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1. 50-year-old patient presents with symptomatic nephrolithiasis. He reports that he
underwent a jejunoileal bypass for morbid obesity when he was 39. Which of
the following is a complication of jejunoileal bypass?
A.
B.
C.
D.
E.
Pseudohyperparathyroidism
Hyperuric aciduria
Hungry bone syndrome
Hyperoxaluria
Sporadic unicameral bone cysts
2. A patient with a nonobstructing carcinoma of the sigmoid colon is being prepared
for elective resection. Which of the following reduces the risk of postoperative
infectious complication?
A. A single preoperative dose of antibiotic effective against aerobes and anaerobes
B. Avoidance of oral antibiotics to prevent emergence of Clostridium difficile
C. Postoperative administration for 48 hours of parenteral antibiotics effective against
aerobes anaerobes
D. Postoperative administration of parenteral antibiotics effective against aerobes and
anaerobes until the patient intravenous lines and all other drains are removed
E. Redosing of antibiotics in the operating room if the case lasts for more than 2 hours
3. A previously healthy 55-year-old man undergoes elective right hemi-colectomy for
a Stage I ( T2N0M0) cancer of the cecum. His postoperative ileus is somewhat
prolonged and on the fifth postoperative day his naso-gastric tube is still in place.
Physical examination reveals diminished skin turgor, dry mucous membranes,
and orthostatic hypotension, Pertinent laboratory values are as follows:
Arterial blood gases: pH 7.56 Pco2 50 mm Hg, Po2 85 mm Hg.
Serum electrolytes (mEq/L): Na+ 132, K+ 3.1 C1- 80; HCO3-42.
Urine electrolytes (mEq/L): Na+2.K+5,C1-6.
What is the patient’s acid – base abnormality?
A.
B.
C.
D.
E.
Uncompensated metabolic alkalosis
Respiratory acidosis with metabolic compensation
Combined metabolic and respiratory alkalosis
Metabolic alkalosis with respiratory compensation
Mixed respiratory acidosis and respiratory alkalosis .
1
4. A 52-year-old man with gastric outlet obstruction secondary to a duodenal ulcer
presents with hypochloremic, metabolic alkalosis . Which of the following is the
most appropriate therapy for this patient?
A. Infusion of 0.9% NaCl supplemental KCl until clinical signs of volume depletion are
eliminated.
B. Infusion of isotonic (0.15N) HCl via a central venous catheter
C. Clamping the nasogastric tube to prevent further acid losses
D. Administration of acetazolamide to promote renal excretion of bicarbonate
E. Intubation and controlled hypoventilation on a volume – cycled ventilator to further
increase Pco2
5. A victim of blunt abdominal trauma undergoes a partial hepatectomy. During surgery,
he receives twelve units of packed red blood cells. In the recovery room, he is noted to
be bleeding from intravenous puncture sites and the surgical incision. Which of the
following statements regarding the coagulopathy is most likely true?
A. The patient has an unknown primary bleeding disorder
B. The coagulopathy is secondary to the partial hepatectomy
C. The coagulopathy is secondary to dilutional thrombocytopenia and deficiency of clotting factors
from the massive blood transfusion
D. The treatment is oral vitamin K
E. The treatment is intravenous vitamin K.
6. A 59-year-old man is planning to undergo a coronary artery bypass. He has
osteoarthritis and consumes nonsteroidal anti-inflammatory drugs (NSAIDs) for the
pain. Which of the following is the most appropriate treatment prior to surgery to
minimize his risk of bleeding from his NSAID use?
A.
B.
C.
D.
Begin Vitamin K 1 week prior to surgery
Give FFP few hours before surgery
Stop the NSAIDs 1 week prior to surgery
Stop the NSAIDs 3 to 4 days prior to surgery
E. Stop the NSAIDs the day before Surgery .
7. A 12-year-old boy with a femur fracture after a motor vehicle collision undergoes
operative repair. After induction of anesthesia, he develops a fever of 40°C (104°F) ,
shaking rigors, and blood-tinged urine. Which of the following is the best treatment
option?
A.
B.
C.
D.
Alkalinization of the urine, administration of mannitol, and continuation with the procedure
Administration of dantrolene sodium and continuation with the procedure
Administration of dantrolene sodium and termination of the procedure
Administration of intravenous steroids and an antihistamine agent contin-uation of the
procedure
E. Administration of intravenous steroids and an antihistamine agent with termi-nation of the
procedure
2
8. A 53-year-old man with no significant medical problems undergoes lysis of adhesions for
a small-bowel obstruction. Postoperatively, he is placed on lactated Ringer solution for
the first 24 hours. Which of the following is true regarding lactated Ringer?
A.
B.
C.
D.
E.
It contains a higher concentration of sodium ions than does plasma
It is most appropriate for replacement of nasogastric tube losses
It is isosmotic with plasma
It has a pH of less than 7.0
It may induce a significant metabolic acidosis
9. A 74-year-old woman with a history of a previous total abdominal hys-terectomy
presents with abdominal pain and distention for 3 days. She is noted on plain films to
have dilated small-bowel obstruction. Which of the following inhalational anesthetics
should be avoided because of accumulation in air-filled cavities during anesthesia ?
A.
B.
C.
D.
E.
Diethyle ether
Nitrous oxide
Halothane
Methoxyflurane
Trichloroethylene.
10. A 64-year-old man with history of emphysema is admitted for hematemesis . The
bleeding ceases soon after admission, but the patient become confused and agitated.
Arterial blood gases are as follows: pH 7.23;Po2 42 mm Hg; Pco2 75 mm Hg. Which of
the following is the best initial therapy for this patient?
A.
B.
C.
D.
E.
Correct hypoxemia with high-flow nasal O2
Correct acidosis with sodium bicarbonate
Administer 10 mg intravenous dexamethasone
Administer 2 mg intravenous Ativan
Intubate the patient
11. A 65-year-old man undergoes a left upper lobectomy . An epidural catheter is inserted
for postoperative pain relief. Ninety minutes after the first dose of epidural morphine,
the patient complains of itching and becomes increasingly somnolent . Blood-gas
measurement reveals the following pH 7.24, Paco2 58, Pao2 100, and HCO3- 28.
Which of the following is the most appropriate initial therapy for this patient?
A.
B.
C.
D.
E.
Endotracheal intubation
Intramuscular diphenhydramine (Benadry1).
Epidural naloxone
Intravenous naloxone
Alternative analgesia .
3
12. A 43-year-old trauma patient develops acute respiratory distress syndrome (ARDS)
and has difficulty oxygenating despite increased concentrations of inspired O2.
After positive end-expiratory pressure (PEEP) is increased, the patient’s
oxygenation improves. What is the mechanism by which this occurs?
A.
B.
C.
D.
E.
Decreasing dead-space ventilation
Decreasing the minute ventilation requirement
Increasing tidal volume
Increasing function residual capacity
Redistribution of lung water from the interstitial to the alveolar space
13. A 22-year-old man sustains severe blunt trauma to the back. He notes that he
cannot move his lower extremities. He is hypotensive and bradycardic. Which of
the following is the best initial management of the patient?
A.
B.
C.
D.
E.
Administration of phenylephrine
Administration of dopamine
Administration of epinephrine
Intravenous fluid bolus
Placement of a trancutaneous pacer.
14. An elderly nursing home resident arrives at the emergency room mori-bund, with
little helpful history. She is profoundly alkalotic by blood-gas measurement, and
her urine shows an acid pH. Which of the following is the best possible explanation
for these findings?
A.
B.
C.
D.
E.
Release of inappropriate antidiuretic hormone
Severe crush injury
Acute tubular necrosis
Gastric outlet obstruction
An eoinophilic pituitary adenoma
15. A patient has a clean incision and then closure of the incision to excise an
unwanted benign nevus. With regard to the healing process, which of the
following statements is correct?
A.
B.
C.
D.
Collagen content reaches a maximum at approximately 1 week after injury
Monocytes are essential for normal wound healing
Fibroblasts appear in the wound within 24 to 36 hours after the injury
The function of monocytes in wound healing is limited to phagocytosis of bacteria and
debris
E. Early in wound healing, type I collagen is predominant .
4
16. A 35-year-old man with new diagnosis of Crohn disease presents with rapidly
enlarging painful ulcerations on the lower extremities. Cultures of the lesion are
negative, and skin biopsy reveals no evidence of malignancy. Which of the
following is the most appropriate treatment option ?
A.
B.
C.
D.
E.
Surgical debridement of the wound with skin grafting
Local wound care with silver sulfadiazine
Topical corticosteroids
Systemic steroids and immunosuppressants
Saphenous vein stripping and compressive stockings.
17. A 24-year-old firefighter sustains 30% total body surface area (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.
B.
C.
D.
E.
Hypernatremia
Metabolic acidosis
Hiperchloremia
Neutropenia
Hyponatremia
18. A 42-year-old woman has childhood history of a third-degree scald burn to her
right lower extremity that did not require skin grafting. She states that she
experienced trauma to the wound 1 year ago and since then she has had
persistent nonhealing of the area. A biopsy of the wound is performed. Which of
the following is the most likely diagnosis?
A.
B.
C.
D.
E.
Anioarcoma
Malignant melanoma
Squamous cell carcinoma
Kaposi sarcoma
Keloid
19. A 65-year-old man sustains a 50% TBSA burn while burning trash in the
backyard. The patient is resuscitated with lactated Ringer (LR) solution using
the Parkland formula a weight of 80Kg. What is the rate of LR given in the first
8 hours?
A.
B.
C.
D.
E.
100 mL/h
500 mL/h
1000 mL/h
5000mL/h
10000mL/h
5
20. A teenage boy falls from his bicycle and is run over by a truck. On arrival in the
emergency room (ER), he is awake and alert and appears frightened but in no distress.
The chest radiograph suggests an air-fluid level in the left lower lung and the
nasogastric tube seems to coil upward into the left chest. Which of the following is the
next best step in his management ?
A.
B.
C.
D.
E.
Placement of a left chest tube
Thoracotomy
Laparotomy
Esphagogastroscopy
Diagnostic peritoneal lavage.
21. A 28-year-old man is brought to the ER for a severe head injury after a fall. He was
intubated in the field for decreased level of consciousness. He is tachycardia and
hypotensive. On examination, he is noted to have an obvious skull fracture and his
right pupil is dilated. Which of the following is the most appropriate method for
initially reducing his intracranial pressure?
A.
B.
C.
D.
Elevation of the head of the bed
Saline-furosemide (Lasix) infusion
Mannitol infusion
Intravenous dexamethasone (Decadron)
E. Hyperventilaion
22. An 18-year-old high school football player is kicked in the left flank. Three hours later
he develops hematuria. His vital signs are stable. A CT scan demonstrates a Grad II
renal injury based on the Urologic Injury Scale of the American Association for the
Surgery of Trauma. Which of the following the most appropriate treatment for this
patient?
A.
B.
C.
D.
E.
Resumption of normal daily activity excluding sport
Exploration and suture of the laceration
Exploration and wedge resection of the kidney
Nephrostomy
Strict rest with serial hemoglobin levels .
23. A 19-year-old college student presents with a testicular mass, and after treatment he
returns for regular follow-up visits. Which of the following is the most useful serum
marker for detecting recurrent disease after treatment of nonseminomatous testicular
cancer?
A.
B.
C.
D.
E.
Carinoembryonic antigen (CEA)
Human chorionic gonadotropin (hCG)
Prostate-specific antigen (PSA)
CA125
P53 oncogene
6
24. A 50-year-old man is incidentally discovered to have non-Hodgkin lymphoma
confined to the submucosa of the stomach during esophagogas-troduodenoscopy
for dyspepsia. Which of the following statement is true regarding his condition?
A. Surgery alone cannot be considered adequate treatment
B. Combined chemotherapy and radiation therapy, without prior resection, are not
effective.
C. Combined chemotherapy and radiation therapy, without prior resection, result in a
high risk severe hemorrhage and perforation.
D. Outcome (freedom from progression and overall survival ) is related to the histologic
grade of the tumor.
E. The stomach is the most common site for non-Hodgkin lymphoma of the
gastrointestinal tract.
25. A 33 –year-old woman seeks assistance because of a swelling of her right parotid
gland. Biopsy is performed and reveals acinar carcinoma. In your discussion
regarding surgery, which of the following statements regarding malignant
parotid tumors is correct?
A. Acinar carcinoma is a highly aggressive malignant tumor of the parotid gland
B. Squamous carcinoma of the parotid gland exhibits only moderately malignant
behavior
C. Regional node dissection for occult metastases is not indicated malignant parotid
tumors because to their low incidence and the morbidity of lymphadenectomy
D. Facial nerve preservation should be attempted when the surgical margins of
resection are free of tumor.
E. Total parotidectomy (superficial and deep portions of the gland) is indicated for
malignant tumors.
26. A 53-year-old man presents with constipation and a 10-kg weight loss over the
course of 6 months. Colonoscopy reveals a fungating mass in the sigmoid colon;
biopsy is consistent with adenocarcinoma. His metastatic workup is negative. A
CEA level is obtained and is fourfold greater than normal. Which of the
following is the appropriate use of this test?
A.
B.
C.
D.
E.
As an indication for neoadjuvant chemotherapy
As an indication for postoperative radiation therapy
As an indication for preoperative PET scanning
As an indication for a more aggressive sigmoid resection
As a baseline measurement prior to monitoring postoperatively for recurrence
7
27. recurrent laryngeal nerve is in close association with
A.
B.
C.
D.
E.
superior thyroid artery
inferior thyroid artery
meddle thyroid vein
superior thyroid vein
arteria thyroidea ima
28. thyrogossal cyst may occasionally give rise which carcinoma
A.
B.
C.
D.
E.
papillary
medullary
anaplastic
follicular
Hurthle cell
29. which of the following statements regarding unusual hernias is incorrect
A. an obturator hernia may produce nerve compression diagnosed by a positive HowshipRomberg sign
B. Grynfeltts hernia appears through the superior lumbar triangle, whereas Petits hernia
occurs through the inferior triangle
C. sciatic hernia usually present with a painful groin mass below the inguinal ligament
D. Litters hernia is defined by a Meckels diverticulum presenting as the sole component of the
hernial sac
E. Richters hernia involves the antimezenteric surface of the intestine within the hernia sac and
may present with partial intestinal obstruction
30- All of the following statements concerning the abdominal wall layers are correct
except
A. scarpas fascia affords little strength in wound closure
B. the internal abdominal oblique muscles have fibers that continued into the scrotum as
cremastric muscle
C. the transversalis facsia is the most important layer of the abdominal wall in preventing
hernias
D. the lymphatics of the abdominal wall drains into the ipsilateral axillary lymph nodes above
the umbilicus and into the ipsilateral superfiscial inguinal lymphnodes below the umbilicus
E. the deep inferior epigastric arteries comes from the common femoral artery
31. A 77-year-old multiparous female presents with a bowel obstruction. She has no
previous abdominal operations and no abdominal wall hernias can be detected. In
addition to her abdominal symptoms, she reports pain in her right medial thigh. One of
the following statements is true concerning her diagnosis and management.
a. Expectant management with nasogastric suction and IV fluid replacement is indicated
b. A right groin approach is indicated for exploration and repair of the presumed hernia
c. The use of a polypropylene mesh will likely be necessary for repair
d. A correct diagnosis can usually be made by visualizing an external mass in the upper, medial thigh
e. Plain radiographs are helpful in diagnosis of most cases
8
32. Which of the following statements about surgical anatomy of the colon and
rectum is correct?
A. The cecum has the largest inner diameter of all segments of the colon (13 to 15 cm.).
B. The rectosigmoid junction is situated at approximately 20 to 25 cm. from the anus.
C. The rectum is entirely an intraperitoneal organ.
D. The ileocolic, right colic, and middle colic arteries are branches from the inferior
mesenteric artery.
E. The arterial arcade created by communicating vessels at 1 to 2 cm. from the
mesenteric is called the artery of Drummond.
33. Which of the following statements about familial adenomatous polyposis (FAP) is
true?
A. Inherited in an autosomal-dominant manner, this genetic defect is of variable
penetrance, some patients having only a few polyps whereas others develop thousands.
B. The phenotypic expression of the disease depends mostly on the genotype.
C. Appropriate surgical therapy includes total abdominal colectomy with ileorectal
anastomosis and ileoanal pull-through with rectal mucosectomy.
D. Panproctocolectomy with ileostomy is not appropriate therapy for this disease.
E. Pharmacologic management of this disease may be appropriate in some instances.
34. Which of the following statements about hemobilia are true?
A. Tumors are the most common cause.
B. The primary treatment of severe hemobilia is an operation.
C. Percutaneous cholangiographic hemobilia is usually needs surgical intervention.
D. Ultrasonography usually reveals a specific diagnosis.
E. Arteriography remains the best diagnostic method.
35-Which of the following statements MOST accurately applies to the ZollingerEllison syndrome?
A.
B.
C.
D.
E.
75% of patients will have multiple endocrine neoplasia type 1
Requires total gastrectomy
Patients have an increase in gastrin with secretin stimulation
Patients usually have a basal acid secretion of less than 15 mEq/hr
Spontaneous resolution of the gastrinoma associated with the disease is common
36-Gastric polyps
A.
B.
C.
D.
E.
Are most commonly adenomatous
Require gastrotomy and removal if greater than 2 cm and are pedunculated
Are rarely multiple
Are clearly premalignant
Are more frequent in achlorhydric patients
9
37-All of the following statements are true about patients with carcinoid tumors
EXCEPT
A.
B.
C.
D.
E.
They often have evidence of serotonin production
Tumor growth is often slow
The majority have carcinoid syndrome
They have a much better prognosis if the tumors are less than 2cm
The combination of streptozotocin and 5-fluorouracil can often in objective response
38-Carcinoma of the gallbladder is
A.
B.
C.
D.
E.
Associated with a good prognosis
Most commonly metastatic to the lung
Rarely associated with jaundice
Usually not diagnosed preoperatively
Best treated with radiation and chemotherapy
39-All of the following are true statements concerning Paget’s disease of the nipple
EXCEPT
A.
B.
C.
D.
E.
It is very uncommon, accounting for only 2% of all breast cancers
It is an in situ squamous cell malignancy of the nipple
It is an eczematoid lesion
It has a better prognosis than the majority of the breast cancers
It can be confused with malignant melanoma histologically
40-A 46- year- old male presents with recurrent episodes of severe headaches and
sweating. Physical examination reveals a blood pressure of 170/95, a pulse of 95,
and a thyroid nodule. Which of the following laboratory results would you
expect to be elevated?
A.
B.
C.
D.
E.
Thyroid-stimulating hormone
Urinary 5-hydroxyindoleacetic acid
Plasma serotonin
Urinary catecholamines
Serum thyroxine level
41-Atrophy in the thyroid epithelium in hashimoto’s disease results from
A.
B.
C.
D.
E.
Auto-immunity
Pituitary malfunction
Malnutrition
Pressure caused by adjacent neoplasm
Excessive TSH
42-After injury with loss of cells which of the following is (are) most likely to
regenerate most completely
A.
B.
C.
D.
E.
Neurons of CNS
Liver parenchymal cells
Skeletal muscle
Heart muscle
Neurons of retina
10
43-Which of the following is not a neoplasm of mesenchymal origin?
A.
B.
C.
D.
E.
Papilloma
Hemangiona
Lipoma
Rhabdomyoma
Leiomyome
44-Which of the following characteristic is not typical of sarcoma?
A.
B.
C.
D.
E.
Pleomorphism
Blood vessel invasion
Lymphatic invasion
Mesodermal origin
Metastases to distant sites
45-All of the following statement about small bowel neoplasms are true except
A.
B.
C.
D.
E.
They account less than 10% of all GI tumors
Malignant tumor are more prevalent than benign tumor
Adenomatous polyps are the most common type of benign tumor
Large adenomas of small bowel often undergo malignant transformation
Malignant lymphoma occurs more frequently than adenoearcinoma
46-A 63-year-old female has been vomiting for several hours. Her blood gases are
PH 7.51 HCO3 32 mmoL/L AND pco2 40 mmHH. The most likely diagnose is
A.
B.
C.
D.
E.
Anion gap metabolic acidosis
Nonunion gap metabolic acidosis
Metabolic alkalosis
Respiratory acidosis
Respiratory alkalosis
47-The symptom complex of dermatitis, dementia, and diarrhea is strongly
suugeestive of a deficiency of
A.
B.
C.
D.
E.
Nicotinamide
Folic acid
Vitamin C
Riboflavin
Non of the above
48-Which of the following cell types is most crucial in chronic rejection reaction?
A.
B.
C.
D.
E.
Lymphocytes
Plasma cells
Histiocytes
Tissue eosinophils
Segmented leukocytes
11
49-Primary causes of noninflammatory edema include all of the following EXCEPT:
A.
B.
C.
D.
E.
An increase in intravascular hydrostatic pressure
Increased vascular permeability
Diminished plasma colloid osmotic pressure
Lymphatic obstruction
An impairment of renal function
50-A localized overgrowth of mature cells in a tissue resembling, or having some
features, of a tumor most closely describes:
A.
B.
C.
D.
E.
Desmoplasia
Metaplasia
Choriostoma
Hamartoma
Anaplasia
51-Dysplasia is characterized by all of the following EXCEPT
A.
B.
C.
D.
E.
Disorderly proliferation of cells
Pleomorphism
Hyperchromaticity
Most frequently occurs in epithelium
Relentless progression to malignant neoplasm
52-All of the following are true of achalasia EXCEPT:
A.
B.
C.
D.
E.
It may be caused by trypanosome cruzi infection
There is partial or incomplete relaxation of lower esophageal sphincter (LES)
Dilatational tortuosity of the esophagus above the level of the sphincter is the rule
Consistently shows the absence of myenteric ganglion cells in the lower sphincter
The esophageal mucosa may show ulceroinflammatory and fibrotic lesions
53-The most vulnerable part of the colon to transmural infarction (gangrene) caused
by thrombotic or embolic occlusion of the celiac-mesenteric axis is the:
A.
B.
C.
D.
E.
Splenic flexure
Cecum
Transverse colon
Ascending colon
Rectum
54-Which of the following is NOT true of the laceration in the Mallory-Weiss
syndrome?
A.
B.
C.
D.
E.
Linear configuration
Variable length- from a few millimeters to several centimeters
Usually observed in the distal esophagus
Aligned at right angle to the long axis of the esophagus
May stretch across the esophagogastric junction
12
55-Which of the following statements concerning carcinoid tumor is NOT true?
A. The neoplasm arise from basigranular Kulchitsky’s cells
B. The neoplasm most frequently occurs in distal ileum and appendix
C. Episodic skin flushing, diarrhea, bronchospam, and hypotension are the symptoms of
the carcinoid syndrome
D. Involvement of the tricuspid valves is the usual cardiac lesion in cases where the heart
is involoved
E. The most common site of metastases is the lung
56-Splenomegaly associated with cirrhosis is
A.
B.
C.
D.
E.
Neoplastic
Dysplastic
Congestive
Hamartomatous
Inflammatory
57-The most helpful serological test in primary biliary cirrhosis is
A.
B.
C.
D.
E.
Antismooth muscle antibodies
Antimitochondrial antibodies
HBsAG
Antinuclear ntibodies
Non of the above
58-Pseudomyxoma peritonei may be expected to arise from which ovarian
neoplasm?
A.
B.
C.
D.
E.
Mucinous cystadenocarcinoma
Endometrial adenocarcinoma
Serous cystadenocarcinoma
Clear cell adenocarcinoma
Undifferentiated carcinoma
59-Carcinoma of the thyroid is characterized by all of the following EXCEPT
A.
B.
C.
D.
E.
Nearly half of the thyroid nodules in children are malignant
A history of previous irradiation in infancy can be elicited in about 25% of patients
The incidence is higher in girls than boys
The tumor may be multifocal
A follicular pattern is the predominant type
60-All of these are true of pancreatic pseudocysts EXCEPT
A. They may be found within the pancreatic tissue but more often are located adjacent to
the pancreas
B. Most are secondary to pancreatitis,pancreatic necrosis, or hemorrhage
C. They usually are connected to the pancreatic duct system
D. They are devoid of an epithelial lining
E. They are usually unilocular
13
61-The current proposed pathogenesis of Graves’ disease implicates
A.
B.
C.
D.
E.
Dyshormogenesis
Granulomatous inflammation
Nonspecific chronic inflammation
Autoimmunity
Excessive production of thyroid- stimulating hormone
62- Malignant melanoma occurring in which of the following parts of the
gastrointestinal tract is most likely to be a primary neoplasm.
A.
B.
C.
D.
E.
Stomach
Duodenum
Jejunum
Colon
Anal canal
63-Truses and surgical belts are contraindicated for patient with .
A.
B.
C.
D.
E.
Inguinal hernia
Femoral hernia
Incisional hernia
Umbilical hernia
Epigastric hernia
64- Forniers gangrene is seen at the :
A.
B.
C.
D.
E.
dorsum of hand.
scrotum.
axilla.
deep palmer space.
omentum
65-In patients with neoplastic obstruction of the common bile duct:
A.
B.
C.
D.
E.
The gallbladder is never distended
The gallbladder is rarely distended
The gallbladder is frequently distended
Tenderness is rarely present
The prognosis is generally excellent
66-In severe hypospadias,the possibility of an intersex problem is settled by:
A.
B.
C.
D.
E.
Careful inspection of the genitals
Biopsy of the gonadal tissue
Karyotyping
Hormone assay
Laparotomy
14
67-The most frequent complication of amebiasis is :
A.
B.
C.
D.
E.
Lung abscess
Liver abscess
Convulsions and coma
Hemolytic anemia and bone marrow suppression
Retinal detachment
68- Each of the following is a well-recognized complication of ulcerative colitis,
except:
A.
B.
C.
D.
E.
diabetes
fatty infiltration of the liver
Arthritis
Pyoderma gangrenosum
Erythema nodosum
69-The most common liver tumor is:
A.
hepatocellular carcinoma
B.
C.
D.
E.
hepatoblastoma
cholangiocarcinoma
metastatic disease
angiosarcoma
70--The first step in management of sigmoid volvulus should be
A.
B.
C.
D.
E.
administration of laxatives and cleansing enemas
barium enema
rigid sigmoidoscopy
sigmoid resection
transverse colostomy
71- after direct blow to scroto perineal area your patient is unable to void urine,
having blood drop at the meatus , your management may include all exept :
A.
B.
C.
D.
E.
suprapubic catheter.
urethrogram.
F. catheter.
admission to hospital.
PR examination
72. in carpel tunnel syndrome the nerve compressed is
A.
B.
C.
D.
E.
ulnar
radial
musculo-cutaneous
median
posterior interosseious
73. Bloody nipple discharge may be caused by the following except:
15
A.
B.
C.
D.
E.
duct papilloma
fibroadenoma of the breast
carcinoma of the breast
duct ectasia
trauma of the breast with bleeding disorder
74-A 74-year – old woman complains of vomiting and intermittent colicky abdominal
pain. X-ray revealed fluid levels and air in the biliary tree. What is the likely
cause?
A.
B.
C.
D.
E.
Abdominal adhesions.
Gallstone ileus .
Carcinoma of the right colon.
Adbominal lymphosarcoma .
Previous choledochoduodenstomy.
75. A 25-year-old man presents to the emergency room having swallowed two open
safety pins 6 h ago. X-rays show the pins to be located in the small intestine. The
most appropriate management at this point would be
A. administration of a broad-spectrum antibiotic intravenously
B. a 10-day course of oral metronidazole
C. administration of 250 mL of magnesium citrate to induce catharsis and increase the rapidity of
passage
D. follow-up with serial x-rays and abdominal examinations
E. immediate surgery
76-The commonest benign tumor of parotid gland is:
A.
B.
C.
D.
E.
oxyphil adenoma
warthin`s tumor
mixed tumor
lymphangioma
haemangioma
77-. Which is incorrect regarding acute abdomen:
A.
B.
C.
D.
E.
the absence of the air on an erect chest XR excludes perforated duodual ulcer.
can be caused by mesenteric lymphadenitis
herpis zoster can give a picture of acute abdomen
Henoch-Schonlein purpura may present by acute abdominal pain
three fold increase of serum amylase is diagnostic of pancreatitis
16
78-which one of the following clinical signs or symptoms is not associated with serum
sodium concentrations below 125 mEq/L?
A.
B.
C.
D.
E.
Headache
Hallucinations
Bradycardia
Hypoventilation
Hyperthermia
79-Regarding peritonitis which of the following statements is not true?
A. Primary peritonitis is commoner in children with nephrosis and adults with cirrhosis
than in patients without such conditions
B. Primary peritonitis is usually monomicrobial
C. Chemical peritonitis often precedes bacterial contamination
D. Multiple organisms are commonly cultured from peritoneal dialysis catheters
E. Tuberculosis peritonitis has an insidious onset
80-Effective management of gastric acid aspiration include which of the following?
A.
B.
C.
D.
Tracheal intubation and saline lavage of the lungs
Prophylactic antibiotic therapy
prophylactic steroid therapy
Tracheal intubation, suctioning, and controlled ventilation with positive endexpiratory pressure(PEEP) therapy
E. Diuresis
81-which of the following is an indication for resection of a segment of small bowel ?
A.
B.
C.
D.
E.
loss of more than 20% of the bowel wall
two injuries in a segment
compromise of the blood supply of a segment
injuries within 40cm of the ileocecal valve
injuries within 40cm of the ligament of Treitz
82-In liver trauma
A. Nonoperative treatment is considered the treatment of choice for stable patients with
isolated hepatic trauma
B. Temporary compression of the hepatoduodenal ligament may be performed for up to
90 min without causing ischemic damage
C. Contained subcapsular hematomas discovered in the operating room should always be
explored
D. For deep lacerations that are actively bleeding the finger fracture technique is rarely
successful
E. Liberal use of intraoperative packing, rapid abdominal closure and secondary
resuscitation in the intensive care unit has led to increased mortality rates in patients
with grade IV and V hepatic injuries
17
83- A33-year old woman involved in a house fire sustain burns to bilateral lower
extremities, anterior torso ,genital area and entire left arm .approximately what
percentage of the total body surface area is burned ?
A.
B.
C.
D.
E.
45%
64%
36%
72%
54%
84- All of the following are adverse events associated with use of quinolones except
A.
B.
C.
D.
E.
Tendonitis and possible tendon rupture
Seizures
Arthropathy in children
C.difficile colitis
Narrowing of the QT interval
85-During an emergency appendectomy, a surgical resident sustained an injury from
a contaminated hollow-bore needle with spontaneous bleeding. Which of the
following blood-borne organisms is most likely to be transmitted, assuming the
patient was infected with all of them?
A.
B.
C.
D.
E.
HIV
Hepatitis B
Hepatitis C
Malaria
E.Syphilis
86- which of the following insufflation gases for laparoscopic pneumoperitoneum
has the greatest solubility in water?
A.
B.
C.
D.
E.
Carbon dioxide
Nitrous oxide
Helium
Argon
Air
87- which of the following body compartments is the largest reservoir for CO2?
A.
B.
C.
D.
E.
Bone
Skeletal muscle
Lungs
Peritoneum
Bowel
88-Regarding metastatic cancer, which of the following statements is true?
18
A.
B.
C.
D.
E.
Axillary lymph node dissection is essential for staging a sarcoma of the breast
Melanoma tends to metastasize first to the lung, brain and gas trointestinal tract
Bone is frequently the site of metastasis for cancer of the breast and prostate
Primary brain cancers have a predilection for metastasis to the lung
None of the above
89-with regard to keloids and hypertrophic scars, which of the following
statements is true?
A.
B.
C.
D.
There are no histologic differences between the two
The differences between hypertrophic scar and keloid are clinical, not pathologic
Hypertrophic scars does not outgrow their original borders
Hypertrophic scars and keloids have been treated successfully with intralesional injection of
steroids
E. keloids are seen in dark skinned individuals, whereas hypertrophic
90-with regard to cystosarcoma phylloides, which of the following statements is not
true?
A.
B.
C.
D.
E.
It bears a histologic relationship to fibroadenoma
Ten percent are malignant
As with ductal carcinoma, it has a high incidence of multicentricity within the breast
Axillary lymph nodal metastases are uncommon
Wide local excisions or total (simple) mastectomy usually suffices for treatment
91-regarding acute supurative parotitis, which one of the following statements is not
true?
A.
B.
C.
D.
It usually occurs in elderly or debilitated patients
Dehydration is a major contributing factor
Immediate surgical drainage is mandatory
The numerous vertically oriented fascial septa of the parotid space lead to multilocalated
abscesses when infection
E. S. aureas is the most frequent causative organism
92-in regard to follicular thyroid cancer, which of the following is true?
A. It occurs predominantly in females, and estrogens have been recently found to be a risk factor
B. The major histologic criterion for diagnoses is unequivocal capsular and vascular invasion
C. Both minimally invasive and widely invasive follicular Cancers are likely to have regional
lymph node involvement on presentation
D. Cytologically, it can be easily differentiated from a benign adenoma
E. None of the above
93-A patient with previous diagnoses of primary hyperparathyroidism presents with
rapidly developing muscular weakness, nausea, vomiting, and confusion. Which of the
following initial step of management?
A.
B.
C.
D.
E.
Vigorous hydration with intravenous saline solution
Intravenous furosemide
Intravenous mithramycin
Intravenous calcitonim
Immediate parathyroid exploration
94-which of the following
pheochromocytoma?
studies
are
19
useful
for
the
diagnosis
of
a
A.
B.
C.
D.
E.
Clonidine suppression test
24-hr urine metanephrine levels
24-hr urine vanillylmandelic acid levels
plasma catecholamine levels
none of the above
95-During an operation for presumed appendicitis, the appendix is found to be
normal. The terminal ileum, however, is markedly thickened and feels rubbery to
firm. It's serosa is erythematous and inflamed, and several loops of apparently
normal small intestine are adherent to it. The terminal ileum mesentery
thickened, with fat growing about the bowel circumference. Which of the
following is the most likely diagnoses?
A.
B.
C.
D.
E.
Crohn's disease of the terminal ileum
Perforated meckel's diverticulum
Ulcerative colitis
Ileusecal tuberculosis
Acute ileitis
96-A 26-year-old man presents to the emergency room with the complaint of
recurrent, colicky, midabdominal pain. Physical examinations reveals a
palpable abdominal mass and several areas of increasing pigmentation on his
lips, palms, and soles. He states that his father had a colon polyp removed
several years ago. Which of the following is the most likely diagnoses?
A.
B.
C.
D.
E.
Familial polyposis with malignant degeneration
Gardner syndrome with intussusception
Peutz-jeghers (PJS) syndrome with intussusception
Symptomatic Crohn's disease
Mesentric lymphadeitis
97-with regards to Meckel's diverticula, which of the following statements is true?
A. They are found in various anatomic forms and clinical presentations in 50% of the
population
B. They are true diverticula
C. Some can be visualized on technetium 99m pertechnetate (99mTc)scans
D. most complications occur in the elderly
E. diverticulitis is the most common complication
98-which of the following statements regarding the pathogenesis of appendicitis is
false?
20
A.
B.
C.
D.
Luminal obstruction is always the cause of acute appendicitis
Luminal obstruction leads to increased pressure and distention of the appendix
Obstruction of venous outflow and then arterial inflow results in gangrene
Obstruction of the lumen may occur from lymphoid hyperplasia, inspissated stool, or a
foreign body
E. Viral or bacterial infections can precede an episode of appendicitis
99-which of the following proteins is not primarily synthesized in the liver?
A.
B.
C.
D.
E.
Albumin
Fibrinogen
Von wilebrand factor
Transferring
Factor VII
100-Laparoscopic cholecystectomy is most strongly contraindicated in?
A.
B.
C.
D.
E.
pregnancy
prior upper abdominal surgery
known common bile duct stones
chronic obstructive pulmonary disease
gallbladder cancer
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