Palestinian Medical Council

Final General Surgery Written Exam (April,2011)

Paper ( I )

Candidate’s Name:…………………………………………………………………………………………………………….
Choose the best appropriate answer in each of the following questions:

1. Which of the following statements about extracellular fluid is true?

A. The total extracellular fluid volume represents 40% of the body weight.
B. The plasma volume constitutes 20%of the total extracellular fluid volume.
C. Potassium is the principal cation in extracellular fluid.
D. The protein content of the plasma produces a lower concentration of cations than in the
interstitial fluid.
E. The interstitial fluid equilibrates slowly with the other body compartments.

2. Anion gap is:

A. The difference between measured anions and measured cations
B. Is normal in lactic acidosis
C. Is high in shock
D. Normally is 20 mmol
E. High in pancreatic fistula

3. A 23-year-old female receiving chronic corticosteroid therapy for an autoimmune disease

underwent minor surgery for incision and drainage of an abscess on her upper outer right
arm. The wound healed poorly over the next month. Which of the following aspects of wound
healing is most likely to be deficient?
A. Re-epithelization
B. Fibroblast growth factor elaboration
C. Collagen deposition cvdsawsdsr
D.Serine proteinase production
E.Neutrophil infiltration

4. Preoperative investigation and preparation of a patient with obstructive jaundice should

include all of the following except :
A. measurement of coagulation status.
B. measurement of 24-hour urinary output.
C. measurement of serum urea and electrolytes.
D. fluid restriction during the 24 hours preoperatively.
E. administration of antibiotics during invasive diagnostic procedures (e.g. PTC, ERCP)
5.Diffuse axonal injury (DAI) results from what type of force acting on the brain?
A. direct impact
B. axial loading
C. linear acceleration
D. rotational acceleration
E. accceleration deceleration injury

6. A 35-year-old trauma victim requires hyperalimentation. The patient’s injuries include a

stable undisplaced fracture of the third thoracic vertebra, a closed head injury, multiple upper
and lower extremity fractures and bilateral pulmonary contusions requiring ventilatory
support. Which of the following are the most appropriate site and type of venous access in
this patient?
A. bilateral antecubital fossae, 18G peripheral intravenous catheters
B. femoral vein, central venous catheter
C. dorsum of one foot, single 16G peripheral intravenous catheter
D. subclavian vein, central venous catheter
E. long saphenous vein cut-down, long catheter

7.The mesentery of small intestine, along its attachment to the posterior abdominal wall,
crosses all of the following structures except
A. Left gonadal vessels
B. Third part of duodenum
C. Aorta
D. Right Ureter
E. All the above

8. The intravenous fluid that a 60 kg., 30-year-old woman with an 80% burn should be given
in the first 24 hours following burn injury is:
A. 19.2 liters of 5% glucose in lactated Ringer's.
B. 14.4 liters of lactated Ringer's.
C. 9.6 liters of hypertonic salt solution (sodium concentration 200 mEq) per liter..
D. 7.2 liters of 5% albumin solution.
E. 5.5 liters of the pentafraction component of hydroxyethyl starch.

9. All of the following are potential outcome in laparoscopic surgery EXCEPT :

A. Hypercarbia
B. Alkalosis
C. Decrease urine out put
D. Increase intracranial pressure
E. Increased cardiac work
10. In chest injury the following are indications of thoracotomy EXCEPT :
A. When cardiac tamponade present.
B. Massive air leak
C. For all transmediastinal wounds
D. Flail chest with sever lung contusion
E. Clotted hemothorax

11. Acute Epidural haematoma :

A. due to meningeal artery tear
B. can be treated conservatively
C. classically there is contra lateral, dilated, fixed pupil
D. needs operation within 24 hours
E. a and c only

12. All the following about Rectus Sheath is true except :

A. Enclose the rectus abdominis and pyramidalis muscles
B. Formed by the Aponeuroses of two abdominal muscles
C. Contain anterior rami of lower 6 thoracic nerves
D. Contain superior and inferior epigastric vessels
E. Separated from its fellow on the opposite side by linea alba

13. Regarding Acute subdural haematoma :

A. It is due to meningeal artery tear
B. has 30% mortality.
C. may cause secondary brain injury
D. Treated by early operation
E. More urgent than epidural haematoma

14. Causes of hypovolaemic shock include all the following Except:

A. burn injury.
B. low output intestinal fistula
C. spinal cord transaction.
D. myocardial infarction.
E. endotoxaemia.

15. Management of hypovolaemic shock involves all except:

A. achievement of venous access via peripheral vein catheterisation.
B. bladder catheterisation.
C. immediate administration of whole blood or red cell concentrate.
D. effective analgesia.
E. oxygen administration.

16. Stored whole blood used for transfusion:

A. contains similar amounts of coagulation factors blood.
B. contains a concentration of leucocytes similar to normal blood.
C. can be stored for up to 100 days at 4±2°C.
D. contains normal platelet count.
E. is used when rapid volume transfusion is required for a patient who has suffered major
trauma.

17. Concerning the use of a central venous catheter:

A. administration of TPN is safe and does not require repetitive haematological and
biochemical monitoring.
B. its insertion should have mandatory electrocardiographic monitoring.
C. it provides a convenient portal for blood sampling and antibiotic administration.
D. if tunnelled subcutaneously it has a higher incidence of infection with endogenous
staphylococcus.
E. if infected it is effectively treated by administration of antibiotics via the offending catheter.

18. Which of the following changes would you expect to find in a patient who developed
acute renal failure after ingesting poisonous mushrooms that caused renal tubular necrosis?

A. Increased plasma bicarbonate concentration

B. Metabolic acidosis

C. Decreased plasma potassium concentration

D. Decreased blood urea nitrogen concentration

E. Decreased hydrostatic pressure in Bowman's capsule

19 .A 16-year old driver, without seat belt, is involved in a rollover head-on accident.
Extensive damage to the vehicle . The patient was pulled out of the car, hemodynamically
unstable and was transported to a trauma center. During transportation the patient became
severely hypotensive , with distended neck veins, unresponsive, with impending respiratory
distress. Which of the following is considered an immediate life-threatening injury in this
patient?
A. pneumothorax secondary to rib fractures
B. aortic intimal tear
C. diaphragm rupture
D. tension pneumothorax
E. myocardial contusion
20.The metabolic response to injury is characterised by a sequence of physiological events
aimed at:
A. increasing core body temperature.
B. conservation of sodium and water.
C. mobilising glucose from fat and protein stores.
D. maintaining body weight.
E. enhancing immune function.

21. Fasciotomy for extremity compartment syndrome should be performed at a compartment

pressure exceeding :
A. 20 mmHg
B. 30 mmHg
C. 40 mmHg
D. 50 mmHg
E. none of the above

22. A 50 year old man present with haematemsis, Endoscopy shows a bleeding peptic ulcer in
the posterior wall of the first part of duodenum. Which artery is involved
A. Right gastric artery
B. Right gastroepiploic artery
C. inferior pancreaticoduodenal artery
D. gasrtoduodenal artery
E. superior pancreaticoduodenal artery

23. All of the following are true about neurogenic shock except:

A. there is a decrease in systemic vascular resistance and an increase in venous capacitance.

B. tachycardia or bradycardia may be observed, along with hypotension.
C. the use of an alpha agonist such as phenylephrine is the mainstay of treatment.
D. Severe head injury, spinal cord injury, and high spinal anesthesia may all cause neurogenic
shock.

24. Anaphylactic shock:

A. is an immune-mediated reaction.
B. results in mast cell activation and increased circulating histamine concentrations.
C. produces microcirculatory changes similar to hypovolaemic shock.
D. requires prompt treatment with parenteral adrenaline and hydrocortisone.
E. may occur after ingestion of drugs
25. Which of the following best characterizes the secretions of the small intestine?

A. Hypotonic and slightly acidic

B. Hypotonic and slightly alkaline

C. Isotonic and slightly alkaline

D. Isotonic and slightly acidic

26. Nasotracheal intubation all true except :

A. Is preferred for the unconscious patient without cervical spine injury.

B. Is preferred for patients with suspected cervical spine injury.
C. Maximizes neck manipulation.
D. Is contraindicated in the patient who is breathing spontaneously.

27. The radiographic findings indicating a torn thoracic aorta include all Except :

A. Widened mediastinum.
B. Presence of an apical “pleural cap.”
C. Tracheal deviation to the right.
D. right hemothorax.

28.Pseudomembranous enterocolitis is caused by which the following organisms:

A. Clostridium sporogenes
B. Clostridium defficile
C. Streptococcus faecalis
D. Penicillin sensitive staphylocci
E. Pseudomonas aeruginos

29.Tuberculous cervical lymphadenitis:

A. is caused by bovine tuberculous bacillus rather than the human bacillus
B. usually occurs through the tonsil of the corresponding side
C. collar-stud abscess is never a feature of T. B adenitis
D. is treated always by surgery
E. biopsy is not necessary for diagnosis
30. Which of the following structures in the gastrointestinal tract is most at risk in a patient as
a consequence of the circulatory shock?

(A) Submucosal glands

(B) Brunner's glands

(C) Tips of the villi

(D) Sphincter muscles

31. Carotid body tumour:

A. is chromffin paragranuloma
B. is usually bilateral
C. is called chemodactoma or potato tumour
D. is situated at the bifurcation of the carotid artery
E. C and D are correct

32. The greatest burst strength of the wound will be achieved by:

A. 1 week

B. 3 weeks

C. 6 weeks

D. 12 weeks

E. 6 months

33. With regards to cytokines, which of the following alternatives is correct?

A. IL- is secreted mainly by lymphocytes and mediates inflammation.

B. IL- 10involved in cell division and activation.

C. IL-8 is secreted by macrophages and promotes chemotaxis.

D. IL-2 is a major inhibitor of cell division.

E. TNF-a is produced by T cells and is associated with a rise of immature neutrophils in the
blood circulation.
34. A 63-year-old male with end-stage renal disease requiring hemodialysis three times per
week presents with bone pain and several pathologic fractures of the extremities. Which is
the most likely electrolyte abnormality in this patient?

A. hypokalemia

B. hypernatremia

C. hyperphosphatemia

D. hypercalcemia

E. hypochloremia

35. Which of the following will immediately delay or cancel an elective surgical case if not
obtained appro priately preoperatively?

A. CBC

B. urinalysis

C. CXR

D. informed consent

E. ECG

36. The cell type most characteristic of chronic inflammation is the:

A. macrophage

B. B cell

C. natural killer cell

D. neutrophil

E. eosinophil
37.Which of the following is not an action of angiotensin II?

A. aldosterone secretion

B. sodium absorption

C. efferent arteriolar constriction

D. arterial dilation

E. nephrosclerosis in the kidney

38.Which hormone is produced by the kidney?

A. calcitonin

B. erythropoietin

C. 25 hydroxyvitamin D

D. aldosterone

E. antidiuretic hormone

39.What segment of the nephron is responsible for the majority of sodium absorption?

A. proximal convoluted tubule

B. loop of Henle

C. distal convoluted tubule

D. collecting tubule

40. A 46-year-old patient had respiratory failure from pneumonia and developed acute
respiratory distress syndrome (ARDS). He remained on a ventilator for a prolonged period of
time and ultimately underwent a tracheostomy at the level of tracheal ring 4. The patient is
now in the rehabilitation unit of your hospital 2 weeks after his tracheostomy and you are
called to see him about bright red blood around his tracheostomy site. The most common
cause of this bleeding is
 A. granulation tissue
B. erosion of the inferior thyroid artery
C. erosion of the innominate artery
D. tracheal chondritis
E. recurrence of pneumonia

41. Low molecular weight heparin (LMWH) produces its primary effects because of its inhibition
of which factor?

A. IIa

B. IXa

C. Xa

D. XIa

E. XIIa

42. Regarding Shock, all are correct Except :

A. it is defined as inadequate cellular perfusion.
B. it may occur in the presence of normotension.
C. it may occur following cardiomyopathy.
D. it may follow gastrointestinal perforation.
E. it invariably results in sympathomimetic activity in circulation.

43. Which of the following is not associated with increased likelihood of infection after major
elective surgery?

A. Age over 70 years.

B. Chronic malnutrition.
C. Controlled diabetes mellitus.
D. Long-term steroid use.
E. Infection at a remote body site.

44. Advantages of epidural analgesia include:

A. Earlier mobilization after surgery.

B. Earlier return of bowel function.
C. Shorter hospitalizations.
D. Decreased stress response to surgery.
E. All of the above.

45. The following structures form the walls of the inguinal canal except:
A. The conjoint tendon
B. The aponeurosis of external oblique muscle
C. The internal oblique muscle
D. The lacunar ligament
E. the fascia transversalis

46. A 60 years old male present with dysphagia. Flexible endoscopy shows a growth at
cardia. What is the distance of this growth from the incisor teeth
A. 25 cm
B. 30 cm
C. 35 cm
D. 40 cm
E. 45 cm

47. Regarding the blood supply of the stomach which of the following is not true
A. Left gastric artery arise from hepatic artery
B. Right gastric artery the lower right part of stomach
C. The short gastric artery supply the fundus
D. Left gastroepiploic artery arise from splenic artery at the hilum of stomach
E. right gastroepiploic artery arise from gasrtoduodenal artery

48. what is the least common position of appendix

A. Preileal
B. Postileal
C. Pelvic
D. Paracaecal
E. Subcaecal

49. Which of the following is true regarding the blood supply of appendix:
A. The Appendicular artery passes in front the terminal ileum
B. Blood from appendix drained by inferior mesenteric vein
C. The Appendicular artery is a branch of lower division of ileocolic artery
D. In most of the people there is accessory Appendicular artery
E. The Appendicular artery run toward the base of appendix
F.

50. Recurrent laryngeal nerve

A. Is a pure motor nerve
B. Supply cricothyroid muscle
C. Supply mucous membranes of larynx above vocal cords
D. The rate of injury during thyroid surgery is about 10%
E. None of the above
F.
51. Which of the following disorders is not associated with hypocalcemia?

A. sarcoidosis

B. vitamin D deficiency

C. renal insufficiency

D. hypoparathyroidism

E. pancreatitis

52. Regarding the anatomy of gallbladder (GB) all the following is true except:
A. GB lies in a fossa separating the right and quadrate lobes of liver
B. The cystic duct is 3 cm length usually
C. The intraduodenal part of common bile duct passes through the second part of
duodenum
D. Cystic artery is a branch of left hepatic artery
E. Lymphatic vessels of GB drain into lymph node of Lund

53. Level one Axillary clearance

A. Means removing lymph nodes behind pectoralis minor
B. Mean dissecting apical lymph nodes
C. Include removing anterior and posterior Axillary lymph nodes
D. Include removing central Axillary nodes
E. None of the above

54. The following statement concerning the anal canal are correct except :
A. It encircle the anal canal
B. It is not attached to the anococcygeal body
C. It is composed of striated muscle fibers
D. It is not responsible for causing the anal canal and rectum to join at an acute angle
E. It is innervated by the middle rectal nerve

55. Which of the following can’t be palpated in the anterior surface while doing PR( digital
rectal examination)
A. Prostate
B. Bulb of penis
C. Posterior surface of bladder
D. Seminal vesicle
E. Ischiorectal fossa

56. Which of the following changes tends to increase urinary Ca++ excretion?
 A. Extracellular fluid volume expansion

B. Increased plasma parathyroid hormone concentration

C. Decreased blood pressure

D. Increased plasma phosphate concentration

E. Metabolic acidosis

57. 75% of the breast is drained by axillary lymph nodes, regarding the axillary lymph node
which of the following is not true
A. Anterior group lie indirect contact with the axillary tail of Spence
B. Posterior group lie along to lateral thoracic vein
C. The intercostobrachial nerve passes between the central lymph nodes
D. The apical group receive most of lymph from upper part of breast
E. Lateral group lie along upper part of Humerus

58. While performing total thyroidectomy the surgeon ligates the superior pedicle as close to
thyroid as possible to avoid injury of:
A. External laryngeal nerve
B. Recurrent laryngeal nerve
C. Superior laryngeal nerve
D. Internal laryngeal nerve
E. All the above

59. All true about the blood supply of thyroid gland except
A. Superior thyroid artery is the first branch of ECA
B. Inferior thyroid artery is a branch of thyrocervical trunk
C. Thyroida ima arise from subclavian artery
D. Superior and middle thyroid vein drain into IJV
E. Inferior thyroid vein drain into brachiocephalic veins

60. The following statements concerning the parotid salivary gland are correct except
A. The facial nerve passes through it, dividing the gland into superficial and deep parts.
B. The secretomotor nerve supply is derived from the facial nerve.
C. The parotid duct pierces the buccinator muscle and opens into the mouth.
D. The external carotid artery divides within its substance to form the superficial temporal
and maxillary arteries.
 E. The retromandibular vein is formed within it by the union of the superficial temporal vein
and the maxillary vein

61. Which of the following changes would you expect to find in a patient consuming a high-
sodium diet (200 mEq/day) compared with the same patient on a normal-sodium diet (100
mEq/day), assuming steady-state conditions?

A. Increased plasma aldosterone concentration

B. Increased urinary potassium excretion

C. Decreased plasma renin activity

D. Decreased plasma atrial natriuretic peptide

E. An increase in plasma sodium concentration of at least 5 mmol/L

62. All the following structures lie in the transpyloric plane EXCEPT:
A. origin of the inferior mesenteric artery
B. fundus of the gall-bladder
C. termination of the spinal cord
D. pancreatic neck
E. duodenojejunal flexure

63. Over a period of several months, a 39-year-old woman has developed

hyperpigmentation in association with an increase in blood pressure. Addition-
ally, her blood glucose concentration has increased slightly. Which of the
following is the most likely diagnosis?

A. Addison's disease

B. Conn's syndrome

C. Pituitary tumor secreting large amounts of adrenocorticotropic hormone

D. Adrenal tumor secreting large amounts of cortisol

E. Panhypopituitarism
 64. The anatomical left & right lobes of the liver are separated on the diaphragmatic surface
of the liver by which of the following structures
A. fissure for the round ligament of the liver
B. fissure for the ligamentum venosum
C. falciform ligament
D. porta hepatic
E. lesser omentum

65.The structure in the free border of lesser omentum from anterior to posterior are
A. Common bile duct (CBD), Hepatic artery (HA), portal Vein (PV).
B. PV, HA, CBD
C. HA, PV, CBD
D.PV, CBD, HA

66. Reed-Sternberg cells are characteristic of :

A. chronic lymphatic leukemia

B. cat scratch disease

C. Hodgkin’s disease

D. histiocytic medullary reticulosis

E. large cell lymphoma

67. The primary anatomic site of pressure regulation in the vascular system is

A. aorta

B. arteries

C. arterioles

D. capillaries

E. heart

68. The most common cause of aortic aneurysms is

A. syphilis

B. congenital weakness of the aortic wall

C. atherosclerosis
D. occlusion of the vasa vasorum

E. bacterial arteritis

69. The major cause of pulmonary thromboemboli is:

A. hypertension

B. heart failure

C. atherosclerosis

D. thrombophlebitis

E. varicose veins

70. Brown tumors of bone are the result of

A. hyperparathyroidism

B. trauma

C. metastatic carcinoma

D. occlusion of the nutrient artery

E. vitamin deficiency

71. Which is the most common primary malignant neoplasm of bone in the age group 15—25
years ?

A. giant cell tumor

B. Ewing’s sarcoma

C. chondroblastoma

D. osteosarcoma

E. chondrosarcoma

72. The most common breast lesion in women is

A. fibroadenoma

B. carcinoma of the breast

C. fibrocystic disease

D. ductal papilloma

73. Bleeding from the nipple in a 45-year-old woman, without a palpable breast mass should
suggest

A. fibroadenoma

B. sclerosing adenosis

C. fat necrosis

D. intraductal papilloma

E. chronic cystic mastitis

74. Which breast lesion is most commonly bilateral

A. intraductal carcinoma

B. medullary carcinoma

C. tubular carcinoma

D. in situ lobular carcinoma

75. Pathologic fractures most typically occur with which of the following

A. pituitary adenoma

B. adrenal adenoma

C. thyroid adenoma

D. parathyroid adenoma

E. pheochromocytoma

76. Diabetes insipidus is associated with a lack of

A. glucocorticoids

B. insulin

C. thyroid hormone
D. antidiuretic hormone

E. growth hormone

77. Third space loss is due to all except

A. Burns crush syndrome.
B. Severe soft tissue infections
C.Repeated vomiting
D. Intestinal obstruction
E.Site of major operative dissection
F.

78. Each of the following applies to Hirschsprung’s disease except

A. intestinal obstruction

B. absence of ganglion cells in myenteric plexus

C. treated by removal of distended segment of bowel

D. toxic megacolon as complication

E. narrow, more distal segment exhibits characteristic deficiency of development

79. Regarding polyps of the colon

A. Adenomatous polyps are usually solitary

B. Villous polyps are usually pedunculated
C. Metaplastic polyps are not precancerous
D. Villous polyps occur more proximal in colon
E. Cancer risk is not related to size of polyp

80. Carcinoid tumors (argentaffinomas) are characterized by all of the following except

A. many are multiple especially in the ileum

B. can occur in alimentary, biliary and respiratory tracts

C. may produce systemic symptoms when accompanied by liver metastases

D. appendix is the most common site

E. appendiceal types have greatest malignant potential

81.Which of the following laboratory values correspond with acute DIC?

A. slowly rising platelet count

B. selective deficiency of vitamin K factors

C. hypofibrigonemia

D. prolonged bleeding time

E. presence of fibrin split products

82. Damage to the pelvic nerves does which of the following?

A. Has little, if any, effect on the defecation reflex

B. Attenuates the defecation reflex

C. Increases the strength of the defecation reflex

D. Results in a continuous urge to defecate (rectal urgency)

83. The most common site of peptic ulcer formation is shown at which point on the figure
below?

(A) Point A

(B) Point B

(C) Point C

(D) Point D
84. A 45-year-old man is found to have a condition in which the parietal cells of his stomach
have been destroyed by an autoimmune mechanism. His diagnosis is chronic autoimmune
gastritis. This condition is often associated with which of the following?

A. Pernicious anemia

B. Gastric ulceration

C. Steatorrhea

D. Protein deficiency

85.The fundus of gall-bladder is in the angle between lateral border of right recius abdominis
and which costal cartilage?

A. 6th
B. 7th
C. 8th
D. 9th
E. 10th

86. Hypochlorhydria is a condition in which acid secretion by the stomach is greatly reduced.
How does this condition affect the digestion and absorption of food?

A. Digestion and absorption of all food substances are nearly normal

B. Digestion and absorption of all foods substances are markedly reduced

C. Digestion and absorption of carbohydrates are greatly affected by this condition

D. Digestion and absorption of fats are greatly affected by this condition

87. Psychological stress is often associated with peptic ulcer disease. Which of the following is
thought to be a contributing factor in stress-induced ulcer disease?

A. Sympathetic stimulation decreases gastric acid secretion

B. Sympathetic stimulation increases peristalsis, which decreases the transit time of ingested
food

C. Psychological stress increases mucous secretion

D. Sympathetic stimulation decreases the alkaline mucous secretions of Brunner's glands

located in the first few centimeters of the duodenal wall

88. Regarding nitrogen balance

A. 60% of nitrogen is lost in urine
B. 40% of nitrogen is lost in skin and stool
C. 10 gm nitrogen is present in 62.5 gm proteins
D. Nitrogen requirement is urinary nitrogen +40%
E. All of the above

89. Regarding K+ ions:

A. Hypokalemia Is defined as K+ level less than 3.9 mmol per liter
B. Hypokalemia lead to wide QRS complex
C. More than 80 % of K is present intracellulary
D. K+ maintenance per day is around 3 mmol/ kg /day
E. Hypokalemia cause metabolic alkalosis

90. Which of the following is true of mass movements?

A. They normally move colonic contents from the cecum to the transverse colon

B. They are strong peristaltic contractions of the small intestine in response to mucosal
irritation

C. They normally occur approximately 9 to 12 times per minute

D. They are a modified type of peristalsis that occurs in the large intestine

91. A 60-year-old man is being treated for persistent diverticulitis with a prolonged course of
antibiotic therapy. The antibiotic being used has broad-spectrum activity and over time has
caused sterilization of the gut in this patient. Which of the following sequelae is likely to be
observed in this patient?
A. Vitamin B!2 deficiency

B. Steatorrhea

C. Vitamin K deficiency

D. Bloating due to excess gas formation

92. Which of the following would cause the greatest degree of hyperkalemia?

A. Increase in potassium intake from 60 to180mmol/day in a person with normal kidneys and
a normal aldosterone system

B. Chronic treatment with a diuretic that inhibits the action of aldosterone

C. Decrease in sodium intake from 200 to l00mmol/day

D. Chronic treatment with a diuretic that inhibits loop of Henle Na +-2 Cl -- K+ co-transport

E. Chronic treatment with a diuretic that inhibits sodium reabsorption in the collecting ducts

93. Furosemide (Lasix) is a diuretic that also produces natriuresis. Which of the following is an
undesirable side effect of furosemide due to its site of action on the renal tubule?

A. Edema

B. Hyperkalemia

C. Hypercalcemia

D. Decreased ability to concentrate the urine

E. Heart failure

94. A 26-year-old man develops glomerulonephritis, and his glomerular filtration rate (GFR)
decreases by 50 per cent and remains at that level. For which of the following substances
would you expect to find the greatest increase in plasma concentration.
A. Creatinine

B. K+

C. Glucose

D. Na+

E. Phosphate

F. H+

95. When compared with the late-evening values typically observed in normal
subjects, plasma levels of both adrenocorticoiropic hormone and conisol would
be expected to be higher in which of the following individuals?

A. Normal subjects after waking in the morning

B. Normal subjects administered dexamethasone

C. Patients with Cushing's syndrome (adrenal adenoma)

D. Patients with Addison's disease

E. Patients with Conn's syndrome

96. Where does the arterial supply to the superior and inferior parathyroids originate from?

A. superior thyroid artery

B. inferior thyroid artery

C. external carotid artery

D. internal carotid artery

E. common carotid artery

97. According to the tumor, node, metastasis (TNM) stag ing for colon cancer, which of the
following is true?

A. All perforated colon cancers are considered T4.

B. N2 refers to involvement of greater than one regional lymph node.

C. T5 grade involves direct carcinoma invasion into adjacent solid organs.

D. MX indicates metastatic disease involvement of more than one additional organ system (e.g.,
liver, lung, brain(.

E. Five-year survival for stage I colon cancer is approximately 75%.

98. To confirm endotracheal intubations in emergency room, all are true except

A. Equal bilateral breath sounds.

B. Pulse oximetry
C. No noise over epigastrium.
D. Chest x ray.
E. CO 2 detector

99.A 5-year-old boy presents to Accident and Emergency complaining of acute pain over his
upper tibia. He is febrile and he refuses to move his leg. A diagnosis of osteomyelitis is
suspected. The likely infecting organism is?

A. Clostridium difficile
B. Haemophilus influenzae
C. Pseudomonas
D. Salmonella
E. Staphylococcus aureus

100. The rectum:

A. is devoid of peritoneum

B. is surrounded by peritoneum

C. has peritoneum on its lateral surfaces for its upper two- thirds, and on its anterior

surface for its upper one-third

D. has pritoneum on its anterior surface for its upper two-thirds, and on its lateral surfaces

for its upper one-third

E. has peritoneum on its anterior surface only

GOOD LUCK