CEBU INSTITUTE OF MEDICINE

BLUEPRINT FOR QUESTIONS

SURGERYCONTENT AREA SPECIFICATIONS

WEIGHT RECALL COMPREHENSION

APPLICATION

GENERAL SURGERY (53%)Abdominal

Stomach 6 0 3 3Small intestine 6 4 2 0Colon/Rectum 9 8 1 0

Appendix 6 4 2 0Liver 4 0 2 2Biliary tree 9 5 2 2

Breast 1 3 1 0Head and Neck 9 7 2 0

53 31 15 7SURGICAL SPECIALTIES (47%)

Pedia Surg 4 3 1 - TCVS 10 10 0 - Urology 10 9 1 -Neurosurgery 10 7 3 -Plastic

reconstructive3 2 1 -

Orthopedics 10 10 0 -TOTAL 47 41 6 0

MEAN MPL FOR THE EXAM = 60.45

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CEBU INSTITUTE OF MEDICINE

Department of Surgery

DIRECTION: Each question below is followed by four possible answers. Select the one best response and mark the appropriate spaces on the answer sheet provided for.

1. The most common and most life threatening surgical abdominal emergency in a 3 to 10 month old infant is:

A. Necrotizing enterocolitisB. Ascaris bolus causing intestinal obstructionC. Ileocolic intussusceptionD. Midgut volvulus

2. In acute appendicitis among children:A. Diagnosis is straightforward and easy among infantsB. “Dance sign”C. Abdominal films are useful in most casesD. A palpable right lower quadrant mass in the abdomen will indicate a localized

abscess3. Known predisposing factors for necrotizing enterocolitis:

A. Premature contractionsB. Breech extractionC. Maternal intake of drugsD. Maternal viral infections

4. Therapeutic management of unilateral Wilm’s tumor in a 3 year old child with a favorable histology:

A. Radical nephrectomy for stages I to IIIB. If stage II, adjuvant methotrexateC. Irradiation for all stagesD. Renal transplantation

5. An easily compressible blind ending tubular structure measuring 5 mm or less on graded sonography means:

A. Acute appendicitisB. Ruptured appendendictisC. Normal appendixD. Caecal carcinoma

6. In some patients, an ill defined mass on the right lower quadrant will be detected on physical examination. In a patient over the age of 50 years old, this mass is most likely due to:

A. PhlegmonB. Periappendiceal abscessC. Ruptured appendixD. Perforated cecal carcinoma

7. Pneumatosis cystoides intestinalis develops after one of the following events in a patient with small bowel tumor:

A. BleedingB. ObstructionC. PerforationD. Fistula formation

8. Which of the following is the LEAST likely reason why the diagnosis of small bowel carcinoma is often delayed and far advanced at the time of operation?

A. Because of the rarity of the lesionB. Vagueness of the symptomsC. Absence of the physical findingsD. Lack of available diagnostic studies

9. Diverticula associated with the ampulla of Vater have significant relationship to:A. Diabetes mellitusB. Non-specific symptomsC. Cholangitis, pancreatitis, stone diseaseD. Obstruction, perforation, bleeding

10. Radiation enteritis may cause malnutrition syndrome and this is brought about by:A. Decrease in the effective length of the small bowelB. Decreased digestive activityC. Changes in microorganism population

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D. Changes in the mucosal epithelial cells11. Psudo-obstruction, post-vagotomy syndrome, and small bowel diverticula create intestinal

stasis and will eventually cause malnutrition syndrome due to:A. Decrease in the effective length of the small bowelB. Decreased digestive activityC. Changes in microorganism populationD. Changes in the mucosal epithelial cells

12. The diagnosis of appendicitis should be questioned if it is not accompanied by which of the following?

A. PainB. AnorexiaC. VomitingD. Obstipation or diarrhea

/Ref. pp 138313. The passive internal rotation of the flexed right thigh with the patient supine producing

hypogastric pain is termed as the:A. Psoas signB. Obturator signC. Rovsing’s signD. Fothergill sign

14. The inflammatory process that involves the serosa of the appendix and in turn the parietal peritoneum produces a shift:

A. To the left in white blood cell countB. Of the somatic phase to the visceral phaseC. Of the pain to the right lower quadrantD. Of the innervating nerve fibers

15. This is a rapid method of taking fresh tissue in the operating room and staining it for microscopic study so that the slides can be examined in a short period of time. It is a highly accurate method of diagnosis with the main purpose of making a therapeutic decision. It is ideal for thyroid, breast and other soft tissue tumors:

A. Open biopsyB. Frozen section biopsyC. Fine needle aspiration biopsyD. Exfoliative cytology

16. Masses in the upper cervical region may be related to metastatic lesions coming from the:A. StomachB. PancreasC. LungsD. Nasophayrnx

17. All of these symptoms/complaints for malignancies such as nasal, auricular, neuro-ophthalmic, and tumoral symptom are exhibited by malignancies affecting the:

A. NasopharynxB. HypopharynxC. LarynxD. Cervical esophagous

18. An immediate neck exploration should be done with penetrating injuries involving which zone of the neck?

A. IB. IIC. IIID. All of the above

19. The immediate cause of death from untreatable asphyxiation in thermal airway injury is:A. Mucosal and sub-mucosal edemaB. ErythemaC. HemorrhageD. Ulceration

20. The small bowel segment most susceptible to primary disease is:A. JejunumB. Duodenal bulbC. IleumD. Jejuno-ileal junction

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21. Among young patients with hereditary descending colon cancer, the accepted most radical surgical option would be:

A. Left hemicolectomyB. Extended left hemicolectomyC. Total proctocolectomyD. Total abdominal colectomy

22. For CEA (carcino embryonic antigen) to be useful in the postoperative monitoring for cancer recurrence, at what value must it be preoperatively?

A. More than 1.0 ng/mlB. More than 2.1 ng/mlC. More than 4.6 ng/mlD. More than 6.0 ng/ml

/Ref. pp 126523. The cecum is the most common site of colonic rupture as explained by the Laplace’s law

which states that tension is directly proportional to the ___ of a sphere.A. DiameterB. Wall thicknessC. RadiusD. Circumference

(Answer C/MPL – 0.6/Ref. pp 1265)24. Cancerous lesions of the anal verge usually drain to the:

A. Inguinal nodesB. Nodes at origin of sigmoid artery branchesC. Sacral nodesD. Internal iliac nodes

25. When colonic pseudo-obstruction is suspected and the cecal diameter is greater than 12 cm, the initial approach should be:

A. Colonoscopic decompressionB. Barium enemaC. Transverse loop colostomyD. Cecostomy

26. Bird’s beak deformity in volvulus points to the:A. ObstructionB. Gangrenous segmentC. CauseD. Potential point of rupture

27. Full rectal prolapse patients with normal sphincteric function should be treated with:A. Thiersch procedureB. Perineal proctectomyC. Low anterior resectionD. Abdomino-perineal resection

28. Hemorrhoids that bleed, prolapse and require manual reduction are classified as:A. 1st degreeB. 2nd degreeC. 3rd degreeD. 4th degree

29. The most common complication after an excisional hemorrhoidectomy is:A. BleedingB. InfectionC. Fecal impactionD. Urinary retention

(Answer C/ MPL – 0.3/Ref. pp 1265)30. Sistrunk procedure is done in:

A. Papillary carcinoma of thyroidB. Thyroid adenomaC. Thyroglossal duct cystD. Lingual thyroid

(Answer C/ MPL – 0.6/Ref. pp 1661)31. Most clinicians believe that the single most sensitive test of thyroid function is:

A. T4B. T3

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C. TSHD. Free thyroxine index

32. When doing thyroidectomy for diffuse toxic goiter with severe ophthalmopathy, the extent should ideally be:

A. TotalB. Near totalC. Subtotal, bilateralD. Subtotal one lobe, total in the other

33. When a thyroid cyst is more than 4 cm in diameter or has solid and cystic components, thyroid lobectomy is recommended because:

A. Repeated aspiration may cause hemorrhageB. Repeated aspiration will not totally eradicate the cystC. Of high potential for malignancyD. Of high incidence of thyrotoxicity

34. The most commonly performed operation for stage II breast cancer is:A. Total mastectomyB. Modified radical mastectomyC. Classical radical mastectomyD. Quadrantectomy

35. The most common cause of valvular dysfunction in the Philippines:A. Infective endocarditisB. Rheumatic heart diseaseC. Papillary muscle rupture secondary to myocardial infarctionD. Congenital in origin

36. The best option for valvular surgery:A. Replacement with a bioprosthetic valveB. Replacement with a mechanical valveC. Replacement with an allograft or autograftD. Preservation of existing valve if repairable

37. Definite indications for Coronary artery bypass graft (CABG):A. Left main stenosis > 50%B. Proximal LAD stenosis > 90%C. Double valve disease > 50%D. Acute myocardial infarction > 6 hrs in CHF

38. Patients who had valvular replacement with mechanical valves would require anticoagulation for:

A. 4 weeksB. 3 monthsC. 6 months D. life

39. The three major coronary supply to the heart:A. Left anterior descending, right posterior descending, circumflex arteryB. Diagonal, right posterolateral artery, circumflex arteryC. Left anterior descending, right coronary artery, circumflex arteryD. Ramus intermedius, right coronary artery, circumflex artery

40. The best method of preserving the heart during bypass:A. Moderate hypothermic arrest at 32oCB. Profound hypothermic arrest at 12oCC. Fibrillatory arrestD. Cardioplegic arrest

41. Cardiac tamponade arising from massive pericardial effusion can present as a classical syndrome of Beck’s triad. The following are components of the triad, EXCEPT:

A. Elevation of systemic venous pressureB. Systemic arterial hypertensionC. Distant heart soundsD. Engorged neck veins

42. The most common tumor in the anterior mediastinum:A. ThymomaB. Foregut cystC. Pericardial cystD. Neurofibroma

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43. The following congenital heart disease presents with decreased pulmonary blood flow EXCEPT:

A. Tetralogy of FalotB. Tricuspid atresiaC. Aortopulmonary windowD. Hypoplastic left heart syndrome

44. Blalock-Tausig shunt, a palliative systemic-to-pulmonary artery shunt is indicated in the following, EXCEPT:

A. Tetralogy of FalotB. Tricuspid atresiaC. Pulmonary atresiaD. Truncus arteriosus

45. The most radioopaque stone among the following isA. Uric acid stoneB. Cystine stoneC. Struvite stoneD. Calcium phosphate stone

46. The following may be manifestations of renal tumors EXCEPTA. PainB. MassC. HematuriaD. None of the above

47. The most common presentation of Urinary Bladder tumors is:A. Suprapubic massB. Gross or microscopic hematuriaC. Urinary frequencyD. Fever

48. The most common testicular tumor of childhood is:A. SeminomaB. TeratomaC. Embryonal carcinomaD. Choriocarcinoma

49. The histology of ureteral cancers are generally:A. AdenocarcinomaB. Squamous cell carcinomaC. Transitional cell carcinomaD. Choriocarcinoma

50. Benign prostatic hypertrophy (BPH) arises in the :A. Peripheral zoneB. Transition zoneC. Central zoneD. Anterior fibromuscular stroma

51. The following statements are true regarding renal trauma, EXCEPT:A. Urinalysis is the most important laboratory test in the evaluation of renal traumaB. The degree of hematuria predicts the severity of renal injuryC. Hematuria is present in greater than 95% of renal traumaD. Gross hematuria is associated with more severe renal trauma than is microscopic

hematuria52. The most common histologic type of penile malignancies is:

A. Mucoid adenocarcinomaB. Clear cell adenocarcinomaC. Squamous cell carcinomaD. Rhabdomyosarcoma

53. The following are the organisms implicated in non specific urethritis EXCEPT:A. Chlamydia trachomatisB. Ureaplasma urealyticumC. Nisseria gonnorheaD. Trichomonas vaginalis

54. The normal capacity of the human urinary bladder:A. 150 – 250 ccB. 350 – 500 ccC. 800 – 1000 cc

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D. 50 – 150 cc55. The most common location of hypertensive intracerebral bleed:

A. Frontal lobeB. ThalamusC. PutamenD. Cerebellum

56. Transient disturbance of neurologic function without gross pathologic changes due to trauma is called:

A. Cerebral contusionB. Cerebral concussionC. Diffuse axonal injuryD. Hemorrhagic contusion

57. How does a 10cc volume pineal gland tumor cause increased intracranial pressure?A. Adding volume intracraniallyB. Increase in production of CSFC. Increased cerebral edemaD. Obstruction of the aqueduct of Sylvius

58. Ocular sign of uncal herniation:A. AnisocriaB. PapilledemaC. Conjunctival injection/congestionD. Medial deviation of eyeball

59. Most common cause of spontaneous subarachnoid hemorrhage:A. HypertensionB. Ruptured AV malformationC. Ruptured aneurysmD. Blood dyscrasia

60. A patient with gradually decreasing visual acuity and frequent urination with ophthalmologic finding of bilateral optic nerve atrophy would most likely have a:

A. Sphenoid wing meningiomaB. Occipital lobe astrocytomaC. Cerebellar tumor (medulloblastoma)D. Pituitary tumor

61. When the mean arterial blood pressure decreases, the cerebral arteriesA. VasoconstrictB. VasodilateC. Remain the sameD. Develop obstruction due to thrombosis

62. Common location of otogenic brain abscess is:A. FrontalB. ParietalC. TemporalD. Occipital

63. Cardiac or carotid plaque embolism usually lodges in which branch of the internal carotid artery?

A. Anterior cerebral arteryB. Ophthalmic arteryC. Middle cerebral arteryD. Posterior cerebral artery

64. Definitive diagnostic procedure for intracranial vascular anomaly such as aneurysm or AV malformation is:

A. CT ScanB. MRIC. Cerebral angiogramD. CSF analysis for evidence of hemorrhage

For question numbers 65 – 67 please refer to the case below.

A 45 year old male complaining of sudden onset of epigastric pain started about 5 hours ago was seen at the emergency room. Vital signs includes BP=125/80 mmHg PR= 95/min RR= 25/min Temp = 37.8 o C. Significant physical examination include direct and rebound tenderness with guarding all over the abdomen, hypoactive bowel sounds.

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65. Your initial clinical impression would most likely be:A. Acute appendicitisB. Acute pancreatitisC. Perforated peptic ulcerD. Intestinal obstruction

66. The single most important X ray procedure should include:A. Chest PAB. Flat plate of the abdomenC. Upright film of the abdomenD. Chest AP

67. Your impression would be confirmed by the presence of what findings in the above X-ray?A. Presence of air-fluid levelB. Presence of pneumoperitoneumC. Presence of soft tissue density at the right lower quadrantD. Presence of gallbladder shadow

For question numbers 68 – 70 please refer to the case below.

A 55 year old female complaining of recurrent right upper quadrant tenderness specially after a fatty meal. The pain usually disappears after a while.

68. What is the most likely condition that the patient may have?A. Hydrops gallbladderB. Empyema gallbladderC. CholecystolithiasisD. Acute cholecystitis

69. The single most important laboratory examination to document the problem is:A. UltrasoundB. Serum bilirubin (direct type)C. CBCD. Chest X-ray

70. The pain persisted for more than 24 hours and is getting more severe. The patient was seen in the emergency room. In your PE, you were able to elicit direct tenderness on the right subcostal area on deep inspiration. This maneuver is known as:

A. Murphy’s punch signB. Murphy’s signC. McMurphy’s punch signD. McMurphy’s sign

71. Conditions to consider in a 25 year old male patient presenting with right lower quadrant pain:

A. Acute appendicitisB. Ruptured ovarian cystC. Tubo-ovarian abscessD. Ectopic pregnancy

72. Which of the following conditions may present with pneumoperitoneum?A. Ruptured appendicitisB. Perforated peptic ulcerC. Ruptured gallbladderD. All of the above

73. Primary peritonitis may occur in association with:A. Chronic renal failureB. Perforated peptic ulcerC. Acute appendicitisD. Cholecystolithiasis

74. A 28 year old female, single presents with sudden onset of generalized abdominal tenderness. Patient has a pulse rate of 110/min and BP of 80/60 mmHg. Direct and rebound tenderness of the abdomen. A single most important laboratory examination to confirm your diagnosis is:

A. Chest PA X-rayB. CBC

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C. Pregnancy testD. Ultrasound of the biliary tree

75. The risk for development of invasive breast cancer is 8-10 times higher compared to the base population if the histologic findings show:

A. Atypical lobular hyperplasiaB. Florid hyperplasiaC. Sclerosing adenosisD. Sever ductal hyperplasia

76. With invasion of cancer cells in the surrounding breast parenchyma, the accompanying fibrosis shorten the suspensory ligament of Cooper producing:

A. Nipple retractionB. Peau d orangeC. UlcerationD. Satellite nodule

77. The most important risk variable for recurrence of breast cancer is?A. Tumor histologyB. Tumor gradeC. Tumor Estrogen receptor statusD. Tumor size

For question numbers 78 – 79 please refer to the case below.

A 56 year old married male from Mandaue City was seen at the emergency room because of hematemesis and melena. He is a known heavy alcoholic drinker for the past 20 years and often times skip meals. PE: BP= 80/50 mmHg PR = 120/min RR = 24/min Skin: pale Sclerae: non icteric; Abdomen: globular, slightly distended, soft, palpable liver edge and spleen, positive shifting wave.

78. The probable cause of bleeding in this patient is:A. Esophageal tear from vomitingB. Acute gastritisC. Peptic ulcerD. Gastro-esophageal varices

79. The probable source of bleeding can be best identified with:A. Insertion of nasogastric tubeB. Upper gastrointestinal seriesC. EndoscopyD. Ultrasonography

80. Which of the following is the most common acid-base disturbance in patients with liver cirrhosis and portal hypertension?

A. Metabolic alkalosisB. Metabolic acidosisC. Respiratory alkalosisD. Respiratory acidosis

81. Which of the following statements most accurately describes the current therapy of pyogenic hepatic abscess?

A. Antibiotics alone are adequate for the treatment in most casesB. All patients require open surgical drainage for optimal managementC. Optimal treatment involves treatment of not only the abscess but the underlying

source as wellD. Percutaneous drainage is more successful in multiple rather than in solitary lesions

For question numbers 82 – 86 please refer to the case below.

A 36 year old female 5’5” in height, 100 lbs with history of passing out ascaris per stool in her childhood comes to you with complaints of colicky epigastric pain, intermittent jaundice, and intermittent acholic stools. Pertinent physical examination: Temp= 39.8 o C BP = 80/50 mmHg PR= 120/min; Skin: cold, clammy perspiration; sclerae: (+) jaundice; Abdomen: Flat, soft, (+) tenderness at the epigastric and right subcostal area, no palpable mass appreciated; Total serum bilirubin: 6 mg%

82. The most probable diagnosis is:A. Carcinoma of the common bile ductB. Sclerosing cholangitisC. Choledocholithiasis

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D. Choledochal cyst

83. The clinical manifestations of shock is most probably due to:A. HemorrhageB. Perforation of the gallbladderC. CholangitisD. Generalized peritonitis

84. If your diagnosis is a choledochal cyst, what is the most pertinent PE finding in the abdomen?

A. Board like rigidityB. MassC. Rebound tendernessD. Absent bowel sounds

85. If your diagnosis is sclerosing choalngitis, the pathology involves mainly the:A. Intrahepatic ductsB. Extrahepatic ductsC. GallbladderD. All of the above

86. If your diagnosis is carcinoma of the distal common bile duct, what is the pathological finding in the gallbladder?

A. InflamedB. DistendedC. ContractedD. Normal

87. What is the initial immediate treatment of patients with septic shock?A. Exploratory laparotomyB. Blood transfusion resuscitationC. Isotonic solution resuscitationD. Vasoconstrictor drugs

88. Requisites for cleft lip surgery according to the “Rule of Tens” include:A. Age of at least 10 monthsB. Body weight of no less than 10 kgs.C. WBC count not more than 10,000/ cummD. Hemoglobin of 10 gms or less

89. Which of the following statements regarding skin grafts and flaps is NOT VALID?A. Facial defects are best covered by either full thickness grafts or random pattern graftsB. Areas of dense scaring, defects with exposure to vital structures and those where

secondary surgical procedures are still planned are ideally covered with full thickness skin graft

C. Split thickness skin grafts are usually harvested using a dermatome from the the thigh or anterior abdomen

D. Myocutaneous flaps provide viable coverage of composite defects, with good restoration of form, contour and symmetry

90. Clinical signs suggestive of facial bone fractures include all of the following, EXCEPT:A. Subconjunctival hemorrhageB. MalocclusionC. EpistaxisD. Ectropion

91. Most common ligament injured in ankle sprain:A. Posterior talofibular LigB. Calcaneo-fibular LigC. Ant Talofibular Lig D. Spring Ligament

92. Blood clotting noted in veins of Lower Extremities:A. Deep vein thrombosisB. VaricositiesC. Pulmonary embolismD. Chronic Venous Insufficiency

93. Pain on calf muscles noted on walking, commonly in diabetics:A. ArthropathyB. Diabetic footC. Ulcer

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D. Claudication94. Splint for fractures in lower extremity:

A. Jefferson splintB. Skin SplintC. Thomas splintD. Sling & Swathe

95. Fracture in one side of cortex:A. TorusB. GreenstickC. CompressionD. Epiphyseal Fractures

96. Disease entity that features destruction of large joint commonly seen in elderly:A. Osteopetrosis B. OsteoporosisC. OsteoarthritisD. Rheumatoid arthritis

97. Decrease in bone mass with altered bone microarchitecture and fracture risks:A. OsteopeniaB. OsteoarthritisC. OsteoporosisD. Osteopetrosis

98. Nerve affected in carpal tunnel syndrome:A. Median NerveB. Musculocutaneous N.C. Femoral nerveD. Posterior interosseos N.

99. Muscle group that gives stability to the shoulder:A. ScapulothoracicB. TrapeziusC. DeltoidD. Rotator cuff

100. 45 year old female post total abdominal hysterectomy & salphingo-ophorectomy. Long term complication includes:

A. OsteoporosisB. Osteoarthritis C. AnemiaD. Calcium Deficiency

Reference:

Schwartz, S; Shires, T; Spencer, F. (editors). Principles of Surgery, 7 th edition, 1999. New York: McGraw-Hill

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