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answer .1
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Rush Pre-test surgery (*) .2
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*1. Which of the following is the mechanism of action of omeprazole?
A. Blockage of the breakdown of mucosa-damaging metabolites of nonsteroidal antiinflammatory drugs (NSAIDs)
B. Provision of a direct cytoprotective effect
C. Buffering of gastric acids
D. Inhibition of parietal cell hydrogen potassium ATPase (adenosine triphosphatase)
E. Inhibition of gastrin release and parietal cell acid production
*2. Which of the following is the most common serious complication of an end
colostomy?
A. Bleeding
B. Skin breakdown
C. Parastomal hernia
D. Colonic perforation during irrigation
E. Stomal prolapse
*3. A 45-year-old woman with history of heavy nonsteroidal anti-inflammatory drug
ingestion presents with acute abdominal pain. She undergoes exploratory
laparotomy 30 hours after onset of symptoms and is found to have a perforated
duodenal ulcer. Which of the following is the procedure of choice to treat her
perforation?
A. Simple closure with omental patch
B. Truncal vagotomy and pyloroplasty
C. Truncal vagotomy and antrectomy
D. Highly selective vagotomy with omental patch
4. Which of the following hernias follows the path of the spermatic cord within the
cremaster muscle?
A. Femoral
B. Direct inguinal
C. Indirect inguinal
D. Spigelian
E. Interparietal
*5. A 70-year-old woman has nausea, vomiting, abdominal distention, and episodic
crampy midabdominal pain. She has no history of previous surgery but has a long
history of cholelithiasis for which she has refused surgery. Her abdominal
radiograph reveals a spherical density in the right lower quadrant. Which of the
following is the definitive treatment for this patients bowel obstruction?
A. Ileocolectomy
B. Cholecystectomy
C. Ileotomy and extraction
D. Nasogastric (NG) tube decompression
E. Intravenous antibiotics
*6. A previously healthy 15-year-old boy is brought to the emergency room with
complaints of about 12 hours of progressive anorexia, nausea, and pain of the right
lower quadrant. On physical examination, he is found to have a rectal temperature
of 38.18C (100.72F) and direct and rebound abdominal tenderness localizing to
McBurney point as well as involuntary guarding in the right lower quadrant. At
operation through a McBurney-type incision, the appendix and cecum are found to
be normal, but the surgeon is impressed by the marked edema of the terminal ileum,
which also has an overlying fibrinopurulent exudate. Which of the following is the
most appropriate next step?
A. Close the abdomen after culturing the exudate.
B. Perform a standard appendectomy.
C. Resect the involved terminal ileum.
D. Perform an ileocolic resection.
E. Perform an ileocolostomy to bypass the involved terminal ileum.
*7. A 50-year-old man presents to the emergency room with a 6-hour history of
excruciating abdominal pain and distention. The abdominal film shown here is
obtained. Which of the following is the most appropriate next diagnostic maneuver?
A. Emergency celiotomy
B. Upper GI series with small-bowel follow-through
C. CT scan of the abdomen
D. Barium enema
E. Sigmoidoscopy
*8. Which of the following is the most common diagnosis for tumors involving the
lips?
A. Squamous cell carcinoma
B. Basal cell carcinoma
C. Malignant melanoma
D. Keratoacanthoma
E. Verrucous carcinoma
30. A 21-year-old man is taken to the emergency department with a gunshot wound
to the right side of his chest. The first wound is located 2 cm lateral to the right
nipple, and a second wound is present just medial to the tip of the right scapula.
Vital signs on initial evaluation are a heart rate of 126 beats/min and a systolic blood
pressure of 88 mm Hg. A right-sided chest tube is placed, with return of 1200 mL of
blood. He is resuscitated with 2 L of lactated Ringer solution, and his vital signs
return to within normal limits. His chest tube output is rechecked 4 hours later, and
the total amount in the collection container is 2300 mL. What is the next most
appropriate step in management?
A. Chest CT
B. Immediate complete blood count
C. Thoracotomy
D. Immediate arterial blood gas analysis
E. Admission to the ICU for continuous cardiac monitoring and pulse oximetry
31. Which of the following regarding burn wound depth is true?
A. First-degree burns heal rapidly but contribute significantly to the total body surface
area (TBSA) burned in large, mixed-depth wounds.
B. Second-degree burns characteristically cause erythema, pain, and blistering.
C. Third-degree burns are generally painful and extremely sensitive to touch.
D. Fourth-degree burns mandate amputation of the involved extremities.
E. Superficial partial-thickness burn is the contemporary term for first-degree burns.
32. Which of the following patients do not meet the criteria for referral to a burn
center?
A. A 50-year-old woman with a 1% TBSA partial-thickness burn on her left hand from a
cooking accident
B. A 30-year-old construction worker with pain and blistering bilaterally on the knees
after kneeling in wet cement all afternoon
C. A 25-year-old man with 7% TBSA partial-thickness burns on the chest
D. A 42-year-old woman with no cutaneous injury, found lying down at the scene of a
house fire, and noted to have carbonaceous sputum after intubation in the field
E. An 18-year-old man in a motor vehicle collision with 30% TBSA burns on his chest
and circumferential burns bilaterally on his arms
33. A 42-year-old woman has a mass in the posterior aspect of the upper part of her
arm that was first noted 3 months earlier. It is not painful and she has no associated
symptoms. Magnetic resonance imaging (MRI) demonstrates a 5-cm neoplasm
arising from the triceps. The best next step in the management of this patient is:
A. PETcomputed tomography (CT)
B. Fine-needle aspiration (FNA) biopsy
C. Percutaneous core needle biopsy
D. Incisional biopsy
E. Excisional biopsy
34. According to the Nyhus classification of groin hernias, which of the following
statements are true?
A. A type II indirect hernia has a dilated internal ring and extends into the scrotum.
B. A type IIIa hernia is a classically described indirect hernia.
C. A femoral hernia is classified as type IIIc.
D. Type IV hernias are pantaloon-type hernias.
E. Type V hernias are spigelian hernias.
35. A sliding inguinal hernia on the left side is likely to involve which of the
following?
A. Ileal mesentery composing the lateral wall of the sac
B. Ovary and fallopian tube in a female infant
C. Omentum
D. Bladder composing the posterolateral wall of the sac
E. Cecum composing the anteromedial wall of the sac
36. Which of the following hernias represent incarceration of a limited portion of
the small bowel?
A. Spigelian hernia
B. Grynfeltt hernia
C. Petit hernia
D. Richter hernia
E. Littre hernia
37. Which of the following risk factors is most strongly associated with ductal
adenocarcinoma of the pancreas?
A. Chronic pancreatitis
B. Diabetes mellitus
C. Cigarette smoking
D. Coffee consumption
E. Alcohol consumption
38. A 15 year old girl presents with a mobile, 8 cm mid abdominal mass that moves
freely from left to right but does not move superiorly or inferiorly, which of the
following is the most likely diagnosis?
A. omental cyst
B. ovarian cyst
C. gastric duplication.
D. appendicular mass.
E. mesenteric cyst.
39. for which of the following conditions perioperative prophylactic antibiotics are
least indicated:
A. simple inflamed appendix.
B. Mastectomy.
C. Open fracture of humerus.
D. colonic perforation.
E. Laparoscopic cholecystectomy due to acute cholecystitis.
40. Regarding overwhelming postsplenectomy infection (OPSI), all the following
are true except
A. The risk of overwhelming sepsis is increased significantly after splenectomy.
B. The risk influenced by the nature of the disease for which the spleen been removed.
C. Lowest risk in infants & children's < 5yrs after splenectomy
D. Mortality rate: 50-80%
E. Commonly caused by encapsulated bacteria
41. Crohn's disease:
A. Is caused by Mycobacterium paratuberculosis.
B. It does not affect the colon
C. Tends to occur in families.
D. Complete resection of affected bowel is recommended as recurrence after complete
resection is rare
E. Is improved by smoking.
41. Which of the following statements about hemorrhoids is/are not true?
A. Hemorrhoids are specialized cushions present in everyone that aid continence.
B. External hemorrhoids are covered by skin whereas internal hemorrhoids are covered
by mucosa.
C. Pain is often associated with uncomplicated hemorrhoids.
D. Hemorrhoidectomy is reserved for third- and fourth-degree hemorrhoids.
E. Thrombosed piles can be treated conservatively
42. A patient with a history of familial polyposis undergoes a diagnostic
polypectomy; whith of the following types of polyps is most likely to be found?
A. Villous adenoma
B. Hyperplastic polyp
C. Adenomatous polyp
D. Retension polyp
E. None of the above
43. After intraductal papilloma, unilateral bloody nipple discharge from one duct
orifice is most commonly caused by which of the following pathologic conditions?
A. Paget's disease of the nipple.
B. Intraductal carcinoma.
C. Inflammatory carcinoma.
D. Subareolar mastitis.
E- Simple cyst
*47. Indications for operation in Crohns disease include which of the following?
A. Intestinal obstruction
B. Enterovesical fistula
C. Ileumascending colon fistula
D. Enterovaginal fistula
E. Free perforation
*48. True statements regarding cavernous hemangiomata of the liver in adults
include (
A. The majority become symptomatic
B. They may undergo malignant transformation
C. They enlarge under hormonal stimulation
D. They should be resected to avoid spontaneous rupture and life-threatening hemorrhage
E. A liver/spleen radionucleotide scan is the most sensitive and specific way to make the
diagnosis
50. Which of the following breast lesions are non-invasive malignancies?
A. Intraductal carcinoma of the comedo type.
B. Tubular carcinoma and mucinous carcinoma.