Surgery Esophagoscopy

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1 .Heparin
        1. Acts as an anti-platelet
        2. Acts as an anti-thromboplastinx
        3. Acts as an antithrombin ^
        4. All of the above
        5. None of the above
2. Hyperparathyroidism is associated with
        X. Increased serum calcium, deci eased serum phosphate
        2. Increased serum calcium, increased serum phosphate
        3. Decreased serum calcium, increased serum phosphate
        4. Decreased serum calcium, decreased serum phosphate
        5. None of the above
3. Frey's Syndrome is associated with
          1. Thyroiditis
          2. Thyroidectomy
          3. Hyperparathyroidism
          4. Parotitis
          5. Parotidectomy
4. An insulinoma is characterised by,
         1. May lead to patient's incarceration in a mental institution and be confused with
        2. Is palpable
             Causes hypoglycemia which is constant
        4. Is characterised by loss of appetite
        5. Is easily diagnosed by ERCP
5. Wound infection commonly occurs on which post-op day,
        1. 1st
        2. 2nd-4th
        4. 8th-10th
        5.11th -13th

6. Which of the following do you consider to be the most important clinical sign in acute
        1. Abdominal tenderness around the umbilicus
        2. Abdominal tenderness in the RTF tt. Tenderness over McBumey' s point
        4. Rovsing's sign positive
        5. Suprapubic tenderness

7.         Post-surgery      weight loss is considered serious when the percentage of
body weight lost is
        1. 5%
        2. 10%
        3.     15%
         4.    20%
         5.    25%
8. Which of the following is true of thyroglossal cyst and sinus tract?
         1. They contain thymic tissue
            Should be removed together with middle part of hyoid bone
         3. They open behind SCM
         4. They extend to the tonsillar fossae
         5. Never have any relationship with cancer
9. A patient develops a fever after appendectomy for acute appendicitis. Which of the
following investigations is inappropriate?
          1. Pus in urine
          2. X-ray screen for air under diaphragm
          3. Cholecystogram
          3. Look for DVT
          4. Look for wound infection
10. Which of the following are frequent complications of thyroid surgery?
         1. Haemorrhage and tracheal compression
         2. Tetany
         3. Recurrent laryngeal nerve injury
         4. Thyroid storm
         5. All of the above
11. Which of the following concerning fluctuance and fluid impulse are true,
         1. They are the same thing
         2. 2 fingers are used to examine a small lump
         3. A large lump requires examination with 3 fingers
         4. The plane of a transmitted fluid impulse is unimportant
         5. <unknown>
12. Commonest surgical disease of the parotid is
        1. Carcinoma
        2.   Warthin's tumour
        3. Calculus
        4. Mixed tumour
         5. Chronic parotitis

13.Incidence of renal injuries in abdominal trauma?

        none of the above
14.Regarding etiology of CA prostate,
       1. A genetically induced susceptibility is suggested on the high occurrence
          rate amongst American Blacks
       2 A hormonal basis is possible because of regression following castration of
       estrogen therapy
       3. Exposure to dust of calcium salts has resulted in an increase in incidence
       3. None of the above
       3. All of the above
15.Which of the following is true as regards amoebiasis?
       Infection caused by Entamoeba coll
       Can be reliably diagnosed by sigmoidoscopy
       Entamoeba histolytica
16.Resection of the colon in diverticulitis is indicated in all of the following except,
       Absence of complications
       Recurrent or more obstructions
       Sudden heavy bleeding
       When the possibility of cancer can't be excluded
       All of the above
2. Which of the following are not seen in the anabolic phase following uncomplicated
elective surgery?
         Positive nitrogen balance
         Increased synthesis of protein
          High insulin to glucagon ratio
          All of the above
2. Best form of palliation in advanced gastric cancer is,
         Gastric bypass procedure
19. All of the following are mechanisms of urinary calculi formation except,
             Prolonged recumbency
             Infection with urea-splitting organisms
              Foreign body
             Urinary tract obstruction
20. Which of the following is not present in tetralogy of Fallot?
       Obstruction of the pulmonary outflow tract
       Right ventricular hypertrophy
       Dextroposition of the aorta
       Ventricular septal defect
        Ostium secundum defect
 21. Regarding UTIs, which of the following is/are true?
        1. Simple urologic procedures such as cystoscopy, urethral dilation and
        catheterisation don't hold risk of introducing pathogens into the bladder
        2.There is an increased risk of intrinsic infection in secondary fluid of prostate
        which increases risk of UTI in urologic surgery
        3.Pre-op sterilisation of urine is not mandatory to reduce morbidity
        4.Critical factor in prevention of infection is choice of antibiotic not duration of
        5.All of the above
10. Which of the following is incorrect in Paget's disease of nipple,
        Presents with eczema and redness of the nipple and areola
       Tumour arises from epidermal layer of nipple and not from epidermal layer of
underlying ducts
         Underlying carcinoma may be present beneath the nipple
         Mastectomy is considered the treatment of choice
        5. It is considered carcinoma-in-situ          C"
11. Which of the following as regards Hirschprung's disease,
        3. More common in premature babies
        4. 90% of affected babies cannot pass meconium
        5. Some mild cases present as adults
        6. Full thickness rectal biopsy is required for diagnosis
       7.    There are no ganglion cells in Meissner's and Auerbach's plexuses
24. Organisms most commonly isolated in UTIs,
       4. Kleb
       5. Proteus
       6. Acinetobacter
       7. All of the above
1. Composition of urinary calculi most often seen in Singapore,
      4. Uric acid
      5. Triple phosphate
            Calcium oxalate with a mixture of phosphate and magnesium
       5. Urate and phosphate
       6. Cysteine          , ^r^
1. Likeliest cause of hypokalemia?
       1.     Watery diarrhoea
       2.     Vomitting
       7.   Diarrhoea
       8.   Incomplete small gut obstruction
       9.   Hypovolemia from blood loss
2. Blood transfusion before elective operation
       12. Given a few days before to prevent stress of transfusion
       13. Given a few days before to allow complications to manifest if any
       14. Given immediately before surgery to get maximum benefit
       3. Given a few days before as level of 2,3-DPG in transfused blood is low
       4. <unknown>
 28. Excessive saliva in a newborn is due to
       1. Esophageal atresia
        2. Salivary gland tumour
       15. <unknown>
       16. <unknown>
       17. <unknown>
29. Daily fluid replacement for a 55 yr old elderly woman?
        4. 1625
        5. 2025
        3. 2200
        4. 2375
        5. 2550
30. In acute cholecystitis, which of the following is false
        10. In early cholecystectomy, high risk of duct damage
        11. Operation is much more difficult in first 48 hours compared to 10 days later
        12. Delay is okay as there is a low risk of perforation
             Cholecystectomy is needed because of gallstones
        5. Cholecystectomy is rarely if ever needed
31. Which of the following measures is not part of aseptic technique observed?
       2. Impermeable gloves
       3. Lodophor sol for skin preparation
        4. Filtered air in operating theatre
        5. Antibiotic therapy
        5. Gas sterilisation of instruments
32. The most frequent congenital diaphragmatic hernia seen in infants is,
             Paraesophageal hernia
             Sliding hernia
             Congenitally short esophagus
             Hernia through the foramen of Bochdalek-
              5. Hernia through the foramen of Morgagni
33. Cardiac arrest is irreversible after
        5. 1-4 mins
        6. -4-6 mins
            6-10 mins*
        5. 10-15 mins
        6. 15-30 mins
34. 30 year old man presents with enlarged left testicle, firm to hard in consistency. The
best approach is
             Trans-scrotal tru-cut needle biopsy
        18. High inguinal exploration and frozen section before orchidectomy
        19. Lymphangio-graphy/CT abdo
        20. Trans-scrotal orchidectomy
        21. Explore the testis only if AFP, beta-HCG levels are elevated
35. Which is the preferred drainage system for duodenal stump leak after surgery?
       3. Penrose drain
       4. Radivac drain with suction
           Large silicon tube with suction
       4. T-tube with suction
       4. Sump drain with suction
36. <unknown>

37.An undescended testis.
       4. Can be associated with contralateral testicular dysfunction
       4. Should be treated by orchidopexy by age 2
      3. Is associated with inguinal hernia
        4.     Predisposes to malignant change
        5. All of the above
7. Which of the following regarding visceral pain is true?
         l. Pain referred away from source
        5.  Localised to particular dermatome
        6.  Localised to surgical scar
        7.  "Habit forming"
        8.  All of the above
8. The wound made to remove a perforated appendix is classified as,
              Clean -                                        +
             4 Dirty                              °
             5. Doesn't apply as the wound isn't a traumatic one
40.Concerning the treatment of haemorrhoids,
       4. Can be by diet
       4. By injection sclerotherapy
       4. By banding
      4. Is mainly by haemorrhoidectomy
        4. All of the above
4. Which of the following causes of IO gives the worse prognosis?
       4. Adhesions
       4. Diverticulitis
       4. Mesenteric ischaemia
       4. Intrinsic tumour
       4. Hernia
4. The following is/are an indication for thoracotomy in chest injury,
        4. Cardiac tamponade
        4. Uncontrolled pulmonary air leakage
        4. Perforation of thoracic esophagus
        4. Blood loss of200ml/hr for 2-3 hrs via chest tube
        4. All of the above
4. All the following are seen in patients following blood transfusion. Which can not be
attributed to transfusion reaction?
         4. Jaundice
         4. Hemoglobinuria
         4. Severe loin pain
             Fever and chills

44.Chronic varicose ulcers don't heal well because of
       1. Eczematous pigmentation
         Ischaemic venous stress
          Recurrent trauma
          Recurrent infection
       5 . Peripheral capillary occlusion
 In an upper GI bleed, in some cases a Sengstaken-Blakemore tube is incerted. What is
the primary purpose of the tube?
         22. Aspirate blood from the stomach
         23. Tube feeding
         24. Tamponade for varices
         25. To decompress bowel
        26. All of the above
Risk factors for pulmonary embolism do not include which of the following?
        3. DVT
        3. Recent surgery
        3. Old age
        3. Myocardial infarction
        3. Chest infection
4. Villous adenomas of the rectum should be completely removed because of its tendency
        4. Cause severe diarrhoea
        4. Prolapse
          Malignant change
        4. Cause intestinal bleeding
        4. Cause pain
Which of the following are not found in peritonitis?
       4. Patient is lying still
       4. Guarding
       4. Rebound tenderness
       4. Hyperactive bowel sounds
       4. Rigid abdomen
4. Le Fort fractures are fractures of the
        4. Malar
        4. Frontal
        4. Maxilla
        1. Mandible
        2. Nasal
50.Major post-op complication of abdominal surgery
          Reactive hemorrhage
       7. Wound infection
       7. Urinary retention
       7. Chest infection
       7. Aspiration pneumonia
8. Commonest site for CA breast
      27. Upper outer quadrant
      28. Upper inner quadrant
      29. Lower outer quadrant
      30. Lower inner quadrant
      31. None of the above
3. Main blood supply of breast comes from which of the following vessels?
             Internal mammary
        3.   Intercostal arteries
        3.   Long thoracic
        3.   Pectoral branch of thoraco-acromial
        3.   <unknown>
3. UT stones most commonly present as
             Loin pain
        3.   Hematuria
        3.   Dysuria
        3.   Infection
        3.   Renal failure
54. Following a head injury, a CT scan is primarily indicated for which of the following
        1. Headache
        3. Epistaxis
        3. Neck stiffness
        3. Loss of papillary reflexes
55. Antibiotic therapy in surgery except
        3. <unknown>
        3. <unknown>
           Just before surgery
        4. <unknown>

57. Concerning bladder tumours,
1.           Common in men
        2. May be caused by schistosomiasis

58. Raised AFP, beta-HCG are not seen in which of the following,
        2. Mixed seminoma
        3. Teratoma
        4. Pure seminoma
        5. Embryonal cell tumour
        6. Yolk sac tumour
59. Wound infection in large bowel surgery is likely to be due to
        3.   Kleb
        4.   E. Coli
        5.   Bacteroides
        6.   Proteus
        7. Staph, Strep
60. A rectal tumour is staged at T3M2N0. Which of the following is most important for
reducing the rate of recurrence?
        1. Neoadjuvent chemo
           Adjuvant chemo following resection
        1. Adjuvant RT following resection
        2. Intense surveillance and monitoring following resection
        3. Super radical surgery

     ,1. Which of the following about nerve block for cancer pain treatment is not correct?
     A.Different block is selected for cancer pain of different location and property
     B.nerve block is indicated for all cancer pain
     C.Objective, outcome, prognosis and possible complications should be clearly narrated
     to the patient and his family members before the nerve block be carried out
      DNerve block is indicated localized cancer pain
     E.diagnosis must be cleared and test dose oflocal anesthetics must be given before
     destructive block is carried is likely that neuropathic pain from a variety of causes is:

     A,secondary to peripheral sensitization
     B.secondary to central sensitization
     C.secondary to both peripheral and central sensitization
     D.none of the above

     3; Characteristic sign of fracture:
     A. history: present & past
     B. Pain , disability , motion limit
     C. C.swelling, blue, tender
     D. crepitus, Deformity, Abnormal motion

     4.the principle of TREATMENT in fracture –

    5.After reduction of Colles's fracture, the hand should be held with
        radial deviation
    3. extension
    4. flexion
       the wrist flexed, pronated, and in ulnar deviation

    6.The complications of scaphoid fracture includes:
      avascular necrosis, non-union, osteoarthritis                    . -v
      nerve injury
      artery injury

7. The complications of hip dislocation includes

B. swelling
C.sciatic palsy, avascular necrosis of femoral head, osteoarthritis, peri-articular ossification
8.The diagnosis of bone tumor depends on
CT scan
 history, age,. Physical examination, plain radiographs and biopsy
9.In view of the treatment of displaced intra-articular fracture, is a better choice.
close reduction
open reduction
 open reduction & internal fixation

10.A patient, female, 28 years old, complain of vomiting after meal for 1 0 years. X-ray
examination: the esophagus had grossly distended anfr-ar smooth stricture at lower end.
The most likely .diagnosis for this patient is:
5.          Cardiac cancer.
6.          Achalasia.
            Congenital        diaphragm hernia
            Erosive esophageal constriction..
           Benign tumor of esophagus.
11.The fibers that are the largest and have the fastest conduction velocity are the:
               Large-diameter myelinated fibers
                Unmyelinated          delta fibers
                Thin-myelinated       A-delta fibers
                Unmyelinated          C fibers
12.The following are all true about chronic pain except:
Responds to medical management
Effects mood and sleep
Requires prompt treatment
Has a protective function
13.There is some evidence that anticonvulsants are effective in
Trigeminal neuralgia
Prevention of migraine
 Neuropathic pain
 all of the above
   14. Now considered first choice to treat rheumatoid arthritis: ^
   C.MARDS (disease modifying antirheumatic drugs)
   D.None of the Above
   An essential feature in trigeminal neuralgia is the presence of trigger zones. These
   zones are concentrated around the:
   1. Mouth
   2. Lips
   3. Nose
   4. All of the above
   Several medical treatments have been tried for trigeminal neuralgia: however, the
   drug of choice is:
   A. Phenytoin
   B. Carbamazepine
   C. Oxcarbazepine
   D. Lamotrigine
The first choice of pharmacotherapy recommended by WHO is
   dehydrated alcohol or phenol glycerin
   5. adrenocorticosteroid
     6. chemotherapy ladder analgesics
   7. antibiotics
,18, The first choice for control cancer pain is
A. section of involved nerve
B. pharmacotherapy
C. destructive therapy by dehydrated alcohol or phenol glycerin
D. radiotherapy
E. chemotherapy
   19. The 3rd ladder of WHO'S 3 ladder analgesics for cancer pain is
   Strong opioids
    mild opioids

    20.The main route for analgesics administration is
        intravenous pump
    4. by subcutaneous pump
    5.   by intravertebral route
    6.    by oral route
    E    .by transcutaneous route

21. Which of the following treatments may be proper for a female with breast carcinoma
and 3 lymph nodes found in axilla
 A local excision
 B local excision + radiotherapy
C chemotherapy only
D local excision + chemotherapy
 E modified mastectomy

 22.A female of 55 years old has a mass in external upper quadrant of the right breast.
The mass is immobile, hard and with a diameter of 3cm. Which of the following
diagnostic modalities is the gold standard
     A aspiration

    C ultrasonography

     D isotope examination

     E biopsy + histopathological examination

23. Which of the following may be the diagnosis for the patient mentioned above

A breast carcinoma

B fibroadenoma

C fibroadenosis

D duct papilloma

E fat necrosis

24. What is the most common pathogen of urinary tract infection?

    5. Fungi
    6. Virus
    7. Chlamydia and Mycoplasma
    8. 25. What is not the factor predisposing to UTIs.

     A. lesions causing stasis and obstruction
     B. Normal Defensive ability of body
    C. Presence of foreign body
    D. Catheterization and mycoplasma

26.How much cfu(colony forming unit) per ml of urine referring to
 bacteriuria with clinical significance?
 >10s B.
 . 103 - 104

 What is the most common cause of hospital acquired UTIs. /

  A.     Inappropriate antibiotics

  B.     Instrumental examination

  C.   catheterization.
  D. Operation
 9. What is the pathway of TB to infect urinary tract.
   A. Ascending route
   B. descending route
   C. Lymphatogenous spreads
   D. Direct extension from another organ
   What is the most common clinical: manifestation in upper urinary tract stone?
   3. Vesical irritability
   3. Chill and fever
   3. nausea and vomiting
   3. Pain and hematuria^
 30. Which is not the choice for the treatments of acute renal colicky pain?-
   3. Antispasmodics and Analgetics
   3. Antibiotics ^
   3. Fluid supplement
   3. Opening surgery
 3. A male. 60 years old, had progressive Dysphagia for 5 months, and now he can only
 take semi-liquid food. There is no enlarged lymph node over clavicle area. The most likely
 diagnosis for this patient is:
 3. Achalasia.
 3. Reflux esophagitis.
 3. essophageal carcinoma.
 3. Esophageal web.
 3. Pharyngeal pouch.
 3. A male. 58 years old. had dysphagia for 3 months. And now he can take semi-liquid
 food. There are no enlarged lymph nodes been found over clavicle area. For this patient,
 which examination is the first choice for
Barium swallow examination.
Esophageal balloon cytological examination.
CT scan.
MRI scan.
33.For a patient with esophageal cancer, if he had hoarseness, which may be invaded:
  Superior laryngeal nerve.
   Recurrent laryngeal nerve
   diaphragmatic nerve.
34.The acute empyema is most likely secondary to:
A. Perforation of gastro- duodenum ulcer.
   chronic infection of gallbladder.
4. Bronchitis
5. Pulmonary infarction.
35.A 35 years old female was admitted to hospital for pneumonia for 10 days. Now, she
ran a high fever and had pleural effusion. When thoracocentesis was performed, there was
some pus been drawn out from pleural cavity. At this time, which is the best treatment?
6. Thoracotomy.
7. Using antibiotics with large dosage.
   using bacteria sensitive antibiotics and thoracic drainage.
3. Injecting antibiotics into thoracic cavity.
4. Open drainage.
36.A patient with lung cancer had Horner's syndrome. Which may be invaded?
1. Brachial nerve.
2. Phrenic nerve.
3. Superior vena cava.
4. Recurrent laryngeal nerve.
5. Sympathetic nerve.
37.A male. 50 years old, complained of irritant cough for 3 months and some blood in his
sputum occasionally. The chest film showed an atelectasis of right upper lobe. The most
likely diagnosis for this patient is:
Inflammatory pseudotumor.
Secondary tumor.
Lung cancer
38.A male, 60 years old, complained of cough, bloody sputum for 4 months. Chest film
showed a 6 x 6 cm irregular mass near the hilum. For exact diagnosis, which method is
the first choice?

1. Thoracoscopy.
2. Sputum cytology.
3. Exploratory surgery.
4. Using antibiotics and then re-examination.
39Whichof the following is true about orange skin sign in breast carcinoma

A. the neoplasm invades lymph duct and leads to dermal edema
B .the neoplasm invades breast duct and leads to constriction of duct
C .the neoplasm invades the Cooper's suspensory ligament
D.the neoplasm invades the skin directly
E .all above are not true
40.A female of 26 years has a mass in external upper quadrant of the left breast .The
mass has a well-defined margin and round shape with diameter of 3cm . The mass is
highly mobile and non-tender. Which of the following might be the diagnosis

A breast carcincna
C fibroadenosis
D duct papilloma
E fat necrosis
41.which therapeutic modalities to reduce Increased ICP is wrong:
C: Diuretics Morphine
42.Diagnosis of congenital dislocation of hip in older child can be made based on
   limited abduction of hip
   asymmetry of thigh folds
   X-ray film showing that the head of femur falling in the upper or outer quadrants
   specific walking appearance.
  apparent shortening of the extremity
43. Which of the following statements about congenital dislocation of hip is true

a.there's dominant male to female preponderance derives from altered intrauterine position
c.early diagnosis is essential because early open surgery may result in good function
d.the extremity with dislocation is shorter than the contralateral one
e.for infant, or child with unstable but not dislocated hip, surgery may not be the first of
44.Which of the following statement about imperforate anus is not true
   All the newborns with this disorder will die of intestinal obstruction soon if they do not
undergo surgical correction ^^^ '
   decision of surgical procedure for patient with this disorder is mainly based on the
location or level of the atretic end of rectus
  an X-ray film with patient in upside down position taken at 12 hour^ after birth is
needed to show the atretic end
   the aim of therapy is not only to achieve successful passage of stool, but a
functioning anus
  good postoperative outcome may be expected in patient with low-type anal atresia
45.For patient with which of the following conditions, colostomy is unnecessary

3.low-type atresia
4. anorectal atresia with rectovesical fistula
5. anorectal atresia with agenesis and without fistula
6. anorectal atresia with rectourethral fistula
7. low-type with deteriorated general condition and predominant distension of
47.The most effective treatment of anorectal abscess is:
   Surginal drainage
8.         physical therapy
9. antibiotics
10. resection
11.       medical treatment
47.Which one is the characterized symptom of anal fissure :
  Acute pain during defaecation

10.         bleeding stool
11. diarrhea
13.intermittent discharge of mucus
48.Location of anal fissure mostly. been found in which clock by knee-chest position:

1. twelve
2. three
3. nine
4. six
5. three and six
49.which one is not suitable to diagnose colon cancer:
B CEA in serum
E.occult blood in stool
50.For colon cancer, the spreading distance along the colon wall to the margin of cancer
is about:
1. 1cm
2.    2—3 cm
3. 4~~5cm cm
4. 6 cm
51.Which is the typical symptom of vesical stone?
   5. urine retention
   6. Vesical irritability
   7. Sudden interruption Of the urinary stream
   8. suprapubic pain
  52.Which is not resulted from ureter stone?
       Ureteral dilation,
       Urine retention

  6. What is the most common urinary injury in developed countries?
      Urethral trauma
      Renal trauma
      Ureteral trauma
      Bladder trauma
54. Which belongs to minor renal injury?
      Incomplete superficial laceration
   14.Complete laceration.
   15.Shattered kidney
   16.pedicle injury
   55.What are the basic pathologic changes in urinary trauma?
   3. Hemorrhage and shock
   4. Hematoma and abscess
   5. Hemorrhage and urinary extravasation*
        Infection and extravasation
56.Which is not correct in the nonsurgical measures of renal trauma treatments?
   strictly confined to bed for 2 months«-
   B. Fluid infusion and blood transfusion if necessary
   C. Antibacterial measures and release of symptoms
   D. Observe vital signs of the patients
57. What is not indicated in the diagnosis of bladder trauma
  Collection of injury history
   c ystosco py
   Bladder irrigation test

58. Which is the most common cause of the injury to bulbous urethra?
   Pelvic fracture
   Straddle-type fall
   6. Catheterization
   6. Knife wound
•59. Normal intracranial pressure (ICP) of
           CSF within cranium in adult is
0.8 ~ 1.8 kPa
1.5-2.5 kPa
60. The triad of ICP are:
    B: Bradycardia+ headach+vomiting
   DHeadache+Papilloedema+dilated pupil
   61.A thyroid nodule was found in a 27-year-old female 3 months ago. Honer's Syndrom
   occurred in this patient 1 month ago. Right vocal cord paralysis is found through
   laryngoscopy. Which one is the most possible diagnosis?
       4.     severe thyroidism
       5.     thyroid adenoma
       6.      nodular goiter with malignant change
               Hashimoto's Disease
               thyroid carcinoma
.Which of the following injury is closed injury
   A. abrasion
   B. laceration
   C. gun shot wound
   D. cut wound
63.Which of the following injury is open injury                \
   1. contusion
   2. sprain
   3. dislocation
   4. abrasion»
      rupture of spleen
64.Which of the following is NOT usually present in severe injury
   enhanced basic metabolic rate
   increased energy consumption
   lnhanced immune function
   decreased neutrophil and monocyte function
   increased accumulation of water and natrium
65.Which of the following statements is correct in wound healing
   7. in inflammatory phase, fibroblasts and endothelial celis"proliferate and fill the wouiid
   8. in proliferation phase, coagulation activity is at a high level
   9. granulation is the chief way to filling the wound defect in
   •proliferation phase, \
      in maturation phase, cross-linking of collagen is decreased
   9. in maturation phase, capillaries increase rapidly
    66.In which of the following a primary intention healing could NOT be achieved        -
  a cut wound of the thigh is treated with debridement and closure immediately after injury
  an open wound of the hand is treated with debridement and closure 4 hours after injury
  laceration of scalp is treated with debridement and closure 9 hours after injury
  a cut wound of the thigh is treated with debridement and closure 11 hours, after injury
  a cut wound of the thigh with earth contamination is treated with debridement and closure
  6 hours after injury
  67.As to the usage of tourniquet, which of the following is NOT right
  7. it is indicated in massive bleeding of limb with failure in pressure dressing
8. pneumatic tourniquet is superior to rubber tube
9. a tourniquet may be employed for up to 4 hours when intermittently released
   when definite treatment is available-far from the injury scene and transportation is
necessary, the tourniquet must be released for several minutes every hour
  in massive bleeding of the leg. a string may be employed at the knee
68.Which of the following conditions should be the first to deal with in patient with
multiple injuries
7. viscera injury
8. bone fracture
9. shock
10. open wound
    asphyxia or suffocation
69.Which      of the following statement is true in diagnosis of trauma
a. in patient with suspected intestinal perforation, abdominal paracentesis is warranted as
well as X-ray plain film
b.CT scan is superior to X-ray plain film in diagnosis of bone fracture
c.ultrasound is of little value in diagnosis of abdomen injury MRI is valuable in diagnosis of disorders of central nervous system, it should be
employed as routine in head injury
70.Which of the following is NOT nonspecific infection
9. furuncle
9. carbuncle
9. gas gangrene
9. acute appendicitis
9. acute mastitis
71.Which one of the following is not the symptom of haemorrhoids:
A.perianal irritation and itching
B.aching discomfort exacerbated by defaecation
C.haemorrhoidal prolapse
D.rectal bleeding
Eanal ulcer
72.Which one of the following treatments is not suitable for haemorrhoids:
17.      injection
18.       banding
19.       lord's stretch
20.       haemorrhoidectomy
21.       surgical drainage^
73.Which one of the following is not the early complications to large bowel surgery:
1.       wound infection
2.            anastomotic leak
3. intra-abdominal abscess
4. Systemic sepsis
5.     impotence
74.which is the indication of operation among the following thyroid diseases ?
       hyperthyoidism secondary to nodular goiter
    1. Mild primary hyperthyroidism
    2. Adolescent goiter
          3. Goiter in early pregnancy
          4. Adolescent hyperthyroidism
     6. The following descriptions are about the iodine treatment of the preoperative
     preparations for patients with hyperthyroidism. Which one q£ them is false?
         A.To inhibit the proteases that hydrolyzes the thyroglobulin to iodothyronines.

          B.To suppress the synthesis of thyroid hormone.

          C.once the treatment of iodine is stopped, large number of thyroid hormone stored in
          the gland will be released

          D.Iodine should not be administered to patients who are not going to receive

          E.To     reduce vascularity of thyroid gland. of the following diseases is not the indication for subtotal thyroidectomy ?
1.              Toxic adenoma or secondary hyperthyroidism
        2.        Primary hyperthyroidism moderate
        3.        Adolescent hyperthyroidism
        4.        goiter with compressive symptoms or substernal goiter
     with hyperthyroidism
        5.         recurrent hyperthyroidism after the treatment of
     antithyroid drugs
     77.One patient with primary hyperthyroidism received subtotal thyroidectomy . Twelve
     hours after operation, he experienced an episode of sudden hyperthermia , intense
     irritability , vomiting and tachycardia. Which one of the following complications is the
     possible cause ?
         2.            aspiration pneumia
         3.               postoperative upper respiratory tract infection
         4.               postoperative pain
         5.               thyrotoxic crisis
         6.               .postoperative haemorrhage

     .78. Which one is the main cause of simple goiter?
        3.         increased demand for thyroid hormone
        4.           dysfunction in thyroid hormone synthesis l^rfodine deficiency
        1.            dysfunction        in thyroid hormone secretion
        2.                administration of antithyroid drugs
     4.    A 20-year-old male patient goes to see a doctor because a mass was found in his
     neck 2 days ago. During physical examination , a stiff nodule is palpated lateral to the
     right side of trachea . The nodule can rise and fall while the patients swallows. Two
     enlarged lymph nodes are palpated anterior to the ipsilateral sternomastoid. What is the
     initial diagnosis of this patient?
         A. cervical lymphnoditis
         B. cervical tuberculous lymphadenitis
         C. malignant       lymphoma
         D. D.thyroid adenoma
         E.thyroid carcinoma
     79.35-year-old female complaining of cough and low fever went to see a doctor one week
     ago , and was diagnosed as upper respiratory tract infection. Two days ago, she felt pain
     in her neck , and the pain radiated to her ear and temple. Physical Examination : The
     thyroid gland is
  diffusely enlarged . stiff and tender. T: 38 °C : erythrocyte sedimentation rate (ESR) :
  20mm/h: Thyroid radioiodide uptake(RAIU): 5% (2 hours after oral ingestion of 131 I),
  20% (24 hours after oral ingestion of m t)i basic metabolism rate (BMR) # +20% : Fine-
  needle aspiration cytology(FNA): invasion of the thyroid by polymorphonuclear
  leukocytes, lymphocytes and foreign-body giant cells. What is the diagnosis of this
  patient? ?A.mild hyperthyroidism B.nodular goiter ^6?Simple goiter
      22.        subacute thyroiditis
      23.            Lymphocytic Thyroidiris

  81.When the blood pressure is normal and central venous pressure low after the
  patient with' shock is given adequate fluid, what of the following should be employed
  B. vasodilator
  C. vasoconstrictor
  3. high dose of corticoids
  4. diuretics
  The major index indicating effective fluid resuscitation is
  32. blood pressure return to normal
  33.relief of thirsty
       increase of urine output
  3. respiratory and pulse rate return to normal
  4. the fingers turn warm.
  83.The chief problem of shock is hypotension
  4. cellular oxygen deficiency
  4. acidosis
  4. decreased urine output
  4. high central venous pressure
  ,84.The key to correcting acidosis in shock is ^
  A. hyperventilation
  B. supplementation of basic solution
     amelioration of tissue perfusion
  E. elevation of blood pressure
  F. use of corticoids
   85.Which of the following causes of abdominal external hernia is essential
6.decreased strength of abdominal wall
7. chronic constipation
8. chronic coughing
9. dysury
10. ascites formation
86.Which of the following is the most common content of hernia
 great omentum
 small intestine
  urinary bladder
  transverse colon
87.The main difference between incarcerated hernia and strangulated hernia is at
4. presence of tenderness
4. duration of content being arrested
4. damage of blood supply                       t
4.         presence of shock
4. presence of intestinal obstruction

88.When part of intestinal wall consists the content of hernia, such hernia is named
4. Littre's hernia
4. sliding hernia
4. reducible hernia
4. Richter's hernia
E. irreducible hernia
89.The main difference between incarcerated hernia and strangulated hernia is at
4.         Presence of tenderness
4. duration of content being arrested
4. damage of blood supply
4. presence of shock
4. presence of intestinal obstruction
90.Which of the following hernias necessitate emergency surgery
4. oblique inguinal hernia
4. direct inguinal hernia
4. incarcerated inguinal hernia
  E. umbilical hernia
  F. irreducible hernia

91.Chronic surgical infection means infection with a course
3. within 3 weeks
4. within 4 weeks
5. within 1 month
6. within 2 months
7. beyond 2 months
92.Based on which of the following evidences a diagnosis of abscess is likely to be
. fluctuation
36.increased WBC count
37. hypodynamia
93.The pathogen of gas gangrene is ^
  staphylococcus aureus
3.    streptococcus
3. enteric bacilli
3. bacteroid
3. spore-forming anaerobe-
94.The most definite and effective prophylactic measure to avoid gas gangrene is
  definite debridement
3. penicillin
3. high pressure oxygen •
3. specific anti-serum
3. systemic supportive therapy
    95.Which of the following sites is likely to suffer from carbuncle
         the neck
    3.   the chest
    3.   the waist
    3.   the perineum
    3.   the lower extremity

    96.Common pyogenic infection may manifest the following signs except
    97.Which of the following is evidence of deep abscess
24.obvious redness
25. fluctuation
     local edema with tenderness, and pus is obtained in paracentesis
2. no dysfunction
3. no obvious systemic symptom
98.Which of the following manifestations is not the typical feature of the hypovolemic shock
A. low cardiac output
low venous pressure
low blood pressure.
Low peripheral vascular resistance
increased pulse rate
99.Hypovolemic shock usually means

          neurogenic shock
          septic shock
          cardiogenic shock
            hemorrhagic shock

100.. Which cf the following causes listed is not contributed to the impairment of cardiac
function in shock patient
A. inadequate perfusion of cononary artery
B.release of catecholamine in large amounts
D.metabolic acidosis