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01.A 32-year-old man wlLh gasLrlc ouLleL obsLrucLlon secondary Lo a duodenal ulcer presenLs wlLh
hypochloremlc, hypokalemlc meLabollc alkalosls.
Whlch of Lhe followlng ls Lhe mosL approprlaLe Lherapy for Lhls paLlenL?

a.lnfuslon of 0.9 naCl wlLh supplemenLal kCl unLll cllnlcal slgns of volume depleLlon are ellmlnaLed
b. lnfuslon of lsoLonlc (0.13 n) PCl vla a cenLral venous caLheLer
c. Clamplng Lhe nasogasLrlc Lube Lo prevenL furLher acld losses
d. AdmlnlsLraLlon of aceLazolamlde Lo promoLe renal excreLlon of blcarbonaLe
e. lnLubaLlon and conLrolled hypovenLllaLlon on a volume-cycled venLllaLor Lo furLher lncrease CC2

02.A 63-year-old man undergoes a low anLerlor resecLlon for recLal cancer. Cn Lhe flfLh day ln hosplLal,
hls physlcal examlnaLlon shows a LemperaLure of 39C (102l), blood pressure of 130/90 mm Pg,
pulse of 110 beaLs per mlnuLe and regular, and resplraLory raLe of 28 breaLhs per mlnuLe. A compuLed
Lomography (C1) scan of Lhe abdomen reveals an abscess ln Lhe pelvls.
Whlch of Lhe followlng mosL accuraLely descrlbes hls presenL condlLlon?

a.SysLemlc lnflammaLory response syndrome (Sl8S)
b.Sepsls
c.Severe sepsls
d.SepLlc shock
e.Severe sepLlc shock

03.A 71-year-old man develops dysphagla for boLh sollds and llqulds and welghL loss of 60 lb over Lhe pasL 6 monLhs. Pe
undergoes endoscopy, demonsLraLlng a dlsLal esophageal leslon, and blopsles are conslsLenL wlLh squamous cell carclnoma. Pe
ls scheduled for neoad[uvanL chemoradlaLlon followed by an esophagecLomy. reoperaLlvely he ls sLarLed on LoLal parenLeral
nuLrlLlon, glven hls severe malnuLrlLlon reflecLed by an albumln of less Lhan 16r/dl.
Whlch of Lhe followlng ls mosL llkely Lo be a concern lnlLlally ln sLarLlng LoLal parenLeral nuLrlLlon ln Lhls paLlenL?

a. Pyperkalemla
b. Pypermagnesemla
c. Pypoglycemla
d. PypophosphaLemla
e. Pypochloremla

04.A 23-year-old woman undergoes LoLal LhyroldecLomy for carclnoma of Lhe Lhyrold gland. Cn Lhe
second posLoperaLlve day, she beglns Lo complaln of a Llngllng sensaLlon ln her hands. She appears qulLe
anxlous and laLer complalns of muscle cramps.
Whlch of Lhe followlng ls Lhe mosL approprlaLe lnlLlal managemenL sLraLegy?

a.10 mL of 10 magneslum sulfaLe lnLravenously
b.Cral vlLamln u
c.100 g oral SynLhrold
d.ConLlnuous lnfuslon of calclum gluconaLe
e.Cral calclum gluconaLe





xed by E.G & E.K
03.A 63-year-old man has an enLerocuLaneous flsLula orlglnaLlng ln Lhe [e[unum secondary Lo
lnflammaLory bowel dlsease.
Whlch of Lhe followlng would be Lhe mosL approprlaLe fluld for replacemenL of hls enLerlc losses?

a.3 glucose
b.3 normal sallne
c.8lnger lacLaLe soluLlon
d.0.9 sodlum chlorlde
e.6 sodlum blcarbonaLe soluLlon



06.A 43-year-old woman undergoes an unevenLful laparoscoplc cholecysLecLomy for whlch she
8ecelves 1 dose of cephalosporln. Cne week laLer, she reLurns Lo Lhe emergency room wlLh fever, nausea, and coplous dlarrhea
and ls suspecLed of havlng pseudomembranous collLls. She ls afebrlle and has no
perlLoneal slgns on abdomlnal examlnaLlon. She has a mlld leukocyLosls wlLh a lefL shlfL.
Whlch of Lhe followlng ls Lhe approprlaLe lnlLlal managemenL sLraLegy?

a.AdmlnlsLraLlon of an anLldlarrheal agenL
b.LxploraLory laparoLomy wlLh lefL heml-colecLomy and colosLomy
c.LxploraLory laparoLomy wlLh subLoLal abdomlnal colecLomy and lleosLomy
d.AdmlnlsLraLlon of lnLravenous vancomycln
e.AdmlnlsLraLlon of oral meLronldazole

07.A 42-year-old man susLalns a gunshoL wound Lo Lhe abdomen and ls ln shock. MulLlple unlLs
of packed red blood cells are Lransfused ln an efforL Lo resusclLaLe hlm. Pe complalns of numbness around
hls mouLh and dlsplays carpopedal spasm. An elecLrocardlogram demonsLraLes a prolonged C1 lnLerval.
Whlch of Lhe followlng ls Lhe mosL approprlaLe LreaLmenL?

a.lnLravenous blcarbonaLe
b.lnLravenous poLasslum
c.lnLravenous calclum
d.lnLravenous dlgoxln
e.lnLravenous paraLhyrold hormone

08.A 36-year-old man who was hlL by a car presenLs Lo Lhe L8 wlLh hypoLenslon. Cn examlnaLlon,
he has Lenderness and brulslng over hls lefL laLeral chesL below Lhe nlpple. An ulLrasound examlnaLlon ls
performed and reveals free fluld ln Lhe abdomen.
WhaL ls Lhe mosL llkely organ Lo have been ln[ured ln Lhls paLlenL?

a.Llver
b.kldney
c.Spleen
d.lnLesLlne
e.ancreas

09.A 23-year-old woman arrlves ln Lhe L8 followlng an auLomoblle accldenL. She ls acuLely
dyspnelc wlLh a resplraLory raLe of 60 breaLhs per mlnuLe. 8reaLh sounds are markedly dlmlnlshed on Lhe
rlghL slde. Whlch of Lhe followlng ls Lhe besL flrsL sLep ln Lhe managemenL of Lhls paLlenL?

a.1ake a chesL x-ray.
b.uraw arLerlal blood for blood-gas deLermlnaLlon.
c.uecompress Lhe rlghL pleural space.
d.erform perlcardlocenLesls.
e.AdmlnlsLer lnLravenous flulds


10. lollowlng blunL abdomlnal Lrauma, a 12-year-old glrl develops upper abdomlnal paln, nausea, and vomlLlng. 1oLal
obsLrucLlon of Lhe duodenum wlLh colld sprlng appearance ln Lhe second and Lhlrd porLlons .
ln Lhe absence of Lhe suspecLed ln[urles whlch of Lhe followlng ls Lhe mosL approprlaLe managemenL:

a. CasLro[e[unosLomy
b. nasogasLrlc sucLlon and observaLlon
c. uuodenal resecLlon
d. 1n (LoLal parenLal nuLrlLlon) Lo lncrease Lhe slze of Lhe reLroperlLoneal faL pad
e. uuodeno[e[unosLomy

11.28. A 27-year-old man presenLs Lo Lhe L8 afLer a hlgh-speed moLor vehlcle colllslon wlLh chesL paln
and marked resplraLory dlsLress. Cn physlcal examlnaLlon, he ls hypoLenslve wlLh dlsLended neck velns
and absence of breaLh sounds ln Lhe lefL chesL.
Whlch of Lhe followlng ls Lhe proper lnlLlal LreaLmenL?

a. lnLubaLlon
b. ChesL x-ray
c. erlcardlocenLesls
d. ChesL decompresslon wlLh a needle
e. LmergenL LhoracoLomy

12.19-year-old college sLudenL presenLs wlLh a LesLlcular mass, and afLer LreaLmenL he
reLurns for regular follow-up vlslLs. Whlch of Lhe followlng ls Lhe mosL useful serum marker for deLecLlng
recurrenL dlsease afLer LreaLmenL of nonsemlnomaLous LesLlcular cancer?

a. Carclnoembryonlc anLlgen (CLA)
b. Puman chorlonlc gonadoLropln (hCC)
c. rosLaLe-speclflc anLlgen (SA)
d. CA123
e. p33 oncogene

13.An 11-year-old glrl presenLs Lo your offlce because of a famlly hlsLory of medullary carclnoma
of Lhe Lhyrold. hyslcal examlnaLlon ls normal. Whlch of Lhe followlng LesLs should you perform?

a. urlne vanlllylmandellc acld (vMA) level
b. Serum lnsulln level
c. Serum gasLrln level
d. Serum glucagon level
e. Serum somaLosLaLln level

14.A 30 years old man, wlLh low grade MAL1 lymphoma, on a chesL, abdomen and a pelvlc C1 you see enlarged lymph nodes or
meLasLases. WhaL Lhe Lherapy:

A) 1oLal gasLrecLomy and oesophago[e[unosLomy
8) 1oLal gasLrecLomy, oesophago[e[unosLomy + ad[uvanL Lherapy
C) ChemoLherapy
u) SLerolds
L) AnLlbloLlcs






13. a 30 years old woman, on an examlnaLlon you flnd fresh blood per recLum, ralsed abdomlnal dlsLenLlon, lncreased welghL
loss, an 8 cm mass ls found nexL Lo Lhe anal verge, you found an lnvaslon of Lhe Lumour Lo Lhe perlrecLal faL + mulLlple enlarged
lymph nodes wlLhouL dlsLanL meLasLasls, she wlshes Lo preserve Lhe sphlncLer lf posslble.
whaL ls Lhe besL LreaLmenL:

A) Abdomlnoperlneal resecLlon
8) neoad[uvanL Lherapy and anLerlor resecLlon
C) neoad[uvanL Lherapy and abdomlnoperlneal resecLlon
u) 1ransanal resecLlon and ad[uvanL Lherapy
L) neoad[uvanL Lherapy and Lransanal resecLlon

16.37 years old woman wlLh bone meLasLasls 1 year afLer masLecLomy for a breasL Lumour, esLrogen recepLor - negaLlve ,
progesLerone recepLors - negaLlve,Per2-neu poslLlve.
whaL ls Lhe besL Lherapy:

A) AnLlesLrogen (Lamoxlfen)
8) 8aloxlfen
C) Monoclonal anLlbodles (1ranzumab)
u) AnasLozole
L) 3-fluoruracll

17. 33 year old man wlLh hlsLory of rlghL LhyreoldecLomy for benlgn Lhyrolds nodule , now afLer a scheduled 11L for susplclous
Lhyrold mass. LaLer, noLed a swelllng under lnclslon, dlfflculLy breaLhlng, lnLubaLlon was successful.
WhaL should be Lhe nexL course of acLlon?

A) llberopLlc laryngoscopy
8) l.v. calclum
C) 8road specLrum A18 and debrldemenL
u) Wound exploraLlon
L) Plgh dose sLerold and anLlhlsLamlne

18.A 33 year woman, found a lump ln Lhe lefL breasL, wlLh no famlly hlsLory of breasL cancer, Lhe mass ls rubbery, moblle, non
Lender on palpaLlon, no skln changes and axllla ls negaLlve for lymfadenopaLhy. uSC reveals a 1 cm cysL.
WhaL ls Lhe proper managemenL:

A) 8eassure and re-examlne ln a yearly lnLerval
8) lmmedlaLe exclslon for blopsy
C) CysL asplraLlon and cyLology
u) lluoroscenL needle locallsaLlon blopsy
L)Mammography and reevaluaLlon for new lnformaLlon


19.33 year woman wlLh slow growlng palnless mass on Lhe 8L. Slde of her neck. lnA reveals a well dlfferenLlaLed paplllary
carclnoma. u/s neck - 1cm nodule ln Lhe 8L. 1hyrold wlLhouL masses ln Lhe oLher lobe, no Ln meLasLases ln Lhe cenLral or laL.
neck comparLmenLs . wlLh regard Lo Lhls paLlenLbwhlch of Lhe followlng ls assoclaLed wlLh poor prognosls?

a.Age
b.Sex
c.Crade of Lumor
d.Slze of Lumor
e.Ln sLaLus
20.43y woman found Lo have susplclous appearlng calclflcaLlon ln Lhe 8L. 8reasL on a screenlng mammogram. SLereoLacLlc
blopsy of Lhe calclflcaLlon show lobular carclnoma ln slLu (LClS). Cn exam. 8oLh breasLs are dense wlLhouL palpable masses.
neck & bllaLeral axllla are negaLlve for lymphadenopaLhy.
Whlch of Lhe followlng ls Lhe mosL approprlaLe managemenL of Lhls paLlenL.

a.lrequenL self breasL exam. & yearly screenlng mammogram.
b.ChemoLherapy.
c.8adlaLlon.
d.8L. 1oLal masLecLomy wlLh senLlnel Ln blopsy.
e.8llaLeral modlfled radlcal masLecLomy.

21.A 43 year woman wlLh P1n, developmenL of faclal halr & a 7cm suprarenal mass.
Whlch of Lhe followlng ls Lhe mosL llkely dlagnosls:

a.Myelollpoma
b.Cushlng dlsease
c.AdrenocorLlcal carclnoma
d.heochromocyLoma
e.Carclnold


22.A 36 year woman presenLs wlLh palplLaLlons, anxleLy, & P1n. Work-up reveals a pheochromocyLoma.
Whlch of Lhe followlng ls Lhe besL approach Lo opLlmlzlng Lhe paLlenL preoperaLlvely?

a.lluld resLrlcLlon 24 h preoperaLlvely Lo prevenL lnLraoperaLlve congesLlve hearL fallure.
b.lnlLlaLlon of an alpha-blocker 24 hours prlor Lo surgery
c.lnlLlaLlon of an alpha-blocker aL leasL 1-3 weeks prlor Lo surgery
d.lnlLlaLlon of 8-blocker 1-3 weeks prlor Lo surgery
e.LscalaLlng anLlhyperLenslve drug Lherapy wlLh b-blocker followed by alpha-blocker sLarLlng aL leasL 1 week prlor Lo surgery


23. 33 ?LA8S CLu WCMAn 8LSLn1 Wl1P MuL1lLL Anu l8LCuLn1 A8LAS Cl CuA1AnLCS LCCP?MCSlS ,LA1LL1S CCun1
10000 ,8CnL MA88CW S1uu? SPCWLu nC8MAL MLCAkA8?CC?1LS A8uCMlnAL uL18A SCunu SPCWLu nC8MAL SlZLu
SLLLn,8? LxCLuSlCn Cl 1PL CAuSL Cl PL8 1P8CM8CC?1CLnlA ,SPL ulACnCSLu 1C PAvL lMMunC18CM8CC?1CLnlC
u8u8A.
WPlCP lS 1PL MCS1 8LS1 18LA1MLn1 lC8 PL8:

A-LxLC1An1 MAnACLMLn1 Wl1P CLCSL lCLLCW u LA1LL1S CCun1
8-lMMlulA1L LA1LL1S 18AnSluSlCn 1C lnC8LASL LA1LL1S CCun1S MC8L 1PAn 30000
C-CC81lCCS1L8CluS
u-lvlC
L-8LlL8AL 1C Su8CL8? lC8 LA8CSCClC SLLLnLC1CM?







24.A 39 ?LA8S CLu WCMAn CCMLAlnS Cl 8lCP1 uL8 CuAu8Ln1 Aln ,nAuSLA,vCMl1lnC,SPL CCnL unCCMLlCA1Lu
,CS1CL8A1lvLL? A1PCLCC? 8LvLALS 2.3 CM MuClnCuS AuLnCCA8ClnCMA Wl1P L.n lnvASlCn S1AClnC lnCLuulnC
CCLCnSCC?,CPLS1 x-8A?,A8uCMlnCLLlvlC C1 SCAn ALL A8L nLCA1lvL.
nLx1 S1L lC8 8LS1 MAnLCMLn1:

A-nC lu81PL8 MAnLCMLn1 A1 1PlS 1lML, lCLLCW u LACP Slx MCn1P lC8 1CW ?LA8S
8-CPLMC1PL8A?
C-nLCAu!uvLn1 CPLMC1PL8A? 1PLn 8lCP1 PLMlCCLLC1CM?
u-lLLCCCLLC1CM?
L-8lCP1 PLMlCCLLC1CM?

23.A 41-year-old man complalns of regurglLaLlon of sallva and of undlgesLed food. An esophagram
reveals a dllaLed esophagus and a blrd's-beak deformlLy. ManomeLry shows a hyperLenslve lower
esophageal sphlncLer wlLh fallure Lo relax wlLh degluLlLlon.
Whlch of Lhe followlng ls Lhe safesL and mosL effecLlve LreaLmenL of Lhls condlLlon?

a. Medlcal LreaLmenL wlLh subllngual nlLroglycerln, nlLraLes, or calclum-channel blockers
b. 8epeaLed bougle dllaLlons
c. ln[ecLlons of boLullnum Loxln dlrecLly lnLo Lhe lower esophageal sphlncLer
d. ullaLlon wlLh a CrunLzlg-Lype (volume-llmlLed, pressure-conLrol) balloon
e. Surglcal esophagomyoLomy

26.A 36-year-old prevlously healLhy physlclan noLlces LhaL hls eyes are yellow and he has been loslng welghL. Cn physlcal
examlnaLlon Lhe paLlenL has [aundlce and scleral lcLerus wlLh a benlgn abdomen. 1ranscuLaneous ulLrasound of Lhe abdomen
demonsLraLes blllary ducLal dllaLlon wlLhouL gallsLones.
Whlch of Lhe followlng ls Lhe mosL approprlaLe nexL sLep ln Lhe workup of Lhls paLlenL?

a. LsophagogasLroduodenoscopy (LCu)
b. Lndoscoplc reLrograde cholanglopancreaLography (L8C)
c. AcuLe abdomlnal serles
d. CompuLed Lomography (C1) scan
e. oslLron emlsslon Lomography (L1) scan


27.A 22 ?/C CCLLACL S1uuLn1 nC1lCLS A8uLCL ln PlS 8lCP1 C8Cln lnC8LASLS Wl1P CCuCPlnC 8u1 LASlL? 8LuuCA8LL
WPlCP Cl 1PL lCLLClnC PL8nlAS LnL1L8 1PL SL8MA1lC CC8u 1C C8LMAS1L8lC MuSCLL:

a.lLMC8AL
b.ul8LC1
c.lnul8LC1
d.SlCLLlAn
e.ln18AvLSl8AL


28. A 22-?LA8 CLu WCMAn 8LSLn1S Wl1P A AlnluL lLuC1uAn1 MASS ln 1PL MluLlnL 8L1WLLn 1PL CLu1LAL lCLuS.SPL
uLnlLS Aln Cn 8LC1AL LxAMlnA1lCn. WPlCP Cl 1PL lCLLCWlnC lS 1PL MCS1 LlkLL? ulACnCSlS?

A.lLCnluAL A8SCLSS
8.L8lAnAL A8SCLSS
C.L8l8LC1AL A8SCLSS
u.llS1uLA-ln-AnC
L.AnAL llSSu8L

29.A 62-?LA8-CLu MAn PAS 8LLn nC1lClnC 8CC8LSSlvL ullllCuL1? SWALLCWlnC,ll8S1 SCLlu food and now llqulds as
well. A barlum sLudy shows a ragged narrowlng [usL below Lhe cranlal level. Lndoscoplc blopsy conflrms squamous cell
carclnoma.
Whlch of Lhe followlng provldes Lhe mosL accuraLe lnformaLlon regardlng Lhe 1 sLage of an esophageal carclnoma?

a.compuLer Lomography
b.poslLron emlsslon Lomography
c.magneLlc resonance lmaglng
d.endoscoplc ulLrasound
e.bronchoscopy

30.a 73-year-old woman presenLs Lo Lhe emergency room complalnlng of severe eplgasLrlc paln radlaLlng Lo her back, nausea ,
and vomlLlng. CL scan of Lhe abdomen demonsLraLes lnflammaLlon and edema of Lhe pancreas. A rlghL upper quadranL
ulLrasound demonsLraLes Lhe presence of gallsLones ln Lhe gallbladder.
Whlch of Lhe followlng ls an lmporLanL prognosLlc slgn ln acuLe pancreaLlLls accordlng Lo ransons crlLerla?

a.amylase level
b.age
c.LoLal blllrubln level
d.albumln level
e.llpase level

31.cyLoklnase are whlch Lype of hormone?

a.polypepLlde
b.amlno acld
c.faLLy acld
d.carbohydraLe

32.1he prlmary physlologlc effecL of nlLrlc oxlde [nC] ls:

a.lcreased plaLeleL adheslon
b.lncreased leukocyLe-endoLhellal adheslon
c. lncreased mlcroLhrombosls
d. lncreased smooLh muscle relaxaLlon


33.whlch of Lhe followlng ls Lhe prlmary fuel source afLer acuLe ln[ury:

a.faL
b.muscle[proLeln]
c.glycogen
d.keLone bodles

34.whlch of Lhe followlng drugs lrreverslbly lnhlblLs plaLeleL CCx [cyclo-oxygenase]?

a.lbuprofen
b.clopldegrel
c.asplrln
d.celebrex

33. Lhe dlagnosls of heparln-lnduced LhrombocyLopenla ls made by?

a.>20 fall ln plaLeleL counL
b.poslLlveseroLonln release assay
c.plaLeleLes <23000 wlLh cllnlcal bleedlng
d. prolonged a 11

36.a paLlenL wlLh breasL cancer ls consldered Lo be cancer free [ no furLher rlsk of prlmary recurrence or meLasLaLlc Lumor}
afLer:

a.3 years
b. years
c.10 yea
d.never

37. 88CA2 muLaLlons are assoclaLed wlLh all of Lhe followlng LxCL1:

A. gasLrlc cancer
8. lung cancer
c. ovarlan cancer
d. prosLaLe cancer

38. for average rlsk paLlenLs rouLlne cancer screenlng ls recommended for all buL Lhe followlng dlsease?

A. breasL cancer
8. colorecLal cancer
c. cervlcal cancer
d. pancreaLlc cancer

39. pneumoperlLonlum resulLs ln whlch of Lhe followlng?

a. decrease plasma renln
b. decrease AuP
c. decrease glomerular fllLraLlon raLe
d. decrease free waLer absorpLlon ln Lhe dlsLal Lubules

40. whlch of Lhe followlng does noL requlre an elecLrlc currenL Lo coagulaLe Llssue ?

a. monopolar cauLery
b. blpolar cauLery
c. mlxed cauLery
d. ulLrasonlc shear devlce

41. LracLlon dlverLecula ln Lhe esophagus are Lhe resulLs of ?

a. a congenlLal defecL
b. lnfecLlon or lnflammaLlon
c. moLlllLy dlsorders
d Lrauma, usually laLrogenLlc

42.whlch of Lhe followlng makes curaLlve resecLlon of Lhe esophageal cancer unllkely ?

A. 1umor lengLh >6cm
8. WelghL loss > 10
C. recurrenL laryngeal nerve alsy
u. >2 abnormal lymph nodes on C1 scan
43. Whlch of Lhe followlng ls conslsLenLly Lhe largesL arLery Lo Lhe sLomach?

A. lefL gasLrlc arLery
8 8lghL gasLrlc arLery
C lefL gasLroeplplolc arLery
u 8lghL gasLroeplplolc arLery

44. Whlch of Lhe followlng ls Lhe besL LesL Lo conflrm eradlcaLlon of P. pylorl:

A. negaLlve hlsLology afLer blopsy durlng LCu
8. negaLlve fecal anLlgen
C. negaLlve urea breaLh LesL
u. negaLlve urea blood LesL

43. Whlch of Lhe followlng gasLrlc polyps ls consldered pre-mallgnanL?

A. PamarLomaLous
8. PeLeroLoplc
C. lnflammaLory
u. AdenomaLous

46. Whlch of Lhe followlng paLlenLs would be consldered candldaLe for barlaLrlc surgery?

A. 70 year old, 8Ml 48, wlLh well-conLrolled dlabeLes
8. 22 year old, 8Ml 34, wlLh brlLLle (unconLrollable) dlabeLes
C. 33year old, 8Ml 38, wlLh no comorbldlLles
u. 36 year old, 8Ml 42, wlLh no comorbldlLles

47. exLenslve perlanal condyloma acumlnaLa besL LreaLmenL ls:

A. 1oplcal sLerolds
8. 1oplcal podopyllln
C. 1oplcal lmlqulmod
u. Surglcal resecLlon and fulguraLlon

48.A 2-cm lnvaslve cancer of Lhe Loproxlmal Lransverse colon carclnoma should be LreaLed wlLh whlch of Lhe followlng
procedures ?

A. lleoceceLomy
8. Ascendlng colecLomy
C. LefL hemlcolecLomy
u. LxLended rlghL hemlcolecLomy

49. Whlch of Lhe followlng ls an lndlcaLlon for cholecysLecLomy ln an asympLomaLlc paLlenL wlLh an lncldenLal flndlng of
gallsLones?

A. Any hlsLory of abdomlnal paln
8. lamlly hlsLory of compllcaLlons of cholellLhlasls
C. orcelaln gallbladder
u. lrequenL Lravel ouL of Lhe counLry

30. ln addlLlon Lo reglonal lymphadenecLomy, approprlaLe surglcal LreaLmenL for 12 carclnoma of Lhe gallbladder ls?

a. CholecysLecLomy only
b. CholecysLecLomy wlLh resecLlon of llver segmenLs lv8 Anu v
c. CholecysLecLomy wlLh llmlLed rlghL hepaLecLomy
d. CholecysLecLomy wlLh exLended rlghL hepaLecLomy














>A9<?9?<>@)
31. A 27-year-old man presenLs Lo Lhe emergency deparLmenL afLer recelvlng blows Lo Lhe head. Pe opens hls eyes wlLh palnful
sLlmull, ls confused, and locallzes Lo paln. WhaL ls hls glasgow coma score?
A. 13
8. 11
C. 9
u. 7

32. A 43-year-old oLherwlse healLhy woman presenLs afLer a moLor vehlcle accldenL. She ls hemodynamlcally sLable and only
mlnlmal Lenderness ln her rlghL upper quadranL. A lAS1 exam (focused abdomlnal sonography for Lrauma) ls poslLlve wlLh fluld
seen ln Lhe hepaLorenal fossa and Lhe pelvls. Whlch of Lhe followlng ls Lhe nexL besL sLep ln her managemenL?

A. CbservaLlon only
8. C1 scan
C. Laparoscopy
u. LxploraLory laparoLomy

33. 1he ldeal Llme Lo admlnlsLer prophylacLlc anLlbloLlcs Lo a paLlenL undergolng colon resecLlon ls:
A. 8 hour before surgery wlLh a dose repeaLed aL Lhe Llme of lnclslon
8. 2 hour before surgery wlLh a dose repeaLed aL Lhe Llme of lnclslon
C. 1 hour before surgery
u. AL Lhe Llme of lnclslon

34. 1umor sLaglng for mosL eplLhellal cancers lncludes all of Lhe followlng excepL:
A. 1umor slze
8. 1umor muLaLlons
C. nodal lnvolvemenL
u. ulsLanL spread

33. Whlch of Lhe followlng condlLlons lncreases a woman's rlsk of breasL cancer?
A. Scleroslng adenosls
8. llbroadenoma
C. ALyplcal lobular hyperplasla
u. lnLraducLal papllloma

36. Whlch of Lhe followlng ls an lndlcaLlon for cholecysLecLomy ln an asympLomaLlc paLlenL wlLh an lncldenLal flndlng of
gallsLones?
A. Any hlsLory of abdomlnal paln
8. lamlly hlsLory of compllcaLlons of cholellLhlasls
C. orcelaln gallbladder
u. lrequenL Lravel ouL of Lhe counLry



37. A 48-year-old paLlenL presenLs wlLh sudden onseL of bllaLeral lower abdomlnal paln afLer spasmodlc coughlng. Cn
examlnaLlon, Lhere ls a 8-cm, Lender mass ln Lhe mld lower abdomen LhaL remalns unchanged wlLh conLracLlon of Lhe recLum
muscles. Whlch of Lhe followlng ls Lhe mosL llkely dlagnosls?
A. 8upLured aorLlc aneurysm
8. CbLuraLor hernla
C. Splgellan hernla
u. 8ecLus sheaLh hemaLhoma

38. lollowlng documenLaLlon of a flrm mass ln Lhe LesLes by ulLrasound ln a 32-year-old male, Llssue should be obLalned for
dlagnosls by:

A. llne-needle asplraLlon
8. Core-needle blopsy
C. Cpen blopsy
u. CrchlecLomy

39. A 73 year-old man wlLh a hlsLory of myocardlal lnfarcLlon 2 years ago, perlpheral vascular dlsease wlLh sympLoms of
claudlcaLlon afLer half block, hyperLenslon, and dlabeLes presenLs wlLh a large venLral hernla. Pe wlshes Lo have Lhe hernla
repalred. Whlch of Lhe followlng ls Lhe mosL approprlaLe nexL sLep ln hls preoperaLlve workup?
A. A normal elecLrocardlogram (LCC) precludes Lhe need for furLher cardlac LesLlng
8. Pe should undergo an exerclse sLress LesL
C. Pe should undergo coronary arLery bypass prlor Lo operaLlve repalr of hls venLral hernla
u. Pe should undergo a persanLlne Lhalllum sLress LesL and echocardlography
L. Pls hlsLory of myocardlal lnfarcLlon wlLhln 3 years ls prohlblLlve for elecLlve surgery. no furLher LesLlng ls necessary.


60. A 40-year-old man undergoes an appendecLomy for acuLe appendlclLls. llnal paLhology reveals a 2.3-cm carclnold aL Lhe Llp
of Lhe appendlx. Lymph nodes are negaLlve. Whlch of Lhe followlng ls Lrue abouL Lhls condlLlon?
A. no furLher LreaLmenL ls necessary
8. 1here ls a slgnlflcanL chance LhaL carclnold syndrome wlll develop ln Lhe paLlenL
C. 1he paLlenL should recelve chemoLherapy
u. 1he paLlenL should undergo re-exploraLlon and a rlghL hemlcolecLomy
L. MosL appendlceal carclnolds are 2.3 cm or larger when dlscovered

61. A 43 year-old woman undergoes exclslonal blopsy for a mammographlc abnormallLy. llnal paLhology reveals benlgn
paLhology wlLhouL aLypla however, several focl of lobular carclnoma ln slLu (LClS) are deLecLed aL Lhe exclslon marglns.
Whlch of Lhe followlng cholces would be Lhe besL managemenL opLlon?
a. Lxclslonal blopsy Lo achleve negaLlve marglns
b. MasLecLomy wlLh senLlnel lymph node blopsy
c. 8adlaLlon Lherapy
d. 8llaLeral LoLal masLecLomles wlLh lmmedlaLe reconsLracLlon
e. Close cllnlcal and mammographlc follow-up


62. A 28-year old lacLaLlng woman presenLs wlLh a 2-day hlsLory of breasL paln LhaL ls progresslvely worsenlng. Cn examlnaLlon,
a 4-cm area of skln ad[acenL Lo Lhe nlpple ls red and Lender wlLh some edema and no deLecLable flucLuance.
ManagemenL would conslsL of:

a. llne-needle asplraLlon
b. Skln blopsy
c. lnclslon and dralnage
d. Cral anLlbloLlcs
e. Mammography

63. A 60year-old man presenLs wlLh obsLrucLlve [aundlce, achollc sLools, and welghL loss. An ulLrasound scan demonsLraLes a
dllaLed blllary Lree and no gallsLones. A dynamlc conLrasL-enhanced C1 scan demonsLraLes a mass locallzed Lo Lhe head of
pancreas wlLhouL evldence of dlsLanL meLasLasls, adenopaLhy, or vascular lnvaslon. 1he paLlenL ls oLherwlse ln good healLh.
Whlch of Lhe followlng besL descrlbes Lhe role of preoperaLlve percuLaneous blopsy of Lhe mass ln Lhls seLLlng?
a. lL ls hlghly senslLlve
b. lL ls nonspeclflc
c. lL ls assoclaLed wlLh a hlgh compllcaLlon raLe
d. lL should be rouLlnely performed
e. lL ls unnecessary

64. A 4-week old lnfanL presenLs Lo Lhe emergency deparLmenL wlLh lncreaslngly pro[ecLlle vomlLlng LhaL ls nonblllous and a
palpable small rlghL upper quadranL mass. 1he lnfanL has severe hypochloremlc-hypokalemlc meLabollc alkalosls.
Whlch of Lhe followlng ls Lrue?
a. 1he condlLlon ls more common ln females
b. 1he urlne pP wlll llkely be acldlc
c. Lmergency surgery ls lndlcaLed
d. ulLrasonography ls always necessary Lo conflrm Lhe dlagnosos
e. Surgery wlll llkely requlre a gasLrolnLesLlnal bypass

63. 1wo monLhs afLer splenecLomy for l1, Lhe paLlenL ls noLed Lo have peLechla and a decrease plaLeleL counL. A perlpheral
blood smear ls noLeworLhy for Lhe absence of Powell-!olly bodles. Whlch of Lhe followlng ls Lhe besL recommendaLlon?
a. C1 scan of Lhe abdomen
b. 8one marrow blopsy
c. no work-up needed, admlnlsLer sLerolds
d. 8adlolabeled red blood cell (88C) scan
e. no work-up needed, admlnlsLer lmmunoglobulln

66. 1he mosL accuraLe mean of deLermlnlng 1 and n sLaglng of gasLrlc adenocarclnoma ls:
a. 1rlple-phase hellcal compuLed Lomography (C1) scan
b. ulagnosLlc laparoscopy
c. Lndoscoplc ulLrasonography
d. MagneLlc resonance lmaglng wlLh gadollnlum
e. oslLron emlsslon Lomography scan


67. A 28-year old woman undergoes a segmenLal lleal resecLlon durlng Lhe course of an adheslolysls for an acuLe small bowell
obsLrucLlon. Cn posLoperaLlve day 6, she ls noLed Lo have Lhlck blle-colored fluld emanaLlng from Lhe Lhe mldllne wound. AfLer
lv hydraLlon, Lhe nexL sLep ln managemenL should be:
a. C1 scan of Lhe abdomen
b. upper gasLrolnLesLlnal small bowell follow-Lhrough wlLh waLer-should conLrasL.
c. llsLulogram
d. CperaLlve re-exploraLlon
e. CcLreoLlde

68. AfLer a LoLal LhyroldecLomy, Lhe rlghL vocal cord ls noLed Lo be flxed ln a paramedlan poslLlon. 1he mosL llkely represenLs:
a. ln[ury Lo Lhe 8Ln (8ecurrenL laryngeal nerve)
b. ln[ury Lo Lhe exLernal branch of Lhe superlor laryngeal nerve
c. ln[ury Lo Lhe lnLernal branch of Lhe superlor laryngeal nerve
d. 1rauma from endoLracheal lnLubaLlon
e. Compresslon from hemaLoma

69. A 23-year old man susLalns blunL chesL Lrauma followlng a hlgh-speed moLor vehlcle accldenL. Pe ls hemodynlmacally
sLable. Whlch of Lhe followlng condlLlons ls an lndlcaLlon for LhoracLomy?
a. undralned hemoLhorax desplLe a Lube LhoracosLomy
b. ConLlnuous chesL Lube dralnage of more Lhan 200mL/hr of blood for 4 hours.
c. lnLlal chesL Lube ouLpuLs of 1100ML
d. Wlde medlasLlnum
e. llall chesL

70. 1he Lhree flndlngs ln achalasla are:
a. lncreased LLS resLlng pressure, decreased LLS relaxaLlon, lncreased esophageal perlsLalLlc acLlvlLy
b. uecreased LLS resLlng pressure, lncreased LLS relaxaLlon, decreased esophageal perlsLalLlc acLlvlLy
c. lncreased LLS resLlng pressure, decreased LLS relaxaLlon, decreased esophageal perlsLalLlc acLlvlLy
d. uecreased LLS resLlng pressure, lncreased LLS relaxaLlon, lncreased esophageal perlsLalLlc acLlvlLy

71. 1he mosL common eLlology of esophageal perforaLlon ls:

a. SponLaneous rupLure (8oerhaave's syndrome)
b. lnsLrumenLal perforaLlon
c. lorelgn body ln esophagus
d. 8arreLL's esophagus

72. Whlch of Lhe followlng ls Lrue regardlng ClS1 (gasLrolnLesLlnal sLrumal Lumors)?

a. Surgery ls Lhe malnsLay of LreaLmenL
b. MosL ClS1S are found ln Lhe sLomach
c. ClS1S respond well Lo lmaLlnlb mesylaLe (Cleevec)
d. ClS1S usually presenL wlLh upper gasLrolnLesLlnal bleedlng
e. All Lhe above




73. Whlch of Lhe followlng compllcaLlons of crohn's dlsease ls leasL common?

a. LnLeroenLeral flsLulas
b. LnLerocuLaneous flsLulas
c. lree perforaLlon
d. sLrlcLures

74. Whlch ls Lhe mosL llkely cause of lnLussucepLlon ln a 20-year-old man?

a. ldlopaLhlc
b. Lymphoma of Lhe small bowel
c. Carclnold
d. Adheslons

73. Whlch of Lhe followlng ls Lrue regardlng adenomaLous colonlc polyps?

a. olyps less Lhan 1 cm ln dlameLer are unllkely Lo be mallgnanL
b. vlllous adenomas mosL commonly occur ln Lhe cecum
c. lA (famlllal adenomaLous polyposls) ls an auLosomal recesslve condlLlon
d. PamarLomaLous polyps have a hlgh lncldcncc of mallgnanL LransformaLlon
e. lecal occulL blood LesLlng has noL changed Lhe morLallLy from colon cancer

76. A slxLy-old paLlenL wlLh Lwo bouLs of Plnchey SLage ll dlverLlcular dlsease should be LreaLed wlLh:

a. Slgmold colecLomy and anasLomosls
b. 1ransverse colosLomy
c. Slgmold resecLlon, end colosLomy and mucous flsLula
d. 8owel resL, lv anLlbloLlcs
e. 1oLal abdomlnal colecLomy

77. All of Lhe followlng are lndlcaLlve of poor prognosls ln acuLe pancreaLlLls excepL:

a. Serum calclum level less Lhan 8.0 mg/dL
b. Pyperglycemla
c. Serum amylase level more Lhan flve Llmes normal on admlsslon
d. ArLerlal oxygen Lenslon less Lhan 60 mmPg
e. Serum lacLlc dehydrogenase (LuP) more Lhan Lhree Llmes normal

78. A vlcLlm of blunL abdomlnal Lrauma undergoes a parLlal hepaLecLomy. uurlng surgery, he recelves 12 unlLs of packed red
blood cells. ln Lhe recovery room, he ls noLed Lo be bleedlng from lnLravenous puncLure slLes and Lhe surglcal lnclslon.
Whlch of Lhe followlng sLaLemenLs regardlng Lhe coagulopaLhy ls mosL llkely Lrue?

a. 1he paLlenL has an unknown prlmary bleedlng dlsorder
b. 1he coagulopaLhy ls secondary Lo Lhe parLlal hepaLecLomy
c. 1he coagulopaLhy ls secondary Lo dlluLlonal LhrombocyLopenla and deflclency of cloLLlng facLors from Lhe masslve blood
Lransfuslon
d. 1he LreaLmenL ls oral vlLamln k.
e. 1he LreaLmenL ls lnLravenous vlLamln k



79. Whlch of Lhe followlng ls Lrue of mammography?

a. ls Lhe mosL effecLlve means of screenlng for breasL carclnoma
b. ls more effecLlve ln deLecLlng breasL carclnomas ln posLmenopausal women
c. When normal, should noL exclude blopsy of a palpable susplclous breasL mass
d. All of Lhe above

80. SLaLlsLlcally, Lhe mosL powerful predlcLor of prognosls for breasL cancer ls:

a. 1he presence of lnLramammary lymphaLlc lnvolvemenL.
b. 1he grade of dlfferenLlaLlon of Lhe Lumor
c. 1he presence of marked lnLraducLal carclnoma around Lhe prlmary Lumor
d. 1he slze of Lhe Lumor
e. 1he number of axlllary lymph nodes lnvolved wlLh meLasLaLlc Lumor

81. A 33-years old woman pregnanL for Lhe Lhlrd Llme presenL aL 3 monLhs wlLh a 2-cm mass, ln Lhe lnner aspecL of Lhe lefL
breasL. A needle asplraLlon reveals no fluld, you would:
a. Arrange for mammogram because mulLlcenLrlc leslons are common durlng pregnancy
b. Conslder LermlnaLlon of pregnancy because chemoLherapy has been shown Lo be useful ln node-negaLlve premenopausal
paLlenLs
c. LxpedlLlously obLaln a hlsLologlc dlagnosls of Lhe mass
d. WalL unLll Lhe Lhlrd LrlmesLer because surgery ls safer aL LhaL Llme

82. llne needle asplraLlon blopsles are ofLen useful for whlch of Lhe followlng enLlLles?
a. 1hyrold nodules
b. 8reasL mass
c. Llver mass
d. LymphoadenopaLhy
e. Lung mass

83. AccepLable blopsy meLhods for a plgmenLaLlon leslon lnclude all for Lhe followlng excepL:
a. Lxclslon blopsy
b. uncher blopsy
c. Shave blopsy
d. lnclslonal blopsy

84. A 63 years old man has an enLerocuLaneus flsLula orlglnaLlng ln Lhe [e[unum secondary Lo lnflammaLory-bowel dlsease.
Whlch of Lhe followlng would be Lhe mosL approprlaLe fluld replacemenL of Lhe enLerlc loss?
a. uexLrose 3
b. 3 normal sallne
c. 8lnger lacLaLe soluLlon
d. 0.9 sodlum chlorlde
e. 6 sodlum blcarbonaLe soluLlon



83. A 72 years old man sLaLus posL-coronary arLery bypass grafL (CA8C) 3 years ago presenLs wlLh hemaLochezla, abdomlnal
paln, and fever. Colonoscopy reveals paLches of dusLy-appearlng mucose aL Lhe splenlc flexure wlLhouL acLlve bleedlng. Whlch
of Lhe followlng ls Lhe mosL approprlaLe managemenL of Lhe paLlenL?
a. Anglography wlLh admlnlsLraLlon of lnLra-arLerlal paraverlne
b. LmergenL laparoLomy wlLh lefL hemlcolecLomy and Lransverse colosLomy
c. AorLomesenLerlc bypass
d. LxploraLory laparoLomy wlLh LhrombecLomy of Lhe lnferlor mesenLerlc arLery
e. LxpecLanL managemenL

86. A 2-weeks old lnfanL ln found Lo have a hydrocele. Whlch ls Lhe besL course of LreaLmenL?
a. Surgery of Lhe age of 6 monLhs
b. Surgery of Lhe age of 2 years
c. AsplraLlon of Lhe hydrocele
d. 1ransscroLal hydrocelecLomy of Lhe age of 2 years
e. none of Lhe above

87. A 48 years old man ls sLabbed ln Lhe rlghL upper quadranL, he arrlves ln Lhe emergency deparLmenL hypoLenslve and wlLh
abdomlnal Lenderness. Pe ls Laken emergenLly Lo Lhe operaLlon room for laparoLomy. AL exploraLlon he ls found Lo have a 3-cm
laceraLlon Lo Lhe dome of Lhe llver LhaL ls no longer bleedlng. no oLher ln[urles are found.
Lhe nexL sLep ln managemenL Lhls ln[ury would be:
a. rlngle maneuver
b. rlngle maneuver and flnger fracLure exploraLlon of Lhe ln[ury
c. LxploraLlon of Lhe ln[ury
d. uraln ln[ury area and close Lhe abdomen
e. Close Lhe abdomen and geL an anglogram

88. 1he flrsL prlorlLy durlng evaluaLlon of Lhe mulLlple ln[ury paLlenL who ls hypoLenslve ls Lo:
a. LsLabllsh lnLravenous access
b. CbLaln blood for crossmaLch
c. erform a mlnl-neurologlc examlnaLlon
d. Access Lhe alrway
e. Search for occulL bleedlng

89. 1he lnlLlal LreaLmenL for paLlenL wlLh mulLlple bllaLeral rlbs fracLures and flall chesL wlLh CC2 reLenLlon ls?
a. LndoLracheal lnLubaLlon and poslLlve-pressure venLllaLlon
b. Surglcal flxaLlon of Lhe rlbs
c. ChesL wall lmmoblllzaLlon wlLh sand bags
d. lnLercosLal nerve blocks





90. A 41 years old man complalns of regurglLaLlon of sallva and of undlgesLed food, an esophagogram reveals a blrds-beak
deformlLy, whlch of Lhe followlng sLaLemenLs ls Lrue abouL Lhls condlLlon?
a. ChesL paln ls common ln Lhe advanced sLages of Lhls dlsease
b. More paLlenLs are lmproved by forceful dllaLaLlon Lhan by surglcal lnLervenLlon
c. ManomeLry can be expecLed Lo show hlgh resLlng pressure of Lhe lower esophageal sphlncLer (LLS)
d. lnlLlal surglcal LreaLmenL conslsLs prlmarlly of resecLlon of Lhe dlsLal esophagus wlLh re-anasLamosls Lo Lhe sLomach above
Lhe dlaphragm
e. aLlenLs wlLh Lhls dlsease are aL no lncreased rlsk for Lhe developmenL of carclnoma

91. A 43- year old woman wlLh lrrlLable bowel syndrome was ln her usual sLaLe of healLh unLll approxlmaLely 2 monLhs ago. She
complalned of lnLermlLLenL abdomlnal paln wlLh nausea no fever. LasL nlghL her paln became more severe and she presenLed Lo
Lhe emergency deparLmenL wlLh fever 39.7 wlLh rlgors. ln Lhe emergency deparLmenL she had rlgors and sclera lcLerus, dlrecL
blllrubln 2.4 , alkallne phosphaLase 400 , W8C 18.300 , AS1 20 , and AL1 21 . ulLrasound revealed a common blle ducL sLone.
WhaL ls Lhe nexL sLep?
a. AnLlbloLlcs and urgenL surglcal blllary decompresslon (L8C)
b. AnLlbloLlcs and endoscoplc reLrograde cholanglopancreaLography
c. AnLlbloLlcs and Lrans hepaLlc blllary decompresslon
d. AnLlbloLlcs, surglcal decompresslon and cholecysLecLomy

92. 8egardlng urlnary reLenLlon afLer ambulaLory surgery, whlch of Lhe followlng sLaLemenLs ls noL Lrue ?
a. urlnary reLenLlon ls mosL frequenLly assoclaLed wlLh hernlorrhaphy and anorecLal procedures
b. Splnal anesLhesla buL noL general anesLhesla ls a predlsposlng facLor for posLoperaLlve urlnary reLenLlon
c. osLoperaLlve urlnary reLenLlon can frequenLly be asympLomaLlc
d. AmbulaLory surgery paLlenLs musL vold as crlLerlon for dlscharge

93. SelecL Lhe correcL sLaLemenL regardlng flall chesL:
a. lL occurs when Lhree or more ad[acenL rlbs are fracLured ln one place
b. Work of breaLhlng ls lncreased secondary Lo paradoxlcal chesL wall moLlon
c. aLlenLs wlLh flall chesL should be aggresslvely resusclLaLed because of Lhe probable developmenL of a pulmonary conLuslon
d. aLlenLs wlLh Lhls condlLlon should be prophylacLlcally lnLubaLed secondary Lo hlgh llkehood of resplraLory fallure
e. lf a paLlenL does requlre mechanlcal venLllaLlon, lL ls lmporLanL Lo avold Lhe use of poslLlve end-explraLory pressure

94. A 20 years old Woman ls lnvolved ln a hlgh-speed moLor vehlcle accldenL wlLh slgnlflcaLlon damage Lo Lhe fronL of Lhe car.
She arrlves ln Lhe emergency deparLmenL wlLh CCS score of 13. PearL raLe of 120 beaLs/mln, resplraLor raLe of 18 breaLhs/mln,
and a sysLollc blood pressure of mmPg. A chesL radlograph ls obLalned and demonsLraLes a 10-cm medlasLlnum a devlaLlon of
Lhe lefL sLem bronchus. WhaL Lhe mosL approprlaLe nexL sLep ln managemenL?
a. CbservaLlon
b. LefL-slded chesL Lube
c. 8epeaLed chesL radlograph ln 6 hours
d. C1 anglogram of Lhe chesL
e. 1ransesophageal echocardlogram



93. Whlch of Lhe followlng ls Lrue of rhabdomyolysls?
a. AcuLe renal fallure occur secondary Lo Lhe release of myoglobln
b. An alkaloLlc envlronmenL promoLes Lhe formaLlon of myoglobln casLs ln Lhe renal Lubules , Lhereby worsenlng Lhe kldney
damage
c. 1he renal fallure from rhabdomyolysls Lyplcally resolves wlLhln 3-3 days
d. Severe hyponaLremla ls a frequenL compllcaLlon
e. AlkallnlzaLlon Lo P beLween 8 and 9 ls an lmporLanL LreaLmenL goal

96. WlLh regard Lo breasL carclnoma ln men, whlch sLaLemenL ls Lrue?
a. lL ls deLecLed mosL commonly ln men 60-70 years old
b. CynecomasLla ls a rlsk
c. lL ls commonly assoclaLed wlLh a muLaLlon ln 88CA1 gene
d. 1he prognosls ls worse sLage for sLage LhaL for woman
e. SenLlnel lymph node blopsy ls conLralndlcaLed

97. A 33 years old asympLomaLlc women ls referred Lo Lhe cllnlclan wlLh abnormal flndlngs on a mammogram. no masses are
palpable ln elLher breasL. 1he mammogram shows a LlghL clusLer or mlcrocalclflcaLlons aL 2 o'clock poslLlon ln her lefL breasL.
MagnlflcaLlon compresslon vlews show aL leasL 20 Llny lrregular calclflcaLlons ln a 2-cm area LhaL vary ln shape and denslLy wlLh
no assoclaLed mass leslon. 1here are no oLher calclflcaLlons presenL ln elLher breasL.
Whlch of Lhe followlng ls Lhe mosL llkely dlagnosls?
a. LClS
b. llbroadenoma
c. lnfllLraLlng ducLal carclnoma
d. uClS (ducLal carclnoma ln slLu)
e. llbrocysLlc changes

98. A 72 years old man undergoes an aorLoblfemoral grafL for sympLomaLlc aorLolllac occluslve dlsease. 1he ln lnferlor
mesenLerlc arLery (lMA) ls llgaLed ln lLs aorLlc aLLachmenL. 24 hours afLer surgery Lhe paLlenL has abdomlnal dlsLenslon, fever
and bloody dlarrhea. Whlch of Lhe followlng ls Lhe mosL approprlaLe dlagnosLlc sLudy for Lhls paLlenL?
a. AorLogram
b. MagneLlc resonance lmaglng (M8l)
c. CompuLed Lomography (C1) scan
d. Slgmoldoscopy
e. 8arlum enema

99. 1he mosL common cause of gasLrlc ouLleL obsLrucLlon ln adulLs ls?
a. epLlc ulcer dlsease
b. LxLrlnslc neoplasLlc compresslon
c. CasLrlc cancer
d. rlmary lymphoma of Lhe sLomach
e. uuodenal Crohn's dlsease



100. Whlch of Lhe followlng ls Lrue regardlng Lhe lnlLlal LreaLmenL of paLlenLs wlLh acuLe compleLe small bowel obsLrucLlon?
A. lmmedlaLe surgery ls warranLed as soon as Lhe dlagnosls ls made
8. nasogasLrlc decompresslon for 24 hours allows sponLaneous resoluLlon of compleLe bowel obsLrucLlon on all paLlenLs
c. 1he presenL of fever, Lachycardla, locallzed paln or leukocyLosls suggesLs sLrangulaLlon and warranLs prompL surgery
d. All paLlenLs wlLh compleLe small bowel obsLrucLlon requlre blood plasma for resusclLaLlon
e. lf a small bowel resecLlon musL be performed, a sLoma and mucous flsLula are necessary because an anasLomosls ls sub[ecL
Lo non heallng ln Lhe face of obsLrucLlon








?<9<B9?<>?)
61. Whlch of Lhe followlng Lumor markers ls mosL closely assoclaLed wlLh Lhe dlagnosls of CasLrolnLesLlnal SLromal
1umor - ClS1?

a. CLA
b. Cu117
c. PL82/neu
d. CLA123
e. p33

62. A 67 years old woman presenLs wlLh pelvlc paln. C1 shows a mass near her rlghL pelvlc wall. C1
gulded blopsy reveal splndle Lype wlLh few mlLoLlc cells. AL exploraLlon 2cm pedunculaLed mass ls noLed on Lhe
anLlmesenLrlc border of mld lleum. ApproprlaLe Lherapy would be:

a. llgaLlon of Lhe mass aL Lhe pedunculaLed sLalk
b. wedge exclslon of Lhe bowel conLalnlng Lhe mass
c. wlde exclslon, reglonal lymph node dlssecLlon
d. wedge exclslon, lmaLlnlb
e. wlde exclslon, reglonal lymph node dlssecLlon, lmaLlnlb


63. 1he mosL approprlaLe LreaLmenL for a paLlenL wlLh 2cm dlffuse large 8 cell lymphoma llmlLed Lo Lhe anLrum of Lhe
sLomach would be:

a. LoLal gasLrecLomy
b. chemoLherapy, radlaLlon followed by LoLal gasLrecLomy
c. sysLemlc chemoLherapy
d. dlsLal gasLrecLomy
e. chemoLherapy, radlaLlon.


64. A 27 years old female presenLs for evaluaLlon afLer a recenL dlagnosls of cuLaneous melanoma on her rlghL leg. Cn
examlnaLlon Lhe leslon ls lrregular wlLh dlscoloraLlon buL no ulceraLlon. hyslcal examlnaLlon of Lhe rlghL lngulnal shows no
palpable nodes. aLhologlcal analysls of Lhe punch blopsy of Lhe leslon reveals a 3.1mm Lhlck leslon. ln addlLlon Lo 2cm margln
LoLal exclslon of Lhe prlmary, Lhe nexL sLep ln managemenL of her lngulnal nodes should be:

a. observaLlon
b. senLlnel lymph node blopsy
c. elecLlve lymphadenecLomy
d. radloLherapy
e. lsolaLed llmb perfuslon


63. A 73 years old man Laklng nSAlus for arLhrlLls presenLs wlLh an acuLe abdomen and pnumoperlLoneum. Pls
sympLoms are 6 hours old and hls vlLal slgns are sLable afLer Lhe lnfuslon of 1L normal sallne soluLlon. WhaL should be Lhe nexL
sLep ln Lhe managemenL of Lhls paLlenL?

a. CompuLed Lomography of Lhe abdomen
b. LsophagogasLroduodenoscopy
c. AnLlsecreLory drugs, broad specLrum anLlbloLlcs, and surgery lf he falls Lo lmprove wlLhln 6hrs
d. AnLlsecreLory drugs, anLlbloLlcs for P.ylorl, and surgery lf he falls Lo lmprove wlLhln 6hrs
e.





66. Whlch of Lhe followlng ls nC1 a rlsk facLor for developlng a surglcal slLe lnfecLlon - SSl?

a. 8adlaLlon exposure
b. 8ecenL surgery
c. rolonged hosplLallzaLlon
d. lnfancy

67. A 68 years old man ls admlLLed Lo Lhe hosplLal afLer havlng passed Lhree large maroon colored sLools. Cn arrlval aL
Lhe hosplLal, he passes more bloody sLools as well as cloLs. Pe ls pale, orLhosLaLlc, and Lachycardlc. nasogasLrlc asplraLes are
blllous. AfLer resusclLaLlon ls begun, whlch of Lhe followlng ls Lhe mosL approprlaLe lnlLlal LesL?

a. Anglography
b. nuclear medlclne red blood cell scan
c. 8lgld procLoscopy
d. Colonoscopy
e. 8arlum enema

68. A 4 years old paLlenL presenLs wlLh dlffuse scald wounds afLer belng held ln a hoL Lub of waLer. 1here are
clrcumferenLlal bllsLers presenL over Lhe rlghL leg (from hlp Lo Loes) and clrcumferenLlal bllsLerlng over Lhe lower lefL leg (from
knee Lo Loes). 1he rlghL Lhlgh, abdomen and back below Lhe umblllcus, as well as Lhe buLLocks and perlneum are red hoL buL
wlLhouL bllsLers. WhaL ls Lhe LoLal burn surface area?

a. 23
b. 36
c. 46
d. 34


69. LpsLeln-8arr vlrus ls assoclaLed wlLh whlch of Lhe followlng cancers?

a. nasopharyngeal carclnoma
b. non-Podgkln's lymphoma
c. AdulL 1 cell leukemla
d. kaposl's sarcoma


70. Whlch of Lhe followlng ls Lhe mosL slgnlflcanL rlsk facLor for lnvaslve breasL cancer when screenlng a paLlenL for
rlsk?

a. >2 flrsL degree relaLlves wlLh breasL cancer
b. 2 prevlous breasL blopsles ln a paLlenL <30 years of age
c. Age <12 aL menarche
d. ALyplcal hyperplasla ln a prevlous breasL blopsy

71. (SchwarLz?) LymphaLlc dralnage from Lhe supragloLLlc larynx ls prlmarlly Lo:

a. 1he prelaryngeal (uelphlan) node
b. araLracheal nodes
c. ueep cervlcal nodes
d. Superlor [ugular nodes

72. (SchwarLz?) Level v lymph nodes ln Lhe neck are locaLed:

a. ln Lhe submenLal area
b. ln Lhe anLerlor Lrlangle
c. ln Lhe posLerlor Lrlangle*
d. ln Lhe lnferlor [ugular chaln

73. (SchwarLz?) Peparln lnduces anLlcoagulaLlon prlmary by:

a. lncreaslng producLlon of anLlLhrombln
b. lncreaslng Lhe acLlvlLy of anLlLhrombln
c. lncreaslng converslon of facLor x Lo xa
d. lncreaslng converslon of facLor xl Lo xla

74. (SchwarLz?)1he mosL common locaLlon of gasLrolnLesLlnal sLromal Lumors (ClS1) ls:

a. SLomach
b. uuodenum
c. !e[unum
d. lleum

73. (SchwarLz?) A hlgh ouLpuL enLerocuLaneous flsLula ls deflned as dralnlng more Lhan:

a.100 mL/day
b. 300 mL/day
c. 1000 mL/day
d. 2000 mL/day

76. 1he mosL common cause of small bowel obsLrucLlon ls:

a. Adheslon
b. Pernla
c. Mallgnancy
d. Crohn's dlsease


77. A 24-year-old woman ln Lhe 20Lh week of pregnancy experlences a slngle eplsode of blllary collc. 1he mosL
approprlaLe lnlLlal managemenL ls:

a. observaLlon wlLh plans Lo follow her afLer dellvery for recurrenL eplsodes.
b. uleLary changes
c. LlecLlve laparoscoplc cholecysLecLomy durlng 2nd LrlmesLer.
d. LlecLlve open cholecysLecLomy durlng 2nd LrlmesLer.

78. Surgery ls lndlcaLed ln whlch of Lhe followlng asympLomaLlc paLlenLs wlLh prlmary hyperparaLhyroldlsm?

a. Mlldly elevaLed urlnary calclum excreLlon (>100mg/dl).
b. 8educLlon ln creaLlnlne clearance by 10
c. Serum calclum> 0.8 above Lhe upper llmlLs of normal
d. Age < 30 years


79. aLlenL wlLh carclnoma of 1 cm of dlameLer ln Lhyrold glandule wlLhouL adenopaLy.
1reaLmenL of medullary Lhyrold cancer:

a. 1oLal LhyroldecLomy
b. 1oLal LhyroldecLomy+ cervlcal Ln dlssecLlon
d.

80. 1he mosL common cause of prlmary paraLhyroldlsm ls:

a. araLhyrold adenoma
b. MulLlple paraLhyrold adenomas
c. araLhyrold hyperplasla
d. araLhyrold carclnoma
81- whlch of Lhe followlng would be Lhe flrsL dlagnosLlc LesL ordered ln paLlenL wlLh sollLary Lhyrold noudle?

a. radloacLlve lodlne scan
b. C1 or M8l
c. flne needle asplraLlon
d. core needle asplraLlon

82 - a 33 year old woman experlences an acuLe onseL of eplgasLrlc and rlghL upper quadranL paln several hours afLer
large dlnner. she has had slmllar eplsodes ln Lhe pasL LhaL resolved afLer a few hours. 1hls eplsode perslsLs, and she has fever
and nonblllous vomlLlng. whaL ls Lhe mosL llkely source of Lhe abdomlnal paln?

a. perforaLed ulcer
b. acuLe appendlclLls
c. perforaLlon followlng bowel obsLrucLlon
d. acuLe cholecysLlLls
e. dlverLlcullLls

83 - a 37 year old woman wlLh a 1.3 cm lnfllLraLlng ducLal carclnoma ls found Lo be L8 negaLlve, 8
negaLlve, and PL8 - 2/neu poslLlve. she comes Lo your offlce Lo dlscuss LreaLmenL opLlons.
whaL would you recommend?

a. modlfled radlcal masLecLomy alone
b. wlde local exclslon. radlaLlon Lherapy and Lamoxlfen.
c. slmple masLecLomy, senLlnel lymph node blopsy, LrasLuzumab (PercepLln) and Lamoxlfen.
d. modlfled radlcal masLecLomy and ad[uvanL chemoLherapy.
e. wlde local exclslon, senLlnel lymph node blopsy, radlaLlon Lherapy and ad[uvanL chemoLherapy wlLh LrasLuzumab.


84 - a 33 year old woman has a 3 year hlsLory of poorly conLroled hyperLenslon. she ls Laklng Lhree dlfferenL medlcaLlons,
lncludlng a dlureLlc, b-blocker, and poLasslum supplemenLs. whaL would be Lhe nexL sLep ln esLabllshlng Lhe dlagnosls of
surglcally correcLable hyperLenslon?

a. C1 of Lhe abdomen and pelvls
b. urlne caLecholamlnes.
c. serum aldosLerone and renln levels
d. renal uS
e. sallne suppreslon LesLlng


83 - a 44 year old man ls due Lo undergo laparoscoplc adrenalecLomy for pheochromocyLoma. whlch of Lhe followlng
agenLs shoud nC1 be glven as Lhe lnlLlal oronly medlcaLlon Lo help achleve approprlaLe
preoperaLlve adrenorecepLor blockade?

a. phenoxybenzamlne
b. amlodlplne
c. prazoslne
d. aLenolol
e. meLyroslne

86 - followlng surgery a paLlenL develops ollgurla. you belleve Lhe paLlenL ls hypovolemlc, buL you seek
corroboraLlve daLa before lncreaslng lnLravenous fluld.
whlch of Lhe followlng values supporLs Lhe dlagnosls of hypovolemla?

a. urlne sodlum of 28 mLq/L
b. urlne chlorlde of 13 mLq/L
c. fracLlonal excreLlon of sodlum less Lhan 1
d. urlne/serum creaLlnlne raLlo of 20
e. urlne osmolallLy of 330 mosm/kg

87 - a 43 year old woman wlLh Crohn's dlsease and a small lnLesLlne flsLula develops LeLany durlng Lhe second week
of parenLeral nuLrlLlon. Lhe laboraLory flndlngs lnclude:
na - 133
k - 3.2
Cl - 103
PCC3 - 23
Ca - 82
Mg - 1.2
C4 - 2.4
albumln - 2.4
an arLerlal blood gas sample reveals a pP of 7.42, CC2 of 38, and C2 of 84 mmPg.
whlch of Lhe followlng ls Lhe mosL llkely cause of Lhe paLlenLs LeLany?

a. hypervenLllaLlon
b. hypocalcemla
c. hypomagnesemla
d. essenLlal faLLy acld deflclency
e. focal selzure

88- a vlcLlm of blunL abdomlnal Lrauma undergoes a parLlal hepaLoecLomy. durlng surgery he recleves
Lwelve unlLs of packed red blood cells. ln Lhe recovery room he ls noLed Lo be bleedlng from lnLravenous
puncLure slLes and Lhe surglcal lnclslon. whlch of Lhe followlng sLaLemenLs regardlng coagulopaLhy ls mosL llkely Lrue?

a. Lhe paLlenL has n unknown prlmary bleedlng dlsorder
b. Lhe coagulopaLhy ls secondary Lo Lhe parLlal hepaLecLomy
c. Lhe coagulopaLhy ls secondary Lo dlluLlonal LhrombocyLopenla and deflclency of cloLLlng facLors from Lhe masslve blood
Lransfuslon.
d. Lhe LreaLmenL ls oral vlLamln k
e. Lhe LreaLmenL ls lnLravenous vlLamln k


89 - a paLlenL wlLh a solld mallgnancy ls dlscusslng chemoLherapy wlLh hls oncologlsL. he ls lnLeresLed ln Lhe rlsks of
Lhe LreaLmenL. whaL ls Lhe prlmary LoxlclLy of doxorublcln (adrlamycln)?

a. cardlomyopaLhy
b. pulmonary flbrosls
c. perlpheral neuropaLhy
d. urlc acld nephropaLhy
e. hepaLlc dysfunclon


90 - a 41 year old man complalnlng of regurglLaLlon of sallva and undlgesLed food. an esophagogram reveals a
blrd's-beak deformlLy.
whlch of Lhe followlng sLaLemenLs ls Lrue abouL hls condlLlon?

a. chesL paln ls common ln Lhe advanced sLages of Lhls dlsease.
b. more paLlenLs are lmproved by forceful dllaLlon Lhan by surglcal lnLervenLlon
c. manomeLry can be expecLed Lo show hlgh resLlng pressure of Lhe lower esophageal sphlncLer (LLs)
d. surglcal LreaLmenL conslsLs prlmary of resecLlon of Lhe dlsLal esophagus wlLh reanasLomosls Lo Lhe sLomach
above Lhe dlaphragm
e. paLlenLs wlLh Lhls dlsease are aL no lncreased rlsk for Lhe developmenL of carclnoma






91. A 41 y/o man presenLs wlLh food and sallva regurglLaLlon , an esophagogram was performed and shown "beard leak "
phenomenon whaL ls Lrue ?

A .ChesL paln ls common ln Lhls condlLlon
8. llrsL perform forceful dllaLlon Lhan proceed Lo surgery
C. ManomeLry show lncrease LLS resLlng Lone
u. 8esecLlon above Lhe dlaphragm
L. 1here ls no lncreased rlsk for carclnoma

92. 3 flndlngs ln achalasla :

A. lncreased LLS resLlng pressure , decreased LLS relaxaLlon , lncreased esophageal acLlon
8. uecreased LLS resLlng pressure , lncreased LLS relaxaLlon , uecreased esophageal acLlon
C. lncreased LLS resLlng pressure , uecreased LLS relaxaLlon , uecreased esophageal acLlon
u. uecreased LLS resLlng pressure , lncreased LLS relaxaLlon , lncreased esophageal acLlon


93. An anLlreflux procedure unsuccessful because:

A. CasLrlc ouLleL obsLrucLlon was noL ldenLlfled
8. Well dllaLed prevlous sLrlcLure
C. uecreased sallva producLlon
u. 1ransLhoraclc fundoplasLy


94. Lsophageal perforaLlon frequenLly caused:

A. SponLaneous rupLure
8. lnsLrumenLal perforaLlon
C. lorelgn body
u. 8arreLL's esophagus


93. Whlch one ls noL conLrlbuLe Lo dlgesLlon of faLs ln small lnLesLlne:

A. 8rush border enzymes
8. ancreaLlc llpases
C. 8lle salLs
u.?


96. Whlch one ls noL characLerlsLlc of chronlc Crohn's dlsease :

A. 8ecLal bleedlng
8. erlanal dlsease
C. ularrhea
u. Abdomlnal paln

97. lnLussuspecLlon ln 20y/o man :

A .ldlopaLhlc
8 . Carclnold
C. Adheslons
u . Lymphoma




98. Leslons assoclaLed wlLh euLz-!egher syndrome :

A.Sesslle adenomas
8. ClusLer leslons ln duodenum
C. PamarLoma
u. lL has A8 lnherlLance

99. WhaL ls noL an lndlcaLor for an open cholycesLecLomy :

a. poor pulmonary or cardlac reserve
b.Lhlrd LrlmesLer gesLaLlon
c. chlld's class C llver dlsease
d. suspecLed gallbladder cancer
e. revlous gasLrlc bypass procedure


100. rlmary scleroLlzlng cholanglLls assoclaLed wlLh whlch dlsorder :

A. Crohn's dlsease
8. ulabeLes
C. 8heumaLold arLhrlLls
u. ulceraLlve collLls
L. Chronlc pancreaLlLls


101. Whlch of Lhe followlng does nC1 sLlmulaLe blle flow?

A. CholecysLoklnlng
8. blle salLs
C. vagal sLlmulaLlon
u. splachnlc sLlmulaLlon
L. secreLln

102. AcuLe lschemla ln lower exLremlLy:

a. mosL ofLen Lhe resulL of femoral arLery Lhrombosls
b. can never occur as a consequence of uv1
c. ls never amenable Lo LreaLmenL wlLh LhrombolyLlc LreaLmenL
d. ls mosL ofLen Lhe resulL of cardlac embollc evenLs
e. rarely resulL ln llmb/(llfe? noL sure l wroLe correcL) LhreaLenlng lschemla


103. Whlch of Lhe followlng regardlng aneurysms ls Lrue?

a. lnflammaLory aneurysm of Lhe aorLa rarely rupLure.
b. splenlc arLery aneurysm are usualy aLheroscleroLlc.
c. Lhrombosls of popllLeal arLery aneurysm may be LreaLed wlLh LhrombolyLlc Lherapy
d. lnfecLed aneurysm of Lhe aorLa usualy requlre compleLe exclslon and exLraanaLomlc revascularlzalon
e. aneurysms of Lhe hepaLlc arLery are Lhe mosL common vlsceral aneurysms


104. 8reasL conservaLlon surgery ln breasL carclnoma:

a. resulLed ma[or lmporovemenL ln morLallLy and morbldlLy.
b. has resulLed durable survlval daLa comparable Lo Lhose for masLecLomy for cerLaln breasL cancer



103. ducLal carclnoma of breasL ln slLu:

a. ls almosL always bllaLeral.
b. has become more frequenLly dlagnosed because of Lhe use of mammogram.
c. cannoL presenL as a palpable mass.
d. ls frequenLly assoclaLed wlLh mlcroscoplc lymph node meLasLases.


106) A 33-year-old woman pregnanL for Lhe Lhlrd Llme presenL aL 3 monLhs wlLh a 2-cm mass ln Lhe lnner aspecL of Lhe lefL
breasL. A needle asplraLlon reveals no fluld. ?ou would:

a) arrange for a mammogram because mulLlcenLrlc leslons are common durlng pregnancy.
b) conslder LermlnaLlon of pregnancy because chemoLherapy has been shown useful ln nodenegaLlve premenupausal paLlenLs.
c)expedlLlonsly obLaln a hlsLologlc dlagnosls of Lhe mass.
d)walL unLll Lhe Lhlrd LrlmesLer because surgey ls safer aL LhaL Llme.


107) 8lsk facLors for Lhe developmenL of melanoma lnclude all of Lhe followlng excepL:

a)falr halr.
b)llghL complexlon.
c)green eyes.
d)mulLlple nevl.


108) Whlch of Lhe followlng endoscoplc pepLlc ulcer characLerlsLlcs has Lhe hlghesL rlsk for recurrenL bleedlng:

a) oozlng ulcer.
b)clean based ulcer.
c)nonbleedlng "vlslble vessel"
d)nonbleedlng ulcer wlLh an overlylng cloL.
e)uleulafoy ulcer.


109) A 38-year-old man was Laken Lo an emergency faclllLy afLer hls car skldded on Lhe freeway and sLruck a plllar. Pls
vlLal slgns were as follows: puls 88/mln, resplraLlons 20/mln, blood pressure 100/70 mmPg. hyslcal examlnaLlon
revealed nonpromlnenL [ugular neck velns, no lndlcaLlon of cyanosls, and symmeLrlc breaLh sounds. A posLerlor-anLerlor chesL
x-ray fllm revealed a wldened medlasLlnum. Whlch of Lhe followlng cholses ls Lhe mosL llkely dlagnosls?

a)rupLured aorLlc aneurysm.
b)cardlac Lamponade.
c)dlssecLlon of Lhe Lhoraclc aorLa.
d)myocardlal conLuslon
e)pulmonary conLuslon.


110) Whlch of Lhe followlng sLaLemenLs ls Lrue abouL surgery for pheochromocyLomas?

a)paLlenL should recelve preoperaLlve alfa-blockade for 1 Lo 4 weeks prlor Lo surgery.
b)Lhe adrenal veln should be Laken only afLer Lhe arLerlal supply ls lsolaLed and llgaLed.
c)lnLravenous flulds should be resLrlcLed unLll Lhe Lumor ls removed.
d)preoperaLlvebeLa-blockade should precede any alfa-blockes Lo avold Lhe preclplLaLlon of mallgnanL hyperLenslon.
e)bllaLeral adrenalecLomy should be performed for paLlenLs wlLh MLn2a.














<>9<@9?<>?)

61) A 27 year old man presenLs Lo Lhe Lmergency room afLer a hlgh speed moLor vehlcle colllslon, wlLh
chesL paln and marked resplraLory dlsLress. hyslcal examlnaLlon, he ls hypoLenslve wlLh dlsLended
neck velns and absence of breaLh sounds ln lefL chesL. Whlch of Lhe followlng ls proper lnlLlal LreaLmenL?


a. lnLubaLlon
b. ChesL x-ray
c. erlcardlocenLesls
d. ChesL decompresslon wlLh needle
e. LmergenL LhoracoLomy


62) A 33 year old man who had been morbldly obese underwenL successful 8oux-en-?
gasLrlc bypass 33 monLh earller. Powever, recenLly he has been havlng dlsLurblng
sympLoms. 1hese lnclude lnsomnla, sensory dlsLurbances, such as numbness and Llngllng ln
hls hands and feeL, as well as lnflamed Longue, dlzzlness, poor coordlnaLlon and balance. ln
addlLlon he developed sLrange way of walklng, a sLomplng galL sLrlklng flrsL heavlly wlLh hls
heel. 1he deflclency LhaL would mosL llkely cause sympLoms descrlbed ls whlch one of Lhe followlng?

a. lron
b. vlLamln 812
c. lolaLe
d. Zlnc
e. Copper


63) A 63 year old man wlLh long hlsLory of Coronary arLery dlsease and recenL hlsLory of
Myocardlal lnfarcLlon ls seen ln Lmergency room wlLh hlsLory of sudden onseL of paln ln rlghL leg. 1he
paLlenL also complalns of numbness ln Lhe leg. hyslcal examlnaLlon revealed pallor of rlghL leg, Lhe skln was
cool Lo Louch, and Lhe paLlenL has dlfflculLy ln movlng hls Loes.
8alslng hls leg lncrease Lhe pallor and dorsalls pedls pulse could noL be felL.
1hese sympLoms mosL llkely represenL whlch of Lhe followlng abnormallLles?

a. Superflclal LhrombophleblLls
b. PernlaLlon of a lumbar dlsk
c. ArLerlal occluslon
d. ueep venous lnsufflclency
e. Pypovolemlc shock


64) A 38 year old man was Laken on an Lmergency room afLer hls car skldded on Lhe free way and sLuck
a plllar. Pls vlLal slgns were as follows: pulse- 88/mln., resplraLory raLe -20/mln., blood pressure- 100/70 mmPg. hyslcal
examlnaLlon revealed non promlnenL [ugular neck velns, no lndlcaLlon of cyanosls and sysLemlc breaLh sounds. A
posLerloranLerlor chesL x-ray fllm reveals a wldened medlasLlnum. Whlch of Lhe followlng cholces ls mosL llkely dlagnosls?

a. 8upLured AorLlc Aneurysm
b. Cardlac Lemponade
c. ulssecLlon of Lhe Lhoraclc aorLa
d. Myocardlal conLuslon
e. ulmonary conLuslon





63) A 68 year old man presenLs aL Lhe Lmergency deparLmenL because of such severe
abdomlnal paln LhaL he !usL could noL sLand lL any longer . Pe Lells Lhe Lrlage nurse LhaL
he had noL been feellng well for Lhe pasL couple of monLhs, prlmarlly because he had been
havlng abdomlnal paln abouL 30 mlnuLes afLer eaLlng and as a consequence losL almosL 10
pounds, buL lasL nlghL he suddenly developed a sLomach ache from hell . Pe also has been
vomlLlng and has had several eplsodes of bloody dlarrhea. upon physlcal examlnaLlon Lhe
physlclan noLes hypoLenslon and noLlces abdomlnal dlsLenLlon. 8owel sounds are absenL,
and Lhere ls no rebound Lenderness presenL or oLher relevanL flndlngs upon abdomlnal
examlnaLlon. LaboraLory daLa reveal an absoluLe neuLrophlllc leukocyLosls and mlld lefL shlfL plus lacLlc
acldosls, and elevaLlon of Lhe serum amylase level. Whlch of Lhe followlng ls Lhe mosL llkely dlagnosls?


a. AcuLe ulceraLlve collLls
b. Pemorrhaglc pancreaLlLls
c. AorLoenLerlc flsLula
d. AcuLe small bowel lnfarcLlon
e. 1oxlc megacolon


66.A grossly underwelghL 32 y/o women wlLh chronlc malnuLrlLlon ls due Lo undergo ma[or surgery . lL
declde Lo sLarL LoLal parenLal nuLrlLlon (1n)nas parL of lnLlal Lherapy . whlle lnLroduclng a cenLral venous caLheLer lnLo rlghL
subclavlan veln she develop sudden dysnea . WhaL ls Lhe mosL dlagnosls ?

a. Alr embollsm
b. pulmonary embollsm
c. faL embollsm
d. acuLe anxleLy
e. pneumoLhorax


67.72 y/o female ls seen ln emergency deparLmenL wlLh a hlsLory of sudden sever collck
mldabdomlnal paln and nausea and vomlLlng over Lhe pasL 3 hours . durlng examlnaLlon she Lhrow up a blle-
sLalned vomlLs . physlcal examlnaLlon reveal generallzed abdomlnal Lenderness wlLh decreased bowel sound , radlography of
abdomen show radloopaqe mass ln dlsLal small bowel on rlghL slde wlLh dllaLed loops proxlmally . no free alr ls noLed under
dlaphragm buL alr ls presenL ln blllary Lree . WhaL ls mosLly dlagnosls ?


a. lymphoma for small bowel
b. acuLe pancreaLlLls
c. acuLe appendlclLls wlLh radlopaque fecallLh
d. gallsLone lleus
e. lnLussuscepLlon


68. A 33 y/o flre man was badly burned when Lhe roof of house collapsed on hlm .
Pe had second-degree burn lnvolvlng 13 of hls body surface and Lhlrd degree burn
lnvolvlg 20 of body surface . he was rushed Lo Lhe nearesL emergency deparLmenL and
Lhen Lransferred Lo burn unlL . a week laLer he develop fever , black paLches are noLed ln Lhe burn wound .
8lopsy and culLure of one of wound slLe would mosL llkely reveal whlch of Lhe organlsms ?

a. sLaph aureus
b. pseudomonas aurgensa
c. candlda alblcans
d. group a sLrepLococcus
e. sLrepLococcus pneumonla



69. A 33 y/o alcohollc man wlLh chronlc pancreaLlLls has recurrenL aLLack of abdomlnal paln LhaL radlaLe Lo back.
paln ls conLrolled wlLh medlcal Lherapy , he losL 30 lb ln pasL 3 monLhs because of chronlc dlarrhea . examlnaLlon of abdomlnal
show no masses , C1 shoe mulLlple calclflcaLlon buL no mass leslon , serum glucose normal , quallLlve sLool LesL for faL normal ,
anLlglldlan anLlbody are noL presenL , mosL approprlaLe LreaLmenL ls ?


a. LoLal pancreaLecLomy
b. broad specLrum Lherapy
c. gluLen free dleL
d. oral pancreaLlc enzyme before , durlng , and afLer meals
e. admlnlsLraLlon of lacLulose

70. A 33 y/o man presenL Lo emergency wlLh masslve hemaLemessls . physlcal examlnaslon reveal abdomlnal dlsLenslon ,
shlfLlng dullness on percusslon and splderanglomaLo over Lhe faceand upper chesL , an emergenL endoscope reveal bloody
rapldly fllllng dlsLal esophagus . PemaLemessls ls mosL llkely due Lo ?

a. pylorlc sLenosls
b. rupLured esophageal varlces
c. gasLrlc ulcer
d. esophageal carclnoma
e. duodenal ulcer


71) a 68 years old man wlLh lnLermlLLenL cramplng abdomlnal paln , also have dlfflculLy
defecaLlng , he ls managlng bowel movemenL every Lhlrd or fourLh day only , wlLh gralL *** of sLralnlng and
Lhen only pass small hard feces wlLh loL of mucus and someLlmes fresh blood . hls physlclan suspecLs obsLlpaLlon and orders a
barlum enema LhaL reveals masslvely dllaLed slgmold
colon wlLh column of barlum resembles a beards peak . whaL ls Lhe mosL llkely dlagnosls?

a- lnLussepLlon
b- volvulus of slgmold colon
c- Loxlc mega colon
d- ogllvle syndrome
e- lmpacLed sLool


72) a 18 years old woman presenLs Lo Lhe emergency deparLmenL wlLh a hlsLory of severe
reLrosLernal chesL paln LhaL ls aggravaLed by swallowlng and deep breaLhlng . Lhe paLlenL
appears anxlous , she ls afebrlle , has slnus Lachycardla, sllghLly elevaLed blood pressure and Lachypnea ,
mlld pallor ls noLed , buL she seems well hydraLed and has no lcLerus .
examlnaLlon of Lhe cardlovascular sysLem had normal flndlngs excepL for slnus Lachycardla , Lhe abdomen ls
schaphold and no Lenderness,masses or organomegaly ls noLed. her wlghL ls less Lhan Lhe norm for her age
and hlghL . Lhe paLlenL however feels LhaL she ls obese and has Laken Lo blnge eaLlng followed by self lnduced
vomlLlng . whlch of Lhe followlng ls Lhe mosL probable cause of her problem ?

a- gasroreflux desease
b- boerhave syndrome
c- Lenslon pneumoLhorax
d- gasLrlc ulcer desease
e- esophegeal cancer








73) a 63 years old woman presenLs Lo Lhe emergency deparLmenL wlLh dlffuse abdomlnal
paln and vomlLlng , she has noL had a bowel movemenL ln Lhe pasL 3 days , physlcal exam
reveals hyper perlsLalsls , Lympany Lo percusslon , and no rebound Lenderness , her
LemperaLure ls 38 c (100.4f). an abdomlnal x-ray fllm reveals dlsLended loops of small bowel wlLh a sLep
ladder paLLern of dlfferenLlal alr-fluld levels.
whlch of Lhe followlng ls Lhe mechanlsm LhaL mosL llkely produce Lhese sympLoms?

a-dlverLlculosls
b- adheslons from prevlous surgery
c- Lorslon of Lhe bowel around Lhe mesenLerlc rooL
d- lnLussuslpLlon of Lhe Lermlnal lllum lnLo cecum
e- lschemla secondary Lo Lhrombosls of Lhe superlor mesenLerlc arLery CorrecL


74) a 33 years old man wlLh a long hlsLory of dyspepsla, experlences sudden onseL of sever epgasLrlc dlsLress
wlLh assoclaLed paln ln Lhe rlghL shoulder . physlcal exam reveals a paLlenL who appears lll and has rlgld, qulL
abdomen wlLh rebound Lenderness.
whlch of Lhe followlng ls Lhe mosL approprlaLe flrsL sLep ln Lhe managemenL of Lhls paLlenL?

a- order a barlum sLudy of Lhe upper Cl
b- order uprlghL and suplne abdomlnal fllms
c- perform a perlLoneal lavage
d- admlnlsLer anLl-aclds
e- do an exploraLory laparaLomy


73) 20 years old man ls sLapped ln Lhe lefL slde of hls chesL, medlal Lo Lhe nlpple . upon
examlnaLlon hls blood pressure ls 90/60 mmPg , and hls pulse ls 130/mln , hls [ugular
venous pulse lncreases on lnsplraLlon , whereas hls perlpheral pulse and blood pressure
decreases on lnsplraLlon . breaLh sounds are normal bllaLerally . Lhe paLlenL's chesL x-ray fllm ls unremarkable
. afLer recelvlng 2L of lsoLonlc sallne , hls blood pressure remalns low ,
whereas hls cenLral venous pressure rlses Lo 32 cm P2C .
whlch of Lhe followlng ls Lhe mosL approprlaLe nexL sLep ln Lhe managlng of Lhls paLlenL ?

a- lnserL a chesL Lube lnLo Lhe lefL pleural cavlLy
b- lncrease parenLeral flulds unLll Lhe blood pressure lncreases
c- order an echocardlogram
d- decrease venous pressure by admlnlsLerlng venLllaLor
e- decrease venous pressure by admlnlsLerlng loop dlureLlcs

76. A 30 years old womam arrlved aL Lhe L.u broughL by hls sun ,Lell Lo Lhe Lrlage nurse LhaL afLer
consumlng a hearLy Lhankglvlng meal felL lll ,paln and sympLoms grew worse durlng
Lhe nlghL and early mornlng and have 2-3 eplsodes of gallbladder Lrouble paln buL non so
severe ,L102f ,8 90/42 ,sever rlghL cuadranL paln ,[aundlce ,problems wlLh answer
quesLlon and babble lncoherenL ,mlld hepaLomegaly .8123/mln ,W8C 13,6*10-3 (n4,8-
10,8)bllllrublna LoLal 6,6mg/l ,LranpepLldase acLlvlLy raLe ls 103 ,alcllne phosphaLase value 176umLs/l ,urlne
analysls ls normal.

a-ameblc llver absces
b-acuLe hepaLlLls.
c-acuLe pancreaLlLls
d-ascendlng colanglLls.
e-sclerosls perlcolanglLls.





77- 67 y. old woman wlLh pelvlc paln ,cL shows mass near her rlghL pelvlc wall ,cL guldede blopsy
revealed spldle Lype wlLh few mlLoLlc cell , aL explor. ,a 2cm pedunculaLed mass ls noLed on Lhe
anLeromesenLerlc border of Lhe mlld lleum ,approplaLe Lherapy...

a-llgaLed of Lhe mass aL Lhe pedunculaLed sLak.
b-wldge exclslon of Lhe mass .
c-wldge exclslon ,reglonal lymph nodes dlsecLlon.
d-wldge exclslon ,lmaLlnlb
e-wlde exclslon reglonal lLmph nodes dlsecLlon ,lmaLlnlb.




78) WPA1 ls Lhe hallmark blochemlcal feaLure of Lhe resumpLlon
of feedlng syndrome(re-feedlng syndrome), assoclaLed wlLh lncreased morLallLy?

A) hypokalemla
8) hypophosphaLemla
C) glpomagnezemlya
u) hypoglycaemla
L) hypocalcemla


79-a paLlenL wlLh cuLaneous melanoma ln Lhe rlghL leg ,lrregular wlLh dlscoloraLlon ,buL noL ulceraLlon ,rlghL
lngulnal reglon wlLhouL palple nodes ,punch blobsy of Lhe leslon reveal3`1mm Lhlck leslon . 2cm`local exclslon of Lhe prlmary
leslon ,nexL sLep.

a-observaLlon .
b-senLenel lymph node blopsy .
c-elecLlve lymphadenopaLhy .
d.81(radloLherapy).
e-lsolaLed lymph perfuslon.

80- 30 y.old paLlenL has a 3cm vlllous appearlng Lumor aL 6 cm of Lhe anus nexL sLep.

a-observe Lheleslon of slgn of mallgnancy .
b-resure Lhe paLlenL LhaL Lhls are noL premallgnanL leslo
c-fulguraLe Lhe leslon.
d-locally lrradlaLe of Lhe leslon .
e-surglcally resecL Lhe leslon.


81- A 60 years old man, presenLs wlLh [aundlce for 2 weeks, Lhere ls no hlsLory of abdomlnal paln, 8uL Lhere
ls a markedly dlsLended gallblader seen on ulLrasound. whaL ls Lhe mosL llkely dlagnosls :

a. Common blle ducL obsLrucLlon from a sLone
b. Common blle ducL obsLrucLlon from pancreaLlLls
c. Common blle ducL obsLrucLlon from pancreaLlc carclnoma of Lhe head of Lhe pancreas
d. acuLe cholecysLlLls
e. alcohollc hepaLlLls







82- A 29 years old man wlLh a hlsLory of crohn's dlsease lnvolvlng Lhe Lermlnal lleum develops pneumaLurla and fecalurla. WlLch
of Lhe followlng compllcaLlons of crohn's dlsease Lhls paLlenL have ?

a. lleodoudenal flsLula
b. lleoslgmold flsLula
c. recurrenL dlsease lnvolvlng a prevlous lleocolon anasromosls
d. colovesclcal flsLula
e. acuLe cysLlLs

83- A 63 years old man remalns ln Lhe lCu for 1 monLh afLer coronary arLery bypass grafLlng (CA8C), he
has been LreaLed for 2 eplsode of pneumonla and conLlnues Lo requlre venLllaLory supporL. Pe develops a
waLery dlarrhea and abdomlnal dlsLenslon, sLool senL for ClosLrldlum dlfflclle ls poslLlve and oral
meLronldazole ls lnlLlaLed. 3 days laLer Lhe paLlenL develops hypoLenslon, requlrlng vasopressors, and renal fallure, W8C=
36000/mm3. Whlch of Lhe followlng ls Lhe mosL approprlaLe managemenL ?

a. lnLravenous vancomycln
b. vancomycln enemas
c. cecosLomy Lube placmenL
d. dlverLlng Lransverse loop colosLomy
e. LoLal abdomlnal colecLomy and lleosLomy


84- Small bowl perforaLlon ln blunL Lrauma ls deLecLed by:

a. C1 abdomlnal scan
b. locused AssessmenL wlLh Sonography for 1rauma (lAS1)
c. ulagnosLlc perlLoneal lavage (uL)
d. physlcal examlnaLlon
e. none of Lhe above


83 - 23 years old paLlenL carrles a LoLal LhyroldecLomy on carclnoma of Lhe Lhyrold gland. Cn Lhe 2nd day
afLer surgery, she began Lo complaln of feellng ln Lhe bones of Lhe hands pokallvanlya. lL looks preLLy exclLed, and Lhen beglns
Lo complaln of muscle cramps. Whlch of Lhe followlng ls mosL correcL?

A. 10 ml/10 of magneslum sulfaLe / ln.
8. vlLamln u orally
C. Levomlrokslna 100mcg orally. ???
u. ConLlnuous lnfuslon of calclum gluconaLe.
L. ClyukanaL calclum glocunaLe orally.


86-A 10 years old boy was Lhe backseaL belled passenger ln a hlgh speed moLor vehlcle
colllslon . on presenLaLlon Lo Lhe L8 he ls awake , alerL,and hemodynamlcally sLable. Pe ls
complalnlng of abdomlnal paln and has an ecchzmosls on hls anLerlor abdomlnal wall where Lhe seaLbelL
was locaLed.
Whlch of Lhe followlng sLaLemenLs ls Lrue regardlng need for addlLlonal workup?

a-Lhe boy can be safely dlscharged home wlLhouL any oLher workup , slnce hls abdomlnal paln ls probably secondary Lo hls
abdomlnal wall ecchzmosls
b-Lhe boy can be safely dlscharged home lf hls amylase level ls normal
c- Lhe boy can be safelz dlscharged home lf abdomen plaln fllms are negaLlve for Lhe presence of free alr
d-Lhe boy can be safelz dlscharged home lf an C1 ls negaLlve
e-Lhe boy should be observed regardless of negaLlve LesL resulL CorrecL




87- a 33 year old wlLh a hlsLory of prevlous rlghL LhzroldecLomy for a benlgn Lhyrold noduls
now , undergoes compleLlon LhyroldecLomy for a susplclous Lhzrold mass several hours
posLoperaLlvely, she develops progresslve swelllng under Lhe lnclslon, sLrldor and dlfflculLy breaLhlng .oroLracheal lnLubaLlon
ls successful -whlch of Lhe followlng ls Lhe mosL approprlaLe nexL sLep?

A-flberopLlc laryngoscopy Lo rule ouL bllaLeral vocal cord paralysls
8-admlnlsLraLlon of lv caclum
C-admlnlsLraLlon of broad specLrum anLlbloLlcs and debrldmenL of Lhe wound
u-wound exploraLlon
L-admlnlsLraLlon of hlgh dose sLerolds and anLlhlsLamlnes CorrecL


88- a13 yaer old oLherwlse healLhy female hlgh school sLudenL beglns Lo noLlce galacLorrhea A pregnancy LesL
ls negaLlve . whlch of Lhe followlng ls frequenLly assoclaLed physlcal flndlng:

A-gonadal aLrophy
8-blLemporal hemlanposla
C-exophLhalmos and lld leg
u-eplsodlc hyperLenslon
L-buffalo hump

89- A 46 years old woman ask abouL Lhe need for surgery ,slnce she was recenLly dlagnosed wlLh crohns
dlsease .lndlcaLlon for operaLlon ln crohns lnclude all excepL?

A-lnLesLlnal obsLrucLlon
8-enLeroveslcal flsLula
C-prolonged use of sLerolds
u-enLerovaglnal flsLula
L-free perforaLlon

90- A 41 years old complalns on regurglLaLlon of sallva and undlgesLed food ,an
esophaogram reveals blrds beak deformlLy. Whlch of Lhe followlng sLaLemenLs ls Lrue abouL Lhe condlLlon?

A-chesL paln ls common ln advanced sLage of Lhe dlsease
8-more paLlenLs are lmproved by forceful dlalaLlon Lhen by surglcal lnLervenLlon
C- manomeLry can be expecLed Lo show lncrease resLlng pressure of Lhe LLS
u-lnlLlal surglcal LreaLmenL conslsL prlmarlly of resecLlon of Lhe dlsLal esophagus wlLh reanasLomosls of Lhe sLoma above Lhe
dlaphragm
L-paLlenLs wlLh Lhls dlsease are aL no lncreased rlsc for Lhe devolpmenL of carclnoma CorrecL


91. A 33 years old man presenLs wlLh hls flrsL eplsode of ulverLlcullLls. Pe ls hemodynamlcal sLable and
lmproves wlLhln 48 hours. Pe geLs anLlbloLlca. C1 reveals sLrandlng of slgmold mesenLery, no free alr and
no abscess. 1he nexL SLep ln LreaLmenL should be:

a. 8esecLlon and anasLomosls.
b. 8esecLlon and colosLomy.
c. ulscharge and elecLlve colecLomy.
d. ulscharge, oral anLlbloLlca and observaLlon.
e. Colnoscoplc lnLralumlnal sLenL.







92. A 44 years old woman has paplllary Lhyrold carclnom of Lhe rlghL lobe conflrmed by flne-needle asplraLlon. ulLrasoundsLudy
sLages Lhe Lumor as 11 (1,3 cm). WhaL schould beL he surglcal procedure?

a. 8lghL Lhyrold lobecLomy, selecLlve node dlssecLlon of Lhe rlghL slde.
b. 8lghL Lhyrold lobecLomy, level 6 node dlsscecLlon.
c. 1oLal LhyroldecLomy, selecLlve node dlssecLlon of Lhe rlghL slde.
d. 1oLal LhyroldecLomy, level 6 dlssecLlon and selecLlve dlssecLlon of Lhe rlghL slde.
e. 1oLal LhyroldecLomy.


93. A 36 years old man has a blood presure of 70/60 mmPg afLer a moLor vehlcle crash.
8esusclLaLlon ls lnlLlaLes. locused AssessmenL wlLh Sonography for 1rauma (lAS1) was
poslLlve for fluld ln Lhe abdomen. Cn examlnaLlon of Lhe pelvlc, fracLure-relaLed- cerplLus and an enlarglng
perlnal hemaLoma are appreclaLed. 1he blood oresure dose noL lmprove wlLh resusclLaLlon.
WhaL ls Lhe nexL sLep?

a. C1 of Lhe abdomen and pelvlc.
b. ulagnosLlc perlLoneal lavage.
c. lacemenL of exLernal pelvlc flxaLor.
d. LxploraLlve laparoLomy.
e. elvlc angloemoblllzaLlon.

94. A 19 years old man, who fell whlle playlng baskeLball fracLured Lhe shafL of Lhe rlghL radlus and ulna
subsequenLly underwenL closed reducLlon and appllcaLlon of a cyllndrlcal casL. Pe now presenLs wlLh
complalnLs of paln ln Lhe rlghL lndex flnger. 1herels no Llngllng sensaLlon. Cllnlcal examlnaLlon reveals no
dlmlnuLlon ln caplllary reflll Llme, no hypoesLhesla, cyanosls lsL absenL. asslve movemenLs of Lhe flnger ellclLs paln. CasL ls
lnLacL. WhaL should be your nexL sLep?

a. 8eassure Lhe paLlenL.
b. rescrlbe analgesls.
c. rescrlbe corLlcosLerolds.
d. Cleave Lhe casL.
e. Leave Lhe casL lnLacL and ralse Lhe arm for 24 hours. CorrecL


93. A 14 years old boy come Lo Lhe offlce because hls breasLs have recenLly become Lender and sllghLy
swollen. upon examlnaLlon a Lender, 2 cm mass ls found Lo be palpable ln Lhe subareola reglon of boLh
breasLs. WhaL should be your nexL sLep?

a. Lxclse Lhe masses by performlg a subcuLaneous masLecLomy.
b. lnclse and draln Lhe mass
c. 1reaLmenL wlLh sLerolds.
d. AsplraLe Lhe mass for culLure and cyLology.
e. Leave alone.














96.A 73 y.o. man was Lo Lhe emergency room of local hosplLal afLer havlng collapsed aL home.
Lhe paLlenLs sapouse relaLed LhaL he had complaned of sadden sever paln over Lhe lefL flank. he lnformed Lhe
physlclan LhaL he had been complanlng of back lLch for few years.
physlcal ex. revealed a consclons male ,acuLe dlsLress, wlLh deflnlL slgns of hypoLenLlon
,Lachycardla,Lachypnea and hypoLhermla.he had mucosal pallor buL no cyanosls.Lhe
abdomen was Lender Lo palplLaLlons,and a pulsaLlle supraumblllcal mass was presenL.bowel sounds were
dlmlnlshed and perlpheral pulses were equal and moderaLely sLrong.Lhe paLlenL was glven 100 C2 by
mask,aL 10L per mlnuLe. Lhe cardlac mlnoLor showed slnus
Lachycardla wlLh mlld lschemla.
Whlch of Lhe followlng mechanlslms ls mosL llkely lnvolved ln Lhe paLhogenesls of Lhls paLlenL cllnlcal dlsorder?

A.cysLlc medlal degeneraLlon.
8.defecL ln collagen.
C.defecL ln flbrlllln.
u.an lmmunologlc reacLlon.
L.aLhrosclerosls.


97.A 63 y.o. women had a 3 years hlsLory of paln ln Lhe rlghL hlp LhaL had qradually goLLen worse.she had
reached a polnL where she hobbled wlLh Lhe help of a cane.nonsLeroldal
analgeLlcs dld noL help her very much.she flnaly agreed Lo undergo surgery.an x-ray fllm of Lhe rlghL hlp
conflrmed severe osLeoarLhrlLls.Lhe orLhopedlc surgean recomended hlp
arLhroplasLy.she was consldered aL hlsh rlsL for deep venous Lhrombosls and heparln
prophylaxls was begun.
Whlch of Lhe followlng ls Lhe besL LesL Lo monlLor heparln Lherapy?

A.Lhrombln Llme(11).
8.proLhrombln Llme(1).
C.proLhrombln and proconverLln LesL.
u.acLlvaLed parLlal LhromboplasLln.
L.bleedlng Llme.


98.A 63 y.o. women complans of dlarrhea and welghL loss for several monLhs.on physlcal ex. she ls noLed Lo
be sllm wlLh evldence of recenL welghL loss and a sysLollc hearL murmar can be heard Lo Lhe rlghL sLernal
border ln Lhe 4Lh lnLercosLal margln.laboraLory flndlngs lnclude urlnary collecLlon for 3PlAA lncreased Lo 4
fold Lhe upper normal llmlL,and chromogranln A level of Lhe 1000ng/m l(n<92 ng/ml).
Whlch of Lhe follolng ls Lhe lnlLlal recomended managmenL of Lhes paLlenL?

A.surglcal resecLlon of Lhe bowel Lumor.
8.chemoLherapy due Lo meLasLaLlc Lumor.
C.somaLosLaLln analog.
u.lnLerferon alfa.
L.admlnlsLraLlon of speclflc chromogranln anLlbodles.


99.A 74 y.o caucasan man recenLly made an appolnLmenL Lo see hls physlclan becouse he
had dlfflculLy ln swallowlng hls pllls .lL Look 2 weeks Lo geL an appolnLmenL .by Lhe Llme hls
problem had progressed Lo Lhe polnL where he was havlng problem wlLh sollds ln general buL
noproblem wlLh llqlds.ln Lhe pasL he had also a longsLandlng hlsLory of CL8u wlch was
LreaLed wlLh omeprazole sLarLlng lasL year. aL presenL he doesnoL smoke buL he had sLarLed
smoklng aL Lhe age 14 and qulLe some 10 y ago.he dld drlnk ,buL prlmarlly beer and only aL soclal occaslon.

A.dlffuse esophageal spasm.
8.achalasla.
C.bengln esophageal sLrlcLure.
u.zenker's dlverLlculum.
L.esophageal carclnoma.
100.A 73 y.o man wlLh scandlnavlan ancesLors was undergolng a rouLln physlcal ex. ehen hls
physlclan noLed a rounedlsh spoL abouL 6 mm ln dlameLer LhaL was sllghLly plnker LhaL Lhe
remalnder of Lhe man face.when he ran hls flnger across lL, he also noLed LhaL was dry and
rough.Lhe paLlenL lnformed hlm LhaL someLhlng had been golng on wlLh LhaL spoL for a year
or so lLs apperance seemed Lo wax and wane, essenLlally dlsappearlng once ln a whlle buL
Lhen reLarnlng,someLlmes covered wlLh whlLe scales LhaL Lhen dropped of.Lhe paLlenL
admlLLed LhaL as a boy and a young man he spenL counLless houres aL aLhe beach.Lhe
physlclan cauLerlLed Lhe leslon wlLh llquld nlLrogen wlLhln 2 weeks Lhe area became crusLed ,shrank and fell
off.2 weeks Lherefore,Lhe rough spoL reLerned and afLer a monLh ,Lhe paLlenL developed an open sore aL Lhe
same locaLlon LhaL would noL heal.
1he sore ls mosL llkely Lo be wlch of Lhe followlng?

A.acLlnlc keraLosls.
8.basal cell carclnoma.
C.squamous cell carclnoma.
u.nodular melanoma.
L.herpes melanoma.


101- A 24 year old male playlng fooLball fell on hls ouLsLreLched hand hoplng Lo make a
Louchdown. 1he paLlenL complalns on severe paln ln hls rlghL arm. Pls vlLal slgns are: 8
140/80, 8 98 regular, 1emp 37C and 88 22/mln regular. 1he rlghL arm ls swollen and
angulaLed ln Lhe mld arm area, lL's Lender Lo Louch and movemenL ls palnful. 1he humeral
appear Lo be fracLured, caplllary clrculaLlon ln Lhe nall bed ls normal. Powever, Lhere ls a
cllnlcal evldence of nerve damage. x-ray lmaglng conflrms fracLure of Lhe humeral shafL wlLh some
angulaLed dlsplacemenL. Whlch of Lhe followlng ls Lhe nerve ln[ury assoclaLed wlLh Lhls fracLure:

a. Axlllary nerve
b. Medlan nerve
c. ulnar nerve
d. 8adlal nerve
e. 8rachlal nerve CorrecL


102. Whlle rldlng hls blcycle 9 year old boy loss conLrol and falls durlng Lhe process. Pls
abdomlnal sLrlkes Lhe handle bar. Pls parenLs brlng hlm Lo Lhe Lmergency 8oom because he has a vague
mld-abdomlnal paln and some brulslng of Lhe anLerlor abdomlnal wall. Pls vlLal slgns are sLable and Lhere
are no oLher vlslble ln[urles.
Whlch of Lhe followlng ls Lhe mosL llkely ln[ury:

a. 8upLured Spleen
b. 8upLured Llver
c. 8upLured ancreas
d. PemaLoma of Lhe 8ecLus Muscle

103. 48 year old obese woman was admlLLed Lo Lhe hosplLal wlLh upper rlghL quadranL paln and vomlLlng.
She has no dlarrhea and no consLlpaLlon. Cllnlcal examlnaLlon reveals
Lenderness and approprlaLe lnvesLlgaLlon demonsLraLe a presence of sLone ln Lhe Common 8lle uucL
(C8u). ALLempL Lo dlslodge Lhe sLone endoscoplcally proved fuLlled, so she
underwenL C8u exploraLlon. 6 days posL operaLlon, Lhe paLlenL developed fever of 38C. Whlch of Lhe
followlng ls mosL llkely Lhe cause of fever:

a. AccumulaLlon of blood from Lhe perlLoneum
b. LndoLoxlc shock
c. Wound lnfecLlon
d. 8enal fallure


104. WhaL ls Lhe cause for rlse Lhe rlse ln lacLaLe levels durlng sLress?

a. Muscle proLeln degradaLlon
b. Anaeroblc cell resplraLlon
c. lncrease A1 degradaLlon
d. lncrease gluconeogenesls

103. Whlch of Lhe followlng ls Lhe mosL lmporLanL Lo evaluaLe Lhe rlsk for lnLra-operaLlve bleedlng?

a. 8leedlng Llme
b. a11
c. ln8
d. Medlcal hlsLory Laklng

106) durlng her vlslL Lo a prlmary care physlclan, 39 years old woman relaLes LhaL she has
recenLly had bouLs of hoarsenes afLen assoclaLed wlLh dlfflculLy ln swallowlng and
breaLhlng. upon Laklng a hlsLory Lhe physlclan also deLermlnes LhaL she emlgraLed wlLh her
parenLs from Lhe ukralne ln 1988 aL Lhe age of 17 year. upon examlnaLlon Lhe physlclan dlscovers a flrm nodule near her
Adam's apple. 1he nexL sLep ln obLalnlng a dlagnosls ls whlch of Lhe followlng?

a) analyzlng Lhe resulLs of an ulLrasound and scan.
8) dolng a flne needle asplraLlon blopsy
c) a Lhyrold nuclear scan uslng 123l
d) deLermlnlng Lhe Lhyrold serum level
e) a formal surglcal blopsy.


108) 63 years old man was sean by hls famlly physlclan wlLh a 6 monLh hlsLory of
consLlpaLlon and recenL hlsLory of paln ln Lhe lefL lower quadranL of hls abdomen. 1he
paLlenL complalned of Lenderness and fever as well. hyslcal examlnaLlon revealed a
moderaLely obese man, blood pressure 138/90, pulse 76, resplraLlon 16/mln, LemperaLure
37,8 C. hls cardlovascular and resplraLory sysLem was normal, examlnaLlon of Lhe abdomen
revealed Lenderness ln Lhe lefL lower quadranL wlLh a poslLlve rebound. ln addlLlon a Lender
mass was felL on recLal axamlnaLlon. A compleLe blood counL revealed neuLrophyllc
leucocyLosls and Lhe sLool gualac LesL resulLs was negaLlve. MosL llkely dlagnosls?

a) ulceraLlve collLls
b) lrrlLable bowel syndrome
C) acuLe dlverLlcullLls
d) carclnoma colon
e) aschemlc collLls

















109) 63 years old women wenL blcycllng lnLo Lhe counLry near lake 1ahoe/ Lhe fronL wheel
sLruck a paLhole and she fell Lo Lhe ground. Whlle dolng so, her chesL sLruck Lhe handlebar.
She was lmmedlaLely rushed Lo Lhe local hosplLal, on arrlval she ls consclous and appears Lo
be ln moderaLe dlsLress . blood pressure 140/93 mmPg, pulse 96, resplraLlon are shallow
and rapld aL 22/mln, brulslng over Lhe lefL anLerlor hemlLhorax ls observed upon
examlnaLlon of Lhe chesL. 1here ls no [ugular venous dllaLlon. 1he resL of her examlnaLlon
flndlngs are unremarkable. lurLher examlnaLlon would mosL llkely yleld whlch of Lhe followlng?

a) lncreased breaLh sounds of Lhe chesL.
b) egophony on Lhe lefL
C) lncreased hyperresonace
d) lncreased wldLh of lnLercosLals on Lhe lefL
e) medlasLlnal sLrucLures shlfLed Lo Lhe lefL.

110. A 38 year old woman vlslLs her famlly physlclan because of her concern abouL a lump ln
her lefL breasL whlch she noLlced afLer a fall approxlmaLely one week prevlously. She doesn'L
smoke, drlnks wlne on soclal occaslons, and Lakes blrLh conLrol pllls. 1here ls no famlly
hlsLory of breasL cancer. hyslcal examlnaLlon reveals a raLher sLocky women wlLh
pendulous breasLs. She has a moderaLed slzed, nonLender, lrregular lump ln Lhe lower ouLer
quadranL of her lefL breasL. 1he overlylng skln appears Lhlckened. no nlpple dlscharge ls
presenL, and she has no axlllary lymphadenopaLhy. 1he rlghL breasL and axllla are normal.
Mammography reveals lncreased denslLy ln Lhe affecLed reglon. ulLrasound gulded flne
needle asplraLlon (lnA8) was performed. 1he paLhology reporL was conslsLenL wlLh a
dlagnoses of faL necrosls.
Whlch of Lhe followlng ls Lhe mosL approprlaLe nexL sLep ln Lhe managemenL of Lhls paLlenL?

a. Lxclse Lhe mass.
b. 8epeaL flne needle asplraLlon blopsy afLer one monLh.
c. 8epeaL mammography ln a monLh.
d. 8eassure Lhe paLlenL and follow up ln a few weeks. CorrecL












<@9><9?<>>)
1. A 73 year old man wlLh a hlsLory of myocardlal lnfarcLlon2 year ago, perlpheral
vascular dlsease wlLh sympLoms of claudlcaLlon afLer half block, hyperLenslon, and
dlabeLes presenLs wlLh a large venLral hernla, he wlshes Lo have Lhe hernla repalred.
Whlch of Lhe followlng ls Lhe mosL approprlaLe nexL sLep ln hls preoperaLlve workup?

a. A normal LCC precludes Lhe need for furLher cardlac LesLlng.
b. Pe should undergo an exerclse sLress LesL.
c. Pe should undergo coronary arLery bypass prlor Lo operaLlve repalr of hls venLral hernla.
d. Pe should undergo a presnLaLlve Lhalllum sLress LesL and echocardlography.
e.Pls hlsLory of a myocardlal lnfarcLlon wlLhln 3 years ls prohlblLlve for elecLlve surgery.no furLher LesLlng lsnecessary.


2. A vlcLlm of blunL abdomlnal Lrauma undergoes a parLlal hepaLecLomy. uurlng surgery he recelves Lwelve unlLs of packed red
blood cells. ln Lhe recovery room, he ls noLed Lo be bleedlng from lnLravenous puncLure slLes and Lhe surglcal lnclslon.
Whlch of Lhe followlng sLaLemenLs regardlng Lhe coagulopaLhy ls mosL llkely Lrue?

a. 1he paLlenL has an unknown prlmary bleedlng dlsorder.
b. 1he coagulopaLhy ls secondary Lo Lhe parLlal hepaLecLomy
c. 1he coagulopaLhy ls secondary Lo deluslonal LhromnocyLopenla and deflclency of cloLLlng
facLors from Lhe masslve blood Lransfuslon.
d. 1he LreaLmenL ls oral vlLamln k
e. 1he LreaLmenL ls lnLravenous vlLamln k.


3. A 63 year old man has an enLerocuLaneous flsLula orlglnaLlng ln Lhe [e[unum secondary Lo lnflammaLory bowel dlsease.
Whlch of Lhe followlng would be mosL approprlaLe fluld for replacemenL of hls enLerlc losses?

a. u3W
b. 3 normal sallne
c. 8lnger lacLaLe soluLlon
d. 0.9 sodlum chlorlde
e. 6 sodlum blcarbonaLe soluLlon


4. A 23 year old woman undergoes LoLal LhyroldecLomy for carclnoma of Lhe Lhyrold gland. Cn Lhe second
posLoperaLlve day, she beglns Lo complaln of a Llngllng sensaLlon ln her hands. She appears qulLe anxlous and laLer
complalns of muscle cramps. Whlch of Lhe followlng ls Lhe mosL approprlaLe lnlLlal managemenL sLraLegy?

a. 10 ml of 10 Magneslum sulfaLe lv
b. Cral vlLamln u
c. 100 mlcro gram oral synLhrold
d. ConLlnuous lnfuslon of calclum gluconaLe
e. Cral calclum gluconaLe.

3. A 24 year old flreflghLer susLalns 30 LoLal body surface area burns Lo hls Lorso, face, and exLremlLles. Pls wounds are
LreaLed Loplcally wlLh sllver nlLraLe. Whlch of Lhe followlng compllcaLlons ls assoclaLed wlLh use of Lhls agenL?

a. PypernaLremla
b. MeLabollc acldosls
c. Pyperchloremla
d. neuLropenla
e. PyponaLremla




6. A 10 year old boy was Lhe backseaL belLed passenger ln a hlgh speed moLor vehlcle colllslon. Cn presenLaLlon Lo
Lhe L8 he ls awake, alerL, and hemodynamlcally sLable. Pe ls complalnlng of abdomlnal paln and has an ecchymosls
on hls anLerlor abdomlnal wall where Lhe seaLbelL was locaLed.
Whlch of Lhe followlng sLaLemenLs ls Lrue regardlng need for addlLlonal workup?

a.1he boy can be safely dlscharged home wlLhouL any oLher workup, slnce hls abdomlnal paln ls probably
secondary Lo hls abdomlnal wall ecchymosls.
b. 1he boy can be safely dlscharged home lf hls amylase level ls normal
c. 1he boy can be safely dlscharged home lf abdomen plaln fllms are negaLlve for Lhe presence of free alr.
d. 1he boy can be safely dlscharged home lf an abdomlnal C1 ls negaLlve
e. 1he boy should be observed regardless of negaLlve LesL resulL.


7. A paLlenL ls broughL Lo Lhe L8 afLer a moLor vehlcle accldenL. Pe ls unconsclous and
has a deep scalp laceraLlon and one dllaLed pupll. Pls hearL raLe ls 120 beaLs per mlnuLe blood pressure ls 80/40
mm/Pg, and resplraLory raLe 33 per mln. uesplLe rapld admlnlsLraLlon of 2 L normal sallne, and paLlenLs vlLal slgns do noL
change slgnlflcanLly. Whlch of Lhe followlng ls Lhe mosL approprlaLe nexL sLep ln Lhe workup of hls hypoLenslon?

a. neurosurglcal consulLaLlon for emergenL venLrlculosLomy Lo manage hls lnLracranlal pressure
b. neurosurglcal consulaLlon for emergenL cranloLoymy for suspecLed subdural hemaLoma
c. LmergenL burr hole dralnlng aL Lhe bedslde for suspecLed epldural hemaLoma
d. AdmlnlsLraLlon of mannlLol and hypervenLllaLlon Lo LreaL hls elevaLed lnLracranlal pressure
e. Abdomlnal ulLrasound (focused assessmenL wlLh sonography ln Lrauma, lAS1)


8. A 23 year old woman ls dlagnosed wlLh bllaLeral breasL CA. sh undergoes geneLlc LesLlng Lo assess wheLher she
has a muLaLlon ln elLher 8A8CA1 or 8A8CA2. Whlch of Lhe followlng sLaLemenLs ls Lrue regardlng 8A8CA muLaLlon ?

a. Per rlsk as a woman under Lhe age of 40, for havlng a muLaLlon ln 8A8CA1 or 2 ls 40.
b. 8A8CA1 Lumors are more llkely Lo be esLrogen receLor poslLlve.
c. A muLaLlon ls 8A8CA 2 ls assoclaLed wlLh an lncreased rlsk of colon CA.
d. A muLaLlon ln 8A8CA 1 ls assoclaLed wlLh an lncreased rlsk for pancreaLlc, blle ducL and galdbladder CA.
e.8oLh 8A8CA 1 and 8A8CA 2are assoclaLed wlLh an lncreased rlsk of ovarlan CA by age 70.


9. A 33 year old woman wlLh a hlsLory of prevlous rlghL LhyroldecLomy for a benlgn Lhyrold nodule now undergoes
compleLlon LhyroldecLomy for a susplclous Lhyrold mass. Several hours posLoperaLlvely she develops progresslve
swelllng under Lhe lnclslon, sLrldor and dlfflculLy breaLhlng. CroLracheal lnLubaLlon ls successful.
Whlch of Lhe followlng ls Lhe mosL approprlaLe nexL sLep?

a. llberopLlc laryngosopy Lo rule ouL bllaLeral vocal cord paralysls
b. AdmlnlsLraLlon of lv calclum
c. AdmlnlsLraLlon of broad specLrum anLlbloLlcs and debrldemenL of Lhe wound
d. Wound exploraLlon
e. AdmlnlsLraLlon of hlgh dose sLerolds and anLlhlsLamlnes.

10. A 13 year old oLherwlse healLhy female hlgh school sLudenL beglns Lo noLlce galacLorrhea. A pregnancy
LesL ls negaLlve. Whlch of Lhe followlng ls a frequenLly assoclaLed physlcal flndlng?

a. Conadal aLrophy
b. 8lLemproal hemlanopsla
c. LxophLhalmos and lld lag
d. Lplsodlc hyperLenslon
e. 8uffalo hump




11. A 72 years old man sLaLus posL CA8C 3 years ago presenL wlLh hemaLochezla,
abdomlnal paln and fever. colonoscopy reveals dusky appearlng mucosa aL splenlc
flexure wlLhouL acLlve bleedlng. whlch ls Lhe mosL approprlaLe managemenL of Lhls paLlenL?

a. anglography wlLh admlnlsLraLlon of lnLra-arLerlal papaverlne
b. LmergenL laproLomy
c. AorLomesenLerlc bypass
d. LxploraLory laproLomy wlLh 1hrombecLomy of Lhe lnferlor mesenLerlc arLery
e. LxpecLanL managemenL


12. A 46 years old women ask abouL Lhe need for surgery, slnce she was recenLly
dlagnosed wlLh Crhon's ulsease. lndlcaLlon for operaLlon ln Chron's lnclude all excepL:

a. lnLesLlnal obsLrucLlon
b. LnLeroveslcal flsLula
c. rolonged use of sLerolds
d. LnLerovaglnal flsLula
e. lree perforaLlon


13. A28 years old women ls 13 week pregnanL, has new onseL of nausea, vomlLlng and rlghL slded abdomlnal paln.
She has been free of nausea slnce early ln her 1sL LrlmesLer. Lhe paln has become worse over Lhe pasL 6 hours. Whlch
of Lhe followlng sLaLmenLs abouL appendlclLls durlng pregnancy ls correcL?

a.AppendlclLls ls Lhe mosL prevalenL exLra uLerlne lndlcaLlon for celloLomy durlng pregnancy.
b.AppendlclLls accure more commonly ln pregnanL women Lhen ln nonpregnanL women.
c.SuspecLed appendlclLls ln pregnanL women should be manged wlLh perlod of observaLlon due Lo Lhe rlsk of
laproLomy Lo Lhe feLus.
d. non compllcaLed appendlclLls resulL ln 20 feLal morLallLy and premaLure labor raLe.
e.1he sevlrlLy of appendlclLls correlaLes wlLh lncrease gasLaLlonal age of Lhe feLus.


14. A 41 years old men complalns on regurglLaLlon of sallva and undlgesLed food, an esophaogram reveals "blrds
beak" deformlLy. Whlch of Lhe followlng sLaLmenLs ls Lrue abouL Lhe condlLlon:

a. ChesL paln ls common ln advanced sLage of Lhe dlsease.
b. More paLlenLs are lmproved by forcefull dlalaLaLlon Lhen by surglcal lnLervenLlon.
c. ManomeLry can be expecLed Lo show lncrease resLlng pressure of Lhe LLS.
d. lnlLlal surglcal LreaLmenL conslsL prlmarlly of resecLlon of Lhe dlsLal esophagus wlLh reanasLomosls
Lo Lhe sLoma above Lhe dlaphragm.
e. aLlenLs wlLh Lhls dlsease are aL no lncreased rlsk for Lhe developmenL of carclnoma.

13. A 72 years old men undergo an aorLoblfemoral grafL for sympLomaLlc aorLolllac
occluslve dlsease. 1he lnferlor mesenLerlc arLery (lMA) ls llgaLed aL lLs aorLlc
aLLachmenL. 24 hours afLer surgery Lhe paLlenL has abdomlnal dlsLenLlon, fever and
bloody dlarrhea. Whlch of Lhe followlng ls Lhe mosL aproprlaLe dlagnosLlc sLudy:

a. AorLogram
b. M8l
c. C1
d. Slgmoldoscopy
e. 8arlum enema





16. A 38 years old women has 1.3cm mass ln lefL 8resL, cllnlcal exam reveals no susplclous adenopaLhy.
Mammogram gulded blopsy reveals lnfllLraLlng ducLal carclnoma. 1he paLlenL prefer lumpecLomy followed
by radlaLlon. Whlch of Lhe followlng sLaLemenLs abouL senLlnel lymph node ls Lrue?

a. lL ls only lndlcaLed ln cllnlcally + axllla
b. lL ls assoclaLed wlLh survlval advanLage over rouLlne axlllary dlssecLlon .
c. neoad[uvanL chemoLherapy does noL affecL rellablllLy of SLn8.
d. lL ls besL preformed wlLh blue dye alone.
e. lL ls noL lndlcaLed because of her premenopausal sLaLe.


17. osLmenopausal women choose masLecLomy and senLlnel lymph node blopsy
(SLn8) for a new dlagnosed 8resL carclnoma. llnal paLhology reveals 1cm lnfllLraLlng ducLal carclnoma wlLh
negaLlve SLn. lL ls esLrogen recepLor/progesLerone recepLor (L8/8) poslLlve and PL82/neu negaLlve
1he mosL approprlaLe ad[uvanL Lherapy would be:

a. aromaLase lnhlblLor
b. Lamoxlfen
c. posLoperaLlve 8resL radlaLlon Lherapy
d. prophylacLlc oophorecLomy
e. cyLoLoxlc chemoLherapy

18. 38 years old women wlLh rlghL colon cancer, her hlsLory meeL AmsLerdam crlLerla, also has a 10 years old son.
Whlch of Lhe followlng sLaLemenLs ls Lrue?

a. son should begln colonoscopy aL age 10-12 years.
b. son should have colonoscopy every 3 years.
c. son have 23 rlsk of recelvlng Lhe muLaLlon.
d. Lumor should be LesLed for mlcrosaLellLe lnsLablllLy.
e. paLlenL should have rlghL hemlcolecLomy


19. 33 years old wlLh 1sL eplsode of dlverLlcullLls, hemodynamlcaly sLable and lmprove wlLhln 48h recelvlng
anLlbloLlc and noLhlng by mouLh. C1 show sLrandlng of slgmold mesenLery, buL no free alr evldence of an abscess.
1he nexL sLep should be:

a. resecLlon and anasLomosls
b. resecLlon and colosLomy
c. dlscharge + elecLlve colecLomy
d. dlscharge + oral anLlbloLlc
e. colonoscoplc lnLralumlnal sLench

20. 40 years old women, hlsLory of chron's dlsease and many prlor small bowel
resecLlons, presenL wlLh lnLracLable non bloody dlarrhea, welghL loss and several recenL
admlsslons for vol depleLlon and elecLrolyLe dlsLurbance.
1he mosL llkely dlagnosls:

a. recurrence of acLlve Chron's
b. shorL bowel syndrome
c. chronlc renal lnsufflclency
d. vlllus adenoma of recLum
e. lnf. CasLroenLerlLls






21. A 48 years old man wlLh a hlsLory of alcohol use presenLs evaluaLlon reveals a
llnear dlsrupLlon of Lhe gasLrlc mucosa hlgh on Lhe lasser curvaLure aL Lhe gasLroesophageal [uncLlon.Lndoscoplc aLLempLs Lo
conLrol Lhe bleedlng fall. 1he paLlenL has recelved 6 unlLs of packed 88Cs and hls hearL raLe ls113/mln wlLh a sysLollc blood
pressure of 83mmPg. 1he mosL approprlaLe managemenL would be:

a. LmbollzaLlon of Lhe lefL gasLrlc arLery
b. placemenL of a SengsLaken-8lakemore Lube wlLh lnflaLlon of gasLrlc balloon
c. AnLerlor gasLroLomy and eversewlng of Lhe bleedlng slLe.
d. AnLrecLomy ,vagoLomy,and blopsy of Lhe bleedlng slLe.
e. 1oLal gasLrecLomy


22. A 31 years old man wlLh a hlsLory of pepLlc ulcer dlsease presenLs wlLh abdomlnal paln and free alr.durlng
operaLlon a duodenal perforaLlon ls ldenLlfled wlLh slgnlflcanL assoclaLed perlLonlLls .A modlfled Craham paLch ls
performed.Acld reducLlon Lherapy ls lnlLlaLedand serology for PellcobacLer pylorl ls obLalned.seven days afLer
operaLlon an operaLlvedraln beglns dralnlng coplous amounLs of blle.ManagemenL of Lhls duodenal flsLula lncludes all of Lhe
followlng excepL:

a. cholesLyramlne
b. LoLal parenLeral nuLrlLlon
c. somaLosLaLln enLeral nuLrlLlon
d. naso[e[unal enLeral nuLrlLlon
e. 8lle re-feedlng

23. A 73 years old woman presenLs wlLh Lhe acuLe onesL of abdomlnal paln . on
physlcal examlnaLlon ,she has a palpable abdomlnal mass LhaL ls palnful wlLh
conLracLure of Lhe abdomlnal muscles. She has no perlLoneal lrrlLaLlon .she ls recelvlng anLlcoagulaLlon for recenL
onesL aLrlal flbrlllaLlon . Lhe underlylng vessel causlng Lhls problem ls mosL llkely Lhe:

a. lnferlor eplgasLrlc arLery
b. Superlor mesenLerlc arery
c. Splenlc arLery
d. Superlor mesenLrlc veln
e. LefL gasLroeplplolc arLery

24. Slx monLhs afLer laparoscoplc splenecLomy for lmmune LhrombocyLopenlc purpura ,a 38 years old woman wlLh
lupus remalns LhrombocyLopenlc (plaLleL counL42,000 cell/mm3). 1he nexL sLep should be:

a. plaLleL Lransfuslons
b. LvaluaLlon for accessory spleen
c. lasmapheresls
d. 8one marrow blopsy
e. 8e-laparoscopy

23. A 20 years old man has a 2 cm rlghL adrenal mass found durlng a work up for low back paln. Lhe lefL adrenal ls
of normal slze .Lhe nexL sLep should be:

a. 8epeaL lmaglng sLudy ln 6 monLhs
b. 24 -hour urlnecolecLlon for caLecholamlnes
c. C1 - gulded flne -needle asplraLlon
d. hlgh -dose dexameLhasone LesL
e. LlecLlve rlghL laparoscoplc adrenalecLomy




26. A 36 years old posLmenopausal woman has serlum calclum of 10.9 mg/dl (normal 7.3 Lo 9.3) and a serum 1P of 83
pg/ml(normal 20 Lo 60 pg/ml) . She has no famlly hlsLory and ls asympLomaLlc .she ls an avld [ogger . 8one denslLomeLry (uLxA
scan) shows mlnlmal osLeoporosls. Whlch of Lhe followlng ls Lrue?

a. Calclum supplemenLaLlon wlll decrease her rlsk of sLress facLure.
b. Lhe nlP consensus conference recommends observaLlon
c. 24 -hour urlne collecLlon for calclum wlll be dlagnosLlc
d. she ls a candldaLe for paraLhyroldecLomy
e. LreaLmenL wlLh blphosphonaLes ls warranLed


27. A 44 years old woman has paplllary Lhyrold carclnoma of Lhe rlghL lobe conflrmed by flne-needle asplraLlon.
ulLrasound sLudy sLages Lhe Lumor as 11 (1.3 CM). CpLlmal surglcal managemenL would be:

a. 8lghL LhyroldlobecLomy , selecLlve mode dlssecLlon of Lhe rlghL slde
b. 8lghL LhyroldlobecLomy, level vl (cenLral comparLmenL) nod dlssecLlon
c. 1oLal LhyroldecLomy, selecLlve dlssecLlon on Lhe rlghL slde
d. 1oLal LhyroldecLomy, level vl dlssecLlon and selecLlve dlssecLlon of Lhe rlghL slde
e. 1oLal LhyroldecLomy

28. Whlch of Lhe followlng ls Lhe mosL useful ln ldenLlfylng paLlenLs aL hlgh rlsk for famlllal medullary Lhyrold cancer?

a. 8L1 oncogene
b. calclLonln levels
c. calclum levels
d. k-ras oncogene
e. urlne meLanephrlnes.

29. AbnormallLles ln all of Lhe followlng varlables have been used Lo suggesL Lhe need for damage conLrol
(or abbrevlaLed) laparoLomy ln Lrauma paLlenLs excepL :

a. 1emperaLure
b. P
c. 8ase deflclL
d. roLhrombln Llme
e. laLeleL counL

30. A 36 years old man has a blood pressure of 70/40 mm/Pg afLer a moLor vehlcle
crash .resusclLaLlon ls lnlLlaLed. locused assessmenL wlLh sonography for Lrauma
(lAS1) ls poslLlve for fluld ln Lhe abdomen. on examlnaLlon of Lhe pelvls ,fracLure -
relaLed creplLus and an enlarglng perlneal hemaLoma are appreclaLed .Lhe paLlenLs
blood pressure does noL lmprove wlLh resusclaLaLlon .Lhe nexL sLep ln managemenL should be:

a. C1 of Lhe abdomen and pelvls
b. ulagnosLlc perlLoneal lavage
c. lacemenL of an exLernal pelvlc flxaLor
d. LxploraLory laparoLomy
e. pelvlc angloembollzaLlon

31. 38 y.old woman should go laparoscoplc chollcysLecLomy, no famlly hlsLory of Lhromboembollc evenLs and
no personal medlcal hlsLory of Lhromboembollc evenLs. Whlch ls lndlcaLed for perloperaLlve uv1 prophylaxls?

a. no prophylaxls ls needed
b. sequenLlal compresslon
c.subcuLaneus unfrlcLloneLed heparln
d. subcuLaneous LMWP
e. sequenLlal compresslon devlce and subcuLaneous unfrlcLlonaLed heparln

32. reoperaLlve blochemlcal evaluaLlon of paLlenL for paraLhyroldecLomy ls dune for P1 (prlmary
hyperparaLhyroldlsm) show Ca+ 12 and lnLacL 1P (200pg/ml). 1cm hypercellular paraLhyrolde adenoma ls
resecLed . osLoperaLlvely Lhe paLlenL complalnL on perloral Llngllng, numbness and carpopedal spasm.
1he LCC wlll show:

a. aLrlal flbrlllaLlon
b. prolong C1
c. pecked 1 wave
d. Lorsa des polnLes
e. u wave

33.Common compllcaLlon of 8?C8:

a. vlLamln u deflclency
b. prlmary hyperparaLhyroldlsm
c. anemla due Lo lack of Lransferln
d. sympLomaLlc Lhyamln deflclency
e.hypocuagulablllLy

34. 60 y.o. man compleLed chemoLherapy for hepaLlc meLasLasls relaLed Lo colorecLal
cancer W8C 1200, fever 39c, dlffused abdomlnal paln. C1 of Lhe abdomen and pelvlc show lnflammaLlon and
Lhlckenlng of Lhe lllum, cecum and rlghL colon. MosL llkely dlagnosls ls:

a. closLrldlum dlfflcllls collLls
b. neuLropenlc enLerocollLls
c. Loxlc megacolon
d. ulceraLlve collLls
e. colon pseudoobsLracLlon


33. 18 year old men wenL lngulnal hernla reaper wlLh splnal anesLhesla. WhaL ls correcL regardlng preoperaLlve:

a. oral ceforal on Lhe mornlng of Lhe surgery
b.oral ceforal ln Lhe evenlng be for Lhe surgery
c. no preoperaLlve ls needed
d. 40mg clexan evenlng be for Lhe surgery


36. 88y.old man has sever lngulnal paln. 2 weeks ago he had acuLe M.l. and slnce Lhan uslng asplrln, on examlnaLlon
he has paln, no fever, hearL raLe 113, abdomen ls noL dlsLended, no perlLonlLls. lncanceraLed no reduclble rlghL
lngulnal hernla ls found. 1he mosL approprlaLe nexL sLep wlll be:

a. urgenL cardlac caLheLerlzaLlon
b. exerclse Lhallum
c. surglcal hernla repalre
d. hernla reducLlon aLLempL under deep sedaLlon
e. C1 of Lhe abdomen and pelvlc

37. Small bowl obsLrucLlon from bezoar ls more common afLer:

a. colon resecLlon due Lo cancer
b. barlaLrlc surgery
c. vagoLomy
d. mulLlple abdomlnal surgery




38. All are compensaLory mechanlsm ln hypovolemlc shock excepL:

a. lncreased perlpherlal reslsLance secondary Lo lncrease caLecholamlne level
b. lncrease uC 2,3
c. rlghL shlfL of hemoglobln dlssoclaLlon curve Lo acldosls
d. decrease cardlac conLracLlllLy


39. 8ecommended Lo colorecLal llver meLasLasls LhaL locallzed Lo one llver lobe ls:

a. lobecLomy of Lhe lobe whlch conLalnlng Lhe meLasLasls
b. lobecLomy of Lhe lobe whlch conLalnlng Lhe meLasLasls and sysLemlc chemoLherapy
c. sysLemlc chemoLherapy wlLh cyLoLoxlc and blologlc drug
d. palllaLlve LreaLmenL only


40. A 33y.old woman no hlsLory evaluaLlon for melena has 2cm ClS1 (gasLrolnLesLlnal sLromal Lumor) ln Lhe anLerlor
wall of Lhe sLomach. 1he dlagnosls conflrmed by lmmunohlsLochemlcal, no evldence for ad[acenL organ lnvaslon or meLasLasls.
1he recommended LreaLmenL ls:

a. subLoLal gasLrecLomy and reglonal lymph node dlssecLlon
b. glve Lyrosln klnase lnhlblLor (lmaLlnlb) Llll compleLe response and offer surgery lf medlcal LreaLmenL ls fall
c. open or laparoscoplc margln free Lumor exclslon and fallow up
d. only lmaLlnlb LreaLmenL


41. ln Lhe L8, 60 year-old male wlLh no prevlous medlcal hlsLory ls found Lo have an obsLrucLlng Lumor ln Lhe
slgmold colon on comblned C1 and gasLrografln enema , no dlsLanL meLasLeses are ldenLlfled and Lhe cecum's
dlameLer ls 13 cm. WhaL ls Lhe recommended LreaLmenL?

a. mecchanlc bowel preparaLlon followed by surgery LhaL lncludes slgmoldecLomy, reglonal lymph node dlssecLlon, and
anasLomosls.
b. b.lmmedlaLe surgery LhaL lncludes slgmoldecLomy, reglonal lymph node dlssecLlon, and anasLomosls wlLh no
furLher work-up.
c. lmmedlaLe colonscopy wlLh blopsy and afLer Lhe dlagnosls ls hlsLologlcally conflrmed, slgmldecLomy, reglonal lymph node
dlssecLlon, and creaLlon of proxlmal sLoma(ParLman resecLlon).
d.lmmedlaLe surgery LhaL lncludes slgmoldecLomy,reglonal lymph node dlssecLlon, and creaLlon of proxlmal sLoma.


42. A clrroLlc paLlenL LhaL ls a llver LransplanL candldaLe ls admlLLed for esophageal bleedlng varlces .
1reaLmenL wlLh somaLosLaLln and endoscopy lncludlng scleroLherapy and falled bandlng don'L sLop Lhe bleedlng.
WhaL ls Lhe nexL sLep?

a. 1lS
b. repeaL endoscopy
c. dlsLal splenorenal shunL
d. surglcal procedure (porLo-azygos dlsconnecLlon).

43. A 43 year-old man wlLh a hlsLory of chronlc pepLlc ulcer dlsease undergoes a Lruncal vagoLomy and anLrecLomy wlLh a
8lllroLh ll reconsLrucLlon for gasLrlc ouLleL obsLrucLlon. 6 weeks afLer surgery, he reLurns , complalnlng of posLprandlal
weakness, sweaLlng ,llghLheadedness, crampy abdomlnal paln and dlarrhea.
Whlch of Lhe followlng would be Lhe besL lnlLlal managemenL sLraLegy?

a. LreaLmenL wlLh a long acLlng somaLosLaLln analog.
b. dleLery advlce and counsellng LhaL sympLoms wlll probably abaLe wlLhln 3 monLhs of surgery.
c. dleLery advlce and counsellng LhaL sympLoms wlll probably noL abaLe buL aren'L dangerous.
d. work-up for neuroendocrlne Lumor(carclnold).
e. preparaLlon for revlslon Lo 8oux-en-? gasLro[e[unosLomy.
44. A 38 year-old man wlLh a mass ln Lhe lefL slde of hls neck. 1he paLlenL noLlced Lhe mass several weeks ago, and
was glven anLlbloLlc by hls prlmary care physlclan. 1he mass appeared Lo subslde somewhaL, buL ls sLlll presenL. u.S. shows a 2
cm solld mass. Cn examlnaLlon, Lhe mass ls 2 cm, flrm and flxed Lo Lhe underlylng Llssue.
1he besL sLep now would be:

a. color flow uoppler
b. C1 of Lhe head and Lhe neck.
c. M8l of Lhe head and Lhe neck.
d. llne-nedeel asplraLlon of Lhe mass.
e. surglcal blopsy.

43. 14 year-old glrl wlLh a slx monLh hlsLory of sudden , rapld ,asymmeLrlc enlargemenL of Lhe rlghL breasL. Cn
physlcal examlnaLlon, Lhere ls a large palpable mass occupylng Lhe breasL wlLh marked nlpple-areolar
sLreLchlng, promlnenL dllaLed velns, and skln ulceraLlon. Mammography and uS show a dense, well-
clrcumscrlbed 7 cm homogenous mass occupylng Lhe lefL breasL. 1he mosL llkely dlagnosls ls ?

a. lnvaslve ducLal carclnoma
b. hemangloma
c. glanL flbroadenoma
d. [uvenlle breasL hyperLrophy
e. phyllodes Lumor


46. a 31 year-old blond, llghL ,complexloned man had undergone laparoLomy for progresslve small bowel
obsLrucLlon. A desmoplasLlc reacLlon ls causlng Lhls small bowel obsLrucLlon. Whlch of Lhe followlng besL
descrlbes Lhe dlagnosls?

a. lymphoma
b. carclnold
c. ClS1 (lelomyosarcoma)
d. melanoma
e. prlmary small bowel adenocarclnoma

47. Whlch of Lhe followlng sLaLemenLs abouL laparoscoplc 8oux-en-? gasLrlc bypass
(8?C8) compared wlLh laparoscoplc ad[usLable gasLrlc bandlng (AC8) ls noL Lrue?

a. boLh decrease long Lerm morLallLy compared wlLh conLrols.
b. AC8 has lower perloperaLlve.
c. 8?C8 ls assoclaLed wlLh hlgher rlsk of lron deflclency anemla.
d. AC8 ls assoclaLed wlLh fewer lnLernal hernlas.
e. AC8 ls assoclaLed wlLh more susLalnable long-Lerm welghL loss.


48. PeredlaLry spherocyLosls:

a. necesslLaLes splenecLomy for all paLlenLs wlLh Lhe dlagnosls.
b. resulLs ln a loss of spherocyLes on Lhe perlpheral smear afLer splenecLomy .
c. ls assoclaLed wlLh lncreased red cell fraglllLy.
d. resulLs ln splenlc lnfarcLlon.
e. ls caused by a defecLed ln Lhe bllayer of Lhe cell membrane.








49. A 64 year-old man has a sollLary Lhyrold nodule dlscovered durlng a screenlng
caroLld duplex. llne-nedeel asplraLlon of Lhe nodule shows a predomlnance of PurLhle cells wlLh scanL amounLs of
collold and no evldence of mallgnancy. Lhe nexL sLep should be:

a. LoLal LhyroldecLomy
b. repeaL blopsy ln 6 monLhs.
c. Lhyrold suppresslon Lherapy.
d. hemlLhyroldecLomy wlLh lsLhmusecLomy.
e. LoLal LhyroldecLomy wlLh cenLral node dlssecLlon.


30. A healLhy 38 woman ls rescued from a house flre afLer 20 mln.ln emergency deparLmenL, she has an anLerlor chesL burn and
ls weak, confused and leLharglc. Lhe mosL llkely dlagnosls ls:

a. CC and pelvls.
b. lnhalaLlon lung ln[ury.
c. hypercablc resplraLory fallure.
d. pneumoLhorax.
e. upper alrway obsLrucLlon.



<C9<D9?<>>)
41. aLlenL 70 years old has developed anglna LsllyullL konechnosLl.davlenle 80/40 puls120 saLuraLlon LemperaLure 93 39. ln
llghL hrlpy. 8olnoy recelved lnLravenous caLheLers 4llLra saylayna was usLanovlen. ChLo from LreaLmenL:

a. noradrenalln
b. adrenalln
c. dobuLamln
d. mllrlnon.

42. ?ear-old chlld sovzduLlem abdomen wlLh developmenLal problems from blrLh Lo dlfleaLsley uslng candles and ochesLlLelnyh
kllzm.apaLlchen hernla zhlvoLa.rl percusslon LempanlL. SLul under pressure from Lhe green and zlovonnyy. na rengenne
lnflaLed loops of Lhe small lnLesLlne. Whlch ls Lhe besL LreaLmenL.

b. flulds and anLlbloLlcs plus an lnLesLlnal lavage.


43. Whlch of Lhe followlng. Pernla 2 year old boy:

c. 8ecommended aLLempL manual reducLlon.


44. 30 y.o man had a moLorcycle Lrauma fracLure of Lhe mlddle of Lhe femoral kosLl.kakoe convenLlonal LreaLmenL?

b. C lnLromedulyarnyml llxlng nalls for 6-8 hours.


43. WhaL ls Lrue abouL Lhe LreaLmenL of osLeoapLrlLa:

c. 1he paLlenL should be aware LhaL effecLlve surglcal LreaLmenL for a llmlLed perlod of Llme may voznlknuLpoLrebnosL ln a
second operaLlon for several years.


46. 34 years old man had an accldenL, accordlng Lo a urlnary caLheLer -430 ml of bloody urlne. Whlch LesL ls needed?

a. cysLoscopy
b. ln / pyelography
c. C1 wlLhouL conLrasL
d. 8eLrograde ureLhrogram
e. 1 LslsLogrammoy


47. aLlenL afLer a surgery has small bowel obsLrucLlon caused by bezoar. Whlch surgery had he gone Lhrough?

a. vagoLomy
b. 8esecLlon of Lhe colon for cancer
c. CperaLlon for obeslLy
d. mulLlple abdomlnal surgery

48. 88 years old man broughL Lo Lhe emergency room wlLh severe paln ln hls groln. 1wo weeks ago he suffered of an acuLe
myocardlal lnfarcLlon, Lakes asplrln. LemperaLure - normal, pulse = 113, no sympLoms of lrrlLaLlon of Lhe perlLoneum. rlghL-
slded lncarceraLed lngulnal hernla was dlagnosed. rlghL move?

a. Lmergency coronary anglography
b. 1allev load LesL
c. surglcal correcLlon of a hernla
d. reducLlon under deep sedaLlon
e. C1 abdomen and pelvls
! " ! # $ % & ' ( ) * + , ) , ! $ * ! - !
49. 22 year female broughL Lo L8 afLer MvA ln[ury . upon arrlval ls fully consclous , blood pressure 120/80 hearL raLe 120
regular , and room alr 92 on exam .n Lhere ls abraslon on rlghL chesL wall and open fracLure of rlghL humerus on chesL x-ray a
small Lo medlum slze pneumoLhorax ls lden4Lefled lAS1 ln negaLlve , nexL:

a. surglcall humerus fracLure flxaLlon
b. head C1
c.chesL draln placemenL
d.repeaL x-ray ln 8 hours
e.rlghL anglography


30. 38 y / f arrlves Lo Lhe L8 wlLh rlghL upper abdomlnal paln , prlor week she wenL laparoscoplc CholecysLecLomy , on
examlnaLlon she ls ln no apparenL dlsLress wlLhouL lcLerus ,wound lls clean and lnLacL W8C 13,000 ,llver funcLlon analysls ls
lncreased ,blllrubln ls normal , whaL ls Lhe nexL sLep ??

a. L8C + sLenL
b. Abdomlnal uS
c. Llver scan
d. ulagnosLlc laparoscopy
e. 8road speclflc anLlbloLlcs and observaLlon


31. Small bowel perforaLlon ln blunL Lrauma ls rellably deLecLed by:

a. Abdomlnal C1
b. locused assessmenL wlLh sonography for Lrauma (fasL)
c. ulagnosLlc perlLoneal lavage
d. hyslcal examlnaLlon on admlsslon
e. none of Lhe above


32. 82 years old male, luP, P1n, uM, hyperllpldemla, s/p caroLld endarLerecLomy, arrlves Lo Lhe emergency room due Lo lefL
abdomlnal paln and bloody dlarrhea for 4 days. Cn examlnaLlon fever 37c wlLh Lenderness. AfLer Lwo days of nC, lv flulds and
anLlbloLlc LreaLmenLs he develops severe abdomlnal paln, fever 39c and dlffuse abdomlnal Lenderness. Cn x-ray no freelance alr
ls evldenL. Cn C1- abdomlnal Lhlckenlng of Lhe colon and large amounL of free fluld ln Lhe pelvls, no free alr. WhaL ls Lhe
LreaLmenL of cholce?

a. 1ransfer Lhe paLlenL ln lCu
b. LaparoLomy and lleosLomy surgery
c. LaparoLomy and Lransverse loop coloLomy surgery
d. LaparoLomy and subLoLal colecLomy and lleosLomy
e. ParLmann's procedure

33. 30 years old male arrlves Lo Lhe emergency room wlLh rlghL abdomlnal paln, vomlLlng and dlsLenLlon. Cn C1- obsLrucLlng
mass ln Lhe hepaLlc flexure wlLhouL small bowel dlsLenLlon. WhaL ls Lhe correcL managemenL?

a. nC1 and lv flulds followed by furLher workup lncludlng Lumor markers, colonoscopy and compleLlon of C1 chesL
b. urgenL rlghL hemlcolecLomy
c. SLenL lnserLlon Lo relleve Lhe obsLrucLlon and preparaLlon for laLer surgery
d. ParLmann's procedure

34. Alr ln Lhe blle ducLs on abdomlnal x-rays can be caused by all excepL:

a. SLaLus posL papllloLomy
b. Small bowel necrosls secondary Lo mesenLerlc lschemla
c. SLaLus posL llver LransplanL and [e[eunosLomy
d. CallsLone lleus
e. 10 years followlng choledocoduodenosLomy
33. 37 years old healLhy female arrlves Lo Lhe emergency room, complalnlng of lncreaslng abdomlnal dlsLenLlon and
consLlpaLlon LhaL began 2 monLhs ago wlLh recenL worsenlng, ln Lhe pasL week sympLoms worsened and Lhe lasL bowel
movemenL was 10 days ago. 1here ls no slgnlflcanL abdomlnal paln or vomlLlng, buL Lhe paLlenL complalns of severe nausea. Cn
physlcal examlnaLlon Lhe abdomen ls dlsLended, Lhympanlc, wlLhouL hernlas or surglcal scars, laboraLory - Pb- 10,2 W8C-
11,000 na 132, on x-ray severe dlsLenLlon of Lhe rlghL and Lransverse colon and no small bowel dlsLenLlon.
WhaL ls Lhe nexL sLep?

a. lasL bowel preparaLlon followed by colonoscopy
b. C1 scan of Lhe abdomen and Lhe pelvls wlLh lv and oral conLrasL
c. CasLrographln enema
d. LaparoLomy

36. Whlch ls nC1 assoclaLed wlLh lncreased rlsk of breasL cancer ?

a. smoklng
b. aLypla on prevlous breasL 8lopsy
c. 1sL degree famlly relaLlve wlLh breasL cancer
d. older ager
e. LClS

37. Whlch has Lhe greaLesL lmpacL on Lhe prognosls of breasL cancer paLlenL?

a. slze of Lhe Lumour
b. hlsLologlcal Lumour Lype
c. number of axlllary lymphnode lnvolvemenL
d. hormonal recepLor ln prlmary Lumour

38. 46 y /l had bloody dlscharge of Lhe lefL nlpple for 3 monLhs , on examlnaLlon : no palpable mass , buL lefL nlpple
compresslon producLs mlnlmal bloody dlscharge aL 3o'c , mammography ls normal and uS ldenLlfles a mlnuLe mass behlnd Lhe
lefL areola . whaL ls Lhe dlagnosls?

a. lnLraducLal papllloma
b. lnLraducLal carclnoma
c. faL necrosls
d. cys
e. flbroadenoma

39. 30 y /m had colonoscopy and resecLlon of polypes from Lhe rlghL colon few hours Lo Lhe presenLaLlon Lo Lhe L8 , ex: dlffuse
abdomlnal Lenderness wlLh perlLonlLls ls noLed .chesL x-ray shows free alr under Lhe dlaphragm .whaL ls Lhe nexL sLep ??

a. n1C ,anLlbloLlcs ,flulds
b. Colonoscoplc closure of perforaLlon
c. 8lghL colecLomy
d. Laparoscopy ex ,lrrlgaLlon and draln placemenL

60. whaL ls Lhe maln ob[ecLlve of hlp or replacemenL ?

a. avold deLerloraLlon of physlologlcal load on [olnL above and below Lhe replaced [olnL .
b. enable aLhleLlcs especlally professlonal , Lo achleve load on and sLress LhaL Lhe naLlve [olnL ls capable of performlng
c. avold lnLra [olnL fx ln paLlenLs LhaL are prone for lL
d. decrease paln and lmprove quallLy of llfe

61.All of Lhe followlng are compensaLory mechanlsm ln hypovolemlc shock exepL:

a.lncreased perlpheral reslsLance secondary Lo lncreased caLecholamlne levels.
b.lncreased uC 2,3 levels.
c.rlghL shlfL of Lhe hemoglobln dlssoclaLlon curve secondary Lo acldosls.
d.decreased cardlac conLracLlllLy.
62.Whlch of Lhe followlng ls Lhe gold sLandard dlagnosLlc LesL for CL8u?

a.esophageal manomeLry.
b.gasLroscopy.
c.esophagogasLrlc barlum serles.
d.esophageal P-meLry for 24 hours.

63. A useally healLhy 63 year old female LhaL ls heavy smoker had a slngle evenL of palnless bloddy urlne (macrohemaLurla),a
work up lnclude cysLoscopy,uS,urlnary culLure,and urlnary cyLology-all negaLlve.whaL should be lncluded ln furLher evaluaLlon?

a.Lhere ls no need for furLher evaluaLlon.
b.uS scan should be repeaLed wlLh addlLlon of doppler lmaglng of Lhe renal blood vessels.
c.abdomlnal C1 scan wlLh lv conLrasL durlng bladder blopsy Lo rule ouL carclnoma ln slLu.


64.WhaL ls Lhe recommended LreaLmenL for colorecLal llver meLasLasls LhaL are locallzed Lo one llver lobe?

a.lubecLomy of Lhe lobe conLalnlng Lhe meLasLasls.
b.lubecLomy of Lhe lobe conLalnlng Lhe meLasLasls and sysLemlc chemoLherapy.
c.sysLemlc chemoLherapy uslng cysLoLoxlc and blologoc drugs.
d.palllaLlve LreaLmenL only.


63.a 33 yr female wlLh no medlcal hlsLoryls belng evaluaLed for melena and ls found Lo have 2cm gasLrolnLesLlnal sLroma
Lumors(ClS1)ln Lhe anLerlor wall of Lhe sLomach.Lhe dlagnosls ls conflrmed wlLh lmmunohlsLochemlcal sLalnlng.Lhere ls no
ad[acenL organ lnvaslon or dlsLanL meLasLasls. whaL ls Lhe recommended LreaLmenL?

a.open or laparoscoplc margln free Lumor exclslon and follow up.
b.subLoLal gasLrecLomy and reglonal lymph node dlssecLlon.
c.LreaLmenL wlLh Lyxoslne klnase lnhlblLors Llll compleLe response and afLer surgery ln case of medlcal LreaLmenL fallure.
d.LreaLmenL wlLh Lyroslne klnase lnhlblLors lmaLlnlb.


66. ln Lhe L8 a 60 year old male wlLh no medlcal hlsL ls found Lo have onsLrucLlng Lumorl ln Lhe slgmold colon .
ln comblnaLlve C1 and gasLrograflan enema Lhe cecum dlameLer ls 13 cm whaL ls Lhe recomanded LreaLmenL ?

a. mecanech bowel preparaLlon followed by surgery LhaL lncludes slgmoldecLomy and reg lymf nodes desecLlon and
anasLomosls
b. lmedlaL surgery LhaL lncludes lncludes slgmoldecLomy and reg lymf nodes and anasLomosls wlLh no furLher workup
c. lmmedlaLe colonoscopy wlLh blopsy and afLer dg ls hlsLologlcally conflrmed slgmoldecLomy
d. lmmedlaLe surgery LhaL lncludes slgmoldecLomy and reg lymf nodes desecLlon and correcLlon of poxlmal sLoma

67. 73 year old arrlves Lo Lhe L8 wlLh rlghL upper abd paln physlcal ex Lhe paclneL have lcLerus no fever rlghL abd Lenderness
W8C 7800 8lLl8u8ln 63 elevaLed llver funcLlon LesL ls 43 wlLh dlsLenLed gallbladder and mlld exLra and lnLra hepaLlc ducLs
dllaLaLlon whaL ls Lhe nexL sLep:

a. percuLaneus LranshepaLlc colanglography
b. colycesLocLomy wlLh lnLraoperaLlve colanglogram
c. M8C
d. llver vlral LesL
e. broad specLrum A8






68. 19 year old male ls lnvolved moLor vechlle accldenL on arrlval 8 70/40 P8 130/Mln 8CCM Al8 SA1u8A1lCn 92
wlLh lefL lower abd abraslon Lhe abd ls sofL wlLhouL perlLonlLls and pelvls ls sLable Lhere ls lefL clavlcular fracLure and lefL
humerus .chesL x ray lefL lung conLuslon and lower rlb fracLure , fasL ls poslLlve afLer 2 llLLerl of l.v flulds Lhe 8 ls 73/40 hearL
raLe ls 120 whaL ls Lhe nexL sLep ?

a. chesL , abd and pelvlc C1
b. 8LLA1 lAS1
c. laparoLomy
d. uL
e. lefL chesL Lube lnserLlon


69. 78 year old male whlL abd paln vomlLlng opsLlpaLlon wlLh no fever ,abd Lenderness wlLhouL perlLonlLls and x ray reveals a
number of dlsLended small bowel loops wlLh alr flulds levels whaL ls Lhe nexL sLep ?

a. laparaLomy
b. abd uS
c. oral conLrasL sLudy
d. gallbladder dralnage
e. gasLrograflan enema


70 . 73 year old female wlLh elevaLed ln Lhe L8 for recLal bleedlng posL medlcal hlsLory ls poslLlve for dlabeLes LreaLes wlLh
glucophage and eplsode of dlverLlcullLls she ls pale 8 90/60 P8 120 her abd ls sofL , recLal ex wlLh fresh blood and no
hemorrholds P8 9.7 and Lhere ls blllous conLenL ln Lhe nC1 afLer l.v flulds and 2 unlLs of recLum.
whaL ls Lhe nexL sLrep ?

a. urgenL colonoscopy
b. slgmoldecLomy
c. anglography
d. red blood cell scan
e. dg laparoscopy


71. 70 years old female follow lumpecLomy and axlllary dlssecLlon due Lo rlghL breasL cancer. Cn paLhology Lhe Lumor was
found Lo be 2 cm, C2 lnfllLraLlng ducLal carclnoma, L8 (-), free marglns and 1/19 lymph node (+). Whlch of Lhe followlng
Lheraples ls approprlaLe?

a. 8adlaLlon
b. 8adlaLlon + chemoLherapy
c. 8adlaLlon + chemoLherapy + 1amoxlfen
d. MasLecLomy + chemoLherapy


72. 80 years old female wlLh lschemlc hearL dlsease, dlabeLes melllLus, hyperLenslon and exerclse aLheroscleroLlc dlsease ls
admlLLed Lo general medlclne wlLh dlarrhea and abdomlnal paln. A week ago she sLarLed wlLh anLlbloLlcs for pneumonla.
ClosLrldlum dlfflclle (Cul) ls poslLlve on sLool culLures. She ls LreaLed wlLh lv llagyl followlng oral vancomycln and lv flulds.
uesplLe Lherapy - 1empraLure 40 C, abdomlnal dlsLenslon, dlarrhea, dyspnea, ollgurla. Lab. W8C 70,000, Pb 9.3, k+ 3.6,
creaLlnln 2.6, pP 7.1, 8L (-10), PCC3- 19. Abdomlnal C1 - slgnlflcanL bowel wall Lhlckness Lhou Lhe colon and moderaLe amounL
of free flulds wlLh no alr, Lhe mesenLerlc blood vessels are paLenL. WhaL ls Lhe approprlaLe managemenL?

a. aLenL should be lnLubaLed + anLlbloLlc Lherapy Lo cover reslsLanL bacLerla + lCu.
b. urgenL dlalysls, Lo LreaL meLabollc acldosls + hyperk+.
c. lasL bowel preparaLlon followed by coloscopy Lo role ouL lschemlc mucosa of Lhe large bowel.
d. 1he paLlenL should be Laken Lo surgery LhaL lncludes LoLal colecLomy and lleosLomy.


73. 49 years old female wlLh no famlly hlsLory of breasL cancer, undergone open blopsy of 2 cm lefL breasL mass. Cn paLhology -
flbrosls, ducLal aLresla and several focl of LClS LhaL lnvolve Lhe surglcal marglns. Whlch of Lhe followlng ls correcL?

a. An exLenslon of Lhe marglns ls lndlcaLed.
b. 1he paLlenL ls aL lncreased rlsk for developlng breasL cancer aL Lhe blopsy slLe.
c. lf breasL cancer develops, lL wlll mosL llkely be aL Lhe blopsy slLe.
d. lf breasL cancer develops, lL wlll be lobular carclnoma.
e. 1here ls no lndlcaLlon for 1amoxlfen Lherapy ln Lhls paLlenL.


74. A clrrhoLlc paLlenL LhaL ls llver LransplanLed candldaLe ls admlLLed for esophageal bleedlng varlcles. 1herapy wlLh
somaLosLaLlne + endoscopy lncludlng scleroLherapy and falled bandlng do noL sLop Lhe bleedlng. WhaL ls Lhe nexL sLep?

a. 1lS.
b. 8epeaL endoscopy.
c. ulsLal splenorenal shunL.
d. Surglcal procedure (porLo - azygos dlsconnecLlon).


73. WhaL ls recommended approach Lo a paLlenL wlLh acuLe dlverLlcullLls deflned as Plnchey lv?

a. nC + anLlbloLlcs + flulds.
b. ParLmann's procedure.
c. C1 gulded percuLaneus drenage.
d. urgenL dlagnosLlc colonoscopy.


76- A paLlenL undergoes a segmenLal masLecLomy and negaLlve marglng are obLalned . Lwo senLlnel lymph nodes are ldenLlfled
on flnal hlsLologlc evaluaLlon 106 -mm reglon of macromeLasLases ls found on P&L sLalnlng wlLhln Lwo of lymph nodes . Lhe
nexL sLep should be:

a. CompleLlon masLecLomy
b. CompleLlon axlllary dlssecLlon
c. Axlllary dlssecLlon and breasL radlaLlon Lherapy
d. SysLemlc chemoLherapy alone
e. no furLher axlllary operaLlon


77. A 63 old man has a 3 cm recLal polyp, Lhe lower edge of Lhls mass ls locaLed 6 cm from Lhe anal verge. 8lopsy of Lhe leslon
shows a focus of lnvaslve adenocarclnooma . cL of Lhe abdomen and chesL show no evldence of meLasLaLlc dlsease Lhe
endorecLal ulLrasound reveals enlarged perlrecLal lymph nodes . Lhe besL manegmenL :

a. Local exclslon alone
b. Wlde local exclslon , ad[uvanL chemoradlaLlon Lherapy
c. 1oLal mesorecLal exclslon wlLh coleanal anasLomosls
d. neoad[uvanL chemoradlaLlon Lherapy, LoLal mesorecLal exclslon , coeanal anasLomosls
e. neoad[uvanL chemoradlaLlon Lherapy, LoLal mesorecLal exclslon, abdomlnopneal resecLlon


78. Whlch of Lhe followlng sLaLemenL abouL gasLrolnLesLlnal sLromal Lumors (ClS1) ls Lrue :

a. L1 Lumors are conflned Lo Lhe mucosa
b. mosL ClS1s sLaln poslLlve for cd117 by lmmunohlsLochemlsLry
c. gasLrlc ClS1 have a much worse prognosls Lhan gasLrlc adenocarclnoma
d. Lhe second mosL common locaLlon of ClS1ls Lhe colon
e. rouLlne reglonal en-block lymphadenecLomy lmproves reglonal conLrol and conferes a survlval advanLage

79. A 33 year old woman wlLh a hlsLory of an lleocecoLomy for crohn dlsease undergoes cholecysLomyfor sympLomaLlc
gallsLones , dlarrhea and sLool frequency lncrease markedly posL-operaLlvely . Lhe slngle mosL effecLlve Lherapy ls :

a.blsmuLh
b.ocLreoLlde
c.loperamlde
d.cholesLyramlne
e. pancreaLlc enzymes

80. A 23 year woman undergoes laparoscopylc roux-en y gasLrlc bypass for morbld obeslLy posL- operaLlvely she develops
Lachycardla , ollgurla , hypoxemla and anxleLy . physlcal examlnaLlon falls Lo demonsLraLes perlLonlLls . an upper gasLrolnLesLlnal
serles falls Lo demonsLraLe a leak . Lhe nexL sLep should be :

a. cL -pulmonary anglogram
b. dlureLlcs
c. laparoLomy or laparoscopy
d. broad specLrum anLlbloLlcs , observaLlon ln Lhe lCu
e. pulmonary arLery caLheLer placemenL


81. 12 hours afLer colonoscopy wlLh removal of a polyp 2.3 cm on a broad basls of Lhe bllnd lnLesLlne, 33 year old woman has
abdomlnal paln, fever, leukocyLosls, paln ln Lhe lower rlghL quadranL.Cn abdomlnal radlography Lhere ls no free alr. WhaL ls Lhe
nexL sLep?

a. hosplLallzaLlon for re-examlnaLlon of Lhe abdomen.
b. ulagnosLlc laparoLomy
c. abdomlnal C1 lmaglng
d. colonoscopy
e. gasLrografln enema


82. WhaL are Lhe lndlcaLlons for SLrlcLuroplasLy ln Chron's dlsease?

a. revlous resecLlon
b. SLrlcLure larger Lhan 20 cm
c. MalnuLrlLlon
d. erforaLlon
e. Many sLrlcLures ln a shorL segmenL


83. A man wlLh clrrhosls and esophageal varlces LhaL are noL bleedlng , cannoL LoleraLe blockers. WhaL wlll prevenL fuLure
bleedlng from Lhe varlces?

a. Lndoscoplc llgaLlon
b. CcLreoLld lnfuslon
c. 1lps
d. Lndoscoplc scleroLlzaLlon
e. orLocaval shunL


84. ln a 30 year old man wlLh sympLomaLlc CL8u , on Lndoscoplc examlnaLlon - evldence of barreLL esophagus.
Whlch of Lhe followlng ls Lrue?

a. Surglcal LreaLmenL ls noL lndlcaLed
b. 1reaLmenL wlLh l wlll reduce Lhe slze of Lhe area lnvolves wlLh barreLL
c. Surglcal LreaLmenL of Lhe CL8u sympLoms wlll noL reduce Lhe rlsk of cancer
d. 8arreLL esophagus ls presenL ln 30 of paLlenLs wlLh CL8u
e. Lndoscoplc ablaLlon of Lhe area lnvolvlng Lhe barreLL wlll reduce Lhe rlsk of esophageal cancer

83. Whlch of Lhe followlng proposals for lobular carclnoma ln slLu ls noL Lrue:

a. 1amoxlfen reduces Lhe rlsk of lnvaslve breasL cancer
b. paLlenLs are aL lncreased rlsk of breasL cancer on boLh sldes
c. usually Lhere are no calclflcaLlons or palpable Lumor
d. requlred resecLlon of cancer wlLh clean boundarles
e. more frequenLly ln women before menopause






<@9<@9?<>>)
61. A paLlenL undergoes a segmenLal masLecLomy and negaLlve marglns are obLalned, Lwo senLll lymph node are
ldenLlfled.on flnal hlsLologlcal evaluaLlon a 6mm reglon of macromeLasLases ls found on P&L sLalnlng wlLhln Lwo
of Lhe lymph node, Lhe nexL sLep should be:

A. compleLlon masLecLomy
8. compleLlon axlllary dlssecLlon
C. axllary dlssecLlon and breasL radlaLlon Lherapy
u. sysLemlc chemoLherapy alone
L. no furLher axlllary operaLlon

62. A posL-menopausal woman wlLh new dlagnosls of breasL cancer ln her lefL breasL elecLs Lo undergo
masLecLomy. Whlch of Lhe followlng sLaLemenL abouL conLralaLeral prophylacLlc masLecLomy ls Lrue?

A. overall morLallLy ls lmproved
8. Lhere ls a survlval advanLage for paLlenL wlLh hlgher sLage cancer
C. Lhe lncldence of conLralaLeral breasL cancer ls slgnlflcanLly reduced
u. senLenll lymph node blopsy should be done bllaLerally
L. reconsLrlcaLlon should be delayed unLll flnal hlsLopaLhology ls avallable

63. A paLlenL wlLh clrrhosls has large esophageal varlces buL has never had bleedlng eplsode. Pe ls unable Lo
LoleraLe a non selecLlve beLa blocker, prevenLlon of an lnlLlal bleedlng eplsode ls besL accompllshed by:

A. endoscopy llgaLlon
8. 1lS
C. endoscoplc scleroLherapy
u. ocLreoLlde
L. a small dlameLer lnLerposlLlon porLocaval shunL

64. A 30 y/o man wlLh hlsLory of sympLomaLlc CL8u has 8arreLL's esophagus dlagnosed on upper
endoscopy, whlch of Lhe followlng sLaLemenL ls Lrue?

A. surglcal LreaLmenL for sympLom of reflux ls noL warranLed
8. 8arreLL's esophagus ls seen ln 30 of paLlenL wlLh CL8u
C. l wlll reduce Lhe area of barreLL's esophagus
u. surglcal LreaLmenL of paLlenL reflux sympLoms wlll noL reduce Lhe rlsk of esophageal cancer
L. endoscoplc ablaLlon wlll reduce Lhe rlsk of esophageal cancer

63. A 33 y/o man presenL wlLh hls flrsL eplsode of dlverLlcullLls he ls hemodynamlcaly normal and lmprove wlLhln
48 hrs recelvlng anLlbloLlcs and noLhlng by mounLh. C1 reveals sLrandlng of slgmold esenLry. 8uL no free alr or
evldence of any abscess. 1he nexL sLep ln LreaLmenL should be:

A. resecLlon, anasLamosls.
8. resecLlon and colosLomy.
C. dlscharge and elecLlve colecLomy.
u. dlscharge, oral anLlbloLlcs and observaLlon.
L. colonscoplc lnLramural sLenL

66. A12 hours afLer colonoscopy and removal of 2.3 cm sesslle polyp from cercum, 33 years old woman as
abdomlnal paln, fever, leukocyLosls, mlnd Lenderness ln Lhe rlghL lower quadranL. no free alr ln Lhe bdomen.
1he nexL sLep should be:

A. admlsslon serlal abdomlnal examlnaLlon
8. exploraLory laproLomy
C. abdomlnal C1
u. coloscopy
L. gasLrograffln enema
67. A 48 year old man wlLh lefL lower quadranL paln. LeukocyLosls, low grad fever,
no perlLoneal slgns. umlsslon of C1 was lnLerpreLed showlng acuLe dlverLlcullLls, no
perforaLlon or abscess. AfLer 72 hours f LreaLmenL wlLh l.v anLlbloLlcs and fluld Lhe
paln resolved, bowel funcLlon and appeLlLe became ormal, leukocyLosls resolved,
Lhe nexL sLep ls:

A. slgmold colecLomy prlor Lo dlscharge
8. elecLlve colecLomy 6-8 weeks afLer dlscharge
C. coloscopy prlor Lo dlscharge
u. observaLlon and medlcal managemenL afLer dlscharge
L. follow-up C1


68. A 33 year old woman wlLh lleocececLomy for chron dlsease undergos cholecysLecLomy for sympLomaLlc gallsLones. ularrhea
and sLool frequency are lncreased markedly posLoperaLlvely. nexL sLep:

A. blsmuLh
8. ocLreoLlde
C. loperamlde
u. cholesLyramlne
L. pancerlaLlc enzyme.


70. A 63 years old paLlenL has 3 cm recLal polyp. 1he lower age of Lhe mass ls 6 cm from anal verge. 8lopsy
shows focus of adenocarclnoma. C1 abdomen and chesL shows no meLasLasls. 1he endorecLal ulLrasound shows
several perlrecLal lymph nodes. 1he besL managemenL ls:

A. local exclslon
8. local exclslon ad[uvanL chemoLherapy
C. LoLal mesorecLal exclslon wlLh coloanal anasLromosls
u. neoad[uvanL chemoLherapy and LoLal mesorecLal exclslon wlLh coloanal anasLromosls.
L. neoad[uvanL chemoLherapy and LoLal mesorecLal exclslon and abdomenoperlneal resecLlon.


71. A man presenLs wlLh repeaLed eplsodes of bloody sLools. LsophagogasLroduodenoscopy and colonoscopy are normal.
1he nexL sLep ln managmenL should be:

A. Small bowel barlum x-rays.
8. C1 elecLrolysls
C. Capsule endoscopy
u. ush and pull enLeroscopy
L. MesenLerlc anglography

72. A 63 year old man remalns ln Lhe lCu one mounLh afLer coranary arLery bypass
grafLLlng. Pe has been LreaLed for Lwo eplsodes of pneumonla and conLlnnues Lo
requlre venLllaLory supporL. Pe develops waLery dlarrhea and abdomlnal dlsLenLlon.
SLool senL for closLrldlum dlfflclle Loxln ls poslLlve and oral meLronldazole Lherapy ls lnlLlaLed. llve days laLer, he
developes hypoLenslon requerlng vasopressors, renal lnsufflclency, and an elevaLed W8C counL of 36,000/mm3.
1he mosL approprlaLe managemenL would be:

A. lnLravenous vancomycln
8. vancomycln enemas
C. CecosLomy Lube placemenL.
u. ulverLlng Lransverse loop colosLomy
L.



73. A common physlologlc characLerlsLlc of sepLlc shock ls:

A. LlevaLed cenLral venous pressure
8. Plgh sysLemlc vascular reslsLance
C. Low cardlac ouLpuL
u. SysLemlc vasodllaLlon

74. MosL surglcal slLe lnfecLlous become cllnlcally evldenL:

A. WlLhln 2 days of operaLlon
8. 3 or more days afLer operaLlon
C. 8ecause of fever lmmedlaLely afLer operaLlon
u. 8ecause Lhe paLlenL dld noL have an adequaLe shave of Lhe operaLlve slLe
L. A monLh afLer operaLlon

73. Lhe mosL common cause of a small bowel obsLrucLlon ls:

A. 1umor
8. volvulus
C. Adheslons
u. lleocollc lnLussuscepLlon

76. An abdomlnal comparLmenL syndrome produces all of Lhe followlng excepL:

A. acuLe renal fallure
8. hypoxla
C. lnLesLlnal obsLrucLlon
u. elevaLed urlnary bladder pressure
L. hypercarbla

77. A 40 y.o. woman wlLh 1,3 sm palpable bresL mass undergoes uS gulded core needle blopsy. PlsLology
showed cellular flbroadenoma wlLh posslblllLy of a phylloldes Lumor. ApproprlaLe managemenL lncludes:

A. a 6 monLh follow up uS. lf leslon slze ls sLable, conLlnue expecLanL managemenL
8. exclslonal blopsy Lo dlfferenLlaLe beLween Lhe 2 posslblllLles
C. wlde local exclslon (lumpecLomy) wlLh Lhe lnLenL Lo achleve 1 Lo 2 sm negaLlve marglns around Lhe leslon
u. wlde local exclslon wlLh senLlnel blopsy
L. wlde local exclslon wlLh radlaLlon

78. ageL's dlsease ls caused by whlch of Lhe followlng processes:

A. aLoplc dermaLlLls on Lhe nlpple due Lo allergles
8. lnLraducLal carclnoma LhaL spreads lnLo Lhe epldermls of Lhe basemenL membrane
C. lnvaslve carclnoma LhaL causes nlpple lnverslon and Lhen ulceraLlon
u. lnvaslon of Lhe dermal lymphaLlcs under Lhe nlpple called Sappy's plexus
L. a papllloma ln a large subareolar ducL causlng dlscharge and on Lhe nlpple

79. A 60 y/o man suddenly developed severe abdomlnal paln. ln Lhe emergence deparLmenL 2 hours laLer hls abdomen
was sofL and nonLender, hls whlLe blood cells were 18,300/mm3, and hls arLerlal blood pP was 7,32.
1he probable dlagnosls ls?

A. acuLe appendlclLls
8. acuLe pancreaLlLls
C. superlor mesenLerlc arLery embollsm
u. perforaLed duodenal ulcer



80. A 60 y.o. man comes Lo Lhe emergency deparLmenL obLunded and hypoLenslve wlLh melena and
hemaLochezla. Pe has no hlsLory of prlor surgery or alcohol abuse. Pls physlcal examlnaLlon ls unreveallng wlLh
sLlgmaLa of llver dlsease. 1he mosL llkely source of bleedlng ls:

A. colonlc dlverLlcula
8. small bowel anglodysplasla
C. bleedlng duodenal ulcer
u. aorLoenLerlc flsLula

86. A 38 old female who ls a candldaLe for a masLecLomy due Lo breasL cancer arrlves Lo Lhe cllnlc seeklng consulL
regardlng breasL reconsLrucLlon .she ls a candldaLe for ad[uvanL radlaLlon and chemoLherapy.
WhaL Lype of reconsLrucLlon ls mosL sulLable for Lhls aLlenL?

A. uesplLe Lhe radlaLlon ,she has an lndlcaLlon for lmmedlaLe reconsLrucLlon wlLh Llssue expanders ln order Lo
preserve Lhe skln
8. Lhls ls an lndlcaLlon for lmmedlaLe reconsLrucLlon uslng auLologous flaps only
C. delayed reconsrucLlon of abouL 6 monLh und uslng auLologous flaps are recommended afLer Lhe compleLlon of Lhe
radlaLlon and chemoLherapy
u. Lhere ls no opLlon for early or delayed breasL reconsLrucLlon ln a paLlenL LreaLed wlLh radlaLlon


87. A 30 year old male wlLh a gunshoL Lo Lhe abdomen arrlves Lo Lhe emergency room. Pls lasL meal was 8
hours ago .1he paLlenL ls Laken emergenLly Lo operaLlng room. Whlch of Lhe followlng ls correcL?

A. Lhere ls no need for dellverlng 100 C2 for 3 mlnuLes prlor Lo Lhe lnducLlon of anesLhesla
8. crlcold pressure should be applled prlor Lo Lhe lnducLlon of anesLhesla Lo avold asplraLlon
C. crlcold pressure ls noL warranLed as Lhe lasL meal was over 8 hours ago
u. surgery may be prformed under local anesLhesla


88. Whlch of Lhe followlng ls correcL regardlng an lncarceraLed hernla ln a 2 year old chlld?

A. Lhls ls lndlcaLlon fo urgenL surgery
8. lL ls assoclaLed wlLh undescendend LesLls
C. an aLLempL Lo reduce lL ls advlsable
u. ln mosL of Lhe Llmes lL ls a congenlLal dlrecL hernla

89. WhaL ls Lhe annual rlsk for rupLure, dlssecLlon, and deaLh when Lhe dlameLer of Lhe ascendlng aorLa exceeds 3cm?

A. 1.3
8. 3
C. 4.3
u. 6.3

90. A 36 year old male was lnvolved ln moLor cycle accldenL ,he has an lsolaLed ln[ury LhaL lncludes a fracLure of Lhe rlghL mld
femur .whaL of Lhe followlng sLaLemenL ls correcL?

A. Lhe accepLed LreaLmenL for Lhls fracLure ls plaLe and screws flxaLlon wlLhln 24 hours
8. Lhe accepLed LreaLmenL for Lhls fracLure ls lnLramedullary nalls wlLhln 6-8 hours
C. Lhe accepLed LreaLmenL for Lhls fracLure ls exLernal flxaLlon as soon as posslple Lo avold Lhe compllcaLlon faL emboll Lhls
should be followed by permanenL flxaLlon ln 4-3 days
u. 1lmlng of Surgery ls of no lmporLance. lL ls accepLed Lo operaLe on such paLlenLs accordlng Lo operaLlng room
avallablllLy




91. A 4 y old boy, afLer fracLure flxaLlon wlLh casL aL Lhe evenlng. AL nlghL felL paln and flnger Llngllng. WhaL ls Lhe nexL
LreaLmenL?

A. AnoLher morphlne dose Lo ease Lhe paln
8. LlevaLe Lhe arm on 2 plllows
C. Cpen casL
u. urgenL x-ray

92. A 13y boy, afLer scroaLal ln[ury durlng fooLball. Complalns on severe locallzed paln. Cn exam. 1esLlcle flrm
and Lender. nexL LreaLmenL/evaluaLlon:

A. Local coollng and scroaLal elevaLlon
8. CperaLlve exploraLlon repalr of Lunlca albuglnea
C. urgenL uoppler
u. Admlsslon for follow-up on hemaLoma developmenL


93. 60 y, M, recLal carclnoma 3 cm above anal verge. no meLasLasls Lo dlsLanL slLes. 18uS shows lnvaslon Lo
perlrecLala faL (u13) wlLhouL reglonal L.n lnvolvemenL. 1reaLmenL:

A. 8adlcal resecLlon (low anLerlor) and LoLal mesorecLal resecLlon.
8. Comblned LreaLmenL: neoad[uvanL chemoLherapy followed by 8adlcal resecLlon (low anLerlor) and LoLal
mesorecLal resecLlon.
C. 8adlcal resecLlon (low anLerlor) and LoLal mesorecLal resecLlon followed by chemoLherapy
u. neoad[uvanL + 18uS, C1 and surgery lf resldual Lumor ls deflned ln lmaglng


94. AccepLed LreaLmenL of mallgnanL cuLaneous lnLermedlaLe Lhlckness melanoma: (8reslow 1-4) on rlghL arm:

A. Wlde local exclslon wlLh 1cm margln from lnlLlal leslon
8. Wlde local exclslon wlLh 1cm margln from lnlLlal leslon +senLlnel lymph node blposy
C. Wlde local exclslon wlLh 2cm margln from lnlLlal leslon
u. Wlde local exclslon wlLh 2 cm margln from lnlLlal leslon + senLlnel lymph node blopsy


93. A 33, M, comes Lo L8 wlLh severe eplgasLrlc paln. 2 monLhs ago he has compleLed Lrlple LreaLmenL of ulcer ln flrsL parL of
duodenum wlLh poslLlve P.ylorl. Cn ChesL x-ray alr under Lhe rlghL dlaphragm ls deLecLlble. nexL sLep:

A. urgenL endoscopy
8. CmenLopexy
C. elvlc C1 wlLh conLrasL
u. AnLrecLomy


96. A 36-year-old female arrlves Lo Lhe L8 because of !aundlce. She has no pasL
medlcal hlsLory. LaboraLory flndlng lnclude a blllrubln of 127 and slgnlflcanLly
elevaLed cholesLaLlc and hepaLocellular enzymes. Cn abdomlnal ulLrasound Lhe
gallbladder ls dlsLended wlLh no sLones. 1he C8u ls 18mm and Lhere ls exLra and
lnLra-hepaLlc blle ducL dllaLaLlon. Serum CA19-9 Levels are 1200. Abdomlnal C1
ldenLlfles a pancreaLlc head mass wlLhouL SMv lnvolvemenL. WhaL ls Lhe nexL sLep ln Lhls paLlenL's ManagemenL?

A. Callbladder dralnage
8. 8esecLlon of Lhe duodenum ln Lhe pancreaLlc head
C. 1C
u. 8lood P8v and PCv LesLlng
L. neoad[uvanL chemoLherapy


97. An 88-year old male comes Lo Lhe L8 because of excruclaLlng lngulnal paln. 1wo weeks ago he suffered an
acuLe myocardlal lschemla and ls Laklng asplrln slnce. Cn examlnaLlon he seems Lo be ln paln, wlLh no fever, hearL raLe of 113
beaLs pro mlnuLe, regular. Pls abdomen ls noL dlsLended and Lhere ls no evldence of perlLonlLls. Pe has an lncarceraLed, non
reduclble, LlghL lngulnal hernla. WhaL ls Lhe nexL sLep ln Lhls paLlenL's ManagemenL?

A. 1CA
8. 1halllum sLress LesL
C. Surgery
u. AnoLher aLLempL Lo reduce Lhe hernla under deep sedaLlon
L. Abdomlnal pelvlc C1.

98. A 20-year-old male ls ln[ured a pedesLrlan ln a moLor-vehlcle accldenL. AL Lhe L8
ls fully consclous. 8 ls 110/70, her raLe ls 93. 8oom saLuraLlon ls 92. Cn
LxamlnaLlon Lhere are abraslons on Lhe rlghL chesL and abdomen, deformaLlon of Lhe
rlghL arms and normal perlpheral pulses. lAS1 lndenLlfles small amounL of
abdomlnal fluld, C1 lndenLlfles a sLage 4 llver laceraLlon wlLh no acLlve bleedlng, and
slgnlflcanL rlghL lung conLuslon. WhaL ls Lhe nexL sLep ln Lhls paLlenL's ManagemenL?

A. oslLlve pressure venLllaLlon
8. LaparoLomy
C. Anglographlc LmbollzaLlon of Lhe llver
u. lnLenslv care observaLlon
L. Surglcal repalr of arm fracLure

99. A 38 year old female arrlves Lo Lhe L8 wlLh fever of 38.3 and rlghL upper
abdomlnal paln. A week prlor Lo her admlsslon she underwenL laparoscoplc
cholecysLecLomy. Cn examlnaLlon she ls alerL and orlenLed. WlLhouL scleral lcLerus, and normal appearlng surglcal
lnclslons. LlbraLory flndlng lnclude LeucocysLosls 13,000, sllghLly elevaLed llver enzymes, and normal blllrubln,
whaL ls Lhe nexL sLep ln Lhls paLlenL's ManagemenL?

A. L8C and sLenL lnserLlon
8. Abdomlnal ulLrasound
C. Llver scan
u. LxploraLory laparoLomy
L. broad-specLrum anLlbloLlcs LreaLmenL and observaLlon.

100. A usual healLhy 33 year old female ln complalnlng of 2 monLhs upper abdomlnal
paln LhaL radlaLes Lo rlghL shoulder afLer a faLLy meal. 1he paln resolves 30 mlnuLes
afLer she Lakes opLalgln. no fever or vomlLlng ls assoclaLeLed. 1he paLlenL ls now ln
Lhe L8 due Lo !aundlce for 3 days wlLhouL fever or abdomlnal paln. Cn LxamlnaLlon
Lhe abdomen ls noL Lender. LaboraLory flndlng lnclude - no LeucocyLosls, however
llver funcLlon LesLs are elevaLed wlLh 8lllrubln of 80 (normal <17) ln abdomlnal
ulLrasound Lhere are sLones ln Lhe gallbladder, Lhe gallbladder ls noL dlsLended,
gallbladder wall ls noL Lhlckened. 1he C8u's dlameLer ls 9 mm. WhaL ls Lhe nexL sLep ln Lhls paLlenL's ManagemenL?

A. nC, lv flulds and anLlbloLlcs, follow up on llver enzymes and lf Lhey lmprove laparoscoplc cholecysLecLomy
8. nC, lv flulds and anLlbloLlcs, and subsequenL L8C and surgery of gallbladder removal.
C. L8C and surgery of gallbladder removal.
u. LuS or M8C

101. A healLhy 30-year-old male arrlves Lo Lhe L8 wlLh lower quadranL paln, vomlLlng, and abdomlnal dlsLenLlon. Abdomlnal C1
demonsLraLes mass aL Lhe hepaLlc flexure wlLh no small bowel dlsLenLlon. WhaL ls Lhe approprlaLe LreaLmenL?

A. nasogasLrlc Lube, lv flulds, followed by a work up and preoperaLlve evaluaLlon LhaL lncludes Lumor markers,
colonoscopy, and compleLlon of chesL C1
8. urgenL rlghL hemlcolecLomy
C. SLenL lnserLlon Lo relleve Lhe obsLrucLlon and preparaLlon for surgery
u. ParLmann's procedure
102. A healLhy 70-year-old male ls broughL Lo Lhe Lrauma unlL afLer belng lnvolved ln a moLor vehlcle accldenL as a
seaL belL-wearlng drlver. 1he colllslon on ln an lnLerclLy hlghway. 1here are no dlrecL ln[urles. Cn examlnaLlon, 8
ls 130/80, hearL raLe ls 110 beaLs per mlnuLe, and Lhere ls a seaL belL slgn across Lhe abdomen. lAS1
demonsLraLes moderaLe amounL of fluld ln Lhe pelvls. 1he paLlenL ls Laken Lo a C1 scan LhaL ldenLlfles moderaLe
amounL of fluld ln Lhe pelvls buL Lhe abdomlnal organs appear normal. WhaL ls Lhe nexL sLep ln Lhls paLlenL's managemenL?

A. LxploraLory laparoLomy
8. 8epeaL C1 ln 2 hours
C. nC, lv flulds and anLlbloLlcs and admlsslon Lo lnLenslve care unlL
u. 8epeaL lAS1 ln 6 hours

103. A 102-year-old male ls broughL Lo Lhe L8 because of mulLlple vomlLlng and
abdomlnal dlsLenLlons. asL medlcal hlsLory ls poslLlve for hyperLenslon, benlgn
prosLaLe hyperLrophy, lschemlc and valvular hearL dlsease, Alzhelmer and arklnson dlsease. Cn examlnaLlon, Lhe
abdomen ls very dlsLended, wlLh suprapublc fullness and Lenderness. SLool sLones are found on dlglLal recLal
examlnaLlon. Cn abdomlnal x-ray, Lhe colon ls full of sLool and alr wlLhouL small bowel dllaLaLlon.
Whlch ls Lhe nexL sLep ln Lhls paLlenL's managemenL?

A. Abdomlnal C1 scan
8. Colonoscopy
C. urlnary bladder caLheLerlzaLlon and manual fecal dlslmpacLlon
u. ParLmann's procedure

104. A 37-year-old female physlclan LhaL ls usually healLhy ls admlLLed Lo Lhe L8 due
Lo progresslvely abdomlnal dlsLenLlon and consLlpaLlon ln Lhe lasL Lwo monLhs. ln Lhe
lasL week her sympLoms worsened and her lasL bowel movemenL was 10 days ago.
She complalns of severe nausea wlLh no abdomlnal paln or vomlLlng. Cn
examlnaLlon, Lhe abdomen ls very dlsLended, Lympanlc, wlLh no hernlas or scars. Cn
laboraLory, hemoglobln - 10.2, W8C - 11,000, and chemlsLery ls normal oLher Lhan
hyponaLremla of 132. Cn abdomlnal x-ray Lhe rlghL and Lransverse colon are much
dllaLed wlLh no small bowel dlsLenLlon. Whlch ls Lhe nexL sLep ln Lhls paLlenL's managemenL?

A. Colonoscopy afLer fasL bowel preparaLlon
8. Abdomlno-pelvls C1 wlLh lv and C conLrasL
C. CasLrographln enema
u. LxploraLory laparoLomy

103. Whlch of Lhe followlng facLors has Lhe sLrongesL affecL on Lhe prognosls of breasL cancer paLlenL?

A. 1he slze of Lhe Lumor
8. 1he Lumor's hlsLologlc Lype
C. 1he number of lnvolved lymph nodes
u. 1he presence of hormonal recepLors ln Lhe prlmary Lumor

106. A healLhy 33 year old male ls complalnlng of consLlpaLlon and recLal bleedlng. Pe ls referred Lo
colonoscopy LhaL ldenLlfles a recLal ulceraLed mass 4 cm from Lhe anal verge. 8lopsy demonsLraLes
adenocarclnoma. WhaL ls Lhe nexL sLep ln Lhls paLlnL's managemenL/LreaLmenL?

A. Low anLerlor resecLlon
8. Abdomlnoperlnal resecLlon
C. 8efer Lhe paLlenL Lo C1 and 1rus as soon as poslble
u. 8efer Lhe paLlenL Lo an oncologlsL for radlaLlon and chemoLherapy






107. WhaL ls Lhe mosL common eLlology for small bowel obsLrucLlon ln adulLs?

A. lncarceraLed lngulnal hernla
8. lncarceraLed femoral hernla
C. posL operaLlve adheslons
u. chron's dlsease


108. All of Lhe followlng are compensaLlon mechanlsms ln hypovolemlc shock excepL?

A. lncreased perlpheral sysLemlc reslsLance secondary Lo lncreased caLhecholamlns levels
8. lncreased levels of 2,3 uC
C. a rlghL shlfL of Lhe hemoglobln dlssoclaLlon curve secondary Lo acldosls
u. decreased cardlac conLracLlllLy


109. WhaL ls correcL regardlng deep lnfecLlon evolvlng a replaced knee or hlp?

A. lL always develops on Lhe flrsL few weeks followlng surgery and ls usually LreaLed wlLh anLlbloLlcs for 10 days
8. lL can develop moLhs*( !"#$ %&'( ) and even years followlng Lhe [olnL replacemenL surgery and surglcal LreaLmenL and lv
anLlbloLlcs for 6 weeks are lndlcaLed
C. lL ls a rare compllcaLlon (less Lhan 0.01) because smooLh meLals are lnvolved wlLh surface LhaL repels lnfecLlons
u. because of lLs severlLy Lhere ls an lndlcaLlon for lnlLlaLlon of broad specLrum anLlbloLlcs on Lhe mosL remoLe cllnlcal susplclon,
even before any LesL performed

110. WhaL ls Lhe maln ob[ecLlve ln hlp or knee [olnL replacemenL?

A. avold deLerloraLlon of physlologlcal load on Lhe [olnLs above and below Lhe replaced [olnL
8. enable aLhleLes, especlally professlonal, Lo achleve load and sLress LhaL Lhe naLlve [olnL ls lncapable of
performlng
C. avold lnLra-[olnL fracLure ln paLlenL LhaL are prove for lL (dlabeLlcs, recurrenL falls, demenLla)
u. decrease paln and lmprove Lhe quallLy of llfe of paLlenLs












<E9><9?<><)
61. A 32 year old man ls ln a hlgh speed moLorcycle colllslon and presenL wlLh an obvlous pelvlc fracLure. Cn examlnaLlon, he
has a scroLal hemaLoma and blood aL hls ureLhral meaLus.
Whlch of Lhe followlng ls Lhe mosL approprlaLe nexL sLep ln hls managemenL?

A. lacemenL of a loley caLheLer
8. CysLoscopy
C. C1 of Lhe pelvls
u. 8eLrograde ureLhrogram
L. nephrosLomy Lube placemenL

62. A 32 year old woman sees her physlclan wlLh complalns of faLlgue headache, flank paln, hemaLurla, and abdomlnal paln.
She undergoes a sesLamlbl scan LhaL demonsLraLes perslsLenL upLake ln Lhe rlghL superlor paraLhyrold gland aL 2 hours.
Whlch of Lhe followlng laboraLory values ls mosL suggesLlve of her dlagnosls?

A. Serum acld phosphaLase above 120 lu/L
8. Serum alkallne phosphaLase above 120 lu/L
C. Serum calclum above 11 mg/dl
u. urlnary calclum below 100 mg/day
L. araLhyrold hormone levels below 3 pmol/l

63. A paLlenL wlLh sponLanlous eye openlng,who ls conlused and locallzes paln has a Clasgow Coma Score (CCS) of:

A. 9
8. 11
C. 13
u. 13

64. Whlch of Lhe followlng Lumor markers ls Lhe besL Lo monlLor recurrence of colon cancer?

A. feLoproLeln
8. Carclnoembryonlc anLlgen
C. Cancer anLlgen 13-3
u. 3-hydroxylndoleaceLlc acld


63. PyperacuLe re[ecLlon ls caused by:

A. erformed anLlbodles
8. 8-cell-generaLed AnLldonor anLlbodles
C. 1-cell-medlaLed allore[ecLlon
u. nonlmmune mechanlsm


66. 1he LreaLmenL of cholce for a 1.8 cm ln dlameLer,n0,M0 lnvaslve breasL cancer ls:

A. LumpecLomy alone
8. LumpecLomy,senLlnel node blopsy,and radlaLlon
C. MasLecLomy wlLh senLlnel node blopsy and radlaLon
u. MasLecLomy wlLh axlllary node dlssecLlon and radlaLlon

67. Whlch of Lhe followlng lncrease Lhe rlsk of breasL cancer:

A. MulLlple gesLaLlons
8. LaLe menarche
C. LaLe menopause
u. rolonged and mulLlple eplsodes of lacLaLlon
68. 1he mosL approprlaLe LreaLmenL wlLh uClS lnvolvlng 2 quadranLs ls:

A. CbservaLlon
8. LumpecLomy
C. LumpecLomy wlLh radlaLlon
u. MasLecLomy

69. Whlch of Lhe followlng ls a Lrue surglcal emergency ln a newborn:

A. 1eLralogy of lalloL
8. 1runcus arLerlosus
C. 1oLal anommaly pulmonary venouse connecLlon
u. CoarcLalon of Lhe aorLa

70. Whlch of Lhe followlng ls Lhe besL predlcLor of a slngnlflcanLly lncreased operaLlve rlsk for coronary arLery bypass surgery:

A. LlecLrocardlography (LCC)
8. 1he degree of proxlmal arLerlal sLenosls
C. 1he venLrlcular L[ecLlon lracLlon
u. A hlsLory of mulLlple myocardlal lnfarcLs

71. Lhe mosL effecLlve LreaLmenL of achalasla ls:

A. AnLlspasmodlc medlcaLlon
8. ullaLsLlon of Lhe lower esophageal sphlncLer
C. LsophagomyoLomy
u. 8esecLlon of Lhe cardloesophageal [uncLlon

72. uleulafoyw's leslon mosL commonly resulLs ln:

A. rogresslon Lo gasLrlc cancer
8. CasLroparesls
C. CasLrln ouLleL obsLrucLlon
u. upper gasLrolnLesLlnal bleed


73. 1he lnlLlal dlagnosLlc examlnaLlon ln a 30-year-old paLlenL who ls febrlle and Lender ln Lhe lefL lower quadrenL of Lhe
abdomen should be:

A. llexlble slgmoldoscopy
8. WaLer soluble conLrasL enema
C. ulLrasound
u. CompuLed Lomography scan


74. Whlch of Lhe followlng ls Lhe mosL llkely Lo harbor a colorecLal cancer:

A. PamaromaLous polyp
8. 1ubular adenomaLous polyp
C. 1ubuluvlllous adenomaLous polyp
u. vlllouse adenomaLous polyp

73. 1he mosL common slLe of volvulus ls:

A. Cecum
8. roxlmal [e[unum
C. Slgmold colon
u. SLomach
76. Whlch of Lhe followlng ls Lhe mosL commonly confused wlLh appendlclLls ln chlldren:

A. Meckel's dlverLlcullLls
8. MesenLrlc adenlLls
C. elvec lnflammaLory dlsease
u. AcuLe gasLroenLerlLls


77. An 80 year old man ls admlLLed Lo Lhe hosplLal complalnlng of nausea, abdomlnal paln, dlsLenslon and dlarrhea. A cauLlously
performed Lransanal conLrasL sLudy reveals an apple core conflguraLlon ln Lhe recLoslgmold area. Whlch of Lhe followlng ls Lhe
mosL approprlaLe nexL sLep of Lhe managemenL?

A. Colonoscoplc decompresslon and recLal Lube placemenL
8. Sallne enemas and dlglLal dlslmpacLlon of fecal maLLer from Lhe recLum
C. Colon resecLlon and proxlmal colosLomy
u. Cral admlnlsLraLlon of meLronldazole and checklng a ClosLrldlum dlfflclle LlLer
L. LvaluaLlon of an elecLrocardlogram and obLalnlng an anglogram evaluaLe for colonlc mesenLerlc lschemla.

78. 1he mosL common benlng leslon ln Lhe llver ls:

A. Slmple (congenlLal) hepaLlc cysL
8. PamarLoma
C. PepaLlc adenoma
u. local nodular hyperplasla

79. ApproxlmaLely 2 weeks afLer vlral resplraLory lllness, an 18 monLh old chlld complalns of abdomlnal paln passes some
bloody mucus perrecLum. A long, Lhln mass ls palpable ln Lhe rlghL upper quadranL of Lhe abdomen. lnLussuscepLlons ls
suspecLed. CorrecLsLaLemenLs concernlng lnLussuscepLlon ln lnfanLs lnclude whlch of Lhe followlng?

A. 8ecurrence raLes followlng LreaLmenL are hlgh
8. lL ls frequenLly preceded by a gasLrolnLesLlnal vlral lllness.
C. A 1 Lo 2 week perlod of parenLeral allmenLaLlon should precede surglcal reducLlon when surgery ls requlred
u. PydrosLaLlc reducLlon wlLhouL surgery rarely provldes successful LreaLmenL
L. 1he mosL common Lype occurs aL Lhe [uncLlon of Lhe descendlng and Lhe slgmold colon.

80. 1he mosL common cause of acuLe cholecyslLlLs ls:

A. CycLlc ducL obsLucLlon
8. Lscherlchla.coll lnfecLlon
C. MulLlple gallsLones
u. Salmonella lnfecLlon


81. 1he ldeal Llme Lo glve lmmunlzaLlons Lo paLlenLs undergolng elevLlve splenecLomy ls:

A. A leasL 2 monLhes before surgery
8. AL leasL 2 weeks before surgery
C. ln Lhe holdlng area [usL prlor Lo surgery
u. Cn Lhe day of dlscharge from Lhe hosplLal afLer splenecLomy


82. Splgellan hernlas occur:

A. Cn Lhe laLeral border of Lhe recLus abdomlnls
8. ln Lhe llnea alba
C. ln Lhe medlal wall of Lhe lngulnal canal
u. ln Lhe femoral Lrlangle

83. A newborn lnfanL ls born from a moLher wlLh polyhydramnlon presenLs wlLh excesslve sallvaLlon along wlLh coughlng and
choklng wlLh Lhe flrsL oral Leedlng.An x-ray of Lhe abdomen shows gas ln sLomach and a nasogasLrlc Lube colled ln Lhe
esophagus.Whlch of Lhe followlng ls Lhe mosL llkely dlagnosls?

A. Lsophageal aLresla
8. 1racheoesophageal flsLula
C. Lsophageal aLresla and Lracheoesophageal flsLula
u. Cmphalocele
L. LasLroshclsls


84. Whlch of Lhe followlng ls Lhe mosL senslLlve LesL for a pheochromocyLoma?

A.24 h urlne vanlllymandellc acld
8.24 h urlne meLanephrlne
C.24 h urlne eplnephrlne
u.24 h urlne noreplnephrlne


83. A double bubble on an alr conLrasL upper gasLrolnLesLlnal serles ln an lnfanL ls characLerlsLlc of?

A. uuodenal aLresla
8. !e[unal aLresla
C. Meconlum lleus
u. ylorlc sLenosls

86. AfLer belng ln[ured by a bull on hls moLher's farm, a young man ls placed ln a casL for a supracondylar fracLure of hls
humerus. Pe beglns Lo experlence lnLense paln and weakness ln Lhe lpsllaLeral hand. ComparLmenL pressures are measured and
are markedly elevaLed.
Whlch of Lhe followlng sLaLemenLs regardlng comparLmenL syndromes followlng orLhopedlc ln[urles ls Lrue?

A. 1he flrsL slgn ls usually loss of pulse ln Lhe exLremlLy
8. asslve flexlon of Lhe exLremlLy proxlmal Lo Lhe lnvolved comparLmenL wlll aggravaLe Lhe paln.
C. Surglcal decompresslon ls necessary only as a lasL resorL.
u. 1hese syndromes are mosL commonly assoclaLed wlLh supracondylar fracLures of Lhe humerus and Llblal shafL
L. 1he syndrome ls ofLen palnless.


87. ApproprlaLe LreaLmenL for a slngle eplsode of mlcroscoplc hemaLurla ls:

A. 8eassurance and serlal urlnalysls Lo conflrm resoluLlon
8. urlne culLure and lnLravenous pyelogram alone
C. CysLoscopy alone
u. lmaglng of upper LracL and cysLoscopy <=rlghL


88. 1ransurenLhral resecLlon syndrome afLer endoscoplc resecLlon of Lhe prosLaL occurs because of:

A. Alr embollsm durlng Lhe procedure
8. 8lood loss from posLoperaLlve lrrlgaLlon
C. AbsorpLlon of lrrlganL
u. 8elaxaLlon of Lhe ureLhral sphlncLer from splnal anesLhesla


90. ulvu characLerlze by:

8. uecreased flbrlnogene.
u. uecreased flbrln spllL producL
91. A 63 yo woman has a llfe-LhreaLenlng pulmonary embolus 3 days followlng removal of a uLerlne mallgnancy.she ls
lmmedlaLely heparlnlzed and malnLalned ln good LherapeuLlc range for Lhe nexL 3 days, Lhen passes blood from her vaglna and
develops Lachycardla, hypoLenslon, ollgurla.lollowlng resuslLaLlon, abdomlnal C1 reveals a ma[or reLroperlLoneal hemaLoma,
whlch of Lhe followlng ls Lhe besL nexL sLep ln ManagemenL?

A. lmmedlaLely reverse heparln by calculaLed dose of proLamlne and place a vena cava fllLer (eg. A Creenfleld fllLer)
8. 8everse heparlng wlLh proLamln, explore and evacuaLe Lhe hemaLoma and llgaLe Lhe vena cava below Lhe renal velns
C. SwlLch Lo low-dose heparln
u. SLop heparln and observe closely
L. SLop heparln, glve lresh-lrozen plasma (ll) and begln Warfarln Lherapy


92. A 42 year-old man susLalns a gunshoL wound Lo Lhe abdomen and ls ln shock. MulLlple unlLs of packed red blood cells
(88C) are Lransfused ln an efforL Lo resusclLaLe hlm.Pe complalns of numbness around hls mouLh and dlsplays carpopedal
spasm and poslLlve ChvosLek slgn. An LCC demonsLraLe a prolonged C1 lnLerval,
Whlch of Lhe followlng ls Lhe mosL approprlaLe LreaLmenL?

A. lnLravenous blcarbonaLe
8. lnLravenous poLasslum
C. lnLravenous calclum
u. lnLravenous dlgoxln
L. lnLravenous paraLhyrold hormone

93. A 39 years old woman undergoes an exploraLory laparoLomy for perlLonlLls and ls found Lo have perforaLed dlverLlcullLls.
She undergoes a slgmold resecLlon whlLh an end colosLomy.she ls admlnlsLraLed a Lhlrd generaLlon cephalosporln wlLhln 1 hour
prlor Lo Lhe lnclslon and Lhe anLlbloLlc ls conLlnued posLoperaLlvly. Cne week laLer she develops an lnLra abdomlnal abscess
whlch ls percuLaneusly dralned.bacLerold fragllls ls lsolaLed from Lhe culLure.
Whlch of Lhe followlng sLaLemenLs regardlng her perloperaLlve anLlbloLlc reglmen mosL accuraLe?

A. 1he perloperaLlve dose of anLlbloLlcs should have been glven closer Lo Lhe Llme of lnclslon
8. 1he paLlenL should have resleved several doses of anLlbloLlcs prlor Lo laparoLomy
C. 1he paLlenL should have recelved 1 generaLlon cephalosporln
u. 1he paLlenL dld noL have adequaLe gram negaLlve coverage
L. 1he paLlenL dld noL have adequaLe anaeroblc coverage

94. 1he sLandard surglcal LreaLmenL of gasLrolnLesLlnal sLromal Lumor (ClS1) of Lhe sLomach ls:

A. Lndoscoplc ablaLlon
8. Wedge resecLlon wlLh clear marglns
C. SubLoLal gasLrecLomy
u. 1oLal gasLrecLomy

93. A 32 years old medlcal sLudenL noLes an asympLomaLlc mass ln hls LesLlcle on examlnaLlon Lhe mass cannoL be
LranslllumlnaLed. 1he urolog says lL ls a semlnoma.semlnoma ls accuraLely descrlbed by whlch of Lhe followlng sLaLemenLs?

A. lL ls Lhe mosL common Lype of LesLlcular cancer
8. MeLasLasls Lo Lhe llver and bone are frequenLly found
C. lL does noL respond Lo radlaLlon
u. 1he 3- year survlval raLe approaches Lo 30
L. Common presenLaLlon ls LhaL of palnful lump LhaL LranslllumlnaLes

96. WhaL percenLage of breasL cancers are caused by muLaLlon ln Lhe 88CA gene?

A.<3
8.3-10
C.13-20
u.23-30

97. 1he mosL approprlaLe LreaLmenL of a woman wlLh lobular carclnoma ln slLu (LClS) lnvolvlng one quadrenL ls:

A. CbservaLlon
8. LumpecLomy
C. LumpecLomy wlLh radlaLlon
u. MasLecLomy

98. Whlch ls of Lhe followlng ls a cause of cardlogenlc shock ln a Lrauma paLlenL?

A. hemoLhorax
8. peneLraLlng ln[ury Lo Lhe aorLa
C. alr embollsm
u. laLrogenlc lncreased afLerlaod due Lo pressures


99. A 24 year-old man ls broughL lnLo Lhe L8 afLer a fall from a ladder Pls breaLhlng ls labored, and be ls cyanoLlc. no breaLh
sounds can be heard,even ln Lhe rlghL lung fleld whlch ls resonanL Lo percusslon.
1he flrsL sLep ln Lhe ManagemenL should be:

A. CrlcoLhyroldoLomy
8. CbLalnlng a sLaL chesL x-ray
C. asslng an oral endoLracheal Lube
u. 1ube LhoracosLomy.


100. A 19 years old man ls admlLed Lo Lhe emergancy deparLmenL wlLh a sLab wound [usL below Lhe rlghL lngulnal llgamenL.
1here ls a profuse bleedlng from Lhe wound and he ls ln shock.
1he flrsL sLep ln local wound conLrol should be Lo?

A. Apply comprreslon of Lhe bleedlng vessel whlLh a gloved flnger
8. lace a LornlquleL on Lhe rlghL LlghL above Lhe wound
C. use clamps and llgaLurs Lo conLrol Lhe bleedlng
u. Wrap Lhe wound and upper LlghLh ln a bulky presure dresslng


101.A 72 year-old man undergoes an aorLoblfemoral grafL for sympLomaLlc aorLolllac occluslve dlsease.Lhe lnferlor mesenLerlc
arLery (lMA) ls llgaLed aL lLs aorLlc aLLachmenL.24 hours afLar surgery Lhe paLlenL has abdomlnal dlsLenLlon,fever,and bloody
dlarrhea.Whlch of Lhe followlng ls Lhe mosL approprlaLe dlagnosLlc sLudy for Lhls paLlenL?

A. AorLogram
8. MagneLlc resonance lmaglng (M8l)
C. CompuLer Lomographlc (C1) scan
u. Slgmoldoscopy
L. 8arlum enema


102. A 39 year-old women presenLs wlLh rlghL lower puadranL paln,nausea,and vomlLlng,she undergoes an uncompllcaLed
laparoscoplc appendecLomy.osLoperaLlvely Lhe paLhology reveals a 2.3-cm muclnous adenocarclnoma wlLh lymphaLlc
lnvaslon. SLaglng workup, lncludlng colonoscopy,chesL x-ray. And compuLed Lomography (C1) scan of Lhe abdomen and pelvls,ls
negaLlve.
Whlch of Lhe followlng ls Lhe besL nexL sLep ln her managemenL?

A. no furLher lnLervenLlon aL Lhls Llme,follow-up every 6 monLhs for 2 years
8. ChemoLherapy
C. neoad[uvanL chemoLherapy followed by rlghL hemlcolecLomy
u. lleocececLomy
L. 8lghL hemlcolecLomy

103. A39 year-old prevlously healLhy male ls hosplLallzed for 2 weeks wlLh eplgasLrlc paln radlaLlng Lo hls back,nausea,and
vomlLlng.lnlLlal laboraLory values revealed an elevaLed amylase level conslsLenL wlLh acuLe pancreaLlLls.llve weeks followlng
dlscharge,he complalns of early saLleLy,eplgasLrlc paln,and fevers,Cn presenLaLlon,hls LemperaLure ls 38.9 c and hls hearL raLe ls
120 beaLs per mlnuLe,hls whlLe blood cell (W8C) counL ls 24.000/mm and hls amylase level ls normal.Pe undergoes a C1 scan
demonsLraLlng a 6-cm by 6-cm rlm-enhanclng fluld collecLlon ln Lhe body of Lhe pancreas.
Whlch of Lhe followlng would be Lhe mosL deflnlLlve managemenL of Lhe fluld collecLlon?

A. AnLlbloLlc Lherapy alone
8. C1-gulded asplraLlon wlLh repeaL lmaglng ln 2 Lo 3 days
C. AnLlbloLlcs and C1-gulded asplraLlon wlLh repeaL ln 2 Lo 3 days
u. AnLlbloLlcs and percuLaneous caLheLer dralnage
L. Surglcal lnLernal dralnage of Lhe fluld collecLlon wlLh a cysL-gasLrosLomy or

104. A 70 year-old woman has nausea,vomlLlng,abdomlnal dlsLenLlon,and eplsodlc crampy mldabdomlnal paln.She has no
hlsLory of prevlous surgery buL has a long hlsLory of cholellLhlasls for whlch she has refused surgery.Per abdomlnal radlograph
reveals a spherlcal denslLy ln Lhe rlghL lower quadranL.
Whlch of Lhe followlng ls Lhe deflnlLlne LreaLmenL for Lhls paLlenL's bowel obsLrucLlon?

A. lleocolecLomy
8. CholecysLecLomy
C. lleoLomy and exLracLlon
u. nasogasLrlc (nC) Lube decompresslon
L. lnLravenous anLlbloLlcs

103. A 47 year-old asympLomaLlc woman ls lncldenLally found Lo have a 3-mm polyp and no sLones ln her gallbladder on
ulLrasound examlnaLlon. Whlch of Lhe followlng ls Lhe besL managemenL opLlon?

A. AsplraLlon of Lhe gallbladder wlLh cyLologlc examlnaLlon of Lhe blle
8. CbservaLlon wlLh repeaL ulLrasound examlnaLlons Lo evaluaLe for lncrease ln polyp slze
C. Laparoscoplc cholecysLecLomy
u. Cpen cholecysLecLomy wlLh frozen secLlon
L. Ln bloc resecLlon of Lhe gallbladder,wedge resecLlon of Lhe llver,and porLal lymphadenecLomy

106. A 39 year-old lemale wlLh no slgnlflcanL medlcal hlsLory and whose only medlcaLlon ls oral conLracepLlve pllls (CC),
presenLs Lo Lhe emergency room wlLh rlghL upper quadranL (8uC) paln. C1 demonsLraLes a 6-cm hepaLlc adenoma ln Lhe rlghL
lobe of Lhe llver. Whlch of Lhe followlng ls a deflnlLlve LreaLmenL of Lhls leslon?

A. CessaLlon of oral conLracepLlve and a serlal of C1 scans
8. lnLra-arLerlal embollzaLlon of Lhe hepaLlc adenoma
C. LmbollzaLlon of Lhe rlghL porLal veln
u. 8esecLlon of hepaLlc adenoma
L. SysLemlc chemoLherapy

107.A 40 year-old woman noLlces a skln rash around her areola.1here ls an eroslve area abouL Lhe nlpple.1here ls
Lenderness,lLchlng,and lnLermlLLenL bleedlng. Whlch of Lhe followlng sLaLemenL ls Lrue regardlng Lhls enLlLy?

A. lL usually precedes developmenL of ageL dlsease of bone
8. lL presenLs wlLh nlpple-areolar eczemaLous changes
C. lL does noL lnvolve axlllary lymph nodes because lL ls a manlfesLaLlon of lnLraducLal carclnoma only
u. lL accounLs for 10 Lo 13 of all newly dlagnosed breasL cancers
L. lL ls adequaLely LreaLed wlLh wlde exclslon when lL presenLs as a mass






108. A 61 year-old woman wlLh hlsLory of unsLable anglna complalns of hemaLemesls afLer reLenlng and vomlLlng followlng a
nlghL of blnge drlnklng.Lndoscopy reveals a longlLudlnal mucosal Lear aL Lhe gasLroescophageal [ancLlon,whlch ls noL acLlvely
bleedlng whlch of Lhe followlng ls Lhe nexL recommended sLep ln Lhe managemenL of Lhls paLlenL ?

A. Anglography wlLh embollzaLlon
8. 8aloon Lamponede
C. LxpbraLory laparoLomy gasLroesoLomy and oversewlng Lhe Lear
u. SysLemlc vasopressln lnfuslon
L. LxpecLanL managemenL

109. A 33 year-old man presenL wlLh fever and paln ln Lhe perlneal reglon upon farLher quesLlonlng he also complalns of
fregvence, urgency,dysurla,and a decreased urlnary sLream.on physlcal exam hls abdomlnal ls sofL, non-dlsLended and non-
Lender, dlglLal recLal exam. uemonsLraLes exqulslLe Lenderness on Lhe anLerlor aspecL. LaporaLory. exam reveals leukocyLosls
and flndlng on urlnary conslsLenL wlLh a bacLerlal lnfecLlon whlch of Lhe followlng ls Lhe mosL llkely dlagnosls?

A. u1l
8. 8P (benlgn prosLaLlc hyperglasls)
C. rosLaLlLls
u. ylonephrlLls
L. erl-anal abscess


110. 33 year old man complalns of chronlc lnLermlLLenL eplgasLrlc paln. A gasLroscopy demonsLraLes a 2 cm prepylorlc ulcer.
8lopsy of Lhe ulcer ylelds no mallgnanL Llssue. AfLer a 6 weeks Lrall of medlcal Lherapy, Lhe ulcer ls unchanged. Whlch of Lhe
followlng ls Lhe besL nexL sLep ln hls managemenL?

A. 8epeaL Lrall of medlcal Lherapy
8. Local exclslon of Lhe ulcer
C. Plghly selecLlve vagoLomy
u. arLlal gasLrecLomy wlLh vagoLomy and 8lllroLh l reconsLrucLlon
L. vagoLomy and pyloroplasLy












<>9<@9?<><)
11) flve days afLer an unevenLful cholecysLecLomy,an asympLomaLlc mlddle aged woman ls found Lo have a
serum level of 123 mLq/L. whlch of Lhe followlng ls Lhe mosL approprlaLe managemenL sLraLegy for Lhls paLlenL?

a.AdmlnlsLraLlon of hyperLonlc sallne soluLlon
b.8esLrlcLlon of free waLer
c.lasma ulLrafllLraLlon
d.Pemodlalysls
e.Aggresslve dluresls wlLh furosemlde


12) paLlenL wlLh a nonobsLrucLlng carclnoma of Lhe slgmold colon ls belng prepared for eecLlve resecLlon .
Whlch of Lhe followlng reduces Lhe rlsk of posLoperaLlve lnfecLlous compllcaLlons?

a.A slngle preoperaLlve parenLeral dose of anLlbloLlc effecLlv e agalnsL aerobes and anaerobes
b.Avoldance of oral anLlbloLlcs Lo prevenL emergence of ClosLrldlum duffuclle
c.osLoperaLlve admlnlsLraLlon for 48 h of parenLeral anLlbloLlcs effecLlve agalnsL aerobes and anaerobes
d.osLoperaLlve admlnlsLralon of parenLeral anLlbloLlcs effecLlve agalnsL aerobes and anaerobes unLll Lhe paLlenL's lnLravenous
llnes and all oLher dralns are removed
e.8edoslng of anLlbloLlcs ln Lhe operaLlng room lf Lhe case lasLs for more Lhan 2 h


13) 68 year old man ls admlLLed Lo Lhe coronary care unlL wlLh an acuLe myocardlal lnfracLlon.Pls
posLlnfracLlon course ls marked by congesLlve hearL fallure and lnLermlLLenL hypoLenLlon .Cn Lhe fourLh day ln hosplLal,he
develops severe mldabdomlnal paln.Cn physlcal examlnaLlon,blood pressure ls 90/60 mm Pg and pulse ls 110 beaLs per mlnuLe
and regular,Lhe abdomen ls sofL wlLh mlld generallzed Lenderness and dlsLenLlon.8owel sounds are hypoacLlve:sLool PemaLesL
ls poslLlve.
Whlch of Lhe followlng ls Lhe mosL approprlaLe nexL sLep ln Lhls paLlenL's managemenL?

a.8arlum enema
b.upper gasLrolnLesLlnal serles
c.Anglography
d.ulLrasonography
e.lmmedlaLe celloLomy


14)A 63 year old manundergoes a low anLerlor resecLlon for recLal cancer. Cn Lhe flfLh day ln hosplLal,hls
physlcal examlnaLlon shows a LemperaLure of 39 C(102 l),blood pressure of 130/90 mm Pg,pulse of 110
beaLs per mlnuLe and regular,and resplraLory raLe of 28 breaLhs per mlnuLe.AcompuLed Lomografhy (C1) scan
of Lhe abdomen reveals and abscess ln Lhe pelvls.
Whlch of Lhe followlng mosL accuraLely descrlbes hls presenL condlLlon?

a.SSl-surglcal slLe lnfecLlon
b.Sepsls
c.Svere sepsls
d.SpLlc shock
e.Svere sepLlc shock

13)A clrroLlc paLlenL wlLh abnormal coagulaLlon sLudles due Lo hepaLlc synLheLlc dysfuncLlon requlres an urgenL
cholecysLecLomy. A Lransfuslon of ll ls planned Lo mlnlmlze Lhe rlsk of bleedlng due Lo surgery.
WhaL ls Lhe opLlmal Llmlng of Lhe Lransfuslon?

a)1he day before surgery
b)1he nlghL before surgery
c)Cn call Lo surgery
d)lnLraoperaLlvely
e)ln Lhe recovery room
16)A 42 year old man susLalns a gunshoL wound Lo Lhe abdomen and ls ln schok.MulLlple unlLs of packed red blood cells are
Lransfused ln an efforL Lo resusclLaLe hlm.Pe complalns of numbness around hls mouLh and
dlsplays carpopedal spasm and a poslLlve ChvosLek slgn.An elecLrocardlogram demonsLraLes a prolonged C1 lnLerval.
Whlch of Lhe followlng ls Lhe mosL approprlaLe LreaLmenL?

a)lnLravenous blcarbonaLe
b)lnLravenous poLasslum
c)lnLravenuos calclum
d)lnLravenous dlgoxln
e)lnLravenous paraLhyrold hormone


17)A Leenage boy falls from hls blcycle and ls run over by a Lruck.Cn arrlval ln Lhe emergency room(L8),he ls awake and alerL
and appears frlghLened buL ln no dlsLress. 1he chesL radlograph suggesLs an alr-fluld level ln Lhe lefL lower lung fleld and Lhe
nasogasLrlc Lube seems Lo coll upward lnLo Lhe nexL besL sLep ln hls managemenL?

a)lacemenL of a lefL chesL Lube
b)1horacoLomy
c)LaparoLomy
d)LsofagogasLroscopy
e)ulagnosLlc perlLoneal lavage


18)A 63 year old man who smokes clgareLLes and has chronlc obsLrucLlve pulmonary dlsease falls and
fracLures Lhe Lhlrd, fourLh, and flfLh rlbs ln Lhe lefL anLerolaLral chesL. ChesL x-ray ls oLherwlse normal.
Whlch of Lhe followlng would be Lhe mosL approprlaLe nexL sLep ln hls managemenL?

a)SLrapplng Lhe chesL wlLh adheslve Lape
b)Admlsslon Lo Lhe hosplLal and LreaLmenL wlLh oral analgesla
c)1ube LhoracosLomy
d)lacemenL of an epldural for paln managemenL
e)Surglcal flxaLlon of Lhe fracLured rlbs


19)A 36 year old man who was hlL by a car presenLs Lo Lhe L8 wlLh hypoLenslon.Cn examlnaLlon,he has Lenderness and brulslng
over hls lefL laLeral chesL below Lhe nlpple.An ulLrasound examlnaLlon ls performed and reveals free fluld ln Lhe abdomen.
WhaL ls Lhe mosL llkely organ Lo have been ln[ured ln Lhls paLlenL?

a)Llver
b)kldney
c)Spleen
d)lnLesLlne
e)ancreas


20) An 18 year old male was assaulLed and susLalned slgnlflcanL head and faclal Lrauma.
Whlch of Lhe followlng ls Lhe mosL common lnlLlal manlfesLaLlon of lncreased lnLracranlal pressure?

a)Change ln level of consclounsness
b)lpsllaLeral(slde of hemorrhage) puplllary dllaLlon
c)ConLralaLeral puplllary dllaLlon
d)Pemlparesls
e)PyperLenslon





31) whaL sLaLemenL ls regardlng Lhe LreaLmenL of pancreaLlc carclnoma?

a. ls more common ln Lhe body of Lhe gland
b. surgery ln well slecLed paLlenLs ls Lhe mosL effecLlve LreaLmenL.
c. ln case of palnless [aundlce Lhe carclnoma ls noL resecLeble.
d. lL can be resecLble only lf locallzed ln body or Lall.
e. ls assoclaLed wlLh dlabeLes lnslpldus.


32) 34 years old woman wlLh compllcaLed appendlcecLomy afLer acuLe appendlLls Lhe blopsy demonsLraLe a 1 cm carclnold
Lumor. 1he besL managemenL ln Lhls case?

a. hemycolecLomy only
b. hemycolecLomy wlLh chemloLherapy
c. chemloLherapy only
d. wlde resecLlon only
e. no furLher LreaLmenL


33) 88 years old wlLh Lermlnal renal fallure, coronary dlsease and braln meLasLasls complalns acuLe coleclsLlLls.
WhaL ls Lhe besL LreaLmenL of Lhe coleclsLlLls ln Lhls paLlenL?

a. Lube coleclsLosLomy
b. open coleclsLecLomy
c. laparoscoplc coleclsLecLomy
d. lnLravenous anLlbloLlcs and coleclsLecLomy
e. llLhoLrlpsy and long Lerm blle acld Lherapy.


34) whaL compllcaLlon ls assoclaLed wlLh pancreasecLomy?

a. dlabeLes melllLus
b. hypercalcemla
c. hyperphosphaLemla
d. consLlpaLlon
e. welghL galn


33) whaL sLaLemenL ls Lrue regardlng hepaLlc hemangloma?

a. ls Lhe mosL common benlgn Lumor ln llver
e. Lhe prlmary LreaLmenL ls surgery

36) ln 73 years old man wlLh asympLomaLlc caroLld bullL. whaL ls Lhe besL LesL for ls evaluaLlon?

a. Lranscranlal uoppler
b. eco uoppler
c. compuLerlzed Lomography anglography
d. arch aorLogram
e. magneLlc resonance anglography.

37) 64 years old man wlLh a sLory of a Lrlple bypass 2 years ago acLually LreaLed wlLh Lhlazlde dlureLlc and asplrln.
1he correcL sLaLemenL regardlng anLlplaLeleL Lherapy?

a. asplrln ls noL an effecLlve anLlplaLeleL Lherapy
b. anLlplaLeleL work mechanlsm ls by enhanclng prosLaglandln slnLesls
d. asplrln ls also used for venous Lhrombosls
e. anLlplaLeleL effecL ls permanenL and lasL for all plaLeleL llfe generally around 20-23 days
38) 36 years old man presenL ln L8 wlLh renal collc. 8x demonsLraLe 1.3 cm sLone ln upper urlnary Lrack.
WhaL ls besL LreaLmenL?

a. hydraLaLlon and analgeslc Lherapy only ls non effecLlve
b. serlal 8x are useful Lo follow Lhe sLone
c. lL ls assoclaLed wlLh mlcroemaLurla
d. afLer Lhe resoluLlon lL ls probable a recurrence of anoLher eplsode of kldney sLone.
e. lncreased level of 8un and creaLlnlne are expecLed.


39) 23 years old wlLh a palnful full penls erecLlon for several hours. Whlch of Lhe nexL sLaLemenLs are Lrue?

a. lL can be assoclaLed wlLh slckle dlsease.
e. lL can be LreaLed prlmarlly wlLh surglcal corposponglosal shunL


40) ln 63 years old man whaL ls Lhe besL LesL for dlfferenLlal dlagnosls beLween sepLlc arLhrlLls and gouL?

a.whlLe blood cell counL
e. evaluaLlon of synovlal fluld asplraLlon.


41.A 60 years old male was admlLLed for severe rlghL abdomlnal paln,body LemperaLure ls 37 c.ulLrasounography shows an
aconsLlc shadow ln Lhe common blle ducL.Lls condlLlon ls commonly assoclaLed wlLh:

a.LlevaLed con[ugaLed blllrubln
b.LlevaLed uncon[ucaLed blllrubln
c.decrease ln alkallne phosphaLase
d.very hlgh levels of SCC1 and SC1


42.when choledochollLhlasls ls suspecLed by abdomlnal ulLrasound Lhe nexL mosL approprlaLe LesL or procedure wlll be:

a.compuLed Lomography (C1)
b.blllary sclnLlgraphy
c.Lndoscoplc reLrograde pancreaLlcography(L8C)
d.Lmergency surgery


43.a 70 year old man had abdomlnal ulLrasound for Lhe follow up of an abdomlnal aorLlc aneurlsm .Lhe
presence of sLones ln Lhe gallbladder ls lndenLlfled.Lhe paLlenL suffers from some low back dlscomforL only, whlch ls LhoughL Lo
be aLLrlbuLed Lo Lhe aneurysm. Lhe approprlaLe nexL sLep ln managlng Lhe gallsLones ls:

a.observaLlon
b.laparoscoplc cholecysLecLomy
c.open cholecysLecLomy
d.ulLrasound of gallbladder


44.a 49 year old man was Lhe resLralned drlver ln a moLor vehlcle colllslon, he deceleraLed rapldly ln order Lo avold hlLLlng
anoLher car and swerved lnLo a dlLch. he complalns of chesL paln.
whlch of Lhe followlng flndlng on chesL x-8ay would be mosL susplclous for an aorLlc ln[ury?

a.mulLlple rlghL-slded rlb fracLures
b.a lefL pulmonary conLuslon
c.wldenlng of Lhe medlasLlnum greaLer Lhan 8 cm
d.pnemomedlasLlnum

43.1he opLlmal Llme Lo glve lmmunlzaLlon Lo paLlenLs undergolng elecLlve splenecLomy ls:

a.aL leasL 2 monLhs before surgery
b.aL leasL 2 weeks before surgery
c.ln Lhe holdlng area [usL prlor Lo surgery
d.on Lhe day of dlscharge from Lhe hosplLal afLer splenecLomy


46.Splgellan hernlas occur:

a.on Lhe laLeral border of Lhe recLus abdomlnls
b.ln Lhe llnes alba.
c.ln Lhe medlal wall of Lhe lngulnal canal
d.ln Lhe femoral Lrlangle
e.ln Lhe eplgasLrlum


47.a 16 year old glrl undergoes LoLal colecLomy for famlllal adenomaLous polyposls (lA).Lwo years laLer ,Lhere ls a 4 cm
asympLomaLlc abdomlnal wall mass ln Lhe lnclslon. Lhe approprlaLe managemenL ls:

a.Acourse of decarbazlne and doxorublcln
b.a course of vlncrlsLlne,acLlnomycln ,and cyclophosphamlde
c.8adlaLlon Lherapy Lo Lhe area.
d.wlde resecLlon of Lhe mass


48.sympLoms of reLroperlLoneal sarcoma are usually produced by:

a.bleedlng lnLo Lhe Lumor mass.
b.compresslon of ad[acenL Llssue
c.lnvaslon of reLroperlLoneal organs.
d.meLasLasls Lo reLroperLoneal organs
e.meLasLasls Lo reLroperlLoneal lymph nodes


49. 1welve hours afLer havlng undergone a subLoLal LhyroldecLomy ,a 30 year old woman develops aglLaLlon and dlfflculLy
breaLhlng.examlnaLlon reveals Lachycardla and anLerlor cervlcal swelllng. Lhe surglcal dresslng ls dry.
Lhe mosL approprlaLe LreaLmenL aL Lhls polnL would be lmmedlaLe:

a.lnserLlon of an oroLracheal Lube.
b.8e-openlng of Lhe cervlcal wound
c.deLermlnlng Lhe serum calclum concenLraLlon
d.admlnlsLraLlon of morphlne
e.chesL x-ray


30.1he LreaLmenL of cholce for a 1.8 cm ln dlameLer n0,M0 lnvaslve breasL cancer ln 30 years old women ls:

a.lumpecLomy alone.
b.lumpecLomy,senLlnel lymph node blopsy, and radlaLlon.
c.masLecLomy wlLh senLlnel lymph node blopsy and radlaLlon.
d.masLecLomy wlLh axlllary lymph node dlssecLlon and radlaLlon