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Surgery 4th LE: TCVS ver.1 8.

A 31 year old female with persistent cough,


wheezing and occasional hemoptysis is found to
1. A 45 y/o patient comes in for hemoptysis about 5 have a right bronchial obstruction. This is most
times, each amounting to about 100 ml, still likely due to:
ongoing. The gdiagnostic exam of choice to a. Carcinoid tumor
localize the site of bleeding is b. Hamartoma
a. Chest xray c. SVC sundrome
b. Chest CT scan d. Lymphoma
c. Bronchography e. Thymoma
d. Fiberoptic bronchoscopy
e. Rigid bronchoscopy 9. A patient with emphysematous bullae is a good
candidate for surgery if he has
2. The most common cause of such hemoptysis is a. Chronic symptoms, stable disease
a. PTB b. Multiple, one sided small bullae
b. Lung cancer c. Concomitant tb lesion on the same lobe
c. Lung abscess d. Single large bulla involving more than 1/3 of the
d. Bronchiectasis hemithorax
e. Bronchial carcinoid e. Poor pulmonary function ( target: improvement)

3. A 67 year old asymptomatic smoker presents 10. Neoadjuvant chemotherapy for lung cancer is
with a 2.6 cm mass with ill defined borders in the sometimes recommended to
right upper lobe. He has a history of a. Alleviate the systemic effect of chemotherapy by
thyroidectomy for well- differentiated thyroid spreading out the treatment intervals
cancer 10 years ago. The most likely diagnosis is b. Reduce the extent of surgical resection
a. Metastatic cancer from the thyroid c. Make the surgery more manageable if the tumor
b. Primary lung cancer is big or bulky, and near vital Structures
c. Metastasis from an unknown head and neck cancer d. Reduce the total radiation dose needed
d. Metastasis from a gi tract cancer e. To kill the tumor cells prior to surgical manipulation
e. Tb granuloma
11. In a patient with suspected pleural mesothelomia
4. A 27 year old diving instructor came in for mild which diagnostic procedure would you
chest pain and was found on chest xray to have recommend?
15% pneumothorax on the right lung. Definitive a. Thoracentesis with fluid cytology
treatment would ideally consist of b. Percutaneous lung biopsy
a. Observation and treatment with analgesics c. Mediastinoscopy
b. 100% oxygen inhalation with complete resorption of d. VATS
thepneumothorax e. Thoracotomy and open biopsy
c. Tube thoracostomy
d. VATS 12. Neglected empyema thoracis often results in
e. Open thoracotomy a. Lung abscess
b. Necrotizing pneumonia
5. An otherwise healthy patient consults for sudden c. Empyema necessitates
difficulty in breathing and is found to have d. Trapped lung
decreased breath sounds on the left and tracheal e. Mediastinitis
deviation to the right. He has a bp of 80/60 and
rr of 34. He probably has 13. A 44 year old female presents with an anterior
a. Cardiac tamponade neck mass of 12 years duration but is otherwise
b. Traumatic asphyxia asymptomatic. On work up the mass is seen to
c. Massive left hemothorax have a connection to a moderately large
d. Tension pneumothorax mediastinal mass. This is most likely
e. Severe bronchoconstriction a. Lymphoma
b. Cervical goiter with mediastinal extension
6. Which of the following constitutes a c. Benign thymoma with cervical involvement
contraindication to surgery in lung CA? d. Mediastinal thyroid with cervical involvement
a. Ipsilateral hilar lymphadenopathy e. Parathyroid adenoma with mediastinal involvement
b. Pleural effusion
c. 4cm tumor involving the hilum 14. An 18 year old student is brought in by his
d. Chest wall involvement by the tumor parents for a well circumscribed 1.5 cm mass
e. Superior vena cava syndrome lesion in the right upper lobe, he is otherwise
asymptomatic. They are concerned because the
7. A 19 year old male presents with an anterior family is up for immigration to Canada within the
mediastinal mass found on routine chest xray. next 3 months. You would advise
Which among these tests should you request for a. Observation with serial radiography/ imaging studies
in the work up? b. VATS, possible wedge resection
a. A-feto protein c. Open thoracotomy, possible lobectomy
b. CEA d. Radiation trial
c. B-HCG e. Treat with anti tb for 6 months
d. CA-125
e. Cytokeratin

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15. A 22 year old female is referred to you for ptosis, Items 37-40
mild dysphagia and progressive weakness a. Primary lung cancer
through the day of a few months duration. She is b. Secondary lung cancer ( metastatic)
found to have an anterior mediastinal mass. You c. Both
would suggest d. Neither
a. Medical management for myasthenia gravis
b. Radiation therapy 37. Pleural effusion C
c. Excision of the mass ( thymoma) 38. CT scan guided needle biopsy C
d. Thymectomy 39. Pneumonectomy A
e. Surgery and adjuvant chemotherapy/radiotherapy 40. Neoadjuvant radiation therapy D

Items 16-23 VASCULAR SURGERY


a. Surgery 41. An 80 year old male with a history of bleeding
b. Chemotherapy peptic ulcer and recent stroke is the ER
c. Both complaining of severe pain of the left leg and
d. Neither foot. On examination, the extremity is cold with
absent pulses. Treatment should consist of:
16. Stage III B non small cell lung CA B a. Oral anticoagulant
17. Seminoma B b. Embolectomy
18. Mediastinal lymphoma B c. Systemic thrombolysis
19. Thymoma C d. Heparinization
20. Chest wall osteosarcoma C
21. Chest wall chondroma A 42. Lower extremity arterial revascularization for
22. Bronchial carcinoid A chronic arterial occlusion is recommended for
23. SVC syndrome B which of the ff conditions?
a. Claudication
Items 24-28 b. Diabetic neuropathy
a. Chest X-ray c. Ischemic gangrene of leg and foot
b. Chest CT scan d. Resting foot pain
c. Both
d. Neither 43. A 72 y/o pulsatile abdominal mass aorta
a. Abdominal CT scan
24. Bullous emphysema C b. Aortography
25. Empyema thoracis C c. MRI
26. Lung abscess C d. Exploratory surgery
27. Bronchogenic cyst A
28. Massive hemoptysis D 44. The most effective treatment modality for
Buergers disease is:
Items 29-33 a. Diet
a. Tube thoracostomy b. Vasodilator therapy
b. Thoracotomy c. Surgery
c. Both d. Abstinence from tobacco
d. Neither
45. Proper management of a 86 y/o patient with
29. Spontaneous pneumothorax with blebs A asymptomatic 3cm intrarenal abdominal aortic
30. Moderate pleural effusion secondary to PTB aneurysm would consist of:
B a. Elective aneurysm repair
31. Tension pneumothorax b. Intervention only if symptoms develop
B c. Medication and limitation of activity
32. Empyema thoracis, trapped lung d. Reassurance and observation
A
33. Giant lung abscess A 46. Ischemic resting pain typically involves the
a. Diet
Items 34-36 b. Thigh
a. VATS c. Calf
b. open thoracotomy d. Sole and hindfoot
c. Both e. Forefoot and toes
d. Neither
47. The diagnosis of Buergers disease can be best
34. Unexplained one-sided pleural effusion A made on the basis of
35. Thymoma C a. History of arm and thigh claudication
36. Mesothelioma b. Young age, blood type a
A c. Gangrene of the fingers and toes
d. Finding of inflammatory cells forming a large
part of the occluding thrombus

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48. The most ominous sign of advanced acute Proximal lower extremity v.
arterial occlusion is
a. Ischemic ulceration 65. Management of AOD EXCEPT:
b. Severe unrelenting pain Vasodilator
c. Paralyzed anesthetic extremity Items 66-70 Arterial vs. Venous
d. Coldness and pallor a. Venous
b. Arterial
49. Which of the following statement regarding c. Both
lower extremity arterial disease is NOT TRUE? d. Neither
a. Ankle/ brachial index of 0.9 or lower is seen in
normal individuals 66. Homocysteine C
b. calcification of leg arteries in diabetes may result in 67. LMW heparin A
abnormally high ankle/ brachial indeces 68. Cigarette smoking B
c. arterial duplex scan is the initial diagnostic exam of 69. Gangrene C
choice 70. Warfarin C
d. segmental pressure measurements can define disease
location in most instances Items 71-75 CVI vs Primary varicose veins
a. CVI
50. Which of the following statements most b. Primary varicose veins
appropriately describes claudication? c. Both
a. It is typically manifested a joint below the level of d. Neither
occlusion
b. Diabetics rarely experience claudication mainly 71. Valvular incompetence C
because of their neuropathy 72. Stockings C
c. Claudication typically starts at the buttocks, 73. Thrombosis C
down the thigh, calf and foot 74. Venous ulcers A
d. Claudication frequently progresses to gangrene of the 75. Warfarin D
lower extremity
Items 76-80 Buergers vs Artherosclerotic occlusive
Items 51-55 disease
a. Acute arterial occlusion a. Buergers
b. Chronic arterial occlusion disease b. Artherosclerotic occlusive disease
c. Both c. Both
d. Neither d. Neither

51. Heparinization A 76. Inflammation A


52. Ischemic/Necrosis C 77. Smoking C
53. Paralysis C 78. Gangrene C
54. Amputation A 79. Upper extremity involvement C
55. Vasodilator therapy D 80. DM B

56. Pulmonary embolism greatest risk Items 81-85 Unfractioned vs LMW heparin
Iliofemoral thrombosis a. LMW heparin
b. Unfractioned heparin
57. Vena caval filter placement for c. Both
Patient with DVT who had stroke d. Neither

58. Primary varicose veins 81. Venous thrombosis A


Valvular reflux 82. Acute arterial occlusion B
83. Chronic arterial occlusion D
59. Pulmonary embolism 84. Protime/PTT C
Ventilation/Perfusion scan 85. Subcutaneous injection C

60. Treatment for varicose vein EXCEPT: Items 86-90 Arterial ulcer vs Neuropathic ulcer
Chelation a. Arterial ulcer
b. Neuropathic ulcer
61. At risk for DVT c. Both
Hip replacement therapy d. Neither

62. CV Except: 86. DM C


Venous thrombosis 87. Bleeding B
88. Painless B
63. Source of LE arterial emboli 89. Goiter area D
Left atrium 90. Delayed/poor healing C

64. Mc source of clinically important PE

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