​ ​ THIRD BIMONTHLY COMPILATION

​ ​ SURGERY 1 LONG EXAMS

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7. Which best defines the complement system in the inflammatory response?
THIRD BIMONTHLY A.​ It activates platelets that trigger vasodilation
B.​ It promotes the formation of MAC to lyse pathogens
LESSON 1, 2 & 3 C.​ It promotes the inflammasome complex to pyroptosis
D.​ It activates kininogen to promote bradykinin
1.HMGB1 plays a significant role in gene expression. In response to stress, they are released to the
extracellular space. Where is their normal intracellular location? 8. Which of the following statements defines CIRCI, a result of impaired function of the HPA axis in
A.​ Mitochondria critically ill patients?
B.​ Endoplasmic Reticulum A.​ It is a dysregulated systemic inflammatory response characterized by overproduction of
C.​ Nucleus glucocorticoids and their
D.​ Extracellular Matrix B.​ It is an exaggerated pro-inflammatory response characterized by impaired adrenocortical
response producing
2. The inflammasome is a protein complex that mediates caspase-1 activation, allowing pyroptosis. The
C.​ It is a counter-regulatory phenomenon of hyper-stimulation of the HPA axis producing
IL-1 receptor is associated with:
elevation of catecholamines and
A.​ TLR (Toll-like Receptor)
D.​ It is an impaired feedback loop mechanism producing increased membrane attack complexes
B.​ NOD (Nucleotide-binding Oligomerization Domain)
in the setting of depressed antigen presentation.
C.​ RAGE (Receptor for Advanced Glycation End-products)
D.​ IL-1R (Interleukin-1 Receptor) 9. What cytokine prevents pro-inflammatory effects by inhibiting TNF-a, IL-1, IL-6, IL-8, and IFN-y? It
impairs phagocytosis of cells in the innate immune system and prevents antigen presentation in APCs.
3. Which of the following events occurs first in the systemic inflammatory response?
A.​ TNF-a
A.​ Inflammasome activation
B.​ IL-1
B.​ Release of cytokines
C.​ TGF-B
C.​ Alarmin release
D.​ IL-10
D.​ Neutrophil activation
10. Serotonin is released from platelets during inflammation and is involved in which of the following
4. Which of the following is the major APC in the humoral immune system?
processes?
A.​ B cell
A.​ Vasodilation and increased capillary permeability
B.​ Macrophage
B.​ Chemotaxis of immune cells
C.​ T cell
C.​ Inhibition of complete activation
D.​ Dendrites
D.​ Reduction of leukocyte adhesion to blood vessel walls
5. Marginal B cells are found in the spleen and function as the first line of defense against blood-borne
11. Histamine is released predominantly by what cells?
pathogens by secreting IgM. However, circulating follicular B cells found in the lymph nodes, during
A.​ Macrophage
infection, produce IgG, IgA, IgE instead. What is the process called?
B.​ Mast cells
A.​ Immune maturation
C.​ T lymphocytes
B.​ Cellular adaptation
D.​ Neutrophils
C.​ Functional morphism
D.​ Class switching 12. In the regulated inflammatory response, leukocytes are attracted to the site of injury. They undergo
capture, fast rolling, slow rolling, and eventually arrest at the site of injury. What molecule facilitates this
6. Which of the following cytokines is considered the primary initiating signal that coordinates the
event?
mobilization of immune cells to the site of injury? It is a hyperacute mediator with elevations within 10
A.​ Immunoglobulins
minutes and peak effects within 1-2 hours after injury.
B.​ Nitric Oxide
A.​ TNF-a
C.​ Endothelins
B.​ IL-1B
D.​ Selectins
C.​ TGF-B
D.​ IL-10
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13. In the assessment of MOF (multi-organ failure), which organ system is NOT part of the most widely 20. Shock index is considered to be the best marker in assessing the severity of shock than heart rate
accepted scoring systems? and BP alone. For the above-mentioned patient, based on the ASI, what is the percentage of blood
A.​ Cardiovascular loss?
B.​ Gastrointestinal A.​ 0
C.​ Biliary B.​ 10-20%
D.​ Renal C.​ 20-30%
14. The diagnosis of SIRS requires the presence of at least two of the following criteria, except? D.​ 30-40%
A.​ Body temperature <36°C or >38°C 21. For the above-mentioned patient, what is the maintenance fluid in 24 hours based on the
B.​ Heart rate >90 bpm Holiday-Segar equation?
C.​ Respiratory rate <12 breaths/min 22. A.​ 1500 ml/hr
D.​ WBC count <4,000 cells/mm3 or >12,000 cells/mm3 B.​ 1750 ml/hr
15. Matching Type Produces Fever: C.​ 2100 ml/hr
A.​ IL1 D.​ 2500 ml/hr
B.​ TNF 22. Which of the following active warming techniques is the most effective against hypothermia by
C.​ Both delivering the most kcal/hr?
D.​ Neither 23. A.​ Overhead reactive warmer
16. Causes hypercortisolism? B.​ Cardiopulmonary bypass
A.​ IL-1 C.​ Heating blankets
B.​ TNF D.​ Continuous arteriovenous warming
C.​ Both 23. Treatment of metabolic acidosis in severe trauma is mainly treating the blood loss. Despite the
D.​ Neither elevation of BP in initial concentration and without compensatory regulation, what is the major
17. Activates coagulation cascade: drawback of sodium bicarbonate? This leads to the preferential use of THAM.
A.​ IL-1 A.​ Increased intravascular volume
B.​ TNF B.​ Impaired gluconeogenesis
C.​ Both C.​ Cerebral shrinkage
D.​ Neither D.​ Increased CO2 production

18. Increases pulmonary edema: 24. In the measurement of clinical sepsis, coagulation parameters are also assessed in the SOFA.
A.​ IL-1 What coagulation factor is included in the parameters?
B.​ TNF A.​ Bleeding time
C.​ Both B.​ Activated partial thromboplastin
D.​ Neither 25. C.​ Platelet count
D.​ International normalized ratio
19. The above-mentioned patient was involved in a vehicular 26. accident. His vital signs are BP 110/80
mmHg, HR 110 bpm, RR 25 cpm. According to ATLS, what type of class of hemorrhagic shock? 25. NO INPUT
A.​ Class 1 26. Which of the following clinical findings on Lactated Ringer's solution (LRS) is TRUE?
B.​ Class 2 A.​ L-lactate causes more pulmonary apoptosis than D-lactate.
C.​ Class 3 B.​ LRS causes neutrophil activation in hemorrhagic shock.
D.​ Class 4 C.​ LRS causes diminished leukocyte gene expression and decreased cytokine release.
D.​ L-lactate causes more inflammation than D-lactate.
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27. The major function of magnesium is: 35. ALTERNATIVE: Which of the following statements about albumin is true
A.​ Fluid volume A.​ Albumin level is an indicator of nutritional status and fluctuates with changes in BMI.
B.​ Heart & muscle B.​ Albumin is limited to use in preoperative surgical settings.
C.​ Neuromuscular excitability C.​ Albumin shuttles various molecules across the body.
D.​ Neuromuscular depression D.​ Albumin is not influenced by surgical interventions or stress.
28. The major function of sodium is: 36. In the measurement of nutritional needs, what factor remains the gold standard in calculating
A.​ Fluid volume energy expenditure?
B.​ Heart & muscle contraction A.​ Oxygen consumption
C.​ Neuromuscular excitability B.​ Heat production
D.​ Neuromuscular depression C.​ Tissue fat determination
29. Trousseau's sign is caused by: D.​ Weight, height, age
A.​ Hypercalcemia 37. Refeeding Syndrome, which of the following statements is false?
B.​ Hypocalcemia A.​ Shifting
C.​ Hypophosphatemia B.​ Leads to hyperglycemia
D.​ Hypomagnesemia C.​ Causes electrolyte imbalances
30. A 37-year-old male admitted with severe maxillofacial fractures with tracheal and esophageal D.​ Accelerates metabolic acidosis
injuries. What is the appropriate route of internal access? 38. Which of the following cytokines inhibits and down-regulates pro-inflammatory cytokines like IL-1,
A.​ NGT IL-6, and IFN gamma?
B.​ PEG A.​ IL-10
C.​ Open gastrostomy B.​ TGF-β
D.​ Surgical colostomy C.​ IL-4
31. Classification of warming techniques: Passive warming techniques include: D.​ IL-1Ra
A.​ Warm blankets 39. Which disease increases ADH production?
B.​ Overhead reactive warmers A.​ SIADH
C.​ Cardiopulmonary bypass B.​ Diabetes insipidus
D.​ Continuous arteriovenous warming C.​ Both
32. Which of the following produces more carbon dioxide than oxygen consumed? D.​ Neither
A.​ Carbohydrates 40. In patients with severe burns, what is the ideal ratio of Non-Protein Calories to Nitrogen?
B.​ Protein A.​ 120:1
C.​ Fats B.​ 100:1
D.​ Fiber C.​ 125:2
33. In Nutritional Risk Screening or the Nutrition Risk in the Critically Ill (NUTRIC), what parameter is D.​ 150:1
not included? 41. 90% symptoms of Addison's disease are due to secondary adrenocortical insufficiency. (NO
A.​ BEE CHOICES INPUT)
B.​ SOFA 42. A 65-year-old male underwent emergency laparoscopy, has severe abdominal trauma, multiple liver
C.​ Comorbidities injuries, and massive blood loss. What type of feeding is appropriate?
D.​ ICU admission A.​ Diet as tolerated (DAT)
34. The following statement is true for albumin: B.​ Total parenteral nutrition (TPN)
A.​ Synthesized in the liver C.​ Partial enteral nutrition (PEN)
B.​ Contributes to oncotic pressure D.​ Partial parenteral nutrition (PPN)
C.​ Acts as a carrier protein for hormones and drugs
D.​ Increased loss in conditions with capillary leak
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43. For a healthy, non-stressed 55-year-old, 60 kg male who goes to the gym for muscle building, what 4. Which of the following regarding the remodeling phase of wound healing is TRUE?
is his ideal minimum daily NPC requirement? (Recommended daily protein requirement is 0.8g/kg per a.​ Vasodilation brings more WBCs to the injured area, releasing growth factors.
day.) b.​ The wound is at its weakest, and the risk of dehiscence is highest.
A.​ 921 kcal c.​ Cross-linking and maturation of collagen fibers improve wound tensile strength.
B.​ 1152 kcal d.​ Fibroblasts differentiate from resting mesenchymal cells after activation by growth factors.
C.​ 1800 kcal 5. Being the most potent stimulant of fibroplasia, which of the following growth factors is
D.​ 7200 kcal most directly involved in the promotion of wound contraction during the proliferative
44. The major function of magnesium is: phase?
A.​ Fluid volume a.​ Transforming Growth Factor-beta (TGF-β)
B.​ Heart & muscle b.​ Vascular Endothelial Growth Factor (VEGF)
C.​ Neuromuscular excitability c.​ Platelet-Derived Growth Factor (PDGF)
D.​ Neuromuscular depression d.​ Epidermal Growth Factor (EGF)
6. During epithelialization, which of the following processes is most critical for the
​ 45. Protein synthesis, DNA replication, depressed appetite are A.​ Vitamin A re-establishment of a fully functional epidermal barrier?
associated with which vitamin? B.​ Vitamin B1
a.​ Myofibroblast contraction and collagen deposition
​ 46. Antibacterial functions, lymphocyte function, and C.​ Vitamin C
​ 47. Coagulation, easy bruisability, and hemorrhage are D.​ Vitamin K b.​ Angiogenesis and granulation tissue formation
associated with which vitamin? E.​ Zinc c.​ Neutrophil infiltration and clearance of pathogens
​ 48. Collagen cross-linking, glucose to TCA cycle, and d.​ Keratinocyte proliferation, migration, and differentiation
Wernicke-Korsakoff syndrome are associated with which vitamins?
7. Which of the following statements about abnormal wound healing is TRUE?
​ 49. Coagulation, easy bruisability, hemorrhage are associated
with which vitamin? a.​ Keloid scars have thick collagen bundles with a hypercellular central core in the epidermis.
​ 50. Which vitamin is necessary for the prevention of scurvy? b.​ Hypertrophic scars form structures composed of islands of fibroblasts and collagen fibers in
the epidermis.
c.​ Hypertrophic scars are prevented by making skin incisions perpendicular to the underlying
muscle fibers.
LESSON 4, 5 & 6
d.​ Hypertrophic scars treated with radiation therapy show decreased recurrence compared to
1. Formation of granulation tissue is an expected event in which phase of wound healing? excision therapy.
a.​ Inflammation 8. Which of the following factors contributes most to delayed wound healing in the elderly?
b.​ Proliferation a.​ The dermis has more Langerhans cells and melanocytes, leading to impaired immune

⬆️
c.​ Maturation response.
d.​ All of the b.​ Widening of the dermal-epidermal junction increases by 50%, reducing keratinocyte
2. Angiogenesis of tissue is expected to occur in which phase of healing? proliferation.
a.​ Inflammation c.​ The dermis has more fibroblasts, macrophages, mast cells, and an increased extracellular
b.​ Proliferation matrix, leading to abnormal healing.
c.​ Maturation d.​ keloid are treated w/ excision alone can decrease recurrence compared to brachytherapy
d.​ All of the above 9. The conventional gauze OS (Open Surgery) bandage is a form of what class of dressing?
3. Which of the following cytokines has anti-inflammatory effects to balance the events of a.​ Non-adherent fabric
inflammation? b.​ Occlusive dressing
a.​ IL-4 c.​ Absorptive dressing
b.​ IL-6 d.​ Solution
c.​ Tumor Necrosis Factor-alpha (TNF-α)
d.​ Interferon-gamma (IFN-γ)
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10. Which of the following antibacterial solutions used in wound dressing has a distinct 20. Hematopoietic stem cells (HSCs) can give rise to all the blood cells. These sources are harvested
disadvantage of fibroblast toxicity? non-invasively as they have higher proliferative capacity and a lower risk of graft-versus-host
a.​ Neosporin disease (GVHD) in transplantation. From which tissue are these stem cells typically harvested for
b.​ Silver sulfadiazine medical use?
c.​ Acetic acid a.​ Peripheral blood
d.​ Dakin’s solution b.​ Bone marrow
11. Which layer of the intestine provides the greatest suture-holding capacity and the greatest c.​ Spleen
tensile strength? d.​ Umbilical cord
a.​ Mucosa 21. Despite their potential for generating multiple specific cell lines, which of the following
b.​ Submucosa statements shows the greatest limitation of using induced pluripotent stem cells (iPSCs) in clinical
c.​ Muscularis applications?
d.​ Serosa a.​ PSC cannot differentiate into specialized tissues.
12. A 26-year-old male involved in a vehicular accident had his arm pinned down before rescuers b.​ PSC cannot be differentiated into mesodermal lineage cells
were able to remove him from the wreckage. Two months after, he still has persistent weakness of c.​ Their differentiation potential is more restricted than lineage cells.
the involved extremity. What type of injury is taking place? d.​ The reprogramming process requires extensive modifications, increasing the risk of
a.​ Neuropraxia tumorigenicity.
b.​ Axonotmesis Matching Type: Match A (events) with B (tissue involvement and growth factors).
c.​ Synaptic disconnect
​ 22. Unipotent a.​ Chondrocytes
d.​ Neurotmesis
​ 23. Multipotent b.​ Umbilical cord
13. Which of the following is a limiting factor in the healing of cartilage? ​ 24. Pluripotent c.​ Somatic cells/ Yamanaka factor
a.​ High rate of cellular turnover ​ 25. Totipotent d.​ Blastomere
b.​ Excessive fibrosis
c.​ Suboptimal collagen fibers 26. In the context of 3D bioprinting for tissue engineering, which of the following is a major challenge
d.​ Relative avascularity when using hydrogels as bioinks for cell encapsulation?
Matching Type: Match A (events) with B (tissue involvement). a.​ Hydrogels are too soft to gel for encapsulation after printing.
b.​ Hydrogels often lack sufficient mechanical strength to support tissue formation.
​ 14. Chondration a.​ Cartilage c.​ Hydrogels do not provide the necessary biocompatibility for long term implantation.
​ 15. Restitution b.​ GIT d.​ Hydrogels degrade too quickly to support long-term cell or tissue maturation.
​ 16. Collagen fibrogenesis c.​ Ligament
27. In cell sheet technology, what is the primary advantage of using temperature-responsive culture
​ 17. Soft callus formation d.​ bone
substrates?
18. Which of the following stem cell types is derived from the inner cell mass of a blastocyst and has a.​ They enhance the ability of cells to differentiate into specific lineages.
the ability to differentiate into all tissue types of the body? b.​ They allow for non-enzymatic detachment of intact cell sheets, removing the potential risk of
a.​ Induced pluripotent stem cells (iPSCs) matrix degradation-associated cytotoxicity.
b.​ Embryonic stem cells c.​ They prevent the introduction of foreign biomaterials into the recipient tissue.
c.​ Mesenchymal stem cells (MSCs) d.​ They reduce the need for scaffolds, making the procedure more cost-effective.

19. Which stem cell source is obtained from adult tissues and is primarily used in tissue 28. In the context of CRISPR/Cas genome editing for tissue engineering, which of the following
regeneration due to its ability to differentiate into mesenchymal lineage cells like bone, cartilage, represents an ethical concern among potential limitations of the technique?
and fat? a.​ The potential for unintended genetic mutations.
a.​ Embryonic stem cells b.​ The inability to introduce site-specific genetic changes.
b.​ Induced pluripotent stem cells (iPSCs) c.​ The increased risk of immune system rejection.
c.​ Mesenchymal stem cells (MSCs) d.​ The limited application to adult tissues.
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29. Which of the following biomaterials is commonly used as a scaffold in tissue engineering due to 39. What is the most common adverse effect observed in patients following blood transfusion, per
its ability to support cell attachment and growth? unit transfused of RBCs?
a.​ Glass a.​ Allergy
b.​ Collagen b.​ Pulmonary embolism
c.​ Polyethylene glycol (PEG) c.​ Fever
d.​ Silicon d.​ Hemolysis
Matching Type: Match A (technology) with B (Bioengineering principle) 40. For the cognitive assessment of geriatric populations, which Mini-Cog score indicates possible
impairment?
​ 30. Tissue constructs with biomaterial and a.​ acid-grafted scaffolds
a.​ 2
biomolecule b.​ 3d printing
b.​ 3
​ 31. Poly-lactic-co-glycolic c.​ Cell sheet
c.​ 4
​ 32. Cell encapsulation in microspheres & microfibers d.​ microfluidics
d.​ 5
​ 33. CRISPR/Cas system e.​ gene editing
41. As part of the preoperative protocol prior to an elective surgery, what is the recommended
34. For procedure-related risk assessment, which procedure is classified as High Risk? minimum fasting period for oral intake of Kentucky Fried Chicken?
a.​ Carotid endarterectomy a.​ 2 hours
b.​ Repair of aortic aneurysms b.​ 4 hours
c.​ Repair of diaphragmatic hernia c.​ 6 hours
d.​ Thyroidectomy d.​ 8 hours
35. For patient-related risk assessment, which factor is NOT a pulmonary risk? 42. As part of the preoperative protocol prior to an elective surgery, what is the recommended
a.​ Alcoholism Timing of giving antimicrobial prophylaxis?
b.​ ASA Class ≥ 3 a.​ 1 hour
c.​ Tobacco use b.​ 2 hours
d.​ Thrombocytopenia c.​ 24hours
d.​ 72 hours
36. For patient-related risk assessment, what is the recommended period to stop smoking prior to
an operation? 43. Which of the following serum markers is a more stable index of acute nutritional status?
a.​ 1 month a.​ Albumin
b.​ 2 months b.​ Prealbumin
c.​ 4 months c.​ Transferrin
d.​ 6 months d.​ All of the above
37. For patients without cirrhosis undergoing hepatic resection, what residual liver volume is Matching Type: Match A (System evaluation) with B (Index)
considered adequate?
​ 44. Pulmonary a.​ AIRCRAFT
a.​ 20%
​ 45. Hepatobiliary b.​ MODIFIED CTP
b.​ 25%
​ 46. Cardiac c.​ RCRI
c.​ 30%
​ 47. Geriatric d.​ TUG
d.​ 40%
38. For most hemodynamically stable yet anemic hospitalized patients, including those in the Matching Type:
intensive care unit, what is the indicated adult hemoglobin threshold level for transfusion?
a.​ 6 g/dL ​ 48. Coagulation by vibration a.​ ultrasound
b.​ 7 g/dL ​ 49. Alternating current for b.​ ablation
c.​ 8 g/dL denaturation & coagulation c.​ electrocautery
d.​ 9 g/dL ​ 50. tissue vaporization
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7. In the management of Necrotizing Infections, which of the following surgical strategies is most critical
LESSON 7, 8 & 9
in preventing sepsis and mortality?
1. In the expanded criteria of SIRS, which of the following variables is NOT a factor of organ a.​ Early wound closure after debridement facilitates tissue preservation
dysfunction ? b.​ Drain placement in all affected areas with vacuum-assisted closure therapy
a.​ Thrombocytopenia c.​ Early and aggressive debridement of all necrotic tissues
b.​ Hyperbilirubinemia d.​ Skin sparing procedures reduce associated hypothermia and hyponatremia
c.​ Bandemia 8. A 28 yo male motorcycle rider sustained abrasions on his left knee while doing banking. He was
d.​ Arterial hypoxemia uncertain of his immunization status when asked about his history. What tetanus prophylaxis is
2. In the rapid assessment for the presence of sepsis, which of the following parameters is NOT part of recommended?.
the qSOFA? a.​ Tetanus toxoid only
a.​ Hyperglycemia in the absence of diabetes b.​ Tetanus toxoid + Anti-tetanus serum
b.​ Systolic BP < 90 mmHg c.​ Tetanus toxoid + Tetanus lg
c.​ Tachypnea > 22 cpm d.​ No prophylaxis recommended
d.​ Fever 9. A 23 yo male tumor resection of a descending colon mass with anastomosis. 5 days later, he
developed fever and abdominal pain. CTscan showed abscess accumulation at the left lower quadrant.
3. A 46 yo male received IV Cefazolin + Metronidazole preoperatively for an elective colorectal surgery. What is the classification of the intra abdominal abscess?
What is the rationale of antibiotic use? a.​ Primary
a.​ Prophylactic b.​ Delayed Primary
b.​ Empiric c.​ Secondary
c.​ Therapeutic d.​ Tertiary
d.​ Generic 10. In the management of intrathoracic abscess, this form of drainage acts as a one-way valve to drain
4. A 57 yo female presented with abdominal distention and associated fever, ileus and leukocytosis. pleural space fluid without allowing entry of air into the pleural space?
She underwent surgery for intestinal obstruction 2 to post-operative (previous CS) adhesions and a.​ Closed tube thoracostomy
received IV Cefoxitin preoperatively. What is the rationale of antibiotic use? b.​ Eloesser flap
a.​ Prophylactic c.​ Jackson-Pratt drain
b.​ Therapeutic d.​ Clagett window
c.​ Empiric 11. According to Spivak et al, which of the following defines UNNECESSARY antimicrobial use??
d.​ Generic a.​ use of antimicrobials for noninfectious syndromes and nonbacterial infections
5. When suspecting Necrotizing fasciitis, which of the following laboratory parameters poses the highest b.​ antimicrobial duration of use beyond the indicated period without clinical indication
risk factor for diagnosis? c.​ failure to narrow down an empiric antibiotic spectrum after culture and sensitivities
a.​ Glucose d.​ All of the above
b.​ Sodium 12. Which of the following infections is transmitted by direct contact, from patients &/or healthcare
c.​ WBC personnel?
d.​ CRP a.​ Vancomycin-Resistant Enterococcus
6. When diagnosing Necrotizing Infections, which imaging test has the highest sensitivity? b.​ Aspergillus
a.​ CTScan c.​ Hepatitis
b.​ Ultrasound d.​ Candida
c.​ MRI
d.​ Xray
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13. Regarding the Surviving Sepsis Campaign Guideline, which of the following statements is NOT
​ 27. Crowding in cross hands
included in the recommendations?
a.​ Use proton pump inhibitor or H2 blocker and LD-heparin for stress ulcer and DVT prophylaxis
Matching Type.
b.​ For patients requiring ventilatory support, use of Positive End-Expiratory pressure prevents
ventilator-associated lung injury. ​ 28. Actual 3D vision a.​ Open surgery
c.​ Remove intravascular access devices if potentially infected. ​ 29. 4 DOFs b.​ MiS Laparoscopy
d.​ Norepinephrine is the first-line choice to maintain MAP ≥ 65 mmg for patients requiring ​ 30. Tremor enhancement c.​ Robotics
vasopressor support. ​ 31. Haptic Feedback d.​ All
Matching type ​ 32. Sound Ergonomic
​ 33. Motion scaling
​ 14. Necrotizing fasciitis a.​ Clean ​ 34. Fulcrum effect
​ 15. Inguinal hernia repair b.​ Clean-Contaminated
​ 16. Penetrating stab wound c.​ Contaminated 35. Which of the following is the most common cause of fever Day 1 after surgery?
​ 17. Appendectomy d.​ Dirty-Infected a.​ CRBSI
b.​ SSI-Superficial
18. Which of the following minimally-invasive procedures DOES NOT require air insufflation? c.​ Atelectasis
a.​ Inguinal hernia repair d.​ SSI Organ
b.​ Video-assisted thoracoscopic surgery VATS
36. For surgeries with high risk of bleeding, aspirin should be discontinued for how many days
c.​ Nephrectomy
preoperatively?
d.​ Cholecystectomy
a.​ 1-2
19. Which of the following energy sources is based on laser technology? b.​ 5
a.​ Nd: YAG c.​ 3-5
b.​ Ligasure d.​ 7-10
c.​ Harmonic scalpel
37. For surgeries with high risk of bleeding, clopidogrel should be discontinued for how many days
d.​ Cautery
preoperatively?
20. What is the recommended approach in the placement of trocars for pregnant patients? a.​ 1-2
a.​ Veress b.​ 3-5
b.​ Hasson c.​ 710
c.​ Linton d.​ 5
d.​ Hand-assisted
38. Wound dehiscence as a complication of infection is usually manifested during which day after
21. For intraperitoneal procedures, which configuration offers best placement of trocars and surgery?
sectorization of camera? a.​ Day 1
a.​ Smiley b.​ Day 5
b.​ Diamond c.​ Day 3
c.​ Triangle d.​ Day 7
d.​ Square
39. Which of the following is the most common cause of nosocomial bacteremia and sepsis?
Matching Type. a.​ CRBSI
b.​ VAP
​ 22. Ergonomic triangulation a.​ SILS
c.​ CAUTI
​ 23. Small specimen extraction site b.​ NOTES
d.​ SSI
​ 24. Long distance of entry point and surgical site c.​ Conventional
​ 25. Scarless surgery laparoscopy
​ 26. Umbilical 1-point entry d.​ ALL
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40. Which of the following is the most common cause of malignant hyperthermia? 48. In preventing intestinal anastomotic leaks, which of the following is NOT a definitive factor that
a.​ Halothane increases its incidence?
b.​ Hyperthyroidism a.​ Surgeon's technique
c.​ Vancomycin b.​ Tension on suture lines
d.​ SIADH c.​ Mechanical bowel preparation
41. For deep breathing exercises, patient must hold their breaths for how many seconds? d.​ presence of sepsis
a.​ > 5 seconds 49. In the management of preoperative thyroid crisis, which treatment modality lacks extrathyroidal
b.​ > 15 seconds conversion of T4 to T3?
c.​ > 10 seconds a.​ Methimazole
d.​ > 30 seconds b.​ PTU
42. Foratening lo surge complication of surgical procedures to be classified as "permanent, what is the c.​ Lugol solution
time d.​ Plasmapheresis
a.​ 2 days 50. High output enteric fistulas are defined as?
b.​ 2 hours a.​ 200 ml/8h shift
c.​ 2 weeks b.​ > 500 ml/day
d.​ 2 months c.​ >1.000 ml/day
43. Mendelson syndrome is aspiration of sterile gastric contents which leads to this respiratory d.​ >1000 ml/8h Shift
complication -
a.​ Atelectasis
b.​ Pneumonitis
FOURTH BIMONTHLY
c.​ ARDS
d.​ Pneumonia
TUMOR
44. Which factor is NOT a component of Virchow's triad as risk factors for the development of DVT?
a.​ venous stasis Tumor Biology
b.​ VTE prophylaxis [Link] guardian of the genome, which of the following is the most commonly mutated tumor suppressor
c.​ endothelial injury gene?
d.​ hypercoagulability A.​ PTEN
45. To prevent the formation of pulmonary embolism in patients with diagnosed DVTs, what prophylaxis B.​ TP53
modality can be employed? C.​ MUTYH
a.​ Anti-embolic stockings D.​ SMAD4
b.​ VC filter 2. Which of the following is the most common form of programmed cell death involved in the regulation
c.​ Preoperative anticoagulant of tumor cells?
d.​ Early immobilizer A.​ Ferroptosis
46. Which of the following is the most common cause of SIADH? B.​ Apoptosis
a.​ Tuberculosis C.​ Autophagy
b.​ Head & Neck tum D.​ Mitotic catastrophe
c.​ Small Cell Lung Carcinoma 3. Which of the following statements on the replicative immortality of tumor genes is TRUE?
d.​ Encephalitis A.​ Tumor genes have limited replicative potential.
47. Which procedure is closely associated with the incidence of postoperative pancreatitis? B.​ Tumor genes stop growing when they have reached their differentiated genotype.
a.​ Sphincterotomy C.​ Tumor genes have elevated telomerase activity that elongates telomeric DNA.
b.​ Cholecystectomy D.​ They have high telomeric attrition giving them infinite replication abilities.
c.​ Duodenotomy
d.​ Roux-en-Y
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4. Which of the following theories explains the metastatic ability of tumor cells by changing configuration 14. Which of the following creates immunosuppressive tumor microenvironment thereby limiting t-cell
into spindle cells to invade tissues and the bloodstream? infiltration and immune response?
A.​ Growth Factor theory A.​ Elevated levels of regulatory T-cells (Tregs)
B.​ Warburg Effect B.​ Increased expression of tumor antigens on MHC class I molecules
C.​ Epithelial-Mesenchymal Transition C.​ Abundant tumor-associated macrophages (TAMs) expressing M1 markers
D.​ Chemokine Receptor-Ligand Axis D.​ High levels of PD-L1 expression on tumor cells
5. Identify the sequence of events involved in immunoediting of tumor cells? 15. They are the serial killers of multiple tumor cells by ligation of "death receptors" or release of
A.​ Elimination - Equilibrium - Escape perforin & granulysin?
B.​ Escape - Elimination - Equilibrium A.​ CD4+ T-cells
C.​ Equilibrium - Elimination - Escape B.​ CD8+ T-cells
D.​ Equilibrium - Escape - Elimination C.​ APCs
6. The only bacterial infection declared as carcinogenic, what is the organ involved in tumor D.​ Dendritic cells
development? 16. Which of the following mechanisms is most likely responsible for the immune evasion observed
A.​ Lymph nodes in tumors treated with immune checkpoint inhibitors?
B.​ Cervix A.​ Increased expression of PD-L1 on tumor cells and antigen-presenting cells
C.​ Liver B.​ Reduced production of cytokines by tumor-infiltrating lymphocytes (TILs)
D.​ Stomach C.​ Upregulation of MHC class I molecules on tumor cells
Matching Type. Match A (Tumor Biomarker) with B (Primary Cancer) D.​ Activation of macrophages via toll-like receptors (TLRS) to enhance antigen presentation
Matching Type. Match A (Therapy) with B (Classification).
​ 7. EGFR A.​ Colorectal CA
​ 8. Musashi gene MSi B.​ Pancreas ​ 17. Bevacizumab A.​ Bispecific antibodies
​ 9. C-kit C.​ Gastric GIST ​ 18. Blinatunomab B.​ Unconjugated antibodies
​ 10. CA 19-9 D.​ Lung CA (non-small cell) ​ 19. Tositumomab C.​ IgG antibodies
​ 20. Tremelimumab D.​ Immunoconjugates

Tumor Immunology
11. Which of the following statements about tumor vaccines is most accurate? Transplant Immunology
A.​ Tumor vaccines are primarily composed of viral antigens from the tumor's virus of origin. 21. Which of the following is the most important factor in determining the compatibility between a donor
B.​ Tumor vaccines aim to stimulate the immune system to recognize and attack tumor cells by and recipient in organ transplantation?
presenting tumor-specific antigens. A.​ Blood group compatibility
C.​ Tumor vaccines are universally effective in all cancer types, including advanced stages. B.​ Human leukocyte antigen (HLA) matching
D.​ Tumor vaccines require the administration of immunosuppressive drugs to be effective in C.​ Tissue type matching
advanced cancers. D.​ CD status
12. Which of the following immune checkpoint molecules is primarily responsible for suppressing T- cell 22. In the context of allogeneic organ transplantation, which of the following is the most common cause
activation in the tumor microenvironment by binding to PD-1 on T-cells? of acute rejection?
A.​ CTLA-4 A.​ Antibody-mediated rejection
B.​ PD-L1 B.​ T-cell mediated rejection
C.​ Combine C.​ Graft-versus-host disease
D.​ RAS pathway D.​ Chronic rejection
13. Which of the following statements describes neoantigens in tumor immunology?
A.​ They are produced by viruses integrated into the tumor genome.
B.​ They are highly conserved between different cancer types.
C.​ They are derived from normal, overexpressed self-antigens in tumors.
D.​ They arise from mutations in the tumor DNA that are not present in normal cells.
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23. Which of the following immunosuppressive drugs acts by inhibiting T-cell proliferation via 30. Which of the following is the principal mechanism by which the immunosuppressive drug Sirolimus
inhibition of the enzyme calcineurin? (Rapamycin) prevents graft rejection in organ transplantation?
A.​ Azathioprine A.​ Inhibition of calcineurin activation
B.​ Cyclosporine B.​ Blockade of T-cell proliferation by inhibiting IL-2 signaling and blocking mTOR
C.​ Mycophenolate mofetil C.​ Inhibition of CD3 receptor signaling
D.​ Methotrexate D.​ Suppression of antigen-presenting cell function
24. Which of the following best describes the mechanism of graft-versus-host disease (GVHD) in
allogeneic stem cell transplantation? Transplant
A.​ The recipient's immune system attacks the grafted stem cells. 31. Which of the following statements regarding DOMINO transplantation is NOT TRUE?
B.​ The donor T-cells attack the recipient's tissues, leading to inflammation and damage. A.​ Donation of a portion of a solid organ
C.​ The recipient's T-cells attack the donor's tissues, leading to graft failure. B.​ Remaining donor organ can undergo regeneration
D.​ The donor's stem cells fail to engraft due to recipient immunity. C.​ Donor donates a fully functional organ in exchange for a less effective organ
D.​ Donor was recently declared dead.
25. Which of the following is a key feature of hyperacute rejection in organ transplantation?
A.​ It is primarily mediated by T-cells and results in gradual graft damage. 32. The official organ procurement organization in the Philippines that is based in the National Kidney &
B.​ It occurs within minutes to hours of transplant due to pre-existing antibodies. Transplant Institute at Quezon City
C.​ It is associated with a delayed onset and is seen in chronic transplant rejection. A.​ HOPE
D.​ It is the result of a slow accumulation of immune complexes over weeks to months. B.​ DREAM
C.​ LIFE
26. Which of the following is a major contributor to the development of chronic graft rejection?
D.​ WISH
A.​ Activation of donor-derived T-cells recognizing recipient antigens
B.​ Chronic activation of recipient T-cells by donor-derived antigen-presenting cells 33. Maastricht Classification of potential organ donors who was already declared brain
C.​ Formation of anti-donor antibodies directed against HLA molecules dead and underwent a recent cardiac arrest;
D.​ Chronic inflammation and fibrosis in the graft due to sustained immune responses A.​ Category I
B.​ Category II
27. In organ transplantation, which of the following best describes the role of the recipient's dendritic
C.​ Category III
cells in the process of allorecognition?
D.​ Category IV
A.​ Dendritic cells are responsible for the production of antibodies that target donor antigens.
B.​ Dendritic cells activate donor-specific T-cells through presentation of donor antigens. 34. Which among the waitlist recipients is highly prioritized for the next available donor
C.​ Dendritic cells suppress the recipient's immune system to prevent rejection. organ?
D.​ Dendritic cells are not involved in allorecognition, as they are part of the innate immune A.​ MELD 6-9
response. B.​ MELD 10-19
C.​ MELD 20-29
28. Which of the following factors is most likely to increase the risk of transplant rejection in an organ
D.​ MELD > 30
transplant recipient?
A.​ High levels of immunosuppressive medication 35. Who among the potential individuals is a potential candidate for kidney donation?
B.​ Blood group compatibility between donor and recipient A.​ Obese at BMI > 40
C.​ A mismatch in HLA Class I antigens B.​ Chronic smoker
D.​ Low levels of donor-specific antibodies in the recipient C.​ Hypertensive
D.​ Diabetic
29. Which of the following is the most common consequence of the activation of the host immune
system in solid organ transplantation? 36. This is an exclusionary, non-invasive biomarker for acute cellular rejection in intestinal
A.​ Chronic graft-versus-host disease transplantation
B.​ Graft tolerance A.​ HLA status
C.​ Acute cellular rejection B.​ PRA status
D.​ Engraftment Syndrome C.​ Citrulline
D.​ DSA Donor-Specific Antibody
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37. Which of the following organs for transplant cannot tolerate prolong periods of cold 44. The most common cause of irreversible intestinal failure in Western adults is;
ischemia? A.​ trauma
A.​ Kidney B.​ Crohn's disease
B.​ Pancreas C.​ Radiation enteritis
C.​ Liver D.​ Intestinal atresia
D.​ Intestine 45. What is the most severe complication of prolonged parenteral nutrition?
38. By indication of procedure, what organ usually is simultaneously transplanted with the A.​ ESRD
kidney? B.​ PNALD
A.​ Kidney C.​ IDDM
B.​ Pancreas D.​ Intestinal failure
C.​ Heart 46. Type of tissue rejection which is mediated by pre-existing antibodies against grafted cells, causing
D.​ Intestine massive thrombosis preventing endothelial vascularization
39. A post-kidney transplantation patient who experiences hemorrhage will manifest usually A.​ Hyperacute Rejection
with which symptom? B.​ Chronic Rejection
A.​ Hypotension C.​ Complement-mediated Rejection
B.​ Hypertension D.​ Cell-mediated Rejection
C.​ Tachycardia Matching Type. Match A (Unique Complication) with B (Associated solid organ procedure).
D.​ Hematoma
​ 47. Lymphocele A.​ Pancreas
40. Active malignancy is generally contraindicated in Kidney Transplant recipients
​ 48. Bowel obstruction B.​ Kidney
EXCEPT this tumor type
​ 49. Elevated bilirubin C.​ Intestine
A.​ Renal cell CA
​ 50. Lymphoproliferative disorder D.​ Liver
B.​ Multiple myeloma
C.​ Breast cancer
D.​ Non-small cell CA of lungs
41. The most common site of kidney transplantation is:
BURNS, ABDOMINAL WALL, BITES
A.​ Right Iliac fossa
B.​ Left Iliac fossa Difficult Abdominal Wall
C.​ Transperitoneal 1. A normal intraabdominal pressure is at 5-7 mmHg. What is the critical level of significant
D.​ Pelvic intraabdominal hypertension to cause acute compartment syndrome?
42. The type of transplant procedure employed when the native diseased organ is left in- A.​ > 12 mmHg
situ is: B.​ > 25 mmHg
A.​ Auxillary C.​ >35 mmHg
B.​ Split organ D.​ > 40 mmHg
C.​ Orthotopic 2. Which of the following is the least expected complication in abdominal compartment syndrome ACS?
D.​ Heterotopic A.​ Limb ischemia
43. The most common cause of Short Bowel Syndrome in pediatric population is; B.​ Acute Kidney injury
A.​ Gastroschisis C.​ Decreased cardiac preload
B.​ Necrotizing enterocolitis D.​ Restrictive respiratory failure
C.​ Congenital Ladd's bands 3. Which of the following suture quality minimizes the risk of surgical site infection?
D.​ Intestinal atresia A.​ Braided barbed, absorbable
B.​ Monofilament, nonabsorbable
C.​ Barbed polyfilament, absorbable
D.​ Unbraided monofilament, absorbable
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4. Which of the following are expected complications in abdominal wall closure EXCEPT: Emergency Care of MSK Injuries
A.​ Postoperative adhesions 11. This term refers to an incomplete cortical disruption when a perpendicular force is applied
B.​ Wound dehiscence to the axis.
C.​ Surgical site infection A.​ Buckle
D.​ Incisional hernia B.​ Torus
5. The following closure techniques are recommended to minimize complications, which is proven to be C.​ Greenstick
of less benefit? D.​ Butterfly
A.​ en-masse closure 12. This area of the long bone is located between the physis, or physeal scar, and articular surface and
B.​ small width, short interval serves vital in bone growth and articular function -
C.​ Retention sutures A.​ Diaphysis
D.​ 4:1 suture:wound length B.​ Epiphysis
6. Which of the following is NOT a complication of an Open Abdomen? C.​ Symphysis
A.​ Loss of domain D.​ Metaphysis
B.​ Compartment syndrome 13. In assessing open bone fractures, which classification offers a prognostic index for associated soft
C.​ Enteric fistulas tissue injury and infection?
D.​ Sepsis A.​ Salter-Harris.
7. A newborn presented with an eviscerated 20 cm-segment of small intestine through a 3cm umbilical B.​ Winquist-Hansen
defect. Which closure techniques provide gradual replacement of the eviscerated contents without C.​ Gustilo-Anderson
producing acute [Link]? D.​ Enneking-Skywalker
A.​ Wittman patch 14. Which of the following xray images will give an orthogonal view of the involved segment?
B.​ Vacuum-Assisted closure A.​ Hip: cross-table lateral
C.​ Negative pressure closure B.​ Pelvis: Judet
D.​ Silo bag closure C.​ Axilla: Velpeau
8. A 42yo victim of blunt abdominal trauma underwent damage control surgery for massive liver injury D.​ Ankle: Bohler angle
and bleeding. Which closure techniques provide higher eventual fascial closure rates and minimal 15. A basketball player sprained his ankle during a game. When suspecting a ligamentous injury, which
fistula formation complications? imaging test would you prescribe?
A.​ Wittman patch A.​ Xray
B.​ Vacuum-Assisted closure B.​ MRI
C.​ MESH with Negative pressure closure C.​ CTscan
D.​ Fascial bridge D.​ Ultrasound with doppler studies
9. Which of the following factors is the most common cause of synthetic mesh failure in 16. A 35-year-old male presents to the ER with a displaced midshaft femur fracture following a motor
abdominal wall closure? vehicle accident. On examination, the leg is shortened and externally rotated with no skin injury. The
A.​ Adhesions patient is hemodynamically stable, and radiographs confirm the fracture. Which of the following is the
B.​ Infection most appropriate initial management for this patient?
C.​ Ventral wall hernia A.​ Immediate surgical intervention will prevent damage to the growth plate and avoid further
D.​ Internal fistulas shortening.
10. This technique of definitive abdominal closure involves a sublay mesh placed in the retromuscular B.​ Application of a skeletal traction device provides temporary stabilization and helps control
space and offers optimal protection of the bowel- pain and bleeding.
A.​ Transversus abdominis release C.​ Antibiotic with coverage for G(+) and an aminoglycoside for G(-) must be initiated to prevent
B.​ Ramirez surgical site infection.
C.​ Rives-Stoppa D.​ Treatment requires immediate surgical debridement within 6-24 hours.
D.​ Wittman patch
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Matching Type. Match A (Skeletal Stabilization) with B (Fracture Indication) Burns
31. Which of the following is the ultimate guide for fluid replacement therapy in burn?
​ 17. Intramedullary nailing A.​ Torus fracture
A.​ % total body surface area
​ 18. Cast or Splint B.​ Small bone fractures
B.​ Mean arterial pressure
​ 19. Open Reduction-Internal Fixation C.​ Articular fractures
C.​ urine output
​ 20. Closed Reduction-Transósseous D.​ Long bone fractures
D.​ parkland's formula
Pinning
32. According to Jackson's Theory of thermal wounds, an eschar burn wound represent which
pathologic zone?
Bites and Stings A.​ Zone of necrosis
21. Which of the following is the primary mechanism responsible for the systemic effects observed in B.​ Zone of coagulation
envenomation by venomous snakes? C.​ Zone of hyperemia
A.​ Direct toxicity to myocardial cells, leading to arrhythmias D.​ Zone of stasis.
B.​ Neurotoxicity causes respiratory failure
Matching Type. Match A (Antimicrobial agent) with B (Effect; Side effect).
C.​ Inhibition of acetylcholine release at the neuromuscular junction
D.​ Activation of the coagulation cascade leading to consumptive coagulopathy. ​ 33. 5% Mafenide acetate to A.​ no-minimal eschar penetration; Leukopenia.
22. A patient presents to the ER with a recent intramuscular snakebite from a Crotalid species. What is ​ 34. 1% Silver sulfadiazine B.​ penetrates eschar; Metabolic acidosis
the most appropriate initial step in the management of this patient? ​ 35. 0.5% Silver nitrate C.​ fungicidal; acidosis resistant to bicarbonate
A.​ Prophylactic fasciotomy prevents compartment syndrome ​ 36. 10% Povidone iodine D.​ limited eschar penetration;
B.​ Application of a tourniquet above the bite site to reduce venom spread Methemoglobinemia
C.​ Rapid administration of appropriate antivenom CroFab
Matching Type. Match A (Antimicrobial agent) with B (Effect; Side effect),
D.​ Elevation of the affected limb to reduce swelling and improve circulation
23. A patient presents to the ER with a deep laceration on her forearm from a cat bite. What is the ​ 37. Cherry red skin with blebs A.​ 1° superficial
primary concern in managing high-risk bites injury? ​ 38. Epidermis erythematous, intact; no scarring B.​ 2° partial thickness,
A.​ Increased risk of Lyssavirus co-infection ​ 39. Charred subcutaneous and muscle C.​ 3° full thickness
B.​ Increased risk of tetanus infection due to anaerobic bacteria ​ 40. Appendages destroyed; pearly white D.​ 4° beyond skin
C.​ High likelihood of septic arthritis due to Bordatella spp.
D.​ High risk of developing a severe soft tissue infection due to Pasteurella spp.
Bedside Procedures -INCOMPLETE
Matching Type. Match A (Pathophysiology) with B (Arthropod agent). 41. Which of the following is the most appropriate indication for performing a tracheotomy in a patient
with prolonged mechanical ventilation needs?
​ 24. Dermonecrotic loxoscelism A.​ Bark scorpion
​ 25. Excess stimulation of neuromuscular junctions B.​ Hymenoptera bee
​ 26. Rapid systemic neurotoxicity C.​ Black widow spider
​ 27. IgE mediated anaphylaxis D.​ Brown recluse spider
TRAUMA AND CRITICAL CARE
Matching Type. Match A (Marine agent) with B (Pathophysiologic defense mechanism):
Critical Care
​ 28. Bristle worm A.​ Neurotoxic harpoon-like dart 1. Which of the following statements regarding pain sensation and management is NOT TRUE?
​ 29. Cone snail B.​ Hemotoxic whiplike spine A.​ Pain sensation is always objective and graded and treatment is dose-dependent.
​ 30. Stingray C.​ Cytotoxic fiberglass-like spine. B.​ VAS requires patients to make subjective numerical comparisons, which can be difficult for
those with cognitive impairments.
C.​ For agitated patients, tachycardia and hypertension are physiologic signs of pain sensation.
D.​ If objective data are unavailable, the patient is presumed to be in pain and must be managed
accordingly.
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2. Which of the following best describes the ERAS (Enhanced Recovery After Surgery) 8. In the management of ARDS, the goal of lung protective ventilation is to increase oxygenation
recommendation for the use of opioids in post-surgical pain management? requirements. The following recommended steps improve ventilation, EXCEPT for?
A.​ ERAS guidelines recommend opioid-based analgesia as the first-line treatment for all A.​ deep sedation to maintain ventilator synchrony
patients undergoing major surgery. B.​ fluid diuresis to prevent extrapulmonary edema
B.​ ERAS guidelines advocate for multimodal analgesia to minimize opioid consumption, thereby C.​ prone position improves diaphragmatic excursion and reduces atelectasis
reducing opioid-related side effects and improving recovery outcomes. D.​ Combination of ECMO and steroids improves ventilatory shunt and reduces mortality
C.​ ERAS guidelines suggest using opioids exclusively for post-surgical pain in patients with a 9. In the critically-ill patient, which of the following components is the most important
history of opioid use disorder. macronutrients?
D.​ ERAS guidelines recommend long-acting opioids for all patients post-surgery to provide A.​ Carbohydrates
extended pain relief and reduce the need for frequent dosing. B.​ Proteins
3. Which of the following is a centrally acting a2-adrenoreceptor agonist that DOES NOT affect the C.​ Fats
respiration? D.​ Sugar
A.​ Dexmedetomidine 10. A 48 yo female was admitted for severe abdominal pain. CTScan revealed a huge pelvic mass
B.​ Propofol consistent with endometrial carcinoma. Nutritional buildup includes placing an NGT and an intravenous
C.​ Benzodiazepine nutritional support. How would you classify the type of feeding?
D.​ Restrictive respiratory failure A.​ Diet as tolerated DAT
4. This Agitation-Sedation Scale is a 10-point scale used to assess a patient's level of agitation or B.​ Total Enteral Nutrition TEN
sedation, ranging from +4 (combative) to -5 (unarousable), with 0 indicating an alert and calm state C.​ Total Parenteral nutrition TPN
A.​ Berlin D.​ Partial parenteral nutrition PPN
B.​ Richmond 11. A 77 yo male was admitted for severe maxilla-facial fractures. What would be the appropriate route
C.​ Confusion Assessment Method of giving enteral access?
D.​ Glasgow Coma Scale A.​ Nasogastric tube
5. Which of the following parameters is NOT part of the basic settings for mechanical B.​ Open gastrostomy
ventilation on assist control C.​ percutaneous endoscopic gastrostomy
A.​ Positive End-Expiratory Pressure D.​ Surgical enterostomy
B.​ Fraction of inspired Oxygen, FiO2 12. Which of the following is NOT a common complication of Total Parenteral Nutrition?
C.​ Peak Inspiratory Pressure A.​ Hypoglycemia
D.​ Tidal volume B.​ Mucosal atrophy
6. Which of the following factors is the best predictor of successful extubation? C.​ Cholelithiasis
A.​ Spontaneous breathing trial D.​ Hepatic steatosis
B.​ Incentive spirometry 13. In the critically-ill patient, which of the following factors is the main risk factor in the development of
C.​ Respiratory rate > 20 bpm stress ulcer?
D.​ SPO2 >95% A.​ Mechanical ventilation > 48 hours
7. What is the recommended bed-head elevation to prevent hospital-acquired pneumonía? B.​ History of gastritis
A.​ 100 C.​ Fever
B.​ 300 D.​ administration of IV medications
C.​ 450 14. Which of the following statements regarding cirrhotic patients is TRUE?
D.​ 60° A.​ The most common risk factors is having a skin tattoo within the last 6 months.
B.​ The 1-year mortality rate for Child-Pugh-Turcot Class A is 20% with increased risk for
esophageal bleeding.
C.​ Surgery, even emergency, is generally safe for patients with MELD score < 10.
D.​ Coagulopathy is best corrected with vitamin K and fresh frozen plasma.
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15. Based on the recommendation of American Association of Blood Banks (AABB), what is Matching Type. Match A (Mode of ventilation) with B (Associated event)
the minimum hemoglobin threshold level for blood transfusion?
​ 28. High-Frequency Oscillatory A.​ low tidal volume at high rate
A.​ 7 g/dL
​ 29. Assist-Controlled B.​ minimum pressure in reduced lung
B.​ 8 g/dL
​ 30. Airway pressure compliance
C.​ 9 g/dL
​ 31. Synchronized Intermittent C.​ full volume support for every initiated
D.​ 10 g/dL
breaths
16. Which of the following statements regarding Central Line-Associated Bloodstream Infections D.​ full pressure support for spontaneous
(CLABSI) is NOT TRUE? breaths
A.​ The mainstay treatment for a CLABSI is line removal and antibiotic therapy.
B.​ Salvaging the catheter with antibiotics alone is not recommended. Matching Type. Match A (Event) with B (Associated electrolyte abnormality)
C.​ After line removal, catheter tips are sent for culture studies.
D.​ The most common organism cultured is staphylococci. ​ 32. Insulin+ Dextrose administration A.​ Hypocalcemia
​ 33. Osmotic demyelination Syndrome B.​ Hyperkalemia
17. Which of the following parameters would be able to detect coagulopathy of trauma?
​ 34. Hyperparathyroidism C.​ Hyponatremia
A.​ Prothrombin time
​ 35. Metastatic calcifications D.​ Hypercalcemia
B.​ Bleeding time
C.​ Activated partial thromboplastin time
D.​ Thrombolelastography Trauma
18. In the analysis of thromboelastograms, which of the following values reflects the 36. Which of the following trauma scoring guidelines is based on the patient's vital signs?
amplification phase of coagulation? A.​ Abbreviated Injury Scale
A.​ K-kinetics B.​ Injury Severity Score
B.​ Ly30-lysis at 30 C.​ Revised Trauma Score
C.​ A-alpha angle D.​ Glasgow Coma Scale
D.​ R-reaction time 37. Which of the following airway devices does not require visualization of the glottis?
19. Which of the following is NOT a contraindication to thrombophylaxis? A.​ Laryngeal mask
A.​ Deep vein thrombosis B.​ Lighted stylet
B.​ Intracranial hemorrhage C.​ Video-assisted laryngoscopy
C.​ Disseminated Intravascular Coagulopathy D.​ Endotracheal tube
D.​ Severe thrombocytopenia 38. Which of the following is NOT a life-threatening condition that directly affects ventilation?
Matching Type. Match A (Cardiac Arrythmias) with B (Associated event) A.​ Tension pneumothorax
B.​ Sucking pneumothorax
​ 20. Ventricular bradycardia A.​ Hypomagnesemia C.​ Massive airleak
​ 21. Multifocal atrial tachycardia B.​ Torsades de pointes D.​ Flail chest without contusion
​ 22. Atrial fibrillation C.​ Thrombus formation
39. A 30 yo male sustained a stabbed wound at the right flank. His VS: BP 80/40, HR 124, RR 31, 02
​ 23. Polymorphic ventricular tachycardia D.​ AV node dysfunction
91%. How many units of fresh whole blood would you probably require? (1 unit FWB = 500mL)
A.​ 1-2
Matching Type. Match A (Shock) with B (Associated event)
B.​ 2-3
​ 24. Hemorrhagic shock A.​ cold shock C.​ 3-4
​ 25. Septic shock B.​ Thromboelastography D.​ >5
​ 26. Hypovolemic shock C.​ "Marik" protocol
​ 27. Neurogenic shock D.​ warm shock
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40. A 36 yo female was a victim of hit-and-run. Her BP is 80/40 mmHg, HR 130, RR 28. There was no 44. A 26 yo PNP officer sustained a gunshot wound at L2 midvertebral line. The family is anxious of his
evident blood loss. Where is the most likely source of bleeding? prognosis. Of the spinal cord syndromes, which has the poorest prognosis?
A.​ Intracranial A.​ Anterior cord syndrome
B.​ Anterior compartment, thigh B.​ Central cord syndrome
C.​ Pelvis C.​ Posterior cord syndrome
D.​ Neck D.​ Brown Sequard syndrome
41. A 36 yo male jeepney driver figured in a vehicular crash and was brought in by medics for loss of 45. The central cord syndrome is the most common incomplete spinal cord injury involving the neck,
consciousness. His initial GCS score is 14. However he suddenly became stuporous and keeps on manifesting as loss of motor & sensory function. What is the CNS pathway more commonly affected?
moaning. There was a slight eye opening during chest sternal rub and pushed away the stimulating A.​ Anterior corticospinal tract
hand. What is his prognosis? B.​ Lateral corticospinal tract
A.​ Good prognosis C.​ Dorsal column
B.​ Mild D.​ Lateral spinothalamic tract
C.​ Moderate 46. A 22 yo male sustained a stab wound on the LUQ abdomen. What is the fastest way to diagnose
D.​ Severe hemoperitoneum?
42. Diagnosis? A.​ FAST
B.​ CTscan
C.​ Chest xray
D.​ MRI
47. A 22 yo male sustained a single stab wound at Zone II neck. Vital signs are stable. 2 days later he
developed chest pains and fever. What is the appropriate management plan?
A.​ Perform angiography
B.​ Perform esophagogram
C.​ Perform bronchoscopy
D.​ Operative exploration
A.​ Cerebral concussion, 48. A 46 yo male underwent IJ (Internal Jugular Vein) catheter for total parenteral nutrition. Which of the
B.​ Cerebral contusion following injuries in central line catheterization is associated with significant subcutaneous
C.​ Diffuse axonal injury emphysema?
D.​ Subarachnoid hemorrhage A.​ Injury to apical lung
43. Epidural hematoma creates a characteristic lenticular form as the hematoma is contained by which B.​ Injury to the superior vena cava
of the following structures? C.​ Injury to common carotid artery
A.​ Middle meningeal arteries D.​ Injury to internal jugular vein
B.​ Bridging veins 49. Liver is the most common organ involved in blunt abdominal trauma. To control bleeding, the
C.​ Lateral sutures hepatoduodenal ligament is clamped to occlude the portal vein and hepatic jartery. Identify the
D.​ Lateral ventricles procedure described?
A.​ Valsalva maneuver
B.​ Mattox maneuver
C.​ Cattell maneuver
D.​ Pringle maneuver
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50. A 32 yo male sustained a stabbed wound at the flank. Intraoperative findings revealed a
nonexpanding hematoma on the Zone 2, right retroperitoneum. What organs/structures are anticipated
to sustain injuries?
A.​ Abdominal Aorta
B.​ Right Common Iliac Artery
C.​ Right Renal Artery
D.​ Infrarenal Aorta

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