surgery mcqs

Q56. Endoscopic stone extraction from CBD is not possible  in all except?

a) Multiple CBD stones

b) Intrahepatic stones

c) Multiple Gallstones

d) Prior Gastrectomy

e)Duodenal diverticula

57. What is the management of choledochal cyst adherent to portal vein?

a) Excision and Roux en y hepaticojejunostomy

b)Internal drainage into roux en y jejunal limb

c) Hepatic lobectomy

d) The internal lining of the cyst can be excised, leaving the external portion of the cyst

      wall intact.

e) Marsupialization

58. The most common cystic disease of the spleen is

a) Hydatic cyst of spleen

b) Pseudo cyst of the spleen

c) Columnar lined cyst of spleen

d) Cystic lymphangioma

e) Dermoid cyst

59. OPSI is commonest in splenectomy done for

a) Thalassemia

b) Trauma

c) Hereditary Spherocytosis

d) ITP

e) Sickle cell disease

Q60. Which of the following is not true regarding wandering spleen?

a) The spleen is attached to a long vascular pedicle without the usual mesenteric  

     attachments.

b) Torsion and infarction of the spleen are common complications

c) There is congenital atresia of the dorsal mesogastrium in children

d) Splenectomy is required in all cases

e) May present as acute abdomen

61. Treatment for bleeding duodenal diverticulum is

a) Diverticulectomy

b) Diverticulopexy

c) Diverticulization

d) Subtotal diverticulectomy

e) Gastro-jejunostomy

62. Which of the following does not appear to cause early dumping

a) Serotonin

b) Bradykinin

c) Neurotensin

d) Secretin

e)Enteroglucagon

63. Which is false for GIST (Gastro intestinal stromal tumor)  of stomach

a) It is the same as leiomyoma and leomyosarcoma as described previously.

b) origin is from mucosa from the interstitial cells of Cajal

c) Associated with C-Kit Mutation

d) Imatinab is a new effective drug for adjuvant therapy

e) Detection of KIT protein distiguishes GIST from smooth muscle tumors

64. Most important investigation for Dysphagia in 60 year old is

a) Upper GI Endoscopy                 

b) CT Thorax
c) Barium meal X-ray 

d) MRI Scan

e) Laproscopy 

65. Maximum potassium concentration is seen in

a)                  Saliva

b)                  Gastric secretions

c)                  Jejunum

d)                 Bile

e)                  Colon                                            

66. Which of the following muscles do not form the posterior relation of breast?

a) Pectoralis major

b) Serratus Anterior

c) Rectus Abdominis

d) Lattismus Dorsi

e) Pectoralis minor

67. Minimum number of lymph nodes to be dissected in Axillary sampling in brest   

      conservation surgery is

a) 2

b) 3

c) 4

d) 5

e) 10

68. Which of the following is a contraindication for breast conserving surgery (BCT)?

a) Small lump to breast ratio

b) Central breast tumor mass

c) Breast Tumor size less than 5 cm

d) Young age

e) Old age

69. Which of the following is not an indication for admission in a case of burns

a) Full thickness burns more than 5% of total body surface area (TBSA)

b) Partial thickness burns more than 10% in adults

c) Partial thickness burns more than 10% in children

d) Inhalationsl burns

e) Electrical burns

70. Which is the site for escharotomies in extremities for deep burns?

a) Anterior aspect

b) Posterior Aspect of the limb

c) Medial or lateral aspect of limb

d) It can be anywhere

e)None of the above

71. The most common Vein to be involved in Extrahepatic portal hypertension in chronic pancreatitis is

a) Portal vein

b) Splenic vein

c) Superior mesenteric vein

d) Inferior mesenteric vein

e) Inferior vena cava

72. Which one is a definite urgent indication of thoracotomy:

a)Bilateral hemothorax

b)Tension pneumothorax containing more than 1.5 litres of air

c)Flail chest with more than 10 ribs fracture

d)Ahemothorax draining more than 200ml per hour

e)All of the above

73. Which one of the following is false regarding hernias:

a) Inguinal hernia is superomedial to pubic tubercle

b) Femoral hernia is inferolateral to pubic tubercle

c) Men are more likely to have inguinal hernia than females

d) Men are more likely to have femoral hernia than females

e) Inguinal hernia are more common in females

74. A lesion typically found on legs in diabetics

a) Erythema nodosum

b) Necrobiosis lipoidica

c) Erythema  ab igne

d) Pyoderma gangrenosum

e) Erythema multiforme

75. Which one of the following is incorrect regarding ulcerative colitis?

a) Smoking is protective

b) Predominantly involves large bowel

c) Can present with erythema nodosum

d) A COBBLE –STONE appearance is seen on colonoscopy

e) Acute episodes are treated by i/v steroids and azothiaprine

76.  Which ONE of the following is NOT an absorbable suture?

a) Catgut

b) polyglyconate

c) PDS (Polydioxanone)

d) Silk

e) Vicryl (Polyglactins.

77. Adequate minimum urine output in a 70kg man during resuscitation is

a)                  35 ml/hr

b)           20 ml/hr

c)                  50 ml/hr

d)                 45 ml /hr

e)                  60 ml/hr

78. Which of the following is true for basal cell carcinoma?

a)                  metastases to lymph node is rare

b)                  common at non-sun exposed area

c)                  UV light is not a cause

d)                 morpheous type is easily treated

e)                  treatment of choice is radiotherapy

79.  A 28 year old lady complains of painful defecation associated with fresh per-rectal bleed. Possible diagnosis to consider:

a)                  hiradenitis suppurativa

b)                  dermoid cyst

c)                  pilonidal sinus

d)                 anal fissure

e)                  pruritis ani

80. Haemorrhoids

a)                  are commonly believed to be venous malformation

b)                  require surgical excision if small and symptomatic

c)                  commonly present with painful bleeding and perianal swelling

d)                 may undergo malignant metaplasia in those with chronic prolapse

e)                  pruritis ani

81. The Thyroid gland:

a)         Is derived from the third and fourth pharyngeal pouches

b)         Isthmus overlies the 5th and 6th tracheal rings normally

c)         Embryologically, descends along the thyroglossal tract

d)         Is supplied by the superior thyroid branch of the internal carotid artery

e)         Is supplied by the inferior thyroid branch of the external carotid artery

82. A nodule in the thyroid gland:

a)         May be a presentation of multinodular goitre

b)         Is unlikely to be a cyst if painful

c)         Should not be investigated with needle cytology

d)         Usually requires excision

e)         Will require radio-isotope scanning to help distinguish between a benign and a malignant nodule.

83. A multinodular goitre:

a)         Is more common in patients who are iodine deficient

b)         Is not preceded by a diffuse goitre in early adult life

c)         Often becomes neoplastic

d)         May be effectively treated with thyroid hormone

e)         Always needs surgical treatment

84. Autoimmune thyroiditis (Hashimoto’s disease):

a)         Characteristically occurs in young females

b)         Always presents with hyperthyroidism

c)         Produces a nodular enlargement of the thyroid gland

d)         Is associated with regional lymph node enlargement

e)         Is associated with raised serum levels of thyroid antibodies

85. Thyroid cancer:

a)         Frequently produces multinodular enlargement of the gland

b)         May well be diagnosed by thyroid scan

c)         Causes a hard nodule in the gland

d)         Often produces a bruit over the gland

e)         Should be suspected if there is vocal cord palsy

86. Papillary carcinoma of the thyroid:

a)         May follow radiation exposure in childhood

b)         Is a rapidly-growing tumour

c)         Doesnot metastasizes to lymph nodes

d)         Is often a localized tumour

e)         Is rarely cured by surgery

87. Follicular carcinoma of the thyroid:

a)         Is more common in males

b)         Is more common below the age of 30 years

c)         Usually metastasizes to lymph nodes

d)         Is associated with a relatively good prognosis in old age

e)         Is best treated by total thyroidectomy

88. Undifferentiated (anaplastic) carcinoma of the thyroid:

a)         Is more common in females

b)         Is less common above the age of 60 years

c)         Is often thyroid stimulating hormone (TSH) dependent

d)         Often exhibits independent thyroid hormone production

e)         Is usually preceded by a long-standing goitre

89. The surgical treatment of differentiated thyroid cancer:

a)         Should be by total thyroidectomy in the potentially curable patient

b)         Should include a frozen section histological examination of the tumour

c)         Should include block dissection of the neighbouring lymph nodes, whether or not they appear to contain tumour

d)         Is most successful in anaplastic cancer

e)         Should be preceded by a therapeutic dose of I131

90. Recurrent thyroid cancer can effectively be treated by all except:

a)         High doses of I131

b)         High doses of thyroid hormone

c)         External irradiation

d)         Chemotherapy

e)         Further surgery

91. Which of the following is not true for Hashimoto thyroiditis?

a)         It is an autoimmune disease caused by CD4 cells with specificity to thyroid antigens

b)         commonly presents as hypothyroidism

c)         Surgery is required in almost all cases

d)         Hashimoto thyroiditis can progress to lymphoma of thyroid

e)         Primary treatment is thyroxine

92. In which of the following conditions anti thyroid antibody may not be elevated?

a)         Hashimoto thyroiditis

b)         Grave's disease

c)         Multinodular goitre

d)         Lymphoma of thyroid

e)         None of the above

93. What is the most common composition of renal stones?

a)         Uric acid stones

b)         struvite

c)         calcium oxalate

d)         Magnesium

e)         Xanthine

94. The most common cause of stone formation is?

a)      metabolic abnormalities

b)      urological abnormalities

c)      infection

d)     Immobilization

e)      Vitamin A deficiency

95. In the ED what is a value for defining hematuria?

a)      Any RBCs/hpf

b)      2 RBCs/hpf

c)      4 RBCs/hpf

d)     5 RBCs/hpf

e)      10RBCs/hpf

96. In the treatment of a 3 year old boy with a UTI,  the strongest indication for admission?

a)         Localized myalgias

b)         Maculopapular rash

c)         Marked fever

d)         Mucoid Diarrhea

e)         Persistent Vomiting

97. Which of the following statements regarding imaging techniques for evaluation of

      suspected kidney stones is correct?

a)         CT scanning poses risk of nephrotoxic contrast

b)         CT scanning provides little data about the adjacent intrabdominal structures

c)         Intravenous pyelogram is highly sensitive but does not provide information on renal function

d)         Plain radiography is highly specific

e)         Ultrasonography is the preferred modality for pregnant pts but might not identify stones smaller than 5mm

98. A 13 year old boy is brought to the ER for sudden onset of groin pain. On

      examination his right testicle is swollen, raised, and tender. Which of the following   

     statements regarding this pts condition is correct?

a)         CT of the affected are is the imaging study of choice

b)         Duplex ultrasonography provides little useful anatomic information

c)         Positive creamasteric reflex confirms the diagnosis

d)         Relief of pain with elevation reliably differentiates this condition from  

            epididymitis

e)         The bell clapper deformity predisposes pts to this condition

99. What is the most common symptom of localized prostate ca.?

a)         Hematuria

b)         Urinary sx’s -- frequency,nocturia

c)         Bony pain

d)         No symptoms

e)         Retention of urine

100.Which one is an absolute contraindication of suprapubic catheterization:

a)         Lower urinary tract infection

b)         Cancer of urinary bladder

c)         Bladder calculi

d)         Interstitial cystitis

e)         Palpable urinary bladder

101- About inguinal hernia, which is FALSE?

a)     deep ring is a defect in fascia transversalis

b)     cannot get above it

c)     cough impulse may be absent in large hernia

d)     mesh repair is contraindicated unless recurrence

e)     repair can be done under local anaesthesia

102. A 40 year old man presented to the A&E department with ureteric colic. Which of the following investigation is not relevant?

a)      abdominal ultrasound

b)      non-contrast CT scan

c)      intravenous urogram

d)     urine dipstick

e)      urine culture

103. Which of the following drugs should not be used in pregnancy?

a)      amoxicillin

b)      tetracycline

c)      erythromycin

d)     acyclovir

e)      zidovudine

104. Endometrioma is associated with

a)      cervical cancer

b)      vulva cancer

c)      clear cell cancer of ovary

d)     cancer of fallopian tube

e)      germ cell tumour of ovary

105. The single largest factor determining long term survival in breast cancer is:

a)      tumour size

b)      tumour grade

c)      tumour subtype

d)     nodal positivity

e)      adjuvant chemotherapy

106. What is not true about nephroblastoma?

a)      also known as Wilm’s tumour

b)      occurs in 10% of children

c)      presents as an abdominal mass

d)     more common in children before 3 years of age

e)      composed purely of epithelial elements

107. Procedure of choice to define anatomic details of calyces, pelvis and ureter is:

a)      intravenous urogram

b)      ultrasound

c)      CT scan

d)     nuclear renogram

e)      retrograde pyelography

108. Effectiveness of breast cancer screening has been shown to be most useful in the following age group

a)      < 35

b)      40 – 49

c)      50 – 64

d)     > 70

e)      All age groups

109. Management of 3cm stone in renal pelvis:

a)     PCNL

b)     ESWL

c)     conservative management

d)     open pyelolitomy

e)     double J-stenting

110. The following is associated with increased risk of breast cancer:

a)     fibroadenoma

b)     fibrocystic disease

c)     atypical duct hyperplasia

d)     ductal papilloma

e)     increase breast size