Surgery Pearls

TOPNOTCH MEDICAL BOARD PREP SURGERY PEARLS HANDOUT BY DR LOUBOMIR ANTONIO
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This handout is only valid for the March 2022 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly.
Excessive administration of normal saline for fluid
IMPORTANT LEGAL INFORMATION resuscitation can lead to what metabolic derangement?
A. Metabolic alkalosis
The handouts, videos and other review materials, provided by Topnotch Medical Board B. Metabolic acidosis
Preparation Incorporated are duly protected by RA 8293 otherwise known as the C. Respiratory alkalosis
Intellectual Property Code of the Philippines, and shall only be for the sole use of the person:
a) whose name appear on the handout or review material, b) person subscribed to Topnotch
D. Respiratory acidosis
Medical Board Preparation Incorporated Program or c) is the recipient of this electronic In a previously unexposed patient, when does the platelet
communication. No part of the handout, video or other review material may be reproduced, count fall in heparin-induced thrombocytopenia(HI )?
shared, sold and distributed through any printed form, audio or video recording, electronic
medium or machine-readable form, in whole or in part without the written consent of A. <24 hours
Topnotch Medical Board Preparation Incorporated. Any violation and or infringement, B. 24–28 hours
whether intended or otherwise shall be subject to legal action and prosecution to the full
extent guaranteed by law.
C. 3–4 days
D. 5–7 days
DISCLOSURE Which finding is not consistent with TTP?
The handouts/review materials must be treated with utmost confidentiality. It shall be the A. Microangiopathic hemolytic anemia
responsibility of the person, whose name appears therein, that the handouts/review B. Schistocytes on peripheral blood smear
materials are not photocopied or in any way reproduced, shared or lent to any person or
disposed in any manner. Any handout/review material found in the possession of another
C. Fever
person whose name does not appear therein shall be prima facie evidence of violation of RA D. Splenomegaly
8293. Topnotch review materials are updated every six (6) months based on the current Less than 0.5% of transfusions result in a serious
trends and feedback. Please buy all recommended review books and other materials listed
below. transfusion-related complication. What is the leading
THIS HANDOUT IS NOT FOR SALE! cause of transfusion-related deaths?
A. Transfusion-related acute lung injury (TRALI)
REMINDERS B. ABO hemolytic transfusion reactions
1. The Pearls Lecture serves as the final coaching. It is expected that you have finished at C. Bacterial contamination of platelets
least the Main Lecture videos prior to watching the Phase 3 videos
2. The guided content of the video lectures are seen within the handout. Answers to D. Iatrogenic hepatitis C infection
questions / blanks will be seen in the Pearls Lecture video. What is the risk of Hepatitis C and HIV-1 transmission with
blood transfusion?
A. 1:10,000,000
This handout is only valid for the March 2022 PLE batch.
B. 1:1,000,000
This will be rendered obsolete for the next batch
C. 1:300,000
since we update our handouts regularly.
D. 1:100,000
Shock caused by a large tension pneumothorax is
SURGERY – PEARLS categorized as?
By Loubomir E. Antonio, MD, FSOSP, FPCS, FPSGS, A. Traumatic
B. Vasodilatory
C. Cardiogenic
Which of the following is an antifibrinolytic agent used in D. Obstructive
regular clinical practice? A 70-kg male patient presents to ED following a stab wound
A. Unfractionated heparin (UFH) to the abdomen. He is hypotensive, markedly tachycardic,
B. Tranexamic acid (TXA) and appears confused. What percent of blood volume has
C. Protamine sulfate he lost?
D. Tissue plasminogen activator (tPA) A. 5%
E. Plasminogen activator inhibitor-1 (PAI-1) B. 15%
A unit of blood could be transfused most rapidly through C. 35%
which of the following vascular access catheters? D. 55%
A. An 18-gauge, 16-cm, triple-lumen catheter in the Vasodilatory shock
right IJV A. Is characterized by failure of vascular smooth muscle
B. A 16-gauge, 30-cm, triple-lumen catheter in the right to constrict due to low levels of catecholamines
SCV B. Leads to suppression of the renin-angiotensin system
C. An 18-gauge catheter inserted into the cephalic vein C. Can also be caused by carbon monoxide poisoning
at the wrist D. Is similar to early cardiogenic shock
D. A 16-gauge, 3-cm peripheral IV in the right
A patient with necrotizing pancreatitis undergoes
antecubital fossa
computed tomography (CT)-guided aspiration, which
E. An 18-gauge, 3-cm peripheral IV in the right
results in growth of Escherichia coli on culture. The most
antecubital fossa
appropriate treatment is ?
In cirrhotic patients who are actively bleeding, the A. Culture-appropriate antibiotic therapy
coagulopathy of end-stage liver disease can be B. ERCP with sphincterotomy
differentiated from DIC most readily by estimation of C. CT-guided placement of drains
which of the following factors? D. Exploratory laparotomy
A. Factor II
Which factor does not influence the development of
B. Factor IX
Surgical Site Infections (SSIs)?
C. Factor VII
A. Degree of microbial contamination
D. Factor VIII:C
B. Duration of the procedure
E. Factor X
C. Malnutrition
A 26-year-old man is found to be brain-dead after a D. General anesthesia
gunshot wound to the head. His family consents to organ
What is the estimated risk of transmission of human
donation. Which of the following is a contraindication to
immune deficiency virus (HIV) from a needle stick from a
organ donation?
source with HIV-infected blood?
A. Positive hepatitis B core antibody
A. <0.5%
B. Active hepatitis C
B. 1.8%
C. History of basal cell carcinoma 5 years ago
C. 5%
D. Donor liver biopsy with 10% steatosis
D. 10%
E. Creutzfeldt–Jakob disease
Nutritional formulas used to treat pulmonary failure
typically increase the fat intake of a patient’s total caloric
intake to?
A. 50%
B. 20%
C. 80%
D. 10%
TOPNOTCH MEDICAL BOARD PREP SURGERY PEARLS HANDOUT BY DR LOUBOMIR ANTONIO Page 1 of 18
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Closure of an appendectomy wound in a patient with Which of the following is the only thing that has been
perforated appendicitis who is receiving appropriate shown to decrease wound infections in surgical patients
antibiotics will result in a wound infection in what with contaminated wounds?
percentage of patients? A. Use of iodophor-impregnated polyvinyl drapes.
A. 3–4% B. Saline irrigation of the peritoneum and wound.
B. 8–12% C. Antibiotic irrigation of the peritoneum and wound.
C. 15–18% D. 24 hours of appropriate antibiotics postoperatively
D. 22–25%- (in addition to preoperative dose).
A chronic carrier state occurs with hepatitis C infection in Following caustic injury to the skin with an alkaline agent
what percentage of patients? the affected area should initially be?
A. 90–99% A. Treated with running water or saline for 30 minutes
B. 75–80% B. Treated with running water or saline for 2 hours
C. 50–60% C. Treated with a neutralizing agent
D. 10–30% D. Treated with topical emollients and oral analgesics
The most effective post exposure prophylaxis for a surgeon In the ABCDE of melanoma, the D stands for diameter
stuck with a needle while operating on an HIV-positive greater than?
patient is? A. 2 mm
A. None B. 4 mm
B. Two or three drug therapy started within hours of C. 6 mm
injury D. 8 mm
C. Single drug therapy started within 24 hours Ocular melanoma
D. Triple drug therapy started within 24 hours A. Exclusively metastasizes to the lungs
At what pressure is operative decompression of a B. Exclusively metastasizes to the brain
compartment mandatory? C. Exclusively metastasizes to regional lymph nodes
A. 15 mmHg D. Exclusively metastasizes to the liver
B. 25 mmHg The most common pattern of benign calcification in lung
C. 35 mmHg hamartomas is?
D. 45 mmHg A. Solid
The proliferative phase of wound healing occurs how long B. Diffuse
after the injury? C. Central
A. 1 day D. Popcorn
B. 2 days An “onion-peel” appearance of a rib on CT is suggestive of?
C. 7 days A. Chondroma
D. 14 days B. Ewing sarcoma
The annual age-adjusted cancer incidence rates among C. Plasmacytoma
men and women are decreasing for all of the following D. Osteosarcoma
EXCEPT: A chylothorax is likely to be present in a patient whose
A. Colorectal pleural fluid analysis results show a triglyceride level of?
B. Oropharynx A. 80mg/100mL
C. Lung B. 100mg/100mL
D. Thyroid C. 45mg/100mL
After completion of vascular anastomoses, drainage of a D. 130mg/100mL
transplanted pancreas is accomplished by anastomosis to? The most common age to close asymptomatic ASDs is?
A. Right colon A. In the immediate newborn period
B. Left colon B. After the child reaches 10kg in weight
C. Duodenum C. Age 4–5 years
D. Bladder or small bowel D. During puberty
The Donabedian model of measuring quality identifies all Which of the following is a true surgical emergency in a
of the following as main types of improvements EXCEPT? newborn?
A. Changes to structure A. Tetralogy of Fallot (TOF)
B. Changes to process B. Truncus arteriosus (TA)
C. Changes to culture C. Total anomalous pulmonary venous connection (TAPVC)
D. Changes to outcomes D. Coarctation of the Aorta (COA)
Prophylaxis using low-dose UFH reduces the incidence of The arterial switch operation for transposition of the great
fatal pulmonary embolisms by? vessels is best performed?
A. 45% A. Within 2 weeks of birth
B. 50% B. At 1year of age
C. 60% C. At 10kg of weight
D. 35% D. In adolescence
Which of the following is the best test to predict successful The most commonly recommended age for correction of a
extubation of a patient? TOF is ?
A. Respiratory rate A. Neonate younger than 3 months
B. Negative inspiratory pressure B. 6 months of age
C. Tobin index C. 1year of age
D. Minute ventilation D. 4–5years of age
The root cause of the majority of wrong-site surgeries What is the best predictor of spontaneous closure of a VSD?
result from? A. Size
A. Communication errors B. Age at diagnosis
B. Emergency surgery C. Gestational age
C. Multiple procedures D. Lack of electrocardiogram changes
D. Multiple surgeons During left thoracotomy or repair of patent ductus
Which of the following have been shown to decrease the arteriosus the blood pressure is 70/22. Immediately after
time of post-operative ileus? placement of a clip across the duct the blood pressure is?
A. Cyclooxygenase-1inhibitors A. 70/22
B. Morphine patient-controlled analgesia B. 70/40
C. Nasogastric drainage until full return of bowel function C. 90/ 22
D. Erythromycin D. 90/ 40
The bypass conduit with the highest patency rate is the? Which of the following statements about the use of latex
A. Radial artery gloves during an operation is correct?
B. Internal thoracic artery A. The incidence of puncture holes is not related to the
C. Greater saphenous vein duration of the surgery
D. Radial artery B. The right index finger is the most common site of
Each of the following effects is anticipated after insertion perforation
of an intra-aortic balloon pump EXCEPT? C. About 40,000 organisms may pass through a glove
A. Preload decrease pinhole in a 20-minute period
B. Increased total myocardial oxygen consumption D. Gloves made of latex maybe re-used after re-
C. Improvement in cardiac index sterilization
D. Coronary blood flow increase Anesthesia dolorosa is pain felt in the face which is
During cardiopulmonary bypass (CPB) anticoagulation, completely numb to touch. The pain is characterized as
the range of heparin needed to increase the activated constant, burning, or aching. It is usually a side effect of
clotting time to greater than 450 seconds is? surgery of ____?
A. 200 to 300 A. Chemodectoma
B. 300 to 400 B. Bell’s palsy
C. 400 to 500 C. Vestibular schwannoma
D. 450 to 550 D. Trigeminal neuralgia
Which of the following is the most common cause of Tic douloureux is a chronic pain that involves cranial nerve
thoracic aortic aneurysms? V. Which of the following does not explain this pain?
A. Atherosclerosis A. Trigeminal nerve myelin sheath loss
B. Marfan syndrome B. Nerve compression of a tumor
C. Takayasu arteritis C. Injury during parotid surgery
D. Nonspecific medial degeneration D. Blood vessel pressing on the nerve at it exits the
The most common complication of extensive repair or brainstem
distal aortic aneurysms is? Which of the following is FALSE regarding the immediate
A. Spinal cord ischemia post-operative period?
B. Renal failure A. Detailed treatment orders should be written upon
C. Pulmonary dysfunction arrival at the recovery room
D. Left recurrent laryngeal nerve injury B. While the patient is en-route to the recovery room, the
According to the Crawford classification scheme, surgical patient should be accompanied by a physician and
repair of thoracoabdominal aortic aneurysms with repairs qualified attendants
beginning near the left subclavian artery but extending C. The post-anesthetic recovery unit should be staffed by
distally into the infrarenal abdominal aorta, often reaching specially trained personnel
the aortic bifurcation is classified as D. Written orders are sufficient for unusual or
A. Extent I particularly important post-operative orders.
B. Extent II Discharge criteria following ambulatory surgery includes
C. Extent III all of the following except;
D. Extent IV A. Ability to eat solid food
The compartment most commonly affected in a lower leg B. Stable vital signs
compartment syndrome is the? C. Ability to ambulate
A. Anterior compartment D. Adequate pain control
B. Lateral compartment Which of the following cell types is not crucial for healing a
C. Deep posterior compartment clean incisional wound?
D. Superficial posterior compartment A. Macrophage
The correct classification for the degree of stenosis in the B. Polymorphonuclear leukocyte
internal carotid artery of a patient with a luminal diameter C. Platelet
of 69% is? D. Fibroblast
A. Mild All of the following situations are known to increase the
B. Moderate risk of infection of the surgical site following elective
C. Severe hernia repair except:
D. No stenosis A. Failing to continue prophylactic antibiotics for 24
Hollenhorst plaque is found within the? hours after the end of the operation
A. Internal carotid artery B. Shaving the operative site before taking the patient to
B. Retinal vessels the operating room
C. Peripheral arteries C. Placing a drain in the wound
D. Renal arteries D. Tying the skin sutures very tightly
Which of the following statements concerning carotid body The most common source of bacteria that causes SSI’s
tumors is true? following procedures other than elective clean operation
A. Over 50% are hereditary. is?
B. Require resection of the underlying carotid artery A. The hands of the operating team
with reconstruction or cure. B. The nasopharynges of the operating room personnel
C. Are associated with catecholamine release. C. The patient’s endogenous bacteria
D. Are usually benign. D. Airborne bacteria from the operating room
The most common location for the development of environment
atherosclerotic disease is? Which of the following is the most common form of
A. The renal artery. entrapment neuropathy?
B. The coronary arteries. A. Cubital tunnel syndrome
C. The abdominal aorta B. Tunnel of Guyon syndrome
D. The arteries of the circle of Willis C. Tarsal tunnel syndrome
D. D. Carpal tunnel syndrome
Superior vena cava (SVC) syndrome is a group of symptoms On closer examination, the body parts with surface area
caused by compression of the superior vena cava most burn are front of the torso, front and back of her right arm
often caused by bronchogenic carcinoma. Which of the as well as front and back areas of her right leg. What is the
following treatment options should extreme care be taken appropriate percentage of burn injury sustained by the
for it can further worsen SVC compression? patient?
A. Glucocorticoid A. 75%
B. Continuous positive pressure B. 45%
C. Endovascular stenting C. 15%
D. Furosemide D. 80%
Following laparotomy, gastrointestinal peristalsis The following statements about early post-operative fever
temporarily decreases. Which of the following statements are correct except:
is INCORRECT? A. Close to 90% of patients with fever on the first post-
A. Opioid can interfere with gastric motility operative day have a radiographic evidence of
B. NGT insertion is performed on all patients undergoing atelectasis
laparotomy. B. About 75% of patients with atelectasis doesn’t have
C. Peristalsis returns within 24 hours in the small fever
intestines followed by the stomach and then the colon. C. Atelectasis is a common cause of post-operative fever
D. In operations not involving the bowels, diet is D. Most fevers that appear in the first 24 hours after
resumed as soon as the effect of the anesthesia has surgery are the result of tissue injury sustained during
worn – off. the procedure
Which of the following statements correctly describes a Components of the Whipple’s triad except?
primary microbial peritonitis? A. Reproduction of symptoms with insulin
A. Microbes invade the normally sterile confines of the administration
peritoneal cavity through hematogenous route. B. Symptomatic fasting hypoglycemia
B. Treatment aimed at identifying the source of the C. Serum glucose <50mg/dL
contamination and possible resection of the diseased D. Relief of symptoms with glucose administration
organ A 64-year-old woman undergoing radical hysterectomy
C. Contamination of the peritoneal cavity from under general anesthesia is transfused with 2 U of packed
perforation or infection of any intraabdominal organ RBCs. A hemolytic transfusion reaction during anesthesia
D. Antibiotic regimen should include coverage for will be characterized by which of the
aerobic and anaerobic organisms following?
Which of the following is an adjuvant treatment for breast A. Shaking chills and muscle spasms
cancer patients with estrogen receptor positive tumor? B. Fever and oliguria
A. Anakinra C. Hyperpyrexia and hypotension
B. Anastrozole D. Bleeding and hypotension
C. Trastuzumab A 35 year old female patient presents with fatigue,
D. Bicalutamide shortness of breath and increasing abdominal girth. She
Which drug is a kinase inhibitor, a type of targeted drug, also reports recent weight gain around 10 lbs the past 2
given to treat advanced breast cancer? months. PE: reveals dullness to percussion over the right
A. Capecitabine side, decreased breath sounds on the right, (+) shifting
B. Letrozole dullness and palpable left adnexal mass, what is the most
C. Lapatinib likely diagnosis?
D. Cisplatin A. Meig’s syndrome
Which of the following is NOT typically seen in patients B. Ruptured ectopic pregnancy
with benign prostatic hyperplasia (BPH)? C. Ovarian torsion
A. Poor correlation between size of prostate gland and D. Subserosal uterine myoma
degree of symptoms According to the transfusion guidelines, which among the
B. Higher intravesical pressure required to accomplish ff. is an inaccurate statement?
voiding A. A patient scheduled to undergo a major surgery with
C. Vesical muscle hypertrophy Hgb of 9.5mg/dl should be given 1 unit of pRBC
D. Decrease urinary outflow resistance. B. In a patient receiving massive transfusion, platelets
Patients undergoing resection of pheochromocytoma can and FFP should be transfused together with pRBCs in
be affected by the sudden release of catecholamines. Which a 1:1:1 ratio
of the following need NOT be available at the time of C. Most surgeries can be carried out safely with a platelet
surgery? count above 50x109 or INR below 2.0
A. Arterial line for monitoring D. Massive transfusion should be terminated once the
B. Nitroprusside patient is no longer actively bleeding
C. Beta Blocker Felty’s syndrome is composed of all of the ff. except?
D. Corticosteroid A. Rheumatoid arthritis
A 55 year old was rescued from a fire in Pasay City. She was B. Splenomegaly
rushed to the emergency room with burn injury . She is C. Leukopenia
unconscious. Responding only to pain stimuli with a blood D. Weight loss
pressure of 150/90, heart rate of 110/ minute, respiratory A 23 year old male patient presents with nausea, vomiting
rate of 30/min. 02 saturation at the ER showed 90 mmHg and stabbing abdominal pain most prominent after meals.
with 5L/min oxygen delivered by facemask. (+) abdominal distention, reflux episodes and tenderness
in the abdomen area. CT scan of the abdomen shows
Which of the following does not necessarily indicate that compression of the duodenum between the superior
the patient received pulmonary burn? mesenteric artery and the abdominal aorta, what is the
A. Percentage of burn injury most likely diagnosis?
B. Carbonaceous sputum A. SMA syndrome
C. Patient inhales explosive gases B. Wilkie’s syndrome
D. Upper torso burn C. Cast syndrome
D. Mesenteric root syndrome
E. All of the above
The classic triad of Plummer-Vinson syndrome is
composed of the ff. except?
A. Dysphagia
B. Esophageal webs
C. Iron deficiency anemia
D. Heartburn
Plummer’s disease is seen in
A. Grave’s disease
B. Toxic multinodular goiter
C. Hashimoto’s
D. Hypothyroidism
All of the ff. statements regarding blood transfusion are
correct except?
A. It is advised to adhere to a restrictive transfusion
strategy as much as possible
B. If the patient is anemic and symptomatic, transfusion
is warranted A simple mastectomy is different from a radical
C. Peripheral blood hematocrit should be the basis for mastectomy in that a simple mastectomy involves all of the
transfusion during acute blood loss ff. structures except?
D. There should be no universal Hgb level transfusion A. Nipple
trigger B. All breast tissue
In a patient with viral conjunctivitis, which among the ff. C. Areola
treatments should you avoid? D. Level I axillary lymph nodes
A. Oral acyclovir Which of the ff. structures is not part of the uveal tract?
B. Acyclovir eye ointment A. Choroid
C. Topical steroids B. Ciliary body
D. Supportive treatment C. Iris
Which of the ff. statements regarding fractures in children D. Retina
are true? A 24 year old male patient sustained a penetrating chest
A. Healing of fractures in adults is faster than in children trauma to the right hemithorax, he was brought to the
B. Immobilization is not tolerated well by children emergency room and was conscious but anxious, BP was
C. Healing is slower in fractures on the same plane of the 90/60, HR 135, RR 35, T>36.5C, PE revealed decreased to
movement of the joint absent breath sounds over the right hemithorax, with
D. Stabilization of epiphyseal fractures is critical to lagging over the right, dull to percussion, Xray reveals
minimize growth disturbances effusion up to half of the right hemithorax, a chest tube was
What knot tie is used when there is increased wound to be placed, where should be the site?
tension? A. 4th ICS posterior axillary line
A. Slip knot B. 2nd ICS parasternal line
B. Surgeon’s knot C. 5th ICS MCL
C. Square knot D. 5th ICS midaxillary line
D. Double square knot In relation to the question above, the patient is in what
SUTURE KNOTS stage of shock?
A. Class I
B. Class II
Square Knot
C. Class III
• Consists of two sequential D. Class IV
throws that lie in opposite
directions
• This is necessary to create a
knot that will not slip
Surgeon’s Knot
• Variation in which a double
throw is followed by a single
throw to increase the
friction on the suture
In relation to the question above, it is classified as a
material and to decrease the
massive hemothorax if
initial slip until a full square
A. >750 mL of blood in the pleural space
knot has been completed
B. >1000 mL of blood in the pleural space
C. >1500 mL of blood in the pleural space
All of the ff. are true regarding disc herniations except?
D. >2000 mL of blood in the pleural space
A. The L4 nerve root passes over the L4-L5 disc space
and may be compressed at this level If there is suspected cardiac injury in the case above,
B. Lumbar herniation can occur with or without history acutely, how many mL of blood can lead to cardiac
of trauma tamponade?
C. Surgery is indicated for progressive motor deficits A. <50 mL
D. Most herniated lumbar discs improve B. <100 mL
symptomatically without surgery C. <150 mL
D. <200 mL
In relation to the above case, if fluid resuscitation is to be
given to this patient, which among the ff. should be given
initially?
A. 1L colloid bolus
B. 20 mL/kg IV saline bolus
C. 1L IV Lactated Ringers bolus, 2 lines
D. 2L IV Lactated Ringers bolus 2 lines
Which of the following is not an indicated approach for 30 minutes after induction of anesthesia, the patient
pericardial decompression in patients with cardiac develops a fever of 39.5C, increased heart rate, rapid
tamponade? breathing, rigidity and increased CO2 production. This is
A. Right anterior thoracotomy the patient’s first surgery for thyroidectomy. Which among
B. Left anterior thoracotomy the ff. is the best management for this patient?
C. Median sternotomy A. Increase tidal volume and FiO2
D. Pericardiocentesis B. Give epinephrine
What is the sequence in which the body utilizes its stored C. Give dantrolene
energy? D. Give IV methylprednisolone
A. Glycogen -> fats -> protein A 60 year old male patient presents with a lesion on the
B. Protein -> fats -> glycogen face. The lesion is a pinkish erythematous plaque with a
C. Fats -> protein -> glycogen depressed center with raised borders. Hx shows significant
D. Glycogen -> protein - > fats sun exposure because he works as a farmer up to the
How many months will it take for the wound to achieve 70- present. What is the most likely diagnosis in this case?
80% of its tensile strength? A. Basal cell carcinoma
A. 1 month B. Malignant melanoma
B. 2 months C. Squamous cell carcinoma
C. 3 months D. Kaposi’s sarcoma
D. 4 months Which among the ff. skin cancers is most likely to recur
A type of hernia occurring at the lateral border of the locally and invasive?
rectus abdominis muscle? A. Squamous cell carcinoma
A. Morgagni hernia B. Basal cell carcinoma
B. Bankart C. Malignant melanoma
C. Pantaloon D. Dysplastic nevus
D. Spigelian Which among the ff. is the most common type of skin
E. Richter’s cancer?
A hernia through the superior lumbar triangle is called? A. Squamous cell carcinoma
A. Grynfeltt’s B. Basal cell carcinoma
B. Littre’s C. Malignant melanoma
C. Pantaloons D. Dysplastic nevus
D. Richter’s Which of the ff. is considered a risk factor for malignant
E. Spigelian melanoma?
During an abdominal surgery involving an extensive A. Presence of myelodysplastic nevus
hepatic laceration from trauma, the head surgeon says that B. Irregular border
they have to do a Pringle maneuver, which among the ff. C. Change in color
structures is least likely to be compressed? D. Raised surface
A. Common bile duct The type of malignant melanoma common among dark
B. Cystic duct skinned individuals found usually on the palmar, plantar
C. Hepatic artery and subungual areas?
D. Portal vein A. Superficial spreading
A 50 year old female patient underwent a needle guided B. Nodular
excisional biopsy in her right breast. The rest of her history C. Lentigo maligna
is unremarkable. This is classified under which of the ff. D. Acral lentiginous
wound classes? All of the ff. are part of the vertical facial buttress except?
A. Clean A. Nasomaxillary
B. Clean/contaminated B. Zygomaticomaxillary
C. Contaminated C. Pterygomaxillary
D. Dirty D. Hard palate and maxillary alveolus
In relation to the above case, which among the ff. Which among the ff. is a disorder of delayed gastric
statements are true? emptying in the absence of mechanical obstruction after
A. Prophylactic antibiotics should be given 30minutes post gastrectomy?
prior to incision A. Dumping disease
B. Readministration of antibiotics must be done to cover B. Diarrhea
1 to 2 half-lives of the antibiotic C. Gastric stasis
C. Antibiotics should be limited only to up to 72 hours D. Roux syndrome
post-surgery The cause of Zollinger Ellison syndrome is commonly
D. All of the above found at the?
E. None of the above A. Pancreas
Which antibiotic provides adequate coverage for B. Proximal duodenum
prophylaxis for most types of procedures? C. Abdominal lymph nodes
A. Cefuroxime D. Gastrinoma triangle
B. Cefazolin Which among the ff. is the least likely manifestation of
C. Metronidazole Menetrier’s disease?
D. Ampicillin sulbactam A. Large rugal folds
During elective colorectal surgery, considerable spillage of B. Diffuse hyperplasia of mucus cells
colon contents occurs, the surgeon then decides to C. Hypoplasia of parietal cells
administer antibiotic therapy, this is classified under D. Increased gastric acid
A. Prophylaxis A 36 year old male patient presents with recurrent
B. Empiric therapy intermittent hematemesis. Initial Upper GI endoscopy
C. Therapy of established infection showed negative findings. A repeat upper GI endoscopy
D. Culture guided therapy showed a large submucosal artery near the
gastroesophageal junction what is the diagnosis?
A. Gastric vascular ectasia
B. Dieulafoy’s lesion
C. Esophageal varices
D. Menetrier’s disease
A 30 year old male sheep farmer presents with vague What is the most vulnerable segment of the large intestine
abdominal discomfort. Workup reveals multiple small well to obstruction?
defined hypodense lesions in the liver with distinct wall, A. Ascending colon
some containing calcifications. Which among the ff. is true B. Descending colon
regarding this condition? C. Transverse colon
A. Mebendazole is the best drug for this condition D. Sigmoid colon
B. Metronidazole should be given A 36 year old male patient presents in the emergency
C. Spillage of cyst contents may result in anaphylaxis department with abdominal pain generalized intermittent
D. Large abscess which do not respond to medical characterized as spasmodic accompanied by nausea and
therapy can be aspirated vomiting. There is abdominal distention as well. There is
In relation to the above case, the causative agent of the no rebound tenderness noted. Patient has not passed any
above disease is? stool for the last 2 days. There is also no passage of flatus.
A. Entamoeba histolytica What is the next best step in the management of this
B. Echinococcus granulosus patient?
C. Escherichia coli A. Scout film of the abdomen
D. All of the above B. Abdominal CT scan
Gallbladder stones commonly lodge where? C. Ultrasound of the abdomen
A. Common bile duct D. Colonoscopy
B. Common hepatic duct In relation to the above case, which among the ff. is the
C. Cystic duct most likely finding after workup?
D. Ampulla of Vater A. Appendicolith
Which among the ff. is the least likely manifestation of B. Bent inner tube or coffee bean appearance
choledochal cysts? C. Edematous pancreas with fat stranding
A. Fever D. Multiple colonic diverticula
B. Pain If the above diagnosis turns out to be volvulus, what is the
C. Jaundice next best step in the management?
D. Mass A. Endoscopic detorsion
In relation to the above case, what is the management of B. Emergency laparotomy
choice for a type 3 choledochal cyst? C. IV fluids and observation
A. Segmental resection of the liver D. Surgical debridement
B. Roux-en-Y hepaticojejunostomy What is the most common site of volvulus?
C. Sphincterotomy A. Cecum
D. All of the above B. Sigmoid
What is the most common functional pancreatic endocrine C. Transverse colon
neoplasm? D. Jejunum
A. Gastrinoma All of the ff. are indications for emergency surgery in
B. Insulinoma ulcerative colitis except?
C. VIPoma A. Toxic megacolon
D. Glucagonoma B. Massive hemorrhage
A 60 year old male patient a known diabetic for 20 years C. Fulminant colitis
presents with jaundice. He denies any abdominal pain, D. Intractability despite maximal medical therapy
vomiting or nausea or anorexia but with some documented E. None of the above
10lb weight loss over the past month. There was no All of the ff. are true regarding ulcerative colitis except?
palpable abdominal mass. The patient also reports dark A. The rectum is invariably involved
colored urine and pale stools. What is the next best step in B. Colon may have lead pipe appearance
the management of this patient? C. Strictures are common
A. Abdominal CT scan D. It is associated strongly with primary sclerosing
B. Abdominal ultrasound cholangitis
C. ERCP Which among the ff. tumor markers has utility for
D. HIDA scan pancreatic cancer?
In relation to the above case, if workup reveals dilated bile A. Calcitonin
ducts what is the next best step in the management of this B. CA 19-9
patient? C. AFP
A. Abdominal CT scan D. CD117
B. Abdominal ultrasound A 24 year old patient was brought to the emergency
C. ERCP department after being involved in a scuffle. He sustained
D. HIDA scan numerous deep lacerations over the thigh and abrasions
In relation to the above case, what is the most likely over the extremities. He has unrecalled vaccination
diagnosis? history. Which among the ff. should be given?
A. Choledocholithiasis A. Tetanus immune globulin only
B. Viral hepatitis B. Td vaccine only
C. Liver cirrhosis C. Both A and B
D. Ampullary mass D. Tetanus antitoxin
In relation to the above case, if for example the diagnosis is Medications administered per rectum has less first pass
a pancreatic head mass, what is the best definitive effect because the blood supply bypasses the portal tract
management for this case? via
A. Pancreaticoduodenectomy A. Superior rectal vein
B. Minimally invasive pancreatectomy B. Middle rectal vein
C. Combine chemoradiation C. Inferior rectal vein
D. Endoscopy and biliary stenting D. Both B and C
In a case of an acute abdomen, the examiner places the E. Both A and B
patient on his left side and then proceeds to slowly extend
the right thigh to elicit abdominal pain on the RLQ, what is
this called?
A. Blumberg sign
B. Rovsing’s sign
C. Psoas sign
D. Obturator sign
A patient with liver cirrhosis was treated with a shunt for In relation to the above case, if initial tissue histology was
the treatment of portal hypertension, which of the ff. blood attempted initially and was an acellular specimen with cyst
vessels are the ones connected? fluid and blood, what is the next best step in the
A. Portal vein and inferior vena cava management?
B. Hepatic vein and portal vein A. Repeat biopsy under ultrasound guidance
C. External iliac and inferior vena cava B. Repeat biopsy after 6 months
D. Inferior vena cava and azygous veins C. For observation
A patient involved in a MVA comes into the ED. The D. For elective surgery
physician knows that the most commonly injured organ In relation to the above case, if initial tissue histology
with blunt abdominal trauma is returned as suspicious for malignancy, what is the next
A. Liver best step in the management?
B. Spleen A. Repeat biopsy under ultrasound guidance
C. Small intestine B. Repeat biopsy after 6 months
D. Colon C. For observation
The most common clinical sign in pheochromocytoma is D. For elective surgery
A. Palpitations In relation to the above case, if tissue biopsy revealed
B. Anxiety polygonal spindle shaped cells with amyloid, what is the
C. Diaphoresis most likely diagnosis?
D. Hypertension A. Metastatic lymphoma
Which medication should be given 1-3 weeks before B. Papillary thyroid cancer
surgery of pheochromocytoma? C. Medullary thyroid cancer
A. Phenoxybenzamine D. Follicular thyroid cancer
B. Clonidine E. Anaplastic cancer
C. Prazosin In relation to the above question, what is the treatment of
D. Metoprolol choice for this patient?
A 1 week old infant presents bilious vomiting and A. RAI ablation
irritability. On examination he has no abdominal B. Total thyroidectomy
distention, no palpable masses, ultrasound reveals 2 C. Total lobectomy
discrete cystic structures in the upper abdomen, what is D. Subtotal thyroidectomy
the most likely diagnosis? E. Both A and D
A. Hypertrophic pyloric stenosis In addition to the above management which among the ff.
B. Midgut volvulus should be included?
C. Duodenal atresia A. Right lateral neck dissection
D. Malrotation B. Bilateral lateral neck dissection
A 28 year old female patient presents with painful C. Bilateral central neck dissection
subcutaneous nodules, draining sinus tracts with foul D. Right central neck dissection
smelling exudates, some previous scars seen in the right E. None of the above
axillary area. No other complaints were noted. This has been In relation to the above case, which among the ff. is the
on and off for past 2 years. What is the most likely diagnosis? more sensitive tumor marker for this disease?
A. Pyoderma gangrenosum A. Calcitonin
B. Hidradenitis suppurativa B. CEA
C. Tuberculous lymphadenitis C. Thyroglobulin
D. Squamous cell carcinoma D. AFP
Which of the ff. cancers can spread and metastasize Each of the following conditions is a primary indication for
through the Batson’s plexus? thyroidectomy EXCEPT:
A. Breast A. 2 cms thyroid nodule with hoarseness
B. Prostate B. Thyroiditis
C. Colorectal C. Recurrent Graves disease in second trimester
D. All of the above pregnancy
E. None of the above D. Dysphagia with submanubrial goiter
24 year old male patient was brought to the emergency Which of the following is not an acceptable indication for
department, he looks cyanotic, gasping for air, dyspneic. He thyroidectomy in a patient with Grave’s disease?
was involved in a local scuffle. Examination reveals A. When the patient complains of difficulty of breathing.
multiple scattered abrasions and lacerations and swelling B. When remission is not achieved after 1 year of
and hematoma over the neck region. Diagnosis was medical therapy.
suspected laryngeal fracture, what is the next best in the C. When patient refuses to take medications
management of this patient? D. When the patient is allergic to the medications
A. Endotracheal intubation Which surgeon was awarded the Nobel Prize in Physiology
B. Emergency tracheostomy for Medicine for his work on the “physiology, pathology,
C. Cardiopulmonary resuscitation and surgery of the thyroid gland?”
D. Rigid bronchoscopy A. Theodore Billroth
A 32 year old female patient presents with a neck mass B. Emil Kocher
which she incidentally discovered 6 months ago. The mass C. John Hunter
has been noted to slowly enlarge. She is otherwise D. Harvey Cushing
asymptomatic and sought consult because she was merely The most common variant of a congenital diaphragmatic
concerned. PE reveals an asymmetrically enlarged thyroid hernia constitutes which of the ff. defects?
with the right lobe larger with an ill defined mass, there A. Anterolateral
was some palpable cervical lymphadenopathy. Initial TSH B. Posterolateral
was within normal limits, what is the next best step in the C. Anteromedial
diagnosis of this patient? D. Posteromedial
A. FNAB In relation to the above case, it is usually called this type of
B. excisional biopsy hernia?
C. neck ultrasound A. Morgagni
D. CT scan of the neck B. Richter’s
C. Bochdalek
D. Spigelian
What is the management of choice in newborn infants who 30 y/o M victim of a motor vehicular accident while riding
experience respiratory distress and are found to have his motorcycle under alcohol intoxication came to the ER.
congenital diaphragmatic hernia? BP 80/60, HR 121, RR20, T>36.5 with ecchymosis and
A. Emergency surgery abrasions on the abdomen. Patient is anxious and
B. Mechanical ventilation confused, Which of the ff. is the appropriate next step in
C. Keeping the ductus arteriosus patent with PGE1 evaluation of the abdomen?
D. IV antibiotics A. FAST
What is the most common of the primary esophageal B. diagnostic peritoneal lavage
motility disorders? C. CT scan of the abdomen
A. Achalasia D. Laparotomy
B. Nutcracker esophagus The above patient is most likely in which stage or class of
C. Diffuse esophageal spasm shock?
D. Hypertensive Lower esophageal sphincter A. Class 1
In relation to the question above, all of the ff. manometric B. Class 2
findings are consistent with the disease above except? C. Class 3
A. Increased mean peristaltic amplitude in distal D. Class 4
esophagus Evaluation of the victim above showed free intraperitoneal
B. Increased duration of contractions fluid in the left upper quadrant, what is the appropriate
C. Incomplete LES relaxation next step in the management of this patient?
D. Normal peristaltic sequence A. FAST
What is the most common cause of ulcer related death? B. Diagnostic peritoneal lavage
A. Perforation C. CT scan of the abdomen
B. Bleeding D. Laparotomy
C. Malignancy Patient 23 y/o M had a motor vehicular accident, his
D. Penetration helmet was crushed with visible ecchymosis over the right
All of the ff. are tissue-based repairs of inguinal hernia eye area, patient was awake alert with no reported loss of
except? consciousness, Vital signs were stable, PE: revealed some
A. Lichtenstein deficits with extraocular movements of the right eye, which
B. McVay of the ff. is the most common site of orbital blowout
C. Shouldice fractures?
D. Bassini A. Roof
A 26 year old male patient was brought into the emergency B. Medial wall
was involved in a scuffle there was penetrating trauma a C. Lateral wall
knife to the left chest wall, patient was dead on arrival and D. Floor
CPR was performed for 5 minutes already while on the way In the case above, which bone is usually affected?
to the hospital, what is the next best step in the A. Zygomatic bone
management? B. Lamina papyracea
A. Continue CPR C. Maxillary bone
B. Resuscitative thoracotomy D. Palatine bone
C. Immediate chest tube insertion Patient who sustained a motor vehicular accident without
D. Emergency thoracentesis a helmet was brought to the ER, patient sustained multiple
Which of the ff. is not included in a skin sparing lacerations and abrasions and contusions over the facial
mastectomy? area, there was (+) epistaxis, patient was noted to be
A. Skin anxious and was breathing noisily, BP100/60 HR108 RR 30
B. Nipple T>36.5 which of the ff. is the immediate course of action?
C. Areola A. Establish a patent airway
D. Breast tissue B. Insert 2 large bore IV cannulas
26 y/o patient with an anterior abdominal stab wound C. Emergent laparotomy
came to the ER. BP 120/80, HR108 RR20 D. FAST
T-afebrile, the knife wound is near the RUQ and right flank, Upon careful examination, patient was noted to have a step
what is the appropriate next step in the management of deformity near the infraorbital margin, bilateral
this patient? circumorbital ecchymosis, epistaxis, zygomatic area is
A. Diagnostic peritoneal lavage intact, nasal bones are mobile as well as the center midface,
B. Emergent laparotomy some numbness over the maxillary area, which type of
C. Local wound exploration fracture is this?
D. FAST A. Le Fort 1
Upon close examination of the patient above, it was found B. Le Fort 2
out that there is violation of the posterior fascia, what test C. Le Fort 3
will you order to know the trajectory of the knife and be D. Le Fort 4
able to observe the patient after? In a Le Fort fracture, if the midface was involved, you may
A. Diagnostic peritoneal lavage find the ff. symptoms in the patient except?
B. FAST A. Periorbital ecchymosis
C. Local wound exploration B. Anosmia
D. Abdominal CT scan C. Inability to protrude tongue
Just in case a diagnostic peritoneal lavage was done, the D. Epistaxis
surgeon knows that all of the ff. are positive findings for What would decrease the chance of recurrence to a CIS
abdominal trauma except? breast cancer?
A. RBC count >100,000 A. Chemotherapy
B. Lipase >2000 U/L B. Lumpectomy
C. Alkaline Phosphatase >2 IU/L C. MRM
D. Bilirubin >0.01 mg/dL D. Radiation
A modified radical (“Patey”) mastectomy removes all of the
ff. except?
A. All breast tissue
B. Skin
C. Level 1,2,3 axillary lymph nodes
D. Nipple-areola complex
E. Pectoralis major and minor
A Halsted radical mastectomy removes all of ff. except? A 26 y/o patient after an episode of an alcoholic binge
A. All breast tissue drinking had several episodes of retching and vomiting.
B. Level 1,2,3 axillary lymph nodes Patient started having profuse hematemesis afterward.
C. Nipple-areola complex Endoscopy revealed longitudinal fissures in the mucosa of
D. Pectoralis major and minor the herniated stomach with bleeding, what is the
E. None of the above diagnosis?
After undergoing right breast surgery, patient developed A. Boerhaave’s syndrome
shoulder weakness and winging of the right scapula, which B. Spontaneous esophageal rupture
nerve is implicated? C. Mallory Weiss tear
A. Thoracodorsal nerve D. Bleeding esophageal varices
B. Axillary nerve A 30 y/o M patient was rushed to the ER after being
C. Long thoracic nerve involved in a stabbing incident on the left lateral upper
D. Anterior thoracic pectoral nerve chest wall, patient was noted to be gasping for air, anxious,
All of the following are potential candidates for radiation BP70/50 despite bolus fluid resuscitation it increased to
therapy except? 80/60, HR 130, T>36.5, O2 saturation 80%, PE: noted
A. Those undergoing breast conservation surgery costal retractions, decreased breath sounds over the left
B. With ≥4 involved axillary lymph nodes lung field, hyperresonant to percussion on the left
C. Low risk patients after simple mastectomy with hemithorax, what is the next most appropriate step for this
negative margins patient?
D. Internal mammary node involvement A. CTT
E. Tumor with chest wall and skin involvement B. Needling
All of the ff. are potential candidates for chemotherapy in C. Chest xray
breast cancer except? D. Chest CT scan
A. Hormone receptor negative >1cm in size If a chest xray was requested in the above patient, which of
B. Node positive breast cancer the ff. findings is most compatible with the above case?
C. Tubular/mucinous/medullary breast cancer >3cm A. Consolidation of the left upper lung
D. For stage 3A breast cancer as neoadjuvant B. Hyperlucent right lung field
chemotherapy C. Deviation of trachea towards the right
E. Negative node breast cancer ≤0.5cm D. Absence of vascular markings over the right
Routine screening mammography in women for breast hemithorax
cancer is started at what age? Intervention for the above patient should be done at this
A. 35 location
B. 40 A. Fifth Left ICS posterior axillary line
C. 45 B. 2nd left ICS mid clavicular line
D. 50 C. 2nd right ICS mid clavicular line
The preferred method for diagnosis of palpable or D. 7th left ICS posterior axillary line
nonpalpable breast abnormalities? E. 7th right ICS posterior axillary line
A. Fine needle aspiration biopsy A 56 y/o male with chronic alcoholism presented to the ED
B. Needle wire localization excision biopsy with massive hematemesis, patient has no abdominal pain,
C. Core needle biopsy patient has no history of recent NSAID use or persistent
D. UTZ guided fine needle aspiration abdominal pain or reflux, no previous retching or vomiting
Mechanism of characteristic skin retraction in breast episodes until this present one, BP80/60 HR128 RR 28
cancer? T>36.5, what is the most likely diagnosis?
A. Localized edema from blocked drainage of lymph A. Bleeding peptic ulcer disease
B. Peau d’orange response B. Mallory-Weiss tear
C. Desmoplastic response shortens Cooper’s ligaments C. NSAID gastropathy
D. Nipple inversion D. Bleeding esophageal varices
All of the ff. characteristics point to DCIS except? In relation to the patient above, what is the next best step
A. Usually in the older age group of management?
B. With microcalcifications on mammography A. Upper GI Endoscopy
C. Usually multicentric and bilateral B. Sengstaken
D. With high incidence of synchronous invasive cancer C. Blakemore tube insertion
The type of esophageal hernia where there is an upward D. Epinephrine injection
dislocation of the cardiac portion of the stomach into the E. IV fluid resuscitation
posterior mediastinum In relation to the patient above, which of the ff. can be done
A. Type 1 to help stop the acute bleeding of esophageal varices?
B. Type 2 A. Epinephrine
C. Type 3 B. Octreotide
D. Type 4 C. Vasopressin
Which of the ff. factors will lead to relaxation of the Lower D. Propranolol
esophageal sphincter? Which of the ff. sign or symptom if present makes the
A. Swallowing diagnosis of esophageal perforation almost certain?
B. Decreased gastric luminal pressure A. Subcutaneous emphysema
C. Increased esophageal pressure B. Pain
D. Increased esophageal pH C. retching/vomiting
A tooth abscess which spread to the neck area? D. Fever
A. Bezold’s abscess Tumor affectation of the nasopharyngeal area will most
B. Ludwig’s angina likely metastasize and involve which lymph nodes?
C. Pautrier’s abscess A. Level VI
D. Munro’s abscess B. Level V
Rovsing’s sign is elicited by? C. Level II
A. Pain in the RLQ when the RLQ is palpated D. Level IV
B. Pain in the RLQ when the LLQ is palpated All of the ff. are indications for bariatric surgery except?
C. Pain in the LLQ when the RLQ is palpated A. Patient feels fat
D. Pain in the LLQ when the LLQ is palpated B. Psychologically stable
C. BMI ≥40 with no comorbids
D. BMI ≥35 with comorbids
A 26 y/o patient who had a motor vehicular accident All of the ff. are possible surgical indications for surgery in
sustained an open fracture of the right femur, all of the ff. Crohn’s disease except?
are appropriate interventions for this patient except? A. Repair or removal of segment with fistulae
A. Immediate casting and immobilization B. Stricturoplasty or resection
B. Irrigation and wound debridement C. Intraabdominal abscess
C. antibiotic treatment D. Prevention of recurrence of the disease
D. assessment of neurovascular status of the limb All of the ff. findings point to fracture of the skull base
All of the ff. are appropriate in the management of burn except?
patients except? A. Otorrhea
A. Give tetanus vaccination if appropriate B. Battle’s sign
B. Early excision and grafting of full and deep partial C. Anosmia
thickness burns is appropriate D. Raccoon eyes
C. Give prophylactic IV antibiotic therapy E. None of the above
D. Electrical, chemical and inhalational burns warrant Most common cause of cataract?
referral to a burn center A. Steroid use
Topical burn wound therapy that is used mostly for B. Trauma
prevention of wound infections, soothing quality, C. Aging
inexpensive, not absorbed systemically, may cause D. Congenital
neutropenia and cannot be used for skin graft sites A 44 y/o female patient presents to the ED with sudden
A. Silver sulfadiazine blurring of vision more prominent on the right eye,
B. Mafenide acetate accompanied by unilateral right sided headache and eye
C. Silver nitrate pain, nausea and vomiting, PE: ciliary injection over the
D. Biobrane right eye, smoky cornea, mid-dilated pupil, what is the
Topical burn wound therapy that is used mostly for both most likely diagnosis?
treatment and prevention of burn wound infections, can be A. Open angle glaucoma
used on skin grafts and can penetrate eschar, associated B. Optic neuritis
with pain on application and absorbed systemically C. Acute angle closure glaucoma
causing metabolic acidosis D. Acute retinal detachment
A. Silver sulfadiazine E. CRAO
B. Mafenide acetate Which of the ff. is an expected fundoscopic finding in this
C. Silver nitrate patient?
D. Biobrane A. Cherry red spot
Topical burn wound therapy that is used mostly as dilute B. Papilledema
solution with broad antimicrobial activity, it is associated C. Absent ROR and cannot visualize the retina
with hyponatremia and methemoglobinemia. Inexpensive D. Increased cup to disc ratio
but causes black stains on garments All of the ff. are fundoscopic findings in glaucoma except?
A. Silver sulfadiazine A. Thin neuroretinal rim
B. Mafenide acetate B. Notching of the optic cup at the inferior rim
C. Silver nitrate C. Cherry red spot in the macula
D. Biobrane D. Displacement of central retinal vessels
The most common symptom or presentation of Which of the ff. diagnostic procedures can visualize the
intussusceptions in the adult? anterior chamber angle?
A. Bleeding A. Gonioscopy
B. Constipation B. Tonometry
C. Weight loss C. Indirect fundoscopy
D. Bowel obstruction D. Goldmann perimetry
Patient is a 7 y/o male who presents with left groin or knee All of the ff. medications used for glaucoma suppress
pain, decreased hip motion and a limp. There was no aqueous production except?
history of injury/fall, xray reveals osteonecrosis of the A. Timolol
proximal femoral epiphysis, what is the most likely B. Latanoprost
diagnosis C. Brimonidine
A. Legg-Calve-Perthes disease D. Dorzolamide
B. Osgood-Schlatter disease All of the ff. are surgical procedures for the treatment of
C. Slipped capital femoral epiphysis glaucoma except?
D. Developmental dysplasia of the hip A. Iridotomy
Patient is an active 14 y/o Male who is part of the schools B. Laser trabeculoplasty
track and field team, he presents with localized pain and C. Panretinal laser photocoagulation
tenderness at the area of the tibial tubercle, xray reveals D. Trabeculectomy
calcification of the tendon near the tibial tubercle, what is A 55 y/o male patient with hypertension and diabetes
the diagnosis? wakes up in the morning only to find out that his right eye
A. Legg-Calve-Perthes disease was bright red near the lower part of the pupil, patient has
B. Osgood-Schlatter disease no eye pain or blurring of vision or discharge, no previous
C. Slipped capital femoral epiphysis history of similar episodes, no other associated symptoms.
D. Developmental dysplasia of the hip Patient on antihypertensives, oral hypoglycaemic agents
Which of the following statements is INCORRECT regarding and aspirin. What is the most likely diagnosis?
Galeazzi’s fracture? A. Anterior uveitis
A. This is fracture of radial shaft with a distal radio-ulnar B. Allergic conjunctivitis
joint injury. C. Iritis
B. If the distal radio-ulnar joint is unstable , wires are D. Subconjunctival hemorrhage
used to pin the distal radius in a reduced position and
immobilized postoperatively for 4-6 weeks
C. In adults Galeazzi fracture is managed non-
operatively.
D. The recommended treatment is open reduction –
internal fixation (ORIF) and operative evaluation
stability of the distal radio-ulnar joint.
A 24 y/o sexually active male presents to the clinic with red Type of shock where cardiac index is increased, systemic
eye initially over the right eye eventually involving the left. vascular resistance is decreased, decreased CVP and
(+) mild pain and foreign body sensation, PE reveals: decreased mixed venous O2, and no change in venous
conjunctival injection with thick copious purulent capacitance
discharge and matting of the eyelashes, which among the ff. A. Hypovolemic
is the most likely causative agent? B. Septic
A. HSV C. Cardiogenic
B. Amebic keratitis D. Neurogenic
C. Gonorrhoea All of the ff. are true regarding antibiotic prophylaxis in
D. Syphilis surgery except?
Which of the ff. responses is immediately activated A. Select an agent for organisms commonly found at
following severe traumatic injury? surgical site
A. Acute proinflammatory response B. Initial Dose of antibiotic given within 30min prior to
B. Anti-inflammatory response incision
C. Suppression of adaptive immunity C. Antibiotic should be redosed depending on half life of
D. All of the above the agent
Which of the ff. events promote the greatest severity of D. Antibiotics should only be used up to 24-48 hours
nitrogen wasting? after surgery
A. Skeletal trauma Patient is about to undergo a cholecystectomy, this is
B. Severe sepsis classified under which type of surgical wound?
C. Major burns A. Class 1
D. Elective surgery B. Class 2
The intravascular volume or plasma composes how many C. Class 3
% of the body weight? D. Class 4
A. 5% E. Class 1D
B. 15% All of the ff. are considered manifestations of the bloody
C. 20% vicious cycle and is an indication for damage control
D. 40% surgery except?
E. 60% A. Coagulopathy
The most common cause of volume deficit in surgical B. Hypotension
patients is C. Hypothermia
A. Intraoperative blood loss D. Metabolic acidosis
B. Inadequate oral intake Which of the ff. accurately describes flail chest?
C. Loss of GI fluids A. Paradoxical abdominal inspiration
D. Increased urinary excretion of free water B. 2 or more contiguous ribs are fractured in at least 3
GI secretion with the highest potassium content? locations
A. Stomach C. 3 or more contiguous ribs are fractures in at least 2
B. Small intestine locations
C. Colon D. Paradoxical chest inspiration
D. Pancreas All of the following are part of the secondary survey in
GI secretion with the highest HCO3 content? trauma except?
A. Stomach A. Allergies
B. Small intestine B. Neurological deficits
C. Colon C. Pregnancy status
D. Pancreas D. Past illnesses
Which of the ff. electrolyte disturbances is associated with
nausea, vomiting and weakness?
A. Hyperkalemia
B. Hypermagnesemia END OF SURGERY – PHASE 3
C. Hypercalcemia
D. All of the above
Which of the ff. intravenous solutions most closely
approximates extracellular fluid?
A. Lactated Ringer’s
B. 0.9% NaCl
C. D5 0.45% NaCl
D. D5W
All of the ff. are basic components of damage control
resuscitation except?
A. Permissive hypotension
B. Minimizing crystalloid based resuscitation
C. Administration of predefined blood products
D. Appropriate use of vasopressors
Type of von Willebrand factor deficiency where there is a
qualitative defect of the von Willebrand factor?
A. Type 1
B. Type 2
C. Type 3
D. Type 4
The most common abnormality of hemostasis that results
in bleeding in the surgical patient?
A. Thrombocytopenia
B. Anticoagulant use
C. Coagulation factor deficiency
D. Functional platelet defect
• Ileus
BUZZWORDS Causes of stress-related • Glucagon
QUESTION ANSWER hyperglycemia in post- • Epinephrine
• Gradient Pressure <30mmHg op patients • Glucocorticoid
(diastolic P - compartment P) • Eye opening
• Absolute compartment P > Components of Glasgow
Fasciotomy is indicated • Verbal response
30mmHg Coma Scale
if • Motor response
• Ischemic periods >6 hours • Central venous pressure
• Combined arterial and venous Invasive monitoring of
• When large amounts of fluid
injuries patient’s fluid status
are administrated
• Remnants of amnion are not Most common thyroid
reabsorbed cancer affecting younger • Papillary thyroid carcinoma
• Abdominal organs in the patients
Omphalocele features hernia Management for middle
• Not covered by membranes • Radical mastoidectomy
ear and mastoid disease
• Abdominal wall defect in with cholesteatoma
midline • Primary tumor
• Encounters less resistance Structures excised in
Monofilament suture • Cervical nodes
when passing through tissues composite resection
advantages vs • Part of the mandible
• Less infection-causing Prognostic indicator in
multifilament
organisms medullary thyroid • Calcitonin doubling time
• Pliability for ease of handling carcinoma patients
Ideal suture
and knot security • Extranodal extension
characteristics
• Uniform tensile strength Indications of post-op • Perineural invasion
Closed by secondary • For heavily contaminated radiation therapy • Lymphovascular invasion
intention wounds • Positive cervical lymph nodes
Coagulation factors • Factors VIII, IX, XI, XII Indications for surgical • Suspicious for malignancy
tested by aPTT (intrinsic) removal of nodular • Symptoms of pressure
• Retained surgical items goiter • Substernal extension
• Wrong-site surgery Contributory factors to • Defective lower esophageal
Never events
• Death on the day of surgery of the development of sphincter
a normal healthy patient GERD • Degree of hiatal herniation
• Deep breathing exercises • Pituitary apoplexy
Pulmonary
• Early mobilization Acute painful visual loss • Acute onset of headache,
rehabilitation
• Incentive spirometry without red eye nausea, visual field loss, and
Clean wounds • Hernia repair, breast biopsy ocular paresis
• Requires short course of • Glaucoma
Post-operative UTI Conditions that result in
antibiotics (3-5 days) • Uveitis
Management of blindness
• Corneal ulcer
transfusion-related • Stop transfusion Anterior knee pain
acute lung injury • Patellofemoral pain syndrome
involving the patella and
Manifestations of • RR > 30/min (runner’s knee)
retinaculum
respiratory failure in • PaCO2 > 45 mmHg • Risk of trauma to the testicle
post-op patient • PaO2 < 60 mmHg Orchidopexy procedure located at the pubic tubercle
Tests for pulmonary risk considerations in • Increased incidence of torsion
pre-operative • CXR, CBC, PFTs cryptorchidism • Psychological impact of an
assessment empty scrotum
Candidates for bleeding • Patients on anticoagulants • Dehydroepiandrosterone
risk pre-operative • Liver and kidney dysfunction Virilizing adrenal
• Androstenedione
assessment tumors secretions
• Anemia • Testosterone and estrogen
• Cardiac tamponade Structure kyphosis
• Gibbus deformity
Life-threatening • Massive hemothorax affecting the lower
• Tuberculous spondylitis (Pott
traumatic injuries • Hemoperitoneum thoracic and upper
disease)
• Unstable pelvic fractures lumbar regions
• Limit enteric content spillage • Tear supplementation
Treatment for dry eye
Damage control surgery • Prevent bloody vicious cycle • Environment coping strategies
syndrome
goals • Control bleeding and prevent • Application of warm compress
(keratoconjunctivitis
ischemia sicca) • Amelioration of eyelid
• Hemoperitoneum abnormalities
• Adjusting to eating patterns IV anesthetic drug
Goals post-bariatric • Ketamine
• Early identification of post- causing increased ICP
surgery
operative complications and Contraindicated in • Prednisone ophthalmic drops
preventive measures Herpes simplex • Steroids could potentiate the
• Hypothermia conjunctivitis infection
Causes of bleeding after • Dilutional coagulopathy • Surgery if completely
Treatment of choice in
massive blood • Fibrinolysis or resectable
early-stage tracheal
transfusion hypofibrinogenemia • Primary resection and
neoplasm
• Platelet dysfunction anastomosis
• Sciatic nerve in over 90% of Causes of non- • Primary tumor invasion of the
Common nerve palsy pulmonary thoracic vagus nerve and right
cases followed by femoral
after hip arthroplasty symptoms laryngeal nerve
nerve
Common cause of Management of early • Surgical resection via video-
inguinal hernia in • Patent processus vaginalis lung cancer (T1, T2, and assisted lobectomy or
infancy T3 without N1) pneumonectomy
Complications of • Infection Malignancy that affects
• Pancoast tumor
exploratory laparotomy • Atelectasis the pulmonary apex
progressively affecting • Presents with pain and Radical nephrectomy for • Ipsilateral regional
the brachial nerve weakness of the arm and hand renal cell carcinoma retroperitoneal lymph nodes
muscles includes the ff • Ipsilateral adrenal gland
Most appropriate structures • Gerota’s fascia
• Insertion of chest tube
treatment for Cause of traumatic • Tear in the arteries
drainage of the pleural space
pneumothorax epidural hematoma • Middle meningeal artery
Commonly injured • Caused by ascending coliform
nerve in the surgical • Recurrent laryngeal nerve bacteria
closure of PDA Characteristics of
• Urinary retention managed by
• Shortness of breath bacterial prostatitis
transurethral catheterization
• Unilateral chest pain • Empiric systemic antiobiotic
Physical exam findings • Decreased breath sounds Drugs used in the • Aminoglutethimide
of pneumothorax ipsilateral side management of • Ketoconazole
• Hyperresonant on percussion Cushing’s disease • Metyrapone
of the ipsilateral side Acute red eye with no
• Increase metabolic demand • Subconjunctival hemorrhage
Characteristics of loss of vision risk
• Cause direct mucosal and heat Profuse purulent
inhalation injury • Gonococcal conjunctivitis
injury to upper airways discharge from eye
Lung cancer least Best approach for
• Adenocarcinoma
associated with smoking vertical band
• Stop at the tentorium cerebelli • Laparoscopic
gastroplasty in bariatric
Features of subdural and falx cerebri surgery
hematoma • Hyperdense crescent-shaped Treatment for
lesion on CT scan cavernous sinus • Antibiotics
• Very young and old patient thrombosis
Risk factors for subdural
• Cerebrospinal fluid leak Manipulations that will • Prostate biopsy
hematoma
• Anticoagulant therapy cause a false elevation of • Cystoscopy
Vulnerability of • Lacks a serosal layer PSA • Urethral catherization
esophagus to • Allows the smooth muscle to • High serum lactate
perforation dilate with ease Poor prognosticating
dehydrogenase
index for metastatic
• Older age, chronic alcoholic • High serum calcium
renal cancer
• Cirrhosis symptoms • Low hemoglobin
Clinical features of
• Mass in the right lobe of the • Tumor with adjacent
hepatocellular Surgical objectives for
liver on imaging uninvolved stomach
carcinoma resection of a gastric
• Elevated alpha fetoprotein • Duodenum
level laboratory carcinoma
• Regional lymph node
Important lab test for • Specimen of blood for cross • Washboard abdomen
pre-op management of matching should be sent Clinical features of an
• Absent bowl sounds
patient with acute whenever urgent surgery is acute abdomen
• Involuntary guarding
abdomen anticipated Symptom of carcinoma
• Esophageal varices • Migratory thrombophlebitis
Etiology of hematemesis of body and tail
• Endoscopy with variceal band • Trousseau’s syndrome
that will require carcinoma of pancreas
ligation should be carried out Definitive management • Endoscopic biliary
emergency management
as soon as possible for cholangitis decompression
Next work-up for Goals of management • Relieving gastric outlet
substernal chest pain for late-stage pancreatic obstruction and biliary
after trial of PPI and • Cardiac work-up cancer obstruction
unremarkable Primary histologic type
endoscopic findings • Adenocarcinoma (>95%)
of cholangiocarcinoma
Signs of acute abdomen • Bleeding Management for • Conservative with clinical and
requiring urgent • Ischemic bowel paralytic ileus pharmacological management
surgery • Perforated viscus Bowel preparation prior • Antibiotics
Self-limited disease • Acute mesenteric adenitis to surgical resection of • Enema
most often confused • Pain is usually diffuse bowel • Laxatives
with acute appendicitis • Tenderness not as sharply Risk factors for • Ulcerative colitis
in children localized development of colon • Crohn’s colitis
• Cullen’s sign (periumbilical cancer • Inflammatory bowel diseases
Signs of abdominal wall
ecchymosis) Diagnostic modalities • Lymphoscintigraphy
hemorrhage associated
• Grey Turner sign (flank
with acute pancreatitis for lymphedema • Duplex ultrasound
ecchymosis)
Most common cause of
• Electrocardiogram mechanical bowel
Should be monitored in • Adhesion
• Jaundice could be a obstruction for post-
patients with cholestatic
presentation of cardiac disease hysterectomy patients
jaundice
due to chronic liver congestion Condition associated
Indication of surgical • Palpable mass • Extramammary perianal
with synchronous GIT
incurability for • Signs of metastasis in Paget’s disease
adenocarcinoma
pancreatic cancer advanced stages Laxative that produces
Presentation of calcium • Hypophosphatemia hydrogen and methane
stone formation in • Increased calciuria • Mannitol
gases that can explode
hyperparathyroidism • Hypercalcemia with electrocautery
Electrolyte that needs to • Hypokalemia • Expeditious surgery
Management for
be controlled pre-op for • Hyperaldosteronism leads to • “The sun should never rise and
adrenalectomy complete small bowel
hypertension and low K levels set on a complete bowel
obstruction
obstruction”
Depth of chest
• 5.6 cm (2.0-2.4 in) deep
compressions in CPR
Number of rescue In septic shock secondary to
• 2 breaths
breath per cycle peritonitis, which of these
Number of chest vasopressors is the initial Norepinephrine
• 30 compressions
compression per cycle drug of choice to stabilize the
Number of cycles patient?
rescuers should perform The order of priority in the
• 5 cycles in 2 minutes Chest and abdomen; head
for the CPR to be management of a multiply
and spine; limb
effective injured patient is ____.
Percentage of women The FREQUENT cause of
with BRCA1 mutation hospital acquired UTI among Urethral catheterization
• 55-65% of women
developing breast surgical patients is ____.
cancer before age 70 Which of the following
Inguinal hernia repair traumatic abdominal injuries
Eviscerated omentum
procedure with the least • Shouldice repair (2.2%) necessitates immediate
recurrence rate surgical exploration?
Repair procedure for • Ureteroureterostomy True statement regarding
Given one hour prior to
intraoperative (upper or middle ureter) PROPHYLACTIC antibiotics is
surgery
iatrogenic ureteral • Ureteroneocystostomy ____.
injury (lower ureter) The recommended first-line
• Long-standing, severe vasoactive drug used in the
Norepinephrine
secondary HPT which has management of hypotension
Cause of tertiary in severe sepsis is ____.
turned autonomous once the
hyperparathyroidism Which has an inhibitory effect
cause of secondary HPT has Drotrecogin alfa
been removed on the coagulation process?
Cause of secondary • Deficiency in vitamin D or In healthy patients who
hyperparathyroidism uremia bleed, how many percent of
• Adenoma of one or more the blood volume is lost for 30%
Cause of primary them to manifest significant
parathyroid glands
hyperparathyroidism changes in the vital signs?
• Hyperplasia
Watershed area of the After massive bowel
colon supplied by the • Splenic flexure resection due to mesenteric
SMA and IMA vascular occlusion resulting
Hypokalemia,
• Hemodynamic instability in short guy syndrome, a 55-
hypomagnesemia,
year-old male is tarted on
• Obvious peritoneal signs hypophosphatemia,
TPN. Which of the following
Indication for • Impaled foreign body hypocalcemia
electrolyte abnormalities
laparotomy in • Pneumoperitoneum
characterizes the re-feeding
penetrating abdominal • Herniated abdominal organs syndrome?
trauma • GSW with evidence of Which coagulation factor
intraperitoneal penetration DOES NOT require vitamin K V
• Blood in orifices in its production?
• MTC The following are indication
• Pheochromocytoma for performing exploratory
• Multiple neuromas RBC count of 5,000/mL on
Diagnostic features of laparatomy among
• Long narrow face, diagnostic peritoneal lavage
MEN2B abdominal trauma patients,
retrognathia, highly arched EXCEPT ____.
palate In trauma, victims, life-
• Marfanoid habitus threatening conditions are
Primary survey
identified and corrected
during the ____.
Which of the following Elevated fibrin split products
FOR MARCH 2022 PLE BATCH USE ONLY findings is consistent with Thrombocytopenia
disseminated intravascular Low fibrinogen level
coagulopathy? Prolonged prothrombin time
Which of the following Myoepithelial cell-derived A 30-year-old male
statements regarding wound growth factors cause complaining of a 6 cm hard,
healing is TRUE? fibroblast differentiation fixed, left mandibular mass
The MOST common cause of with radiographic features of
The tongue falls back into the Ameloblastoma
upper airway obstruction in multi-loculated lesion in the
posterior pharynx parasymphyseal area is
an unconscious patient is ____.
Which of the following is a Is notorious for occult MOST likely suffering from
characteristic of zone I neck hemothorax/ great vessel ____.
injury? injury Which of the following types
The MAIN action of Papillary of thyroid cancer has the best
Inhibits the inflammatory prognosis?
glucocorticoids in response to
response During parotidectomy, which
injury and stress is ____.
The MOST commonly injured Mandibular branch of the facial nerve is
intra abdominal organ MOST commonly injured?
Spleen The MAJOR advantage of neo-
following a blunt abdominal
trauma is the ____. Decreases recurrence after adjuvant radiotherapy for
The PRIMARY purpose for surgery head and neck malignancies
Increase venous return to the is ____.
using pneumatic anti-shock
right atrium Fine needle cytology result of
garments (PASG) is to ____. Surgical intervention
What type of shock is follicular lesion warrants ____.
characterized by increase Thyroid cancer with the
cardiac output tachycardia, Septic shock Anaplastic poorest overall survival is
warm dry skin and increased ____.
central venous pressure?
During parotidectomy, which Hepatic resection is MOST
structure can be used to Stylomastoid foramen commonly considered for
identify the facial nerve? localized metastatic spread Stomach
A 25-year-old known case of from which of the following
Grave's disease is being given primary site?
iodine for the last 10 days Control the tachycardia The MOST likely diagnosis in
prior to surgery. Iodine was a 70-year-old male
given in order to ____. presenting with significant
Which among the following weight loss accompanied by
Hepatocellular carcinoma
would be safest to give in progressive jaundice,
Propylthiouracil
pregnant hyperthyroid anorexia, pruritus, and tea-
patients? colored urine with positive
Which is NOT USED during Courvoisier's sign is ____.
coronary artery by-pass graft Jugular vein A 75-year-old hypertensive
(CABG)? but otherwise asymptomatic
The MOST common risk female during her annual
factor associated with executive check-up was Close monitoring /
Cigarette smoking found to have a 5 mm stone observation
thromboangitis obliteralis is
____. in her thin walled gall
On routine pre-employement bladder. What treatment
check-up, a 40-year-old option is BEST for her?
woman was found to have a The MOST common solid
1.5 cm circular, peripheral benign mass in the liver is Hemangioma
GeneXpert test for TB ____.
density in her right upper
lobe on chest radiograph. Choledochal cysts that are
What should come NEXT in NOT completely excised
Cholangiocarcinoma
her evaluation? during surgery may
The MOST common primary developed into____.
tumor involving the heart is Myxoma A 15-year-old male patient
____. comes in because of fever and
The IDEAL force expiratory jaundice. On PE, a palpable
volume in 1 second (FEV1) mass is felt at the RUQ. Initial
value of a patient with left ultrasound shows a fusiform
2.5 L Choledochal cyst
lung carcinoma who is to dilatation of the CBD; the
undergo pneumonectomy is intrahepatic ducts are
____. normal. The gallbladder is
Ankle Brachial Index (ABI) normal. The MOST likely
value of less than 0.9 is a diagnosis is ____.
good measurement to Arterial obstuction / A 50-year-old female
determine a patient's risk to coronary heart disease complains of constipation
develop which of the and anal pain with a magnetic
following? resonance imaging finding of
Chordoma
What is the MOST common posterior extra rectal mass
symptom of acute aortic Severe pain that is adherent to the
dissection? sacrum. What is the MOST
Prolonged post-operative likely diagnosis?
ileus is defined as that which The MOST common type of
5 anal fistula accounting for
is seen beyond how many Intersphincteric fistula
days after surgery? about 70 percent of cases is
An 8-year-old boy swallowed ____.
a one-peso coin three hours After colonoscopic
prior to consultation. Plain polypectomy a 2 cm polyp, 4
abdominal x-ray is cm from the anal verge
compatible with the foreign Clinical observation turned out to be an Abdomino-perineal resection
body being located at the adenomatous polyp. The
gastro-duodenal area. As the MOST appropriate step to do
attending doctor, what will next is ____.
you advice the parents? Colonic pseudo-obstruction is
Ogilvie's syndrome
Which can prevent the also known as ____.
occurrence of overwhelming Annual administration of Pre-operative bowel
Complete intestinal
post-splenectomy infection polyvalent flu vaccine preparation is NOT done in
obstuction
(OPSI)? which of these?
The MOST common tumor of The development of rectus
Lipoma sheath hematoma after a
the omentum is ____.
Which is CORRECT regarding prolonged labor is usually Inferior epigastric artery
Smoking is a risk factor due to a break in which of
carcinoma of the esophagus?
The standard treatment for a these blood vessels?
patient with biliary colic and Endoscopic retrograde Which of the following is
Must be done for recurrent
cholecystholithiasis by cholangiography (ERCP) TRUE regarding mesh hernia
hernias
ultrasound is ____. repair?
In patients with obstructive The MOST common content
jaundice, what non-invasive Magnetic resonance of a complete indirect Small intestine
procedure would help you in cholangio-pancreatography inguinal hernia is the ____.
localizing the cause? The MOST common subtype
Superficial spreading
of melanoma is ____.
Which of the statements is Based on the Parkland
TRUE regarding breast Adjuvant radiotherapy is a formula, a 70 kg patient with
4.2 L (1st 8 hours - 1/2 of
conservation treatment for a must 30 percent second degree
total - from time of burn)
T2N0M0 breast carcinoma? should be given how much
8.4 L (1st 24 hours from time
Reddish, tender, warm breast lactated Ringer's solution (in
of burn)
in a nursing mother is MOST Chronic cystic mastitis cc) during the first 8 hours of
likely a case of ____. fluid resuscitation?
Which of the following is a Which of the following is a
characteristic of a pathologic Spontaneous and bloody type of intravenous Propofol
nipple discharge? anesthetic?
Which of these abdominal A patient undergoing
wall hernias arise from the Spigelian debridement of abscess on
Decreased pH of the infected
arcuate line? the left big toe under local
tissue
Post-operative maintenance anesthetic infiltration may
therapy after total Hydrocortisone still feel pain because of ____.
adrenalectomy is ____. Which of the following Caused by estrogen secreting
MOST widely used and characterizes endometrial tumors like granulosa cell
accurate modality for pre- hyperplasia? tumor
operative localization of Technitium-sestamibi scan Disease free interval after
abnormal parathyroid gland excision of basal cell
Histologic type
is ____. carcinoma of the lip depends
Best treatment modality is on ____.
surgery Which of the following is
Reversible state of various
provided by general
levels of unconsciousness
The recurrence rate of anesthesia?
meningioma is associated Surgery as the primary
Which of these statements is
with the extent of surgical modality of treatment for
TRUE regarding
removal. Using the original cervical cancer is generally I
meningiomas?
Simpson grading system, the recommended for what stage
overall recurrence rates for of the disease?
grades 1, 2, 3, and 4 are 9%, How long should a pulse
No more than 10 seconds
19%, 29%, and 40%, check last?
respectively. An enlarged painless scrotum
Which peripheral nerve is without an inguinal bulge and
Hydrocele
compressed in a 30-year-old positive transillumination
Median nerve
call center agent with carpal test is MOST likely a ____.
tunnel syndrome? A newborn baby girl presents
Virilization caused by with persistent non-bilous
congenital adrenal vomiting and failure to thrive. Hypertrophic pyloric stenosis
Glucocorticoid
hyperplasia is treated with This is clinically suspicious
____. for ____.
Neurosurgical procedure that The MOST dreaded
may improve motor function complication seen in elderly
and quality of life of patients Deep brain stimulation (DBS) patients with displaced Uncontrolled bleeding
with Parkinson's disease is interthrocanteric hip fracture
____. is ____.
A patient with lumbar spinal The MOST common
canal stenosis has relief of the malignancy involving bone is Osteosarcoma
Body flexion
symptoms when he assumes ____.
which of these positions? A 20-year-old basketball
Acoustic neuroma arises from Cranial nerve VIII player with a tear in his
which nerve? (vestibulocochlear nerve) anterior cruciate ligament
Arthroscopic surgery
Which statement regarding manifested by pain and
It is located in the loose
the emissary vein is swelling is BEST treated with
areolar tissue
CORRECT? ____.
A patient with lumbar spinal Bilateral fracture of the pars
canal stenosis has relief of the interarticularis involving the Hangman's fracture
Body flexion
symptoms when he assumes C2 spine is called ____.
which of these positions? A 10-year-old boy with
The standard of care for hemophilia A is scheduled for
patients with Stage 2a Radical prostatectomy emergency appendectomy. Factor VIII
prostate cancer is ____. Which should you administer
An obtunded motorcycle PRIOR to surgery?
rider, after an accident, Treatment of choice for non-
presented which lower aligned femoral neck fracture Total hip replacement
abdominal pain and is ____.
Retrograde urethrogram
tenderness. Blood was noted A fracture of the distal radius
coming out of his urethral in which the distal fragment Colles' fracture
meatus. Identify the is dorsally displaced is ____.
procedure to be done. Which of the following BEST
There is no overlying sac
The life-threatening describes gastroschisis?
complication of obstructive Herniation
hydrocephalus is ____.
Wound closure characterized
by initial debridement and
observation for around 5 Tertiary intention
days before closure is called
____.
A 55-year-old male presents
with a progressively
enlarging abdominal mass
accompanied by pain and
weight loss. Abdomen shows
an ill-defined abdominal
mass around 12 cm in its
widest diameter, non-tender,
with smooth consistency. No
other findings were noted.
If the mass turns out to be a
Chemotherapy and
lymphoma, the BEST
radiotherapy
treatment is ____.
On further work up the mass
was found to be solid
measuring 15x10x7 cm
located at the right
Surgery
retroperitoneal space with
involvement of the inferior
vena cava. What would you
do NEXT?
The BEST imaging procedure
to determine the nature of MRI
the mass is ____.
An 18-year-old male student
with a clinical impression of
acute appendicitis was
scheduled for emergency
surgery.
Through a McBurney incision,
the appendix and the rest of
the visible/palpable The normal appendix should
structures were normal. be removed
Which of the following
statement is TRUE?

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TOPNOTCH MEDICAL BOARD PREP SURGERY PEARLS HANDOUT BY DR LOUBOMIR ANTONIO

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