MCQs Mock Exams for
What is the
General Surgery Board
Exam
Mock Exam 1- 25 MCQs
Breast
1. After intraductal papilloma, unilateral
bloody nipple discharge from one duct
orifice is most commonly caused by
which of the following pathologic
conditions?
A. Paget's disease of the nipple.
B. Intraductal carcinoma.
C. Inflammatory carcinoma.
D. Subareolar mastitis.
Answer: B
2. Which of the following conditions is
associated with increased risk of breast
cancer?
A. Fibrocystic mastopathy.
B. Severe hyperplasia.
C. Atypical hyperplasia.
D. Papillomatosis.
Answer: C
3. Which of the following breast lesions
are noninvasive malignancies?
A. Intraductal carcinoma of the comedo
type.
B. Tubular carcinoma and mucinous
carcinoma.
C. Infiltrating ductal carcinoma and
lobular carcinoma.
D. Medullary carcinoma, including
atypical medullary lesions.
Answer: A
4. A 36-year-old woman complains of a
3-month history of bloody discharge
from the nipple.
At examination, a small nodule is
found, deep to the areola. Careful
palpation of the nippleareolar
complex results in blood arrearing at
the 3 O’clock position. Mammogram
findings are normal.
likeliest diagnosis?
(A) Intraductal papilloma
(B) Breast cyst
(C) Intraductal carcinoma
(D) Carcinoma in situ
(E) Fat necrosis
Answer: (A) Intraductal papilloma is
the most common cause of bloody
discharge from the nipple. The lesion is
treated by excision and is benign in
most cases. Cancer is present in 5% of
cases. Preoperative ductography can be
used to help locate the offending duct .
Endocrine
5. When progressive enlargement of a
multinodular goiter causes symptomatic
tracheal compression, the preferred
management in otherwise good-risk
patients is:
A. Iodine treatment.
B. Thyroid hormone treatment.
C. Surgical resection of the abnormal
thyroid.
D. Radioactive iodine treatment.
Answer: C
6. The most precise diagnostic
screening procedure for differentiating
benign thyroid nodules from malignant
ones is:
A. Thyroid ultrasonography.
B. Thyroid scintiscan.
C. Fine-needle-aspiration biopsy
(FNAB).
D. Thyroid hormone suppression.
Answer: C
7. The preferred operation for initial
management of a thyroid nodule that is
considered suspicious for malignancy
by FNAB is:
A. Excision.
B. Partial lobectomy.
C. Total lobectomy and isthmusectomy.
D. Total thyroidectomy.
Answer: C
8. At the age of 46, an accountant has
developed hoarseness due to an
inoperable cancer of the
left upper lung lobe. He has smoked
heavily since the age of 14. Which of
the following features
of cancer of the lung indicates distant
spread?
(A) Hypercalcemia
(B) Cushing-like syndrome
(C) Gynecomastia
(D) Syndrome of inappropriate
secretion of antidiuretic hormone
(SIADH)
(E) Brachial plexus lesion (Pancoast’s
syndrome)
Answer: (E) In apical lung cancers,
the malignant tumor may extend above
the thoracic inlet, penetrate the
suprapleural membrane, and infiltrate
the structures found at the root of the
neck. The first thoracic nerve and lower
trunk of the brachial plexus are most
likely to be involved initially, as
T1 passes along the inner border of the
first rib to reach the neck. If the
sympathetic nerve is involved, pupil
constriction and ptosis may be evident
(Horner syndrome). The other listed
items are all features of the
paraneoplastic syndrome associated
with lung cancer and do not necessarily
indicate extranodal metastasis.
Cushing’s syndrome in lung cancer
occurs more frequently in men and in
an older age group and has a more
rapid downhill course than typical
Cushing’s syndrome. SIADH should be
suspected if the patient with a lung
lesion develops unexplained mental
changes and an extremely low serum
sodium level. Fluid restriction is
required. Urine osmolarity is low.
Abdoman
9. The most common hernia in females
is:
A. Femoral hernia.
B. Direct inguinal hernia.
C. Indirect inguinal hernia.
D. Obturator hernia.
E. Umbilical hernia.
Answer: C
10. Which of the following statements
regarding unusual hernias is incorrect?
A. An obturator hernia may produce
nerve compression diagnosed by a
positive Howship-Romberg sign.
B. Grynfeltt's hernia appears through
the superior lumbar triangle, whereas
Petit's hernia occurs through the
inferior lumbar triangle.
C. Sciatic hernias usually present with a
painful groin mass below the inguinal
ligament.
D. Littre's hernia is defined by a
Meckel's diverticulum presenting as the
sole component of the hernia sac.
E. Richter's hernia involves the
antimesenteric surface of the intestine
within the hernia sac and may present
with partial intestinal obstruction.
Answer: C
11. Staples may safely be placed
during laparoscopic hernia repair in
each of the following structures except:
A. Cooper's ligament.
B. Tissues superior to the lateral
iliopubic tract.
C. The transversus abdominis
aponeurotic arch.
D. Tissues inferior to the lateral
iliopubic tract.
E. The iliopubic tract at its insertion
onto Cooper's ligament.
Answer: D
Osop & Dudenum
12. Which of the following statements
about the anatomic course of the
esophagus is correct?
A. The cervical esophagus passes
behind and to the right of the trachea.
B. The thoracic esophagus enters the
posterior mediastinum anterior to the
aortic arch.
C. The thoracic esophagus passes
behind the right mainstem bronchus
and the pericardium.
D. The esophagus enters the
diaphragmatic hiatus at the level of T8.
E. The esophagus deviates anteriorly
and to the left as it enters the
abdomen.
Answer: E
13. Which of the following statements
about esophageal anatomy is correct?
A. The esophagus has a poor blood
supply, which is segmental in
distribution and accounts for the high
incidence of anastomotic leakage.
B. The esophageal serosa consists of a
thin layer of fibroareolar tissue.
C. The esophagus has two distinct
muscle layers, an outer, longitudinal
one and an inner, circular one, which
are striated in the upper third and
smooth in the distal two thirds.
D. Injury to the recurrent laryngeal
nerve results in vocal cord dysfunction
but does not affect swallowing.
E. The lymphatic drainage of the
esophagus is relatively sparse, localized
primarily to adjacent paraesophageal
lymph nodes.
Answer: C
14. Which of the following statements
about the lower esophageal sphincter
(LES) mechanism, or high-pressure
zone (HPZ), is true?
A. The LES is a circular smooth muscle
ring that is 3 to 5 cm. long.
B. In assessing esophageal manometric
data, mean HPZ pressure less than 6
mm. Hg or overall length less than 2
cm. is more likely to be associated with
incompetence of the LES and
gastroesophageal reflux.
C. Esophageal manometry and the acid
perfusion (Bernstein) test reliably
identify the patient with an incompetent
LES mechanism.
D. Distal HPZ relaxation occurs within 5
to 8 seconds of initiating a swallow.
E. Twenty-four–hour distal esophageal
pH monitoring is achieved with an
intraesophageal pH electrode positioned
at the esophagogastric junction.
Answer: B
Intestine
15. The most common site of
adenocarcinoma of the small intestine
is the:
A. Duodenum.
B. Jejunum.
C. Ileum.
Answer: A
16. The most common benign tumor of
the small intestine is:
A. Adenoma.
B. Hemangioma.
C. Leiomyoma.
Answer: C
17. An 80-year-old man who has been
bedridden for many years following a
stroke presents with acute onset of
abdominal distention, obstipation, and
colicky abdominal pain. Abdominal x-
rays reveal dilated loops of small bowel
and a dilated sigmoid colon resembling
a bent inner tube. Examination reveals
distention with mild direct tenderness
but no rigidity or rebound tenderness.
Initial management should consist of:
A. Barium enema examination.
B. Laparotomy with resection of
descending colon and descending
colostomy.
C. Multiple cleansing enemas to remove
impacted feces.
D. Rigid sigmoidoscopy and
decompression of the sigmoid colon.
Answer: D
18. A 45-year-old man complains of
burning epigastric pain that wakes him
up at night. The pain is relieved by
eating or using over-thecounter
antacids and H2 blockers. Diagnosis is
best confirmed by which of the
following?
(A) Urea breath test
(B) Serum gastrin levels
(C) Barium meal examination
(D) Upper endoscopy
(E) Upper endoscopy and biopsy
Answer: (E) Duodenal ulcer is best
diagnosed by upper endoscopy and
biopsy. Findings of gastritis and the
presence of H.pylori are indications to
prescribe appropriate therapy. This
typically includes a PPI and two
antibiotics (one regimen includes
amoxicillin and clarithromycin).
Although the urea breath test is the
most sensitive and specific test used to
detect H. pylori, it is not readily
available in all settings.
19. A 25-year-old male develops
diarrhea and colicky abdominal pain.
Ulcertive colitus is
diagnosed on colonoscopy. Which of the
following findings is consistent with the
diagnosis?
(A) The rectum is not involved.
(B) The disease is confluent, there are
no
skip areas in the colon and the rectum
is involved.
(C) The full thickness of the bowel wall
is involved.
(D) Microscopic examination of the
mucosa reveals normal cells without
evidence of dysplasia.
(E) The incidence of colorectal cancer is
equal to that of the general population.
Answer: (B) Ulcerative colitis is a
disease of unknown etiology, which
involves the colon and rectum
and spares the remainder of the GI
tract. It’s clinical course is variable with
inflammatory
changes and clinical symptoms ranging
from mild to severe. The process is
confined to the
mucosa and the submucosa and does
not extend through the full thickness of
the bowel
wall. Inflammatory changes are
confluent with no skip areas. The risk of
dysplasia and colorectal
cancer is higher in ulcerative colitis
than in the general population.
20. A 1-week-old infant is brought to
the hospital because of vomiting. An
upper gastrointestinal (GI) series
reveals duodenal obstruction. On
laparotomy, annular pancreas is found.
Which of the following statements
about annular pancreas is TRUE?
(A) Resection is the treatment of
choice.
(B) It is associated with Down’s
syndrome.
(C) Symptoms usually begin with back
pain.
(D) It is most likely due to abnormal
rotation encircling the third part of the
duodenum.
(E) Symptoms begin in childhood.
Answer: (B) Annular pancreas is a
congenital anomaly; a band of
pancreatic tissue encircles the second
part of the duodenum. Annular
pancreas is associated with Down
syndrome as well as duodenal stenosis
or atresia. Duodenojejunostomy and
gastrojejunostomy are acceptable
treatments. Resection is not an
acceptable choice due to the high
incidence of fistula In adults, annular
pancreas usually presents with
abdominal pain, nausea, and vomiting.
Liver
21. Which of the following clinical
situations are considered good
indications for PVS?
A. A 50-year-old cirrhotic man had an
emergency portacaval shunt for
bleeding varices and postoperatively
had an ascites leak and mild superficial
wound infection.
B. A 57-year-old woman with primary
biliary cirrhosis (PBC) has difficult to
control ascites and diuretic-induced
encephalopathy.
C. A 46-year-old resistant alcoholic has
chronic ascites uncontrolled by diuretics
combined with repeat paracentesis.
D. A 34-year-old woman taking BCPs
had rapid onset of ascites and is found
to have hepatic vein thrombosis
causing the Budd-Chiari syndrome.
Answer: C
Spleen
22. Hodgkin's disease is a malignant
lymphoma with four histologic
subtypes. Which of the following is not
one of the subtypes?
A. Lymphocyte predominance.
B. Nodular sclerosis.
C. Mixed cellularity.
D. Lymphocyte depletion. E. Leukocyte-
lymphocyte dominance.
Answer: E
Genato urenery
23. Ureteral obstruction:
A. Is associated with hematuria.
B. Is associated with deterioration of
renal function and rising blood urea
nitrogen (BUN) and creatinine values.
C. Is commonly caused by a urinary
tract calculus.
D. Usually requires open surgical relief
of the obstruction. E. Is usually
associated with infection behind the
obstruction.
Answer: C
24. A20-year-old unrestrained driver
was involved in a motor-vehicle crash.
A computed tomography
(CT) of the abdomen revealed a large
hematoma in the second portion of
duodenum. The rest of the abdomen is
normal. The initial management of this
duodenal hematoma should be:
(A) Operative evacuation
(B) Nasogastric decompression,
intravenous fluids, and gradual
resumption of oral diet
(C) Endoscopic retrograde
cholangiopancreatogram (ERCP)
(D) Laparotomy, pyloric exclusion, and
gastrojejunostomy
(E) Octreotide
Answer:. (B) Intramural duodenal
hematoma may occur secondary to
blunt trauma of the abdomen. Usually
this hematoma is submucosal and the
injury is not transmural. It may cause a
temporary obstruction of the duodenum
and usually responds to nasogastric
suction and intravenous
fluids. Only if the patient has persistent
obstruction (as demonstrated by an
upper GI study)
beyond 2 weeks, a surgical approach
may be required.
25. In a patient who had a motor-cycle
crash, a CT of the abdomen revealed a
peri pancreatic hematoma and
indistinct pancreatic border. The most
definitive test for a pancreatic injury
requiring operative intervention is:
(A) ERCP
(B) Ultrasonography
(C) CT scanning
(D) Operative exploration
(E) Amylase test of lavage fluid
Answer:. (A) The most definitive test
for a lesion requiring operative
correction is demonstration of a
disrupted major pancreatic duct. While
CT scanning may give a suggestion of a
ductal injury, and operative exploration
of the area of injury may be
inconclusive, ERCP is very reliable in
showing a disrupted duct. Amylase
testing of lavage effuent is nonspecific.