MCQs Mock Exams for General Surgery Board Exam
Mock Exam 8- 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 intraductal papilloma?
a. This lesion is the most common cause of bloody nipple discharge
b. Serous non-bloody discharge is unlikely to be due to an intraductal papilloma
c. A nonpalpable lesion can often be diagnosed with ductography
d. An isolated lesion is considered premalignant
Answer: a, c
2. Which of the following are factors associated with an increased risk for
developing breast cancer?
a. Nulliparity
b. Oophorectomy before age 35
c. Use of oral contraceptives
d. High-fat, high-caloric diet
e. Post-menopausal use of conjugated estrogens
Answer: a, d
3. Which of the following treatment(s) is/are of proven benefit in the treatment of
mastodynia associated with fibrocystic breast disease?
a. Avoidance of methylxanthine compounds, particularly caffeine
b. Cessation of smoking
c. Vitamin E
d. Danazol
Answer: a, b, d
4. Hypercortisolism:
A. Is most often ACTH-dependent, owing to an ACTH-producing pituitary adenoma.
B. Is best diagnosed by measurement of cortisol from a serum sample collected at
8 A.M.
C. Is attributable to an adrenal source if the basal serum ACTH level is above 10 pg.
per ml., if the hypercortisolism is suppressed by high-dose dexamethasone, and if
an adrenal tumor is visualized radiographically.
D. May be caused by small cell carcinoma of the lung, carcinoid tumors, tumors of
the endocrine pancreas, pheochromocytoma, or medullary thyroid carcinoma
(MTC).
E. In children is most often caused by adrenocortical neoplasia.
Answer: ADE
5. Primary aldosteronism:
A. Produces a syndrome of diastolic hypertension, hypokalemia, and edema.
B. Is suggested by findings of serum potassium less than 3.5 mEq. per liter, urinary
potassium excretion greater than 30 mEq. per day, upright plasma renin below 3
ng. per ml., and a plasma aldosterone concentration–plasma renin activity ratio
greater than 20:1.
C. Is most often due to an aldosterone-producing adrenal adenoma, which may be
distinguished from idiopathic adrenal hyperplasia by its sensitivity to diurnal
changes in ACTH and insensitivity to changes in posture.
D. May be diagnosed in hypertensive patients by demonstration of an adrenal mass
larger than 1 cm. on computed tomography alone. E. Is best treated surgically if it
is due to either aldosteronoma or idiopathic adrenal hyperplasia.
Answer: BC
6. Adrenocortical carcinoma:
A. May be suspected in a patient with rapidly progressive Cushing's syndrome and
virilizing features or in asymptomatic patients with adrenal tumors larger than 6 cm
on CT.
B. Most often is diagnosed early in its course when disease is confined to the
adrenal gland.
C. Is differentiated from benign adrenocortical adenoma by tumor necrosis,
hemorrhage, and cellular features of large hyperchromatic nuclei and more than 20
mitoses per high-power field.
D. Should be resected only if disease is localized to the adrenal gland; otherwise
treatment with mitotane is indicated. E. Carries a poor prognosis: overall 5-year
survival less than 25%.
Answer: AE
7. A 28-year-old bank employee undergoes investigation for infertility that revealed
oligospermia.
On further inquiry, it is found that he has suffered from repeated bouts of coughing
since
childhood and episodes of recurrent pancreatitis. Clubbing of the fingers is evident.
Which
test is most likely to reveal the cause of his chronic lung disease?
(A) Chest x-ray
(B) X-ray of the humerus
(C) Sweat chloride elevated to over 80 mEq/L
(D) Sweat chloride reduced to less than 50 mEq/L
(E) Aspergillus in the sputum
Answer: (C) Cystic fibrosis is the most common cause of chronic obstructive lung
disease (COLD) in children and adolescents. It is an autosomal-recessive disease
that affects widespread exocrine glands. COLD is evident in all patients who survive
childhood.
8. Which of the statement(s) is/are true concerning laparoscopic hernia repair?
a. General anesthesia is required
b. Either an abdominal or preperitoneal approach is possible
c. The use of prosthetic mesh is required in all variations
d. Long-term results suggest that the laparoscopic approach is equal or better than
traditional repairs
Answer: a, b, c
9. The following statement(s) is/are true concerning the epidemiology of inguinal
hernias.
a. Inguinal hernias occur with a male-to-female ratio of about 7:1
b. Femoral and umbilical hernias are more common in women, with a female-to-
male ratio of 4:1
c. The frequency of inguinal hernias increases with age
d. Almost all umbilical hernias occur in the pediatric age group
Answer: a, c
10. Retroperitoneal fibrosis is a fibrosing condition of retroperitoneum, which is of
significance as it generally encompasses the ureters and eventually causes
hydronephrosis and kidney damage. Which of the following statement(s) is/are true
concerning this condition?
a. The majority of cases are idiopathic in nature
b. A history of use of methysergide for treatment of migraine headaches would be
significant
c. There is no known association of malignancy with retroperitoneal fibrosis
d. The disease occurs more commonly in women than in men
Answer: a, b
11. Which of the following statements about gastric leiomyomas is/are true?
A. They are the most common type of gastric tumor of the stomach at autopsy.
B. The leiomyoblastoma cell type reflects malignant transformation of gastric
leiomyomas.
C. A conservative surgical approach is indicated for their resection since regional
lymphadenectomy has not been proved reliable even when they turn out to be
malignant.
D. Severe hemorrhage may occur from deep ulcerations overlying the intramural
tumor.
Answer: ACD
12. The sine qua non of the histologic diagnosis of a gastric pseudolymphoma is:
A. Extragastric extension of the gastric lesion.
B. Nodal involvement beyond the immediate stomach.
C. A germinal center in the gastric lesion.
D. Extension into esophagus and duodenum.
E. Unresponsive to conservative gastric resection.
Answer: C
13. All of the following statements about surgical management of gastric
lymphomas are true except:
A. Stage I gastric lymphomas (small lesions confined to the stomach wall) can be
cured completely with surgical therapy alone.
B. Extensive gastric lymphomas that initially are treated with radiation and/or
chemotherapy occasionally perforate during treatment and require secondary
resection.
C. Patients explored with a presumptive diagnosis of gastric lymphoma should
undergo an attempt at curative resection when this is safe and feasible.
D. Without a preoperative diagnosis resection for gastric mass should not be
attempted unless lymphoma can be excluded.
E. Appropriate staging for primary gastric lymphoma includes bone marrow biopsy.
Answer: D
14. Patients with established, complete, simple, distal small bowel obstruction
usually have the following findings on plain and upright abdominal radiographs:
A. Distended small bowel identifiable by the valvulae conniventes.
B. Multiple air-fluid levels.
C. Modest amount of gas in the pelvis.
D. Peripheral, rather than central, distribution of gas.
E. Prominent haustral markings.
F. Free air.
Answer: AB
15. A 43-year-old woman presents with complaints of anal pain and spotting of
blood with defecation. Physical examination reveals a 2 3 cm area of ulceration
within the anal canal. The remainder of the physical examination is normal.
Incisional biopsy is positive for squamous cell carcinoma. Appropriate management
includes which of the following?
a. Abdominoperineal resection
b. Wide local excision, skin grafting, proximal diverting colostomy
c. Primary radiation therapy
d. Local excision and primary closure
Answer: c
16. Meckel's diverticulum most commonly presents as:
A. Gastrointestinal bleeding.
B. Obstruction.
C. Diverticulitis.
D. Intermittent abdominal pain.
Answer: A
17. Three months after recovery from an operation to treat peptic ulcer disease, a
patient complains that she has difficulty eating a large meal. A 99m Tc-labeled
chicken scintigraphy test confirms a marked delay in gastric emptying. Adelay in
gastric emptying may be due to which of the following?
(A) Zollinger-Ellison syndrome (ZES)
(B) Steatorrhea
(C) Massive small-bowel resection
(D) Previous vagotomy
(E) Hiatal hernia
Answer: (D) Following truncal land selective vagotomy, gastric empyting is
delayed. If a vagotomy (truncal or selective) is performed, a drainage procedure is
necessary (e.g., pyloroplasty). A disturbance is gastric motility with a delay in
gastric emptying may occur with a mechanical gastric outlet obstruction, diabetes,
myxedema, hypokalemia, or the administration of anticholinergic or opiate drugs.
Rapid gastric empyting may be seen with ZES, retained gastric antrum syndrome,
steatorrhea, or massive smallbowel resection where there is impared ability to
reduce gastric acid secretion. Failure of switch-off mechanism to inhibit acid
secretion also results in increased motility and emptying of the stomach.
18. The patient responds to resuscitation with normalization of vital signs but
continues to bleed.He is taken to the angiography suite for further evaluation.
Which of the following is TRUE?
(A) The inferior mesenteric artery should be injected first because most diverticula
are in the sigmoid colon.
(B) Vasopressin be selectively infused into a bleeding mesentric vessel with virtually
no risk to the patient.
(C) Embolization with gel foam or autologous clots may be used to stop bleeding.
(D) Since angiography is both diagnostic and therapeutic surgery will not be
necessary.
(E) A bleeding rate of 0.1 mL/min is necessary for a positive scan.
Answer: (B) Vasopressin can be selectively infused into a bleeding mesentric
vessel. Ableeding rate of .5 per minute is necessary for a positive angiogram.
Temporary success in stopping the bleeding will not obviate the need for surgery.
The angiodysplasia of the colon is one of the most common causes of lower GI
bleeding in elderly patients. With diverticular disease, 75% of the patients will have
only a single episode of hemorrhage, whereas angiodysplasia patients are very
likely to have recurrent episodes of variable severity.
19. A 62-year-old postal officer develops minimal urinary symptoms. His PSA level
is elevated
and continues to increase during a 6-month period of observation. The next step in
evaluation,
if transrectal ultrasound (TRUS) prostate biopsy (Fig. 9–1) were positive for
adenocarcinoma
of prostate, would be:
(A) Refer to oncologist for chemotherapy
(B) Metastatic evaluation including CT and bone scans
(C) Repeat PSA and biospy
(D) Evaluation by radiation oncologist
(E) Start hormonal ablation treatment
Answer: (B) Typical workup after a positive TRUS biopsy would be evaluating the
common metastatic sites (pelvic lymph nodes and bone). CT scan of abdomen and
pelvis with and without contrast is performed to also rule out other GU
abnormalities (i.e., renal mass, renal stone, and so forth) in addition to pelvic
lymphadenopathy. Bone scan, however, is typically not indicated for PSA <20
mg/mL.
20. A 35-year-old woman is evaluated for seizure disorder, mental obtundation, and
personality change. Physical examination is normal. Fasting serum glucose is 44
mg/dL. Other serum values are normal. Subsequent investigations should include
which of the following?
a. Oral glucose tolerance test
b. Determination of fasting insulin/glucose ratios
c. Assay of serum C-peptide levels
d. Determination of serum prolactin levels
Answer: b, c
21. Which of the following statements regarding post splenectomy sepsis are true?
a. The incidence in children is generally reported as less than 5%
b. Haemophilus influenzae, Streptococcus pneumoniae and Neiseria meningitidis
are the most common causative organisms
c. Autotransplantation techniques eliminate this risk
d. The mortality rate is now approximately 50%
e. The incidence in adults in approximately 1%
Answer: a, b, d, e
22. Which of the following statement(s) are true concerning bladder carcinoma?
a. Epidemiologic studies have implicated cigarette smoking as a risk factor
b. If cystoscopy demonstrates a bladder carcinoma as the cause of painless
hematuria, no further evaluation is necessary
c. Multi-focal and recurrent bladder tumors are usually treated with transurethral
resection and intravesical chemotherapy
d. The results of treatment for locally advanced bladder tumors are similar with
either radical cystectomy or radiation therapy
Answer: a, c
23. A 22-year-old woman presents to the emergency department with a chief
complaint of severe left upper quadrant (LUQ) pain after being punched by her
husband. Her blood pressure is 110/70 mm Hg, pulse is 100 bpm, and respiration
rate is 24 breaths per minute. The best means to establish a diagnosis is which of
the following?
(A) FAST
(B) Physical examination
(C) CT of the abdomen
(D) Peritoneal lavage
(E) Upper gastrointestinal (GI) series
Answer. (C) The best means to establish the diagnosis is CT scan of the abdomen.
It will demonstrate solid-organ injury and the appropriate amount of fluid (blood) in
the peritoneal cavity. It also serves as a baseline for a patient being treated
conservatively for spleen and liver injuries.
24. A 20-year-old woman presents to the emergency department with a stab
wound to the abdomen. There is minimal abdominal tenderness. Local wound
exploration indicates that the knife penetrated the peritoneum. What is the ideal
use of antibiotic administration?
(A) Preoperatively
(B) Intraoperatively, if a colon injury is found
(C) Postoperatively, if the patient develops fever
(D) Postoperatively, based on culture and sensitivity of fecal contamination found at
the time of surgery
(E) Intraoperatively, if any hollow viscus is found to be injured
Answer. (A) Antibiotics should be given preoperatively to all patients with wounds
penetrating the peritoneal cavity. Intraoperative and postoperative antibiotics fail to
reduce postoperative abscesses and wound infections adequately.should be used
immediately?
(A) Pringle’s maneuver
(B) Packing the liver
(C) Suture ligation
(D) Ligation of the right hepatic artery
(E) Ligation of the proper hepatic artery
25. A 23-year-old man is shot with a handgun and found to have a through-and-
through injury to the right transverse colon. There is little fecal contamination and
no bowel devascularization. At operation, what does he require?
(A) Right hemicolectomy with ileotransverse colon anastomosis
(B) Right hemicolectomy with ileostomy and mucous fistula
(C) Debridement and closure of wounds with exteriorization of colon
(D) Debridement and closure of wounds
(E) Segmental resection with primary anastomosis
Answer. (D) Most gunshot injuries to the right side of the colon should be closed
primarily. Resection is required only where there is extensive devitalization of tissue
or injury to the mesocolon causing devascularization of the bowel.
