1-Which is the shortest phase of the normal cell cycle?

a) G1 phase
b) S phase
c) G2 phase
d) M phase
e) All phases approximately equal in length
2- A 67 year-old women with rectal cancer is admitted to gereral surgical floor which of the following
laboratory studies should be included in the surgeons initial nutritional assessment :
a) Transferrin
b) Prealbumin
c) Albumin
d) Glutamine
e) All of above
3- In which of the following conditions is the entral route appropriate for nutrition :
a) Upper gastrointestinal obstruction
b) Complete small bowel obstruction
c) Acute flare-up of Crohns disease
d) Low out put colonic fistula
e) Non of the above
4-5-Which is the most commonly cultured hospital acquired organism in critical care with aspiration
pneumonia:
a) Staphylococcus aureus
b) Streptococcus pneumonia
c) Anaerobic species
d) Pseudomonas aeroginosa
e) Haemophlus influenzae
5-Which is the most appropriate single agent for empiric coverage of the above patient :
a) Metranidazole
b) Clindamycin
c) Pipracillin_tazobactam
d) Vancomycin
e) First generation penicillin

6-All of the following are true about neurogenic shock except:

a) There is a decrease in systemic vascular resistance and an increase in venous capacitance.
b) Tachycardia or bradycardia may be observed, along with hypotension.
c)

The use of an alpha agonist such as phenylephrine is the mainstay of treatment.

d) Severe head injury, spinal cord injury, and high spinal anesthesia may all cause neurogenic
shock.
e)

A and B

7-Which of the following statements about head injury and concomitant hyponatremia are true?
a) There are no primary alterations in cardiovascular signs.
b) Signs of increased intracranial pressure may be masked by the hyponatremia.
c)

Oliguric renal failure is an unlikely complication.

d) Rapid correction of the hyponatremia may prevent central pontine injury.

e)

This patient is best treated by restriction of water intake

8 Regarding Cushing's Syndrome

a)

20% of cases are due to pituitary adenomas (Cushing's Disease)

b) Most ACTH secreting pituitary adenomas are more than 2 cm in diameter

c)

Is characterised by loss of the diurnal rhythm of cortisol secretion

d) Cortisol production is suppressed by low-dose dexamethasone

e)

Adrenal carcinomas are more common than adrenal adenomas

9-Which of the following statements about extracellular fluid are true?

a) The total extracellular fluid volume represents 40% of the body weight.
b) The plasma volume constitutes one fourth of the total extracellular fluid volume.
c)

Potassium is the principal cation in extracellular fluid.

d) The protein content of the plasma produces a lower concentration of cations than in the
interstitial fluid.
e)

The interstitial fluid equilibrates slowly with the other body compartments.

10-In patients receiving massive blood transfusion for acute blood loss, which of the following is/are
correct?
a)

Packed red blood cells and crystalloid solution should be infused to restore oxygen-carrying
capacity and intravascular volume.
b) Two units of FFP should be given with every 5 units of packed red blood cells in most cases.
c)

A six pack of platelets should be administered with every 10 units of packed red blood cells
in most cases.

d) One to two ampules of sodium bicarbonate should be administered with every 5 units of
packed red blood cells to avoid acidosis.
e)

One ampule of calcium chloride should be administered with every 5 units of packed red
blood cells to avoid hypocalcemia.

11- Which of the following statements about the presence of gallstones in diabetes patients is/are
correct?
a) Gallstones occur with the same frequency in diabetes patients as in the healthy population.
b) The presence of gallstones, regardless of the presence of symptoms, is an indication for
cholecystectomy in a diabetes patient.
c)

Diabetes patients with gallstones and chronic biliary pain should be managed nonoperatively
with chemical dissolution and/or lithotripsy because of severe complicating medical
conditions and a high operative risk.

d) The presence of diabetes and gallstones places the patient at high risk for pancreatic cancer.
e)

Diabetes patients with symptomatic gallstones should have prompt elective cholecystectomy,
to avoid the complications of acute cholecystitis and gallbladder necrosis.

12. concerning Tetanus all true except:

a. Is due to an infection with a gram-negative spore forming rod
b. The organism produces a powerful exdotoxin
c. The toxin prevents the release of inhibitory neurotransmitter
d. Clostridium tetani is sensitive to penicillin

e. Risus sardonicus is the typical facial spasm

13-when should parentral antibiotics be given perioperatively?

a) The night before

b) 6 hr prior to surgery
c)

30 minutes prior to incision .

d) at the time of incision

e)

30 minutes after incision

14. Which of the following statements about esophageal anatomy is correct?

a)

The esophagus has a poor blood supply, which is segmental in distribution and accounts for
the high incidence of anastomotic leakage.
b) The esophageal serosa consists of a thin layer of fibroareolar tissue.
c)

The esophagus has two distinct muscle layers, an outer, longitudinal one and an inner, circular
one, which are striated in the upper third and smooth in the distal two thirds.

d) Injury to the recurrent laryngeal nerve results in vocal cord dysfunction but does not affect
swallowing.
e)

The lymphatic drainage of the esophagus is relatively sparse, localized primarily to adjacent
paraesophageal lymph nodes.

15 Wich of the following medication should be given in preparation of a pation with

pheochromocytoma?
a) Phnoxybenzamine
b) Nifedipine
c)

Linsinopril

d) Hydrochlorothiazide
e)

Propranolol

16-Which of the following statement(s) is true concerning excessive scarring processes?

a) Keloids occur randomly regardless of gender or race
b) Hypertrophic scars and keloid are histologically different
c)

Keloids tend to develop early and hypertrophic scars late after the surgical injury

d) Simple reexcision and closure of a hypertrophic scar can be useful in certain situations such as
a wound closed by secondary intention
e)

Non of the above

17-A 22-year-old man sustains a single stab wound to the left chest and presents to the emergency
room with hypotension. Which of the following statement(s) is true concerning his diagnosis and
management?
a)

The patient likely is suffering from hypovolemic shock and should respond quickly to fluid
resuscitation
b) Becks triad will likely be an obvious indication of compressive cardiogenic shock due to
pericardial tamponade
c)

Echocardiography is the most sensitive noninvasive approach for diagnosis of pericardial

tamponade

d) The placement of bilateral chest tubes will likely resolve the problem

18-Which of the following statement(s) is/are true concerning septic shock?

a)

The clinical picture of gram negative septic shock is specifically different than shock
associated with other infectious agents
b) The circulatory derangements of septic shock precede the development of metabolic
abnormalities
c)

Splanchnic vascular resistance falls in similar fashion to overall systemic vascular resistance

d) Despite normal mechanisms of intrinsic expansion of the circulating blood volume, exogenous
volume resuscitation is necessary
19- During surgery on the submandibular gland
a)

An incision on the lower border of the mandible is safe

b) The submandibular gland is seen to wrap around the posterior border of mylohyoid
c)

The facial artery and vein are divided as they course through the deep part of the gland

d) The hypoglossal nerve is seen to loop under the submandibular duct

e)

Damage to the lingual nerve will cause loss of sensation to the posterior third of the tongue

20- Regarding benign breast disease

a) Cyclical mastalgia is the commonest reason for referral to the breast clinic
b) Fibroadenomas are derived from the breast lobule
c)

Lactational breast abscesses are usually due to Staph aureus

d) Duct ectasia is more common in smokers

e)

Atypical lobular hyperplasia is associated with an decreased risk of breast cancer

21-. Which of the following statements regarding unusual hernias is incorrect?

a)

An obturator hernia may produce nerve compression diagnosed by a positive HowshipRomberg sign.
b) Grynfeltt's hernia appears through the superior lumbar triangle, whereas Petit's hernia occurs
through the inferior lumbar triangle.
c)

Sciatic hernias usually present with a painful groin mass below the inguinal ligament.

d) Littre's hernia is defined by a Meckel's diverticulum presenting as the sole component of the
hernia sac.
e)

Richter's hernia involves the antimesenteric surface of the intestine within the hernia sac and
may present with partial intestinal obstruction

22- Staples may safely be placed during laparoscopic hernia repair in each of the following structures
except:
a) Cooper's ligament.
b) Tissues superior to the lateral iliopubic tract.
c)

The transversus abdominis aponeurotic arch.

d) Tissues inferior to the lateral iliopubic tract.

e)

The iliopubic tract at its insertion onto Cooper's ligament.

23-The following statements about the repair of inguinal hernias are true except:
a) The conjoined tendon is sutured to Cooper's ligament in the Bassini hernia repair.
b) The McVay repair is a suitable option for the repair of femoral hernias.
c)

The Shouldice repair involves a multilayer, imbricated repair of the floor of the inguinal canal.

d) The Lichtenstein repair is accomplished by prosthetic mesh repair of the inguinal canal floor
in a tension-free manner.
e)

The laparoscopic transabdominal preperitoneal (TAPP) and totally extraperitoneal approach

(TEPA) repairs are based on the preperitoneal repairs of Cheattle, Henry, Nyhus, and Stoppa.

24-A number of special circumstances exist in the repair of inguinal hernias. The following
statement(s) is correct.
a)

Simultaneous repair of bilateral direct inguinal hernias can be performed with no significant
increased risk of recurrence
b) The preperitoneal approach may be appropriate for repair of a multiple recurrent hernia
c)

A femoral hernia repair can best be accomplished using a Bassini or Shouldice repair

d) Management of an incarcerated inguinal hernia with obstruction is best approached via

laparotomy incision
e)

All are correct.

25- Which of the following statement(s) is true about benign lesions of the liver?
a)

Adenomas are true neoplasms with a predisposition for complications and should usually be
resected.
b) Focal nodular hyperplasia (FNH) is a neoplasm related to birth control pills (BCPs) and
usually requires resection.
c)

Hemangiomas are the most common benign lesions of the liver that come to the surgeon's
attention.

d) Nodular regenerative hyperplasia does not usually accompany cirrhosis

26. Ligation of all of the following arteries usually causes significant hepatic enzyme abnormalities
except:
a) Ligation of the right hepatic artery.
b) Ligation of the left hepatic artery.
c)

Ligation of the hepatic artery distal to the gastro-duodenal branch.

d) Ligation of the hepatic artery proximal to the gastroduodenal artery.

27- Which of the following is the most effective definitive therapy for both prevention of recurrent
variceal hemorrhage and control of ascites?
a) Endoscopic sclerotherapy.
b) Distal splenorenal shunt.

c)

Esophagogastric devascularization (Sugiura procedure).

d) Side-to-side portacaval shunt.

e)

End-to-side portacaval shunt.

28-which of the following is associated with best prognosis for patient with breast cancer?
a) Male sex
b) Estrogen receptor positive
c)

Patient age <35 years

d) Pregnant patient
e)

Tumor with overexpression of HER/ner.

29-A 49-year-old women has a palpable breast mass in the upper outer quadrant. The size of the mass
has increased over the last month . exicisional biopsy reveals cystic carcinoma with invasion
.appropriate management now would be :
a) Re-excision with wide margins
b) Axillary node dissection and hormonal therapy
c)

Simple mastectomy

d) Modified radical mastectomy

e)

Bilateral mastectomies

30-A contraindication to stereotactic core biopsy of the breast is the mammographic presence of:
a) Microcacification
b) A radial scar
c)

A nonpalpable mass lesion

d) Lesions<8 mm in diameter
e)

Mutifocal lesions.

31-. Which of the following statements about epiphrenic diverticula of the esophagus is/are correct?
a) They are traction diverticula that arise close to the tracheobronchial tree.
b) They characteristically arise proximal to an esophageal reflux stricture.
c)

The degree of dysphagia correlates with the size of the pouch.

d) They are best approached surgically through a right thoracotomy.

e)

The operation of choice is a stapled diverticulectomy, long esophagomyotomy, and partial

fundoplication.

32- Which of the following statements about Schatzki's ring is correct?

a) The ring represents a panmural fibrotic stricture resulting from gastroesophageal reflux.
b) Dysphagia occurs when the ring diameter is 13 mm. or less.
c)

The ring occurs within 1 to 2 cm. of the squamocolumnar epithelial junction.

d) Schatzki's ring indicates reflux esophagitis.

e)

Schatzki's ring signifies the need for an antireflux operation.

33. Which of the following statements about pathology encountered at esophagoscopy is/are correct?
a)

Reflux esophagitis should be graded as mild, moderate, or severe, to promote consistency

among different observers.
b) An esophageal reflux stricture with a 2-mm. lumen is not dilatable and is best treated with
resection.
c)

A newly diagnosed radiographic distal esophageal stricture warrants dilation and antireflux
medical therapy.

d) In patients with Barrett's mucosa, the squamocolumnar epithelial junction occurs 3 cm. or
more proximal to the anatomic esophagogastric junction.
e)

After fasting at least 12 hours, a patient with megaesophagus of achalasia can safely undergo
flexible fiberoptic esophagoscopy.

34. Infantile hypertrophic pyloric stenosis

a)

Occurs with a female : male ratio of 4:1.

b) Sons of affected mothers have a 20% risk of developing the lesion

c)

Invariably presents between six and eights months of age

d) Typically presents with bile stained projectile vomiting

e)

Surgical treatment is by Heller's Cardiomyotomy

35-. Which of the following statements regarding the pathology of esophageal carcinoma is/are correct?
a)
b)

Worldwide, adenocarcinoma is the most common esophageal malignancy.

Squamous cell carcinoma is most common in the distal esophagus, whereas adenocarcinoma predominates in the
middle third.

c)

Patients with Barrett's metaplasia are 40 times more likely than the general population to develop adenocarcinoma.

d)

Metastases from esophageal carcinoma are characteristically localized to regional mediastinal lymph nodes adjacent
to the tumor.

e)

Achalasia, radiation esophagitis, caustic esophageal stricture, Barrett's mucosa, and Plummer-Vinson syndrome are all
premalignant esophageal lesions that predispose to the development of squamous cell carcinoma.

36-45-year-old with isolated 6-cm colorectal metastasis in the liver 2 years after colectomy, otherwise
healthy pest treatment would be:
a) Radiofrequency ablation
b) Systemic chemotherapy
c)

Hepatic lobectomy

d) Liver transplantation
e)

Cryosurgical ablation

37- Oesophageal atresia all true except:

a)

Is often associated with a distal trachea-oesophageal fistula

b) Polyhydramnios is often present late in pregnancy

c)

50% have other associated congenital abnormalities

d) Contrast X-ray studies are necessary to confirm the diagnosis

e)

Post-operatively over 30% develop oesophageal strictures

38-All are true about the dumping syndrome except:

a) Symptoms can be controlled with a somatostatin analog.
b) Diarrhea is always part of the dumping syndrome.
c)

Flushing and tachycardia are common features of the syndrome.

d) Separating solids and liquids in the patient's oral intake alleviates some of the symptoms of the
syndrome.
e)

Early postoperative dumping after vagotomy often resolves spontaneously.

39-Which of the following statements about gastric polyps is/are true?

a) Like their colonic counterparts, gastric epithelial polyps are common tumors.
b) They are analogous to colorectal polyps in natural history.
c)

Endoscopy can uniformly predict the histology of a polyp based on location and appearance.

d) In a given patient, multiple polyps are generally of a multiple histologic type.

e)

Gastric adenomatous polyps greater than 2 cm. in diameter should be excised because of the
risk of malignant transformation.

40-All of the following statements about surgical management of gastric lymphomas are true except:
a)

Stage I gastric lymphomas (small lesions confined to the stomach wall) can be cured
completely with surgical therapy alone.
b) Extensive gastric lymphomas that initially are treated with radiation and/or chemotherapy
occasionally perforate during treatment and require secondary resection.
c)

Patients explored with a presumptive diagnosis of gastric lymphoma should undergo an

attempt at curative resection when this is safe and feasible.

d) Without a preoperative diagnosis resection for gastric mass should not be attempted unless
lymphoma can be excluded.
e)

Appropriate staging for primary gastric lymphoma includes bone marrow biopsy.

41-the most accurate test to confirm diagnosis of infected necrotizing pancreases is:
a) Abdominal ultrasound study
b) Indium-labeled leeukocte scan
c)

Cimputed tomographic scan

d) Elevated serum level of interleukain 6 and 8

e)

Percutaneous needle aspiration

42- Which of the following variables best predicts prognosis for patients with a recent diagnosis of
cutaneous melanoma and no clinical evidence of metastatic disease?
a) Breslow thickness.
b) Clark's level.
c)

Ulceration.

d) Gender.
e)

Celtic complexion.

43-the following are true about intracranial tumors except:

a) The most common location of brain tumors of childhood is the posterior cranial fossa.
b) With few exceptions, examination of the CSF is of no value in the diagnosis of an intracranial
tumor.
c)

Even the most malignant of primary brain tumors seldom spread outside the confines of the
central nervous system (CNS).

d) The majority of astrocytomas can be cured surgically.

e)

Primary neoplasms of astrocytic, oligodendroglial, or ependymal origin represent gradations

of a spectrum from slowly growing to rapidly growing neoplasms.

44 A right-sided disc herniation at the L5S1 level typically may cause:

a) Low back pain and left sciatica.
b) Weakness of dorsiflexion of the right foot.
c)

A diminished or absent right ankle jerk.

d) Diminution of sensation over the medial aspect of the right foot, including the great toe.
e)

Weakness of dorsiflexion of the left foot.

45-. The preferred operation for initial management of a thyroid nodule that is considered suspicious
for malignancy by FNAB is:
a) Excision.
b) Partial lobectomy.
c)

Total lobectomy and isthmusectomy.

d) Total thyroidectomy.
e)

All methods are correct

46-the most common presentation of Meckel,s diverticulum in an adult is:

a) GIT bleeding
b) GIT obstruction
c)

Intussuception

d) Litter,s hernia
e)

Diverticulitis

47-Optimal front-line treatment of squamous cell carcinoma of the rectum includes:

a) Abdominal perineal resection.
b) Low anterior resection when technically feasible.
c)

Radiation therapy.

d) Chemotherapy.
e)

Combined radiation and chemotherapy.

48 -65-year-old man presents with complaints of mucous discharge and perianal discomfort. Physical
examination reveals a fistulous opening lateral to the anus. Anoscopic examination permits passage of a
probe through the fistula tract. The fistula traverses the internal anal sphincter, the intersphincteric
plane, and a portion of the external anal sphincter. The fistula is categorized as which type?
a)
b)

Intersphincteric
Transsphincteric

c)

Suprasphincteric

d)

Extrasphincteric

e)

Non of the above

49-Warthin's tumor:
a) Is a pleomorphic adenoma of salivary gland
b) Should be treated by total paritidectomy
c)

Is considered a benign salivary gland neoplasia

d) Respond well to preoperative radiotherapy

e) Often present with facial nerve compression

50-A 38 year old woman presents with right upper quadrant pain and bouts of vomiting. She is
known to have gallstones and has had similar episodes in the past. Which of the following might
support a diagnosis of acute cholecystitis rather than biliary colic
a) duration of symptoms
b) Severity of vomiting
c) Presence of Murphy's sign
d) Presence of gas under right hemidiaphragm on erect CXR.

1.
3.
5.
7.
9.
11.
13.
15.
17.
19.
21.
23.
25.
27.
29.
31.
33.
35.
37.
39.
41.
43.
45.
47.
49.

D
D
C
A
B
E
C
A
C
B
C
A
A
D
C
E
D
C
B
E
E
E
C
E
C

2.
4.
6.
8.
10.
12.
14.
16.
18.
20.
22.
24.
26.
28.
30.
32.
34.
36.
38.
40.
42.
44.
46.
48.
50.

C
D
C
C
A
A
C
B
D
E
D
B
D
B
B
B
B
C
B
D
A
C
A
B
C