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BChemotherapy

CRadiation therapy

DImmunotherapy

ERegional hyperthermic perfusion View Answer

21.A 21 -year-old male suffers a severe comminuted fracture of the right lower extremity with considerable soft tissue loss after a motorcycle accident. He has exposed bone and tendon in his wound after external fixation. Which is the appropriate management ?

ASplit -thickness skin graft

BFull -thickness skin graft

CAllograft followed by full -thickness skin graft

DZ plasty

EMuscle flap

View Answer

22.The son of a 74 -year-old woman calls her primary care physician for advice. He says that his mother has been complaining of headache and vertigo for several hours and is vomiting. Apart from a deep venous thrombosis in her left leg 2 months ago, she has been healthy. They shared dinner the night before, and she had been fine. She now is asking for a prescription for the same motion sickness pills that she used to help her son when she drove him to camp. What should the physician do?

A Call in a prescription for droperidol

B Make arrangements to see the patient in clinic tomorrow C Make arrangements to see the patient in clinic today

D Recommend that the patient be taken to the emergency department in an ambulance

E Order a ventilation/perfusion ([V with dot above]/[Q with dot above]) scan to rule out pulmonary embolism

View Answer

23.Which of these statements is true?

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A Brain metastases occur more frequently than primary brain tumors.

B The Cushing's response is the tachycardia and hypertension seen with mass lesions of the pituitary. C The Cushing's response is bradycardia and hypotension seen with terminal brain herniation.

D The Cushing's response is the maintenance of cerebral perfusion pressure against variations in systemic blood pressure.

E Primary brain tumors are more common than metastatic brain tumors. View Answer

Questions 24–25

A 38 -year -old previously healthy female presents with a single partial seizure. Physical examination is unremarkable. A CT head scan shows a lesion that enhances with contrast measuring 1.5 × 1 cm in the tip of the right temporal lobe surrounded by a rim of local edema.

24.What is the best way to proceed?

A Stereotactic needle biopsy B Open biopsy

C Tumor resection

D Electroencephalography (EEG)

E Brain magnetic resonance imaging (MRI), chest radiograph View Answer

25.If this patient's lesion is resected and it turns out to be a glioblastoma, which of the following is true?

A The patient's median expected survival is 2 years. B Additional surgery is not meaningful.

C The patient's prognosis is unchanged by radiation therapy. D Age is an important prognostic factor for this tumor.

E The clinical presentation of the tumor was uncommon for this patient.

View Answer

26.Which of the following major joint dislocations constitutes the most dire surgical emergency?

A Hip dislocation B Knee dislocation

C Shoulder dislocation D Elbow dislocation

E Subtalar dislocation View Answer

27.A 37 -year-old intoxicated man is struck by the bumper of a car while he is crossing the street. He sustains a comminuted closed proximal one -third tibia and fibula fractures. The fractures are stabilized with an external fixator 1 hour after the man arrives at the trauma bay. Approximately 2 hours after surgery, he has a severe pain that is not controlled by intravenous morphine. The physical examination demonstrates 2+ dorsalis pedis and posterior tibial pulses, increased swelling of the leg, decreased sensation and paresthesias of the first web space, and exquisite pain with active and passive motion of the toes. What should be the next step in treatment?

A Four compartment fasciotomies of the leg B Femoral angiography with runoff

C Elevation of the leg above the heart D Continued observation

E Repeat plain radiographs of the leg View Answer

28.Which of the following describes the most appropriate treatment regimen for a newly diagnosed primary osteogenic sarcoma of the distal femur?

A Above -knee amputation and chemotherapy B Radiation therapy

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C Limb -salvage surgery with marginal excision

D Neoadjuvant and adjuvant chemotherapy with surgical excision

E A combination of chemotherapy and radiation therapy

View Answer

29.A 2,600 -g newborn without any obvious anomalies turns blue during her first feeding. An attempt at passing an oral gastric tube to decompress the stomach is unsuccessful. Which of the following statements is correct?

A The most likely form of tracheal esophageal malformation is a blind pouch without a tracheal fistula. B No further workup for other anomalies is indicated owing to the normal appearance of the patient. C Because the orogastric tube does not pass, it should be removed to prevent gagging.

D Primary repair can be undertaken if the defect is less than 2 cm in length

E If the lung fields are clear to auscultation after the cyanotic episode, an immediate chest radiograph would not aid in the newborn's management.

View Answer

30.Which of the following statements about laparoscopic surgery is true?

A Due to the minimally invasive nature of laparoscopy, preoperative evaluation of patients is less critical than for laparotomy.

B Routine use of orogastric tubes and urinary catheters is unnecessary during advanced laparoscopic procedures.

C The abdomen is always prepared and draped for potential laparotomy.

D Antithromboembolic pumps are not needed during laparoscopic procedures, as the risk of deep venous thrombosis is less than for laparotomy.

E Spinal anesthesia is sufficient for most advanced laparoscopic procedures. View Answer

31.Which of the following physiologic changes occurs as a result of carbon dioxide pneumoperitoneum ?

A Decreased pulmonary compliance due to diaphragm elevation and increased abdominal pressure B Metabolic alkalosis from systemic absorption of carbon dioxide

C Increased cardiac output as a result of increased venous return D Decreased systemic vascular resistance

E Decreased mean arterial pressure View Answer

32.A 32 -year-old woman undergoes a laparoscopic cholecystectomy for biliary colic. Forty-eight hours after the operation, she complains of fever and right upper quadrant pain. Laboratory studies reveal an elevated white blood cell count as well as an elevated total bilirubin. Which of the following is not part of the initial management ?

A CT scan of the abdomen

B Hydroxy iminodiacetic acid (HIDA) biliary scan C Surgical exploration

D Endoscopic retrograde cholangiopancreatography (ERCP) E Broad spectrum antibiotics

View Answer

33.Which of the following is true about pediatric hernias?

A The incidence is roughly equal in males and females, with males becoming more common as age increases.

B Congenital pediatric hernias are bilateral 50% of the time.

C Inguinal hernias often close spontaneously in children, and repair should be delayed until 2 years of age.

D Incarcerated hernias in children should never be reduced. Emergency repair is mandatory. E Right -sided inguinal hernias are twice as common as left -sided inguinal hernias.

View Answer

34. A victim of a motor vehicle accident who was thrown from the vehicle is brought to the emergency department. The patient is unconscious and hypotensive. He is found to have a dilated left pupil, P.603

decreased breath sounds over the right chest, a moderately distended abdomen, an unstable pelvis, and severe bruises over the thighs. After resuscitation with 2 L of crystalloid and 2 units of type-specific packed red blood cells, the patient remains hypotensive with a systolic blood pressure in the low 80s. What is the least likely explanation for this patient's hypotension?

A External blood loss

B Bleeding into the chest C Retroperitoneal bleeding

D Severe closed head injury E Femoral fractures

View Answer

35.An adult male is brought to the emergency department for evaluation and treatment following injury in a house fire. The patient was found in a closed room. He has singed facial hair and full-thickness burns over approximately 30% of his body surface area. All of the following are important in his initial stabilization and treatment except which ?

A Endotracheal intubation

B Intravenous fluid resuscitation C Insertion of a ureteral catheter D Tetanus toxoid administration E Systemic antibiotics

View Answer

36.Which of the following is not associated with an increased incidence of invasive ductal carcinoma of the breast ?

A Sclerosing adenosis

B Lobular carcinoma in situ

C Atypical ductal hyperplasia

D Epithelial hyperplasia

EPapillomatosis View Answer

37.With the increasing use of ultrasound, prenatal diagnosis of abdominal wall defects is becoming more common. You are asked to consult a family with this prenatal diagnosis. Which of the following points and discussion is not true?

AClosure may require more than a single operation.

BIf gastroschisis is strongly suspected, amniocentesis is essential to rule out chromosomal abnormalities.

CTotal parenteral nutrition is frequently used.

DThe outcome of this category of patient is related both to the integrity of the gastrointestinal tract or to associated anomalies.

EOne of the primary goals of treatment with abdominal wall defects is to protect the exposed contents of the abdomen.

View Answer

38.A patient is involved in a high -speed motor vehicle collision. The patient has a GCS score of 7 on arrival. Which of the following is not indicated?

AEmergent intubation

BPlacement of an intraventricular catheter

CNasogastric tube to prevent aspiration

DSpinal cord immobilization

EUrgent CT scan of the brain

View Answer

39. Disadvantages of laparoscopy when compared with laparotomy include all of the following except which ?

A Difficulty controlling severe bleeding

B Poorer visualization of the operative field C Greater difficulty placing sutures

D Loss of tactile sensation

E Higher operating room costs View Answer

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40. Laparoscopic cholecystectomy is indicated for all of the following conditions except which ?

A Biliary dyskinesia

B Initial treatment in patients with severe cholangitis C Acute cholecystitis

D Symptomatic cholelithiasis E Biliary pancreatitis

View Answer

Directions: The group of items in this section consists of lettered options followed by a set of numbered items. For each item, select the lettered option(s) that is(are) most closely associated with it. Each lettered option may be selected once, more than once, or not at all.

Questions 41–44

Match the correct treatment with each inflammatory or infectious process of the breast .

41. Mastitis

A Surgical drainage

B Excision of sinus tract

CAntibiotics

DNonsteroidal anti -inflammatory drugs (NSAIDs) View Answer

42. Abscess

A Surgical drainage

B Excision of sinus tract

CAntibiotics

DNonsteroidal anti -inflammatory drugs (NSAIDs) View Answer

43.Chronic subareolar abscess

ASurgical drainage

BExcision of sinus tract

CAntibiotics

DNonsteroidal anti -inflammatory drugs (NSAIDs) View Answer

44.Mondor's disease

ASurgical drainage

BExcision of sinus tract

CAntibiotics

DNonsteroidal anti -inflammatory drugs (NSAIDs) View Answer

Questions 45–49

For each clinical situation, match the appropriate diagnosis .

45.Occurs when there is cross -match incompatibility

A Acute tubular necrosis B Hyperacute rejection

C Graft versus host disease D Acute rejection

E Chronic rejection View Answer

46.Usually a temporary condition or poor renal function that lasts from 1–14 days related to preservation, ischemia, and reperfusion of the transplanted kidney

A Acute tubular necrosis B Hyperacute rejection

C Graft versus host disease D Acute rejection

E Chronic rejection View Answer

47.Can usually be successfully treated with high doses of immunosuppression, such as methylprednisolone

A Acute tubular necrosis B Hyperacute rejection

C Graft versus host disease D Acute rejection

E Chronic rejection View Answer

48.More prevalent in small bowel transplantation than in other organ transplants related to the large amount of lymphoid tissue associated with the graft

A Acute tubular necrosis B Hyperacute rejection

C Graft versus host disease D Acute rejection

E Chronic rejection View Answer