اسئلة الجراحة العامة 2013/12
Surgery 12,2013
1) All of the following are symptoms and signs of hypothyroidism except ?
Low body temperature
Amenorrhea
Constipation
Weight gain
Cold intolerance
2) All of the following are true regarding chronic lymphocytic ( Hashimoto ) thyroiditis except ?
It is the most common inflammatory thyroid disorder .
Leading cause of hypothyroidism .
Autoimmune , inherited .
Malignancy found in 15% of the cases .
Age of presentation is 30_50 years
3) All of the following are indications for thyroidectomy in thyroid cyst except ?
Failure to do complete aspiration .
Large cyst > 4 cm .
Complex cyst ( solid _ cystic ) .
Recurrence after frequent aspirations .
If it is painless .
4) The most common malignant liver mass ?
Hepatocellular carcinoma
Hepatoblastoma
Angiosarcoma
Lymphoma
Metastatic tumor
5) Most of the cases of liver cancer are advanced at time of diagnosis because all of the following except ?
Symptoms usually don't appear until late in the disease .
Liver cancer grow quickly .
Liver tumors resemble those of other medical conditions .
Liver cancer can't be diagnosed using a standard liver tests .
Liver tissue is not able to regenerate to replace the damaged tissue
6) Mondors disease is a variant of Thrombophlebitis that involves the superficial veins of ?
The anterior chest wall and breast .
The thighs .
The legs .
The scrotum .
The vagina .
7) The dominant etiologic factor in Acute appendicitis is ?
Travelling infection from large bowel .
Decrease local immunity of appendix .
Part of inflammatory bowel disease .
Obstruction of the lumen by fecaliths .
Distal colonic obstruction .
8) The Body mass index of the normal weight is ?
15_19 kg/m2
20_25 kg/m2
26_29 kg/m2
30_34 kg/m2
35_39 kg/m2
9) Disadvantages of laparoscopy when compared with laparotomy include all of the following except which ?
Difficulty controlling severe bleeding .
Poorer visualization of the operative fields .
Greater difficulty placing sutures .
Loss of tactile sensation .
Higher operating room costs .
10) Laparoscopic Cholecystectomy is indicated for all of the following conditions except which ?
Biliary dyskinesia .
Initial treatment in patients with severe Cholangitis .
Acute Cholecystitis .
Symptomatic cholelithiasis .
Biliary pancreatitis .
11) The most common cause of pyogenic liver abscess is ?
Hematogenous infection .
Lymphatic spread .
Secondary to infected abdominal viscera .
Secondary infection of a Hydatid .
Biliary obstruction .
12) Which of the following conditions are associated with increased risk of breast cancer ?
Fibrocystic mastopathy
Fibroadenoma
Atypical hyperplasia
Papillomatosis
Breast Lipoma
13) All of the following are true regarding Fibroadenoma of the breast except ?
It is the most common breast tumor in adolescents and young women .
Painless , mobile and slow growing mass .
Firm and rubbery texture .
Are not Premalignant lesions .
Excisional biopsy is necessary for every Fibroadenoma .
14) A 15 year old boy awakens with sudden onest of right scrotal pain and tenderness accompanied by nausea and vomiting . Which of the following is the most appropriate diagnosis and represents a surgical emergency ?
Acute prostatitis
Acute epididymitis
Torsion of the testicle
Acute appendicitis
Orchitis
15) All are true regarding achalasia except ?
Dysphagia to both solids and liquid is classic .
Barium swallow reveals a birdlike narrowing in the distal esophagus .
Treatment of choice is total gasterectomy .
Usually associated with weight loss .
The underlying defect is failure of the lower esophageal sphincter to relax .
16) One of the following is the most common cause of massive upper GI bleeding ?
Gastritis
Duodenal ulcer
Oesophagitis
Mallory Weiss syndrome
Esophageal varices
17) What is the most reliable method for precisely locating the site of Upper GI bleeding ?
Barium meal study
Exploratory laparotomy
Arteriography
Upper endoscopy
Radionuclide scanning
18) One of the following is not true regarding Meckels diverticulum ?
It is the most common diverticulum of the GI tract .
It can cause bleeding .
It can cause intussusception and obstruction .
Asymptomatic Meckels diverticulum should be resected .
More common in males .
19) Uncomplicated acute pancreatitis is best managed with all of the following except ?
Intravenous hydration .
Naso_gastric decompression .
Abdominal imaging with ultrasound and / or CT scan .
Strong painless killer .
Urgent laparotomy to clean the abdomen .
20) The most common complication after hemorrhoidectomy is which of the following ?
Urinary retention
Rectal bleeding
Incontinence
Wound infection
Intestinal obstruction
21) Which of the following types of colonic polyps is associated with the highest incidence of malignant degeneration ?
Tubular adenoma
Tubulovillous adenoma
Villous adenoma
Hamartomatous polyp
Lipomatous polyp
22) The major problem with Ogilvie syndrome ( Acute obstruction of the colon in the absence of any identifiable mechanical obstructing lesion ) is the risk of ?
Cecal perforation
Malignancy
Rectal prolapsed
Duodenal ulcer
Small bowel perforation
23) Characteristic injuries of blunt thoracic include all the following except ?
Fractured sternum
Transected aorta
Pulmonary contusion
Ruptured urinary bladder
Bilateral rib fractures
24) Concerning clinical evaluation of pelvic injuries , one is true ?
Rectal examination is often unnecessary .
The patient should have a urethral catheter inserted in all cases to monitor urine output .
Lateral compression injuries are usually more severe than antero_posterior compression injuries .
Pelvic stabilization is the first priority .
Unstable pelvic ring fractures are associated with a high mortality .
25) The following are indications for laparotomy in abdominal trauma except ?
Peritonitis .
Persistent shock .
If there is no intra abdominal free fluid on CT scan and ultrasound .
Uncontrolled hemorrhage .
Gunshot wounds .
26) The following would be indications to transfer a patient to a burns centre except ?
Chemical burns .
Burns involving inhalation injury .
Circumferential burns of the extremities .
Third degree burn to the genital organs .
First degree burn of 15 % of TBSA to the chest of an adult man .
27) The following are risk factors for perioperative DVT except ?
Obesity
Operation with long duration
Patient with malignancy
Pelvic operations
Young age
28) The best policy to treat postoperative pain is to give ?
NSAIDs
Subcutaneous morphine
Paracetamol
Regional anesthesia
Multimodal analgesia
29) What is the most common breast condition that a middle aged woman can have of the following ?
Breast cancer
Fibroadenoma
Fibrocystic disease
Ductectasia
Lipoma
30) Ketamine is contraindicated ?
In an asthmatic patient
For cesarean section
In a patient with facial burns
In a patient with increased ICP
In hypotensive patient
31) A 45 years old man presents with progressive cervical lymph nodes enlargement , since 4 months , the most appropriate investigation is ?
X Ray soft tissue
FNAC
Lymph node biopsy
Thyroid isotope scan
Tuberculin test
32) Clinical features of paralytic ileus include the following except ?
Effortless vomiting
Absolute constipation
Abdominal distension
Severe abdominal pain
Absent bowel sounds
33) The most precise diagnostic screening procedure for differentiating benign thyroid nodules from malignant ones is ?
Thyroid ultrasonography
Thyroid scintiscan
Thyroid hormone level
Neck CT scan
FNAB
34) The mainstay of therapy for all forms of shock is ?
IV fluid
Epinephrine
Phenylephrine
Red blood cells
Oxygen
35) All of the following are expected in a patient with Pheochromocytoma except ?
HTN
Palpitations
Headache
Anhydrosis
Nausea and vomiting
36) Which of the following is the best guide to fluid replacement in a burns patient ?
Hemoglobin and haematocrit .
Urine output .
Urine osmolality .
Plasma volume .
Specific gravity .
37) The first manifestation of Iatrogenic removal of all parathyroid glands after total thyroidectomy is ?
Carpal spasm .
Facial twitching on tapping the facial nerve .
Circumoral numbness .
Pedal spasm .
Diarrhea .
38) The best prophylaxis against infection in dirty wounds is achieved by ?
Avoiding the use of local anesthesia .
Inserting a drain into the wound .
Administrating a large dose of an appropriate antibiotic .
Administrating tetanus antitoxin .
Removing foreign bodies and devitalized tissues .
39) Which of the following is not a sign of portal hypertension ?
Caput medus
Hepatomegaly
Ascites
Splenomegaly
Lower limb varicose veins
40) All of the following are common causes of small bowel obstruction except ?
Post surgical adhesion
Inguinal hernia
Incisional hernia
Small bowel tumor
Fecal impaction
41) The etiology of anal fistula includes ?
Anal gland infection
Ulcerative colitis
Ischemic colitis
Anal warts
Levator ani syndrome
42) The most common cause of Hypoparathyroidism is ?
Congenital absence of the parathyroids .
Autoimmune parathyroid failure .
Parathyroid cancer .
Surgical removal of the parathyroids at total thyroidectomy .
Acute bacterial infection .
43) Which of the following is an indication for removal of a Lipoma ?
3 cm Lipoma in the tibialis anterior .
3 cm Lipoma in the subcutaneous fat of the anterior abdominal wall .
3 cm Lipoma in the subcutaneous fat of the buttock .
A Lipoma of many years standing which has not changed in size .
A Lipoma on CT scanning of homogeneous density
44) Which of the following is not considered an immediate threat to life ?
Fracture of T8 with a complete spinal cord transaction .
Splenic injury with ongoing bleeding .
Open pneumothorax .
Rapidly rising intracranial pressure .
Aspiration .
45) Hypovolemic shock can result from any of the following except ?
Pulmonary laceration
Extradural hemorrhage
Pelvic fracture
Femur fracture
Laceration to scalp
46) The cardinal feature of a compartment syndrome is ?
Pain
Hyperthermia
Rubor
Ecchymosis
Limb hyperactivity
47) In assessing the severity of an acute fracture , one must always ?
Examine for subcutaneous emphysema .
Examine for evidence of gangrene .
Examine the status of the neurovascular system of the fractured part .
Examine for a temperature and arrhythmia .
Examine for evidence of a fat embolism .
48) Which of the following steps is not part of the primary survey in a trauma patient ?
Insuring adequate ventilatory support .
Measurement of blood pressure and pulse .
Neurologic evaluation .
Protection of the cervical spine .
Deep cut wound exploration and suturing .
49) In obstructive jaundice , bleeding tendency is due to deficiency of the following clotting factors except ?
2
7
8
9
10
50) In the treatment of head injury , one of the following is true ?
Steroids are regularly used .
Patient with Glasgow coma score less than 8 are usually intubated and ventilated .
Antibiotics are routinely used .
Pyrexia is nearly always due to severe infection .
Severe fluid restriction is necessary
51) Which of the following is true about the diabetic foot complications ?
The neuropathy is only sensory .
There is no relation to ongoing smoking .
The metatarsal phalangeal joints do not dislocate .
The prognosis is worse with arterial disease and ongoing smoking .
There is no place for surgical management .
52) The most common cause of Constipation ?
Slow transit constipation
Hypothyroidism.
Rectocele .
Obstruction from colorectal cancer .
Inadequate dietary fiber and fluids
53) The incorrect statement regarding passage of black and tarry stools is ?
It is usually an indication of bleeding from the upper GI tract .
It can be mimicked by the ingestion of iron medication .
It is commonly a symptom of a cancer of the colon .
It can be present without other symptoms .
It is often but not universally associated with hematemesis
54) All of the following are diagnostic tools for dysphagia except ?
Upper GI endoscopy.
Barium swallow examination .
Upper abdominal ultrasound examination .
CT examination of the chest .
Esophageal manometry .
55) Acute epididymo_Orchitis is characterized by the following features except ?
History of urinary tract infection .
Rapid onest of pain .
Swollen tender testes .
Tenderness of the cord .
Pyrexia and Leucocytosis .
56) All of the following are risk factors for SCC of esophagus except ?
Alcohol
Tobacco
Achalasia
Plummer Vinson syndrome
Barrett esophagus
57) All of the following are manifestations of hypervolemia except ?
Confusion or lethargy
Peripheral edema
Slow and weak pulse
Dyspnea and crackles in lungs
Weight gain
58) Pain in the hypogastrium when internal rotation of the hip is ?
The pointing sign
The psoas sign
The Obturator sign
Rovsing sign
Blumbert sign
59) Which is the least common cause of pain in right iliac fossa in pregnant woman ?
Acute appendicitis
Ectopic pregnancy
Right acute pyelonephritis
Adenopathy
Twisting ovarian cyst
60) The initial response to vessel injury is ?
Vasodilatation
Vasoconstriction
Platelet aggregation
Platelet plug formation
Thromboxane A2 production
61) The most common late complication of a colostomy is ?
Colostomy necrosis
Retraction
Obstruction
Parastomal hernia
Prolapse
62) The initiating event that leads to acute calculous Cholecystitis is the obstruction of ?
Common bile duct
Common hepatic duct
Cystic duct
Right hepatic duct
Left hepatic duct
63) The most common complication after open splenectomy is ?
Left lower lobe lung Atelectasis .
Pleural effusion and pneumonia .
Subphrenic hematoma .
Subphrenic abscess .
Pancreatitis .
64) Signs of severe varicose veins include all of the following except ?
Thrombophlebitis
Hyperpigmentation
Ulceration
Compressible upon pressure
Bleeding
65) All of the following increase intracranial pressure except ?
Pain
Fever
Cough
Constipation
Sleeping
66) Most common brain tumor in adults is ?
Glioblastoma multiforme
Medulloblastoma
Meningioma
Pituitary tumors
Metastasis
67) All are true about back pain except ?
Most common cause is disc prolapse .
Prevalence is almost 100% in a life time .
In elderly and very young patients should warrant investigation .
Most patients improve without investigation on pain killers and muscle relaxants .
When persists more than 4 weeks should be investigated .
68) All of the following are indications for urgent surgical treatment of a depressed skull fracture except ?
A.Neurological deficit .
B .Decreased level of consciousness .
C .If associated with mandibular fracture .
D .Underlying Subdural hematoma causing mass effect .
E .Cosmetic .
69) Regarding the metabolic abnormalities in Pyloric stenosis all are true except ?
Hyponatremia
Hypochloremia
Hyperkalemia
Primary metabolic alkalosis
Compensatory respiratory acidosis
70) The early clinical presentation of Tracheosophageal fistula consists of all of the following except ?
Choking on first feed
Coughing
Cyanosis
Excessive salivation
Aspiration pneumonia
71) The most common perianal fistula type is ?
Transsphincteric fistulae
Extrasphincteric fistulae
Intersphincteric fistulae
Suprasphincteric fistulae
Infrasphincteric fistulae
72) All of the following statements are true about the Lateral internal sphincterotomy except ?
Overall healing rates of 90_100% .
Recurrence rate is low , the majority in the range of 1_3% .
The treatment of choice for anal fissure refractory to non surgical therapy .
Incontinence sufficient to cause any measurable impairment quality of life is uncommon , in the range of 3%.
LIS is inferior to fissurectomy and posterior midline sphincterotomy with respect to healing rates , pain relief and incontinence .
73) The most common site of metastasis in patients with Hepatocellular carcinoma is ?
Adrenal glands
Lymph nodes
Lungs
Bone
Brain
74) Which of the following congenital anomalies occurs most frequently in patients with an Imperforate anus ?
Esophageal atresia
Presacral dermoid
Urological anomaly
Tethered spinal cord
Cleft palate
75) One of the following is not presentation of right side colonic tumor ?
Melena
IDA
Abdominal mass
Obstruction
Anorexia and weight loss
76) The most common histological type of colorectal cancer is ?
Adenocarcinoma
Lymphoma
Carcinoid
Melanoma
Mesenchymal tumor
77) All of the following are parts of prognostic Ranson criteria except ?
Age
Blood sugar
Serum amylase
White cell count
Pao2
78) Which of the following hernia may close spontaneously in children ?
Inguinal hernia
Umbilical hernia
Incisional hernia
Bochdalek hernia
Paraumbilical hernia
79) The commonest cause of ascending Cholangitis is ?
Stone impaction in CBD .
Cancer head of the pancreas .
Cholangiocarcinoma .
Lymphadenopathy of the porta hepatis .
Ruptured Hydatid cyst into the biliary tree
80) In monitoring the hourly urinary output of a patient with 60 kg body weight , the amount of urine that is considered minimal acceptable is ?
60 ml
45 ml
30 ml
100 ml
75 ml
1) All of the following are symptoms and signs of hypothyroidism except ?
Low body temperature
Amenorrhea
Constipation
Weight gain
Cold intolerance
2) All of the following are true regarding chronic lymphocytic ( Hashimoto ) thyroiditis except ?
It is the most common inflammatory thyroid disorder .
Leading cause of hypothyroidism .
Autoimmune , inherited .
Malignancy found in 15% of the cases .
Age of presentation is 30_50 years
3) All of the following are indications for thyroidectomy in thyroid cyst except ?
Failure to do complete aspiration .
Large cyst > 4 cm .
Complex cyst ( solid _ cystic ) .
Recurrence after frequent aspirations .
If it is painless .
4) The most common malignant liver mass ?
Hepatocellular carcinoma
Hepatoblastoma
Angiosarcoma
Lymphoma
Metastatic tumor
5) Most of the cases of liver cancer are advanced at time of diagnosis because all of the following except ?
Symptoms usually don't appear until late in the disease .
Liver cancer grow quickly .
Liver tumors resemble those of other medical conditions .
Liver cancer can't be diagnosed using a standard liver tests .
Liver tissue is not able to regenerate to replace the damaged tissue
6) Mondors disease is a variant of Thrombophlebitis that involves the superficial veins of ?
The anterior chest wall and breast .
The thighs .
The legs .
The scrotum .
The vagina .
7) The dominant etiologic factor in Acute appendicitis is ?
Travelling infection from large bowel .
Decrease local immunity of appendix .
Part of inflammatory bowel disease .
Obstruction of the lumen by fecaliths .
Distal colonic obstruction .
8) The Body mass index of the normal weight is ?
15_19 kg/m2
20_25 kg/m2
26_29 kg/m2
30_34 kg/m2
35_39 kg/m2
9) Disadvantages of laparoscopy when compared with laparotomy include all of the following except which ?
Difficulty controlling severe bleeding .
Poorer visualization of the operative fields .
Greater difficulty placing sutures .
Loss of tactile sensation .
Higher operating room costs .
10) Laparoscopic Cholecystectomy is indicated for all of the following conditions except which ?
Biliary dyskinesia .
Initial treatment in patients with severe Cholangitis .
Acute Cholecystitis .
Symptomatic cholelithiasis .
Biliary pancreatitis .
11) The most common cause of pyogenic liver abscess is ?
Hematogenous infection .
Lymphatic spread .
Secondary to infected abdominal viscera .
Secondary infection of a Hydatid .
Biliary obstruction .
12) Which of the following conditions are associated with increased risk of breast cancer ?
Fibrocystic mastopathy
Fibroadenoma
Atypical hyperplasia
Papillomatosis
Breast Lipoma
13) All of the following are true regarding Fibroadenoma of the breast except ?
It is the most common breast tumor in adolescents and young women .
Painless , mobile and slow growing mass .
Firm and rubbery texture .
Are not Premalignant lesions .
Excisional biopsy is necessary for every Fibroadenoma .
14) A 15 year old boy awakens with sudden onest of right scrotal pain and tenderness accompanied by nausea and vomiting . Which of the following is the most appropriate diagnosis and represents a surgical emergency ?
Acute prostatitis
Acute epididymitis
Torsion of the testicle
Acute appendicitis
Orchitis
15) All are true regarding achalasia except ?
Dysphagia to both solids and liquid is classic .
Barium swallow reveals a birdlike narrowing in the distal esophagus .
Treatment of choice is total gasterectomy .
Usually associated with weight loss .
The underlying defect is failure of the lower esophageal sphincter to relax .
16) One of the following is the most common cause of massive upper GI bleeding ?
Gastritis
Duodenal ulcer
Oesophagitis
Mallory Weiss syndrome
Esophageal varices
17) What is the most reliable method for precisely locating the site of Upper GI bleeding ?
Barium meal study
Exploratory laparotomy
Arteriography
Upper endoscopy
Radionuclide scanning
18) One of the following is not true regarding Meckels diverticulum ?
It is the most common diverticulum of the GI tract .
It can cause bleeding .
It can cause intussusception and obstruction .
Asymptomatic Meckels diverticulum should be resected .
More common in males .
19) Uncomplicated acute pancreatitis is best managed with all of the following except ?
Intravenous hydration .
Naso_gastric decompression .
Abdominal imaging with ultrasound and / or CT scan .
Strong painless killer .
Urgent laparotomy to clean the abdomen .
20) The most common complication after hemorrhoidectomy is which of the following ?
Urinary retention
Rectal bleeding
Incontinence
Wound infection
Intestinal obstruction
21) Which of the following types of colonic polyps is associated with the highest incidence of malignant degeneration ?
Tubular adenoma
Tubulovillous adenoma
Villous adenoma
Hamartomatous polyp
Lipomatous polyp
22) The major problem with Ogilvie syndrome ( Acute obstruction of the colon in the absence of any identifiable mechanical obstructing lesion ) is the risk of ?
Cecal perforation
Malignancy
Rectal prolapsed
Duodenal ulcer
Small bowel perforation
23) Characteristic injuries of blunt thoracic include all the following except ?
Fractured sternum
Transected aorta
Pulmonary contusion
Ruptured urinary bladder
Bilateral rib fractures
24) Concerning clinical evaluation of pelvic injuries , one is true ?
Rectal examination is often unnecessary .
The patient should have a urethral catheter inserted in all cases to monitor urine output .
Lateral compression injuries are usually more severe than antero_posterior compression injuries .
Pelvic stabilization is the first priority .
Unstable pelvic ring fractures are associated with a high mortality .
25) The following are indications for laparotomy in abdominal trauma except ?
Peritonitis .
Persistent shock .
If there is no intra abdominal free fluid on CT scan and ultrasound .
Uncontrolled hemorrhage .
Gunshot wounds .
26) The following would be indications to transfer a patient to a burns centre except ?
Chemical burns .
Burns involving inhalation injury .
Circumferential burns of the extremities .
Third degree burn to the genital organs .
First degree burn of 15 % of TBSA to the chest of an adult man .
27) The following are risk factors for perioperative DVT except ?
Obesity
Operation with long duration
Patient with malignancy
Pelvic operations
Young age
28) The best policy to treat postoperative pain is to give ?
NSAIDs
Subcutaneous morphine
Paracetamol
Regional anesthesia
Multimodal analgesia
29) What is the most common breast condition that a middle aged woman can have of the following ?
Breast cancer
Fibroadenoma
Fibrocystic disease
Ductectasia
Lipoma
30) Ketamine is contraindicated ?
In an asthmatic patient
For cesarean section
In a patient with facial burns
In a patient with increased ICP
In hypotensive patient
31) A 45 years old man presents with progressive cervical lymph nodes enlargement , since 4 months , the most appropriate investigation is ?
X Ray soft tissue
FNAC
Lymph node biopsy
Thyroid isotope scan
Tuberculin test
32) Clinical features of paralytic ileus include the following except ?
Effortless vomiting
Absolute constipation
Abdominal distension
Severe abdominal pain
Absent bowel sounds
33) The most precise diagnostic screening procedure for differentiating benign thyroid nodules from malignant ones is ?
Thyroid ultrasonography
Thyroid scintiscan
Thyroid hormone level
Neck CT scan
FNAB
34) The mainstay of therapy for all forms of shock is ?
IV fluid
Epinephrine
Phenylephrine
Red blood cells
Oxygen
35) All of the following are expected in a patient with Pheochromocytoma except ?
HTN
Palpitations
Headache
Anhydrosis
Nausea and vomiting
36) Which of the following is the best guide to fluid replacement in a burns patient ?
Hemoglobin and haematocrit .
Urine output .
Urine osmolality .
Plasma volume .
Specific gravity .
37) The first manifestation of Iatrogenic removal of all parathyroid glands after total thyroidectomy is ?
Carpal spasm .
Facial twitching on tapping the facial nerve .
Circumoral numbness .
Pedal spasm .
Diarrhea .
38) The best prophylaxis against infection in dirty wounds is achieved by ?
Avoiding the use of local anesthesia .
Inserting a drain into the wound .
Administrating a large dose of an appropriate antibiotic .
Administrating tetanus antitoxin .
Removing foreign bodies and devitalized tissues .
39) Which of the following is not a sign of portal hypertension ?
Caput medus
Hepatomegaly
Ascites
Splenomegaly
Lower limb varicose veins
40) All of the following are common causes of small bowel obstruction except ?
Post surgical adhesion
Inguinal hernia
Incisional hernia
Small bowel tumor
Fecal impaction
41) The etiology of anal fistula includes ?
Anal gland infection
Ulcerative colitis
Ischemic colitis
Anal warts
Levator ani syndrome
42) The most common cause of Hypoparathyroidism is ?
Congenital absence of the parathyroids .
Autoimmune parathyroid failure .
Parathyroid cancer .
Surgical removal of the parathyroids at total thyroidectomy .
Acute bacterial infection .
43) Which of the following is an indication for removal of a Lipoma ?
3 cm Lipoma in the tibialis anterior .
3 cm Lipoma in the subcutaneous fat of the anterior abdominal wall .
3 cm Lipoma in the subcutaneous fat of the buttock .
A Lipoma of many years standing which has not changed in size .
A Lipoma on CT scanning of homogeneous density
44) Which of the following is not considered an immediate threat to life ?
Fracture of T8 with a complete spinal cord transaction .
Splenic injury with ongoing bleeding .
Open pneumothorax .
Rapidly rising intracranial pressure .
Aspiration .
45) Hypovolemic shock can result from any of the following except ?
Pulmonary laceration
Extradural hemorrhage
Pelvic fracture
Femur fracture
Laceration to scalp
46) The cardinal feature of a compartment syndrome is ?
Pain
Hyperthermia
Rubor
Ecchymosis
Limb hyperactivity
47) In assessing the severity of an acute fracture , one must always ?
Examine for subcutaneous emphysema .
Examine for evidence of gangrene .
Examine the status of the neurovascular system of the fractured part .
Examine for a temperature and arrhythmia .
Examine for evidence of a fat embolism .
48) Which of the following steps is not part of the primary survey in a trauma patient ?
Insuring adequate ventilatory support .
Measurement of blood pressure and pulse .
Neurologic evaluation .
Protection of the cervical spine .
Deep cut wound exploration and suturing .
49) In obstructive jaundice , bleeding tendency is due to deficiency of the following clotting factors except ?
2
7
8
9
10
50) In the treatment of head injury , one of the following is true ?
Steroids are regularly used .
Patient with Glasgow coma score less than 8 are usually intubated and ventilated .
Antibiotics are routinely used .
Pyrexia is nearly always due to severe infection .
Severe fluid restriction is necessary
51) Which of the following is true about the diabetic foot complications ?
The neuropathy is only sensory .
There is no relation to ongoing smoking .
The metatarsal phalangeal joints do not dislocate .
The prognosis is worse with arterial disease and ongoing smoking .
There is no place for surgical management .
52) The most common cause of Constipation ?
Slow transit constipation
Hypothyroidism.
Rectocele .
Obstruction from colorectal cancer .
Inadequate dietary fiber and fluids
53) The incorrect statement regarding passage of black and tarry stools is ?
It is usually an indication of bleeding from the upper GI tract .
It can be mimicked by the ingestion of iron medication .
It is commonly a symptom of a cancer of the colon .
It can be present without other symptoms .
It is often but not universally associated with hematemesis
54) All of the following are diagnostic tools for dysphagia except ?
Upper GI endoscopy.
Barium swallow examination .
Upper abdominal ultrasound examination .
CT examination of the chest .
Esophageal manometry .
55) Acute epididymo_Orchitis is characterized by the following features except ?
History of urinary tract infection .
Rapid onest of pain .
Swollen tender testes .
Tenderness of the cord .
Pyrexia and Leucocytosis .
56) All of the following are risk factors for SCC of esophagus except ?
Alcohol
Tobacco
Achalasia
Plummer Vinson syndrome
Barrett esophagus
57) All of the following are manifestations of hypervolemia except ?
Confusion or lethargy
Peripheral edema
Slow and weak pulse
Dyspnea and crackles in lungs
Weight gain
58) Pain in the hypogastrium when internal rotation of the hip is ?
The pointing sign
The psoas sign
The Obturator sign
Rovsing sign
Blumbert sign
59) Which is the least common cause of pain in right iliac fossa in pregnant woman ?
Acute appendicitis
Ectopic pregnancy
Right acute pyelonephritis
Adenopathy
Twisting ovarian cyst
60) The initial response to vessel injury is ?
Vasodilatation
Vasoconstriction
Platelet aggregation
Platelet plug formation
Thromboxane A2 production
61) The most common late complication of a colostomy is ?
Colostomy necrosis
Retraction
Obstruction
Parastomal hernia
Prolapse
62) The initiating event that leads to acute calculous Cholecystitis is the obstruction of ?
Common bile duct
Common hepatic duct
Cystic duct
Right hepatic duct
Left hepatic duct
63) The most common complication after open splenectomy is ?
Left lower lobe lung Atelectasis .
Pleural effusion and pneumonia .
Subphrenic hematoma .
Subphrenic abscess .
Pancreatitis .
64) Signs of severe varicose veins include all of the following except ?
Thrombophlebitis
Hyperpigmentation
Ulceration
Compressible upon pressure
Bleeding
65) All of the following increase intracranial pressure except ?
Pain
Fever
Cough
Constipation
Sleeping
66) Most common brain tumor in adults is ?
Glioblastoma multiforme
Medulloblastoma
Meningioma
Pituitary tumors
Metastasis
67) All are true about back pain except ?
Most common cause is disc prolapse .
Prevalence is almost 100% in a life time .
In elderly and very young patients should warrant investigation .
Most patients improve without investigation on pain killers and muscle relaxants .
When persists more than 4 weeks should be investigated .
68) All of the following are indications for urgent surgical treatment of a depressed skull fracture except ?
A.Neurological deficit .
B .Decreased level of consciousness .
C .If associated with mandibular fracture .
D .Underlying Subdural hematoma causing mass effect .
E .Cosmetic .
69) Regarding the metabolic abnormalities in Pyloric stenosis all are true except ?
Hyponatremia
Hypochloremia
Hyperkalemia
Primary metabolic alkalosis
Compensatory respiratory acidosis
70) The early clinical presentation of Tracheosophageal fistula consists of all of the following except ?
Choking on first feed
Coughing
Cyanosis
Excessive salivation
Aspiration pneumonia
71) The most common perianal fistula type is ?
Transsphincteric fistulae
Extrasphincteric fistulae
Intersphincteric fistulae
Suprasphincteric fistulae
Infrasphincteric fistulae
72) All of the following statements are true about the Lateral internal sphincterotomy except ?
Overall healing rates of 90_100% .
Recurrence rate is low , the majority in the range of 1_3% .
The treatment of choice for anal fissure refractory to non surgical therapy .
Incontinence sufficient to cause any measurable impairment quality of life is uncommon , in the range of 3%.
LIS is inferior to fissurectomy and posterior midline sphincterotomy with respect to healing rates , pain relief and incontinence .
73) The most common site of metastasis in patients with Hepatocellular carcinoma is ?
Adrenal glands
Lymph nodes
Lungs
Bone
Brain
74) Which of the following congenital anomalies occurs most frequently in patients with an Imperforate anus ?
Esophageal atresia
Presacral dermoid
Urological anomaly
Tethered spinal cord
Cleft palate
75) One of the following is not presentation of right side colonic tumor ?
Melena
IDA
Abdominal mass
Obstruction
Anorexia and weight loss
76) The most common histological type of colorectal cancer is ?
Adenocarcinoma
Lymphoma
Carcinoid
Melanoma
Mesenchymal tumor
77) All of the following are parts of prognostic Ranson criteria except ?
Age
Blood sugar
Serum amylase
White cell count
Pao2
78) Which of the following hernia may close spontaneously in children ?
Inguinal hernia
Umbilical hernia
Incisional hernia
Bochdalek hernia
Paraumbilical hernia
79) The commonest cause of ascending Cholangitis is ?
Stone impaction in CBD .
Cancer head of the pancreas .
Cholangiocarcinoma .
Lymphadenopathy of the porta hepatis .
Ruptured Hydatid cyst into the biliary tree
80) In monitoring the hourly urinary output of a patient with 60 kg body weight , the amount of urine that is considered minimal acceptable is ?
60 ml
45 ml
30 ml
100 ml
75 ml
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