General surgery

1.    Anatomy of Gastrointestinal Tract.

***) The length of the esophagus in adults is:

A.    15 cm

B.     25 cm

C.     30 cm

D.    40 cm

E.     50 cm

Answer: B* 25 cm

***) All of the following arteries contribute in the blood supply of the stomach, except:

A.    Celiac

B.     Hepatic

C.     Splenic

D.    Gastroduodenal

E.     Superior mesenteric

Answer: E* Superior mesenteric

·      Thoracic Surgery GS13-GS17.

1.    Esophagus.

***) Concerning carcinoma of the esophagus, all of the following are true, except:

A.    It occurs usually in elderly ages

B.     Progressive dysphagia is a common symptom

C.     Common sites are in the middle and lower third

D.    Squamous cell carcinoma is the commonest type

E.     It is usually associated with good prognosis

Answer: E* It is usually associated with good prognosis

***) Concerning carcinoma of the esophagus, all are true, except:

A.    It occurs in males more than in females

B.     It is squamous cell carcinoma except its lower few centimeters where it is adenocarcinoma

C.     Dysphagia is an important leading symptom

D.    Barium swallow usually reveals massive dilatation above the tumor

E.     Esophagoscopy is usually diagnostic

Answer: D* Barium swallow usually reveals massive dilatation above the tumor

·      Stomach and Duodenum GS17-GS21.

1.    Peptic Ulcer Disease PUD.

***) All of the following are indications for surgical treatment of peptic ulcers, except:

A.    Perforation

B.     Failure of medical treatment

C.     Gastric outlet obstruction

D.    Hyperacidity

E.     Recurrent massive bleeding

Answer: D* Hyperacidity

***) All of the following are indications for surgical treatment of peptic ulcers, except:

A.    Penetration and intractable pain

B.     Pyloric stenosis

C.     Hyperacidity

D.    Perforation

E.     Recurrent massive bleeding

Answer: C* Hyperacidity

***) Complications of duodenal ulcer include all of the following, except:

A.    Perforation

B.     Penetration

C.     Massive bleeding

D.    Obstruction of pylorus

E.     Malignant change

Answer: E* Malignant change

***) The best radiological examination to diagnose perforated peptic ulcer is:

A.    Barium swallow

B.     Barium meal

C.     Gastrographin meal

D.    Chest X-ray standing

E.     Technecium scanning

Answer: D* Chest X-ray standing

***) The complication of peptic ulcer that needs immediate surgical treatment is:

A.    Perforation

B.     Penetration

C.     Bleeding

D.    Stenosis

E.     Suspicion of malignancy

Answer: A* Perforation

***) Regarding perforated duodenal ulcer, one is correct:

A.    There is always history of peptic ulcer disease

B.     Generalized abdominal rigidity is an early sign

C.     May present with pain in right iliac fossa

D.    Pyrexia is an early sign

E.     Diagnoses only when plain abdominal X-ray shows gas under diaphragm

Answer: B* Generalized abdominal rigidity is an early sign

***) 30 years old male patient presented with gastric outlet obstruction and vomiting, all are clinical findings, except:

A.    Hypochloremic metabolic alkalosis

B.     Constipation and loss of weight

C.     Succussion splash is present

D.    Dehydration

E.     Hypochloremic metabolic acidosis

Answer: E* Hypochloremic metabolic acidosis

2.    Gastric Carcinoma.

***) In gastric carcinoma the following are true, except:

A.    Adenocarcinoma is the commonest malignant tumor of the stomach

B.     Patients with pernicious anemia and blood group A have an increased incidence

C.     Anorexia and weight loss are commonest manifestations

D.    Chemotherapy is a good adjuvant to radical surgery for early tumors

E.     Metastases to bone are uncommon

Answer: E* Metastases to bone are uncommon

***) Concerning gastric carcinoma all of the following are signs of advanced stage, except:

A.    The mass is clinically palpable

B.     Severe hematemesis

C.     Ascites

D.    Involved left supraclavicular lymph node

E.     Liver involvement with jaundice

Answer: B* Severe hematemesis

***) In carcinoma of the stomach, all are true, except:

A.    It is about 3 times more likely to occur in patients with pernicious anemia

B.     It has a positive association with blood group A

C.     It usually presents with recurrent hematemesis

D.    It may give rise to krukenberg tumor of ovaries

E.     It is a late complication of a partial gastrectomy for duodenal ulcer

Answer: B* It has a positive association with blood group A

***) All are true of polyps of the stomach except:

A.    They tend to be multiple

B.     They occur in atrophic mucosa

C.     They may first appear after adolescence

D.    They may be part of a familial disease

E.     Malignant change is uncommon

Answer: E* Malignant change is uncommon

3.    Gastric Sarcoma.

***) Sarcoma spreads mainly through:

A.    Blood vessels

B.     Lymph vessels

C.     Nerve trunks

D.    Natural passages

E.     Invasion to nearby structures

Answer: A* Blood vessels

4.    Gastrectomy Complications.

***) Which of the following does not occur after partial gastrectomy:

A.    Dumping syndrome

B.     Hyperglycemia

C.     B₁₂ deficiency

D.    Osteomalacia

E.     Carcinoma of stomach

Answer: B* Hyperglycemia

·      Small Intestine GS21-GS22.

1.    Meckel's Diverticulum.

***) Regarding Meckel's diverticulum all of the following are true, except:

A.    It is an acquired resulting from an increased intraluminal pressure

B.     It is situated usually 2-3feet proximal to ileocecal junction

C.     It may be silent, discovered incidentally during laparotomy

D.    It may cause intestinal obstruction

E.     It may cause frank bleeding per rectum

Answer: A* It is an acquired resulting from an increased intraluminal pressure

***) The most common presentation of Meckel's diverticulum in children is:

A.    Frank rectal bleeding

B.     Acute diverticulitis

C.     Intussusception

D.    Perforation of the diverticulum

E.     Volvulus of small intestine

Answer: A* Frank rectal bleeding

***) The most common complication of Meckel's diverticulum is:

A.    Perforation

B.     Hemorrhage

C.     Obstruction

D.    Umbilical anomalies

E.     Carcinoma

Answer: C* Obstruction

·      Hernia GS22-GS24.

1.    Groin Hernias.

***) The most common form of hernia in females is:

A.    Indirect inguinal hernia

B.     Direct inguinal hernia

C.     Femoral hernia

D.    Umbilical hernia

E.     Diaphragmatic hernia

Answer: A* Indirect inguinal hernia

***) In strangulated inguinal hernia during childhood, which of the following is true:

A.    The pain is of low intensity and gradual onset

B.     Local tenderness is mild

C.     The cause is adhesions at the neck of the sac

D.    The incidence of strangulation is lower the older is the child

E.     Immediate operation must be done even the hernia reduced by sedation

Answer: E* Immediate operation must be done even the hernia reduced by sedation

***) A 3 months old infant found to have a right inguinal hernia, the best management is:

A.    Re-examination every month until it disappears spontaneously

B.     Application of a truss

C.     Surgical treatment when he is six months old

D.    Surgical treatment when he is one year old

E.     Surgical treatment as soon as possible

Answer: E* Surgical treatment as soon as possible

***) Regarding femoral hernia, one is correct:

A.    It occurs only in women

B.     They are the least dangerous variety of hernia

C.     It lies medial to pubic tubercle

D.    It usually lies below inguinal ligament

E.     It is transilluminates

Answer: D* It usually lies below inguinal ligament

***) The symptoms of epigastric hernia usually resemble those of one of the following:

A.    Angina pectoris

B.     Gall stone

C.     Hiatus hernia

D.    Peptic ulcer

E.     Diverticular disease of the colon

Answer: D* Peptic ulcer

***) A 60 years old female presented with irreducible tender swelling below and lateral to the pubic tubercle. She most likely has:

A.    Strangulated direct inguinal hernia

B.     Strangulated indirect inguinal hernia

C.     Strangulated femoral hernia

D.    Saphena varix

E.     Obturator hernia

Answer: D* Strangulated femoral hernia

***) Regarding indirect inguinal hernia in children, all of the following are true, except:

A.    Right side is more common than left side

B.     Boys are affected much more than girls

C.     Incarceration occurs more often in small babies

D.    Operative correction is delayed till the child is one year old

E.     Inguinal truss is nowadays not used in the management

Answer: D* Operative correction is delayed till the child is one year old

***) Concerning femoral hernia all of the following are true, except:

A.    The hernial sac passes through the femoral ring

B.     The femoral vein lies lateral to the hernial neck

C.     It is not liable for irreducibility and strangulation as it has a wide neck

D.    When large, it can be missed as an inguinal hernia

E.     It may not give positive expansive cough impulse

Answer: C* It is not liable for irreducibility and strangulation as it has a wide neck

***) A 30 years old healthy male complaining of upper abdominal discomfort, on examination he had a small swelling in the middle between the umbilicus and xiphisternum. He most likely had:

A.    Umbilical hernia

B.     Paraumbilical hernia

C.     Spigelian hernia

D.    Epigastric hernia

E.     Morgagni hernia

Answer: D* Epigastric hernia

***) Spermatic cord contains all the following, except:

A.    Autonomic nerve fibers

B.     Lymphatics

C.     Artery of the vas

D.    Iliohypogastric nerve

E.     Pampiniform plexus

Answer: D* Iliohypogastric nerve

·      Bowel Obstruction GS24-GS26.

1.    Small Bowel Obstruction.

***) In small intestine obstruction, the most helpful diagnostic method is:

A.    Small bowel follow-through

B.     CT scan

C.     Erect and supine X-Ray

D.    US for abdomen

E.     Endoscopy

Answer: B* CT scan

***) On supine abdomen X-Ray for intestinal obstruction, the small bowel is identified by:

A.    Valvulae conniventes

B.     Haustrations

C.     Peripheral location

D.    Double-bubble appearance

E.     Air fluid level

Answer: A* Valvulae conniventes

***) In all the following acute abdominal conditions vomiting is infrequent, except:

A.    Intra-abdominal bleeding

B.     Perforated peptic ulcer

C.     High small intestinal obstruction

D.    Acute appendicitis

E.     Volvulus of sigmoid colon

Answer: C* High small intestinal obstruction

***) Obstruction of the lower intestinal tract could be caused by all of the following, except:

A.    Hirschsprung's disease

B.     Meconium ileus

C.     Pyloric stenosis

D.    Ileal atresia

E.     Malrotation of the colon

Answer: C* Pyloric stenosis

2.    Large Bowel Obstruction.

***) The most common cause of colonic obstruction is:

A.    Adhesions

B.     Diverticulitis

C.     Cancer

D.    Intussusception

E.     Hernia

Answer: C* Cancer

·      Colonic Pseudo-Obstruction GS26-GS28.

1.    Toxic Megacolon.

***) Acute toxic dilatation of the colon is typically a complication of one of the following:

A.    Perforated carcinoma of the colon

B.     Amebic colitis

C.     Ulcerative colitis

D.    Large bowel obstruction

E.     Ischemic colitis

Answer: C* Ulcerative colitis

2.    Paralytic Ileus.

***) All of the following are causes of paralytic ileus, except:

A.    Peritonitis

B.     Abdominal trauma

C.     Hypokalemia

D.    Anemia

E.     Excessive administration of ganglionic blockers

Answer: D* Anemia

***) All of the following are manifestations of paralytic ileus, except:

A.    Abdominal colic

B.     Vomiting

C.     Constipation

D.    Abdominal distension

E.     Dehydration

Answer: A* Abdominal colic

***) Paralytic ileus may be caused by each of the following, except:

A.    Hypokalemia

B.     Intussusception

C.     Pneumonia

D.    Peritonitis

E.     Appendicitis

Answer: C* Pneumonia

·      Appendix GS28-GS29.

1.    Appendicitis.

***) Pelvic abscess developed after appendectomy for a perforated appendix, which of the following organisms would be the most likely cause:

A.    Streptococcus faecalis

B.     Escherichia coli

C.     Bacteroides

D.    Proteus

E.     Pseudomonas aeruginosa

Answer: C* Bacteroides

***) All the following statements concerning appendicitis in pregnancy are true except:

A.    Diagnosis is difficult

B.     Maternal death rate increases as gestational age increases

C.     Surgical treatment should be delayed until the diagnosis is firmly establishes

D.    The incidence is not changed by pregnancy

E.     The rate of fetal loss is about 15%

Answer: C* Surgical treatment should be delayed until the diagnosis is firmly establishes

***) A patient had appendectomy for perforated appendix, few days later he had diarrhea with tenesmus, and the most likely cause is:

A.    Enterocolitis

B.     Adhesive intestinal obstruction

C.     Pelvic abscess

D.    Mesenteric lymphadenitis

E.     Paralytic ileus

Answer: C* Pelvic abscess

***) The treatment of acute appendicitis during the first trimester of pregnancy is:

A.    Urgent appendectomy plus D&C (dilatation and curettage)

B.     Conservative treatment and doing appendectomy one month after delivery

C.     Conservative treatment then doing appendectomy and elective CS when pregnancy reaches 32 weeks

D.    Conservative treatment will be sufficient to abort the condition permanently

E.     Urgent appendectomy and observation of any vaginal bleeding

Answer: E* Urgent appendectomy and observation of any vaginal bleeding

***) In appendicitis during pregnancy, one is correct:

A.    May present with right upper quadrant or right flank pain

B.     Should be treated initially by antibiotics to avoid operation

C.     Occurs more frequently in pregnant than in non pregnant women

D.    Appendectomy is associated with 80% of abortion

E.     Maternal mortality is about 20%

Answer: A* May present with right upper quadrant or right flank pain

***) In acute appendicitis which, one is correct:

A.    Localized right iliac fossa tenderness is most reliable site

B.     Vomiting usually precedes pain

C.     WBC and RBC in urine will rule out the diagnosis

D.    In elderly patient with cardiac disease should be treated non-operatively

E.     If diarrhea is present the diagnosis is excluded

Answer: A* Localized right iliac fossa tenderness is most reliable site

***) A 17 years old female had undergone appendectomy for perforated appendicitis one week ago, presented with anorexia, swinging fever, ill looking and diarrhea with tenesmus. She is most likely has:

A.    Subphrenic abscess

B.     Pelvic abscess

C.     Gastroenteritis

D.    Intussusception

E.     Subacute intestinal obstruction

Answer: B* Pelvic abscess

***) The diagnosis of acute appendicitis is difficult in which of the following patients:

A.    Infant

B.     Pregnant

C.     Elderly

D.    Obese

E.     Child

Answer: B* Pregnant

***) Most common cause of abdominal pain in adolescent age is:

A.    Volvulus

B.     Intussusception

C.     Appendicitis

D.    Mesenteric adenitis

E.     Cholecystitis

Answer: C* Appendicitis

***) The following peritonitis all are true except:

A.    Peritonitis is defined as inflammation of the peritoneum

B.     Most surgical peritonitis is secondary to bacterial contamination

C.     Primary peritonitis is more common in adults than in children

D.    Tuberculous peritonitis can present with or without ascites

E.     Can be septic or aseptic

Answer: C* Primary peritonitis is more common in adults than in children

2.    Tumors of the Appendix.

***) The most common organ in which carcinoid tumor arises is:

A.    Rectum

B.     Colon

C.     Small intestine

D.    Appendix

E.     Bronchus

Answer: D* Appendix

***) A 14 years old boy started to complain of central abdominal pain, nausea, anorexia and slight rise of temperature. One week later he developed a tender mass in the right iliac fossa. Most probably he has:

A.    Carcinoma of the cecum

B.     Ileo-cecal tuberculosis

C.     Appendicular mass

D.    Intussusception

E.     Fecal impaction

Answer: C* Appendicular mass

·      Colorectal Neoplasms GS33-GS37.

1.    Colorectal Carcinoma.

***) The most common site of carcinoma of the colon is:

A.    Descending colon

B.     Splenic flexure

C.     Rectosigmoid

D.    Cecum

E.     Transverse colon

Answer: C* Recto-sigmoid

***) Histological carcinoma of the colon is usually:

A.    Basal celled carcinoma

B.     Squamous celled carcinoma

C.     Transitional celled carcinoma

D.    Well to moderately differentiated adenocarcinoma

E.     Columnar celled carcinoma

Answer: D* Well to moderately differentiated adenocarcinoma

***) All of the following are pre-malignant lesions as regarding colorectal carcinoma, except:

A.    Familial polyposis of colon

B.     Ulcerative colitis

C.     Villous papilloma

D.    Hamartomatous polyp

E.     Adenomatous polyp

Answer: D* Hamartomatous polyp

***) The most useful screening for colon cancer is:

A.    Sigmoidoscopy

B.     Colonoscopy

C.     Test for occult blood in stool

D.    Level of carcinoembryonic antigen

E.     Barium enema

Answer: C* Test for occult blood in stool

***) Concerning carcinoma of the colon, all of the following are true, except:

A.    Although most patients are above 60 years of age, younger ages are not immune

B.     Usually it is either well or moderately differentiated adenocarcinoma

C.     Right colon is affected more than left

D.    Recent changes of bowel habit and rectal bleeding are early manifestations

E.     Barium enema or colonoscopy must be done in all cases

Answer: C* Right colon is affected more than left

***) In which of the following conditions is Duke's classification used:

A.    Thyroid cancer

B.     Breast cancer

C.     Peptic ulcer complications

D.    Colorectal carcinoma

E.     Acute pancreatitis

Answer: D* Colorectal carcinoma

***) The followings are recognized risk factors for colon cancer, except:

A.    Adenomatous polyp formation

B.     Hyperplastic polyp formation

C.     Familial polyposis coli

D.    Chronic ulcerative colitis

E.     Family history of colon cancer

Answer: C* Familial polyposis coli

***) In elderly patient with a recent alteration of bowel habits and painless bleeding per rectum the likely diagnosis is:

A.    Inflammatory bowel disease

B.     Internal hemorrhoids

C.     Diverticulosis coli

D.    Large bowel carcinoma

E.     Meckel's diverticulum with heterotopic gastric mucosa

Answer: D* Large bowel carcinoma

·      Anorectum GS39-GS42.

1.    Anorectum.

***) All the following are painful anal and perianal conditions, except:

A.    Third degree hemorrhoids

B.     Acute anal fissure

C.     Ischio-rectal abscess

D.    Perianal hematoma

E.     Perianal abscess

Answer: A* Third degree hemorrhoids

***) All of the following can be felt during per-rectum digital examination, except:

A.    Chronic anal fissure

B.     Rectal carcinoma

C.     Second degree hemorrhoids

D.    Prostate in males

E.     Cervix of uterus in females

Answer: B* Second degree hemorrhoids

2.    Hemorrhoids.

***) Regarding hemorrhoids, one is correct:

A.    Usually present by pain and bleeding per rectum

B.     Bleeding hemorrhoids must be managed by surgical incision

C.     Recurrence is uncommon after proper surgical excision

D.    Is best diagnosed by per rectum examination to feel the hemorrhoids

E.     Surgery is the only effective and curable treatment

Answer: B* Bleeding hemorrhoids must be managed by surgical incision

3.    Anal Fissures.

***) On rectal examination the anus is tightly closed and patient resists attempted rectal exam, you suspect:

A.    Internal piles

B.     External piles

C.     Anal fissure

D.    Fistula in anus

E.     Carcinoma of rectum

Answer: C* Anal fissure

***) In acute anal fissure all are true, except:

A.    Presents with severe anal pain

B.     Anal spasm is a frequent finding

C.     Usually preceded by an episode of constipation

D.    Most of cases presents with severe bleeding per rectum

E.     Lateral sphincterotomy is the treatment of choice

Answer: D* Most of cases presents with severe bleeding per rectum

***) Concerning anal fissure all of the following are true, except:

A.    It is a longitudinal mucosal tear or ulcer in the upper half of the anal canal

B.     Constipation is an important predisposing factor

C.     Pain during a half to one hour after defecation is an important leading symptom

D.    It is usually situated in the midline posteriorly

E.     Lateral sphincterotomy is now the ideal treatment of the chronic fissure

Answer: A* It is a longitudinal mucosal tear or ulcer in the upper half of the anal canal

4.    Fistula in Anal.

***) Concerning fistula in anus all are possible causes, except:

A.    Inflammatory bowel disease

B.     After perianal abscess

C.     Trauma

D.    Tuberculosis

E.     Meckel's diverticulum

Answer: E* Meckel's diverticulum

***) Concerning fistula all of the following are correct, except:

A.    It is an abnormal communication between two epithelial surfaces

B.     It may be congenital or acquired

C.     The congenital is lined by epithelium

D.    The acquired is lined by granular tissue and in long run by epithelium

E.     All congenital fistulae close spontaneously

Answer: E* All congenital fistulae close spontaneously

·      Liver GS42-GS46.

1.    Liver Cysts.

***) The treatment of choice of hydatid cyst of the liver is:

A.    Medical

B.     Surgical excision

C.     Needle aspiration

D.    Chemotherapy

E.     Radiation

Answer: B* Surgical excision

***) All of the following can help in the diagnosis of hydatid disease of the liver, except:

A.    Stool examination

B.     Indirect hemagglutination test

C.     Ultrasonography

D.    CT scanning

E.     Casoni test

Answer: A* Stool examination

***) The most common organ in which hydatid cyst arises is:

A.    Lung

B.     Liver

C.     Spleen

D.    Brain

E.     Bone

Answer: B* Liver

***) Concerning hydatid cyst all of the following are correct, except:

A.    It is the larval stage of the worm taenia echinococcus

B.     The liver is the most common organ infected

C.     The patient may remain symptom free for long time

D.    Suppuration, rupture and death of the cyst are known sequela

E.     Treatment of choice is by long term therapy with mebendazole

Answer: E* Treatment of choice is by long term therapy with mebendazole

***) The most common tumor found in the liver is:

A.    Hemangioma

B.     Hepatocellular adenoma

C.     Metastatic nodules

D.    Cholangiocarcinoma

E.     Hepatocarcinoma

Answer: C* Metastatic nodules

***) All of the following are indications of liver biopsy, except:

A.    Liver cirrhosis

B.     Pyrexia of unknown origin

C.     Hydatid cyst

D.    Unexplained hepatomegaly

E.     Hemochromatosis

Answer: C* Hydatid cyst

***) All of the following are indications for liver biopsy, except:

A.    Unexplained hepatomegaly

B.     Cirrhosis

C.     Infiltrations

D.    Tumors

E.     Prolonged prothrombin time

Answer: E* Prolonged Prothrombin time

2.    Liver Abscesses.

***) Concerning amebic liver abscess all of the following are correct, except:

A.    Most cases develop soon after an attack of amebic dysentery but occasionally amebic abscess develops in a carrier who has not had overt dysentery

B.     In 70% of cases the abscess is solitary and located in the upper part of the right lobe

C.     Clinical picture simulates acute cholecystitis

D.    Metronidazole 800mg three times daily for 7-10 days may abort early cases

E.     If medical treatment fails incision and drainage of the abscess must be done

Answer: A* Most cases develop soon after an attack of amebic dysentery but occasionally amebic abscess develops in a carrier who has not had overt dysentery

3.    Neoplasms.

***) All of the following can cause hepatocellular carcinoma, except:

A.    Hepatitis B

B.     Hepatitis C

C.     Hemochromatosis

D.    Alcoholic cirrhosis

E.     Fatty liver

Answer: C* Hemochromatosis