Question 1
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1. Which of the following statements regarding hand hygiene is NOT correct?
Answer
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Health care workers (HCWs) should clean their hands with an antiseptic-containing agent before and after each contact with a patient
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The use of soap and water for hand washing is required when hands are visibly soiled with blood or bodily fluids
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Alcohol-based hand rubs are inferior to antimicrobial soaps for hand decontamination
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Vancomycin-resistant enterococci are frequently isolated from the hands of HCWs
Question 2
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Question 3
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2. Out of the following four indicators, the best clinical sign of successful fluid resuscitation and end-organ perfusion in a patient with hemorrhagic shock is:
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An increase in blood pressure
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An increase in urine output
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An increase in arterial oxygenation
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A decrease in tachycardia
Question 4
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Question 5
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3. Technical errors during surgical procedures are MOST likely to occur:
Answer
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During routine procedures in complex patients
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In high-complexity operations
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Due to surgical inexperience
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Due to inadequate resident supervision
Question 6
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Question 7
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4. In the AD DAVID system for writing post-op orders, the “I” is an abbreviation for 3 things. Of the following, what does the “I” NOT stand for?
Question 8
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Question 9
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5. The risk of developing a surgical site infection is dependent on all of the following factors, EXCEPT:
Answer
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Hyperthermia
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Immunosuppression
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Diabetes mellitus
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Length of operation
Question 10
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Question 11
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6. Of the following, what is NOT considered a phase of normal wound healing?
Question 12
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Question 13
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7. Please choose the CORRECT statement regarding wound healing and closure.
Answer
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Wound healing via secondary intention leads to improved scar formation and superior cosmetic outcome
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A contaminated wound from an open fracture should be immediately closed via primary intention
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Wound healing via primary intention requires manual approximation of wound edges and healing through the normal stages of wound healing
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Wound healing via tertiary intention is reserved for simple, uncomplicated lacerations
Question 14
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Question 15
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8. With regards to the fundamental principles of antibiotic prophylaxis in surgery, which of the following are INCORRECT?
Answer
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The antibiotic of choice should be active against organisms usually found at the site of surgery
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During surgeries that go longer than expected, the antibiotic should be re-dosed to ensure adequate levels
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The antibiotic should be given 30 minutes prior to the incision
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The antibiotic should be continued for 7 days post surgery to prevent antibiotic resistance
Question 16
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Question 17
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9. What is NOT a benefit of laparoscopic surgery versus open surgery?
Answer
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Decreased trauma to the abdominal wall and decreased post-operative scarring
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Shorter recovery time
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Decreased post-operative pain
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Improved tactile sensation of tissues
Question 18
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Question 19
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10. Which of the following is NOT a physiological consequence of routine laparoscopic surgery?
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Hypercarbia due to absorption of CO2 used to create a pneumoperitoneum
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Decreased blood return from the lower body back to the heart
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Decreased systemic blood pressure
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Decreased lung volume and residual functional capacity
Question 20
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Question 21
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11. You are preparing to make an abdominal incision for a laparotomy as you suspect your patient has complex perforated appendectomy. What is the correct order of the layers you will cut through, starting with the most superficial layer?
Answer
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Skin, superficial fascia (Camper’s and Scarpa’s), external oblique, internal oblique, transversus abdominis, transversalis fascia, extraperitoneal fascia, parietal peritoneum
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Skin, extraperitoneal fascia, superficial fascia (Camper’s and Scarpa’s), external oblique, internal oblique, transversus abdominis, parietal peritoneum
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Skin, superficial fascia (Camper’s and Scarpa’s), extraperitoneal fascia, external oblique, internal oblique, transversus abdominis, transversalis fascia, parietal peritoneum
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Skin, extraperitoneal fascia, external oblique, internal oblique, transversus abdominis, transversalis fascia, superficial fascia (Camper’s and Scarpa’s), parietal peritoneum
Question 22
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Question 23
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12. Of the following, what is NOT an indication for chest tube insertion?
Question 24
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Question 25
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13. Regarding chest tubes, which of the following answers is correct?
Answer
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If a chest tube needs to be repositioned further into the chest cavity after insertion, simply advance it further as necessary
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A chest X-ray should ALWAYS be taken to confirm the location of a chest tube
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Routine chest tubes should be placed in the second intercostal space in the anterior axillary line
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Prophylactic antibiotics (most commonly cefazolin) are indicated for chest tube insertions to prevent infection
Question 26
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Question 27
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14. A security guard sustains a left thoraco-abdominal stab wound. He is alert, talking, and hemodynamically stable. On examination, his abdomen is soft and non-tender. The most appropriate management would be:
Answer
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Observation
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Diagnostic peritoneal tap
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CT thorax, abdomen, and pelvis
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Laparotomy
Question 28
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Question 29
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15. A 30-year-old male pedestrian presents with a posterior left knee dislocation after being hit by a car. He has no distal pulses in his left leg. The most appropriate next step in his management would be to:
Question 30
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Question 31
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16. Comparing internal and external fixation, which of the following is true?
Answer
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Internal fixation is generally preferable for open fractures
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External fixation makes access for wound care more difficult
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External fixation is useful in very comminuted fractures
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Internal fixation is less invasive than external fixation
Question 32
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Question 33
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17. A patient is brought into the trauma bay after a high-speed motor vehicle collision. He has decreased breath sounds on the right with a deviated trachea to the left, a laceration of his left radial artery with pulsatile bleeding, and an obvious deformity of his right thigh with bone protruding through a 7-cm wound. Which of the following is the most important next step in his management?
Answer
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Chest tube on the left (5th intercostal space, mid-axillary line)
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Pressure dressing on the left forearm
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Sterile dressing on the right thigh wound, antibiotics, tetanus booster
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Needle thoracotomy on the right (2nd intercostal space, mid-clavicular line)
Question 34
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Question 35
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18. Which of the following is true?
Answer
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Lag screws cause compression, stabilization, and healing mainly through secondary bone healing
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External fixation causes compression and healing mainly through primary bone healing
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Casting, splinting, and bracing result in callus formation leading to secondary bone healing
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Bone plating induces absolutely stability and mainly leads to healing via secondary bone healing
Question 36
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Question 37
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19. A primipara is in labour and an episiotomy is about to be cut. Compared with a midline episiotomy, an advantage of mediolateral episiotomy is:
Question 38
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Question 39
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20. A patient sustained a laceration of the perineum during delivery. It involved the muscles of perineal body but not the anal sphincter. Such a laceration would be classified as:
Answer
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First degree
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Second degree
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Third degree
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Fourth degree
Question 40
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Question 41
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21. Which of the following statements about episiotomy is FALSE?
Answer
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Episiotomy incisions are repaired anatomically in layers
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Mediolateral or lateral episiotomy may be associated with more blood loss than median one
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Indications for episiotomy include avoiding an imminent perineal tear, the use of forceps, breech delivery, and the delivery of premature infants.
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In general, the earlier the episiotomy is done during delivery, the more beneficial it will be in speeding up the delivery
Question 42
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Question 43
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22. Which is NOT an indication for urethral catheterization?
Answer
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Chronic obstruction causing hydronephrosis
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Acute urinary retention (BPH, blood clots, etc.)
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Traumatic injury to the lower urinary tract causing painful urination
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Intermittent decompression for neurogenic bladder
Question 44
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Question 45
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23. Urethral strictures also occur away from the ureterointestinal anastomosis. These are most commonly found in the _____ ureter.
Answer
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Left
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Right
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Pelvic ureters
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Infantile
Question 46
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Question 47
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24. With regard to acute traumatic subdural hematoma, which of the following is true?
Answer
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Blood products collect between the inner surface of the calvarium and dura
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Bleeding usually results from tearing of the bridging veins
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Cerebral contusions are infrequently seen
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Burr hole drainage is the surgical treatment of choice
Question 48
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Question 49
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25. The most common location for spontaneous intracerebral hemorrhage secondary to hypertension is the:
Answer
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Cerebellum
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Cerebral white matter
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Basal ganglia
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Brainstem
Question 50
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Question 51
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26. Indications for treatment of an unruptured intracerebral aneurysm include all of the following except:
Question 52
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Question 53
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27. For local excision, what is generally the best shape to use for ease of closure?
Answer
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S-Shape
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Ellipse
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Rectangle
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Square
Question 54
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Question 55
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28. To minimize scarring, in what orientation should incision lines be placed in reference to the lines of minimal tension?
Answer
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Circumferential
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Cross
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Parallel
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Perpendicular
Question 56
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Question 57
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29. An 8-year-old girl has a 2.5 cm breast mass that is enlarging just beneath her left nipple-areolar complex. Her mother first noticed this mass 2 months previously. Management may include all of the following, EXCEPT:
Question 58
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Question 59
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30. A 62-year-old patient comes to clinic with a suspicious 2.0 cm lesion, which characteristic of the lesion would make you want to avoid investigating with a punch biopsy?
Answer
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Ulcerated
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Pigmented
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Rapidly growing
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Hard horn present
Question 60
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