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Surgery p4(151-200)

Generate an image of a surgeon in a surgical theater, focused on a patient while surrounded by surgical instruments, with a sense of urgency and professionalism.

Surgical Knowledge Challenge

Test your knowledge of surgical principles and procedures with our comprehensive quiz designed for healthcare professionals and students alike. This quiz includes a range of cases and questions that challenge your understanding of surgical practices, anatomy, and critical decision-making.

Join now and explore topics such as:

Gastrointestinal surgeries
Oncology principles
Pediatric concerns
Urological conditions
Trauma management

50 Questions12 MinutesCreated by HealingHand247

Dieulafoy’s lesion of the stomach is characterized by

A. A large mucosal defect with underlying, friable vascular plexus

B. Frequent rebleeding after endoscopic treatment

C. Massive bleeding that requires subtotal gastrectomy

D. Location in the proximal stomach

E. Acid-peptic changes of the gastric mucosa

During an appendectomy for acute appendicitis, a 4-cm mass is found in the midportion of the appendix. Frozen section reveals this lesion to be a carcinoid tumor. Which of the following statements is true?

A. No further surgery is indicated

B. A right hemicolectomy should be performed

C. There is about a 50% chance that this patient will develop the carcinoid syndrome

D. Carcinoid tumors arise from islet cells

E. Carcinoid syndrome can occur only in the presence of liver metastases

Correct statements regarding rectal carcinoid tumors include

A. Endoscopic resection is sufficient for tumors smaller than 2 cm

B. Patients frequently present with the carcinoid syndrome

C. They are rapidly growing tumors

D. Local recurrence is rare with complete resection of the primary lesion

E. They can develop the carcinoid syndrome even in the absence of liver metastases

Indications for surgical removal of polypoid lesions of the gallbladder include

A. Size greater than 0.5 cm

B. Presence of clinical symptoms

C. Patient age of over 25 years

D. Presence of multiple small lesions

E. Absence of shadowing on ultrasound

A patient who has a total pancreatectomy might be expected to develop which of the following complications?

A. Diabetes mellitus

B. Hypercalcemia

C. Hyperphosphatemia

D. Constipation

E. Weight gain

A 28-year-old previously healthy woman arrives in the emer- gency room complaining of 24 h of anorexia and nausea and lower abdominal pain that is more intense in the right lower quadrant than elsewhere. On examination she has peritoneal signs of the right lower quadrant and a rectal tem- perature of 38.38°C (101.8°F). At exploration through incision of the right lower quadrant, she is found to have a small, contained perfora- tion of a cecal diverticulum. Which of the following statements regard- ing this situation is true?

A. Cecal diverticula are acquired disorders

B. Cecal diverticula are usually multiple

C. Cecal diverticula are mucosal herniations through the muscularis propria

D. Diverticulectomy, closure of the cecal defect, and appendectomy may be indicated

E. An ileocolectomy is indicated even with well-localized inflammation

True statements regarding cavernous hemangiomata of the liver in adults include

A. The majority become symptomatic

B. They may undergo malignant transformation

C. They enlarge under hormonal stimulation

D. They should be resected to avoid spontaneous rupture and life threatening hemorrhage

E. A liver/spleen radionucleotide scan is the most sensitive and specific way to make the diagnosis

A 72-year-old patient with an intractable type I ulcer along the incisura with a significant amount of scarring along the entire length of the lesser curvature (SELECT 1 PROCEDURE). Select the appropriate surgical procedure for the patient.

A. Vagotomy and antrectomy

B. Antrectomy alone

C. Vagotomy and pyloroplasty

D. Vagotomy and gastrojejunostomy

E. Proximal gastric vagotomy

A 46-year-old patient with gastric outlet obstruction sec- ondary to ulcer disease and severe inflammation around the pylorus and first and second portions of the duodenum (SELECT 1 PROCEDURE). Select the appropriate surgical procedure for the patient.

A. Vagotomy and antrectomy

B. Antrectomy alone

C. Vagotomy and pyloroplasty

D. Vagotomy and gastrojejunostomy

E. Proximal gastric vagotomy

A 90-year-old patient with a bleeding duodenal ulcer (SELECT 1 PROCEDURE) Select the appropriate surgical procedure for the patient.

A. Vagotomy and antrectomy

B. Antrectomy alone

C. Vagotomy and pyloroplasty

D. Vagotomy and gastrojejunostomy

E. Proximal gastric vagotomy

A 36-year-old patient with a type III (pyloric) ulcer that is refractory to medical treatment (SELECT 1 PROCEDURE). Select the appropriate surgical procedure for the patient.

A. Vagotomy and antrectomy

B. Antrectomy alone

C. Vagotomy and pyloroplasty

D. Vagotomy and gastrojejunostomy

E. Proximal gastric vagotomy

The most common congenital diaphragmatic hernia in infants (SELECT 1 ABNORMALITY) Match each description with the correct abnormality.

A. Rupture of the diaphragm

B. Paraesophageal hiatal hernia

C. Sliding hiatal hernia

D. Foramen of Bochdalek hernia

E. Foramen of Morgagni hernia

The hernia most likely to cause acute respiratory distress in infants (SELECT 1 ABNORMALITY) Match each description with the correct abnormality.

A. Rupture of the diaphragm

B. Paraesophageal hiatal hernia

C. Sliding hiatal hernia

D. Foramen of Bochdalek hernia

E. Foramen of Morgagni hernia

Among the cardiovascular anomalies of newborns, the one most likely to present with cyanosis is

A. Patent ductus arteriosus

B. Coarctation of the aorta

C. Atrial septal defect

D. Ventricular septal defect

E. Transposition of the great vessels

The superior vena cava syndrome is most frequently seen in association with

A. Histoplasmosis (sclerosing mediastinitis)

B. Substernal thyroid

C. Thoracic aortic aneurysm

D. Constrictive pericarditis

E. Bronchogenic carcinoma

During endoscopic biopsy of a distal esophageal cancer, perfora- tion of the esophagus is suspected when the patient complains of significant new substernal pain. An immediate chest film reveals air in the mediastinum. You would recommend

A. Placement of a nasogastric tube to the level of perforation, antibiotics, close observation

B. Spit fistula (cervical pharyngostomy), gastrostomy

C. Left thoracotomy, pleural patch oversewing of perforation, drainage of mediastinum

D. Esophagogastrectomy via celiotomy and right thoracotomy

E. Transhiatal esophagogastrectomy with cervical esophagogastrostomy

A 3-year-old child with congenital cyanosis is most probably suffering from

A. Tetralogy of Fallot

B. Ventricular septal defect

C. Tricuspid atresia

D. Transposition of the great vessel

E. Patent ductus arteriosus

A correct statement concerning bronchial carcinoid tumors is that

A. They frequently metastasize

B. They most commonly arise in peripheral terminal bronchioles

C. They rarely produce the carcinoid syndrome

D. They are radiosensitive

E. Five-year survival is less than 50%

Initial management of a patient who has a flaccid neurogenic bladder may include which of the following measures?

A. Surgical bladder augmentation

B. Self-catheterization

C. Supravesical urinary diversion

D. Limiting fluid intake to less than 300 mL/day

E. Transurethral resection of the bladder neck

Which of the following state- ments regarding hypospadias is correct?

A. It is often associated with chordee (ventral curvature of the penis)

B. It is associated with undescended testes in more than 50% of cases

C. It is a rare fusion defect of the posterior male urethra

D. It occurs sporadically, without evidence of familial inheritance

E. The most common location is penoscrotal

The recommended treatment for stage A (superficial and submucosal) transitional cell carcinoma of the bladder is

A. Local excision

B. Radical cystectomy

C. Radiation therapy

D. Topical (intravesicular) chemotherapy

E. Systemic chemotherapy

A 36-year-old man presents to the emergency room with renal colic. A radiograph reveals a 1.5- cm stone. Which of the following statements regarding this disorder is correct?

A. Conservative treatment including hydration and analgesics will not result in a satisfactory outcome

B. Serial kidney, ureter, bladder (KUB) radiographs should be used to follow this patient

C. The urinalysis will nearly always reveal microhematuria

D. When the acute event is correctly treated, this disease seldom recurs

E. Elevated BUN and creatinine are expected

Optimal management of bi- lateral undescended testicles in an infant is

A. Immediate surgical placement into the scrotum

B. Chorionic gonadotropin therapy for 1 mo; operative placement into the scrotum before age 1 if descent has not occurred

C. Observation until the child is 2 years old because delayed descent is common

D. Observation until age 5; if no descent by then, plastic surgical scrotal prostheses before the child enters school

E. No therapy; reassurance of the parent that full masculinization and normal spermatogenesis are likely even if the testicle does not fully descend

Seminoma is accurately de scribed by which of the following statements?

A. It is the most common type of tes- ticular cancer

B. Metastases to liver and bone are fre- quently found

C. It does not respond to radiation

D. The 5-year survival rate approaches 50%

E. Common presentation is that of a painful lump that transilluminates

A 10-year-old boy presents to the emergency room with testicular pain of 5 h duration. The pain was of acute onset and woke the patient from sleep. On physical examination, he is noted to have a high- riding, indurated, and markedly tender left testis. Pain is not diminished by elevation. Urinalysis is unremarkable. Which of the fol- lowing statements regarding the patient’s diagnosis and treatment is true?

A. There is a strong likelihood that this patient’s father or brother has had or will have a similar event

B. Operation should be delayed until a technetium scan clarifies the diag nosis

C. The majority of testicles that have undergone torsion can be salvaged if surgery is performed within 24 h

D. If torsion is found, both testes should undergo orchiopexy

E. The differential diagnosis includes spermatocele

Genitourinary tuberculosis in a male patient is suggested by which of the following findings?

A. Microscopic hematuria

B. Bacteriuria without pyuria

C. Unilateral renal cysts

D. Painful swelling of the epididymis

E. Pneumaturia

Which of the following state- ments regarding carcinoma of the prostate is true?

A. It has a higher incidence among American blacks than other American ethnic groups

B. A single microscopic focus of prostate cancer discovered on transurethral resection of the prostate (TURP) is an indication for radical prostatectomy

C. It arises initially in the gland’s central portion

D. It commonly produces osteoclastic bony metastases

E. Screening for prostate-specific antigen, although easily done, offers no advantage over simple rectal examination in the detection of the disease

Which of the following state- ments regarding benign prostatic hyperplasia (BPH) is true?

A. The fibrostromal proliferation of BPH occurs mainly in the outer portion of the gland

B. Assuming a voided volume greater than 100 mL, a peak urine flow rate of 30 mL/s or less is good evidence of outflow obstruction

C. Suprapubic prostatectomy for BPH involves enucleation of the entire prostate and eliminates the risk of future prostate cancer

D. Indications for surgery include acute urinary retention and recur- rent urinary tract infections (UTIs)

E. BPH is a risk factor for the development of prostatic cancer

During the course of an oper- ation on an unstable, critically ill patient, the left ureter is lacerated through 50% of its circumference. If the patient’s condition is felt to be too serious to allow time for defini- tive repair, alternative methods of management include

A. Ligation of the injured ureter and ipsilateral nephrostomy

B. Ipsilateral nephrectomy

C. Placement of a catheter from the distal ureter through an abdominal wall stab wound

D. Placement of a suction drain adjacent to the injury without further manipulation that might convert the partial laceration into a complete disruption

E. Bringing the proximal ureter up to the skin as a ureterostomy

A pedestrian is hit by a speeding car. Radiologic studies obtained in the emergency room, including a retrograde urethro- gram, are consistent with a pelvic fracture with a rupture of the urethra superior to the urogenital diaphragm. Management should consist of

A. Immediate percutaneous nephrostomy

B. Immediate placement of a Foley catheter through the urethra into the bladder to align and stent the injured portions

C. Immediate reconstruction of the ruptured urethra after initial stabilization of the patient

D. Immediate exploration of the pelvis for control of hemorrhage from pelvic fracture and drainage of the pelvic hematoma

E. Immediate placement of a suprapubic cystostomy

Meniscal tears usually result from which of the following circumstances?

A. Hyperextension

B. Flexion and rotation

C. Simple hyperflexion

D. Compression

E. Femoral condylar fracture

Volkmann’s ischemic contracture is associated with

A. Intertrochanteric femoral fracture

B. Supracondylar fracture of the humerus

C. Posterior dislocation of the knee

D. Traumatic shoulder separation

E. Colles “silver fork” fracture

In an uncomplicated disloca- tion of the glenohumeral joint, the humeral head usually dislocates primarily in which of the following directions?

A. Anteriorly

B. Superiorly

C. Posteriorly

D. Laterally

E. Medially

The most severe epiphyseal growth disturbance is likely to result from which of the following types of fracture?

A. Fracture dislocation of a joint adja- cent to an epiphysis

B. Fracture through the articular carti- lage extending into the epiphysis

C. Transverse fracture of the bone shaft on the metaphyseal side of the epiphysis

D. Separation of the epiphysis at the diaphyseal side of the growth plate

E. Crushing injury compressing the growth plate

Which of the following frac- tures is most commonly seen in healthy bones subjected to violent falls?

A. Colles fracture

B. Femoral neck fracture

C. Intertrochanteric fracture

D. Clavicular fracture

E. Vertebral compression fracture

In a failed suicide gesture, a depressed student severs her radial nerve at the wrist. The expected disability is

A. Loss of ability to extend the wrist

B. Loss of ability to flex the wrist

C. Wasting of the intrinsic muscles of the hand

D. Sensory loss over the thenar pad and the thumb web

E. Palmar insensitivity

Which of the following statements regarding compartment syndromes following orthopedic injuries is true?

A. The first sign is usually loss of pulse in the extremity

B. Passive flexion of the extremity proximal to the involved compart- ment will aggravate the pain

C. Surgical decompression (fasciectomy) is necessary only as a last resort

D. These syndromes are most commonly associated with supracondy- lar fractures of the humerus and tibial shaft

E. The syndrome is often painless

In contrast to closed reduc- tion, open reduction of a fracture

A. Produces a shorter healing time

B. Decreases trauma to the fracture site

C. Produces a higher incidence of nonunion

D. Reduces the risk of infection

E. Requires longer periods of immobilization

Epileptiform convulsion may be a cause. (SELECT 1 INJURY) For description above, select the type of fracture or dislocation with which it is most likely to be associated.

A. Navicular (scaphoid) fracture

B. Monteggia’s deformity

C. Greenstick fracture

D. Spiral fracture

E. Posterior shoulder dislocation

Avascular necrosis is not uncommon. (SELECT 1 INJURY) For description above, select the type of fracture or dislocation with which it is most likely to be associated.

A. Navicular (scaphoid) fracture

B. Monteggia’s deformity

C. Greenstick fracture

D. Spiral fracture

E. Posterior shoulder dislocation

The radial head is dislocated and the proximal third of the ulna is fractured. (SELECT 1 INJURY) For description above, select the type of fracture or dislocation with which it is most likely to be associated.

A. Navicular (scaphoid) fracture

B. Monteggia’s deformity

C. Greenstick fracture

D. Spiral fracture

E. Posterior shoulder dislocation

Tenderness in the anatomist’s snuffbox may be observed. (SELECT 1 INJURY) For description above, select the type of fracture or dislocation with which it is most likely to be associated.

A. Navicular (scaphoid) fracture

B. Monteggia’s deformity

C. Greenstick fracture

D. Spiral fracture

E. Posterior shoulder dislocation

Association with hyperparathyroidism (SELECT 1 DISEASE). For description above, select the type of bone disease with which it is most likely to be associated.

A. Osteogenesis imperfecta

B. Osteopetrosis

C. Osteitis fibrosa cystica

D. Osteomalacia

E. Osteitis deformans

A defect in the mineralization of adult bone secondary to abnormalities in vitamin D metabolism (SELECT 1 DISEASE). For description above, select the type of bone disease with which it is most likely to be associated.

A. Osteogenesis imperfecta

B. Osteopetrosis

C. Osteitis fibrosa cystica

D. Osteomalacia

E. Osteitis deformans

Genetically determined disorder in the structure or processing of type I collagen (SELECT 1 DISEASE). For description above, select the type of bone disease with which it is most likely to be associated.

A. Osteogenesis imperfecta

B. Osteopetrosis

C. Osteitis fibrosa cystica

D. Osteomalacia

E. Osteitis deformans

Synonym for Paget’s disease (SELECT 1 DISEASE). For description above, select the type of bone disease with which it is most likely to be associated.

A. Osteogenesis imperfecta

B. Osteopetrosis

C. Osteitis fibrosa cystica

D. Osteomalacia

E. Osteitis deformans

Which of the following state- ments regarding glioblastoma mul- tiforme is true?

A. It is a neuronal cell tumor

B. It arises from the malignant degeneration of an astrocytoma

C. With aggressive treatment, most patients can live up to 10 years with this disease

D. It is the most common childhood intracranial neoplasm

E. With combined surgery, chemotherapy, and radiation therapy, cure rates now approach 50%

Which of the following statements regarding skull fractures is true?

A. Depressed fractures are those in which the patient’s level of consciousness is diminished or absent

B. Compound fractures are those in which the skull is fractured and the underlying brain is lacerated

C. Any bone fragment displaced more than 1 cm inwardly should be elevated surgically

D. Drainage of cerebrospinal fluid via the ear or nose requires prompt surgical treatment

E. Most skull fractures require surgical treatmen

An acute increase in intracra- nial pressure is characterized by which of the following clinical find- ings?

A. Respiratory irregularities

B. Decreased blood pressure

C. Tachycardia

D. Papilledema

E. Compression of the fifth cranial nerve

Which of the following state ments about schwannomas is true?

A. They represent central nerve tumors

B. Treatment is via excision

C. They arise most frequently in motor nerves

D. They often degenerate to malignancy

E. The most common presentation is a painful mass

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