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GI Surgery

Total questions: 80

Worksheet time: 40mins

Name
Class
Date
1.

Which of the following correctly describes the anatomical location of the deep inguinal ring?

a)

Within the rectus sheath near the linea alba

b)

Medial to the inferior epigastric vessels

c)

Lateral to the femoral vein

d)

In the fascia transversalis, just above the midpoint of the inguinal ligament

2.

Which type of hernia protrudes medial to the inferior epigastric vessels through the floor of the inguinal canal?

a)

Indirect inguinal hernia

b)

Femoral hernia

c)

Direct inguinal hernia

d)

Umbilical hernia

3.

Which of the following is most likely to present as an emergency due to strangulation or incarceration?

a)

Indirect inguinal hernia

b)

Direct inguinal hernia

c)

Umbilical hernia in a child

d)

Femoral hernia

4.

A patient presents with a non-reducible groin bulge and systemic signs of infection. Which hernia complication is most likely?

a)

Reducible hernia

b)

Incarcerated hernia

c)

Strangulated hernia

d)

Sliding hernia

5.

Which of the following is true regarding Richter’s hernia?

a)

It includes the entire bowel circumference and always causes obstruction

b)

It only occurs in infants

c)

It involves only a portion of the bowel wall and may not cause obstruction

d)

It occurs exclusively in femoral hernias

6.

What is the most appropriate initial management for a minimally symptomatic inguinal hernia in a male with significant comorbidities?

a)

Immediate surgical repair with mesh

b)

Nonoperative management with education on signs of incarceration

c)

Emergency laparotomy

d)

Laparoscopic repair under general anesthesia

7.

In which of the following patients is mesh contraindicated for hernia repair?

a)

Elderly patient with a large reducible inguinal hernia

b)

Patient undergoing elective hernia repair with no comorbidities

c)

Patient with contaminated field due to necrotic bowel

d)

Patient with bilateral inguinal hernias

8.

An umbilical hernia in a 3-year-old child is noted on exam. What is the next best step in management?

a)

Surgical repair immediately

b)

Order an abdominal CT scan

c)

Reassurance and observation until age 4

d)

Start oral antibiotics

9.

Which patient is at highest risk for developing an indirect inguinal hernia?

a)

40-year-old obese woman with constipation

b)

35-year-old man with chronic cough and a history of open appendectomy

c)

22-year-old healthy male with no risk factors

d)

60-year-old woman with a history of hysterectomy

10.

What distinguishes a sliding hernia from other inguinal hernias?

a)

It contains bladder or colon as part of the hernia sac wall

b)

It is always reducible

c)

It only occurs in children

d)

It occurs lateral to the femoral vessels

11.

Which of the following is the most common cause of gastroesophageal reflux disease (GERD)?

a)

Esophageal stricture

b)

Lower esophageal sphincter hypotonia

c)

Esophageal varices

d)

Cricopharyngeal spasm

12.

A 50-year-old male presents with dysphagia to both solids and liquids, regurgitation of undigested food, and weight loss. A barium swallow shows a “bird’s beak” appearance. What is the most likely diagnosis?

a)

Esophageal cancer

b)

Peptic stricture

c)

Achalasia

d)

Esophageal web

13.

Which of the following is the gold standard test for diagnosing GERD?

a)

Upper endoscopy

b)

Barium swallow

c)

Esophageal manometry

d)

24-hour pH monitoring

14.

Which esophageal disorder is most associated with increased risk of squamous cell carcinoma of the esophagus?

a)

Achalasia

b)

Barrett's esophagus

c)

Reflux esophagitis

d)

Zenker's diverticulum

15.

What is the key distinguishing anatomical feature of a paraesophageal hiatal hernia?

a)

The gastroesophageal junction and stomach both herniate above the diaphragm

b)

Only the stomach herniates beside the esophagus while the GE junction remains in place

c)

The entire stomach migrates into the thoracic cavity

d)

It always requires emergent surgery

16.

Which of the following is the most common symptom of esophageal carcinoma?

a)

Hematemesis

b)

Progressive dysphagia

c)

Regurgitation

d)

Heartburn

17.

What is the initial imaging modality of choice for evaluating a suspected Zenker diverticulum?

a)

Esophageal manometry

b)

Barium swallow

c)

Endoscopy

d)

CT of the neck

18.

What is the most appropriate initial management for a patient with Boerhaave syndrome presenting within 12 hours of onset?

a)

Oral proton pump inhibitor and observation

b)

Nasogastric tube placement and upper endoscopy

c)

Emergent surgical repair with drainage

d)

Broad-spectrum antibiotics only

19.

Which test provides the most accurate assessment of esophageal tumor depth and local lymph node involvement?

a)

CT chest

b)

Endoscopic ultrasound

c)

PET scan

d)

Barium esophagram

20.

What is the characteristic finding on endoscopy for Barrett’s esophagus?

a)

Ulcerated mass with active bleeding

b)

Pseudodiverticulum

c)

Salmon-colored columnar epithelium above the GE junction

d)

Pulsion diverticulum with intact squamous lining

21.

Which organism is most commonly associated with peptic ulcer disease (PUD)?

a)

Streptococcus viridans

b)

Helicobacter pylori

c)

Escherichia coli

d)

Candida albicans

22.

What distinguishes duodenal ulcers from gastric ulcers in terms of pain pattern?

a)

Duodenal ulcers worsen immediately after eating

b)

Gastric ulcers improve with food

c)

Duodenal ulcers improve with food

d)

Both worsen with food

23.

Which of the following diagnostic tests is most specific for Zollinger-Ellison syndrome?

a)

Urea breath test

b)

Serum gastrin level >1000 pg/mL

c)

Barium swallow

d)

Endoscopy showing multiple shallow ulcers

24.

Which of the following is an indication for surgical intervention in peptic ulcer disease?

a)

Diagnosis of H. pylori

b)

Uncomplicated duodenal ulcer on endoscopy

c)

Refractory bleeding or perforation

d)

Gastritis with positive urease test

25.

Which of the following combinations is most appropriate for H. pylori eradication in a patient allergic to penicillin?

a)

PPI + amoxicillin + clarithromycin

b)

PPI + metronidazole + clarithromycin

c)

H2 blocker + tetracycline

d)

PPI + ciprofloxacin + rifaximin

26.

What is the characteristic radiologic finding on barium study suggestive of gastric outlet obstruction?

a)

Corkscrew appearance

b)

Meniscus sign

c)

Large gastric air-fluid level with retained food

d)

Apple core lesion

27.

Which of the following complications of PUD is most likely associated with free air under the diaphragm on X-ray?

a)

Obstruction

b)

Bleeding

c)

Penetration

d)

Perforation

28.

What is the surgical procedure of choice for a perforated duodenal ulcer when definitive therapy is needed?

a)

Simple oversew

b)

Antrectomy alone

c)

Vagotomy and drainage procedure

d)

Pyloroplasty only

29.

What is the significance of a gastric ulcer that has irregular margins, nodular folds, or fails to heal with treatment?

a)

Suggests benign disease

b)

Suggests NSAID-induced ulcer

c)

Suggests malignancy and requires biopsy

d)

No clinical significance

30.

A 58-year-old man with epigastric pain and early satiety is found to have a large ulcerated mass in the gastric antrum. Multiple biopsies are taken. What is the next best step?

a)

Start empiric antibiotics

b)

Observe for spontaneous resolution

c)

Stage for possible gastric carcinoma

d)

Immediate antrectomy without staging

31.

A 22-year-old male presents with RLQ pain, nausea, and anorexia. What physical exam sign is most specific for appendicitis?

a)

Rovsing sign

b)

Murphy’s sign

c)

Obturator sign

d)

McBurney’s point tenderness

32.

What is the most common complication following appendectomy?

a)

Small bowel obstruction

b)

Incisional hernia

c)

Intra-abdominal abscess

d)

Fecal fistula

33.

Which of the following is true regarding appendiceal carcinoid tumors?

a)

Always metastatic at diagnosis

b)

Typically located at the base of the appendix

c)

Often incidental and benign when <2 cm

d)

Require right hemicolectomy regardless of size

34.

A 2-year-old presents with painless lower GI bleeding. A technetium-99m pertechnetate scan is most helpful for diagnosing:

a)

Intussusception

b)

Appendicitis

c)

Meckel's diverticulum

d)

Hirschsprung disease

35.

What is the appropriate treatment for an incidentally found asymptomatic Meckel’s diverticulum in an adult?

a)

Immediate diverticulectomy

b)

Observation unless complications arise

c)

Appendectomy

d)

Right hemicolectomy

36.

Which of the following is more characteristic of Crohn’s disease than ulcerative colitis?

a)

Continuous colonic involvement

b)

Bloody diarrhea

c)

Transmural inflammation with skip lesions

d)

Mucosal and submucosal inflammation only

37.

Which of the following small bowel tumors is associated with flushing, diarrhea, and bronchospasm?

a)

A. Adenocarcinoma

b)

B. Carcinoid tumor

c)

C. Gastrointestinal stromal tumor

d)

D. Lymphoma

38.

A patient with Crohn’s disease presents with bowel obstruction symptoms. What is the most likely cause?

a)

Intussusception

b)

Volvulus

c)

Adhesions from prior surgery

d)

Stricture formation

39.

A 67-year-old female presents with abdominal distension, vomiting, and obstipation. X-ray shows dilated small bowel loops with air-fluid levels. What is the most likely diagnosis?

a)

Gastric outlet obstruction

b)

Large bowel obstruction

c)

Small bowel obstruction

d)

Pseudo-obstruction

40.

Which imaging modality is most appropriate for evaluating small bowel obstruction and identifying possible strangulation?

a)

Abdominal ultrasound

b)

Upright chest X-ray

c)

CT abdomen with IV contrast

d)

Colonoscopy

41.

What is the most common complication of diverticulitis?

a)

Ischemic colitis

b)

Abscess formation

c)

Intussusception

d)

Hemorrhoids

42.

A 60-year-old patient presents with painless rectal bleeding and a change in bowel habits. What is the most likely diagnosis?

a)

Hemorrhoids

b)

Diverticulosis

c)

Colorectal cancer

d)

Anal fissure

43.

Which of the following is most characteristic of ulcerative colitis (UC) compared to Crohn’s disease?

a)

Skip lesions

b)

Transmural inflammation

c)

Continuous mucosal inflammation starting at the rectum

d)

Granuloma formation

44.

What is the most appropriate initial test for a suspected large bowel obstruction?

a)

Colonoscopy

b)

Abdominal X-ray

c)

CT scan with contrast

d)

Sigmoidoscopy

45.

A 42-year-old woman with known diverticulosis presents with LLQ pain, fever, and leukocytosis. What is the most appropriate next step in management?

a)

Emergent surgery

b)

Observation only

c)

Oral antibiotics and bowel rest

d)

Colonoscopy

46.

Internal hemorrhoids are classified based on:

a)

The number of blood vessels involved

b)

Their histology

c)

The depth of rectal mucosal invasion

d)

Their degree of prolapse

47.

A 30-year-old presents with a painful, bright red rectal bleeding during defecation. Physical exam reveals a posterior midline tear. What is the most likely diagnosis?

a)

External hemorrhoid

b)

Anal fissure

c)

Fistula-in-ano

d)

Rectal prolapse

48.

A perianal abscess is diagnosed. What is the most appropriate treatment?

a)

Oral antibiotics only

b)

Incision and drainage

c)

Digital rectal exam

d)

Watchful waiting

49.

Which of the following best describes the typical presentation of squamous cell carcinoma of the anal canal?

a)

Occult bleeding and constipation

b)

Chronic diarrhea and steatorrhea

c)

Perianal pain, mass, and bleeding

d)

Night sweats and weight loss

50.

Which of the following is the diagnostic test of choice for lymphogranuloma venereum (LGV)?

a)

Colonoscopy with biopsy

b)

NAAT (nucleic acid amplification test)

c)

Gram stain

d)

Culture on Thayer-Martin agar

51.

Which of the following is the most common type of gallstone in the U.S.?

a)

Calcium carbonate

b)

Pigment stones

c)

Mixed cholesterol stones

d)

Bile acid stones

52.

Which patient scenario warrants elective cholecystectomy for asymptomatic gallstones?

a)

Patient with diabetes and no symptoms

b)

Patient with gallstones found incidentally

c)

Patient with gallstones and porcelain gallbladder

d)

Pregnant patient with no biliary symptoms

53.

A 45-year-old woman presents with RUQ pain, fever, and jaundice. What is the most likely diagnosis?

a)

Acute cholecystitis

b)

Acute hepatitis

c)

Acute cholangitis

d)

Gallstone ileus

54.

Which of the following laboratory findings is most consistent with choledocholithiasis?

a)

Elevated amylase only

b)

Elevated AST with normal ALP

c)

Elevated ALP and direct bilirubin

d)

Isolated elevated lipase

55.

What imaging study is most sensitive for diagnosing common bile duct stones?

a)

CT abdomen

b)

Ultrasound

c)

ERCP

d)

Plain abdominal X-ray

56.

Which of the following is true regarding laparoscopic cholecystectomy?

a)

It is contraindicated in patients with prior abdominal surgery

b)

It has a longer recovery time than open cholecystectomy

c)

It is associated with higher rates of bile duct injury than open

d)

It is the preferred approach in most patients

57.

A patient has Charcot’s triad (RUQ pain, fever, jaundice). What is the best initial management step?

a)

Emergent cholecystectomy

b)

Broad-spectrum antibiotics and supportive care

c)

ERCP for stone extraction

d)

Percutaneous drainage of the gallbladder

58.

What distinguishes suppurative cholangitis from acute cholangitis?

a)

Lack of systemic symptoms

b)

Hypotension and altered mental status

c)

No elevation in bilirubin

d)

Absence of bile duct dilation

59.

What is the classic triad of symptoms for gallstone pancreatitis?

a)

Fever, nausea, jaundice

b)

Epigastric pain, nausea, elevated lipase

c)

RUQ pain, leukocytosis, steatorrhea

d)

Murphy's sign, hematemesis, hyperglycemia

60.

What is the most appropriate management for a stable patient with symptomatic cholelithiasis and confirmed gallbladder carcinoma on pathology?

a)

Observation only

b)

Repeat ultrasound in 6 months

c)

Extended cholecystectomy with liver segment resection and lymphadenectomy

d)

Start antibiotics

61.

Which of the following is the most common cause of acute pancreatitis in the United States?

a)

Trauma

b)

Hypertriglyceridemia

c)

Gallstones

d)

Autoimmune disease

62.

What Ranson criteria value on admission is associated with poor prognosis in acute pancreatitis?

a)

AST < 200 IU/L

b)

Glucose > 200 mg/dL

c)

WBC < 16,000/mm³

d)

Age < 55 years

63.

Which of the following is a complication seen early in the course of acute pancreatitis?

a)

Pancreatic cancer

b)

Duodenal obstruction

c)

Acute respiratory distress syndrome (ARDS)

d)

Chronic diarrhea

64.

A 35-year-old presents with abdominal pain, weight loss, and a palpable epigastric mass 6 weeks after an episode of pancreatitis. What is the most likely diagnosis?

a)

Pancreatic pseudocyst

b)

Abscess

c)

Gastric carcinoma

d)

Splenic infarct

65.

Which imaging study is most appropriate to evaluate a suspected pancreatic pseudocyst?

a)

Plain abdominal X-ray

b)

Endoscopic retrograde cholangiopancreatography (ERCP)

c)

CT abdomen with contrast

d)

Colonoscopy

66.

Which pancreatic tumor is most commonly associated with endocrine symptoms such as hypoglycemia or gastrin excess?

a)

Serous cystadenoma

b)

Insulinoma

c)

Adenocarcinoma

d)

Solid pseudopapillary tumor

67.

A 68-year-old with painless jaundice, weight loss, and a palpable gallbladder should be evaluated for:

a)

Gallstones

b)

Pancreatic adenocarcinoma

c)

Acute pancreatitis

d)

Gastric ulcer

68.

What is the most common location for a gastrinoma (Zollinger-Ellison syndrome)?

a)

Liver

b)

Duodenal submucosa

c)

Gallbladder

d)

Colon

69.

Which of the following is true regarding the prognosis of pancreatic adenocarcinoma?

a)

Most are detected early and are resectable

b)

The overall 5-year survival rate is >60%

c)

Prognosis is closely linked to tumor cell type and nodal status

d)

Surgical resection is curative in nearly all cases

70.

What is the preferred surgical procedure for resectable tumors in the head of the pancreas?

a)

Distal pancreatectomy

b)

Central pancreatectomy

c)

Whipple procedure (pancreaticoduodenectomy)

d)

Hepatectomy

71.

Which of the following liver tumors is most often benign and seen in young women on oral contraceptives?

a)

Hepatocellular carcinoma

b)

Hepatic adenoma

c)

Focal nodular hyperplasia

d)

Hemangioma

72.

Which of the following improves prognosis after resection of hepatic metastases from colorectal cancer?

a)

Presence of portal hypertension

b)

Multiple bilobar lesions

c)

Ability to obtain negative surgical margins

d)

Elevated AFP

73.

What are the two most common primary hepatobiliary malignancies?

a)

Hepatic adenoma and cholangiocarcinoma

b)

Cholangiocarcinoma and hepatocellular carcinoma

c)

Hepatocellular carcinoma and hemangioma

d)

Focal nodular hyperplasia and cholangiocarcinoma

74.

Which of the following complications is most directly associated with portal hypertension?

a)

Hepatic adenoma

b)

Biliary atresia

c)

Esophageal varices

d)

Pyogenic liver abscess

75.

Which physical exam finding is most suggestive of chronic liver disease with ascites?

a)

Psoas sign

b)

Murphy’s sign

c)

Shifting dullness

d)

Cullen’s sign

76.

What is the first-line therapy for acute variceal hemorrhage in a cirrhotic patient?

a)

Non-selective beta-blocker

b)

Emergent liver transplant

c)

IV PPI and endoscopy in 72 hours

d)

IV octreotide and urgent endoscopy

77.

Which of the following is NOT a typical site of portosystemic collateral formation?

a)

Esophagus

b)

Umbilicus

c)

Rectum

d)

Gallbladder

78.

Which of the following is the most common indication for liver transplantation in the United States?

a)

Hepatitis B infection

b)

Fulminant hepatic failure

c)

Alcoholic cirrhosis

d)

Primary biliary cholangitis

79.

Which of the following is most associated with a poor prognosis in fulminant hepatic failure?

a)

Mild coagulopathy

b)

Age under 40

c)

Development of encephalopathy

d)

Elevated alkaline phosphatase

80.

After liver transplantation, patients are most at risk for which of the following in the immediate post-op period?

a)

 Portal vein thrombosis only

b)

Opportunistic bacterial, fungal, and viral infections

c)

 Gallstone ileus

d)

 Renal cell carcinoma


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