Name: ……………………………………………. Date …../…../……….

1. A 65-year-old man undergoes a low anterior resection for rectal cancer. On the fifth day in hospital, his
physical examination shows a temperature of 39°C
(102°F), blood pressure of 150/90 mm Hg, pulse of 110 beats per minute and regular, and respiratory rate of 28
breaths per minute. A computed tomography (CT)
scan of the abdomen reveals an abscess in the pelvis. Which of the following most accurately describes his
present condition?
a. Systemic inflammatory response syndrome (SIRS)
b. Sepsis
c. Severe sepsis
d. Septic shock
e. Severe septic shock

2. A victim of blunt abdominal trauma has splenic and liver lacerations as well as an unstable pelvic
fracture. He is hypotensive and tachycardic with a heart rate of
150 despite receiving 2 L of crystalloid en route to the hospital. He was intubated prior to arrival due to declining
mental status. He is taken emergently to the
operating room for exploratory laparotomy and external fixation of his pelvic fracture. Which of the following is the
best resuscitative strategy?
a. Infusion of another liter of crystalloid
b. Infusion of 500 mL of 5% albumin
c. Infusion of packed red blood cells followed by fresh-frozen plasma and platelets as indicated by the PT and
platelet counts on laboratory values
d. Infusion of packed red blood cells and early administration of fresh-frozen plasma and platelets prior to return
of laboratory values
e. Infusion of packed red blood cells and vitamin K

3. A cirrhotic patient with abnormal coagulation studies due to hepatic synthetic dysfunction requires an urgent
cholecystectomy. A transfusion of FFP is planned to
minimize the risk of bleeding due to surgery. What is the optimal timing of this transfusion?
a. The day before surgery
b. The night before surgery
c. On call to surgery
d. Intraoperatively
e. In the recovery room

4. A 16-year-old adolescent boy with a history of severe hemophilia A is undergoing an elective inguinal hernia
repair. Which of the following is the best option for
preventing or treating a bleeding complication in the setting of this disease?
a. Fresh-frozen plasma
b. Combination of desmopressin and fresh-frozen plasma
c. DDAVP
d. Combination of ε-aminocaproic acid and desmopressin
e. Factor IX concentrate

5. A 65-year-old man has an enterocutaneous fistula originating in the jejunum secondary to inflammatory bowel
disease. Which of the following would be the most
appropriate fluid for replacement of his enteric losses?
a. D5W
b. 3% normal saline
c. Ringer lactate solution
d. 0.9% sodium chloride
e. 6% sodium bicarbonate solution

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6. A 35-year-old woman undergoes an elective laparoscopic cholecystectomy for symptomatic cholelithiasis.
Which of the following wound classes best describes
her procedure?
a. Class I, Clean
b. Class II, Clean/contaminated
c. Class III, Contaminated
d. Class IV, Dirty
e. None of the above

7. 24-year-old firefighter sustains 30% total body surface area (TBSA) burns to his torso, face, and extremities.
His wounds are treated topically with silver
nitrate. Which of the following complications is associated with use of this agent?
a. Hypernatremia
b. Metabolic acidosis
c. Hyperchloremia
d. Neutropenia
e. Hyponatremia

8. A 75-year-old thin cachectic woman undergoes a tracheostomy for failure to wean from the ventilator. One
week later, she develops significant bleeding from the
tracheostomy. Which of the following would be an appropriate initial step in the management of this problem?
a. Remove the tracheostomy and place pressure over the wound.
b. Deflate the balloon cuff on the tracheostomy.
c. Attempt to reintubate the patient with an endotracheal tube.
d. Upsize the tracheostomy.
e. Perform fiberoptic evaluation immediately.

9. A 56-year-old woman is referred to you about 3 months after a colostomy subsequent to a sigmoid resection
for cancer. She complains that her stoma is not
functioning properly. 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

10 . A 42-year-old man with no history of use of NSAIDs presents with recurrent gastritis. The patient was
diagnosed and treated for Helicobacter pylori 6 months
ago. Which of the following tests provides the least invasive method to document eradication of the infection?
a. Serology testing for H pylori
b. Carbon-labeled urea breath test
c. Rapid urease assay
d. Histologic evaluation of gastric mucosa
e. Culturing of gastric mucosa

11. A 29-year-old woman complains of postprandial right upper quadrant pain and fatty food
intolerance. Ultrasound examination reveals no evidence of gallstones
or sludge. Upper endoscopy is normal, and all of her liver function tests are within normal limits. Which of the
following represents the best management option?
a. Avoidance of fatty foods and reexamination in 6 months.
b. Ultrasound examination should be repeated immediately, since the falsenegative rate for ultrasound in
detecting gallstones is 10% to 15%.
c. Treatment with ursodeoxycholic acid.
d. CCK-HIDA scan should be performed to evaluate for biliary dyskinesia.
e. Laparoscopic cholecystectomy for acalculous cholecystitis.

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12. A 22-year-old woman presents with a painful fluctuant mass in the midline between the gluteal folds. She
denies pain on rectal examination. Which of the
following is the most likely diagnosis?
a. Pilonidal abscess
b. Perianal abscess
c. Perirectal abscess
d. Fistula-in-ano

13.A neonate is found to have an imperforate anus. As the pediatric surgeon you recommend studies to search
for other anomalies. Which of the following is an
associated abnormality?
a. Congenital pulmonary airway malformation
b. Hydrocephalus
c. Duodenal atresia
d. Congenital heart disease
e. Corneal opacities

14. Which of the following statements regarding total body water is false?
A. In males, approximately 60% of total body weight is water
B. The percentage of total body weight that is water is higher
in males than in females
C. Lean individuals have a greater proportion of water (relative
to body weight) than do obese individuals
D. The percentage of total body water decreases with age
E. The majority of body water

15. 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