اسئلة الجراحة 2017 (3)
1) 65 year old male has an entero_cutaneous fistula originating from the jejunum , suffered from inflammatory bowel disease , which of the following would be the most appropriate replacement of his losses ?
A . DW5%
B . N/S 3%
C . Ringer lactate
D . 0.9% sodium chloride
E . 6% sodium bicarbonate solution
2) A 84 year old man presents with a small ulcer on the bridge of his nose . It has been present for a number of months . On examination it has pearly white rolled edges . The type of ulcer is ?
A . Curling ulcer
B . Cushing ulcer
C . Marjolin ulcer
D . Rodent ulcer
E . Venous ulcer
3) Which of the following skin tumors is the most common in whites ?
A . SCC
B . BCC
C . Malignant melanoma
D . Merkel cell tumor
E . Dermatofibrosarcoma
4) All of the following is true regarding the femoral triangle except ?
A . The inguinal ligament forms the base .
B . The medial border is formed by the lateral border of the adductor longus .
C . The lateral border is formed by the medial border of the Sartorius .
D . The floor is formed by the adductor longus and pectineus muscle medially .
E . The floor is formed by the Iliopsoas muscle laterally .
5) A 54 year old man on renal dialysis is found to have raised serum calcium and PTH . This is called ?
A . Primary hyperparathyroidism .
B . Secondary hyperparathyroidism .
C . Tertiary hyperparathyroidism .
D . Hypercalcemia of malignancy .
E . Hypoparathyroidism .
6) Most common cause of non pitting edema ?
A . Iatrogenic
B . Filariasis
C . Lymph node resection surgery .
D . Leptospirosis
E . Chagas disease
7) A 19 year old man involved in RTA , found to have a femur fracture and crush injury to his foot . After fixation he becomes dyspneic and hypoxemic . The most likely etiology ?
A . Aspiration
B . Atelectasis
C . Fat embolism
D . Fluid overload
E . Pneumonia
8) ) After exposure to suspected rabied animal , which of the following should be given ?
A . Rabies immunoglobulin and one dose of vaccine as soon as possible .
B . Rabies immunoglobulin then several doses of vaccine .
C . Rabies immunoglobulin alone .
D . Rabies immunoglobulin and antibiotic .
E . Vaccine and antibiotics .
9) Which of the following supports the diagnosis of Hypovolemia ?
A . Urine sodium 28 meq/L
B . Urine chloride 15 meq/L
C . Fe Na < 1
D . Urine / serum creatinine ratio of 20
E . Urine Osmolarity of 350 mosm/ kg
10) Calcitonin sometimes elaborated by which one of the following tumors ?
A . Medullary carcinoma of the breast .
B . Medullary carcinoma of the thyroid .
C . Giant cell carcinoma of the pancreas .
D . Carcinoid tumor of appendix .
E . Ganglioneuromas .
11) In the management of pyloric stenosis , which of the following is true ?
A . Acidosis should be corrected first .
B . Chloride level is normal in spite alkalosis .
C . Hypokalemia should be corrected .
D . Usually there is compensatory hypocarbia .
E . Paradoxical aciduria is not a feature .
12) Differential diagnosis of right iliac fossa pain includes all of the following except ?
A . Tubo _ ovarian mass
B . Acute pyelonephritis
C . Crohn disease
D . Empyema of the gallbladder
E . Splenic vein thrombosis
13) The GCS for 25 year man involved in RTA in a head on collision with a lorry . On examination he is unable to obey commands but localizes to pain and is able to speak , but appear confused . He only opens his eyes to pain ?
A . 4
B . 6
C . 7
D . 10
E . 13
14) Which of the following is not associated with compartment syndrome ?
A . Disproportionate level of pain .
B . Absent distal pulses .
C . Paresthesia .
D . Calor = Heat .
E . Paralysis .
15) 80 year old woman presents with hematemesis . She has had intermittent epigastric pain after food for the past 6 months . She has lost weight about 4 kg . She was recently started on Diclofenac . The most likely cause for her condition ?
A . Mallory Weiss tear
B . Esophagitis
C . Gastric malignancy
D . Aortoenteric fistula
E . Gastric ulcer
16) Which of the following is not an increased risk for venous Thromboembolism ?
A . Active cancer
B . Age greater than 60
C . Thrombophilia
D . Obesity BMI > 30
E . Surgery to excise scalp lipoma
17) What is the first parameter to change in early hypovolemic shock ?
A . Systolic blood pressure
B . Pulse rate
C . Diastolic blood pressure
D . Respiratory rate
E . Level of consciousness
18) A 32 year old man presents with Hematuria . A KUB X_Ray reveals a staghorn calculus in the right kidney and midstream urine , sample grows proteus . The most likely stone type is ?
A . Bile pigment stone
B . Calcium oxalate
C . Calcium phosphate
D . Cholesterol stone
E . Cystine stone
19) Most common site of volvulus in the colorectal region ?
A . Descending colon
B . Sigmoid
C . Transverse colon
D . Rectum
E . Ascending colon
20) 52 year old male patient was found to have Gastrinoma , which of the following is the most likely location for Gastrinoma ?
A . Fundus of stomach
B . Antrum of stomach
C . The triangle formed by the junction of the second and third portion of the duodenum , the junction of the neck and body of the pancreas and the junction of the cystic and common bile duct .
D . The tail of pancreas
E . The triangle formed by the inferior edge of the liver , the cystic duct , and the common hepatic duct .
21) An 18 year old female patient develops urticaria and wheezing after injection of intravenous contrast for an abdominal CT scan . Her BP 120/60 ,HR 155 / min , RR 30 / min , which of the following is the most appropriate immediate therapy ?
A . Intubation
B . Epinephrine
C . B _ blockers
D . Iodine
E . Fluid challenge
22) Which is gram negative organism ?
A . Group A Streptococcus
B . MRSA
C . Pseudomonas aeruginosa
D . Clostridium tetani
E . Listeria
23) The most reliable indicator of the adequacy of burn resuscitation is ?
A . CVP
B . PCWP
C . Urine output
D . Blood pressure
E . Heart rate per minute
24) The most common site for SCC of the lips is ?
A . Upper lip midline
B . Upper lip laterally
C . Lower lip midline
D . Lower lip laterally
E . Oral commissure
25) A 39 year old man presents with severe epigastric pain and right upper quadrant pain . Radiating to the back associated with nausea and vomiting . Inspection of the abdomen shows bruising below the inguinal ligament . This sign is called ?
A . Cullen sign
B . Boas sign
C . Fox sign
D . Grey turner sign
E . Murphy's sign
26) Pleomorphic adenomas of the salivary glands are characterized by one of the following ?
A . They occur only in the parotid glands .
B . They grow rapidly .
C . They rarely recur if simply enucleated .
D . They present as rock _ hard masses .
E . They are common benign salivary tumors .
27) A 20 year old man involved in RTA sustains bilateral fractured femurs . On assessment , he is anxious and confused , with a pulse of 130 / min and BP of 70/50 mmhg . Urine output over 1 hour is 10 ml . This patient has hemorrhagic shock type ?
A . Class 1
B . Class 2
C . Class 3
D . Class 4
E . Class 5
28) All of the following are branches from the external carotid artery except ?
A . Superior thyroid artery
B . Ascending pharyngeal artery
C . Lingual artery
D . Inferior thyroid artery
E . Facial artery
29) On postoperative day 5 post hepatic resection a healthy 55 year old patient is noted to have fever 38.6 c . Which of the following is the most common associated ?
A . UTI
B . Wound infection
C . Pneumonia
D . Intra_abdominal abscess
E . Intravenous catheter related infection
30) One of the following statement is incorrect ?
A . Elevated CA125 is associated with ovarian carcinoma .
B . Elevated CEA is associated with chondrosarcoma .
C . Elevated CA 15_3 is associated with certain breast cancer .
D . Elevated B_HCG is associated with certain testicular cancer .
E . Elevated CA 19_9 is associated with pancreatic cancer .
31) The spleen filters all of the following particles cells except ?
A . Malformed erythrocytes
B . T lymphocytes
C . Malarial parasites
D . Streptococcus pneumonia
E . Platelets
32) Which of the following is not a feature of Crohn disease ?
A . Involvement from mouth to anus .
B . Risk of flare up is decreased with smoking .
C . Macroscopically demonstrates cobblestone .
D . Endoscopically demonstrates skip lesions .
E . Histologically demonstrates transmural granulomatous inflammation .
33) A 45 year old female . Patient presented to E.R complaining of right hypochondriac pain and nausea with repeated vomiting for the last few hours . She recalls eating a cheese cake earlier that day . Examination showed right hypochondriac tenderness but otherwise soft and lax . Her laboratory results were normal . The most appropriate next investigation ?
A . Erect abdominal X_Ray
B . Endoscopy
C . CT abdomen
D . Ultrasound of the abdomen
E . H1 breath test for H pylori
34) A 50 year old man presented to E.R complaining of severe epigastric pain of 5 hours duration . The pain is radiating to his back associated with recurrent vomiting . His amylase is 2017 u/ L . All of the following criteria are used to predict the severity of the case 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 /UL
E . LDH more than 350 u/ L
35) The highest potassium concentrate in ?
A . Saliva
B . Gastric juice
C . Bile
D . Ileal
E . Duodenum
36) Regarding abdominal trauma in pediatric age group , which of the following is true ?
A . Clinical examination , stabilization and resuscitation are not of priority .
B . Ultrasound is the diagnostic tool of choice .
C . Blood transfusion should be started immediately .
D . Peritoneal lavage is contraindicated .
E . Splenectomy is not a routine management for all types of Splenic injuries .
37) Which of the following is true regarding the femoral pulse ?
A . It is usually felt at the midpoint of inguinal ligament .
B . The femoral nerve is medial to the femoral pulse .
C . The femoral pulse is lateral to the deep inguinal ring .
D . The femoral pulse is felt at the mid inguinal point .
E . A Radio_femoral delay is usually felt in aortic stenosis .
38) Which of the following is not true regarding sepsis ?
A . Tachycardia and / or tachypnea may be a sign .
B . Sepsis is defined as systemic inflammatory response syndrome in the presence of infection .
C . Leukocytosis or leukopenia may be a sign .
D . Sepsis and hypotension is defined as septic shock .
E . Temperature greater than 38 or less than 36 may be a sign .
39) Regarding the oxygen dissociation curve , one is true ?
A . Is shifted to the left by increase 2.3 _ DPG .
B . Is Sigmoid shape for both hemoglobin and myoglobin .
C . Is shifted to the left when one ascends to high altitude .
D . Is shifted to the right by an increase in the PH .
E . Is ideally 50% saturated at a PO2 of 28 mmhg .
40) One of the following passes through the aortic hiatus in the diaphragm ?
A . Vagal trunks
B . Right phrenic nerve
C . Thoracic duct
D . Esophagus
E. Branches from left gastric artery
41) A 62 year old male patient presented complaining of bloody diarrhea and cramps , he has recently been started on Clindamycin for septic arthritis . As he is allergic to penicillin . Which of the following is the most likely diagnosis ?
A . Campylobacter jujeni diarrhea .
B . Pseudomembranous colitis .
C . Salmonella typhi diarrhea .
D . Rectal cancer .
E . Hemorrhoids .
42) One of the following is not a complication of gallstones ?
A . Intestinal obstruction
B . Mucocele .
C . Acute cholycystitis .
D . Liver cirrhosis .
E . Pancreatitis .
43) Which of the following statements is true concerning Meckels diverticulum ?
A . It's found within 2 inches of the ileocecal valve .
B . It's a remnant of the embryonic vitelline duct .
C . Ectopic colonic epithelium is found in it .
D . Diagnosis is best made by CT_ scan .
E . It's usually found on the mesentric border of the bowel .
44) A 34 years old male patient presented after being in RTA with severe shortness of breath . Examination revealed a deviated trachea to the left side . Absent breath sounds on the right side of the chest . The best initial management option for this patient is ?
A . Intubate the patient .
B . Insert a chest tube on the right side .
C . Do a chest X_Ray then manage accordingly .
D . Insert a needle thoracostomy followed by a chest tube in the right side of chest .
E . Insert 2 large bore cannulas and give 1 liter of ringer lactate .
45 ) All of the following are true regarding colon cancer except ?
A . It's the second most common cause of cancer related death in Jordan .
B . A ( T1 N1 M0 stage 3 ) tumor is equivalent to Duke stage C tumor .
C . A majority of colorectal cancers occur in the descending colon .
D . FAP and HNPCC are two inherited causes of colorectal cancer .
E . Patients with primary sclerosing cholangitis and ulcerative colitis have increased risk of developing colon cancer .
46) One of the following is false regarding crystalloid solutions ?
A . Osmolarity of Ringer lactate solution 273 mosm L .
B . Ringer lactate contain 154 meq/L sodium .
C . Readily pass through semi _ permeable membrane , therefore they are considered extravascular space expanders .
D . Have poor capillary perfusion and no allergic reaction and short intravascular half life 20_30 minutes .
E . Hartmann solution , 0.9% NaCl solution , 5% Dextrose in water are isotonic crystalloid solutions .
47) How much calories per liter in D_Dextrose 5% ?
A . 150
B . 170
C . 180
D . 200
E. 250
48) A 66 years old woman falls fracturing the surgical neck of humerus . Sex months later she is unable to abduct her arm's above her hand . Most likely nerve injury ?
A . Median nerve
B . Radial nerve .
C . Ulnar nerve
D . Axillary nerve
E . Musclo_cutaneous nerve
49) A 45 years old female found to have wasting of intrinsic muscle , of the hand , weakness and pain in the wrist , most likely nerve injury ?
A . Ulnar nerve
B . Radial nerve
C . Median nerve
D . Axillary nerve
E . Thenar and hypothenar nerves
50) The following causes of Hypercalcemia except ?
A . Sarcoidosis
B . Primary hyperparathyroidism
C . Acute pancreatitis
D . Metastasis bronchial carcinoma
E . Milk Alkali syndrome
51) What is the most likely diagnosis in a 45 year old male patient with HTN , development of facial hair and 7cm suprarenal mass ?
A . Myelolipoma
B . Cushing disease
C . Adrenocortical adenoma
D . Pheochromocytoma
E . Carcinoid tumor
52) 60 kg woman involved with extensive burns . On physical exam found to have pink to red skin colour , slightly swelling and pain , dry skin on the head . Her left arm and leg have dry white painless burns and her anterior torso has Erythematous painful burns with blistering. How much fluid she require ?
A . 2500 ml
B . 10800 ml
C . 8640 ml
D . 12960 ml
E . 17280 ml
53) A patient has the following ABG , PH = 7.56 , PCO2 = 50 mmhg , PO2 = 85 mmhg , HCO3 = 40 meq/L . What is the acid base abnormality ?
A . Uncompensated metabolic alkalosis .
B . Respiratory acidosis with metabolic compensation .
C . Combined metabolic and respiratory alkalosis .
D . Metabolic alkalosis with respiratory compensation .
E . Mixed respiratory and metabolic alkalosis .
54) Most common thyroid tumor that spread via lymphatics ?
A . Follicular
B . Anaplastic
C . Medullary
D . Papillary
E . Lymphoma
55) All of the following are causes of blood stained nipple discharge except ?
A . Intraductal papilloma
B . Carcinoma
C . Ductectasia
D . Fibrocystic disease
E . Fat necrosis of breast
56) Which of the following pathologies is thought to have no malignant potential ?
A . Ulcerative colitis
B . Villous adenoma
C . FAP
D . Hyperplastic polyps
E . Crohn disease
57) Which of the following vaccines are live ?
A . H influenza type B
B . Diphtheria
C . OPV
D . Hepatitis B
E . H influenza A
58) One of the following is true regarding the electrolyte concentration in Hartmann solution ?
A . Chloride 200 mmol/L
B . Lactate 70 mmol/L
C . Sodium 131 mmol/L
D . Potassium 40 mmol /L
E . Calcium 15 mmol/L
59) All are true regarding Heparin except ?
A . It's heterogeneous mixture of sulfated polypeptides .
B . Potentiates the actions of antithrombin 3 .
C . Has a half life of a 90 minutes .
D . Can be reversed by protamine sulphate .
E . Can induce an idiosyncratic thrombocytopenia .
60) All of the following fistulas are unlikely to close spontaneously except ?
A . Fistulas secondary to malignancy .
B . Fistulas due to Crohn disease .
C . Fistulas with epithelized track .
D . Fistulas with long track .
E . Fistulas with foreign bodies .
61) A palpable radial pulse indicate a systolic blood pressure greater than ?
A . 40 mmhg
B . 60 mmhg
C . 80 mmhg
D . 100 mmhg
E . 120 mmhg
62) The main reason of delay of eradication of measles in Jordan is ?
A . Migration or refugee from neighbor Arab countries ( Iraq , Syria ) due to unstable conditions in their countries .
B . Immunization coverage rate is low in Jordan .
C . High cost of vaccine .
D . Cold chain of vaccine is not accurate .
63) One is true regarding electric burns ?
A . Injuries are generally more superficial than those with thermal burns .
B . Intravenous fluid replacement is based on the percentage of body surface area burnt .
C . Electric burns often result in transient traumatic optic neuropathy .
D . Evaluation for fracture of the other extremities and visceral injury is indicated .
E . Cardiac conduction abnormalities are unlikely .
64) 5_HIAA is tested in which of these disease ?
A . Medullary carcinoma of the breast .
B . Papillary thyroid carcinoma .
C . Giant cell carcinoma of the pancreas .
D . Carcinoid tumor .
E . Ganglioneuromas .
65) Capillary refill time is elicited by ?
A . Pressing over the skin for 3 seconds , normally return perfusion by 2 seconds .
B . Pressing over the skin for 5 seconds , normally return perfusion by 2 seconds .
C . Pressing over the skin for 5 seconds, normally return perfusion by 5 seconds .
D . Pressing over the skin 10 seconds , normally return perfusion by 5 seconds .
E . Pressing over the skin for 2 seconds , normally return perfusion by 5 seconds .
66) All of the following are true regarding neck lumps except ?
A . Thyroglossal cysts move upwards 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 .
67) A 50 years old man is admitted to hospital with severe bleeding and bruising . He is on warfarin and his INR is 10 . For rapid complete reversal of his INR , which of the following mostly used ?
A . Platelets .
B . FFP and vitamin K .
C . IV vitamin K .
D . Whole blood and vitamin K .
E . Fresh frozen and vitamin C .
68) All are true about thyroid gland except ?
A . It's composed of two lobes , weighs 25 grams in adult , each lobe 5 cm long , 3 cm wide , 2 cm thick .
B . Epiglotic cartilage lie just above the gland .
C . It extends from first tracheal ring up to sixth tracheal ring .
D . Infrahyoid muscles lie in front , and sternocleidomastoid muscle to the side of the gland .
E . It has follicles , follicular cells , and parafollicular cells .
A . DW5%
B . N/S 3%
C . Ringer lactate
D . 0.9% sodium chloride
E . 6% sodium bicarbonate solution
2) A 84 year old man presents with a small ulcer on the bridge of his nose . It has been present for a number of months . On examination it has pearly white rolled edges . The type of ulcer is ?
A . Curling ulcer
B . Cushing ulcer
C . Marjolin ulcer
D . Rodent ulcer
E . Venous ulcer
3) Which of the following skin tumors is the most common in whites ?
A . SCC
B . BCC
C . Malignant melanoma
D . Merkel cell tumor
E . Dermatofibrosarcoma
4) All of the following is true regarding the femoral triangle except ?
A . The inguinal ligament forms the base .
B . The medial border is formed by the lateral border of the adductor longus .
C . The lateral border is formed by the medial border of the Sartorius .
D . The floor is formed by the adductor longus and pectineus muscle medially .
E . The floor is formed by the Iliopsoas muscle laterally .
5) A 54 year old man on renal dialysis is found to have raised serum calcium and PTH . This is called ?
A . Primary hyperparathyroidism .
B . Secondary hyperparathyroidism .
C . Tertiary hyperparathyroidism .
D . Hypercalcemia of malignancy .
E . Hypoparathyroidism .
6) Most common cause of non pitting edema ?
A . Iatrogenic
B . Filariasis
C . Lymph node resection surgery .
D . Leptospirosis
E . Chagas disease
7) A 19 year old man involved in RTA , found to have a femur fracture and crush injury to his foot . After fixation he becomes dyspneic and hypoxemic . The most likely etiology ?
A . Aspiration
B . Atelectasis
C . Fat embolism
D . Fluid overload
E . Pneumonia
8) ) After exposure to suspected rabied animal , which of the following should be given ?
A . Rabies immunoglobulin and one dose of vaccine as soon as possible .
B . Rabies immunoglobulin then several doses of vaccine .
C . Rabies immunoglobulin alone .
D . Rabies immunoglobulin and antibiotic .
E . Vaccine and antibiotics .
9) Which of the following supports the diagnosis of Hypovolemia ?
A . Urine sodium 28 meq/L
B . Urine chloride 15 meq/L
C . Fe Na < 1
D . Urine / serum creatinine ratio of 20
E . Urine Osmolarity of 350 mosm/ kg
10) Calcitonin sometimes elaborated by which one of the following tumors ?
A . Medullary carcinoma of the breast .
B . Medullary carcinoma of the thyroid .
C . Giant cell carcinoma of the pancreas .
D . Carcinoid tumor of appendix .
E . Ganglioneuromas .
11) In the management of pyloric stenosis , which of the following is true ?
A . Acidosis should be corrected first .
B . Chloride level is normal in spite alkalosis .
C . Hypokalemia should be corrected .
D . Usually there is compensatory hypocarbia .
E . Paradoxical aciduria is not a feature .
12) Differential diagnosis of right iliac fossa pain includes all of the following except ?
A . Tubo _ ovarian mass
B . Acute pyelonephritis
C . Crohn disease
D . Empyema of the gallbladder
E . Splenic vein thrombosis
13) The GCS for 25 year man involved in RTA in a head on collision with a lorry . On examination he is unable to obey commands but localizes to pain and is able to speak , but appear confused . He only opens his eyes to pain ?
A . 4
B . 6
C . 7
D . 10
E . 13
14) Which of the following is not associated with compartment syndrome ?
A . Disproportionate level of pain .
B . Absent distal pulses .
C . Paresthesia .
D . Calor = Heat .
E . Paralysis .
15) 80 year old woman presents with hematemesis . She has had intermittent epigastric pain after food for the past 6 months . She has lost weight about 4 kg . She was recently started on Diclofenac . The most likely cause for her condition ?
A . Mallory Weiss tear
B . Esophagitis
C . Gastric malignancy
D . Aortoenteric fistula
E . Gastric ulcer
16) Which of the following is not an increased risk for venous Thromboembolism ?
A . Active cancer
B . Age greater than 60
C . Thrombophilia
D . Obesity BMI > 30
E . Surgery to excise scalp lipoma
17) What is the first parameter to change in early hypovolemic shock ?
A . Systolic blood pressure
B . Pulse rate
C . Diastolic blood pressure
D . Respiratory rate
E . Level of consciousness
18) A 32 year old man presents with Hematuria . A KUB X_Ray reveals a staghorn calculus in the right kidney and midstream urine , sample grows proteus . The most likely stone type is ?
A . Bile pigment stone
B . Calcium oxalate
C . Calcium phosphate
D . Cholesterol stone
E . Cystine stone
19) Most common site of volvulus in the colorectal region ?
A . Descending colon
B . Sigmoid
C . Transverse colon
D . Rectum
E . Ascending colon
20) 52 year old male patient was found to have Gastrinoma , which of the following is the most likely location for Gastrinoma ?
A . Fundus of stomach
B . Antrum of stomach
C . The triangle formed by the junction of the second and third portion of the duodenum , the junction of the neck and body of the pancreas and the junction of the cystic and common bile duct .
D . The tail of pancreas
E . The triangle formed by the inferior edge of the liver , the cystic duct , and the common hepatic duct .
21) An 18 year old female patient develops urticaria and wheezing after injection of intravenous contrast for an abdominal CT scan . Her BP 120/60 ,HR 155 / min , RR 30 / min , which of the following is the most appropriate immediate therapy ?
A . Intubation
B . Epinephrine
C . B _ blockers
D . Iodine
E . Fluid challenge
22) Which is gram negative organism ?
A . Group A Streptococcus
B . MRSA
C . Pseudomonas aeruginosa
D . Clostridium tetani
E . Listeria
23) The most reliable indicator of the adequacy of burn resuscitation is ?
A . CVP
B . PCWP
C . Urine output
D . Blood pressure
E . Heart rate per minute
24) The most common site for SCC of the lips is ?
A . Upper lip midline
B . Upper lip laterally
C . Lower lip midline
D . Lower lip laterally
E . Oral commissure
25) A 39 year old man presents with severe epigastric pain and right upper quadrant pain . Radiating to the back associated with nausea and vomiting . Inspection of the abdomen shows bruising below the inguinal ligament . This sign is called ?
A . Cullen sign
B . Boas sign
C . Fox sign
D . Grey turner sign
E . Murphy's sign
26) Pleomorphic adenomas of the salivary glands are characterized by one of the following ?
A . They occur only in the parotid glands .
B . They grow rapidly .
C . They rarely recur if simply enucleated .
D . They present as rock _ hard masses .
E . They are common benign salivary tumors .
27) A 20 year old man involved in RTA sustains bilateral fractured femurs . On assessment , he is anxious and confused , with a pulse of 130 / min and BP of 70/50 mmhg . Urine output over 1 hour is 10 ml . This patient has hemorrhagic shock type ?
A . Class 1
B . Class 2
C . Class 3
D . Class 4
E . Class 5
28) All of the following are branches from the external carotid artery except ?
A . Superior thyroid artery
B . Ascending pharyngeal artery
C . Lingual artery
D . Inferior thyroid artery
E . Facial artery
29) On postoperative day 5 post hepatic resection a healthy 55 year old patient is noted to have fever 38.6 c . Which of the following is the most common associated ?
A . UTI
B . Wound infection
C . Pneumonia
D . Intra_abdominal abscess
E . Intravenous catheter related infection
30) One of the following statement is incorrect ?
A . Elevated CA125 is associated with ovarian carcinoma .
B . Elevated CEA is associated with chondrosarcoma .
C . Elevated CA 15_3 is associated with certain breast cancer .
D . Elevated B_HCG is associated with certain testicular cancer .
E . Elevated CA 19_9 is associated with pancreatic cancer .
31) The spleen filters all of the following particles cells except ?
A . Malformed erythrocytes
B . T lymphocytes
C . Malarial parasites
D . Streptococcus pneumonia
E . Platelets
32) Which of the following is not a feature of Crohn disease ?
A . Involvement from mouth to anus .
B . Risk of flare up is decreased with smoking .
C . Macroscopically demonstrates cobblestone .
D . Endoscopically demonstrates skip lesions .
E . Histologically demonstrates transmural granulomatous inflammation .
33) A 45 year old female . Patient presented to E.R complaining of right hypochondriac pain and nausea with repeated vomiting for the last few hours . She recalls eating a cheese cake earlier that day . Examination showed right hypochondriac tenderness but otherwise soft and lax . Her laboratory results were normal . The most appropriate next investigation ?
A . Erect abdominal X_Ray
B . Endoscopy
C . CT abdomen
D . Ultrasound of the abdomen
E . H1 breath test for H pylori
34) A 50 year old man presented to E.R complaining of severe epigastric pain of 5 hours duration . The pain is radiating to his back associated with recurrent vomiting . His amylase is 2017 u/ L . All of the following criteria are used to predict the severity of the case 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 /UL
E . LDH more than 350 u/ L
35) The highest potassium concentrate in ?
A . Saliva
B . Gastric juice
C . Bile
D . Ileal
E . Duodenum
36) Regarding abdominal trauma in pediatric age group , which of the following is true ?
A . Clinical examination , stabilization and resuscitation are not of priority .
B . Ultrasound is the diagnostic tool of choice .
C . Blood transfusion should be started immediately .
D . Peritoneal lavage is contraindicated .
E . Splenectomy is not a routine management for all types of Splenic injuries .
37) Which of the following is true regarding the femoral pulse ?
A . It is usually felt at the midpoint of inguinal ligament .
B . The femoral nerve is medial to the femoral pulse .
C . The femoral pulse is lateral to the deep inguinal ring .
D . The femoral pulse is felt at the mid inguinal point .
E . A Radio_femoral delay is usually felt in aortic stenosis .
38) Which of the following is not true regarding sepsis ?
A . Tachycardia and / or tachypnea may be a sign .
B . Sepsis is defined as systemic inflammatory response syndrome in the presence of infection .
C . Leukocytosis or leukopenia may be a sign .
D . Sepsis and hypotension is defined as septic shock .
E . Temperature greater than 38 or less than 36 may be a sign .
39) Regarding the oxygen dissociation curve , one is true ?
A . Is shifted to the left by increase 2.3 _ DPG .
B . Is Sigmoid shape for both hemoglobin and myoglobin .
C . Is shifted to the left when one ascends to high altitude .
D . Is shifted to the right by an increase in the PH .
E . Is ideally 50% saturated at a PO2 of 28 mmhg .
40) One of the following passes through the aortic hiatus in the diaphragm ?
A . Vagal trunks
B . Right phrenic nerve
C . Thoracic duct
D . Esophagus
E. Branches from left gastric artery
41) A 62 year old male patient presented complaining of bloody diarrhea and cramps , he has recently been started on Clindamycin for septic arthritis . As he is allergic to penicillin . Which of the following is the most likely diagnosis ?
A . Campylobacter jujeni diarrhea .
B . Pseudomembranous colitis .
C . Salmonella typhi diarrhea .
D . Rectal cancer .
E . Hemorrhoids .
42) One of the following is not a complication of gallstones ?
A . Intestinal obstruction
B . Mucocele .
C . Acute cholycystitis .
D . Liver cirrhosis .
E . Pancreatitis .
43) Which of the following statements is true concerning Meckels diverticulum ?
A . It's found within 2 inches of the ileocecal valve .
B . It's a remnant of the embryonic vitelline duct .
C . Ectopic colonic epithelium is found in it .
D . Diagnosis is best made by CT_ scan .
E . It's usually found on the mesentric border of the bowel .
44) A 34 years old male patient presented after being in RTA with severe shortness of breath . Examination revealed a deviated trachea to the left side . Absent breath sounds on the right side of the chest . The best initial management option for this patient is ?
A . Intubate the patient .
B . Insert a chest tube on the right side .
C . Do a chest X_Ray then manage accordingly .
D . Insert a needle thoracostomy followed by a chest tube in the right side of chest .
E . Insert 2 large bore cannulas and give 1 liter of ringer lactate .
45 ) All of the following are true regarding colon cancer except ?
A . It's the second most common cause of cancer related death in Jordan .
B . A ( T1 N1 M0 stage 3 ) tumor is equivalent to Duke stage C tumor .
C . A majority of colorectal cancers occur in the descending colon .
D . FAP and HNPCC are two inherited causes of colorectal cancer .
E . Patients with primary sclerosing cholangitis and ulcerative colitis have increased risk of developing colon cancer .
46) One of the following is false regarding crystalloid solutions ?
A . Osmolarity of Ringer lactate solution 273 mosm L .
B . Ringer lactate contain 154 meq/L sodium .
C . Readily pass through semi _ permeable membrane , therefore they are considered extravascular space expanders .
D . Have poor capillary perfusion and no allergic reaction and short intravascular half life 20_30 minutes .
E . Hartmann solution , 0.9% NaCl solution , 5% Dextrose in water are isotonic crystalloid solutions .
47) How much calories per liter in D_Dextrose 5% ?
A . 150
B . 170
C . 180
D . 200
E. 250
48) A 66 years old woman falls fracturing the surgical neck of humerus . Sex months later she is unable to abduct her arm's above her hand . Most likely nerve injury ?
A . Median nerve
B . Radial nerve .
C . Ulnar nerve
D . Axillary nerve
E . Musclo_cutaneous nerve
49) A 45 years old female found to have wasting of intrinsic muscle , of the hand , weakness and pain in the wrist , most likely nerve injury ?
A . Ulnar nerve
B . Radial nerve
C . Median nerve
D . Axillary nerve
E . Thenar and hypothenar nerves
50) The following causes of Hypercalcemia except ?
A . Sarcoidosis
B . Primary hyperparathyroidism
C . Acute pancreatitis
D . Metastasis bronchial carcinoma
E . Milk Alkali syndrome
51) What is the most likely diagnosis in a 45 year old male patient with HTN , development of facial hair and 7cm suprarenal mass ?
A . Myelolipoma
B . Cushing disease
C . Adrenocortical adenoma
D . Pheochromocytoma
E . Carcinoid tumor
52) 60 kg woman involved with extensive burns . On physical exam found to have pink to red skin colour , slightly swelling and pain , dry skin on the head . Her left arm and leg have dry white painless burns and her anterior torso has Erythematous painful burns with blistering. How much fluid she require ?
A . 2500 ml
B . 10800 ml
C . 8640 ml
D . 12960 ml
E . 17280 ml
53) A patient has the following ABG , PH = 7.56 , PCO2 = 50 mmhg , PO2 = 85 mmhg , HCO3 = 40 meq/L . What is the acid base abnormality ?
A . Uncompensated metabolic alkalosis .
B . Respiratory acidosis with metabolic compensation .
C . Combined metabolic and respiratory alkalosis .
D . Metabolic alkalosis with respiratory compensation .
E . Mixed respiratory and metabolic alkalosis .
54) Most common thyroid tumor that spread via lymphatics ?
A . Follicular
B . Anaplastic
C . Medullary
D . Papillary
E . Lymphoma
55) All of the following are causes of blood stained nipple discharge except ?
A . Intraductal papilloma
B . Carcinoma
C . Ductectasia
D . Fibrocystic disease
E . Fat necrosis of breast
56) Which of the following pathologies is thought to have no malignant potential ?
A . Ulcerative colitis
B . Villous adenoma
C . FAP
D . Hyperplastic polyps
E . Crohn disease
57) Which of the following vaccines are live ?
A . H influenza type B
B . Diphtheria
C . OPV
D . Hepatitis B
E . H influenza A
58) One of the following is true regarding the electrolyte concentration in Hartmann solution ?
A . Chloride 200 mmol/L
B . Lactate 70 mmol/L
C . Sodium 131 mmol/L
D . Potassium 40 mmol /L
E . Calcium 15 mmol/L
59) All are true regarding Heparin except ?
A . It's heterogeneous mixture of sulfated polypeptides .
B . Potentiates the actions of antithrombin 3 .
C . Has a half life of a 90 minutes .
D . Can be reversed by protamine sulphate .
E . Can induce an idiosyncratic thrombocytopenia .
60) All of the following fistulas are unlikely to close spontaneously except ?
A . Fistulas secondary to malignancy .
B . Fistulas due to Crohn disease .
C . Fistulas with epithelized track .
D . Fistulas with long track .
E . Fistulas with foreign bodies .
61) A palpable radial pulse indicate a systolic blood pressure greater than ?
A . 40 mmhg
B . 60 mmhg
C . 80 mmhg
D . 100 mmhg
E . 120 mmhg
62) The main reason of delay of eradication of measles in Jordan is ?
A . Migration or refugee from neighbor Arab countries ( Iraq , Syria ) due to unstable conditions in their countries .
B . Immunization coverage rate is low in Jordan .
C . High cost of vaccine .
D . Cold chain of vaccine is not accurate .
63) One is true regarding electric burns ?
A . Injuries are generally more superficial than those with thermal burns .
B . Intravenous fluid replacement is based on the percentage of body surface area burnt .
C . Electric burns often result in transient traumatic optic neuropathy .
D . Evaluation for fracture of the other extremities and visceral injury is indicated .
E . Cardiac conduction abnormalities are unlikely .
64) 5_HIAA is tested in which of these disease ?
A . Medullary carcinoma of the breast .
B . Papillary thyroid carcinoma .
C . Giant cell carcinoma of the pancreas .
D . Carcinoid tumor .
E . Ganglioneuromas .
65) Capillary refill time is elicited by ?
A . Pressing over the skin for 3 seconds , normally return perfusion by 2 seconds .
B . Pressing over the skin for 5 seconds , normally return perfusion by 2 seconds .
C . Pressing over the skin for 5 seconds, normally return perfusion by 5 seconds .
D . Pressing over the skin 10 seconds , normally return perfusion by 5 seconds .
E . Pressing over the skin for 2 seconds , normally return perfusion by 5 seconds .
66) All of the following are true regarding neck lumps except ?
A . Thyroglossal cysts move upwards 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 .
67) A 50 years old man is admitted to hospital with severe bleeding and bruising . He is on warfarin and his INR is 10 . For rapid complete reversal of his INR , which of the following mostly used ?
A . Platelets .
B . FFP and vitamin K .
C . IV vitamin K .
D . Whole blood and vitamin K .
E . Fresh frozen and vitamin C .
68) All are true about thyroid gland except ?
A . It's composed of two lobes , weighs 25 grams in adult , each lobe 5 cm long , 3 cm wide , 2 cm thick .
B . Epiglotic cartilage lie just above the gland .
C . It extends from first tracheal ring up to sixth tracheal ring .
D . Infrahyoid muscles lie in front , and sternocleidomastoid muscle to the side of the gland .
E . It has follicles , follicular cells , and parafollicular cells .
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