ABSITE EXAM 2026 - Miscellaneous (Heme, OBGYN, ENT, nutrition, toxicology,
periop, anatomy, physiology, urology, anesthesia, infectious disease, biostats)
Question 1
A 28-year-old female is diagnosed with Immune Thrombocytopenic Purpura (ITP) with a platelet
count of 15,000/µL. She has no active bleeding. Which of the following is the most appropriate
first-line therapy?
A) Immediate platelet transfusion
B) Intravenous immunoglobulin (IVIG)
C) High-dose steroids
D) Emergent splenectomy
E) Rituximab
Correct Answer: C) High-dose steroids
Rationale: In ITP, the primary pathophysiology involves IgG-coated platelets being
sequestered and destroyed by splenic macrophages. High-dose steroids are the gold-
standard first-line therapy to decrease this immune destruction. Platelet transfusion is
generally avoided and only indicated in the setting of life-threatening active bleeding, as
transfused platelets will be rapidly destroyed by the same mechanism.
Question 2
A patient with Type 1 Von Willebrand Disease (vWD) is undergoing a minor surgical procedure.
Which of the following is the most appropriate initial treatment to minimize bleeding risk?
A) Cryoprecipitate
B) Fresh Frozen Plasma
C) Desmopressin (DDAVP)
D) Factor VIII concentrate
E) Vitamin K
Correct Answer: C) Desmopressin (DDAVP)
Rationale: Desmopressin is the treatment of choice for Type 1 vWD. It works by stimulating
the release of endogenous von Willebrand factor and Factor VIII from endothelial Weibel-
Palade bodies. Cryoprecipitate (Option A) contains vWF but is typically reserved for more
severe types or when DDAVP is ineffective/contraindicated due to the risk of transfusion-
transmitted infections.
Question 3
A 19-year-old male with Hemophilia A requires an inguinal hernia repair. What is the target
Factor VIII activity level recommended for major surgery in this patient?
A) 30%
B) 50%
C) 80%
D) 100%
E) 120%
Correct Answer: C) 80%
, 2
Rationale: Hemophilia A is a deficiency in Factor VIII. For major surgical procedures,
Factor VIII levels should be checked preoperatively and replaced to a target level of at least
80% to 100% to ensure adequate hemostasis. Postoperatively, levels are typically
maintained at 50% for several days.
Question 4
A patient on long-term clopidogrel (Plavix) therapy requires emergent surgery for a perforated
viscus. Which of the following is the most effective way to reverse the antiplatelet effects of this
medication?
A) Protamine sulfate
B) Vitamin K
C) Platelet transfusion
D) Desmopressin
E) Idarucizumab
Correct Answer: C) Platelet transfusion
Rationale: Clopidogrel irreversibly inhibits the P2Y12 adenosine diphosphate (ADP)
receptor on platelets. Because the inhibition is irreversible for the life of the platelet (7–10
days), the only way to rapidly restore platelet function in an emergent setting is the
transfusion of new, functional platelets.
Question 5
Following a high-level spinal cord injury, a patient presents with hypotension, bradycardia, and
warm extremities. Which of the following hemodynamic profiles is most consistent with this
condition?
A) Increased SVR, Increased CVP
B) Reduced SVR, Increased PCWP
C) Reduced SVR, Reduced CVP, Bradycardia
D) Increased CO, Increased SVR
E) Increased PCWP, Reduced CI
Correct Answer: C) Reduced SVR, Reduced CVP, Bradycardia
Rationale: Neurogenic shock results from a loss of sympathetic tone. This leads to massive
vasodilation (reduced SVR), decreased venous return (reduced CVP), and a loss of
compensatory tachycardia (bradycardia). PCWP is typically unchanged or decreased due
to the expanded vascular space relative to volume.
Question 6
A 24-year-old female presents with a mucopurulent cervical discharge and a friable cervix.
Which of the following is the most appropriate antibiotic regimen?
A) Penicillin G
B) Ceftriaxone and Doxycycline
C) Metronidazole only
, 3
D) Ciprofloxacin
E) Vancomycin
Correct Answer: B) Ceftriaxone and Doxycycline
Rationale: This presentation is classic for mucopurulent cervicitis, most commonly caused
by Neisseria gonorrhoeae and Chlamydia trachomatis. Current guidelines recommend dual
therapy with Ceftriaxone (to cover gonorrhea) and Doxycycline (to cover chlamydia).
Question 7
A 30-year-old female with a suspected ectopic pregnancy is hemodynamically stable. Which of
the following findings would most strongly favor surgical intervention over methotrexate
therapy?
A) Adnexal mass of 2 cm
B) BHCG level of 2,500 mIU/mL
C) Adnexal mass of 5 cm
D) Absence of fetal heart tones
E) History of a previous C-section
Correct Answer: C) Adnexal mass of 5 cm
Rationale: In ectopic pregnancy, surgical intervention (e.g., laparoscopic salpingostomy) is
indicated for hemodynamic instability, inability to tolerate or follow up with methotrexate,
an adnexal mass > 4 cm, or a BHCG level > 5,000 mIU/mL. Smaller masses and lower
BHCG levels are often amenable to medical management.
Question 8
A patient is found to have a tumor of a minor salivary gland. In which of the following
anatomical locations is this tumor most likely to be found?
A) Buccal mucosa
B) Tongue base
C) Hard palate
D) Floor of mouth
E) Nasopharynx
Correct Answer: C) Hard palate
Rationale: The most common site for minor salivary gland tumors is the palate (specifically
the hard palate). Unlike major salivary gland tumors, which are mostly benign, a higher
percentage of minor salivary gland tumors are malignant.
Question 9
Which of the following salivary gland malignancies is characterized by a slow, insidious growth
pattern but a high propensity for late distant metastasis and significant "nerve avidity" (perineural
invasion)?
A) Mucoepidermoid carcinoma
B) Warthin's tumor
, 4
C) Adenoid cystic carcinoma
D) Pleomorphic adenoma
E) Acinic cell carcinoma
Correct Answer: C) Adenoid cystic carcinoma
Rationale: Adenoid cystic carcinoma is notorious for its insidious growth and high affinity
for nerves (perineural invasion). While it may be treated locally, it often presents with
distant metastases (often to the lungs) many years after the initial diagnosis.
Question 10
What is the recommended daily maintenance requirement of Vitamin D for an average adult?
A) 100–200 IU
B) 400–600 IU
C) 600–2,000 IU
D) 5,000–10,000 IU
E) 20,000 IU
Correct Answer: C) 600–2,000 IU
Rationale: Daily maintenance requirements for Vitamin D generally range from 600 to
2,000 IU. Deficiency is common in surgical patients and can be identified as a component of
preoperative nutritional risk assessments like the Duke PONS.
Question 11
The Duke Preoperative Nutrition Score (PONS) is used to identify patients at risk for poor
surgical outcomes. Which of the following is NOT a component of this score?
A) BMI < 18.5
B) Weight loss > 5% in past 3 months
C) Decreased appetite for the past week
D) Albumin < 3.0 g/dL
E) Serum Transferrin < 200 mg/dL
Correct Answer: E) Serum Transferrin < 200 mg/dL
Rationale: The Duke PONS uses four criteria: 1) BMI (Big), 2) Weight loss over the past 3
months (Women), 3) Decreased appetite over the past week (Don't), and 4) Albumin < 3 or
Vitamin D < 20 (Albumin). Serum transferrin is not part of this specific scoring system.
Question 12
Administering a tetanus booster to a patient with a clean wound is an example of which level of
prevention?
A) Primary prevention
B) Secondary prevention
C) Tertiary prevention
D) Quaternary prevention
E) Primordial prevention
periop, anatomy, physiology, urology, anesthesia, infectious disease, biostats)
Question 1
A 28-year-old female is diagnosed with Immune Thrombocytopenic Purpura (ITP) with a platelet
count of 15,000/µL. She has no active bleeding. Which of the following is the most appropriate
first-line therapy?
A) Immediate platelet transfusion
B) Intravenous immunoglobulin (IVIG)
C) High-dose steroids
D) Emergent splenectomy
E) Rituximab
Correct Answer: C) High-dose steroids
Rationale: In ITP, the primary pathophysiology involves IgG-coated platelets being
sequestered and destroyed by splenic macrophages. High-dose steroids are the gold-
standard first-line therapy to decrease this immune destruction. Platelet transfusion is
generally avoided and only indicated in the setting of life-threatening active bleeding, as
transfused platelets will be rapidly destroyed by the same mechanism.
Question 2
A patient with Type 1 Von Willebrand Disease (vWD) is undergoing a minor surgical procedure.
Which of the following is the most appropriate initial treatment to minimize bleeding risk?
A) Cryoprecipitate
B) Fresh Frozen Plasma
C) Desmopressin (DDAVP)
D) Factor VIII concentrate
E) Vitamin K
Correct Answer: C) Desmopressin (DDAVP)
Rationale: Desmopressin is the treatment of choice for Type 1 vWD. It works by stimulating
the release of endogenous von Willebrand factor and Factor VIII from endothelial Weibel-
Palade bodies. Cryoprecipitate (Option A) contains vWF but is typically reserved for more
severe types or when DDAVP is ineffective/contraindicated due to the risk of transfusion-
transmitted infections.
Question 3
A 19-year-old male with Hemophilia A requires an inguinal hernia repair. What is the target
Factor VIII activity level recommended for major surgery in this patient?
A) 30%
B) 50%
C) 80%
D) 100%
E) 120%
Correct Answer: C) 80%
, 2
Rationale: Hemophilia A is a deficiency in Factor VIII. For major surgical procedures,
Factor VIII levels should be checked preoperatively and replaced to a target level of at least
80% to 100% to ensure adequate hemostasis. Postoperatively, levels are typically
maintained at 50% for several days.
Question 4
A patient on long-term clopidogrel (Plavix) therapy requires emergent surgery for a perforated
viscus. Which of the following is the most effective way to reverse the antiplatelet effects of this
medication?
A) Protamine sulfate
B) Vitamin K
C) Platelet transfusion
D) Desmopressin
E) Idarucizumab
Correct Answer: C) Platelet transfusion
Rationale: Clopidogrel irreversibly inhibits the P2Y12 adenosine diphosphate (ADP)
receptor on platelets. Because the inhibition is irreversible for the life of the platelet (7–10
days), the only way to rapidly restore platelet function in an emergent setting is the
transfusion of new, functional platelets.
Question 5
Following a high-level spinal cord injury, a patient presents with hypotension, bradycardia, and
warm extremities. Which of the following hemodynamic profiles is most consistent with this
condition?
A) Increased SVR, Increased CVP
B) Reduced SVR, Increased PCWP
C) Reduced SVR, Reduced CVP, Bradycardia
D) Increased CO, Increased SVR
E) Increased PCWP, Reduced CI
Correct Answer: C) Reduced SVR, Reduced CVP, Bradycardia
Rationale: Neurogenic shock results from a loss of sympathetic tone. This leads to massive
vasodilation (reduced SVR), decreased venous return (reduced CVP), and a loss of
compensatory tachycardia (bradycardia). PCWP is typically unchanged or decreased due
to the expanded vascular space relative to volume.
Question 6
A 24-year-old female presents with a mucopurulent cervical discharge and a friable cervix.
Which of the following is the most appropriate antibiotic regimen?
A) Penicillin G
B) Ceftriaxone and Doxycycline
C) Metronidazole only
, 3
D) Ciprofloxacin
E) Vancomycin
Correct Answer: B) Ceftriaxone and Doxycycline
Rationale: This presentation is classic for mucopurulent cervicitis, most commonly caused
by Neisseria gonorrhoeae and Chlamydia trachomatis. Current guidelines recommend dual
therapy with Ceftriaxone (to cover gonorrhea) and Doxycycline (to cover chlamydia).
Question 7
A 30-year-old female with a suspected ectopic pregnancy is hemodynamically stable. Which of
the following findings would most strongly favor surgical intervention over methotrexate
therapy?
A) Adnexal mass of 2 cm
B) BHCG level of 2,500 mIU/mL
C) Adnexal mass of 5 cm
D) Absence of fetal heart tones
E) History of a previous C-section
Correct Answer: C) Adnexal mass of 5 cm
Rationale: In ectopic pregnancy, surgical intervention (e.g., laparoscopic salpingostomy) is
indicated for hemodynamic instability, inability to tolerate or follow up with methotrexate,
an adnexal mass > 4 cm, or a BHCG level > 5,000 mIU/mL. Smaller masses and lower
BHCG levels are often amenable to medical management.
Question 8
A patient is found to have a tumor of a minor salivary gland. In which of the following
anatomical locations is this tumor most likely to be found?
A) Buccal mucosa
B) Tongue base
C) Hard palate
D) Floor of mouth
E) Nasopharynx
Correct Answer: C) Hard palate
Rationale: The most common site for minor salivary gland tumors is the palate (specifically
the hard palate). Unlike major salivary gland tumors, which are mostly benign, a higher
percentage of minor salivary gland tumors are malignant.
Question 9
Which of the following salivary gland malignancies is characterized by a slow, insidious growth
pattern but a high propensity for late distant metastasis and significant "nerve avidity" (perineural
invasion)?
A) Mucoepidermoid carcinoma
B) Warthin's tumor
, 4
C) Adenoid cystic carcinoma
D) Pleomorphic adenoma
E) Acinic cell carcinoma
Correct Answer: C) Adenoid cystic carcinoma
Rationale: Adenoid cystic carcinoma is notorious for its insidious growth and high affinity
for nerves (perineural invasion). While it may be treated locally, it often presents with
distant metastases (often to the lungs) many years after the initial diagnosis.
Question 10
What is the recommended daily maintenance requirement of Vitamin D for an average adult?
A) 100–200 IU
B) 400–600 IU
C) 600–2,000 IU
D) 5,000–10,000 IU
E) 20,000 IU
Correct Answer: C) 600–2,000 IU
Rationale: Daily maintenance requirements for Vitamin D generally range from 600 to
2,000 IU. Deficiency is common in surgical patients and can be identified as a component of
preoperative nutritional risk assessments like the Duke PONS.
Question 11
The Duke Preoperative Nutrition Score (PONS) is used to identify patients at risk for poor
surgical outcomes. Which of the following is NOT a component of this score?
A) BMI < 18.5
B) Weight loss > 5% in past 3 months
C) Decreased appetite for the past week
D) Albumin < 3.0 g/dL
E) Serum Transferrin < 200 mg/dL
Correct Answer: E) Serum Transferrin < 200 mg/dL
Rationale: The Duke PONS uses four criteria: 1) BMI (Big), 2) Weight loss over the past 3
months (Women), 3) Decreased appetite over the past week (Don't), and 4) Albumin < 3 or
Vitamin D < 20 (Albumin). Serum transferrin is not part of this specific scoring system.
Question 12
Administering a tetanus booster to a patient with a clean wound is an example of which level of
prevention?
A) Primary prevention
B) Secondary prevention
C) Tertiary prevention
D) Quaternary prevention
E) Primordial prevention
