Surgery- General

Rotation

Sarah Basel
Corrected by:
Ameen Alsaras
Questions with * are mentioned more than once so focus on them & their topics in general
1- Regarding abdominal wall hernias:

A. Are 2nd to adhesions as a cause of strangulated intestinal obstruction

B. 20% of inguinal hernias are indirect

C. In women inguinal hernias are less common than femoral hernias

D. The mortality associated with bowel strangulation is over 10%

E. Trial reduction of pediatric inguinal hernias is not recommended

2- Regarding the femoral canal, all of the following statements are true EXCEPT:

A. Lies medial to the femoral vein

B. Has the inguinal ligament as its anterior border

C. Has the lacunar ligament as its lateral border

D. Has the pectineal ligament as its posterior border

E. Contains the lymph node of Cloquet

3- Which of the following organisms is not a gastrointestinal source of peritonitis?*

A. bacteroids

B. chlamydia

C. escherichia coli

D. clostridium

E. streptococci

4- All of the following is a risk factor for developing Clostridium Difficile Colitis EXCEPT:

A. Prolonged intravenous antibiotics

B. Contraceptive pills

C. Mal-nutrition

D. Steroids

E. Proton pump inhibitor

5- All of the following are true about Fournier gangrene EXCEPT:

A. More in elderly patient

B. Affect patient with significant comorbidity

C. Caused by mixed organisms

D. If it affects the scrotum in males, debridement and orchidectomy is essential

E. Carries a high risk of mortality

6- A 23-year-old male patient, presented with right forearm pain for one day duration after aggressive
scratching, exam showed an area at the forearm with hotness, redness and tenderness. All of the
following is true about the above condition EXCEPT:

[Link] of the patient’s arm is part of the treatment

B. Antibiotics need to be started

C. The cause of this pathology is most likely gram-positive organism

D. Underlying osteomyelitis is a common predisposing factor

E. Axillary lymph node might be palpable

7- Which statement regarding the management of hypernatremia is INCORRECT:

A. Hypernatremia, if not corrected, has a high mortality rate

B. It may exist in the presence of low, normal or high effective circulating

volume

C. Hypotonic fluid therapy may be given by mouth, by tap water enema or

parenterally

D. The aim of fluid replacement is to decrease serum osmolality gradually by

about 10 mOsm/hour

E. May be associated with major burn

8- A 70 kg man with pyloric obstruction resulting from ulcer disease is admitted to

the hospital for resuscitation after 1 week of prolonged vomiting. What metabolic

disturbance is expected to occur?*

A. Hypokalemic hyperchloremic metabolic acidosis

B. Hyperkalemic hypochloremic metabolic alkalosis

C. Hyperkalemic hyperchloremic metabolic acidosis

D. Hypokalemic hypochloremic metabolic alkalosis

E. Hypokalemic hypernatremic hypochloremic metabolic acidosis

9- The majority of the blood volume at rest is contained within the:

A. Arterial system.

B. Capillary bed.

C. Portal circulation.

D. Pulmonary circulation.

E. Venous system.

10- Which group of the following cells is NOT phagocytic in nature?

A. Neutrophil polymorphonuclear leucocytes.

B. Lymphocytes.

C. Microglial cells.

D. Macrophages.

E. Kupffer cells.

11- All of the following are associated with increased likelihood of surgical site infection after major
elective surgery, EXCEPT**

A. Age over 70 years.

B. Chronic malnutrition.

C. Controlled diabetes mellitus.

D. Long-term steroid use.

E. Infection at a remote body site.

12- All the following can explain lower limb edema EXCEPT:

A. Congestive heart failure

B. Hepatic failure

C. Deep venous thrombosis

D. Acute lower limb ischemia

E. Nephrotic syndrome

13- Blood transfusions may cause all of the following EXCEPT:

A. Microcirculation thrombosis

B. Transmission of Cytomegalovirus

C. Allergic reaction

D. Bronchospasm

E. Increased platelets count

14- The first step in treating Ludwig’s angina*

A. IV antibiotics

B. Incision and drainage

C. Treat underlying cause

D. Secure airway

E. IV fluids

15- All of the following types of shock are distributive EXCEPT:

A. Septic shock

B. Hemorrhagic shock

C. Addisonian shock

D. Neurogenic shock
E. Anaphylaxis

16- The GCS (Glasgow Coma Scale) of a patient who responds with inappropriate words, opens eye to
painful stimuli, and flexing in response to pain is*

A. 6

B. 8

C. 7

D. 10

E. 9

17- Regarding sepsis and septic shock, all of the following are true EXCEPT*

A. Sepsis is a clinical syndrome of life-threatening organ dysfunction caused by a

dysregulated response to infection.

B. IV fluids challenge with 20-30 ml/kg is the first method used to restore

perfusion.

C. Intra-venous antibiotics could be delayed up to 6 hours until specimens of

blood, have been taken for Gram stain and culture.

D. The source of infection should be controlled as early as possible.

E. Estimates of successful reperfusion include ScvO2 (Central Venous

saturation) and lactate clearance.

18- One of the following does NOT fit the definition of Massive Blood transfusion:

A. Replacement of one entire blood volume within 24 h.

B. Transfusion of >10 units of packed red blood cells (PRBCs) in 24 h.

C. Transfusion of >4 units of PRBCs in 1 h when on-going need is foreseeable.

D. Replacement of 50% of total blood volume (TBV) within 3 h.

E. The need to transfuse fresh frozen plasma to correct the Coagulopathy of

blood transfusion.
19- Regarding Enteral Nasogastric tube feeding, one of the following is CORRECT*

A. Highly thrombogenic.

B. Used in patients with the short gut syndrome.

C. A potential cause of abdominal cramps and diarrhea.

D. More likely to cause septic complications than parenteral nutrition.

E. Contraindicated in patients after a cerebrovascular accident.

20- All the following are contraindications to major elective surgery requiring general

anesthesia, EXCEPT:

A. Myocardial infarction 2 months ago.

B. Preoperative serum potassium of 2.5 mmol/liter in a patient on diuretic

therapy.

C. Previous mitral valve replacement.

D. A resolving upper respiratory tract infection.

E. Stroke within 4 months before surgery.

21- Potential sites of hemorrhage leading to hypotensive chock in children and

adolescents include all the following EXCEPT:

A. Thorax

B. Abdomen

C. Intracranial

D. Pelvis

E. Femur

22- Which phase of hypermetabolic state can last for an extended period of time

leading to adverse nutritional status?

A. Ebb phase

B. Flow phase
C. Cycling phase

D. Imbalance phase

E. Healing phase

23- All of the following is an obligatory glucose user EXCEPT:

A. Red Blood Cells

B. Cardiac Muscles

C. Renal Medulla

D. Bone Marrow

E. Brain

24- To prevent gluconeogenesis, glucose administration must be carefully monitored, the protein
sparing effect of glucose administration begins to be manifested after administration of how much
glucose?*

A. 100 gm

B. 200 gm

C. 75 gm

D. 300 gm

E. 500 gm

25-Regarding abdominal surface anatomy, all of the following are true EXCEPT*

A. The abdomen can be divided into 4 quadrants.

B. The trans pyloric plane is at the level of L1

C. The deep inguinal ring is 1.25cm below the mid inguinal point

D. McBurney's point in located one third distance between anterior superior iliac

spine and the umbilicus

E. The umbilicus is normally situated mid-way between the xyphoid process and

the symphysis pubis

26- Surgical wounds are classified based on the presumed magnitude of the bacterial

load at the time of surgery. The best to represent a clean/contaminated (class II)

wound is*

A. Penetrating abdominal trauma

B. Large tissue injury

C. Elective upper GI surgery

D. Enterotomy during bowel obstruction

E. Perforated diverticulitis

27- A 68-year-old woman underwent tracheostomy for prolonged intubation, 2 weeks

later she developed brisk bright red bleeding from the tracheostomy site that

resolved without intervention. Her Hb is 10.2 g/dL, and coagulation studies are

normal. What is the most likely diagnosis?

A. Pneumonia

B. Tracheitits

C. Bleeding of granulation tissue in the stoma

D. Tracheoinnominate fistula

E. Bleeding from the anterior jugular vein

28- 45-year-old male, non-diabetic scheduled for laparoscopic cholecystectomy, the

best antimicrobial prophylaxis that have significantly lower overall infectious

complications is:

A. Cephazolin

B. Cefuroxime sodium

C. Ceftriaxone

D. Gentamycin

E. Metronidazole
29- For a feeding gastrostomy all are true EXCEPT:

A. It can be either a temporary or a permanent method of feeding.

B. Is safer than intravenous feeding.

C. It is usually created endoscopically.

D. The risk of aspiration is less than jejunostomy feeding.

E. Does not require surgical closure after cessation of feeding.

30- For a 70 kg man, the minimum acceptable urine output is:

A. 7 ml/ hour.

B. 70 ml/ hour.

C. 35 ml/ hour.

D. 100 ml/ hour.

E. 105 ml/ hour.

31- Sequence of return of gastrointestinal motility after abdominal surgery is*

A. intestine, stomach, colon

B. stomach, intestine, colon

C. colon, intestine, stomach

D. colon, stomach, intestine

E. stomach, colon, intestine

32- The principal types of proliferating cells in granulation tissue are:

A. Fibroblasts and macrophages

B. Fibroblasts and endothelial cells

C. Leukocytes and endothelial cells

D. Lymphocytes and fibroblasts

E. Macrophages and leukocytes

33- Deficiency of which of the following vitamins influence wound healing?*

A. Vitamin A

B. Vitamin B6

C. Vitamin B12

D. Vitamin C

E. Vitamin D

34- For a 70 kg healthy patient the postoperative maintenance fluids should be around*

a. 1800 ml per 24 hours.

b. 2800 ml per 24 hours.

c. 3800 ml per 24 hours.

d. 4800 ml per 24 hours.

e. 5800 ml per 24 hours

35- All the following are metabolic effects of injury and sepsis EXCEPT:

a. fluid retention

b. insulin resistance and glucose intolerance

c. positive nitrogen balance

d. hypoalbuminemia

e. increased gluconeogenesis and protein catabolism

36- Which of the following statements about total body water composition is correct?

a. Females and obese persons have an increased percentage of body water.

b. Increased muscle mass is associated with decreased total body water.

c. Newborn infants have the lowest proportion of total body water.

d. Total body water increases steadily with age.

e. Any person's percentage of body water is subject to wide physiologic variation.

37- Absorption of the majority of nutrients takes place in which part of the gastrointestinal tract?

a. Stomach

b. Duodenum

c. Jejunum

d. Ileum

e. Colon

38- Compared to enteral nutrition, parenteral nutrition (PN):

a. Is less expensive

b. Has less infectious complications

c. Preserves immunologic function of gut

d. Is not associated with metabolic bone dysfunction

e. Is less likely to cause diarrhea

39- A 16-year-old boy presented to emergency room with a tender red and fluctuant swelling in the

right forearm of 2 days duration. He reported a pencil-stick injury at the site of swelling one

week ago. The most likely diagnosis is*

a. Abscess

b. Lymphangitis

c. Cellulitis

d. Clostridium tetani

e. Gas gangrene

40- Which of the following statements regarding cellulitis is TRUE?

a. This is non-suppurative spreading infection of the skin.

b. It is rarely caused by wounds.

c. It is commonly caused by staphylococci.

d. Gram negative organisms do not cause cellulitis.

e. Penicillin is an effective treatment

41- Which of the following statements is FALSE of gastrointestinal (GI) secretions?

a. Pancreatic fluid is alkaline.

b. The chloride content of gastric fluid is around 110 mmol/L.

c. Gastric fluid has a high concentration of potassium.

d. Bile has a pH of 7.2.

e. Most losses can be replaced with normal saline with or without potassium NOT SURE

42- Which of the following statements regarding direct inguinal hernias is TRUE?

a. They protrude medially to the inferior epigastric vessels

b. They are common in women

c. They commonly reach the scrotal sac in men

d. They obstruct more commonly than indirect hernias

e. They are more common than indirect inguinal hernias in men

43- In which of the following surgeries preoperative antibiotic administration is not indicated?**

a. Inguinal hernioplasty

b. Breast surgery for duct ectasia

c. Thyroid surgery for multinodular goitre

d. Laparoscopic cholecystectomy for symptomatic gall stones

e. Coronary bypass surgery

44- The use of vasopressors is crucial in which of the following types of shock?

a. Hypovolemic shock

b. Neurogenic shock

c. Cardiogenic shock

d. Septic shock

e. Hemorrhagic shock

*actually this applies to any distributive shock, so septic is a correct answer as well
45- One is true in regarding trauma of the spleen:

a. This organ is rarely involved in blunt trauma.

b. Splenic preservation should be the rule when there are associated significant injuries.

c. Vaccine should be given 1-2 weeks after splenectomy.

d. Overwhelming postsplenectomy sepsis (OPSS) is more than 10%.

e. Non-operative management is limited to grades 1&2

46-The most common cause of secondary bleeding that happens several days postoperatively is*

a. Infection

b. Bleeding disorder

c. Slipped ligature

d. Improper surgical technique

e. Hypothermia

47- Which is false regarding antibiotic prophylaxis in surgery?**

a. Decrease bacterial counts at surgical site

b. Given for 72 hrs

c. Started one hour prior to incision

d. Chosen according to the expected pathogen

e. Repeat dose is given in long surgeries

48- If appropriately utilized, supervised exercise programs for patients with peripheral vascular

disease can help achieve which of the following?

a. Gradual improvement in ankle brachial index.

b. Improve collateral circulation.

c. Increased walking distance.

d. Clinical benefit in patients with claudication and rest pain but not in patients presenting with

tissue loss.
e. Reduces the need for long term antiplatelet therapy.

49- All of the following are true regarding lymphedema EXCEPT:

a. Lymphedema praecox denotes primary lymphedema, while secondary lymphedema is also

termed lymphedema tarda.

b. Primary lymphedema has a marked female predominance.

c. The most common world-wide cause of secondary lymphedema is filariasis.

d. Lymphoscintigraphy is a reliable diagnostic tool for lymphedema.

e. Methods of treatment include manual lymphatic drainage, compression devices, and surgery.

50- Which of the following Blood transfusion complication is most likely to result in the death of a

patient?

a. Circulatory overload

b. Allergic reaction

c. Febrile reaction

d. ABO incompatibility

e. Transfusion related Acute lung injury

51- A 25-year-old lady loses 15 % of her blood during surgery, the best immediate management is*

a. Colloids

b. Crystalloids

c. Crystalloids and packed Red cells

d. Fresh Frozen P and PRC

e. Fresh Whole Blood

52- Transfusion Related Acute Lung Injury (TRALI), one of the following is TRUE*

a. Can be caused by blood products transfusion, like fresh frozen plasma

b. Is associated with significantly elevated pulmonary artery capillary wedge pressure

c. Is the commonest cause of morbidity associate with blood transfusion

d. Should be treated with high dose steroids

e. Typically presents 24 hours after transfusion

53- All of the following are associated with increased likelihood of wound infection after major

elective surgery, EXCEPT:

a. Age over 70 years.

b. Chronic malnutrition.

c. Hyperthermia during the operation.

d. Long-term steroid use.

e. Infection at a remote body site.

54- A major problem in nutritional support is identifying patients at risk. All of the following can

identify the patient at risk, EXCEPT:

a. Weight loss of greater than 15% over 2 to 4 months.

b. Serum albumin.

c. Malnutrition as identified by Physical examination.

d. Serum transferrin.

e. Hemoglobin Level.

55-A 17-year-old patient involved in an automobile accident is paralyzed with multiple peripheral

extremity injuries. Nutritional support is instituted with a nasogastric feeding catheter. Which

of the following statement is TRUE concerning the patient’s management?

a. Feeding into the stomach results in stimulation of the biliary/pancreatic axis which is trophic for

small bowel.

b. Gastric secretions will dilute the feeding increasing the risk of diarrhea.

c. The risk of aspiration is minimized by using the nasal route.

d. The cost of the new feeding formulas is more expensive than total parenteral nutrition

e. The risk of infection is higher than with Total Parenteral Nutrition

56- One of the following is a cyanotic congenital heart disease in the newborn:

a. Transposition of the Great vessels

b. Aortic stenosis

c. Atrial Septal Defect

d. Ventricular Septal Defect

e. Patent Ductus Arteriosus

57- Postoperative oliguria with a fractional excretion of Sodium of less than 1% is most consistent

With*

a. Pre renal acute renal failure.

b. Intrinsic acute renal failure.

c. Chronic renal insufficiency.

d. Acute tubular necrosis.

e. Obstructive uropathy.

58- A 60-year-old TPN-dependent male with short gut syndrome and diarrhea presents with non-healing
leg wound. Which trace element he may need supplementation with?

a. Manganese.

b. Fluorine.

c. Selenium.

d. Copper.

e. Zinc

59- All the following are benefits of vacuum assisted wound closure (VAC) EXCEPT:

a. Keeps wound clean.

b. Increases angiogenesis.

c. Increases granulation tissue growth.

d. Can be used in cases of exposed major blood vessels.

e. Decreases edema.
60- Regarding normal physiology of body fluids in adults, all of the following statements are true

EXCEPT:

a. Intra-vascular compartment contains approximately (1/12) of total body water

b. Intra-vascular and interstitial compartments have different levels of sodium ions.

c. The main intra-cellular cation is potassium.

d. The main intra-vascular anion is chloride.

e. Starling forces control diffusion between intra-vascular and interstitial compartments.

61- Body mass index is calculated*

a. By a ratio of soft tissue mass to bone mass.

b. By multiplying height (in meters) by weight (in kilograms).

c. By dividing body weight (in kilograms) by a bone density factor.

d. By dividing twice the body weight (in kilograms) by half the height in meters.

e. By dividing body weight in kilograms by the square of body height in meters.

62- A 65-year-old man undergoes a low anterior resection for rectal cancer. On the fifth day in

hospital, his physical examination shows a temperature of 39°C (102°F), blood pressure of

150/90 mm Hg, pulse of 110 beats per minute and regular, and respiratory rate of 28 breaths

per minute. A computed tomography (CT) scan of the abdomen reveals an abscess in the

pelvis. Which of the following most accurately describes his present condition?**

a. Systemic inflammatory response syndrome (SIRS)

b. Sepsis (SIRS + documented infection = sepsis)

c. Severe sepsis

d. Septic shock

e. Severe septic shock

63- A patient with grossly contaminated wound presents 12 hours after an accident, his wound

should be managed by:

a. Thorough cleaning and primary repair

b. Thorough cleaning with debridement of all dead and devitalized tissue without primary closure

c. Primary closure over a drain

d. Covering the defect with split skin graft after cleaning

e. Covering it with a full thickness skin graft

64- The most common radiographic finding on X-ray after aspiration of a foreign body is:

a. Pleural effusion

b. hyperinflation

c. Atelectasis

d. Identification of the foreign body

e. Pneumonia

65- All of the following is true about antibiotic prophylaxis in surgical patients except:

[Link] choice of antibiotic is based on type of surgery performed.

[Link] should be given before the start of anaesthesia

[Link] doses can be given for 2-3 days

[Link] doses of antibiotics are occasionally required during the same procedure

[Link] or multiple types of antibiotics can be given

66- You are called to observe a patient in the ICU who came to the hospital two days ago and has started
to have gram-negative septicaemia. In addition, he has significant heart disease with a history of MI two
years ago. Right now, he has Hypotension, high blood volume, high central venous pressure and
decreased central venous oxygen saturation which would point to a diagnosis of:

[Link] shock

[Link] hydration

[Link] shock

[Link] respiratory distress syndrome

[Link] shock
67- One of the following is correct about groin hernia:

[Link] hernia is more common in males.

[Link] inguinal hernia appears medial and below to the pubic tubercle.

[Link] inguinal hernia is lateral to the inferior epigastric artery.

[Link] is the surgical treatment for inguinal hernia in adult men.

[Link] risk of strangulation is more common in inguinal compared to femoral hernia

68- Cellulitis, all the following are true, EXCEPT:

[Link] signs are not present

[Link] culture is often negative

[Link] can be caused by clostridium perfringens.

[Link] is poorly localized.

[Link] is non-suppurative invasive infection of tissue.

69- Regarding necrotizing soft-tissue infections. All the following are true EXCEPT:

[Link] pyogenes cause toxic shock syndrome.

[Link] is mainly surgical.

[Link] onset is usually gradual, and they run a chronic course

[Link] are usually polymicrobial infections.

[Link] water pus is a characteristic feature.

70- Regarding sepsis, one of the following is false:

[Link] is defined as life-threatening organ dysfunction caused by a dysregulated host response to

infection.

[Link] baseline SOFA score can be assumed to be zero in patients not known to have pre-existing organ
dysfunction.

[Link] dysfunction can be identified as an acute change in total SOFA(sequential organ failure
assessment score ) score ≥4 points consequent to the infection. (>= 2)

[Link] with Broad spectrum Antibiotic should be done within one hour of diagnosis.
e. SOFA score ≥2 reflects an overall mortality risk of approximately 10% in a general hospital

701 Regarding the direct inguinal hernia

[Link] of surgical mesh is a must.

[Link] sac should be excised at surgery.

[Link] a preformed sac formed by a persistent processus vaginalis.

[Link] neck of its sac lies medial to the inferior epigastric artery.

[Link] is mostly congenital

72- A 20-year-old male patient underwent an uneventful appendectomy for acute appendicitis. All the
following are true about his postoperative care except:

[Link] swelling and discharge could be a sign of wound infection

[Link] examination of the appendix is mandatory

[Link] development of new onset diarrhoea could be due to pelvic abscess

[Link] use of post-operative metronidazole and cefuroxime for 3 days reduce postoperative hospital
stay.

[Link] mobilization can reduce the risk of deep vein thrombosis

73- A 52-year-old obese lady reports a painless grape sized mass in her groin area. She has no medical
conditions apart from some varicose veins. There is a cough impulse, and the mass disappears on lying
down. What is the most likely cause?

a. Saphena varix

b. Arteriovenous malformation

c. False aneurysm of the femoral artery

d. Femoral hernia

e. Inguinal hernia

74- What is the ideal time for prophylactic dose of antibiotic in patient who is planned for right
hemicolectomy?

a. Early morning of the day of surgery

b. One day before surgery

c. One hour after incision

d. Four hours before incision

e. Thirty minutes before incision

75- All of the following are advantages of FAST (focused assessment with sonography for trauma),
compared to CT scan of the abdomen, in blunt abdominal trauma EXCEPT:

a. Gives early diagnosis

b. The diagnosis is usually specific of which organ is affected

c. Does not need patient transport

d. Can be repeated

e. Performed rapidly

76- One of the following patients require urgent investigation to malignancy

a. A 58-year-old with anemia and low MCV

b. A 45-year-old male with constipation of 2 weeks duration

c. A 60-year-old Patient with anal pain and fresh rectal bleeding

d. A 24-year-old female patient with right iliac fossa pain

e. A 65-year-old female with full thickness rectal prolapse

77- The most common microorganism causing liver abscess is?

a. Klebsiella

b. Staphylococcus (according to the internet)

c. proteus

d. Pseudomonas

e. E-coli

78- All the following is true about inguinal hernia repair EXCEPT

a. Irreducible hernia is a risk factor for strangulation

b. Chronic postoperative pain can be as high as 20 % of cases

c. Is a clean operation

d. Cannot be performed as a day case setting if it was done under local anesthesia

e. Testicular atrophy is a known postoperative complication

79- Life threatening organ dysfunction caused by a dysregulated host response to infection is the
definition of:

a. Septicemia
b. Sepsis
c. Septic shock
d. Refractory shock
e. Severe sepsis

80- All of the following are part of the primary survey in trauma patients except:

a. Plain abdomen X-ray

b. CXR
c. FAST
d. Pelvic X-ray
e. Cervical spine

81- All true about necrotizing fasciitis except:

a. Carries high mortality

b. Occur in immunocompromised subjects
c. Is a single microbial infection in 80% of cases
d. Trauma can be a predisposing factor
e. Require urgent treatment with antibiotics and debridement

82- Noradrenaline will be most useful in which form of shock?**

a. Obstructive
b. Is contraindicated in shock
c. distributive
d. Metabolic
e. Cardiogenic
83- All of the followings are within the spermatic cord in the inguinal canal
except:

a. Testicular artery
b. Genital branch of genitofemoral nerve
c. Artery to the vas
d. Lymphatics
e. Inferior epigastric artery

84- All are correct about Clostridium Difficile colitis except:

a. Most likely affect elderly patients with co-morbidities

b. The use of a cephalosporin-based antibiotic is a risk factor
c. Surgery is the first line of management
d. Oral but not intravenous vancomycin is of help in this situation
e. Can be diagnosed by performing flexible sigmoidoscopy

85- One of the following is true about inguinal hernia

a. More common in females

b. Reducible hernia is a high-risk factor for strangulation
c. Testicular atrophy is a known postoperative complication
d. Can’t be performed as a day-case setting
e. Is a clean-contaminated operation

*If it was a herniotomy (in peds) or without using a mesh it would’ve been clean

86- False about hypernatremia?

a. cannot use NL saline if the patient has hypovolemia

b. associated with inadequate water intake

c. Should not be corrected greater than 0.5mmol/L/hr

d. clinically manifest primarily by neurological effects

e. if hypervolemia is present use furosemide

87- Wrong about Inguinal hernia?

a. femoral is the most common hernia in females

b. females are more likely to have femoral

c. males are more likely to have inguinal

d. Inguinal hernia is superior & medial to pubic tubercle

e. Femoral hernia is inferior & lateral to pubic tubercle

88- Who should receive blood transfusion?

a. A patient with with Hb 8 with tachycardia and SOB

b. A patient with with HB 10 and CAD

c. A patient on hemodialysis and Hb 7

d. A patient with 1 g\dL drop in Hb after bleeding

89- Which of the following is an indication for FFP?

a. volume repletion

b. reversal of bleeding due to clopidogrel

c. A patient who received 1 PRBC

d. A patient who is on warfarin with a high INR

90- not commonly seen with diarrhea?

a. alkalosis
b. hypercalcemia

91- All of the following can present in an acute trauma patient except:

a. hypoglycemia

b. lipolysis.

c. hypercatabolism

d. gluconeogenesis.

92- A patient presenting to the ER after an RTA. He is conscious and communicative. He was

found to be hypotensive and is complaining of abdominal pain. What is the best next

step?

a. Jaw thrust

b. chin lift

c. intubation

d. IV line
E. emergent laparotomy

93- A patient was being treated for lower leg ulcer with a cephalosporin. He developed

diarrhea and tested positive for [Link] with the stool toxin test. Best next step?

a. Switch to oral vancomycin

b. start metronidazole therapy

94- Which of the following is associated with the highest perioperative mortality?

a. MI 4 months ago

b. Aortic stenosis

c. CHF with Hb 7 “not sure”

d. Frequent PVCs

e. Age more than 70

95- A patient had epidural anesthesia for a lower abdominal surgery, she has headache after

the procedure, which of the following is not done to decrease the headache?

a. bed rest

b. analgesics

c. decrease caffeine intake

d. epidural blood patch

e. oral hydration

96- Which of the following is false about hypercalcemia:

a. breast cancer metastasis is an unusual cause

b. severely hypercalcemic patient will have signs of extracellular fluid volume deficit

c. Volume repletion would result in increased urinary excretion of calcium

d. Hypercalcemic patients will have signs and symptoms similar to hyperglycemia

97- Not given in cardiogenic shock: (both could be given according to the internet)

a. nitroprusside

b. norepinephrine

98- Antibiotic given for cholecystectomy prophylaxis:

a. Cefuroxime
b. Cefazolin
c. Ceftriaxone
d. Metronidazole

99- Drug of choice for hydatid cyst:

a. Mebendazole
b. Ketoconazole
c. Albendazole

100- Wrong about femoral canal:

a. Inguinal ligament is the superior border of femoral canal

b. Pectinular line posterioly to femoral canal
c. Contains lymph Nodes
d. lacunar ligament is the lateral border

101- All of following considered distributive shock except:

a. anaphylactic

b. hemorrhagic

c. septic

102- Unlikely injured site to cause hypovolemic shock:

a. Intracranial
b. Spleen

103- Wrong about Massive blood transfusion:

a. One blood volume in 24

b. 10 units in 12 hrs

c. 50% blood volume in 3 hrs

d. 4 units in one hour

e. Transfusion needing FFP to treat coagulopathy

104- About hernias what is true:

a. Strangulation mortality is above 10%

b. Indirect hernia are 20% of inguinal hernia
c. Females have femoral hernia more than inguinal hernia
d. Are second to adhesions as a cause of intestinal obstruction

105- Sepsis with organ failure and persistent hypotension is the definition of:

a. Septic shock

b. SIRS

c. Severe sepsis

d. MODS

106- Not part of the SIRS criteria:

a. Temperature < 36

b. HR >90

c. WBC > 12000 or < 4000

d. RR>8 or PaCO2 >23mmHg

e. Cell bands > 10%

107- Antibiotic prophylaxis for inguinal hernia repair with mesh:

a. Vancomycin

b. 1st generation cephalosporin (cefazolin)

c. 2nd generation cephalosporin

d. 3rd generation cephalosporin

108- all are risk factors for C. difficile infection except:

a. smoking

b. PPI

c. Prolonged broad-spectrum antibiotics use

d. Severely ill patient

109- Rare hernia in females:

a. direct inguinal hernia

b. indirect inguinal hernia

c. femoral hernia

d. incisional hernia

e. umbilical hernia

110- All are absolute contraindications to insert NGT except:

a. confirmed esophageal rupture

b. suspected esophageal rupture

c. esophageal stricture (Most likely )

d. foreign body in esophagus

111- False about IV fluids :

A. NaCL has 154 mEq Na & 154 mEq Cl

B. RL is the most physiological

C. hypotonic fluids can increase intracerebral pressure (or edema)

D. colloids can cause volume overload

E. G5W is enough to support nutrition for a fasting patient

112- All given for treatment of pseudo membranous colitis except:

a. metronidazole

b. vancomycin

c. steroids

d. stop offending antibiotic

113- All risk factors for [Link] infections except:

a. vegetarian
b. long course of antibiotics
114- High velocity penetrating trauma, transverse abdomen at mid umbilicus, which is likely to be
injured:

a. small bowel

b. liver

c. kidney

d. spleen

115- Source of infection after inguinal hernia repair is:

a. Patient’s skin (NOT SURE)

b. instruments

c. surgeon

116- False about hypermagnesemia:

A. associated with ECG changes consistent with hyperkalemia

b. Deep tendon reflexes are exaggerated (lost usually)

c. Levels are parallel with potassium levels

117- most important factor for wound healing:

a. vit.D

b. vit.C

c. carbohydrate

d. caloric intake

e. balanced diet

118- Source of protein in pts with trauma is:

a. liver

b. plasma protein

c. skeletal muscle
119- About erysipelas, all are true except:

a. caused by group A Strep

b. Painful
c. Red, flat, skin lesions
d. Face is common site
e. Treated with penicillin

120- SSI, usually occurs when?

a. 4-5 days post op

121- Prophylactic antibiotic not indicated in:

a. Hernioplasty
b. Herniorrhaphy
c. Duct ectasia
d. Colectomy

122- All are risk factors of wound infection except:

a. DM
b. Immunosuppression
c. Vit C def
d. Young age

123- A patient with multiple fractures and hypovolemic shock, what is the initial resuscitation?

a. Blood
b. FFP
c. Hypertonic saline
d. Ringer’s lactate

124- Body response to major trauma/ shock includes one of the following:

a. Increased Na and water secretion

b. Increased renal perfusion
c. Hyperkalemia
d. Hypoglycemia
e. Decreased cortisol production

125- Compared to ICF, the ECF has one of the following:

a. Lower Cl-
b. Higher K+
c. Lower protein
d. Lower pH
 e. Bigger in volume

126- Which of the following is true about femoral hernia?

a. More common in middle aged and older women

b. Can be above and medial to the inguinal ligament

127- What is the volume of distribution of crystalloids?

a. ECF
b. ICF
c. Transcellular fluid

128- After a CVA, an elective surgery must be delayed for how long?

a. 7 days
b. 6 weeks (for MI)
c. 3 months
d. 6 months
e. 1 year

129- A 24-year-old healthy male, undergoing hernia repair at 12mid-day, he started fasting at midnight
(12 hours fasting), what is the maintenance fluid therapy?

a. 1250 ml NS+ 500 ml D5W

b. 1250 ML D5W+ 500 ml NS
c. 1000 ml D5W+ 2500ml RL
d. 1000 ml RL+ 2500 ml D5W

130- 10 Kgs infant, 11 months old, temp 38 C, what is the maintenance fluid per day?

a. 300 ml
b. 500 ml
c. 800 ml
d. 1200 ml
e. 1500 ml

131- At which day post-op will the protein start to be metabolized?

a. 5
b. 7 NOT SURE
c. 10
d. 13
e. 15
132- All of the following statements regarding the use of systemic prophylactic antibiotics are true,

EXCEPT:

A. The goal is to attain high tissue level at time of incision.

B. Should be as broad-spectrum as possible in most cases.

C. Are usually given as a single dose.

D. They are not effective if given 3 hours after making the incision.

E. Are not effective in reducing postoperative respiratory infections.

133- Concerning erysipelas, all of the following statements are true, EXCEPT:

A. Is caused by staphylococcus.

B. Is typically painless.

C. Is effectively treated by penicillin.

D. Hands are mainly involved.

E. The lesion has ill-defined flat edge.

143- tetanus, all of the following statements are true, EXCEPT:

A. The majority of cases are due to endogenous infection.

B. It is caused by gram negative anaerobic bacilli.

C. Tetanolysin is the most important neurotoxin responsible for the disease

D. The disease is characterized by episodes of convulsions with short period of muscle relaxation in

between.

E. Penicillin and metronidazole are used to treat an established infection.

135- All of the following statements about surgical site infections (SSIs) are true, EXCEPT:

A. Infection in the musculofascial tissues is known as deep SSI.

B. The patient may have systemic signs in a minor SSI.

C. Infection causing delay in hospital discharge is a major SSI.

D. The differentiation between major and minor SSIs is extremely important.

E. Surveillance for surgical site infection should be done for a year after implanted joint surgery.
136- Which of the following statement concerning intravenous nutritional support is TRUE?

A. Concentrations of glucose no higher than 5% should be used to avoid peripheral vein sclerosis

B. A major disadvantage of the peripheral technique is limited caloric delivery

C. If total parenteral nutrition is required, access to the superior vena cava via the external jugular vein

is the most suitable site

D. Venous thrombosis is an uncommon complication for long-term central vein catheterization

E. amino acid solutions should only be administered centrally

137- A 40 year old male patient involved in a road traffic accident, at the accident and emergency
department his Glasgow coma scale was 15, but he had shortness of breath, hypotension with
tachycardia. He had a patent airway with difficulty in breathing. The air entry was reduced and hyper-
resonant on the right side of the chest. The most appropriate next step is:

A. Urgent chest x ray

B. IV access and blood transfusion

C. Intubation and ventilation

D. Needle thoracostomy

E. Diagnostic peritoneal lavage

138- All of the following is correct about Femoral hernia EXCEPT:

A. More common in women

B. The risk of strangulation is more as compared with inguinal hernia

C. It present as a swelling below and medial to Pubic tubercle

D. The sac may contain omentum

E. Can be a cause of small bowel obstruction

139- A 35 year old male patient, admitted with abdominal pain, distension and excessive vomiting. He
had previous history of appendectomy at the age of 18. The most likely cause for this illness is:

A. Internal hernia

B. Right colon cancer

C. Volvulus
D. Adhesions

E. Acute mesenteric ischaemia

140- Concerning postoperative atelectasis, all of the following statements are true EXCEPT:

A. This is the most common cause of postoperative fever that starts on postoperative day four.

B. The physical examination may demonstrate dullness to percussion over the involved area and

diminished or absent breath sounds.

C. The most common cause of postoperative atelectasis is bronchial obstruction by plugs of tenacious

sputum.

D. Postoperative atelectasis is best managed by standard chest physiotherapy, deep breathing,

coughing, and suctioning of patients who are intubated.

E. Judicious use of postoperative analgesia is an essential adjunct permitting patients to breathe deeply,

cough forcefully and participate in chest physiotherapy

141- The most commonly involved organ in penetrating abdominal trauma is:

A. Small bowel

B. Colon

C. Liver

D. Spleen

E. Kidney

142- How many kilocalories per gram are contained in the glucose used in parenteral formulas?

A. 4.0

B. 5.5

C. 9.0

D. 10.0

E. 11.9
143- Re-feeding syndrome is characterized by which of the following electrolyte abnormalities?

A. Hyponatremia, hypokalemia, hypercalcemia

B. Hyperphosphatemia, hypokalemia, hypocalcemia

C. Hypokalemia, hypomagnesemia, hypophosphatemia

D. Hypocalcemia, hyponatremia, hypomagnesemia

E. Hyperglycemia, hyperkalemia, hyperphophatemia

144- A child who was involved in a road traffic accident has a bleeding open femur fracture. What is the
first step in fluid resuscitation in the emergency room?

A. Bolus 10ml/kg of normal saline

B. Bolus 20ml/kg of normal saline

C. Bolus 20ml/kg of colloid

D. Transfuse 20ml/kg of packed red blood cells

E. Transfuse 20ml/kg of packed red blood cells, fresh frozen plasma, and platelets

145- The least likely differential diagnosis of a groin lump in a supine patient is?

A. Irreduicable inguinal hernia.

B. Psoas abscess.

C. Hodgkin lymphoma.

D. Saphena varix.

E. Femoral artery aneurysm.

146- A loss of 30% of blood volume in a 70kg man results in:

A. few initial symptoms

B. slight decrease in hematocrit

C. increased capillary hydrostatic pressure

D. decrease in venomotor tone

E. increased release of anti-diuretic hormone (ADH)

147- All of the following are signs of hypovolemic shock EXCEPT:

A. Skin vasoconstriction

B. Confusion

C. Tachycardia

D. Distended neck veins

E. Tachypnea

148- All of the following are considered early postoperative complications EXCEPT:

A. Fever

B. Urinary Tract Infection

C. Wound Infection

D. Deep Venous Thrombosis

E. Incisional hernia

149- All of the following options are correct regarding major lower limb amputation EXCEPT:

A. Energy expenditure to achieve mobility is lower following above knee amputation compared to

below knee amputation

B. Patient outcome is worse following emergency amputation than elective amputation

C. Amputations performed by specialist surgeons have improved outcomes

D. Compared to the general population, patients with diabetes are at higher risk of major amputations

E. Deep vein thrombosis is a recognized risk following major amputation

150- Complications of massive blood transfusion include all of the following EXCEPT**

A. Hypothermia

B. Thrombocytopenia

C. Hyperkalaemia

D. Hypercalcaemia

E. Metabolic acidosis
• Not to do in sepsis? Infection source control During 1st hour, stabilize the patient first
• Wrong about fluids: 130mml/L of Cl in ringer lactate
• Regarding wounds Which is true? Diverticulitis stage 2 is considered a contaminated wound
• 1st in hemostasis >>> Vasoconstriction
• Vit. C.>>> Hydroxyaltion of procollagen
• True about abx: carabapenems have good coverage for gram +ve and anaerobes
• True about gas gangrene?? pain, crepitus and toxemia
• True>>> Canal of Nuck opens in labia majora
• true about hypovolemic shock? Increased SVR
• MCC in septic shock? staph/ pseudomonas/ Ecoli
• true about septic shock: persisting hypotension requiring vasopressors to maintain a MAP of 65
• Management of gastric outlet obstruction with hypochloremic hypokalemic metabolic alkalosis? 0.9
NS infusion with KCl
• Most common cause of death after blood transfusion? - TRALI
• Which of the following is true about body fluids? ± It might be affected by wide range of
physiological variation
• Which of the following is true about body fluids? ± The concentration of sodium in the intravascular
and the interstitial compartment is almost equal.
• Amino acid most important in improving immunity: glutamine
• limit for K in peripheral line: 20 mEq
• Pt with crush injury, in respiratory distress, multiple rib fractures, life saving measure is: intubation
and mechanical ventilation
• Plain AXR in SBO, what is the finding? Valvulae conniventes (plica circularis)
• Not complication of TPN: - Hypoglycemia (mentioned in past papers, but both HYPO/HYPER
glycemia are possible complications of TPN)