SURGERY
1. A man sustained severe blunt injuries in a car crash twelve hours ago.The
activity of this hormone is now expected to be decreased in this patient:
A. insulin
B. cortisol
C. epinephrine
D. aldosterone
(Classification - Application; Source – Schwartz‟s Textbook of Surgery (8th
edition): pp. 25-29)
2. A young woman is debilitated by pruritus and burning sensation from her
presternal keloid. The recommended initial treatment is:
A. topical application of silicone sheets
B. intralesional corticosteroid injection
C. surgical excision
D. low-dose radiation
(Classification - Recall; Source – Schwartz‟s Textbook of Surgery (8th edition):pp.
241-242)
3. A patient is placed on NPO in preparation for an elective major abdominal
surgery. The body‟s preferred initial fuel source during the fasting state is:
A. hepatic glycogen
B. skeletal muscle glycogen
C. muscle protein
D. body fat
(Classification - Recall; Source – Schwartz‟s Textbook of Surgery (8th edition): p.24)
4. A 48-year-old woman has prolonged ileus after surgery for an obstructed
duodenal ulcer. The problem is probably due to:
A. hypochloremia
B. hypocalcemia
C. hypomagnesemia
D. hypokalemia
(Classification - Application; Source – Schwartz‟s Textbook of Surgery (8th
edition): pp. 48-49)
5. A man with chronic prepyloric ulcer appears weak after repeated bouts of non-
bilious vomiting over the past 3 days. Fluid therapy should be startedusing:
A. Normosol M
B. Lactated Ringer‟s solution
C. Normal saline solution
D. Hypertonic saline solution
(Classification - Application; Source – Schwartz‟s Textbook of Surgery (8th
edition): pp. 51-52)
6. A multiply injured patient has persistently low urine output. The oliguria is most
likely due to prerenal failure rather than acute tubular necrosis if thetests reveal:
A. low urine specific gravity
B. low urinary excretion of sodium
C. low BUN/creatinine ratio
D. low creatinine clearance
,(Classification - Application; Source – Schwartz‟s Textbook of Surgery (8th
edition): pp. 348-349)
7. A woman admitted to the ICU for severe acute pancreatitis begins to manifest
paresthesia of the face and extremities, muscle cramps, and apositive
Chvostek‟s sign. These are probably due to:
A. hypocalcemia
B. hypokalemia
C. hypomagnesemia
D. hypophosphatemia
(Classification - Application; Source – Schwartz‟s Textbook of Surgery (8th
edition): p. 50)
8. Increased nutritional support appears to aggravate tachypnea in a septic patient
with respiratory failure. Lessening the amount of this substrate mayalleviate the
problem:
A. carbohydrate
B. fat emulsion
C. essential amino acids
D. non-essential amino acids
(Classification - Recall; Source – Schwartz‟s Textbook of Surgery (8th edition):pp.
28-29)
9. Administration of this amino acid is expected to be beneficial to a patient
suffering from damage to intestinal mucosa due to adjuvant chemotherapyfor
esophageal cancer:
A. arginine
B. valine
C. leucine
D. glutamine
(Classification - Recall; Source – Schwartz‟s Textbook of Surgery (8th edition): p.38)
10. Early supplementation of this vitamin is recommended to promote woundrepair
in a patient with extensive second-degree flame burns:
A. A
B. C
C. D
D. E
(Classification - Application; Source – Schwartz‟s Textbook of Surgery (8th
edition): p. 210)
11. A diabetic 41-year-old man is admitted for necrotizing fasciitis in the
perineum. A high dose of this antibiotic is generally included in the initial
antimicrobial therapy because of concern for clostridial pathogens:
A. metronidazole
B. vancomycin
C. penicillin G
D. aminoglycoside
(Classification - Recall; Source – Schwartz‟s Textbook of Surgery (8th edition): p.122)
12. Transfusion of properly cross matched blood is begun on a man admittedfor
massive bleeding from erosive gastritis and thirty minutes later, he develops
urticaria and fever. This should be administered to the patient:
A. antihistamine
B. mannitol
C. furosemide
, D. sodium bicarbonate
(Classification - Application; Source – Schwartz‟s Textbook of Surgery (8th
edition): pp. 79-80)
13. A patient under anticoagulation therapy using warfarin, who is set to
undergo surgery for acute cholecystitis, has decreased prothrombin
concentration. Warfarin can be reversed by parenteral dose of:
A. protamine sulfate
B. vitamin K
C. EACA
D. hydroxyurea
(Classification - Recall; Source – Schwartz‟s Textbook of Surgery (8th edition):pp.
73-74)
14. Arterial blood gas analysis is performed on a patient just admitted with a
diagnosis of severe acute pancreatitis. This reveals a pH of 7.30 and low levels
of bicarbonate and pCO2. The most urgent part of management is:
A. volume resuscitation
B. intravenous bicarbonate
C. calcium infusion
D. mechanical ventilation
(Classification - Application; Source – Schwartz‟s Textbook of Surgery (8th
edition): pp. 50-51)
15. Seven days after surgery for a perforated appendicitis, the primarily closed
incision is noted to be erythematous, slightly swollen and tender. The appropriate
treatment is:
A. local heat therapy
B. topical antibiotics
C. new systemic antibiotics
D. incision and drainage
(Classification - Application; Source – Schwartz‟s Textbook of Surgery (8th
edition): pp. 119-120)
16. A man is brought to the E.R. with blood spurting from a hacking wound in the in
the distal right thigh. He is alert and has a systolic BP of 100 mmHg.What is the
initial management step?
A. apply direct pressure on the wound with sterile gauze
B. apply digital pressure on proximal femoral artery
C. apply a thigh tourniquet above the wound
D. open the wound and clamp the bleeders
(Classification - Application; Source – Schwartz‟s Textbook of Surgery (8th
edition): p. 74)
17. A young man presents to the E.R. with a stab wound in the left chest.
Examination reveals subcutaneous emphysema and absent breath sounds on
the left chest; the trachea is shifted to the right. What is theprobable
diagnosis?
A. massive hemothorax
B. tension pneumothorax
C. cardiac tamponade
D. flail chest
(Classification - Application; Source – Schwartz‟s Textbook of Surgery (8th
edition): p. 131)
, distended, rigid and diffusely tender. This diagnostic test should be donefirst:
A. upright chest x-ray
B. esophagogastroduodenoscopy
C. abdominal ultrasound
D. abdominal CT scan
(Classification - Application; Source – Schwartz‟s Textbook of Surgery (8th
edition): pp. 959-960)
19. After aggressive fluid therapy, a trauma victim shows a systolic BP of 110mm
Hg, cold extremities, rapid but strong peripheral pulse, and a central venous
pressure of 12 cmH2O. The patient has:
A. increased systemic vascular resistance
B. decreased stroke volume index
C. decreased cardiac index
D. excessive cardiac preload
(Classification - Application; Source – Schwartz‟s Textbook of Surgery (8th
edition): p. 132)
20. An elderly man admitted with a diagnosis of sigmoid volvulus has a markedly
distended, non-tender abdomen and hyperactive bowel sounds.The initial
treatment is:
A. endoscopic detorsion
B. detorsion via laparotomy
C. decompressing transverse loop colostomy
D. Re section of involved segment of colon
(Classification - Recall; Source – Schwartz‟s Textbook of Surgery (8th edition): p.1098)
21. Pancreatic necrosis is suspected in a 49-year-old woman who has not
improved despite 3 days of intensive care for acute pancreatitis. The
diagnosis is best established through:
A. C-reactive protein measurement
B. abdominal ultrasound
C. contrast-enhanced CT scan
D. CT-guided percutaneous biopsy
(Classification - Recall; Source – Schwartz‟s Textbook of Surgery (8th edition):pp.
1234-1238)
22. A chronically constipated 67-year-old woman presents with acute leftlower
quadrant (LLQ) abdominal pain, LLQ direct and rebound tenderness, and
fever. The appropriate diagnostic examination is:
A. transvaginal ultrasound
B. abdominal CT scan
C. proctosigmoidoscopy
D. barium enema
(Classification - Application; Source – Schwartz‟s Textbook of Surgery (8th
edition): pp. 1082-1083)
23. After an elective hemicolectomy for colon cancer, a 78-year-old man remains
hypotensive and tachycardic. He has distended neck veins, coldskin, oliguria,
and elevated central venous pressure. He apparently is suffering from this type
of shock:
A. hypovolemic
B. cardiogenic
C. septic
D. neurogenic
1. A man sustained severe blunt injuries in a car crash twelve hours ago.The
activity of this hormone is now expected to be decreased in this patient:
A. insulin
B. cortisol
C. epinephrine
D. aldosterone
(Classification - Application; Source – Schwartz‟s Textbook of Surgery (8th
edition): pp. 25-29)
2. A young woman is debilitated by pruritus and burning sensation from her
presternal keloid. The recommended initial treatment is:
A. topical application of silicone sheets
B. intralesional corticosteroid injection
C. surgical excision
D. low-dose radiation
(Classification - Recall; Source – Schwartz‟s Textbook of Surgery (8th edition):pp.
241-242)
3. A patient is placed on NPO in preparation for an elective major abdominal
surgery. The body‟s preferred initial fuel source during the fasting state is:
A. hepatic glycogen
B. skeletal muscle glycogen
C. muscle protein
D. body fat
(Classification - Recall; Source – Schwartz‟s Textbook of Surgery (8th edition): p.24)
4. A 48-year-old woman has prolonged ileus after surgery for an obstructed
duodenal ulcer. The problem is probably due to:
A. hypochloremia
B. hypocalcemia
C. hypomagnesemia
D. hypokalemia
(Classification - Application; Source – Schwartz‟s Textbook of Surgery (8th
edition): pp. 48-49)
5. A man with chronic prepyloric ulcer appears weak after repeated bouts of non-
bilious vomiting over the past 3 days. Fluid therapy should be startedusing:
A. Normosol M
B. Lactated Ringer‟s solution
C. Normal saline solution
D. Hypertonic saline solution
(Classification - Application; Source – Schwartz‟s Textbook of Surgery (8th
edition): pp. 51-52)
6. A multiply injured patient has persistently low urine output. The oliguria is most
likely due to prerenal failure rather than acute tubular necrosis if thetests reveal:
A. low urine specific gravity
B. low urinary excretion of sodium
C. low BUN/creatinine ratio
D. low creatinine clearance
,(Classification - Application; Source – Schwartz‟s Textbook of Surgery (8th
edition): pp. 348-349)
7. A woman admitted to the ICU for severe acute pancreatitis begins to manifest
paresthesia of the face and extremities, muscle cramps, and apositive
Chvostek‟s sign. These are probably due to:
A. hypocalcemia
B. hypokalemia
C. hypomagnesemia
D. hypophosphatemia
(Classification - Application; Source – Schwartz‟s Textbook of Surgery (8th
edition): p. 50)
8. Increased nutritional support appears to aggravate tachypnea in a septic patient
with respiratory failure. Lessening the amount of this substrate mayalleviate the
problem:
A. carbohydrate
B. fat emulsion
C. essential amino acids
D. non-essential amino acids
(Classification - Recall; Source – Schwartz‟s Textbook of Surgery (8th edition):pp.
28-29)
9. Administration of this amino acid is expected to be beneficial to a patient
suffering from damage to intestinal mucosa due to adjuvant chemotherapyfor
esophageal cancer:
A. arginine
B. valine
C. leucine
D. glutamine
(Classification - Recall; Source – Schwartz‟s Textbook of Surgery (8th edition): p.38)
10. Early supplementation of this vitamin is recommended to promote woundrepair
in a patient with extensive second-degree flame burns:
A. A
B. C
C. D
D. E
(Classification - Application; Source – Schwartz‟s Textbook of Surgery (8th
edition): p. 210)
11. A diabetic 41-year-old man is admitted for necrotizing fasciitis in the
perineum. A high dose of this antibiotic is generally included in the initial
antimicrobial therapy because of concern for clostridial pathogens:
A. metronidazole
B. vancomycin
C. penicillin G
D. aminoglycoside
(Classification - Recall; Source – Schwartz‟s Textbook of Surgery (8th edition): p.122)
12. Transfusion of properly cross matched blood is begun on a man admittedfor
massive bleeding from erosive gastritis and thirty minutes later, he develops
urticaria and fever. This should be administered to the patient:
A. antihistamine
B. mannitol
C. furosemide
, D. sodium bicarbonate
(Classification - Application; Source – Schwartz‟s Textbook of Surgery (8th
edition): pp. 79-80)
13. A patient under anticoagulation therapy using warfarin, who is set to
undergo surgery for acute cholecystitis, has decreased prothrombin
concentration. Warfarin can be reversed by parenteral dose of:
A. protamine sulfate
B. vitamin K
C. EACA
D. hydroxyurea
(Classification - Recall; Source – Schwartz‟s Textbook of Surgery (8th edition):pp.
73-74)
14. Arterial blood gas analysis is performed on a patient just admitted with a
diagnosis of severe acute pancreatitis. This reveals a pH of 7.30 and low levels
of bicarbonate and pCO2. The most urgent part of management is:
A. volume resuscitation
B. intravenous bicarbonate
C. calcium infusion
D. mechanical ventilation
(Classification - Application; Source – Schwartz‟s Textbook of Surgery (8th
edition): pp. 50-51)
15. Seven days after surgery for a perforated appendicitis, the primarily closed
incision is noted to be erythematous, slightly swollen and tender. The appropriate
treatment is:
A. local heat therapy
B. topical antibiotics
C. new systemic antibiotics
D. incision and drainage
(Classification - Application; Source – Schwartz‟s Textbook of Surgery (8th
edition): pp. 119-120)
16. A man is brought to the E.R. with blood spurting from a hacking wound in the in
the distal right thigh. He is alert and has a systolic BP of 100 mmHg.What is the
initial management step?
A. apply direct pressure on the wound with sterile gauze
B. apply digital pressure on proximal femoral artery
C. apply a thigh tourniquet above the wound
D. open the wound and clamp the bleeders
(Classification - Application; Source – Schwartz‟s Textbook of Surgery (8th
edition): p. 74)
17. A young man presents to the E.R. with a stab wound in the left chest.
Examination reveals subcutaneous emphysema and absent breath sounds on
the left chest; the trachea is shifted to the right. What is theprobable
diagnosis?
A. massive hemothorax
B. tension pneumothorax
C. cardiac tamponade
D. flail chest
(Classification - Application; Source – Schwartz‟s Textbook of Surgery (8th
edition): p. 131)
, distended, rigid and diffusely tender. This diagnostic test should be donefirst:
A. upright chest x-ray
B. esophagogastroduodenoscopy
C. abdominal ultrasound
D. abdominal CT scan
(Classification - Application; Source – Schwartz‟s Textbook of Surgery (8th
edition): pp. 959-960)
19. After aggressive fluid therapy, a trauma victim shows a systolic BP of 110mm
Hg, cold extremities, rapid but strong peripheral pulse, and a central venous
pressure of 12 cmH2O. The patient has:
A. increased systemic vascular resistance
B. decreased stroke volume index
C. decreased cardiac index
D. excessive cardiac preload
(Classification - Application; Source – Schwartz‟s Textbook of Surgery (8th
edition): p. 132)
20. An elderly man admitted with a diagnosis of sigmoid volvulus has a markedly
distended, non-tender abdomen and hyperactive bowel sounds.The initial
treatment is:
A. endoscopic detorsion
B. detorsion via laparotomy
C. decompressing transverse loop colostomy
D. Re section of involved segment of colon
(Classification - Recall; Source – Schwartz‟s Textbook of Surgery (8th edition): p.1098)
21. Pancreatic necrosis is suspected in a 49-year-old woman who has not
improved despite 3 days of intensive care for acute pancreatitis. The
diagnosis is best established through:
A. C-reactive protein measurement
B. abdominal ultrasound
C. contrast-enhanced CT scan
D. CT-guided percutaneous biopsy
(Classification - Recall; Source – Schwartz‟s Textbook of Surgery (8th edition):pp.
1234-1238)
22. A chronically constipated 67-year-old woman presents with acute leftlower
quadrant (LLQ) abdominal pain, LLQ direct and rebound tenderness, and
fever. The appropriate diagnostic examination is:
A. transvaginal ultrasound
B. abdominal CT scan
C. proctosigmoidoscopy
D. barium enema
(Classification - Application; Source – Schwartz‟s Textbook of Surgery (8th
edition): pp. 1082-1083)
23. After an elective hemicolectomy for colon cancer, a 78-year-old man remains
hypotensive and tachycardic. He has distended neck veins, coldskin, oliguria,
and elevated central venous pressure. He apparently is suffering from this type
of shock:
A. hypovolemic
B. cardiogenic
C. septic
D. neurogenic
