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*1. Which of the following is the mechanism of action of omeprazole? A. Blockage of the breakdown o f mucosa-damaging metabolites of nonsteroidal antiinflammatory drugs (NSAIDs) B. Provision of a direct cytoprotective effect C. Buffering of gastric acids D. Inhibition of parietal cell hydrogen potassium ATPase (adenosine triphosphatase) E. Inhibition of gastrin release and parietal cell acid produ ction *2. Which of the following is the most common serious complication of an end colostomy? A. Bleeding B. Skin breakdown C. Parastomal hernia D. Colonic perforation during irrigation E. Stomal prolapse *3. A 45-year-old woman with history of heavy nonsteroidal anti-inflammatory drug ingestion presents with acute abdominal pain. She undergoes exploratory laparotomy 30 hours after onset of symptoms and is found to have a perforated duodenal ulcer. Which of the following is the procedure of choice to treat her perforation? A. Simple closure with omental patch B. Truncal vagotomy and pyloroplasty C. Truncal vagotomy and antrectomy D. Highly selective vagotomy with omental o mental patch 4. Which of the following hernias follows the path of the spermatic cord within the cremaster muscle? A. Femoral B. Direct inguinal C. Indirect inguinal D. Spigelian E. Interparietal
*5. A 70-year-old woman has nausea, vomiting, abdominal distention, and episodic crampy midabdominal pain. She has no history of previous surgery but has a long history of cholelithiasis for which she has refused surgery. Her abdominal radiograph reveals a spherical density in the right lower quadrant. Which of the following is the definitive treatment for this patient’s bowel obstruction? A. Ileocolectomy B. Cholecystectomy C. Ileotomy and extraction D. Nasogastric (NG) tube decompression E. Intravenous antibiotics *6. A previously healthy 15-year-old boy is brought to the emergency room with complaints of about 12 hours of progressive anorexia, nausea, and pain of the right lower quadrant. On physical examination, he is found to have a rectal temperature of 38.18°C (100.72°F) and direct and rebound abdominal tenderness localizing to McBurney point as well as involuntary guarding in the right lower quadrant. At operation through a McBurney-type incision, the appendix and cecum are found to be normal, but the surgeon is impressed by the marked edema of the terminal ileum, which also has an overlying fibrinopurulent exudate. Which of the following is the most appropriate next step? A. Close the abdomen after culturing the exudate. B. Perform a standard appendectomy. C. Resect the involved terminal ileum. D. Perform an ileocolic resection. E. Perform an ileocolostomy to bypass the involved terminal ileum.
*7. A 50-year-old man presents to the emergency room with a 6-hour history of excruciating abdominal pain and distention. The abdominal film shown here is obtained. Which of the following is the most appropriate next diagnostic maneuver?
A. Emergency celiotomy B. Upper GI series with small-bowel follow-through C. CT scan of the abdomen D. Barium enema E. Sigmoidoscopy *8. Which of the following is the most common diagnosis for tumors involving the lips? A. Squamous cell carcinoma B. Basal cell carcinoma C. Malignant melanoma D. Keratoacanthoma E. Verrucous carcinoma
9. Warthin's tumor is commonly seen in A. Sublingual salivary gland B. Submandibular salivary gland C. Accessory salivary gland D. Parotid gland 10. Parotid gland is a A. Protenaceous salivary gland B. Serous salivary gland C. Mucoserous salivary gland D. Mucinous salivary gland 11. Sialolithiasis is common in A. Sublingual salivary gland B. Parotid gland C. Accessory salivary gland D. Submandibular salivary gland 12. Twenty-four hours after admission to the surgical intensive care unit (ICU), a postoperative patient is noted to have bright red blood through the nasogastric tube. All of the following have shown efficacy in preventing stress gastritis except: A. Sucralfate B. Proton pump inhibitors C. Enteral diet D. Histamine-2 (H2) receptor antagonists E. Antacids 13. A patient is brought to the surgical ICU after emergency exploratory laparotomy for fecal peritonitis. The operation was prolonged and required 10 L of fluid resuscitation. All of the patient was doing well postoperatively until 4 hours later, when the nurse noted a change in urine color from yellow to dark brown. She also says that the patient’s output has decreased and his creatinine has risen from 1.0 to 1.5. Which test would confirm the cause of these findings? A. Renal ultrasound B. Haptoglobin C. Serum creatine kinase D. Complete blood count E. Urine electrolytes 14. The physiologic parameters used in the definition of SIRS include all of the following except: A. Temperature lower than 36° C B. Respiratory rate greater than 20 breaths/min C. Paco2 less than 32 mm Hg D. Systolic blood pressure lower than 90 mm Hg E. Heart rate greater than 90 beats/min
15. With regard to measurement of bleeding times, which of the following statements is true? A. Spontaneous bleeding may occur with platelet counts higher than 15,000/μL. B. Platelet counts higher than 150,000/μL exclude the possibility of a primary hemostatic disorder. C. Bleeding time is a predictor of surgical bleeding. D. Platelet counts higher than 50,000/μl are usually associated with a normal bleeding time and adequate surgical hemostasis. E. Normal bleeding time excludes von Willebrand disease as a potential factor affecting surgical hemostasis. 16. Which of the following conditions is associated with an isolated prothrombin time (PT) prolongation? A. von Willebrand disease B. Factor VIII deficiency (hemophilia A) C. Common pathway factor deficiencies (factors II, V, and X and fibrinogen) D. Therapeutic anticoagulation with warfarin (Coumadin) E. Therapeutic anticoagulation with heparin 17. Which of the following pairing statements regarding daily fluid balance is incorrect? A. Daily water intake, 2000 to 2500 mL B. Average stool loss, 1000 mL C. Average insensible loss, 600 mL D. Average urine volume, 800 to 1500 mL E. Average increase in insensible loss in a febrile patient, 250 mL/day for each degree of fever 18. Which of the following clinical situations can be associated with hypovolemic hyponatremia? A. CHF B. SIADH C. Cirrhosis D. Hyperglycemia E. Gastrointestinal losses 19. With regard to potassium, which of the following statements is not true? A. Normal dietary intake of potassium is 50 to 10 0 mEq/day. B. In patients with normal renal function, most ingested potassium is excreted in urine. C. More than 90% of the potassium in the body is located in the extracellular compartment. D. Critical hyperkalemia (>6 mEq/L) is rarely encountered if renal function is normal. E. Administration of sodium bicarbonate shifts potassium from the extracellular space (ECF) to the intracellular space (ICF).
20. Glucagon mobilizes which of the following: A. Glycogen from muscle tissue B. Liver glycogen C. Insulin to improve cellular uptake of glucose D. Glucose to the liver for storage E. None of the above 21. Which of the following vitamins is water-soluble? A. Vitamin A B. Vitamin D C. Vitamin E D. Vitamin C E. Vitamin K 22. A 33-year-old woman is scheduled for elective cholecystectomy. Preoperative evaluation shows the presence of mild to moderate hypothyroidism. Select the next most appropriate action: A. Proceed with surgery with the know ledge that minor perioperative complications could develop. B. Postpone surgery until a euthyroid state is achieved. C. Proceed with surgery while beginning treatment with levothyroxine. D. Proceed with surgery while beginning treatment with thionamides. E. Proceed with surgery if severe clinical symptoms are not present. 23. Which of the following is not a trigger of visceral pain? A. Ischemia B. Traction C. Distention D. Heat E. Inflammation 24. A 35-year-old woman experiences an acute onset of epigastric and right upper quadrant pain several hours after a large dinner. She has had similar episodes in the past that resolved after a few hours. This episode persists, and she has fever and nonbilious vomiting. What is the most likely source of the abdominal pain? A. Perforated ulcer B. Acute appendicitis C. Perforation following bowel obstruction D. Cholecystitis E. Diverticulitis 25. Regarding patients with a rigid abdomen and free air on plain film, which of the following statements is true? A. No further radiologic work-up is required. B. CT scanning with contrast enhancement is required to confirm the diagnosis.
C. Bedside sonographic imaging is preferred over CT imaging to confirm the diagnosis of free air. D. Narcotics are contraindicated in patients with an acute abdomen. E. Preoperative prophylactic steroids are indicated in patients with free air. 26. A 65-year-old man with a history of chronic constipation has a 3-day history of abdominal distention without a bowel movement. He has fever and abdominal rigidity. What is the most likely source of the abdominal pain? A. Perforated ulcer B. Acute appendicitis C. Perforation following bowel obstruction D. Cholecystitis E. Diverticulitis 27. A 44-year-old man suffers a gunshot wound to his left thigh that results in an injury to the superficial femoral artery. The injury is repaired with a saphenous vein interposition graft within 4 hours of the injury. Although the patient had equal pulses bilaterally and was neurologically intact, 5 hours postoperatively the left distal pulses diminish and he begins to experience pain with passive dorsiflexion and extension. The left anterior compartment of the lower part of the leg has a pressure of 30 mm Hg. Which of the following statements is true regarding compartment syndrome in an extremity? A. Fractures are the cause of appro ximately 30% of all compartment syndromes. B. The lateral compartment of the lower part of the leg is the most commonly affected. C. A compartment pressure of 25 mm Hg negates a need for fasciotomy. D. hypotension are an early clinical development. E. A four-compartment fasciotomy should be performed. 28. A 28-year-old woman is an unrestrained driver in a motor vehicle crash. She has stable vital signs and left upper quadrant tenderness without signs of peritonitis. Select the most appropriate next step in management of the abdominal pain? A. Computed tomographic (CT) scan of the abdomen and pelvis B. Diagnostic peritoneal lavage (DPL) C. Admission for observation and serial abdominal examinations D. Abdominal ultrasound E. Exploratory laparotomy 29. The head and face of 45-year-old man were assaulted with fists and feet. He arrives at the emergency department with incomprehensible responses to questions, eyes opening to pain only, and a flexor response to pain. What is this patient’ s Glasgow Coma Scale (GCS) score? A. 5 B. 6 C. 7 D. 8 E. Not enough information given to calculate
30. A 21-year-old man is taken to the emergency department with a gunshot wound to the right side of his chest. The first wound is located 2 cm lateral to the right nipple, and a second wound is present just medial to the tip of the right scapula. Vital signs on initial evaluation are a heart rate of 126 beats/min and a systolic blood pressure of 88 mm Hg. A right-sided chest tube is placed, with return of 1200 mL of blood. He is resuscitated with 2 L of lactated Ringer solution, and his vital signs return to within normal limits. His chest tube output is rechecked 4 hours later, and the total amount in the collection container is 2300 mL. What is the next most appropriate step in management? A. Chest CT B. Immediate complete blood count C. Thoracotomy D. Immediate arterial blood gas analysis E. Admission to the ICU for continuous cardiac monitoring and pulse oximetry 31. Which of the following regarding burn wound depth is true? A. First-degree burns heal rapidly but contribute significantly to the total body surface area (TBSA) burned in large, mixed-depth wounds. B. Second-degree burns characteristically cause erythema, pain, and blistering. C. Third-degree burns are generally painful and extremely sensitive to touch. D. Fourth-degree burns mandate amputation of the involved extremities. E. Superficial partial-thickness burn is the contemporary term for first-degree burns. 32. Which of the following patients do not meet the criteria for referral to a burn center? A. A 50-year-old woman with a 1% TBSA partial-thickness burn on her left hand from a cooking accident B. A 30-year-old construction worker with pain and blistering bilaterally on the knees after kneeling in wet cement all afternoon C. A 25-year-old man with 7% TBSA partial-thickness burns o n the chest D. A 42-year-old woman with no cutaneous injury, found lying down at the scene of a house fire, and noted to have carbonaceous sputum after intubation in the field E. An 18-year-old man in a motor vehicle collision with 30% TBSA burns on his chest and circumferential burns bilaterally on his arms 33. A 42-year-old woman has a mass in the posterior aspect of the upper part of her arm that was first noted 3 months earlier. It is not painful and she has no associated symptoms. Magnetic resonance imaging (MRI) demonstrates a 5-cm neoplasm arising from the triceps. The best next step in the management of this patient is: A. PET – computed tomography (CT) B. Fine-needle aspiration (FNA) biopsy C. Percutaneous core needle biopsy D. Incisional biopsy E. Excisional biopsy
34. According to the Nyhus classification of groin hernias, which of the following statements are true? A. A type II indirect hernia has a dilated internal ring and extends into the scrotum. B. A type IIIa hernia is a classically described indirect hernia. C. A femoral hernia is classified as type IIIc. D. Type IV hernias are pantaloon-type hernias. E. Type V hernias are spigelian hernias. 35. A sliding inguinal hernia on the left side is likely to involve which of the following? A. Ileal mesentery composing the lateral wall of the sac B. Ovary and fallopian tube in a female infant C. Omentum D. Bladder composing the posterolateral wall of the sac E. Cecum composing the anteromedial wall of the sac 36. Which of the following hernias represent incarceration of a limited portion of the small bowel? A. Spigelian hernia B. Grynfeltt hernia C. Petit hernia D. Richter hernia E. Littre hernia 37. Which of the following risk factors is most strongly associated with ductal adenocarcinoma of the pancreas? A. Chronic pancreatitis B. Diabetes mellitus C. Cigarette smoking D. Coffee consumption E. Alcohol consumption 38. A 15 year old girl presents with a mobile, 8 cm mid abdominal mass that moves freely from left to right but does not move superiorly or inferiorly, which of the following is the most likely diagnosis? A. omental cyst B. ovarian cyst C. gastric duplication. D. appendicular mass. E. mesenteric cyst. 39. for which of the following conditions perioperative prophylactic antibiotics are least indicated: A. simple inflamed appendix. B. Mastectomy. C. Open fracture of humerus.
D. colonic perforation. E. Laparoscopic cholecystectomy due to acute cholecystitis. 40. Regarding overwhelming postsplenectomy infection (OPSI), all the following are true except A. The risk of overwhelming sepsis is increased significant ly after splenectomy. B. The risk influenced by the nature of the disease for which the spleen been removed. C. Lowest risk in infants & children's < 5yr’s after splenectomy D. Mortality rate: 50-80% E. Commonly caused by encapsulated bacteria 41. Crohn's disease: A. Is caused by Mycobacterium paratuberculosis. B. It does not affect the co lon C. Tends to occur in families. D. Complete resection of affected bowel is recommended as recurrence after complete resection is rare E. Is improved by smoking. 41. Which of the following statements about hemorrhoids is/are not true? A. Hemorrhoids are specialized “cushions” present in everyone that aid continence. B. External hemorrhoids are covered by skin whereas internal hemorrhoids are covered by mucosa. C. Pain is often associated with uncomplicated hemorrhoids. D. Hemorrhoidectomy is reserved for third- and fourth-degree hemorrhoids. E. Thrombosed piles can be treated conservatively 42. A patient with a history of familial polyposis undergoes a diagnostic polypectomy; whith of the following types of polyps is most likely to be found? A. Villous adenoma B. Hyperplastic polyp C. Adenomatous polyp D. Retension polyp E. None of the above 43. After intraductal papilloma, unilateral bloody nipple discharge from one duct orifice is most commonly caused by which of the following pathologic conditions? A. Paget's disease of the nipple. B. Intraductal carcinoma. C. Inflammatory carcinoma. D. Subareolar mastitis. E- Simple cyst
*44. An 80-year-old man is admitted to the hospital complaining of nausea, abdominal pain, distention, and diarrhea. A cautiously performed transanal contrast study reveals an “apple core” configuration in the rectosigmoid. Appropriate management at this time would include A. Colonoscopic decompression and rectal tube placement B. Saline enemas and digital disimpaction o f fecal matter from the rectum C. Colon resection and proximal colostomy D. Oral administration of metronidazole and check ing a Clostridium difficile titer E. Evaluation of an electrocardiogram and obtaining an angiogram to evaluate for colonic mesenteric ischemia *45. Which of the following statements concerning Hirschsprung’s disease is true? A. It is initially treated by co lostomy B. It is best diagnosed in the newborn period by barium enema C. It is characterized by the absence of ganglion cells in the transverse colon D. It is associated with a high incidence of genitourinary tract anomalies E. It is the congenital disease that most commonly leads to subsequent fecal incontinence *46. Which of the following would be expected to stimulate intestinal motility? A. Fear B. Gastrin C. Secretin D. Acetylcholine E. Cholecystokinin
*47. Indications for operation in Crohn’s disease include which of the following? A. Intestinal obstruction B. Enterovesical fistula C. Ileum – ascending colon fistula D. Enterovaginal fistula E. Free perforation *48. True statements regarding cavernous hemangiomata of the liver in adults include ( A. The majority become symptomatic B. They may undergo malignant transformation C. They enlarge under hormonal stimulation D. They should be resected to avoid spontaneous rupture and life-threatening hemorrhage E. A liver/spleen radionucleotide scan is the most sensitive and specific way to make the diagnosis 50. Which of the following breast lesions are non-invasive malignancies? A. Intraductal carcinoma of the comedo type. B. Tubular carcinoma and mucinous carcinoma.
C. Infiltrating ductal carcinoma and lobular carcinoma. D. Medullary carcinoma, including atypical medullary lesions. 51. Which of the following are the most important and clinically useful risk factors for breast cancer? A. Fibrocystic disease, age, and gender. B. Cysts, family history in immediate relatives, and gender. C. Age, gender, and family history in immediate relatives. D. Obesity, nulliparity, and alcohol use. 52. Failure to perform radiation after wide excision of an invasive cancer risks which of the following outcomes? A. Recurrence of cancer in the ipsilateral breast. B. Shorter survival time. C. Regional nodal recurrence. D. Greater chance of breast cancer mortality. 53. The proper treatment for lobular carcinoma in situ (LCIS) includes which of the following components? A. Close follow-up. B. Radiation after excision. C. Mirror-image biopsy of the opposite breast. D. Mastectomy and regional node dissection. 54. Which of the following statement(s) is/are true concerning the anatomy of the breast except? A. most of the lymphatic drainage of the breast courses to the axillary LN B. Nerves within the axillary fat pad include the intercostal brachial nerve, the long thoracic nerve, and thoracodorsal nerve C. Fascial bands projecting through the breast to the skin form a supporting framework known as Cooper’s ligaments D. The ductal system of the breast from the alveoli to t he skin are lined with columnar epithelium 55. A 35-year-old woman, who is currently breast-feeding her firstborn child, develops an erythematous and inflamed fluctuant area on breast examination. Which of the following statement(s) is/are true concerning her diagnosis and management except? A. The most common organism which would expect to be cultured is Staphylococcus aureus B. Open surgical drainage is likely indicated C. Breast-feeding absolutely should be discontinued D. If the inflammatory process does not completely respond, a biopsy may be indicated
56. When progressive enlargement of a multinodular goiter causes symptomatic tracheal compression, the preferred management in otherwise good-risk patients is: A. Iodine treatment. B. Thyroid hormone treatment. C. Surgical resection of the abnormal thyroid. D. Radioactive iodine treatment. 57. The most precise diagnostic screening procedure for differentiating benign thyroid nodules from malignant ones is: A. Thyroid ultrasonography. B. Thyroid scintiscan. C. Fine-needle-aspiration biopsy (FNAB). D. Thyroid hormone suppression. 58. Indications for operation in a patient with previously asymptomatic hyperparathyroidism include except : A. Age older than 60. B. Nephrolithiasis. C. A substantial decline in renal function. D. A substantial decline in bone mass. E. all of the above 59. The following statement(s) is/are true concerning umbilical hernias in adults. A. Most umbilical hernias in adults are the result of a co ngenital defect carried into adulthood B. A paraumbilical hernia typically occurs in multiparous females C. The presence of ascites is a contraindication to elective umbilical hernia repair. D. Incarceration is uncommon with umbilical hernias 60. Acute appendicitis is most commonly associated with which of the following signs? A. Temperature above 104 F. B. Frequent loose stools. C. Anorexia, abdominal pain, and right lower quadrant tenderness. D. White blood cell count greater than 20,000 per cu. Mm 61. The test with the highest diagnostic yield for detecting a colovesical fistula is: A. Barium enema. B. Colonoscopy. C. Computed tomography (CT). D. Cystography. E. Cystoscopy. 62. Which of the following is not true of diverticular disease: A. It is more common in the United States and Western Europe than in Asia and Africa. B. A low-fiber diet may predispose to development of diverticulosis.
C. It involves sigmoid colon in more than 90% of patients. D. Sixty per cent develop diverticulitis sometime during their lifetime. E. It is the most common cause of massive lower gastrointestinal hemorrhage 63. Which of the following steps is/are part of the primary survey in a trauma patient except? A. Insuring adequate ventilatory support B. Measurement of blood pressure and pulse C. Neurologic evaluation with the Glasgow Coma Scale D. Examination of the cervical spine 64. Advantages of total thyroidectomy for management of papillary carcinomas of the thyroid larger than 1.5 cm. include except? A. Possibility of using radioactive iodine postoperatively to identify and treat metastases. B. The ability to use thyroglobulin levels as a marker for recurrence. C. Lower overall recurrence rate. D. Lower risk of hypoparathyroidism 65. Chronic groin pain following inguinal hernia repair may be the result of: A. Division of the nerves during the surgical procedure B. Postoperative scar tissue C. Use of mesh D. Injury from the use of tacks or staples E. All of the above 66. The best treatment for diastasis of recti is A. Primary open repair B. Open repair with mesh C. Laparoscopic repair with mesh D. Observation E. Injection sclerotherapy 67. A 35-year-old man is admitted to the surgical ICU with a diagnosis of acute alcoholic pancreatitis. Systemic inflmmatory response syndrome (SIRS) develops and the patient requires 8 L of flid resuscitation to keep his central venous pressure higher than 10 mm Hg. You have a high index of suspicion for the development of abdominal compartment syndrome (ACS). This clinical entity: A. Requires immediate decompressive laparotomy for intraabdominal pressures greater than 20 mm Hg B. Results in hypocapnia C. Is associated with decreased systemic vascular resistance D. Will not affect cerebral perfusion E. Should be suspected in any patient taking vasopressors who requires more than 6 L of resuscitative fluid over a short period 68. Tributaries to Saphenofemoral junction
69. Renal Colic most resolve spontaneously 70. False regarding urinary tract malignancy painful hematuria 71. Middle thyroid vein drain into internal jugular vein
th By: B elal M . Abu Samha/ 6 year medical student
