SURGERY Topnotch 2024
The amount of time kidneys for transplantation can be preserved is:
A. 6-8hrs
B. 16hrs
C. 24hrs
D. 36-40hrs
E. 48-72hrs - ANSW D.
6-8hrs heart and lungs
16hrs - liver
24hrs - pancreas
36-40hrs Kidneys
Which of the following treatment used for the management of burn wounds can be
absorbed systemically and cause metabolic acidosis?
A. Silver nitrate
B. Silver sulfadiazine
C. Mafenide acetate
D. A and B
E. All of the above - ANSW C.
Silver sulfadiazine: antimicrobial activity, soothing quality, inexpensive and easily
applied, neutropenia
Mafenide acetate: antimicrobial activity, painful, metabolic acidosis
Silver nitrate: antimicrobial activity, hyponatremia, methemoglobinemia, black staining
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE
A 70 year old male incurred 20% TBSA burns. If PE revealed normal and stable vital
signs, how much fluids should be given to him in the first hour?
A. 250cc
B. 350cc
C. 450cc
D. 550cc
E. 1 L fast drip - ANSW B.
Parkland formula = (4ml/kg/%burned) ½ given in the first 8hrs then the next half given
over the next 16hrs.
70x20x4/2/8 = 350cc
In which type of hiatal hernia does the fundus of the stomach herniate?
A. Type I
B. Type II
C. Type III
D. Type IV
E. Type V - ANSW B.
Type I (sliding) Cardia
,Type II (rolling) Fundus
Type III (mixed) cardia and fundus
Type IV intestines
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE
Which of the following maneuvers involve clamping of the portal triad and is used for
hemostasis and control of bleeding during hepatic surgery?
A. Madison maneuver
B. Pringle maneuver
C. Hendersons maneuver
D. Koch maneuver
E. Rovsing maneuver - ANSW B.
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE
Patient is diagnosed with a superior sulcus tumor (a form of lung adenocarcinoma).
Invasion of nearby structures results to which clinical findings?
A. Hoarseness
B. Back pain
C. Ptosis, miosis, anhidrosis
D. Shoulder pain, hiccups and dyspnea
E. Conjunctival edema, swelling of the head and neck, headache - ANSW C. This is a
case of pancoast syndrome. Invasion of the stellate sympathetic ganglion results to the
classic Horners triad ptosis, miosis, anhidrosis. SIMILAR TO PREVIOUS BOARD
EXAM CONCEPT/PRINCIPLE
A fistula with an external opening located anteriorly 2.75cm from the anal margin will
have:
A. Short, radial tract to the anterior midline
B. Curvilinear tract to the posterior midline
C. Curvilenear tract to the anterior midline
D. A and C E. All of the above - ANSW A. Goodsall's rule dictates that fistulas with an
external opening anteriorly connect to the internal opening by a short, radial tract.
Fistulas with an external opening posteriorly track in a curvilinear fashion to the
posterior midline. However, if the anterior external opening is greater than 3cm from the
anal margin, such fistulas tract to the posterior midline. SIMILAR TO PREVIOUS
BOARD EXAM CONCEPT/PRINCIPLE
The Pouparts ligament is derived from which of the following structures?
A. External oblique
B. Internal oblique
C. Trasversus abdominis
D. Transversalis fascia
E. Peritoneum - ANSW A. The Poupart's ligament/inguinal ligament forms the inferior
margin of the inguinal canal. Inside courses the spermatic cord.
,A 26 year victim of a vehicular accident is brought on a stretcher in the ER. On physical
examination his blood pressure is 70/40 and heart rate is 65. The extremities are warm
and he is noted to have decreased sensorium. Which of the following is the appropriate
initial management?
A. Fluid resuscitation
B. Blood transfusion
C. Dopamine/Norepinephrine
D. Dobutamine/Digoxin
E. Epinephrine/Antihistamine/ Corticosteroids - ANSW A. This is a case of neurogenic
shock. The classic description of neurogenic shock consists of decreased BP
associated with bradycardia (absence of reflexive tachycardia due to disrupted
sympathetic discharge), warm extremities (loss of peripheral vasoconstriction), motor
and sensory deficits indicative of a spinal cord injury, and radiographic evidence of a
vertebral column fracture. After the airway is secured and ventilation is adequate, fluid
resuscitation and restoration of intravascular volume often will improve perfusion in
neurogenic shock. Most patients with neurogenic shock will respond to restoration of
intravascular volume alone, with satisfactory improvement in perfusion and resolution of
hypotension. Administration of vasoconstrictors will improve peripheral vascular tone,
decrease vascular capacitance, and increase venous return, but should only be
considered once hypovolemia is excluded as the cause of the hypotension, and the
diagnosis of neurogenic shock established.
A 43 year old male incurred corneal scarring from eye herpes and lost vision of his left
eye. A full thickness corneal transplant was done. Examples of full thickness
keratoplasty include:
A. Penetrating keratoplasty
B. Descemet stripping with endothelial keratoplasty
C. Descemet membrane keratoplasty
D. A and B
E. All of the above - ANSW A.
Penetrating keratoplasty - full thickness
Deep anterior lamellar keratoplasty - Partial thickness
Descemet stripping with endothelial keratoplasty - Descemet membrane keratoplasty
Which of the following structures are removed in a skin sparing mastectomy?
A. All breast tissue
B. Nipple areola complex
C. Scars from previous biopsy procedures
D. A and B
E. All of the above - ANSW E.
*Breast conservation:* resection of primary breast cancer + margin of normal appearing
breast tissue + assessment of regional lymph node status
*Radical mastectomy:* Medial/Lateral pectoral nerves, Long thoracic nerve,
Thoracodorsal nerve + Pectoralis Major and minor + All LN + All breast
*Modified radical mastectomy:* Same as Radical mastectomy except all nerves are
spared, level III LN spared, Pectoralis major spared
, Which of the following pertains to Osteonecrosis of the proximal femoral epiphysis of
the pediatric hip and is thought to be due to vascular compromise?
A. Slipped capital femoral epiphysis
B. Developmental dysplasia of the hip
C. Talipes equinovarus
D. Legg-Calve-Perthes disease
E. Osgood-Schlatter disease - ANSW D. Legg-Calve-Perthes disease also known as
cox plana is a condition of the pediatric hip characterized by a flattened misshapen
femoral head. The etiology is related to osteonecrosis of the proximal femoral epiphysis
and is thought to result from vascular compromise. SIMILAR TO PREVIOUS BOARD
EXAM CONCEPT/PRINCIPLE
Which of the following orthopedic conditions describe a form of neuropathic arthropathy
that affects some diabetics with peripheral neuropathy?
A. Charcot joints
B. Osgood Schlatter Disease
C. Paget Schroetter Disease
D. Kimmel-Steil Wilson Lesions
E. None of the above - ANSW A. It may also occur with several other diseases that
affect the sensory nervous system (alcoholism, leprosy, syphilis, Charcot-Marie- Tooth
Disease to name a few). In the United States, diabetes is the number-one cause.
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE
A 57 year old male with poorly controlled hypertension presents with acute onset
painless loss of vision in the left eye. PE reveals a relative afferent pupillary defect and
fundoscopy of the affected eye showed a cherry red spot over a pale background. What
is the diagnosis?
A. Rhegmatogenous retinal detachment
B. Age related macular degeneration
C. Central serous retinopathy
D. Central retinal artery occlusion
E. Central retinal vein occlusion - ANSW D. Also called amaurosis fugax.
Management options include direct infusion of thrombolytic to the ophthalmic artery or
by decreasing IOP (IV acetazolamide or vitreous paracentesis) SIMILAR TO
PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE
Which of the following aortic aneurysms merit/merits operative management?
A. Sudden onset lower back pain in a man diagnosed with aortic aneurysm 6 months
ago. Last CT showed diameter of 4.5cm.
B. Asymptomatic ascending thoracic aortic aneurysm of 5.75cm
C. Asymptomatic descending thoracic aortic aneurysm of 5.75cm
D. A and B only
E. All of the above - ANSW D. Indications for repair of aortic aneurysms in
asymptomatic patients without connective tissue disorders:
The amount of time kidneys for transplantation can be preserved is:
A. 6-8hrs
B. 16hrs
C. 24hrs
D. 36-40hrs
E. 48-72hrs - ANSW D.
6-8hrs heart and lungs
16hrs - liver
24hrs - pancreas
36-40hrs Kidneys
Which of the following treatment used for the management of burn wounds can be
absorbed systemically and cause metabolic acidosis?
A. Silver nitrate
B. Silver sulfadiazine
C. Mafenide acetate
D. A and B
E. All of the above - ANSW C.
Silver sulfadiazine: antimicrobial activity, soothing quality, inexpensive and easily
applied, neutropenia
Mafenide acetate: antimicrobial activity, painful, metabolic acidosis
Silver nitrate: antimicrobial activity, hyponatremia, methemoglobinemia, black staining
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE
A 70 year old male incurred 20% TBSA burns. If PE revealed normal and stable vital
signs, how much fluids should be given to him in the first hour?
A. 250cc
B. 350cc
C. 450cc
D. 550cc
E. 1 L fast drip - ANSW B.
Parkland formula = (4ml/kg/%burned) ½ given in the first 8hrs then the next half given
over the next 16hrs.
70x20x4/2/8 = 350cc
In which type of hiatal hernia does the fundus of the stomach herniate?
A. Type I
B. Type II
C. Type III
D. Type IV
E. Type V - ANSW B.
Type I (sliding) Cardia
,Type II (rolling) Fundus
Type III (mixed) cardia and fundus
Type IV intestines
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE
Which of the following maneuvers involve clamping of the portal triad and is used for
hemostasis and control of bleeding during hepatic surgery?
A. Madison maneuver
B. Pringle maneuver
C. Hendersons maneuver
D. Koch maneuver
E. Rovsing maneuver - ANSW B.
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE
Patient is diagnosed with a superior sulcus tumor (a form of lung adenocarcinoma).
Invasion of nearby structures results to which clinical findings?
A. Hoarseness
B. Back pain
C. Ptosis, miosis, anhidrosis
D. Shoulder pain, hiccups and dyspnea
E. Conjunctival edema, swelling of the head and neck, headache - ANSW C. This is a
case of pancoast syndrome. Invasion of the stellate sympathetic ganglion results to the
classic Horners triad ptosis, miosis, anhidrosis. SIMILAR TO PREVIOUS BOARD
EXAM CONCEPT/PRINCIPLE
A fistula with an external opening located anteriorly 2.75cm from the anal margin will
have:
A. Short, radial tract to the anterior midline
B. Curvilinear tract to the posterior midline
C. Curvilenear tract to the anterior midline
D. A and C E. All of the above - ANSW A. Goodsall's rule dictates that fistulas with an
external opening anteriorly connect to the internal opening by a short, radial tract.
Fistulas with an external opening posteriorly track in a curvilinear fashion to the
posterior midline. However, if the anterior external opening is greater than 3cm from the
anal margin, such fistulas tract to the posterior midline. SIMILAR TO PREVIOUS
BOARD EXAM CONCEPT/PRINCIPLE
The Pouparts ligament is derived from which of the following structures?
A. External oblique
B. Internal oblique
C. Trasversus abdominis
D. Transversalis fascia
E. Peritoneum - ANSW A. The Poupart's ligament/inguinal ligament forms the inferior
margin of the inguinal canal. Inside courses the spermatic cord.
,A 26 year victim of a vehicular accident is brought on a stretcher in the ER. On physical
examination his blood pressure is 70/40 and heart rate is 65. The extremities are warm
and he is noted to have decreased sensorium. Which of the following is the appropriate
initial management?
A. Fluid resuscitation
B. Blood transfusion
C. Dopamine/Norepinephrine
D. Dobutamine/Digoxin
E. Epinephrine/Antihistamine/ Corticosteroids - ANSW A. This is a case of neurogenic
shock. The classic description of neurogenic shock consists of decreased BP
associated with bradycardia (absence of reflexive tachycardia due to disrupted
sympathetic discharge), warm extremities (loss of peripheral vasoconstriction), motor
and sensory deficits indicative of a spinal cord injury, and radiographic evidence of a
vertebral column fracture. After the airway is secured and ventilation is adequate, fluid
resuscitation and restoration of intravascular volume often will improve perfusion in
neurogenic shock. Most patients with neurogenic shock will respond to restoration of
intravascular volume alone, with satisfactory improvement in perfusion and resolution of
hypotension. Administration of vasoconstrictors will improve peripheral vascular tone,
decrease vascular capacitance, and increase venous return, but should only be
considered once hypovolemia is excluded as the cause of the hypotension, and the
diagnosis of neurogenic shock established.
A 43 year old male incurred corneal scarring from eye herpes and lost vision of his left
eye. A full thickness corneal transplant was done. Examples of full thickness
keratoplasty include:
A. Penetrating keratoplasty
B. Descemet stripping with endothelial keratoplasty
C. Descemet membrane keratoplasty
D. A and B
E. All of the above - ANSW A.
Penetrating keratoplasty - full thickness
Deep anterior lamellar keratoplasty - Partial thickness
Descemet stripping with endothelial keratoplasty - Descemet membrane keratoplasty
Which of the following structures are removed in a skin sparing mastectomy?
A. All breast tissue
B. Nipple areola complex
C. Scars from previous biopsy procedures
D. A and B
E. All of the above - ANSW E.
*Breast conservation:* resection of primary breast cancer + margin of normal appearing
breast tissue + assessment of regional lymph node status
*Radical mastectomy:* Medial/Lateral pectoral nerves, Long thoracic nerve,
Thoracodorsal nerve + Pectoralis Major and minor + All LN + All breast
*Modified radical mastectomy:* Same as Radical mastectomy except all nerves are
spared, level III LN spared, Pectoralis major spared
, Which of the following pertains to Osteonecrosis of the proximal femoral epiphysis of
the pediatric hip and is thought to be due to vascular compromise?
A. Slipped capital femoral epiphysis
B. Developmental dysplasia of the hip
C. Talipes equinovarus
D. Legg-Calve-Perthes disease
E. Osgood-Schlatter disease - ANSW D. Legg-Calve-Perthes disease also known as
cox plana is a condition of the pediatric hip characterized by a flattened misshapen
femoral head. The etiology is related to osteonecrosis of the proximal femoral epiphysis
and is thought to result from vascular compromise. SIMILAR TO PREVIOUS BOARD
EXAM CONCEPT/PRINCIPLE
Which of the following orthopedic conditions describe a form of neuropathic arthropathy
that affects some diabetics with peripheral neuropathy?
A. Charcot joints
B. Osgood Schlatter Disease
C. Paget Schroetter Disease
D. Kimmel-Steil Wilson Lesions
E. None of the above - ANSW A. It may also occur with several other diseases that
affect the sensory nervous system (alcoholism, leprosy, syphilis, Charcot-Marie- Tooth
Disease to name a few). In the United States, diabetes is the number-one cause.
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE
A 57 year old male with poorly controlled hypertension presents with acute onset
painless loss of vision in the left eye. PE reveals a relative afferent pupillary defect and
fundoscopy of the affected eye showed a cherry red spot over a pale background. What
is the diagnosis?
A. Rhegmatogenous retinal detachment
B. Age related macular degeneration
C. Central serous retinopathy
D. Central retinal artery occlusion
E. Central retinal vein occlusion - ANSW D. Also called amaurosis fugax.
Management options include direct infusion of thrombolytic to the ophthalmic artery or
by decreasing IOP (IV acetazolamide or vitreous paracentesis) SIMILAR TO
PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE
Which of the following aortic aneurysms merit/merits operative management?
A. Sudden onset lower back pain in a man diagnosed with aortic aneurysm 6 months
ago. Last CT showed diameter of 4.5cm.
B. Asymptomatic ascending thoracic aortic aneurysm of 5.75cm
C. Asymptomatic descending thoracic aortic aneurysm of 5.75cm
D. A and B only
E. All of the above - ANSW D. Indications for repair of aortic aneurysms in
asymptomatic patients without connective tissue disorders:
