Surgery 2 SEPT SOLVED

12/10/21, 9:49 AM Surgery 2 SEPT Batch 2021-2022 2nd LE
4. What is the half time of solid emptying of the stomach? *

(1 Point)
120 minutes
30 minutes
12 minutes
60 minutes
5. What is the most common primary malignant neoplasm of the stomach? *

(1 Point)
Adenocarcinoma
Malignant GIST
Lymphoma
Squamous cell carcinoma
6. Which of the following diagnostics is considered a gold standard for gastric

cancer? *
(1 Point)
Endoscopy with biopsy
MRI of the abdomen
CT scan
Upper GI series
7. Match the Hinchey Stage to the Clinical Manifestation of Diverticulitis

Clinical Manifestation: Fecal peritonitis
*
(1 Point)
Stage II
Stage I
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Stage III
Stage IV
8. Clinical manifestations differentiating Right-sided colonic cancer from Left-

sided: *
(1 Point)
More likely to cause painful bleeding
They are less likely to cause bowel obstruction
Tend to occur with change in bowel habits and gross bleeding
Produces an “apple-core” deformity on Barium enema
9. Which of the following is treatment for duodenal ulcer? *

(1 Point)
Vagotomy and drainage
Vagotomy and Antrectomy
Oversewing, vagotomy and drainage
Patch, highly selective vagotomy
10. The development of the esophagus is at the 3rd week AOG and is from the
primitive midgut. *
(1 Point)
True
False
11. Characterized by chest pain in relation to GERD rather than intraluminal

hypertension, this disease entity may be treated with calcium channel blockers
and antispasmodics. *
(1 Point)
Ineffective esophageal motility disorder
Nutcracker esophagus
Diffuse esophageal spasm
Hypertensive lower esophageal sphincter
12. What is the average daily secretion of the small intestine? *

(1 Point)
2000 ml
1500 ml
1000 ml
500 ml
13. Which of the following statements is true about peptic ulcer disease? *
(1 Point)
H. Pylori infection is more commonly associated with hemorrhage and perforation
NSAID use causes acid hypersecretion
H. Pylori can be treated with antibiotics alone
Majority are caused by Helicobacter pylori infection
14. This clinical syndrome is associated with polyposis with alopecia, cutaneous
pigmentation, and atrophy of the fingernails and toenails: *
(1 Point)
Cowden Syndrome
Cronkite Canada syndrome
Juvenile polyposis
Peutz-Jeghers syndrome
15. A 65 y/o male has undergone colonoscopy for a 1 year history of

hematochezia. Patient was noted to have a 1.5 x 1 cm pedunculated polyp ~ 25
cms from the anal verge. Which of the following should be done? *
(1 Point)
Sigmoidectomy + primary anastomosis
Saline Lift
Endoscopic submucosal dissection
Snare excision
Observe only
16. The acute phase of caustic injury focuses on the treatment of strictures. *
(1 Point)
False
True
17. Which of the following is the most distal segment of the small intestine? *
(1 Point)
Duodenum
Jejunum
Ileum
18. Which of the following is the most common indication for surgery in a patient
with Crohn’s disease? *
(1 Point)
Intestinal obstruction
Intestinal perforation
Growth retardation
Gastrointestinal hemorrhage
19. The most common site of diverticular disease of the colon is the: *
(1 Point)
Ascending colon
Transverse colon
Sigmoid colon
Descending colon
20. Which structure marks the beginning of the pyloric antrum? *

(1 Point)
Angle of His
Greater curvature
Lesser curvature
Angularis incisura
21. The following blood vessels are ligated during a Left hemicolectomy, EXCEPT: *
(1 Point)
Left branches of the middle colic artery
Middle colic artery
Left colic artery
First branches of the sigmoid artery
22. When compared with normal ileal fluid, ileostomy effluent contains a 100-fold
increase in the number of aerobes and a 2500-fold increase in the number of
coliform bacteria. *
(1 Point)
False
True
23. In the management of massive, acute lower GI hemorrhage, the following

principles apply: *
(1 Point)
Radionuclide imaging or Tagged RBC scan can be used as the sole basis to plan surgical
management
Insert an NGT in order to identify if a potential bleeding source is proximal to the

ligament of Treitz
Colonoscopy has no role in the management of massive acute lower GI bleeding.
Perform CT angiography to verify the source of bleeding
24. A 24-year-old male patient was brought to the ER because of abdominal pain
and distention associated with vomiting. On PE, abdomen is distended with
mild to moderate tenderness and hypoactive bowel sounds. Two years prior,
patient underwent exploratory laparotomy with segmental bowel resection
secondary to gun shot wound. What is the likely diagnosis? *
(1 Point)
Volvulus
Post-op adhesion
Acute appendicitis
Intestinal malignancy
25. Hypertensive lower esophageal motility disorder is considered as a primary

esophageal motility disorder. *
(1 Point)
False
True
26. This condition is an autosomal dominant genetic abnormality from a mutation

in the APC gene which results in hundreds to thousands of adenomatous
polyps after puberty: *
(1 Point)
Familial Adenomatous Polyposis
Attenuated FAP
Familial Colorectal Cancer
Lynch Syndrome
27. Only observation is warranted in 1st or 2nd degree burns of the esophagus as
seen in esophagoscopy. *
(1 Point)
False
True
28. Lymphatics of the distal greater curvature of the stomach drains into which
group of nodes? *
(1 Point)
R gastric nodes
L gastroepiploic chain
R gastroepiploic chain
Splenic hilum
29. The vagal nerves and the esophageal nerve plexus lie on the muscular wall of
the thoracic esophagus. *
(1 Point)
True
False
30. Which of the following statements is true about the treatment of gastric
cancer? *
(1 Point)
Adequate lymphadenectomy should involve at least 5 lymph nodes
Surgical resection is the ONLY curative treatment for gastric cancer
Curative resection is always possible in all cases of gastric cancer
Tumor margin should be< or equal to 2cm
31. Which of the following statements is TRUE regarding small intestines? *

(1 Point)
Ileum is located retroperitoneally.
Jejunum is the longest segment comprising about 60% of the entire length of the small
intestine.
Duodenum is the shortest segment and is bounded by the pylorus and ligament of
Treitz.
The vasa recta is longer distally.
32. The lower esophageal sphincter is entirely separated from the abdominal
esophagus. *
(1 Point)
True
False
33. In colorectal cancer surgery, what is the minimum required number of lymph
nodes that should be harvested? *
(1 Point)
12
10
14
34. Which of the following is NOT considered an alarm symptom indicating need
for endoscopy? *
(1 Point)
Weight loss
Epigastric pain
Dysphagia
Bleeding
35. The cicatrization phase of caustic injury is where stricture formation should be
addressed and prevented. *
(1 Point)
True
False
36. Which of the following statements is TRUE regarding embryonic development

of the small intestine? *
(1 Point)
Lengthening of the bowel begins at the 5th week AOG with subsequent extracelomic
herniation.
The embryonic gut tube is formed from the mesoderm at 4th week AOG.
Peritoneal cavity results from the division of the endoderm at around 5th week AOG.
37. The degree and extent of lesions in the acute phase of caustic injury is
dependent on the contact time and concentration of the substance. *
(1 Point)
False
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True
38. An epiphrenic diverticula which arise from the terminal third of the thoracic
vertebrae is associated with diffuse spasm or achalasia, is diagnosed thru: *
(1 Point)
Incidentally seen in thoracic CT scan
Chest xray
Endoscopic ultrasound
Barium esophagogram
39. Fibers from the posterior vagus nerve found in the posterior aspect of the
fundus is known as *
(1 Point)
Nerves of the Latarjet
Hepatic branch of the left vagus
Celiac branch of the right vagus
Criminal nerve of Grassi
40. The squamocolumnar epithelial junction identifies the gastroesophageal

junction. *
(1 Point)
True
False
41. The esophagus deviates to the left in the lower portion of the neck and upper
portion of the thorax and returns to the midline in the midportion of the thorax
near the bifurcation of the trachea. *
(1 Point)
True
False
42. Which of the following is a function of the stomach? *

(1 Point)
Regulates production of cholesterol
Produces cholecystokinin
Where early enzymatic digestion starts
Facilitates digestion and absorption
43. Following an abdominal surgery, when would small bowel motility be expected
to return? *
(1 Point)
48 hours
12 hours
72 hours
24 hours
44. Which of the following is true about gastric glands? *

(1 Point)
Oxyntic or parietal cells make up the majority in the stomach
Gastrin secreting G cells are mostly in the fundus
Parietal cells secrete acid, intrinsic factor and bicarbonate
Parietal and chief cells are predominant in the antrum

Clinical Manifestation: Pelvic abscess
*
(1 Point)
Stage I
Stage IV
Stage II
Stage III
46. An important diagnostic tool to accurately assess the depth of invasion of

neoplastic lesions in the rectum: *
(1 Point)
Endorectal ultrasound
CT scan with IV contrast
Colonoscopy
MRI
47. What is the most prevalent congenital anomaly of the GI tract? *

(1 Point)
Chron’s disease
Intestinal atresia
Gastroschisis
Meckel’s diverticulum
48. The left gastric artery and inferior phrenic arteries supply the abdominal
portion of the esophagus. *
(1 Point)
False
True
49. TRUE regarding diverticular bleeding: *

(1 Point)
Fluid resuscitation is crucial to stop the bleeding process.
Bleeding is due to erosion of the peridiverticular arteriole
If bleeding persists for 24 hours, colonoscopy is the next step.
Most cases require urgent surgical management
50. What is the main blood supply to the small intestine? *

(1 Point)
Pacreaticoduodenal artery
Inferior mesenteric artery
Superior mesenteric artery
Gastroduodenal artery
51. This artery mainly supplies the cecum, ascending, and proximal transverse
colon: *
(1 Point)
Superior Mesenteric Artery
Celiac trunk
Gastroepiploic Artery
Middle colic artery
52. Which of the following drains to the superior mesenteric veins? *

(1 Point)
L gastroepiploic vein
R gastric vein
L gastric vein
R gastroepiploic vein
53. The constrictions of the esophagus hold up swallowed foreign objects and the
overlying mucosa is subject to injury by swallowed corrosive liquids due to their
slow passage thru these areas. *
(1 Point)
False
True
54. What is the best type of imaging used to detect pneumoperitoneum? *

(1 Point)
Abdominal CT scan
Upright chest film
Abdominal MRI
Plain abdominal film
55. The most serious complication of Zenker’s diverticula is:

*
(1 Point)
Stricture
Perforation
Carcinoma
Aspiration
56. Regarding the microscopic appearance of Crohn’s disease, which of the

following statements is true? *
(1 Point)
The disease is confined to the mucosa and submucosa.
Granulomas demonstrating caseation without acid-fast bacilli confirm the diagnosis.
Marked lymphangiectasia is a prominent microscopic feature.
The disease is confined to the mucosa.
Submucosal fibrosis occurs secondary to bacterial invasion.
57. The most common cause of Lower GI hemorrhage among infants and young
children is: *
(1 Point)
Polyps
Inflammatory bowel disease
Intestinal duplication
58. Pancreatic tissue is the most common ectopic tissue found in Meckel's
diverticula.
*
(1 Point)
False
True
59. Which of the following is an inhibitory neurotransmitter involved in gastric

innervation? *
(1 Point)
Substance P
Nitric oxide
Acetylcholine
Tachykinins
60. True about intestinal fistula: *

(1 Point)
More than 80% is due to iatrogenic complications
Presence of distal obstruction is insignificant
The treatment is always surgical
It is almost always high output
61. Which of the following is NOT an indication for surgery in the treatment of
duodenal and gastric ulcer? *
(1 Point)
Bleeding
Obstruction
Chronic epigastric pain
Perforation
62. This procedure is oncologically the most appropriate operation for curative
intent resection of operable ascending colon carcinoma: *
(1 Point)
Right hemicolectomy
Left hemicolectomy
Subtotal colectomy
Transverse colectomy
63. Which of the following is appropriate surgical treatment for proximal tumors? *
(1 Point)
Total gastrectomy
Radical subtotal gastrectomy
Antrectomy
Wide excision
64. Which of the following stimulates secretion or inhibits absorption of water in

the intestine? *
(1 Point)
Somatostatin
Vasopressin
Dopamine
Aldosterone
65. Which of the following is also known as the lesser omentum? *

(1 Point)
Omental bursa
Gastronomic omentum
Splenorenal ligament
Hepatogastric ligament
66. Mimics achalasia but produces a larger degree of dysphagia with substernal
pain and shows a corkscrew deformity on barium esophagogram: *
(1 Point)
67. A defining feature that will help determine Ulcerative colitis from Crohn’s
disease is: *
(1 Point)
Absence of cobblestone appearance of the colonic mucosa
Rectum is only very rarely involved in disease
Fistula formation is common
Affects any part of the GIT from the mouth to the anus
68. What is the most common genetic abnormality involved in gastric cancer? *
(1 Point)
ras overexpression
COX-2 amplification
Microsatellite instability
E-cadherin gene suppression
69. Which of the following stimulates absorption or inhibits secretion of water in

the intestine? *
(1 Point)
Prostaglandin
Substance P
Somatostatin
Acetylcholine
70. Final pathological report after sigmoidectomy showed tumor size of 5x5 cm
invading up to the subserosa. All of the 12 nodes were negative for
malignancy. What is the TN stage of this patient?
*
(1 Point)
T2N0
T1N0
T3N0
T4N0
71. Which of the following plain abdominal x-ray findings will indicate a small
bowel obstruction? *
(1 Point)
Paucity of air in the colon
free air levels seen in upright films
well spaced gas pattern in the small intestines
thickness of the bowel walls
72. Which of the following statements is true about the blood supply of the
stomach? *
(1 Point)
Even if just one artery is ligated, vascular compromise will ensue
Angiographic control of gastric bleeding requires embolization of just one of the main
feeding arteries
Can be used as a shunt to decompress patients with portal hypertension
Most arteries are end arteries with no significant collaterals
73. The center narrowing of the esophagus is created by the diaphragmatic

constriction. *
(1 Point)
True
False
74. The acute necrotic phase of caustic injury is marked by coagulation of

intracellular proteins resulting in cell necrosis. *
(1 Point)
False
True
75. Which of the following produces somatostatin? *

(1 Point)
Parietal cell
D cell
Chief cell
Enterochromaffin-like cell
76. Which of the following is the pathogenesis of Achalasia?

*
(1 Point)
Initiated by a viral infection
Neurogenic
Idiopathic
Intra luminal obstruction
77. The most common benign neoplasm of the intestine is the adenoma.
*
(1 Point)
True
False
78. A 15-year-old male was wheeled into the operating room for an emergency
appendectomy. Intra-operative findings revealed normal appendix. However,
upon examination of the proximal small bowel segment, there was note of a
tubular outpouching approximately 100 cm from the ileocecal valve. What is
the most likely diagnosis? *
(1 Point)
Small intestinal adenoma
Enteric fistula

Clinical Manifestation: Purulent Peritonitis
*
(1 Point)
Stage I
Stage IV
Stage II
Stage III
80. Which of the following can be directly absorbed by the intestinal epithelium? *
(1 Point)
Maltose
Glucose
Lactose
Sucrose
81. Which of the following structures form the microscopic boundary for invasive
gastric carcinoma? *
(1 Point)
Lamina propria
Muscularis mucosa
Surface epithelium
Submucosa
82. Which of the following is an indication for surgical intervention for Ulcerative
Colitis? *
(1 Point)
Toxic megacolon
Response to medications
Presence of ulcerations
Minor GI bleeding
83. Which of the following BEST describes the characteristic manifestations of

Chron’s disease? *
(1 Point)
Cobblestone appearance of the mucosa
Inflammation can affect discontinuous portions of intestine ("skip lesions“)
All of the statement best described Chron's disease.
Note of encroachment of mesenteric fat onto the serosal surface of the bowel (Fat
wrapping)
84. The middle thyroid arteries supply the cervical portion of the esophagus. *
(1 Point)
True
False
85. Which of the following is NOT considered a prognostic indicator for stomach
cancer? *
(1 Point)
Tumor grade
Size of the tumor
Tumor depth
Lymph node involvement
86. Peyer’s patches are part of the GALT and function as an inductive site to
process foreign antigens. *
(1 Point)
True
False
87. The genetic defects associated with this autosomal dominant disease arise
from errors in mismatch repair, the phenotypic result is Microsatellite
Instability. *
(1 Point)
Familial Adenomatous Polyposis
Familial Colorectal Cancer
Attenuated FAP
Lynch Syndrome
88. Degenerative changes in achalasia results in the following event/s: *

(1 Point)
Sphincter relaxation on swallowing
Loss of progressive peristalsis in the body of the esophagus
Laxity of the lower esophageal sphincter
Esophageal constriction
89. Small bowel strangulation is confirmed with which finding in the CT-scan? *
(1 Point)
Collapsed distal bowels
Pneumatosis intestinalis
Thinned out bowel walls
Ill defined gas patterns
90. Inactivation of the following genes lead to the adenoma-carcinoma sequence

leading to colorectal cancer, EXCEPT: *
(1 Point)
APC
K-ras
DCC
p53
91. The esophagus has only 2 layers, lacking a serosa which is present in other GI
structures. *
(1 Point)
False
True
92. Which of the following are the cells of origin of Gastrointestinal stromal
tumors? *
(1 Point)
Meissner’s autonomic submucosal plexus
Lamina propria
Interstitial cells of Cajal
Auerbach’s plexus

Clinical Manifestation: Pericolic abscess
*
(1 Point)
Stage II
Stage III
Stage IV
Stage I
94. A 56-year-old male patient was diagnosed to have bowel obstruction through
abdominal CT-scan. What would be the appropriate initial management? *
(1 Point)
insert foley catheter for urine output
Insert NGT for decompression
Insert central line for hydration
Insert rectal tube for decompression
95. Characterized by simultaneous, nonperistaltic contractions and repetitive and

multipeaked contractions in manometry: *
(1 Point)
96. Which of the following is the most common complication of duodenal and
gastric ulcer? *
(1 Point)
Obstruction
Perforation
Intractability
Bleeding
97. If a diverticulum is large enough to persist after a myotomy, it may be sutures

in an inverted position to the prevertebral fascia. This is called: *
(1 Point)
Marsupialization
Diverticulopexy
Diverticulotomy
Diverticulectomy
98. Pulsion diverticula is a false diverticula due to elevated intraluminal pressures

generated from abnormal motility disorders *
(1 Point)
True
FAlse
99. Which of the following conditions is not associated with an increased risk for
small bowel malignancy? *
(1 Point)
Peutz-Jegher Syndrome
Celiac disease
Crohn’s disease
Familial adenomatous polyposis
Scleroderma
100. This U-shaped striated pelvic floor muscle serves as a sling that regulates
defecation: *
(1 Point)
Levator ani
Pubococcygeus
Puborectalis
Iliococcygeus
101. This type of adenomatous polyp may harbour cancer in up to 40% of cases: *
(1 Point)
Tubulovillous adenoma
Tubular adenoma
Hyperplastic polyp
Villous adenoma
102. This tumor marker is found to be elevated in 60-90% of colorectal cancers: *

(1 Point)
CEA
CA19-9
AFP
LDH
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12/10/21, 9:49 AM Surgery 2 SEPT Batch 2021-2022 2nd LE

4. What is the half time of solid emptying of the stomach? *

5. What is the most common primary malignant neoplasm of the stomach? *

Squamous cell carcinoma

6. Which of the following diagnostics is considered a gold standard for gastric

Endoscopy with biopsy

MRI of the abdomen

7. Match the Hinchey Stage to the Clinical Manifestation of Diverticulitis

8. Clinical manifestations differentiating Right-sided colonic cancer from Left-

More likely to cause painful bleeding

They are less likely to cause bowel obstruction

Tend to occur with change in bowel habits and gross bleeding

Produces an “apple-core” deformity on Barium enema

9. Which of the following is treatment for duodenal ulcer? *

Vagotomy and drainage

Vagotomy and Antrectomy

Oversewing, vagotomy and drainage

Patch, highly selective vagotomy

11. Characterized by chest pain in relation to GERD rather than intraluminal

Ineffective esophageal motility disorder

Diffuse esophageal spasm

Hypertensive lower esophageal sphincter

12. What is the average daily secretion of the small intestine? *

H. Pylori infection is more commonly associated with hemorrhage and perforation

NSAID use causes acid hypersecretion

H. Pylori can be treated with antibiotics alone

Majority are caused by Helicobacter pylori infection

Cronkite Canada syndrome

15. A 65 y/o male has undergone colonoscopy for a 1 year history of

Sigmoidectomy + primary anastomosis

Endoscopic submucosal dissection

20. Which structure marks the beginning of the pyloric antrum? *

Left branches of the middle colic artery

Middle colic artery

Left colic artery

First branches of the sigmoid artery

23. In the management of massive, acute lower GI hemorrhage, the following

Insert an NGT in order to identify if a potential bleeding source is proximal to the

Colonoscopy has no role in the management of massive acute lower GI bleeding.

Perform CT angiography to verify the source of bleeding

25. Hypertensive lower esophageal motility disorder is considered as a primary

26. This condition is an autosomal dominant genetic abnormality from a mutation

Familial Adenomatous Polyposis

Familial Colorectal Cancer

Adequate lymphadenectomy should involve at least 5 lymph nodes

Surgical resection is the ONLY curative treatment for gastric cancer

Curative resection is always possible in all cases of gastric cancer

Tumor margin should be< or equal to 2cm

31. Which of the following statements is TRUE regarding small intestines? *

Ileum is located retroperitoneally.

The vasa recta is longer distally.

36. Which of the following statements is TRUE regarding embryonic development

Incidentally seen in thoracic CT scan

Nerves of the Latarjet

Hepatic branch of the left vagus

Celiac branch of the right vagus

Criminal nerve of Grassi

40. The squamocolumnar epithelial junction identifies the gastroesophageal

42. Which of the following is a function of the stomach? *

Regulates production of cholesterol

Where early enzymatic digestion starts

Facilitates digestion and absorption

44. Which of the following is true about gastric glands? *