1.
A 50 year old alcoholic has been having recurrent
and frequent abdominal pain. He was diagnosed to
have chronic pancreatitis and has a sclerotic duct
and enlarged pancreatic head. The surgical
treatment of choice will be
A. Duodenum preserving pancreatic head resection
B. Puestow’s pancreaticojejenostomy
C. Total pancreatectomy
D. 95% pancreatectomy
2. A patient with chronic pancreatitis has been
complaining of abdominal fullness and had
difficulty eating because of post-prandial pain, ct
scan showed a 4cm pseudocyst at the back of the
stomach. Recommended treatment will be
A. Observation and periodic abdominal ultrasound
B. External drainage
C. Internal drainage
D. NPO and TPN for 4-6 weeks
3. A 60 year old man with jaundice underwent
ERCP, the result showed diluted CBD and these is
abrupt termination of the pancreatic duct(double
duct sign).Most likely diagnosis is
A. Chronic pancreatitis
B. Gallstone pancreatitis
C. CA of the pancreas
D. Acute pancreatitis
4. An alcoholic 45 year old man has an acute
pancreatitis, he has been in the hospital for 2
weeks and was improving but developed with high
grade fever, tachycardia and abdominal distention.
CT scan showed retroperitoneal air. Most likely
diagnosis is
A. Pseudocyst of the pancreas
B. Pancreatic infection
C. Pancreatic abscess
D. Infected Pseudocyst
5. Which of the following initiated acute
pancreatitis?
A. Impaired production of zymogen granules
B. Impaired protein and calcium synthesis
C. Increased extrusion rate of zymogen granules
D. Fusion of lysosomes and zymogen granules
6. A 33 year old man with history of drug addiction
complained of left upper quadrant pain, high grade
fever and tachycardia. CT scan of the abdomen
showed a 5cm solitary complex mass on spleen and
was diagnosed to be a splenic abscess. Appropriate
treatment will be
A. Broad spectrum antibiotics
B. Percutaneous drainage of the complex mass
plus broad spectrum antibiotics
C. Broad spectrum antibiotics plus splenectomy
D. Exploratory laparotomy and drainage of the
abscess
7. A 34 year old female has history of melena,
epistaxis, easy bruisability and ecchymosis, the
initial diagnosis made by the attending physician is
Idiopathic Thrombocytopenic Purpura. Which of
the following is true regarding her condition?
A. It is caused by overproduction of IgM which
coats the platelets
B. Based on her clinical manifestation, her platelet
count must be at least 40,000/cu.mm
C. Spontaneous resolution is common in children
D. Spleen is enlarged and best treated by
splenectomy
8. A 5 year old boy fell from his bicycle; his spleen
ruptured and has to undergo splenectomy. Which
of the following is true regarding his condition?
A. The surgery must be postponed until he
becomes older
B. He will no longer be infected with malaria after
splenectomy
C. Meningococci is the most common organism
that may infect the patient after splenectomy
D. He must be vaccinated at least 2 weeks after
splenectomy
9. Which of the following is most sensitive test for
chronic pancreatitis?
A. Pancreatic Polypeptide after a test meal
B. Bentiromide test
C. FBS
D. P-amylase determination
10. A non-alcoholic 50 year old woman has a
honeycombed 3 cm mass at the head of the
pancreas that incidentally. You will advise the
following except
A. Do EUS and sampling for presence of mucin
B. Advise Whipple’s surgery
C. Do CEA determination
D. Most likely it is benign
11. Which of the following statements is true
regarding Thalassemia?
A. Splenectomy is the primary treatment
B. Diagnosis is by demonstrating Hyperchromic
Macrocytic Anemia
C. Part of the treatment is using
D. B-Thallassemia patients are sym
12. The following statements are true regarding
Sickle Cell Anemia, except
A. It is due to mutation of adenine to thymine of
the B globin gene
B. The most common indication for splenectomy is
pain due to acute sequestration crises
C. There is lack of deformability of RBC
D. Splenectomy will prevent the sickling of RBC
13. A 50 year old has been complaining of gnawing
epigastric pain, fatigue, irritability and
diarrhea….Proton pump inhibitor and loperamide
but seems not to respond well. EGD showed
multiple ulcers in the…..duodenum. Serum calcium
is 13 mg/dl. The initial impression is Zollinger-
Ellison Syndrome. The following ….Except:
A. Ultrasound
B. MRI
C.Octreotide Scintigraphy
D. BAO/MAO
14. The above case was confirmed to be Zolinger-
Ellison syndreome with MEN 1, the primary
treatment ………
A. Enucleation of the tumor
B. Selective Vagotomy
C. Parathyroidectomy
D. Pancrea
15. A 15 year old boy was brought to the hospital
because of vomiting and abdominal pain. 2 weeks…
from his bike, the handle bar hitting his abdomen.
On examination, the boy is pale looking;
the…Upper quadrant and positive Kher sign. Ct
scan showed a 15% subcapsular hematoma on
the… tachycardic. Best management will be to :
A. Explore-lap, evacuation of hematoma, suturing
of the laceration
B. Observation, Blood transfusion, CT scan
monitoring of splenic injury
C. Explore lap
D. Explore lap
16. In order to prevent Overwhelming Post
splenectomy sepsis, the best thing to do for the ..
A. Give prophylactic antibiotics
B. Annual vaccination
C. Vaccination 7 days after surgery
D. Preserve splenic tissue as possible
17. A 43 year old man had been having episodes of
watery diarrhea of 2 years duration. This was
accompanied by epigastric pain, feeling bloated
and weight loss. The proton pump inhibitor he has
been taking seems to have no beneficial effet. The
diagnostic test that is best done will be
A. Serum gastrin determination
B. Esophagogastroduodenoscopy
C. Secretin provocative test
D. Maximal acid output determination
18. A serum gastrin level on the patient on the
preceding number was 200pg/ml. The next logical
procedure to be done is to do
A. Secretin provocative test
B. Get the ratio of BAO to MAO
C. Esophagogastroduodenoscopy
D. Re- test serum gastrin level
19. This patient was eventually diagnosed to have
Zollinger-Ellison syndrome. You expect the ratio of
his BAO to Mao to be
A. <80%
B. >30%
C. >60%
D. >40%
20. The best way to locate the lesion of the patient
on the preceding number before surgery is to
request for
A. MRI
B. Explore the Pasaro’s triangle
C. CT scan with contrast
D. Endoscopic Utrasound with Octreotide
Scintiscan
MATCHING TYPE
21. Marjolins ulcer
22. Level 4 malignant melanoma, neg. LN
23. Locally recurrent lymphatic invading melanoma
24. Level 2 ( <1mm) malignant melanoma
A. excision with 1cm margin 30. A 3 year old baby girl has 2 cm hemangioma on
B. Melphalan the left lower lip that seems to be rapidly growing
C. Excision with 2cm margin + sentinel LN biopsy in skin. The…is by
D. Excision with 1cm margin + Prophylactic LN A. Excision
dissection B. Laser surgery
C. Systemic prednisone
MULTIPLE CHOICE D. Observation

25. A bullous lesions affecting 8% of the body 31. A 35 year old female complained of flat, dull
surface erupted on a 5 year old few days after red lesion located along the cranial nerve V….Most
taking antibiotics for streptococcal infection of the likely diagnosis is
pharynx. Most likely diagnosis is A. Cavernous hemangioma
A. Steven Johnson syndrome B. Congenital nevus
B. TEN C. A-V malformation
C. SSSS D. Capillary malformation
D. Varicella Zoster
32. Involving the papillary-reticular dermis junction.
26. Based on your diagnosis on the preceding This melanoma is
number, you expect the following except: A. Clark level 1
A. cleavage plane is on the epidermal-dermal B. Clark level 2
junction C. Cark Level 3
B. there is sloughing of the respiratory tract D. Clark level 4
C. Defect is similar to 1st degree burns
D. Intestinal malabsorption 33. Best treatment for the melanoma discussed in
the preceding number is
27. Accepted treatment for the bullous lesion on A. Excision with 2cm margin + sentinel LN
the preceding cases are the ff. except dissection
A. Biologic dressing B. Excision with 1cm margin + sentinel LN
B. Correct fluid and electrolyte deficit dissection
C. Discontinue the antibiotic C. Excision with 3cm margin
D. Must continue the antibiotic to contain the D. Excision with 4cm margin + elective LN
bacteria dissection

28. A 65 year old patient presents with painless 1.5 34. A 23 year old female had an Open Reduction
cm ulcerating lesion on her right cheek. The lesion and Internal Fixation (ORIF) of an open fracture.
has been pres…. P.E. revealed no lymph node. The Incision site remained fresh x-ray of the involved
most likely diagnosis is limb showed osteomyositis. Most likely diagnosis is
A. pyogenic granuloma A. Hypertrophic scar
B. Melanoma B. Squamous cell carcinoma
C. Basal cell carcinoma C. Basal cell carcinoma
D. Squamous cell carcinoma
35. The best treatment for the above problem is
29. The standard treatment for ulcerating lesion of A. Excision with 1cm margin + prophylactic LN
the 65 year old patient mentioned on the dissection
preceding number is B. Excision with 4mm margin + LN dissection
A. excision with 2mm margin C. Excision with 1cm margin
B. MOH’s surgery D. Excision of the scar + intradermal injection of
C. Electrodessication Triamcinolone
D. Excision with 1cm margin
36. A 1 year old baby has an enlarging soft
compressible papular mass on the right
cheek…birth. Most likely diagnosis is
A. Capillary Hemangioma
B. Port wine stain
C. Cavernous Hemangioma
37. The best treatment of the above lesion is
A. Systemic injection of prednisone
B. Observation
C. Excision
38. A 50 year old female has been complaining of
stabbing pain on the pulp of her… nodule located
on subungal region of her right index finger. Most
likely diagnosis is
A. Acra Lentiginous melanoma
B. Glomus Tumor
C. Benign
39. A 5 year old boy with Pneumonia developed a
necrotic lesion with thick..after being injected with
3rd gen cephalosphorin thru the IV fluids. The injury
is
A. The antibiotic injected prevents the release of
cytokines and growth factor
B. Pressure effect on closed space
40. A 10 year old boy was bitten by a stray dog on
his right leg. The wound is
A. Copious irrigation, debridement, suturing and
antibiotics
B. Copious irrigation, debridement and skin grafting
and antibiotics
C. Copious irrigation, debridement, healing by
secondary intention and
D. Copious irrigation, debridement, antibiotics and
suturing after 4-5
41. Which of the following statements regarding
the anatomic location of the appendix is true?
A. The base of the appendix can always be found at
the continue of the ca..
B. In the majority of the cases, this tip of the
appendix is found in the pelvis
C. The appendix is often retrocecal and
extraperitoneal
D. The position of the tip of the appendix in
appendicitis does not determine the symptoms of
the..
42. A 29 year old presents with a 24-hour history of
abdominal pain and anorexia. He initially
described… states the pain is severe in his right
lower quadrant. He is febrile and has a leukocytosis
with.. reveals tenderness of the right lower
quadrant and guarding. The patient is taken to the
operating room… with the working diagnosis of
appendicitis. On laparoscopic evaluation, the
appendix was normal… significantly inflamed.
Which of the following is the most appropriate next
step?
A. Schedule for laparotomy and Ileocecectomy
B. Schedule for laparotomy and Right
Hemicolectomy
C. Schedule appendectomy
D. terminate the procedure and perform interval
appendectomy in 6 weeks
E. Laparoscopic drain placement without
appendectomy
43. Which of the following is true about acute
appendicitis?
A. Impacted fecalith almost always lead to acute
appendicitis
B. There is a predominance of gram (-) aerobes in
an inlamed appendix
C. The most diagnostic of the classic PE signs is the
(+)Rovsing’s sign
D. CT scan play a major role in the diagnosis of
acute appendicitis in elderly
E. none
44. Administration of prophylactic antibiotics in
acute appendicitis is indicated towards which of
the…
A. Prevent intraperitoneal infection
B. Prevent surgical site infection
C. Prevent gangrene formation
D. Prevent perforation
E. Prevent sepsis
45. Considered to be a constant finding in adult
patients with acute appendicitis
A. anorexia
B. Nausea and vomiting
C. Mucosal guarding
D. (+) Rovsing’s sign
46. A 21 year old female was admitted because of
right iliac pain of 12 hours duration. PE: abdom…
RLQ and hypogastric area. Rectal exam A. 24 hours
unremarkable. What is the appropriate initial B. 24- 48 hours
approach? C. 3-5 days
A. CT scan D. 7-10 days
B. Initiate antibiotics E. 10-14 days
C. Plain abdominal film
D. Pregnancy test 53. A 25 y/o female complains of severe pain in her
central lower abdomen of 4 hours… of thirst. Gyne
47. The lifetime risk of appendicitis in females: hx: LMP cannot be recalled with alleged
A. 10% contraceptives use. She is…fever. Her abdomen
B. 15% was marked and rebound tenderness. Some
C. 20% discoloration was…dx?
D. 25% A. Early appendicitis
E. 30% B. Ectopic pregnancy
C. Mittleschermz
48. In patients with ruptured appendicitis, the best
antibiotic combination is: 54. A 28 y/o female complains of sudden onset of
A. 1st gen cephalosphorin + metronidazole severe right sided abdominal pain and apparently
B. 2nd gen cephalosphorin + metronidazole cannot find a comfortable position to get relief
C. 3rd gen cephalosphorin + metronidazole from the pain. She has tenderness on the right side
D. 4th gen cephalosphorin + metronidazole of the abdomen with rigidity but no rebound. The
A. Acute AP
49. Which of the following statements regarding B. Acute Pyelonephritis
the clinicall course of appendicitis, is/are C. Penorated PUD
A. The typical history is one of vague abdominal
pain, followed by periumbilical pain 55. A 20 y/o female complains of sudden pain in
B. Nausea and vomiting usually precede the pain the pelvis and right iliac fossa…have normal
C. Gross hematuria and proteinuria are quite menses and her last mens was 15 days ago. She
common sometimes… The most likely diagnosis is…
D. Most patients……… A. Early appendicitis
E. A&B only B. Ectopic Pregnancy
C. Mittleschermz
50. A 35 y/o male consulted due to abdominal pain 56. The most common complication of acute
for the past 24 hours. Abdominal PE shows… appendicitis:
Rebound tenderness with muscle guarding at the A. Colo- cutaneous fistula
RLQ. CBC/ Urinalysis is normal. The… B. Liver Abscess
A. Schedule for immediate surgery C. Pyelophlebitis
B. Reevaluate abdomen after 4hours D.
C. Plain abdominal scout film
D. Repeat CBC/ Urinalysis after 4 hours 57. Special populations of people that may have
delayed diagnosis of
51. Differential diagnosis of acute appendicitis A. Very young patients
includes the following, except: B. Elderly Patients
A. Perforated peptic ulcers C. Patients with HIV infection
B. Meckel’s diverticulitis
C. PID 58. Which of the following modalities has the
D. highest sensitivity rate in the…
A. Abdominal scout film
52. Recommended duration of antibiotic coverage B. Oxaded compression USG
in non- perforated appendicitis: C. Enterocly..

rd
59. A 33 y/o female on her 3 trimester of
pregnancy came- in with right…fever of 12 hours
duration. The pain started with vague abdominal
dis…examination there is very well localized
tenderness of palpitation and… normal. CBC show
only mild leukocytosis . Urine and other
investigation…
A. Conservative management is the option of
choice because 3rd…
B. Antacids should be given to rule out acid- peptic
disease initial…
C. Immediate appendectomy should be performed
otherwise co…
D. Diagnosis of acute appendicitis is highly unlikely
since pain…
E. Acute pyelitis of pregnancy and torsion of an
ovarian cyst.. diagnosis in pregnancy
60. Atypical presentation and difficulty of diagnosis
is seen in…
A. Pelvic
B. Postileal
C. Retrocecal
D. Retroileal
61. Which of the following is / are TRUE regarding
intra- abdominal abscess and peritonitis
A. Host defense mechanism continue anastomic
leakage to form an abscess
B. A fistula forms when an abscess ruptures into
another hollow viscus
C. If an abscess perforates in free peritoneal cavity,
diffuse peritonitis results
D. In peritonitis, the focus is sepsis is within the
peritoneal cavity
E. All of the above
62. True regarding the peritoneal cavity, EXCEPT:
A. The peritoneum is formed by a single layer of
mesothelial cells
B. Peritoneal fluid has the same properties if lymph
C. Peritoneal fluid is secreted everywhere by the
peritoneal serosa
D. Diaphragmatic motion, negative intrathoracic
pressure and positive intra-abdominal pressure
promotes peritoneal fluid and particles
E. The patency of diaphragmatic stomata may be
altered by the respiratory cycle.
63. True regarding clinical manifestations of
peritonitis, EXCEPT:
A. Expansion of intravascular volume by rapid
infusion of intravenous fluid (IVF) can augment
cardiac…
B. As pulmonary edema progresses, protein rich
fluid accumulates in the alveoli
C. Thrombocytopenia is peritonitis commonly
occurs and suggests that disseminated
intravascular coagu…
D. Initial bowel response in peritonitis is a
transient hypermotility
E. Peritonitis acts as a stimulus to many endocrine
organs
64. True regarding the diagnosis of acute intra
abdominal infection, EXCEPT:
A. Radiologic picture mimics that if paralytic ileus
B. CT scan is required in the initial work- up of
acute peritonitis
C. CT scan and ultrasound are very helpful in the
diagnosis of intra abdominal abscess
D. Leukocyte count of >25, 000 or leucopenia of
<4000/mL3 are both associated with high mortality
E. Air beneath the diaphragm may be noted on
chest x-ray if patient remains in an upright
position..film is made
65. Spontaneous bacterial peritonitis, EXCEPT:
A. Monomicrobial infection
B. More common in adults than in children
C. Peritoneal tap is the most useful diagnostic test
D. Diarrhea is usually seen in neonates
E. When the diagnosis is confirmed immediate
surgical intervention should be done
66. Tertiary peritonitis
A. Failure if autoregulation of normally activated
host defense
B. Autoagressive devastation of organ system
functions
C. Clinical picture of sepsis without the presence of
a focus of infection
D. On operation, no pathogens are present or only
microorganisms of low- grade pathogenicity
E. All of the above
67. Intra- abdominal abscess:
A. May be seen with primary peritonitis
B. May be seen with secondary peritonitis
C. Better prognosis than diffuse peritonitis
D. Abdominal CT is the most efficient diagnosis
E. All of the above
68. True regarding the management if intra-
abdominal abscess, EXCEPT:
A. Treatment of suspected intra- abdominal
abscess by antibiotic therapy without drainage
B. In later stages of an abscess, most antibiotics are
ineffective
C. Percutaneous needle aspiration and closed
catheter drainage is preferred to operative d…
D. Crystalloid solutions are the mainstay of fluid
volume resuscitation
E. After percutaneous or open drainage of an
abscess, the drains are left in place until…
69. Which of the following is NOT an indication for
open surgical drainage:
A. Inability to safely drain percutaneously
B. Presence of a pancreatic or carcinomatous
abscess
C. Association with a bowel fistula
D. Unilocular fluid collection
70. True regarding the use if antibiotics in the
management if intra- abdominal abscess…
A. It should e initiated before the percutaneuos or
operative drainage
B. IT should be guided by sensitivity studies
obtained from previous intra-operative… treatment
of antecedent abdominal infection
C. It should always include the use if metronidazole
or another drug with anti…
D. It should continue until drains remain in place
71. Which of the following statements regarding
open surgical drainage is/are TRUE:
A. The presence of multiple, isolated, interloop
abscesses is an indication for…
B. It is essential to obtain specimens of the abscess
content
C. Abscess cavity should be thoroughly explored
digitally and all loculations..residual space.
D. Exploration & open drainage is undertaken
whenever the presence of CT & US.
E. All of the above?
72. Which of the following conditions would
indicate a staged abdominal repair?
A. Poor patient condition preludes definitive
closure
B. Source of infection is not eliminated or
controlled
C. Uncontrolled hemorrhage managed by packing
D. ALL?
73. Which of the ff. statements about perforation
peritonitis is NOT true:
A. Perforation from peptic ulcer presents acutely,
that the patients…perforation occurred
B. Typhoid perforation is usually seen in the first
week of infection
C. Carcinoma of the colon, if the ileocecal valve is
competen… rupture of the cecum as ascending
colon
D. In ruptured appendicitis, there is usually sudden
deterioration in clinical status when diffuse…
E. Liver abscess can perforate and cause diffuse
peritonitis
74. Earliest sign of peritonitis related to peritoneal
dialysis
A. Fever
B. Abdominal pain
C. Cloudy dialysis efficient
D. Positive blood culture
75. Which of the following concerning peritoneal
response to injury is NOT TRUE:
A. Non absorbed fibrin is invaded by fibroblasts
between 5-10 days after injury, resulting to fibrous
B. Denuded peritoneum heals slowly over a course
if 5-7 days
C. Adhesions form when peritoneal healing is
delayed or incomplete
D. With time, fibrous adhesions can become
attenuated and may disappear
E. Peritoneal healing occurs by ingrowth of
mesothelial cells from the edges of the defect
No. 76- 80 MATCHING TYPE: Match the types of
PERITONITIS with their corresponding clinical.
A. Peritonitis following pancreatitis
B. Post- operative peritonitis
C. Perforation peritonitis
D. Spontaneous primary peritonitis
E. Tuberculous peritonitis
E. 76. Stalavtite-like fibrinous messes hang from D. In distal small bowel obstruction, repetitive
parietal peritoneum on laparaoscopy vomiting does not prevent the…
E. Free peritoneal fluid in the peritoneal cavity
D. 77. Adult patients with ascites implies perforation of bowel.
B. 78. Anastomotic leakage 85. Radiographic finding of moderate gaseous
distention of entire small and large….
A. 79. Increased amylase or lipase in serum or urine A. Colonic obstruction with competent ileocecal
valve
C. 80. Most common form of acute intra-abdominal B. Paracolic ileus
infection C. Complete small bowel obstruction
D. Partial small…
MULTIPLE CHOICE: E. Normal abdom….
81. Physical exam findings of a patient with
mechanical bowel obstruction, EXCEPT: 86. Which of the following abdominal signs will
A. Fever and Tachycardia most likely be positive in a patient…
B. Dehydration A. Carnett sign
C. Oliguria B. Forthergill sign
D. Completely silent abdomen is suggestive of C. Kistner Sign
paralytic ileus D. A & B only
E. Systemic sepsis or toxemia suggest presence of
gangrenous bowel 87. Coffee- bean sign on abdominal x-ray:
A. Fecal impaction
82. Which of the following will NOT cause B. Carcinoma of the colon
constipation: C. Ogilvie’s syndrome
A. Improper toilet training during childhood D.none?
B. Diet of highly refined foods
C. Weak abdominal muscles 88. Which of the following statements concerning
D. High fiber diet the diagnosis of the acute…
A. The patient with generalized peritonitis lies
83. Which of the following statements about motionless
gastrointestinal bleeding is INCORRECT: B. The abdomen becomes distended only in
A. Hematemesis may occur as a result of any patients with infracted b…
significant bleeding occurring at a… C. Corticosteroids do not affect the diagnosis of
B. Melena may persist for as long as 5 days after a acute abdominal distention…
significant gastrointestinal bleeding… D. Patients with paralytic ileus often have an area
C. Hematocrit is a reliable indicator of the degree of localized tenderness
of hemorrhage early in the setti… E. All of the above
D. Coffee ground vomitous is due to the gastric acid
effect on the blood that may 89. A 60 year old male patient develops sudden,
E. Azotemia often accompanied bleeding from severe, excruciating…
esophageal varices. A. Myocardial Infarction
B. Acute Appendicitis C. Perforated peptic ulcer
84. TRUE regarding abdominal distention in C. Perforated peptic ulcer
intestinal obstruction: D. Ruptured abdominal aneurysm
A. Gaseous distention if primarily from bacterial gas
production 90. The following statements concern the
B. The fluid component of abdominal distention is differential diagnosis of a…
from fluid sequestration with… A. A patient with acute abdominal pain persisting
C. Free peritoneal fluid seen in intestinal for more than
obstruction contributes significantly
B. The most reliable physical finding in acute
appendicitis..
C. Appendectomy is well- tolerated during
pregnancy
D. Mesenteric adenitis may mimic acute
appendicitis in child
E. When visceral pain becomes superseded by
somatic pain
91. CASE: A 45 y/o woman had an apparently
uncomplicated… is 38.8 degrees Celsius, and her PR
is 110. The most likely cause is :
A. Urinary tract infection
B. Cholangitis
C. Wound infection
92. Concerning ileus, the following statements are
true, EXCEPT:
A. Excessive surgical manipulation can cause ileus
B. The stomach is the earliest to recover from …
SMALL BOWEL DAPAT
C. Oglivie’s syndrome is a form of adynamic ileus
D. Small bowel obstruction and ileus can have sin…
E. Adynamic ileus is the most common type of il..
93. All of the following findings seen in early
mechanical small bowel obstruction, EXCEPT:
A. Crampy abdominal pain that waxes and…
B. Abdominal distention
C. Paucity or absence of colonic gas on abdominal
plain films
D. Absence of bowel sounds
E. Hypovolemia
94. CASE: A 45 y/o woman comes to the ED
complaining of nausea and vomiting and absence
of flatus or stool. She had a C-Section through a
low midline incision about 7 years ago. Which of
the following is the most likely causes of her
problem:
A. Hernia
B. Adhesion
C. Tumor
D. Congenital bands
E. Intra- abdominal abscess
95. The following statements concerning anorexia
are true, EXCEPT:
A. It precedes the onset of pain in acute
appendicitis
B. It may be associated with malignancy
C. It is a potential side effect of some drugs
D. It is mediated through the spinal reflexes
E. It may be associated with inflammatory
abdominal pathology
***96. You were on duty at the ED when a 26 y/o
female patient came in. She is at the midpoint of
her menstrual cycle and…. Has right lower
quadrant pain and tenderness, fever 39 degrees
Celsius and two episodes of vomiting. WBC count:
12500/mm3. Most likely diagnosis:
A. Acute appendicitis
B. Ruptured graafian follicle?
C. Acute gastroenteritis
D. Pelvic inflammatory disease?
E. Acute mesenteric lymphadenitis
97. The most frequent cause of upper
gastrointestinal bleeding is:
A. Esophageal varices
B. Gastritis
C. Angimata
D. Peptic ulcer disease
E. Mallory- Weiss disease
98. The following statements are true regarding
strangulating obstruction, EXCEPT:
A. A strangulating obstruction can progress to
infarction and gangrene in as little as 6 hours
B. Ischemic bowel becomes edematous and infarcts
leading to gangrene and perforation
C. Venous obstruction occurs first followed by
arterial occlusion
D. Vovulus can cause strangulating obstruction
E. Strangulation is more common in large bowel
obstruction than in small bowel obstruction
99. The localization of pain to the right lower
quadrant, which often occurs in individuals who
have acute appendicitis is… of:
A. Inflammation of parietal peritoneum
B. Distention of appendix
C. Vascular engorgement
D. Perforation of appendix
E. Bowel infarction
100. Murphy’s sign:
A. The development of acute cholecystitis when
the patient is least able to tolerate it
B. Right upper quadrant pain while the surgeon is
palpating and the patient is inspiring
C. Resistance to passive dorsiflexion of the foot
D. Arrest of inspiration while the surgeon is
palpating the right upper quadrant
E. A nontender palpable gallbladder

***THE END***