Midyear 2009 GS Office 2003

1

The most common malignant neoplasm of the submandibular gland:

a) Mucoepidermoid carcinomab) Acinic cell carcinomac) Squamous cell carcinomad) Adenoid cystic carcinomae) Mucinous adenocarcinoma.

D

2

Carcinoma of the bronchus:

a) Commonly presents with hematemesisb) Squamous cell carcinoma has the

worst prognosisc) Can present as gynecomastia and

achanthosis nigricansd) CTscan guided transthoracic biopsy

has an 80% sensitivitye) VATS(vedio assisted thoracic

laparscopy) is the best modality for excision of lesion deeply seated in the lobe tissue. C

3

Warthin's tumor:

a) Is a pleomorphic adenoma of the parotid gland.

b) Should be treated by a total parotidectomy.

c) Is considered a benign salivary gland neoplasm.

d) Responds well to pre-operative radiation therapy.

e) Often presents with facial nerve palsyC

4

The single most effective method of diagnosis for 60-year-old man with a-6 month history of hoarsness and neck mass:

a) FNA of the neck mass.b) CTscan of head, neck and chest.c) c-Incisional biopsy of the neck mass.d) Excisional biopsy of the neck mass.e) Laryngoscopy with biopsy.

A

5

Which of the following tumor markers is best to monitor recurrence of colon cancer?

a) Alpha feto proteinb) Carcino emborionc antigen(CEA)c) Cancer antigen 15-3d) 5-hydroxi-indol acetic acid (5-H IAA)e) Thyroglobulin

B

6

A double bubble sign on air contrast upper gastro intestinal series is characteristic of:

a) Duodenal Artesiab) Jejunal Artesiac) Meconuim ileusd) Midgut volvoluse) Pyloric stenosis

A

7

Grey-Turner sign in acute pancreatitis is :

a) Discoloration in the loinsb) Shifting dullness over the spleenc) Discoloration around the umbilicusd) A fluid level in the first loop of the

jejunume) Upper abdominal rigidity

A

8

Nine days following splenectomy, a 13 year old patient presents with fever and leukocystosis. The chest x-ray showed air under the diaphragm. The most likely diagnosis is?

a) postsplenectomy sepsisb) colonic perforationc) pneumococcal infectiond) subphrenic abscesse) gastric wall ulcer D

9

An early sign of systemic sepsis in a patient receiving intravenous hyper alimentation is :

a) Appearance of shaking chillb) Hypotensionc) Rapid drop in arterial pHd) Sudden development of glucose

intolerancee) Tachycardia

D

10

lnitial treatment of patient with acute complete small bowel obstruction includes which of the following:

a) Immediate operation is warranted as soon as the diagnosis is made

b) NGT decompression for 24hallows spontaneous resolution in most of the patient

c) The presence of fever,tachycardia,and localized pain suggest strangulation and warrants prompt operation

d) All patients with complete obstruction require blood and plasma for resuscitation

e) If small bowel resection is indicated ,a stoma and mucus fistula are necessaryC

11

25-year-old lady presented with thyrotoxicosis and she is 4-months pregnant. The best line of management is :

a) Observationb) Carbimozoll0 mg three times dailyc) Radio iodine therapyd) Carbimazol 20 mg three times daily

and Inderal 20 mg three times dailye) surgery

E

12

Which of the following sedatives has active metabolites that may accumulate in clinically significant amounts if it is used as a continuous drip?

a) Lorazepamb) Midazolamc) Diazepamd) Dexmedetom idinee) Propofol C

13

Which of the following is contraindication to the use of epidural anesthesia in critically ill patients?

a) Feverb) Increased WBC countc) Coagulopathyd) Intractable anginae) Peripheral vascular disease

C

14

Sentinellymph node biopsy for melanoma

a) Predicts prognosisb) Improves survivalc) Is indicated for melanoma < 1 mm

thickd) Is associated with a complication rate

of 23%e) Should be followed by completion

lymph node dissection in patients who have positive results

A

15

Hyperextension of the proximal phalanges of the little and ring fingers can result from damage to:

a) Ulnar nerveb) Axillary nervec) Radial nerved) Median nervee) Anterior interosseous nerve

A

16

An inability to oppose the thumb to the little finger can result from damage to:

a) Anterior interosseous nerveb) Posterior interosseousc) Radial nerved) Ulnar nervee) median nerve

E

17

When mucocele of the appendix is found at the time of surgery, Which of the following is appropriate therapy?

a) Incisional biopsy with subsequent appendectomy if malignancy is confirmed

b) Right hemicoloctomyc) Right hemicoloctomy with lymph node

dissectiond) Appendectomye) Needle aspiration of cystic fluid for

cytology examinationD

18

A singer is complaining of her voice becoming weak after high pitched singing for short period of times, this is due injury to :

a) Recurrent laryngeal nerve.b) External laryngeal nerve.c) Phrenic nerve.d) lingual nerve.e) Parathyroid gland.

B

19

A patient who is 2 months postpartum has a 2-cm fluctuant tender mass in the upper outer quadrant of her Rt breast. Management should include:

a) core biopsy of the breast massb) urgent surgical exploration of the Rt

breastc) aspiration and antibioticsd) bilateral mammographye) breast MRI C

20

A laparoscopic cholecystectomy is performed in a 60-year-old woman. Pathology reveals gall bladder adenocarcarcinoma confined to mucosal lamina propria. Appropriate management includes:

a) observation and follow upb) excision of the gallbladder fossa and

laparoscopic port sitesc) excision of the gallbladder fossa, port

sites and portal lymphadenectomyd) excision of gallbladder fossa, port sites,

portal lymphadenectomy and excision of the common bile duct

e) irradiation of the gallbladder bed A

21

Risk factors for adenocarcinoma of small bowel include all of the following EXCEPT:

a) familial adenomatous polyposisb) Crohn's diseasec) hereditary non polyposis colorectal

cancerd) ulcerative colitise) Von Recklingha usen's disease D

22

Which of the following statement is INCORRECT regarding ischiorectal fossa?

a) The pudendal nerve lies in its lateral wallb) The floor is formed by the superficial

fascia and skinc) The lateral wall is formed by the

obturater muscle and its fasciad) The medial wall is formed in part by

levator ani musclese) The roof is formed by the urogenital

diaphragmE

23

Spirometry measures:

a) Total lung capacityb) Forced vital capacityc) Peak exploratory flow rated) lung compliancee) Carbon monoxide level

B

24

A 35-year old man was punched in the right side of the abdomen and chest. There was some right upper abdomen tenderness but no guarding. Results of a gastrografin upper GI study showed a coiled-spring appearance of the second and third part of the duodenum. What is the most likely diagnosis?

a) Rupture of the duodenumb) Contusion to the head of the pancreasc) Intraluminal blood clotd) Retroperitoneal hematomae) Duodenal hematoma

E

25

A 16 year old boy presents to the emergency department with a gunshot wound to the abdomen. The best management is?

a) peritoneal lavageb) wound explorationc) CT with ora I and IV contrastd) exploratory laparotomye) ultrasound

D

26

A 35-year-o'd patient underwent a segmental jejunal resection as result of a perforation due to intraperitoneal TB. On the 3rd post operative day, the patient develops a brown -greenish discharge from the wound. This continues with a daily volume of 400-600 ml. The patient remains stable with no signs of peritonitis. The likely complication described is :

a) Wound dehiscenceb) Enterocutanous fistulac) Wound abscessd) Stitch sinuse) Wound seroma

B

27

cont.The likely metabolic changes

associated with this condition is :

a) Hypokalemic metabolic acidosisb) Hpokalemic metabolic alkalosisc) Hypernatremic meta bolic acidosisd) Hypocalcemic metabolic alkalosise) Norma I findings

A

28

Cont.The treatment of choice for this

complication is:

a) Keep the patient NPO and maintain him on Ringer's lactate

b) Keep the patient NPO and start TPNc) Open the whole wound and perform

abed side debridmentd) Insert a gauze at the site of

discharge and continue IV antibioticse) Immediate exploratory laparotomy B

29

A predictor of a dvanced pancreatic cancer is :

a) Back painb) Tumor size 1-2 cm in diameterc) Deep jaundiced) Raised CA 125e) Dilated CBD to more than 1.5 cm in

diameter.A

30

a young patient underanwent appendectomy .At surgery the appendix was normal .The terminal ileum was thick, edematous ,and with extensive fat wrapping around the ileal wall extending from the mesentry. The most likely diagnosis is:

a) Tuberculous enteritisb) Amoebic enteritisc) Typhoid diseased) Crohn's diseasee) Meckel's diverticulitis.

D

31

Ringer's lactate is a solution that does no contain:

a) sodiumb) chloridec) bicarbonated) potassiume) lactate

C

32

A 19-year-old man with a right flail chest segment and a normal vital signs should be treated by :

a) Insertion of chest tubeb) Intubation and ventilationc) Good analgesiad) Banding the cheste) Open reduction and internal fixation

of the flail segment

C

33

A patient was brought to the emergency room with a history of an electrical burn. On obtaining a urine sample was noted to be dark. The next step of management is :

a) Aggressive intravenous fluid infusionb) Send urine for myoglobin levelc) Request a CXRd) Ultrasound of the abdomene) Obtain a sickling test

A

34

ln head injury Cushing's triad indicates:

a) Diffuse axonal injuryb) Basal skull fracturec) Depressed skull fractured) Raised intracranial pressuree) SpinaI shock

D

35

Hikman line is often used for:

a) Intraperitoneal drainageb) Peripheral TPN infusionc) Continuous arterial pressure

monitoringd) Pulmonary wedge pressure

monitoringe) Administration of chemotherapeutic

agentsE

36

A previously healthy 35-year-old woman reports difficulty swallowing liquids and occasional regurgitation. Manometric studies show an increase in pressure in the body of the esophagus .The most likely diagnosis is :

a) Carcinoma of the esophagusb) Plummer-Vinson syndromec) Reflux esophagitisd) Epiphrenic diverticulume) Achalasia E

37

The commonest cause of intussusceptions in infant is:

a) Acute Mickel's diverticulitisb) Carcinoid tumourc) Payer's patches lymphadenitisd) lymphomae) Mesenteric lymphadenitis

C

38

A cute lymphangitis of the arm is a condition that requires:

a) Immediate skin debridementb) Admission and systemic antibioticsc) Oral antibiotics and follow up in the

clinicd) topical antibiotics and NSAIDe) Cold compression and elevation

B

39

The most common complication after a big inguina-scrotal hernia repair in a 32-year old man is:

a) Reactionary hemorrhageb) Wound infectionc) DVTd) Scrotal hematomae) Impotence

D

40

A 20-year-old healthy man was diagnosed to have medullary cancer of the thyroid. The patient was also noted to have hyperplasia of the parathyroid gland. The patient must now be investigated for the possibility of :

a) Bowen's tumorb) Hodgkin's lymphomac) Pheochromocytomad) Squamous cell carcinoma of the

esophaguse) Malignant melanoma C

41

Failure of penile erection following an abdomino-peroneal resection is due to injury of :

a) Parasympathetic Nervi eregentisb) Pudendal nervec) Sympathetic Hypogasteric nerved) Parasympathetic Hypogastric nervee) Obturator nerve

D

42

Regarding hemorrhagic shock in adult:

a) Class I is characterized by loss of 25% of circulating volume

b) Increase pulse pressure is an early sign of significant blood loss

c) There is severe tachycardia in class Id) Diastolic blood pressure may rise in

class IIe) There is no change in blood pressure

when the blood loss occur in patient taking B-blockers

B

43

Which of the following statement is TRUE regarding immunosuppressive drugs?

a) Azathioprine is selectively immunosuppressive

b) Cyclosporine is selectively immunosuppressive

c) Cyclosporine causes gingival atrophyd) Hair loss is side effect of cyclosporinee) Cyclosporine is a water soluble

B

44

Umblical Hernia:

a) Treated adequately by a truss in adults

b) Should be repaired surgically in infants

c) complications are more in children than in adults

d) males are affected more than femalese) Managed conservatively in infants

with 1 cm defectE

45

A 25-year old man is shot in the left lateral chest. In the emergency department, his bIood pressure is 120/90, his pulse rate is 104beats/min, and his respiration rate is 36 breaths per minute. Chest x-ray shows air and fluid in the left pleural cavity. Nasogastric aspiration reveals blood-stained fluid. What is the best step to rule out esophageal injury?

a) insertion of chest tubeb) insertion of nasogastric tubec) gastrografin swallowd) Peritoneal lavagee) barium swallow C

46

A 33-year old man presents to the emergency department with a gunshot injury to the abdomen. At laparotomy, a deep laceration is found in the pancreas just to the left of the vertebral column with severance of the pancreatic duct. What is the next step in management?

a) intraoperative cholangiogramb) debridment and drainage of defectc) distal pancreatectomyd) debridment and closure of the duct with

drainage of defecte) pancreaticojejunostomy to the end of the

pancreasC

47

A 70-year old man is brought to the emergency department following a car crash. X-ray revealed a fracture ribs on the left and a fracture of the right femur. A CT scan of the abdomen showed a left-sided retroperitoneal hematoma adjacent to the left kidney and no evidence of urine extravasations. After 1h in the emergency room he became hypotensive. The hematoma should be managed by which of the following?

a) fluid resuscitation and observationb) exploratory laparotomy through a mid-line

incisionc) CTscan guided aspirationd) surgical exploration through a left flank

retroperitoneal approache) Pneumatic antishock garment (PASG) B

48

A 22-year old year old man is found to have a complete transaction of the common bile duct following a gunshot wound to the abdomen. The bile duct injury should be managed by?

a) primary repair with a cholecystostomy tube

b) whipple's operationc) choledochojejunostomy and

cholecystectomyd) primary repair with T-tubee) choledochoduodenostomy C

49

A 13-year-old boy presents with acute scrotal pain following a football match. Examination revealed a swollen tender right testis with some bluish discoloration of the scrotum. The left testis appears normal. The next line of management is :

a) Schedule the patient for immediate exploration of right scrotum and consent for orchiodectomy

b) Admit the patient and start intravenous gentamvcin

c) Admit and schedule for a right inguinal hernia repair

d) Admit and consent for laparoscopic orchiopexye) Obtain an ultrasound guided testicular biopsy

A

50

What is the correct management of the metabolic acidosis seen in hemorrhagic shock?

a) Intravenous sodium bicarbonateb) Component blood therapyc) Vassopressorsd) Increased fluid administratione) Fresh frozen plasma

D

51

Prior to hepatic resection, investigations and preparation should include:

a) exact definition of the nature of the lesion with a tissue biopsy

b) preoperative antibiotics for 24 hours prior to the procedure

c) hepatic angiographyd) radiological assessment for

respectability is adequate in all casese) detailed cardiopulmonary workup D

52

Liver resection is not safely done:

a) when 80% of the liver volume is removed

b) in cirrhotic liverc) if the reduction of the functional

liver by 70%d) if the serum billirubin is less than

2mg/mle) in the non clinically detectable

ascitesB

53

Worldwide, the most important predisposing factor for HCC(hepatocellular carcinoma) is :

a) alcoholic cirrhosisb) hepatitis B infectionc) chronic liver disease of any etiologyd) hepatitis C infectione) repeated ingestion of aflatoxin

C

54

Which of the following patients is not likely to have an elevated AFP level?

a) fulminant hepatitis Bb) HCCc) Yolk sac tumord) Teratocarcinomae) Cholangiocarcinoma

E

55

A 53 year old man has long standing liver cirrhosis secondary to hepatitis C infection. The most appropriate screening regimen should include:

a) liver USand a yearly CTscanb) AFP and USc) AFPand yearly CTscand) AFP, USand yearly CTscane) AFP and liver biopsy when a lesion

developsB

56

lntraductal papillary mucinous neoplasm of the pancreas:

a) are always benignb) are most commonly found in the tail

of the pancreasc) have a lower 5-year survival than

adenocarcinomad) frequently recure) are prefentially treated by

inoculation E

57

Regarding the extrahepatic biliary and vascular anatomy Which of the following is TRUE?

a) the boundries of the triangle of Calot include the common hepatic duct, cystic duct, and cystic artery

b) the common duct courses posterior to the portal vein

c) the right branch of the hepatic artery crosses posterior to the common bile duct

d) the cystic artery usually crosses the common bile duct posteriorly

e) the hepatic artery lies lateral to the common bile duct

C

58

Which of the following is not involved in the activity of the gallbladder?

a) vegal stimulationb) splanchinic sympathetic activityc) somatostatind) motiline) Cholecystokinin

D

59

Regarding the management of acute calculus cholecystitis. Mark the correct answer?

a) open cholecystectomy is the standared of care

b) the conversion in the acute setting is less than the chronic cholecystitis

c) laproscopic cholecystectomy should be delayed in the acute setting for 6 weeks for the acute attack to subside

d) cholecystectomy should be delayed untill the patient is afebrile and with normal WBC

e) conversion to open should be done whenever the anatomy is not clear E

60

Which of the following studies is not recommended for the diagnosis of Caroli's disease? .

a) MRIb)CTscanc)abdominal USd)HIDA scane)ERCP

A

61

What is the most common location of a cholangiocarcinoma?

a) right hepatic ductb) left hepatic ductc) hepatic duct confluenced) CBDe) both right and left hepatic ducts

C

62

Which of the following practices would help promote a culture of safety in the operating room environment?

a) Maintaining strict accountability for mistakes

b) Emphasizing timely completion of the procedures

c) Addressing everyone by formal titled) Reporting problems face to facee) Stressing role of flexibility in crisis

situation E

63

Which of the following is TRUE about iodine metabolism:

a) The thyroid gland has 50% of the body's iodine stores

b) Iodide transport into follicular cells takes place via passive diffusion

c) Iodide excess causes multinodular goiter

d) TSHstimulates iodide transport into follicular cells

e) Iodine excess causes hypothyroidism D

64

Which of the following statements about a retrosternal goiter is TRUE:

a) It may be associated with subclinical hyperthyroidism

b) CTScan is the best modality for imagingc) Airway obstruction is an unusual

presentationd) It involves only the anterior

mediastinume) Total Thyroidectomy is the treatment of

choice. B

65

Which of the following is TRUEabout the treatment and management of Graves‘ disease:

a) Subtotal thyroidectomy is the treatment of choice

b) Irradiation is a much better treatment option than subtotal thyroidectomy

c) Subtotal thyroidectomy results in improvement in exophthalmos

d) Recurrence rates for antithyroid drugs are comparable to that for subtotal thyroidectomy

e) Radioactive iodine is the treatment of choice other than in children and women of childbearing age.

E

66

With regards to papillary carcinoma of the thyroid, which of the following is TRUE:

a) It is the second most common thyroid malignancy

b) It has the best prognosis.c) Often metastasizes to bone and lungd) Most tumors are unilateral.e) It Has no association with previous

irradiation B

67

With regard to follicular thyroid cancer, the following is TRUE:

a) It is less common in geographic regions that are iodine deficient

b) It occurs predominantly in females, and oestrogens have been recently found to be a risk factor

c) The major histological criteria for diagnosis are unequivocal capsular and vascular invasion

d) Cytologically, it can be easily differentiated from benign adenoma

e) Both minimally invasive and widely invasive follicular cancers are likely to have regional lymph node involvement at presentationC

68

Indications for parathyroidectomy include all but which one of the following:

a) Development of open ulcerative skin lesions from calcinosis

b)Bone pain or pathological fracturesc) Renal failured) Intractable pruritise) Ectopic calcifications

C

69

Which of the following is the most important for identifying a patient who will suffer complications from myocardial contusion:

a) Serial CPKisoenzyme measurementsb) ECGstudiesc) Echocardiographic studiesd) Gated ventricular angiographic

studiese) Spiral chest CT scanning B

70

Biopsy of a villous lesion of the rectum beginning 4cm from the anal verge and extending for 5 cm proximally exhibits cellular atypia. Which of the following is the most appropriate management:

a) Repeated biopsyb) Transanal excisionc) Fulgrationd) Abdominoperineal resectione) Intracavitary radiotherapy B

71

With regards to haemorrhoids, which of the following statements is TRUE:

a) Internal haemorrhoids are vascular cushions above the de!ntate line and are covered byanoderm

b) Prolapsing haemorrhoids are external haemorrhoids covered byanoderm

c) Bleeding internal hemorrhoids are best treated by surgical excision

d) Thrombosed hemorrhoids are best treated by haemorrhoidectomy, with the patient under general anesthesia

e) Recurrence is uncommon after surgical haemorrhoidectomy

E

72

Which type of collagen is the most important in wound healing?

a) Type IIIb) Type Vc) Type VIId) Type XIe) Type X

A

73

A direct inguinal hernia results from a defect in :

a) Peritoneumb) Transversalis fasciac)Internal oblique fasciad)Conjoint tendone)Rectus sheath

B

74

Which of the followings is the most potent mediator of the inflammatory response?

a) Corticosteroidsb) Heat shock proteinc) Cytokinesd) Thyroid hormonese) Nor-epineprine

C

75

A 76-year-old man has a slowly growing lump in his left neck, anterior to the sternocleidomastoid muscle just below the angle of the mandible .He has no history of cancer and no constitutional symptoms. Fine needle aspiration cytology is consistent with squamous cell carcinoma. The test most likely to identify the primary lesion would be:

a) Chest X-rayb) Contrast -enhanced CTof the soft tissues of

the neckc) MRI of the head and neckd) Pan endoscopy under anesthesia with

random biopsye) 2-fluro-2-deoxy -D-glucosejpositron emission

tomography (FOG-PET) D

76

A 55-year-old man is admitted to the hospital and treated with broad spectrum antibiotics for uncomplicated diverticulitis .On day 5 of his hospital stay ,increase WBC ,abdominal pain and foul smelling diarrhea developed. Which of the following diagnosis is most likely?

a) Pseudomemberanous colitisb) Progression of diverticulitisc) Infectious colitisd) Retained colonic bloode) Toxic mega colon

A

77

A 35-year-old woman who underwent lap.cholecystectomy,one week ago comes to ERwith a history of 3-days of abdominal pain nausea, vomiting and jaundice. Which of the following is the most likely diagnosis

a) Bile duct injury with intra abdominal bile collection

b) Normal post-operative nausea and discomfort

c) Post-operative bowel obstructiond) Post-operative ileuse) Duodenal injury with leakage A

78

What is the leading cause of death from acute pancreatitis?

a) Hemorrhageb) Pseudo cyst rupturec) Secondary pancreatic infectiond) Billiary sepsise) Renal failure

C

79

A 14-year-old patient refuses to have any surgical intervention for suspected appendicitis. Who is the person capable of giving informed consent?

a) The patient.b) His doctor.c) His parents.d) His psychiatrist.e) The judge. C

80

The initial haemostatic response to injury is :

a) Platelets adherenceb) Fibrinolysisc) Vasoconstrictiond) Initiation of coagulation cascadee) Conversion of prothrombin to

thrombinC

81

A patient who has an elective surgery done with spinal anesthesia developed blood pressure of 70/40 mmHg.There is no evidence of hemorrhage or sepsis. The initial therapy consists of administration of:

a) 2 L normal salineb) Whole bloodc) Adrenal corticosteroidsd) Beta adrenergic stimulatione) Vasopressor drug E

82

The major complication associated ,with tracheostomy is :

a) Tracheal stenosisb) Tracheoinominate fistulac) Tracheo-esophageal fistulad) Tracheocutanous fistulae) Tracheomalacia

B

83

An adult who sustains burn involving entire surface of right upper extremity, one half of anterior trunk, and one third of right lower extremity. How many % of his total body surface area is involved?

a) 14 %b) 19 %c) 24 %d) 29 %e) 34 % C

84

Sclorotic bone metastasis usually is seen in cancer of :

a) Prostateb) Breastc) Colond) Bronchuse) Urinary bladder

A

85

Which of the following is associated with an increased risk of in situ carcinoma of the breast?

a) Sclerosing adenosisb) Fibro adenomac) Galactoceled) Intraductal papilomae) Atypical lobular hyperplasia

E

86

Which of the following is the most accurate method for identifying hepatic metastasis?

a) Trans-abdominal ultrasound imaging .

b) CTscanningc) Laparoscopyd) Intra-operative palpatione) Intra-operative ultrasound imagingE

87

The common metabolic complications of enteral feeding:

a) Hpoglycemia and hypophosphatemiab) Hyperglycemia and hypophosphatemiac) Hypocalcaemia and hypophosphatemiad) Hypokalemia and hyperphosphatemiae) hyponatremia and hyperphosphatemia

B

88

A 55-year-old man presents with a 2-cm ulcerated lesion on his right lateral mobile tongue and a firm 2x1 cm in the right neck. Which of the following statements is TRUE?

a) Induction therapy with 50 fluorouracil and cisplatin is indicated

b) Five-year survival rate is 60 %c) Adjuvant radiotherapy is indicatedd) Resection with selective neck

dissection is indicatede) Synchronus malignancy in the lung or

upper aerodigestive track occurs in 20% of cases C

89

Which of the following affects the probability of wound infection:

a) Hair removal the night before surgeryb) Strict maintenance of blood glucose

level below 110 mgfdlc) 3 days of perioperative antibioticsd) Iodine -based rather of alcohol-based

scrube) Tacking a shower the night before

surgery B

90

A 32-year-old patient undergoes an appendicectomy. During recovery ,the patient has not voided for 4 hours. His vital signs are normal. What is the next step in management?

a) Administer l-L bolus of normal salineb) Continue IVF at the current rate for an

additional 2h and if he has not voided insert a Foley catheter

c) Insert a Foley catheterd) Insert suprapubic cathetere) Do ultrasound B

91

The neck of the femoral hernia is closely related to the:

a) Transversalis fasciab) Iliopectineal ligamentc) lIeo-lnguinal nerved) Cribriform fasciae) Obturator nerve

B

92

A healthy young married lady presented with a blood stained discharge from the right nipple. Examination was negative for breast lump, the most likely diagnosis is :

a) Papilloma of the nippleb) Fibroadenomac) Duct papillomad) Ductectasiae) Fibrocystic disease. C

93

Necrotizing fasciitis :

a) Is a synonymous of cellulitisb) Is an extensive of fast spreading

inflammation of the skin caused by mixed organisms

c) Is treated appropriate antibiotics based on culture result

d) Is self localizing conditione) Extensive repeated debridement and

appropriate antibiotics constitute the only chance of cure. E

94

ln mesenteric bowel ischemia:

a) Abdominal signs are usually diagnostic

b) Presence of atrial fibrillation is essential for a correct diagnosis

c) lactic acidosis, and bloody diarrhea rules out the diagnosis

d) Spiral CT is the gold standard for the diagnosis

e) Mesenteric angiography constitute the corner stone of the diagnosis

E

95

Hypotensive patient with pelvic fractures requires:

a) Abdominal explorationb) Focused abdominal ultrasound

examination (FAST)c) Angiography after resuscitationd) Diagnostic laparoscopye) Double contrast CT

C

96

Which of the following is associated with the highest risk for surgery?

a) A trial fibrillation since one monthb) Mild renaI insufficiencyc) Diabetes melitesd) Subendocardial infarction since one

monthe) blood pressure of 140/90

D

97

A patient presented with 3 months history of Colle's fracture and a complaint of numbness over the thumb and index fingers. This is due injury to :

a) Planter superficial cutaneous nerveb) Ulna r nervec) Radial nerved) Median nervee) lateral cutaneous nerve D

98

A patient with chest injury developed hemopneumothorax .Which of the following is most consistent with tracheobronchial injury ?

a) Mediastinal shiftb) Massive air leak and failure of the

lung to expandc) Air fluid leveld) Depressed diaphragme) Drainage of > 500 ml in the chest

tube B

99

Which of the following drug is known to cause malignant hyperthermia?

a) Succinyl cholineb) Ampicillinc) Halothand) Gentamycine) Mefoxin

A

100

A 33-year-old lady, 38 weeks pregnant involved in RTA ,she was brought to ER hypotensive, with bleeding per vagina and hard tender uterus. The most likely diagnosis is ;

a) Ruptured spleenb) Ruptured uterusc) Ruptured bladderd) Placenta abruptione) liver laceration D