Download Pre-Test

The New York General Surgery Board Review Course 2013
Presented by Oakstone
October 26, 2013 – October 30, 2013 – Teaneck, NJ
________________________________________________________________________________
Pre-Test
1. Youarecalledtoseeanelderlymulti‐traumapatientwhohasaknownhistoryofsignificantcoronary
arterydisease,atrialfibrillation,andmildheartfailure.Heishypotensive,hisabdomenisdistended,
theFASTrevealsalargeamountoffluidaroundthespleen,andthereisanopenfractureofthefemur.
Whichofthefollowingwillbemostbeneficialinhisearlytreatment?
a. Norepinephrinetoincreasehisbloodpressure
b. Increasingtheafterloadtoraisethebloodpressureimmediately
c. Cardioversionofthechronicatrialfibrillationtorestorethe“atrialkick”
d. Rapidinfusionof20mL/kgofRinger’slactate
e. Beta‐blockadetocontrolexcessiveventricularratesthatcancausehypotension
2. Youaretreatingasepticpatientwhoisonhigh‐doseLevophedforbloodpressuresupport.HisPCWP
is20mmHg,withthemostrecentsystemicvascularresistanceabout2600.Whichofthefollowingis
theappropriatechangetomake?
a. Adda1‐agonist
b. Adda2‐blocker
c. Addan1‐agonist
d. Addan2‐blocker
e. Addepinephrineorvasopressin
3. YouhavejustinsertedaSwan‐Ganzcatheterandcannotbesurethat,withtheballooninflated,thetip
isactuallywedged.Yourecallthatinthewedgedpositionthebloodgasonthespecimenobtainedby
drawingbackonthelineafterdiscardingthefirst5to10ccofbloodshouldbeintherangeof:
a. pO2>60
b. pO2<60
c. pCO2>60
d. pCO2<30
e. pH>7.6
4. Youindeedwereinthewedgedpositionandnowobtainthefollowingdata.Yourpatient’ssystemic
pressureis90/40,theheartrateis120,andtheurineoutputisscant.TheRApressureis2,theRV
pressureis18/2,thePApressureis18/4,andthewedgedpressureis4.Thecardiacoutputis1.8L,
andthesystemicvascularresistanceis2300.Thelikelycauseofshockinthispatientis:
a. Fluidoverload
b. Pulmonaryembolism
c. Cardiactamponade
d. Hypovolemia
e. Neurogenicshock
946-NYGS Pre Test Questions
The New York General Surgery Board Review Course 2013
Presented by Oakstone
October 26, 2013 – October 30, 2013 – Teaneck, NJ
________________________________________________________________________________
5. Yourpatientwithknowncoronaryarterydiseaseisinrefractoryshockintherecoveryroom.He
sufferedfromanacutemyocardialinfarctionduringarecentcolectomy.Thecardiologistwantstodo
anemergencycardiaccathtodeterminewhetherthereisablockageamenabletostenting.The
cardiologistdeterminedthataballoonpumpwasneededforinterimsupportandwasinsertingthe
percutaneousballooncatheterwhenhehadtoleaveforanotheremergencyandaskedthatyoufinish
settingthetimeforballooninflation.Howcanyoutellwhenballooninflationistooearlyortoolate?
a. LookattheECG,timebytheTwave
b. LookattheECG,timebytheQRS
c. Lookatthearterialwaveformproximaltotheballoonsite
d. Lookatthearterialwaveformdistaltotheballoonsite
e. Checkthecardiacoutputserially
6. Howmanyofthefollowingwillincreasevenousreturninpatientsonmechanicalventilation?
 Smalltidalvolumes
 Briefinspiratorytime
 LimitingPEEPtotheminimaltomaintainsatisfactoryoxygenation
a. All
b. 2
c. 1
d. None
7. Allofthefollowingarecontraindicationsfortheuseofcontrolledhypercapniaexcept:
a. CNSproblems,trauma,tumor
b. SevereHTN
c. Severemetabolicalkalosis
d. Hypovolemia
e. Severerefractoryhypoxia
8. ToxicityoftacrolimusincludesallofthefollowingEXCEPT:
a. Nephrotoxicity
b. Hypertension,headaches,andvasospasm
c. Alopecia
d. Hyperlipidemia
e. Poorwoundhealing
9. WhichofthefollowingcellsareNOTactiveininnateimmunity?
a. TcellsandBcells
b. NKcells
c. Neutrophils
d. Mastcells
e. Macrophages
946-NYGS Pre Test Questions
The New York General Surgery Board Review Course 2013
Presented by Oakstone
October 26, 2013 – October 30, 2013 – Teaneck, NJ
________________________________________________________________________________
10. MacrophagemediatorsincludeallofthefollowingEXCEPT:
a. Complementcomponents
b. Proteolyticenzymes
c. Regulatorymediators–IL‐1,TNF‐,IL‐6
d. Lysozymeandhydrolases
e. Antibodiestocellsandorgans
11. Tcellsrecognizeantigensthroughallbutoneofthefollowing:
a. Directbindingtotheantigen
b. RecognizingapeptidefragmentofanantigenboundtoanMHCmolecule
c. Presentationbyaprofessionaldendriticcell
d. Presentationbyanon‐professionalendothelialcell
e. Presentationbyanendothelialcell
12. Immunecellscommunicatebyallthefollowingmethodsexceptfor:
a. Directcell‐to‐cellcontact
b. Solublefactorschemoattractantcytokines
c. Combinationofcell‐to‐cellcontactandacytokine
d. Contactwithcellsurfacemolecules,whichcanconvertintosolublemediators
e. Useofanimmunosuppressivedrug
13. HowoftendoesidenticalHLAphenotypeoccuramongsiblings?
a. 25%ofthetime
b. 50%ofthetime
c. 75%ofthetime
d. 100%ofthetime
e. Occursonlyinidenticaltwins
14. A28‐year‐oldmanisseenonarenaltransplantconsultationwithhismother,father,3brothers,and1
sister.Allarewillingtodonateakidney,allarebloodgroupcompatible,andallareveryhealthy.
Whichoneshouldbeselectedasadonor?
a. Motherwhoisa1haplotypematch
b. Sisterwhoisa2haplotypematch
c. Brotherwhoisa1haplotypematch
d. Brotherwhoisa0haplotypematch
e. Fatherwhoisa1haplotypematch
946-NYGS Pre Test Questions
The New York General Surgery Board Review Course 2013
Presented by Oakstone
October 26, 2013 – October 30, 2013 – Teaneck, NJ
________________________________________________________________________________
15. A45‐year‐oldmanreceivesadeceaseddonorkidneyand,2daysfollowingoperation,hasaminimal
urinaryoutputof10cc/hrandstillrequireshemodialysis.Hehasanormalduplexultrasoundofthe
kidney.Themostlikelydiagnosisis:
a. Renalarterystenosis
b. Recurrentfocalsegmentalglomerulosclerosis
c. Acutetubularnecrosis
d. Hyperacuterejection
e. Tacrolimusnephrotoxicity
16. Youarecalledtoseeayoungsterwhowasplayingbaseballearlierthatdayandwasstruckontheleft
sideofhisheadbyalinedrive.Hereportedlywasknockeddownbutgotupshortlythereafterand
continuedtoplaysayinghewas“OK.”Onthewayhomefromthegame,hisparentsthoughtheshould
becheckedwhenhesaidhisheadwashurting.Helapsedintocomashortlythereafter.On
examination,youfinda“fixedanddilatedleftpupil.”Whatisthemostlikelycauseofthis
abnormality?
a. Theyoungsterhasaglasseyefollowingpriorenucleationforocularmelanoma
b. Theyoungsterhasanexpandingcontusionofthebrainintheoculomotorcortex
c. Theyoungsterhasacutehydrocephaly
d. Theyoungsterhasanacutesubduralhematomaonthesideoppositetheinjury
e. Theyoungsterhasanacuteepiduralhematomaonthesideoftheinjury
17. Youarecoveringyoursurgicalgroupfortheweekendandarecalledtoseeyourpartner’s
postoperativetotalthyroidectomycase,doneformedullarycarcinoma.Thepatient’swifeis
concernedbecausethepatientis“veryhoarse.”Hewasscheduledfordischargebyyourpartner
beforeheleftfortheweekend.Onexamination,heisbreathingwellbutisaphonic.Whatisthelikely
cause?
a. Idonotknowwhat“aphonic”meanssoguess“B”andgotothenextquestion
b. Thepatientishavingaconversionreaction
c. Thepatienthasunilateralacutevocalcordparalysis,sidetobedetermined
d. Thepatienthasbilateralvocalcordparalysis
e. Thisscenarioiscorrupt.Helikelyhasbilateralvocalcordparalysisbutshouldhavebeen
stridorous,sothescenarioisimpossible.
946-NYGS Pre Test Questions
The New York General Surgery Board Review Course 2013
Presented by Oakstone
October 26, 2013 – October 30, 2013 – Teaneck, NJ
________________________________________________________________________________
18. Youareevaluatingyourtraumapatientwhohasundergoneastentplacementforanacuteruptureof
theaortajustdistaltothesubclavianartery.Pleasedwiththe“save,”younotethathislegsareweak
andthathehaslostpinpricksensationbilaterallyyethasmaintainedproprioception.Helikelyhas
sustainedanischemicinsultandnowhas:
a. Brown‐Sequardsyndrome
b. Anteriorcordsyndrome
c. Centralcordsyndrome
d. Expectedchangespostsurgery,openorclosed
e. AcutereactionduetoexcessiveadministrationofIVcontrastmaterial
19. YourpatientwithBRACA1‐associatedbreastcancerhashadabilateralmastectomydone
prophylactically.Onin‐officefollow‐up,sheisconcernedthatherrightshoulderbladeseems“weird”
sincetheoperation.Younotethatindeedshehasa“wingedscapula”onthesameside.Themostlikely
causeisoperativeinjurytothe:
a. Vagusnerve,ipsilateral
b. Spinalaccessorynerve
c. Ipsilaterallongthoracicnerve
d. Ipsilateralthoracodorsalnerve
20. Fromwhatnervedoesthe“criminalnerveofGrassi"arise?
a. Thegreatersplanchnicnerve
b. Thelessersplanchnicnerve
c. Theleftvagusnerve
d. Therightvagusnerve
21. Youareevaluatingajaundicedmanwhowasfoundtohavea“replacedrighthepaticartery”on
angiography.Whatdoesthatmean?
a. Hehasnoarterialbloodflowtotherightlobeoftheliver
b. Hehasdoublearteriesperfusingtherightlobeoftheliver
c. Hehasnobloodflowtotheleftlobeoftheliver
d. TherighthepaticarteryarisesfromtheSMA
e. TherighthepaticarteryarisesfromtheIMA
22. Themostcommonnonatheroscleroticcauseofcarotidstenosisis:
a. Fibromusculardysplasia
b. Carotiddissection
c. Giantcellarteritis
d. Takayasu’sarteritis
946-NYGS Pre Test Questions
The New York General Surgery Board Review Course 2013
Presented by Oakstone
October 26, 2013 – October 30, 2013 – Teaneck, NJ
________________________________________________________________________________
23. Themostappropriatemanagementforayoung,otherwisehealthypatientwithclaudicationdueto
poplitealentrapmentsyndromeis:
a. Exerciseregimen
b. Exerciseregimenwithcilostazol(Pletal®)
c. Transluminalangioplastyandstentplacement
d. Interpositionveingraftwithdivisionofmedialheadofthegastrocnemiusmuscle
24. Theearliestformofatheroscleroticdamagetoperipheralarteriesis:
a. Fattystreaks
b. Intermediatelesions
c. Prototypicalplaque
d. Thrombosedplaque
25. Theankle‐brachialindex:
a. Isreliableinpatientswithseverelycalcifiedarteries
b. Shouldneverbe>1.0
c. Canbeusedtoscreenforcoronaryarterydisease
d. Isaninvasivetest
e. Mustbecombinedwithtreadmillexercisetobeuseful
26. Regardingswallowing:
a. Swallowingisnotaffectedbytherecurrentlaryngealnerve
b. Asleeveresectionoftheesophagusshouldnotbeperformedasthisdisruptsthe
propulsionoftheesophagus
c. Alargehiatalherniacandisruptpropulsionintheesophagus
d. Tertiaryperistalsisisimportantinclearingresidualmaterialintheesophagus
e. Alloftheabovearetrue
27. Inregardtotheanatomyofthestomach:
a. Theanatomicbeginningoftheantrumistheangularisincisura
b. ThecriminalnerveofGrassiisnearthepylorus
c. Byfindingthevagusnervemoredistallyontheesophagus,thesurgeonismorelikelyto
divideallthefibersinavagotomy
d. Theconsistentlylargestarterytothestomachistherightgastric
e. Thegastroepiploicarteriesrunalongthelessercurvatureofthestomach
946-NYGS Pre Test Questions
The New York General Surgery Board Review Course 2013
Presented by Oakstone
October 26, 2013 – October 30, 2013 – Teaneck, NJ
________________________________________________________________________________
28. Regardingacidsecretion:
a. AcidsecretionoccurswhentheH+/K+ATPaseenzymeisactivated
b. BecausePPIsirreversiblyinterferewiththeenzymeassociatedwiththeprotonpump,
functiondoesn’treturnwhenthesemedicationsarestopped
c. Somatostatinisapowerfulstimulantofacidsecretion
d. Theintestinalphaseaccountsforthemajorityofacidsecretion
e. Alloftheabove
29. Intermsofthesmallintestine:
a. Thestrengthlayerofthebowelisthemuscularismucosa
b. Thestrengthlayerofthesmallintestineistheserosa
c. Theproximalintestinehasalargercircumference
d. Peyer’spatchesaremostprominentintheduodenum
e. Shortbowelsyndromeislikelytooccurif<300cmofsmallbowelremainsafterresection
30. WhichisNOTtrueregardinganalcontinence?
a. Internalhemorrhoidscontributetoanalcontinence
b. Theexternalsphinctersuppliesthemajorityoftherestingtone
c. Thepuborectalismuscleisimportantinanalcontinence
d. Decreasedrectalcompliancecompromisescontinence
e. Thepudendalnerveinnervatestheinternalandexternalsphincters
31. CO2pneumoperitoneummayrequiretheanesthesiologisttoaltertheventilatorsettingsby
a. Decreasingtherate
b. Increasingtherate
c. Increasingoxygencontent
d. Increasingtheisoflurane
e. Alloftheabove
32. Allofthefollowingarearesultofincreasingtheintra‐abdominalpressureexcept:
a. IncreasedSVR
b. IncreasedCI
c. IncreasedMAP
d. IncreasedCVPandPCWP
e. IncreasedPVR
946-NYGS Pre Test Questions
The New York General Surgery Board Review Course 2013
Presented by Oakstone
October 26, 2013 – October 30, 2013 – Teaneck, NJ
________________________________________________________________________________
33. Studieshaveshownthat,afterlaparoscopy,thereisLESSofasystemicriseforallofthefollowing
EXCEPT:
a. IL‐6
b. TNF
c. ACTH
d. WBC
e. Noneoftheabove
34. A35‐year‐oldwomanwhois22weekspregnantpresentswithanewpalpablemassintheUOQofthe
rightbreast.Themassis2.5cminsizeandfeelsbenigninnature.Shehasnopalpableaxillarynodes.
Ultrasoundrevealedthefollowing:
Whichofthefollowingisthebestnextstepinmanagement?
a. Delaymanagementuntilafterdelivery
b. Needlebiopsy
c. Excisionalbiopsy
d. Bilateralmammogram
e. BreastMRI
946-NYGS Pre Test Questions
The New York General Surgery Board Review Course 2013
Presented by Oakstone
October 26, 2013 – October 30, 2013 – Teaneck, NJ
________________________________________________________________________________
35. Inregardtotheanus:
a. Hasananaltransitionzonethatiscomposedofcolumnarepithelium
b. Thehemorrhoidalplexusissynonymouswiththeinferiorrectalvein
c. Patientswithrectalvariceshaveanincreasedriskforhemorrhoids
d. Melanomasoftheanusmayrequireanabdominoperinealresection
e. Externalhemorrhoidsshouldnotbetreatedwithbanding
36. Incidentalappendectomyisrecommended:
a. InindividualswithCrohndiseasewhenthececumisfreeofdisease
b. Inchildrenabouttoundergochemotherapy
c. DuringLadd’sprocedure
d. Inpatientsaged<25years
e. Alloftheabove
37. LaparoscopicappendectomyisNOTrecommendedinwhichofthefollowingsituations?
a. Appendicealmucocele
b. Perforatedappendicitis
c. Obesepatients
d. Patientswithpreviousabdominalsurgery
e. Elderlypatients
38. Inpatientswithsignificantrectalbleeding:
a. Anoscopyisnotrecommended,assignificantbleedingrarelyresultsfromhemorrhoidal
bleeding
b. Angiographyismoresensitivethantaggedredbloodcellscanfordetectingbleeding
c. Taggedredbloodcellscanningismoreaccurateinlocalizingrectalbleeding
d. PatientswhocomplainofrectalbleedingshouldhaveaFOBTperformedtoconfirm
e. Angioembolizationmaybeusedforintestinalbleedinglocalizedwithangiography
39. Inpatientswithdiverticulardisease:
a. Resectionshouldincludeallobviousdiverticula
b. Whenoperatingurgently,asigmoidresectionwithendcolostomyandHartmann’spouch
shouldalwaysbeperformed
c. Surgeryshouldbeavoidedinimmunosuppressedpatientsbecauseofincreased
complicationswithsurgery
d. Diverticularabscessesdonotrespondtoantibiotics
e. Mostpatientswithuncomplicateddiverticulitiswillrespondtooutpatienttherapywith
broad‐spectrumoralantibiotics
946-NYGS Pre Test Questions
The New York General Surgery Board Review Course 2013
Presented by Oakstone
October 26, 2013 – October 30, 2013 – Teaneck, NJ
________________________________________________________________________________
40. AdvantagesofCTcolonography(virtualcolonoscopy)include:
a. Lesspatientdiscomfort
b. Avoidanceofabowelpreparation
c. Avoidanceofinsufflationandriskofperforation
d. Similarsensitivitytocolonoscopyforlesions>1cm
41. WhichistrueregardingPEGs?
a. Localwoundinfectionscanbedecreasedbyadministeringpre‐procedureantibiotics
b. Gastrocolicfistulasdonotoccur,asthestomachisremotefromthecolon
c. Closureofthegastrostomytubegenerallyrequiresoperativetakedown
d. Localinfectionsusuallyrequireremovalofthegastrostomytubeforresolution
e. Thecrossbarshouldbetightenedasmuchaspossibletoavoidseparationofthestomach
fromtheabdominalwall
42. Colonicpolyps:
a. Shouldneverbeexcisedpiecemeal,asthismakespathologicinterpretationdifficult
b. Perforationfollowingcolonoscopymaynotbeevidentforseveraldays
c. Chromoendoscopyisroutinelyusedfordetectionofischemia
d. Argonplasmacoagulationisnotsafeinthecolon,asithasasignificantdepthof
penetration
e. Perforationfollowingcolonoscopyalwaysmandatesoperativeexploration
43. RegardingERCP:
a. ItispreferredinpregnancytoIOCasitdoesn’tinvolveionizingradiation
b. Itincludesevaluationoftheesophagusandstomachforpathology
c. Theminorpapillaisproximaltothemajorpapilla
d. Plasticstentsarecommonlyusedformalignantstrictures
e. Metalstentsarecommonlyusedforbenignstrictures
44. TheLap‐Band®procedureisassociatedwith:
a. Excessiveweightlossovertime
b. Manymetabolicproblems
c. Lowoperativemorbidity
d. Latestenoses
45. Comparingopentolaparoscopicbariatricprocedures,itisevidentthat:
a. Theopenoperativeapproachisbothmoretimeconsumingandmoreexpensivetoperform
b. Thelaparoscopicapproachissuperiorinpatientcomfortpostoperatively
c. Ghrelininfusionsshortenthelengthofstay
d. Alloftheabove
e. Noneoftheabove
946-NYGS Pre Test Questions
The New York General Surgery Board Review Course 2013
Presented by Oakstone
October 26, 2013 – October 30, 2013 – Teaneck, NJ
________________________________________________________________________________
46. Followingbariatricsurgery,patientsshow:
a. Noweightlossforthefirst3months
b. RapidweightgainONLYifthestomachstaplesfallout
c. Improvementinsensitivitytoinsulin
d. Afrequentfatal“gasbloat”syndrome
e. Noneoftheabove
47. Bariatricsurgeryisnowbeingperformedonunemancipatedminorsage13to16years.Theoperative
consentshouldbesigned,notingthat:
a. Allbariatricsurgeryisexperimentalandcarriespotentiallylethalbutunknownrisks
b. Parentsorguardianslosetheirrightsbecausetheyallowedtheirchildtobecomemorbidly
obese,thustheyareguiltyofMunchausensyndromebyproxy
c. Nosignatureoftheteenagerisadvisablebecausethepatientisunderage
d. Theteenagergaveconsentalongwiththeresponsibleparentorguardiangivingconsent
e. Theteenagergaveassentalongwiththeresponsibleparentorguardiangivingconsent
48. YouhavereadanarticleonastudyofanewdrugtreatmentforCrohndisease.Itreportsthatthedrug
wasfoundtobeeffective,witha“Pvalue”≤0.05.Thismeansthat
a. Thedrugworked95%ofthetime
b. Ifthedrugdidnotreallywork,youstillcouldendupwithrejectionofthenullhypothesis
5%ofthetime.Inthiscase,thefindingsofthestudywouldrepresenta“falsepositive”
c. Thestudyisunderpowered5%ofthetime
d. 95%ofresearchisaccurate
e. Youhaveabetaerror5%ofthetime
49. A66‐year‐olddiabetichasbeenonaventilatorfor5daysfollowingsurgeryforperitonitisduetoa
perforatedappendix.Sheremainsnasotracheallyintubated.Initiallyfebrile,shedefervescedonPOD2
butnowhasspikedafeverto39°C.Thechestx‐rayremainsclear,andtheabdominalexamis
unremarkable.ACTofthesinusesrevealedaleftmaxillarysinusitis.Themostlikelycausative
organismis:
a. Staphylococcusaureus
b. Enterococcusfecalis
c. Escherichiacoli
d. Klebsiellapneumoniae
e. Pseudomonasaeruginosa
946-NYGS Pre Test Questions
The New York General Surgery Board Review Course 2013
Presented by Oakstone
October 26, 2013 – October 30, 2013 – Teaneck, NJ
________________________________________________________________________________
50. Youhaveperformedatotalthyroidectomyforalargepapillarycarcinomaofthethyroid,andthe
PGY1residentwhoscrubbedonthecasetellsyouthatthepatienthasapositiveChvosteksigninthe
recoveryroom.Heisconcernedthatthepatientishypocalcemic.Whichofthefollowingstatementsis
mostcorrect?
a. TheChvosteksignisrarelypresentinnormocalcemicpatients
b. TheChvosteksignisusuallypresentinnormocalcemicpatients
c. TheChvosteksignishighlysensitiveforhypocalcemia
d. TheChvosteksignishighlyspecificforhypocalcemia
e. TheChvosteksignisneitherhighlysensitivenorhighlyspecificforhypocalcemia
51. A72‐year‐oldmanpresentswithaparotidmass.Imagingstudiesconfirmthatthemassisinthe
superficiallobeofthegland.Fine‐needleaspirationofthemassis:
a. Usefulintreatmentplanning
b. Likelytogiveacorrecttissuediagnosisoftumortypein95%ofcases
c. Contraindicated
d. Likelytospreadthediseasetothelymphglandsin5%ofcases
e. Moredangerousthanacore‐needlebiopsy
52. Followingthyroidsurgery,yourpatientisnotedtobeaphonicintherecoveryroom.Themostlikely
causeis:
a. Post‐intubationedemaofthevocalcords
b. Injurytotherightrecurrentlaryngealnerve
c. Injurytotheleftrecurrentlaryngealnerve
d. Bilateralsuperiorlaryngealnerveinjury
e. Bilateralrecurrentnerveinjury
53. Thebloodsupplytocarotidbodytumorsarisesfromthe:
a. Subclavianartery
b. Commoncarotidartery
c. Internalcarotidartery
d. Externalcarotidartery
e. Transversecervicalartery
54. Canapatientgivenanarcoticagentgiveinformedconsent?
a. Yes,butonlyinemergencies
b. Yes,butonlyiftheintentofthemedicationwastogetthepatienttoagreetosurgery
c. Yes,butonlyifthepatientisahabitualuserofnarcotics
d. Never
e. Yes,butonlyifthepatientisalert,oriented,andcapableofmakingadecision
946-NYGS Pre Test Questions
The New York General Surgery Board Review Course 2013
Presented by Oakstone
October 26, 2013 – October 30, 2013 – Teaneck, NJ
________________________________________________________________________________
55. Concerningadvancedirectives,allofthefollowingaretrueexcept:
a. Availabilityoftheformsisrequiredbylawatthetimeofhospitalization
b. Itisarightofthepatienttocompletesuchforms
c. Itisdesirablethatsuchformsbecompletedbeforemajoroperativeprocedures
d. Itismandatorythattheformsbecompletedbeforeelectivesurgery
e. Patientsmayrefusetofillinsuchforms
56. YourelderlycancerpatienthasaDNRorder.Hehassustainedanesophagealperforationduringan
attemptedPEGinsertion.Whileintheoperatingroom,hehasacardiacarrest.Shouldresuscitationbe
attempted?
a. Itisasimpleanswer,YES.DNRordersareautomaticallycancelledwhenapatiententers
theOR
b. Itisasimpleanswer,NO.DNRorderscannotberescinded
c. Onlyifyoubelieveitwillbesuccessful
d. Onlyifyoubelievethefamilywantsitdone
e. OnlyiftherewaspreoperativediscussionofsuspensionoftheDNRorderandthepatient
agreedtoperioperativediscontinuationoftheDNRorder
57. Thetypicalpatientbelievesthattheprincipalcauseofmedicalerrorsis:
a. Incompetence
b. Overtiredness
c. Insufficientattentionbyphysician
d. Poornursingcare
58. Informedconsentisbestdescribedas:
a. Followingthedoctor’sadvice
b. Aprocessofshareddecisionmakingbasedonmutualrespectandparticipation
c. Aprocessofcommunicationthatisessentialonlytotreatmentforalife‐threateningillness
d. Obtainingasecondopinionpriortostartingtreatment
e. Providingthepatienttheconsentformtostudy
59. Withholdingorwithdrawingtreatmentisbestdescribedas:
a. Passiveeuthanasia
b. Activelytakingstepstocauseapatient'sdeath
c. Assistedsuicide
d. Lettingnaturetakeitscourse
e. Noneoftheabove
946-NYGS Pre Test Questions
The New York General Surgery Board Review Course 2013
Presented by Oakstone
October 26, 2013 – October 30, 2013 – Teaneck, NJ
________________________________________________________________________________
60. Themostimportantfactorindeterminingifsomeoneisasuitablecandidateforanorgantransplant
is:
a. Emotionalstability
b. Someoneforwhomatransplantoffersareasonablelikelihoodofrecovery
c. Abilitytodealwithstress
d. Age
e. Insurancecoverage
61. Theneedfornewmethodsofdefininganddeterminingdeathwascreatedbywhatmedical
procedure?
a. Brainsurgery
b. Openheartsurgery
c. Artificialresuscitation
d. Organtransplantation
e. Cardiacpacemakers
62. Youwillreceive______medicalcareifyoudonothaveanyadvancedirectives.
a. little
b. full
c. no
d. reluctant
e. substandard
63. Esophagealmanometryinpatientswithachalasiausuallyshowswhichoneofthefollowingfindings?
a. Frequentuncoordinatedperistalsis
b. Primarymotorwaves
c. Secondarymotorwaves
d. Aperistalsis
e. RelaxationoftheLES
64. WhichofthefollowingstatementsischaracteristicofpatientswhohaveaZenkerdiverticulum?
a. Usuallyareintheir40sor50s
b. ShouldhaveEGDtomakethediagnosis
c. Medicaltherapyiswarrantedbeforesurgery
d. GERDusuallyworsensaftersurgeryontheZenkerdiverticulum
e. Myotomyisindicated
946-NYGS Pre Test Questions
The New York General Surgery Board Review Course 2013
Presented by Oakstone
October 26, 2013 – October 30, 2013 – Teaneck, NJ
________________________________________________________________________________
65. Post‐emeticesophagealperforationischaracterizedbythefollowing:
a. Oftenoccursinpatientswithunderlyingesophagealdisease
b. BariumesophagramshouldbedoneifBoerhaavesyndromeissuspected
c. Subcutaneousemphysemaisalwayspresent
d. Surgicalrepairisbestdonelaparoscopically
e. 2‐layerclosureoftheesophaguswithsometypeofbuttressingshouldbeusedfordelayed
repair
66. Riskfactorsforesophagealcancerinclude:
a. Achalasia
b. Barrettesophagus
c. GERD
d. Smoking,alcoholabuse
e. Alloftheabove
67. PatientswithGERDandshortsegmentsofBarrettepitheliumshouldalwayshavethefollowing:
a. 24‐hourpHstudiestoevaluatetheseverityofreflux
b. AvoidanceofaggressivemedicalmanagementofGERDsinceitcouldmasksymptoms
c. EMRofBarrettmucosa
d. LaparoscopicNissenfundoplication
e. EGDand4‐quadrantbiopsiestodetectHGD
68. A33‐year‐oldwomanpresentswithworseningrightlowerquadrantabdominalpainof2days'
duration.Sheiscarryingtwinsat24weeks’gestation.Shehasapoorappetiteandmildnausea.Her
abdominalexamrevealsdecreasedbowelsounds,moderatetendernesstopalpationintherightmid
andlowerabdomen,questionablerebound,andagraviduterusthatisnontender.Hercervixisclosed,
andtherearenouterinecontractionsonthemonitor.HerWBCis18,400withashifttotheleft.What
diagnosisismostlikely,giventhepreviousinformation?
a. Pretermlabor
b. Placentalabruption
c. Appendicitis
d. Duodenalulcer
69. Whichoneofthefollowingstatementsistrueregardingappendicitisinpregnancy?
a. Rovsingandpsoassignsareaspredictiveinpregnancyasinnon‐pregnantwomen
b. Lackoffeverexcludesthediagnosis
c. CTscancannotbeusedtoaidindiagnosis
d. RLQpainisseenin~80%ofpatients
e. AWBCof>16Kispredictiveofappendicitis
946-NYGS Pre Test Questions
The New York General Surgery Board Review Course 2013
Presented by Oakstone
October 26, 2013 – October 30, 2013 – Teaneck, NJ
________________________________________________________________________________
70. A33‐year‐oldwomanpresentswithacuteupperabdominalpainof1day'sduration.Sheiscarrying
twinsat28weeks’gestation.Shehasapoorappetite,nausea,andemesis.Herabdominalexam
revealsdecreasedbowelsounds,moderatetendernesstopalpationintheRUQandepigastrium,anda
graviduterusthatisnontender.Hercervixisclosed,andtherearenouterinecontractionsonthe
monitor.Ultrasoundrevealsgallstones.Amylaselipaseandtotalbilirubinaremarkedlyelevated.All
thefollowingareappropriateinpreparationforsurgeryexcept:
a. Administeringantibiotics
b. Consideringtocolysis
c. Intraoperativefetalmonitoring
d. Havingcesareansectiontrayonstandby
e. Positioningthepatientflat
71. Allthefollowingprinciplesareappropriateinsurgeryforthispregnantpatientexcept:
a. Providingleftlateraldisplacementoftheuterus
b. Acceptingapneumoperitoneumof20to25mmHg,giventheadvancedgestationalage
c. MonitoringmaternalendtidalCO2tominimizematernalandfetalacidosis
d. UsinganopenHassontechniquetodecreasetheriskforuterineinjury
72. Whichofthefollowingisanincorrectchoiceforthedesiredultrasoundimaging?
a. 3.5‐MHzprobeforathyroidscan
b. 5.0‐MHztransducerforaFASTexam
c. 7.5‐MHzprobeforultrasound‐guidedaspirationofabreastcyst
d. 10.0‐MHzlaparoscopicprobeforintraoperativelocalizationofapancreaticendocrine
tumor
e. 12.0‐MHzlaparoscopicprobeforultrasoniccholangiography
73. WhichofthefollowingstatementsisINCORRECT?
a. AFASTexaminationwillhelplocalizethesourceofbleedinginapatientwithpenetrating
abdominaltrauma.
b. Ultrasoundcanbeusefulindifferentiatingbetweencholelithiasis,polyps,and
adenomyomatosis.
c. Ultrasoundcanbeusefulindifferentiatingbetweencysticmassesandsolidmasses.
d. Higher‐frequencyprobesoffergreaterresolutionattheexpenseofdecreaseddepth
penetration.
e. Anorectalultrasoundfindingsarepredictiveoftumorstage.
946-NYGS Pre Test Questions
The New York General Surgery Board Review Course 2013
Presented by Oakstone
October 26, 2013 – October 30, 2013 – Teaneck, NJ
________________________________________________________________________________
74.
Shownaboveisasonographicexaminationofabreastina25‐year‐oldnulliparouswomanwitha
historyofanewlynotedpainfulmass.Thenextstepinmanagementshouldbe:
a. NSAIDs
b. Ductallavage
c. Percutaneouscystdrainageandfollow‐upprn
d. Excisionalbiopsywithsentinellymphnodesampling
e. Observation
946-NYGS Pre Test Questions
The New York General Surgery Board Review Course 2013
Presented by Oakstone
October 26, 2013 – October 30, 2013 – Teaneck, NJ
________________________________________________________________________________
75. Thestructureidentifiedabovebythesmallarrowheadsismostlikely:
a. Lymphnode
b. Parathyroidadenoma
c. Esophagus
d. Hyoidbone
e. Carotidbodytumor
946-NYGS Pre Test Questions
The New York General Surgery Board Review Course 2013
Presented by Oakstone
October 26, 2013 – October 30, 2013 – Teaneck, NJ
________________________________________________________________________________
76. YouarecalledinconsultforapatientwithhemoptysiswhohasbeenonaventilatorintheICUforthe
past3weeks.Themostlikelydiagnosisis:
a. Tracheo‐innominatefistula
b. Tuberculosis
c. Lungcancer
d. PAcatheterperforation
e. Bleedingfromthetraumaofsuctioning
77. Youarecalledtoseeayoungmanwitharecurrentspontaneouspneumothorax.Hewastreatedat
anotherhospital2weeksago,withchesttubedrainagefor5days.Acceptablemanagementincludes
allthefollowingEXCEPT:
a. Smokingcessationcounseling
b. Needleaspirationfollowedbyobservation
c. Initialchesttubeplacement
d. CTscanningofthechest
e. Thoracoscopicdefinitivetreatment
78. TreatmentoptionsforchylothoraxmayincludeallthefollowingEXCEPT:
a. Needleaspiration
b. Chesttubedrainage
c. High‐fat,high‐protein,low‐carbohydratediet
d. Totalparenteralnutrition
e. Thoracicductligation
79. Synthesisandbreakdownofcollagenoccursinwhichstageofwoundhealing?
a. Coagulationstage
b. Inflammatorystage
c. Proliferativestage
d. Remodelingstage
e. Woundcontraction
80. Hydroxylationofprolineandlysinetoincreasewoundstrengthisdependenton:
a. VitaminA
b. VitaminD
c. VitaminD3
d. VitaminC
e. VitaminE
946-NYGS Pre Test Questions
The New York General Surgery Board Review Course 2013
Presented by Oakstone
October 26, 2013 – October 30, 2013 – Teaneck, NJ
________________________________________________________________________________
81. RandomizedprospectivedataexisttosupportthefollowingbenefitsofVAC®therapyEXCEPT:
a. Decreasingthebacterialburdeninwounds
b. Avoidingneedforflapprocedureswhentreatingunderlyingosteomyelitis
c. Acceleratingwoundhealingbysecondaryintention
d. Decreasingtotalwoundcarecosts
e. Improvingconvenienceforpatientandwoundcaregiver
82. Youareaskedtoassumecareforachronicmedialanklewoundina60‐year‐olddiabeticwitha25
pack‐yearhistoryofsmoking.AcomprehensivetreatmentplanincludesallthefollowingEXCEPT:
a. Smokingcessationstrategies
b. ApplicationofPDGF(Regranex®)
c. Useofelectromagneticfieldtherapy
d. Administrationofpentoxifylline(Trental®)400mgTID
e. Aggressivehydrotherapy/Whirlpool
83. Currentlyavailable,topicallyappliedagents,showntobeeffectiveinmodulatingscarappearance,
includeallEXCEPT:
a. Steroidpreparations
b. Siliconegelsandocclusivesheets
c. Hydroquinones
d. Antibioticointments
e. Pressuregarments
84. A55‐year‐oldpatientwithhistoryofsulfaallergysustainsa20%TBSAsecond‐andthird‐degree
burntohischestandarmsafterfallingasleepwhilesmokinginbed,ignitinghispajamas.Themost
appropriatetopicalantimicrobialtouseforhisburncareis:
a. Silversulfadiazine(Silvadene®)
b. Mafenideacetate(Sulfamylon®)
c. Bacitracinantibioticointment
d. Mupirocin(Bactroban®)
e. Silvernitrate
85. Thecareofpatientssustainingmajorelectricalburnsdiffersfromthatinthermalburnpatientsinall
areaslistedbelowEXCEPT:
a. Calculationoffluidresuscitationneeds
b. Developmentofelectrolyteabnormalities
c. Surgicalmanagementofinjuredareas
d. Immuneresponsetotheburninjury
e. Impactoftheinjuryoncardiacfunction
946-NYGS Pre Test Questions
The New York General Surgery Board Review Course 2013
Presented by Oakstone
October 26, 2013 – October 30, 2013 – Teaneck, NJ
________________________________________________________________________________
86. Youareevaluatinga45‐year‐oldwomanforapalpablerightneckmassidentifiedonphysical
exambyhergynecologist.Shehasnofamilyhistoryofthyroidcancerorradiationexposure.HerTSH
isnormal.Whatistheleastinvasivetesttomakeadefinitivediagnosis?
a. Radioactiveiodinescan
b. Thyroglobulinlevel
c. CEAlevel
d. Fine‐needleaspirationbiopsy
e. USG
87. Youareevaluatinga60‐year‐oldwomanwhopresentswitha3‐cmleftthyroidnodule.Fine‐
needlebiopsyissuggestiveoffollicularneoplasm.USGdemonstratesanormalrightthyroidlobe.
Whatisyourrecommendationforfurthertreatment?
a. RepeatUSGandbiopsyin6months
b. Thyroidhormonesuppression
c. Diagnosticleftthyroidlobectomy
d. Totalthyroidectomy
e. Totalthyroidectomyandleftmodifiedradicalneckdissection
88. Youareevaluatinga25‐year‐oldmanwithanewthyroidnodule.Hereportsalongstandinghistoryof
HTNandepisodicheadaches.Hisfamilyhistoryissignificantforamotherandsisterwhohadtheir
thyroidsremovedforcancer,andhissisterdiedontheoperatingroomtable.Whatadditionaltest
shouldyouobtainpriortoafine‐needlebiopsy?
a. Calcium
b. Plasmametanephrines
c. 24‐hoururinecortisollevels
d. CA19‐9levels
e. Thyroglobulin
89. A2.8‐kgneonatewithexcessivesalivationdevelopsrespiratorydistress.Attemptstopassan
urogastriccatheterfailasthecathetercoilsinthebackofthethroat.X‐rayshowsrightupperlobe
atelectasisandagaslessabdomen.Themostlikelydiagnosisis:
a. Proximalesophagealatresiawithoutafistula
b. Proximalesophagealatresiawithadistaltracheo‐esophagealfistula(TEF)
c. “H‐type”TEfistula
d. EsophagealatresiawithbothproximalanddistalTEF
946-NYGS Pre Test Questions
The New York General Surgery Board Review Course 2013
Presented by Oakstone
October 26, 2013 – October 30, 2013 – Teaneck, NJ
________________________________________________________________________________
90. Ininfantswithduodenalatresia,allthefollowingstatementsaretrueEXCEPT:
a. ThereisanincreasedriskforDownsyndrome
b. Itcanbedetectedbyprenatalultrasoundexamination
c. Itmayoccurininfantswithsitusinversus,malrotation,annularpancreas,andanterior
portalvein
d. Itisbesttreatedbygastroenterostomy
e. Thereisahighincidenceofassociatedcardiacdefects
91. Thetreatmentofchoiceforneonateswithuncomplicatedmeconiumileusis:
a. Observation
b. Emergencylaparotomy,bowelresection,andBishop‐Koopenterostomy
c. IntravenoushydrationandaGastrografin®enema
d. Emergencylaparotomy,bowelresection,andanastomosis
e. Sweatchloridetestandpancreaticenzymetherapy
92. WhichofthefollowingstatementsaboutHirschsprungdiseaseisnottrue?
a. TherearenoganglioncellsseeninAuerbachplexus.
b. ThereisanincreasedincidenceofDownsyndrome.
c. Itismorecommoningirls.
d. Itmaybeassociatedwithenterocolitis.
e. Itmayinvolvethesmallintestine.
93. PolyhydramniosisfrequentlyobservedinallthefollowingconditionsEXCEPT:
a. Esophagealatresia
b. Duodenalatresia
c. Pyloricatresia
d. Hirschsprungdisease
e. Congenitaldiaphragmatichernia
94. Ininfantswithgastroschisis,whichofthefollowingstatementsisnottrue?
a. Itisassociatedwithmalrotation.
b. Thereisahighincidenceofassociatedanomalies.
c. Thereisprolongedadynamicileusfollowingrepair.
d. Itiscomplicatedbyintestinalatresiain10%to12%ofcases.
e. Itisnotassociatedwithchromosomalsyndromes.
946-NYGS Pre Test Questions
The New York General Surgery Board Review Course 2013
Presented by Oakstone
October 26, 2013 – October 30, 2013 – Teaneck, NJ
________________________________________________________________________________
95. Inneonateswithnecrotizingenterocolitis,whichofthefollowingfindingsisanindicationof
significantbowelischemia?
a. Increasedgastricresiduals
b. Septicshock
c. Cardiacfailureduetoapatentductusarteriosus
d. Elevatedplateletcount
e. Erythemaoftheabdominalwall
96. AllthefollowingconditionsarederivedfromtheprimitiveembryologicforegutEXCEPT:
a. Bronchogeniccyst
b. Cysticadenomatoidmalformation
c. Gastricduplication
d. Mesentericcyst
e. Pulmonarysequestration
97. A25‐year‐oldmaleundergoes4cyclesofetoposideandplatinumfollowingarightorchiectomyfor
stageIIbnon‐seminomagermcelltumor(NSGCT).SerumtumormarkersandchestCTarenormal.
AbdominalCTscanisshownbelow.
Whichofthefollowingismostappropriate?
a. Observation
b. Post‐chemoRPLND
c. Radiation
d. Furtherchemo
e. Insufficientinformation
946-NYGS Pre Test Questions
The New York General Surgery Board Review Course 2013
Presented by Oakstone
October 26, 2013 – October 30, 2013 – Teaneck, NJ
________________________________________________________________________________
98. A32‐year‐oldalcoholicmalepresentstotheEDwithnausea,vomiting,andepigastricpain.Heis
diagnosedwithpancreatitis.WhichofthefollowingisNOToneoftheRansoncriteria,whichcan
helpyoudecideontheseverityoftheattack?
a. Calciumlevel<8mg/dLatadmission
b. WBC>16,000atadmission
c. LDH>350IU/Latadmission
d. Glucose>200atadmission
e. Age>55years
99. Whichofthefollowingstatementsregardinggroinherniasisfalse?
a. Menaremuchmorelikelytodevelopinguinalherniasthanarewomen.
b. Inwomenwithinguinalhernias,thereisanequalincidenceofdirectandindirecthernias.
c. Femoralherniasarethemostlikelytostrangulateofanygroinhernias.
d. Acombineddirectandindirectinguinalherniaisknownasa“pantaloon”hernia.
e. Inguinalherniasaremorecommoninwomenthanarefemoralhernias.
100. Whichofthefollowingstatementsregardingtherepairofinguinalherniasiscorrect?
a. Applyingconsiderabletensiontothesuturesisimportanttopreventbulgesfrom
occurring.
b. Recurrenceriskfromopenandlaparoscopicherniarepairsarethesame.
c. Thelowestrecurrenceratesarereportedaftertension‐freerepairswithmesh.
d. TheBassinirepairinvolvessuturingtransversusabdoministotheCooperligament.
e. Ifthespermatic(testicular)arteryisinadvertentlytransectedduringaninguinalhernia
repair,thetesticlemustberemoved.
946-NYGS Pre Test Questions