The most common malignant neoplasm of

the submandibular gland:

a) Mucoepidermoid carcinoma
b) Acinic cell carcinoma
c) Squamous cell carcinoma
d) Adenoid cystic carcinoma
e) Mucinous adenocarcinoma.

D
1
 Carcinoma of the bronchus:

a) Commonly presents with hematemesis

b) Squamous cell carcinoma has the worst
prognosis
c) Can present as gynecomastia and achanthosis
nigricans
d) CTscan guided transthoracic biopsy has an 80%
sensitivity
e) VATS(vedio assisted thoracic laparscopy) is the
best modality for excision of lesion deeply seated
in the lobe tissue.
C
2
Warthin's tumor:

a) Is a pleomorphic adenoma of the parotid

gland.
b) Should be treated by a total parotidectomy.
c) Is considered a benign salivary gland
neoplasm.
d) Responds well to pre-operative radiation
therapy.
e) Often presents with facial nerve palsy
C
3
The single most effective method of diagnosis
for 60-year-old man with a-6 month history
of hoarsness and neck mass:

a) FNA of the neck mass.

b) CTscan of head, neck and chest.
c) c-Incisional biopsy of the neck mass.
d) Excisional biopsy of the neck mass.
e) Laryngoscopy with biopsy.

A
4
Which of the following tumor markers is best to
monitor recurrence of colon cancer?

a) Alpha feto protein

b) Carcino emborionc antigen(CEA)
c) Cancer antigen 15-3
d) 5-hydroxi-indol acetic acid (5-H IAA)
e) Thyroglobulin

B
5
A double bubble sign on air contrast upper
gastro intestinal series is characteristic of:

a) Duodenal Artesia
b) Jejunal Artesia
c) Meconuim ileus
d) Midgut volvolus
e) Pyloric stenosis

A
6
Grey-Turner sign in acute pancreatitis is :

a) Discoloration in the loins

b) Shifting dullness over the spleen
c) Discoloration around the umbilicus
d) A fluid level in the first loop of the jejunum
e) Upper abdominal rigidity

7
Nine days following splenectomy, a 13 year old
patient presents with fever and leukocystosis.
The chest x-ray showed air under the
diaphragm. The most likely diagnosis is?

a) postsplenectomy sepsis
b) colonic perforation
c) pneumococcal infection
d) subphrenic abscess
e) gastric wall ulcer
D
8
An early sign of systemic sepsis in a patient
receiving intravenous hyper alimentation is :

a) Appearance of shaking chill

b) Hypotension
c) Rapid drop in arterial pH
d) Sudden development of glucose intolerance
e) Tachycardia

D
9
lnitial treatment of patient with acute complete small
bowel obstruction includes which of the following:

a) Immediate operation is warranted as soon as the

diagnosis is made
b) NGT decompression for 24hallows spontaneous
resolution in most of the patient
c) The presence of fever,tachycardia,and localized pain
suggest strangulation and warrants prompt
operation
d) All patients with complete obstruction require blood
and plasma for resuscitation
e) If small bowel resection is indicated ,a stoma and
mucus fistula are necessary
C
10
25-year-old lady presented with thyrotoxicosis
and she is 4-months pregnant. The best line of
management is :

a) Observation
b) Carbimozoll0 mg three times daily
c) Radio iodine therapy
d) Carbimazol 20 mg three times daily and
Inderal 20 mg three times daily
e) surgery
E
11
Which of the following sedatives has active
metabolites that may accumulate in clinically
significant amounts if it is used as a continuous
drip?

a) Lorazepam
b) Midazolam
c) Diazepam
d) Dexmedetom idine
e) Propofol
C
12
Which of the following is contraindication to
the use of epidural anesthesia in critically ill
patients?

a) Fever
b) Increased WBC count
c) Coagulopathy
d) Intractable angina
e) Peripheral vascular disease

13
Sentinellymph node biopsy for melanoma

a) Predicts prognosis
b) Improves survival
c) Is indicated for melanoma < 1 mm thick
d) Is associated with a complication rate of 23%
e) Should be followed by completion lymph
node dissection in patients who have positive
results

A
14
Hyperextension of the proximal phalanges of
the little and ring fingers can result from
damage to:

a) Ulnar nerve
b) Axillary nerve
c) Radial nerve
d) Median nerve
e) Anterior interosseous nerve

15
An inability to oppose the thumb to the little
finger can result from damage to:

a) Anterior interosseous nerve

b) Posterior interosseous
c) Radial nerve
d) Ulnar nerve
e) median nerve

E
16
When mucocele of the appendix is found at the
time of surgery, Which of the following is
appropriate therapy?

a) Incisional biopsy with subsequent

appendectomy if malignancy is confirmed
b) Right hemicoloctomy
c) Right hemicoloctomy with lymph node
dissection
d) Appendectomy
e) Needle aspiration of cystic fluid for cytology
examination
D
17
A singer is complaining of her voice becoming
weak after high pitched singing for short
period of times, this is due injury to :

a) Recurrent laryngeal nerve.

b) External laryngeal nerve.
c) Phrenic nerve.
d) lingual nerve.
e) Parathyroid gland.

B
18
A patient who is 2 months postpartum has a 2-
cm fluctuant tender mass in the upper outer
quadrant of her Rt breast. Management
should include:

a) core biopsy of the breast mass

b) urgent surgical exploration of the Rt breast
c) aspiration and antibiotics
d) bilateral mammography
e) breast MRI
C
19
A laparoscopic cholecystectomy is performed in a 60-
year-old woman. Pathology reveals gall bladder
adenocarcarcinoma confined to mucosal lamina
propria. Appropriate management includes:

a) observation and follow up

b) excision of the gallbladder fossa and laparoscopic port
sites
c) excision of the gallbladder fossa, port sites and
portal lymphadenectomy
d) excision of gallbladder fossa, port sites, portal
lymphadenectomy and excision of the common bile
duct
e) irradiation of the gallbladder bed

A
20
Risk factors for adenocarcinoma of small bowel
include all of the following EXCEPT:

a) familial adenomatous polyposis

b) Crohn's disease
c) hereditary non polyposis colorectal cancer
d) ulcerative colitis
e) Von Recklingha usen's disease

21
Which of the following statement is INCORRECT
regarding ischiorectal fossa?

a) The pudendal nerve lies in its lateral wall

b) The floor is formed by the superficial fascia and
skin
c) The lateral wall is formed by the obturater
muscle and its fascia
d) The medial wall is formed in part by levator ani
muscles
e) The roof is formed by the urogenital diaphragm
E 22
Spirometry measures:

a) Total lung capacity

b) Forced vital capacity
c) Peak exploratory flow rate
d) lung compliance
e) Carbon monoxide level

23
A 35-year old man was punched in the right side of
the abdomen and chest. There was some right
upper abdomen tenderness but no guarding.
Results of a gastrografin upper GI study showed
a coiled-spring appearance of the second and
third part of the duodenum. What is the most
likely diagnosis?

a) Rupture of the duodenum

b) Contusion to the head of the pancreas
c) Intraluminal blood clot
d) Retroperitoneal hematoma
e) Duodenal hematoma

E
24
A 16 year old boy presents to the emergency
department with a gunshot wound to the
abdomen. The best management is?

a) peritoneal lavage
b) wound exploration
c) CT with ora I and IV contrast
d) exploratory laparotomy
e) ultrasound

D
25
A 35-year-o'd patient underwent a segmental jejunal
resection as result of a perforation due to
intraperitoneal TB. On the 3rd post operative
day, the patient develops a brown -greenish
discharge from the wound. This continues with a
daily volume of 400-600 ml. The patient remains
stable with no signs of peritonitis. The likely
complication described is :

a) Wound dehiscence
b) Enterocutanous fistula
c) Wound abscess
d) Stitch sinus
e) Wound seroma
B 26
cont.
The likely metabolic changes associated with
this condition is :

a) Hypokalemic metabolic acidosis

b) Hpokalemic metabolic alkalosis
c) Hypernatremic meta bolic acidosis
d) Hypocalcemic metabolic alkalosis
e) Norma I findings

A
27
Cont.
The treatment of choice for this complication is:

a) Keep the patient NPO and maintain him on

Ringer's lactate
b) Keep the patient NPO and start TPN
c) Open the whole wound and perform abed
side debridment
d) Insert a gauze at the site of discharge and
continue IV antibiotics
e) Immediate exploratory laparotomy
B 28
A predictor of a dvanced pancreatic cancer is :

a) Back pain
b) Tumor size 1-2 cm in diameter
c) Deep jaundice
d) Raised CA 125
e) Dilated CBD to more than 1.5 cm in diameter.

29
a young patient underanwent appendectomy .At
surgery the appendix was normal .The terminal
ileum was thick, edematous ,and with extensive
fat wrapping around the ileal wall extending
from the mesentry. The most likely diagnosis is:

a) Tuberculous enteritis
b) Amoebic enteritis
c) Typhoid disease
d) Crohn's disease
e) Meckel's diverticulitis.
D
30
Ringer's lactate is a solution that does no
contain:

a) sodium
b) chloride
c) bicarbonate
d) potassium
e) lactate

31
A 19-year-old man with a right flail chest
segment and a normal vital signs should be
treated by :

a) Insertion of chest tube

b) Intubation and ventilation
c) Good analgesia
d) Banding the chest
e) Open reduction and internal fixation of the
flail segment
C
32
A patient was brought to the emergency room
with a history of an electrical burn. On
obtaining a urine sample was noted to be
dark. The next step of management is :

a) Aggressive intravenous fluid infusion

b) Send urine for myoglobin level
c) Request a CXR
d) Ultrasound of the abdomen
e) Obtain a sickling test
A
33
ln head injury Cushing's triad indicates:

a) Diffuse axonal injury

b) Basal skull fracture
c) Depressed skull fracture
d) Raised intracranial pressure
e) SpinaI shock

34
Hikman line is often used for:

a) Intraperitoneal drainage
b) Peripheral TPN infusion
c) Continuous arterial pressure monitoring
d) Pulmonary wedge pressure monitoring
e) Administration of chemotherapeutic agents

35
A previously healthy 35-year-old woman reports
difficulty swallowing liquids and occasional
regurgitation. Manometric studies show an
increase in pressure in the body of the
esophagus .The most likely diagnosis is :

a) Carcinoma of the esophagus

b) Plummer-Vinson syndrome
c) Reflux esophagitis
d) Epiphrenic diverticulum
e) Achalasia
E
36
The commonest cause of intussusceptions in
infant is:

a) Acute Mickel's diverticulitis

b) Carcinoid tumour
c) Payer's patches lymphadenitis
d) lymphoma
e) Mesenteric lymphadenitis

37
A cute lymphangitis of the arm is a condition
that requires:

a) Immediate skin debridement

b) Admission and systemic antibiotics
c) Oral antibiotics and follow up in the clinic
d) topical antibiotics and NSAID
e) Cold compression and elevation

38
The most common complication after a big
inguina-scrotal hernia repair in a 32-year old
man is:

a) Reactionary hemorrhage
b) Wound infection
c) DVT
d) Scrotal hematoma
e) Impotence

D
39
A 20-year-old healthy man was diagnosed to
have medullary cancer of the thyroid. The
patient was also noted to have hyperplasia of
the parathyroid gland. The patient must now
be investigated for the possibility of :

a) Bowen's tumor
b) Hodgkin's lymphoma
c) Pheochromocytoma
d) Squamous cell carcinoma of the esophagus
e) Malignant melanoma
C
40
Failure of penile erection following an
abdomino-peroneal resection is due to injury
of :

a) Parasympathetic Nervi eregentis

b) Pudendal nerve
c) Sympathetic Hypogasteric nerve
d) Parasympathetic Hypogastric nerve
e) Obturator nerve

D
41
Regarding hemorrhagic shock in adult:

a) Class I is characterized by loss of 25% of

circulating volume
b) Increase pulse pressure is an early sign of
significant blood loss
c) There is severe tachycardia in class I
d) Diastolic blood pressure may rise in class II
e) There is no change in blood pressure when
the blood loss occur in patient taking B-
blockers
B
42
Which of the following statement is TRUE
regarding immunosuppressive drugs?

a) Azathioprine is selectively
immunosuppressive
b) Cyclosporine is selectively
immunosuppressive
c) Cyclosporine causes gingival atrophy
d) Hair loss is side effect of cyclosporine
e) Cyclosporine is a water soluble
B
43
Umblical Hernia:

a) Treated adequately by a truss in adults

b) Should be repaired surgically in infants
c) complications are more in children than in
adults
d) males are affected more than females
e) Managed conservatively in infants with 1 cm
defect

E
44
A 25-year old man is shot in the left lateral chest. In
the emergency department, his bIood pressure is
120/90, his pulse rate is 104beats/min, and his
respiration rate is 36 breaths per minute. Chest
x-ray shows air and fluid in the left pleural cavity.
Nasogastric aspiration reveals blood-stained
fluid. What is the best step to rule out
esophageal injury?

a) insertion of chest tube

b) insertion of nasogastric tube
c) gastrografin swallow
d) Peritoneal lavage
e) barium swallow
C
45
A 33-year old man presents to the emergency
department with a gunshot injury to the abdomen. At
laparotomy, a deep laceration is found in the pancreas
just to the left of the vertebral column with
severance of the pancreatic duct. What is the next
step in management?

a) intraoperative cholangiogram
b) debridment and drainage of defect
c) distal pancreatectomy
d) debridment and closure of the duct with drainage of
defect
e) pancreaticojejunostomy to the end of the pancreas
C
46
A 70-year old man is brought to the emergency department
following a car crash. X-ray revealed a fracture ribs on the
left and a fracture of the right femur. A CT scan of the
abdomen showed a left-sided retroperitoneal hematoma
adjacent to the left kidney and no evidence of urine
extravasations. After 1h in the emergency room he became
hypotensive. The hematoma should be managed by which of
the following?

a) fluid resuscitation and observation

b) exploratory laparotomy through a mid-line incision
c) CTscan guided aspiration
d) surgical exploration through a left flank retroperitoneal
approach
e) Pneumatic antishock garment (PASG)

B
47
A 22-year old year old man is found to have a
complete transaction of the common bile duct
following a gunshot wound to the abdomen. The
bile duct injury should be managed by?

a) primary repair with a cholecystostomy tube

b) whipple's operation
c) choledochojejunostomy and cholecystectomy
d) primary repair with T-tube
e) choledochoduodenostomy
C

48
A 13-year-old boy presents with acute scrotal pain
following a football match. Examination revealed a
swollen tender right testis with some bluish
discoloration of the scrotum. The left testis appears
normal. The next line of management is :

a) Schedule the patient for immediate exploration of

right scrotum and consent for orchiodectomy
b) Admit the patient and start intravenous gentamvcin
c) Admit and schedule for a right inguinal hernia repair
d) Admit and consent for laparoscopic orchiopexy
e) Obtain an ultrasound guided testicular biopsy

A
49
What is the correct management of the
metabolic acidosis seen in hemorrhagic
shock?

a) Intravenous sodium bicarbonate

b) Component blood therapy
c) Vassopressors
d) Increased fluid administration
e) Fresh frozen plasma
D

50
Prior to hepatic resection, investigations and
preparation should include:

a) exact definition of the nature of the lesion with

a tissue biopsy
b) preoperative antibiotics for 24 hours prior to
the procedure
c) hepatic angiography
d) radiological assessment for respectability is
adequate in all cases
e) detailed cardiopulmonary workup
D
51
Liver resection is not safely done:

a) when 80% of the liver volume is removed

b) in cirrhotic liver
c) if the reduction of the functional liver by 70%
d) if the serum billirubin is less than 2mg/ml
e) in the non clinically detectable ascites

52
Worldwide, the most important predisposing
factor for HCC(hepatocellular carcinoma) is :

a) alcoholic cirrhosis
b) hepatitis B infection
c) chronic liver disease of any etiology
d) hepatitis C infection
e) repeated ingestion of aflatoxin

53
Which of the following patients is not likely to
have an elevated AFP level?

a) fulminant hepatitis B
b) HCC
c) Yolk sac tumor
d) Teratocarcinoma
e) Cholangiocarcinoma

E
54
A 53 year old man has long standing liver
cirrhosis secondary to hepatitis C infection.
The most appropriate screening regimen
should include:

a) liver USand a yearly CTscan

b) AFP and US
c) AFPand yearly CTscan
d) AFP, USand yearly CTscan
e) AFP and liver biopsy when a lesion develops
B
55
lntraductal papillary mucinous neoplasm of the
pancreas:

a) are always benign

b) are most commonly found in the tail of the
pancreas
c) have a lower 5-year survival than
adenocarcinoma
d) frequently recur
e) are prefentially treated by inoculation
E
56
Regarding the extrahepatic biliary and vascular
anatomy Which of the following is TRUE?

a) the boundries of the triangle of Calot include the

common hepatic duct, cystic duct, and cystic
artery
b) the common duct courses posterior to the portal
vein
c) the right branch of the hepatic artery crosses
posterior to the common bile duct
d) the cystic artery usually crosses the common bile
duct posteriorly
e) the hepatic artery lies lateral to the common bile
duct
C
57
Which of the following is not involved in the
activity of the gallbladder?

a) vegal stimulation
b) splanchinic sympathetic activity
c) somatostatin
d) motilin
e) Cholecystokinin

58
Regarding the management of acute calculus
cholecystitis. Mark the correct answer?

a) open cholecystectomy is the standared of care

b) the conversion in the acute setting is less than
the chronic cholecystitis
c) laproscopic cholecystectomy should be delayed
in the acute setting for 6 weeks for the acute
attack to subside
d) cholecystectomy should be delayed untill the
patient is afebrile and with normal WBC
e) conversion to open should be done whenever
the anatomy is not clear
E
59
Which of the following studies is not
recommended for the diagnosis of Caroli's
disease? .

a) MRI
b)CTscan
c)abdominal US
d)HIDA scan
e)ERCP
A

60
What is the most common location of a
cholangiocarcinoma?

a) right hepatic duct

b) left hepatic duct
c) hepatic duct confluence
d) CBD
e) both right and left hepatic ducts

61
Which of the following practices would help
promote a culture of safety in the operating
room environment?

a) Maintaining strict accountability for mistakes

b) Emphasizing timely completion of the
procedures
c) Addressing everyone by formal title
d) Reporting problems face to face
e) Stressing role of flexibility in crisis situation
E
62
Which of the following is TRUE about iodine
metabolism:

a) The thyroid gland has 50% of the body's

iodine stores
b) Iodide transport into follicular cells takes
place via passive diffusion
c) Iodide excess causes multinodular goiter
d) TSHstimulates iodide transport into follicular
cells
e) Iodine excess causes hypothyroidism
D
63
Which of the following statements about a
retrosternal goiter is TRUE:

a) It may be associated with subclinical

hyperthyroidism
b) CTScan is the best modality for imaging
c) Airway obstruction is an unusual presentation
d) It involves only the anterior mediastinum
e) Total Thyroidectomy is the treatment of
choice.
B
64
Which of the following is TRUEabout the treatment
and management of Graves‘ disease:

a) Subtotal thyroidectomy is the treatment of

choice
b) Irradiation is a much better treatment option
than subtotal thyroidectomy
c) Subtotal thyroidectomy results in improvement
in exophthalmos
d) Recurrence rates for antithyroid drugs are
comparable to that for subtotal thyroidectomy
e) Radioactive iodine is the treatment of choice
other than in children and women of
childbearing age.
E
65
With regards to papillary carcinoma of the
thyroid, which of the following is TRUE:

a) It is the second most common thyroid

malignancy
b) It has the best prognosis.
c) Often metastasizes to bone and lung
d) Most tumors are unilateral.
e) It Has no association with previous irradiation
B

66
With regard to follicular thyroid cancer, the following is
TRUE:

a) It is less common in geographic regions that are

iodine deficient
b) It occurs predominantly in females, and oestrogens
have been recently found to be a risk factor
c) The major histological criteria for diagnosis are
unequivocal capsular and vascular invasion
d) Cytologically, it can be easily differentiated from
benign adenoma
e) Both minimally invasive and widely invasive follicular
cancers are likely to have regional lymph node
involvement at presentation
C
67
Indications for parathyroidectomy include all
but which one of the following:

a) Development of open ulcerative skin lesions

from calcinosis
b)Bone pain or pathological fractures
c) Renal failure
d) Intractable pruritis
e) Ectopic calcifications
C

68
Which of the following is the most important
for identifying a patient who will suffer
complications from myocardial contusion:

a) Serial CPKisoenzyme measurements

b) ECGstudies
c) Echocardiographic studies
d) Gated ventricular angiographic studies
e) Spiral chest CT scanning

B
69
Biopsy of a villous lesion of the rectum
beginning 4cm from the anal verge and
extending for 5 cm proximally exhibits cellular
atypia. Which of the following is the most
appropriate management:

a) Repeated biopsy
b) Transanal excision
c) Fulgration
d) Abdominoperineal resection
e) Intracavitary radiotherapy
B
70
With regards to haemorrhoids, which of the following
statements is TRUE:

a) Internal haemorrhoids are vascular cushions above

the de!ntate line and are covered byanoderm
b) Prolapsing haemorrhoids are external haemorrhoids
covered byanoderm
c) Bleeding internal hemorrhoids are best treated by
surgical excision
d) Thrombosed hemorrhoids are best treated by
haemorrhoidectomy, with the patient under general
anesthesia
e) Recurrence is uncommon after surgical
haemorrhoidectomy
E
71
Which type of collagen is the most important in
wound healing?

a) Type III
b) Type V
c) Type VII
d) Type XI
e) Type X

72
A direct inguinal hernia results from a defect in :

a) Peritoneum
b) Transversalis fascia
c)Internal oblique fascia
d)Conjoint tendon
e)Rectus sheath

73
Which of the followings is the most potent
mediator of the inflammatory response?

a) Corticosteroids
b) Heat shock protein
c) Cytokines
d) Thyroid hormones
e) Nor-epineprine

74
A 76-year-old man has a slowly growing lump in his left
neck, anterior to the sternocleidomastoid muscle
just below the angle of the mandible .He has no
history of cancer and no constitutional symptoms.
Fine needle aspiration cytology is consistent with
squamous cell carcinoma. The test most likely to
identify the primary lesion would be:

a) Chest X-ray
b) Contrast -enhanced CTof the soft tissues of the neck
c) MRI of the head and neck
d) Pan endoscopy under anesthesia with random
biopsy
e) 2-fluro-2-deoxy -D-glucosejpositron emission
tomography (FOG-PET)
D
75
A 55-year-old man is admitted to the hospital and
treated with broad spectrum antibiotics for
uncomplicated diverticulitis .On day 5 of his
hospital stay ,increase WBC ,abdominal pain and
foul smelling diarrhea developed. Which of the
following diagnosis is most likely?

a) Pseudomemberanous colitis
b) Progression of diverticulitis
c) Infectious colitis
d) Retained colonic blood
e) Toxic mega colon
A
76
A 35-year-old woman who underwent
lap.cholecystectomy,one week ago comes to
ERwith a history of 3-days of abdominal pain
nausea, vomiting and jaundice. Which of the
following is the most likely diagnosis

a) Bile duct injury with intra abdominal bile

collection
b) Normal post-operative nausea and discomfort
c) Post-operative bowel obstruction
d) Post-operative ileus
e) Duodenal injury with leakage
A
77
What is the leading cause of death from acute
pancreatitis?

a) Hemorrhage
b) Pseudo cyst rupture
c) Secondary pancreatic infection
d) Billiary sepsis
e) Renal failure

78
A 14-year-old patient refuses to have any
surgical intervention for suspected
appendicitis. Who is the person capable of
giving informed consent?

a) The patient.
b) His doctor.
c) His parents.
d) His psychiatrist.
e) The judge.
C
79
The initial haemostatic response to injury is :

a) Platelets adherence
b) Fibrinolysis
c) Vasoconstriction
d) Initiation of coagulation cascade
e) Conversion of prothrombin to thrombin

80
A patient who has an elective surgery done with
spinal anesthesia developed blood pressure
of 70/40 mmHg.There is no evidence of
hemorrhage or sepsis. The initial therapy
consists of administration of:

a) 2 L normal saline
b) Whole blood
c) Adrenal corticosteroids
d) Beta adrenergic stimulation
e) Vasopressor drug
E

81
The major complication associated ,with
tracheostomy is :

a) Tracheal stenosis
b) Tracheoinominate fistula
c) Tracheo-esophageal fistula
d) Tracheocutanous fistula
e) Tracheomalacia
B

82
An adult who sustains burn involving entire
surface of right upper extremity, one half of
anterior trunk, and one third of right lower
extremity. How many % of his total body
surface area is involved?

a) 14 %
b) 19 %
c) 24 %
d) 29 %
e) 34 %
C
83
Sclorotic bone metastasis usually is seen in
cancer of :

a) Prostate
b) Breast
c) Colon
d) Bronchus
e) Urinary bladder

84
Which of the following is associated with an
increased risk of in situ carcinoma of the
breast?

a) Sclerosing adenosis
b) Fibro adenoma
c) Galactocele
d) Intraductal papiloma
e) Atypical lobular hyperplasia
E

85
Which of the following is the most accurate
method for identifying hepatic metastasis?

a) Trans-abdominal ultrasound imaging .

b) CTscanning
c) Laparoscopy
d) Intra-operative palpation
e) Intra-operative ultrasound imaging

86
The common metabolic complications of
enteral feeding:

a) Hpoglycemia and hypophosphatemia

b) Hyperglycemia and hypophosphatemia
c) Hypocalcaemia and hypophosphatemia
d) Hypokalemia and hyperphosphatemia
e) hyponatremia and hyperphosphatemia
B

87
A 55-year-old man presents with a 2-cm ulcerated
lesion on his right lateral mobile tongue and a
firm 2x1 cm in the right neck. Which of the
following statements is TRUE?

a) Induction therapy with 50 fluorouracil and

cisplatin is indicated
b) Five-year survival rate is 60 %
c) Adjuvant radiotherapy is indicated
d) Resection with selective neck dissection is
indicated
e) Synchronus malignancy in the lung or upper
aerodigestive track occurs in 20% of cases
C
88
Which of the following affects the probability of
wound infection:

a) Hair removal the night before surgery

b) Strict maintenance of blood glucose level
below 110 mgfdl
c) 3 days of perioperative antibiotics
d) Iodine -based rather of alcohol-based scrub
e) Tacking a shower the night before surgery
B

89
A 32-year-old patient undergoes an
appendicectomy. During recovery ,the patient
has not voided for 4 hours. His vital signs are
normal. What is the next step in management?

a) Administer l-L bolus of normal saline

b) Continue IVF at the current rate for an additional
2h and if he has not voided insert a Foley
catheter
c) Insert a Foley catheter
d) Insert suprapubic catheter
e) Do ultrasound
B
90
The neck of the femoral hernia is closely related
to the:

a) Transversalis fascia
b) Iliopectineal ligament
c) lIeo-lnguinal nerve
d) Cribriform fascia
e) Obturator nerve

91
A healthy young married lady presented with a
blood stained discharge from the right nipple.
Examination was negative for breast lump,
the most likely diagnosis is :

a) Papilloma of the nipple

b) Fibroadenoma
c) Duct papilloma
d) Ductectasia
e) Fibrocystic disease.
C
92
Necrotizing fasciitis :

a) Is a synonymous of cellulitis
b) Is an extensive of fast spreading inflammation of
the skin caused by mixed organisms
c) Is treated appropriate antibiotics based on
culture result
d) Is self localizing condition
e) Extensive repeated debridement and
appropriate antibiotics constitute the only
chance of cure.
E
93
ln mesenteric bowel ischemia:

a) Abdominal signs are usually diagnostic

b) Presence of atrial fibrillation is essential for a
correct diagnosis
c) lactic acidosis, and bloody diarrhea rules out
the diagnosis
d) Spiral CT is the gold standard for the
diagnosis
e) Mesenteric angiography constitute the
corner stone of the diagnosis
E
94
Hypotensive patient with pelvic fractures
requires:

a) Abdominal exploration
b) Focused abdominal ultrasound examination
(FAST)
c) Angiography after resuscitation
d) Diagnostic laparoscopy
e) Double contrast CT

95
Which of the following is associated with the
highest risk for surgery?

a) A trial fibrillation since one month

b) Mild renaI insufficiency
c) Diabetes melites
d) Subendocardial infarction since one month
e) blood pressure of 140/90

96
A patient presented with 3 months history of
Colle's fracture and a complaint of numbness
over the thumb and index fingers. This is due
injury to :

a) Planter superficial cutaneous nerve

b) Ulna r nerve
c) Radial nerve
d) Median nerve
e) lateral cutaneous nerve
D
97
A patient with chest injury developed
hemopneumothorax .Which of the following
is most consistent with tracheobronchial
injury ?

a) Mediastinal shift
b) Massive air leak and failure of the lung to
expand
c) Air fluid level
d) Depressed diaphragm
e) Drainage of > 500 ml in the chest tube
B
98
Which of the following drug is known to cause
malignant hyperthermia?

a) Succinyl choline
b) Ampicillin
c) Halothan
d) Gentamycin
e) Mefoxin
A

99
A 33-year-old lady, 38 weeks pregnant involved
in RTA ,she was brought to ER hypotensive,
with bleeding per vagina and hard tender
uterus. The most likely diagnosis is ;

a) Ruptured spleen
b) Ruptured uterus
c) Ruptured bladder
d) Placenta abruption
e) liver laceration
D
100