1-On which of the following does aldosterone exert its greatest effect?

A. Glomerulus
B. Proximal tubule
C. Thin portion of the loop of Henle
D. Thick portion of the loop of Henle
E. Cortical collecting duct
E
2-MEN 2A and MEN 2B syndromes are associated with germline mutations in:
A. The p53 tumor suppressor gene.
B. The H-ras gene.
C. The N-myc gene.
D. The RET proto-oncogene.
Answer: D
3-A 28-year-old male was injured in a motorcycle accident in which he was not
wearing a helmet. On admission to the emergency room he was in severe
respiratory distress and hypotensive (blood pressure 80/40 mm. Hg), and appeared
cyanotic. He was bleeding profusely from the nose and had an obviously open
femur fracture with exposed bone. Breath sounds were decreased on the right side
of the chest. The initial management priority should be:
A. Control of hemorrhage with anterior and posterior nasal packing.
B. Tube thoracostomy in the right hemithorax.
C. Endotracheal intubation with in-line cervical traction.
D. Obtain intravenous access and begin emergency type O blood transfusions.
E. Obtain cross-table cervical spine film and chest film.
Answer: C
4-. 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. Celtic complexion.
Answer: A
5-Biologic features of adult soft tissue sarcomas include the following except:
A. Mutations of p53 in metastatic liposarcoma.
B. A low (less than 1%) risk of metastasis for small, low-grade lesions.
C. Recurrent disease in at least 33% of patients.
D. Lymph node metastasis in less than 3% of patients.
E. Mutations of p53 in Li-Fraumeni syndrome.
A
6. A new marker that has possible utility in the management of patients with non
small-cell lung cancer (NSCLC) is:
A. Calcitonin.
B. Neuron-specific enolase.
C. CYFRA 21-1.
D. Glucagon.
E. Chromogranin A.
Answer: C
7-. The presence of which marker is a significant poor prognosis variable for patients
with breast cancer:
A. CEA.
B. C-erb B-2.
C. AFP.
D. Human chorionic gonadotropin (hCG).
E. RB-1.
Answer: B
8-. A 45-year-old man with long-standing gastroesophageal reflux undergoes upper
endoscopy that reveals patchy areas of epithelium resembling gastric mucosa
extending 5 cm proximal to the esophagogastric junction. Biopsies are obtained.
The pathologic report describes Barretts epithelium. Which of the following

processes does this finding represent?

a. Cellular hyperplasia
b. Cellular hypertrophy
c. Metaplasia
d. Carcinoma in situ
Answer: c
9- Patients that have acquired immunodeficiency syndrome are at increased risk for
which of the following neoplasms?
a. Colorectal cancer
b. Meningioma
c. Kaposis sarcoma
d. Hepatocellular carcinoma
e. Esophageal carcinoma
Answer: c
10- DNA viruses have been implicated as etiologic agents in several human tumors.
Evidence for a causative role exists for which of the following neoplasms?
a. Hodjkin lymphoma
b. Testicular carcinoma
c. Cervical carcinoma
d. Osteogenci sarcoma
e. Esophageal carcinoma
Answer: c
11- Which of the following statements about surgical anatomy of the colon and
rectum is/are correct?
A. The cecum has the largest inner diameter of all segments of the colon (13 to 15
cm.).
B The rectum is entirely an intraperitoneal organ.
C The ileocolic, right colic, and middle colic arteries are branches from the superior
mesenteric artery

C
12-. All are true about the dumping syndrome except:
A. Symptoms can be controlled with a somatostatin analog.
B. Diarrhea is always part of the dumping syndrome.
C. Flushing and tachycardia are common features of the syndrome.
D. Separating solids and liquids in the patient's oral intake alleviates some of the
symptoms of the syndrome.
E. Early postoperative dumping after vagotomy often resolves spontaneously.
Answer: B
13-a 40 year old woman is admitted to the icu after retroperitoneal sarcoma
resection on postoperative day 5 her platelet count dropped to 85000(baseline
325,000) . she has been receiving unfractional heparin for venous
thromboembolism prophylaxis perioperatively. She has no evidence of clinical
bleeding. All of the following are indicated except
Oral warfarin
Direct thrombin inhibitor
Discontinuing all heparin
Testing for heparin induced thrombocytopenia (HIT) antibodies
Evaluation for venous thromboembolism
A
14- which of the following is a common complication of roux-y gastric bypass
(rygb)?
Vitamin D deficiency
Primary hyperparathyroidism
Anemia due to lack of transferring

Symptomatic thiamine deficiency

Hypocoagulable state
A
15- when a patient with colonic pseudo-obstruction fails to improve after two doses
of neostigmin, the next step should be
Laparotomy and partial colectomy with anastomosis
Percutaneous cecostomy
Additional dose of neostigmin
Erythromycin administration
Colonscopic decompression
E
16- Which of the following statements about laparoscopic surgical complications is
not true?
A. Damage to the common bile duct is most frequent
B. Electrocautey equipment is the most common type of device causing injury
C. Excessive pain is the most common indication for re-laparoscopy less than 48 hours
D. Delayed re-laparoscopy significantly increases length of hospital stay
E. Delayed identification of the injury is common
B
17- a 45 year old man with a history of hepatitis C and cirrhosis presents for elective
cholecystectomy for symptomatic gallstones. The single best predictor of
perioperative mortality is

A. Ultrasound appearance of the gallbladder

B. CT appearance of the liver
C. Child-Pugh classification
D. MELD score
E. Hepatitis C viral load
D
18- Negative pressure wound is associated with all of the following except
A. Increased local blood flow
B. Stimulation of granulation tissue
C. Decreased tissue edema
D. Decreased bacterial counts
E. Increased rate of wound healing
D
19- Which of the following has not been shown to decrease the incidence of
ventilator-associated pneumonia(VAP)?
A. Topical oral cholrhexidine
B. Elevation of the head of the bed 30 degree
C. Silver-coated endotracheal tubes
D. Early tracheostomy
E. Decreased sedative use
D
20- which of the following is recommended to prevent nosocomial pneumonia in
patients with flail chest associated with an underlying pulmonary contusion?

A. Mandatory mechanical ventilatory support

B. Corticosteroids
C. Epidural analgesia
D. Antibiotics
E. Immediate chest wall fixation
C
21- which of the following statements about corticosteroid administration in septic
shock is true?
A. Intravenous corticosteroids should be administered simultaneously with initial fluid
rescuscitation
B. Hypoalbuminemia less than 2.5 g/dl decreases total cortisol levels
C. Hydrocortisone less than 450mg/day is required to demonstrate optimal benefit
D. Cosyntropin stimulation testing is accurate for evaluating adrenal insufficiency
E. Dexamethasone is the preferred corticosteroid foe use of septic shock
B
22- which of the following statements about thrombocytosis in trauma patients in
the ICU is true?
A. Does not increase the risk of venous thromboembolism
B. Occurs in 50%
C. Increases mortality
D. Not associated with infection
E. Normalizes in 3 to 5 days
A

23- of the following the most appropriate feeding approach for patients with severe
head injury would be
A. Total parenteral nutrition (TPN) at day 3
B. Enteral feeding at day 3
C. TPN day 5
D. Enteral feeding at day 5
E. Peripheral caloric support at day 1
B
24- which of the following statements about posttraumatic renal failure (creatinine
more than mg/dl) among patients in a level 1 trauma centre is true?
A. Occurs in more than 5% of patients
B. Has in hospital mortality of nearly 40%
C. Dialysis required in 50% of cases
D. Creatinine generally rises above 2 mg/dl within 48 hours
E. Most surviving patients require posthospital dialysis
B
25- which of the following statements about fetal death after a motor vehicle crash
is true?
A. Maternal acetabular fracture are not associated with increased fetal mortality
B. Uterine rupture is the leading cause of fetal death
C. Abruption placenta is the leading cause of fetal death
D. Three point seatbelt use in the third trimester has no effect on fetal outcome
E. Intra-uterine fetal death is rare after a motor vehicle crash in the first trimester

C
26- three years after renal transplant . a 65 year old patient with a newly diagnosed
colon carcinoma. The patient receives monotherapy with sirolimus for
immunosuppression. An elective colon resection is scheduled. This patient has an
increased risk for
A. Intraoperative bleeding
B. Wound dehiscence
C. Deep venous thrombosis
D. Postoperative diabetes
E. Adrenal deficiency
B
27- which of the following statements about tunneled dialysis catheter is true?
The right internal jugular vein is the preferred approach
They are the preferred mode of dialysis in diabetics
The tip of catheter should be in the right ventricle
The risk of infection is lower than with a polytetrafluoroethylene (PTFE) graft
Hemodialysis is more efficient than with an arteriovenous fistula
A
28- renal transplant patients have an increased incidence of
A. Adenocarcinoma of the uterus
B. Nonmelanoma skin cancer
C. Lobular breast cancer

D. Colonic carcinoid
E. Lung cancer
B
29- a 12 year old premenarched girl presents with a 2 week history of progressive
abdominal pain and urinary retention. Placement of a urinary catheter yield 700 ml
of clear urine. On examination, she is afebrile with normal vital signs. She has a
palpable, mildy tender mass filling her pelvis and lower abdomen. The most likely
diagnosis is
A. Posterior urethral valves
B. Imperforate hymen
C. Appendiceal abscess
D. Ovarian teratoma
E. Urinary tract infection
B
30- the single most important risk factor for noninfectious sternal dehiscence after
median sternostomy is
A. Hyperglycemia
B. Hypertension
C. Obesity
D. Internal thoracic artery use
E. Femal sex
C
31-which of the following statements about massive hemoptysis is true?

A. Exanguination is the most common cause of mortality

B. Pulmonary artery embolization is the most effective nonsurgical treatment option
C. bronchial arteries are the most common source of bleeding
D. rigid bronchoscopy is contraindicated
E. CT is the initial diagnostic procedure of choice
C
32- the most appropriate treatment for a patient with a 2 cm diffuse large B-cell
lymphoma limited to the antrum of the stomach would be
A. Total gastrectomy
B. Radiotherapy followed by gastrectomy
C. Systemic chemotherapy
D. Distal gastrectomy
E. Chemoradiation
C
33- which of the following statements about medullary thyroid cancer (MTC) true?
A. All forms are hereditary
B. The most aggressive fowm is MEN2B
C. Normal calcitonin levels excludes the diagnosis
D. MEN2B is associated with mucosal neuromas, pheochromocytoma, parathyroid
hyperplasia, and MTC
E. MEN2A patients usually exhibit findings consistent with pheochromocytoma prior to
MTC
B

34- which of the following tumor markers is most closely associated with the
diagnosi of gastrointestinal stromal tumor (GIST)?
A. CEA
B. CD117
C. HER/neu
D. CA125
E. P53
B
35- pressure sores are best prevented by
A. Routine use of air-flow mattresses
B. Frequent re-positioning
C. Aggressive nutritional support
D. Infection control
E. Drying powders to moist skin surfaces
B
36- when performing a four-compartment fasciotomy for leg compartment
syndrome the
A. Femoral nerve can be easily injuried
B. Soleus muscle is taken down off the tibia to decompress the deep compartment
C. Anterior tibial artery can be easily injuried
D. Procedure should not be performed until the pedal pulses are absent
E. Skin should be loosely closed
B

37- During cholecystectomy in a 67-year-old woman,

there is severe bleeding from accidental injury to the
hepatic artery. The patient requires transfusion of
2000 mL of blood. After the operation, 24-hour urine
output varies between 1250 and 2700 mL/d. She was
adequately hydrated, but BUN levels continue to rise
10-12 mg daily over a 5-day period.
What is the main finding?
(A) Progressive bleeding
(B) High-output renal failure
(C) Postcholecystectomy syndrome
(D) Glomerulonephritis
(E) Obstructive jaundice

B
38- Metabolic changes likely to occur include which
of the following?
(A) Hyperkalemia
(B) Hyponatremia
(C) Hypophosphatemia
(D) Metabolic alkalosis
(E) Hypomagnesemia

A
39- Management includes which of the following?
(A) Restriction of fluids to 750 mL/d
(B) 8 L of fluid daily to remove urea
(C) Replacement of fluid loss plus insensible
loss
(D) 80 mEq potassium chloride (KC1) per
12 hour
(E) Ammonium chloride IV

40- A 70-year-old woman has low cardiac output

with increased PCWP and increased systemic
vascular resistance. What should be the drug of
choice?
(A) Dopamine
(B) Norepinephrine
(C) Dobutamine
(D) Epinephrine
(E) Phenylephrine

C
41- A 60-year-old man had undergone exploratory
laparotomy for perforated gastric ulcer with
severe peritoneal contamination. Six hours after
surgery, he is tachycardic, hypertensive, and
has shallow respirations. Intubation and institution of ventilatory support is indicated in the
presence of which of the following?
(A) Respiratory rate of 23 breaths/min
(B) PaC0 2 of 45 mm Hg
(C) Pa0 2 of 55 mm Hg on room air
(D) HR of 140 bpm
(E) BP of 150/100 mm Hg

C
42- A 20-year-old man has undergone appendectomy
for perforated appendicitis with generalized peritonitis. Seven days postoperatively, his temperature
continues to spike to 103. 8F despite antibiotic therapy with ampicillin, gentamicin, and metronidazole.
A CT scan reveals a large pelvic abscess. Soon afterward, he has bleeding from the mouth and nose with
increasing oozing from the surgical wound and all
intravenous puncture sites. What is the most likely
diagnosis?
(A) Anaphylactoid reaction to intravenous
dye
(B) Disseminated intravascular coagulation
(DIC)

(C) Antibiotic -induced coagulopathy

(D) Liver failure
(E) Congenital bleeding disorder

B
43- A 65-year-old male is resuscitated using hydroxyethyl starch (hetastarch). Which of the following is associated with the use of hetastarch ?
(A) Thrombotic thrombocytopenia
(B) Elevated levels of factor VIII
(C) Elevation of serum creatinine
(D) Hyperbilirubinemia
(E) Hyperamylasemia

E
44- A 64-year-old assistant hair stylist undergoes a
vaginal hysterectomy under spinal anesthesia.
Bleeding occurs when an attempt is made to
separate and exclude the right ureter from the
operating field. After a short interval, respiratory arrest occurs and intubation must be
instituted. What is the most likely cause of respiratory arrest during this procedure under
spinal anesthesia?
(A) Paralysis of the intercostal muscle
(B) Paralysis of the diaphragm (phrenic
nerves)
(C) Centrally induced mechanism secondary
to decreased cardiac output
(D) Diffusion of anesthetic to the level of the
pons
(E) Diffusion of anesthetic to the level of the
medulla
C
45- A full term neonate is found to have a swollen
right scrotom. Gentle persistent pressure easily
reduces an air filled structure back into the
abdomen. The condition recurs promptly as

the infant begins to cry. This

(A) Mandates immediate surgical repair
(B) Is the same defect as a communicating
hydrocoele
(C) Should have a tension-free mesh repair
(D) Should prompt exploration of the left
groin
(E) Is generally irreducible in children

B
46- You are called to the emergency room to see a
5-year-old child who has been vomiting for
two days. She is thin, pale, lethargic, and febrile
to 102.4F. She has a respiratory rate of 39 beats
per minute (bpm) and a diffusely tender, rigid
abdomen without localizing signs. You should
(A) Order an abdominal/pelvic CT scan with
oral contrast to clarify the diagnosis.
(B) Realize that her omentum is likely to
"wall off" and contain the infection.
(C) Order a barium enema to rule out
intussusception.
(D) Start fluid resuscitation and observe on
broad-spectrum IV antibiotics.
(E) Take her immediately to the operating
room for abdominal exploration.

E
47- You are called to see a 4-hour-old neonate in the
well-baby nursery who has developed bilious
vomiting after taking his first feeding. He was
born at 39-week gestation, has not yet passed
meconium and has an unremarkable examination. An upper gastrointestinal (GI) series
would be the study of choice to rule out which
of the following clinical conditions?
(A) Ileal atresia
(B) Meconium ileus
(C) Duodenal web

(D) Malrotation
(E) Tracheoesophageal fistula

E
48- A 3-year-old, recently adopted Romanian boy
is referred after his initial pediatrician's assessment for an undescended testicle. On exam his
left testicle is normal and in place. He has no
evidence of hernias. However, his right hemiscrotum is empty and there is a testicule sized
mass plapable at the pubic tubercle. The most
appropriate next step is
(A) Observation until age 5
(B) Right orchiopexy
(C) Right orchiopexy and right inguinal
hernia repair
(D) Right orchiopexy and right testicle biopsy
(E) An abdominal ultrasound

C
49- A 6-year-old girl presents with a left breast mass.
Her mother first noticed it a day before and is
very concerned because both the child's maternal grandmother and maternal aunt have had
breast cancer. It is firm, smoothly circumscribed,
and slightly eccentric under the left areola. The
right breast is unremarkable. You suggest
(A) Immediate excisional biopsy
(B) A mammogram
(C) Repeat examination in 1 month
(D) Genetic testing for breast cancer (BRCA)
1 and 2 mutations
(E) Sterotactic needle biopsy

C
50- A 4-year-old girl is referred to your office by the
pediatrician for the finding of an abdominal
mass on her 4-year-old well child visit. She had

been consistently in the seventy-fifth pecentile

for height and weight and although she is still in
the seventy-fifth pecentile for height she is only
in the fortieth percentile for weight. She has been
eating normally and having normal daily BMs.
On examination you palpate an 8-cm right
midabdominal mass. It is firm, nontender, and
poorly mobile. The most likely diagnosis is
(A) Constipation with a distended cecum
(B) Wilms' tumor
(C) Neuroblastoma
(D) Lymphoma
(E) Hempatoblastoma

C
51-A 12-year-old girl presents to the emergency department following a skiing crash
in which the left side of her midtorso hit a tree. She pres-ents with left side lower
chest and upper abdominal pain. She also complains of left shoulder pain. The most
likely diagnosis is which of the following?
(A) Rib fractures
(B) Liver injury
(C) Ruptured diaphragm
(D) Splenic injury
(E) Ruptured stomach

D
52- which is the
best method to distinguish a Wilm's tumor
from a neuroblastoma?
(A) Shifting dullness
(B) Physical examination of the abdomen
(C) Catecholamine levels
(D) Auscultation for bowel sounds
(E) Cortisol administration

B
53- A newborn full-term baby boy with diagnosis
of imperforate anus (Fig. 13-2) is also at risk to
have a
(A) Dextrocardia
(B) Rib cage anomaly
(C) Tracheoesophageal fistula
(D) Ulnar skeletal deformity
(E) Proximal limb malformation

C
54- The most common pathogen in neonatal
sepsis is
(A) Haemophilus influenzae
(B) Pneumococcus
(C) Klebsiella pneumoniae
(D) Escherichia coli
(E) Staphylococcus epidermidis

E
55- A patient in the surgical ICU is in septic shock
after surgery for perforated diverticulitis. His
temperature is 102. 3F and his heart rate is
120 bpm. He is requiring dopamine for BP
support. Which of the following drugs would
be appropriate for use in this situation?
(A) Recombinant activated protein C
(B) Antitumor necrosis factor(TNF)antibody
(C) Interleukin-1 (IL-1) receptor antagonist
(D) Antiendotoxin antibody
(E) Sodium nitroprusside

56-A 51-year-old man presents with recent onset of what appears to be a large left
varicocele. He should be investigated for possible:
(A) Infertility
(B) Testicular tumor
(C) Renal tumor
(D) Portal hypertension
(E) Torsion of the appendix testis

C
57- Elevated serum levels of alpha fetoprotein in a man is in which of the followings
A. seminomatous germ cell tumor
B. non seminomatous germ cell tumor
C. leydind cell tumor
D. sertoli cell tumor
B
58- a patient with renal cell carcinoma with extension to the IVC is best treated with
A. radiotherapy
B. chemotherapy
C. thrombolytic therapy
D. nephrectomy and remove the site of metastasis
E. nephrectomy and remove the site of metastasis with graft
E
59- initial management of a patient with priapism includes
A. bed rest, narcotics, and hydration

B. Administration of beta blockers

C. Placement of an 18-g IV catheter into the corpus cavernosum
D. Surgical exploration
C
60- a patient with a complex pelvic fracture is scheduled for open reduction and
fixation of the fracture in the operating room. He also has an extraperitoneal
bladder injury with a contained area of extravasation. The best treatment for the
bladder injury is
A. Leaving foley catheter in place for 7-10 days
B. Percutaneous drainage of the extravasation and foley catheter drainage of the
bladder
C. Transurethral repair of the bladder injury
D. Open repair of the bladder injury
D
61- paraphimosis refer to
Inability to retract the foreskin
Inability to reduce the foreskin after it has been retracted
Infection of the foreskin
Excessive length of foreskin
B
62- the most common malignant tumor of the brain in children is
A. Ganglioneuroma
B. Neuroblastoma

C. Medulloblastoma
D. Glioblastoma
C
63- which of the following test is most sensitive in determining if the fluid is
cerebrospinal fluid
Glucose level
Halo test
Fluid serum LDH ratio
Beta transferring
D
64- clinical finding which can be seen in a patient who is brain dead include
Minimally reactive pupil unilaterally
No spontaneous breathing with a paco2 of 50 mmhg
Minimal, unilateral decorticate posturing to painful stimulus
Positive triple flexion reflex of the leg
Extension position
D
65- a 4 year old presents with a fracture of the femur (midshaft) with 20% of
anterior angulation. Which of the following is the best treatment for this child ?
Traction and bed rest
Closed reduction and application of spica cast

Open reduction and external fixation

Open reduction and intramedullary fixation
B
66- which of following is associated with forced dorsiflexion of the foot?
A. Fracture of the talus
B. Fracture of the navicular
C. Fracture of the cuneiform
D. Fracture of the cuboid
A
67- tear in the medial meniscus in a young athelete is best treated by
A. Immobilization and anti inflammatory agents
B. Arthroscopic repair of meniscus
C. Resection of the meniscus
D. Resection of the meniscus and replacement with allograft
B
68- which of the following statements is true concerning the effect of
pneumoperitoneum on the circulatory system
A. Cardiac output is significantly improved secondary to an attenuated stress
response
B. Cardiac output is always increased secondary to augmented venous return
(increases preload)
C. Pneumoperitoneum decreases the capillary wedge pressure
D. Systemic absorption of co2 has no significant hemodynamic effects

E. Cardiac work is increased

E
69- an 18 year old girl is transported to the emergency department after a fall
from a tree. Survey reveals bilateral foot injuries with tenderness and crepitus
over the heels. In addition to ordering chest, pelvis, C-spine, and calcaneal
radiographs, evaluating physician should also examine and order radiograph of:
A. The thoracic spine
B. The maxilla
C. Bilateral wrist
D. The lumbosacral spine
E. Bilateral elbows
D
70- a 42 year male passenger is brought to the emergency department after
being ejected during a motor vehicle rollover. In the trauma room he is
hemodynamically stabilized after intubation. Among other injuries he is
noted to have tense swelling of his right thigh. Radiographs confirm a
midshaft femur fracture. This injury:
A. has no systemic effect on the patients overall morbidity and mortality
B. alone cannot cause enough bleeding to produce hemodynamic
instability
C. rarely leads to fat embolism and ARDS
D. should be definitely stabilized in 24 hours
D

71- a patient with a nonobstructing carcinoma of the sigmoid colon is

being prepared for elective resection. Which of the following reduce the
risk of postoperative infectious complicatios?
A. A single preoperative parenteral dose of antibiotic effective against
aerobes and anaerobes.
B. Avoidance of oral antibiotics to prevent emergence of clostridium
difficile
C. Postoperative administration for 48 hours of parenteral antibiotics
effective against aerobes and anaerobes
D. Postoperative administration of parenteral antibiotics effective
against aerobes and anaerobes until the patients intravenous lines
and all other drains are removed
E. Redosing of antibiotics in the operating room if the case lasts for
more than 2 hours
A
72- an elderly diabetic woman with chronic steroid-dependent bronchospasm has
an ileocolectomy for a perforated cecum. She is taken to the ICU intubated and is
maintained on broad-spectrum antibiotics, renal-dose dopamine, and a rapid steroid
taper. On postoperative day 2 she develops a fever of 39.2C (102.5F), hypotension,
lethargy, and laboratory values remarkable for hypoglycemia and hyperkalemia.
Which of the following is the most likely explanation for her deterioration?
a. Sepsis
b. Hypovolemia
c. Adrenal insufficiency
d. Acute tubular necrosis
e. Diabetic ketoacidosis

C
73- Signs and symptoms associated with early sepsis include
a. Respiratory acidosis
b. Decreased cardiac output
c. Hypoglycemia
d. Increased arteriovenous oxygen difference
e. Cutaneous vasodilation
E

74- a 65 year old man has an enterocutaneous fistula originating in the jejunum secondary to
inflammatory bowel disease. Which of the following would be the most appropriate fluid for
replacement of his enteric losses?

A. D.W

B. 3% normal saline
C. Ringer lactate
D. 0.9% sodium chloride
E. 6% sodium bicarbonate solution
C
75- a 23 year old man arrives in the ER after a motor vehicle collision .
examination reveals an unstable pelvis and blood at the urethral meatus.
Which of the following studies would most accurately identify a urethral
injury?
A. CT scan of the pelvis
B. Intravenous pyelogram
C. Stress cystogram
D. Antegrade urethrogram
E. Retrograde urethrogram
E
76- 10- year-old boy develops right lower quadrant pain, nausea,
vomiting, and a fever . you suspect appendicitis and plan for an emergent
appendectomy. As you are preparing to transport him to the operating
room, his parents mention that he jas hemophilia A. what should you
administer for this condition?
A. Vitamin K
B. FFP
C. Factor Viii
D. Cryoprecipitate
E. Factor Vii
C
77- about lactated ringers solution which is true
Composed of 130 meq Na
Should not be given to patient with acidosis because of increases
in serum lactic acid
Should not be used in patients with liver injury
A
78- a 40 year old man sustains a gunshot wound to the neck just above the
clavicle. Initial systolic blood pressure in the emergency department is 70
mm hg and increases to 90 mm hg with fluids. The next step in management
would be:
left anterolateral thoracotomy
Right anterolateral thoracotomy
Median sternotomy
Right supraclavicular and infraclavicular exploration
Insertion of foley balloon into the bullet wound
C
79- in a failed suicide attempt a depressed student severs her radial nerve at
the wrist the expected disability is:
loss of ability to extend the wrist
loss of ability to flex the wrist
wasting of the intrinsic muscles of the hand

sensory loss over the thenar pad and thumb web

palmar insensitivity
D
80- with regard to anatomy of esophagus which of the following is true
the esophagus is 35 cm long
the esophagus is divided into three segments
there are five predictable areas of narrowing (1) the thyropharyngeus (2)
the thoracic inlet (3) the left subclavian artery (4) the left bronchus and
(5) the crossing of the thoracic duct
the arterial blood is supplied by the splenic right gastric pulmonary and
innominate arteries
the pharyngoesophageal segment of the esophagus consists of the three
constrictors and stylopharyngeus muscle
B?
81- the gastroduodenal artery is a branch of :
celiac trunk
superior mesenteric
left gastric artery
common hepathic artery
Right gastric artery
D
82- which of the following statements describe the typical venous drainage of
the adrenal gland
Plexuses of small veins provides the major drainage of each gland
A primary central vein provides the minor drainage of each gland
Both glands drain into the inferior vena cava
left adrenal gland drain to the left renal vein
right adrenal gland drain to the right renal vein
D
83- Which of the following is not a pathophysiological feature of thermal
injury?
increase capillary permeability due to the direct effect of heat and the
liberation of vasoactive mediators
increase pulmonary vascular resistance during the immediate postburn
period
elevated thyronine(T3) and thyroxine (T4) levels
elevated (IL-6) level
decreased immunoglobulin G (igG) level
C
84- a 45 year old man weighing 70 kg sustains second and third degree
burns to 5% of the TBSA with inhalation injury. Resuscitation is initiated
according to the parkland formula. Which of the following best represents
the initial intravenous fluid rate for this patient?
437.5 ml/hr
625 ml/hr
875 ml/hr

732 ml/hr
1000 ml/hr
C
85- a young adult had partial hepatectomy for severe injury. During
surgery, he was transfused with twelve units of packed red blood cells. In
the recovery room, he was noted be bleeding from the surgical incision
and IV puncture sites.
The most likely cause of this bleeding is:
Secondary to partial hepatectomy
Unknown primary bleeding disorder
Hypercalcemia
Hypocalcemia
Secondary to dilutional thrombocytopenia and deficiency of clotting
factors
E
86- the most Important aspect in treating DIC is
A.
B.
C.
D.
E.
C

Administer heparin
Administer platelets
Treat the underlying disease
Achieve normal level of fibrinogen
Transfuse with fresh frozen plasma and ryoprecipitate

87- meniscal tears usually result from which of the following circumstances?
A. Hyperextension
B. Flexion and rotation
C. Simple hyperflexion
D. Compression
E. Femoral condylar fracture
B
88- which of the following statements regarding compartment syndromes
following orthopedic injuries is true?
A. The first sign is loss of pulse in the extremity
B. Passive flexion of the extremity proximal to the involved
compartment will aggravate the pain
C. Surgical decompression (fasciotomy) is necessary only as a last
resort
D. These syndromes are most commonly associated with
supracondylar fracture of humerus and tibial shaft
E. The syndrome is often painless
D
89- complications of hypospadias include all of the following except
A. Urethrocutaneous fistula
B. Meatal stenosis
C. Retrograde ejaculation
D. Urethral diverticulum
E. Residual penile curvature

C
90- the most significant prognostic factor for soft tissue sarcoma is
A. Site
B. Size
C. Grade of malignancy
D. Cell type
E. Tissue origin
C
91- stored blood is deficient in
A. Factor ii
B. Factor vii
C. Factor viii
D. Factor ix
E. Factor xi
C
92- Succinylcholine is contraindicated for:
(a) patients with hepatitis
(b) emergency intubation of burn victims
(c) celiotomy 2 weeks after spinal cord injury
(d) parotidectomy
(e) thyroidectomy
C
93- A patient with head injury opens his eyes and withdraws
his arm to pain. He is making incomprehensible
sounds. His Glasgow Coma Scale score is:
(a) 3
(b) 4
(c) 8
(d) 6
(e) 5
C
94- During CO2 pneumoperitoneum:
(a) the mean arterial pressure increases
(b) the mean arterial pressure decreases
(c) the systemic vascular resistance increases
(d) the systemic vascular resistance decreases
(e) the cardiac output increases
C
95- Tissue loss almost always results from ligation of
the:
(a) popliteal artery
(b) common femoral artery
(c) superficial femoral artery
(d) brachial artery
(e) portal vein
A
96- A middle-aged woman is admitted unconscious to the Emergency Department
following a head injury in a car accident. There is bruising over the upper abdomen. Blood
pressure is 80 mm Hg systolic, pulse 120/minute. What is the most important initial step in
the management of this patient?

Immediate laparotomy
Perform emergency burrholes
X-ray (three views) of abdomen
Diagnostic peritoneal lavage
Check airway breathing and circulation

E
97- A 54-year-old man presents with extreme pain and swelling of the left middle finger.
Four days earlier, he suffered a small puncture wound to the volar aspect of the finger at
the level of the distal flexor crease. Passive extension of the proximal interphalangeal
(PIP) and distal interphalangeal (DIP) joints severely aggravates his symptoms. Which one
of the following is the most likely diagnosis?
Mid-palmar space infection
Septic tenosynovitis
Cellulitis
Septic arthritis distal interphalangeal (DIP) joint
Pulp space infection

B
98- a patient has a blood pressure of 70/50 and serum lactate level of 30mg/100 ml
his cardiac output is 1.9 l/min and his central venous pressure is 2 cmh2o the most
likely diagnosis is
A. Congestive heart failure
B. Cardiac tamponade
C. Pulmonary embolus
D. Hypovolemic shock
E. Septic shock
D
99- after a major trauma all of the following hormones increase except
A. Cortisol
B. ACTH
C. Glucagons
D. Thyroxine
E. Arginine vasopressin
D
100- the best way to determine the effectiveness of pulmonary ventilation
preoperatively is by

A.
B.
C.
D.
E.
A?

Arterial blood gas analysis

Serial spirometry
PH determination
Expired lung Pco2
Pulmonary dead space

101- The etiologic factor implicated

in the development of pulmonary
insufficiency following major nonthoracic
trauma is
a. Aspiration
b. Atelectasis
c. Fat embolism syndrome
d. Fluid overload
e. Pneumonia
C
102. the most common bacterial infection in spleenectomized patient is
A. streptococcus pneumonia
B. staphylococcus
C. H.influenza
A
103. the phase that is resistant to radiation is
A. G0
B. G1
C. G2
D. (S)phase
E. (M) phase
D
104. regarding wound healing except radiation promote wound healing
105. ventral bud of pancreas develop to form
A. Unicinate process
B. Superior part of head
C. Neck
D. Body
A

106. which statement is true unicinate process pass behind 3rd portion of duodenum?
107. regarding C.difficile: indication of colectomy in patients not respond to medical
therapy and develop toxic megacolon
108.according to brain abscess : forms are acute, subacute and chronic?
109.regarding brain metastasis : breast is the second most common cause
110. changes in patient with nasogastric tube is : metabolic alkalosis
111. facial fracture with diplopia is due to fracture of
temporal bone
maxilla
zygomatic arch
ethmoid
C
112. Vitamin K deficiency the factors affected are : ii,vii,ix,x
113.patient develop a large solid neck hematoma postthyroidectomy is due to :
failure of hemostasis
114. renal cell carcinoma prognosis depend on :Staging
115.IgA transferred by the process of
pinocytosis
transcytosis
primary active transport
secondary active transport

B
116.quadratus femoris supplied by: sacral plexus nerve
117.regarding compartment syndrome: most commonly occur after supracondylar
fracture of humerus and tibial fracture
118.which of the following regarding cerebral edema caused by head injury is more
accurate
A. Cerebral edema caused by head injury is vasogenic and nontoxic in origin
B. Steroids are useful for the treatment of head trauma
C. Hypercapnia induces cerebral vasoconstriction and is useful for decreasing blood
volume
D. Within 2-3 days after injury maximal cerebral edema has already formed so
further monitoring is unnecessary if the patient is clinically stable
D
119. all are true regarding epidural analgesia except: it has sedative effect?
120.a surgeon open the suture postoperatively and remove it the cells found on it
are:monocyte?
121. a patient has a fever and cough and night sweating not respond to antibiotics it
found to have TB the cells responsible are : plasma cells
122. aneuploidy means: abnormal number of chromosomes
123. the characteristic of malignant cells is: invasion
124. Staphylococcus epidermidis:

a. is coagulase positive
b. on microscopy are Gram positive cocci in chains
c. are usually sensitive to penicillin
d. grown in blood cultures are due to contamination and should be ignored
e. are destroyed by povodine iodine
E
125. The following are true about disinfectants that can be used effectively
for skin:
a. glutaraldehyde
b. ethyl alcohol with povidone-iodine
c. ethylene oxide
d. chloramphenicol drops
B
126. cefuroxime mechanism : inhibit cell wall synthesis
127.amekacin mechanism: inhibit ribosomal RNA
128. Bacteria spores:
a. are sensitive to antibiotics
b. allow the bacteria to multiple in adverse condition
c. are usually formed by Gram-negative bacteria
d. can be identified with Gram stains except.
e. are killed by temperature of 1200 for 20 minutes.
E
129. The following are true about Clostridium tetani:
a. it is a Gram positive bacilli with terminal spore
b. tetanus can occur weeks after the initial infection
c. the symptoms of tetanus is produced by an exotoxin
d. tetanus antitoxin is ineffective when the toxin enters the nervous tissue
e. gas gangrene can result from Clostridium tetani infection
E
130. The following are true about hepatitis B:
a. it is a RNA virus

b. immunity can be acquired by vaccination with a live attenuated virus

c. persistent presence of HBsAg increases the risk of acute liver disease
d. the average incubation period is 30 days
e. the presence of antibody to hepatitis B surface antigen is a reliable
indicator of non-infectivity
E
131.cytokeratin appears in melanoma
132. the best indicator to determine the condition of the patient and surgical
intervention: history
133. alternate involuntary continuous rhythmic muscular contraction and
relaxation in rapid succession is called
A. Hypertonia
B. Hypotonia
C. Clonus
C
134.platelet disorder will affect :
A. bleeding time
B. clotting time
C. PT
D. APTT
A
135. correct about corticosteroids : bind to the cell membrane
136.according to parotid gland is true: it is bilobed deep and superficial
and facial nerve pass between them?
137.patient prepared for liver transplantation what is the risk that will
delay the operation
: alcohol intake for 3 months
138.most risk factor of operation is :COPD
139.estrogen in females primarily produced by : granulose cells
140. confirm pulmonary embolism by V/Q scan
141. treatment of MRSA is: macrolids
142. not transmitted by blood transfusion
A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. HIV
E. Malaria
A
143. a patient transfused with infected blood with hepatitis B, it will
manifest : 6months or later
144. carcinoid hypertensive crisis best treated with : octreotide
145. hyperkalemia :wide QRS
146: best to be given in burn is: crystalloid
147. the best fluid to be given to the burn patient within 48 hours is
:crystalloid
148. all rae true except : lumbar puncture is contraindicated in subarachnoid
hemorrhage
149. inflammatory is : IL-10

150. confirm inhalation burn: carbonaceous sputum

151. In keloid: increase epidermoid growth factor
152:asbestos: increase thoracic mesothelioma
153: (pepsinogen) is released by the: chief cells
154: routin renal function test are: serum urea and serum creatinine
155:Which of the following statements regarding compartment syndromes following
orthopedic
injuries is true?

a. The first sign is usually loss of pulse in the extremity

b. Passive flexion of the extremity proximal to the involved compartment will aggravate the
pain
c. Surgical decompression (fasciectomy) is necessary only as a last resort
d. These syndromes are most commonly associated with supracondylar fractures of the
humerus and
tibial shaft
e. The syndrome is often painless

D
156: a 6 year old boy is brought into the emergency . Perths disease (Q446
pretest 13)
157: drug that should not be discontinued abruptly
Cimetidine
Clonidine
Amiodarone
Digoxin
B
158: drug that not cause ototoxicity :
A. Ethacrynic acid
B. Gentamicin
C. Frusemide
D. Cefuroxime
E. Streptomycin
D
159: decrease risk of aspiration pneumonia by give metoclopromide
160: good wound healing in open wound : depend on vascularity of the edges
161: patient cant move peripheries after administration of drug: vasogenic
shock?
162: most common site of pathologic fracture of femur iS subtrochanteric
163: regarding pethidine except
A. Causes more myosis than morphine
B. It metabolized to active substances with analgesic properties
C. Has a longer duration than morphine
D. Possesses atropine like activity
E. Has some local anaesthetic activity
C
164: In the fetal circulation:

a)The oxygen dissociation curve of fetal haemoglobin is shifted to the right

compared with adult haemoglobin ensuring oxygen delivery to the fetus despite
low oxygen partial pressures

b)It is the presence of the ductus arteriosus and large pulmonary vascular
resistance which ensures most of the right ventricular output passes into the
aorta
c)The patency of the ductus arteriosus is maintained by high oxygen tensions
d)The patency of the ductus arteriosus
is maintained by the vasodilating effects of
prostaglandin G2
e)2,3 DPG levels are higher in fetal haemoglobin compared with adult
haemaglobin

B
165 sever gram negative infection tachycardia hypotension delirium
166: the strongest buffer system in the body is : renal
167: amino acid initiate salivary gland production: glutamate ?
168: fasciotomy most common injured superficial peroneal ?
169: post pancreatic cyst aspiration respiratory insufficiency due to :
atelectasis
170: hydrocele : between visceral and peritoneal layers of tunica vaginalis
171 part of anatomical oral cavity
soft palate
posterior tongue
anterior tongue
retromolar trigone
D?
172 : lidocaine can cause except
A. Sedation
B. convulsions
C. slowed a-v conduction
D. prolongation of cardiac action potential
E. shortening of the refractory phase
D