1.

Which of the following statements about pyogenic abscess of the liver

is true?

A. The left lobe is more commonly involved than the rt lobe.

B. Appendicitis with perforation and abscess is the most common underlying
cause of hepatic abscess.

C. Mortality is largely determined by the underlying disease.

D. Mortality from hepatic abscess is currently greater than 40%.

E. Bacteria that predominate in pyogenic liver abscesses are gram-negative

anaerobes.

2. Which of the following statements most accurately describes the

current therapy for pyogenic hepatic abscess?

A. Antibiotics alone are adequate for the treatment of most cases.

B. All patients require open surgical drainage for optimal management.

C. Optimal treatment involves treatment of not only the abscess but the
underlying source as well.

D. Percutaneous drainage is more successful for multiple lesions than for solitary
ones.

E. Hepatectomy is never needed as a part of treatment.

3. Which of the following statements about amebic abscess in not true?

A. Mortality is higher than that for similarly located pyogenic abscesses.

B. The diagnosis of amebic abscess may be based on serologic tests and
resolution of symptoms.

C. In contrast to pyogenic abscess, the treatment of amebic abscess is primarily

medical.

D. Patients with amebic abscess tend to be younger than those with pyogenic
abscess.

E. Amebic abscess affects males in a 9:1 to 10:1 ratio.

A

4. Which of the following statements is true about solid lesions of the

liver?

A. Adenomas are true neoplasms with a predisposition for complications and

should usually be resected.
B. Focal nodular hyperplasia (FNH) is a neoplasm related to oral contraceptive
pills (OCPs) and usually requires resection.

C. Hamartomas are the most common benign lesions of the liver that come to the
surgeon's attention.

D. Focal nodular hyperplasia (FNH) has a propensity to bleed and to undergo

malignant change.

E. Hemangiomas are usually confirmed by biopsy.

5. About malignant neoplasms of the liver all are true except:

A. Hepatocellular carcinoma is probably the number 1 cause of death from

cancers worldwide.
B. The most common resectable hepatic malignant neoplasm is colorectal
metastasis.

C. Fibrolamellar variant of primary cancers has a much more benign course than
hepatomas in general.

D. Hepatomas are generally slower growing than was formerly believed.

E. Hepatocellular carcinoma is associated with infection with hepatitis A,

hepatitis B, and hepatitis C

6. About Echinococcosis liver disease caused by Echinococcus

granulosus all are true except:

A. Is not a neoplasm.
B. Is endemic to parts of Europe and Asia but not the United States.

C. Is usually curable by resection.

D. Is more deadly than in its Echinococcus multilocularis form.

 E. Albendazole is used more frequently in treatment.

7. Which of the following is the most effective definitive therapy for both
prevention of recurrent variceal hemorrhage and control of ascites?

A. Endoscopic sclerotherapy.
B. Distal splenorenal shunt.

C. Esophagogastric devascularization (Sugiura procedure).

D. Side-to-side portacaval shunt.

E. End-to-side portacaval shunt.

8. Which of the following treatments most effectively preserves hepatic

portal perfusion?

A. Distal splenorenal shunt.

B. Conventional splenorenal shunt.

C. Endoscopic sclerotherapy.

D. Side-to-side portacaval shunt.

E. Transjugular intrahepatic portosystemic shunts (TIPS)

9. Which of the following complications of portal hypertension often

require surgical intervention (for more than 25% of patients)?

A. Hypersplenism.
B. Variceal hemorrhage.

C. Ascites.

D. Encephalopathy.

E. Portal vein thrombosis.

B
10. Regarding the differential diagnosis between an amoebic and a
pyogenic liver abscess one is true.

A. The clinical presentation is often clearly distinguishable.

B. A history of recent travel or origin from a high risk area is in favor of a
pyogenic liver abscess.

C. Routine liver chemistries frequently can distinguish pyogenic from amoebic

liver abscess.

D. Serologic testing for the presence of antibody to entamoeba histolyctica is the

only specific and sensitive way to confirm the diagnosis of amoebic liver
abscess.

E. Distinguishing pyogenic from hepatic abscesses preoperatively is not

important since surgical drainage is imperative for both.

11. One of the following statements concerning treatment of pyogenic

liver abscess is not true?

A. Antibiotic therapy alone may be advisable in patients with multiple

small abscesses.
B. Percutaneous drainage provides comparable results to surgical
drainage in patients with unilocular large abscesses.

C. Sufficient antibiotic coverage for most hepatic abscesses includes

coverage for gram-positive aerobic bacteria only.

D. In patients with a primary biliary origin for the hepatic abscess,

treatment must also be addressed at underlying biliary pathology such
as choledocholithiasis or biliary ductal obstruction.

E. The culture is negative in ~20 % of cases.

12. Important spontaneous portosystemic collaterals which develop in the

face of portal hypertension include:

A. The hemorrhoidal veins.

B. Left renal vein.

C. The Para umbilical venous plexus.

 D. The coronary, short gastric, and paraesophageal veins.

E. All of the above.

13. About bleeding oesophageal varices one is true:

A. All patients with portal hypertension will develop esophageal varices.

B. Endoscopic sclerotherapy is effective as endoscopic banding in the control of
acute bleeding episodes.

C. Variceal size can predict the incidence of variceal hemorrhage.

D. Control of acid secretion by H2 blockade can decrease the incidence of

rebleeding after esophageal hemorrhage.

E. None of the above.

14. Regarding hepatic encephalopathy, the condition is exacerbated by all

of the following except:

A. Bleeding varices.
B. Diazepam.

C. Infections.

D. Protein diet.

E. Neomycin.

15. As the functional anatomy of the spleen is divided into red pulp,
white pulp, and marginal zone, what function is incorporated into the
anatomy of the cortical zone that relates to infection control?

A. Filtration of red cells, encapsulated bacteria, and other foreign material.

B. Red pulp for formation of red cells.

C. White pulp for its role in formation of granulocytes.

D. Gray areas, so formed because of the production of platelets.

 F. Fibrous trabeculae.

16. During the evolution of the understanding of hematologic diseases,

the indications for splenectomy have changed. The most common
indications for splenectomy are, in descending order of frequency:

A. Traumatic injury, immune thrombocytopenia, hypersplenism.

B. Immune thrombocytopenic purpura, traumatic injury, hypersplenism.

C. Hypersplenism, traumatic injury, immune thrombocytopenia.

D. Immune thrombocytopenia, hypersplenism, traumatic injury.

E. None of the above.

17. Useful methods for detection of splenic injury, in descending order of

sensitivity, are:

A. Diagnostic peritoneal lavage.

B. CT.

C. Ultrasonography.

D. Isotope scan.

F. Magnetic resonance imaging (MRI).

18. Regarding the following statements about splenosis one is true:

A. Autotransplantation of splenic tissue is an etiology.

B. May protect against OPSS (overwhelming post splenectomy sepsis).

C. May over time be “born again” and regain some immune function.

D. May produce tuftsin and properdin.

E. All of the above.

E
19. About Idiopathic thrombocytopenic purpura ( ITP) one is true:

A. Is most common in men in their 20s.

B. Is frequently cured in adults by corticosteroid administration.

C. Usually requires splenectomy in children.

D. Is most common in the sixth decade of life.

E. Is in remission in more than 80% of patients with splenectomy.

20. Regarding Splenectomy and perioperative therapy for ITP one is true:

A. Follow successful steroid therapy.

B. Respond permanently to high-dose intravenous gamma globulin.

C. Are best preceded by polyvalent vaccines for Pneumococcus, Haemophilus

influenzae, and Neisseria meningitidis.

D. Cannot be done laparoscopically.

E. Are associated with splenomegaly.

21. Regarding post splenectomy sepsis all are true except:

A. The incidence in children is generally reported as less than 5%.

B. Haemophilus influenzae, Streptococcus pneumoniae and Neiseria meningitidis
are the most common causative organisms.

C. Autotransplantation techniques eliminate this risk.

D. The mortality rate is now approximately 50%.

E. The incidence in adults in approximately 1%.

22. Incidence of sialolithiasis is very high in:

A. Submandibular gland.
B. Parotid gland.

C. Sublingual gland.
 D. Minor salivary glands.

E. Sebaceous glands.

23. Regarding benign salivary gland adenomas one is false:

A. Pleomorphic adenomas account for less than 10% of parotid gland tumours.
B. Pleomorphic adenomas can undergo malignant change.

C. Warthin's tumour is otherwise known as an adenolymphoma.

D. Adenolymphomas usually occur in elderly men.

E. Approximately 10% of adenolymphomas are bilateral.

24. During surgical excision of the submandibular gland all are true except:

A. The skin incision should be placed 4cm below the lower border of the mandible.
B. Both the facial artery and vein may need to be divided.
C. The lingual nerve should be identified and preserved.
D. The hypoglossal nerve should be divided.
E. The submandibular duct is ligated and divided as far forward as possible.

25. With regard to acute suppurative parotitis, all the following statements
are true except:

A. Tends to occur in the elderly or debilitated patient.

B. Dehydration is a major contributing factor.

C. Immediate surgical drainage is mandatory.

D. Staphylococcus aureus is the organism most likely to be found.

E. Chronic bacterial sialoadenitis is rare in the parotid gland.

C
26. Regarding the anatomy of the salivary glands one is true:

A. The parotid gland is divided into two well defined lobes (superficial and deep)
based on the neurovascular supply of the gland and embryologic lobar
encapsulation.
B. Injury to one or more branches of the facial nerve may occur during operations on
the submandibular salivary gland as well as on the parotid gland.

C. There are approximately 40-60 minor salivary glands scattered in the submucosal
plane of the oral cavity of most individuals.

D. The facial nerve and its branches course superficial to the external parotid fascia
and therefore may be injured during parotid surgery.

E. E-The submandibular gland main duct is called Wharton's duct and opens in front
of the upper second molar tooth.