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Collections Of

General Surgery MCQS


2018
For undergraduate surgical training students

Prepared by:
Naser Radwan,MD
FEBS,PMCCS.
Consultant of general surgery
Head of surgical departments Indonesia Hospital,
Ass. Prof Al Azhar Univ.
Surgery MCQS
1. These ABGs (pH-7.51, pCO2-28, HCO3-26) show

A. Uncompensated respiratory acidosis


B. Partially compensated metabolic acidosis
C. Normal acid-base balance
D. Uncompensated respiratory alkalosis
E. A combined metabolic and respiratory alkalosis

2. These ABGs (pH-7.13, PCO2-36, HCO3-14) are interpreted as

A. Partially compensated respiratory acidosis


B. Uncompensated metabolic acidosis
C. Combined respiratory and metabolic acidosis
D. Uncompensated metabolic alkalosis
E. Normal acid-base balance
3. A patient has the following ABGs :PH -7.43, PCO2-28 mmHg, and HCO3-18mEq/L
This is interpreted as
A. Partially compensated respiratory alkalosis
B. fully compensated metabolic acidosis
C. Partially compensated respiratory acidosis
D. Fully compensated respiratory alkalosis

4.A patient has the following ABGs :PH -7.50, PCO2-49 mmHg, and HCO3-30mEq/L
This is interpreted as
A. Fully compensated respiratory acidosis
B. partially compensated metabolic alkalosis
C. partially compensated metabolic acidosis
D. fully compensated metabolic alkalosis

5. Indications for nutritional support include All the following except


A. Severe anorexia
B. Moderate or severe malnutrition but unable to eat sufficient orally.
C. Pre-op patient with wt loss ≥ 10% BW
D. Unable to eat or swallow.
E. Oral diet not anticipated for ≥ 5 days

6. Contraindications to enteral nutrition include All the following except

A. Low output intestinal fistula


B. Intractable vomiting
C. Intractable diarrhea
D. Severe malabsorption
E. Ischemic intestine

7. ALL are Contraindications to PEG tube except

A. Coagulopathy
B. Neuro disorders
C. Peritonitis
D. ileus
E. Anorexia nervosa

8. indications for parenteral nutrition include All the following except

A. Short bowel
B. Loss of 5% of BW in 4 months
C. Prolonged ileus
D. Pancreatitis
E. Sepsis

9. All the following are causes of metabolic acidosis except

A. Shock
B. Diabetes
C. small bowel fistula
D. pancreatic fistula
E. Repeated vomiting

10. Chloride resistance metabolic alkalosis include all the following except

A. Loss of acid from GIT


B. Excessive alkali Administration
C. Massive blood transfusion
D. Severe K depletion
E. Mineralocorticoid excess

11. Regarding 1st Degree Burns , All are true except

A. Superficial burns involving epidermis


B. Local pain and erythema
C. Multiple blister formation
D. Spontaneous healing without treatment
E. Skin pealing may occur
12. Major Severe Burns

A. Second degree burns of greater than 25% BSA in adults or greater than 20%
in children or elderly
B. Second-degree burns of less than 15% BSA in adults or 10% BSA in children &
elderly
C. Second-degree burns of 15%-25% BSA in adults or 10%-20% BSA in children or
elderly
D. Less than 10% BSA full-thickness burns
E. More than 10% BSA full-thickness burns

13. Early surgical excision of the eschar and grafting is best performed on

A. 2nd day
B. 5th day
C. 7th day
D. 10th day
E. 14th day

14. One of the following is not an Indication of Hospital admission in burns

A. Second degree burns affecting 10% of the body surface area in adults
B. 5% Third degree burns.
C. Most burns of the head and face
D. Electric burns, severe chemical burns
E. inhalation injuries.

15.One of the following is not a cause of SIADH (syndrome of inappropriate anti-


diuretic hormone)

A. Early Post operative period.


B. Lung neoplasms, infections.
C. Trauma, Head injuries.
D. Hypothyroid.
E. Excess water loss.

16. During laparotomy insensible losses reach

A. 700-1000 ml/H
B. 200-300 ml/H
C. 100-200 ml/H
D. 400-600 ml/H
E. 70-100 ml/H

17. The highest bicarbonate concentration is found in the secretion of

A. Salivary glands.
B. Pancreas
C. stomach.
D. Bile
E. Intestine

18- Staphylococcal infections:


 Do not cause cellutitis.
 Do not produce septicaemia.
 Do not produce fever.
 Produce yellow odourless pus.
 A&C only

19- Streptococcal infections:


 Are characterised by abscess formation.
 Rarely produce lymphadenitis.
 Do not produce baceraemia.
 Can produce a gangrenous skin infection.
 All of the above.

20- Tatanus prophylaxis in a patient with a badly contaminated wound:(all correct


except one)
 Depends, even in an actively immunised patient, on meticulous immediate
debridement of the wound.
 Should include the administration of tetanus toxoid.
 Is more safely achieved with human antitoxin.
 Is unnecessary in patients who have been recently actively immunised.
 Is necessary for the actively immunised patient to have a booster dose of
toxiod.

21- Tetanus:
 May have an incubation period of over 20 days.
 Can be prevented by the immediate administration of tetanus toxoid.
 Is more common after scalp lacerations than wounds of the extremities.
 Is usually associated with stupor or coma.
 B&C only.

22- In clostridial infections:


 A spreading cellutitis may be present.
 Gram-positive cocci can be isolated from the discharge.
 Surgical treatment has a minor part to play.
 Gas production is often present.
 C&D only.

23- Actinomycosis is characterised by:


 Chronic abscesses of the foot.
 A granulomatous abcess.
 Red coloured pus.
 Its resistance to antibiotics.
 Blake coloured pus

24- A subphrenic abscess:


 Is usually accompanied by consederable systemic effects.
 Is associated with local rib tenderness.
 Rarely produces abnormal signs in the chest.
 Usually can be diagnosed by a barium meal examinations.
 A&C only.

25- A pelvic abscess:


 Lies extrapeitoneally.
 May be a complication of abdominal surgery.
 Rarely presents with diarrhoea.
 Should be treated with antibiotics alone.
 A&C only

26- Paralytic ileus:


 Is associated with electrolyte imbalance.
 May be associated with mechanical intestinal obstruction.
 Requires treatment with nasogastric suction and intravenous fluids.
 Is associated with retroperitoneal haematoma
 All of the above.

27- Acute postoperative gastric dilatation:


 Usually cause postoperative vascular collapse.
 Can be prevented by regular nasogastric aspiration.
 Characteristically occurs on the first postoperative day.
 Is a relatively common problem after surgery on the gastrointetinal tract.
 A&D only.
28- The appearance of jaundice in the postoperative period: (all correct except one)
 May indicate an intraperitoneal haemorrhage.
 Is usually due to the toxic effects of anaesthetic agents.
 May be due to septicaemia.
 May indicate chronic liver disease.
 May be due acute liver insalt

29- A clean incised skin wound:


 Undergoes an inflammatory phase during the processes of repair.
 Commences epithelialization after 7 to 10 days.
 Regains the full strength of normal skin within 10 days.
 Regains its strength as the result of fibroblast activity.
 A&D only.

30- Wound healing:


 Is impaired in anaemic patients.
 Is impaired by haematoma formation.
 Is not impaired by hypoproteinaemia.
 Is stimulated by steroids.
 A&D only.

31- The principles of wound care include: (All except one)


 Early skin cover.
 Removal of foreign material.
 Routine administration of antibiotics.
 Close apposition of uninfected wounded tissues.
 Wound toilet if possible.

32-Heavily contaminated and dirty wounds:


 Require surgical toilet and delayed closure.
 Require the administration of systemic antibiotics.
 Can usually be treated by wound toilet and primary closure.
 Should be totally excised.
 A&B only.

33- surgical drainage of abscesses:


 Should be via a small incision with minimal disturbance of the adjacent tissues.
 Should be dependent wherever possible.
 Has been outmoded by antibiotic therapy.
 Should be undertaken before the signs of fluctuation appear.
 Usually performed under local anaethesia.

34- In localised surgical infections:


 An elevated leucocyte count is usually present.
 Fever and tenderness are usually present.
 The presence of glycosuria usually indicates metastatic pancreatic abscesses.
 Pus is frequently absent.
 A&B only.

35- A distal small bowel fistula:


 Loses intestinal fluid rich in potassium and sodium.
 May give rise to a metabolic acidosis.
 Rapidly results in dehydration.
 May be managed conservatively
 All of the above.
36- A pancreatic fistula:
 Loses fluids with high potassium and lower sodium levels than plasma.
 May give rise to a metabolic acidosis.
 Requires long term treatment with intravenous normal saline.
 Will usually close if oral feeding is temporarily suspended.
 All of the above.

37- Bed sores:


 Can be prevented by sheepskin blankets.
 Can be prevented by changing the patient’s position four times each 24 hours.
 Are the consequence of local ischemia.
 Only occur over the sacrum.
 A&B only.
38-Regarding tension pneumothorax, the first step in the management
is:
A. Obtaining a stat chest x-ray.
B. Cricothyroidotomy
C. Pass in an endotracheal tube
D. Starting oxygen by a valve-mask device
E. Chest decompression needle.

39- Regarding central facial bone injury in polytrauma victim Who has
labored breathing the first step in management is:
A. Perform tracheostomy
B. Perform chricothyroidotomy
C. Pass endotracheal tube by oral root.
D. Pass endotracheal tube by nasal root
E. Obtain a cross table x-ray of cervical spine.

40- A young man is admitted to Emergency department with a stab


wound to upper third of his right thigh with severe bleeding, the first
thing to do is:
A. Apply compression to the bleeding vessel with gloved finger.
B. Apply bandage and splint to the right thigh.
C. Apply tourniguet on right side above the wound.
D. Use clamps to control the bleeding.
E. Start blood transfusion.

41- Regarding the management of polytrauma:


A. Death follow a trimodal distribution.
B. X-ray after primary survey should be AP cervical spine, chest and pelvis.
C. Cardiac tamponade is characterized by raised B.p, a low JUP.
D. Assessment of uncomplicated limb fractures should occur during the primary
survey.
E. A and B only.
42- Blunt injuries to the abdomen
(all are correct except)
A. May cause shock
B. May cause peritonitis
C. May cause acute gastroduodenal ulceration
D. May treated conservativly
E. Rarely need urgent laparatomy

43- A serious intra-abdominal injury in a comatose patient may be


diagnosed by: (all are correct except one)
A. Abdominal paracentesis.
B. The observation of pattern bruising on the abdominal wall.
C. Falling of heamoglobin values.
D. The presence of marked abdominal distetion
E. The presence of diarrhea.

44- Injuries to the urethra (all are correct except one)


A. Are more common in male.
B. Are often caused by road traffic accidents.
C. Are easily diagnosed on intra venous pyelography.
D. Require urgent surgical treatment.
E. Diagnosed by retrograde urethragraphy.

45- Regarding injury to the spleen (all are correct except one )
A. Is the commonest organ injured in blunt abdominal trauma.
B. Usually continues to bleed once its capsule and its pulp lacerated.
C. Usually managed conservatively in polytrauma patient.
D. Should be removed if there is severe laceration of its capsule.
E. The risk of infection is increase after its removal.

46- Regarding urinary tract injuries (all are correct except one)
A. Are usually accompanied by haematuria.
B. Require urgent intravenous pyelogram.
C. Involving the kidney require urgent surgery.
D. May cause by RTA.
E. Which demonstrate extravasations of urine from urinary bladder require
surgery.

47- Patient with renal trauma


A. Usually present with hematuria
B. Usually require surgical management.
C. May require an intravenous pyelogram.
D. Often present with acute renal failure.
E. B & C only.
48- Regarding traumatic rupture of the spleen (all are correct except
one )
A. Frequently presents more than 7 days after the causative injury.
B. Frequently presents with shoulder tip pain
C. May be diagnosed by paracentesis.
D. May be accompanied by other abdominal organ injuries.
E. Usually manage conservatively

49- Car seat belts when properly adjusted


A. Prevent injuries to abdominal organs.
B. May cause small bowel injuries.
C. Do not reduce the incidence of head injuries of passengers involving in RTA.
D. Protect the cervical spine during sudden acceleration
D. A & D only.

50- Penetrating wounds of the abdomen.


A. Can be adequately explored by a probe.
B. Frequently result in acquired abdominal wall hernia.
C. May be managed by careful observation, laparatomy being indicated if signs of
peritonitis occur.
D. Can be treated conservatively if cause by gun shot.
E. A&D only.

51- In head trauma patient after control of air way , the first diagnostic
study
A. X-rays of the skull.
B. CT scan of the head.
C. X-rays of cervical spine
D. Carotid angiography.
E. Lumber puncture.

52- In abdominal trauma with signs of hypovolamic shock the first thing
to do after resuscitation of the patient is
A. Obtain lateral x-rays of cervical spine.
B. Obtain supine x-rays of the abdomen.
C. Obtain abdominal CT scan.
D. Obtain an abdominal aortogram.
E. Explore the abdomen.

53. An early signs of anterior compartment syndrome in the calf is:


A. Absence of pulse in the foot.
B. Firm calf muscle
C. Foot drop
D. Paraethesia between the big and second toes.
E. Painful calf muscle.

54- Haematuria:
• At the beginning of micturition is usually indicative of urethral pathology.
• At the end of micturition is usually due to bladder neck pathology.
• Throughout the urinary stream is typical of renal pathology.
• In elderly males is usually related to benign prostatic hypertrophy.
• All of the above.

55- An intravenous pyelogram:


• Yields most diagnostic information when performed on a slightly hydrated
patient.
• Should be preceded by a plain film of the abdomen.
• Normally shows incomplete filling of the ureter in any one exposure.
• Should provide evidence of the presence, if any , of lower urinary tract
obstruction.
• All of the above.

56- Wilms’ tumours:


• Metastasise readily to the lungs.
• Metastasise rarely to the bones.
• Are usually bilateral.
• Have the worst prognosis of all childhood abdominal tumours.
• B&C only.

57- In renal transplantation:


• A donor kidney may be used from a patient with malignancy provided there is
no abdominal involvement.
• ABO compatibility between donor and recipient does not have to be
considered.
• Satisfactory renal function can be expected with a warm ischaemic time of up
to 200 minutes.
• The characteristic signs of acute rejection include pyrexia, hypertension
and leucocytosis.
• A&B only.

58- An adenocarcinoma of the kidney:


• Usually occurs in the 35 to 45 age group.
• Usually presents with a urinary infection.
• Is often distinguishable from a renal cyst radiologically.
• Frequently invades and grows along the renal vein.
• A&C only.

59- Tumours of the renal pelvis )All correct except one)


• Rarely present as a mass in the loin.
• Are possibly due to a urinary carcinogen.
• Resemble those of the bladder in their histology.
• Are best treated by a partial or total nephrectomy.
• Usually cause hematuria and clot colic.

60- Ureteric calculi:


• Often result from urinary tract infection.
• Rarely cause haematuria.
• Are not usually radio-opaque.
• producing ureteric colic should be surgically removed.
• B&C only.

61- Cancer of the penis:


• Is more common in the circumcised.
• Commonly arises from the corona of glans penis.
• Is usually an adenocarcinoma.
• Rarely metastasises.
• C&D only.

62- Carcinoma of the prostate:


• Is commonly of squamous cell origin.
• Usually originates in the periphery of the gland.
• Usually presents relatively early with lower urinary tract symptoms.
• Rarely can be diagnosed on rectal examination.
• All other above.

63- Carcinoma of the prostate:


• Does not usually metastasise.
• Usually produces an elevated serum acid phosphatase.
• Can be effectively treated by hormones.
• Is most effectively treated by surgery.
• B&C only.

64- Benign prostatic hypertrophy: )all correct except one)


• Is the result of hyperplasia of the fibromuscular capsule of the gland.
• Results in diminished power of urination.
• Results in terminal dribbling of urine.
• Often presents with haematuria.
• Might cause mild elevation of serum PSA.

65- Benign prostatic hypertrophy:


• Can readily be assessed on rectal examination.
• Can be effectively treated with hormones.
• Is most effectively treated by surgery.
• Is a premalignant condition.
• Rarely presented with macroscopic hematuria

66- Acute prostatitis: (all correct except one)


• Is most commonly due to coliform organisms.
• Often presents as an ache in the perineum.
• May be diagnosed by rectal examination.
• Requires bladder catheterisation as part of the treatment .
• May be lead to a prostate abscess formation.

67-Bladder cancer: ( all correct except one)


• May follow exposure to beta-naphthylamine.
• Is more common in heavy smokers.
• Is more common in females.
• Is frequently associated with bladder schistosomiasis.
• May caused by chronic urinary bladder inflamation.

68- Bladder cancers:


• Are usually adenocarcinomas.
• Are usually ulcerating.
• Usually present with suprapubic pain radiating to the perineum.
• Are usually diagnosed on cystoscopy.
• All of the above.

69- Undescended testes:


• Are often associated with inguinal hernia.
• Usually descend at puberty.
• Can usually be made to descend by the examiner with warm hands.
• Should be treated by orchidopexy at puberty.
• Can be exist without any complication.
70- The spermatic cord contains:
• The inferior epigastric vein.
• The deep circumflex iliac artery.
• The pudendal nerve.
• The subcostal nerve.
• Vas deference.

71- Torsion of the spermatic cord:


• Often presents with vomiting and lower abdominal pain.
• Often produces gangrene of the testis.
• May be diagnosed clinically.
• Always requires surgical treatment.
• All of the above.

72- Seminomas of the testis:


• Most commonly occur before the age of 40.
• Are usually sensitive to radiotherapy.
• Rarely metastasise via the blood stream.
• Generally carry a good prognosis.
• All of the above.

73- Hypospadias:
• Is the result of failure of scrotal development.
• Results in the abnormal urethra opening on to the dorsum of the penis.
• Is associated with chordee.
• Is associated with maldescent of the testis.
• C&D only.

74-Which is the shortest phase of the normal cell cycle?


a) G1 phase
b) S phase
c) G2 phase
d) M phase
e) All phases approximately equal in length

75- A 67 year-old women with rectal cancer is admitted to gereral surgical floor which of
the following laboratory studies should be included in the surgeon’s initial nutritional
assessment :
a) Transferrin
b) Prealbumin
c) Albumin
d) Glutamine
e) All of above

76- In which of the following conditions is the entral route appropriate for nutrition :
a) Upper gastrointestinal obstruction
b) Complete small bowel obstruction
c) Acute flare-up of Crohn’s disease
d) Low out put colonic fistula
e) Non of the above

77-Which is the most commonly cultured hospital acquired organism in critical care with
aspiration pneumonia:
a) Staphylococcus aureus
b) Streptococcus pneumonia
c) Anaerobic species
d) Pseudomonas aeroginosa
e) Haemophlus influenzae

78-Which is the most appropriate single agent for empiric coverage of the above patient :
a) Metranidazole
b) Clindamycin
c) Pipracillin_tazobactam
d) Vancomycin
e) First generation penicillin

79-All of the following are true about neurogenic shock except:

a) There is a decrease in systemic vascular resistance and an increase in venous


capacitance.
b) Tachycardia or bradycardia may be observed, along with hypotension.
c) The use of an alpha agonist such as phenylephrine is the mainstay of
treatment.
d) Severe head injury, spinal cord injury, and high spinal anesthesia may all cause
neurogenic shock.
e) A and B

80-Which of the following statements about head injury and concomitant hyponatremia
are true?

a) There are no primary alterations in cardiovascular signs.


b) Signs of increased intracranial pressure may be masked by the hyponatremia.
c) Oliguric renal failure is an unlikely complication.
d) Rapid correction of the hyponatremia may prevent central pontine injury.
e) This patient is best treated by restriction of water intake

81- Regarding Cushing's Syndrome


a) 20% of cases are due to pituitary adenomas (Cushing's Disease)
b) Most ACTH secreting pituitary adenomas are more than 2 cm in diameter
c) Is characterised by loss of the diurnal rhythm of cortisol secretion
d) Cortisol production is suppressed by low-dose dexamethasone
e) Adrenal carcinomas are more common than adrenal adenomas
82-Which of the following statements about extracellular fluid are true?

a) The total extracellular fluid volume represents 40% of the body weight.
b) The plasma volume constitutes one fourth of the total extracellular fluid
volume.
c) Potassium is the principal cation in extracellular fluid.
d) The protein content of the plasma produces a lower concentration of cations than
in the interstitial fluid.
e) The interstitial fluid equilibrates slowly with the other body compartments.

83-In patients receiving massive blood transfusion for acute blood loss, which of the
following is/are correct?

a) Packed red blood cells and crystalloid solution should be infused to restore
oxygen-carrying capacity and intravascular volume.
b) Two units of FFP should be given with every 5 units of packed red blood cells in
most cases.
c) A “six pack” of platelets should be administered with every 10 units of packed red
blood cells in most cases.
d) One to two ampules of sodium bicarbonate should be administered with every 5
units of packed red blood cells to avoid acidosis.
e) One ampule of calcium chloride should be administered with every 5 units of
packed red blood cells to avoid hypocalcemia.

84- Which of the following statements about the presence of gallstones in diabetes
patients is/are correct?

a) Gallstones occur with the same frequency in diabetes patients as in the healthy
population.
b) The presence of gallstones, regardless of the presence of symptoms, is an
indication for cholecystectomy in a diabetes patient.
c) Diabetes patients with gallstones and chronic biliary pain should be managed
nonoperatively with chemical dissolution and/or lithotripsy because of severe
complicating medical conditions and a high operative risk.
d) The presence of diabetes and gallstones places the patient at high risk for
pancreatic cancer.
e) Diabetes patients with symptomatic gallstones should have prompt elective
cholecystectomy, to avoid the complications of acute cholecystitis and
gallbladder necrosis.

85. concerning Tetanus all true except:


a. Is due to an infection with a gram-negative spore forming rod
b. The organism produces a powerful exdotoxin
c. The toxin prevents the release of inhibitory neurotransmitter
d. Clostridium tetani is sensitive to penicillin
e. Risus sardonicus is the typical facial spasm
86-when should parentral antibiotics be given perioperatively?

a) The night before


b) 6 hr prior to surgery
c) 60 minutes prior to incision .
d) at the time of incision
e) 30 minutes after incision

87- Which of the following statements about esophageal anatomy is correct?

a) The esophagus has a poor blood supply, which is segmental in distribution and
accounts for the high incidence of anastomotic leakage.
b) The esophageal serosa consists of a thin layer of fibroareolar tissue.
c) The esophagus has two distinct muscle layers, an outer, longitudinal one and
an inner, circular one, which are striated in the upper third and smooth in the
distal two thirds.
d) Injury to the recurrent laryngeal nerve results in vocal cord dysfunction but does
not affect swallowing.
e) The lymphatic drainage of the esophagus is relatively sparse, localized primarily
to adjacent paraesophageal lymph nodes.

88- Which of the following medication should be given in preparation of a pation with
pheochromocytoma?

a) Phnoxybenzamine
b) Nifedipine
c) Linsinopril
d) Hydrochlorothiazide
e) Propranolol

89-Which of the following statement is true concerning excessive scarring processes?

a) Keloids occur randomly regardless of gender or race


b) Hypertrophic scars and keloid are histologically different
c) Keloids tend to develop early and hypertrophic scars late after the surgical injury
d) Simple reexcision and closure of a hypertrophic scar can be useful in certain
situations such as a wound closed by secondary intention
e) Non of the above

90-A 22-year-old man sustains a single stab wound to the left chest and presents to the
emergency room with hypotension. Which of the following statement is true concerning
his diagnosis and management?

a) The patient likely is suffering from hypovolemic shock and should respond
quickly to fluid resuscitation
b) Beck’s triad will likely be an obvious indication of compressive cardiogenic shock
due to pericardial tamponade
c) Echocardiography is the most sensitive noninvasive approach for diagnosis of
pericardial tamponade
d) The placement of bilateral chest tubes will likely resolve the problem

91-Which of the following statement is true concerning septic shock?

a) The clinical picture of gram negative septic shock is specifically different than
shock associated with other infectious agents
b) The circulatory derangements of septic shock precede the development of
metabolic abnormalities
c) Splanchnic vascular resistance falls in similar fashion to overall systemic vascular
resistance
d) Despite normal mechanisms of intrinsic expansion of the circulating blood
volume, exogenous volume resuscitation is necessary

92- During surgery on the submandibular gland


a) An incision on the lower border of the mandible is safe
b) The submandibular gland is seen to wrap around the posterior border of
mylohyoid
c) The facial artery and vein are divided as they course through the deep part of the
gland
d) The hypoglossal nerve is seen to loop under the submandibular duct
e) Damage to the lingual nerve will cause loss of sensation to the posterior third of
the tongue

93- Regarding benign breast disease


a) Cyclical mastalgia is the commonest reason for referral to the breast clinic
b) Fibroadenomas are derived from the breast lobule
c) Lactational breast abscesses are usually due to Staph aureus
d) Duct ectasia is more common in smokers
e) Atypical lobular hyperplasia is associated with an decreased risk of breast
cancer

94-. Which of the following statements regarding unusual hernias is incorrect?

a) An obturator hernia may produce nerve compression diagnosed by a positive


Howship-Romberg sign.
b) Grynfeltt's hernia appears through the superior lumbar triangle, whereas Petit's
hernia occurs through the inferior lumbar triangle.
c) Sciatic hernias usually present with a painful groin mass below the inguinal
ligament.
d) Littre's hernia is defined by a Meckel's diverticulum presenting as the sole
component of the hernia sac.
e) Richter's hernia involves the antimesenteric surface of the intestine within the
hernia sac and may present with partial intestinal obstruction

95- Staples may safely be placed during laparoscopic hernia repair in each of the
following structures except:

a) Cooper's ligament.
b) Tissues superior to the lateral iliopubic tract.
c) The transversus abdominis aponeurotic arch.
d) Tissues inferior to the lateral iliopubic tract.
e) The iliopubic tract at its insertion onto Cooper's ligament.

96-The following statements about the repair of inguinal hernias are true except:

a) The conjoined tendon is sutured to Cooper's ligament in the Bassini hernia


repair.
b) The McVay repair is a suitable option for the repair of femoral hernias.
c) The Shouldice repair involves a multilayer, imbricated repair of the floor of the
inguinal canal.
d) The Lichtenstein repair is accomplished by prosthetic mesh repair of the inguinal
canal floor in a tension-free manner.
e) The laparoscopic transabdominal preperitoneal (TAPP) and totally extraperitoneal
approach (TEPA) repairs are based on the preperitoneal repairs of Cheattle, Henry,
Nyhus, and Stoppa.

97-A number of special circumstances exist in the repair of inguinal hernias. The
following statement(s) is correct.

a) Simultaneous repair of bilateral direct inguinal hernias can be performed with no


significant increased risk of recurrence
b) The preperitoneal approach may be appropriate for repair of a multiple
recurrent hernia
c) A femoral hernia repair can best be accomplished using a Bassini or Shouldice
repair
d) Management of an incarcerated inguinal hernia with obstruction is best
approached via laparotomy incision
e) All are correct.

98- Which of the following statement(s) is true about benign lesions of the liver?

a) Adenomas are true neoplasms with a predisposition for complications and


should usually be resected.
b) Focal nodular hyperplasia (FNH) is a neoplasm related to birth control pills (BCPs)
and usually requires resection.
c) Hemangiomas are the most common benign lesions of the liver that come to the
surgeon's attention.
d) Nodular regenerative hyperplasia does not usually accompany cirrhosis
99- Ligation of all of the following arteries usually causes significant hepatic enzyme
abnormalities except:

a) Ligation of the right hepatic artery.


b) Ligation of the left hepatic artery.
c) Ligation of the hepatic artery distal to the gastro-duodenal branch.
d) Ligation of the hepatic artery proximal to the gastroduodenal artery.

100- Which of the following is the most effective definitive therapy for both prevention
of recurrent variceal hemorrhage and control of ascites?

a) Endoscopic sclerotherapy.
b) Distal splenorenal shunt.
c) Esophagogastric devascularization (Sugiura procedure).
d) Side-to-side portacaval shunt.
e) End-to-side portacaval shunt.

28-which of the following is associated with best prognosis for patient with breast
cancer?

a) Male sex
b) Estrogen receptor positive
c) Patient age <35 years
d) Pregnant patient
e) Tumor with overexpression of HER/ner.

29-A 49-year-old women has a palpable breast mass in the upper outer quadrant. The size
of the mass has increased over the last month . exicisional biopsy reveals cystic
carcinoma with invasion .appropriate management now would be :

a) Re-excision with wide margins


b) Axillary node dissection and hormonal therapy
c) Simple mastectomy
d) Modified radical mastectomy
e) Bilateral mastectomies

30-A contraindication to stereotactic core biopsy of the breast is the mammographic


presence of:

a) Microcacification
b) A radial scar
c) A nonpalpable mass lesion
d) Lesions<8 mm in diameter
e) Mutifocal lesions.
31-. Which of the following statements about epiphrenic diverticula of the esophagus
is/are correct?

a) They are traction diverticula that arise close to the tracheobronchial tree.
b) They characteristically arise proximal to an esophageal reflux stricture.
c) The degree of dysphagia correlates with the size of the pouch.
d) They are best approached surgically through a right thoracotomy.
e) The operation of choice is a stapled diverticulectomy, long esophagomyotomy,
and partial fundoplication.

32- Which of the following statements about Schatzki's ring is correct?

a) The ring represents a panmural fibrotic stricture resulting from gastroesophageal


reflux.
b) Dysphagia occurs when the ring diameter is 13 mm. or less.
c) The ring occurs within 1 to 2 cm. of the squamocolumnar epithelial junction.
d) Schatzki's ring indicates reflux esophagitis.
e) Schatzki's ring signifies the need for an antireflux operation.

33. Which of the following statements about pathology encountered at esophagoscopy


is/are correct?

a) Reflux esophagitis should be graded as mild, moderate, or severe, to promote


consistency among different observers.
b) An esophageal reflux stricture with a 2-mm. lumen is not dilatable and is best
treated with resection.
c) A newly diagnosed radiographic distal esophageal stricture warrants dilation and
antireflux medical therapy.
d) In patients with Barrett's mucosa, the squamocolumnar epithelial junction occurs 3
cm. or more proximal to the anatomic esophagogastric junction.
e) After fasting at least 12 hours, a patient with megaesophagus of achalasia can
safely undergo flexible fiberoptic esophagoscopy.

34. Infantile hypertrophic pyloric stenosis


a) Occurs with a female : male ratio of 4:1.
b) Sons of affected mothers have a 20% risk of developing the lesion
c) Invariably presents between six and eights months of age
d) Typically presents with bile stained projectile vomiting
e) Surgical treatment is by Heller's Cardiomyotomy

35-. Which of the following statements regarding the pathology of esophageal carcinoma
is/are correct?

a) Worldwide, adenocarcinoma is the most common esophageal malignancy.


b) Squamous cell carcinoma is most common in the distal esophagus, whereas
adenocarcinoma predominates in the middle third.
c) Patients with Barrett's metaplasia are 40 times more likely than the general
population to develop adenocarcinoma.
d) Metastases from esophageal carcinoma are characteristically localized to regional
mediastinal lymph nodes adjacent to the tumor.
e) Achalasia, radiation esophagitis, caustic esophageal stricture, Barrett's mucosa,
and Plummer-Vinson syndrome are all premalignant esophageal lesions that
predispose to the development of squamous cell carcinoma.

36-45-year-old with isolated 6-cm colorectal metastasis in the liver 2 years after
colectomy, otherwise healthy pest treatment would be:

a) Radiofrequency ablation
b) Systemic chemotherapy
c) Hepatic lobectomy
d) Liver transplantation
e) Cryosurgical ablation

37- Oesophageal atresia all true except:


a) Is often associated with a distal trachea-oesophageal fistula
b) Polyhydramnios is often present late in pregnancy
c) 50% have other associated congenital abnormalities
d) Contrast X-ray studies are necessary to confirm the diagnosis
e) Post-operatively over 30% develop oesophageal strictures

38-All are true about the dumping syndrome except:

a) Symptoms can be controlled with a somatostatin analog.


b) Diarrhea is always part of the dumping syndrome.
c) Flushing and tachycardia are common features of the syndrome.
d) Separating solids and liquids in the patient's oral intake alleviates some of the
symptoms of the syndrome.
e) Early postoperative dumping after vagotomy often resolves spontaneously.

39-Which of the following statements about gastric polyps is/are true?

a) Like their colonic counterparts, gastric epithelial polyps are common tumors.
b) They are analogous to colorectal polyps in natural history.
c) Endoscopy can uniformly predict the histology of a polyp based on location and
appearance.
d) In a given patient, multiple polyps are generally of a multiple histologic type.
e) Gastric adenomatous polyps greater than 2 cm. in diameter should be excised
because of the risk of malignant transformation.

40-All of the following statements about surgical management of gastric lymphomas are
true except:

a) Stage I gastric lymphomas (small lesions confined to the stomach wall) can be
cured completely with surgical therapy alone.
b) Extensive gastric lymphomas that initially are treated with radiation and/or
chemotherapy occasionally perforate during treatment and require secondary
resection.
c) Patients explored with a presumptive diagnosis of gastric lymphoma should
undergo an attempt at curative resection when this is safe and feasible.
d) Without a preoperative diagnosis resection for gastric mass should not be
attempted unless lymphoma can be excluded.
e) Appropriate staging for primary gastric lymphoma includes bone marrow biopsy.

41-the most accurate test to confirm diagnosis of infected necrotizing pancreases is:

a) Abdominal ultrasound study


b) Indium-labeled leeukocte scan
c) Cimputed tomographic scan
d) Elevated serum level of interleukain 6 and 8
e) Percutaneous needle aspiration

42- Which of the following variables best predicts prognosis for patients with a recent
diagnosis of cutaneous melanoma and no clinical evidence of metastatic disease?

a) Breslow thickness.
b) Clark's level.
c) Ulceration.
d) Gender.
e) Celtic complexion.

43-the following are true about intracranial tumors except:

a) The most common location of brain tumors of childhood is the posterior cranial
fossa.
b) With few exceptions, examination of the CSF is of no value in the diagnosis of an
intracranial tumor.
c) Even the most malignant of primary brain tumors seldom spread outside the
confines of the central nervous system (CNS).
d) The majority of astrocytomas can be cured surgically.
e) Primary neoplasms of astrocytic, oligodendroglial, or ependymal origin represent
gradations of a spectrum from slowly growing to rapidly growing neoplasms.

44 A right-sided disc herniation at the L5–S1 level typically may cause:

a) Low back pain and left sciatica.


b) Weakness of dorsiflexion of the right foot.
c) A diminished or absent right ankle jerk.
d) Diminution of sensation over the medial aspect of the right foot, including the
great toe.
e) Weakness of dorsiflexion of the left foot.

45-. The preferred operation for initial management of a thyroid nodule that is considered
suspicious for malignancy by FNAB is:

a) Excision.
b) Partial lobectomy.
c) Total lobectomy and isthmusectomy.
d) Total thyroidectomy.
e) All methods are correct

46-the most common presentation of Meckel,s diverticulum in an adult is:

a) GIT bleeding
b) GIT obstruction
c) Intussuception
d) Litter,s hernia
e) Diverticulitis

47-Optimal front-line treatment of squamous cell carcinoma of the rectum includes:

a) Abdominal perineal resection.


b) Low anterior resection when technically feasible.
c) Radiation therapy.
d) Chemotherapy.
e) Combined radiation and chemotherapy.

48 -65-year-old man presents with complaints of mucous discharge and perianal


discomfort. Physical examination reveals a fistulous opening lateral to the anus.
Anoscopic examination permits passage of a probe through the fistula tract. The fistula
traverses the internal anal sphincter, the intersphincteric plane, and a portion of the
external anal sphincter. The fistula is categorized as which type?

a) Intersphincteric
b) Transsphincteric
c) Suprasphincteric
d) Extrasphincteric
e) Non of the above

49-Warthin's tumor:

a) Is a pleomorphic adenoma of salivary gland


b) Should be treated by total paritidectomy
c) Is considered a benign salivary gland neoplasia
d) Respond well to preoperative radiotherapy
e) Often present with facial nerve compression

50-A 38 year old woman presents with right upper quadrant pain and bouts of vomiting.
She is known to have gallstones and has had similar episodes in the past. Which of the
following might support a diagnosis of acute cholecystitis rather than biliary colic

a) duration of symptoms
b) Severity of vomiting
c) Presence of Murphy's sign
d) Presence of gas under right hemidiaphragm on erect CXR.

Hemorrhoids MCQS

1. Which of the following is accurate about hemorrhoids?

A. Most symptoms arise from enlarged internal hemorrhoids as opposed to external


hemorrhoids
B. Of the three main hemorrhoidal venous cushions, hemorrhoids are most
commonly associated with the right anterior area of the anal canal, compared with
the left lateral and right posterior areas
C. External hemorrhoids are more common in older adults
D. Portal hypertension is associated with more frequent hemorrhoidal symptoms and
massive bleeding

2. Which of the following is accurate about the presentation and physical


examination of hemorrhoids?

A. The identification of anal fissures and perianal dermatitis requires internal


probing
B. Pain truly caused by hemorrhoids typically arises only with acute thrombus
formation and peaks at 48-72 hours
C. Internal hemorrhoids that are not thrombosed are often palpable during digital
examination
D. If rectal bleeding is bright red, anoscopy and/or flexible sigmoidoscopy is not
required for evaluation

3. Which of the following is accurate about the grading of internal hemorrhoids?

A. Grade IV hemorrhoids usually contain both internal and external components


B. Grade II hemorrhoids often bleed but do not prolapse
C. Grade I hemorrhoids protrude spontaneously and require manual reduction
D. Grade III hemorrhoids protrude with straining or defecating but reduce
spontaneously

4. Which of the following is accurate about the workup of hemorrhoids?


A. Barium enema is routinely indicated for patients with suspected hemorrhoids
B. Histologic examination of hemorrhoidal tissue is routinely indicated
C. Proctoscopy may be used in place of anoscopy in the assessment of internal
hemorrhoids
D. The presence of anemia on laboratory testing should raise suspicion of an
alternate diagnosis to hemorrhoids

5. Which of the following is accurate about the treatment of hemorrhoids?


A. External hemorrhoid symptoms respond well to enucleation
B. Although initially effective, most external hemorrhoids treated with operative
hemorrhoidectomy recur
C. Grade II and III hemorrhoids are initially treated with nonsurgical procedures
D. When treating acutely thrombosed external hemorrhoids in an emergency setting,
simple incision and clot evacuation is indicated
In a normal adult patient, a red blood cell travelling from the aorta to the portal

vein is most likely to pass through which structures?

A. Inferior mesenteric artery, superior rectal artery, rectal veins

B. Coeliac trunk, left gastro-omental artery, splenic vein

C. Right gastric artery, short gastric vein, splenic vein

D. Superior mesenteric artery, right colic vein, inferior mesenteric vein

E. Coeliac trunk, gastroduodenal artery, epigastric vein

1. The radial nerve.


A. Is a branch of the anterior cord of the brachial plexus.
B. Is derived from the posterior primary rami of C5 to C7.
C. Supplies the flexors of the arm.
D. Gives rise to the anterior interosseous nerve.
E. Injury above elbow produces a classical wrist drop.

2. Regarding femoral canal all are true except:


A. Lies lateral to the femoral vein.
B. Has the inguinal ligament as its anterior border.
C. Has the lacunar ligament as its medial border.
D. Has the pectineal ligament as its posterior border.
E. Contains the lymph node of Cloquet.

3. The following causes hypercalcaemia except:


A. Sarcoidosis.
B. Primary hyperparathyroidism.
C. Acute pancreatitis.
D. Metastatic bronchial carcinoma.
E. Milk-Alkali syndrome.

4. Number of human chromosomes in human female are:


A. 23 pairs +XX.
B. 21 pairs +XY.
C. 22 pairs +XY.
D. 22 pairs +XX.
E. 23 pairs +XY.

5. Potassium deficiency should be suspected in all the following except:


A. In cases of paralytic ileus.
B. When the patient's reflexes are exaggerated.
C. If there is a decrease in height and peaking of the T waves of an ECG.
D. In alkalotic states.

6. Active immunization in case of tetanus:


A. Antitetanus human serum.
B. Gives short period of protection.
C. Given in case proved tetanus.
D. Use of immunoglobulin.
E. None of the above.

7. All of the following are signs of rised intracranial pressure except:


A. Headache.
B. Vomiting.
C. Papilledema.
D. Aphasia.
E. Bradycardia.

8. All of the following are extra cranial hematomas except:


A. Subcutaneos haematoma.
B. Extra dural haematoma.
C. Cephalohaematoma.
D. Subgaleal hematoma.
E. Subperiostial haematoma.

9. Glasgow coma scale all the following are true except:


A. Used for evaluation of comatose patient.
B. It ranges from ( 3 to 15).
C. Useful for neurological follow up.
D. Useful for pupils evaluation.
E. Best motor response given 6 point.

10. All the followings are Indications for central line insertion EXCPET:
A. Massive fluid replacement
B. Massive blood replacement
C. Measurement of central venous pressure
D. Prolonged Intervenes fluid therapy

11. Most common early complication of central venous line is:


A. Sepsis
B. Pneumothorax
C. Thoracic duct injury
D. Thrombosis
12. The following are Complications of shock:
A. Acute Respiratory failure
B. Acute myocardial infarction
C. Acute renal failure
D. A&C only
E. All the above

13. Causes of delayed union of fractures includes all the following EXCPET:
A. Compound fracture
B. Infection
C. Adequate immobilization
D. Poor blood supply

14. In Head injury C.T. scan is indicated in the following


A. Aphasia after the injury
B. Deterioration of level of consciousness
C. Skull fracture with persistent headache
D. A&B only
E. All the above
15. Most important steps in management of head injury include:
A. Prevent hypoxia
B. Prevent Dehydration
C. Assure Brain Metabolism
D. Prevent secondary brain injury
E. All the above

16. Tension pneumothorax


A. is the commonest type of chest injuries
B. Needs urgent X-Ray chest
C. Is a clinical Diagnosis
D. Causes flat neek viens
E. Treated by thoracotomy tube after chest X-ray.

17. Calcitonin hormon is secreted to the blood circulations from:


A. Parathyroid gland.
B. Parafollicular cells of thyroid gland.
C. Supra renal gland.
D. Pituitary gland.
E. Gonads.
18. Regarding tension pneumothorax, the first step in the management is:
A. Obtaining a stat chest x-ray.
B. Cricothyroidectomy.
C. Pass an endotracheal tube.
D. Starting oxygen by a valve-mask device.
E. Chest decompression needle.

19. The following are features of thyrotoxicosis except:


A. Weight gain.
B. Palpitations.
C. Proximal myopathy.
D. Increased skin pigmentation.
E. Pretibial myxoedema.

20. The following is a clinical feature of Horner's syndrome:


A. Miosis
B. Failure of abduction of the orbit
C. Increased sweating on the contralateral side of the forehead
D. Exophthalmos.
E. All are true

21. In role of nine extent of burn if entire trunk is burned it will be equal to:
A. 9% body surface area.
B. 18% body surface area.
C. 36% body surface area.
D. 27% body surface area.
E. 45% body surface area.
22. Trachlea (4th) cranial nerve supply :
A. Lateral rectus muscle of th eye.
B. Medial rectus muscle of the eye.
C. Superior obligue rectus muscle of the eye.
D. Superior oblique muscle of the eye.
E. Muscles of the upper eye lid.

23. Regarding pathological terms :


A. Hypertrophy is an increase in tissue size due to increased cell number.
B. Hyperplasia is an increase in tissue size due to an increase in cell size.
C. Atrophy is an increase in tissue size due to disuse.
D. Metaplasia is a change form one abnormal tissue type to another.
E. A hamartoma is a developmental abnormality.

24. Regarding nephroblastomas:


A. They are otherwise known as a Wilm's tumour.
B. Account for 10% of childhood tumours.
C. The commonest presentation is with an abdominal mass.
D. Most commonly present between 2nd and 4th year of life.
E. All are true.

25. Regarding fluid losses in a major burn all are true except:
A. Are maximal between 12 and 24 hours after the injury.
B. Are related to the age of the patient.
C. Are not related to the weight of the patient.
D. Are related to the area burnt.
E. Are not related to the burn duration.

26. In obstructive jaundice :


A. Urinary conjugated bilirubin is increased.
B. Serum unconjugated bilirubin is increased.
C. Urinary urobilinogen is increased.
D. Serum conjugated bilirubin is reduced.
E. Faecal stercobilinogen is increased.

27. Regarding Hydatid disease:


A. Is due to Ecchinococcus granulosa.
B. Man is an accidental intermediate host.
C. The liver is the commonest site of infection.
D. Can be diagnosed by the Casoni test.
E. All are true.

28. The first aid of treatment in fracture of cervical spine should be:
A. Cervical spine x-ray.
B. Analgesia.
C. Neck immoblization.
D. Cervical traction.
E. Non of teh above.

29. The first aid of treatment in fracture of cervical spine should be:
A. Cervical spine x-ray.
B. Analgesia.
C. Neck immoblization.
D. Cervical traction.

30. Regarding local anaesthesia:


A. Local anaesthetics act on small before large nerve fibres
B. Adrenaline reduces absorption and prolongs the local effects
C. Preparations containing adrenaline are safe to use on digits and appendages
D. Lignocaine has a longer duration of action than bupivicaine.
E. All are false.

31. Small bowel obstruction often results in: (all correct except one)
A. Hyperkalaemia.
B. Metabolic alkalosis.
C. Oliguria.
D. Hypovolaemia.
E. Severe dehydration.

32. A serious intra-abdominal injury in a comatose patient may be diagnosed by (all


are correct except one):
A. Abdominal paracentesis.
B. The observation of bruising pattern on the abdominal wall.
C. Falling of heamoglobin values.
D. The presence of marked abdominal distetion.
E. The presence of diarrhea.

33. A perforated duodenal ulcer, all are true except:


A. Usually lies on the anterior or superior surface of the duodenum.
B. Usually presents with the acute onset of severe back pain.
C. Produces radiological evidence of free gas in the peritoneum in over 90 percent of
the patients.
D. Is usually treated by vagotomy and pyloroplasty.
E. Is usually treated conservatively.

34. Acute pancreatitis typically: (all correct except one)


A. Is accompanied by hypocalcaemia.
B. Produces paralytic ileus.
C. Is associated with a pleural effusion.
D. Produces pyloric stenosis.
E. Upper abdominal pain and vomiting.

35. Biliary colic typically:


A. Occurs 3 to 4 hours after meals.
B. Lasts 5 to 20 minutes.
C. Radiates from the upper abdomen to the right subscapular region.
D. Is made better by deep inspiration.
E. B&C only.
36. In post operative DVT, the following are true except:
A. Clinical DVT occures in the 4th post operative day.
B. If complicated by pulmonary embolism, it occures usually after the 7th post
operative day.
C. The process of DVT starts preoperatively with the induction of anaesthesia .
D. When discovered we should start the patient on coumadin "Warfarin
anticoagulation".
E. It may lead to chronic venous in suffering as a complication of DVT.

37. In acute appendicitis all of the following are true except:


A. Anorexia.
B. Abdominal pain usually preceedes vomiting.
C. Pain after begins in the paraumbilical region.
D. Constipation diarrhea may occur.
E. Dysuria excludes the diagnosis.

38. The most common cause of massive haemorrhage in the lower gastroinfestinal
tract is :
A. Carcinoma.
B. Diverticulosis
C. Diverticulitis
D. Polyp.
E. Ulcerative colitis.

39. Painless haematuria is the leading presentation of :


A. Renal cell carcinoma.
B. Transitional cell carcinoma of the bladder .
C. Ureteric stone.
D. Pelvi-ureteric obstruction.
E. Ureterocele.

40. All of the following are complications of massive blood transfusion except:
A. Acute congestive heart failure.
B. Transmission of infection.
C. Hypercalcaemia.
D. Hyperkalaemia.
E. Transfusion reactions.

41. Complication of undescended testis include all of the following except :


A. Malignant degeneration.
B. Increased susceptability to trauma.
C. Increased spermatogenesis.
D. More liable to testiculer torsion.
E. Psychological complication.
42. The recurrent laryngoeal nerve is branch of :
A. Facial nerve.
B. Glosso-pharyngeal nerve.
C. Cervical plexus.
D. Vagus nerve.
E. Brachial plexus.

43. The thyroid tumor which is may be associated with pheochromocytoma is :


A. Papillary carcinoma.
B. Medullary carcinoma.
C. Follicular carcinoma.
D. Anaplastic carcinoma.
E. Malignant lymphoma.

44. The most common pancreatic cyst is :


A. Dermoid cyst of the pancreas.
B. Hydatid cyst of the pancreas.
C. Pancreas pseudocyst.
D. Pancreatic cystadenoma.
E. Congenital cystic disease of the pancreas.

45. The anatomical division between the anus and rectum :


A. Lateral haemorrhoidal groove.
B. Inter haemorrhoidal groove.
C. Dentate line.
D. Arcuate line
E. Ano-rectal ring.

46. The comments type of Anorectal abscess is:


A. Ischio rectal
B. Perianal
C. Submucons
D. Pelvirectal

47. Anal Fissure:


A. Usually anterior
B. May be caused by previous anal surgery
C. Can cause dark bleeding PR.
D. Sometimes is painful
E. Treated by steroids

1. The effective osmotic pressure between the plasma and interstitial fluid
compartments is primarily controlled by:
A. Bicarbonate.
B. Chloride ion.
C. Potassium ion.
D. Protein.
E. Sodium ion.

2. Symptoms and signs of extracellular fluid volume deficit include all of the
following except:
A. Anorexia.
B. Apathy.
C. Decreased body temperature.
D. High pulse pressure.
E. Orthostatic hypotension.

3. The osmolarity of the extracellular fluid space is determined primarily by the


concentration of:
A. Bicarbonate
B. Chloride ion
C. Phosphate radicals
D. Sodium ion
E. Sulfate radicals

4. Potassium deficiency should be suspected in all except:


A. In cases of paralytic ileus.
B. When the patient's reflexes are exaggerated.
C. If there is a decrease in height and peaking of the T waves of an ECG.
D. In alkalotic states.

5. The sodium ion


A. Is the principal regulator of the intracellular volume.
B. Is the major ionic component of the intracellular fluid volume.
C. Is present in greater concentration in intracellular fluid than extracellular fluid.
D. Is excreted in larger amounts than normal in the early postoperative period.
E. C&D only

6. Acute post traumatic renal failure:


A. May be due to hypovolaemia and poor tissue perfusion.
B. Is particularly associated with crush injuries.
C. May be due to kidney damage following tubular obstruction.
D. Should initially be treated by fluid restriction.
E. Should be treated initially by fluid restriction.

7. Intravenous parenteral feeding:


A. Should deliver at least 2500 calories/day to an adult.
B. Should deliver at least 10g of nitrogen (i.e. 66g of protein)/day to an adult.
C. Can be effectively achieved with isotonic solutions.
D. Is with complications with present day solutions and methods of administration.
E. Can be given by central intravenous infusion line(CVL)

8. Acute abdominal pain which is (all correct except one)


A. Colicky in nature indicates obstruction of hollow viscus.
B. In right upper quadrant increased by inspiration is typical of cholecystitis
C. Continuous is typical of inflammation
D. Maximal in the right loin is typical with duodenal ulcer.
E. Maximal in epigastrium and related to meal is typical of gastric problem.

9. Faeculent vomiting:
A. Is commonly seen after upper gastrointestinal tract.
B. Indicates large bowel obstruction.
C. Indicates bacterial proliteration in the upper intestinal.
D. Suggests a gastro-colic fistula.
E. Suggests small bowel fistula

10. Perforated duodenal ulcers: (all correct except one)


A. Occur most frequently in female
B. Are usually preceded by an exacerbation of ulcer symptoms.
C. Are usually accompanied by a leucocytosis.
D. Produce abdominal tenderness which is most marked in the epigastrium.
E. May cause septicemia.

11. A perforated duodenal ulcer:


A. Usually lies on the anterior or superior surface of the duodenum.
B. Usually presents with the acute onset of severe back pain.
C. Produces radiological evidence of free gas in the peritoneum in over 90 percent of
the patients.
D. Is usually treated by vagotomy and pyloroplasty
E. Is usually treated conservatively.

12. Appendicitis is all true except:


A. More common in females
B. Distributed evenly thoughout the world's population
C. More likely to occur if the appendix is in the retrocaecal position.
D. Commonly the result of appendicular obstruction.

13. Patients with early appendicitis:


A. Usually present with central abdominal pain.
B. Rarely present with anorexia.
C. Have usually vomited many time.
D. Usually complain of similar attacks of pain in the previous few weeks.
E. B&C only.

14. Obstruction of the lumen of the appendix may lead to: (all correct except one)
A. Mucosal ulceration
B. Gangrenous appendicitis.
C. A perforated appendix.
D. Intussusception of the appendix.
E. Acute appendicitis.

15. In the differential diagnosis of appendicitis in an infant it's important to


consider: (all correct except)
A. Ileo-ileal instussusception.
B. Basal pneumonia.
C. Henoch-schoenlein purpura.
D. Torsion of an ovarian cyst.
E. Gastroenteritis.

16. Acute non-specific mesenteric lymphadenitis: (all correct except one)


A. Is commonest between 5 and 12 years of age.
B. Is usually associated with an upper respiratory tract infection.
C. Is usually associated with cervical lymphadenopathy
D. Is characterized by enlarged mesenteric lymph nodes which are infected by gram-
negative organisms.
E. Is one of the differential diagnosis of acute appendicitis.

17. The level of intestinal obstruction can be determined by:(all correct except one)
A. Questioning the patient.
B. Examining the patient.
C. Radiological examination of the patient.
D. Repeated measurements of the patient's girth.
E. Upper & lower contrast studies.

18. Acute small bowel obstruction: (all correct except one)


A. Is commonly caused by postoperative adhesions.
B. Accompanied by the signs of peritonitis, suggests bowel strangulation.
C. Is often associated with a raised serum amylase.
D. Generally produces abdominal distension within 2 to 3 hours of onset.
E. Can be diagnosed by history and clinical examination

19. Strangulation of the bowel: (all correct except one)


A. commonly complicates closed loop obstruction.
B. Is difficult to distinguish from simple intestinal obstruction.
C. Is accompanied by bleeding into the affected bowel.
D. Frequently causes peritonitis.
E. Is characterized by severe abdominal pain.
20. Large bowel obstruction:
A. Is most commonly caused by colonic cancer
B. Has its maximum incidence before the age of 50.
C. Frequently presents with nausea and vomiting.
D. Usually heralds its onset with constant suprapubic pain.
E. Frequently treated conservatively.

21. Acute pancreatitis typically: (all correct except one)


A. Is accompanied by hypercalcaemia.
B. Produces paralytic ileus.
C. Is associated with a pleural effusion.
D. Produces pyloric stenosis.
E. Upper abdominal pain and vomiting.

22. Patients with acute colonic diverticulitis:


A. Often give a history of recent lower abdominal colic.
B. Often present with pyrexia.
C. Can be frequently diagnosed on sigmoidoscopic appearances.
D. Frequently develop faecal peritonitis.
E. All the above.

23. Acute pancreatitis: (all correct except one)


A. Often simulates a perforated peptic ulcer in its presentation.
B. Often presents with the signs of hypovolaemia.
C. Can readily be distinguished from other causes of acute abdominal pain by the
presence of a raised serum amylase.
D. Frequently has a raised concentration of urinary amylase.
E. Most commonly caused as a complication of GB stones.

24. Childhood intussusception: (all correct except one)


A. Usually presents during the first year of life.
B. Is frequently ileocolic.
C. Can usually be diagnosed without x-ray examination of the abdomen.
D. Rarely requires surgical treatment.
E. Can be diagnosed by abdominal US.

25. Neonatal duodenal obstruction:


A. May be associated with down's syndrome.
B. Is more frequently found in premature infants.
C. Typically presents with gross abdominal distension.
D. Usually presents with vomiting of non-bile stained fluid
E. B&C only.

26. acute superior mesenteric artery occlusion: (all correct except one)
A. Characteristically presents with sudden pain and tenderness of increasing intensity.
B. Is frequently accompanied by overt or occult blood loss in the stools.
C. Frequently produces peritonitis.
D. Can usually be diagnosed on plain abdominal x-rays.
E. Can be diagnosed by mesenteric artery ongiography.

27. Biliary colic typically:


A. Occurs 3 to 4 hours after meals.
B. Lasts 5 to 20 minutes.
C. Radiates from the upper abdomen to the right subscapular region.
D. Is made better by deep inspiration.
E. B&C only.

28. Regarding tension pneumothorax, the first step in the management is:
A. Obtaining a stat chest x-ray.
B. Cricothyroidectomy
C. Passin on endotracheal tube
D. Starting oxygen by a valve-mask device
E. Chest decompression needle.

29. Regarding the management of polytrauma:


A. Death follow a trimodal distribution.
B. X-ray after primary survey should be AP cervical spine, chest and pelvis.
C. Cardiac tamponade is characterized by raised B.p, a low JUP.
D. Assessment of uncomplicated limb fractures should occur during the primary
survey.
E. A and B only.

30. Blunt injuries to the abdomen (all are correct except)


A. May cause shock
B. May cause peritonitis
C. May cause acute gastroduodenal ulceration
D. May treated conservativly
E. Rarely need urgent laparatomy
31.Injuries to the urethra (all are correct except one)
A. Are more common in male.
B. Are often caused by road traffic accidents.
C. Are easily diagnosed on intra venous pyelography.
D. Require urgent surgical treatment.
E. Diagnosed by antegrade urethragraphy.
32.Car seat belts when properly adjusted
A. Prevent injuries to abdominal organs.
B. May cause small bowel injuries.
C. Do not reduce the incidence of head injuries of passengers involving in RTA.
D. Protect the cervical spine during sudden acceleration .
E. A & D only.

33. In head trauma patient after control of air way , the first diagnostic study
A. X-rays of the skull.
B. CT scan of the head.
C. X-rays of cervical spine
D. Carotid angiography.
E. Lumber puncture.

34. Estimation of the area of a burn: ( all correct except one)


A. Is of very little clinical significance.
B. Provides important prognostic information.
C. Is an important factor in the estimation of the fluid required.
D. Can be based on a formula which states that the adult trunk is 36 per cent of the
whole body surface area.
E. Should be recorded in each chart of burned patient.

35. Patients with major burns:


A. Are in a negative nitrogen balance.
B. Have normal calorie requirements.
C. Do not generally become anaemic.
D. Are resistant to septicaemia.
E. All of the above.

36. Scalds:
A. Are more frequent in children.
B. Commonly cause full thickness skin loss.
C. Should be skin grafted within 48 hours of the injury.
D. Need routine antibiotic treatment.
E. All of the above.

37. Major burns are sometimes complicated by: (all correct except one)
A. Acute gastric and duodenal ulcers.
B. Paralytic ileus.
C. Cerebral oedema.
D. Mesenteric thrombosis.
E. Septicemia.

38.In all forms of shock there is:


A. An impairment of cellular oxygenation.
B. A decreased cardiac output.
C. An increased effective circulating fluid volume.
D. A low central venous pressure (CVP).
E. An increased pulse rate.

39.The metabolic acidosis of shock can be effectively treated by:


A. Warming the patient.
B. Administering ammonia chloride.
C. Artificial ventilation.
D. Restoring normal tissue perfusion.

40.. septic shock is associated with a hypodynamic cardiovascular state: ( all correct
except one)
A. if preceded by existing hypovolaemia.
B. In generalized peritonitis.
C. When there is a gram-positive bacteraemia.
D. In elderly patients.
E. In late gram negative septicemia.

41. In cardiogenic shock:


A. The central venous pressure is high.
B. The difference in the arteriovenous oxygen tension is increased.
C. The haematocrit is raised.
D. The blood pressure is unaffected.
E. C&D only.

42. A blood transfusion reaction: (all correct except one)


A. May be due to incompatibility of the recipient serum and donor cells.
B. Is manifest by thrombophlebitis of the infusion site.
C. Occurs within the first 30 minutes of transfusion.
D. May produce renal damage.
E. May produce anaphylactic shock.

43. Massive blood transfusions may be complicated by all true except:


A. Hyperkalaemia.
B. Hypocalcaemia.
C. Coagulopathy.
D. Leucopenia.
E. DIC.

44. In a healing fracture: (All correct except one)


A. The haematoma is initially invaded by osteoblasts.
B. The tissue formed by the invading osteoblasts is termed osteoid.
C. Calcium salts are laid down in the osteoid tissue.
D. The final stage of repair is the remodelling of the callus.
E. The callus formation is related to the amount of stress at fracture side.

45. Non-union is often seen in:


A. Fractures of the 4th metatarsal.
B. Fractures of the neck of the femur.
C. Fractures of the condyle of the mandible.
D. Colles’ fractures.
E. Oblique fracture line of femur.

46. In a colles’ fracture the distal radial fragment:


A. Is dorsally angulated on the proximal radius.
B. Is usually torn from the intra-articular triangular disc.
C. Is deviated to the ulnar side.
D. Is rarely impacted.
E. Is ventrally displaced.

47. A malignant melanoma:


A. Frequently arises from hair-bearing naevi.
B. Frequently arises from junctional naevi.
C. Has a worse prognosis when it areses on the leg.
D. Should be suspected in any big pigmented lesion.
E. Non of the above is correct.

48. Squamous cancer of the lip:


A. Is most common in early adult life.
B. Is more common in fair skinned subjects.
C. Metastasises readily by the blood stream.
D. Is preferably treated by radiotherapy once lymph node deposits are present.
E. All of the above are correct.

49. Basal cell carcinomas:


A. Usually metastasise to regional lymph nodes.
B. Are less common than squamous cell carcinomas.
C. Are characterised histologically by epithelial pearls.
D. Are particularly common in oriental races.
E. Non of the above is correct.
50. Fiboadenomata of the breast:
A. Are commonest in early adult life.
B. Are indiscrete and difficult to distinguish.
C. Are usually painless.
D. Resolve without treatment.
E. A&C only.

51. Paget’s disease of the nipple:


A. Usually presents as abilateral eczema of the nipple.
B. Is always related to an underlying breast cancer.
C. Indicates incurable breast cancer.
D. Has non-specific histological characteristics.
E. A&C only

52. Gallstones: (all correct except one)


A. Have an incidence which increases with age.
B. Are more frequent in females.
C. Usually contain a predominance of cholesterol.
D. Are formed in bile which is supersaturated with bile acids.
E. Are formed in bile which is supersaturated with cholesterol.

53. stones in the common bile duct:


A. Are present in nearly 50 per cent of cases of cholecystitis.
B. Often give rise to jaundice, fever and biliary colic.
C. Are usually accompanied by progressive jaundice.
D. Are usually associated with a distended gallbladder.
E. A&D only

54. Ulcerative colitis:


A. Is more common in female than males.
B. Appears most commonly between the ages of 20 and 30.
C. Usually presents with abdominal discomfort and diarrhoea.
D. Can usually be diagnosed on sigmoidoscopic examination.
E. All of the above correct.

55. Diverticular disease of the colon:


A. Is usually asymptomatic.
B. Often presents with lower abdominal pain.
C. May present with severe rectal haemorrhage.
D. May present with peritonitis.
E. All of the above are correct.
56. Colonic polyps: (all correct except one)
A. Are associated with colonic cancer.
B. May be hereditary.
C. Should not be removed if they are asymptomatic.
D. May be hyperplastic.
E. Are commonly adenomatous.

57. Signs and symptoms of hyperthytoidism include: (All correct except one)
A. Decreased sweating.
B. An irregular pulse rate.
C. Cardiac failure.
D. Diplopia.
E. Loss of weight.

58. a multinodular (adenomatous) goitre:


A. Is more common in those patients having a deficient iodine intake.
B. Is usually preceded by a diffuse goitre in early adult life
C. Is rarely a precancerous condition.
D. Is effectively treated in early stage with thyroid hormones to prevent further
adenomatous changes.
E. All of the above.

59. Hashimoto’s disease:


A. Is often associated with increased levels of circulating thyroid antibodies.
B. Is characterized by lymphocytic infiltration and fibrosis of the thyroid gland.
C. Is usually treated by sub-total thyroidectomy.
D. Should be treated by anti-thyroid drugs.
E. A&B only.

60. The surgical treatment of thyroid cancer:


A. Should be by total thyroidectomy in the potentially curable patient.
B. Should include block dissection of the neighboring lymph nodes whether or not
they appear to contain tumour.
C. Is most successful in the papillary type of cancer.
D. Should be preceded by a therapeutic dose of iodine 131.
E. A& C only.

61. The earliest symptoms of hyperparathyroidism include:


A. Diarrhea.
B. Polydipsia and polyuria.
C. Unexplained weight gain.
D. Muscle spasm
E. C&D only.
62. Phaeochromocytomata:
A. Are tumors of the spinal nerve roots.
B. Are frequently multiple.
C. Characteristically present with a yellow skin discoloration.
D. Can be effectively managed by long term medical therapy.
E. C&D only.
63. In cushing’s syndrome:
A. There is usually an increased deposition of fat over the face and trunk.
B. Hypotension and hypokalaemia are frequently present.
C. There is an increased production of adrenal hormones.
D. The cause is most frequently an adrenal tumor.
E. A&C only.

64. Streptococcal infections:


A. Are characterised by abscess formation.
B. Rarely produce lymphadenitis.
C. Do not produce baceraemia.
D. Can produce a gangrenous skin infection.
E. All of the above.

65. A pelvic abscess:


A. Lies extrapeitoneally.
B. May be a complication of abdominal surgery.
C. Rarely presents with diarrhoea.
D. Should be treated with antibiotics alone.
E. A&C only

66. Heavily contaminated and dirty wounds:


A. Require surgical toilet and delayed closure.
B. Require the administration of systemic antibiotics.
C. Can usually be treated by wound toilet and primary closure.
D. Should be totally excised.
E. A&B only.

67. Inguinal herniae:


A. In children are usually of the direct type.
B. Of the indirect type are congenital in origin.
C. Will regress spontaneously in children.
D. In young adults are most commonly of the direct type.
E. C&D only.
68. Strangulated contents of hernial sacs:
A. Are always accompanied by intestinal obstruction.
B. Are more common in direct than indirect inguinal herniae.
C. Are usually reducible.
D. Produce local pain and tenderness.
E. All of the above
69. Incisional herniae are related to:(ِAll correct except one)
A. Wound infections.
B. Anaemia and malnutrition.
C. Obesity.
D. The use of absorbable suture materials.
E. To the technique of wound closure.
70. True statements concerning a femoral hernia include which of the following?
A. It is common in male.
B. It is usually results from a defect in lateral part of transversalis fascia.
C. It is common in children.
D. It is less common in female.
E. It may be confused with inguinal lymphadenopathy.
71. Acute arterial occlusion:
A. Should be treated conservatively if the site of the occlusion is above the inguinal
ligament.
B. Demands the urgent use of vasodilator drugs.
C. Of a limb is usually painless due to the anoxic damage produced in the peripheral
nerves.
D. May produce irreversible muscle necrosis after 6 hours.
E. B&C only.

72. Common sites for atheromatous arterial aneurysms are:


A. The femoral artery.
B. The middle cerebral artery.
C. The abdominal aorta.
D. Intrarenal.
E. A&C only
73. The long saphenous vein:
A. Arises on the medial aspect of the sole of the foot.
B. Passes 1cm in front of the medial malleolus.
C. Passes in front the knee joint.
D. Enters the femoral sheath by piercing the fascia lata.
E. Related to the sural nerve

74. In deep venous thrombosis of the lower limb:


A. One of the most common sites of origin is the short saphenous vein.
B. One of the common sites of origin is in the iliofemoral segment.
C. The diagnosis can usually be made by clinical examination.
D. Tender swollen thrombosed veins are usually palpable.
E. Usually associated with varicose vein.
75. In head injuries the causes of a rising intracranial pressure: (all correct except
one)
A. Intracerebral haemorrhage.
B. Cerebral oedema.
C. Rhinorrhoea.
D. Meningitis.
E. Extradural hemorrhage.

76. Birth injuries involving the fifth and sixth cervicaal nerve roots of the brachial
plexus:
A. Are known as klumpke’s palsy.
B. Are rarely followed by full recovery.
C. Are characterised by the arm being held in the pronated and internally rotated
position.
D. Show weakness and wasting of the small muscles of the hand.
E. Non of the above correct.
77. Following a peripheral nerve injury:
A. Loss of axon continuity is described as neuropraxia.
B. Due to gunshot wounds primary nerve repair is desirable.
C. Delayed suture is best performed one week after the injury.
D. Delayed suture is best performed three months after the injury.
E. None of the above is correct.

1. The best test to monitor adequacy of L-Thyroxine therapy is :


A. radioactive isotope thyroid scan
B. thyroglobulin blood level
C. total T4 blood level
D. free T3 blood level
E. blood level of TSH

2. Hashimoto s thyroiditis :
A. is of viral origin
B. presents usually by nodular goiter
C. can be diagnosed by thyroid antibodies and fine needle aspiration of thyroid
D. is often premalignant
E. must be treated always by surgery

3. Thyrotoxicosis usually manifests by all of the following EXCEPT:


A. loss of weight inspite of good appetite
B. a recent preference to cold
C. palpitation
D. more common in male than in female
E. excitability of the patient

4. Exophthalmos :
A. is always present in thyrotoxicosis
B. is always bilateral
C. can cause diplopia in severe cases
D. decreases by hypothyroidism
E. is cured by surgery to the thyrotoxic goiter

5. Complications after thyroidectomy include all the following EXCEPT:


A. parathyroid insufficiency
B. recurrent laryngeal nerve paralysis
C. tracheomalacia
D. thyrotoxic crisis(storm) on operating on inadequitly prepared thyrotoxic patient
E. hypercalcemia

6. Regardig Carcinoma of the thyroid gland:


A. common diffrenciated types are the papillary and the follicular carcinoma
B. medullary carcinoma of the thyroid is treated only by resection of the involved
lobe
C. papillary carcinoma never metastasize to cervical lymph nodes
D. anaplastic carcinoma is more common in the young age group

7. Tuberculous cervical lymphadenitis:


A. is caused by bovine tuberculous bacillus rather than the human bacillus
B. usually occurs through the tonsil of the corresponding side
C. collar-stud abscess is never a feature of T. B adenitis
D. is treated always by surgery
E. biopsy is not necessary for diagnosis
8. Branchial cyst:
A. develops from the third branchial cleft
B. presence of cholesterol crystals in aspirated fluid from the cyst is
pathognomonic to it
C. should be treated with repeated aspiration
D. is not related to carotid vessles,hypoglossal and spinal accessory nerves
E. is never inflamed

9. Cystic hygroma:
A. develops as a sequestration of a portion of a jugular lymph sac
B. typically occupies the upper one third of the neck
C. occasionally may occur in cheek ,axilla and groin but exceptionally in tongue and
mediastinum
D. repeated aspiration is the only treatment
E. A and C are correct

10. Carotid body tumour:


A. is chromffin paragranuloma
B. is usually bilateral
C. is called chemodactoma or potato tumour
D. is situated ot the bifurcation of the carotid artery
E. C and D are correct

11. Differential diagnosis of lateral sided neck swelling:


A. cannot be diagnosed by fine needle asoiration
B. can be thyroglssal cyst
C. can be a lymphoma when having other characteristic features
D. cannot be diffrenciated into solid or cystic by ultrasound
E. is never a reactive lymphadenitis or secondary malignant disease

12. The breast :


A. is a modified apocrine sweat gland
B. overlies the third to the sixth rib
C. is having usually more than 30 lacteferous ducts
D. is drained only by six groups of axillary lymph nodes
E. is having no attachment to skin

13. The commonest cause of bloody nipple discharge is :


A. mammary ductectasia
B. carcinoma of the breast
C. lactational mastitis
D. duct papilloma
E. fibrocystic disease of the breast

14. All of the following may be manifestations of breast carcinoma EXCEPT


A. peau d orange of covering skin
B. no mass may be felt clinically
C. enlargement of the ipsilateral axillary lymph nodes
D. cervical spine metastasis
E. none of the above

15. Bacterial mastitis:


A. never occurs in lactating mothers
B. is usually caused by streptococcus hemolyticus
C. is mostly caused by staphylococcus aureus
D. is treated only by incision and drainage
E. is the same as mastitis of puberty

16. Signs of malignancy on mammogram may include all of the following EXCEPT :
A. mass lesions with poorly defined irregular margins
B. fine stipped soft tissue with periductal and not vascular microcalcifications
C. thickening and retraction of the overlying skin
D. dysplastic ductal pattern
E. well circumscribed , homogenous,and often surrounded by a zone of fatty tissue

17. Early detection of carcinoma of the breast includes all of the following EXCEPT:
A. self-examination just after menstruation
B. screening mammography
C. frequent consultations among the high risk group patients
D. presence of fixed breast mass to chest wall with skin changes on clinical
examination
E. A, B, C, are correct

18. Regarding Paget s disease of the nipple :


A. It is a benign condition
B. It is simply an eczematous lesion of the nipple
C. It is treated by excision of the nipple
D. It is usually diagnosed by biopsy of the suspected lesion
E. the areola and the surrounding skin are never involved

19. in a patient with fibroadenosis of the breast ;


A. cyst formation, adenosis, fibrosis,epitheliosis and papillomatosis are invariably
present
B. is premalignant
C. pregnancy usually produces relief
D. presentation may include pain, nipple discharge, and/ or breast lump
E. all of the above are usually characteristics
20. Regarding gynaecomastia :
A. it is hypertrophy of female breast
B. it is hypertrophy of male breast
C. it may associate leprosy and liver failure
D. it may associate cimetidine, spironolactone, INH, or digitalis thrapy
E. B, C, and D are correct

21. Regarding modified radical mastectomy all are correct EXCEPT :


A. it is indicated recently for T1N0M0
B. pectoralis major muscle is excised
C. axillary clearance is mandatory
D. adjuvant radiotherapy must be given for all patients post-operatively
E. the long thoracic nerve of Bell (nerve to serratous anterior) must be preserved but
nerve to latismus dorsi might be sacrified

22. Mammary duct ectasia is characterized by the following EXCEPT :


A. is defiened as primary dilatation of major ducts of breast in middle aged women
B. may present with nipple retraction and Peau d orange picture
C. is treated usually by simple mastectomy
D. anaerobic superinfection commonly occurs in this recurrent periductal plasma cell
mastitis
E. is commonly pre-malignant
23. Regarding carcinoma of the breast :
A. invasive intraductal carcinoma is the commonest form
B. lobular carcinoma may present bilateral
C. clinical staging is always correct and definit
D. the medullary (anaplastic) type feels hard
E. A, and B, are correct

A pregnant woman in her 32nd wk of gestation is given magnesium sulfate for .1


pre-eclampsia . The earliest clinical indication of hypermagnesemia is
A. Loss of deep tendon reflexes
B. Flaccid paralysis
C. Respiratory arrest
D. Hypotension
The chief surgical risk to which patients with polycythemia vera are exposed is .2
that due to
A. Anemic disturbances
B. Hemorrhage
C. Infection
D. Renal dysfunction

The surgeon should be particularly concerned about which coagulation function .3


?in patients receiving anti-inflammatory or analgesic medications
A. APTT
B. PT
C. Reptilase time
D. Bleeding time

The substrate depleted earliest in the postoperative period is .4


A. Branched-chain amino acids
B. Non-branched-chain amino acids
C. Ketone
D. Glycogen
E. Glucose
Signs and symptoms of hemolytic transfusion reactions include .5
A. Hypothermia
B. Hypertension
C. Polyuria
D. Abnormal bleeding

A patient suspected of having a hemolytic transfusion reaction should be managed .6


with
A. Removal of nonessential foreign body irritants, e.g., Foley catheter
B. Fluid restriction
C. 0.1 M HC1 infusion
D. Steroids
E. Fluids and mannitol

In a hemolytic reaction caused by an incompatible blood transfusion, the .7


treatment that is most likely to be helpful is
A. Promoting a diuresis with 250 ml of 50% mannitol
B. Treating anuria with fluid and potassium replacement
C. Acidifying the urine to prevent hemoglobin precipitation in the renal tubules
D. Removing foreign bodies, such as Foley catheters, which may cause hemorrhagic
complications
E. Stopping the transfusion immediately

The enteric fluid with an electrolyte (Na+, K+, C1 ) content similar to that of .8
Ringer’slactate is
A. Saliva
B. Contents of small intestine
C. Contents of right colon
D. Pancreatic secretions
E. Gastric juice

Which of the following medications administered for hyperkalemia counteracts .9


?the myocardial effects of potassium without reducing the serum potassium level
A. Sodium polystyrene sulfonate(Kayexalate)
B. Sodium bicarbonate
C. 50% dextrose
D. Calcium gluconate
E. Insulin
Hypocalcemia is associated with .10
A. Acidosis
B. Shortened QT interval
C. Hypomagnesemia
D. Myocardial irritability

?Which of the following might increase the risk of a wound infection .11
A. History of colon surgery
B. Hypertension
C. Male sex
D. Receipt of chemotherapy
E. Asthma

A correct statement regarding 5% dextrose in 0.9% saline is which of the .12


?following
A. It contains the same concentration of sodium ions as does plasma
B. It can be given in large quantities without seriously affecting acid-base balance
C. It is isosmotic with plasma
D. It has a pH of 7.4
E. It may cause a dilutional acidosis

Correct statements regarding lactated Ringer’s solution include which of the .13
?following
A. It contains a higher concentration of sodium ions than does plasma
B. It is most appropriate for replacement of nasogastric tube losses
C. It is isosmotic with plasma
D. It has a pH of less than 7.0
E. It may induce a significant metabolic acidosis

Prophylactic regimens of documented benefit in decreasing the risk of .14


postoperative thromboembolism include
A. Early ambulation
B. External pneumatic compression devices placed on the upper extremities
C. Elastic stockings
D. Leg elevation for 24 h postoperatively

Signs and symptoms associated with early sepsis include .15


A. Respiratory acidosis
B. Decreased cardiac output
C. Hypoglycemia
E. Cutaneous vasodilation

The most common physiologic cause of hypoxemia is .16


A. Hypoventilation
B. Incomplete alveolar oxygen diffusion
C. Ventilation-perfusion inequality
D. Pulmonary shunt flow

Generally accepted indications for mechanical ventilatory support include .17


A. PaO2 of less than 70 kPa and Pa greater than 50 kPa while breathing room air
B. Alveolar-arterial oxygen tension difference of 150 kPa while breathing 100% O2
C. Vital capacity of 40–60 mL/kg
D. Respiratory rate greater than 35 breaths/min
E. A dead space:tidal volume ratio (VD /VT) less than 0.6 CO2 of

Which of the following inhalation anesthetics accumulates in air-filled cavities .18


?during general anesthesia
A. Diethyl ether
B. Nitrous oxide
C. Halothane
D. Methoxyflurane
E. Trichloroethylene

Major alterations in pulmonary function associated with adult respiratory .19


distress syndrome (ARDS) include
A. Hypoxemia
B. Increased pulmonary compliance
C. Increased resting lung volume
E. Decreased dead space ventilation

Dopamine is a frequently used drug in critically ill patients because .20


A. At high doses it increases splanchnic flow
B. At high doses it increases coronary flow
C. At low doses it decreases heart rate
D. At low doses it lowers peripheral resistance

If end-diastolic pressure is held constant, increasing which of the following will .21
?increase the cardiac index
A. Peripheral vascular resistance
B. Pulmonary wedge pressure
C. Heart rate
D. Systemic diastolic pressure

The preoperative characteristics of patients likely to experience postoperative .22


ischemia after non cardiac surgery include
A. Angina
B. More than three premature ventricular contractions (PVCs) per minute
C. Dyspnea on exertion
D. Tricuspid regurgitation

Compensatory mechanisms during acute hemorrhage include .23


A. Decreased cerebral and coronary blood flow
B. Decreased myocardial contractility
C. Renal and splanchnic vasodilation
D. Increased respiratory rate
E. Decreased renal sodium resorption

An 18-year-old woman develops urticaria and wheezing after an injection of .24


penicillin. Her blood pressure is 120/60 mm Hg, heart rate is 155 beats/min, and
respiratory rate is 30 breaths/min. Immediate therapy should include
A. Intubation
B. Epinephrine
C. Beta blockers
D. Iodine
E. Fluid challenge

During blood transfusion, clotting of transfused blood is associated with .25


A. ABO incompatibility
B. Minor blood group incompatibility
C. Rh incompatibility
D. Transfusion through Ringer’s lactate

When an arterial blood gas determination of PCO2 40 kPa is obtained .26


A. There is probably a paradoxical aciduria
B. Alveolar ventilation is adequate
C. Arterial P will indicate the adequacy of alveolar ventilation
D. Arterial PO2 will indicate the degree of ventilation-perfusion mismatch
E. Arterial PO2 can be safely predicted to exceed 90 kPa on room air
Among patients who require nutritional resuscitation in an intensive care unit, .27
the best evidence that nutritional support is adequate is
A. Urinary nitrogen excretion levels
B. Total serum protein level
C. Serum albumin level
D. Serum transferrin levels

Paradoxical aciduria (the excretion of acid urine in the presence of metabolic .28
alkalosis) may occur in the presence of
A. Release of inappropriate antidiuretic hormone
B. Severe crush injury
C. Acute tubular necrosis
D. Gastric outlet obstruction

If a patient suffered a pulmonary arterial air embolism during an open .29


thoracotomy, the anesthesiologist’s most likely observation would be
A. Unexpected systemic hypertension
B. Rising right atrial filling pressures
C. Reduced systemic arterial oxygen saturation
D. Rising systemic CO partial pressures
E. Falling end-tidal CO2

A 72-year-old man undergoes resection of an abdominal aneurysm. He arrives in .30


the ICU with a core temperature of 33°C (91.4°F) and shivering. The physiologic
consequence of the shivering is
A. Rising mixed venous oxygen saturation
B. Increased production of carbon dioxide
C. Decreased consumption of oxygen
D. Rising base excess
E. Decreased minute ventilation

To prepare for operating on a patient with a bleeding history diagnosed as von .31
Willebrand’s disease (recessive), you would give
A. High-purity factor VIII:C concentrates
B. Low-molecular-weight dextran
C. Fresh frozen plasma (FFP)
D. Cryoprecipitate
E. Whole blood
The accidental aspiration of gastric contents into the tracheobronchial tree .32
should be initially treated by
A. Tracheal intubation and suctioning
B. Steroids
C. Intravenous fluid bolus
D. Cricothyroidotomy

In performing a tracheostomy .33


A. The strap muscles should be divided
B. The thyroid isthmus should be preserved
C. The trachea should be entered at the second or third cartilaginous ring
D. Only horizontal incisions should be used

If malignant hyperthermia is suspected intraoperatively .34


A. Complete the procedure but pretreat with dantrolene prior to future elective surgery
B. Administer inhalational anesthetic agents
C. Administer succinylcholine
D. Hyperventilate with 100% oxygen
E. Acidify the urine to prevent myoglobin precipitation in the renal tubules

Central venous pressure (CVP) may be decreased by .35


A. Pulmonary embolism
B. Hypervolemia
C. Positive-pressure ventilation
D. Pneumothorax
E. Gram-negative sepsis

Characteristics of continuous arteriovenous hemofiltration (CAVH) in the .36


treatment of surgical patients with acute renal failure include
A. CAVH is useful only in hemodynamically stable patients
B. CAVH requires placement of large bore(8 French) arterial and venous catheters,
usually in the femoral vessels
C. CAVH is not effective in treating hypervolemia
D. Continuous heparinization of the patient who undergoes CAVH is unnecessary
E. During CAVH, blood flow is maintained by a
mechanical extracorporeal pump–oxygenator

Signs and symptoms of unsuspected Addison’s disease include .37


A. Hypothermia
B. Hypokalemia
C. Hyperglycemia
D. Hyponatremia
E. Hypervolemia

The etiologic factor implicated in the development of pulmonary insufficiency .38


following major non thoracic trauma is
A. Aspiration
B. Atelectasis
C. Fat embolism syndrome
D. Fluid overload

For the severely traumatized patient requiring airway management .39


A. Awake endotracheal intubation is indicated in patients with penetrating ocular
injury
B. Steroids have been shown to be of value in the treatment of aspiration of acidic
gastric secretions
C. The stomach may be assumed to be empty only if a history is obtained indicating
no ingestion of food or liquid during the prior 8 h
D. Intubation should be performed in the emergency room if the patient is unstable
E. Cricothyroidotomy is contraindicated in the presence of maxillofacial injuries

Treatment for clostridial myonecrosis (gas gangrene) Includes which of the .40
?following measures
A. Administration of an antifungal agent
B. Administration of antitoxin
C. Wide debridement
D. Administration of hyperbaric oxygen

An abnormal ventilatioperfusion ratio (Qs/Qr) in the postoperative patient has .41


been associated with
A. Pulmonary thromboembolism
B. Lower abdominal surgery
C. starvation
D. The upright position
E. Increased cardiac output

Correct statements concerning drowning or near-drowning include which of the .42


?following
A. The prognosis for recovery of cerebral function in affected persons is better if
submersion occurs in warm water rather than extremely cold water
B. A majority of victims will demonstrate a severe metabolic alkalosis
C. Prompt administration of corticosteroids to affected persons has been shown to
decrease the extent of pulmonary membrane damage
D. Renal damage may occur in affected persons as a result of hemoglobinuria
E. The most important initial treatment of drowning victims is emptying the stomach
of swallowed water
Spontaneous retroperitoneal hemorrhage during anticoagulant therapy .43
A. Is best confirmed by bleeding scan
B. Is equally likely with parenteral and oral anticoagulants
C. May mimic an acute surgical abdomen
D. Frequently requires laparotomy for ligation of the bleeding site

Indications for surgical intervention to remove smuggled drug packets that have .44
been ingested include
A. Refusal to take high doses of laxatives
B. Refusal to allow endoscopic retrieval
C. Refusal to allow digital rectal disimpaction
D. Intraintestinal drug packets evident on abdominal x-ray in an asymptomatic
smuggler

1. Wasting of the intrinsic muscles of the hand can be expected to follow injury of
the
A. Ulnar nerve
B. Radial nerve
C. Brachial nerve
D. Axillary nerve

2. A 30-year-old man is stabbed in the arm. There is no evidence of vascular injury,


but he cannot flex his three radial digits. He has injured the
C. Median nerve

3. Although wide surgical excision is the traditional treatment for malignant


melanoma, narrow excision of thin (less than 1 mm deep) stage I melanomas has
been found to be equally safe and effective when the margin of resection is as small
as
C. 1 cm

4. With regard to wound healing, which one of the following statements is correct?
B. Monocytes are essential for normal wound healing
5. While you are on duty in the emergency room, a 12-year-old boy arrives with pain
and inflammation over the ball of his left foot and red streaks extending up the inner
aspect of his leg. He remembers removing a wood splinter from the sole of his foot
on the previous day. The most likely infecting organism is
E. Streptococcus
6. The appropriate antibiotic to prescribe while awaiting specific culture verification
is
A. Penicillin
7. Proper treatment for frostbite consists of
D. Immersion of the affected part in water at 40–44°C (104–111.2°F)
8. The true statement regarding tendon injuries in the hand is
E. The process of healing a tendon injury involves formation of a tenoma

9. Which one of the following cases is considered a clean contaminated wound


A. Open cholecystectomy for cholelithiasis
B. Herniorrhaphy with mesh repair
C. Lumpectomy with axillary node dissection
D. Appendectomy with walled-off abscess
10. True statements regarding squamous cell carcinoma of the lip include
A. The lesion often arises in areas of persistent hyperkeratosis
B. More than 90% of cases occur on the upper lip
C. The lesion constitutes 30% of all cancers of the oral cavity
D. Radiotherapy is considered inappropriate treatment for these lesions

11. Which of the following statements regarding carpal tunnel syndrome is correct?
B. It may be associated with pregnancy

12. Which of the following is true with regard to wound contraction?


D. It is based on specialized fibroblasts that contain actin myofilaments

13. Management of leukoplakia of the oral cavity includes


A. Excisional biopsy of all lesions
B. Application of topical antibiotics
C. Low-dose radiation therapy
D. Ascertaining that dentures fit properly

14. An 8-lb infant, born following uncomplicated labor and delivery, is noted to have
a unilateral cleft lip and palate .The parents should be advised that
A. The child almost certainly has other congenital anomalies
B. Rehabilitation requires adjunctive speech therapy
C. Lip repair is indicated at 1 year of age
D. Palate repair is indicated prior to 6 mo of age

15. A teenage boy falls from his bicycle and is run over by a truck. On arrival in the
emergency room, he is awake and alert and appears frightened but in no distress.
The chest radiograph suggests an airfluid level in the left lower lung field and the
nasogastric tube seems to coil upward into the left chest. The next best step in
management is
C. Immediate celiotomy

16. Which of the following conditions is most likely to follow a compression-type


abdominal injury?
A. Renal vascular injury
B. Superior mesenteric thrombosis
C. Mesenteric vascular injury
D. Avulsion of the splenic pedicle
E. Diaphragmatic hernia

17. A 65-year-old man who smokes cigarettes and has chronic obstructive pulmonary
disease falls and fractures the 7th, 8th, and 9th ribs in the left anterolateral chest.
Chest x-ray is otherwise normal. Appropriate treatment might include
D. Peritoneal lavage

18. A 27-year-old man sustains a single gunshot wound to the left thigh. In the
emergency room he is noted to have a large hematoma of his medial thigh. He
complains of paresthesias in his foot. On examination there are weak pulses palpable
distal to the injury and the patient is unable to move his foot. The appropriate initial
management of this patient would be
B. Immediate exploration and repair

Items 19–20 A 25-year-old woman arrives in the emergency room


following an automobile accident. She is acutely dyspneic with a
respiratory rate of 60 breaths/min. Breath sounds are markedly
diminished on the right side.

19. The first step in managing the patient should be to


C. Decompress the right pleural space

20. A chest x-ray of this woman Before therapy would probably reveal
A. Air in the right pleural space

21. Among the physiologic responses to acute injury is


A. Increased secretion of insulin
B. Increased secretion of thyroxine
C. Decreased secretion of vasopressin (ADH)
D. Decreased secretion of glucagon

22. In a stable patient, the management of a complete transection of the common


bile duct distal to the insertion of the cystic duct would be optimally performed with
a
D. Roux-en-Y choledochojejunostomy

23. Non operative management of penetrating neck injuries has been advocated as
an alternative to mandatory exploration in asymptomatic patients. Which of the
following findings would constitute a relative, rather than an absolute, indication for
formal neck exploration?
A. Expanding hematoma
B. Dysphagia
C. Dysphonia
D. Pneumothorax
E. Hemoptysis

24. Following blunt abdominal trauma, a 12-year-old girl develops upper abdominal
pain, nausea, and vomiting. An upper gastrointestinal series reveals a total
obstruction of the duodenum with a “coiled spring” appearance in the second and
third portions. Appropriate management is
B. Nasogastric suction and observation

25. Following traumatic peripheral nerve transection, regrowth usually occurs at


which of the following rates?
A. 0.1 mm per day
B. 1 mm per day
C. 5 mm per day
D. 1 cm per day
Items 26–27 A 28-year-old man is brought to the emergency room for a
severe head injury after a fall. Initially lethargic, he becomes comatose
and does not move his right side .His left pupil is dilated and responds
only sluggishly.

26. The most common initial manifestation of increasing intracranial pressure in the
victim of head trauma is
A. Change in level of consciousness

27. Initial emergency reduction of intracranial pressure is most rapidly


accomplished by
E. Hyperventilation

28. In the patient described, compression of the affected nerve is produced by


B. Herniation of the uncal process of the temporal lobe

29. Regarding high-voltage electrical burns to an extremity


D. Evaluation for fracture of the other extremities and visceral injury is indicated

30. Which of the following fractures or dislocations of the extremities induced by


blunt trauma is associated with
significant vascular injuries?
A. Knee dislocation
31. Protein metabolism after trauma is characterized by
A. Decreased liver gluconeogenesis
B. Inhibition of skeletal muscle breakdown)
C. Decreased urinary nitrogen loss
D. Hepatic synthesis of acute-phase reactants

32. The response to shock includes which of the following metabolic effects?
A. Increase in sodium and water excretion
B. Increase in renal perfusion
C. Decrease in cortisol levels
D. Hyperkalemia
E. Hypoglycemia

33. Appropriate treatment for an acute stable hematoma of the pinna of the ear
includes which of the following measures?
A. Ice packs and prophylactic antibiotics
B. Excision of the hematoma
C. Needle aspiration
D. Incision, drainage, and pressure bandage

34. Animal and clinical studies have shown that administration of lactated Ringer’s
solution to patients with hypovolemic shock may
A. Increase serum lactate concentration
B. Impair liver function
C. Improve hemodynamics by alleviating the deficit in the interstitial fluid
compartment

35. Which of the following situations would be an indication for performance of a


thoracotomy in the emergency room?
C. Rapidly deteriorating patient with cardiac tamponade from penetrating thoracic
trauma

Items 36–37 An 18-year-old high school football player is kicked in the


left flank. Three hours later he develops hematuria.His vital signs are
stable.

36. The diagnostic tests performed reveal extravasation of contrast into the renal
parenchyma .Treatment should consist of
E. Antibiotics and serial monitoring of blood count and vital signs
37. Initial diagnostic tests in the emergency room should include which of the
following?
D. Intravenous pyelogram

38. True statements concerning penetrating pancreatic trauma include


E. The major cause of death is exsanguination from associated vascular injuries

39. A 26-year-old man sustains a gunshot wound to the left thigh. Exploration
reveals that a 5-cm portion of superficial femoral artery is destroyed .Appropriate
management includes
A. Debridement and end-to-end anastomosis
B. Debridement and repair with an interposition prosthetic graft
C. Debridement and repair with an interposition arterial graft
D. Debridement and repair with an interposition vein graft

1. Estrogen receptor activity is clinically useful in predicting


A. The presence of ovarian cancer
B. The presence of metastatic disease
C. Response to chemotherapy
D. Response to hormonal manipulation

2. When galactorrhea occurs in a high school student, a diagnostic associated finding


would be
A. Gonadal atrophy
B. Bitemporal hemianopia
C. Exophthalmos and lid lag
E. “Buffalo hump”

3. The diagnosis of primary hyperparathyroidism is most strongly suggested by


A. Serum acid phosphatase above 120 IU/L
B. Serum alkaline phosphatase above 120 IU/L
C. Serum calcium above 11 mg/dL
D. Urinary calcium below 100 mg/day

4. Somatostatin contributes to which of the following processes?


B. Inhibition of pancreatic cells

5. A 35-year-old woman undergoes her first screening mammogram. Which of the


following mammographic findings would require a breast biopsy?
A. Breast calcifications larger than 2 mm in diameter
B. Five or more clustered breast microcalcifications per square centimeter
C. A density that effaces with compression
E. Multiple round well-circumscribed breast densities

6. Which of the following statements concerning Cushing syndrome secondary to


adrenal adenoma is true?
A. Adrenal adenomas cause 40–60% of all cases of Cushing syndrome
B. Biochemical and x-ray procedures are generally unsuccessful in lateralizing the
tumors preoperatively
C. Exploration of both adrenal glands is indicated
D. For uncomplicated tumors, an open transperitoneal surgical approach is usually
employed

7. Which statement concerning radiation-induced thyroid cancer is true?


E. The treatment of choice is a neartotal (or total) thyroidectomy

8. Fibrocystic disease of the breast has been associated with elevated blood levels of
A. Testosterone
B. Progesterone
C. Estrogen
D. Luteinizing hormone
9. As an incidental finding during an upper abdominal CT scan, a 3-cm mass in the
adrenal gland is noted. The appropriate next step in analysis and management of
this finding would be
A. Observation
B. CT-guided needle biopsy
C. Excision of the mass
D. Measurement of urine catecholamine excretion
E. Cortisol provocation test

10. The most likely diagnosis in a patient with hypertension, hypokalemia, and a 7-
cm suprarenal mass is
A. Hypernephroma
B. Cushing’s disease
C. Adrenocortical carcinoma
D. Pheochromocytoma

11. Appropriate treatment of this condition would include which of the following?
A. Embolization of the arterial blood supply,
B. Metronidazole
C. Mitotane
E. Phenoxybenzamine
12. For pregnant women who are found to have breast cancer
E. Administration of adjuvant chemotherapy is safe for the fetus during the
second and third trimesters

13. True statements regarding Paget’s disease of the breast include that it
A. Usually precedes development of Paget’s disease of bone
B. Presents with nipple-areolar eczematous changes
C. Does not involve axillary lymph nodes because it is a manifestation of intraductal
carcinoma only
D. Accounts for 10–15% of all newly diagnosed breast cancers
E. Is adequately treated with wide excision when it presents as a mass

14. Of the common complicationsof thyroidectomy, the one that may be avoided
through prophylaxis is
A. Injury to the recurrent laryngeal nerve
B. Injury to the superior laryngeal nerve
D. Thyroid storm
E. Postoperative hemorrhage and wound hematoma

15. Following correction of the patient’s hypercalcemia with hydration and gentle
diuresis with furosemide, the most likely therapeutic approach would be
D. Neck exploration and resection of a parathyroid adenoma

16. This 30-year-old woman presented with weakness, bone pain, an elevated
parathormone level, and a serum calcium level of 15.2 mg/dL. Skeletal survey films
were taken, including the hand films and chest x-ray shown. The most likely cause of
these findings is
E. Primary hyperparathyroidism

17. A 36-year-old woman, 20 wk pregnant, presents with a 1.5-cm right thyroid


mass. Fine-needle aspiration is consistent with a papillary neoplasm. The mass is
“cold” by scan and solid by ultrasound. Which method of treatment would be
contraindicated?
A. Right thyroid lobectomy
B. Subtotal thyroidectomy
C. Total thyroidectomy
D. Total thyroidectomy with lymph node dissection
E. 131I radioactive ablation of the thyroid gland
18. Incisional biopsy of a breast mass in a 35-year-old woman demonstrates a
hypercellular fibroadenoma (cystosarcoma phylloides) at the time of frozen section.
Appropriate management of this lesion could include
A. Wide local excision with a rim of normal tissue

19. True statements about discharge from the nipple include


A. Intermittent thin or milky discharge can be physiologic
B. Expressible nipple discharge is an indication for open biopsy
C. Bloody discharge is indicative of an underlying malignancy
D. Galactorrhea is indicative of an underlying malignancy

20. The incidence of breast cancer


A. Increases with increasing age
B. Has declined since the 1940s
C. Is related to dietary fat intake
D. Is related to coffee intake
E. Is related to vitamin C intake

21. A cross-match is performed by incubating


B. Donor lymphocytes with recipient serum and complement

22. The primary mechanism of action of cyclosporine A is inhibition of


D. Interleukin 2 production

23. After the first postoperative year of cardiac transplantation, the most common
cause of death is
C. Accelerated graft arteriosclerosis

24. Which of the following precludes cadaveric renal transplantation?


A. Positive cross-match

25. In centers with experienced personnel, 1-year liver transplant survival is now
approximately
B. 80%

26. Graft-versus-host disease has occurred with the transplantation of which of the
following?
D. Bone marrow
27. The most useful serum marker for detecting recurrent disease after treatment of
nonseminomatous testicular cancer is
B. alpha-fetoprotein (AFP)

28. For which of the following malignancies does histologic grade best correlate with
prognosis?
E. Soft tissue sarcoma

29. Interferons are correctly characterized by which of the following statements?


B. They are produced by virus-infected cells

30. Which of the following potentially operable complications is a common


occurrence among patients receiving systemic chemotherapy?
B. Perirectal abscess

31. Human immunodeficiency virus (HIV) has been isolated from many body fluids.
Which of the following is a major source of transmission?
A. Tears
B. Sweat
C. Semen
D. Urine
E. Breast milk

32. Which of the following agents causes hemorrhagic cystitis?


E. Cyclophosphamide

33. What is the most common serious complication of an end colostomy?


A. Bleeding
B. Skin breakdown
C. Parastomal hernia
D. Colonic perforation during irrigation
E. Stomal prolapse

34. Which of the following colonic pathologies is thought to have no malignant


potential?
A. Ulcerative colitis
B. Villous adenomas
C. Familial polyposis
D. Peutz-Jeghers syndrome
E. Crohn’s colitis

35. Which of the following hernias follows the path of the spermatic cord within the
cremaster muscle?
A. Femoral
B. Direct inguinal
C. Indirect inguinal
D. Spigelian

36. Spontaneous closure of which of the following congenital abnormalities of the


abdominal wall generally occurs by the age of 4?
A. Umbilical hernia
B. Patent urachus
C. Patent omphalomesenteric duct
D. Omphalocele

37. Laparoscopic cholecystectomy is indicated for symptomatic gallstones in which


of the following conditions?
A. Cirrhosis
B. Prior upper abdominal surgery
C. Suspected carcinoma of the gallbladder
D. Morbid obesity
E. Coagulopathy

38. In determining the proper treatment for a sliding hiatal hernia, the most useful
step would be
A. Barium swallow with cinefluoroscopy during Valsalva maneuver
B. Flexible endoscopy
C. 24-h monitoring of esophageal pH
D. Measuring the size of the hernia

39. A previously healthy 9-year old child comes to the emergency room because of
fulminant upper gastrointestinal bleeding. The hemorrhage is most likely to be the
result of
A. Esophageal varices
B. Mallory-Weiss syndrome
C. Gastritis
D. A gastric ulcer

40. Intragastric pressure remains steady near 2–5 mm Hg during slow gastric filling,
but rises rapidly to high levels after reaching a volume of
A. 400–600 mL
B. 700–900 mL
C. 1000–1200 mL
D. 1300–1500 mL

41. Local stimuli that inhibit the release of gastrin from the gastric mucosa include
which of the following?
A. Small proteins
B. 20-proof alcohol
C. Caffeine
D. Acidic antral contents

42. For a symptomatic partial duodenal obstruction secondary to an annular


pancreas, the operative treatment of choice is
A. A Whipple procedure
B. Gastrojejunostomy
D. Partial resection of the annular pancreas
E. Duodenojejunostomy

43. Which of the following would be expected to stimulate intestinal motility?


A. Fear
B. Gastrin
C. Secretin
D. Acetylcholine
E. Cholecystokinin

44. Which of the following statements concerning carcinoma of the esophagus is


true?
B. Squamous carcinoma is the most common type at the cardioesophageal junction
C. It has a higher incidence in males
D. It occurs more commonly in patients with corrosive esophagitis
E. Surgical excision is the only effective treatment

45. The most common clinical presentation of idiopathic retroperitoneal fibrosis is


A. Ureteral obstruction
B. Leg edema
D. Jaundice
E. Intestinal obstruction

46. In planning the management of a 2.8-cm epidermoid carcinoma of the anus, the
first therapeutic approach should be
E. Combined radiation therapy and chemotherapy
47. Indications for operation in Crohn’s disease include which of the following?
A. Intestinal obstruction
B. Enterovesical fistula
C. Ileum–ascending colon fistula
E. Free perforation

48. Which of the following is most likely to require surgical correction?


A. Large sliding esophageal hiatal hernia
B. Paraesophageal hiatal hernia
C. Traction diverticulum of esophagus
D. Schatzki’s ring of distal esophagus

49. Which statement regarding adenocarcinoma of the pancreas is true?


A. It occurs most frequently in the body of the gland
B. It carries a 1–2% 5-year survival rate
C. It is nonresectable if it presents as painless jaundice
D. It can usually be resected if it presents in the body or tail of the pancreas and does
not involve the common bile duct

50. Which of the following statements regarding direct inguinal hernias is true?
A. They are the most common inguinal hernias in women
B. They protrude medially to the inferior epigastric vessels
C. They should be opened and ligated at the internal ring
D. They commonly protrude into the scrotal sac in men

51. Which of the following statements regarding stress ulceration is true?


A. It is true ulceration, extending into and through the muscularis mucosa
B. It classically involves the antrum
C. Increased secretion of gastric acid has been shown to play a causative role
D. It frequently involves multiple sites

52. Which statement concerning cholangitis is correct?


A. The most common infecting organism is Staphylococcus aureus
B. The diagnosis is suggested by the Charcot triad (fever, jaundice, pain)
C. The disease occurs primarily in young, immunocompromised patients
D. Cholecystectomy is the procedure of choice in affected patients

53. Indications for surgical removal of polypoid lesions of the gallbladder include
A. Size greater than 0.5 cm
B. Presence of clinical symptoms
C. Patient age of over 25 years
D. Presence of multiple small lesions
54. A patient who has a total pancreatectomy might be expected to develop which of
the following complications?
A. Diabetes mellitus
B. Hypercalcemia
C. Hyperphosphatemia
D. Constipation
E. Weight gain

55. True statements regarding cavernous hemangiomata of the liver in adults include
A. The majority become symptomatic
B. They may undergo malignant transformation
C. They enlarge under hormonal stimulation
D. They should be resected to avoid spontaneous rupture and lifethreatening
hemorrhage

1. The superior vena cava syndrome is most frequently seen in association with
A. Histoplasmosis (sclerosing mediastinitis)
C. Thoracic aortic aneurysm
D. Constrictive pericarditis
E. Bronchogenic carcinoma

2. A 3-year-old child with congenital cyanosis is most probably suffering from


A. Tetralogy of Fallot
B. Ventricular septal defect
C. Tricuspid atresia
D. Transposition of the great vessels

3. Superior pulmonary sulcus carcinomas (Pancoast tumors) are bronchogenic


carcinomas that typically produce which of the following clinical features?
A. Atelectasis of the involved apical segment
B. Horner syndrome (miosis, ptosis, anhidrosis)
C. Pain in the T4 and T5 dermatomes
D. Nonproductive cough

4. Which of the following statements is true concerning aortocoronary bypass


grafting?
A. It is indicated for crescendo (preinfarction) angina

8. Which of the following statements is true regarding the thoracic outlet syndrome?
C. If conservative measures fail, it is best treated by surgical decompression of the
brachial plexus
6. A 2-year-old asymptomatic child is noted to have a systolic murmur, hypertension,
and diminished femoral pulses. Which of the following is true about this child’s
disorder?
C. Rib notching is often seen on x-ray (Coarctation of the aorta)

7. A correct statement concerning bronchial carcinoid tumors is that


C. They rarely produce the carcinoid syndrome

8. Patients with phlebographically confirmed deep vein thrombosis of the calf


E. Are at risk for significant pulmonary embolism

9. Symptoms or signs of atherosclerotic occlusive disease of the bifurcation of the


abdominal aorta (Leriche syndrome) include
A. Claudication of the buttock and thigh

10. Initial management of a patient who has a flaccid neurogenic bladder may
include which of the following measures?
A. Surgical bladder augmentation
B. Self-catheterization
C. Supravesical urinary diversion
D. Limiting fluid intake to less than 300 mL/day
11. The recommended treatment for stage A (superficial and sub
mucosal)transitional cell carcinoma of the bladder is
A. Local excision
B. Radical cystectomy
D. Topical (intravesicular) chemotherapy
E. Systemic chemotherapy

12. Seminoma is accurately described by which of the following statements?


A. It is the most common type of testicular cancer
B. Metastases to liver and bone are frequently found
C. It does not respond to radiation
E. Common presentation is that of a painful lump that trans illuminates

13. Meniscal tears usually result from which of the following circumstances?
A. Hyperextension
B. Flexion and rotation
C. Simple hyperflexion
D. Compression
14. In an uncomplicated dislocation of the glenohumeral joint, the humeral head
usually dislocates primarily in which of the following directions?
A. Anteriorly
B. Superiorly
C. Posteriorly
D. Laterally

15. Which of the following fractures is most commonly seen in healthy bones
subjected to violent falls?
A. Colles fracture
B. Femoral neck fracture
C. Intertrochanteric fracture
D. Clavicular fracture

16. Which of the following statements regarding compartment syndromes following


orthopedic injuries is true?
A. The first sign is usually loss of pulse in the extremity
B. Passive flexion of the extremity proximal to the involved compartment will
aggravate the pain
C. Surgical decompression (fasciectomy) is necessary only as a last resort
D. These syndromes are most commonly associated with supracondylar fractures of
the humerus and tibial shaft

17. In contrast to closed reduction, open reduction of a fracture


A. Produces a shorter healing time
B. Decreases trauma to the fracture site
C. Produces a higher incidence of nonunion
D. Reduces the risk of infection

18. In a failed suicide gesture, a depressed student severs her Radial nerve at the
wrist. The expected disability is
A. Loss of ability to extend the wrist
B. Loss of ability to flex the wrist
C. Wasting of the intrinsic muscles of the hand
D. Sensory loss over the thenar pad and the thumb web

19. The most severe epiphyseal growth disturbance is likely to result from which of
the following types of fracture?
E. Crushing injury compressing the growth plate

20. Which of the following statements regarding the Glasgow coma scale is true?
B. A high score correlates with a high mortality
C. It includes measurement of intracranial pressure
D. It includes measurement of pupillary reflexes
E. It includes measurement of verbal response

21. Which of the following statements regarding glioblastoma multiforme is true?


B. It arises from the malignant degeneration of an astrocytoma

22. Which of the following statements regarding skull fractures is true?


C. Any bone fragment displaced more than 1 cm inwardly should be elevated
surgically

23. An acute increase in intracranial pressure is characterized by which of the


following clinical findings?
A. Respiratory irregularities
B. Decreased blood pressure
C. Tachycardia
D. Papilledema

24. Which of the following statements about schwannomas is true?


B. Treatment is via excision

25. Which of the following statements regarding cerebral contusions is true?


B. They may occur opposite the point of skull impact

26. True statements regarding meningiomas include that they


C. Are treated primarily by surgical excision

27. Which of the following statements about craniopharyngiomas is true?


D. The tumors may cause compression of the optic tracts and visual symptoms

28. Which of the following statements regarding symptomatic thyroglossal duct cysts
is true?
A. Over 90% manifest themselves before age 12
B. Treatment includes resection of the hyoid bone
C. They usually present as a painful swelling in the lateral neck
29. Pleomorphic adenomas (mixed tumors) of the salivary glands are characterized
by which of the following?
A. They occur most commonly on the lips, tongue, and palate

30. Verrucous carcinoma of the buccal mucosa is identified with which of the
following characteristics?
C. It has a predilection for the gingivobuccal gutter

1-The diagnosis of an inguinal hernia:


 In infants often depends on the history given by its mother.
 In the adult is most easily made with the patient in the sitting position.
 Depends on the hernial sac or cough impulse being felt below the inguinal
ligament.
 Is supported by the presence of a transilluminable scrotal swelling.
 B&C only.
2- Inguinal herniae:
 In children are usually of the direct type.
 Of the indirect type are congenital in origin.
 Will regress spontaneously in children.
 In young adults are most commonly of the direct type.
 C&D only.

3- Strangulated contents of hernial sacs:


 Are always accompanied by intestinal obstruction.
 Are more common in direct than indirect inguinal herniae.
 Are usually reducible.
 Produce local pain and tenderness.
 All of the above

4- Incisional herniae are related to:)All correct except one)


 Wound infections.
 Anaemia and malnutrition.
 Obesity.
 The use of absorbable suture materials.
 To the technique of wound closure.

5- herniae in the umbilical region:


 Are always congenital in origin.
 Usually occur in males.
 Usually require surgical repair in infants.
 Rarely strangulate.
 All of the above.

6- A discharge from the umbilicus: (all correct except one)


 May indicate a patent vitello-intestinal duct.
 May indicate an anomaly of the urachus.
 At the time of menstration may indicate endometriosis.
 In the neonate is of no immediate clinical significance.
 May indicate infection of the umbilicus (omphalitis)
7- An exomphalos:
 Is a congenital defect of the urethra.
 Is acquired defect of the anterior abdominal wall.
 Is otherwise known as gastroschisis.
 Needs urgent surgical treatment.
 A&B only.

8- The cremaster muscle is derived from:


 External oblique aponeurosis.
 Internal oblique muscle.
 Transversus abdominis muscle
 Transversalis fascia
 Parietal peritoneum.

9- structures lying within the spermatic cord include: ( all correct except
one)
 Direct hernia sac
 Testicular artery.
 Indirect hernia sac.
 Properitoneal fat.
 Vas deferens.

10- True statements concerning a femoral hernia include which of the following?
 It is common in male.
 It is usually results from a defect in lateral part of transversalis fascia.
 It is common in children.
 It is less common in female.
 It may be confused with inguinal lymphadenopathy.

1- Acute abdominal pain which is


(all correct except on)
A. Colicky in nature indicates obstruction of hollow viscus.
B. In right upper quadrant increased by inspiration is typical of cholecystitis
C. Continuous is typical of inflammation
D. Maximal in the right loin is typical with duodenal ulcer.
E. Maximal in epigastrium and related to meal is typical of gastric problem.

2- Vomiting in acute abdomen


A. Occurring soon after the oncet of colicky pain indicates pathology outside the
gastrointestinal tract.
B. Of fluid containing no bile is characteristic of small bowl obstruction
C. Of faeculent fluid usually indicates gastrointestinal fistula.
D. Of bile stain fluid usually indicates stomach outlet obstruction
E. B&C only

3- Faeculent vomiting:
A. Is commonly seen after upper gastrointestinal tract bleeding.
B. Indicates large bowel obstruction.
C. Indicates bacterial proliteration in the upper intestinal.
D. Suggests a gastro-colic fistula.
E. Suggests small bowel fistula

4- A patient with generalized peritonitis:


(all correct except one)
A. Usually has an elevated temperature and pulse rate.
B. Characteristically complains of spasmodic severe pain which causes him to be
restless.
C. Is characteristically vomites.
D. Will usually have a rapid and deep respiratory pattern.
E. Is Usually has an elevated WBCs.

5- A perforated duodenal ulcer:


A. Usually lies on the anterior or superior surface of the duodenum.
B. Usually presents with the acute onset of severe back pain.
C. Produces radiological evidence of free gas in the peritoneum in over 90 percent of
the patients.
D. Is usually treated by vagotomy and pyloroplasty
E. Is usually treated conservatively.

6- Congential pyloric stenosis:


(all correct except one)
A. Occurs more commonly in male children.
B. Usually presents in the first few days of life.
C. Presents with non bile stained vomiting.
D. Is usually diagnosed on clinical examination.
E. May cause right upper quadrant tenderness.

7- Appendicitis is:
A. More common in females
B. Distributed evenly thoughout the world's population
C. More likely to occur if the appendix is in the retrocaecal position.
D. Commonly the result of appendicular obstruction.
E. B&C only.
8- Likely differential diagnoses in a young woman with appendicitis
include:
A. Ovarian carcinoma
B. Ruptured ectopic pregnancy.
C. Colonic diverticulitis.
D. Caecal carcinoma.
E. C&D only.

9- Obstruction of the lumen of the appendix may lead to:


(all correct except one)
A. Mucosal ulceration
B. Gangrenous appendicitis.
C. A perforated appendix.
D. Intussusception of the appendix.
E. Acute appendicitis.

10- Acute non-specific mesenteric lymphadenitis: (all correct except one)


A. Is commonest between 5 and 12 years of age.
B. Is usually associated with an upper respiratory tract infection.
C. Is usually associated with cervical lymphadenopathy
D. Is characterized by enlarged mesenteric lymph nodes which are infected by gram-
negative organisms.
E. Is one of the differential diagnosis of acute appendicitis.

11- The level of intestinal obstruction can be determined by:


(all correct except one)
A. Questioning the patient.
B. Examining the patient.
C. Radiological examination of the patient.
D. Repeated measurements of the patient's girth.
E. Upper & lower contrast studies.

12- Acute small bowel obstruction:


(all correct except one)
A. Is commonly caused by postoperative adhesions.
B. Accompanied by the signs of peritonitis, suggests bowel strangulation.
C. Is often associated with a raised serum amylase.
D. Generally produces abdominal distension within 2 to 3 hours of onset.
E. Can be diagnosed by history and clinical examination.

13-In the treatment of intestinal obstruction:


A. Nasogastric suction should be instituted preoperatively.
B. Intravenous fluid replacement might be required.
C. Immediate surgery is essential.
D. Surgery should be restricted to those cases where strangulation is diagnosed.
E. C&D only.

14- Strangulation of the bowel:


(all correct except one)
A. commonly complicates closed loop obstruction.
B. Is difficult to distinguish from simple intestinal obstruction.
C. Is accompanied by bleeding into the affected bowel.
D. Frequently causes peritonitis.
E. Is characterized by severe abdominal pain.

15- Large bowel obstruction:


A. Is most commonly caused by colonic cancer
B. Has its maximum incidence before the age of 50.
C. Frequently presents with nausea and vomiting.
D. Usually heralds its onset with constant suprapubic pain.
E. Frequently treated conservatively.

16- Patients with acute colonic deveticulitis:


A. Often give a history of recent lower abdominal colic.
B. Often present with pyrexia.
C. Can be frequently diagnosed on sigmoidoscopic appearances.
D. Frequently develop faecal peritonitis.
E. All the above.

17- Acute pancreatitis typically:


(all correct except one)
A. Is accompanied by hypercalcaemia.
B. Produces paralytic ileus.
C. Is associated with a pleural effusion.
D. Produces pyloric stenosis.
E. Upper abdominal pain and vomiting.

18- Acute pancreatitis:


(all correct except one)
A. Often simulates a perforated peptic ulcer in its presentation.
B. Often presents with the signs of hypovolaemia.
C. Can readily be distinguished from other causes of acute abdominal pain by the
presence of a raised serum amylase.
D. Frequently has a raised concentration of urinary amylase.
E. Most commonly caused as a complication of GB stones.

19- The treatment of acute pancreatitis:


A. Is largely nonspecific and supportive.
B. Should include a laparotomy in the majority of cases.
C. Should routinely include the administration of calcium.
D. Should routinely include the administration of antibiotics.
E. All the above.

20- Childhood intussusception:


(all correct except one)
A. Usually presents during the first year of life.
B. Is frequently ileocolic.
C. Can usually be diagnosed without x-ray examination of the abdomen.
D. Rarely requires surgical treatment.
E. Can be diagnosed by abdominal US.

21- Meconium ileus:


A. Is the presenting feature in the majority of patients with cystic fibrosis.
B. Is associated with achlorhydria.
C. Presents with a distended abdomen and bilious vomiting.
D. Often can be effectively treated with acetyl cysteine.
E. All the above.

22- Neonatal duodenal obstruction:


A. May be associated with down's syndrome.
B. Is more frequently found in premature infants.
C. Typically presents with gross abdominal distension.
D. Usually presents with vomiting of non-bile stained fluid
E. B&C only.

23- acute superior mesenteric artery occlusion: (all correct except one)
A. Characteristically presents with sudden pain and tenderness of increasing intensity.
B. Is frequently accompanied by overt or occult blood loss in the stools.
C. Frequently produces peritonitis.
D. Can usually be diagnosed on plain abdominal x-rays.
E. Can be diagnosed by mesenteric artery ongiography.

24- A ruptured ectopic pregnancy:


(all correct except one)
A. Usually occurs in the first month of pregnancy.
B. Usually presents with severe lower abdominal pain.
C. Frequently presents with hypovolaemic shock.
D. Can usually be diagnosed by pelvic examination.
E. Can usually be diagnosed by transvaginal US.

25- Biliary colic typically:


A. Occurs 3 to 4 hours after meals.
B. Lasts 5 to 20 minutes.
C. Radiates from the upper abdomen to the right subscapular region.
D. Is made better by deep inspiration.
E. B&C only.

1- When determining the depth of a burn:


A. A knowledge of the type of injury is important.
B. The presence of blisters is of no clinical significance.
C. Impairment of sensibility of the burned area denotes full thickness burn.
D. The presence of severe pain denotes a full thickness skin loss.
E. A&C only.

2- Estimation of the area of a burn: ( all correct except one)


A. Is of very little clinical significance.
B. Provides important prognostic information.
C. Is an important factor in the estimation of the fluid required.
D. Can be based on a formula which states that the adult trunk is 36 per cent of the
whole body surface area.
E. Should be recorded in each chart of burned patient.

3- Patients with major burns:


A. Are in a negative nitrogen balance.
B. Have normal calorie requirements.
C. Do not generally become anaemic.
D. Are resistant to septicaemia.
E. All of the above.

4- The catabolic response to trauma and infection is characterized by:


A. An increase in lean body mass.
B. A positive nitrogen balance.
C. Gluconeogenesis.
D. A falling haemoglobin level.
E. A&B only.

5- The catabolic response to trauma:


A. Is related to the severity of the trauma.
B. Is accompanied by decreased urinary losses of potassium and nitrogen.
C. Can be prevented by parenteral nutrition.
D. Does not occur in the adrenalectomised patient.
E. C&D only.

6- Scalds:
A. Are more frequent in children.
B. Commonly cause full thickness skin loss.
C. Should be skin grafted within 48 hours of the injury.
D. Need routine antibiotic treatment.
E. All of the above.

7- The dressing of a small burn should be:


A. Occlusive.
B. Non-absorbtive.
C. Non-compressive.
D. Changed daily as a routine.
E. All of the above

8- A partial thickness burn:


A. Usually requires grafting.
B. May deteriorate into full thickness skin loss.
C. Rarely causes severe physiological derangement of the patient.
D. Heals within 7 days in the absence of infection.
E. C&D only.

9-Fluid losses in a major burn:


A. Are maximal between 12 and 24 hours after the injury.
B. Are related to the age of the patient.
C. Are not related to the weight of the patient.
D. Are related to the area burnt.
E. Are not related to the burnt duration.

10- The increased fluid requirements of a patient with a full thickness


burn are due to: (all correct except one)
A. Increased evaporative water loss.
B. Sequestration of fluid in the injured tissues.
C. Serum exuding from the burned area.
D. Destruction of blood in the skin vessels.
E. Vomiting & paralytic ileus occasionally

11- 48 hours after a major burn and with satisfactory fluid therapy a
patient:
A. Has very few abnormal fluid losses.
B. May need a blood transfusion.
C. Is often hypornatraemic.
D. Usually needs skin grafting.
E. C&D only.

12- Major burns are sometimes complicated by: (all correct except one)
A. Acute gastric and duodenal ulcers.
B. Paralytic ileus.
C. Cerebral oedema.
D. Mesenteric thrombosis.
E. Septicemia.

13- If burned patient, associated pulmonary injury: (all correct except


one)
A. Should be suspected in head and neck burns.
B. Should be suspected when the nasal hairs are burnt.
C. Does not appear clinically in the first 24 hours.
D. Should be suspected if burns occurred in closed space.
E. May require ICU care.

14- Secondary infection of burns:


A. Is less common in partial than in full thickness skin loss.
B. Is relatively more common in burns of more than 20 per cent body area.
C. Is avoided by leaving the burn eschar intact.
D. Is avoided by the immediate application of a sterile occlusive dressing.
E. All of the above.

15- . The early management of a burn wound may include:


A. Early excision.
B. Occlusive dressings.
C. Exposure treatment.
D. Dressings with local antibiotics.
E. All of the above.

16- Skin grafting of a burn wound:


A. Should usually be with full thickness skin grafts.
B. Is more likely to be successful if undertaken in the first week after injury.
C. Will be unsuccessful unless the wound surface is sterile.
D. Minimizes scar contracture.
E. A&C only.

17- The prognosis of a burned patient is:


A. Not related to the patient's age.
B. Related to the area burnt.
C. Generally better below the age of 10 years.
D. Very poor in the patient with burns of over 40 per cent surface area.
E. C&D only.
1- Diverticular disease of the colon:
• Is usually asymptomatic.
• Often presents with lower abdominal pain.
• May present with severe rectal haemorrhage.
• May present with peritonitis.
• All of the above are correct.
2- Ulcerative colitis:
• Is more common in female than males.
• Appears most commonly between the ages of 20 and 30.
• Usually presents with abdominal discomfort and diarrhoea.
• Can usually be diagnosed on sigmoidoscopic examination.
• All of the above correct.
3- Crohn’s disease: ( all correct except one)
• Is associated with an anal fissure or fistula in the majority of cases.
• May produce intestinal obstruction
• May involve the colon and the ileum.
• Is characterised by long periods of remission.
• May produce pritonitis.
4-Regarding ischaemic colitis:
(all correct except one)
• Often presents with diarrhoea.
• Often presents with rectal bleeding
• Is commonly setuated around the splenic flexure.
• Is often effectively managed by non-surgical means.
• The baruim enema may reveal localised bowel oedema or stricture.
5- A volvulus of the colon:
(all correct except one)
• Most frequently occurs in eastern Europe and Africa.
• Most frequently occurs on the right side and includes the caecum.
• Usually produces abdominal distension which is most marked on the left side.
• May be effectively treated without resorting to laparotomy.
• May produce bowel strangulation.
6- Hirschsprung’s disease:
• Is the result of acquired aganglionosis of the large bowel.
• Usually becomes evident in early adult life.
• Can usually be diagnosed on a barium enema.
• Can usually be managed by dietary means.
• A&D only.
7- Colonic polyps: (all correct except one)
• Are associated with colonic cancer.
• May be hereditary.
• Should not be removed if they are asymptomatic.
• May be hyperplastic.
• Are commonly adenomatous.
8- A right sided colonic cancer frequently presents with:
• Anaemia.
• Intestinal obstruction.
• Rectal bleeding
• An abdominal mass.
• A&D only
9- A left sided colonic cancer frequently presents with: ( all correct except one)
• Anaemia.
• Intestinal obstruction.
• Rectal bleeding.
• Abdominal pain.
• Pencil like stools.
1- Acute cholecystitis: (all correct except one)
• Is almost invariably related to the presence of gallstones.
• Usually presents with biliary colic.
• Is often associated with jaundice.
• Is characterised by a pyrexia in the early hours of the disease..
• May be complicated by peritonitis.
2- Acute cholecystitis should usually be treated by: (all correct except one)
• Nasogastric suction and intravenous fluids.
• Antibiotic therapy.
• Urgent cholecystectomy.
• Cholecystostomy.
• Analgesics and antispasmotics.
3- Gallstones: (all correct except one)
• Have an incidence which increases with age.
• Are more frequent in females.
• Usually contain a predominance of cholesterol.
• Are formed in bile which is supersaturated with bile acids.
• Are formed in bile which is supersaturated with cholesterol.
4- The presence of stones in the common bile duct: ( all correct except one)
• Is commonly associated with a long history of dyspepsia.
• Is usually associated with jaundice.
• Must be considered during every cholecystectomy.
• May requeres treatment by choledochoduodenostomy.
• May cause liver abscess.
5- stones in the common bile duct:
• Are present in nearly 50 per cent of cases of cholecystitis.
• Often give rise to jaundice, fever and biliary colic.
• Are usually accompanied by progressive jaundice.
• Are usually associated with a distended gallbladder.
• A&D only.
6- In severe jaundice diagnostic evidence of an extrahepatic obstrction of the biliary
tract may be gained by: (all correct except one)
• Intravenous cholangiography.
• A barium meal.
• Endoscopic retrograde cholangiography.
• Percutaneous transhepatic cholangiography.
• CT scan of the abdomen.
7- Internal biliary fistulae:
(all correct except one)
• Most commonly arise as a consequence of cholecystitis.
• Most commonly occur between the gallbladder and the duodenum.
• Can result in intestinal obstruction.
• Are in most cases fatal complications.
• May cause cholongitis.
8- Carcinoma of the gallbladder:
• Is usually a squamous cell neoplasm.
• Is more common in men.
• Is rarely associated with gallstones.
• Has a relatively poor prognosis.
• Non of the above is correct.
9- hypersplenism:
• Results in anaemia, leucopenia and thrombocytopenia.
• Only occurs in the presence of a large spleen.
• Frequently follows liver cirrhosis.
• May be diagnosed by bone marrow biopsy.
• All of the above are correct.
10- Acute pancreatitis: (all correct except one)
• Has a higher incidence in alcoholics.
• Is commonly associated with the presence of gallstones.
• Occurs most commonly in diabetics.
• Becomes less severe with each recurring episode.
• May occurs as a complication of abdomenal trauma.
11- Acute pancratitis is characterised by:
(all correct except one)
• A history of gallstones
• Diffuse epigastric pain.
• Exaggerated bowel sounds.
• An elevated urinary amylase.
• An elevated serum amylase.

12-chronic pancreatitis:
• Is commonly associated with alcoholism.
• Is associated with diabetes.
• May be diagnosed by the analysis of pancreatic secretions.
• May be treated by surgical procedures which decompress the pancreatic duct.
• All of the above are correct.
13-Pancreatic pseudocysts:
(all correct except one)
• Are developmental in origin.
• Usually arise in the lesser peritoneal sac
• Produce a smooth epigastric mass which does not moves on respiration.
• May be effectively treated by internal drainage.
• May be associated by elevation of serum amylase.
The effective osmotic pressure between the plasma and -1 •
:interstitial fluid compartments is primarily controlled by
• A. Bicarbonate.
• B. Chloride ion.
• C. Potassium ion.
• D. Protein.
• E. Sodium ion.

• 2- Symptoms and signs of extracellular fluid volume deficit
include all of the following except:
• A. Anorexia.
• B. Apathy.
• C. Decreased body temperature.
• D. High pulse pressure.
• E. Orthostatic hypotension.

• 3- The osmolarity of the extracellular fluid space is determined
primarily by the concentration of:
• A. Bicarbonate
• B. Chloride ion
• C. Phosphate radicals
• D. Sodium ion
• E. Sulfate radicals

• 4- When lactic acid is produced in response to injury, the body
minimizes pH change by:
• A. Decreasing production of sodium bicarbonate in tissues.
• B. Excreting carbon dioxide through the lungs.
• C. Excreting lactic acid through the kidneys
• D. Lowering renal output of chloride ions
• E. Metabolizing the lactic acid in the liver

• 5- The simplest effective method of estimating the degree of
acidosis in a patient in shock is the measurement of:
• A. Arterial pH
• B. End tidal CO concentration
• C. pH of mixed venous blood
• D. serum CO level
• E. urinary pH


• 6- A decrease in intracellular water can be precipitated by:
• A. A decrease in sodium in extracellular fluid
• B. An increase in sodium in extracellular fluid
• C. An increase in sodium in intracellular fluid
• D. An isotonic decrease in extracellular fluid
• E. An isotonic increase in extracellular fluid

• 7- The first step in the management of acute hypercalcemia
should be:
• A. Correction of deficit of extracellular fluid volume
• B. Hemodialysis
• C. Administration of furosemide
• D. Administration of mithramycin
• E. Parathyroidectomy.

• 8- Postoperative third-space accumulation should be managed by
intravenous:
• A. Albumin
• B. Dextrose in water
• C. Fluid restriction
• D. 1/2 normal saline with potassium supplements
• E. Normal saline

• 9- The normal adult value for:
• A. urine output is 1.5 litre/day.
• B. Insensible water loss is 200 ml/day.
• C. Potassium requirement is 150 mEq (150mmol)/day.
• D. Protein requirement is 120 g/day.
• E. B&C only

• 10- Potassium deficiency should be suspected: ( All Correct Except
one)
• A. In cases of paralytic ileus.
• B. When the patient's reflexes are exaggerated.
• C. If there is a decrease in height and peaking of the T waves of an ECG.
• D. In alkalotic states.
• E. In intestinal obstruction.

• 11- The sodium ion:
• A. Is the principal regulator of the intracellular volume.
• B. Is the major ionic component of the intracellular fluid volume.
• C. Is present in greater concentration in intracellular fluid than extracellular fluid.
• D. Is excreted in larger amounts than normal in the early postoperative period.
• E. C&D only


• 12-Acute post traumatic renal failure:
(All Correct Except One)
• A. May be due to hypovolaemia and poor tissue perfusion.
• B. Is particularly associated with crush injuries.
• C. May be due to kidney damage following tubular obstruction.
• D. Should initially be treated by fluid restriction.
• E. Should be treated initially by increase the amount of intravenous fluid.

• 13- The anuric patient:
• A. Should have a fluid in take of 1 to 1.5 litres per day.
• B. Should have no potassium administered.
• C. Is at risk from metabolic alkalosis.
• D. Should be on continuous urinary catheter drainage.
• E. A&D only.

• 14- Intravenous parenteral feeding:
(All Correct Except One)
• A. Should deliver at least 2500 calories/day to an adult.
• B. Should deliver at least 10g of nitrogen (i.e. 66g of protein)/day to an adult.
• C. Can be effectively achieved with isotonic solutions.
• D. Is with complications with present day solutions and methods of
administration.
• E. Can be given by central intravenous infusion line (CVL)

1- A fracture is said to be:
• Closed if an overlying skin laceration has been sutured.
• Comminuted if there has been associated damage to adjacent nerves or vessels.
• A fatigue fracture if it occurs through a diseased bone.
• Pathological if it occurs through a bony metastasis.
• Non of the above correct.

2- In a healing fracture:
(All correct except one)
• The haematoma is initially invaded by osteoblasts.
• The tissue formed by the invading osteoblasts is termed osteoid.
• Calcium salts are laid down in the osteoid tissue.
• The final stage of repair is the remodelling of the callus.
• The callus formation is related to the amount of stress at fracture side.

3- Non-union is often seen in:


• Fractures of the 4th metatarsal.
• Fractures of the neck of the femur.
• Fractures of the condyle of the mandible.
• Colles’ fractures.
• Oblique fracture line of femur.

4- Fractures of the clavicle:


• Are usually of the greenstick variety in children under the age of 10 years.
• Are usually the result of direct violence.
• Can be recognised by the abnormal elevation of the distal fragment.
• Are usually treated by internal fixation.
• C&D only.

5- in fractures of the surgical neck of the humerus: (All correct except one)
• The lesion is usually due to indirect violence.
• The fragments are usually impacted.
• The proximal fragment is usually internally rotated.
• The distal fragment is usually adducted.
• Early mobilisation is encouraged.

6- In a fracture of the distal third of the shaft of the humerus:


• The distal fragment is usually posteriorly angulated by the action of biceps.
• The radial nerve is rarely damaged.
• Delayed radial nerve palsy is usually due to oedema.
• Late onset of radial nerve palsy is usually due the involvement of the nerve
with callus.
• Non of the above is correct.

7- A supracondylar fracture of the humerus:


( All correct except one)
• Is a fracture commonly seen in childhood.
• Is particularly subject to the complication of ischaemic muscle contracture.
• Is held in the position of reduction by the tendon of brachioradialis.
• When properly reduced has the index finger pointing approximately to the tip
of the shoulder of the same side.
• When reduced care must be taken to ensure that the radial pulse is present.

8- A transverse fracture of the scaphoid is:


• Prone to infection.
• Usually seen in old men.
• Prone to avascular necrosis.
• Usually seen on an early scaphoid x-ray.
• All of the above is correct.

9- In a colles’ fracture the distal radial fragment:


• Is dorsally angulated on the proximal radius.
• Is usually torn from the intra-articular triangular disc.
• Is deviated to the ulnar side.
• Is rarely impacted.
• Is ventrally displaced.

10- dislocations of the shoulder joint:


• Most commonly occur in middle age.
• Usually occur when the arm is in the abducted position.
• Usually have the head of the humerus situated behind the glenoid fossa.
• Are often recurrent in the young.
• B&D only.

11- In pelvic fractures:


• Avulsion injuries are usually treated by early mobilisation.
• Undisplaced lesions of the ischial or pubic rami are usually treated by early
dmbilisation.
• Extraperitoneal urinary extravasation may be due to damage either to the
membraneous urethra or to the base of the bladder.
• Which are unstable are accompanied by extensive hemorrhage.
• All of the above are correct.
12- Intracapsular fractures of the upper end of the femur are usually: (All correct
except one)
• Accompanied by shortening of the leg.
• Accompanied by external rotation of the leg.
• Accompanied by adduction of the leg.
• Treated by internal fixation.
• Accompanied with a vascular necrosis of the head of femur.

13- Extracapsular fractures of the upper end of the femur are usually:
• Subtrochanteric in position.
• Subject t o avascular necrosis of the head of the femur.
• Accompanied by internal rotation of the leg.
• Treated by external fixation.
• Non of the above are correct.

14- In fractures of the mid shaft of the femur:


( all correct except one)
• The proximal fragment is usually flexed.
• The proximal fragment is usually abducted.
• The distal fragment is usually adducted.
• The common femoral vessels are usually damaged.
• Hamstring and quadriceps produce some shortening of the leg.

15- In fractures of the middle third of the tibia and fibula: (All correct except one)
• Delayed union is common.
• Indirect violence usually results in a spiral or oblique fracture line.
• Shortening and anterior angulation of the tibia are common.
• Comminuted fractures are usually treated external fixation.
• All of the above are correct.

16- In injuries of the ankle joint:


• Eversion injuries are the most commonly encoutered.
• Inversion injuries are usually accomapanied by a tear of the deltoid ligament.
• There is frequently associated posterior tibial nerve damage.
• The joint is rendered unstable by rupture of the inferior tibio-fibular ligament.
• A&B only.

17- Dislocation of the hip joint:


• Is most common when the hip is in a neutral position.
• Is usually associated with a fracture of the acetabular rim.
• Usually results in the femoral head coming to lie anteiorly over the pubis or
obturator externus.
• May be associated with injuries of the sciatic nerve.
• B&D only.

18- Acute osteomyelitis in childhood:


• Is usually the result of compound bony injuries.
• Is characterised by a constant bone pain.
• Characteristiclly produces necrosis of the periosteum overlying the infected
bone.
• Is not demonstrable radiologically for the first week of the disease.
• All of the above are correct.

19- In osteoarthritis of the hip joint:


• The articular cartilage undergoes initial hypertrophy and then becomes
hardened and eburnated.
• The joint capsule becomes stretched and lax.
• The leg is usually adducted and externally rotated when the patient lies supine.
• A femoral osteotomy usually helps halt the progress of the disease process.
• C&D only.

20- In a case of congenital dislocation of the hip:


• There is a defect of the posterior rim of the acetabulum.
• On bilateral hip abduction with the knees extended there is often limited
abduction on the diseased side.
• Reduction is sometimes hindered by a tight gluteus minimus muscle.
• Splinting of the limbs following reduction should be maintained until the
femoral epiphysis returns to its normal density on x-ray examination.
• Non of the above is correct.

21- Osteognic sarcoma:


• Are most frequent in the 10 to 25 year age group.
• Readily metastasise via the blood stream.
• Are frequently surrounded by non-malignant new bone formation.
• When treated by conventional methods have a 10 percent 5 years survival rate.
• All of the above are correct.

1- 'Shock' can be most comprehensively defined as:


A. A sudden large volume blood loss.
B. A diminished effective circulating fluid volume.
C. A hypotensive state with peripheral vasoconstriction.
D. An unexpected psychological insult.
E. A&C only.

2- In all forms of shock there is:


A. An impairment of cellular oxygenation.
B. A decreased cardiac output.
C. An increased effective circulating fluid volume.
D. A low central venous pressure (CVP).
E. An increased pulse rate.

3- The metabolic acidosis of shock can be effectively treated by:


A. Warming the patient.
B. Administering ammonia chloride.
C. Artificial ventilation.
D. Restoring normal tissue perfusion.
E. Nacl intravenous infusion.

4- In hypovolaemic shock:
A. The central venous pressure is high.
B. The difference in arteriovenous oxygen tension is unaffected.
C. The extremities are pale, cold and sweating.
D. Urine output is unaffected.
E. C&D only.

5- Hypovolaemic shock may result from:


(all correct except one)
A. A 25 per cent third degree burn.
B. Generalized peritonitis.
C. Massive pulmonary embolism.
D. Intestinal obstruction.
E. Massive blood loss.

6- Septicshock is particularly associated with: (all correct except one)


A. Thoracic surgical patients.
B. Hypovolaemia.
C. Indwelling urinary or intravenous catherers.
D. Gram-negative bacteraemia.
E. Gram-positive.

7- siptic shock is associated with a hypodynamic cardiovascular state:


( all correct except one)
A. if preceded by existing hypovolaemia.
B. In generalized peritonitis.
C. When there is a gram-positive bacteraemia.
D. In elderly patients.
E. In late gram negative septicemia.
8- The mortality from septic shock can be effectively reduced by:
(all correct except one)
A. Surgical drainage of abscesses.
B. The administration of appropriate antibiotics.
C. The restoration of a normal cardiovascular state.
D. Positive pressure respiration via an indotracheal intubation or tracheostomy.
E. The administration of corticosteroid.

9- In cardiogenic shock:
A. The central venous pressure is hig.
B. The difference in the arteriovenous oxygen tension is increased.
C. The haematocrit is raised.
D. The blood pressure is unaffected.
E. C&D only.

10- Prospective blood donors:


A. Should be asked about previous attacks of jaundice.
B. Should have serological tests for syphilis.
C. May transmit glandular fever to a recipient.
D. May transmit malaria to a recipient.
E. All the above.

11- A blood transfusion reaction:


(all correct except one)
A. May be due to incompatibility of the recipient serum and donor cells.
B. Is manifest by thrombophlebitis of the infusion site.
C. Occurs within the first 30 minutes of transfusion.
D. May produce renal damage.
E. May produce anaphylactic shock.

12- Pyrexial reactions to blood transfusions:


(all correct except one)
A. Have decreased since the introduction of sterile disposable infusion sets.
B. May be caused by allergic reactions.
C. May be caused by contaminated blood.
D. May be a response to a large transfusion of cooled blood.
E. Usually caused by pyrogen reaction.

13. Massive blood transfusions may be complicated by:


(all correct except one)
A. Hyperkalaemia.
B. Hypocalcaemia.
C. Coagulopathy.
D. Leucopenia.
E. DIC.

1- Malignant melanomata:
• Occur more commonly in the black races.
• Occur with equal frequency in all ages.
• Frequently arise from pre-existing benign naevi.
• Occur more frequently in non tropical regions.
• A&B only.
2- A malignant melanoma:
• Frequently arises from hair-bearing naevi.
• Frequently arises from junctional naevi.
• Has a worse prognosis when it arises on the leg.
• Should be suspected in any big pigmented lesion.
• Non of the above is correct.

3- The treatment of a malignant melanoma should include:


( All correct except one)
• A preliminary incision biopsy.
• Wide excision of the tumour.
• ‘En bloc’ removal of adjacent involved lymph nodes.
• Immediate excision of any enlarging lymph node in the postoperative period.
• Excision of 5cm margin of normal tissue.
4- Squamous cancer of the lip:
• Is most common in early adult life.
• Is more common in fair skinned subjects.
• Metastasises readily by the blood stream.
• Is preferably treated by radiotherapy once lymph node deposits are present.
• All of the above are correct.
5 - Basal cell carcinomas:
• Usually metastasise to regional lymph nodes.
• Are less common than squamous cell carcinomas.
• Are characterised histologically by epithelial pearls.
• Are particularly common in oriental races.
• Non of the above is correct.
6 – Capillary angiomas of childhood (strawberry naevi):
• Arise in the dermis.
• Are premalignant.
• Are most satisfactorily treated with superficial radiotherapy.
• Should be surgically excised.
• B&C only.
7- Fiboadenomata of the breast:
• Are commonest in early adult life.
• Are indiscrete and difficult to distinguish.
• Are usually painless.
• Resolve without treatment.
• A&C only.
8 –Fibrocystic disease of the breast:
• Is a variant of the normal cyclical changes that the breast undergoes during
menstruation.
• Is normally unilateral.
• Tends to progress in the post-menopausal years.
• Is precancerous.
• C&D only.
9 –The management of fibrocystic breast disease should:
• Usually be by surgical excision.
• Include mammography when available.
• Include therapy with oestrogens.
• Include therapy with progesterone.
• Corticosteroids.
10 – An intradut papilloma of the breast:
• May cause a colourless nipple descharge.
• May be diagnosed with the aid of contrast radiography.
• Should be treated by simple mastectomy.
• Is associated with fibrocystic disease of the breast.
• Is usually a premalignant lesion.

11 – Paget’s disease of the nipple:


• Usually presents as abilateral eczema of the nipple.
• Is always related to an underlying breast cancer.
• Indicates incurable breast cancer.
• Has non-specific histological characteristics.
• A&C only.
12- x-ray examijnation of the breast (mammography):
• Does not improve the clinician’s diagnosis rate of benign and malignant breast
disease.
• Is diagnostically most useful in young women.
• Is practical as a nationwide presymptomatic screening procedure.
• Contributes nothing to the management of the patients with clinically obvious
breast cancer.
• Non of the above is correct.
13- Breast cancer:
• Is one of the commonest female neoplasm.
• Has its highest incidence in social class v.
• Has a familial tendency.
• Is less common in nulliparous women.
• A&C only.
14 – Breast cancer: (all correct except one)
• May be presents with a history of breast pain.
• Is most common in the upper outer quadrant of the breast.
• Can be diagnosed preoperatively by the experienced clinician in 95 per cent
of cases.
• Must be considered on discovering any discrete mass in the breast.
• Usually presents as a painless lump.
15 –The signs and symptoms of breast cance include: (all correct except one)
• A bloody nipple discharge.
• Eczematous changes in the nipple and areola.
• Pre-menstrual breast pain.
• Skin tethering.
• A discrete breast lump.
16 – The histological study of breast cancers has shown that:
• The prognosis is not related to histological type.
• The commonest carcinoma is a squamous carcinoma.
• Most breast cancers arise from the epithelium of the breast duct.
• Satellite breast cancers are uncommon.
• B&D only.
17- Signs of incurable breast cancer include:
• Tumour fixity to the chest wall.
• Skin ulceration.
• Palpably enlarged mobile ipsilateral axillary lymph nodes.
• A bloody nipple discharge.
• A&B only.
18– The prognosis of treated breast cancer:
• Is related to the clinical staging of the cancer.
• Is not related to the number of axillary nodes found to be invaded by cancer at
operation.
• Is related to the use of postoperative radiotherapy to the regional nodes and
operative field.
• Is better after simple rather than radical mastectomy.
• Non of the above is correct.
19 – The prognosis of treated stage 1 breast cancer:
• Cannot be satisfactorily assessed until 15 years have elapsed.
• Is adversely affected by a subsequent pregnancy.
• Is worse in the male.
• Is worse if the cancer is discovered during late pregnancy or the puerperium.
• A&D only.

1. Which of the following is not true about neurogenic shock?


a. It may follow spinal fractures.
b. There is tachycardia.
c. The extremities are warm.
d. There is bradycardia and hypotension.
e. Vasopressors may be useful.

2. All the following are complications of massive blood transfusion except:


a. Hypothermia.
b. Hypocalcaemia.
c. Hypokalaemia.
d. Acidosis.
e. DIC.

3. In idiopathic thrombocytopenic purpura all the following are present


except:
a. Megakaryocytes are present in the bone marrow.
b. Cortisone therapy may improve the condition.
c. Marked enlargement of the spleen is present.
d. Haemarthrosis is not a complication.
e. The INR is normal.
f. The disease is due to the presence of immunoglobulins.

4. Regarding hyperkalemia all are true EXCEPT:


a. Is mostly the result of renal failure.
b. Is common with massive tissue destruction.
c. Muscle rigidity is a manifestation of severe hyperkalemia.
d. Causes a peaked T-wave on the electrocardiogram.
e. Urgent treatment is by Ca gluconate and Na bicarbonate.

5. One of the following is an anaerobic organism:


a. Staphylococcus aureus.
b. E. coli.
c. Klebsiella.
d. Pseudomonas aeroginosa.
e. Bacteriodes.

6. Which of the following tests will be affected after intake of non-steroidal


anti-inflammatory drugs:
a. Coagulation time.
b. PTT.
c. INR.
d. Bleeding time.
e. Thrombin time.

7. All of the following can be treated conservatively in a stable trauma


patient except:
a. Lung contusion.
b. Liver laceration.
c. Kidney laceration.
d. Splenic hematoma.
e. Perforation of the small intestine.

8. The initial maneuver to establish an airway in a patient with multiple


injuries is:
a. Oropharyngeal airway.
b. Uncuffed endo-tracheal tube.
c. Suctioning foreign debris and lifting up the mandible.
d. Cuffed endo-tracheal tube.
e. Tracheostomy.
9. Which is the most commonly injured intra-abdominal organ in blunt
trauma?
a. Pancreas.
b. Kidney.
c. Spleen.
d. Stomach.
e. Colon.
10. In malignant melanoma which of the following correlates best with the
prognosis?
a. Age of the patient.
b. Gender.
c. Clark’s level.
d. Site of the lesion.
e. Breslew thickness of the lesion.

11. Risk factors for breast cancer include the following except:
a. Prior breast cancer.
b. Mammary duct ectasia.
c. Breast cancer has affected a sister.
d. Early menarche and late menopause.
e. In situ lobular or duct carcinoma.

12. The commonest histological type of breast cancer is:


a. Duct carcinoma in situ.
b. Lobular carcinoma in situ.
c. Invasive duct carcinoma.
d. Invasive lobular carcinoma.
e. Paget’s disease of nipple.

13. What is the commonest presentation of a nephroblastoma?


a. Abdominal pain.
b. Haematuria.
c. Fever.
d. Abdominal mass.
e. Loss of weight.

14. All the following statements about follicular thyroid cancer are true
except:
a. It present at a later age than papillary carcinoma.
b. It disseminates via hematogenous route.
c. It is less common than papillary carcinoma.
d. It is frequently multicentric.
e. Bone is a favorite metastatic site.

15. To prevent foot infection in a diabetic patient the following


recommendations are all correct except:
a. Careful trimming of toe nails.
b. Monthly injection of the long-acting benzathene penicillin.
c. Regular washing and daily inspection of the feet by the patient.
d. Early treatment of taenia pedis infection.
e. Avoidance of walking bare-footed.

16. Which of the following tests is used to monitor the adequacy of


anticoagulation with warfarin?
a. Bleeding time.
b. Clotting time.
c. Activated partial thromboplastin time (APTT).
d. Fibrinogen level.
e. International normalized ratio (INR).
f. Marjolin’s ulcer.

17. Severe limb pain of sudden onset can be caused by all the following
conditions except:
a. Acute ischaemia.
b. Deep venous thrombosis.
c. Muscle tear.
d. Sciatica.
e. Bone fracture.

18. The following statements about gall bladder stones are all correct except:
a. Most of these stones are radio-opaque.
b. In many cases these stones produce no symptoms.
c. Gall stones are present in most cases of gall bladder cancer.
d. Ultrasonography is the preferred imaging study.
e. Removal of the gall balder is the standard treatment of symptomatic
cases.

19. The following statements about acute cholecystitis are all correct except:
a. The great majority of cases are caused by stones.
b. The condition is more serious in diabetics.
c. Differential diagnosis includes acute pancreatitis.
d. The main presentation is jaundice.
e. Initial treatment may be conservative.

20. Which of the following is a common cause for massive lower


gastrointestinal bleeding?
a. Crohn’s colitis.
b. Rectal polyp.
c. Angiodysplasia of the colon.
d. Carcinoma of the caecum.
e. Solitary rectal ulcer.

21. Which of the following is not true about achalasia of the cardia?
a. It usually occurs in middle age.
b. There are hyyperperistlatic waves in the body of the esophagus.
c. It predisposes to squamous cell carcinoma of the esophagus.
d. Manometric study is diagnostic.
e. Pneumatic dilatation is a line of treatment.

22. Organisms found in the large bowel are mostly:


a. Gram-positive cocci and anaerobes.
b. Gram-negative cocci and anaerobes.
c. Gram-negative bacilli and anaerobes.
d. Gram-positive bacilli and anaerobes.
e. Gram-negative cocci only.

23. Which of the following operations is considered as clean contaminated


operation?
a. Herniorrhophy.
b. Axillary block dissection.
c. Ureterolithotomy.
d. Urgent colectomy.
e. Appendicular abscess drainage.

24. During conservative treatment of a patient with adhesive intestinal


obstruction, which of the following is an indication to proceed to
surgery?
a. Nasogastric suction of more than 2 L/24 hours.
b. Exaggerated bowel sounds.
c. Abdominal rigidity.
d. Abdominal distension.
e. Serum K level below 2.5 mEq/L.
25. The most important prognostic index in breast cancer is:
a. Age of the patient.
b. Site of the lesion.
c. Presence of lymph node metastases.
d. Level of CEA.
e. Presence of micro-calcification.

11. Which of the following are not found in peritonitis?


a. Patient is lying still
b. Guarding
c. Rebound tenderness
d. Hyperactive bowel sounds
e. Rigid abdomen

The following is an indication for thoracotomy in chest .28


,injury

a. Cardiac tamponade
b. Uncontrolled pulmonary air leakage
c. Perforation of thoracic esophagus
d. Blood loss of 200ml/hr for 2-3 hrs via chest tube
e. All of the above

1. Which of the following do you consider to be the most important clinical sign in acute
appendicitis,

1. Abdominal tenderness around the umbilicus


2. Abdominal tenderness in the RIF
3. Tenderness over McBurney’s point
4. Rovsing’s sign positive
5. Suprapubic tenderness

2. All of the following are mechanisms of urinary calculi formation except,

1. Hypoparathyroidism
2. Prolonged recumbency
3. Infection with urea-splitting organisms
4. Foreign body
5. Urinary tract obstruction

3. Organisms most commonly isolated in UTIs,

1. Kleb
2. E. Coli
3. Proteus
4. Acinetobacter
5. All of the above

4-The ideal fluid therapy in a patient with pyloric stenosis and repeated vomiting is:
a. Isotonic crystaloid containing sodium chloride

b. Hypertonic crystaloid containing dextrose – saline

c. Isotonic solution containing dextrose

d. Large molecular weight colloid containing dextran

5. Excessive saliva in a newborn is due to

1. Esophageal atresia
2. Salivary gland tumour
3. Primary Hypertrophic Pyloric Stenosis
4. Midgut volvulus
5. Hirschprung’s disease

6. The evaluation of a comatose patient with a head injury begins with:

a.The cardiovascular system.

b. Pupillary reflexes.

c. Establishment of an airway.

d. Computed tomography (CT) of the brain

e .insertion of Intravenous canula

7. The following is an indication for thoracotomy in chest injury,

f. Cardiac tamponade
g. Uncontrolled pulmonary air leakage
h. Perforation of thoracic esophagus
i. Blood loss of 200ml/hr for 2-3 hrs via chest tube
j. All of the above

8. In an upper gastrointestinal bleed, in some cases a Sengstaken-Blakemore tube is


incerted. What is the primary purpose of the tube?

a. Aspirate blood from the stomach


b. Tube feeding
c. Tamponade for varices
d. To decompress bowel
e. All of the above
9. Which of the following is not found in peritonitis?

a. Patient is lying still


b. Guarding
c. Rebound tenderness
d. Hyperactive bowel sounds
e. Rigid abdomen

10. Commonest site for Cancer breast

a. Upper outer quadrant


b. Upper inner quadrant
c. Lower outer quadrant
d. Lower inner quadrant
e. None of the above

11. The back of the medial epicondyle is related to the:

a. Radial nerve.

b. Axillary nerve.

c. Ulnar nerve.

d. Median nerve.

e. None of the above.

12. Regarding Gallstones all of the following are true except:-

a. Prevalence increases with advancing age


b. 30% of gallstones are radio-opaque
c. Cholesterol stones result from a change in solubility of bile constituents
d. Biliary infection, stasis and changes in gallbladder function can
precipitate stone formation
e. Gram-negative organisms are the most common isolated

13.Clinical features of limb ischaemia includes

a. Paraesthesia
b. Pallor
c. Pulselessness
d. Paralysis
e. All of the above

14. Regarding Hydatid disease all of the following are true except:-
a. Due to infection with the helminth Ecchinococcus granulosa
b. Man is an accidental intermediate host
c. Lunges is the commonest organ involved
d. Diagnosis can be confirmed by indirect haemagglutinin assay
e. Aspiration should not be performed if hydatid disease is suspected

15.Which hypersensitivity reaction is associated with serum sickness?


a. Type I: immediate
b. Type II: cytotoxic
c. Type III: immune complex
d. Type IV: cell mediated
e. None of the above

16. The most common cause of mass in the posterior mediastinum is


a. Vascular
b. Esophageal diverticula
c. Neurogenic tumors
d. Lymphomas
e. Bronchogenic cysts

17.In obstructive jaundice:


a. Urinary conjugated bilirubin is increased
b. Serum unconjugated bilirubin is increased
c. Urinary urobilinogen increased
d. Serum conjugated bilirubin is reduced
e. Faecal stercobilinogen is increased

18-Which of the following statements about extracellular fluid is true?

a. The total extracellular fluid volume represents 40% of the body weight.
b. The plasma volume constitutes 20%of the total extracellular fluid
volume.
c. Potassium is the principal cation in extracellular fluid.
d. The protein content of the plasma produces a lower concentration of
cations than in the interstitial fluid.
e. The interstitial fluid equilibrates slowly with the other body
compartments.

19. The following cause hypercalcaemia except :


a. Sarcoidosis
b. Primary hyperparathyroidism
c. Acute pancreatitis
d. Metastatic bronchial carcinoma
e. Milk-Alkali syndrome

20.For a 22-kg baby the maintenance daily fluid requirement is approximately


which of the following?
a. 1100 ml
b. 1250 ml
c. 1550 ml
d. 1700 ml
e. 1850 ml

21.The transfusion of fresh frozen plasma (FFP) is indicated for which of the
following reasons?
a. Volume replacement.
b. As a nutritional supplement.
c. Treatment of prolonged bleeding time.
d. For the correction of abnormal PT secondary to warfarin therapy,
vitamin K deficiency, or liver disease.
e. All are correct

22.A 9 month old boy presents with an acute scrotal swelling. The following
diagnoses are likely:
a. Epididymitis
b. Orchitis
c. Torsion of the testicular appendage
d. Irreducible inguinal hernia
e. Acute idiopathic scrotal oedema

23- A 24-year-old man has sustained significant brain injury following an assault. He
is showing signs of a raised intra-cranial pressure. Which of the cranial nerves is
usally the first to be affected by a raised intracranial pressure?

a. The abducent nerve

b. The facial nerve

c. The hypoglossal nerve

d. The vagus nerve

e. The vestibulocochlear nerve


24. Anaphylactic shock:

a. Is an immune-mediated reaction.

b. Results in mast cell activation and increased circulating histamine


concentrations.

c. Produces microcirculatory changes similar to hypovolaemic shock.

d. Requires prompt treatment with parenteral adrenaline and


hydrocortisone.

e. May occur after ingestion of drugs

25. A 33-year-old woman develops a reducible mass of the groin that is inferolateral
to the pubic tubercle and medial to the femoral vein. Which of the following is the
most likely diagnosis?
a. Direct inguinal hernia

b. Femoral hernia

c. Incisional hernia

d. Indirect inguinal hernia

e. Umbilical hernia

26- Regarding papillary thyroid cancer

a. Account for 40% of thyroid cancer

b. Early blood spread

c. Commonest thyroid cancer in children

d. Common in endemic goiter areas

e. Multifocality is rare

27- The most commonly used imaging method for diagnosis of acute cholecystitis is:

a. CT of the abdomen.

b. Ultrasonography of the gallbladder.


c. Oral cholecystogram.

d. Radionuclide (HIDA) scan of the gallbladder

e. MRI

28. Fibro adenoma

a. Is common in females between 15-25 years

b. Usually soft indiscreet lump

c. Malignant changes in 5 %

d. Arise from duct of breast

e. none of the above

29-In tension pneumothorax the following signs are present except:

a. Hypoxia
b. Hyperresonance to percussion on the affected side
c. Tracheal deviation to the ipsilateral side
d. Distended neck veins
e. Tachycardia

30-Foot droop is usually associated with paralysis of the:

a. Tibial nerve
b. Common peroneal
c. Obturater
d. Medial planter
e. Lateral planter

1.The ilio-inguinal nerve:

A. supplies the rectus abdominis muscle

B. supplies skin on inner side of thigh

C. supplies the cremasteric muscle

D. supplies the urethra


E. does none of the above

2. The skin of the tip of the index finger is supplied by


the:

A. Radial nerve only

B. Radial & median nerves

C. Median & ulnar nerves

D. Ulnar nerve only

E. Median nerve only

3. Hypovolaemic shock is characterized by:

A. A low central venous pressure , high cardiac output,


low peripheral resistance

B. A high central venous pressure, high cardiac output,


high peripheral resistance

C. A low central venous pressure , low cardiac output,


high peripheral resistance

D. A low central venous pressure , high cardiac output,


high peripheral resistance

E. A high central venous pressure, low cardiac output,


low peripheral resistance

4. Which of the following in NOT true of Hodgkin's


disease?

A. Usually starts from several groups of nodes simultaneously


B. Usually involves liver & spleen

C. Sometimes manifests itself as pyrexia of unknown origin

D. Severe pain follows ingestion of alcohol

E. Shows increased susceptibility to opportunistic infection

5. Tetanus toxoid:

A. Is produced by injecting animals with antititanic serum

B. Is administered to previously immunized subjects with potentially


infected wounds

C. Frequently gives rise to anaphylactic reaction

D. Is used to induce active immunity against tetanus

6. The most probable cause of shock in a patient with multiple injuries &
craniocerebral trauma is:

A. Depression of vital medullary centres

B. Hypoperfuion control over subcortical areas

C. Loss of cortical control over subcortical areas

D. Hypovolaemia

E. Inadequate ADH response

7. The most sensitive guide to acute changes in fluid balance in a surgical


patient is:

A. Accurate daily weight

B. Serial serum Na concentration

C. Fluid balance sheets recording inputs & outputs

D. Daily urine output


E. Serial anion gap measurements

8. cellullitis is:

A. Inflammation of the bone marrow

B. Inflammation of the mastoid cells

C. Inflammation of the subcutaneous tissues

D. Infiltration of the skin by gaint cells

E. A malignant condition

9. secondary haemorrhage occurs:

A. Within 6 hours of operation

B. 7-14 days after operation

C. As a result of violent coughing on recovery from anaesthesia

D. Due to a blood transfusion line disconnected

E. When a ligature slips

10. the minimum urine output for 24 hours required to excrete end
products of protein metabolism is:

A. 200 ml

B. 300 ml

C. 400 ml

D. 500 ml

E. 600 ml

11. Potassium deficiency is present if the plasma-potassium level is:


A. 6.0 mmol/l

B. 5.0 mmol/l

C. 4.5 mmol/l

D. 4.0 mmol/l

E. 3.0 mmol/l

12.in health the pH of the blood lies between the range:

A. pH 7.05-7.19

B. 7.20-7.35

C. 7.36-744

D. 7.45-7.59

E. 7.60-7.80

13. TNM classification of a malignant tumour was designed as:

A. An histological staging

B. A clinical staging

C. A staging carried out at operation

D. A staging dependent upon radio scanning & skeletal survey

E. A staging dependent upon ultrasound

14. a blue-green discharge from an ulcer will be seen to contain:

A. Pseudomonas pyocyaneus

B. Streptococcus viridians

C. Candida albicans
D. Staphylococcus aureus

E. Haemophilius influenzae

15. a rodent ulcer is:

A. A squamous cell carcinoma

B. A basal cell carcinoma

C. Only occur on the face

D. Contains epithelial pearls

E. A venous ulcer

16. the space of Parona is:

A. In the wrist between the deep flexor tendons & the pronator quadratus

B. Above the patella between the quadriceps muscle & the femur

C. Benath the tendon of the iliopsos

D. Between the achills tendon & the posterior aspect of the tibia

E. The web space of the palm

17. 'rest pain' occurs:

A. Anywhere in the body at rest

B. In the thigh of a patient with Buerger's disease

C. In the calf of a patient with intermittent claudicating

D. In the foot of a patient with severe vascular disease

E. In the back

18. ischaemia means:


A. Pain in the ischial tuberosities

B. Anaemia due to malignant seconderies in the ischial part of the pelvis

C. Lack of blood flow

D. Increased blood flow

E. Polycythaemia

19. Colles' fracture is:

A. A common in adolescence

B. A fracture about the ankle joint

C. Common in elderly women

D. A fracture of the head of the radius

E. A fracture of scaphoid

20. Pott's disease is;

A. A fracture dislocation about the ankle

B. A neuropathic joint

C. Traumatic ostechondritis of the spine

D. Tuberculosis of the spine

E. A secondary tumour in the skull

21. Vincent's angina is a form of angina associated with:

A. Spasm of the oesophagus

B. Diphtheria

C. An infection of the mouth


D. Coronary artery spasm

E. Carcinoma of the bronchus

22. Ludwig's angina is due to :

A. A type of coronary artery spasm

B. Oesophageal spasm

C. Retropharyngeal infection

D. A virulent infection of the cellular tissue around the submandibular


salivary gland

E. Infection with candida

23. in simple nodular goiter:

A. Carcinoma occurs in 30% of cases

B. The nodular stage is irreversible

C. Operation is contraindicated

D. The patient does not develop hyperthyroidism

E. Cretinism is the presenting feature

24. Hashimoto's disease is:

A. A granulomatous thyroiditis

B. An auto-immune thyroiditis

C. An infiltrating fibrosis of the thyrois & the adjacent muscles

D. Focal thyroiditis

E. A parathyroid tumour
25. A thyroglossal fistula:

A. Is never congenital

B. Follows inadequate removal of a thyroglossal cyst

C. Has a hood of skin with its concavity upwards

D. Is lined throughout by squamous epithelium

E. Occurs in carcinoma of the tongue

26. The following are clinical signs supporting an early diagnosis of


carcinoma of the breast:

A. A prickling sensation in a breast lump

B. Peau d'ornge

C. Brawny arm

D. Cancer en cuirasse

E. A krukenderg tumour

27.The gastroduodenal artery is a branch of the:

A. Celiac axis

B. Hepatic artery

C. Superior mesenteric artery

D. Gastroepiploic artery

E. Splenic artery

28.Chronic gastric ulcers most often occur in patients with:

A. Blood groub A

B. Tend to occur in alkaline mucosa


C. Muscularis mucosae is separated from the muscularis at the edge of the
ulcer

D. Are malignant when there is epithelial proliferation & downgrowths

E. Are never large

29. Meckel's diverticulum:

A. Is present in 20% of the human race

B. Arises from the mesenteric border of the jejunum

C. May contain heterotopic pancreas

D. Is only present in the male sex

E. Is a diverticulum of the bladder

30. Intussusception is related to:

A. Mucoviscidosis

B. Swollen Peyer's patches

C. Volvulus

D. A littre's hernia

E. A patent vitello intestinal duct

31. The site of the neck of a femoral hernia is the:

A. Transversalia fascia

B. Iliopectineal ligament

C. Femoral ring

D. Cribriform fascia

E. Obturator foramen
32. Regarding operation for an indirect inguinal hernia:

A. It should not be performed on patients who have chronic bronchitis

B. General anaesthesia has to be used

C. In infants the posterior inguinal wall should be repaired

D. In adults the internal inguinal ring usually needs to be strengthened

E. Mesh implants are mandatory

2. Which hypersensitivity reaction is associated with a tuberculin reaction?


a. Type I: immediate
b. Type II: cytotoxic
c. Type III: immune complex
d. Type IV: cell mediated

3. The most common location for a gastric ulcer is


a. Fundus
b. Greater curvature
c. Cardia
d. Body
e. Antrum

4. Regarding the management of major trauma


a. Deaths follow a trimodal distribution
b. Cardiac tamponade is characterised by raised BP, low JVP and muffled heart
sounds
c. Assessment of uncomplicated limb fractures should occur during the primary
survey
d. Deterioration of the casualty during the primary survey should lead to the
secondary survey
e. All are false

5. All of the following are true about neurogenic shock except:


a. There is a decrease in systemic vascular resistance and an increase in venous
capacitance.
b. Tachycardia or bradycardia may be observed, along with hypotension.
c. The use of an alpha agonist such as phenylephrine is the mainstay of treatment.
d. Severe head injury, spinal cord injury, and high spinal anesthesia may all cause
neurogenic shock.

6. The following cause hypercalcaemia except :


a. Sarcoidosis
b. Primary hyperparathyroidism
c. Acute pancreatitis
d. Metastatic bronchial carcinoma
e. Milk-Alkali syndrome

7. For a 40-kg baby the maintenance daily fluid requirement is approximately which of the
following?
a. 1100 ml
b. 1250 ml
c. 1550 ml
d. 1700 ml
e. 2000 ml

8. . Infantile hypertrophic pyloric stenosis


a. Occurs with a male: female ratio of 4:1.
b. Presents between six and eight months of age
c. Typically presents with bile stained projectile vomiting
d. Surgical treatment is by Heller's Cardiomyotomy
e. all are false

8. Which of the following do you consider to be the most important clinical sign in acute
appendicitis,

1. Abdominal tenderness around the umbilicus


2. Abdominal tenderness in the RIF
3. Tenderness over McBurney’s point
4. Rovsing’s sign positive
5. Suprapubic tenderness

9.Heparin

1. Acts as an anti-platelet
2. Acts as an anti-thromboplastin
3. Acts as an antithrombin
4. All of the above
5. None of the above
10. All of the following are mechanisms of urinary calculi formation except,

1. Hypoparathyroidism
2. Prolonged recumbency
3. Infection with urea-splitting organisms
4. Foreign body
5. Urinary tract obstruction

11. Which of the following are not found in peritonitis?

1. Patient is lying still


2. Guarding
3. Rebound tenderness
4. Hyperactive bowel sounds
5. Rigid abdomen

12-Which one of the following suggest a diagnosis of Hirschsprung's disease?

a. A contrast-study showing dilatation of the aganglionic bowel segment.


b. Early presentation with vomiting.
c. Neonatal large bowel obstruction.
d. Presentation after 1 year of age.
e. Red current jelly stools.

13-Which of the following regarding the anatomy of the heart is true?

a. The aortic valve is tricuspid.


b. The ascending aorta is entirely outside the pericardial sac.

c. The left atrial appendage is identified readily by transthoracic echocardiography.


d. The pulmonary trunk lies anterior to the ascending aorta.
e. The right atrium is posterior to the left atrium.

14-Which of the following is true concerning Scaphoid fractures?

a. Rarely occur in young adults


b. when complicated by avascular necrosis the proximal pole is usually affected

c. should be treated by bone grafting and internal fixation even if undisplaced

d. wrist fractures are uncommon


e. anteriorposterior and lateral radiographs reveal most fractures
15-Which of the following statements is true of upper limb nerve injuries?

a. Injury to the median nerve results in a wrist drop


b. Injury to the radial nerve results in loss of sensation over the palmar aspect of the
index finger
c. Injury to the median nerve results in loss of sensation in the anatomical snuffbox
d. Injury to the ulnar nerve results in a claw hand
e. Injury to the ulnar nerve results in loss of sensation over the thumb

16- Regarding intravenous solutions:

a. Normal saline contains 180mmol/l of sodium


b. Ringer's lactate solutions is designed for intracellular fluid replacement
c. Sodium bicarbonate 8.4% is a hyperosmolar solution
d. Normal saline with added potassium is appropriate therapy to correct a
respiratory alkalosis
e. All are True

17-Which of the following concerning the Femoral sheath is false:

a. Contains the femoral artery


b. Contains lymph nodes
c. Contains the femoral canal
d. Contains femoral nerve
e. Contains the femoral vein

18-The following is true of the spleen:

a. Is the largest lymphoid organ in the body


b. Lies obliquely between the seventh and tenth rib
c. The lower pole extends beyond the mid-axillary line
d. Is usually palpable when normal
e. Usually measures 16cm in maximum length when healthy

19-Breast cancer risk is increased in association with the following factors except:

a. Nulliparity
b. Immediately after pregnancy
c. Early menarche
d. Early age at first pregnancy
e. Late menopause

20-In tension pneumothorax the following signs are present except:

f. Hypoxia
g. Hyperresonance to percussion on the affected side
h. Tracheal deviation to the ipsilateral side
i. Distended neck veins
j. Tachycardia

21- The most common hernia in females is:

a. Femoral hernia.
b. Direct inguinal hernia.
c. Indirect inguinal hernia.
d. Obturator hernia.
e. Umbilical hernia.

22-. The most helpful diagnostic radiographic procedure in small bowel obstruction is:

a. CT of the abdomen.
b. Contrast study of the intestine.
c. Supine and erect x-rays of the abdomen.
d. Ultrasonography of the abdomen.
e. MRI Abdomen

23- In role of nine extent of burn if entire trunk is burned it will be equal to:

a. 9% body surface area.


b. 18% body surface area.
c. 36% body surface area.
d. 27% body surface area.
e. 45% body surface area.

24-. If torsion of the testicle is suspected, surgical exploration:

a. Can be delayed 24 hours and limited to the affected side.


b. Can be delayed but should include the asymptomatic side.
c. Should be immediate and limited to the affected side.
d. Should be immediate and include the asymptomatic side.

25- Hyperthyroidism can be caused by all of the following except:

a. Graves' disease.
b. Plummer's disease.
c. Struma ovarii.
d. Hashimoto's disease.
e. Medullary carcinoma of the thyroid.

26- A 9 month old boy presents with an acute scrotal swelling. The following diagnoses are likely:

a. Epididymitis
b. Orchitis
c. Torsion of the testicular appendage
d. Irreducible inguinal hernia
e. Acute idiopathic scrotal oedema

27. The evaluation of a comatose patient with a head injury begins with:

a.The cardiovascular system.

b. Pupillary reflexes.

c. Establishment of an airway.

d. Computed tomography (CT) of the brain

e .insertion of Intravenous canula

28. The following is an indication for thoracotomy in chest injury,

k. Cardiac tamponade
l. Uncontrolled pulmonary air leakage
m. Perforation of thoracic esophagus
n. Blood loss of 200ml/hr for 2-3 hrs via chest tube
o. All of the above

29. Regarding Gallstones all of the following are true except:-

f. Prevalence increases with advancing age


g. 30% of gallstones are radio-opaque
h. Cholesterol stones result from a change in solubility of bile constituents
i. Biliary infection, stasis and changes in gallbladder function can precipitate stone
formation
j. Gram-negative organisms are the most common isolated

30.In obstructive jaundice:


a. Urinary conjugated bilirubin is increased
b. Serum unconjugated bilirubin is increased
c. Urinary urobilinogen increased
d. Serum conjugated bilirubin is reduced
e. Faecal stercobilinogen is increased

1) Abduction of the vocal cords results from contraction of the:


A) crico-thyroid muscles
B) posterior crico-arytenoid muscles
C) vocalis muscles
D) thyro-ary-epiglottic muscles
E) lateral crico-arytenoid and transverse arytenoids muscles
2) The rectum:
A) is devoid of peritoneum
B) is surrounded by peritoneum
C) has peritoneum on its lateral surfaces for its upper two- thirds, and
on its anterior surface for its upper one-third
D) has pritoneum on its anterior surface for its upper two-thirds, and
on its lateral surfaces for its upper one-third
E) has peritoneum on its anterior surface only
3) The umbilicus:
A) lies near the to the xiphoid than to the pubis
B) derives its cutaneous innervation from the eleventh thoracic nerve
C) transmits, during development, the umbilical cord two arteries and
two veins
D) usually lies at about the level between the third and fourth lumbar
vertebra
E) emberiologicall, may transmit urine but never bowel contents
4) The superficial perineal pouch:
A) is limited inferiorly by the urogenital diaphragm
B) is not continuous with the space in the scrotum occupied by the
testes
C) has a membranous covering which provides a fascial sheath around
the penis
D) is traversedby the urethera in the male but not the urethera and
vagina in the female
E) in the female, the greater vestibular glands are situated outside this
pouch
5) The tongue:
A) has a foramen caecum at the base of the frenulum
B) is separated from the epiglottis by the valleculae on each side of the
midline
C) has 7-12 circumvallate papillae situated behind the sulcus terminalis
D) is attached to the hyoid bone by the genioglossus muscle
E) is supplied only by hypoglossal nerve
6) Hypovolaemic shock is characterized by:
A) a low central venous pressure , low cardiac output , low peripheral
resistance
B) a high central venous pressure , high cardiac output , low peripheral
resistance
C) a low central venoys pressure , low cardiac output , high periphera
resistance
D) a low central venous pressure , high cardiac output , high peripheral
resistance
E) a high central venous pressure , low cardiac output , low peripheral
resistance
7) An oxygen debt is:
A) the amount of oxygen in excess of the resting metabolic needs that
must be consumed after completion of exercise
B) build up because the pulmonary capillaries limit the uptake of
Oxygen at high rates of oxygen consumption
C) related to the fact that skeletal muscle cannot function temporarily in
the absence of oxygen
D) associated with a decrease in blood lactate
E) associated with alkalosis
8) Pulmonary embolism may be a complication of:
A) prolonged bed rest
B) a surgical operation
C) vitamine K deficiency
D) oral contraceptive therapy
E) Antithrombin III deficiency
9) Which of the following statements regarding potassium metabolism is NOT
True?:
A) potassium deficiency commonly results from thiazide diuretic theraoy
B) the normal compensation for potassium deficiency is a metabolic
extracellular acidosis
C) aldosterone increases urinary potassium loss
D) hyperkalaemia causes bradycardia and loss of P waves on the ECG
E) hypokalaemia aggrevates the cardiac effects of digitalis toxicity
10) Cutaneous pain:
A) is due to overstimulation of receptors serving other sensory modalities
B) cannot be elicited more readily if the tissue has recently been injured
C) is due to exitation of receptors by pain-producing chemical substances in
the injured tissue
D) shows marked adaptation, i. e. decrease in severity in response to a
constant stimulus
E) is conducted through the medial spinothalamic tract
11) Which of the following is NOT associated with hyperthyroidism?:
A) increase size of the thyroid gland
B) increased amount of colloid in thyroid follicle
C) increased height of epithelium of the thyroid follicle
D) increased vascularity of the thyroid gland
E) increased uptake of iodine by the thyroid gland

12) Sarcomata may show all of the following EXCEPT:


A) production of myxomatous tissue
B) production of collagen
C) spindle shaped cells
D) signet ring cells
E) blood stream metastasis
13) Anaphylaxis is characterized by all of the following EXCEPT:
A) is a reaction either local or general , frequently occurs within five
minutes
B) causes an urticarial eruption
C) is produced by IgA antibody
D) causes eosinophilia
E) causes degranulation of basophils and mast cells
14) Autoimmunity is characterized by the following EXCEPT:
A) occurs because of a breakdown in the ability of the body to distinguish
between self and non self
B) is involved in some forms of orchitis
C) is involved in formation of cryo globulin
D) is important in the pathogenesis of lupus erytheromatosus
E) does not result in immune complex disease
15) Pseudomembranous enterocolitis is caused by the following organisms:
A) Clostridium sporogenes
B) Clostridium defficile
C) Streptococcus faecalis
D) Penicillin sensitive staphylocci
E) Pseudomonas aeruginos

B) CLINICAL SUGERY
16) The “ white clot syndrome”:
A) is usually characterized with antithrombin III deficiency
B) most often present with arterial complicatios of heparin induced
throbocytopenin
C) is best managed by loe molecular weight dextran
D) is best managed by halving the therapeutic dose of heparin sodium
E) results from nitric oxide deficiency of endothelial cells
17) A 21-year-old man who was the driver in a head-on collision has a pulse of
140/min , respiratory rate of 36 and blood pressure of 75 palpable. His trachea
is deviated to the left, with palpable subcutaneous emphysema and poor breath
sounds in the right hemithorax, The most appropriate initial treatment must
be
A) immediate thoracotomy
B) catheter insertion in the subclavian vein for fluid resuscitation
C) intubation and ventilation
D) tube thoracostomy
E) immediate tracheostomy
18) The best test to monitor the adequacy of levothyroxin therapy is:
F) radioactive iodine uptake
G) thyroglobulin
H) free thyroxine index (T4)
I) triiodothyronine resin uptake (T3)
J) thyroid stimulating hormone (TSH)
19) Which of the following statements about fungal infection is NOT true ?:
A) Prior or synchronous culture positive for Candida at another site
occurs in few patients with candidimia
B) For critically ill patients nonhaematogenous sites of candida are
appropriately treated with systemic antifungal therapy
C) Mortality rates are similar regardlss of whether C. albicans fungmia
is treated with amphotericin B or fluconazole
D) Intravenous catheters and the gastrointestinal tract are common
portals for Candida to gain blood stream access
E) Septic emboli are more common with fungal endocarditis than with
bacterial endocarditis
20) The maximum safe dose of local anaesthetic administered
subcutaneously in a 70-kg man is:
A) 10 to 20 ml of 1% lidocaine
B) 40 to 50ml oh 2% lidocaine with epinephrine
C) 40 to 50 ml of 1% lidcaine with epinephrine
D) 40 to 50 ml of 1% bupivacaine (marcaine)
E) 40 to 50 ml of 1%lidocaine without epinephrine
21) Two days after right hemicolectomy for a Dukes B caecal carcinoma ,
the
Patient complains of sharp right-sided chest pain and dyspnea.
HisPaO2
Is 64mmHg ,his PaCo2 is 32mmHg. CVP is 26 cm water, and the blood
pressure is 102/78mmHg. A pulmonary embolus is suspected,
The next step in management should be:
A) A ventilation- perfusion lung scan
B) A pulmonary arteriogram
C) Postrioanterior and lateral chest x-rays
D) Heparin sodium ,100 units/kg intravenously
E) Immediate duplex scanning of both lower extremities
22) The major cause of graft loss in heart and kidney allograft is:
A) acute rejection
B) hyperacute rejection
C) vascular thrombosis
D) chronic rejection
E) graft infection
23) All of the following are indicators of tumor aggressiveness and poor
outcome for papillary carcinoma of the thyroid gland EXCEPT:
A) age over 50 years
B) microscopic lymph node metstasis
C) tumor larger than 4 cm
D) poorly differentiated histological grade
E) invasion through capsule to adjacent tissues
24) A 40-year-old woman has extensive microcalcifications involving the
entire upper aspect of the right breast. Biopsy shows a commedo
pattern of intraductal carcinoma.
The most appropriate treatment is :
A) wide local excision
B) radiation therapy
C) wide local excision plus radiation therapy
D) right total mastectomy
E) right modified radical mastectomy
25) In the conventional ventilator management of acute adult respiratory
distress syndrome (ARDS) , arterial O2 saturation is maintained above
90% by all the following EXCEPT :
F) increasing the ventilatory rate
G) the use of positive end-expiratory pressure (PEEP)
H) increasing mean airway pressure
I) increasing tidal volumes
J) increasing FiO2
26) Which of the following statements about patients with abdominal
compartment syndrome is NOT true ?
A) Abdominal pressure is usually measured indirectly through inferior
vena cava
B) Multiple contributing factors are commonly responsible
C) The chief manifestations are reflected in central venous pressure ,
ventilatory function, and oliguria
D) Decopression of the abdomen is required to resverse the syndrome
E) Aggressive hemodynamic monitoring and management is required
when the abdomen is opened
27) The most appropriate treatment for histologically malignant
cystadenoma phylloides is :
A) total mastectomy without axillary node dissection
B) total mastectomy with axillary node dissection
C) wide margin (3) cm excision of the lesion
D) post operative hormonal manipulation
E) postoperative adjuvant chemotherapy
28) Deep venous thrombosis resulting from upper extremity central
venous lines:
A) should be treated with catheter removal, heparin therapy, and long
term anticoagulants
B) is best with urokinase through the catheter
C) is innocuous and self limiting, and best treated with catheter
removal only
D) is best treated with low-dose warfarin (coumadin, 1 mg / day) ,
without catheter removal
E) is best managed by single systemic dose of low molecular weight
heparin daily and continued catheter use
29) Emergency surgery is indicated for all of the following complications
of ulcerative colitis EXCEPT:
A) colonic dilatation greater than 12 cm (toxic mega colon )
B) free perforation
C) complete intestinal obstruction
D) intractable haemorrhage
E) abscess formation
30) All the following statements concerning carcinoma of the oesophagus
are true EXCEPT that:
A) it has a higher incidence in males than females
B) alcohol has been implicated as a precipitating factor
C) adenocarcinoma is the most common type at the cardio esophageal
junction
D) it occurs more commonly in patients with corrosive oesophagitis
E) surgical excision is the only effective treatment
31-. Which of the following statements about epiphrenic diverticula of the esophagus
is/are correct?

f) They are traction diverticula that arise close to the tracheobronchial tree.
g) They characteristically arise proximal to an esophageal reflux stricture.
h) The degree of dysphagia correlates with the size of the pouch.
i) They are best approached surgically through a right thoracotomy.
j) The operation of choice is a stapled diverticulectomy, long esophagomyotomy,
and partial fundoplication.

32- Which of the following statements about Schatzki's ring is correct?

f) The ring represents a panmural fibrotic stricture resulting from gastroesophageal


reflux.
g) Dysphagia occurs when the ring diameter is 13 mm. or less.
h) The ring occurs within 1 to 2 cm. of the squamocolumnar epithelial junction.
i) Schatzki's ring indicates reflux esophagitis.
j) Schatzki's ring signifies the need for an antireflux operation.

33. Which of the following statements about pathology encountered at


esophagoscopy is/are correct?

f) Reflux esophagitis should be graded as mild, moderate, or severe, to promote


consistency among different observers.
g) An esophageal reflux stricture with a 2-mm. lumen is not dilatable and is best
treated with resection.
h) A newly diagnosed radiographic distal esophageal stricture warrants dilation and
antireflux medical therapy.
i) In patients with Barrett's mucosa, the squamocolumnar epithelial junction occurs 3
cm. or more proximal to the anatomic esophagogastric junction.
j) After fasting at least 12 hours, a patient with megaesophagus of achalasia can
safely undergo flexible fiberoptic esophagoscopy.

34. Infantile hypertrophic pyloric stenosis


f) Occurs with a female : male ratio of 4:1.
g) Sons of affected mothers have a 20% risk of developing the lesion
h) Invariably presents between six and eights months of age
i) Typically presents with bile stained projectile vomiting
j) Surgical treatment is by Heller's Cardiomyotomy

35-. Which of the following statements regarding the pathology of esophageal


carcinoma is/are correct?

f) Worldwide, adenocarcinoma is the most common esophageal malignancy.


g) Squamous cell carcinoma is most common in the distal esophagus, whereas
adenocarcinoma predominates in the middle third.
h) Patients with Barrett's metaplasia are 40 times more likely than the general
population to develop adenocarcinoma.
i) Metastases from esophageal carcinoma are characteristically localized to regional
mediastinal lymph nodes adjacent to the tumor.
j) Achalasia, radiation esophagitis, caustic esophageal stricture, Barrett's mucosa,
and Plummer-Vinson syndrome are all premalignant esophageal lesions that
predispose to the development of squamous cell carcinoma.

36-45-year-old with isolated 6-cm colorectal metastasis in the liver 2 years after
colectomy, otherwise healthy pest treatment would be:

f) Radiofrequency ablation
g) Systemic chemotherapy
h) Hepatic lobectomy
i) Liver transplantation
j) Cryosurgical ablation

37- Oesophageal atresia all true except:


f) Is often associated with a distal trachea-oesophageal fistula
g) Polyhydramnios is often present late in pregnancy
h) 50% have other associated congenital abnormalities
i) Contrast X-ray studies are necessary to confirm the diagnosis
j) Post-operatively over 30% develop oesophageal strictures

38-All are true about the dumping syndrome except:


f) Symptoms can be controlled with a somatostatin analog.
g) Diarrhea is always part of the dumping syndrome.
h) Flushing and tachycardia are common features of the syndrome.
i) Separating solids and liquids in the patient's oral intake alleviates some of the
symptoms of the syndrome.
j) Early postoperative dumping after vagotomy often resolves spontaneously.

39-Which of the following statements about gastric polyps is/are true?

f) Like their colonic counterparts, gastric epithelial polyps are common tumors.
g) They are analogous to colorectal polyps in natural history.
h) Endoscopy can uniformly predict the histology of a polyp based on location and
appearance.
i) In a given patient, multiple polyps are generally of a multiple histologic type.
j) Gastric adenomatous polyps greater than 2 cm. in diameter should be excised
because of the risk of malignant transformation.

40-All of the following statements about surgical management of gastric lymphomas


are true except:

f) Stage I gastric lymphomas (small lesions confined to the stomach wall) can be
cured completely with surgical therapy alone.
g) Extensive gastric lymphomas that initially are treated with radiation and/or
chemotherapy occasionally perforate during treatment and require secondary
resection.
h) Patients explored with a presumptive diagnosis of gastric lymphoma should
undergo an attempt at curative resection when this is safe and feasible.
i) Without a preoperative diagnosis resection for gastric mass should not be
attempted unless lymphoma can be excluded.
j) Appropriate staging for primary gastric lymphoma includes bone marrow biopsy.

41-the most accurate test to confirm diagnosis of infected necrotizing pancreases is:

f) Abdominal ultrasound study


g) Indium-labeled leeukocte scan
h) Cimputed tomographic scan
i) Elevated serum level of interleukain 6 and 8
j) Percutaneous needle aspiration

42- Which of the following variables best predicts prognosis for patients with a
recent diagnosis of cutaneous melanoma and no clinical evidence of metastatic
disease?

f) Breslow thickness.
g) Clark's level.
h) Ulceration.
i) Gender.
j) Celtic complexion.
43-the following are true about intracranial tumors except:

f) The most common location of brain tumors of childhood is the posterior cranial
fossa.
g) With few exceptions, examination of the CSF is of no value in the diagnosis of an
intracranial tumor.
h) Even the most malignant of primary brain tumors seldom spread outside the
confines of the central nervous system (CNS).
i) The majority of astrocytomas can be cured surgically.
j) Primary neoplasms of astrocytic, oligodendroglial, or ependymal origin represent
gradations of a spectrum from slowly growing to rapidly growing neoplasms.

44 A right-sided disc herniation at the L5–S1 level typically may cause:

f) Low back pain and left sciatica.


g) Weakness of dorsiflexion of the right foot.
h) A diminished or absent right ankle jerk.
i) Diminution of sensation over the medial aspect of the right foot, including the
great toe.
j) Weakness of dorsiflexion of the left foot.

45-. The preferred operation for initial management of a thyroid nodule that is
considered suspicious for malignancy by FNAB is:

f) Excision.
g) Partial lobectomy.
h) Total lobectomy and isthmusectomy.
i) Total thyroidectomy.
j) All methods are correct

46-the most common presentation of Meckel,s diverticulum in an adult is:

f) GIT bleeding
g) GIT obstruction
h) Intussuception
i) Litter,s hernia
j) Diverticulitis

47-Optimal front-line treatment of squamous cell carcinoma of the rectum includes:

f) Abdominal perineal resection.


g) Low anterior resection when technically feasible.
h) Radiation therapy.
i) Chemotherapy.
j) Combined radiation and chemotherapy.

48 -65-year-old man presents with complaints of mucous discharge and perianal


discomfort. Physical examination reveals a fistulous opening lateral to the anus.
Anoscopic examination permits passage of a probe through the fistula tract. The
fistula traverses the internal anal sphincter, the intersphincteric plane, and a portion
of the external anal sphincter. The fistula is categorized as which type?

a) Intersphincteric
b) Transsphincteric
c) Suprasphincteric
d) Extrasphincteric
e) Non of the above

49-Warthin's tumor:

f) Is a pleomorphic adenoma of salivary gland


g) Should be treated by total paritidectomy
h) Is considered a benign salivary gland neoplasia
i) Respond well to preoperative radiotherapy
j) Often present with facial nerve compression

50-A 38 year old woman presents with right upper quadrant pain and
bouts of vomiting. She is known to have gallstones and has had similar
episodes in the past. Which of the following might support a diagnosis
of acute cholecystitis rather than biliary colic

a) duration of symptoms
b) Severity of vomiting
c) Presence of Murphy's sign
d) Presence of gas under right hemidiaphragm on erect CXR.

1. The radial nerve.


a) Is a branch of the anterior cord of the brachial plexus.
b) Is derived from the posterior primary rami of C5 to C7.
c) Supplies the flexors of the arm.
d) Gives rise to the anterior interosseous nerve.
e) Injury above elbow produces a classical wrist drop.
2. Regarding femoral canal all are true except:
a) Lies lateral to the femoral vein.
b) Has the inguinal ligament as its anterior border.
c) Has the lacunar ligament as its medial border.
d) Has the pectineal ligament as its posterior border.
e) Contains the lymph node of Cloquet.
3. The following causes hypercalcaemia except:
a) Sarcoidosis.
b) Primary hyperparathyroidism.
c) Acute pancreatitis.
d) Metastatic bronchial carcinoma.
e) Milk-Alkali syndrome.
4. Number of human chromosomes in human female are:
a) 23 pairs +XX.
b) 21 pairs +XY.
c) 22 pairs +XY.
d) 22 pairs +XX.
e) 23 pairs +XY.
5. Potassium deficiency should be suspected in all the following
except:
a) In cases of paralytic ileus.
b) When the patient's reflexes are exaggerated.
c) If there is a decrease in height and peaking of the T waves of an
ECG.
d) In alkalotic states.
6. Active immunization in case of tetanus:
a) Antitetanus human serum.
b) Gives short period of protection.
c) Given in case proved tetanus.
d) Use of immunoglobulin.
e) None of the above.
7. All of the following are signs of rised intracranial pressure
except:
a) Headache.
b) Vomiting.
c) Papilledema.
d) Aphasia.
e) Bradycardia.
8. All of the following are extra cranial hematomas except:
a) Subcutaneos haematoma.
b) Extra dural haematoma.
c) Cephalohaematoma.
d) Subgaleal hematoma.
e) Subperiostial haematoma.
9. Glasgow coma scale all the following are true except:
a) Used for evaluation of comatose patient.
b) It ranges from ( 3 to 15).
c) Useful for neurological follow up.
d) Useful for pupils evaluation.
e) Best motor response given 6 point.
10. All the followings are Indications for central line insertion
EXCPET:
a) Massive fluid replacement
b) Massive blood replacement
c) Measurement of central venous pressure
d) Prolonged Intervenes fluid therapy
11. Most common early complication of central venous line is:
a) Sepsis
b) Pneumothorax
c) Thoracic duct injury
d) Thrombosis
12. The following are Complications of shock:
a) Acute Respiratory failure
b) Acute myocardial infarction
c) Acute renal failure
d) A&C only
e) All the above
13. Causes of delayed union of fractures includes all the following
EXCPET:
a) Compound fracture
b) Infection
c) Adequate immobilization
d) Poor blood supply
14. In Head injury C.T. scan is indicated in the following
a) Aphasia after the injury
b) Deterioration of level of consciousness
c) Skull fracture with persistent headache
d) A&B only
e) All the above
15. Most important steps in management of head injury include:
a) Prevent hypoxia
b) Prevent Dehydration
c) Assure Brain Metabolism
d) Prevent secondary brain injury
e) All the above
16. Tension pneumothorax
a) is the commonest type of chest injuries
b) Needs urgent X-Ray chest
c) Is a clinical Diagnosis
d) Causes flat neek viens
e) Treated by thoracotomy tube after chest X-ray.
17. Calcitonin hormon is secreted to the blood circulations from:
a) Parathyroid gland.
b) Parafollicular cells of thyroid gland.
c) Supra renal gland.
d) Pituitary gland.
e) Gonads.
18. Regarding tension pneumothorax, the first step in the management
is:
a) Obtaining a stat chest x-ray.
b) Cricothyroidectomy.
c) Pass an endotracheal tube.
d) Starting oxygen by a valve-mask device.
e) Chest decompression needle.
19. The following are features of thyrotoxicosis except:
a) Weight gain.
b) Palpitations.
c) Proximal myopathy.
d) Increased skin pigmentation.
e) Pretibial myxoedema.
20. The following is a clinical feature of Horner's syndrome:
a) Miosis
b) Failure of abduction of the orbit
c) Increased sweating on the contralateral side of the forehead
d) Exophthalmos.
e) All are true
21. In role of nine extent of burn if entire trunk is burned it will be
equal to:
a) 9% body surface area.
b) 18% body surface area.
c) 36% body surface area.
d) 27% body surface area.
e) 45% body surface area.
22. Trachlea (4th) cranial nerve supply :
a) Lateral rectus muscle of th eye.
b) Medial rectus muscle of the eye.
c) Superior obligue rectus muscle of the eye.
d) Superior oblique muscle of the eye.
e) Muscles of the upper eye lid.
23. Regarding pathological terms :
a) Hypertrophy is an increase in tissue size due to increased cell
number.
b) Hyperplasia is an increase in tissue size due to an increase in cell
size.
c) Atrophy is an increase in tissue size due to disuse.
d) Metaplasia is a change form one abnormal tissue type to another.
e) A hamartoma is a developmental abnormality.
24. Regarding nephroblastomas:
a) They are otherwise known as a Wilm's tumour.
b) Account for 10% of childhood tumours.
c) The commonest presentation is with an abdominal mass.
d) Most commonly present between 2nd and 4th year of life.
e) All are true.
25. Regarding fluid losses in a major burn all are true except:
a) Are maximal between 12 and 24 hours after the injury.
b) Are related to the age of the patient.
c) Are not related to the weight of the patient.
d) Are related to the area burnt.
e) Are not related to the burn duration.
26. In obstructive jaundice :
a) Urinary conjugated bilirubin is increased.
b) Serum unconjugated bilirubin is increased.
c) Urinary urobilinogen is increased.
d) Serum conjugated bilirubin is reduced.
e) Faecal stercobilinogen is increased.
27. Regarding Hydatid disease:
a) Is due to Ecchinococcus granulosa.
b) Man is an accidental intermediate host.
c) The liver is the commonest site of infection.
d) Can be diagnosed by the Casoni test.
e) All are true.
28. The first aid of treatment in fracture of cervical spine should
be:
a) Cervical spine x-ray.
b) Analgesia.
c) Neck immoblization.
d) Cervical traction.
e) Non of teh above.
30. Regarding local anaesthesia:
a) Local anaesthetics act on small before large nerve fibres
b) Adrenaline reduces absorption and prolongs the local effects
c) Preparations containing adrenaline are safe to use on digits and
appendages
d) Lignocaine has a longer duration of action than bupivicaine.
e) All are false.
31. Small bowel obstruction often results in: (all correct except one)
a) Hyperkalaemia.
b) Metabolic alkalosis.
c) Oliguria.
d) Hypovolaemia.
e) Severe dehydration.
32. A serious intra-abdominal injury in a comatose patient may be
diagnosed by: (all are correct except one)
a) Abdominal paracentesis.
b) The observation of bruising pattern on the abdominal wall.
c) Falling of heamoglobin values.
d) The presence of marked abdominal distetion.
e) The presence of diarrhea.
33. A perforated duodenal ulcer, all are true except:
a) Usually lies on the anterior or superior surface of the duodenum.
b) Usually presents with the acute onset of severe back pain.
c) Produces radiological evidence of free gas in the peritoneum in
over 90 percent of the patients.
d) Is usually treated by vagotomy and pyloroplasty.
e) Is usually treated conservatively.
34. Acute pancreatitis typically: (all correct except one)
a) Is accompanied by hypocalcaemia.
b) Produces paralytic ileus.
c) Is associated with a pleural effusion.
d) Produces pyloric stenosis.
e) Upper abdominal pain and vomiting.
35. Biliary colic typically:
a) Occurs 3 to 4 hours after meals.
b) Lasts 5 to 20 minutes.
c) Radiates from the upper abdomen to the right subscapular region.
d) Is made better by deep inspiration.
e) B&C only.
36. In post operative DVT, the following are true except:
a) Clinical DVT occures in the 4th post operative day.
b) If complicated by pulmonary embolism, it occures usually after the
7th post operative day.
c) The process of DVT starts preoperatively with the induction of
anaesthesia .
d) When discovered we should start the patient on coumadin
"Warfarin anticoagulation".
e) It may lead to chronic venous in suffering as a complication of
DVT.
37. In acute appendicitis all of the following are true except:
a) Anorexia.
b) Abdominal pain usually preceedes vomiting.
c) Pain after begins in the paraumbilical region.
d) Constipation diarrhea may occur.
e) Dysuria excludes the diagnosis.
38. The most common cause of massive haemorrhage in the lower
gastroinfestinal tract is :
a) Carcinoma.
b) Diverticulosis
c) Diverticulitis
d) Polyp.
e) Ulcerative colitis.
39. Painless haematuria is the leading presentation of :
a) Renal cell carcinoma.
b) Transitional cell carcinoma of the bladder .
c) Ureteric stone.
d) Pelvi-ureteric obstruction.
e) Ureterocele.
40. All of the following are complications of massive blood transfusion
except:
a) Acute congestive heart failure.
b) Transmission of infection.
c) Hypercalcaemia.
d) Hyperkalaemia.
e) Transfusion reactions.
41. Complication of undescended testis include all of the following
except :
a) Malignant degeneration.
b) Increased susceptability to trauma.
c) Increased spermatogenesis.
d) More liable to testiculer torsion.
e) Psychological complication.
42. The recurrent laryngoeal nerve is branch of :
a) Facial nerve.
b) Glosso-pharyngeal nerve.
c) Cervical plexus.
d) Vagus nerve.
e) Brachial plexus.
43. The thyroid tumor which is may be associated with
pheochromocytoma
is :
a) Papillary carcinoma.
b) Medullary carcinoma.
c) Follicular carcinoma.
d) Anaplastic carcinoma.
e) Malignant lymphoma.
44. The most common pancreatic cyst is :
a) Dermoid cyst of the pancreas.
b) Hydatid cyst of the pancreas.
c) Pancreas pseudocyst.
d) Pancreatic cystadenoma.
e) Congenital cystic disease of the pancreas.
45. The anatomical division between the anus and rectum :
a) Lateral haemorrhoidal groove.
b) Inter haemorrhoidal groove.
c) Dentate line.
d) Arcuate line
e) Ano-rectal ring.
46. The comments type of Anorectal abscess is:
a) Ischio rectal
b) Perianal
c) Submucons
d) Pelvirectal
47. Anal Fissure:
a) Usually anterior
b) May be caused by previous anal surgery
c) Can cause dark bleeding PR.
d) Sometimes is painful
e) Treated by steroids
48. Neonatal duodenal obstruction:
a) May be associated with down's syndrome.
b) Is more frequently found in premature infants.
c) Typically presents with gross abdominal distension.
d) Usually presents with vomiting of non-bile stained fluid
e) B&C only.
49. acute superior mesenteric artery occlusion: (all correct except one)
a) Characteristically presents with sudden pain and tenderness of
increasing intensity.
b) Is frequently accompanied by overt or occult blood loss in the stools.
c) Frequently produces peritonitis.
d) Can usually be diagnosed on plain abdominal x-rays.
e) Can be diagnosed by mesenteric artery ongiography.
50. Regarding the management of polytrauma:
a) Death follow a trimodal distribution.
b) X-ray after primary survey should be AP cervical spine, chest
and pelvis.
c) Cardiac tamponade is characterized by raised B.p, a low JUP.
d) Assessment of uncomplicated limb fractures should occur
during the primary survey.
e) A and B only.
51. Injuries to the urethra (all are correct except one)
a) Are more common in male.
b) Are often caused by road traffic accidents.
c) Are easily diagnosed on intra venous pyelography.
d) Require urgent surgical treatment.
e) Diagnosed by retrograde urethragraphy.
52 .Car seat belts when properly adjusted
a) Prevent injuries to abdominal organs.
b) May cause small bowel injuries.
c) Do not reduce the incidence of head injuries of passengers involving
in RTA.
d) Protect the cervical spine during sudden acceleration .
e) A & D only.
53. Patients with major burns:
a) Are in a negative nitrogen balance.
b) Have normal calorie requirements.
c) Do not generally become anaemic.
d) Are resistant to septicaemia.
e) All of the above.
54 . In a healing fracture: (All correct except one)
a) The haematoma is initially invaded by osteoblasts.
b) The tissue formed by the invading osteoblasts is termed osteoid.
c) Calcium salts are laid down in the osteoid tissue.
d) The final stage of repair is the remodelling of the callus.
e) The callus formation is related to the amount of stress at fracture side.
55. In a colles’ fracture the distal radial fragment:
a) Is dorsally angulated on the proximal radius.
b) Is usually torn from the intra-articular triangular disc.
c) Is deviated to the ulnar side.
d) Is rarely impacted.
e) Is ventrally displaced.
56. A malignant melanoma:

a) Frequently arises from hair-bearing naevi.


b) Frequently arises from junctional naevi. *
c) Has a worse prognosis when it areses on the leg.
d) Should be suspected in any big pigmented lesion.
e) Non of the above is correct.
57. Squamous cancer of the lip:
a) Is most common in early adult life.
b) Is more common in fair skinned subjects.
c) Metastasises readily by the blood stream.
d) Is preferably treated by radiotherapy once lymph node deposits are
present.
e) All of the above are correct.
58- Basal cell carcinomas:
a) Usually metastasise to regional lymph nodes.
b) Are less common than squamous cell carcinomas.
c) Are characterised histologically by epithelial pearls.
d) Are particularly common in oriental races.
e) Non of the above is correct.
59- Fiboadenomata of the breast:
a) Are commonest in early adult life.
b) Are indiscrete and difficult to distinguish.
c) Are usually painless.
d) Resolve without treatment.
e) A&C only.
60. Paget’s disease of the nipple:
a) Usually presents as abilateral eczema of the nipple.
b) Is always related to an underlying breast cancer.
c) Indicates incurable breast cancer.
d) Has non-specific histological characteristics.
e) A&C only.
61- stones in the common bile duct:
a) Are present in nearly 50 per cent of cases of cholecystitis.
b) Often give rise to jaundice, fever and biliary colic.
c) Are usually accompanied by progressive jaundice.
d) Are usually associated with a distended gallbladder.
e) A&D only.
62- Colonic polyps: (all correct except one)
a) Are associated with colonic cancer.
b) May be hereditary.
c) Should not be removed if they are asymptomatic.
d) May be hyperplastic.
e) Are commonly adenomatous.

A 40-year-old female has a 4-cm hemangioma in the right lobe


of the liver on computed tomography scan. She is
asymptomatic. Appropriate action should be:

(a) fine-needle biopsy

(b) arrangement for elective resection

(c) no further action

(d) angiographic embolization

Regarding an amebic liver abscess:

(a) surgical drainage is usually required

(b) negative stool testing for amebiasis rules out the disease

(c) it should be drained percutaneously under com- puted


tomography guidance
(d) it is treated with metronidazole

A single organism is usually the causative agent in:


(a) pelvic inflammatory disease
(b) perforated diverticulitis
(c) acute cholecystitis
(d) primary peritonitis
(e) diabetic foot infections

Signs and symptoms of hemolytic transfusion reactions include


a. Hypothermia
b. Hypertension
c. Polyuria
d. Abnormal bleeding
e. Hypesthesia at the transfusion site

In a hemolytic reaction caused by an incompatible blood


transfusion, the treatment that is most likely to be helpful is:
a. Promoting a diuresis with 250 ml of 50% mannitol
b. Treating anuria with fluid and potassium replacement
c. Acidifying the urine to prevent hemoglobin precipitation in the
renal tubules
d. Removing foreign bodies, such as Foley catheters, which may
cause hemorrhagic complications
e. Stopping the transfusion immediately

Which statements about extrahepatic bile duct cancer are


correct?

A. Cholangiography is not essential in evaluating patients for


resectability.

B. The prognosis is excellent when appropriate surgical and


adjuvant therapy are given.
C. The location of the tumor determines the type of surgical
procedure.

D. The disease usually becomes manifest by moderate to severe


right-side upper quadrant pain.

Which of the following statements about the diagnosis of acute


calculous cholecystitis is true?

A. Pain is so frequent that its absence almost precludes the


diagnosis.

B. Jaundice is present in a majority of patients.

C. Ultrasonography is the definitive diagnostic test.

D. Cholescintigraphy is not definitive diagnostic test.

Which statement about acute acalculous cholecystitis is


correct?

A. The disease is often accompanied by or associated with other


conditions.

B. The diagnosis is often difficult.

C. The mortality rate is higher than that for acute calculous


cholecystitis.

D. The disease has been treated successfully by percutaneous


cholecystostomy

E- all are correct


Which of the following statements about laparoscopic
cholecystectomy are correct?

A. The procedure is associated with less postoperative pain and


earlier return to normal activity.

B. The incidence of bile duct injury is lower than for open


cholecystectomy.

C. Laparoscopic cholecystectomy should be used in asymptomatic


patients because it is safer than open cholecystectomy.

D. Pregnancy is a contraindication.

A 15-year-old female presents with RUQ abdominal pain.


Workup reveals a choledochal cyst. Which of the following
statements is TRUE?

(A) Choledochal cysts are more common in men.


(B) Laparoscopic cholecystectomy is the recommended treatment.
(C) Patients with a choledochal cyst have an increased risk of
cholangiocarcinoma.
(D) All patients with a choledochal cyst have abdominal pain, a
RUQ mass, and jaundice.
(E) The etiology is infectious.

An 85-year-old man is brought to the hospital with a 2-day


history of nausea and vomiting. He has not passed gas or
moved his bowels for the last 5 days. Abdominal films show
dilated small bowel, no air in the rectum and air in the biliary
tree. Which of the following statements is TRUE?

(A) Air in the biliary tree associated with small-bowel


obstruction suggests a diagnosis of gallstone ileus.
(B) An enterotomy should be distal to the site of obstruction and
the stone should be removed.
(C) Gallstone ileus is more common in the young adults.
(D) Cholecystectomy is contraindicated.
(E) Small-bowel obstruction usually occurs in the distal jejunum.

A45-year-old patient with chronic pancreatitis is suffering from


malnutrition and weight loss secondary to inadequate
pancreatic exocrine secretions. Which is TRUE regarding
pancreatic secretions?
(A) Secretin releases fluid rich in enzymes.
(B) Secretin releases fluid rich mainly in electrolytes and
bicarbonate.
(C) Cholecystokinin releases fluid,predominantly rich in
electrolytes, and bicarbonate.
(D) All pancreatic enzymes are secreted in an inactive form.
(E) The pancreas produces proteolytic enzymes only.

A 43-year-old woman has gallstone pancreatitis that resolves in


2 days with conservative treatment. She has no abdominal
complaints and her liver and pancreatic laboratory values have
returned to normal. She is scheduled for laparoscopic
cholecystectomy. Which of the following statements is TRUE?
(A) Intraoperative cholangiography is associated with a
decreased risk of biliary tract injury .
(B) The procedure should be scheduled for 6 weeks after
resolution of symptoms .
(C) Intraoperative cholangiography in this patient will identify
choledocholithiasis in 50% of cases .
(D) Preoperative endoscopic retrograde
cholangiopancreatography (ERCP) should be performed.
(E) The sensitivity of magnetic resonance
cholangiopancreatography (MRCP) for choledocholithiasis in this
patient is less than 50%.

A 39-year-old woman is admitted with gallstone pancreatitis


and epigastric pain. Pertinent data include amylase, 2000 U/L;
bilirubin, 1.2 mg/dL; and WBC count, 15,000/mm3 . After 2
days of medical management, her epigastric pain resolves. Her
amylase is 340 U/L and her bilirubin and WBC count have
returned to normal. Laparoscopic cholecystectomy should be
attempted:

(A) after endoscopic retrograde cholangiopancreatography


(ERCP) and sphincterotomy
(B) prior to discharge
(C) once her amylase is normal
(D) 4 to 6 weeks later
(E) only if the patient develops recurrent pancreatitis

Following a motor vehicle accident a truck driver complains of


severe abdominal pain. Serum amylase level is markedly
increased to 800 U. Grey Turner’s sign is seen in the flanks.
Pancreatic trauma is suspected. Which statement is true of
pancreatic trauma?
(A) It is mainly caused by blunt injuries.
(B) It is usually an isolated single-organ injury.
(C) It often requires a total pancreatectomy.
(D) It may easily be overlooked at operation.
(E) It is proved by the elevated amylase level.

In obstructive jaundice, which of the following statements is


true regarding alkaline phosphatase?
(A) Its level increases before that of bilirubin.
(B) Its level is unlikely to be increased in pancreatic malignancy.
(C) Its elevation indicates bone metastasis.
(D) Its elevation excludes hepatic metastasis.
(E) Its level falls after that of the bilirubin,following surgical
intervention.

A48-year-old female travel agent presents with jaundice.


Radiological findings confirm the presence of sclerosing
cholangitis. She gives a long history of diarrhea for which she
has received steroids on several occasions. She is likely to suffer
from which of the following?
(A) Pernicious anemia
(B) Ulcerative colitis
(C) Celiac disease
(D) Liver cirrhosis
(E) Crohn’s disease

A38-year-old male lawyer develops abdominal pain after


having a fatty meal. Examination reveals tenderness in the
right hypochondrium and a positive Murphy’s sign. Which test
is most likely to reveal acute cholecystitis?
(A) trans abdominal ultrasound
(B) Oral cholecystogram
(C) Intravenous cholangiogram
(D) CT scan of the abdomen
(E) ERCP

A 65-year-old woman is admitted with RUQ pain radiating to


the right shoulder, accompanied by nausea and vomiting.
Examination reveals tenderness in the RUQ and a positive
Murphy’s sign. A diagnosis of acute cholecystitis is made. What
is the most likely finding?
(A) Serum bilirubin levels may be elevated.
(B) Cholelithiasis is present in 40–60%.
(C) Bacteria are rarely found at operation.
(D) An elevated amylase level excludes this diagnosis.
(E) A contracted gallbladder is noted on ultrasound.

A 32-year-old diabetic woman who has taken contraceptive


pills for 12 years develops RUQ pain. CT scan of the abdomen
reveals a 5-cm hypodense lesion in the right lobe of the liver
consistent with a hepatic adenoma. What should the patient be
advised to do?
(A) Undergo excision of the adenoma
(B) Stop oral contraceptives only
(C) Stop oral hypoglycemic medication
(D) Undergo right hepatectomy
(E) Have serial CT scans every 6 months

A 9 month old boy presents with an acute scrotal swelling. The


mos likely diagnosis is:
A. Epididymitis
B. Orchitis
C. Torsion of the testicular appendage
D. Irreducible inguinal hernia
E. Acute idiopathic scrotal oedema

A 76-year-old man presents with weight loss, dark urine,


and pale stools which are difficult to flush away. An excess
of which of the following would account for this history?
a. Conjugated bilirubin
b. Hyperbilirubinaemia
c. Stercobilinogen
d. Unconjugated bilirubin
e. Urobilinogen

An otherwise well 13-year-old boy is admitted complaining


of sudden onset severe left sided testicular pain 2 hours prior to
admission. He gives no history of trauma, dysuria or frequency.
On examination he is found to have a tender, high-riding
testicle.What is the most appropriate next step in this young
?man’s management
a. Herniography
b. Scrotal Doppler ultrasound on the next available list
c. FBC and U&E
d. Scrotal Doppler ultrasound as an emergency
e. Surgical exploration of his scrotum

Acute scrotum
a. Torsion testis should be operated within 12 hour of
presentation
b. Epidedimoorchitis pain increase by testicular elevation
c. If in doubt scrotum should be explored
d.Doppler ultrasound has no role in diagnosis
e.None of the above

stones in the common bile duct:


a. Are present in nearly 50 per cent of cases of
cholecystitis.
b. Often give rise to jaundice, fever and biliary colic.
c. Are usually accompanied by progressive jaundice.
d. Are usually associated with a distended gallbladder.
e. A&D only.

Which of the following statements regarding whole blood


transfusion is correct?
a. Whole blood is the most commonly used red cell
preparation for
transfusion in the
b. Whole blood is effective in the replacement of acute
blood loss.
c. Most blood banks have large supplies of whole blood
available.
d. The use of whole blood produces higher rates of disease
transmission than the use of individual component therapies.
e. Old Whole blood is effective in the replacement of
platelets.

Acute cholecystitis all are true except


a. Commonest bacteria is E .coli
b. Wall thickness more than 3mm by ultrasound
c. WCC is between 10-15 000 cell/mm3
d. Mild elevated bilirubin may accompany it
e. HIDA scan has no role in diagnosis of acute
cholecystitis

A 51-year-old male experiences the sudden onset of massive


emesis of bright red blood. There have been no prior episodes
of hematemesis. He is known to be hepatitis B surface antigen
positive. His hematemesis is most likely a consequence of which
of the following abnormalities of the esophagus?
a. Varices
b. Barrett esophagus
c. Candidiasis
d. Reflux esophagitis
e. Squamous cell carcinoma

A 61-year-old male has had ascites for the past year. After a
paracentesis with removal of 1 L of slightly cloudy,
serosanguinous fluid, physical examination reveals a firm,
nodular liver.Laboratory findings include positive serum
HBsAg and presence of hepatitis B core antibody. He has a
markedly elevated serum alpha-fetoprotein (AFP) level. Which
of the following hepatic lesions is he most likely to have?
a. Hepatocellular carcinoma
b. Massive hepatocyte necrosis
c. Marked steatosis
d. Wilson disease
e. Autoimmune hepatitis

Acute pancreatitis
a.Serum calcium start to rise after 48 hours
b.Hypoglycaemia is bad prognostic factor
c.Age is an important prognostic factor
d.Serum amylase is more specific than serum lipase
e.Severe pancreatitis compromise around 40% of cases
The most commonly used imaging method for diagnosis of
acute cholecystitis is:
f. CT of the abdomen.
g. Ultrasonography of the gallbladder.
h. Oral cholecystogram.
i. Radionuclide (HIDA) scan of the gallbladder
j. MRI
A 23-year-old male presents to the emergency department after
being involved in a motor vehicle accident. On physical
examination, he opens his eyes spontanously, he occasionally
mumbles incomprehensible sounds, he localizes to painful
stimulation with his right upper extremity, His pupils are 4 mm
bilaterally and reactive. This patient’s Glasgow Coma Scale
(GCS) score:
a. 7
b. 9
c. 8
d. 11
e. 12

Complication of undescended testis include all of the following


except :
a. Malignant degeneration.
b. Increased susceptability to trauma.
c. Increased spermatogenesis.
d. More liable to testiculer torsion.
e. Psychological complication
Neonatal duodenal obstruction:
a. May be associated with down's syndrome.
b. Is more frequently found in premature infants.
c. Typically presents with gross abdominal distension.
d. Usually presents with vomiting of non-bile stained fluid
e. B&C only.

Markedly elevated alpha-fetoprotein is diagnostic


(A) Hepatic hemangioma
(B) Angiosarcoma in the liver
(C) Hepatic adenoma
(D) Focal nodular hyperplasia
(E) Hepatocellular carcinoma
on clinical examination of tortion testis all are true except:
a. testis is tender and swollen.
b.testis is elevated and raised.
c.loss of cremasteric reflex.
d.redness with possible reactive hydrocele.
e. pain decrease with elevation of the testis .

Regarding cryptorchidism(undesended testis) all are true except


a. refers to the interruption of the normal descent of the testis into
the scrotum.
b. The testicle may reside in the retroperitoneum, in the —
internal inguinal ring, in the inguinal canal, or even at the
.external ring
C. At birth, approximately 95% of infants have the testicles —
.normally positioned in the scrotum
D. it’s a common disorder and incidence increased up to 30 % —
. in premature
E. undescended testis is always regarded as an ectopic —
.testis

.:Regarding GI(gastrointestinal bleeding ) all are true except


a.Lower GI hemorrhage is defined as an abnormal intra luminal
.blood loss from a source distal to the Treitz ligament
b.The most cause of massive lower GI bleeding in adults are
.diverticulosis and angiodysplasia
c.Cancer colon is usually associated with massive lower GI
.hemorrhage
d.Hemorrhage from diverticular disease stops spontaneously —
.in 80% of patients
E. patients with massive upper GI bleeding may present with —
.maroon stools or bright red blood from the rectum
—
:Signs of severe bood loss include the following except —
a.Pallor —
b.Clammy skin —
c.bradycardia —
d.Tachycardia —
e.Hypotension —
: regarding stigmata of bleeding in peptic ulcer
. a.its associated with increase risks for rebleeding
.b.adherent clot is the most significant stigmata
c.arterial spurting hemorrhage associated with low risk of
. rebleeding
d.risk of rebleeding in ulcer with clean base is above 50%
e.nonbleeding visible vessel is not associated with risk of
. rebleeding

Features of inflammatory response syndrome (SIRS) include


the following except:
a. Temperature> 38.4C
b. Temperature <36.C
c. WCC<4.ooo cells per ml
d. Respiratory rate >20 per minute
e. PCO2> 32 mmHg

The development of thrombocytopenia and arterial thrombosis


with heparin requires:
a. Continuation of heparin and platelet transfusion
b. Continuation of heparin and thrombolysis
c. Doubling the heparin dosage
d. Changing the route of heparin administration
e. Discontinuation of heparin

Regarding Heparin-induced thrombocytopenia (HIT) all are


true except
a. Is a special case of drug-induced immune
thrombocytopenia.
b. The platelet count typically begins to fall 5 to 14
days after heparin has been started.
c. Thrombocytopenia is usually severe.
d. HIT should be suspected if the platelet count
falls to less than 100,000 or if it drops by 50%
from baseline in a patient receiving heparin
e. HIT is more common with full-dose
unfractionated heparin (1 to 3%)

Regarding gall bladder and bile secretion all are true except :
— a.The gallbladder is a pear-shaped, about 7 to 10 cm long
with an average capacity of 30 to 50ml.
— b.When obstructed, the gallbladder can distend markedly and
contain up to 300 mL
— c. Anomalies of the hepatic artery and the cystic artery are
quite common, occurring in as many as 50% of cases.
— d.liver produces 500 to 1000 mL of bile a day
— e.Vagal stimulation decreases secretion of bile
—
— Regarding gall bladder stones all are true except:
a. Prevalence increases with advancing age —
b. Over 10% of those with stones in the gallbladder —
.have stones in the common bile duct
c.10-20% become symptomatic
d.cholesterol stones are the most common type.
e.pigment stones are associated with secondary common
bile duct stones .

In acute cholecystitis all true except :


a.Most common organisms are E. coli
b. 90% cases result from obstruction to the cystic duct by a
stone.
C .patient present with constant pain usually greater than 6
hours duration in right upper quadrant .
d.presence of gall stones and percholecystic fluid on US is
diagnostic
e.Cholecystectomy is contraindicated in acute stage .

complication of acute cholecystitis include all the following


except:
a.Gangrenous cholecystitis
b.Gallbladder perforation
c.Cholecystoenteric fistula
d.mesnteric ischemia
e.Gallstone ileus
Regarding choledocholithisis all are true except:
a. may be silent and or may cause obstruction, complete or
incomplete
b. may manifest with cholangitis or gallstone pancreatitis.
c.present with severe jaundice and cholangitis in case of stone
impaction
d.Rt upper quadrant pain ,fever,and jaundice are called charcots
triad in cholangitis.
e.impaction of small stones has no relation with acute
pancreatitis .

Regarding acalculous cholecystistis all are true except:


a. Acute inflammation of the gallbladder can occur without
gallstones
b. Acalculous cholecystitis typically develops in critically ill
patients in the intensive care unit.
c. Patients on parenteral nutrition with extensive burns, sepsis,
major operations are at risk for developing acalculous
cholecystitis.
d.US is not a good diagnostic tool.
E.can be managed by cholecystectomy or percutanous
cholecyststomy .

Regardind gall bladder cancer all are true except:


a. Larger stones (>3 cm) are associated with a 10-fold increased
risk of cancer.
b. up to 95% of patients with carcinoma of the gallbladder have
gallstones.
c. Polypoid lesions of the gallbladder are not associated
with increased risk of cancer
d. Patients with choledochal cysts have an increased risk of
developing cancer
e. Sclerosing cholangitis is risk factor for developing gall
bladder cancer .

Regarding tumors of the liver all are true except :


a.Hemangioma is the most common solid benign lesion .
b.Spontaneous rupture in hemangioma (bleeding) is rare.
c.Hepatic adenomas carry a significant risk of spontaneous
rupture with intraperitoneal bleeding.
d. Hepatic adenomas have a risk of malignant transformation to
a well-differentiated HCC(hepatocellular carcinoma).
e.focal nodular hyperplasia lesions(FNH) lesions usually
rupture spontaneously and have significant risk of
malignant transformation .

Regarding pyogenic liver abscess all are true except :


a. arise as a result of biliary sepsis.
b.associated with high mortality.
c .appendicitis is unlikely the cause pyogenic liver abscess.
d.30% of patient have pleural effusion on presentation .
e.lab.investiation show elevated WBC and abnormal liver
function .
Regarding acute pancreatitis all are true except:
a.Gallstones less than 5mm diameter are more likely to cause
pancreatitis than larger ones
b.. The mortality associated with infected necrosis is about 40%
c.Cullen's sign is a sign of retroperitoneal hemorrhage in severe
hemorrhagic pancreatitis .
d.elevated serum amylase is a significant predictor of
severity .
e.. 50% of deaths occur within first week due to multi-organ
failure .

All occur as a complication of acute pancreatitis except:


a.panreatic fluid collection
b.colonic necrosis
c.coagulopathy
d.hypercalcemia
e.respiratory failure

Regarding head trauma all are true except:


a.basal skull fracture regarded when one of the orbital roof
,sphenoidal bone or petromastoid portion are involved .
b.epidural hematoma is an Lens shape hematoma between dura
and the skull.
c.subdural hematoma is crescent shaped hematoma ,between
brain and dura
d.secondary brain injury is preventable.
e.GCS glascow Coma scale 3/15 indicate uncomprehensive
sounds .

Regarding chronic lower limb ischemia all are true except:


a. Claudication distance is distance after which the pain is felt.
b. Rest pain is continous severe burning pain in the foot which
indicate critical ischemia.
c. trophic changes include tapering digits ( loss of S.C fat ) and
muscle wasting .
d. usuall presentations of patients with lower limb ischemia are
pain,trophic changes and gangrene.
e. venous filling time more than 2 minutes indicates mild
lower limb ischemia.

Regarding 4 weeks 4 Kg bodywt. old full term neonate


presented with rapidly progressive projectile non bilious
vomiting and palpable upper abdominal mass all are true
except :
a. dehydration and alkalosis are prominent features.
b.maintenance fluid therapy is about 4ml /Kg /hour.
c.administration of IV fluids with 5% dextrose, 0.5% normal
saline, and KCl usually corrects the alkalosis .
d.Estimated total blood volume is about 320 cc.
E. the most likely diagnosis is high jejunal atresia
All are true regarding jejunoileal atresia except:
a. present with bile stained vomiting .
b. Failure to pass meconium or small amounts of mucus or
meconium maybe passed per rectum.
c. present with abdominal distention.
d. X-ray show double bubble appearance .
e. The x-rays usually show multiple air-fluid levels.

regarding malrotation of the gut all are true except:


a.The patient might be asymptomatic and then develop the
symptoms when he is older.
b.Commonest abnormality results in caecum lying close to DJ
flexure.
c.Fibrous bands may be present between caecum and DJ flexure
(Ladd's bands).
d. the patient is unlikely to have clinical picture of duodenal
obstruction .
e. In malrotation midgut mesentery is abnormally narrow and
liable to volvulus.

26. The initial maneuver to establish an airway in a patient with multiple


injuries is:
a. Oropharyngeal airway.
b. Uncuffed endo-tracheal tube.
c. Suctioning foreign debris and lifting up the mandible.
d. Cuffed endo-tracheal tube.
e. Tracheostomy.

27. Which is the most commonly injured intra-abdominal organ in blunt


trauma?
a. Pancreas.
b. Kidney.
c. Spleen.
d. Stomach.
e. Colon.

28. The most important principle in the management of severe


hemorrhagic shock is to:
a) Obtain blood for possible type-specific transfusion.
b) Place CVP lines early for fluid resuscitation and monitoring.
c) Rapidly infuse colloid fluids.
d) Apply MAST garment.
e) Secure the airway and adequate ventilation.

29. A 6-year-old child sustained the following injuries in an accident.


Which one of the followings should be managed first?
a. Extradural hematoma.
b. Pneumothorax.
c. Hollow viscus injury.
d. Renal injury.
e. Liver laceration.

30. All the following are complications of massive blood transfusion


except:
a. Hypothermia.
b. Hypocalcaemia.
c. Hypokalaemia.
d. Acidosis.
e. DIC.
6.Severe limb pain of sudden onset can be caused by all the
following conditions except:
a. Acute ischaemia.
b. Deep venous thrombosis.
c. Muscle tear.
d. Sciatica.
e. Bone fracture.

?Which of the following is not a classic sign of a basal skull fracture .7


a. Battle sign
b. racoon eyes
c. hemotympanum
d. Gray –Turner sign
e. CSF rhinnorhea/ottorrhea
.e. thiamine

:Tension pneumothorax is best diagnosed with.8


A, stat CT scan
b. chest x-ray
c. watch and wait
d. clinical exam
.e. none of the above

:While doing thoracocentesis, it is advisable to introduce needle along .9


.a. Upper border of the rib
.b. lower border of the rib
.c. In the center of the inter-costal space
.d. In anterior part of inter-costal space
.e. any where

10. The most significant immediate complication associated with pelvic fracture is:
a. Hemorrhage.
b. Rectal or vaginal lacerations.
c. Sciatic nerve injury.
d. Infection.
e. Myositis ossificans.

11 - Which is not contributory to Glasgow Coma Scale?

a. obey commands
b. localizes painful stimuli
c. open eyes to calling
d. incomprehensible sounds
e. 5mm pupils

12. In role of nine extent of burn if entire trunk is burned it will be equal to:
a. 9% body surface area.
b. 18% body surface area.
c. 36% body surface area.
d. 27% body surface area.
e. 45% body surface area.

13. A 54-year-old man presents with two episodes of hematemesis since


yesterday. The most likely cause of this patient’s upper gastrointestinal
bleeding is:
a. Gastritis.
b. Esophagitis.
c. Esophageal varices.
d. Peptic ulcer disease.
e. Mallory-Weiss tear.

14. Adequate minimum urine output in a 70kg man during resuscitation is

a) 35 ml/hr
b) 20 ml/hr
c) 50 ml/hr
d) 45 ml /hr
e) 60 ml/hr

15. A 28 year old lady complains of painful defecation associated with fresh per-
rectal bleed. Possible diagnosis to consider:

a) hiradenitis suppurativa
b) dermoid cyst
c) pilonidal sinus
d) anal fissure
e) pruritis ani

16. Which is not a cause of pancreatitis?

a) hypercalcaemia
b) hypokalaemia
c) hyperlipidaemia
d) obstruction at ampulla of Vater
e) thiazide

17-All of the following can be treated conservatively in a stable trauma


patient except:
a. Lung contusion.
b. Liver laceration.
c. Kidney laceration.
d. Splenic hematoma.
e. Perforation of the small intestine.

18.What is the commonest presentation of a nephroblastoma?


a) Abdominal pain.
b) Haematuria.
c) Fever.
d) Abdominal mass.
e) Loss of weight.

19. Which of the following are not found in peritonitis?


f. Patient is lying still
g. Guarding
h. Rebound tenderness
i. Hyperactive bowel sounds
j. Rigid abdomen

The following is an indication for thoracotomy in chest .20


,injury

p. Cardiac tamponade
q. Uncontrolled pulmonary air leakage
r. Perforation of thoracic esophagus
s. Blood loss of 200ml/hr for 2-3 hrs via chest tube
t. All of the above

1. In the preoperative assessment,which of the following is not suggestive


of a platelet disorder?

(A) Epistaxis

(B) Gingival bleeding

(C) Hemarthrosis

(D) Easy bruising

(E) Petechia

2. Which of the following is a physical finding specific for vascular


structures?

(A) Reducibility

(B) Fluctuation

(C) Transillumination

(D) Compressibility
(E) Crepitancy

3. Which of the following medications must be stopped preoperatively:

(A) Atenolol

(B) Thyroxine

(C) Albuterol

(D) Aspirin

(E) Enalapril

4. A patient has undergone an ileal resection. Which of the following


conditions would be the least likely to develop?

(A) Alopecia

(B) Megaloblastic anemia

(C) Neurological symptoms

(D) Steatorrhea

(E) Cholelithiasis

5. Which of the following is the best method to assess the perioperative


pulmonary risk?

(A) Arterial blood gas

(B) Pulmonary function test

(C) CXR

(D) Detailed history & physical exam

(E) Diffusion capacity study

6. Which of the following is the least important data/test to obtain for the
preoperative risk assessment of coagulopathy?

(A) Bleeding time


(B) History& physical examination

(C) Prothrombin time

(D) liver function test

(E) Fibrinogen levels

7. The most consistent physical sign of hyperthyroidism is:

(A) Tachycardia

(B) Exophthalmus

(C) Excessive sweating

(D) Confusion

(E) Hyperperistalsis

8. Which of the following would be the most difficult to manage


preoperatively?

(A) Chronic renal failure

(B) Hemophilia

(C) COPD

(D) Heart failure

(E) Advanced cirrhosis

9. Which of the following is the least likely to develop in hospitalized


surgical patients?

(A) DVT

(B) Pneumonia

(C) Surgical wound infection

(D) Systemic candidiasis


(E) Urinary tract infection

10. When should parenteral antibiotics be given before mastectomy?

(A) the night before

(B) 6 h prior to surgery

(C) Not indicated in such a case

(D) at the time of incision

(E) 30 min after incision

11. A patient with a postoperative wound cellulitis should be treated with:

(A) Antibiotics and warm soaks to the wound

(B) Incision & drainage

(C) Antibiotics and opening the wound

(D) Antibiotics alone

(E) observation

12. Which of the following is the most likely cause of fever in the first 2
days postoperatively?

(A) Malignant hyperthermia

(B) wound abscess

(C) Urinary tract infection

(D) Pulmonary complications

(E) drug fever

13. Neurogenic shock is characterized by all of the following except:


(A) Warm skin

(B) Bradycardia

(C) Vasoconstriction

(D) Normal blood volume

(E) Good response to vasopressors

14. A 24-year-old man is brought into the emergency department after a fall
from 4 meters height. His breathing is distressed, and he is cyanotic. No
breath sounds can be heard in the right lung field, which is resonant to
percussion. Chest tube was inserted. The next step in his management
should be:

(A) Mechanical ventilation

(B) Surgical intervention

(C) IV fluid replacement

(D) Passing an oral endotracheal tube

(E) Obtaining an urgent chest X-ray

15. Which of the following is not a cause of cardiogenic/cardiac


compressive shock in a trauma patient?

(A) Air embolism

(B) Tension pneumothorax

(C) Flail chest

(D) Cardiac tamponade

(E) Myocardial contusion

16. The severity of hypovolemic shock has been found to correlate with the

(A) hematocrit

(B) pulmonary capillary wedge pressure (PCWP)

(C) The percentage of volume lost

(D) PaO2
(E) white blood cell count

17. A patient is transported to the ER following a fall from height . The Glasgow Com
Scale (GCS) can categorize the patient's neurologic status by assessing all of the
following except:

(A) Withdrawal to pain

(B) Inappropriate words

(C) Eye opening response

(D) pupil response to light

(E) Obeying commands

18. Neurogenic shock can be caused by all of the following except:

(A) Spinal anaesthesia

(B) Isolated head ingury

(C) Extremely severe pain

(D) Accidental back trauma

(E) Unpleasent scenes

19. Which of the following types of shock is characterized by a higher


incidence of delayed mortality?

(A) hypovolemic

(B) cardiogenic

(C) neurogenic

(D) cardiac compressive

(E) septic

20.What is the first priority in the management of trauma patients ?


(A) continued intravenous hydration

(B) Oxygen mask

(C) Chest tube

(D) Airway & C-spine control

(E) Blood transfusion

21. In physical examination if an inguinal hernia is completely irreducible it


is called

(A) Strangulated

(B) obstructed

(C) Recurrent

(D) Fixed

(E) Incarcerated

22. Which of the following is not a characteristic of uncomplicated inguinal


hernia

(A) Reducible

(B) Expansile

(C) May be congenital or acquired

(D) Pulsatile

(E) May be caused by chronic cuogh

23. The extension of the existing pain to a site other than the original one
is called:

(A) Radiation

(B) Shifting

(C) migration

(D) Exacerbation

(E) All of the above


24. All of the following symptoms and signs are suggestive of acute
pancreatitis EXCEPT

(A) Anorexia

(B) Severe epigastric pain

(C) Pain is colicky in nature

(D) Vomiting

(E) Ileus

25. A 42-year-old female comes to the ER complaining of right


upper quadrant abdominal pain for the last 36 h, associated with
fever up to 39°C, bilious vomiting, and jaundice. Direct bilirubin 2.2,
alkaline phosphatase 450, WBC 19,000.

What is the best cost- effective imaging study to define the


etiology?

(A) HIDA scan

(B) Ultrasound

(C) CT

(D) MRI

(E) Plain abdominal x-ray

26. The diagnosis of appendicitis depends mainly on :

(A) CBC

(B) Ultrasound

(C) Clinical assessment

(D) CT scan

(E) None of the above

27. The risk of which of the following infections is markedly increased after
splenectomy?
(A) Candidiasis

(B) Pneumococcal pneumonia

(C) Cytomegalovirus

(D) E.coli

(E) All of them

28. In breast examination dimpling of the overlying skin is most likely due
to:

(A) Breast abscess

(B) Mastitis

(C) Cancer

(D) Fibroadenoma

(E) None of the above

29. Melena may be caused by which of the following?

(A) Diverticular disease

(B) Hemorrhiods

(C) Peptic ulcer

(D) Rectal cancer

(E) Anal fissure

30. All of the following increase the risk of breast cancer except?

(A) Estrogen containing oral contraceptives

(B) Early menarche

(C) Prolonged and multiple episodes of lactation

(D) Late menopause


(E) The presence of family history of breast cancer

Nd 1

A 44-year-old man presents with painless rectal bleeding of 1 month's duration. He reports a history
of constipation. He works in heavy labor.
For this patient, which of the following statements regarding internal hemorrhoids is true?

Choose one answer


a. Stapled hemorrhoidectomy should be done for grade 1 and 2 hemorrhoids
b. All of the above
c. Internal hemorrhoids are located proximal to the dentate line and therefore are usually painless
d. A grade 1 internal hemorrhoid represents bleeding with prolapse

39. A 34-year-old woman presents for evaluation of severe and frequent bloody bowel movements, as
well as abdominal pain, dehydration, and anemia. She has had these symptoms for 2 days. She has
not had any similar symptoms in the past, and she has been in relatively good health.
If the patient has toxic megacolon, under what circumstances emergency surgical management is
indicated?

Choose one answer.


a. There is a perforation
b. Any of the above
c. The patient's clinical or radiographic status worsens
d. There is no improvement in 24 to 36 hours after aggressive medical therapy

Complications of untreated pancreatic pseudocysts include all of the following EXCEPT:

Choose one answer.


a. intracystic hemorrhage
b. abscess
c. pancreatic necrosis
d. free rupture
e. gastrointestinal obstruction

Platelets in the wound form a hemostatic clot and release clotting factors to produce:

Choose one answer.


a. thrombin
b. Fibrin
c. Fibrinogen
d. Fibroblasts
e. thromboplastin

A 43-year-old man presents to the office for evaluation of recent weight loss and frequent loose stools.
He is concerned because his father was diagnosed with colon cancer at the age of 50.

Besides family history, what are some other risk factors for colorectal cancer?
Choose one answer.
a. Hypertension
b. Diabetes
c. All of the above
d. Inflammatory bowel disease

A 40-year-old woman presents to the office for evaluation of yellowish skin. She states that over the
past few weeks, she has noticed that her eyes and skin have developed a yellow tint. She also reports
that she has dark urine and pale-colored stools. Further history elicits periodic bouts of right upper
quadrant pain after eating. She is otherwise healthy. She denies using any medications. On physical
examination, a yellowish tint is observed on the patient's skin, sclera, and mucous membranes.

On the basis of this patient's history and clinical examination, which type of bilirubin would you
expect to predominate?

Choose one answer.


a. Mixed
b. Conjugated
c. Unconjugated
d. Indirect

39. A 38-year-old man presents with a complaint of a slow-growing mass over his right parotid gland.
The lesion is fixed to the underlying structures and has recently become painful.
Which of the following features strongly suggests that this patient's lesion is a malignancy?

Choose one answer.


a. Ipsilateral numbness of the tongue
b. .All of the above
c. Overlying skin involvement
d. Facial nerve paralysis

Axillary lymph nodes are classified according to the relationship with the

Choose one answer.


a. pectoralis minor muscle
b. pectoralis major muscle
c. axillary vein
d. serratus anterior muscle
e. latissimus dorsi muscle

39. A 78-year-old man is recovering from abdomino-perineal (A-P) resection for Ca rectum, which
was performed 3 days ago. The patient is now complaining of mild shortness of breath and chest pain.
On physical examination, the patient's right leg is slightly more swollen than his left. The pulse
oximetry reading is 90%.
What is the principal method of diagnosing acute pulmonary embolism?

Choose one answer.


a. Magnetic resonance imaging
b. Chest x-ray
c. Ultrasound
d. Spiral computed tomography scanning

10

Compartment syndrome

Choose one answer.


a. Passive stretch decrease muscle pain
b. Due to decrease pressure in muscle compartments
c. Pulse is the first thing to disappear
d. Cause severe pain in the limb
e. Treatment is by delayed fasciotomy

11

The most significant risk factor for the development of adenocarcinoma of the esophagus is:

Choose one answer.


a. lye stricture
b. alcohol abuse
c. Barrett's esophagus
d. long-standing achalasia
e. smoking

12

All of the following statements are true about patients with carcinoid tumors EXCEPT:

Choose one answer.


a. the combination of streptozotocin and 5-fluorouracil (chemotherapy) can often result in objective
response.
b. tumor growth is often slow
c. they often have evidence of serotonin production
d. the majority have carcinoid syndrome
e. they have a much better prognosis if the tumors are less than 2 cm.

13

39. A 67-year-old man presents with left-lower-quadrant pain and low-grade fever. He has had these
symptoms for 1 day. The patient denies experiencing any rectal bleeding, but for the past week, his
bowel movements have been irregular.
For this patient, which of the following statements is true regarding diverticular disease?

Choose one answer.


a. The sigmoid colon is the most common site of diverticula
b. All of the above
c. Most diverticula of the colon involve the muscular layer
d. Smoking does not seem to be related to the development of diverticular disease

14

All of the following are components of the MEN type 2B syndrome except:

Choose one answer.


a. Multiple neuromas on the lips, tongue, and oral mucosa
b. Medullary thyroid carcinoma
c. Pheochromocytoma
d. Hyperparathyroidism.

15

The risk of bilateral breast cancer is HIGHEST if the first breast shows:

Choose one answer.


a. inflammatory carcinoma
b. medullary carcinoma
c. infiltrating ductal carcinoma
d. paget’s disease
e. lobular carcinoma

16

The best initial therapy for deep venous thrombosis of the common femoral vein is:

Choose one answer.


a. warfarin
b. streptokinase
c. Heparin
d. venous thrombectomy
e. placement of a vena caval filter

17

Complications after thyroidectomy include all the following EXCEPT:

Choose one answer.


a. recurrent laryngeal nerve paralysis
b. parathyroid insufficiency
c. thyrotoxic crisis(storm) on operating on inadequitly prepared thyrotoxic patient
d. tracheomalacia
e. hypercalcemia

18

A 55-year-old man presents with hematemesis that began 2 hours ago. He is hypotensive and has
altered mental status. No medical history is available.
For this patient, which of the following statements regarding nasogastric aspiration is true?

Choose one answer.


a. None of the above
b. A clear, nonbilious aspirate rules out the need for EGD
c. A clear, bilious aspirate rules out the need for EGD
d. A bloody aspirate is an indication for esophagogastroduodenoscopy (EGD)

19

The major cause of impaired wound healing is:

Choose one answer.


a. steroid use
b. malnutrition
c. diabetes mellitus
d. local tissue infection
e. anemia

20

Common presenting conditions in patients with pancreatic carcinoma include all of the following
EXCEPT:

Choose one answer.


a. esophageal varices.
b. palpable gallbladder
c. weight loss.
d. abdominal pain

21

All of the following statements about keloids are true EXCEPT:

Choose one answer.


a. Keloid tissue contains an abnormally large amount of collagen
b. A keloid does not regress spontaneously
c. Keloid tissue contains an unusually large amount of soluble collagen
d. A keloid extends beyond the boundaries of the original wound
e. Keloids or hypertrophic scars are best managed by excision and careful reapproximation of the
wound

22

The treatment of choice for a 40-year-old man who is found on endoscopy and biopsy to have a
gastric lymphoma would be:

Choose one answer.


a. wide local excision
b. subtotal gastrectomy
c. chemotherapy
d. subtotal gastrectomy and radiotherapy
e. Radiotherapy

23

The treatment of an esophageal burn with a caustic agent may include all of the following EXCEPT:

Choose one answer.


a. boogieing. (dilatation)
b. induction of vomiting
c. gastrectomy
d. expeditious administration of an antidote
e. steroids and antibiotics.

24

A 32-year-old man with a family history of familial adenomatous polyposis (FAP) presents with
hematochezia. He denies having any diarrhea, abdominal pain, or fever.

For this patient, which of the following statements regarding FAP is true?

Choose one answer.


a. CRC does not occur in patients with FAP if they are given adequate medical treatment
b. Total proctocolectomy (TPC) is considered the only option for the surgical management of FAP
c. For patients with FAP, there is a 10% risk of CRC by age 40 if prophylactic colectomy is not performed
d. In the setting of FAP, colorectal cancer (CRC) is more commonly located on the left side

25

When stage I breast cancer is treated by partial mastectomy and axillary dissection, further therapy
should include:

Choose one answer


a. antiestrogen agents.
b. radiation of the affected breast.
c. oophorectomy if premenopausal.
d. nothing
e. chemotherapy

26

For the patient in Question 68, which of the following statements is true regarding an esophageal
varix as the site of bleeding?

Choose one answer.


a. I.V. propranolol should be administered first
b. Balloon tamponade should be performed first
c. Rubber banding or intravariceal sclerotherapy should be performed first
d. I.V. somatostatin should be administered first

27

Drugs which may produce gynecomastia include all of the following EXCEPT:

Choose one answer.


a. furosemide
b. cimetidine
c. Verapamil
d. Diazepam
e. Tamoxifen

28

Splenectomy is commonly indicated for the following EXCEPT:

Choose one answer.


a. hypersplenism associated with cirrhosis
b. hereditary spherocytosis
c. splenic tumor
d. immune thrombocytopenic purpura
e. grade four splenic injury in trauma

29

An ischiorectal abscess is characterized by all of the following EXCEPT:

Choose one answer.


a. Requires deroofing
b. Should be treated entirely by antibiotics
c. May be tuberculous in origin
d. Can be followed by anal fistula
e. Is an infective necrosis of the fat of the ischiorectal fossa

30
Marks: 1

The most common presentation of Meckel’s diverticulum in an adult is:

Choose one answer.


a. intussuception
b. Littre’s hernia
c. Gastrointestinal bleeding
d. diverticulitis

31

For the patient in Question 65, which of the following is an indication for immediate surgery?

Choose one answer.


a. Closed-loop obstruction
b. All of the above
c. Complete bowel obstruction
d. Incarcerated hernia

32

Choledocholithiasis in a patient who previously had cholecystectomy is BEST treated with:

Choose one answer.


a. endoscopic sphincterotomy
b. choledochoduodenostomy
c. choledochojejunostomy.
d. dissolution with mono-octanoin
e. open common bile duct exploration with stone removal

33

39. A 77-year-old man undergoes endoscopic ultrasonography as part of a workup for jaundice. He is
found to have a tumor in the head of the pancreas.
For this patient, which of the following findings would indicate that the tumor is unresectable?

Choose one answer.


a. All of the above
b. Peritoneal metastases
c. Invasion of the superior mesenteric artery
d. Metastases to celiac lymph nodes

34

Regarding polyps of the colon

Choose one answer.


a. Villous polyps are usually pedunculated
b. Villous polyps occur more proximal in colon
c. Adenomatous polyps are usually solitary
d. Cancer risk is not related to size of polyp
e. Metaplastic polyps are not precancerous

35

The most likely diagnosis in elderly patient with abdominal pain and colonoscopy finding of patchy
mucosal ulceration at the splenic flexure of the colon is :

Choose one answer.


a. ulcerative colitis
b. crohns disease
c. ischemic colitis
d. diverticulitis
e. lymphogranuloma venerum

36

39. A 54-year-old man presents with a neck mass of 2 weeks' duration. He has no significant medical
history. He smokes two packs of cigarettes a day and has been doing so since he was 21 years of age.
For this patient, which of the following statements is true?

Choose one answer.


a. Low cervical nodes are more likely to contain metastases from a primary source other than the
head and neck, whereas upper cervical nodes are more likely to contain metastases from the head
and neck
b. Soft or tender nodes are more likely to derive from an inflammatory or infectious condition,
whereas hard, fixed, painless nodes are more likely to represent metastatic cancer
c. All of the above
d. Enlarged lymph nodes are by far the most common neck masses encountered

37

The first-choice diagnostic study for suspected deep venous thrombosis of the lower extremity is:

Choose one answer.


a. real-time Doppler imaging
b. contrast sonography
c. radioactive labeled fibrinogen uptake
d. impedance plethysmography
e. isotope injection with gamma scintillation scanning

38

Decreased PaCO2 levels should be attained in a patient at serious risk for cerebral edema secondary
to a head injury in order to :

Choose one answer.


a. prevent neurogenic pulmonary edema
b. prevent increased capillary permeability
c. prevent metabolic acidosis
d. allow reciprocally high levels of PaO2 in the brain
e. prevent cerebral vasodilation

39

Causes of third space loss include all except:

Choose one answer.


a. Acute pancreatitis
b. Pancreatic fistula
c. Necrotizing fasciitis
d. Site of major surgery
e. Crush syndrome

40

Causes of metabolic acidosis include all except:

Choose one answer.


a. Small bowel fistula
b. Shock
c. CO poisoning
d. severe anemia
e. All of the above

41

A 39-year-old man comes in for evaluation of intermittent anal pain and bleeding after bowel
movements. He also has hard stools. He has had these symptoms for over 1 year .
For this patient, which of the following is included in the classic triad of signs of chronic anal
fissures?

Choose one answer.


a. An anal fissure
b. All of the above
c. A sentinel skin tag
d. Hypertrophy of the anal papilla

42

All the following statements about achalasia are true EXCEPT:

Choose one answer.


a. it occurs most commonly in persons between the ages of 30 and 50 years
b. in most affected persons, ganglion cells in the body of the esophagus either are absent or have
degenerated
c. esophageal cancer is seven times as common in affected persons as in the general population
d. pressure in the body of the esophagus is lower than normal
e. affected persons usually experience more difficulty swallowing cold foods than warm foods ??

43

A patient with the Zollinger-Ellison syndrome is found to have the multiple endocrine neoplasia type
I (MEN-I) syndrome. Appropriate management for the ulcer symptoms should be:

Choose one answer.


a. Omeprazole
b. pancreatic resection
c. streptozocin
d. cimetidine
e. total gastrectomy

44

Fat absorption occurs primarily in the:

Choose one answer.


a. Ileum
b. third portion of the duodenum
c. Stomach
d. Jejunum
e. first portion of the duodenum

45

39. A 56-year-old woman has been experiencing abdominal pain for 4 hours. The pain is in right
upper quadrant and radiates into the scapular region. She has had multiple episodes of vomiting.
For this patient, which of the following signs on physical examination is associated with acute
cholecystitis?

Choose one answer.


a. Carnett sign
b. Kehr sign
c. Murphy sign
d. Rovsing sign

46

Mammary duct ectasia is characterized by the following EXCEPT :

Choose one answer.


a. Is treated usually by simple mastectomy
b. May present with nipple retraction and Peau d'orange picture
c. Anaerobic superinfection cmmmonly occurs in this recurrent periductal plasma cell mastitis
d. Is defined as primary dilatation of major ducts of breast in middle aged women
e. Iscommonly pre-malignant

47

Regarding veins of lower limbs all are true except:

Choose one answer.


a. Valves allow flow from deep to superficial system Venous return from lower limbs is aided by
respiratory movements
b. Superficial veins lie in subcutaneous tissue
c. The pressure in veins of the foot while standing is 100mmHg
d. a) Stasis of blood is important factor in developing varicose veins

48

Most common complication of central venous access is:

Choose one answer.


a. major artery damage.
b. Catheter problems.
c. Thrombosis of central vein
d. Catheter related sepsis
e. Pleural space damage, pneumothorax
49

Factors associated with increase risk of death in acute pancreatitis include all except:

Choose one answer.


a. Ranson score more than five
b. Obesity?
c. High APACHE_II score
d. Age more than 70 years
e. sterile necrosis

50

For the patient in Question 56, which of the following chronic conditions can cause a neck mass?

Choose one answer.


a. Tuberculosis
b. Sarcoidosis
c. AIDS
d. All of the above

51

For the patient in Question 56, if metastatic cancer is suspected initially, which of the following would
be the most appropriate step to take next in the workup?

Choose one answer.


a. CT scan
b. Empirical therapy with antibiotics
c. Fine-needle aspiration (FNA)
d. Observation only

52

The largest component of intestinal gas is:

Choose one answer.


a. Nitrogen
b. carbon dioxide
c. Oxygen
d. ammonia
e. hydrogen

53

A 66-year-old woman presents to the office complaining of a sharp, constant pain in her lower
abdomen. She has had this pain for the past 2 weeks. Examination of her abdomen is normal.
However, subsequent ultrasound reveals a 4.5 cm Aortic abdominal aneurysm (AAA). Spiral computed
tomography confirms the ultrasound findings.

Aside from rupture, which of the following is a complication associated with (AAA) ?

Choose one answer.


a. Aortoenteric fistula
b. Lower-extremity atheroemboli
c. All of the above
d. Thrombosis

54

Diagnosis of esophageal perforation is best established by:

Choose one answer.


a. transesophageal ultrasound study
b. esophagoscopy with a flexible esophagoscope
c. contrast esophagograms
d. esophagoscopy with a rigid esophagoscope
e. upright X-rays of the chest including lateral and oblique films

55

For the patient in Question 68, which of the following is an indication for surgery?

Choose one answer.


a. Ongoing hemorrhage occurs from a gastric ulcer in a hemodynamically unstable patient
b. All of the above
c. Bleeding continues from either a duodenal ulcer or a gastric ulcer despite medical and endoscopic
therapy
d. Substantial bleeding occurs from a duodenal ulcer that is not controlled by EGD

56

Yesterday, a 38-year-old woman underwent a laparoscopic cholecystectomy for cholelithiasis and was
discharged home 8 hours after surgery. She returns this morning complaining of worsening
abdominal pain. The oral narcotics that the patient was prescribed are ineffective in controlling the
pain. The patient's temperature is (38.3 C). Laboratory studies reveal an elevated white blood cell
count. Abdominal ultrasonography shows a large subhepatic fluid collection. The fluid is
percutaneously aspirated and reveals enteric contents.

What step should be taken next in the management of this patient?

Choose one answer.


a. Immediate laparotomy
b. I.V. antibiotics and close observation
c. None of the above
d. Observation in the hospital until pain improves

57

The most common symptom after major pulmonary embolism is:

Choose one answer.


a. cough
b. Dyspnea?
c. Hemoptysis
d. pleural pain
e. fear of death

58

Treatment of paralytic ileus includes all of the following


EXCEPT :

Choose one answer.


a. intravenous fluids
b. cessation of oral intake
c. correction of electrolyte imbalance
d. early operation
e. nasogastric suction

59
Lymphedema :
Choose one answer
a. e) None of the above
b. b) should be bilateral
c. c) may be pitting in early stage
d. d) A & C only
e. a) may be Congenital

60

The level of consciousness for a head injury patient is BEST evaluated by :

Choose one answer.


a. CT scan
b. visual evoked potentials
c. Glasgow coma scale
d. papillary responses
e. response to pain

61

A 52-year-old male weighing 70 kg, sustained a 65% total body surface area (TBSA) burn. What are
his fluid requirements?

Choose one answer.


a. 18,200 cc in 16 h
b. 9100 cc in the first 8 h
c. 8000 cc in 24 h
d. 12,800 cc in 24 h

62

Management of cholangitis may include all of the following EXCEPT:

Choose one answer.


a. decomperession of the common bile duct.
b. cholecystostomy
c. IV antibiotics.
d. correct underlying cause.
e. percutaneous transhepatic cholangiography.

63

A 48-year-old woman presents to the emergency department complaining of right upper quadrant
pain, which began 4 hours ago. She reports the pain as being spasmodic and sharp and that it
radiates to her right shoulder blade. She says that she has had similar episodes over the past few
months, especially after eating large meals. Associated with the pain is nausea and vomiting. Her
blood pressure is 120/85 mm Hg, and her pulse is 100 beats/min. On physical examination, the patient
is found to have a nontender abdomen with no palpable masses. Her chest and cardiovascular
examinations are normal. The nurse notices that her sclerae are slightly icteric. On subsequent
laboratory studies, her serum bilirubin level is found to be 10 mg/dl.

What imaging study should be performed next for this patient with presumed posthepatic jaundice?
Choose one answer.
a. Percutaneous transhepatic cholangiography (PTC)
b. Ultrasonography
c. Endoscopic retrograde cholangiopancreatography (ERCP)
d. Magnetic resonance imaging

64

39. An HIV-positive man presents for evaluation of new oral cavity lesions he discovered last month.
Physical examination reveals purple exophytic masses involving the palate mucosa and gingiva.
What is the most likely diagnosis of these oral cavity lesions?

Choose one answer.


a. Oral hairy leukoplakia
b. Non-Hodgkin lymphoma
c. Syphilis
d. Kaposi sarcoma

65

Brain injury alone

Choose one answer.


a. causes shock only if the skull is intact
b. rarely causes shock
c. causes shock that is reversed by very simple measures
d. frequently causes shock
e. causes shock if hypoxia is superimposed

66

All of the following substances are irritating to the peritoneum EXCEPT:

Choose one answer.


a. bile.
b. blood
c. gastric content.
d. meconium
e. pus

67

Regarding volvulus of the sigmoid colon, each of the following is true except :

Choose one answer.


a. likely results from redundant sigmoid colon with an elongated narrow mesocolon
b. there appears to be a congenital predisposition sigmoid volvulus.
c. diagnostic barium enema for sigmoid colon is essential
d. diagnostic x-ray for sigmoid volvulus shows a dilated loop of colon which points toward the right upper
quadrant.

68

Gallstones are characterized by all the following EXCEPT:

Choose one answer.


a. cause mucocoele of the gall bladder
b. are present in the common bile duct in 40% of patients with stones in the gall bladder
c. are becoming common in post-partum primipara who were pre pregnancy ‘Pill’ takers
d. are frequently the cause of flatulent dyspepsia
e. may be present in the newborn

69

Following a burn, the agent responsible for early increased capillary permeability is

Choose one answer.


a. thromboxane A2
b. serotonin
c. histamine?
d. prostacyclin PGI2
e. bradykinin

70

Incisonal hernias all are true except:

Choose one answer.


a. 10 % of all hernias
b. Usually easy to reduce
c. Multiloculated sac
d. Operative technique is most important cause
e. Complication is common

71

In the treatment of gastric cancer, all of the following are true EXCEPT:

Choose one answer.


a. five-year survival rates in the continue to be between 10% and 25%.
b. Palliative resection is frequently helpful with advanced disease.
c. Lymph node involvement is associated with a poorer prognosis.
d. Finding early disease at the time of operation is associated with a better prognosis.
e. total gastrectomy is mandated in most patient. ***

72

of the involved area and : Severe cases of hidradenitis suppurativa in the groin area are best managed
by excision

Choose one answer.


a. transfer of a rectus abdominus muscle flap
b. split thickness skin grafting
c. primary closure
d. delayed primary closure
e. closure by secondary intention

73

Patients at increased risk for gastric carcinoma include all the following EXCEPT:

Choose one answer.


a. those who have undergone gastric bypass for morbid obesity
b. those who have undergone gastric resection for duodenal ulcer
c. those with pernicious anemia
d. those with a high consumption of smoked fish
e. those with blood group A

74

A 56-year-old woman presents with symptoms of abdominal pain, weight loss, and rectal bleeding.
She is anemic and hypotensive, but she is stable.
For this patient, which of the following should be done first if the gastric lavage yields copious
amounts of bile?

Choose one answer.


a. Arteriography
b. Emergency laparotomy
c. Colonoscopy
d. Esophagogastroduodenoscopy

75

A 39-year-old man presents with lower GI bleeding. He has no abdominal discomfort and has
experienced no loss of weight.
For this patient, which of the following statements regarding the etiology of lower GI bleeding is
true?

Choose one answer.


a. Lower GI bleeding from diverticulosis often requires surgery
b. Arteriovenous malformations (AVMs) are the most common cause of lower GI bleeding
c. 6% to 10% of patients with ulcerative colitis have lower GI bleeding severe enough to necessitate
emergency surgical resection
d. None of the above

76

For the patient in Question 65, which of the following statements regarding abdominal radiographic
findings is true?

Choose one answer.


a. In gastric outlet obstruction, no gastric air will be seen, but large amounts of air will be seen in the small
bowel and colon
b. Mechanical small bowel obstruction usually shows no air-fluid levels, nor will distended bowel loops of
similar sizes be seen
c. All of the above
d. High-grade obstruction of the colon in association with an incompetent ileocecal valve may mimic small
bowel obstruction on x-ray

77

A 41-year-old female presents to the emergency department after sustaining a gunshot wound to the
abdomen, with injuries to the liver and large bowel. Despite successful resuscitation and operative
intervention, the patient dies 2 weeks later of multisystem organ failure in the intensive care unit.
Which organ most likely first experienced dysfunction?

Choose one answer.


a. lung
b. heart
c. liver
d. gastrointestinal tract
e. kidney

78

39. A 35-year-old man presents with severe acute abdominal pain of sudden onset. The pain initially
began in the upper abdomen and has now settled in the whole abdomen. On examination, the
abdomen was rigid. Chest X-Ray showed free gas under diaphragm.
Which of the following is the most appropriate course of management for this patient?

Choose one answer.


a. Observation
b. Urgent laparotomy
c. Nonurgent laparotomy
d. Laparoscopy

79

All are true about the dumping syndrome except:

Choose one answer.


a. Symptoms can be controlled with a somatostatin analogue.
b. Early postoperative dumping after vagotomy often resolves spontaneously.
c. Flushing and tachycardia are common features of the syndrome.
d. Diarrhea is always part of the dumping syndrome.
e. Separating solids and liquids in the patient's oral intake alleviates some of the symptoms of the syndrome.

80

An anal fissure is characterized by the following EXCEPT:

Choose one answer.


a. Is more common in women.
b. Is an ulcer of the anal mucosa.
c. Can be treated coservatively.
d. Usually lies anteriorly.

81

All of the following statements are true of esophageal carcinoma


EXCEPT

Choose one answer.


a. squamous cell tumor is the most frequent histology.
b. operation is frequently curative.
c. patient often require a pyloroplasty with operation.
d. patients usually die within one year of diagnosis
e. patient can have intestinal continuity reestablished using the stomach after esophageal resection.

82

A serum tumor marker correlated with recurrence after management of colon cancer is:

Choose one answer.


a. carcinoembryonic antigen (CEA)
b. Calcitonin
c. 5-hydroxyindoleacetic acid
d. CA 15-3
e. Alpha-fetoprotein
83

Conditions associated with gastric cancer include all of the following EXCEPT:

Choose one answer.


a. adenomatous polyps.
b. a high intake of dietary nitrates.
c. pernicious anemia.
d. higher socioeconomic groups.
e. chronic atrophic gastritis.

84

Which of the following is required for addressing any pressure sore?

Choose one answer.


a. pressure reduction
b. hyperbaric oxygen
c. antibiotics
d. skin flap coverage

Treatment of pressure sores requires relief of pressure with special cushions and beds and
nutritional support to promote healing.
85

The most effective treatment of achalasia is:

Choose one answer.


a. antireflux surgical procedures
b. Esophagomyotomy
c. dilation of the lower esophageal sphincter
d. antispasmodic medication
e. resection of the cardioesophageal junction

86

Regarding desmoid tumors all are true except:

Choose one answer.


a. Treatment is wide local excision with safety margins
b. Has high rate of local recurrence
c. Is a low grade fibro sarcoma
d. More common in females
e. Is radio resistant

87

Which of the following variables best predicts prognosis for patients with a recent diagnosis of
cutaneous melanoma and no clinical evidence of metastatic disease?

Choose one answer.


a. Ulceration.
b. Clark's level.
c. Gender
d. Bleeding
e. Breslow thickness.

88
In the treatment of acute cholecystitis, most patient are BEST served with:
Choose one answer.
a. endoscopic sphincterotomy.
b. cholecystostomy.
c. percutaneous drainage of the gallbladder.
d. early cholecystectomy (within 3 days of onset of symptoms).
e. IV antibiotics and cholecystectomy in 6 to 8 weeks.

89

Regarding crohn's disease all are true except

Choose one answer.


a. Cause non caseating granuloma
b. commonly affect small bowel
c. Causes sub mucosal fibrosis
d. It is full thickness inflammation
e. Cause depletion of goblet cell mucin

90

Advantages of laparoscopic versus open cholecystectomy include all of the following EXCEPT:

Choose one answer.


a. decreased pain.
b. less risk of bile duct injury.
c. reduced hospitalization.
d. improved cosmetic.
e. reduced ileus.

91

The most common cause of massive hemorrhage in the lower gastrointestinal tract is:

Choose one answer.


a. carcinoma
b. Diverticulosis
c. Diverticulitis
d. Polyp
e. ulcerative colitis

92

Carcinoma of the gallbladder is

Choose one answer.


a. rarely associated with jaundice.
b. associated with a good prognosis.
c. usually not diagnosed preoperatively.
d. most commonly metastatic to the lung.
e. best treated with radiation and chemotherapy

93

All the following statements concerning nipple discharges are true EXCEPT:
Choose one answer.
a. benign duct papillomas are the most common cause of bloody discharges.
b. when bloody , the discharge is due to a malignancy 70% of the time
c. a) excision of involved duct may be necessary to determine the etiology
d. they may be caused by multiple lesions.
e. a milky discharge may be due to a pituitary adenoma .

94

39. A 28-year-old woman presents with a complaint of a growing, painless mass in her neck. Physical
examination reveals a firm, fixed nodule measuring 2 cm on the right lobe of her thyroid. The
surgeon recommends fine-needle aspiration (FNA) of the lesion instead of excisional biopsy.
What are the advantages of FNA over excisional biopsy?

Choose one answer.


a. FNA is associated with a decreased risk of tumor seeding
b. FNA requires only an office visit
c. Anesthesia is not necessary
d. All of the above

95

For the patient in Question 74, which of the following is a sign of a colovesical fistula associated with
diverticulitis, as seen on computed tomography with contrast?

Choose one answer.


a. Thickening of the bladder and the colon
b. Sigmoid diverticula
c. All of the above
d. Air in the bladder

96

All of the following are true statements concerning paget ’ s disease of the nipple EXCEPT:

Choose one answer.


a. it is an eczematoid lesion.
b. it is very uncommon, accounting for only 2% of all breast cancers.
c. it is an in situ squamous cell malignancy of the nipple.
d. it can be confused with malignant melanoma histologically
e. it has a better prognosis than the majority of other breast cancers.

97

The classical picture of Acute arterial embolism include all the following except:

Choose one answer.


a. peripheral pulses
b. Parasthesia
c. All the above
d. Pain
e. Pallor

98

Extra colonic manifestation of inflammatory bowel disease include all except:

Choose one answer.


a. Erythema nodosum
b. Mixed connective tissue disease
c. Primary Sclerosing cholangitis
d. Polyarthopathy
e. Episcleritis

99

A 45-year-old woman presents with abdominal pain and vomiting of 1 day's duration. The patient
underwent an exploratory laparotomy after a motor vehicle accident 8 years ago.
Which of the following statements is true for this patient?

Choose one answer.


a. Pain from mechanical obstruction is usually more severe than pain from ileus
b. The severity of pain from mechanical obstruction may decrease over time
c. Pain from mechanical obstruction is usually localized in the middle of the abdomen, whereas pain from
ileus or pseudo-obstruction is diffuse
d. All of the above

100

A 4-year-old girl has been experiencing dyspnea on exertion. Chest x-ray shows a Morgagni hernia.
For this patient, which of the following statements is true?

Choose one answer.


a. Morgagni hernias can be repaired with a subcostal, a paramedian, or a midline incision
b. Morgagni hernias are most commonly seen on the right side
c. All of the above
d. The average age at diagnosis is typically greater for patients with Morgagni hernia than for patients with
Bochdalek hernia

Abduction of the vocal cords results from contraction of the:


K) crico-thyroid muscles
L) posterior crico-arytenoid muscles
M) vocalis muscles
N) thyro-ary-epiglottic muscles
O) lateral crico-arytenoid and transverse arytenoids muscles

17) The rectum:


A) is devoid of peritoneum
B) is surrounded by peritoneum
C) has peritoneum on its lateral surfaces for its upper two-
thirds, and on its anterior surface for its upper one-third
D) has pritoneum on its anterior surface for its upper two-thirds,
and on its lateral surfaces for its upper one-third
E) has peritoneum on its anterior surface only

18) The umbilicus:


A) lies near the to the xiphoid than to the pubis
B) derives its cutaneous innervation from the eleventh thoracic
nerve
C) transmits, during development, the umbilical cord two arteries
and two veins
D) usually lies at about the level between the third and fourth
lumbar vertebra
E) emberiologicall, may transmit urine but never bowel contents

19) The superficial perineal pouch:


A) is limited inferiorly by the urogenital diaphragm
B) is not continuous with the space in the scrotum occupied by
the testes
C) has a membranous covering which provides a fascial sheath
around the penis
D) is traversedby the urethera in the male but not the urethera
and vagina in the female
E) in the female, the greater vestibular glands are situated
outside this pouch
20) The tongue:
A) has a foramen caecum at the base of the frenulum
B) is separated from the epiglottis by the valleculae on each side
of the midline
C) has 7-12 circumvallate papillae situated behind the sulcus
terminalis
D) is attached to the hyoid bone by the genioglossus muscle
E) is supplied only by hypoglossal nerve
21) Hypovolaemic shock is characterized by:
A) a low central venous pressure , low cardiac output , low
peripheral resistance
B) a high central venous pressure , high cardiac output , low
peripheral resistance
C) a low central venoys pressure , low cardiac output , high
periphera resistance
D) a low central venous pressure , high cardiac output , high
peripheral resistance
E) a high central venous pressure , low cardiac output , low
peripheral resistance

22) An oxygen debt is:


A) the amount of oxygen in excess of the resting metabolic needs
that
must be consumed after completion of exercise
B) build up because the pulmonary capillaries limit the uptake
of
Oxygen at high rates of oxygen consumption
C) related to the fact that skeletal muscle cannot function temporarily in the
absence of oxygen

F) associated with a decrease in blood lactate


G) associated with alkalosis

23) Pulmonary embolism may be a complication of:


A) prolonged bed rest
B) a surgical operation
C) vitamine K deficiency
D) oral contraceptive therapy
E) Antithrombin III deficiency
24) Which of the following statements regarding potassium
metabolism is NOT
True?:
A) potassium deficiency commonly results from thiazide diuretic
theraoy
B) the normal compensation for potassium deficiency is a
metabolic extracellular acidosis
C) aldosterone increases urinary potassium loss
D) hyperkalaemia causes bradycardia and loss of P waves on the
ECG
E) hypokalaemia aggrevates the cardiac effects of digitalis
toxicity

25) Cutaneous pain:


A) is due to overstimulation of receptors serving other sensory
modalities
B) cannot be elicited more readily if the tissue has recently been
injured
C) is due to exitation of receptors by pain-producing chemical
substances in the injured tissue
D) shows marked adaptation, i. e. decrease in severity in
response to a constant stimulus
E) is conducted through the medial spinothalamic tract

26) Which of the following is NOT associated with hyperthyroidism?:


A) increase size of the thyroid gland
B) increased amount of colloid in thyroid follicle
C) increased height of epithelium of the thyroid follicle
D) increased vascularity of the thyroid gland
E) increased uptake of iodine by the thyroid gland

27) Sarcomata may show all of the following EXCEPT:


A) production of myxomatous tissue
B) production of collagen
C) spindle shaped cells
D) signet ring cells
E) blood stream metastasis

28) Anaphylaxis is characterized by all of the following EXCEPT:


A) is a reaction either local or general , frequently occurs within
five minutes
B) causes an urticarial eruption
C) is produced by IgA antibody
D) causes eosinophilia
E) causes degranulation of basophils and mast cells

29) Autoimmunity is characterized by the following EXCEPT:


A) occurs because of a breakdown in the ability of the body to
distinguish between self and non self
B) is involved in some forms of orchitis
C) is involved in formation of cryo globulin
D) is important in the pathogenesis of lupus erytheromatosus
E) does not result in immune complex disease

30) Pseudomembranous enterocolitis is caused by the following


organisms:
A) Clostridium sporogenes
B) Clostridium defficile
C) Streptococcus faecalis
D) Penicillin sensitive staphylocci
E) Pseudomonas aeruginos

B) CLINICAL SUGERY

31) The “ white clot syndrome”:


A) is usually characterized with antithrombin III deficiency
B) most often present with arterial complicatios of heparin
induced throbocytopenin
C) is best managed by loe molecular weight dextran
D) is best managed by halving the therapeutic dose of heparin
sodium
E) results from nitric oxide deficiency of endothelial cells

17) A 21-year-old man who was the driver in a head-on collision has
a pulse of 140/min , respiratory rate of 36 and blood pressure of 75
palpable. His trachea is deviated to the left, with palpable subcutaneous
emphysema and poor breath sounds in the right hemithorax, The most
appropriate initial treatment must be
A) immediate thoracotomy
B) catheter insertion in the subclavian vein for fluid
resuscitation
C) intubation and ventilation
D) tube thoracostomy
E) immediate tracheostomy

18) The best test to monitor the adequacy of levothyroxin


therapy is:
F) radioactive iodine uptake
G) thyroglobulin
H) free thyroxine index (T4)
I) triiodothyronine resin uptake (T3)
J) thyroid stimulating hormone (TSH)

24) Which of the following statements about fungal infection is NOT


true ?:
A) Prior or synchronous culture positive for Candida at
another site occurs in few patients with candidimia
B) For critically ill patients nonhaematogenous sites of
candida are appropriately treated with systemic
antifungal therapy
C) Mortality rates are similar regardlss of whether C.
albicans fungmia is treated with amphotericin B or
fluconazole
D) Intravenous catheters and the gastrointestinal tract are
common portals for Candida to gain blood stream access
E) Septic emboli are more common with fungal endocarditis
than with bacterial endocarditis

25) The maximum safe dose of local anaesthetic administered


subcutaneously in a 70-kg man is:
A) 10 to 20 ml of 1% lidocaine
B) 40 to 50ml oh 2% lidocaine with epinephrine
C) 40 to 50 ml of 1% lidcaine with epinephrine
D) 40 to 50 ml of 1% bupivacaine (marcaine)
E) 40 to 50 ml of 1%lidocaine without epinephrine

26) Two days after right hemicolectomy for a Dukes B caecal


carcinoma , the
Patient complains of sharp right-sided chest pain and dyspnea. HisPaO2
Is 64mmHg ,his PaCo2 is 32mmHg. CVP is 26 cm water, and the blood
pressure is 102/78mmHg. A pulmonary embolus is suspected,
The next step in management should be:
F) A ventilation- perfusion lung scan
G) A pulmonary arteriogram
H) Postrioanterior and lateral chest x-rays
I) Heparin sodium ,100 units/kg intravenously
J) Immediate duplex scanning of both lower extremities

27) The major cause of graft loss in heart and kidney allograft is:
A) acute rejection
B) hyperacute rejection
C) vascular thrombosis
D) chronic rejection
E) graft infection
28) All of the following are indicators of tumor aggressiveness and
poor outcome for papillary carcinoma of the thyroid gland
EXCEPT:
A) age over 50 years
B) microscopic lymph node metstasis
C) tumor larger than 4 cm
D) poorly differentiated histological grade
E) invasion through capsule to adjacent tissues

24) A 40-year-old woman has extensive microcalcifications


involving the
entire upper aspect of the right breast. Biopsy shows a commedo pattern of
intraductal carcinoma.
The most appropriate treatment is :
F) wide local excision
G) radiation therapy
H) wide local excision plus radiation therapy
I) right total mastectomy
J) right modified radical mastectomy

25) In the conventional ventilator management of acute adult respiratory


distress syndrome (ARDS) , arterial O2 saturation is maintained above 90%
by all the following EXCEPT :
F) increasing the ventilatory rate
G) the use of positive end-expiratory pressure (PEEP)
H) increasing mean airway pressure
I) increasing tidal volumes
J) increasing FiO2

31) Which of the following statements about patients with


abdominal compartment syndrome is NOT true ?
A) Abdominal pressure is usually measured indirectly
through inferior vena cava
B) Multiple contributing factors are commonly responsible
C) The chief manifestations are reflected in central venous
pressure , ventilatory function, and oliguria
D) Decopression of the abdomen is required to resverse the
syndrome
E) Aggressive hemodynamic monitoring and management is
required when the abdomen is opened

32) The most appropriate treatment for histologically malignant


cystadenoma phylloides is :
A) total mastectomy without axillary node dissection
B) total mastectomy with axillary node dissection
C) wide margin (3) cm excision of the lesion
D) post operative hormonal manipulation
E) postoperative adjuvant chemotherapy

33) Deep venous thrombosis resulting from upper extremity central


venous lines:
A) should be treated with catheter removal, heparin therapy,
and long term anticoagulants
B) is best with urokinase through the catheter
C) is innocuous and self limiting, and best treated with
catheter removal only
D) is best treated with low-dose warfarin (coumadin, 1 mg /
day) , without catheter removal
E) is best managed by single systemic dose of low molecular
weight heparin daily and continued catheter use

34) Emergency surgery is indicated for all of the following


complications of ulcerative colitis EXCEPT:
A) colonic dilatation greater than 12 cm (toxic mega colon )
B) free perforation
C) complete intestinal obstruction
D) intractable haemorrhage
E) abscess formation

35) All the following statements concerning carcinoma of the


oesophagus are true EXCEPT that:
A) it has a higher incidence in males than females
B) alcohol has been implicated as a precipitating factor
C) adenocarcinoma is the most common type at the cardio
esophageal junction
D) it occurs more commonly in patients with corrosive
oesophagitis
E) surgical excision is the only effective treatment

31-. Which of the following statements about epiphrenic diverticula of the


esophagus is/are correct?

k) They are traction diverticula that arise close to the tracheobronchial


tree.
l) They characteristically arise proximal to an esophageal reflux
stricture.
m) The degree of dysphagia correlates with the size of the pouch.
n) They are best approached surgically through a right thoracotomy.
o) The operation of choice is a stapled diverticulectomy, long
esophagomyotomy, and partial fundoplication.

32- Which of the following statements about Schatzki's ring is correct?

k) The ring represents a panmural fibrotic stricture resulting from


gastroesophageal reflux.
l) Dysphagia occurs when the ring diameter is 13 mm. or less.
m) The ring occurs within 1 to 2 cm. of the squamocolumnar epithelial
junction.
n) Schatzki's ring indicates reflux esophagitis.
o) Schatzki's ring signifies the need for an antireflux operation.

33. Which of the following statements about pathology encountered at


esophagoscopy is/are correct?

k) Reflux esophagitis should be graded as mild, moderate, or severe, to


promote consistency among different observers.
l) An esophageal reflux stricture with a 2-mm. lumen is not dilatable and
is best treated with resection.
m) A newly diagnosed radiographic distal esophageal stricture warrants
dilation and antireflux medical therapy.
n) In patients with Barrett's mucosa, the squamocolumnar epithelial
junction occurs 3 cm. or more proximal to the anatomic
esophagogastric junction.
o) After fasting at least 12 hours, a patient with megaesophagus of
achalasia can safely undergo flexible fiberoptic esophagoscopy.

34. Infantile hypertrophic pyloric stenosis


k) Occurs with a female : male ratio of 1:4.
l) Sons of affected mothers have a 20% risk of developing the lesion
m) Invariably presents between 3 and 4 WK of age
n) Typically presents with out bile stained projectile vomiting
o) Surgical treatment is by Heller's( Ramsted myotomy) Cardiomyotomy

35-. Which of the following statements regarding the pathology of


esophageal carcinoma is/are correct?

k) Worldwide, adenocarcinoma is the most common esophageal


malignancy.
l) Squamous cell carcinoma is most common in the distal esophagus,
whereas adenocarcinoma predominates in the middle third.
m) Patients with Barrett's metaplasia are 40 times more likely than the
general population to develop adenocarcinoma.
n) Metastases from esophageal carcinoma are characteristically
localized to regional mediastinal lymph nodes adjacent to the tumor.
o) Achalasia, radiation esophagitis, caustic esophageal stricture,
Barrett's mucosa, and Plummer-Vinson syndrome are all premalignant
esophageal lesions that predispose to the development of squamous
cell carcinoma.

36-45-year-old with isolated 6-cm colorectal metastasis in the liver 2 years


after colectomy, otherwise healthy pest treatment would be:

k) Radiofrequency ablation
l) Systemic chemotherapy
m) Hepatic lobectomy
n) Liver transplantation
o) Cryosurgical ablation

37- Oesophageal atresia all true except:


k) Is often associated with a distal trachea-oesophageal fistula
l) Polyhydramnios is often present late in pregnancy( Early)
m) 50% have other associated congenital abnormalities
n) Contrast X-ray studies are necessary to confirm the diagnosis
o) Post-operatively over 30% develop oesophageal strictures
38-All are true about the dumping syndrome except:

k) Symptoms can be controlled with a somatostatin analog.


l) Diarrhea is always part of the dumping syndrome.
m) Flushing and tachycardia are common features of the syndrome.
n) Separating solids and liquids in the patient's oral intake alleviates
some of the symptoms of the syndrome.
o) Early postoperative dumping after vagotomy often resolves
spontaneously.

39-Which of the following statements about gastric polyps is/are true?

k) Like their colonic counterparts, gastric epithelial polyps are common


tumors.
l) They are analogous to colorectal polyps in natural history.
m) Endoscopy can uniformly predict the histology of a polyp based on
location and appearance.
n) In a given patient, multiple polyps are generally of a multiple
histologic type.
o) Gastric adenomatous polyps greater than 2 cm. in diameter should be
excised because of the risk of malignant transformation.

40-All of the following statements about surgical management of gastric


lymphomas are true except:

k) Stage I gastric lymphomas (small lesions confined to the stomach


wall) can be cured completely with surgical therapy alone.
l) Extensive gastric lymphomas that initially are treated with radiation
and/or chemotherapy occasionally perforate during treatment and
require secondary resection.
m) Patients explored with a presumptive diagnosis of gastric lymphoma
should undergo an attempt at curative resection when this is safe and
feasible.
n) Without a preoperative diagnosis resection for gastric mass should
not be attempted unless lymphoma can be excluded.
o) Appropriate staging for primary gastric lymphoma includes bone
marrow biopsy.

41-the most accurate test to confirm diagnosis of infected necrotizing


pancreases is:
k) Abdominal ultrasound study
l) Indium-labeled leeukocte scan
m) Cimputed tomographic scan
n) Elevated serum level of interleukain 6 and 8
o) Percutaneous needle aspiration

42- Which of the following variables best predicts prognosis for patients
with a recent diagnosis of cutaneous melanoma and no clinical evidence of
metastatic disease?

k) Breslow thickness.
l) Clark's level.
m) Ulceration.
n) Gender.
o) Celtic complexion.

43-the following are true about intracranial tumors except:

k) The most common location of brain tumors of childhood is the


posterior cranial fossa.
l) With few exceptions, examination of the CSF is of no value in the
diagnosis of an intracranial tumor.
m) Even the most malignant of primary brain tumors seldom spread
outside the confines of the central nervous system (CNS).
n) The majority of astrocytomas can be cured surgically.
o) Primary neoplasms of astrocytic, oligodendroglial, or ependymal
origin represent gradations of a spectrum from slowly growing to
rapidly growing neoplasms.

44 A right-sided disc herniation at the L5–S1 level typically may cause:

k) Low back pain and left sciatica.


l) Weakness of dorsiflexion of the right foot.
m) A diminished or absent right ankle jerk.
n) Diminution of sensation over the medial aspect of the right foot,
including the great toe.
o) Weakness of dorsiflexion of the left foot.
45-. The preferred operation for initial management of a thyroid nodule that
is considered suspicious for malignancy by FNAB is:

k) Excision.
l) Partial lobectomy.
m) Total lobectomy and isthmusectomy.
n) Total thyroidectomy.
o) All methods are correct

46-the most common presentation of Meckel,s diverticulum in an adult is:

k) GIT bleeding
l) GIT obstruction
m) Intussuception
n) Litter,s hernia
o) Diverticulitis

47-Optimal front-line treatment of squamous cell carcinoma of the rectum


includes:

k) Abdominal perineal resection.


l) Low anterior resection when technically feasible.
m) Radiation therapy.
n) Chemotherapy.
o) Combined radiation and chemotherapy.

48 -65-year-old man presents with complaints of mucous discharge and


perianal discomfort. Physical examination reveals a fistulous opening
lateral to the anus. Anoscopic examination permits passage of a probe
through the fistula tract. The fistula traverses the internal anal sphincter, the
intersphincteric plane, and a portion of the external anal sphincter. The
fistula is categorized as which type?

a) Intersphincteric
b) Transsphincteric
c) Suprasphincteric
d) Extrasphincteric
e) Non of the above

49-Warthin's tumor:

k) Is a pleomorphic adenoma of salivary gland


l) Should be treated by total paritidectomy
m) Is considered a benign salivary gland neoplasia
n) Respond well to preoperative radiotherapy
o) Often present with facial nerve compression

50-A 38 year old woman presents with right upper quadrant pain and bouts
of vomiting. She is known to have gallstones and has had similar episodes in
the past. Which of the following might support a diagnosis of acute
cholecystitis rather than biliary colic

a) duration of symptoms
b) Severity of vomiting
c) Presence of Murphy's sign
d) Presence of gas under right hemidiaphragm on erect CXR.

1. The radial nerve.


f) Is a branch of the anterior cord of the brachial plexus.
g) Is derived from the posterior primary rami of C5 to C7.
h) Supplies the flexors of the arm.
i) Gives rise to the anterior interosseous nerve.
j) Injury above elbow produces a classical wrist drop.

2. Regarding femoral canal all are true except:


f) Lies lateral to the femoral vein.
g) Has the inguinal ligament as its anterior border.
h) Has the lacunar ligament as its medial border.
i) Has the pectineal ligament as its posterior border.
j) Contains the lymph node of Cloquet.

3. The following causes hypercalcaemia except:


a) Sarcoidosis.
b) Primary hyperparathyroidism.
c) Acute pancreatitis.( hypocalcemia)
d) Metastatic bronchial carcinoma.
e) Milk-Alkali syndrome.

4. Number of human chromosomes in human female are:


f) 23 pairs +XX.
g) 21 pairs +XY.
h) 22 pairs +XY.
i) 22 pairs +XX.
j) 23 pairs +XY.

6. Potassium deficiency should be suspected in all the following except:


e) In cases of paralytic ileus.
f) When the patient's reflexes are exaggerated.
g) If there is a decrease in height and peaking of the T waves of an
ECG.
h) In alkalotic states.

6. Active immunization in case of tetanus:


f) Antitetanus human serum.
g) Gives short period of protection.
h) Given in case proved tetanus.
i) Use of immunoglobulin.
j) None of the above.

7. All of the following are signs of rised intracranial pressure


except:
a) Headache.
b) Vomiting.
c) Papilledema.
d) Aphasia.
e) Bradycardia.

8. All of the following are extra cranial hematomas except:


a) Subcutaneos haematoma.
b) Extra dural haematoma.
c) Cephalohaematoma.
d) Subgaleal hematoma.
e) Subperiostial haematoma.

9. Glasgow coma scale all the following are true except:


f) Used for evaluation of comatose patient.
g) It ranges from ( 3 to 15).
h) Useful for neurological follow up.
i) Useful for pupils evaluation.
j) Best motor response given 6 point.

10. All the followings are Indications for central line insertion EXCPET:
e) Massive fluid replacement
f) Massive blood replacement
g) Measurement of central venous pressure
h) Prolonged Intervenes fluid therapy

11. Most common early complication of central venous line is:


a) Sepsis
b) Pneumothorax( But if late answer is A or D )
c) Thoracic duct injury
d) Thrombosis

12. The following are Complications of shock:


a) Acute Respiratory failure
b) Acute myocardial infarction
c) Acute renal failure
d) A&C only
e) All the above

13. Causes of delayed union of fractures includes all the following


EXCPET:
a) Compound fracture
b) Infection
c) Adequate immobilization
d) Poor blood supply

14. In Head injury C.T. scan is indicated in the following


f) Aphasia after the injury
g) Deterioration of level of consciousness
h) Skull fracture with persistent headache
i) A&B only
j) All the above

15. Most important steps in management of head injury include:


f) Prevent hypoxia
g) Prevent Dehydration
h) Assure Brain Metabolism
i) Prevent secondary brain injury
j) All the above

16. Tension pneumothorax


f) is the commonest type of chest injuries
g) Needs urgent X-Ray chest
h) Is a clinical Diagnosis
i) Causes flat neek viens
j) Treated by thoracotomy tube after chest X-ray.
17. Calcitonin hormon is secreted to the blood circulations from:
f) Parathyroid gland.
g) Parafollicular cells of thyroid gland.( Calcitonin increase in
medullary carcinoma)
h) Supra renal gland.
i) Pituitary gland.
j) Gonads.

18. Regarding tension pneumothorax, the first step in the management is:
f) Obtaining a stat chest x-ray.
g) Cricothyroidectomy.
h) Pass an endotracheal tube.
i) Starting oxygen by a valve-mask device.
j) Chest decompression needle.
19. The following are features of thyrotoxicosis except:
f) Weight gain.
g) Palpitations.
h) Proximal myopathy.
i) Increased skin pigmentation.
j) Pretibial myxoedema.

20. The following is a clinical feature of Horner's syndrome:


e) Miosis
f) Failure of abduction of the orbit
g) Increased sweating on the contralateral side of the forehead
h) Exophthalmos.
e) All are true

21. In role of nine extent of burn if entire trunk is burned it will be equal to:
f) 9% body surface area.
g) 18% body surface area.
h) 36% body surface area.
i) 27% body surface area.
j) 45% body surface area.

22. Trachlea (4th) cranial nerve supply :


f) Lateral rectus muscle of th eye.
g) Medial rectus muscle of the eye.
h) Superior obligue rectus muscle of the eye.
i) Superior oblique muscle of the eye.
j) Muscles of the upper eye lid.

23. Regarding pathological terms :


f) Hypertrophy is an increase in tissue size due to increased cell
number.
g) Hyperplasia is an increase in tissue size due to an increase in
cell size.
h) Atrophy is an increase in tissue size due to disuse.
i) Metaplasia is a change form one abnormal tissue type to
another.
j) A hamartoma is a developmental abnormality.

24. Regarding nephroblastomas:


f) They are otherwise known as a Wilm's tumour.
g) Account for 10% of childhood tumours.
h) The commonest presentation is with an abdominal mass.
i) Most commonly present between 2nd and 4th year of life.
j) All are true.

25. Regarding fluid losses in a major burn all are true except:
f)Are maximal between 12 and 24 hours after the injury.
g) Are related to the age of the patient.
h) Are not related to the weight of the patient.
i)Are related to the area burnt.
j)Are not related to the burn duration.

26. In obstructive jaundice :


f)Urinary conjugated bilirubin is increased.
g) Serum unconjugated bilirubin is increased.
h) Urinary urobilinogen is increased.
i)Serum conjugated bilirubin is reduced.
j)Faecal stercobilinogen is increased.

27. Regarding Hydatid disease:


f) Is due to Ecchinococcus granulosa.
g) Man is an accidental intermediate host.
h) The liver is the commonest site of infection.
i) Can be diagnosed by the Casoni test.
j) All are true.

28. The first aid of treatment in fracture of cervical spine should be:
f) Cervical spine x-ray.
g) Analgesia.
h) Neck immoblization.
i) Cervical traction.
j) Non of teh above.

29. The first aid of treatment in fracture of cervical spine should be:
a) Cervical spine x-ray.
b) Analgesia.
c) Neck immoblization.
d ) Cervical traction.

30. Regarding local anaesthesia:


a) Local anaesthetics act on small before large nerve
fibres
b) Adrenaline reduces absorption and prolongs the local
effects
c) Preparations containing adrenaline are safe to use on
digits and appendages
d) Lignocaine has a longer duration of action than
bupivicaine.
e) All are false.

31. Small bowel obstruction often results in: (all correct except one)
f)Hyperkalaemia.
g) Metabolic alkalosis.
h) Oliguria.
i)Hypovolaemia.
j)Severe dehydration.
32. A serious intra-abdominal injury in a comatose patient may be
diagnosed by: (all are correct except one)
f)Abdominal paracentesis.
g) The observation of bruising pattern on the abdominal wall.
h) Falling of heamoglobin values.
i)The presence of marked abdominal distetion.
j)The presence of diarrhea.

33. A perforated duodenal ulcer, all are true except:


f) Usually lies on the anterior or superior surface of the
duodenum.
g) Usually presents with the acute onset of severe back pain.
h) Produces radiological evidence of free gas in the peritoneum
in over 90 percent of the patients.
i) Is usually treated by vagotomy and pyloroplasty.
j) Is usually treated conservatively.

34. Acute pancreatitis typically: (all correct except one)


f)Is accompanied by hypocalcaemia.
g) Produces paralytic ileus.
h) Is associated with a pleural effusion.
i)Produces pyloric stenosis.
j)Upper abdominal pain and vomiting.
35. Biliary colic typically:
f)Occurs 3 to 4 hours after meals.
g) Lasts 5 to 20 minutes.
h) Radiates from the upper abdomen to the right subscapular
region.
i)Is made better by deep inspiration.
j)B&C only.
36. In post operative DVT, the following are true except:
f) Clinical DVT occures in the 4th post operative day.( any time)
g) If complicated by pulmonary embolism, it occures usually after the
7th post operative day.
h) The process of DVT starts preoperatively with the induction of
anaesthesia .
i)When discovered we should start the patient on coumadin "Warfarin
anticoagulation".
j)It may lead to chronic venous in suffering as a complication of DVT.

37. In acute appendicitis all of the following are true except:


f)Anorexia.
g) Abdominal pain usually preceedes vomiting.
h) Pain after begins in the paraumbilical region.
i)Constipation diarrhea may occur.
j)Dysuria excludes the diagnosis.

38. The most common cause of massive haemorrhage in the lower


gastroinfestinal tract is :
f)Carcinoma.
g) Diverticulosis
h) Diverticulitis
i)Polyp.
j)Ulcerative colitis.

39. Painless haematuria is the leading presentation of :


f)Renal cell carcinoma.
g) Transitional cell carcinoma of the bladder .
h) Ureteric stone.
i)Pelvi-ureteric obstruction.
j)Ureterocele.

40. All of the following are complications of massive blood transfusion


except:
f)Acute congestive heart failure.
g) Transmission of infection.
h) Hypercalcaemia.
i)Hyperkalaemia.
j)Transfusion reactions.

41. Complication of undescended testis include all of the following except :


f) Malignant degeneration.
g) Increased susceptability to trauma.
h) Increased spermatogenesis.
i) More liable to testiculer torsion.
j) Psychological complication.

42. The recurrent laryngoeal nerve is branch of :


f) Facial nerve.
g) Glosso-pharyngeal nerve.
h) Cervical plexus.
i) Vagus nerve.
j) Brachial plexus.

43. The thyroid tumor which is may be associated with pheochromocytoma


is :
f)Papillary carcinoma.
g) Medullary carcinoma.
h) Follicular carcinoma.
i)Anaplastic carcinoma.
j)Malignant lymphoma.

44. The most common pancreatic cyst is :


f)Dermoid cyst of the pancreas.
g) Hydatid cyst of the pancreas.
h) Pancreas pseudocyst.
i)Pancreatic cystadenoma.
j)Congenital cystic disease of the pancreas.
45. The anatomical division between the anus and rectum :
f)Lateral haemorrhoidal groove.
g) Inter haemorrhoidal groove.
h) Dentate line.
i)Arcuate line
j)Ano-rectal ring.

46. The comments type of Anorectal abscess is:


e) Ischio rectal
f) Perianal
g) Submucons
h) Pelvirectal

47. Anal Fissure:

f) Usually anterior
g) May be caused by previous anal surgery
h) Can cause dark bleeding PR.
i) Sometimes is painful
j) Treated by steroids

48. Neonatal duodenal obstruction:

f) May be associated with down's syndrome.


g) Is more frequently found in premature infants.
h) Typically presents with gross abdominal distension.
i) Usually presents with vomiting of non-bile stained fluid
j) B&C only.

49. acute superior mesenteric artery occlusion: (all correct except one)

f) Characteristically presents with sudden pain and tenderness of


increasing intensity.
g) Is frequently accompanied by overt or occult blood loss in the stools.
h) Frequently produces peritonitis.
i) Can usually be diagnosed on plain abdominal x-rays.
j) Can be diagnosed by mesenteric artery ongiography.

50. Regarding the management of polytrauma:

f) Death follow a trimodal distribution.


g) X-ray after primary survey should be AP cervical spine, chest
and pelvis.
h) Cardiac tamponade is characterized by raised B.p, a low JUP.
i) Assessment of uncomplicated limb fractures should occur
during the primary survey.
j) A and B only.

51. Injuries to the urethra (all are correct except one)

a) Are more common in male.


b) Are often caused by road traffic accidents.
c) Are easily diagnosed on intra venous pyelography.
d) Require urgent surgical treatment.
e) Diagnosed by retrograde urethragraphy.

52 .Car seat belts when properly adjusted


a) Prevent injuries to abdominal organs.
b) May cause small bowel injuries.
c) Do not reduce the incidence of head injuries of passengers involving
in RTA.
d) Protect the cervical spine during sudden acceleration .
e) A & D only.

53. Patients with major burns:


f) Are in a negative nitrogen balance.
g) Have normal calorie requirements.
h) Do not generally become anaemic.
i) Are resistant to septicaemia.
j) All of the above.

54 . In a healing fracture: (All correct except one)


a) The haematoma is initially invaded by osteoblasts.
b) The tissue formed by the invading osteoblasts is termed osteoid.
c) Calcium salts are laid down in the osteoid tissue.
d) The final stage of repair is the remodelling of the callus.
e) The callus formation is related to the amount of stress at fracture side.

55. In a colles’ fracture the distal radial fragment:


f) Is dorsally angulated on the proximal radius.
g) Is usually torn from the intra-articular triangular disc.
h) Is deviated to the ulnar side.
i) Is rarely impacted.
j) Is ventrally displaced.

56. A malignant melanoma:

a) Frequently arises from hair-bearing naevi.


b) Frequently arises from junctional naevi. *
c) Has a worse prognosis when it areses on the leg.
d) Should be suspected in any big pigmented lesion.
e) Non of the above is correct.

57. Squamous cancer of the lip:

a) Is most common in early adult life.


b) Is more common in fair skinned subjects.
c) Metastasises readily by the blood stream.
d) Is preferably treated by radiotherapy once lymph node deposits are
present.
e) All of the above are correct.

58- Basal cell carcinomas:


a) Usually metastasise to regional lymph nodes.
b) Are less common than squamous cell carcinomas.
c) Are characterised histologically by epithelial pearls.
d) Are particularly common in oriental races.
e) Non of the above is correct.

59- Fiboadenomata of the breast:


a) Are commonest in early adult life.
b) Are indiscrete and difficult to distinguish.
c) Are usually painless.
d) Resolve without treatment.
e) A&C only.

60. Paget’s disease of the nipple:


a) Usually presents as abilateral eczema of the nipple.
b) Is always related to an underlying breast cancer.
c) Indicates incurable breast cancer.
d) Has non-specific histological characteristics.
e) A&C only.

61- stones in the common bile duct:


a) Are present in nearly 50 per cent of cases of cholecystitis.
b) Often give rise to jaundice, fever and biliary colic.
c) Are usually accompanied by progressive jaundice.
d) Are usually associated with a distended gallbladder.
e) A&D only.

62- Colonic polyps: (all correct except one)


f) Are associated with colonic cancer.
g) May be hereditary.
h) Should not be removed if they are asymptomatic.
i) May be hyperplastic.
j) Are commonly adenomatous.

1-Which is the shortest phase of the normal cell cycle?


f) G1 phase
g) S phase
h) G2 phase
i) M phase
j) All phases approximately equal in length

2- A 67 year-old women with rectal cancer is admitted to gereral surgical


floor which of the following laboratory studies should be included in the
surgeon’s initial nutritional assessment :
f) Transferrin
g) Prealbumin
h) Albumin
i) Glutamine
j) All of above

3- In which of the following conditions is the entral route appropriate for


nutrition :
f) Upper gastrointestinal obstruction
g) Complete small bowel obstruction
h) Acute flare-up of Crohn’s disease
i) Low out put colonic fistula
j) Non of the above

4-5-Which is the most commonly cultured hospital acquired organism in


critical care with aspiration pneumonia:
f) Staphylococcus aureus
g) Streptococcus pneumonia
h) Anaerobic species
i) Pseudomonas aeroginosa
j) Haemophlus influenzae

5-Which is the most appropriate single agent for empiric coverage of the
above patient :
f) Metranidazole
g) Clindamycin
h) Pipracillin_tazobactam
i) Vancomycin
j) First generation penicillin

6-All of the following are true about neurogenic shock except:

f) There is a decrease in systemic vascular resistance and an increase in


venous capacitance.
g) Tachycardia or bradycardia may be observed, along with hypotension.
h) The use of an alpha agonist such as phenylephrine is the mainstay of
treatment.
i) Severe head injury, spinal cord injury, and high spinal anesthesia may
all cause neurogenic shock.
j) A and B

7-Which of the following statements about head injury and concomitant


hyponatremia are true?

f) There are no primary alterations in cardiovascular signs.


g) Signs of increased intracranial pressure may be masked by the
hyponatremia.
h) Oliguric renal failure is an unlikely complication.
i) Rapid correction of the hyponatremia may prevent central pontine
injury.
j) This patient is best treated by restriction of water intake

8 Regarding Cushing's Syndrome


f) 20% of cases are due to pituitary adenomas (Cushing's Disease)
g) Most ACTH secreting pituitary adenomas are more than 2 cm in
diameter
h) Is characterised by loss of the diurnal rhythm of cortisol secretion
i) Cortisol production is suppressed by low-dose dexamethasone
j) Adrenal carcinomas are more common than adrenal adenomas

9-Which of the following statements about extracellular fluid are true?

f) The total extracellular fluid volume represents 40% of the body


weight.
g) The plasma volume constitutes one fourth of the total extracellular
fluid volume.
h) Potassium is the principal cation in extracellular fluid.
i) The protein content of the plasma produces a lower concentration of
cations than in the interstitial fluid.
j) The interstitial fluid equilibrates slowly with the other body
compartments.

10-In patients receiving massive blood transfusion for acute blood loss,
which of the following is/are correct?

f) Packed red blood cells and crystalloid solution should be infused to


restore oxygen-carrying capacity and intravascular volume.
g) Two units of FFP should be given with every 5 units of packed red
blood cells in most cases.
h) A “six pack” of platelets should be administered with every 10 units of
packed red blood cells in most cases.
i) One to two ampules of sodium bicarbonate should be administered
with every 5 units of packed red blood cells to avoid acidosis.
j) One ampule of calcium chloride should be administered with every 5
units of packed red blood cells to avoid hypocalcemia.

11- Which of the following statements about the presence of gallstones in


diabetes patients is/are correct?

f) Gallstones occur with the same frequency in diabetes patients as in


the healthy population.
g) The presence of gallstones, regardless of the presence of symptoms, is
an indication for cholecystectomy in a diabetes patient.
h) Diabetes patients with gallstones and chronic biliary pain should be
managed nonoperatively with chemical dissolution and/or lithotripsy
because of severe complicating medical conditions and a high
operative risk.
i) The presence of diabetes and gallstones places the patient at high risk
for pancreatic cancer.
j) Diabetes patients with symptomatic gallstones should have prompt
elective cholecystectomy, to avoid the complications of acute
cholecystitis and gallbladder necrosis.

12. concerning Tetanus all true except:


a. Is due to an infection with a gram-negative spore forming rod
b. The organism produces a powerful exdotoxin
c. The toxin prevents the release of inhibitory neurotransmitter
d. Clostridium tetani is sensitive to penicillin
e. Risus sardonicus is the typical facial spasm

13-when should parentral antibiotics be given perioperatively?

f) The night before


g) 6 hr prior to surgery
h) 30 minutes prior to incision .
i) at the time of incision
j) 30 minutes after incision

14. Which of the following statements about esophageal anatomy is correct?

f) The esophagus has a poor blood supply, which is segmental in


distribution and accounts for the high incidence of anastomotic
leakage.
g) The esophageal serosa consists of a thin layer of fibroareolar tissue.
h) The esophagus has two distinct muscle layers, an outer, longitudinal
one and an inner, circular one, which are striated in the upper third
and smooth in the distal two thirds.
i) Injury to the recurrent laryngeal nerve results in vocal cord
dysfunction but does not affect swallowing.
j) The lymphatic drainage of the esophagus is relatively sparse,
localized primarily to adjacent paraesophageal lymph nodes.
15 Wich of the following medication should be given in preparation of a
pation with pheochromocytoma?

f) Phnoxybenzamine
g) Nifedipine
h) Linsinopril
i) Hydrochlorothiazide
j) Propranolol

16-Which of the following statement(s) is true concerning excessive scarring


processes?

f) Keloids occur randomly regardless of gender or race


g) Hypertrophic scars and keloid are histologically different
h) Keloids tend to develop early and hypertrophic scars late after the
surgical injury
i) Simple reexcision and closure of a hypertrophic scar can be useful in
certain situations such as a wound closed by secondary intention
j) Non of the above

17-A 22-year-old man sustains a single stab wound to the left chest and
presents to the emergency room with hypotension. Which of the following
statement(s) is true concerning his diagnosis and management?

e) The patient likely is suffering from hypovolemic shock and should


respond quickly to fluid resuscitation
f) Beck’s triad will likely be an obvious indication of compressive
cardiogenic shock due to pericardial tamponade
g) Echocardiography is the most sensitive noninvasive approach for
diagnosis of pericardial tamponade
h) The placement of bilateral chest tubes will likely resolve the problem

18-Which of the following statement(s) is/are true concerning septic shock?

e) The clinical picture of gram negative septic shock is specifically


different than shock associated with other infectious agents
f) The circulatory derangements of septic shock precede the
development of metabolic abnormalities
g) Splanchnic vascular resistance falls in similar fashion to overall
systemic vascular resistance
h) Despite normal mechanisms of intrinsic expansion of the circulating
blood volume, exogenous volume resuscitation is necessary

19- During surgery on the submandibular gland


f) An incision on the lower border of the mandible is safe
g) The submandibular gland is seen to wrap around the posterior border
of mylohyoid
h) The facial artery and vein are divided as they course through the deep
part of the gland
i) The hypoglossal nerve is seen to loop under the submandibular duct
j) Damage to the lingual nerve will cause loss of sensation to the
posterior third of the tongue

20- Regarding benign breast disease except


f) Cyclical mastalgia is the commonest reason for referral to the breast
clinic
g) Fibroadenomas are derived from the breast lobule
h) Lactational breast abscesses are usually due to Staph aureus
i) Duct ectasia is more common in smokers
j) Atypical lobular hyperplasia is associated with an decreased risk of
breast cancer

21-. Which of the following statements regarding unusual hernias is


incorrect?

f) An obturator hernia may produce nerve compression diagnosed by a


positive Howship-Romberg sign.
g) Grynfeltt's hernia appears through the superior lumbar triangle,
whereas Petit's hernia occurs through the inferior lumbar triangle.
h) Sciatic hernias usually present with a painful groin mass below the
inguinal ligament.
i) Littre's hernia is defined by a Meckel's diverticulum presenting as the
sole component of the hernia sac.
j) Richter's hernia involves the antimesenteric surface of the intestine
within the hernia sac and may present with partial intestinal
obstruction

22- Staples may safely be placed during laparoscopic hernia repair in each
of the following structures except:
f) Cooper's ligament.
g) Tissues superior to the lateral iliopubic tract.
h) The transversus abdominis aponeurotic arch.
i) Tissues inferior to the lateral iliopubic tract.
j) The iliopubic tract at its insertion onto Cooper's ligament.

23-The following statements about the repair of inguinal hernias are true
except:

f) The conjoined tendon is sutured to Cooper's ligament in the Bassini


hernia repair.
g) The McVay repair is a suitable option for the repair of femoral
hernias.
h) The Shouldice repair involves a multilayer, imbricated repair of the
floor of the inguinal canal.
i) The Lichtenstein repair is accomplished by prosthetic mesh repair of
the inguinal canal floor in a tension-free manner.
j) The laparoscopic transabdominal preperitoneal (TAPP) and totally
extraperitoneal approach (TEPA) repairs are based on the
preperitoneal repairs of Cheattle, Henry, Nyhus, and Stoppa.

24-A number of special circumstances exist in the repair of inguinal hernias.


The following statement(s) is correct.

f) Simultaneous repair of bilateral direct inguinal hernias can be


performed with no significant increased risk of recurrence
g) The preperitoneal approach may be appropriate for repair of a
multiple recurrent hernia
h) A femoral hernia repair can best be accomplished using a Bassini or
Shouldice repair
i) Management of an incarcerated inguinal hernia with obstruction is
best approached via laparotomy incision
j) All are correct.

25- Which of the following statement(s) is true about benign lesions of the
liver?

e) Adenomas are true neoplasms with a predisposition for complications


and should usually be resected.
f)Focal nodular hyperplasia (FNH) is a neoplasm related to birth control
pills (BCPs) and usually requires resection.
g) Hemangiomas are the most common benign lesions of the liver that
come to the surgeon's attention.
h) Nodular regenerative hyperplasia does not usually accompany
cirrhosis

26. Ligation of all of the following arteries usually causes significant hepatic
enzyme abnormalities except:

e) Ligation of the right hepatic artery.


f) Ligation of the left hepatic artery.
g) Ligation of the hepatic artery distal to the gastro-duodenal branch.
h) Ligation of the hepatic artery proximal to the gastroduodenal artery.

27- Which of the following is the most effective definitive therapy for both
prevention of recurrent variceal hemorrhage and control of ascites?

f) Endoscopic sclerotherapy.
g) Distal splenorenal shunt.
h) Esophagogastric devascularization (Sugiura procedure).
i) Side-to-side portacaval shunt.
j) End-to-side portacaval shunt.

28-which of the following is associated with best prognosis for patient with
breast cancer?

f) Male sex
g) Estrogen receptor positive
h) Patient age <35 years
i) Pregnant patient
j) Tumor with overexpression of HER/ner.

29-A 49-year-old women has a palpable breast mass in the upper outer
quadrant. The size of the mass has increased over the last month .
exicisional biopsy reveals cystic carcinoma with invasion .appropriate
management now would be :

f) Re-excision with wide margins


g) Axillary node dissection and hormonal therapy
h) Simple mastectomy
i) Modified radical mastectomy
j) Bilateral mastectomies
30-A contraindication to stereotactic core biopsy of the breast is the
mammographic presence of:

f) Microcacification
g) A radial scar
h) A nonpalpable mass lesion
i) Lesions<8 mm in diameter
j) Mutifocal lesions.

31-. Which of the following statements about epiphrenic diverticula of the


esophagus is/are correct?

p) They are traction diverticula that arise close to the tracheobronchial


tree.
q) They characteristically arise proximal to an esophageal reflux
stricture.
r) The degree of dysphagia correlates with the size of the pouch.
s) They are best approached surgically through a right thoracotomy.
t) The operation of choice is a stapled diverticulectomy, long
esophagomyotomy, and partial fundoplication.

32- Which of the following statements about Schatzki's ring is correct?

p) The ring represents a panmural fibrotic stricture resulting from


gastroesophageal reflux.
q) Dysphagia occurs when the ring diameter is 13 mm. or less.
r) The ring occurs within 1 to 2 cm. of the squamocolumnar epithelial
junction.
s) Schatzki's ring indicates reflux esophagitis.
t) Schatzki's ring signifies the need for an antireflux operation.

33. Which of the following statements about pathology encountered at


esophagoscopy is/are correct?

p) Reflux esophagitis should be graded as mild, moderate, or severe, to


promote consistency among different observers.
q) An esophageal reflux stricture with a 2-mm. lumen is not dilatable and
is best treated with resection.
r) A newly diagnosed radiographic distal esophageal stricture warrants
dilation and antireflux medical therapy.
s) In patients with Barrett's mucosa, the squamocolumnar epithelial
junction occurs 3 cm. or more proximal to the anatomic
esophagogastric junction.
t) After fasting at least 12 hours, a patient with megaesophagus of
achalasia can safely undergo flexible fiberoptic esophagoscopy.

34. Infantile hypertrophic pyloric stenosis


p) Occurs with a female : male ratio of 4:1.
q) Sons of affected mothers have a 20% risk of developing the lesion
r) Invariably presents between six and eights months of age
s) Typically presents with bile stained projectile vomiting
t) Surgical treatment is by Heller's Cardiomyotomy

35-. Which of the following statements regarding the pathology of


esophageal carcinoma is/are correct?

p) Worldwide, adenocarcinoma is the most common esophageal


malignancy.
q) Squamous cell carcinoma is most common in the distal esophagus,
whereas adenocarcinoma predominates in the middle third.
r) Patients with Barrett's metaplasia are 40 times more likely than the
general population to develop adenocarcinoma.
s) Metastases from esophageal carcinoma are characteristically
localized to regional mediastinal lymph nodes adjacent to the tumor.
t) Achalasia, radiation esophagitis, caustic esophageal stricture,
Barrett's mucosa, and Plummer-Vinson syndrome are all premalignant
esophageal lesions that predispose to the development of squamous
cell carcinoma.

36-45-year-old with isolated 6-cm colorectal metastasis in the liver 2 years


after colectomy, otherwise healthy pest treatment would be:

p) Radiofrequency ablation
q) Systemic chemotherapy
r) Hepatic lobectomy
s) Liver transplantation
t) Cryosurgical ablation

37- Oesophageal atresia all true except:


p) Is often associated with a distal trachea-oesophageal fistula
q) Polyhydramnios is often present late in pregnancy
r) 50% have other associated congenital abnormalities
s) Contrast X-ray studies are necessary to confirm the diagnosis
t) Post-operatively over 30% develop oesophageal strictures
38-All are true about the dumping syndrome except:

p) Symptoms can be controlled with a somatostatin analog.


q) Diarrhea is always part of the dumping syndrome.
r) Flushing and tachycardia are common features of the syndrome.
s) Separating solids and liquids in the patient's oral intake alleviates
some of the symptoms of the syndrome.
t) Early postoperative dumping after vagotomy often resolves
spontaneously.

39-Which of the following statements about gastric polyps is/are true?

p) Like their colonic counterparts, gastric epithelial polyps are common


tumors.
q) They are analogous to colorectal polyps in natural history.
r) Endoscopy can uniformly predict the histology of a polyp based on
location and appearance.
s) In a given patient, multiple polyps are generally of a multiple
histologic type.
t) Gastric adenomatous polyps greater than 2 cm. in diameter should be
excised because of the risk of malignant transformation.

40-All of the following statements about surgical management of gastric


lymphomas are true except:

p) Stage I gastric lymphomas (small lesions confined to the stomach


wall) can be cured completely with surgical therapy alone.
q) Extensive gastric lymphomas that initially are treated with radiation
and/or chemotherapy occasionally perforate during treatment and
require secondary resection.
r) Patients explored with a presumptive diagnosis of gastric lymphoma
should undergo an attempt at curative resection when this is safe and
feasible.
s) Without a preoperative diagnosis resection for gastric mass should
not be attempted unless lymphoma can be excluded.
t) Appropriate staging for primary gastric lymphoma includes bone
marrow biopsy.
41-the most accurate test to confirm diagnosis of infected necrotizing
pancreases is:

p) Abdominal ultrasound study


q) Indium-labeled leeukocte scan
r) Cimputed tomographic scan
s) Elevated serum level of interleukain 6 and 8
t) Percutaneous needle aspiration

42- Which of the following variables best predicts prognosis for patients
with a recent diagnosis of cutaneous melanoma and no clinical evidence of
metastatic disease?

p) Breslow thickness.
q) Clark's level.
r) Ulceration.
s) Gender.
t) Celtic complexion.

43-the following are true about intracranial tumors except:

p) The most common location of brain tumors of childhood is the


posterior cranial fossa.
q) With few exceptions, examination of the CSF is of no value in the
diagnosis of an intracranial tumor.
r) Even the most malignant of primary brain tumors seldom spread
outside the confines of the central nervous system (CNS).
s) The majority of astrocytomas can be cured surgically.
t) Primary neoplasms of astrocytic, oligodendroglial, or ependymal
origin represent gradations of a spectrum from slowly growing to
rapidly growing neoplasms.

44 A right-sided disc herniation at the L5–S1 level typically may cause:

p) Low back pain and left sciatica.


q) Weakness of dorsiflexion of the right foot.
r) A diminished or absent right ankle jerk.
s) Diminution of sensation over the medial aspect of the right foot,
including the great toe.
t) Weakness of dorsiflexion of the left foot.
45-. The preferred operation for initial management of a thyroid nodule that
is considered suspicious for malignancy by FNAB is:

p) Excision.
q) Partial lobectomy.
r) Total lobectomy and isthmusectomy.
s) Total thyroidectomy.
t) All methods are correct

46-the most common presentation of Meckel,s diverticulum in an adult is:

p) GIT bleeding
q) GIT obstruction
r) Intussuception
s) Litter,s hernia
t) Diverticulitis

47-Optimal front-line treatment of squamous cell carcinoma of the rectum


includes:

p) Abdominal perineal resection.


q) Low anterior resection when technically feasible.
r) Radiation therapy.
s) Chemotherapy.
t) Combined radiation and chemotherapy.

48 -65-year-old man presents with complaints of mucous discharge and


perianal discomfort. Physical examination reveals a fistulous opening
lateral to the anus. Anoscopic examination permits passage of a probe
through the fistula tract. The fistula traverses the internal anal sphincter, the
intersphincteric plane, and a portion of the external anal sphincter. The
fistula is categorized as which type?

a) Intersphincteric
b) Transsphincteric
c) Suprasphincteric
d) Extrasphincteric
e) Non of the above
49-Warthin's tumor:

p) Is a pleomorphic adenoma of salivary gland


q) Should be treated by total paritidectomy
r) Is considered a benign salivary gland neoplasia
s) Respond well to preoperative radiotherapy
t) Often present with facial nerve compression

50-A 38 year old woman presents with right upper quadrant pain and bouts
of vomiting. She is known to have gallstones and has had similar episodes in
the past. Which of the following might support a diagnosis of acute
cholecystitis rather than biliary colic

a) duration of symptoms
b) Severity of vomiting
c) Presence of Murphy's sign
d) Presence of gas under right hemidiaphragm on erect CXR.

32) Abduction of the vocal cords results from contraction of


the:
A) crico-thyroid muscles
B) posterior crico-arytenoid muscles
C) vocalis muscles
D) thyro-ary-epiglottic muscles
E) lateral crico-arytenoid and transverse arytenoids
muscles

33) The rectum:


A) is devoid of peritoneum
B) is surrounded by peritoneum
C) has peritoneum on its lateral surfaces for its upper
two- thirds, and on its anterior surface for its upper
one-third
D) has pritoneum on its anterior surface for its upper
two-thirds, and on its lateral surfaces for its upper
one-third
E) has peritoneum on its anterior surface only
34) The umbilicus:
A) lies near the to the xiphoid than to the pubis
B) derives its cutaneous innervation from the eleventh
thoracic nerve
C) transmits, during development, the umbilical cord
two arteries and two veins
D) usually lies at about the level between the third and
fourth lumbar vertebra
E) emberiologicall, may transmit urine but never bowel
contents

35) The superficial perineal pouch:


A) is limited inferiorly by the urogenital diaphragm
B) is not continuous with the space in the scrotum
occupied by the testes
C) has a membranous covering which provides a fascial
sheath around the penis
D) is traversedby the urethera in the male but not the
urethera and vagina in the female
E) in the female, the greater vestibular glands are
situated outside this pouch

36) The tongue:


A) has a foramen caecum at the base of the frenulum
B) is separated from the epiglottis by the valleculae on
each side of the midline
C) has 7-12 circumvallate papillae situated behind the
sulcus terminalis
D) is attached to the hyoid bone by the genioglossus
muscle
E) is supplied only by hypoglossal nerve

37) Hypovolaemic shock is characterized by:


A) a low central venous pressure , low cardiac output ,
low peripheral resistance
B) a high central venous pressure , high cardiac output ,
low peripheral resistance
C) a low central venoys pressure , low cardiac output ,
high periphera resistance
D) a low central venous pressure , high cardiac output ,
high peripheral resistance
E) a high central venous pressure , low cardiac output ,
low peripheral resistance

38) An oxygen debt is:


A) the amount of oxygen in excess of the resting
metabolic needs that
must be consumed after completion of exercise
B) build up because the pulmonary capillaries limit
the uptake of
Oxygen at high rates of oxygen consumption
C) related to the fact that skeletal muscle cannot function
temporarily in the absence of oxygen

H) associated with a decrease in blood lactate


I) associated with alkalosis

39) Pulmonary embolism may be a complication of:


A) prolonged bed rest
B) a surgical operation
C) vitamine K deficiency
D) oral contraceptive therapy
E) Antithrombin III deficiency

40) Which of the following statements regarding potassium


metabolism is NOT
True?:
A) potassium deficiency commonly results from thiazide
diuretic theraoy
B) the normal compensation for potassium deficiency is
a metabolic extracellular acidosis
C) aldosterone increases urinary potassium loss
D) hyperkalaemia causes bradycardia and loss of P
waves on the ECG
E) hypokalaemia aggrevates the cardiac effects of
digitalis toxicity

41) Cutaneous pain:


A) is due to overstimulation of receptors serving other
sensory modalities
B) cannot be elicited more readily if the tissue has
recently been injured
C) is due to exitation of receptors by pain-producing
chemical substances in the injured tissue
D) shows marked adaptation, i. e. decrease in severity
in response to a constant stimulus
E) is conducted through the medial spinothalamic tract

42) Which of the following is NOT associated with


hyperthyroidism?:
A) increase size of the thyroid gland
B) increased amount of colloid in thyroid follicle
C) increased height of epithelium of the thyroid follicle
D) increased vascularity of the thyroid gland
E) increased uptake of iodine by the thyroid gland

43) Sarcomata may show all of the following EXCEPT:


A) production of myxomatous tissue
B) production of collagen
C) spindle shaped cells
D) signet ring cells
E) blood stream metastasis

44) Anaphylaxis is characterized by all of the following


EXCEPT:
A) is a reaction either local or general , frequently
occurs within five minutes
B) causes an urticarial eruption
C) is produced by IgA antibody
D) causes eosinophilia
E) causes degranulation of basophils and mast cells

45) Autoimmunity is characterized by the following


EXCEPT:
A) occurs because of a breakdown in the ability of the
body to distinguish between self and non self
B) is involved in some forms of orchitis
C) is involved in formation of cryo globulin
D) is important in the pathogenesis of lupus
erytheromatosus
E) does not result in immune complex disease

46) Pseudomembranous enterocolitis is caused by the


following organisms:
A) Clostridium sporogenes
B) Clostridium defficile
C) Streptococcus faecalis
D) Penicillin sensitive staphylocci
E) Pseudomonas aeruginos

B) CLINICAL SUGERY

47) The “ white clot syndrome”:


A) is usually characterized with antithrombin III
deficiency
B) most often present with arterial complicatios of
heparin induced throbocytopenin
C) is best managed by loe molecular weight dextran
D) is best managed by halving the therapeutic dose of
heparin sodium
E) results from nitric oxide deficiency of endothelial
cells

17) A 21-year-old man who was the driver in a head-on


collision has a pulse of 140/min , respiratory rate of 36 and
blood pressure of 75 palpable. His trachea is deviated to the
left, with palpable subcutaneous emphysema and poor breath
sounds in the right hemithorax, The most appropriate initial
treatment must be
A) immediate thoracotomy
B) catheter insertion in the subclavian vein for fluid
resuscitation
C) intubation and ventilation
D) tube thoracostomy
E) immediate tracheostomy

18) The best test to monitor the adequacy of


levothyroxin therapy is:
F) radioactive iodine uptake
G) thyroglobulin
H) free thyroxine index (T4)
I) triiodothyronine resin uptake (T3)
J) thyroid stimulating hormone (TSH)

29) Which of the following statements about fungal infection


is NOT true ?:
A) Prior or synchronous culture positive for Candida
at another site occurs in few patients with
candidimia
B) For critically ill patients nonhaematogenous sites
of candida are appropriately treated with systemic
antifungal therapy
C) Mortality rates are similar regardlss of whether C.
albicans fungmia is treated with amphotericin B
or flconazole
D) Intravenous catheters and the gastrointestinal
tract are common portals for Candida to gain
blood stream access
E) Septic emboli are more common with fungal
endocarditis than with bacterial endocarditis

30) The maximum safe dose of local anaesthetic administered


subcutaneously in a 70-kg man is:
A) 10 to 20 ml of 1% lidocaine
B) 40 to 50ml oh 2% lidocaine with epinephrine
C) 40 to 50 ml of 1% lidcaine with epinephrine
D) 40 to 50 ml of 1% bupivacaine (marcaine)
E) 40 to 50 ml of 1%lidocaine without epinephrine

31) Two days after right hemicolectomy for a Dukes B caecal


carcinoma , the
Patient complains of sharp right-sided chest pain and
dyspnea. HisPaO2
Is 64mmHg ,his PaCo2 is 32mmHg. CVP is 26 cm
water, and the blood pressure is 102/78mmHg. A
pulmonary embolus is suspected,
The next step in management should be:
K) A ventilation- perfusion lung scan
L) A pulmonary arteriogram
M) Postrioanterior and lateral chest x-rays
N) Heparin sodium ,100 units/kg intravenously
O)Immediate duplex scanning of both lower
extremities

32) The major cause of graft loss in heart and kidney


allograft is:
A) acute rejection
B) hyperacute rejection
C) vascular thrombosis
D) chronic rejection
E) graft infection
33) All of the following are indicators of tumor
aggressiveness and poor outcome for papillary
carcinoma of the thyroid gland EXCEPT:
A) age over 50 years
B) microscopic lymph node metstasis
C) tumor larger than 4 cm
D) poorly differentiated histological grade
E) invasion through capsule to adjacent tissues

24) A 40-year-old woman has extensive


microcalcifications involving the
entire upper aspect of the right breast. Biopsy shows a
commedo pattern of intraductal carcinoma.
The most appropriate treatment is :
K) wide local excision
L) radiation therapy
M) wide local excision plus radiation therapy
N) right total mastectomy
O)right modified radical mastectomy

25) In the conventional ventilator management of acute


adult respiratory distress syndrome (ARDS) , arterial O2
saturation is maintained above 90% by all the following
EXCEPT :
F) increasing the ventilatory rate
G) the use of positive end-expiratory pressure (PEEP)
H) increasing mean airway pressure
I) increasing tidal volumes
J) increasing FiO2
36) Which of the following statements about patients with
abdominal compartment syndrome is NOT true ?
A) Abdominal pressure is usually measured indirectly
through inferior vena cava
B) Multiple contributing factors are commonly
responsible
C) The chief manifestations are reflected in central
venous pressure , ventilatory function, and
oliguria
D) Decopression of the abdomen is required to
resverse the syndrome
E) Aggressive hemodynamic monitoring and
management is required when the abdomen is
opened

37) The most appropriate treatment for histologically


malignant cystadenoma phylloides is :
A) total mastectomy without axillary node dissection
B) total mastectomy with axillary node dissection
C) wide margin (3) cm excision of the lesion
D) post operative hormonal manipulation
E) postoperative adjuvant chemotherapy

38) Deep venous thrombosis resulting from upper extremity


central venous lines:
A) should be treated with catheter removal, heparin
therapy, and long term anticoagulants
B) is best with urokinase through the catheter
C) is innocuous and self limiting, and best treated
with catheter removal only
D) is best treated with low-dose warfarin (coumadin,
1 mg / day) , without catheter removal
E) is best managed by single systemic dose of low
molecular weight heparin daily and continued
catheter use

39) Emergency surgery is indicated for all of the following


complications of ulcerative colitis EXCEPT:
A) colonic dilatation greater than 12 cm (toxic mega
colon )
B) free perforation
C) complete intestinal obstruction
D) intractable haemorrhage
E) abscess formation

40) All the following statements concerning carcinoma of


the oesophagus are true EXCEPT that:
A) it has a higher incidence in males than females
B) alcohol has been implicated as a precipitating
factor
C) adenocarcinoma is the most common type at the
cardio esophageal junction
D) it occurs more commonly in patients with
corrosive oesophagitis
E) surgical excision is the only effective treatment
1

A 44-year-old man presents with painless rectal bleeding of 1 month's


duration. He reports a history of constipation. He works in heavy labor.
For this patient, which of the following statements regarding internal
hemorrhoids is true?

Choose one answer


e. Stapled hemorrhoidectomy should be done for grade 1 and 2
hemorrhoids
f. All of the above
g. Internal hemorrhoids are located proximal to the dentate line and
therefore are usually painless
h. A grade 1 internal hemorrhoid represents bleeding with prolapse

39. A 34-year-old woman presents for evaluation of severe and frequent


bloody bowel movements, as well as abdominal pain, dehydration, and
anemia. She has had these symptoms for 2 days. She has not had any
similar symptoms in the past, and she has been in relatively good health.
If the patient has toxic megacolon, under what circumstances emergency
surgical management is indicated?

Choose one answer.


e. There is a perforation
f. Any of the above
g. The patient's clinical or radiographic status worsens
h. There is no improvement in 24 to 36 hours after aggressive medical
therapy

Complications of untreated pancreatic pseudocysts include all of the


following EXCEPT:

Choose one answer.


f. intracystic hemorrhage
g. abscess
h. pancreatic necrosis
i. free rupture
j. gastrointestinal obstruction
4

Platelets in the wound form a hemostatic clot and release clotting factors
to produce:

Choose one answer.


f. thrombin
g. Fibrin
h. Fibrinogen
i. Fibroblasts
j. thromboplastin

A 43-year-old man presents to the office for evaluation of recent weight


loss and frequent loose stools. He is concerned because his father was
diagnosed with colon cancer at the age of 50.

Besides family history, what are some other risk factors for colorectal
cancer?

Choose one answer.


e. Hypertension
f. Diabetes
g. All of the above
h. Inflammatory bowel disease

A 40-year-old woman presents to the office for evaluation of yellowish


skin. She states that over the past few weeks, she has noticed that her eyes
and skin have developed a yellow tint. She also reports that she has dark
urine and pale-colored stools. Further history elicits periodic bouts of
right upper quadrant pain after eating. She is otherwise healthy. She
denies using any medications. On physical examination, a yellowish tint is
observed on the patient's skin, sclera, and mucous membranes.

On the basis of this patient's history and clinical examination, which type
of bilirubin would you expect to predominate?

Choose one answer.


e. Mixed
f. Conjugated
g. Unconjugated
h. Indirect

39. A 38-year-old man presents with a complaint of a slow-growing mass


over his right parotid gland. The lesion is fixed to the underlying
structures and has recently become painful.
Which of the following features strongly suggests that this patient's lesion
is a malignancy?

Choose one answer.


e. Ipsilateral numbness of the tongue
f. .All of the above
g. Overlying skin involvement
h. Facial nerve paralysis

Axillary lymph nodes are classified according to the relationship with the

Choose one answer.


f. pectoralis minor muscle
g. pectoralis major muscle
h. axillary vein
i. serratus anterior muscle
j. latissimus dorsi muscle

39. A 78-year-old man is recovering from abdomino-perineal (A-P)


resection for Ca rectum, which was performed 3 days ago. The patient is
now complaining of mild shortness of breath and chest pain. On physical
examination, the patient's right leg is slightly more swollen than his left.
The pulse oximetry reading is 90%.
What is the principal method of diagnosing acute pulmonary embolism?

Choose one answer.


e. Magnetic resonance imaging
f. Chest x-ray
g. Ultrasound
h. Spiral computed tomography scanning
10

Compartment syndrome

Choose one answer.


f. Passive stretch decrease muscle pain
g. Due to decrease pressure in muscle compartments
h. Pulse is the first thing to disappear
i. Cause severe pain in the limb
j. Treatment is by delayed fasciotomy

11

The most significant risk factor for the development of adenocarcinoma of


the esophagus is:

Choose one answer.


f. lye stricture
g. alcohol abuse
h. Barrett's esophagus
i. long-standing achalasia
j. smoking

12

All of the following statements are true about patients with carcinoid
tumors EXCEPT:

Choose one answer.


f. the combination of streptozotocin and 5-fluorouracil (chemotherapy)
can often result in objective response.
g. tumor growth is often slow
h. they often have evidence of serotonin production
i. the majority have carcinoid syndrome
j. they have a much better prognosis if the tumors are less than 2 cm.

13

39. A 67-year-old man presents with left-lower-quadrant pain and low-


grade fever. He has had these symptoms for 1 day. The patient denies
experiencing any rectal bleeding, but for the past week, his bowel
movements have been irregular.
For this patient, which of the following statements is true regarding
diverticular disease?
Choose one answer.
e. The sigmoid colon is the most common site of diverticula
f. All of the above
g. Most diverticula of the colon involve the muscular layer
h. Smoking does not seem to be related to the development of
diverticular disease

14

All of the following are components of the MEN type 2B syndrome except:

Choose one answer.


e. Multiple neuromas on the lips, tongue, and oral mucosa
f. Medullary thyroid carcinoma
g. Pheochromocytoma
h. Hyperparathyroidism.

15

The risk of bilateral breast cancer is HIGHEST if the first breast shows:

Choose one answer.


f. inflammatory carcinoma
g. medullary carcinoma
h. infiltrating ductal carcinoma
i. paget’s disease
j. lobular carcinoma

16

The best initial therapy for deep venous thrombosis of the common
femoral vein is:

Choose one answer.


f. warfarin
g. streptokinase
h. Heparin
i. venous thrombectomy
j. placement of a vena caval filter

17

Complications after thyroidectomy include all the following EXCEPT:


Choose one answer.
f. recurrent laryngeal nerve paralysis
g. parathyroid insufficiency
h. thyrotoxic crisis(storm) on operating on inadequitly prepared
thyrotoxic patient
i. tracheomalacia
j. hypercalcemia

18

A 55-year-old man presents with hematemesis that began 2 hours ago. He


is hypotensive and has altered mental status. No medical history is
available.
For this patient, which of the following statements regarding nasogastric
aspiration is true?

Choose one answer.


e. None of the above
f. A clear, nonbilious aspirate rules out the need for EGD
g. A clear, bilious aspirate rules out the need for EGD
h. A bloody aspirate is an indication for esophagogastroduodenoscopy
(EGD)

19

The major cause of impaired wound healing is:

Choose one answer.


f. steroid use
g. malnutrition
h. diabetes mellitus
i. local tissue infection
j. anemia

20

Common presenting conditions in patients with pancreatic carcinoma


include all of the following EXCEPT:

Choose one answer.


e. esophageal varices.
f. palpable gallbladder
g. weight loss.
h. abdominal pain

21

All of the following statements about keloids are true EXCEPT:

Choose one answer.


f. Keloid tissue contains an abnormally large amount of collagen
g. A keloid does not regress spontaneously
h. Keloid tissue contains an unusually large amount of soluble collagen
i. A keloid extends beyond the boundaries of the original wound
j. Keloids or hypertrophic scars are best managed by excision and
careful reapproximation of the wound

22

The treatment of choice for a 40-year-old man who is found on endoscopy


and biopsy to have a gastric lymphoma would be:

Choose one answer.


f. wide local excision
g. subtotal gastrectomy
h. chemotherapy
i. subtotal gastrectomy and radiotherapy
j. Radiotherapy

23

The treatment of an esophageal burn with a caustic agent may include all
of the following EXCEPT:

Choose one answer.


f. boogieing. (dilatation)
g. induction of vomiting
h. gastrectomy
i. expeditious administration of an antidote
j. steroids and antibiotics.

24

A 32-year-old man with a family history of familial adenomatous polyposis


(FAP) presents with hematochezia. He denies having any diarrhea,
abdominal pain, or fever.
For this patient, which of the following statements regarding FAP is true?

Choose one answer.


a. CRC does not occur in patients with FAP if they are given adequate
medical treatment
b. Total proctocolectomy (TPC) is considered the only option for the surgical
management of FAP
c. For patients with FAP, there is a 10% risk of CRC by age 40 if
prophylactic colectomy is not performed
d. In the setting of FAP, colorectal cancer (CRC) is more commonly located
on the left side

25

When stage I breast cancer is treated by partial mastectomy and axillary


dissection, further therapy should include:

Choose one answer


a. antiestrogen agents.
b. radiation of the affected breast.
c. oophorectomy if premenopausal.
d. nothing
e. chemotherapy

26

For the patient in Question 68, which of the following statements is true
regarding an esophageal varix as the site of bleeding?

Choose one answer.


e. I.V. propranolol should be administered first
f. Balloon tamponade should be performed first
g. Rubber banding or intravariceal sclerotherapy should be performed
first
h. I.V. somatostatin should be administered first

27

Drugs which may produce gynecomastia include all of the following


EXCEPT:

Choose one answer.


f. furosemide
g. cimetidine
h. Verapamil
i. Diazepam
j. Tamoxifen

28

Splenectomy is commonly indicated for the following EXCEPT:

Choose one answer.


f. hypersplenism associated with cirrhosis
g. hereditary spherocytosis
h. splenic tumor
i. immune thrombocytopenic purpura
j. grade four splenic injury in trauma

29

An ischiorectal abscess is characterized by all of the following EXCEPT:

Choose one answer.


f. Requires deroofing
g. Should be treated entirely by antibiotics
h. May be tuberculous in origin
i. Can be followed by anal fistula
j. Is an infective necrosis of the fat of the ischiorectal fossa

30
Marks: 1

The most common presentation of Meckel’s diverticulum in an adult is:

Choose one answer.


e. intussuception
f. Littre’s hernia
g. Gastrointestinal bleeding
h. diverticulitis

31

For the patient in Question 65, which of the following is an indication for
immediate surgery?

Choose one answer.


e. Closed-loop obstruction
f. All of the above
g. Complete bowel obstruction
h. Incarcerated hernia

32

Choledocholithiasis in a patient who previously had cholecystectomy is


BEST treated with:

Choose one answer.


f. endoscopic sphincterotomy
g. choledochoduodenostomy
h. choledochojejunostomy.
i. dissolution with mono-octanoin
j. open common bile duct exploration with stone removal

33

39. A 77-year-old man undergoes endoscopic ultrasonography as part of a


workup for jaundice. He is found to have a tumor in the head of the
pancreas.
For this patient, which of the following findings would indicate that the
tumor is unresectable?

Choose one answer.


e. All of the above
f. Peritoneal metastases
g. Invasion of the superior mesenteric artery
h. Metastases to celiac lymph nodes

34

Regarding polyps of the colon

Choose one answer.


f. Villous polyps are usually pedunculated
g. Villous polyps occur more proximal in colon
h. Adenomatous polyps are usually solitary
i. Cancer risk is not related to size of polyp
j. Metaplastic polyps are not precancerous
35

The most likely diagnosis in elderly patient with abdominal pain and
colonoscopy finding of patchy mucosal ulceration at the splenic flexure of
the colon is :

Choose one answer.


f. ulcerative colitis
g. crohns disease
h. ischemic colitis
i. diverticulitis
j. lymphogranuloma venerum

36

39. A 54-year-old man presents with a neck mass of 2 weeks' duration. He


has no significant medical history. He smokes two packs of cigarettes a
day and has been doing so since he was 21 years of age.
For this patient, which of the following statements is true?

Choose one answer.


e. Low cervical nodes are more likely to contain metastases from a
primary source other than the head and neck, whereas upper cervical
nodes are more likely to contain metastases from the head and neck
f. Soft or tender nodes are more likely to derive from an inflammatory or
infectious condition, whereas hard, fixed, painless nodes are more
likely to represent metastatic cancer
g. All of the above
h. Enlarged lymph nodes are by far the most common neck masses
encountered

37

The first-choice diagnostic study for suspected deep venous thrombosis of


the lower extremity is:

Choose one answer.


f. real-time Doppler imaging
g. contrast sonography
h. radioactive labeled fibrinogen uptake
i. impedance plethysmography
j. isotope injection with gamma scintillation scanning
38

Decreased PaCO2 levels should be attained in a patient at serious risk for


cerebral edema secondary to a head injury in order to :

Choose one answer.


f. prevent neurogenic pulmonary edema
g. prevent increased capillary permeability
h. prevent metabolic acidosis
i. allow reciprocally high levels of PaO2 in the brain
j. prevent cerebral vasodilation

39

Causes of third space loss include all except:

Choose one answer.


f. Acute pancreatitis
g. Pancreatic fistula
h. Necrotizing fasciitis
i. Site of major surgery
j. Crush syndrome

40

Causes of metabolic acidosis include all except:

Choose one answer.


f. Small bowel fistula
g. Shock
h. CO poisoning
i. severe anemia
j. All of the above

41

A 39-year-old man comes in for evaluation of intermittent anal pain and


bleeding after bowel movements. He also has hard stools. He has had
these symptoms for over 1 year .
For this patient, which of the following is included in the classic triad of
signs of chronic anal fissures?

Choose one answer.


e. An anal fissure
f. All of the above
g. A sentinel skin tag
h. Hypertrophy of the anal papilla

42

All the following statements about achalasia are true EXCEPT:

Choose one answer.


f. it occurs most commonly in persons between the ages of 30 and 50
years
g. in most affected persons, ganglion cells in the body of the esophagus
either are absent or have degenerated
h. esophageal cancer is seven times as common in affected persons as in
the general population
i. pressure in the body of the esophagus is lower than normal
j. affected persons usually experience more difficulty swallowing cold
foods than warm foods

43

A patient with the Zollinger-Ellison syndrome is found to have the


multiple endocrine neoplasia type I (MEN-I) syndrome. Appropriate
management for the ulcer symptoms should be:

Choose one answer.


f. Omeprazole
g. pancreatic resection
h. streptozocin
i. cimetidine
j. total gastrectomy

44

Fat absorption occurs primarily in the:

Choose one answer.


f. Ileum
g. third portion of the duodenum
h. Stomach
i. Jejunum
j. first portion of the duodenum
45

39. A 56-year-old woman has been experiencing abdominal pain for 4


hours. The pain is in right upper quadrant and radiates into the scapular
region. She has had multiple episodes of vomiting.
For this patient, which of the following signs on physical examination is
associated with acute cholecystitis?

Choose one answer.


e. Carnett sign
f. Kehr sign
g. Murphy sign
h. Rovsing sign

46

Mammary duct ectasia is characterized by the following EXCEPT :

Choose one answer.


f. Is treated usually by simple mastectomy
g. May present with nipple retraction and Peau d'orange picture
h. Anaerobic superinfection cmmmonly occurs in this recurrent
periductal plasma cell mastitis
i. Is defined as primary dilatation of major ducts of breast in middle
aged women
j. Iscommonly pre-malignant

47

Regarding veins of lower limbs all are true except:

Choose one answer.


e. Valves allow flow from deep to superficial system Venous return from
lower limbs is aided by respiratory movements
f. Superficial veins lie in subcutaneous tissue
g. The pressure in veins of the foot while standing is 100mmHg
h. a) Stasis of blood is important factor in developing varicose veins

48

Most common complication of central venous access is:

Choose one answer.


f. major artery damage.
g. Catheter problems.
h. Thrombosis of central vein
i. Catheter related sepsis
j. Pleural space damage, pneumothorax
49

Factors associated with increase risk of death in acute pancreatitis include


all except:

Choose one answer.


f. Ranson score more than five
g. Obesity
h. High APACHE_II score
i. Age more than 70 years
j. sterile necrosis

50

For the patient in Question 56, which of the following chronic conditions
can cause a neck mass?

Choose one answer.


e. Tuberculosis
f. Sarcoidosis
g. AIDS
h. All of the above

51

For the patient in Question 56, if metastatic cancer is suspected initially,


which of the following would be the most appropriate step to take next in
the workup?

Choose one answer.


e. CT scan
f. Empirical therapy with antibiotics
g. Fine-needle aspiration (FNA)
h. Observation only

52

The largest component of intestinal gas is:


Choose one answer.
f. Nitrogen
g. carbon dioxide
h. Oxygen
i. ammonia
j. hydrogen

53

A 66-year-old woman presents to the office complaining of a sharp,


constant pain in her lower abdomen. She has had this pain for the past 2
weeks. Examination of her abdomen is normal. However, subsequent
ultrasound reveals a 4.5 cm Aortic abdominal aneurysm (AAA). Spiral
computed tomography confirms the ultrasound findings.

Aside from rupture, which of the following is a complication associated


with (AAA) ?

Choose one answer.


e. Aortoenteric fistula
f. Lower-extremity atheroemboli
g. All of the above
h. Thrombosis

54

Diagnosis of esophageal perforation is best established by:

Choose one answer.


f. transesophageal ultrasound study
g. esophagoscopy with a flexible esophagoscope
h. contrast esophagograms
i. esophagoscopy with a rigid esophagoscope
j. upright X-rays of the chest including lateral and oblique films

55

For the patient in Question 68, which of the following is an indication for
surgery?

Choose one answer.


e. Ongoing hemorrhage occurs from a gastric ulcer in a
hemodynamically unstable patient
f. All of the above
g. Bleeding continues from either a duodenal ulcer or a gastric ulcer
despite medical and endoscopic therapy
h. Substantial bleeding occurs from a duodenal ulcer that is not
controlled by EGD

56

Yesterday, a 38-year-old woman underwent a laparoscopic cholecystectomy


for cholelithiasis and was discharged home 8 hours after surgery. She
returns this morning complaining of worsening abdominal pain. The oral
narcotics that the patient was prescribed are ineffective in controlling the
pain. The patient's temperature is (38.3 C). Laboratory studies reveal an
elevated white blood cell count. Abdominal ultrasonography shows a large
subhepatic fluid collection. The fluid is percutaneously aspirated and
reveals enteric contents.

What step should be taken next in the management of this patient?

Choose one answer.


e. Immediate laparotomy
f. I.V. antibiotics and close observation
g. None of the above
h. Observation in the hospital until pain improves

57

The most common symptom after major pulmonary embolism is:

Choose one answer.


f. cough
g. Dyspnea
h. Hemoptysis
i. pleural pain
j. fear of death

58

Treatment of paralytic ileus includes all of the following


EXCEPT :

Choose one answer.


f. intravenous fluids
g. cessation of oral intake
h. correction of electrolyte imbalance
i. early operation
j. nasogastric suction

59
Lymphedema :
Choose one answer
f. e) None of the above
g. b) should be bilateral
h. c) may be pitting in early stage
i. d) A & C only
j. a) may be Congenital

60

The level of consciousness for a head injury patient is BEST evaluated


by :

Choose one answer.


f. CT scan
g. visual evoked potentials
h. Glasgow coma scale
i. papillary responses
j. response to pain

61

A 52-year-old male weighing 70 kg, sustained a 65% total body surface


area (TBSA) burn. What are his fluid requirements?

Choose one answer.


a. 18,200 cc in 16 h
b. 9100 cc in the first 8 h
c. 8000 cc in 24 h
d. 12,800 cc in 24 h

62

Management of cholangitis may include all of the following EXCEPT:


Choose one answer.
a. decomperession of the common bile duct.
b. cholecystostomy
c. IV antibiotics.
d. correct underlying cause.
e. percutaneous transhepatic cholangiography.

63

A 48-year-old woman presents to the emergency department complaining


of right upper quadrant pain, which began 4 hours ago. She reports the
pain as being spasmodic and sharp and that it radiates to her right
shoulder blade. She says that she has had similar episodes over the past
few months, especially after eating large meals. Associated with the pain is
nausea and vomiting. Her blood pressure is 120/85 mm Hg, and her pulse
is 100 beats/min. On physical examination, the patient is found to have a
nontender abdomen with no palpable masses. Her chest and
cardiovascular examinations are normal. The nurse notices that her
sclerae are slightly icteric. On subsequent laboratory studies, her serum
bilirubin level is found to be 10 mg/dl.

What imaging study should be performed next for this patient with
presumed posthepatic jaundice?

Choose one answer.


a. Percutaneous transhepatic cholangiography (PTC)
b. Ultrasonography
c. Endoscopic retrograde cholangiopancreatography (ERCP)
d. Magnetic resonance imaging

64

39. An HIV-positive man presents for evaluation of new oral cavity lesions
he discovered last month. Physical examination reveals purple exophytic
masses involving the palate mucosa and gingiva.
What is the most likely diagnosis of these oral cavity lesions?

Choose one answer.


a. Oral hairy leukoplakia
b. Non-Hodgkin lymphoma
c. Syphilis
d. Kaposi sarcoma
65

Brain injury alone

Choose one answer.


a. causes shock only if the skull is intact
b. rarely causes shock
c. causes shock that is reversed by very simple measures
d. frequently causes shock
e. causes shock if hypoxia is superimposed

66

All of the following substances are irritating to the peritoneum EXCEPT:

Choose one answer.


a. bile.
b. blood
c. gastric content.
d. meconium
e. pus

67

Regarding volvulus of the sigmoid colon, each of the following is true


except :

Choose one answer.


a. likely results from redundant sigmoid colon with an elongated narrow
mesocolon
b. there appears to be a congenital predisposition sigmoid volvulus.
c. diagnostic barium enema for sigmoid colon is essential
d. diagnostic x-ray for sigmoid volvulus shows a dilated loop of colon which
points toward the right upper quadrant.

68

Gallstones are characterized by all the following EXCEPT:

Choose one answer.


a. cause mucocoele of the gall bladder
b. are present in the common bile duct in 40% of patients with stones in the
gall bladder
c. are becoming common in post-partum primipara who were pre pregnancy
‘Pill’ takers
d. are frequently the cause of flatulent dyspepsia
e. may be present in the newborn

69

Following a burn, the agent responsible for early increased capillary


permeability is

Choose one answer.


a. thromboxane A2
b. serotonin
c. histamine
d. prostacyclin PGI2
e. bradykinin

70

Incisonal hernias all are true except:

Choose one answer.


a. 10 % of all hernias
b. Usually easy to reduce
c. Multiloculated sac
d. Operative technique is most important cause
e. Complication is common

71

In the treatment of gastric cancer, all of the following are true EXCEPT:

Choose one answer.


a. five-year survival rates in the continue to be between 10% and 25%.
b. Palliative resection is frequently helpful with advanced disease.
c. Lymph node involvement is associated with a poorer prognosis.
d. Finding early disease at the time of operation is associated with a better
prognosis.
e. total gastrectomy is mandated in most patient. ***

72
of the involved area and : Severe cases of hidradenitis suppurativa in the
groin area are best managed by excision

Choose one answer.


a. transfer of a rectus abdominus muscle flap
b. split thickness skin grafting
c. primary closure
d. delayed primary closure
e. closure by secondary intention

73

Patients at increased risk for gastric carcinoma include all the following
EXCEPT:

Choose one answer.


a. those who have undergone gastric bypass for morbid obesity
b. those who have undergone gastric resection for duodenal ulcer
c. those with pernicious anemia
d. those with a high consumption of smoked fish
e. those with blood group A

74

A 56-year-old woman presents with symptoms of abdominal pain, weight


loss, and rectal bleeding. She is anemic and hypotensive, but she is stable.
For this patient, which of the following should be done first if the gastric
lavage yields copious amounts of bile?

Choose one answer.


a. Arteriography
b. Emergency laparotomy
c. Colonoscopy
d. Esophagogastroduodenoscopy

75

A 39-year-old man presents with lower GI bleeding. He has no abdominal


discomfort and has experienced no loss of weight.
For this patient, which of the following statements regarding the etiology
of lower GI bleeding is true?

Choose one answer.


a. Lower GI bleeding from diverticulosis often requires surgery
b. Arteriovenous malformations (AVMs) are the most common cause of
lower GI bleeding
c. 6% to 10% of patients with ulcerative colitis have lower GI bleeding
severe enough to necessitate emergency surgical resection
d. None of the above

76

For the patient in Question 65, which of the following statements


regarding abdominal radiographic findings is true?

Choose one answer.


a. In gastric outlet obstruction, no gastric air will be seen, but large amounts
of air will be seen in the small bowel and colon
b. Mechanical small bowel obstruction usually shows no air-fluid levels, nor
will distended bowel loops of similar sizes be seen
c. All of the above
d. High-grade obstruction of the colon in association with an incompetent
ileocecal valve may mimic small bowel obstruction on x-ray

77

A 41-year-old female presents to the emergency department after


sustaining a gunshot wound to the abdomen, with injuries to the liver and
large bowel. Despite successful resuscitation and operative intervention,
the patient dies 2 weeks later of multisystem organ failure in the intensive
care unit. Which organ most likely first experienced dysfunction?

Choose one answer.


a. lung
b. heart
c. liver
d. gastrointestinal tract
e. kidney

78

39. A 35-year-old man presents with severe acute abdominal pain of


sudden onset. The pain initially began in the upper abdomen and has now
settled in the whole abdomen. On examination, the abdomen was rigid.
Chest X-Ray showed free gas under diaphragm.
Which of the following is the most appropriate course of management for
this patient?

Choose one answer.


a. Observation
b. Urgent laparotomy
c. Nonurgent laparotomy
d. Laparoscopy

79

All are true about the dumping syndrome except:

Choose one answer.


a. Symptoms can be controlled with a somatostatin analogue.
b. Early postoperative dumping after vagotomy often resolves spontaneously.
c. Flushing and tachycardia are common features of the syndrome.
d. Diarrhea is always part of the dumping syndrome.
e. Separating solids and liquids in the patient's oral intake alleviates some of
the symptoms of the syndrome.

80

An anal fissure is characterized by the following EXCEPT:

Choose one answer.


a. Is more common in women.
b. Is an ulcer of the anal mucosa.
c. Can be treated coservatively.
d. Usually lies anteriorly.

81

All of the following statements are true of esophageal carcinoma


EXCEPT

Choose one answer.


a. squamous cell tumor is the most frequent histology.
b. operation is frequently curative.
c. patient often require a pyloroplasty with operation.
d. patients usually die within one year of diagnosis
e. patient can have intestinal continuity reestablished using the stomach
after esophageal resection.
82

A serum tumor marker correlated with recurrence after management of


colon cancer is:

Choose one answer.


a. carcinoembryonic antigen (CEA)
b. Calcitonin
c. 5-hydroxyindoleacetic acid
d. CA 15-3
e. Alpha-fetoprotein

83

Conditions associated with gastric cancer include all of the following


EXCEPT:

Choose one answer.


a. adenomatous polyps.
b. a high intake of dietary nitrates.
c. pernicious anemia.
d. higher socioeconomic groups.
e. chronic atrophic gastritis.

84

Which of the following is required for addressing any pressure sore?

Choose one answer.


a. pressure reduction
b. hyperbaric oxygen
c. antibiotics
d. skin flap coverage

85

The most effective treatment of achalasia is:

Choose one answer.


a. antireflux surgical procedures
b. Esophagomyotomy
c. dilation of the lower esophageal sphincter
d. antispasmodic medication
e. resection of the cardioesophageal junction
86

Regarding desmoid tumors all are true except:

Choose one answer.


a. Treatment is wide local excision with safety margins
b. Has high rate of local recurrence
c. Is a low grade fibro sarcoma
d. More common in females
e. Is radio resistant

87

Which of the following variables best predicts prognosis for patients with a
recent diagnosis of cutaneous melanoma and no clinical evidence of
metastatic disease?

Choose one answer.


a. Ulceration.
b. Clark's level.
c. Gender
d. Bleeding
e. Breslow thickness.

88
In the treatment of acute cholecystitis, most patient are BEST served with:
Choose one answer.
a. endoscopic sphincterotomy.
b. cholecystostomy.
c. percutaneous drainage of the gallbladder.
d. early cholecystectomy (within 3 days of onset of symptoms).
e. IV antibiotics and cholecystectomy in 6 to 8 weeks.

89

Regarding crohn's disease all are true except

Choose one answer.


a. Cause non caseating granuloma
b. commonly affect small bowel
c. Causes sub mucosal fibrosis
d. It is full thickness inflammation
e. Cause depletion of goblet cell mucin

90

Advantages of laparoscopic versus open cholecystectomy include all of the


following EXCEPT:

Choose one answer.


a. decreased pain.
b. less risk of bile duct injury.
c. reduced hospitalization.
d. improved cosmetic.
e. reduced ileus.

91

The most common cause of massive hemorrhage in the lower


gastrointestinal tract is:

Choose one answer.


a. carcinoma
b. Diverticulosis
c. Diverticulitis
d. Polyp
e. ulcerative colitis

92

Carcinoma of the gallbladder is

Choose one answer.


a. rarely associated with jaundice.
b. associated with a good prognosis.
c. usually not diagnosed preoperatively.
d. most commonly metastatic to the lung.
e. best treated with radiation and chemotherapy

93

All the following statements concerning nipple discharges are true


EXCEPT:

Choose one answer.


a. benign duct papillomas are the most common cause of bloody discharges.
b. when bloody , the discharge is due to a malignancy 70% of the time
c. a) excision of involved duct may be necessary to determine the etiology
d. they may be caused by multiple lesions.
e. a milky discharge may be due to a pituitary adenoma .

94

39. A 28-year-old woman presents with a complaint of a growing, painless


mass in her neck. Physical examination reveals a firm, fixed nodule
measuring 2 cm on the right lobe of her thyroid. The surgeon recommends
fine-needle aspiration (FNA) of the lesion instead of excisional biopsy.
What are the advantages of FNA over excisional biopsy?

Choose one answer.


a. FNA is associated with a decreased risk of tumor seeding
b. FNA requires only an office visit
c. Anesthesia is not necessary
d. All of the above

95

For the patient in Question 74, which of the following is a sign of a


colovesical fistula associated with diverticulitis, as seen on computed
tomography with contrast?

Choose one answer.


a. Thickening of the bladder and the colon
b. Sigmoid diverticula
c. All of the above
d. Air in the bladder

96

All of the following are true statements concerning paget ’ s disease of the
nipple EXCEPT:

Choose one answer.


a. it is an eczematoid lesion.
b. it is very uncommon, accounting for only 2% of all breast cancers.
c. it is an in situ squamous cell malignancy of the nipple.
d. it can be confused with malignant melanoma histologically
e. it has a better prognosis than the majority of other breast cancers.
97

The classical picture of Acute arterial embolism include all the following
except:

Choose one answer.


a. peripheral pulses
b. Parasthesia
c. All the above
d. Pain
e. Pallor

98

Extra colonic manifestation of inflammatory bowel disease include all


except:

Choose one answer.


a. Erythema nodosum
b. Mixed connective tissue disease
c. Primary Sclerosing cholangitis
d. Polyarthopathy
e. Episcleritis

99

A 45-year-old woman presents with abdominal pain and vomiting of 1


day's duration. The patient underwent an exploratory laparotomy after a
motor vehicle accident 8 years ago.
Which of the following statements is true for this patient?

Choose one answer.


a. Pain from mechanical obstruction is usually more severe than pain from
ileus
b. The severity of pain from mechanical obstruction may decrease over time
c. Pain from mechanical obstruction is usually localized in the middle of the
abdomen, whereas pain from ileus or pseudo-obstruction is diffuse
d. All of the above

100
A 4-year-old girl has been experiencing dyspnea on exertion. Chest x-ray
shows a Morgagni hernia.
For this patient, which of the following statements is true?

Choose one answer.


a. Morgagni hernias can be repaired with a subcostal, a paramedian, or a
midline incision
b. Morgagni hernias are most commonly seen on the right side
c. All of the above
d. The average age at diagnosis is typically greater for patients with
Morgagni hernia than for patients with Bochdalek hernia

1. A 40-year-old female has a 4-cm hemangioma in the right lobe of the liver on
computed tomography scan. She is asymptomatic. Appropriate action should be:
A. fine-needle biopsy
B. arrangement for elective resection
C. no further action
D. angiographic embolization

2. Regarding an amebic liver abscess:


A. surgical drainage is usually required
B. negative stool testing for amebiasis rules out the disease
C. it should be drained percutaneously under com- puted tomography guidance
D. it is treated with metronidazole

3. A single organism is usually the causative agent in:


A. pelvic in&#64258;ammatory disease
B. perforated diverticulitis
C. acute cholecystitis
D. primary peritonitis
E. diabetic foot infections

4. Signs and symptoms of hemolytic transfusion reactions include


A. Hypothermia
B. Hypertension
C. Polyuria
D. Abnormal bleeding
E. Hypesthesia at the transfusion site

5. In a hemolytic reaction caused by an incompatible blood transfusion, the


treatment that is most likely to be helpful is:
A. Promoting a diuresis with 250 ml of 50% mannitol
B. Treating anuria with fluid and potassium replacement
C. Acidifying the urine to prevent hemoglobin precipitation in the renal tubules
D. Removing foreign bodies, such as Foley catheters, which may cause hemorrhagic
complications
E. Stopping the transfusion immediately

6. Which statements about extrahepatic bile duct cancer are correct?


A. Cholangiography is not essential in evaluating patients for resectability.
B. The prognosis is excellent when appropriate surgical and adjuvant therapy are
given.
C. The location of the tumor determines the type of surgical procedure.
D. The disease usually becomes manifest by moderate to severe right-side upper
quadrant pain.

7. Which of the following statements about the diagnosis of acute calculous


cholecystitis is true?
A. Pain is so frequent that its absence almost precludes the diagnosis.
B. Jaundice is present in a majority of patients.
C. Ultrasonography is the definitive diagnostic test.
D. Cholescintigraphy is not definitive diagnostic test.

8. Which statement about acute acalculous cholecystitis is correct?


A. The disease is often accompanied by or associated with other conditions.
B. The diagnosis is often difficult.
C. The mortality rate is higher than that for acute calculous cholecystitis.
D. The disease has been treated successfully by percutaneous cholecystostomy
E. all are correct

9. Which of the following statements about laparoscopic cholecystectomy are


correct?
A. The procedure is associated with less postoperative pain and earlier return to
normal activity.
B. The incidence of bile duct injury is lower than for open cholecystectomy.
C. Laparoscopic cholecystectomy should be used in asymptomatic patients because it
is safer than open cholecystectomy.
D. Pregnancy is a contraindication.

10. A 15-year-old female presents with RUQ abdominal pain. Workup reveals a
choledochal cyst. Which of the following statements is TRUE?
A. Choledochal cysts are more common in men.
B. Laparoscopic cholecystectomy is the recommended treatment.
C. Patients with a choledochal cyst have an increased risk of cholangiocarcinoma.
D. All patients with a choledochal cyst have abdominal pain, a RUQ mass, and
jaundice.
E. The etiology is infectious.

11. An 85-year-old man is brought to the hospital with a 2-day history of nausea and
vomiting. He has not passed gas or moved his bowels for the last 5 days. Abdominal
films show dilated small bowel, no air in the rectum and air in the biliary tree.
Which of the following statements is TRUE?
A. Air in the biliary tree associated with small-bowel obstruction suggests a diagnosis
of gallstone ileus.
B. An enterotomy should be distal to the site of obstruction and the stone should be
removed.
C. Gallstone ileus is more common in the young adults.
D. Cholecystectomy is contraindicated.
E. Small-bowel obstruction usually occurs in the distal jejunum.

12. A 45-year-old patient with chronic pancreatitis is suffering from malnutrition


and weight loss secondary to inadequate pancreatic exocrine secretions. Which is
TRUE regarding pancreatic secretions?
A. Secretin releases fluid rich in enzymes.
B. Secretin releases fluid rich mainly in electrolytes and bicarbonate.
C. Cholecystokinin releases fluid,predominantly rich in electrolytes, and bicarbonate.
D. All pancreatic enzymes are secreted in an inactive form.
E. The pancreas produces proteolytic enzymes only.

13. A 43-year-old woman has gallstone pancreatitis that resolves in 2 days with
conservative treatment. She has no abdominal complaints and her liver and
pancreatic laboratory values have returned to normal. She is scheduled for
laparoscopic cholecystectomy. Which of the following statements is TRUE?
A. Intraoperative cholangiography is associated with a decreased risk of biliary tract
injury .
B. The procedure should be scheduled for 6 weeks after resolution of symptoms .
C. Intraoperative cholangiography in this patient will identify choledocholithiasis in
50% of cases .
D. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) should be
performed.
E. The sensitivity of magnetic resonance cholangiopancreatography (MRCP) for
choledocholithiasis in this patient is less than 50%.

14. A 39-year-old woman is admitted with gallstone pancreatitis and epigastric pain.
Pertinent data include amylase, 2000 U/L; bilirubin, 1.2 mg/dL; and WBC count,
15,000/mm3 . After 2 days of medical management, her epigastric pain resolves. Her
amylase is 340 U/L and her bilirubin and WBC count have returned to normal.
Laparoscopic cholecystectomy should be attempted:
A. after endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy
B. prior to discharge
C. once her amylase is normal
D. 4 to 6 weeks later
E. only if the patient develops recurrent pancreatitis

15. A 48-year-old woman is admitted with acute cholecystitis. The bilirubin level is
elevated, as are the serum and urinary amylase levels. Which radiologic sign
indicates biliary obstruction in pancreatitis?
A. Pancreatic intraductal calcification
B. Smooth narrowing of the distal CBD
C. Stomach displaced anteriorly
D. Calcified gallstone
E. Air in the biliary tree)

16. Following a motor vehicle accident a truck driver complains of severe abdominal
pain. Serum amylase level is markedly increased to 800 U. Grey Turner’s sign is seen
in the flanks. Pancreatic trauma is suspected. Which statement is true of pancreatic
trauma?
A. It is mainly caused by blunt injuries.
B. It is usually an isolated single-organ injury.
C. It often requires a total pancreatectomy.
D. It may easily be overlooked at operation.
E. It is proved by the elevated amylase level.

17. A 73-year-old woman is evaluated for obstructive jaundice after an injury to the
CBD, 7 months previously at laparoscopic cholecystectomy. The alkaline
phosphatase is elevated. In obstructive jaundice, which of the following statements is
true regarding alkaline phosphatase?
A. Its level increases before that of bilirubin.
B. Its level is unlikely to be increased in pancreatic malignancy.
C. Its elevation indicates bone metastasis.
D. Its elevation excludes hepatic metastasis.
E. Its level falls after that of the bilirubin,following surgical intervention.

18. A48-year-old female travel agent presents with jaundice. Radiological findings
confirm the presence of sclerosing cholangitis. She gives a long history of diarrhea
for which she has received steroids on several occasions. She is likely to suffer from
which of the following?
A. Pernicious anemia
B. Ulcerative colitis
C. Celiac disease
D. Liver cirrhosis
E. Crohn’s disease

19. A38-year-old male lawyer develops abdominal pain after having a fatty meal.
Examination reveals tenderness in the right hypochondrium and a positive
Murphy’s sign. Which test is most likely to reveal acute cholecystitis?
A. HIDA scan
B. Oral cholecystogram
C. Intravenous cholangiogram
D. CT scan of the abdomen
E. ERCP

20. A 65-year-old woman is admitted with RUQ pain radiating to the right shoulder,
accompanied by nausea and vomiting. Examination reveals tenderness in the RUQ
and a positive Murphy’s sign. A diagnosis of acute cholecystitis is made. What is the
most likely finding?
A. Serum bilirubin levels may be elevated.
B. Cholelithiasis is present in 40–60%.
C. Bacteria are rarely found at operation.
D. An elevated amylase level excludes this diagnosis.
E. A contracted gallbladder is noted on ultrasound.

21. A 32-year-old diabetic woman who has taken contraceptive pills for 12 years
develops RUQ pain. CT scan of the abdomen reveals a 5-cm hypodense lesion in the
right lobe of the liver consistent with a hepatic adenoma. What should the patient be
advised to do?
A. Undergo excision of the adenoma
B. Stop oral contraceptives only
C. Stop oral hypoglycemic medication
D. Undergo right hepatectomy
E. Have serial CT scans every 6 months

22. A 9 month old boy presents with an acute scrotal swelling. The following
diagnoses are likely:
A. Epididymitis
B. Orchitis
C. Torsion of the testicular appendage
D. Irreducible inguinal hernia
E. Acute idiopathic scrotal oedema

23. A 76-year-old man presents with weight loss, dark urine, and pale stools which
are difficult to flush away. An excess of which of the following would account for this
history?
A. Conjugated bilirubin
B. Hyperbilirubinaemia
C. Stercobilinogen
D. Unconjugated bilirubin
E. Urobilinogen
24. An otherwise well 13-year-old boy is admitted complaining of sudden onset
severe left sided testicular pain 2 hours prior to admission. He gives no history of
trauma, dysuria or frequency. On examination he is found to have a tender, high-
riding testicle.What is the most appropriate next step in this young man’s
management?
A. Herniography
B. Scrotal Doppler ultrasound on the next available list
C. FBC and U&E
D. Scrotal Doppler ultrasound as an emergency
E. Surgical exploration of his scrotum

25. Acute scrotum


A. Torsion testis should be operated within 12 hour of presentation
B. Epidedimoorchitis pain increase by testicular elevation
C. If in doubt scrotum should be explored
D. Doppler ultrasound has no role in diagnosis
E. None of the above

26. stones in the common bile duct:


A. Are present in nearly 50 per cent of cases of cholecystitis.
B. Often give rise to jaundice, fever and biliary colic.
C. Are usually accompanied by progressive jaundice.
D. Are usually associated with a distended gallbladder.
E. A&D only.

27. Which of the following statements regarding whole blood transfusion is correct?
A. Whole blood is the most commonly used red cell preparation for transfusion in the
B. Whole blood is effective in the replacement of acute blood loss.
C. Most blood banks have large supplies of whole blood available.
D. The use of whole blood produces higher rates of disease transmission than the use
of individual component therapies.
E. Old Whole blood is effective in the replacement of platelets.

28. Acute cholecystitis all are true except


A. Commonest bacteria is E .coli
B. Wall thickness more than 3mm by ultrasound
C. WCC is between 10-15 000 cell/mm3
D. Mild elevated bilirubin may accompany it
E. HIDA scan has no role in diagnosis of acute cholecystitis
29. A 51-year-old male experiences the sudden onset of massive emesis of bright red
blood. There have been no prior episodes of hematemesis. He is known to be
hepatitis B surface antigen positive. His hematemesis is most likely a consequence of
which of the following abnormalities of the esophagus?
A. Varices
B. Barrett esophagus
C. Candidiasis
D. Reflux esophagitis
E. Squamous cell carcinoma

30. A 61-year-old male has had ascites for the past year. After a paracentesis with
removal of 1 L of slightly cloudy, serosanguinous fluid, physical examination reveals
a firm, nodular liver.Laboratory findings include positive serum HBsAg and
presence of hepatitis B core antibody. He has a markedly elevated serum alpha-
fetoprotein (AFP) level. Which of the following hepatic lesions is he most likely to
have?
A. Hepatocellular carcinoma
B. Massive hepatocyte necrosis
C. Marked steatosis
D. Wilson disease
E. Autoimmune hepatitis

31. A 76-year-old man presents with weight loss, dark urine, and pale stools which
are difficult to flush away. An excess of which of the following would account for this
history?
A. Conjugated bilirubin
B. Hyperbilirubinaemia
C. Stercobilinogen
D. Unconjugated bilirubin
E. Urobilinogen

32. Acute pancreatitis


A. Serum calcium start to rise after 48 hours
B. Hypoglycaemia is bad prognostic factor
C. Age is an important prognostic factor
D. Serum amylase is more specific than serum lipase
E. Severe pancreatitis compromise around 40% of cases

33. The most commonly used imaging method for diagnosis of acute cholecystitis is:
A. CT of the abdomen.
B. Ultrasonography of the gallbladder.
C. Oral cholecystogram.
D. Radionuclide (HIDA) scan of the gallbladder
E. MRI
34. A 23-year-old male presents to the emergency department after being involved in
a motor vehicle accident. On physical examination, he opens his eyes spontanously,
he occasionally mumbles incomprehensible sounds, he localizes to painful
stimulation with his right upper extremity, His pupils are 4 mm bilaterally and
reactive. This patient’s Glasgow Coma Scale (GCS) score:
A. 7
B. 9
C. 8
D. 11
E. 12

35. Complication of undescended testis include all of the following except :


A. Malignant degeneration.
B. Increased susceptability to trauma.
C. Increased spermatogenesis.
D. More liable to testiculer torsion.
E. Psychological complication
36. Neonatal duodenal obstruction:
A. May be associated with down's syndrome.
B. Is more frequently found in premature infants.
C. Typically presents with gross abdominal distension.
D. Usually presents with vomiting of non-bile stained fluid
E. B&C only.

37. Markedly elevated alpha-fetoprotein is diagnostic


A. Hepatic hemangioma
B. Angiosarcoma in the liver
C. Hepatic adenoma
D. Focal nodular hyperplasia
E. Hepatocellular carcinoma

38. on clinical examination of tortion testis all are true except:


A. testis is tender and swollen.
B. testis is elevated and raised.
C. loss of cremasteric reflex.
D. redness with possible reactive hydrocele.
E. pain decrease with elevation of the testis .

39. Regarding cryptorchidism(undesended testis) all are true except :


A. refers to the interruption of the normal descent of the testis into the scrotum.
B. The testicle may reside in the retroperitoneum, in the internal inguinal ring, in the
inguinal canal, or even at the external ring.
C. At birth, approximately 95% of infants have the testicles normally positioned in the
scrotum.
D. it’s a common disorder and incidence increased up to 30 % in premature .
E. undescended testis is always regarded as an ectopic testis.
40. Regarding GI(gastrointestinal bleeding ) all are true except:
A. Lower GI hemorrhage is defined as an abnormal intra luminal blood loss from a
source distal to the Treitz ligament.
B. The most cause of massive lower GI bleeding in adults are diverticulosis and
angiodysplasia.
C. Cancer colon is usually associated with massive lower GI hemorrhage.
D. Hemorrhage from diverticular disease stops spontaneously in 80% of patients.
E. patients with massive upper GI bleeding may present with maroon stools or bright
red blood from the rectum.

41. Signs of severe bood loss include the following except:


A. Pallor
B. Clammy skin
C. bradycardia
D. Tachycardia
E. Hypotension

42. regarding stigmata of bleeding in peptic ulcer :


A. its associated with increase risks for rebleeding .
B. adherent clot is the most significant stigmata.
C. arterial spurting hemorrhage associated with low risk of rebleeding .
D. risk of rebleeding in ulcer with clean base is above 50%
E. nonbleeding visible vessel is not associated with risk of rebleeding .

43. Features of inflammatory response syndrome (SIRS) include the following


except:
A. Temperature> 38.4C
B. Temperature <36.C
C. WCC<4.ooo cells per ml
D. Respiratory rate >20 per minute
E. PCO2> 32 mmHg

44. The development of thrombocytopenia and arterial thrombosis with heparin


requires:
A. Continuation of heparin and platelet transfusion
B. Continuation of heparin and thrombolysis
C. Doubling the heparin dosage
D. Changing the route of heparin administration
E. Discontinuation of heparin
45. Regarding Heparin-induced thrombocytopenia (HIT) all are true except
A. Is a special case of drug-induced immune thrombocytopenia.
B. The platelet count typically begins to fall 5 to 14 days after heparin has been
started.
C. Thrombocytopenia is usually severe.
D. HIT should be suspected if the platelet count falls to less than 100,000 or if it drops
by 50% from baseline in a patient receiving heparin
E. HIT is more common with full-dose unfractionated heparin (1 to 3%)

46. Regarding gall bladder and bile secretion all are true except :
A. The gallbladder is a pear-shaped, about 7 to 10 cm long with an average capacity
of 30 to 50ml.
B. When obstructed, the gallbladder can distend markedly and contain up to 300 mL
C. Anomalies of the hepatic artery and the cystic artery are quite common, occurring
in as many as 50% of cases.
D. liver produces 500 to 1000 mL of bile a day
E. Vagal stimulation decreases secretion of bile

47. Regarding gall bladder stones all are true except:


A. Prevalence increases with advancing age
B. Over 10% of those with stones in the gallbladder have stones in the common bile
duct.
C. 10-20% become symptomatic
D. cholesterol stones are the most common type.
E. pigment stones are associated with secondary common bile duct stones .

48. In acute cholecystitis all true except :


A. Most common organisms are E. coli
B. 90% cases result from obstruction to the cystic duct by a stone.
C. patient present with constant pain usually greater than 6 hours duration in right
upper quadrant .
D. presence of gall stones and percholecystic fluid on US is diagnostic
E. Cholecystectomy is contraindicated in acute stage .

49. complication of acute cholecystitis include all the following except:


A. Gangrenous cholecystitis
B. Gallbladder perforation
C. Cholecystoenteric fistula
D. mesnteric ischemia
E. Gallstone ileus
50. Regarding choledocholithisis all are true except:
A. may be silent and or may cause obstruction, complete or incomplete
B. may manifest with cholangitis or gallstone pancreatitis.
C. present with severe jaundice and cholangitis in case of stone impaction
D. Rt upper quadrant pain ,fever,and jaundice are called charcots triad in cholangitis.
E. impaction of small stones has no relation with acute pancreatitis .

51. Regarding acalculous cholecystistis all are true except:


A. Acute inflammation of the gallbladder can occur without gallstones
B. Acalculous cholecystitis typically develops in critically ill patients in the intensive
care unit.
C. Patients on parenteral nutrition with extensive burns, sepsis, major operations are
at risk for developing acalculous cholecystitis.
D. US is not a good diagnostic tool.
E. can be managed by cholecystectomy or percutanous cholecyststomy .

52. Regardind gall bladder cancer all are true except:


A. Larger stones (>3 cm) are associated with a 10-fold increased risk of cancer.
B. up to 95% of patients with carcinoma of the gallbladder have gallstones.
C. Polypoid lesions of the gallbladder are not associated with increased risk of cancer
D. Patients with choledochal cysts have an increased risk of developing cancer
E. Sclerosing cholangitis is risk factor for developing gall bladder cancer .

53. Regarding tumors of the liver all are true except :


A. Hemangioma is the most common solid benign lesion .
B. Spontaneous rupture in hemangioma (bleeding) is rare.
C. Hepatic adenomas carry a significant risk of spontaneous rupture with
intraperitoneal bleeding.
D. Hepatic adenomas have a risk of malignant transformation to a well-differentiated
HCC(hepatocellular carcinoma).
E. focal nodular hyperplasia lesions(FNH) lesions usually rupture spontaneously and
have significant risk of malignant transformation .

54. Regarding pyogenic liver abscess all are true except :


A. arise as a result of biliary sepsis.
B. associated with high mortality.
C. appendicitis is unlikely the cause pyogenic liver abscess.
D. 30% of patient have pleural effusion on presentation .
E. lab.investiation show elevated WBC and abnormal liver function .

55. Regarding acute pancreatitis all are true except:


A. Gallstones less than 5mm diameter are more likely to cause pancreatitis than larger
ones
B. The mortality associated with infected necrosis is about 40%
C. Cullen's sign is a sign of retroperitoneal hemorrhage in severe hemorrhagic
pancreatitis .
D. elevated serum amylase is a significant predictor of severity .
E. 50% of deaths occur within first week due to multi-organ failure .

56. All occur as a complication of acute pancreatitis except:


A. panreatic fluid collection
B. colonic necrosis
C. coagulopathy
D. hypercalcemia
E. respiratory failure

57. Regarding head trauma all are true except:


A. basal skull fracture regarded when one of the orbital roof ,sphenoidal bone or
petromastoid portion are involved .
B. epidural hematoma is an Lens shape hematoma between dura and the skull.
C. subdural hematoma is crescent shaped hematoma ,between brain and dura
D. secondary brain injury is preventable.
E. GCS glascow Coma scale 3/15 indicate uncomprehensive sounds .

58. Regarding chronic lower limb ischemia all are true except:
A. Claudication distance is distance after which the pain is felt.
B. Rest pain is continous severe burning pain in the foot which indicate critical
ischemia.
C. trophic changes include tapering digits ( loss of S.C fat ) and muscle wasting .
D. usuall presentations of patients with lower limb ischemia are pain,trophic changes
and gangrene.
E. venous filling time more than 2 minutes indicates mild lower limb ischemia.

59. Regarding 4 weeks 4 Kg bodywt. old full term neonate presented with rapidly
progressive projectile non bilious vomiting and palpable upper abdominal mass all
are true except :
A. dehydration and alkalosis are prominent features.
B. maintenance fluid therapy is about 4ml /Kg /hour.
C. administration of IV fluids with 5% dextrose, 0.5% normal saline, and KCl usually
corrects the alkalosis .
D. Estimated total blood volume is about 320 cc.
E. the most likely diagnosis is high jejunal atresia
60. All are true regarding jejunoileal atresia except:
A. present with bile stained vomiting .
B. Failure to pass meconium or small amounts of mucus or meconium maybe passed
per rectum.
C. present with abdominal distention.
D. X-ray show double bubble appearance .
E. The x-rays usually show multiple air-fluid levels.

61. regarding malrotation of the gut all are true except:


A. The patient might be asymptomatic and then develop the symptoms when he is
older.
B. Commonest abnormality results in caecum lying close to DJ flexure.
C. Fibrous bands may be present between caecum and DJ flexure (Ladd's bands).
D. the patient is unlikely to have clinical picture of duodenal obstruction .
E. In malrotation midgut mesentery is abnormally narrow and liable to volvulus.

1 C 11 A 21 A 31 A 41 C 51 D 61 D
2 D 12 B 22 D 32 C 42 A 52 C
3 D 13 A 23 A 33 B 43 E 53 E
4 D 14 B 24 E 34 E 44 E 54 C
5 E 15 B 25 C 35 C 45 C 55 D
6 C 16 D 26 B 36 A 46 E 56 C
7 A 17 A 27 B 37 E 47 E 57 E
8 E 18 B 28 E 38 E 48 E 58 E
9 A 19 A 29 A 39 E 49 D 59 E
10 C 20 A 30 A 40 C 50 E 60 D

1. Which hypersensitivity reaction is associated with a tuberculin reaction?


A. Type I: immediate
B. Type II: cytotoxic
C. Type III: immune complex
D. Type IV: cell mediated

2. The most common location for a gastric ulcer is


A. Fundus
B. Greater curvature
C. Cardia
D. Body
E. Antrum

3. Regarding the management of major trauma


A. Deaths follow a trimodal distribution
B. Cardiac tamponade is characterised by raised BP, low JVP and muffled heart
sounds
C. Assessment of uncomplicated limb fractures should occur during the primary
survey
D. Deterioration of the casualty during the primary survey should lead to the
secondary survey
E. All are false

4. All of the following are true about neurogenic shock except:


A. There is a decrease in systemic vascular resistance and an increase in venous
capacitance.
B. Tachycardia or bradycardia may be observed, along with hypotension.
C. The use of an alpha agonist such as phenylephrine is the mainstay of treatment.
D. Severe head injury, spinal cord injury, and high spinal anesthesia may all cause
neurogenic shock.

5. The following cause hypercalcaemia except :


A. Sarcoidosis
B. Primary hyperparathyroidism
C. Acute pancreatitis
D. Metastatic bronchial carcinoma
E. Milk-Alkali syndrome

6. For a 40-kg baby the maintenance daily fluid requirement is approximately


which of the following?
A. 1100 ml
B. 1250 ml
C. 1550 ml
D. 1700 ml
E. 2000 ml

7. Infantile hypertrophic pyloric stenosis


A. Occurs with a male: female ratio of 4:1.
B. Presents between six and eight months of age
C. Typically presents with bile stained projectile vomiting
D. Surgical treatment is by Heller's Cardiomyotomy
E. all are false

8. Which of the following do you consider to be the most important clinical sign in
acute appendicitis,
A. Abdominal tenderness around the umbilicus
B. Abdominal tenderness in the RIF
C. Tenderness over McBurney’s point
D. Rovsing’s sign positive
E. Suprapubic tenderness

9. Heparin
A. Acts as an anti-platelet
B. Acts as an anti-thromboplastin
C. Acts as an antithrombin
D. All of the above
E. None of the above

10. All of the following are mechanisms of urinary calculi formation except,
A. Hypoparathyroidism
B. Prolonged recumbency
C. Infection with urea-splitting organisms
D. Foreign body
E. Urinary tract obstruction

11. Which of the following are not found in peritonitis?


A. Patient is lying still
B. Guarding
C. Rebound tenderness
D. Hyperactive bowel sounds
E. Rigid abdomen

12. Which one of the following suggest a diagnosis of Hirschsprung's disease?


A. A contrast-study showing dilatation of the aganglionic bowel segment.
B. Early presentation with vomiting.
C. Neonatal large bowel obstruction.
D. Presentation after 1 year of age.
E. Red current jelly stools.

13. Which of the following regarding the anatomy of the heart is true?
A. The aortic valve is tricuspid.
B. The ascending aorta is entirely outside the pericardial sac.
C. The left atrial appendage is identified readily by transthoracic echocardiography.
D. The pulmonary trunk lies anterior to the ascending aorta.
E. The right atrium is posterior to the left atrium.
14. Which of the following is true concerning Scaphoid fractures?
A. Rarely occur in young adults
B. when complicated by avascular necrosis the proximal pole is usually affected

C. should be treated by bone grafting and internal fixation even if undisplaced


D. wrist fractures are uncommon
E. anteriorposterior and lateral radiographs reveal most fractures

15. Which of the following statements is true of upper limb nerve injuries?
A. Injury to the median nerve results in a wrist drop
B. Injury to the radial nerve results in loss of sensation over the palmar aspect of the
index finger
C. Injury to the median nerve results in loss of sensation in the anatomical snuffbox
D. Injury to the ulnar nerve results in a claw hand
E. Injury to the ulnar nerve results in loss of sensation over the thumb

16. Regarding intravenous solutions:


A. Normal saline contains 180mmol/l of sodium
B. Ringer's lactate solutions is designed for intracellular fluid replacement
C. Sodium bicarbonate 8.4% is a hyperosmolar solution
D. Normal saline with added potassium is appropriate therapy to correct a respiratory
alkalosis
E. All are True

17. Which of the following concerning the Femoral sheath is false:


A. Contains the femoral artery
B. Contains lymph nodes
C. Contains the femoral canal
D. Contains femoral nerve
E. Contains the femoral vein

18. The following is true of the spleen:


A. Is the largest lymphoid organ in the body
B. Lies obliquely between the seventh and tenth rib
C. The lower pole extends beyond the mid-axillary line
D. Is usually palpable when normal
E. Usually measures 16cm in maximum length when healthy

19. Breast cancer risk is increased in association with the following factors except:
A. Nulliparity
B. Immediately after pregnancy
C. Early menarche
D. Early age at first pregnancy
E. Late menopause
20. In tension pneumothorax the following signs are present except:
A. Hypoxia
B. Hyperresonance to percussion on the affected side
C. Tracheal deviation to the ipsilateral side
D. Distended neck veins
E. Tachycardia
21. The most common hernia in females is:
A. Femoral hernia.
B. Direct inguinal hernia.
C. Indirect inguinal hernia.
D. Obturator hernia.
E. Umbilical hernia.

22. The most helpful diagnostic radiographic procedure in small bowel obstruction
is:
A. CT of the abdomen.
B. Contrast study of the intestine.
C. Supine and erect x-rays of the abdomen.
D. Ultrasonography of the abdomen.
E. MRI Abdomen

23. In role of nine extent of burn if entire trunk is burned it will be equal to:
A. 9% body surface area.
B. 18% body surface area.
C. 36% body surface area.
D. 27% body surface area.
E. 45% body surface area.

24. If torsion of the testicle is suspected, surgical exploration:


A. Can be delayed 24 hours and limited to the affected side.
B. Can be delayed but should include the asymptomatic side.
C. Should be immediate and limited to the affected side.
D. Should be immediate and include the asymptomatic side.

25. Hyperthyroidism can be caused by all of the following except:


A. Graves' disease.
B. Plummer's disease.
C. Struma ovarii.
D. Hashimoto's disease.
E. Medullary carcinoma of the thyroid.

26. A 9 month old boy presents with an acute scrotal swelling. The following
diagnoses are likely:
A. Epididymitis
B. Orchitis
C. Torsion of the testicular appendage
D. Irreducible inguinal hernia
E. Acute idiopathic scrotal oedema

27. The evaluation of a comatose patient with a head injury begins with:
A. The cardiovascular system.
B. Pupillary reflexes.
C. Establishment of an airway.
D. Computed tomography (CT) of the brain
E. insertion of Intravenous canula
28. The following is an indication for thoracotomy in chest injury,
A. Cardiac tamponade
B. Uncontrolled pulmonary air leakage
C. Perforation of thoracic esophagus
D. Blood loss of 200ml/hr for 2-3 hrs via chest tube
E. All of the above

29. Regarding Gallstones all of the following are true except:-


A. Prevalence increases with advancing age
B. 30% of gallstones are radio-opaque
C. Cholesterol stones result from a change in solubility of bile constituents
D. Biliary infection, stasis and changes in gallbladder function can precipitate stone
formation
E. Gram-negative organisms are the most common isolated

30. In obstructive jaundice:


A. Urinary conjugated bilirubin is increased
B. Serum unconjugated bilirubin is increased
C. Urinary urobilinogen increased
D. Serum conjugated bilirubin is reduced
E. Faecal stercobilinogen is increased

31. The ideal fluid therapy in a patient with pyloric stenosis and repeated vomiting
is:
A. Isotonic crystaloid containing sodium chloride
B. Hypertonic crystaloid containing dextrose – saline
C. Isotonic solution containing dextrose
D. Large molecular weight colloid containing dextran

32. Which of the following do you consider to be the most important clinical sign in
acute appendicitis,
A. Abdominal tenderness around the umbilicus
B. Abdominal tenderness in the RIF
C. Tenderness over McBurney’s point
D. Rovsing’s sign positive
E. Suprapubic tenderness

33. All of the following are mechanisms of urinary calculi formation except,
A. Hypoparathyroidism
B. Prolonged recumbency
C. Infection with urea-splitting organisms
D. Foreign body
E. Urinary tract obstruction

34. Which of the following is incorrect in Paget’s disease of nipple,


A. Presents with eczema and redness of the nipple and areola
B. Tumour arises from epidermal layer of nipple and not from epidermal layer of
underlying ducts
C. Underlying carcinoma may be present beneath the nipple
D. Mastectomy is considered the treatment of choice
E. It is considered carcinoma-in-situ

35. Organisms most commonly isolated in UTIs,


A. Kleb
B. E. Coli
C. Proteus
D. Acinetobacter
E. All of the above

36. Excessive saliva in a newborn is due to


A. Esophageal atresia
B. Salivary gland tumour
C. Primary Hypertrophic Pyloric Stenosis
D. Midgut volvulus
E. Hirschprung’s disease

37. The most frequent congenital diaphragmatic hernia seen in infants is,
A. Paraesophageal hernia
B. Sliding hernia
C. Congenitally short esophagus
D. Hernia through the foramen of Bochdalek
E. Hernia through the foramen of Morgagni

38. An undescended testis.


A. Can be associated with contralateral testicular dysfunction
B. Should be treated by orchidopexy by age 2
C. Is associated with inguinal hernia
D. Predisposes to malignant change
E. All of the above

39. The wound made to remove a perforated appendix is classified as,


A. Clean
B. Clean, contaminated
C. Contaminated
D. Dirty
E. Doesn’t apply as the wound isn’t a traumatic one

40. Concerning the treatment of haemorrhoids,


A. Can be by diet
B. By injection sclerotherapy
C. By banding
D. Is mainly by haemorrhoidectomy
E. All of the above

41. The following is an indication for thoracotomy in chest injury,


A. Cardiac tamponade
B. Uncontrolled pulmonary air leakage
C. Perforation of thoracic esophagus
D. Blood loss of 200ml/hr for 2-3 hrs via chest tube
E. All of the above
42. In an upper GI bleed, in some cases a Sengstaken-Blakemore tube is incerted.
What is the primary purpose of the tube?
A. Aspirate blood from the stomach
B. Tube feeding
C. Tamponade for varices
D. To decompress bowel
E. All of the above

43. Risk factors for pulmonary embolism do not include which of the following?
A. DVT
B. Recent surgery
C. Old age
D. Myocardial infarction
E. Chest infection

44. Which of the following is not found in peritonitis?


A. Patient is lying still
B. Guarding
C. Rebound tenderness
D. Hyperactive bowel sounds
E. Rigid abdomen
45. Commonest site for CA breast
A. Upper outer quadrant
B. Upper inner quadrant
C. Lower outer quadrant
D. Lower inner quadrant
E. None of the above

46. The most common site of fracture of the clavicle is:


A. Medial end.
B. Lateral end.
C. Midpoint of the clavicle.
D. Junction of the medial two-thirds and the lateral third.
E. Junction of the lateral two-thirds and the medial third.

47. The back of the medial epicondyle is related to the:


A. Radial nerve.
B. Axillary nerve.
C. Ulnar nerve.
D. Median nerve.
E. None of the above.

48. Regarding Gallstones all of the following are true except:-


A. Prevalence increases with advancing age
B. 30% of gallstones are radio-opaque
C. Cholesterol stones result from a change in solubility of bile constituents
D. Biliary infection, stasis and changes in gallbladder function can precipitate stone
formation
E. Gram-negative organisms are the most common isolated

49. Clinical features of limb ischaemia includes


A. Paraesthesia
B. Pallor
C. Pulselessness
D. Paralysis
E. All of the above

50. Regarding Hydatid disease all of the following are true except:-
A. Due to infection with the helminth Ecchinococcus granulosa
B. Man is an accidental intermediate host
C. Lunges is the commonest organ involved
D. Diagnosis can be confirmed by indirect haemagglutinin assay
E. Aspiration should not be performed if hydatid disease is suspected

1 D 11 D 21 C 31 A 41 E
2 E 12 C 22 C 32 C 42 C
3 A 13 A 23 C 33 A 43 E
4 C 14 B 24 D 34 A 44 D
5 C 15 D 25 D 35 B 45 A
6 E 16 C 26 D 36 A 46 D
7 A 17 D 27 C 37 D 47 C
8 C 18 A 28 E 38 E 48 B
9 C 19 D 29 B 39 B 49 E
10 A 20 C 30 A 40 E 50 C

28.A midline neck mass, located between the thyroid bone and suprasternal notch that
moves upward when the tongue is stuck out most likely is:
a. thyroglossal duct cyst-

29.A smooth cystic neck mass located along the anterior border of the
sternocleidomastoid muscle most likely is:
a. brachial cleft cyst -

30.A lymphatic neck cyst located in the posterior triangle just above the clavicle most
likely is:
a. cystic hygroma-

65.Battle's sign of basilar skull fracture refers to blue-gray discoloration:


a. behind the mastoid process =
118.The most common complication of thyroidectomy is:
a. hypoparathyroidism =

What is the most common tumor of the appendix?


a. carcinoid =

123.The classical triad for a ruptured abdominal aneurysm includes a pulsatile abdominal
aortic mass, back pain, and:
a. jaundice
b. vomiting
c. headache

126.Sigmoid volvulus should be initially treated with:


a. decompression=

133.Compression of the oculomotor (3rd) nerve by an aneurysm, most likely from:


a. posterior communicating artery=

210.The most common complication of a major hip fracture is:


a. hemorrhage =

211.The most common complication of dislocation of the knee is:


a. popliteal artery injury =

247.Which of the following is the most common indication for major surgery in females?
a. uterine leiomyomas (fibroids)=

300.Schatzki's ring is associated with:


a. hiatal hernia =

311.Benign bone tumors are not painful EXCEPT for:


a. endochondroma
b. osteoid osteoma -
c. giant cell tumors
d. unicameral bone cysts

567.Osteoid osteomas:
a. are malignant tumors
b. generally occur after 50 years of age
c. cause progressive localized ache -
d. occur in females more commonly than in males

312.Ewing's tumor is a:
a. malignant sarcoma-
329.A pseudocyst following an acute pancreatitis does NOT:
a. rupture
b. form an abscess
c. resolve spontaneously -
d. cause an internal hemorrhage

330.Which of the following suggests bad prognosis in a 58 year old man with acute
pancreatitis
a. total bilirubin of 1.0 mg/dL
b. blood glucose of 240 mg/Dl-
c. serum amylase of 120 U/L
d. white blood cell count of 14,000/mm3

568.The most common malignant tumor of the spine is:


a. multiple myeloma -

332.In trauma patients, which of the following should be treated first?


a. flail chest-
b. pleural effusion
c. laceration of the liver
d. fractured tibia and ulna

334.12 year old male complains of painful defecation, the most likely cause is:
a. anal cancer
b. anal abscess
c. anal fissure -
d. internal hemorrhoids

336.Following a major surgery, a 68 year old man develops massive colonic dilatation
and constipation, the most likely cause is:
a. paralytic ileus
b. toxic megacolon
c. fulminating colitis
d. Ogilvie's syndrome (pseudo-obstruction) -

353.The most common surgical procedure performed in patients with sickle cell anemia
is:
a. splenectomy
b. gastrectomy
c. appendectomy
d. cholecystectomy-

366.Which of the following is NOT a risk factor for colorectal cancer?


a. Turner's syndrome-
b. Turcot's syndrome
c. Gardner's syndrome
d. Oldfield's syndrome

507.Kohler disease is osteochondrosis of the:


a. navicular-

508.Sever disease is osteochondrosis of the:


a. apophysis of the os calis -

511.(Blade of grass) or (flame like) lesion on long bone X-ray and osteoporosis
circumscripta are features of:
a. Paget's disease of the bone -

524.Serum alkaline phosphatase is normal in:


a. osteoporosis -
b. osteomalacia
c. primary hyperparathyroidism

525.Bone X-ray shows pseudofractures (Looser's zones) in:


a. osteomalacia-

526.The characteristic dorsal kyphosis and cervical lordosis (dowager's hump) are
features of:

a. osteoporosis-

527.Following are secondary causes of osteoporosis, EXCEPT:


a. obesity -
b. anorexia nervosa
c. Marfan's syndrome
d. hyperprolactinemia

528.72 year old woman presents with back pain, X-ray shows compression fractures and
kyphosis in the spine, the most likely diagnosis is:
a. osteoporosis-

529.Back pain with increased urinary hydroxyproline and serum alkaline phosphatase in a
70 year old man is most likely due to:
a. Paget's disease of the bone -

530.Following are laboratory abnormalities seen patients with Paget's disease, EXCEPT
a. hypocalcemia -
b. hyperuricemia
c. increased urinary hydroxyproline
d. increased serum alkaline phosphatase
535.An acute upper GI bleeding from longitudinal esophageal tears after repeated
vomiting occurs in:
a. Mallory-Weiss syndrome -

548.Breast cancer my occur in women who:


a. are overweight -
b. had 5 or more children
c. went in menopause at the age of 38
d. had their first menstruation at the age of 20

549.Definitive diagnosis of breast cancer is made by:


a. X-ray
b. CT scan
c. mammogram
d. histological examination-

558.Bright red blood on the surface of the feces with pain during defecation in an 8 year
old boy is most likely due to:
a. anal fissure -

560.The best management for a ganglion tumor is:


a. surgery -

570.64 year old man complains of nocturia, dribbling and urinary hesitancy, the most
likely diagnosis is:
a. benign prostatic hypertrophy-

407.The most common site of bone metastasis from prostate cancer is:
a. pelvis-

408.The most common indication for surgery in regional enteritis is:


a. fistula
b. abscess
c. bleeding
d. obstruction-

413.Anal fissure is associated with:


a. ischemic colitis
b. Crohn's disease -
c. ulcerative colitis
d. irritable bowel syndrome

415.2 year old child has hematuria, hypertension and a palpable mass in the left flank, the
most likely diagnosis is:
a. Wilms' tumor-
416.Intussusception is characterized by:
a. projectile vomiting
b. currant-jelly stools -
c. olive-shaped mass in upper abdomen
d. all of the above

418.Which of the following types of kidney stones is radiotransparent?


a. uric acid -

423.The most common cause of hypercalcemia in a 32 year old woman is:


a. primary hyperparathyroidism-

424.What type of breast cancer has the worst prognosis?


a. Lobular-
b. medullary
c. inflammatory
d. infiltrating ductal

430.Which of the following is NOT a risk factor for osteoporosis?


a. Multiparity-
b. lack of exercise
c. low calcium intake
d. excessive alcohol intake

440.A transilluminated, soft mass in the posterior triangle just above the clavicle of an
infant is most likely due to:
a. cystic hygroma-

441.What percentage of congenital diaphragmatic hernias in neonates are located on the


left side?
a. 85% -

446.The most common bacteria found in wound infections is:


a. staphylococcus-

459.The most common cause of trochlear nerve palsy is:


a. trauma -

480.Diagnosis of Meckel's diverticulum is made by:


a. technetium scan -

493.What percentage of abdominal aortic aneurysms are diagnosed while they are still
asymptomatic?
a. 75% -
495.36 year old man presents with acute abdomen due to small bowel obstruction, the
most likely cause is:
a. adhesions -

496.The mortality rate for colonic obstruction is about:


a. 20%-

Ewing sarcoma most commonly occur in:


a. femur and tibia-

Tachypnea, cyanosis, dyspnea, and severe acidosis within few hours after birth is most
likely due to:
a. diaphragmatic hernia--

Renal biopsy is contraindicated in the presence of:


a. solitary or ectopic kidney --

(coffee-bean) shape of dilated bowel loop on plain X-ray and (ace of spades) shape on
barium enema are typical of:
a. volvulus --

957.Massive lower gastrointestinal bleeding in elderly patients is due to:


a. diverticulosis
b. angiodysplasia
c. both--

.A fragment of fractured bone pulled off by ligament or tendon at its attachment, this is
called:
a. avulsion --

964.A break with 3 or more fragments of a fractured bone is called:


a. comminuted--

968.Approximately what percentage of patients with cirrhosis have esophageal varices?


a. 50%--

933.Paralysis of abduction and adduction of all fingers is due to injured:


a. ulnar nerve --
b. radial nerve
c. median nerve

Pain, paresthesia, and numbness over the bottom of the foot at night is most likely due to:
a. tarsal tunnel syndrome --

862.The most common bone tumor in a 64 year old man is:


a. metastatic tumor--

873.The most common glenohumeral dislocation is:


a. anteroinferior--

32 year old woman presents with a solitary thyroid nodule, the best management is:
a. fine-needle aspiration--

816.What is the most common cause of primary hyperparathyroidism?


a. single adenoma --

820.Carpal tunnel syndrome is LEAST likely to be a feature of:


a. leukemia
b. myxedema
c. hypocalcemia
d. Parkinson's disease --

62 year old man is unable to fully extend his right 4th finger, the most likely diagnosis is:
a. Dupuytren's contracture --

32 year old man presents with a painful nodule on the dorsum of the hand, the
most likely diagnosis is:

a. ganglion-

703.A man presents with a painful encapsulated nodule near the nail, the most likely
diagnosis is:
a. glomus tumor-

Which of the following is NOT included in the four P's of compartment syndrome?

a. pallor
b. paralysis
c. penetration-
d. pulselessness

789.26 year old man presents with swelling around the margin of the nail plate of his
right index, the most likely diagnosis is:
a. paronychia -

754.62 year old man presents with sudden onset of severe pain in his left leg, the leg is
pale and the pulse is absent, the most likely diagnosis is:
a. arterial embolism -

One-third of individuals with inflammatory involvement of the terminal ileum


have:
a. gallstones -

736.The first and the most common sign/s of obstruction of extrahepatic system is/are:
a. progressive jaundice -

716.Osteoporosis is characterized by increased:


a. serum alkaline phosphatase
b. serum parathyroid hormone
c. serum calcium and phosphorus
d. the rate of the bone resorption -

717.Which of the following is NOT a risk factor for osteoporosis?


a. heparin therapy
b. copper deficiency
c. Marfan's syndrome
d. vitamin A deficiency -

718.Osteomalacia is characterized by:


a. bone pain
b. proximal muscle weakness
c. both -

719.Paget's disease of the bone is characterized by increased serum:


a. calcium
b. alkaline phosphatase-

What percentage of gallstones are symptomatic?

a. 30% -

1016. Following are predisposing factors for colorectal cancer, EXCEPT:


a. 50 years of age or older
b. consumption of vegetables
c. upper socioeconomic group

d. consumption of calories and meat protein

1019. Hepatocellular adenomas are benign tumors of the liver found


predominantly in females in their:
a. 3rd and 4th decades

b.
1020. Hepatocellular carcinoma is up to four times more common in men than
in women and with the peak incidence in the:
a. 5th and 6th decades
1021. Patients with severe abdominal pain often obtain relief by sitting with
the trunk flexed and knees drawn up in:
a. acute pancreatitis
1022. Paget's disease (osteitis deformans) is characterized by increased:
a. serum calcium
b. serum phosphate
c. both

d. neither
1023. Acute cholecystitis is characterized by the triad of sudden onset of right
upper quadrant tenderness, fever, and:
a. leukocytosis

b.
1024. Which of the following bone tumors is the most common one in a 16
year old boy?
a. osteosarcoma

b.
. Few days after coronary artery bypass surgery, a 74 year old man develops
melena, the most likely diagnosis is:
a. ischemic colitis

b.

a.

a.

1044. A patient is unable to oppose his thumb to the base of the little finger, which of
the following nerves is most likely to be injured?
a. median

b.
1069.The most accurate method for the diagnosis of thrombophlebitis of the deep veins
is:
a. ascending contrast venography

1070.The most common cause of septic thrombophlebitis is:


a. staphylococcus

1071.The most common initial presentation of chronic venous insufficiency is:


a. pain
b. edema
c. itching
d. hyperpigmentation

1152. Approximately what percentage of acute cholecystitis is NOT associated with


gallstones?
a. 10%

1153. 62 year old man has a metastatic renal cancer, the most likely source is the cancer
of:
a. lung
b. colon
c. liver

d. prostate
1159. Erysipelas is usually caused by:
a. group A beta-hemolytic streptococci
1173. 28 year old woman presents with breast pain, the most likely diagnosis is:
a. fibrocystic disease

46 year old woman presents with bullae and scarring on the dorsum of her
1174.
hands, the most likely diagnosis is:
a. porphyria cutanea tarda
1195. How long after surgery, wound infections classically become apparent?
a. 4 to 7 days

1032. Romberg How ship sign is associated with:


a. obturator hernia

1033. Double bubble sign on X-ray is associated with:


a. annular pancreas
b. duodenal atresia
c. intestinal malrotation

d. all of the above


A woman has phlebitis of the superficial veins in the outer quadrants of the
1219.
breast, the likeliest diagnosis is:
a. Paget's disease
b. Mondor's disease =
c. plasma cell mastitis

d. fibrocystic adenoma
1220. Patients with portal hypertension are LEAST likely to have:
a. hemorrhoids
b. facial edema =
c. caput medusa

d. Budd-Chiari syndrome
Caput medusae (abnormal wall collaterals increased in size, radiating from
1221.
the umbilicus) is a feature of:
a. portal hypertension=

Following are important diagnostic aids for peripheral arterial diseases, EXCEPT:
a. ultrasound
b. thermography =
c. plethysmography

d. plain X-ray studies


The (five P's) of acute arterial occlusion are pain, pallor, and all of the following, EXCEPT:
a. pulseless
b. paralysis
c. paresthesia

d. propagation ==
Buerger's disease is an inflammatory disease that involves:
a. veins
b. arteries
c. both =

The (gold standard) of the diagnosis of deep venous thrombosis (DVT) is:
a. plethysmograph
b. contrast venogram =
c. doppler ultrasound

d. radionuclide venogram
The most reason women bring their varicose veins to the attention of the physician is:
a. leg pain
b. leg swelling
c. purely cosmetic =

d. statsis dermatitis
What percentage of patients with proved pulmonary emboli will have demonstrable
deep venous thrombosis?
a. 95% =
Dilated veins on chest wall with swelling of neck and upper extremities in a 56 year old
man is most likely due to:
a. filariasis
b. lung cancer =
c. Buerger's disease

d. abdominal aortic aneurysm

The most decisive way to confirm the diagnosis of splenic rupture is:
a. plain X-ray
b. ultrasound
c. exploratory laparotomy=

d. CT scan of the abdomen


An abrupt cutoff of colnic gas in the region of the splenic flexure (colon cutoff sing) is
associated with:
a. diverticulosis
b. Crohn's disease
c. chronic pancreatitis

d. sever hemorrhagic pacreatitis =


The most common cause of a lower abdominal mass in males over 50 years of age is:
a. Hodgkin's disease
b. colon cancer
c. retroperitoneal cysts

d. bladder obstructed by benign prostatic hypertrophy =


An elderly male presents with urinary obstruction, the chance of having a prostatic
cancer is:
a. 20% =

Rupture of the posterior prostatic urethra is associated with:


a. scrotal swelling
b. fractures of the pelvis =
c. dripping of blood from urethra

d. he matoma under Buck's facia


What percentage of polyps and carcinomas of the large intestine arise within reach of
the sigmoidoscope?
a. 60% =
What is the chance for patients with diverticulosis of developing diverticulitis?
a. 1 in 6 =

The most common type of polyp of the large bowel is:


a. tubular =
b. villous
c. juvenile

d. Peutz-Jeghers

Injury to nerve root C6 (Intervertebral level C5-C6) causes motor deficit in:
a. Biceps=

Injury to nerve root C7 (Intervertebral level C6-C7) causes motor deficit in:
a. triceps =

Testicular tumors:

a. are benign in most cases


b. constitute 25% of all male malignant tumors
c. are choriocarcinomas in most cases

d. should be removed if malignancy suspected =


Complication of acute appendicitis
a. hemorrhage
b. intestinal obstruction
c. malignant transformation

d. rupture and periappendicual abscess =


Tylosis is associated with carcinoma of:

a. lung
b. colon
c. esophagus =

d. pancreas
749.Whipple's disease is diagnosed by:
a. jejunal biopsy -

Management of a cold thyroid nodule does NOT include:


a. ultrasound
b. needle biopsy
c. surgical excision
d. injection of thyroxine into the nodule -
314.Epulis is a swelling of:
a. gums-

49. Paralysis of the serratus anterior cause:


a. winging of the scapula

A femoral hernia with only a portion of bowel passed through hernia ring is called:
a. incarcerated hernia
b. Richter's hernia =
c. incisional hernia

d. strangulated hernia
Cryptorchidism is almost invariably associated with:
a. indirect inguinal hernia =
Which of the following pancreatic islet cells secret serotonin?
a. enterchromaffin cells=

Patients with necrotizing migratory erythema are most likely to have:


a. glucagonoma =

14 year old boy complains of aching in the front of the knee after exercise,
1242.
the most likely diagnosis is:
a. Osgood-Schlatter disease (tibial epiphysitis) =
1244. Regarding Ewing's tumor, which of the following in NOT true?
a. it is radiosensitive
b. usually occurs in ages 1 to 4 years =
c. usually affects diaphysis of the long bones

d. most commonly affects tibia, fibula, humerus and fermur

1. Which of the following statements about open fractures are correct?


A. Intravenous antibiotics should be administered as soon as possible.
B. They should be regarded as an emergency.
C. Wound closure is necessary within 8 hours.
D. Systematic wound débridement and irrigation should be performed.

Answer: C

2. The goals of proper fracture reduction include which of the following?


A. Providing patient comfort and analgesia.
B. Allowing for restoration of length of the extremity.
C. Correcting angular deformity and rotation.
D. Enabling immediate motion of all fractured extremities.

Answer: ABC
6. The neurovascular structure most commonly injured as a result of an anterior
dislocation of the shoulder is the:
A. Musculocutaneous nerve.
B. Axillary nerve.
C. Axillary artery.
D. Median nerve.

Answer: B

7. The classification of fractures of the proximal humerus is based on:


A. The number of fracture segments and amount of displacement.
B. The mechanism of injury.
C. Presence or absence of associated dislocations.

Answer: A
8. The radial nerve is at greatest risk for injury with which fracture?
A. Fracture of the surgical neck of the humerus.
B. Fracture of the shaft of the humerus.
C. Supracondylar fracture of the humerus.
D. Olecranon fractures.

Answer: B

9. The best method of treating a supracondylar fracture of the humerus in a child


that is unstable when the elbow is flexed to 90 degrees is:
A. Hyperflexion of the elbow to 130 degrees and casting.
B. Open reduction and internal fixation.
C. Percutaneous pinning.
Answer: C

10. Both-bone forearm fractures in adults are best managed by:


A. Closed reduction and casting.
B. Closed reduction and application of an external fixator.
C. Open reduction and placement of intramedullary rods.
D. Open reduction and internal fixation with compression plates.

Answer: D

11. The most consistent sign of a fracture of the carpal scaphoid is:
A. Wrist pain during attempted push-ups.
B. Diffuse swelling on the dorsum of the wrist.
C. Localized tenderness in the anatomic snuffbox.
D. Wrist popping on movement.
Answer: C

12. A patient describes a fall on the outstretched hand during sports activities.
Multiple radiographic views show no distinct fracture. He is tender to palpation in
the anatomic snuffbox. The most suitable method of management is:
A. Diagnose “sprained wrist” and apply an elastic bandage.
B. Diagnose suspected scaphoid fracture and apply a short-arm cast to include
the thumb.
C. Apply a canvas wrist splint for immobilization.
D. Prescribe salicylates and permit continued activity.

Answer: B

13. Median nerve compression syndrome in which the patient has motor
weakness of the flexor pollicis longus and the flexor digitorum profundus of the
index finger without alteration in sensibility is due to:
A. Compression of the median nerve at the elbow by the lacertus fibrosus.
B. Compression of the median nerve in the axilla.
C. Compression of the anterior interosseous nerve by the arcade of Frohse.
D. Compression of the anterior interosseous nerve by an aberrant accessory
forearm muscle.
Answer: D

15. The most common physical findings in a patient with median nerve
compression at the wrist (carpal tunnel syndrome) are:
C. A positive percussion test at the wrist and a positive wrist flexion test
producing paresthesias at the thumb, index, and
long fingers.

16. Which of the following describes the most desirable position in which to
immobilize the hand?
E. Wrist is extended, MCP joints are flexed, and IP joints are extended.

17. An early sign of compartment syndrome in the hand includes:


A. Pain with passive stretch of the digits.
B. Absent radial pulse.
C. Motor paralysis.
D. Swelling of the digits.
E. Stiffness of the digits.

Answer: A

18. Palmar dislocation of the PIP joint with fracture:


D. If not splinted properly, will cause a boutonniere deformity.

19. Fracture of the fifth metacarpal neck:


C. Is called a “boxer's fracture.”

20. A Bennett's fracture is:


B. Displaced by the pull of the abductor pollicis longus and adductor pollicis.

27. Prognosis of healing in tibial fractures correlates best with:


A. Energy absorption at the time of fracture.
B. Amount of soft tissue damage.
C. Location of the fracture (i.e., in the proximal, middle, or distal third).
D. Age of patient.

Answer: A

28. Management of a III-b tibia fracture is best treated initially by:


A. Plaster immobilization.
B. Immediate plating.
C. Reamed intramedullary nailing.
D. External fixation.

Answer: D

29. The most frequent forces acting on the foot that cause ankle fractures are:
A. External rotation.
B. Internal rotation.
C. Plantar flexion.
D. Dorsiflexion.

Answer: A

30. Patients who have abduction injuries to the foot are prone to injure the
following structures:
A. Medial malleolus and deltoid.
B. Lateral malleolus and deltoid ligament.
C. Interosseous ligament.
D. Posterior tibiofibular ligament.

Answer: A

31. Of the following bones in the foot, the tarsal bone that is most prone to
vascular compromise is the:
A. Calcaneus.
B. Navicular.
C. Talus.
D. Cuboid.

Answer: C

32. A Lisfranc fracture is a fracture-dislocation involving:


B. Tarsometarsal joint.

33. The most common reason for surgical amputation in the general population
is:
E. Ischemia.

36. Hematogenous osteomyelitis most frequently affects:


A. The diaphysis of long bones.
B. The epiphysis.
C. The metaphysis of long bones.
D. Flat bones.
Answer: C

47. The zone of flexor tendon injury that carries the poorest prognosis following
injury and repair is:
B. Zone II.

53. The most important structural component of connective tissue is collagen.


Which of the following statement(s) is/are
true concerning types of collagen? ex
a. All collagen is fiber forming
b. Type 1 collagen is the most abundant in the human body
c. Type 2 collagen is found in cartilage
d. The basement membrane collagens, type 4 and 5, do not form regular fibers

Answer: b, c, d
57. Which of the following statement(s) is/are true concerning bone remodeling?
ex
a. Remodeling can occur only on the surface of trabeculi
b. The remodeling process takes approximately 120 days in an adult
c. Trabecular bone remodeling occurs up to 10 times faster than cortical bone
remodeling
d. Bone modeling involves bone formation without resorption

Answer: b, c, d

121. Which of the following conditions is considered to increase the risk


of gastric cancer? ex
a. Pernicious anemia
b. Prior partial gastrectomy
c. Gastric hyperplastic polyps
d. Gastric adenomatous polyps

Answer: a, b, d

1. Which of the following statements about the anatomic course of the


esophagus is correct?
E. The esophagus deviates anteriorly and to the left as it enters the
.abdomen

2. Which of the following statements about esophageal anatomy is


correct?
C. The esophagus has two distinct muscle layers, an outer, longitudinal
one and an inner, circular one, which are striated in
.the upper third and smooth in the distal two thirds

6. Which of the following statements about achalasia is/are correct?


D. Manometry demonstrates failure of LES relaxation on swallowing and
absent or weak simultaneous contractions in the
esophageal body after swallowing.

8. Which of the following statements about epiphrenic diverticula of the


esophagus is/are correct?
E. The operation of choice is a stapled diverticulectomy, long
esophagomyotomy, and partial fundoplication

9. Which of the following statements about Schatzki's ring is correct?


.B. Dysphagia occurs when the ring diameter is 13 mm. or less

13. Which of the following statements regarding the pathology of


esophageal carcinoma is/are correct?
C. Patients with Barrett's metaplasia are 40 times more likely than the
.general population to develop adenocarcinoma
15. The best management for a 48-hour-old distal esophageal
perforation is:
A. Antibiotics and drainage.
B. Division of the esophagus and exclusion of the perforation.
C. Primary repair with buttressing.
E. T-tube fistula and drainage.

Answer: C

16. A 50-year-old patient develops sudden left lower chest pain and
epigastric pain after vomiting. The patient shows
diaphoresis, breath sounds are decreased on the left, and there is
abdominal guarding. The most appropriate diagnostic test is:
A. Aortography.
B. Esophagoscopy.
C. Electrocardiogram.
D. Film of the chest.
E. White blood count.

Answer: D
20. The presence of a nonmalignant mid- or upper esophageal stricture
always indicates the presence of:
A. Alkaline reflux esophagitis.
B. Barrett's esophagus.
C. Idiopathic reflux disease.
D. Mediastinal fibrosis.

Answer: B

21. Which of the following is most reliable for confirming the occurrence
of a significant esophageal caustic injury?
A. History of the event.
B. Physical examination of the patient.
C. Barium esophagraphy.
D. Endoscopy.

Answer: D
22. Indications for surgical reconstruction of the esophagus include
which of the following? ex
A. Continuing requirement for frequent dilation of an extensive
esophageal stricture for a minimum of 2 years.
B. Failure or refusal of the patient to comply with a treatment regimen of
regular dilation.
C. Development of a fistula between the esophagus and tracheobronchial
tree.
D. Iatrogenic perforation of the esophagus during attempted dilation.

Answer: BCD

23. First-line therapy for routine peptic duodenal ulcer disease includes:
A. Vagotomy and antrectomy.
B. Upper endoscopy and biopsy to rule out tumor.
C. Evaluation for Helicobacter pylori.
D. Serum gastrin determination.

Answer: C

24. Appropriate management of severe vomiting associated with gastric


outlet obstruction from peptic ulcer disease
includes all of the following except:
A. Nasogastric suction.
B. Intravenous hydration.
C. Nutritional assessment; upper endoscopy to rule out malignancy.
D. Intravenous H 2 antagonist.
E. Oral antacid therapy.

Answer: E

25. All of the following are complications of peptic ulcer surgery except:
A. Duodenal stump blowout.
B. Dumping.
C. Diarrhea.
D. Delayed gastric emptying.
E. Steatorrhea.

Answer: E

26. The presentation of Zollinger-Ellison syndrome includes all of the


following except:
A. Hyperparathyroidism in patients with multiple endocrine neoplasia
type 1 (MEN 1) syndrome.
B. Diarrhea.
C. Migratory rash.
D. Jejunal ulcers.
E. Duodenal ulcers.

Answer: C

27. All are true about the dumping syndrome except:


A. Symptoms can be controlled with a somatostatin analog.
B. Diarrhea is always part of the dumping syndrome.
C. Flushing and tachycardia are common features of the syndrome.
D. Separating solids and liquids in the patient's oral intake alleviates
some of the symptoms of the syndrome.
E. Early postoperative dumping after vagotomy often resolves
spontaneously.

Answer: B
28. In patients with bleeding duodenal ulcers, the endoscopic finding
associated with the highest incidence of
rebleeding is:
A. Visible vessel.
B. Cherry-red spot.
C. Clean ulcer bed.
D. Duodenitis.
E. Shallow, 3-mm. ulcer.

Answer: A

29. All of the following are contraindications for highly selective


vagotomy except:
A. Intractable duodenal ulcer disease.
B. Peptic ulcer disease causing gastric outlet obstruction.
C. Fundic peptic ulceration.
D. Cigarette chain smoking.
E. Perforated peptic ulcer disease with more than 24 hours' soilage.

Answer: A
30. All the following are true of omeprazole except:
A. It is the only drug available that has the potential to achieve
pharmacologically induced achlorhydria.
B. It works by blocking the hydrogen-potassium ATPase in the parietal
cell.
C. It is parietal cell specific.
D. It has a short half-life (about 90 minutes) when taken orally.
E. It has been associated with gastric neoplasm in a rat model.

Answer: D

31. All of the following statements about gastrin-releasing peptide (GRP)


are true except:
A. In species other than man and dog GRP is commonly referred to as
bombesin.
B. GRP serves as a neurotransmitter.
C. GRP inhibits pancreatic secretion when given intravenously.
D. GRP stimulates gastric acid secretion when given intravenously.
E. GRP is released in response to cholinergic stimulation of the
.parietal cells to stimulate release of gastrin
Answer: C

32. Cholecystokinin (CCK) is believed to function in all of the following


processes except:
A. It physiologically delays gastric emptying.
B. It appears to have a role in satiety regulation.
C. It contracts the gallbladder.
D. It stimulates pancreatic secretion.
E. It is important in the control of the anal sphincter.

Answer: E

33. All of the following measures have been recommended for control of
acid secretion in patients with Zollinger-
Ellison syndrome except:
A. Antrectomy.
B. Highly selective vagotomy.
C. Total gastrectomy.
D. Vagotomy and pyloroplasty.
E. Medical therapy with Prilosec (omeprazole).

Answer: A
34. All of the following contribute to peptic ulcer disease except:
A. Cigarette smoking.
B. Nonsteroidal anti-inflammatory drugs.
C. Helicobacter pylori.
D. Gastrinoma.
E. Spicy foods.

Answer: E

35. Which of the following statements about gastric polyps is/are true?
A. Like their colonic counterparts, gastric epithelial polyps are common
tumors.
B. They are analogous to colorectal polyps in natural history.
C. Endoscopy can uniformly predict the histology of a polyp based on
location and appearance.
D. In a given patient, multiple polyps are generally of a single histologic
type.
E. Gastric adenomatous polyps greater than 2 cm. in diameter should be
excised because of the risk of malignant
transformation.

Answer: DE
36. Which of the following statements about gastric leiomyomas is/are
true?
A. They are the most common type of gastric tumor of the stomach at
autopsy.
B. The leiomyoblastoma cell type reflects malignant transformation of
gastric leiomyomas.
C. A conservative surgical approach is indicated for their resection since
regional lymphadenectomy has not been proved
reliable even when they turn out to be malignant.
D. Severe hemorrhage may occur from deep ulcerations overlying the
intramural tumor.

Answer: ACD

39. Which of the following risk factors have been shown to increase
significantly the incidence of gastrointestinal
bleeding from stress gastritis in intensive care unit (ICU) patients?
A. Glucocorticoid administration.
B. Respiratory failure.
C. Coagulopathy.
D. Organ transplantation.
E. Jaundice.

Answer: BC
43. Numerous epidemiologic associations have been made between (1)
environmental and dietary factors and (2) the
incidence of gastric cancer, including all except:
A. Dietary nitrites.
B. Dietary salt.
C. Helicobacter pylori infection.
D. Dietary ascorbic acid.

Answer: D

44. All of the following benign conditions are associated with increased
rates of gastric cancer except:
A. Pernicious anemia.
B. Multiple endocrine neoplasia type I (MEN 1).
C. Adenomatous polyps.
D. Chronic atrophic gastritis.

Answer: B
45. Which of the following statements concerning the pathology of
gastric cancer is true?
A. Distal gastric cancers are becoming more common.
B. Intestinal-type gastric tumors resemble colon carcinomas and have a
better prognosis than diffuse type.
C. Early gastric cancers are confined to the mucosa and are lymph node
negative.
D. Broders' histologic grading system correlates well with survival:
patients with grade IV tumors have 5-year survival
rates around 65%.

Answer: B

46. An 80% distal gastrectomy is performed for a 6-cm. antral cancer


with extension to the muscularis propria and
three positive lymph nodes less than 3 cm. from the tumor. The stage of
this tumor was:
A. Stage I.
B. Stage II.
C. Stage III A.
D. Stage III B.

Answer: B
47. Which of the following statements about the surgical treatment of
gastric cancer is false?
A. Patients with tumors of the middle and proximal thirds should
undergo total gastrectomy.
B. Adenocarcinoma of the cardia-gastroesophageal junction may require
reconstruction in the abdomen, chest, or neck.
C. Palliative resection yields better results than palliative bypass.
D. Japanese patients who undergo gastric resection are, on average, 10
years younger and much leaner than their Western
counterparts.

Answer: A

51. Which of the following is/are contraindications to gastric bypass


surgery?
A. Diabetes mellitus.
B. Hypertension.
C. Pickwickian syndrome.
D. Failure to agree to long-term follow-up.
E. Sleep apnea.

Answer: D
53. Metabolic complications of subtotal gastrectomy with Billroth I or
Billroth II reconstruction include: ex
A. Hypothyroidism.
B. Anemia.
C. Reactive hypoglycemia.
D. Dumping syndrome.
E. Metabolic bone disease.

Answer: BCDE

62. Which of the following statement(s) concerning pharyngoesophageal


disorders is/are true? ex
a. In neuromuscular diseases, dysphagia is often worse for liquids than
for solids
b. Cricomyotomy may be indicated for a wide variety of neuromuscular
disorders involving the pharyngoesophageal
phase of swallowing
c. Excision of a Zenker’s diverticulum is indicated to prevent malignant
change in the sac
d. Complications of all operations on the cervical esophagus include
hematoma formation and recurrent nerve
paralysis

Answer: a, b, d
67. Which of the following statement(s) is/are true concerning the
surgical anatomy of the esophagus?
b. Spontaneous esophageal perforation tends to be associated with
leakage into the left chest

79. Which of the following statement(s) is/are true concerning caustic


injury to the esophagus?
a. Alkaline injury is more destructive than acid injury
b. Acid ingestion is not injurious to the stomach due to its normal acidic
pH
c. Ingested caustic agents rapidly pass through the esophagus and
stomach into the small intestine
d. Unless perforation occurs, clinical manifestations resolve quickly with
initial clinical improvement noted
e. Children are less likely to form a late esophageal stricture than adults

Answer: a, d, e
85. At a cellular level, the major stimulant(s) of acid secretion by the
gastric parietal cell is/are:
a. Histamine
b. Prostaglandin E2
c. Acetylcholine
d. Gastrin
e. Norepinephrine

Answer: a, c, d

86. Which of the following statement(s) regarding the vagus nerves


is/are true?
a. The right and left vagus nerves derive from a nerve plexus inferior to
the tracheal bifurcation
b. The posterior vagus nerve is closely applied to the intrathoracic
esophagus
c. The anterior vagus supplies a hepatic division which passes to the
right in the lesser omentum
d. Approximately 90% of vagal fibers are afferent, transmitting
information from the gastrointestinal tract to the
central nervous system
e. The vagus nerves transmit gastroduodenal pain sensations associated
with peptic ulceration

Answer: a, c, d
87. Important stimulants of gastrin release from endocrine cells in the
antrum include:
a. Acidification of the antral lumen
b. Small peptide fragments and amino acids from luminal proteolysis
c. Locally released somatostatin
d. Dietary fats

Answer: b

88. Which of the following statements regarding human gastric acid


secretion is/are true?
a. Fasting acid secretion, normally 2 to 5 mEq/h, is due to ambient vagal
tone and histamine secretion
b. Truncal vagotomy decreases basal secretion by 80%
c. Histamine2 receptor antagonist administration can decrease basal
acid secretion by 80%
d. Fasting acid secretion, normally 5 to 10 mEq/h, is due to circulating
levels of gastrin

Answer: a, b, c
93. Which of the following statements regarding intrinsic factor is/are
correct?
a. Intrinsic factor is produced in chief cells located in the gastric fundus
b. Total gastrectomy is followed by folate deficiency due to vitamin
malabsorption secondary to intrinsic factor
deficiency
c. Intrinsic factor secretion, like that of acid, is stimulated by gastrin,
histamine, and acetylcholine
d. Intrinsic factor deficiency accompanies H pylori-caused antral
gastritis

Answer: c

94. A 24-year-old woman develops epigastric pain and has a diagnosis of


duodenal ulcer confirmed by
esophagogastroduodenoscopy. The patient is in the third month of a
pregnancy. The most appropriate treatment would
be:
a. Proximal gastric vagotomy
b. Misoprostol 400 mg b.i.d.
c. Sucralfate 1 gm q.i.d.
d. Cimetidine 400 mg b.i.d.

Answer: c
104. Which of the following clinical circumstances have been identified
as predisposing factors for the development of
stress ulceration?
a. Intraperitoneal sepsis
b. Hemorrhagic shock
c. Isolated tibial fracture
d. 50% total surface area second degree burn
e. Adult respiratory distress syndrome

Answer: a, b, d, e

107. With regard to benign gastric ulceration, the most common location
of disease is which of the following?
a. Along the greater curvature
b. Immediately distal to the esophagogastric junction along the lesser
curvature
c. In the area of the incisura angularis along the lesser curvature
d. Within the gastric antrum

Answer: c

110. Agents demonstrated to have an efficacy of greater than 90% for


prophylactic treatment of stress ulceration include
which of the following?
a. Antacids
b. H2 receptor antagonists
c. Sucralfate
d. Misoprostil

Answer: a, b, c

1. You are called to see an elderly multi-trauma patient who has a known
history of significant coronary artery disease, atrial fibrillation, and mild heart failure.
He is hypotensive, his abdomen is distended, the FAST reveals a large amount of fluid
around the spleen, and there is an open fracture of the femur.
Which of the following will be most beneficial in his early treatment?
a. Norepinephrine to increase his blood pressure
b. Increasing the afterload to raise the blood pressure immediately
c. Cardioversion of the chronic atrial fibrillation to restore the “atrial kick”
d. Rapid infusion of 20 mL/kg of Ringer’s lactate
e. Beta-blockade to control excessive ventricular rates that can cause hypotension
2. You are treating a septic patient who is on high-dose Levophed for blood pressure
support. His PCWPis 20 mm Hg, with the most recent systemic vascular resistance
about 2600. Which of the following is the appropriate change to make?
a. Add a beta1-agonist
b. Add a beta2-blocker
c. Add an alpha1-agonist
d. Add an alpha2-blocker
e. Add epinephrine or vasopressin
3. You have just inserted a Swan-Ganz catheter and cannot be sure that, with the
balloon inflated, the tip is actually wedged. You recall that in the wedged position the
blood gas on the specimen obtained by drawing back on the line after discarding the
first 5 to 10 cc of blood should be in the range of:
a. pO2 >60
b. pO2 <60
c. pCO2 >60
d. pCO2 <30
e. pH >7.6
4. You indeed were in the wedged position and now obtain the following data. Your
patient’s systemic pressure is 90/40, the heart rate is 120, and the urine output is
scant. The RA pressure is 2, the RV pressure is 18/2, the PA pressure is 18/4, and the
wedged pressure is 4. The cardiac output is 1.8 L, and the systemic vascular
resistance is 2300. The likely cause of shock in this patient is:
a. Fluid overload
b. Pulmonary embolism
c. Cardiac tamponade
d. Hypovolemia
e. Neurogenic shock
5. Your patient with known coronary artery disease is in refractory shock in the
recovery room. He suffered from an acute myocardial infarction during a recent
colectomy. The cardiologist wants to do an emergency cardiac cath to determine
whether there is a blockage amenable to stenting. The cardiologist determined that a
balloon pump was needed for interim support and was inserting the percutaneous
balloon catheter when he had to leave for another emergency and asked that you
finish setting the time for balloon inflation. How can you tell when balloon inflation
is too early or too late?
a. Look at the ECG, time by the T wave
b. Look at the ECG, time by the QRS
c. Look at the arterial waveform proximal to the balloon site
d. Look at the arterial waveform distal to the balloon site
e. Check the cardiac output serially
6. How many of the following will increase venous return in patients on mechanical
ventilation?
 Small tidal volumes
 Brief inspiratory time
 Limiting PEEP to the minimal to maintain satisfactory oxygenation
a. All
b. 2
c. 1
d. None
7. All of the following are contraindications for the use of controlled hypercapnia
except:
a. CNS problems, trauma, tumor
b. Severe HTN
c. Severe metabolic alkalosis
d. Hypovolemia
e. Severe refractory hypoxia
8. Toxicity of tacrolimus includes all of the following EXCEPT:
a. Nephrotoxicity
b. Hypertension, headaches, and vasospasm
c. Alopecia
d. Hyperlipidemia
e. Poor wound healing
9. Which of the following cells are NOT active in innate immunity?
a. T cells and B cells
b. NK cells
c. Neutrophils
d. Mast cells
e. Macrophages
10. Macrophage mediators include all of the following EXCEPT:
a. Complement components
b. Proteolytic enzymes
c. Regulatory mediators – IL-1, TNF-, IL-6
d. Lysozyme and hydrolases
e. Antibodies to cells and organs
11. T cells recognize antigens through all but one of the following:
a. Direct binding to the antigen
b. Recognizing a peptide fragment of an antigen bound to an MHC molecule
c. Presentation by a professional dendritic cell
d. Presentation by a non-professional endothelial cell
e. Presentation by an endothelial cell
12. Immune cells communicate by all the following methods except for:
a. Direct cell-to-cell contact
b. Soluble factors chemoattractant cytokines
c. Combination of cell-to-cell contact and a cytokine
d. Contact with cell surface molecules, which can convert into soluble mediators
e. Use of an immunosuppressive drug
13. How often does identical HLA phenotype occur among siblings?
a. 25% of the time
b. 50% of the time
c. 75% of the time
d. 100% of the time
e. Occurs only in identical twins
14. A 28-year-old man is seen on a renal transplant consultation with his mother,
father, 3 brothers, and 1
sister. All are willing to donate a kidney, all are blood group compatible, and all are
very healthy.
Which one should be selected as a donor?
a. Mother who is a 1 haplotype match
b. Sister who is a 2 haplotype match
c. Brother who is a 1 haplotype match
d. Brother who is a 0 haplotype match
e. Father who is a 1 haplotype match
15. A 45-year-old man receives a deceased donor kidney and, 2 days following
operation, has a minimal urinary output of 10 cc/hr and still requires hemodialysis.
He has a normal duplex ultrasound of the kidney. The most likely diagnosis is:
a. Renal artery stenosis
b. Recurrent focal segmental glomerulosclerosis
c. Acute tubular necrosis
d. Hyperacute rejection
e. Tacrolimus nephrotoxicity
16. You are called to see a youngster who was playing baseball earlier that day and
was struck on the left side of his head by a line drive. He reportedly was knocked
down but got up shortly thereafter and continued to play saying he was “OK.” On the
way home from the game, his parents thought he should be checked when he said his
head was hurting. He lapsed into coma shortly thereafter. On examination, you find a
“fixed and dilated left pupil.” What is the most likely cause of this abnormality?
a. The youngster has a glass eye following prior enucleation for ocular melanoma
b. The youngster has an expanding contusion of the brain in the oculomotor cortex
c. The youngster has acute hydrocephaly
d. The youngster has an acute subdural hematoma on the side opposite the injury
e. The youngster has an acute epidural hematoma on the side of the injury
17. You are covering your surgical group for the weekend and are called to see your
partner’s
postoperative total thyroidectomy case, done for medullary carcinoma. The patient’s
wife is
concerned because the patient is “very hoarse.” He was scheduled for discharge by
your partner before he left for the weekend. On examination, he is breathing well but
is aphonic. What is the likely cause?
a. I do not know what “aphonic” means so guess “B” and go to the next question
b. The patient is having a conversion reaction
c. The patient has unilateral acute vocal cord paralysis, side to be determined
d. The patient has bilateral vocal cord paralysis
e. This scenario is corrupt. He likely has bilateral vocal cord paralysis but should
have been
stridorous, so the scenario is impossible.
18. You are evaluating your trauma patient who has undergone a stent placement for
an acute rupture of the aorta just distal to the subclavian artery. Pleased with the
“save,” you note that his legs are weak and that he has lost pinprick sensation
bilaterally yet has maintained proprioception. He likely has sustained an ischemic
insult and now has:
a. Brown-Sequard syndrome
b. Anterior cord syndrome
c. Central cord syndrome
d. Expected changes post surgery, open or closed
e. Acute reaction due to excessive administration of IV contrast material
19. Your patient with BRACA1-associated breast cancer has had a bilateral
mastectomy done
prophylactically. On in-office follow-up, she is concerned that her right shoulder
blade seems “weird” since the operation. You note that indeed she has a “winged
scapula” on the same side. The most likely cause is operative injury to the:
a. Vagus nerve, ipsilateral
b. Spinal accessory nerve
c. Ipsilateral long thoracic nerve
d. Ipsilateral thoracodorsal nerve
20. From what nerve does the “criminal nerve of Grassi" arise?
a. The greater splanchnic nerve
b. The lesser splanchnic nerve
c. The left vagus nerve
d. The right vagus nerve
21. You are evaluating a jaundiced man who was found to have a “replaced right
hepatic artery” on
angiography. What does that mean?
a. He has no arterial blood flow to the right lobe of the liver
b. He has double arteries perfusing the right lobe of the liver
c. He has no blood flow to the left lobe of the liver
d. The right hepatic artery arises from the SMA
e. The right hepatic artery arises from the IMA
22. The most common nonatherosclerotic cause of carotid stenosis is:
a. Fibromuscular dysplasia
b. Carotid dissection
c. Giant cell arteritis
d. Takayasu’s arteritis
23. The most appropriate management for a young, otherwise healthy patient with
claudication due to popliteal entrapment syndrome is:
a. Exercise regimen
b. Exercise regimen with cilostazol (Pletal®)
c. Transluminal angioplasty and stent placement
d. Interposition vein graft with division of medial head of the gastrocnemius muscle
24. The earliest form of atherosclerotic damage to peripheral arteries is:
a. Fatty streaks
b. Intermediate lesions
c. Prototypical plaque
d. Thrombosed plaque
25. The ankle-brachial index:
a. Is reliable in patients with severely calcified arteries
b. Should never be >1.0
c. Can be used to screen for coronary artery disease
d. Is an invasive test
e. Must be combined with treadmill exercise to be useful
26. Regarding swallowing:
a. Swallowing is not affected by the recurrent laryngeal nerve
b. A sleeve resection of the esophagus should not be performed as this disrupts the
propulsion of the esophagus
c. A large hiatal hernia can disrupt propulsion in the esophagus
d. Tertiary peristalsis is important in clearing residual material in the esophagus
e. All of the above are true
27. In regard to the anatomy of the stomach:
a. The anatomic beginning of the antrum is the angularis incisura
b. The criminal nerve of Grassi is near the pylorus
c. By finding the vagus nerve more distally on the esophagus, the surgeon is more
likely to
divide all the fibers in a vagotomy
d. The consistently largest artery to the stomach is the right gastric
e. The gastroepiploic arteries run along the lesser curvature of the stomach
28. Regarding acid secretion:
a. Acid secretion occurs when the H+/K+ ATPase enzyme is activated
b. Because PPIs irreversibly interfere with the enzyme associated with the proton
pump,
function doesn’t return when these medications are stopped
c. Somatostatin is a powerful stimulant of acid secretion
d. The intestinal phase accounts for the majority of acid secretion
e. All of the above
29. In terms of the small intestine:
a. The strength layer of the bowel is the muscularis mucosa
b. The strength layer of the small intestine is the serosa
c. The proximal intestine has a larger circumference
d. Peyer’s patches are most prominent in the duodenum
e. Short bowel syndrome is likely to occur if <300 cm of small bowel remains after
resection
30. Which is NOT true regarding anal continence?
a. Internal hemorrhoids contribute to anal continence
b. The external sphincter supplies the majority of the resting tone
c. The puborectalis muscle is important in anal continence
d. Decreased rectal compliance compromises continence
e. The pudendal nerve innervates the internal and external sphincters
31. CO2 pneumoperitoneum may require the anesthesiologist to alter the ventilator
settings by
a. Decreasing the rate
b. Increasing the rate
c. Increasing oxygen content
d. Increasing the isoflurane
e. All of the above
32. All of the following are a result of increasing the intra-abdominal pressure
except:
a. Increased SVR
b. Increased CI
c. Increased MAP
d. Increased CVP and PCWP
e. Increased PVR
33. Studies have shown that, after laparoscopy, there is LESS of a systemic rise for all
of the following
EXCEPT:
a. IL-6
b. TNF
c. ACTH
d. WBC
e. None of the above
34. A 35-year-old woman who is 22 weeks pregnant presents with a new palpable
mass in the UOQ of the right breast. The mass is 2.5 cm in size and feels benign in
nature. She has no palpable axillary nodes.
Ultrasound revealed the following:
Which of the following is the best next step in management?
a. Delay management until after delivery
b. Needle biopsy
c. Excisional biopsy
d. Bilateral mammogram
e. Breast MRI
35. In regard to the anus:
a. Has an anal transition zone that is composed of columnar epithelium
b. The hemorrhoidal plexus is synonymous with the inferior rectal vein
c. Patients with rectal varices have an increased risk for hemorrhoids
d. Melanomas of the anus may require an abdominoperineal resection
e. External hemorrhoids should not be treated with banding
36. Incidental appendectomy is recommended:
a. In individuals with Crohn disease when the cecum is free of disease
b. In children about to undergo chemotherapy
c. During Ladd’s procedure
d. In patients aged <25 years
e. All of the above
37. Laparoscopic appendectomy is NOT recommended in which of the following
situations?
a. Appendiceal mucocele
b. Perforated appendicitis
c. Obese patients
d. Patients with previous abdominal surgery
e. Elderly patients
38. In patients with significant rectal bleeding:
a. Anoscopy is not recommended, as significant bleeding rarely results from
hemorrhoidal
bleeding
b. Angiography is more sensitive than tagged red blood cell scan for detecting
bleeding
c. Tagged red blood cell scanning is more accurate in localizing rectal bleeding
d. Patients who complain of rectal bleeding should have a FOBT performed to
confirm
e. Angioembolization may be used for intestinal bleeding localized with angiography
39. In patients with diverticular disease:
a. Resection should include all obvious diverticula
b. When operating urgently, a sigmoid resection with end colostomy and Hartmann’s
pouch
should always be performed
c. Surgery should be avoided in immunosuppressed patients because of increased
complications with surgery
d. Diverticular abscesses do not respond to antibiotics
e. Most patients with uncomplicated diverticulitis will respond to outpatient therapy
with
broad-spectrum oral antibiotics
40. Advantages of CT colonography (virtual colonoscopy) include:
a. Less patient discomfort
b. Avoidance of a bowel preparation
c. Avoidance of insufflation and risk of perforation
d. Similar sensitivity to colonoscopy for lesions >1 cm
41. Which is true regarding PEGs?
a. Local wound infections can be decreased by administering pre-procedure
antibiotics
b. Gastrocolic fistulas do not occur, as the stomach is remote from the colon
c. Closure of the gastrostomy tube generally requires operative takedown
d. Local infections usually require removal of the gastrostomy tube for resolution
e. The crossbar should be tightened as much as possible to avoid separation of the
stomach
from the abdominal wall
42. Colonic polyps:
a. Should never be excised piecemeal, as this makes pathologic interpretation
difficult
b. Perforation following colonoscopy may not be evident for several days
c. Chromoendoscopy is routinely used for detection of ischemia
d. Argon plasma coagulation is not safe in the colon, as it has a significant depth of
penetration
e. Perforation following colonoscopy always mandates operative exploration
43. Regarding ERCP:
a. It is preferred in pregnancy to IOC as it doesn’t involve ionizing radiation
b. It includes evaluation of the esophagus and stomach for pathology
c. The minor papilla is proximal to the major papilla
d. Plastic stents are commonly used for malignant strictures
e. Metal stents are commonly used for benign strictures
44. The Lap-Band® procedure is associated with:
a. Excessive weight loss over time
b. Many metabolic problems
c. Low operative morbidity
d. Late stenoses
45. Comparing open to laparoscopic bariatric procedures, it is evident that:
a. The open operative approach is both more time consuming and more expensive to
perform
b. The laparoscopic approach is superior in patient comfort postoperatively
c. Ghrelin infusions shorten the length of stay
d. All of the above
e. None of the above
46. Following bariatric surgery, patients show:
a. No weight loss for the first 3 months
b. Rapid weight gain ONLY if the stomach staples fall out
c. Improvement in sensitivity to insulin
d. A frequent fatal “gas bloat” syndrome
e. None of the above
47. Bariatric surgery is now being performed on unemancipated minors age 13 to 16
years. The operative
consent should be signed, noting that:
a. All bariatric surgery is experimental and carries potentially lethal but unknown
risks
b. Parents or guardians lose their rights because they allowed their child to become
morbidly
obese, thus they are guilty of Munchausen syndrome by proxy
c. No signature of the teenager is advisable because the patient is underage
d. The teenager gave consent along with the responsible parent or guardian giving
consent
e. The teenager gave assent along with the responsible parent or guardian giving
consent
48. You have read an article on a study of a new drug treatment for Crohn disease. It
reports that the drug
was found to be effective, with a “P value” ≤0.05. This means that
a. The drug worked 95% of the time
b. If the drug did not really work, you still could end up with rejection of the null
hypothesis
5% of the time. In this case, the findings of the study would represent a “false
positive”
c. The study is underpowered 5% of the time
d. 95% of research is accurate
e. You have a beta error 5% of the time
49. A 66-year-old diabetic has been on a ventilator for 5 days following surgery for
peritonitis due to a perforated appendix. She remains nasotracheally intubated.
Initially febrile, she defervesced on POD 2 but now has spiked a fever to 39°C. The
chest x-ray remains clear, and the abdominal exam is unremarkable. A CT of the
sinuses revealed a left maxillary sinusitis. The most likely causative organism is:
a. Staphylococcus aureus
b. Enterococcus fecalis
c. Escherichia coli
d. Klebsiella pneumoniae
e. Pseudomonas aeruginosa
50. You have performed a total thyroidectomy for a large papillary carcinoma of the
thyroid, and the PGY1 resident who scrubbed on the case tells you that the patient
has a positive Chvostek sign in the recovery room. He is concerned that the patient is
hypocalcemic. Which of the following statements is most correct?
a. The Chvostek sign is rarely present in normocalcemic patients
b. The Chvostek sign is usually present in normocalcemic patients
c. The Chvostek sign is highly sensitive for hypocalcemia
d. The Chvostek sign is highly specific for hypocalcemia
e. The Chvostek sign is neither highly sensitive nor highly specific for hypocalcemia
51. A 72-year-old man presents with a parotid mass. Imaging studies confirm that
the mass is in the superficial lobe of the gland. Fine-needle aspiration of the mass is:
a. Useful in treatment planning
b. Likely to give a correct tissue diagnosis of tumor type in 95% of cases
c. Contraindicated
d. Likely to spread the disease to the lymph glands in 5% of cases
e. More dangerous than a core-needle biopsy
52. Following thyroid surgery, your patient is noted to be aphonic in the recovery
room. The most likely cause is:
a. Post-intubation edema of the vocal cords
b. Injury to the right recurrent laryngeal nerve
c. Injury to the left recurrent laryngeal nerve
d. Bilateral superior laryngeal nerve injury
e. Bilateral recurrent nerve injury
53. The blood supply to carotid body tumors arises from the:
a. Subclavian artery
b. Common carotid artery
c. Internal carotid artery
d. External carotid artery
e. Transverse cervical artery
54. Can a patient given a narcotic agent give informed consent?
a. Yes, but only in emergencies
b. Yes, but only if the intent of the medication was to get the patient to agree to
surgery
c. Yes, but only if the patient is a habitual user of narcotics
d. Never
e. Yes, but only if the patient is alert, oriented, and capable of making a decision
55. Concerning advance directives, all of the following are true except:
a. Availability of the forms is required by law at the time of hospitalization
b. It is a right of the patient to complete such forms
c. It is desirable that such forms be completed before major operative procedures
d. It is mandatory that the forms be completed before elective surgery
e. Patients may refuse to fill in such forms
56. Your elderly cancer patient has a DNR order. He has sustained an esophageal
perforation during an attempted PEG insertion. While in the operating room, he has
a cardiac arrest. Should resuscitation be attempted?
a. It is a simple answer, YES. DNR orders are automatically cancelled when a patient
enters
the OR
b. It is a simple answer, NO. DNR orders cannot be rescinded
c. Only if you believe it will be successful
d. Only if you believe the family wants it done
e. Only if there was preoperative discussion of suspension of the DNR order and the
patient
agreed to perioperative discontinuation of the DNR order
57. The typical patient believes that the principal cause of medical errors is:
a. Incompetence
b. Overtiredness
c. Insufficient attention by physician
d. Poor nursing care
58. Informed consent is best described as:
a. Following the doctor’s advice
b. A process of shared decision making based on mutual respect and participation
c. A process of communication that is essential only to treatment for a life-
threatening illness
d. Obtaining a second opinion prior to starting treatment
e. Providing the patient the consent form to study
59. Withholding or withdrawing treatment is best described as:
a. Passive euthanasia
b. Actively taking steps to cause a patient's death
c. Assisted suicide
d. Letting nature take its course
e. None of the above
60. The most important factor in determining if someone is a suitable candidate for
an organ transplant is:
a. Emotional stability
b. Someone for whom a transplant offers a reasonable likelihood of recovery
c. Ability to deal with stress
d. Age
e. Insurance coverage
61. The need for new methods of defining and determining death was created by
what medical
procedure?
a. Brain surgery
b. Open heart surgery
c. Artificial resuscitation
d. Organ transplantation
e. Cardiac pacemakers
62. You will receive ______ medical care if you do not have any advance directives.
a. little
b. full
c. no
d. reluctant
e. substandard
63. Esophageal manometry in patients with achalasia usually shows which one of
the following findings?
a. Frequent uncoordinated peristalsis
b. Primary motor waves
c. Secondary motor waves
d. Aperistalsis
e. Relaxation of the LES
64. Which of the following statements is characteristic of patients who have a Zenker
diverticulum?
a. Usually are in their 40s or 50s
b. Should have EGD to make the diagnosis
c. Medical therapy is warranted before surgery
d. GERD usually worsens after surgery on the Zenker diverticulum
e. Myotomy is indicated
65. Post-emetic esophageal perforation is characterized by the following:
a. Often occurs in patients with underlying esophageal disease
b. Barium esophagram should be done if Boerhaave syndrome is suspected
c. Subcutaneous emphysema is always present
d. Surgical repair is best done laparoscopically
e. 2-layer closure of the esophagus with some type of buttressing should be used for
delayed
repair
66. Risk factors for esophageal cancer include:
a. Achalasia
b. Barrett esophagus
c. GERD
d. Smoking, alcohol abuse
e. All of the above
67. Patients with GERD and short segments of Barrett epithelium should always have
the following:
a. 24-hour pH studies to evaluate the severity of reflux
b. Avoidance of aggressive medical management of GERD since it could mask
symptoms
c. EMR of Barrett mucosa
d. Laparoscopic Nissen fundoplication
e. EGD and 4-quadrant biopsies to detect HGD
68. A 33-year-old woman presents with worsening right lower quadrant abdominal
pain of 2 days' duration. She is carrying twins at 24 weeks’ gestation. She has a poor
appetite and mild nausea. Her abdominal exam reveals decreased bowel sounds,
moderate tenderness to palpation in the right mid and lower abdomen, questionable
rebound, and a gravid uterus that is nontender. Her cervix is closed, and there are no
uterine contractions on the monitor. Her WBC is 18,400 with a shift to the left. What
diagnosis is most likely, given the previous information?
a. Preterm labor
b. Placental abruption
c. Appendicitis
d. Duodenal ulcer
69. Which one of the following statements is true regarding appendicitis in
pregnancy?
a. Rovsing and psoas signs are as predictive in pregnancy as in non-pregnant women
b. Lack of fever excludes the diagnosis
c. CT scan cannot be used to aid in diagnosis
d. RLQ pain is seen in ~80% of patients
e. A WBC of >16K is predictive of appendicitis
70. A 33-year-old woman presents with acute upper abdominal pain of 1 day's
duration. She is carrying twins at 28 weeks’ gestation. She has a poor appetite,
nausea, and emesis. Her abdominal exam reveals decreased bowel sounds, moderate
tenderness to palpation in the RUQ and epigastrium, and a gravid uterus that is
nontender. Her cervix is closed, and there are no uterine contractions on the monitor.
Ultrasound reveals gallstones. Amylase lipase and total bilirubin are markedly
elevated. All the following are appropriate in preparation for surgery except:
a. Administering antibiotics
b. Considering tocolysis
c. Intraoperative fetal monitoring
d. Having cesarean section tray on standby
e. Positioning the patient flat
71. All the following principles are appropriate in surgery for this pregnant patient
except:
a. Providing left lateral displacement of the uterus
b. Accepting a pneumoperitoneum of 20 to 25 mm Hg, given the advanced
gestational age
c. Monitoring maternal end tidal CO2 to minimize maternal and fetal acidosis
d. Using an open Hasson technique to decrease the risk for uterine injury
72. Which of the following is an incorrect choice for the desired ultrasound imaging?
a. 3.5-MHz probe for a thyroid scan
b. 5.0-MHz transducer for a FAST exam
c. 7.5-MHz probe for ultrasound-guided aspiration of a breast cyst
d. 10.0-MHz laparoscopic probe for intraoperative localization of a pancreatic
endocrine
tumor
e. 12.0-MHz laparoscopic probe for ultrasonic cholangiography
73. Which of the following statements is INCORRECT?
a. A FAST examination will help localize the source of bleeding in a patient with
penetrating
abdominal trauma.
b. Ultrasound can be useful in differentiating between cholelithiasis, polyps, and
adenomyomatosis.
c. Ultrasound can be useful in differentiating between cystic masses and solid
masses.
d. Higher-frequency probes offer greater resolution at the expense of decreased
depth
penetration.
e. Anorectal ultrasound findings are predictive of tumor stage.
74.

Shown above is a sonographic examination of a breast in a 25-year-old nulliparous


woman with a history of a newly noted painful mass. The next step in management
should be:
a. NSAIDs
b. Ductal lavage
c. Percutaneous cyst drainage and follow-up prn
d. Excisional biopsy with sentinel lymph node sampling
e. Observation

75.

The structure identified above by the small arrowheads is most likely:


a. Lymph node
b. Parathyroid adenoma
c. Esophagus
d. Hyoid bone
e. Carotid body tumor
76. You are called in consult for a patient with hemoptysis who has been on a
ventilator in the ICU for the past 3 weeks. The most likely diagnosis is:
a. Tracheo-innominate fistula
b. Tuberculosis
c. Lung cancer
d. PA catheter perforation
e. Bleeding from the trauma of suctioning
77. You are called to see a young man with a recurrent spontaneous pneumothorax.
He was treated at another hospital 2 weeks ago, with chest tube drainage for 5 days.
Acceptable management includes all the following EXCEPT:
a. Smoking cessation counseling
b. Needle aspiration followed by observation
c. Initial chest tube placement
d. CT scanning of the chest
e. Thoracoscopic definitive treatment
78. Treatment options for chylothorax may include all the following EXCEPT:
a. Needle aspiration
b. Chest tube drainage
c. High-fat, high-protein, low-carbohydrate diet
d. Total parenteral nutrition
e. Thoracic duct ligation
79. Synthesis and breakdown of collagen occurs in which stage of wound healing?
a. Coagulation stage
b. Inflammatory stage
c. Proliferative stage
d. Remodeling stage
e. Wound contraction
80. Hydroxylation of proline and lysine to increase wound strength is dependent on:
a. Vitamin A
b. Vitamin D
c. Vitamin D3
d. Vitamin C
e. Vitamin E
81. Randomized prospective data exist to support the following benefits of VAC ®
therapy EXCEPT:
a. Decreasing the bacterial burden in wounds
b. Avoiding need for flap procedures when treating underlying osteomyelitis
c. Accelerating wound healing by secondary intention
d. Decreasing total wound care costs
e. Improving convenience for patient and wound caregiver
82. You are asked to assume care for a chronic medial ankle wound in a 60-year-old
diabetic with a 25 pack-year history of smoking. A comprehensive treatment plan
includes all the following EXCEPT:
a. Smoking cessation strategies
b. Application of PDGF (Regranex®)
c. Use of electromagnetic field therapy
d. Administration of pentoxifylline (Trental®) 400 mg TID
e. Aggressive hydrotherapy/Whirlpool
83. Currently available, topically applied agents, shown to be effective in modulating
scar appearance, include all EXCEPT:
a. Steroid preparations
b. Silicone gels and occlusive sheets
c. Hydroquinones
d. Antibiotic ointments
e. Pressure garments
84. A 55-year-old patient with history of sulfa allergy sustains a 20% TBSA second-
and third-degree burn to his chest and arms after falling asleep while smoking in
bed, igniting his pajamas. The most appropriate topical antimicrobial to use for his
burn care is:
a. Silver sulfadiazine (Silvadene®)
b. Mafenide acetate (Sulfamylon®)
c. Bacitracin antibiotic ointment
d. Mupirocin (Bactroban®)
e. Silver nitrate
85. The care of patients sustaining major electrical burns differs from that in thermal
burn patients in all
areas listed below EXCEPT:
a. Calculation of fluid resuscitation needs
b. Development of electrolyte abnormalities
c. Surgical management of injured areas
d. Immune response to the burn injury
e. Impact of the injury on cardiac function
86. You are evaluating a 45-year-old woman for a palpable right neck mass identified
on physical
exam by her gynecologist. She has no family history of thyroid cancer or radiation
exposure. Her TSH
is normal. What is the least invasive test to make a definitive diagnosis?
a. Radioactive iodine scan
b. Thyroglobulin level
c. CEA level
d. Fine-needle aspiration biopsy
e. USG
87. You are evaluating a 60-year-old woman who presents with a 3-cm left thyroid
nodule. Fineneedle biopsy is suggestive of follicular neoplasm. USG demonstrates a
normal right thyroid lobe. What is your recommendation for further treatment?
a. Repeat USG and biopsy in 6 months
b. Thyroid hormone suppression
c. Diagnostic left thyroid lobectomy
d. Total thyroidectomy
e. Total thyroidectomy and left modified radical neck dissection
88. You are evaluating a 25-year-old man with a new thyroid nodule. He reports a
longstanding history of HTN and episodic headaches. His family history is significant
for a mother and sister who had their thyroids removed for cancer, and his sister
died on the operating room table. What additional test should you obtain prior to a
fine-needle biopsy?
a. Calcium
b. Plasma metanephrines
c. 24-hour urine cortisol levels
d. CA 19-9 levels
e. Thyroglobulin
89. A 2.8-kg neonate with excessive salivation develops respiratory distress.
Attempts to pass an urogastric catheter fail as the catheter coils in the back of the
throat. X-ray shows right upper lobe atelectasis and a gasless abdomen. The most
likely diagnosis is:
a. Proximal esophageal atresia without a fistula
b. Proximal esophageal atresia with a distal tracheo-esophageal fistula (TEF)
c. “H-type” TE fistula
d. Esophageal atresia with both proximal and distal TEF
90. In infants with duodenal atresia, all the following statements are true EXCEPT:
a. There is an increased risk for Down syndrome
b. It can be detected by prenatal ultrasound examination
c. It may occur in infants with situs inversus, malrotation, annular pancreas, and
anterior
portal vein
d. It is best treated by gastroenterostomy
e. There is a high incidence of associated cardiac defects
91. The treatment of choice for neonates with uncomplicated meconium ileus is:
a. Observation
b. Emergency laparotomy, bowel resection, and Bishop-Koop enterostomy
c. Intravenous hydration and a Gastrografin® enema
d. Emergency laparotomy, bowel resection, and anastomosis
e. Sweat chloride test and pancreatic enzyme therapy
92. Which of the following statements about Hirschsprung disease is not true?
a. There are no ganglion cells seen in Auerbach plexus.
b. There is an increased incidence of Down syndrome.
c. It is more common in girls.
d. It may be associated with enterocolitis.
e. It may involve the small intestine.
93. Polyhydramnios is frequently observed in all the following conditions EXCEPT:
a. Esophageal atresia
b. Duodenal atresia
c. Pyloric atresia
d. Hirschsprung disease
e. Congenital diaphragmatic hernia
94. In infants with gastroschisis, which of the following statements is not true?
a. It is associated with malrotation.
b. There is a high incidence of associated anomalies.
c. There is prolonged adynamic ileus following repair.
d. It is complicated by intestinal atresia in 10% to 12% of cases.
e. It is not associated with chromosomal syndromes.
95. In neonates with necrotizing enterocolitis, which of the following findings is an
indication of significant bowel ischemia?
a. Increased gastric residuals
b. Septic shock
c. Cardiac failure due to a patent ductus arteriosus
d. Elevated platelet count
e. Erythema of the abdominal wall
96. All the following conditions are derived from the primitive embryologic foregut
EXCEPT:
a. Bronchogenic cyst
b. Cystic adenomatoid malformation
c. Gastric duplication
d. Mesenteric cyst
e. Pulmonary sequestration
97. A 25-year-old male undergoes 4 cycles of etoposide and platinum following a
right orchiectomy for stage IIb non-seminoma germ cell tumor (NSGCT). Serum
tumor markers and chest CT are normal. Abdominal CT scan is shown below. Which
of the following is most appropriate?
a. Observation
b. Post-chemo RPLND
c. Radiation
d. Further chemo
e. Insufficient information

98. A 32-year-old alcoholic male presents to the ED with nausea, vomiting, and
epigastric pain. He is diagnosed with pancreatitis. Which of the following is NOT one
of the Ranson criteria, which can help you decide on the severity of the attack?
a. Calcium level <8 mg/dL at admission
b. WBC >16,000 at admission
c. LDH >350 IU/L at admission
d. Glucose >200 at admission
e. Age >55 years
99. Which of the following statements regarding groin hernias is false?
a. Men are much more likely to develop inguinal hernias than are women.
b. In women with inguinal hernias, there is an equal incidence of direct and indirect
hernias.
c. Femoral hernias are the most likely to strangulate of any groin hernias.
d. A combined direct and indirect inguinal hernia is known as a “pantaloon” hernia.
e. Inguinal hernias are more common in women than are femoral hernias.
100. Which of the following statements regarding the repair of inguinal hernias is
correct?
a. Applying considerable tension to the sutures is important to prevent bulges from
occurring.
b. Recurrence risk from open and laparoscopic hernia repairs are the same.
c. The lowest recurrence rates are reported after tension-free repairs with mesh.
d. The Bassini repair involves suturing transversus abdominis to the Cooper
ligament.
e. If the spermatic (testicular) artery is inadvertently transected during an inguinal
hernia
repair, the testicle must be removed.

Pancreas
1. In pancreas divisum all the following are true except
A. occur in 5% of the population
B. may lead to recurrent pancreatitis
C. duct of Wirsung is the main duct
D. there is failure of fusion
E. diagnosed by ERCP

2. Cystic fibrosis all the following are true except


A. transmitted as autosomal dominent
B. dysfunction of exocrine glands
C. there is poor appetite & growth,
D. patient has distension, steatorhea, finger clubbing present
E. diagnosis by DNA analysis

3. Sever attack of pancreatitis is


A. attack followed by pseudocyst
B. has four points on Ranson criteria
C. has 5 points on Balthazar grade
D. all the above
E. none of the above

4. Antibiotics in acute pancreatitis:


A. not indicated
B. second generations cephalosporins are the best
C. indicated in all cases
D. b and c only
E. none of the above

5. CT in acute pancreatitis :
A. should be done on admission
B. should be done 48 hours later
C. should be done one week later
D. not indicated
E. none of the above

6. Pancreatic pseudocyst
A. usually appears after two weeks of the attack
B. has one layer of epithelial lining
C. may be treated by endoscopy
D. all the above
E. none of the above

7. Percutaneous drainage of pancreatic cyst is indicated in all the following except :


A. after three weeks in order to mature the wall
B. rapidly enlarging cyst
C. difficult sites
D. presence of infection
E. unfit patients

8. The following are known complications of acute pancreatitis except


A. respiratory failure
B. renal failure
C. cardiac failure
D. coagulopathy
E. bleeding gastric erosion

9. The following can cause high serum amylase :


A. perf. GB
B. rupture ectopic pregnancy
C. rupture abdominal aortic aneurysm
D. afferent loop obstruction
E. all the above

10. Carcinoma of the pancreas:


A. 50% adeocarcinoma of duct origin
B. slightly more in the head
C. 10% cystadenocarcioma
D. CIS about 40 %
E. none of the above
11. Insolinoma :
A. age usually above 40
B. hyper glycemia in the early morning is classical
C. clinically may simulate DU
D. insulin / glucose ratio should equal one
E. all of the above

Orthopedic

12. Bennet's fracture is :


A. fracture of the base of first meta tarsal bone
B. fracture of the base first meta carpal bone
C. fracture of the head of first meta tarsal bone
D. fracture of the head first meta carpal bone
E. fracture of the head second meta carpal bone

13. Thomas test is positive in :


A. Paget's disease of the hip
B. Perthe's disease of the hip
C. osteo arthritis of the knee
D. Sudeck's atrophy of the shoulder
E. none of the above

14. All the following are complications of cast except


A. compartment syndrome
B. pressure sore
C. blisters with 2ry infection
D. immobilization of joints
E. crush syndrome

15. Volkmann's ischemic contracture :


A. may follows fracture of radius and ulna
B. fracture neck of femur
C. supracondylar fracture of humerus
D. all the above
E. none of the above

16. Compartment syndrome


A. common in fracture of the leg
B. passive flexing of the toes increase the pain
C. compartment pressure should exceed 50 mmHg
D. treated by urgent fasiectomy
E. all the above

17. Indication of operative treatment in fractures :


A. compound fracture
B. intertrochanteric fracture of femur in the elderly
C. associated complications
D. a and c only
E. all the above

18. The following are methods of stabilization of fractures except:


A. External splint e.g. POP
B. Internal fixation
C. Hanging plaster
D. Skin traction
E. a and b only

19. stress fracture :


A. may affect the shaft of tibia
B. may affect the second metatarsal bone
C. occur in marathon runners
D. all the above

20. Mallet finger is due to:


D. avulsion fracture of the base of terminal phalanx

21. operative approach to the hip joint may be :


A. anterior
B. posterior
C. lateral
E. all the above

22. Salter and Harris classification :


A. classification for fracture tibial platue
B. classification for fracture neck femur
C. classification for fracture growth plate

VASCULAR
23. In critical ischemia there is:
A. rest pain
B. oedema
C. color changes
D. hyperesthesia
E. all the above

24. popliteal artery aneurysm


A. accounts for 70% of all peripheral aneurysms
B. 25% are bilateral
C. 30% develop complication within 5years
D. All of the above

25. Beurger' diseases has :


A. occlusion of small and medium arteries
B. thrombophlebitis
C. Reynold's phenomenon
D. all the above
26. abdominal aortic aneurysm
A. usually due to atherosclerosis
B. usually at the level of L1
C. incidence of rupture is 50% for 5 cm aneurysms
D. elective surgery careies 20% mortality rate
E. all the above

27. Berry's aneurysms


A. are congenital
B. affect medium sized arteries
C. fusiform in shape
D. all the above

28. Secondary varicose viens


A. due to valve destruction
B. due to incompetent perforators
C. has lower complication rate than the primary varicose
D. may lead to venous ulcer
E. none of the above

29. Greenfield filter


A. reduce incidence of DVT
B. inserted in the common iliac vien
C. inserted between L1 and L2 levels
D. can be inserted percutaneous

30. lymph edema tarda


A. usually before the age of 35 years
B. affects upper limbs only
C. affect lower limbs only
D. usually pitting in early stage

BASIC SURGICAL SCIENCES

31. Abduction of the vocal cords results from contraction of the:


A. crico-thyroid muscles
B. posterior crico-arytenoid muscles
C. vocalis muscles
D. thyro-ary-epiglottic muscles
E. lateral crico-arytenoid and transverse arytenoids muscles

32. The rectum:


A. is devoid of peritoneum
B. is surrounded by peritoneum
C. has peritoneum on its lateral surfaces for its upper two- thirds, and on its anterior
surface for its upper one-third
D. has pritoneum on its anterior surface for its upper two-thirds, and on its lateral
surfaces for its upper one-third
E. has peritoneum on its anterior surface only

33. The umbilicus:


A. lies near the to the xiphoid than to the pubis
B. derives its cutaneous innervation from the eleventh thoracic nerve
C. transmits, during development, the umbilical cord two arteries and two veins
D. usually lies at about the level between the third and fourth lumbar vertebra
E. emberiologicall, may transmit urine but never bowel contents

34. The superficial perineal pouch:


A. is limited inferiorly by the urogenital diaphragm
B. is not continuous with the space in the scrotum occupied by the testes
C. has a membranous covering which provides a fascial sheath around the penis
D. is traversedby the urethera in the male but not the urethera and vagina in the
female
E. in the female, the greater vestibular glands are situated outside this pouch

35. The tongue:


A. has a foramen caecum at the base of the frenulum
B. is separated from the epiglottis by the valleculae on each side of the midline
C. has 7-12 circumvallate papillae situated behind the sulcus terminalis
D. is attached to the hyoid bone by the genioglossus muscle
E. is supplied only by hypoglossal nerve

36. Hypovolaemic shock is characterized by:


A. a low central venous pressure , low cardiac output , low peripheral resistance
B. a high central venous pressure , high cardiac output , low peripheral resistance
C. a low central venoys pressure , low cardiac output , high periphera resistance
D. a low central venous pressure , high cardiac output , high peripheral resistance
E. a high central venous pressure , low cardiac output , low peripheral resistance
37. An oxygen debt is:
A. the amount of oxygen in excess of the resting metabolic needs that must be
consumed after completion of exercise
B. build up because the pulmonary capillaries limit the uptake of Oxygen at high rates
of oxygen consumption
C. related to the fact that skeletal muscle cannot function temporarily in the absence
of oxygen
D. associated with a decrease in blood lactate
E. associated with alkalosis

38. Pulmonary embolism may be a complication of except :


A. prolonged bed rest
B. a surgical operation
C. vitamine K deficiency
D. oral contraceptive therapy
E. Antithrombin III deficiency

39. Which of the following statements regarding potassium metabolism is NOT


True?:
A. potassium deficiency commonly results from thiazide diuretic theraoy
B. the normal compensation for potassium deficiency is a metabolic extracellular
acidosis
C. aldosterone increases urinary potassium loss
D. hyperkalaemia causes bradycardia and loss of P waves on the ECG
E. hypokalaemia aggrevates the cardiac effects of digitalis toxicity

40. Cutaneous pain:


A. is due to overstimulation of receptors serving other sensory modalities
B. cannot be elicited more readily if the tissue has recently been injured
C. is due to exitation of receptors by pain-producing chemical substances in the
injured tissue
D. shows marked adaptation, i. e. decrease in severity in response to a constant
stimulus
E. is conducted through the medial spinothalamic tract

41. Which of the following is NOT associated with hyperthyroidism?:


A. increase size of the thyroid gland
B. increased amount of colloid in thyroid follicle
C. increased height of epithelium of the thyroid follicle
D. increased vascularity of the thyroid gland
E. increased uptake of iodine by the thyroid gland

42. Sarcomata may show all of the following EXCEPT:


A. production of myxomatous tissue
B. production of collagen
C. spindle shaped cells
D. signet ring cells
E. blood stream metastasis

43. Anaphylaxis is characterized by all of the following EXCEPT:


A. is a reaction either local or general , frequently occurs within five minutes
B. causes an urticarial eruption
C. is produced by IgA antibody
D. causes eosinophilia
E. causes degranulation of basophils and mast cells

44. Autoimmunity is characterized by the following EXCEPT:


A. occurs because of a breakdown in the ability of the body to distinguish between
self and non self
B. is involved in some forms of orchitis
C. is involved in formation of cryo globulin
D. is important in the pathogenesis of lupus erytheromatosus
E. does not result in immune complex disease

45. Pseudomembranous enterocolitis is caused by the following organisms:


A. Clostridium sporogenes
B. Clostridium defficile
C. Streptococcus faecalis
D. Penicillin sensitive staphylocci
E. Pseudomonas aeruginos
CLINICAL SUGERY

46. The “ white clot syndrome”:


A. is usually characterized with antithrombin III deficiency
B. most often present with arterial complicatios of heparin induced throbocytopenin
C. is best managed by loe molecular weight dextran
D. is best managed by halving the therapeutic dose of heparin sodium
E. results from nitric oxide deficiency of endothelial cells

47. A 21-year-old man who was the driver in a head-on collision has a pulse of
140/min , respiratory rate of 36 and blood pressure of 75 palpable. His trachea is
deviated to the left, with palpable subcutaneous emphysema and poor breath sounds
in the right hemithorax, The most appropriate initial treatment must be
A. immediate thoracotomy
B. catheter insertion in the subclavian vein for fluid resuscitation
C. intubation and ventilation
D. tube thoracostomy
E. immediate tracheostomy

48. The best test to monitor the adequacy of levothyroxin therapy is:
A. radioactive iodine uptake
B. thyroglobulin
C. free thyroxine index (T4)
D. triiodothyronine resin uptake (T3)
E. thyroid stimulating hormone (TSH)

49. Which of the following statements about fungal infection is NOT true ?:
A. Prior or synchronous culture positive for Candida at another site occurs in few
patients with candidimia
B. For critically ill patients nonhaematogenous sites of candida are appropriately
treated with systemic antifungal therapy
C. Mortality rates are similar regardlss of whether C. albicans fungmia is treated with
amphotericin B or flconazole
D. Intravenous catheters and the gastrointestinal tract are common portals for Candida
to gain blood stream access
E. Septic emboli are more common with fungal endocarditis than with bacterial
endocarditis

50. The maximum safe dose of local anaesthetic administered subcutaneously in a


70-kg man is:
A. 10 to 20 ml of 1% lidocaine
B. 40 to 50ml oh 2% lidocaine with epinephrine
C. 40 to 50 ml of 1% lidcaine with epinephrine
D. 40 to 50 ml of 1% bupivacaine (marcaine)
E. 40 to 50 ml of 1%lidocaine without epinephrine

51. Two days after right hemicolectomy for a Dukes B caecal carcinoma , the Patient
complains of sharp right-sided chest pain and dyspnea. HisPaO2 Is 64mmHg ,his
PaCo2 is 32mmHg. CVP is 26 cm water, and the blood pressure is 102/78mmHg. A
pulmonary embolus is suspected, The next step in management should be:
A. A ventilation- perfusion lung scan
B. A pulmonary arteriogram
C. Postrioanterior and lateral chest x-rays
D. Heparin sodium ,100 units/kg intravenously
E. Immediate duplex scanning of both lower extremities

52. The major cause of graft loss in heart and kidney allograft is:
A. acute rejection
B. hyperacute rejection
C. vascular thrombosis
D. chronic rejection
E. graft infection

53. All of the following are indicators of tumor aggressiveness and poor outcome for
papillary carcinoma of the thyroid gland EXCEPT:
A. age over 50 years
B. microscopic lymph node metstasis
C. tumor larger than 4 cm
D. poorly differentiated histological grade
E. invasion through capsule to adjacent tissues

54. A 40-year-old woman has extensive microcalcifications involving the entire upper
aspect of the right breast. Biopsy shows a commedo pattern of intraductal
carcinoma.The most appropriate treatment is :
A. wide local excision
B. radiation therapy
C. wide local excision plus radiation therapy
D. right total mastectomy
E. right modified radical mastectomy
55. In the conventional ventilator management of acute adult respiratory distress
syndrome (ARDS) , arterial O2 saturation is maintained above 90% by all the
following EXCEPT :
A. increasing the ventilatory rate
B. the use of positive end-expiratory pressure (PEEP)
C. increasing mean airway pressure
D. increasing tidal volumes
E. increasing FiO2

56. Which of the following statements about patients with abdominal compartment
syndrome is NOT true ?
A. Abdominal pressure is usually measured indirectly through inferior vena cava
B. Multiple contributing factors are commonly responsible
C. The chief manifestations are reflected in central venous pressure , ventilatory
function, and oliguria
D. Decopression of the abdomen is required to resverse the syndrome
E. Aggressive hemodynamic monitoring and management is required when the
abdomen is opened
57. The most appropriate treatment for histologically malignant cystadenoma
phylloides is :
A. total mastectomy without axillary node dissection
B. total mastectomy with axillary node dissection
C. wide margin (3) cm excision of the lesion
D. post operative hormonal manipulation
E. postoperative adjuvant chemotherapy

58. Deep venous thrombosis resulting from upper extremity central venous lines:
A. should be treated with catheter removal, heparin therapy, and long term
anticoagulants
B. is best with urokinase through the catheter
C. is innocuous and self limiting, and best treated with catheter removal only
D. is best treated with low-dose warfarin (coumadin, 1 mg / day) , without catheter
removal
E. is best managed by single systemic dose of low molecular weight heparin daily and
continued catheter use

59. Emergency surgery is indicated for all of the following complications of


ulcerative colitis EXCEPT:
A. colonic dilatation greater than 12 cm (toxic mega colon )
B. free perforation
C. complete intestinal obstruction
D. intractable haemorrhage
E. abscess formation

60. All the following statements concerning carcinoma of the oesophagus are true
EXCEPT that:
A. it has a higher incidence in males than females
B. alcohol has been implicated as a precipitating factor
C. adenocarcinoma is the most common type at the cardio esophageal junction
D. it occurs more commonly in patients with corrosive oesophagitis
E. surgical excision is the only effective treatment

61. Which of the following statements about pathology encountered at


esophagoscopy is/are correct?
A. Reflux esophagitis should be graded as mild, moderate, or severe, to promote
consistency among different observers.
B. An esophageal reflux stricture with a 2-mm. lumen is not dilatable and is best
treated with resection.
C. A newly diagnosed radiographic distal esophageal stricture warrants dilation and
antireflux medical therapy.
D. In patients with Barrett's mucosa, the squamocolumnar epithelial junction occurs 3
cm. or more proximal to the anatomic esophagogastric junction.

1 C 11 21 E 31 B 41 B 51 D 61
2 A 12 22 C 32 C 42 D 52 D
3 E 13 23 E 33 D 43 C 53 B
4 E 14 24 A 34 C 44 E 54 D
5 A 15 25 D 35 B 45 B 55 A
6 A 16 26 A 36 C 46 B 56 A
7 A 17 27 A 37 A 47 D 57 C
8 C 18 28 D 38 C 48 E 58 A
9 E 19 29 D 39 B 49 A 59 E
10 B 20 30 D 40 C 50 C 60 E

1. A 35-year-old male is struck on the lateral aspect of his right knee by the bumper
of a car travelling at low velocity. On examination he is unable to dorsiflex the ankle,
evert the foot and extend the toes. There is loss of sensation of the dorsum of the
foot. He is most likely to have damaged which structure?
A. Common peroneal nerve
B. Deep peroneal nerve
C. Saphenous nerve

2. Which one of the following suggest a diagnosis of Hirschsprung's disease?


A. A contrast-study showing dilatation of the aganglionic bowel segment.
B. Early presentation with vomiting.
C. neonatal large bowel obstruction.
D. Presentation after 1 year of age
E. Red current jelly stools.

3. A 46-year-old man presents after penetrating injuries to his arm and forearm. He
is unable to extend his fingers. There is no sensory disturbance and there is no
vascular injury. Which nerve has been damaged?
A. anterior interosseous nerve
B. median nerve
C. posterior interosseous nerve
D. radial nerve
E. ulna nerve

4. Which of the following regarding the anatomy of the heart is true?


A. The aortic valve is tricuspid
B. The ascending aorta is entirely outside the pericardial sac
C. The left atrial appendage is identified readily by transthoracic echocardiography.

D. The pulmonary trunk lies anterior to the ascending aorta


E. The right atrium is posterior to the left atrium.

5. Which of the following is not within the carpal tunnel?


A. median nerve
B. flexor digitorum profundus
C. flexor digitorum superficialis
D. flexor pollicis longus?
E. abductor pollicis longus

6. A 48-year-old woman with chronic pancreatitis due to gallstones is noted to have a


macrocytic anemia What is the most likely cause of the anemia?
A. Bone marrow dysfunction
B. Folate deficiency
C. Hyposplenism
D. Hypothyroidism
E. Vitamin B12 deficiency
7. Which of the following organs is in direct contact with the anterior surface of the
left kidney, without being separated from it by visceral peritoneum?
A. Duodenum
B. Jejunum
C. Pancreas
D. Spleen
E. Stomach
8. A 5-year-old boy presents to Accident and Emergency complaining of acute pain
over his upper tibia He is febrile and he refuses to move his leg. A diagnosis of
osteomyelitis is suspected The likely infecting organism is?
A. Clostridium difficile
B. Haemophilus influenzae
C. Pseudomonas
D. Salmonella
E. Staphylococcus aureus

9. Which is the principle root inervation for the small muscles of the hand?
A. C5
B. C6
C. C7
D. C8
E. T1

10. Which of the following is true concerning Scaphoid fractures?


A. Rarely occur in young adults
B. when complicated by avascular necrosis the proximal pole is usually affected

C. should be treated by bone grafting and internal fixation even if undisplaced

11. A 17-year-old girl underwent emergency splenectomy after a domestic accident.


Which one of the following organisms is most likely to cause life-threatening
infection in the future?
A. Actinomycosis
B. Haemophilus influenzae
C. Pseudomonas aeruginosa
D. Staphylococcus aureus
E. Streptococcus pneumonia

12. Which vertebral level and corresponding structure is correct?


A. C4 and bifurcation of the carotid artery
B. T2 and manubriosternal joint
C. T10 and opening for vena cava in diaphragm
D. T12 and oesophageal opening in the diaphragm
E. T8 and aortic opening in the diaphragm
13. Which of the following statements is true of Compartment syndrome:
A. Only occurs following fractures.
B. Loss of distal pulse is an early sign.
C. The presence of pain is unhelpful in diagnosis.
D. Passive stretch of affected muscles exacerbates pain.

14. The axillary nerve passes directly inferior to which muscle as it leaves the axilla?
A. Long head of triceps
B. Long head of biceps
C. Pectoralis major
D. Subscapularis
E. Teres minor

15. Which of the following is not a branch of the pudendal nerve?


A. Perineal nerve
B. Dorsal nerve of the penis.
C. Inferior rectal nerve
D. Genitofemoral nerve
E. Posterior scrotal nerve

16. A patient presents with a history of low back pain and sciatica The pain radiates
to the little toe, the ankle reflex is absent and the patient has difficulty in everting
the foot. Which nerve root is likely to be trapped
A. L3
B. L4
C. L5
D. S1
E. S2

17. The commonest clinical manifestation of primary hyperparathyroidism is:


A. Renal stone disease
B. Bone disease
C. Peptic ulceration
D. Constipation
E. Polyuria

18. Which of the following structures accompany the median nerve in the carpal
tunnel?
A. Flexor carpi ulnaris.
B. Flexor digitorum profundis.
C. The ulnar artery.
D. All of the above
E. None of the above
19. Which of the following is a branch of the LATERAL CORD of the brachial
plexus?
A. Suprascapular nerve
B. Lower subscapular nerve
C. Medial pectoral nerve
D. Musculo-cutaneous nerve
E. Upper subscapular nerve
20. Which of the following vertebrae has the most prominent spinous process?
A. T1.
B. T2.
C. C7.
D. T11.

21. The ulnar nerve all are true except :


A. innervates the first dorsal interosseus muscle
B. originates from the laterall cord of the brachial plexus
C. has no branches above the elbow
D. innervates the medial half of the flexor digitorum profundus
E. innervates the adductor pollicis muscle

22. A 9 month old boy presents with an acute scrotal swelling. The following
diagnoses are likely:
A. Epididymitis
B. Orchitis
C. Torsion of the testicular appendage
D. Irreducible inguinal hernia
E. Acute idiopathic scrotal oedema

23. Congenital pyloric stenosis:


A. Presents in the first few daies after birth.
B. Can cause hyperchloraemic alkalosis.
C. Is inherited as an autosomal recessive
D. Typically presents with bile stained vomiting after feeds
E. Is often diagnosed by feeling a mass in the right hypochondrium.

24. If torsion of the testicle is suspected, surgical exploration:


A. Should be immediate and include the asymptomatic side

25. Meckel's diverticulum all are true except :


A. Can present with chronic anaemia
B. Is present in 2% of the population.
C. Can be diagnosed by hydrogen breath test.
D. May contain ectopic pancreatic tissue
E. May be implicated in Littre's hernia
26. Which of the following statements is true of upper limb nerve injuries?
A. Injury to the median nerve results in a wrist drop
B. Injury to the radial nerve results in loss of sensation over the palmar aspect of the
index finger
C. Injury to the median nerve results in loss of sensation in the anatomical snuffbox
D. Injury to the ulnar nerve results in a claw hand
E. Injury to the ulnar nerve results in loss of sensation over the thumb

27. Concerning the inguinal canal:


A. It transmits the ilio-inguinal nerve
B. The deep inguinal ring lies below the mid-point of inguinal ligament
C. The superficial inguinal ring overlies the pubic tubercle
D. Laterally , the anterior wall is made up of the external oblique aponeurosis
E. Laterally, the posterior wall is formed by the conjoint tendon

28. In chest trauma, urgent cardiothoracic surgical referral is necessary for all
except:
A. Continuing massive air leak following insertion of chest drain
B. Cardiac tamponade
C. Disruption of the great vessels
D. Severe pulmonary contusion
E. Continuing haemorrhage following insertion of chest drain

29. A raised titre of anti-HBs in the bloodallare true except :


A. signifies previous hepatitis B infection
B. is produced after hepatitis B vaccination
C. indicates immunity to hepatitis infection
D. indicates active hepatitis B infection

30. The following statements regarding intravenous solutions is correct:


A. Normal saline contains 180mmol/l of sodium
B. Ringer's lactate solutions is designed for intracellular fluid replacement
C. Sodium bicarbonate 8.4% is a hyperosmolar solution
D. Normal saline with added potassium is appropriate therapy to correct a respiratory
alkalosis

31. The following is true of the blood supply of the rectum all are true except:
A. The principle blood supply is derived from the inferior rectal artery
B. The median sacral vessels contribute to the blood supply
C. As the inferior mesenteric artery crosses the pelvic brim it becomes known as the
superior rectal artery
D. The internal venous rectal plexus is continuous with the vascular cushions of the
anal canal
E. The superior rectal vein drains to the portal system

32. Which of the following concerning the Femoral sheath is false:


A. Contains the femoral artery
B. Contains lymph nodes
C. Contains the femoral canal
D. Contains femoral nerve

33. The following is true of the spleen:


A. Is the largest lymphoid organ in the body
B. Lies obliquely between the seventh and tenth rib
C. The lower pole extends beyond the mid-axillary line
D. Is usually palpable when normal
E. Usually measures 16cm in maximum length when healthy

34. A knife stabbed horizontally through the fourth intercostals space to the right of
the sternum is likely to damage the:
A. Right brachiocephalic vein-
B. Hemiazygos vein
C. Descending aorta
D. Right pulmonary artery
E. Thoracic duct

35. Breast cancer risk is increased in association with the following factors except:
A. Nulliparity
B. Immediately after pregnancy
C. Early menarche
D. Early age at first pregnancy
E. Late menopause

36. The Appendix all true except:


A. Is typically less than 10 cm in length in the adult.
B. Is located in the retrocaecal recess.
C. Macburneys point, lies 2/3 laterally from a line from umbilicus to the anterior
superior iliac spine
D. The longitudinal coat of the appendix is derived from the three bands of taenia coli.
E. Is supplied by branches of the inferior mesenteric artery

37. In tension pneumothorax the following signs are present except:


A. Hypoxia
B. Hyper resonance to percussion on the affected side
C. Tracheal deviation to the ipsilateral side
D. Distended neck veins
E. Tachycardia

38. The following are encountered during inguinal hernia repair :


A. Scarpas' fascia
B. Colle's fascia
C. Ilioinguinal nerve
D. Cremaster muscle
E. Genitofemoral nerve

39. Which of the following variables best predicts prognosis for patients with a
recent diagnosis of cutaneous melanoma and no clinical evidence of metastatic
disease?
A. Breslow thickness

40. The intravenous fluid that a 60 kg., 30-year-old woman with an 80% burn should
be given in the first 24 hours following burn injury is:
A. 19.2 liters of 5% glucose in lactated Ringer's.
B. 14.4 liters of lactated Ringer's.

41. All venous sinuses of the dura mater ultimately drain into :
A. Internal jugular vein

42. The tendon of biceps bronchii muscle inserted into the


A. Radial tuberosity

43. the saphenous nerve is terminal branch of the :


A. Ilioinguinal nerve
B. Femoral nerve
C. Genitofemoral nerve
D. Superior glutial nerve
E. popliteal nerve

44. All the following origenat on the scapula except


A. Trapezius
B. Teres major
C. Deltoid
D. Brachio-radialis
E. Coraco-brachialis
45. Total number of human vertebra is:
A. 33 vertebras.

46. Foot droop is usually associated with paralysis of the:


A. Common peroneal

47. The following pass through the aortic hiatus of the diaphragm
A. Aorta
B. Azygos vein
C. Thoracic duct
D. All of the above
E. Non of the above

48. At birth the umbilical vein become the:


A. Round ligament of the liver

49. Arrangement of structures at hilum of the right kidney as following from


anterior to posterior:
A. Vein ,artery , ureter

50. Shock can best be defined as:


A. Hypotension.
B. Hypo perfusion of tissues.
C. Hypoxemia
D. All of the above

51. All of the following are true about neurogenic shock except:
A. there is a decrease in systemic vascular resistance and an increase in venous
capacitance
B. tachycardia or bradycardia may be observed, along with hypotension.
C. the use of an alpha agonist such as phenylephrine is the mainstay of treatment.
D. Severe head injury, spinal cord injury, and high spinal anesthesia may all cause
neurogenic shock.

52. All of the following may be useful in the treatment of cardiogenic shock except:
A. Dobutamine
B. Sodium nitroprusside
C. Pneumatic antishock garment.
D. Intra-aortic balloon pump.

53. All of the following statements about hemorrhagic shock are true except:
A. Following hemorrhagic shock, there is an initial interstitial fluid volume
contraction.
B. Dopamine, or a similar inotropic agent, should be given immediately for
resuscitation from hemorrhagic shock, to increase cardiac output and improve oxygen
delivery to hypoperfused tissues.
C. The use of colloid solutions or hypertonic saline solutions is indicated for treatment
of hemorrhagic shock.
D. In hemorrhagic shock, a narrowed pulse pressure is commonly seen before a fall in
systolic blood pressure

54. Which of the following statements about head injury and concomitant
hyponatremia is true?
A. There are no primary alterations in cardiovascular signs.
B. Signs of increased intracranial pressure may be masked by the hyponatremia
C. Oliguric renal failure is an unlikely complication.
D. Rapid correction of the hyponatremia may prevent central pontine injury.
E. This patient is best treated by restriction of water intake

55. Which of the following statements about extracellular fluid is true?


A. The total extracellular fluid volume represents 40% of the body weight.
B. The plasma volume constitutes 20%of the total extracellular fluid volume
C. Potassium is the principal cation in extracellular fluid
D. The protein content of the plasma produces a lower concentration of cations than in
the interstitial fluid
E. The interstitial fluid equilibrates slowly with the other body compartments.

56. Which of the following statements is true of a patient with hyperglycemia and
hyponatremia?
A. Insulin administration will increase the potassium content of cells.
B. The sodium concentration must be corrected by 5 mEq. per 100 mg. per 100 ml.
elevation in blood glucose
C. With normal renal function, this patient is likely to be volume overloaded
D. Proper fluid therapy would be unlikely to include potassium administration.

57. Which of the following is not associated with increased likelihood of infection
after major elective surgery?
A. Age over 70 years.
B. Chronic malnutrition.
C. Controlled diabetes mellitus.
D. Long-term steroid use
E. Infection at a remote body site

58. The transfusion of fresh frozen plasma (FFP) is indicated for which of the
following reasons?
A. For the correction of abnormal PT secondary to warfarin therapy, vitamin K
deficiency, or liver disease
B. Volume replacement.
C. As a nutritional supplement.
D. Treatment of prolonged bleeding time

59. In patients receiving massive blood transfusion for acute blood loss, which of the
following is correct?
A. Packed red blood cells and crystalloid solution should be infused to restore
oxygen-carrying capacity and intravascular volume
B. Two units of FFP should be given with every 5 units of packed red blood cells in
most cases.
C. A “six pack” of platelets should be administered with every 10 units of packed red
blood cells in most cases.
D. One to two ampules of sodium bicarbonate should be administered with every 5
units of packed red blood cells to avoid acidosis.

60. Hemostasis and the cessation of bleeding require which of the following
processes?
A. Adherence of platelets to exposed subendothelial glycoproteins and collagen with
subsequent aggregation of platelets and formation of a hemostatic plug.
B. Interaction of tissue factor with factor VII circulating in the plasma
C. The production of thrombin via the coagulation cascade with conversion of
fibrinogen to fibrin.
D. Cross-linking of fibrin by factor XIII.
E. All of the above

61. Advantages of epidural analgesia include:


A. Earlier mobilization after surgery.
B. Earlier return of bowel function.
C. Shorter hospitalizations.
D. Decreased stress response to surgery.
E. All of the above

62. Factors that decrease collagen synthesis include all of the following except:
A. Protein depletion.
B. Infection.
C. Anemia
D. Advanced age
E. Hypoxia

63. Which of the following statement is true concerning excessive scarring


processes?
A. Keloids occur randomly regardless of gender or race
B. Hypertrophic scars and keloid are histologically different
C. Keloids tend to develop early and hypertrophic scars late after the surgical injury
D. Simple reexcision and closure of a hypertrophic scar can be useful in certain
situations such as a wound closed by secondary intention

64. Which of the following statement is true concerning the vascular response to
injury?
A. Vasoconstriction is an early event in the response to injury
B. Vasodilatation is a detrimental response to injury with normal body processes
working to avoid this process
C. Vascular permeability is maintained to prevent further cellular injury
D. Histamine, prostaglandin E2 (PGE2) and prostacyclin (PGI2) are important
mediators of local vasoconstriction

65. All are true ligamentous attachments of liver except


A. Falciform ligament
B. Coronary Ligaments
C. Hepatoduodenal ligaments
D. Glisson's capsul

66. The appropriate surgical treatment for suspected carcinoma of the testis is:
A. Inguinal exploration, control of the spermatic cord, biopsy, and radical orchectomy
if tumor is confirmed

67. Nasotracheal intubation all true except :


A. Is preferred for the unconscious patient without cervical spine injury.
B. Is preferred for patients with suspected cervical spine injury.
C. Maximizes neck manipulation.
D. Is contraindicated in the patient who is breathing spontaneously.

68. The radiographic findings indicating a torn thoracic aorta include all except :
A. Widened mediastinum.
B. Presence of an apical “pleural cap.”
C. Tracheal deviation to the right.
D. right hem thorax.

69. Which of the following steps is not a part of the primary survey in a trauma
patient?
A. Insuring adequate ventilatory support
B. Measurement of blood pressure and pulse
C. Neurologic evaluation with the Glasgow Coma Scale
D. Examination of the cervical spine
70. Which of the following statement(s) is/are true concerning the Advanced Trauma
Life Support (ATLS) classification system of hemorrhagic shock?
A. Class I shock is equivalent to voluntary blood donation
B. In Class II shock there will be evidence of change in vital signs with tachycardia,
tachypnea and a significant decrease in systolic blood pressure
C. Class IV hemorrhage can usually be managed by simple administration of
crystalloid solution
D. Class III hemorrhage involves loss of over 40% of blood volume loss and can be
classified as life-threatening

71. The clinical picture of gallstone ileus includes all except ?


A. Air in the biliary tree
B. Small bowel obstruction.
C. A stone at the site of obstruction.
D. Acholic stools.
E. Associated bouts of cholangitis.

72. The evaluation of a comatose patient with a head injury begins with:
A. Establishment of an airway.

73. Which of the following signs does Horner's syndrome include?


A. Ptosis.
B. Facial hyperhidrosis.
C. Exophthalmos.
D. Mydriasis.

74. The goals of proper fracture reduction include all except?


A. Providing patient comfort and analgesia
B. Allowing for restoration of length of the extremity.
C. Correcting angular deformity and rotation.
D. Enabling immediate motion of all fractured extremities.

75. The neurovascular structure most commonly injured as a result of an anterior


dislocation of the shoulder is the:
A. Musculocutaneous nerve
B. Axillary nerve
C. Axillary artery.
D. Median nerve

76. The radial nerve is at greatest risk for injury with which fracture?
A. Fracture of the surgical neck of the humerus.
B. Fracture of the shaft of the humerus.
C. Supracondylar fracture of the humerus.

77. The most consistent sign of a fracture of the carpal scaphoid is:
A. Wrist pain during attempted push-ups.
B. Diffuse swelling on the dorsum of the wrist.
C. Localized tenderness in the anatomic snuffbox.
D. Wrist popping on movement.

78. Hematogenous osteomyelitis most frequently affects:


A. The diaphysis of long bones.
B. The epiphysis.
C. The metaphysis of long bones.
D. Flat bones.
E. Cuboidal bones.
79. The most common hernia in females is:
A. Femoral hernia
B. Direct inguinal hernia
C. Indirect inguinal hernia

80. Which of the following most often initiates the development of acute
appendicitis?
A. A viral infection.
B. Acute gastroenteritis.
C. Obstruction of the appendiceal lumen.

81. The most helpful diagnostic radiographic procedure in small bowel obstruction
is:
A. CT of the abdomen.
B. Contrast study of the intestine
C. Supine and erect x-rays of the abdomen.
D. Ultrasonography of the abdomen.

82. Which of the following treatments should never be recommended to a patient


with purely intraductal carcinoma?
A. Modified radical mastectomy.
B. Lumpectomy to clear surgical margins, followed by observation.
C. Incisional biopsy with an involved margin, followed by radiation.
D. Excisional biopsy to clear margins, followed by radiation.

83. In role of nine extent of burn if entire trunk is burned it will be equal to:
A. 9% body surface area
B. 18% body surface area
C. 36% body surface area
D. 27% body surface area

84. Which of the following does not describe intermittent claudication?


A. Is elicited by reproducible amount of exercise
B. Abates promptly with rest.
C. Is often worse at night.
D. May be an indication for bypass surgery.

85. Which of the following statements are true?


A. Patients with critical limb ischemia have paralysis and paresthesias.
B. All arterial injuries are associated with absence of a palpable pulse
C. Preoperative arteriography is required to diagnose an arterial injury.
D. The presence of Doppler signals indicates that an arterial injury has not occurred
E. In all patients with multiple trauma, arterial injuries should be repaired before other
injuries are addressed

86. A patient with acute urinary tract infection (UTI) usually presents with:
A. Chills and fever.
B. Flank pain.
C. Nausea and vomiting.
D. Painful urination.
87. The most precise diagnostic screening procedure for differentiating benign
thyroid nodules from malignant ones
A. Fine-needle-aspiration biopsy (FNAB).

88. Hyperthyroidism can be caused by all of the following except:


A. Graves' disease
B. Plummer's disease
C. Struma ovarii.
D. Hashimoto's disease
E. Medullary carcinoma of the thyroid
1 A 21 B 41 A 61 E 81 C
2 C 22 D 42 A 62 C 82 C
3 C 23 E 43 B 63 D 83 C
4 A 24 A 44 A 64 A 84 C
5 E 25 C 45 A 65 D 85 A
6 E 26 D 46 A 66 A 86 D
7 C 27 A 47 D 67 B 87 A
8 E 28 D 48 A 68 D 88 D
9 E 29 D 49 A 69 D
10 B 30 C 50 B 70 A
11 E 31 A 51 C 71 D
12 A 32 D 52 C 72 A
13 D 33 A 53 B 73 A
14 D 34 D 54 A 74 D
15 D 35 D 55 B 75 B
16 D 36 E 56 A 76 B
17 A 37 C 57 C 77 C
18 B 38 B 58 A 78 C
19 D 39 A 59 A 79 C
20 C 40 B 60 E 80 C

1. Which of the following anatomic features of the biliary system are important
considerations in operative cholangiography?
A. The left hepatic duct comes off farther anterior than the right one.
B. At the confluence there may be more than just a right and a left hepatic duct.
C. Dissection of the triangle of Calot is more important than cholangiography in
preventing bile duct injury.
D. Segments V, VII, or VIII sometimes join the biliary system below the confluence.
E. All of the above are correct.

2. Which of the following statements characterize amebic abscess?


A. Mortality is higher than that for similarly located pyogenic abscesses.
B. The diagnosis of amebic abscess may be based on serologic tests and resolution of
symptoms.
C. In contrast to pyogenic abscess, the treatment of amebic abscess is primarily
surgical.
D. Patients with amebic abscess tend to be older than those with pyogenic abscess.

3. Which of the following statement(s) is/are true about benign lesions of the liver?
A. Adenomas are true neoplasms with a predisposition for complications and should
usually be resected.
B. Focal nodular hyperplasia (FNH) is a neoplasm related to birth control pills (BCPs)
and usually requires resection.
C. Hemangiomas are the most common benign lesions of the liver that come to the
surgeon's attention.
D. Nodular regenerative hyperplasia does not usually accompany cirrhosis.
4. Which of the following statements about hemobilia are true?
A. Tumors are the most common cause.
B. The primary treatment of severe hemobilia is an operation.
C. Percutaneous cholangiographic hemobilia is usually minor.
D. Ultrasonography usually reveals a specific diagnosis.

5. Ligation of all of the following arteries usually causes significant hepatic enzyme
abnormalities except:
A. Ligation of the right hepatic artery.
B. Ligation of the left hepatic artery.
C. Ligation of the hepatic artery distal to the gastroduodenal branch.
D. Ligation of the hepatic artery proximal to the gastroduodenal artery

6. Which of the following is the most common acid-base disturbance in patients with
cirrhosis and portal hypertension?
C. Metabolic alkalosis.

7. Cytokines are endogenous signals that stimulate:


A. Septic shock
B. The central nervous system to initiate fever.
C. The production of “acute-phase proteins.”
D. Hypoferremia.
E. All of the above are correct.
8. Which of the following statements about maxillofacial trauma is/are false?
A. Asphyxia due to upper airway obstruction is the major cause of death from facial
injuries.
B. The mandible is the most common site of facial fracture.
C. The Le Fort II fracture includes a horizontal fracture of the maxilla along with
nasal bone fracture.
D. Loss of upward gaze may indicate either an orbital floor or orbital roof fracture.

9. A 28-year-old male was injured in a motorcycle accident in which he was not


wearing a helmet. On admission to the emergency room he was in severe respiratory
distress and hypotensive (blood pressure 80/40 mm. Hg), and appeared cyanotic . He
was bleeding profusely from the nose and had an obviously open femur fracture
with exposed bone . Breath sounds were decreased on the right side of the chest. The
initial management priority should be:
A. Control of hemorrhage with anterior and posterior nasal packing.
B. Tube thoracostomy in the right hemithorax.
C. Endotracheal intubation with in-line cervical traction.
D. Obtain intravenous access and begin emergency type O blood transfusions.
E. Obtain cross-table cervical spine film and chest film.
10. Regarding the diagnosis and treatment of cardiac tamponade, which of the
following statements is/are true?
A. Accumulation of greater than 250 ml. of blood in the pericardial sac is necessary to
impair cardiac output.
B. Beck's classic triad of signs of cardiac tamponade include distended neck veins,
pulsus paradoxicus, and hypotension.
C. Approximately 15% of needle pericardiocenteses give a false-negative result.
D. Cardiopulmonary bypass is required to repair most penetrating cardiac injuries.

11.Which of the following statement(s) is true concerning the diagnosis of a


peripheral vascular injury?
A. The presence of a Doppler signal over an artery in an extremity essentially rules
out an arterial injury
B. Doppler examination is a valuable tool in the diagnosis of venous injuries
C. A gunshot wound in the proximity of a major vessel is an absolute indication for
arteriography
D. Both the sensitivity and specificity of arteriography of the injured extremity
approaches 100%

12. An 18-year-old male suffers a gunshot wound to the abdomen, resulting in


multiple injuries to the small bowel and colon. Which of the following statement(s)
is/are true concerning this patient’s perioperative management?
A. A multi-agent antibiotic regimen is indicated
B. Antibiotics should be continued postoperatively for at least 7 days
C. Laparotomy, as a diagnostic test for postoperative sepsis, should be considered
D. The incidence of postoperative wound or intraabdominal infection would be
increased in association with a colon injury

13. A 75-year-old man is involved in a motor vehicle accident. Which of the following
statement(s) is/are true concerning this patient’s injury and management?
A. Acceptable vital sign parameters are similar across all age groups
B. Hypertonic solutions should not be used for resuscitation due to concerns for fluid
overload
C. The patient would be more prone to a subdural hematoma than a younger patient
D. There is no role for inotropic agents in the management of this patient

14. Valid points in the management of burns on special areas include:


A. The large majority of genital burns are best managed by immediate excision and
autografting
B. All digits with deep dermal and full-thickness burns should be immobilized with
six weeks of axial Kirschner wire fixation
C. Deep thermal burns of the central face are best managed with immediate excision
and autografting
D. Burns of the external ear are commonly complicated by acute suppurative
chondritis if topical mafenide acetate is not applied

15. Which of the following statements regarding unusual hernias is incorrect?


A. An obturator hernia may produce nerve compression diagnosed by a positive
Howship-Romberg sign.
B. Grynfeltt's hernia appears through the superior lumbar triangle, whereas Petit's
hernia occurs through the inferior lumbar triangle.
C. Sciatic hernias usually present with a painful groin mass below the inguinal
ligament.
D. Littre's hernia is defined by a Meckel's diverticulum presenting as the sole
component of the hernia sac.
E. Richter's hernia involves the antimesenteric surface of the intestine within the
hernia sac and may present with partial intestinal obstruction.

16. The following statement(s) is/are true concerning umbilical hernias in adults.
A. Most umbilical hernias in adults are the result of a congenital defect carried into
adulthood
B. A paraumbilical hernia typically occurs in multiparous females
C. The presence of ascites is a contraindication to elective umbilical hernia repair.
D. Incarceration is uncommon with umbilical hernias

17. Which of the following statements about esophageal anatomy is correct?


A. The esophagus has a poor blood supply, which is segmental in distribution and
accounts for the high incidence of anastomotic leakage.
B. The esophageal serosa consists of a thin layer of fibroareolar tissue.
C. The esophagus has two distinct muscle layers, an outer, longitudinal one and an
inner, circular one, which are striated in the upper third and smooth in the distal two
thirds.
D. Injury to the recurrent laryngeal nerve results in vocal cord dysfunction but does
not affect swallowing.
E. The lymphatic drainage of the esophagus is relatively sparse, localized primarily to
adjacent paraesophageal lymph nodes.

18. Which of the following is most reliable for confirming the occurrence of a
significant esophageal caustic injury?
A. History of the event.
B. Physical examination of the patient.
C. Barium esophagraphy.
D. Endoscopy.
19. Numerous epidemiologic associations have been made between (1) environmental
and dietary factors and (2) the incidence of gastric cancer, including all except:
A. Dietary nitrites.
B. Dietary salt.
C. Helicobacter pylori infection.
D. Dietary ascorbic acid.

20. Complete mechanical small bowel obstruction can cause dehydration by:
A. Interfering with oral intake of water.
B. Inducing vomiting.
C. Decreasing intestinal absorption of water.
D. Causing secretion of water into the intestinal lumen.
E. All of the above

21. Meckel's diverticulum most commonly presents as:


A. Gastrointestinal bleeding.
B. Obstruction.
C. Diverticulitis.
D. Intermittent abdominal pain.

22. A 45-year-old man with a history of previous right hemicolectomy for colon
cancer presents with colicky abdominal pain which has become constant over the
last few hours. He has marked abdominal distension and has had only minimal
vomiting of a feculent material. His abdomen is diffusely tender. Abdominal x-ray
shows multiple air fluid levels with dilatation of some loops to greater than 3 cm in
diameter. The most likely diagnosis is:
A. Proximal small bowel obstruction
B. Distal small bowel obstruction
C. Acute appendicitis
D. Closed-loop small bowel obstruction

23. Which of the following statement(s) is true concerning laboratory tests which
might be obtained in the patient discussed above?
A. The presence of a white blood cell count > 15,000 would be highly suggestive of a
closed-loop obstruction
B. Metabolic acidosis mandates emergency exploration
C. An elevation of BUN would suggest underlying renal dysfunction
D. There is no rapidly available test to distinguish tissue necrosis from simple bowel
obstruction

24. Recurrence after operation for Crohn's disease:


A. Occurs after operations for ileal Crohn's but not colonic Crohn's.
B. Is usually found just proximal to an enteric anastomosis.
C. Rarely requires reoperation.
D. Occurs in 1% of patients at risk per year during the first 10 years after the
operation.
E. Is prevented by maintenance therapy with corticosteroids.

25. The most common indication for surgery secondary to acute diverticulitis is:
A. Abscess.

26. Many patients with ulcerative colitis are operated upon electively with total
abdominal colectomy, rectal mucosectomy, formation of a small intestinal reservoir,
and ileoanal anastomosis. The most common postoperative complication after this
operation is which of the following?
B. Small bowel obstruction

27. A 30-year-old male two years postoperative after total abdominal colectomy with
ileoanal anastomosis reports a sudden increase in stool frequency, nocturnal leakage,
and low-grade fevers. Physical examination is unremarkable . Flexible endoscopic
examination of the small intestinal pouch reveals a friable erythematous mucosa
.Biopsies of the mucosa are obtained. While awaiting biopsy results, which of the
following is the most appropriate empiric therapy?
C. Oral metronidazole

28. Useful methods for detection of splenic injury, in descending order of sensitivity,
are:
A. Magnetic resonance imaging (MRI)
B. CT.
C. Ultrasonography.
D. Isotope scan.

29. Which of the following comments does not describe hypersplenism?


A. It may occur without underlying disease identification.
B. It may be secondary to many hematologic illnesses.
C. It is associated with work hypertrophy from immune response.
D. It requires evaluation of the myeloproliferation.
E. It is associated with antibodies against platelets.

30.You are consulted regarding a 50-year old male with Laennec’s cirrhosis, portal
hypertension and hypersplenism. He has no history of gastrointestinal bleeding. You
would recommend which of the following?
D. Observation
31. Which of the following statements about the differential diagnosis of
hypercalcemia is correct.
A. Malignant tumors typically cause hypercalcemia by ectopic production of
parathyroid hormone (PTH).
B. The diagnosis of primary hyperparathyroidism is supported by these serum levels:
calcium, 10.8 mg. per dl.; chloride, 104 mmol. per liter; bicarbonate 21 mmol. per liter;
phosphorus, 2.4 mg. per dl.; elevated parathyroid hormone.
C. Familial hypocalciuric hypercalcemia is distinguished from primary
hyperparathyroidism by parathyroid imaging.
D. Although serum albumin binds calcium, the measured total calcium value is
usually unaffected in patients with severe hypoproteinemia.
E. Thiazide diuretics are a good treatment for hypercalcemia and can be given to
patients with apparent hypercalcemia of malignancy.

32. The parathyroid glands:


A. Develop from the second and third pharyngeal pouches, along with the palatine
tonsil and the thymus.
B. Migrate caudally in the neck in normal development but can be found anywhere
from the pharyngeal mucosa to the deep mediastinum.
C. Secrete PTH and calcitonin to manage calcium homeostasis.
D. Usually number four, but frequently number only two or three.
E. Contain enzymes that catalyze the conversion of 25(OH) vitamin D 3 to 1,25(OH)
2 vitamin D 3.

33. Which of the following breast lesions are noninvasive malignancies?


A. Intraductal carcinoma of the comedo type.
B. Tubular carcinoma and mucinous carcinoma.
C. Infiltrating ductal carcinoma and lobular carcinoma.
D. Medullary carcinoma, including atypical medullary lesions.

34. A 45-year-old woman presents with a weeping eczematoid lesion of her nippl
E. Which of the following statement(s) is/are true concerning her diagnosis and
management?
A. Treatment is with warm compresses and oral antibiotics
B. Biopsy of the nipple revealing malignant cells within the milk ducts is invariably
associated with an underlying invasive carcinoma
C. The appropriate treatment is mastectomy
D. The lesion always represents a high-risk disease with a significant risk of
subsequent metastatic disease

35. The effect of high positive end-expiratory pressures (PEEP) on cardiac output is:
A. None.
B. Increased cardiac output.
C. Decreased cardiac output because of increased afterload to the left ventricle.
D. Decreased cardiac output because of decreased effective preload to the left
ventricle.

36. The diagnosis of myasthenia gravis can be confirmed most reliably using:
D. Single-fiber EMG.

37. In an infant with suspected PDA, which of the following would be the optimal
method of confirming the diagnosis?
D. Two-dimensional echocardiography with continuous-wave and color-flow Doppler
echocardiography.

38. A 5-year-old girl is found on routine examination to have a pulmonic flow


murmur, fixed splitting of P2 and a right ventricular lift. The following is/are true:
A. Cardiac catheterization is indicated if the chest film shows cardiomegaly
B. Radiology report of “scimitar syndrome” findings on the chest film would indicate
need for an arteriogram
C. If the catheterization report is “ostium secondum defect,” at least one pulmonary
vein drains anomalously
D. Measured pulmonary vascular resistance of 14 Woods units/m2 with an ASD
mandates early repair
E. An ASD with Qp/Qs of 1.8 can be observed until symptoms occur

39. The single most important indication for emergency pulmonary embolectomy is:
C. The presence of persistent and intractable hypotension.

40. A 67-year-old man with acute popliteal arterial embolism has a negative cardiac
echo for source of the thrombus. The following is/are true:
A. Most likely non-cardiac source is a thoracic aortic aneurysm
B. Embolism is more common from femoral than popliteal arterial aneurysms
C. Emboli from popliteal aneurysms are often clinically silent
D. Embolism is rare from subclavian artery aneurysms

41. Which of the following statements about allograft rejection are true?
A. In the absence of immunosuppression, the time and intensity of rejection of
transplants between unrelated donors and recipients is highly variable.
B. Allograft rejection may be mediated by antibodies or by cells.
C. Allograft rejection is thought to be caused by Th2 cells.
D. Acute cellular rejection is the major cause for loss of clinical organ transplants.
E. An individual with “tolerance” is unable to reject an allograft.

42. Which of the following are contraindications to lung transplantation?


A. Age 65 years or older.
B. Current corticosteroid therapy.
C. History of thoracotomy.
D. Ventilator-dependent respiratory failure.

43. Familial hypercholesterolemia has been proposed as a disease to be treated by


gene therapy. The molecular basis of familial hypercholesterolemia is which of the
following?
A. Absence of hepatic low density lipoprotein receptors
B. Overproduction of high density lipoprotein
C. Absence of lipoprotein lipase
D. Overproduction of hepatic ornithine transcarbamylase

44. The pentalogy of Cantrell includes all of the following except:


A. Epigastric omphalocele.
B. Sternal cleft.
C. Intracardiac defect.
D. Pericardial cyst.
E. Ectopia cordis.

45. Patients with Wilms’ tumors most frequently present with which of the
following?
E. A unifocal, unilateral lesion

46. Renal adenocarcinomas:


A. Are of transitional cell origin.
B. Usually are associated with anemia.
C. Are difficult to diagnose.
D. Are extremely radiosensitive.
E. Frequently are signaled by gross hematuria.

47. A 55-year-old male presents with severe flank pain radiating to the groin
associated with nausea and vomiting. Urinalysis reveals hematuria .A plain
abdominal film reveals a radiopaque 5 mm stone in the area of the ureterovesical
junction. Which of the following statement(s) is/are true concerning this patient’s
diagnosis and management?
A. A likely stone composition for this patient would be uric acid
B. The stone will likely pass spontaneously with the aid of increased hydration
C. Stone analysis is of relatively little importance
D. Patients with a calcium oxalate stone and a normal serum calcium level should
undergo further extensive metabolic evaluation
48. The most common physical findings in a patient with median nerve compression
at the wrist (carpal tunnel syndrome) are:
A. Diminished two-point discrimination and dryness of the index and long fingers.
B. Atrophy of the abductor pollicis brevis and opponens pollicis.
C. A positive percussion test at the wrist and a positive wrist flexion test producing
paresthesias at the thumb, index, and long fingers.
D. A weak grip in addition to hand cramping and difficulty writing.

49. Isolated flexor digitorum superficialis tendon function is determined by


assessing:
A. Flexion of the metacarpophalangeal joint.
B. Flexion of the proximal interphalangeal joint with the adjacent digits held in
extension.
C. Flexion of the distal interphalangeal joint.
D. Flexion of the proximal interphalangeal joint.
50. Which of the following statements are true?
A. The Hoffmann-Tinel sign localizes the level of a nerve injury.
B. Causalgia is a term used to denote the etiology of pain.
C. Secondary repair of a lacerated nerve 3 to 8 weeks after injury has several
advantages.
D. A surgeon who finds at delayed (3 to 8 weeks) exploration that a clinically
nonfunctioning nerve is in continuity should resect the injured portion of the nerve and
suture together the ends.
E. If a nerve is found to be disrupted at delayed (3 to 8 weeks) exploration, the
surgeon should find the two ends of the nerve and suture them together.

51. What is the critical difference between frame-based and frameless stereotactic
procedures?
A. The use of digitized imaging studies such as CT and MRI.
B. The use of rendered three-dimensional images and a three-dimensional digitizer.
C. Rigid fixation of the patient's head to the operating room table.
D. The presence of a lesion in the brain on digitized imaging studies.
E. The absence of a lesion in the brain on digitized imaging studies.

52. The following are absorbable sutures


A. Catgut
B. Silk
C. Polyamide (Nylon)
D. Polyglyconate (Maxon)
E. Polyglactin (Vicryl)

53. During surgery on the submandibular gland


A. An incision on the lower border of the mandible is safe
B. The submandibular gland is seen to wrap around the posterior border of mylohyoid
C. The facial artery and vein are divided as they course through the deep part of the
gland
D. The hypoglossal nerve is seen to loop under the submandibular duct
E. Damage to the lingual nerve will cause loss of sensation to the posterior third of the
tongue

54. Regarding pancreatic carcinoma false


A. 90% are ductal adenocarcinomas
B. Less than 20% occur in the head of the gland
C. The usual presentation is with pain, weight loss and obstructive jaundice
D. Ultrasound has a sensitivity of 80-90% in the detection of the tumour
E. Less than 20% of patients are suitable for curative surgery

55. Regarding the management of major trauma


A. Deaths follow a trimodal distribution
B. X-rays after the primary survey should be of AP Cervical spine, chest and pelvis
C. Cardiac tamponade is characterised by raised BP, low JVP and muffled heart
sounds
D. Assessment of uncomplicated limb fractures should occur during the primary
survey
E. Deterioration of the casualty during the primary survey should lead to the
secondary survey

56. Regarding appendicitis


A. The risk of developing the illness is greatest in childhood
B. Mortality decreases with age .
C. 20% of appendices are extraperitoneal in a retrocaecal position
D. Faecoliths are present in 75-80% of resected specimens
E. Appendicitis is a possible diagnosis in the absence of abdominal tenderness

57. Regarding stones in the gallbladder


A. Cholesterol stones are the least common
B. Pigment stones are due increased excretion of polymerised conjugated bilirubin
C. Are not a risk factor for the development of gallbladder carcinoma
D. 90% of gallstones are radio-opaque
E. A mucocele of the gallbladder is caused by a stone impacted in Hartmann's pouch

58. Stones in the common bile duct the false is


A. Are found in 30% of patients undergoing cholecystectomy (Without pre-op ERCP)
B. Can present with Charcot's Triad
C. Are suggested by an bile duct diameter >8mm on ultrasound
D. ERCP, sphincterotomy and balloon clearance is now the treatment of choice
E. If removed by exploration of the common bile duct the T-tube can be removed after
3 days
59. Regarding crystalloid solutions the false is
A. Normal saline contains 154 mmol sodium and 154 mmol of chloride
B. 3 litres of dextrose saline in a day will provide 90 mmol of sodium
C. 2 grams of potassium chloride is equal to 57 mmol of the salt
D. Hartmann's solution contains calcium and bicarbonate
E. The daily maintenance potassium requirement of a 40 Kg woman is about 40 mmol

60. Solitary thyroid nodules the false is


A. Are more prevalent in women
B. In the adult population less than 10% are malignant
C. Less than 20% of scintigraphically cold nodules are malignant
D. The risk of a hot module being malignant is negligible
E. Should be surgically removed in all patients

61. Regarding abdominal wall hernias the false is


A. Almost 100,000 hernia operations are performed annually in the United Kingdom
B. Over 60% of inguinal hernias are indirect
C. In women inguinal hernias are as common as femoral hernias
D. The mortality assocaited with strangulation is over 10%
E. The mortality has reduced dramatically over the past 30 years

62. The femoral canal the false is


A. Lies medial to the femoral vein
B. Has the inguinal ligament as its anterior border
C. Has the lacunar ligament as its lateral border
D. Has the pectineal ligament as its posterior border
E. Contains the lymph node of Cloquet

63. Intermittent claudication the false is


A. Affects less than 1% of men over the age of 50 years
B. At 5 years 10% of claudicants will have progressed to an amputation
C. At 5 years 20% of claudicants will have died from ischaemic heart disease
D. Is usually associated with an ankle / brachial pressure index (ABPI) 0.3- 0.7
E. Is associated with a fall in the ABPI on exercise with delayed recovery

64. The pathology of ulcerative colitis the false is


A. Shows full thickness inflammation
B. The rectum is almost always involved
C. 10% patients have terminal ileal disease
D. Enterocutaneous or intestinal fistulae are less common
E. The serosa is usually normal
65. Regarding benign breast disease the false is
A. Cyclical mastalgia is the commonest reason for referral to the breast clinic
B. Fibroadenomas are derived from the breast lobule
C. Lactational breast abscesses are usually due to Staph aureus
D. Duct ectasia is less common in smokers
E. Atypical lobular hyperplasia is associated with an increased risk of breast cancer

66. Regarding anal fissures the false is


A. 10% occur in the posterior midline
B. Multiple fissures suggest a diagnosis of tuberculosis or Crohn's Disease
C. 50% of acute fissures heal with the use of a bulking agent
D. Sphincterotomy has a success rate of over 90%
E. Sphincterotomy is associated with minor faecal incontinence in over 15% of
patients

67. Fibroadenomas the false is


A. Are benign monoclonal neoplasms
B. Most commonly present in late adolescence or the early 20s
C. Should be diagnosed by triple assessment
D. At least 30% reduce in size over a 2 year period
E. Can be safely managed conservatively

68. Warfarin the false is


A. Reduces the concentration of vitamin A dependent clotting factors
B. Has a half life of about 36 hours
C. Crosses the placenta and should be avoided in pregnancy
D. Doses should be reduced in liver disease
E. An INR of between 2.0 and 3.0 is appropriate in the treatment of DVT

69. Heparin the false is


A. Is a heterogeneous mixture of sulphated polysaccharides
B. Potentiates the actions of antithrombin III
C. Has a half life of 12 hours
D. Can be reversed by protamine sulphate
E. Can induce an idiosyncratic thrombocytopenia

70. The following cause hypercalcaemia except


A. Sarcoidosis
B. Primary hyperparathyroidism
C. Acute pancreatitis
D. Metastatic bronchial carcinoma
E. Milk-Alkali syndrome
71. Regarding oesophageal cancer the false is
A. Squamous carcinomas predominate in the upper 2/3 of the oesophagus
B. Overall 5 year survival is greater than 50%
C. Tylosis genetically predisposes to the disease
D. 15% of adenocarcinomas are associated with Barrett's oesophagus
E. For palliation an Atkinson tube can be inserted endoscopically

72. Infantile hypertrophic pyloric stenosis the false is


A. Occurs with a male : female ratio of 4:1.
B. Sons of affected mothers have a 20% risk of developing the lesion
C. Invariably presents between three and four weeks of age
D. Typically presents with nonbilious vomiting
E. Surgical treatment is by Heller's Cardiomyotomy

73. Oesophageal atresia the false is


A. Is often associated with a distal trachea-oesophageal fistula
B. Polyhydramnios is often present late in pregnancy
C. 50% have other associated congenital abnormalities
D. Contrast X-ray studies are necessary to confirm the diagnosis
E. Post-operatively over 30% develop oesophageal strictures

74. The following are features of Fallot's Tetralogy except


A. An atrial septal defect
B. Pulmonary stenosis
C. Right ventricular hypertrophy
D. A right to left cardiac shunt
E. Cyanotic attacks during feeding and crying

75. The functions of a tracheostomy are to except


A. Bypass an upper airway obstruction
B. Reduce the anatomical dead space
C. Increase airway resistance
D. Protect against aspiration
E. Allow frequent airway suction

76. Medullary carcinoma of the thyroid the false is


A. Is a tumour of the parafollicular C cells
B. Produce thyroxine as the principle hormone
C. 90% of cases are sporadic
D. Can occur as part of the MEN type II syndrome
E. Total thyroidectomy is the surgical treatment of choice
77. The following are features of thyrotoxicosis except
A. Weight gain
B. Palpitations
C. Proximal myopathy
D. Increased skin pigmentation
E. Pretibial myxoedema

78. Regarding abdominal aortic aneurysms the false is


A. They commonly remain symptomless until they rupture
B. The risk of rupture increases with aortic diameter
C. Elective repair should have a 30-day mortality of less than 5%
D. Emergency repair has a 30-day mortality of less than 10%
E. The benefits of surgery for small (4.0-5.5 cm) is unproven

79. In patients with carotid artery disease


A. A bruit is a reliable sign of the degree of stenosis
B. Atheroma is most commonly seen in the external carotid artery
C. An embolic event often results in an ipsilateral hemiplegia
D. Prophylactic aspirin reduces the risk of a stroke
E. Surgery is of proven benefit in those with asymptomatic stenoses

80. Hepatocellular carcinoma the false is


A. Has a high incidence in East Africa and South-east Asia
B. Its worldwide incidence parallels the prevalence of Hepatitis B
C. Mycotoxins (e.g. aflatoxin) are an important aetiological factor
D. Over 80% of tumours are surgically resectable
E. Liver transplantation offers the only chance of cure in those with irresectable
disease

81. Serum alpha fetoprotein the false is


A. Is increased in testicular tumours
B. In testicular tumours is produced by trophoblastic elements
C. Is increased in over 70% patients with hepatocellular carcinoma
D. In patients with hepatocellular carcinoma levels correlate well with size of the
tumour
E. In patients with hepatocellular carcinoma levels fall following resection of the
tumour

82. Regarding testicular tumours


A. They are the commonest malignancy in young men
B. Peak incidence for teratomas is seen at the age of 25 years
C. Seminomas are radiosensitive
D. Over 75% of Stage I teratomas are cured by surgery alone
E. Chemotherapy rarely produces a cure in those with metastatic disease

83. In patients with ascites the false is


A. A exudate has a protein content of greater than 30 g per litre
B. Both malignancy and infection result in a transudate
C. Ovarian carcinoma is the commonest malignant cause of ascites
D. Cirrhosis results in marked sodium retention
E. Tumour cells increase the permeability of the peritoneum

84. Regarding opiate analgesia the false is


A. Patient controlled analgesia (PCA) is more effective than intermittent parenteral
dosing
B. The total opiate dose is usually reduced with a PCA
C. Fentanyl is more lipid soluble than morphine
D. Epidural morphine can result in late respiratory depression
E. Epidural and parenteral morphine can be safely administered together

85. Intussusception the false is


A. Is most common in children from 6 to 12 years
B. Presents with colicky abdominal pain, rectal bleeding and an abdominal mass
C. 10% present with diarrhoea and vomiting suggestive of gastroenteritis
D. If no shock or peritonitis hydrostatic reduction can be attempted
E. A Meckel's diverticulum can induce an intussusception

86. Hirschsprung's disease the false is


A. Is due to absent ganglion cells in Auerbach's plexus
B. 10% cases have involvement of the recto-sigmoid segment
C. 80% cases present with delayed passage of meconium in the first 24 hours after
birth
D. The affected segment of bowel appears as cone-shaped contracted zone on barium
enema
E. On rectal biopsy there increased acetylcholinesterase containing cells in the
muscularis

87. Laparoscopic cholecystectomy the false is


A. Is usually performed using a four port technique
B. The Veress needle is an 'open' technique for inducing the pneumoperitoneum
C. A supraumbilical abdominal scar is a contraindication to laparoscopic
cholecystectomy
D. Dissection of Calot's triangle should be performed before the cystic duct is clipped
E. Most series report a conversion rate of less than 5%
88. In obstructive jaundice the false is
A. Urinary conjugated bilirubin is increased
B. Serum unconjugated bilirubin is increased
C. Urinary urobilinogen is reduced
D. Serum conjugated bilirubin is increased
E. Faecal stercobilinogen is reduced

89. Regarding the anatomy of the inguinal canal the false is


A. The internal ring lies midway between the symphysis pubis and anterior superior
iliac spine
B. The internal ring lies medial to the inferior epigastric vessels
C. The external oblique aponeurosis forms the anterior boundary
D. The inguinal ligament forms the inferior boundary
E. The conjoint tendon forms the medial part of the posterior wall

90. Papillary carcinoma of the thyroid the false is


A. Can be reliably diagnosed using fine needle aspiration cytology
B. Is almost always unifocal
C. Histologically displays Psammoma bodies
D. Typically spread to the cervical lymph nodes
E. Requires a total thyroidectomy for large tumours

91. Regarding bladder tumours the false is


A. 90% are squamous carcinomas
B. Painless haematuria is the commonest presentation
C. Cigarette smoking is an important aetiological factor
D. 80% of tumours are superficial (i.e no muscle invasion)
E. Superficial tumours are often well controlled by transurethral resection

92. Regarding ureteric calculi the false is


A. Are most often composed of calcium oxalate or phosphate
B. Most stones of those less than 5 mm in diameter pass spontaneously
C. Extracorporeal lithotripsy is useful for stones in the upper third of the ureter
D. About 30% of patients require open surgery to remove the stone
E. An obstructed ureter in the presence of infection is a surgical emergency

93. Regarding bladder calculi the false is


A. The incidence has fallen markedly in this country since the late 19th century
B. They may be totally asymptomatic
C. They are more prevalent in patients with chronic urinary sepsis
D. They are associated with squamous metaplasia of the bladder mucosa
E. They increase the risk of transitional cell carcinoma
94. Ectopic pregnancy the false is
A. Occurs in about 1% of pregnancies
B. The risk is increased in those with a history or pelvic inflammatory disease
C. Usually presents between 2 and 4 months of gestation
D. Patients usually have a positive pregnancy test
E. if shocked early laparotomy is essential

95. Tetanus the false is


A. Is due to an infection with a gram-positive spore forming rod
B. The organism produces a powerful endotoxin
C. The toxin prevents the release of inhibitory neurotransmitter
D. Clostridium tetani is sensitive to penicillin

96. Regarding pathological terms


A. Hypertrophy is an increase in tissue size due to increased cell number
B. Hyperplasia is an increase in tissue size due to an increase in cell size
C. Atrophy is an increase in tissue size to disuse
D. Metaplasia is a change form one abnormal tissue type to another
E. A hamartoma is a developmental abnormality

1 E 16 B 31 B 46 E 61 E 76 B 91 A
2 B 17 C 32 B 47 B 62 C 77 A 92 D
3 A 18 D 33 A 48 C 63 A 78 E 93 E
4 C 19 D 34 C 49 B 64 A 79 D 94 C
5 D 20 E 35 D 50 C 65 D 80 D 95 B
6 C 21 A 36 D 51 B 66 A 81 B 96 E
7 E 22 B 37 D 52 A+D+E 67 A 82 E
8 B 23 D 38 B 53 B 68 A 83 B
9 C 24 B 39 C 54 B 69 C 84 E
10 C 25 A 40 C 55 A 70 C 85 A
11 D 26 B 41 B 56 B 71 B 86 B
12 D 27 C 42 D 57 E 72 E 87 B
13 C 28 B 43 A 58 E 73 D 88 B
14 D 29 E 44 D 59 C 74 A 89 B
15 C 30 D 45 E 60 E 75 C 90 B

1. The ilio-inguinal nerve:


A. supplies the rectus abdominis muscle
B. supplies skin on inner side of thigh
C. supplies the cremasteric muscle
D. supplies the urethra
E. does none of the above

2. The skin of the tip of the index finger is supplied by the:


A. Radial nerve only
B. Radial & median nerves
C. Median & ulnar nerves
D. Ulnar nerve only
E. Median nerve only

3. Hypovolaemic shock is characterized by:


A. A low central venous pressure , high cardiac output, low peripheral resistance
B. A high central venous pressure, high cardiac output, high peripheral resistance
C. A low central venous pressure , low cardiac output, high peripheral resistance
D. A low central venous pressure , high cardiac output, high peripheral resistance
E. A high central venous pressure, low cardiac output, low peripheral resistance

4. Which of the following in NOT true of Hodgkin's disease?


A. Usually starts from several groups of nodes simultaneously
B. Usually involves liver & spleen
C. Sometimes manifests itself as pyrexia of unknown origin
D. Severe pain follows ingestion of alcohol
E. Shows increased susceptibility to opportunistic infection

5. Tetanus toxoid:
A. Is produced by injecting animals with antititanic serum
B. Is administered to previously immunized subjects with potentially infected
wounds
C. Frequently gives rise to anaphylactic reaction
D. Is used to induce active immunity against tetanus

6. The most probable cause of shock in a patient with multiple injuries &
craniocerebral trauma is:
A. Depression of vital medullary centres
B. Hypoperfuion control over subcortical areas
C. Loss of cortical control over subcortical areas
D. Hypovolaemia
E. Inadequate ADH response

7. The most sensitive guide to acute changes in fluid balance in a surgical patient is:
A. Accurate daily weight
B. Serial serum Na concentration
C. Fluid balance sheets recording inputs & outputs
D. Daily urine output
E. Serial anion gap measurements
8. cellullitis is:
A. Inflammation of the bone marrow
B. Inflammation of the mastoid cells
C. Inflammation of the subcutaneous tissues
D. Infiltration of the skin by gaint cells
E. A malignant condition
9. secondary haemorrhage occurs:
A. Within 6 hours of operation
B. 7-14 days after operation
C. As a result of violent coughing on recovery from anaesthesia
D. Due to a blood transfusion line disconnected
E. When a ligature slips

10. the minimum urine output for 24 hours required to excrete end products of
protein metabolism is:
A. 200 ml
B. 300 ml
C. 400 ml
D. 500 ml
E. 600 ml

11. Potassium deficiency is present if the plasma-potassium level is:


A. 6.0 mmol/l
B. 5.0 mmol/l
C. 4.5 mmol/l
D. 4.0 mmol/l
E. 3.0 mmol/l

12. in health the pH of the blood lies between the range:


A. pH 7.05-7.19
B. pH 7.20-7.35
C. pH 7.36-744
D. pH 7.45-7.59
E. pH 7.60-7.80

13. TNM classification of a malignant tumour was designed as:


A. An histological staging
B. A clinical staging
C. A staging carried out at operation
D. A staging dependent upon radio scanning & skeletal survey
E. A staging dependent upon ultrasound

14. a blue-green discharge from an ulcer will be seen to contain:


A. Pseudomonas pyocyaneus
B. Streptococcus viridians
C. Candida albicans
D. Staphylococcus aureus
E. Haemophilius influenzae
15. a rodent ulcer is:
A. A squamous cell carcinoma
B. A basal cell carcinoma
C. Only occur on the face
D. Contains epithelial pearls
E. A venous ulcer

16. the space of Parona is:


A. In the wrist between the deep flexor tendons & the pronator quadratus
B. Above the patella between the quadriceps muscle & the femur
C. Benath the tendon of the iliopsos
D. Between the achills tendon & the posterior aspect of the tibia
E. The web space of the palm

17. 'rest pain' occurs:


A. Anywhere in the body at rest
B. In the thigh of a patient with Buerger's disease
C. In the calf of a patient with intermittent claudicating
D. In the foot of a patient with severe vascular disease
E. In the back

18. ischaemia means:


A. Pain in the ischial tuberosities
B. Anaemia due to malignant seconderies in the ischial part of the pelvis
C. Lack of blood flow
D. Increased blood flow
E. Polycythaemia

19. Colles' fracture is:


A. A common in adolescence
B. A fracture about the ankle joint
C. Common in elderly women
D. A fracture of the head of the radius
E. A fracture of scaphoid

20. Pott's disease is;


A. A fracture dislocation about the ankle
B. A neuropathic joint
C. Traumatic ostechondritis of the spine
D. Tuberculosis of the spine
E. A secondary tumour in the skull

21. Vincent's angina is a form of angina associated with:


A. Spasm of the oesophagus
B. Diphtheria
C. An infection of the mouth
D. Coronary artery spasm
E. Carcinoma of the bronchus
22. Ludwig's angina is due to :
A. A type of coronary artery spasm
B. Oesophageal spasm
C. Retropharyngeal infection
D. A virulent infection of the cellular tissue around the submandibular salivary gland
E. Infection with candida

23. in simple nodular goiter:


A. Carcinoma occurs in 30% of cases
B. The nodular stage is irreversible
C. Operation is contraindicated
D. The patient does not develop hyperthyroidism
E. Cretinism is the presenting feature

24. Hashimoto's disease is:


A. A granulomatous thyroiditis
B. An auto-immune thyroiditis
C. An infiltrating fibrosis of the thyrois & the adjacent muscles
D. Focal thyroiditis
E. A parathyroid tumour

25. A thyroglossal fistula:


A. Is never congenital
B. Follows inadequate removal of a thyroglossal cyst
C. Has a hood of skin with its concavity upwards
D. Is lined throughout by squamous epithelium
E. Occurs in carcinoma of the tongue

26. The following are clinical signs supporting an early diagnosis of carcinoma of the
breast:
A. A prickling sensation in a breast lump
B. Peau d'ornge
C. Brawny arm
D. Cancer en cuirasse
E. A krukenderg tumour

27. The gastroduodenal artery is a branch of the:


A. Celiac axis
B. Hepatic artery
C. Superior mesenteric artery
D. Gastroepiploic artery
E. Splenic artery
28. Chronic gastric ulcers most often occur in patients with:
A. Blood groub A
B. Tend to occur in alkaline mucosa
C. Muscularis mucosae is separated from the muscularis at the edge of the ulcer
D. Are malignant when there is epithelial proliferation & downgrowths
E. Are never large
29. Meckel's diverticulum:
A. Is present in 20% of the human race
B. Arises from the mesenteric border of the jejunum
C. May contain heterotopic pancreas
D. Is only present in the male sex
E. Is a diverticulum of the bladder

30. Intussusception is related to:


A. Mucoviscidosis
B. Swollen Peyer's patches
C. Volvulus
D. A littre's hernia
E. A patent vitello intestinal duct

31. The site of the neck of a femoral hernia is the:


A. Transversalia fascia
B. Iliopectineal ligament
C. Femoral ring
D. Cribriform fascia
E. Obturator foramen

32. Regarding operation for an indirect inguinal hernia:


A. It should not be performed on patients who have chronic bronchitis
B. General anaesthesia has to be used
C. In infants the posterior inguinal wall should be repaired
D. In adults the internal inguinal ring usually needs to be strengthened
E. Mesh implants are mandatory

33. Cystic fibrosis of the pancreas


A. is inherited as autosomal recessive
B. islets of Langerhans are affected
C. diagnosis is pssible by DNA analysis
D. all the above
E. a and c only

34. the following are clinical criteria of Bank ad Wise


A. pulmonary
B. neurological
C. renal
D. all the above
E. a and c only

35. antibiotics in acute pancreatitis


A. must be given to all cases
B. should not be given
C. given only to modarate & sever cases
D. should cover anaerobic & Gam positive bactria
E. none of the above
36. pancreatic carcinoma
A. occure usually at the age of 50years
B. usually is cystadenocarcinoma
C. more favaorable in the body and tail
D. less favourable if occure with back pain
E. all the above

37. infected pancreatic necrosis


A. is a collection of pus around the pancreas
B. diagnosed by CT scan
C. more serious than pancreatic abscess
D. all the above
E. none of the above

38. secondarey survay in polytrauma


A. should be done in the first hour
B. done as soon as the patient is stable
C. detects life threateing problems
D. a and c
E. none of the above

39. spontaneous ruptur of the spleen


A. occure less in tropical countries
B. the spleen may be enlarged
C. malaria is a common cause
D. all the above

40. spleic aretry aneurysm


A. incidence is around 5%
B. usually symptomless
C. more conmmon in males
D. all the above
41. wolf skin graft
A. used to cover large area of burn
B. success rate is less than split thckness graft
C. both thighs are common donor areas
D. usually contracts

42. medullary carcinoma of the thyroid


A. is a tumor of the G cells
B. familial in 70% of the cases
C. diagosed by low level of calcitonin
D. amyloid stroma is charactrestic

43. solitary thyroid nodule


A. 70% are follicular adenoma
B. 30% are malignant
C. more favourable in young males
D. all the above
E. none of the above

44. rupture of the diaphragm


A. is a life threatenig problem
B. usually missed
C. poly galctan suture is used for repair
D. all the above
E. noe of the above

45. Complication of vascular graft includes All the following except:


A. Infection
B. Aneurysm
C. Graft failure
D. Hemorrhage
E. a & c only

46. Gangrene:
A. is necrosis of tissue
B. The cause may be venous occlusion
C. usually painful
D. All the above
E. None of the above

47. Lynphedema:
A. may be Congenital
B. should be bilateral
C. may be pitting in early stage
D. A & C only
E. None of the above

48. Suprapubic cystostomy:


A. indicated in case of bladder out flow obstruction
B. indicated in case of urethral injury
C. indicated in case of urethral stricture
D. All the above
E. B& C only

49. differential diagnosis of Acute scrotal swelling in young adult includes all the
follow except:
A. Incarcerated inguinal hernia .
B. Torsion of testes
C. Acute epididymo- orchitis
D. Teratoma
E. Seminoma
50. Horizontal spread of infection across the external sphincter can result in which
type of anorectal abscess:
A. ischiorectal
B. perianal
C. supralevator
D. intersphincteric
E. intermuscular

51. All of the following statements are true of diffuse esophageal spasm EXCEPT:
A. chest pain is frequently seen
B. high amplitude esophageal contraction are present.
C. it is best diagnosed with barium esophogram.
D. usual surgical treatment is long esohagomyotomy.
E. most patients do not have significant coronary artery disease.

52. The treatment of an esophageal burn with a caustic agent may include all of the
following EXCEPT:
A. expeditious administration of an antidote.
B. induction of vomiting.
C. steroids and antibiotics.
D. bougienage.
E. gastrectomy.

53. All of the following substances are irritating to the peritoneum EXCEPT:
A. bile.
B. meconium.
C. blood.
D. gastric content.
E. pus.

54. Complications of truncal vagotomy and pyloroplasty include all of the following
EXCEPT:
A. dumping syndrome.
B. recurrent ulcer.
C. diarrhea.
D. alkaline reflux gastritis.
E. steatorrhea.

55. Gastric polyps:


A. are most commonly adenomatous.
B. require gastrotomy and removal if greater than 2 cm and are pedunculated.
C. are rarely multiple.
D. are clearly premalignant.
E. are more frequent in achlorhydric patients.

56. Vascular compression of the duodenum resulting in obstruction:


A. is present primarily in patients who are overweight.
B. should be given a trial of conservative management.
C. is common in pediatric patients.
D. is best diagnosed by identifying a "double bubble" sign on abdominal x-ray.
E. includes as medical therapy lying in the supine position after meals
57. Conditions associated with gastric cancer include all of the following EXCEPT:
A. higher socioeconomic groups.
B. pernicious anemia.
C. chronic atrophic gastritis.
D. adenomatous polyps.
E. a high intake of dietary nitrates

58. Patients with morbid obesity have an increased incidence of all of the following
EXCEPT:
A. gastric carcinoma.
B. diabetes.
C. stroke
D. gallbladder disease.
E. joint deterioration.

59. All of the following contribute to malabsorption following truncal vagotomy and
antrectomy EXCEPT:
A. increased rate of gastric emptying.
B. poor mixing of pancreatic secretions and bile salts with food.
C. increased release of secretions and bile salts with food.
D. decreased small intestinal transit time.
E. malabsorption of fat and carbohydrates.

60. All of the following statements are true about patients with carcinoid tumors
EXCEPT:
A. they often have evidence of serotonin production.
B. tumor growth is often slow.
C. the majority have carcinoid syndrome.
D. they have a much better prognosis if the tumors are less than 2 cm.
E. the combination of streptozotocin and 5-fluorouracil can often result in objective
response.

61. The followings are usually associated with acute appendicitis EXCEPT
A. Abdominal pain and nausea
B. CT scan with water soluble enema is the most helpful imaging study
C. Deep right lower abdominal tenderness by rectal examination
D. Positive Rovsing sign
E. WBCs around 20,000/mm3

62. The least problem that cause right lower abdominal pain in a 18 years female is
A. Ectopic pregnancy
B. Acute appendicitis
C. Ovarian torsion
D. Perforated peptic ulcer
E. Mittleschmerz

63. A patient with high hichitic fever, severe tenderness and rigidity at the right ileac
fossa, WBCs 18000/mm3 and abdominal ultrasound showed a heterogeneous mass in
the right iliac fossa with a central fluid collection. Management may include any of
the followings EXCEPT
A. Open drainage
B. I.V antibiotics
C. Appendix should be resected in the open drainage
D. Percutaneous drainage under U/S or CT guidance
E. Oral feeding shouldn’t be delayed in the absence of ileus

64. Regarding the lower esophageal sphincter the following are correct EXCEPT
A. It is a physiological sphincter
B. Located in the distal 3-5cm of the esophagus
C. Has a resting pressure of 20-60 mmHg
D. Abdominal pressure play a role
E. Its pressure can be estimated by esophageal manometry
65. In esophageal perforation, the most sensitive diagnostic study is
A. Plain film abdomen
B. Plain film chest and neck
C. Esophagogram
D. Esophagoscopy
E. CT chest and neck

66. Achalasia can be presented with all of the followings EXCEPT


A. Recurrent pulmonary infections
B. Weight loss
C. Regurgitation
D. Irregular narrowing of the distal esophagus by Ba. Swallow
E. Retrosternal chest pain

67. Complications of reflux esophagitis include the followings EXCEPT


A. Dysmotility
B. Schatzki's ring
C. Barrett's esophagus
D. Epiphrenic esophageal diverticulum
E. Hemorrhage

68. The pressure in the lower esophageal sphincter decreases by all of the following
EXCEPT
A. Alcohol
B. Nitroglycerin
C. Anticholinergics