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:
5%
10%
20%
40%
Answer
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?
Urologic problems, cholelithiasis, pelvic inflammatory disease
Mittelschmerz, appendicitis, ureterolithiasis
Nonspecific abdominal pain, appendicitis, intestinal obstruction
Appendicitis, pelvic inflammatory disease, perforated ulcer
Answer
Nonsurgical causes of acute abdominal pain may include which of the following?
Hyperthyrodism
Adrenal insufficiency
Pneumonia
Diabetic ketoacidosis
Answer
Which of the following cause visceral pain from the abdominal organs?
Stretching and contraction
Traction, compression, torsion
Cutting
Certain chemicals
Answer
Factors which may influence the clinical presentation of intraabdominal pathology include which of the following?
Pregnancy
Oral anticoagulants
Age
HIV infection
Answer
Prospective studies have shown incidental appendectomy to be advantageous in which of the following patient groups?
Children undergoing staging laparotomy for malignancy who are then to enter chemotherapy
HIV infected patients
Patients over 50 years of age
Patients with spinal cord injuries
None of the above
Answer
Visceral pain is typically:
Well localized
Sharp
Mediated via spinal nerves
Perceived to be in the midline
Answer
True statements regarding the pathophysiology of acute appendicitis include which of the following:
Fecaliths are responsible for the disease process in approximately 30% of adult patients
Lymphoid hyperplasia is a rare cause of appendicitis in young patients
Clostridium difficile is implicated as a pathogenic organism
Carcinoid tumors account for approximately 5% of all cases of acute appendicitis
Answer
A 26-year old woman in her first trimester of pregnancy presents with a 2-day history of right lower quadrant pain and fever. Physical examination reveals a tender, palpable, right lower quadrant mass. There is no evidence of peritonitis or systemic sepsis. Laboratory evaluation is remarkable for mild leukocytosis, and abdominal ultrasound demonstrates an inflammatory mass but no evidence of abscess. As the surgeon on call, your recommendation would be:
Intravenous hydration, antibiotic prophylaxis, and urgent appendectomy
Intravenous hydration, antibiotics, bowel rest, and interval appendectomy in 4 to 6 weeks
Intravenous hydration, antibiotics, and appendectomy if no improvement in 12 to 24 hours
Intravenous hydration, antibiotics, and interval appendectomy when fever has subsided, leukocyte count has returned to normal, and the patient is pain free
Emergent obstetrical consultation for evaluation and treatment of possible ectopic pregnancy
Answer
True statements regarding appendiceal neoplasms include which of the following?
Carcinoid tumors of the appendix less than 1.5 cm are adequately treated by simple appendectomy
Appendiceal carcinoma is associated with secondary tumors of the GI tract in up to 60% of patients
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
Mucinous cystadenocarcinoma of the appendix is adequately treated by simple appendectomy, even in patients with rupture and mucinous ascites
Up to 50% of patients with appendiceal carcinoma have metastatic disease, with the liver as the most common site of spread
Answer
Which of the following is NOT correct?
Diverticulitis is associated with a low fibre diet leading to increased pressure on the bowel wall.
Crohn’s disease may involve the large and small intestine.
Bowel cancer does not produce pain in the early stages.
Ulcerative colitis is not associated with an increased risk of colon cancer.
Answer
Which of the following is correctly matched?
malabsorption - hepatobiliary disease
malabsorption - pancreatic insufficiency
maldigestion - coeliac disease
malabsorption - Crohn’s disease
Answer
The therapeutic effect of histamine-2 receptor antagonists such as cimetidine
on peptic ulcers is related to the ability of these drugs to:
block histamine receptors on the gastric mucosa
neutralise acid secretions
reduce gastric acid secretion by reducing parasympathetic activity
block the attachment of Helicobacter pylori to the gastric mucosa
Answer
Which of the following is correct in relation to jaundice:
Jaundice will only occur when there is liver damage
An increased rate of red blood cell destruction may lead to jaundice.
Liver damage due to invasion by cancer cells generally does not cause jaundice while alcoholic liver damage does.
Jaundice will only occur when bile flow is disrupted, as is the case with gallstones.
Answer
Peptic ulcers are now most commonly treated by a combination of an antisecretory agent and 2 or more antibiotics because:
ulcerated gastric mucosa is at risk of infection
removal of Helicobacter pylori prevents ulcers re-occurring
bacteria from the large intestine are involved in ulcer formation
excess gastric acid secretion is the main cause of ulcers
Answer
Excessive use of laxatives is often associated with electrolyte imbalances and
dehydration. Which of the following laxatives would be most likely to cause such
problems?
bulk-forming laxatives
contact or stimulant purgatives
lubricants
surfactants
Answer
Which of the following statement(s) is/are true concerning the diagnosis and management of epigastric hernias?
A large peritoneal sac containing abdominal viscera is common
At the time of surgical repair, a careful search for other defects should be performed
Recurrent epigastric hernias after simple closure is uncommon
Patients with symptoms of a painful midline abdominal mass frequently will contain incarcerated small bowel
Answer
Which of the following congenital abnormalities are correctly defined?
A. Omphalocele represents a defect in the abdominal wall lateral to the umbilical cord.
B. The herniated viscera associated with omphaloceles are usually covered with a membranous sac.
C. An umbilical polyp is a small excrescence of omphalomesenteric duct mucosa that is retained in the umbilicus.
D. Meckel's diverticulum results when the intestinal end of the omphalomesenteric duct persists and represents a true diverticulum.
Which of the following statements concerning the abdominal wall layers are correct?
A. Scarpa's fascia affords little strength in wound closure.
B. The internal abdominal oblique muscles have fibers that continue into the scrotum as cremasteric muscles.
C. The transversalis fascia is the most important layer of the abdominal wall in preventing hernias.
D. The lymphatics of the abdominal wall drain into the ipsilateral axillary lymph nodes above the umbilicus and into the ipsilateral superficial inguinal lymph nodes below the umbilicus.
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.
E. The laparoscopic transabdominal preperitoneal (TAPP) and totally extraperitoneal approach (TEPA) repairs are based on the preperitoneal repairs of Cheattle, Henry, Nyhus, and Stoppa.
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.
E. The majority of inguinal hernias are acquired.
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. Direct inguinal hernia—Type IIIa.
E. Indirect inguinal hernia with destruction of the transversalis fascia of Hesselbach's triangle—Type II.
Staples may safely be placed during laparoscopic hernia repair in each of the following structures except:
A. Cooper's ligament.
B. Tissues superior to the lateral iliopubic tract.
C. The transversus abdominis aponeurotic arch.
D. Tissues inferior to the lateral iliopubic tract.
E. The iliopubic tract at its insertion onto Cooper's ligament.
Which of the following statements regarding unusual hernias is incorrect?
A. An obturator hernia may produce nerve compression diagnosed by a positive Howship-Romberg sign.
B. Grynfeltt's hernia appears through the superior lumbar triangle, whereas Petit's hernia occurs through the inferior lumbar triangle.
C. Sciatic hernias usually present with a painful groin mass below the inguinal ligament.
D. Littre's hernia is defined by a Meckel's diverticulum presenting as the sole component of the hernia sac.
E. Richter's hernia involves the antimesenteric surface of the intestine within the hernia sac and may present with partial intestinal obstruction.
Answer
The most common hernia in females is:
A. Femoral hernia.
B. Direct inguinal hernia.
C. Indirect inguinal hernia.
D. Obturator hernia.
E. Umbilical hernia.
The following statement(s) is/are true concerning the indications for treatment of an inguinal hernia.
