MCQs Mock Exams for General Surgery Board Exam

Mock Exam 1- 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.

Breast
1. After intraductal papilloma, unilateral bloody nipple discharge from one
duct orifice is most commonly caused by which of the following pathologic
conditions?
A. Paget's disease of the nipple.
B. Intraductal carcinoma.
C. Inflammatory carcinoma.
D. Subareolar mastitis.
Answer: B
2. Which of the following conditions is associated with increased risk of
breast cancer?
A. Fibrocystic mastopathy.
B. Severe hyperplasia.
C. Atypical hyperplasia.
D. Papillomatosis.
Answer: C
3. Which of the following breast lesions are noninvasive malignancies?
A. Intraductal carcinoma of the comedo type.
B. Tubular carcinoma and mucinous carcinoma.
C. Infiltrating ductal carcinoma and lobular carcinoma.
D. Medullary carcinoma, including atypical medullary lesions.
Answer: A
4. A 36-year-old woman complains of a 3-month history of bloody discharge
from the nipple.
At examination, a small nodule is found, deep to the areola. Careful
palpation of the nippleareolar
complex results in blood arrearing at the 3 Oclock position. Mammogram
findings are normal. What is the likeliest diagnosis?
(A) Intraductal papilloma
(B) Breast cyst
(C) Intraductal carcinoma
(D) Carcinoma in situ
(E) Fat necrosis
Answer: (A) Intraductal papilloma is the most common cause of bloody
discharge from the nipple. The lesion is treated by excision and is benign in

most cases. Cancer is present in 5% of cases. Preoperative ductography can

be used to help locate the offending duct .
Endocrine
5. When progressive enlargement of a multinodular goiter causes
symptomatic tracheal compression, the preferred management in otherwise
good-risk patients is:
A. Iodine treatment.
B. Thyroid hormone treatment.
C. Surgical resection of the abnormal thyroid.
D. Radioactive iodine treatment.
Answer: C
6. The most precise diagnostic screening procedure for differentiating
benign thyroid nodules from malignant ones is:
A. Thyroid ultrasonography.
B. Thyroid scintiscan.
C. Fine-needle-aspiration biopsy (FNAB).
D. Thyroid hormone suppression.
Answer: C
7. The preferred operation for initial management of a thyroid nodule that is
considered suspicious for malignancy by FNAB is:
A. Excision.
B. Partial lobectomy.
C. Total lobectomy and isthmusectomy.
D. Total thyroidectomy.
Answer: C
8. At the age of 46, an accountant has developed hoarseness due to an
inoperable cancer of the
left upper lung lobe. He has smoked heavily since the age of 14. Which of
the following features
of cancer of the lung indicates distant spread?
(A) Hypercalcemia
(B) Cushing-like syndrome
(C) Gynecomastia
(D) Syndrome of inappropriate secretion of antidiuretic hormone (SIADH)
(E) Brachial plexus lesion (Pancoasts syndrome)
Answer: (E) In apical lung cancers, the malignant tumor may extend
above the thoracic inlet, penetrate the suprapleural membrane, and infiltrate
the structures found at the root of the neck. The first thoracic nerve and
lower trunk of the brachial plexus are most likely to be involved initially, as
T1 passes along the inner border of the first rib to reach the neck. If the
sympathetic nerve is involved, pupil constriction and ptosis may be evident
(Horner syndrome). The other listed items are all features of the
paraneoplastic syndrome associated with lung cancer and do not necessarily
indicate extranodal metastasis. Cushings syndrome in lung cancer occurs
more frequently in men and in an older age group and has a more rapid

downhill course than typical Cushings syndrome. SIADH should be

suspected if the patient with a lung lesion develops unexplained mental
changes and an extremely low serum sodium level. Fluid restriction is
required. Urine osmolarity is low.
Abdumin
9. The most common hernia in females is:
A. Femoral hernia.
B. Direct inguinal hernia.
C. Indirect inguinal hernia.
D. Obturator hernia.
E. Umbilical hernia.
Answer: C
10. Which of the following statements regarding unusual hernias is
incorrect?
A. An obturator hernia may produce nerve compression diagnosed by a
positive Howship-Romberg sign.
B. Grynfeltt's hernia appears through the superior lumbar triangle, whereas
Petit's hernia occurs through the inferior lumbar triangle.
C. Sciatic hernias usually present with a painful groin mass below the
inguinal ligament.
D. Littre's hernia is defined by a Meckel's diverticulum presenting as the sole
component of the hernia sac.
E. Richter's hernia involves the antimesenteric surface of the intestine within
the hernia sac and may present with partial intestinal obstruction.
Answer: C
11. Staples may safely be placed during laparoscopic hernia repair in each
of the following structures except:
A. Cooper's ligament.
B. Tissues superior to the lateral iliopubic tract.
C. The transversus abdominis aponeurotic arch.
D. Tissues inferior to the lateral iliopubic tract.
E. The iliopubic tract at its insertion onto Cooper's ligament.
Answer: D
Osop & Dudenum
12. Which of the following statements about the anatomic course of the
esophagus is correct?
A. The cervical esophagus passes behind and to the right of the trachea.
B. The thoracic esophagus enters the posterior mediastinum anterior to the
aortic arch.
C. The thoracic esophagus passes behind the right mainstem bronchus and
the pericardium.
D. The esophagus enters the diaphragmatic hiatus at the level of T8.
E. The esophagus deviates anteriorly and to the left as it enters the
abdomen.
Answer: E

13. Which of the following statements about esophageal anatomy is correct?

A. The esophagus has a poor blood supply, which is segmental in distribution
and accounts for the high incidence of anastomotic leakage.
B. The esophageal serosa consists of a thin layer of fibroareolar tissue.
C. The esophagus has two distinct muscle layers, an outer, longitudinal one
and an inner, circular one, which are striated in the upper third and smooth
in the distal two thirds.
D. Injury to the recurrent laryngeal nerve results in vocal cord dysfunction
but does not affect swallowing.
E. The lymphatic drainage of the esophagus is relatively sparse, localized
primarily to adjacent paraesophageal lymph nodes.
Answer: C
14. Which of the following statements about the lower esophageal sphincter
(LES) mechanism, or high-pressure zone (HPZ), is true?
A. The LES is a circular smooth muscle ring that is 3 to 5 cm. long.
B. In assessing esophageal manometric data, mean HPZ pressure less than
6 mm. Hg or overall length less than 2 cm. is more likely to be associated
with incompetence of the LES and gastroesophageal reflux.
C. Esophageal manometry and the acid perfusion (Bernstein) test reliably
identify the patient with an incompetent LES mechanism.
D. Distal HPZ relaxation occurs within 5 to 8 seconds of initiating a swallow.
E. Twenty-fourhour distal esophageal pH monitoring is achieved with an
intraesophageal pH electrode positioned at the esophagogastric junction.
Answer: B
Intestine
15. The most common site of adenocarcinoma of the small intestine is the:
A. Duodenum.
B. Jejunum.
C. Ileum.
Answer: A
16. The most common benign tumor of the small intestine is:
A. Adenoma.
B. Hemangioma.
C. Leiomyoma.
Answer: C
17. An 80-year-old man who has been bedridden for many years following a
stroke presents with acute onset of abdominal distention, obstipation, and
colicky abdominal pain. Abdominal x-rays reveal dilated loops of small bowel
and a dilated sigmoid colon resembling a bent inner tube. Examination
reveals distention with mild direct tenderness but no rigidity or rebound
tenderness. Initial management should consist of:
A. Barium enema examination.
B. Laparotomy with resection of descending colon and descending colostomy.
C. Multiple cleansing enemas to remove impacted feces.
D. Rigid sigmoidoscopy and decompression of the sigmoid colon.

Answer: D
18. A 45-year-old man complains of burning epigastric pain that wakes him
up at night. The pain is relieved by eating or using over-thecounter antacids
and H2 blockers. Diagnosis is best confirmed by which of the following?
(A) Urea breath test
(B) Serum gastrin levels
(C) Barium meal examination
(D) Upper endoscopy
(E) Upper endoscopy and biopsy
Answer: (E) Duodenal ulcer is best diagnosed by upper endoscopy and
biopsy. Findings of gastritis and the presence of H.pylori are indications to
prescribe appropriate therapy. This typically includes a PPI and two
antibiotics (one regimen includes amoxicillin and clarithromycin). Although
the urea breath test is the most sensitive and specific test used to detect H.
pylori, it is not readily available in all settings.
19. A 25-year-old male develops diarrhea and colicky abdominal pain.
Ulcertive colitus is
diagnosed on colonoscopy. Which of the following findings is consistent with
the diagnosis?
(A) The rectum is not involved.
(B) The disease is confluent, there are no
skip areas in the colon and the rectum is involved.
(C) The full thickness of the bowel wall is involved.
(D) Microscopic examination of the mucosa reveals normal cells without
evidence of dysplasia.
(E) The incidence of colorectal cancer is equal to that of the general
population.
Answer: (B) Ulcerative colitis is a disease of unknown etiology, which
involves the colon and rectum
and spares the remainder of the GI tract. Its clinical course is variable with
inflammatory
changes and clinical symptoms ranging from mild to severe. The process is
confined to the
mucosa and the submucosa and does not extend through the full thickness
of the bowel
wall. Inflammatory changes are confluent with no skip areas. The risk of
dysplasia and colorectal
cancer is higher in ulcerative colitis than in the general population.
20. A 1-week-old infant is brought to the hospital because of vomiting. An
upper gastrointestinal (GI) series reveals duodenal obstruction. On
laparotomy, annular pancreas is found. Which of the following statements
about annular pancreas is TRUE?
(A) Resection is the treatment of choice.
(B) It is associated with Downs syndrome.
(C) Symptoms usually begin with back pain.
(D) It is most likely due to abnormal rotation encircling the third part of the
duodenum.

(E) Symptoms begin in childhood.

Answer: (B) Annular pancreas is a congenital anomaly; a band of
pancreatic tissue encircles the second part of the duodenum. Annular
pancreas is associated with Down syndrome as well as duodenal stenosis or
atresia. Duodenojejunostomy and gastrojejunostomy are acceptable
treatments. Resection is not an acceptable choice due to the high incidence
of fistula In adults, annular pancreas usually presents with abdominal pain,
nausea, and vomiting.

Liver
21. Which of the following clinical situations are considered good indications
for PVS?
A. A 50-year-old cirrhotic man had an emergency portacaval shunt for
bleeding varices and postoperatively had an ascites leak and mild superficial
wound infection.
B. A 57-year-old woman with primary biliary cirrhosis (PBC) has difficult to
control ascites and diuretic-induced encephalopathy.
C. A 46-year-old resistant alcoholic has chronic ascites uncontrolled by
diuretics combined with repeat paracentesis.
D. A 34-year-old woman taking BCPs had rapid onset of ascites and is found
to have hepatic vein thrombosis causing the Budd-Chiari syndrome.
Answer: C
Spleen
22. Hodgkin's disease is a malignant lymphoma with four histologic
subtypes. Which of the following is not one of the subtypes?
A. Lymphocyte predominance.
B. Nodular sclerosis.
C. Mixed cellularity.
D. Lymphocyte depletion. E. Leukocyte-lymphocyte dominance.
Answer: E
Genato urenery
23. Ureteral obstruction:
A. Is associated with hematuria.
B. Is associated with deterioration of renal function and rising blood urea
nitrogen (BUN) and creatinine values.
C. Is commonly caused by a urinary tract calculus.
D. Usually requires open surgical relief of the obstruction. E. Is usually
associated with infection behind the obstruction.
Answer: C
24. A20-year-old unrestrained driver was involved in a motor-vehicle crash.
A computed tomography
(CT) of the abdomen revealed a large hematoma in the second portion of
duodenum. The rest of the abdomen is normal. The initial management of
this duodenal hematoma should be:
(A) Operative evacuation

(B) Nasogastric decompression, intravenous fluids, and gradual resumption

of oral diet
(C) Endoscopic retrograde cholangiopancreatogram (ERCP)
(D) Laparotomy, pyloric exclusion, and gastrojejunostomy
(E) Octreotide
Answer: . (B) Intramural duodenal hematoma may occur secondary to
blunt trauma of the abdomen. Usually this hematoma is submucosal and the
injury is not transmural. It may cause a temporary obstruction of the
duodenum and usually responds to nasogastric suction and intravenous
fluids. Only if the patient has persistent obstruction (as demonstrated by an
upper GI study)
beyond 2 weeks, a surgical approach may be required.
25. In a patient who had a motor-cycle crash, a CT of the abdomen revealed
a peripancreatic
hematoma and indistinct pancreatic border. The most definitive test for a
pancreatic injury requiring operative intervention is:
(A) ERCP
(B) Ultrasonography
(C) CT scanning
(D) Operative exploration
(E) Amylase test of lavage fluid
Answer:. (A) The most definitive test for a lesion requiring operative
correction is demonstration of a
disrupted major pancreatic duct. While CT scanning may give a suggestion of
a ductal injury, and operative exploration of the area of injury may be
inconclusive, ERCP is very reliable in showing a disrupted duct. Amylase
testing of lavage effuent is nonspecific.