Sugery Finals 1st Source

Suppose you are the surgeon on duty and noted that the vital signs were stable. Few hours post-op you noticed the abdomen to be distended the drain were dry, blood pressure dropped to 90/60. PR 20. In this patient the possible cause of hypotension:
A. Severe dehydration
B. Inadequate hydration
C. Third space loss
D. Internal bleeding

C. Third space loss

Management of the above patient:
A. Re-explore the patient
B. Transfuse blood then above
C. Give adequate IVF to reverse dehydration
D. Give broad spectrum antibiotics

C. Give adequate IVF to reverse dehydration

Suppose the patient developed fever 12 hours post-op. The most probable cause of the fever is:
A. Wound infection
B. UTI
C. Atelectasis
D. Thrombophlebitis

C. Atelectasis

Diagnostic test to confirm the above:
A. Blood gas
B. Urinalysis
C. Chest X-ray
D. Blood culture

C. Chest X-ray

The most important component/s of a TPN solution, EXCEPT:
A. Amino acid solution
B. Trace elements like copper, zinc, etc.
C. Dextrose
D. NOTA

D. NOTA

Which of the following studies is/are most useful in the pre-operative evaluation of a patient's risk for operation:
A. History
B. EKG
C. Physical examination
D. Liver function test

A. History (most important)

Indication for insertion of Foley catheter is/are the following. EXCEPT:
A. Acute urinary obstruction
B. In comatose patient
C. In urethral injury
D. Benign prostatic hypertrophy

C. In urethral injury

Factor that increases risk in surgery:
A. Age
B. Nutrition
C. Pulmonary function
D. AOTA

D. AOTA

In pre-op preparation, shaving of the operative site should be:
A. The night before the operation
B. At least 4 hours prior to operation
C. In the OR prior to operation
D. Does not matter, as long as the operative site is cleaned with antiseptic solution

C. In the OR prior to operation

Requires Vit. K for synthesis, EXCEPT:
A. Factor II
B. Factor VII
C. Factor IX
D. Factor XI

D. Factor XI

The most effective way to control active bleeding in most cases is:
A. Cautery
B. Direct mechanical pressure
C. Laser
D. Gelfoam

B. Direct mechanical pressure

Acquired hemostatic defect. EXCEPT:
A. Thrombocytopenia
B. Myeloid metaplasia
C. Polycythemia vera
D. Dengue hemorrhagic fever

C. Polycythemia vera

Most common cause of intra or post-operative bleeding is:
A. Blood transfusion reaction
B. Fibrinolysis
C. Undetected hemostatic defect
D. Consumption coagulopathy

A. Blood transfusion reaction

The first sign of a transfusion reaction during an operation is:
A. Hypotension
B. Diffuse bleeding on the operative site
C. Increase in temperature
D. Bronchospasm

B. Diffuse bleeding on the operative site

Complication/s of massive blood transfusions, EXCEPT:
A. Hypocalcemia
B. Transfusion reaction
C. Pulmonary edema
D. Infectious disease transmission

D. Infectious disease transmission

Manifestations of hemolytic transfusion reaction, EXCEPT:
A. Lumbar pain
B. Hypertension/Bradycardia
C. Fever/Chills
D. Pain/heat along the vein

B. Hypertension/Bradycardia

The best predictor of mortality in a patient with hemorrhagic shock is:
A. Base deficit
B. Acid base disorder
C. Central venous oxy-hemoglobin saturation
D. Oxy-hemoglobin dissociation curve

A. Base deficit

Angiotensin II, one of the most potent vasoconstricting agents, is produced in the:
A. Brain
B. Kidney
C. Lung
D. Adrenals

C. Lung

The cell's ability to maintain proper electrochemical difference depends on the production of:
A. ADP
B. Lactic Acid
C. ATP
D. Oxidative phosphorylation

C. ATP

Mediator/s which causes arteriovenous shunting and maldistribution of blood flow in capillary beds is/are:
A. Angiotensin II
B. Arachidonic acid metabolites
C. Interleukins
D. Kinins

D. Kinins

The decreased urine output and GFR in shock kidney is secondary to:
A. Hypotension
B. Renal infarct
C. Tubular obstruction by hyaline casts
D. Renal vasoconstriction

D. Renal vasoconstriction

Effects of shock in the liver are the following, EXCEPT:
A. Decrease total cellular and mitochondrial calcium content
B. Decrease ATP
C. Reduced Kupffer cells function
D. Reduced production of coagulation factors

A. Decrease total calcium content

The diagnosis of ARDS is based on the following findings, EXCEPT:
A. Hyperventilation with hypocarbia
B. Hypoxemia
C. Diminished pulmonary compliance
D. Pulmonary venous hypertension

D. Pulmonary venous hypertension

Cellular response in shock:
A. Decrease intracellular sodium and water
B. Decrease plasma potassium
C. Decrease cell membrane permeability to sodium
D. Decrease ATP

D. Decrease ATP

The causes of hypoxemia in ARDS are the following, EXCEPT:
A. Hypoventilation
B. Shunting
C. Diffuse defects
D. Increased dead space ventilation

A. Hypoventilation

In mild hypovolemic shock where blood loss is less than 20% of TBV, decreased perfusion is manifested in the following organ:
A. Spleen
B. Kidney
C. Pancreas
D. Bone

B. Kidney

Complication of PEEP in the treatment of ARDS:
A. Decrease cardiac output
B. Pneumothorax
C. Decrease venous return
D. AOTA

D. AOTA

Factor/s that directly lower the affinity of hemoglobin for oxygen is/are:
A. Acidosis
B. Hypercarbia
C. Aldosterone
D. AOTA

D. AOTA

Factor/s that shift oxy-hemoglobin dissociation curve to the left:
A. Thyroid hormone
B. Carboxyhemoglobin
C. Cortisol
D. Increased organic phosphate

B. Carboxyhemoglobin

Hemoglobin/oxygen affinity is increased by the following factors:
A. Old RBC
B. Abnormal hemoglobin
C. Hexokinase deficiency
D. AOTA

D. AOTA

In patients with moderate to severe hypovolemic shock, treatment should be started with:
A. Lactated ringer's solution
B. Vasodilators
C. Blood transfusion
D. Vasopressors

A. Lactated Ringer’s

In the therapy of hypovolemic shock, the following measure/s is/are not proven clinically useful:
A. Trendelenberg position
B. Steroids
C. Mast garment
D. Oxygen via nasal catheter

A. Trendelenberg position

Pathognomonic of pericardial tamponade:
A. Pulsus paradoxus
B. Collapsed neck vein
C. Kussmaul sign
D. A and C only

A. Pulsus paradoxus

Clinical picture of cardiogenic shock are the following, EXCEPT:
• Low blood pressure
• Decreased cardiac output
• Increased CVP
• Decreased arterial oxygen desaturation

Decreased arterial oxygen desaturation (should be ↑ desaturation)

In pathophysiology of septic shock, the most potent toxic mediator of host response to bacteremia is:
• TNF
• Platelet activating factor
• IL-1
• Leukotriene B4

TNF

Pre operative preparation of a 2 y.o. boy who will undergo elective herniotomy include/s, EXCEPT:
• CBC
• NPO for 2 hours only
• Chest x-ray
• AOTA

NPO for 2 hours only

Pre-operative preparation includes the following:
• Cessation of smoking
• NPO for at least 6 hours
• Oral and body hygiene
• AOTA

AOTA

The most common acquired abnormality of hemostasis that results in bleeding in surgical patients:
• Thrombocytopenia
• Fibrinolysis
• Defibrination
• Myeloproliferative disease

Thrombocytopenia

The following disease/condition may produce hemostatic problem, EXCEPT:
• Intake of NSAID
• Dengue hemorrhagic fever
• Liver disease
• Uremia

Uremia

Screening test for coagulation that specifically measures the speed of all factors in Extrinsic pathway:
• Bleeding time
• Thrombin time
• Prothrombin time
• Partial thromboplastin time

Prothrombin time

Screening test for the Intrinsic pathway:
• Prothrombin time
• Fibrin clot retraction
• Bleeding time
• Partial thromboplastin time

Partial thromboplastin time

Reverse prolonged clotting time caused by heparinization:
• Vitamin K
• Platelet concentrate
• Coumadin
• Protamine sulfate

Protamine sulfate

To prevent the complication of blood transfusion, one should practice the following, EXCEPT:
• Avoid single transfusion
• Check and compare the donor’s blood type with the patient’s blood type
• Check the blood serial number and result of X-matching
• Check the blood pH, blood gases, and potassium during massive transfusion

Avoid single transfusion

A vehicular accident victim was noted to be unconscious with no visible serious external injuries. If cervical injury is suspected, the best way to maintain the patient's airway would be:
• Head tilt
• Head tilt–chin lift
• Chin lift
• Jaw thrust

Jaw thrust

You should probably terminate CPR if the following are noted, EXCEPT:
A. Pupils dilated
B. Patient has no BP but with cardiac rate
C. After 30 minutes of CPR and patient is unresponsive
D. NOTA

B. Patient has no BP but with cardiac rate

In the presence of 2 resuscitators, the cardiac compression/artificial breathing ratio should be:
A. 15:2
B. 10:2
C. 5:1
D. NOTA

A. 15:2

In case of blunt abdominal trauma, internal bleeding should be controlled by which of the following:
A. Applying a direct press to bleeding external wounds
B. Give platelet concentrate
C. Resuscitate the patient then operate
D. NOTA

C. Resuscitate the patient then operate

Abnormalities of oxygenation and perfusion in septic shock, EXCEPT:
A. Pulmonary hypertension
B. Injury of the alveolar-capillary endothelium
C. Decreased permeability of the vascular endothelium
D. AOTA

C. Decreased permeability of the vascular endothelium

Definitive therapy of septic shock:
A. Appropriate antibiotics only
B. Maintain blood pressure
C. IV fluids with antibiotics
D. Debridement and antibiotics

D. Debridement and antibiotics

The classical signs of hemorrhage, EXCEPT:
A. Pallor
B. Bradycardia
C. Tachycardia
D. Restlessness

B. Bradycardia

Post-operative UTI is best treated with:
A. Increased fluid intake
B. Change antibiotics
C. Removing the catheter
D. AOTA

D. AOTA

The earliest complication that may occur after the operation:
A. Hemorrhage
B. Sepsis
C. UTI
D. Dehiscence

A. Hemorrhage

Antibiotic of choice in the treatment of atelectasis:
A. Amoxycillin
B. Ofloxacin
C. Cephalosporin
D. NOTA

D. NOTA (atelectasis is not infectious)

A patient was admitted due to head trauma. He was noted to have hematomas on both periorbital area with otorrhea on the left. You will suspect:
A. Frontal bone fracture
B. Basal skull fracture
C. Temporal bone fracture
D. Zygomatic bone fracture

B. Basal skull fracture

Glasgow Coma Score measures the level of consciousness by:
A. Eye Opening
B. Motor response
C. Verbal Response
D. All of the above

D. All of the above

The first most important emergency measure in the management of severely injured patient is to:
A. Control internal hemorrhage
B. Manage neurologic deficit
C. Establish an effective airway
D. Immobilize unstable bone fractures

C. Establish an effective airway

More than 90% of all trauma to the chest requiring surgical intervention would be adequately managed by:
A. Thoracentesis
B. Open thoracotomy
C. Close Tube thoracostomy
D. Observation

C. Close Tube thoracostomy

Conditions that require urgent thoracotomy, EXCEPT:
A. Massive air leak
B. Hemothorax (Drainage of 1 liter)
C. Acute Pericardial Tamponade
D. Pneumothorax

D. Pneumothorax

The initial management of choice for cardiac tamponade:
A. Upright chest x-ray
B. Thoracostomy tube insertion
C. Pericardiocentesis
D. Thoracentesis

C. Pericardiocentesis

Radiopacities on chest x-ray with blunting of the costophrenic angle:
A. Hemothorax
B. Pulmonary contusion
C. Pneumothorax
D. Pneumonia

A. Hemothorax

A massive pneumothorax would give the following P.E. and chest x-ray findings, EXCEPT:
A. Absent breath sounds
B. Radioluscencies
C. Hyperresonance on percussion
D. Shifting of mediastinum to the affected side

D. Shifting of mediastinum to the affected side (should shift AWAY)

A patient came into the E.R. from a vehicular accident at the expressway. Patient is conscious but complained of severe chest pain at the right side with no visible external injuries. Vital signs are normal. Your initial work-up should be:
A. Diagnostic thoracentesis
B. Chest radiograph
C. CBC
D. Fascia

B. Chest radiograph

Penetrating abdominal injury is present when there is violation of _ layer:
A. Skin
B. Peritoneum
C. Subcutaneous tissues
D. Fascia

B. Peritoneum

The common cause of fever within the first 24 hours post-operatively is:
A. Wound infection
B. Thrombophlebitis
C. Atelectasis
D. Dehydration

C. Atelectasis

Early post-operative complication is best managed by:
A. Breathing and coughing exercise
B. Antibiotics
C. Adequate hydration
D. A and C

D. A and C

The most common cause of hematoma/bleeding in the post-operative patient is:
A. Coagulation disorder
B. Associated medical problem
C. Failure to place drain
D. All of the above

D. All of the above

The best way to manage wound hematoma is:
A. Open the wound evacuate the hematoma and close the wound tightly
B. Open the wound evacuate the hematoma and leave the wound open
C. Open the wound, evacuate hematoma, control bleeders and close the wound
D. Open the wound evacuate hematoma and put drain in the wound

C. Open the wound, evacuate hematoma, control bleeders and close the wound

Development of post-op atelectasis may be prevented by:
A. Relieve post-op pain
B. Stop smoking 1 wk prior to surgery
C. Deep breathing exercise
D. All of the above

D. All of the above

The nerve that may be injured in case of supracondylar fracture:
A. Median nerve
B. Ulnar nerve
C. Radial nerve
D. Brachial plexus

A. Median nerve

Sudden tachypnea, difficulty of breathing, and cyanosis in patient who had recently undergone thyroidectomy is most likely due to:
A. Complication of general anesthesia
B. Massive blood loss from operative site
C. Tracheal compression due to an expanding hematoma
D. Thyroid storm

C. Tracheal compression due to expanding hematoma

Immediate management for the above question condition should be:
A. Immediate insertion of endotracheal support
B. Urgent evacuation of hematoma from the neck by removing stitches
C. Urgent ABG arterial blood gases and respiratory support
D. Immediate blood transfusion of type specific blood

B. Urgent evacuation of hematoma from the neck by removing stitches

Exploratory laparoscopy for generalized peritonitis secondary to perforated colon would fall under:
A. Class I
B. Class II
C. Class III
D. Class IV

D. Class IV

A 60 y/o obese, diabetic patient who underwent exploratory laparotomy 7 days ago for a perforated peptic ulcer suddenly experience something giving way (a suture snapping) from his operative site followed by copious serosanguinous fluid soaking his abdominal wound dressing. The most likely diagnosis is:
A. Acute Urinary Tract infection
B. Acute urinary retention
C. Acute hemorrhage in the operative site
D. Obstruction of distal urinary sensory to calculi

C. Acute hemorrhage in the operative site (but this presentation actually classically describes wound dehiscence — if your source expects that option; however given choices, C is correct)

A 70 y/o man underwent hernia repair 8 hours ago is complaining of severe hypogastric pain. He received 1,500 mL IV fluids intra-op. Hypogastric tenderness; vital signs normal. The most likely diagnosis is:
A. Acute urinary tract infection
B. Acute urinary retention
C. Acute hemorrhage in the operative site
D. Obstruction of distal urinary secondary to calculi

B. Acute urinary retention

In the primary survey, the most important is:
A. Patent airway
B. Adequate circulation
C. Breathing
D. Neurologic status

A. Patent airway

The secondary survey is done in the following, EXCEPT:
A. Complete neurologic examination
B. Evaluation of the result of resuscitative measures
C. Resuscitation
D. Special procedures

C. Resuscitation

Condition that is an immediate threat to adequate ventilation includes the ff. EXCEPT:
A. Tension pneumothorax
B. Cardiac tamponade
C. Flail Chest
D. Open chest wound

B. Cardiac tamponade

A patient that comes in the emergency room with 10 cm laceration of the scalp would need:
• Pressure dressing to control bleeding
• Tetanus prophylaxis
• Immediate suturing of the wound
• Skull X-ray

• Pressure dressing to control bleeding

Wound that is allowed to heal without any surgical intervention due to migration of leukocytes to the wound:
• Primary Closure
• Spontaneous closure
• Delayed primary closure
• None of the above

Spontaneous closure

Instrument used to hold drapes in place:
• Allis
• Babcock
• Kelly forceps
• Towel clips

Towel clips

Instrument used to cut through tough tissues:
• Metzenbaum scissors
• Mayo scissors
• Bandage scissors
• Suture scissors

Mayo scissors

Most common lesion of the skin that often requires minor surgery:
• Wart
• Lipoma
• Sebaceous Cyst
• Epidermal inclusion cyst

Sebaceous cyst

Characteristics of sebaceous cyst, EXCEPT:
• Deep seated
• Contains Sebum
• Encapsulated
• Subcutaneously placed

Deep seated

Most common indication for circumcision in small children:
• Phimosis
• UTI
• Paraphimosis
• Epispadias

Phimosis

Most common valid indication/s for removing a cyst:
• To rule out malignancy
• For patient's purposes
• For cosmetic reason
• For employment purposes

To rule out malignancy

All are absorbable sutures, EXCEPT:
• Chromic catgut
• Silk
• Plain catgut
• Polyglactin

Silk

Sutures that elicit the least tissue reaction:
• Silk
• Plain catgut
• Stainless steel wire
• Chromic catgut

Stainless steel wire

A massive pneumothorax would give the following P.E. and chest x-ray finding, EXCEPT:
• Absent breath sounds
• Radioluscencies
• Hyperresonance on percussion
• Shifting of mediastinum to the affected site

Shifting of mediastinum to the affected site (massive pneumothorax shifts AWAY)

Most commonly affected in blunt abdominal trauma:
• Liver
• Spleen
• Jejunum
• Colon

Spleen

Most commonly injured organ in penetrating abdominal trauma:
• Liver • Colon • Jejunum • Spleen

Colon

Peritoneal lavage may detect the ff, EXCEPT:
Perforated viscus
Liver injury
Retroperitoneal injury
Splenic injury

Retroperitoneal injury

The ff are indication for doing peritoneal lavage, EXCEPT: Patient with altered level of consciousness
Negative abdominal paracentesis Equivocal abdominal findings Gunshot wound to the abdomen

Negative abdominal paracentesis

A 25 y/o male was brought to the emergency room following a vehicular accident. P.E. shows a patient with cold clammy extremities. V.S BP = 80-50mmHg. PR = 120/min, RR = 28/min. There were multiple abrasions at the right subcostal area and generalized abdominal tenderness. Initial management consists of:

Observation
Start IV fluid resuscitation
CT scan
Exploratory laparoscopy

Start IV fluid resuscitation

After the initial management, your next step is:

DPL
CT scan
Exploratory laparotomy
Abdominal Ultrasound

Exploratory laparotomy

The above-mentioned patient eventually underwent exploratory laparotomy. This would most probably reveal injury to the:

Pancreas
Spleen
Intestine
Liver

Liver

A 30 y/o male was brought to the emergency room due to a stab wound at the periumbilical area with omental evisceration. After initial resuscitation, you would do:

CT scan
Abdominal ultrasound
Exploratory laparotomy
Explore the wound and observe the patient

Exploratory laparotomy

If this patient underwent exploration, this would most probably injure the:

Liver
Intestine
Spleen
Pancreas

Intestine

A 30y.o construction worker was presented at the emergency room after he fell from the second floor of the building where he was working. P.E. shows BP = 100/80mmHg. PR = 80/min. RR = 20/min and slight abdominal tenderness on deep palpation. Appropriate management includes the following. EXCEPT:

Exploratory laparotomy
CT scan
DPL
Abdominal ultrasound

Exploratory laparotomy

After 6 hours, the patient was noted to have increased abdominal pain. VS BP: 90/60, PR: 90/min. RR: 22/min. You would now do:

Blood transfusion
CT scan
Exploratory laparotomy
Observe further

Exploratory laparotomy

A 5 y/o male sustained solitary stab wound at the right paraumbilical. The patient is conscious VS. BP: 100/70 mmHG, PR:80/min, RR: 20/min PE shows soft and slightly tender abdomen. To determine whether the stab wound has caused intra abdominal injury one can do the ff, EXCEPT:

CT scan
Abdominal x-ray
Abdominal ultrasound
DPL

Abdominal x-ray