MCQ Surgery 5

"2,8 kg neonate with excessive salivation developed respiratory distress attempt to pass orogastric catheter fall because the catheter in the back of throat chest film is obtain and show right upper lobe atelectasis and gasless abdomen the most likely diagnosis A. Proximal esophagus atresia without fistula B. Proximal esophagus atresia with distal tracheoesophagus fistula C. H type tracheoesophagus fistula D. Esophagus atresia with both proximal and distal tracheoesophus fistula E. Congenital esophageal stricture"

A

"2.8 kg neonate with excessive salivation develops respiratory distress. Attempts to pass an orogastric catheter fail because the catheter coils in the back of the throat. A chest film is obtained and shows right upper lobe atelectasis and a gasless abdomen. The most likely diagnosis is: A. Proximal esophageal atresia without fistula B. Proximal esophageal atresia with a distal tracheoesophageal fistula C. H-type te fistula D. Esophageal atresia with both proximal and distal te fistula E. Congenital esophageal stricture"

A

"A 2.8 kg Neonate with excessive salivation develops respiratory distress. Attempts to pass an orogastric catheter fail because the catheter coils in the back of the throat. A chest film is obtained and shows right upper lobe atelectasis and a gasless abdomen. The most likely diagnosis is: A. Proximal esophageal atresia without a fistula. B. Proximal esophageal atresia with a distal tracheoesophageal TE fistula C. H-typete fistula. D. Esophageal atresia with both proximal and distal te fistula. E. Congenital esophageal stricture."

A

"A 34 years old woman present with hypertension , generlized weakness and polyuria. Her electrolyte panel is significant for hypokalaemia . Which of the following is the best intiail test given her presentation and laboratory findings ? A. Plasma renin activity and plasma aldosterone concentration B. Urine electrolytes C. Plasma cortisol level D. Overnight low dose dexamethasone suppression test E. Twenty four hours urinary aldosterone level"

A

"A 50-year-old man presents to the emergency department with chest pain. The patient is evaluated for a myocardiac infarction. The workup is negative. On further questioning, his symptoms include dysphagia (with both liquids and solids). Which of the following is TRUE? A. A barium swallow will always show a corkscrew esophagus. B. Manometry shows simultaneous high-amplitude contractions. C. Initial evaluation should exclude coronary artery disease. D. A pulsion diverticulum may be present. E. Patients refractory to medical management may respond to long esophagomyotomy."

A

"A 56-year-old male complains of pain and weakness in both legs on standing and on exercise. It is not relieved by rest. He is a non-smoker, with no relevant family history. On examination peripheral pulses are intact.What is the likely diagnosis? A. Neurogenic claudication B. Varicose veins C. Vascular claudication D. Peripheral myopathy E. Osteoarthritis"

A

"A 60-year-old diabetic man is admitted to the hospital with a diagnosis of acute cholecystitis. The WBC count is 28000, and a plain film of abdomen and CT scan show evidence of intramural gas in the gallbladder. What is the most likely diagnosis? A. emphysematous GB B. acalculous cholecystitis C. sclerosing cholangitis D. gallstone ileus E. cholangioheptits"

A

"As an accidental finding during upper Abdominal CT scan , a 3 cm mass in adrenal gland is noted . Which of the following would Not be an appropriate step in patients work up ? A. Laparoscopic adrenalectomy B. measurements of serum electrolytes C. measurements of plasma aldosterone and renin D. measurements of urine catecholamines excretion E. Dexamethasone suppression test"

A

"In a 55-year-old grocery store cashier with an 8-month history of leg edema increasing over the course of a work day, associated with moderate to severe lower leg bursting pain, the most appropriate investigative study or studies are: A. Doppler duplex ultrasound. B. Brodie-Trendelenburg test. C. Ascending and descending phlebography. D. measurement of ambulatory and resting foot venous pressure. E. venous reflux plethysmography."

A

"You are asked to see a 73-year-old lady with a large ulcer over the medial malleolus of her left foot. There is a healthy base, with granulation tissue present. There are superficial dilated veins over the medial aspect of the leg.What is the likely diagnosis? A. venous ulcer B. Arterial ulcer C. Marjolin's ulcer D. Curling's ulcer E. Cushing's ulcer"

A

"A 15-year-old boy complains of right-sided weakness and gait impairment. ACT scan shows a large, nonenhancing cyst in the posterior cranial fossa, with an enhancing tumor nodule in the left cerebellum. What is the most likely diagnosis? A. An arachnoid cyst B. A cystic astrocytoma C. Rathke's cleft cyst D. Glioblastomamultiforme E. A large sebaceous cyst ans"

B

"A 32-week pregnant patient presented with bright red bleeding per rectum, which was not mixed with the stool. The most probable diagnosis A. duodenal ulcer B. Piles C. Diverticulitis D. Colonic polyps E. Ulcerative colitis"

B

"A 33-year-old female noted a discharge from a sinus in the overlying skin below the right angle of the mandible. She recalls previous episodes of fullness and mild pain in this region over the past several years. What is the most likely cause? A. Thyroglossal duct cyst B. Branchial cyst C. teratoma D. Myeloma E. trauma to the neck"

B

"A 35-year-old man involved in a motor vehicle accident presents with a knee dislocation that is easily reduced. Radiography of the knee shows no fracture. Which of the following statements about h is treatment are true? A. If he has normal pulses he can be discharged. B. If he has normal pulses he requires either close observation or arteriography. C. If he has absent distal pulses and severe ischemia he should undergo arteriography in the radiology suite. D. A popliteal vein injury is best treated with ligation. E. A popliteal artery injury should be repaired with the ipsilateral saphenous vein if available."

B

"A 36-year-old man presents with weight loss and a large palpable tumor in the upper abdomen. Endoscopy reveals an intact gastric mucosa without signs of carcinoma. Multiple biopsies show normal gastric mucosa. A UGI study shows amass in the stomach. At surgery, a 3-kg mass is removed. It is necessary to remove the left side of the transverse colon. What is the most likely diagnosis? A. Gastric cancer B. Gastrointestinal stromal tumor (GIST) C. Choledochoduodenal fistula D. Eosinophilic gastroenteritis E. Linitis plastica"

B

"A 5-year-old girl presents with difficulty breathing. On examination, of the oral cavity a 3-cm mass is found in the midline on the posterior aspect of the tongue. The most likely diagnosis is: A. Lingual tonsil B. Lingual thyroid C. Foreign body stuck to the tongue D. Dermoid E. Angioneurotic edema"

B

"A 50-year-old obese man complains of epigastric discomfort, and on OGD the OG (oesophageal gastric. junction is noted to be at an abnormal position, though intact, with no other abnormality. What is the likely diagnosis? A. Hiatus hernia; sliding B. Hiatus hernia; rolling C. Diaphragmatic hernia D. Congenital hernia E. Helicobacter related gastritis"

B

"A 59-year-old woman has discomfort in the posterior part of her tongue. Abiopsy confirms that the lesion is a carcinoma. What is true in carcinoma of the posterior third of the tongue? A. Lymphoid tissue is absent. B. Lymph gland spread is often encountered. C. There is an excellent prognosis. D. The tissue is well differentiated. E. The recurrent laryngeal nerve is infiltrated."

B

"A 62-year-old man undergoes excision of a cylindroma of the submandibular gland. He is most likely to have an injury to which of the following? A. Maxillary branch of the trigeminal nerve B. Lingual nerve C. Vagus nerve D. Floor of the maxilla E. Frontozygomatic branch of the facial nerve"

B

"A 73-year-old lady presents to the outpatient department for routine follow up 4 weeks after an abdominoperineal resection, for rectal cancer. She is doing extremely well, and just as she is leaving happens to mention that her left leg has become extremely painful over the past 2 weeks. On examination, the left lower leg is erythematous, painful to touch and oedematous, peripheral pulses intact, with no obvious trauma. What is the most likely diagnosis? A. Cellulitis B. Deep vein thrombosis C. Ruptured Baker's cyst D. Muscle rupture E. Arterial insufficiency"

B

"An elderly gentleman underwent extensive gastric resection and anastomosis without bypass. He reports that he is doing well, his bowels are returning to normal and his appetite is picking up, however he feels noticeably more fatigued since the operation. What would be a concern? A. Dumping syndrome B. Anaemia: B12 deficiency C. Steatorrhoea D. Anaemia: folate deficiency E. Ulceration"

B

"An elderly nursing home pt is brought to the hospital with recent onset of colicky abdominal pain, distention and constipation on examination the abdomen is markedly distended and tympanic. There's no marked tenderness. Plain abdominal X-Ray shows a markedly distended loop located mainly in the right upper quadrant. The likely diagnosis is: A. Small bowel obstruction B. Large bowel obstruction C. Gallstone D. mesenteric vascular occlusion E. Sigmoid volvulus"

B

"The patient continues to have symptoms despite this treatment, and undergoes a TURP. Postoperatively he initially does well, but his wife reports that he does not seem himself and is becoming increasingly confused; he also complains of nausea. His observations are stable and bladder irrigation fluid is flowing very well. bloods are sent to the lab and reveal hyponatraemia. What is the likely diagnosis? A. Internal haemorrhage B. TURP syndrome C. Urinary infection D. Bladder neck stenosis E. Worsening of existing cerebral degeneration"

B

"18 years old male student who lives at a hostel, presented with one day history of anal pain. On examination there was anal fissure at 6, O'clock position. This patient should be treated by: A. Fissurectory B. Lateral sphincterotomy C. Local anesthesia, analgesic and laxative D. Manual dilatation under general anesthesia E. Anoplasty"

C

"45 years old pt. Presents in shock complaining of sudden onset generalized upper abdominal pain radiating to the right iliac fossa and the tip of his right shoulder. He reports one episode of vomiting. But none since. He has no past medical problems. On examination, his abdomen is rigid and bowel sounds are absent. The diagnosis is: A. Caecal volvulus B. Pancreatitis C. Perforated duodenal ulcer D. Ascending cholangitis E. Appendicitis"

C

"60-year-old smoker presents to the urology clinic after a GP referral for haematuria. He is pain free with only the occasional clot seen. He is on warfarin, his most recent INR being 2.5 yesterday. Where is the likely location of the bleeding? A. Kidney B. Ureter C. Bladder D. Prostate E. Urethra"

C

"66 years old Male pt has DM presented with acute RUQ pain for 6 hours and vomiting. He is febrile 39 C and tachycardic. He is jaundiced with total bilirubin of 3.6 and direct of 2.8 his WBC is 16,000. Hb 14, ALT 150, AST 90, he has past history of gallbladder stones, regarding his diagnosis and management which is true: A. The pt has acute cholecystitis and needs I.V antibiotics and lap. cholecystectomy B. The pt has acute cholecystitis and needs ERCP and lap. Cholecystectomy C. The pt has ascending cholangitis and needs I.V antibiotics and ERCP urgently D. The pt has ascending cholangitis and needs I.V antibiotics and lap cholecystectomy E. The pt has gallstone pancreatitis and needs lap cholecystectomy before discharge"

C

"69yearold female presents to her GP with a 1week history of being told she looks 'yellow by her friends. She also complains of itching. On examination there is a mass in the right upper quadrant. She is pain free.What sign/law is this? A. Trousseau's sign B. Homans' sign C. Courvoisier's law D. Rovsing's sign E. Murphy's sign"

C

"A 23 year old male presented with acute scrotal pain and swelling which of the following suggest epididymitis over testiculer torsion as a cause of his presentation? A. Presence of bell clapper deformity B. Absent of cremastric reflex C. Postive perhn's sign D. Elevated WBC E. Acute onset of pain"

C

"A 24-year-old man is involved in an industrial accident in which he sustains a crushed pelvis. Diagnostic peritoneal lavage is positive. At exploration, a large pelvic hematoma is found. What is the best treatment? A. Explore all the major arteries and veins of the pelvis and surgically control the bleeding if possible. B. Do not explore the pelvic hematoma. Close the abdomen and apply a MAST suit. C. Do not explore the pelvic hematoma. Apply a pelvic fixator and send the patient to radiology f or possible embolization of bleeding pelvic vessels. D. Use sustained hypotensive anesthesia to try to control bleeding. E. Open the pelvic hematoma and apply laparotomy pads with topical hemostatic agents."

C

"A 28-year-old woman developed a painful thrombosis of a superficial varix in the left upper calf 2 days previously. After spending the 2 days in bed with her leg elevated, she felt better and the tenderness resolved; however, when out of bed she developed a twinge of right-sided chest pain when walking and a feeling of heaviness in the calf. Which treatment is most appropriate? A. Check for leg swelling, tenderness, and Homan's sign, and obtain a Doppler ultrasound study. B. Begin antibiotics for a probable secondary bacterial infection. C. Order emergency venography, and if it is abnormal, begin heparin administration. D. Begin ambulation and discontinue bed rest that probably caused muscle pain by hyperextension of the knee. E. If there is no pain on dorsiflexion of the left foot reassure her, since a negative Homan's sign precludes the diagnosis of DVT."

C

"A 29-year-old woman is referred by her doctor with a 3month history of a painless lump in the anterior aspect of the neck. She does not describe any hoarseness of voicE. Examination reveals a lump in the left anterior triangle, which moves up and down with swallowing. FNA cytology of the lump reveals nuclear grooves and Psamomma's bodies. What is the most likely diagnosis? A. Follicular adenoma B. Follicular carcinoma C. Papillary carcinoma D. medullary carcinoma E. Anaplastic carcinoma"

C

"A 36 year old man who was hit by a car presents to ER hypotension, on examination he has tenderness and brusing over the left lateral chest below nipple, ultrasound examination is performed and reveals free fluid in the abdomen. What's most likely organ to have been injured ? A. Liver B. Kidney C. Spleen D. Intestine E. Pancrease"

C

"A 45-year-old patient presents in shock complaining of sudden-onset generalized upper abdominal pain radiating to the right iliac fossa and the tip of his right shoulder. He reports one episode of vomiting, but none since. He has no past medical problems. On examination, his abdomen is rigid and bowel sounds are absent. The diagnosis is: A. Caecal volvulus B. Pancreatitis C. Perforated duodenal ulcer D. Ascending cholangitis E. Appendicitis"

C

"A 50-year-old gynecologist complains of dysphagia, regurgitation, and weight loss. She also states that she feels as if food is stuck at the level of the xiphoid. An upright chest x-ray shows a dilated esophagus with an air-fluid level. Which of the following is FALSE? A. A barium swallow will show a "bird's peak" deformity B. Manometry will demonstrate that the leS fails to relax during swallowing. C. Upper endoscopy should be avoided because of the risk of complications. D. medical treatment includes nitrates and calcium channel blockers. E. Intersphincteric injection of botulinum toxin can be therapeutic."

C

"A 53 year old man brought into ER after a gunshot wound to the left flank .You suspect a splenic injury with ongoing bleeding . The patient on coumarin (warfarin). His INR is 3.0 what do you do to correct coagulopathy on route to the operating room A. IV vitamin K B. Orally administered vitamin k C. Fresh frozen plasma transfusion D. PRBCs E. Protamine Infusion"

C

"A 55-year-old woman gives a history of tiredness, aching, and a feeling of heaviness in the left lower leg for the past 3 months. These symptoms are relieved by leg elevation. She is also awakened frequently by calf and foot cramping, which is relieved by leg elevation, walking, or massage. On physical examination there are superficial varicosities, non pitting edema, and a slightly painful, 2 cm. diameter superficial ulcer 5 cm. above and behind the left medial malleolus. What is the most appropriate diagnosis? A. Isolated symptomatic varicose veins. B. Superficial lymphatic obstruction. C. Deep venous insufficiency. D. Arterial insufficiency. E. Incompetent perforating veins."

C

"A 60-year-old man has been having vague symptoms of upper abdominal discomfort, early satiety, and fatigue. He is referred to a gastroenterologist, who performs an upper endoscopy. Although a discrete mass is not visualized, the stomach looks abnormal. It does not distend easily with insufflation. A biopsy shows signet ring cells. Which of the following is TRUE? A. Signet ring cells are typically found in intestinal type gastric adenocarcinoma. B. Signet ring cell cancer is the most common type of gastric cancer. C. "leather bottle stomach" is a term used to describe a nondistensible stomach infiltrated by cancer. D. The gross appearance of the stomach always shows classic findings of linitus plastica. E. Linitus plastica has an excellent prognosis"

C

"A 62-year-old alcoholic presents with an indurated ulcer, 1.5 cm in length, in the left lateral aspect of her tongue (not fixed to the alveolar ridgE. There are no clinically abnormal glands palpable in the neck, and a biopsy of the tongue lesion reveals squamous cell carcinomA. What should she undergo? A. Chemotherapy B. Local excision of the ulcer C. Wide excision and left radical neck dissection D. Antibiotic therapy and should be encouraged to stop smoking E. Wide excision of ulcer and radiotherapy"

C

"A 67-year-old woman complains of paresthesias in the limbs. Examination shows loss of vibratory sense, positional sense, and sense of light touch in the lower limbs. She is found to have pernicious anemia. Endoscopy reveals an ulcer in the body of the stomach. What does she most likely have? A. Excess of vitamin B12 B. Deficiency of vitamin K C. Cancer of the stomach D. Gastric sarcoma E. Esophageal varices"

C

"A 78-year-old woman undergoes an uncomplicated minor surgical procedure under local anesthesia. At the completion of the operation, she suddenly develops pallor, sweating, bradycardia, hypotension, abdominal pain, and gastric distension. What is the next stem in management? A. Rapid infusion of 3 L of Ringer's lactate B. Digoxin C. Insertion of a nasogastric tube D. Morphine E. neostigmine"

C

"A man aged 32 years complains of pain and distention after meals. He feels better after inducing vomiting. He had past history of hunger pain. The pain is periodical and comes after tension. On abdominal examination visible peristalsis from left to right. No mass could be felt the most probable diagnosis is A. Gastric outlet obstruction due to carcinoma of the pylorus B. Chronic gastritis C. Gastric outlet obstruction due to chronic duodenal ulcer. D. Upper intestinal obstruction E. Hiatus hernia."

C

"A young man complains of bright red blood on paper and in the pan after passing stool. He also occasionally feels a 'lump come down' when straining.What is the most likely diagnosis? A. Colonic carcinoma B. Fissure C. Haemorrhoids D. Diverticular disease E. Ulcerative colitis"

C

"A40-year-old man has had recurrent symptoms suggestive of peptic ulcer disease for 4 years. Endoscopy reveals an ulcer located on the greater curvature of the stomach. A mucosal biopsy reveals Helicobacter. pylori. What is TRUE About H. pylori? A. Active organisms can be discerned by serology. B. It is protective against gastric carcinomA. C. It is associated with chronic gastritis. D. It causes gastric ulcer but not duodenal ulcer. E. It can be detected by the urea breath test in <60% of cases."

C

"A43-year-old teacher underwent left parotidectomy. Upon awakening from surgery, paralysis of the left lower lip was observed. This complication was most likely due to injury to which of the following: A. Parotid duct B. Facial nerve temporal branch C. Facial nerve cervical branch D. Facial nerve main trunk E. Platysma muscle"

C

"A64-year-old supermarket manager had an elective operation for duodenal ulcer disease. He has not returned to work because he has diarrhea with more than 20 bowel movements per day medication has been ineffective. The exact details of his operation cannot be ascertained. What operation was most likely performed? A. Antrectomy and Billroth I anastomosis B. Gastric surgery combined with choleystectomy C. Truncal vagotomy D. Highly selective vagotomy E. selective vagotomy"

C

"A73-year-old woman is admitted to the hospital with a mild UGI hemorrhage that stopped spontaneously. She did not require transfusion. She had ingested large amounts of aspirin in the past 4 months to relieve the pain caused by severe rheumatoid arthritis. Endoscopy confirms the presence of a duodenal ulcer. A biopsy is done. What is the next step in the management of a duodenal ulcer associated with a positive biopsy for H. pylori? A. H2 blockers B. Bipolar electrocautery of the ulcer C. Triple therapy D. Photocoagulation E. Elective surgery"

C

"A9-year-old boy complains of a swelling on the left side of his neck in the supraclavicular region. The swelling is translucent; a diagnosis of cystic hygroma is established. What is true of cystic hygroma? A. It arises from sweat glands in the neck. B. It is usually an anterior midline structure. C. It may occur in the mediastinum. D. Its lesions are usually easy to enucleate. E. It is premalignant."

C

"You are called to the ward to review a patient who has lost consciousness after what the nurse describes as a heavy fall, broken only by his head after tripping on his walking frame. She tells you he is on warfarin for atrial fibrillation, and she is worried. At what point should intubation be considered? A. GCS < 12 B. GCS < 10 C. GCS < 8 D. GCS < 6 E. GCS < 4"

C

"A 40-year-old woman complains of heartburn located in the epigastric and retrosternal areas. She also has symptoms of regurgitation. Endoscopy shows erythema of the esophagus consistent with reflux esophagitis. The patient has tried conservative measures, including PPls with no improvement in symptoms. Which of the following is TRUE? A. Manometry does not add any additional information. B. The 24-hour pH test is no longer used. C. If endoscopy has been done, an esophagogram is unnecessary. D. Nissen fundoplication is the surgical treatment of choice. E. Toupet fundoplication is 360 curve"

D

"A 46-year-old man present with dysphagia of recent onset. His esophogram shows a lesion in the lower third of his esophagus. Biopsy of the lesion shows adenocarcinoma. His general medical condition is excellent, and his metastatic workup is negative. What should his management involve? A. Chemotherapy B. Radiation therapy C. Insertion of a stent to improve swallowing D. Surgical resection of the esophagus E. Combination of chemotherapy and radiation therapy"

D

"A 50-year-old woman presents with duodenal ulcer disease and high basal acid secretory outputs. secretin stimulated serum gastrin levels are in excess of 1000 pg/mL. She has a long history of ulcer disease that has not responded to intense medical therapy. What is the most likely diagnosis? A. Hyperparathyroidism B. Pernicious anemia C. renal failure D. ZES E. Multiple endocrine neoplasia"

D

"A 53-year-old moderately obese woman presents with heartburn aggravated mainly by eating and lying down in the horizontal position. Her symptoms are suggestive of gastroesophangeal reflux disease (GERC. Which of the following statements is TRUE? A. It is best diagnosed by an anteroposterior A.P) and lateral film of the chest. B. It may be alleviated by certain drugs, especially theophylline, diazepam, and calcium channel blockers. C. It is not relieved by cessation of smoking. D. If it is associated with dysphagia, it suggests a stricture or motility disorder. E. It should be immediately treated with Surgery"

D

"A 58-year-old woman undergoes excision biopsy of a tumor in the left posterior triangle of her neck. Histology suggests that this is a metastatic cancer. What is the most likely site of the primary tumor? A. Ovary B. Adrenal gland C. Kidney D. Piriform fossa E. Stomach"

D

"A 63-year-old man has an upper gastrointestinal (UGI) study as part of his workup for abdominal pain. The only abnormal finding was in the antrum, where the mucosa prolapsed into the duodenum. There were no abnormal findings on endoscopy. What should he do? A. Sleep with his head elevated. B. Be placed on an H2 antagonist. C. Undergo surgical resection of the antrum. D. Be observed and treated for pain accordingly. E. Have laser treatment of the antral mucosA."

D

"19 years old male patient is suffering from abdominal pain that is releived by food or drinking soda. Today be presented to the casualty with 10 hours of vomiting and severe abdominal pain . On examination the abdomen was tender & rigid. What is the most probable diagnosis A. Pyloric stenosis B. Cancer stomach C. Bleeding ulcer D. Perforated ulcer E. penetrating ulcer"

D

"55 years old diabetic patient presented with 5 days history of throbbing anal pain, his temperature was 38.90° C, pulse was 97 min examination revealed red tender mass in perianal area. The BEST managementement is: A. Hot fomentation B. Bed rest C. Systemic antibiotic D. Incision and drainage E. Analgesic"

D

"A 17 year old girl presented with o 2.5 cm nodule in the right lobe of the thyroid gland and enlarged three cervical LNs confirmed by US FNA cytology revealed malignant cells with vesicular nuclei, the most probable diagnosis is: A. Lymphoma B. Anaplastic carcinoma C. Follicular carcinoma D. Papillary carcinoma E. medullary carcinoma"

D

"A 17-year-old male presents with 3-month history of headache, weight gain, decreased concentration, polyuria, and polydypsia. His headaches are mostly in morning and involvesthe frontal region. On examination he was found to have bitemporal visual field defect and no facial hair. MRI scan revealed a suprasellar partially calcified cystic lesion with displacement of optic chiasm. The most likely pathology is: A. Giant aneurysm of carotid artery B. Pituitary macroadenoma C. Glioblastomamultiforme D. Craniopharyngioma E. testicular metastasisans"

D

"A 79-year-old retired opera singer presents with dysphagia, which has become progressively worse during the last 5 years. He states that he is sometimes aware of a lump on the left side of his neck and that he hears gurgling sounds during swallowing. He sometimes regurgitates food during eating. What is the likely diagnosis? A. Carcinoma of the esophagus B. Foreign body in the esophagus C. Plummer-Vinson (Kelly-Patterson) syndrome D. Zenker's (pharyngoesophageal) diverticulum E. Scleroderma"

D

"A baby aged 5 months presented to the outpatient clinic with a mass in his umbilicus that appears on crying and disappears spontaneously. Which the following statement is TRUE regarding this case? A. It should be operated upon urgently B. Operation must be postponed till the age of puberty C. The best thing is to put a truss D. It can disappear spontaneously E. Can be operated upon under local anesthesia"

D

"A50-year-old man presents with vague gastric complaints. Findings on physical examination are unremarkable. The serum albumin level is markedly reduced (1.8 g/100 mL). A barium study of the stomach shows massive gastric folds within the proximal stomach. These findings are confirmed by endoscopy. What is the correct diagnosis? A. Hypertrophic pyloric stenosis B. Gallstone ileus C. Mallory-Weiss tear D. Hypertrophic gastritis E. Crohn's disease"

D

"A63-year-old man underwent gastric resection for severe peptic ulcer disease. He had complete relief of his symptoms but developed "dumping syndrome." This patient is most likely to complain of which of the following? A. Gastric intussusception B. repeated vomiting C. severe diarrhea D. severe vasomotor symptoms after eating E. Intestinal obstruction"

D

"A68-year-old woman has been diagnosed with a benign ulcer on the greater curvature of her stomach, 5 cm proximal to the antrum. After 3 months of standard medical therapy, she continues to have guaiac positive stool, anemia, and abdominal pain with failure of the ulcer to heal. Biopsies of the gastric ulcer have not identified a malignancy. The next step in management is which of the following? A. Treatment of the anemia and repeat all studies in 6 weeks B. Endoscopy and bipolar electrocautery or laser photocoagulation of the gastric ulcer C. Admission of the patient for total parenteral nutrition (TPN), treatment of anemia, and endoscopic therapy D. Surgical intervention, including partial gastric resection E. Surgical intervention, including total Gastrectomy"

D

"All of the following are considered an increased a risk factor for cancer in a patient with a thyroid mass except A. Age younger than 25 or older than 60 B. Rapid growth C. Family history D. Hot nodule on thyroid uptake scan E. Male gender"

D

"Four days after undergoing a right hemicolectomy for ceacal volvulus, an obese 65 year old man has a leakage of serosanguineouse fluid between the inscision staples, the dresssing is soaked. He has COPD which he takes corticosteroids. His vital signs are stable. Abdomen examination shows distention with minimal inscisional tenderness and no erthyema. What is the most likely diagnosis? A. Anastomosis leak B. Wound infection C. Necrotizing fascitis D. Wound dehiscence E. Evisceration"

D

"Four days after undergoing a right hemicolectomy for cecal volvulus, obese 65 years old man has a leakage of seroanguineous fluid between the incision staples, the dressing is soaked. He has COPD to which he takes corticosteroids . His vital signs are stable. Abdomen examination shows distention with minimal incisional tenderness and no erythemA. What's the most likely diagnosis? A. Anastomotic leak B. Wound infection C. Necrotizing fasciitis D. Wound dehiscence E. Evisceration"

D

"the most urgent measure in management of severly injured patient A. Control of active bleeding B. Taking blood sample for grouping and cross matching C. Establishing an intervenouse line D. securing clear airway and adaquate pulmonary ventilation E. tetnus prophylaxis"

D

"49 Years old lady developed change in bowel habit of recent onset. Barium investigation showed apple core appearance"" This characteristic feature of A. Ulcerative colitis B. TB C. Ischemic colitis D. Angiopdysplesia E. Cancer colon"

E

"A 30-yeor old female presents for evolution of a palpable thyroid nodule Tc99 scan demonstrated a single cold nodule it may be the following EXCEPT: A. Carcinoma B. Non-functioning adenoma C. thyroid cyst D. Colloid nodule E. Autonomous nodule"

E

"A 43-year-old man is treated with pyridostigmine for facial, ocular, and pharyngeal weakness due to myasthenia gravis. Which statement is true of pyridostigmine? A. It is unrelated to neostigmine. B. It has far more side effects than neostigmine. C. Pyridostigmine and neostigmine reverse depolarizing neuromuscular blockade. D. It causes greater muscarinic effect than neostigmine. E. It is an anticholinesterase agentans"

E

"A 44-year-old woman is scheduled for gastric surgery. She has no comorbid disease. The anesthesiologist has difficulty inserting the orotracheal tubE. In between intubation attempts he uses an ambu bag to oxygenate the patient. The patient's abdomen gets distended and tympany is noted in the left upper quadrant. Suddenly the patient becomes hypotensive. Which of the following can cause a vosogvagal response during anesthesia? A. The gastric remnant following a distal gastrectomy B. Corrosive gastritis C. Pernicious anemia D. Gastric volvulus E. Acute gastric dilatation"

E

"A 45 year old man presents with a mass in right lower abdomen for 2 months he has altered bowel habits & weight loss but no vomiting. Which of the Following conditions is NOT a differential diagnosis in this patient? A. Ileo-cecal kochs B. Crohn's disease C. Carcinoma cecam D. Amoebiasis of cecum E. mesenteric ischemia"

E

"A 54-year-old man presents with a massive UGI bleed. After resuscitation, endoscopy is performed. No esophageal varices, gastritis, or gastric ulcers are seen. After copious irrigation, a pinpoint lesion is seen near the GE junction. What can be said about this lesion? A. It is a carcinoid. B. It is related to alcohol use. C. It is exclusively a mucosal lesion. D. Surgery if first-line therapy. E. Bleeding is from a submucosal vessel"

E

"A 64-year-old woman presents with severe upper abdominal pain and retching of 1-day duration. Attempts to pass a nasogastric tube are unsuccessful. Xrays show an air-fluid level in the left side of the chest in the posterior mediastinum. An incarcerated paraesophageal hernia and gastric volvulus is diagnosed. What is the next step in management? A. Insertion of a weighted bougie to untwist the volvulus B. Elevation of the head of the bed C. Placing the patient in the Trendelenburg position with the head of the bed lowered D. Laparotomy and vagotomy E. Surgery, reduction of the gastric volvulus, and repair of the hernia"

E

"A routine sography for healthy 59 years old female shows a cluster of microcalcification . What is the most appropriate next step in management this patient: A. repeat mammography again B. repeat mamography at 6 months C. Presecribe anti estrogen for 6 months D. Assure her and send her home E. Take a biopsy"

E

"A30-year-old psychiatric patient has a barium swallow after removal of a foreign body to rule out a small perforation of the esophagus. No perforation is seen, but an epiphrenic diverticulum is visualized. An epiphrenic diverticulum may be associated with which of the following? A. Duodenal ulcer B. Gastric ulcer C. Cancer of the tongue D. Cancer of the lung E. Hiatal hernia"

E

"During examination of the patient you notice that when he is asked to raise his head off the bed there is a large midline mass protruding from the xiphisternum to the umbilicus. What is this likely to be A. Congenital diaphragmatic hernia B. Incisional hernia C. traumatic hernia D. Spigelian hernia E. Divarification of the rectus"

E