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Surgery Review Questions 174 Surgery Review Questions 1. Regarding contrast study for intestinal obstruction: 6. Rightward shift of oxyhemoglobin dissociation (a) Gastrografin is preferred to barium for studying curve occurs with: distal small bowel (a) hypothermia (b) Gastrografin has no therapeutic potential (b) acidosis (c) Gastrografin is less hazardous than barium if (c) decrease in 2,3-diphosphoglycerate aspiration occurs (d) hypocapnia (d) Gastrografin can cause serious fluid shift (e) methemoglobinemia (e) barium can convert partial small bowel obstruc- tion into complete obstruction 7. The most common site of gastrointestinal lym- phoma is: 2. An absolute contraindication to breast-conserving (a) small intestine surgery for breast cancer is: (b) stomach (a) large tumor (c) colon (b) tumor of high grade (d) duodenum (c) early pregnancy (e) appendix (d) retroareolar tumor (e) clinical axillary nodes 8. Meckel’s diverticulum: (a) is a false diverticulum 3. The most common indication for surgery in chronic (b) is asymptomatic in most cases pancreatitis is: (c) commonly presents as gastrointestinal bleeding (a) jaundice in adults (b) pain (d) commonly presents with intestinal obstruction (c) pseudocyst in children (d) gastric outlet obstruction (e) is found in approximately 5% to 10% of people (e) endocrine deficiency 4. The most common cause of spontaneous intestinal 9. Biliary-enteric fistula most commonly connects: fistula is: (a) gallbladder and ileum (a) radiation injury (b) gallbladder and duodenum (b) malignancy (c) common bile duct and jejunum (c) Crohn’s disease (d) gallbladder and jejunum (d) ulcerative colitis (e) common bile duct and ileum (e) diverticular disease 10. Spontaneous closure is least likely in fistulae origi- 5. Gastrointestinal stromal tumors (GIST): nating from: (a) occur most commonly in the duodenum (a) colon (b) are almost always malignant (b) esophagus (c) can be treated adequately with enucleation (c) pancreas (d) are often radioresistant (d) stomach (e) spread mainly via the lymphatics (e) small intestine 406 Part XVI. Surgery Review Questions and Answers 11. Gastrointestinal diverticula do not occur in: 18. Malignant small bowel neoplasms most commonly (a) cecum present with: (b) duodenum (a) weight loss (c) rectum (b) abdominal pain (d) jejunum (c) gastrointestinal bleeding (e) ileum (d) jaundice (e) intestinal perforation 12. The hepatic caudate lobe: 19. Small bowel obstruction in an elderly female (a) drains directly into the inferior vena cava without external hernia or previous surgery is most (b) represents segment IV likely caused by: (c) is supplied by the left portal vein only (a) small bowel neoplasm (d) is supplied by the right portal vein only (b) volvulus (e) lies to the right of the inferior vena cava (c) gallstone ileus (d) abdominal abscess 13. von Willebrand’s disease: (e) obturator hernia (a) is an autosomal dominant disorder (b) results in prolonged prothrombin time 20. During cell cycle, DNA replication occurs in: (c) is associated with normal bleeding time (a) G1 phase (d) is due to decreased hepatic synthesis of von (b) G2 phase Willebrand’s factor (c) S phase (e) is typically associated with joint bleeding (d) M phase 21. Li-Fraumeni syndrome shows increased incidence 14. Which of the following is consistent with syndrome of: of inappropriate antidiuretic hormone (SIADH)? (a) colon cancer (a) hypovolemia (b) ovarian cancer (b) increased urine sodium (c) lung cancer (c) hypernatremia (d) breast cancer (d) plasma hyperosmolarity (e) pancreatic cancer (e) excessive diuresis 22. The best operative approach to choledochal cyst is: (a) cystoduodenostomy 15. Normal anion gap acidosis is associated with: (b) cystojejunostomy (a) ketoacidosis (c) Roux-en-Y cystojejunostomy (b) lactic acidosis (d) Cyst excision and hepaticojejunostomy (c) salicylate poisoning (d) severe diarrhea 23. Leiomyoma of the esophagus: (e) uremic acidosis (a) commonly presents with dysphagia (b) is more common in females 16. Benign small bowel tumors most commonly present (c) is usually multiple as: (d) is usually diagnosed with endoscopic biopsy (a) small bowel obstruction (e) is usually located in the lower one-third of the (b) gastrointestinal bleeding esophagus (c) weight loss (d) incidental finding on laparotomy 24. Hemangioma of the liver: (e) intestinal perforation (a) is the most common benign hepatic tumor (b) is diagnosed with percutaneous needle biopsy (c) is associated with α-fetoprotein level 17. The diagnostic test of choice for suspected acute (d) should be resected as soon as diagnosed sigmoid diverticulitis is: (a) barium enema 25. Phosphorus: (b) Gastrografin enema (a) is a major extracellular anion (c) computed tomography scan of the abdomen (b) is passively absorbed from the gastrointestinal and pelvis tract (d) abdominal ultrasound (c) deficiency may result in insulin resistance (e) colonoscopy (d) deficiency is rare in hospitalized patients 174. Surgery Review Questions 407 26. Hypermagnesemia is a complication of: 33. Intussusception in adults: (a) extensive burns (a) is idiopathic in most cases (b) acute pancreatitis (b) usually requires resection (c) oliguric renal failure (c) is often successfully treated with hydrostatic (d) resection of the terminal ileum reduction (e) diuretic therapy (d) is seldom recurrent 27. The optimal management of traumatic duodenal 34. Optimal treatment for an ileosigmoid fistula in hematoma is: Crohn’s disease is: (a) angiography and embolization (a) closure of the fistula (b) laparotomy and evacuation (b) proximal ileostomy (c) laparotomy and gastrojejunostomy (c) proximal ileostomy and closure of fistula (d) observation (d) ileocecectomy and sigmoid colectomy (e) ileocecectomy and closure of the sigmoid 28. Hairy cell leukemia: defect (a) can be cured with splenectomy (b) is an aggressive form of leukemia 35. Obturator hernia: (c) death is usually related to infectious com- (a) is most common in older women with plications cachexia (d) is a T-cell leukemia (b) is associated with pain in the sciatic nerve distribution 29. Overwhelming postsplenectomy sepsis: (c) is repaired through a transverse incision in the (a) commonly occurs after splenectomy for trauma upper medial thigh (b) does not occur if accessory spleens are present (d) is rarely strangulated (c) can be fatal within hours of onset 36. Gastrointestinal bleeding in Mallory-Weiss (d) is most common in elderly patients syndrome: (e) most fatal cases occur 10 to 15 years after (a) is occult in the vast majority of cases splenectomy (b) can be controlled with balloon tamponade (c) stops with nonoperative management in most 30. The development of thrombocytopenia and arterial cases thrombosis with heparin requires: (d) is caused by mucosal tear in the lower one-third (a) continuation of heparin and platelet trans- of the esophagus fusion (b) continuation of heparin and thrombolysis 37. The risk of overwhelming postsplenectomy sepsis is (c) doubling the heparin dosage highest for patients requiring splenectomy for: (d) changing the route of heparin administration (a) thalassemia (e) discontinuation of heparin (b) trauma (c) immune thrombocytopenic purpura 31. A trauma patient has a Glasgow Coma Scale score (d) hereditary spherocytosis of 13, blood pressure 80/40; widened mediastinum (e) acquired hemolytic anemia on chest x-ray, and bloody peritoneal tap. The next step in management is: 38. After mastectomy, winging of the scapula results (a) obtain head computed tomography scan from injury to: (b) perform thoracotomy (a) the medial pectoral nerve (c) perform arch angiography (b) the lateral pectoral nerve (d) monitor intracranial pressure (c) the long thoracic nerve (e) perform laparotomy (d) the thoracodorsal nerve (e) the intercostal-brachial nerve 32. Insulinomas: (a) are often multiple 39. von Willebrand’s disease: (b) are mostly benign (a) is the most common congenital bleeding (c) are a common component of multiple endo- disorder crine neoplasia type 1 (MEN 1) (b) commonly results in hemarthrosis (d) are commonly located in the head of the (c) affects males only pancreas (d) results in prolonged prothrombin time 408 Part XVI. Surgery Review Questions and Answers 40. Disc lesion between L4 and L5 will lead to: 47. The most common cause of hypercalcemic crisis is: (a) reduced knee jerk (a) sarcoidosis (b) reduced ankle jerk (b) primary hyperparathyroidism (c) weakness of foot dorsiflexion (c) secondary hyperparathyroidism (d) reduced sensation on the small toe (d) malignancy (e) renal failure 41. Kidney transplant recipients are at increased risk for: (a) epidermoid skin cancer 48. A sudden onset of glucose intolerance in patients (b) lung cancer receiving total parenteral nutrition often indicates: (c) colon cancer (a) diabetes mellitus (d) breast cancer (b) sepsis (e) uterine cancer (c) hypophosphatemia (d) adrenal insufficiency 42. The optimum management of medullary thyroid (e) zinc insufficiency carcinoma in multiple endocrine neoplasia type 2 (MEN 2) is: (a) thyroid lobectomy 49. Pectus excavatum: (b) thyroid lobectomy and cervical lymphadenec- (a) is usually associated with respiratory dysfunc- tomy tion (c) radioactive iodine (b) is usually associated with dysphagia (d) radiotherapy (c) is often associated with cardiac dysfunction (e) total thyroidectomy ± radical neck dissection (d) cosmesis is usually the indication for surgery 43. Optimum management for a 2-cm mass in the head of the pancreas with hypoglycemia and high insulin 50. Sacrococcygeal teratoma: levels is: (a) is usually malignant (a) total pancreatectomy
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