MCQs Mock Exams for General Surgery Board Exam

Mock Exam 4- 25 MCQs

Share from Dr. Muhanad Deeb. Riyadh, King Faisal Hospital (muhanad.deeb.5facebook.com)
References:
1. Comprhensive "AIO" Revision on SURGERY by Dr.Adel Abdel Hamid. 2008
2. Lange Q & A 5th Edition.

1. Which of the following statements most accurately reflects the findings of large
overview analyses of clinical trials in which adjuvant chemotherapy for early-stage
breast cancer was compared to a control group treated only with surgery?
A. The benefit of adjuvant therapy is confined to young patients.
B. Adjuvant therapy benefits all patients and is independent of age or node status.
C. Adjuvant therapy does not work in estrogen-positive patients.
D. The magnitude of benefit is very large.
Answer: B

2. A 45-year-old woman presents with a weeping eczematoid lesion of her nipple.

Which of the following statement(s) is/are true concerning her diagnosis and
management?
a. Treatment is with warm compresses and oral antibiotics
b. Biopsy of the nipple revealing malignant cells within the milk ducts is invariably
associated with an underlying invasive carcinoma
c. The appropriate treatment is mastectomy
d. The lesion always represents a high-risk disease with a significant risk of
subsequent metastatic disease
Answer: c

3. Which of the following statement(s) is/are correct concerning cystosarcoma

phyllodes?
a. The tumor is most commonly seen in post-menopausal women
b. Total mastectomy is necessary for all patients with this diagnosis
c. Axillary lymph node dissection is not necessary for malignant cystosarcoma
phyllodes
d. Most patients with the malignant variant of cystosarcoma phyllodes die of
metastatic disease
Answer: c

4. A 52-year-old undergoes a left modified radical mastectomy for a 2-cm breast

cancer. She should
be informed that the factor which has the greatest impact on her prognosis is?
(A) The size of the primary tumor
(B) The histological type of the carcinoma
(C) The number of axillary nodes positive for metastasis
(D) Hormonal receptor status of the primary tumor
(E) Positive findings on tests for the presence of the BRCA(breast cancer)1 gene
Answer: (C) The number of positive axillary nodes remains one of the best
prognostic indicators in
breast carcinoma. The current American Joint Committee on Cancer (AJCC) staging
classification
now defines patients with 1–3 positive nodes (N1), 4–9 positive nodes (N2), and 10
or
more positive nodes (N3) due to their different prognosis.

5. Prolactinomas of the pituitary:

A. Most often produce dysfunctional uterine bleeding in women.
B. Most commonly produce infertility in men.
C. When asymptomatic, are best treated surgically early in the microadenoma
stage.
D. May enlarge during pregnancy, requiring treatment with bromocriptine or
surgery.
E. Commonly occur in patients with MEN 2.
Answer: D

6. Hyperthyroidism can be caused by all of the following except:

A. Graves' disease.
B. Plummer's disease.
C. Struma ovarii.
D. Hashimoto's disease.
E. Medullary carcinoma of the thyroid.
Answer: E

7. Which of the following is true about the use of radioiodine to treat

hyperthyroidism?
A. If hyperthyroidism is secondary to radioiodine use, it will occur within 2 years of
treatment.
B. There is a markedly increased risk of future thyroid cancer following radioiodine
therapy.
C. The risk of leukemia following radioiodine therapy is approximately 10%.
D. Mutation abnormalities occur in 15% of fetuses in utero following internal
treatment of the mother with radioiodine during pregnancy.
E. Radioiodine may pass through the placenta and lactating breast to produce
hypothyroidism in a fetus or infant.
Answer: E

8. After undergoing a percutaneous needle biopsy, a 49-year-old electrical engineer

is found to have small-cell carcinoma. The chest x-ray shows a lesion in the
peripheral part of the right middlelobe. The patient should be advised to undergo
which of the following?
(A) Right lobectomy
(B) Right pneumonectomy
(C) Excision of lesion and postoperative radiotherapy
(D) Combination chemotherapy
(E) Radiotherapy
Answer: (D) Patients with small-cell carcinoma should not be treated initially by
thoracotomy. This cancer responds favorably to combination chemotherapy, but
few patients survive for more than 1 year. More than 160,000 cases of
bronchogenic carcinoma are diagnosed in the United States per year. It accounts
for 33% of all cancer deaths in men and 20% of all cancer deaths in women. The
most common cancers of the lung are squamous carcinoma, 30% (tumor tends to
be central); adenocarcinoma, 30%, (tumor tends to be peripheral) small-cell
carcinoma, 20% (tumor tends to be central); and large-cell carcinoma, 15% (tumor
tends to be peripheral).

9. The following statement(s) is/are true concerning umbilical hernias in adults.

a. Most umbilical hernias in adults are the result of a congenital defect carried into
adulthood
b. A paraumbilical hernia typically occurs in multiparous females
c. The presence of ascites is a contraindication to elective umbilical hernia repair.
d. Incarceration is uncommon with umbilical hernias
Answer: b

10. A number of special circumstances exist in the repair of inguinal hernias. The
following statement(s) is/are correct.
a. Simultaneous repair of bilateral direct inguinal hernias can be performed with no
significant increased risk of recurrence
b. The preperitoneal approach may be appropriate for repair of a multiple recurrent
hernia
c. A femoral hernia repair can best be accomplished using a Bassini or Shouldice
repair
d. Management of an incarcerated inguinal hernia with obstruction is best
approached via laparotomy incision
Answer: b

11. The following statement about peritonitis are all true except:
A. Peritonitis is defined as inflammation of the peritoneum.
B. Most surgical peritonitis is secondary to bacterial contamination.
C. Primary peritonitis has no documented source of contamination and is more
common in adults than in children and in men than in women.
D. Tuberculous peritonitis can present with or without ascites.
Answer: C

12. Which of the following statements about pathology encountered at

esophagoscopy is/are correct?
A. Reflux esophagitis should be graded as mild, moderate, or severe, to promote
consistency among different observers.
B. An esophageal reflux stricture with a 2-mm. lumen is not dilatable and is best
treated with resection.
C. A newly diagnosed radiographic distal esophageal stricture warrants dilation and
antireflux medical therapy.
D. In patients with Barrett's mucosa, the squamocolumnar epithelial junction occurs
3 cm. or more proximal to the anatomic esophagogastric junction.
E. After fasting at least 12 hours, a patient with megaesophagus of achalasia can
safely undergo flexible fiberoptic esophagoscopy.
Answer: D

13. Which of the following statements about the diagnosis and treatment of
esophageal leiomyomas is/are correct?
A. The majority are diagnosed after they cause dysphagia and chest pain.
B. Biopsy is indicated at the time of esophagoscopy, to rule out carcinoma.
C. Full-thickness elliptical excision of the esophageal wall is the preferred surgical
approach.
D. Endoscopic ultrasonography is a reliable means of following leiomyomas
conservatively.
E. Recurrence of resected leiomyomas is minimized by wide local excision.
Answer: D

14. Which of the following statements regarding the pathology of esophageal

carcinoma is/are correct?
A. Worldwide, adenocarcinoma is the most common esophageal malignancy.
B. Squamous cell carcinoma is most common in the distal esophagus, whereas
adenocarcinoma predominates in the middle third.
C. Patients with Barrett's metaplasia are 40 times more likely than the general
population to develop adenocarcinoma.
D. Metastases from esophageal carcinoma are characteristically localized to regional
mediastinal lymph nodes adjacent to the tumor.
E. Achalasia, radiation esophagitis, caustic esophageal stricture, Barrett's mucosa,
and Plummer-Vinson syndrome are all premalignant esophageal lesions that
predispose to the development of squamous cell carcinoma.
Answer: C

15. Which of the following statement(s) is/are true concerning drug therapy for
Crohn’s disease?
a. Corticosteroids have been demonstrated to effectively treat acute exacerbations
and to prolong remission in patients with Crohn’s disease
b. Sulfasalazine is indicated primarily for the treatment of patients with acute
exacerbations of Crohn’s disease involving the small bowel
c. Azathioprine, an immunosuppressant, has been shown to be effective in
maintaining remission of Crohn’s disease
d. Low dose cyclosporine has significant therapeutic benefit for patients with both
low and high disease activity
Answer: c
16. A 25-year-old woman with known ulcerative colitis presents to the emergency
room with a 24-hour history of abdominal pain, distention, and obstipation. Physical
examination reveals a temperature of 38.6° C, abdominal distention, and diffuse
abdominal tenderness. Abdominal x-rays show marked colonic dilatation, most
pronounced in the transverse colon. Laboratory examination reveals a white blood
count of 19,000/mm3. Over the first 24 hours of hospitalization, symptoms are
progressive in spite of intravenous fluid resuscitation, nasogastric suctioning, and
intravenous antibiotics. The most appropriate management for this patient would
include which of the following?
a. Decompressive colonoscopy
b. Proctocolectomy with formation of end ileostomy
c. Total abdominal colectomy with formation of Hartmann pouch and end ileostomy
d. Cecostomy
Answer: c

17. Crohn's disease:

A. Is caused by Mycobacterium paratuberculosis.
B. Is more common in Asians than in Jews.
C. Tends to occur in families.
D. Is less frequent in temperate climates than in tropical ones.
E. Is improved by smoking.
Answer: C
18. A 44-year-old dentist was admitted to the hospital with a 1-day history of
hematemesis caused by a recurrent duodenal ulcer. He has shown considerable
improvement following operative treatment by a truncal vagotomy and
pyloroplasty, 10 years prior to this incident. Which is TRUE of truncal vagotomy?
(A) It is performed exclusively via the thorax.
(B) It can be performed in the neck.
(C) If complete, it will result in increased acid secretion.
(D) It requires a gastric drainage procedure
(E) It has been abandoned as
Answer: (D) If vagotomy alone is performed, gastric stasis occurs in more than
40% of cases.
Branches of the vagus nerve innervate the pylorus. A drainage procedure is
necessary; a yloroplasty or a gastroenterostomy should be performed and both of
these require a laparotomy. Truncal vagotomy can also be done through a thoracic
approach. Transection of the vagus nerve in the neck results in paralysis of the
recurrent laryngeal nerve.
19. A 55-year-old man presents with left lower quadrant (LLQ) abdominal pain of
2-day duration, associated with constipation. On physical examination, he has
tenderness localized to the LLQ with fullness in that area leukocyte count is 22,000
and temperature is 101.5°F. Which would be the best diagnostic study to evaluate
this man?
(A) Diagnostic laparoscopy
(B) Barium enema
(C) Plain abdominal roentgenogram
(D) Computed tomography (CT) of the abdomen/pelvis with orally (PO) and
intravenous (IV) contrast
(E) Colonoscopy
Answer: (D) The man likely has diverticulitis. The differential includes irritable
bowel, appendicitis,
inflammatory bowel disease, pyelonephritis ischemic colitis, and perforated
carcinoma. Diverticulitis is an infectious complication of diverticulosis resulting from
perforation of the colonic diverticulum. The resulting inflammation may be confined
to the pericolonic tissue (incomplicated diverticulitis) or result in abscess, free
perforation, fistulization, or obstruction (complicated diverticulitis). The clinical
spectrum is correspondingly broad ranging from mild symptoms to peritonitis and
sepsis. Patients with signs and symptoms of sepsis should be hospitalized and
undergo diagnostic study. A CT scan is the best study to evaluate the extent of the
inflammatory process as well as to exclude other pathology. Plain x-ray would not
reveal specific pathology. Both barium enema and colonoscopy in the acute setting
are risky and may cause free perforation and contamination of the peritoneal cavity
there by converting a localized process to generalized peritonitis. Barium has the
additional risk of a chemical peritonitis caused by the barium itself. Diagnostic
laparoscopy is invasive and may risk spreading a localized process.

20. A 6-month-old boy presents with an inguinal hernia, first noticed 2 weeks after
birth. What is the best treatment choice?
(A) Observation
(B) Laparotomy
(C) Surgical repair when the child is fully grown
(D) Surgical repair of the affected side
(E) Surgical repair of the affected side and exploration of the nonaffected side to
search for and repair a sac that was not previously detected by clinical means
Answer: (E) Inguinal hernias in infancy are almost always congenital and indirect
and are often bilateral. Bilateral exploration is recommended, except when the
surgery is performed for incarceration.

21. 68. A 52-year-old male, known to be alcoholic, is evaluated because of chronic

abdominal pain. The clinical diagnosis of chronic pancreatitis is supported by ERCP
findings of pancreatic ductal ectasia with alternating areas of stricture and
dilatation. Several pancreatic ductal stones are also noted. With chronic pain as the
operative indication, the most appropriate procedure would be:
a. 80% distal pancreatectomy with splenectomy
b. Longitudinal pancreaticojejunostomy
c. Distal pancreatectomy with end pancreaticojejunostomy
d. Total pancreatectomy
Answer: b

22. For the patient in the preceding question, the most appropriate long-term
management is which of the following?
a. Endoscopic stenting of the distal common bile duct
b. Choledochoduodenostomy
c. Pancreaticoduodenectomy (Whipple procedure)
d. Percutaneous transhepatic drainage of the common hepatic duct
Answer: b

23. The most frequent cause of primary lymphedema is:

A. A deficiency of transporting lymphatic channels.
B. Valvular incompetence in lymphatic channels.
C. Obstruction or removal of regional lymph nodes.
D. Thrombosis of lymphatic channels.
Answer: A

24. . A 55-year-old male presents with severe flank pain radiating to the groin
associated with nausea and vomiting. Urinalysis reveals hematuria. A plain
abdominal film reveals a radiopaque 5 mm stone in the area of the ureterovesical
junction. Which of the following statement(s) is/are true concerning this patient’s
diagnosis and management?
a. A likely stone composition for this patient would be uric acid
b. The stone will likely pass spontaneously with the aid of increased hydration
c. Stone analysis is of relatively little importance
d. Patients with a calcium oxalate stone and a normal serum calcium level should
undergo further extensive metabolic evaluation
Answer: b

25. A 60-year-old woman runs her car off the road and it hits a telephone pole. She
presents to the emergency department with severe anterior chest pain and a blood
pressure of 110/80 mm Hg. A chest x-ray shows a questionably widened
mediastinum. The next step in management should be which of the following?
(A) Transthoracic echocardiogram
(B) Pericardiocentesis
(C) Aortogram
(D) Central venous access line
(E) CT of chest
Answer. (C) The most definitive test for aortic injury is the aortogram, even
though only 20–30% of patients with widened mediastinum demonstrate it. A
transthoracic echocardiogram does not image the aorta wall; however, a
transesophageal
echocardiogram may have more value in experienced hands