Pretest Surgery ( 2 )

1. Wasting of the intrinsic muscles of the hand can be expected to follow injury of the
A. Ulnar nerve
B. Radial nerve
C. Brachial nerve
D. Axillary nerve

2. A 30-year-old man is stabbed in the arm. There is no evidence of vascular injury, but he cannot flex his three
radial digits. He has injured the
C. Median nerve

3. Although wide surgical excision is the traditional treatment for malignant melanoma, narrow excision of thin
(less than 1 mm deep) stage I melanomas has been found to be equally safe and effective when the margin of
resection is as small as
C. 1 cm

4. With regard to wound healing, which one of the following statements is correct?
B. Monocytes are essential for normal wound healing

5. While you are on duty in the emergency room, a 12-year-old boy arrives with pain and inflammation over the
ball of his left foot and red streaks extending up the inner aspect of his leg. He remembers removing a wood
splinter from the sole of his foot on the previous day. The most likely infecting organism is
E. Streptococcus

6. The appropriate antibiotic to prescribe while awaiting specific culture verification is

A. Penicillin

7. Proper treatment for frostbite consists of

D. Immersion of the affected part in water at 40–44°C (104–111.2°F)

8. The true statement regarding tendon injuries in the hand is

E. The process of healing a tendon injury involves formation of a tenoma

9. Which one of the following cases is considered a clean contaminated wound

A. Open cholecystectomy for cholelithiasis
B. Herniorrhaphy with mesh repair
C. Lumpectomy with axillary node dissection
D. Appendectomy with walled-off abscess
10. True statements regarding squamous cell carcinoma of the lip include
A. The lesion often arises in areas of persistent hyperkeratosis
B. More than 90% of cases occur on the upper lip
C. The lesion constitutes 30% of all cancers of the oral cavity
D. Radiotherapy is considered inappropriate treatment for these lesions

11. Which of the following statements regarding carpal tunnel syndrome is correct?
B. It may be associated with pregnancy

12. Which of the following is true with regard to wound contraction?

D. It is based on specialized fibroblasts that contain actin myofilaments

13. Management of leukoplakia of the oral cavity includes

A. Excisional biopsy of all lesions
B. Application of topical antibiotics
C. Low-dose radiation therapy
D. Ascertaining that dentures fit properly

14. An 8-lb infant, born following uncomplicated labor and delivery, is noted to have a unilateral cleft lip and
palate .The parents should be advised that
A. The child almost certainly has other congenital anomalies
B. Rehabilitation requires adjunctive speech therapy
C. Lip repair is indicated at 1 year of age
D. Palate repair is indicated prior to 6 mo of age

15. A teenage boy falls from his bicycle and is run over by a truck. On arrival in the emergency room, he is
awake and alert and appears frightened but in no distress. The chest radiograph suggests an airfluid level in the
left lower lung field and the nasogastric tube seems to coil upward into the left chest. The next best step in
management is
C. Immediate celiotomy

16. Which of the following conditions is most likely to follow a compression-type abdominal injury?
A. Renal vascular injury
B. Superior mesenteric thrombosis
C. Mesenteric vascular injury
D. Avulsion of the splenic pedicle
E. Diaphragmatic hernia

17. A 65-year-old man who smokes cigarettes and has chronic obstructive pulmonary disease falls and fractures
the 7th, 8th, and 9th ribs in the left anterolateral chest. Chest x-ray is otherwise normal. Appropriate treatment
might include
D. Peritoneal lavage
18. A 27-year-old man sustains a single gunshot wound to the left thigh. In the emergency room he is noted to
have a large hematoma of his medial thigh. He complains of paresthesias in his foot. On examination there are
weak pulses palpable distal to the injury and the patient is unable to move his foot. The appropriate initial
management of this patient would be
B. Immediate exploration and repair

Items 19–20 A 25-year-old woman arrives in the emergency room following an automobile
accident. She is acutely dyspneic with a respiratory rate of 60 breaths/min. Breath sounds are
markedly diminished on the right side.

19. The first step in managing the patient should be to

C. Decompress the right pleural space

20. A chest x-ray of this woman Before therapy would probably reveal
A. Air in the right pleural space

21. Among the physiologic responses to acute injury is

A. Increased secretion of insulin
B. Increased secretion of thyroxine
C. Decreased secretion of vasopressin (ADH)
D. Decreased secretion of glucagon

22. In a stable patient, the management of a complete transection of the common bile duct distal to the insertion
of the cystic duct would be optimally performed with a
D. Roux-en-Y choledochojejunostomy

23. Non operative management of penetrating neck injuries has been advocated as an alternative to mandatory
exploration in asymptomatic patients. Which of the following findings would constitute a relative, rather than an
absolute, indication for formal neck exploration?
A. Expanding hematoma
B. Dysphagia
C. Dysphonia
D. Pneumothorax
E. Hemoptysis

24. Following blunt abdominal trauma, a 12-year-old girl develops upper abdominal pain, nausea, and vomiting.
An upper gastrointestinal series reveals a total obstruction of the duodenum with a “coiled spring” appearance
in the second and third portions. Appropriate management is
B. Nasogastric suction and observation

25. Following traumatic peripheral nerve transection, regrowth usually occurs at which of the following rates?
A. 0.1 mm per day
B. 1 mm per day
C. 5 mm per day
D. 1 cm per day
Items 26–27 A 28-year-old man is brought to the emergency room for a severe head injury after
a fall. Initially lethargic, he becomes comatose and does not move his right side .His left pupil is
dilated and responds only sluggishly.

26. The most common initial manifestation of increasing intracranial pressure in the victim of head trauma is
A. Change in level of consciousness

27. Initial emergency reduction of intracranial pressure is most rapidly accomplished by

E. Hyperventilation

28. In the patient described, compression of the affected nerve is produced by

B. Herniation of the uncal process of the temporal lobe

29. Regarding high-voltage electrical burns to an extremity

D. Evaluation for fracture of the other extremities and visceral injury is indicated

30. Which of the following fractures or dislocations of the extremities induced by blunt trauma is associated with
significant vascular injuries?
A. Knee dislocation

31. Protein metabolism after trauma is characterized by

A. Decreased liver gluconeogenesis
B. Inhibition of skeletal muscle breakdown)
C. Decreased urinary nitrogen loss
D. Hepatic synthesis of acute-phase reactants

32. The response to shock includes which of the following metabolic effects?
A. Increase in sodium and water excretion
B. Increase in renal perfusion
C. Decrease in cortisol levels
D. Hyperkalemia
E. Hypoglycemia

33. Appropriate treatment for an acute stable hematoma of the pinna of the ear includes which of the following
measures?
A. Ice packs and prophylactic antibiotics
B. Excision of the hematoma
C. Needle aspiration
D. Incision, drainage, and pressure bandage
34. Animal and clinical studies have shown that administration of lactated Ringer’s solution to patients with
hypovolemic shock may
A. Increase serum lactate concentration
B. Impair liver function
C. Improve hemodynamics by alleviating the deficit in the interstitial fluid compartment

35. Which of the following situations would be an indication for performance of a thoracotomy in the emergency
room?
C. Rapidly deteriorating patient with cardiac tamponade from penetrating thoracic trauma

Items 36–37 An 18-year-old high school football player is kicked in the left flank. Three hours
later he develops hematuria.His vital signs are stable.

36. The diagnostic tests performed reveal extravasation of contrast into the renal parenchyma .Treatment
should consist of
E. Antibiotics and serial monitoring of blood count and vital signs

37. Initial diagnostic tests in the emergency room should include which of the following?
D. Intravenous pyelogram

38. True statements concerning penetrating pancreatic trauma include

E. The major cause of death is exsanguination from associated vascular injuries

39. A 26-year-old man sustains a gunshot wound to the left thigh. Exploration reveals that a 5-cm portion of
superficial femoral artery is destroyed .Appropriate management includes
A. Debridement and end-to-end anastomosis
B. Debridement and repair with an interposition prosthetic graft
C. Debridement and repair with an interposition arterial graft
D. Debridement and repair with an interposition vein graft

1 A 11 B 21 A 31 D
2 C 12 D 22 C 32 D
3 C 13 D 23 E 33 D
4 B 14 B 24 B 34 C
5 E 15 C 25 B 35 C
6 A 16 E 26 A 36 E
7 D 17 D 27 E 37 D
8 E 18 B 28 B 38 E
9 A 19 C 29 D 39 D
10 A 20 A 30 A