:

answer .1
.sheet
Rush Pre-test surgery (*) .2
.
*1. Which of the following is the mechanism of action of omeprazole?
A. Blockage of the breakdown of 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 production
*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 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 patients 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 38.18C (100.72F) 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 patients 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/L.
B. Platelet counts higher than 150,000/L exclude the possibility of a primary hemostatic
disorder.
C. Bleeding time is a predictor of surgical bleeding.
D. Platelet counts higher than 50,000/l 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 100 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 knowledge 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 approximately 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 patients
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 on 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. PETcomputed 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 significantly 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 < 5yrs 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 colon
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 of fecal matter from the rectum
C. Colon resection and proximal colostomy
D. Oral administration of metronidazole and checking 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 Hirschsprungs disease is true?
A. It is initially treated by colostomy
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 Crohns disease include which of the following?
A. Intestinal obstruction
B. Enterovesical fistula
C. Ileumascending 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
Coopers ligaments
D. The ductal system of the breast from the alveoli to the 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 congenital 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

By: Belal M. Abu Samha/ 6th year medical student