1.

A 20-year-old woman is found to have an activated partial thromboplastin time

(APTT) of 78/32 on routine testing prior to cholecystectomy. Further investigation
reveals a prothrombin time (PT) of 13/12 (patient/control), a bleeding time of 13
min, and a platelet count of 350 × 100/μL. Which one of the following
characteristics of this woman’s coagulopathy is true?
A. Infusion of purified factor VIII is usually required to normalize its concentration
prior to surgery
B. Infusion of cryoprecipitate will not be followed by an improvement in coagulation
C. Most of these patients are, or become, seropositive for HIV
D. Epistaxis or menorrhagia is uncommon
E. Lack of platelet aggregation in response to ristocetin is a common feature of this
disease

The answer is E

2. A victim of blunt abdominal trauma requires a partial hepatectomy. He is rapidly

transfused with 8 units of appropriately crossmatched packed red blood cells from
the blood bank. He is noted in the recovery room to be bleeding from intravenous
puncture sites and the surgical incision. His coagulopathy is likely due to
thrombocytopenia and deficiencies of which clotting factors?
A. II only
B. II and VII
C. V and VIII
D. IX and X
E. XI and XII

The answer is C

3. The substrate depleted earliest in the postoperative period is

A. Branched-chain amino acids
B. Non-branched-chain amino acids
C. Ketone
D. Glycogen
E. Glucose

The answer is D
4. Prophylactic regimens of documented benefit in decreasing the risk of
postoperative thromboembolism include
A. Early ambulation
B. External pneumatic compression devices placed on the upper extremities
C. Elastic stockings
D. Leg elevation for 24 h postoperatively
E. Dipyridamole therapy for 48 h postoperatively

The answer is B

5. Which statement regarding transmission of viral illness through homologous blood

transfusion is true?
A. The most common viral agent transmitted via blood transfusion in the United States
is human immune deficiency virus (HIV)
B. Blood is routinely tested for cytomegalovirus (CMV) because CMV infection is
often fatal
C. The most frequent infectious complication of blood transfusion continues to be viral
meningitis
D. Up to 10% of those who develop posttransfusion hepatitis will develop cirrhosis or
hepatoma or both
E. The etiologic agent in posttransfusion hepatitis remains undiscovered

The answer is D

6. Which of the following inhalation anesthetics accumulates in air-filled cavities

during general anesthesia?
A. Diethyl ether
B. Nitrous oxide
C. Halothane
D. Methoxyflurane
E. Trichloroethylene

The answer is B

7. Dopamine is a frequently used drug in critically ill patients because

A. At high doses it increases splanchnic flow
B. At high doses it increases coronary flow
C. At low doses it decreases heart rate
D. At low doses it lowers peripheral resistance
E. It inhibits catecholamine release

The answer is B
8. Above this level, spinal cord injury might results in neurogenic shock
A. T8
B. C4
C. T10
D. C6
E. T6

The answer is E

9. Which of the following fractures or dislocations of the extremities induced by blunt

trauma is associated with significant vascular injuries?
A. Knee dislocation
B. Closed posterior elbow dislocation
C. Midclavicular fracture
D. Supracondylar femur fracture
E. Tibial plateau fracture

The answer is A

10. When galactorrhea occurs in a high school student, a diagnostic associated finding
would be
A. Gonadal atrophy
B. Bitemporal hemianopia
C. Exophthalmos and lid lag
D. Episodic hypertension
E. “Buffalo hump”

The answer is B

11. A 39-year-old female presents with a 2-cm palpable breast mass. On exam, she
is also noted to have a warm, erythematous breast with peau d’orange changes.
Biopsy of the mass reveals infiltrating ductal carcinoma. What is the next step in
management?
A. Breast-conserving surgery with SLN biopsy
B. Modified radical mastectomy
C. Breast-conserving surgery with SLN biopsy followed by chemotherapy
D. Neoadjuvant chemotherapy followed by modified radical mastectomy
E. Neoadjuvant chemotherapy followed by breast-conserving surgery

The answer is D

12. Risk factors for colonic injury during PCNL include all of the following except one
A. Horseshoe kidney
B. Kyphoscoliosis
C. Access lateral to the posterior axillary line
D. Previous jejunoileal bypass for obesity
E. Upper pole puncture

The answer is E

13. Regarding uroflowmetry one is true

A. Alone is insufficient to diagnose bladder outlet obstruction
B. It can distinguish true obstruction from poor detrusor contractility
C. Small voided volume not affecting the Q-max
D. The normal flow pattern is interrupted
E. Voided time is not affecting the normal reading

The answer is A

14. What is the first step in investigating a 26 year old male with solitary thyroid nodule
1 cm in size in the right lobe of the thyroid?
A. Radio Isotope scan.
B. Thyroid function test
C. US guided FNA.
D. Clinical examination every 6 months.
E. Right hemithyroidectomy.

The answer is B

15. Which of the following is the best therapy for a single 4 cm hepatocellular
carcinoma in a patient with uncontrollable ascites and recurrent variceal bleeding:
A. Liver resection.
B. Ethanol injection.
C. Liver transplantation.
D. Chemotherapy.
E. Radiofrequency ablation.

The answer is C

16. A 25-year-old female driver of an automobile sustained severe multiple traumatic

injuries. She had an altered sensorium and required intubation. Etomidate was
used for induction. A noted side effect of this agent is associated with what
electrolyte abnormality?
A. Hypomagnesemia
B. Hypokalemia
C. Hyperphosphatemia
D. Hyponatremia and hyperkalemia
E. Hypernatremia and hypokalemia

The answer is D

17. In which of the following cases should a sentinel lymph node biopsy be performed?
A. A 0.7-mm melanoma over the right tibia with a clinically negative right groin
B. A 1.0-mm melanoma overlying the left groin
C. A 1.5-mm melanoma of the right upper arm and clinically negative right axilla
D. A 1.7- to 5-mm melanoma of the left thigh with palpable adenopathy of the left
groin
E. A 0.6-mm melanoma of the left face

The answer is C

18. A 62-year-old female presents with scaly skin surrounding her nipple that has
not resolved. A biopsy including skin was performed at this area. Pathology
returns with large vacuolated cells in the epithelium and no other atypical
cells or cancerous cells are present. Her treatment should be:
A. Modified radical mastectomy
B. Simple mastectomy
C. Steroid cream
D. Simple mastectomy with SLN
E. Wide excision of the skin involved
The answer is B
19. A 17-year-old male has a 2-cm right cervical nodule. An FNA is done and cells
stain positive for calcitonin. Labs also reveal elevated calcium. What is the most
likely diagnosis?
A. Familial MTC
B. Follicular thyroid cancer
C. MEN 1
D. MEN 2a
E. MEN 2b

The answer is D

20. A 25-year-old man presents with high fevers and RUQ pain. His WBC count is
19,000. An ultrasound shows a 6-cm fluid collection in the right lobe of the liver.
On CT scan, the fluid collection shows a peripheral rim of edema. The cause of
the fluid collection is most likely determined by:
A. Blood and stool cultures
B. Percutaneous aspiration of the liver lesion
C. Serologic tests
D. LFTs
 E. MRCP

The answer is C

21. A 38-year-old woman presents with RUQ. Imaging with CT shows a 3-cm mass
in segment 7 of the liver that is well demarcated with a central fibrotic area. This
central scar does not enhance in the arterial phase of the CT scan. Workup shows
no evidence of cirrhosis, hepatitis and a normal AFP level, and slightly elevated
neurotensin. What is the diagnosis?
A. FNH
B. Hepatic adenoma
C. Fibrolamellar carcinoma
D. Hepatoma
E. Hemangioma

The answer is C

22. A patient with acute pancreatitis deteriorates clinically and is reimaged. CT scan
shows findings of a fluid collection consistent with infected pancreatic necrosis
that is adherent to the posterior gastric wall and close to the pancreatic head.
What is the best management?
A. Endoscopic drainage
B. Cystogastrostomy
C. Roux-en-Y cystojejunostomy
D. Percutaneous drainage
E. ERCP

The answer is D

23. After a 3-hole esophagectomy with a cervical anastomosis, the patient begins to
develop leukocytosis, fever, and erythema of the wound. A barium swallow is
performed and there is an anastomotic leak noted. What is the most appropriate
management of this patient?
A. Open the wound and redo the anastomosis
B. Open the wound and widely drain the anastomosis
C. Endoluminal stent
D. IV antibiotics and NPO
E. Observation

The answer is B

24. A hypotensive patient had sustained multiple stab wounds to the abdomen. In
the operating room, a through-and-through laceration to the stomach and a
pancreatic and a low-grade splenic injury. How would you manage the gastric
perforations?
A. Gastric resection with primary closure
B. Primary closure of both wounds
C. A posterior gastrojejunostomy with primary repair of the anterior injury
D. Resection with Roux-en-Y reconstruction
E. Subtotal gastrectomy with gastrojejunostomy

The answer is B

25. A 23-year-old male spills hydrofluoric acid on the dorsum of his left hand. What
is the most appropriate treatment?
A. Copious irrigation with water
B. Copious irrigation with water and application of calcium gluconate gel
C. Copious irrigation with normal saline and application of mafenide acetate
D. Immediate surgical excision
E. IV antibiotics and wound dressing

The answer is B

26. A 69-year-old man is seen in the office to discuss management options for his
abdominal aortic aneurysm. A recent CT performed in the emergency
department showed it to be 6.5 cm. Which of the findings below would preclude
endovascular repair?
A. Contained rupture
B. 1 cm infrarenal aortic neck
C. 3 cm diameter at iliac bifurcation
D. Growth of >1 cm over the past year
E. Multiple prior abdominal surgeries

The answer is B

27. A 73-year-old male presents 2 years after aortobifemoral bypass with a swollen,
tender mass in his groin. CT scan shows air and fluid around the left femoral
anastomosis that tracts into the abdomen. The correct management of this
condition is:
A. Culture-directed antibiotic treatment and close observation
B. Endovascular repair
C. Removal of aortobifemoral bypass and replacement with Rifampin soaked Dacron
D. Removal of aortobifemoral bypass followed by axillary-bifemoral bypass the
following day
E. Axillary bifemoral bypass followed by excision of aortobifemoral bypass

The answer is E

28. A 4-day-old 28-week gestational male develops increasing abdominal distention

and feeding intolerance. His nurse notes scant blood with the patient’s last bowel
movement. An abdominal radiograph reveals portal venous gas and pneumatosis
intestinalis. An orogastric tube is placed and IV antibiotic therapy is initiated. All
 of the following are indications for immediate operation except:
A. Worsening pneumatosis intestinalis and portal venous gas
B. Worsening acidosis
C. Abdominal wall erythema
D. Positive paracentesis cultures
E. Pneumoperitoneum

The answer is A

29. A 25-year-old man presents to the emergency center with complaints of vague
chest discomfort. Acute coronary syndromes have been ruled out and the patient
is noted to have a large anterior mediastinal mass. The α-fetoprotein levels are
markedly elevated. What is the likely diagnosis?
A. Nonseminomatous germ cell tumor
B. Seminoma
C. Thymoma
D. Lymphoma
E. Ectopic thyroid goiter

The answer is A

30. Which of the following fractures is most closely associated with intra-abdominal
injuries?
A. Calcaneal fractures
B. Distal radius fractures
C. Chance fractures
D. Jefferson fracture
E. Femoral neck fractures

The answer is C

A 46 years old women who underwent her first bilateral screening mammogram
received report that BIRAD 0 , in addition to commented that her breast density class 4 ( >
75% glandular tissue) the best next step :
A. Follow up 6 month with repeat mammogram
B. Bilateral breast u/s
C. Bilateral breast MRI
D. Obtain CT guided biopsy
E. Consult medical oncologist for breast ca treatment
ANSWER : C
11 years old boy present to ED complain of sudden sharp pain in lt testicle began 1.5
hour ago. Onexamination he has high riding firm and markedly tender lt testis , rt testis is
normal. Urine analysis normal. The most appropriate management well be:
A. Antibiotic and observation
B. Scrotal exploration and orchipexy for lt testicle
 C. Scrotal exploration and orchipexy for both testicles
D. Analgesia and discharge to home
E. Admission and observation for 24 h if pain increase, explore
ANSWER : C
A 88 year old man with severe dementia present to ER from his nursing home with
constipation and abdomen distention for last 8 days. Past medical history is remarkable for
type 2 heart block and dementia. On examination abdomen distended non tender. Abd x ray
markedly dilated large bowel with no visible air in rectum. The next step in management is:
A. Urgent laparotomy for toxic megacolon
B. Decompression rectal type
C. Neostigmine for pseudo-obstruction
D. Gastrografin enema
E. Loop colostomy for chronic obstruction
ANSWER:D

A 59 years old female newly dx of rectal Ca 14 cm from anal verge. Histopathology

consistent with moderatelydifferentiated adenocarcinoma. Staging shows tumor confined to
bowel wall without lymphadenopathy or Mets. Next step in management:
A. Transanal excision
B. Chemoradiotion
C. Resection with 5cm distal margin
D. Resection with 2cm distal margin
E. Resection with total mesorectal excision
ANSWER:C

By which of the following modalities is the staging of thymomas primarily determined:

A. Surgical resection
B. Immunohistochemistry assay
C. MRI evaluation
D. CT scan
E. Mediastinoscopy
ANSWER:A

A 55 year old women with BMI 41presents to clinic with continuedreflux symptoms
despiteNissen fundoplication and 2 revisions. During work up,It is evident that
fundoplication has failed what is the best option for this pt:
A. Conversion to toupet fundoplication
B. Laparoscopic revision of Nissen fundoplication
C. Esophageal dilatation
D. Truncal vagotomy and gastric resection
E. Laparoscopic revision to gastric bypass
ANSWER:E
 5 month old infant present with mix hyperbilirubinemia undergoes percutaneous liver
biopsy, MRCP and abdominal u/s that ultimately revealed the diagnosis of biliary atresia
which of the following is the best treatment:
A. CT guided drainage of biliary tree
B. Chocystostomy tube
C. Kasai portoenterostomy
D. Liver transplant
E. ERCP and stent
ANSWER:D

All of the following are consider risk factors for squamous cell carcinoma except:
A. Burns
B. B-pilonidal abscess
C. Rhabdomyolysis
D. Irradiation
E. Venous stasis ulcer
ANSWER:C

A 47 year old women is found to have cluster calcification on mammogram. True cut
bx reveals pleomorphic lobular carcinoma in situ. The next step in management is:
A. Observation with 6 month follow-up u/s
B. Observation with 6 month follow- upmammogram
C. Add aromatase inhibitor
D. Add trastuzumab
E. Wire localized partial mastectomy
ANSWER:E

70 y old man with caecal carcinoma undergoing Rt hemicolectomy through transverse

incision .the procedure is difficult and the incision extended medially by divided rectus
sheath. Brisk arterial hemorrhage ensues. From which of the damaged vessel originate?
A. External iliac artery
B. Femoral artery
C. Common iliac artery
D. Internal iliac artery
E. Superior vesical artery
ANSWER:A

Regarding vitamins and wound healing which od the following is correct:

A. Vit A potentiate the effect of steroids
B. Vit E has anti-inflammatory properties
C. Zinc deficiency has no effect in wound healing
D. Vit C is not essential for wound healing
E. Catabolic bioproducts of arginine can retard wound healing
ANSWER:B
 A Patient present to the ED with an avulsed amputation through the proximal phalanx
of his left index, the treatment of choice is:
A. Toe to finger transfer
B. Thenar flap
C. Replantation
D. Revision amputation
E. Local flap
ANSWER:D

The best neuromuscular relaxant for intubate 33 year old male with end stage renal
failure who candidate to perform lap cholecystectomy:
A. Mivacurium
B. Pancuronium
C. Succinylcholine
D. Vecoronium
E. Atracoronium
ANSWER:E

A 53 year old man presents with biopsy proven 4 cm buccal mucosa squamous cell
carcinoma of his left check, no lymph node palpable or visible on CT scan .the best
treatment well be:
A. Wide resection with radical neck dissection
B. Wide resection with modifying radical neck dissection
C. Local excision
D. Wide resection with selective neck dissection
E. Radiation therapy
ANSWER:D

All of the following compose the femoral triangle except:

A. Inguinal ligament
B. Sartorius
C. Adductor brevis
D. Iliopsoas
E. Fascia lata
ANSWER:C

A 56-year-old man undergoes a left upper lobectomy. An epidural catheter is inserted

for postoperative pain relief. Ninety minutes after the first dose of epidural morphine, the
patient complains of itching and becomes increasingly somnolent. Blood-gas measurement
reveals the following: pH 7.24, PaCO2 58, PaO2 100, and HCO3− 28. Which of the
following is the most appropriate initial therapy for this patient?
A. Endotracheal intubation
B. Intramuscular diphenhydramine (Benadryl)
C. Epidural naloxone
D. Intravenous naloxone
 E. Alternative analgesia
ANSWER:D

A 65-year-old woman undergoes breast conserving surgery for an area of

microcalcification. The pathology report describes a clear margin of <2 mm on the medial
aspect of the wide local excision specimen, which contained ductal carcinoma in situ only
and no invasive malignancy.
What is the most appropriate management?
A. Axillary clearance
B. Mastectomy
C. Re-excision of the medial margin
D. Re-excision of the lateral and medial margins
E. Sentinel lymph node biopsy
ANSWER:C

All are matched correctly except:

A. Suture repair of inguinal hernia with double breasting of posterior wall of
inguinal
canal.(Shouldice operation)
B. Open pre-peritoneal mesh repair for complex inguinal hernia. (Stoppa
operation)
C. Suture repair of paraumbilical hernia with double breasting of anterior
sheath.
(Mayo repair)
D. Open mesh repair of inguinal hernia.(Bassini repair)
E. Muscle release to aid abdominal wall closure in large incisional hernia.
(Ramirez
technique)
ANSWER:D

A 52 year old man presents to the emergency room with abdominal pain, weight loss
and dehydration. He has large volume diarrhea(>3L/Day) over the past few weeks.
Abdominal CT scan reveals a small mass in the tail of pancreas. Which of the following is
most consistent with a diagnosis of Verner-Morrison syndrome?
A. Abdominal pain
B. Osmotic diarrhea
C. Stool osmotic gap of 300 mOsm/kg
D. VIP plasma level of 600 pg/ml
E. Weight loss
ANSWER:D
A 65-year-old woman presents with a 1-cm lesion with a pearly border on her nose, and
punch biopsy is consistent with a basal cell carcinoma. She is scheduled to undergo Mohs
surgery. Which of the following is a benefit of Mohs surgery over wide local excision?
A. Mohs surgery results in a smaller cosmetic defect while obtaining negative
margins circumferentially.
 B. Mohs surgery offers a shorter operating time.
C. Mohs surgery can be performed on many different types of skin cancers.
D. Mohs surgery results in less recurrence and metastases.
E. Mohs surgery does not depend on intraoperative evaluation of specimen margins
with frozen sections.
ANSWER:A

The only abductor of vocal cords is :

A. Posterior cricoarytenoid muscle
B. Lateral cricoarytenoidmuscle
C. Inter-arytenoidmuscle
D. Cricothyroidmuscle
E. cricopharyngeusmuscle
ANSWER:A
A42-year-old man who weighs 60 kg is receiving3 L of standard hypertonic 25%
glucoseaminoacid solution. He has no history ofsmoking or bronchial asthma. In the ICU,
he isalert, afebrile, and hemodynamically stable,but he remains intubated and attempts to
weanhim off the ventilator have been unsuccessful. What is the most likely cause?
A. Copper deficiency
B. Excess fat calories
C. Excess glucose calories
D. Excess amino acids
E. Inadequate glucose calories
ANSWER:C

A 45 year old woman sustains a small calibre gunshot wound to the left upper quadrant.
Her BP and heart rate in the emergency department are normal on arrival. At laparotomy ,
she is found to have an injury to the colon. Which of the following is NOT true :
A. Primary repair in 1 or 2 layers is indicated for injuries involving less than 50
percent of the circumference
B. Resection with primary anastomosis of destructive injuries is preferable
C. Right hemicolectomy with primary anastomosis for injuries proximal to the
middle colic artery is useful for injuries to the cecum or ascending colon
D. Colostomy is the treatment of choice for injuries to the transverse and
descending colon
E. Placement of presacral drains for rectal injuries is not considered mandatory
ANSWER:D

Which of the following may be appropriate initial therapy for 4 cm anal cancer
involving the internal sphincter?
A. Abdomino-perineal resection.
B. Wide local excision.
 C. Radiotherapy and chemotherapy
D. Interstitial radiotherapy
E. Wide local excision with bilateral groin dissection.
ANSWER:C

Which of the following hemodynamic parameters decreases during laparoscopy with

CO2 pneumoperitoneum :
A. Mean arterial pressure
B. Pulmonary vascular resistance
C. Systemic vascular resistance
D. Heart rate
E. Peripheral blood flow
ANSWER:E

35 year old man presents with a 6-week history of a rapidly enlarging lesion on his left
arm . on examination, it is hyperkeratotic and measures less than 1 cm in diameter. You
excise the lesion. What is the most likely pathological diagnosis :
A. Melanoma
B. Squamous cell carcinoma
C. Keratoacanthoma
D. Blue nevus
E. Basal cell carcinoma
ANSWER:C

During a routine screening mammography, a62-year-old teacher is informed that she

has changes on her mammography, and she should consult her physician. She can be
reassured that the findings that indicate a benign condition are which of the following?
A. Discrete, stellate mass
B. Fine, clustered calcifications
C. Coarse calcifications
D. Solid, clearly defined mass with irregular edges
E. Discrete, nonpalpable mass that has enlarged when compared with a masss
shown on a mammogram taken 1 year previously
ANSWER:C

An 80 year old woman on Plavix for coronary stent placed years ago presents
with acute abdominal pain after a coughing spell . Her BP is 90/50 and HR 100 . She
had no previous surgeries . You feel a mass-like area in her lower abdominal wall .
The most appropriate next step is :
A. Open exploration and ligation
 B. Angio-embolization
C. Laparotomy
D. Platelets
E. Heparin drip
ANSWER:D

A 38 year old woman presents with a 1- day history of nausea, vomiting,

abdominal distension , and obstipation. She has no history of surgery and no medical
problems. The physical examination is significant for distention with atympanic
mass in the left upper quadrant and mild abdominal tenderness . The WBC count is
normal. A plain abdominal radiograph reveals a markedly dilated, kidney-shaped
loop of bowel with haustral markings that projects from the right lower quadrant to
the left upper quadrant . Which of the following is likely to be the best treatment
option :
A. Cecostomy
B. Operative detorsion with cecopexy
C. Right hemicolectomy with an ileostomy and mucus fistula
D. Initial endoscopic detorsion with a subsequent right hemicolectomy
E. Right hemicolectomy with primary anastomosis
ANSWER:E

Which one of the following gene mutations is most commonly involved in the
early development of colon carcinoma (i.e., early step in the multistep process to the
development of colon carcinoma)?
A. Inactivation of p53 tumour suppressor gene.
B. Mutation of k-ras oncogene.
C. Mutation in Herceptin 2 gene.
D. Mutation of SMAD4 gene.
E. Mutation of the Adenomatous Polyposis Coli (APC) tumour suppressor
gene.
ANSWER:E

Metabolic acidosis is a specific risk for which of the following agents :

A. Etomidate
B. Sevoflurane
C. Ketamine
D. Propofol
E. pecedex
ANSWER:D
Which of the following is most likely to require surgical correction?
A. Large sliding esophageal hiatal hernia
B. Paraesophageal hiatal hernia
C. Traction diverticulum of esophagus
D. Schatzki’s ring of distal esophagus
E. Esophageal web
ANSWER:B

A-33-year-old female is involved in a motor vehicle collision and found to have a

complete transaction of the pancreas at the level of the pancreatic neck:
A. Oversewing of the proximal segment and distal pancreatectomy
B. Drainage of the proximal and distal segments
C. Drainage of the proximal segment and oversewing of the distal segment
D. Oversewing of the proximal segment and drainage of the distal segment
E. Roux-en-Y pancreaticojejunostomy of the proximal pancreas and distal
pancreatictomy
ANSWER:A

Which of the following is not an indication to repair a splenic artery aneurysm?

A. Asymptomatic and size more than 2 cm
B. Pregnancy
C. Symptomatic and size equal 1.5 cm
D. Presence of collagen vascular disease
E. Proximal aneurysm 1.5 cm
ANSWER:D

A 55-year-old female undergoes liver resection for metastatic carcinoid tumor.

Upon induction, she becomes flushed, tachycardic to HR = 120 bpm, and
hypotensive with a systolic blood pressure of 70 mm Hg. Her end-tidal CO2
is normal and she remains normothermic. What is the next best step in
management?
A. Abort the operation
B. Administer dexamethasone
C. Administer dantrolene
D. Administer octreotide
E. Administer Benadryl
ANSWER:D

Bevacizumab
A. Is a monoclonal antibody that targets vascular endothelial growth factor (VEGF)
B. Known as Erbitux as trade name
C. Has no proven survival benefit in the metastatic setting
D. Is standard treatment for metastatic colorectal cancer in the UK
E. Is indicated in stage 2 colon cancer
ANSWER:A
Which of the following is false about the physiology of colon?
A. Colectomy increases Na requirement by 80 to 100 mEq/d
B. Short chain fatty acids are produced by bacteria from sugar
C. Short chain fatty acids have nutrient value for colonocytes
D. Motility of colon is 8 to 12 cm/h
E. Colon absorbs Na and water
ANSWER:D

Which of the following patients is at an average risk of colorectal cancer?

A. 45-year-old female with an aunt and cousin with colorectal cancer
B. 35-year-old female with ulcerative colitis diagnosed at age 25
C. 75-year-old male with a history of recurrent diverticulitis
D. 60-year-old male whose grandfather was diagnosed with colon cancer at age 60
E. 25-year-old male whose older brother had hundreds of polyps on colonoscopy
ANSWER:C

Which intracranial component can be affected most rapidly to decrease

intracranial pressure in an acute situation?
A. Intravascular blood
B. Cerebral spinal fluid
C. A mass lesion
D. An extra-axial hematoma
E. Brain tissue
ANSWER:A

A 28-year-old woman complaining of 24 h of anorexia and nausea and lower abdominal

pain. On examination she has peritoneal signs of the right lower quadrant and a temperature
of 38.3°C. At exploration she is found to have a small, contained perforation of a cecal
diverticulum. Which of the following statements regarding this situation is true?
A. Cecal diverticula are acquired disorders
B. Cecal diverticula are usually multiple
C. Cecal diverticula are mucosal herniations through the muscularis propria
D. Diverticulectomy, closure of the cecal defect, and appendectomy may be indicated
E. An ileocolectomy is indicated even with well-localized inflammation
ANSWER:D

How many times a day does enterohepatic circulation occur?

A. 2 times per day
B. 4 times per day
C. 6 times per day
D. 8 times per day
E. 10 times per day
ANSWER:E
Concerning the tumor marker CA19-9, all of the following is true except:
A. Can be elevated in cholangitis.
B. Is elevated in colorectal carcinomas.
C. Usually elevated in cholangiocarcinoma.
D. Usually elevated in pancreatic cancer.
E. 5-10 % of the population cannot produce CA19-9 even in the presence of
biliary or pancreatic diseases.
ANSWER:B

Hyperthyroidism can be caused by all of the following except:

A. Graves' disease.
B. Plummer's disease.
C. Struma ovarii.
D. Hashimoto's disease.
E. Medullary carcinoma of the thyroid.
ANSWER:E

What percentage of patient with ulcerative colitis of 20 years duration will have malignant
change?
A. 1%
B. 10%
C. 20%
D. 30%
E. 40%
ANSWER:B

What percentage of women aged 40 will have gallstones?

A. 10%
B. 15%
C. 20%
D. 25%
E. 30%
ANSWER:A

Kidney transplant recipients are at increased risk for:

A. Epidermoid skin cancer
B. Lung cancer
C. Colon cancer
D. Breast cancer
E. Uterine cancer
ANSWER:A
55y old women has incidentally identified cystic lesion in the head of pancreas. She no
pervious history of pancreatitis, analysis of fluid revealed normal amylase level, v low CEA,
negative mucin and scant cells. Mostly likely diagnosis:
A. IPMN
B. Pancreatic pseudocyst
C. Mucinous cystic neoplasm
D. Serous cystic neoplasm
E. Pancreatic duplication
ANSWER:D

33 years old female known case of GBS, admitted to hospital as case of mild acute
pancreatitis( amylase 1400). 2 days after admission on her abdomen pain resolved but her
serum amylase remain elevated (amylase 856); LFT within normal limit and her u/s shows
cholelithiasis and normal CBD. The pest next step:
A. Continue observation and repeat labs and do lap cholecystectomy after
normalize
B. Discharge and schedule her for elective lap cholecystectomy after 6 weeks
C. Procced with lap cholecystectomy
D. Do abdomen CT scan and give here ursodeoycholate to dissolve stones
E. Do ERCP for CBD stone prior to lap cholecystectomy
ANSWER:C

Most common site of malignancy that leads to metastasis to liver:

A. Cervix
B. Colon
C. Lung
D. Ovary
E. Stomach
ANSWER:B

55 years old male stepped on a rusty nail in his garage. thearea has sounding erythema .he
reports that he received his full series of vaccinations as child . He received last tetanus
booster shot when he was 20 years. what should he received for tetanus prophylaxis:
A. Tetanus toxoid 0.5 ml IM
B. Tetanus immune globin 250 IU IM
C. Tetanus toxoid 0.5 ml IM and Tetanus immune globin 250 IU IM
D. Nothing
E. Just antibiotic prophylaxis
ANSWER:A

The deleterious effect of steroid on wound healing can be partially reverse by:
A. Vitamin B1
B. Vitamin D
C. Vitamin C
D. Vitamin A
E. Vitamin B2
ANSWER:D
Compare to truncal vagotomy and pyloroplasty, proximal gastric vagotomy:
A. Decrease gastric empty
B. Impair antral pump mechanism
C. Increase dump syndrome
D. Maintain gastric empty
E. Reduce acid production
ANSWER:D

Which of the following statements concerning perioperative management of patients with

pheochromocytoma is false?
A. α-Adrenergic blockade with phenoxybenzamine may require 2 to 4 weeks of
therapy.
B. β-blockade is useful as a primary antihypertensive agent.
C. Clinical criteria confirm adequate α-adrenergic blockade.
D. Intraoperative hypotension following resection of the tumor is best treated
with vasopressin and/or methylene blue.
E. Sevoflurane is the preferred anesthetic agent vs. Desflurane.
ANSWER:D

Which of the following is true regarding the anatomy of anal canal?

A. the dentate line lies above the columns of morgagni
B. anal gland ducts are completely separate from the anal crypts
C. the column of morgagni overlies the internal hemorroidal plexus
D. the typical location of internal hemorrhoids are right lateral and left anterior
E. anal gland are frequently found in the ischiorectal space
ANSWER:C

The mainstay of therapy for ischemic colitis includes all the following except:
A. Intravenous fluids
B. Oxygen mask
C. Broad spectrum antibiotics
D. Support blood pressure using alpha agonist
E. Support blood pressure using beta agonist
ANSWER:D

Which of the following statement relating to anal sphincteric function is correct?

A. When the rectum is distended, the internal anal sphincter relaxes and the external
anal sphincter contracts
B. When the rectum is distended, the internal anal sphincter contracts and the external
anal sphincter relaxes
C. The external anal sphincter is responsible for resting anal pressure
D. The internal anal sphincter is responsible for squeezing anal pressure
E. Reflex contraction of the internal sphincter prevents rectal content from leaking
through the anus
ANSWER:A
With regard to medical management of anal fissure all are true except?
A. Initial therapy for an anal fissure is medical in nature, and most of acute anal fissures
resolve without further therapy
B. Medical therapy consists of intra-anal application of 0.4% nitroglycerin ointment
directly to the internal sphincter.
C. Patients should be instructed to use NTG ointment for the first time in the early
morning.
D. Botulinum toxin has been used to treat acute and chronic anal fissures.
E. Nifedipine ointment is also available for use in clinical trials. It is thought to have
similar efficacy to NTG
ANSWER:C

Following insertion of a Veress needle, what is the initial maneuver to confirm intraperitoneal
placement?
A. Saline drop test
B. Aspiration of the needle
C. Flushing the needle
D. Measuring insufflation pressure
E. Starting high-flow insufflations
ANSWER:B