GENERAL SURGERY 2019

WOUND HEALING MCQs

1. Which one of the following is correct order of wound healing phases?

A) Inflammatory, hemostasis, proliferative, remodeling
B) Hemostasis, inflammatory, proliferative, remodeling (answer)
C) Inflammatory, hemostasis, remodeling, proliferative
D) Hemostasis , inflammatory, remodeling, proliferative

2. Which vitamin is required for fibroblast to produce collagen?

A) Vitamin A
B) Vitamin C (answer)
C) Vitamin K
D) Vitamin E

3. Which of the following statements about the process of wound healing are true?
A) The inflammatory phase begins 2–3 days after the injury.
B) The proliferative phase lasts from 3 days to 3 weeks following the injury. (answer)
C) The remodelling phase involves fibroblast activity and production of collagen and ground
substance.
D) Fibroblasts require vitamin A to produce collagen.
E) The white cells stick to the damaged endothelium and release adenosine diphosphate
(ADP) and cytokines.

4. Which of these factors influences healing of a wound?

A) Vascular insufficiency
B) Diabetes mellitus
C) Malnutrition
D) Site of Wound
E) all of the above (answer)

5. The role of collagen is

A) Cell adhesion
B) Locomotion
C) Expansion and contraction
D) Strength and support (answer)

6. Which of the following statements is false?

A) The most common chronic wound in developed countries is the leg ulcer.
B) Pressure sores occur in approximately 5 per cent of all hospitalised patients.
C) Bed-bound patients should be turned every 4 h to prevent pressure sores (answer)
D) Risk of tissue necrosis increases if the external pressure exceeds the capillary occlusive
pressure (30 mmHg).

7. A clean incised wound heals by:

A) primary intention (answer)
B) excessive scaring
C) secondary intention
D) none of the above

8. Pressure sores can occur over which of the following areas?

A) Sacrum
B) Heel
C) Greater trochanter
D) a&c
E) all of the above (answer)

9. A diabetic patient has an ulcer on their great toe, which statement is false regarding it’s
healing
A) It will heal by secondary intention
B) Substantial scar formation is likely
C) The amount of acute inflammation is small, slowing the healing (answer)
D) Wound contraction requires actin containing fibroblasts
E) Large amounts of granulation tissue grow in from the periphery of the wound

10. A 30-year-old woman undergoes an elective laparoscopic cholecystectomy for

symptomatic cholelithiasis. Which of the following wound classes best describes her
procedure?

A) Class I, Clean
B) Class II, Clean/contaminated (answer)
C) Class III, Contaminated
D) Class IV, Dirty
E) None of the above

Fluid & Electrolytes imbalance

1. Which of the following fluid compartments contains the largest volume of water?
A) Plasma
B) Interstitial compartment
C) Intracellular compartment
D) Extracellular compartment
E) Lymph
Answer: c
2. Which of the following people would be most severely affected by prolonged vomiting?
A) 3-year-old baby
B) 15-year-old boy
C) 35-year-old male
D) 35-year-old female
E) 50-year-old male
Answer: a

3. You’ve been working outside in the hot sun and are dripping wet with sweat. Your fluid intake has
been minimal as you have been too busy to stop and get a drink. You would expect
A) Your blood osmolality to be low.
B) An increase in the production of urine.
C) Aldosterone levels to decrease.
D) ADH levels to increase.
E) ADH levels to decrease.
Answer: d

4. Which of the following would be expected to cause hyponatremia?

A) High intake of sodium
B) Increased aldosterone production
C) Increased urine output
D) Increased ADH production
E) Decreased ADH production
Answer: d

5. The normal pH for blood plasma is

A) 7.00.
B) 7.25.
C) 7.40.
D) 7.55.
E) 7.60.
Answer: c

6. Which of the following is correctly matched?

A) Alkalosis – hypokalemia
B) Cell destruction – hypokalemia
C) Increased secretion of aldosterone – hyperkalemia
D) Overuse of diuretics - hyperkalemia
E) Acidosis – hypokalemia
Answer: a

7. Which of the following events occurs last?

A) Release of renin by the kidney
B) Release of aldosterone by the adrenal cortex
C) Sodium reabsorption by the kidney tubules
D) Angiotensinogen → angiotensin I
E) Angiotensin I → angiotensin II
Answer: c

8. Extracellular fluid has a

A) Higher protein content than intracellular fluid.
B) Higher potassium content that intracellular fluid.
C) Higher sodium content than intracellular fluid.
D) Higher magnesium content than intracellular fluid
E) Higher number of large organic molecules than intracellular fluid.
Answer: c

9. What maintains the difference in cation concentration between the ICF and ECF?
a. Na+, K+ -adenosine triphosphate
b. Cell membrane sodium conductance pathways
c. Cell membrane potassium conductance pathways
d. Free movement of water
e. All of the above
Answer: e

10. If 1 liter of 5 percent dextrose is given to the patient described above, what will be the fall in
serum sodium concentration?
a. 2.4 mEq per liter
b. 4.8 mEq per liter
c. 9.6 mEq per liter
d. 19.2 mEq per liter
e. 29.2 mEq per liter
Answer: b

HERNIA

1. True about indirect inguinal hernia

• It travels through both superficial and deep inguinal ring

• It travels through deep inguinal ring only
• It travels through superficial inguinal ring only
• It occurs through Hesselbach’s triangle
2. A 40-year-old patient was being operated for a direct hernia. During surgery,
two sacs were seen. The diagnosis is:

• Pantaloons hernia
• Ritcher hernia
• Spigelian hernia
• Littre hernia
3. Most common nerve damaged during hernia repair:

• Ilioinguinal nerve
• Iliohypogastric
• Genitofemoral
• None
4. What is the most frequent complication of a hernia?

• Infection
• Strangulation
• Blockage
• Gangrene
5. Spigelian hernia is a type of hernia occuring at ?

• Medial border of rectus abdominis

• Lateral border of rectus abdominis
• Lumbar region
• Femoral canal
6. Which of the following is a content of littre’s hernia ?

• Urinary bladder
• Meckels diverticulum
• Circumference of intestinal wall
• Appendix
7. The most common hernia in females is:
• Femoral hernia.
• Direct inguinal hernia.
• Indirect inguinal hernia.
• Obturator hernia.

8. Neck of sac of femoral hernia lies

• Below and lateral to pubic tubercle

• Above and lateral
• Above and medial
• Below and medial
9. Strangulation most commonly occurs in

• Femoral hernia
• Direct inguinal hernia
• Indirect inguinal hernia
• Lumbar hernia

10. Which of the following is untrue about hernia?

• A reducible hernia imparts a expansile impulse on coughing
• The last part of a omentocele reduces more easily than the initial part
• The external ring becomes wide in an inguinal hernia
• A hernia becomes irreducible before it strangulates

PANCREATIC DISORDERS

1. Most common site of insulinoma ?

• Head
• Body
• Tail
• Equally distributed
2. Gold standard investigation for chronic pancreatitis ?

• MRI
• ERCP
• Pancreatic function test
• Fecal fat estimation
3. Which of the following is not a feature of acute pancreatitis ?

• Hyperbilrubinemia
• Hypercalcemia
• Hyperglycemia
• Increased serum LDH level
4. Hemorrhagic pancreatitis ,bluish discolouration of flank

• Grey turner sign

• Cullen sign
• Trosseau sign
• none
5. Which of the following is recognized as one of the common causes of acute pancreatitis?

• Infection
• Gallstones passing into the bile duct
• Hereditary pancreatitis
• Hypercalcemia
6. Which of the following physical findings may indicate severe necrotizing pancreatitis?

• Jaundice
• Erythematous skin nodules
• Fever
• Hypotension

7. Complication of chronic pancreatitis include all except?

• Renal artery stenosis

• Pesudocyst
• Splenic vein stenosis
• fistulae
8. Which of the following is true about pancreatic injury?

• Most cases are iatrogenic

• Blunt trauma is the most common cause
• Urine amylase is diagnostic
• HRCT is a investigation of choice

9. Which of the following bacteria are likely to be implicated in infected pancreatic necrosis?

• Listeria monocytogenes
• Haemophilus influenzae
• Klebsiella pneumoniae
• Streptococcus agalactiae

10. Destruction of fat in acute pancreatitis is due to

• Lipase and trypsin

• Secretin
• Lipase and elastase
• Cholecystokinin and trypsin
Perianal anorectal questions

1. A 32-year-old male presents to the clinic with a complaint of intermittent bloody anal discharge
for 6 months duration. He has no family history of malignancy. The drainage occurs several times
weekly and stains his underclothing. He denies incontinence to flatus. Examination demonstrates a
3-mm area of elevated granulation tissue 1.5 cm from the anus in the posterior midline. Digital rectal
and anoscopy are otherwise unremarkable. Which of the following is the next step in management?
A. Colonoscopy
B. Excisional biopsy of the elevated tissue
C. Curetting of any sinus tract
D. Fistulotomy
E. Fistulectomy
ANSWER… D (FISTULOTOMY)

2. What are possible findings in a digital prostate exam?

A.anal fissure. Gentle separation of the anal margins may reveal the lower edge of the fissure.
B. anxiety, inflammation, or scarring. Laxity occurs in neurologic diseases
C. rectal "shelf" of peritoneal metastases or the tenderness of peritoneal inflammation
D. rectal shelf
ANSWER…C

3. What can cause sphincter tightness?

A. anxiety, inflammation, or scarring. Laxity occurs in neurologic diseases

B. rectal "shelf" of peritoneal metastases or the tenderness of peritoneal inflammation
C. hemorrhoids, venereal warts, herpes, syphilitic chancre, and carcinoma
D. polyps,cancer, GI bleeding,local hemorrhoids; mucus may accompany villous adenoma
ANSWER…A

4. Only the ________ surface of the prostate is palpable

A. Proctitis
B. posterior
C. pruritus ani
D. colon cancer
ANSWER…B

5. Abscesses tunneling to the skin surface from the anus or rectum may form a what?

A. anal fissure. Gentle separation of the anal margins may reveal the lower edge of the fissure.
B. rectal "shelf" of peritoneal metastases or the tenderness of peritoneal inflammation
C. clogged or draining anorectal fistula. Fistulas may ooze blood, pus, or feculent mucus.
D. large, hard stools, IBD, or STIs
ANSWER….C

6. Anal fissures can be found in → proctitis and Crohn's disease

A. True
B. False
ANSWER…A

7. Nonmalignant enlargement of the prostate gland that increases with age, presents in more than
50% of men by 50 years of age. Symptoms arise both from smooth-muscle contraction in the
prostate and bladder neck and from compression of the urethra. → benign prostatic hyperplasia

A. True
B. False
ANSWER…A

8. On straining for a bowel movement, the rectal mucosa, with or without its muscular wall, may
prolapse through the anus, appearing as a doughnut or rosette of red tissue. → prolapse of the
rectum.
A. True
B. False
ANSWER….A

9. Hard areas in the prostate are not always malignant. What are some other things that can cause
hard areas in the prostate? → Proctitis.
A. True
B. False
ANSWER…B

10. what are examples of anal and perianal lesions? → hemorrhoids, venereal warts, herpes,
syphilitic chancre, and carcinoma

A. True
B. False
ANSWER….A

Surgical Site Infections

1)A patient who develops a pneumonia after a partial pulmonary lobectomy is said to have
a(an)
( A)Organ/space SSI (Answer)
(B) Deep incisional SSI
(C) Clean Contaminated SSI
(D) Contaminated SSI
2) which of the following is not an established risk factor for an SSI?
(A) Smoking
(B) Diabetes Mellitus
(C) Male gender (Answer)
(D) Shaving the surgical site

3) Which one of the following cephalosporin’s is most likely to prolong prothrombin time?
(A) Cephalothin
(B) Ceftriaxone
(C) Cefuroxime
(D) Cefotetan (Answer)

4) Which of the following is not a characteristic of a high-surgical-infection-risk patient

undergoing gastroduodenal surgery?
(A) preoperative sucralfate therapy. (Answer)
(B)Gastric ileus
(C) Zollinger-Ellison syndrome
(D) Bleeding duodenal ulcer

5) Which of the following statements about colorectal surgery is true?

(A) Patients receiving oral and intravenous antibiotics are less likely to develop an SSI than
those receiving oral antibiotics alone.
(B) patients receiving oral and intravenous antibiotics are less likely to develop an SSI than
those receiving intravenous antibiotics alone. (Answer)
(C) mechanical bowel preparation always should be administered after the oral antibiotic
prophylaxis.
(D) mechanical bowel preparation should be administered concomitantly with the oral
antibiotic therapy.

6) Single-dose therapy with cefazolin for surgical prophylaxis is appropriate for all the
following except
(A) Head and neck surgery. (Answer)
(B) transurethral resection of the prostate (TURP).
(C) Craniotomy
(D) Open cholecystectomy.

7) Laparoscopic procedures
(A) Are generally associated with lower risk of infection, and in most cases, antimicrobial
therapy is not warranted. (Answer)
(B) Are associated with increased infection rates and always require antimicrobial
prophylaxis.
(C) Are associated with lower infection rates than traditional procedures, but for the most
part, antimicrobial prophylaxis has been shown to reduce SSIs in this subset of patients.
(D) Are associated with higher rates of infection, but further study of antimicrobial
prophylaxis needs to be done in this area before recommendations can be made.

8) With regards to SSIs after neurosurgery,

(A) craniotomies and shunt procedures can be classified together because they are both
clean procedures.
(B) prophylactic antibiotics are not necessary because neurosurgery is considered clean
surgery.
(C) Single-dose cefazolin therapy is adequate for most neurosurgical procedures including
shunt procedures. (Answer)
(D) All of the above

9) A patient requiring urologic

(A) Will require a therapeutic course of antibiotics if he or she has a preoperative urinary
tract infection. (Answer)
(B) Will require prophylactic antibiotics if he or she has an indwelling bladder catheter prior
to surgery.
(C) May receive a single dose of oral ciprofloxacin for surgical prophylaxis instead of
parenteral antibiotics.
(D) All of the above

10) Which of the following is(are) common pathogen(s) in SSIs after orthopedic surgery?
(A) S. epidermidis
(B) E. coli
(C) S. aureus
(D) All of the above
(E) A and C only (Answer)

BURNS

Question 1

The newly admitted client has burns on both legs. The burned areas appear white and
leather-like. No blisters or bleeding are present, and the client states that he or she has little
pain. How should this injury be categorized?

A Superficial

B Partial-thickness superficial

C Partial-thickness deep

D Full thickness
Question 2

The newly admitted client has a large burned area on the right arm. The burned area
appears red, has blisters, and is very painful. How should this injury be categorized?

A Superficial

B Partial-thickness superficial

C Partial-thickness deep

D Full thickness

Question 3

The burned client newly arrived from an accident scene is prescribed to receive 4 mg of
morphine sulfate by IV push. What is the most important reason to administer the opioid
analgesic to this client by the intravenous route?

A The medication will be effective more quickly than if given intramuscularly.

B It is less likely to interfere with the client’s breathing and oxygenation.

C The danger of an overdose during fluid remobilization is reduced.

D The client delayed gastric emptying.

Question 4

Which vitamin deficiency is most likely to be a long-term consequence of a full-thickness

burn injury?

A Vitamin A
B Vitamin B

C Vitamin C

D Vitamin D

Question 5

Which client factors should alert the nurse to potential increased complications with a burn
injury?

A The client is a 26-year-old male.

B The client has had a burn injury in the past.

C The burned areas include the hands and perineum.

D The burn took place in an open field and ignited the client’s clothing.

Question 6

The burned client is ordered to receive intravenous cimetidine, an H2 histamine blocking

agent, during the emergent phase. When the client’s family asks why this drug is being
given, what is the nurse’s best response?

A “To increase the urine output and prevent kidney damage.”

B “To stimulate intestinal movement and prevent abdominal bloating.”

“To decrease hydrochloric acid production in the stomach and prevent

C
ulcers.”
 “To inhibit loss of fluid from the circulatory system and prevent hypovolemic
D
shock.”

Question 7

At what point after a burn injury should the nurse be most alert for the complication of
hypokalemia?

A Immediately following the injury

B During the fluid shift

C During fluid remobilization

D During the late acute phase

Question 8

What clinical manifestation should alert the nurse to possible carbon monoxide poisoning in
a client who experienced a burn injury during a house fire?

A Pulse oximetry reading of 80%

B Expiratory stridor and nasal flaring

C Cherry red color to the mucous membranes

D Presence of carbonaceous particles in the sputum

Question 9
What clinical manifestation indicates that an escharotomy is needed on a circumferential
extremity burn?

A The burn is full thickness rather than partial thickness.

B The client is unable to fully pronate and supinate the extremity.

C Capillary refill is slow in the digits and the distal pulse is absent.

D The client cannot distinguish the sensation of sharp versus dull in the extremity.

Question 10

What additional laboratory test should be performed on any African American client who
sustains a serious burn injury?

A Total protein

B Tissue type antigens

C Prostate-specific antigen

D Hemoglobin S electrophoresis

UPPER GI BLEED

1) Your patient has a past medical history of scleroderma ,which of the following is the
most likely
cause of her UGIB ?
a)Gastric vasculitis ectasia
b) Peptic ulcer
c) Portal hypertensive gastropaty
d) Esophageal varices
2) A patient with Mallory weis ,what is the most common cause of this diagnosis
A chest trauma
b) Prolong/severe vomiting
c) chronic alchohol abuse
d) Gastritis

3) NSAIDS induced ulcers differ from H.pylori associated ulcers

In that a patient with NSAIDS induced ulcers are more likely have
A) duodenal ulcers
B) more severe upper GI bleeds
C) ulcers related epigastric pain
D) gastric CA

4) Which of the following is a complication of PUD ?

a) GI bleeding
b) perforation
c) Obstruction
d) All of the above
e) None of the above

5) What structure separated the upper gastrointestinal segment from lower?

A) Ligament of venosum
B) Stomach
C) Ligament of treitz
D) Ligament of teres

6) All of the following are causes of portal hypertension except ?

A) thrombosis of portal vein
B) liver cirrchosis
C) Schistomoasis
D) Acute hepatitis

7) In emergency management of acute severe non variceal upper gastrointestinal

hemorrhage with
hypotension ,which of the following would not be in your initial mangament ?
a) gain 2 large bore iv access
b) Iv crystalloids
c) Preform HOURLy measure of BP,pulse And UO
d) Endoscopy
8) what is the most realiable test in peptic ulcer
a) endoscopy
b) blood test
c) physical examination
d) MRI

9) gastric ulcer are more likely to have maliganant changes rather than peptic ulcers
a) true
b) flase

10. Risk factors for peptic ulcers include the following except
a) Spicy food
b) Alcohol
c) NSAID
d) H.Pylori