GENERAL SURGERY BOARD EXAM QUESTIONS biomechanics of penetrating injuries:

A. Stab wounds are associated with significant cavitation

NAME: B. Hollow point bullet is associated with an enlarged area of injury
C. High velocity gunshot wound creates a vacuum pulling clothing, bacteria,
B__1. Which of the following statements about maxillofacial trauma is/are and other debris into the wound
false: D. The frontal area of impact of a bullet is determined by the caliber of the
A. Asphyxia due to upper airway obstruction is the major cause of death bullet
from facial injuries
B. The mandible is the most common site of facial fracture B__10. The following clinical situations are indications for peritoneal lavage:
C. The LeFort II fracture includes a horizontal fracture of the maxilla along A. Patient with suspected intraabdominal injury who will undergo prolonged
with nasal bone fracture general anesthesia fro another injury outside the abdomen
D. Loss of upward gaze may indicate either an orbital floor or orbital roof B. A patient with high velocity abdominal gunshot wound
fracture. C. Patient with abdominal knife wound
D. Patient with major noncontiguous injuries (chest /lower extremity)
C__2. Regarding the diagnosis and treatment of cardiac tamponade, which
of the following statements is true: C/D__11. (2 answers) The following are physiologic responses to
A. Accumulation of >250mL of blood in the pericardial sac is necessary to hypothermia:
impair cardiac output A. Tachycardia regardless of core temperature
B. Beck’s classic triad of signs of cardiac tamponade include distended neck B. Tachypnea regardless of core temperature
veins, pulsus paradoxicus, and hypotension C. Pupillary dilatation and loss of cerebral autoregulation at temperatures
C. 15% of needle pericardiocentesis give a false-negative result <26C
D. Cardiopulmonary bypass is required to repair most penetrating cardiac D. Cardiac rhythm contraindicates cardiopulmonary resuscitation even in the
injuries absence of a palpable pulse

A___3. The following statements are true concerning the biomechanics of B__12. The following statements are true concerning the injury pattern in
blunt trauma, EXCEPT: patients with blunt versus penetrating injuries, EXCEPT:
A. A small child and a large adult have a markedly different level of energy A. Solid organs are most frequently injured following blunt trauma
transfer in a high speed vehicular collision B. Liver is the most frequently injured organ in both penetrating and blunt
B. Shear strain injuries ersult from rapid acceleration or deceleration trauma
C. Tensile strain results from direct compression of tissues C. Major vascular injuries occur more commonly in penetrating trauma
D. Tolerance of biologic tissue to trauma injury is directly proportional to D. Injury patterns for blunt abdominal trauma in children are different than
elasticity of organ adults, whereas with penetrating trauma no such difference exists

C/D__4. The patient suffered major facial trauma. Which of the following D__13. A 22yo male driving a car at a high-speed and not wearing a seatbelt,
statements is/are true: leaves a road and crashes with a full frontal impact into a tree. The following
A. A frontal bone fracture and injury to the frontal sinus is a common facial injury patterns may be predictable from this type of MVA, EXCEPT:
injury in a young adult A. Orthopedic injuries involving kness, femurs, or hips
B. The optic nerve can be injured in a LeFort type II fracture B. Laceration to the aorta
C. A facial nerve injury may occur with the fracture of the temporal bone C. Hyperextension of the neck with cervical spine injury
D. Coronal CT sscan images can be useful adjunct to the evaluation of the D. Diaphragmatic rupture due to marked increase in intraabdominal pressure
patient with facial and head injuries
B__14. The management of a patient with frostbite includes:
D__5. Hemorrhage initiates a series of compensatory responses. The A. Gradual spontaneous warming
following statements are true concerning the physiologic responses to B. Emersion of the tissue in a large water bath with a temperature of 40-42C
hemorrhagic shock, EXCEPT: C. Immediate initiation of prophylactic antibiotics
A. Immediate response is an increased sympathetic discharge with resultant D. Systemic anticoagulation with heparin
reflex tachycardia and vasoconstriction E. Immediate debridement of necrotic tissue
B. Transcapillary refill is a response serving to restore circulating volume
C. Extracellular fluid becomes increasingly hyperosmolar C__15. A 75yo man is involved in a MVA. Which of the following statements
D. Adrenergically mediated vasoconstriction is well maintained at the is true concerning this patient’s injury and management:
arteriolar and precapillary sphincters A. Acceptable vital sign parameters are similar across all age groups
B. Hypertonic solutions should not be used for resuscitation due to concerns
D__6. The following steps are parts of the primary survey in a trauma for fluid overload
patient, EXCEPT: C. Patient would be more prone to a subdural hematoma than a younger
A. Insuring adequate ventilatory support patient
B. Measurement of blood pressure and pulse D. There is no role for inotropic agents in the management of this patient
C. Neurologic evaluation with the Glasgow Coma Scale
D. Examination of the cervical spine C__16. Alterations in the immunologic response after a major trauma
includes the following, EXCEPT:
D__7. The following are immediate life-threatening injuries that preclude air A. Decreased CD3 and CD4 production
exchange which can be treated in the field, EXCEPT: B. Depression of neutrophil antimicrobial functions including chemotaxis and
A. Tension pneumothorax C. Sucking chest wounds phagocytosis
B. Massive open chest wounds D. Tracheal disruption C. Decreased levels of pro-inflammatory cytokines including TNF, IL-1, IL-6
D. Impaired macrophage receptor expression and antigen presentation
C__8. A 22yo male is hospitalized with multiple extremity fractures including
a comminuted fracture of the femur and multiple rib fractures. Which of the B__17. The IV fluid that a 60kg, 30yo woman with an 80% burn should be
statements is true concerning his hospital course: given in the first 24h following burn injury is:
A. Low-dose heparin should not be employed during his hospital stay A. 19.2L of 5% glucose in lactated Ringer’s
B. Acute respiratory failure associated with petechiae of the head, torso, and B. 14.4L of lactated Ringer’s
sclerae would suggest a pulmonary embolism C. 9.6L of hypertonic salt solution (sodium conc. 200mEq/L)
C. Early fracture fixation would decrease the incidence of fat emboli D. 7.2L of 5% albumin solution
D. Placement of a Greenfield filter should be avoided due to the risk of lower E. 5.5L of pentafraction component of hydroxyethyl starch
extremity edema
B__18. Indications for excharotomy of a circumferentially burned right lower
B/C__9. Which of the following statements is/are true concerning the limb include all of the following, EXCEPT:
A. Progressively severe deep tissue pain C__30. Which of the following most often initiates the development of acute
B. Coolness of unburned skin of the toes of the right foot appendicitis:
C. Pressure of 40mmHg in the anterior compartment of the distal right leg A. Viral infection C. Obstruction of appendiceal lumen
D. Edema of the unburned skin of the right foot B. Acute gastroenteritis D. Primary clostridial infection

B__19. The clinical and hisologic sign of invasive burn wound infection D__31. The best type of x-ray to locate free abdominal air is:
include the following, EXCEPT: A. Posteroanterior view of the chest
A. Focal dark red or dark brown discoloration of the eschar B. Flat and upright view of the abdomen
B. Delayed separation of the eschar C. CT of the abdomen
C. Conversion of an area of partial-thickness burn to full-thickness necrosis D. Lateral decubitus x-ray, right side up
D. Presence of microorganisms in the unburned subcutaneous tissue in a
burn wound biopsy specimen C__32. The most helpful diagnostic radiographic procedure in small bowel
obstruction is:
B__20. Characteristics of the hypermetabolic response to burn injury A. CT of abdomen C. Supine and erect x-ray of abdomen
includes the following, EXCEPT: B. Contrast study of intestine D. UTZ of the abdomen
A. Elevation of core temperature, skin temperature, and core-to-skin heat
transfer D__33. Meckel’s diverticulitis most often occurs in the:
B. Ambient temperature dependency of metabolic rate A. Proximal jejunum C. Proximal ileum
C. A marked increase of blood flow to the burn wound B. Distal jejunum D. Distal ileum
D. Oxidation of stored lipid as the major source of metabolic energy
A__34. The following are nonsurgical causes of acute abodminal pain,
C__21. The following are accepted adjuncts in the management of EXCEPT:
hypertrophic scar, EXCEPT: A. Hyperthyroidism C. Pneumonia
A. Local steroid injection B. Adrenal insufficiency D. Diabetic ketoacidosis
B. Compression garments
C. Topical platelet-derived growth factor C__35. The following causes visceral pain from the abdominal organs,
D. Topical silicone EXCEPT:
A. Stretching and contraction C. Cutting
D__22. In the healing of clean wound, the maximum immeiate strength of B. Traction, compression, torsion D. Certain chemicals
the wound is reach by:
A. 2-3 days C. 10-12 days D__36. Visceral pain is typically:
B. 4-7 days D. 13-18 days A. Well-localized C. Mediated via spinal nerves
B. Sharp D. Perceived to be in the midline
B__23. Cell not involved in healing of clean wound:
A. Macrophages C. Fibroblasts C__37. Which of the following is the most common serious complication of
B. Platelet D. PMNs an end colostomy:
A. Bleeding C. Parastomal hernia
B__24. The tensile strength of the wound starts and increases after: B. Skin breakdown D. Stromal prolapse
A. Immediate suture of the wound C. 7-10 days
B. 3-4 days D. 6 months D__38. Which of the following statements about the anatomic course of the
esophagus is correct:
A__25. Which one of the following surgical procedures is considered to have A. Cervical esophagus passes behind and to the right of the trachea
a clean-contaminated wound: B. Thoracic esophagus enters the posterior mediastinum anterior to the
A. Elective cholecystectomy for cholelithiasis aortic arch
B. Herniorrhaphy with mesh repair C. Thoracic esophagus passes behind the right mainstem bronchus and the
C. Lumpectomy with axillary node dissection pericardium
D. Appendectomy with walled off abscess D. Esophagus deviates anteriorly and to the left as it enters the abdomen

A__26. Keloid scar is made up of:a B__39. Which of the following statements about Schatzki’s ring is correct:
A. Dense collagen C. Granulomatous tissue A. The ring represents a panmural fibrotic stricture resulting from
B. Loose fibrous tissue D. Loose areolar tissue gastroesophageal reflux
B. Dysphagia occurs when the ring diameter is 13 mm or less
A__27. The following congenital abnormalities are correctly defined, EXCEPT: C. Schatzki’s ring indicates reflux esophagitis
A. Omphalocele represents a defect in the abdominal wall lateral to the D. Schatzki’s ring signifies the need for an antireflux operation
umbilical cord
B. The herniated viscera associated with omphaloceles are usually covered D__40. A 50yo patient develops sudden left lower chest pain and epigastric
with membranous sac pain after vomiting. The patient shows diaphoresis, breath sounds are
C. Umbilical polyp is a small excrescence of omphalomesenteric duct mucosa decreased on the left, with abdominal guarding. The most appropriate
that is retained in the umbilicus diagnostic test is:
D. Meckel’s diverticulum results when the intestinal end of A. Aortography C. Electrocardiogram
omphalomesenteric duct persists and represents a true diverticulum B. Esophagoscopy D. Film of the chest

B__28. Which of the following statement is true concerning umbilical hernias C__41. The following statements are true about the influence of diet and
in adults: lifestyle on lower esophageal sphincter (LES) function, EXCEPT:
A. Most umbilical hernias in adults are the result of a congenital defect A. High-protein diet increases LES pressure
carried into adulthood B. Fat meal results in sustained decrease in LES pressure
B. A paraumbilical hernia typically occurs in multiparous females C. Cigarette smoking produces no significant changes in LES pressure
C. Presence of ascites is a contraindication to elective umbilical hernia repair D. Chocolate ingestion causes a decrease in LES pressure
D. Incarceration is uncommon with umbilical hernias
B__42. The presence of a non-malignant mid- or upper esophageal stricture
D__29. The following structures are derived from the external oblique always indicates the presence of:
muscle and its aponeurosis, EXCEPT: A. Alkaline reflux esophagitis C. Scleroderma
A. Inguinal or Poupart’s ligament C. Superficial inguinal ring B. Barrett’s esophagus D. Mediastinal fibrosis
B. Lacunar ligament D. Conjoined tendon D__43. Which of the following is most reliable for confirming the occurrence
of a significant esophageal caustic injury:
A. History of event C. Barium esophagraphy A. Peutz-Jegher syndrome
B. PE of the patient D. Endoscopy B. Crohn’s disease
C. Simple tubular adenomas of small intestine
C__44. First-line therapy for routine peptic duodenal ulcer disease includes: D. Colon carcinoma
A. Vagotomy & antrectomy C. Evaluation of H. pylori
B. Upper endoscopy and biopsy D. Cream/ milk-based “sippy” diet C__57. Small intestinal carcinoids may present in a multitude of fashions.
The following may be seen as a presentation of carcinoid tumors of the small
A__ 45. Appropriate management of severe vomiting associated with gastric intestine, EXCEPT:
outlet obstruction from peptic ulcer disease includes all of the following, A. Intestinal obstruction C. Small intestinal infarction
EXCEPT: B. GI bleeding D. Asymptomatic
A. Oral antacid therapy C. IV H2 antagonist
B. Nasogastric suction D. Intravenous hydration B__58. The most common indication for operation in Crohn’s disease of the
colon is:
B__46. All of the following are complications of peptic ulcer surgery, EXCEPT: A. Obstruction C. Bleeding
A. Duodenal stump blowout C. Diarrhea B. Chronic debility D. Perforation
B. Steatorrhea D. Delayed gastric emptying
C__59. The following statements about colonic motility are true, EXCEPT:
D__47. Cholecystokinin is believed to function in all of the following A. Mass contractions involve only the rectum
processes, EXCEPT: B. Stool in the colon is propelled by tonic contractions
A. It physiologically delays gastric emptying C. “Antiperistaltic” contractions occur in the descending colon
B. It has a role in satiety regulation D. Defecation involves both sensory and motor pathways
C. Contracts gallbladder
D. Important in the control of anal sphincter C__60. Which of the following patients generally does NOT require surgical
intervention as a consequence of acute diverticulitis:
B__48. All of the following benign conditions are associated with increased A. 35yo man without history of diverticulitis
rates of gastric cancer, EXCEPT: B. 68yo man status 2 weeks post-renal transplantation
A. Pernicious anemia C. Adenomatous polyp C. 55yo woman with hypertension and DM
B. MEN type 1 D. Chronic atrophic gastritis D. 50yo man with pneumaturia

A__49. Which of the ff statements is true concerning the process of D__61. The test with the highest diagnostic yield for detecting a colovesical
swallowing and esophageal transit of food: fistula is:
A. Injury to recurrent laryngeal nerves can cause motility problems of the A. Barium enema C. Computed tomography
cervical esophagus and resulting aspiration B. Colonoscopy D. Cystoscopy
B. Esophageal reflux does not lead to impaired esophageal motility
C. Overall length of the LES is the only factor influencing the pressure A__62. The most common indication for surgery secondary to acute
gradient of the sphincter diverticulitis:
D. A mechanically defective sphincter is always associated with increased A. Abscess C. Colovesical fistula
esophageal acid exposure B. Colonic obstruction D. Hemorrhage

C__50. The following clinical circumstances are predisposing factors for the B__63. The initial management of toxic ulcerative colitis should include:
development of stress ulceration, EXCEPT: A. 6-Mercaptourine C. Opioid antidiarrheals
A. Intraperitoneal sepsis C. Isolated tibial fracture B. IVF and electrolyte resuscitation D. Colonoscopic decompression
B. Hemorrhagic shock D. Adult RDS
D__64. Axial twisting of the right colon or cecal volvulus has been shown to
C__51. With regard to benign gastric ulceration, the most common location be associated with each of the following, EXCEPT:
of disease is which of the following: A. History of abdominal operation
A. Along the greater curvature B. Mobile cecum
B. Distal to the esophagogastric junction along the lesser curvature C. Obstructing lesion in the transverse or left colon
C. Area of the incisura angularis along the lesser curvature D. Inflammatory bowel disease
D. Within the gastric antrum
B__65. Sigmoid volvulus has been associated with each of the following,
A__52. The most common site of adenocarcinoma of the small intestine is EXCEPT:
the: A. Chronic constipation and laxative abuse
A. Duodenum C. Ileum B. Chronic rectal prolapse
B. Jejunum D. Colon C. Chronic traumatic paralysis
D. Medical management of Parkinson’s disease
A__53. Meckel’s diverticulum most commonly presents as:
A. Gastrointestinal bleeding C. Diverticulitis A__66. Which oft he following statement(s) about complete rectal prolapse,
B. Obstruction D. Intermittent abdominal pain or procidentia is true:
A. Rectal prolapse results from intussusception of the rectum and
C__54. Simple screening tests for malabsorption includes the following, rectosigmoid
EXCEPT: B. Disorder is more common in men than in women
A. Microscopic exam C. 72-hr stool collection for fats C. Continence nearly always is recovered after correction of the prolapse
B. D-xylose absoprtion D. Small bowel x-ray series D. All are true

C__55. Extensive resection of the small bowel, leaving 2 or 3 feet beyong the C__67. Which of the following statements about hemorrhoids is NOT true:
ligament of Treitz anastomosed to the transverse colon, can lead to the A. Hemorrhoids are specialized “cushions” present in everyone that aid
following metabolic complications, EXCEPT: continence
A. Gastric hyperacidity and hypersecretion B. External hemorrhoids are covered by skin whereas internal hemorrhoids
B. Hyperoxaluria are covered by mucosa
C. Hypermatabolic response C. Pain is associated with uncomplicated hemorrhoids
D. Fat-soluble vitamin deficiency D. Hemorrhoidectomy is reserved for 3rd and 4th degree hemorrhoids

B__56. An increased evidence of adenocarcinoma of the small intestine has A__68. How much of the daily insensible water loss is due to loss in stool:
been established with which of the following conditions: A. 200mL C. 600mL
B. 400mL D. 800mL B. Insulin, somatostatin, CCK, pancreatic polypeptide
C. Insulin, somatostatin, glucagon, pancreatic polypeptide
D__69. The following are tumor suppressor genes that have been associated D. Insulin, secretin, glucagon, CCK
with the development of colorectal cancer, EXCEPT:
A. DCC gene C. P53 gene D__82. The most appropriate test to confirm a clinical diagnosis of early
B. APC gene D. Rb gene chronic pancreatitis is which of the following:
A. Serum amylase determination
B__70. The most common oncogene abnormality observed in association B. Calculation of urinary amylase clearance
with colorectal cancer is which of the following: C. Measurement of para-aminobenzoic acid absorption
A. Overexpression of the N-myc oncogene D. Endoscopic retrograde cholangiopancreatography
B. Amplification of the K-ras oncogene
C. Suppression of the erbB oncogene C__83. Which of the ff is the most common cause of obstructive jaundice in
D. Amplification of the L-myc oncogene patients with chronic pancreatitis:
A. AdenoCA of the head of the pancreas
C__71. Which of the following types of colonic polyps is associated with the B. Choledocholithiasis
highest incidence of malignant degeneration: C. Fibrotic stricture of the common bile duct
A. Tubular adenoma C. Villous adenoma D. Pancreatic pseudocyst formation
B. Tubulovillous adenomaD. Hamartomatous polyp
A__84. Which of the ff have been shown to be risk factors for development
A__72. Dietary risk factors thought to play a causative role in development of adenocarcinoma of the pancreas:
of colorectal cancer include which of the following: A. Prior gastrectomy C. Adult-onset DM
A. Hight fat intake C. High smoked food intake B. Coffee drinking D. Chronic coumadin usage
B. High fiber intake D. High vegetable intake
A__85. The most frequent cause of primary lymphedema is:
A__73. The most common complication after hemorrhoidectomy is which of A. Deficiency of transporting lymphatic channels
the following: B. Valvular incompetence in lymphatic channels
A. Urinary retention C. Incontinence C. Obstruction or removal of regional lymph nodes
B. Rectal bleeding D. Wound infection D. Thrombosis of lymphatic channels

D__74. The following regarding Echinococcosis liver disease caused by C__86. The most precise diagnostic screening procedure for differentiating
Echinococcus granulosus are true, EXCEPT: benign thyroid nodules from malignant ones is:
A. Not a neoplasm A. Thyroid ultrasonography C. FNAB
B. It is endemic to parts of Europe B. Thyroid scintiscan D. Thyroid hormone suppression
C. Usually curable by resection
D. More deadly than in its Echinococcus multilocularis form A__87. The following are indications for surgical thyroidectomy for Grave’s
disease, EXCEPT:
D__75. Ligation of all of the following arteries usually cuases significant A. Ocular involvement C. Women of childbearing age
hepatic enzyme abnormalities, EXCEPT: B. Symptomatic large goiter D. Concomitant thyroid nodule
A. Ligation of the right hepatic artery
B. Ligation of the left hepatic artery C__88. The following conditions are associated with hypercalcemia, EXCEPT:
C. Ligation of the hepatic artery distal to the gastroduodenal branch A. Hyperthyroidism C. Terminal ileal resection
D. Ligation of the hepatic artery proximal to the gastroduodenal artery B. Thiazide diuretics D. Breast cancer

C__76. Which of the following is the most common acid-base disturbance in D__89. The most common mass lesion in the sella turcica is which of the
patients with cirrhosis and portal hypertension: following:
A. Metabolic acidosis C. Metabolic alkalosis A. Craniopharyngioma C. Benign pituitary cyst
B. Respiratory alkalosis D. Respiratory acidosis B. Aneurysm D. Pituitary adenoma

A__77. Which of the following are indications for cholecystectomy C__90. Which of the following conditions is associated with increased risk of
A. Presence of gallstones in a patient with intermittent episodes of RUQ pain breast cancer:
B.Presence of gallstones in an asymptomatic patient A. Fibrocystic mastopathy C. Atypical hyperplasia
C. Presence of symptomatic gallstones in a patient with angina pectoris B. Severe hyperplasia D. Papillomatosis
D. Presence of asymptomatic gallstones in a patient who has insulin-
dependent diabetes C__91. Which of the ff are the most important and clinically useful risk
factors for breast caner:
A__78. The following statements about cholangitis are correct, EXCEPT: A. Fibrocystic disease, age, gender
A. Charcot’s triad is always present B. Cysts, family history in immediate relative and gender
B. Associated biliary tract disease is always present C. Age, gender, family history in immediate relatives
C. Chills and fever are due to presence of bacteria in the bile duct system D. Obesity, nulliparity, alcohol use
D. Most common cause of cholangitis is choledocholithiasis
A__92. Failure to perform radiation after wide excision of an invasive cancer
D__79. The following are the clinical pictures of gallstone ileus, EXCEPT: risks which of the ff outcomes:
A. Air in the biliary tree C. Stone at the site of obstruction A. Recurrence of cancer in the ipsilateral breast
B. Small bowel obstruction D. Acholic stools B. Shorter survival time
C. Regional nodal recurrence
C__80. Which of the following parameters is NOT included in the Ranson’s D. Greater chance of breast cancer mortality
prognostic signs useful in the early evaluation of a patient with acute
pancreatitis: B__93. A 21yo woman presents with an asymptomatic breast mass. Which of
A. Elevated blood glucose the ff statements is true concerning her diagnosis and treatment:
B. Leukocytosis A. Mammography will play an important role in diagnosing the lesion
C. Amylase value >1000U/dL B. UTZ is often useful in differential disgnosis of this lesion
D. Serum LDH >350 IU/dl C. Mass should always be excised
C__81. The islets of Langerhans contain four major endocrine cell types that D. Lesion should be considered pre-malignant
secrete which of the following hormones:
A. Insulin, somatostatin, glucagon, secretin A__94. Which of the ff are factors associated with an increased risk for
developing breast cancer: A Orchidopexy in a subdartos pouch is the treatment of choice.
A. Nulliparity B The operation is recommended at the age of 2 years.
B. Oophorectomy <35yo C When a testis is impalpable and therefore intra-abdominal, laparotomy
C. Use of OCPs should be done.
D. Post-menopausal use of conjugated estrogens D Laparoscopy is the gold standard procedure for an intra-abdominal testis.

C__95. The following treatments are proven benefit in the treatment of D__107. What is the operation for congenital hypertrophic pyloric stenosis
mastodynia associated with fibrocystic breast disease, EXCEPT: called?
A. Avoiding methylxanthine compounds, like caffeine A Hartmann D Ramstedt
B. Cessation of smoking B Whipple E Ivor-Lewis.
C. Vit E C Heller
D. Danazol
D__108. 5 A neonate has bile-stained vomiting with passage of bloodstained
A__96. In which of the following cases might tachycardia accompany shock? stools. The baby is very sick and a contrast meal shows the bowel mostly on
A Hypovolaemia due to gastrointestinal (GI) bleeds the right side with a subhepatic caecum.
B Cardiogenic shock A Tracheo-oesophageal fistula C Intestinal atresia
C Patients with implanted pacemakers B Congenital diaphragmatic hernia D Intestinal malrotation
D Fit young adults with normal pulse rate of 50/min
B__109. A 2-week-old neonate who was born with jaundice has exhibited
B__97. Which of the following statements regarding hypovolaemic shock are increasing yellowish discoloration of skin and conjunctiva ever since birth.
true? There are some superficial skin bruises
A It is associated with high cardiac output. A Intestinal malrotation C Hirschsprung’s disease
B The vascular resistance is high. B Biliary atresia D Necrotising enterocolitis
C The base deficit is low.
D The mixed venous saturation is high. D__110. A few days after birth, a neonate has developed abdominal
distension, bloodstained stools and bilious vomiting. The baby is toxic with
B__98. The following is a complication of massive blood septic shock.
Transfusions, EXCEPT? A Intestinal malrotation C Hirschsprung’s disease
A Coagulopathy D Hypokalaemia B Biliary atresia D Necrotising enterocolitis
B Hypercalcaemia E Hypothermia.
C Hyperkalaemia C__111. A 67-year-old female is referred for consideration of total
parenteral nutrition (TPN) following a total colostomy. Which of the
B__99. The following is a natural barrier to infection, EXCEPT? following biochemical and clinical markers are suggestive of malnutrition?
A Intact epithelial surface C Macrophages A Albumin C Transthyretin
B High gastric pH D. Antibodies B Urea D Skin fold thickness

C__100. The following are causes of secondary (or exogenous) infection, A__112. The following statements regarding water homeostasis are
EXCEPT? True, EXCEPT?
A Poor hand-washing technique C Community A The total body water (TBW) content in an adult male is 70% of body weight
B Anastomotic leak D Inadequate air filtration in the theatre B Two-thirds of TBW is intracellular.
C An average adult has approx. 3 L of plasma.
B__101. The following statements regarding abscesses are true, EXCEPT? D Water moves freely across cell membranes
A Staphylococcus aureus is one of the most common causative organisms.
B The abscess wall is composed of epithelium. C__113. Which of the following statements regarding starvation is true?
C Actinomyces can cause a chronic abscess A Fats are initially mobilized to meet energy requirements.
D Antibiotics are indicated if there is evidence of cellulitis. B Muscle glycogen can be directly utilized.
C After a short fast, insulin level falls.
D__102. The following statements regarding cellulitis are true, EXCEPT? D Gluconeogenesis only takes place in the liver
A This is non-suppurative invasive infection of tissues.
B It is poorly localised. B__114. Which of the following statements regarding 0.9 per cent normal
C It is commonly caused by Clostridium perfringens. saline is true?
D Blood culture is usually positive A It has the same sodium concentration as plasma.
B It has equimolar concentration of sodium and chloride.
C__103. A 78-year-old nursing home resident who has finished a course of C It is low in potassium.
antibiotics recently presents with severe diarrhoea for the past 3 days. On D It is the best fluid to be used in hypovolaemia
examination, he is very unwell and in shock. Abdominal examination reveals
generalised distension and tenderness. A__115. The following statements regarding bowel resections are true,
A Gas gangrene C Pseudomembranous colitis EXCEPT?
B Necrotising fasciitis D Tetanus A Diarrhoea is unusual, following ileal resection.
B The sodium content of high output fistulas is about 90 mmol/L.
A__104. A young soldier injured in combat develops severe pain over his leg C Oxalate stones are commoner following bowel resection
wound. Examination reveals thin, brown, sweet-smelling exudate with D Peptic ulceration is a complication of short-bowel syndrome.
oedema and crepitus C Pseudomembranous colitis
A Gas gangrene D Tetanus B__116. The following statements regarding acid–base balance are true,
B Necrotising fasciitis EXCEPT?
A Na and K are the major cations.
C__105. Which of the following statements about inguinoscrotal swellings B Bicarbonate is the major anion.
are false? C A decreased anion gap can occur in myeloma.
A A hydrocele is a patent processus vaginalis as is a hernia. D A raised anion gap can occur in DKA.
B Hernia is always indirect.
C Hernia can be direct or indirect. B__117. Which of the following is not a cause of acute shortness of breath
D In incarcerated hernia, reduction should be attempted by taxis followed by on the first postoperative day?
operation 24 h later. A Atelectasis D Chest infection
B Pulmonary embolism E Pneumothorax.
C__106. The following are true for undescended testis, EXCEPT? C Myocardial infarction
 A. Epigastric omphalocele C. Intracardiac defect
B__118. Which of the following statements with regard to postoperative B. Sternal cleft D. Pericardial cyst
vomiting are false?
A Inadequate analgesia can be a cause of postoperative vomiting. D__132. Neonates with NEC may demonstrate all of the following findings on
B All abdominal operations must routinely have a NGT inserted abdominal films, EXCEPT:
preoperatively. A. Pneumatosis intestinalis C Pneumoperitoneum
C Metoclopramide and cyclazine can help. B. Portal vein air D. Colovesical fistula
D Pulmonary aspiration may inadvertently occur.
E Wound dehiscence is a distinct possibility. A__133. The most common type of congenital diaphragmatic hernia is
caused by:
E__119. In firearm injuries, the following statements are true, EXCEPT? A. Defect through the pleuroperitoneal fold
A Low-velocity bullet wounds behave like knife injuries. B. Defect in the central tendon
B High-velocity bullets cause cavitation. C. Defect through the space of Larrey
C A permanent cavity is one that remains after the initial impact. D. Abnormally wide esophageal hiatus
D A permanent cavity gives an idea of the extent of damage.
A__134. Branchial cleft remnants most often present with which of the
A__120. Which of the following statements regarding Glasgow Coma Scale following clinical problems:
(GCS) is true? A. Infection C. Hemorrhage
A A GCS of 6 means the patient is in coma. B. Airway obstruction D. Malignant degeneration
B The minimum score is 0.
C A GCS of 10 means the patient is in coma. A__135. The following are typical causes of neonatal intestinal obstruction,
D Eye opening to command/speech is scored as 2. EXCEPT:
A. Intussusception C. Hirschprung’s disease
D__123. The following statements regarding extradural haematoma are B. Meconium ileus D. Incarcerated hernia
true, EXCEPT?
A It is often caused by a skull fracture with laceration of the middle B__136. At what age is surgical orchiopexy recommended for a child with a
meningeal artery. unilateral undescended testis:
B It commonly occurs at the pterion. A. Promptly upon discovery, regardless of age C. 5-6years
C There is often a lucid interval. B. 1 year D. At puberty
D Treatment is with a burrhole.
B__137. The medical indications for circumcision includes the following,
D__124. The following statements regarding acute subdural haematoma are EXCEPT:
true, EXCEPT? A. Infants with history of UTI C. Phimosis
A It is a collection of blood between the dura and arachnoid membranes. B. Hypospadias D. Vesicoureteral reflux
B It can be caused by laceration of the brain.
C It can be due to disruption of a cortical blood vessel. D__138. Which is not a principle of compound fracture treatment:
D It has a good prognosis. A. No tendon repair C. Wound debridement
B. Aggressive antibiotic cover D. Immediate wound closure
A__125. Which of the following statements regarding third nerve palsy in
head injury is true? A__139. Medial meniscus is more vulnerable to injury because of:
A It causes a fixed, dilated pupil. A. Its fixity to tibial collateral ligament
B It may cause the eye to deviate upwards. B. Semicircular shape
C It is never bilateral. C. Action of adductor magnus
D It usually occurs on the opposite side to the haematoma. D. Attachment to fibrous capsule

2__126. What are the common signs and symptoms of a fractured zygoma? A__140. Injury to the popliteal artery in fracture lower end of femur is often
A Battle’s sign due to:
B Infraorbital paraesthesia A. Distal fragment pressing the artery
C VII nerve palsy B. Proximal fragment pressing the artery
D Supraorbital paraesthesia C. Tight plaster
E Subconjunctival haemorrhage. D. Hematoma

B__127. The following are common findings in patients with Le Fort II D__141. The most important factor in fracture healing is:
fractures, EXCEPT? A. Good alignment
A Malocclusion B. Organization of blood clot
B Inferior alveolar nerve paraesthesia C. Accurate reduction and 100% apposition of fractured fragments
C Infraorbital nerve paraesthesia D. Immobilization
D Palatal mobility E. Adequate calcium intake

C__128. What is the most commonly fractured facial bone? D__142. The most preferred treatment of fracture of neck of femur in a
A Mandible C Nasal bones young person is:
B Zygoma D Maxilla A. Hemiarthroplasty C. Conservative treatment
B. Total hip treatment D. Closed reduction & internal fixation
A__129. The following may be associated with epistaxis, EXCEPT?
A Fractured zygomatic arch A__143. Lisfranc dislocation is:
B Fractured anterior wall of frontal sinus A. Tarsometatarsal dislocation C. Scaphoid dislocation
C Orbital blow-out injury B. Lunate dislocation D. Posterior dislocation of elbow
D Le Fort II fracture of maxilla
B__144. Most common cause of pathological fracture in a child is:
D__130. In neonates with necrotizing enterocolitis, which of the following A. Malignancy C. Fibrous dysplasia
findings is an indication of significant bowel ischemia: B. Bone cyst D. Paget’s disease
A. Increased gastric residuals C. Elevated platelet count
B. Septic shock D. Erythema of abdominal wall

D__131. The pentalogy of Cantrell includes all of the following, EXCEPT: