question

GASTRO

answer

1_M

question

Neoplastic diseases in which splenectomy may play a role in the management if hypersplenism include (Multiple):

answer

Hairy cell Leukemia Chronic Lymphocytic Leukemia (CLL) Non-Hodgkin Lymphoma

question

Choose the correct statements for gastric cancer: (Multiple)

answer

Weight loss is one of the most common symptom. Surgical resection is the only curative treatment. Gastric epithelial cancers are almost always adenocarcinoma. H.Pylori infection has an important role in the etiology of this disease.

question

What are the most frequent complications of cholelithiasis? (Multiple)

answer

Gangrene of the gallbladder. Perforation of the gallbladder. Cholangitis.

question

Choose the clinical signs and symptoms most often associated with a pancreas pseudocyst? (Multiple)

answer

Palpable abdominal mass. Pancreatic cyst demonstrated by ultrasound or CT scan. Serum Amylase elevation.

question

What is the annular pancreas? (Multiple)

answer

Ring of pancreatic tissue from the head of the pancreas surrounding the descending duodenum. A rare congenital condition.

question

Choose the characteristic clinical signs and symptoms associated with acute pancreatitis (Multiple)

answer

Abdominal pain, frequently with back pain. Elevated serum amylase and lipase. Nausea and vomiting.

question

Routine treatment of the primary hepatocellular cancer may include: (Multiple)

answer

surgical resection. Arterial chemo-embolisation. Percutaneous ethanol injection. Radiofrequency ablation.

question

From the following options which are the main etiologic factors of hepatocellular carcinoma? (Multiple)

answer

HCV infection. HBV infection.

question

Which of the following conditions are NOT possible causes of prehepatic jaundice? (Multiple) Hemolysis, Crigler-Najar sy and Gilbert disease are possible reasons.

answer

Sphincter of Oddi stenosis. Choledocholithiasis.

question

Which are the most frequent causes of benign biliary obstruction? (Multiple)

answer

Sphincter of Oddi stenosis. Cholidocholithiasis. Chronic pancreatitis.

question

Choose the true statements for Hepatocellular Carcinoma (HCC): (Multiple)

answer

Can be associated with all causes of cirrhosis. HCC comprises around 80% of all primary hepatic malignancies.

question

Surgery is indicated in patients with GERD: (Multiple)

answer

Young patient who require chronic therapy with proton pump inhibitors for control of symptoms. Patients with Barrett esophagitis. Patients in whom regurgitation persists during adequate drug therapy.

question

Choose the correct statements for acute peptic perforation: (Multiple)

answer

Epigastrial muscle guarding is a typical finding. The patient may or may not mention preceding chronic symptoms of peptic ulcer disease.

question

Choose the most common causes of massive upper GI hemorrhage from the following conditions: (Multiple)

answer

Peptic ulcer. Esophageal Varices.

question

Choose the true statements for the Veress needle (Multiple)

answer

Developed by Janos Veres, a hungarian chest physician. A needle equipped with a spring loaded obturator that is used for insufflation of the abdomen in laparascopic surgery.

question

The most common complications of peptic ulcers are: (Multiple)

answer

Bleeding. Perforation.

question

Common symptoms of gastric cancer are: (Multiple)

answer

Anorexia, weight loss. Postprandial abdominal heaviness. Vomiting.

question

Which statement(s) is/are true about gastric cancer? (Multiple)

answer

Surgical resection is the only curative treatment. H.pylori is an etiologic factor.

question

Symptoms acute calculous cholecystitis: (Multiple)

answer

Fever and leukocytosis. Stone(s) on the gallbladder on ultrasound. Right upper quadrant pain.

question

Common complications of acute cholelithiasis: (Multiple)

answer

Development of pancreatitis. Gallbladder perforation.

question

Main advantages of laparascopic cholecystectomy: (Multiple)

answer

Better cosmetic results. Less pain than after the traditional cholecystectomy.

question

Choose the correct establishment about the anatomy of the liver: (Multiple)

answer

The portal vein is formed by the confluence of the splenic and superior mesenteric veins. There are three major hepatic veins: left, right and middle.

question

Etiologic factors of primary liver cancer are: (Multiple)

answer

Chronic hepatitis B and C virus infections Longstanding chronic cholelithiasis Cirrhosis from almost any cause (Alcohol abuse, hemachromatosis, primary biliary cirrhosis, toxins)

question

Potential treatment for metastatic neoplasms of the liver are: (Multiple)

answer

Chemotherapy Radiofrequency ablation Angiographic embolisation Hepatic resection

question

Most common etiologic factors of acute pancreatitis are: (Multiple)

answer

Alcohol abuse Cholelithiasis

question

Symptoms of acute pancreatitis: (Multiple)

answer

Severe epigastric or mid-abdominal pain decreased or absent bowel sounds elevated serum amylase and urinary amylase nausea and vomiting

question

True establishments about the prognosis of pancreatic adenocarcinoma are: (Multiple)

answer

Following a whipple procedure, survival averages about 18 months overall 5 year survival is about 10% Mean survival following palliative therapy is 7 months

question

Disorders associated with secondary hypersplenism are: (Multiple)

answer

Myeloproliferative disease Chronic hemolytic disease Portal or splenic vein obstruction

question

Indications for splenectomy are: (Multiple)

answer

Primary splenic tumor Hereditary spherocytosis

question

Disadvantage of laparoscopic surgery: (Multiple)

answer

Loss of tactile information 2-dimensional rendition on the screen Expensive instruments

question

Which two are among the most common laparoscopic operations? (Multiple)

answer

Cholecystectomy Inguinal hernia repair

question

Select the absolute contraindications of laparoscopic cholecystectomy (Multiple)

answer

Severe cardio-respiratory insufficiency suspected diffuse peritonitis patient is unfit for general anesthesia

question

Select those diseases that are typically presented with right subcostal pain (Multiple)

answer

cholecystitis Cancer of the hepatic flexure

question

Select the correct statement for Zollinger-Ellison syndrome! (Multiple)

answer

Zollinger-Ellison syndrome is manifested by gastric acid hyperscretion caused by gastrin producing tumor Hypergastrinemia in the presence of acid hypersecretion is almost pathognomonic for Zollinger Ellison syndrome Hemorrhage, perforation and obstruction are common complications

question

Select the correct statement for gastric cancer! (Multiple)

answer

H. pylori is known to be a cause of chronic atrophic gastritis, which in turn is a recognized precursor of gastric adenocarcinoma The earliest symptom is usually vague postprandial abdominal heaviness the overall 5 year survival rate of gastric cancers is about 10-15%

question

From the following options which are produced by the gastric parietal cells in the stomach (Multiple)

answer

Gastric acid Intrinsic factor

question

What are the major complications of a large pancreatic pseudocyst? (Multiple)

answer

Infection rupture hemorrhage

question

What are the most common cellular types of the primary liver cancer? (Multiple)

answer

Hepatocellular carcinoma cholangiocellular carcinoma

question

Select the correct answer regarding liver disease: (Multiple)

answer

about 75% of patients with HCC are positive for HBsAG or hepatitis C symptomatic liver cysts are best treated with laparoscopic fenestration (unroofing)

question

What structures do normally run in the hepatoduodenal ligament? (Multiple)

answer

proper hepatic artery portal vein common bile duct

question

select the correct answers:

answer

The child-pugh score is used to assess the prognosis of chronic liver disease clamping of the portal inflow pedicle (Pringle Maneuver) for short periods is commonly used to minimize blood loss during hepatic surgery Liver function may be impaired for several weeks after an extensive liver resection

question

what are the possible treatment options for a pancreatic pseudocyst? (Multiple)

answer

Percutaneous CT-guided drainage internal drainage to the stomach internal drainage to the jejunum external surgical drainage

question

Which statements are true for the treatment of a diffuse type gastric cancer? (Multiple)

answer

the typical surgery is total gastrectomy with D2 lymphadenectomy Lymph node involvement is generally an indication for systemic chemotherapy

question

Which statement is true for biliary tract malignancies? (Multiple)

answer

the peak of onset is above 40 years of age PSC (primary sclerosing cholangitis) is a major risk factor in the development of the disease

question

Which statements are true for peptic ulcer? (Multiple)

answer

The standard medical treatment is administration of PPI's. Underlying H.Pylori infection can be detected in many cases

question

During a Billroth II surgery we: (Multiple)

answer

create an anastomosis between the stomach and jejunum Remove the distal part of the stomach

question

Generally speaking, which of the following conditions necessitate performing a total gastrectomy? (Multiple)

answer

Histologically confirmed cardia tumor diffuse type gastric cancer on the corpus

question

Which if the following statements are true for GIST? (Multiple)

answer

Gastrointestinal stromal tumors are rare mesenchymal tumors that can arise anywhere in the GI tract. GIST have now been identified as originating from the interstitial cells of Cajal. GIST are often diagnosed incidentally at endoscopy. Surgical resection is the primary treatment.

question

If ERCP cannot be performed in a patient, what other methods can be commonly used for the assessment of the extrahepatic biliary tract? (Multiple)

answer

MRCP Surgical exploration Percutaneous transhepatic cholangiography

question

Which blood vessels are connected directly to the liver? (Multiple)

answer

Portal vein Proper hepatic artery hepatic veins

question

Select the correct statements about hepatic diseases. (Multiple)

answer

FNH is more prevalent in women and often associated with the oral contraceptive pill In advanced cases of primary sclerosing cholangitis liver transplantation is an option.

question

Which statements are correct for acute pancreatitis? (Multiple)

answer

Gallstones and alcoholism together account for about 80% of acute pancreatitis worldwide Activation of trypsin is probably the key initiating event in the onset of acute pancreatitis The most severe stage of acute pancreatitis is associated with pancreatic necrosis. In severe acute gallstone pancreatitis, urgent ERCP and sphincterectomy should be carried out within 72 hours.

question

GASTRO

answer

1_S

question

From the following options which is the main use of the Dormia basket?

answer

It is used to remove stones from the biliary tract during ERCP

question

CHOOSE THE FALSE ANSWER! Posthepatic jaundice most often results from Right answers; Stricture of the biliary tract, Choledocholithiasis and biliary obstruction by a malignant tumor.

answer

WRONG ANSWER: hemolysis

question

From the following options which describes best the typical clinical manifestation of posthepatic mechanical icterus?

answer

Yellow skin and/or sclera, dark urine, light colored stool.

question

What is Mirizzi syndrome?

answer

Biliary stricture secondary to direct compression by chronically impacted cystic duct gallstone or chronically inflamed gallbladder.

question

Select the correct statement regarding pancreas pseudocysts!

answer

Pseudocysts are lined with granulation tissue.

question

From the following substances which is produced in the islets of Langerhans?

answer

Glucagon

question

Which procedure is NOT approved for the treatment of gallbladder cancer? which are; cholecystectomy alone or with lymphadenectomy and/or hepatic resection, biliary stenting.

answer

NOT approved: cholecystectomy + pancreatic resection + lymphadenectomy

question

which is the most common histological type of gastric cancer?

answer

adenocarcinoma

question

Which is not a damaging factor to the gastric mucosa in relation to development of peptic ulcer?

answer

Prostaglandins

question

From the following options, which arteries provide the primary blood supply of the stomach?

answer

Left and right gastric arteries, left and right gastro-epiploic arteries.

question

Which enzyme is produced in the pancreas in an inactive form?

answer

Trypsin

question

Four days after an uneventful Billroth-II gastric resection, a 55 year old man suddenly develops severe upper abdominal pain. On examination, his abdomen is rigid and he has a fever. The probable diagnosis is:

answer

Duodenal stump leak.

question

Which of the following is NOT associated with splenonmegaly? ARE associated; Portal HTN, spherocytosis, Lymphomas, Malaria.

answer

NOT associated with splenomegaly: Sickle cell disease.

question

Which statement is true for pancreatic cancer in general?

answer

The traditional procedure for a resectable pancreatic head malignancy is the Whipple operation.

question

Please select the structures that surgeons dissect during a normal laparoscopic cholecystectomy.

answer

Cystic duct and cystic artery.

question

Which statement is true for acute pancreatitis?

answer

The most common cause are alcohol abuse and biliary tract disorders.

question

From the following options select the scoring system currently used to help predict the severity of acute pancreatitis.

answer

APACHE-II

question

From the following options which is the most typical complication of a cancer in the head of the pancreas?

answer

Obstruction in the common bile duct.

question

Partial gastric resection is indicated in the following case:

answer

Small antrum tumor with intestinal type Lauren Classification

question

Which of the following statements is NOT true for laparascopic cholecystectomy when compared to open procedure? ARE true: shorter hospitalization time, less postop pain, better cosmetic results.

answer

NOT true; rate of complications is lower.

question

From the following treatment options which is the most appropriate for a patient with suddenly developing jaundice, proven gallstones and no signs of acute abdomen?

answer

Urgent ERCP followed by laparoscopic cholecystectomy.

question

Which of the following conditions presents as an indication for hepatic resection?

answer

Solitary liver metastasis

question

Which is the most characteristic sign of gastric perforation in the first hour?

answer

Sharp epigastric pain

question

Which disease is treated by the Heller operation?

answer

Achalasia of the cardia

question

Which of the following conditions is H.pylori infection NOT associated with?

answer

Acute Gastritis

question

From the following options which characteristics or studies can preoperatively distinguish a benign gastric ulcer from a cancer?

answer

Multiple biopsies.

question

Which conditions is NOT associated with an increased risk of gastric cancer?

answer

Acute Alcoholic gastritis

question

Which of the following is the characteristic feature of the Mallory-Weiss sy?

answer

Rupture of the esophageal mucosa and the gastric mucosa in the region of the cardia.

question

The most frequent severe complication of a Roux-en-Y type gastric resection?

answer

Dehiscence of the duodenal stump (anastomotic leakage)

question

Regarding hepatic diseases, which statement is true?

answer

The liver has such a good regeneration potential that often as much as 75-80% of the hepatic volume can be removed during surgery.

question

The most prevalent cause of mortality due to a duodenal ulcer can be:

answer

Hemorrhage

question

The treatment of choice fro a symptomatic pancreatic abscess is:

answer

External drainage

question

Select the condition which is most likely to be candidate for laparoscopic splenectomy:

answer

Idiopathic thrombocytopenic purpura

question

All of the following factors cause acute pancreatitis EXCEPT:

answer

Reduced serum calcium level. That DO cause acute pancreatitis; hyperglycemia and glycosuria, high urinary amylase level, prolonged coagulation time, high surges of serum amylase level.

question

What is the most severe possible complication of acute cholangitis?

answer

Hepatic abscess

question

The incidence of biliary stones is supposed to increase after which of the following operations?

answer

Resection of the ileum

question

Which of the following compounds is contraindicated following a liver resection?

answer

Hypnotic analgesics

question

Characteristic features of thrombocytopenic purpura include all of the following EXCEPT:

answer

Significant splenomegaly is present. ARE characteristic; female prevalence, normal or increased megakaryocyte count in bone marrow, subnormal platelet count in blood, petechiae, ecchymoses or hemorrhages.

question

Splenectomy has a beneficial effect in all of the following hemolytic conditions EXCEPT:

answer

Hemolytic anemia due to glucose 6 Phosphatase deficiency IS beneficial in; Sickle cell disease, Thalassemia, hereditary spherocytosis and hereditary elliptocytosis.

question

Spontaneous rupture of the spleen may occur in all of the following conditions EXCEPT:

answer

Portal HTN May occur in: Malaria, Polycythemia vera, leukemia, infectious mono

question

Gastric carcinoma develops most frequently in the region of the:

answer

pyloric and antral region

question

From the following options CANNOT be used in the treatment of achalasia?

answer

Intraluminal cryotherapy. Can be used: Heller's myotomy, Balloon dilation and self expandable stent implantation.

question

All of the following procedures are appropriate for the treatment of verified cholecoholithiasis EXCEPT:

answer

Percutaneous extraction of biliary calculi using a Dormia basket. are appropriate: Transduodenal sphincteroplasty, choledochotomy and T-tube drainage, endoscopic papillotomy and extraction of biliary calculi.

question

Regarding the prognosis of gastric adenocarcinoma, which of the following statements is FALSE:

answer

Length of survival is improved by chemo and radiation therapy after curative resection. TRUE; cure rates of 80-90% are obtained for lesions confined to the mucosa, the intestinal histo type carries a better prognosis than the diffuse type, the polypoid macroscopic type carries a better prognosis than the diffusely infiltrating type.

question

The pathologic lesion characteristic of the mallory-weiss syndrome is:

answer

Laceration of the mucosa at the gastroesophageal junction.

question

Which of the following disorders is associated with an elevated serum alpha-fetoprotein level?

answer

Carcinoma of the liver

question

Which of the following is the anatomic border between the left and right lobes of the liver?

answer

the line connecting the fossa of the gallbladder and the fossa of the inferior vena cava.

question

Which statement is not true for gastric cancer in general?

answer

NOT true: the generally accepted complex treatment is surgery, irradiation, chemo and hormone therapy. TRUE: in linitis plastica only total gastrectomy is considered oncologically radical, a CT scan helps to assess the infiltration of the surrounding organs/tissues and the most frequent signs are weight loss, abdominal pain and vomiting or bleeding.

question

What is NOT considered a frequent complication after splenectomy?

answer

NOT: Pulmonary embolism IS a common complication; subphrenic abscess, postsplenectomy fever, bleeding.

question

Which operation is the most commonly accepted in acute necrotizing pancreatitis?

answer

Necrectomy + drainage

question

What is NOT a typical symptom in peptic ulcer disease?

answer

NOT: fresh blood in the stool IS: melena, bloating, nausea, vomiting, abdominal or epigastric pain.

question

The landmark delineating the junction of the antral and the fundic regions on the lesser curvature of the stomach is the:

answer

Angular incisure

question

Stress ulcers have been observed in all of the following conditions EXCEPT:

answer

NOT observed during penicillin administration. IS observed; after salicylate ingestion, in CNS lesions, after severe burns and after alcohol ingestion.

question

A 45 year old female patient has undergone a laparoscopic cholecystectomy. Three days after the procedure, she gradually develops signs of acute abdomen and fever. The possible cause may be, EXCEPT:

answer

NOT: Pulmonary embolism Possible causes: perforation of the transverse colon, development of acute pancreatitis, injury of the common bile duct, injury of the hepatic duct.

question

All of the following are true for pain associated with pancreatitis EXCEPT:

answer

NOT: Colic subcostal pain IS: abrupt onset, the pain radiates to the back, diffuse mid-abdominal pain, unremitting (generalized) pain.

question

From the following options which is the most common type of weight reduction surgery?

answer

Laparoscopic adjustable gastric banding.

question

Which of the following procedures is performed on the stomach?

answer

Selective vagotomy

question

Approx what is the normal diameter of the common bile duct in adults?

answer

6-8mm

question

Which is NOT a typical complication of laparocopic cholecystectomy?

answer

Dissection of the cystic duct. IS: hematoma under the liver, postop bile leak, common bile duct lesion.

question

Metabolic consequences of gastric resection include:

answer

macrocytic anemia

question

All of the following statements are valid regarding gastric polyps EXCEPT:

answer

NOT: gastric polyps are not expected to undergo malignant transformation. TRUE: gastric polyps; have propensity for multiple occurence, develop on atrophic gastric mucosa, my develop first after puberty and can develop as a feature of a familial disease.

question

Which vessel provides the blood supply of the pancreas?

answer

Both the superior mesenteric artery and the celiac trunk.

question

Which is the most common form of the gallbladder perforation?

answer

Localized perforation with pericholecystic abscess.

question

An absolute contraindication of laparoscopic cholecystectomy?

answer

Inability to tolerate general anesthesia.

question

What is the gold standard treatment of symptomatic cholelithiasis?

answer

Laparoscopic cholecystectomy

question

In an operable pancreatic head malignancy which is considered the most successful operation?

answer

Pancreatoduodenectomy

question

Which disease is characterized by a mid-abdominal, "belt-like" pain?

answer

Pancreatitis

question

What is the most common benign tumor of the liver?

answer

Hemangioma

question

What is the main disadvantage of the Billroth-1 operation?

answer

The bile and pancreas fluid can easily reflux to the gastric stump.

question

What is the main advantage of the roux en Y anastomosis in gastric resection?

answer

Passage of food and bile is well separated, thus reducing the risk of bilirary reflux.

question

Which statement is true?

answer

The blood supply to the duodenum is from the superior and inferior pancreaticoduodenal arteries.

question

TRUE or FALSE: the vast majority of gastric ulcers are located on the lesser curvature of the stomach.

answer

TRUE

question

TRUE or FALSE: peptic ulcer is the most common cause of massive upper GI hemorrhage.

answer

TRUE

question

What is the most appropriate curative surgical treatment of an early stage proximal biliary tract malignancy (Klatskin tumor)?

answer

Bile duct resection + hepaticojejunostomy

question

What is the typcial formation of the major vessels in the hepatoduodenal ligament?

answer

In the hepatoduodenal ligament the hepatic artery is to the left of common bile duct and the portal vein is posterior and medial.

question

What does the abbreviation PTC stand for when speaking of biliary tract disease?

answer

Percutaneous Transhepatic Cholangiography

question

TRUE or FALSE: chemical and shockwave lithotripsy is commonly used in the treatment of gallbladder stones as an alternative to surgery?

answer

FALSE

question

In chronic pancreatitis, if the Wirsungian duct is dilated, which surgical technique can be used best to relieve pain and facilitate pancreatic drainage?

answer

Longitudinal pancreaticojejunostomy

question

What is the courvoisier's sign in pancreas cancer?

answer

A palpable non-tender gallbladder in a jaundiced patient suggesting neoplastic obstruction of the common bile duct.

question

What are the key parts of the classic Whipple operation?

answer

Resection of the common bile duct, the gallbladder, the duodenum and the pancreas to the mid-body.

question

Select the correct answer! (about the formation of the portal vein)

answer

The portal vein is formed by the confluence of the splenic and superior mesenteric veins.

question

Which statement is FALSE when speaking of gastric resections? The billroth I resection is now considered somewhat outdated -After total gastrectomy the continuity of the GI tract is most often reestablished by a Roux-en-Y esophagojejunostomy -A cancer in the cardia most often allows for a Billroth II subtotal resection. -Total gastrectomy with splenectomy is required for tumors of the proximal half of the stomach and for extensive tumors.

answer

FALSE: A cancer in the cardia most often allows for a Billroth II subtotal resection.

question

What is the Virchow node in gastric cancer?

answer

A lymph node in the left supraclavicular fossa which may be metastatic in advanced stage gastric cancer.

question

What is the duct of Wirsung?

answer

The main pancreatic duct.

question

TRUE or FALSE: during a cholecystectomy the cystic vein has to be carefully ligated to prevent postoperative hemorrhage.

answer

FALSE

question

TRUE or FALSE: Damage of the hepatic artery is a well known complication during a laparoscopic cholecystectomy.

answer

FALSE

question

Choose the substances that contribute to the development of gallstones: Lecithin Cholesterol Bile salts All of the above

answer

All of the above.

question

What is the Atlanta classification?

answer

It is a scoring system used in acute pancreatitis to assess clinical manifestations and prognosis.

question

Which statement is NOT true for Chrons's disease: -CD is characterized by long remission periods followed by acute onsets -Surgical intervention is reserved for the treatment of severe complications. -CD is rarely seen outside of the small bowels. -The disease can lead to the development of intra- or extraabdominal fistulae and abscesses.

answer

FALSE: CD is rarely seen outside of the small bowels.

question

Select the statement which is NOT characteristic of ulcerative cholitis: -UC affects only the large bowels. -The most frequent surgical related complications are bleeding and perforation. -UC can turn into malignancy. -UC is one of the major representatives of IBD. -UC is usually diagnosed after 50 years of age.

answer

FALSE: -UC is usually diagnosed after 50 years of age.

question

What is the average overall 5 year survival rate in gastric cancer? (all stages considered) 0-5% 10-20% 30-40% 40-50% 50-60%

answer

10-20%

question

What do you have to do with the common bile duct during a laparoscopic cholecystectomy? -Close it with metal clips -Close it with sutures -Open and put in a t-tube -Open and put in an expanding stent -None of the above

answer

None of the above

question

Which one of the following describes the Roux-en-Y anastomosis? -Gastro-duodenostomy -Gastro-jejunostomy -Gastro-duodenostomy and jejuno-jejunostomy -Gastro-jejunostomy and jejuno-jejunostomy -Gastro-jejunostomy and gastro-duodenostomy

answer

-Gastro-jejunostomy and jejuno-jejunostomy

question

Select the correct description regarding the normal anatomy of the extrahepatic ducts:

answer

The right and left hepatic ducts join to form the common hepatic duct; this in turn is joined by the cystic duct to from the common bile duct.

question

What is the main function of the sphincter of Oddi?

answer

It prevents reflux of the duodenal contents into the common bile duct and pancreatic duct.

question

What is the indocyanine-green retention test when speaking of liver diseases?

answer

It can be used to assess the functional reserve of the liver before surgery.

question

TRUE or FALSE: The most common elective indication for splenectomy is immune thrombocytopenic purpura (ITP) in which antiplatelet antibodies lead to platelet destruction and an increased risk of spontaneous hemorrhage.

answer

TRUE.

question

GASTRO SURGERY

answer

2_M

question

From the following options which surgical techniques can be routinely used in the treatment of ulcerative colitis? (Multiple) -Proctocolectomy with ileo-anal anastomosis and ileum pouch -Proctocolectomy with ileostomy -Left sided hemicolectomy -Total colectomy with ileo-rectal anastomosis -Proctocolectomy with sigmoidostomy

answer

Proctocolectomy with ileo-anal anastomosis and ileum pouch. Proctocolectomy with ileostomy. Total colectomy with ileo-rectal anastomosis.

question

From the following options which are the most frequent causes of small bowel obstruction in adults? (Multiple) -Congenital atresia -Malignancy -Diverticulitis -Adhesion -Stricture

answer

Malignancy Adhesion Stricture

question

Which statements are true for the pathogenesis of bowel obstruction? (Multiple) -Bacterial overgrowth and translocation may lead to septic complications -Impaired bowel wall perfusion leads to ischemia and necrosis -Obstruction leads to decreased intraluminal pressure and decreased absorption -Fluid is sequestrated in the mucosal cells resulting in hypovolaemia

answer

Bacterial overgrowth and translocation may lead to septic complications. Impaired bowel wall perfusion leads to ischemia and necrosis.

question

Seeing which symptoms should you always think of the possibility of an inflammatory bowel disease? (Multiple) -Chronic constipation -Frequent vomiting -Diarrhea for more than 4 weeks -Abdominal pain -Stool containing blood, mucus or pus

answer

Diarrhea for more than 4 weeks. Abdominal pain. Stool containing blood, mucous or pus.

question

What are the main symptoms of Chron's disease in general? (multiple) -Pyelonephritis -Liver disorders -Erythema nodosum -Perianal fistulae -Arthritis

answer

Liver disorders. Erythema nodosum. Arthritis.

question

Which of the following statements are true for colorectal cancer (CRC)? (Multiple) -Colonoscopic screening of the general population has been proved to increase survival. -Surgical resection can provide the only curative treatment modality in most of the cases. -Rectal cancer has slightly better prognosis than colonic cancer due to easier diagnosis. -About 10-20% of CRC cases might be palpated through the anus (rectal exam). -Around 20% of all colorectal malignancies are familial.

answer

Surgical resection can provide the only curative treatment modality in most of the cases. About 10-20% of the CRC cases might be palpated through the anus (rectal exam). Around 20% of all colorectal malignancies are familial.

question

Which sign is NOT characteristic for intestinal obstruction? (Multiple) Vomiting Rectal bleeding Absent or hyperactive bowel movement Sharp epigastrial pain Constant severe pain

answer

Rectal bleeding. Sharp epigastric pain. Constant severe pain.

question

Which diseases are associated typically with a right lower quadrant abdominal pain? (Multiple) -Diverticulitis -Right ovarian torsion -Appendicitis -Pancreatitis -Choledocholithiasis

answer

Right ovarian torsion. Appendicitis.

question

Choose the indirect signs of appendicitis: (Multiple) -Rovsing sign -Blumberg sign -Psoas sign -Horner sign -Trotter sign

answer

Rovsing sign Blumberg sign Psoas sign

question

Regarding the cause of aseptic "chemical" peritonitis, which of the following statements are true? (Multiple) -Barium produces peritonitis because of bacterial contamination associated with visceral perforations. -Endotoxic peritonitis cannot occur unless there is perforation of the bowel. -When bile gets into the abdominal cavity, it might eventually be contaminated by the gut flora. -Patients receiving H2 blockers have an increased risk for bacterial colonization of gastric contents. -In the absence of secondary infection, sterile bile does not irritate the peritoneum.

answer

When bile gets into the abdominal cavity, it might eventually be contaminated by the gut flora. Patients receiving H2 blockers have an increased risk for bacterial colonization of gastric contents.

question

Concerning the clinical presentation of peritonitis, which of the following statements are true? (Multiple) -Peritonitis is usually associated with marked elevations of the white blood cell count. -High-pitched bowel sound become prominent as bowel wall edema leads to progressive compromise of the intestinal lumen. -Temperature elevation may be only minimal in infants and debilitated elderly patients. -Patients with peritonitis frequently shift position in order to relieve the pain. -Procalcitonin may be elevated in bacterial peritonitis.

answer

Temperature elevation may be only minimal in infants and debilitated elderly patients. Procalcitonin may be elevated in bacterial peritonitis.

question

The therapy of the initial phase of an acute diverticulitis includes: (Multiple) -Intravenous fluid replacement. -Administration of systemic antibiotics. -Liquid or low fiber diet. -Surgical resection of the affected part. -Loop colostomy for mechanical decompression.

answer

Intravenous fluid replacement. Administration of systemic antibiotics. Liquid or low fiber diet.

question

Surgical decompression of the dilated and distended bowels during surgery is beneficial because: (Multiple) -It facilitates closure of the abdominal wound. -It reduces the risk of a wound infection. -It reduces the risk of postoperative hernia formation. -It removes toxins from the intestinal lumen. -It improves the circulation of the intestinal wall.

answer

It facilitates closure of the abdominal wound. It removes toxins from the intestinal lumen. It improves the circulation of the intestinal wall.

question

Causes of extracellular hypovolemia developing in intestinal obstruction include: (Multiple) -Fluid sequestration in the intestinal wall. -Vomiting and the suction of gastric content through a nasogastric tube. -Fluid sequestration in the lumen of the obstructed intestinal loops. -Fluid loss into the abdominal cavity.

answer

Fluid sequestration in the intestinal wall. Vomiting and the suction of gastric content through a nasogastric tube. Fluid sequestration in the lumen of the obstructed intestinal loops. Fluid loss into the abdominal cavity.

question

Typical radiographic signs of small bowel obstruction are: (Multiple) Abnormal gas content in the small bowel. Multiple air fluid levels. Free air on the right side, under the diaphragm. Absence of gas in the large bowel.

answer

Abnormal gas content in the small bowel. Multiple air fluid levels. Absence of gas in the large bowel.

question

The characteristic features of intestinal obstruction include: (Multiple) Vomiting Per rectal bleeding Colicky abdominal pain No flatus is passed Distended abdomen

answer

Vomiting Colicky abdominal pain No flatus is passed Distended abdomen

question

The treatment of paralytic ileus includes: (Multiple) Bowel decompression by a nasogastric tube Intravenous fluid replacement Bowel motility support Early surgery

answer

Bowel decompression by a nasogastric tube Intravenous fluid replacement Bowel motility support

question

Which of the following statements are true for colorectal surgery? (Multiple) -Neoadjuvant chemoradiation is reserved for a locally advanced, low rectal cancer. -Worldwide overall 5-year survival is around 70% in colorectal cancer (all stages considered). -Local excision may be adequate in early stage rectal cancer. -Laparoscopic techniques have minimal role in colorectal surgery.

answer

Neoadjuvant chemoradiation is reserved for a locally advanced, low rectal cancer. Local excision may be adequate in early stage rectal cancer.

question

What are the frequent spots of metastasis formation in rectal cancer? (Multiple) Skin Bone Liver Spleen Lung

answer

Bone Liver Lung

question

Which of the following treatment modalities can be routinely used in the treatment of a Stage 3 colonic cancer (ascending colon)? (Multiple) TNF-alpha inhibitors VEGF inhibitors Chemotherapy Irradiation Surgical resection

answer

VEGF inhibitors Chemotherapy Surgical resection

question

An increased risk of developing colorectal cancer has been PROVED in which of the following conditions? (Multiple) Familial Adenomatous Polyposis Prior cholecystectomy Diet high in red meats Ulcerative colitis Diet high in fibers

answer

FAP Diet high in red meats UC

question

The therapeutic regimen in IBD may include the following drugs: (Multiple) Steroids Immunosuppressants TNF-alpha inhibitors VEGF inhibitors Antibiotics

answer

Steroids Immunosuppressants TNF-alpha inhibitors Antibiotics

question

Which of the following statements are TRUE when comparing Crohn's disease to ulcerative colitis (UC)? (Multiple) -Proctocolectomy is usually performed in Crohn's disease, but not in UC. -The bowel infiltration is often transmural in UC and superficial in Crohn's. -Perianal involvement is common in Crohn's and usually rare in UC. -The risk of malignant transformation is higher in UC than in Crohn's. -Ulcerative colitis is more frequent than Crohn's disease.

answer

Perianal involvement is common in Chron's and usually rare in UC. The risk of malignant transformation is higher in UC than in Chron's

question

Which of the following statements are TRUE for surgery in Crohn's disease? (Multiple) -Perirectal disease may respond to resection of diseased small bowel. -During a bowel resection in Crohn's disease, the surgeon should remove as large portion of the bowel as possible to prevent future recurrence. -The most common indications for operation are obstruction and abscesses. -The recurrence rate after operation is around 10%. -The surgery is usually curative.

answer

Perirectal disease may respond to resection of diseased small bowel. The most common indications for operation are obstruction and abscesses.

question

Which statements are TRUE for colorectal cancer? (Multiple) -Fast growing, aggressive malignancies which metastasize early. -Tumors on the right colon side tend to bleed earlier. -Semimalignant lesions. -With complex oncologic treatment the average 5-year survival can reach 50-60%. Rectal cancer is more prone to cause bowel obstruction than colonic cancer.

answer

Tumors on the right colon side tend to bleed earlier. With complex oncologic treatment the average 5-year survival can reach 50-60%. Rectal cancer is more prone to cause bowel obstruction than colonic cancer.

question

Which of the following options can be routinely used for the surgical treatment of hemorrhoids? Hemorrhoidectomy Elastic band ligation Stapled hemorrhoidopexy Anterior resection Abdominoperineal resection

answer

Hemorrhoidectomy Elastic band ligation Stapled hemorrhoidopexy

question

Which of the following statements are true about Laparoscopic Adjustable Gastric Banding (LAGB)? (Multiple) -An inflatable band is placed around the gastroesophageal junction. -The diameter/volume of the gastric band can be adjusted through a subcutaneous port. -During LAGB surgery a part of the stomach is resected and a gastro-jejunostomy is performed. -One of the most fearsome complications during LAGB surgery is esophageal perforation. -The LAGB is a non-reversible bariatric surgery.

answer

An inflatable band is placed around the gastroesophageal junction. The diameter/volume of the gastric band can be adjusted through a subcutaneous port. On of the most fearsome complications during LAGB sugery is esophageal perforation.

question

Select the correct statements about gastric bypass surgery (weight-loss surgery). (Multiple) -Since gastric bypass is a relatively complicated surgery, it is rarely performed by laparoscopic means -Of the available techniques, it is one of the most effective -The effect is considered irreversible -During gastric bypass surgery a part of the stomach is resected and a gastro-jejunostomy is performed -It's complication rate is one of the lowest among the available methods

answer

Of the available techniques, it is one of the most effective. The effect is considered irreversible. During a gastric bypass surgery a part of the stomach is resected and a gastro-jejunostomy is performed.

question

Which of the following methods are routinely used for weight-loss (bariatric) surgery? (Multiple) Laparoscopic Adjustable Gastric Banding Gastric Bypass Duodenal Switch Vertical banded gastroplasty

answer

Laparoscopic Adjustable Gastric Banding Gastric Bypass Duodenal Switch Vertical banded gastroplasty

question

From the following options which can be used for the treatment of symptomatic hemorrhoids? (Multiple) Medical management Elastic band ligation Photocoagulation Parks hemorrhoidectomy Dixon hemorrhoidectomy

answer

Medical management Elastic band ligation Photocoagulation Parks hemorrhoidectomy

question

Select the correct statements regarding the treatment of anal fissures. (Multiple) -Lateral internal sphincterotomy is the procedure of choice after conservative measures have failed. _Lateral external sphincterotomy is the procedure of choice after conservative measures have failed. -Stool softeners, bulking agents, and sitz baths will heal 90% of anal fissures. -Nitric oxide relaxes the internal sphincter and improves blood flow to the anoderm

answer

Lateral internal sphincterotomy is the procedure of choice after conservative measures have failed. Stool softeners, bulking agents and sitz baths will heal 90% of anal fisures. Nitric oxide relaxes the internal sphincter and improves blood flow to the anoderm.

question

Select the causes of an acute abdomen for which surgery is NOT indicated. (Multiple) Diabetic crisis Duodenal ulcer Incarcerated hiatal hernia Acute rheumatic fever Myocardial infarction

answer

Diabetic crisis Duodenal ulcer Acute rheumatic fever Myocardial infarction

question

Select the correct statements regarding ulcerative colitis. (Multiple) -Toxic megacolon occurs in approximately two thirds of the patients. -Perianal fistulae are frequent and may precede diagnosis of intestinal disease. -X-Ray studies reveal confluent, diffuse involvement of the large bowel. -Inflammatory reaction is usually limited to mucosa and submucosa. -Recurrence is common even after a total colectomy in the anastomosis line.

answer

X-ray studies reveal confluent, diffuse involvement of the large bowel. Inflammatory reaction is usually limited to mucosa and submucosa.

question

Select the correct statements regarding Crohn's disease. (Multiple) -Typical morphological changes include segmental involvement of the bowel, lymphadenomegaly, thickened mesocolon. -Perianal fistulae are frequent and may precede diagnosis of intestinal disease. -Recurrence is common even after an extensive surgery. -Surgery should always precede any medical treatment to increase the effectiveness of the drugs. -Any portion of intestinal tract may be involved; may be limited to ileum and right colon.

answer

Typical morphological changes include segmental involvement of the bowel, lymphadenomegaly, thickened mesocolon. Perianal fistulae are frequent and may precede diagnosis of intestinal disease. Recurrence is common even after extensive surgery. Any portion of intestinal tract may be involved; may be limited to the ileum and right colon.

question

From the following options which diseases are the most frequent causes of acute abdomen? (Multiple) Appendicitis Small and large bowel obstruction Perforated peptic ulcer Acute gastritis Hepatitis infection

answer

Appendicitis Small and large bowel obstruction Perforated gastric ulcer

question

What surgery can be generally performed in the obstructing lesions of the right colon? (Multiple) Right hemicolectomy Left hemicolectomy Formation of an ileostomy (two-staged surgery) Proximal bypass in inoperable cases Total proctocolectomy

answer

Right hemicolectomy Formation of an ileostomy (two-staged surgery) proximal bypass in inoperable cases

question

Select the correct answers regarding colorectal cancer. (Multiple) -Whenever persistent rectal bleeding occurs, even in the presence of hemorrhoids, cancer must be ruled out. -The sigmoid colon has a large caliber and the fecal content here is fluid; thus, sigmoid cancers usually attain quite large size before they are diagnosed. -The most specific tumormarker for colorectal cancer is AFP (alpha-fetoprotein). -Regional lymph node metastasis is the most common form of tumor spread in colorectal cancer. -Endorectal ultrasound is now routinely used in the diagnosis and staging of rectal cancer.

answer

Whenever persistent bleeding occurs, even in the presence of hemorrhoids, cancer must be ruled out. Regional lymph node metastasis is the most common form of tumor spread in colorectal cancer. Endorectal ultrasound is now routinely used in the diagnosis and staging of rectal cancer.

question

Select the correct statements regarding ulcerative col itis. (Multiple) -The diseased areas are contiguous and extend proximally from the rectum. -Except in the most severe forms, the muscular layers are spared. -Emergency operation is indicated for proved or suspected perforation of the colon. -The cardinal symptoms are obstruction and vomiting. -The mortality rate of ulcerative colitis stayed high during the past decades.

answer

The diseased areas are contiguous and extend proximally from the rectum. Except in the most severe forms, the muscular layers are spared. Emergency operation is indicated for proved or suspected perforation of the colon.

question

Which statements are true for Crohn's Disease? (Multiple) -Crohn's Disease ultimately becomes a transmural inflammatory process with thickening of the bowel wall. -Laboratory findings are nonspecific and vary greatly according to the site of intestinal involvement. -Deformity of the cecum, fistulas, abscesses, and skip lesions can be seen with imaging studies. -Intestinal complications, such as obstruction, abscess, fistula, and anorectal lesions, are very common. -The distal jejunum is becoming diseased in about three fourths of patients.

answer

Crohn's Disease ultimately becomes a transmural inflammatory process with thickening of the bowel wall. Laboratory findings are nonspecific and vary greatly according to the site of intestinal involvement. Deformity of the cecum, fistulas, abscesses, and skip lesions can be seen with imaging studies. Intestinal complications, such as obstruction, abscess, fistula, and anorectal lesions, are very common.

question

Which statements are true for inflammatory bowel diseases in general? (Multiple) -Symptoms usually develop at young adolescent age. -They are usually diagnosed in elderly patients. -Surgical treatment is usually reserved in complicated cases. -The primary treatment is usually surgical. -The small bowel are more frequently involve.

answer

Symptoms usually develop at young adolescent age. Surgical treatment is usually reserved in complicated diseases. The small bowel are more frequently involved.

question

Select the correct answers for the acute abdomen! (Multiple) -Fever is often mild or absent in elderly, chronically ill, or immunosuppressed patients. -Extreme pallor, hypothermia, bloody vomiting and sweating suggest severe peritonitis. -General observation affords a fairly reliable indication of the severity of the clinical situation. -Tenderness is usually poorly demarcated in acute cholecystitis, appendicitis and diverticulitis. -A rectal examination should be performed in most patients with an acute abdomen.

answer

Fever is often mild or absent in elderly, chronically ill, or immunosuppressed patients. General observation affords a fairly reliable indication of the severity of the clinical situation. A rectal examination should be performed in most patients with an acute abdomen.

question

From the following options, in which diseases has a plain abdominal X-ray scan real diagnostic significance? (Multiple) Appendicitis Bowel obstruction Splenic rupture Gastric perforation Ovarial torquation

answer

Bowel obstruction. Gastric perforation.

question

Which of the following diagnostic signs and symptoms are characteristic of a complete or incomplete bowel obstruction? (multiple) Fever Presence of intra-abdominal fluid on abdominal X-ray Presence of air-fluid levels on abdominal X-ray Dehydration and/or electrolyte abnormalities Vomiting

answer

Presence of air-fluid levels on abdominal X-ray Dehydration and/or electrolyte abnormalities Vomiting

question

From the following options what are the real disadvantages of the neoadjuvant chemoradiotherapy when treating a rectal cancer? (Multiple) -The cancer may shrink making it more difficult to find during surgery. -Neoadjuvant administration of chemotherapy makes postoperative treatment impossible. -The surgery can be performed only several months later. -Preoperative irradiation may cause radiation damage to the bowels. -A stenosing rectal cancer may cause bowel obstruction - requiring urgent surgery - during the prolonged treatment period.

answer

The surgery can be performed only several months later. Preoperative irradiation may cause radiation damage to the bowels. A stenosing rectal cancer may cause bowel obstruction - requiring urgent surgery - during the prolonged treatment period.

question

GASTRO SURGERY

answer

2_S

question

Which of the following statements is NOT characteristic to large bowel obstruction? No passage of flatus or stool Symptoms generally develop late Gradual increase of diffuse pain Vomiting comes early, may be feculent On X-ray small and large bowels are filled with gas

answer

Vomiting comes early, may be feculent.

question

What is the correct definition of a T3 colorectal cancer?

answer

Tumor invades into subserosa or into non-peritonealized pericolic or perirectal tissue.

question

What is the main genetic pathomechanism in the development of HNPCC (Hereditary Non-Polyposis Colorectal cancer)?

answer

mutation of the mismatched repair genes

question

What is the characteristic feature of the pain found in duodenal ulcer perforation?

answer

Sharp, epigastric pain gradually shifting to the lower abdomen and becoming more diffuse.

question

What is the abdominoperineal resection?

answer

Removal of the rectum and anus with the sphinchter, creating a permanent ostomy.

question

Which disease is associated typically with a lower left qudrant abdominal pain?

answer

Diverticulitis

question

What does T3N1Mx colorectal cancer stand for?

answer

Tumor infiltrates the subserosa, 1-3 positive lymph nodes, no information on distal metastasis.

question

Which of the following signs and symptoms is NOT characteristic to a proximal mechanical ileus?

answer

Rectal bleeding. What ARE characteristic signs of proximal mechanical ileus: abdominal pain, nausea and vomiting and abdominal distension.

question

Which is the proper treatment from the following options for a large cecal tumor infiltrating the abdominal wall?

answer

Palliative resection with primary anastomosis.

question

Which one is NOT a sign of peritoneal irritation in appendicitis?

answer

Horner sign Which ARE a sign of peritoneal irritation in appendicitis: Psoas, Rovsing and Blumberg signs.

question

From the following options which is the most frequent cause of mechanical ileus?

answer

Obstructing tumor

question

Which one is the proper treatment in fecal peritonitis caused by a perforating sigmoid tumor?

answer

Hartmann's procedure

question

Regarding Chron's, which of the following statements are correct? -The disease involves the proximal ileum in the majority of the cases. -It is characterized by transmural inflammation and skip lesions. -The long-term base therapy is based on administration of systemic steroids. -The risk for malignant transformation decreases over the course of disease.

answer

It is characterized by transmural inflammation and skip lesions.

question

Concerning the clinical presentation of peritonitis, which of the following statements are true? -Peritonitis is always associated with marked elevations of the white blood cell count -High-pitched bowel sound become prominent as bowel wall edema leads to progressive compromise of the intestinal lumen -Temperature elevation may be only minimal in infants and debilitated elderly patients -Before the diagnosis can be confirmed, there must be x-ray evidence of ileus and obliteration of the psoas shadow -Patients with peritonitis frequently shift position in order to relieve the pain

answer

Temperature elevation may be only minimal in infants and debilitated elderly patients

question

In which of the following primary malignancies has the resection of hepatic metastasis the most pronounced effect on survival?

answer

Colorectal

question

An increased risk of developing colonic cancer is associated with the following conditions EXCEPT: Diet low in animal fat and protein Crohn's disease Ulcerative colitis Familial polyposis Diabetes mellitus

answer

Diet low in animal fat and protein

question

Villous adenomas (hairy polyps) are best treated by:

answer

Local excision of the lesion.

question

All of the following statements are valid regarding the development of cancer in patients with ulcerative colitis EXCEPT: -The incidence of cancer increases proportionally to the duration of the disease. -The prognosis is poor. -The age of onset of ulcerative colitis determines the incidence of any associated cancer. -The malignant neoplasms develop from pseudopolyps. -The neoplasms are multiple, circumscribed and invasive.

answer

The malignant neoplasms develop from pseudopolyps

question

All of the following statements are valid regarding perforated appendicitis EXCEPT: -It is more prevalent among the poor. -In acute appendicitis, early antibiotic therapy prevents the perforation of the processus vermiformix. -The incidence of this condition is higher in very young or old patients. -Perforated appendicitis still carries significant mortality and morbidity rates.

answer

In acute appendicitis, early antibiotic therapy prevents the perforation of the processus vermiformix.

question

Which is the most reliable physical finding in acute appendicitis?

answer

Localized right lower quadrant tenderness.

question

What is the Hartmann's procedure?

answer

Two-staged bowel resection with the formation of a temporary ostomy.

question

What is the currently accepted surgical treatment of an anal fissure?

answer

Lateral internal sphincterotomy

question

What is the role of postoperative irradiation in colonic cancer?

answer

Irradiation is not part of the routine therapeutic practice.

question

Elevated CEA (carcinoembryonic antigen) levels have been observed in all of the following conditions EXCEPT: Breast cancer Myeloma Carcinoma of the pancreas Lung cancer Colonic cancer

answer

Myeloma

question

Colonic obstruction due to a sigmoid cancer is best treated by:

answer

Resection and temporary colostomy

question

From the following procedures which can be performed in a rectosigmoid cancer causing incomplete obstruction?

answer

Resection with primary anastomosis.

question

The anatomical border between the anus and the rectum is the:

answer

Dentate line

question

The most prevalent type of colorectal polyps is:

answer

Tubular adenoma

question

From the following options which is true for IBD? -The typical age at the onset of the disease is around 60-70 years. -The exact pathomechanism of the disease is well established. -Severe rectal bleeding is more common in ulcerative colitis than in Crohn's disease. -The most common symptoms are epigastric pain and vomiting.

answer

Severe rectal bleeding is more common in ulcerative colitis than in Crohn's disease

question

The operation of choice for congenital megacolon is: Splanchnicectomy Total colectomy None of the above Enterostomy Colostomy

answer

None of the above

question

Which of the following procedures is appropriate for the definitive diagnosis of congenital megacolon? Pancreatic enzyme activity measurements from stool Radiographic examination Sweat test Stool culture and parasitology Rectal biopsy

answer

Rectal biopsy

question

All of the following statements are true regarding thrombosed hemorroids EXCEPT: -The appearance of a tense, bluish, tender induration on the anal border. -Prompt surgical decompression brings symptomatic relief. -Hemorrhoids usually resolve within 24 hours. -The abrupt appearance of a painful external bulge in the anal region. -An untreated lesion has a tendency to ulcerate and bleed.

answer

Hemorrhoids usually resolve within 24 hours

question

In which condition is a "drain-pipe" colon a characteristic feature visible on X-ray taken after a barium enema? Granulomatous enteritis Ulcerative colitis Familial polyposis Tuberculosis of the colon Amebiasis

answer

Ulcerative colitis

question

The most appropriate surgical intervention for a rectal cancer located 3 cm above the anal verge is:

answer

Abdominoperineal resection of the rectum.

question

Mechanical ileus do to obstruction by a biliary stone develops most frequently in the:

answer

Ileum

question

The most common cause of massive rectal bleeding is:

answer

colonic diverticulosis

question

All of the following drugs can induce GI bleeding, EXCEPT: Anticoagulants Corticosteroids Phenothiazines Salicylates Alcohol

answer

Phenothiazines

question

Which of the following statements is the most appropriate following the resection of a carcinoma of the descending colon? Checking the stool for occult bleeding every 3 months Monitoring of the serum CEA, US and colonoscopy at regular intervals Abdominal US and barium enema repeated every 6 months Abdominal US and colonoscopy repeated every 6 months Sulfasalazine (Salazopyrine) and prednisone therapy

answer

Monitoring of the serum CEA, US and colonoscopy at regular intervals

question

All of the following are appropriate in the treatment of pseudommembranous colitis EXCEPT: Metronidazole therapy The correction of electrolyte- and fluid losses Vancomycin therapy Corticosteroid therapy Discontinuing the causative antibiotic(s)

answer

Corticosteroid therapy

question

Characteristic features of ischemic colitis are influenced by all of the following factors, EXCEPT: The patency of the collateral circulation The intensity of the inflammation The extent of bacterial invasion The duration of obstruction The extent of vascular obstruction

answer

the intensity of the inflammation

question

All of the following are present in longstanding Ulcerative Colitis, EXCEPT; Dull, grayish mucosal surface Shrinkage and thickening of the mesentery Enlarged masses comprised of lymph node conglomerates Perforation and abscesses along the mesenteric margin Shortening of the gut

answer

Enlarged masses comprised of lymph node conglomerates

question

What is the least prevalent site for the development of intraperitoneal abscess?

answer

The peritoneal sac.

question

The most common factor in the etiology of acute appendicitis is?

answer

Mechanical obstruction.

question

Which of the following disorders may cause paralytic ileus? Annular pancreas Diffuse peritonitis Volvulus Obstructing colonic cancer Intussusception/invagination

answer

Diffuse peritonitis.

question

In people over the age of 50, the incidence of colonic diverticula is approximately...?

answer

30-40%

question

In Chron's disease the most frequent indication for surgery is:

answer

Intestinal obstruction

question

In which disease is the "string sign" a characteristic feature?

answer

Chron's

question

All of the following are intestinal complications of Chron's disease EXCEPT; Intestinal obstruction Colonic polyposis Fistula formation Rectal bleeding Perforation

answer

Colonic polyposis

question

All of the following are extraintestinal manifestations of Chron's EXCEPT Erythema nodosum Uveitis Arthritis An increased risk of malignant transformation Portal fibrosis

answer

An increased risk of malignant transformation

question

The most important sign of appendicitis is :

answer

Right lower abdominal quadrant pain.

question

All of the following signs are present in mesenteric artery obstruction EXCEPT: Bloody stool An urge to defecate Sudden pain around the umbilicus Bowel sounds reflecting permanently hyperactive peristalsis The pain is disproportionally intense compared to the severity of physical signs

answer

Bowel sounds reflecting permanently hyperactive peristalsis

question

Intestinal diverticula develop most frequently in the:

answer

Sigmoid colon

question

What percent of the small intestine can be removed without severe consequences on digestive capacity and the subsequent risk of metabolic disorders?

answer

70%

question

Select the correct statement regarding HNPCC (Hereditary Non-Polyposis Colorectal Cancer): The appearance of concomitant extracolonic malignancies is very rare The diagnosis can be made based on the Vienna and Berlin criteria Characterized by the appearance of colorectal cancer before the age of 50 Basically it is another name for FAP

answer

Characterized by the appearance of colorectal cancer before the age of 50

question

What is the main role of ultrasound in the diagnosis of rectal cancer?

answer

It provides detailed information on the depth of bowel wall penetration of tumor

question

Apart from the TNM system, what other clasification is commonly used in the staging of colorectal cancer?

answer

Dukes classification

question

Select the FALSE answer regarding GIST: GIST is one of the most common epithelial tumors of the gastrointestinal tract Most GISTs arise because of a mutation in a gene called c-kit Surgery is the mainstay of therapy for non-metastatic GISTs A tyrosine kinase inhibitor (imatinib, Glivec) can be used in the treatment of GIST

answer

GIST is one of the most common epithelial tumors of the gastrointestinal tract

question

All of the following statements are true for the treatment of fecal peritonitis caused by a perforated sigmoid tumor EXCEPT: Broad-spectrum systemic antibiotics should be administered Complex intensive supportive therapy is often required The abdominal cavity should be rinsed thoroughly with saline solution The abdominal cavity is commonly rinsed with broad-spectrum antibiotic solution The most commonly used surgical technique is the Hartmann's operation

answer

The abdominal cavity is commonly rinsed with broad-spectrum antibiotic solution

question

What is the most common radiological finding in small bowel obstruction?

answer

Air-fluid levels

question

In which segment of the anus are fissures most prevalent?

answer

Posteriorly in the midline

question

When do we speak of grade III hemorrhoids?

answer

The hemorrhoids prolapse upon defecation and must be reduced manually

question

What does TME stand for?

answer

Total Mesorectum Excision

question

What is the adequate treatment of an early stage carcinoid tumor (less than 2 cm, no lymph nodes) in the appendix?

answer

Appendectomy alone

question

The billroth II resection (gastro-duodenostomy) is a safe and easy procedure in gastric ulcer surgery, thus it is gaining more and more widespread use. Both parts of the sentence are TRUE The first part of the sentence is TRUE, the second part is FALSE The first part of the sentence is FALSE, the second part is TRUE Both parts of the sentence are FALSE

answer

BOTH PARTS OF THE SENTANCE ARE FALSE

question

In ulcerative colitis the endoscopic finding is usually segmental involvement of the bowel wall with or without skip areas, thus the surgical treatment is most often total colectomy or proctocolectomy. Both parts of the sentence are TRUE The first part of the sentence is TRUE, the second part is FALSE The first part of the sentence is FALSE, the second part is TRUE Both parts of the sentence are FALSE

answer

The first part of the sentence is FALSE, the second part is TRUE

question

What is the usual surgical treatment in acute mesenteric infarction (necrosis) involving more than three fourths of the small intestines and almost all of the large intestines?

answer

No resection should be done.

question

What is the obturator sign?

answer

Internal and external rotation of the flexed thigh exerts painful pessure.

question

which artery supplies the anorectum?

answer

The arterial supply of the anorectum is via the superior, middle and inferior rectal arteries.

question

From the following options which muscles form the pelvic floor? M. levator ani and m. puborectalis M. levator ani and m. cremaster M. puborectalis and m. obliquus abdominis M. levator ani and m. obliquus abdominis

answer

M. levator ani and m. puborectalis

question

What is the supposed level of obstruction in mechanical ileus of the abdominal x-ray shows dilated small and large bowels?

answer

Sigmoid

question

Select the correct statement regarding the adjustable gastric banding procedure (obesity surgery) This procedure may not be sufficient enough in super obese patients It has a very low long-term complication rate The main postoperative complication is anastomotic leakage Since no foreign body is implanted, this surgery is suitable for almost everybody

answer

this procedure may not be sufficient enough in super obese patients

question

Which of the following surgeries can be used in an extensive, non-healing perianal/scrotal abscess to facilitate the closure of the wound? Rectosigmoid resection Formation of a temporary double-barrel colostomy Formation of a temporary double-barrel ileostomy Abdominoperineal resection (exstirpation) Stapled hemorrhoidectomy

answer

Formation of a temporary double-barrel colostomy

question

Rectopexy is the surgical treatment for which of the following diseases? Rectal cancer Diverticulitis Rectal prolapse Rectovaginal fistula Perianal abscess

answer

Rectal prolapse

question

What is the most frequent cause of large bowel obstruction in adults?

answer

Cancer

question

The Amsterdam and Bethesda criterea are used in the diagnosis of which disease?

answer

HNPCC

question

TRUE OR FALSE: In an advanced stage colonic cancer (coecum), if the cancer is considered too large for resection, neoadjuvant chemo-radiotherapy is indicated in an attempt of tumor regression

answer

FALSE

question

TRUE OR FALSE? In mechanical ileus feculent vomiting is a typical sign of a proximal (duodenal or small bowel) obstruction

answer

FALSE

question

Which statement is FALSE for chron's ? Surgery is usually not curative Over the long term, about 70% of patients with CD undergo surgery Symptomatic strictures are usually treated by hemicolectomy Surgery should be used to manage complications in coordination with medical therapy

answer

Symptomatic strictures are usually treated by hemicolectomy

question

What does "colic pain" mean?

answer

Intermittent pain due to smooth muscle contraction of hollow viscera.

question

From the following options, which describes best a typical complete distal (e.g. sigmoid) bowel obstruction? First sign is vomiting, distended small and larger bowels, no or minimal stool Vomiting may come late, distended small and large bowels, no or minimal stool First sign is vomiting, minimal abdominal distension, no or minimal stool Vomiting may come late, minimal abdominal distension, almost normal stool

answer

Vomiting may come late, distended small and large bowels, no or minimal stools.

question

Which of the following options is FALSE for colonoscopy? Diagnostic colonoscopy should be performed in adults at the age of 50 and repeated periodically The main complications of colonoscopy procedures are perforation and bleeding The main advantage of colonoscopy over a barium enema is the possibility of biopsy taking and better visualization Colonoscopy is used mainly for diagnosis and has little therapeutic use Insufficient bowel preparation may severely limit the efficacy of colonoscopy

answer

Colonoscopy is used mainly for diagnosis and has little thereapeutic use.

question

If the patients has external hemorrhoids, what is the most frequent cause on an acute onset of severe perianal pain?

answer

Thrombosed hemorrhoid

question

Which of the following methods is NOT a common treatment option in hemorrhoid disease? Elastic band ligation Injection sclerotherapy Rectal excision Excisional hemorrhoidectomy Stapled hemorrhoidectomy

answer

Rectal excision

question

When speaking of rectal cancer, what does the term complete pathological response mean?

answer

There is no tumor mass in the surgically removed specimen with pathological examination after neoadjuvant therapy.

question

TRUE OR FALSE. Sigmoid diverticulae should be operated as soon as diagnosed since they can lead to inflammation and perforation

answer

FALSE

question

GENERAL SURGERY

answer

1_M

question

The most frequent complications of paraesophageal hernia are: (Multiple)

answer

Incarceration Hemorrhage

question

Choose the factors most often responsible for incisional hernia: (Multiple)

answer

Previous surgeries using the same incision Obesity Placement of drains or stomas in the primary operative wound. Postoperative wound infection.

question

From the following options choose the tension free operations for hernias of the abdominal wall: (Multiple)

answer

Sublay mesh implantation from laparoscopic approach. Lichtenstein repair

question

Aggravating factors of inguinal hernias are: (Multiple)

answer

Prostatic hyperplasia Intraabdominal malignancies Presence of ascites Chronic coughing

question

From the following options which factors contribute to the development of surgical infections? (Multiple)

answer

Closed, unperfused spaces Susceptible host Pathogen bacteria

question

Which is/are true about wound healing? (Multiple)

answer

Secondary intention occurs in open wounds Primary healing is simpler and requires less time Primary intention occurs when tissue is clearly incised Most infected wounds and burns heal secondary

question

Possible method for preventing surgical infections: (Multiple)

answer

Surgery in a sterile operating room Surgical hand washing use of antibiotic prophlaxis

question

Symptoms of tetanus:

answer

Opisthotonus Spasm of the facial muscles

question

Which of the following conditions form an absolute indication for surgery? (Multiple)

answer

Symptomatic gallstones Confirmed cancer of the ascending colon

question

Which of the following interventions are performed on with a diagnostic intent? (Multiple)

answer

Staging mediastinoscopy Submandibular lymph node biopsy

question

Which are true statements about inguinal hernias? (Multiple)

answer

The complications of incarceration, obstruction and strangulation are greater threats than are the risks of operation. Successful repair requires that any correctable aggravating factors be identified and treated. Inguinal hernias should always be repaired unless there are specific contraindications. Them most common cause is the weakness of the posterior inguinal wall.

question

Operations for inguinal hernia repair are: (Multiple)

answer

TAPP Liechtestein operation Shouldice

question

Possible etiological factors for incisional hernia are: (Multiple)

answer

Poor surgical technique Postoperative physical activity Length of incision Postoperative wound infection

question

Which of the following interventions are considered diagnostic surgeries? (Multiple)

answer

Lymph node biopsy Diagnostic laparoscopy

question

From the following options what are the two most common causes of wound healing failure? (Multiple) Hyperproteinaemia Coagulopathies Insufficient blood perfusion Inappropriate suturing material Insufficient oxygenization

answer

Insufficient blood perfusion insufficient oxygenization

question

From the following surgical infections which are spread via the bloodstream? (Multiple)

answer

Endocarditis Brain abscess Pyelphlebitis

question

Which of the following surgeries can be used for the treatment of a femoral hernia? (Multiple) Lichtenstein operation Mayo operation Fabricius operation Lotheissen-McVay operation Nissen operation

answer

Fabricus operation Lotheissen-McVay operation

question

Which of the following represent a RELATIVE indication for surgery? (Multiple) Asymptomatic gallstones Symptomatic inguinal hernia Appendicitis Colonic cancer Gastro-esophageal reflux disease

answer

Asymptomatic gallstones Gastro-esophageal reflux disease

question

Which of the following conditions are GENERALLY considered an absolute contraindication of surgery? (Multiple) Moribund state Age over 80 years Severe metabolic or hemostatic imbalance No patient consent Pregnancy

answer

Moribund state Severe metabolic or hemostatic imbalance No patient consent

question

Select the correct statements regarding inguinal hernias. (Multiple) A femoral hernia passes beneath the iliopubic tract and inguinal ligament into the upper thigh A weakness or defect in the transversal fascia at the Hasselbach triangle results in an indirect inguinal hernia An indirect inguinal hernia results when obliteration of the processus vaginalis, the peritoneal extension accompanying the testis in its descent into the scrotum, fails to occur An inguinal hernia that descends into the scrotum is almost certainly direct All symptomatic inguinal hernias should be repaired if the patient can tolerate surgery

answer

A femoral hernia passes beneath the iliopubic tract and inguinal ligament into the upper thigh. An indirect inguinal hernia results when obliteration of the processus vaginalis, the peritoneal extension accompanying the testis in its descent into the scrotum, fails to occur. All symptomatic inguinal hernias should be repaired if the patient can tolerate surgery.

question

What are the most important elements in the acute management of gas gangrene? (Multiple) Radical surgical exploration and necrectomy Administration of antibiotics (Penicillin) Local administration of hydrogen peroxide Immediate transfer to a hyperbaric chamber Immediate CT scans to evaluate the extent of the infection

answer

Radical surgical exploration and necrectomy Administration of antibiotics (Penicillin) Local administration of hydrogen peroxide

question

From the following options which are used in the treatment of a tetanus infection? (Multiple) Active immunization (tetanus toxoid) Passive immunization (TIG) Administration of antibiotics Hyperbaric treatment Surgical wound care

answer

Active immunization (tetanus toxoid) Passive immunization (TIG) Administration of antibiotics Surgical wound care

question

Which statements are true for the TAPP hernia surgery? (Multiple) This is a laparoscopic procedure for the treatment of an abdominal wall incisional hernia During this procedure a synthetic mesh is placed under the peritoneum to cover the defect. This procedure is ideal for the treatment of bilateral hernias. This procedure cannot be performed in recurrent hernias. This procedure is getting outdated nowadays due to its poor long-term results.

answer

During this procedure a synthetic mesh is placed under the peritoneum to cover the defect. This procedure is ideal for the treatment of bilateral hernias.

question

Surgeries usually performed on a cosmetic basis: (Multiple)

answer

Breast augmentation Liposuction

question

Which pathological processes play a role in the development of acute inflammation? (Multiple) Constriction of local blood vessels Decreased capillary permeability Fibrinogen polymerizing to fibrin in damaged tissue Drainage of inflammatory exudates to local lymph nodes and lymphatic vessels Leukocyte migration to the site of injury

answer

Fibrinogen polymerizing to fibrin in damaged tissue Drainage of inflammatory exudates to local lymph nodes and lymphatic vessels Leukocyte migration to the site of injury

question

Select the FALSE answers regarding groin hernias. (Multiple) The recurrence rate can reach 25% after a Lichtenstein hernia repair Inguinal hernias occur much more often in males because of the abdominal wall deficiency caused by testicular descent Direct hernias commonly enter the scrotum The incidence of femoral hernias is higher in women and increases with age If strangulation is not relieved by manual or operative reduction, infarction follows

answer

The recurrence rate can reach 25% after a Lichtenstein hernia repair Direct hernias commonly enter the scrotum

question

GENERAL SURGERY

answer

1_S

question

From the following options which statement is true for indirect inguinal hernias? They are slightly more common in females than males Indirect hernias occur medial to the inferior epigastric vessels The hernial sac protrudes below the inguinal ligament The hernial sac follows the course of the inguinal canal Indirect hernias occur medial to the superior epigastric vessels

answer

The hernial sac follows the course of the inguinal canal

question

Which statement is true? A symptomatic inguinal hernia is relative indication for surgery A symptomatic inguinal hernia is not an indication for surgery A symptomatic inguinal hernia is vital indication for surgery A symptomatic inguinal hernia is absolute indication for surgery A symptomatic inguinal hernia is cosmetic indication for surgery

answer

A symptomatic inguinal hernia is absolute indication for surgery

question

During a laparoscopic surgery, with what gas is the abdominal cavity traditionally insufflated?

answer

Carbon Dioxide

question

Best definition of Calot's triangle?

answer

An anatomic space bounded by the common hepatic duct, the cystic duct and the inferior edge of the liver.

question

What is the principle of the Liechtenstein operation?

answer

A synthetic mesh is placed over the defect, thus strengthening the abdominal wall.

question

What is the pinciple of the Bassini operation?

answer

The internal oblique muscle is approximated to the inguinal ligament, thus strengthening the abdominal wall.

question

Which statement is true for an irreducible inguinal hernia? Due to the incarceration of the hernia contents, an urgent surgery is required Non-surgical treatment is usually sufficient in these cases It is usually difficult to return the contents of the hernia sac to the abdominal cavity The contents of the hernia sac cannot be returned to the abdominal cavity

answer

The contents of the hernia sac cannot be returned to the abdominal cavity.

question

Select the surgical intervention which is routinely NOT performed by laparoscopic means! Gastrectomy Cholecystectomy Inguinal hernia repair Splenectomy Adrenalectomy

answer

Gastrectomy

question

Which of the following is an abbreviations for a laparoscopic surgery? VATS APR TAPP SNB

answer

TAPP

question

Select the correct definition of the vital indication for surgery!

answer

The disease can only be treated with an urgent/immediate surgery.

question

From the following options which is true for the tetanus infection? It is caused by bacteria from the Streptococcus species It is caused by bacteria from the Clostridium species It is caused by bacteria from the Enterococcus species It is caused by bacteria from the Escherichia species It is caused by bacteria from the Staphylococcus species

answer

It is caused by bacteria from the Clostridium species

question

What is the main principle in the treatment of perianal abscess?

answer

The abscess should be drained and the wound left open.

question

From the following options which is true for necrotizing fascitis? It spreads across the fascial planes within/under the subcutaneous tissue It is caused exclusively by Clostridium species It spreads alongside the long bones under the subcutaneous tissue The leading sign is the formation of skin rashes/blisters

answer

It spreads across the fascial planes within/under the subcutaneous tissue

question

In which situation are you allowed to operate on a patient without prior written consent? Minor patient with symptomatic cholelithiasis Adult patient with stable aortic aneurysm Adult patient with ruptured aortic aneurysm Adult patient with symptomatic cholelithiasis Patient under guardianship with a confirmed colonic cancer

answer

Adult patient with ruptured aortic aneurysm.

question

When was the first human laparoscopic cholecystectomy performed?

answer

in the 80's

question

Which of the following famous surgeons was awarded the Nobel prize? Theodor Billroth Cesar Roux Eduardo Bassini Theodor Kocher

answer

Theodor Kocher

question

Which is NOT considered a wound healing complication? Seroma Dehiscence Keloid formation Primary wound healing

answer

Primary wound healing

question

The most significant advantage of the tension free inguinal hernia repair over the conventional technique is: It's cheaper than the Bassini operation The patient can leave the hospital sooner Yields better cosmetic results The rate of recurrence is lower

answer

The rate of recurrance is lower

question

From the following options which factor does NOT impair the wound healing process? Mobilization of the patient Anemia Jaundice Chemotherapeutic drugs

answer

Mobilization of patient

question

Which pathogen is common cause of gas gangrene?

answer

Clostridium

question

Select the diseases that pose an absolute indication for surgery: Enlarged axillary lymph nodes Obstructing colonic cancer Large, symptomatic pancreatic pseudocyst Duodenal ulcer Stones in the common bile duct causing jaundice

answer

Obstructing colonic cancer

question

select the FALSE statement: Incisional hernia can develop wherever there is a scar on the abdomen Obesity and liver cirrhosis can aggravate the development of umbilical hernias Indirect inguinal hernia is the most common of the external abdominal wall hernias Reducible hernias require urgent operation within 12 hours

answer

Reducible hernias require urgent operation within 12 hours

question

Using of which anticoagulants requires close monitoring of the hemostatic parameters? Aspirin Low molecular weight heparin Ca-Heparin Clopidogrel

answer

Ca-Heparin

question

Which of the following operations CANNOT be used in the treatment of an inguinal hernia? Lichtenstein operation Bassini operation Shouldice operation Mayo operation TAPP (transabdominal pre-peritoneal hernia repair)

answer

Mayo operation

question

From the following options, which is characteristic to modern age surgery? Generally low degree of specialization Limited use of related resources (imaging techniques, laboratory tests, endoscopy) Lack of general anesthesia limits the feasibility of major abdominal interventions Research oriented, evidence based development of surgery

answer

Research oriented, evidence based development of surgery

question

Characteristics of the medieval medicine and surgery and Europe:

answer

Surgery practiced by barber surgeons

question

What is the typical rate of recurrence after a Lichtenstein inguinal hernia repair?

answer

under 2%

question

Which of the following statements is true regarding the Hesselbach's triangle? Defines the inguinal floor in the region of a direct inguinal hernia Is bounded medially by the inferior epigastric vessels Is found in a single plane of the inguinal floor and is bounded by the superior epigastric artery, inguinal ligament, and rectus sheath Defines the boundaries of a low lumbar hernia

answer

Defines the inguinal floor in the region of a direct inguinal hernia

question

Which of the following statements is true for hernias in general? Risk of incarceration is higher in hernias with a large orifice The indirect inguinal hernia is the most common hernia in males Mesh implantation has no benefit in direct inguinal hernia Femoral hernias are more common in males than in females

answer

The indirect inguinal hernia is the most common hernia in males

question

Which of the following microorganisms is considered to be the pathogen of the pseudomembranous colitis associated with antibiotic therapy?

answer

Clostridium difficile

question

Pilonidal sinuses frequently develop in:

answer

young adult males

question

generalized (diffuse) bleeding following surgical procedures may result from all of the following EXCEPT: Hypoproteinemia Frequent coughing Early mobilization Surgical site infection Anemia

answer

Early mobilization

question

Case study: a 23 year old girl developed shaking chills, high grade fever and chest pain after obtaining a 75 ml blood transfusion. Select the most likely cause of these symptoms: Hemolytic transfusion reaction Presence of cold agglutinins Infected blood product Citrate toxicity Pyrogenic reaction

answer

Hemolytic transfusion reaction

question

Which of the following facilitates collagen deposition during the process of wound healing? Capillary network Endothelial cells Epithelial cells Fibroblasts None of the above

answer

Fibroblasts

question

Which of the following options stands for a laparoscopic hernia repair surgery? TAPP and TEP Lichtenstein and Shouldice operation Onlay or sublay eversion technique TAP and TEPP

answer

TAPP and TEP

question

Among all the severe complications of blood transfusions, the most common problem is:

answer

Hemolytic reactions

question

Which of the following diseases can be most likely transmitted by a blood transfusion? Hepatitis Lymphoblastic leukemia Mye loblastic leukemia Erythrocytosis Hodgkin's lymphoma

answer

Hepatitis

question

The commonly occuring paronychia of the fingers is caused by:

answer

frequent injury to the delicate skin of the fingers

question

Mild infections of the hand can progress to potentially severe infections because:

answer

There are numerous tendons with a poor blood supply and the maintenance of any required immobilization is difficult

question

The most efficient method for the prevention of a wound infection after the operation of a perforated appendicitis: Flushing the wound with antibiotic solutions Drainage of the peritoneal cavity None of the above Rinsing the subcutaneous tissues with disinfectant solution Sprinkling the wound with sulphonamide powder

answer

Rinsing the subcutaneous tissues with disinfectant solution

question

In case of clean, closed wounds, the most common source of a Staphylococcus infection is:

answer

Bacterial flora of the patient or hospital personnel.

question

Paronychia of the finger is best treated by which of the following types of incisions? A wide "fishmouth" shaped incision Any incision that ensures adequate drainage from the phalanx A "J-shaped" incision at a 3 mm distance from the distal unguicular margin Halfway between the unguicular margin and the pulp of the finger At a considerable distance from the distal unguicular margin

answer

A "J-shaped" incision at a 3 mm distance from the distal unguicular margin

question

the most appropriate definition of tetanus?

answer

A medical condition characterized by a prolonged contraction of skeletal muscle fibers.

question

From the following famous physicians who was NOT a surgeon? Theodor Kocher William Halsted Janos Balassa Theodor Billroth Ignac Semmelweiss

answer

Ignac Semmelweiss

question

The keloid

answer

Is an agglomeration of fibrous tissue

question

Select the CORRECT statement regarding an open incisional hernia repair? Incisional hernias cannot develop after laparoscopic procedures During the Lichtenstein operation the mesh is fixed to the rectus sheath Hernia repair with strong sutures yields equal results as the tension-free techniques The contents of the hernia sac must always be checked for signs of infarction

answer

The contents of the hernia sac must always be checked for signs of infarction.

question

What is the anatomical structure that distinguishes a hernia considered inguinal or femoral?

answer

Inguinal ligament

question

Select the correct statements: From the groin hernias the direct inguinal hernia has the highest risk of incarceration From the groin hernias the indirect inguinal hernia has the highest risk of incarceration From the groin hernias the femoral hernia has the highest risk of incarceration There is no real difference between the groin hernias in terms of risk of incarceration

answer

From the groin hernias the femoral hernia has the highest risk of incarceration

question

What was Joseph Lister's most important contribution to the development of surgery?

answer

He used carbolic acid to disinfect surgical wounds.

question

What is a sliding inguinal hernia?

answer

The wall of the hernia sac is partly an organ like the bladder or colon

question

TRUE or FALSE: Splenectomy in autoimmune disorders is usually effective because it removes the principal site of red cell destruction.

answer

TRUE

question

What is Richters hernia?

answer

When only a part of the intestinal wall protrudes through the defect, such that the lumen of the intestine is incompletely contained in the hernia sac.

question

TRUE or FALSE: . The Egyptian Edwin Smith papyrus is the oldest medical document mentioning surgery as a well-defined specialty.

answer

TRUE

question

T or F: The Salerno School, commenced in the 17th century, was the first dedicated medical school in Europe.

answer

FALSE

question

Which of the following statement is true for surgical site infection (SSI): SSIs are typically presented as bacteremia and generalized sepsis SSIs result from bacterial contamination during or after a surgical procedure Perianal abscess is a typical example of SSI since it requires surgical intervention Preoperative administration of local antibiotics on the surgical site is the best way to prevent SSIs

answer

SSIs result from bacterial contamination during or after a surgical procedure

question

Best definition of hydradenitis suppurativa?

answer

Hydradenitis suppurativa is a serious skin infection of the axillae or groin, consisting of multiple abscesses of the apocrine sweat glands.

question

Select the correct definition of the absolute indication for surgery!

answer

the disease can only be treated by surgical means but the timing can be chosen.

question

Which of the following surgical contraindications is considered absolute?

answer

Moribund state.

question

Which statement is true about Mayo hernia repair?

answer

This surgery is used for the repair of an umbilical hernia.

question

What is the best definition of the relative indication of surgery?

answer

The disease may be treated by non-surgical means or no harm done without surgery.

question

What is the best definition of a complete inguinal hernia?

answer

A hernia that passes fully into the scrotum.

question

which is the best definition of septic shock?

answer

SIRS associated with hypotension refractory to volume replacement and requiring vasopressor.

question

What is the usual pathogen causing pseudomembranous colitis?

answer

Clostridium difficile

question

Which of the following surgeries would you choose for the simultaneous repair of a bilateral inguinal hernia?

answer

TAPP

question

T or F:The TAPP laparoscopic hernia repair always uses a mesh to cover the defect from the inside.

answer

TRUE

question

TRUE OR FALSE. Incisional abdominal wall hernias can rarely be managed by laparoscopic hernia repair due to the bowels slipping inside the hernia sac.

answer

FALSE

question

What does the term telesurgery mean?

answer

A procedure when the operating surgeon is not physically present by the side of the patient.

question

From the following options select the contraindications of kidney transplantation? (Multiple) Non-compliance Mild atherosclerosis Severe obesity Active CMV infection Active hepatitis infection

answer

Non-compliance Severe obesity Active hepatitis infection

question

Which criteria must be met to prove the lack of brain function? (Multiple) Lack of brain stem reflexes Loss of consciousness Aphasia Apnoe test Deep coma

answer

Lack of brain stem reflexes. Apnoe test. deep coma.

question

Select the correct answers regarding organ transplantation: (Multiple) The rate of multi-organ transplantation is decreasing worldwide due to the high costs The survival rate of the transplanted organ is largely determined by the length of the ischemia time Harvesting a kidney from a living donor cannot be done by laparoscopic approach The diameter of the transplanted kidney is an important factor when selecting an appropriate recipient Living donor kidney transplantation yields better long-term results than cadaver transplantation

answer

The survival rate of the transplanted organ is largely determined by the length of the ischemia time. Living donor kidney transplantation yields better long-term results than cadaver transplantation.

question

From the following organs which are routinely transplanted? (multiple) Large bowels Kidney Liver Pancreas Heart

answer

Kidney Liver Pancreas Heart

question

What are the common surgical approaches to an appendectomy? (multiple) Inguinal incision Laparoscopic approach Lumbal incision McBurney's incision Midline laparotomy

answer

Laparoscopic approach McBurney's incision Midline laparotomy

question

Which of the following options can be routinely used for the prevention of thromboembolism after surgeries? (Multiple)

answer

Early mobilization of the patient compression stockings LMWH administration

question

Select the true statements regarding kidney transplantation: (multiple) The leading cause of renal failure leading to transplan tation is diabetic nephropathy Kidney transplantation between identical twins is very successful since no immunosuppressive therapy is required Nowadays the total number of kidneys harvested from living donors far exceeds that obtained from deceased donors The transplanted kidney is placed in the iliac fossa in an intraperitoneal position

answer

The leading cause of renal failure leading to transplan tation is diabetic nephropathy Kidney transplantation between identical twins is very successful since no immunosuppressive therapy is required

question

How long observation period is needed before organ transplantation to prove the irreversible lack of brain function?

answer

12 hours

question

Indications for a liver transplantation in humans inlcude all of the following EXCEPT: Acute liver damage Biliary cirrhosis Primary neoplasms confined to the liver Advanced liver cirrhosis Congenital biliary atresia

answer

Advanced liver cirrhosis

question

What is the cause of a hyperacute rejection reaction ensuing after renal transplantation?

answer

Circulating antibodies

question

The immunosuppressive drug that has vastly improved the results of organ transplantation?

answer

cycloporin A

question

The most common indication for renal transplantation:

answer

End stage glomerulonephritis or pyelonephritis

question

Allotransplantation means:

answer

Transplantation between the members of the same species.

question

Which one of the following criteria is obligatory for organ transplantation? ABO and Rh blood group identity Negative crossmatch Complete HLA matching Positive crossmatch

answer

Negative crossmatch

question

Select the correct answer! Kidney is transplanted: To the iliacal fossa To its original position Ortotopically To wherever anatomically possible

answer

to the iliacal fossa

question

select the correct answer regarding kidney transplantation in general: Transplantation singifincantly improves patient survival Dialysis provides better quality of life than kidney t ransplantation Transplantation does not influence quality of life Kidney can only be procured (removed) from braindead patients for transplantation

answer

Transplantation singifincantly improves patient survival

question

Select the correct answer regarding heart transplantation: The first successful human heart allograft was performed in 1947 by Christiaan Barnard. The first successful human heart allograft was performed in 1957 by Christiaan Barnard. The first successful human heart allograft was performed in 1967 by Christiaan Barnard. The first successful human heart allograft was performed in 1977 by Christiaan Barnard.

answer

1967

question

What does the term split liver transplantation mean?

answer

The deceased donor liver is divided into right and left portions that are implanted into two recipients.

question

TRUE OR FALSE. When harvesting a kidney from a deceased donor, the organ must be immediately, within 30 minutes be transplanted to a carefully selected recipient.

answer

FALSE

question

TRUE OR FALSE. Children under 6 years of age are not candidates for kidney transplantation due to the poor postoperative results

answer

FALSE

question

ONCO surgery

answer

1_M

question

What are the most important risk factors of breast cancer regarding survival rates? (Multiple) Tumor size Location of the tumor within the breast Receptor status Tumor grade Axillary nodal status

answer

Tumor size Receptor status Tumor grade Axillary nodal status

question

From the following options which are the main causes of hyperthyroidism? (Multiple) Toxic adenoma Malignancy Graves' disease Late stage Hashimoto's thyroiditis Toxic multinodular goiter

answer

Toxic adenoma Grave's disease Toxic multinodular goiter

question

From the following options which are characteristic signs of phaeochromocytoma? (Multiple) Elevated level of catecholamines Excessive sweating Hypoglicaemia Episodic headache Visual blurring

answer

Elevated levels of catecholamines Excessive sweating Episodic headache Visual blurring

question

Select the indications of parathyreoid surgery from the following options: (Multiple) Significantly reduced excretion of calcium in the urine Hypercalcaemia in patients younger than 50 years Progressive reduction in bone density Symptomatic hypercalcaemia in all age groups Suspicion of malignant parathyroid disease

answer

Hypercalcaemia in patients younger than 50 years Progressive reduction in bone density Symptomatic hypercalcaemia in all age groups Suspicion of malignant parathyroid disease

question

A thyroid storm (thyreotoxic crisis): (Multiple) Propranolol administration is benefical as it antagonizes sympathic dominance Can be induced by trauma, infection or acidosis Is usually treated by considerable doses of iodine Cortisone is a valuable drug in its therapy

answer

Propranolol administration is benefical as it antagonizes sympathic dominance Can be induced by trauma, infection or acidosis Is usually treated by considerable doses of iodine Cortisone is a valuable drug in its therapy

question

Characteristics of the papillary carcinoma of the thyroid are: (Multiple) It features the slowest growth-rate among the malignancies of the thyroid gland It is dependent on the stimulatory effect of TSH The frequency of development decreases with age Hematogenous metastases are frequent in this type of cancer It can transform into the anaplastic form

answer

It features the slowest growth-rate among the malignancies of the thyroid gland It is dependent on the stimulatory effect of TSH It can transform into the anaplastic form

question

A medullary carcinoma of the thyroid may be associated with: (Multiple) Cushing's syndrome Hyperparathyroidism Pituitary adenomas Pheochromocytoma

answer

Cushing's syndrome Hyperparathyroidism Pheochromocytoma

question

Case Study: A 2.5 cm node was detected in the left lobe of the thyroid gland of a female patient and a partial thyroidectomy was performed. A histological examination demonstrated a papillary cancer. The subsequent therapy includes: (Multiple) Chemotherapy External irradiation A modified radical neck dissection Regular follow-up examinations Completing total thyroidectomy

answer

Regular follow-up examinations Completing total thyroidectomy

question

Which of the following statements are true for thyroid surgery in general? (Multiple) After a total thyreoidectomy, life-long hormone supplementation is required The surgery is usually performed with the patient in a supine position In hyperthyreosis surgery is usually preceded by conditioning with iodine drops The standard approach is through a vertical Kocher incision

answer

After a total thyreoidectomy, life-long hormone supplementation is required In hyperthyreosis surgery is usually preceded by conditioning with iodine drops

question

Select the most frequent signs of breast cancer: Cyclic pain Skin ulceration Palpable mass Nipple discharge

answer

Skin ulceration Palpable mass Nipple discharge

question

The postoperative treatment after a breast conserving resection due to invasive ductal cancer may include: (Multiple) Chemotherapy Irradiation Oophorectomy Hormonal therapy Sentinel node biopsy

answer

Chemotherapy Irradiation Hormonal therapy

question

A mammography is indicated: (Multiple) For monitoring the contralateral breast in females who have undergone unilateral mastectomy For the drainage of a large breast cyst For the assessment of a suspicious mass detected in patients with multiple cysts For the annual screening of females over 25 years of age

answer

For monitoring the contralateral breast in females who have undergone unilateral mastectomy For the assessment of a suspicious mass detected in patients with multiple cysts

question

Paget's disease of the areola: (Multiple) Is usually presents of an eczematous lesion Is a primary cancer of the ducts Is rare and comprises 1% of all breast cancers Has much worse prognosis than breast cancer in general

answer

Is usually presents of an eczematous lesion Is a primary cancer of the ducts Is rare and comprises 1% of all breast cancers

question

Bloody discharge from the nipple: (Multiple) The standard treatment is radical mastectomy May result from a ductal papilloma or carcinoma May result from injury of the breast Is associated with malignant neoplasms in 10-30% of t he cases

answer

May result from a ductal papilloma or carcinoma May result from injury of the breast Is associated with malignant neoplasms in 10-30% of t he cases

question

Select the correct answers: (Multiple) Diagnosis of phaeochromocytoma can be made by a urine test for vanillylmandelic acid Phaeochromocytoma is a disease of the adrenal cortex Phaeochromocytoma can lead to severe and abrupt hypotensive episodes Approximately 10% of all phaeochromocytomae is extra-adrenal Phaeochromocytoma is almost always malignant

answer

Diagnosis of phaeochromocytoma can be made by a urine test for vanillylmandelic acid Approximately 10% of all phaeochromocytomae is extra-adrenal

question

Carcinoids of the processus vermiformis: (Multiple) The carcinoid syndrome is uncommon Can mimic the signs of appendicitis An extended right-sided hemicolectomy is the standard treatment Comprise 50% of all carcinoids developing in the gastrointestinal tract

answer

The carcinoid syndrome is uncommon Can mimic the signs of appendicitis Comprise 50% of all carcinoids developing in the gastrointestinal tract

question

Clinical manifestations of the carcinoid syndrome include: (Multiple) Right-sided heart disease Flushing of the upper half of the body Diarrhea with cramping abdominal pain Bronchospasm with wheezing Elevated blood pressure

answer

Right-sided heart disease Flushing of the upper half of the body Diarrhea with cramping abdominal pain Bronchospasm with wheezing

question

From the following options which surgeries can be used for the treatment of Cushing-disease? (Multiple) Laparoscopic adrenalectomy Transsphenoidal pituitary gland excision Transsphenoidal pineal gland excision Laparoscopic nephrectomy+adrenalectomy

answer

Laparoscopic adrenalectomy Transsphenoidal pituitary gland excision

question

What are the main advantages of the Sentinel Node Biopsy over the traditional axillary lymph node dissection in breast cancer? (Multiple) Less chance of damage to the axillary vessels Less chance of lymphedema Less postoperative pain Oncologically more radical Requires no special dye or tracer

answer

Less chance of damage to the axillary vessels Less chance of lymphedema Less postoperative pain

question

Commonly used treatment option in acute mastitis include: (Multiple) Administration of systemic antibiotics Surgical incision in the case of an abscess Use of pain-killers and ice packs Surgical excision of the inflamed mass Total mastectomy and axillary dissection

answer

Administration of systemic antibiotics Surgical incision in the case of an abscess Use of pain-killers and ice packs

question

From the following options select the characteristics of a papillary thyroid cancer. (Multiple) Papillary cancer occurs usually in young adults Papillary cancer grows slowly Papillary cancer metastasizes through direct spreading Papillary cancer is compatible with relatively long life even in the presence of metastases Papillary adenocarcinoma accounts for 85% of cancers of the thyroid gland

answer

Papillary cancer occurs usually in young adults Papillary cancer grows slowly Papillary cancer is compatible with relatively long life even in the presence of metastases Papillary adenocarcinoma accounts for 85% of cancers of the thyroid gland

question

What diagnostic methods are routinely used in the evaluation of thyroid nodules? (Multiple) Physical examination Ultrasound Needle biopsy Radioiodine scan PET/CT scan

answer

Physical examination Ultrasound Needle biopsy Radioiodine scan

question

What are the main treatment options in hyperthyroidism? (Multiple) Antithyroid drugs Thyroxine supplementation Radioiodine treatment Total thyroidectomy Subtotal thyroidectomy

answer

Antithyroid drugs Radioiodine treatment Subtotal thyroidectomy

question

What substance can you use during a breast cancer surgery to identify the Sentinel Lymph Node? (Multiple) A special dye 18-FDG Glucose Radio-labeled tracer Radiopaque contrast material Barium

answer

A special dye Radio-labeled tracer

question

OncoSurgery

answer

1_S

question

Which is true for the surgical treatment of inflammatory breast cancer? The best treatment is a total mastectomy, axillary lymph node dissection is not necessary The best treatment is a total mastectomy with axillary lymph node dissection The best treatment is partial or total mastectomy, depending on the size of the lesion The treatment is primarily non-surgical, palliative ablation may be considered

answer

The treatment is primarily non-surgical, palliative ablation may be considered

question

When do we speak of secondary reconstruction after a total mastectomy?

answer

Reconstruction is performed 1-2 years after definitive surgery and adjuvant therapy if no recurrence is detectable.

question

When do we speak of a competion thyroid surgery?

answer

Second surgery after inadequate resection in thyroid cancer.

question

When do we speak of subclinical hyperthyroidism?

answer

TSH low, T3/T4 normal

question

Which is the most frequent cause of symptomatic primary hyperparathyreosis ?

answer

Solitary adenoma

question

Which sign is NOT characteristic for Cushing's disease? Hyperglycaemia Purple striae Hypotension Hirsutism Muscle weakness

answer

Hypotension

question

Which anatomic structure is most prone to injury during a thyroid surgery?

answer

Recurrent laryngeal nerve

question

Which is the most frequent sign of breast cancer?

answer

Palpable mass

question

Which is NOT and indication of parathyreoid surgery from the following options? Suspicion of malignant parathyroid disease Symptomatic hypercalcaemia in all age groups Hypercalcaemia in patients younger than 50 years Significantly reduced excretion of calcium in the urine Progressive reduction in bone density

answer

Significantly reduced excretion of calcium in the urine

question

From the following options which is true for breast cancer? The incidence of early-stage breast cancer is decreasing since the establishment of a nation-wide screening program DCIS/LCIS can eventually turn into invasive breast cancer The standard operation for a T1N0 breast cancer is mastectomy with axillary lymph node dissection Radical surgery is indicated in most of the cases even in the presence of multiple distant metastases

answer

DCIS/LCIS can eventually turn into invasive breast cancer

question

Select the correct answer: Phaeochromocytoma can lead to severe and abrupt hypotensive episodes Phaeochromocytoma is almost always malignant Approximately 10% of all phaeochromocytomae is extra-adrenal Phaeochromocytoma is a disease of the adrenal cortex

answer

Approximately 10% of all phaeochromocytomae is extra-adrenal

question

Regarding papillary thyroid carcinoma, which of the following statements is FALSE? The presence of resectable lymph node metastases does not appear to worsen prognosis It is the type of thyroid cancer most often associated with prior radiation exposure There is a high likelihood of occult multicentric disease Papillary cancer is characterized by frequent hematogenous metastases

answer

Papillary cancer is characterized by frequent hematogenous metastases

question

The most frequent cause of a palpable breast lump above 50 years is:

answer

cancer

question

Which is the least frequent from the following types of thyroid cancer? Medullary cancer Follicular cancer Anaplastic cancer Papillary cancer

answer

Anaplastic cancer

question

From the following options which is true for Sentinel Node Biopsy in breast cancer? The axillary dissection has to be performed even if the sentinel nodes were found to be tumor-free Clinically detectable axillary lymph node enlargement requires Sentinel Node Biopsy At least 5 lymph nodes has to be removed for correct histological sampling The sentinel node(s) can be identified using a radioactive tracer or special dye

answer

The sentinel node(s) can be identified using a radioactive tracer or special dye

question

The incidence of which of the following cancer types has decreased over the last 40 years? Bone marrow cancer Lung cancer Colon cancer Stomach cancer Breast cancer

answer

Stomach cancer

question

What is the percentage of breast cancer among all the malignancies occurring in females?

answer

25%

question

Mammography is a particularly valuable method for the reduction of breast cancer mortality, because...:

answer

It can detect the disease at an early stage

question

Which of the following therapies is recommended for breast cancer patients with extensive systemic metastases? Simple mastectomy Radical mastectomy Chemo/radiotherapy Breast conserving surgery

answer

Chemo/radiotherapy

question

The most prevalent histologic type of breast cancer is the..?

answer

Invasive ductal carcinoma

question

Brest cancer develops most frequently in which region of the breast?

answer

Upper-lateral quadrant

question

The risk of bilateral breast cancer is high when the primary lesion (having developed in the breast affected first) is ...?

answer

Invasive lobular cancer

question

Acute mastitis is most prevalent in:

answer

breast feeding

question

A carcinoma of the thyroid gland:

answer

is generally characterized by NORMAL thyroid function

question

Complications of hypoparathyroidism include: Hydronephrosis Diabetes Cataract formation and cerebral calcification Adrenal insufficiency

answer

Cataract formation and cerebral calcification

question

Type-II multiplex endocrine neoplasia (MEN) consists of all the following, EXCEPT: Pituitary neoplasms Parathyroid adenoma or hyperplasia Multiple neuromas Medullary carcinoma of the thyroid gland Pheochromocytoma

answer

Pituitary neoplasms

question

The most reliable test in diagnosing a pheochromocytoma is:

answer

measurement of the 24 hour urinary metanephrine excretion rate

question

In which of the following forms of primary hyperaldosteronism is the value of surgical therapy controversial? Primary hyperaldosteronism due to adrenal hyperplasia Carcinoma of the adrenal cortex Hyperaldosteronism sensitive to glucose administration Primary hyperaldosteronism of unknown origin Solitary aldosterone producing adenoma

answer

Hyperaldosteronism sensitive to glucose administration

question

What is the proper surgical treatment of an asymptomatic papillary thyroid cancer - found incidentally - which is 5mm in diameter in the left lobe if there are no enlarged lymph nodes?

answer

Lobectomy on the left side.

question

The treatment of choice for Cushings disease is :

answer

irradiation of the pituitary gland

question

The most common type of congenital adrenal hyperplasia develops as a result of ...:

answer

21-hydroxylase enzyme deficiency

question

All of the following belong to skeletal changes occurring in hyperparathyroidism EXCEPT: Osteopetrosis Pathologic fractures Osteitis fibrosa cystica Osteoporosis Solitary or multilocular bone cysts

answer

osteopetrosis

question

The most prevalent type of thyroid cancer is :

answer

papillary carcinoma

question

The recommended therapy for intestinal carcinoid tumor is:

answer

intestinal resection

question

Breast conserving surgery is contraindicated in the following cases: If the axillary nodal status is positive Two or more primary tumors are present in separate quadrants of the breast Patient is older than 70 years Neo-adjuvant therapy was administered before surger

answer

Two or more primary tumors are present in separate quadrants of the breast

question

All of the following substances are produced by functional carcinoid neoplasms, EXCEPT: Parathormone Serotonin 5-hydroxy-tryptophan Kallikrein and histamine ACTH

answer

Parathormone

question

What is the advantage of core biopsy over fine-need le aspiration biopsy (FNAB)? Less painful for the patient The rate of complications is much lower The sensitivity and specificity is superior to FNAB, enables immunhistochemistry investigations It can be performed without radiological guidance

answer

The sensitivity and specificity is superior to FNAB, enables immunhistochemistry investigations

question

From the following options which is true for Graves' disease? Treatment is multimodal and should always be started with subtotal or total thyroid resection Graves' disease is the most common cause of hypothyroidism The pathomechanism is the chronic stimulation of the thyroid follicles by autoantibodies The pathomechanism is the chronic stimulation of the TSH receptors by autoantibodies The thyroid is usually not enlarged

answer

The pathomechanism is the chronic stimulation of the TSH receptors by autoantibodies

question

Which parameters are routinely checked for the evaluation of thyroid function?

answer

sTSH, fT3, fT4

question

Regarding medullary thyroid cancer, which of the following statements is correct? The prognosis is approximately the same as that of the papillary cancer It is derived from a dedifferentiated variant of the same cells that produce papillary and follicular cancers The serum calcitonin level is useful in the diagnosis and treatment Medullary cancer almost always gives distant metastases

answer

The serum calcitonin level is useful in the diagnosis and treatment

question

Which of the following studies CANNOT be used for the localization of a parathyroid adenoma? Neck X-ray CT Technetium-thallium scan Ultrasonography

answer

Neck X-ray

question

What is the life time risk of developing breast cancer in BRCA1 or BRCA2 positive cases?

answer

over 50%

question

what is carcinoid syndrome?

answer

Bronchospasm, flushing, diarrhea, right sided heart failure.

question

Bone metastasis rarely develop at which of the following sites? Vertebrae Skull Pelvis Bones distal to the knee or elbow Long bones

answer

Bones distal to the knee or elbow

question

What is the typical surgical treatment of an invasive ductal breast cancer (2cm in diameter, peripheral) if the axillary lymph nodes are found metastatic with staging examinations? Total mastectomy + ALND Total mastectomy + SNB Breast conserving surgery + ALND Breast conserving surgery + SNB

answer

Breast conserving surgery + ALND

question

Which of the following statements is FALSE when speaking of the Paget carcinoma of the breast? Paget carcinoma is not common (about 1% of all breast cancers) It affects the nipple and may or may not be associated with a breast mass The basic lesion is usually a poorly-differentiated squamous cell cancer The first symptom is often itching or burning of the nipple The diagnosis is established by biopsy of the area of erosion

answer

The basic lesion is usually a poorly-differentiated squamous cell cancer

question

TRUE OR FALSE: In secondary hyperparathyroidism, there is an increase in parathyroid hormone secretion in response to low plasma concentrations of ionized calcium, usually owing to renal disease and malabsorption.

answer

TRUE

question

What is the main value of the intraoperative parathormone testing? It helps determining whether the probable parathyroid adenoma was removed It helps determining whether the probable thyroid nodule was removed It helps determining whether the surgery for a thyroid malignancy was radical enough It helps determining whether the laryngeal nerve was damaged during surgery It helps determining whether the patient will react to radioiodine treatment

answer

It helps determining whether the probable parathyroid adenoma was removed

question

What surgery would you perform from the following options in this case? Invasive ductal breast cancer (2 cm) in the upper inner quadrant with palpable axillary lymph nodes. Mastectomy with axillary lymph node dissection Sectoral excision with axillary lymph node dissection Mastectomy with sentinel lymph node biopsy Sectoral excision with sentinel lymph node biopsy

answer

Sectoral excision with axillary lymph node dissection

question

What surgery would you perform from the following options in this case? Centrally located invasive lobular breast cancer (4cm) with no signs of metastatic spreading. Mastectomy with axillary lymph node dissection Sectoral excision with axillary lymph node dissection Mastectomy with sentinel lymph node biopsy Sectoral excision with sentinel lymph node biopsy

answer

Mastectomy with sentinel lymph node biopsy

question

THORACIC SURGERY

answer

1_M

question

Patients with esophageal cancer are considered candidates for esophageal resection ONLY if: (Multiple) The cancer is limited to the cervical part of the esophagus The cancer is limited to the thoracal part of the esophagus The patient is fit from a cardiac and respiratory point of view There is no evidence of distant metastases There is no evidence of spread of the tumor to structures next to the esophagus

answer

The patient is fit from a cardiac and respiratory point of view There is no evidence of distant metastases There is no evidence of spread of the tumor to structures next to the esophagus

question

Which statements are true for achalasia? (Multiple) Most of the patients suffer from recurrent gastroenteritis Patients are at increased risk of pancreatic cancer Dysphagia is the most common symptom Regurgitation of undigested food is the second-most common symptom Most of the patients suffer from recurrent cholangitis

answer

Dysphagia is the most common symptom Regurgitation of undigested food is the second-most common symptom

question

Typical clinical findings in case of Mallory-Weiss Syndrome are: (Multiple) Frequent coughing Extremely high body temperature (39-40 C) Bloody vomitus Melena

answer

Bloody vomitus Melena

question

Diagnostic symptoms of achalasia: (Multiple) Retention of ingested food in the esophagus Radiologic evidence of dilated body of the esophagus Weight gain Dysphagia

answer

Retention of ingested food in the esophagus Radiologic evidence of dilated body of the esophagus Dysphagia

question

Which statements are true about the treatment of hiatal hernias: (Multiple) PPI is always enough Operative repair is indicated in many of the cases since complications are frequent The surgery could be performed only laparoscopically It is unnecessary to excise the hernia sac

answer

Operative repair is indicated in many of the cases since complications are frequent It is unnecessary to excise the hernia sac

question

Choose the right answers about esophageal cancer: (Multiple) The operation is easy to perform and has great results Preoperative radiation therapy may convert an unresectable growth to a resectable one. Esophageal carcinoma is treated by surgery, radiotherapy, chemotherapy or a combination of these methods. After potentially curative resection, survival for 5 years is more than 50%.

answer

Preoperative radiation therapy may convert an unresectable growth to a resectable one Esophageal carcinoma is treated by surgery, radiotherapy, chemotherapy or a combination of these methods

question

Select the correct statements for achalasia (Multiple) It is a neuromuscular disorder in which esophageal dilation and hypertrophy occur without organic stenosis Absent primary peristalsis by manometry and/or radiographic studies is a key diagnostic criteria Dysphagia is the dominant symptom The circular muscle layer of the esophagus hypertrophies, while the longitudinal coat retains its normal thickness The gastroesophageal junction is dilated while the proximal part of the esophagus is conically narrowed

answer

It is a neuromuscular disorder in which esophageal dilation and hypertrophy occur without organic stenosis Absent primary peristalsis by manometry and/or radiographic studies is a key diagnostic criteria Dysphagia is the dominant symptom The circular muscle layer of the esophagus hypertrophies, while the longitudinal coat retains its normal thickness

question

Select the correct statements regarding gastro-esophageal reflux disease (GERD). (Multiple) GERD is caused by the abnormal retrograde flow of gastric contents into the esophagus A defective upper esophageal sphincter is the most common cause of GERD Heartburn, regurgitation, and dysphagia are considered typical symptoms of GERD A laparoscopic Nissen fundoplication is considered the gold-standard operation in GERD Control of typical symptoms is obtained in about 90% of patients after a fundoplication

answer

GERD is caused by the abnormal retrograde flow of gastric contents into the esophagus Heartburn, regurgitation, and dysphagia are considered typical symptoms of GERD A laparoscopic Nissen fundoplication is considered the gold-standard operation in GERD Control of typical symptoms is obtained in about 90% of patients after a fundoplication

question

Select the correct statements regarding hiatal hernia. (Multiple) There are two types of esophageal hiatal hernia: paraesophageal and sliding The paraesophageal herniation often occurs in association with the sliding type, thus symptoms due to reflux and obstruction can be present at the same time Symptoms in hiatal hernia typically develop by the early adolescent years Even in symptomatic cases, the treatment of choice in hiatal hernia is PPI administration The most frequent complications of paraesophageal hernia are hemorrhage, incarceration, obstruction, and strangulation

answer

There are two types of esophageal hiatal hernia: paraesophageal and sliding The paraesophageal herniation often occurs in association with the sliding type, thus symptoms due to reflux and obstruction can be present at the same time The most frequent complications of paraesophageal hernia are hemorrhage, incarceration, obstruction, and strangulation

question

Which of the following signs and symptoms may be associated with an acute onset of hiatal hernia? (Multiple) Dysphagia (sometimes total) Hematemesis Obstruction Gangrene/Perforation Peritonitis

answer

Dysphagia (sometimes total) Hematemesis Obstruction Gangrene/Perforation Peritonitis

question

Which of the following arteries supply the esophagus? (Multiple) Inferior thyroid artery Direct branches from the internal carotid artery Direct branches from the aorta Bronchial arteries Branches from the left gastric and splenic arteries

answer

Inferior thyroid artery Direct branches from the aorta Bronchial arteries Branches from the left gastric and splenic arteries

question

Which of the following signs and symptoms are characteristic of an esophageal epihrenic diverticulum? (Multiple) Dysphagia Sensation of pressure in the lower oesophagus Intermittent vomiting Laryngeal or pharyngeal pain Regurgitation of food

answer

Dysphagia Sensation of pressure in the lower oesophagus Intermittent vomiting Regurgitation of food

question

Thoracic surgery

answer

1_S

question

Choose the FALSE statement for achalasia: Surgical treatment is laparoscopic Heller myotomy and partial fundoplication. Typical radiological finding is the evidence of distal esophageal narrowing. Esophageal peristalsis is usually absent on esophageal manometry. Often associated with diverticulosis of the stomach.

answer

Often associated with diverticulosis of the stomach.

question

What is the main role of the endoscopic ultrasound in the staging of an esophageal cancer? It helps determine the presence of pulmonary metastases It helps determine the exact size of the tumor It helps determine the supraclavicular lymphatic status It helps determine the presence of liver metastases

answer

It helps determine the exact size of the tumor

question

Which is NOT a sign of the perforation of the cervical esophagus? Fever Free air in the abdominal cavity Subcutaneous emphysema Dysphagia Pain

answer

Free air in the abdominal cavity

question

From the following options which is NOT a typical sign of a Zenker's diverticulum? Gurgling sounds when swallowing Regurgitation of undigested food Sharp pain when swallowing Dysphagia

answer

Sharp pain when swallowing

question

Which diagnostic modality CANNOT be used to assess the depth of malignant infiltration in esophageal cancer? Endoscopy and biopsy CT scan PET-CT Endosonography

answer

Endoscopy and biopsy

question

Which of the following conditions requires urgent surgery? Paraesophageal hernia with incarceration Paraesophageal hernia with erosion Paraesophageal hernia with severe reflux Large symptomatic paraesophageal hernia

answer

Paraesophageal hernia with incarceration

question

What is the most common type of surgery in esophageal malignancies? Total esophageal resection Subtotal esophageal resection Segmental esophageal resection Mucosal excision

answer

Subtotal esophageal resection

question

What is the average length of the esophagus from the teeth to the gastroesophageal junction?

answer

40-45 cm

question

What is the leading symptom of an epihrenic esophhageal diverticulum?

answer

Dysphagia and a sensation of pressure in the lower esophagus after eating.

question

Which of the following diagnostic modalities is NOT used regularly in the diagnosis of esophageal diseases? Native/swallowing X-ray PET-CT Endoscopic UH Manometry, pH monitoring MRI

answer

MRI

question

Which of the following is NOT a type of hiatal hernia? Epiphrenal Paraesophageal Sliding Mixed Upside-down stomach

answer

Epiphrenal

question

From the following options, which is the single most frequent cause of esophageal perforation? Foreign body Endoscopic intervention Barium swallow study Thyroid surgery Head/neck trauma

answer

Endoscopic intervention

question

Thoracic surgery

answer

2_M

question

Which of the following diagnostic tools are NOT routinely used for the staging of a small-cell lung cancer? (Multiple) Transesophageal biopsy Transthoracal biopsy Transdiaphragmatic biopsy Transbronchial biopsy

answer

Transesophageal biopsy Transdiaphragmatic biopsy

question

From the following options which lesions are benign tumors of the chest wall? (multiple) Myxochondroma Dermatofibroma Osteosarcoma Osteochondroma Chondroma

answer

Myxochondroma Osteochondroma Chondroma

question

What are the most frequent chest deformities requiring surgery? (Multiple) Pectus carinatum Pectus protuberans Pectus osseoficans Pectus diastasis Pectus excavatum

answer

Pectus carinatum Pectus excavatum

question

The primary treatment of the pyogenic lung abscesses includes: (Multiple) Surgical resection Systemic antibiotic therapy based on cultures and resistance testing Local antibiotics administered through chest tubes Bronchoscopic aspiration of the pus

answer

Systemic antibiotic therapy based on cultures and resistance testing Bronchoscopic aspiration of the pus

question

Which statements are true for sarcoidosis? (Multiple) Definitive treatment comprises removal of the hilar lymph nodes by open procedure Up to 70% of patients do not require surgical therapy Definitive treatment comprises removal of the hilar lymph nodes by thoracoscopy Mediastinoscopy can be used for histological confirmation Severe symptoms are generally treated with steroids

answer

Up to 70% of patients do not require surgical therapy Mediastinoscopy can be used for histological confirmation Severe symptoms are generally treated with steroids

question

Thoracic surgery

answer

2_S

question

The treatment of malignant chest wall tumors is: Excision Radical resection with chest wall reconstruction Radiotherapy Radical resection

answer

Radical resection with chest wall reconstruction

question

What is the therapy of lung metastases? Lobectomy with lymphadenectomy Segmentectomy with lymphadenectomy Metastasectomy and/or lung resection with lymphadenectomy Lobectomy

answer

Metastasectomy and/or lung resection with lymphadenectomy

question

In hiatal hernia the most important examination to determine the type of the planned fundoplication is: Endoscopy and manometry 24-hour Ph monitoring and manometry Barium swallow and 24-hour Ph monitoring Endoscopy

answer

24-hour Ph monitoring and manometry

question

Which operation can be performed in isolated pulmonary metastasis from colorectal cancer? Lobectomy with lymphadenectomy Subtotal pulmonectomy Segmentectomy with lymphadenectomy Metastasectomy and/or tissue-sparing lung resection with lymphadenectomy

answer

Metastasectomy and/or tissue-sparing lung resection with lymphadenectom

question

What is the preferred operation for spontaneous pneumothorax? Videothoracoscopy and pleurodesis Thoracotomy and resection of the ruptured bulla and pleurodesis Videothoracoscopic resection of the ruptured bulla and pleurodesis Peritoneal tube drainage

answer

Videothoracoscopic resection of the ruptured bulla and pleurodesis

question

What kind of operation is preferred in the treatment of pectus excavatum? Videothoracoscopic Nuss operation Reconstruction of the sternum with open operation Urgent thoraco-laparotomy Videothoracoscopic Nissen operation

answer

Videothoracoscopic Nuss operation

question

Choose the most appropriate therapy of non-metastatic Non Small Cell Lung Cancer from the following options: Lung resection alone Lung resection with lymphadenectomy, adjuvant chemo and/or radiotherapy Chemo and radiotherapy Wait-and-see strategy

answer

Lung resection with lymphadenectomy, adjuvant chemo and/or radiotherapy.

question

The therapy of choice for patients with tension pneumothorax associated with dyspnea is: Immediate release of the air from the pleural cavity Intravenous volume replacement Administration of oxygen by mask Administration of analeptic drugs Immediate intubation

answer

Immediate release of the air from the pleural cavity

question

The most common cause of the superior vena cava syndrome is: Mediastinal fibrosis Neoplasm of the thymus Bronchial carcinoma arising from the upper-right lobe Thyroid cancer Multinodular goiter

answer

Bronchial carcinoma arising from the upper-right lobe

question

Hemoptysis can result from all of the following, EXCEPT: Bronchial asthma Pulmonary infarction Pulmonary tuberculosis Bronchial carcinoma Bronchiectasia

answer

Bronchial asthma

question

A possible etiologic factor in the development of pleural mesothelioma is: Peritoneal mesothelioma Asbestosis Anthracosis Pneumoconiosis Hereditary disposition

answer

Asbestosis

question

The most common malignancy of the bony chest wall is: Ewing's sarcoma Multiple myeloma Osteogenic sarcoma Chondrosarcoma Solitary bone metastasis

answer

Chondrosarcoma

question

The 5-year survival of all lung cancer cases is not higher than...:

answer

10%

question

All of the following are diagnostic signs of cardiac tamponade, EXCEPT: Reduced blood pressure Reduced cardiac output Increased filling volume of the heart during diastole Increased venous pressure Shock

answer

Increased filling volume of the heart during diastole

question

All of the following are manifestations of the superior vena cava syndrome, EXCEPT: Enlarged veins which are visible on the anterior chest wall Dyspnea Edema of the head and neck Cyanosis Increased venous pressure

answer

Dyspnea

question

All of the following statements are valid regarding lung cancer, EXCEPT: A dry, distressing, unproductive cough may often be the only symptom of lung cancer Lung cancer is never symptom-free Hemoptysis is common in lung cancer On X-ray it can occur as a coin lesion (round shadow) on the periphery of the lung Partial or complete airway obstruction may predispose to lung infection

answer

Lung cancer is never symptom-free

question

All of the following represent an indication for resection in pulmonary tuberculosis, EXCEPT: Tuberculotic bronchiectasis of the middle and lower lobes Negative sputum with destroyed segment residue Local infection caused by atypical acid-fast bacteria Open cavity with positive sputum despite 3-6 months of therapy New lesion with positive sputum

answer

New lesion with positive sputum

question

The most frequent cause of thoracic empyema is: Rupture of an emphysematous bleb Pneumonia of the ipsilateral lung Subphrenic abscess Penetrating chest injury Ruptures of the thoracic segments of the esophagus

answer

Pneumonia of the ipsilateral lung

question

The treatment of choice for hemothorax with an effusion of 500 cm3 or more is by: Intercostal tube thoracostomy Thoracotomy and ligation of the ruptured blood vessel Supportive therapy with monitoring Transfusion of fresh blood Needle aspiration

answer

Intercostal tube thoracostomy

question

All of the following conditions are complications of empyema, EXCEPT: Pericarditis Circumscribed pneumonia Bronchopleural fistula Osteomyelitis Pleural adhesions

answer

Osteomyelitis

question

A solitary mass in the lung of a middle-aged patient is most likely a: Malignancy Secondary neoplasm Granuloma Tuberculotic lesion Adenoma

answer

Granuloma

question

The chest x-ray of a 30-year-old patient with a simple rib fracture shows a 50% pneumothorax. The first line of treatment should be: Tube thoracostomy Coughing and respiratory exercises The administration of analgesics The infiltration of the injured intercostal nerve with a local anesthetic External fixation with adhesive tape

answer

Tube thoracostomy

question

A lung abscess develops most frequently in the: Right-middle lobe Lingular segment Upper-dorsal segments of the right lung Left-upper lobe Left-lower lobe

answer

Upper-dorsal segments of the right lung

question

The most frequent cause of lung abscess is: The aspiration of infective material from the oral cavity or pharynx Penetrating chest injury Lymphatic spread from an infective focus Bronchogenic carcinoma Blood-borne infection

answer

The aspiration of infective material from the oral cavity or pharynx

question

Which of the two main types of lung cancer has the better prognosis? The 5-year overall survival is the same Small cell lung cancer Non-small cell lung cancer

answer

Non-small cell lung cancer

question

The following factors all support the malignant nature of a solitary pulmonary nodule, EXCEPT: Doubling time between 20 and 450 days Doubling time over 500 days Age over 65 years Spiculated edge Patient is a smoker

answer

Doubling time over 500 days

question

Which condition is NOT considered as indication for pulmonary resection? Bilateral lung cancer Lung cancer infiltrating the thoracic wall Stage II small-cell lung cancer Lung cancer with confirmed mediastinal lymph node metastases Central lung cancer

answer

Lung cancer with confirmed mediastinal lymph node metastases

question

Which of the following options is NOT a typical location for metastasis formation of lung cancer? Bones Adrenals Brain Liver Kidneys

answer

Kidneys

question

What is the preferred treatment in a right sided partial (3 mm), asymptomatic pneumothorax? Thoracic drain age VATS resection Conservative treatment Lobectomy from thoracotomy

answer

Conservative treatment

question

What is the preferred treatment in a recurrent left sided pneumothorax? Lobectomy from thoracotomy Repeated thoracic drainage Observation is enough VATS resection

answer

VATS resection

question

The rate of recurrence after drainage of a unilateral pneumothorax is: ~50% ~20-30% ~2-3% There is no recurrence

answer

~20-30%

question

In the case of a lung cancer (17 mm in diameter) localized in the right upper lobe with no lymph node metastasis, the first choice of therapy is: Adjuvant chemotherapy Adjuvant radiotherapy Lobectomy Pneumonectomy

answer

Lobectomy

question

What surgery should be performed in a technically resecable lung cancer with mediastinal lymph node metastases? Pneumonectomy with lymph node dissection Pneumonectomy alone Lobectomy with lymph node dissection Lobectomy alone No lung resection should be performed at all

answer

No lung resection should be performed at all

question

Which one of the following diagnostic tools is the gold-standard in the preoperative planning of thoracic surgeries? Radiography MRI CT Ultrasound Scintigraphy

answer

CT

question

In a stage 1b lung cancer, the recommended operation is: Segmentectomy+lymphadenectomy Pneumonectomy Lobectomy+lymphadenectomy Lobectomy alone

answer

Lobectomy+lymphadenectomy

question

In pancoast tumors the common therapeutic strategy is: Neoadjuvant chemo/radiotherapy only Adjuvant radiotherapy, then surgical resection Adjuvant chemo/radiotherapy only Neoadjuvant radiotherapy, surgical resection, adjuvant chemo/radiotherapy

answer

Neoadjuvant radiotherapy, surgical resection, adjuvant chemo/radiotherapy

question

VASCULAR surgery

answer

2_M

question

What are the elements of the classic diagnostic triad of a ruptured abdominal aortic aneurysm? (Multiple) Haematuria Hypotension Postural hypertension Pulsating mass Severe abdominal pain

answer

Hypotension Pulsating mass Severe abdominal pain

question

Which of the following statements are true for Intermittent Claudication? (Multiple) The pain never develops at rest The pain can develop at rest Trophic lesions are often present Common in the gastrocnemius-soleus muscle group Presence of burning, cramping pain

answer

The pain never develops at rest Common in the gastrocnemius-soleus muscle group Presence of burning, cramping pain

question

Which conditions do NOT require an urgent vascular surgical intervention? (Multiple) Asymptomatic carotid stenosis Gangraena of the lower extremity Acute aortic occlusion Mesenterial thrombosis Arterial embolism

answer

Asymptomatic carotid stenosis Gangraena of the lower extremity

question

Which are NOT reconstructive arterial procedures? (Multiple) Thrombectomy Bypass Varicectomy Sympathectomy Thrombendarterectomy (TEA)

answer

Varicectomy Sympathectomy

question

Venous circulatory failure of the lower extremity can be corrected by which of the following methods? (Multiple) Ligation of incompetent perforator veins Ligation and removal of the saphenous vein (by stripping) Ligation and removal of the femoral vein (by stripping) Bed rest, elevation of the lower extremity and the application of elastic bandages Sclerotherapy of the superficial spider veins

answer

Ligation of incompetent perforator veins Ligation and removal of the saphenous vein (by stripping) Bed rest, elevation of the lower extremity and the application of elastic bandages

question

The therapy of an abdominal aortic dissection includes: (Multiple) Replacement of the damaged section with a venous graft Replacement of the damaged section with a synthetic graft Blood pressure reduction (hypotensive therapy) Insertion of a stent graft over the dissected segment Administration of beta-blockers

answer

Replacement of the damaged section with a synthetic graft Blood pressure reduction (hypotensive therapy) Insertion of a stent graft over the dissected segment Administration of beta-blockers

question

Which of the following conditions require acute vascular surgical intervention? (Multiple) Arterial embolism Deep vein thrombosis Aortic dissection Ruptured aortic aneurysm Symptomatic lower leg varicosity with ulcer

answer

Arterial embolism Aortic dissection Ruptured aortic aneurysm

question

What are the commonly used diagnostic methods for the diagnosis of arterial vascular disease? (Multiple) Seldinger angiography MRI CT Angiography Phlebography Doppler US

answer

Seldinger angiography CT Angiography Doppler US

question

Which of the following surgeries are arterial vascular surgical interventions? (Multiple) Thrombendarteriectomy (TEA) Direct suture Bypass surgeries Crossectomy Sympathectomy

answer

Thrombendarteriectomy (TEA) Direct suture Bypass surgeries

question

From the following options, which vascular diseases may lead frequently to the development of acute abdomen? (Multiple) Ruptured abdominal aortic aneurysm Acute ischemic colitis Takayashu arteritis Mesenteric thrombosis Chronic Leriche's syndrome

answer

Ruptured abdominal aortic aneurysm Acute ischemic colitis Mesenteric thrombosis

question

The typical clinical signs of carotid stenosis include: (Multiple) Tetraplegia Aphasia Ringing in the ear (tinnitus) Loss of vision Vomiting

answer

Aphasia Loss of vision

question

From the following options which steps are routinely performed during a varicose surgery? (Multiple) Crossectomy Thrombectomy Stripping of the greater saphenous vein Ligation of the thrombosed femoral vein Ligation of the perforating veins

answer

Crossectomy Stripping of the greater saphenous vein Ligation of the perforating veins

question

What are the common signs and symptoms in chronic lower extremity arterial disease WITHOUT critical limb ischaemia? (Multiple) Decreased pulses High ankle-brachial index Intermittent claudication Gangrene Rest pain of the foot

answer

Decreased pulses Intermittent claudication

question

VASCULAR SURGERY

answer

2_S

question

Which of the following statement is NOT true for the pathogenesis of diabetic foot? Elevated serum glucose level makes it easier for bacteria to infect wounds The underlying pathomechanism is usually the ischaemia and necrosis of the tissues Diabetic neuropathy is almost always present Structural changes of the foot play an important role

answer

The underlying pathomechanism is usually the ischaemia and necrosis of the tissues

question

Surgical treatment of lower-limb varicosity includes the following steps: (GSV: Great Saphenous Vein) GSV ligation and stripping, phlebectomy, perforator ligation TEA, phlebectomy, GSV ligation and stripping, perforator ligation Scalenotomy, phlebectomy, GSV ligation and stripping Saphenous bypass, phlebectomy, GSV ligation and stripping GSV stripping, phlebectomy, perforator ligation

answer

GSV ligation and stripping, phlebectomy, perforator ligation

question

Choose the correct statement regarding Critical Limb Ischemia: CLI usually requires conservative treatment only CLI is a clinical entity with generalized symptoms and multiple cardiovascular co-morbidities CLI is a relatively benign clinical entity with the worse outcome being minor amputation CLI is best treated with primary, major amputation

answer

CLI is a clinical entity with generalized symptoms and multiple cardiovascular co-morbidities

question

Which is NOT a possible diagnostic modality for pulmonary embolism? D-Dimer test Perfusion/ventilation scintigraphy Ankle/Brachial Index Chest X-Ray

answer

Ankle/Brachial Index

question

Find the false statement! An angiogram was performed for left limb short distance claudication. Right limb is symptom free. DSA shows an 80% short stenosis of the right common iliac vessel. In general: symptom free stenosis should not be angioplastied Angioplasty is an operation with all the risks involved Angioplasty should be a clinical decision made by physician in charge preferably after multidisciplinary discussion The symptom free narrowing should be angioplastied as a preventive measure

answer

In general: symptom free stenosis should not be angioplastied

question

Select the correct statement. Intermittent claudication carries a high risk of limb loss within a year Intermittent claudication does not correlate with cardiovascular mortality Intermittent claudication should be treated with PTA regardless of the claudication distance Intermittent claudication should be treated with best medical and/or surgical treatment depending on the claudication distance

answer

Intermittent claudication should be treated with best medical and/or surgical treatment depending on the claudication distance

question

Which method is NOT appropriate for the diagnosis of deep-vein thrombosis? Doppler-ultrasonography Radioisotope labeled fibrinogen uptake test Measurement of the arterial flow-rate Impedance plethysmography Phlebography

answer

Measurement of the arterial flow-rate

question

A 65-year-old male patient passes tarry and loose stools (melena) 10 months after an aorto-bifemoral bypass surgery. The most likely cause of this conditionis: Ischemic colitis Aorto-duodenal fistula Anastomotic leakage Ulcerative colitis

answer

Aorto-duodenal fistula

question

The most common site of peripheral atherosclerotic aneurysms is: The carotid artery The subclavian artery The popliteal artery The femoral artery The ulnar artery

answer

The popliteal artery

question

All of the following may lead to thoracic outlet syn drome, EXCEPT: Costoclavicular compression Hyperabduction syndrome The scalenic anticus syndrome Raynaud's disease A cervical rib

answer

Raynaud's disease

question

All of the following are characteristic features of Buerger's disease, EXCEPT: It is more prevalent in males It is an unusual form of atherosclerosis It is closely associated with smoking It is rare in blacks The peak incidence occurs between 20 and 40 years of age

answer

It is an unusual form of atherosclerosis

question

All of the following statements are valid regarding abdominal aortic aneurysms, EXCEPT: A pulsating mass is palpated in the abdomen Calcification of the aorta and large vessels is often visible on plain abdominal X-ray The abrupt onset of severe pain, radiating to the back and the hip indicates dissection or rupture of the aneurysm The diameter of the aneurysm is not related to the risk of rupture Most patients are asymptomatic; however the lesion can be detected by a routine physical examination

answer

The diameter of the aneurysm is not related to the risk of rupture

question

The most frequent cause of arterial occlusion is: All of the these Arteriosclerosis Varicose veins Embolism

answer

Arteriosclerosis

question

All of the following are trophic changes resulting from chronic ischemia, EXCEPT: Skin atrophy Muscle atrophy Osteoporosis Friable, opaque fingernails Hair loss

answer

Osteoporosis

question

The therapy of an arteriovenous fistula includes: Ligation of the vein distal to the fistulae Drug therapy only Ligation of the artery distal to the fistulae Amputation of the extremity Excision of the fistula and restoration of the continuity of the blood vessels

answer

Excision of the fistula and restoration of the continuity of the blood vessels

question

The treatment of choice for stenosis of the internal carotid artery is: Reversal endarterectomy Administration of platelet aggregation inhibitors Bypass grafting Ligation of the internal carotid artery Eversion endarterectomy

answer

Eversion endarterectomy

question

All of the following statements are valid regarding an aneurysm of the splenic artery, EXCEPT: The calcified ring of the aneurysm may be visible on plain abdominal X-rays It is usually the consequence of degenerative changes in the tunica media of the arterial wall This is the least prevalent of the aneurysms developing on visceral arteries It causes pain felt in the left hypochondrium and radiating to the left shoulder The risk of rupture is high during pregnancy

answer

This is the least prevalent of the aneurysms developing on visceral arteries

question

The primary therapy for pulmonary embolism is: Ligation of the inferior vena cava Pulmonary embolectomy Thrombectomy Anticoagulant therapy

answer

Anticoagulant therapy

question

All of the following factors predispose to pulmonary embolism, EXCEPT: Male gender Oral contraceptives Sedentary lifestyle Presence of an underlying cardiac disease Presence of a neoplasm

answer

Male gender

question

All of the following are appropriate for the treatment of trophic ulcers after venous thrombosis, EXCEPT: Venous bypass surgery Removal of the saphenous vein Compression dressing of varicose veins Skin grafting Elevation of the leg

answer

Venous bypass surgery

question

Postthrombotic varicose veins develop as a result of: Obstruction of the great saphenous vein Iliofemoral insufficiency The insufficiency of the perforator veins The destruction of deep veins The destruction of superficial veins

answer

The insufficiency of the perforator veins

question

What is the most common cause of dissecting aneurysms of the thoracic aorta? Coarctation of the aorta Syphilis Degeneration of the tunica media Injury Tricuspidal valve insufficiency

answer

Degeneration of the tunica media

question

The most severe complication of an abdominal aorta aneurysm is: Colon perforation Compression of the portal vein Aortic valve insufficiency Compression of the urether Rupture

answer

Rupture

question

All of the following are associated with the formation of aneurysms of the descending aorta, EXCEPT: Atherosclerosis Marfan's syndrome Syphilis Injury

answer

Injury

question

What does the abbreviation DSA stand for in vascular surgery? Digital Substraction Angiography Direct Supraclavicular Angiography Direct Stent Angioplasty Digital Selective Angiography

answer

Digital Substraction Angiography

question

From the following options which approach is NOT used for the treatment of an abdominal aortic aneurysm? Laparoscopic retroperitoneal approach Endovascular repair (stenting) Open transperitoneal approach Open retroperitoneal approach

answer

Laparoscopic retroperitoneal approach

question

Which statement is true for diabetic foot? The basic pathomechanism is the atherosclerosis of the major femoral arteries It is characterized by calf pain, nonhealing ulcers and gangrene It is characterized by foot pain, nonhealing ulcers and gangrene The basic pathomechanism is the atherosclerosis of the major crural arteries

answer

It is characterized by foot pain, nonhealing ulcers and gangrene

question

What is the Homan's sign? Inguinal pain with foot dorsiflexion in patients with DVT Calf pain with foot dorsiflexion in patients with DVT Plantar pain with foot dorsiflexion in patients with DVT Calf pain with foot plantarflexion in patients with DVT Chest pain with foot dorsiflexion in patients with DVT

answer

Calf pain with foot dorsiflexion in patients with DVT

Surgery Minimals Unideb 2016 – Flashcards

Unlock all answers in this set

Haven't found what you were looking for?

Search for samples, answers to your questions and flashcards