1.

Formation of a platelet plug requires these 2

electrolytes:
A. Calcium and magnesium
B. Potassium and Sodium
C. Potassium and magnesium
D. Sodium and magnesium
E. Calcium and sodium
ANSWER: A

2. This test measures the time to formation of a platelet plug

A. Thrombin
B. Bleeding
time
C. PT
D. PTT
E. None of the above.

ANSWER: B
3. Most common congenital
bleeding disorder:
a. Von Willebrand disease
b. Hemophilia A
c. Hemophilia B
d. Hemophilia C
e. Factor VII deficiency
ANSWER: A

4. Example of clean-contaminated wound

A. Hernia repair wound
B. Gunshot wound to colon with repair
C. Abscess
D. Elective colon resection with bowel prepation.
E. Thyroidectomy wound
ANSWER: D
5. the most likely bloodborne organism to be transmitted after a hollow-bore
needle stick

a. Hepatitis
A
b. Hepatitis
B
c. Hepatitis C
d. HIV
e. Hepatitis E
ANSWER: B

6. infection/abscess formation in apocrine sweat glands is called:

A. Cellulitis
B. Carbuncle
C. Furuncle
D. Suppurative hiradenitis
E. None of the above.
ANSWER: D

7. Antibiotic of choice for Actinomyces infection

 A. Cefazolin
B. Ceftria
ne
c. Penicillin G
d. Vancomycin
e. Erythromycin
ANSWER: C

8. The main nutrient of a

colonocyte is:
A. Short chain fatty
acids
B. Glutamate
C. Long-chain fatty acids
D. Aspartate
E. Glycine
ANSWER: A

The thick condensation of endopelvic fascia that connects the presacral

9.
fascia to the fascia propria at the level of S4, which then extends to the
anorectal ring is called:
A. Denonvilliers fascia
B. Pouch of douglas
C. Waldeyer fascia
D. Retzius fascia
E. None of the above
ANSWER: C

10. The polyps in familial juvenile polyposis are:

A. Hyperplastic
 B. Pseudopolyp
C. Adenomatous
D. Hamartomas
E. None of the above
Answer: d

11. Which one of the following would be most likely to cause early onset (within
the first 4 days of hospitalization) ventilator‐associated pneumonia (VAP)?
A Streptococcus pneumonia
B Staphylococcus aureus
C Acinetobacter
D Pseudomonas aeruginosa
E Klebsiella pneumonia
ANSWER A
12. All of the following are complications of central line insertion except:
A. Arterial puncture.
B. Pneumothorax.
C. Fat embolism.
D. Catheter-related thrombosis.
E. Local site or systemic infection.
ANSWER C

13. Perioperative complications due to poorly controlled diabetes include all

except:
A. Increased susceptibility to fluid and electrolyte derangement
B. ketoacidosis
C. Non-clostridial gas-forming wound infection
D. Fungal mouth infection
E. Hematoma formation
ANSWER E
14. A 30-year-old asthmatic patient is scheduled for elective inguinal hernia
repair. In the holding area, he exhibits bilateral wheezing on auscultation. Which of
the following would be the best initial approach to perioperative management for
this patient’s surgery?
A. Perform a field block with local anesthesia and sedation.
B. Administer albuterol nebulizer treatment preoperatively and proceed with
general anesthesia via a laryngeal mask airway.
C. Postpone surgery for 4 to 6 weeks.
D. Perform surgery with spinal anesthesia.
E. Administer hydrocortisone 100 mg IV and proceed with general anesthesia.
ANSWER C
15. Regarding patients with diabetes undergoing surgery, All of the following
statements are true except;
A. Tight glucose control was associated with a significant reduction in hospital
mortality.
B. Target perioperative blood glucose should be between 110 to 150 mg/dL in all
patients, regardless of diabetic status.
C. Diabetic patients have an increased risk of cardiac events.
D. HbA1c reflects glucose control over the preceding 8 to 12 weeks.
E. Poor wound healing is more common in diabetic patients.
ANSWER A

16. All of the following are true about cystic swelling except;
A. Branchial cyst contains fluid rich in cholesterol crystals.
B. Dermoid cyst is a congenital lesion occurs in the midline
C. Sebaceous cyst is lined by glandular epithelium filled with clear fluid.
D. Ganglion is a cystic mass occurring over the tendon sheath
E. Cystic terartoma contains the hair and teeth.
ANSWER C
17. Which of the following variables best predicts prognosis for patients with a
recent diagnosis of cutaneous melanoma and no clinical evidence of metastatic
disease?
A. Breslow thickness.
B. Clark's level.
C. Ulceration.
D. Gender.
E. White complexion.
ANSWER A
18. Keloids are characterized by the following, except:
A. Consist of dense overgrowth of scar tissue.
B. Develop after wounds, burns and vaccination marks.
C. Are particularly common in negroes and pregnant females.
D. Occur most often on the face. neck and front of the chest.
E. May turn malignant.
ANSWER E
19. Congenital dermoid cysts are characterized by the following features except;
A. Occur at lines of embryological fusion.
B. Are commonest on the face.
C. Are often attached to the overlying skin.
D. May cause hollowing of subjacent bone.
E. Are lined by stratified squamous epithelium.
ANSWER C

20. A 15-year-old girl has a strong family history of thyroid malignancy. She is a
multiple endocrine neoplasia-2A kindred, with relatives diagnosed in their early
20s. What is the most appropriate serum marker to gauge the extent of disease?
A. Carcinoembryonic antigen
B. Serum calcitonin
C. Serum chromogranin
D. Serum free calcium levels
E. Serum thyroglobulin
ANSWER B
21. A 24-year-old female presents with an isolated, firm, midline swelling which
has recently rapidly enlarged, becoming transiently painful. Fine-needle aspiration
cytology of the lesion reveals only squamous debris. What is the most likely
diagnosis?
A. Reactive lymph node
B. Sebaceous cyst
C. Squamous cell carcinoma
D. Thyroglossal cyst
E. Thyroid cyst
ANSWER D

22. Indications for calcium supplementation after total thyroidectomy include all of
the following except:
A. Circumoral paresthesias.
B. Carpopedal spasm.
C. ECG abnormalities.
D. Stridor.
E. Calcium less than 7.1 mg/dL.
ANSWER D
23. Which of the following structures is not an anatomical relation to the
submandibular salivary gland?
A. The anterior facial vein
B. The facial artery
C. The inferior alveolar nerve
D. The lingual nerve
E. The hypoglossal nerve.
ANSWER C
24. Which of the following structures does not lie in the parotid gland?
A. The facial nerve
B. Terminal branches of the external carotid
C. The glossopharyngeal nerve
D. The retromandibular vein
E. Lymph node
ANSWER C
25. The commonest swellings in the carotid triangle are:
A. Thyroid nodules
B. Lymphadenopathy
C. Carotid body tumour
D.Branchial cyst
E. Lipoma
ANSWER B
26. The term lateral aberrant thyroid implies;
A. Congenital aberrant thyroid tissue lateral to the thyroid
B. Metastasis in cervical lymph node from on occult thyroid carcinoma
C. Metastasis from carcinoma of the larynx
D. Type of bronchial cyst
E. That a loose piece of thyroid has become implanted in a thyroidectomy scar
ANSWER B

27.Which one of the following gut hormones increases after RYGB?

A. GLP-1
B. Ghrelin
C. GIP
D. Leptin
E. Gastrin

Answer: A

28.A 45-year-old woman undergoes laparoscopic sleeve gastrectomy for morbid

obesity. She returns to clinic for routine postoperative evaluation and is tolerating
liquids and has lost 7 kg . in 14 days. Review of final pathology shows a 5.2cm
GIST in the greater curvature with 9 mitoses/hpf. What is the next best step in
management?
A. Adjuvant Imatinib Therapy
B. Advance diet, follow up in 2 months
C. CT chest/abdomen/pelvis with IV and PO contrast
D. PET/CT
E. FOLFOX chemotherapy
Correct Answer: A

29.Which of the following does not predispose to atherosclerosis?

A. Smoking
B. Diabetes
C. Hormone replacement therapy
D. Obesity
E. Systemic arterial hypertension
Answer: D
30.The best treatment option for a 56-year-old lady with superficial
thrombophlebitis at the knee level is:
A. Lifelong warfarin therapy
B. 3 months apixaban therapy
C. 4 to 6 weeks prophylactic dose fondaparinux
D. 4 to 6 weeks rivaroxaban therapy
E. Observation
Answer: C

31.A 70-year-old man presented with a 1.5cm left popliteal artery aneurysm while
being investigated for painful knee, what is the most appropriate management in
this case:
A. Aspirin
B. Dual antiplatelet therapy
C. Warfarin
D. Surgery
E. Endovascular stenting
Answer: A
32.Which of the following is true regarding low molecular weight heparin
(LMW)?
A. Exerts its anticoagulant effect via binding with factor VIII
B. Has more potent effect on platelets than does unfractionated heparin
C. Inactivates thrombin more readily than unfractionated heparin
D. Is excreted in urine
E. Is less efficacious compared with unfractionated heparin
Answer: D

33.Pco2 50 mm Hg, and PH 7.20, respectively. How would the acid-base status be
best described?
A. Mixed respiratory and metabolic acidosis
B. Uncompensated respiratory acidosis
C. Fully compensated respiratory acidosis
D. Uncompensated metabolic acidosis
E. Fully compensated metabolic acidosis
Answer: A
34. The vertebrocostal ribs are
A. 1st and 2nd ribs
B. 3rd till 7th ribs
C. 8th, 9th and 10th ribs
D. 11th and 12th ribs
E. All true ribs
Answer: C
35.Which of the following factors has no influence on the recurrence rate of
spontaneous pneumothorax?
A. Smoking
B. Concurrent history of pulmonary tuberculosis
C. Gender
D. Surgical treatment
E. Prior history of spontaneous pneumothorax
Answer: C
36.in major acute burn patients , changes in glucose metabolism include
A. increased serum glucose and increased serum insulin
B. increased serum glucose and decreased serum insulin
C. decreased serum glucose and increased serum insulin
D. decreased serum glucose and increased serum insulin
E. normal serum glucose and normal serum insulin
Answer: A
37.full thickness burns are characterized by the following except
A. presence of blisters
B. brown, black or white surface
C. leathery look
D. insensate
E. non blanchable
Answer: A

38. For a 22-kg child, the maintenance daily fluid requirement is approximately
which of the following?
A. 1100 ml
B. 1250 ml
C. 1550 ml
D. 1700 ml
E. 1850 ml
Answer: C
39. All of the following conditions are derived from the primitive embryonic
foregut except:
A. Bronchogenic cyst.
B. Cystic adenomatoid malformation.
C. Gastric duplication.
D. Mesenteric cyst.
E. Pulmonary sequestration.
Answer: D

40.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
41.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

42. A 66-year-old man has just been diagnosed with Barrett’s disease.
Which of the following statements best describes Barrett’s disease?
A. Columnar mucosa is replaced by squamous mucosa
B. Endoscopic mucosal resection and ablative therapy is appropriate treatment
C. It is a congenital condition
D. It is found in 5–10% of patients undergoing upper gastrointestinal endoscopy
E. No surveillance is required for Barrett’s disease
B

43. A 48-year-old woman is diagnosed on esophageal biopsies to have loss of

ganglion cells in the myenteric plexus.
What is the most likely diagnosis?
A. Achalasia
B. Barrett’s disease
C. esophageal cancer
D. Pulsion diverticulum
E. Sclerosis
A
44. Regarding gastric acid secretion, which is INCORRECT?

A. Cephalic phase of acid secretion is vagal dependent

B. Cephalic phase accounts for 60% of total acid secretion
C. Gastric phase begins when food reaches the stomach
D. Gastrin is the main hormonal component of the gastric phase
E. Gastrin, histamine and acetylcholine stimulate parietal cells to secrete HCl
B
45.A most common site of Curling’s ulcer:
A. Ileum
B. Stomach.
C. Duodenum.
D. Jejunum.
E. Esophagus.

C
46. The most common malignancy following transplantation is:
A.Lung cancer.
B.Prostate cancer.
C.Breast cancer.
D.Skin cancer.
E.Thyroid cancer.
D
47. One of the following is false:
A. The most common metastasis to small bowel is lung cancer.
B. The most common metastasis to an axillary node is lymphoma.
C. The most important prognostic factor for sarcomas devoid metastases is
tumor grade.
D. The most important prognostic factor for breast cancer devoid of systemic
metastases is nodal status.
E. The most common route for papillary thyroid cancer metastasis is lymphatic.
A
48. The principal cells involved in acute rejection:
A. B cells.
B. T cells.
C. Macrophages.
D. Platelets.
E. Lymphocyte.
B

49. Which of the following statement is true concerning the initial fluid
resuscitation of a burn patient?

a. Rigid adherence to the Modified Brooke formula is advised

b. In general, children require less fluid than that predicted by standard formulae
c. Patients with inhalation injuries require less fluid than predicted by standard
formulae
d. Dextrose should not be given as the primary resuscitative fluid for any age group
e. Most resuscitative formulae withhold colloid solutions until 24 hours post-injury
E

50. A 47-year-old man is brought to the emergency department having been

trapped in a burning house for 20 minutes before rescue. He has sustained burns to
his entire back, and left arm, anteriorly and posteriorly and they are red and
painful. He does not appear to have airway compromise, and in particular there is
no singing of nasal hair. His blood pressure and pulse are acceptable. His estimated
weight is 80kg. What is the most appropriate resuscitation plan?
a) 3 L compound crystalloid over 8 hours, and the same again over 16 hours.
b) 4.5 L compund crystalloid over 8 hours, and the same again over 16 hours.
 c) 4.5 L compund crystalloid over 12 hours.
d) 8.5 L compund crystalloid over 12 hours.
e) Bolus resuscitation with colloid until urinary output established.

51. The intravenous fluid that a 60 kg. 30-year-old woman with an 80% burn
should be given in the first 24 hours following burn injury is:
A.19.2 liters of 5% glucose in lactated Ringer's.
B. 14.4 liters of lactated Ringer's.
C. 9.6 liters of hypertonic salt solution (sodium concentration 200 mEq. per liter).
D. 7.2 liters of 5% albumin solution.
E. 5.5 liters of the pentafraction component of hydroxyethyl starch.
B
52. A 44-year-old patient develops a mass on the anterior abdominal wall. He
notes that the mass has gradually increased in size over the last 3 months. On
examination, the lesion is a 5 × 8 cm mass in the left iliac fossa and hypogastrium.
Which test will establish whether the tumor is arising from the abdominal wall or
the abdominal cavity?
(A) Needle biospy
(B) Ability to elicit a cough impulse
(C) Transillumination
(D) Examination of the mass with the patient in a prone position
(E) Examination of the mass with the patient instructed to attempt sitting up
ANSWER: E
53.The lateral umbilical folds in the abdominal wall are formed by:

A. Urachus
B. Obliterated umbilical artery
C. Superior epigastric artery
D. Obliterated umbilical vein
E. Inferior epigastric artery
 ANSWER: E

54. Which of the following statements is TRUE concerning small bowel fistula?
(A) If internal, it occurs mainly from iatrogenic causes.
(B) It occurs more commonly after an anastomosis than spontaneously.
(C) If internal, it always causes serious complications.
(D) If external, it closes spontaneously in 10% of cases.
(E) If external, it requires immediate closure in most cases.
ANSWER: B

55.What is the T stage for an ulcerated skin melanoma, Clarks level 3, Breslow
depth 3.5 mm with 5 mitoses/mm2?
A. T2b
B. T3a
C. T3b
D. T4a
E. T1

Answer: C
56.The vertebral level at which the abdominal aorta commonly bifurcate is:

A. L1
B. L2
C. L3
D. L4
E. L5

ANSWER:D
 57.With regard to the control of pancreatic exocrine function, which of the
following statement is FALSE ?

A. Cholecystokinin, a hormone released from the duodenal mucosa, is the

predominant stimulus for pancreatic enzyme secretion
B. Gastrin is a major stimulant for pancreatic bicarbonate secretion
C. Secretin is released from the duodenum upon mucosal acidification and
stimulates pancreatic bicarbonate secretion
D. Acetylcholine, released from pancreatic nerves, stimulates enzyme
secretion
E. Enzyme secretion is regulated primarily through hormonal and neural
factors
ANSWER:B

58.All of the following are signs of portal hypertension EXCEPT:

A. Ascites
B. Esophageal varices
C. Thrombocytosis
D. Rectal varices
E. Caput medusa
ANSWER: C
59.A cirrhotic patient is admitted with variceal bleeding. The bleeding is
controlled with pharmacologic therapy, and the patient recovers from the acute
episode. Assuming they receive no other therapies to treat their varices or their
underlying cause, what is the likelihood that they will experience a recurrent
variceal bleed within 2 years?
A. 20%
B. 40%
C. 70%
D. 100
E.10%
ANSWER: C
60.Which of the following anatomic features may contribute to stricture
formation after injury to the CBD?
A. The blood supply to the supraduodenal bile duct has a longitudinal pattern.
B. The blood supply to the supraduodenal bile duct has a lateral pattern.
 C. The blood supply to the supraduodenal bile duct has a segmental end-artery
arrangement.
D. The blood supply to the CBD is derived primarily from the common hepatic
artery.
E. The blood supply to the CBD has a fragile anastomotic network.
ANSWER:A
61.All of the following are different morphological classifications of bile duct
adenocarcinomas EXCEPT
A. Nodular
B. Scirrhous
C. Diffusely infiltrating
D. Serous
E. Papillary
ANSWER: D
62.Indications for surgery in intraductal papillary mucinous neoplasms of the pancreas
include all the following except
A. Branch duct type.
B. Presence of symptoms.
C. Cyst larger than 3 cm.
D. Mural nodularity.
E. High level of carbohydrate antigen 19-9.
ANSWER: A

63.Of the following parameters, which is the best predictor of successful

extubation?
A. Increase in Paco2 of less than 10 mmHg during a spontaneous
breathing trial (SBT)
B. Spontaneous tidal volume (Vt)
C. 10-s head raise
D. Rapid shallow breathing index (RSBI)
E. Minute ventilation
ANSWER: D
 64.The maximum dose of lidocain without adrenaline is?
A. 3mg/kg
B. 4mg/kg
C. 5mg/kg
D. 7mg/kg
E. 8mg/kg
ANSWER: A

65. A43-year-old man had a previous injury to his wrist. The ulnar nerve was
severed, as indicated by which of the following?
A. Claw hand involving the ring and little fingers
B. Claw hand involving the index and middle fingers
C. Atrophy of the thenar muscles
D. Absent sensation in the index finger
E. Inability to flex the distal phalanx of the index finger
ANSWER: A
66.Compared to epidural hematoma, subdural hematoma has one of the
following features:

A. Arterial in origin
B. Less common
C. Lenticular shape on CT scan
D. More serious underlying brain damage
E. Associated with lucid interval
ANSWER: D
67.Fournier gangrene in the early stage is least likely to be associated with
scrotal:
A. pain
B. discharge
C. crepitatiom
D. erythema.
E. Swelling
ANSWER: B
 68.The pampiniform plexus of veins on the right side empties into the:
A. Internal iliac vein
B. Right renal vein
C. Inferior mesenteric vein
D. Left renal vein
E. Inferior vena cava
ANSWER:E

69- Which of the following is false about human body fluids?

A. Water constitutes about 40 to 50% of body weight in adults.
B. Muscle have higher water content than bone.
C. Young adult males have higher percentage of body water than young adult
females.
D. Malnourished individuals have higher percentage of body water than normal
individuals.
E. Approximately, 80% of the total body weight in newborns is water.
ANSWER: A

70. All of the following are clinical manifestations of hypocalcemia EXCEPT:

A. Carpopedal spasm.
B. Psychosis.
C. Depressed tendon reflexes.
D. Circumoral numbness.
E. Dysphagia.
ANSWER: C
71- Which does not shift K+ into cells?
A. Insulin
B. Dextrose
C. NaHCO3
D. Salbutamol
E. Acidosis
ANSWER: E

72- All the following are signs of hypernatremia except

A. Irritability.
B. Weakness.
C. Sticky mucus membranes.
D. Fever.
E. Bradycardia.
ANSWER: E

73- A study done to see the relation between obesity and breast cancer. The
odds ratio in this study
A. Represents the relative risk of an obese woman to have breast cancer in
comparison to a non-obese woman
B. Represents the percentage of obese women who develop breast cancer
C. Indicates the power of the results of the study statistically
D. Represent the ratio between the obese patients who developed breast
cancer to the obese patients who did not develop.
E. Indicates if there is a bias in interpreting the results
ANSWER: A
74- 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

75- All the following are clinical pictures in a patient with hypovolemic shock.
Except.

A. Increased heart rate

B. Wide pulse pressure
C. Decreased urine output
D. Flat neck vein
E. Pale and cold extremities.
ANSWER: B
76- Septic shock is characterized by all the following responses except
A. Increased cardiac output.
B. Increased systemic vascular resistance.
C. Increased blood volume in the venous capacitance.
D. Central venous pressure may not be altered significantly.
E. Mixed venous oxygen saturation may not be altered significantly.
ANSWER: B
77- All the following are well known causes of vasodilatory shock except
A. Septic shock.
B. Sever necrotizing pancreatitis without infection.
C. Diabetic ketoacidosis.
D. Anaphylaxis.
E. Prolonged sever hypotension.
ANSWER: C
78- Neurogenic shock is usually caused by
A. Head trauma.
B. Cervical spine fractures.
C. Epidural hematoma.
D. Spinal cord neoplasms.
E. Opiate toxicity.
ANSWER: B

79- Contents of the spermatic cord include all the following structures
except
A. Vas deferens.
B. Testicular artery.
C. Pampiniform plexus of veins>
D. Femoral branch of genito-femoral nerve.
E. Cremasteric artery.
ANSWER: D

80- All the following are true about the anatomy of breast except
A. Most of it extends from the lateral border of the sternum to the anterior
axillary line.
B. There is about 5 to 10 lactiferous ducts in each breast.
C. Cooper’s ligaments are attached to the clavipectoral fascia and the dermis
of the breast skin.
D. The areola contains involuntary muscles.
E. Breast lymphatics are drained to the axillary lymph nodes.
ANSWER: B
81- All the following are branches of the external carotid artery except
A. Superior thyroid thyroid.
B. Lingual.
C. Facial.
D. Occipital.
E. Ophthalmic artery.
ANSWER: E

82- During tracheostomy sited in theatre for a patient who has suffered
extensive facial trauma. Which of the following structures is not encountered
during insertion of a tracheostomy?
A. Platysma muscle
B. Thyroid isthmus
C. Strap muscles
D. Sternocleidomastoid muscle
E. Investing layer of deep cervical fascia
ANSWER D

83- All the following about the great saphenous vein are true except
A. It originates from the dorsal venous arch of the foot.
B. It courses on the medial aspect of the lower limb.
C. It passes anterior to the lateral malleolus.
D. It enters the femoral vein below the inguinal ligament.
E. It is accompanied by the saphenous nerve from the ankle to the level of
the knee.
ANSWER: C
84- All the following are true about Schwann cells except
A. They are glial cells.
B. They are present in the central nervous system.
C. They play a role in the maintenance of the nerves.
D. They play a role in the regeneration of the nerves.
E. Each Myelinating Schwan cell associates with a single axon.
ANSWER: B

85- A 20 years old male had a foot trauma during a basketball game. In the
foot x-ray two small spherical bony structures were seen around the
metacarpophalangeal joint of the big toe. They are most likely
A. Chip fractures.
B. Comminuted fracture.
C. Short bones.
D. Sesamoid bones.
E. Irregular bones.
ANSWER: D
86- The highest amount of nitrogen wasting occurs in
A. Skeletal trauma.
B. Sever sepsis.
C. Major elective surgery.
D. Major burn.
E. Total starvation.
ANSWER: D

87- In nutritional therapy, overfeeding may lead to all the following except.
A. Increased CO2 production.
B. Prolongation of the need of ventilatory support.
C. Hypoglycemia.
D. Increased risk of infections.
E. Fatty liver
ANSWER: C
 88.The best way to reduce pain from solitary bone metastasis in the third
dorsal vertebra in a patient with breast cancer is:
a) Tamoxifin
b) Chemotherapy
c) Radiotherapy
d) Bilateral adrenalectomy
e) Transphenoidal hypophysectomy
ANSWER: C

89.A 41-year-old woman has noted unilateral nipple discharge from her
right breast. No associated mass is identified on ultrasound or mammogram.
Which of the following is the next appropriate step in her management?
a) No further intervention
b) Administration of antibiotics
c) Administration of tamoxifen
d) Major duct excision
e) Nipple areolar excision with central lumpectomy
ANSWER: D
90.Select the appropriate stage of breast cancer in a patient that has tumor not
palpable, clinically positive ipsilateral axillary lymph nodes fixed to one
another; no evidence of metastases.
a) Stage 0
b) Stage I
c) Stage II
d) Stage III
e) Stage IV
ANSWER: D
91.Select the appropriate stage of breast cancer in a patient that has tumor 4.0
cm; clinically positive, movable axillary ipsilateral lymph nodes; no evidence
of metastases.
a) Stage 0
b) Stage I
c) Stage II
d) Stage III
 e) Stage IV
ANSWER: C

92.After major trauma all the following are true EXCEPT:

a) Increased ACTH levels are found
b) Increased insulin levels are present
c) The hormonal response depends upon an intact nerve supply
d) Increased aldosterone levels occur
e) The catecholamine levels are high
ANSWER: B

93.In the catabolic phase following major trauma, all of the following
statements are true EXCEPT?
A. The resting energy expenditure is increased up to 200%.
B. Insulin level is diminished.
C. Gluconeogenesis is augmented.
D. Ketosis is stimulated by glucagon.
E. Total parenteral nutrition can reverse the catabolic state.
ANSWER: E

94. A 36-year-old man who was hit by a car presents to the ER complaining of
abdominal pain. His vital signs are HR 92, BP 127/65, and RR 16. On
examination, he has tenderness to palpation in the right upper quadrant. An
ultrasound examination is performed and reveals fluid between the liver
and the kidney in Morison’s pouch. Which of the following is the most
appropriate next step in his management?
a) CT scan of the abdomen/pelvis
b) Intravenous pyelogram
c) Angiography
d) Diagnostic laparoscopy
e) Exploratory laparotomy
ANSWER: A
95. A 27-year-old man sustains a single gunshot wound to the left thigh. In the
ER, he is noted to have a large hematoma of his medial thigh. He
complains of paresthesias in his left foot. On examination, there are no
palpable pulses distal to the injury and the patient is unable to move his
foot. Which of the following is the most appropriate initial management of
this patient?
a) Angiography of the left lower extremity
b) Immediate exploration and repair in the operating room
c) Fasciotomy of the anterior compartment of the calf
d) Administration of intravenous papaverine
e) Local wound exploration at the bedside

ANSWER: B

96. A 22-year-old woman who is 21-weeks pregnant presents after a highspeed

motor vehicle collision complaining of abdominal pain and right leg pain.
She has an obvious deformity of her right femur. Her heart rate is 125
beats/minute and blood pressure is 118/52 mm Hg. FAST exam shows
fluid in the pelvis. Which of the following is the best next step in her
management?
a) Observation with serial abdominal exams
b) Diagnostic peritoneal lavage
c) CT scan of the abdomen and pelvis
d) MRI of the abdomen and pelvis
e) Diagnostic laparoscopy
ANSWER: C
 97. A 32-year-old man is in a high-speed motorcycle collision and presents
with an obvious pelvic fracture. On examination, he has a scrotal
hematoma and blood at his urethral meatus. Which of the following is the
most appropriate next step in his management?
a) Placement of a Foley catheter
b) Cystoscopy
c) CT of the pelvis
d) Retrograde urethrogram
e) Nephrostomy tube placement
ANSWER: D
98. Which of the following is true about wound healing?
a) Angiogenesis is the major contributor to the erythema seen in wounds.
b) Pain in the first 48 hours is secondary to newly active fibroblasts
attempting to contract the wound edges.
c) At 48 hours, phagocytic cells predominate in the wound bed.
d) In the first 36 hours, macrophages are the predominate cells in the
wound bed.
e) While erythema and pain can be normal, induration is typically
pathologic.
ANSWER: C
99. In wound healing the ground substance is laid down by:
a) Epithelial cells
b) Fibroblasts
c) Myoepithelial cells
d) Mast cells
e) Endothelial cells
ANSWER: B

100. Which of the following agents can BLOCK the adverse effect of
corticosteroids on wound healing?
a) Vitamin A.
b) Vitamin C.
c) Vitamin E.
d) Nicotinic acid.
e) Folic acid.
ANSWER: A