ASIR SURGICAL RESIDENCY PROGRAM
Presents:
FIRST EDITION
1422-2002
This project was raised after an idea by:
Dr. Gharama Al-Shehri (surgical consultant)
Developed and typed by:
Dr. Ghazi Al-Shumrani (intern)
, INTRODUCTION
In The Name of Allah, The Most Gracious, The Most Merciful
The surgical field is a live specialty that has a good outcome. Unfortunately,
many people may believe that surgery is a branch that does not need any effort more
than training and practicing operations. This is not enough, because theoretical
knowledge is essential for any medical field including surgery. We, as doctors,
should always keep in mind that famous word saying: “to study the phenomena of
disease without books is to sail an uncharted sea, while to study books without
patients is not to go to sea at all”.
For the aim of consolidation of the theoretical knowledge in an easier way than
reading the text books, and for preparing for surgical written examinations; this
MCQs bank was prepared. The idea was raised by Dr. Gharama Al-Shehri, the
surgical residency program director in Asir Central Hospital. The idea is that any
surgical resident reads the major, most famous five or six surgical MCQs books
should pass the written examinations especially the first part or first step examination.
The beginning of any thing is the most difficult part of its entire course. During
developing of this project, I have faced many difficulties. The most difficult
difficulties were the technical ones. My initial impression about MCQs books that are
created on CD-ROM is that the all questions with their answers in a certain topic are
going to be in one page. What I was faced with is totally the opposite. I found each
question is located in one page with its answer is in another page. That is why I spent
about seven weeks to develop this project, while I was expecting it not to take more
than seven days!
As just a beginning of this project, almost all the MCQs in two major surgical
MCQs books have been included; those are Sabiston and Greenfield. Other books
were about to be included but I was faced with technical difficulties, that is why those
books need to be typed (manually). I organized this book in a way similar to the
surgical book so called “RUSH”, as I find it very famous and widely accepted by
surgical residents. Because of the short time before a coming written surgical
examination, I believed that this MCQs bank should be distributed at this time.
I think the most important success gained at this time, is that we developed a
backbone for this project. It is going to be much easier in the future to add to and
modify this MCQs bank.
I will be happy to receive any suggestions to improve this bank or to add to it
in the coming editions.
I like to say (at the end) that this project in this shape “is not the end, nor the
beginning of the end, but, probably, is the end of the beginning”.
Finally, I pray to Allah to bless our efforts and to let them aiming only for sake
of Him.
Dr. Ghazi Adlan Al-Shumrani (intern)
Abha- 4/1/1422* 18.March.2002
Mobile No. 055782749
Email: <>
2
, CONTENTS
000-introduction …………………………………………..…………………….. 1
001-basic surgical background ………………………………………………… 4
002-trauma & burns …………………………………………………………….. 105
003-abdominal wall & acute abdomen ……………………………………….. 110
004-esophagus, stomach & duodenum ……………………………………... 157
005-small intestine ……………………………………………………………… 203
006-large intestine ……………………………………………………………… 221
007-hepatobiliary & pancreatic ……………………………………………….. 247
008-spleen ……………………………………………………………………….. 304
009-endocrine …………………………………………………………………… 311
010-breast ……………………………………………………………………... 339
011-thoracic surgery ……………………………………………………………. 353
012-cardiac surgery ……………………………………………………………... 381
013-vascular surgery ……………………………………………………………. 422
014-transplantation ……………………………………………………………… 460
015-oncology ……………………………………………………………………. 481
016-pediatric surgery …………………………………………………………… 496
017-urology …………………………………………………………………… 519
018-orthopedics ………………………………………………………………. 529
019-neurosurgery ……………………………………………………………….. 545
3
, Basic surgical background (Biochemistry, Fluids, Electrolytes, Hemostasis, Shock, Surgical Infections, Wound Healing …etc)
1. Skeletal muscle breakdown produces predominantly liberation of which two amino acids?
A. Lysine.
B. Tyrosine.
C. Alanine.
D. Glutamine.
E. Arginine.
Answer: CD
DISCUSSION: Alanine is released from skeletal muscle and extracted by the liver, where it is converted to new glucose.
Glutamine is also released from muscle and participates in renal acid-base homeostasis and serves as fuel for rapidly
growing cells such as enterocytes, stimulated macrophages, and fibroblasts. Together, these two amino acids account for
approximately two thirds of the nitrogen released from skeletal muscle.
2. In “catabolic” surgical patients, which of the following changes in body composition do not occur?
A. Lean body mass increases.
B. Total body water increases.
C. Adipose tissue decreases.
D. Body weight decreases.
Answer: A
DISCUSSION: Lean body mass represents the body compartment that contains protein. Because critical illness stimulates
proteolysis and increased excretion of body nitrogen, this compartment is consistently reduced, not increased. The change in
body composition is associated with a loss of body weight, an increase in total body water, and a decrease in body fat.
3. The hormonal alterations that follow operation and injury favor accelerated gluconeogenesis. This new glucose is
consumed by which of the following tissues?
A. Central nervous system.
B. Skeletal muscle.
C. Bone.
D. Kidney.
E. Tissue in the healing wound.
Answer: ADE
DISCUSSION: Glucose is produced in increased amounts to satisfy the fuel requirements of the healing wound. In addition,
nerve tissue and the renal medulla also utilize this substrate. Skeletal muscle primarily utilizes fatty acids, and bone utilizes
mineral substrate.
4. Cytokines are endogenous signals that stimulate:
A. Local cell proliferation within the wound.
B. The central nervous system to initiate fever.
C. The production of “acute-phase proteins.”
D. Hypoferremia.
E. Septic shock.
Answer:ABCD
DISCUSSION: Although cytokines exert primarily autocrine and paracrine effects, they may also cause systemic effects.
5. The characteristic changes that follow a major operation or moderate to severe injury do not include the following:
A. Hypermetabolism.
B. Fever.
C. Tachypnea.
D. Hyperphagia.
E. Negative nitrogen balance.
Answer: D
Asir Surgery MCQs Bank. © 1422H-2002- first impression ©
4
This project was raised after an idia by Dr. Gharama Al-Shehri (consultant surgeon). Developed and typed by Dr. Ghazi Al-Shumrani (intern).
Presents:
FIRST EDITION
1422-2002
This project was raised after an idea by:
Dr. Gharama Al-Shehri (surgical consultant)
Developed and typed by:
Dr. Ghazi Al-Shumrani (intern)
, INTRODUCTION
In The Name of Allah, The Most Gracious, The Most Merciful
The surgical field is a live specialty that has a good outcome. Unfortunately,
many people may believe that surgery is a branch that does not need any effort more
than training and practicing operations. This is not enough, because theoretical
knowledge is essential for any medical field including surgery. We, as doctors,
should always keep in mind that famous word saying: “to study the phenomena of
disease without books is to sail an uncharted sea, while to study books without
patients is not to go to sea at all”.
For the aim of consolidation of the theoretical knowledge in an easier way than
reading the text books, and for preparing for surgical written examinations; this
MCQs bank was prepared. The idea was raised by Dr. Gharama Al-Shehri, the
surgical residency program director in Asir Central Hospital. The idea is that any
surgical resident reads the major, most famous five or six surgical MCQs books
should pass the written examinations especially the first part or first step examination.
The beginning of any thing is the most difficult part of its entire course. During
developing of this project, I have faced many difficulties. The most difficult
difficulties were the technical ones. My initial impression about MCQs books that are
created on CD-ROM is that the all questions with their answers in a certain topic are
going to be in one page. What I was faced with is totally the opposite. I found each
question is located in one page with its answer is in another page. That is why I spent
about seven weeks to develop this project, while I was expecting it not to take more
than seven days!
As just a beginning of this project, almost all the MCQs in two major surgical
MCQs books have been included; those are Sabiston and Greenfield. Other books
were about to be included but I was faced with technical difficulties, that is why those
books need to be typed (manually). I organized this book in a way similar to the
surgical book so called “RUSH”, as I find it very famous and widely accepted by
surgical residents. Because of the short time before a coming written surgical
examination, I believed that this MCQs bank should be distributed at this time.
I think the most important success gained at this time, is that we developed a
backbone for this project. It is going to be much easier in the future to add to and
modify this MCQs bank.
I will be happy to receive any suggestions to improve this bank or to add to it
in the coming editions.
I like to say (at the end) that this project in this shape “is not the end, nor the
beginning of the end, but, probably, is the end of the beginning”.
Finally, I pray to Allah to bless our efforts and to let them aiming only for sake
of Him.
Dr. Ghazi Adlan Al-Shumrani (intern)
Abha- 4/1/1422* 18.March.2002
Mobile No. 055782749
Email: <>
2
, CONTENTS
000-introduction …………………………………………..…………………….. 1
001-basic surgical background ………………………………………………… 4
002-trauma & burns …………………………………………………………….. 105
003-abdominal wall & acute abdomen ……………………………………….. 110
004-esophagus, stomach & duodenum ……………………………………... 157
005-small intestine ……………………………………………………………… 203
006-large intestine ……………………………………………………………… 221
007-hepatobiliary & pancreatic ……………………………………………….. 247
008-spleen ……………………………………………………………………….. 304
009-endocrine …………………………………………………………………… 311
010-breast ……………………………………………………………………... 339
011-thoracic surgery ……………………………………………………………. 353
012-cardiac surgery ……………………………………………………………... 381
013-vascular surgery ……………………………………………………………. 422
014-transplantation ……………………………………………………………… 460
015-oncology ……………………………………………………………………. 481
016-pediatric surgery …………………………………………………………… 496
017-urology …………………………………………………………………… 519
018-orthopedics ………………………………………………………………. 529
019-neurosurgery ……………………………………………………………….. 545
3
, Basic surgical background (Biochemistry, Fluids, Electrolytes, Hemostasis, Shock, Surgical Infections, Wound Healing …etc)
1. Skeletal muscle breakdown produces predominantly liberation of which two amino acids?
A. Lysine.
B. Tyrosine.
C. Alanine.
D. Glutamine.
E. Arginine.
Answer: CD
DISCUSSION: Alanine is released from skeletal muscle and extracted by the liver, where it is converted to new glucose.
Glutamine is also released from muscle and participates in renal acid-base homeostasis and serves as fuel for rapidly
growing cells such as enterocytes, stimulated macrophages, and fibroblasts. Together, these two amino acids account for
approximately two thirds of the nitrogen released from skeletal muscle.
2. In “catabolic” surgical patients, which of the following changes in body composition do not occur?
A. Lean body mass increases.
B. Total body water increases.
C. Adipose tissue decreases.
D. Body weight decreases.
Answer: A
DISCUSSION: Lean body mass represents the body compartment that contains protein. Because critical illness stimulates
proteolysis and increased excretion of body nitrogen, this compartment is consistently reduced, not increased. The change in
body composition is associated with a loss of body weight, an increase in total body water, and a decrease in body fat.
3. The hormonal alterations that follow operation and injury favor accelerated gluconeogenesis. This new glucose is
consumed by which of the following tissues?
A. Central nervous system.
B. Skeletal muscle.
C. Bone.
D. Kidney.
E. Tissue in the healing wound.
Answer: ADE
DISCUSSION: Glucose is produced in increased amounts to satisfy the fuel requirements of the healing wound. In addition,
nerve tissue and the renal medulla also utilize this substrate. Skeletal muscle primarily utilizes fatty acids, and bone utilizes
mineral substrate.
4. Cytokines are endogenous signals that stimulate:
A. Local cell proliferation within the wound.
B. The central nervous system to initiate fever.
C. The production of “acute-phase proteins.”
D. Hypoferremia.
E. Septic shock.
Answer:ABCD
DISCUSSION: Although cytokines exert primarily autocrine and paracrine effects, they may also cause systemic effects.
5. The characteristic changes that follow a major operation or moderate to severe injury do not include the following:
A. Hypermetabolism.
B. Fever.
C. Tachypnea.
D. Hyperphagia.
E. Negative nitrogen balance.
Answer: D
Asir Surgery MCQs Bank. © 1422H-2002- first impression ©
4
This project was raised after an idia by Dr. Gharama Al-Shehri (consultant surgeon). Developed and typed by Dr. Ghazi Al-Shumrani (intern).
