1. 50-year-old patient presents with symptomatic nephrolithiasis. He reports that he underwent a jejunoileal bypass for morbid obesity when he was 39. Which of the following is a complication of jejunoileal bypass? A. Pseudohyperparathyroidism B. Hyperuric aciduria C. Hungry bone syndrome D. Hyperoxaluria E. Sporadic unicameral bone cysts

2. A patient with a nonobstructing carcinoma of the sigmoid colon is being prepared for elective resection. Which of the following reduces the risk of postoperative infectious complication? A. A single preoperative 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 anaerobes D. Postoperative administration of parenteral antibiotics effective against aerobes and anaerobes until the patient 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

3. A previously healthy 55-year-old man undergoes elective right hemi-colectomy for a Stage I ( T2N0M0) cancer of the cecum. His postoperative ileus is somewhat prolonged and on the fifth postoperative day his naso-gastric tube is still in place. Physical examination reveals diminished skin turgor, dry mucous membranes, and orthostatic hypotension, Pertinent laboratory values are as follows: Arterial blood gases: pH 7.56 Pco2 50 mm Hg, Po2 85 mm Hg. Serum electrolytes (mEq/L): Na+ 132, K+ 3.1 C1- 80; HCO3-42. Urine electrolytes (mEq/L): Na+2.K+5,C1-6. What is the patient’s acid – base abnormality? A. Uncompensated metabolic alkalosis B. Respiratory acidosis with metabolic compensation C. Combined metabolic and respiratory alkalosis D. Metabolic alkalosis with respiratory compensation E. Mixed respiratory acidosis and respiratory alkalosis .

1 4. A 52-year-old man with gastric outlet obstruction secondary to a duodenal ulcer presents with hypochloremic, metabolic alkalosis . Which of the following is the most appropriate therapy for this patient? A. Infusion of 0.9% NaCl supplemental KCl until clinical signs of volume depletion are eliminated. B. Infusion of isotonic (0.15N) HCl via a central venous catheter C. Clamping the nasogastric tube to prevent further acid losses D. Administration of acetazolamide to promote renal excretion of bicarbonate E. Intubation and controlled hypoventilation on a volume – cycled ventilator to further increase Pco2

5. A victim of blunt abdominal trauma undergoes a partial hepatectomy. During surgery, he receives twelve units of packed red blood cells. In the recovery room, he is noted to be bleeding from intravenous puncture sites and the surgical incision. Which of the following statements regarding the coagulopathy is most likely true? A. The patient has an unknown primary bleeding disorder B. The coagulopathy is secondary to the partial hepatectomy C. The coagulopathy is secondary to dilutional thrombocytopenia and deficiency of clotting factors from the massive blood transfusion D. The treatment is oral vitamin K E. The treatment is intravenous vitamin K.

6. A 59-year-old man is planning to undergo a coronary artery bypass. He has osteoarthritis and consumes nonsteroidal anti-inflammatory drugs (NSAIDs) for the pain. Which of the following is the most appropriate treatment prior to surgery to minimize his risk of bleeding from his NSAID use? A. Begin Vitamin K 1 week prior to surgery B. Give FFP few hours before surgery C. Stop the NSAIDs 1 week prior to surgery D. Stop the NSAIDs 3 to 4 days prior to surgery E. Stop the NSAIDs the day before Surgery .

7. A 12-year-old boy with a femur fracture after a motor vehicle collision undergoes operative repair. After induction of anesthesia, he develops a fever of 40°C (104°F) , shaking rigors, and blood-tinged urine. Which of the following is the best treatment option? A. Alkalinization of the urine, administration of mannitol, and continuation with the procedure B. Administration of dantrolene sodium and continuation with the procedure C. Administration of dantrolene sodium and termination of the procedure D. Administration of intravenous steroids and an antihistamine agent contin-uation of the procedure E. Administration of intravenous steroids and an antihistamine agent with termi-nation of the procedure

2 8. A 53-year-old man with no significant medical problems undergoes lysis of adhesions for a small-bowel obstruction. Postoperatively, he is placed on lactated Ringer solution for the first 24 hours. Which of the following is true regarding lactated Ringer? A. It contains a higher concentration of sodium ions than does plasma B. It is most appropriate for replacement of nasogastric tube losses C. It is isosmotic with plasma D. It has a pH of less than 7.0 E. It may induce a significant metabolic acidosis

9. A 74-year-old woman with a history of a previous total abdominal hys-terectomy presents with abdominal pain and distention for 3 days. She is noted on plain films to have dilated small-bowel obstruction. Which of the following inhalational anesthetics should be avoided because of accumulation in air-filled cavities during anesthesia ? A. Diethyle ether B. Nitrous oxide C. Halothane D. Methoxyflurane E. Trichloroethylene.

10. A 64-year-old man with history of emphysema is admitted for hematemesis . The bleeding ceases soon after admission, but the patient become confused and agitated. Arterial blood gases are as follows: pH 7.23;Po2 42 mm Hg; Pco2 75 mm Hg. Which of the following is the best initial therapy for this patient? A. Correct hypoxemia with high-flow nasal O2 B. Correct acidosis with sodium bicarbonate C. Administer 10 mg intravenous dexamethasone D. Administer 2 mg intravenous Ativan E. Intubate the patient

11. A 65-year-old man undergoes a left upper lobectomy . An epidural catheter is inserted for postoperative pain relief. Ninety minutes after the first dose of epidural morphine, the patient complains of itching and becomes increasingly somnolent . Blood-gas measurement reveals the following pH 7.24, Paco2 58, Pao2 100, and HCO3- 28. Which of the following is the most appropriate initial therapy for this patient? A. Endotracheal intubation B. Intramuscular diphenhydramine (Benadry1). C. Epidural naloxone D. Intravenous naloxone E. Alternative analgesia .

3 12. A 43-year-old trauma patient develops acute respiratory distress syndrome (ARDS) and has difficulty oxygenating despite increased concentrations of inspired O2. After positive end-expiratory pressure (PEEP) is increased, the patient’s oxygenation improves. What is the mechanism by which this occurs? A. Decreasing dead-space ventilation B. Decreasing the minute ventilation requirement C. Increasing tidal volume D. Increasing function residual capacity E. Redistribution of lung water from the interstitial to the alveolar space

13. A 22-year-old man sustains severe blunt trauma to the back. He notes that he cannot move his lower extremities. He is hypotensive and bradycardic. Which of the following is the best initial management of the patient? A. Administration of phenylephrine B. Administration of dopamine C. Administration of epinephrine D. Intravenous fluid bolus E. Placement of a trancutaneous pacer.

14. An elderly nursing home resident arrives at the emergency room mori-bund, with little helpful history. She is profoundly alkalotic by blood-gas measurement, and her urine shows an acid pH. Which of the following is the best possible explanation for these findings? A.Release of inappropriate antidiuretic hormone B.Severe crush injury C.Acute tubular necrosis D.Gastric outlet obstruction E.An eoinophilic pituitary adenoma

15. A patient has a clean incision and then closure of the incision to excise an unwanted benign nevus. With regard to the healing process, which of the following statements is correct? A. Collagen content reaches a maximum at approximately 1 week after injury B. Monocytes are essential for normal wound healing C. Fibroblasts appear in the wound within 24 to 36 hours after the injury D. The function of monocytes in wound healing is limited to phagocytosis of bacteria and debris E. Early in wound healing, type I collagen is predominant .

4 16. A 35-year-old man with new diagnosis of Crohn disease presents with rapidly enlarging painful ulcerations on the lower extremities. Cultures of the lesion are negative, and skin biopsy reveals no evidence of malignancy. Which of the following is the most appropriate treatment option ? A. Surgical debridement of the wound with skin grafting B. Local wound care with silver sulfadiazine C. Topical corticosteroids D. Systemic steroids and immunosuppressants E. Saphenous vein stripping and compressive stockings.

17. A 24-year-old firefighter sustains 30% total body surface area (TBSA) burns to his torso, face, and extremities. His wounds are treated topically with silver nitrate. Which of the following complications is associated with use of this agent? A. Hypernatremia B. Metabolic acidosis C. Hiperchloremia D. Neutropenia E. Hyponatremia

18. A 42-year-old woman has childhood history of a third-degree scald burn to her right lower extremity that did not require skin grafting. She states that she experienced trauma to the wound 1 year ago and since then she has had persistent nonhealing of the area. A biopsy of the wound is performed. Which of the following is the most likely diagnosis? A. Anioarcoma B. Malignant melanoma C. Squamous cell carcinoma D. Kaposi sarcoma E. Keloid

19. A 65-year-old man sustains a 50% TBSA burn while burning trash in the backyard. The patient is resuscitated with lactated Ringer (LR) solution using the Parkland formula a weight of 80Kg. What is the rate of LR given in the first 8 hours? A. 100 mL/h B. 500 mL/h C. 1000 mL/h D. 5000mL/h E. 10000mL/h

5 20. A teenage boy falls from his bicycle and is run over by a truck. On arrival in the emergency room (ER), he is awake and alert and appears frightened but in no distress. The chest radiograph suggests an air-fluid level in the left lower lung and the nasogastric tube seems to coil upward into the left chest. Which of the following is the next best step in his management ? A. Placement of a left chest tube B. Thoracotomy C. Laparotomy D. Esphagogastroscopy E. Diagnostic peritoneal lavage.

21. A 28-year-old man is brought to the ER for a severe head injury after a fall. He was intubated in the field for decreased level of consciousness. He is tachycardia and hypotensive. On examination, he is noted to have an obvious skull fracture and his right pupil is dilated. Which of the following is the most appropriate method for initially reducing his intracranial pressure? A. Elevation of the head of the bed B. Saline-furosemide (Lasix) infusion C. Mannitol infusion D. Intravenous dexamethasone (Decadron) E. Hyperventilaion

22. An 18-year-old high school football player is kicked in the left flank. Three hours later he develops hematuria. His vital signs are stable. A CT scan demonstrates a Grad II renal injury based on the Urologic Injury Scale of the American Association for the Surgery of Trauma. Which of the following the most appropriate treatment for this patient? A. Resumption of normal daily activity excluding sport B. Exploration and suture of the laceration C. Exploration and wedge resection of the kidney D. Nephrostomy E. Strict rest with serial hemoglobin levels .

23. A 19-year-old college student presents with a testicular mass, and after treatment he returns for regular follow-up visits. Which of the following is the most useful serum marker for detecting recurrent disease after treatment of nonseminomatous testicular cancer? A. Carinoembryonic antigen (CEA) B. Human chorionic gonadotropin (hCG) C. Prostate-specific antigen (PSA) D. CA125 E. P53 oncogene

6 24. A 50-year-old man is incidentally discovered to have non-Hodgkin lymphoma confined to the submucosa of the stomach during esophagogas-troduodenoscopy for dyspepsia. Which of the following statement is true regarding his condition? A.Surgery alone cannot be considered adequate treatment B.Combined chemotherapy and radiation therapy, without prior resection, are not effective. C.Combined chemotherapy and radiation therapy, without prior resection, result in a high risk severe hemorrhage and perforation. D.Outcome (freedom from progression and overall survival ) is related to the histologic grade of the tumor. E.The stomach is the most common site for non-Hodgkin lymphoma of the gastrointestinal tract.

25. A 33 –year-old woman seeks assistance because of a swelling of her right parotid gland. Biopsy is performed and reveals acinar carcinoma. In your discussion regarding surgery, which of the following statements regarding malignant parotid tumors is correct? A. Acinar carcinoma is a highly aggressive malignant tumor of the parotid gland B. Squamous carcinoma of the parotid gland exhibits only moderately malignant behavior C. Regional node dissection for occult metastases is not indicated malignant parotid tumors because to their low incidence and the morbidity of lymphadenectomy D. Facial nerve preservation should be attempted when the surgical margins of resection are free of tumor. E. Total parotidectomy (superficial and deep portions of the gland) is indicated for malignant tumors.

26. A 53-year-old man presents with constipation and a 10-kg weight loss over the course of 6 months. Colonoscopy reveals a fungating mass in the sigmoid colon; biopsy is consistent with adenocarcinoma. His metastatic workup is negative. A CEA level is obtained and is fourfold greater than normal. Which of the following is the appropriate use of this test? A. As an indication for neoadjuvant chemotherapy B. As an indication for postoperative radiation therapy C. As an indication for preoperative PET scanning D. As an indication for a more aggressive sigmoid resection E. As a baseline measurement prior to monitoring postoperatively for recurrence

7 27. recurrent laryngeal nerve is in close association with A. superior thyroid artery B. inferior thyroid artery C. meddle thyroid vein D. superior thyroid vein E. arteria thyroidea ima 28. thyrogossal cyst may occasionally give rise which carcinoma A. papillary B. medullary C. anaplastic D. follicular E. Hurthle cell 29. which of the following statements regarding unusual hernias is incorrect A. an obturator hernia may produce nerve compression diagnosed by a positive Howship- Romberg sign B. Grynfeltts hernia appears through the superior lumbar triangle, whereas Petits hernia occurs through the inferior triangle C. sciatic hernia usually present with a painful groin mass below the inguinal ligament D. Litters hernia is defined by a Meckels diverticulum presenting as the sole component of the hernial sac E. Richters hernia involves the antimezenteric surface of the intestine within the hernia sac and may present with partial intestinal obstruction

30- All of the following statements concerning the abdominal wall layers are correct except A. scarpas fascia affords little strength in wound closure B. the internal abdominal oblique muscles have fibers that continued into the scrotum as cremastric muscle C. the transversalis facsia is the most important layer of the abdominal wall in preventing hernias D. the lymphatics of the abdominal wall drains into the ipsilateral axillary lymph nodes above the umbilicus and into the ipsilateral superfiscial inguinal lymphnodes below the umbilicus E. the deep inferior epigastric arteries comes from the common femoral artery

31. A 77-year-old multiparous female presents with a bowel obstruction. She has no previous abdominal operations and no abdominal wall hernias can be detected. In addition to her abdominal symptoms, she reports pain in her right medial thigh. One of the following statements is true concerning her diagnosis and management. a. Expectant management with nasogastric suction and IV fluid replacement is indicated b. A right groin approach is indicated for exploration and repair of the presumed hernia c. The use of a polypropylene mesh will likely be necessary for repair d. A correct diagnosis can usually be made by visualizing an external mass in the upper, medial thigh e. Plain radiographs are helpful in diagnosis of most cases

8 32. Which of the following statements about surgical anatomy of the colon and rectum is correct? A. The cecum has the largest inner diameter of all segments of the colon (13 to 15 cm.). B. The rectosigmoid junction is situated at approximately 20 to 25 cm. from the anus. C. The rectum is entirely an intraperitoneal organ. D. The ileocolic, right colic, and middle colic arteries are branches from the inferior mesenteric artery. E. The arterial arcade created by communicating vessels at 1 to 2 cm. from the mesenteric is called the artery of Drummond.

33. Which of the following statements about familial adenomatous polyposis (FAP) is true? A. Inherited in an autosomal-dominant manner, this genetic defect is of variable penetrance, some patients having only a few polyps whereas others develop thousands. B. The phenotypic expression of the disease depends mostly on the genotype. C. Appropriate surgical therapy includes total abdominal colectomy with ileorectal anastomosis and ileoanal pull-through with rectal mucosectomy. D. Panproctocolectomy with ileostomy is not appropriate therapy for this disease. E. Pharmacologic management of this disease may be appropriate in some instances.

34. Which of the following statements about hemobilia are true? A. Tumors are the most common cause. B. The primary treatment of severe hemobilia is an operation. C. Percutaneous cholangiographic hemobilia is usually needs surgical intervention. D. Ultrasonography usually reveals a specific diagnosis. E. Arteriography remains the best diagnostic method.

35-Which of the following statements MOST accurately applies to the Zollinger- Ellison syndrome? A. 75% of patients will have multiple endocrine neoplasia type 1 B. Requires total gastrectomy C. Patients have an increase in gastrin with secretin stimulation D. Patients usually have a basal acid secretion of less than 15 mEq/hr E. Spontaneous resolution of the gastrinoma associated with the disease is common

36-Gastric polyps A. Are most commonly adenomatous B. Require gastrotomy and removal if greater than 2 cm and are pedunculated C. Are rarely multiple D. Are clearly premalignant E. Are more frequent in achlorhydric patients

9 37-All of the following statements are true about patients with carcinoid tumors EXCEPT A. They often have evidence of serotonin production B. Tumor growth is often slow C. The majority have carcinoid syndrome D. They have a much better prognosis if the tumors are less than 2cm E. The combination of streptozotocin and 5-fluorouracil can often in objective response

38-Carcinoma of the gallbladder is A. Associated with a good prognosis B. Most commonly metastatic to the lung C. Rarely associated with jaundice D. Usually not diagnosed preoperatively E. Best treated with radiation and chemotherapy

39-All of the following are true statements concerning Paget’s disease of the nipple EXCEPT A. It is very uncommon, accounting for only 2% of all breast cancers B. It is an in situ squamous cell malignancy of the nipple C. It is an eczematoid lesion D. It has a better prognosis than the majority of the breast cancers E. It can be confused with malignant melanoma histologically

40-A 46- year- old male presents with recurrent episodes of severe headaches and sweating. Physical examination reveals a blood pressure of 170/95, a pulse of 95, and a thyroid nodule. Which of the following laboratory results would you expect to be elevated? A. Thyroid-stimulating hormone B. Urinary 5-hydroxyindoleacetic acid C. Plasma serotonin D. Urinary catecholamines E. Serum thyroxine level

41-Atrophy in the thyroid epithelium in hashimoto’s disease results from A. Auto-immunity B. Pituitary malfunction C. Malnutrition D. Pressure caused by adjacent neoplasm E. Excessive TSH

42-After injury with loss of cells which of the following is (are) most likely to regenerate most completely A. Neurons of CNS B. Liver parenchymal cells C. Skeletal muscle D. Heart muscle E. Neurons of retina 43-Which of the following is not a neoplasm of mesenchymal origin? 10 A. Papilloma B. Hemangiona C. Lipoma D. Rhabdomyoma E. Leiomyome

44-Which of the following characteristic is not typical of sarcoma? A. Pleomorphism B. Blood vessel invasion C. Lymphatic invasion D. Mesodermal origin E. Metastases to distant sites

45-All of the following statement about small bowel neoplasms are true except A. They account less than 10% of all GI tumors B. Malignant tumor are more prevalent than benign tumor C. Adenomatous polyps are the most common type of benign tumor D. Large adenomas of small bowel often undergo malignant transformation E. Malignant lymphoma occurs more frequently than adenoearcinoma

46-A 63-year-old female has been vomiting for several hours. Her blood gases are PH 7.51 HCO3 32 mmoL/L AND pco2 40 mmHH. The most likely diagnose is A. Anion gap metabolic acidosis B. Nonunion gap metabolic acidosis C. Metabolic alkalosis D. Respiratory acidosis E. Respiratory alkalosis

47-The symptom complex of dermatitis, dementia, and diarrhea is strongly suugeestive of a deficiency of A. Nicotinamide B. Folic acid C. Vitamin C D. Riboflavin E. Non of the above

48-Which of the following cell types is most crucial in chronic rejection reaction? A. Lymphocytes B. Plasma cells C. Histiocytes D. Tissue eosinophils E. Segmented leukocytes

49-Primary causes of noninflammatory edema include all of the following EXCEPT: A. An increase in intravascular hydrostatic pressure 11 B. Increased vascular permeability C. Diminished plasma colloid osmotic pressure D. Lymphatic obstruction E. An impairment of renal function

50-A localized overgrowth of mature cells in a tissue resembling, or having some features, of a tumor most closely describes: A. Desmoplasia B. Metaplasia C. Choriostoma D. Hamartoma E. Anaplasia

51-Dysplasia is characterized by all of the following EXCEPT A. Disorderly proliferation of cells B. Pleomorphism C. Hyperchromaticity D. Most frequently occurs in epithelium E. Relentless progression to malignant neoplasm

52-All of the following are true of achalasia EXCEPT: A. It may be caused by trypanosome cruzi infection B. There is partial or incomplete relaxation of lower esophageal sphincter (LES) C. Dilatational tortuosity of the esophagus above the level of the sphincter is the rule D. Consistently shows the absence of myenteric ganglion cells in the lower sphincter E. The esophageal mucosa may show ulceroinflammatory and fibrotic lesions

53-The most vulnerable part of the colon to transmural infarction (gangrene) caused by thrombotic or embolic occlusion of the celiac-mesenteric axis is the: A. Splenic flexure B. Cecum C. Transverse colon D. Ascending colon E. Rectum

54-Which of the following is NOT true of the laceration in the Mallory-Weiss syndrome? A. Linear configuration B. Variable length- from a few millimeters to several centimeters C. Usually observed in the distal esophagus D. Aligned at right angle to the long axis of the esophagus E. May stretch across the esophagogastric junction 55-Which of the following statements concerning carcinoid tumor is NOT true? A.The neoplasm arise from basigranular Kulchitsky’s cells B.The neoplasm most frequently occurs in distal ileum and appendix 12 C.Episodic skin flushing, diarrhea, bronchospam, and hypotension are the symptoms of the carcinoid syndrome D.Involvement of the tricuspid valves is the usual cardiac lesion in cases where the heart is involoved E.The most common site of metastases is the lung

56-Splenomegaly associated with cirrhosis is A. Neoplastic B. Dysplastic C. Congestive D. Hamartomatous E. Inflammatory

57-The most helpful serological test in primary biliary cirrhosis is A. Antismooth muscle antibodies B. Antimitochondrial antibodies C. HBsAG D. Antinuclear ntibodies E. Non of the above

58-Pseudomyxoma peritonei may be expected to arise from which ovarian neoplasm? A. Mucinous cystadenocarcinoma B. Endometrial adenocarcinoma C. Serous cystadenocarcinoma D. Clear cell adenocarcinoma E. Undifferentiated carcinoma

59-Carcinoma of the thyroid is characterized by all of the following EXCEPT A. Nearly half of the thyroid nodules in children are malignant B. A history of previous irradiation in infancy can be elicited in about 25% of patients C. The incidence is higher in girls than boys D. The tumor may be multifocal E. A follicular pattern is the predominant type

60-All of these are true of pancreatic pseudocysts EXCEPT A. They may be found within the pancreatic tissue but more often are located adjacent to the pancreas B. Most are secondary to pancreatitis,pancreatic necrosis, or hemorrhage C. They usually are connected to the pancreatic duct system D. They are devoid of an epithelial lining E. They are usually unilocular 61-The current proposed pathogenesis of Graves’ disease implicates A. Dyshormogenesis B. Granulomatous inflammation C. Nonspecific chronic inflammation 13 D. Autoimmunity E. Excessive production of thyroid- stimulating hormone

62- Malignant melanoma occurring in which of the following parts of the gastrointestinal tract is most likely to be a primary neoplasm. A. Stomach B. Duodenum C. Jejunum D. Colon E. Anal canal

63-Truses and surgical belts are contraindicated for patient with . A. Inguinal hernia B. Femoral hernia C. Incisional hernia D. Umbilical hernia E. Epigastric hernia

64- Forniers gangrene is seen at the : A. dorsum of hand. B. scrotum. C. axilla. D. deep palmer space. E. omentum

65-In patients with neoplastic obstruction of the common bile duct: A. The gallbladder is never distended B. The gallbladder is rarely distended C. The gallbladder is frequently distended D. Tenderness is rarely present E. The prognosis is generally excellent

66-In severe hypospadias,the possibility of an intersex problem is settled by: A. Careful inspection of the genitals B. Biopsy of the gonadal tissue C. Karyotyping D. Hormone assay E. Laparotomy

67-The most frequent complication of amebiasis is : A. Lung abscess B. Liver abscess C. Convulsions and coma

14 D. Hemolytic anemia and bone marrow suppression E. Retinal detachment

68- Each of the following is a well-recognized complication of ulcerative colitis, except: A. diabetes B. fatty infiltration of the liver C. Arthritis D. Pyoderma gangrenosum E. Erythema nodosum

69-The most common liver tumor is: A. hepatocellular carcinoma B. hepatoblastoma C. cholangiocarcinoma D. metastatic disease E. angiosarcoma

70--The first step in management of sigmoid volvulus should be A. administration of laxatives and cleansing enemas B. barium enema C. rigid sigmoidoscopy D. sigmoid resection E. transverse colostomy

71- after direct blow to scroto perineal area your patient is unable to void urine, having blood drop at the meatus , your management may include all exept : A. suprapubic catheter. B. urethrogram. C. F. catheter. D. admission to hospital. E. PR examination

72. in carpel tunnel syndrome the nerve compressed is A. ulnar B. radial C. musculo-cutaneous D. median E. posterior interosseious 73. Bloody nipple discharge may be caused by the following except: A. duct papilloma B. fibroadenoma of the breast C. carcinoma of the breast D. duct ectasia E. trauma of the breast with bleeding disorder

15 74-A 74-year – old woman complains of vomiting and intermittent colicky abdominal pain. X-ray revealed fluid levels and air in the biliary tree. What is the likely cause? A. Abdominal adhesions. B. Gallstone ileus . C. Carcinoma of the right colon. D. Adbominal lymphosarcoma . E. Previous choledochoduodenstomy.

75. A 25-year-old man presents to the emergency room having swallowed two open safety pins 6 h ago. X-rays show the pins to be located in the small intestine. The most appropriate management at this point would be A.administration of a broad-spectrum antibiotic intravenously B.a 10-day course of oral metronidazole C.administration of 250 mL of magnesium citrate to induce catharsis and increase the rapidity of passage D.follow-up with serial x-rays and abdominal examinations E.immediate surgery

76-The commonest benign tumor of parotid gland is: A. oxyphil adenoma B. warthin`s tumor C. mixed tumor D. lymphangioma E. haemangioma

77-. Which is incorrect regarding acute abdomen: A. the absence of the air on an erect chest XR excludes perforated duodual ulcer. B. can be caused by mesenteric lymphadenitis C. herpis zoster can give a picture of acute abdomen D. Henoch-Schonlein purpura may present by acute abdominal pain E. three fold increase of serum amylase is diagnostic of pancreatitis

78-which one of the following clinical signs or symptoms is not associated with serum sodium concentrations below 125 mEq/L? A. Headache B. Hallucinations C. Bradycardia D. Hypoventilation E. Hyperthermia

16 79-Regarding peritonitis which of the following statements is not true? A. Primary peritonitis is commoner in children with nephrosis and adults with cirrhosis than in patients without such conditions B.Primary peritonitis is usually monomicrobial C.Chemical peritonitis often precedes bacterial contamination D.Multiple organisms are commonly cultured from peritoneal dialysis catheters E.Tuberculosis peritonitis has an insidious onset

80-Effective management of gastric acid aspiration include which of the following? A. Tracheal intubation and saline lavage of the lungs B. Prophylactic antibiotic therapy C. prophylactic steroid therapy D. Tracheal intubation, suctioning, and controlled ventilation with positive end- expiratory pressure(PEEP) therapy E. Diuresis

81-which of the following is an indication for resection of a segment of small bowel ? A. loss of more than 20% of the bowel wall B. two injuries in a segment C. compromise of the blood supply of a segment D. injuries within 40cm of the ileocecal valve E. injuries within 40cm of the ligament of Treitz

82-In liver trauma A. Nonoperative treatment is considered the treatment of choice for stable patients with isolated hepatic trauma B. Temporary compression of the hepatoduodenal ligament may be performed for up to 90 min without causing ischemic damage C. Contained subcapsular hematomas discovered in the operating room should always be explored D. For deep lacerations that are actively bleeding the finger fracture technique is rarely successful E. Liberal use of intraoperative packing, rapid abdominal closure and secondary resuscitation in the intensive care unit has led to increased mortality rates in patients with grade IV and V hepatic injuries

83- A33-year old woman involved in a house fire sustain burns to bilateral lower extremities, anterior torso ,genital area and entire left arm .approximately what percentage of the total body surface area is burned ? A. 45% B. 64% C. 36% D. 72% E. 54%

17 84- All of the following are adverse events associated with use of quinolones except A. Tendonitis and possible tendon rupture B. Seizures C. Arthropathy in children D. C.difficile colitis E. Narrowing of the QT interval

85-During an emergency appendectomy, a surgical resident sustained an injury from a contaminated hollow-bore needle with spontaneous bleeding. Which of the following blood-borne organisms is most likely to be transmitted, assuming the patient was infected with all of them? A. HIV B. Hepatitis B C. Hepatitis C D. Malaria E. E.Syphilis

86- which of the following insufflation gases for laparoscopic pneumoperitoneum has the greatest solubility in water? A. Carbon dioxide B. Nitrous oxide C. Helium D. Argon E. Air

87- which of the following body compartments is the largest reservoir for CO2? A. Bone B. Skeletal muscle C. Lungs D. Peritoneum E. Bowel

88-Regarding metastatic cancer, which of the following statements is true? A. Axillary lymph node dissection is essential for staging a sarcoma of the breast B. Melanoma tends to metastasize first to the lung, brain and gas trointestinal tract C. Bone is frequently the site of metastasis for cancer of the breast and prostate D. Primary brain cancers have a predilection for metastasis to the lung E. None of the above 89-with regard to keloids and hypertrophic scars, which of the following statements is true? A.There are no histologic differences between the two

18 B.The differences between hypertrophic scar and keloid are clinical, not pathologic C. Hypertrophic scars does not outgrow their original borders D. Hypertrophic scars and keloids have been treated successfully with intralesional injection of steroids E.keloids are seen in dark skinned individuals, whereas hypertrophic 90-with regard to cystosarcoma phylloides, which of the following statements is not true? A. It bears a histologic relationship to fibroadenoma B. Ten percent are malignant C. As with ductal carcinoma, it has a high incidence of multicentricity within the breast D. Axillary lymph nodal metastases are uncommon E. Wide local excisions or total (simple) mastectomy usually suffices for treatment 91-regarding acute supurative parotitis, which one of the following statements is not true? A. It usually occurs in elderly or debilitated patients B. Dehydration is a major contributing factor C. Immediate surgical drainage is mandatory D. The numerous vertically oriented fascial septa of the parotid space lead to multilocalated abscesses when infection E. S. aureas is the most frequent causative organism

92-in regard to follicular thyroid cancer, which of the following is true? A. It occurs predominantly in females, and estrogens have been recently found to be a risk factor B. The major histologic criterion for diagnoses is unequivocal capsular and vascular invasion C. Both minimally invasive and widely invasive follicular Cancers are likely to have regional lymph node involvement on presentation D. Cytologically, it can be easily differentiated from a benign adenoma E. None of the above 93-A patient with previous diagnoses of primary hyperparathyroidism presents with rapidly developing muscular weakness, nausea, vomiting, and confusion. Which of the following initial step of management? A. Vigorous hydration with intravenous saline solution B. Intravenous furosemide C. Intravenous mithramycin D. Intravenous calcitonim E. Immediate parathyroid exploration 94-which of the following studies are useful for the diagnosis of a pheochromocytoma? A. Clonidine suppression test B. 24-hr urine metanephrine levels C. 24-hr urine vanillylmandelic acid levels D. plasma catecholamine levels E. none of the above

95-During an operation for presumed appendicitis, the appendix is found to be normal. The terminal ileum, however, is markedly thickened and feels rubbery to

19 firm. It's serosa is erythematous and inflamed, and several loops of apparently normal small intestine are adherent to it. The terminal ileum mesentery thickened, with fat growing about the bowel circumference. Which of the following is the most likely diagnoses? A. Crohn's disease of the terminal ileum B. Perforated meckel's diverticulum C. Ulcerative colitis D. Ileusecal tuberculosis E. Acute ileitis

96-A 26-year-old man presents to the emergency room with the complaint of recurrent, colicky, midabdominal pain. Physical examinations reveals a palpable abdominal mass and several areas of increasing pigmentation on his lips, palms, and soles. He states that his father had a colon polyp removed several years ago. Which of the following is the most likely diagnoses? A. Familial polyposis with malignant degeneration B. Gardner syndrome with intussusception C. Peutz-jeghers (PJS) syndrome with intussusception D. Symptomatic Crohn's disease E. Mesentric lymphadeitis

97-with regards to Meckel's diverticula, which of the following statements is true? A.They are found in various anatomic forms and clinical presentations in 50% of the population B.They are true diverticula C. Some can be visualized on technetium 99m pertechnetate (99mTc)scans D.most complications occur in the elderly E.diverticulitis is the most common complication

98-which of the following statements regarding the pathogenesis of appendicitis is false? A. Luminal obstruction is always the cause of acute appendicitis B. Luminal obstruction leads to increased pressure and distention of the appendix C. Obstruction of venous outflow and then arterial inflow results in gangrene D. Obstruction of the lumen may occur from lymphoid hyperplasia, inspissated stool, or a foreign body E. Viral or bacterial infections can precede an episode of appendicitis

99-which of the following proteins is not primarily synthesized in the liver? A. Albumin 20 B. Fibrinogen C. Von wilebrand factor D. Transferring E. Factor VII

100-Laparoscopic cholecystectomy is most strongly contraindicated in? A. pregnancy B. prior upper abdominal surgery C. known common bile duct stones D. chronic obstructive pulmonary disease E. gallbladder cancer

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