Surgery p3(100-150)
Breast and Abdominal Surgery Quiz
Test your knowledge on breast cancer staging and various surgical procedures related to abdominal conditions with this comprehensive quiz. Designed for medical students, residents, and healthcare professionals, it covers a wide range of topics from tumors to surgical techniques.
- 50 carefully crafted multiple-choice questions
- Focus on surgical knowledge and clinical scenarios
- Assess your understanding and readiness for real-world medical situations
Tumor not palpable, clinically positive lymph nodes fixed to one another, no evidence of metastases. For the clinical description select the appropriate stage of breast cancer.
A. Stage I
B. Stage II
C. Stage III
D. Stage IV
E. Inflammatory carcinoma
Tumor 5.0 cm; clinically positive, movable ipsilateral lymph nodes; no evidence of metastases. For the clinical description select the appropriate stage of breast cancer.
A. Stage I
B. Stage II
C. Stage III
D. Stage IV
E. Inflammatory carcinoma
Tumor 2.1 cm, clinically negative lymph nodes, no evidence of metastases For the clinical description select the appropriate stage of breast cancer.
A. Stage I
B. Stage II
C. Stage III
D. Stage IV
E. Inflammatory carcinoma
Tumor not palpable but breast diffusely enlarged and erythematous, clinically positive supraclavicular nodes, and evidence of metastases. For the clinical description select the appropriate stage of breast cancer.
A. Stage I
B. Stage II
C. Stage III
D. Stage IV
E. Inflammatory carcinoma
Tumor 0.5 cm, clinically negative lymph nodes, pathological rib fracture. For the clinical description select the appropriate stage of breast cancer.
A. Stage I
B. Stage II
C. Stage III
D. Stage IV
E. Inflammatory carcinoma
A 43-year-old man presents with signs and symptoms of peri- tonitis in the right lower quadrant. The clinical impression and sup- portive data suggest acute appen- dicitis. At exploration, however, a tumor is found; frozen section sug- gests carcinoid features. For the tumor described, choose the most appropriate surgical procedure. A 2.5-cm tumor at the base of the appendix.
A. Appendectomy
B. Segmental ileal resection
C. Cecectomy
D. Right hemicolectomy
E. Hepatic wedgeresection and appropriate bowel resection
A 43-year-old man presents with signs and symptoms of peri- tonitis in the right lower quadrant. The clinical impression and sup- portive data suggest acute appen- dicitis. At exploration, however, a tumor is found; frozen section sug- gests carcinoid features. For the tumor described, choose the most appropriate surgical procedure. A 1.0-cm tumor at the tip of the appendix.
A. Appendectomy
B. Segmental ileal resection
C. Cecectomy
D. Right hemicolectomy
E. Hepatic wedgeresection and appropriate bowel resection
A 43-year-old man presents with signs and symptoms of peri- tonitis in the right lower quadrant. The clinical impression and sup- portive data suggest acute appen- dicitis. At exploration, however, a tumor is found; frozen section sug- gests carcinoid features. For the tumor described, choose the most appropriate surgical procedure. A 0.5-cm tumor with serosal umbilication in the ileum.
A. Appendectomy
B. Segmental ileal resection
C. Cecectomy
D. Right hemicolectomy
E. Hepatic wedgeresection and appropriate bowel resection
A 43-year-old man presents with signs and symptoms of peri- tonitis in the right lower quadrant. The clinical impression and sup- portive data suggest acute appen- dicitis. At exploration, however, a tumor is found; frozen section sug- gests carcinoid features. For the tumor described, choose the most appropriate surgical procedure. A 1.0-cm tumor of the midappendix; 1-cm firm, pale lesion at the periphery of the right lobe of the liver
A. Appendectomy
B. Segmental ileal resection
C. Cecectomy
D. Right hemicolectomy
E. Hepatic wedgeresection and appropriate bowel resection
A 43-year-old man presents with signs and symptoms of peri- tonitis in the right lower quadrant. The clinical impression and sup- portive data suggest acute appen- dicitis. At exploration, however, a tumor is found; frozen section sug- gests carcinoid features. For the tumor described, choose the most appropriate surgical procedure. A 3.5-cm tumor encroaching onto the cecum and extensive liver metastases
A. Appendectomy
B. Segmental ileal resection
C. Cecectomy
D. Right hemicolectomy
E. Hepatic wedgeresection and appropriate bowel resection
Omeprazole has been added to the H2 antagonists as a therapeu- tic approach to the management of acute gastric and duodenal ulcers. It acts by
A. Blocking breakdown of mucosal- damaging metabolites of NSAIDs
B. Providing a direct cytoprotective effect
C. Buffering gastric acids
D. Inhibiting parietal cell hydrogen- potassium-ATPase
E. Inhibiting gastrin release and pari- etal cell acid production
Evidence that a splenectomy might benefit a patient with immune (idiopathic) thrombocy- topenic purpura (ITP) includes
A. A significant enlargement of the spleen
B. A high reticulocyte count
C. Megakaryocytic elements in the bone marrow
D. An increase in the platelet count on cortisone therapy
E. Patient age of less than 5 years
Which of the following state- ments concerning imperforate anus is true?
A. Imperforate anus affects males more frequently than females
B. In 90% of males, but only 50% of females, the rectum ends below the level of the levator ani complex
C. The rectum usually ends in a blind pouch
D. The chance for eventual continence is greater when the rectum has descended to below the levator ani muscles
E. Immediate definitive repair of the anatomic defect is required to max- imize the chance of eventual conti- nence
A patient with a history of familial polyposis undergoes a diagnostic polypectomy. Which of the following types of polyps is most likely to be found?
A. Villous adenoma
B. Hyperplastic polyp
C. Adenomatous polyp
D. Retention polyp
E. Pseudopolyp
What is the most common serious complication of an end colostomy?
A.leeding
B. Skin breakdown
C. Parastomal hernia
D. Colonic perforation during irrigation
E. Omal prolapse
Which of the following state- ments regarding pancreatic carci- noma is true?
A. The majority of cases present with jaundice alone
B. CT scan, angiography, and laparoscopy have been unsuccessful in predicting resectability
C. If a patient is jaundiced, the resectability rate is less than 5%
D. 99% of patients with pancreatic cancer have metastatic disease at the time of diagnosis
E. The 5-year survival rate after a Whipple procedure (pancreatico- duodenectomy) performed for cure is 30–40%
A 45-year-old woman is explored for a perforated duodenal ulcer 6 h after onset of symptoms. She has a history of chronic peptic ulcer disease treated medically with minimal symptoms.The procedure of choice is
A. Simple closure with omental patch
B. Truncal vagotomy and pyloroplasty
C. Antrectomy and truncal vagotomy
D. Highly selective vagotomy
E. Hemigastrectomy
A 45-year-old woman is explored for a perforated duodenal ulcer 6 h after onset of symptoms. She has a history of chronic peptic ulcer disease treated medically with minimal symptoms. Six weeks after surgery, the patient returns complaining of postprandial weakness, sweating, light-headedness, crampy abdomi- nal pain, and diarrhea. The best management would be
A. Antispasmodic medications (e.g., Lomotil)
B. Dietary advice and counseling that symptoms will probably abate within 3 month of surgery
C. Dietary advice and counseling that symptoms will probably not abate but are not dangerous
D. Workup for neuroendocrine tumor (e.g., carcinoid)
E. Preparation for revision to Roux- en-Y gastrojejunostomy
A 55-year-old man complains of chronic intermittent epigastric pain, and gastroscopy demonstrates a 2-cm ulcer of the distal lesser curvature. Endoscopic biopsy yields no malignant tissue. After a 6-wk trial of H2 blockade and antacid therapy, the ulcer is unchange
A. Proper therapy at this point is
B. Repeat trial of medical therapy b. Local excision of the ulcer
C. Billroth I partial gastrectomy
D. Billroth I partial gastrectomy with vagotomy
E. Vagotomy and pyloroplasty
A 60-year-old male alcoholic is admitted to the hospital with hematemesis. His blood pressure is 100/60 mm Hg, the physical examination reveals splenomegaly and ascites, and the initial hematocrit is 25%. Nasogastric suction yields 300 mL of fresh blood. After initial resuscitation, this man should undergo
A. Esophageal balloon tamponade
B. Barium swallow
C. Selective angiography
D. Esophagogastroscopy
E. Exploratory celiotomy
During an operation for car- cinoma of the hepatic flexure of the colon, an unexpected discontinuous 3-cm metastasis is discovered in the edge of the right lobe of the liver. The surgeon should
A. Terminate the operation, screen the patient for evidence of other metas- tases, and plan further therapy after the reevaluation
B. Perform a right hemicolectomy and a right hepatic lobectomy
C. Perform a right hemicolectomy and a wedge resection of the metastasis
D. Perform a cecostomy and schedule reoperation after a course of systemic chemotherapy
E. Perform local resection of the primary colon cancer and plan radiation therapy for the lesion on the liver
A 42-year-old man with no history of use of nonsteroidal anti- inflammatory drugs (NSAIDs) pre- sents with recurrent gastritis. Infection with Helicobacter pylori is suspected. Which of the following statements is true?
A. Morphologically, the bacteria is a gram-positive, tennis-racket-shaped organism
B. Diagnosis can be made by serologic testing or urea breath tests
C. Diagnosis is most routinely achieved via culturing endoscopic scrapings
D. The most effective way to treat and prevent recurrence of this patient’s gastritis is through the use of single drug therapy aimed at eradicating H.pylori
E. The organism is easily eradicated
Which of the following her- nias follows the path of the spermatic cord within the cremaster muscle?
A. Femoral
B. Direct inguinal
C. Indirect inguinal
D. Spigelian
E. Interparietal
A 70-year-old woman has nausea, vomiting, abdominal dis- tention, and episodic, crampy mida- bdominal pain. She has no history of previous surgery but has a long history of cholelithiasis for which she has refused surgery. Her abdom- inal radiograph reveals a spherical density in the right lower quadrant. Correct treatment should consist of
A. Ileocolectomy
B. Cholecystectomy
C. Ileotomy and extraction
D. Nasogastric tube decompression
E. Intravenous antibiotics
Which of the following state- ments concerning Hirschsprung’s disease is true?
A. It is initially treated by colostomy
B. It is best diagnosed in the newborn period by barium enema
C. It is characterized by the absence of ganglion cells in the transverse colon
D. It is associated with a high inci- dence of genitourinary tract anomalies
E. It is the congenital disease that most commonly leads to subsequent fecal incontinence
Spontaneous closure of which of the following congenital abnormalities of the abdominal wall generally occurs by the age of 4?
A. Umbilical hernia
B. Patent urachus
C. Patent omphalomesenteric duct
D. Omphalocele
E. Gastroschisis
Laparoscopic cholecystec- tomy is indicated for symptomatic gallstones in which of the following conditions?
A. Cirrhosis
B. Prior upper abdominal surgery
C. Suspected carcinoma of the gall bladder
D. Morbid obesity
E. Coagulopathy
Infants with anorectal anom- alies tend to have other congenital anomalies. Associated abnormali- ties include which of the following?
A. Abnormalities of the cervical spine
B. Hydrocephalus
C. Duodenal atresia
D. Heart disease
E. Corneal opacities
A 48-year-old woman devel- ops pain of the right lower quad- rant while playing tennis. The pain progresses and the patient presents to the emergency room later that day with a low-grade fever, a white blood count of 13,000, and com- plaints of anorexia and nausea as well as persistent, sharp pain of the right lower quadrant. On examina- tion she is tender in the right lower quadrant with muscular spasm and there is a suggestion of a mass effect. An ultrasound is ordered and shows an apparent mass in the abdominal wall. Which of the fol- lowing is the most likely diagnosis?
A. Acute appendicitis
B. Cecal carcinoma
C. Hematoma of the rectus sheath
D. Torsion of an ovarian cyst
E. Cholecystitis
In determining the proper treatment for a sliding hiatal her- nia, the most useful step would be
A. Barium swallow with cinefluoroscopy during Valsalva maneuver
B. Flexible endoscopy
C. 24-h monitoring of esophageal pH
D. Measuring the size of the hernia
E. Assessing the patient’s smoking and drinking history
Which of the following state- ments regarding the etiology of obstructive jaundice is true?
A. A markedly elevated SGOT and SGPT are usually associated with obstructive jaundice
B. When extrahepatic biliary obstruction is suspected, the first test should be endoscopic ultrasonog- raphy (EUS)
C. A Klatskin tumor will result in extrahepatic ductal dilation only
D. A liver-spleen scan will add signifi- cantly to the diagnostic workup for obstructive jaundice
E. Carcinoma of the head of the pan- creas can cause deep epigastric or back pain in as many as 80% of patients
A previously healthy 9-year- old child comes to the emergency room because of fulminant upper gastrointestinal bleeding. The hemorrhage is most likely to be the result of
A. Esophageal varices
B. Mallory-Weiss syndrome
C. Gastritis
D. A gastric ulcer
E. A duodenal ulcer
Operative planning and pre- operative counseling for a patient with a rectal carcinoma can be best provided if the patient is staged before surgery by
A. Rigid proctoscopy
B. Barium enema
C. MRI of the pelvis
D. CT scanning of the pelvis
E. Rectal endosonography
Which statement regarding absorption by the small intestine is true?
A. All but the fat in milk is digested and absorbed in humans by the end of the duodenum
B. Complete absorption of carbohydrates in a normal meal occurs in the ileum
C. In short gut syndrome, much of the dietary carbohydrate appears in the stool
D. Aldosterone markedly decreases sodium transport across the gut mucosa
E. Enzymes of the brush border of the small intestine can digest and absorb less than 5% of an average protein meal in the absence of the pancreas
Local stimuli that inhibit the release of gastrin from the gastric mucosa include which of the fol- lowing?
A. Small proteins
B. 20-proof alcohol
C. Caffeine
D. Acidic antral contents
E. Antral distention
For a symptomatic partial duodenal obstruction secondary to an annular pancreas, the operative treatment of choice is
A. A Whipple procedure
B. Gastrojejunostomy
C. Vagotomy and gastrojejunostomy
D. Partial resection of the annular pancreas
E. Duodenojejunostomy
Which of the following would be expected to stimulate intestinal motility?
A. Fear
B. Gastrin
C. Secretin
D. Acetylcholine
E. Cholecystokinin
Which of the following statements concerning carcinoma of the esophagus is true?
A. Alcohol has been implicated as a precipitating factor
B. Squamous carcinoma is the most common type at the cardioesophageal junction
C. It has a higher incidence in males
D. It occurs more commonly in patients with corrosive esophagitis
E. Surgical excision is the only effective treatment
A 30-year-old man with a duodenal ulcer is being considered for surgery because of intractable pain and a previous bleeding epi- sode. Serum gastrin levels are found to be over 1000 pg/mL (normal 40–150) on three separate determi- nations. The patient should be told that the operation of choice is
A. Vagotomy and pyloroplasty
B. Highly selective vagotomy and tumor resection
C. Subtotal gastrectomy
D. Total gastrectomy
E. Partial pancreatectomy
The most common clinical presentation of idiopathic retroperitoneal fibrosis is
A. Ureteral obstruction
B. Leg edema
C. Calf claudication
D. Jaundice
E. Intestinal obstruction
In planning the management of a 2.8-cm epidermoid carcinoma of the anus, the first therapeutic approach should be
A. Abdominoperineal resection
B. Wide local resection with bilateral inguinal node dissection
C. Local radiation therapy
D. Systemic chemotherapy
E. Combined radiation therapy and chemotherapy
Indications for operation in Crohn’s disease include which of the following?
A. Intestinal obstruction
B. Enterovesical fistula
C. Ileum ascending colon fistula
D. Enterovaginal fistula
E. Free perforation
Which of the following organisms is most closely associ- ated with gastric and duodenal ulcer disease?
A. Campylobacter
B. Cytomegalovirus
C. Helicobacter
D. Mycobacterium aviumintracellulare
E. Yersinia enterocolitica
Which statement regarding adenocarcinoma of the pancreas is true?
A. It occurs most frequently in the body of the gland
B. It carries a 1–2% 5-year survival rate
C. It is nonresectable if it presents as painless jaundice
D. It can usually be resected if it pre- sents in the body or tail of the pan- creas and does not involve the common bile duct
E. It is associated with diabetes insipidus
Correct statements concerning intussusception in infants include which of the following?
A. Recurrence rates following treatment are high
B. It is frequently preceded by a gastrointestinal viral illness
C. A 1- to 2-wk period of parenteral alimentation should precede surgical reduction when surgery is required
D. Hydrostatic reduction without surgery rarely provides successful treatment
E. The most common type occurs at the junction of the descending colon and sigmoid colon
A 32-year-old woman pre- sents to the hospital with a 24-h history of abdominal pain of the right lower quadrant. She under- goes an uncomplicated appendec- tomy for acute appendicitis and is discharged home on the fourth postoperative day. The pathologist notes the presence of a carcinoid tumor (1.2 cm) in the tip of the appendix. Which of the following statements is true?
A. The patient should be advised to undergo ileocolectomy
B. The most common location of carcinoids is in the appendix
C. The carcinoid syndrome occurs in more than half the patients with carcinoid tumors
D. The tumor is an apudoma
E. Carcinoid syndrome is seen only when the tumor is drained by the portal venous system
Which of the following statements regarding direct inguinal hernias is true?
A. They are the most common inguinal hernias in women
B. They protrude medially to the inferior epigastric vessels
C. They should be opened and ligated at the internal ring
D. They commonly protrude into the scrotal sac in men
E. They incarcerate more commonly than indirect hernias
Which of the following state- ments regarding stress ulceration is true?
A. It is true ulceration, extending into and through the muscularis mu- cosa
B. It classically involves the antrum
C. Increased secretion of gastric acid has been shown to play a causative role
D. It frequently involves multiple sites
E. It is seen following shock or sepsis, but for some unknown reason does not occur following major surgery, trauma, or burns
Which statement concerning cholangitis is correct?
A. The most common infecting organ- ism is Staphylococcus aureus
B. The diagnosis is suggested by the Charcot triad
C. The disease occurs primarily in young, immunocompromised patients
D. Cholecystostomy is the procedure of choice in affected patients
E. Surgery is indicated once the diag- nosis of cholangitis is made
An 88-year-old man with a history of end-stage renal failure, severe coronary artery disease, and brain metastases from lung cancer presents with acute cholecystitis. His family wants “everything done.” The best management option in this patient would be
A. Tube cholecystostomy
B. Open cholecystectomy
C. Laparoscopic cholecystectomy
D. Intravenous antibiotics followed by elective cholecystectomy
E. Lithotripsy followed by long-term bile acid therapy
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