surgery quiz 1

dr. ngalob
multiple choice
1. the following concepts in surgical infections are true except:
a. sepsis is both the presence of infection and systemic inflammatory response syndrome
b. surgical infection or sepsis in itself is a clinical spectrum, ranging from sepsis to severe
sepsis, to septic shock
c. outcomes in patients with sepsis are improved with an organized approach to therapy
that includes rapid resuscitation, antibiotics, and source control
d. patients with sirs are considered emergencies and require immediate admission in
the intensive care unit, where physicians and nurses are readily available, and
where close and continued monitoring are provided.
2. the following are principles relevant to appropriate antibiotic prophylaxis for surgery except:
a. during elective surgeries with no signs/symptoms of infection, select a broad spectrum
antibiotic agent to ensure coverage for most infectious organisms.
b. the initial dose of the antibiotic should be given within 30 minutes prior to the creation
of the incision
c. the antibiotic should be redosed during long operations based upon the half-life of the
agent to ensure adequate tissue levels
d. the antibiotic regimen should not be continued for more than 24 hours after surgery for
routine prophylaxis
3. when using antimicrobial agents for therapy of serious infection, several principles should be
followed except:
a. identify the likely sources of infection
b. select an agent (or agents) that will have efficacy against likely organisms for these
sources
c. inadequate or delayed antibiotic therapy results in increased mortality, so it is
important to begin therapy rapidly with broader coverage
d. cultures are not really necessary especially in the seriously ill; it is more prudent to do
immediate debridement to remove necrotic and infective sources, and then extend
antibiotic usage
4. the incidence of surgical site infections can be reduced by the following except:
a. appropriate patient preparation
b. timely preoperative antibiotic administration
c. maintenance of induced hypothermia
d. appropriate wound management
5. in an elective surgical procedure, the following are factors in the development of surgical site
infection (ssi) except:
a. degree of microbial contamination of the wound during surgery
b. duration of the procedure
c. previous history of ssi
d. host factors such as diabetes mellitus, immunocompromised state and malnutrition
6. transmission of hiv and other infections spread by blood and body fluid from patient to
health care worker. this can be minimized by the following except:
a. wearing of goggles during surgery
 c. washing if hands and other skin surfaces after the surgical procedure when with
contact with blood or other body fluids
d. careful handling and disposing of sharp instruments during and after use
e. wearing double gloves
7. the following are the criteria in the diagnosis of systemic inflammatory response syndrome
(sirs) except:
a. fever (core temp >38 degrees c) or hypothermia (core temp <36 degrees c)
b. wbc > 12,000 or < 4,000
c. arterial hypotension less than 90mmhg diastolic bp
d. heart rate >90 beats/min
8. the primary precept of surgical infectious disease therapy consists of the following except:
a. drainage of all purulent material
b. debridement of infected, devitalized tissue, and debris on the surface of the involved
tissue
c. removal of foreign bodies at the site of infection
d. remediation of the underlying cause of infection
9. the following are patient risk factors in the development of surgical site infection except:
a. elderly
b. obesity
c. very short hospital stay
d. prolonged procedure
e. smoking
10. the following are true regarding the classes of surgical site infection except:
a. class i: clean – example is hernia surgery
b. class ii: clean-contaminated – example is elective colon surgery
c. class iii: contaminated – example is diverticulitis w/ fecal spillage
d. class iv: dirty – example is ruptured appendicitis

identification
11. percentage risk of ssi in clean (class i) surgeries?
12. what does dolor mean?
13. what does “function laesa” mean?
14. sirs + identifiable source of infection = _
15. what is the most common organism in the git?
16. number of doses given in antibiotic prophylaxis during a 1 hour
cholecystectomy
17. maneuvers to diminish the presence of exogenous (surgeon and
operating room environment) and endogenous (patient) microbes,
and consist of the use of mechanical, chemical, and antimicrobial
modalities, or a combination of these methods are know as
18. the presence of pathogenic or supraphysiologic amounts of
microorganism in host tissue or bloodstream is termed as
19. what is the single most common organism in most ssis?
20. “surgery is always the . if there exist other means to purge a
disease, do so.”
 principles of pre-operative and operative surgery

21. the following statements are true regarding pre-operative preparation except:
a. it is a convergence of art and science
b. ranges from outpatient consultation to emergency referral to inpatient management
c. depend on the patient’s age and gender
d. comorbidities are independent factors in patient preparation
22. determining the need for surgery is an invaluable task. the following should be highly
considered before, during, and after surgery except:
a. history and physical examination should be expedited to give more time to diagnostics
and therapeutics
b. referral to other specialties decreases the risk for mortality and morbidity
c. intra-operative complications should always be revealed to patients and family
members
d. in emergency cases, the surgeon may forego diagnostics and proceed w/ immediate
surgery
23. in the practice of medicine and surgery, “the knife is always _”
a. the first resort
b. avoided
c. the answer
d. the last resort
24. considerations after the decision to do surgery are as follows except:
a. timing and site of surgery
b. financial capacity of the patient
c. patient’s comorbidities
d. type of anesthesia to be used
25. operation room briefing involves the following except:
a. requirements and needs before and during the procedure
b. critical parts of the surgery
c. the names and roles of the members of the operating team
d. things that went wrong during the procedure
26. which asa status confers to a patient with sever systemic disease that limits activity but is not
incapacitating
a. i
b. ii
C. iii
d. iv
27. the following are the requirements for blood transfusion except:
a. hgb <6g/dl – transfusion required
b. 6 – 10 g/dl – depend on clinical circumstance
c. > 10g/dl – not required
D. tachycardia and hypertension refractory to volume suggests need for tranfusion
28. the following are peri-operative considerations in the surgery of the elderly except:
a. elderly patient have greater risks for morbidity and mortality
b. many elderly patients present atypical signs and symptoms
 c. routine diagnostics are offered to these special population of patients
d. comorbidities further increase perioperative and post-operative untoward events
29. the following are true in the assessment of nutritional status in surgical patients except:
a. weight loss of >10% for the past 6 months increases mortality
b. events such as mi and stroke are decreased in patients with a bmi of 27
c. albumin determination is a must in malnourished patients
d. surgical site infection is increased in the obese
30. the following are true regarding antibiotic prophylaxis except:
a. select an agent with activity against organisms commonly found at the site of surgery
b. the initial dose of the antibiotic must be given within 30 minutes prior to the creation of
the incision
c. the antibiotic should be redosed during long operations based upon the half-life of the
agent to ensure adequate tissue levels and
d. the antibiotic regimen should not be continued for more than 48 hours after surgery for
routine prophylaxis

identification
31. what class of wound infection is antibiotic prophylaxis not given
32. in pre-operative fasting, how long are solids held prior to surgery
33. risk of mortality in anaphylaxis during surgery
34. treatment given intra-operatively to sudden increase in sympathetic
nervous system function resulting to acidosis and arrhythmia most
likely from ingestion of a halogenated anesthetic
35. give the 2 most common clinical signs of malignant hyperthermia
36.
37. the most compelling reason why an operating room should have well-
trained personnel and complete equipment
38. how many days does the “post-operative period” encompass
39. the primary reason why patients need to undergo npo the night before
the surgery is to prevent
40. percentage risk of mortality in asa v patients

wound healing
matching type
a. hemostasis
b. inflammation
c. proliferation
d. maturation
e. epithelization
f. remodellling
41. scar formation
42. formation of a new transitional cell layer after urinary bladder injury by a stone
43. creation of new blood vessels (angiogenesis)
44. collagen synthesis
45. migration of leukocytes, neutrophils & macrophages
46. vascular constriction
47. platelet plug formation
 48. introduction of ascorbic acid
49. collagen degradation
50. keloid formation

identification
51. in the phase of hemostasis, this is an intrinsic pathway “cleaving”
product
52. “formula” of platelet plug formation
53. what degrades the platelet plug?
54. malignant transformation of a chronic non healing wound is called a
55. scar that rises over the skin level but stays within the confines of the
original wound and regresses over time
56. scar that rises over the skin and extends beyond the borders of the
original wound and does not usually regress
57. 1st line of treatment of scars that grow beyond the borders of the
original wound
58. vitamin c is ideally started on what day/s after injury?
59. how long does hemostasis last after injury?
60. what is the very 1st reaction of the human body after a bleeding
injury

dr. dahilan

true of false
61. one of the risk factors of having post-transplant lymphoproliferative disorder
(ptld) includes primary cytomegalovirus (cmv) infection post-transplant
62. most acute rejections for heart and lung transplantation are very difficult to
manage
63. lung graft failure may present with copious secretions in the presence of
pulmonary edema
64. the presence of early rejection inn lung transplantation is monitored by way
of bronchoalveolar lavage
65. the most common indication for heart transplant is ischemic or dilated
cardiomyopathy
66. patients who are stable with total parenteral nutrition (tpn) and have no
metabolic complications are generally not suitable candidates for intestinal
transplant because of higher survival rate than with transplantation
67. immunologic memory response is a result when recipient cells have been
sensitized by previous exposure to antigens present in the donor as seen in
acute rejection of graft
68. in immunobiology, class i molecules are generally found and expressed by
antigen-presenting cells such as b-lymphocytes
69. accelerated acute rejection predominantly involves a cell-mediated process
frequently heralded by fever, chills, and body malaise
70. interleukin 2 (il – 2) gene expression is the key in permitting the entire
cascade of t-cell activation
multiple choice
71. the most common indication for pediatric liver transplantation is:
a. wilson’s disease
b. fulminant hepatic failure
c. biliary atresia
d. alpha 1 antitrypsin deficiency
72. the best way of monitoring intestinal grafts is via
a. laparoscopic evaluation
B. endoscopic monitoring
c. serial wbc count testing for infection
d. none of the above
73. which is not true regarding lymphocele formation post kidney transplant?
a. ultrasound to diagnose fluid collection
b. peritoneal window creation is a standard drainage procedure
C. occurs as early as 1 week post-transplant
d. may manifest as unilateral leg swelling on the site of the transplant
74. the most common indication for heart transplantation is
a. dilated cardiomyopathy
b. intractable angina
c. congenital heart disease
d. valvular disease
75. generally accepted principle in heart transplant is to anastomose this structure the last:
a. aorta
b. pulmonary artery
c. right atrium
d. left atrium

matching type
a. dacluzimab
b. corticosteroids
c. azathioprine
d. thymoglobulin
e. cyclosporine
f. mycophenolate mofetil
76. binds to cyclophilin
77. first line agents in acute rejection
78. inhibitors of de novo purine synthesis
79. interferes with dna and rna synthesis
80. anti-cd 25 monoclonal antibodies

surgical nutrition
true or false
81. overnutrition in itself is a form of malnutrition
82. a bmi of 35 can be categorized as extreme obesity
83. in nutrition risk level assessment, a patient is considered high risk if the
aggregate score is >3
84. patients may have fluid accumulations that mask weight loss or over inflate
current weight negating accurate nutrition assessment
85. low serum albumin (<2.2g/dl) is a marker of a negative catabolic state, and a
predictor of patient outcome
86. serum transferrin has an intermediate half-life of eight to nine days, reflecting
protein status for the past two to four months
87. bmi alone provides current weight status, but doesn’t account for the rate of
weight change that is important to identify when screening for malnutrition
88. studies have shown that the use of parenteral nutrition (pn) in the absence of
malnutrition should trend towards better control of complications and
improved outcomes compared to the use of nutrition alone
89. enteral feeding via nasogastric tubes have the additional advantage of being
able to quantify gastric residuals and they are also less likely to become
unchanged
90. parenteral support is indicated in postoperative patients who are unable to
receive adequate enteral nutrition by postoperative days 10 to 14
91. surgery must be delayed for preoperative parenteral or enteral
supplementation for patients who have mild-to-moderate malnutrition
92. oxidative stress means a shift to catabolic metabolism associated with
mucosal atrophy of the intestines
93. hemodynamic instability may not hamper a decision to proceed with enteral
feeding for reasons of better clinical outcomes when it is instituted early
94. prokinetic agents may provide some benefit in patients with documented
dysmotility
95. clostridium infection may be a significant cause of diarrhea in patients that are
critically ill undergoing enteral nutrition support
96. arginine serves as a precursor for the de novo production of glutamine for
enhanced immune function
97. glutamine is a key fuel for immune cells that increases human leukocyte
antigen-dr expression on monocytes and enhances neutrophil phagocytosis
98. patients with severe sepsis may not have favorable immunologic response
when given arginine supplementation
99. omega-3 fatty acids generally helps in decreasing neutrophil adhesion and
subsequent inflammatory response that occur in the critically
100. earlier intervention with the use of parenteral nutrition (pn) may be
appropriate in patients who are severely malnourished at baseline, or who
have a complicated postoperative course.
 surgery quiz 2
dr. pangilinan
you are the surgeon on duty in the emergency room. 2 hours into your shift, a 29 year old male was
brought to the er about 15 minutes after falling from the 3rd floor of a building. he was unconscious with
the following vital signs: bp 70/40, cr 130/min, rr 29/min. physical exam: 10cm scalp laceration (left
parietal area) with brain evisceration and decompressed skull fracture, mid face fracture with blood
oozing from mouth and nose; 4cm laceration lateral neck with pulsatile bleeding, a piece of wood impaled
to his right upper quadrant, open fracture of right femur
1. what should you do first?
A. check airway
B. cpr
C. cover the head wound
D. stop the bleeding
2. how would you establish a patent airway?
A. chin lift
B. endotracheal intubation
C. tracheotomy
D. jaw thrust
3. what class of hemorrhage does the patient belong to?
A. class i
B. class ii
C. class iii
D. class iv
4. which of his injuries will you treat first?
A. head injury
B. neck injury
C. abdominal injury
D. fracture femur
5. you have no rigid collars in the er. what can you use to immobilize the patient’s neck?
A. soft pillows
B. sand bags
C. rocks
D. no need to immobilize his neck

after establishing an airway and hemorrhage control, you splint the fracture and insert iv lines

6. if his estimated blood loss is 1.5l, how much fluids will you give?
A. 1.5l
B. 2.5l
C. 3.5l
D. 4.5l
7. what type of fluid will you give?
A. d5lrs
B. plain lr
 C. dextran
D. d5nss

after giving the computed fluid volume for resuscitation, his blood pressure became 110/80 but
dropped back to 70/40

8. what should you do next?

A. bring to radiology for imaging studies
B. bring to or for urgent surgery
C. bring to icu for rewarming
D. continue fluid resuscitation
9. what will you do to the piece of wood protruding from his ruq?
A. pull it out in the er, bring to or if he bleeds
B. bring him to or, open his abdomen, and pull out the object under direct vision
C. bring him to or, pull out the object. if he bleeds, open his abdomen
D. bring to or, incise into the abdominal wound until the impaled object is removed
10. ct scan of the head revealed a crescenteric opacity on the parietal area. this is indicative of
which of the following?
A. subdural hematoma
B. epidural hematoma
C. dai
D. intracerebral blood
11. what is the usual source of bleeding in question #10?
A. arterial
B. venous
C. capillary
D. ventricular
12. if the patient survives his injuries and is discharged, what would you recommend?
A. physical therapy
B. psychological therapy
C. occupational therapy
D. aota

a 35 year old male was brought to you after being stabbed in the chest and abdomen 2 hours prior to
admission. he is ambulatory with the following vital signs: bp 110/80 cr 110/min rr 21/min. he has a stab
wound in the 6th ics left mcl, the epigastric area, left lower quadrant, and hypogastric area. breath sounds
were diminished on the left… was equivocal.
13. what imaging studies will you request?
A. chest ct
B. chest x ray
C. chest ultrasound
D. abdominal ct
 14. if there is a hemothorax, how will you treat it?
A. observation
B. thoracentesis
C. insert a chest tube
D. open thoracotomy
15. initial drainage from chest is 1000cc of blood. what do you do next?
A. close monitoring
B. thoracentesis
C. explore lap
D. open thoracotomy
16. how will you investigate the abdomen?
A. fast
B. ugis
C. dpl
D. any of the above
17. which of the following are positive findings of dpl:
A. < 5000 rbc
B. > 5000 rbc
C. food fibers
D. b and c only

an exploratory laparotomy was done and revealed the following: single stomach perforation, gallbladder
perforation, descending colon perforation, 6 ileal perforations close to each other. no fecal
contamination.

18. how will you treat the stomach injury?

A. primary suture repair
B. billroth ii repair
C. resect the injured area and anastomose
D. apply fibrin glue to the perforation
19. how will you treat the gallbladder injury?
A. primary suture repair
B. cholecystectomy
C. cholecystostomy
D. apply fibrin glue to the perforation
20. how will you treat the colonic injury?
A. primary suture repair
B. double barrel colostomy
C. resect the injured area and anastomose
D. apply fibrin glue to the perforation
21. how will you treat the ileal perforation?
A. primary suture repair
B. double barrel ileostomy
C. resect the injured area and anastomose
 D. apply fibrin glue to the perforation

a 40 year old male patient came into the er after stabbed in the abdomen. he was stable but the
abdomen was tender all over. exploratory laparotomy was done which revealed a non-expanding, non-
pulsatile retroperitoneal hematoma in zone 1, and an isolated ductal injury at the tail pancreas.

22. what will you do regarding the retroperitoneal hematoma?

A. leave the hematoma alone
B. perform intra-op colonoscopy
C. close patient then do post-op ct scan to monitor progression of the hematoma
D. explore the hematoma
23. how will you treat the pancreatic injury?
A. distal pancreatectomy
B. whipple’s maneuver
C. pancreaticojejunostomy
D. drain only
24. what are structures in the zone i of the retroperitoneum?
A. kidneys
B. 2nd portion of duodenum
C. abdominal aorta
D. spleen
25. what is the 2nd most common injured organ after penetrating abdominal trauma?
A. liver
B. spleen
C. kidney
D. colon
26. what are the structures that are clamped during the pringle’s maneuver?
A. portal vein
B. common bile duct
C. common hepatic artery
D. aota
27. what percentage of penetrating chest injuries can be treating by chest tube insertion along? a.
85%
b. 80%
c. 90%
d. 100%
28. which of the following are indications for chest tube thoracotomy?
A. initial chest tube output of 1500cc
B. penetrating chest injury
C. single pneumothorax
D. tube output of 1500cc
29. which of the following are included in the “cervical spine” series?
A. cervical ap view
B. cross table lateral view
 C. ap open mouth view
D. aota
30. in aortic injuries, what is the critical clump time to prevent distal ischemia or paraplegia?
A. 30 minutes
B. 40 minutes
C. 1 hour
D. 2 hours
31. what is the most frequently injured organ following blunt abdominal injury?
A. liver
B. spleen
C. kidney
D. colon
32. left medial visceral rotation is also known as:
A. mattox maneuver
B. cattell-braasch maneuver
C. pringle’s maneuver
D. nota
33. the suprarenal aorta is best exposed using which of the following?
A. mattox maneuver
B. cattell-braasch maneuver
C. pringle’s maneuver
D. nota
34. the inferior vena cave is best exposed using which of the following?
A. mattox maneuver
B. cattell-braasch maneuver
C. pringle’s maneuver
D. nota
35. which of the following are indications for surgery following abdominal stab wounds?
A. soft abdomen
B. blood in ngt
C. absent bowel sounds
D. b and c only
36. the “coiled spring” sign on contrast radiography is pathognomonic for this injury:
A. gastric perforation
B. intussusception
C. intestinal perforation
D. duodenal intramural hematoma
37. a patient with cardiac tamponade will present with the following:
A. distended neck veins
B. hypotension
C. muffled heart sounds
D. aota
38. in what class of hemorrhage would tachycardia occur?
A. class i
 B. class ii
C. class iii
D. class iv
39. which of the following is true in a hypotensive trauma patient with cardiac tamponade?
A. neck veins distended
B. neck veins flat
C. bradycardia
D. nota
40. which of the following characteristic of patient with chest injury who suddenly deteriorates after
intubation and positive pressure ventilation?
A. tension pneumothorax
B. myocardial infarction
C. cardiac tamponade
D. air embolism
41. what is the glasgow coma score of a patient who has abnormal flexion, inappropriate words, and
has no eye opening?
A. 6
B. 7
C. 8
D. 9
42. which of the following conditions would require thromboembolism prophylaxis in the trauma
patient?
A. coma
B. age over 55 years old
C. obesity
D. aota
43. what is the most important single factor in the management of contaminated wounds?
*debridement dapat
A. tetanus prophylaxis
B. antibiotic administration
C. irrigation
D. hemostasis
44. which of the following is the most ominous sign of a urethral injury?
A. scrotal hematoma
B. blood in the urethral meatus
C. pelvic instability
D. nota
45. what are the options for hemostasis in pelvic fracture?
A. immediate external fixation
B. angio-embolization
C. pelvic packing
D. aota
in the secondary survey, what does the acronym a.m.p.l.e. stand for?
46. a -
 47. m-
48. p–
49. l–
50. e–

dr. bangaoet
1. in doing a thoracentesis, you may go 2 interspaces below the top of the effusion..
A. 7th ics
B. 8th ics
C. 9th ics
D. 10th ics
2. complication of thoracentesis, except:
A. intercostal vessel damage
B. poor flow
C. pneumonia
D. pneumothorax
3. indication for chest tube thoracotomy, except:
A. emphysema
B. symptomatic pneumothorax any size
C. pleural effusion
D. hemothorax
4. complications of ctt, except:
A. hemorrhage
B. lung injury
C. cardiac dysrhythmia
D. pneumothorax
5. indication for ngt insertion, except:
A. ileus
B. ugib
C. parenteral feeding
D. small bowel obstruction
6. complications of ngt insertion, except:
A. gastritis
B. sinusitis
C. esophageal irritation
D. epistaxis
7. contraindication of ngt insertion, except:
A. bowel ileus
B. pregnancy
C. bowel obstruction
D. coagulopathy
8. preferred site for entry in paracentesis, except:
A. just below umbilicus
B. either lower quadrant (asis)
 C. level of umbilicus
D. medial to the rectus sheath
9. complication of paracentesis, except:
A. bowel perforation
B. hypertension
C. hemorrhage
D. hypotension
10. contraindication in doing a dpl, except:
A. cirrhosis
B. prior surgery
C. pregnancy
D. morbid obesity
11. indication for urethral catheterization, except:
A. post op urethral stenting
B. urinary retention
C. intravesical chemotherapy
D. urethral injury bypass
12. indication for surgical cricothyroidotomy, except:
A. unsuccessful tracheal intubation
B. prolonged intubation
C. upper airway obstruction
D. extensive orofacial trauma
13. complication of venous cut down, except:
A. infection
B. phlebitis
C. bleeding
D. thrombosis
14. when inserting an ngt, what position is ideal for the patient
A. supine
B. trendelenburg
C. prone
D. high back rest
15. when doing thoracentesis, what would be a good indication to slow the collection of the …
A. hypotension
B. coughing
C. pallor
D. hemoptysis
16. when inserting a chest tube, the insertion of the finger into the tract is to palpate for the
following, except:
A. adhesions
B. lung parenchyma
C. pleural space
D. stomach
17. the most important checkpoint in ifc insertion prior to inflation of the balloon
 A. urine is flowing
B. absence of pain
C. catheter is inserted up to the bifurcation
D. no resistance
18. insertion a wire through the needle in the chest then removal of the needle leaving the wire is a
part of what technique
A. robertson’s technique
B. seldinger technique
C. watson’s technique
D. roger’s method
19. an 18 year old female student comes into the er with alar flaring, dyspnea and a spo2 of 75. what
are you supposed to do?
A. x-ray
B. auscultate the chest
C. insert a needle at the 5th interspace
D. ctt insertion
20. in question 18, it was noted that the patient had absent breath sounds on the right. what is the
next best things to do?
A. ctt right
B. cxr to verify pe finding
C. insert a large bore needle at the 2nd interspace mid axillary line, right
D. insert a large bore needle at the 2nd interspace mid clavicular line, right
21. an 80 year old male comes into the er with a complaint of dysuria. ie finding reveals a distended
bladder. what are you supposed to do at this time?
A. history taking
B. ultrasound of the prostate
C. ifc insertion
D. suprapubic tap
22. in question 21, history revealed patient to be taking anti bph drugs and has a recurrent history of
urinary retention, what are you supposed to do now?
A. do a suprapubic tap
B. confirm bph with a rectal exam
C. insert an ifc after infiltration of the urethra with lidocaine jelly
D. confirm bph with an ultrasound
23. you are on duty at the er when a 25 year old male comes in with multiple stab wounds to the
chest. patient has decreased breath sounds on both lung fields. bp is palpatory and has cold
clammy perspiration. double line ivf was hooked, o2 inhalation given per face mask. what do you
do next?
A. insert a ctt, right
B. do a thoracentesis on both thoracic cavities
C. do a portable cxr
D. insert a bilateral ctt
24. cxr revealed hemothorax, bilateral. what is the best thing to do at this time?
A. do a thoracentesis on both cavities
 B. resuscitate patient with blood prior to ctt
C. ctt insertion bilateral
D. bring patient directly to the or
25. after insertion of the ctt on the right in question 24, the patient was noted to be relived and
started breathing normally, what should we do next?
A. observe
B. monitor if a ctt left is indicated
C. admit patient
D. proceed to insertion of a ctt, left
26. the vein of choice in pediatric patient is
A. basilic vein
B. cephalic vein
C. saphenous vein
D. axillary vein
27. in the event that an artery was cannulated instead of a vein during cut down, what is the best
thing to do?
A. ligate the artery
B. use the artery for access
C. repair the injured vessel
D. abort the procedure
28. in a patient with bowel obstruction, there was noted billous output in the bedside bottle
attached to the ngt, however, the patient started vomiting, what should you do?
A. put patient in trendelenburg position
B. put patient in fowler’s position
C. check for patency of the ngt
D. reinsert ngt immediately
29. contraindicated in ifc insertion in a male patient is:
A. blood per meatus
B. bladder distention
C. bladder collapse
D. hypotension
30. a patient with pneumo-hemothorax on the left underwent a chest tube insertion on the
ipsilateral side, on post ctt x-ray, it was noted that the chest tube was in the abdominal cavity,
what should you do?
A. reinsert the ctt properly and do a repeat x-ray
B. request for an abdominal ultrasound
C. request for an abdominal ct scan
D. do an ex-lap post proper ctt reinsertion
31. insertion of a ctt is least likely done in the following:
A. asymptomatic pneumothorax
B. asymptomatic hemothorax
C. pleural effusion
D. tension pneumothorax
 32. a 22 year old male, thin, tall patient comes to the er with difficulty of breathing. what should
you do initially?
A. taking the history
B. palpate
C. percuss
D. auscultate
33. in question 32, there was decreased breath sounds in the left lung field, what should you do?
A. give o2 inhalation by face mask
B. give o2 inhalational by nasal cannula
C. insert a needle at the 2nd interspace, mid clavicular line, left
D. intubate patient

dr. genuino
a 24 year old patient with chronic cholecystitis was scheduled for laparoscopic cholecystectomy. during the
operation, the main surgeon asked you to assist in positioning the patient:
1. the patient’s position during the procedure is:
A. reverse trendelenburg
B. fowler’s position
C. head part up-foot part down
D. aota
E. nota
2. the patient’s arms are
A. tucked
B. abducted side wards externally rotated
C. either a or b
D. nota
3. with regards to the patient’s index
A. left side up
B. right side up
C. either a or b
D. nota
4. you are designated as the cameraman, you will be staying at
A. the patient’s left side, at the main surgeon’s left side
B. the patient’s left side, at the main surgeon’s right side
C. either a or b
D. nota
5. the surgeon asked you for the preferred entry technique for a safer surgery. your answer will be
A. closed technique
B. open technique
C. veress needle technique
D. dota
an 18 year old female was diagnosed with acute appendicitis. she was scheduled for an emergency
laparoscopic appendectomy
6. the patient’s position during the procedure is:
A. reverse trendelenburg
B. fowler’s position
C. head part up-foot part down
D. aota
E. nota
7. the patient’s arms are
A. tucked
B. abducted side wards externally rotated
C. either a or b
D. nota
8. with regards to the patient’s index
A. left side up
B. right side up
C. either a or b
D. nota
9. you are the designated as the cameraman, you will be staying at
A. the patient’s left side, at the main surgeon’s left side
B. the patient’s left side, at the main surgeons’ right side
C. either a or b
D. nota
10. upon inserting the 1st trochar, the main surgeon asked you what will you use to enter the
abdomen that will combine the close and open technique:
A. veress needle
B. optical trochar
C. hanson’s trochar
D. nota
11. for trocar placement:
A. it should be at least 10cm apart
B. it should be made of plastic
C. it should be made of metal
D. nota
12. during a laparoscopic cholecystectomy, the patient’s lives obtained a thermal injury because of a
breech insulator of the cautery which directly burned the liver. this is called:
A. direct coupling
B. capacitive coupling
C. indirect coupling
D. nota
13. safest period to perform a laparoscopic procedure in a pregnant patient:
A. 1st trimester
B. 2nd trimester
C. 3rd trimester
 D. after childbirth
14. a truly scar free surgery
A. sils
B. robotic surgery
C. notes
D. aota
15. the gas we use for laparoscopic procedure
A. air
B. n2o
C. co2
D. aota
16. the following are systemic effects of the gas used in producing pneumoperitoneum
A. acidosis
B. increased afterload
C. myocardial stress
D. aota
17. the lateral extension of the retzius space utilized in laparoscopic hernia repair is called
A. space of bogros
A. space of burgos
B. space of bodros
C. nota