General surgery

·      Spleen GS54-GS55.

1.    Splenic Trauma.

***) The fallowing normal structures may be palpable in healthy subject, except:

A.    Liver

B.     Right Kidney

C.     Spleen

D.    Transverse colon

E.     Sigmoid and colon

Answer: C* Spleen

***) The most common organ injured in blunt abdominal trauma is:

A.    Liver

B.     Spleen

C.     Kidney

D.    Bowel

E.     Pancreas

Answer: B* Spleen

2.    Splenectomy.

***) A woman who has been splenectomized as a result of car accident wonders if there is any special immunization she would have, your answer will be:

A.    Measles

B.     Mumps

C.     Pertussis

D.    Pneumococcus

E.     Meningococcus

Answer: D* Pneumococcus

***) All the following are indications for splenectomy, except:

A.    Congenital spherocytosis

B.     Splenic abscess

C.     Typhoid fever

D.    Splenic hydatid cyst

E.     Traumatic massive laceration

Answer: C* Typhoid fever

***) All of the following are absolute indications for splenectomy, except:

A.    Massive tear of the spleen

B.     Malaria

C.     Traumatic rupture

D.    Splenic abscess

E.     Idiopathic thrombocytopenic purpura

Answer: B* Malaria

***) Following splenectomy in a child having blood dyscrasia, which one of the following drugs has to be given:

A.    Tetanus toxoid

B.     Antitetanic human immunoglobulin

C.     Pneumococcal vaccine

D.    Long term tetracycline therapy

E.     Triple vaccine

Answer: D* Long term tetracycline therapy

***) Following splenectomy in a child having blood dyscrasia which one of the following has to be given:

A.    Tetanus toxoid

B.     Triple vaccine

C.     Pneumococcal vaccine

D.    Long term tetracycline therapy

E.     Sabin vaccine

Answer: C* Pneumococcal vaccine

***) Grossly enlarged spleen occurs in one of the following:

A.    Typhoid fever

B.     Sickle cell anemia

C.     Rheumatoid arthritis

D.    Chronic myeloid leukemia

E.     Infective endocarditis

Answer: D* Chronic myeloid leukemia

·      Surgical Complications GS07-GS13.

1.    Postoperative Fever.

???) The most common complication post abdominal Surgery is:

DVT

Pneumonia

Atelectasis

Aspiration

Infection

Answer: C* Atelectasis

2.    Wound Complications.

???) Hemorrhage occurring 7 to 10 days after surgery is called:

Capillary hemorrhage

Reactionary hemorrhage

Primary hemorrhage

Secondary hemorrhage

Venous hemorrhage

Answer: 4* Secondary hemorrhage

???) All of the following are manifestations of internal hemorrhage, except:

Progressive pallor

Progressive hypotension

Progressive bradycardia

Rapidrespiration

Cold extremities

Answer: 3* Progressive bradycardia

·      Biliary Tract GS46-GS51.

1.    Cholelithiasis.

???) The following conditions are associated with increased gall stone formation, except:

Hemolytic anemia

Multiparity

Obesity

Resection of terminal ileum

Ulcerative colitis

Answer: 5* Ulcerative colitis

???) Gallstones in an infant or child are most frequently associated with:

Sickle cell anemia

Hepatitis B

Pyloric stenosis

Salmonella dysentery

Biliary atresia

Answer: 1* Sickle cell anemia

???) Gall stones may develop in one of the following disease:

Idiopathic thrombocytopenic purpura

Sickle cell anemia

Hemophilia

Congenital spherocytosis

Myelofibrosis

Answer: 2* Sickle cell anemia

???) One of the following is not used nowadays in the investigation of the biliary system:

Oral cholecystography

Ultrasonography

Intravenous cholangiography (IVC)

CT scan

Endoscopic retrograde cholangiopancreatography (ERCP)

Answer: 1* Oral cholecystography

???) The most common biliary stone is:

Bile pigment stone

Calcium carbonate

Calcium oxalate

Mixed stones

Pure cholesterol stone

Answer: 4* Mixed stones

???) All of the following are possible complications of biliary stones, except:

Obstructive jaundice

Ascending cholangitis

Intestinal obstruction

Acute pancreatitis

Gastric ulcer

Answer: 5* Gastric ulcer

???) All of the following stones may be found in the biliary tract, except:

Pure cholesterol stone

Mixed stone

Cystine stone

Pigment stone

Calcium carbonate stone

Answer: 3* Cystine stone

???) A 32 years old female found accidentally to have asymptomatic multiple small gall bladder stones, the best action to be taken is:

Follow up and observation to have surgery when symptomatic

Cholecystostomy and removal of the stones

Lithotripsy by shock waves

Chemical dissolution of the stones

Cholecystectomy

Answer: 5* Cholecystectomy

???) All of the following are risk factors for cholesterol gall stones, except:

Females more than males

Obesity

Contraceptive pills

Peptic ulcer

Multiparity

Answer: 4* Peptic ulcer

???) In extrahepatic biliary obstruction all of the following are true, except:

Elevated direct serum bilirubin

Prolonged protrombine time that does not respond to parenteral vitamin K administration

Clay-colored stool

Bile in urine

Increased serum alkaline phosphatase

Answer: 2* Prolonged protrombine time that does not respond to parenteral vitamin K administration

???) In obstructive jaundice all of the following are true, except:

Increased serum alkaline phosphatase

Increased serum direct bilirubin

Increased urinary bilirubin

Increase in urine urobilinogen

Increased fat content of stool

Answer: 4* Increase in urine urobilinogen

???) In a patient with obstructive jaundice bleeding tendency is due to:

Low platelet count

Thromboasthenia

Vitamin K deficiency

Hypofibrinogenemia

Hypoalbuminemia

Answer: 3* Vitamin K deficiency

???) All of the following are causes of cholestatic jaundice, except:

Common duct stones

Carcinoma of the head of pancreas

Biliary stricture

Sclerosing cholangitis

Hemolytic jaundice

Answer: 5* Hemolytic jaundice

2.    Cholecystitis.

***) Regarding acute cholecystitis all are true except:

A.    Greatest incidence occurs between the fourth and eighth decades

B.     Female to male ratio of 3:1

C.     Tenderness, muscle rigidity, Murphy's sign are common findings

D.    Treatment is always surgical

E.     Ultrasound shows calculi, thickened wall, and pericholecystic fluid

Answer: D* Treatment is always surgical

3.    Acute Cholangitis.

???) A middle-aged female with acute right upper abdominal pain, fever, rigors and jaundice suggests the diagnosis of:

Viral hepatitis

Ascending cholangitis

Acute pancreatitis

Acute pyelonephritis

Mucocele of the gall bladder

Answer: 2* Ascending cholangitis

???) Acute upper right abdominal pain with high fever, rigor and tinge of jaundice are manifestations of:

Ascending cholangitis

Acute biliary pain

Viral hepatitis

Mucocele of gall bladder

Acute cholecystitis

Answer: 1* Ascending cholangitis

4.    Gallstone Ileus.

???) A 40 year old female patient, presented with colicky abdominal pain, vomiting and abdominal distension, no hernias. Abdominal X-Ray shows dilated loops of small bowel, air in the biliary tree. The most likely diagnosis is:

Gallstone ileus

Internal hernia

Colon cancer

Umbilical hernia

Adhesion

Answer: 1* Gallstone ileus

???) On plain X-ray of a patient with acute abdomen air is seen in the biliary tree, the likely diagnosis is:

Calcular obstructive jaundice

Gall stone ileus

Chronic pancreatitis

Mucocele of gall bladder

Viral hepatitis

Answer: 2* Gall stone ileus

·      Pancreas GS51-GS54.

1.    Acute Pancreatitis.

???) The most common complication of the Endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy is:

Pancreatitis

Bleeding

Perforation

Cholangitis

Cholecystitis

Answer: 1* Pancreatitis

***) All of the following are causes of acute pancreatitis, except:

A.    Gall stones

B.     Alcohol

C.     Mumps

D.    Corticosteroids

E.     Contraceptive pills

Answer: B* Alcohol

***) Acute pancreatitis is associated with all of the following, except:

A.    Hyperglycemia

B.     Jaundice

C.     Right pleural effusion

D.    Ecchymosis around the umbilicus

E.     Increased urinary amylase

Answer: D* Ecchymosis around the umbilicus

???) The most common complication pancreatitis is:

Abscess

Pseudocyst

Acute respiratory distress syndrome (ARDS)

Splenic vein thrombosis

Dehydration

Answer: 2* Pseudocyst

???) In the initial 48 hours of acute pancreatitis all of the following are objective prognostic signs, except:

Hematocrite fall > 10%

Serum calcium level < 8 mg%

Serum proteins level < 5 mg%

Pa02 < 60 mm Hg

Estimated fluid sequestration > 6,0 ml

Answer: 3* Serum proteins level < 5 mg%

???) In the initial 48 hrs of acute pancreatitis, all the following are objective prognostic score (Ranson's criteria during the initial 48 hrs) except:

Hematocrit drop of more than 10%

Calcium less than 8 mg / dL

Oxygen less than 60

Sequestration more than 6 L

Amylase value more than 100

Answer: 5* Amylase value more than 100

???) All of the following are considered to be bad prognostic signs in acute pancreatitis, except:

Old age

PaO2 50

Serum calcium 5 mg%

Leukocytosis more than 20 000/ml

Blood urea 25 mg%

Answer: 5* Blood urea 25 mg%

???) Regarding acute pancreatitis all are true except:

Around 85% of patients have mild form of interstitial edema of the gland

Pancreatic divisum may be a cause of recurrent pancreatitis

Alcoholism and biliary tract disease are common causes

Serum amylase level is important in determining survival

May be the initial presentation in some patients with pancreatic cancer

Answer: 4* Serum amylase level is important in determining survival

???) The mortality of severe acute pancreatitis can be minimized by using a comprehensive management plan. This plan includes the following except :

Determination of the etiology of pancreatitis

Assessment of the severity and intensive care support

Prompt institution of aggressive fluid resuscitation

Aggressive surgical debridement of infected cases

Administration of proton pump inhibiter

Answer: 5* Administration of proton pump inhibiter

???) The most common cause of acute pancreatitis is:

Trauma

Steroids

Gallstones

Ethanol

Mumps

Answer: 3* Gallstones

???) All of the following parameters are well established criteria for severe pancreatitis, except:

Low calcium

High blood sugar

Low pO2 (Partial Pressure of Oxygen)

Low blood urea

Elevated liver enzymes (transaminases)

Answer: 4* Low blood urea

2.    Chronic Pancreatitis.

***) The most common cause of chronic pancreatitis is:

A.    Protein malnutrition

B.     Hyperlipidemia

C.     Alcohol

D.    Idiopathic

E.     Post ERCP

Answer: C* Alcohol

???) Clinical presentation of chronic pancreatitis may include all of the following, except:

Jaundice

Pain in the abdomen

Diabetes mellitus

Weight gain

Mal absorption

Answer: 4* Weight gain

3.    Pancreatic Cancer.

???) Which of the following has been implicated in pancreatic cancer:

Protein rich diet

Fat rich diet

Fiber rich diet

Alcohol

Smoking

Answer: 5* Smoking

???) All the following are risk factors for pancreatic cancer except:

Obstructive jaundice

Unexplained weight loss

Type 1 DM

Steatorrhea

Idiopathic acute pancreatitis

Answer: 5* Idiopathic acute pancreatitis

???) The most common cystic swelling of the pancreas is:

Hydatid cyst

Dermoid cyst

Cystadenoma

Pancreatic pseudocyst

Congenital cysts

Answer: 4* Pancreatic pseudocyst

***) Regarding pancreatic cysts and pseudo-cysts, one is correct:

Are the same things

Are different on clinical examination

Cause a swelling above umbilicus

Cause a swelling below umbilicus

Aspiration is a treatment of choice

Answer: 3* Cause a swelling above umbilicus

***) Regarding anular pancreas, one is correct:

All cases present in new born infants

Frequently present with pancreatitis

Usually present with duodenal obstruction

It is best treated by resection of the annular portion

Associated with risk of adenocarcinoma

Answer: 3* Usually present with duodenal obstruction

·      Breast GS55-GS60.

1.    Benign Breast Lesions.

***) Number of the breast lobes and in turn the number of the duct orifices at the nipple is:

A.    2 – 3

B.     5 – 7

C.     9 – 11

D.    15 – 20

E.     25 – 30

Answer: D* 15 – 20

***) Fibroadenoma may be associated with one of the following breast diseases:

A.    Fibrocystic disease of breast

B.     Intraductal papilloma

C.     Duct ectasia

D.    Galactocele

E.     Medullary carcinoma

Answer: A* Fibrocystic disease of breast

***) Nipple discharge can be a manifestation of all of the following, except:

A.    Fibrocystic disease

B.     Duct ectasia

C.     Fibroadenoma

D.    Breast carcinoma

E.     Intraductal carcinoma

Answer: C* Fibroadenoma

***) All of the following conditions are benign breast disease, except:

A.    Fibroadenoma

B.     Duct ectasia

C.     Fibroadenosis

D.    Duct papilloma

E.     Breast abscess

Answer: C* Fibroadenosis

***) In breast abscess the commonest causative bacteria are:

A.    Staphylococcus

B.     Streptococcus

C.     Pneumococcus

D.    Tuberculosis bacilli

E.     Bacteroids

Answer: A* Staphylococcus

***) All of the following are usually caused by streptococcal infection, except:

A.    Cellulites

B.     Breast abscess

C.     Erysipelas

D.    Tonsillitis

E.     Scarlet fever

Answer: B* Breast abscess

***) The treatment of acute breast abscess is:

A.    Intravenous antibiotics for one week

B.     Repeated needle aspiration

C.     Incision and drainage under general anesthesia

D.    Localized incision

E.     Simple mastectomy

Answer: C* Incision and drainage under general anesthesia

2.    Breast Cancer.

***) Breast self-examination in reproductive age women is best performed:

A.    At the onset of menses

B.     Just after menses

C.     At mid cycle

D.    Just before the onset of menses

E.     Monthly at anytime during the cycle

Answer: B* Just after menses

***) The most common site for breast cancer to appear is:

A.    Upper outer quadrant

B.     Upper inner quadrant

C.     Lower outer quadrant

D.    Lower inner quadrant

E.     Under the nipple

Answer: A* Upper outer quadrant

***) Breast cancer is least associated with one of the following:

A.    Positive family history of breast cancer

B.     Late first pregnancy

C.     Multiparity

D.    Hard fibroadenoma

E.     Fibrocystic disease

Answer: C* Multiparity

***) A 40 years old lady with premenstrual breast pain, nipple discharge of variable color and the breasts are coarse nodular and tender, this lady probably has:

A.    Acute mastitis

B.     Duct ectasia

C.     Fat necrosis

D.    Fibroadenosis of the breast

E.     Paget's disease of the breast

Answer: D* Fibroadenosis of the breast

***) Bleeding from the nipple may occur in all of the following, except:

A.    Fibroadenoma

B.     Fibrocystic disease

C.     Duct ectasia

D.    Intraductal papilloma

E.     Intraductal carcinoma

Answer: B* Fibrocystic disease

***) A 35 years old lady with a painless hard mass in her breast, the first step to be done is:

A.    Total body CT scanning

B.     Excisional biopsy

C.     Fine needle aspiration for cytology

D.    Incisional biopsy

E.     Broad spectrum antibiotics and follow up

Answer: C* Fine needle aspiration for cytology

***) The following are more liable to develop breast carcinoma, except:

A.    Females with positive family history of breast carcinoma

B.     Nulliparous women

C.     Women with long standing fibrocystic disease of breast

D.    Females with fat necrosis of the breast

E.     Females who have first child above thirty

Answer: D* Females with fat necrosis of the breast

***) Regarding Paget’s disease of the breast, one is correct:

A.    It is a sort of chronic eczema of the nipple

B.     It is usually bilateral

C.     It is a malignant disease of breast

D.    Needs long treatment with steroid ointment

E.     Associated with nipple retraction in early stages

Answer: C* It is a malignant disease of breast

***) Blood stained discharge from one orifice of the nipple is a characteristic of:

A.    Early menarche

B.     Lactation

C.     Pregnancy

D.    Intra-ductal papilloma

E.     Fibroadenoma

Answer: D* Intra-ductal papilloma

***) Unilateral retraction of the nipple may occur in all of the following, except:

A.    Duct ectasia

B.     Fibroadenoma

C.     Intraductal carcinoma

D.    Developmental occurring at the time of puberty

E.     Chronic breast abscess

Answer: B* Fibroadenoma

***) The risk of bilateral breast cancer is high if the first breast shows:

A.    Comedocarcinoma

B.     Inflammatory carcinoma

C.     Lobular carcinoma

D.    Paget's disease

E.     Duct papillary carcinoma

Answer: C* Lobular carcinoma

***) The initial site of distant metastasis in breast cancer:

A.    Lungs

B.     Liver

C.     Bones

D.    Brain

E.     Spleen

Answer: C* Bones

***) All the following are clinical features of breast cancer except:

A.    Hard mass

B.     Well defined borders

C.     Limited mobility

D.    Watery discharge

E.     Nipple retraction

Answer: B* Well defined borders

***) All the following are risk factors of breast cancer except:

A.    Personal history of breast cancer

B.     Family history in first degree relatives

C.     Late menarche and early menopause

D.    Nulliparity or late age of first pregnancy

E.     Post menopausal hormonal replacement therapy

Answer: C* Late menarche and early menopause

·      Clinical Nutrition G50-G52.

1.    Nutrition.

???) Regarding nutritional requirements, all the following are true except:

Energy requirement is 25-30 kcal/kg/day

1 gram of fat gives 9 kcal

1 gram of protein gives 4 kcal

1 gram of carbohydrate gives 4 kcal

During hyperthermia the energy requirement decreased

Answer: 5* During hyperthermia the energy requirement decreased

???) Concerning Starvation symptoms, all the following are true except:

Food intolerance, hepatic gluconeogenesis

Hyperglycemia, increased insulin concentration

Diarrhea, increased protein catabolism

Acidosis, increased plasma glucagon, decreased energy requirement

Low plasma insulin concentrations, lipolysis

Answer: 2* Hyperglycemia, increased insulin concentration

???) The addition of fat to carbohydrate in TPN will do all of the following except:

Prevent essential fatty acid deficiency

Reduce the likelihood of respiratory distress from carbohydrate infusion

Reduce the incidence of fatty liver infiltration

Improve nitrogen balance

Reduce the chance of glucose intolerance in diabetic patients

Answer: 4* Improve nitrogen balance

2.    Parenteral Nutrition (PN).

???) Parenteral feeding is given usually through:

The antecubital vein

The caphalic vein

The subclavian vein

The saphenous vein

The portal vein

Answer: 3* The subclavian vein

***) The following diseases are autosomal recessive, except:

A.    Thalassemia

B.     Hemochromatosis

C.     Cystic fibrosis

D.    Frederick ataxia

E.     Familial adenomatous polyposis

Answer: E* Familial adenomatous polyposis