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Zitiervorschau

1. Which is the shortest phase of the normal cell cycle? A. G1 phase B. S phase C. G2 phase D. M phase E. All phases approximately equal in length 2. A 67 year-old women with rectal cancer is admitted to gereral surgical floor which of the following laboratory studies should be included in the surgeon’s initial nutritional assessment : A. Transferrin B. Prealbumin C. Albumin D. Glutamine E. All of above 3. In which of the following conditions is the entral route appropriate for nutrition : A. Upper gastrointestinal obstruction B. Complete small bowel obstruction C. Acute flare-up of Crohn’s disease D. Low out put colonic fistula E. Non of the above

4. Which is the most commonly cultured hospital acquired organism in critical care with aspiration pneumonia: A. Staphylococcus aureus B. Streptococcus pneumonia C. Anaerobic species D. Pseudomonas aeroginosa E. Haemophlus influenzae

5. Which is the most appropriate single agent for empiric coverage of the above patient : A. Metranidazole B. Clindamycin C. Pipracillin_tazobactam D. Vancomycin E. First generation penicillin

6. All of the following are true about neurogenic shock except: A. There is a decrease in systemic vascular resistance and an increase in venous capacitance. B. Tachycardia or bradycardia may be observed, along with hypotension. C. The use of an alpha agonist such as phenylephrine is the mainstay of treatment. D. Severe head injury, spinal cord injury, and high spinal anesthesia may all cause neurogenic shock. E. A and B

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7. Which of the following statements about head injury and concomitant hyponatremia are true? A. There are no primary alterations in cardiovascular signs. B. Signs of increased intracranial pressure may be masked by the hyponatremia. C. Oliguric renal failure is an unlikely complication. D. Rapid correction of the hyponatremia may prevent central pontine injury. E. This patient is best treated by restriction of water intake 8. Regarding Cushing's Syndrome A. 20% of cases are due to pituitary adenomas (Cushing's Disease) B. Most ACTH secreting pituitary adenomas are more than 2 cm in diameter C. Is characterised by loss of the diurnal rhythm of cortisol secretion D. Cortisol production is suppressed by low-dose dexamethasone E. Adrenal carcinomas are more common than adrenal adenomas 9. Which of the following statements about extracellular fluid are true? A. The total extracellular fluid volume represents 40% of the body weight. B. The plasma volume constitutes one fourth of the total extracellular fluid volume. C. Potassium is the principal cation in extracellular fluid. D. The protein content of the plasma produces a lower concentration of cations than in the interstitial fluid. E. The interstitial fluid equilibrates slowly with the other body compartments.

10. In patients receiving massive blood transfusion for acute blood loss, which of the following is/are correct? A. Packed red blood cells and crystalloid solution should be infused to restore oxygen-carrying capacity and intravascular volume. B. Two units of FFP should be given with every 5 units of packed red blood cells in most cases. C. A “six pack” of platelets should be administered with every 10 units of packed red blood cells in most cases. D. One to two ampules of sodium bicarbonate should be administered with every 5 units of packed red blood cells to avoid acidosis. E. One ampule of calcium chloride should be administered with every 5 units of packed red blood cells to avoid hypocalcemia.

11. Which of the following statements about the presence of gallstones in diabetes patients is/are correct? A. Gallstones occur with the same frequency in diabetes patients as in the healthy population. B. The presence of gallstones, regardless of the presence of symptoms, is an indication for cholecystectomy in a diabetes patient. C. Diabetes patients with gallstones and chronic biliary pain should be managed nonoperatively with chemical dissolution and/or lithotripsy because of severe complicating medical conditions and a high operative risk. D. The presence of diabetes and gallstones places the patient at high risk for pancreatic cancer. E. Diabetes patients with symptomatic gallstones should have prompt elective cholecystectomy, to avoid the complications of acute cholecystitis and gallbladder necrosis.

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12. concerning Tetanus all true except: A. Is due to an infection with a gram-negative spore forming rod B. The organism produces a powerful exdotoxin C. The toxin prevents the release of inhibitory neurotransmitter D. Clostridium tetani is sensitive to penicillin E. Risus sardonicus is the typical facial spasm 13. when should parentral antibiotics be given perioperatively? A. The night before B. 6 hr prior to surgery C. 30 minutes prior to incision . D. at the time of incision E. 30 minutes after incision 14. Which of the following statements about esophageal anatomy is correct? A. The esophagus has a poor blood supply, which is segmental in distribution and accounts for the high incidence of anastomotic leakage. B. The esophageal serosa consists of a thin layer of fibroareolar tissue. C. The esophagus has two distinct muscle layers, an outer, longitudinal one and an inner, circular one, which are striated in the upper third and smooth in the distal two thirds. D. Injury to the recurrent laryngeal nerve results in vocal cord dysfunction but does not affect swallowing. E. The lymphatic drainage of the esophagus is relatively sparse, localized primarily to adjacent paraesophageal lymph nodes. 15. Wich of the following medication should be given in preparation of a pation with pheochromocytoma? A. Phnoxybenzamine B. Nifedipine C. Linsinopril D. Hydrochlorothiazide E. Propranolol 16. Which of the following statement(s) is true concerning excessive scarring processes? A. Keloids occur randomly regardless of gender or race B. Hypertrophic scars and keloid are histologically different C. Keloids tend to develop early and hypertrophic scars late after the surgical injury D. Simple reexcision and closure of a hypertrophic scar can be useful in certain situations such as a wound closed by secondary intention E. Non of the above

17. A 22-year-old man sustains a single stab wound to the left chest and presents to the emergency room with hypotension. Which of the following statement(s) is true concerning his diagnosis and management? A. The patient likely is suffering from hypovolemic shock and should respond quickly to fluid resuscitation B. Beck’s triad will likely be an obvious indication of compressive cardiogenic shock due to pericardial tamponade C. Echocardiography is the most sensitive noninvasive approach for diagnosis of pericardial tamponade D. The placement of bilateral chest tubes will likely resolve the problem

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18. Which of the following statement(s) is/are true concerning septic shock? A. The clinical picture of gram negative septic shock is specifically different than shock associated with other infectious agents B. The circulatory derangements of septic shock precede the development of metabolic abnormalities C. Splanchnic vascular resistance falls in similar fashion to overall systemic vascular resistance D. Despite normal mechanisms of intrinsic expansion of the circulating blood volume, exogenous volume resuscitation is necessary 19. During surgery on the submandibular gland A. An incision on the lower border of the mandible is safe B. The submandibular gland is seen to wrap around the posterior border of mylohyoid C. The facial artery and vein are divided as they course through the deep part of the gland D. The hypoglossal nerve is seen to loop under the submandibular duct E. Damage to the lingual nerve will cause loss of sensation to the posterior third of the tongue 20. Regarding benign breast disease A. Cyclical mastalgia is the commonest reason for referral to the breast clinic B. Fibroadenomas are derived from the breast lobule C. Lactational breast abscesses are usually due to Staph aureus D. Duct ectasia is more common in smokers E. Atypical lobular hyperplasia is associated with an decreased risk of breast cancer 21. Which of the following statements regarding unusual hernias is incorrect? A. An obturator hernia may produce nerve compression diagnosed by a positive Howship-Romberg sign. B. Grynfeltt's hernia appears through the superior lumbar triangle, whereas Petit's hernia occurs through the inferior lumbar triangle. C. Sciatic hernias usually present with a painful groin mass below the inguinal ligament. D. Littre's hernia is defined by a Meckel's diverticulum presenting as the sole component of the hernia sac. E. Richter's hernia involves the antimesenteric surface of the intestine within the hernia sac and may present with partial intestinal obstruction

22. Staples may safely be placed during laparoscopic hernia repair in each of the following structures except: A. Cooper's ligament. B. Tissues superior to the lateral iliopubic tract. C. The transversus abdominis aponeurotic arch. D. Tissues inferior to the lateral iliopubic tract. E. The iliopubic tract at its insertion onto Cooper's ligament.

23. The following statements about the repair of inguinal hernias are true except: A. The conjoined tendon is sutured to Cooper's ligament in the Bassini hernia repair. B. The McVay repair is a suitable option for the repair of femoral hernias. C. The Shouldice repair involves a multilayer, imbricated repair of the floor of the inguinal canal. D. The Lichtenstein repair is accomplished by prosthetic mesh repair of the inguinal canal floor in a tensionfree manner. E. The laparoscopic transabdominal preperitoneal (TAPP) and totally extraperitoneal approach (TEPA) repairs are based on the preperitoneal repairs of Cheattle, Henry, Nyhus, and Stoppa. 4

24. A number of special circumstances exist in the repair of inguinal hernias. The following statement(s) is correct. A. Simultaneous repair of bilateral direct inguinal hernias can be performed with no significant increased risk of recurrence B. The preperitoneal approach may be appropriate for repair of a multiple recurrent hernia C. A femoral hernia repair can best be accomplished using a Bassini or Shouldice repair D. Management of an incarcerated inguinal hernia with obstruction is best approached via laparotomy incision E. All are correct.

25. Which of the following statement(s) is true about benign lesions of the liver? A. Adenomas are true neoplasms with a predisposition for complications and should usually be resected. B. Focal nodular hyperplasia (FNH) is a neoplasm related to birth control pills (BCPs) and usually requires resection. C. Hemangiomas are the most common benign lesions of the liver that come to the surgeon's attention. D. Nodular regenerative hyperplasia does not usually accompany cirrhosis 26. Ligation of all of the following arteries usually causes significant hepatic enzyme abnormalities except: A. Ligation of the right hepatic artery. B. Ligation of the left hepatic artery. C. Ligation of the hepatic artery distal to the gastro-duodenal branch. D. Ligation of the hepatic artery proximal to the gastroduodenal artery. 27. Which of the following is the most effective definitive therapy for both prevention of recurrent variceal hemorrhage and control of ascites? A. Endoscopic sclerotherapy. B. Distal splenorenal shunt. C. Esophagogastric devascularization (Sugiura procedure). D. Side-to-side portacaval shunt. E. End-to-side portacaval shunt. 28. which of the following is associated with best prognosis for patient with breast cancer? A. Male sex B. Estrogen receptor positive C. Patient age