st

2017 Surgery Ultimate 1 Semester Compilation A. Obstruction

by Steve Harrington
14. In the pathogenesis of appendicitis, what is the inciting
event that cause distention and serosal inflammation?
PRELIM
A. Proximal obstruction of the lumen = closed loop
obstruction
SMALL INTESTINE & APPENDIX
15. Arrowhead sign in Appendicitis can be seen on:
1. Calcium is primarily absorbed in the A. CT
B. Duodenum
16. Carcinoid tumor - commonly in tip of appendix
2. Which of the following distinguishes jejunum from ileum?
D. Longer vasa recta 17. The treatment for lymphoma confined to the appendix is
A. Appendectomy alone
3. The total volume of fluid secreted daily by the salivary
glands, stomach, liver, and pancreas in a normal adult is 18. Management of Carcinoid tumor that is 2cm and located
approximately at the base - Right Hemicolectomy
C. 6 liters
19. Management of Primary AdenoCA of appendix - Right
4. Which of the following statements about gut-associated Hemicolectomy
lymphoid tissue (GALT) is NOT true?
A. GALT contains approximately 20% of the body’s immune 20. Appendicitis inflammatory response score of 5-8 -
cells diagnostic laparoscopy

5. Which cells are responsible for generating the basic rhythm 21. Which of the following is important to consider in the
of peristalsis in the bowel? differential diagnosis of an HIV+ patient with right lower
B. Cells of Cajal quadrant abdominal pain?
B. Cytomegalovirus infection
6. Meissner’s plexus is located in which layer of the bowel
wall? 22. Midgut malrotation - appendix remain in the left upper
B. Submucosa quadrant

7. The most common location for a primary adenocarcinoma 23. Which of the following is produced by the appendix?
of the small bowel is D. IgA
A. Duodenum
24. Established function of the appendix - secretion of IgA
8. The most common cause of acute mesenteric ischemia is
A. Arterial embolus 25. McBurney's point - between ASIS and umbilicus

9. Which of the following has been shown to be effective in 26. Main etiologic factor of appendicitis - obstruction of the
reducing the duration of postoperative ileus? lumen due to fecaliths
C. Early enteral feeding
27. Disease identity confused with AA in Children - acute
10. A patient with an asymptomatic 4-cm duodenal mesenteric adenitis
diverticulum should be treated with
A. Observation alone 28. Diffuse Periumbilical pain - stimulation of nerve endings
of visceral afferent stretch fibers
11. The most common location for gastrointestinal stromal
tumors (GIST) is 29. Sonography - thickening of the appendiceal wall
A. Stomach
30. The appendix is usually seen in the following areas except
12. Which of the following is the LAST to recover from A. Subpancreatic
postoperative ileus?
C. Colon 31. Which of the following is a positive Rovsing sign?
B. Pain in the right lower quadrant with compression of the
13. The most common complication seen in adults with a left lower quadrant
Meckel’s diverticulum is

32. Cultures should be taken at the time of surgery
C. For immunocompromised patients with appendicitis
33. During surgical resection, the surgeon takes off the
proximal part of ileocolic artery. Which of the following
organs will devascularize?
A. terminal ileum
B. cecum
C. appendix
D. all of the above
34. Bacteria associated with acute appendicitis
A. E. coli
35. Not a classic sign of appendicitis during physical
examination
D. Vomiting
36. Role of parasites in appendicitis
C. Live parasites can irritate the tip of appendix causing
appendicitis
37. The luminal capacity of a normal appendix is
A. 0.1 mL
38. Appendectomy may decrease the risk of developing which
of the following diseases?
C. Ulcerative colitis
39. Lymphoid tissue in the appendix
C. Is maximally present during puberty
40. Incidental appendectomy is indicated in which of the
following patients?
a. Otherwise healthy patients between the age of 16 and 30
years
41. At the time of laparoscopic surgery for presumed
appendicitis, the patient is noted to have a mucous-filled,
distended appendix measuring 3 cm in diameter. There is no
acute inflammation or signs of perforation. The correct
treatment for this patient is
a. Diagnostic laparoscopy only (no resection) with CT scan
staging before proceeding with further surgery
42. Lifetime appendectomy, except:
A. males higher incidence than females (males 12%, females
25%)
43. Site of rupture of appendix – Antimesenteric border
44. TRUE about appendicitis on pregnancy:
D. Common on 1st and 2nd Trimesters
45. Classic signs of appendicitis except
B. Vomiting
46. Function of Octreotide in the management of Short Bowel
Syndrome - reduce GI secretions
47. Cause of bleeding associated with Meckel’s Diverticulum -
result of ileal mucosal irritation
48. Postive Tagged RBC scan - Angiography and treatment
49. True about Crohn’s disease - associated with Episcleritis &
Conjunctivitis
50. First thing to be done in the management of patients with
enterocutaneous fistula - stabilization of patient by providing
nutrition through parenteral route
51. Factors negatively impacting fistula closure:
Foreign body within the fistula tract
Radiation enteritis
Infection/Inflammation at the fistula origin,
Epithelialization of the fistula tract,
Neoplasm at the fistula origin,
52. Three mechanisms of Chylous Ascites
A. exudation of chyle from dilated lymphatics on the wall of
thebowel and in the mesentery caused by obstruction of
lymphatic vessels at the base of the mesentery or the cisterna
chili
B. direct leakage of chyle through a lymphoperitoneal fistula
(e.g., those that develop as a result of trauma or surgery)
C. exudation of chyle through the wall of dilated
retroperitoneal lymphatic vessels
D. All of the above
53. There are four cell types which originate in the crypts of
the small bowel mucosa. Which one of these cell types
completes differentiation in the crypt instead of during
migration to the villus?
D. Paneth cell
54. The first hormone discovered in the human body was
B. Secretin
55. The digestion of proteins in healthy individuals is initiated
by
A. Pepsin
56. Which of the following is an excitatory transmitter for
small bowel motility?
D. Acetylcholine
57. Which of the following is the origin of the epithelium of
the small bowel?
C. Endoderm

58. Which of the following factors is associated with poor
spontaneous enterocutaneous fistulae closure rate?
A. Radiation
59. Which of the following findings is virtually pathognomic
for Crohn’s disease?
C. Fat wrapping
60. Which of the following is NOT associated with successful
weaning of TPN in patients with short bowel syndrome?
D. Age >30 years
61. Diverticulum with only mucosa & submucosa – False
diverticulum
72. Risk factor for Crohn’s disease
D. Smoking
73. True about appendicitis in young, except
A. Diagnosis of acute appendicitis is easier in young than in
adult
ESOPHAGUS, STOMACH, COLON, RECTUM, ANUS
1. Pharyngeal sphincters except: LES
2. Not included in swallowing: movement of tongue forward
3. PPI - peptic ulcer Western countries smoking - true

62. Function of somatostatin: 4. Intrinsic factor secretion - oxyntic/parietal cells

A. inhibit splanchnic perfusion
63. Most probable etiology of patient who developed acute
abdomen after endoscopy:
● iatrogenic/perforation
● occult bleeding d/t inc. pressure(?)
● electrolyte imbalance
64. Location of the base of the appendix - Longitudinally
oriented taenia coli to confluence of the cecum
65. Fowler-Weir Incision - Medial extension of incision with
division of anterior and posterior rectus sheath
66. Nasogastric tube - is connected to suction to facilitate
gastric decompression
5. True of the esophagus, except: esophagus has serosa
6. Esophagoscopy -dx for any pt. complaining of dysphagia
7. Imaging for structural esophageal defects - barium swallow
8. Esophageal cancer generally presents with:
c. dysphagia
9. Part of the pharyngeal cylinder except
a. LES
10. Pressure in hypophaynx rises abruptly at least 60mmHg
due to, except:
a. forward movement of tongue

67. Patient went to the hospital with diffuse periumbilical 11. Swallowing, except: opening of the nasopharynx
pain and voluntary guarding. Patient had history of
respiratory complaint two weeks prior 12. Function of normal esophageal constrictions:
B. Observe first at ED a. hold up swallowed foreign objects

68. Jejunum resection is better than ileum because - Vitamin 13. CASE (about sleeve resection of the esophagus): the
B12 is absorbed in the ileum pressure waves begins distally below the cut as it dies out at
the proximal end above the cut.
69. Which of the following distinguishes jejunum from ileum?
A. Larger diameter 14. Cork-like appearance: due to helical arrangement of the
B. Thicker wall circular muscles
D. AOTA
15. Physiologic reflux: patient is awake and in the upright
70. Diverticulum with both mucosa & submucosa. position
A. True diverticulum
B. False diverticulum 16. Goal of antireflux surgery: safely create antireflux valve
D. AOTA at the gastroesophageal junction , while preserving the
patients ability to swallow normally and to belch to relieve
71. Mutation in the NOD2 gene is associated with an gaseous distension
increased risk of
A. Crohn’s disease 17. Minimally invasive procedure: Esophagectomy
18. Feelings of food getting stuck: Transport Dysphagia
19. Manometric characteristic of Achalasia: incomplete LES
relaxation
20. Treatment for GERD: PPI
21. CASE: patient awaken at night by pain, which of the
following is true of his condition: Bacterial Colonization +
increased bicarbonate secretion leading to inflammation
FUSED EVALS
1. Absolute indication for cholecystectomy? PORCELAIN
GALLBLADDER
2. Is it possible to resect the head of the pancreas without
devascularizing the duodenum? FALSE
3. Indication of higher likelihood of spontaneous recovery in
acute liver failure? HYPOPHOSPHATEMIA
4.Gallstones in ultrasound? ACOUSTIC DENSE SHADOWS
5. The most common causative agent of OPSS? S.
PNEUMONIAE
6.The most common cause of pyogenic liver abscess? E. COLI
7. The most common location of pain in biliary colic?
EPIGASTRIUM
8. The location of VIPoma? TAIL OF PANCREAS
9. Gallstones imaging modality? ULTRASOUND
10. All are retroperitoneal organs, except? TRANSVERSE
COLON
11.The differential diagnosis for right sided abdominal pain,
except? SPLENIC ABSCESS (left upper quadrant)
12. Triad of rheumatoid arthritis, splenomegaly and
neutropenia? FELTY’S SYNDROME
13. Increase of indirect bilirubin? RESORPTION
LARGEHEMATOMA
14. One component of gallstones? LECITHIN
15. Indication for OPEN SPLENECTOMY? TRAUMATIC SPLENIC
RUPTURE
16. Dreadful complication of post splenectomy? PULMONARY
HYPERTENSION
17. Most common anomaly of spleen? ACCESSORY SPLEEN
18. Apron like structure? GREATER OMENTUM
19. First part of duodenum? EPIGASTRIUM
20. Common symptom of generalized peritonitis? ANXIOUS
FACE
21. Falciform ligament? SUBPHRENIC
22. Falciform ligament divides? SEGMENT III AND IV
23. Middle portion of ascending colon? RIGHT FLANK
24. Upon PE, mass lesion was mobile only from patient’s
RIGHT TO LEFT or LEFT TO RIGHT? TILLAUX’S SIGN –
MESENTERIC CYSTS
25. Semisynthetic ergot alkaloid for treatment of migraine,
causing retroperitoneal fibrosis? METHYSERGIDE
26. Usually identified with physical exam alone? DIASTASIS
RECTI
27. Gold standard for elective splenectomy with normal sized
spleen? LAPAROSCOPIC SPLENECTOMY
28. Hodgkin’s dse on both diaphragm, but limited to lymph
nodes, spleen, and waldeyer’s ring? STAGE III
29. Most important intervention in early management of
acute pancreatitis is fluid resuscitation with balanced
crystalloid. LACTATED RINGER’S SOL’N
30. Gold standard for diagnosis and staging of chronic
pancreatitis? ERCP
OF 31. Bile acids are conjugated to what amino acids before
secretion to bile? GLYCINE OR TAURINE
32. Hepatic cells that provides primary defense against
lipopolysaccharide? KUPFFER CELLS
33. Most specific for liver dse? ALT (3x nag ulit)
34. MELD score is calculated using? BILIRUBIN, CREATININE,
INR
35. Portal hypertension? SPLENIC PRESSURE >15 mmhg
36. Mass in liver with central scar on CT scan? FOCAL
NODULAR HYPERPLASIA
37. Consumption of large amounts will decrease pH of bile?
PROTEINS
38. Primary mediator of gallbladder contraction? CCK
(CHOLECYSTOKININ)
39. Highest concentration of pancreatic polypeptide (PP)?
HEAD OF PANCREAS
40. Secreted in active form in pancreas? AMYLASE
41. Primary function of spleen? HOST DEFENSE
42. Transposition b/w bcr gene on chromosome 9 and able
gene on chromosome 22 is the hallmark of? CHRONIC
MYELOID LEUKEMIA
43. Patient undergoing elective splenectomy should receive
vaccination against S. pneumonia, H. influenza type B, and
meningococcus? AT LEAST 2 WEEKS BEFORE SURGERY (2-4
weeks)
44. Most common early complication of open splenectomy?
ATELACTASIS
45. Inguinal ligament is the inferior most part of? EXTERNAL
OBLIQUE
46. Best treatment for diastasis recti? OBSERVATION
47. Tenders mass remains unchanged with contraction of
rectus muscles? HEMATOMA (Fothergill’s sign)
48. Most common risk factor for gallbladder
CHOLELITHIASIS
49. Asia something, most common cause of HCC? HEPA B
50. True of gallbladder? LACKS MUSCULARIS MUCOSA AND
SUBMUCOSA
51. Gallbladder contraction, except? SYMPHATHETIC
STIMULATION (relaxationdapat)
52. Severe intermittent watery diarrhea leading to
dehydration and weakness from fluid and electrolyte losses?
VIPoma or WHDA? (UNSA TAMA? ANA SI DOC ISA LANG
DAW DAPAT ANG ANSWER)
53. Vaccine prior to splenectomy against? ENCAPSULATED
PATHOGEN
54. Vaccine for splenectomy? BOTH A AND B (at least 2
weeks before surgery and if removed emergently given
ASAP after surgery)
55. For patients undergoing splenectomy with concomitant
thrombocytopenia? TRANSFUSE INTRA OP, AFTER LIGATION
OF SPLENIC ARTERY
56. Most common cause of splenic cyst worldwide?
PARASITIC CYST (ECHINOCOCCUS SPP.)
PRELIM EXAM
1. True about esophagus except: -ans. The uppermost
narrowing is located at the entrance into the esophagus and
is caused by the sternocleidomastoid muscle
2. Innervation of esophagus
A. Parasympathetic innervation of the esophagus is provided
mainly by vagus
B. The cricopharyngeal sphincter and cervical portion of
esophagus receive branches from recurrent laryngeal nerve C.
Recurrent laryngeal nerve originate from vagus nerve
D. AOTA- ans
3. The following statements are true regarding oesophageal
carcinoma.
a. Resection for cure of carcinoma of the esophagus of an 82
year old patient is rarely indicated
b. FEV of <1.25 is a good candidate for thoracotomy (poor
candidate)
c. In patients with poor pulmonary reserve, the transhiatal
esophagectomy should be considered
CA? d. A and C
e. A,B and C
4. Curative resection for metastatic esophageal ca and locally
invasive ca. It is also indicated for tracheoesophageal fistula.
Answer- both are wrong (should be palliative)
5. True of Esophagus, except:
a) Barium enema for anatomy and motility....
B) hiatal hernia best in supine...
C) radiologic xray not complete if without stomach and
duodenum included....
D) Upper gastric endoscopy for mucosa and biopsy.... E) G
6. Gold standard for GER. Answer: 24 hour pH monitoring
7. achalasia in manometry:
c. incomplete relaxation of LES (ANS)
8. True about Barret's Esophagus
A. Specialized, intestinal epithelium is the only tissue
predisposed to malignancy
B. Diagnosis limited to 3cm to distal
D. AOTA ANSWER
9. Esophageal cancer common metastasis?-lungs
10. 35 y.o male with dysphagia, recurrent vomiting,
respiratory infections, positive regurgitation of undigested
bland material. What’s the diagnosis?
c. zenkers diverticulum-ans
11. True of diaphragmatic hernia? AOTA(type I, II, III as
described in the book)
12. A normal person can have occasional GERD -- Ans: true
13. GERD treatment include: A. PPI (answer
14. True of vascular supply of the stomach:
B. At least 2 of 4 gastric arteries may be occluded-ans
15. in modified johnson class, which can have normal gastric
secretion
ans. 1and 4 (Normal or Decrease gastric secretion) 2 and 3
(Normal or Increase gastric secretion)
16. The ff situation/s require/s UGIE when presenting with
PUD s/sx 1. Age >45 years old (true) 2. Age <45 with
significant wt loss (true) 3. Intractable sx 4. With H. Pylori
infxn (false)
Ans. A. Only 1, 2, 3 are correct
17. associated with MEN-1: A.pituitary B.parathyroid
C.gastrinoma D.adrenal tumor E. ABC-ans
18. The following predisposes one to gastric adenocarcinoma
d. Frequent intake of preserved food-ans
19. causes gastric acid release
A. Acetylcholine B. Gastrin C. Histamine D. Eating fresh candy
E. 1234 (aota) is correct-ans
20. Tumors in the lesser and greater curvature - celiac nodal
basin
21. Distal greater curvature lymph drainage: right
gastroepiploic nodes
22. The medial half of the stomach corpus - nodes along the
left gastric and celiac axis
23. The lesser curvature side of the antrum- usually drains to
the right gastric and pyloric nodes
24. True on mucosal defenses: A. Hydrogen back diffusion B.
PG, NO and Histamines are mediators of mucosal defense
25. Increased levels of Leptin produced in stomach chief cells
causes fullness – True
26. Chronic use of PPI to treat peptic ulcer can cause
carcinoid tumor of stomach - true
27. CT and MRI, used for staging gastric tumors. True
28. CT scan and MRI are both used in staging gastric cancer -
ANS: True
29. True or False UGIS is better than CT scan in detecting the
location and size of hiatal hernia
30. True of mucus secreting cells.. All of the above
31. 50 y.o male sales executive is complaining of burning
epigastric pain after food intake assoc. With pallor and
nausea. True to this pts.
A. Common complication of disease identity in this pt is
bleeding (true) B. Do not need endoscopy and biopsy C. 70-
90% is caused by H. Pylori (True)
32. Pathogenesis of ulcer: A. ...H.pylori B. ....NSAID C.
....increase Acid secretion D. AOTA-ans
33. 65yo male admitted due to progressive weight loss, pallor
and burning epigastric pain that awakens him during sleep.
The ff are true.
A. Smoking and nsaid use are not predisposing factors (false)
B. Caused by inc. Gastroduodenal prostaglandin production
and pacreaticoduodenal bicarbonate production (false) C.
D. Aota E.Nota So either C or E lang ito-ans
34. 47. 65 y/o male presenting with weight loss, early satiety,
abdominal pain and positive FOBT. Upper GI endoscopy
revealed mass on cardia. Which is not true?
A. Most probably adenocarcinoma (true) B. Diet high in
nitrates, salt and fat (true)
C. D. Surgical resection with no lymphadenectomy (with
lymphadenectomy)-ans
35. About gastric lymphoma.
A. Usually caused by h.pylori
36. isolated esophageal varices – occur in the absence of
esophageal varices, usually associated with portal
hypertension and splenic vein thrombosis
37. Menetrier's Disease- giant gastric fold
38. Watermelon stomach- parallel red stripes..
39. dieulafoy's tortuous vessels
40. Mallory weis tear-longitudinal tear
41. Which is true
A. Appendicitis rupture is common in less than 5
42. . Midline incision that extends.. Separates ant and post
rectus A. Fowler
43. true about carcinoid:
A. at tip of appendix
44. Which of the following is true about lymphoma in the
appendix? B)Lymphoma confined to the appendix can be
treated by appendectomy alone. (Ans)
45. immunoglobulin secreted by appendix – IgA
46. the tip of the appendix is located in the ff, EXCEPT: B.
Subpancreatic-ans
47. The following is/are false regarding appendicitis except
b. Ellipsoidal infarcts develop in the antimesenteric border -
ans
c. Luminal capacity of the normal appendix is only 0.5 mL
(0.1mL – 9th edition) d. All of the above e. None of the above
48. Most common causes of appendicitis Ans: E. Coli and
B.fragilis-ans
49. True in perforated appendicitis except
A. Uncommon in less than 5 y.o.(common)- most probably
ito ang answer
50. The recommended treatment for all patients with
adenocarcinoma of the appendix.
Ans: formal right hemicolectomy
51. True of pseudomyxoma peritonei A. Rare condition B. Ct
scan preferred modality C. D. All of the above (ans)
52. arrowhead sign Ans-CT SCAN
53. Which of the following is true of the small intestine?
A. Largest organ of the immune and endocrine system B.
Tubular structure from pylorus to cecum C. Length of 4-6m D.
All of the above
54. er pilot left abdominal mass, direct rebound tenderness,
fever and pain. – a. complicated disease b. hechley's 1&2 c.
3&4 d. a and b e. b and c A and C dapat answer
55. True about developmental rotation of intestine)
D. duodenum is in retroperitonium-)
56. incidence of appendicitis except Lifetime rate of
appendectomy is greater in Males (tama gud ang males) So
check nalang sa other choices (murag katong 20 out of
10,000 ata tong except diri kay dapat 15 out of 10,000)
57. call center agent has colicky abdominal pain, distention....
midline incision... true for his condition, except:
answer: gas and fluid accumulation causes intraluminal
pressure to decrease
58. 32 y/o female consulted for abdominal pain... One of the
differential diagnosis is Crohn's disease. The following is
correct about this disease:
a. ...continuous from mouth to anus (true)-ans
59. Treatment of enterocutaneous fistula
b. Fluid and electrolyte resuscitation. Nutrition is provided,
usually through the parenteral route-ans
60. Case: exlap (something like with post op ileus) which is
true of the ff.
a. Caused by surgical stress and anesthesia-ans
61. 2 year old with lower abdominal bleed. Dx of meckels
diverticulum:
A. Bleeding cause of ectopic gastric div-ans B.
62. true for large intestine:
a. 90% of water is absorbed
c. oxygen and methane are produced
e. a & c - ans.
63. A 70-yr old pt came to the er d/t pallor, dizziness and
melena... diaphoretic...vs: bp=80/50,cr=110bpm,rr=22cpm.
What is the initial mgt?
D. large bore iv and ivf infusion (answer..nasa algorithm) -
64. true about cause of diverticular disease
A. The lack of dietary fiber results in smaller stool volume,
requiring hign intraluminal pressure and high colonic wall
tension for propulsion
65. not premalignat, melanin spots in the lips ans.
hamartomatous polyp
65. 29 year old with change in bowel habits. Colonoscopy
done, revealed multiple polyps. Which is true?
A. Cancer at age 50
B. Total colectomy and ileorectal anastomosis should be
done.
C. Mutations in APC at chromosome 5q
D. A, B and C
66. 90% obstruction in rectum. Invaded peri-anal tissues.
a. T stage predicts nodal metastasis
67. True about hemorrhoids. Answer: A. Part of continence
mechanics
68. Complication of abscess- fistula in ano
69. A 23 y.o. Transgender
a. Proctitis
b. N. Gonorrhoea is most common cause
c. Sexually transmitted
d. Aota -ans
70. What is true about congenital megacolon?
A. Failure of neutral Crest cells to migrate to distal large
intestine
71. misdiagnosis of appendicitis in children
a-c meckel, uti, adenitis
d. all of the above (ans)
72. True about intestinal duplication
a. duplications represents intestinal mucosa in continuity
with the GIT-ans
SUPPLEMENT
>Widest portion in terms of diameter-cecum
>Arc of Riolan-aka meandering mesenteric
artery,provides blood to left side of Colon,basically
connects SMA to IMA
>all retroperitoneal except ceum
(ascending,descending colon,post surfaces of the
flexures)
>Rectum-relies mostly on externa pressure to empty
>Anus-normally relaxed @ rest
>Colon-absorbs H20,Na & Cl
>defacation-rectal distention allows relaxation of the
internal sphincter,Rectal contents are felt @
Transition
zone, Voluntary In intraabdominal pressure
>psuedomembranous colitis DOC-Metronidazole
>Amoeboma found mostly in-Cecum
>Aborectal abcess w/ an external sign of
inflammation-perianal,ischirectal
>Anorectal abscesses-Tx by immediate
drainage,Antibiotics are NOT needed
>Mainstay of TX of Necrotizing fasciitis-Immediate
debridement
>Chronic outcome of anorectal abcess-Fistula in ano
>Chron's-anywhere of GIT,transmural
>UC-Rectum
>Both-Premalignant
>Volvulus-Plain Xray "OMEGA SIGN"
>Diverticular dses of the colon-Most commin in the
CECUM
>Hemorrhoids-dx by anoscopy,typical symptoms are
bleeding and prolapse
>Anal fissure-greater than 90% in the POST
midline,Medical mgmt is the INITIAL
tx,sphincterotomy yields
>90% success rate
>adenomatous polyp w/ highest malignant potential-
Villous
>Carcinoid does not beling in the histologic
classification of polyps
>syndrome of multiple hamartomatous polyps in the
colon,mucosal pigmentatio,alopecia and nail atrophy-
Cronkhite-Canada syndrome
>FAP-Premalignant,>200 hyperplastic polypls in the
colon,Autosomal dominant
>Sporadic colon ca-80%
>Early signs of Colon/rectal CA-Change in bowle
habilts,Bleeding,Tenesmus (NOT WT LOSS)
>Treated as a skin malignancy-Anal Margin Tumors
>Hepatoduodenal Ligament,The CBD is located
ANTERIOR to the PV-TRUE
>The true division of the liver into R&L lobes is in line
with the line where the fossa for the IVC posteriorly
&GB posteriorly-TRUE
>The hepatic artery provides 80% of the Blood to the
liver-FALSE
>A reduciton of Serum ALB is one of the most
accurate reflections of the extent of the liver disease-
TRUE
>Most common antecedednt cause of pyogenic liver
abcess is hepatic trauma-TRUE
>Hemangioma-most common nodule of the liver
>Hepatocellular CA is detected later
>Pringle Maneuver-Ligation of the hepatic arteries
>Charcot's Triad-Jaundice,Fever, R Abdominal pain
>Most Ideal.preferred TX of Acute calculous
cholecystitis-Early Laparoscopic cholecystectomy
>Bacterial infection-BROWN pigment stone
>Condition that distends the GB w/ mucous- Hydrops
of the Bladder
>Billiary tract obs-ALP high,Direct Bil is elev,PT is
prolonged
>CBD and Pancreatic duct unite @? Ampulla of Vater
>Gallbladder is located @W/c segments of the
bladder-4&5
>Pancres divisum-failure of fusion of the 2 primordial
ductal system,recognized in 10% of the pxx,rare
cause
of idiopathic pancreatitis
>Annular pancreas-Failure of normal CLOCKwise
rotation of VENTRAL pancrea,cause of duodnal
obstruction in CHILDREN,excision is done to relieve
pancreatitis or obstruction
>Pancreas-Retroperitoneal,located in the 2nd protion
of the duodenum,20 cm length
>EXOcrine Pancreas-Acini,Ducts
>Alcohol induced pancreatitis-Inc ductal
permability,Ductal
obstruction,HypERtruglyceridemia,02-derived
free radicals
>Suggestive of pancreatitis in a plain film-Sentinel
Loop,Colon Cut-off,Widened C-loop
>Exocrine pancreatic malignancies-Common among
blacks,smokers and linked to DM
>Exocrine pancreatic malignancies-Common among
blacks,smokers and linked to DM
>Somatosiatinomas present-
Hyperglycemia,Steatorrhea,Gallsstone formation
>ZES-Gastrin is the majo hormone secreted by the
tumor,Clinically presents as INTRACTABLE peptic
ulcers,50% chance that the tumor is malignant
>Early characteristic changes by ERCP in Chronic
Pancreatitis-DUCTAL DILATION
>Uncinate process is NOT part of the neck
>Beta cells produce insulin and compose about 25%
of the Islet bulk
>Turner's sign-Bluish discoloration of the right flank
following SEVERE acute pancreatitis
>Initial presnce of Jaundice in acute pancreatitis-
suggests biliary etiology
>Most impt medical management of acute
pancreatitis- Inhibition of EZ secretion
>Presnce of pancreatic calcifications on plain
abdominal Xray is almost always indicative/specific for
CHRONIC pancreatitis
>The most common histologic typ of pancreatic
malignancy - Duct cell adennocarcinoma
>Pathognomonic finfing of chronic pancreatits during
ERCP- Chain of lakes pancreatogram
>Diabetic patien presents w/ persistent abdominal
pain is diagnostoc of CHRONIC pancreatitis
>The most common cause of CHRONIC pancreatitis-
ALCOHOL ABUSE
>Redpulp-Dynamic filter of the sleen
>Infectious mononucleosis-Spontaneous rupture
>OPSS- ENCAPSULATED BACTERIA!!!
>Resultant inc in AP dimention during insp greated
@RIBS 5-7
MIDTERM
PANCREAS, SPLEEN, GALLBLADDER, AND
EXTRAHEPATIC BILIARY SYSTEM
1. It is possible to resect the head of the pancreas
without devascularizing the duodenum
Ans. False
2. dreadful complication of post splenectomy -C.
Pulmonary hypertension
3. 2. Patient presenting with 2.2cm pancreatic mass
without involvement of SMA and SMA-
B. Stage 1b
4. Lymphoma can affect the pancreas.primary
involvement of the pancreas with no disease outside
the pancrease also occur. The ff are done except:
C.resection is done
5. The classical clinical syndrome of this panceatic
endocrine neoplasm consists of severe intermittent
watery diarrhea leading to dehydration and weakness
from fluid and electrolyte losses. –
D. VIPoma
6. Pancreatic juice surrounded by early granulation
tissue, 3-4 weeks post acute pancreatitis
A. acute pseudocyst
7. Intrapancreatic complication of pseudocyst except
D. Ductal obstruction
8. Ranson's criteria for acute gallstone pancreatitis
during the initial 48 hrs:
C. Serum Calcium, Base Deficit, BUN - ANSWER
9. the following are benign tumors EXCEPT?
d intraductal mucinous papillary tumor (ANS)
10. If the cause of abcess is infection, drainage is
indicated. T or F. ..symptomatic ang patient s case.
11. If pseudocyst failed to resolve after conservative
therapy, and symptoms persist, external drainage is
preferred than internal drainage to avoid developing
pancreaticocutaneous fistula. -False
12. Tissue diagnosis of pancreaticoduodenal is not
essential, complications include hemorrhage, etc- true
13. Periampullary cancer includes tumors arising from
the distal bile duct, duodenal mucosa, or adjacent to
the ampulla. True
14. Mechanisms by which ethanol causes acute
pancreatitis except:
D. Increase in protein content of panc juice, bicarb, &
trypsin inh conc
20. To diagnose acute pancreatitis abdominal pain (with
radiation to back) & elevated amylase/lipase (>3) is
needed. T or F- true
21. True about the histology & physiology of pancreas
except:
20% of normal pancreas is required to prevent
insufficiency(diabetes mellitus)
22. True if insulin:
B. inhibit hepatic glucose production
C. protein synthesis
E. B and c
23. Exocrine function of pancreas
A. Bicarbonate in greater amount something
B. Sodium and potassium is independent of something
C. Chloride is inversely proportional with bicarbonate
Ans. AOTA
24. Patient 45 yo, male presented with epigastric pain
that radiates to the mid back and increased serum
amylase 3 times the normal. What is true?
B. Contrast CT scan is not needed
C. There is no significant correlation between the
magnitude of serum amylase elevation and severity of
pancreatitis
E. B and C
25. On admission, wbc of 20, ldh of 500. After 48hrs,
Bun of 10, base deficit of 6, arterial po2 of 40, calcium
of 2. A boy asks about his father's condition, what will
you tell him?
A. His father has 50-50& chance of living
B. His father needs dialysis
D. A&B
26. true about blood supply of spleen
d. splenic vein joins the superior mesenteric artery to
form the portal vein
27. Basic requirement for vaccine before surgery malaise and low grade fever. What is true about the
B. against encapsulated pathogen patient?

28. dreadful complication of post splenectomy A. History of post op vaccine should be ascertained
C. Pulmonary hypertesion B. Readmit the px
D. A&B
29. female with LUQ pain, UTZ showed splenomegaly
with encapsulated fluid filled mass. the possible 40. Predisposing factors of asplenic patients to
mechanism are the ff except: D. malignancy infections EXCEPT
E. None of the above See page 1445
30. Most common anatomic variant of the spleen-
accessory spleen 48. 6 year old boy undergone splenectomy due to
trauma. Post op considerations except:
31. Hodgkins disease staging Ans - Stage 3 involves C. Booster dose in elevated antibody titres
disease in both sides of the diaphragm
49. Triad of Rheumatoid Arthritis, Splenomegaly and
32. True of Gaucher's Disease: Neutropenia:
A. deficiency in activity of lysosomal hydrolase A. Felty's syndrome
B. Abnormal glycolipid storage results to splenomegaly
C. hypersplenism results of excessive sequestration of 50. Most common type of splenic cyst? Echinococcus
blood elements in the spleen. cyst - ANS
D. splenectomy alleviates...
51. A 30-year old female was referred for splenectomy
E. AOTA
by her haematologist. The following are possible
reasons for this surgical referral except?
33. Possible complications of splenectomy except
E. NOTA (ans)
D. None of the above
52. A 35 y/o female; splenectomized due to blunt
34. The most common causative agent of OPSS
trauma; given adequate blood resuscitation. The
b. S.pneumonia
following can be seen in PBS except:
35. True of vaccination for patients who will undergo
C.Thrombocytopenia
splenectomy.
A. They should be vaccinated at least 2 weeks prior to
53. Thalassemia, splenectomy indications, except:
surgery
E.NOTA
B. In cases of immediate urgent spleen removal, give
vaccine immediately post-op
55. Intrapancreatic complication of pseudocyst:
E. A & B only See page 1439
D. ductal obstrction
36. For patients undergoing splenectomy with
56. True of Gaucher's Disease: a. deficiency in activity of
concomitant thrombocytopenia
lysosomal hydrolase b. Abnormal gylolipid storage
D. Transfuse intra op after ligation of splenic artery
results to splenomegaly c. hypersplenism results of
excessive sequestration of blood elements in the
37. . Most common indication for OS:
spleen. d. splenectomy alleviates... D. ALL OF THE
C. Traumatic splenic rupture
ABOVE (answer)
38. The common cause of inadvertent intra-operative
57. Lymphoma can affect the pancreas.primary
splenic injury
involvement of the pancreas with no disease outside
C.Improper traction of the spleen
the pancreas also occur. The ff are done except
C.resection is done
39. The above patient was discharged 7 days post op. 5
days after discharge, she presented at the ER with body
58. Therefore, it is possible to resect the head of the
pancreas without devascularizing the duodenum: False
59. Primary tumor of the Spleen- Ans. SARCOMA
60. The following are primary benign tumors of the
pancreas.
C. Intraductal mucinous papillary tumor
61. Predisposing factors to development of gallstones.
Except?
c. Terminal ileum resection
62. Classical syndrome assoviated with this pancreatic
neoplasm consists of severe intermittent diarrhea
leading to dehydration, weakness from fluid and elec
losses.
VIPOMA
63. 45 yo male, epigastric pain radiating to midback,
increased serum amylase 3x normal
B. CT not needed
C. no significant correlation between the magnitude of
serum amylase elevation and severity of pancreatitis
E. B and C
65. which of the ff functions to store and regulate the
flow of bile a. gallbladder b. bile duct c. splinter of oddi
d. all
66. Although percutaneous ct biopsy is safe,
complications such as hemorrhage, pancreatitis abscess,
and usually seeding of tumor in the subcutaneous layer
of needle is common.
A. True
67. Ranson's criteria for acute gallstone pancreatitis
during the initial 48 hrs:
C. Serum Calcium, Base Deficit, BUN
68. True of ana and histo of pancreas except. B. At least
20% of normal pancreas to prevent pt become
diabetic- ans?
69. Indication for cholecystectomy: porcelain
gallbladder
70. Amount of bile produced: 500- 1000
71. Pancretic Head Tumor.. indication of Resection,
except: None of the above- answer
72. Postsplenectomy vaccination –
elective splenectomy, patients should be vaccinated
2weeks prior to surgery
73. Diff bet charcot's triad and reynold's pentad: septic
shock, sensorial changes
74. Exocrine function of pancreas A. Bicarbonate in
greater amount something
B. Sodium and potassium is independent of something
C. Chloride is inversely proportional with bicarbonate
D. AOTA -answer
75. True or false . The diagnosis of acute pancreatitis
includes epigastric pain (that radiates to the back) and
elevated serum amylase 3x of normal level- TRUE
76. Patient presenting with 2.2cm pancreatic mass
without involvement of SMA and SMA. Stage. A. Stage
1a B. Stage 1b - ans C. Stage 2a
77. True about sphincter of oddi...except? D. Passive
conduit in the mechanical flow of bile
78. Immunologic functions of spleen, except:
B. Site of initiation of T&B lymphocyte activities
ABDOMINAL WALL & ACUTE ABDOMEN
1. Extension and flexion of leg against resistance.
Ans. Iliopsoas maneuver
2. Pneumoperitoneum EXCEPT: pancreatitis
3. 1st line treatment for hypotension: DOPAMINE
4. a 25 y/o female came in the ER because of Left
shoulder pain pallor dizziness. She recalled missed
menstrual period last month. On PE, tenderness of
lower quadrants of abdomen, pain on Left shoulder is
due to?
B irritation of diaphragm secondary to
hemoperitoneum...
6. Key features in evaluating px with acute abdomen
except: E. None
7. Treatment goals for Patients with Sepsis includes the
following, except:
D. Initiation of resuscitation only upon ICU admission
8. A 78 year old male, diabetic, smoker, presented to
the ER due to abdominal pain. His abdomen was soft
and non-tender. The admitting physician stated that the
abdominal pain is disproportionate to the physical
findings. The most likely diagnosis is:
B. Acute Mesenteric Vascular Ischemia
9. Fluid of choice in resuscitation of pts with sepsis
B. Crystalloids
10. Treatment for ruptured appendicitis?
A. order to be given antibiotic
C. Healing by secondary intention
E. A and C
11. Masks s/sx of acute abdomen except
D. Gender
12. 22 yr old female with left shoulder pain, fever, with
abdominal tenderness on lower quadrants. What is the
probable cause for left shoulder pain?
B. Irritation of diaphragm due to hemoperitoneum
13. Diagnostic Tests for Acute Abdomen except: MRI
14. Parietal pain except
A. Poorly localized
LIVER & GALLBLADDER
1. The liver is closely separated into right and left lobes
by the plane from the gallbladder fossa to the inferior
vena cava known as cantlie's line TRUE
2. Portal vein supplies 75-80% of unoxygenated blood to
the liver TRUE
3. Ascending infection mc cx pyogenic liver abscess..
TRUE
4. Hepatocellular carcinoma is the most common
primary liver cancer. TRUE
5. Hepatocellular carcinoma is diagnosed in early stage
FALSE
6. In the hepatoduodenal ligament, the common bile
duct lies lateral to the proper hepatic artery. -- TRUE
7. Sgpt/alt is more specific for liver disease than
sgot/ast. – TRUE
8. Elevated alkaline phosphatase indicates biliary
obstruction- TRUE
9) in obstructive jaundice, lack of bile in small intestine
causes an increase in PT time- TRUE
10.) Most common organism isolated in Pyogenic Liver
Abcess: E. Coli TRUE
15. Congenital hepatic cysts contain clear, nonbillous
fluid associated with high cystic pressure- TRUE
16) Klatskin's tumor is an extrahepatic carcinoma that
manifests with painless and obstructive jaundice.- TRUE
17. FNH suburst –TRUE
18. Majority of hepatocellular carcinoma arise from a
cirrhotic liver. TRUE
19. Surgery is the mainstay tx for HCC- TRUE
20) Liver transplant may be a treatment modality in
HCC- TRUE
21. Based on asia-pacific region. esp philippines Hepa B
most common cause of hcc. Answer: TRUE
22. HCC, HBsag monitoring for 3-6months? TRUE?
23. Early arterial uptake of dye is diagnostic of hcc
irrespective of serum AFP -TRUE
25. Liver metastasis is the most common malignant
tumor of the liver. – TRUE
26. the boundaries for the triangle of calot are the
following:
b. cystic artery and common bile duct
27. TRUE about the gallbladder
E. Lacks muscularis mucosa and submucosa - ans
29. Common variation of the anatomy of the cystic duct.
EXCEPT
B. Fusiform dilatation of the CD.
30. Variation of arterial supply of gallbladder...
A. 2 cystic arteries one from right and one from left
B. 2 cystic arteries from right hepatic artery and from
common hepatic artery
C. Cystic from right hepatic artery 90% 46. Common cause of bile duct stricture: OPERATIVE
D. All of the above- ANSWER INJURY
31. Bile production 500-1000mL
48. Cholangiocarcinoma, except. C. FROM
32.) Factors for gallbladder contraction EXCEPT? HEPATOCYTES
SPLANCHNIC SYMPATHETIC STIMULATION
49. Most common manifestation of
33. What is the primary role of bile? Cholangiocarcinoma?
B. Aid in the digestion of lipids and fatty acids E. Painless Jaundice

34. Which of the following work together to store and 50. Which is the most common risk factor for
regulate the flow of bile? gallbladder carcinoma?
A. Gallbladder C. Cholelithiasis
B. Bile ducts
C. Sphincter of oddi ABSITE
D. A, B, C

35. TRUE about absorption and secretion. Liver weighs:

- 1500g
A. Gallbladder mucosa has the greatest absorptive
power per unit area of any structure in the body Which of the following laboratory tests
B. 10x fold concentrating ability is most specific for the liver?
C. Rapidly absorbs sodium, chloride and water against B. ALT
significant concentration gradient.
Which is a cause of indirect
D. AOTA hyperbilirubinemia?
D. Resorption of large hematoma
36. Gallbladder motility – CCK
Sign of recovery in patients with ALF -
37. TRUE of motor activity of gallbladder – hypophosphatemia
ANTRAL DISTENTION OF THE STOMACH CAUSES BOTH
GALLBLADDER CONTRACTION AND RELAXATION OF schistosomiasis will cause what kind of portal hypertension
THE SPHINCTER OF ODDI (p1281, 31-5)
B. presinusoidal intrahepatic
38.TRUE about sphincter of oddi, except?
D. Passive portal of bile
40y/o Male, CT = 3cm mass on the R lobe of the liver,
hypervascular on CT Arterial Phase. The mass is probably
39.all are risk factors for developing gall stones except.
D. HCC
e.none of the above
Indication for cholecystectomy for symptomatic px?
40) complications of gallstones except: Ans. Porcelain gallbladder
C) Choledocholic cyst
53 y.o male, abdominal pain x 24 hours. npo, antibiotics
41. Absolute indication. for cholecystectomy. done... cholecystectomy done...
D. Presence of porcelain gallbladder b. 1-3 days

44. Charcot's Triad vs. Reynold's Pentad:

sparing of something during whipple procedure
SEPSIS AND SENSORIAL CHANGES
B. Maintenance of hormone release

45. TRUE of cholangitis. Regarding CIRCI : Ans. hypotension

A. Presence of Obstruction and bacterial
contamination Most common cancer of the exocrine pancreas:
A. Ductal adenocarcinoma (ans)

2nd most common site for accessory spleen
B. Gastrocolic ligament
Primary function of spleen D. Host defense
Hereditary spherocytosis - ankyrin
Abnormal storage of sphingomyelin is found in:
B. Neimann-Pick
increased risk for Pulmonary hypertension after splenectomy
C) thalassemia
Which is not a retro peritoneal organ?
B. Transverse colon
Differential diagnosis for right sided abdominal pain, EXCEPT:
E. Splenic abscess***
Dermatomal or myotomal pain
Ans. Referred visceral pain
percentage risk of SSI of ruptured something - 3-12%
PREFINALS
ACUTE ABDOMINAL HEMORRHAGE
1. 52 year old px. Labs: hgb- 9%, mcv-79fl. CXR &UA-
unremarkable, Slightly high TAG, Guiac (+).
Next appropriate step?
C. Refer to colonoscopy
2. Above case is:Occult GI bleeding
3. Least differentials: Ischemic Colitis
4. Therapeutic plan: Antobiotic coverage for 7 days
5. UIGB: DIEULAFOY’S LESION
6. True of diverticular disease:
a. up to 20% bleed during lifetime and 5 % massive bleeding
b. Most bleeding comes from non-inflamed diverticula
d. a and b
7. Patho of Angioectasia except:
A. Chronic, partial and intermittent low grade obstruction......
8. Melena except: absent in lower GI Bleeding
9. Lower GI Bleeding except: Dieulafoy
10. Upper GI Bleeding: Menetrier Diease
11. True of bleeding from PUD except:
d. ¼ of the px come woth peptic ulcer will stop bleeding if
given acid suppression and nothing by mouth
12. True regarding BPUD rebleed except
d. when rebleeding occurs, appropriate resuscitative
measures should be taken including fast drip IV....
13. Indications for BPUD surgery except
d. Hemorrhage unresponsiveness to aggressive IV fluid ....
14. Early surgery for BPUD:
C. oversew, biopsy, vagotomy plus drainage procedure
15. True of esophageal variceal bleeding except
d. 17% of x who survive the initial bleed will experience
recurrent variceal hemorrhage
16. Prevention of EVB Except
B. Administration of propanolol and nadolol
17. True of EV Ligation except:
d. Surveillance EGD every 3-4 months to monitor recurrence
18. Management of EVB except
a. Shunt therapy with either surgical or TIPS
19. 73 year old px came to er with frequent light headedness
and occasional per rectal bleeding . DRE showed mixed fresh
and clotted blood. Example of?
Obscure Bleeding
RADIOLOGY
1. Patient with injury in the femur. You suspect
abdominal trauma. What test you will order:
C. Abdominal xray supine
2. Advantage of xray of the abdomen.except
D. None of the above
3. Esophagogram except:
B. Bronchi
4.) The following are solid organs except: D. None
5.) Pseudotumors can be found in:
D.)stomach
6. The loss of the outline of the psoas muscle margins in
a plain radiograph of the abdomen may be seen in
which pathological state?
A. Retroperitonial tumor
7. Widened c loop or duodenal sweep: pancreatic head 23. Commonly seen in peritonitis?
tumor -loss of properitoneal fat

8. Barium enema EXCEPT: 24. crescent shape

d. duodenum -pneumoperitoneum (cupola sign)

9. UGIS: 25. Sentinel loop LUQ

A.single contrast -Acute pancreatitis or acute pyelonephritis (either)
B.double contrast???
D. both a & b CHEST WALL, LUNG, MEDIASTINUM

10. Air fluid level in fundus 1. 13yo boy with chest wall mass, consistent w/ Ewing's
C. Upright sarcoma: ESR

11. Iv Urogram 2. Guidelines in using VATS to excise potentially

a. anatomic/structural assessment the renal collecting malignant lesions include:
system A. Should not be directly manipulated by instruments
b. physiologic assessment of the renal collecting system C. Excised nodule must be placed in a bag
c. a and b E. A and C

12. Demarcates termination of duodenum and 3. Principles of tracheal resection except

commences jejunum: ligament of treitz A. 80% is resected (up to 50% only)

13. Dependent when upright something..dli q xur sa 4. What is the most common primary tracheal
question: Fundus neoplasm: squamous cell ca/adenoid cystic carcinoma

14. Crescent shape right diaphragmatic region:
Pneumoperitoneum
15. Transverse colon displaces inferiorly and laterally
A. Liver
16. Contrast use for perforation
B. Iodine
17. Use for opacification of duodenum
B. UGIS
18. Most radiopaque C. Lumbar spine
5. Safe removal of chest tube drainage is indicated in:
B. Air leak is resolved
C. Chest tube drainage of 150ml/24hrs or less
E. B&C
6. Indication for drainage of a peri-pneumonic effusion:
ph <7.20
7. Lymphathic sump of Borie drain: All pulmonary lobes
of the corresponding lung
8. advantage of VATS over open thoracotomy:
C. Fast return to work

19. Gallstone calculi location: RUQ 9. Primary diagnostic tool for lung abscess: Chest Xray

20. Normal radioluscent, mottled: 10. Management massive hemoptysis persistent:

C. fecal material Rigid bronchoscopy with ice lavage
21. 23/F left shoulder pain, diaphoresis, lower
abdominal pain, radiograph use? 11. General principle in appropriate selection of
-AP abdominal supine patients for pulmonary metastasectomy:
A. primary tumor must already be controlled
22. What to rule out in above case? B. metastases must be resectable based on CT imaging
-Ruptured ectopic pregnancy C. patient must be able to tolerate general anesthesia
D. A, B, C
12. Most common neoplasm of the mediastinum among
patients at late 40 to 60 years old:
A. Thymoma
13. Tracheal stenosis secondary to tracheostomy is
most commonly caused by: Excess granulation tissue
around the stoma
14. Number of bronchopulmonary segments in the left
lung: 9 (right=10)
15. Occur primarily in heavy smokers and in the mid to
peripheral lung fields. They are often large with central
necrosis and a high mitotic rate: Grade 3
16. Lung cancer with chest pain: Adenocarcinoma
17. Adenocarcinoma with 100% disease-specific survival
with complete surgical resection, <5mm invasion
B. Minimally Invasive Adenocarcinoma
18. Protein lost in a patient with chylothorax whose
chest tube drains 1000ml/day: 25 - 50g
19. True of smoking except.
C. Unfiltered smoke less risk of cancer
20. Pulmonary carcinoma as incidental finding, a solitary
pulmonary nodule has a high risk of malignancy if:
A. Patient is a smoker (50% increase risk)
C. Pt is symptomatic
E. A & C
21. True of the narrowest portion of the trachea:
A. internal diameter of approximately 2 cm
B. begins at the inferior surface of the vocal cords
C. Subglottic space
D. All of the above
22. An effusion is exudative if:
A. Pleural fluid-to-serum ratio of protein is greater than
0.5
B. LDH ratio is greater than 0.6.
C. Absolute pleural LDH level is greater than two thirds
of the normal upper limit for serum.
D. All of the above
23. Normal AFP, slightly increase bHCG: seminoma
24. Tumor usually seen in those who have never
smoked: Adenocarcinoma
25. Pancoast except: pleuritic pain
26. Significant cause of bronchiectasis: nontuberculous
mycobacterial
27. The most appropriate for clinically significant
tracheal stenosis is: Resection & primary anastomosis
28. Immunohistochemical staining for neuroendocrine
markers that accurately diagnose most tumors
A. Chromogranin
B. Synaptophysin
C. CD57
D. Neuron specific Enolase
E. AOTA
29. When treating trauma victims, which thoracic
surgical approach is typically used:
D. anterolateral thoracotomy
30. Treatment priorities in massive hemoptysis:
A. Achieve respiratory stabilization and prevent
asphyxiation.
B. Localize the bleeding site.
C. Determine the cause.
D. Definitively prevent recurrence.
E. AOTA
31. Most common mediastinal mass children
B. Neurogenic tumor
32. Histology of the lung: Type I Pneumocyte 40%
epithelial but covers 95% of surface area.
33. What is the mechanism of the formation of a
tracheoesophageal fistula in mechanically ventilated
patients?
D. Cuff compression of the membranous trachea and
the nasagastric tube causes the tracheoesophageal
fistula
34. Primary indication for indwelling pearl catheter to
treat malignant pleural effusion: page682
A. Poor lung expansion
B. Purulent, foul smelling pleural fluid
C. Long life expectancy
D. Positive result of d dimer blood test
E. Presence of pleural effusion
35. A preinvasive lesion that induces a transformation
of the tracheobronchial pseudostratified epithelium to
metaplastic squamous mucosa: Squamous dysplasia
and carcinoma in situ
36. Sarcoma to respond to preoperative chemotherapy:
PNET
37. Primary treatment for oat cell carcinoma:
chemotherapy and radiation therapy
38. Case: 65 years old, smoked 2packs/day for 45 years,
have a 2cm SPN: FNA
39. Ankle, feet, forearm, and hand tenderness and
swelling are characteristic, resulting from periostitis of
the fibula, tibia, radius, metacarpals, and metatarsals:
Hypertrophic pulmonary osteoarthropathy (HPO)
40. Indications for surgical drainage procedures for lung
abscesses: Abscess under tension
41. Causes tracheal injury except:
E. Avoidance requires careful cuff management;
maintain a pressure of more than 20 mmHg is
advisable. (should be <20mmhg)
42. Tracheostomy: 2nd- 4th tracheal rings
43. N1 except: page 611
44. True of Invasive Mucinous Adenocarcinoma
C. Frequent multifocal and multilobar presentation
45. True of SCC except:
D. taas ang statement pero most probably mao ni ang
answer.. 
46. SVC syndrome except:
C. hoarseness
47. Cause of primary spontaneous pneumothorax:
rupture of apical bleb
48. True of hemoptysis:
C. bronchial artery= most common
49. Indications for urgent operative intervention for
massive hemoptysis (p.663)
B. Presence of a lung abscess
50. Major cause of pleural effusion: CHF
INTRA-ABDOMINAL INFECTIONS
1. GI Bleeding in px with long standing arthritic pains
- Drug induced gastritis
2. Massive upper GI Bleeding due to penetrating
posterior duodenal ulcer involves:
- Gastroduodenal artery
3. While ER, Px came with hematemesis. All are
questions relevant except?
- Change in bowel habits
4. The previous px is an heavy alcohol drinker. The
cause of hematemesis:
-Bleeding esophageal varices
5. Initial dx to confirm the site of bleeding in the case
- NGT insertion
6. The following can be performed in Upper GI bleeding
during endoscopy except
- Embolization
7. 80 year old px rushed to ER due to hematochezia.
Which of the ff. Actions is not warranted?
-Do an immediate proctosigmoidoscopy/colonoscopy
8. Previous barium enema of the above px done 8
months earlier showed saccular out-pouchings of the
large intestines. The likely source
- Diverticulosis
9. Vomiting of blood- hematemesis
10. Passage of blood and blood clots of varied
brightness- Hematochezia
11. Presence of exudates derived from enteric source
- Secondary peritonitis
12. Empiric therapy initiating in secondary peritonitis
AOTA
13. If with severe reaction with penicillin
-Aztreonam+ Clindamycin
14. Most common organism in Secondary Peritonitis
- Aerobic gram (-) bacilli and B. Fragilis
15. Goals of prophylactic antibiotics except
- Treat ongoing infection and avoid abscess formation

16. Most common etiologic agent for CAPD except

- Anaerobes

17. Presence of bacteria in blood culture with systemic

signs of infection
- Sepsis Syndrome

18. Multiple organ failure, first organ to fail

- Renal system

19. Least likely seen in peritoneal irritation

- diarrhea

20. Initial response to peritoneal irritation

- Adynamic ileus

21. Less irritating in peritoneal irritation

-blood

22. Presence of bacteria in blood cultures without systemic

signs of infection
- Bacteremia

23. Systemic inflammatory response syndrome

- Septicemia

24. Most common antecedent for R subhepatic abscess

- Biliary tract procedures

25. Presence of bacteria in blood cultures originating from

infectious focus with systemic host response
- Septicemia

26. True of intra andominal infections except

- Interloop abscess is best managed by percutaneous
drainage

27. Antibiotics alone are ineffective except

- Presence of capsule resulting to poor penetration

28. Not true in intra abdominal infections post-operative

- Diffuse abdominal trnderness maybe masked by incisional
pain