SURGERY

SURGERY MIDTERM LONG QUIZ RECALLS

Surg Trans Group

REFERENCES
• Reference 1 4. A 50 year-old female is about to undergo excision biopsy of
• Reference 2 breast mass on the left. Her platelet count at this time was
35,000uL. Other bleeding parameter were normal. No active
Legends:
viral nor bacterial infection noted. What would be the best
REMEMBER Previous Trans Clinical course of action?
Lecturer Book
(Exams) Trans Com Correlation
A. Risk of bleeding would be minimal, continue the procedure
      B. Postpond the surgery, transfused 1 unit of platelet
concentrate and reassess the patient
C. Prepare FFP to be used during the procedure
From the Subject Head / Trans Group / Review of Concepts D. Give vitamin K 1 ampule now through IV then continue with
the procedure

I. MIDTERM LONG QUIZ 5. As soon as the need for massive transfusion is recognized:
A. For every6 RBCs, give 6 FFP, 6 pack of platelets
RATIONALE B. For every6 RBCs, give 5 FFP, 4 packs of platelets
A set of reasons or a logical basis for a course of action or a C. For every6 RBCs, give 3 FFP, 2 pack of platelets
particular belief D. For every6 RBCs, give 1 FFP, 1 pack of platelets
Choice 2 – Information/Rationale
Hemostasis, Surgical Bleeding and Infusion
Choice 3 – Information/Rationale
1. What is the most common intrinsic platelet defect? Choice 4 – Information/Rationale
A. Storage Pool Disease
B. Glanzmann Thrombathenia A. For every6 RBCs, 6 FFP, 6 packs of platelets
C. Bernard Soulier
D. Von Willebrand’s Disease 6. Sorage of RBC will decrease 2,3 DPG which will:
Choice 2 – Information/Rationale A. Decrease affinity of hemoglobin to Oxygen
Choice 3 – Information/Rationale B. Increase affinity of hemoglobin to Oxygen
Choice 4 – Information/Rationale C. Shift oxygen dissociation curve to the right
D. Not cause any shift in the oxygen dissociation curve
A. Storage Pool Disease – Information/Rationale
Choice 1 – Information/Rationale
Choice 2 – Information/Rationale
2. What Protein stabilizes platelet-platelet interaction, which Choice 3 – Information/Rationale
are released by the alpha granules
A. Thrombospondin B. Increased in affinity of hemoglobin to Oxygen – decrease
B. Platelet factor 4 in 2,3DPG increases O2 hemoglobin affinity
C. Fibrinogen
D. Von Willebrand Factor 7. Which of the following is an example of topical hemostatic
Choice 1 – Information/Rationale agents classified as biologic?
Choice 2 – Information/Rationale A. Gelatin Foam
Choice 3 – Information/Rationale B. Oxidized Cellulose
C. Microfibrilar Collagens
A. thrombospondin – Information/Rationale D. Topical Thrombin
D. Topical Thrombin – All the others are absorbable agents
3. What blood test could give an approximation of the intrinsic (Surg2.1, p6)
pathway of hemostasis
A. Prothrombin Tim 8. What would be the Component to be transfused in a patient
B. Activated Partial Thromboplastin Time with fibrinogen level of 150mg/dL?
C. Bleeding Time A. Washed RBC
D. Rotational Thromboelastometry B. Platelet Concentrate
Choice 2 – Information/Rationale C. Cryoprecipitate
Choice 3 – Information/Rationale D. FFP
Choice 4 – Information/Rationale
C. Cryoprecipitate – 20 units to be given, if less than (or equal to)
200mg/dL ang fibrinogen
B. Activated Partial Prothrombin time – Information/Rationale

Transers: Surg Trans Group 1 of 5

 C. First 24 hrs after injury
9. Transfusing 1 unit of platelet concentrate will increase D. First 48 hrs after injury
paltelets in a 70kg person by:
A. 10,000/uL C. First 24 hrs after injury - Mortality of trauma patients
B. 20,000/uL can be stratified according to the magnitude of base
C. 100,00/uL deficit measured in the 1st 24 hours after admission
D. 50,000/uL (Surg. 2.2, p. 12)
Choice 2 – Information/Rationale
Choice 3 – Information/Rationale 5. What is the optimal blood pressure for damage control
Choice 4 – Information/Rationale resuscitation prior to surgery?
A. 80mmHg
A. 10,000/uL – Information/Rationale B. 100mmHg
C. 120mmHg
10. A type of platelet functional defectdue to surface protein D. 140mmHg
abnormality of Gp Ib/IX/V defect:
A. Glanzmann Thrombasthenia A. 80mmHg – “So you maintain the
B. Bernard-Soulier Syndrome blood pressure 70 – 80. Maximum na ‘yung 90.” (Surg. 2.2, p.
C. Storage Pool Disease 8)
D. Von Willebrand’s Disease
Choice 1 – Information/Rationale 6. In the initial management of trauma patient, what is the most
Choice 2 – Information/Rationale immediate concern in resuscitation?
Choice 3 – Information/Rationale A. Check if the patient is capable of inhaling and exhaling
B. Check if the patient is conscious
B. Bernard-Soulier Syndrome – Information/Rationale C. Check if the patient has blood pressure
D. Check for the patency of the respiratory passageway
Shock
1. What is the option of choice to diagnose a stable patient with D. Check for the patency of the respiratory passageway –
a stab wound at the cardiac box to rule out cardiac Initially empiric (ABCDE): Airway, Breathing, Circulation,
tamponade? Disability, Exposure (Surg. 2.2, p. 8)
A. Pericardiocentesis
B. Chest x-ray 7. What is the paramount priority in the core principles in the
C. 12-L ECG management of Hemorrhagic shock?
D. Pericardial window A. Control of active bleeding
C. 12-L ECG – Stable si patient, so no need for immediate B. Control of airway
intevetion. Since cardiac tamponade is fluid build up in th C. Volume resuscitation
pericardial sac, 12-L ecg nalang para non-invasive. D. Proper exposure

2. What is the average blood loss of class III hypovolemic A. Control of active bleeding - Control of active hemorrhage
shock? - “This is the paramount priority because most often than
A. 1500 – 2000ml not, lalo na yung trauma, nawawala yung intravascular
B. 500 – 1000ml fluid and this will lead to inadequate tissue perfusion,
C. 100 – 500 ml kaya kailangan macontrol muna yon.” (Surg. 2.2, p. 1)
D. 1000 – 1500ml
8. Which of the following is defined as failure to meet the
A. 1500-2000ml – Class III: 1500-2000ml blood loss (Surg. 2.2,
metabolic demands of the cells, tissues and organs, and the
Table 2, p. 6)
consequences that ensues?
3. What is the class of hemorrhagic shock will you see
A. Hypotension
hypotension initially?
B. SIRS
A. Class I
C. Sepsis
B. Class II
D. Shock
C. Class III
D. Shock – “Shock is the failure to meet the metabolic needs
D. Class IV
of the cell and the consequences that ensue” (Surg. 2.2, p. 1)
Class I – Normal
Class II – Orthostatic
9. Which of the following developed from the cellular effect
Class IV – Severe Hypotension
level?
A. Neurogenic shock
C. Class III – Hypotension (Surg. 2.2, Table 2, p. 6)
B. Cardiogenic shock
C. Traumatic shock
4. For the assessment of endpoint of resuscitation, base deficit
D. Hemorrhagic shock
should be measured at what time frame?
A. First 24 hrs after resuscitation
C. Traumatic Shock – Traumatic shock
B. First 48 hrs after resuscitation

Transers: Surg Trans Group 2 of 5

 - Damage-associated molecular patterns (DAMPs;
ribonucleic acid, uric acid) released at the cellular
level (Surg. 2.2, p. 9)

10. In the vicious cycle of shock, which of the following

contributes to decrease in cardiac output? 5. What is the principal fuel source of a healthy patient during
A. Decreased venous return short term fasting?
B. Metabolic alkalosis A. Protein
C. Increased coronary perfusion B. Carbohydrates
D. Cellular hypercarbia C. Fats
D. Lactic acid
A. Decreased venous return
C.Fats
– “For example, decreased cardiac output ka because
of decreased volume of blood or may heart attack,
pag nangyari yun magkakaroon ka ng decreased
tissue perfusion and once this happens konti ang
babalik na blood sa heart so decreased venous 6. Oxidation of 2 g of fat will yield?
return” (Surg. 2.2, p. 2) A. 4 kcal
B. 6 kcal
Surgical Metabolism and Infection C. 9 kcal
1. During starvation, proteolysis mainly occurs where? D. 10 kcal
A. Heart
A – 1g carbohydrate = 4 kcal, 1 g protein = 4 kcal
B. Brain
C. Skeletal muscles C.9 kcal
D. Smooth muscles
C. Skeletal muscles

7. What is the process of collecting and assessing data about

2. During prolonged starvation, what does vital organs use as clinical conditions, diet, body composition, and biochemical
a principal fuel source? data to identify patients with poor nutritional status?
A. Lactate A. Nutritional screening
B. Ketone bodies B. Malnutrition evaluation
C. Glucose C. Nutritional assessment
D. Fats D. Subjective global assessment

B. Ketone bodies C.Nutritional assessment

Nutritional assessment determines the severity of deficiencies/
excess

8. What is the recommended nonprotein-calorie:nitrogen ratio

considered as basal caloric requirement that should be
provided to limit the use of protein as an energy source?
A. 80:1
3. Every 6g of protein will yield how many grams of nitrogen?
B. 120:1
A. 1 g
C. 150:1
B. 2 g
D. 180:1
C. 3 g
D. 4 g A – lower rate of 80-100:1 beneficial in some critically ill or
hypermetabolic patients
A. 1g
B – 80-120:1 calorie to nitrogen ratio is under high protein
formulas for patients who are critically ill or trauma patients

C.150:1
Nonprotein calories: Nitrogen ratio = 150:1

4. What is the dextrose content in total parenteral nutrition? 9. Which enteral solution has the capability of reducing
A. 15-25 % aromatic acid levels and increasing the branched chain
B. 10-15 % amino acid levels which can potentially reverse
C. 20-25 % encephalopathy?
D. 25-30 % A. MCT based formulas with prebiotics
A. 15-25 % B. Hepatic failure formulas
C. Immune enhancing formulas

Transers: Surg Trans Group 3 of 5

 D. Elemental formulas
A. continuous subcuticular suturing
C – Immune-Enhancing formulas enhances various aspects of
(Correct Answer)
immune or solid organ function, benefits are not consistend in trials – in wounds with strong skin tension and for those prone to keloid
and are expensive formation
D – Elemental formulas contain predigested nutrients and proteins (Surg 2.4 p. 2)
in the form of small peptides, limited complex carbs and fat, easily
absorbed but has limited long term use
4. Which of the following is/are the use(s) of bandaging?
B. Hepatic failure formula
A. Hold dressing in place
B. Create pressure over a bleeding wound
C. Secure a splint to an injured part of the body and provide
support to an injured partof the body
D. all of the above

D. all of the above

10. Every 12 g of protein will yield: (Correct Answer)
A. 1 g nitrogen
B. 2 g nitrogen
C. 6 g nitrogen - all statements are true regarding bandaging
D. 4 g nitrogen (Surg 2.4 p. 4)

B. 2 g nitrogen 5. Which statement is true with regards to OR

instrumentations?
A. Use fine scissors when cutting sutures
B. Choose the shortest instrument that comfortably
Basic Sugical Skills
reach operative site
1. True of suturing:
C. Sterile instrument(s) can be held even prior to scrubbing
A. Braided sutures are ideal for contaminated wounds
and gloving
B. its aim is to apply tension to approximate wound edges
D. All of the above
C. Use minimal size and amount of suture to close wounds
D. Sutures must be placed very close to each other
A – False: Avoid using fine scissors when cutting sutures or non-
A – False: Braided sutures are not ideal for contaminated wounds
and the risk of dirt insinuating in the thread is higher. tissue materials
B – False: Its aim is to approximate wound edges without gaps or C – False: Sterile instrument(s) cannot be held even prior to
tension scrubbing and gloving
D – False: Size of “bite” and its interval should be equal in length D – False: Only statement B is true regarding OR instrumentation

C.Use minimal size and amount of suture to close wounds B. Choose the shortest instrument that comfortably reach
(correct answer) operative site
(Correct Answer)
(Surg 2.4 p.1)
(Surg 2.4 p. 7)

2. When suturing:
A. Needle driver is held in a way that rotation occurs at the 6. What blade is ideally used for for stab incision?
elbow A. blade 10
B. pass the needle tip through skin at 45˚ B. blade 11
C. Use the curve of the needle in turning it through tissue C. blade 15
D. Closure of the skin of deep wounds is done abruptly. D. any of the above
A – False: Hold needle driver in a way that rotation of the wrist is
possible B. blade 11
(Correct Answer)
B – False: Pass the needle tip through skin at 90˚
D – False: Close deep wounds in layers
Blade #11 for stab incision
(Surg 2.4 p. 8)
C. Use the curve of the needle in turning it through tissue
(correct answer)
7. Which is true of surgical gloves and/or gloving?
(Surg 2.4 p.1) A. It may prevent transmission of infections
B. A punctured glove during surgery need not be changed
3. For patients who are prone to keloid formation, the C. Open sealed package of sterile gloves after scrubbing and
preferred suturing technique is: gowning
A. continuous subcuticular suturing D. All of the above
B. interrupted suturing B – False: Promptly change a glove punctured during surgery,
C. purse string suturing rinsed hand with antiseptic or rescrub.
D. vertical mattress suturing

Transers: Surg Trans Group 4 of 5

C – False: Open sealed package of sterile gloves before scrubbing
and gowning.
D – False: Only statement A is true regarding gloving

A. It may prevent transmission of infections

(Correct Answer)
Surgical gloves prevent transmission of infections
(Surg 2.4 p. 7)
8. True of hand-washing:
A. Plain soap and H2O is effective
B. Wash with vigorous mechanical action on all hand surfaces
C. Wash for at least 40 seconds and wash above wrists
D. All of the above

D. all of the above

(Correct Answer)

all statements are true regarding handwashing

(Surg 2.4 p. 4)

9. This suturing technique uses circular pattern to draw

tissues together inthe path of suture:
A. simple interrupted suturing
B. continuous subcuticular suturing
C. purse string suturing
D. retention sutures
A – Most commonly used for lacerations
B – in wounds with strong skin tension and for those prone to
keloid formation
D – Place retention sutures through full thickness of abdominal
wall leaving them untied

C. purse string suturing

(Correct Answer)
Circular pattern drawing tissue in path of suture together and is
used around drain sites
(Surg 2.4 p. 3)

10. True of mattress sutures:

A. for relief of wound tension
B. for precise wound edge apposition
C. more complex
D. all of the above

D. all of the above

(Correct Answer)

all statements are true regarding mattress sutures

(Surg 2.4 p. 2)

Transers: Surg Trans Group 5 of 5