MCQ General Surgery (M.B.B.Ch.

MCQ
Systemic Response to Injury and
Metabolic Support

1. C-reactive protein:
A) Is secreted in a circadian rhythm with higher levels in
the morning
B) Increases after eating a large meal
C) Does not increase in response to stress in patients with
liver failure
D) Is less sensitive than erythrocyte sedimentation rate as
a marker of inflammation
Answer C: Clinically, only C-reactive protein (CRP) has
been consistently used as a marker of injury response due
to its dynamic reflection of inflammation. Importantly,
CRP levels do not show diurnal variations and are not
affected by feeding. Only preexisting liver failure will
impair CRP production.

2. Healthy patients undergoing uncomplicated surgery can

remain m.p.o. (with intravenous fluid support) for how
many days before significant protein catabolism occurs?
A) 2 days
B) 4 days
C) 7 days
D) 10 days
Answer D: Healthy patients without malnutrition undergoing
uncomplicated surgery can tolerate 10 days of partial
starvation (i.e, maintenance intravenous fluids only) before
any significant protein catabolism occurs.

3. Enteral nutrition:
A) Results in a reduction of infections complications I critically ill
patients

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B) Is more expensive than parenteral nutrition

C) Results in faster return of bowel function in healthy patients
after gastrointestinal surgery
D) Has a higher complication rate than parenteral nutrition
Answer A: Most prospectively randomized studies for severe
abdominal and thoracic trauma demonstrate significant
reductions in infectious complications for patients given early
enteral nutrition when compared with those are unfed or
receiving parenteral nutrition.

4. Which of the following are the most potent mediators of the

inflammatory response?
A) Corticosteroids
B) Heat shock proteins
C) Cytokines
D) Eicosanoids
Answer C: Cytokines appear to be the most potent mediators
of the inflammatory response.

5. All of the following statements about thyroid hormone function

during acute injury are true EXCEPT:
A) Free triiodothyronine (T3) levels are frequently decreased
B) Reduced free thyroxine (T4) concentrations are predictors of
high mortality
C) Thyroid-stimulating hormone (TSH) release undergoes a
compensatory rise as T3 levels drop
D) Total T4 (protein bound and free) levels may be reduced
Answer C: TSH release is not increased when T3 levels drop
in trauma patients. Free T4 remains relatively constant,
although total T4 levels may be reduced. A reduced free T4
level in a severely injured patient is predictive of high
mortality.

6. The most frequent trace mineral deficiency developing in a

patient receiving parenteral alimentation is a deficiency of:

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A) Calcium
B) Chromium
C) Magnesium
D) Zinc
Answer D: Zinc deficiency is marked by an eczematoid rash
either diffusely or in intertriginous areas. Daily administration
of trace metal supplements obviates these problems.

7. A primary action of aldosterone is to:

A) Convert angiotenogen to angiotensin
B) Decrease chloride reabsorption in the renal tubule
C) Decrease potassium secretion in the renal tubule
D) Increase sodium reabsorption in the renal tubule
E) Increase renin release by the juxtaglomerular apparatus
Answer D: Aldosterone, produced by the adrenal zona
glomerulosa, acts to preserve hemostasis by maintaining
serum sodium and chloride levels and by promoting secretion
of excess potassium.

Fluid and Electrolyte Management

of the Surgical Patient

8. Metabolic acidosis with a normal anion gap (AG) occurs with:

A) Diabetic acidosis
B) Renal failure
C) Severe diarrhea
D) Starvation
Answer C: Metabolic acidois with a normal anion gap results
from either acid administration (HCI or NH4) or a loss of
bicarbonate from gastrointestinal sources such as diarrhea,
fistulas (enteric, pancreatic, or biliary).

9. Which of the following is an early sign of hyperkalemia?:

A) Peaked T waves
B) Peaked P waves

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C) Peaked (shortened) QRS complex

D) Peaked U waves
Answer A: Hsymptoms of hyperkalemia are primarily
gastrointestinal, while cardiovascular manifestations range
from electrocardiogram (ECG) changes to cardiac arrhythmias
and arrest. ECG changes that may be seen with hyperkalemia
include.

10.Norma saline is:

A) 135 mEq NaCl/L
B) 145 mEq NaCl/L
C) 148 mEq NaCl/L
D) 154 mEq NaCl/L
Answer D: Sodium chloride is mildly hypertonic, containing
154 mEq of sodium that is balanced by 154 mEq of chloride.
The high chloride concentration imposes a significant chloride
load upon the kidneys and may lead to a hyperchloremic
metabolic acidosis.

11.Water constitutes what percentage of total body weight?

A) 30 – 40%
B) 40 – 50%
C) 50 – 60%
D) 60 – 70%
Answer C: Water constitutes approximately 50% to 60% of
total body weight. The relationship between total body
weight and total body water (TBW) is relatively constant for
an individual and is primarily a reflection of body fat.

12.A patient who has spasms in the hand when a blood pressure
cuff is blown up most likely has:
A) Hypercalcemia
B) Hypocalcemia
C) Hypermagnesemia
D) Hypomagnesemia

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Answer B: Asymptomatic hypocalcemia may occur with

hypoproteinemia (normal ionized calcium), but symptoms can
develop with alkalosis (decreased ionized calcium). Patients
will demonstrate hyperreflexia and positive Chvostek’s sign
(spasm resulting from tapping over the facial nerve) and
Trousseau’s sign (spasm resulting from pressure applied to the
nerves and vessels of the upper extremity, as when obtaining a
blood pressure.

13.The effective osmotic pressure between the plasma and

interstitial fluid compartments is primarily controlled by:
A) Bicarbonate
B) Chloride ion
C) Potassium ion
D) Protein
Answer D: The dissolved protein in plasma does not pass
through the semipermeable cell membrane and this fact is
responsible for the effective or colloid osmotic pressure.

14.The most common fluid disorder in the surgical patient is:

A) Extracellular fluid deficit
B) Hyperkalemia
C) Hyponatremia
D) Metabolic acidosis
E) Metabolic alkalosis
Answer A: The most common causes of extracellular fluid
deficit in the surgical patient are gastrointestinal fluid losses
from vomiting, nasogastric suction, diarrhea and fistular
drainage.

15.The osmolarity of the extracellular fluid space is determined

primary by the concentration of:
A) Bicarbonate
B) Chloride ion
C) Phosphate radicals

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D) Sodium ion
Answer D: Sodium is the prominent extracellular anion and
determination of serum sodium concentrations generally
indicates the tonicity of body fluids.

16.When lactic acid is produced in response to injury, the body

minimizes pH change by:
A) Decreasing production of sodium bicarbonate in tissues
B) Excreting carbon dioxide through the lungs
C) Excreting lactic acid through the kidneys
D) Metabolizing the lactic acid in the liver
Answer B: Lactic acid reacts with base bicarbonate to
produce carbonic acid. The carbonic acid is broken down into
water and carbon dioxide that is excreted by the lungs. Any
diminution in pulmonary function jeopardizes this reaction.

17.The simplest effective method of estimating the degree of

acidosis in a patient in shock is the measurement of:
A) Arterial pH
B) End tidal CO2 concention
C) pH of Mixed venous blood
D) Serum CO2 level
Answer A: Only the measurement of arterial pH and PCO2
gives an accurate picture of the degree of acid-base
imbalances.

18.A decrease in intracellular water can be precipitated by:

A) A decrease in sodium in extracellular fluid
B) An increase in sodium in extracellular fluid
C) An increase in sodium in intracellular fluid
D) An isotonic decrease in extracellular fluid
Answer B: The cell membrane is semipermeable. Potassium
concentration is higher within cells than in the extracellular
fluid and sodium concentration is higher in the extracellular
space. When sodium rises in the extracellular fluid, water

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moves out of the cells to maintain osmotic equilibrium.

Hemostasis, Surgical Bleeding

and Transfusion

19.Which of the following in NOT one of the four major

physiologic events of hemostasis?
A) Fibrinolysis
B) Vasodilatation
C) Platelet plug formation
D) Fibrin production
Answer B: Four major physiologic events participate, both in
sequence and interdependently, in the hemostatic process.
Vascular constriction, platelet plug formation, fibrin formation
and fibrinolysis occur in that general order.

20.The half-life of platelets is:

A) 2 – 3 days
B) 7 – 10 days
C) 14 – 21 days
D) 30 – 40 days
Answer B

21.Which congenital factor deficiency is associated with delayed

bleeding after initial hemostasis?
A) Factor VII
B) Factor IX
C) Factor XI
D) Factor XIII
Answer D: Congenital factor XIII deficiency also is rare. It is
inherited as an autosomal recessive trait. Bleeding is typically
delayed because clots form normally but are susceptible to
fibrinolysis.

22.A fully heparinized patient develops a condition requiring

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emergency surgery. After stopping the heparin, what else

should be done to prepare the patient?
A) Nothing, if the surgery van be delayed for 2-3 hours
B) Immediate administration of protamine 5 mg for every 100
units of heparin most recently administered
C) Immediate fresh frozen plasma
D) Transfusion of 10 units of platelets
Answer A: Emergency operations are occasionally necessary
in patients who have been heparizined as treatment for deep
venous thrombosis. The first step in managing these patients
is discontinuation of heparin; this may be sufficient if the
operation can be delayed for several hours. For more rapid
reversal, 1 mg of protamine sulfate for every 100 units of
heparin most recently administered is immediately effective.

23.Bank blood is appropriate for replacing each of the following

EXCEPT:
A) Factor I (fibrinogen)
B) Factor II (prothrombin)
C) Factor VII (proconvertin)
D) Factor VIII (antihemophilic factor)
Answer D: Factor VIII is labile and 60-80% of activity is
gone 1 week after collection.

24.Which of the following clotting factors is consumed during

coagulation?
A) Factor I (fibrinogen)
B) Factor IX (Christmas factor)
C) Factor X (Stuart-Prower factor)
D) Factor XI (plasma thromboplasma antecedent)
Answer A: Factor I, factor II (prothrombin), factor V
(proaccelerin) factor VIII (antihemophilic factor) and platelets
are consumed during coagulation and must be replaced by the
body.

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25.Exsanguinating hemorrhage is most likely to follow which of

the following injuries in a previously healthy young adult?
A) Closed fracture of the femur
B) Open fracture of the tibia and fibula
C) Partial transection of the artery from a sharp injury
D) Severe crush injury of the foot
Answer C: One artery is partially transected, complete
constriction of the injured arterial ends is not possible and
spontaneous cessation of bleeding does not occur.

26.Frozen plasma prepared from freshly donated blood is

necessary when a patient requires:
A) Fibrinogen
B) Prothrombin
C) Antihemophilic factor
D) Christmas factor
E) Hageman factor
Answer C: Frozen plasma is required for the transfusion of
antihemophilic factor (factor VIII) or proaccelerin (factor V).

27.The most common cause for a transfusion reaction is:

A) Air embolism
B) Contaminated blood
C) Human error
D) Unusual circulating antibodies
Answer C: Although contaminated or outdated blood may
cause a reaction, the most common cause is human-blood
drawn for typing from the wrong patient, blood incorrectly
crossmatched in the laboratory, blood units mislabeled in the
laboratory.

28.Each of the following is a symptom of a hemolytic transfusion

reaction EXCEPT:
A) Constricting chest pain
B) Flushing of the face

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C) Lumbar pain
D) Syncope
Answer D: Syncope is not associated with a hemolytic
transfusion reaction, whereas the other listed symptoms are
common occurrences.

29.The most common clinical manifestation of a hemolytic

transfusion reaction is:
A) Flank pain
B) Jaundice
C) Oliguria
D) A shaking chill
Answer C: All of the manifestations listed can occur with a
hemolytic transfusion reaction. In a large series, oliguria
(58%) and hemoglobinuria (56%) were the most common
findings.

30.The most common fatal infection complication of a blood

transfusion is:
A) Acquired immunodeficiency syndrome
B) Cytomegalovirus
C) Malaria
D) Viral hepatitis
Answer D: Any of the listed diseases can be transmitted by
contaminated blood, but posttransfusion viral hepatitis is the
most common fatal problem.

31.In the awake, nonanesthetized patient suspected of having a

hemolytic posttransfusion reaction, the most characteristic
signs are:
A) Nausea and vomiting
B) Fever and chills
C) Oliguria and hemoglobinuria
D) Cyanosis and dyspnea
Answer C: Although all the signs listed in the question can be

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seen in hemolytic transfusion reactions, oliguria and

hemoglobinuria are the most common.

32.After tissue injury, the first step in coagulation is:

A) Binding of factor XII to subendothelial collagen
B) Cleavage of factor XI to active factor IX
C) Complexing of factor IX with factor VIII in the presence of
ionized calcium conversion of prothrombin to thrombin
D) Formation of fibrin from fibrinogen
Answer A: All the listed steps are part of the cascade
involved in establishing a firm clot. The process begins with
binding of Hageman factor (factor XII) to subendothelial
collagen and ends with the conversion of fibrinogen to tibrin.

33.Which of the following is NOT in the intrinsic pathway of

coagulation?
A) II
B) XII
C) XI
D) IX
Answer A: The intrinsic pathway begins with factor XII and
through a cascade of enzymatic reactions, activates factors XI,
IX and VII in sequence. This pathway is referred to as
“intrinsic” because all of the components leading ultimately to
fibrin clot formation are intrinsic to the circulating plasma and
no surface is required to initiate the process.

Shock

34.In the presence of acute blood loss, adequate preload to the

heart is maintained initially by the:
A) Development of tachycardia
B) Hormonal effects of angiotensin
C) Hormonal effects of renin
D) Increase in systemic vascular resistance

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Answer D: Increase in venous time and in systemic vascular

resistance augments preload in an effort to maintain cardiac
output.

35.Neurogenic shock is characterized by the presence of:

A) Cool moist skin
B) Increased cardiac output
C) Decreased peripheral vascular resistance
D) Decreased blood volume
Answer C: Neurogenic shock is caused by loss of arteriolar
and venular tone in response to paralysis (such as occurs with
high spinal anesthesia, acute gastric dilatation, or sudden pain
or unpleasant sights: as such, it is characterized by a decrease
in peripheral vascular resistance.

36.Which of the following is a cause of vasodilatory shock?

A) Aspirin poisoning
B) Carbon monoxide poisoning
C) Snake bite
D) Severe muscle injury with rhabdomyolysis
Answer B: Vasodilatory shock is characterized by both
peripheral vasodilatation with resultant hypotension and
resistance to treatment with vasopressors. Despite the
bypotension, plasma calecholamine levels are elevated and the
renin-angiotensin system is activated in vasodilatory shock.
The most frequently encountered form of vasodilatory shock
is septic shock. Other causes of vasodilatory shock include
hypoxic lactic acidosis, carbon monoxide poisoning,
decompensated and irreversible hemorrhagic shock, terminal
cardiogenic shock and postcardiotomy shock.

37.Which of the following (if present) is a distinguishing feature of

nurogenic shock?
A) Hypotension
B) Bradycardia

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C) Vasodilation
D) Vasoconstriction
Answer B: Acute spinal cord injury may result in
bradycardia, hypotension, cardiac dysthythmias, reduced
cardiac output and decreased periperal vascular resistance.

38.Dobutamine:
A) Increases cardiac output and causes peripheral vasodilation
B) Decreases cardiac output and causes peripheral vasodilation
C) Increases cardiac output and causes peripheral vasoconstriction
D) Decreases cardiac output and causes peripheral
vasoconstriction
Answer A: Dobutamine primarily stimulates cardiac 1
receptors to increase cardiac output, but may also vasodilate
peripheral vascular beds, lower total peripheral resistance and
lower systemic blood pressure through effects on 2 receptors.
Ensuring adequate preload and intravascular volume is
therefore essential prior to instituting therapy with
dobutamine.

Surgical Infections

39.Patients with a penicillin allergy are LEAST likely to have a

cross-reaction with:
A) Synthetic penicillins
B) Carbapenems
C) Cephalosporins
D) Monobactams
Answer D: Although avoiding the use of any beta-lactam
drug is appropriate in patients who manifest significant
allergic reactions to penicillins, the incidence of
crossreactivity appears highest for crbapenems, much lower
for cephalosporins (-5 to 7%) and extremely small or
nonexistent for monobactams.

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40.A patient with a localized wound infection after surgery should

be treated with:
A) Antibiotics and warm soaks to the wound
B) Antibiotics alone
C) Antibiotics and opening the wound
D) Incision and drainage alone
Answer D: Effective therapy for incisional (surgical site
infections) SSIs consists solely of incision and drainage
without the addition of antibiotics. Antibiotic therapy is
reserved for patients in whom evidence of severe cellulitis is
present, or who manifest concurrent sepsis syndrome.

41.The most appropriate treatment of a 4-cm hepatic abscess is:

A) Antibiotic therapy alone
B) Aspiration for culture and antibiotic therapy
C) Percutaneous drainage and antibiotic therapy
D) Operative exploration, open drainage of the abscess and
antibiotic therapy
Answer C: Small (<1 cm), multiple abscesses should be
sampled and treated with a 4- to 6-week course of antibiotics.
Large abscesses invariably are amenable to percutaneous
drainage, with parameters for antibiotic therapy and drain
removal similar to those mentioned above.

42.The classic chest X-ray finding in anthrax is:

A) Bilateral apical penumothorax
B) Basilar pneumonia
C) Widened mediastinum and effusions
D) Pulmonary edema
Answer C: Anthrax is zoonotic disease occurring in
domesticated and wild herbivores. Characteristic chest
roentgeonographic findings include a widened mediasfinum
and pleural effusions. A key aspect in establishing the
diagnosis is eliciting an exposure history.

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43.The best antibiotic for post-exposure prophylaxis to Bacillus

anthracis (anthrax) is:
A) Rifampin
B) Clindamycin
C) Doxycycline
D) Amoxicillin
Answer B: Treatment options include combination therapy
with ciprofloxacin, clindamycin and rifampin, with
clindamycin added to block production of toxin and rifampin
for its ability to penetrate the central nervous system and
intracellular locations.

44.Infections that require operative treatment include all of the

following EXCEPT:
A) Empyema
B) Infected ascites
C) Nocrotizing fasciitis of the thigh
D) Vascular graft infection
Answer B: Ascites is a diffuse process and is not amenable to
surgical drainage.

45.The intense pain associated with a felon occurs because of:

A) Bone involvement
B) A closed space infection
C) Digital artery thrombosis
D) Nail bed involvement
Answer B: A felon is an infection of the distal pulp space of a
digit, usually secondary to a puncture wound. This is a closed
space at the level of the distal interphalangeal joint. Because
the infection cannot spread proximal to this point, pain is
throbbing and intense.

46.Which of the following is the most commonly acquired

infection in hospitalized surgical patients?
A) Lower gastrointestinal tract

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B) Lower respiratory tract

C) Nasopharyns
D) Surgical wound
Answer D: Infection may occur at any site when a patient’s
immunity is low due to an operation. The surgical wound is
the most frequent site of infection for surgical patients,
according to a report from the Centers for Disease Control and
Prevention.

47.Which of the following is the most effective way to prevent

post-operative seroma/infection in an obese patient after an
open apendectomy?
A) Leaving the subcutaneous tissue and skin open to heal by
secondary intention
B) Closing the wound a rubber drain
C) Closing the wound with a closed suction drain
D) Closing the wound with multiple sutures in the subcutaneous
tissue
Answer C: With a clean-contaminated wound after an
appendectomy, it should not be necessary to leave the wound
open. In an obese patient, seroma in the wound is a
possibility and primary wound closure might not be
appropriate. The best option is to close the wound carefully
over a closed-suction drain. Whatever method is used, all
devitalized tissue should be removed and careful hemostasis
accomplished before the procedure is completed.

48.Staphylococcus aureus produces each of the following

EXCEPT:
A) cell wall peptidoglycam
B) Enterotoxin
C) Epidermolytic toxia
D) Neuroexotoxin
Answer D: Neuroexotoxin is produced by Clostridium tetani
and is responsible for the symptoms of tetanus.

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Staphylococcal cell wall peptidoglycan inhibits edema

production and migration of leukocytes in tissue.

49.An exotoxin plays in important part in the pathogenicity of

infection with each of the following EXCEPT:
A) Clostridium botulinum
B) Clostridium tetani
C) Escherichia coli
D) Staphylococcus aureus
Answer C: Escherichia coli and other gram-negative bacteria
produce endotoxins that are lipopolysaccharide-protein
complexes of the cell wall.

50.A 30-years-old, otherwise healthy woman undergoes an open

appendectomy with primary closure of the wound for a
perforated appendix. No antibiotics are administered.
Should this patient develop an intraabdominal abscess,
which of the following organisms would most likely the
responsible?
A) Escherchia coli
B) Bacteroides
C) Streptococcus faecalis
D) Serratia
Answer B: A number of organism can cause abscesses after
appendectomy, but Bacteroides, either alone or in
combination with other organisms, is most commonly
responsible. Anaerobes are associated with 90% of cases of
intraabdominal abscess and 95% of cases of appendiceal
abscess.

51.The drug of choice for clostridial myonecrosis is:

A) Penicillin G
B) Ampicillin
C) Amikacin
D) Cephalosporin

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Answer A: Antibiotic therapy with penicillin G or

tetracycline is effective as an adjunct to multiple longitudinal
incision for decompression and drainage and aggressive
debridement.

52.An infection with Staphycoccus aureus acquired in an intensive

care unit should be treated initially with:
A) Aztreonam
B) Erythromycin
C) Methicillin
D) Vancomycin
Answer D: Most nosocomial staphylococcal infections are
resistant to erythromycin, methicillin and penicillin G.
Aztreonam is useful against gram-negative, not gram-positive,
organisms.

Trauma

53.Which of the following would lead you to an arteriogram

and/or exploration of a possible femoral artery injury from
a gunshot wound?
A) Proximity of the probable bullet path to the neurovascular
bundle
B) A small hematoma at the entrance site
C) Systolic blood pressure 5% different in the two legs
D) A bruit over the injury
Answer A: Physical findings are classified as either hard
signs or soft signs. In general, hard signs constitute indications
for operative exploration, whereas soft signs are indications
for observation or further testing. Arteriogrphy may be
helpful to localize the injury in some patients with penetrating
injuries and hard signs.

54.What percentage of blood volume must be lost in healthy

patients before hypotension occurs?

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A) 10 – 30%
B) 20 – 30%
C) 30 – 40%
D) 40 – 50%
Answer C: Hypotension is not a reliable early sign of
hypovolemia. In healthy patients blood volume must decrease
by 30 to 40% before hypotension occurs.

55.A patient with spontaneous eye opening, who is confused and

localizes pain has a Glasgow Coma Score of:
A) 9
B) 11
C) 13
D) 15
Answer C: The Glasgow Coma Score (GCS) should be
determined for all injured patients. It is calculated by adding
the scores of the best motor response best verbal response and
eye opening. Scores range from 3 (the lowest) to 15 (normal).
Scores of 13 to 15 indicate mild head injury. 9 to 12 moderate
injury and less than 9 severe injury. The GCS is useful for
both triage and prognosis.

56.A patient with penetrating injury to the should undergo

thoracotomy if:
A) There is more than 1000 mL of blood which drains from the
chest tube placed
B) There is more than 200 mL/hour for 3 h from the chest tube
C) There is an air leak that persists >48h
D) There is documented lung injury on computed to-mography
scan
Answer B: Indications for operating treatment of penetrating
thoracic injuries. Continuous hemorrhage of more than 200
mL/h for >3 consecutive hours.

57.A 20-year-old man has an injury to the posterior urethra.

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After appropriate initial management and follow-up care of

this injury, themost likely late complication is:
A) Ascending urinary tract infection
B) Retrograde ejaculation
C) Sterility
D) Urethral stricture
Answer D: Initial management involves passage of catheters
through the urethral meatus and through an incision in the
bladder. After this has been accomplished, a Foley catheter is
threaded through the urethra into the bladder and left in situ.
Urethral healing occurs as the hematoma resolves, but a
posterior urethral stricture is not uncommon.

58.Significant vascular injury is likely to occur with all of the

following fractures or dislocations EXCEPT:
A) Fracture of the midshaft of the humerus
B) Supracondylar fracture of the humerus
C) Fracture of the femoral shaft
D) Supracondylar fracture of the femur
Answer A: Although fractures of the humeral shaft are
frequently associated with radial nerve injury, damage to the
accompanying deep brachial artery is not usually a problem
because of the rich collateral circulation around the elbow.

Burns

59.What percentage burn does a patient have who has suffered

burns to one leg (circumferenial), one arm (circumferential)
and the anterior trunk?
A) 18%
B) 27%
C) 35%
D) 45%
Answer D: A general idea of the burn size can be made by
using the rule of nines. Each extremity accounts for 9% of the

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total body surface area (TBSA), each lower extremity

accounts for 18%, the anterior and posterior trunk each
account for 18%, the head and neck account for 9% and the
perineum accounts for 1%.

60.The appropriate management of a deep partial-thickness burn

is:
A) Early excision and grafting
B) Surgical debridement and dressings
C) Dressings only
D) Observation
Answer A: For deeper burns (i.e., deep partial-thickness and
full-thickness burns), rather than waiting for spontaneous
separation, the eschar is surgically removed and the wound
closed via grafting techniques and/or immediate flap
procedures tailored to the individual patient. This aggressive
surgical approach to burn wound management has become
known as early excision and grafting (E&G).

61.The most frequent nonbacterial, opportunistic organism

recovered from burn wounds is:
A) Aspergillus
B) Candida
C) Fusarium
D) Phycomycetes
Answer B: The most common nonbacterial, opportunistic
organism recovered from burn wounds in Cundida. Although
this imperfect fungus has the potential to invade viable tissue
and colonize deep layers of the eschar, it rarely does so.

Wound Healing

62.The proliferative phase of wound healing occurs how long after

the injury?
A) 1 day

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B) 2 days
C) 7 days
D) 14 days
Answer C: The proliferative phase is the second phase of
wound healing and roughly spans days 4 through 12. It is
during this phase that tissue continuity is re-established.

63.Steroids impair wound healing by:

A) Decreasing angiogenesis and macrophage migration
B) Decreasing platelet plug integrity
C) Increasing release of lysosomal enzymes
D) Increasing fibrinolysis
Answer A: The major effect of steroids is to inhibit the
inflammatory phase of wound healing (angiogenesis,
neutrophil and macrophage migration, and fibroblast
proliferation) and the release of lysosomal enzymes.

64.Signs of malignant transformation in a chronic wound include:

A) Persistent granulation tissue with bleeding
B) Overturned wound edges
C) Non-healing after 2 weeks of therapy
D) Distal edema
Answer B: Malignant wounds are differentiated clinically
from nonmalignant wounds by the presence of overturned
wound edges.

65.The major cause of impaired wound healing is:

A) Anemia
B) Diabetes mellitus
C) Local tissue infection
D) Malnutrition
Answer C: All the factors listed impair wound healing, but
local infection is the major problem. The surgeon should
make every effort o remove all devitalized tissue and leave a
clean wound for closure.

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66.Bradkinin, serotonin and histamine in wounds are released

from:
A) Lymphocytes
B) Mast cells
C) Polymorphonuclear leukocytes
D) Platelets
Answer B: Bradykinin, serotonin and histamine are released
from tissue mast cells. They facilitate diapedesis of
intravascular cells through vessel walls into the extravascular
space of the wound.

67.Platelets in the wound form a hemostatic clot and release

clotting factors to produce:
A) Fibrin
B) Fibrinogen
C) Thrombin
D) Thromboplastin
Answer A: Platelet clotting factors initiate a healing cascade
by producing hemostatic fibrin. A mesh is produced and
inflammatory cells and fibroblasts migrate into the mesh.

68.In a healing wound, metalloproteinases are responsible for:

A) Establishing collagen cross-links
B) Glycosylation of collagen molecules
C) Incorporation of hydroxyproline into the collagen chain
D) Initiating collagen degradation
Answer D: In a healing wound, collagen is both synthesized
and degraded. Specific enzymes called metalloproteinases
initiate degradation.

69.All of the following statements about keloids are true

EXCEPT:
A) A keloid does not regress spontaneously

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 MCQ General Surgery (M.B.B.Ch.)

B) A keloid extends beyond the boundaries of the

original wound
C) Keloids or hypertrophic scars are best managed by excision and
careful reapproximation of the wound
D) Keloid tissue contains an abnormally large amount of collagen
Answer C: Keloids tend to recur after excision and any
surgical therapy should be undertaken cautiously, with the
patient aware that the result not be ideal.

70.When a long bone fracture is repaired by internal fixation with

plates and screws:
A) Callus at the fracture site forms more rapidly
B) Delayed union is prevented
C) Direct bone-to-bone healing occurs without soft callus
formation
D) Endochondral ossification is more complete
Answer C: Precise fracture reduction and fixation allows the
fracture to heal bone-to-bone without the soft callus formation
and endochondral ossification, which are characteristic of
closed fracture management.

71.The presence of sulfur granules in a draining wound should

lead to the use of which of the following antibiotics:
A) Penicillin
B) Gentamicin
C) Rifampin
D) Amphotericin
Answer A: Actinomycosis is a granulomatous suppurative
bacterial disease caused by actinomyces. Diagnosis depends
on the presence of characteristic sulfur granules on
microscopic examination. Special stains should be used to
exclude fungal infection. Penicillin and sulfonamides are
effective against these infections.

72.Lymphogranuloma venereum is caused by:

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A) Treponema pallidum
B) Chlamydia trachomatis
C) Neisseria gonorrhea
D) Mycobacterium fortuitum
Answer B: Chlamydia trachomatis is a sexually transmitted,
intracellular, gram-negative bacterium. After infection and a
2-week incubation period, an inconspicuous ulcer appears on
the penis or labia, although in more than half of the cases, this
lesion is not noticed or does not appear. A few weeks later,
inguinal lymphadenopathy is apparent.

73.Which of the following is the most common type of melanoma?

A) Acral lentiginous
B) Superficial spreading
C) Nodular
D) Lentigo maligna
Answer B: There are four common types of melanoma.
These are, in order of decreasing frequency, superficial
spreading, nodular, lentigo maligna and lentiginous. Each has
distinct characteristics and behaviors. The most common
type, representing up to 70% of melanomas, is the superficial
spreading type. These lesions occur anywhere on the skin
except the hands and feet.

74.What is the most common melanoma in dark-skinned people?

A) Acral lentiginous
B) Superficial spreading
C) Nodular
D) Lentigo maligna
Answer A: Acral lentiginous type is the least-common
subtype, representing only 2 to 8% of melanoma in whites. It
occurs on the palms and soles and in the subungual regions.

75.Th tumor, node, metastases classification for melanoma uses

the following in its classification EXCEPT:

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 MCQ General Surgery (M.B.B.Ch.)

A) Regional lymph nodes

B) Serum protein level
C) Vertical thickness of the primary tumor
D) Depth of invasion
E) Metastases
Answer B

76.Clark Level IV extends to which of the following structures?

A) Epidermis
B) Papillary dermis
C) Reticular dermis
D) Subcutaneous tissue
Answer C: Clark used the histologic level: I, superficial to
basement membrane (in situ); II, papillary dermis; III,
papillary/reticular dermal junction; IV, reticular dermis; and
V, subcutaneous fat.

77.A patient with a 3-mm deep melanoma of the face with a

clinically positive jugular node should undergo what
procedure in addition to resection of the primary?
A) None
B) Resection of grossly positive nodes
C) Modified radical neck dissection
D) Modified radical neck dissection and superficial parotidectomy
Answer C: All clinically positive lymph nodes should be
removed by regional nodal dissection. If possible, the
lymphatics between the lesion and the regional nodes are
removed in continuity.

Skin and Subcutaneous Tissue

78.The presence of sulfur granules in a draining wound should

lead to the use of which of the following antibiotics?
A) Penicillin
B) Gentamicin

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 MCQ General Surgery (M.B.B.Ch.)

C) Rifampin
D) Amphotericin
Answer A: Actionomycosis is a grandulomatous bacterial
disease caused by actionomyes. Diagnosis lepends on the
presence of characteristic sulfur grandules on microscopic
examination. Special stains should be used to exclude fungal
infection. Penicillin and sulfonamides are effective against
these infections.

79.Lymphogranuloma venereum is caused by:

A) Treponema pallidum
B) Ghlmodia trachomatis
C) Nerisseria gonorrhea
D) Myoducerterium fortuitum
Answer B: Chlamydia truchomatic is a sexually transmitted,
intracellular, gram-negative bacterium. After infection and a
2-week incubation period, an inconspicuous ulcer appears on
the penis or labia, although in more than half of the cases, this
lesion is not noticed or does not appear. A few weeks later,
inguinal lymphadelenopathy is apparent.

80.Which of the following is the most common common type of

melanoma?:
A) Acral lentiginous
B) Superficial spreading
C) Nodular
D) Lentigo maligna
Answer B: There are four common type of melanoma. These
are, in order of decreasing frequency superficial spreading
nodular, lentigo maligna and acral lentiginous. Each has
distinct characterisics and behaviors. The most common type,
representing up to 70% of melanomas, is the superficial
spreading type. These lestions occur anywhere on the skin
except the hands and feet.

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81.What is the most common melanoma in dark-skinned people?

A) Acral lentiginous
B) Superficial spreading
C) Nodular
D) Lentigo maligna
Answer A: Acral lentiginous type is the least-common
subtype, representing only 2 to 8% of melanoma in whites. It
occurs on the palms and soles and in the sububgual regions.

82.Clark Level IV extends to which of the following structures?

A) Epidemis
B) Papillary dermis
C) Reticular dermis
D) Subcutaneous tissue
Answer C: Clark used the histologic level: I, superficial to
basement membrane (in situ); II, papillary dermis; III,
papillary/reticular dermal junction; IV, reticular dermis and V,
subcutaneous fat.

83.A patient with a 3-mm deep melanoma of the face with a

clinically positive jugular node should undergo what
procedure in addition to resection of the primary?
A) None
B) Resection of grossly positive nodes
C) Modified radical neck dissection
D) Modified radical neck dissection and superficial parotidectomy
Answer C: All clinically positive lymph nodes should be
removed by regional nodal dissection. If possible, the
lymphatics between the lesion and the regional nodes are
removed in continuity.

84.The best cosmetic results for large capillary (port wine)

hemangiomas are achieved by:
A) Excision and split-thickness graft
B) Tattooing

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C) Cryosurgery
D) Laser destruction
Answer D: The capillary (port wine) hemangioma is a lesion
majke up of closely packed, dilated, abnormal cpaillaries in
the subpapillary, dermal, or subdermal layer of the skin.
Recently, the introduction of laser destruction of large lesions
has provided the most effective and best cosmetic results.

85.All of the following statements about Kaposi’s sarcoma in

patients with acquired immunodeficiecy syndrome (AIDS)
are correct EXCEPT:
A) The lesions are usually multifocal
B) Lesions are rubbery blue nodules that resemble hemangiomas
C) The gastrointestinal tract is often involved
D) Intravenous drug abusers are frequently affected
Answer D: For unclear reasons, Kaposi’s sarcoma in AIDS
patients has been found in male homosexuals but not in
intravenous drug abusers or hemophiliacs.

86.A 65-year-old farmer presents with a 1.5-cm ulcerated lesion

on the middle third of his lower lip. The lesion has been
present for 4 months and is not painful. No lymph nodes
are palpable in the patient’s neck. The most likely diagnosis
is:
A) Squamous cell carcinoma
B) Herpes simplex
C) Keratoacanthoma
D) Lichen planus
Answer A: The majority of cancers of the lip are squamous
cell carcinomas and 93% of these arise in the lower.

87.A 65-year-old patient who spends winters in Florida presents

with a painless, ulcerated lesion on his right check. The
lesion has been present for 1 year. Physical examination of
the patient’s neck reveals no lymph node enlargement. The

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most likely diagnosis is:

A) Melanoma
B) Basal cell carcinoma
C) Squamous cell carcinoma
D) Sebaceous cyst
Answer B: Basal cell carcinoma is the most common low-
grade malignancy of skin found in the head and neck region.
Regional lymph node metastases are rare in this condition
compared with the incidence of regional node metastasis that
occurs with squamous cell carcinoma or melanoma.

The Breast

88.The treatment of choice for a 1.8 cm in diameter, N0, M0

invasive breast cancer is:
A) Lumpectomy alone
B) Lumpectomy, sentinel node biopsy and radiation
C) Mastectomy with sentinel node biopsy and radiation
D) Mastectomy with axillary node dissection and radiation
Answer B: Currently, mastectomy with assessment of axillary
lymph node status and breast conservation (lumpectomy with
assessment of axillary lymph node status and radiation
therapy) are considered equivalent treatments for stages I and
II breast cancer.

89.Which of the following is associated with an increased risk of in

situ carcinoma of the breast?
A) Sclerosing adenosis
B) Intraductal papilloma
C) Fibroadenoma
D) Atypical lobular hyperplasia
Answer D: Cancer risk associated with benign breast
disorders and in situ carcinoma of the breast:
Atypical lobular hyperplasia
4-fold

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Atypical ductal hyperplasia

4-fold
Ductal involvement by cells of atypical ductal hyperplasia
7-fold

90.The benign disorder most likely to mimic carcinoma of the

breast is:
A) Fibroadenoma
B) Papilloma
C) Sclerosing adenosis
D) Apocrine metaplasia
Answer C: Proliferative breast disorders without atypia
include sclerosing adenosis, radal scars, complex sclerosing
lesions, ductal epithelial hyperplasia and intraductal
papillomas.

91.Which of the following increases the risk of breast cancer?

A) Multiple gestations
B) Late menarche
C) Late menopause
D) Prolonged and multiple episodes of lactation
Answer C: Increased exposure to estrogen is associated with
an increased risk for developing breast cancer, whereas
reducing exposure is thought to be protective. Factors that
increase the number of menstrual cycles, such as early
menarche, nulliparity and late menopause, are associated with
increased risk.

92.Lobular carcinoma in situ (LCIS):

A) Can be diagnosed on mammogram by microcalcifications
adjacent to a mass B)
B) Can occur in men, although it is rare
C) Is usually diagnosed in the sixth decade of life
D) Progresses to lobular carcinoma in 50% of women
Answer A: LCIS may be observed in breast tissues that

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contain microcalcifications, but the calcifications associated

with LCIS typically occur in adjacent tissues.

93.The false-positive rate for mammography in the diagnosis of

breast cancer is:
A) <1%
B) -5%
C) -10%
D) -15%
Answer C: An experienced radiologist can detect breast
cancer with a false-positive rate of 10% and a false-negative
rate of 7%.

94.A breast cancer that is larger than 5 cm with no positive nodes

or metastases is:
A) Stage I
B) Stage II
C) Stage III
D) Stage IV
Answer C

95.Level II axillary nodes:

A) Are located around the axillary vein
B) Are medial to or above the pectoralis minor muscle
C) Are made up of the central and interpectoral nodes
D) Are made up of the external mammary and scapular nodes
Answer C: Lymph nodes located superficial or deep to the
pectoralis minor muscle are referred to as level II lymph
nodes, which include the central and interpectoral groups.

96.The BRCA genes are:

A) Tumor suppressor genes
B) Proto-oncogenes
C) Regulators of RNA transcription
D) Regulators of protein modification

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Answer A: Both BRCA-1 and BRCA-2 function as tumor-

suppressor genes and for each gene, loss of both alleles in
required for the initiation of cancer.

97.The histological characteristic that defines in situ (as opposed o

invasive) ductal carcinoma is:
A) Fewer than three cell layers protruding into the lumen of the
duct
B) Fewer than five cell layers protruding into the lumen of the
duct
C) No invasion through the basement membrane
D) Invasion into a blood vessel
Answer C: Cancer cells are in situ or invasive depending on
whether or not they invade through the basement membrane.

98.Antibodies in colostrum are produced by:

A) Duct epithelium
B) Lactiferous sinus epithelium
C) Lymphocytes
D) Myoepithelial cells
Answer C: Colostrum contains a considerable quantity of
preformed antibodies that are transferred to the fetus.
Lymphocytes and plasma cells that infiltrate the breast during
pregnancy are the source of these antibodies.

99.Which statement best describes lymphatic drainage from the

breast?
A) All quadrants of the breast drain into both the axillary and the
parasternal nodes
B) The areolar area of the breast drains into retrosternal internal
mammary nodes
C) The lateral area of the breast drains into axillary nodes
D) The medial area of the breast drains into parasternal nodes
Answer A: Vital dye flow studies report that both the axillary
and the parasternal lymphatic groups receive lymph from all

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quadrants of the breast.

100. Drugs that may produce gynecomastia include all of the

following EXCEPT:
A) Cimetidine
B) Diazepam
C) Furosemide
D) Tamoxifen
Answer D: Tamoxifen is occasionally used to treat benign
disease such as gynecomastia.

101. Mammography is indicated for evaluation of a 40-year-old

woman in all of the following situations EXCEPT:
A) Breast pain and discomfort in large fatty breasts without
palpable nodules
B) Breasts with multiple nodules but no dominant area
C) Follow-up of the opposite breast after contralateral mastectomy
for carcinoma
D) Presence of a small, smooth, solitary lesion as a substitute for
hiopsy
Answer D: Mammography is not a substitute for biopsy and a
40-year-old patient with an isolated breast lesion should
undergo biopsy regardless of mammographic findings.

102. A 40-year-old woman is found to have a 3-cm, firm, smooth

mass in the upper outer quadrant of the breast. The mass is
aspirated and 10 mL of cloudy green fluid is removed. The
appropriate management at this time is:
A) Administration of estrogen
B) Cytologic evaluation of the aspirated fluid
C) Excision of the cyst
D) Observation only
Answer D: A cyst containing clear or cloudy green fluid is
appropriately managed by cyst aspiration. Unless the fluid is
bloody, cytology is not required. There is no need to remove

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a solitary cyst.

103. Which of the following biopsy findings has the greatest

relative risk for later carcinoma?
A) Apocrine metaplasia
B) Atypical lobular hyperplasia
C) Ductal ectasia
D) Sclerosing adenosis
Answer B: Apocrine atypical lobular hyperplasia has a
moderately increased risk (4 to 5 times) of later cancer.

104. A breast cancer that is 3 cm in diameter with positive,

moveable, ipsilateral nodes is:
A) Stage I
B) Stage II
C) Stage III
D) Stage IV
Answer B

Disorders of the Head and Neck

105. Hemangioma of the face in children:

A) Should be resected in the newborn period
B) Should be resected only if it persists 10 years of age
C) Will involute by 3 years of age in most children
D) Can be treated by laser ablation
Answer D: Hemangiomas are the most common vascular
lesions present in infancy and childhood. Treatment is
performed with either the flashlamp-pumped pulsed-dye laser
(FPDL), the potassium itanyl phosphate (KTP) laser, or the
neodymium yttrium-aluminum garnet (Nit:YAG) laser,
repeated every 4 to 6 weeks until the lesion disappears.

106. Le Fort II fracture entails injuries to all of the following

EXCEPT:

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 MCQ General Surgery (M.B.B.Ch.)

A) Medial wall of the orbit

B) Alveolus
C) Zygomaticomaxillary articulation
D) Nasofrontal buttress
E) Mandible
Answer E: The Le Fort II fracture extends through the
nasofrontal buttress, medial wall of the orbit, across the
infraorbital rim and through the zygomaticomaxillary
articulation.

107. The most common site of Kaposi’s sarcoma in the head and
neck is:
A) Buccal mucosa
B) Palate
C) Tongue
D) Floor of mouth
Answer B: Kaposi’s sarcoma of the palate is the most
common intraoral site for this tumor.

108. Which of the following are level III lymph nodes of the
neck?
A) Upper jugular chain nodes
B) Middle jugular chain nodes
C) Lower jugular chain nodes
D) Posterior triangle nodes
E) Submental nodes
Answer B: Level III-middle jugular chain nodes; inferior to
the hyoid, superior to the level of the hyoid, deep to
sternocleidomastoid muscle (SCM) from posterior posterior
border of the muscle to the strap muscles medially.

Chest Wall, Lung, Mediastinum and Pleura

109. Which of the following is an indication for surgical drainage

of a lung abscess?

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 MCQ General Surgery (M.B.B.Ch.)

A) Abscess >3 cm in diameter

B) Hemoptysis
C) Failure to decrease in size after 1 week of antibiotic therapy
D) Persistent fever
Answer B: Surgical drainage of lung abscesses is uncommon
since drainage usually occurs spontaneously via the
tracheobronchial tree. Indications for intervention include
failure of medical therapy; an abscess under tension; an
abscess increasing in size during appropriate treatment;
contralateral lung contamination; an abscess larger than 4 to 6
cm in diameter; narcotizing infection with multiple abscesses,
hemoptysis, abscess rupture, or pyopneumothorax and
inability to exclude a cavitating carcinoma.

110. Desmoid tumors:

A) Arise from the periosteum of the rib
B) Require chemotherapy to treat or prevent metastatic disease
C) Require radical excision (sacrificing neurovascular structures)
to obtain 4-cm margins
D) Are treated with wide local excision with a 2- to 4- cm margin
Answer D: Desmoid tumors are unusual soft tissue neoplasms
that arise from fascial or musculoaponeurotic structures.
Surgery consists of wide local excision with a margin of 2 to 4
cm and with intraoperative assessment of resection margins
by frozen section.

111. An “onion-peel” appearance of a rib on computed

tomography is suggestive of:
A) Chondroma
B) Osteosarcoma
C) Plasmacytoma
D) Ewing’s sarcoma
Answer D: Ewing’s sarcomas occur in adolescents and young
adults who present with progressive chest wall pain, but
without the presence of a mass. Radiograhically, the

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characteristic onion-peel appearance is produced by multiple

layers of periosteum in the bone formation.

112. Mesotheliomas:
A) Occur only in the pleural space
B) Are usually diagnosed by cytology on pleural fluid
C) Have a better outcome with a mixed cell type
D) Are treated by pleurectomy for early stage disease
Answer D: For patients with early-stage mesotheliomas and
good pulmonary function, extrapleueral pneumonectomy is
recommended, specially for epithelial mesotheliomas.

113. The most common benign tumor of the rib is:

A) Osteochondroma
B) Fibrous dysplasia
C) Chondroma
D) Eosinophilic granuloma
Answer A: Osteohondromas are overall the most common
benign bone tumor.

114. Osteosarcoma of the rib:

A) Is considered non-operable if pulmonary metastases are present
B) Is treated with adjuvant chemotherapy before resection
C) Is treated with radiation therapy before resection
D) Requires excision with a 6-cm margin
Answer B: Osteostarcomas are potentially sensitive to
chemotherapy. Currently, preoperative chemotherapy before
surgical resection is common.

Arterial Disease

115. The most common peripheral artery aneurysm is:

A) Brachial
B) Radial
C) Popliteal

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D) Tibial
Answer C: Popliteal arterial aneurysms are the most common
peripheral arterial aneurysms, accounting for 70%.

116. The compartment most commonly affected in a lower leg

compartment syndrome is the:
A) Anterior compartment
B) Lateral compartment
C) Deep posterior compartment
D) Superficial posterior compartment
Answer A: The most commonly affected compartment is the
anteior compartment in the leg. Numbness in the web space
between the first and second toes is diagnostic due to
compression of the deep peroneal nerve.

117. The preferred procedure for treatment of typical occlusive

disease of the aorta and both iliac arteries is:
A) Endovascular stenting
B) Extra-anatomic bypass
C) Aortoiliac endarterectomy
D) Aortobifemoral bypass
Answer D: In most cases aortobifemoral bypass grafting is
the procedure of choice of these authors.

118. The treatment of acute embolic mesenteric ischemia is:

A) Observation
B) Anticoagulation
C) Thrombolysis
D) Operative embolectomy
Answer D: The primary goal of surgical treatment in embolic
mesenteric ischemia is to restore arterial perfusion with
removal of the embolus from the vessel.

119. Rest pain seen with occlusion peripheral vascular disease in

the lower extremity most commonly occurs in:

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 MCQ General Surgery (M.B.B.Ch.)

A) The buttock
B) The quadriceps
C) The calf muscles
D) The metatarsophalangeal joint
Answer D: Rest pain (a manifestation of severe underlying
occlusive disease) is constant and occurs in the foot (not the
muscle groups), typically at the metatarsophalangeal junction
and is relieved by dependency.

120. A patient who develops dizziness, drop attacks and diplopia

with exercise most likely has:
A) Carotid stenosis
B) Subclavian steal syndrome
C) Coronary subclavian steal syndrome
D) Coronary artery disease
Answer B: The most common location for atherosclerosis
affecting the upper limb is at the origin of the subclavian
artery. Subclavian steal syndrome occurs when posterior
circulation symptoms (dizziness, drop attacks and diplopia)
occur during arm exercise in patients with proximal
subclavian artery occlusion.

121. An ankle-brachial index of 0.7:

A) Is normal
B) Indicates an increased risk of cardiovascular events
C) Is indicative of moderate ischemia with rest pain
D) Is indicative of severe ischemia with a risk for gangrene
Answer B: There is increasing interest in the use of the ankle-
brachial index (ABI) to evaluate patients at risk for
cardiovascular events. An ABI less than 0.9 correlates with
increased risk of myocardial infarction and indicates
significant, although perhaps asymptomatic, underlying
peripheral vascular disease.

122. The most common presenting symptom of acute arterial

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occlusion is:
A) Pain
B) Pallor
C) Paresthesia
D) Pulselessness
Answer A: Pain is usually the first symptom or sign in a
cascade that includes all of the other listed items in addition to
poikilothermia (coolness).

123. Platelets are derived from:

A) Eosinophils
B) Lymphocytes
C) Megakaryocytes
D) Monocytes
Answer C: Platelets are membrane-bound cytoplasmic
remnants of bone marrow megakaryocytes.

124. Chronic occlusion of the popliteal artery may produce:

A) Brawny discoloration of the skin over the ankle
B) Dilated collateral vessels in calf and foot
C) Pain in the calf that is relieved by dependency
D) Ulceration over the medial malleolus
Answer C: The excessive pain associated with arterial
occlusion is frequently relieved by holding the foot quiet in a
dependent position, taking advantage of gravity to increase
blood flow.

125. The most common type of aneurysm is:

A) Degenerative
B) Dissecting
C) Poststenotic
D) Traumatic
Answer A: The common aortic aneurysm below the renal
arteries is frequently called an atherosclerotic oneurysm.
Because the role of atherosclerosis in aneurysmal disease is

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 MCQ General Surgery (M.B.B.Ch.)

unclear, the term “degeneration” is more appropriate.

126. Each of the following is characteristic of causalgia of an

extremity EXCEPT:
A) Anbydrosis
B) Burning pain
C) Coolness
D) Skin hypersensitivity
Answer A: Causalgia occurs after partial nerve transection.
The burning pain is severe and the skin hypersensitivity may
make contact with clothing intolerable. Coolness, cyanosis,
hypethy drosis and edema are also characteristic of the
syndrome.

127. The first change encountered in acute mesenteric ischemia

is:
A) Severe periumbilical pain
B) Elevation of creatine phosphokinase levels
C) Hyperkalemia
D) Metabolic acidosis
Answer A: Severe periumbilical pain out of proportion to the
physical findings, especially in an older patient, must be
considered evidence of mesenteric ischemia until proved
otherwise.

128. Which of the following treatments is contraindicated in the

management of frostbite of an extremity?
A) Rapid warming in warm water
B) Antibiotics and tetanus antiserum
C) Elevation of the extremity
D) Early amputation of demarcated areas
Answer D: Amputation should be delayed despite
demarcation because ultimate loss of tissue cannot be
determined ealy and although the skin may be gangrenous, the
underlying tissue may be viable.

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Venous and Lymphatic Disease

129. Which of the following veins has valves?

A) Portal vein
B) Superior vena cava
C) Inferior vena cava
D) Iliac veins
Answer B: The inferior vena cava, the common iliac veins,
the portal venous system, and the cranial sinuses are
valveless.

130. Which of the following is NOT seen in phlegmasia cerulean

dolens?
A) Pain
B) Edema
C) Blanching
D) Cyanosis
Answer C: Phlegmasia centlea dolens is preceded by
phlegmasia alba dolens in 50 to 60% of patients. The affected
extremity in phlegmasia cerulea dolens is extremely painful,
edematous and cyanotic and may be associated with arterial
insufficiency or compartment syndrome.

131. The initial dose of unfractionated heparin (UFH) to fully

heparinize a patient is:
A) 20 IU/kg IV
B) 40 IU/kg IV
C) 60 IU/kg IV
D) 80 IU/kg IV
Answer D: Weight-based UFH dosages have been shown to
be more effective than standard fixed boluses in rapidly
achieving therapeutic levels. Weight-based dosng of UFH is
initiated with a bolus of 80 IU/kg IV and a maintenance
continuous infusion is started at 18 IU/kg per hour IV.

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132. Initial therapy of a patient with mesenteric venous

thrombosis (MVT) without peritonitis is:
A) Bowel rest and observation
B) IV dobutamine
C) Anticoagulation
D) Laparotomy
Answer C: Patients with MVT should have adequate fluid
resuscitation and be anticoagulated with heparin.

133. The most common form of primary lymphedema is:

A) Congenital lymphedema
B) Lymphedema praecox
C) Lymphedema internedius
D) Lymphedema tarda
Answer B: Lymphedema praecox is the most common form
of primary lymphedema, accounting for 94% of cases.
Lymphedema prsecox is fat more common in women.

134. The primary treatment for lymphedema is:

A) Excision of lymphedematous tissue with reconstruction
B) Microvascular lymphovenous anastomosis
C) Microvascular lympholymphatic anastomosis
D) Conpression garnents
Answer D: Graded compression stockings are widely used in
the treatment of lymphedema. The stockings reduce the
amount of swelling in the involved extremity by preventing
the accumulation of edema while the extremity is dependent.

135. In a patient after a moderate-risk general surgical

operation, such as a low anterior resection of the colon, the
most effective step in the prevention of postoperative
pulmonary embolization is:
A) Early ambulation
B) Leg elevation

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C) Use of elastic stockings

D) Use of intermittent pneumatic leg compression
Answer D: Intermittent pneumatic leg compression is the
most effective measure.

130.The most common symptom after major pulmonary

embolism is:
A) Cough
B) Dyspnea
C) Hemoptysis
D) Pleural pain
Answer B: Pulmonary embolism may be responsible for each
of the listed symptoms. Data from a national urokinase
pulmonary embolism trial found that dyspnea, present in 80%
of patients, was the most frequent symptom.

131.The first-choice diagnostic study for suspected deep venous

thrombosis of the lower extremity is:
A) Contrast sonography
B) Impedance plethysmography
C) Radioactive-labeled fibrinogen uptake
D) Real-time Doppler imaging
Answer D: Real-time B-mode Doppler imaging is the method
of choice because it is noninvasive and has sensitivity,
specificity and accuracy in the 90-95% range.

132.The best initial therapy for deep venous thrombosis of the

common femoral vein is:
A) Heparin
B) Placement of a vena caval filter
C) Streptokinase
D) Venous thrombectomy
Answer A: Primary management of deep venous thrombosis
involves heparin followed by a 3- to 6-month course of
warfarin.

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Esophagus and Diphragmatic Hernia

133.Grade II esophagitis on endoscopy is defined by:

A) Erythema extending circumferentially in the mucosa
B) Any ulceration
C) Linear ulcerations with friable granulation tissue
D) Circumferential loss of eithelium
Answer C: Grade I esophagitis is defined as small, circular,
nonconfluent erosions. Grade II esophagitis is defined by the
presence of linear erosions lined with granulation tissue that
bleeds easily when touched.

134.Which of the following patients should be offered anti-reflux

surgery as the first treatment option in the treatment of
gastroesophageal reflux disease?
A) Hiatal hernia
B) Symptoms of >5-year duration
C) Barrett’s esophagitis on endoscopy
D) pH <4 for >20% of the day
Answer C: Endoscopic examination at this stage of the
patient’s evaluation provides the opportunity for assessing the
severity of mucosal damage and the presence of Barrett’s
esophagus. Both of these findings on initial endoscopy are
associated with a high probability that medical treatment will
fail.

135.Which of the following is an indication for a gastroplasty?:

A) Presence of a sliding hiatal hernia that does not reduce in the
standing position
B) Large paraesophageal hernia
C) Redundant fundus
D) Gastric outlet obstruction
Answer A: When esophageal shortening is present, the
motility of the esophageal body must be carefully evaluated

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and if inadequate, a gastrooplasty should be performed.

136.Primary treatment of a Zenker’s diverticulum is:

A) Reassurance and dietary changes
B) Open esection of the diverticulum
C) Cervical myotomy with resection of large diverticulum
D) Esophagectomy
Answer C: The low morbidity and mortyality assciated with
cricopharyngeal and upper esophageal myotomy have
encouraged a liberal approach toward its use for almost any
problem in the oropharyngeal phase of sellowing.

137.The most common primary esophageal motility disorder is:

A) Achlasia
B) Segmental esophageal spasm
C) Diffuse esophageal spasm
D) “Nutcracker” esophagus
Answer D: It is the most common of the primary esophageal
motility disorders. By definition the socalled nutcracker
esophagus is a manometric abnormality in patients with chest
pain characterized by peristaltic esophageal contractions with
peak amplitudes greater than two standard deviations above
the normal values in individual laboratories.

138.Which of the following is the most effective treatment for

achalasia?
A) Repeated balloon dilatation
B) Laparoscopic Heller myotomy
C) Thoracoscopic Heller myotomy
D) Dietary changes and observation
Answer B

139.Patients with hiatal hernias on barium swallow:

A) Are usually symptomatic (gastrointestinal reflux disease)
B) Should be treated initially with proton pump inhibitors

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C) Require surgical therapy only if the hernia is large

D) Should be further evaluated by endoscopy
Answer C: A small hiatal hernia is usually not associated
with significant symptoms or illness and its presence in an
irrelevant finding unless the hiatal hernia is large, the hiatal
opening is narrow and interrupts the flow of barium into the
stomach, or the hernia is of the paraesophageal.

140.Which of the following is one of the five principles of anti-

refdlux surgery?
A) A 360-degree fundopliction should be used
B) The posterior wall of the fundoplication should be sutured to
the crura o maintain the inferior fixation of the esophagus
C) A fundoplication should restore the lower esophageal sphincter
pressure to twice that of the resting gastric pressure
D) At least 5 cm of intra-abdominal esophagus should be created
Answer C: The five principles:
1. Restore the pressure of the distal esophageal sphincter to twice
the resting gastric pressure and it’s length to at least 3 cm
2. Place an adequate length of the distal esophageal sphincter in
the abdomen (positive pressure)
3. The reconstructed cardia should be able to relax with
swallowing
4. Do not exceed the peristaltic ability of the distal esophagus
5. The fundoplication should be maintained in the abdomen
without undue tension

141.Valves involved in the act of swallowing include all of the

following EXCEPT:
A) Cricopharyngeus
B) Epiglottis
C) Lower esophageal sphincter
D) Tongue
Answer D: The tongue acts as a piston, moving the bolus of
food into the posterior oropharynx and hypopharyns.

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142.The most significant risk factor for the development of

adenocarcinoma of the esophagus is:
A) Alcohol abuse
B) Barrett’s esophagus
C) Long-standing achalasia
D) Smoking
Answer B: In Barrett’s esophagus, there is a metaplastic
change in the esophageal mucous membrane. The resulting
columnar epithelium is susceptible to the development of
adenocarcinoma.

143.A 56-year-old patient has a carcinoma of the esophagus at

the level of the sternal notch. The are no palpable lymph
nodes in the neck. He appropriate management of this
patient is:
A) Chemotherapy
B) Combination chemotherapy and radiation therapy
C) Preoperative radiation therapy and surgical resection
D) Surgical resection
Answer D: Lesions at this level have a poor prognosis. Local
recurrence, however, is more common after radiation therapy
or chemotherapy than after surgical resection and the recurrent
lesion usually is difficult to treat.

144.Spontaneous perforation of the esophagus most frequently

occurs in the:
A) Left pleural cavity
B) Pericardium
C) Posterior mediastinum
D) Retropharyngeal region
Answer A: Perforation usually occurs either in the left pleural
cavity or just above the gastroesophageal junction.

145.Diagnosis of esophageal perforation is best established by:

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A) Contrast esophagograms
B) Esophagoscopy with a flexible esophagoscope
C) Esophagoscopy with a rigid esophagoscope
D) Upright X-rays of the chest, including lateral and oblique films
Answer A: Esophagograms demonstrate extravasation in 90%
of patients with esophageal perforation. A water-soluble
contrast medium should be used and the patient should be
positioned in the right lateral decubitus position so that the
entire esophagus can be visualized.

146.All of the following statements about achalasa are true

EXCEPT:
A) In most affected persoms, ganglion cells in the body of the
esophagus either are absent or have degenerated
B) Pressure in the body of the esophagus is lower than normal
C) Affected persons usually experience more difficulty
swallowing cold foods than warm foods
D) Esophageal cancer is seven times as common in affected
persons as in the general population
Answer B: Esophageal motility is uncoordinated and pressure
in the body of the esioghagus usually is higher than normal.

147.After a patient has ingested lye, esophagoscopy should be

performed:
A) Shortly after the event to establish the degree of injury
B) After several weeks have passed to prevent early perforation
C) Only if evidfence of dysphagia occurs
D) After several days of antibiotic therapy
Answer A: Early esophagoscopy to, but not beyond, the level
of injury is safe and it is the best method of evaluating the
degree of injury.

148.All of the following statements about paraesophageal hernia

are true EXCEPT:
A) Heartburn is the usual chief complaint of affected persons

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B) Symptoms can stem from obstruction and hemorrhage

C) The herniated portion of the stomach may become gangrenous
and perforate
D) Surgical repair generally is indicated
Answer A: Obstruction and hemorrhage are the chief
complications of paraesophageal hernia in which a part of the
stomach has herniated into the thorax.

149.The treatment of choice for perforation of the cervical

esophagus is:
A) Bed rest and use of antibiotics
B) Nasogastric intubation and use of antibiotics
C) Cervical exploration, drainage of superior mediastinum and use
of antibiotics
D) Resection and colonic interposition
Answer C: Surgical exploration of the neck combined with
drainage of the retrovisceral space is the preferred treatment
of persons who have a cervical esophageal perforation.

150.The most effective treatment of achalasia is:

A) Antispasmodic medication
B) Dilation of the lower esophageal sphincter
C) Esophagomyotomy
D) Resection of the cardioesophageal junction
Answer C: Esophagomyotomy is currently the treatment of
choice for patients who have achalasia.

Stomach

151.The consistently largest artery to the stomach is the:

A) Right gastroepiploic
B) Left gastroepiploic
C) Right gastric
D) Left gastric
Answer D: The consistently largest artery to the stomach is

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the left gastric artery, which usually arises directly from the
celiac trunk and divides into an ascending and descending
branch along the lesser gastric curvature.

152.The left gastroepiploic artery arises from:

A) The left gastric artery
B) The splenic artery
C) The right hepatic artery
D) The gastroduodenal artery
Answer B: The left gastroepiploic artery arises from the
splenic artery and together with the right gastroepiploic artery,
forms the rich gastroepiploic arcade along the greater
curvature.

153.Which of the following is secreted by gastric chief cells?

A) Somatostatin
B) Gastrin
C) Pepsinogen
D) Histamine
E) Glucagon
Answer C:
Cell Type Substance(s)
Chief cells Lipase,
Oxyntic (parietal) cells pepsinogen
D cells Acid, intrinsic
G cells factor
Superficial epithelial Somatostatin
cells Gastrin
Enterochromaffin-like Bicarbonate,
cells mucous
Histamine

154.Which of the following is the best test to use to confirm

eradication of Helicobacter pylori infection after treatment?
A) Serologic test
B) Urea breath test
C) Histology

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D) Rapid urease test

Answer B: The labeled carbon urea breath test has recently
available. This has become the standard test to confirm
eradication of H. pylori following appropriate treatment.
Ingests urea labeled with radioactive 14C or nonradicative 13C.
The lubeled urea is acted upon by the urease present in the H.
pylori and converted into ammonia and carbon dioxide. The
radiolabeled carbon dioxide is excreted from the lungs and
can be detected in the expired air. It also can be detected in a
blood sample.

155.The most accurate diagnostic test for Zollinger-Ellison

syndrome (ZES) is:
A) Fasting serum gastrin
B) Computed tomography scan
C) Endoscopy
D) Secretin stimulation test
Answer D: The diagnosis of ZES is confirmed by the secretin
stimulation test. An intravenous bolus of secretin (2 U/kg) is
given and gastrin levels are checked before and after injection.
An increase in serum gastrin of 200 pg/mL or greater suggests
the presence of gastrinoma.

156.Which blood group is associated with an increased risk of

gastric cancer?
A) A
B) B
C) AB
D) O
Answer A: Gastric cancer is more common in patients with
pernicious anemia, blood group A, or a family history of
gastric cancer.

157.Initial treatment for severe early dumping after gastrectomy

is:

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A) Expectant management
B) Oral glucose for symptoms
C) Octreotide
D) Surgical conversion to a Roux-en-Y drainage
Answer C: The medical therapy for the dumping syndrome
consists of dietary management and somatostatin analogue
(octrotide). Often symptoms improve if the patient avoids
liquids during meals.

158.A 55-year-old executive who is seen because of severe

epigastric pain is found by gastroduodenal endoscopy to
have a large ulcer in the duodenal bulb. He is placed on a
diet and H2 blocker, but his symptoms persist. At this time,
it would be most appropriate to suggest a:
A) Course of metronidazole, tetracycline and bismuth
B) Highly selective vagotomy
C) Truncal vagotomy and antrectomy
D) Truncal vagotomy and pyloroplasty
Answer A: Surgery is no longer commonly offered to patients
with severe ulcer pain. Careful medical management with
acid reduction and control of Helicobacter pylori infection is
effective for most patients and the need for operation is
unusual.

159.All of the following occur after highly selective vagotomy

EXCEPT:
A) Basal acid secvretion reduced
B) Basal gastrin production is decreased
C) Liquids pass more rapidly into the duodenum
D) Solids pass into the duodenum at a normal rate
Answer B: After highly selective vagotomy, basal gastrin
production is increased, but the gastrin response to a meal is
reduced.

160.A 65-year-old woman with a known duodenal ulcer is being

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treated with diet and H2 blocker therapy. She is admitted

with a major upper gastrointestinal hemorrhage. After
blood replacement is begun, the next step in her
management should be:
A) Beginning bismuth, tetracycline and metronidazole
B) Beginning omeprazole
C) Endoscopy and coagulation of the bleeding vessel
D) Pyloroduodenotomy and oversewing of the bleeding vessel
Answer C: In the pesence of an acute hemorrhage, none of
the listed drug regimens provides immediate control.
Endoscopy with coagulation of the bleeding vessel should be
attempted.

161.The normal stomach secretes all of the following EXCEPT:

A) Bicarbonate
B) Intrinsic factor
C) Lipase
D) Pepsinogen
E) G;icagon
Answer E

162.Patients at increased risk for gastric carcinoma include all of

the following EXCEPT:
A) Those who have undergone gastric resection for duodenal ulcer
B) Those with pernicious anemia
C) Those who have undergone gastric bypass for morbid obesity
D) Those with blood group A
Answer C: Gastric cancer is not recognized as a complication
of gastric bypass procedures.

163.A patients with the Zollinger-Ellison syndrome is found to

have the multiple endocrine neoplasia type I (MEN-I)
syndrome. Appropriate management for the ulcer
symptoms should be:
A) Cimetidine

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B) Omeprazole
C) Pancreatic resection
D) Streptozocin
Answer B: Patients with MEN-1 syndrome have multiple
small pancreatic tumors not amenable to resection.
Omeprazole, a protein pump blocker, has been more effective
than cimetidine in managing the ulcer diathesis in these
patients.

164.Fat absorption occurs primarily in the:

A) Stomach
B) Third portion of the duodenum
C) Jejunum
D) Ileum
Answer C: Fat digestion and absorption occur in the jejunum
where triglycerides are partially hydrolyzed by pancreatic
lipase.

165.The treatment of choice for a 40-year-old man who is found

on endoscopy and biopsy to have a gastric lymphoma
would be:
A) Subtotal gastrectomy
B) Radiotherapy
C) Chemotherapy
D) Wide local excision
Answer B: Lymphoma accounts for about 2% of all gastric
malipnancies. The treatment of choice once a histologic
fiagnosis has been condirmed is radiation therapy. This lesion
is quite radiosensitive and morbidity from radiation is low.
Operative resection is reserved for bulky lesions with gastric
outlet obstruction.

Small Intestine

166.The sensitivity of plain radiographs in the diagnosis of small

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bowel obstruction is:

A) 30 – 40%
B) 50 – 60%
C) 70 – 80%
D) 90 – 100%
Answer C: The diagnosis of small-bowel obstruction is
usually confirmed with radiograhic examination. The
abdominal series consists of a radiograph of the abdomen with
the patient in a supine position, a radiograph of the abdomen
with the patient in an upright position and a radiograph of the
chest with the patient in an upright position.

167.The best examination for the diagnosis of partial small bowel

obstruction is:
A) Plain radiographs
B) Upper gastrointestinal (UGI) with small bowel follow-through
C) Computed tomography (CT) scan with contrast
D) Magnetic resonance imaging (MRI)
Answer C: A limitation of CT scanning is its low sensitivity
(<50%) in the detection of low-grade or partial small-bowel
obstruction.

168.The most common tumor of the small bowel is:

A) Carcinoma
B) Adenoma
C) Fibroma
D) Hemangioma
Answer B: Adenomas are the most common benign neoplasm
of the small intestine.

169.The most common small bowel cancer is:

A) GIST (gastrointestinal stromal tumor)
B) Carcinoid tumors
C) Adenocarcinoma
D) Lymphoma

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Answer C: Among small bowel cancers, adenocarcinomas

comprise 35 to 50% of all cases, carcinoid tumors comprise
20 to 40%, and lymphomas comprise approximately 10 to
15%.

170.The appropriate treatment of localized small bowel

lymphoma is:
A) Segmental resection only
B) Adjuvant chmotherapy followed by segmental resection
C) Segmental resection followed by chemotherapy
D) Resection, chemotherapy and X-ray therapy
Answer C: Localized small-intestinal lymphoma should be
treated with segmental resection of the involved intestine and
adjacent mesentery.

171.Appropriate therapy for a bleeding Meckel’s diverticulum

is:
A) H2 blockade followed by diverticulectomy
B) Diverticulectomy alone
C) Diverticulectomy and oversewing of the bleeding point
D) Segmental small bowel resection to include the Meckel’s
diverticulum
Answer D: The surgical treatment of symptomatic Meckel’s
diverticula should consist of diverticulectomy with removal of
associated bands connecting the diverticulum to the
abdominal wall or intestinal mesentery. If the indication for
diverticulectomy is bleeding, segmental resection of ileum
that includes both the diverticulum and the adjacent ileal
peptic ulcer should be performed.

172.The treatment of choice for an asymptomatic acquired

duodenal diverticulum in:
A) Observation
B) Endoscopic resection
C) Surgical resection

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D) Surgical bypass
Answer A: Asymptomatic acquired diverticula should be left
alone. Bacterial overgrowth associated with acquired
diverticula is treated with antibiotics.

173.Which of the following in NOT an extraintestinal

manifestation of Crohn’s disease?
A) Pyoderma gangrenosum
B) Erythema bodosum
C) Ankylosing spondylitis
D) Nodular arthritis
Answer D

174.The surgical treatment of radiation enteritis is indicated for:

A) Persistent low-grade stenosis
B) Persistent crampy pain
C) Prevention of malignant degeneration
D) Enteroenteric fistula
Answer D: Surgery for this condition is difficult, is associated
with high morbidity rates and should be voided in the absence
of specific indications such as high-grade obstruction,
perforation, hemorrhage, intra-abdominal abscesses and
fistulas.

175. Secretin has all of the following actions EXCEPT:

A) Inhibition of the flow of bile
B) Inhibition of gastrin release
C) Stimulation of release of bicarbonate from pancreatic ductal
cells
D) Stimulation of release of water from pancreatic ductal cells
Answer A: Secretin stimulates bicarbnate and water release
from pancreatic ductal cells. It also stimulates the flow of bile
and inhibits gastrointestinal mobility.

176. Cholecystokinin has all of the following actions EXCEPT:

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A) It inhibits boel motility

B) It produces relaxation of the sphincter of Oddi
C) It stimulates gallbladder contractility
D) It stimulates release of insulin
Answer A: Cholecystokinin stimulates release of bile by
producing gallbladder contractions and relaxing the sphincter
of Oddi. It also stimulates release of insulin, stimulates
secretion of enzyme by pancreatic acinar cells and increases
bowel motility.

177.Vasoactive intestinal peptide (VIP) has all of the following

actions EXCEPT:
A) It leads to the watery diarrhea syndrome
B) It produces potent vasodilatation
C) It stimulates gastric acid secretion
D) It stimulates intestinal secretion
Answer C: VIP is a potent vasodilator, which is the chief
agent responsible for the watery diarrhea syndrome. It also
stimulates in testinal and pancreatic secretion but inhibits
gastric acid secretion.

178.The most common small bowel malignancy in children under

10 years of age is:
A) Carcinoid
B) Carcinoma
C) Leiomyosarcoma
D) Lymphoma
Answer D: Lymphomas, especially in the ileum, are the most
common small bowel malignancy in children.

179. The most common sarcoma in the small intestine in adults is:
A) Angiosarcoma
B) Fibrosarcoma
C) Kaposi’s sarcoma
D) Leiomyosarcoma

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Answer D: Leiomyosarcomas are evenly distributed

throughout the small intestine.

180. After massive small bowel resection the body compensates

by:
A) Increased number of villi
B) Lengthened individual villi
C) Increased life span for absorptive cells
D) Increased synthesis of digestive enzymes by absorptive cells
Answer B: When a massive small bowel resection is
necessary, the body attempts to adapt by increasing digestion
and absorption of nutrients. This is accomplished by
lengthening the individual villi and the number of active cells
on the villous surface, which effectively increases the
absorptive area available.

181.In response to antigen stimulation the secretary immune

system in the gut is a major source of:
A) Immunoglobulin A (IgA)
B) Immunoglobulin G (IgG)
C) Interleukin-4
D) Interleukin-5
Answer A: The gut serves a major immune function in
dealing with the bacteria, viruses and enterotoxins present in
the bowel lumen. Antigens entering the gut wall stimulate the
production of IgA by plasma cells within the lamina propria.
IgG is the antibody that mediates general humoral immunity.

182.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) Administration of 250 mL of magnesium citrate to induce
catharsis and increase the rapidity of passage

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C) Follow-up with serial X-rays and abdominal examinations

D) Immediate surgery
Answer C: Most swallowed foreign bodies pass through the
alimentary tract without causing intestinal perforation.
However, persons who have swallowed objects capable of
piercing the intestinal wall should be carefully observed by
way of repeated abdominal examinations and plain X-rays of
the abdomen.

183.All of the following conditions are associated with resection

of the terminal ileum EXCEPT:
A) Megloblastic anemia
B) Choleretic diarrhea
C) Low levels of serum iron
D) Vitamin B12 deficiency
Answer C: The terminal ileum is not the site of absorption for
iron.

Colon, Rectum and Anus

184.Which of the following extraintestinal manifestations of

ulcerative colitis improves with colectomy?
A) Sclerosing cholangitis
B) Arthritis
C) Erythema nodosum
D) Uveitis
Answer B: Arteritis is also a common extracolonic
manifestation of inflammatory bowel disease and the
incidence is 20 times greater than in the general population.
Arthritis usually improves with treatment of the colonic
disease.

185.Which of the following is a first-line agent in the treatment of

mild to moderate colitis from inflammatory bowel disease?
A) Salicylates
B) Steroids
C) 6-Mercaptopurine

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D) Methotrexate
Answer A: Sulfasalazine (Azulfidine), 5-aminosalicylic acid
(5-ASA) and related compounds are first-line agents in the
medical treatment of mild to moderate inflammatory bowel
disease.

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