DE LA SALLE UNIVERSITY MEDICAL CENTER

DEPARTMENT OF SURGERY

SENIOR INTERN’S ENTRANCE EXAMINATION

May – June 2020

GENERAL DIRECTIONS: Choose the best answer. (100 items)

1. A diabetic woman has excruciating anal pain without associated swelling, erythema, fluctuation or
fever. Imaging studies confirm the diagnosis of anorectal abscess confined to the deep post-anal
space. The indicated management is
A. Prompt surgical drainage
B. Surgical drainage plus antibiotics
C. Hot sitz baths and analgesics
D. Antibiotics plus hot sitz baths and analgesics

2. Following Goodsall’s rule, a fistula-in-ano with a right anterior external opening located 1.5cm from
the anal verge would have its internal opening located:
A. Radially left anterior
B. In the anterior midline
C. Radially, right anterior
D. In the posterior midline

3. What is the recommended treatment for a 25y/o patient with occasional constipation associated with
spontaneously reducible mass and blood streaked stools?
A. Resection with colo-anal anastomosis
B. Colonoscopy with biopsy
C. Stool softeners and avoidance of straining
D. Closed hemorrhoidectomy

4. In what part of the Pathophysiology of acute appendicitis will direct and rebound tenderness be
manifested?
A. Distention of the appendix
B. Obstruction of the appendiceal lumen
C. Accumulation of PMN cells at the site of inflammation with irritation of the parietal
peritoneum
D. Perforation of the appendix

5. A 32-year-old male came to ER complaining of RLQ pain 6 hours ago but is presently asymptomatic.
A CT scan of the abdomen was done which revealed 0.6mm diamterappendix with no fat stranding
and periappendiceal fluid collection but with appendicolith. What is the recommended management?
A. Observe and IV antibiotics
B. Appendectomy
C. Discharge
D. Observe

6. 20y/o M presented with per umbilical pain shifting to the RLQ, anorexia and vomiting, fever. On PE
direct and rebound tenderness at the RLQ of the abdomen. The diagnosis is acute appendicitis.
Which among the ff condition will be the closest differential diagnosis?
A. Ascending colon diverticulitis
B. Meckels diverticulitis
C. Acute gastroenteritis
D. UTI

7. The major trigger for DIC in trauma and burns:

A. Endothelial injury
B. Tumor necrosis factor
C. Endotoxin
D. Bacterial mucopolysaccharide

8. 30-year old female presents with breast pain and a non-tender, well-defined 3cm movable mass on
the left breast. Aspiration yielded 10cc clear fluid with disappearance of the mass. The appropriate
advise is:
A. Excision biopsy to prevent recurrence
B. Observation and follow up
C. Repeat sonomammography
D. Cytologic examination of the aspirate fluid

9. The recommended prophylactic antibiotic for acute appencitis uncomplicated is?

A. First generation cephalosporin
B. Penicillin G
C. 2nd generation cephalosporin with anaerobic coverage
D. 3rd generation cephalosporin
10. Coagulation problems due to shock and trauma are best treated with
A. Cryoprecipitate
B. Fresh whole blood
C. Fresh frozen plasma
D. Platelet concentrates

11. What is a sentinel lymph node?

A. The farthest node draining the area of the tumor
B. The largest node draining the area of the tumor
C. The first node draining the area of the tumor
D. The node nearest to a major vein

12. What nerve when transected during mastectomy will result in numbness of the upper medial aspect
of the upper arm?
A. Thoracoacromial nerve
B. Long thoracic nerve
C. Intercotobrachial nerve
D. Thoracodorsal nerve

13. Clinically, full-thickness or 3rd degree burns are characterized as:

A. Painful but do not blister
B. Painless, with blister and blanching
C. Painful with weeping and blisters
D. Painless, leathery and non-blanching

14. True of deep partial thickness burns:

A. Moist and pink in color
B. Generally heals in 3-5 weeks
C. Does not result to hypertrophic scarring
D. Involves the epidermis and only the upper dermis

15. A more accurate measure of the hydration status during the early fluid resuscitation in acute burm:
A. Pulse rate
B. Urine output
C. Mean blood pressure
D. Central venous pressure

16. In which part of the of the large bowel do most colorectal cancers occur?
A. Ascending colon and rectum
B. Transverse colon and rectum
C. Sigmoid colon and rectum
D. Descending colon and rectum

17. A 70-year old man undergoes colonoscopy because of intermittent rectal bleeding caused by internal
hemorrhoids. The colonoscopy revealed a polyp which was removed. This type of polyp has the
highest risk for malignancy
A. Tubulovillous adenomatous polyp
B. Tubular adenomatous polyp
C. Hyperplastic polyp
D. Villous adenomatous polyp

18. A 45-year-old male with bowel movement changes tested positive for fecal occult. The next
appropriate step is:
A. CEA determination
B. Colonoscopy
C. Whole abdomen CT Scan
D. Stool DNA test

19. Which of the following organs is the most common site of metastasis from colon cancer?
A. Kidney
B. Liver
C. Pancreas
D. Adrenal gland

20. Imaging studies reveal diverticula with phlegmon in the sigmoid colon and minimal pericolic fluid
collection in a 63-year-old woman who presented with LLQ pain and fever. The appropriate
treatment option for her at this time is antibiotics plus
A. Supportive management
B. Percutaneous drainage
C. Open surgical drainage
D. Surgical resection and anastomosis
21. In patients with bleeding from colonic diverticula:
A. Diverticular bleeding is generally massive even among young adults
B. Bleeding usually coexists with diverticulitis
C. Bleeding source is venous
D. PE findings except for rectal bleeding are usually unremarkable

22. Sigmoid diverticulitis is considered to be uncomplicated if it is associated only with:

A. Bladder fistula
B. Loculated abscess
C. Phlegmon
D. Stricture

23. A 50-year-old man is admitted to the emergency department due to massive hematemesis following
a bout of repeated vomiting. Esophagogastroscopy reveals a linear mucosal tear with a pulsatile
vessel at the gastroesophageal junction. The most likely diagnosis is:
A. Barret's esophagus
B. Mallory-Weis lesion
C. Carcinoma of the oesophagus
D. Dieulafor lesion

24. Barium esophagogram will best confirm this condition:

A. Esophageal perforation
B. Achalasia
C. GERD
D. Adenocarcinoma of the distal esophagus

25. A patient who drank 300mls of liquid sosa was brought to the ER 3 hours post ingestion. What is the
recommended diagnostic modality to request?
A. Chest CT scan
B. Endoscopy
C. Esophagogram
D. Chest x-ray

26. A 58 year old male is brought to ER with hematemesis and hemotochezia. Patient is hypotensive
and tachycardic. What is the recommended INITIAL step in managing this patient?
A. Aggressive resuscitation
B. Watchful waiting
C. Perform endoscopy
D. Immediate surgery

27. 38M complaining of dysphasia & pain of 6 months duration. PE revealed normal findings. Barium
swallow showed a 2 cms. smooth crescent shaped filling defect at the distal esophagus. What is the
most likely diagnosis?
A. Adenocarcinoma
B. Polyp
C. Leiomyoma
D. Varix

28. For patients with jaundice, what would be the most appropriate initial diagnostic modality to be
requested?
A. Magnetic Resonance Cholangiopancreatography
B. CT Scan of the Upper Abdomen
C. Hepatobiliary tree ultrasound
D. Endoscopic Retrograde Cholangiopancreatography

29. A 45 year old male presents with RUQ pain and jaundice. Ultrasound reveals gallbladder stones and
CBD is 1 cm in diameter. Serum bilirubin is 5mg/dL. How should this patient be managed?
A. Laparoscopic cholecystectomy
B. ERCP with stone extraction
C. ERCP with stone extraction + laparoscopic cholecystectomy
D. MRCP then ERCP with stone extraction

30. What structure is usually found inside the Triangle of Calot?

A. Common bile duct
B. Cystic Artery
C. Hepatic artery
D. Cystic duct

31. Which of the following findings in intra-operative cholangiogram is abnormal?

A. Common bile duct measures 5 mm
B. Tapering of the distal CBD
C. No filling defects
D. No passage of contrast into the duodenum
32. A 28-year-old female underwent laparoscopic cholecystectomy 2 days ago. She is now in your clinic
with jaundice, abdominal pain, and fever. What is the most probable diagnosis?
A. Parasitic infestation of the common bile duct
B. Viral hepatitis
C. Common bile duct injury
D. Cirrhosis

33. A 30 year old male developed RUQ abdominal pain, fever and chills 5 days prior to consult. On PE,
there is direct tenderness on the RUQ. Ultrasound reveals a 4 cm hypoechoic mass with gas
formation at the right lobe of the liver. What is the INITIAL management for this patient?
A. Percutaneous aspiration
B. Fine-needle biopsy
C. Broad-spectrum IV antibiotic
D. Exploratory laparotomy

34. What is the most common malignant tumor found in the liver?
A. Hemangiosarcoma
B. Metastatic hepatic tumors
C. Hepatocelluluar carcinoma
D. Cholangiocarcinoma

35. A 50 year old male presents with 6 day history of right upper quadrant pain, fever and chills. He is
post cholecystectomy 1 month ago due to a gangrenous gallbladder. There is no jaundice and
abdomen is tender on the RUQ. What is the most likely diagnosis?
A. Acute cholangitis
B. Pyogenic liver abscess
C. Amebic liver abscess
D. Acute hepatitis

36. Which of the following is true regarding colorectal liver metastasis?

A. Liver metastasis with concomitant pulmonary metastasis can still be resected
B. There is no more survival benefit for resecting a recurrent metastasis
C. Debulking of a large liver metastasis can decrease the tumor load
D. Chemotherapy can be employed prior to resection of liver metastasis

37. Which of the following liver tumor warrants percutaneous biopsy?

A. Hepatitis carrier, normal AFP, 3 cm tumor non-classic enhancement on CT scan
B. Cirrhotic liver, normal AFP, 3 cm tumor with classic tumor enhancement on CT scan
C. Non-cirrhotic liver with 4 cm solid tumor with central scar on CT scan
D. Hepatitis carrier, elevated AFP and 3 cm with classic tumor enhancement on CT scan

38. A 60 year old female complains of frequent RUQ pain not associated with food intake. Upper
endoscopy is normal. Liver CT scan shows a 15 cm well demarcated mass with water attenuation
and with no contrast enhancement. Liver function test is normal. What is the treatment of choice?
A. Laparoscopic unroofing
B. Observe and do serial ultrasound
C. Percutaneous aspiration
D. Formal liver resection

39. A 55-year-old male consulted you for a right preauricular mass of 19-years duration. Except for its
bothersome appearance, she is otherwise asymptomatic. The most likely diagnosis is:
A. Adenoid cystic carcinoma
B. Mucoepidermoid carcinoma
C. Lymphadenopathy
D. Pleomorphic adnoma

40. What is the appropriate treatment for a 2cm low grade mucoepidermoid carcinoma of the superficial
lobe of the parotid glad?
A. Radiotherapy
B. Total parotidectomy with neck dissection
C. Total parotidectomy
D. Superfical parotidectomy

41. The physical finding present in a parotid mass that connotes malignant behavior:
A. Hardness
B. Sanguinous discharge
C. Ternderness
D. Facial nerve palsy
42. Which of the following medications will NOT lower thyroid hormone levels?
A. Methimazole
B. Propylthiouracil
C. Metoprolol
D. Carbimazole

43. For a patient with a thyroid nodule with suppressed TSH, what is the next appropriate step in
management?
A. Give levothyroxine
B. FNAB
C. Radioactive iodine uptake scan
D. Thyroidectomy

44. Fine needle aspiration biopsy is warranted when on ultrasound the thyroid nodule is found to:
A. Be hyperechogenic
B. No increase in central vascularity
C. Have regular borders
D. Have micro- or speckled calcifications within

45. A post-thyroidectomy patient is found to be hoarse. This could be due to injury to the:
A. Vagus Nerve
B. Recurrent Laryngeal Nerve
C. Superior Laryngeal Nerve
D. Spinal Accessory Nerve

46. A patient complains of hoarseness after undergoing thyroidectomy? What is the recommend course
of action?
A. If there is suspicion of injury, request for barium swallow
B. Perform immediate tracheostomy
C. Request for an ultrasound of the neck
D. Reassure patient as function may return 1 to 2 months after injury

47. What is the most common immediate complication of an open hernia repair?
A. Urinary retention
B. Recurrence
C. Wound infection
D. Chronic inguinal pain

48. The Hesselbach’s Triangle is bounded by:

A. Rectus muscle medially, inguinal ligament laterally, inferior epigastric vessels superiorly
B. Rectus muscle medially, inguinal ligament inferiorly, inferior epigastric vessels laterally
C. Rectus muscle laterally, inguinal ligament inferiorly, inferior epigastric vessels medially
D. Rectus muscle laterally, inguinal ligament superiorly, inferior epigastric vessels medially

49. An indirect inguinal hernia is caused by:

A. Congenital fascial defect
B. Weakness of the floor
C. Patent processus vaginalis
D. Obesity

50. Most common complication of total thyroidectomy?

A. Hematoma
B. Surgical site infection
C. Transient hypocalcemia
D. Recurrent laryngeal nerve injury

51. A clean-contaminated wound results from:

A. A fresh traumatic injury
B. A non-traumatic case where the alimentary has been entered in a controlled manner
C. Surgery with major break in technique
D. An operation associated with the presence of gross spillage from the GIT

52. Antimicrobial prophylaxis is highly recommended in which of the following wound classification?
A. Dirty
B. Clean-contaminated
C. Contaminated
D. Clean
53. The proper time to give the antimicrobial prophylaxis is:
A. Within 1 hour after operation
B. During surgical wound closure
C. Within 1 hour before operation
D. The night before surgery

54. Peripheral vasoconstriction triggered by hypovolemia due to bleeding peptic ulcer would manifest
with:
A. Poor capillary refill
B. Cold extremities
C. Low diastolic pressure
D. Peripheral cyanosis

55. This measure will greatly improve the balance between oxygen delivery and oxygen consumption in
the critically ill blunt trauma victim:
A. Giving inotropes to maintain systolic BP above 100 mm Hg
B. Keeping the room temperature cold
C. Infusing NaHCO3 to keep blood pH slightly alkalotic
D. Correcting peripheral vasoconstriction with vasodilators
E. Relieving tachypnea by mechanical ventilation

56. After surgery for blunt trauma, the patient exhibits an intraabdominal pressure of 20 mm Hg. For the
abdominal organs to get adequate perfusion, the patient’s mean arterial pressure must be at least:
A. 90 mm Hg
B. 80 mm Hg
C. 60 mm Hg
D. 70 mm Hg

57. A currently utilized intervention that might improve oxygenation by way of reopening collapsed alveoli
in patients under mechanical ventilation due to ARDS is:
A. Positive end-expiratory pressure
B. Administration of nitric oxide
C. High tidal volume ventilation
D. Use of high fractions of inspired oxygen

58. When oxygen delivery persists to be inadequate for the needs of a critically ill trauma victim, the
result would be:
A. Decreased oxygen extraction ratio
B. Increased venous oxygen tension
C. Increased serum lactate
D. Decreased urine sodium concentration

59. In trauma and surgical patients, early feeding will:

A. Increase risk for bacterial infection
B. Accelerate utilization of fat stores
C. Increase mortality and morbidity
D. Decrease muscle breakdown

60. A 47 year old patient with known alcohol abuse is admitted to the ER with sudden onset of gnawing
epigastric pain 10 hours before admission. Blood chemistry reveals lipase levels of 494 U/L [10-140],
leukocytosis of 16,000 [4.3-10]. Abdominal ultrasound shows gallbladder stones. The common bile
duct cannot be visualized. HR 124/min. RR 90/60 mmHg. What is the recommended treatment
approach for this patient?
A. Fluids, NPO, pain treatment
B. Fluids, antibiotics, NPO, probiotics, pain treatment
C. Fluids, enteral nutrition, pain treatment
D. Fluids, antibiotics, pain treatment

61. What is the optimal timing for the initial intervention in a clinically stable patient with infected
pancreatic necrosis?
A. 20 days after the onset of pancreatitis
B. 40 days or later after the onset of pancreatitis
C. 10 days after the onset of pancreatitis
D. 30 days after the onset of pancreatitis

62. What is the BEST laboratory goal to use to guide fluid resuscitation in acute pancreatitis?
A. Hematocrit
B. Blood urea nitrogen
C. Serum creatinine
D. Amylase
63. What is the most common type of acute pancreatitis?
A. Fulminant
B. Infected necrotizing
C. Interstitial
D. Hemorrhagic

64. Which blood exam is the most important in confirming acute pancreatitis?
A. Bilirubin
B. CBC
C. Amylase
D. Lipase

65. Spontaneous closure for pediatric umbilical hernias may still occur until:
A. 5 years
B. Less than a year
C. 10 years
D. 2 years

66. A 3 year old boy consulted because of a tender, erythematous scrotum. The most likely diagnosis is:
A. Torsion of testis
B. Tumor
C. Epididymitis
D. Torsion of testicular appendage

67. A 45-year-old man is involved in a high-speed automobile collision. He arrives at ER with BP 70

palpatory, and weak pulse rate at 130s bpm. He is unresponsive with fixed dilated pupils. He has
other multiple physical injuries. The following could be the reasons of the patient's low BP and
tachycardia, EXCEPT:
A. Bilateral femoral open fractures
B. Spinal cord injury
C. Pelvic fracture
D. Massive hemothorax

68. Fill in the blanks: Oxygen Delivery (DO2) = Arterial oxygen content (CaO2) x __________.
A. Arterial oxygen pressure (PaO2)
B. Oxygen saturation (SaO2)
C. Hemoglobin (Hb)
D. Cardiac output (CO)

69. Hypothermia in neurogenic shock is caused by what mechanism?

A. Increased heat loss due to profound vasodilatation
B. Disruption of hypothalamic thermoregulatory center
C. Influx of interstitial fluid into the intravascular space
D. Infusion of cold fluids and blood products

70. A 32-year old male pedestrian is struck by car and is noted to have dropping blood pressure,
increasing heart rate and progressive abdominal distention. What is the most likely mechanism
causing his symptoms?
A. Diaphragmatic hernia with pneumothorax
B. Massive pneumoperitoneum
C. Tension pneumothorax
D. Hemorrhage in the abdomen

71. Obstructive shock is associated with:

A. Bronchoconstriction and flushing
B. Decreased cardiac output
C. Decreased peripheral vascular resistance
D. Decreased blood volume

72. Marked tachycardia and hypotension begins at class of shock: Class ___ shock.
A. 2
B. 4
C. 3
D. 1

73. What substance converts inactive angiotensinogen into angiotensin I in response to shock?
A. Aldosterone
B. Thromboxane
C. Angiotensin converting enzyme
D. Renin
74. Type of shock in a patient with penetrating chest trauma presenting with muffled heart sounds,
distended neck veins and hypotension:
A. Cardiogenic
B. Neurogenic
C. Obstructive
D. Hypovolemic

75. Which of the following is a manifestation of inadequate oxygen delivery at the cellular level?
A. Hyperglycemia
B. Skin mottling
C. Hypothermia
D. Lactic acidosis

76. Blood loss enough to cause hypovolemic shock is seen in:

A. Pericardial tamponade
B. Complex pelvic fracture
C. Humeral fracture
D. Epidural hematoma

77. True of basal cell carcinoma:

A. No recurrence even if inadequately excised
B. High metastatic rates to the regional lymph nodes
C. Arise from keratinocytes of the epidermis
D. Slow-growing but locally destructive

78. A 48-year-old diabetic woman, consulted you because of an erythematous, tender mass on her back
with multiple draining sinuses. The diagnosis is:
A. Folliculitis
B. Abscess
C. Carbuncle
D. Furuncle

79. What is the stage classification of pressure wounds that involves the full thickness of the skin without
muscle necrosis?
A. 2
B. 3
C. 1
D. 4

80. Recommended management for an uncomplicated furuncle or abscess is/are:

A. Incision and drainage plus IV antibiotics and flammazine
B. Incision and drainage
C. IV antibiotics
D. Incision and drainage plus IV antibiotics

81. 65 y/o Male presenting with colicky abdominal pain, vomiting, and obstipation for 24 hrs, fever,
abdominal distention, hypoactive bowel sound. Supine upright film of the abdomen showed,
distended bowel loops with air fluid level and no gas at the distal colon. The most probable
impression is?
A. Prolongted Ileus
B. Complete intestinal obstruction with possible strangulation
C. Partial intestinal obstruction
D. Complete intestinal obstruction

82. A 65-year-old male presents with colicky abdominal pain, vomiting, and obstipation for 24 hours. PE
reveals fever, distend and tender abdomen with hypoactive bowel sounds. Supine and upright
abdominal xrays showed distended bowel loops with air-fluid levels. What is the most probable
diagnosis?
A. Complete gut obstruction
B. Partial gut obstruction
C. Complete gut obstruction with strangulation
D. Ileus

83. A 45-year old male with long standing history of dyspepsia and chronic use of NSAID developed
sudden weight loss, anemia, and recurrent vomiting. What is the recommended initial diagnostic
evaluation that should be requested?
A. Esophagogastroduodenoscopy
B. Ultrasound
C. CT scan
D. X-ray
84. H. pylori incite peptic ulcer by way of:
A. Local alkalinization of the gastric fundus
B. Decreasing acid-stimulated duodenal bicarbonate release
C. Stimulating the antral D cells to increase the levels of stomatostatin
D. Inhibiting local cytokines and inflammatory mediators

85. Complication/s of peptic ulcer is/are

A. Intractability
B. Obstruction
C. Bleeding
D. Perforation
E. All

86. What is the recommended surgical procudre for perforated peptic ulcer?
A. Gastrojejunostomy
B. Omental patching
C. Pyloroplastry
D. Total gastrectomy

87. Which surgical procedure provides the lowest risk of peptic ulcer recurrence?
A. Gastrojejunostomy
B. Pyloroplasty
C. Truncal vagotomy
D. Wedge resection

88. A chest x-ray upright was requested for patient suspected to have perforated peptic ulcer. What
finding should your search for?
A. Blunting of the costophrenic angle
B. Pneumothorax
C. Pneumopertineum
D. Gastric buble

89. A 54-year old male who has been taking diclofenac for nearly 5 years for the relief of his arthritic
pains, came to ER with complaint of sudden onset of severe epigastric pain. Abdominal finding
revealed diffuse rigidity. What is the recommended surgical procedure that should be performed?
A. Vagotomy
B. Vagotomy and total gastrectomy
C. Omental patching
D. Vagotomy and pyloroplasty

90. What the recommended post-op treatment of a 10cm gastric GIST after a complete resection?
A. 5-fluoropyrimidine
B. Imatinib
C. Surgery is sufficient
D. Herceptin

91. Which GIST has the least aggressive behavior?

A. Gastric, tumor size of 3cm, mitotic count of <5/50 hpf
B. Duodenal, tumor size of 3cm, mitotic count of <5/50 hpf
C. Gastric, tumor size of 3cm, mitotic count of >5/50 hpf
D. Gastric, tumor size of 10cm, mitotic count of <5/50 hpf

92. A poorly nourished 64-year-old male underwent colon surgery for an obstructing tumor of more than
3 days. On day 5 post-operation, the wound was noted to exude purulent fluid. On day 7, however,
the entire incision wound opened with complete separation of the fascial layers and evisceration
bowel loops in between. What is the recommended management?
A. Re-suture wound at the wards
B. Immediately start chemotherapy
C. Continue watchful waiting
D. Bring patient back to operating room

93. What would be the most accurate means of measuring adequacy of fluid replacement for this
patient?
A. Serum osmolality
B. Pulmonary capillary wedge pressure
C. Hourly urine output
D. Central venous pressure
94. Sepsis is defined as SIRS plus?
A. Wbc count < 10000/L
B. Organ dysfunction
C. Identifiable source of infection
D. Vascular collapse

95. Hormonal response to injury results in increased glycogenolysis, gluconeogenesis and lipolysis. This
change in substrate utilization is the result of increased circulating levels of:
A. Insulin, catecholamines, glucagon
B. Growth hormone, insulin, catecholamines
C. Glucagon, growth hormone, cortisol
D. Catecholamines, glucagon, cortisol

96. In the prolonged fasting state the heart, kidney, muscle and liver adapt to use this substrate as fuel:
A. Ketones
B. Amino acids
C. Glycerol
D. Glucose

97. Which one of the following findings in an adult is most likely to require immediate management
during the primary survey?
A. Distended abdomen
B. Respiratory rate of 40 breaths per minute
C. Glasgow Coma Scale score of 11
o
D. Temperature of 36.5 C

98. A patient is shot in the back. Retroperitoneal organs that can be injured include:
A. Aorta, Inferior vena cava, urinary bladder
B. Duodenum, pancreas, kidney
C. Spleen, kidney, duodenum
D. Transverse colon, kidney, ureter

99. Complex pelvic fractures are commonly associated with:

A. Severe hemorrhage
B. Renal injury
C. Small bowel injury
D. Spinal cord transection

100. A contraindication to nasogastric intubation is the presence of:

A. Gastric perforation
B. Le Fort III fracture
C. Open depressed skull fracture
D. Cervical spine fracture

---------------------------------------------END OF EXAMINATION ---------------------------------------------