Free Bachelor of Medicine & Bachelor of Surgery MCQ Questions and Answers — Questions and Answers
Question 1: An 82-year-old woman presents with post-prandial dull abdomen pain that has been present for almost a year. She dropped 25 pounds in the previous three months as a result of avoiding oral intake due to worsening discomfort symptoms. Her symptoms have not improved after repeated normal upper endoscopies and long-term proton-pump inhibitor medication. She underwent a laparoscopic cholecystectomy six months earlier for several tiny gallstones, which were discovered during a right upper quadrant ultrasound. Four months ago, a colonoscopy revealed a solitary, fully excised pedunculated tubular adenoma. A CT scan was conducted, and it reveals no indication of cancer (see below). The patient is cachectic upon examination. Her abdomen is soft and not painful to the touch, and no lumps are visible. An analysis of the lab results reveals microcytic anemia and an albumin level of 2.4. The most effective course of treatment for this patient would be:
- Total parenteral nutrition
- Selective angiography (Correct answer)
- High-dose megestrol acetate
- Placement of a jejuna feeding tube
Correct answer: Selective angiography
The patient's symptoms of chronic post-prandial abdominal pain, significant weight loss, microcytic anemia, and low albumin, despite normal upper endoscopy and colonoscopy, are highly suggestive of chronic mesenteric ischemia. This condition results from insufficient blood flow to the intestines, typically due to atherosclerotic narrowing of the mesenteric arteries. Selective angiography is the most effective diagnostic tool, as it directly visualizes these arteries and can often be combined with therapeutic revascularization (e.g., stenting) to restore blood flow.
Question 2: A dental operation is being performed on a 45-year-old male who had a prosthetic aortic valve replaced five years prior. Given its better absorption, which preventive antibiotics are advised?
- IV penicillin
- IV Ampicillin
- Oral Vancomycin
- Oral amoxicillin (Correct answer)
Correct answer: Oral amoxicillin
For patients with prosthetic heart valves undergoing dental procedures, antibiotic prophylaxis is recommended to prevent infective endocarditis. Oral amoxicillin is the first-line antibiotic of choice due to its broad spectrum against common oral bacteria and its excellent oral absorption. This ensures adequate antibiotic levels are achieved to protect against bacteremia during the procedure.
Question 3: A 73-year-old man who has a history of atrial fibrillation and hypertension appears with mid-abdominal pain that started out of nowhere. A little while afterwards, I had a black, liquid bowel movement. There are no signs of peritonitis on an abdominal exam. The patient does, however, have leukocytosis. He is brought into the surgery room to be examined. The ascending colon, cecum, and distal small bowel appear dark and purple. What will management do next?
- Warm the bowel and re-evaluate in 24 hours
- Revascularization followed by bowel resection (Correct answer)
- Systemic heparinization
- Bowel resection and anastomosis
Correct answer: Revascularization followed by bowel resection
The patient's acute mid-abdominal pain, black bowel movement, history of atrial fibrillation, leukocytosis, and ischemic bowel findings in the operating room are classic for acute mesenteric ischemia, likely due to an embolic event. The priority in managing ischemic bowel is to restore blood flow as quickly as possible to salvage viable tissue. Therefore, revascularization (e.g., embolectomy or bypass) followed by resection of any irreversibly damaged bowel is the most appropriate course of action.
Question 4: A 59-year-old man who has a slight fullness behind his right knee but no pain or restrictions in knee motion presents. He smokes 30 packs a year, consumes 1 to 2 beers socially each year, and takes hydrochlorothiazide to control his hypertension. He was examined because of a noticeable popliteal pulse, and duplex ultrasonography revealed a 3.4 cm popliteal aneurysm. His left lower extremity pulses are normal, as are the femoral and distal pulses on his right leg. The best course of action for management would be:
- Abdominal ultrasound (Correct answer)
- Open aneurysmal exclusion with bypass
- Surveillance duplex ultrasonography in 1 year
- Endovascular popliteal artery stent placement
Correct answer: Abdominal ultrasound
Popliteal aneurysms have a strong association with abdominal aortic aneurysms (AAAs); a significant percentage of patients with one will also have the other. Therefore, upon diagnosis of a popliteal aneurysm, it is crucial to screen for an AAA to identify any coexisting pathology. An abdominal ultrasound is a non-invasive and effective method for screening for AAAs.
Question 5: What pulmonary function test is the most effective at predicting postoperative performance when lobectomy is being considered?
- Quantitative radionucleotide perfusion scanning
- Gas exchange functions, such as DLCO (diffusion of carbon monoxide in the lung)
- Plain chest roentgenogram
- Predicted postoperative forced expiratory volume (FEV) in 1 second (FEV1) (Correct answer)
Correct answer: Predicted postoperative forced expiratory volume (FEV) in 1 second (FEV1)
When considering a lobectomy, accurately predicting the patient's postoperative pulmonary function is critical for assessing surgical candidacy and minimizing complications. The predicted postoperative forced expiratory volume in 1 second (ppoFEV1) is the most effective and widely accepted pulmonary function test for this purpose. It provides a reliable estimate of the remaining lung function after resection, guiding surgical decisions.
Question 6: Which of the following statements about the lymphatic drainage of the lungs is true?
- Flow of lymph from the left lower lobe may drain to the right mediastinal (paratracheal) lymph nodes (Correct answer)
- The upper 2/3 of each lung drains to the hilum, while the bottom 1/3 drains below the diaphragm
- The thymus gland drains the anterior portions of both lungs
- The thoracic duct picks up tributaries along its route through the mediastinum, providing most of the drainage of the left lung
Correct answer: Flow of lymph from the left lower lobe may drain to the right mediastinal (paratracheal) lymph nodes
The lymphatic drainage of the lungs is complex and can involve cross-midline pathways, particularly from the lower lobes. Lymph from the left lower lobe can indeed drain to the right mediastinal (paratracheal) lymph nodes. This anatomical detail is clinically significant for understanding the potential spread of lung cancer and for accurate staging.
Question 7: Which of the following statements about a tumor marker and the malignancy it is typically linked with is true?
- Carcinoembryonic antigen (CEA) and melanoma
- Alpha-fetoprotein and brain tumors
- CA 19-9 and pancreatic cancer (Correct answer)
- CA 125 and thyroid cancer
Correct answer: CA 19-9 and pancreatic cancer
CA 19-9 is a well-established tumor marker primarily associated with pancreatic cancer. It is commonly used to monitor treatment response and detect recurrence in patients diagnosed with pancreatic adenocarcinoma. While not specific enough for screening, its elevation is a strong indicator in the context of pancreatic malignancy.
Free Bachelor of Medicine & Bachelor of Surgery MCQ Questions and Answers
An 82-year-old woman presents with post-prandial dull abdomen pain that has been present for almost a year.
She dropped 25 pounds in the previous three months as a result of avoiding oral intake due to worsening discomfort symptoms.
Her symptoms have not improved after repeated normal upper endoscopies and long-term proton-pump inhibitor medication.
She underwent a laparoscopic cholecystectomy six months earlier for several tiny gallstones, which were discovered during a right upper quadrant ultrasound.
Four months ago, a colonoscopy revealed a solitary, fully excised pedunculated tubular adenoma.
A CT scan was conducted, and it reveals no indication of cancer (see below).
The patient is cachectic upon examination.
Her abdomen is soft and not painful to the touch, and no lumps are visible.
An analysis of the lab results reveals microcytic anemia and an albumin level of 2.4.
The most effective course of treatment for this patient would be: