Surgery 1001-1200 ចម្លើយពេញ

1194 Neoplastic hypersecretion of the hormone vasoactive intestinal peptide is associated with which of the following features? A Hypokalemia, hypochlorhydria, diarrhea B Hyperglycemia, necrolytic rash, hypoaminoacidemia C Constipation, gallstones, hyperglycemia D Hyperkalemia, necrolytic rash, diarrhea

A Hypokalemia, hypochlorhydria, diarrhea

1169 Standard supportive measures for patients with mild pancreatitis include the following: A Intravenous fluid and electrolyte therapy. B Withholding of analgesics to allow serial abdominal examinations. C Subcutaneous octreotide therapy. D Nasogastric decompression.

A Intravenous fluid and electrolyte therapy.

1171 Which of the following statements about adenocarcinoma of the pancreas is/are correct? A It is the fifth most common cause of cancer death in the U.S. B Most cases occur in the body and tail of the pancreas, making distal pancreatectomy the most commonly performed resectional therapy. C For cancers of the head of the pancreas resected by pancreaticoduodenectomy, prognosis appears to be independent of nodal status, margin status, or tumor diameter. D The most accurate screening test involves surveillance of stool for carbohydrate antigen (CA 19-9).

A It is the fifth most common cause of cancer death in the U.S.

1127 Which of the following statements regarding the risk of cancer in the context of ulcerative colitis is/are correct? A After 10 years of active disease, the risk of cancer approximates 20% to 30% B After 10 years of active disease, the risk of cancer approximates 2% to 3% C The risk of colon cancer in ulcerative colitis is identical to controls D After 20 years of disease activity, the risk of colon cancer approximates 80%

B After 10 years of active disease, the risk of cancer approximates 2% to 3%

1135 The most common oncogene abnormality observed in association with colorectal cancer is which of the following? A Overexpression of the N-myc oncogene B Amplification of the K-ras oncogene C Suppression of the erbB oncogene D Amplification of the L-myc oncogene

B Amplification of the K-ras oncogene

1184 For the patient in the preceding question, the most appropriate long-term management is which of the following? A Endoscopic stenting of the distal common bile duct B Choledochoduodenostomy C Pancreaticoduodenectomy (Whipple procedure) D Percutaneous transhepatic drainage of the common hepatic duct

B Choledochoduodenostomy

1106 The most common indication for operation in Crohn's disease of the colon is: A Obstruction. B Chronic debility. C Bleeding. D Perforation.

B Chronic debility.

1094 For which of the following consequences of radiation injury of the intestine is urgent laparotomy required? A Small bowel obstruction. B Colonic perforation. C Rectovaginal fistula. D Malabsorption and diarrhea.

B Colonic perforation.

1147 A 65-year-old woman develops obstipation, lower abdominal pain, and fever. Physical examination reveals a temperature of 38.5°C, left lower quadrant tenderness, and an ill-defined lower abdominal mass. White blood count is 17,500 per mm3. Intravenous hydration, broad spectrum antibiotics, and analgesics are ordered. After 48 hours, symptoms have not improved. Appropriate management includes which of the following? A Barium enema B Computed tomography of the abdomen C Immediate laparotomy D Intravenous pyelogram

B Computed tomography of the abdomen

1102 An increased evidence of adenocarcinoma of the small intestine has been established with which of the following conditions? A Peutz-Jegher Syndrome B Crohn's disease C Simple tubular adenomas of the small intestine D Colon carcinoma

B Crohn's disease

1051 All are true about the dumping syndrome except: A Symptoms can be controlled with a somatostatin analog. B Diarrhea is always part of the dumping syndrome. C Flushing and tachycardia are common features of the syndrome. D Separating solids and liquids in the patient's oral intake alleviates some of the symptoms of the syndrome.

B Diarrhea is always part of the dumping syndrome.

1096 A 45-year-old man with a history of previous right hemicolectomy for colon cancer presents with colicky abdominal pain which has become constant over the last few hours. He has marked abdominal distension and has had only minimal vomiting of a feculent material. His abdomen is diffusely tender. Abdominal x-ray shows multiple air fluid levels with dilatation of some loops to greater than 3 cm in diameter. The most likely diagnosis is: A Proximal small bowel obstruction B Distal small bowel obstruction C Acute appendicitis D Closed-loop small bowel obstruction

B Distal small bowel obstruction

1035 Which of the following statements about Schatzki's ring is correct? A The ring represents a panmural fibrotic stricture resulting from gastroesophageal reflux. B Dysphagia occurs when the ring diameter is 13 mm. or less. C The ring occurs within 1 to 2 cm. of the squamocolumnar epithelial junction. D Schatzki's ring indicates reflux esophagitis.

B Dysphagia occurs when the ring diameter is 13 mm. or less.

1131 One year following ileal pouch-anal anastomosis, the mean 24-hour stool frequency is which of the following? A Two to three B Five to six C Eight to nine D Eleven to twelve

B Five to six

1128 A 19-year-old male is seen in consultation with complaints of bloody diarrhea (10 bowel movements per day), and weight loss (10 pounds). Physical examination reveals the presence of two circular, 4 cm erythematous lesions on the trunk. Each lesion has an area of necrosis in the center. The abdominal examination reveals mild hypogastric tenderness. The stool is guaiac positive. The most appropriate next diagnostic step includes which of the following? A Barium enema B Flexible sigmoidoscopy C Liver biopsy D Chest x-ray

B Flexible sigmoidoscopy

1183 A 52-year-old male, known to be alcoholic, is evaluated because of chronic abdominal pain. The clinical diagnosis of chronic pancreatitis is supported by ERCP findings of pancreatic ductal ectasia with alternating areas of stricture and dilatation. Several pancreatic ductal stones are also noted. With chronic pain as the operative indication, the most appropriate procedure would be: A 80% distal pancreatectomy with splenectomy B Longitudinal pancreaticojejunostomy C Distal pancreatectomy with end pancreaticojejunostomy D Total pancreatectomy

B Longitudinal pancreaticojejunostomy

1070 Which of the following statement(s) is/are true concerning the surgical anatomy of the esophagus? A Surgical exposure of the cervical esophagus is best gained via the right neck B Spontaneous esophageal perforation tends to be associated with leakage into the left chest C Access to the entire thoracic esophagus can be obtained only via the left chest D The lower esophageal sphincter can be recognized distinctly by inspection of the gastroesophageal junction

B Spontaneous esophageal perforation tends to be associated with leakage into the left chest

1063 An 80% distal gastrectomy is performed for a 6-cm. antral cancer with extension to the muscularis propria and three positive lymph nodes less than 3 cm. from the tumor. The stage of this tumor was: A Stage I. B Stage II. C Stage III A. D Stage III B.

B Stage II.

1089 A patient with gastric adenocarcinoma undergoes subtotal gastrectomy. Pathological examination reveals that the tumor penetrates to the serosa. Regional lymph nodes are not involved. Distant metastases are not detected. What is the correct tumor stage and 5-year survival rate? A Stage I: 90% 5-year survival B Stage II: 45% 5-year survival C Stage III: 15% 5-year survival D Stage II: 15% 5-year survival

B Stage II: 45% 5-year survival

1022 The most commonly used imaging method for diagnosis of acute cholecystitis is: A CT of the abdomen. B Ultrasonography of the gallbladder. C Oral cholecystogram. D Radionuclide (HIDA) scan of the gallbladder.

B Ultrasonography of the gallbladder.

1161 Which of the following complications of portal hypertension often require surgical intervention (for more than 25% of patients)? A Hypersplenism. B Variceal hemorrhage. C Ascites. D Encephalopathy.

B Variceal hemorrhage.

1006 Acute appendicitis is most commonly associated with which of the following signs? A Temperature above ؛104 F. B Frequent loose stools. C Anorexia, abdominal pain, and right lower quadrant tenderness. D White blood cell count greater than 20,000 per cu. mm.

C Anorexia, abdominal pain, and right lower quadrant tenderness.

1141 A 72-year-old woman complains of anal itching and burning. Physical examination reveals an erythematous, scaly lesion, 3 cm in circumference, within the anal canal. The intersphincteric groove can not be appreciated in the area of the lesion. The remainder of the physical examination is normal. Appropriate initial management includes which of the following? A Acyclovir 200 mg QID for 10 days B Hydrocortisone cream 0.1% topically for 14 days C Incisional biopsy D Metronidazole 250 mg PO QID for 14 days

C Incisional biopsy

1152 Which of the following statements most accurately describes the current therapy for pyogenic hepatic abscess? A Antibiotics alone are adequate for the treatment of most cases. B All patients require open surgical drainage for optimal management. C Optimal treatment involves treatment of not only the abscess but the underlying source as well. D Percutaneous drainage is more successful for multiple lesions than for solitary ones.

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

1132 A 30-year-old male two years postoperative after total abdominal colectomy with ileoanal anastomosis reports a sudden increase in stool frequency, nocturnal leakage, and low-grade fevers. Physical examination is unremarkable. Flexible endoscopic examination of the small intestinal pouch reveals a friable erythematous mucosa. Biopsies of the mucosa are obtained. While awaiting biopsy results, which of the following is the most appropriate empiric therapy? A Oral corticosteroids B Oral vancomycin C Oral metronidazole D Corticosteroid enema

C Oral metronidazole

1121 Which of the following statements about hemorrhoids is/are not true? A Hemorrhoids are specialized "cushions" present in everyone that aid continence. B External hemorrhoids are covered by skin whereas internal hemorrhoids are covered by mucosa. C Pain is often associated with uncomplicated hemorrhoids. D Hemorrhoidectomy is reserved for third- and fourth-degree hemorrhoids.

C Pain is often associated with uncomplicated hemorrhoids.

1119 Optimal front-line treatment of squamous cell carcinoma of the rectum includes: A Abdominal perineal resection. B Low anterior resection when technically feasible. C Radiation therapy. D Combined radiation and chemotherapy.

D Combined radiation and chemotherapy.

1108 The test with the highest diagnostic yield for detecting a colovesical fistula is: A Barium enema. B Colonoscopy. C Computed tomography (CT). D Cystoscopy.

D Cystoscopy.

1158 Which of the following is the most effective definitive therapy for both prevention of recurrent variceal hemorrhage and control of ascites? A Endoscopic sclerotherapy. B Distal splenorenal shunt. C Esophagogastric devascularization (Sugiura procedure). D Side-to-side portacaval shunt.

D Side-to-side portacaval shunt.

1049 All of the following are complications of peptic ulcer surgery except: A Duodenal stump blowout. B Dumping. C Diarrhea. D Steatorrhea.

D Steatorrhea.

1046 Which of the following is most reliable for confirming the occurrence of a significant esophageal caustic injury? A History of the event. B Physical examination of the patient. C Barium esophagraphy. D Endoscopy.

D Endoscopy.

1187 Which of the following is the most common clinical manifestation of chronic pancreatitis? A Epigastric pain with radiation to the hypogastrium B Diabetes mellitus C Steatorrhea D Epigastric pain with radiation to the upper lumbar vertebrae

D Epigastric pain with radiation to the upper lumbar vertebrae

1101 The following statement(s) is/are true concerning the epidemiology of Crohn's disease. A Crohn's disease has an age distribution with peaks between the ages of 15 and 30 years and 65 and 75 years B There is a definite female predilection for Crohn's disease C The disease is equally prevalent in industrialized versus underdeveloped countries D First and second generation relatives with Crohn's disease have an increased prevalence when compared to the general population

D First and second generation relatives with Crohn's disease have an increased prevalence when compared to the general population

1115 Axial twisting of the right colon or cecal volvulus has been shown to be associated with each of the following except: A A history of abdominal operation. B A mobile cecum. C An obstructing lesion in the transverse or left colon. D Inflammatory bowel disease.

D Inflammatory bowel disease.

1156 Ligation of all of the following arteries usually causes significant hepatic enzyme abnormalities except: A Ligation of the right hepatic artery. B Ligation of the left hepatic artery. C Ligation of the hepatic artery distal to the gastroduodenal branch. D Ligation of the hepatic artery proximal to the gastroduodenal artery.

D Ligation of the hepatic artery proximal to the gastroduodenal artery.

1117 Which of the following statements is not true about inhereted susceptibility to colon cancer? A There is no known genetic susceptibility to colon cancer. B There are known genetic susceptibilities to colon cancer, but they are always associated with multiple adenomatous polyps. C There are known genetic susceptibilities to colon cancer, but they are always associated with specific ethnic or racial groups. D None of the above.

D None of the above.

1168 The preferred treatment for carcinoma of the gallbladder is: A Radical resection that includes gallbladder in continuity with the right hepatic lobe and regional lymph node dissection. B Radiation therapy. C Chemotherapy. D None of the above.

D None of the above.

1157 Which of the following is the most common acid-base disturbance in patients with cirrhosis and portal hypertension? A Metabolic acidosis. B Respiratory alkalosis. C Metabolic alkalosis. D Respiratory acidosis.

C Metabolic alkalosis.

1136 Which of the following types of colonic polyps is associated with the highest incidence of malignant degeneration? A Tubular adenoma B Tubulovillous adenoma C Villous adenoma D Hamartomatous polyp

C Villous adenoma

1139 A 58-year-old male undergoes resection of a Dukes C2 colon cancer via right hemicolectomy. Three years postoperatively, rising CEA levels prompt evaluation including abdominal computed tomography. Two lesions, each measuring 2 cm, are noted in the right hepatic lobe. No other abnormalities are noted. A right hepatic lobectomy is performed without complication. Which of the following most closely approximates anticipated 5-year survival? A 85-90% B 65-70% C 45-50% D 25-30%

D 25-30%

1122 The widely accepted treatment of most localized epidermoid, cloacogenic, or transitional cell carcinoma of the anal canal is: A Surgical resection. B Chemotherapy alone. C Radiotherapy alone. D Combined chemoradiation.

D Combined chemoradiation.

1182 The most appropriate test to confirm a clinical diagnosis of early chronic pancreatitis is which of the following? A Serum amylase determination B Calculation of urinary amylase clearance C Measurement of para-aminobenzoic acid absorption D Endoscopic retrograde cholangiopancreatography

D Endoscopic retrograde cholangiopancreatography

1186 Alcohol-induced and hereditary chronic pancreatitis are the two most common etiologies observed in North American patients. Most of the remaining patients fall into which of the following categories? A Chronic pancreatitis secondary to hyperparathyroidism B Chronic pancreatitis caused by protein-calorie malnutrition C Chronic pancreatitis secondary to congenital pancreatic ductal obstruction D Idiopathic chronic pancreatitis

D Idiopathic chronic pancreatitis

1124 How much of the daily insensible water loss is due to loss in stool? A 200 ml B 400 ml C 600 ml D 800 ml

A 200 ml

1189 A 67-year-old male presents with complaints of itching, dark urine, and epigastric pain. Physical examination reveals jaundice. Initial laboratory tests show total bilirubin of 6.5 mg/dL, alkaline phosphatase elevated at 3 the upper limit of normal, and mild elevations in serum transaminases. Appropriate management includes which diagnostic test next? A Abdominal ultrasonography B Computed tomography of the abdomen C Magnetic resonance imaging of the abdomen D Endoscopic retrograde cholangiography

A Abdominal ultrasonography

1110 The most common indication for surgery secondary to acute diverticulitis is: A Abscess. B Colonic obstruction. C Colovesical fistula. D Free perforation.

A Abscess.

1153 Which of the following statement(s) is/are true about benign lesions of the liver? A Adenomas are true neoplasms with a predisposition for complications and should usually be resected. B Focal nodular hyperplasia (FNH) is a neoplasm related to birth control pills (BCPs) and usually requires resection. C Hemangiomas are the most common benign lesions of the liver that come to the surgeon's attention. D Nodular regenerative hyperplasia does not usually accompany cirrhosis.

A Adenomas are true neoplasms with a predisposition for complications and should usually be resected.

1179 A 36-year-old woman is admitted to a the hospital with upper abdominal pain, hyperamylasemia, elevation of serum alkaline phosphatase and ultrasound evidence of cholelithiasis. With intravenous hydration and analgesia, symptoms rapidly resolved. After 48 hours, serum amylase and alkaline phosphatase values had returned to normal and physical examination revealed lessening tenderness in the right upper quadrant of the abdomen. Appropriate management consists of which of the following as the next step? A Cholecystectomy and intraoperative cholangiography before hospital discharge B Elective cholecystectomy at approximately 8 weeks C Endoscopic sphincterotomy before discharge followed by cholecystectomy at approximately 8 weeks D Observation

A Cholecystectomy and intraoperative cholangiography before hospital discharge

1145 An elderly man presents with complaints that he is passing gas with urination. The past medical history is positive for one episode of diverticulitis, treated medically, transurethral resection of the prostate for benign prostatic hypertrophy, and diabetes. Which of the following diagnostic tests is most appropriate initially? A Computed tomography of the abdomen and pelvis B Cystoscopy C Barium enema D Intravenous pyelography

A Computed tomography of the abdomen and pelvis

1188 For the patient in the preceding question, appropriate management includes which of the following? A Distal pancreatectomy B Cystjejunostomy C Percutaneous drainage D Primary radiotherapy and chemotherapy

A Distal pancreatectomy

1113 Which finding(s) suggest(s) the diagnosis of chronic ulcerative colitis as opposed to Crohn's colitis? A Endoscopic evidence of backwash ileitis. B Granulomas on biopsy. C Anal fistula. D Rectal sparing.

A Endoscopic evidence of backwash ileitis.

1174 Orally administered glucose provokes a greater insulin response than an equivalent amount of intravenously administered glucose. The incremental response to ingested glucose is due to the effects of which of the following hormones? A Gastric inhibitory peptide B Somatostatin C Pancreatic polypeptide D Secretin

A Gastric inhibitory peptide

1198 The liver plays a vital role in carbohydrate metabolism and regulation of blood glucose. The following statement(s) is/are true concerning carbohydrate metabolism by the liver. A Glycogen, a complex polymer of glucose, is synthesized by the hepatocyte in a remarkably energy efficient process B Glucagon stimulates glycogenesis C Glycolysis, the process by which glucose is converted to two molecules of pyruvate, occurs in the liver mitochondria D If glycogen stores become depleted, the liver is capable of synthesizing new glucose by the process of gluconeogenesis, which is stimulated by insulin

A Glycogen, a complex polymer of glucose, is synthesized by the hepatocyte in a remarkably energy efficient process

1181 Which of the following statement(s) relating to chronic pancreatitis is/are correct? A In the United States, the most common cause of chronic pancreatitis is alcohol abuse B Approximately 50% of chronic alcoholics develop chronic pancreatitis C Clinically significant chronic pancreatitis develops on average after five years of alcohol abuse in men DThe risk of alcohol-induced chronic pancreatitis can be decreased by consumption of a high-protein diet

A In the United States, the most common cause of chronic pancreatitis is alcohol abuse

1160 Which of the following veins is preserved in performing the extensive esophagogastric devascularization procedure described by Sugiura? A Left gastric (coronary) vein. B Short gastric vein. C Splenic vein. D Left gastroepiploic vein.

A Left gastric (coronary) vein.

1195 A patient with biochemically confirmed gastrinoma undergoes computed tomography for tumor localization. CT reveals a 2 cm mass in the head of the pancreas and multiple nodules within right and left lobes of the liver. Appropriate management includes which of the following? A Omeprazole administration B Radiotherapy C Pancreaticoduodenectomy D Proximal gastric vagotomy

A Omeprazole administration

1134 A 72-year-old woman undergoes anterior resection for a rectal cancer located 7 cm proximal to the anal verge. Pathologic examination of the resected specimen reveals invasion of the tumor into the muscularis propria. Five of 8 lymph nodes contain microscopic tumor. There is no evidence of disseminated disease. Appropriate subsequent management includes which of the following? A Postoperative radiation plus intravenous 5FU B Postoperative radiation alone C Observation D Postoperative radiation plus intravenous adriamycin

A Postoperative radiation plus intravenous 5FU

1165 The initial goal of therapy for acute toxic cholangitis is to: A Prevent cholangiovenous reflux by decompressing the duct system. B Remove the obstructing stone, if one is present. C Alleviate jaundice and prevent permanent liver damage. D Prevent the development of gallstone pancreatitis.

A Prevent cholangiovenous reflux by decompressing the duct system.

1120 Which of the following statement(s) about complete rectal prolapse, or procidentia is/are true? A Rectal prolapse results from intussusception of the rectum and rectosigmoid. B The disorder is more common in men than in women. C Continence nearly always is recovered after correction of the prolapse. D All of the above are true.

A Rectal prolapse results from intussusception of the rectum and rectosigmoid.

1138 An pedunculated polyp, discovered incidentally at colonoscopy, is removed by snare polypectomy from the ascending colon. Invasive cancer to the level of the submucosa is identified histologically within the polyp. The lesion is well-differentiated. No lymphatic or vascular invasion is noted. The cauterized margin is negative for neoplasm. Appropriate subsequent management includes which of the following? A Repeat endoscopy at 6 months B Right hemicolectomy C Subtotal colectomy D Repeat endoscopy with fulguration of the polypectomy site

A Repeat endoscopy at 6 months

1146 For the patient in the preceding question, a colovesical fistula originating from the sigmoid colon is demonstrated. Colonoscopy reveals diverticula and excludes carcinoma. During laparotomy, a thickened sigmoid colon is found to be adherent to the dome of the bladder. A definite fistula is not observed. Appropriate operative management includes which of the following? A Sigmoid resection, primary colonic anastomosis, catheter drainage of bladder B En-bloc resection of sigmoid colon and adjacent bladder wall, primary colonic anastomosis, suprapubic cystostomy C En-bloc resection of sigmoid colon and adjacent bladder wall, formation of descending colostomy and Hartmann's pouch, suprapubic cystostomy D Sigmoid resection, primary colonic anastomosis, bilateral percutaneous nephrostomies

A Sigmoid resection, primary colonic anastomosis, catheter drainage of bladder

1193 For the patient in the preceding question, an insulin/glucose ratio of 0.5 was documented at 28 hours of fasting. Symptoms of mental obtundation developed concurrently and were reversed by oral glucose administration. Endoscopic ultrasonography demonstrated a 1.2 cm mass in the head of the pancreas. Appropriate management consists of which of the following? A Surgical enucleation of the tumor B Total pancreatectomy C Long-term octreotide administration D Primary radiotherapy

A Surgical enucleation of the tumor

1164 Which of the following are indications for cholecystectomy? A The presence of gallstones in a patient with intermittent episodes of right-side upper quadrant pain. B The presence of gallstones in an asymptomatic patient. C The presence of symptomatic gallstones in a patient with angina pectoris. D The presence of asymptomatic gallstones in a patient who has insulin-dependent diabetes.

A The presence of gallstones in a patient with intermittent episodes of right-side upper quadrant pain.

1148 The most common complication after hemorrhoidectomy is which of the following? A Urinary retention B Rectal bleeding C Incontinence D Wound infection

A Urinary retention

1052 In patients with bleeding duodenal ulcers, the endoscopic finding associated with the highest incidence of rebleeding is: A Visible vessel. B Cherry-red spot. C Clean ulcer bed. D Duodenitis.

A Visible vessel.

1176 A 50-year-old man develops acute pancreatitis due to alcohol abuse. Hyperamylasemia resolves by the third day after admission. By the eighth hospital day, the patient is noted to have recurrent fever (38.5°C), progressive leukocytosis (18,500 WBC/mm3), and tachypnea. The most appropriate management includes which as the next step? A Laparotomy with pancreatic debridement B CT guided aspiration of peripancreatic fluid collections C ERCP with sphincterotomy and placement of biliary stent D Intravenous amphotericin B

B CT guided aspiration of peripancreatic fluid collections

1116 Sigmoid volvulus has been associated with each of the following except: A Chronic constipation and laxative abuse. B Chronic rectal proplapse. C Chronic traumatic paralysis. D Medical management of Parkinson's disease.

B Chronic rectal proplapse.

1180 For the patient in the preceding question, symptomatic recurrence at 3 weeks after aspiration is confirmed ultrasonographically. Endoscopic retrograde pancreatography does not demonstrate communication of a major pancreatic duct with the pseudocyst. Appropriate management includes which of the following? A Pancreatectomy to include the pseudocyst B Cystgastrostomy C Repeat aspiration followed by injection of sodium morrhuate into the pseudocyst cavity D Pancreatic debridement followed by external drainage

B Cystgastrostomy

1199 Which of the following statement(s) is/are true concerning acute, fulminant hepatic failure? A The most frequent cause of acute hepatic failure world-wide is hepatitis B infection B Higher grades of encephalopathy are associated with a worse prognosis C Hypoglycemia is a common complication of all liver diseases D Liver transplantation would appear indicated in all patients with hepatic coma secondary to acute liver failure

B Higher grades of encephalopathy are associated with a worse prognosis

1190 The most common cause of death in the postoperative period following pancreaticoduodenectomy is which of the following? A Myocardial infarction B Intraperitoneal hemorrhage C Pulmonary embolism D Pneumonia

B Intraperitoneal hemorrhage

1104 Recurrence after operation for Crohn's disease: A Occurs after operations for ileal Crohn's but not colonic Crohn's. B Is usually found just proximal to an enteric anastomosis. C Rarely requires reoperation. D Occurs in 1% of patients at risk per year during the first 10 years after the operation.

B Is usually found just proximal to an enteric anastomosis. C Rarely requires reoperation.

1112 Surgical alternatives for the treatment of ulcerative colitis include all of the following except: A Colectomy with ileal pouch-anal anastomosis. B Left colectomy with colorectal anastomosis. C Proctocolectomy with Brooke ileostomy or continent ileostomy. D Subtotal colectomy with ileostomy and Hartmann closure of the rectum.

B Left colectomy with colorectal anastomosis.

1118 Which of the following recommendations for adjuvant chemotherapy of colorectal carcinoma are true? A Patients with Stage I or Dukes A and B1 disease should receive adjuvant treatment for 1 year with levamisole combined with 5-FU. B Patients with Stage III or Dukes C disease should receive adjuvant treatment for 1 year with levamisole combined with 5-FU. C There is no role for adjuvant therapy for colon cancer at any stage. D Adjuvant chemotherapy is active in colon cancer only when combined with radiotherapy.

B Patients with Stage III or Dukes C disease should receive adjuvant treatment for 1 year with levamisole combined with 5-FU.

1197 Intraoperative ultrasound is now commonly used by the hepatic surgeon. Which of the following statement(s) is/are true concerning intraoperative ultrasound and hepatic surgery? A An intraoperative ultrasound offers no advantage to conventional transcorporial ultrasound in detection of hepatic lesions B Portal structures can be differentiated from hepatic veins by the extension of Glisson's capsule surrounding these structures C It is difficult on ultrasound to differentiate a vascular structure from a mass D The short hepatic veins are difficult to detect with intraoperative ultrasound

B Portal structures can be differentiated from hepatic veins by the extension of Glisson's capsule surrounding these structures

1144 Recurrent episodes of sigmoid colonic diverticulitis prompt operative therapy. Which of the following describe the appropriate margins for resection? A Proximal margin, splenic flexure; distal margin, rectosigmoid junction B Proximal margin, descending colon; distal margin, rectosigmoid junction C Proximal margin, descending colon; distal margin, mid-rectum D Proximal margin, transverse colon; distal margin, mid-rectum

B Proximal margin, descending colon; distal margin, rectosigmoid junction

1129 Many patients with ulcerative colitis are operated upon electively with total abdominal colectomy, rectal mucosectomy, formation of a small intestinal reservoir, and ileoanal anastomosis. The most common postoperative complication after this operation is which of the following? A Enterocutaneous fistula B Small bowel obstruction C Pulmonary embolism D Urinary retention

B Small bowel obstruction

1140 An asymptomatic 52-year-old man is undergoing screening sigmoidoscopy. In the rectum, at 6 cm from the anal verge, a 2 cm yellow, submucosal nodule is noted. Deep endoscopic biopsies are consistent with carcinoid. Appropriate management includes which of the following? A Observation B Transanal excision C Low anterior resection D Abdominoperineal resection

B Transanal excision

1149 A 65-year-old man presents with complaints of mucous discharge and perianal discomfort. Physical examination reveals a fistulous opening lateral to the anus. Anoscopic examination permits passage of a probe through the fistula tract. The fistula traverses the internal anal sphincter, the intersphincteric plane, and a portion of the external anal sphincter. The fistula is categorized as which type? A Intersphincteric B Transsphincteric C Suprasphincteric D Extrasphincteric

B Transsphincteric

1162 Which of the following clinical situations are considered good indications for PVS? A A 50-year-old cirrhotic man had an emergency portacaval shunt for bleeding varices and postoperatively had an ascites leak and mild superficial wound infection. B A 57-year-old woman with primary biliary cirrhosis (PBC) has difficult to control ascites and diuretic-induced encephalopathy. C A 46-year-old resistant alcoholic has chronic ascites uncontrolled by diuretics combined with repeat paracentesis. D A 34-year-old woman taking BCPs had rapid onset of ascites and is found to have hepatic vein thrombosis causing the Budd-Chiari syndrome.

C A 46-year-old resistant alcoholic has chronic ascites uncontrolled by diuretics combined with repeat paracentesis.

1107 Which of the following patients generally does not require surgical intervention as a consequence of acute diverticulitis? A A 35-year-old man with no history of diverticulitis. B A 68-year-old man status 2 weeks post-renal transplantation. C A 55-year-old woman with hypertension and diabetes mellitus. D A 50-year-old man with pneumaturia.

C A 55-year-old woman with hypertension and diabetes mellitus.

1142 For the patient in the preceding question, biopsy revealed an invasive apocrine gland neoplasm. The deep margins included striated muscle infiltrated by neoplastic cells. Appropriate management includes which of the following? A Primary radiation B Abdominoperineal resection with bilateral inguinal lymph node dissection C Abdominoperineal resection only D Carbon dioxide laser fulguration

C Abdominoperineal resection only

1111 Which of the following statements about familial adenomatous polyposis (FAP) is/are true? A Inherited in an autosomal-dominant manner, this genetic defect is of variable penetrance, some patients having only a few polyps whereas others develop thousands. B The phenotypic expression of the disease depends mostly on the genotype. C Appropriate surgical therapy includes total abdominal colectomy with ileorectal anastomosis and ileoanal pull-through with rectal mucosectomy. D Panproctocolectomy with ileostomy is not appropriate therapy for this disease.

C Appropriate surgical therapy includes total abdominal colectomy with ileorectal anastomosis and ileoanal pull-through with rectal mucosectomy.

1125 A 52-year-old woman is involved in an automobile accident and sustains an open fracture of the fight femur, compression fractures of the 10th and 11th thoracic vertebrae and right pulmonary contusion. On the fourth day after injury, her abdomen is noted to be distended, tympanitic and diffusely tender. Abdominal radiographs reveal gaseous distension of the ascending and transverse segments of the colon. The cecum is 13 cm in greatest diameter. Appropriate management includes which of the following as the next step? A Right hemicolectomy B Operative cecostomy C Colonoscopy D Contrast enema

C Colonoscopy

1150 For the patient in the preceding question, appropriate management includes which of the following? A Division of the tissues over the probe with electrocautery, leaving the wound open to heal by secondary intention B Division of the tissues over the probe with electrocautery, closing the wound using a pedicled skin flap C Division of the internal anal sphincter using electrocautery, encircling the external sphincter with a seton D Proximal diverting colostomy and antibiotics

C Division of the internal anal sphincter using electrocautery, encircling the external sphincter with a seton

1137 A 52-year-old man undergoes a right hemicolectomy for a carcinoma of the ascending colon. Pathological examination of the resected specimen reveals invasion of the tumor to the level of the muscularis propria. Three of 17 lymph nodes contain microscopic tumor. What is the correct Dukes classification (Aster-Coller modification) and associated 5- year survival for this lesion? A Dukes C2, 45% 5-year survival B Dukes B1, 75% 5-year survival C Dukes C1, 45% 5-year survival D Dukes B3, 65% 5-year survival

C Dukes C1, 45% 5-year survival

1159 Which of the following treatments most effectively preserves hepatic portal perfusion? A Distal splenorenal shunt. B Conventional splenorenal shunt. C Endoscopic sclerotherapy. D Side-to-side portacaval shunt.

C Endoscopic sclerotherapy.

1185 Which of the following is the most common cause of obstructive jaundice in patients with chronic pancreatitis? A Adenocarcinoma of the head of the pancreas B Choledocholithiasis C Fibrotic stricture of the common bile duct D Pancreatic pseudocyst formation

C Fibrotic stricture of the common bile duct

1175 The islets of Langerhans contain four major endocrine cell types that secrete which of the following hormones? A Insulin, somatostatin, glucagon, secretin B Insulin, somatostatin, cholecystokinin, pancreatic polypeptide C Insulin, somatostatin, glucagon, pancreatic polypeptide D Insulin, secretin, glucagon, cholecystokinin

C Insulin, somatostatin, glucagon, pancreatic polypeptide

1163 Which of the following statements about biliary tract problems are correct? A Choledochal cyst should be treated by Roux-en-Y cystojejunostomy. B Sclerosing cholangitis is characterized by long, narrow strictures in the extrahepatic biliary duct system. C Operative (needle) cholangiography is indicated in patients who at operation appear to have no gallbladder. DThe long cystic duct, which appears to be fused with the common duct and enters it distally, should be dissected free and ligated at its entrance into the common duct.

C Operative (needle) cholangiography is indicated in patients who at operation appear to have no gallbladder.

1133 For the patient in the preceding question, after obtaining diagnostic samples, the most appropriate management would include which of the following? A Oral metronidazole B Intravenous metronidazole C Oral vancomycin D Intravenous vancomycin

C Oral vancomycin

1155 Which of the following statements about hemobilia are true? A Tumors are the most common cause. B The primary treatment of severe hemobilia is an operation. C Percutaneous cholangiographic hemobilia is usually minor. D Ultrasonography usually reveals a specific diagnosis.

C Percutaneous cholangiographic hemobilia is usually minor.

1143 A 43-year-old woman presents with complaints of anal pain and spotting of blood with defecation. Physical examination reveals a 2 3 cm area of ulceration within the anal canal. The remainder of the physical examination is normal. Incisional biopsy is positive for squamous cell carcinoma. Appropriate management includes which of the following? A Abdominoperineal resection B Wide local excision, skin grafting, proximal diverting colostomy C Primary radiation therapy D Local excision and primary closure

C Primary radiation therapy

1103 Crohn's disease: A Is caused by Mycobacterium paratuberculosis. B Is more common in Asians than in Jews. C Tends to occur in families. D Is less frequent in temperate climates than in tropical ones.

C Tends to occur in families.

1173 Pancreas divisum results from incomplete fusion of the ventral pancreatic duct with the dorsal pancreatic duct during embryologic development. Which of the following statements correctly describes pancreas divisum? A The body and tail of the pancreas drain via an accessory ampulla distal to the ampulla of Vater. The uncinate process drains via the ampulla of Vater B The entire pancreatic ductal system drains via the ampulla of Vater C The entire pancreatic ductal system drains via an accessory ampulla proximal to the ampulla of Vater D The body and tail of the pancreas are absent. The uncinate process drains via the ampulla of Vater

C The entire pancreatic ductal system drains via an accessory ampulla proximal to the ampulla of Vater

1196 In the patient described above, which of the following are important operative steps in the performance of a right hepatic lobectomy? A The use of an ultrasonic dissector is essential for division of the hepatic parenchyma B If temporary portal inflow occlusion is used (Pringle maneuver), it is not necessary to reestablish blood flow during the course of the parenchymal division C The greater omentum may be used to buttress the transected liver edge D Control of the main right hepatic vein should eliminate all forms of venous drainage

C The greater omentum may be used to buttress the transected liver edge

1166 Which of the following statement(s) about gallstone ileus is/are not true? A The condition is seen most frequently in women older than 70. B Concomitant with the bowel obstruction, air is seen in the biliary tree. C The usual fistula underlying the problem is between the gallbladder and the ileum. D When possible, relief of small bowel obstruction should be accompanied by definitive repair of the fistula since there is a significant incidence of recurrence if the fistula is left in place.

C The usual fistula underlying the problem is between the gallbladder and the ileum.

1130 A 25-year-old woman with known ulcerative colitis presents to the emergency room with a 24-hour history of abdominal pain, distention, and obstipation. Physical examination reveals a temperature of 38.6° C, abdominal distention, and diffuse abdominal tenderness. Abdominal x-rays show marked colonic dilatation, most pronounced in the transverse colon. Laboratory examination reveals a white blood count of 19,000/mm3. Over the first 24 hours of hospitalization, symptoms are progressive in spite of intravenous fluid resuscitation, nasogastric suctioning, and intravenous antibiotics. The most appropriate management for this patient would include which of the following? A Decompressive colonoscopy B Proctocolectomy with formation of end ileostomy C Total abdominal colectomy with formation of Hartmann pouch and end ileostomy D Cecostomy

C Total abdominal colectomy with formation of Hartmann pouch and end ileostomy

1177 The patient in the above question is treated by observation for 8 weeks. He continues to be symptomatic with epigastric pain. A repeat abdominal CT scan reveals a persistent 6 cm pseudocyst in the region of the body of the pancreas. The pseudocyst is unilocular and demonstrates a well-defined rim of fibrous tissue. The gastric antrum is displaced anteriorly. Using CT guidance, 300 ml of fluid is aspirated from the lesion which is shown to be collapsed radiographically. No further intervention is performed. What is the risk of pseudocyst recurrence after simple aspiration? A 80-85% B 60-65% C 40-45% D 20-25%

D 20-25%

1123 Which statement(s) is/are true about hidradenitis suppurativa? A It is a disease of the apocrine sweat glands. B It causes multiple perianal and perineal sinuses that drain watery pus. C The sinuses do not communicate with the dentate line. D All of the above.

D All of the above.

1167 Which of the following lesions are believed to be associated with the development of carcinoma of the gallbladder? A Cholecystoenteric fistula. B A calcified gallbladder. C Adenoma of the gallbladder. D All of the above.

D All of the above.

1172 A 35-year-old woman presents with episodes of obtundation, somnolence, and tachycardia. An insulinoma is suspected based on a random serum glucose test value of 38 mg. per dl. Which of the following statements is/are true? A The most important diagnostic study for insulinoma is an oral glucose tolerance test. B It may be helpful to perform ERCP in an effort to localize the tumor. C Most patients with insulinoma present with extensive disease, rendering them only rarely resectable or curable. D An important component of the preoperative evaluation in patients with presumed insulinoma involves confirming elevated C-peptide or proinsulin levels and screening for anti-insulin antibodies.

D An important component of the preoperative evaluation in patients with presumed insulinoma involves confirming elevated C-peptide or proinsulin levels and screening for anti-insulin antibodies.

1191 Which of the following surgical procedures has the lowest incidence of recurrent jaundice when used in the context of unresectable carcinoma of the head of the pancreas? A Choledochoduodenostomy B Cholecystojejunostomy C Cholecystoduodenostomy D Choledochojejunostomy

D Choledochojejunostomy

1170 Which of the following statements about chronic pancreatitis is/are correct? A Chronic pancreatitis is the inevitable result after repeated episodes of acute pancreatitis. B Patients with chronic pancreatitis commonly present with jaundice, pruritus, and fever. C Mesenteric angiography is useful in the evaluation of many patients with chronic pancreatitis. D For patients with disabling chronic pancreatitis and a dilated pancreatic duct with associated stricture formation, a longitudinal pancreaticojejunostomy (Peustow procedure) is an appropriate surgical option.

D For patients with disabling chronic pancreatitis and a dilated pancreatic duct with associated stricture formation, a longitudinal pancreaticojejunostomy (Peustow procedure) is an appropriate surgical option.

1178 In prospective, randomized trials which of the following agents or therapeutic measures has/have been demonstrated to accelerate recovery from acute pancreatitis? A Peritoneal lavage B Anticholinergic blockade C Octreotide D None of the above

D None of the above

1154 Which of the following statement(s) is/are true about bile duct cancers? A If resected, proximal lesions are usually curable. B The more proximal the lesion, the more likely is resection to be curative. C Radiation clearly prolongs survival. D None of the above is true.

D None of the above is true.

1192 A 45-year-old woman is evaluated for epigastric and back pain. Physical examination is normal. Computed tomography of the abdomen reveals a 8 cm cystic lesion in the region of the tail of the pancreas. The cyst demonstrates internal septations and papillary projections from its walls. Which of the following diagnoses is most likely in this patient? A Pancreatic lymphoma B Retroperitoneal liposarcoma C Pancreatic pseudocyst D Pancreatic mucinous cystadenoma

D Pancreatic mucinous cystadenoma

1114 An 80-year-old man who has been bedridden for many years following a stroke presents with acute onset of abdominal distention, obstipation, and colicky abdominal pain. Abdominal x-rays reveal dilated loops of small bowel and a dilated sigmoid colon resembling a bent inner tube. Examination reveals distention with mild direct tenderness but no rigidity or rebound tenderness. Initial management should consist of: A Barium enema examination. B Laparotomy with resection of descending colon and descending colostomy. C Multiple cleansing enemas to remove impacted feces. D Rigid sigmoidoscopy and decompression of the sigmoid colon.

D Rigid sigmoidoscopy and decompression of the sigmoid colon.

1151 Which of the following statements about the segmental anatomy of the liver are not true? A Segments are subdivisions in both the French and American systems. B Segments are determined primarily by the hepatic venous drainage. C The French anatomic system is more applicable than the American system to clinical hepatic resection. D Segments are important to the understanding of the topographic anatomy of the liver.

D Segments are important to the understanding of the topographic anatomy of the liver.

1109 Which of the following is not true of diverticular disease: A It is more common in the United States and Western Europe than in Asia and Africa. B A low-fiber diet may predispose to development of diverticulosis. C It involves sigmoid colon in more than 90% of patients. D Sixty per cent develop diverticulitis sometime during their lifetime.

D Sixty per cent develop diverticulitis sometime during their lifetime.

1105 Excision rather than bypass is preferred for surgical treatment of small intestinal Crohn's because: A Excision is safer. B Bypass does not relieve symptoms. C Excision cures the patient of Crohn's disease but bypass does not. D The risk of small intestine cancer is reduced.

D The risk of small intestine cancer is reduced.

1126 Which of the following features is/are consistent with a diagnosis of colonic inertia? A Alternating episodes of severe constipation and normal bowel activity B Total bowel transit time of 24 hours C Total bowel transit time of 48 hours D Total bowel transit time of 96 hours

D Total bowel transit time of 96 hours

1200 The following statement(s) is/are true concerning the management of ascites associated with chronic liver disease. A Spontaneous bacterial peritonitis is an insignificant complication B Large volume paracentesis is unsafe due to excessive volume loss from the intervascular space C Peritoneovenous shunting is a trivial surgical procedure with minimal perioperative morbidity and mortality D Transjugular intrahepatic portosystemic shunts (TIPS) can effectively treat ascites in patients refractory to conventional medical therapy

D Transjugular intrahepatic portosystemic shunts (TIPS) can effectively treat ascites in patients refractory to conventional medical therapy

1056 All of the following measures have been recommended for control of acid secretion in patients with Zollinger-Ellison syndrome except: A Antrectomy. B Highly selective vagotomy. C Total gastrectomy. D Vagotomy and pyloroplasty.

A Antrectomy.

1073 The incidence of adenocarcinoma of the esophagus is increasing at a very rapid rate, which is largely the result of the growing prevalence of adenocarcinoma arising in Barrett's mucosa. Which of the following statement(s) is/are true concerning adenocarcinoma of the esophagus? A Barrett's mucosa with specialized columnar epithelium characterized by veliform folds, lined by secreting columnar and goblet cells has the highest association with carcinoma of the esophagus B Less than 5% of patients with Barrett's mucosa will harbor adenocarcinoma C Severe dysplasia of Barrett's mucosa requires frequent reexamination and biopsy D Adenocarcinoma of the esophagus has a less aggressive behavior than squamous cell carcinoma

A Barrett's mucosa with specialized columnar epithelium characterized by veliform folds, lined by secreting columnar and goblet cells has the highest association with carcinoma of the esophagus

1012 True statements regarding appendiceal neoplasms include which of the following? A Carcinoid tumors of the appendix less than 1.5 cm are adequately treated by simple appendectomy B Appendiceal carcinoma is associated with secondary tumors of the GI tract in up to 60% of patients C Survival following right colectomy for a Dukes' stage C appendiceal carcinoma is markedly better than that for a similarly staged colon cancer at 5 years D Mucinous cystadenocarcinoma of the appendix is adequately treated by simple appendectomy, even in patients with rupture and mucinous ascites

A Carcinoid tumors of the appendix less than 1.5 cm are adequately treated by simple appendectomy

1029 True statements regarding appendiceal neoplasms include which of the following? A Carcinoid tumors of the appendix less than 1.5 cm are adequately treated by simple appendectomy B Appendiceal carcinoma is associated with secondary tumors of the GI tract in up to 60% of patients C Survival following right colectomy for a Dukes' stage C appendiceal carcinoma is markedly better than that for a similarly staged colon cancer at 5 years D Mucinous cystadenocarcinoma of the appendix is adequately treated by simple appendectomy, even in patients with rupture and mucinous ascites

A Carcinoid tumors of the appendix less than 1.5 cm are adequately treated by simple appendectomy

1011 True statements regarding the pathophysiology of acute appendicitis include which of the following: A Fecaliths are responsible for the disease process in approximately 30% of adult patients B Lymphoid hyperplasia is a rare cause of appendicitis in young patients C Clostridium difficile is implicated as a pathogenic organism D Carcinoid tumors account for approximately 5% of all cases of acute appendicitis

A Fecaliths are responsible for the disease process in approximately 30% of adult patients

1092 Meckel's diverticulum most commonly presents as: A Gastrointestinal bleeding. B Obstruction. C Diverticulitis. D Intermittent abdominal pain.

A Gastrointestinal bleeding.

1053 All of the following are contraindications for highly selective vagotomy except: A Intractable duodenal ulcer disease. B Peptic ulcer disease causing gastric outlet obstruction. C Fundic peptic ulceration. D Cigarette chain smoking.

A Intractable duodenal ulcer disease.

1064 Which of the following statements about the surgical treatment of gastric cancer is false? A Patients with tumors of the middle and proximal thirds should undergo total gastrectomy. B Adenocarcinoma of the cardia-gastroesophageal junction may require reconstruction in the abdomen, chest, or neck. C Palliative resection yields better results than palliative bypass. D Japanese patients who undergo gastric resection are, on average, 10 years younger and much leaner than their Western counterparts.

A Patients with tumors of the middle and proximal thirds should undergo total gastrectomy.

1088 Which of the following statements is correct with regard to gastric bypass for obesity? A Rapid weight loss following successful gastric bypass for obesity is associated with an increased risk of developing cholelithiasis B Marginal ulcer develops in 25% of gastric bypass patients C Vitamin B12 deficiency is a potential complication of gastric bypass due to gastric mucosal atrophy D Anastamotic leak after gastric bypass is often heralded by bradycardia

A Rapid weight loss following successful gastric bypass for obesity is associated with an increased risk of developing cholelithiasis

1003 A 28-year-old woman with a history of an appendectomy presents with a nontender palpable mass in the right lower quadrant abdominal incision. The following statement(s) is/are true concerning the diagnosis and management of this patient. A The best diagnostic test involves imaging of the abdominal wall by either CT or MRI B Resection of the mass with a 2 cm margin is usually adequate C Low dose radiation is a suitable alternative to surgery for primary treatment D Re-resection for recurrence will likely have a higher rate of recurrence than for primary resection

A The best diagnostic test involves imaging of the abdominal wall by either CT or MRI

1018 A 28-year-old woman with a history of an appendectomy presents with a nontender palpable mass in the right lower quadrant abdominal incision. The following statement(s) is/are true concerning the diagnosis and management of this patient. A The best diagnostic test involves imaging of the abdominal wall by either CT or MRI B Resection of the mass with a 2 cm margin is usually adequate C Low dose radiation is a suitable alternative to surgery for primary treatment D Re-resection for recurrence will likely have a higher rate of recurrence than for primary resection

A The best diagnostic test involves imaging of the abdominal wall by either CT or MRI

1016 The following statements about the repair of inguinal hernias are true except: A The conjoined tendon is sutured to Cooper's ligament in the Bassini hernia repair. B The McVay repair is a suitable option for the repair of femoral hernias. C The Shouldice repair involves a multilayer, imbricated repair of the floor of the inguinal canal. D The Lichtenstein repair is accomplished by prosthetic mesh repair of the inguinal canal floor in a tension free manner.

A The conjoined tendon is sutured to Cooper's ligament in the Bassini hernia repair.

1020 The following statement(s) is/are true concerning umbilical hernias in adults. A Most umbilical hernias in adults are the result of a congenital defect carried into adulthood B A paraumbilical hernia typically occurs in multiparous females C The presence of ascites is a contraindication to elective umbilical hernia repair. D Incarceration is uncommon with umbilical hernias

B A paraumbilical hernia typically occurs in multiparous females

1017 Which of the following statement(s) is/are true concerning the diagnosis and management of epigastric hernias? A A large peritoneal sac containing abdominal viscera is common B At the time of surgical repair, a careful search for other defects should be performed C Recurrent epigastric hernias after simple closure is uncommon D Patients with symptoms of a painful midline abdominal mass frequently will contain incarcerated small bowel

B At the time of surgical repair, a careful search for other defects should be performed

1045 The presence of a nonmalignant mid- or upper esophageal stricture always indicates the presence of: A Alkaline reflux esophagitis. B Barrett's esophagus. C Idiopathic reflux disease. D Mediastinal fibrosis.

B Barrett's esophagus.

1086 A 52-year-old woman is hospitalized with acute upper gastrointestinal hemorrhage. Endoscopic examination reveal a 2.5 cm ulcer in the area of the incisura angularis. The remainder of the endoscopic examination is normal. Continued bleeding requires operative therapy. Optimal therapy consists of which of the following? A Gastrotomy with oversewing of the bleeding site B Distal gastrectomy including the area of ulceration C Proximal gastric vagotomy and oversewing of the bleeding ulcer D Truncal vagotomy, pyloroplasty, and oversewing of the bleeding ulcer

B Distal gastrectomy including the area of ulceration

1090 A 55-year-old male is evaluated because of symptoms of epigastric pain and anorexia. Physical examination is normal except for guaiac positivity of stool. Upper endoscopic examination reveals a 1.5 cm ulcer along the lesser curvature of the stomach proximal to the incisura angularis. Optimal management consists of which of the following: A Sucralfate 1 gm q.i.d. for 8 weeks B Endoscopic biopsy of the ulcer rim C Endoscopic cautery of the ulcer base D Endoscopic biopsy of the ulcer base

B Endoscopic biopsy of the ulcer rim

1032 Which of the following statements about the lower esophageal sphincter (LES) mechanism, or high pressure zone (HPZ), is true? A The LES is a circular smooth muscle ring that is 3 to 5 cm. long. B In assessing esophageal manometric data, mean HPZ pressure less than 6 mm. Hg or overall length less than 2 cm. is more likely to be associated with incompetence of the LES and gastroesophageal reflux. C Esophageal manometry and the acid perfusion (Bernstein) test reliably identify the patient with an incompetent LES mechanism. D Distal HPZ relaxation occurs within 5 to 8 seconds of initiating a swallow.

B In assessing esophageal manometric data, mean HPZ pressure less than 6 mm. Hg or overall length less than 2 cm. is more likely to be associated with incompetence of the LES and gastroesophageal reflux.

1062 Which of the following statements concerning the pathology of gastric cancer is true? A Distal gastric cancers are becoming more common. B Intestinal-type gastric tumors resemble colon carcinomas and have a better prognosis than diffuse type. C Early gastric cancers are confined to the mucosa and are lymph node negative. D Broders' histologic grading system correlates well with survival: patients with grade IV tumors have 5-year survival rates around 65%.

B Intestinal-type gastric tumors resemble colon carcinomas and have a better prognosis than diffuse type.

1080 A 42-year-old man with a recently diagnosed duodenal ulcer develops melena and nearsyncope. After fluid resuscitation, upper gastrointestinal endoscopy is performed. During the examination, a 1 cm ulcer is noted in the proximal duodenum. A fresh clot is observed within the ulcer and blood is noted to be oozing around the clot. Optimal therapy would consist of which of the following? A Angiographic embolization of the gastroduodenal artery B Irrigation of the clot followed by endoscopic application of a heat probe C Transfusion and intravenous cimetidine D Angiographic infusion of vasopressin into the gastroduodenal artery

B Irrigation of the clot followed by endoscopic application of a heat probe

1078 Development of duodenal ulceration is dependent upon gastric acid secretion. Which of the following statements correctly characterizes acid secretion in duodenal ulcer patients? A Groups of duodenal ulcer patients demonstrate decreased basal acid secretion B Maximal acid output to histamine averages 40 mEq/h in duodenal ulcer patients, twice that of normal C Tissue gastrin levels, on average, are twice normal in patients with active ulceration D Exogenously administered somatostatin is ineffective in suppressing acid secretion in patients with active ulceration

B Maximal acid output to histamine averages 40 mEq/h in duodenal ulcer patients, twice that of normal

1061 All of the following benign conditions are associated with increased rates of gastric cancer except: A Pernicious anemia. B Multiple endocrine neoplasia type I (MEN 1). C Adenomatous polyps. D Chronic atrophic gastritis.

B Multiple endocrine neoplasia type I (MEN 1).

1095 In addition to its absorptive and digestive roles, the small bowel also plays a significant role in the body's immune system. Gut-associated lymphoid tissue (GALT) represents a major division of the immune system. Which of the following statement(s) is/are true concerning the immunologic functions of the small intestine? A The B lymphocytes of the small intestine do not produce immunoglobulin A (IgA) B Peyer's patches, an example of an aggregated cellular portion of the gut-associated lymphoid system tissue, are large collections of lymphoid follicles found on the antimesenteric border of the ileum C The major immunoglobulin of the intestinal immune system is IgM D IgA produced by the intestinal immune system produces the classic Fc-mediated inflammatory reactions to antigen stimulus

B Peyer's patches, an example of an aggregated cellular portion of the gut-associated lymphoid system tissue, are large collections of lymphoid follicles found on the antimesenteric border of the ileum

1079 Which of the following statement(s) is/are correct with regard to pyloric obstruction secondary to peptic ulceration? A Pyloric obstruction is suggested by hypochloremic hyponatremic alkalosis B Pyloric obstruction is suggested by hypochloremic hypokalemic alkalosis C Approximately 80% of patients with benign gastric outlet obstruction obtain permanent relief of symptoms by endoscopically-directed balloon dilatation D The lifetime risk of pyloric obstruction in peptic ulcer patients is 40%

B Pyloric obstruction is suggested by hypochloremic hypokalemic alkalosis

1075 Important stimulants of gastrin release from endocrine cells in the antrum include: A Acidification of the antral lumen B Small peptide fragments and amino acids from luminal proteolysis C Locally released somatostatin D Dietary fats

B Small peptide fragments and amino acids from luminal proteolysis

1099 Which of the following statement(s) is/are true concerning postoperative ileus? A The use of intravenous patient-controlled analgesia has no effect on return of small bowel motor activity B The presence of peritonitis at the time of the original operation delays the return of normal bowel function C The routine use of metoclopramide will hasten the return of small intestinal motor activity D Contrast radiographic studies have no role in distinguishing early postoperative bowel obstruction from normal ileus

B The presence of peritonitis at the time of the original operation delays the return of normal bowel function

1081 A 50-year-old patient has undergone truncal vagotomy and antrectomy with Billroth II reconstruction two years ago. The patient now complains of recurrent postprandial pain, nausea, and vomiting. Endoscopic examination reveals bile in the stomach; endoscopic biopsies demonstrate histologic evidence of moderately severe gastritis. No other endoscopic abnormalities are noted. Appropriate therapy could include: A Octreotide administration B Total gastrectomy C Conversion of Billroth II gastrojejunostomy to Billroth I gastroduodenostomy D Conversion of Billroth II gastrojejunostomy to Roux-en-Y gastrojejunostomy

B Total gastrectomy

1025 A patient is seen in the emergency room with reproducible right lower quadrant tenderness. The approximate incidence of finding a normal appendix on right lower quadrant exploration in similar nonselected patients is which of the following: A 5% B 10% C 20% D 40%

C 20%

1058 The sine qua non of the histologic diagnosis of a gastric pseudolymphoma is: A Extragastric extension of the gastric lesion. B Nodal involvement beyond the immediate stomach. C A germinal center in the gastric lesion. D Extension into esophagus and duodenum.

C A germinal center in the gastric lesion.

1074 Benign tumors of the esophagus are rare constituting less than 1% of esophageal neoplasms. Which of the following statement(s) is/are true concerning benign esophageal neoplasms? A Most esophageal polyps are located just above the gastroesophageal junction B Malignant degeneration of leiomyomas of the esophagus is a frequent occurrence C An asymptomatic leiomyoma can be safely observed and followed with periodic barium esophograms and endoscopic ultrasonography D Most leiomyomas of the esophagus require esophagectomy

C An asymptomatic leiomyoma can be safely observed and followed with periodic barium esophograms and endoscopic ultrasonography

1065 Which of the following measures of obesity correlates best with mortality? A The 1983 Metropolitan Life Insurance Company tables for ideal body weight. B Hydroimmersion measurements of body fat composition. C Body mass index (BMI). D Skinfold thickness.

C Body mass index (BMI).

1100 The following statement(s) is/are true concerning the surgical management of Crohn's disease. A Strictureplasty, although offering short-term benefits, is associated with a higher rate of recurrence when compared to resection B Frozen section examination of the margin of resection is essential to prevent both recurrent disease and early anastomotic complications C Conservative margins of resection are appropriate, resecting only grossly involved segments of bowel D Patients with Crohn's disease confined to the colon may be treated with total proctocolectomy with construction of an ileal-anal pouch anastomosis

C Conservative margins of resection are appropriate, resecting only grossly involved segments of bowel

1068 Which of the following statement(s) is/are true concerning the diagnosis and management of the patient whose barium esophogram is shown in Figure 18-29? A The condition is due to neuronal generation of the myenteric plexus in the lower esophageal sphincter B The patient will report symptoms of vomiting of sour or bitter material C Despite the impressive radiologic picture, passage of the endoscope through the area of narrowing will likely be possible D Manometry and 24 hour pH monitoring should be performed for confirmation of the diagnosis

C Despite the impressive radiologic picture, passage of the endoscope through the area of narrowing will likely be possible

1047 First-line therapy for routine peptic duodenal ulcer disease includes: A Vagotomy and antrectomy. B Upper endoscopy and biopsy to rule out tumor. C Evaluation for Helicobacter pylori. D Serum gastrin determination.

C Evaluation for Helicobacter pylori.

1054 All of the following statements about gastrin-releasing peptide (GRP) are true except: A In species other than man and dog GRP is commonly referred to as bombesin. B GRP serves as a neurotransmitter. C GRP inhibits pancreatic secretion when given intravenously. D GRP stimulates gastric acid secretion when given intravenously.

C GRP inhibits pancreatic secretion when given intravenously.

1083 With regard to benign gastric ulceration, the most common location of disease is which of the following? A Along the greater curvature B Immediately distal to the esophagogastric junction along the lesser curvature C In the area of the incisura angularis along the lesser curvature D Within the gastric antrum

C In the area of the incisura angularis along the lesser curvature

1013 The most common hernia in females is: A Femoral hernia. B Direct inguinal hernia. C Indirect inguinal hernia. D Obturator hernia.

C Indirect inguinal hernia.

1008 The diagnosis of acute appendicitis is most difficult to establish in: A Persons aged 60 and older. B Women aged 18 to 35. C Infants younger than 1 year. D Pregnant women.

C Infants younger than 1 year.

1076 Which of the following statements regarding intrinsic factor is/are correct? A Intrinsic factor is produced in chief cells located in the gastric fundus B Total gastrectomy is followed by folate deficiency due to vitamin malabsorption secondary to intrinsic factor deficiency C Intrinsic factor secretion, like that of acid, is stimulated by gastrin, histamine, and acetylcholine D Intrinsic factor deficiency accompanies H pylori-caused antral gastritis

C Intrinsic factor secretion, like that of acid, is stimulated by gastrin, histamine, and acetylcholine

1050 The presentation of Zollinger-Ellison syndrome includes all of the following except: A Hyperparathyroidism in patients with multiple endocrine neoplasia type 1 (MEN 1) syndrome. B Diarrhea. C Migratory rash. D Jejunal ulcers.

C Migratory rash.

1026 Of adult patients presenting to the emergency room for evaluation of acute abdominal pain, which one of the following answers includes the most common diagnoses? A Urologic problems, cholelithiasis, pelvic inflammatory disease B Mittelschmerz, appendicitis, ureterolithiasis C Nonspecific abdominal pain, appendicitis, intestinal obstruction D Appendicitis, pelvic inflammatory disease, perforated ulcer

C Nonspecific abdominal pain, appendicitis, intestinal obstruction

1007 Which of the following most often initiates the development of acute appendicitis? A A viral infection. B Acute gastroenteritis. C Obstruction of the appendiceal lumen. D A primary clostridial infection.

C Obstruction of the appendiceal lumen.

1038 Which of the following statements regarding the pathology of esophageal carcinoma is/are correct? A Worldwide, adenocarcinoma is the most common esophageal malignancy. B Squamous cell carcinoma is most common in the distal esophagus, whereas adenocarcinoma predominates in the middle third. C Patients with Barrett's metaplasia are 40 times more likely than the general population to develop adenocarcinoma. D Metastases from esophageal carcinoma are characteristically localized to regional mediastinal lymph nodes adjacent to the tumor.

C Patients with Barrett's metaplasia are 40 times more likely than the general population to develop adenocarcinoma.

1005 The following statement about peritonitis are all true except: A Peritonitis is defined as inflammation of the peritoneum. B Most surgical peritonitis is secondary to bacterial contamination. C Primary peritonitis has no documented source of contamination and is more common in adults than in children and in men than in women. D Tuberculous peritonitis can present with or without ascites.

C Primary peritonitis has no documented source of contamination and is more common in adults than in children and in men than in women.

1040 The best management for a 48-hour-old distal esophageal perforation is: A Antibiotics and drainage. B Division of the esophagus and exclusion of the perforation. C Primary repair with buttressing. D Resection with cervical esophagostomy, gastrostomy, and jejunostomy.

C Primary repair with buttressing.

1014 Which of the following statements regarding unusual hernias is incorrect? A An obturator hernia may produce nerve compression diagnosed by a positive Howship- Romberg sign. B Grynfeltt's hernia appears through the superior lumbar triangle, whereas Petit's hernia occurs through the inferior lumbar triangle. C Sciatic hernias usually present with a painful groin mass below the inguinal ligament. D Littre's hernia is defined by a Meckel's diverticulum presenting as the sole component of the hernia sac.

C Sciatic hernias usually present with a painful groin mass below the inguinal ligament.

1087 A 25-year-old man is involved in an automobile accident with resultant injuries including bilateral closed femur fractures, left pulmonary contusion, and closed head injury. On post-injury day 4, significant upper gastrointestinal hemorrhage begins. Endoscopic examination reveals an area of confluent ulceration with bleeding in the gastric fundus. Endoscopic hemostasis fails. Appropriate immediate management includes: A Lavage of gastric contents with iced saline B Urgent total gastrectomy C Selective arterial infusion of vasopressin via the left gastric artery D Insertion of Sangstaken-Blakemore balloon

C Selective arterial infusion of vasopressin via the left gastric artery

1077 A 24-year-old woman develops epigastric pain and has a diagnosis of duodenal ulcer confirmed by esophagogastroduodenoscopy. The patient is in the third month of a pregnancy. The most appropriate treatment would be: A Proximal gastric vagotomy B Misoprostol 400 mg b.i.d. C Sucralfate 1 gm q.i.d. D Cimetidine 400 mg b.i.d.

C Sucralfate 1 gm q.i.d.

1021 The most helpful diagnostic radiographic procedure in small bowel obstruction is: A CT of the abdomen. B Contrast study of the intestine. C Supine and erect x-rays of the abdomen. D Ultrasonography of the abdomen.

C Supine and erect x-rays of the abdomen.

1031 Which of the following statements about esophageal anatomy is correct? A The esophagus has a poor blood supply, which is segmental in distribution and accounts for the high incidence of anastomotic leakage. B The esophageal serosa consists of a thin layer of fibroareolar tissue. C The esophagus has two distinct muscle layers, an outer, longitudinal one and an inner, circular one, which are striated in the upper third and smooth in the distal two thirds. D Injury to the recurrent laryngeal nerve results in vocal cord dysfunction but does not affect swallowing.

C The esophagus has two distinct muscle layers, an outer, longitudinal one and an inner, circular one, which are striated in the upper third and smooth in the distal two thirds.

1091 All of the following statements about the embryology of Meckel's diverticulum are true except: A Meckel's diverticulum usually arises from the ileum within 90 cm. of the ileocecal valve. B Meckel's diverticulum results from the failure of the vitelline duct to obliterate. C The incidence of Meckel's diverticulum in the general population is 5%. D Meckel's diverticulum is a true diverticulum possessing all layers of the intestinal wall.

C The incidence of Meckel's diverticulum in the general population is 5%.

1039 Which of the following statements about the surgical treatment of esophageal carcinoma is/are correct? A The finding of severe dysphagia in association with Barrett's mucosa is an indication for an antireflux operation to prevent subsequent development of carcinoma. B Long-term survival is improved by radical en bloc resection of the esophagus with its contained tumor, adjacent mediastinal tissues, and regional lymph nodes. C The morbidity and mortality rates for cervical esophagogastric anastomotic leak are substantially less than those associated with intrathoracic esophagogastric anastomotic leak. D The leading complications of transthoracic esophagectomy and intrathoracic esophagogastric anastomosis are bleeding and wound infection.

C The morbidity and mortality rates for cervical esophagogastric anastomotic leak are substantially less than those associated with intrathoracic esophagogastric anastomotic leak.

1004 A 77-year-old multiparous female presents with a bowel obstruction. She has no previous abdominal operations and no abdominal wall hernias can be detected. In addition to her abdominal symptoms, she reports pain in her right medial thigh. The following statement(s) is/are true concerning her diagnosis and management. A Expectant management with nasogastric suction and IV fluid replacement is indicated B A right groin approach is indicated for exploration and repair of the presumed hernia C The use of a polypropylene mesh will likely be necessary for repair D A correct diagnosis can usually be made by visualizing an external mass in the upper, medial thigh

C The use of a polypropylene mesh will likely be necessary for repair

1019 A 77-year-old multiparous female presents with a bowel obstruction. She has no previous abdominal operations and no abdominal wall hernias can be detected. In addition to her abdominal symptoms, she reports pain in her right medial thigh. The following statement(s) is/are true concerning her diagnosis and management. A Expectant management with nasogastric suction and IV fluid replacement is indicated B A right groin approach is indicated for exploration and repair of the presumed hernia C The use of a polypropylene mesh will likely be necessary for repair D A correct diagnosis can usually be made by visualizing an external mass in the upper, medial thigh

C The use of a polypropylene mesh will likely be necessary for repair

1084 A 35-year-old smoker is involved in a house fire and receives a 45% total surface area burn. One half of the burned surface appears to be third degree. On the third post-burn day, the patient is noted to have bloody drainage from a nasogastric tube and a decrease of 5% in his hematocrit. Appropriate management should include which of the following? A Urgent upper gastrointestinal contrast study to delineate site of bleeding B Immediate selective arteriography via the left gastric artery to diagnose and treat presumed stress ulceration C Urgent esophagogastroduodenoscopy to diagnosis the cause of bleeding D Urgent intravenous infusion of vasopressin at 0.2-0.4 IU/min

C Urgent esophagogastroduodenoscopy to diagnosis the cause of bleeding

1044 When assessing gastroesophageal reflux disease by manometry each of the following statements is correct except one. Identify the incorrect one. A Absent or extremely low LES pressures have predictive value in identifying more severe reflux. B Peristaltic dysfunction increases with increasing severity of esophagitis. C With established reflux disease the UES is hypertensive. D Esophageal functional changes are worst in patients with a circumferential columnar lined esophagus.

C With established reflux disease the UES is hypertensive.

1009 The best type of x-ray to locate free abdominal air is: A A posteroanterior view of the chest. B A flat and upright view of the abdomen. C Computed tomograph (CT) of the abdomen. D A lateral decubitus x-ray, right side up.

D A lateral decubitus x-ray, right side up.

1098 A 75-year-old woman is hospitalized after a fall in which she has experienced a hip fracture. Several days after her surgical procedure, progressive painless abdominal distension is noted. Which of the following statement(s) is/are true concerning her diagnosis and management? A Colon distension with a cecal diameter in excess of 12 cm should indicate the need for urgent operation B Endoscopic decompression may be attempted but seldom is successful C After successful colonoscopic decompression, recurrence is unlikely D A rectal tube as the primary treatment is generally not successful

D A rectal tube as the primary treatment is generally not successful

1093 Which of the following physical factors of irradiation is/are related to the potential for radiation injury? A The dimension of the radiation portals. B The number of portals. C The number of fractions. D All of the above.

D All of the above.

1067 A 34-year-old morbidly obese diabetic woman underwent a gastric bypass about 12 hours ago. The operation was technically difficult but finally went well. You are called because she now has a temperature of 99.2? F, pulse of 134, and some pain in her incision and her back. She looks well; the incision is clean; and her examination is otherwise negative. A bolus of 500 ml. of dextrose/lactated Ringer's did not change her vital signs, except that her pulse rose to 140 without an increase in urine output. Your next step should be: A Another bolus of crystalloids. B Posterioanterior and lateral chest films. C Obtain white cell count, differential count, and electrolyte values. D Call the operating room and warn them that you need to re-explore for a leak.

D Call the operating room and warn them that you need to re-explore for a leak.

1042 The following statements about the influence of diet and lifestyle on lower esophageal sphincter (LES) function are true except one. Identify the incorrect statement. A A high-protein diet increases LES pressure. B A fat meal results in sustained decrease in LES pressure. C Chocolate ingestion causes a decrease in LES pressure. D Cigarette smoking produces no significant changes in LES pressures.

D Cigarette smoking produces no significant changes in LES pressures.

1060 Numerous epidemiologic associations have been made between (1) environmental and dietary factors and (2) the incidence of gastric cancer, including all except: A Dietary nitrites. B Dietary salt. C Helicobacter pylori infection. D Dietary ascorbic acid.

D Dietary ascorbic acid.

1010 Meckel's diverticulitis most often occurs in the: A Proximal jejunum. B Distal jejunum. C Proximal ileum. D Distal ileum.

D Distal ileum.

1024 Meckel's diverticulitis most often occurs in the: A Proximal jejunum. B Distal jejunum. C Proximal ileum. D Distal ileum.

D Distal ileum.

1002 Which of the following statements about the causes of inguinal hernia is correct? A Excessive hydroxyproline has been demonstrated in the aponeuroses of hernia patients. B Obliteration of the processus vaginalis is a contributing factor for the development of an indirect inguinal hernia. C Physical activity and athletics have been shown to have a protective effect toward the development of inguinal hernias. D Elevated levels of circulating serum elastalytic activity have been demonstrated in patients with direct herniation who smoke.

D Elevated levels of circulating serum elastalytic activity have been demonstrated in patients with direct herniation who smoke.

1037 Which of the following statements about the diagnosis and treatment of esophageal leiomyomas is/are correct? A The majority are diagnosed after they cause dysphagia and chest pain. B Biopsy is indicated at the time of esophagoscopy, to rule out carcinoma. C Full-thickness elliptical excision of the esophageal wall is the preferred surgical approach. D Endoscopic ultrasonography is a reliable means of following leiomyomas conservatively.

D Endoscopic ultrasonography is a reliable means of following leiomyomas conservatively.

1085 A 45-year-old male presents with symptoms of epigastric pain, worsened with ingestion of food. Physical examination is normal. Upper abdominal ultrasonography is unremarkable. Contrast radiography reveals a 2 cm ulcer in the gastric fundus along the lesser curvature. Therapy with omeprazole 20 mg per day is begun but symptoms persist 3 weeks later. Appropriate management includes which of the following? A Increase in omeprazole dose to 40 mg per day B Addition of sucralfate 1 gm every 8 hours C Addition of cimetidine 200 mg b.i.d. D Esophagogastroduodenoscopy with biopsy of ulceration

D Esophagogastroduodenoscopy with biopsy of ulceration

1066 Which of the following is/are contraindications to gastric bypass surgery? A Diabetes mellitus. B Hypertension. C Pickwickian syndrome. D Failure to agree to long-term follow-up.

D Failure to agree to long-term follow-up.

1041 A 50-year-old patient develops sudden left lower chest pain and epigastric pain after vomiting. The patient shows diaphoresis, breath sounds are decreased on the left, and there is abdominal guarding. The most appropriate diagnostic test is: A Aortography. B Esophagoscopy. C Electrocardiogram. D Film of the chest.

D Film of the chest.

1036 Which of the following statements about pathology encountered at esophagoscopy is/are correct? A Reflux esophagitis should be graded as mild, moderate, or severe, to promote consistency among different observers. B An esophageal reflux stricture with a 2-mm. lumen is not dilatable and is best treated with resection. C A newly diagnosed radiographic distal esophageal stricture warrants dilation and antireflux medical therapy. D In patients with Barrett's mucosa, the squamocolumnar epithelial junction occurs 3 cm. or more proximal to the anatomic esophagogastric junction.

D In patients with Barrett's mucosa, the squamocolumnar epithelial junction occurs 3 cm. or more proximal to the anatomic esophagogastric junction.

1023 Acute salpingitis occurs most often: A After menopause. B In patients with unilateral lower abdominal pain. C During the menstrual cycle. D In patients with cervical tenderness and vaginal discharge.

D In patients with cervical tenderness and vaginal discharge.

1001 The following Nyhus classification of hernias is correct except for: A Recurrent direct inguinal hernia—Type IVa. B Indirect inguinal hernia with a normal internal inguinal ring—Type I. C Femoral hernia—Type IIIc. D Indirect inguinal hernia with destruction of the transversalis fascia of Hesselbach's triangle—Type II.

D Indirect inguinal hernia with destruction of the transversalis fascia of Hesselbach's triangle—Type II.

1055 Cholecystokinin (CCK) is believed to function in all of the following processes except: A It physiologically delays gastric emptying. B It appears to have a role in satiety regulation. C It contracts the gallbladder. D It is important in the control of the anal sphincter.

D It is important in the control of the anal sphincter.

1033 Which of the following statements about achalasia is/are correct? A In most cases in North America the cause is a parasitic infestation by Trypanosoma cruzi. B Chest pain and regurgitation are the usual symptoms. C Distal-third esophageal adenocarcinomas may occur in as many as 20% of patients within 10 years of diagnosis. D Manometry demonstrates failure of LES relaxation on swallowing and absent or weak simultaneous contractions in the esophageal body after swallowing.

D Manometry demonstrates failure of LES relaxation on swallowing and absent or weak simultaneous contractions in the esophageal body after swallowing.

1069 Which of the following statement(s) is/are true concerning the blood supply and lymphatic drainage of the esophagus? A The thoracic esophagus receives no direct branches from the aorta therefore allowing the technique of transhiatal (blunt) esophagectomy B Bleeding esophageal varices are most prominent in the mid-esophagus C Lymphatic drainage of the lower third of the esophagus goes entirely to the abdominal lymphatic system D Nodal involvement in esophageal cancer is quite common even if the tumor is limited to the level of the submucosa

D Nodal involvement in esophageal cancer is quite common even if the tumor is limited to the level of the submucosa

1027 Prospective studies have shown incidental appendectomy to be advantageous in which of the following patient groups? A Children undergoing staging laparotomy for malignancy who are then to enter chemotherapy B HIV infected patients C Patients over 50 years of age D None of the above

D None of the above

1082 A 50-year-old male with a 2 year history of duodenal ulceration develops sudden, severe epigastric pain 4 hours prior to evaluation. Physical examination reveals T 101° F, pulse 80, BP 125/90, diminished bowel sounds, and abdominal muscular rigidity. An upright chest x-ray reveals pneumoperitoneum. At laparotomy, an anterior perforation in the first portion of the duodenum is observed. Optimal treatment would include: A Omental patch of the perforation followed by truncal vagotomy and antrectomy after 8 weeks B Omental patch of the perforation followed by truncal vagotomy and pyloroplasty after 8 weeks C Omental patch of the perforation followed by chronic cimetidine administration D Omental patch of the perforation plus proximal gastric vagotomy

D Omental patch of the perforation plus proximal gastric vagotomy

1048 Appropriate management of severe vomiting associated with gastric outlet obstruction from peptic ulcer disease includes all of the following except: A Nasogastric suction. B Intravenous hydration. C Nutritional assessment; upper endoscopy to rule out malignancy. D Oral antacid therapy.

D Oral antacid therapy.

1043 When a stricture is present in association with gastroesophageal reflux, each of the following is an acceptable repair for reflux control except one. Identify the poorest repair. A Intrathoracic total fundoplication. B Lengthening gastroplasty with total fundoplication. C Total fundoplication. D Partial fundoplication.

D Partial fundoplication.

1028 Visceral pain is typically: A Well localized B Sharp C Mediated via spinal nerves D Perceived to be in the midline

D Perceived to be in the midline

1072 Which of the following statement(s) is/are correct concerning the options for resection of esophageal carcinoma? A The development of reflux esophagitis seldom occurs following intrathoracic resection due to the limited life expectancy of these patients B Transhiatal esophagectomy, although conceptually sound, is not technically possible in most patients with esophageal carcinoma C Transhiatal resection, although less morbid, has unfavorable survival statistics compared to transthoracic resection D Radical transthoracic esophagectomy with en bloc dissection of continuous lymph node bearing tissues has not been shown to improve survival over transhiatal esophagectomy

D Radical transthoracic esophagectomy with en bloc dissection of continuous lymph node bearing tissues has not been shown to improve survival over transhiatal esophagectomy

1071 Which of the following statement(s) is/are true concerning infectious esophagitis? A Candida albicans is not normally found in the mouth but results from the overgrowth of this fungus in patients on broad spectrum antibiotics B Candida esophagitis is usually self-limited and is seldom associated with chronic problems C Systemic therapy is seldom indicated D Small ulcers on barium esophogram in a transplant patient complaining of dysphagia and odynophagia are likely due to herpes simplex viral infection

D Small ulcers on barium esophogram in a transplant patient complaining of dysphagia and odynophagia are likely due to herpes simplex viral infection

1030 Which of the following statements about the anatomic course of the esophagus is correct? A The cervical esophagus passes behind and to the right of the trachea. B The thoracic esophagus enters the posterior mediastinum anterior to the aortic arch. C The thoracic esophagus passes behind the right mainstem bronchus and the pericardium. D The esophagus deviates anteriorly and to the left as it enters the abdomen.

D The esophagus deviates anteriorly and to the left as it enters the abdomen.

1034 Which of the following statements about epiphrenic diverticula of the esophagus is/are correct? A They are traction diverticula that arise close to the tracheobronchial tree. B They characteristically arise proximal to an esophageal reflux stricture. C The degree of dysphagia correlates with the size of the pouch. D The operation of choice is a stapled diverticulectomy, long esophagomyotomy, and partial fundoplication.

D The operation of choice is a stapled diverticulectomy, long esophagomyotomy, and partial fundoplication.

1097 Which of the following statement(s) is/are true concerning laboratory tests which might be obtained in the patient discussed above? A The presence of a white blood cell count > 15,000 would be highly suggestive of a closed loop obstruction B Metabolic acidosis mandates emergency exploration C An elevation of BUN would suggest underlying renal dysfunction D There is no rapidly available test to distinguish tissue necrosis from simple bowel obstruction

D There is no rapidly available test to distinguish tissue necrosis from simple bowel obstruction

1015 Staples may safely be placed during laparoscopic hernia repair in each of the following structures except: A Cooper's ligament. B Tissues superior to the lateral iliopubic tract. C The transversus abdominis aponeurotic arch. D Tissues inferior to the lateral iliopubic tract.

D Tissues inferior to the lateral iliopubic tract.

1059 All of the following statements about surgical management of gastric lymphomas are true except: A Stage I gastric lymphomas (small lesions confined to the stomach wall) can be cured completely with surgical therapy alone. B Extensive gastric lymphomas that initially are treated with radiation and/or chemotherapy occasionally perforate during treatment and require secondary resection. C Patients explored with a presumptive diagnosis of gastric lymphoma should undergo an attempt at curative resection when this is safe and feasible. D Without a preoperative diagnosis resection for gastric mass should not be attempted unless lymphoma can be excluded.

D Without a preoperative diagnosis resection for gastric mass should not be attempted unless lymphoma can be excluded.

1057 All of the following contribute to peptic ulcer disease except: A Cigarette smoking. B Helicobacter pylori. C Gastrinoma. D E. Spicy foods.

E