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Surgery .DR.

marwan abu sa3da 2010

A 40-year-old female has a 4-cm hemangioma in the right lobe of the liver on computed -2
:tomography scan. She is asymptomatic. Appropriate action should be
ne-needle biopsy (a)
arrangement for elective resection (b)
no further action (c)
angiographic embolization (d)
:Regarding an amebic liver abscess -3
surgical drainage is usually required (a)
negative stool testing for amebiasis rules out the disease (b)
it should be drained percutaneously under com- puted tomography guidance (c)
it is treated with metronidazole (d)
:A single organism is usually the causative agent in -4
(a) pelvic inammatory disease
(b) perforated diverticulitis
(c) acute cholecystitis
(d) primary peritonitis
(e) diabetic foot infections
9- Signs and symptoms of hemolytic transfusion reactions include
a. Hypothermia
b. Hypertension
c. Polyuria
d. Abnormal bleeding
e. Hypesthesia at the transfusion site
10- In a hemolytic reaction caused by an incompatible blood transfusion, the treatment that is most
likely to be helpful is:
a. Promoting a diuresis with 250 ml of 50% mannitol
b. Treating anuria with fluid and potassium replacement
c. Acidifying the urine to prevent hemoglobin precipitation in the
renal tubules
d. Removing foreign bodies, such as Foley catheters, which may cause hemorrhagic complications
e. Stopping the transfusion immediately
11- Which statements about extrahepatic bile duct cancer are correct?
A. Cholangiography is not essential in evaluating patients for resectability.
.B. The prognosis is excellent when appropriate surgical and adjuvant therapy are given
.C. The location of the tumor determines the type of surgical procedure

.D. The disease usually becomes manifest by moderate to severe right-side upper quadrant pain
?Which of the following statements about the diagnosis of acute calculous cholecystitis is true -12
.A. Pain is so frequent that its absence almost precludes the diagnosis
.B. Jaundice is present in a majority of patients
.C. Ultrasonography is the definitive diagnostic test
.D. Cholescintigraphy is not definitive diagnostic test

?Which statement about acute acalculous cholecystitis is correct -13


.A. The disease is often accompanied by or associated with other conditions
.B. The diagnosis is often difficult
.C. The mortality rate is higher than that for acute calculous cholecystitis
D. The disease has been treated successfully by percutaneous cholecystostomy
E- all are correct
?Which of the following statements about laparoscopic cholecystectomy are correct -14
.A. The procedure is associated with less postoperative pain and earlier return to normal activity
.B. The incidence of bile duct injury is lower than for open cholecystectomy
C. Laparoscopic cholecystectomy should be used in asymptomatic patients because it is safer than open
.cholecystectomy
.D. Pregnancy is a contraindication
A 15-year-old female presents with RUQ abdominal pain. Workup reveals a choledochal cyst. -15
?Which of the following statements is TRUE
(A) Choledochal cysts are more common in men.
(B) Laparoscopic cholecystectomy is the recommended treatment.
(C) Patients with a choledochal cyst have an increased risk of cholangiocarcinoma.
(D) All patients with a choledochal cyst have abdominal pain, a RUQ mass, and jaundice.
(E) The etiology is infectious.
An 85-year-old man is brought to the hospital with a 2-day history of nausea and vomiting. He has -16
not passed gas or moved his bowels for the last 5 days. Abdominal films show dilated small bowel, no
?air in the rectum and air in the biliary tree. Which of the following statements is TRUE

(A) Air in the biliary tree associated with small-bowel obstruction suggests a diagnosis of gallstone ileus.
(B) An enterotomy should be distal to the site of obstruction and the stone should be removed.
(C) Gallstone ileus is more common in the young adults.
(D) Cholecystectomy is contraindicated.
(E) Small-bowel obstruction usually occurs in the distal jejunum.
17- A45-year-old patient with chronic pancreatitis is suffering from malnutrition and weight loss
secondary to inadequate pancreatic exocrine secretions. Which is TRUE regarding pancreatic
secretions?
(A) Secretin releases fluid rich in enzymes.
(B) Secretin releases fluid rich mainly in electrolytes and bicarbonate.
(C) Cholecystokinin releases fluid,predominantly rich in electrolytes, and bicarbonate.
(D) All pancreatic enzymes are secreted in an inactive form.
(E) The pancreas produces proteolytic enzymes only.
18-A 43-year-old woman has gallstone pancreatitis that resolves in 2 days with conservative treatment.
She has no abdominal complaints and her liver and pancreatic laboratory values have returned to
normal. She is scheduled for laparoscopic cholecystectomy. Which of the following statements is
TRUE?
(A) Intraoperative cholangiography is associated with a decreased risk of biliary tract injury .
(B) The procedure should be scheduled for 6 weeks after resolution of symptoms .
(C) Intraoperative cholangiography in this patient will identify choledocholithiasis in 50% of cases .
(D) Preoperative endoscopic retrograde cholangiopancreatography (ERCP) should be performed.
(E) The sensitivity of magnetic resonance cholangiopancreatography (MRCP) for choledocholithiasis in
this patient is less than 50%.

19-A 39-year-old woman is admitted with gallstone pancreatitis and epigastric pain. Pertinent data
include amylase, 2000 U/L; bilirubin, 1.2 mg/dL; and WBC count, 15,000/mm3 . After 2 days of
medical management, her epigastric pain resolves. Her amylase is 340 U/L and her bilirubin and WBC
count have returned to normal. Laparoscopic cholecystectomy should be attempted:
(A) after endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy
(B) prior to discharge
(C) once her amylase is normal
(D) 4 to 6 weeks later
(E) only if the patient develops recurrent pancreatitis
20- A 48-year-old woman is admitted with acute cholecystitis. The bilirubin level is elevated, as are the
serum and urinary amylase levels. Which radiologic sign indicates biliary obstruction in pancreatitis?
(A) Pancreatic intraductal calcification
(B) Smooth narrowing of the distal CBD
(C) Stomach displaced anteriorly
(D) Calcified gallstone
(E) Air in the biliary tree)
21. Following a motor vehicle accident a truck driver complains of severe abdominal pain. Serum
amylase level is markedly increased to 800 U. Grey Turners sign is seen in the flanks. Pancreatic
trauma is suspected. Which statement is true of pancreatic trauma?
(A) It is mainly caused by blunt injuries.
(B) It is usually an isolated single-organ injury.
(C) It often requires a total pancreatectomy.
(D) It may easily be overlooked at operation.
(E) It is proved by the elevated amylase level.

22. A 73-year-old woman is evaluated for obstructive jaundice after an injury to the CBD, 7 months
previously at laparoscopic cholecystectomy. The alkaline phosphatase is elevated. In obstructive
jaundice, which of the following statements is true regarding alkaline phosphatase?
(A) Its level increases before that of bilirubin.
(B) Its level is unlikely to be increased in pancreatic malignancy.
(C) Its elevation indicates bone metastasis.
(D) Its elevation excludes hepatic metastasis.
(E) Its level falls after that of the bilirubin,following surgical intervention.
23. A48-year-old female travel agent presents with jaundice. Radiological findings confirm the
presence of sclerosing cholangitis. She gives a long history of diarrhea for which she has received
steroids on several occasions. She is likely to suffer from which of the following?
(A) Pernicious anemia
(B) Ulcerative colitis
(C) Celiac disease
(D) Liver cirrhosis
(E) Crohns disease
24. A38-year-old male lawyer develops abdominal pain after having a fatty meal. Examination reveals
tenderness in the right hypochondrium and a positive Murphys sign. Which test is most likely to
reveal acute cholecystitis?
(A) HIDA scan
(B) Oral cholecystogram
(C) Intravenous cholangiogram
(D) CT scan of the abdomen
(E) ERCP
25. A 65-year-old woman is admitted with RUQ pain radiating to the right shoulder, accompanied by
nausea and vomiting. Examination reveals tenderness in the RUQ and a positive Murphys sign. A
diagnosis of acute cholecystitis is made. What is the most likely finding?
(A) Serum bilirubin levels may be elevated.
(B) Cholelithiasis is present in 4060%.
(C) Bacteria are rarely found at operation.
(D) An elevated amylase level excludes this diagnosis.
(E) A contracted gallbladder is noted on ultrasound.
26. A 32-year-old diabetic woman who has taken contraceptive pills for 12 years develops RUQ pain.
CT scan of the abdomen reveals a 5-cm hypodense lesion in the right lobe of the liver consistent with a
hepatic adenoma. What should the patient be advised to do?
(A) Undergo excision of the adenoma
(B) Stop oral contraceptives only
(C) Stop oral hypoglycemic medication
(D) Undergo right hepatectomy
(E) Have serial CT scans every 6 months
27- A 9 month old boy presents with an acute scrotal swelling. The following diagnoses are likely:
a.
Epididymitis
b.
Orchitis
c.
Torsion of the testicular appendage
d.
Irreducible inguinal hernia
e.
Acute idiopathic scrotal oedema
28- A 76-year-old man presents with weight loss, dark urine, and pale stools which are difficult
to flush away. An excess of which of the following would account for this history?

a. Conjugated bilirubin
b. Hyperbilirubinaemia
c. Stercobilinogen
d. Unconjugated bilirubin
e. Urobilinogen
28- An otherwise well 13-year-old boy is admitted complaining of sudden onset severe left sided
testicular pain 2 hours prior to admission. He gives no history of trauma, dysuria or frequency. On
examination he is found to have a tender, high-riding testicle.What is the most appropriate next step
in this young mans management?
a. Herniography
b. Scrotal Doppler ultrasound on the next available list
c. FBC and U&E
d. Scrotal Doppler ultrasound as an emergency
e. Surgical exploration of his scrotum
Acute scrotum -29
Torsion testis should be operated within 12 hour of presentation
Epidedimoorchitis pain increase by testicular elevation
If in doubt scrotum should be explored
Doppler ultrasound has no role in diagnosis
None of the above
30- stones in the common bile duct:
a. Are present in nearly 50 per cent of cases of cholecystitis.
b. Often give rise to jaundice, fever and biliary colic.
c. Are usually accompanied by progressive jaundice.
d. Are usually associated with a distended gallbladder.
e.

A&D only.

31- Which of the following statements regarding whole blood transfusion is correct?
a. Whole blood is the most commonly used red cell preparation for
transfusion in the
b. Whole blood is effective in the replacement of acute blood loss.
c. Most blood banks have large supplies of whole blood available.
d. The use of whole blood produces higher rates of disease transmission
than the use of individual component therapies.
e. Old Whole blood is effective in the replacement of platelets.
32- Acute cholecystitis all are true except
a. Commonest bacteria is E .coli
b. Wall thickness more than 3mm by ultrasound
c. WCC is between 10-15 000 cell/mm3
d. Mild elevated bilirubin may accompany it
e. HIDA scan has no role in diagnosis of acute cholecystitis
33. A 51-year-old male experiences the sudden onset of massive emesis of bright red blood. There have
been no prior episodes of hematemesis. He is known to be hepatitis B surface antigen positive. His
hematemesis is most likely a consequence of which of the following abnormalities of the esophagus?
a. Varices
b. Barrett esophagus
c. Candidiasis
d. Reflux esophagitis
e. Squamous cell carcinoma
34- A 61-year-old male has had ascites for the past year. After a paracentesis with removal of 1 L of
slightly cloudy, serosanguinous fluid, physical examination reveals a firm, nodular liver.Laboratory

findings include positive serum HBsAg and presence of hepatitis B core antibody. He has a markedly
elevated serum alpha-fetoprotein (AFP) level. Which of the following hepatic lesions is he most likely
to have?
a. Hepatocellular carcinoma
b. Massive hepatocyte necrosis
c. Marked steatosis
d. Wilson disease
e. Autoimmune hepatitis
35- A 76-year-old man presents with weight loss, dark urine, and pale stools which are difficult to
flush away. An excess of which of the following would account for this history?
a. Conjugated bilirubin
b. Hyperbilirubinaemia
c. Stercobilinogen
d. Unconjugated bilirubin
e. Urobilinogen
36-Acute pancreatitis
Serum calcium start to rise after 48 hours
Hypoglycaemia is bad prognostic factor
Age is an important prognostic factor
Serum amylase is more specific than serum lipase
Severe pancreatitis compromise around 40% of cases

37- The most commonly used imaging method for diagnosis of acute cholecystitis is:
a. CT of the abdomen.
b. Ultrasonography of the gallbladder.
c. Oral cholecystogram.
d. Radionuclide (HIDA) scan of the gallbladder
e. MRI
38- A 23-year-old male presents to the emergency department after being involved in a motor vehicle
accident. On physical examination, he opens his eyes spontanously, he occasionally mumbles
incomprehensible sounds, he localizes to painful stimulation with his right upper extremity, His pupils
are 4 mm bilaterally and reactive. This patients Glasgow Coma Scale (GCS) score:
a. 7
b. 9
c. 8
d. 11
e. 12
39- Complication of undescended testis include all of the following except :
a. Malignant degeneration.
b. Increased susceptability to trauma.
c. Increased spermatogenesis.
d. More liable to testiculer torsion.
e. Psychological complication
40- Neonatal duodenal obstruction:
a. May be associated with down's syndrome.
b. Is more frequently found in premature infants.

c. Typically presents with gross abdominal distension.


d. Usually presents with vomiting of non-bile stained fluid
e. B&C only.
41-Markedly elevated alpha-fetoprotein is diagnostic
(A) Hepatic hemangioma
(B) Angiosarcoma in the liver
(C) Hepatic adenoma
(D) Focal nodular hyperplasia
(E) Hepatocellular carcinoma
2.on clinical examination of tortion testis all are true except:
a. testis is tender and swollen.
b.testis is elevated and raised.
c.loss of cremasteric reflex.
d.redness with possible reactive hydrocele.
e. pain decrease with elevation of the testis .
3. Regarding cryptorchidism(undesended testis) all are true except :
a. refers to the interruption of the normal descent of the testis into the scrotum.
b. The testicle may reside in the retroperitoneum, in the internal inguinal ring, in
.the inguinal canal, or even at the external ring
C. At birth, approximately 95% of infants have the testicles normally positioned
.in the scrotum
. D. its a common disorder and incidence increased up to 30 % in premature
.E. undescended testis is always regarded as an ectopic testis

:Regarding GI(gastrointestinal bleeding ) all are true except .4


a.Lower GI hemorrhage is defined as an abnormal intra luminal blood loss from a
.source distal to the Treitz ligament
b.The most cause of massive lower GI bleeding in adults are diverticulosis and
.angiodysplasia
.c.Cancer colon is usually associated with massive lower GI hemorrhage
.d.Hemorrhage from diverticular disease stops spontaneously in 80% of patients

E. patients with massive upper GI bleeding may present with maroon stools or

.bright red blood from the rectum

:Signs of severe bood loss include the following except .5

a.Pallor

b.Clammy skin

c.bradycardia

d.Tachycardia

e.Hypotension

: regarding stigmata of bleeding in peptic ulcer .6


. a.its associated with increase risks for rebleeding
.b.adherent clot is the most significant stigmata
. c.arterial spurting hemorrhage associated with low risk of rebleeding
d.risk of rebleeding in ulcer with clean base is above 50%
. e.nonbleeding visible vessel is not associated with risk of rebleeding
7.Features of inflammatory response syndrome (SIRS) include the following
except:

a.
b.
c.
d.
e.

Temperature> 38.4C
Temperature <36.C
WCC<4.ooo cells per ml
Respiratory rate >20 per minute
PCO2> 32 mmHg

8.The development of thrombocytopenia and arterial thrombosis with


heparin requires:
a. Continuation of heparin and platelet transfusion
b. Continuation of heparin and thrombolysis
c. Doubling the heparin dosage
d. Changing the route of heparin administration
e.
Discontinuation of heparin
13.Regarding Heparin-induced thrombocytopenia (HIT) all are true except
a.
Is a special case of drug-induced immune thrombocytopenia.
b. The platelet count typically begins to fall 5 to 14 days after heparin
has been started.
c.
Thrombocytopenia is usually severe.
d.
HIT should be suspected if the platelet count falls to less than
100,000 or if it drops by 50% from baseline in a patient receiving
heparin
e. HIT is more common with full-dose unfractionated heparin (1 to
3%)

14.Regarding gall bladder and bile secretion all are true except :
a.The gallbladder is a pear-shaped, about 7 to 10 cm long with an average
capacity of 30 to 50ml.
b.When obstructed, the gallbladder can distend markedly and contain up to 300
mL
c. Anomalies of the hepatic artery and the cystic artery are quite common,
occurring in as many as 50% of cases.
d.liver produces 500 to 1000 mL of bile a day
e.Vagal stimulation decreases secretion of bile
15.Regarding gall bladder stones all are true except:
a. Prevalence increases with advancing age
b. Over 10% of those with stones in the gallbladder have stones in the
.common bile duct
c.10-20% become symptomatic
d.cholesterol stones are the most common type.
e.pigment stones are associated with secondary common bile duct stones .
16. In acute cholecystitis all true except :
a.Most common organisms are E. coli
b. 90% cases result from obstruction to the cystic duct by a stone.
C .patient present with constant pain usually greater than 6 hours duration in
right upper quadrant .

d.presence of gall stones and percholecystic fluid on US is diagnostic


e.Cholecystectomy is contraindicated in acute stage .
17.complication of acute cholecystitis include all the following except:
a.Gangrenous cholecystitis
b.Gallbladder perforation
c.Cholecystoenteric fistula
d.mesnteric ischemia
e.Gallstone ileus
18.Regarding choledocholithisis all are true except:
a. may be silent and or may cause obstruction, complete or incomplete
b. may manifest with cholangitis or gallstone pancreatitis.
c.present with severe jaundice and cholangitis in case of stone impaction
d.Rt upper quadrant pain ,fever,and jaundice are called charcots triad in
cholangitis.
e.impaction of small stones has no relation with acute pancreatitis .
19.Regarding acalculous cholecystistis all are true except:
a. Acute inflammation of the gallbladder can occur without gallstones
b. Acalculous cholecystitis typically develops in critically ill patients in the intensive
care unit.
c. Patients on parenteral nutrition with extensive burns, sepsis, major operations
are at risk for developing acalculous cholecystitis.
d.US is not a good diagnostic tool.
E.can be managed by cholecystectomy or percutanous cholecyststomy .
20.Regardind gall bladder cancer all are true except:
a. Larger stones (>3 cm) are associated with a 10-fold increased risk of cancer.
b. up to 95% of patients with carcinoma of the gallbladder have gallstones.
c. Polypoid lesions of the gallbladder are not associated with increased risk of
cancer
d. Patients with choledochal cysts have an increased risk of developing cancer
e. Sclerosing cholangitis is risk factor for developing gall bladder cancer .
21.Regarding tumors of the liver all are true except :
a.Hemangioma is the most common solid benign lesion .
b.Spontaneous rupture in hemangioma (bleeding) is rare.
c.Hepatic adenomas carry a significant risk of spontaneous rupture with
intraperitoneal bleeding.
d. Hepatic adenomas have a risk of malignant transformation to a welldifferentiated HCC(hepatocellular carcinoma).
e.focal nodular hyperplasia lesions(FNH) lesions usually rupture spontaneously and
have significant risk of malignant transformation .
22.Regarding pyogenic liver abscess all are true except :
a. arise as a result of biliary sepsis.
b.associated with high mortality.
c .appendicitis is unlikely the cause pyogenic liver abscess.
d.30% of patient have pleural effusion on presentation .
e.lab.investiation show elevated WBC and abnormal liver function .
23.Regarding acute pancreatitis all are true except:

a.Gallstones less than 5mm diameter are more likely to cause pancreatitis than
larger ones
b.. The mortality associated with infected necrosis is about 40%
c.Cullen's sign is a sign of retroperitoneal hemorrhage in severe hemorrhagic
pancreatitis .
d.elevated serum amylase is a significant predictor of severity .
e.. 50% of deaths occur within first week due to multi-organ failure .
24.All occur as a complication of acute pancreatitis except:
a.panreatic fluid collection
b.colonic necrosis
c.coagulopathy
d.hypercalcemia
e.respiratory failure
25.Regarding head trauma all are true except:
a.basal skull fracture regarded when one of the orbital roof ,sphenoidal bone or
petromastoid portion are involved .
b.epidural hematoma is an Lens shape hematoma between dura and the skull.
c.subdural hematoma is crescent shaped hematoma ,between brain and dura
d.secondary brain injury is preventable.
e.GCS glascow Coma scale 3/15 indicate uncomprehensive sounds .
27.Regarding chronic lower limb ischemia all are true except:
a. Claudication distance is distance after which the pain is felt.
b. Rest pain is continous severe burning pain in the foot which indicate critical
ischemia.
c. trophic changes include tapering digits ( loss of S.C fat ) and muscle wasting .
d. usuall presentations of patients with lower limb ischemia are pain,trophic
changes and gangrene.
e. venous filling time more than 2 minutes indicates mild lower limb ischemia.
28.Regarding 4 weeks 4 Kg bodywt. old full term neonate presented with
rapidly progressive projectile non bilious vomiting and palpable upper
abdominal mass all are true except :
a. dehydration and alkalosis are prominent features.
b.maintenance fluid therapy is about 4ml /Kg /hour.
c.administration of IV fluids with 5% dextrose, 0.5% normal saline, and KCl usually
corrects the alkalosis .
d.Estimated total blood volume is about 320 cc.
E. the most likely diagnosis is high jejunal atresia
29.All are true regarding jejunoileal atresia except:
a. present with bile stained vomiting .
b. Failure to pass meconium or small amounts of mucus or meconium maybe
passed per rectum.
c. present with abdominal distention.
d. X-ray show double bubble appearance .
e. The x-rays usually show multiple air-fluid levels.
30.regarding malrotation of the gut all are true except:
a.The patient might be asymptomatic and then develop the symptoms when he is
older.
b.Commonest abnormality results in caecum lying close to DJ flexure.

c.Fibrous bands may be present between caecum and DJ flexure (Ladd's bands).
d. the patient is unlikely to have clinical picture of duodenal obstruction .
e. In malrotation midgut mesentery is abnormally narrow and liable to volvulus.