia c) Urobilinemia d) Stercobilinemia 59.Which approach is correct for the treatment of open pneumothorax? a) Liquidation of damaged area and placement of active drainage in the pleural cavity b) Tracheostomy c) Thoracostomy d) Set on ventilator 60.Most frequently acute peritonitis develops as a complication of: a) Acute appendicitis b) Acute pancreatitis c) Bowel’s obstruction d) Peptic ulcer perforation
- A 22-year-old gang member arrives in the emergency department with multiple gun shot wounds in chest and abdomen. His trachea is deviated to the left and right side of his chest hyper resonant to percussion with no breath sounds. which is the initial step of management? a) E. Pericardiocentesis b) Immediate chest x-ray films c) Awake endotracheal intubation
- A 68-year-old man is brought to the emergency department following a high-speed automobile. He is alert and complains of chest pain and mild back pain. His blood pressure is 80/60 mmHg. Chest x-ray chows a widened mediastinum, tracheal deviation, bronchial displacement, and loss of the aortic knob. Which of the following is the most likely diagnosis? a) Cardiac tamponade b) Myocardial contusion c) Pulmonary contusion d) Traumatic aortic rupture 67.What is necessary to do when closing thoracic cavity a) Thoracic cavity is closed without drainage tube b) Active drainage to be set in the pleural cavity c) Passive drainage is set in pleural cavity d) Buttress like suture should be used only 68.Which of the following statements about acute intussusception is true? a) The condition occurs equally in children and adults b) Intussusception in all age groups is ileocolic c) All cases of intussusception will require an operation d) It occurs in children during transition phase from breast feeding to natural food 69.During the hiatal hernia occur a) Abnormal heart rhythm b) Dysphagia c) Gastroesophageal reflux sign d) All of them
- Which of the following is characteristic for achalasia:
a) Dysphagia, regurgitation, pain b) Aerophagia c) Heartburn d) Nocturnal cough 71.Which of the following method of treatment is useful for upper GI bleeding? a) Aortography b) Sonography c) laser photocoagulation d) CT 72.Which inguinal hernia repair technique modifies Bassini operation where the posterior wall of the inguinal canal is opened from the deep inguinal ring to the pubic tubercle then closed in two overlapping layers? a) Mayo repair b) Desarda repair c) Shoulidce operation d) Billroth operation 73.What substance is secreted by the G cells? a) Gastrin b) Pepsin c) Pepsinogen d) Gastric acid
- A 68 year old man is brought to the emergency department with excruciating back pain that began suddenly 45 minutes ago. The pain is constant and is not exacerbated by sneezing or coughing. He is diaphoretic add has a systolic blood pressure of 90 mm HG. There …. Years ago, he was
79.Cause of bleeding from upper GI tract might be: a) Appendicitis b) Pancreatitis c) Mallory-Weiss syndrome d) Incarcerated hernia 80.Management of ascites and chronic liver failure does not include: a) Salt restriction and diuretics an abdominal paracentesis b) Diagnostic peritoneal lavage c) Transjugular intrahepatic portosystemic stent stent shunts (TIPS) d) liver transplantation 81.What is Pylephlebitis? a) Septic inflammation of the kidneys parenchyma b) Septic inflammation of the liver c) Septic thrombosis of the portal vein system or Septic thrombophlebitis of the vena cava d) Amoebic liver Abscess 82.A 19-year-old man sustains multiple injuries in a high speed automobile collision. there is a pneumothorax on the left, for which he has a chest tube placed. Over the next several days, a large amount of air drains continuously through the tube (a large “Alec”), and……… which of the following is the most likely cause of these findings? a) Air embolism b) Tension pneumothorax c) Injury to a major bronchus d) Insufficient suction being applied to the chest tube 83.What is the key management for corrosive injuries of the easophagus? a) Immediate surgery
b) wait and watch c) early endoscopy by an experienced endoscopist to inspect the whole of the esophagus and stomach d) esophagectomy
- Femoral foramen lateral border is represented by: a) femoral artery b) femoral vein medial surface c) Cooper's ligament d) inguinal ligament 85.A 14 year old boy presents with enlarging breasts which are embarrassing. Which of the following is the most likely diagnosis? a) breast hyperplasia b) gynecomastia c) breast cancer d) Fibroadenoma
- Patient presents repeated episodes of right upper quadrant abdominal pain. The pain is brought about by the ingestion of fatty food and is relieved by the administration of anticholinergic medications. The pain is colicky, radiates to the right shoulder and around to the back, and is accompanied by nausea and occasional vomiting. Which of the following is the most appropriate next step in management? a) Sonogram of the biliary tract with gallbladder b) Upper gastrointestinal series with barium c) Antibiotics, IV fluids, and nothing by mouth d) Endoscopic retrograde cholangiopancreatogram (ERCP)
