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‫بسم هللا الرحمن الرحيم‬

:‫مالحظة‬
answer ‫ هناك مجوعة من األسئلة تبدو إجاباتها خاطئة وغير منطقية ولكن اإلجابة هيك موجودة في‬.1
.sheet
Rush ‫أما باقي األسئلة فهي من‬Pre-test surgery ‫ األسئلة التي بجانبها عالمة نجمة (*) مصدرها‬.2
.‫ومن اإلنترنت‬
*1. Which of the following is the mechanism of action of omeprazole?
A. Blockage of the breakdown of mucosa-damaging metabolites of nonsteroidal antiinflammatory drugs (NSAIDs)
B. Provision of a direct cytoprotective effect
C. Buffering of gastric acids
D. Inhibition of parietal cell hydrogen potassium ATPase (adenosine triphosphatase)
E. Inhibition of gastrin release and parietal cell acid production
*2. Which of the following is the most common serious complication of an end
colostomy?
A. Bleeding
B. Skin breakdown
C. Parastomal hernia
D. Colonic perforation during irrigation
E. Stomal prolapse
*3. A 45-year-old woman with history of heavy nonsteroidal anti-inflammatory drug
ingestion presents with acute abdominal pain. She undergoes exploratory
laparotomy 30 hours after onset of symptoms and is found to have a perforated
duodenal ulcer. Which of the following is the procedure of choice to treat her
perforation?
A. Simple closure with omental patch
B. Truncal vagotomy and pyloroplasty
C. Truncal vagotomy and antrectomy
D. Highly selective vagotomy with omental patch
4. Which of the following hernias follows the path of the spermatic cord within the
cremaster muscle?
A. Femoral
B. Direct inguinal
C. Indirect inguinal
D. Spigelian
E. Interparietal

Which of the following is the most appropriate next step? A.*5. Nasogastric (NG) tube decompression E. abdominal distention. Intravenous antibiotics *6. Resect the involved terminal ileum. Close the abdomen after culturing the exudate. and pain of the right lower quadrant. Ileotomy and extraction D. which also has an overlying fibrinopurulent exudate. Which of the following is the definitive treatment for this patient’s bowel obstruction? A. Perform an ileocolostomy to bypass the involved terminal ileum. She has no history of previous surgery but has a long history of cholelithiasis for which she has refused surgery. . the appendix and cecum are found to be normal. vomiting. Perform an ileocolic resection. A previously healthy 15-year-old boy is brought to the emergency room with complaints of about 12 hours of progressive anorexia. A 70-year-old woman has nausea. Cholecystectomy C. On physical examination. he is found to have a rectal temperature of 38. At operation through a McBurney-type incision. E. Ileocolectomy B. C. Perform a standard appendectomy.18°C (100. but the surgeon is impressed by the marked edema of the terminal ileum.72°F) and direct and rebound abdominal tenderness localizing to McBurney point as well as involuntary guarding in the right lower quadrant. Her abdominal radiograph reveals a spherical density in the right lower quadrant. nausea. B. D. and episodic crampy midabdominal pain.

Squamous cell carcinoma B. Basal cell carcinoma C. Which of the following is the most appropriate next diagnostic maneuver? A. CT scan of the abdomen D. Malignant melanoma D. Verrucous carcinoma . Keratoacanthoma E. Which of the following is the most common diagnosis for tumors involving the lips? A. Emergency celiotomy B. Upper GI series with small-bowel follow-through C. Sigmoidoscopy *8.*7. A 50-year-old man presents to the emergency room with a 6-hour history of excruciating abdominal pain and distention. Barium enema E. The abdominal film shown here is obtained.

Proton pump inhibitors C.0 to 1. Which test would confirm the cause of these findings? A. Submandibular salivary gland 12. Paco2 less than 32 mm Hg D.9. Temperature lower than 36° C B. Enteral diet D. when the nurse noted a change in urine color from yellow to dark brown. Sublingual salivary gland B. Haptoglobin C. Renal ultrasound B. a postoperative patient is noted to have bright red blood through the nasogastric tube. Mucoserous salivary gland D. Accessory salivary gland D. Submandibular salivary gland C. Serum creatine kinase D. Protenaceous salivary gland B. Urine electrolytes 14. Mucinous salivary gland 11. Twenty-four hours after admission to the surgical intensive care unit (ICU). Parotid gland is a A. Sublingual salivary gland B. Complete blood count E. All of the following have shown efficacy in preventing stress gastritis except: A. Serous salivary gland C. Parotid gland C. Antacids 13. Heart rate greater than 90 beats/min . The physiologic parameters used in the definition of SIRS include all of the following except: A. She also says that the patient’s output has decreased and his creatinine has risen from 1. Histamine-2 (H2) receptor antagonists E. Systolic blood pressure lower than 90 mm Hg E. Parotid gland 10. The operation was prolonged and required 10 L of fluid resuscitation.5. All of the patient was doing well postoperatively until 4 hours later. Warthin's tumor is commonly seen in A. A patient is brought to the surgical ICU after emergency exploratory laparotomy for fecal peritonitis. Sucralfate B. Sialolithiasis is common in A. Respiratory rate greater than 20 breaths/min C. Accessory salivary gland D.

000/μl are usually associated with a normal bleeding time and adequate surgical hemostasis. most ingested potassium is excreted in urine. 2000 to 2500 mL B. 250 mL/day for each degree of fever 18. Normal dietary intake of potassium is 50 to 100 mEq/day. B.000/μL exclude the possibility of a primary hemostatic disorder. Critical hyperkalemia (>6 mEq/L) is rarely encountered if renal function is normal. SIADH C. V. E. With regard to potassium. . 600 mL D. Average insensible loss. Average urine volume. 16. Therapeutic anticoagulation with warfarin (Coumadin) E. D. Hyperglycemia E. Which of the following conditions is associated with an isolated prothrombin time (PT) prolongation? A. Administration of sodium bicarbonate shifts potassium from the extracellular space (ECF) to the intracellular space (ICF). Which of the following clinical situations can be associated with hypovolemic hyponatremia? A. Average increase in insensible loss in a febrile patient. Therapeutic anticoagulation with heparin 17. Factor VIII deficiency (hemophilia A) C. 1000 mL C.000/μL. which of the following statements is not true? A. Average stool loss. More than 90% of the potassium in the body is located in the extracellular compartment. C.15. which of the following statements is true? A. von Willebrand disease B. and X and fibrinogen) D. CHF B. C. With regard to measurement of bleeding times. Daily water intake. Bleeding time is a predictor of surgical bleeding. Which of the following pairing statements regarding daily fluid balance is incorrect? A. Normal bleeding time excludes von Willebrand disease as a potential factor affecting surgical hemostasis. B. Platelet counts higher than 150. Cirrhosis D. Gastrointestinal losses 19. In patients with normal renal function. E. Common pathway factor deficiencies (factors II. Platelet counts higher than 50. Spontaneous bleeding may occur with platelet counts higher than 15. 800 to 1500 mL E. D.

A 33-year-old woman is scheduled for elective cholecystectomy. D. Perforated ulcer B. She has had similar episodes in the past that resolved after a few hours. B. . Heat E. Glycogen from muscle tissue B. Diverticulitis 25. CT scanning with contrast enhancement is required to confirm the diagnosis. Proceed with surgery if severe clinical symptoms are not present. No further radiologic work-up is required. which of the following statements is true? A. C. Perforation following bowel obstruction D. Proceed with surgery with the knowledge that minor perioperative complications could develop. Acute appendicitis C. A 35-year-old woman experiences an acute onset of epigastric and right upper quadrant pain several hours after a large dinner. Traction C. Preoperative evaluation shows the presence of mild to moderate hypothyroidism. Vitamin C E. Regarding patients with a rigid abdomen and free air on plain film. Vitamin A B. B. Vitamin D C. Vitamin K 22. This episode persists. Glucose to the liver for storage E. Inflammation 24. None of the above 21. Proceed with surgery while beginning treatment with levothyroxine. Proceed with surgery while beginning treatment with thionamides. 23. What is the most likely source of the abdominal pain? A. Glucagon mobilizes which of the following: A. E. Liver glycogen C. Insulin to improve cellular uptake of glucose D. Ischemia B. Which of the following is not a trigger of visceral pain? A. Postpone surgery until a euthyroid state is achieved. Which of the following vitamins is water-soluble? A.20. Cholecystitis E. Select the next most appropriate action: A. Vitamin E D. and she has fever and nonbilious vomiting. Distention D.

Not enough information given to calculate . Perforated ulcer B. hypotension are an early clinical development. Which of the following statements is true regarding compartment syndrome in an extremity? A. A 28-year-old woman is an unrestrained driver in a motor vehicle crash. 7 D. The left anterior compartment of the lower part of the leg has a pressure of 30 mm Hg. E. 8 E. 5 B. 5 hours postoperatively the left distal pulses diminish and he begins to experience pain with passive dorsiflexion and extension. Diagnostic peritoneal lavage (DPL) C. Narcotics are contraindicated in patients with an acute abdomen.C. He has fever and abdominal rigidity. B. What is this patient’s Glasgow Coma Scale (GCS) score? A. A 44-year-old man suffers a gunshot wound to his left thigh that results in an injury to the superficial femoral artery. E. C. The lateral compartment of the lower part of the leg is the most commonly affected. Fractures are the cause of approximately 30% of all compartment syndromes. 28. Computed tomographic (CT) scan of the abdomen and pelvis B. Exploratory laparotomy 29. Admission for observation and serial abdominal examinations D. Cholecystitis E. Bedside sonographic imaging is preferred over CT imaging to confirm the diagnosis of free air. What is the most likely source of the abdominal pain? A. A 65-year-old man with a history of chronic constipation has a 3-day history of abdominal distention without a bowel movement. Diverticulitis 27. Acute appendicitis C. Although the patient had equal pulses bilaterally and was neurologically intact. 6 C. She has stable vital signs and left upper quadrant tenderness without signs of peritonitis. D. Preoperative prophylactic steroids are indicated in patients with free air. D. Perforation following bowel obstruction D. The head and face of 45-year-old man were assaulted with fists and feet. Abdominal ultrasound E. The injury is repaired with a saphenous vein interposition graft within 4 hours of the injury. A four-compartment fasciotomy should be performed. A compartment pressure of 25 mm Hg negates a need for fasciotomy. eyes opening to pain only. Select the most appropriate next step in management of the abdominal pain? A. and a flexor response to pain. He arrives at the emergency department with incomprehensible responses to questions. 26.

and a second wound is present just medial to the tip of the right scapula. Immediate arterial blood gas analysis E. Percutaneous core needle biopsy D. PET–computed tomography (CT) B. Admission to the ICU for continuous cardiac monitoring and pulse oximetry 31. Incisional biopsy E. and his vital signs return to within normal limits. Third-degree burns are generally painful and extremely sensitive to touch. Chest CT B. A 42-year-old woman with no cutaneous injury. A 25-year-old man with 7% TBSA partial-thickness burns on the chest D. A 30-year-old construction worker with pain and blistering bilaterally on the knees after kneeling in wet cement all afternoon C. and the total amount in the collection container is 2300 mL. Magnetic resonance imaging (MRI) demonstrates a 5-cm neoplasm arising from the triceps. Superficial partial-thickness burn is the contemporary term for first-degree burns. 32. E. A 42-year-old woman has a mass in the posterior aspect of the upper part of her arm that was first noted 3 months earlier. Vital signs on initial evaluation are a heart rate of 126 beats/min and a systolic blood pressure of 88 mm Hg. It is not painful and she has no associated symptoms. Excisional biopsy . D. An 18-year-old man in a motor vehicle collision with 30% TBSA burns on his chest and circumferential burns bilaterally on his arms 33. The first wound is located 2 cm lateral to the right nipple. Second-degree burns characteristically cause erythema. A 21-year-old man is taken to the emergency department with a gunshot wound to the right side of his chest. First-degree burns heal rapidly but contribute significantly to the total body surface area (TBSA) burned in large.30. and blistering. mixed-depth wounds. His chest tube output is rechecked 4 hours later. C. found lying down at the scene of a house fire. A 50-year-old woman with a 1% TBSA partial-thickness burn on her left hand from a cooking accident B. Which of the following patients do not meet the criteria for referral to a burn center? A. He is resuscitated with 2 L of lactated Ringer solution. B. Immediate complete blood count C. What is the next most appropriate step in management? A. and noted to have carbonaceous sputum after intubation in the field E. with return of 1200 mL of blood. The best next step in the management of this patient is: A. Fourth-degree burns mandate amputation of the involved extremities. Which of the following regarding burn wound depth is true? A. A right-sided chest tube is placed. Thoracotomy D. Fine-needle aspiration (FNA) biopsy C. pain.

Ileal mesentery composing the lateral wall of the sac B. Grynfeltt hernia C. C. A femoral hernia is classified as type IIIc. Cigarette smoking D. Type IV hernias are pantaloon-type hernias. simple inflamed appendix. Which of the following risk factors is most strongly associated with ductal adenocarcinoma of the pancreas? A. A type II indirect hernia has a dilated internal ring and extends into the scrotum. appendicular mass. 35. B. A sliding inguinal hernia on the left side is likely to involve which of the following? A. omental cyst B. Omentum D.34. Ovary and fallopian tube in a female infant C. which of the following is the most likely diagnosis?‫ملعوب فيه‬ A. Littre hernia 37. Open fracture of humerus. Alcohol consumption 38. Richter hernia E. Type V hernias are spigelian hernias. gastric duplication. According to the Nyhus classification of groin hernias. Which of the following hernias represent incarceration of a limited portion of the small bowel? A. Bladder composing the posterolateral wall of the sac E. A type IIIa hernia is a classically described indirect hernia. D. Spigelian hernia B. Chronic pancreatitis B. Mastectomy. which of the following statements are true? ‫ملعوب فيه‬ A. Coffee consumption E. Cecum composing the anteromedial wall of the sac 36. Petit hernia D. 39. E. ovarian cyst C. Diabetes mellitus C. A 15 year old girl presents with a mobile. B. C. E. 8 cm mid abdominal mass that moves freely from left to right but does not move superiorly or inferiorly. for which of the following conditions perioperative prophylactic antibiotics are least indicated: A. . D. mesenteric cyst.

Hemorrhoids are specialized “cushions” present in everyone that aid continence. colonic perforation. unilateral bloody nipple discharge from one duct orifice is most commonly caused by which of the following pathologic conditions? A. B. Paget's disease of the nipple.D. Hyperplastic polyp C. all the following are true except A. Subareolar mastitis. D. The risk influenced by the nature of the disease for which the spleen been removed. 40. 41. Crohn's disease: A. Villous adenoma B. Thrombosed piles can be treated conservatively 42. Complete resection of affected bowel is recommended as recurrence after complete resection is rare E.Simple cyst . Commonly caused by encapsulated bacteria 41. E. External hemorrhoids are covered by skin whereas internal hemorrhoids are covered by mucosa. Mortality rate: 50-80% E. Is caused by Mycobacterium paratuberculosis. Is improved by smoking. E. Regarding overwhelming postsplenectomy infection (OPSI). The risk of overwhelming sepsis is increased significantly after splenectomy. D. Adenomatous polyp D. Retension polyp E. None of the above 43. Inflammatory carcinoma. E. Which of the following statements about hemorrhoids is/are not true? A. It does not affect the colon C. C. C. Intraductal carcinoma. C. Lowest risk in infants & children's < 5yr’s after splenectomy D. Pain is often associated with uncomplicated hemorrhoids. Laparoscopic cholecystectomy due to acute cholecystitis. B. whith of the following types of polyps is most likely to be found? A. After intraductal papilloma. B. D. Hemorrhoidectomy is reserved for third. Tends to occur in families.and fourth-degree hemorrhoids. A patient with a history of familial polyposis undergoes a diagnostic polypectomy. B.

Intestinal obstruction B. Appropriate management at this time would include A. Which of the following would be expected to stimulate intestinal motility? A. Tubular carcinoma and mucinous carcinoma.*44. Colon resection and proximal colostomy D. Evaluation of an electrocardiogram and obtaining an angiogram to evaluate for colonic mesenteric ischemia *45. It is initially treated by colostomy B. A liver/spleen radionucleotide scan is the most sensitive and specific way to make the diagnosis 50. It is best diagnosed in the newborn period by barium enema C. An 80-year-old man is admitted to the hospital complaining of nausea. Saline enemas and digital disimpaction of fecal matter from the rectum C. . Enterovesical fistula C. Secretin D. Acetylcholine E. A cautiously performed transanal contrast study reveals an “apple core” configuration in the rectosigmoid. Colonoscopic decompression and rectal tube placement B. and diarrhea. distention. Which of the following statements concerning Hirschsprung’s disease is true? A. Indications for operation in Crohn’s disease include which of the following? A. Oral administration of metronidazole and checking a Clostridium difficile titer E. Fear B. Ileum–ascending colon fistula D. It is associated with a high incidence of genitourinary tract anomalies E. Which of the following breast lesions are non-invasive malignancies? A. They may undergo malignant transformation C. Gastrin C. The majority become symptomatic B. They should be resected to avoid spontaneous rupture and life-threatening hemorrhage E. True statements regarding cavernous hemangiomata of the liver in adults include ( ‫هذا السؤال كله خطأ‬ A. abdominal pain. It is characterized by the absence of ganglion cells in the transverse colon D. It is the congenital disease that most commonly leads to subsequent fecal incontinence *46. Free perforation *48. Intraductal carcinoma of the comedo type. Cholecystokinin *47. They enlarge under hormonal stimulation D. B. Enterovaginal fistula E.

Mastectomy and regional node dissection. and gender. 51. including atypical medullary lesions. If the inflammatory process does not completely respond. a biopsy may be indicated . C. A 35-year-old woman. C. most of the lymphatic drainage of the breast courses to the axillary LN B. and gender. Failure to perform radiation after wide excision of an invasive cancer risks which of the following outcomes? A. and family history in immediate relatives. Greater chance of breast cancer mortality. Medullary carcinoma. The proper treatment for lobular carcinoma in situ (LCIS) includes which of the following components? A. The ductal system of the breast from the alveoli to the skin are lined with columnar epithelium 55. D. Mirror-image biopsy of the opposite breast. Obesity. The most common organism which would expect to be cultured is Staphylococcus aureus B. Cysts. 53. Which of the following statement(s) is/are true concerning her diagnosis and management except? A. D. and alcohol use. B. Fibrocystic disease.C. Fascial bands projecting through the breast to the skin form a supporting framework known as Cooper’s ligaments D. and thoracodorsal nerve C. C. Which of the following statement(s) is/are true concerning the anatomy of the breast except? A. D. Nerves within the axillary fat pad include the intercostal brachial nerve. Age. 54. nulliparity. Which of the following are the most important and clinically useful risk factors for breast cancer? A. Regional nodal recurrence. Radiation after excision. Recurrence of cancer in the ipsilateral breast. D. Breast-feeding absolutely should be discontinued D. B. Close follow-up. who is currently breast-feeding her firstborn child. age. Infiltrating ductal carcinoma and lobular carcinoma. Open surgical drainage is likely indicated C. gender. family history in immediate relatives. develops an erythematous and inflamed fluctuant area on breast examination. B. 52. Shorter survival time. the long thoracic nerve.

C. C. and right lower quadrant tenderness. Mm 61. C. E. The following statement(s) is/are true concerning umbilical hernias in adults. White blood cell count greater than 20. The most precise diagnostic screening procedure for differentiating benign thyroid nodules from malignant ones is: A. Colonoscopy. Thyroid scintiscan. Age older than 60. A paraumbilical hernia typically occurs in multiparous females C. Thyroid ultrasonography. B. D. D. The test with the highest diagnostic yield for detecting a colovesical fistula is: A. D. Most umbilical hernias in adults are the result of a congenital defect carried into adulthood B. all of the above 59. Acute appendicitis is most commonly associated with which of the following signs? A. D. A low-fiber diet may predispose to development of diverticulosis. Temperature above 104‫ ؛‬F. A substantial decline in renal function. the preferred management in otherwise good-risk patients is: A. Radioactive iodine treatment. Barium enema. A. 62. Which of the following is not true of diverticular disease: A. C. 57. D. B. B. B.000 per cu. Fine-needle-aspiration biopsy (FNAB). B.56. Iodine treatment. D. B. Cystoscopy. C. The presence of ascites is a contraindication to elective umbilical hernia repair. Cystography. Thyroid hormone suppression. abdominal pain. A substantial decline in bone mass. 58. Frequent loose stools. When progressive enlargement of a multinodular goiter causes symptomatic tracheal compression. Thyroid hormone treatment. Indications for operation in a patient with previously asymptomatic hyperparathyroidism include except: A. . E. It is more common in the United States and Western Europe than in Asia and Africa. Anorexia. Incarceration is uncommon with umbilical hernias 60. Computed tomography (CT). Nephrolithiasis. Surgical resection of the abnormal thyroid.

Should be suspected in any patient taking vasopressors who requires more than 6 L of resuscitative fluid over a short period 68. It is the most common cause of massive lower gastrointestinal hemorrhage 63. Tributaries to Saphenofemoral junction . Advantages of total thyroidectomy for management of papillary carcinomas of the thyroid larger than 1.C. D. Lower overall recurrence rate. E. Sixty per cent develop diverticulitis sometime during their lifetime. Results in hypocapnia C. Possibility of using radioactive iodine postoperatively to identify and treat metastases. Chronic groin pain following inguinal hernia repair may be the result of: A. Lower risk of hypoparathyroidism 65. Injection sclerotherapy 67. Examination of the cervical spine 64. Will not affect cerebral perfusion E. Systemic inflmmatory response syndrome (SIRS) develops and the patient requires 8 L of flid resuscitation to keep his central venous pressure higher than 10 mm Hg. Insuring adequate ventilatory support B. Which of the following steps is/are part of the primary survey in a trauma patient except? A. B. It involves sigmoid colon in more than 90% of patients. Requires immediate decompressive laparotomy for intraabdominal pressures greater than 20 mm Hg B. include except? A. Is associated with decreased systemic vascular resistance D. D. This clinical entity: A. Postoperative scar tissue C. Neurologic evaluation with the Glasgow Coma Scale D. The ability to use thyroglobulin levels as a marker for recurrence. Open repair with mesh C. Use of mesh D. A 35-year-old man is admitted to the surgical ICU with a diagnosis of acute alcoholic pancreatitis. All of the above 66. Observation E. Measurement of blood pressure and pulse C. Laparoscopic repair with mesh D.5 cm. Division of the nerves during the surgical procedure B. The best treatment for diastasis of recti is A. You have a high index of suspicion for the development of abdominal compartment syndrome (ACS). Injury from the use of tacks or staples E. C. Primary open repair B.

Renal Colic  most resolve spontaneously 70. Abu Samha/ 6th year medical student .69. Middle thyroid vein drain into  internal jugular vein By: Belal M. False regarding urinary tract malignancy  painful hematuria 71.