1.

Which of the following clotting factors has the shortest half life
a. Factor V
b. Factor VI
c. Factor VII
d. Factor VIII
e. Factor IX
ANSWER: C

2. The second most common cause of transfusion related death:

a. Infection
b. ABO incompatibility
c. Acute lung injury
d. Delayed transfusion reaction
e. Graft-versus-host reaction
ANSWER: B

3. Most common nosocomial infection contribute to surgical patients’

mortalities:
a. UTI
b. Pneumonia
c. Wound infection
d. Intra-abdominal abscess
e. Meningitis
ANSWER: B

Cryoprecipitate contains a low concentration of which of following?

4.
a. Fibrinogen
b. Factor VIII
c. Von Willebrand factor
d. Fibronectin
e. FACTOR XI
ANSWER: E
 5. Regarding Neutropenic enterocolitis (typhlitis), which of the following is
TRUE
a. a life-threatening problem with a mortality rate of <50%
b. A normal appearing ct scan does not exclude the diagnosis
c. CT scan of the abdomen often shows a dilated sigmoid with pericolic
stranding.
d. Its etiology is well understood
e. Characterized by abdominal pain and distention, fever, diarrhea (often
bloody), in a patient with > 1000 neutrophils/μL
ANSWER: B

6. A 21-year-old male with a family history of colon cancer is informed he is a

mismatch repair gene carrier and is at risk of HNPCC. Which of the
following screening recommendation should be applied?
A. Colonoscopy and upper GI endoscopy every five years starting now
B. Two-yearly colonoscopy from age 25 and 3-5-year upper GI endoscopy
from age 40
C. Annual colonoscopy and two-yearly upper GI endoscopy starting now
D. Colonoscopy every 3 years from age 30 and upper GI endoscopy every 3
years from age 40
E. Colonoscopy every 5 years and upper GI endoscopy every 10 years starting
now
ANSWER: B

Regarding ileostomies, one is true:

7.
A. Loop ileostomies are associated with more ischemia compared to end
ileostomies.
B. Loop ileostomies are associated with more prolapse compared to end
ileostomies.
C. Loop ileostomies are associated with fewer hernias compared to end
ileostomies.
D. Ileostomies are associated with a decrease in bacterial colonization of the
small intestine.
E. Ileostomies are associated with a decrease in small intestinal transit time.
ANSWER: B
 8. A 65-year-old woman with a 3-month history of rectal bleeding is found to
have a sessile mass on colonoscopy. Biopsy reveals a well-differentiated
adenocarcinoma. On digital rectal examination, a fixed lesion is felt 6 cm
from the anal verge. Computed tomography (CT) images of the chest,
abdomen, and pelvis demonstrate a 3-cm rectal mass, with no evidence of
distant metastasis. Which of the following is the most appropriate next
step?
A- Magnetic resonance imaging (MRI) of the rectum
B- Whole-body positron-emission tomography (PET)
C- Chemoradiation therapy
D- Transanal excision of the rectal lesion
E- CT scan of the pelvic.
ANSWER: A

9. With regards to a diaphragmatic injury following penetrating trauma, which of

the following diagnostic modality has the highest sensitivity?
A. Chest and Abdomen CT scan
B. Magnetic resonance imaging (MRI)
C. Diagnostic Laparoscopy
D. Diagnostic peritoneal lavage
E. Fluoroscopy
ANSWER: C
10. 55 years old male patient in ICU with a lower esophagus carcinoma. he is
unable to maintain adequate nutrition with by-mouth intake alone .Which of the
following is an absolute contraindication to percutaneous endoscopic gastrostomy
(PEG) placement?
A. Active infection
B. Hepatitis with large ascites
C. History of abdominal surgery
D. Peptic ulcer disease
E. Expected survival of less than 6 months
ANSWER B

11. A 25 years old male was stabbed in the neck just above the cricoid. He is
hemodynamically stable, however there is a large pulsatile hematoma. What is the
next step in management?
A. Rapid sequence intubation in the ER followed by surgical exploration
B. Emergent cricothyroidotomy in the ER followed by surgical exploration
C. Intubation in the operating room followed by surgical exploration of the neck
D. Observation in the intensive care unit
E. Placement of laryngeal mask airway (LMA) followed by surgical exploration.
ANSWER C

12. A 24‐year‐old man presents with an anterior Zone II stab wound. Upon
exploration, a laceration to the anterior trachea is noted across the first and second
and third tracheal rings. The next step in his evaluation would include:
A. Exploration of the innominate artery.
B. Exposure of the brachiocephalic vein.
C. Inspection of the bilateral recurrent laryngeal nerves.
D. Examination of the superior laryngeal nerve.
E. Examination of the posterior tracheal wall.
ANSWER E

13. Which of the following statements regarding traumatic diaphragmatic hernia

(TDH) is true?
A. TDH is more common on the right than the left
B. TDHs are always isolated condition .
C. TDHs due to blunt trauma are smaller than those due to penetrating trauma
D. TDHs are rarely found in association with other injuries
E. TDHs can present in a delayed fashion, months to years after the initial trauma.
ANSWER E
14. About tracheostomy, all the following statements are true, except:
A. Tracheostomy is indicated if mechanical ventilation is needed for a long time
B. Emergency tracheostomy is done at the scene of an accident if there is upper
airway obstruction
C. Percutaneous tracheostomy is suitable for critically-ill ICU patients
D. In adults, an ellipse is removed from the anterior wall of 2nd, 3rd and 4th
tracheal rings
E. One of its possible complications is subglottic stenosis
ANSWER B

15. A fit 50 year old man has treatment for rectal cancer at 10cm from the anal
verge. Biopsy confirms an adenocarcinoma. MRI shows a tumour which extends
beyond the bowel wall to the edge of the mesorectum with enlarged mesorectal
LN. CT does not show any metastatic disease. What is the likely treatment?
A. Anterior resection then postoperative chemoradiotherapy.
B. Preoperative chemotherapy then anterior resection.
C. Abdomino‐perineal resection.
D Preoperative radiotherapy then anterior resection with loop ileostomy.
E. Preoperative Chemoradiotherapy then anterior resection.
ANSWER D

16. All of the following statements concerning perioperative management of

patients with pheochromocytoma are true except;
A. α-Adrenergic blockade with phenoxybenzamine may require 2 to 4 weeks of
therapy.
B. Once the catecholamine secreting tumor is removed, persistent vasoconstriction
well developed.
C. Clinical criteria confirm adequate α-adrenergic blockade.
D. Intraoperative hypotension following resection of the tumor is best treated with
vasopressin.
E. Vasopressin is most effective to treat perioperative hypotension.
ANSWER B

17. A 55-year-old female is about to undergo an elective abdominoperineal

resection for a low rectal carcinoma. She usually takes 2.5 mg warfarin per day for
recurrent Deep Vein Thromposis. Her most recent international normalized ratio
(INR) is 3.0. Which of the following is the best preoperative strategy?
A. Admit the patient 1 day prior to surgery to stop warfarin and check the INR
B. Admit the patient 3–5 days prior to surgery to stop the warfarin and check the
INR <1.5
C. Admit the patient 3–5 days prior to surgery to stop the warfarin, check the INR
<1.5 and start aspirin
D. Admit the patient 3–5 days prior to surgery to stop the warfarin, check INR,
start low-molecular-weight heparin
E. Admit the patient 1 day prior to surgery to stop warfarin, check the INR <1.5
and start low-molecular-weight heparin
ANSWER D
18. A 31-year-old man presents with a mole on his anterior chest wall. It has grown
over the past 4 months and is very itchy. It bleeds occasionally. On examination
there is a 2.5-cm, irregular mole with a surrounding halo. He is also jaundiced .the
most likely diagnosis is:
A. Pyoderma gangrenosum.
B. Dermatofibroma.
C. Keratoacanthoma.
D. Melanoma.
E. Squamous cell carcinoma.
ANSWER D
19. All statements about desmoid tumors of the abdominal wall are true except :
A. Arise from the rectus muscle or its sheath.
B. Occur most often in multipara women.
C. Are locally invasive.
D. Usually give rise to metastasis.
E. Should be treated by wide local excision.
ANSWER D

20. A completely excised skin lesion of the face proved to be a basal cell
carcinoma. The further management of the case should be:
A. Lymph node dissection.
B. Radiotherapy.
C. Chemotherapy.
D. Regular follow up.
E. Reassurance of the patient.
ANSWER D

21. hypoparathyroidism following thyroid surgery most common occurs within ?

A.12 hours
B. 24 hours
C. 2-5 days
D. 7-14 days
E. 2-3 weeks
ANSWER C
22. The repair of cleft lip should be done at what age
A. 1 month
B. 3 months
C. 6 months
D. 12 months
E.18 months
Answer: B

23. Parotid gland is the most common salivary gland affected by the following
pathologies except:
A. Acute bacterial sialadenitis.
B. Salivary stones.
C. Pleomorphic adenoma.
D. Adenolymphoma (Warthin'stumor).
E. Mumps.
ANSWER B

24. A 24-year-old woman has a 4 cm intrathyroidal mass felt to the right of midline
with a cytologically-proven papillary thyroid cancer with neither palpable nodes,
no any nodes on ultrasound .What is the most appropriate treatment?
A. Right lobectomy and biopsy of any suspicious nodes.
B. Right lobectomy and central compartment nodal dissection.
C. Total thyroidectomy only.
D. Total thyroidectomy and central compartment nodal dissection only.
E. Total thyroidectomy, central compartment nodal dissection, clearance of right-
sided III-VI nodes.
ANSWER D

25. All of these structure that are at risk during the removal of submandibular
salivary gland except?
A. Marginal mandibular branch of facial nerve
B. Lingual nerve
C. Superior laryngeal nerve
D. Whartons duct
E. Hypoglossal nerve
ANSWER C
26. All of the following statements about branchial fistula are true except;
A. Commonly results from rupture of a branchial cyst.
B. Usually at the lower third of the anterior border of the sternocleidomastoid
muscle.
C. Is often bilateral.
D. Discharges clear mucoid fluid.
E. Requires removal of the whole track by the "step-ladder' operation.
ANSWER A
27. A 30 years old male patient presented with headache and flushing . he has a
family history of his relative having died of a thyroid tumor. The investigation that
would be required for this patient will be ?
A. Chest x-ray
B. Measurement of 5-HIAA
C. Measurement of catecholamine
D. Intravenous pyelography
E. Measurement Calcium
ANSWER C

28. Concerning pleomorphic adenoma (mixed salivary tumor), all of the following
statements are true except:
A. Is the commonest salivary tumor.
B. Has a very heterogeneous histological structure.
C. Is well-encapsulated.
D. Presents as a slow-growing firm swelling just below the lobule of the ear.
E. Tends to recur after enucleation .
ANSWER C
29. Which of the following is most likely to be present in inflammatory aortic
aneurysm?
A. CRP<12mg/dL
B. ESR<35mm/hr
C. Fever
D. Intestinal obstruction
E. Ureteric obstruction
Answer: E
30. Regarding Fibromuscular dysplasia of the carotid artery, all are true except:
A. Its more common in middle aged females
B. It usually affects the proximal part of the carotid artery after the bifurcation
C. It can lead to stenosis and aneurysmal degeneration
D. It is a nonatherosclerotic and a non-inflammatory process
E. It often leads to bilateral involvement of the carotid arteries
Answer: B
31. A 46-year-old man presents with dysphagia, halitosis, and regurgitation. When
reviewing his fluoroscopic swallow study, the area of highest likelihood for a
suspected upper esophageal diverticulum is:
A. Between the circular and longitudinal muscle layers of the upper esophagus.
B. Between the cricopharyngeus muscle and the longitudinal muscle of the upper
esophagus
C. Between the thyropharyngeus and the cricopharyngeus muscles
D. Distal to the cricopharyngeus muscle
E. Proximal to the inferior pharyngeal constrictor muscle
Answer: C
32.A strong risk factor for malignancy in a solitary pulmonary nodule is
A. Presence of calcium deposits in the lesion
B. Calculated doubling time of less than 30 days
C. A Standardized uptake value (SUV) of 2.5 or less on PET/CT scan
D. A spiculated border on CT scan
E. History of tuberculosis
Answer: D

33. which of the following is not true for Marjolin’s ulcer?

A. it is a squamous cell carcinoma
B. it develops in an area of chronic inflammation and scarring
C. it carries a risk of metastasis of nearly 50%
D. it does spread to regional lymph nodes
E. diagnostic biopsy should be taken from the edge rather than the base
Answer: C
34. regarding full thickness (FTSG) and split thickness skin grafts (STSG) , all the
following are false except
A. primary contracture is more in STSG
B. STSG gives better cosmetic outcome
C. FTSG has lower chance of graft survival
D. FTSG can cover wider areas than STSG
E. STSG is more resistant to trauma than FTSG
Answer: C
35. most common nerve used for nerve graft is
A. common peroneal nerve
B. sural nerve
C. deep peroneal nerve
D. musculocutaneous nerve
E. tibial nerve
Answer: B
36. In neonates with necrotizing enterocolitis, which of the following findings is an
indication of significant bowel ischemia?
A. Increased gastric residuals.
B. Septic shock.
C. Cardiac failure due to a patent ductus arteriosus.
D. Elevated platelet count.
E. Erythema of the abdominal wall.
Answer: E

37.The treatment of choice for neonates with uncomplicated meconium ileus is:
A. Observation.
B. Emergency laparotomy, bowel resection, and Bishop-Koop
enterostomy.
C. Intravenous hydration and a gastrograffin enema.
D. Emergency laparotomy, bowel resection, and anastomosis.
E. Sweat chloride test and pancreatic enzyme therapy.
Answer: C

38. Patients with Wilms’ tumors most frequently present with which of the
following?
A. Bilateral metachronous lesions
B. Bilateral synchronous lesions
C. An extrarenal primary
D. A multicentric primary lesion
E. A unifocal, unilateral lesion
Answer: E

39. A 47-year-old morbidly obese woman comes to the ER complaining of nausea,

diarrhea, and malaise. She underwent a laparoscopic gastric bypass procedure 7
weeks ago for weight reduction. She has lost 15 kg since the surgery, and her
current BMI is 41 kg/m2. Her only medications are vitamin supplements. Her
temperature is 37.0℃), BP is 114/75 mm Hg, and pulse is 92/min. Her abdomen is
distended and tympanic with mild diffuse tenderness. Abdominal X-ray
demonstrates a diffusely dilated small bowel with no obvious distal decompressed
bowel and no abdominal free air. This patient's diagnosis is most likely related to
which of the following?
A. Anastomotic dehiscence
B. Perforation
C. Bacterial overgrowth
D. Fistula
E. Stricture
Answer C
40. After years of lifestyle modification trials, a patient with a BMI of 46 and
multiple co-morbidities is considering bariatric surgery as a resort to weight loss.
Which of the following is correct regarding Sleeve Gastrectomy?
A. Staple line leaks involving the antrum might require interval conversion to
gastric bypass
B. Current consensus regarding stapler selection favors a diameter that ensures a
narrow sleeve
C. Staple line leaks currently occur with an incidence of approximately 3% to 5%
D. Infection is the most dire complication post sleeve gastrectomy
E. Hemorrhage after sleeve gastrectomy is managed operatively regardless of
hemodynamic stability
Answer: A

41. All of the following gases could be used to provide pneumoperitoneum during
laparoscopic surgeries, except:
A. Methane
b. Carbon dioxide
c. Helium
d. Nitrous oxide
e. Argon
Answer: A
42. Hemodynamic changes associated with carbon dioxide pneumoperitoneum, for
laparoscopy, include the increase in the following, except:
a. Central venous pressure
b. Heart rate
c. Mean arterial pressure
d. Cardiac output
e. Peripheral vascular resistance
Answer: d

43. Which of the following best describes endoscopic therapy for esophageal
cancer?
A. Ablative therapy should not be given after endomucosal resection
B. It is not used inpatients unsuitable for surgery
C. It should be offered to patients with high-grade dysplasia and intramural
cancer (T1a)
D. Photodynamic therapy is not indicated for clinical use
E. Radiofrequency ablation is not suitable for flat high-grade dysplasia
C
44.Which of the following statements best describes gastric cancer?
A. Gastrectomy and D2 lymphadenectomy should be performed routinely for all
gastric cancers.
B. Removal of station 10 lymph nodes include nodes along the splenic artery
C. There is minimal additional risk associated with D2 lymphadenectomy for
distal stomach cancers
D. Total gastrectomy with en-bloc pancreaticosplenectomy should be performed
for distal gastric cancers
E. Total gastrectomy is not indicated for proximal cancers
A

45. A 72-year-old woman is found at have a solitary diverticulum in her

esophagus.Which of the following statements best describes esophageal
diverticulum?
A. Achalasia does not lead to diverticula
B. Pulsion diverticula are most common in the distal esophagus
C. Pulsion diverticula most commonly arise from the anterolateral wall of the
esophagus
D. Pulsion diverticula only occur in the distal esophagus
E. Traction diverticula are more common than pulsion diverticula
B
46. A 69-year-old woman has undergone a gastrojejunostomy and complains
postoperatively of pain after eating food. This pain is relieved by vomiting which
is projectile and contains bile only.What is the most likely diagnosis?
A. Chronic afferent loop syndrome
B. Dumping syndrome
C. Enterogastric reflux
D. Gastro-oesophageal reflux
E. Small stomach syndrome
A
47. Which of the following statements is true regarding the pathophysiology of
peptic ulcer disease
 A.High acid secretion is associated with type 4 gastric ulcers
B.Type 2 peptic ulcers are unlikely to be associated with helicobacter pylori
C.Gastrin hypersecretion leads to increased parietal cells production of acid
D.Non-steroidal anti-inflammatory drugs increased acid secretion
E.Most acid is produced in the antrum of the stomach
C
48. Petersen hernia, which is True

A. An internal hernia behind Roux en Y limb.

B. An internal hernia via Transverse mesocolon.
C. Total gastrectomy associated with larger Petersen space and higher risk of
hernia than distal gastrectomy.
D. A hernia via epiploic foramen.
E. More common in retrocolic than antecolic anastomosis.
A

49. In comparing laparoscopic gastrostomy versus percutaneous endoscopic

gastrostomy(PEG) tubes, which of the following statements is true?
A. Complications rates are similar in adults.
B. Early pneumoperitoneum is seen only after laparoscopic gastrostomy tube
placement.
C. Laparoscopic gastrostomy tube placement is associated with more
complications in children younger than 5 years of age.
D. Previous fundoplication is a contraindication to PEG tube placement.
E. Mortality is higher after PEG tube placement.
A

50. a 60-year-old man undergoes an endoscopy for reflux disease. He is being

treated with proton pump inhibitors. His endoscopy reveals a 1-cm subepithelial
lesion on the lesser curvature of the stomach, 3 cm from the gastroesophageal
junction with smooth appearance on endoscopic ultrasound with no high-risk
features. Needle–guided core biopsy reveals a CD 117+ tumor. What is the most
appropriate management?
 A. Endoscopic submucosal dissection.
B. Laparoscopic partial gastrectomy.
C. Subtotal gastrectomy with modified D2 node dissection.
D. Stop proton pump inhibitor therapy.
E. Observation.
E

51. A 50-year-old man undergoes excisional biopsy of a mole overlying the

lateral aspect of his left scapula. Other than the mole, his physical examination
is normal. Pathology demonstrates a 2.5-mm thick melanoma. Initial surgical
management includes
A. 0.5-cm margins with sentinel lymph node dissection.
B.1.0-cm margins with sentinel lymph node dissection
C. 2.0-cm margins with sentinel lymph node dissection
D. 2.5-cm margins with sentinel lymph node dissection
E. 5.0-cm margins with sentinel lymph node dissection
C
52. The genetic defect in patient with a lynch-syndrome associated colon cancer
result in
A. chromosome deletion.
B. Microsatellite instability.
C. Constitutively active K-ras.
D. Mitochondrial DNA mutation.
E. Disruption of binding in beta-catenin.
B

53. A45-year-old woman undergoes breast conservation surgery and sentinel

lymph node biopsy for 1.2-cm invasive ductal carcinoma of her right breast.
Lumpectomy margins are clear, only 1 of 4 sentinel lymph nodes is positive for
metastatic disease. The tumor is strongly ER\PR positive and Her2\neu
negative.What biomarker would provide information that would mitigate her need
for adjuvant chemotherapy?
A. p53.
B. 21-gene expression profile.
C. Ki-67.
D. BRACA1\BRACA2.
E. PD-L1.
B
54. Two months after kidney transplant, your patient develops respiratory
symptoms requiring admission to the icu. Chest Xry shows diffuse infiltrates and
bronchial washings show cells with inclusion bodies. creatinine has risen from 1.4
to 2.0. The most appropriate treatment:
A. Ganciclovir.
B. Acyclovir.
C. Bactrim.
D. Penicillin.
E. Hydrocortisone.
A
55. A cross match for transplantation is performed by:
A. Mixing donor lymphocytes with recipient serum.
B. Mixing recipient lymphocytes with donor serum.
C. Mixing donor plasma with recipient serum.
D. Mixing recipient plasma with donor serum.
E. Mixing donor serum with recipient serum.
A

56. Eight hours after treatment for a scald injury, an infant has a temperature of
40C and WBC of 5000/mm3. The burn wound is clean. The most likely diagnosis
is:
a) Cytomegalovirus infection
b) Clostridial wound infection
c) Toxic shock syndrome
 d) Pseudomonas wound infection
e) Pneumocystis pneumoniae

C
57. The best nutrition access method for a critically ill burn patient is:
a) Nasogastric
b) Nasojejunal
c) Parenteral
d) Percutaneous gastrostomy
e) Witzel jejunostomy

58. The following Nyhus classification of hernias is correct Except for:

A. Recurrent direct inguinal hernia—Type IVa.
B. Indirect inguinal hernia with a normal internal inguinal ring—Type I
C. Femoral hernia—Type IIIc.
D. Direct inguinal hernia—Type IIIa.
E. Indirect inguinal hernia with destruction of the transversalis fascia of
Hesselbach's triangle—Type II.
ANSWER: E

59. The following statements about the repair of inguinal hernias are true
Except:
A. The conjoined tendon is sutured to Cooper's ligament in the Bassini hernia
repair.
B. The McVay repair is a suitable option for the repair of femoral hernias.
C. The Shouldice repair involves a multilayer, imbricated repair of the floor
of the inguinal canal.
D. The Lichtenstein repair is accomplished by prosthetic mesh repair of the
inguinal canal floor in a tension-free manner.
E. The laparoscopic transabdominal preperitoneal (TAPP) and totally
extraperitoneal approach (TEPA) repairs are based on the preperitoneal
repairs of Cheattle, Henry, Nyhus, and Stoppa.
ANSWER: A
 60. Which of the following statements is true regarding surgical technique?
A. A Bassini repair can be used for femoral hernias.
B. A Shouldice repair approximates the transverses abdominis aponeurosis to
Cooper’s ligament medially and the iliopubic tract laterally. It requires a
relaxing incision.
C. A total extraperitoneal repair (TEP) is a laparoscopic approach that stays in
the preperitoneal space by using a balloon dissector.
D. A Bassini repair uses a piece of mesh to reinforce the floor of the inguinal
canal and recreate the internal ring in a tension-free manner.
E. A McVay repair may never be used for femoral hernias.

ANSWER:C

61. Which of the following is true regarding the principles of surgical treatment
of fistula in-ano?
A. After identification of external and internal fistula openings, the tract
should be incised unless excessive overlying muscle is present.
B. The granulation tissue exposed in the fistula tract should be left
untreated.
C. Fistulotomy should not be performed if a portion of external sphincter
is involved.
D. Treatment of horseshoe fistula-in-ano should include complete
resection of the entire fistula tract regardless of the extent of soft
tissue involvement.
E. Complex transphincteric fistulas require a cutting seton tightened over
time.
ANSWER: A
 62. The most common clinical presentation of idiopathic retroperitoneal
fibrosis is
a. Ureteral obstruction
b. Leg edema
c. Calf claudication
d. Jaundice
e. Intestinal obstruction
ANSWER: A

63. All of the following syndromes are associated with soft tissue sarcoma
EXCEPT:
A. Familial retinoblastoma
B. von Hippel-Lindau syndrome
C. Li-Fraumeni syndrome
D. Gardner syndrome
E. Tuberous sclerosis
ANSWER: B
 64. Which of the followings statements regarding intraductal papillary mucinous
neoplasms of the pancreas is true

A. The tubular variety of carcinoma arising in an IPMN indicates a better

prognosis than the colloid type
B. Main-duct IPMN have greater malignant potential than do the branch duct
type
C. IPMN is more common in men than in women
D. Cystic lesions larger than 3 cm should undergo surgical resection
E. Branch-duct IPMN should undergo resection regardless of size
Answer: B

65. A patient presents to the emergency department with obstructive jaundice. A

percutaneous transhepatic cholangiogram and biliary drainage is performed.
Shortly afterward, the patient develops a UGI bleed. What is the most likely
cause?
A. The patient has developed stress gastritis.
B. The patient has ingested NSAIDs after the procedure.
C. The patient has developed hemobilia.
D. The patient is bleeding from esophageal varices.
E. The catheter has migrated from the biliary tree into the stomach.
Answer: C
66. The most common presenting clinical sign in Budd-Chiari syndrome is:
A. Ascitis.
B. Esophageal varices.
C. Jaundice.
D. Encephalopathy.
E. Hemorroids.
ANSWER:A

67. A 42-year-old man is admitted with bleeding from esophageal varices.

Investigation reveals that he has an occlusion of the portal vein. There is no
evidence of liver cirrhosis. Which test will most likely reveal an underlying
predisposing factor for this condition?
A. Hepatitis screening
B. Isoamylase
C. Intravenous pyelogram to exclude hydronephrosis
D. Coagulation tests to include antithrombin III
E. CT of abdomen

ANSWER: D

68. During liver resection, where is the most common site of life-threatening
hemorrhage?
A. Main hepatic arteries
B. Portal vein branches
C. Intrahepatic vena cava
D. Hepatic vein branches
E. Hepatic artery variants
ANSWER: D

69. All the following are true about Transjugular Intrahepatic Portosystemic
Shunt (TIPS) except
A. Its main indication is to stop esophageal variceal hemorrhage not responded to
medical treatment.
B. t doesn’t affect possible future liver transplant plan.
C. It improves hepatic encephalopathy.
D. It may induce renal failure.
E. Shunt thrombosis rate is high.
ANSWER: C

70. For a symptomatic partial duodenal obstruction secondary to

an annular pancreas, the operative treatment of choice is
a. A Whipple procedure
b. Gastrojejunostomy
c. Vagotomy and gastrojejunostomy
d. Partial resection of the annular pancreas
e. Duodenojejunostomy
ANSWER: E

71.Which of the following is considered a primary determinant of

suitability for resection when evaluating a patient with hepatic colorectal
metastases?

a. Number of metastatic tumors

b. Size of metastatic tumors
c. Predicted volume of hepatic remnant
d. Prior chemotherapy
e. Prior radiotherapy
ANSWER: C

72.A 46-year-old man with a 13 kg weight loss undergoes a CT of his

abdomen which diagnoses cancer in the head of the pancreas.
Which of the following statements best describes the management of pancreatic
cancer?
A All patients should undergo endoscopic ultrasound assessment of a suspected
lesion
B Pylorus-preserving pancreaticoduodenectomy may be the preferred treatment
option for this patient.
C Surgical options do not exist for locally advanced disease
D Triple phase CT of the abdomen reliably stages the lymph nodes
E Tumours are chemoradiation resistant with few palliative options

ANSWER: B

73.According to the Bismuth-Corlette classification system, perihilar

cholangiocarcinomas extending into the right secondary intrahepatic ducts
are classified as:
A. Type II
B. Type IIIb
C. Type IIIa
D. Type IV
E. Type I
ANSWER: C

74. The best way to confirm proper placement of endotracheal intubation is:
a. Direct visualization of tube passing through the vocal cords
b. Auscultation of lungs
c. Observation of condensation within tube
d. Chest x-ray
e. End-tidal CO2
Answer: E

75. The most likely site of injury leading to cerebrospinal fluid rhinorrhea is an
occult fracture in the frontal basal skull of which of the following?
A. Semicircular canal
B. Cavernous sinus
C. Eustachian auditory tube
D. Odontoid process
E. Superior orbital fissure
ANSWER: C

76. Which of the following anatomical statements are INCORRECT?

A. The bladder is lined by transitional epithelium.
B. Hypertrophy of the detrusor muscle results in bladder trabeculation.
C. The epithelium of the trigone extends into the lower ends of ureters
and proximal urethra.
D. The internal sphincter prevents urinary incontinence.
E. The distal urethral sphincter is supplied by S2–S4 fibres via the
pudendal nerves.
ANSWER: D

77. What is the electrolyte abnormality most commonly seen when ileum or
colon is used in the urinary tract:
A. Hyponatremic, hypochloremic, hyperkalemic metabolic acidosis
B. Hyperchloremic metabolic acidosis
C. Hypochloremic metabolic alkalosis
D. Hyponatremic, hypochloremic, hyperkalemic metabolic alkalosis
E. Hyperchloremic hypernatrimic metabolic acidosis
ANSWER: B
78. Which of the following is true about the anion gap?
A. It is calculated by subtracting the serum anions from the serum cations.
B. Hypoalbuminemia reduces the anion gap.
C. Administration of HCL increases the anion gap.
D. Methanol toxicity leads to normal anion gap metabolic acidosis.
E. The normal anion gap is up to 4mmol per liter.
ANSWER: B

79. Which of the following is a cause of pseudo hyponatremia?

A. Intravenous infusion of hypotonic solution.
B. Hyperlipidemia.
C. Postoperative increase in ADH level.
D. Nasogastric tube.
E. Uretrosigmoidostomy.
ANSWER: B

80. All the following are causes of hyperphosphatemia except

A. Renal failure.
B. Hyperparathyroidism.
C. Hyperthyroidism.
D. Tumor lysis syndrome.
E. Malignant hyperthermia.
ANSWER: B
81. All the following are risk factors of retained surgical sponges in surgery
except
A. Emergency surgery.
B. Obese patients.
C. Multiple surgical specialties involved in the operation.
D. Changing nursing shifts.
E. Thoracic surgery.
ANSWER: E
82. A study was done about the age at diagnosis of colorectal cancer. The
standard deviation was big. This means that
 A. The mean age of the studied group is above the mean age of the general
population.
B. The ages of the studied group included in the study are widely dispersed.
C. The study has low statistical significance.
D. The method of conducting the study is not correct.
E. The risk of colorectal cancer increases with age.
ANSWER: B

83. Following a hypovolemic shock which lasted for hours, which of the
following tissues can withstand ischemia most?
A. Skeletal muscle
B. Vascular smooth muscle
C. Kidney.
D. Myocardium
E. Liver
ANSWER: B
84. Which of the following mediators is proinflammatory?
A. Interferon.
B. Interleukin-4.
C. Interleukin-10.
D. Prostaglandin E2.
E. Transforming growth factor beta.
ANSWER: A

85. The right adrenal vein is usually drains to

A. Inferior vena cava.
B. Right renal vein.
C. Lumber veins.
D. Right inferior phrenic vein.
E. Right gonadal vein.
ANSWER: A
86. Which of the following arteries of the blood supply to the pancreas is
not derived from the splenic artery?
 A. Greater pancreatic.
B. Inferior pancreatico-duodenal.
C. Dorsal pancreatic.
D. Aka transverse pancreatic.
E. Caudal pancreatic.
ANSWER: B
87. In comparison between Jejunum and Ilium which of the following is
true?
A. Jejunum is longer.
B. Absorption of B12 occurs in the Jejunum.
C. Arterial arcades in the mesentery of the Ilium are shorter.
D. Digestion and secretion of enzymes take place in the Ilium.
E. The major amount of mucosa associated lymphoid tissue is present in the
Jejunum.
ANSWER: C

NUTRITION

88. Currently, which percentage of the standard total enteral feeding

calories intake is approximately given as carbohydrates?
A. 20%.
B. 35%.
C. 50%.
D. 65%.
E. 80%.
ANSWER:C

89. Which of the following is true about glutamine?

A. It is an essential amino acid.
B. It is present in minute amount in human body.
C. It provides a major fuel source for enterocytes.
D. Glutamine supplementation is highly recommended in critically ill
patients.
E. It has strong immunoenhancing properties.
ANSWER: C
90.Which of the following breast papillomas has the highest premalignant
potential:
a) Segmental duct papillomas.
b) Subsegmental duct papillomas.
c) Terminal duct unit papillomas.
d) Juvenile papillomas in any duct.
e) Adolescence papillomatosis in any duct.
ANSWER: c
91.A 62-year-old woman presents with invasive ductal carcinoma of the right
breast. Which of the following findings would still allow her to receive
breast-conservation surgery?
a) Diffuse suspicious microcalcifications throughout the breast
b) Multifocal disease
c) Previous treatment of a breast cancer with lumpectomy and radiation
d) Large tumor relative to breast size
e) Persistently positive margins after multiple reexcisions of the breast
cancer
ANSWER: B

92.A 40-year-old woman presents with a 6-month history of erythema and

edema of the right breast with palpable axillary lymphadenopathy. A
punch biopsy of the skin reveals neoplastic cells in the dermal lymphatics.
She has a full staging workup, including bilateral mammogram, ultrasound
of the bilateral breasts and axillae, and CT scan of the chest, abdomen, and
pelvis. She has no other sites of disease. Which of the following is the best
sequence of steps in her management?
a) A course of antibiotics to treat the overlying cellulitis and then
neoadjuvant chemotherapyfor breast cancer
b) Modified radical mastectomy followed by adjuvant chemotherapy
c) Modified radical mastectomy followed by hormonal therapy
 d) Combined modality chemotherapy and radiation therapy to the right
breast with
surgery reserved for residual disease
e) Combined modality therapy with chemotherapy, surgery, and radiation
ANSWER: E
93.A 45-year-old woman is found to have suspicious appearing calcifications
in the right breast on a screening mammogram. Stereotactic biopsy of
the calcifications shows lobular carcinoma in situ (LCIS). On examination,
both breasts are dense without palpable masses. The cervical, supraclavicular,
and bilateral axilla are negative for lymphadenopathy. Which of the following
is the most appropriate management of this patient?
a) Hormone therapy
b) Chemotherapy
c) Radiation
d) Right total mastectomy with sentinel lymph node biopsy
e) Bilateral modified radical mastectomy
ANSWER: A

94.A 33-year-old pregnant woman notices a persistent, painless lump

in the left breast. On examination the left breast has a single mobile mass
without evidence of skin changes or lymphadenopathy in the neck or axilla.
An ultrasound demonstrates a solid, 1-cm mass in the upper outer quadrant
of the breast. A core-needle biopsy shows invasive ductal carcinoma. The
patient is in her first trimester of pregnancy. Which of the following is the
most appropriate management of this patient?
a) Termination of the pregnancy followed by total mastectomy
b) Immediate administration of chemotherapy followed by modified radical
mastectomyafter delivery of the baby
c) Segmental mastectomy, sentinel lymph node biopsy, and adjuvant
radiation therapy
shortly after surgery
d) Total mastectomy with sentinel lymph node biopsy
e) Modified radical mastectomy

ANSWER: D
95.A 35-year-old female has a 6-month history of a 2-cm breast mass which
was biopsied and consistent with a fibroadenoma. She now comes into the
office reporting that the mass has rapidly enlarged and is now 10 cm.
Which of the following is the most appropriate initial management strategy
for this lesion?
a) Wide local excision with a rim of normal tissue
b) Lumpectomy and axillary lymphadenectomy
c) Modified radical mastectomy
d) Excision and postoperative radiotherapy
e) Excision, postoperative radiotherapy, and systemic chemotherapy
ANSWER: A

96.Regarding abdominal vascular trauma:

a) In blunt trauma arteries are more commonly injured than veins
b) It is not a common cause of death in abdominal injuries
c) The portal vein can be safely ligated
d) The liver can stand warm ischemia for 6 hours
e) Ligation of the inferior vena cava below the renal veins is commonly
fatal
ANSWER: C

97.A 31-year-old man is brought to the ER following an automobile accident

in which his chest struck the steering wheel. Examination reveals stable
vital signs and no evidence of respiratory distress, but the patient exhibits
multiple palpable rib fractures and paradoxical movement of the right side
of the chest. Chest x-ray shows no evidence of pneumothorax or
hemothorax. Which of the following is the most appropriate initial
management of this patient?
a) Intubation, mechanical ventilation, and positive end-expiratory pressure
b) Stabilization of the chest wall with sandbags
c) Stabilization with towel clips
d) Immediate operative stabilization
e) Pain control, chest physiotherapy, and close observation
ANSWER: E

98.A 25-year-old man sustains an abdominal gunshot wound. At laparotomy,

it is discovered that the transverse colon has incurred a through-and-
through injury with minimal fecal soilage of the peritoneum. Which of the
following is the most appropriate management of this patient?
 a) A colostomy should be performed regardless of the patient’s
hemodynamic status to decrease the risk of an intraabdominal infection.
b) Primary repair should be performed, but only in the absence of
hemodynamic instability.
c) Primary repair should be performed with placement of an intra-
abdominal drain next to the repair.
d) Primary repair should be performed, and intravenous antibiotics
administered for 14 days.
e) The patient should undergo a 2-stage procedure with resection of the
injured portion and reanastomosis 48 hours later when clinically
stabilized

ANSWER: B
99.Which of the following is a contraindication for negative-pressure wound
therapy (NPWT)?
a) Newly grafted skin
b) Wounds with a fistula
c) Diabetic wounds
d) Ischemic wounds
e) Venous stasis wounds

ANSWER: D

100. A 35-year-old woman with breast cancer underwent lumpectomy and

radiation therapy. She had recurrence of the tumor and underwent a
modified radical mastectomy. Regarding radiotherapy’s effect on wound
healing, all of the following statements are true, except:
a) It can cause fibroblast injury.
b) It decreases the amount of collagen deposition.
c) Effects are reversible after 1 year of last treatment.
d) Radiation therapy increases the risk of wound infection.
e) Wound healing is impaired because of vascular damage.

ANSWER: C