Surgery (3) اسئلة الامتياز

The following are characteristic signs and symptoms of severe (critical ischemia of the lower extremity, except: Pain at rest Gangrene of the toes Claudication distance of more than 500 meters Tender calf muscles Loss of power and sensation

...: D* Tender calf muscles

The treatment of acute appendicitis during the first trimester of pregnancy is: Urgent appendectomy plus D&C (dilatation and curettage Conservative treatment and doing appendectomy one month after delivery Conservative treatment then doing appendectomy and elective CS when pregnancy reaches 32 weeks Conservative treatment will be sufficient to abort the condition permanently Urgent appendectomy and observation of any vaginal bleeding

...: E* Urgent appendectomy and observation of any vaginal bleeding

Which of the following IV solutions is the best plasma expander: 5% dextrose water 0,9% NaCl 0,45% NaCl Gelfusine 0,18% NaCl

1* 5% dextrose water

In total parenteral nutrition the recommended method to give the IV solution is through a: Central venous line Peripheral arterial line Nasogastric feeding tube Peripheral venous line Feeding jejunostomy tube

1* Central venous line

Which one of the following IV solutions contains potassium (K): Ringer's lactate Dextran 40 Dextran 70 Dextrose water 5% Dextrose saline

1* Ringer's lactate

The daily insensible water loss from skin and lungs in healthy adult is: 500 ml 900 ml 1500 ml 2000 ml 2500 ml

2* 900 ml

All the following clinical findings are seen in patient with hypovolemia except: Hypotension Bradycardia Decreased urine output Pale Decreased level of conscious

2* Bradycardia

In a patient with severe hypovolemic shock all of the following are common clinical features, except: Tachycardia Sweating Hyperpyrexia Pallor Hypotension

3* Hyperpyrexia

All of the following are causes of shock, except: Myocardial infarction Cardiac tamponade Respiratory failure Burns Sepsis

3* Respiratory failure

Patient with hemorrhagic shock, the best IV solution to be given until blood is at hand is: G/W 5% G/W 10% Ringer's lactate Albumin Aminoacid solution

3* Ringer's lactate

Amount of calories contained in 1 liter of G/W 20% is: 100 Kcal 400 Kcal 800 Kcal 1000 Kcal 2000 Kcal

3*800 Kcal

All the following conditions can lead to compressive shock except: Tension pneumothorax Pericardial effusion Positive pressure ventilation with high airway pressure Myocardial infarction Abdominal compartment syndrome

4* Myocardial infarction

About the body water all are true except: It comprises about 55% by weight of the average 70 kg female It's chiefly in the intracellular fluid and decreases with age It's proportionally larger in infants than in adults It's proportionally smaller in female than in male Obese needs more fluid than sportsmen

5* Obese needs more fluid than sportsmen

Which of the following IV solution has almost the same electrolytes like plasma: Dextrose 5% Dextran 40 Normal saline Dextrose saline Ringers lactate

5* Ringers lactate

The most commonly injured structure in blunt neck injury is: Cervical spine Left carotid artery Right carotid artery Left jugular vein Right jugular vein

: 1* Cervical spine ???

Which of the following approaches is currently acceptable for the management of large traumatic pneumothorax: Chest tube insertion alone is enough for the majority of cases Medical observation is enough Thoracoscopic surgery and pleurodesis should be used Thoracotomy and pleurodesis should be used Operation on presentation for all patients

: 1* Chest tube insertion alone is enough for the majority of cases ???

All the following are characteristics of diagnostic peritoneal lavage in abdominal trauma except: Sensitivity of 30% Does not discriminate well between affected organs Its role in trauma evaluation decreased these days due to advancement in radiological techniques Fluid obtained should be examined for red cell amount, chemistries and gram stain Pelvic fractures may cause false positive results

: 1* Sensitivity of 30% ???

End toxic shock causes the following except: Systemic arterial hypertension Low cardiac output Oliguria Systemic hypotension Metabolic acidosis

: 1* Systemic arterial hypertension ***

The best investigation to identify air under diaphragm in trauma patients is: Supine Chest X-Ray Standing Chest X-Ray Supine Abdominal X-Ray Standing Abdominal X-Ray Abdominal US

: 2 * Standing Chest X-Ray ???

Which of the following has got the priority in trauma management Breathing Airway Circulation Exposure Disability

: 2* Airway ???

Tracheostomy is beneficial in one of the following chest injuries: Rib contusion Flail chest Traumatic hemothorax Traumatic pneumothorax Sucking wound of the chest wall

: 2* Flail chest ???

Scalp hematoma which is small, very painful and tend is: Subgaleal Subcutaneous Subpericranial Intramuscular Epidural

: 2* Subcutaneous ???

Useful methods of local treatment for snake bites include all of the following, except: Immobilization Tourniquet Incision and suction Excision Cryotherapy

: 3* Incision and suction ??? السؤال كله غلط ...بس الاولى مسموحه و الباقي ملغي

The first to be managed in multi-injured patient is: Shock Intracranial hematoma Respiratory problems Open fracture of long bones Crushed contaminated wounds

: 3* Respiratory problems ???

Which of the following thoracic emergencies require most urgent treatment: Closed pneumothorax Open pneumothorax Tension pneumothorax Fracture ribs Hemothorax

: 3* Tension pneumothorax ???

In a patient with head injury which of the following Glasgow coma scale scores carry the worst prognosis: 14 10 8 4 12

: 4* 4 ???

All of the following data are considered positive peritoneal lavage after blunt abdominal trauma, except: Amylase positive in the lavage fluid Bile positive in the lavage fluid Red blood cell count 100 000/ml Albumin of 5g/l Gram stain positive for bacteria in the lavage fluid

: 4* Albumin of 5g/l ???

A 35 years old man involved in road traffic accident presented to you in deep coma, pin pointed pupils. High fever and spastic rigidity of both upper and lower limbs, this man has: Frontal lobe injury Extradural hemorrhage Subdural hemorrhage Brain stem injury Cerebellar injury

: 4* Brain stem injury ???

Manifestations of rupture one major bronchi include all the following except: Uncontrolled pneumothorax Progressive mediastinal and subcutaneous emphysema Hemothorax Hematemeais All of the above

: 4* Hematemeais ???

All of the following are usually accepted in the treatment of poisonous snake bite, except: Tourniquet placed above the bite area Immobilization of involved extremity Applying ice to the wound Incision and suction at the site of bite Fasciotomy is sometimes indicated

: 4* Incision and suction at the site of bite ???

In head injury all of the following are true, except: Skull X-ray is a useful method of showing the site of skull fracture CT scan is an excellent method of showing intracranial injuries and lesions Hyperventilation is an excellent method of reducing the intracranial pressure Patient with Glasgow coma scale of 14 carries a bad prognosis Extradural hematoma mat produce contralateral hemiparesis

: 4* Patient with Glasgow coma scale of 14 carries a bad prognosis ???

Abdominal trauma secondary to one of the following is not considered iatrogenic: Liver biopsy Peritoneal dialysis External cardiac massage Road traffic accidents Paracentesis

: 4* Road traffic accidents ***

Patient presented to emergency department with severe blunt neck injury and hypotension, best next step is: Blood transfusion Intravenous line Surgical exploration Secure airway Heart circulation

: 4* Secure airway ???

Which of the following is not effective in preventing urinary tract infection in postoperative patients: Assuring complete emptying of the urinary bladder Cleansing of the urethral meatus with antimicrobial prior to catheter insertion Use of a closed drainage system in catheterized patients Irrigation of indwelling catheters with antimicrobial solutions Administration of systemic antibiotics that are selectively concentrated in die urine

: 5* Administration of systemic antibiotics that are selectively concentrated in die urine ***

One of the following is the most informative in evaluation of diaphragmatic injury: Supine Abdominal X-Ray Abdominal US Abdominal CT scan Diagnostic peritoneal lavage Diagnostic Laproscopy

: 5* Diagnostic Laproscopy ???

The most commonly injured organ in a patient with seat belt sign is: Liver Spleen Colon Pancreas Small intestine

: 5* Small intestine

All of the following are manifestations of paralytic ileus, except: Abdominal colic Vomiting Constipation Abdominal distension Dehydration

: A* Abdominal colic ***

Sarcoma spreads mainly through: Blood vessels Lymph vessels Nerve trunks Natural passages Invasion to nearby structures

: A* Blood vessels ***

The most common presentation of Meckel's diverticulum in children is: Frank rectal bleeding Acute diverticulitis Intussusception Perforation of the diverticulum Volvulus of small intestine

: A* Frank rectal bleeding ***

The most common form of hernia in females is: Indirect inguinal hernia Direct inguinal hernia Femoral hernia Umbilical hernia Diaphragmatic hernia

: A* Indirect inguinal hernia ***

Concerning anal fissure all of the following are true, except: It is a longitudinal mucosal tear or ulcer in the upper half of the anal canal Constipation is an important predisposing factor Pain during a half to one hour after defecation is an important leading symptom It is usually situated in the midline posteriorly Lateral sphincterotomy is now the ideal treatment of the chronic fissure

: A* It is a longitudinal mucosal tear or ulcer in the upper half of the anal canal ***

Regarding Meckel's diverticulum all of the following are true, except: It is an acquired resulting from an increased intraluminal pressure It is situated usually 2-3feet proximal to ileocecal junction It may be silent, discovered incidentally during laparotomy It may cause intestinal obstruction It may cause frank bleeding per rectum

: A* It is an acquired resulting from an increased intraluminal pressure ***

In acute appendicitis which, one is correct: Localized right iliac fossa tenderness is most reliable site Vomiting usually precedes pain WBC and RBC in urine will rule out the diagnosis In elderly patient with cardiac disease should be treated non-operatively If diarrhea is present the diagnosis is excluded

: A* Localized right iliac fossa tenderness is most reliable site ***

In appendicitis during pregnancy, one is correct: May present with right upper quadrant or right flank pain Should be treated initially by antibiotics to avoid operation Occurs more frequently in pregnant than in non pregnant women Appendectomy is associated with 80% of abortion Maternal mortality is about 20%

: A* May present with right upper quadrant or right flank pain ***

Concerning amebic liver abscess all of the following are correct, except: ِِA-Most cases develop soon after an attack of amebic dysentery but occasionally amebic abscess develops in a carrier who has not had overt dysentery B- In 70% of cases the abscess is solitary and located in the upper part of the right lobe C- Clinical picture simulates acute cholecystitis D-Metronidazole 800mg three times daily for 7-10 days may abort early cases E- If medical treatment fails incision and drainage of the abscess must be done

: A* Most cases develop soon after an attack of amebic dysentery but occasionally amebic abscess develops in a carrier who has not had overt dysentery ***

The complication of peptic ulcer that needs immediate surgical treatment is: Perforation Penetration Bleeding Stenosis Suspicion of malignancy

: A* Perforation ***

All of the following can help in the diagnosis of hydatid disease of the liver, except: Stool examination Indirect hemagglutination test Ultrasonography CT scanning Casoni test

: A* Stool examination ***

Which of the following is commonly found in the posterior mediastinum: Teratoma Substernal thyroid Thymoma Neurofibroma Dermoid cyst

: A* Teratoma ***

All the following are painful anal and perianal conditions, except: Third degree hemorrhoids Acute anal fissure Ischio-rectal abscess Perianal hematoma Perianal abscess

: A* Third degree hemorrhoids ***

On supine abdomen X-Ray for intestinal obstruction, the small bowel is identified by: Valvulae conniventes Haustrations Peripheral location Double-bubble appearance Air fluid level

: A* Valvulae conniventes ***

The length of the esophagus in adults is: 15 cm 25 cm 30 cm 40 cm 50 cm

: B* 25 cm ***

Concerning malignant melanoma warning changes in a pigmented lesion include all of the following, except: Previously exciting mole becomes enlarged, itchy bleeds A congenital single mole in a child Pigmented lesion appears in adults and grow rapidly Rapidly growing fleshy ulcerated skin tumor Pigmented mole in the sole of the foot

: B* A congenital single mole in a child ***

Regarding hemorrhoids, one is correct: Usually present by pain and bleeding per rectum Bleeding hemorrhoids must be managed by surgical incision Recurrence is uncommon after proper surgical excision Is best diagnosed by per rectum examination to feel the hemorrhoids Surgery is the only effective and curable treatment

: B* Bleeding hemorrhoids must be managed by surgical incision ***

In small intestine obstruction, the most helpful diagnostic method is: Small bowel follow-through CT scan Erect and supine X-Ray US for abdomen Endoscopy

: B* CT scan ***

Regarding perforated duodenal ulcer, one is correct: There is always history of peptic ulcer disease Generalized abdominal rigidity is an early sign May present with pain in right iliac fossa Pyrexia is an early sign Diagnoses only when plain abdominal X-ray shows gas under diaphragm

: B* Generalized abdominal rigidity is an early sign ***

Which of the following does not occur after partial gastrectomy: Dumping syndrome Hyperglycemia B12 deficiency Osteomalacia Carcinoma of stomach

: B* Hyperglycemia ***

The most common organ in which hydatid cyst arises is: Lung Liver Spleen Brain Bone

: B* Liver ***

All of the following are known predisposing factors for deep vein thrombosis, except: Endothelial injury Low dose salicylates Antithrombin III deficiency Dehydration Congestive heart failure

: B* Low dose salicylates ***

All of the following are absolute indications for splenectomy, except: Massive tear of the spleen Malaria Traumatic rupture Splenic abscess Idiopathic thrombocytopenic purpura

: B* Malaria ***

The most common site of the dermoid cyst in the region of the head is: The midline of the scalps Over the external angular process Over the internal angular process Post-auricular Sublingual

: B* Over the external angular process ***

The earliest symptom in patient with deep venous thrombosis is: Swelling Pain Fever Tenderness Edema

: B* Pain ***

A 17 years old female had undergone appendectomy for perforated appendicitis one week ago, presented with anorexia, swinging fever, ill looking and diarrhea with tenesmus. She is most likely has: Subphrenic abscess Pelvic abscess Gastroenteritis Intussusception Subacute intestinal obstruction

: B* Pelvic abscess ***

The diagnosis of acute appendicitis is difficult in which of the following patients: Infant Pregnant Elderly Obese Child

: B* Pregnant ***

All of the following can be felt during per-rectum digital examination, except: Chronic anal fissure Rectal carcinoma Second degree hemorrhoids Prostate in males Cervix of uterus in females

: B* Second degree hemorrhoids Hemorrhoids. ***

Concerning gastric carcinoma all of the following are signs of advanced stage, except: The mass is clinically palpable Severe hematemesis Ascites Involved left supraclavicular lymph node Liver involvement with jaundice

: B* Severe hematemesis ***

The most common organ injured in blunt abdominal trauma is: Liver Spleen Kidney Bowel Pancreas

: B* Spleen ***

The treatment of choice of hydatid cyst of the liver is: Medical Surgical excision Needle aspiration Chemotherapy Radiation

: B* Surgical excision ***

On rectal examination the anus is tightly closed and patient resists attempted rectal exam, you suspect: Internal piles External piles Anal fissure Fistula in anus Carcinoma of rectum

: C* Anal fissure ***

Most common cause of abdominal pain in adolescent age is: Volvulus Intussusception Appendicitis Mesenteric adenitis Cholecystitis

: C* Appendicitis ***

A 14 years old boy started to complain of central abdominal pain, nausea, anorexia and slight rise of temperature. One week later he developed a tender mass in the right iliac fossa. Most probably he has: Carcinoma of the cecum Ileo-cecal tuberculosis Appendicular mass Intussusception Fecal impaction

: C* Appendicular mass ***

Pelvic abscess developed after appendectomy for a perforated appendix, which of the following organisms would be the most likely cause: Streptococcus faecalis Escherichia coli Bacteroides Proteus Pseudomonas aeruginosa

: C* Bacteroides ***

The most common cause of colonic obstruction is: Adhesions Diverticulitis Cancer Intussusception Hernia

: C* Cancer ***

The followings are recognized risk factors for colon cancer, except: Adenomatous polyp formation Hyperplastic polyp formation Familial polyposis coli Chronic ulcerative colitis Family history of colon cancer

: C* Familial polyposis coli ***

In all the following acute abdominal conditions vomiting is infrequent, except: Intra-abdominal bleeding Perforated peptic ulcer High small intestinal obstruction Acute appendicitis Volvulus of sigmoid colon

: C* High small intestinal obstruction ***

All of the following are indications of liver biopsy, except: Liver cirrhosis Pyrexia of unknown origin Hydatid cyst Unexplained hepatomegaly Hemochromatosis

: C* Hydatid cyst ***

All of the following are indications for surgical treatment of peptic ulcers, except: Penetration and intractable pain Pyloric stenosis Hyperacidity Perforation Recurrent massive bleeding

: C* Hyperacidity \ ***

All of the following predispose to venous thrombosis, except: Congestive cardiac failure Behchet's disease Iron deficiency anemia Paroxysmal nocturnal hemoglobinuria Malignancy

: C* Iron deficiency anemia ***

All of the following regarding abdominal aortic aneurysm are correct, except: It is the most common visceral aneurysm In the majority of cases it is infrarenal in position It can resolve by control of hypertension Rupture is the most lethal complication It may cause distal embolization

: C* It can resolve by control of hypertension ***

Concerning femoral hernia all of the following are true, except: The hernial sac passes through the femoral ring The femoral vein lies lateral to the hernial neck It is not liable for irreducibility and strangulation as it has a wide neck When large, it can be missed as an inguinal hernia It may not give positive expansive cough impulse

: C* It is not liable for irreducibility and strangulation as it has a wide neck ***

The following about Herpes are true, except: It may cause permanent scarring Pain and paresthesia may persist for months It is usually bilateral It may be recurrent It is a recognized feature of HIV infected patient

: C* It is usually bilateral ***

All are true in basal cell carcinoma, except: The commonest skin cancer Arise from the basal cell layer of epidermis It is usually metastasize to lymph nodes, not blood Can be treated surgically by excision with 5mm safety margin Commonest site in the face

: C* It is usually metastasize to lymph nodes, not blood ***

Rodent ulcer most frequently occurs: It occurs on the palm of the hand It occurs on the toe of the foot It occurs on the face above a line drawn from the angle of mouth to ear lobule It occurs on the scrotum It occurs on the tongue

: C* It occurs on the face above a line drawn from the angle of mouth to ear lobule ***

All of the following are true regarding rodent ulcer, except: It is basal cell carcinoma It arises mostly on the face It spreads mainly by lymph vessels It occurs mostly in white skinned people Treatment is by surgery or radiotherapy

: C* It spreads mainly by lymph vessels ***

Concerning basal cell carcinoma all of the following are true, except: It occurs in white-skinned people who are exposed much to sunlight Although it mostly appears as rodent ulcer nodular cystic and field-fire forms may occur It spreads mainly by lymphatics The face is the most common site Treatment is by surgery or radiotherapy

: C* It spreads mainly by lymphatics ***

The most common tumor found in the liver is: Hemangioma Hepatocellular adenoma Metastatic nodules Cholangiocarcinoma Hepatocarcinoma

: C* Metastatic nodules ***

Alopecia is associated with all the following, except: Heparin Cytotoxic therapy Minoxidil therapy Iron deficiency Congenital

: C* Minoxidil therapy ***

Concerning basal cell carcinoma all of the following are true, except: It is a locally malignant tumor Can invade deep to bone Most common in the hands Most common in blond people Is usually curable if treated adequately

: C* Most common in the hands ***

The most common complication of Meckel's diverticulum is: Perforation Hemorrhage Obstruction Umbilical anomalies Carcinoma

: C* Obstruction ***

A patient had appendectomy for perforated appendix, few days later he had diarrhea with tenesmus, and the most likely cause is: Enterocolitis Adhesive intestinal obstruction Pelvic abscess Mesenteric lymphadenitis Paralytic ileus

: C* Pelvic abscess ***

Following splenectomy in a child having blood dyscrasia which one of the following has to be given: Tetanus toxoid Triple vaccine Pneumococcal vaccine Long term tetracycline therapy Sabin vaccine

: C* Pneumococcal vaccine ***

Paralytic ileus may be caused by each of the following, except: Hypokalemia Intussusception Pneumonia Peritonitis Appendicitis

: C* Pneumonia ***

The following peritonitis all are true except: Peritonitis is defined as inflammation of the peritoneum Most surgical peritonitis is secondary to bacterial contamination Primary peritonitis is more common in adults than in children Tuberculous peritonitis can present with or without ascites Can be septic or aseptic

: C* Primary peritonitis is more common in adults than in children ***

Obstruction of the lower intestinal tract could be caused by all of the following, except: Hirschsprung's disease Meconium ileus Pyloric stenosis Ileal atresia Malrotation of the colon

: C* Pyloric stenosis ***

The most common site of carcinoma of the colon is: Descending colon Splenic flexure Rectosigmoid Cecum Transverse colon

: C* Recto-sigmoid ***

Concerning carcinoma of the colon, all of the following are true, except: Although most patients are above 60 years of age, younger ages are not immune Usually it is either well or moderately differentiated adenocarcinoma Right colon is affected more than left Recent changes of bowel habit and rectal bleeding are early manifestations Barium enema or colonoscopy must be done in all cases

: C* Right colon is affected more than left ***

The fallowing normal structures may be palpable in healthy subject, except: Liver Right Kidney Spleen Transverse colon Sigmoid and colon

: C* Spleen ***

Which type of lung tumor is most often associated with cigarette smoking: Alveolar cell carcinoma Adenocarcinoma Squamous cell carcinoma Lymphoma Adenoma

: C* Squamous cell carcinoma ***

All the following statements concerning appendicitis in pregnancy are true except: Diagnosis is difficult Maternal death rate increases as gestational age increases Surgical treatment should be delayed until the diagnosis is firmly establishes The incidence is not changed by pregnancy The rate of fetal loss is about 15%

: C* Surgical treatment should be delayed until the diagnosis is firmly establishes ***

All the following are indications for splenectomy, except: Congenital spherocytosis Splenic abscess Typhoid fever Splenic hydatid cyst Traumatic massive laceration

: C* Typhoid fever ***

All of the following in cases of urticaria are true, except: The cause of chronic urticaria is generally difficult to uncover Angioedema and urticaria often coexist Typical lesion is called iris or target lesion Pruritic Antihistamines are usually effective

: C* Typical lesion is called iris or target lesion ???

Acute toxic dilatation of the colon is typically a complication of one of the following: Perforated carcinoma of the colon Amebic colitis Ulcerative colitis Large bowel obstruction Ischemic colitis

: C* Ulcerative colitis ***

All of the following are causes of paralytic ileus, except: Peritonitis Abdominal trauma Hypokalemia Anemia Excessive administration of ganglionic blockers

: D* Anemia ***

Concerning carcinoma of the esophagus, all are true, except: It occurs in males more than in females It is squamous cell carcinoma except its lower few centimeters where it is adenocarcinoma Dysphagia is an important leading symptom Barium swallow usually reveals massive dilatation above the tumor Esophagoscopy is usually diagnostic

: D* Barium swallow usually reveals massive dilatation above the tumor ***

All of the following predisposes to deep venous thrombosis, except: Pelvic infection Obesity Pelvic surgery Breast feeding Varicose veins

: D* Breast feeding ***

The best radiological examination to diagnose perforated peptic ulcer is: Barium swallow Barium meal Gastrographin meal Chest X-ray standing Technecium scanning

: D* Chest X-ray standing ***

Grossly enlarged spleen occurs in one of the following: Typhoid fever Sickle cell anemia Rheumatoid arthritis Chronic myeloid leukemia Infective endocarditis

: D* Chronic myeloid leukemia

In which of the following conditions is Duke's classification used: Thyroid cancer Breast cancer Peptic ulcer complications Colorectal carcinoma Acute pancreatitis

: D* Colorectal carcinoma ***

All of the following conditions are known complications of deep vein thrombosis, except: Pulmonary embolism Venous gangrene Varicose veins Disseminated intravascular coagulation Leg ulcers

: D* Disseminated intravascular coagulation ***

All of the following predisposes to the development of DVT, except: Delivery Prolonged immobilization Dehydration Early post operative ambulation Intimal injury

: D* Early post operative ambulation ***

A 30 years old healthy male complaining of upper abdominal discomfort, on examination he had a small swelling in the middle between the umbilicus and xiphisternum. He most likely had: Umbilical hernia Paraumbilical hernia Spigelian hernia Epigastric hernia Morgagni hernia

: D* Epigastric hernia ***

All of the following are pre-malignant lesions as regarding colorectal carcinoma, except: Familial polyposis of colon Ulcerative colitis Villous papilloma Hamartomatous polyp Adenomatous polyp

: D* Hamartomatous polyp ***

All of the following are indications for surgical treatment of peptic ulcers, except: Perforation Failure of medical treatment Gastric outlet obstruction Hyperacidity Recurrent massive bleeding

: D* Hyperacidity ***

The following are known causes of varicose veins, except: Deep vein thrombosis Arteriovenous malformations Incompetence of saphenofemoral vein junction Hyperthyroidism Hereditary weakness of the media (muscle wall

: D* Hyperthyroidism

Spermatic cord contains all the following, except: Autonomic nerve fibers Lymphatics Artery of the vas Iliohypogastric nerve Pampiniform plexus

: D* Iliohypogastric nerve ***

Regarding femoral hernia, one is correct: It occurs only in women They are the least dangerous variety of hernia It lies medial to pubic tubercle It usually lies below inguinal ligament It is transilluminates

: D* It usually lies below inguinal ligament ***

All the following may be linked to the etiology of malignant melanoma, except: Fair complexion Intermittent sun exposure Positive family history Junctional nevus Dysplastic nevus

: D* Junctional nevus ***

In elderly patient with a recent alteration of bowel habits and painless bleeding per rectum the likely diagnosis is: Inflammatory bowel disease Internal hemorrhoids Diverticulosis coli Large bowel carcinoma Meckel's diverticulum with heterotopic gastric mucosa

: D* Large bowel carcinoma ***

The usual site of varicose ulcer is: Tip of the toes Sole of the foot Dorsum of the foot Lower third of the leg medially Upper third of the leg laterally

: D* Lower third of the leg medially ***

In acute anal fissure all are true, except: Presents with severe anal pain Anal spasm is a frequent finding Usually preceded by an episode of constipation Most of cases presents with severe bleeding per rectum Lateral sphincterotomy is the treatment of choice

: D* Most of cases presents with severe bleeding per rectum ***

Regarding indirect inguinal hernia in children, all of the following are true, except: Right side is more common than left side Boys are affected much more than girls Incarceration occurs more often in small babies Operative correction is delayed till the child is one year old Inguinal truss is nowadays not used in the management

: D* Operative correction is delayed till the child is one year old ***

The symptoms of epigastric hernia usually resemble those of one of the following: Angina pectoris Gall stone Hiatus hernia Peptic ulcer Diverticular disease of the colon

: D* Peptic ulcer ***

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

: D* Pneumococcus ***

All of the following may predispose to chronic ischemia of the lower limbs, except: Diabetes mellitus Hypertension Smoking Prolonged salicylates intake Hypercholesterolemia

: D* Prolonged salicylates intake ***

A 60 years old female presented with irreducible tender swelling below and lateral to the pubic tubercle. She most likely has: Strangulated direct inguinal hernia Strangulated indirect inguinal hernia Strangulated femoral hernia Saphena varix Obturator hernia

: D* Strangulated femoral hernia ***

All of the following are manifestations of acute arterial obstruction in the limbs, except: Paresthesia Pain Paresis or paralysis Swelling and cyanosis of the limb Pulselessness and coldness of the limb

: D* Swelling and cyanosis of the limb ***

Squamous cell carcinoma in the usual type of primary malignant epithelial tumors arising of the following organs, except: Tongue Uterine cervix Skin Urinary bladder Esophagus

: D* Urinary bladder ***

Histological carcinoma of the colon is usually: Basal celled carcinoma Squamous celled carcinoma Transitional celled carcinoma Well to moderately differentiated adenocarcinoma Columnar celled carcinoma

: D* Well to moderately differentiated adenocarcinoma ***

Concerning fistula all of the following are correct, except: It is an abnormal communication between two epithelial surfaces It may be congenital or acquired The congenital is lined by epithelium The acquired is lined by granular tissue and in long run by epithelium All congenital fistulae close spontaneously

: E* All congenital fistulae close spontaneously ***

30 years old male patient presented with gastric outlet obstruction and vomiting, all are clinical findings, except: Hypochloremic metabolic alkalosis Constipation and loss of weight Succussion splash is present Dehydration Hypochloremic metabolic acidosis

: E* Hypochloremic metabolic acidosis ***

In strangulated inguinal hernia during childhood, which of the following is true: The pain is of low intensity and gradual onset Local tenderness is mild The cause is adhesions at the neck of the sac The incidence of strangulation is lower the older is the child Immediate operation must be done even the hernia reduced by sedation

: E* Immediate operation must be done even the hernia reduced by sedation ***

All of the following are complications of varicose veins, except: Thrombophlebitis Edema Skin ulceration Hemorrhage Intermittent claudication

: E* Intermittent claudication ***

Concerning carcinoma of the esophagus, all of the following are true, except: It occurs usually in elderly ages Progressive dysphagia is a common symptom Common sites are in the middle and lower third Squamous cell carcinoma is the commonest type It is usually associated with good prognosis

: E* It is usually associated with good prognosis ***

Complications of duodenal ulcer include all of the following, except: Perforation Penetration Massive bleeding Obstruction of pylorus Malignant change

: E* Malignant change ***

All are true of polyps of the stomach except: They tend to be multiple They occur in atrophic mucosa They may first appear after adolescence They may be part of a familial disease Malignant change is uncommon

: E* Malignant change is uncommon ***

Concerning fistula in anus all are possible causes, except: Inflammatory bowel disease After perianal abscess Trauma Tuberculosis Meckel's diverticulum

: E* Meckel's diverticulum ***

In gastric carcinoma the following are true, except: Adenocarcinoma is the commonest malignant tumor of the stomach Patients with pernicious anemia and blood group A have an increased incidence Anorexia and weight loss are commonest manifestations Chemotherapy is a good adjuvant to radical surgery for early tumors Metastases to bone are uncommon

: E* Metastases to bone are uncommon ***

All of the following are indications for liver biopsy, except: Unexplained hepatomegaly Cirrhosis Infiltrations Tumors Prolonged prothrombin time

: E* Prolonged Prothrombin time ***

Concerning thrombophlebitis all of the following are correct, except: It occurs usually in the superficial veins Veins affected by varices or that canulated for transfusion are the usual victims Pain, redness and tenderness are the usual manifestations Spontaneous migratory thrombophlebitis brings to mind visceral malignancy Pulmonary embolism is the usual sequela of this condition

: E* Pulmonary embolism is the usual sequela of this condition ***

All of the following arteries contribute in the blood supply of the stomach, except: Celiac Hepatic Splenic Gastroduodenal Superior mesenteric

: E* Superior mesenteric ***

A 3 months old infant found to have a right inguinal hernia, the best management is: Re-examination every month until it disappears spontaneously Application of a truss Surgical treatment when he is six months old Surgical treatment when he is one year old Surgical treatment as soon as possible

: E* Surgical treatment as soon as possible ***

Concerning hydatid cyst all of the following are correct, except: It is the larval stage of the worm taenia echinococcus The liver is the most common organ infected The patient may remain symptom free for long time Suppuration, rupture and death of the cyst are known sequela Treatment of choice is by long term therapy with mebendazole

: E* Treatment of choice is by long term therapy with mebendazole ***

Malignant hyperthermia is treated specifically with: Dantrolene Chlorpromazine Sodium EDTA Calcium EDTA Calcium gluconate

A* Dantrolene

In the 30 year old patient with head injury, the first to be considered is: Airway, breathing, circulation Level of consciousness Pupillary reaction Asymmetry of movements in limbs Subdoral hematoma on CT scan

Airway, breathing, circulation

Emergency drugs in anaphylaxis include all of the following, except: Adrenaline Aminophylline Corticosteroids Oxygen Chlorphenamine

Aminophylline

Hypovolemic shock is characterized by: 1-A low central venous pressure, low cardiac output, low peripheral resistance 2-A high central venous pressure, high cardiac output, low peripheral resistance 3-A low central venous pressure, low cardiac output, high peripheral resistance 4-A low central venous pressure, high cardiac output, high peripheral resistance 5-A high central venous pressure, low cardiac output, low peripheral resistance

C* A low central venous pressure, low cardiac output, high peripheral resistance

All of the following are important compensatory mechanisms in hemorrhagic shock, except: Tachycardia Venous constriction Decreased peripheral vascular resistance Absorption of fluids from the intestine Formation of angiotensin 2

C* Decreased peripheral vascular resistance

Following splenectomy in a child having blood dyscrasia, which one of the following drugs has to be given: Tetanus toxoid Antitetanic human immunoglobulin Pneumococcal vaccine Long term tetracycline therapy Triple vaccine

C* Pneumococcal vaccine ***

The most useful screening for colon cancer is: Sigmoidoscopy Colonoscopy Test for occult blood in stool Level of carcinoembryonic antigen Barium enema

Colonoscopy ***

Regarding diazepam, all of the following are correct except: It is a respiratory depressant Has anticonvulsant effect Has a hypnotic effect Has antidepressant action Releases aggressive tendency

D* Has antidepressant action

In septic shock all the following occur at an early stage except: Decreased peripheral vascular resistance Decreased cardiac output Increased metabolic demand Impaired oxygen uptake at tissue level Warm peripheries

Decreased cardiac output

All of the following can cause hepatocellular carcinoma, except: Hepatitis B Hepatitis C Hemochromatosis Alcoholic cirrhosis Fatty liver

Fatty liver ( may cause cirrhosis>> malignancy) but not directly

In carcinoma of the stomach, all are true, except: It is about 3 times more likely to occur in patients with pernicious anemia It has a positive association with blood group A It usually presents with recurrent hematemesis It may give rise to krukenberg tumor of ovaries It is a late complication of a partial gastrectomy for duodenal ulcer

It usually presents with recurrent hematemesis (not ususally , but only in less than 20% of cases)

The most common organ in which carcinoid tumor arises is: Rectum Colon Small intestine Appendix Bronchus

Small intestine