Promortion exam - senior, July 2009

1. Female patient with early sotiaty, CT shows a 10cm mass

that seems to arise from the rt. hepatic lobe, UGIE showed
external compression of the stomach Intraoperativley the
mass is acullay arasing from the stomach. Which is Correct?
a) This is a radiosensitive lesion
b) Lympnodes are likely to be positive
c) The usae of adjuvant Gleevac will not show any benefit on
recurrence and metastasis
d) Is likely to have positive Immunoassey
e) Best treated by enoculation

2. The 5 year survival rate for a totally exiced negative margin

0.7cm thick melanoma of the back is
a) 50%
b) 70%
c) 80%
d) More than 90%
e) 60%

3. You are consulted for a patient who is found to have high

gastrin level. Past surgical history is some sort of anti
peptic surgery. Which of the following is the likely surgery?
a) B1
b) B2
c) Nissen fundoplication
d) Gastrojujnostomy
e)

4. A patient is complaing of fatigability, he’s found to have

high serum calcium, chloride and parathmone with low
phosphate. US shows likely single enlarged parathyroid
gland. The next step is
a) CT
b) MRI
c) Sistamibi
d) MIBG
e) Surgery

5. A patient has a goiter and palpable lymnodes FNA is MTC

the correct therapy is
a) TT
b) TT + radioactive iodine
c) TT+ Modified neck dissection
 d)
e)

6. Which of the following has the lowest pH

a) NS
b) RL
c) Dextran
d) Hetastarch
e) Sodium Bicarb

7. ABG shows low pCo2 low HCO3 and normal PO2, which of
the following can cause this?
a) Emphysema
b) Mechanical ventilation
c) Enterocutanous fistula
d)
e)

8. A 24 year old lade is breast feeding she developed redness

and firmness in the central breats that resolved by
antibiotics, few months later she presents with skin area
being firm and theres a dimple. The MOST likely diagnosis is
a) Mastitis
b) Breast Abscess
c) Inflamatory breast cancer
d) Galactocele
e)

9. SNL is indicated in
a) Palpable LN
b) Inpalpable LN
c) DCIS
d) Tumor > 5cm
e) Post axillary dissection

10. A truam patient is having a BP of 80/50 and CVP 15. The

Cardiac Index is 2.2. Which of the following is most likely to
be useful to determine the type of shock?
a) CT
b) Echocardiography
c)
d)
e)

11. In which of the following surgeriesmay antibiotics be

given?
 a) Cervical LN biopsy
b) Mastectomy
c) Fibroadenoma exision
d) Axillary LN biopsy
e)

12. A patient is having lab and clinical hyperthyroidism.

There is a smooth goiter and no LN in the neck. Which of the
following is the best therapy?
a) Antithyroidal drugs
b) Antithyroidal drugs then subtotal thyroidectomy
c) Antithyroidal drugs then total thyroidectomy
d) Antithyroidal drugs till euthyroid and I123
e) Antithyroidal drugs till euthyroid and I131

13. A patient is having acute abdominal pain afterlifiting a

heavey object. CT shows an 8cm rectus sheeth hematoma.
Which treatmet is correct
a) Surgical evacuation
b) Aspiration
c) Bed rest and analgesia
d) Angiography
e)

14. Which of the following cytotoxic drugs can cause arrest in

any phase of the cell cycle?
a) Cyclophophamide
b) Hydroxyurea
c) Methotrexate
d)
e)

15. Patient with 45% burn undergoing GA for skin grafting, has
sudden cardiac arrest which drug can cause this?
a) --rium
b) Aacorium
c) Roncorium
d) Suchcenyl choline
e) Pancorium

16. Elderly male was resusited after cardiac arrest now……

a) Hypercalcemia
b) Hypernatremia
c) Hyperkalemia
 d) Hypokalmia
e) Hyponatremia

17. A lady in her third trimester develops sudden leg swelling

from the inguinal ligemant to the ankle which of the
following is the correct sequence for therapy?
a) Venogram, bed rest, heparin
b) Duplex, bedrest, heparin
c) Platysmography, bedrest, warferrin
d) Platysmography, bed rest, IVC filter
e) Bedside assessment, bedrest, warferrin

18. Lymphedema tarda

a) Secondary to trauma
b) In children
c) In infants
d) Post axillary dissection
e)

19. Which of the following will have the best results when
treated by splenectomy?
a) Autoimmune hemolytic anemia
b) Idiopathic thrombocytopenia
c) Heridatry spherocytosis
d) Thalacemia
e)

20. A patient has multiloculated splenic abscess 10cm in size.

The best treatment
a) Radiologically guided aspirate
b) Radiologically goiuded drainage
c) Open driange
d) Splenectomy
e) Antibiotics

21. Which is best for the treatment of fistulizing crohn’s?

a) Imuran
b) Steroids
c) 5-ASA
d) Azathiprine
e) Infliximab

22. A patient is newly diagnosed to have FAP, but also has

low rectal malignance invovlve the rectal wall with no LN
and no mets. The correct therapy should be
 a) APR
b) Total proctocolectomy and iliostoy
c) Total colectomy and iliorectal anastamosis
d) Total colectomy and rectal mucusectomy and ilioanal
pouch
e) Total Proctocolectomy and ilio anal pouch

23. Which of the following is the MOST serious complication

of heamorroidecomy?
a) Fecal incontinence
b) Anal stricture
c) Recurrence
d) Bleeding
e) Cancer transformation

24. Which of the following warrents periodic UGI endoscopy

suvialance?
a) Watermelon stomach
b) HNPCC
c) Benign gastric ulcer
d)
e)

25. Which of the following inhibits pancreatic fiud secreation?

a) Gastrin
b) Secretin
c) VIP
d) CIK
e)

26. What is BEST method of palliation in a patient having

malignant obstructive jaundice?
a) Surgical bypass
b) Internal stenting
c) Percutanous stenting
d) Radiotherpay
e) Chemotherapy

27. Which of the following describes type 3 gastric ulcer?

a) Lesser curve ulcer
b) Ulcer in the body and duodenal
c) Ulcer at the GE junction
d) NSAID induced ulcer
e) Prepyloric ulcer
28. The most common presentation of Nasopharyngeal
cancer is
a) Pain
b) Horseness
c) Dysphagia
d) Epistaxis
e) Neck Mass

29. The most important factor for post injury syndrome

a) IL2
b) IL8
c) IL10
d) TNF-alpha
e) IL6

30. What is true regarding spontinous esophageal

perforation
a) Pathology is usually present prior to the attack
b) Occurs usually in the posteriormedial aspect
c)
d)
e)

31. Lady with 6cm breast mass, Mamo central necrosis. FNA
inconclusive. Had excisonal biopsy that was malignant
phylliods. Next step
a) Rexison with 1cm margin
b) Rexixon with 3 cm margin
c) Rexions with 3 cm margin and axillary dissection
d) Mastectomy
e) MRM

32. What is true about LCIS

a) Most have Invasive cancer in 10 years
b) Mamo shows charascterstic microcalcification
c) Needs Mastectomy
d)
e)

33. Mamo shows microcalcification in the entire upper zone

of the breast with biopsy showing DCIS comedo, Treatment
is
a) Lumpectomy
b) Mastectomy
c) Observation
d)
 e)

34. A patient is having cough. Most common primary anterior

mediastinal tumor
a) Retrosternal thyroid extension
b)
c) Thymoma
d) Lymphoma
e)

35. A lady complaing of RUQ pain. US showd 1.5cm gallbladder

polyp, the next step in treatment is
a) Lap chole
b) Resection of bed
c)
d) Observation
e)

36. Best prognosis is seen after repair of which of the following

a) Median nerve at wrist
b) Radial at the midforarm
c) Ulnar at elbow
d) Digital nereve
e) Brachiocutanous

37. Young boy had traumatic amputation of the distal 1/3 of

distal phalynx what will tell the mother
a) It will grow up
b) You will us the ski for grafting
c) Refer tohand surgeon for bone elongation
d)
e)

38. All of the following regarding the prosthesis of the lower

limb amputations which is true?s
a) Shorter the stump more the weight
b) For BKA the prosthesis should be placed withen a month
c) The weight bearing are is the stump
d)
e)

39. Young male gunshot to the thigh, has a large hematoma

medially and distal pulses are weak and the pt. is having
parasthesia what will you do?
a) Fasciotomy
b) Immediate explore and repair
 c) Observe in ICU
d)
e)

40. An elderly lady with abdominal distension and vommetting

and Rt. Knee pain, Xray shows multiple AFL and on clicnical
exam of the rt, knee is normal. The mmost likely diagnosis
a) Myld’s hernia
b) Obstructed Obturator hernia
c) Obstructed groin hernia
d)
e)

41. Which of the following is diagnostic of hashimotoe’s

thyroditis
a) Hypothyroidism
b) Antithyroglubilin antibodies
c)
d)
e)

42. The most likely cause of failed transplanted kidney 3

weeks post op is
a) Renal artery stenosis
b) Real vien thrombosis
c) VUR
d) Hydronephrosis
e) Renal lymphocele

43. Which f the following is associated with a worse course in

acute pancreatitis?
a) High amylase
b) High Lipase
c) Hypodense lesion in CT >50% of pancrease
d)
e)

44. Pt. with pancreatitis treated improved then has

leakocutosis and fever what to do?
a) Drain peripancreatic flliud
b)
c)
d)
e)
45. Patient has bony lesions on xray and high PSA, which of the
following can be used as palliative medication?
a)
b)
c)
d)
e)

46. A ptient is undergoing lap. Splenectomy by CO2

pneumperitonuem, suddenly has a HR of 45, the mostl likely
cause
a) Gas Embolism
b) CO2 pneumoperitonuem
c) Pnuemothorax
d)
e)

47. In laparoscopy….
a) Inserion throught the umbilicus is easy because there is no
fascia
b) When using the veress and going through the peritoneal
layer you will here 2 clicks
c) Hasson technique uses N2O
d)
e)

54. Which of the following statements are true of a

patient with hyperglycemia and hyponatremia?

a) The sodium concentration must be corrected by 5 mEq. per

100 mg. per 100 ml. elevation in blood glucose.
b) With normal renal function, this patient is likely to be
volume overloaded.
c) Proper fluid therapy would be unlikely to include potassium
administration.
d) Insulin administration will increase the potassium content
of cells.
e) Early in treatment adequate urine output is a reliable
measure of adequate volume resuscitation.

55. Prolactinomas of the pituitary:

a) Most often produce dysfunctional uterine bleeding in women.

b) Most commonly produce infertility in men.
c) When asymptomatic, are best treated surgically early in the
microadenoma stage.
d) May enlarge during pregnancy, requiring treatment with
bromocriptine or surgery.
e) Commonly occur in patients with MEN 2.

56. Imaging of the adrenal gland is best achieved with

which of the following techniques?

a) Ultrasound
f) Computed tomography (CT)
g) Arteriography
h) Scintigraphy with 131I-6 b-iodomethyl-19-norcholesterol
(NP-59)
i) Scintigraphy with 131I-methaiodobenzylguanidine (MIBG)

57. Which of the following adrenal lesions can be treated

definitively by medical means?
a) Benign functional adrenocortical adenoma
b) Adrenocortical carcinoma
c) Congenital adrenal hyperplasia
d) Cushing disease
e) Pheochromocytoma

58. Nine days following splenectomy, a 13 year old

patient presents with fever and leukocystosis. The chest
x-ray showed air under the diaphragm. The most likely
diagnosis is?
a) postsplenectomy sepsis
b) colonic perforation
c) pneumococcal infection
d) subphrenic abscess
e) gastric wall ulcer

59. Hyperextension of the proximal phalanges of the

little and ring fingers can result from damage to:
a) Ulnar nerve
b) Axillary nerve
c) Radial nerve
d) Median nerve
e) Anterior interosseous nerve

60. Reckless ligation of the superior thyroid artery during

thyroidectomy may lead to injury to
 a. External branch of the superior laryngeal nerve
b. Internal branch of the superior laryngeal nerve
c. RLN
d. Superior aryngeal nerve
e.

61. Patients with AIDS are sesibtle to develop

a. Kapopsi’s sarcoma
b. Colorectal cancer
c. Esophageal cancer
d. HCC
e. Meningioma

57. A laparoscopic cholecystectomy is performed in a

60-year-old woman. Pathology reveals gall bladder
adenocarcarcinoma confined to mucosal lamina propria.
Appropriate management includes:
a) observation and follow up
b) excision of the gallbladder fossa and laparoscopic port sites
c) excision of the gallbladder fossa, port sites and portal
lymphadenectomy
d) excision of gallbladder fossa, port sites, portal
lymphadenectomy and excision of the common bile duct
e) irradiation of the gallbladder bed

58. Intraoperative finding of (bowl fibrosis) is seen in

a) UC
b) Crohn’s
c) Typhoid interitis
d) Amebiasis
e)

58. A patient was brought to the emergency room with

a history of an electrical burn. On obtaining a urine
sample was noted to be dark. The next step of
management is :
a) Aggressive intravenous fluid infusion
b) Send urine for myoglobin level
c) Request a CXR
d) Ultrasound of the abdomen
e) Obtain a sickling test

59. Which of the following is regarded as malpratice

a) Patient autonomy
b) Narcotics for medical use
c) Physician assisted suicide
 d) Laparoatomy for concented laparoscopy
e)

60. Which type of collagen is important for wound

healing?
a) III
b) IV
c) VII
d) X
e) V

61. A patient who has an elective surgery done with

spinal anesthesia developed blood pressure of 70/40
mmHg.There is no evidence of hemorrhage or sepsis. The
initial therapy consists of administration of:
a) 2 L normal saline
b) Whole blood
c) Adrenal corticosteroids
d) Beta adrenergic stimulation
e) Vasopressor drug

62. Patient with disk herniation L4 and L5 will present with

a) Weak soles
b) Pain in the anterior thigh
c) Weak gastrocnemos
d) Urinary incontenece
e)

63. Regarding hyperhydrosis in the palm, the involved

sympathetic chain at which level?
a) T1-T2
b) T2-T3
c) T3-T4
d) T4-T5

64. Patient underwent CABG surgery, developed focal

nuerological defecit, likely cause is
a) Intercrebral bleed
b) Air embolism
c) Thromboembolism
d)
e)

65. Regarding Extradural hematoma

 a) On Ct shows as biconcave lesion
b) Assosiated with lucid interval
c) Skull fracture must be present
d) It’s due to bleed from anterior branch of MCA
e)

66. Regarding desmoids tumors

a) Course is predictable
b) Does not recur (recur locally)
c) Is a fibrosarcoma
d)
e)

67. Patient with FAP, presnts with intestinal obstruction. CT

showed mesenteric mass. The most likely diagnosis
a) Desmoid tumor
b) Lipoma
c) Liposarcoma
d) Dermoid tumor
e)

68. Deep surgical site infection is described as infection in

a) skin and SC tissue
b) Fascia and muscle
c) Intra-abdominal organ
d) Inter-organ space
e)

69. Patient is post MVR present with retroperitoneal

hematoma which is true?
a) Ocurrs equally with IV and PO anticoagulation
b) Can present as an acute abdomen
c) More common with Coumaden
d)
e)

70. What is true regarding thyroid hormone physiology

a) T4 is the active form
b) Active T3 is resulted from peripheral T4 conversion
c) Follicular cell uptake of iodide is apassive process
d)
e)

71. The best modality for imaging of a retrosternal goiter is

a) CT
 b) CXR
c) US
d) Radioactive iodine
e)

72. Trauma victim who hit his upper abdomen to the steering
wheel, intraoperative findings were injury to the
duodenum grade 3 (invoving most of the
circumfrance)and normal pancreatic invvlment. Which is
the best surgical treatment?
a) Primary repair and NGT
b) Primary repair doundenostomy
c) Primary repair with pyloric exclusion
d) Pancreaticdoudenectomy
e)

73. 3 year old boy presents with abdominal distension,

constipation and FTT on PR examination patient passes
explosive stool. The next step in managment
a) Barium enema
b) Rectal biopsy
c) Lapartomy and FS
d)
e)

74. Trauma victim was taken to the OR and found to have a

deep liver laceration with active bleeding with low BP low
saturation and tachycardic what should be done?
a) Ligate hepatic artery
b) Contrll individual bleeders
c) Pack and close
d)
e)

75. During trauma lapartomy the correct sequence of action

a) To deal with each issue when encountered
b) Pack each quadrant after dealing with problem
c) Pack each quadrant before dealing with problem
d) Pack all quadrants then deal with the problem individually
e)

76. Regarding malegnant plueral effusion

a) The fliud is usually exudative with blood cells
b) 2 chest tubes at least needed
c) Should be dealt with regardless of the lung expansion
 d) Succeful in 20-30% of patient
e)

77. Post Rt. Hemicolectomy now with abdominal pain and

fever. CT shows multiple collections between the bowel
loops the correct managment
a) CT guided drainage
b) Laparotomy
c) Systemic antibiotics
d) NPO+TPN
e)

78. ??Patient with low HCl??

a) Potassium ion
b) HCL-arginine
c) Maghnesium ion
d)
e)

79. Crohn’s on steroids developed adverse effect of steroids,

which of the following has a steroid sparing effect?
a) Imuran
b) Infliximab
c) Flagyl
d)
e)

80. A 22-year old year old man is found to have a

complete transaction of the common bile duct following a
gunshot wound to the abdomen. The bile duct injury
should be managed by?
a) primary repair with a cholecystostomy tube
b) whipple's operation
c) choledochojejunostomy and cholecystectomy
d) primary repair with T-tube
e) choledochoduodenostomy

81. Patient has a stab wound in the anterior border of the

sternoclidomastoid and 1 cm above the cricoid cartilage
the platesma was penetrated. Compliaing of hemoptesis
but his vitals are stable, what therapy is correct?
a) Intubate and ventelate
b) Surgical exploration
c) Upper GI Endoscopy, vascular angiograpgy, bronchoscopy
d)
e)
82. In patients who develop HIT, which is correct?
a) Stop all forms off heparin
b) Decrease the rate
c) Use LMWH
d)
e)

83. Aromatse inhibitors Vs. Timoxafen, which is true?

a) Aromatase inhibitors are useful for premenoposal women
b) Lower incidence of vascular and cardiac side effects than
timoxafen
c)
d)
e)