This is Part 1 of the General
Surgery Fundamentals 21st
Edition Comprehensive Test Bank
by Brunicardi, Andersen, Billiar,
Dunn, Hunter, Matthews, &
Pollock.
TABLE OF CONTENTS — PART 1
Chapter 1: Surgical Physiology and Homeostasis — Questions 1–20
Chapter 2: Wound Healing and Surgical Infection — Questions 21–40
Chapter 3: Trauma and Burns — Questions 41–60
Chapter 4: Gastrointestinal Surgery — Questions 61–80
Chapter 5: Hepatobiliary and Endocrine Surgery — Questions 81–100
Chapter 1: Surgical Physiology and Homeostasis — Questions 1–20
Q1. Which intravenous fluid is most appropriate for initial resuscitation of a patient with hypovolemic
shock?
A. Lactated Ringer solution
B. Dextrose 5 percent in water
C. Albumin
D. Hypertonic saline
Correct Answer: A
Rationale: Lactated Ringer solution is the preferred crystalloid for initial resuscitation of
hypovolemic shock because it closely resembles extracellular fluid composition and does not cause
hyperchloremic acidosis. Option B is incorrect because dextrose 5 percent in water provides free
water and does not expand intravascular volume effectively. Option C is incorrect because albumin is
a colloid and is not first-line for initial resuscitation. Option D is incorrect because hypertonic saline is
,reserved for specific conditions such as traumatic brain injury with elevated intracranial pressure.
Prompt restoration of intravascular volume with balanced crystalloid improves tissue perfusion and
reduces mortality.
Q2. Which electrolyte abnormality is most commonly seen in the immediate postoperative period
after major abdominal surgery?
A. Hyperkalemia
B. Hyponatremia
C. Hypokalemia
D. Hypercalcemia
Correct Answer: C
Rationale: Hypokalemia is common after major abdominal surgery due to increased renal
excretion, poor oral intake, and shifts of potassium into cells from stress hormones and insulin.
Option A is incorrect because hyperkalemia is more commonly seen in renal failure or crush injuries.
Option B is incorrect because hyponatremia can occur but is less common than hypokalemia. Option
D is incorrect because hypercalcemia is usually associated with hyperparathyroidism or malignancy.
Recognizing and correcting hypokalemia prevents cardiac arrhythmias and ileus.
Q3. What is the normal range for central venous pressure in a spontaneously breathing patient?
A. 0 to 2 cm H2O
B. 2 to 6 cm H2O
C. 8 to 12 cm H2O
D. 15 to 20 cm H2O
Correct Answer: B
Rationale: Normal central venous pressure in a spontaneously breathing patient is
approximately 2 to 6 cm H2O, reflecting right atrial pressure and right ventricular preload. Option A is
incorrect because 0 to 2 cm H2O is lower than normal and suggests hypovolemia. Option C is
incorrect because 8 to 12 cm H2O is elevated and may indicate hypervolemia or right heart failure.
Option D is incorrect because 15 to 20 cm H2O is markedly elevated and suggests tension
pneumothorax or cardiac tamponade. Accurate interpretation of central venous pressure guides fluid
management.
Q4. Which acid-base disturbance is most commonly seen in a patient with prolonged nasogastric
suction?
A. Metabolic acidosis
,B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
Correct Answer: C
Rationale: Prolonged nasogastric suction causes loss of hydrogen ions and chloride, leading to
metabolic alkalosis with hypochloremia and hypokalemia. Option A is incorrect because metabolic
acidosis is seen in diarrhea or renal failure. Option B is incorrect because respiratory acidosis is due
to hypoventilation. Option D is incorrect because respiratory alkalosis is due to hyperventilation.
Recognizing the cause of metabolic alkalosis guides fluid and electrolyte replacement.
Q5. Which parameter is the most sensitive indicator of adequate tissue perfusion in a surgical
patient?
A. Blood pressure
B. Heart rate
C. Urine output
D. Serum lactate
Correct Answer: D
Rationale: Serum lactate is the most sensitive indicator of inadequate tissue perfusion
because it rises early in shock before changes in blood pressure or heart rate. Option A is incorrect
because blood pressure is maintained until late in shock due to compensatory mechanisms. Option B
is incorrect because heart rate can be elevated for many reasons. Option C is incorrect because urine
output is a useful but less sensitive marker. Trending lactate helps guide resuscitation and detect
occult hypoperfusion.
Q6. Which condition is characterized by a decrease in effective circulating volume due to third-
spacing of fluid?
A. Hemorrhagic shock
B. Cardiogenic shock
C. Septic shock
D. Neurogenic shock
Correct Answer: A
Rationale: Hemorrhagic shock can cause third-spacing of fluid into the interstitial space,
decreasing effective circulating volume. Option B is incorrect because cardiogenic shock is due to
pump failure. Option C is incorrect because septic shock is due to vasodilation and capillary leak.
, Option D is incorrect because neurogenic shock is due to loss of sympathetic tone. Recognizing third-
spacing guides fluid resuscitation and monitoring.
Q7. What is the most common cause of hypercalcemia in a hospitalized surgical patient?
A. Primary hyperparathyroidism
B. Malignancy
C. Vitamin D toxicity
D. Immobilization
Correct Answer: B
Rationale: Malignancy is the most common cause of hypercalcemia in hospitalized surgical
patients due to parathyroid hormone-related peptide secretion or bony metastases. Option A is
incorrect because primary hyperparathyroidism is more common in outpatients. Option C is incorrect
because vitamin D toxicity is rare. Option D is incorrect because immobilization can cause
hypercalcemia but is less common. Recognizing malignancy-associated hypercalcemia guides
treatment with hydration and bisphosphonates.
Q8. Which intravenous fluid is contraindicated in a patient with diabetic ketoacidosis?
A. Normal saline
B. Lactated Ringer solution
C. Dextrose 5 percent in water
D. Plasma-Lyte
Correct Answer: C
Rationale: Dextrose 5 percent in water is contraindicated in diabetic ketoacidosis because it
provides additional glucose and worsens hyperglycemia. Option A is incorrect because normal saline
is used for initial resuscitation. Option B is incorrect because lactated Ringer solution can be used but
may worsen acidosis. Option D is incorrect because Plasma-Lyte is a balanced crystalloid. Initial
management focuses on isotonic fluid and insulin.
Q9. Which nutritional parameter is most useful for assessing long-term protein status?
A. Serum albumin
B. Prealbumin
C. Transferrin
D. Nitrogen balance
Correct Answer: D
Surgery Fundamentals 21st
Edition Comprehensive Test Bank
by Brunicardi, Andersen, Billiar,
Dunn, Hunter, Matthews, &
Pollock.
TABLE OF CONTENTS — PART 1
Chapter 1: Surgical Physiology and Homeostasis — Questions 1–20
Chapter 2: Wound Healing and Surgical Infection — Questions 21–40
Chapter 3: Trauma and Burns — Questions 41–60
Chapter 4: Gastrointestinal Surgery — Questions 61–80
Chapter 5: Hepatobiliary and Endocrine Surgery — Questions 81–100
Chapter 1: Surgical Physiology and Homeostasis — Questions 1–20
Q1. Which intravenous fluid is most appropriate for initial resuscitation of a patient with hypovolemic
shock?
A. Lactated Ringer solution
B. Dextrose 5 percent in water
C. Albumin
D. Hypertonic saline
Correct Answer: A
Rationale: Lactated Ringer solution is the preferred crystalloid for initial resuscitation of
hypovolemic shock because it closely resembles extracellular fluid composition and does not cause
hyperchloremic acidosis. Option B is incorrect because dextrose 5 percent in water provides free
water and does not expand intravascular volume effectively. Option C is incorrect because albumin is
a colloid and is not first-line for initial resuscitation. Option D is incorrect because hypertonic saline is
,reserved for specific conditions such as traumatic brain injury with elevated intracranial pressure.
Prompt restoration of intravascular volume with balanced crystalloid improves tissue perfusion and
reduces mortality.
Q2. Which electrolyte abnormality is most commonly seen in the immediate postoperative period
after major abdominal surgery?
A. Hyperkalemia
B. Hyponatremia
C. Hypokalemia
D. Hypercalcemia
Correct Answer: C
Rationale: Hypokalemia is common after major abdominal surgery due to increased renal
excretion, poor oral intake, and shifts of potassium into cells from stress hormones and insulin.
Option A is incorrect because hyperkalemia is more commonly seen in renal failure or crush injuries.
Option B is incorrect because hyponatremia can occur but is less common than hypokalemia. Option
D is incorrect because hypercalcemia is usually associated with hyperparathyroidism or malignancy.
Recognizing and correcting hypokalemia prevents cardiac arrhythmias and ileus.
Q3. What is the normal range for central venous pressure in a spontaneously breathing patient?
A. 0 to 2 cm H2O
B. 2 to 6 cm H2O
C. 8 to 12 cm H2O
D. 15 to 20 cm H2O
Correct Answer: B
Rationale: Normal central venous pressure in a spontaneously breathing patient is
approximately 2 to 6 cm H2O, reflecting right atrial pressure and right ventricular preload. Option A is
incorrect because 0 to 2 cm H2O is lower than normal and suggests hypovolemia. Option C is
incorrect because 8 to 12 cm H2O is elevated and may indicate hypervolemia or right heart failure.
Option D is incorrect because 15 to 20 cm H2O is markedly elevated and suggests tension
pneumothorax or cardiac tamponade. Accurate interpretation of central venous pressure guides fluid
management.
Q4. Which acid-base disturbance is most commonly seen in a patient with prolonged nasogastric
suction?
A. Metabolic acidosis
,B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
Correct Answer: C
Rationale: Prolonged nasogastric suction causes loss of hydrogen ions and chloride, leading to
metabolic alkalosis with hypochloremia and hypokalemia. Option A is incorrect because metabolic
acidosis is seen in diarrhea or renal failure. Option B is incorrect because respiratory acidosis is due
to hypoventilation. Option D is incorrect because respiratory alkalosis is due to hyperventilation.
Recognizing the cause of metabolic alkalosis guides fluid and electrolyte replacement.
Q5. Which parameter is the most sensitive indicator of adequate tissue perfusion in a surgical
patient?
A. Blood pressure
B. Heart rate
C. Urine output
D. Serum lactate
Correct Answer: D
Rationale: Serum lactate is the most sensitive indicator of inadequate tissue perfusion
because it rises early in shock before changes in blood pressure or heart rate. Option A is incorrect
because blood pressure is maintained until late in shock due to compensatory mechanisms. Option B
is incorrect because heart rate can be elevated for many reasons. Option C is incorrect because urine
output is a useful but less sensitive marker. Trending lactate helps guide resuscitation and detect
occult hypoperfusion.
Q6. Which condition is characterized by a decrease in effective circulating volume due to third-
spacing of fluid?
A. Hemorrhagic shock
B. Cardiogenic shock
C. Septic shock
D. Neurogenic shock
Correct Answer: A
Rationale: Hemorrhagic shock can cause third-spacing of fluid into the interstitial space,
decreasing effective circulating volume. Option B is incorrect because cardiogenic shock is due to
pump failure. Option C is incorrect because septic shock is due to vasodilation and capillary leak.
, Option D is incorrect because neurogenic shock is due to loss of sympathetic tone. Recognizing third-
spacing guides fluid resuscitation and monitoring.
Q7. What is the most common cause of hypercalcemia in a hospitalized surgical patient?
A. Primary hyperparathyroidism
B. Malignancy
C. Vitamin D toxicity
D. Immobilization
Correct Answer: B
Rationale: Malignancy is the most common cause of hypercalcemia in hospitalized surgical
patients due to parathyroid hormone-related peptide secretion or bony metastases. Option A is
incorrect because primary hyperparathyroidism is more common in outpatients. Option C is incorrect
because vitamin D toxicity is rare. Option D is incorrect because immobilization can cause
hypercalcemia but is less common. Recognizing malignancy-associated hypercalcemia guides
treatment with hydration and bisphosphonates.
Q8. Which intravenous fluid is contraindicated in a patient with diabetic ketoacidosis?
A. Normal saline
B. Lactated Ringer solution
C. Dextrose 5 percent in water
D. Plasma-Lyte
Correct Answer: C
Rationale: Dextrose 5 percent in water is contraindicated in diabetic ketoacidosis because it
provides additional glucose and worsens hyperglycemia. Option A is incorrect because normal saline
is used for initial resuscitation. Option B is incorrect because lactated Ringer solution can be used but
may worsen acidosis. Option D is incorrect because Plasma-Lyte is a balanced crystalloid. Initial
management focuses on isotonic fluid and insulin.
Q9. Which nutritional parameter is most useful for assessing long-term protein status?
A. Serum albumin
B. Prealbumin
C. Transferrin
D. Nitrogen balance
Correct Answer: D
