Hepatobiliary And Pancreatic Surgery (100q).1

100 Questions | Total Attempts: 247

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Surgery Quizzes & Trivia

Questions and Answers
  • 1. 
    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

  • 2. 
    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

  • 3. 
    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.

  • 4. 
    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. 

      Transplantation is usually successful if the lesion seems confined to the liver

    • E. 

      None of the above is true.

  • 5. 
    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

  • 6. 
    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

  • 7. 
    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.

  • 8. 
    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

    • E. 

      End-to-side portacaval shunt

  • 9. 
    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

  • 10. 
    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.

  • 11. 
    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

  • 12. 
    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

  • 13. 
    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

    • D. 

      The 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.

  • 14. 
    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.

  • 15. 
    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

  • 16. 
    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.

    • E. 

      Ultrasound studies may be of help in identifying a gallstone as the obstructing agent

  • 17. 
    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. 

      Xanthogranulomatous cholecystitis

    • E. 

      All of the above.

  • 18. 
    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. 

      Combined treatment involving surgical therapy, chemotherapy, and radiation.

    • E. 

      None of the above

  • 19. 
    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

    • E. 

      Prophylactic antibiotics

  • 20. 
    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. 

      Total pancreatectomy usually offers the best outcome in patients with chronic pancreatitis

    • E. 

      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.

  • 21. 
    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).

  • 22. 
    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.

  • 23. 
    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 Vatercorrectly describes pancreas divisum?

    • 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

  • 24. 
    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

  • 25. 
    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

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