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2- A 40-year-old female has a 4-cm hemangioma

in the right lobe of the liver on computed


tomography scan. She is asymptomatic.
Appropriate action should be:
(a) ne-needle biopsy
(b) arrangement for elective resection
(c) no further action
(d) angiographic embolization

Answer C

3- Regarding an amebic liver abscess:


(a) surgical drainage is usually required
(b) negative stool testing for amebiasis rules out the
disease
(c) it should be drained percutaneously under computed tomography guidance

(d) it is treated with metronidazole

ANSWER D

4- A single organism is usually the causative


agent in:
(a) pelvic inammatory disease
(b) perforated diverticulitis
(c) acute cholecystitis
(d) primary peritonitis
(e) diabetic foot infections

Answer D

9- Signs and symptoms of hemolytic transfusion


reactions include
a. Hypothermia
b. Hypertension
c. Polyuria
d. Abnormal bleeding
e. Hypesthesia at the transfusion site

AnswerD

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

AnswerE

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.

Answer C
12- Which of the following statements about the
diagnosis of acute calculous cholecystitis is true?
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.

Answer: A

13- Which statement about acute acalculous


cholecystitis is correct?
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

Answer E

14- Which of the following statements about


laparoscopic cholecystectomy are correct?
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.

Answer: A

15- A 15-year-old female presents with RUQ


abdominal pain. Workup reveals a choledochal
cyst. 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.

AnswerC

16- An 85-year-old man is brought to the hospital


with a 2-day history of nausea and vomiting. He
has 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 smallbowel 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.

AnswerA
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.

AnswerB

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%.

Answer A
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

Answer B
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)

Answer B
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.
Answer D
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.
Answer A
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

Answer B

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

Answer A

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.

Answer A

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

Answer A

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

Answer D

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

answer A

An otherwise well 13-year-old boy is -28


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, highriding 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

Answer E

29- Acute scrotum


a. Torsion testis should be operated within 12
hour of presentation
b.Epidedimoorchitis pain increase by
testicular elevation
c. If in doubt scrotum should be explored
d.Doppler ultrasound has no role in diagnosis
e.None of the above
Answer C

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.

AnswerB

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.

Answer B

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

Answer E
A 51-year-old male experiences the sudden .33
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
Varices .a
Barrett esophagus
Candidiasis

.b

.c

Reflux esophagitis

.d

Squamous cell carcinoma .e

Ansewr A

A 61-year-old male has had ascites for the past -34


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 alphafetoprotein (AFP) level. Which of the following
?hepatic lesions is he most likely to have
Hepatocellular carcinoma .a
Massive hepatocyte necrosis
Marked steatosis

.b

.c

Wilson disease .d
Autoimmune hepatitis .e
Answer A
A 76-year-old man presents with weight loss, -35
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

Answer A
36-Acute pancreatitis
a.Serum calcium start to rise after 48 hours
b.Hypoglycaemia is bad prognostic factor
c.Age is an important prognostic factor
d.Serum amylase is more specific than
serum lipase
e.Severe pancreatitis compromise around
40% of cases

Answer C
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

Answer B

A 23-year-old male presents to the -38


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
7 .a
9 .b

8 .c
11 .d
12 .e
Answer E
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

Answer C
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 nonbile stained fluid


e. B&C only.

Answer A
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

Answer E
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 .

Answer E

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
Answer E
.: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


Answer C

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


a.Pallor

b.Clammy skin

c.bradycardia

d.Tachycardia

e.Hypotension

Answer C

: 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

Answer A

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

Answer E
8.The development of thrombocytopenia and arterial thrombosis
with heparin requires:
a.
b.
c.
d.
e.
Answer E

Continuation of heparin and platelet transfusion


Continuation of heparin and thrombolysis
Doubling the heparin dosage
Changing the route of heparin administration
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%)
Answer C
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
Answer E

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 .

Answer E

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 .

Answer E

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

Answer D

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 .

Answer E

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
.

Answer D

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 .

Answer C

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
well-differentiated HCC(hepatocellular carcinoma).
e.focal nodular hyperplasia lesions(FNH) lesions usually rupture
spontaneously and have significant risk of malignant transformation .

Answer E

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 .

Answer C

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 .

Answer D

24.All occur as a complication of acute pancreatitis except:


a.panreatic fluid collection
b.colonic necrosis
c.coagulopathy
d.hypercalcemia
e.respiratory failure

Answer C

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 .

Answer E

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.

Answer E

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

Answer E

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.

Answer D

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.

Answer D