A) BASIC SURGICAL SCIENCES

DIRECTIONS: Each of the following questions contains Five suggested answers.

Select the Best response to each question:

1) Abduction of the vocal cords results from contraction of the:
A) crico-thyroid muscles
B) posterior crico-arytenoid muscles
C) vocalis muscles
D) thyro-ary-epiglottic muscles
E) lateral crico-arytenoid and transverse arytenoids muscles
2) The rectum:
A) is devoid of peritoneum
B) is surrounded by peritoneum
C) has peritoneum on its lateral surfaces for its upper two- thirds, and on its
anterior surface for its upper one-third
D) has pritoneum on its anterior surface for its upper two-thirds, and on its lateral
surfaces for its upper one-third
E) has peritoneum on its anterior surface only
3) The umbilicus:
A) lies near the to the xiphoid than to the pubis
B) derives its cutaneous innervation from the eleventh thoracic nerve
C) transmits, during development, the umbilical cord two arteries and two veins
D) usually lies at about the level between the third and fourth lumbar vertebra
E) emberiologicall, may transmit urine but never bowel contents
4) The superficial perineal pouch:
A) is limited inferiorly by the urogenital diaphragm
B) is not continuous with the space in the scrotum occupied by the testes
C) has a membranous covering which provides a fascial sheath around the penis
D) is traversedby the urethera in the male but not the urethera and vagina in the
female
E) in the female, the greater vestibular glands are situated outside this pouch

5) The tongue:
A) has a foramen caecum at the base of the frenulum
B) is separated from the epiglottis by the valleculae on each side of the midline
C) has 7-12 circumvallate papillae situated behind the sulcus terminalis
D) is attached to the hyoid bone by the genioglossus muscle
E) is supplied only by hypoglossal nerve

6) Hypovolaemic shock is characterized by:

A) a low central venous pressure , low cardiac output , low peripheral resistance
B) a high central venous pressure , high cardiac output , low peripheral resistance
C) a low central venoys pressure , low cardiac output , high periphera resistance
D) a low central venous pressure , high cardiac output , high peripheral resistance
E) a high central venous pressure , low cardiac output , low peripheral resistance
7) An oxygen debt is:
A) the amount of oxygen in excess of the resting metabolic needs that
must be consumed after completion of exercise
B) build up because the pulmonary capillaries limit the uptake of
Oxygen at high rates of oxygen consumption
C) related to the fact that skeletal muscle cannot function temporarily
absence of oxygen
D) associated with a decrease in blood lactate
E) associated with alkalosis
8) Pulmonary embolism may be a complication of:
A) prolonged bed rest
B) a surgical operation
C) vitamine K deficiency
D) oral contraceptive therapy
E) Antithrombin III deficiency

in the

9) Which of the following statements regarding potassium metabolism is NOT

True?:
A) potassium deficiency commonly results from thiazide diuretic theraoy
B) the normal compensation for potassium deficiency is a metabolic extracellular
acidosis
C) aldosterone increases urinary potassium loss
D) hyperkalaemia causes bradycardia and loss of P waves on the ECG
E) hypokalaemia aggrevates the cardiac effects of digitalis toxicity
10) Cutaneous pain:
A) is due to overstimulation of receptors serving other sensory modalities
B) cannot be elicited more readily if the tissue has recently been injured
C) is due to exitation of receptors by pain-producing chemical substances in the injured
tissue
D) shows marked adaptation, i. e. decrease in severity in response to a constant stimulus
E) is conducted through the medial spinothalamic tract
11) Which of the following is NOT associated with hyperthyroidism?:
A) increase size of the thyroid gland
B) increased amount of colloid in thyroid follicle
C) increased height of epithelium of the thyroid follicle
D) increased vascularity of the thyroid gland
E) increased uptake of iodine by the thyroid gland
12) Sarcomata may show all of the following EXCEPT:
A) production of myxomatous tissue
B) production of collagen
C) spindle shaped cells
D) signet ring cells
E) blood stream metastasis
13) Anaphylaxis is characterized by all of the following EXCEPT:
A) is a reaction either local or general , frequently occurs within five minutes
B) causes an urticarial eruption
C) is produced by IgA antibody
D) causes eosinophilia
E) causes degranulation of basophils and mast cells

14) Autoimmunity is characterized by the following EXCEPT:

A) occurs because of a breakdown in the ability of the body to distinguish between self
and non self
B) is involved in some forms of orchitis
C) is involved in formation of cryo globulin
D) is important in the pathogenesis of lupus erytheromatosus
E) does not result in immune complex disease
15) Pseudomembranous enterocolitis is caused by the following organisms:
A) Clostridium sporogenes
B) Clostridium defficile
C) Streptococcus faecalis
D) Penicillin sensitive staphylocci
E) Pseudomonas aeruginos

B) CLINICAL SUGERY

16) The white clot syndrome:

A) is usually characterized with antithrombin III deficiency
B) most often present with arterial complicatios of heparin induced throbocytopenin
C) is best managed by loe molecular weight dextran
D) is best managed by halving the therapeutic dose of heparin sodium
E) results from nitric oxide deficiency of endothelial cells
17) A 21-year-old man who was the driver in a head-on collision has a pulse of 140/min ,
respiratory rate of 36 and blood pressure of 75 palpable. His trachea is deviated to the left,
with palpable subcutaneous emphysema and poor breath sounds in the right hemithorax,
The most appropriate initial treatment must be
A) immediate thoracotomy
B) catheter insertion in the subclavian vein for fluid resuscitation
C) intubation and ventilation
D) tube thoracostomy
E) immediate tracheostomy

18) The best test to monitor the adequacy of levothyroxin therapy is:
F) radioactive iodine uptake
G) thyroglobulin
H) free thyroxine index (T4)
I) triiodothyronine resin uptake (T3)
J) thyroid stimulating hormone (TSH)
19) Which of the following statements about fungal infection is NOT true ?:
A) Prior or synchronous culture positive for Candida at another site occurs in few
patients with candidimia
B) For critically ill patients nonhaematogenous sites of candida are appropriately
treated with systemic antifungal therapy
C) Mortality rates are similar regardlss of whether C. albicans fungmia is treated
with amphotericin B or flconazole
D) Intravenous catheters and the gastrointestinal tract are common portals for
Candida to gain blood stream access
E) Septic emboli are more common with fungal endocarditis than with bacterial
endocarditis
20) The maximum safe dose of local anaesthetic administered subcutaneously in a 70-kg
man is:
A) 10 to 20 ml of 1% lidocaine
B) 40 to 50ml oh 2% lidocaine with epinephrine
C) 40 to 50 ml of 1% lidcaine with epinephrine
D) 40 to 50 ml of 1% bupivacaine (marcaine)
E) 40 to 50 ml of 1%lidocaine without epinephrine
21) Two days after right hemicolectomy for a Dukes B caecal carcinoma , the
Patient complains of sharp right-sided chest pain and dyspnea. HisPaO2
Is 64mmHg ,his PaCo2 is 32mmHg. CVP is 26 cm water, and the blood pressure is
102/78mmHg. A pulmonary embolus is suspected,
The next step in management should be:
A) A ventilation- perfusion lung scan
B) A pulmonary arteriogram
C) Postrioanterior and lateral chest x-rays
D) Heparin sodium ,100 units/kg intravenously
E) Immediate duplex scanning of both lower extremities

22) The major cause of graft loss in heart and kidney allograft is:
A) acute rejection
B) hyperacute rejection
C) vascular thrombosis
D) chronic rejection
E) graft infection
23) All of the following are indicators of tumor aggressiveness and poor outcome for
papillary carcinoma of the thyroid gland EXCEPT:
A) age over 50 years
B) microscopic lymph node metstasis
C) tumor larger than 4 cm
D) poorly differentiated histological grade
E) invasion through capsule to adjacent tissues
24) A 40-year-old woman has extensive microcalcifications involving the
entire upper aspect of the right breast. Biopsy shows a commedo pattern of
intraductal carcinoma.
The most appropriate treatment is :
A) wide local excision
B) radiation therapy
C) wide local excision plus radiation therapy
D) right total mastectomy
E) right modified radical mastectomy
25) In the conventional ventilator management of acute adult respiratory distress
syndrome (ARDS) , arterial O2 saturation is maintained above 90% by all the
following EXCEPT :
F) increasing the ventilatory rate
G) the use of positive end-expiratory pressure (PEEP)
H) increasing mean airway pressure
I) increasing tidal volumes
J) increasing FiO2

26) Which of the following statements about patients with abdominal compartment
syndrome is NOT true ?
A) Abdominal pressure is usually measured indirectly through inferior vena cava
B) Multiple contributing factors are commonly responsible
C) The chief manifestations are reflected in central venous pressure , ventilatory
function, and oliguria
D) Decopression of the abdomen is required to resverse the syndrome
E) Aggressive hemodynamic monitoring and management is required when the
abdomen is opened
27) The most appropriate treatment for histologically malignant cystadenoma
phylloides is :
A) total mastectomy without axillary node dissection
B) total mastectomy with axillary node dissection
C) wide margin (3) cm excision of the lesion
D) post operative hormonal manipulation
E) postoperative adjuvant chemotherapy
28) Deep venous thrombosis resulting from upper extremity central venous lines:
A) should be treated with catheter removal, heparin therapy, and long term
anticoagulants
B) is best with urokinase through the catheter
C) is innocuous and self limiting, and best treated with catheter removal only
D) is best treated with low-dose warfarin (coumadin, 1 mg / day) , without catheter
removal
E) is best managed by single systemic dose of low molecular weight heparin daily
and continued catheter use
29) Emergency surgery is indicated for all of the following complications of ulcerative
colitis EXCEPT:
A) colonic dilatation greater than 12 cm (toxic mega colon )
B) free perforation
C) complete intestinal obstruction
D) intractable haemorrhage
E) abscess formation
30) All the following statements concerning carcinoma of the oesophagus are true
EXCEPT that:
A) it has a higher incidence in males than females
B) alcohol has been implicated as a precipitating factor
C) adenocarcinoma is the most common type at the cardio esophageal junction

D) it occurs more commonly in patients with corrosive oesophagitis

E) surgical excision is the only effective treatment

THE ANSWER KEY :

1- B
2- C
3- D
4- C
5- B
6- C
7- A
8- C
9- B
10- C
11- B
12- D
13- C
14- E
15- B

16- A
17- D
18- E
19- A
20- C
21- D
22- D
23- B
24- D
25- A
26- A
27- C
28- A
29- E
30- E

THYROID GLAND & NECK SWELLINGS

DIRECTIONS :
Choose the BEST appropriate answer for each of the following questions :

1) The best test to monitor adequacy of L-Thyroxine therapy is :

A) radioactive isotope thyroid scan
B) thyroglobulin blood level
C) total T4 blood level
D) free T3 blood level
E) blood level of TSH

2)

Hashimoto s thyroiditis :
A) is of viral origin
B) presents usually by nodular goiter
C) can be diagnosed by thyroid antibodies and fine needle aspiration of thyroid
D) is often premalignant
E) must be treated always by surgery

3) Thyrotoxicosis usually manifests by all of the following EXCEPT:

A) loss of weight inspite of good appetite
B) a recent preference to cold
C) palpitation
D) more common in male than in female
E) excitability of the patient
4)

Exophthalmos :
A)
B)
C)
D)
E)

is always present in thyrotoxicosis

is always bilateral
can cause diplopia in severe cases
decreases by hypothyroidism
is cured by surgery to the thyrotoxic goiter

5) Complications after thyroidectomy include all the following EXCEPT:

A) parathyroid insufficiency
B) recurrent laryngeal nerve paralysis
C) tracheomalacia
D) thyrotoxic crisis(storm) on operating on inadequitly prepared thyrotoxic patient
E) hypercalcemia

6)

Regardig Carcinoma of the thyroid gland:

A) common diffrenciated types are the papillary and the follicular carcinoma
B) medullary carcinoma of the thyroid is treated only by resection of the involved
lobe
C) papillary carcinoma never metastasize to cervical lymph nodes
D) anaplastic carcinoma is more common in the young age group

7) Tuberculous cervical lymphadenitis:

A)
B)
C)
D)
E)

is caused by bovine tuberculous bacillus rather than the human bacillus

usually occurs through the tonsil of the corresponding side
collar-stud abscess is never a feature of T. B adenitis
is treated always by surgery
biopsy is not necessary for diagnosis

8) Branchial cyst:
A) develops from the third branchial cleft
B) presence of cholesterol crystals in aspirated fluid from the cyst is pathognomonic
to it
C) should be treated with repeated aspiration
D) is not related to carotid vessles,hypoglossal and spinal accessory nerves
E) is never inflamed

9) Cystic hygroma:
A) develops as a sequestration of a portion of a jugular lymph sac
B) typically occupies the upper one third of the neck
C) occasionally may occur in cheek ,axilla and groin but exceptionally in tongue
and mediastinum
D) repeated aspiration is the only treatment
E) A and C are correct

10) Carotid body tumour:

A)
B)
C)
D)
E)

is chromffin paragranuloma
is usually bilateral
is called chemodactoma or potato tumour
is situated ot the bifurcation of the carotid artery
C and D are correct

11) Differential diagnosis of lateral sided neck swelling:

A)
B)
C)
D)
E)

cannot be diagnosed by fine needle asoiration

can be thyroglssal cyst
can be a lymphoma when having other characteristic features
cannot be diffrenciated into solid or cystic by ultrasound
is never a reactive lymphadenitis or secondary malignant disease

THE BREAST

1) The breast :
A) is a modified apocrine sweat gland
B) overlies the third to the sixth rib
C) is having usually more than 30 lacteferous ducts
D) is drained only by six groups of axillary lymph nodes
E) is having no attachment to skin
2) The commonest cause of bloody nipple discharge is :
A) mammary ductectasia
B) carcinoma of the breast
C) lactational mastitis
D) duct papilloma
E) fibrocystic disease of the breast
3) All of the following may be manifestations of breast carcinoma EXCEPT
A)
B)
C)
D)
E)

peau d orange of covering skin

no mass may be felt clinically
enlargement of the ipsilateral axillary lymph nodes
cervical spine metastasis
none of the above

4) Bacterial mastitis:
A)
B)
C)
D)
E)

never occurs in lactating mothers

is usually caused by streptococcu hemolyticus
is mostly caused by staphylococcus aureus
is treated only by incision and drainage
is the same as mastitis of puberty

5) Signs of malignancy on mammogram may include all of the following

EXCEPT :
A) mass lesions with poorly defined irregular margins
B) fine stipped soft tissue with periductal and not vascular
microcalcifications
C) thickening and retraction of the overlying skin
D) dysplastic ductal pattern
E) well circumscribed , homogenous,and often surrounded by a zone of
fatty tissue
6) Early detection of carcinoma of the breast includes all of the following
EXCEPT:
A) self-examination just after menstruation
B) screening mammography
C) frequent consultations among the high risk group patients
D) presence of fixed breast mass to chest wall with skin changes on
clinical examination
E) A, B, C, are correct

6) Regarding Paget s disease of the nipple :

A)
B)
C)
D)
E)

It is a benign condition
It is simply an eczematous lesion of the nipple
It is treated by excision of the nipple
It is usually diagnosed by biopsy of the suspected lesion
the areola and the surrounding skin are never involved

7) in a patient with fibroadenosis of the breast ;

A) cyst formation, adenosis, fibrosis,epitheliosis and papillomatosis are
invariably present
B) is premalignant
C) pregnancy usually produces relief
D) presentation may include pain, nipple discharge, and/ or breast lump
E) all of the above are usually characteristics

8) Regarding gynaecomastia :
A)
B)
C)
D)
E)

it is hypertrophy of female breast

it is hypertrophy of male breast
it may associate leprosy and liver failure
it may associate cimetidine, spironolactone, INH, or digitalis thrapy
B, C, and D are correct

9) Regarding modified radical mastectomy all are correct EXCEPT :

A)
B)
C)
D)
E)

it is indicated recently for T1N0M0

pectoralis major muscle is excised
axillary clearance is mandatory
adjuvant radiotherapy must be given for all patients post-operatively
the long thoracic nerve of Bell (nerve to serratous anterior) must be
prsesrved but nerve to latismus dorsi might be sacrified

10) Mammary duct ectasia is characterized by the following

EXCEPT :
A) is defiened as primary dilatation of major ducts of breast in middle
aged women
B) may present with nipple retraction and Peau d orange picture
C) is treated usually by simple mastectomy
D) anaerobic superinfection cmmmonly occurs in this recurrent
periductal plasma cell mastitis
E) is commonly pre-malignant

11)

Regarding carcinoma of the breast :

A)
B)
C)
D)
E)

invasive intraductal carcinoma is the commonest form

lobular carcinoma may present bilateral
clinical staging is always correct and definit
the medullary (anaplastic) type feels hard
A, and B, are correct