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1. Which bug is MOST common in surgical infections?
a. S. aureus
b. Coag Neg. Staph
c. E. Coli
d. Some other wrong answer

Answer: A.


2. All of the following are true of Hep C, EXCEPT:
a. It is an RNA flavavirus
b. 75% of infected people become chronic carriers
c. Risk of transmission via needle stick is 2%
d. Some other answer

Answer: ? (previous answer C). HCV is an RNA flavavirus. HCV typically leads to chronic infection; 60 to 80 percent of cases develop chronic hepatitis (abnormal liver enzymes). 20 to 30 percent of chronically infected individuals develop cirrhosis over a 20- to 30-year period of time The average incidence of seroconversion to HCV after unintentional needle sticks or sharps exposures from an HCV-positive source is 1.8 percent (range, 0-7 percent). The overall rate of HCV transmission after an exposure ranges from essentially zero to about 10%
Source: Up to date. , JAMA. 2002.


3. Electrical Voltage is converted to heat (burns) by a person’s body based on what?
a. Directly proportional to voltage and resistance of the body
b. Inversely proportional to voltage and resistance of the body
c. Directly proportional to the current and resistance of the body
d. Inveresely proportional to the current and resistance of the body

Answer: C.


4. 70kg male pt requires how much daily glucose to prevent the catabolism of protein?
a. 10 g
b. 50 g
c. 200 g
d. 500 g

Answer: C. 100g of dextrose daily provided enough to spare protein catabolism. You may require about 125 g of glucose.
Source: Nutrition support for the critically ill.

Schwarz says avg person needs 80-120g of protein per day. And every 6 grams of protein = 1g of Nitrogen


6. What does the Kaplan Meier Curve measure?
a. Survival
b, c, d- Wrong answers

Answer: A.


7. Which of the following is the most common anaerobic bug in post op infections?
a. Actinomyces
b. Bacteroides
c. Clostridium
d. Another bug

Answer: B.


8. While consenting a pt, it appears she isn’t paying attention. At the completion of your disclosure, the patient states, “I don’t want to hear about all the bad things. I trust you, let’s do it.” Should you:
a. Have someone else explain it to her.
b. Tell her this is important and that she needs to pay attention or you won’t operate on her
c. Document in the chart that disclosure has been provided and that the patient wishes to proceed.
d. Some other answer

Answer: C. may have an answer to the effect of bringing someone else in the room to help explain


9. Pt. injured, unable to consent for emergent op, no one else to give consent. You decide to operate, this is an example of :
a. Beneficience
b. Nonmaleficience
c. Something else
d. Something else

Answer: A Beneficience - Concept involves the physician making the decisions that are best for the patient, without regard to personal gain or the interests of others. "Do good and avoid evil. Nonmaleficence, which derives from the maxim, is one of the principal precepts that all medical students are taught in medical school and is a fundamental principle for emergency medical services around the world. Another way to state it is that "given an existing problem, it may be better to do nothing than to do something that risks causing more harm than good." It reminds the physician and other health care providers that they must consider the possible harm that any intervention might do. It is invoked when debating the use of an intervention that carries an obvious risk of harm but a less certain chance of benefit.


10. Coherent pt. states pre-op that he does not want blood for religious reasons, pt. undergoes AAA repair and becomes unstable in ICU. Wife tells you to disregard his decision and transfuse him. You should:
a. Abide by wife’s wishes because pt. is no longer competent
b. Give him blood but don’t tell him
c. Continue to resuscitate him, but don’t give blood.
d. Something else

Answer: C.


11. Pt. wants to know highest risk of receiving blood product. You tell him:
a. HIV
b. Bacterial Sepsis
c. HBV
d. Something else

Answer: B. ??

Schwartz says that PRBC's with bacteria is very rare. More common with plt transfusion.

General non-hemolytic fever is more common though (1%), and is secondary to prformed cytokines in donor blood. In the table, this has the highest incidence

Allergic reactions also more common (1%). Often not serious and more frequently associated with plts and FFP

Transfusion related deaths, although rare, do occur and are related primarily to transfusion-related acute lung injury (TRALI) (16%–22%), ABO hemolytic transfusion reactions (12%–15%), and bacterial contamination of platelets (11%–18%).86


12. Most like bug from receiving blood product:
a. Treponema Pallidum
b. Staph
c. Something else
d. Something else

Answer: A.


13. In obtaining informed consent, you must provide all of the following EXCEPT:
a. Standard accepted rates of success/failure
b. General risks
c. Special & unique risks
d. Alternatives to the procedure

Answer: C.


14. Nerve most at risk in fasciotomy of ant. compartment of lower leg:
a. Superficial Peroneal N.
b. Tibial N.
c. Femoral N.
d. Common Peroneal N.

Answer: A.


15. Guy cuts his forearm with a box knife, unable to feel his thumb and index finger. Cannot flex PIP. Initial management should consist of:
a. I&D in ER, explore and repair damage to deep structures
b. Give Keflex, keep wound open, splint with MCP flexed and refer to hand surgeon the next day.
c. I&D in ER, explore and repair damage to deep structures, suture wound closed and refer to hand surgeon later.

Answer: B. (previous A). Cannot feel his thumb index – VOLAR. Median nerve. Flexors are median nerve. I would not explore the wound in the ER. No emergent need to repair lacerated nerves – hand is not ischemic where time is a factor.
Source: M.Bernstein, M.D.

I think I would just irrigate, close skin, dress, splint in safety refer to plastics in the morning


16. Which of the following will not increase the likelihood of an incision having healing problems?
b. Previous surgery
d. Corticosteroids

Answer: B. Increases healing.


17. Keloids have the following characteristics, EXCEPT:
a. Occur more commonly in dark skinned people
b. Are cause of scar overgrowth
c. Intralesional steroid injections are helpful
d. Something else

Answer: ? (previous answer C). Certain individuals, most commonly blacks, develop a hyperproliferation of fibroblasts in response to trauma or, less commonly, de novo. Intralesional corticosteroids are first-line therapy for most keloids. A systematic review found that up to 70 percent of patients respond to intralesional corticosteroid injection with flattening of keloids, although the recurrence rate is high in some studies (up to 50 percent at five years
Source: Up to date.


18. Motorcycle rider crashes and has grossly contaminated open mid tibia (Grade IIIB). Besides I&D, tetanus, etc, you should start:
a. Cefazolin
b. Cefazolin and Gentamicin
c. Cefazolin, Gentamicin, and Penicillin
d. Something else

Answer: C. (previous B). The “grossly” suggests that you need to include anaerobic coverage (i.e. PCN).
Source: M.Bernstein

Orthobullet: penicillin only if you suspect anaerobes (farm or bowel)


19. 70 kg. guy with burns is being treated with IVF per Parkland formula. Between hours 4-8 his urine output is 45 cc, 75 cc, 50 cc. You should:
a. Observe and wait
b. Bolus with 1000cc RL
c. Increase IVF by one-third
d. Something else

Answer: A. (previous C) 70 kg adult should have at least 0.5 cc/kg/hr. that is, > 35 cc/hr. He is meeting this goal, therefore observe and wait.


20. Older male pt. with hx of smoking presents with painless gross hematuria. Most likely diagnosis:
a. Prostate CA
b. Renal Calculus
c. Bladder CA
d. Something else

Answer: C.


21. Tobacco smoke is a known carcinogenic factor in all of the following types of cancer EXCEPT:
a. Lung
b. Liver
c. Cervical
d. Oral

Answer: B.


22. All of the following require emergent exploratory laparotomy except:
a. Fractured Kidney
b. Gunshot wound that goes through gut
c. Something else
d. Something else

Answer: A.


23. Pt. with Breast CA develops severe headaches. MRI shows large cerebral mass. You should:
a. Palliative care
b. Resect and XRT
c. XRT
d. Something else

Answer: B. SURGERY — Surgery is used to provide rapid relief of symptoms resulting from the mass effect of a large tumor, to improve local control of brain metastases, and to establish a histologic diagnosis when a brain metastasis is suspected. Advances in neuroanesthesia and neurosurgery have significantly improved the safety of surgical resection of brain metastases, making this approach applicable to a larger number of patients, including lesions in both eloquent and noneloquent regions of the brain [16,17].
However, complications are not rare. In a series of 400 craniotomies patients with brain tumors (206 with gliomas and 194 with metastasectomy), 13 percent suffered major complications including neurologic worsening (8.5 percent) and meningitis (1 percent) [17]. In another series of 382 patients operated on for brain metastases, there was one death (respiratory, in a patient who had a previous pneumonectomy) and 27 other complications (7 percent). These included three cerebral hemorrhages and three cerebral infarcts [18].
The patient's performance status and the extent of extracranial disease are the most important factors in determining whether or not surgery is appropriate. Patients with extensive or uncontrolled systemic disease generally have a poor prognosis and only rarely benefit from surgery. Other factors affecting prognosis and hence the appropriateness of surgery include the number and location of brain metastases. A short interval between diagnosis of the primary tumor and the development of a brain metastasis is generally associated with a poor prognosis [16]. In patients treated with surgery, WBRT is often used postoperatively


24. BEST way to initially assess damage to optic nerve:
a. Fundoscopic Exam
b. Peripheral Vision
c. Visual Acuity
d. Something else

Answer: C. repeat. Best exam to alert the physician for eye injury is initial visual acuity exam.
Source: M.Bernstein, M.D.


25. Pt. unable to be intubated due to stricture and in resp. distress, you should do which of the following?
a. Cricothyrotomy
b. Tracheostomy
c. Nasotracheal intubation
d. Something else

Answer: A. Need emergent airway. Cricothyroidostomy is indicated when an urgent surgical airway is needed.


26. Guy involved in trauma, non responsive. At the scene, all are signs that someone is receiving adequate ventilation, EXCEPT:
a. Normal chest expansion
b. Good air entry via nose & mouth
c. Good breath sounds
d. Pulse oximetry

Source: Wikipedia


27. PET scan useful for detecting CA based on what?
a. Increase blood flow to CA
b. Increased glucose at CA
c. Something else
d. Something else

Answer: B (previous A). If the biologically active molecule chosen for PET is FDG, an analogue of glucose, the concentrations of tracer imaged then give tissue metabolic
activity, in terms of regional glucose uptake
Source: Wikipedia.


28. First cells to arrive at wound healing:
a. PMNs
b. Macrophage
c. Fibroblasts
d. Lymphocytes

Answer: A. (previous answer B). PMNs are the first infiltrating cells to enter the wound site, peaking at 24 to 48 hours. Macrophages are the dominant cell type in the first phase (inflammatory) but are not the first to appear (macrophages are the second cell to enter)
Source: Schwartz’s Surgery


29. Tumors are attacked by:
a. Cell mediated immunity
b. Humoral mediated immunity
c. Cell and Humoral mediated immunity
d. Navy SEALs

Answer: A.


30. Which of the following is an example of a heterotopic allograft?
a. Lung
b. Liver
c. Kidney
d. Cornea

Answer: C. Heterotopic suggests that the transplanted organ will be placed in a non-native anatomic location. Lung and cornea can obviously not be heterotopic. Kidney are often transplanted into the pelvis. Conversely, orthotopic transplantation such as that occurs in the liver = in its natural position.
Source: Schwartz


33. Pt is stabbed in neck at cricoid. Stab wound is in Zone 1. Zone one is between cricoid and which
a. Angle of mandible
b. Cricothyroid membrane
c. Hyoid bone
d. Clavicle

Answer: D.
Look at an image of zones of the neck