general_surgery.csv

question,answer
"A 23-year-old is undergoing surgery for an incarcerated femoral hernia. As part of the surgery, a cut was made of the ligament named after Cooper and bleeding started. For which artery should superselective angiography be performed?
A. Obturator artery.
B. Superior epigastric artery.
C. Inferior Epigastric Artery.
D. Femoral Artery.
",A
"In which surgeries to repair an inguinal hernia with an anterior approach is there an indication for a tissue-type repair.
(without network)?
A. In smokers.
B. In diabetics.
C. In recurrent inguinal hernia repair.
D. When a bowel resection was necessary after it  was incarcerated.
",D
"What is the surgical approach in a patient suffering from an incarcerated femoral hernia with intestinal necrosis who is urgently operated upon?
A. Bassini repair.
B. McVay repair.
C. Lichtenstein repair.
D. Shouldice repair.
",B
"A 70-year-old man complains of tenderness and swelling in the right testicle 3 days after open surgery to repair a recurrent inguinal hernia on the right.
What is the recommended treatment in this situation?
A. Antibiotics.
B. Surgery to review the scrotum.
C. Anti-inflammatory and pain relievers.
D. Anticoagulants.
",C
"A female patient is a candidate for a right mastectomy (mastectomy) due to malignancy. A sentinel node resection was performed in the right armpit,  the frozen section showed  metastasis. What should be the next step of the surgical treatment?
A. Lymphatic dissection of the right armpit - layer 1 and 2.
B. Removal of 3 sentinel lymph nodes.
C. Intraoperative radiation.
D. To end  the surgical operation.
",A
"A 55-year-old candidate for breast conserving surgery due to malignancy in the left breast. During her examination, the malignant mass, 1.5 cm in diameter, was felt in the left breast in the upper outer quadrant, but there were no other findings on examination. During surgery, the malignant mass was resected and 2 sentinel nodes were removed. The nodes were found to be positive for metastases. In addition to radiation to the entire breast, what does the treatment of the patient require?
A. Lymphatic dissection of the left armpit - layer 1 and 2.
B. Systemic treatment (hormonal or chemical).
C. Total mastectomy.
D. Intraoperative radiation to the armpit.
",B
"What is the second most common malignancy in the breast?
A. INVASIVE DUCTAL CARCINOMA.
B. INVASIVE LOBULAR CARCINOMA.
C. MUCINOUS CARCINOMA.
D. INVASIVE PAPILLARY CARCINOMA.
","A,B,C,D"
"The treatment for BORDERLINE PHYLLODES TUMOR type must include, in addition to its excision:
A. Radiation to the operated breast.
B. Taking sentinel lymph nodes in the armpit on the same side.
C. Excision with a desirable margin of at least 1 cm.
D. Systemic treatment.
",C
"Where is Ghrelin secreted from?
A. From the antrum.
B. From the body of the stomach.
C. From the fundus.
D. From the whole stomach.
","B,C"
"A patient with a BMI of 36 presents with one of the following underlying diseases. What underlying disease is not  an indication for bariatric surgery?
A. Diabetes.
B. Dyslipidemia.
C. Ischemic heart disease.
D. Hypertension.
",C
"According to the findings of the Swedish Obese Subjects study, what was the reduction in mortality in patients followed for 15 years post bariatric surgery?
A. About 80%.
B. About 30%.
C. About 15%.
D. About 5%.
",B
"Which finding would confirm the suspicion that a candidate for surgery for obesity is suffering from Pickwickian syndrome?
A. Dilated aorta on chest x-ray.
B. Hematocrit below 35 in blood count.
C. Peaked T-waves in the ECG.
D. PO2>pCO2 in blood gases.
",D
"Which of the following treatments has been shown to reduce mortality in sepsis?
A. Anti-TNF antibody.
B. Recombinant IL-1Ra.
C. Recombinant activated protein C.
D. So far no effective treatment has been found.
",D
"What are Kupffer cells in the liver?
A. Macrophages.
B. Basement membrane cells.
C. Hepatic stem cells.
D. Dendritic cells.
",A
"A TEG (thromboelastogram) was taken for a bleeding injured person, showing an elongated R. What is the treatment in this case?
A. FFP.
B. Platelets.
C. Tranexamic acid.
D. Heparin.
",A
"A 62-year-old diabetic was rescued 12 hours after falling in a wadi. During his examination, a lumbar spine fracture was suspected, with partial motor deficits in the lower limbs. It was decided not to give the injured person steroids. What will justify the decision?
A. Age over 60.
B. Background diabetes.
C. The injury happened 12 hours ago.
D. The paralysis is partial.
",C
"Which of the following is a contraindication for a kidney transplant?
A. Systemic lupus.
B. NYHA heart failure 4.
C. HIV.
D. Diabetes.
",B
"What is the purpose of the CMV test in the donor before small intestine transplant surgery?
A. Prevention of the development of severe colitis in the transplant recipient.
B. Prevention of CMV retinitis in the transplant recipient.
C. Prevention of hearing loss in the transplant recipient.
D. Prevention of the development of lymphoma in the transplant recipient.
","A,D"
"A female patient was diagnosed with a mass in the abdominal wall. Pathology was suggestive of desmoid. In which case will we choose supervision only?
A. The patient has abdominal pain.
B. The mass pushes the ureter.
C. The mass grew from 8 to 10 cm in the radiological follow-up.
D. A 15 cm mass.
",D
"Which of the syndromes is most likely the risk factor for sarcoma of the abdominal wall in a 16-year-old boy?
A. MEN I.
B. Li-Fraumeni Syndrome.
C. BRCA2.
D. Peutz-Jeghers syndrome.
",B
"What size intubation tube will we use in an 8 child?
A. 3.
B. 4.
C. 5.
D. 6.
",D
"A 6-year-old boy who was injured in a car accident has evidence of partial nerve damage in the lower limbs that passes after a few hours. A total body CT was performed and no obvious injury to the spinal vertebrae was demonstrated. What is the diagnosis?
A. Diffuse axonal injury.
B. Air emboli.
C. Spinal injury.
D. Thrombosis of the spinal plexus.
",C
"What is the disadvantage of Peroral endoscopic myotomy (POEM) compared to Laparoscopic Heller
Myotomy?
A. An increase in mortality.
B. Longer recovery time.
C. Higher recurrence rate of dysphagia.
D. An increase in the frequency of reflux.
","C,D"
"Which of the following describes the mechanism of action of MYCOPHENOLATE MOFETIL?
A. INOSINE MONOPHOSPHATE DEHYDROGENASE Antagonist.
B. IL antagonist-2.
C. ANTI CD25 MONOCLONAL ANTIBODIES.
D. ANTI CD3 MONOCLONAL ANTIBODIES.
",A
"What is a side effect of CYCLOSPORINE A?
A. Gingival recession.
B. Extreme drop in blood pressure.
C. Hypertrichosis.
D. Diabetes that is difficult to balance.
",C
"What would not adversely affect prognosis in intrahepatic cholangiocarcinoma (IHCC)?
A. Vascular involvement.
B. Multifocal.
C. Lymph nodes in the porta hepatis are positive for the tumor.
D. CEA above 200 ng/mL.
",D
"What is considered an absolute contraindication to liver resection due to colorectal metastases?
A. Number of metastases of 4 or more.
B. Margins are close.
C. 20%<Future Liver Remnant.
D. Bilateral involvement of the liver lobes.
",C
"1.5 years ago, a 40 year old underwent a right colon resection due to adenocarcinoma, STAGE 1.
In oncological follow-up and in light of an increase in CEA to 15 ng/mL, imaging was performed (PET CT, MRI, CT) which demonstrated one metastasis in segment 2 of the liver with a maximum size of 3 cm. He underwent successful removal surgery.
And the metastasis was excised with a clean margin of 2 cm. What is the expected survival rate for 5 years?
A. 80%.
B. 60%.
C. 30%.
D. 15%.
",B
"With reference to liver adenoma, LIVER CELL ADENOMA, which of the following is considered the most significant risk factor for the development of malignancy?
A. B-CATENIN mutation.
B. Inflammatory Adenoma.
C. HNF1A mutation.
D. Adenomatosis.
",A
"A 32 year old patient is 20 weeks pregnant and has peptic ulcer disease. She is admitted to the emergency department due to sudden severe pain in the abdomen, and signs of peritoneal irritation on physical examination. In blood tests - leukocytosis, liver and pancreas functions within the norm. What will be the first imaging test for further investigation? 
A. X-Ray. 
B. US. 
C. CT. 
D. MRI. 

",A
"A patient is hospitalized in the intensive care unit, ventilated, anesthetized, and paralyzed. Abdominal.
compartment syndrome is suspected and Intra-abdominal pressure is measured through a catheter in the bladder. How should the measurement be performed?
A. Pressure measurement at the beginning of inspirium.
B. Pressure measurement at the end of inspirium.
C. Average of the measurements during several breathing cycles.
D. Pressure measurement during cessation of breathing.
",D
"A 1.5 year-old is crying, and seems to be suffering. The stomach is slightly swollen, and sensitivity is noted on abdominal examination. 
US examination for diagnosing intra-abdominal pathology was performed. Which of the following is the most common sonographic finding?
A. Ovarian environment.
B. Enlarged mesenteric lymph nodes.
C. Target sign.
D. Meckel's diverticulitis.
",C
"In the case of vascular trauma, an approach to repair which blood vessel among the following would be optimal after performing the Left medial visceral rotation maneuver?
A. Inferior Vena Cava.
B. Part II of Superior Mesenteric Artery.
C. Left external iliac artery.
D. Celiac trunk.
",D
"In a patient who regularly takes NSAIDS painkillers drugs from which group may
Increase the risk of bleeding in the digestive system?
A. Selective serotonin reuptake inhibitors.
B. Alpha-adrenergic agonists.
C. H2-receptor antagonists.
D. GLP-1 receptor agonist.
",A
"A 50 year old, with at least 10 years known for peptic disease and recurrent duodenal ulcer despite optimal drug treatment is  hospitalized due to bleeding from the ulcer. Endoscopy to stop the bleeding was partially successful. The patient is stable, but his hemoglobin level is decreasing. During hospitalization, he received 7 doses of PC, 3 of which were in the past 24 hours. Surgical treatment was decided. What is the scope of the recommended surgery? 
A. Pyloroplasty, truncal vagotomy. 
B. Antrectomy, truncal vagotomy. 
C. Parietal cell vagotomy. 
D. Partial gastrectomy, Billroth-II reconstruction. 

",B
"A 50-year-old man was treated with angioembolization due to bleeding from a posterior duodenal ulcer. The radiologist writes that a blockage of the Inferior Pancreaticoduodenal Artery (IPDA) was performed.
In what order did the catheter pass from the aorta to the IPDA?
A. Celiac Trunk Lt Gastric Artery- Gastroepiploic Artery  IPDA.
B. Celiac Trunk Common Hepatic Artery Gastroduodenal Artery IPDA.
Third. Superior Mesenteric Artery Gastroepiploic Artery IPDA.
D. Celiac Trunk Splenic Artery Gastroepiploic Artery IPDA.
",B
"Which lymph nodes will be cut in D-2 gastrectomy in addition to those which are cut in a 1D gastrectomy?
A. Short gastric lymph nodes.
B. Middle colic lymph nodes.
C. Right paracardiac lymph nodes.
D. Proximal splenic lymph nodes.
",D
"According to the Forrest Classification, which of the following types of peptic ulcer is most likely to rebleed?
A. Non-bleeding visible vessel.
B. Adherent clot.
C. Flat pigmented spot.
D. Clean base ulcer.
",A
"In which type of stomach ulcer from the following is there usually excess secretion of acidity in the stomach?
A. Type 1.
B. Type 3.
C. Type 4.
D. Type 5.
",B
"A 44 year old underwent surgery in which an obstructing tumor was found in the region of the jejunum-allium junction. An oncological resection was performed. In the pathological evaluation, immunohistochemical staining appears to be positive for anoctamin-1, KIT. What type of tumor is this most likely? 
A. Carcinoid. 
B. Lymphoma. 
C. GIST. 
D. Hamartoma. 

",C
"A 36 year old, is undergoing HIPEC Cytoreduction Surgery due to Pseudomyxoma peritonei.
Which of the following is the most common chemotherapy drug used in HIPEC?
A. Cisplatin.
B. Mitomycin C.
C. Oxaliplatin.
D. Docetaxel.
",B
"Due to a herniated disc, pressure is created on the nerve roots of L5. In which of the sphincters is it possible to expect to see an injury?
A. Nobody.
B. In the internal sphincter.
C. In the external sphincter.
D. In both.
","A,B"
"A risk factor for anal squamous cell carcinoma?
A. HIV.
B. EBV.
C. CMV.
D. Rotavirus.
",A
"A 72 year old diabetic is sick for a week: high fever and uncontrolled diabetes. In the ER : redness and crepitations in the skin of the perineum. On examination, septic fever, leukocytosis and worsening of kidney functions. After fluid infusion and antibiotics - what is the next step?
A. Abdominal and pelvic CT.
B. Urgent surgery.
C. Opening an abscess in the ER.
D. Hospitalization in the surgical department for continued antibiotic treatment.
",B
"What does a positive push test mean for a patient with suspected NECROTIZING FASCIITIS?
A. Lack of muscle response to diathermy during perineal exploration.
B. Absence of bleeding during exploration of the perineum with a finger.
C. Ability to perform a dissection of subcutaneous tissue in the perineum area to a depth of 1 cm using.
Finger only.
D. The appearance of bleeding during exploration of the perineum with a finger, indicates the viability of the tissues.
",C
"A 74 year old patient is after hip joint replacement surgery that was complicated by paralytic ileus and evidence of CD
(Clostridium difficile infection) with bloody mucous stool. What is the recommended treatment for this patient?
A. IV Metronidazole 500 MG X 3/d + rectal Vancomycin.
B. Oral Vancomycin 500 MG X 3/d.
C. Oral Fidaxomicin 200MGX2/d.
D. Fecal microbiota transplantation.
",A
"A generally healthy 60 year old is hospitalized in the surgical department due to gangrene in the perineum. He underwent  urgent debridement in the operating room and continued intravenous antibiotic treatment for two weeks due to the growth of Clostridium septicum in the blood. What is the mandatory recommendation for this patient upon discharge?
A. Colonoscopy as soon as possible.
B. Completion of antibiotic treatment for one month.
C. Continue treatment with a home VAC.
D. Birohematological.
",A
"For a patient suffering from hypothermia, what are the pathognomonic changes in the ECG?
A. QRS segment widening.
B. Elevated J POINT.
C. Pointed T waves.
D. Inverted U waves.
",B
"One of the first signs of malignant hyperthermia is:
A. Spasm of the masseter muscle.
B. Arrhythmia.
C. Metabolic acidosis.
D. Fever.
",A
"What is the most common bacteria that causes surgical site infections (SSI)?
A. Pseudomonas aeruginosa.
B. Streptococcus.
C. Escherichia coli.
D. S. aureus.
",D
"A patient with a background of ischemic heart disease and hypertension is a candidate for elective major abdominal surgery.
Additional background: diabetes, hypertension, heavy smoking. What is expected to lower the rate of cardiovascular complications and perioperative mortality for this patient?
A. Quit smoking a week before surgery.
B. Discontinuation of drugs from the ACE inhibitor group the day before surgery.
C. Increasing the dose of beta-blockers (־²-blockers) the day before surgery.
D. Discontinuation of metformin treatment the day before surgery.
",B
"A female patient, after major abdominal surgery, has decreased urination. She weighs 60 kg. The amount of urine
In the urinometer 12 hours after surgery was CC 280. On laboratory: creatinine 1.7 (base 0.8). What degree of acute kidney injury is this?
A. Level 1.
B. Level 2.
C. Level 3.
D. Level 4.
",B
"A patient with borderline creatinine clearance (CCT) is a candidate for abdominal CT with intravenous contrast material.
Which means is considered the most effective for preventing acute kidney injury?
A. Acetylcysteine.
B. And vitamin C.
C. Change.
D. 0.9% IV NaCl.
",D
"3 weeks after ventral hernia repair surgery with mesh, during which the partial resection of the small intestine and anastomosis were performed, a patient comes to the emergency department with a clinical picture of intestinal obstruction. What is the most common reason?
For this finding?
A. Adhesions.
B. Leakage from the anastomosis site with the formation of a collection.
C. Internal hernia.
D. Edema in the anastomosis area.
",A
"A patient with a background of cirrhosis, who has undergone Abdominoperineal Resection, comes to the emergency department due to bleeding from parastomal medullas. On admission hemodynamically stable. A week ago, he was hospitalized due to the same problem, and ligation was performed. What is the most effective treatment for this complication?
A. Local adrenaline injection.
B. Religation of varicose veins.
C. Ablation of varicose veins.
D. TIPS.
",D
"In an examination of a patient who underwent Hartman urgent surgery, two days after the operation, a suspicion of ischemia of the stoma was raised. In his examination - a soft abdomen, but the necrotic area seems to involve only the mucosa. What is the recommended treatment?
A. Supervision.
B. Local excision of areas of necrosis.
C. The release of the skin from the mucosa.
D. Repeat laparotomy and revision of the stoma.
",A
"A 30 year old is usually healthy. He was referred to the ER after a car accident, with a seatbelt sign.
In TOTAL BODY CT.
He was diagnosed with multiple rib fractures, without other injuries. The patient is in great pain. What is the treatment?
The most suitable?
A. IV MORPHINE.
B. IV PETHIDINE.
C. Surgery to fix fractures.
D. Epidural anesthesia.
",D
"A 30 year old was brought to the emergency department after attempting suicide by hanging. Upon addmission they are unconscious, blood pressure is 
90/60, and heart rate is 40. The appropriate treatment will be based on?
A. Crystalloid fluids.
B. Vasopressure treatment.
C. Steroids.
D. Blood products.
","A,B"
"A 35 year old is 1 day after bariatric surgery. Decreases in saturation were observed with hypoxia. In the CT angio of the lungs: massive PE in the right pulmonary artery. The patient was admitted to the respiratory intensive care unit, anesthetized and ventilated, and treatment with IV heparin was initiated. Due to drops in blood pressure and tachycardia, the patient underwent an echocardiogram which demonstrated increased pulmonary pressure and right heart failure. The treatment will be based on?:
A. Crystalloid liquids and DOBUTAMINE.
B. NITROGLYCERIN AND NITROPRUSSIDE.
C. ASPIRIN AND NITROPRUSSIDE.
D. Crystalloid fluids and epinephrine.
",A
"A 50 year old with a background of  COPD is hospitalized after resection of the esophagus and thoracic esophagogastric anastomosis and was successfully extubated two weeks ago. Now they have pulmonary edema and hypoxia. What is the recommended treatment?
A. Connection to a BIPAP device.
B. Connection to a CPAP device.
C. Intubation and use of the SIMV method.
D. Intubation and use of the high-frequency FREQUENCY VENTILATION method.
",C
"A 72 year old with kidney failure is treated with dialysis. He was referred to the emergency room after being hit by a vehicle.
CT showed fractures in the pelvis, without active bleeding. Conservative treatment was decided. What anticoagulation therapy is recommended for this patient?
A. Anticoagulation should not be given to this patient.
B. Pneumatic socks.
C. Low molecular weight heparin.
D. Unfractionated heparin.
",D
"Due to uncontrolled fistula after DISTAL PANCREATECTOMY -  a patient is treated with TPN, sandostatin, and fasting.
After a week, a subfebrile fever appeared. Blood cultures, urine cultures, and cultures of fluid drained from the fistula are sterile. Despite treatment with IV Augmentin there is no clinical improvement. What is the recommended empiric treatment?
A. Fluconazole.
B. Vancomycin.
C. Steroids.
D. Septrin.
",A
"A 60 year old with cirrhosis of the liver - Child-Pugh score - B, suffers from ascites. Two weeks ago he was admitted to the intensive care unit after a stroke. During his hospitalization, several episodes of aspiration were observed. What is the appropriate method of feeding?
A. Feed by TPN.
B. Enteral feeding by PEG insertion.
C. Enteral feeding by Nasogastric tube.
D. Surgical gastrostomy.
","B,C"
"A 19-year-old soldier, suffering from a gunshot wound to the jaw only, is fully conscious with a saturation of 96%. When he arrives in the shock room, he vomits a lot of blood, and the saturation drops to 85%. Repeated intubation attempts fail due to the large amount of blood in the oral cavity. What is the next step to take?
A. Laryngeal mask airway.
B. Tracheostomy.
C. Videoscope-directed orotracheal intubation.
D. Cricothyroidotomy.
",D
"A 20 year old fell from scaffolding 6 meters high, and injured his head. He was sent to a shock room with an oxygen mask.
In the initial assessment, he opens his eyes in reaction to voice, pupils are equal and react to light, locates pain with his hand, and mumbles. Of all the characteristics that determine the GCS assessment, which is the best predictor of neurological recovery from the head injury?
A. Pupil reaction.
B. The motor position.
C. The murmur.
D. Opening the eyes.
",B
"A 40-year-old laborer fell from a crane at a height of 7 meters, injured his head and pelvis, was ventilated, and admitted to the ER. After a physical examination and full body CT, it was found that he suffered from a frontal cerebral contusion and pelvic fractures, but without blush. Before he was admitted he had a GCS of 6. After the introduction of ICP in the operating room, he is hospitalized for monitoring in the general intensive care unit.
In intensive care, 5 hours after he arrived the ICP measurements are rising and abnormal. Which of the following actions is not effective for initial treatment of this condition:
A. Lifting the head.
B. Cooling the patient.
C. Hyperventilation.
D. Administration of mannitol.
",B
"What were the conclusions of the CRASH-2 study regarding the use of the preparation tranexamic acid (hexapron)?
A. Increased the number of thrombotic events.
B. Lowered the use of blood units in elective surgeries.
C. Lowered overall mortality.
D. Reduced the need for surgery.
",C
"A 43 year old stabbed himself in a suicide attempt on the right side of the neck, to the right and below the cricoid. He was intubated in the field and a dressing was placed on the stab wound. In the emergency department, he is hemodynamically stable, and breathing well. On examination of the wound, active bleeding is seen from the wound with air bubbles rising from the puncture area. In a chest x-ray: an intubation tube is seen in place, with no findings in the lungs. After starting a large transfusion of blood, what should be done with the injured person?
A. Angioembolization to stop the bleeding.
B. Bronchoscopy and insertion of a stent into the trachea.
C. Tracheostomy in the operating room.
D. Exploratory in the neck.
",D
"A 20-year-old, who was riding a dirt bike, was hit in the neck by a strap that was tied between two trees. He was brought to the emergency room alert, with relaxed breathing, and impressive abrasion marks on his neck on the left. After a first review in the emergency department, he was taken for a neck CTA, where a GRADE 1 left common carotid contusion was found, with no other findings. What should be done with the injured?
A. Exploration in an operating room.
B. Angiography with a carotid stent.
C. Aspirin.
D. Supervision only.
",C
"One of the effects of exposure to smoke in a closed space is inhalation of HCN which exposes the body to cyanide. Which of the following does cyanide cause at the cellular level?
A. Reduces ATP levels.
B. Paradoxically lowers LACTIC ACID levels.
C. Impairs mitochondrial function.
D. Increases the aerobic respiration of the cell.
","A,C"
"What is the reason for postponing elective surgery for another 6 weeks in case of using Avastin.
(Bevacizumab).
A. Due to side effect of cardiomyopathy.
B. Due to side effect of arrhythmias.
C. Due to side effects of bleeding.
D. Due to side effects of hypercoagulability.
",C
"An 18 year old underwent excision of an ulcerative skin lesion and a biopsy revealed superficial spreading malignant melanoma. The penetration depth is 0.9 mm according to Breslow's scale. What is the treatment?
A. Wide excision with a margin of 0.5 cm.
B. Wide excision with a margin of 1 cm.
C. Wide excision with a margin of 1 cm + sentinel node biopsy.
D. Wide excision with a margin of 2 cm + sentinel node biopsy.
","B,C"
"Which infection agent was found to be associated with the development of Idiopathic thrombocytopenic purpura (ITP)?
A. Helicobacter pylori.
B. E. Coli.
C. Mycobacterium tuberculosis.
D. Neisseria meningitidis.
",A
"A 30-year-old woman underwent laparoscopic splenectomy due to ITP. A drain was left in the operation.
In POD-3, a white-yellow discharge appeared in the drain. Despite the drainage, there is a chronic discharge that does not diminish after two weeks. What would be the appropriate treatment for the current situation?
A. Adding fluconazole to the treatment.
B. Distal pancreatectomy.
C. Puestow pancreaticojejunostomy.
D. Endoscopic sphincterotomy.
",D
"After a long course in intensive care due to pancreatitis, a 35-week pregnant woman was found suffering from a complicated urinary tract infection by E. Coli bacteria with multiple resistances but sensitive to Gentamicin only. What is the risk of treatment with this drug?
A. Deafness of the newborn.
B. Premature closure of fetal cardiac vessels.
C. Coloring the baby's teeth.
D. Damage to the cartilage of the fetus.
",A
"A 32-year-old normally healthy woman, 12 weeks pregnant, goes to the clinic due to a prominent umbilical hernia that bothers her.
The umbilical hernia is slightly sensitive but not incarcerated and there have been no cases of incarceration in the past. At what time is it better to operate?
Her?
A. In the second trimester.
B. In the third trimester.
C. Two weeks after giving birth.
D. 8 weeks after birth.
",D
"A usually healthy 30 year old is 10 weeks pregnant and complaining of epigastric pain.  US was performed.
And then an MRI demonstrated a suitable image of a 3 cm adenoma of the left lobe of the liver. What would be the treatment recommendation?
A. Second-trimester surgery.
B. Surgery if there is evidence of bleeding.
C. Postpartum surgery.
D. Immediate surgery.
",A
"According to studies, which temporary abdominal closure technique in a patient after damage control will give the maximum chance for definitive abdominal closure in the future?
A. Closure of the skin only.
B. Bogota bag.
C. Vacuum-assisted closure.
D. Dressing with steridrape.
",C
"In the lateral region of the abdominal wall, in which layer is the nerves that innervate the abdominal wall?
A. Between the peritoneum and transversalis fascia.
B. Between the transversalis fascia and the transversus abdominis muscle.
C. Between the transversus abdominis muscle and the internal oblique muscle.
D. Between the internal oblique muscle and the external oblique muscle.
","C,D"
"A 45 year old is undergoing evaluation for abdominal swelling. Colonoscopy was found to be normal. Abdominal CT shows a large amount of non-clear fluid throughout the abdomen with small masses scattered throughout the abdomen. The appendix is enlarged up to 4 cm, with non-clear fluid inside and nodules on the wall. In the biopsy: mucin and atypical cells. What is the recommended treatment for the patient?
A. Best supportive care.
B. PARP inhibitors.
C. Cytoreductive surgery and HIPEC.
D. Neoadjuvant Chemotherapy.
",C
"A 54 year old has complained of back pain for 4 months. A CT was performed and then an MRI which demonstrated a retroperitoneal mass
with a diameter of 5 cm corresponding to RETROPERITONEAL FIBROSIS. Despite the proximity to the ureters, no expansion of the renal pelvis is visible. What is the initial treatment for the patient?
A. Aspirin treatment.
B. Insertion of a stent into the ureters.
C. Surgery to release the ureters.
D. Methotrexate treatment.
",B
"A female patient is scheduled for surgery to remove a lipoma in the abdominal wall. From previous surgeries, she knows she tends to develop keloids in surgical scars. What may prevent the development of a keloid after surgery?
A. Radiation treatment of the scar.
B. A tattoo of bleomycin in the scar area.
C. Injection of verapamil into the wound area.
D. Dressing with silicone.
",D
"Treatment with Hyperbaric Oxygen has been found to help heal a wound in several situations including ischemia of the wound.
What constitutes an absolute contraindication to this treatment?
A. Evidence of bacterial infection of the wound.
B. Diabetes.
C. Extensive burn of over 40%.
D. Therapeutic treatment with Doxorubicin.
",D
"The ultimate wound healing that does not leave a scar is fetal wound healing.
Which factor is found in high concentration in the wound of a fetus compared to the wound of an adult?
A. TGF־²1.
B. FGF.
C. IL10.
D. PDGF.
",C
"To which stage of the wound healing process does epithelial migration belong?
A. Inflammatory.
B. Proliferative.
C. Maturational.
D. Remodeling.
","A,B"
"Which of the following tumors is more common in FAP carriers?
A. Thyroid cancer.
B. Endometrial cancer.
C. Kidney cancer.
D. Breast cancer.
",A
"A 45-year-old was diagnosed with medullary thyroid cancer; in which situations should a chest/abdominal CT scan be performed to rule out distant metastases?
A. Calcitonin level above 500 pg/ml.
B. If there are enlarged lymph nodes in section 2.
C. Primary tumor over 4 cm.
D. CEA levels above 150.
",A
"In which cases is there an advantage in posterior retroperitoneal adrenalectomy?.
A. The patient with Cushing's syndrome needs bilateral adrenalectomy.
B. Left adrenalectomy for a patient with a BMI of 45.
C. Right adrenalectomy for a patient with 45 BMI.
D. A patient with a 7.0 cm pheochromocytoma.
",A
"A 56 year old with known Cushing's syndrome is one month after right adrenalectomy due to his disease. He was admitted to the intensive care unit due to severe pneumonia. The next day he has low blood pressure, severe abdominal pain, nausea, and vomiting. What is the preferred initial treatment?
A. Normal saline and intravenous hydrocortisone 100 mg.
B. Glucose solution and intravenous administration of Dexcort 4 mg.
C. Administration of U10 insulin and initiation of vasopressor therapy.
D. Antibiotic treatment also covers bacteria of the digestive system and initiation of norepinephrine.
",A
"Which nerve may be damaged during upper pole release during thyroid lobectomy?
A. External branch of superior laryngeal nerve.
B. Internal branch of superior laryngeal nerve.
C. Recurrent laryngeal nerve.
D. Non-recurrent laryngeal nerve.
",A
"A 52 year old with end-stage renal failure was diagnosed with secondary hyperparathyroidism. He was referred for surgery. In pre-surgery imaging, US, and mapping - there is no evidence of a parathyroid adenoma. In D4CT, two enlarged glands on the right were suspected. What is the preferred surgical option?
A. 3.5 Parathyroid gland resection together with thymus resection.
B. Excision of 2 enlarged glands described in imaging.
C. Bilateral cervical examination and excision of the glands that appear enlarged.
D. Excision of 4 parathyroid glands with cryopreservation.
",A
"What is the preferred initial treatment for amiodarone-induced thyrotoxicosis?
A. Methimazole.
B. PTU propylthiouracil.
C. Radioactive Iodine ablation.
D. Total thyroidectomy.
",A
"Which of the following would be an indication for surgery for a 70-year-old, asymptomatic, with a new diagnosis Primary hyperparathyroidism?
A. Compression fracture in 3L a year ago.
B. T SCORE in the femoral neck minus 2.1.
C. Calcium urine collection 350 mg/24 hours.
D. Thyroid cancer in her past.
",A
"Why is there a decrease in pulse pressure in initial shock?
A. Vasoconstriction causes higher diastolic pressures.
B. A decrease in cardiac activity causes lower systolic pressures.
C. The release of catecholamines causes an increase in systolic pressures.
D. An increase in heart rate causes an increase in diastolic pressure.
",A
"Which heart rate would indicate the best prognosis in a patient with arterial bleeding?
A. 50 beats per minute.
B. 70 beats per minute.
C. 100 beats per minute.
D. 120 beats per minute.
",B
"How is the modified shock index calculated?
A. Heart rate divided by PULSE PRESSURE.
B. Heart rate divided by diastolic blood pressure.
C. Heart rate divided by systolic blood pressure.
D. Heart rate divided by mean arterial blood pressure (MAP).
",D
"What is the body's first compensatory mechanism in response to a hypovolemic shock?
A. An increase in the secretion of catecholamines by the adrenal medulla.
B. Activation of the renin-angiotensin system by the kidneys.
C. Increase in sympathetic activity by baroreceptors in the aorta and carotids.
D. Increasing blood flow to vital organs by constricting peripheral blood vessels.
",C
"What is the most effective way to warm a wounded person during trauma?
A. Cover the patient with a heating blanket.
B. Administer warmed intravenous fluids.
C. Administering heated fluids into the pleural space.
D. Heating the room to 37 degrees.
",C
"What is the recommended method for correcting a coagulation problem in patients with congestive heart failure?
A. FFP.
B. PCC.
C. Whole blood.
D. Tranexamic Acid.
",B
"Which of the following contains blood with the highest oxygen content?
A. Inferior Vena Cava.
B. Superior Vena Cava.
C. Pulmonary artery.
D. Coronary sinus.
","A,B,C,D"
"In which of the following cases is a preoperative nutritional assessment necessary?
A. 70 year old man, BMI 19.
B. 54-year-old man, unplanned weight loss from 80 to 74 kg in the last year.
C. 35 year old woman, albumin levels 3.3.
D. A 57-year-old woman, a decrease in eating of 40% of the usual diet in the last week.
",A
"What is the imaging of choice for assessing body mass before surgery?
A. DXA mapping (Dual Emission X-ray Absorptiometry).
B. US muscles.
C. CT.
D. MRI.
",A
"A patient with severe inflammation of the pancreas, in shock, is being treated with amine drugs in the intensive care unit. What is the recommended nutritional administration?
A. TPN.
B. Nasogastric feeding.
C. Post pyloric nasogastric feeding.
D. Feeding Jejunostomy.
","A,C"
"Which of the following dietary recommendations is recommended for a critically ill hospitalized patient in intensive care?
A. Determine the amount of secretion in the nasogastric tube and calculate the volume of the oral economy according to this.
B. Start oral feeding within 24-48 hours and increase the amount up to the feeding goals within a week.
C. Immediate start of intravenous feeding.
D. Avoid administering prokinetic drugs in treating a patient in the intensive care unit.
",B
"A street dweller is brought to the hospital after being attacked. Upon examination, he appears to be in a very poor nutritional state. What is the electrolyte disorder that may develop when he starts feeding it?
A. Hyponatremia.
B. Hypernatremia.
C. Hypophosphatemia.
D. Hyperkalemia.
",C
"Which patient is at risk for short bowel syndrome?
A. 25 years old, after a car accident, he underwent right colon resection and segments of small intestine. The remaining length of the small intestine is 90 cm.
B. 62 years old, after an acute mesenteric event in which a small intestine was resected. The length of the remaining small intestine is 80 cm.
C. 75 years old after Total Proctocolectomy.
D. 35-year-old Crohn's disease patient who underwent surgery to remove a 120 cm jejunostomy from the Treitz.
",A
"A patient who underwent sleeve surgery develops nutritional deficiencies. Which condition is the most common?
A. Hypothyroidism.
B. Megaloblastic anemia.
C. Lactic acidosis.
D. Zinc deficiency.
",B
"A patient underwent Heller myotomy surgery. A few days later he was diagnosed with a perforation and rushed to surgery. Which of the options is most suitable for starting enteral feeding as early as possible?
A. Nasogastric.
B. Nasoduodenal.
C. Gastrostomy.
D. Jejunostomy.
",D
"A patient with severe carotid stenosis and recurrent TIA events despite treatment with aspirin
is a candidate for carotid endarterectomy. What is the patient's ASA rating?
A. 2 ASA.
B. 3 ASA.
C. 4 ASA.
D. 5 ASA.
","B,C"
"A patient with an inguinal hernia that bothers him when playing golf asks for advice on the best time for surgery. A month ago, due to a positive stress test, he underwent catheterization, and due to severe stenosis, angioplasty was performed, and a drug-eluting stent was inserted. He is currently being treated with aspirin and Pelvis. What is the desired date for surgery?
A. A month and a half since the catheterization.
B. 3 months after the catheterization.
C. 6 months from the catheterization.
D. A year since the catheterization.
",D
"What is not included in Fried frailty phenotype?
A. Weight loss.
B. Memory loss.
C. Weakness in grip.
D. Slow walk.
",B
"What is the main risk factor for postoperative delirium?
A. Trauma.
B. Dementia.
C. History of past surgeries.
D. Diabetes.
",B
"Where does the hindgut end?
A. In the upper third of the rectum.
B. In the middle third of the rectum.
C. In the lower third of the rectum.
D. In the anal canal.
",D
"What is the disadvantage of mechanical preparation of the colon before colon resection surgery?
A. Excessive risk of wound infection.
B. Excessive risk of leak.
C. Excessive risk of electrolyte disturbances.
D. Excessive risk of thromboembolic events.
",C
"A patient, after surgery, develops an active infection with Clostridium difficile that does not respond to antibiotic treatment. It was decided to treat with Fecal Microbiota Transplant. What is the most effective approach to providing this treatment?
A. Swallowing frozen capsules.
B. Administration through a nasogastric tube.
C. Colonoscopy administration.
D. There is no difference in effectiveness between the approaches.
","C,D"
"A patient underwent a colonoscopy and complete excision of a polyp on a stalk. The margins are clean. in pathology Well differentiated adenocarcinoma that involves the entire head of the polyp and also penetrates the submucosa of the stalk. What is the chance of metastases to the lymph nodes?
A. Less than 10%.
B. 15-20%.
C. 35%.
D. Over 40%.
",A
"A trauma patient undergoes a laparotomy due to bleeding from the liver. A pulse was felt.
Lateral and right to the common bile duct. What is the blood vessel felt?
A. Common hepatic artery.
B. Hepatic propria artery.
C. Replaced right hepatic artery.
D. Cystic artery.
",C
"A 40-year-old woman is diagnosed with asymptomatic gallstones during a US performed for a workup of urinary tract infections. What is the chance that you will need surgery anyway in the next 20 years due to the onset of symptoms?
A. About 1%.
B. About 5%.
C. About 10%.
D. 20-30%.
",D
"A 30 year old is admitted through the ER with upper right abdominal pain and evidence of fever and peritonitis in the upper right abdomen. She has had similar events in her past that went away without treatment. US is performed due to suspicion of cholecystitis , demonstrating a non-swollen gallbladder, a thickened wall, and stones inside. The findings are inconclusive. What additional test should be performed to help diagnose cholecystitis?
A. CT with contrast material.
B. CT without contrast material.
C. HIDA scan.
D. MRCP.
",C
"What are the typical stones formed de novo in the bile ducts?
A. Black stones.
B. Brown stones.
C. Cholesterol stones.
D. Cholesterol stones with calcium.
",B
"A 50 year old is after a successful ERCP for cholecystitis secondary to gallstones. In the image after the catheter balloon has passed, there is no evidence of stones in the bile ducts. The patient wants to understand what is the risk of a repeated complication of gallstones if he does not undergo a gallbladder resection.
A. Less than 10%.
B. 20%.
C. 30%.
D. Over 50%.
",D
"A patient was operated on for gallstone ileus. What is the chance of the presence of additional large stones in the intestine?
A. About 10%.
B. About 20%.
C. About 30%.
D. 50% or more.
",A
"A post-CABG patient diagnosed with acalculous cholecystitis responds well to percutaneous drainage and antibiotics. Imaging two weeks after recovery shows that there is no evidence of stones in the gallbladder and there is good passage of contrast material to the biliary tract and duodenum. What is the next step in treatment?
A. Pulling out the drain.
B. Pulling out the drain and ordering an elective cholecystectomy 6 weeks after.
C. Elective cholecystectomy along with drainage after 6 weeks.
D. Leaving the drain for supervision for another 3 months.
",A
"A 55-year-old patient was diagnosed with a type I choledochal cyst after an episode of cholangitis that responded well to antibiotics. What is the recommended treatment?
A. Resection with Roux-en-Y hepaticojejunostomy.
B. Cyst drainage with Roux-en-Y cystojejunostomy.
C. Sphincterotomy by ERCP.
D. Supervision only.
",A
"What is the main cause of bicarbonate secretion from the pancreas?
A. The vagus nerve.
B. Trypsin.
C. Secretin.
D. Cholecystokinin.
",C
"What is the best CT scan to assess the extent of pancreatic necrosis in a patient with acute pancreatitis?
A. Before contrast agent injection.
B. In the arterial phase.
C. In the venous phase.
D. In the late review (180-200 seconds after injection).
",C
"A 75-year-old man is diagnosed with acute pancreatitis due to gallstones. Blood tests upon admission:
Glucose 140 mg, leukocytes 20,000, LDH IU/L200, and AST IU/L 90. What is the degree of inflammation according to Ranson's criteria?
A. Mild degree.
B. Medium degree.
C. Severe degree.
D. Cannot be calculated.
",D
"A 45-year-old underwent an abdominal CT for suspicion of appendicitis, and randomly, one cystic lesion was demonstrated in the body of the pancreas. Among these data, what does not support the diagnosis of mucinous cystic neoplasm?
A. Age of the patient.
B. The gender of the patient.
C. The location of the lesions.
D. Number of lesions.
",B
"A 56-year-old man is being investigated for cystic lesions in the pancreas that were randomly discovered in a whole-body CT following a car accident. MRCP demonstrated several cysts in the tail, body, and head of the pancreas with a maximum diameter of one of the cysts located in the body of the pancreas - about 2.2 cm with a thick wall that takes up contrast material enhancement, without Virsong expansion, without a nodule or septum in the contents, without lymphadenopathy No additional aggravating findings were demonstrated in the EUS. What is the further management of the case?
A. Review in a year.
B. EUS or MRI in 3 months.
C. Left pancreatectomy.
D. Complete resection of the pancreas.
",B
"A 68-year-old woman is hospitalized for two weeks due to acute inflammation of the pancreas. Due to the worsening of her condition, with a heart rate of 107 and temperature of 38.9, she underwent an abdominal CT, which demonstrated 2 connected collections with a diameter of about 6 cm adjacent to the pancreas. What is the further management of the case?
A. Antibiotic treatment with Imipenem.
B. EUS-guided puncture of the collections for culture.
C. CT-guided percutaneous drainage.
D. Endoscopic Cystogastrostomy.
",B
"Which of the following measures is included in the qSOFA SCORE?
A. Heartbeat.
B. Body temperature.
C. Breathing rate.
D. Urine output.
",C
"What electrolyte disorder is common in patients with severe burns?
A. Euvolemic hyponatremia.
B. Euvolemic hypernatremia.
C. Hypervolemichyponatremia.
D. Hypervolemic hypernatremia.
",A
"A patient with intestinal obstruction and multiple vomiting develops tachycardia. Superficial T waves are observed in the ECG.
As well as U waves. What is the appropriate treatment?
A. IV FUSID.
B. IV KCL.
C. IV NS.
D. IV BISOPROLOL.
",B
"Which of the following is the preferred agent for induction of anesthesia in an asthmatic patient?
A. Ketamine.
B. Midazolam.
C. Etomidate.
D. Thiopental.
",A
"A 30-year-old is known to have ulcerative colitis and is under biological treatment. He is hospitalized for 5 days due to a flare-up of the disease and is being treated with high-dose fluids and steroids without improvement. Now, his pulse is 110, WBC are 15,000, temperature 38.3, transverse colon on x-ray is 6 cm in diameter, no peritonitis. What is the next step in the management of the case?
A. Immediate colonoscopy to decompress the bowel.
B. Immediate colonoscopy to inject vancomycin antibiotics into the rectal area to treat the condition.
C. Colectomy with ileostomy.
D. Complete resection of the colon and rectum, with ileostomy.
",C
"A 73-year-old man with diabetes and heart failure comes to the emergency room with abdominal pain, tenesmus, and bloody diarrhea. As part of the workup, a colonoscopy is performed, which demonstrates an edematous, reddish segment that bleeds easily with ulcers in the mucosa. Note that the uninvolved areas appear normal. What is the most common location to find it?
A. Cecum.
B. The spleen glove.
C. Ascending colon.
D. Rectum.
",B
"A 65 year old with diabetes and hypertension comes to the emergency room with right abdominal pain and local sensitivity to the touch, and a temperature of 38.5. A CT is performed, which demonstrates diverticulitis of the ascending colon, 1a Hinchey. What is true about the therapeutic approach in this situation?
A. Excision after the flare-up.
B. Excision in the same hospitalization due to a high chance of perforation and abscess in this location.
Third. If you go for surgery, a total abdominal colectomy should be performed to avoid leaving disease in the sigmoid and left colon as well.
D. The therapeutic approach is similar to sigmoid diverticulitis.
",D
"In what situations would we recommend surgery in a patient who responded to conservative treatment for an episode of diverticulitis?
A. In young people.
B. In kidney transplant recipients.
C. In right-sided diverticulitis.
D. After a second episode of diverticulitis.
",B
"In which position should the stoma location be marked before surgery?
A. Sitting down.
B. Lying down.
C. Lying down with back and head raised to 30-45 degrees.
D. The position is not important.
",A
"A 25 year old has fistulous Crohn's disease involving the terminal ileum. Which organ will be most commonly involved?
A. Ascending colon.
B. Sigma.
C. Urinary bladder.
D. Uterus.
",B
"What is the correct abdominal CT protocol when Pancreatic Neuroendocrine Tumor is suspected.
(PNET).
A. Without contrast material.
B. Arterial phase.
C. Portal phase.
D. Late phase.
",B