First Part Gen. Surg.
PI NOV 2019
1. The arterial blood gas analysis of a patient was pH 7.5, PCO2 47 mm Hg, HCO3-35
mmol/L. This patient most likely is suffering from:
A. Chronic obstructive pulmonary disease
B. Diabetic ketoacidosis.
C. Persistent diarrhea.
D. Profound vomiting
E. Salicylate poisoning
2. A 70-year-old man with chronic obstructive pulmonary disease is admitted for elective
hemicolectomy. What is a preoperative arterial blood gas analysis likely to show?
Arterial pCO.
Bicarbonate
A. Decreased.
Decreased
B. Decreased.
Increased
C. Decreased.
Normal
D. Increased.
Decreased
E. Increased.
Increased
3. Paradoxical aciduria (the excretion of acid urine in the presence of metabolic alkalosis)
may occur in the presence of:
A. Release of inappropriate anti-diuretic hormone
B. Severe crush injury
C. Acute tubular necrosis
D. Gastric outlet obstruction
E. An eosinophilic pituitary adenoma
4. A pregnant woman in her 32nd week of gestation is given magnesium sulfate for preeclampsia. The earliest clinical indication of hypermagnesemia is:
A. Loss of deep tendon reflexes
B. Flaccid paralysis
C. Respiratory arrest
D. hypertension
E. stupor
5. Which of the following is characteristic of hypernatremia?
A. Dry and sticky oral mucous membranes
B. Decreased deep tendon reflexes
C. Decreased body temperature
D. Stupor and coma
E. Peaked T wave on ECG
6. An elderly diabetic patient who has acute cholecystitis is found to have a serum sodium
level of 122 mEq/L and blood glucose of 600 mg/dl. After correction of the glucose
concentration to 120 mg/dl with insulin, the serum sodium concentration would:
A. Decrease significantly unless patient receive normal saline
B. Decrease transiently but return to 122 mEq/L
C. Remain essentially unchanged
D. Increase to normal range without specific therapy
E. Increase to hypernatremic level
7. Which of the following conditions can lead to hypovolemic hyponatremia?
A. Congestive cardiac failure
B. Liver cirrhosis
C. Gastrointestinal losses,
D. Hyperglycemia
E. Over transfusion of dextrose 5%
8. A 55-year-old male patient has been receiving TPN for prolonged time and developed
hypomagnesaemia. Which of the following conditions clinically resembles
hypomagnesaemia?
A. Hypoglycemia
B. Hypokalemia
C. Hypophosphatemia
D. Hypocalcemia
E. Hyponatremia
9. A 70-year-old man with sepsis has a PH of 7.18. Which of the following statements is
TRUE regarding his metabolic acidosis?
A. Tissue hypoxia leads to increased oxidative metabolism.
B. Acute compensation for metabolic acidosis is primarily renal.
C. Metabolic acidosis results from the loss of bicarbonate or the gain of fixed acids
D. The most common cause of excess acid is prolonged nasogastric suction.
E. Restoration of blood pressure with vasopressors corrects the metabolic acidosis associated
with circulatory failure.
10. Serum osmolality of the blood can be calculated from serum values of which of the
following?
A. Sodium, potassium, chloride, and bicarbonate
B. Sodium, potassium, urea, and hemoglobin
C. Sodium, potassium, glucose, and urea
D. Sodium, albumin, urea, and glucose
E. Sodium, potassium, albumin, and glucose
11. A 60-year-old male patient is suffering from diabetic ketoacidosis. Which of the
following is the most important buffer base in the extracellular fluid?
A. Bicarbonate
B. Hemoglobin.
C. Lactate.
D. Phosphate.
E. Plasma proteins.
12. Which of the following is most effective in the prevention of aspiration of gastric
contents prior to endotracheal intubation in patients about to undergo general anesthesia?
A. Insertion ofa nasogastric tube
B. Administration of an emetic agent 30 minutes before intubation
C. External pressure on the cricoid cartilage
D. Placement of a Blakemore tube
E. Administration of Ondansetron 15 minutes before intubation.
13. A 5-year-old asthmatic patient is scheduled for elective inguinal hernia repair. In the
holding area, he exhibits bilateral wheezing on auscultation. Which of the following would
be the BEST initial approach to perioperative management for this patient's surgery?
A. Perform a field block with local anesthesia and sedate with IV ketamine and propofol.
B. Administer albuterol nebulizer treatment preoperatively and proceed with general anesthesia
sevoflurane via a laryngeal mask airway (LMA).
C. Postpone surgery for 4 to 6 weeks
D. Perform surgery with spinal anesthesia.
E. Administer hydrocortisone 100 mg IV and proceed with general anesthesia with desflurane
administered via an endotracheal tube.
14. Which of the following options is most appropriate for a type II diabetic patient
undergoing bilateral hernia repair as a day-case procedure under general anesthesia?
A. Their usual diabetic medication should be omitted on the day before surgery
B. They should be prescribed an insulin/dextrose sliding scale starting at 6 a.m. on the day of
surgery
C. They should be placed first on the operating list whenever possible
D. They should be kept nil by mouth at least 8 hours before the procedure
E. Their usual diabetic medication should he omitted on the evening following surgery
15. A 33-year-old woman is scheduled for elective cholecystectomy. Preoperative
evaluation shows the presence of moderate hypothyroidism. What is the most appropriate
policy for this patient?
A. Postpone surgery until an euthyroid state is achieved.
B. Proceed with surgery if severe clinical symptoms are not present.
C. Proceed with surgery while beginning treatment with L-thyroxine.
D. Proceed with surgery with the knowledge that minor perioperative complications
E. Proceed with surgery while beginning treatment with thionamides.
16. You have a patient who has pheochromocytoma and his blood pressure is 200/120 mm
Hg. You are preparing this patient for surgery. Which of the following drugs should be
used first for the control of blood pressure?
A. Phenoxybenzamine
B. Propranolol.
C. Nifedipine.
D. Atenolol.
E. Captopril.
17. A 50-year-old woman scheduled for parathyroidectomy presents to the emergency
department with nausea, vomiting, and altered mental status. Laboratory analysis reveals
serum calcium of 16 mg/dL. In addition to IV fluids, the BEST medication to give
immediately would be:
A. Calcitonin
B. Furosemide
C. Mithramycin
D. Prednisone
E. Zoledronic acid
18. In addition to determining blood glucose levels, the perioperative management of a
patient with diet-controlled diabetes mellitus should include which of the following
considerations?
A. Determination of glycosylated hemoglobin (HbA1c) level before surgery
B. Subcutaneous administration of regular insulin for glucose levels above 140 mg%
C. Metformin initiated three days prior to surgery
D. Intravenous insulin therapy one hour prior to surgery
E. Oral liquid carbohydrate initiated three hours prior to surgery
19. A patient with a non-obstructing carcinoma of the sigmoid colon is being prepared for
elective resection. Which of the following reduces the risk of postoperative infectious
complications?
A. Avoidance of oral antibiotics to prevent emergence of Clostridium difficile.
B. Postoperative administration for 48 hours of parenteral antibiotics effective against aerobes
and anaerobes.
C. Postoperative administration of parenteral antibiotics effective against aerobes and anaerobes
until the patient's intravenous lines and all other drains are removed.
D. Re-dosing of antibiotics in the operating room if the case lasts for more than three hours of
operating time
E Single preoperative parenteral dose of antibiotic effective against aerobes and anaerobes
20. Which of the following measures is most likely to reduce the risk of postoperative
wound infection with MRSA?
A. Five days of broad-spectrum prophylactic antibiotics
B. Ensure that the patient showers with chlorhexidine wash prior to surgery
C. A policy of staff hand-washing between patients
D. Screening patients for MRSA carriage prior to surgery
E. Preoperative shaving the area of incision
21. Which of the following statements regarding prevention of surgical site infection is
TRUE
A. All hair should be removed by shaving from the operative site.
B. Smoking has no effect on postoperative surgical site infection.
C. Prophylactic antibiotics should be administered within 30 minutes of incision
D. Administration of 80 % oxygen reduces surgical site infection in vascular procedures.
E. Chlorhexidine containing skin preparations have a clear benefit in reducing surgical site
infection compared with povidone-iodine solutions.
22. In patients with intermediate predictors of cardiac risk who are scheduled for
intermediate or high-risk surgical procedures, which of the following interventions can
reduce perioperative morbidity and mortality?
A. Continuous intraoperative ST-segment monitoring
B. Regional anesthesia when indicated.
C. Transesophageal echocardiography
D. Routine use of intravenous nitroglycerin.
E. Beta-blockers therapy
23. A 13-year-old child presents with a hard, non-tender swelling in the right lobe of the
thyroid gland which has been present for 4 months. What is the most likely
histopathological diagnosis?
A. Anaplastic carcinoma of the thyroid
B. Follicular carcinoma of the thyroid
C. Lymphoma of the thyroid
D. Papillary carcinoma of the thyroid
E. Subacute thyroiditis.
24. A 5-year-old child presents with a solid painless testicular mass. No history of trauma
or infection. Which of the following is the commonest testicular tumor in children?
A. Choriocarcinoma.
B. Interstitial cell tumor.
C. Seminoma.
D. Sertoli cell tumor
B. Teratoma
25. Which of the following is the indicated treatment for a non-communicating hydrocele
in a 2-month-old infant?
A. Aspiration.
B. Herniotomy.
C. Hydrocelectomy through a groin incision.
D. Hydrocelectomy through a scrotal incision.
E. Observation.
26. A double bubble sign on an air contrast upper gastrointestinal series in an infant is
characteristic of:
A. Duodenal atresia
B. Jejunal atresia.
C. Meconium ileus.
D. Congenital hypertrophic pyloric stenosis.
E. Volvulus neonatorum.
27. A 4-year-old girl is referred to your office complaining of an abdominal mass. She has
been eating normally and having normal daily bowel motions, but she is underweight. On
examination you palpate an 8-cm right mid-abdominal mass. It is firm, non-tender, and
poorly mobile. What is the most likely diagnosis?
A. Constipation with a distended cecum
B. Wilms' tumor
E. Neuroblastoma
D. Lymphoma
E. Hepatoblastoma
28. A 14-year-old boy presents with sudden onset of right testicular pain associated with
nausea and vomiting. Examination reveals that the testicle is found lying at a higher level
and is very tender. What is the recommended management?
A. Prescribe analgesics and reexamine the patient after few hours
B. MRI study
C. Urine examination
D. Urgent exploration of the testis
E. Bed rest and scrotal support
29. An 8-year-old boy presented with a pathological fracture of the left femur. He was
noted to have abdominal distension, loss of weight and a persistent cough over threemonth period. Additional lytic lesions were seen in the vertebral bodies and in the pelvis.
What is the most likely diagnosis?
A. carcinoid tumor of the bronchus
B. malignant melanoma
C. medulloblastoma
D. neuroblastoma
E. papillary carcinoma of the thyroid gland
30. A 7-year-old boy presents with recurrent attacks of pneumonia. Culture showed
Pseudomonas aeruginosa. His mother confirms that he had meconium ileus in the
neonatal period. Which of the following is likely to be increased in his sweat?
A. Alanine transaminase
B. Chloride
C. Creatinine
D. Potassium
E. Urea
31. A mother brings her 2-day-old neonate because of progressive abdominal distension,
failure to pass meconium and bilious vomitus. Plain abdominal x-ray reveals loops of
distended bowel with ground glass appearance. What is the recommended management?
A. Observation
B. Emergency laparotomy, bowel resection, and Bishop-Koop enterostomy
C. Intravenous hydration and a gastrograffin enema
D. Emergency laparotomy, bowel resection, and anastomosis
E. Sweat chloride test and pancreatic enzyme therapy
32. A newborn is evaluated for respiratory distress because of severe hypoxia several
hours after birth. The patient appears dyspneic, tachypneic, and cyanotic. The abdomen is
noted to be scaphoid. Which of the following is TRUE of this newborn?
A. This condition can be diagnosed prenatally with fetal ultrasound
B. An upper gastrointestinal contrast-enhanced study is required to diagnose this condition
C. The survival rate is extremely low.
D. Emergency surgical intervention is required within hours of birth.
E. Emergency placement of a chest tube is required
33. Which of the following is the most common cause of short bowel syndrome in the
pediatric population?
A. Necrotizing enterocolitis
B. Gastroschisis
C. Malrotation with volvulus
D. Intestinal atresia
E. Long-segment Hirschsprung's disease
34. A patient sustains significant thoraco-abdominal injuries from a six meters fall. His
hemodynamic profile is as follows: decreased cardiac output, increased systemic vascular
resistance, decreased pulmonary wedge pressure, decreased CVP and decreased mixed
venous oxygen. All of the following may be appropriate to administer EXCEPT:
A. Steroids
B. Blood products
C. Colloids
D. Isotonic solution
E. Hypertonic solution
35. A 35- year- old man is admitted to the intensive care unit following an emergency
splenectomy and nephrectomy for injuries sustained in a motorcycle crash. He required a
total of 12 units packed red blood cells intraoperatively. What electrolyte abnormality is
most likely to occur?
A. Hypokalemia
B. Hyperkalemia
C. Hypocalcemia
D. Hypomagnesemia
E. Respiratory acidosis
36. A 55-year-old man comes to the emergency room with complaints of nausea,
constipation, and fatigue. He has a history of kidney stones. His serum calcium level is 12
mg/dL. What is the most appropriate initial treatment for his current condition?
A Hydration with normal saline
B. Administration of bisphosphonates
C. Infusion of calcitonin
D. Dialysis
E. Administration of steroids
37. A 56-year-old man is undergoing splenectomy for portal hypertension and
hypersplenism. The most appropriate time of platelet transfusion is
A. 24 hours preoperatively
B. 2 hours preoperatively
C. At induction of anesthesia
D. After ligation of splenic artery
E. On removal of spleen
38. A 22-year-old man sustained a splenic injury in a road traffic accident. He is
undergoing a transfusion of 4 units prior to surgery. Ten minutes from start of the
transfusion he became unwell and agitated. He has a temp of 39.5°C PR 120 beats/min
and BP 80/50 mmHg. Which of the following is the most likely cause?
A Non-hemolytic febrile transfusion reaction
B. Transfusion-related acute lung injury
C. Bacterial contamination
D. Air embolus
E. Hemolytic transfusion reaction (ABO incompatibility)
39. A 40-year-old man who weighs 65 kg is being observed in the ICU. Twenty-four hours
postoperatively, he develops convulsions. His serum sodium is 118 mEq/L Appropriate
management includes which of the following?
A. Administration of normal saline (0.9%)
B. Administration of hypertonic saline (3 %)
C. Emergency hemodialysis
D. Administration of vasopressin
E. Administration of Lasix, 40 mg IV
40. A 64 year- old man undergoing anterior resection for rectal cancer under general
anesthesia is transfused with 2 units of packed RBCS intraoperatively. A hemolytic
transfusion reaction during anesthesia is recognized by which of the following
A. Shaking chills and muscle spasm
B. Fever and oliguria
C. Hyperpyrexia and hypotension
D. Tachycardia and cyanosis
E. Bleeding and hypotension
41. Rapid fluid resuscitation of the hypovolemic patient after abdominal trauma is
significantly enhanced by which of the following?
A. Placement of long 18-gauge subclavian vein catheters
B. Placement of percutaneous femoral vein catheters
C. Bilateral saphenous vein cut downs
D. Placement of short, large-bore percutaneous peripheral intravenous catheters
E. Infusion of cold whole blood
42. A 46-year-old man is brought into the emergency department with partial- thickness
skin burns. Fluids have been prescribed according to the Parkland formula. Which of the
following is the BEST endpoint for initial crystalloid titration?
A. Central venous pressure of 8-12mmHg.
B. Clinical assessment of hydration
C. Mean arterial pressure.
D. Heart rate.
E. Urine output
43. A 45-year-old woman diagnosed with hypothyroidism. Her physician suspects a
pituitary etiology. Which of the following laboratory findings is most consistent with this
condition?
A. Low TSH, low free thyroxine
B. Elevated TSH, low thyroxine
C. Elevated TSH, elevated thyroxine
D. Low TRH
E. Increased thyroglobulin
44. A 35-year-old woman undergoes a thyroidectomy for papillary thyroid cancer. The
surgeon suspects that the parathyroid glands have been removed. Which of the following
findings is most likely to be seen in the patient one week postoperatively?
A. Coma
B. Constipation
C. Esophagitis
D. Muscle spasms and tetany
E. Bone pain
45. A 31-year-old woman takes antacids with and after a meal so that gastric pH does not
decrease below pH 6, for peptic ulcer disease. This agent will cause a greater than normal
secretion of which of the following?
A. Gastrin
B. Secretin
C. Pancreatic bicarbonate
D. CCK-PZ
E. Somatostatin
46. A 32-year-old alcoholic male with chronic pancreatitis in which more than 90% of
pancreatic function is lost. Which of the following is most likely to be observed?
A. Decreased serum secretin levels
B. Depressed blood glucose levels
C. Enhanced bile acid micelle formation
D. Increased duodenal pH levels
E. Steatorrhea
47. Following a blood donation of 500 ml, the donor's red cell production begins to
increase in:
A. 24 hours
B. 30 minutes
C. 2 days
D. 5 days
E. 2 weeks
48. Which of the following is the rank order, from greatest to least, of areas of water
absorption in the GI tract in a normal individual?
A. Colon, small intestine, stomach
B. Colon, stomach, small intestine
C. Small intestine, colon, stomach
D. Small intestine, stomach, colon
E. Stomach, small intestine, colon
49. A patient's blood volume doesn't improve after the administration of crystalloids. The
doctor prescribes a colloid for this patient. Which of the following solutions is a colloid?
A. Dextrose 5 % in half-normal saline solution
B. Dextran
C. Dextrose 10% in water
D. Dextrose 5% in lactated Ringer's solution
E. Hypertonic saline (3%)
50. When a normal subject develops a spontaneous pneumothorax of his right lung, you
would expect the following to occur:
A. Right lung expands.
B. Chest wall on the right expands.
C. Diaphragm moves up.
D. Mediastinum moves to the right.
E. Blood flow to the right lung is reduced.
51. Chemoreceptors are located in:
A. Left atrium
B. Carotid body.
C. Medulla.
D. Coronary Sinus.
E. Lungs.
52. A patient with Type II diabetes reports for his 6-month check-up. His doctor
prescribes a daily 30-minute routine walking at a brisk pace. During aerobic exercise,
blood flow remains relatively constant within which of the following?
A. Brain
В. Heart
C. Skin
D. Skeletal muscles
E. Kidneys
53. A 20-year-old football player sustained a knee injury. Which of the following findings
would be most consistent with a tear to the posterior cruciate ligament?
A. The lower leg sags on passive flexion of the knee at 90° while the patient is supine
B. The lower leg moves forward relative to the knee with forward traction
C. The foot moves laterally when the knee is pushed medially
D. The foot moves medially when the knee is pushed laterally
E. A clicking sensation is appreciated when the knee is flexed and the leg is rotated externally
54. A 17-year-old male comes with pain in his right thigh above his knee that is
particularly bothersome at night. On physical exam, there is a soft tissue mass that is
tender to palpation. The skin overlying the mass is erythematous. An ray is obtained and
shows a "sunburst" pattern in the distal femur. What is most likely diagnosis?
A. Ewing's sarcoma
B. Osteosarcoma
C. Osteomyelitis
D. Osteochondroma
E. Osteoid osteoma
55. A 30- year-old male came to the emergency department because he has pain in the
right arm two hours after he fell in his home. Physical examination showed swelling and
deformity of the right arm. Patient is unable to dorsiflex his wrist What is the most likely
fracture?
A. Supracondylar fracture of the right humerous
B. Dislocation of the right shoulder
C. Spiral fracture of the mid humerous
D. Sub-capital humeral fracture
E. Fracture dislocation of the right shoulder
56. Which of the following is the most CORRECT about Crohn's disease?
A. The risk of bowel resection is about 5 % in the first year after diagnosis
B. The type of anastomotic technique can influence the risk of recurrence
C. No clear evidence that smoking can increase the risk of recurrence
D. Only minority of patient with perianal disease will require proctectomy
E. In the presence of perianal disease, a temporary ileostomy will cure the disease in the
majority of patients to allow reversal
57.Which of the following does NOT increase the risk of Colo-rectal cancer?
A. Ulcerative colitis for 15 years
B. A 2 cm Villous adenoma in the rectum
C. 10 polyps in the colon, two of them more than 1 cm in size
D. Hyperplastic polyp
E. 2 cm flat serrated adenoma
58. A 35-year old man is hospitalized for 2 weeks with acute pancreatitis. Five weeks
following discharge, he was readmitted with epigastric pain and fever. His pulse is 120
beats/min, temp 38.9°C and his WBC is 24,000/mm3. CT abdomen demonstrates a 6x6 cm
fluid collection in the body of the pancreas. The most appropriate management of the
fluid collection is:
A. Antibiotics.
B. CT guided aspiration and repeat CT in 2-3 days.
C. Antibiotics, CT guided aspiration, repeat CT in 2-3 days.
D. Antibiotics and percutaneous catheter drainage.
E. Cystogastrostomy or Roux-en-y cysto-jejunostomy.
59. A 35-year old woman with no significant past medical history and on oral
contraceptive pills, presents with right upper quadrant pain. CT abdomen demonstrates a
8 cm hepatic adenoma in the right lobe of the liver. What is the definitive treatment of this
patient?
A. Cessation of oral contraceptive pills
B. Cessation of oral contraceptive pills and serial CT scans
C. Embolization of the right portal vein
D. Resection of the hepatic adenoma
E. Systemic chemotherapy
60. Regarding idiopathic thrombocytopenic purpura (ITP), all of the followings are
true,EXCEPT:
A. Persistent thrombocytopenia in spite of medical treatment is an indication for surgery
B. Two-thirds of cases have prolonged remission after splenectomy
C. Spontaneous remission occurs in most acute cases
D. Spleen is usually palpable
E. Splenectomy is more often necessary for adult with ITP than for children
61. Which of the following is NOT a part of MEN IIB syndrome?
A. Lip neuromas
B. Parathyroid hyperplasia
C. Pheochromocytoma
D. Tongue neuromas
E. Medullary thyroid cancer
62. What is the most common malignant tumor of the submandibular salivary gland?
A. Mucoepidermoid
B. Adenoid cystic
C. Adenocarcinoma
D. Lymphoma
E. Squamous cell
63. Which one of the followings is NOT included in Milan criteria for liver transplantation
in patients with hepatoma?
A. One lesion smaller than 5 cm
B. Up to 4 lesions smaller than 4 cm
C. Up to 3 lesions smaller than 3 cm
D. No extrahepatic lesions
E. No vascular invasion
64. The BEST correlation between histological grade and prognosis is seen in:
A. Rectal adenocarcinoma
B. Pancreatic adenocarcinoma
C. Melanoma
D. Soft tissue sarcoma
E. Osteosarcoma
65. A 40-year-old male with cecal mass diagnosed by colonoscopy, his father, paternal
grandmother, and paternal uncle all developed colon cancer by their fifth decade.
Mutation of which of the following genes is associated with this disease?
А. АРС
B. BRCA1
C. BRCA2
D. HMSH2
E. K-Ras
66. All of the following paraneoplastic syndromes are associated with gastric cancer,
EXCEPT:
A. Acanthosis nigrans
B. Disseminated intravascular coagulation
C. Thrombophlebitis (Troseau's sign)
D. Pyoderma gangrenosum
E. Nephritic syndrome
67. In a patient with a thyroid nodule; one of the followings is very difficult to be
diagnosed by fine needle aspiration:
A. Medullary neoplasm.
B. Papillary neoplasm.
C. Follicular neoplasm.
D. Thyroid Lymphoma.
E. Non-neoplastic nodule.
68. Which statement is TRUE concerning fetal wound healing?
A. Scarring is similar to adults.
B. There are higher concentrations of Type II collagen
C. There are lower concentrations of hyaluronic acid.
D. There are higher concentrations of Type IV collagen.
E. Concentrations of hyaluronic acid are the same
69. To maintain innervated muscle flaps during abdominal wall component separation for
the closure of midline defects, beneath which of the following is the most appropriate
plane of dissection?
A. Subcutaneous fat pad, above fascia
B. Fascia, above external oblique
C. External oblique, above internal oblique
D. Internal oblique, above transversalis fascia
E. Transversalis, above peritoneum
70. Which of the following is most true during resuscitation of a 6-month old male with a
40% TBSA scald burn?
A. Colloids should not be given in the first 24 hours post burn.
B. There will be increased permeability in the lung.
C. Hemoconcentration indicates inadequate fluid resuscitation.
D. The initial resuscitation fluids should not contain dextrose.
E. Fluid requirement is 3ml/kg/% burn plus maintenance.
71. Melanoma arises from:
A. Superficial keratinocytes.
B. Apocrine sweat glands.
C. Neural crest cells.
D. Hair follicles.
E. Ectopic mucosa
72. Which of the following guidelines to management of skin wounds is CORRECT?
A. Incision should be placed at right angle to relaxed skin- tension lines.
B. Revision of abnormal scars should be performed before maturation process is well
established.
C. Eversion of wound edges.
D. An elliptical excision should be approximately two times longer that it's width.
E. The smaller the angle between the limbs of Z-plasty, the greater is the length gained by Zplasty.
73. Clear cell renal cancer arises from:
A. Proximal tubules
B. Distal tubules
C. Collecting ducts
D. Loop of Henle
E. Pelvis of the kidney
74. What is the most common cause of testicular pain in post pubertal male?
A. Epididymo-orchitis
B. Torsion
C. Seminoma
D. Hydrocele
E. Varicocele
75. Which statement concerning testicular torsion is TRUE?
A. Most common during neonatal period
B. Intravaginal torsion rarely occurs in adolescents
C. The twisted testis is viable if operated within 48 hours
D. Torsion of the appendix of the testis mimics testicular torsion
E. Contralateral orchidopexy is not recommended at the time of scrotal exploration
76. The most frequent pathogen involved in non-gonococcal urethritis is?
A. Herpes simplex
B. Chlamydia trachomatis
C. Ureaplasma urealyticum
D. Corynebacterium genitalium
E. Staphylococcus epidermidis
77. Which of the following is in relation to blunt abdominal injury?
A. Small bowel is most likely to be transected in the distal ileum
B. Pancreatic duct injury causes raised serum amylase
C. Kidney is the most common involved organ
D. Liver laceration is rarely associated with rib fracture
E. Diagnostic peritoneal lavage is the best method used to identify the involved organ
78. Which is the BEST incision preferred while incising the diaphragm?
A. Circumferential
B. Radial
C. Vertical
D. Transverse
E. Left oblique
79. A road traffic accident patient presents with breathlessness. The differentiation
between cardiac tamponade and tension pneumothorax is BEST done by:
A. Pulse pressure
B. Pulse volume
С. JVP
D. Breathing sound
E. Pulse oximeter value
80. A patient presents after road traffic accident. FAST done for the patient shows
hemoperitoneum. His vitals are: BP-110-90 mmHg, PR-90/min. What is the immediate
next step in the management?
A. US scan of the abdomen
B. CT abdomen
C. Exploratory laparotomy
D. Diagnostic peritoneal lavage
Е. MRI
81. What does priapism in poly-trauma patient signify?
A. Penile injury
B. Spinal cord injury
C. Significant head injury
D. Pelvic injury
E. Cauda equina injury
82. A 24-year-old male suffered a road traffic accident with multiple abdominal injuries
and femur fracture. He has lost 10 % of his blood. The initial fluid of choice is:
A. Crystalloid
B. Colloid
C. Packed RBCS
D. Whole blood
E. Fresh frozen plasma
83. Which of the following is the source of bleeding in subdural hematoma?
A. Middle meningeal artery
B. Saccular berry aneurysm
C. Communicating veins to superior sagittal sinus
D. Retromandibular vein
E. Middle cerebral artery
84. A 37-year-old patient presented with left sided abdominal pain 6 hours after RTA. He
was hemodynamically stable and FAST positive, CT scan showed grade III splenic injury.
What will be the appropriate treatment?
A. Splenectomy
B. Splenorrhaphy
C. Partial splenectomy
D. Conservative management
E. Splenic artery embolization
85. Which of the following is the most serious?
A. Open pneumothorax
B. Diaphragmatic injury
C. Flail chest
D. Single rib fracture
E. Mild hemothorax
86 Which of the following is the least common organ injured by blast injury?
A. Tympanic membrane
B. Alveoli of the lung
C. Skull
D. Stomach
E. Eye ball
87. Lucid interval is most commonly seen in in which type of hemorrhage?
A. Acute extradural
B. Chronic subdural
C. Acute subdural
D. Subarachnoid
E. Intracerebral
88. Which one of the following veins should be avoided for intravenous infusion in the
management of abdominal trauma
A. Anti-cubital vein
B. Cephalic vein
C. Long saphenous vein
D. External jugular vein
E. Basilic vein
89. The most common cause of death in blunt trauma to chest is:
A. Esophageal rupture
B. Trachea-bronchial rupture
C. Pulmonary laceration
D. Pneumothorax
E. Flail chest
90. All of the following are features of large intestine, EXCEPT:
A. Large intestine secretes acidic mucus which helps in formation of stools
B. It is a site of mucocutaneous junction
C. Its epithelium contains goblet cells in large numbers
D. Absorbs salt and water
E. Has three tinea coli represents the longitudinal muscle
91. MALT (Mucosa Associated Lymphoid tissue) is present in:
A. Submucosa
B. Lamina propria
C. Muscularis mucosa
D. Adventitia/Serosa
E. Only mucosa
92. What is the most common part of subclavian artery stenosis?
A. First
B. Second
C. Third
D. Terminal
E. Any part may be affected
93. The greater omentum is derived from which of the following embryonic structures:
A. Dorsal mesogastrium
B. Pericardio-peritoneal canal
C. Pleuro-pericardial membranes
D. Ventral mesentery
E. Vitelline duct
94. A surgery performed in the thyroid region has damaged external laryngeal nerve. The
patient will be able to perform all of the following laryngeal movements EXCEPT
A. Abduct the vocal cards
B. Tense the vocal cords
C. Widen the rima glottidis
D. Adduct the vocal cords
E. Narrow the rima glottidis
95. All are true about triangle of Doom EXCEPT:
A. Vas deferens lies medially
B. Testicular vessels lie laterally
C. Surgical staples are avoided here
D. Apex is directed towards superficial ring
E. The base is formed by peritoneal reflection
96. The first muscle to recover from paralysis in general anesthesia is
A. Orbicularis Oris
B. Biceps femoris
C. Diaphragm
D. External intercostals muscle
E. Upper eyelid muscle
97. Regarding the anterior abdominal wall all are true EXCEPT:
A. Camper's fascia is the outer fatty layer of the superficial fascia.
B. The 10th intercostal nerve supply the skin over the umbilicus
C. Scarpa's fascia joints the fascia lata of the lower limb
D. Lymphatic drainage below the umbilicus may cross the midline to both sides.
E. Colle's fascia is the perineal extension of the camper's fascia
98. In relation to anorectal region:
A. In women, Denovilliers fascia separates the rectum from the vagina.
B. Waldeyer fascia attaches to the fascia propria at the anorectal junction.
C. The lower rectum drains into the inferior mesenteric and internal iliac lymph nodes.
D. The external sphincter is voluntary and continuous with the longitudinal muscle of the
rectum.
E. Rich collaterals exist between the rectal arteries such that the rectum is relatively resistant to
ischemia
99. In tension pneumothorax there is
A. Chest wall expansion on affected side
B. Negative intrapleural pressure
C. Decreased surfactant
D. Increased compliance of lung
E. Decreased auto PEEP
100. Upon Identification of a tension pneumothorax, which is the BEST management
pathway?
A. Chest X-ray to confirm the clinical diagnosis
B. Insertion of a chest drain in the 5th intercostal space in mid- axillary line
C, Immediate decompression with a 14G 5-cm needle in the 2nd intercostal space in
midclavicular line
D. Immediately intubate and ventilate
E. Fluid resuscitation to correct hypotension
First Part Gen. Surg.
PII NOV 2019
1. Which of the following will be best initial diagnostic modality for a patient suspected to
have acute pulmonary embolism presenting with hypotension?
A. Echocardiography
B. D-dimer assay
C. V/Q scan
D. Computed tomographic pulmonary angiography
E. Right axis deviation on ECG
2. Regarding Mendelson syndrome, which one of the following is TRUE?
A. Early broad-spectrum antibiotics reduce mortality
B. Steroid therapy should be started at once
C. Aspirated material should be suctioned out through endotracheal tube
D. Bronchospasm should be treated with bronchodilators
E. Treatment depends on the pH of the aspirated gastric contents
3. Regarding lung abscess all are true EXCEPT:
A. Majority of them are caused by anaerobes
B. More than 90% of the patients survive
C. Clindamycin may be used as first-line antibiotic
D. Abscess cavity equal or more than 10 cm is a poor prognostic sign
E. Duration of treatment varies from 1 to 3 months
4.Which of the following group has BEST outcome in terms of mortality from ARDS?
A. Multiple trauma
B.) Chronic liver disease
C. Pneumonia
D. Pancreatitis
E. Age greater than 70
5. In patients admitted to ICU for community acquired pneumonia, the most common
cause is
A. Streptococcus pneumonia
B. Legionella species
C. Hemophilus influenzae
D. Staphylococcus aureus
E. Pseudomonas
6. All of the following are criteria for liver transplant in fulminant hepatic failure
EXCEPT.
A. pH<7.3
B. INR 6.5
C. Serum creatinine level >3.4 mg/dL
D. Serum bilirubin level >10
E. Halothane hepatitis
7. Which of the following is useful for predicting severity of illness in cases of acute
pancreatitis?
A Lactate dehydrogenase level
B. Serum sodium
C. Serum lipase level
D. Serum amylase level
E. Serum creatinine
8. Which one of the following is the commonest cause of ascites:
A. Neoplastic disorders
B Heart failure
E. Tuberculosis
D. Nephritic syndrome
E. Peritonitis
9. Which of following cephalosporin needs no dosage modification in severe renal
dysfunction:
A. Ceftazidime
B. Ceftriaxone
C. Cefotaxime
D. Cefepime
E. Cefpodoxime
10. Palliative care in a terminally ill cancer patient includes all EXCEPT:
A. Relief of pain
B. Correction of hypokalemia
C. Chemotherapy
D. Emotional support
E. Sedation
11. At what time most opportunistic infections occur following transplantation?
M. First week
B. First month
C. Between 1 to 6 months
D. After 12 months
E. Risk is same life long
12. Ten days after a sigmoid colectomy for cancer, a patient's skin staples are removed
and a large gush of serosanguineous fluid emerges. Examination of the wound reveals an
extensive fascial dehiscence. The most appropriate management is:
A. Wide opening of the wound to assure adequate drainage
B. Culture of the fluid and appropriate antibiotics
C. Careful reapproximation of the wound edges with
D. Immediate return to the operating room
E. Application of an abdominal binder.
13. A 23-year-old woman undergoes total thyroidectomy for carcinoma of the thyroid
gland. On the second postoperative day, she begins to complain of tingling sensation in her
hands. She appears quite anxious and later complains of muscle cramps. Initial therapy
should consist of
A. 10 mL of 10% magnesium sulfate intravenously
B. Oral vitamin D
C. 100 Hg of oral Synthroid
D Continuous infusion of calcium gluconate
E. Oral calcium gluconate
14. You are asked to review a 45-year-old man on the surgical ward. Checking through
the notes, you observe that he is one day following an open anterior resection for rectal
carcinoma. He describes severe central abdominal pain associated with dyspnea. The
abdomen is soft but generally tender throughout. His symptoms have occurred despite an
epidural catheter that was inserted prior to surgery. What is the most effective form of
analgesia in this setting?
A. Four-hourly intramuscular morphine
B. Patient-controlled opiate analgesia (PCA)
C. Intravenous paracetamol
D. Per rectum diclofenac
E. Intravenous oxycodeine hydrochloride
15. A 55-year-old patient is admitted to the hospital and treated with broad spectrum
antibiotics for uncomplicated diverticulitis. On day five there is increasing leukocytosis,
abdominal pain and constant foul-smelling diarrhoea develop. Which of the following
diagnoses is most likely?
A. Infectious colitis
B. Progression of diverticulitis.
C. Pseudomembranous colitis
D. Retained colonic clot.
E. Perforated diverticulum.
16. All of the following are principles of antibiotic prophylaxis to prevent surgical site
infection EXCEPT:
A. Administer intravenous antibiotics within one hour of incision time
B. Select an antibiotic with a spectrum of activity against pathogens likely to be, encountered
during surgery
C. Discontinue antibiotics 48 hours postoperatively
D. Intraoperatively re-dose cephalosporin prophylactic antibiotics every two half-lives for long
procedures
E Antibiotics should not be administered after the wound is closed unless there is suspicion of
contamination
17. Which statement about infected wounds is CORRECT?
A. The infection rate in "clean" wounds is 1-2 %
B. A "clean-contaminated" wound has an infection rate of about 25%
C. The incision of an abscess is a "clean-contaminated" wound
D. A right subcostal incision for Cholecystectomy is classified as "contaminated" wound
E Antibiotic prophylaxis is mandatory in "dirty" wounds
18. During laparotomy for obstructed small intestine, the bowel had been accidentally
injured. The abdominal incision is considered now:
A. Clean contaminated
B. Contaminated
C. Infected
D. For secondary closure
E. For drainage
19. During wound healing; angiogenesis would follow which phase?
A. Hemostasis coagulation phase
B, Acute inflammatory phase
C. Granulation tissue formation phase
D. Wound contraction phase
E. Wound remodeling phase
20. Which of the following is least likely to contribute to a surgical site infection?
A. American Society of Anesthesiologists physical status
B. Length of operation
C. Serum glucose level
D. Body temperature
E. Hemoglobin level
21. Which of the following regarding the treatment of diabetic foot infections is TRUE?
A. Acute diabetic foot infections are caused by monomicrobial gram-negative aerobes.
B. The use of antibiotics for an uninfected chronic wound facilitates wound closure and
prevents future infection.
C. Sharp debridement of necrotic or unhealthy tissue prolongs wound healing and removes a
potential reservoir for bacteria.
D. Avoiding direct pressure on the wound facilitates healing.
E. The administration of granulocyte-stimulating factors (GSFS) results in faster resolution of
the infection.
22. Which of the following antimicrobial agents is considered safe in pregnancy?
A. Ganciclovir
B. Albendazole
C. Ketoconazole
D. Streptomycin
E Erythromycin
23. A 47-year-old man has been admitted to the burn ICU for 4 days after sustaining a
30% total body surface area burn, involving the neck, chest, bilateral upper extremities,
and lower extremities. Which of the following is suggestive of a burn wound sepsis?
A Conversion of a partial-thickness burn to a full-thickness burn
B. Fevers greater than 38.0°C
C. Burn wound culture swab revealed 103 organisms per gram of tissue swabbed
D. Inability to tolerate enteral tube feeds for greater than 24 hour
E. Failure to improve with broad-spectrum antibiotic administration.
24. A 45-year-old man who underwent a splenectomy for immune thrombocytopenic
purpura develops a fever. Which of the following is TRUE regarding post splenectomy
sepsis?
A. A fever without other localizing symptoms of infection is usually not worrisome in post
splenectomy patients.
B. Post splenectomy sepsis is almost never seen in patients who complete the appropriate
vaccinations.
C. The most common organism implicated in post splenectomy sepsis is Hemophilus influenzae.
D. Initiation of empiric antibiotics should be delayed until cultures are obtained.
E. Ceftriaxone and vancomycin are an appropriate empiric antibiotic regimen in an asplenic
patient with fever.
25. Which of the following sets of clinical signs are usually associated with a basal skull
fracture?
A. Periorbital ecchymoses, otorrhea, retroauricular ecchymoses, cranial nerve III palsy
B. Periorbital ecchymoses, rhinorrhea, anosmia, cranial nerve VI palsy
C. Rib fracture, otorrhea, rhinorrhea, anosmia
D. Rib fracture, otorrhea, rhinorrhea, retroauricular ecchymoses
E. Periorbital ecchymoses, otorrhea, rhinorrhea, retroauricular ecchymoses
26. A 21-year-old female student presents to the emergency department following a fall
from a height. She opens her eyes when her name is mentioned and is talking about her
studies tomorrow. She also winces when you press her nail bed. Her score according to the
Glasgow Coma Scale will be:
А. 3
В. 5
С. 7
D. 9
E. 11
27. In the management of a 64-year-old woman struck by a car, mannitol is given to do
which of the following?
A. Increase CSF formation
B. Increase the respiratory rate
C. Increase the pulse rate
D. Replace extensive fluid loss
E. Lower raised ICP
28. A patient underwent a craniotomy for resection of his lesion. Twelve hours
postoperatively, he developed diuresis of over 500 mL/h. The diagnosis of Diabetes
insipidus was made. What laboratory findings are most consistent with the clinical
impression?
A. Urine specific gravity of over 1010
B. Serum sodium of less than 135
C. Decreased both serum and urine osmolality
D. Increased serum osmolality and decreased urine osmolality
E. Increased both serum and urine osmolality
29. Which of the following is TRUE regarding head trauma and/or intracranial
hemorrhage?
A. The most common cause of subarachnoid hemorrhage is rupture of a berry aneurysm.
B. Epidural hematoma is typically associated with acceleration-deceleration injuries.
C. A single episode of systolic blood pressure less than 90 mm Hg doubles mortality in patients
with head trauma.
D. Xanthochromia is virtually pathognomonic for acute subdural hemorrhage.
E. In the absence of other findings, reimaging for cerebral contusion is generally Aunnecessary
30. In a patient with 1.5 mm melanoma the appropriate surgical management is excision
with:
A 1.0-cm margins
B 2.0-cm margins
C. 2.0-cm margins and sentinel lymph node (SLN) biopsy
D. 2.0-cm margins and lymph node dissection
E. 3.0-cm margins
31. Which of the following is TRUE about groin dissection for melanoma?
A It is indicated when patients have a positive SLN biopsy.
B. Regional lymph node disease is not predictive of survival or local recurrence.
C. Cloquet's node marks the most inferior lymph node.
D. Borders of the lymph node dissection are the femoral vein, adductor longus muscle,
Poupart's ligament, and the abdominal wall.
E. Deep iliac nodes should be taken routinely
32. What is the most important prognostic indicator for sarcoma?
A. Size
В. Location
C. Lymph node status
D Grade
E. Depth
33. A 54-year-old man sees you because of a growth on his lower lip. He smokes tobacco,
has a fair complexion, and works outdoors. The biopsy report confirms a carcinoma.
Which of the following is the most common tumor involving the lips?
A. Squamous cell carcinoma
B. Basal cell carcinoma
C. Malignant melanoma
D. Keratoacanthoma
E. Verrucous carcinoma
34. Two days after starting warfarin as embolic prophylaxis for atrial fibrillation. a 67year-old woman presents to the emergency room with a 3-cm. black patch of sloughing
skin on her left buttock. Her INR is 1.2 and PTT is 34 seconds. What is the appropriate
management?
A. Continue warfarin and start wet-to-dry management of buttock wound
B. Discontinue warfarin, administer intravenous vitamin K and start topical antibiotics to the
buttock
C. Increase dose of warfarin to achieve INR of 2.5 and sharply debride wound on the buttock
D. Initiate heparin infusion discontinue warfarin, and full thickness skin graft wound on buttock
E. Obtain computed tomography scan of abdomen and pelvis, start subcutaneous low-molecular
weight heparin injection of 100 mg BID, and start broad-spectrum antibiotics
35. Which of the following variables has the least influence on oxygen delivery?
A. Hemoglobin
B. Cardiac contractility
C Heart rate
D Carbon monoxide concentration
E. Partial pressure of dissolved oxygen in the blood
36. A 54-year-old man who weighs 100 kg comes to the ED after vomiting for 3 days and
losing 10 kg. His serum electrolytes are as follows: sodium 136 mEq/L, potassium 3.1
mEq/L, chloride 88 mEq/L, and carbon dioxide 37 mEq/L. Which one of the following
would be most helpful in determining the cause of his acid-base disorder?
A. Urine sodium
B. Urine creatinine
C. Urine chloride
D. Urine pH
E Urine potassium
37. Regarding the of suppurative cholangitis caused management choledocholithiasis,
which of the following is CORRECT?
A. Urgent biliary tract decompression via endoscopic retrograde cholangiopancreatography
(ERCP) is recommended.
B. Percutaneous transhepatic cholangiography (PTC) is preferable for stone extraction and stent
placement.
C. ERCP with a sphincterotomy is equivalent to cholecystectomy or reducing recurrence rates.
D. Should ERCP and PTC fail or are not feasible, operative choledochotomy and tube
placement should be avoided because the risk of surgery.
E. Broad spectrum antibiotic therapy alone will generally provide adequate treatment
38. Shock can BEST be defined as:
A. Hypotension.
B. Hypoperfusion of tissues.
С. Нурохеmia.
D. Bradycardia.
E. Massive blood loss.
39. TRUE statements concerning hypoadrenal shock (Addisonian crisis) include which of
the following?
A, Adrenocortical insufficiency may manifest as severe shock refractory to volume only.
B. The presence of hyperglycemia and hypotension may suggest the diagnosis of shock due to
adrenocortical insufficiency.
C. Hydrocortisone does not interfere with the serum cortisol assay and should be given to
hemodynamically unstable patients suspected of having hypoadrenal shock.
D. The rapid adrenocorticotropic hormone stimulation test should be performed to help
establish the diagnosis of acute adrenocortical insufficiency.
E. Adrenocortical insufficiency may manifest itself as severe shock refractory to the pressor
therapy only.
40. All of the following are true about neurogenic shock EXCEPT:
A. There is a decrease in systemic vascular resistance and an increase in venous capacitance.
B. Tachycardia or bradycardia may be observed, along with hypotension.
C The use of an alpha agonist such as phenylephrine is the mainstay of treatment
D. Severe head injury, spinal cord injury, and high spinal anesthesia may all ca neurogenic
shock
E. Pharmacologic sympathetic blockade leads to sympathetic denervation and vasomotor tone
41. All of the following statements about the role of the gut in shock and septic true
EXCEPT?
A. Selective decontamination of the digestive tract with the use of oral antibiotics has been
shown to reduce nosocomial pneumonias and to improve mortality rates.
B. Enteral nutrition, as compared with parenteral nutrition, preserves the villus architecture of
the gut.
C. Gut dysfunction may be an effect of shock, but it may also contribute to the development of
MODS by the mechanism of bacterial translocation.
D. As compared with parenteral nutrition, enteral nutrition is associated with a reduction in
septic morbidity.
E. Gut ischemia may occur early in the various shock syndromes
42. What is the primary reason that hetastarch products are no longer recommended for
initial resuscitation in hypovolemic shock?
A, Crystalloids clearly result in lower mortality
B. Hetastarch has a higher risk of infections
C. Hetastarch is more effective but avoided due to high cost
D. Hetastarch is associated with acute kidney injury
E. Crystalloids require a smaller administration volume.
43. Which of the following is the most common liver tumor of childhood?
A. Hemangioma and hemangioendothelioma
B. Hepatoblastoma.
C. Hepatocellular carcinoma
D. Mesenchymal hamaratoma.
E. Neuroblastoma.
44. With regard to oncogenes, which of the following is TRUE:
A. They behave in a dominant fashion
B. They encode proteins that negatively regulate growth
C BRCA1 is an oncogene implicated in breast carcinoma
D. Transcription of oncogenes is dysregulated in normal cells
E. Oncogenes are present only in tumour cells.
45. All of the following statements describe an ideal tumor marker EXCEPT?
A. The ideal tumor marker should be tumor specific.
B. The ideal marker must have a low false-negative rate
C. The circulating level of an ideal tumor marker should correlate directly with the amount of
viable tumor and be a measure of the response to therapy
D. The ideal tumor marker should act as a prognostic indicator.
E. The ideal tumor marker should always be hormonal
46. Which of the following variables BEST predicts prognosis for patients with a recent
diagnosis of cutaneous melanoma and no clinical evidence of metastatis disease?
A. Breslow thickness.
B. Clark's level
C. Ulceration.
D. Gender
E. Celtic complexion.
47. A 42-year-old woman presents with an 8 x 6 x 4 cm. mass in the posterior thigh.
Incisional biopsy reveals a high-grade liposarcoma. Her management should include:
A. High thigh amputation.
B, Extra-compartment excision with negative margins.
C. Complete excision with negative margins.
D. Neoadjuvant radiation therapy.
E. Adjuvant chemotherapy.
48. Oncogenes have been implicated in the development of a number of human neoplasms.
Oncogene activation is believed to be required for oncogenesis. All of the following
potential mechanisms are relevant to these processes EXCEPT?
A. Chromosome translocation
B. DNA point mutation
C. Amplification
D. Gene deletion
E. Segment translocation.
49. Patients that have acquired immunodeficiency syndrome are at increased risk for
which of the following neoplasm
A. Colorectal cancer
B. Meningioma
C. Kaposi's sarcoma.
D. Hepatocellular carcinoma
E. Esophageal carcinoma
50. The following precautions have been shown to decrease risk of HIV transmission,
EXCEPT:
A. Gowns
B. Double glove with indicator system
C. Protective eye wear
D. Laminar flow ventilation
E. Surgical masks
51. Which of the following is a commonly used mechanism for reducing medical errors in
hospitals?
A. Confidential peer review
B. National hospital accreditation
C. Departmental grand rounds
D. Longer work shifts for employees to promote continuity of patient care
E. Random drug testing
52. The World Health Organization guidelines for safe surgery, include the sign in, time
out, and sign out check lists. Which of the following is an apparent effect of the Surgical
Safety Checklist?
A. Higher rates of antibiotic administration within the first 60 minutes of the operation.
B. Significant decrease in pneumonia in the first postoperative 30 days.
C. Adequate intravenous access in high-risk operations.
D. Significant benefits observed in hospitals serving low-income locations but not high-income
locations.
E. Decreased postoperative death rates.
53. Which of the following metabolic changes is most prominent during times of
physiologic stress?
A. Increase in growth hormone (GH) release
B. Increase in TSH
C. Increased levels of T4 and T3
D. Initial insulin increase and then suppression
E. Increase in cortisol excretion
54. Cytokines involved in the initial proinflammatory response include all of the following
EXCEPT:
A. Interleukin-6
B. Interleukin-10
C. Tumor necrosis factor-a
D. Interleukin-1
E. Interleukin-8
55. Which of the following interventions reduces the likelihood of Contrast Induced Acute
Kidney Injury (CIAKI)?
A. N-acetylcysteine administration before giving the dye load
B. A one-time dose of prednisone 40 mg before administration of dye load
C. 0.9% normal saline for 12 hours before and after giving the dye load
D. 0.45 % normal saline for 12 hours before and after giving the dye load
E. 1L bolus of 0.9 normal saline at the time of giving the dye load
56. A patient is brought to the emergency department after being found unresponsive.
Electroencephalography (EEG) indicates status epilepticus. A potential secondary clinical
consequence is:
A. Meningitis
B Hypothermia
C. Myoglobinuria
D. Cerebrovascular accident
E. Hypoglycemia
57. A patient with resolving ARDS requires a tracheostomy. The family wants to know the
benefit of early tracheostomy compared with prolonged intubation. Which of the
following is CORRECT?
A. There is no difference in overall mortality between patients receiving prolonged endotracheal
(ET) intubation and those receiving tracheostomy
B. There is increased sedation and pain requirement with a surgically placed tracheostomy.
C. There is an increased risk of pneumonia with ET intubation.
D. There is an increase in the time required for mechanical ventilation with tracheostomy
E. ICU stays are the same for both ET intubation and tracheostomy.
58. A 35-year-old woman presents to you after running her first marathon with
complaints of muscle aches. Which of the following is NOT an action of cortisol in this
metabolically stressed patient?
A. It stimulates release of insulin by the pancreas.
B. It induces insulin resistance in muscles and adipose tissue.
C. It stimulates release of lactate from skeletal muscle.
D. It induces release of glycerol from adipose tissue.
E. It leads to immunosuppression.
59. Which of the following substances has been shown to be usseful as a measurable
marker of the response to injury?
A. Tumor necrosis factor-a (TNF-a)
B. Interleukin-2 (IL-2)
C. IL-6
D. IL-10
C-reactive protein (CRP)
60. A 43-year-old man is diagnosed as a case of gangrenous gallbladder and gram-negative
sepsis. An assay to the tumor necrosis factor (TNF) is performed. Which of the followings
is the origin of this peptide?
A. Fibroblasts
B. Damaged vascular endothelial cells
C Monocytes/macrophages
D. Activated T lymphocytes
E. Activated Killer lymphocytes
61. A 52-year-old woman is listed as a renal transplant candidate. In order to assess the
propriety of the transplant, which of the following combinations represents how a crossmatch is performed?
A. Donor serum with recipient lymphocytes and complement
B. Donor lymphocytes with recipient serum and complement
C. Donor lymphocytes with recipient lymphocytes
D. Recipient serum with a known panel of multiple Donor lymphocytes
E. Recipient serum with donor red blood cells and complement
62. 48 hours after initiation of chemotherapy for a 39-year-old man having non-Hodgkin
lymphoma, he develops a high-grade fever and his Lab. studies demonstrates
hyperkalemia, hyperphosphatemia, and hypocalcemia. Which of the following cells
mediate this syndrome?
A. Macrophages
B. Cytotoxic T lymphocytes
C. Natural Killer cells
D. Polymorph nuclear leukocytes
E., Helper T lymphocytes
63. A 47-year-old man is proposed for kidney transplantation. He is anemic but is Which
of the following would preclude renal
otherwise functional transplantation?
A. Positive cross-match
B. Donor blood type O
C. Two-antigen HLA match with donor
D, Blood pressure of 180/100 mm Hg
E. Hemoglobin level of 8.2g/dL
64. Whish of the following is the most useful serum marker for detecting recurrent disease
after treatment of non-seminomatous testicular cancer?
А. СЕА
B. HCG
С. PSA
D. CA125
E. p53 oncogene
65. A 3-year-old boy is brought to the ER after spilling bleach onto his lower extremities.
He is diagnosed with a chemical burn. In addition to resuscitation, which of the following
is the most appropriate initial management of this patient?
A. Treatment of the burn with antimicrobial agents
B. Neutralize the burn wound with weak acids
C. lavage of the burn wound with large volumes of water
D. Wound debridement in the operating room
E. Treatment of the burn wound with calcium gluconate gel
66. Which of the following is the proper initial treatment for a 42-year-old man who came
to the ER with pain, numbness, and discoloration of his right forefoot after a weekend of
snow skiing?
A. Debridement of the affected part followed by silver sulfadiazine dressings
B. Administration of corticosteroids
C. Administration of vasodilators
D Immersion of the affected part in water at 40-44°c
E. Rewarming of the affected part at room temperature
67. A 25-year-old man was brought to the ER after sustaining burns during a fire in his
apartment. He has blistering and erythema of his face, left upper extremity, and chest. He
also has circumferential frank charring of his right upper extremity with decreased
capillary refill. He is agitated, hypotensive, and tachycardic. Which of the following is the
most appropriate initial management of his wounds?
A. Tropical antibiotics should be applied to the burn wounds
B. Excision of facial and hand burns
C. Escharotomy of the right upper extremity
D. Excision of all third-degree burns
E. Split-thickness skin grafts over the areas of third-degree burns
68. A 65-year-old man who weighs 80 kg, sustains a 50% TBSA burn. Using the Parkland
formula, what is the rate of Lactated Ringer solution should given in the first 8 hours?
A. 100 ml/h
B. 500 ml/h
C. 1000 ml/h
D. 5000 ml/h
E. 10000 ml/h
69. A 24-year-old man sustains 30 % TBSA burns to his torso, face, and extremities. His
wounds are treated topically with silver nitrate. Which of the following complications is
associated with use of this agent?
A. Hyponatremia
B. Metabolic acidosis
C Hyperchloremia
D. Neutropenia
E. Hypernatremia
70. After sigmoid resection with primary anastomosis for recurrent diverticulitis. The
patient returns 10 days later with left flank pain and decreased urine output; laboratory
results shows: WBC of 20,000/mm3. She undergoes a CT scan that demonstrates new left
hydronephrosis, but no evidence of an intraabdominal abscess. Which of the following is
the most appropriate next step in management?
A) Percutaneous nephrostomy
B. Intravenous antibiotics and repeat CT in one week
C. Administration of intravenous methylene blue
D. No further management if urinalysis is negative for hematuria
E. Immediate re-exploration
71. A 63-year-old man with a 40-pack per year smoking history undergoes a low anterior
resection for rectal cancer and on postoperative day 5 develops a fever, new infiltrate on
chest x-ray, and leukocytosis. He is transferred to the ICU for treatment of his pneumonia
because of clinical deterioration. Which of the following is a sign of early sepsis?
A. Respiratory acidosis
B. Decreased cardiac output
C. Hypoglycemia
D. Increased arteriovenous oxygen difference
E. Peripheral vasodilation
72. A 70-kg male patient presents to ED following a stab wound to the abdomen. He is
hypotensive, markedly tachycardic, and appears confused. What percent of blood volume
has he lost?
A. 5%
В. 15%
С. 25%
D 35%
E. 45%
73. A 43-year-old man is struck by a motor vehicle while crossing the street; he arrives in
the ED hypotensive, bradycardic, and unable to move his extremities. What is the most
likely cause of his hypotension?
A. Hypovolemic shock
B. Obstructive shock
C. Neurogenic shock
D. Vasodilatory shock
E. Septic shock
74. A patient with necrotizing pancreatitis undergoes computed tomography -guided
aspiration, which results in growth of Escherichia coli on culture. The most appropriate
treatment is:
A Culture-appropriate antibiotic therapy
B. Endoscopic retrograde cholangiopancreatography with sphincterotomy
C. CT -guided placement of drain(s)
D. Exploratory laparotomy
E. CT-guided aspiration of pus with culture-appropriate antibiotic injection
75. The first step in the evaluation and treatment of a patient with an infected bug bite on
the leg with cellulitis, bullae, thin grayish fluid draining from the wound, and pain out of
proportion to the physical findings is:
A. Obtain C-reactive protein
B. CT-scan of the leg
C. Magnetic resonance imaging (MRI) of the leg
D. Operative exploration
E. Immediate Penicillin-G administration
76. After an automobile accident, a 30-year-old woman is discovered to have a posterior
pelvic fracture. Hypotension and tachycardia respond marginally to volume replacement.
Once it is evident that her major problem is free intraperitoneal bleeding and a pelvic
hematoma in association with the fracture, appropriate management would be:
A. Application of medical anti-shock trousers with inflation of the extremity and abdominal
sections.
B. Arterial embolization of the pelvic vessels.
C. Laparotomy and ligation of the internal iliac arteries bilaterally.
D. Laparotomy and pelvic packing.
E. External fixator application to stabilize the pelvis.
77. At what pressure an operative decompression of extremity compartment is mandatory?
А. 10 mm Hg
В. 15 mm Hg
C. 25 mm Hg
D. 35 mm Hg.
E. 45 mm Hg
78. Which of the following is FALSE regarding healing of full thickness injuries to the GI
tract?
A. Serosal healing is essential to form a water-tight barrier to the lumen of the bowel.
B. Extraperitoneal segments of bowel that lack serosa have higher rates of anastomotic failure
C. There is an early decrease in marginal strength due to an imbalance of greater collagenolysis
versus collagen synthesis.
D. Collagen synthesis is done by fibroblast and smooth muscle cells.
E. The greatest tensile strength of the GI tract is provided by the serosa.
79. Immunologic rejection is mediated by the recipient's:
A. Eosinophils
B Lymphocytes
C. Neutrophils
D. Plasma cells
E. Reticulocytes
80. In the prevention of graft rejection, cyclosporine:
A, Blocks transcription of interleukin-1 and tumor necrosis factor-a.
B. Inhibits lymphocyte nucleic acid metabolism
C. Results in rapid decrease in the number of circulatory T lymphocytes
D. Selectively inhibits T-cell activation
E. Activates the production of corticosteroids
81. Prophylaxis using low-dose unfractionated heparin reduces the incidence of fatal
pulmonary embolisms (PE) by:
А. 20%
В. 35%
C. 50%
D. 75%
E. 90
82. Which of the following have been shown to decrease the time of postoperative ileus?
A. Cyclooxygenase-1 inhibitors
B. Morphine patient-controlled analgesia
C. Nasogastric drainage until full return of bowel function
D. Erythromycin
E. Delayed oral intake
83. Which of the following is the only thing that has been shown to decrease wound
infections in surgical patients with contaminated wounds?
A. Use of iodophor-impregnated polyvinyl drapes.
B. The use of broad-spectrum multiple antibiotics postoperatively
C. Antibiotic irrigation of the peritoneum and wound.
D. 24 hours of appropriate antibiotics postoperatively (in addition to preoperative dose)
E. Saline irrigation of the peritoneum and wound.
84. The most common cause of an empyema in the postoperative patient is:
A. Pneumonia
B. Systemic sepsis
C. Esophageal perforation
D Retained hemothorax
E. Sub-diaphragmatic abscess
85. A 50-year-old patient presents with symptomatic nephrolithiasis. He reports that he
underwent a jejunoileal bypass for morbid obesity when he was 39-year-old. Which of the
following is a complication of jejunoileal bypass?
A. Pseudohyperparathyroidism
B. Hyperuric aciduria
C. Hungry bone syndrome
D. Hyperoxaluria
E. Sporadic unicameral bone cysts
86. Ten days after an exploratory laparotomy and lysis of adhesions, a patient, who
previously underwent a low anterior resection for rectal cancer followed by postoperative
chemo-radiation, is noted to have succus draining from the wound. She appears to have
adequate source control. A febrile with a normal white blood count. The output from the
fistula is approximately 150 cc per day. Which of the following factors is most likely to
prevent closure of the entero-cutaneous fistula?
A. Previous radiation
B. Previous chemotherapy
C. Recent surgery
D. History of malignancy
E. More than 100-cc output per day
87. A 65-year-old woman has a life-threatening pulmonary embolus 5 days following
removal of a uterine malignancy. She is immediately heparinized and maintained in good
therapeutic range for the next 3 days, then passes gross blood from her vagina and
develops tachycardia, hypotension, and oliguria. Following resuscitation, an abdominal
CT scan reveals a major retroperitoneal hematoma. Which of the following is the BEST
next step in management?
A. Immediately reverse heparin by a calculated dose of protamine and place a vena caval filter
B. Reverse heparin with protamine, explore and evacuate the hematoma, and ligate the vena
cava below the renal veins,
C. Switch to low-dose heparin.
D. Stop heparin and observe closely
E. Stop heparin, give fresh-frozen plasma (FFP), and begin warfarin therapy.
88. Which of the following factors is part of the extrinsic pathway in the coagulation
cascade?
A. Factor XII
B. Factor XI
C. Factor IX
D. Factor VII
E. Factor XI
89. Which of the following is NOT true about cerebrospinal fluid (CSF):
A. CSF is produced by the choroid plexus in the lateral and third ventricles
B. CSF passes into the fourth ventricle via the aqueduct of sylvius
C. CSF enters the subarachnoid space through the two lateral foramina of magendie and the
central foramina of luschka
D. The total CSF volume is recycled more than once per day
E. CSF is absorbed by the arachnoid villi into the venous blood of the superior sagittal sinus
90. Which of the following hormones is NOT produced by the anterior pituitary gland:
A Adrenocorticotrophic hormone
B Antidiuretic hormone ADh
C. Growth hormone
D. Thyroid stimulating hormone
E. Prolactin
91. How many calories per day are required to maintain basal metabolism in a healthy
adult?
A. 10-15 Kcal/kg/day
B 20-25 Kcal/kg/day
C. 30-35 Kcal/kg/day
D. 40-45 Kcal/kg/day.
E. 50-55 Kcal/kg/day.
92. A 25-year- old man attends the emergency department following a road traffic
accident. A femoral shaft fracture is seen on X- ray and femoral nailing is carried out the
following morning. Six hours postoperatively, he develops pyrexia, confusion and
petechial rash on the anterior chest wall. What is the most likely diagnosis?
A. Acute lung injury
B. Acute respiratory distress syndrome
C. Atelectasis
D. Fat embolism
E. Pneumonia
93. A 40-year-old man presents with established hepatic disease and preoperative
coagulation screen shows an INR of 2. Which of the following metabolic disturbances is
most likely to have caused this result?
A. Decreased conjugation of bilirubin
B. Decreased formation of prothrombin
C. Decreased cholesterol in the bile
D. Increased formation of bile acids
E. Increased formation of fibrinogen
94. A 55-year-old woman with multiple injuries has developed disseminated intravascular
coagulation leading to hypofibrinogenemia and a risk of excessive hemorrhage. Which of
the following is most likely to have caused this condition?
A. Activation of the extrinsic clotting pathway by a drug administered to her
B, Activation of the extrinsic clotting pathway by products of tissue damage
C. Activation of the intrinsic clotting pathway by excess factor VIII levels
D. Activation, of the intrinsic clottihg pathway by excess calcium ions
E. Excess production of prothrombin (Factor II)
95. The routine use of postoperative nasogastric tubes in patients having major abdominal
operation:
A. Decreases the risk of aspiration pneumonia
B. Decreases the incidence of ventral hernia
C. Often causes metabolic acidosis
D. Decreases the time until return of normal bowel function
E. Increases length of hospital stay
96. Compared with wet to dry dressing changes, negative pressure wound therapy is
associated with all of the following EXCEPT:
A. Increased local blood flow
B. Stimulation of granulation tissue
C. Decreased tissue edema
D. Decreased bacterial counts
E. Increased rate of wound healing
97. Intraoperative hypothermia (patient temperature <35 C) is associated with all of the
following EXCEPT?
A. Increased blood loss during abdominal operation
B. Increased incidence of surgical site infection
C. Decreased clot formation
D. Decreased platelet activity
E. Decreased levels of fibrinogen
98. Raised serum amylase may be seen in all of the following conditions, EXCEPT?
A. Perforated duodenal ulcer
B. Parotiditis
C. Ruptured abdominal aortic aneurysm
D. Intestinal obstruction
E Hyperparathyroidism
99. During pregnancy, what is the optimal time to perform an elective abdominal
operation?
A. 5 to 9 weeks
B. 10 to 13 weeks
C.15 to 18 weeks
D. 26 to 28 weeks
E. After 32 weeks
100. Cryoprecipitate contains high concentrations of all of the following EXCEPT:
A. Fibrinogen
B. Factor VIII
C. Von Willebrand factor
D. Fibronectin
E. Factor X