اسئلة الجراحة 2016 (3)
1) At which level , end of the spinal cord :
A) 4th lumbar vertebrae
B) L3_L4 inter space
C) Second lumbar vertebrae
D) T12_L1 inter space
E) S2_S3 inter space
2) A 20 years old with a bloody single duct discharge and a palpable mass at the areola , no malignant cells and isolated from discharge . The likely diagnosis is :
A) Ductal carcinoma
B) Duct ectasia
C) Intraductal papilloma
D) Prolactinoma
E) Periductal mastitis
3) A 50 years old man , presented to E.R with severe Epigastric pain of 5 hours duration . The pain radiating to back , associated with recurrent vomiting , Amylase level is high , all of the following criteria are used to peridict mortality and morbidity during admission except :
A) Age over 55 years
B) Blood sugar more than 200 mg / dl
C) AST more than 250 u/ L
D) WBC less than 5000/mm3
E) LDH more than 350 u/ L
4) All are true about Crohn disease except :
A) Involvement from mouth to anus
B) Stenosis more seen in ulcerative colitis
C) Macroscopically cobblestoning
D) Endoscopically skip lesions
E) Histologically transmural Granulomas
5) Which of the following statement about the anatomy of the esophagus is correct :
A) The cervical esophagus passes behind and to the right of the trachea
B) The esophagus deviates anteriorly and to the left as it enters the abdomen
C) The thoracic esophagus enters the posterior mediastinum anteriorly to the aortic arch
D) The thoracic esophagus passes behind the right mainstem bronchi and the pericardium
E) The esophagus enters the diaphragmatic hiatus at the level of T8
6) A 35 years old man with known ulcerative colitis , which of the following is an indication for total proctocolectomy :
A) Occasional attack of colic and diarrhea
B) Sclerosing Cholangitis
C) Arthritides
D) Toxic megacolon
E) IDA
7) The most common type of intracranial hemorrhage :
A) Extradural
B) Subdural
C) Subarachnoid
D) Intracerebral
E) Intraventricular
8) One is true regarding the electrolyte concentration in Hartmann solution :
A) chloride 200 mmol / L
B) Lactate 70 mmol /L
C) Na 131 mmol/L
D) K 40 mmol/L
E) Calcium 15 mmol/L
9) Most common hernia in females :
A) Femoral hernia
B) Umbilical hernia
C) Obturator hernia
D) Direct inguinal hernia
E) Indirect inguinal hernia
10) A 73 years old man, known of IHD , presented complaining of severe abdominal pain . In ABG shows PH = 7.31 , PCO2 = 25 mmhg , PO2= 73 mmhg , HCO3 = 14 mmol /L , BE = 15.9 . The diagnosis is :
A ) Metabolic acidosis
B) Metabolic acidosis with respiratory alkalosis compensation
C) Respiratory acidosis
D) Respiratory acidosis with metabolic compensation
E) Metabolic and respiratory acidosis mixed
11) All are true about colorectal except :
A) More than half of the cancers in the recto_sigmoid
B) More common in older people
C) More common in economically and underdeveloped world
D) Risk of synchronous tumor , diagnosis in 5%
E) Patients with family history of CRC have increased risk
12) Allen test is used to examine :
A) Suppurative tenosynovitis
B) Thoracic outlet syndrome
C) Dislocated hip
D) Nerve supply of the upper limb
E) Blood supply of the hand
13) All are features of tumor lysis syndrome except :
A) Hyperkalemia
B) Hyperphosphatemia
C) Hypercalcemia
D) Hyperurecemia
E) High BUN
14) The preferred operation for initial management of a thyroid nodule that is considered suspicious of malignancy by FNAB is :
A) Nodule excision
B) Partial lobectomy
C) Total lobectomy and isthmusectomy
D) Total thyroidectomy
E) Near total thyroidectomy
15) A 50 years old man is admitted to hospital with severe bleeding and bruising . He is on warfarin and INR is 10 , For rapid complete reversal . The best is :
A) Platelets
B) FFP and vitamin K
C) IV vitamin K
D) Whole blood and vitamin K
E) FFP and vitamin C
16 ) A 36 years old woman , 20 weeks pregnant , was in investigating a 1.5 cm right thyroid nodule , fine needle aspiration is consistent with Papillary neoplasm , which of the following methods of treatment is contraindicated :
A) Right thyroid lobectomy
B) Subtotal thyroidectomy
C) Total thyroidectomy
D) Total thyroidectomy with lymph node dissection
E) Radioactive iodine ablation of thyroid gland
17) One of the following suggest portal hypertension :
A) Low platelet
B) High ALP
C) Normal INR
D) Low globulin
E) High GGT
18) Acute appendicitis is most commonly associated with which of the following signs :
A) Temperature above 40 C
B) Frequent loose stools
C) Anorexia , abdominal pain , RLQ tenderness
D) WBC count > 20.000
E) None of above
19) Which of the following is not true regarding sepsis :
A) Tachycardia and / or tachypnea may be a sign
B) Sepsis is defined as systematic inflammatory response in the presence of infection
C) Leucocytosis or Leukopenia may be a sign
D) Sepsis and hypotension despite IV fluid is defined as septic shock
E) Temperature greater than 38 or less than 36 may be a sign
20) Which of the following statement is true about drug therapy for Crohn disease :
A) Corticosteroids effective treat acute attack and to prolong remission
B) Sulfasalazine for acute attack involving small bowel
C) Azathioprine and immunosuppressive drugs for remission
D) Low dose cyclosporine for patients with both low and high disease activity
E) All of the above
21) The spleen filters all of the following particles cells except :
A) Malformed RBCs
B) T lymphocytes
C) Malarial parasites
D) Streptococcus pneumonia
E) Platelets
22) Hyperthyroidism can be caused by all of the following except :
A) MTC
B) Graves disease
C) Plummer disease
D) Struma ovarii
E) Hashimoto disease
23) A major bleed in the thigh is best controlled in emergency room by :
A) Tourniquet
B) Direct compression by hand
C) Exploration under local anesthesia and clamp
D) Exploration and ligation under local anesthesia
E) Send to operating room for exploration under General anesthesia
24) Which of the following is associated with increased risk of development of breast cancer :
A) Fibrocystic mastopathy
B) Atypical hyperplasia
C) Severe simple hyperplasia
D) Papillomatosis
E) Hypertrophy of glandular tissue
25) Post mastectomy and axially clearance for a patient with breast cancer , the patient was found to have a winging scapula , the most likely cause :
A) Patient suffered a TIA
B) Damage to thoracodorsal nerve during surgery
C) Damage to long thoracic nerve during surgery
D) Damage to serratus anterior muscle
E) Dislocated scapula
26) Regarding abdominal trauma in pediatric group , one is true :
A) Splenectomy is not a routine for all types of splenic injuries
B) Peritoneal lavage is contraindicated
C) Blood transfusion must be started immediately
D) Ultrasound is the diagnostic tool of choice
E) Clinical exam , stabilisation , resuscitation are not of priority
27) All of the following is true regarding the femoral triangle except :
A) The inguinal ligament forms the base
B) The medial border _ lateral border of adductor longus muscle
C) The lateral border _medial border of sartorius
D) The floor _ adductor longus and oblique muscle medially
E) The floor _ iliopsoas muscle laterally
28) Capillary refill time is elicited by :
A) Pressing over the skin for 3 seconds , normally return of perfusion by 2 seconds
B) Pressing over the skin for 5 seconds , normally return of perfusion by 2 seconds
C) Pressing over the skin for 5 seconds , normally return of perfusion by 5 seconds
D) Pressing over the skin for 10 seconds , normally return of perfusion by 5 seconds
29) One is false :
A) femoral artery is lateral to femoral vein in the inguinal area
B) Femoral nerve is present within the femoral sheath
C) Femoral triangle is bounded by sartorius muscle laterally
D) Siatic nerve injury can be avoided by giving im injection on the upper lateral quadrant on the gluteal area
E) Great saphenous vein drain to femoral vein below the inguinal ligament
30) The principal blood supply to the parathyroid glands is by :
A) Superior thyroid arteries
B) Inferior thyroid arteries
C) Thyroidea ima arteries
D) Parathyroid arterial branches from external carotid arteries
E) Highly varible
31) Most common cause of Goitrous hypothyroidism in adults is :
A) Hashimoto disease
B) Graves disease
C) Riedels thyroiditis
D) De Quervain thyroiditis
E) Iodine deficiency
32) A 25 years old . Underwent an antrectomy. and vagotomy , he is complaining of nausea, vomiting , diarrhea ,
dizziness , fatigue , bloating . Within 15_30 min from meal ingestion , and low blood sugar within 2 hours from meal . The most likely diagnosis :
A) Anemia
B) Jejunogastric intussusception
C) Dumping syndrome
D) Afferent loop syndrome
E) Alkaline reflex gastritis
33) A 32 years old man present with Hematuria. A KUB X_Ray reveals a staghorn calculus in the right kidney and mid stream urine sample grows proteus . The most likely stone type is :
A) Bile pigment stone
B) Calcium oxalate
C) Calcium phosphate
D) Cholesterol stone
E) Cysteine stone
34) The first step in management hypercalcemia is :
A) IV hydration normal saline 0.9%
B) Hydrocortisone
C) Dialysis
D) Administration of Furosemide
E) Administration of mithramycin
35) A 54 years old man on renal dialysis is have to raised serum calcium and PTH this is called :
A) Primary Hyperparathyroidism
B) Secondary Hyperparathyroidism
C) Tertiary Hyperparathyroidism
D) Hypercalcemia on malignancy
E) Hypoparathyroidism
36) One of the following is an indication for nasogastric tube insertion :
A) Recent esophageal surgery
B) Suspected esophageal perforation
C) PE
D) Perforated stomach
E) Colovesical fistula
37) All of the following are true regarding nick lumps except :
A) Thyroglossal cyst moves upward on protrusion of tongue
B) Branchial cysts typically present in the first decade of life
C) Thyroid masses move upwards on swallowing
D) Cystic hygromas are lymphatic malformation
E) Parotid glands are not normally palpable
38) Assessment of a breast lump include all , except :
A) Clinical examination
B) Mammography
C) Core biopsy
D) FNA
E) Mastectomy
39) Influenza is one of the greatest pandemic disease because of :
A) Mutation of the virus
B) Spread by water
C) Long incubation period
D) High fatality rate
E) Lack of specific vaccines
40) The most important indicator of a population health :
A) Crude birth rate
B) Crude mortality rate
C) Infant mortality rate
D) Maternal mortality rate
E) Total fertility rate
41) Which of the following is not associated with compartment syndrome :
A) Disproportionate level of pain
B) Absent distal pulse
C) Paresthesia
D) Heat
E) Paralysis
42) Colon pseudo_obstruction is caused by all , except :
A) Systemic illness
B) Electrolyte imbalance
C) Fecal impaction
D) Opioids
E) Hypothyroidism
43 ) All predispose to necrotizing fascitis except :
A) Diabetes
B) Severe head injuries
C) Cortisone therapy
D) Advance malignancy
E) Renal failure
44 ) A 59 years old patient presented with left upper abdominal discomfort . His physical exam reveals left upper quadrant tenderness . A CT scan of abdomen _ spleen infarction . Most common cause of of his splenic infarction :
A) Aplastic anemia
B) ITP
C) Gilbert disease
D) Atrial fibrillation
E) Idiopathic pulmonary fibrosis
45 ) A 62 years old female was recently diagnosed with an adenocarcinoma of the Sigmoid colon . You are concerned about the possibility of metastasis. Which of the following is most suggestive of metastatic disease :
A) Multiple hepatic hypoechoic lesions on abdominal ultrasound
B) Mild elevation of carcinoembryonic antigen
C) Abdominal pain
D) Severe constipation
E) Abundant blood per rectum
46) Carpal tunnel syndrome is due to compression of :
A) Median nerve
B) Ulnar nerve
C) Radial nerve
D) Radial artery
E) Ulnar artery
47) The most precise diagnostic screening procedure for differentiating benign thyroid nodules from malignant ones is :
A) Thyroid ultrasonography
B) Thyroid scintiscan
C) Thyroid hormone suppression
D) FNAB
E) CT scan
48) The risk of gallbladder cancer is increased with all of the following except :
A) Obesity
B) Porcelain gallbladder
C) Mirrizzi syndrome
D) Male
E) Large gallstones compared with small
49) Jaundice with absent urinary urobilinogen is most consistent with :
A) Hepatitis
B) Liver cirrhosis
C) Hemolysis
D) CBD stone
E) Sepsis
50) Which of the following is true regarding gallstones type's :
A) Pure cholesterol stones are the commonest
B) Brown stones usually from Hemolysis
C) Black stones usually with bacterial infection
D) Pigment stones are dark because of presence of calcium bicarbonate
E) Most cholesterol stones are radiopaque
51) A strong correlation exists between Nasopharyngeal carcinoma and :
A) White race
B) EBV
C) Betel nut chewing
D) Alcohol
E) Plummer Vinson syndrome
52 ) All of the following are true regarding Clopidogrel except :
A) It inhibits activation of glycoprotein 2B/3A complex
B) The risk of bleeding is increased if it is used with aspirin
C) When discontinued , bleeding time normalizes in approximately 2_3 days
D) It inhibits platelet aggregation within 2 hours of oral administration
E) May cause TTP
53) Management of Ascites due to liver cirrhosis includes all except :
A) TIPS
B) Paracentesis
C) Spironolactone
D) Furosemide
E) Sodium restriction
54) All of the following are part of the child pugh scoring system for portal HTN except :
A) Hemoglobin level
B) Ascites
C) Encephalopathy
D) Serum bilirubin
E) INR
55) Most common functional pancreatic endocrine neoplasm is :
A) Vipoma
B) Glucagonoma
C) Somatostatinoma
D) Gastrinoma
E) Insulinoma
56) A 30 kg child has an estimated daily fluid requirement :
A) 40 ml/hour
B) 50 ml/hour
C) 60 ml/hour
D) 70 ml/hour
E) 80 ml/hour
57) The test with highest sensitivity for Pheochromocytoma is :
A) Plasma catecholamine
B) Plasma metanephrine
C) Urinary catecholamine
D) Urinary metanephrine
E) Urinary VMA
58) Which intestinal cells have been implicated in the formation of GIST :
A) Goblet cells
B) APUD cells
C) Cajal cells
D) Paneth cells
E) G cells
59) Which of the following is the best first line option for an acute exacerbation of Crohn disease :
A) Sulfasalazine
B) Mesalamine
C) Natalizumab
D) Prednisone
E) Infliximab
60) A hernia sac containing a Meckels diverticulum is called :
A) Petit hernia
B) Littre hernia
C) Spiglian hernia
D) Richter hernia
E) Grynfeltt hernia
61) The most common organism associated with overwhelming post splenectomy sepsis :
A) Group A Streptococcus
B) Haemophilus influenzae
C) Streptococcus pneumonia
D) Meningococcus
E) Babesia microti
62) Which of the following is the most effective treatment for intractable Dumping syndrome :
A) Low fat , lactose free diet
B) Serotonin antagonists
C) Low carbs , high fat diet
D) Octreotide
E) Omeprazole
63 ) In the management of hemorrhagic shock , the best clinical sign of successful fluid resuscitation is :
A) Increase in blood pressure
B) Increase in urine output
C) Increase in arterial oxygenation
D) Decrease in thirst
E) Decrease in tachycardia
64) Which of the following is the most common neoplasm of the appendix :
A) Mucinous adenocarcinoma
B) Carcinoid tumor
C) Malignant mucocele
D) Lymphoma
E) Lymphosarcoma
65) Which of the following is the most reliable in confirming the diagnosis of acute appendicitis :
A) Classic history of initial periumbilical pain shifting to the right lower quadrant
B) Rebound tenderness
C) Localized tenderness at Mcburneys point
D) Psaos sign presence
E) Rovsing sign presence
66) The primary adverse reaction to Trastuzumab :
A) Liver toxicity
B) Renal toxicity
C) Thromboembolic events
D) Cardiac toxicity
E) Aplastic anemia
67) After a modified radical mastectomy , A 45 years old woman reports weakness in her arm . On exam she has mild weakness . When she internally rotates and adducts her arm . The most likely injured nerve is :
A) Intercosto_brachial
B) Long thoracic
C) Supraclavicular
D) Medial pectoral
E) Thoracodorsal
68) First degree burns involving the both hands , second degree burns involving the entire head and neck , third degree involving the entire back and half of the chest , would be considered :
A) 12% TBSA
B) 27% TBSA
C) 36% TBSA
D) 40% TBSA
E) 45% TBSA
69) Which of the following are true regarding FAP :
A) It is autosomal recessive
B) The polyps are hamartomas
C) The risk of colon cancer is 100% by age 50
D) Once a polyp is detected total proctocolectomy is recommended
E) There is no association with upper GIT malignancy
70) According to Parkland formula , the amount of crystalloid fluids , that should be administered to the first 8 hours to a 70 kg man with a 15% TBSA first degree burns , 50 % TBSA second degree burn , 20% TBSA third degree burn :
A) 5000 ml
B) 6500 ml
C) 7350 ml
D) 9800 ml
E) 11900 ml
A) 4th lumbar vertebrae
B) L3_L4 inter space
C) Second lumbar vertebrae
D) T12_L1 inter space
E) S2_S3 inter space
2) A 20 years old with a bloody single duct discharge and a palpable mass at the areola , no malignant cells and isolated from discharge . The likely diagnosis is :
A) Ductal carcinoma
B) Duct ectasia
C) Intraductal papilloma
D) Prolactinoma
E) Periductal mastitis
3) A 50 years old man , presented to E.R with severe Epigastric pain of 5 hours duration . The pain radiating to back , associated with recurrent vomiting , Amylase level is high , all of the following criteria are used to peridict mortality and morbidity during admission except :
A) Age over 55 years
B) Blood sugar more than 200 mg / dl
C) AST more than 250 u/ L
D) WBC less than 5000/mm3
E) LDH more than 350 u/ L
4) All are true about Crohn disease except :
A) Involvement from mouth to anus
B) Stenosis more seen in ulcerative colitis
C) Macroscopically cobblestoning
D) Endoscopically skip lesions
E) Histologically transmural Granulomas
5) Which of the following statement about the anatomy of the esophagus is correct :
A) The cervical esophagus passes behind and to the right of the trachea
B) The esophagus deviates anteriorly and to the left as it enters the abdomen
C) The thoracic esophagus enters the posterior mediastinum anteriorly to the aortic arch
D) The thoracic esophagus passes behind the right mainstem bronchi and the pericardium
E) The esophagus enters the diaphragmatic hiatus at the level of T8
6) A 35 years old man with known ulcerative colitis , which of the following is an indication for total proctocolectomy :
A) Occasional attack of colic and diarrhea
B) Sclerosing Cholangitis
C) Arthritides
D) Toxic megacolon
E) IDA
7) The most common type of intracranial hemorrhage :
A) Extradural
B) Subdural
C) Subarachnoid
D) Intracerebral
E) Intraventricular
8) One is true regarding the electrolyte concentration in Hartmann solution :
A) chloride 200 mmol / L
B) Lactate 70 mmol /L
C) Na 131 mmol/L
D) K 40 mmol/L
E) Calcium 15 mmol/L
9) Most common hernia in females :
A) Femoral hernia
B) Umbilical hernia
C) Obturator hernia
D) Direct inguinal hernia
E) Indirect inguinal hernia
10) A 73 years old man, known of IHD , presented complaining of severe abdominal pain . In ABG shows PH = 7.31 , PCO2 = 25 mmhg , PO2= 73 mmhg , HCO3 = 14 mmol /L , BE = 15.9 . The diagnosis is :
A ) Metabolic acidosis
B) Metabolic acidosis with respiratory alkalosis compensation
C) Respiratory acidosis
D) Respiratory acidosis with metabolic compensation
E) Metabolic and respiratory acidosis mixed
11) All are true about colorectal except :
A) More than half of the cancers in the recto_sigmoid
B) More common in older people
C) More common in economically and underdeveloped world
D) Risk of synchronous tumor , diagnosis in 5%
E) Patients with family history of CRC have increased risk
12) Allen test is used to examine :
A) Suppurative tenosynovitis
B) Thoracic outlet syndrome
C) Dislocated hip
D) Nerve supply of the upper limb
E) Blood supply of the hand
13) All are features of tumor lysis syndrome except :
A) Hyperkalemia
B) Hyperphosphatemia
C) Hypercalcemia
D) Hyperurecemia
E) High BUN
14) The preferred operation for initial management of a thyroid nodule that is considered suspicious of malignancy by FNAB is :
A) Nodule excision
B) Partial lobectomy
C) Total lobectomy and isthmusectomy
D) Total thyroidectomy
E) Near total thyroidectomy
15) A 50 years old man is admitted to hospital with severe bleeding and bruising . He is on warfarin and INR is 10 , For rapid complete reversal . The best is :
A) Platelets
B) FFP and vitamin K
C) IV vitamin K
D) Whole blood and vitamin K
E) FFP and vitamin C
16 ) A 36 years old woman , 20 weeks pregnant , was in investigating a 1.5 cm right thyroid nodule , fine needle aspiration is consistent with Papillary neoplasm , which of the following methods of treatment is contraindicated :
A) Right thyroid lobectomy
B) Subtotal thyroidectomy
C) Total thyroidectomy
D) Total thyroidectomy with lymph node dissection
E) Radioactive iodine ablation of thyroid gland
17) One of the following suggest portal hypertension :
A) Low platelet
B) High ALP
C) Normal INR
D) Low globulin
E) High GGT
18) Acute appendicitis is most commonly associated with which of the following signs :
A) Temperature above 40 C
B) Frequent loose stools
C) Anorexia , abdominal pain , RLQ tenderness
D) WBC count > 20.000
E) None of above
19) Which of the following is not true regarding sepsis :
A) Tachycardia and / or tachypnea may be a sign
B) Sepsis is defined as systematic inflammatory response in the presence of infection
C) Leucocytosis or Leukopenia may be a sign
D) Sepsis and hypotension despite IV fluid is defined as septic shock
E) Temperature greater than 38 or less than 36 may be a sign
20) Which of the following statement is true about drug therapy for Crohn disease :
A) Corticosteroids effective treat acute attack and to prolong remission
B) Sulfasalazine for acute attack involving small bowel
C) Azathioprine and immunosuppressive drugs for remission
D) Low dose cyclosporine for patients with both low and high disease activity
E) All of the above
21) The spleen filters all of the following particles cells except :
A) Malformed RBCs
B) T lymphocytes
C) Malarial parasites
D) Streptococcus pneumonia
E) Platelets
22) Hyperthyroidism can be caused by all of the following except :
A) MTC
B) Graves disease
C) Plummer disease
D) Struma ovarii
E) Hashimoto disease
23) A major bleed in the thigh is best controlled in emergency room by :
A) Tourniquet
B) Direct compression by hand
C) Exploration under local anesthesia and clamp
D) Exploration and ligation under local anesthesia
E) Send to operating room for exploration under General anesthesia
24) Which of the following is associated with increased risk of development of breast cancer :
A) Fibrocystic mastopathy
B) Atypical hyperplasia
C) Severe simple hyperplasia
D) Papillomatosis
E) Hypertrophy of glandular tissue
25) Post mastectomy and axially clearance for a patient with breast cancer , the patient was found to have a winging scapula , the most likely cause :
A) Patient suffered a TIA
B) Damage to thoracodorsal nerve during surgery
C) Damage to long thoracic nerve during surgery
D) Damage to serratus anterior muscle
E) Dislocated scapula
26) Regarding abdominal trauma in pediatric group , one is true :
A) Splenectomy is not a routine for all types of splenic injuries
B) Peritoneal lavage is contraindicated
C) Blood transfusion must be started immediately
D) Ultrasound is the diagnostic tool of choice
E) Clinical exam , stabilisation , resuscitation are not of priority
27) All of the following is true regarding the femoral triangle except :
A) The inguinal ligament forms the base
B) The medial border _ lateral border of adductor longus muscle
C) The lateral border _medial border of sartorius
D) The floor _ adductor longus and oblique muscle medially
E) The floor _ iliopsoas muscle laterally
28) Capillary refill time is elicited by :
A) Pressing over the skin for 3 seconds , normally return of perfusion by 2 seconds
B) Pressing over the skin for 5 seconds , normally return of perfusion by 2 seconds
C) Pressing over the skin for 5 seconds , normally return of perfusion by 5 seconds
D) Pressing over the skin for 10 seconds , normally return of perfusion by 5 seconds
29) One is false :
A) femoral artery is lateral to femoral vein in the inguinal area
B) Femoral nerve is present within the femoral sheath
C) Femoral triangle is bounded by sartorius muscle laterally
D) Siatic nerve injury can be avoided by giving im injection on the upper lateral quadrant on the gluteal area
E) Great saphenous vein drain to femoral vein below the inguinal ligament
30) The principal blood supply to the parathyroid glands is by :
A) Superior thyroid arteries
B) Inferior thyroid arteries
C) Thyroidea ima arteries
D) Parathyroid arterial branches from external carotid arteries
E) Highly varible
31) Most common cause of Goitrous hypothyroidism in adults is :
A) Hashimoto disease
B) Graves disease
C) Riedels thyroiditis
D) De Quervain thyroiditis
E) Iodine deficiency
32) A 25 years old . Underwent an antrectomy. and vagotomy , he is complaining of nausea, vomiting , diarrhea ,
dizziness , fatigue , bloating . Within 15_30 min from meal ingestion , and low blood sugar within 2 hours from meal . The most likely diagnosis :
A) Anemia
B) Jejunogastric intussusception
C) Dumping syndrome
D) Afferent loop syndrome
E) Alkaline reflex gastritis
33) A 32 years old man present with Hematuria. A KUB X_Ray reveals a staghorn calculus in the right kidney and mid stream urine sample grows proteus . The most likely stone type is :
A) Bile pigment stone
B) Calcium oxalate
C) Calcium phosphate
D) Cholesterol stone
E) Cysteine stone
34) The first step in management hypercalcemia is :
A) IV hydration normal saline 0.9%
B) Hydrocortisone
C) Dialysis
D) Administration of Furosemide
E) Administration of mithramycin
35) A 54 years old man on renal dialysis is have to raised serum calcium and PTH this is called :
A) Primary Hyperparathyroidism
B) Secondary Hyperparathyroidism
C) Tertiary Hyperparathyroidism
D) Hypercalcemia on malignancy
E) Hypoparathyroidism
36) One of the following is an indication for nasogastric tube insertion :
A) Recent esophageal surgery
B) Suspected esophageal perforation
C) PE
D) Perforated stomach
E) Colovesical fistula
37) All of the following are true regarding nick lumps except :
A) Thyroglossal cyst moves upward on protrusion of tongue
B) Branchial cysts typically present in the first decade of life
C) Thyroid masses move upwards on swallowing
D) Cystic hygromas are lymphatic malformation
E) Parotid glands are not normally palpable
38) Assessment of a breast lump include all , except :
A) Clinical examination
B) Mammography
C) Core biopsy
D) FNA
E) Mastectomy
39) Influenza is one of the greatest pandemic disease because of :
A) Mutation of the virus
B) Spread by water
C) Long incubation period
D) High fatality rate
E) Lack of specific vaccines
40) The most important indicator of a population health :
A) Crude birth rate
B) Crude mortality rate
C) Infant mortality rate
D) Maternal mortality rate
E) Total fertility rate
41) Which of the following is not associated with compartment syndrome :
A) Disproportionate level of pain
B) Absent distal pulse
C) Paresthesia
D) Heat
E) Paralysis
42) Colon pseudo_obstruction is caused by all , except :
A) Systemic illness
B) Electrolyte imbalance
C) Fecal impaction
D) Opioids
E) Hypothyroidism
43 ) All predispose to necrotizing fascitis except :
A) Diabetes
B) Severe head injuries
C) Cortisone therapy
D) Advance malignancy
E) Renal failure
44 ) A 59 years old patient presented with left upper abdominal discomfort . His physical exam reveals left upper quadrant tenderness . A CT scan of abdomen _ spleen infarction . Most common cause of of his splenic infarction :
A) Aplastic anemia
B) ITP
C) Gilbert disease
D) Atrial fibrillation
E) Idiopathic pulmonary fibrosis
45 ) A 62 years old female was recently diagnosed with an adenocarcinoma of the Sigmoid colon . You are concerned about the possibility of metastasis. Which of the following is most suggestive of metastatic disease :
A) Multiple hepatic hypoechoic lesions on abdominal ultrasound
B) Mild elevation of carcinoembryonic antigen
C) Abdominal pain
D) Severe constipation
E) Abundant blood per rectum
46) Carpal tunnel syndrome is due to compression of :
A) Median nerve
B) Ulnar nerve
C) Radial nerve
D) Radial artery
E) Ulnar artery
47) The most precise diagnostic screening procedure for differentiating benign thyroid nodules from malignant ones is :
A) Thyroid ultrasonography
B) Thyroid scintiscan
C) Thyroid hormone suppression
D) FNAB
E) CT scan
48) The risk of gallbladder cancer is increased with all of the following except :
A) Obesity
B) Porcelain gallbladder
C) Mirrizzi syndrome
D) Male
E) Large gallstones compared with small
49) Jaundice with absent urinary urobilinogen is most consistent with :
A) Hepatitis
B) Liver cirrhosis
C) Hemolysis
D) CBD stone
E) Sepsis
50) Which of the following is true regarding gallstones type's :
A) Pure cholesterol stones are the commonest
B) Brown stones usually from Hemolysis
C) Black stones usually with bacterial infection
D) Pigment stones are dark because of presence of calcium bicarbonate
E) Most cholesterol stones are radiopaque
51) A strong correlation exists between Nasopharyngeal carcinoma and :
A) White race
B) EBV
C) Betel nut chewing
D) Alcohol
E) Plummer Vinson syndrome
52 ) All of the following are true regarding Clopidogrel except :
A) It inhibits activation of glycoprotein 2B/3A complex
B) The risk of bleeding is increased if it is used with aspirin
C) When discontinued , bleeding time normalizes in approximately 2_3 days
D) It inhibits platelet aggregation within 2 hours of oral administration
E) May cause TTP
53) Management of Ascites due to liver cirrhosis includes all except :
A) TIPS
B) Paracentesis
C) Spironolactone
D) Furosemide
E) Sodium restriction
54) All of the following are part of the child pugh scoring system for portal HTN except :
A) Hemoglobin level
B) Ascites
C) Encephalopathy
D) Serum bilirubin
E) INR
55) Most common functional pancreatic endocrine neoplasm is :
A) Vipoma
B) Glucagonoma
C) Somatostatinoma
D) Gastrinoma
E) Insulinoma
56) A 30 kg child has an estimated daily fluid requirement :
A) 40 ml/hour
B) 50 ml/hour
C) 60 ml/hour
D) 70 ml/hour
E) 80 ml/hour
57) The test with highest sensitivity for Pheochromocytoma is :
A) Plasma catecholamine
B) Plasma metanephrine
C) Urinary catecholamine
D) Urinary metanephrine
E) Urinary VMA
58) Which intestinal cells have been implicated in the formation of GIST :
A) Goblet cells
B) APUD cells
C) Cajal cells
D) Paneth cells
E) G cells
59) Which of the following is the best first line option for an acute exacerbation of Crohn disease :
A) Sulfasalazine
B) Mesalamine
C) Natalizumab
D) Prednisone
E) Infliximab
60) A hernia sac containing a Meckels diverticulum is called :
A) Petit hernia
B) Littre hernia
C) Spiglian hernia
D) Richter hernia
E) Grynfeltt hernia
61) The most common organism associated with overwhelming post splenectomy sepsis :
A) Group A Streptococcus
B) Haemophilus influenzae
C) Streptococcus pneumonia
D) Meningococcus
E) Babesia microti
62) Which of the following is the most effective treatment for intractable Dumping syndrome :
A) Low fat , lactose free diet
B) Serotonin antagonists
C) Low carbs , high fat diet
D) Octreotide
E) Omeprazole
63 ) In the management of hemorrhagic shock , the best clinical sign of successful fluid resuscitation is :
A) Increase in blood pressure
B) Increase in urine output
C) Increase in arterial oxygenation
D) Decrease in thirst
E) Decrease in tachycardia
64) Which of the following is the most common neoplasm of the appendix :
A) Mucinous adenocarcinoma
B) Carcinoid tumor
C) Malignant mucocele
D) Lymphoma
E) Lymphosarcoma
65) Which of the following is the most reliable in confirming the diagnosis of acute appendicitis :
A) Classic history of initial periumbilical pain shifting to the right lower quadrant
B) Rebound tenderness
C) Localized tenderness at Mcburneys point
D) Psaos sign presence
E) Rovsing sign presence
66) The primary adverse reaction to Trastuzumab :
A) Liver toxicity
B) Renal toxicity
C) Thromboembolic events
D) Cardiac toxicity
E) Aplastic anemia
67) After a modified radical mastectomy , A 45 years old woman reports weakness in her arm . On exam she has mild weakness . When she internally rotates and adducts her arm . The most likely injured nerve is :
A) Intercosto_brachial
B) Long thoracic
C) Supraclavicular
D) Medial pectoral
E) Thoracodorsal
68) First degree burns involving the both hands , second degree burns involving the entire head and neck , third degree involving the entire back and half of the chest , would be considered :
A) 12% TBSA
B) 27% TBSA
C) 36% TBSA
D) 40% TBSA
E) 45% TBSA
69) Which of the following are true regarding FAP :
A) It is autosomal recessive
B) The polyps are hamartomas
C) The risk of colon cancer is 100% by age 50
D) Once a polyp is detected total proctocolectomy is recommended
E) There is no association with upper GIT malignancy
70) According to Parkland formula , the amount of crystalloid fluids , that should be administered to the first 8 hours to a 70 kg man with a 15% TBSA first degree burns , 50 % TBSA second degree burn , 20% TBSA third degree burn :
A) 5000 ml
B) 6500 ml
C) 7350 ml
D) 9800 ml
E) 11900 ml
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