Quiz: surgery — AUA MCQ

The normal pressure of LOS is:

A 5-40 cm H20 B 1 0-20 cm H20 C 20-30 cm H20 D 30-40 cm

All of the following are part of VACTREL syndrome except

A Vaginal hypoplasia B Imperforate anus. C Polydactyly D Polycystic kidney

The best investigation in an new born with arrest of catheter at 1 Ocm from nostril:

A Plain X-ray B Barium swallow C Lipidol swallow D Gastrograffin meal.

A new born diagnosed as esophageal atresia should be kept in:

A Supine position B Prone position C Semisitting position. D Trendlenberg position

As regard Bockdalek hernia all are correct except:

A It always presents in neonatal life B Presents with neonatal distress with scaphoid abdomen C X-ray shows gas shadow with mediastinal shift. D Main line of treatment is conservative with respiratory' support

The commonest diaphragmatic hernia in adults is

A Bockdalek hernia B Morgagni hernia C Rolling hernia D Sliding hiatus hernia.

The commonest diaphragmatic hernia in infants is:

A Bockdalek hernia B Morgagni hernia C Rolling hernia D Sliding hiatus hernia.

Factors associated with the development of complications of gastroesophageal reflux disease include:

A The presence of a defective lower esophageal sphincter B Inadequate esophageal clearance C The presence of a hiatal hernia D All of the above

An asymptomatic lower esophageal ring (Schatzki's ring) is best treated by

A Endoscopic dilatation B Transthoracic resection of the ring C Esophagogastrectomy with jejunal interposition D Transabdottvinal excision of the ring

Which patient should be offered (even poor medical risk) antireflex surgery as first treatment option for G E R D

A Symptoms > 5 years B Hiatus hernia C Barrett's oesophagitis D Esophageal p H< 4 for >20% of the day

. Which of the following tests are helpful in assessing operability of esophageal cancer:

A Esophagoscopy B CT scan C Endoluminal Ultrasonography D B&C

The worst palliative procedure for inoperable oesophageal carcinoma is:

A Colon bypass B Esophagogastrostomy C Esophagojejunostomy D Gastrostomy

The most accurate method to evaluate lymph nodes involvement in esophageal cancer is

A Barium esophagogram B Endoscopic US C CT scan D PET

As regards Plummer Vinson syndrome all are correct except:

A s more common in males B Of unknown etiology. C May lead to postcricoid carcinoma. D Associated with spleenomegaly.

Motility disorder in achalasia include:

A Absent primary wave of peristalsis at LES. B Week or incoordinated secondary wave C Abnormal tertiary wave D All of the above

The following are lines of medical treatment of achalasia:

A Botulinum toxin injection. B Calcium channel blocker C Nitrates D All of the above

Cardiospasm is associated with

A esophageal webs B coronary artery spasm C hiatus hernia D Chagas' disease

Esophageal perforation is most often due to:

A Reflux oesophagitis B Swallowed foreign bodies C Persistent vomiting D Instrumentation

Management of endoscopic perforation of the esophagus All are correct except

A Barium swallow is the test choice B Conservative management is more likely to be SUCCeSSfUt than that of spontaneous rupture C Conservative management is recommended for perforation < lcm ini size D Surgery is recommended for perforation cin in size

The commonest congenital anomaly of the esophagus is

A Atresia with tracheo-esophageal fistula into upper pouch B Atresia with tracheo-esophageal fistula into lower pouch. C tresia with fistula into each pouch. D Simple atresia without fistula.

The most common cause of reflux esophagitis is

A Sliding hiatus hernia B Paraoesophageal hiatus hernia. C Esophageal varices. D Esophago-cardiomytomy (Heller's operation).

Which of the following gives the best results for carcinoma of the esophagus

A Surgical excision alone. B Preoperative radiation and surgical excision C Surgical excision followed by radiotherapy. D Radiotherapy and colon bypass

The following statements about the Mallory-Weiss syndrome are true except that it

A Is due to a mucosal tear along the gastroesophageal B Usually results from forceful retching or vomiting C Is often associated with alcohol abuse. D Should be treated surgically.

A previously healthy 8-year-old boy came to the emergency room because of massive hematemesis. The most probable cause is :

A Erosive gastritis. B ITP C Hemophilia D Esophageal varices

The Mallory-Weiss syndrome Occurs most often in:

A Alcoholics B Pregnant females. C Children D Obese patients.

Which of the following tests are helpful in assessing operability of esophageal cancer:

A Esophagoscopy B CT scan C Endoluminal Ultrasonography D B&C

All of the following are presentations of CHPS except:

A Bile stained vomiting. B Loss of weight in 1 st 4 weeks of life C Loss of weight in 1 st 4 weeks of life D Visible peristalsis.

The most diagnostic investigation of CHPS is

A Abdominal US B Gastrograffin meal C Barium meal. D None of the above

The surgical treatment of CHPS is

A Gastrectomy and gastrojejunostomy B Ramsted's operation. C Hiller's operation. D None of the above.

Congenital atresia of duodenum USUaIIy involves

A First part of duodenum B Second part of duodenum C Neighborhood of ampulla of Vater. D None of the above.

Acute perforation of duodenal ulcer may present by the following except:

A Severe generalized abdominal pain B Colicky pain in lower abdomen. C Septic peritonitis if neglected. D Massive hematemesis if posterior ulcer eroding gastroduodenal artery

The most common site of peptic Ulcer is

A . Fundus of stomach. B Distal end of esophagus C 1 st part of duodenum. D Lesser curvature.

Main line of treatment of gastric erosions is:

A Conservative treatment. B Surgical ligation of feeding vessel. C Gastrectomy D None of the above.

Helicobacter pylori:

A Is a gram —ve bacilli spiral in shape (spirochetes) B Is the most common chronic infection world wide C Is a common cause of chronic peptic ulcer. D All of the above

The precancerous possibility of gastric ulcer makes it different from duodenal ones in that

A Regular follow up by endoscopy is indicated B . Surgical treatment if no response to medical treatment within 8 weeks C Aim of surgery to remove ulcer completely D All of the above.

Which of the following is/are true regarding vagotomy:

A Decrease gastric acidity up to 100% B Trunkal vagotomy must be combined with drainage procedure C Selective vagotomy doesn't need drainage procedure D All of the above.

Metabolic complications of subtotal gastrectomy with Billroth I or Billroth I l reconstruction include the following except

A Hypothyroidism B Anemia C Reactive hypoglycemia. D Dumping syndrome.

Which of the following measures are effective in preventing stress gastritis bleeding in critically ill patients?

A Improving systemic circulation by correcting any shock like state resulting from blood loss or sepsis. B orrecting systemic acid-base abnormality. C Maintaining adequate nutrition D All Of the above

A 50-year-old woman was admitted with a history of weight loss and anemia. An upper gastrointestinal endoscopy revealed atrophic gastric mucosa, apart from iron deficiency type, which other type of anemia is associated with tine lesion shown?

A Hereditary spherocytosis. B Sickle cell anemia C Pernicious anemia. D Mediterranean anemia

High risk patients who will continue bleeding or re-bleed in cases of bleeding peptic ulcer include

A Presentation with shock B Blood transfusion of 4 Units in 24 hours C Active bleeding or visible blood vessels on endoscopy D All of the above

As regards Colloid carcinoma of stomach all are correct except

A Primary colloid carcinoma has better prognosis than secondary B Secondary colloid carcinoma is due to mucinous degeneration of tumor C . Can lead to leather bottle stomach. D Is the most common cause of Krukenberg tumor of ovary.

In a male patient of 45 year complaining of dyspepsia for first time, the investigation of choice is:

A Stool examination. B Barium-follow through. C Upper Gl endoscopy. D Colonoscopy

The following statements about hypertrophic pyloric stenosis are true except that it :

A Affects males more often than females. B Manifests itself at birth. C Is characterized by projectile vomiting D Is often associated with a palpable epigastric mass.

Among the following statements about benign gastric ulcers, the incorrect one is that they

A Occur most often on the lesser curve of the stomach B Are always due to hyperacidity. C Produce epigastric pain soon after meals. D Require routine gastroscopy and endoscopic biopsy

The most important prognostic sign in carcinoma of the stomach is

A Size of the lesion. B Naked eye type. C Histological type D lymph node involvement.

The most frequent site of gastric cancer is the

A Cardia B Fundus C Lesser curvature D Pyloric antrum.

Carcinoma of the stomach is often associated with the following except:

A Achlorhydria of the stomach B Atrophic gastritis. C Adenomatous gastric polyps D Peptic ulceration

The following statements about gastrinomas are correct except that they are:

A Non-beta cell pancreatic tumors B Always benign. C Frequently multiple D . Responsible for the Zollinger-Ellison syndrome.

In acute hematemesis, the diagnosis is best established by:

A Acurate history-taking B Thorough physical examination. C Laboratory work-up D Fiberoptic gastroduodenoscopy

As regard presentations of acute pancreatitis all are correct except:

A Symptoms are more evident than signs. B Pain usually radiate to hypogastrium. C Hematemesis and/or melena may occur. D Board like rigidity of abdomen may occur

Indications for laparotomy in acute pancreatitis include the following except

A Doubtful diagnosis. B Complicated cases C Pseudocyst D Deteriorating cases for debridement.

The most common cause of acute pancreatitis:

A Bile duct stone B Alcoholism C Iatrogenic D Idiopathic

The most common cause of chronic pancreatitis:

A Bile duct stone B Alcoholism C Iatrogenic D Idiopathic

The best treatment of acute pancreatitis is:

A Conservative (ryle, line, IV fluids and antibiotic). B CT guided aspiration. C Laparotomy and debridement D None of the above.

RaiSed amylase level

A Is diagnostic for chronic pancreatitis B Is a screening test for cancer pancreas. C More than 1 000 units is bad prognostic criteria in acute pancreatitis D May occur in non pancreatic diseases as dissecting aortic aneurism.

The following are complications of acute pancreatitis. The most common cause of death is

A Neurogenic shock B Multiorgan failure. C Tetany D Pancreatic abscess and septicemia.

ERCP finding suggestive of chronic pancreatitis include

A Dilated main duct with stones and strictures. B Pancreatic cysts C Chain of lakes appearance D All of the above.

The most sensitive test for diagnosis of acute pancreatitis is:

A Serum amylase level. B Serum lipase level. C Serum calcium level D Amylase creatinine clearance ratio.

As regards Surgical drainage of pseudo pancreatic cyst all are correct except:

A Indicated in all cases B indicated in infection. C Indicated if the cyst >6cm or persistent >6weeks. D Done by cystojejunostomy or more common cystogastrostomy.

What is not true of pancreatic pseudocyst:

A Presents in epigastrium as a fixed swelling. B Mimics aneurysm of aorta if very tense C Pseudocysts less than 6 cm invariably have spontaneous resolution. D All are true

Presentations of Zollinger Ellison syndrome include the following except:

A Peptic ulcer resistant for treatment and recurrent after treatment. B Peptic ulcer in ectopic sites C Peptic ulcer complicated by bleeding and perforation in short time D constipation

The most important investigation for the extent of cancer pancreas is:

A ERCP B US C CT D Barium meal.

As regard treatment of cancer pancreas

A Whipple's operation for operable cases B Triple anastomosis for inoperable cases C Endoscopic stenting in patients unfit for surgery. D All of the above

Carcinoma of the pancreas

A Has a peak incidence in young age B Had a good prognosis C Commonly presents with athenia D Is more common in smokers

Concerning pancreatic pseudocysts, the following statements are correct except that :

A Trauma is the most common cause B They often present as midline pulsating swellings. C hey may resolve spontaneously D Ultrasound is helpful in establishing the diagnosis

Kasai operation is for treatment of

A Intrahepatic biliary atresia B Extrahepatic biliary atresia C Carorli's disease D Choledochai cyst

The most accurate investigation to diagnose cholecystitis is:

A CT scan B IV cholangiography C HIDA scan D US

The best of the following investigations of gall stones is :

A Oral cholangiography B US C Plain X-ray D ERCP

With intraoperative T-tube cholangiography incidence of missed stones is

A 0 % B 5% C 20% D 30%

Without intraoperative T-tube cholangiography incidence of missed stone is:

A 10-20% B 40-50% C 70% D 80%

Which percentage of gall stones is radio-opaque

A 10% B 40% C 70% D 90%

The commonest presentation of gall stones is:

A Asymptomatic B Biliary colic C Charcot's triad D Jaundice

The best treatment of asymptomatic gall stone in diabetics is:

A Prophylactic cholecystectomy B ESWL C Follow up D None of the above

Which of the following statement(s) about gallstone ileus is/are not true?

A The condition is seen most frequently in women older than 70. B oncomitant with the bowel obstruction, air is seen in the biliary tree C The usual fistula underlying the problem is between the gallbladder and the ileum D When possible, relief of small bowel obstruction should be accompanied by definitive repair of the fistula since there is a significant incidence of recurrence if the fistula is left in place

Gas in the biliary system on a plain X-ray is diagnostic of

A Choledochoduodenal fistula B -Intestinal obstruction C Emphysematous Cholecystitis D A and C

Characters of pain in acute cholangitis are the following except:

A Starts as colicky pain B Becomes dull aching with time C Throbbing pain means empyema formation D Referred to groin and inner side of thigh

As regards empyema of gall bladder all are correct except:

A Is a complication of gall stones B Leads to gall bladder mass C Is an indication for cholecystectomy D Should be treated by cholecystostomy

Which statement about acute non calcular cholecystitis is correct?

A The disease is often accompanied by or associated with other conditions. B The diagnosis is often difficult. C The mortality rate is higher than that for acute calCUlOUS cholecystitis D All of the above

Which of the following statements about cholangitis is incorrect:

A Charcot's triad is always present B Associated biliary tract disease is always present. C Chills and fever are due to the presence of bacteria in the bile duct system. D The most common cause of cholangitis is choledocholithiasis.

T-tube should be removed:

A Once cholangiography is done to avoid fibrosis B After 4 days of operation if there is no missed stone C After at least 1 0 days of operation whatever the result of cholangiography D None of the above

As regards treatment of acute cholecystitis all correct except

A Cholecystectomy is the best treatment in early cases B Morphine is given to decrease pain of anxiety of patient C Modified Fowler's position is preferred D Failure of conservative treatment indicates cholecystostomy

Saint's triad includes all the following except

A Achaiasia B Hiatus hernia C Chronic calcular cholecystitis D Diverticular disease of the colon

Which of the following lesions are believed to be associated with the development of carcinoma of the gallbladder?

A Cholecystoenteric fistula. B A calcified gallbladder. C Adenoma of the gallbladder. D All of the above

The preferred treatment for carcinoma of the gallbladder is:

A Radical resection that includes gallbladder in continuity with the right hepatic lobe and regional lymph node dissection. B Radiation therapy. C Chemotherapy D Palliative treatment

Which of the following is true about postcholecystectomy syndrome

A Postoperative stricture is the most common cause of the syndrome B Dyskinesia may be the cause C ERCP is the investigation of choice D All of the above

Indications of alpha feto-protein measuring include:

A Sudden deterioration of hepatic patient. B Focal lesion by abdominal US. C Follow up after surgical removal of tumor. D All of the above

Mortality from rupture liver is about:

A 5% B 20%. C 40%. D 50%

Treatment of traumatic injury to the liver includes all except:

A Resection debridement of devitalized tissues B Ligation of exposed blood vessels and bile ducts C Packing with gauze. D Pringle's maneuver

The following is not a common complication(s) of hydatidosis:

A Anaphylactic shock. B Obstructive jaundice. C Malignant transformation of surrounding tissue. D Multi-system spread.

The most common presentation of hydatidosis is

A Asymptomatic. B Obstructive jaundice C Anaphylactic shock D Cough and haemoptysis.

As regard treatment of hydatidosis the best is:

A Follow up. B Enucleation C Removal en block D Segmentectomy

High fever in amoebic hepatitis indicates:

A Amoebic liver abscess B Systemic spread. C Secondary infection in amoebic liver abscess D All of the above

The most common type of bilharzial periportal fibrosis is:

A Fine B Coarse C Mixed D d

Stage Ill of hepatic bilharziasfs means

A Hepatomegaly B Hepatospleenomegaly C Spleenomegaly with shrunken liver. D None of the above

The most common complication of hepatic hydatid disease is

A Jaundice B Rupture into perionteal cavity C Suppuration D Rupture into biliary channe

Rupture of amoebic liver abscess occurs most offen into

A Peritoneal cavity B Pleural cavity C Pericardial cavity D Duodenum

Paramalignant syndrome may present by the following except:

A Polycythaemia B Fever of unknown etiology C Hypocalcaemia D Haemoptysis

Angiography for detection of hepatoma should be done through:

A Portal vein B Hepatic artery C Retrograde through hepatic veins D Any of the above.

Most common predisposing factor for hepatoma is

A Hepatitis B. B Hepatitis C. C Chronic irritation D Portal hypertension

Tumor marker in fibrolamellar hepatoma is:

A Alpha feto-protein. B Carcino-embryonic Ag. C Carboxyprothrombin D None of the above.

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