MCQs Mock Exams for General Surgery Board Exam

Mock Exam 6- 25 MCQs

Share from Dr. Muhanad Deeb. Riyadh, King Faisal Hospital (muhanad.deeb.5facebook.com)

References:

1. Comprhensive "AIO" Revision on SURGERY by Dr.Adel Abdel Hamid. 2008

2. Lange Q & A 5th Edition.

1. Which of the following statement (s) is/are true concerning the recurrence of
breast cancer?
a. The majority of patients recur within five years of diagnosis
b. More than 70% of breast cancer recurrence involve distant metastases
c. Pulmonary metastases are the most common initial site of distant recurrence
d. The local recurrence rate following breast-conserving procedures varies from
10% to 40% whether or not radiation was used
e. Recurrent disease will be seen in at least 35% of node-negative patients
undergoing appropriate primary breast therapy
Answer: a, b, d
2. Which of the following statement(s) is/are true concerning mammography?
a. Up to 50% of cancers detected mammographically are not palpable
b. One third of palpable breast cancers are not detected by mammography
c. The sensitivity of mammography increases with age
d. The American Cancer Society currently recommends routine screening
mammography beginning at age 40
e. Only about 10% of nonpalpable lesions detection mammographically are found to
be malignant at biopsy
Answer: a, c, d
3. A 35-year-old woman, who is currently breast-feeding her firstborn child,
develops an erythematous and inflamed fluctuant area on breast examination.
Which of the following statement(s) is/are true concerning her diagnosis and
management?
a. The most common organism which would expect to be cultured is Staphylococcus
aureus
b. Open surgical drainage is likely indicated
c. Breast-feeding absolutely should be discontinued
d. If the inflammatory process does not completely respond, a biopsy may be
indicated
Answer: a, b, d
4. A partially blind 65-year-old mother presents with a slight change in color of the
areola of her
left breast. An eczematous rash of the left areola has persisted for the last 3
months. Biopsy of the

nipple reveals Pagets disease. In Pagets disease of the nipple which of the
following is TRUE?
(A) Carcinoma of the breast is rarely found.
(B) Surgical therapy often fails to cure Pagets disease.
(C) The diagnosis should be made by nipple biopsy when suspected.
(D) The underlying carcinoma when present is very large.
(E) Pagets disease of the bone is commonly encountered.
Answer: (C) The diagnosis should be made by nipple biopsy when suspected.
Pagets disease represents a ductal carcinoma that has grown along the ducts into
the nipple/areolar region. The
lesion often presents with an eczematous rash, which does not resolve and can be
diagnosed
with a small incisional biopsy. Typically swollenvacuolated Pagets cells are found on
histologicl
examination. Many cases involve small breast cancers, which are missed on clinical
examination and mammogram. Surgical therapy is often curative. This is unrelated
to Pagets disease of the bone.
5. Advantages of total thyroidectomy for management of papillary carcinomas of
the thyroid larger than 1.5 cm. include:
A. Possibility of using radioactive iodine postoperatively to identify and treat
metastases.
B. The ability to use thyroglobulin levels as a marker for recurrence.
C. Lower overall recurrence rate.
D. Lower risk of hypoparathyroidism.
Answer: ABC
6. Which of the following statements about follicular carcinoma is/are true?
A. It presents at a later age than papillary carcinoma.
B. It disseminates via hematogenous routes.
C. It is the most common type of well-differentiated thyroid carcinoma.
D. Extensive angioinvasion portends a poor prognosis. E. Follicular carcinomas are
frequently multicentric.
Answer: ABD
7. Secondary hyperparathyroidism:
A. Is a metabolic disease in which the primary abnormality is decreased glomerular
filtration rate. B. Is best treated initially by subtotal parathyroidectomy.
C. Is caused by increased production of 1,25(OH) 2 vitamin D 3, causing increasing
intestinal calcium absorption and hypercalcemia.
D. Can have severe effects on bones exacerbated by aluminum contained in
phosphate binders and dialysate water.
E. Is best treated initially by total parathyroidectomy with autotransplantation.
Answer: AD

8. Four years previously, a 56-year-old fisherman underwent thyroidectomy for

cancer of the thyroid gland. He is now noted to have a single 4-cm lesion in the
upper lobe of the left lung.
There is no other evidence of disease, and he is in excellent health. Endobronchial
biopsy confirms
that the lesion is malignant but the organ of origin cannot be determined. What
should he be given?
(A) Radiotherapy
(B) Combination chemotherapy
(C) Attempted curative lung resection
(D) Exploration of the neck for thyroid recurrence
(E) Androgen therapy
Answer: (C) Although there is a history of previous thyroid cancer, the presence of
a solitary nodule on chest x-ray is more likely to represent a primary carcinoma of
the lung than a solitary secondary metastasis. In metastasis, the lesions are more
often multiple, they frequently appear
bilaterally, and they more commonly present in the lower area of the lungs. ACT
scan would be
helpful in delineating the pulmonary findings.
9. Which of the following statements concerning the abdominal wall layers are
correct?
A. Scarpa's fascia affords little strength in wound closure.
B. The internal abdominal oblique muscles have fibers that continue into the
scrotum as cremasteric muscles.
C. The transversalis fascia is the most important layer of the abdominal wall in
preventing hernias.
D. The lymphatics of the abdominal wall drain into the ipsilateral axillary lymph
nodes above the umbilicus and into the ipsilateral superficial inguinal lymph nodes
below the umbilicus.
Answer: ABCD
10. Which of the following congenital abnormalities are correctly defined?
A. Omphalocele represents a defect in the abdominal wall lateral to the umbilical
cord.
B. The herniated viscera associated with omphaloceles are usually covered with a
membranous sac.
C. An umbilical polyp is a small excrescence of omphalomesenteric duct mucosa
that is retained in the umbilicus.
D. Meckel's diverticulum results when the intestinal end of the omphalomesenteric
duct persists and represents a true diverticulum.
Answer: BCD
11. The following statement(s) is/are true concerning the indications for treatment
of an inguinal hernia.
a. Most adult hernias will remain stable in size, therefore delay seldom affects the
technical aspects of a surgical repair

b. There is a direct correlation between the length of time that a hernia is present
and the risk of major complications
c. The morbidity and mortality associated with emergent operation due to hernia
complications is significantly greater than for elective repair of the identical hernia
d. A truss maintains a hernia in the reduced state, therefore, minimizing the risk of
incarceration and strangulation
Answer: b, c
12. Which of the following statements about esophageal motility is/are true?
A. The act of swallowing initiates UES relaxation, which persists until the bolus of
food passes the LES.
B. The primary peristaltic wave normally propels the swallowed bolus through the
esophagus in 4 to 8 seconds.
C. Normally, a progressive peristaltic contraction (primary wave) follows 50% of all
swallows, the remainder being secondary or tertiary contractions.
D. Secondary peristalsis is initiated when the entire swallowed bolus of food fails to
empty from the esophagus into the stomach.
E. Tertiary esophageal contractions are high-amplitude progressive peristaltic
contractions that produce the corkscrew appearance of esophageal spasm on
barium esophagography.
Answer: BD
13. Which of the following statements about UES dysfunction are correct?
A. This condition is diagnosed by the characteristic manometric findings of UES
spasm.
B. Typical symptoms include cervical dysphagia, expectoration of saliva, and
hoarseness.
C. The classic finding on barium esophagogram is a posterior cricopharyngeal bar.
D. Medical or surgical therapy of gastroesophageal reflux may be curative.
E. A cervical esophagomyotomy for UES dysfunction should be limited to 2 to 3 cm.
in length so that normal muscle is not damaged.
Answer: BCD
14. The lamina propria between the intestinal epithelium and the muscularis
mucosae contains:
A. Blood and lymph vessels.
B. Undifferentiated epithelial cells.
C. Nerve fibers.
D. Enterochromaffin cells. E. Macrophages. F. Connective tissue.
Answer: ACEF
15. The intestinal epithelial cells, 22 to 26 mm. tall, exhibit a striated luminal
border (brush border). The brush border microvilli:
A. Produce the brush border appearance. B. Contain amylase.
C. Contain dissacharidases.
D. Increase absorptive area. E. Play an important role in digestion. F. Contain
trypsinogen.
Answer: ACDE

16. A 72-year-old man returns to the hospital 2 weeks following right hip
arthroplasty with complaints of 48 hours of mucoid diarrhea, fever, and crampy
abdominal pain. Physical examination reveals dehydration, diffuse abdominal
tenderness, and a temperature of 102F. Outpatient medications have included
digoxin, propranolol, and cephalothin. If antibiotic-associated colitis is suspected,
which of the following is/are appropriate diagnostic tests?
a. Fecal leukocyte smear
b. Stool culture for C difficile
c. Measurement of C difficile toxin in stool
d. Barium enema
e. Computed topography of abdomen
Answer: a, b, c
17. A 63-year-old woman is admitted to the hospital with severe abdominal pain of
3-hour duration.
Abdominal examination reveals board-like rigidity, guarding, and rebound
tenderness. Her blood pressure is 90/50 mm Hg, pluse 110 bpm (beats per
minute), and respiratory rate is 30 breaths per minute. After a thorough history and
physical, and initiation of fluid resuscitation, what diagnostic study should be
performed?
(A) Supine abdominal x-rays
(B) Upright chest x-ray
(C) Gastrograffin swallow
(D) Computerized axial tomography (CAT)
scan of the abdomen
(E) Abdominal sonogram
Answer: (B) An upright chest x-ray will demonstrate free air below the diaphragm
in about 7075% of patients presenting with a perforated duodenal ulcer. An
abdominal sonogram may
demonstrate free fluid, but not free air. Although a CAT scan will show both free
fluid and free air, it will take longer to perform and may delay the definitive
treatment. The combination of an acute abdomen and an upright chest x-ray with
free air under the diaphragm provides enough information to take the patient to the
operating room for exploration.
18. Apatients CT scan reveals diverticulitis confined to the sigmoid colon. There is
no associated pericolic abscess. What is best course of treatment?
(A) Bowel rest, nasogastric suction, IV fluids, and broad spectrum antibiotics
(B) Urgent surgical resection
(C) Steroids
(D) Diverting colostomy
(E) Ileostomy
Answer:9. (A) Uncomplicated diverticulitis is treated with broad spectrum
antibiotics and bowel rest.
Surgery is not indicatedeither resection or diversion of the fecal stream by
colotomy or ilestomy. Anti-inflamatory agents are not indicated in the therapy of

diverticulitis. The risk of a second episode is less than 30%. After a second episode,
the risk is greater than 50% and resection may be advised at this stage.
19. A 70-year-old cigarette smoker presents with a right inguinal mass that has
enlarged and has
caused discomfort in recent months. He complains of recent difficulty with
micturition and
nocturia. The swelling, which does not extend to the scrotum, reduces when
resting. What is
the likely diagnosis?
(A) Direct inguinal hernia
(B) Strangulated indirect inguinal hernia
(C) Hydrocele
(D) Aneurysm of the femoral artery
(E) Cyst of the cord
Answer: (A) Direct hernias are more common in older patients. There is an
increased incidence in
patients with a chronic cough and prostatic obstruction. They are rarely
encountered in children and women. This type of hernia does not extend to the
scrotum and rarely undergoes strangulation.
20. A 72-year-old man develops jaundice and is demonstrated to have a 2.5 mass
in the pancreatic head by computed tomography. There are no signs of
unresectability on CT examination. Fine needle aspiration cytology is positive for
adenocarcinoma. Which of the following intraoperative findings would indicate
unresectability?
a. Fibrotic reaction in the body and tail of the pancreas
b. Microscopic tumor cells in perigastric lymph nodes on frozen section
c. Inability to develop an avascular plane anterior to the superior mesenteric vein
d. Cholelithiasis
Answer: b, c
21. A 37-year-old female presents with obstructive jaundice due to a mid-bile duct
stricture four months after laparoscopic cholecystectomy. Which of the following
statement(s) are true:
a. Surgical reconstruction is the only option for management of this patient
b. Excellent long-term results can be expected in approximately 80% of patients
following surgical biliary reconstruction
c. One year follow-up after successful repair is satisfactory regardless of the
method of management
d. Surgical reconstruction offers a better chance of long-term success than either
percutaneous or endoscopic dilatation
Answer: b, d
22. Which of the following statements about lymphatic capillaries are true?
A. These vessels have delicate tricuspid valves every 2 to 3 mm.
B. Lymphatic capillaries are more permeable than blood capillaries.

C. Lymphatic capillaries are less permeable than blood capillaries.

D. Lymphatic capillaries contain gaps large enough to admit particles as large as
lymphocytes.
Answer: CD
23. Which of the following statement(s) is/are true concerning benign prostatic
hypertrophy (BPH)?
a. Prostatic size has no consistent relationship to urethral obstruction
b. Renal failure secondary to obstructive uropathy occurs as bladder pressure rises
and is eventually transmitted proximally to the renal pelvis
c. Hormonal treatment for BPH involves treatment with a 5 a-reductase inhibitor
which blocks the conversion of testosterone to the dihydrotestosterone
d. Intermittent catheterization, although a temporizing measure, is not an effective
treatment for relief of symptoms of BPH
Answer: a, b, c
24. A 32-year-old female falls from the tenth floor of her apartment building in an
apparent suicide attempt. Upon presentation, the patient has obvious head and
extremity injuries. Primary survey reveals that the patient is totally apneic. By
which method is the immediate need for a definitive airway in this patient best
provided?
(A) Orotracheal intubation
(B) Nasotracheal intubation
(C) Percutaneous cricothyroidotomy
(D) Intubation over a bronchoscope
(E) Needle cricothyroidotomy
Answer. (A) In a patient with significant blunt mechanism of injury and head
injury, the cervical spine should be protected against further injury. In an apneic
patient with the potential for cervical spine injury, orotracheal intubation
may be attempted with in-line stabilization of the neck. If this is unsuccessful,
percutaneous cricothyroidotomy is the best definitive step.
25. A 17-year-old girl presents to the emergency department with a stab wound to
the abdomen and a blow to the head that left her groggy. Her blood pressure is
80/0 mm Hg, pulse is 120 bpm, and respiration rate is 28 breaths per minute. Her
abdomen has a stab wound in the anterior axillary line at the right costal margin.
Two large-bore intravenous lines, a nasogastric tube, and a Foley catheter are
inserted. The blood pressure rises to 85 mm Hg after 2 L of Ringers lactate. The
appropriate management is which of the following?
(A) Peritoneal lavage
(B) Ultrasound of the abdomen
(C) Laparoscopic assessment of the peritoneal cavity
(D) Exploratory laparotomy
(E) CT of the head
Answer. (D) A patient without other sources of blood loss who presents to the
emergency department with a stab wound to the abdomen and in shock should
have an expeditious exploratory laparotomy. Hemorrhage control should take

precedence over definitive management of a concomitant head injury. The other

tests will waste precious time and are contraindicated in a patient in shock.