Department of Surgery

Revalida Examination

1. What characteristic radiographic findings would be seen in a patient with gallstone

that has eroded into the duodenum? D
a. widened duodenal C-loop
b. gallbladder calcification
c. evidence of gas-forming organism in the retroperitoneum
d. air in the biliary tree
e. a filling defect in the rectosigmoid colon

2. What is the most reliable method for precisely locating an upper gastrointestinal
lesion that is responsible for a bleed? C
a. Upper GI series
b. Explore laparotomy
c. Upper GI endoscopy
d. Arteriography
e. Radionuclide scanning

3. Arterial claudication is associated with all of the following conditions EXCEPT

a. Abnormal lipoprotein concentrations? D
b. Smoking
c. Hypertension
d. Pain in the toes and metatarsal heads
e. Absent extremity pulses

4. Ligation of the superior thyroid artery above the superior pole of the thyroid gland
carries with it the risk of? E
a. Injury to the recurrent nerve
b. Injury to the vagus nerve
c. Devascularization of the inferior parathyroid gland
d. Injury to the hypoglossal nerve
e. Injury to the external branch of the superior laryngeal nerve

5. An elderly man is brought to the emergency room because of massive bleeding

from the rectum. The bleeding is most likely due to? B
a. Carcinoma of the colon
b. Diverticulosis
c. Diverticulitis
d. Ulcerative colitis
e. Colonic polyp

6. Treatment of incarcerated congenital hernia involves? B

a. Immediate operation to prevent the reduction of necrotic intestines
b. Evaluation of the child’s state of hydration after reduction of hernia
 c. Observation after reduction of the hernia until the child is old enough to undergo
surgery
d. Observation after reduction until the processus vaginalis has clearly fused
e. Surgery of the small intestines in both male and female patients

7. An elderly woman is admitted with weakness, anemia, weight loss and palpable
abdominal mass. She has a colon cancer. The most likely anatomic site is the? E
a. Rectum
b. Sigmoid colon
c. Left colon
d. Transverse colon
e. Cecum

8. Which vessel is most commonly associated with a posterior duodenal ulcer? C

a. Right gastroepiploic artery
b. Common hepatic artery
c. Gastroduodenal artery
d. Superior mesenteric artery
e. Middle colic artery

9. The most effective way to prevent infection in a dirty traumatic wound is to? D
a. Administer tetanus toxoid
b. Administer IV antibiotics
c. Apply a skin graft
d. Repeat surgical debridement
e. Administer topical antibiotics

10. Achalasia of the esophagus is suspected on the basis of an x-ray film showing? B
a. Multiple strictures of the esophagus
b. Difuse dilatation of the esophagus
c. “corkcrew” appearance of the esophagus
d. A diverticulum in the cricopharyngeal muscle
e. Reflux of barium into the esophagus

11. All of the following measures are likely to be helpful in the management of
cerebral edema EXCEPT? D
a. Restricting fluids to two-thirds of maintenance
b. Administering osmotic agents (e.g mannitol, glycerol)
c. Monitoring intracranial pressure
d. Maintaining PC02 in the 40mmHg to 45mmHg range
e. Administer barbiturates

12. All of the following components or qualities of stored whole blood tend to decrease
over time EXCEPT? B
a. Red blood cell survival time
b. Potassium concentration
 c. pH
d. platelet activity
e. oxygen carrying capacity

13. What organism most frequently causes a urinary tract infection? C

a. Staphyloccus aureus
b. Staphyloccus epidermidis
c. E. coli
d. Proteus mirabilis
e. Pseudomonas aeriginosa

14. Familial polyposis of the colon is most often associated with which of the
following conditions? B
a. Carcinoma of the pancreas
b. Carcinoma of the colon
c. Granulomatous disease of the colon
d. Pneumatosis cystoides intestinalis
e. Sigmoid volvulus

15. A 5yrs. Old patient has a midline neck mass, which moves with swallowing and is
located just below the hyoid. The mass is most likely to be a? D
a. Branchial cleft cyst
b. Cystic hygroma
c. Teratoma
d. Thyroglossal duct cyst
e. Laryngeal papilloma

16. A 15 yrs. Old girl is admitted with acute generalized abdominal pain. She gives a
history of intermittent abdominal pain and anorexia with vomiting. Examination of
her abdomen reveals a fullness in the right lower quadrant with localized
tenderness. She has a temperature of 102 degrees F, a WBC of 18,000 and a
hematocrit of 45%. What is the most likely diagnosis? B
a. Simple appendicitis
b. Perforated appendicitis with abscess formation
c. Ovarian tumor
d. Ruptured ectopic pregnancy
e. Intussusception

17. Which of the following presenting symptoms of breast cancer is the most common? C
a. Isolated axillary enlargement
b. Nipple discharge
c. Breast mass
d. Mammographic findings of microcalcification
e. Nipple changes and desquamation
 18-22. For each phrase describing a characteristic of ulcer disease, select the most
appropriate answer.

18. The major cause is hypersecretion of gastric acid B

19. Degenaration into cancer may occur D
20. Complications include bleeding and perforation C
21. Smoking and aspirin use are associated with an increased incidence C
22. Surgery is the treatment of choice D

a. Gastric ulcer
b. Duodenal ulcer
c. Both
d. Neither

23-27: Match the following:

23. Blumer’s shelf A

24. Sister Mary Joseph E
25. Krukenberg’s node D
26. Virchow’s node C
27. Rotten’s node B

a. Rectovesical pouch
b. None of the above
c. Supraclavicular node
d. Ovary
e. Peritoneum under umbilicus
f. Axillary node
g. Inguinal node

28-32: Matching type:

28. Principal mechanism is twisting of a segment of bowel on a narrow mesentery C

29. Most common in elderly debilitated persons with psychiatric or neurologic disease A
30. Non-operative reduction is successful in approximately 70% of patients A
31. Abdominal distention, pain and x-ray findings of small bowel obstruction B
32. Mortality rate are not altered whether operating urgently for peritonitis or elective D

a. Sigmoid volvulus
b. Cecal volvulus
c. Both
d. Neither

33. a case ot acute gangrenous appendicitis with perforation and abscesses should best
be manage by? D
a. Conservative medical management
 b. Drainage
c. Lavage and drainage
d. Appendectomy, lavage and drainage
e. Lavage,drainage, and interval appendectomy

34. A 14y/o boy with a history of abdominal pain, vomiting and fever of a 4 days
duration was diagnosed to be suffering from a perforated gangrenous appendicitis
with abscess. Management is? B
a. A. medical management
b. Drainage, lavage and appendectomy
c. Drainage and antibiotics
d. E.L, lavage and drainage

35. Appendectomy and lavage was done on a 30y/o female with ruptured gangrenous
appendicitis. Five days later temperature shoots up and stays intermittent. Most
probable cause is? D
a. Wound infection
b. Pneumonia
c. Urinary tract infection
d. Tubo-ovarian abscess

36. The most likely cause of fever occurring 1 week after an appendectomy for
ruptured appendicitis inspite of antibiotics is? D
a. Allergy
b. UTI
c. Pneumonitis
d. Wound infection

37. Most common complication of explore laparotomy secondary to ruptured

appendicitis?
a. Intraabdominal abscess
b. Cecal fistula
c. Hemorrhage
d. Intestinal obstruction

38. Carcinoid tumor most commonly involved the? B

a. Ileum
b. Appendix
c. Colon
d. Rectum

39. Which of the following symptoms is most likely to be present in patient who has
cancer in the rectum? D
a. Anemia
b. Constipation
c. Diarrhea
 d. Rectal bleed

40. Factors related to the reduction of the incidence of colorectal cancer? A

a. Large bulky stools with rapid transit time
b. Diet of refined and processed food
c. Smaller stools and slower transit time
d. None of the above

41. The surgical treatment of choice of rectal cancer 3cms. From the anal verge? C
a. Anterior resection
b. Left hemicolectomy
c. APR
d. Sigmoidectomy

42. Which of the following is not a frequent symptoms of internal hemorrhoid? E

a. Discharge of mucous
b. Bright red blood unmixed with stool
c. Prolapsed with defacation
d. Severe pain
e. Pruritus

43. Internal hemorrhoid that prolapsed through the anus and reduces spontaneously? C
a. Grade 4
b. Grade 3
c. Grade 2
d. Grade 1

44. A thrombosed hemorrhoid? B

a. Painless
b. Complication of external hemorrhoid
c. Aggravated by constipation
d. Treated by rubber band application

45. Most common cause of mechanical obstruction of the colon? C

a. Adhesion
b. Diverticulitis
c. Cancer
d. Volvulus
e. Hernia

46. Most common cause of massive colonic bleeding? C

a. Cancer
b. Ulcerative colitis
c. Diverticulitis
d. All of the above
47. At present the most useful diagnostic tool for identifying acute hemorrhage or
fracture? B
a. MRI
b. CT scan
c. Myelography
d. Arteriography

48. True regarding traumatic brain injury include the following except? D
a. Males are about twice as female to sustain from TBI
b. Highest groups in TBI include, 0-4 yrs. Old and 15-19 yrs. Old
c. Adult age 75 yrs. And older have the highest rates of TBI related hospitalization
and death
d. None of the above

49. Regarding the evaluation and care of head-injured patients. Which of the following
statements is/are true? C
a. Hypotension is often the direct result of intracranial trauma
b. A decerebrate posturing is a common response to diffuse cortical injury
c. A score of 5 on the GCS is associated with poor prognosis
d. All of the above

50. This is due to rotational acceleration of the head in the absence of significant injury A
a. Cerebral concussion
b. Epidural hemorrhage
c. Subarachnoid hemorrhage
d. Diffuse axonal injury