Surgery a man sustained severe blunt injuries in a car crash twelve hours ago. The activity of this hormone is now expected to be decreased in this patient: insulin



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SURGERY

  1. A man sustained severe blunt injuries in a car crash twelve hours ago. The activity of this hormone is now expected to be decreased in this patient:

  1. insulin

  2. cortisol

  3. epinephrine

  4. aldosterone

(Classification - Application; Source – Schwartz’s Textbook of Surgery (8th edition): pp. 25-29)


  1. A young woman is debilitated by pruritus and burning sensation from her presternal keloid. The recommended initial treatment is:

  1. topical application of silicone sheets

  2. intralesional corticosteroid injection

  3. surgical excision

  4. low-dose radiation

(Classification - Recall; Source – Schwartz’s Textbook of Surgery (8th edition): pp. 241-242)


  1. A patient is placed on NPO in preparation for an elective major abdominal surgery. The body’s preferred initial fuel source during the fasting state is:

  1. hepatic glycogen

  2. skeletal muscle glycogen

  3. muscle protein

  4. body fat

(Classification - Recall; Source – Schwartz’s Textbook of Surgery (8th edition): p. 24)


  1. A 48-year-old woman has prolonged ileus after surgery for an obstructed duodenal ulcer. The problem is probably due to:

  1. hypochloremia

  2. hypocalcemia

  3. hypomagnesemia

  4. hypokalemia

(Classification - Application; Source – Schwartz’s Textbook of Surgery (8th edition): pp. 48-49)


  1. A man with chronic prepyloric ulcer appears weak after repeated bouts of non-bilious vomiting over the past 3 days. Fluid therapy should be started using:

  1. Normosol M

  2. Lactated Ringer’s solution

  3. Normal saline solution

  4. Hypertonic saline solution

(Classification - Application; Source – Schwartz’s Textbook of Surgery (8th edition): pp. 51-52)


  1. A multiply injured patient has persistently low urine output. The oliguria is most likely due to prerenal failure rather than acute tubular necrosis if the tests reveal:

  1. low urine specific gravity

  2. low urinary excretion of sodium

  3. low BUN/creatinine ratio

  4. low creatinine clearance

(Classification - Application; Source – Schwartz’s Textbook of Surgery (8th edition): pp. 348-349)


  1. A woman admitted to the ICU for severe acute pancreatitis begins to manifest paresthesia of the face and extremities, muscle cramps, and a positive Chvostek’s sign. These are probably due to:

  1. hypocalcemia

  2. hypokalemia

  3. hypomagnesemia

  4. hypophosphatemia

(Classification - Application; Source – Schwartz’s Textbook of Surgery (8th edition): p. 50)


  1. Increased nutritional support appears to aggravate tachypnea in a septic patient with respiratory failure. Lessening the amount of this substrate may alleviate the problem:

  1. carbohydrate

  2. fat emulsion

  3. essential amino acids

  4. non-essential amino acids

(Classification - Recall; Source – Schwartz’s Textbook of Surgery (8th edition): pp. 28-29)


  1. Administration of this amino acid is expected to be beneficial to a patient suffering from damage to intestinal mucosa due to adjuvant chemotherapy for esophageal cancer:

  1. arginine

  2. valine

  3. leucine

  4. glutamine

(Classification - Recall; Source – Schwartz’s Textbook of Surgery (8th edition): p. 38)

  1. Early supplementation of this vitamin is recommended to promote wound repair in a patient with extensive second-degree flame burns:

  1. A

  2. C

  3. D

  4. E

(Classification - Application; Source – Schwartz’s Textbook of Surgery (8th edition): p. 210)


  1. A diabetic 41-year-old man is admitted for necrotizing fasciitis in the perineum. A high dose of this antibiotic is generally included in the initial antimicrobial therapy because of concern for clostridial pathogens:

  1. metronidazole

  2. vancomycin

  3. penicillin G

  4. aminoglycoside

(Classification - Recall; Source – Schwartz’s Textbook of Surgery (8th edition): p. 122)


  1. Transfusion of properly cross matched blood is begun on a man admitted for massive bleeding from erosive gastritis and thirty minutes later, he develops urticaria and fever. This should be administered to the patient:

  1. antihistamine

  2. mannitol

  3. furosemide

  4. sodium bicarbonate

(Classification - Application; Source – Schwartz’s Textbook of Surgery (8th edition): pp. 79-80)


  1. A patient under anticoagulation therapy using warfarin, who is set to undergo surgery for acute cholecystitis, has decreased prothrombin concentration. Warfarin can be reversed by parenteral dose of:

  1. protamine sulfate

  2. vitamin K

  3. EACA

  4. hydroxyurea

(Classification - Recall; Source – Schwartz’s Textbook of Surgery (8th edition): pp. 73-74)


  1. Arterial blood gas analysis is performed on a patient just admitted with a diagnosis of severe acute pancreatitis. This reveals a pH of 7.30 and low levels of bicarbonate and pCO2. The most urgent part of management is:

  1. volume resuscitation

  2. intravenous bicarbonate

  3. calcium infusion

  4. mechanical ventilation

(Classification - Application; Source – Schwartz’s Textbook of Surgery (8th edition): pp. 50-51)


  1. Seven days after surgery for a perforated appendicitis, the primarily closed incision is noted to be erythematous, slightly swollen and tender. The appropriate treatment is:

  1. local heat therapy

  2. topical antibiotics

  3. new systemic antibiotics

  4. incision and drainage

(Classification - Application; Source – Schwartz’s Textbook of Surgery (8th edition): pp. 119-120)


  1. A man is brought to the E.R. with blood spurting from a hacking wound in the in the distal right thigh. He is alert and has a systolic BP of 100 mmHg. What is the initial management step?

  1. apply direct pressure on the wound with sterile gauze

  2. apply digital pressure on proximal femoral artery

  3. apply a thigh tourniquet above the wound

  4. open the wound and clamp the bleeders

(Classification - Application; Source – Schwartz’s Textbook of Surgery (8th edition): p. 74)


  1. A young man presents to the E.R. with a stab wound in the left chest. Examination reveals subcutaneous emphysema and absent breath sounds on the left chest; the trachea is shifted to the right. What is the probable diagnosis?

  1. massive hemothorax

  2. tension pneumothorax

  3. cardiac tamponade

  4. flail chest

(Classification - Application; Source – Schwartz’s Textbook of Surgery (8th edition): p. 131)


  1. A 58-year-old woman on NSAID therapy for arthritis has a 6-hour history of epigastric pain that has progressively become severe. Her abdomen is distended, rigid and diffusely tender. This diagnostic test should be done first:

A. upright chest x-ray

B. esophagogastroduodenoscopy

C. abdominal ultrasound

D. abdominal CT scan

(Classification - Application; Source – Schwartz’s Textbook of Surgery (8th edition): pp. 959-960)


  1. After aggressive fluid therapy, a trauma victim shows a systolic BP of 110 mm Hg, cold extremities, rapid but strong peripheral pulse, and a central venous pressure of 12 cmH2O. The patient has:

A. increased systemic vascular resistance

B. decreased stroke volume index

C. decreased cardiac index

D. excessive cardiac preload

(Classification - Application; Source – Schwartz’s Textbook of Surgery (8th edition): p. 132)


  1. An elderly man admitted with a diagnosis of sigmoid volvulus has a markedly distended, non-tender abdomen and hyperactive bowel sounds. The initial treatment is:

A. endoscopic detorsion

B. detorsion via laparotomy

C. decompressing transverse loop colostomy

D. Re section of involved segment of colon

(Classification - Recall; Source – Schwartz’s Textbook of Surgery (8th edition): p. 1098)


  1. Pancreatic necrosis is suspected in a 49-year-old woman who has not improved despite 3 days of intensive care for acute pancreatitis. The diagnosis is best established through:

A. C-reactive protein measurement

B. abdominal ultrasound



C. contrast-enhanced CT scan

D. CT-guided percutaneous biopsy

(Classification - Recall; Source – Schwartz’s Textbook of Surgery (8th edition): pp. 1234-1238)


  1. A chronically constipated 67-year-old woman presents with acute left lower quadrant (LLQ) abdominal pain, LLQ direct and rebound tenderness, and fever. The appropriate diagnostic examination is:

A. transvaginal ultrasound

B. abdominal CT scan

C. proctosigmoidoscopy

D. barium enema

(Classification - Application; Source – Schwartz’s Textbook of Surgery (8th edition): pp. 1082-1083)




  1. After an elective hemicolectomy for colon cancer, a 78-year-old man remains hypotensive and tachycardic. He has distended neck veins, cold skin, oliguria, and elevated central venous pressure. He apparently is suffering from this type of shock:

A. hypovolemic

B. cardiogenic

C. septic

D. neurogenic

(Classification - Application; Source – Schwartz’s Textbook of Surgery (8th edition): pp. 95-100)




  1. For the past 6 weeks, a 67-year-old man has been asymptomatic except for constipation after a course of antibiotic therapy for left lower quadrant abdominal pain. He should undergo:

A. CEA determination

B. barium enema



C. colonoscopy

D. abdominal CT scan

(Classification - Application; Source – Schwartz’s Textbook of Surgery (8th edition): pp. 1082-1083)


  1. A 32-year-old-man with a week’s history of fever presently has right lower quadrant abdominal pain and tenderness and bloody diarrhea. The most probable diagnosis is:

A. typhoid ileitis

B. amebic colitis

C. ileocecal TB

D. intussusception

(Classification - Application; Source – Schwartz’s Textbook of Surgery (8th edition): pp. 1049-1050)


  1. A 75 year old woman in the ICU after undergoing cholecystectomy for acute Cholecystitis is hypotensive and tachycardic. Pulmonary capillary wedge pressure (PCWP) is elevated to 18 mmHg, and cardiac output is 3 L/min. she is shock best described as which of the following?

  1. hypovolemic shock

  2. septic shock



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