1. What is the most likely cause of post-operative hypoxemia

  1. Reduced functional residual capacity
  2. Reduced minute ventilation
  3. Reduced diffusion capacity
  4. Reduced intrapulmonary shunting
  5. Reduced mucociliary action

2. A 69 year old man undergoes an emergency laparotomy for perforated ulcer. That night in the intensive care unit, he is noted to become belligerent and confused. The most probable reason for such behavior include:

  1. ICU psychosis
  2. Phenothiazine overdose
  3. Acute stroke
  4. Narcotic overdose
  5. Alzheimer’s dementia

3. The goals of surgical history and physical exam includes the following:

  1. Document the condition of the patient at the time of admission
  2. Record the medical conditions which have preceded the admission
  3. Outline the reasons for admission
  4. Summate the studies which confirm the admission diagnosis
  5. All of the above

4. A 29 year old woman presents with small bowel obstruction. She has had nausea and vomiting for the past 24 hours. The most likely electrolyte abnormality(ies) would include:

  1. Hyperkalemia
  2. Hypernatremia
  3. Hyponatremia
  4. Hyperchloremia
  5. Hypokalemia

5. During an operation on a patient with Hepatitis C you are punctured by a needle. What steps should you follow:

A. Replace your surgical gloves

B. Report the event to infection control nurse

  1. Proceed to student health for inoculation
  2. Ignore the event
  3. Draw blood tests to determine if the virus can be detected in you.

6. Which if the following is characteristic of early postoperative renal function in response to major surgery?

  1. Sodium retention
  2. Potassium excretion
  3. Water retention
  4. Bicarbonate re-absorption

E. All of the above

7. A 57 year old woman with obstructing esophageal carcinoma is placed on TPN. With 25% dextrose and 5% amino acid solution, supplemented with electrolytes and vitamins. Five days later she becomes lethargic and confused. Her urine output is 3400 ml/24 hrs. The most likely diagnosis is:

  1. Intravascular fluid overload
  2. Hypernatremia
  3. Hypophosphatemia
  4. Diabetes mellitus
  5. Hyperosmolar, nonketotic dehydration

8. The first therapeutic measure to improve cardiac output and blood pressure in septic shock is intravenous

  1. Dopamine
  2. Dobutamine
  3. Nitroprusside
  4. Amrinone
  5. Saline

9. The most common cause of hypovolemic shock is

  1. Peritonitis
  2. Burns
  3. Hemorrhage
  4. Sepsis
  5. Spinal cord injury

10. Of the following, which is best for treatment of an anaerobic infection

  1. Ampicillin
  2. Tobramycin
  3. Metronidazole
  4. Tetracycline
  5. Erythomycin

11. The most common hospital acquired infection is

  1. Pneumonia
  2. Wound infection
  3. Urinary tract infection
  4. Upper respiratory infection
  5. Suppurative phlebitis

12. Age greater than 70 is a contraindication to which of the following operations?

  1. Aortic aneurysm repair
  2. Kidney transplant
  3. Coronary artery bypass
  4. Rhytidectomy
  5. None of the above

13. Concerning surgery in the elderly population when compared to a younger population:

  1. Complications are more frequent in the elderly
  2. Complications are less frequent in the elderly
  3. Surgery in elderly patients has the same complication rate as surgery in younger patients
  4. Complication of surgery are more difficult for elderly patients to overcome
  5. Recovery from complications is quicker in elderly patients

14. The primary reason for progress notes is

  1. To satisfy documentation requirements for billing
  2. To communicate with other health care team members
  3. To record your critique of the patient management
  4. To document the progress of the patient’s treatment
  5. To provide legal protection for the treating physician

15. Hypovolemic shock is characterized by

  1. Decreased PCWP with decreased CVP and elevated PVR
  2. Decreased PCWP with decreased CVP and decreased PVR
  3. Normal PCWP with normal CVP and decreased PVR
  4. Elevated PCWP with elevated CVP and decreased PVR
  5. Elevated PCWP with elevated CVP and elevated PVR

16. Of the following, which is the best means of nutritionally supporting a patient

  1. Peripheral parenteral nutrition (PPN)
  2. Total parenteral nutrition (TPN)
  3. Jejunostomy tube feeding
  4. Gastrostomy tube feeding
  5. Peripheral intravenous dextrose

17. Delirium tremens may involve any of the following characteristics except:

  1. Visual hallucinations
  2. Tachycardia
  3. Muscular tremors
  4. Forgetfulness
  5. Dysphoria

18. Necrotizing fasciitis typically will involve which of the following organisms

  1. Streptococcus
  2. Vibrio
  3. Helicobacter
  4. Candida
  5. Pseudomonas

19. Elective surgery following myocardial infarction should be postponed for

  1. 2 months
  2. 3 months
  3. 6 months
  4. 12 months
  5. 18 months

20. Alveolar hypoventilation is diagnosed most reliably by

  1. Observing the patient’s breathing
  2. Measuring minute ventilation
  3. Spirometry
  4. Measuring arterial oxygen tension (PaO2)
  5. Measuring arterial carbon dioxide tension (PaCO2)

Answer Key

1A

2A

3E

4E

5B, C, E

6E

7E

8E

9C

10C

11C

12E

13D

14D

15A

16D

17A, B, C, E (Ok on 1st - Monday- version)

18A

19C

20E