1.

Regarding Head injuries all are true except:

A. Following head injury nothing can be done to minimize the primary brain injury.
B. Hyperventilation is indicated during initial management.
C. A patient who withdraw normally, but can’t localize a painful stimuli, has a score of 5
on Motor Response part of Glasgow Coma Scale.
D. Subdural hematomas are much more common than epidural hematomas.
E. Ideally, a CT scan should be obtained in all significant head-injured patient if available.

2. T- Tubes

A. Should be removed after 5 days

B. Are usually made from polyvinyl chloride
C. Are brought out through the abdominal wound
D. Cause an intense fibrous reaction
E. Are destroyed by bile salts if left for long time

T-tubes are made from latex rubber to induce an intense fibrous reaction, and thus to produce a
controlled fistula after their removal.

3. A 54-year-old man underwent right hemicolectomy for colon cancer. Pathologic analysis
showed invasion of the tumor into the muscularis propria, with 2 of 18 lymph nodes positive
for tumor. What is his pathologic staging?

A. Dukes A
B. Astler-Coller A
C. T2N1 (stage IIIA)
D. T2N1 (stage IIB)
E. T3N2 (stage IIIA)

Staging TNM Dukes 5-year survival rate

Stage I T1-2, N0, M0 A 80–90%
Stage II T3-4, N0, M0 B 62–76%
Stage III Any T, N1-3, M0 C 30–40%
Stage IV Any T, Any N, M1 D 4–7%

4. Which of the following patients generally does not require surgical intervention as a
consequence of acute diverticulitis?

A. A 35-year-old man with no history of diverticulitis.

B. A 68-year-old man status 2 weeks post–renal transplantation.
C. A 55-year-old woman with hypertension and diabetes mellitus.
D. A 50-year-old man with pneumaturia.
E. A 46-year-old man with right-sided diverticulitis.

5. Which of the following have been shown to be risk factors for development of adenocarcinoma
of the pancreas?

A. Cigarette smoking
B. Coffee drinking
C. Adult-onset diabetes mellitus
D. Chronic coumadin usage
E. Prior gastrectomy

Answer: a, e
6. Which of the following statements about the diagnosis and treatment of esophageal
leiomyomas is/are correct?

A. The majority are diagnosed after they cause dysphagia and chest pain.
B. Biopsy is indicated at the time of esophagoscopy, to rule out carcinoma.
C. Full-thickness elliptical excision of the esophageal wall is the preferred surgical approach.
D. Endoscopic ultrasonography is a reliable means of following leiomyomas conservatively.
E. Recurrence of resected leiomyomas is minimized by wide local excision.

Answer: D

7. Vigorous bleeding from a small bowel lesion is most likely caused by:

A. Adenocarcinoma.
B. Arteriovenous malformation.
C. Leiomyoma.

Answer: C

8. With regard to the control of pancreatic exocrine function, which of the following statement(s)
is/are correct?

A. Cholecystokinin, a hormone released from the duodenal mucosa, is the predominant

stimulus for pancreatic enzyme secretion
B. Gastrin is a major stimulant for pancreatic bicarbonate secretion
C. Secretin is released from the duodenum upon mucosal acidification and stimulates
pancreatic bicarbonate secretion
D. Acetylcholine, released from pancreatic nerves, stimulates enzyme secretion

Answer: a, c, d

9. Which finding(s) suggest(s) the diagnosis of chronic ulcerative colitis as opposed to Crohn's
colitis?

A. Endoscopic evidence of backwash ileitis.

B. Granulomas on biopsy.
C. Anal fistula.
D. Rectal sparing.
E. Cobblestone appearance on barium enema.

Answer: A

10. Which of the following features is/are consistent with a diagnosis of colonic inertia?

a. Alternating episodes of severe constipation and normal bowel activity

b. Total bowel transit time of 24 hours
c. Total bowel transit time of 48 hours
d. Total bowel transit time of 96 hours
e. Marfinoid habitus

Answer: d
11. Which of the following statements regarding the pathology of esophageal carcinoma is/are
correct?

A. Worldwide, adenocarcinoma is the most common esophageal malignancy.

B. Squamous cell carcinoma is most common in the distal esophagus, whereas adenocarcinoma
predominates in the middle third.
C. Patients with Barrett's metaplasia are 40 times more likely than the general population to
develop adenocarcinoma.
D. Metastases from esophageal carcinoma are characteristically localized to regional
mediastinal lymph nodes adjacent to the tumor.
E. Achalasia, radiation esophagitis, caustic esophageal stricture, Barrett's mucosa, and
Plummer-Vinson syndrome are all premalignant esophageal lesions that predispose to the
development of squamous cell carcinoma.

Answer: C

12. Malignant neoplasms of the small bowel tend to have a characteristic anatomic distribution.
Which of the following statements are true?

A. Adenocarcinomas of the small intestine show a distinct polarity with decreasing frequency
from duodenum to ileum
B. Adenocarcinoma of the small intestine associated with Crohn’s disease occurs primarily in
the ileum
C. Lymphomas of the small intestine arise primarily in the jejunum
D. The vast majority of carcinoid tumors of the small intestine occur in the ileum

Answer: a, b, d

13. All are true about the dumping syndrome except:

A. Symptoms can be controlled with a somatostatin analog.

B. Diarrhea is always part of the dumping syndrome.
C. Flushing and tachycardia are common features of the syndrome.
D. Separating solids and liquids in the patient's oral intake alleviates some of the symptoms of
the syndrome.
E. Early postoperative dumping after vagotomy often resolves spontaneously.
Answer: B

14. Neoplastic hypersecretion of the hormone vasoactive intestinal peptide is associated with
which of the following features?

A. Hypokalemia, hypochlorhydria, diarrhea

B. Hyperglycemia, necrolytic rash, hypoaminoacidemia
C. Constipation, gallstones, hyperglycemia
D. Hyperkalemia, necrolytic rash, diarrhea

Answer: a

15. The following statements about the repair of inguinal hernias are true except:

A. The conjoined tendon is sutured to Cooper's ligament in the Bassini hernia repair.
B. The McVay repair is a suitable option for the repair of femoral hernias.
C. The Shouldice repair involves a multilayer, imbricated repair of the floor of the inguinal
canal.
D. The Lichtenstein repair is accomplished by prosthetic mesh repair of the inguinal canal floor
in a tension-free manner.
E. The laparoscopic transabdominal preperitoneal (TAPP) and totally extraperitoneal approach
(TEPA) repairs are based on the preperitoneal repairs of Cheattle, Henry, Nyhus, and Stoppa.
Answer: A

16. Which of the following are tumor suppressor genes that have been associated with the
development of colorectal cancer?

A. The DCC gene

B. The APC gene
C. The P53 gene
D. The Rb gene

Answer: a, b, c

17. The preferred management of a ruptured testis is:

A. orchiectomy.
B. Closure of tunica albuginea.
C. Orchiectomy and prosthesis insertion.
D. Bed rest, scrotal elevation, and ice packs.
E. Incision and drainage of scrotum.

18. A 26-year-old women has a pelvic fracture, collapsed lung, and a severe closed head injury
following an automobile accident. A retrograde cystogram reveals an extra peritoneal bladder
rupture. The next step in management is:

A. Catheter drainage.
B. Immediate surgical repair.
C. Diagnostic peritoneal lavage.
D. Abdominal and pelvic CT scan.
E. Suprapubic cystostomy.

19. Appropriate therapy for an intra-peritoneal bladder rupture from external violence in a man is:

A. 10 days of Foley catheter drainage.

B. 10 days of percutaneous suprapubic catheter drainage.
C. 10 days of formal suprapubic catheter drainage.
D. Percutaneous perivesical drainage and catheter placement.
E. Formal surgical repair and catheter drainage.

20. During an abdominal hysterectomy, the lower third of the right ureter is ligated. After
deligation the ureter looks contused but has peristalsis. The next step is:

A. Close the wound.

B. Place a ureteral stent.
C. Wrap the ureter in omentum.
D. Resect the segment and perform an ureteroureterostomy.
E. Perform an ureteroneocystostomy.

21. Addisonian crisis, or acute adrenocortical insufficiency:

A. Occurs only in patients with known adrenal insufficiency or in those receiving long-term
supraphysiologic doses of exogenous steroids.
B. Can mimic an acute abdomen with fever, nausea and vomiting, abdominal pain, and
hypotension.
C. May cause electrolyte abnormalities, including hypernatremia, hypokalemia, hypoglycemia,
and hypercalcemia, as well as eosinophilia on peripheral blood smear.
 D. Should be diagnosed with the rapid ACTH stimulation test before steroid replacement is
instituted.
E. May be effectively treated with intravenous “stress-dose” glucocorticoid and
mineralocorticoid replacement.

Answer: B

22. 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.

Answer: E

23. Which of the following is/are prognostic signs reported by Ranson to predict outcomes
associated with acute pancreatitis?

A. Age greater than 60 years

B. Hematocrit decrease of 105 within 48 hours of hospital admission
C. Serum amylase value greater than 4 times upper limit of normal
D. Serum glucose greater than 200 mg/dL on admission
E. Ca2+ level less than 8 mg/dL within 48 hours of hospital admission

Answer: b, d, e

24. Which of the following lesions are believed to be associated with the development of
carcinoma of the gallbladder?

A. Cholecystoenteric fistula.
B. A calcified gallbladder.
C. Adenoma of the gallbladder.
D. Xanthogranulomatous cholecystitis.
E. All of the above.

Answer: E

25. Optimal treatment for the neonate who presents with transposition of the great arteries and
intact ventricular septum includes:

A. PGE 1 infusion to maintain duct patency.

B. Administration of intravenous fluid to increase intravascular volume.
C. Hyperventilation to decrease pulmonary resistance.
D. Oxygen administration to increase arterial oxygen tension.
E. Atrial balloon septostomy to improve atrial mixing.

Answer: ABE

26. Which of the following statement(s) is/are true concerning adjuvant systemic therapy?

A. Adjuvant tamoxifen in post-menopausal, node-positive, ER-positive women is equivalent to

cytotoxic chemotherapy
B. Tamoxifen clearly improves survival in all hormonal receptor-positive patients
C. CMF is associated with improved overall survival in both pre-menopausal and post-
menopausal node-positive patients
 D. There is no evidence to suggest a role for chemotherapy in node-negative patients

Answer: a

27. Which of the following recommendations for adjuvant chemotherapy of colorectal carcinoma
are true?

A. Patients with Stage I or Dukes A and B1 disease should receive adjuvant treatment for 1 year
with levamisole combined with 5-FU.
B. Patients with Stage III or Dukes C disease should receive adjuvant treatment for 1 year with
levamisole combined with 5-FU.
C. There is no role for adjuvant therapy for colon cancer at any stage.
D. Adjuvant chemotherapy is active in colon cancer only when combined with radiotherapy.

Answer: B

28. Hyperthyroidism can be caused by all of the following except:

A. Graves' disease.
B. Plummer's disease.
C. Struma ovarii.
D. Hashimoto's disease.
E. Medullary carcinoma of the thyroid.

Answer: E

29. Which of the following statement(s) is/are true concerning Emergency Room thoracotomy?

A. Overall survival rates approach 25%

B. Blunt trauma patients without signs of life upon arrival in the Emergency Room are
candidates for Emergency Room thoracotomy
C. All patients with penetrating trauma to the chest and the absence of vital signs are
candidates for ER thoracotomy
D. None of the above

Answer: d

30. Which of the following statement(s) is/are true concerning the histologic variants of invasive
breast carcinoma?

A. The presence of an in situ component with invasive ductal carcinoma adversely affects
prognosis
B. Medullary carcinomas, although often of large size, are associated with a better overall
prognosis than common invasive ductal cancers
C. Mucinous or colloid carcinoma is one of the more common variants of invasive ductal cancer
D. Invasive lobular carcinoma is associated with a higher incidence of bilateral breast cancer

Answer: b, d

31. Which of the following statement(s) about malignant neoplasms of the liver is/are true?

A. Hepatocellular carcinoma is probably the number 1 cause of death from cancers worldwide.
B. The most common resectable hepatic malignant neoplasm in the United States is colorectal
metastasis.
C. Hepatoma has at least one variant that has a much more benign course than hepatomas in
general.
 D. Hepatomas are generally slower growing than was formerly believed.

Answer: ABCD

Lange/

32. A 33-year-old man presents to the emergency department with a gunshot injury to the
abdomen. At laparotomy, a deep laceration is found in the pancreas just to the left of the
vertebral column with severance of the pancreatic duct. What is the next step in management?

A. Intraoperative cholangiogram
B. Debridement and drainage of defect
C. Distal pancreatectomy
D. Closure of abdomen with J-P drains
E. Vagotomy

33. A19-year-old man is brought to the emergency department with a stab wound at the base of
the neck (zone I). The most important concern for patients with such injuries is which of the
following?

A. Upper extremity ischemia

B. Cerebral infarction
C. Exsanguinating hemorrhage
D. Mediastinitis
E. Tracheal stenosis

34. A43-year-old man had a previous injury to his wrist. The ulnar nerve was severed, as indicated
by which of the following?

A. Claw hand involving the ring and little fingers

B. Claw hand involving the index and middle fingers
C. Atrophy of the thenar muscles
D. Absent sensation in the index finger
E. Inability to flex the distal phalanx of the index finger

35. A 45-year-old man skidded from the road at high speed and hit a tree. Examples of deceleration
injuries in this patient include:

A. Aortic valve rupture

B. Kidney injury
C. Posterior dislocation of shoulder
D. Mesenteric avulsion
E. Stomach rupture

36. A 16-year-old boy presents to the emergency department with a stab wound to the anterior
midneck. On physical examination, it is difficult to determine if the plane of the platysma has
been violated. However, subcutaneous emphysema is found on palpation. What is the next
management step?

A. Esophagogram
B. Arteriography
C. Surgical exploration
D. Esophagoscopy
E. CT scan of the neck with oral and intravenous contrast
37. A 23-year-old man is shot with a handgun and found to have a through-and-through injury to
the right transverse colon. There is little fecal contamination and no bowel devascularization.
At operation, what does he require?

A. Right hemicolectomy with ileotransverse colon anastomosis

B. Right hemicolectomy with ileostomy and mucous fistula
C. Debridement and closure of wounds with exteriorization of colon
D. Debridement and closure of wounds
E. Segmental resection with primary Anastomosis

38. A 60-year-old woman runs her car off the road and it hits a telephone pole. She presents to the
emergency department with severe anterior chest pain and a blood pressure of 110/80 mm Hg.
A chest x-ray shows a questionably widened mediastinum. The next step in management
should be which of the following?

A. Transthoracic echocardiogram
B. Pericardiocentesis
C. Aortogram
D. Central venous access line
E. CT of chest

39. In a patient who had a motor-cycle crash, a CT of the abdomen revealed a peripancreatic
hematoma and indistinct pancreatic border. The most definitive test for a pancreatic injury
requiring operative intervention is:

A. ERCP
B. Ultrasonography
C. CT scanning
D. Operative exploration
E. Amylase test of lavage fluid

40. You are called to see a 4-hour-old neonate in the well-baby nursery who has developed bilious
vomiting after taking his first feeding. He was born at 39-week gestation, has not yet passed
meconium and has an unremarkable examination. An upper gastrointestinal (GI) series would
be the study of choice to rule out which of the following clinical conditions?

A. Ileal atresia
B. Meconium ileus
C. Duodenal web
D. Malrotation
E. Tracheoesophageal fistula

41. The injury most often missed by selective nonoperative management of abdominal stab
wounds is to which of the following?

A. Colon
B. Spleen
C. Ureter
D. Diaphragm
E. Small bowel
42. A 62-year-old man had right carotid endarterectomy 7 years ago. Now he has presented with
80% stenosis on the same side. He has no symptoms from the stenosis. He has carotid artery
stenosis on the opposite side of 80%. He does not have any history of TIA. What is the
appropriate treatment for the patient?

A. Medical management with aspirin

B. Carotid artery redo surgery and patch angioplasty
C. Angiogram and angioplasty and stenting
D. Left carotid endarterectomy
E. Antiocoagulation of the patient to prevent stroke

43. A64-year-old man presents with headache and left-sided upper extremity weakness. The MRI
findings suggest that this is a glioblastoma multiforme. This is because the tumor exhibits
which of the following?

A. It is regular in shape.
B. It is well demarcated from surrounding brain tissue.
C. It shows a ring pattern of enhancement with intravenous contrast and has a non-
enhancing necrotic center.
D. It shows an absence of surrounding white-matter edema.
E. It arises from the carotid body.

44. A65-year-old man is referred to you because of an incidental finding of a 3-cm left popliteal
aneurysm. The patient is completely asymptomatic and has normal pulses. How should the
aneurysm be treated?

A. It should be observed.
B. It should be repaired because it may lead to spontaneous rupture.
C. It should be repaired only if it is larger than 5 cm.
D. It should be repaired because of its tendency to either undergo thrombosis or embolize
distally.
E. It should be repaired because of its tendency to cause nerve compression if it enlarges.

45. An 89-year-old male presents with asymptomatic 8-cm abdominal aneurysm. He has a recent
history of myocardial infarction (MI) and is not a candidate for coronary artery bypass. What
should the treatment options include?

A. Conservative treatment observation

B. Computerized axial tomography (CAT) scan to evaluate eligibility for endovascular repair
C. Open repair without any further workup
D. Axillofemoral bypass and coil embolization of aneurysm
E. b-blocker therapy

46. A newborn girl with family history of lymphedema is noted to have bilateral lower extremity
swelling. What is the diagnosis?

A. Secondary lymphedema
B. Lymphedema praecox
C. Milroy disease
D. Lymphedema tarda
E. Meigs’s syndrome
47. A 50-year-old man with atrial fibrillation is taking warfarin (Coumadin). The effect of Coumadin
is decreased by which of the following?

A. The presence of vitamin K deficiency

B. Phenylbutazone
C. Quinidine
D. Barbiturates
E. Thyrotoxicosis

48. A 6-year-old girl presents with a left breast mass. Her mother first noticed it a day before and is
very concerned because both the child’s maternal grandmother and maternal aunt have had
breast cancer. It is firm, smoothly circumscribed, and slightly eccentric under the left areola.
The right breast is unremarkable. You suggest

A. Immediate excisional biopsy

B. A mammogram
C. Repeat examination in 1 month
D. Genetic testing for breast cancer (BRCA) 1 and 2 mutations
E. Sterotactic needle biopsy

49. A 30-year-old woman is brought to the emergency department after she stepped on a rusty nail
and sustained a puncture wound to the foot. The patient has been on a therapeutic dose of
steroids for the past 5 years for ulcerative colitis. Her last tetanus toxoid booster was 8 years
ago. What should the patient receive?

A. Tetanus toxoid booster

B. Human immunoglobulin
C. Antibiotics with anaerobic coverage
D. Tetanus toxoid plus human immunoglobulin
E. Tetanus toxoid plus human immunoglobulin and antibiotics with aerobic and anaerobic
coverage

50. A20-year-old woman presents to the emergency department with a stab wound to the
abdomen. There is minimal abdominal tenderness. Local wound exploration indicates that the
knife penetrated the peritoneum. What is the ideal use of antibiotic administration?

A. Preoperatively
B. Intraoperatively, if a colon injury is found
C. Postoperatively, if the patient develops fever
D. Postoperatively, based on culture and sensitivity of fecal contamination found at the time of
surgery
E. Intraoperatively, if any hollow viscus is found to be injured

51. A70-year-old woman is hit by a car and injures her mid-abdomen. The best way to rule out a
rupture of the second part of the duodenum is by which mode?

A. Repeated physical examinations

B. Ultrasound
C. Repeated amylase levels
D. CT with oral and intravenous contrast
E. Peritoneal lavage
52. A 70-year-old woman has low cardiac output with increased PCWP and increased systemic
vascular resistance. What should be the drug of choice?

A. Dopamine
B. Norepinephrine
C. Dobutamine
D. Epinephrine
E. Phenylephrine

53. A young man is shot at the level of the right sternoclavicular joint. His blood pressure is 80/60
mm Hg, pulse 120 bpm, and a chest xray shows a right hydropneumothorax. The first step
should be:

A. Insert a chest tube and observe for drainage.

B. Perform an immediate right thoracotomy.
C. Perform an angiogram to rule out great vessels injury.
D. Perform median sternotomy with extension along with right anterior boarder of the
sternocleidomastoid muscle.
E. Perform a CAT scan with contrast, to evaluate extent of injury.

54. A 34-year-old male has serum sodium of 114 mEq/L. Correction of hyponatremia can be done
by raising serum sodium by what amount?

A. 1 mEq/L/h
B. 3 mEq/L/h
C. 5 mEq/L/h
D. 7 mEq/L/h
E. 10 mEq/L/h

55. A 40-year-old man is found to have severe metabolic acidosis with a high anion gap. What is
the most likely cause?

A. Diarrhea
B. Methanol ingestion
C. Proximal renal tubular acidosis
D. Distal renal tubular acidosis
E. Ureterosigmoidostomy

56. Congenital abnormalities, all are true, except:

A. Omphalocele represents a defect in the abdominal wall lateral to the umbilical cord.
B. The herniated viscera associated with omphaloceles are usually covered with a membranous
sac.
C. An umbilical polyp is a small excrescence of omphalomesenteric duct mucosa that is retained
in the umbilicus.
D. Meckel's diverticulum results when the intestinal end of the omphalomesenteric duct
persists and represents a true diverticulum.
E. In gastroschisis no sac is present to cover the herniated intestine

57. The hurtle cell carcinoma are derived from which cells?

A. Follicular cell
B. Para-follicular cell
C. Oxyphilic cells
D. lymphocyte
58. Hypoparathyroidism following thyroid surgery occurs within?

A. 24 hours
B. 2-5 days
C. 7-14 days
D. 2-3 days

59. The most common location of sialolithiasis is

A. Submandibular gland
B. Parotid gland
C. Sublingual
D. Minor salivary glands

60. Following blunt abdominal trauma, mandatory exploration is indicated for any non-expanding
hematoma identified on CT scan in which of the following areas:

A. Right perinephric
B. Midline inframesocolic
C. Lateral pelvic area
D. Retrohepatic
E. Left perinephric

61. Intraoperative heat loss can be reduced by all of the following EXCEPT:

A. condenser-humidifier in the breathing circuit

B. low-flow anesthesia
C. laminar flow in an orthopedic theater
D. use of bowel bag during laparatomy
E. use of nonvolatile surgical preparation sterilizing agents

62. 30 year old man with a gunshot wound to the abdomen has severe injuries involving the liver,
duodenum pancreas and colon. Why is parenteral nutrition support prefer over enteral
nutrition support

A. It is less expensive
B. It preserve gut mucosal mass and mucosal immunity
C. It preserve gut permeability and translocation
D. It is easy to start and administer nutritional requirments rapadily
E. It attenuations hypermetabolic response to surgery

63. Which of the following statements concerning the hormone ghrelin is true?

A. It is produced mainly by the arcuate nucleus of the hypothalamus.

B. Plasma levels increase after meals.
C. Plasma levels are increased after gastric bypass.
D. Plasma levels are increased in individuals following a low-calorie diet.
E. Plasma levels are unchanged after sleeve gastrectomy.

64. Which of the following statements is correct regarding spontaneous bacterial peritonitis (SBP;
primary peritonitis) in a cirrhotic patient?

A. Infection is usually polymicrobial.

B. Ascitic fluid culture results are always positive.
C. The most likely pathogenic mechanism is translocation from the gut.
D. Twenty-one days of antibiotic treatment may be adequate.
E. Infection-related mortality has declined to less than 10%.
65. The carpal tunnel contains all of the following important structures except?

A. Radial Nerve
B. Flexor pollicis longus
C. Flexor digitorum superficialis
D. Flexor pollicis longus
E. Flexor digitorum profundus

66. Which of the following is true regarding gastric bypass?

A. The incidence of postoperative gallstone or sludge formation is about 5%.

B. The greater curvature of the stomach is removed.
C. The gastric pouch is completely divided from the distal part of the stomach.
D. Three anastomoses are required in the Roux-en-Y reconstruction.
E. A common channel of 100 cm is created by measuring proximal to the ileocecal valve.

1. Budd chiari syndrome

2. Gastrosplenic ligament contains the vessels
3. Patient fell down a tree complaining of left upper abdominal pain & chest pain. A common organ
to be injured is spleen
4. Ogilvie syndrome
5. Superior mesenteric artery syndrome