Cheers – Surg 250 Exam 2 Block 1

No feedback was given after the exam. Answers are based on previous samplices.

1) This congenital pathology of the pulmonary system is inherently caused by the fact that the
posterolateral communication of the pleura (chest) and coelomic (abdominal) cavities is the last to
be closed by the developing diaphragm. Chest x-ray findings are herniated abdominal viscera
and mediastinal shift away from the herniated viscera. This type of hernia is called
A. Morgagni
B. Bochdalek
C. Congenital cystic adenomatoid malformation
D. Pulmonary sequestration

Answer: B

2) Urinary incontinence in women isinitiated by

A. Internal sphincter
B. Middle circular layer of the bladder
C. Lower bladder pressure
D. External sphincter

Answer: D

3) In the pathology of nephrolithiasis that emboli to the urinary tract, which of the following is not a
common site of impaction of kidney stone?
A. Ureteral pelvic junction
B. Pelvic brim
C. Ureteral vesical junction
D. NOTA

Answer: D

4) The Allen Test checks for the arterial flow of

A. Deep palmar circumflex artery
B. Branchial
C. Radial artery
D. Dorsalis pedis artery

Answer: C

5) A 1-month old baby boy has a 2x1 cm capillary of the cheek. The best mode of management
A. Observation
B. Excision
C. Sclerosant injection
D. Laser therapy

Answer: A

6) A 2-year old boy has a recurrent right inguinal area mass since birth. The mother claims the
mass appears when the child is straining or crying and disappears when he is quiet or sleeping.
PE shows a soft, reducible right inguinal mass, nontender and nonerythematous. The abdomen is
flat, soft, and nontender, without any palpable mass. The external genitalia are normal. Best
mode of treatment?
A. Observation

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B. Incision and drainage
C. Herniotomy
D. Herniorraphy

Answer: C

7) TRUE regarding Hirschsprung’s disease

A. Parasympathetic innervation of the intestines are absent
B. The most common affected segment of the bowel is the rectosigmoid region
C. The markedly dilated bowel on barium enema is the abnormal segment of intestine
D. Successful nonsurgical management of the condition requires judicious use of suppositories

Answer: B

8) A 1 month old infant was brought to the clinic for an intermittent bulge on the right scrotum.
You do not appreciate the bulge on the sleeping post-prandial baby. There are 2 palpable testes
but no transillumination of the scrotum. Your advice would be
A. Do transillumination at home when the bulge shows up
B. Request for scrotal ultrasound
C. Recommend surgery
D. Make the baby cry

Answer: D

9) The definitive management of thyroglossal duct cysts involves

A. Removal of the thyroid isthmus
B. Removal of the hyoid bone
C. Simple cyst excision
D. Thyroidectomy

Answer: B

10) The most common type of imperforate anus in females is

A. IA with cloacal malformation
B. IA with rectovestibular fistula
C. IA with perineal fistula
D. Low IA with covered anus

Answer: B

11) Among the vascular tumors of the head and face, this group has increased mitotic activity and
as such may be considered true neoplasms. They are typically absent at birth or may be present
as a faint vascular blush, and undergo rapid proliferative phase. Most undergo spontaneous
involution by age 7
A. Hemangiomas
B. AV vascular malformation
C. Cystic hygromas
D. Lymphatic malformation

Answer: A

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12) A 5-month old male infant has a urine output of less than 0.1 ml/kg/hr shortly after undergoing
major surgery. On examination, he has generalized edema. His BP is 94/48, PR 140, abdominal
respirations 20/min. His BUM is 38 mg/dl and serum creatinine is 1.4 mg/dl. Initial urinalysis
shows a specific gravity of 1.018 and 2+ protein. Microscopic examination of the urine sample
reveals 1 WBC per HPF, 18 RBCs per HPF. What is the appropriate next step in diagnosis?
A. CT of the abdomen and pelvis
B. IVP
C. KUB UTZ
D. Cystourethrography

Answer: C

13) A 52/M diabetic with a history of claudication presented with a non-healing wound involving
the left big toe of 2 months duration. Results of arterial pressure obtained at the clinic are as
follows

Right Left
Brachial 160 140
Radial 130 130
Dorsalis pedis 130 80
Posterior tibial 180 60

The ankle brachial index (ABI) on the left lower extremity is?

A. 0.375
B. 0.43
C. 0.5
D. 0.57

Answer: C

14) Diffuse calcification of the lower extremity arteries results in

A. Normal ABI due to incompressible arteries
B. Low ABI due to incompressible arteries
C. Elevated ABI due to incompressible arteries
D. Unobtainable ABI due to absence of adequate flow

Answer: C

15) Allen’s test is useful in evaluating

A. Integrity of the palmar tract
B. Digital blood flow
C. Thoracic outlet compression
D. Acute effort thrombosis

Answer: A

16) 5-alpha reductase inhibitors are used to treat patients with benign prostatic obstruction
because they
A. Inhibit the receptors on the smooth muscles of the prostate
B. Cause a decrease in the intraprostatic pressure
C. Decrease the stromal bulk of the prostate
D. Prevent conversion of testosterone to active form di-hydroxytestosterone

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Answer: D

17) Whom of the following may not resort to vascular revascularization?

A. A soldier with a non-healing wound of the big toe
B. A postman who has pain whenever he delivers mail
C. A cook with gangrene of the middle toe
D. An executive who has leg pain whenever he plays golf

Answer: D

18) The presence of Simonart’s band characterizes this type of cleft

A. Complete cleft lip
B. Incomplete cleft lip
C. Complete cleft palate
D. Incomplete cleft palate

Answer: B

19) Most common primary cardiac tumor in infants

A. Fibroma
B. Myxoma
C. Rhabdomyoma
D. Sarcoma

Answer: C

20) Pericardial cysts are often found in which compartment of the mediastinum
A. Superior compartment
B. Anterior compartment
C. Middle compartment
D. Posterior compartment

Answer: C

21) Midface instability or fracture is elicited by this sign

A. Racoon’s eye sign
B. Telecanthus
C. Drawer’s sign
D. Malocclusion

Answer: C

22) To achieve good occlusion the following is essential drug or prior to fracture fixation
A. Coaptation of the fracture segments
B. Intra-oral fixation
C. Maxillo-mandibular fixation
D. Interdental fixation

Answer: C

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23) Pleural effusion is the accumulation of liquid in the pleural space. A concave meniscus or
“blunting” in the costophrenic angle suggests the presence of at least _____ of pleural effusion
A. 100 ml
B. 175 ml
C. 250 ml
D. 300 ml

Answer: C

24) In the analysis of pleural effusion, it is important to differentiate if it is a transudate or exudate.

Knowledge of the quality of the effusion leads to the diagnosis of the possible pathology and will
affect management. Characteristics that distinguish exudates from transudates includes the
following EXCEPT
A. pH > 7.2
B. High protein content
C. Foul smelling
D. Sterile fluid

Answer: D

25) Chylothorax is a milky, odorless effusion consisting of leaking lymphatic fluid from the thoracic
duct. The most common cause is
A. Iatrogenic
B. Malignancy
C. Spontaneous disruption
D. NOTA

Answer: A

26) TRUE of lung anatomy EXCEPT

A. Right lung has 2 lobes, left has 3
B. Right contains 10 segments, left has 9
C. There are 2 groups of lymph nodes: pulmonary and mediastinal
D. AOTA

Answer: A

27) One of the most common co-morbidity for developing abdominal aortic aneurysm is Marfan
syndrome. This disease is caused by an abnormality in which of the following proteins?
A. Elastin
B. Metalloproteinase
C. Collagen
D. Fibrillin

Answer: D

28) The most common presenting symptom in patients with an ascending thoracic aneurysm is
A. Anterior chest pain
B. Posterior chest pain
C. Aortic valve insufficiency
D. Sudden death

Answer: A

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29) The most common primary cardiac tumor is
A. Fibromas
B. Rhabdomyoma
C. Myxoma
D. Teratoma

Answer: C

30) This is a relatively common congenital heart disease (5-8%) and results from the abnormal
division of the bulbar trunk, where the aorta originated from the right ventricle and the pulmonary
artery from the left ventricle
A. Double outlet right ventricle
B. Transposition of the great vessels
C. Truncus arteriosus
D. Total anomalous pulmonary venous return

Answer: B

31) As a follow-up to the previous question, this congenital disease is classically represented by
which chest x-ray findings
A. Boot shape
B. Egg on a string
C. Calcification on pericardium
D. Massive pleural effusion

Answer: B

32) True of the anatomy of the chest wall EXCEPT

A. Skeletal support consists of the sternum, 12 thoracic vertebrae, 10 pairs of ribs, and 2 pairs of
floating ribs
B. Pectoralis major and pectoralis minor constitutes the principal musculature of the anterior
thorax
C. The parietal and visceral pleura is well-endowed with nerve endings
D. The pleural space extends above the clavicles, increasing the risk for pulmonary injury for
supraclavicular trauma

Answer: C

33) Which incision is optimal for anterior mediastinal and cardiac surgeries?
A. Median sternotomy
B. Midlateral thoracotomy
C. Lateral thoracotomy
D. Posterolateral thoracotomy

Answer: A

34) In the evaluation of patients about to undergo major thoracic surgery, this value may be the
most useful test to monitor patients with marginal pulmonary function, it is reduced in obstructive
airway disease
A. Forced expiratory volume in 1 sec (FEV1)
B. Vital capacity
C. Maximal oxygen consumption
D. Respiratory rate

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Answer: A

35) True of pectus excavatum EXCEPT

nd
A. 2 most common congenital deformity of the chest wall (next to pectus carinatum)
B. Attributed to the overgrowth of the lower costal cartilages and ribs
C. Anomaly is 3x more common in males
D. Operative correction is recommended between 18 months to 5 years

Answer: A

36) Characteristic of the pleural effusion that distinguishes exudates from transudates
A. pH < 7.2
B. High protein content
C. Foul smelling
D. Elevated amylase level
E. AOTA

Answer: E

37) Though more common in the upper lobes, this bronchogenic carcinoma develops in all parts
of the lung. They are relatively slow growing, are late to metastasize, and may present as central
bulky masses with bronchial obstruction (evidence of its association with smoking). This is the
leading pulmonary neoplasm
A. Bronchoalveolar carcinomas
B. Small cell lung CA
C. Squamous cell carcinomas
D. Carcinoid tumors

Answer: C

38) The mediastinum is the central cavity of the thorax bounded by the pleural cavities, inferiorly
by the diaphragm, and superiorly by the thoracic inlet. Where is the thymus organ located
(thymoma being the most common mass in this area)?
A. Anterior
B. Middle
C. Posterior
D. Superior

Answer: A

39) Known risk factor for developing patent ductus arteriosus

A. Rubella infection in the first trimester
B. Radiation with xray during the second trimester
C. Intake of nitrates during the third trimester
D. NOTA

Answer: A

40) Fetal circulation is characterized by the following EXCEPT

A. Elevated vascular resistance and little pulmonary blood flow
B. Shunting of blood from right atrium to left atrium
C. Shunting of blood from pulmonary artery into aorta

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D. NOTA

Answer: D

41) Example of congenital heart disease with right to left shunting of systemic venous blood back
into systemic circulation leading to hypoxemia and cyanosis EXCEPT
A. Tetralogy of Fallot
B. Truncus arteriosus
C. Tricuspid atresia
D. PDA

Answer: D
All the Ts are cyanotic heart diseases (TOF, TGA, truncus arteriosus, tricuspid atresia, etc.)

42) Clinical features of chronic cyanosis secondary to a cyanotic heart disease

A. Hypertrophic osteoarthropathy
B. Polycythemia
C. Brain abscess formation
D. AOTA

Answer: D

43) The following are palliative shunting procedures to relieve cyanosis of certain congenital heart
diseases
A. Blalock-Taussig shunt
B. Glenn shunt
C. Transcatheter dilatation
D. AOTA

Answer: D

44) Coronary artery bypass grafting (CABG) is superior to angioplasty in which subset of
patients?
A. Diabetic patients
B. Triple vessel disease
C. Double vessel disease with right left anterior descending (LAD) artery disease
D. AOTA

Answer: D

45) True of thoracic aneurysm EXCEPT

A. Excisional therapy and endoaneurysmorraphy with internal graft replacement have been used
for repair of thoracic aneurysms
B. Causative factors are age, hypertension, smoking, aortic dissection, connective tissue
disorders
C. Coronary angiography should be performed before surgical repair as most patients have
associated coronary artery disease
D. Operation should be strongly considered in patients with saccular aneurysms or connective
tissue disease when the aneurysm is >7 cm in size

Answer: D

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46) Aortic dissection begins as a tear in the intima with entry of blood and separation of the
media, which results in blood flow down a “false lumen.” A classification was suggested by
Stanford based on the location of the dissection. Which type requires surgical repair (which
involves removing the intimal tear, replacing the diseased aorta, obliterating the false lumen, and
redirecting blood flow into the true lumen)?
A. Stanford type A dissection
B. Stanford type B dissection
C. Stanford type C dissection
D. NOTA

Answer: A

47) In the management of the patient with peripheral arterial occlusion disease, the following
symptoms are “limb-threatening symptoms” and warrant early surgical management EXCEPT
A. Pain at rest
B. Ulceration
C. Gangrene
D. NOTA

Answer: D

48) In the management of arterial trauma, the following caveats are usually followed EXCEPT
A. It is safest to approach arterial injuries only after adequate proximal and distal control has been
achieved. In contrast, proximal and distal control is not helpful in venous injury, and control must
be achieved using direct compression
B. If saphenous vein is used for the arterial reconstruction, it should be taken from the
contralateral extremity because the ipsilateral one may provide an important route for venous
return in the presence of arterial and venous injury
C. In combined arterial-venous injury wherein both vessels are transected, artery is repaired first,
followed by the vein
D. NOTA

Answer: D

49) Virchow postulated three mechanisms for the development of venous thrombosis. This
includes the following EXCEPT
A. Endothelial damage
B. Hypercoagulability
C. Stasis
D. Infection

Answer: D

50) Urodynamics is a branch of urology that focuses on voiding problems. Among the types of
incontinence, which is not properly matched to its definition?
A. Stress urinary incontinence occurs with increase in intra-abdominal pressure associated with
activities such as coughing, laughing, or exercise
B. Urge incontinence is caused by involuntary voiding secondary to increased abdominal
pressure caused by a GI pathology
C. Total incontinence refers to continuous leakage of urine and implies that a fistula exists
between the urinary tract and the skin or vagina
D. Overflow incontinence, often termed false incontinence, is secondary to urinary retention,
resulting from either obstruction or an atonic bladder

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Answer: B

51) The most common composition of kidney stone is

A. Magnesium salts
B. Calcium oxalate
C. Uric acid
D. Cysteine salts

Answer: B

52) A true urologic emergency

A. Testicular torsion
B. 10 x 10 cm communicating hydrocoele
C. Posterior urethral valve
D. Recurrent infection secondary to hypospadias

Answer: A

53) By definition, hypertrophic scars are described as raised, collagen-rich lesions that have
progressed beyond the boundaries of initial insults
A. True
B. False

Answer: B

54) Skin grafts are mainstays for reconstruction of superficial defects or adjuncts to more complex
reconstruction. By definition, grafts and flaps differ by the presence or absence of blood supply.
The term “graft” which implies that some aspect of the blood supply to the segment of tissue has
remained intact during transfer
A. True
B. False

Answer: B

55) A split-thickness graft requires that a portion of the dermis be taken along with the epidermis.
A full thickness graft is one in which the full portion of the dermis is taken with the superficial
dermis. Comparing the 2 types of grafts, which one is theoretically more durable and has the
ability to grow hair, and secrete sweat and sebum?
A. Split thickness
B. Full thickness
C. Both

Answer: B

56) The timing of surgical repair of cleft lip is often dictated by the “rule of tens” with obvious
permutations. This includes the following EXCEPT
A. 10 weeks of age
B. 10 kgs
C. 10 mg/dl hemoglobin
D. NOTA

Answer: B (It should be 10 lbs, not 10 kg)

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57) The bypass graft of choice for children with renovascular hypertension is
A. Saphenous vein graft
B. Prosthetic
C. Dacron
D. Hypogastric artery

Answer: D

58) Which of the following is a component of Tetralogy of Fallot

A. VSD
B. ASD
C. PDA
D. Tricuspid atresia

Answer: A
TOF = VORP (VSD, overriding aorta, RVH, pulmonary outlet obstruction such as stenosis)

59) These are conditions requiring urgent thoracotomy EXCEPT

A. Massive flail chest
B. Pericardial tamponade
C. Esophageal perforation
D. Massive hemothorax (if upon chest tube insertion, initial output >1500 ml or >200 ml/hr for 4
hours)

Answer: A
If the conditions for D are not present, then you don’t need thoracotomy

60) Empyema is a suppurative infection of the pleural space, most often associated with
pneumonia, trauma, pulmonary infarct, and extension from an intraabdominal source. One of the
most feared complications of empyema, thus needing early drainage (CCT, thoracentesis) is
A. Hypoxemia leading to acidosis
B. Extension to pericardium
C. Erosion of the esophagus by the infection, leading to reflux
D. Formation of fibrinous peel leading to “trapped lung”

Answer: D

61) VSD is the most common congenital heart disease. It is further classified into several types
based on the position of the defect. Which among these is the most common type requiring
surgery
A. Posterior inlet
B. Supracristal
C. Perimembranous
D. Muscular

Answer: C

62) A cleft extending posteriorly from the incisive foramen to the uvula is
A. Incomplete cleft lip
B. Incomplete cleft palate
C. Complete cleft lip
D. Submucous cleft

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Answer: B

63) 30/M consulted you at your clinic for a slowly growing scrotal mass, right side. On PE, the
mass is solid, inguinal ring is appreciated, no “bag of worms” appreciated, and negative for
transillumination. Serum examination showed elevated hCG and FSH. Your best differential will
be
A. Hydrocoele
B. Testicular tumor
C. Indirect hernia
D. Varicocoele

Answer: B

64) Vasospastic arterial disorders affect the fingers more frequently than toes. The prototypic
vasospastic disorder is the Raynaud’s syndrome. Treatment entails the following EXCEPT
A. Avoidance of cold
B. Avoidance of tobacco
C. Avoidance of calcium channel blockers
D. Avoidance of beta blockers

Answer: C
Obviously you want CCBs since these are vasodilators

65) This benign hepatic tumor is the most commonly related to intake or oral contraceptives,
pregnancy, DM, or glycogen storage disease. It is recommended that these types of tumor be
removed because of their potential for malignant transformation
A. Hamartoma
B. Adenoma
C. Focal nodular hyperplasia
D. Hemangioma

Answer: B

66) Which tumor marker is ordered for hepatocellular carcinoma?

A. Alpha fetoprotein (AFP)
B. Carcinoembryonic antigen (CEA)
C. CA 19-9
D. Alkaline phosphatase

Answer: A
CEA is for colorectal CA, CA 19-9 is for pancreatic CA, alkaline phosphatase is elevated in biliary
obstruction

67) Thrombi that form in areas of rapidly flowing blood (arteries) are generally grey in color and
primarily composed of platelets. In contrast, thrombi occurring in relatively slowly flowing systems
(veins) are red and primarily composed of fibrin and RBCs.
A. True
B. False

Answer: A

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68) In patients with chronic venous insufficiency and healed venous ulceration, the most
important cause of recurrent ulceration is
A. Repeated leg trauma
B. Recurrent DVT
C. Poor patient compliance
D. Delayed surgery

Answer: B

69) BPH is not always progressive. Patients with mild symptoms can be managed by watchful
waiting. Patients with more severe symptoms should be treated based on the degree of bother.
Absolute indications for treatment including urinary retention, bladder stones, upper tract dilation,
and renal failure. Initial medical management includes the following drugs EXCEPT
A. Finasteride
B. Terazosin
C. Doxazosin
D. Tamsulosin
E. NOTA

Answer: E

70) The standard endoscopic procedure for BPH is

A. Transurethral resection (TUR)
B. Lithotripsy
C. Low anterior resection
D. Hartmann’s procedure

Answer: A

71) At least in Western countries, the most common histologic findings in urinary bladder CA is
A. Squamous cell CA
B. Adenocarcinoma
C. Transitional cell CA
D. All are of similar occurrence rate

Answer: C

72) The most common clinical presentation of urinary bladder CA is

A. Dysuria
B. Urinary retention
C. Hematuria
D. Recurrent UTI

Answer: C

73) In which region does prostate CA usually develop?

A. Central
B. Peripheral
C. Equal occurrence in both
D. AOTA

Answer: B

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74) If the intraoperative cholangiogram confirms the presence of biliary atresia, surgical correction
should be immediately undertaken. The most effective surgical treatment for biliary atresia is
portoenterostomy, the purpose of which is to promote bile flow into the intestine. This procedure
is called the
A. Catle’s procedure
B. Kasai’s procedure
C. Duhamel procedure
D. Alonso-Lej procedure

Answer: B

75) The abdominal wall is formed by four separate embryologic folds – cephalic, caudal, and right
and left lateral folds – each of which is composed of somatic and splanchnic layers. Each of the
folds develops toward the anterior center portion of the coelomic cavity, joining to form a large
umbilical ring that surround the two umbilical arteries, the vein, and the yolk sac or
omphalomesenteric duct. Failure of normal abdominal wall closure leads to
A. Omphalocoele
B. Exstrophy of the bladder
C. Congenital absence of the sternum
D. Exstrophy of the cloaca
E. AOTA

Answer: E

76) Gastroschisis represents a congenital defect characterized by a defect in the anterior

abdominal wall through which the intestinal contents freely protrude. In gastroschisis, unlike in
omphalocoele,
A. there is no overlying sac
B. the size of the defect is greater than 4 cm
C. the most common associated anomaly is intestinal atresia
D. A and C
E. AOTA

Answer: D

77) True of inguinal hernia in pediatric patients EXCEPT

A. Results from a failure of closure of the processus vaginalis, a finger-like projection of the
peritoneum that accompanies the testicle as it descends into the scrotum
B. There is similar rate of inguinal hernias among premature and term infants
C. Partial closure of the processus vaginalis can result in entrapped fluid, which results in the
presence of a hydrocoele
D. Using the classification system that is typically applied to adult hernias, all congenital hernias
in children are by definition indirect inguinal hernias
E. NOTA

Answer: B

78) True of the clinical manifestation of inguinal hernias EXCEPT

A. Occur more commonly in female than in males (10:1)
B. More common the right side than the left
C. Using the classification system that is typically applied to adult hernias, all congenital hernias
in children are by definition indirect inguinal hernias
D. NOTA

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Answer: A

79) Undescended testes (cryptorchidism) refers to the interruption of the normal descent of the
testis into the scrotum. The following statement is TRUE
A. The testicle may reside in the retroperitoneum, in the internal inguinal ring, in the inguinal
canal, or even at the external ring
B. The incidence of undescended testes is approximately 30% in preterm infants, and 1 to 3% at
term
C. It is now established that cryptorchid testes demonstrated an increased predisposition for
malignant degeneration
D. A and C only
E. AOTA

Answer: E

80) The best measure of kidney function that does not involve infusion of exogenous substance is
the
A. Creatinine clearance rate
B. Serum creatinine and BUN level
C. Urine specific gravity
D. Urinalysis

Answer: A

81) In the screening of BPH, which symptom is not included in the questionnaire of the
International Prostate Symptom Score (IPSS)
A. Incomplete voiding
B. Frequency
C. Hematuria
D. Nocturia
E. Weak stream

Answer: C
WINSURF!

82) Most common type of tracheo-esophageal fistula

A. Type A – isolated esophageal atresia
B. Type B – esophageal atresia with tracheo-esophageal fistula at the proximal end
C. Type C – esophageal atresia with tracheo-esophageal fistula at the distal stump
D. Type D – esophageal atresia with fistula between both the proximal and distal ends of the
esophagus and trachea

Answer: C

83) A patient presenting with tracheo-esophageal fistula consulted you at the OPD. What other
diseases should your rule out on the patient (TEF being part of this syndrome)
A. Missing vertebra
B. Congenital cardiac diseases
C. Renal agenesis
D. Imperforate anus
E. AOTA

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Answer: E
Technicaly, VACTERL isn’t a syndrome. But yeah there you go. (Vertebra, Anus, Cardiac,
Tracheo-Esophageal, Renal, Limb)

84) In his classic textbook Pediatric Surgery, Dr. Orvar Swenson – who is eponymously
associated with one of the classic surgical treatments for Hirschsprung’s Disease – described this
condition as follows:
A. Congenital megacolon is caused by a malformation in the pelvic parasympathetic system
which results in the absence of ganglion cells in Auerbach’s plexus of a segment of distal colon
B. Hypertrophy of associated nerve trunks
C. The disease results from a defect in the migration of neural crest cells, which are the
embryonic precursors of the intestinal ganglion cells
D. A and C only
E. AOTA

Answer: D

85) The diagnosis of Hirschsprung’s disease requires surgery in all cases. The classic surgical
approach consisted of a multiple stage procedure. This includes colostomy in the newborn period,
followed by a definitive pull-through operation after the child weighed over 10 kg. There are three
viable options for the definitive pull-through procedure that are currently used (the Swenson,
Soave, and Duhamel procedure). Although individual surgeons may advocate one procedure over
another, studies have demonstrated that the outcome after each type of operation is similar. For
each of these procedures, the principles of treatment include
A. Confirming the location in the bowel where the transition zone between ganglionic and
aganglionic bowel exists
B. Resecting the proximal ganglionic segment of the bowel
C. Performing an anastomosis of ganglionated bowel to either the anus or a cuff of rectal mucosa
D. A and C
E. AOTA

Answer: D

86) True of biliary atresia EXCEPT

A. More recent evidence suggests an acquired basis for this disease, implicating the immune
system and systemic viral infections in its pathogenesis
B. Jaundice, a constant finding, is usually present at birth or shortly thereafter, but may go
undetected or may be regarded as physiologic until the child is 2 or 3 weeks old
C. The infant demonstrates acholic, gray-appearing stools, secondary to obstructed bile flow
D. Later on develops stigmata of liver failure and portal HPN, particularly splenomegaly and
esophageal varices
E. NOTA

Answer: E

87) On diagnosis of biliary atresia, a combination of investigations is required in order to ascertain

the diagnosis. No single test is sufficiently sensitive or specific. In many centers in the US, the
nuclear medicine scan using technetium-99m imindiactete, performed after pretreatment of the
patient with phenobarbital, was proven to be an accurate and reliable study. If radionuclide
appears in the intestine, the diagnosis of biliary atresia is excluded
A. True
B. False

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Answer: A

88) It is worth noting that the intrahepatic bile ducts are always dilated in the patient with biliary
atresia
A. True
B. False

Answer: B

89) On the symptomatology of urologic dysfunction, which term is not properly matched to the
definition?
A. Strangury – severe pain at the termination of urination
B. Hesitancy – indicates delay in voiding after mental command
C. Polyuria – voiding an excessive number of times
D. Intermittency – involuntary stopping or starting of the stream

Answer: C

90) The function of Leydig cells is

A. Testosterone production
B. Support sperm production
C. Establishment of the blood-testis barrier
D. Production of sperm growth factors

Answer: A
The others refer to the Sertoli cells

91) In pediatric patients with inguinal hernia, there is congenital defect in the tunica vaginalis. This
layer corresponds to which layer of the abdominal wall
A. External oblique
B. Peritoneum
C. Internal oblique
D. Transversalis fascia

Answer: B

92) Which of the following is NOT part of the blood supply of the testicles?
A. Gonadal artery
B. Vassal artery
C. Inferior mesenteric artery
D. Cremasteric artery

Answer: C

93) Appropriate treatment for a single episode of microscopic hematuria

A. Reassurance and serial urinalysis to confirm resolution
B. Urine culture and IVP alone
C. Imaging of upper tract and cystoscopy
D. PSA

Answer: C

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94) Which of the following studies is useful in evaluating a patient with BPH?
A. International Prostate Symptom Score questionnaire
B. Cystoscopy
C. Pressure flow study
D. AOTA

Answer: D

95) Transurethral resection syndrome (TRS) after endoscopic resection of the prostate occurs
because of
A. Air embolism during the procedure
B. Blood lost from the postoperative irrigation
C. Absorption of irrigant
D. Relaxation of the urethral sphincter from spinal anesthesia

Answer: C

96) The treatment for acute embolic ischemia is

A. Observation
B. Anticoagulation
C. Thrombolysis
D. Operative embolectomy

Answer: D

97) TRUE of the clinical presentation of Hirschsprung’s disease

A. In the newborn period, the most common symptom is abdominal distension
B. Any infant who does not pass meconium beyond 48 hours of life must be investigated for the
presence of this disease
C. Treatment includes rehydration, systemic antibiotics, nasogastric decompression, and rectal
irrigation while the diagnosis is being confirmed
D. In approximately 20% of cases, the diagnosis is made beyond the newborn period they usually
present with severe constipation, which has usually been treated with laxatives and enemas
E. AOTA

Answer: E

98) A sunburn is a superficial partial thickness burn

A. True
B. False

Answer: B
Sunburns are first degree burns, whereas a partial thickness burn is second degree

99) Deep partial thickness burns are slowly blanching with areas of anesthesia
A. True
B. False

Answer: A

100) The following are components of the primary survey of a burn patient EXCEPT
A. TOI
B. POI

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C. Airway patency
D. Co-morbidities
E. Total surface area of burn

Answer: D?
According to the Topnotch reviewer, which itself is based on Schwartz, airway patency and
determination of total surface area of the burn are part of the initial management of burn patients.
They should also be treated as trauma patients, hence the typical primary survey including DOI,
TOI, POI, MOI should be accomplished. If by co-morbidities we mean medical conditions such as
hypertension and diabetes, these are not part of the primary survey. If by co-morbidities we mean
other injuries sustained in addition to the burn, then it should be part of the primary survey.

101) In pericardial tamponade, Beck’s triad is defined as:

A. Pulsus paradoxus, hypotension, distended neck veins
B. Muffled heart sounds, pulsus alternans, high CVP
C. Muffled heart sounds, hypotension, distended neck veins
D. Pericardial chest wound, hypotension, distended neck veins

Answer: C

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