surgery

ward exam
dr. cadang

1. What is the preferred imaging modality for a 25 year old patient with a 6. A 55 year old female consulted in your clinic because of a 2 cms breast
palpable breast mass? mass which was subsequently diagnosed as IDCA. There were no palpable
a. Mammography axillary lymph nodes. Possible surgical treatment would include:
b. Ultrasound a. Lumpectomy + ALND
c. CT Scan b. Lumpectomy alone
d. MRI c. Total mastectomy
d. MRM
2. What is the preferred imaging modality for a 42 year old female patient
with a palpable breast mass? 7. A 62 year old patient with a 2.5 cms breast mass at the UOQ of the right
a. Mammography breast underwent biopsy which showed IDCA. Mammography showed
b. Ultrasound clustered calcifications in the IUQ and LOQ of the right breast. Biopsy of
c. CT Scan said lesions showed DCIS. Surgical treatment of choice would be:
d. MRI a. BCS
b. MRM
3. A 28 year old female with a palpable breast mass had an Ultrasound result c. Radical Mastectomy
of a solid breast mass suspicious for malignancy. What kind of biopsy is d. Extended radical mastectomy
preferred in this case?
a. FNAB 8. A 52 year old female underwent screening mammography which showed
b. Core Needle Biopsy microcalcifications on her left breast. It was read as BIRADS Category 5
c. Incisional Biopsy lesion. Management would include:
d. Excisional Biopsy a. US guided core biopsy
b. Mammography guided needle localization excision biopsy
4. A 45 year old female with a 5 cms breast mass underwent core biopsy of c. Stereotactic core biopsy
said mass. Final histopathology showed malignant cystosarcoma d. If diagnosed as malignant – determination of hormone receptor
phylloides. Appropriate treatment would include: status
a. Wide Excision e. Frozen section
b. Adjuvant chemotherapy
c. Adjuvant hormonal therapy 9. A 52 year old female who was diagnosed with IDCA is undergoing MRM.
d. MRM During axillary dissection, the surgeon was able to palpate enlarged nodes
e. Adjuvant RT posterior to the pectoralis minor muscle. Appropriate axillary dissection
would be:
5. Risk of subsequent breast cancer among patients with this benign breast a. Axillary sampling
lesion is not increased b. Level 1 dissection only
a. Fibroadenoma c. Level 1 & 2 dissection only
b. Sclerosing adenosis d. Total axillary lymphadenectomy [Level 1,2,3]
c. Apocrine change
d. Atypical hyperplasia


 10. A 70 year old female with 9 mm right breast mass was diagnosed by core 16. What is the most common complication of chronic pancreatitis:
biopsy to have IDCA. Lumpectomy + ALND were done. Axilla was [-] for a. Hemorrhage
mets. Tumor was ER+/PR+. Adjuvant therapy must include: b. Necrotizing infection
a. Adjuvant RT c. Pseudocyst
b. Adjuvant Chemotherapy d. Duodenal obstruction
c. Adjuvant hormonal therapy
17. Which of the following statements is not true about the portal vein?
11. A 51 year old female underwent MRM for a IDCA of the left breast. Tumor a. It is formed by the junction of the superior mesenteric vein and
was ER/PR negative and HER2 negative. These findings are associated with splenic vein
what breast cancer subtype? b. It is the most dorsal structure in the hepatoduodenal ligament
a. Luminal A c. It contains Valve of Mirizzi
b. Luminal B d. It carries deoxygenated blood and provides up to 50% of the liver
c. Basal oxygenation
d. HER2
18. Which of the following is the most common variant of the hepatic artery?
12. A 54 year old female came into your clinic with palpable mass about 2 cms a. Replaced left hepatic artery
in her right breast. Mammography and Ultrasound showed normal results. b. Replaced right hepatic artery
What is the next step? c. More distal bifurcation of the common hepatic artery
a. Needle biopsy d. More proximal bifurcation of the common hepatic artery
b. Excision biopsy
c. Observe 19. How much bile does a healthy adult produce each day?
d. Wide excision a. 50-100 ml
b. 200-300 ml
13. What is the most common cause of chronic pancreatitis worldwide? c. 500-1000 ml
a. Gallstones d. 1200-1800 ml
b. Alcohol intake
c. Hereditary 20. Bile is normally a neutral pH or slightly alkaline. Consumption of large
d. Hypertriglyceridemia amounts of which of the following will decrease the pH of bile?
e. Infectious a. Fat
b. Carbohydrate
14. Which of the following is primary function of the spleen in humans? c. Protein
a. Production of red cells d. Ethanol
b. Production of white cells
c. Storage of blood 21. The cystic artery most commonly arises from the right hepatic artery (80-
d. Host defense 90%). The most anatomic configuration of the cystic artery, which occurs in
10% of people is:
15. A classical symptom of ruptured spleen which manifests as acute pain at a. Two cystic arteries, both arising from the right hepatic artery
the tip of right shoulder when person is lying down b. Two cystic arteries, one arising from the right hepatic artery and
a. Kehr sign one arising from the left hepatic artery
b. Kerr sign c. One cystic artery, arising from an aberrant right artery
c. Kher sign d. One cystic artery, arising from the duodenal artery
d. Kherr sign


 22. The gallbladder is able to store only a small fraction of the bile produced by d. Abdominal CT Scan
the liver. What is the primary mechanism used to keep the gallbladder e. NOTA
from becoming distended (and developing high pressure) by this volume of
bile? 28. Which of the following is not part of Reynold’s pentad?
a. The bile continuously secreted into the duodenum once the a. Hypovolemic shock
pressure in the gallbladder increases b. Jaundice
b. There is enough contraction of the gallbladder in response to c. Mental status change
eating to empty the large volume of bile d. Fever
c. The gallbladder concentrates the large volume of bile
d. The liver decreases bile production when the pressure in the 29. All of the following are true regarding bile and gallstone EXCEPT:
gallbladder increases a. The primary bile acids are cholic and chenodeoxycholic acid
b. The primary phospholipid in bile is lecithin
23. The sensitivity of ultrasound in detecting gallstones is: c. Cholecystectomy increases bile salt secretion
a. >99% d. Half a gram of bile salts is produced daily to replace fecal losses
b. 90-95% e. Bile consists of an equal part bile salts, phospholipids and
c. 85-90% cholesterol
d. 80-85%
30. Hydrops of Gallbladder
24. Which of the following is associated with an increased risk for a. Poses a significantly increased risk of malignancy
cholelithiasis? b. Is due to stone impacted in the cystic duct
a. Ulcerative colitis c. Is typically associated with an enteric bacterial infection
b. Crohn’s disease d. Is associated with marked right upper quadrant tenderness
c. Jejunal resection e. Results in the gallbladder getting filled with bile-stained fluid
d. Carcinoma of the colon
31. Which of the following is true regarding gallstones types?
25. Which of the following is a component of gallstones? a. Pure cholesterol stones are common
a. Biliverdin b. Pigment stones are dark because of the presence of calcium
b. Hemoglobin bilirubinate
c. Lecithin c. Brown stones are usually formed in association with a haemolytic
d. Short chain fatty acids disorder
d. Black stones are associated with bacterial infection
26. Which of the following is an indication for cholecystectomy in an
asymptomatic patient with an incidental finding of gallstones? 32. Which of the following is not a component of gallstones?
a. Any history of abdominal pain a. Bile salts
b. Family history of complications of b. Hemoglobin
c. Porcelain gallbladder c. Lecithin
d. Frequent travel out of the country d. Cholesterol

27. A 27 year old male, arrived at the emergency room with the chief 33. Which of the following is not part of Charcot’s Triad?
complaint of right upper quadrant pain. If you were the surgery intern on a. Hypovolemic shock
duty at the ER, what is the first thing you would do? b. Jaundice
a. Abdominal X-ray c. Right upper quadrant pain
b. Abdominal ultrasound d. Fever
c. Request for complete blood count
 34. A 23 year old male was experiencing severe abdominal pain following 40. A 30 y/o man is taken to the ER after having fallen off a roof. He arrives at
vehicular accident was hypotensive and tachycardic despite fluid the ER with incomprehensible response to questions, eye opening to pain
resuscitation. Your next step is: only and flexor response to pain. What is the GCS score?
a. Abdominal CT Scan a. 6
b. Whole abdominal ultrasound b. 7
c. Immediate explore laparotomy c. 5
d. Blood transfusion d. 8

35. Pre-operative ERCP is warranted for the following patients EXCEPT 41. What is the next best step in management for the patient in the previous
a. A 35 y/o male with fever, chills, right upper quadrant pain and clinical scenario?
jaundice a. Cranial CT Scan
b. A 40 y/o female with ultrasound findings of choledocholithiasis b. Skull and Cervical X-ray
c. A 30 y/o asymptomatic male with dilated common bile duct on c. Immediate endotracheal intubation
ultrasound d. Elevation of the head of bed to 30 degrees
d. A 65 y/o with painless jaundice
42. Select the correct statement regarding flail chest:
36. What is the principal cell type located at the center of the islet of a. Work of breathing is increased is secondary to paradoxical chest
Langerhans? wall motion
a. Alpha cell b. Patient with flail chest should be aggressively resuscitated of the
b. Beta cells possible development of pulmonary contusion
c. Delta cell c. It occurs when 3 or more adjacent ribs are fractured in one place
d. Gamma cell d. If a patient does require ventilation, it is important to avoid the
use of PEEP
37. What is a positive finding in DPL? (Diagnostic Peritoneal Lavage)
a. RBC count > 20,000 43. Which of the following statement regarding brain injuring is FALSE?
b. ALP > 3 IU/L a. Diffuse axonal injury (DAI) is usually an incidental and
c. Bilirubin level > 0.02 mg/dl asymptomatic finding
d. Amylase level of > 19 IU/L b. The extent of brain injury is a function of the mechanism of injury
c. Contusions tend to involve the anterior portion of the frontal and
38. All of the following are hard signs of peripheral vascular injuries EXCEPT temporal lobes
a. Pulsatile haemorrhage d. Not all brain contusions are clinically apparent on neurologic
b. Absent pulse examination
c. Thrill
d. Acute ischemia 44. The physiologic parameters used in the definition of SIRS includes all of the
following EXCEPT
39. A 30 year old male suffered Vehicular accident. He has stable vital signs a. PaCO2 > 32 mmHg
with RUQ tenderness. Select the most appropriate next step in b. Temperature > 38 degree-Celsius
management of abdominal pain? c. Heart rate > 90 bpm
a. Admission for observation and serial abdominal examinations d. WBC count > 10% immature blood cells in PBS
b. Diagnostic peritoneal lavage
c. FAST
d. Exploratory laparotomy
 45. Patient sustained stab wound on the left flank with BP 80/60 mmHg, 51. All of the following are included in the guidelines for referral to a burn
confused and heart rate of 123 bpm. What classification of shock does the center EXCEPT:
patient have? a. Chemical burn
a. Class I b. Inhalational burn
b. Class II c. Third degree burn in any group
c. Class III d. Partial thickness burns lesser than 10% TBSA
d. Class IV
52. A 20 y/o male is brought to the ER after suffering from thermal burn injury
46. What is the expected infection rate in Hernia repair? which are leathery, painless and non-blanching. What is the burn-depth
a. 2% classification of the patient?
st
b. 2.5% a. 1 degree
nd
c. 3% b. 2 degree
rd
d. 5% c. 3 degree
th
d. 4 degree
47. What is the wound classification of colorectal surgery?
a. Class I 53. A 30 y/o male was brought to the ER after suffering flame burn. He has
b. Class II burn in his right arm circumferentially, bilateral on his legs, and on his
c. Class III perineum. What is the approximate % TBSA burned?
d. Class IV a. 36%
b. 46%
48. All of the following are components of Beck’s triad EXCEPT: c. 64%
a. Distended neck veins d. 28%
b. Hypotension
c. Tachycardia 54. Boundaries of Hasselbach triangles except:
d. Muffled heart tone a. Inguinal ligament
b. Inferior epigastric level
49. Patient came in at the ER due to blunt thoracoabdominal trauma, anxious c. Medial edge of rectus sheath
with BP 110/70, CR: 102, RR: 22. What classification of shock does he d. Cooper ligament
have?
a. Class I 55. What is the nyhus classification of direct hernia?
b. Class II a. Type II
c. Class III b. Type IIIA
d. Class IV c. Type IIIB
d. Type IIIC
50. Patient came in at the ER due to fever, with eye opening response to voice,
confused, and withdraws to pain. What is the GCS score? 56. This type of hernia repair uses prosthetic mesh to reinforce the inguinal
a. 9 floor
b. 10 a. Bassini
c. 11 b. Shouldice
d. 12 c. McVay
d. Leichtenstein


 57. Which cell type is matched with the primary anatomic location and 63. All of the following condition are associated with increased risk for small
secretory product? bowel malignancy EXCEPT
a. Chief cell/Cardia/HCl a. Familial adenomatous polyposis
b. Parietal cell/Fundus/HCl b. Peutz-jeghers syndrome
c. G cells/Antrum/Pepsinogen c. Crohn’s disease
d. Delta cell/Corpus/Gastrin d. Scleroderma

58. All of the following are associated with Helicobacter Pylori infection 64. Most common site of perforation of appendix
EXCEPT a. Tip
a. Gastric ulcer b. Base
b. Duodenal ulcer c. Anti-mesenteric border
c. Chronic gastritis d. Body
d. Gastroesophageal reflux disease
65. In acute appendicitis, what is the most common etiology in children?
59. What is the most common primary neoplasm of intestine? a. Luminal obstruction of fecalith
a. Lymphoma b. Lymphoid hyperplasia
b. Leiomyosarcoma c. Infection
c. Adenocarcinoma d. Luminal obstruction by foreign body
d. GIST
66. In acute appendicitis, which of the following is true?
60. What is the most common benign neoplasm of small intestine? a. Early antibiotic treatment decreases the incidence of perforation
a. Adenoma b. Nausea and vomiting precede the pain
b. Lipoma c. Perforation rates correlates with the severity of the illness
c. Leiomyoma d. Resolve spontaneously
d. Hamartoma
67. What is the most sensitive sign of appendicitis?
61. What is the most common findings in small bowel neoplasm? a. Anorexia
a. Anemia b. Vomiting
b. Hematemesis c. RLQ pain
c. Intussusception d. Fever
d. Abdominal pain
68. A 50 y/o female with left breast mass measuring 4 cms in size. Core needle
62. What is the most frequently encountered surgical disorder of the small biopsy done showed IDCA. MRM was done. Tumor was ER+/PR+, HER2+
intestine? with negative axillary LN. All of the following are indicated adjuvant
a. Perforation treatment EXCEPT
b. Bleeding a. Chemotherapy
c. Obstruction b. Hormonal therapy
d. Peritonitis c. Radiotherapy
d. Trastuzumab




 69. Appendix is now well-recognized as an immunologic organ that actively 75. A 60 y/o male is diagnosed of diverticulitis. What is the most common site?
participates in the secretion of immunoglobulins particularly ______? a. Cecum
a. IgM b. Sigmoid
b. IgA c. Transverse
c. IgG d. Descending
d. IgE e. Ascending

70. A 30 y/o female is operated for acute appendicitis, however, in 76. What is the narrowest part of the large intestine?
intraoperative finding, the appendix is normal. Which of the following a. Cecum
would be appropriate treatment? b. Transverse
a. Exploration and treatment of other pathologic condition without c. Ascending
appendectomy d. Sigmoid
b. Exploration and if no pathology is found, closure without e. Descending
appendectomy
c. Proceed with appendectomy, if no other pathology is found 77. A 53 y/o male is brought to the ER because of large bowel obstruction with
d. Exploration and ileal resection if the terminal ileum is inflamed peritonitis. Where is the most probable site of perforation?
a. Cecum
71. All of the following are advantages of laparoscopic appendectomy EXCEPT b. Sigmoid
a. Shortened hospital stay c. Transverse
b. Faster recovery d. Descending
c. Lower infection rates e. Ascending
d. Less surgical cost
78. A 65 y/o male mentally retarded is brought to the ER because of abdominal
72. Most often confused with acute appendicitis in children is: pain, vomiting and abdominal distention. Abdominal xray findings:
a. Urinary tract infection presence of air fluid level and coffee bean sign. What is the diagnosis?
b. Mesenteric adenitis a. Perforated viscus
c. Gastroenteritis b. Volvulus
d. Diverticulitis c. Colon carcinoma
d. Diverticulitis
73. All of the following are signs and symptoms of peritonitis EXCEPT
a. Severe abdominal pain 79. In the above question, what part of the bowel is commonly involved?
b. Muscle guarding a. Cecum
c. Fever b. Ascending colon
d. Abdominal distention c. Transverse colon
d. Descending colon
74. A 23 y/o male is suspected of having acute appendicitis. On PE, abdomen is e. Sigmoid
soft, however, he experiences abdominal pain during extension of the right
thigh while lying on his left side. Where is the location of the appendix? 80. The parasympathetic innervation of the right and transverse colon is from
a. RUQ the ____?
b. LLQ a. Vagus nerve
c. Pelvis b. T6-T12
d. Retrocecal c. L1-L3
d. S2-S4
e. Nervi erigentes
 81. The parasympathetic innervation of the left colon 88. With regard to the blood supply of the anorectum, select the incorrect
a. Vagus nerve pairing
b. T6-T12 a. Inferior mesenteric artery – Superior rectal artery
c. L1-L3 b. Internal iliac artery – Middle rectal artery
d. S2-S4 c. Pudendal artery – Inferior rectal artery
e. Nervi erigentes d. Internal iliac artery – Inferior rectal artery

82. What is the normal length of the rectum? 89. What is the most common malignancy of the GIT?
a. 8-10 cm a. Gastric Ca
b. 10-12 cm b. Small Bowel Ca
c. 12-15 cm c. Colorectal Ca
d. 10-14 cm d. Esophageal Ca

83. What is the common cause of large bowel obstruction? 90. All of the following are screening modalities for colon cancer EXCEPT
a. Neoplasm a. Abdominal xray
b. Post-op adhesion b. FOBT
c. Foreign body c. Colonoscopy
d. Volvulus d. Proctosigmoidoscopy

84. A 50 y/o male is brought to ER because of massive colonic bleeding. What 91. What is the second most common site of volvulus?
is the most common cause of his bleeding? a. Cecum
a. Neoplasm b. Transverse colon
b. Ulcerative colitis c. Stomach
c. Angiodysplasia d. Descending colon
d. Diverticulitis
92. Three hemorrhoidal cushions found in the anorectum EXCEPT
85. All of the following will require colonoscopy EXCEPT: a. Right lateral
a. Family members with HNPCC b. Left lateral
b. Patients with colorectal cancer in first degree relative c. Right anterior
c. Patients with Crohn’s colitis to monitor efficacy and treatment d. Right posterior
d. Patients with adenomatous polyp
93. A 42 y/o female G5P5 came at your clinic complaining of anal mass. You
86. All of the following are branches of superior mesenteric artery EXCEPT: palpated a hemorrhoid proximal to the dentate line. What is the diagnosis?
a. Right colic a. External hemorrhoid
b. Left colic b. Internal hemorrhoid
c. Middle colic c. Mixed hemorrhoid
d. Ileocolic d. Rectal Ca

87. All of the following are branches of inferior mesenteric artery EXCEPT
a. Left colic
b. Sigmoidal artery
c. Superior rectal artery
d. Inferior rectal artery
 94. The patient in question 93 noticed that her hemorrhoid prolapses through 99. A 40 y/o female with anterior neck mass came in at your clinic with
the anus and require manual reduction. What is the grade of her histopath findings of cells that are cuboidal with pale abundant cytoplasm
hemorrhoid? and Orphan Annie nuclei. What is the diagnosis?
a. Grade I a. Papillary
b. Grade II b. Follicular
c. Grade III c. Anaplastic
d. Grade IV d. Medullary

95. What is the most common type of fistula in ano? 100. All of the following are blood supply of the thyroid gland EXCEPT:
a. Transphincteric a. Inferior thyroid artery
b. Intersphincteric b. Middle thyroid artery
c. Suprasphincteric c. Superior thyroid artery
d. Extrasphincteric d. Thyroidea ima

96. According to GOODSALL’S rule, fistulas with _____
a. An external opening anteriorly connects to the internal opening
by curvilinear fashion
b. An external opening anteriorly connects to the internal opening
by a short radial tract
c. An external opening posteriorly connects to the internal opening
by a short radial tract
d. Exception to the rule if posterior opening is greater than 3 cm
from anal margin

97. A 29 y/o female with history of 4 years gradually enlarging anterior neck
mass came at your clinic. All of the following are part of your initial
management EXCEPT
a. Neck ultrasonography
b. FNAB
c. Ft4, TSH determination
d. Total thyroidectomy

98. What is the most common thyroid malignancy?
a. Follicular
b. Papillary
c. Anaplastic
d. Medullary