What is the underlying cause of pernicious anemia in untreated gastrectomy patients?
A lack of vitamin B12 (cobalamin) in the diet
B lack of intrinsic factor secreted by gastric parietal cells
C lack of folate (folic acid) in the diet
D inability to absorb dietary iron
E reduced circulating levels of erythropoietin
Answer

Primary afferents that convey sensory input from the bladder to the micturition center in the pons have cell bodies (i.e., somas) that reside within the:
a. pons
b. medulla
c. dorsal root ganglia of lumbar nerves
d. inferior vagal ganglion

Cutting which of the following nerves would be expected to result in a diminished capacity for the detrusor muscle of the bladder to contract?
a. the pudendal nerve
b. lumbar splanchnic nerves that run to the inferior mesenteric ganglion
c. the hypogastric nerve.

During a massive stimulation of the sympathetic-adrenal medulla system (i.e., a fight or flight response), all of the following responses would be expected EXCEPT:
a. in increase in heart rate
b. an increase in glucose metabolism
c. an increase in gastrointestinal motility and secretion

Which of the following drugs or toxins will result in skeletal muscle paralysis? (E)
a. curare
b. succinlycholine
c. botulinum toxin
d. tetrodotoxin (TTX)
e. all of the above
Answer

A 24 year old man with an anterior lateral cystic neck mass is most apt to have a
A. Thyroglossal duct cyst
B. Brachial cleft cyst
C. Pleomorphic adenoma
D. Warthin tumor
Answer

Granulomas are characteristic of all EXCEPT:
A. Tuberculosis
B. Hypersensitivy pneumonitis
C. Histoplasmosis
D. Sarcoidosis
E. Asbestosis
Answer

A 67 year old man with a slowly worsening shortness of breath and a recent episode of hemoptysis. A non-smoker, he had been a deep coal miner for years. The chest radiographs show bilateral irregular areas of density in the upper lung lobes. An open lung biopsy reveals dense fibrosis and anthracosis in these areas; no malignancy is found. No necrosis is seen and no microorganism's are found. Your diagnosis:
A. Idiopathic interstitial fibrosis
B. Coal miner's pneumoconiosis with progressive massive fibrosis
C. Asbestosis
D. Silicosis
Answer

Pulmonary hypertension is LEAST likely in:
A. Patient with history of pulmonary emboli being treated for cancer by chemotherapy
B. Chronic bronchitis
C. Rheumatiod arthritis
D. Primary tuberculosis
Answer

The most likely cause of a pulmonary embolism:
A. Sudden death
B. Chronic cor pulmonale
C. Pulmonary infarction
D. Transient shortness of breath
E. No symptoms at all
Answer

The most common source of pulmonary emboli:
A. Hypogastric veins
B. Superior vena cava
C. Deep veins of the thigh
D. Axillary veins
E. Jugular veins
Answer

Patients with panacinar (panlobular) emphysema
A. Have diffuse interstitial lung fibrosis
B. May have related portal hypertension
C. Characteristically show mucus gland hyperplasia with an increase in the Reid index
D. Have medial hypertrophy of pulmonary arterial vessels by age 25
E. Have characteristic intra nuclear inclusions in pneumocytes
Answer

A 70 year old man presents slightly short of breath and afebrile. Multiple 1-2 cm nodules are found in the upper lobes of both lungs and mildly enlarged hilar lymph nodes are noted. Unfortunately, he is run down right outside your office by ( you guessed it) the Graham Service before you could talk to him further. The autpsy shows densely hyalinized fibrous with birefringent crystals and mild to moderate fibrosis which is most severe in the upper lobes of his lungs. No giant cells are seen and there is no necrosis. You guess that he retired from:

The most common cause of bacterial pneumonia
A. Pneumocystic carinii
B. Staphlococcus pneumonia
C. Escherichia coli
D. Streptococcus pneumonia
E. Pseudomonas aeroginosa
Answer

Dr. Slurpy, tired old pathologist, inhales his left lower bridge consisting of two teeth and completely obstructs his right lower lobe main bronchus. Wise but stubborn, he refuses surgical intervention for 2 weeks. By that time a right lower lobotomy is necessary. The LEAST likely pathological finding in light of the history:
A. Atelectasis
B. Emphysema
C. Empyema
D. Bronchiectasis
E. Broncopneumonia
Answer

A 45 year old man develops severe shortness of breath after an automobile accident. He is thought to have adult respiratory distress syndrome. The histological finding most characteristic of the first hours of the lesion:
A. Mucus plugs
B. Hemosiderin laden macrophages
C. Abscesses
D. Hyaline membranes
E. Multinucleated giant cells
Answer

The LEAST likely cause of adult respiratory distress syndrome:
A. Smoke inhalation
B. Right lower lobe mycoplasma pneumonia
C. Hemorrhagic shock
D. Disseminated intravascular coagulation
Answer

Mucus plugs are common findings in all EXCEPT:
A. Chronic bronchitis
B. Asthma
C. Panlobular emphysema
D. Cystic fibrosis
Answer

Pleuritis would be most likely in:
A. Lobar pneumonia
B. Early bronchopneumonia
C. Viral pneumonitis
D. Idiopathic pulmonary fibrosis
E. Sarcoidosis
Answer

The disease most likely to present as a solitary pulmonary nodule:
A. Asthma
B. Panacinar emphysema
C. Tuberculosis
D. Hypersensitivity pneumonitis
E. Asbestosis
Answer

Grey hepatization describes:
A. Liver cell metaplasia in interstial pneumonia
B. What happens to livers after the age of 100
C. A classic stage in lobular pneumonia with edema, red cell and neutrophil predominance in the intra-alveolar infiltrate
D. A classic stage in lobar pneumonia with fibrin predominance in the intra-alveolar infiltrate
Answer

The angiomatiod or plexiform lesion of pulmonary hypertension is most likely to occur in:
A. A 60 year old man with chronic bronchitis
B. A 35 year old male with Wegener's necrotizing granulomatosis and vasculitis
C. A 50 year old female non-smoker with an adenocarcinoma of the lung
D. A 5 year old with congenital cyanotic heart disease
E. A 70 year old person with end stage emphysema
Answer

The disease least likely to produce atelectasis:
A. Squamous cell carcinoma
B. Chronic bronchitis
C. Cystic fibrosis
D. Mycoplasma interstitial pneumonitis
Answer

The patient most likely to develop a pulmonary infraction after a pulmonary embolus:
A. A 25 year old athlete on crutches after a tibial fracture
B. A 65 year old chronic smoker hospitalized in traction after a motor vehicle accident with multiple pelvic fractures
C. A 10 month old boy hospitalized with RSV pneumonitis
D. A 32 year old ascribed health nut hospitalized for one week with pancreatis secondary to a common bile duct stone.
Answer

The major differences between bronchopneumonia and lobar pneumonia:
A. Kind of cells in the inflammatory infiltrate
B. Number of cells in inflammatory infiltrate
C. Degree of fibrovascular granulation tissue repair
D. Distribution of inflammatory infiltrate in the lung
E. Kind of chemical mediators initiating injury
Answer

Ferruginous bodies in the lungs are markers for:
A. Coal dust
B. Quartz exposure
C. Thermophillic actinomycea
D. Asbestos exposure
E. Nocardia
Answer

Chronic bronchitis is defined as:
A. Allergic asthma
B. A cough productive of sputum for 3 months for at least 2 years.
C A productive cough in a smoker
D. Chronic bronchial wall inflammation
E. Mucus plugs in bronchioles
Answer

Major basic protein is a major mediator of injury in:
A. Allergic asthma
B. Centrilobular emphysema
C. Panobular emphysema
D. Chronic bronchitis
E. Lobular pneumonia
Answer

A 42 year old black woman presents with shortness of breath. She is a non-smoker. A diffuse interstitial pattern with small parenchymal nodules is seen on chest radiograph, as well as massively enlarged hilar lymph nodes. Based on your suspected clinical diagnosis, what do you expect to find on transbronchial biopsy of the lung?
A. Loss of alveolar walls with minimal changes in the airways
B. Non caseating granulomata
C. Many neutrophils in alveoli with edema
D. Type II pneumocyte proliferation with chronic interstitial inflammation and intranuclear viral inclusions

The cardiomyopathy of alcohol abuse is a/an:
A. Dilated cardiomyopathy
B. Restrictive cardiomyopathy
C. Hypertrophic cardiomyopathy
D. Ischemic cardiomyopathy
Answer

Skeletal muscle breakdown produces predominantly liberation of which two amino acids?
A. Lysine.
B. Tyrosine.
C. Alanine.
D. Glutamine.
E. Arginine.
Answer

In “catabolic” surgical patients, which of the following changes in body composition do not occur?
A. Lean body mass increases.
B. Total body water increases.
C. Adipose tissue decreases.
D. Body weight decreases.
Answer

The hormonal alterations that follow operation and injury favor accelerated gluconeogenesis. This new glucose is consumed by which of the following tissues?
A. Central nervous system.
B. Skeletal muscle.
C. Bone.
D. Kidney.
E. Tissue in the healing wound.
Answer

Cytokines are endogenous signals that stimulate:
A. Local cell proliferation within the wound.
B. The central nervous system to initiate fever.
C. The production of “acute-phase proteins.”
D. Hypoferremia.
E. Septic shock.
Answer

The characteristic changes that follow a major operation or moderate to severe injury do not include the following:
A. Hypermetabolism.
B. Fever.
C. Tachypnea.
D. Hyperphagia.
E. Negative nitrogen balance.
Answer

Shock can best be defined as:
A. Hypotension.
B. Hypoperfusion of tissues.
C. Hypoxemia.
D. All of the above.
Answer

Which of the following statements about continuous cardiac output monitoring are true?
A. Continuous cardiac output monitoring may unmask events not detected by intermittent cardiac output measurements.
B. Continuous cardiac output monitoring by the thermodilution method requires continuous infusion of fluid injectate at a constant rate and temperature.
C. The major advantage of the Fick method over the thermodilution method of calculating cardiac output is that it is noninvasive, requiring only the determination of oxygen consumption by respiratory gas analysis.

Which of the following statements regarding cytokines is incorrect?
A. Cytokines act directly on target cells and may potentiate the actions of one another.
B. Interleukin 1 (IL-1) is a major proinflammatory mediator with multiple effects, including regulation of skeletal muscle proteolysis in patients with sepsis or significant injury.
C. Platelet-activating factor (PAF) is a major cytokine that results in platelet aggregation, bronchoconstriction, and increased vascular permeability.
D. Tumor necrosis factor alpha (TNF-a), despite its short plasma half-life, appears to be a principal mediator in the evolution of sepsis and the multiple organ dysfunction syndrome because of its multiple actions and the secondary cascades that it stimulates.

True statements concerning hypoadrenal shock include which of the following?
A. Adrenocortical insufficiency may manifest itself as severe shock refractory to volume and pressor therapy.
B. The presence of hyperglycemia and hypotension may suggest the diagnosis of shock due to adrenocortical insufficiency.
C. Hydrocortisone does not interfere with the serum cortisol assay and should be given to hemodynamically unstable patients suspected of having hypoadrenal shock.
D. The rapid adrenocorticotropic hormone (ACTH) stimulation test should be performed to help establish the diagnosis of acute adrenocortical insufficiency.
Answer

All of the following are true about neurogenic shock except:
A. There is a decrease in systemic vascular resistance and an increase in venous capacitance.
B. Tachycardia or bradycardia may be observed, along with hypotension.
C. The use of an alpha agonist such as phenylephrine is the mainstay of treatment.
D. Severe head injury, spinal cord injury, and high spinal anesthesia may all cause neurogenic shock.
Answer

True statements regarding eicosanoids include which of the following?
A. Prostaglandins and thromboxanes are synthesized via the cyclo-oxygenase pathway.
B. The vasoconstricting, platelet-aggregating, and bronchoconstricting effects of thromboxane A 2 are balanced by the actions of prostacyclin, which produces the opposite effects.
C. Leukotriene synthesis is inhibited by the action of nonsteroidal anti-inflammatory drugs (NSAIDs).
D. The principal prostaglandins have a short circulation half-life and exert most of their effects locally.
Answer

Which of the following statements about delivery-dependent oxygen consumption are true? A. Below the critical oxygen delivery (DO2crit), one would expect to see a decrease in the lactate-pyruvate ratio.
B. D(overdot)O 2crit may be increased in patients with sepsis.
C. A desirable goal in the treatment of shock is to achieve delivery-independent oxygen consumption.
D. The oxygen extraction ratio remains constant as long as oxygen delivery remains above D(overdot)O 2crit.

All of the following may be useful in the treatment of cardiogenic shock except:
A. Dobutamine.
B. Sodium nitroprusside.
C. Pneumatic antishock garment.
D. Intra-aortic balloon pump.
Answer

An 18-year-old man shot once in the left chest has a blood pressure of 80/50 mm. Hg, a heart rate of 130 beats per minute, and distended neck veins. Immediate treatment might include:
A. Administration of one liter of Ringer's lactate solution.
B. Subxiphoid pericardiotomy.
C. Needle decompression of the left chest in the second intercostal space.
D. Emergency thoracotomy to cross-clamp the aorta.
Answer

Which of the following statements concerning monitoring techniques in the intensive care unit are true?
A. Pulmonary artery and pulmonary capillary wedge pressure readings should be made at end inspiration, to minimize ventilatory artifacts.
B. Continuous SvO 2 monitoring based on the technique of reflectance spectrophotometry has been shown to be accurate and reliable.
C. Direct measurement of gastric intramucosal pH can be provided by gastrointestinal tonometry.
D. Hyperlactatemia may be seen in a number of clinical conditions not associated with tissue hypoxia, including liver disease and hypermetabolic states.

Which of the following statements are true of the multiple organ dysfunction syndrome (MODS)?
A. The “two-hit” model proposes that secondary MODS may be produced when even a relatively minor second insult reactivates, in a more amplified form, the systemic inflammatory response that was primed by an initial insult to the host.
B. The systemic inflammatory response syndrome (SIRS), shock due to sepsis or SIRS, and MODS may be regarded as a continuum of illness severity.
C. Prolonged stimulation or activation of Kupffer cells in the liver is thought to be a critical factor in the sustained, uncontrolled release of inflammatory mediators.

All of the following statements about hemorrhagic shock are true except:
A. Following hemorrhagic shock, there is an initial interstitial fluid volume contraction.
B. Dopamine, or a similar inotropic agent, should be given immediately for resuscitation from hemorrhagic shock, to increase cardiac output and improve oxygen delivery to hypoperfused tissues.
C. The use of colloid solutions or hypertonic saline solutions is contraindicated for treatment of hemorrhagic shock.
D. In hemorrhagic shock, a narrowed pulse pressure is commonly seen before a fall in systolic blood pressure.
Answer

Which of the following statements are true of oxidants?
A. In addition to their pathophysiologic roles in inflammation, injury, and infection, oxidants also have physiologic roles.
B. Oxidants may be generated from activated neutrophils and during reperfusion following a period of ischemia.
C. The deleterious effects of oxidants include lipid peroxidation and cell membrane damage, oxidative damage to DNA, and inhibition of adenosine triphosphate (ATP) synthesis.
D. The mechanism of ischemia-reperfusion injury involved the catalytic production of superoxide anion (O 2•) by the enzyme xanthine oxidase.
Answer

Which of the following statements about septic shock are true?
A. A circulating myocardial depressant factor may account for the cardiac dysfunction sometimes seen with shock due to sepsis or SIRS.
B. A cardiac index (CI) of 6 liters per minute per square meter of body surface, a pulmonary capillary wedge pressure of 15 mm. Hg, and a systemic vascular resistance index (SVRI) of 800 dynes-sec/(cm 5-m 2) is a hemodynamic profile consistent with septic shock.
C. An increase in SvO 2 in septic patients may be explained by the finding of anatomic arteriovenous shunts.

Which of the following statements about the role of the gut in shock and sepsis are true?
A. Selective decontamination of the digestive tract with the use of oral antibiotics has been shown to reduce nosocomial pneumonias and to improve mortality rates.
B. Enteral nutrition, as compared with parenteral nutrition, preserves the villus architecture of the gut.
C. Gut dysfunction may be an effect of shock, but it may also contribute to the development of MODS by the mechanism of bacterial translocation.

The Correct answer is B
The middle ear (tympanic) cavity is derived from the first pharyngeal pouch and the ossicles are from the first and second arch cartilages .
First Pharyngeal Pouch
forms the auditory tube (narrow proximal part) & tympanic cavity (distal sac-like structure) tympanic membrane—forms from lining of tympanic cav. later comes into contact with epithelial lining of 1st pharyngeal cleft (future EAM)

The Correct Option is E
Auditory receptors are located in the cochlea
Hearing is best developed in tetrapods, specifically mammals and birds The cochlea is a spiral-shaped tube consisting of two connected canals; the upper vestibular canal and the lower tympanic canal that are continuous at the apex of the cochlea These two canals are filled with perilymph The middle canal is the cochlear duct, and is filled with endolymph The organ of Corti is located in the cochlear duct, and is composed of hair cells resting on a basilar membrane The basilar membrane separates the cochlear duct from the tympanic canal The tectorial membrane lies above the hair cells In humans, sound waves cause the tympanic membrane to vibrate; the three middle ear bones (malleus, incus, and stapes) transmit and amplify the vibration to the oval window, which transmits the vibration to the perilymph in the vestibular canal The pressure wave is transmitted through the vestibular canal to the tympanic canal, and ultimately causes the basilar membrane to vibrate The tectorial membrane stimulates the hair cells of the organ of Corti, which send impulses to the brain via the cochlear nerve Sounds of different frequencies resonate and stimulate the basilar membrane in different ways and in different areas Loudness is based on a greater number of hair cells being stimulated The human ear typically responds to sounds between 20 and 20,000 cycles per second (Hz), which is much more sensitive than the human eye

Cells considered to be usually in the G0 of the cell cycle would include the following:
A. Columnar epithelium of the gastrointestinal tract
B. Hematopoietic tissues
C. Hepatocytes
D. A and B
E. All of the above
Answer

Both the aPTT and PT would be expected to be prolonged with:
A. Deficiency of factors X, V, II or I
B. Deficiency of factors X, V, II or XIII
C. Deficiency of factors XII, XI, IX, VIII, or IV
D. Deficiency of factors III or VII
E. Deficiency of HWMK (High molecular weight kininogen) or Prekallikrein
Answer

Which of the following would be increased with deficiency(ies) of factors XI, IX, or VIII:
A. aPTT (activated partial thromboplastin time)
B. PT (prothrombin time)
C. Ivey bleeding time
D. Platelet count
Answer

Both the aPTT and PT would be expected to be prolonged with:
A. Deficiency of factors X, V, II or I
B. Deficiency of factors X, V, II or XIII
C. Deficiency of factors XII, XI, IX, VIII, or IV
D. Deficiency of factors III or VII
E. Deficiency of HWMK (High molecular weight kininogen) or Prekallikrein
Answer

Which of the following would be increased with deficiency(ies) of factors XI, IX, or VIII:
A. aPTT (activated partial thromboplastin time)
B. PT (prothrombin time)
C. Ivey bleeding time
D. Platelet count
Answer

Fibrin/Fibrinogen split products may cause prolongation of the aPTT due to:
A. Inhibition of platelet aggregation
B. Inhibition of fibrin crosslinking by factors XIIIa
C. Inhibition of thrombin mediated conversion of fibrinogen to fibrin
D. Conversion of plasminogen to plasmin
Answer

Fibrin/Fibrinogen split products may cause prolongation of the aPTT due to:
A. Inhibition of platelet aggregation
B. Inhibition of fibrin crosslinking by factors XIIIa
C. Inhibition of thrombin mediated conversion of fibrinogen to fibrin
D. Conversion of plasminogen to plasmin
Answer

The pair of substances and special stains which is incorrect:
A. Lipid: Oil Red O (ORO)
B. Hemosiderin: Prussian Blue
C. Glygogen: Periodic Acid Schiff (PAS) without diastase
D. Anthracotic pigment: Alizarin Red
Answer

Multiple clear [unstained] vacuoles are seen in the cytoplasm of hepatocytes on a routinely stained liver biopsy from an alcoholic. A PAS stain fails to show any material in the vacuoles. An Oil Red O stain does stain red in the vacuoles when done on a piece of tissue cut on frozen section. Your conclusion:
A. The material is glycogen; the cytoplasmic vacuoles are normal.
B. The material is amyloid; the cytoplasmic change is irreversible.
C. The material is triglyceride; the change is irreversible.

A Prussion blue stain is done on granular pigment found in the liver; the stain is positive. Your findings and the interpretation:
A. The stain is blue; the pigment is hemosiderin
B. The stain is blue; the pigment is lipofuschin
C. The stain is black; the pigment is carbon
D. The stain is red; the pigment is amyloid
E. The stain is red; the pigment is cholesterol
Answer

A tatooed prison inmate is bitten by another inmate in a fight. You examine his healing scar two
weeks later, are concerned about infection, and do a biopsy and a culture to evaluate the wound. Your friendly local pathologist sees some brown pigment in the tissue. You think it is hemosiderin rather than tatoo pigment. To confirm your suspicion, you suggest that she do a:
A. Prussian blue stain
B. Trichrome stain
C. Oil Red O stain
D. Periodic Acid Schiff stain
E. Gram stain
Answer

The tissue not usually associated with hyperplasia:
A. Gastric mucosa
B. Skin
C. Skeletal muscle
D. Smooth muscle
E. Bronchial lining cells
Answer

Which of the following provides an example of concomitant hyperplasia and hypertrophy?
a. left ventricular cardiac hypertrophy
b. enlargement of skeletal muscle in athletics
c uterine growth during pregnancy
d cystic hyperplasia of the endometrium
Answer

Response of cardiac muscle to systemic hypertension
a. coagulation necrosis
b. hyperplasia
c. aplasia
d. hypertrophy
e. atrophy
Answer

Response of adrenocortical cells to a pituitary adenoma producing ACTH
a. coagulation necrosis
b. hyperplasia
c. aplasia
d. hypertrophy
e. atrophy
Answer

Ischemic damage in survivors of shock may result in this renal abnormality:
a oval fat bodies
b acute tubular necrosis
c proteinuria
d ascites
Answer

Ischemia may be the primary injury producing all of the following results in the affected organ except:
A. atrophy
B. apoptosis
C. coagulative necrosis
D. dystrophic calcification
E. anthracosis
Answer

Lipofuschin is:
A. Limited to the liver
B. Pigment from cellular breakdown
C. Microvesicular fatty change in the myocardium
D. Hyaline pigment in striated muscle cells
E. Stained distinctively by Prussian blue
Answer

Which of the following statements regarding slow waves in the stomach is FALSE? A. They consist of upstroke and plateau phases.
B. Their frequency is 3-5/minute.
C. When the plateau phase exceeds a threshold, contraction occurs.
D. Action potentials on top of the slow waves are required for contraction.

The pathway from the intestinal lumen to the circulating blood for a medium-chain fatty acid is A. enterocytechylomicronlymphatic ductblood
B. enteroctyeVLDLblood
C. enterocyteblood
D. enterocyteLDLlymphatic ductblood
E. enterocytelymphatic ductblood
Answer

Which of the following is responsible for moving fecal material into the rectum? A. segmentation contractions
B. rectosphincteric complex
C. migrating motility complex
D. mass movement
E. peristaltic contractions
Answer

With regard to gastric secretions, A. the higher the flow rate of gastric juice, the higher is its Na+ concentration.
B. H+ is secreted across the apical membrane of the parietal cell in exchange for K+.
C. Cl- is secreted into the lumen via a Cl- active transport protein.

With regard to salivary secretion, A. the major control of secretion is via the enteric nervous system.
B. parasympathetic input stimulates secretion, while sympathetic input inhibits secretion.
C. as flow rate increases, Na+ and Cl- concentrations increase.

With regard to the small intestine, A. peristaltic contractions are the most common type of contractions.
B. slow waves trigger contractions.
C. contractions are more frequent in the ileum than in the duodenum.
D. there is no migrating motility/myoelectric complex.

With regard to pancreatic secretion, A. during the intestinal phase, CCK stimulates pancreatic acinar cells to secrete pancreatic enzymes.
B. as flow rate increases, Na+ concentration increases.
C. CCK does not influence the response of ductal cells to secretin.
D. the HCO3- concentration is always lower than that in plasma.

Which of the following are determinants of the host response to surgical stress?
a. Gender
b. Age
c. Nutritional status
d. Body composition
Answer

Which of the following statement(s) is/are true concerning the role of glutamine in total parenteral nutrition?
a. Glutamine is an essential amino acid
b. Glutamine appears to be of primary benefit in critical illness
c. Glutamine is included in most standard TPN solutions
d. Glutamine is the primary energy source for intestinal mucosal cells of the small bowel and colon

In contrast to a patient undergoing an elective operation, which of the following statement(s) is/are true concerning a patient who has suffered a multiple trauma?
a. Basal metabolic rates are similar
b. The patient is highly sensitive to insulin
c. Utilization of the amino acids, glutamine and alanine, is similar to their composition in skeletal muscle

A 47-year-old patient undergoing a complicated laparotomy for bowel obstruction develops a postoperative enterocutaneous fistula. Which of the following statement(s) is/are true concerning parenteral nutritional support in the postoperative period?
a. Oral intake can result in severe dehydration, electrolyte abnormalities, and perifistula skin injury
b. Total parenteral nutrition increases the spontaneous closure rate of intestinal fistula
c. Total parenteral nutrition decreases mortality rate in patients with intestinal fistulas

Appropriate guidelines for the use of TPN in cancer patients include:
a. Long-term TPN in patients with rapid progressive tumor growth unresponsive to other therapy
b. Mildly malnourished patients undergoing surgery for a curable cancer
c. Preoperatively administered TPN prior to surgery or other therapy in patients with severe malnutrition

Which of the following statements(s) is/are true concerning human energy requirement?
a. In normal subjects, less than 5% of basal energy requirement is spent on cardiac output and the work of breathing
b. Mechanical ventilation can decrease the energy expenditure for normal respiration
c. For a 70 kg male, average resting energy consumption is almost 1500 kcal/day

A 55-year-old male undergoes a total abdominal colectomy. Which of the following statement(s) is/are true concerning the hormonal response to the surgical procedure?
a. Adrenocorticotropic hormone (ACTH) is secreted from the anterior pituitary gland
b. ACTH stimulation results in elevation of serum cortisol levels for up to a week after the operation
c. An increased secretion of aldosterone and ADH may contribute to postoperative fluid retention

Which of the following complications of TPN are appropriately managed with the listed treatment?
a. Air embolism—place patient in reverse Trendelenburg and the left lateral decubitus position and aspirate venous air
b. Hyperchloremic metabolic acidosis—give sodium and potassium as acetate salts
c. Carbon dioxide retention—decrease glucose calories and replace with fat
d. Line sepsis—intravenous antibiotics
Answer

A number of prospective clinical trials have addressed the role of total parenteral nutrition in the cancer patient. The results have been somewhat conflicting. Which of the following statement(s) have been proven correct by prospective trials?
a. Preoperative TPN is beneficial in surgical patients with severe preoperative nutrition
b. Postoperative TPN is of value following pancreatic resection
c. Routine use of perioperative (including prior to the procedure) TPN is of benefit in patients undergoing hepatectomy for hepatoma

Which of the following statements concerning perioperative nutrition is true concerning the above-described patient?
a. Since the patient’s weight had been stable with no preoperative nutritional deficit, 5% dextrose intravenous solutions are adequate for the initial postoperative source of nutrition
b. Preoperative immunologic status should be determined including total peripheral lymphocyte count and delayed hypersensitivity reaction to determine skin-test response to common antigens
c. Routine postoperative fluid administration with intravenous 5% glucose solutions can provide the calories to meet basal energy requirements

Which of the following tissues contain significant collagen useful for placing sutures to allow the prolonged tension necessary to maintain tissue approximation?
a. Dermis
b. Intestinal submucosa
c. Muscular fascia
d. Blood vessel wall
Answer

The neurohormonal arm of the stress response is well defined. Less is known about the inflammatory arm mediated primarily by cytokines. Which of the following statement(s) is/are true concerning this arm of the surgical stress response?
a. Cytokines primarily work locally via direct cell-to-cell communication
b. Cytokines are never detectable in the systemic bloodstream
c. Cytokines are produced only by immune cells attracted to the site of injury

Products of platelet degranulation include:
a. Tumor necrosis factor
b. Interleukin-1
c. Transforming growth factor b
d. Platelet-derived growth factor
Answer

Which of the following factors can be associated with impaired wound healing?
a. Chemotherapy
b. Chronic steroid use
c. Peripheral vascular disease
d. Radiation therapy
e. Diabetes mellitus
Answer

A patient with gross fecal contamination and peritonitis from a ruptured sigmoid diverticulum has his midline wound left open to heal by secondary intention. Which of the following statement(s) describes this healing process?
a. Wounds healing in this fashion have an altered sequence of healing compared to a primarily closed wound
b. A bed of granulation tissue forms over exposed subcutaneous tissue

Which of the following cells or blood elements play a role in the initial phases of wound healing?
a. Polymorphonuclear leukocytes (PMNs)
b. Platelets
c. Monocytes
d. Lymphocytes
Answer

Which of the following surgical techniques lead to improved wound healing?
a. Atraumatic handling of tissue
b. Approximation of underlying fatty tissue to obliterate dead space
c. Protecting the wound from water for at least one week
d. Meticulous hemostasis
Answer

Which of the following statement(s) is/are true concerning the clinical management of an open wound?
a. A wet-to-dry dressing is the most optimal form of wound management
b. A moist occlusive dressing promotes epithelialization and reduces pain
c. The protein rich plasma exudate covering the open wound facilitates healing
d. Irrigation of the wound disrupts epithelialization therefore inhibiting the healing process

Which of the following statement(s) is/are correct concerning the management of an open wound?
a. Frequent surgical debridement is usually necessary
b. Water irrigation can effectively debride most wounds
c. Hydrogen peroxide is particularly useful in the management of open wounds
d. A number of the newer dressing products have clearly been shown to promote wound healing compared to simple moist occlusive dressing

Which of the following statement(s) is/are true concerning the proliferative phase of wound healing?
a. The macrophage is the predominant cell type
b. The pink or purple-red appearance of a wound is due to ingrowth and proliferation of endothelial cells
c. Collagen, the dominant structural molecule of the wound matrix, contains two unique amino acids, hydroxyproline and hydroxylysine

Which of the following statement(s) is/are true concerning the role of antibiotics in wound care?
a. Systemic antibiotics are indicated for all open wounds
b. Bacterial resistance can occur with systemic but not topical antibiotics
c. An indication for systemic antibiotic administration is a granulation tissue bacterial count in excess of greater than 105 organisms/gram of tissue on quantitative analysis

Which of the following statement(s) is/are true about the role of macrophages in the wound healing process? a. Macrophages are the dominant cell type during the inflammatory phase of wound healing
b. Macrophages are not essential for wound healing
c. The macrophage role in wound healing is limited to phagocytosis

Which of the following statement(s) is/are true concerning wound contraction?
a. Wound contraction accounts for similar rates of reduction of wound size regardless of their location
b. The fibroblast, at the cellular level, is the primary force driving wound contraction
c. Excessive wound contraction, when occurring over a joint, may lead to disability

There are a multitude of various dressings available. Which of the following statement(s) is/are true concerning options for surgical dressings?
a. Hydrocolloids, such as karaya compounds, offer the primary advantage of increased absorptive ability
b. Films, such as Op-site, provide a water impermeable environment to achieve a dry wound
c. Impregnates are fine gauze impregnated with a variety of substances such as antibiotics or moisturizing agents that adhere tightly to the wound and do not require a secondary dressing

What is the NNT (number needed to treat) (see question19)? a. 5
b. 50
c. 0.5
d. 500
Answer

Diplopia is the most common clinical manifestation of MEN-1
A. True
B. False
Gastroenterology MCQ Answer 52

Neostigmine (Prostigmin) has been used to treat all of the following conditions EXCEPT
A. paralytic ileus.
B. bladder atony.
C. an overdose of d-tubocurarine.
D. myasthenia gravis.
E. organophosphate intoxication
Click Here For The Answer

To reverse muscle paralysis caused by an overdose of d-tubocurarine (Tubarin), administer
A. physostigmine (eserine).
B. neostigmine (Prostigmin).
C. succinylcholine (Anectine).
D. echothiophate (Phospholine).
E. pancuronium (Pavulon).
Click Here For The Answer

Which drug is LEAST likely to cause central effects?
A. Scopolamine
B. Physostigmine (eserine)
C. Vecuronium (Norcuron)
D. Pilocarpine
E. Cyclobenzaprine (Flexeril)
Click Here For The Answer

Select the TRUE statement.
A. During halothane anesthesia, a higher than normal dose of d-tubocurarine is required to produce skeletal muscle relaxation.
B. Succinylcholine has no potential for interaction with digitalis-like drugs.
C. Cyclobenzaprine is safe to use concurrently with a monoamine oxidase (MAO) inhibitor.
D. During treatment with an aminoglycoside antibiotic, less vecuronium is needed to produce skeletal muscle relaxation.
E. In patients with a history of malignant hyperthermia, succinylcholine can safely be used for endotracheal intubation prior to halothane-induced anesthesia.

Vecuronium (Norcuron)
A. is dangerous to use in asthmatics.
B. is contra-indicated in patients with narrow-angle glaucoma.
C. produces muscle fasiculations prior to muscle relaxation.
D. can potentially interact with aminoglycoside antibiotics.
E. causes desensitization of nicotinic receptors at the motor-endplate region.
Click Here For The Answer

Vecuronium (Norcuron)
A. abolishes autonomic reflexes.
B. causes skeletal muscle fasciculations prior to relaxation.
C. causes numerous CNS side effects.
D. decreases blood pressure dramatically.
E. is better than d-tubocurarine for use in asthmatics.
Click Here For The Answer

According to Poiseuille’s Law, flow through a tube is directly proportional to the driving pressure and the ____________.
vessel radius
vessel length
fluid viscosity
vessel length to the second power
vessel radius to the fourth power
Click Here For The Answer

Most of the blood is found in the _______________________.
capillaries
arteries
arterioles
venules
aorta
Click Here For The Answer

The vessels that exert the most pronounced “windkessel” function are the ________________________.
a. Capillaries
b. Large arteries
c. Large veins
d. Arterioles
e. Venules
Click Here For Answer

An elderly man comes to medical attention because of anemia and multiple infections. Physical examination is remarkable for hepatosplenomegaly. An automated blood count demonstrates pancytopenia.
Review of the peripheral smear by a hematologist demonstrates rare, distinctive, neoplastic white cells covered by fine, hairlike projections. Which of the following characteristics would likely be associated with these cells?
A. Birbeck granules
B. Elevated leukocyte alkaline phosphatase
C. Philadelphia chromosome
D. Positive tartrate-resistant acid phosphatase
E. Production of Bence-Jones proteins
Answer

A 40-year-old, moderately obese man presents with a persistent productive cough. The cough has been present for several weeks, but recently the man noted that his sputum has assumed a greenish color. Further questioning elicits a history of productive cough , usually in the winter months, over the past several years. He has smoked two packs of cigarettes per day since he was 16 years old. On examination, the man is febrile (100° F), and coarse rhonchi and wheezes can be appreciated bilaterally. Which of the following is the most likely diagnosis?

A 7- year-old girl develops behavioral changes, and her performance in school begins to deteriorate. Several months later she develops a seizure disorder, ataxia, and focal neurologic symptoms. She is eventually quadriparetic, spastic, and unresponsive. Death occurs within a year. This patient may have had which of the following viral diseases at 1 year of age?
A. Chickenpox
B. German measles
C. Measles
D. Mumps
E. Parvovirus B19
Answer

A 2-year-old child with leukemia develops nephrotic syndrome. Light microscopic studies are normal. Electron microscopic studies demonstrate fusion of epithelial foot processes. The current hypothesis
for the pathogenesis of this change is that it is secondary to which of the following?
A. Consumption of complement factors
B. IgG directed against basement membrane
C. Immune complex deposition
D. Lymphokine production by T cells
E. Mesangial IgA deposition
Anser

A healthy, 37-year-old, recently divorced woman loses her job at the auto factory. She picks up her three young children from the factory day care center and gets into an automobile accident on the
way home. Her 5-year-old son, who was not wearing a seat belt, sustains a severe head injury. The woman was not hurt in the accident, but is hyperventilating as she sits in the waiting room at the
hospital. She complains of feeling faint and has blurred vision. Which of the following is decreased in this woman?

A 37-year-old female presents to the emergency room with a fever. Chest x-ray shows multiple patchy infiltrates in both lungs. Echocardiography and blood cultures suggest a diagnosis of acute bacterial endocarditis limited to the tricuspid valve. Which of the following is the most probable etiology?
A. Congenital heart disease
B. Illicit drug use
C. Rheumatic fever
D. Rheumatoid arthritis
E. Systemic lupus erythematosus
Answer

The best type of x-ray to locate free abdominal air is:
A. A posteroanterior view of the chest.
B. A flat and upright view of the abdomen.
C. Computed tomograph (CT) of the abdomen.
D. A lateral decubitus x-ray, right side up.
Click For Answer

The most helpful diagnostic radiographic procedure in small bowel obstruction is: A. CT of the abdomen.
B. Contrast study of the intestine.
C. Supine and erect x-rays of the abdomen.
D. Ultrasonography of the abdomen.
Click For Answer

The most commonly used imaging method for diagnosis of acute cholecystitis is: A. CT of the abdomen.
B. Ultrasonography of the gallbladder.
C. Oral cholecystogram.
D. Radionuclide (HIDA) scan of the gallbladder.
Click For Answer

Meckel's diverticulitis most often occurs in the: A. Proximal jejunum.
B. Distal jejunum.
C. Proximal ileum.
D. Distal ileum.
Click For Answer

The diagnosis of acute appendicitis is most difficult to establish in: A. Persons aged 60 and older.
B. Women aged 18 to 35.
C. Infants younger than 1 year.
D. Pregnant women.
Click For Answer

Once a diagnosis of acute appendicitis has been made and appendectomy decided upon, which of the following is/are true? A. Prophylactic antibiotics should be administered.
B. Prophylactic antibitics are not necessary unless there is evidence of perforation.
C. If the appendix is not ruptured and not gangrenous, antibiotics may be discontinued after 24 hours.
D. Multiple antibiotics are in all cases preferable to a single agent.
Click For Answer

Acute salpingitis occurs most often: A. After menopause.
B. In patients with unilateral lower abdominal pain.
C. During the menstrual cycle.
D. In patients with cervical tenderness and vaginal discharge.
Click For Answer

Acute appendicitis is most commonly associated with which of the following signs? A. Temperature above 104؛ F.
B. Frequent loose stools.
C. Anorexia, abdominal pain, and right lower quadrant tenderness.
D. White blood cell count greater than 20,000 per cu. mm.
Click For Answer

Which of the following most often initiates the development of acute appendicitis? A. A viral infection.
B. Acute gastroenteritis.
C. Obstruction of the appendiceal lumen.
D. A primary clostridial infection.
Click For Answer

True or false? A. Mesenteric cysts are most often due to congenital lymphatic spaces that gradually fill with lymph.
B. Mesenteric cysts usually present as abdominal masses accompanied by pain, nausea, or vomiting.
C. Mesenteric cysts are best treated by marsupialization.
D. Omental cysts are frequently asymptomatic unless they undergo torsion.
Click For Answer

Which of the following statements about acute salpingitis are true? A. The disease rarely occurs after menopause.
B. Gonococcal infection is most common.
C. There is minimal cervical tenderness to palpation.
D. Vaginal discharge occurs rarely.
Click For Answer

29. Which of the following statements concerning intraperitoneal fluid collections are correct?
A. Ascites occurs when either the peritoneal fluid secretion rate increases or the absorption rate decreases.
B. Accumulation of lymph within the peritoneal cavity usually results from trauma as tumor involving the intra-abdominal lymphatic structures.
C. Choleperitoneum (intraperitoneal bile) generally occurs following biliary surgery, but spontaneous perforation of the bile duct has been reported.
D. The most common cause of hemoperitoneum is trauma to the liver or spleen.

30. The following statement about peritonitis are all true except:
A. Peritonitis is defined as inflammation of the peritoneum.
B. Most surgical peritonitis is secondary to bacterial contamination.
C. Primary peritonitis has no documented source of contamination and is more common in adults than in children and in men than in women.
D. Tuberculous peritonitis can present with or without ascites.
Click For Answer

The following statement(s) is/are true concerning abdominal incisional hernias.
Large incisional hernias are associated with a high recurrence rate when closed primarily
A large potential space remains anterior to the abdominal wall closure in most patients indicating a need for postoperative wound drainage
The use of prosthetic mesh can often be avoided by employing relaxing incisions in the anterior fascia parallel to the midline

Which of the following structures are derived from the external oblique muscle and its aponeurosis?
The inguinal or Poupart’s ligament
The lacunar ligament
The superficial inguinal ring
The conjoined tendon
Click For Answer

A number of special circumstances exist in the repair of inguinal hernias. The following statement(s) is/are correct.
Simultaneous repair of bilateral direct inguinal hernias can be performed with no significant increased risk of recurrence
The preperitoneal approach may be appropriate for repair of a multiple recurrent hernia
A femoral hernia repair can best be accomplished using a Bassini or Shouldice repair

The following statement(s) is/are true concerning incarceration of an inguinal hernia.
All incarcerated hernias are surgical emergencies and require prompt surgical intervention
Attempt at reduction of an incarcerated symptomatic hernia is generally considered safe
Vigorous attempts at reduction of an incarcerated hernia may result in reduction en masse with continued entrapment and possible progression to obstruction or strangulation