A)

Dr.Sobhi I Skaik,MS,MD,CABS,FRCSEd Consuntant Surgeon,

Ass. Professor of Sirgary

A) BASIC SURGICAL SCIENCES DIRECTIONS: Each of the following questions contains Five suggested answers. Select the Best response to each question:1) Abduction of the vocal cords results from contraction of the:

A) crico-thyroid musclesB) 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 peritoneumC) has peritoneum on its lateral surfaces for its upper two- thirds, and on its anterior surface for its upper one-thirdD) 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 pubisB) 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 contents4) 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 frenulumB) is separated from the epiglottis by the valleculae on each side of the midline

C) has 7-12 circumvallate papillae situated behind the sulcus terminalisD) 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 resistance7) 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 consumptionC) 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 deficiency9) 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 stimulusE) 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 minutesB) 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 selfB) is involved in some forms of orchitis

C) is involved in formation of cryo globulin

D) is important in the pathogenesis of lupus erytheromatosusE) 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 throbocytopeninC) is best managed by loe molecular weight dextran

D) is best managed by halving the therapeutic dose of heparin sodiumE) 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 accessE) 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 epinephrineC) 40 to 50 ml of 1% lidcaine with epinephrineD) 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 extremities22) 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 onlyD) 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 use29) 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 formation30) 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 junctionD) 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?

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 L5S1 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 compression50-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.

THE ANSWER KEY :

1- B 31- E

2- C 32- B

3- D 33- D

4- C 34- B

5- B 35- C

6- C 36- C

7- A 37- B

8- C 38- B

9- B 39- E

10- C 40- D

11- B 41- E

12- D 42- A

13- C 43- E

14- E 44-C

15- B 45- C 16- A 46- A17- D 47- E18- E 48- B19- A 49- C20- C 50- C21- D22- D23- B24- D25- A26- A27- C28- A29- E30- ESurgical MCQ

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.Top of Form

Bottom of Form

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

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. Pagets 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.

Prepared by:

Dr. Spiro A. Tawil

FRCSI

Dip. Pediatric surgery - London

Consultant surgeon

Shifa hospital - Gaza

Key Answers

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