اسئلة الجراحة 2017 (4)
1)One of the following is false concerning gastrointestinal stoma ?
A. Patient with abdomenoperitoneal reaction require a permanent stoma .
B. Iliostomy is usually fashioned with a spout to avoid skin irritation .
C. Colostomy is usually constructed in the Rt iliac Fossa .
D. Patient with Iliostomy may need water and electrolytes replacement by IV .
E. Stoma may be indicated in patient with bowel ischemia
2) all sentences About a colles fracture are true except ?
A. A fracture with mild angulation may require closed reduction .
B. Usually produced by fall on out stretched hand .
C. Defined as a fracture of the distal radius with ventral displacement .
D. Occur more frequently in elderly persons as a result of osteoporosis .
E. Could be complicated by neuropathy and volkman ischemic contracture .
3) All the following are true about pulse oximetry except ?
A. Presence of smoke inhalation injury and may lead to a falsely elevated pulse oximetry .
B. Nails Polish should be removed before any surgery because it affects reading on the pulse oximeter .
C. Ear probes can detect changes on oxygen saturation faster than finger probes .
D. It depends on the fact that oxygenated and deoxygenated Hb absorb red and infra red light differently .
E. It's reading are not affected by the temperature of patient hand.
4) You have been asked to consent a patient for insertion of a central line you counsed the patient through the reason for the procedure, what is the most common immediate complications of central line insertion ?
A. Infection .
B. Thrombus .
C. Hemorrhage .
D. Pneumothorax .
E. Air embolism .
5) which of the following is true about testicular tumors ?
A. The incidence of germ cell tumors has decreased over the past 20 years .
B. An elevated lactate dehydrogenase is indicator of good prognosis .
C. Orchidectomy should be performed only after confirmation of diagnosis with frozen section .
D. Elevated alfa feto protein is found in 75% of patient with pure seminoma .
E. Orchidectomy and nodal radiotherapy result in a cure rate of 98% in stage 1 seminoma .
6 ) Regarding simple appendicitis , all are true except ?
A . Periumbilical pain is visceral in nature and occurs early .
B . Right iliac fossa pain is somatic in nature and occurs later .
C . Positive rebound tenderness means peritoneal irritation .
D . CT scan is the preferred imaging test for appendicitis in females and children .
E . Meckel diverticulum may mimic the clinical picture of appendicitis .
7 ) 57 years old patient presented with nocturia ( 3 time / night ) , weak stream intermittency and frequency , his digital rectal examination revealed induration of the right lobe of prostate . All of the following statements are appropriate except ?
A . Treat the obstructive symptoms .
B . Perform ultrasound for residual urine assessment .
C . Blood sample for prostate specific antigen is not usually required .
D . This patient most likely needs prostate biopsy .
E . His past history and medication have to be checked .
8 ) Severe electrical burn , one is true ?
A . Causes most of it's damage of the exit site .
B . Is usually more sever it caused by direct current rather than alternating current .
C . Frequently causes a muscle injury more like crush injury .
D . Tends to resolve quickly in patients who survive the initial injury .
E . Is usually treated according to the extent of thermal and underlying subcutaneous tissue damage .
9 ) All sentences about burn are correct except ?
A . Circumferential superficial partial thickness burn causes compartment syndrome .
B . Deep partial thickness burn appears more pale and mottled to superficial degree .
C. Blister can form in both superficial and deep partial thickness .
D . Sun burn cause superficial partial thickness burn .
E . Skin grafts are not required in managing partial thickness .
10 ) To allow kidney donation from a young patient intubated in the ICU , a brain death need to confirmed first , all of the following examination finding are consistent with brain death except ?
A . Dilated non reactive pupils .
B . Absent oculocephalic reflex .
C . Extensor posturing .
D . Absent gag reflex .
E . Absent corneal reflex .
11 ) A 56 years old woman presented with sever upper abdominal pain related to her back and associated with nausea and vomiting , her serum lipase level was 6300 u/ L . The patient was given intravenous analgesia . What is the best and most important next step in management ?
A . Begin intravenous fluid resuscitation and oxygen supplement .
B . Begin prophylactic antibiotics to minimize the risk of pancreatic infection .
C . Change her diet to clear liquids by mouth only .
D . Obtain a contrast enhanced CT scan of the abdomen .
E . Obtain a right upper quadrant ultrasound .
12 ) Which of the following statements is true regarding varicocele ?
A . They should be looked for while the patient is supine .
B . They usually result infertility .
C . They may affect sperm motility and count .
D . They result in lower testicular temperature .
E . They should always be required when identified .
13 ) A postoperative patient is being managed on a intensive care unit following subtotal colectomy . Blood result shows the phosphate level is 0.25 mmol/L . Which one of the following statement regarding intravenous phosphate is incorrect ?
A . May cause Hypercalcemia .
B . Should never be given at rate greater than 30 mmol over 6 hours .
C . Should preferentially be given via a central line .
D . May cause metastatic calcification .
E . Should be used even if the patient is asymptomatic .
14 ) 25 years old female patient presented to emergency room after being involved in road traffic accident, 2.5 hours ago as a driver . She complains of right sided headache and can't remember the accident . Examination showed a deformed fracture on the right side of her skull . You sent the patient for CT of her head . After CT the patient suddenly became unresponsive . The CT will most likely show ?
A . Epidural hematoma .
B . Chronic subdural hematoma .
C . Subarachnoid bleeding .
D . Intraventricular bleeding .
E . Diffuse axonal injury .
15 ) Routine tracheostomy , with few exceptions is typically performed at the level of ?
A . Cricoid cartilage .
B . Cricothyroid membrane .
C . Cricoid and first ring .
D . Second ring and third ring .
E . Fifth and sixth tracheal ring .
16 ) Which of the following diagnosis is most likely in a child with HTN and past history of UTI ?
A . Ureteropelvic junction obstruction .
B . Reflux nephropathy .
C . Wilms tumor .
D . Renal artery stenosis .
E . Posterior urethral valve .
17 ) All of the following are true regarding computerized tomography used in urology except ?
A . CT without contrast is the imaging of choice for acute flank pain .
B . CT with contrast is preferred in renal trauma .
C . MRI is more sensitive in evaluating adrenal masses .
D . CT is not operator dependent .
E . Uric acid stones are not visualized by CT scan .
18 ) All sentences about abdominal hernias are true except ?
A . Most umbilical hernias in adult are acquired .
B . Incisional hernia results from a failure of fascial tissue to heal and close after surgery .
C . Incisional hernia is more common after open compared with laparoscopic operation .
D . Lumbar hernia is not common hernia .
E . Divarication of rectus abdominis muscles in elderly necessities surgical repair .
19 ) Optimal medical therapy in a patient with carotid artery stenosis would include ?
A . Smoking cessation .
B . Antiplatelet agent's .
C . Control HTN .
D . Statins drug's .
E . All are true .
20 ) Skin cancer can result from exposure to one of the following ?
A . Microwave .
B . Ionizing radiation .
C . Solar ultraviolet A .
D . X ray .
E . Infrared rays .
21 ) Acute pyelonephritis is best diagnosed by ?
A . Vesicoureteral reflux .
B . Bacteriuria and pyuria .
C . Delayed renal function .
D . Focal scar in renal cortex .
E . Chills , fever and flank pain
22 ) All sentences about appendicitis are true except ?
A . Mcburney point corresponds to the location of the tip of appendix .
B . Psoas sign is elicited by extension of the right hip .
C . Laparoscopy is one of the diagnostic methods .
D . Rovsing sign is elicited by pressing in the left iliac fossa causing pain in the right iliac fossa .
E . Alvardo score is not routinely calculated for the diagnosis of appendicitis .
23 ) One of the following vaccines can't be given to immunocompromised patient ?
A . Hepatitis B .
B . DPT .
C . Influenza vaccine .
D . Inactivated polio vaccine .
E . Oral polio vaccine .
24 ) All of the following are true regarding Hirschsprung disease except ?
A . There is no ganglion cells in Auerbach plexus .
B . There is an increased incidence of Down syndrome .
C . It is more common in girls .
D . On X _ ray the affected bowel is narrowed distally , while the normal bowel is dilated proximally .
25 ) All of the following are true about diverticulosis coli except ?
A . Sigmoid colon in the commonest site .
B . Are considered false diverticulum and it mucosa is lined by normal colonic cell .
C . The affected patient may present with bleeding per rectum .
D . Surgery is the primary treatment for diverticulosis .
E . Low fiber diet is a risk factor for this condition .
26 ) All sentences about neck of femur fracture are true except ?
A . Typically occur in elderly female patient .
B. Leg may be shortened and internally rotated in displaced fracture .
C . AVN is more common in this place than at other site's in the body .
D . Almost always will require corrective surgery .
E . Prognosis is poor in general .
27 ) All of the following sentences about hernia are true except ?
A . Inguinal hernia is the most common hernia in both females and male's .
B . Femoral hernias are most common in females than male's .
C . Morbidity is increased after emergency compared with elective repair of hernia .
D . Urinary hesitancy and straining increase the risk for hernia formation .
E . Open is always better and safer than laparoscopic approach for hernia repair .
28 ) A 28 years old female , previously healthy , presented as an emergency with abdominal pain aggravated by fatty meals , and associated with jaundice , vomiting , itching , clay color stool , tea color urine , no history of weight loss . All are true except ?
A . This patient need admission , pain killer's , rehydration , IV fluids + _ antibiotics .
B . The most likely diagnosis gallstones and stone in the common bile duct .
C . The cause of clay color stool is absence of stercobilinogen from stool .
D . The cause of tea color urine is increased conjugated bilirubin in urine .
E . The serum liver function test will most likely show decreased alkaline phosphatase .
29 ) Regarding breast cancer , all of the following is true except ?
A . Peau d Orange appearance of the breast indicate advanced stage .
B . Eczema around the nipple should always be investigated .
C . Trucut biopsy is more accurate than the needle aspiration ( FNA) .
D . Bloody nipple discharge could be due to a benign cause .
E . Palpable lymph node supraclavicular fossa indicate distant metastasis .
30 ) A 25 years old lady was admitted via emergency complaining of abdominal pain and suspected to have acute gallstone pancreatitis based on symptoms and blood tests . What is the best initial imaging study in this situation ?
A . Abdominal and pelvic computerized tomography .
B . Endoscopic ultrasound .
C . MRCP .
D . ERCP .
E . Abdominal ultrasound .
31 ) In infantile hypertrophic pyloric stenosis , one of the following statements is false ?
A . The infant usually presents with projectile bilious vomiting .
B . The treatment is surgical by Ramstedt operation .
C . Symptoms commence at the age of 3 _ 4 weeks .
D . A palpable olive shaped mass is usually felt in the classical case .
E . Ultrasound is usually diagnostic .
32 ) At 2 day's after a motor vehicle crash , an otherwise healthy 30 years old man is recovering in the ICU from rib fractures , pulmonary contusion , and a liver laceration . He complains of increasing right upper quadrant pain and vomits bright red blood . Which of the following approaches is best ?
A . Operative exploration and liver resection .
B . Hepatic artery ligation .
C . Angiographic arterial embolization .
D . ERCP with sphincterotomy .
E . Coagulopathy workup .
33 ) 50 years old woman came to your clinic stating that she has a one month history of a palpable right breast lump . On examination , you can feel a 1 cm mobile , firm nodule at 2 o'clock position . Your first diagnostic test of choice is ?
A . Excisional biopsy .
B . Incisional biopsy .
C . CT scan .
D . Mammogram .
E . Ultrasound .
34 ) A 41 year old gentleman came to your clinic complaining of respiratory symptoms . Your differential diagnosis is pleural effusion versus pneumothorax . Which of the following physical findings will best help you differentiate between these two possibilities ?
A . Respiratory rate 33 breaths / minute .
B . Agitation due to respiration distress .
C . Decreased breath sounds over the affected hemithorax .
D . Dullness to percussion over the affected hemithorax .
E . Cough .
35 ) All of the following are classic signs of basal skull fracture except ?
A . Raccoon eyes .
B . Battle sign .
C . Hemotympanum .
D . Dilated non reactive pupils .
E . Cerebrospinal fluid rhinorrhea .
36 ) All of the following are true about the assessment of bleeding except ?
A . Taking blood sample at the time of bleeding gives an accurate level of haemoglobin .
B . Hypovolemia increase the risk of tissue hypoxia and multi organ failure .
C . Blood loss could be estimated from the size of blood clot and the weight of swabs used .
D . Any thirsty patient should be considered Hypovolemic .
E . Arterial blood gas is a quick method to measure hemoglobin
37 ) All of the following sentences are true about pathophysiology of shock except ?
A . Shock means inadequate oxygen delivery to meet metabolic demands .
B . Shock may occur without loss in the circulating volume .
C . Severe infection may lead to decreased cardiac preload .
D . Serum lactate decreases in shock .
E . The function of phagocytes is decreased in shock .
38 ) All sentences about arteriovenous fistula are true except ?
A . It's complication include stenosis , aneurysm and heart failure .
B . Renal dialysis is the most common indication to create it .
C . Palpable thrill and audible bruit over the fistula indicate that is thrombosed .
D . Paleness and coldness of the hand during exercise and dialysis indicate the presence of steal syndrome .
E . The three most common sites are radiocephalic , brachiocephalic , and brachial artery to transposed basilic vein .
39 ) Regarding the preoperative management all sentences are true except ?
A . A recent myocardial infarction is the most important risk factor for perioperative myocardial infarction .
B . Patients should take their regular Antihypertensive drug's even on the day of surgery .
C . History and examination alone are not usually sufficient in evaluating the risk of bleeding .
D . LMWH is used in venous thromboembolism prophylaxis .
E . Poorly controlled blood sugar in the preoperative period increases the risk for surgical site infections .
40 ) 40 year old male come to your clinic asking for advice about his anal fissure . One of the following sentences is an appropriate advice ?
A . Surgery is primary treatment for acute anal fissure .
B . Anal fissures are usually located in the lateral aspect of the canal .
C . Anal fissure in patients with Crohn disease usually indicate malignancy .
D . Medical treatment is successful in 20% of case's .
E . Surgical treatment may be complicated by incontinence
41 ) 53 year old female presented as an emergency with crampy abdominal pain for 4 days and associated with vomiting , abdominal distention and constipation . Patient denies weight loss . Her past history was only significant for previous open appendectomy and open cholecystectomy . Abdominal examination did not reveal an Incisional hernia . All of the following sentences are true except ?
A . She should be admitted for intravenous fluid hydration and electrolyte replacement .
B . As female patient , groin examination can be postponed for few days .
C . Adhesion are the most likely cause for her condition .
D . It is essential is to obtain an upright chest x Ray .
E . It is essential is to obtain an abdominal x Ray ( upright and supine ) .
42 ) All of the following sentences about gallstones are true except ?
A . Gallstones in diabetic patients are more dangerous due to silent cholecystitis .
B . Obesity and sickle cell anemia are risk factors for gallstones formation .
C . Cholecystectomy can be performed in pregnant woman .
D . Every patient undergoing cholecystectomy should be consented about bile leak .
E . Extracorporeal shock wave lithotripsy is one of the effective treatments for gallstones .
43 ) All sentences about sialolithiasis are true except ?
A . Parotid gland is the most common site of salivary calculi .
B . Salivary calculus contains debris bacteria , mucous , magnesium and phosphates .
C . Easily demonstrated by x Ray .
D . Most occur in middle aged adults .
E . The main symptoms are pain and swelling before and during eating .
44 ) A 42 year old morbidly obese white woman ( BMI = 40 ) presents to your office requesting information on screening for colon cancer , she is asymptomatic and has a colonoscopy for her is which of the following ?
A . She should have received a colonoscopy between age 10 _ 12 .
B . She should have received a colonoscopy between age 20 _ 25 .
C . She should have received a colonoscopy at age 40 .
D . She should receive a colonoscopy at age 45 .
E . She should receive a colonoscopy at age 50 .
45 ) A 39 year old patient presented to you at the emergency room after chest trauma . Which of the following scenarios is most consistent with left tension pneumothorax ?
A . Hypotension , distended neck veins , midline trachea and muffled heart sounds .
B . Hypotension , open 4 cm 215 , 4 cm lateral chest wound .
C . Hypotension , diminished breath sound on the left tracheal opacification of the left hemithorax .
D . Diminished left sided breath sounds , tracheal deviation to right .
E . Hypotension , adjacent three fractured in two places .
A. Patient with abdomenoperitoneal reaction require a permanent stoma .
B. Iliostomy is usually fashioned with a spout to avoid skin irritation .
C. Colostomy is usually constructed in the Rt iliac Fossa .
D. Patient with Iliostomy may need water and electrolytes replacement by IV .
E. Stoma may be indicated in patient with bowel ischemia
2) all sentences About a colles fracture are true except ?
A. A fracture with mild angulation may require closed reduction .
B. Usually produced by fall on out stretched hand .
C. Defined as a fracture of the distal radius with ventral displacement .
D. Occur more frequently in elderly persons as a result of osteoporosis .
E. Could be complicated by neuropathy and volkman ischemic contracture .
3) All the following are true about pulse oximetry except ?
A. Presence of smoke inhalation injury and may lead to a falsely elevated pulse oximetry .
B. Nails Polish should be removed before any surgery because it affects reading on the pulse oximeter .
C. Ear probes can detect changes on oxygen saturation faster than finger probes .
D. It depends on the fact that oxygenated and deoxygenated Hb absorb red and infra red light differently .
E. It's reading are not affected by the temperature of patient hand.
4) You have been asked to consent a patient for insertion of a central line you counsed the patient through the reason for the procedure, what is the most common immediate complications of central line insertion ?
A. Infection .
B. Thrombus .
C. Hemorrhage .
D. Pneumothorax .
E. Air embolism .
5) which of the following is true about testicular tumors ?
A. The incidence of germ cell tumors has decreased over the past 20 years .
B. An elevated lactate dehydrogenase is indicator of good prognosis .
C. Orchidectomy should be performed only after confirmation of diagnosis with frozen section .
D. Elevated alfa feto protein is found in 75% of patient with pure seminoma .
E. Orchidectomy and nodal radiotherapy result in a cure rate of 98% in stage 1 seminoma .
6 ) Regarding simple appendicitis , all are true except ?
A . Periumbilical pain is visceral in nature and occurs early .
B . Right iliac fossa pain is somatic in nature and occurs later .
C . Positive rebound tenderness means peritoneal irritation .
D . CT scan is the preferred imaging test for appendicitis in females and children .
E . Meckel diverticulum may mimic the clinical picture of appendicitis .
7 ) 57 years old patient presented with nocturia ( 3 time / night ) , weak stream intermittency and frequency , his digital rectal examination revealed induration of the right lobe of prostate . All of the following statements are appropriate except ?
A . Treat the obstructive symptoms .
B . Perform ultrasound for residual urine assessment .
C . Blood sample for prostate specific antigen is not usually required .
D . This patient most likely needs prostate biopsy .
E . His past history and medication have to be checked .
8 ) Severe electrical burn , one is true ?
A . Causes most of it's damage of the exit site .
B . Is usually more sever it caused by direct current rather than alternating current .
C . Frequently causes a muscle injury more like crush injury .
D . Tends to resolve quickly in patients who survive the initial injury .
E . Is usually treated according to the extent of thermal and underlying subcutaneous tissue damage .
9 ) All sentences about burn are correct except ?
A . Circumferential superficial partial thickness burn causes compartment syndrome .
B . Deep partial thickness burn appears more pale and mottled to superficial degree .
C. Blister can form in both superficial and deep partial thickness .
D . Sun burn cause superficial partial thickness burn .
E . Skin grafts are not required in managing partial thickness .
10 ) To allow kidney donation from a young patient intubated in the ICU , a brain death need to confirmed first , all of the following examination finding are consistent with brain death except ?
A . Dilated non reactive pupils .
B . Absent oculocephalic reflex .
C . Extensor posturing .
D . Absent gag reflex .
E . Absent corneal reflex .
11 ) A 56 years old woman presented with sever upper abdominal pain related to her back and associated with nausea and vomiting , her serum lipase level was 6300 u/ L . The patient was given intravenous analgesia . What is the best and most important next step in management ?
A . Begin intravenous fluid resuscitation and oxygen supplement .
B . Begin prophylactic antibiotics to minimize the risk of pancreatic infection .
C . Change her diet to clear liquids by mouth only .
D . Obtain a contrast enhanced CT scan of the abdomen .
E . Obtain a right upper quadrant ultrasound .
12 ) Which of the following statements is true regarding varicocele ?
A . They should be looked for while the patient is supine .
B . They usually result infertility .
C . They may affect sperm motility and count .
D . They result in lower testicular temperature .
E . They should always be required when identified .
13 ) A postoperative patient is being managed on a intensive care unit following subtotal colectomy . Blood result shows the phosphate level is 0.25 mmol/L . Which one of the following statement regarding intravenous phosphate is incorrect ?
A . May cause Hypercalcemia .
B . Should never be given at rate greater than 30 mmol over 6 hours .
C . Should preferentially be given via a central line .
D . May cause metastatic calcification .
E . Should be used even if the patient is asymptomatic .
14 ) 25 years old female patient presented to emergency room after being involved in road traffic accident, 2.5 hours ago as a driver . She complains of right sided headache and can't remember the accident . Examination showed a deformed fracture on the right side of her skull . You sent the patient for CT of her head . After CT the patient suddenly became unresponsive . The CT will most likely show ?
A . Epidural hematoma .
B . Chronic subdural hematoma .
C . Subarachnoid bleeding .
D . Intraventricular bleeding .
E . Diffuse axonal injury .
15 ) Routine tracheostomy , with few exceptions is typically performed at the level of ?
A . Cricoid cartilage .
B . Cricothyroid membrane .
C . Cricoid and first ring .
D . Second ring and third ring .
E . Fifth and sixth tracheal ring .
16 ) Which of the following diagnosis is most likely in a child with HTN and past history of UTI ?
A . Ureteropelvic junction obstruction .
B . Reflux nephropathy .
C . Wilms tumor .
D . Renal artery stenosis .
E . Posterior urethral valve .
17 ) All of the following are true regarding computerized tomography used in urology except ?
A . CT without contrast is the imaging of choice for acute flank pain .
B . CT with contrast is preferred in renal trauma .
C . MRI is more sensitive in evaluating adrenal masses .
D . CT is not operator dependent .
E . Uric acid stones are not visualized by CT scan .
18 ) All sentences about abdominal hernias are true except ?
A . Most umbilical hernias in adult are acquired .
B . Incisional hernia results from a failure of fascial tissue to heal and close after surgery .
C . Incisional hernia is more common after open compared with laparoscopic operation .
D . Lumbar hernia is not common hernia .
E . Divarication of rectus abdominis muscles in elderly necessities surgical repair .
19 ) Optimal medical therapy in a patient with carotid artery stenosis would include ?
A . Smoking cessation .
B . Antiplatelet agent's .
C . Control HTN .
D . Statins drug's .
E . All are true .
20 ) Skin cancer can result from exposure to one of the following ?
A . Microwave .
B . Ionizing radiation .
C . Solar ultraviolet A .
D . X ray .
E . Infrared rays .
21 ) Acute pyelonephritis is best diagnosed by ?
A . Vesicoureteral reflux .
B . Bacteriuria and pyuria .
C . Delayed renal function .
D . Focal scar in renal cortex .
E . Chills , fever and flank pain
22 ) All sentences about appendicitis are true except ?
A . Mcburney point corresponds to the location of the tip of appendix .
B . Psoas sign is elicited by extension of the right hip .
C . Laparoscopy is one of the diagnostic methods .
D . Rovsing sign is elicited by pressing in the left iliac fossa causing pain in the right iliac fossa .
E . Alvardo score is not routinely calculated for the diagnosis of appendicitis .
23 ) One of the following vaccines can't be given to immunocompromised patient ?
A . Hepatitis B .
B . DPT .
C . Influenza vaccine .
D . Inactivated polio vaccine .
E . Oral polio vaccine .
24 ) All of the following are true regarding Hirschsprung disease except ?
A . There is no ganglion cells in Auerbach plexus .
B . There is an increased incidence of Down syndrome .
C . It is more common in girls .
D . On X _ ray the affected bowel is narrowed distally , while the normal bowel is dilated proximally .
25 ) All of the following are true about diverticulosis coli except ?
A . Sigmoid colon in the commonest site .
B . Are considered false diverticulum and it mucosa is lined by normal colonic cell .
C . The affected patient may present with bleeding per rectum .
D . Surgery is the primary treatment for diverticulosis .
E . Low fiber diet is a risk factor for this condition .
26 ) All sentences about neck of femur fracture are true except ?
A . Typically occur in elderly female patient .
B. Leg may be shortened and internally rotated in displaced fracture .
C . AVN is more common in this place than at other site's in the body .
D . Almost always will require corrective surgery .
E . Prognosis is poor in general .
27 ) All of the following sentences about hernia are true except ?
A . Inguinal hernia is the most common hernia in both females and male's .
B . Femoral hernias are most common in females than male's .
C . Morbidity is increased after emergency compared with elective repair of hernia .
D . Urinary hesitancy and straining increase the risk for hernia formation .
E . Open is always better and safer than laparoscopic approach for hernia repair .
28 ) A 28 years old female , previously healthy , presented as an emergency with abdominal pain aggravated by fatty meals , and associated with jaundice , vomiting , itching , clay color stool , tea color urine , no history of weight loss . All are true except ?
A . This patient need admission , pain killer's , rehydration , IV fluids + _ antibiotics .
B . The most likely diagnosis gallstones and stone in the common bile duct .
C . The cause of clay color stool is absence of stercobilinogen from stool .
D . The cause of tea color urine is increased conjugated bilirubin in urine .
E . The serum liver function test will most likely show decreased alkaline phosphatase .
29 ) Regarding breast cancer , all of the following is true except ?
A . Peau d Orange appearance of the breast indicate advanced stage .
B . Eczema around the nipple should always be investigated .
C . Trucut biopsy is more accurate than the needle aspiration ( FNA) .
D . Bloody nipple discharge could be due to a benign cause .
E . Palpable lymph node supraclavicular fossa indicate distant metastasis .
30 ) A 25 years old lady was admitted via emergency complaining of abdominal pain and suspected to have acute gallstone pancreatitis based on symptoms and blood tests . What is the best initial imaging study in this situation ?
A . Abdominal and pelvic computerized tomography .
B . Endoscopic ultrasound .
C . MRCP .
D . ERCP .
E . Abdominal ultrasound .
31 ) In infantile hypertrophic pyloric stenosis , one of the following statements is false ?
A . The infant usually presents with projectile bilious vomiting .
B . The treatment is surgical by Ramstedt operation .
C . Symptoms commence at the age of 3 _ 4 weeks .
D . A palpable olive shaped mass is usually felt in the classical case .
E . Ultrasound is usually diagnostic .
32 ) At 2 day's after a motor vehicle crash , an otherwise healthy 30 years old man is recovering in the ICU from rib fractures , pulmonary contusion , and a liver laceration . He complains of increasing right upper quadrant pain and vomits bright red blood . Which of the following approaches is best ?
A . Operative exploration and liver resection .
B . Hepatic artery ligation .
C . Angiographic arterial embolization .
D . ERCP with sphincterotomy .
E . Coagulopathy workup .
33 ) 50 years old woman came to your clinic stating that she has a one month history of a palpable right breast lump . On examination , you can feel a 1 cm mobile , firm nodule at 2 o'clock position . Your first diagnostic test of choice is ?
A . Excisional biopsy .
B . Incisional biopsy .
C . CT scan .
D . Mammogram .
E . Ultrasound .
34 ) A 41 year old gentleman came to your clinic complaining of respiratory symptoms . Your differential diagnosis is pleural effusion versus pneumothorax . Which of the following physical findings will best help you differentiate between these two possibilities ?
A . Respiratory rate 33 breaths / minute .
B . Agitation due to respiration distress .
C . Decreased breath sounds over the affected hemithorax .
D . Dullness to percussion over the affected hemithorax .
E . Cough .
35 ) All of the following are classic signs of basal skull fracture except ?
A . Raccoon eyes .
B . Battle sign .
C . Hemotympanum .
D . Dilated non reactive pupils .
E . Cerebrospinal fluid rhinorrhea .
36 ) All of the following are true about the assessment of bleeding except ?
A . Taking blood sample at the time of bleeding gives an accurate level of haemoglobin .
B . Hypovolemia increase the risk of tissue hypoxia and multi organ failure .
C . Blood loss could be estimated from the size of blood clot and the weight of swabs used .
D . Any thirsty patient should be considered Hypovolemic .
E . Arterial blood gas is a quick method to measure hemoglobin
37 ) All of the following sentences are true about pathophysiology of shock except ?
A . Shock means inadequate oxygen delivery to meet metabolic demands .
B . Shock may occur without loss in the circulating volume .
C . Severe infection may lead to decreased cardiac preload .
D . Serum lactate decreases in shock .
E . The function of phagocytes is decreased in shock .
38 ) All sentences about arteriovenous fistula are true except ?
A . It's complication include stenosis , aneurysm and heart failure .
B . Renal dialysis is the most common indication to create it .
C . Palpable thrill and audible bruit over the fistula indicate that is thrombosed .
D . Paleness and coldness of the hand during exercise and dialysis indicate the presence of steal syndrome .
E . The three most common sites are radiocephalic , brachiocephalic , and brachial artery to transposed basilic vein .
39 ) Regarding the preoperative management all sentences are true except ?
A . A recent myocardial infarction is the most important risk factor for perioperative myocardial infarction .
B . Patients should take their regular Antihypertensive drug's even on the day of surgery .
C . History and examination alone are not usually sufficient in evaluating the risk of bleeding .
D . LMWH is used in venous thromboembolism prophylaxis .
E . Poorly controlled blood sugar in the preoperative period increases the risk for surgical site infections .
40 ) 40 year old male come to your clinic asking for advice about his anal fissure . One of the following sentences is an appropriate advice ?
A . Surgery is primary treatment for acute anal fissure .
B . Anal fissures are usually located in the lateral aspect of the canal .
C . Anal fissure in patients with Crohn disease usually indicate malignancy .
D . Medical treatment is successful in 20% of case's .
E . Surgical treatment may be complicated by incontinence
41 ) 53 year old female presented as an emergency with crampy abdominal pain for 4 days and associated with vomiting , abdominal distention and constipation . Patient denies weight loss . Her past history was only significant for previous open appendectomy and open cholecystectomy . Abdominal examination did not reveal an Incisional hernia . All of the following sentences are true except ?
A . She should be admitted for intravenous fluid hydration and electrolyte replacement .
B . As female patient , groin examination can be postponed for few days .
C . Adhesion are the most likely cause for her condition .
D . It is essential is to obtain an upright chest x Ray .
E . It is essential is to obtain an abdominal x Ray ( upright and supine ) .
42 ) All of the following sentences about gallstones are true except ?
A . Gallstones in diabetic patients are more dangerous due to silent cholecystitis .
B . Obesity and sickle cell anemia are risk factors for gallstones formation .
C . Cholecystectomy can be performed in pregnant woman .
D . Every patient undergoing cholecystectomy should be consented about bile leak .
E . Extracorporeal shock wave lithotripsy is one of the effective treatments for gallstones .
43 ) All sentences about sialolithiasis are true except ?
A . Parotid gland is the most common site of salivary calculi .
B . Salivary calculus contains debris bacteria , mucous , magnesium and phosphates .
C . Easily demonstrated by x Ray .
D . Most occur in middle aged adults .
E . The main symptoms are pain and swelling before and during eating .
44 ) A 42 year old morbidly obese white woman ( BMI = 40 ) presents to your office requesting information on screening for colon cancer , she is asymptomatic and has a colonoscopy for her is which of the following ?
A . She should have received a colonoscopy between age 10 _ 12 .
B . She should have received a colonoscopy between age 20 _ 25 .
C . She should have received a colonoscopy at age 40 .
D . She should receive a colonoscopy at age 45 .
E . She should receive a colonoscopy at age 50 .
45 ) A 39 year old patient presented to you at the emergency room after chest trauma . Which of the following scenarios is most consistent with left tension pneumothorax ?
A . Hypotension , distended neck veins , midline trachea and muffled heart sounds .
B . Hypotension , open 4 cm 215 , 4 cm lateral chest wound .
C . Hypotension , diminished breath sound on the left tracheal opacification of the left hemithorax .
D . Diminished left sided breath sounds , tracheal deviation to right .
E . Hypotension , adjacent three fractured in two places .
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