Surgery 6th year 11-5-2016

1- Zenker’s diverticulum is:

Select one:
a. a pulsion diverticulum
b. doesn’t cause fetor oris
c. treated with PPI
d. caused by penetrating injury to the neck
e. investigated by esophagoscopy

2- Which of the following statements is most accurate regarding carotid body tumours?

Select one:
a. It represents the most common paraganglioma in the head and neck
b. The majority of these lesions show functional secretion of catecholamines
c. The rate of malignancy is about 30%.
d. FNA biopsy is indicated to rule out malignancy
e. Radiation therapy is the most effective treatment of these lesions

3- Least sensitive in detecting a source of obscure Gi Bleed from small bowel

Select one:
a. Enteroclysis
b. Barium Meal Follow through
c. Angiography
d. Technitium Labelled Nuclear scan

4- All the followings are true of liver biopsy except

Select one:
a. 96% occur during the first 24 hours
b. Should not be done if INR 1.3
c. Approximately 2% of patients undergoing biopsy require hospitalization
d. The majority (60%) of complications occur within the first 2 hours,
e. Pain, Bleeding , haemobilia are the commonest complications
 5- Informed Consent the treating doctor should not

Select one:
a. Discuss the treatment plan & sensible alternatives
b. Do it in the morning before surgery
c. Mention any possible alternatives which might happen during surgery
d. Discuss the type of anaesthetic proposed
e. Discuss possible risks and complications

6- Which of the following statements about colonic pseudo–obstruction (Ogilvie's

syndrome ) is NOT true?

Select one:
a. Treatment with neostigmine is successful in over 80% of patients
b. Success after endoscopic decompression exceeds 60 %
c. Mortality with cecostomy approaches 20%
d. Operation is frequently required
e. Enemas are not advised

7- Which is the most common cause of Hemobilia

Select one:
a. Iatrogenic injury
b. Hepatic artery aneurysm
c. Blunt Trauma Abdomen
d. Cholelithiasis

8- Regarding Giant (Juvenile) Fibroadenoma of the Breast all are true except

Select one:
a. Increased risk of cancer by ten folds
b. Occurring in adolescent
c. Treated by simple excision
d. Frequent rapid growth to > 10 cm
e. More common in black females ,
 9- Which of the following structures is Not retroperitoneal?

Select one:
a. Adrenal glands
b. Ascending colon.
c. Duodenum (D1).
d. Seminal vesicles
e. Descending colon

10- A young adult is brought to the hospital 8 hours after a motor vehicle accident. He is
in shock and severe respiratory distress. His upper airway is clear. Neck veins are not
distended and the trachea is deviated to the right. Breath sounds are absent over the
left chest, and the percussion note over the left chest is dull. Breath sounds are
normal on the right side. What does the patient have?

Select one:
a. Tension pneumothorax
b. Obstructed main stem bronchus
c. Flail chest.
d. Massive hemothorax
e. Ruptured bronchus

11- A 17-year-old female patient presented with a diffuse goiter. US revealed an enlarged
homogeneous thyroid gland. TSH was 0.57 mIU/L. The most appropriate next step in
management, is:

Select one:
a. Anti-thyroid therapy
b. Thyroid scan
c. I131 ablation
d. Fine Needle Aspiration Biopsy
e. Reassurance and observation

12- Indications of drain insertion includes all the following except

Select one:
a. Abscess cavity
b. After trauma
c. Bowel anastomosis
d. Generalized peritonitis
e. Anticipated leakage

13- A 57-year-old man has a partial thyroidectomy. The histological report shows this to
be a medullary cell carcinoma of the thyroid. Which one of the following would be the
most useful further investigation?

Select one:
a. Urinary corticoids
b. Urinary calcium
c. Urinary gonadotrophins
d. Urinary catecholamines
e. Urinary phosphate

14- Hürthle cell carcinoma

Select one:
a. Sub type of papillary carcinoma
b. 7% of thyroid carcinoma , common in the 3rd decade
c. Treated by near total thyroidectomy
d. Found in De Quervan's thyroiditis
e. Also known as oncocytic carcinoma

15- One of the following tumors is related to Epstein-Barr virus:

Select one:
a. Warthin’s tumor
b. Naso-pharyngeal carcinoma
c. Pleomorphic adenoma
d. Papillary thyroid carcinoma
e. Thymoma

16- Pyogenic liver abscess , which of the following is not true

Select one:
a. The most common infecting agents are gram-negative bacteria; E coli is found in 2/3 of cases
b. Rt. Lobe affected twice as Lt. lobe
c. IV antibiotic therapy should be continued for at least 8 weeks
d. Percutaneous drainage is the treatment of choice in most patients
e. Surgical drainage either via the laparoscopic or open approach may become necessary if initial
therapies fail

17- Anal fissure

Select one:
a. All of them
b. May be caused by chronic diarrhea
c. Causes Sever tearing pain during defecation which soon disappears & Anterior fissures account
for 10% of those encountered in men
d. Anterior fissures account for 10% of those encountered in men
e. Causes Sever tearing pain during defecation which soon disappears

18- A 65-year-old diabetic male is undergoing an elective left inguinal hernia repair, with
regard to his risk of surgical site infection, which of the following is true?

Select one:
a. Routine use of vancomycin for antibiotic prophylaxis is recommended
b. Administration of most preoperative antibiotics should be within 1 hour of incision
c. If the procedure necessitates drain placement, studies have shown a decrease in infection rates if
antibiotics are continued until they are removed
d. A surgical site infection is defined as one occurring within 60 days of the procedure or within 6
months if an implant is left in place
e. Antibiotics are given postoperatively because there is documented proof that they decrease the
risk of surgical site infection after wound closure

19- 31-year-old man is brought to the emergency room following an automobile accident
in which his chest struck the steering wheel. Examination reveals stable vital signs,
but the patient exhibits multiple palpable rib fractures and paradoxical movement of
the right side of the chest. Chest x-ray shows no evidence of pneumothorax or
hemothorax. What is the recommended treatment?

Select one:
a. Stabilization of the chest wall with sandbags
b. Stabilization with towel clips
c. Antibiotics and close observation for signs of respiratory failure
d. Immediate operative stabilization
e. Tracheostomy, mechanical ventilation, and positive end-expiratory pressure

20- In acute pancreatitis Grey turner’s sign , or/and Cullen’s sign

Select one:
a. Associated with 40% mortality rate
b. Present in only 50 % of cases
c. Often appear within 12 hours after the onset of symptoms
d. More common in females
e. All of them

21- Most common site for cholangiocarcinoma is

Select one:
a. Intrahepatic bile ducts
b. Lower 1/3rd of CBD (Commmon Bile duct)
c. Hepatic duct bifurcation
d. Lower End of CBD (Common Bile Duct)

22- A 40-year-old woman presents with weight loss, palpitation and exophtalmos. On
physical exam the thyroid gland is diffusely enlarged. Blood tests reveal primary
hyperthyroidism (HT). Which of the following is NOT the treatment of HT?

Select one:
a. Steroids
b. Methimazole
c. Lugols iodine
d. Iodine131
e. Subtotal thyroidectomy

23- Which of the following is the most common cause of death in Crohn's disease
of small intestine

Select one:
a. Sepsis
b. Electrolyte Disorders
c. Malignancy
d. Thromboembolic Phenomenon
 24- Capillary refill time is elicited by:

Select one:
a. Pressing over skin for 5 seconds, normally return of perfusion by 5 seconds.
b. Pressing over skin for 10 seconds, normally return of perfusion by 5 seconds
c. Pressing over skin for 3 seconds, normally return of perfusion (pink) by 2 seconds.
d. Pressing over skin for 5 seconds, normally return of perfusion by 2 seconds.

25- Magnetic resonance imaging in breast cancer, all are true except

Select one:
a. It is the best imaging modality for the breasts of women with implants
b. Can not pick up most of clinically occult lesions
c. Assess the extent of DCIS
d. The standard of care when a lobular cancer is diagnosed
e. Useful as a screening tool in high-risk women of family history

26- A 14-year-old boy is in severe respiratory distress after a motor vehicle accident. He
was ejected from the vehicle and has major facial and head trauma. When managing
his airway, you should:

Select one:
a. Perform a needle cricothyrotomy rather than a formal surgical cricothyrotomy if you cannot
intubate or ventilate
b. Attempt blind nasotracheal intubation with an appropriate size endotrachea
c. Avoid succinylcholine because of the acute trauma
d. Extend the neck to improve visualization of the airway structures
e. Use an appropriately sized laryngeal mask airway to limit the likelihood of aspiration

27- Which of the following has least incidence of malignancy?

Select one:
a. Gastrinoma
b. Glucagonoma
c. VIPoma
d. Insulinoma
 28- All the following are Indications for therapeutic intervention of pancreatic pseudo cyst
except

Select one:
a. Infected pancreatic pseudocysts
b. Pseudo cysts Near the common bile duct
c. Symptomatic, pseudo cysts with nausea and vomiting
d. Asymptomatic pseudo cysts >5 cm, unchanged in size and morphology for more than 6 week
e. Haemorrhage into the cyst or GI bleeding

29- Claudication distance

Select one:
a. Non of them
b. Improves the rest pain after three months
c. May increase with exercise
d. Is the distance the patient can walk after first claudication start
e. Is around 500 meters

30- Fine-needle aspiration of bilateral upper cervical lymphadenopathy shows squamous

cell carcinoma. No primary lesion is found on clinical examination. The most likely
source is:

Select one:
a. tonsils
b. tongue
c. nasopharynx
d. esophagus
e. lungs

31- With regard to Hashimoto thyroiditis, which of the following is true?

Select one:
a. Thyroid microsomal antibodies are detected in the serum of patients
b. The incidence of hypothyroidism in Hashimoto thyroiditis is higher in women than in men
c. It is primarily treated surgically
d. The majority of patients are transiently hypothyroid but with time return to an euthyroid state
e. Radioactive iodine is useful in the treatment of Hashimoto thyroiditis

32- Overwhelming post splenectomy sepsis , all the following are true except

Select one:
a. ients undergoing splenectomy for hematologic or malignant indications have the greatest risk
b. More common in the pediatric population
c. Streptococcus pneumoniae is responsible for 50% of cases
d. Due to deficiency of T and B lymphocytes

33- Regarding varicose veins, which of the following is true?

Select one:
a. Permit blood flow in one direction only
b. Require investigation with ascending phlebograms
c. Non symptomatic varicosities warrant surgery
d. Tributary recurrence after saphenous surgery is treated with injection
sclerotherapy
e. Inheritance has not been established

34- A 32 year-old female thyrotoxic patient with failed medical treatment presented to you
for opinion. What is the best treatment for her at this stage?

Select one:
a. Radiotherapy is the best option
b. Subtotal thyroidectomy
c. Potassium iodide for one week followed by total thyroidectomy
d. Restart medical treatment because she is young
e. Lobectomy and ismuthectomy

35- What is the most common cause of lymphedema (non pitting edema):

Select one:
a. Leptospirosis.
b. Iatrogenic-radiotherapy
c. Iatrogenic-lymph node resection surgery
d. Chaga’s disease
e. Filariasis.
 36- The most common site of blood metastasis in breast carcinoma is

Select one:
a. Lungs
b. Thoracic vertebrae
c. Liver
d. Lumbar vertebrae
e. Neck of femur

37- Thyroglossal cyst

Select one:
a. Malignancy is rare but a known complication
b. In 75% of cases it is presented above the level of the hyoid bone
c. Moves with swallowing
d. Is the commonest benign neck lesion in children
e. Commonly it manifests as infected midline neck mass

38- All the following are Indications for Enteral feeding except

Select one:
a. Adaptive phase of short bowel syndrome
b. Malnourished patient expected to be unable to eat adequately for > 5-7 days
c. Adequately nourished patient expected to be unable to eat > 7-9 days
d. Small bowel fistula
e. Following severe trauma or burns

39- A 45-year-old woman undergoes cardiac catheterization through a right femoral

approach. Two months later, she complains of right lower extremity swelling and
notes the appearance of multiple varicosities. On examination, a bruit is heard over
the right groin. What is the most likely diagnosis?

Select one:
a. Superficial venous insufficiency
b. Pseudoaneurysm
c. Deep vein insufficiency
d. Femoral artery thrombosis
e. Arteriovenous (AV) fistula

40- The best method for obtaining tissue diagnosis in suspected lymphomas, is:

Select one:
a. Excisional biopsy
b. Core biopsy
c. Flow cytometry
d. Fine Needle Aspiration Biopsy
e. Incisional biopsy

41- Complications of hemorrhoidectomy, all are true except

Select one:
a. Anal stricture is the most common complication
b. Reactionary hemorrhage is an early complication
c. May include anal fissure and submucus abscess
d. Anal incontinence may occur
e. Retention of urine occurs in 10% to 50% of patients

42- Choice of surgical incision depends upon all the following except

Select one:
a. The organ of interest
b. Degree of obesity
c. Re-entry into the abdomen should not be done through the previous incision
d. The urgency of the operation
e. Anticipated procedure

43- A 21-year-old man presents to the emergency department with a stab wound to the
anterior midneck. On physical examination, it is difficult to determine if the plane of
platysma has been violated. However, subcutaneous emphysema is found on
palpation.What is the next management step?

Select one:
a. Esophagogram.
b. Arteriogram.
c. Esophagoscopy.
d. CT scan of the neck with oral and intravenous contrast
e. Surgical exploration.

44- Absolute indication of total parenteral nutrition is:

Select one:
a. Major trauma and burns
b. Abdominal sepsis
c. Acute pancreatitis
d. Moderate or severe malnutrition
e. Enterocutaneous fistulae

45- The commonest cause of post operative fever in the 5rd post operative day is:

Select one:
a. Lung collapse
b. Medications
c. Pulmonary embolism
d. Wound infection
e. Urinary tract infection

46- A 53-year-old female who underwent brain tumour resection 4 days ago developed left
lower extremity pain and swelling. A venous duplex scan was performed and revealed
left femoral and popliteal veins thrombosis. Which treatment is MOST
APPROPRIATE?

Select one:
a. Place an IVC filter
b. Order spiral CT scanning to rule out pulmonary embolism
c. Order emergency venography and if abnormal begin intravenous heparin administration
d. Use intermittent leg compression and graduated compression stockings
e. Begin ambulation and discontinue bed rest.

47- A 67-year-old man with dyspepsia undergoes endoscopy showing a 3-cm submucosal
mass in the body of the stomach. Biopsy identifies mucosa-associated lymphoid
tissue (MALT) and spiral-shaped, gram-negative rod bacteria.
The most appropriate therapy for this patient would be:

Select one:
a. chemotherapy
b. subtotal gastrectomy
c. oral antibiotics
d. total gastrectomy
e. local excision

48- Regarding Necrotizing fasciitis, all the following are true except

Select one:
a. There is disproportionate pain in relation to the clinical findings
b. Over 60% commence in abdominal wall
c. Results from a polymicrobial, synergistic infection
d. 80% have a history of previous trauma or infection
e. Is a surgical emergency

49- When part of the bowel wall is involved in a hernia sac, this is called:

Select one:
a. Sliding hernia
b. Spigelian hernia
c. Richter hernia
d. Littre hernia
e. Morgagni hernia

50- A 50 y old female patient taking oral hypoglycremic for her newly discovered Diabetes
millets is scheduled for excision of breast lump next morning , your instructions will
be

Select one:
a. Start 5% dextrose solution with 10 units heparin
b. Omit her morning dose of medication
c. Late surgery ,until fasting blood glucose is normal
d. Start heparin treatment until she starts walking
e. All of them

51- A 65-year-old woman requires an emergency surgery for a strangulated inguinal

hernia.Which of the following is correct regarding her condition?

Select one:
a. Indirect inguinal hernias are not found in female patients
b. Strangulation never results in bowel ischemia & gangrene requiring resection
c. The sac is formed by an unobliterated processus vaginalis
d. Such hernias do not contain small intestine
e. The hernia is direct rather than indirect

52- 30-year-old woman who is 20 weeks pregnant complaining of swelling and pain of her
right leg since 2 days and is now acutely painful to walk on. Clinically there is a
discrepancy of 7cm between the diameter of both calves. No other problems during
her pregnancy . The most likely diagnosis is :

Select one:
a. Deep vein thrombosis
b. Varicose veins
c. Fat embolus
d. Ischaemic limb.
e. Cellulitis.

53- Clinical picture of varicose veins may includes all the following except:

Select one:
a. Ankle swelling at the early hours of the day
b. Night claudication of the affected leg
c. Venous ulcer
d. Itching
e. Heaviness & fullness in legs

54- A 35-year old man is hospitalized for 2 weeks with acute pancreatitis. Five weeks
following discharge, he was readmitted with epigastric pain and fever. His pulse is 120
beats/min, temp 38.9C and his WBC is 24,000/mm3. CT abdomen demonstrates a 6x6
cm fluid collection in the body of the pancreas. The most appropriate management of
the fluid collection is:

Select one:
a. Antibiotics
b. Cystogastrostomy or Roux-en-y cyst-jejunostomy
c. CT guided aspiration and repeat CT in 2-3 days
d. Antibiotics and percutaneous catheter drainage
 55- An arterial blood gas (ABG) result is as follows:
PH 7.3, PCO230 mmHg, PO2 65 mmHg, HCO315
This result indicates:

Select one:
a. Respiratory acidosis
b. Metabolic acidosis
c. Metabolic alkalosis
d. Respiratory alkalosis

56- A 40 years lady presented to the breast clinic with 7cm hard mass in the upper outer
quadrant of the left breast with mobile unilateral axillary lymph nodes, Triple
assessment was diagnostic of invasive cancer. What is her TNM staging

Select one:
a. T4N2M0
b. T4N1MX
c. T3N2MX
d. T3N1MX
e. T2N2MX

57- Most common complication of ileostomy is

Select one:
a. Ileostomy flux (diarrhea)
b. Intestinal Obstruction
c. Stoma Necrosis
d. Stomal retraction

58- Plain x-ray for abdomen showing Double- bubble suggests?

Select one:
a. Duodenal atresia
b. Imperforate anus
c. Jejunal-ileal atresia
d. Pyloric stenosis
e. Meconium ileus
 59- One of the following tumors is neither chemo nor radiosensitive:

Select one:
a. follicular thyroid cancer
b. Ewing sarcoma
c. medullary thyroid cancer
d. papillary thyroid cancer
e. renal cell carcinoma

60- The most common presentation of Meckel’s diverticulum in adult is:

Select one:
a. Diverticulitis
b. GI bleeding
c. Litter’s hernia
d. Intussusception

61- Nutritional support of the burned patient is valuable because it?

Select one:
a. Increase hypermetabolic response
b. Increases incidence of gastric ileus
c. Prevents loss of lean body mass
d. Prevents atrophy of intestinal villi
e. Prevents immunodeficiency

62- Inguinal hernia, all the following are true except

Select one:
a. Indirect hernia usually is congenital
b. Direct hernia usually found in Hasselbach’s triangle
c. Accounts for 75% of abdominal wall hernias
d. Indirect hernia origin is medial to the inferior epigastric vessels
e. Most common hernia in men and women

63- All of the following can be helpful in treating the thyrotoxic crisis, except:

Select one:
a. IV fluids
b. beta blockers
c. aspirin
d. steroids

64- The differential diagnosis for right iliac fossa pain can be all EXCEPT:

Select one:
a. Tubo ovarian mass
b. Splenic vein thrombosis
c. Chron’s disease
d. Acute pyelonephritis
e. Empyema of the gallbladder

65- A 45 year-old male noted a swelling in the submandibular region. Biopsy reveals
malignancy and surgical excision is advised. The risks of this operation include which
of the following?

Select one:
a. Excessive sweating in the temporal region
b. Trismus
c. Deformity of the angle of the mouth
d. Submandibular duct calculus
e. Horner syndrome

66- Most common pediatric abdominal malignancy is:

Select one:
a. Teratoma
b. Wilms' tumor
c. Neuroblastoma
d. Ewing's sarcoma
e. Rhabdomyosarcoma

67- What is not true as differential diagnosis for appendicits in the elderly

Select one:
a. Adenocarcinoma appendix
b. Pyelonephritis
c. Colitis
d. Diverticulitis

68- A 45 year-old man complains of acute epigastric pain radiating to the back. He has
vomited repeatedly. O/E his abdomen is tender. His temperature is 38 C and his
amylase is 1856U/L.
What is the most likely diagnosis?

Select one:
a. Acute pancreatitis
b. Gastric ulcer
c. Acute cholecystitis
d. Cholangitis
e. Pancreatic cancer

69- Cholecystectomy is indicated for all the following except :

Select one:
a. 80 years old patient with asymptomatic stones
b. Patients with asymptomatic stones and congenital haemolytic anaemia
c. Diabetic patients with asymptomatic stones
d. Patients who have asymptomatic stones and undergoing bariatric surgery for morbid obesity
e. Symptomatic gall stones in children

70- Which of the following statements is TRUE regarding the femoral pulse:

Select one:
a. The femoral pulse usually is felt at the midpoint of the inguinal ligament
b. The femoral pulse is lateral to the deep ring.
c. A radio femoral delay may be expected in aortic stenosis
d. The femoral nerve is medial to the femoral pulse
e. The femoral pulse usually felt at the mid inguinal point

71- Which is the most serious complications due to central line catheter insertion for total
parenteral nutrition

Select one:
a. Cardiac arrhythmia
b. Sub clavian artery injury
c. Air embolism
d. Pneumo or haemothorax
e. Catheter related sepsis

72- Which of the following is not true regarding intractable peptic ulcer disease

Select one:
a. Intractability is defined as failure of the ulcer to heal after 8-12 weeks of medical therapy
b. Any ulcer which relapses after discontinuation of therapy once it has been completed
c. All are true
d. Ruling out gastrinoma is necessary

73- The first step following the diagnosis of rectal cancer should be:

Select one:
a. staging workup
b. measurement of CEA and CA 15.3
c. abdomino-perineal resection
d. Total Mesorectal Excision
e. neo-adjuvant chemoradiation

74- All the following are classic signs of basal skull fracture EXCEPT:

Select one:
a. Bilateral periorbital ecchymosis (Raccoon's eyes).
b. Ecchymosis over mastoid (Battle's sign).
c. Dilated and nonreactive pupil.
d. Palsy of the cranial nerve -VII.
e. Hemotympanum.

75- True about Ulcerative Colitis with malignancy

Select one:
a. Is related to disease activity
b. It has a better prognosis
c. Malignancy is more in anorectal ulcerative colitis
d. Is related to duration of ulcerative colitis
 76- Barrett’s oesophagus is a complication of one of the following conditions. Which
one?

Select one:
a. Helicobacter pylori associated gastritis
b. Chronic reflux associated oesophagitis
c. Achalasia of the oesophagus
d. Squamous carcinoma of the oesophagus
e. Oesophageal varices

77- Secondary survey in trauma management all are true except

Select one:
a. Perform a more thorough ‘head to toe’ examination
b. Review of patient’s history
c. Does not begin until, after the 1ry survey has been completed
d. Purpose of the secondary survey is to identify critical injuries
e. In severely injured patient, it may not commence until the patient has returned from the operating
theatre

78- A 70-year-old man has a basal cell carcinoma resected from his nose. What is the
most important prognostic indicator?

Select one:
a. Mitotic index in the tumour islands
b. Intensity of the lymphocytic infiltrate
c. Clinico-pathological type
d. Completeness of excision
e. Lymphovascular invasion

79- Thyroid incidentaloma, all are true except

Select one:
a. Discovered during routine investigations like US
b. Impalpable thyroid swellings
c. The vast majority of swellings <2.5cm can be safely managed expectantly
d. Needs intervention if the swelling becomes palpable
e. Are clinically unsuspected
 80- When a female complains of backache; it is essential to examine:

Select one:
a. Thyroid function
b. Ovaries
c. Stomach
d. Breasts
e. Blood gases

81- Anorectal abscesses all are true except

Select one:
a. E coli is the commonest organism in 60% of cases
b. Clinical picture varies according to the site of the abscess
c. Submucus abscess occur in 5% of cases
d. Ischiorectal abscess is the commonest
e. More common in males

82- Anorectal fistulae

Select one:
a. More common in females
b. Trans sphincteric type is the commonest
c. MRI is the gold standard investigation
d. May have more than one internal opening
e. May have more than one internal opening & MRI is the gold standard investigation

83- Which of the following is considered an indication for referral of the burned patient to
a burns center?

Select one:
a. Scald burn.
b. Partial-thickness burn greater than 7% of the total body surface area.
c. Age above 65 years regardless of the degree and the surface area involved
d. Electrical burn.
e. Burns involving the neck
 84- All of the following represent common etiology for intestinal ileus Except?

Select one:
a. Parasympathomimetics.
b. Pneumonia.
c. Sepsis.
d. Hypomagnesemia.
e. Myocardial infarction

85- A 50-year-old male presents with marked mid-abdominal pain. He had worsening
abdominal pain over the past month. The patient is a chronic alcoholic. Physical
examination reveals right upper and left upper quadrant pain with guarding. An
abdominal radiograph reveals no free air, but there is extensive peritoneal fluid with
dilated loops of small bowel. An abdominal CT scan reveals a 7 to 8 cm cystic mass in
the tail of the pancreas. What would be the most probable diagnosis to explain these
findings?

Select one:
a. Pancreatic adenocarcinoma
b. Metastatic carcinoma
c. Acute pancreatitis
d. Pancreatic pseudocyst
e. Islet cell adenoma

86- Acute gallstone pancreatitis is diagnosed in a 54-year-old man. Which of the following
is considered standard treatment if possible?

Select one:
a. Initial supportive therapy with cholecystectomy performed during the same admission
b. Initial supportive therapy with cholecystectomy performed in 6 to 8 weeks
c. Urgent ERCP and subsequent laparoscopic cholecystectomy
d. Initial supportive therapy with cholecystectomy performed only if symptoms recur
e. Urgent (within 24 hours) cholecystectomy and common bile duct exploration

87- All of the following factors are indication for surgery in enterocutaneous fistula
Except?

Select one:
a. Infection or inflammation at the fistula origin
b. Failure of spontaneous closure after 6 weeks of conservative treatment.
c. Radiation enteritis
d. Neoplasm at site of origin
e. Epithelialization of the fistula tract

88- Which of the following is the best, in assessing acute pancreatitis?

Select one:
a. CT Severity Index
b. Apache II score
c. Galsgow scale
d. Imri score
e. Ranson;s criteria

89- Which of the following studies is the most accurate method for evaluating regional
lymph node involvement in esophageal cancer?

Select one:
a. Bariom esophagogram
b. Poistron emission tomography (PET)
c. Magnetic resonance imaging (MRI)
d. Computed tomography (CT)
e. Endoscopic ultrasound

90- Most common extraintestinal manifestation of Crohn's disease of small intestine is.

Select one:
a. Iritis
b. Erythema Nodosum
c. Ureteral Obstruction
d. Ankylosing Spondylitis

91- Biliary colic all are true except

Select one:
a. Typically Rt U Q or epigastric pain
b. Is usually severe & may last for min or several hours
c. Present in 70 % of patients with gall stones
d. Frequently it pain starts during the night & wakes the patient
e. Is constant ,dull in nature

92- Most common site of gastric ulcer is

Select one:
a. Fundus of stomach
b. Antrum
c. Incisura
d. Greater curvature of stomach

93- Healing by second intention

Select one:
a. Heals slowly
b. Wound edges are opposed
c. More susceptible for infection
d. All of them
e. Leaves minimal scar

94- In patients with retroperitoneal fibrosis which of the following structures is involved
first ?

Select one:
a. Terminal ileum
b. Aorta
c. Duodenum
d. Vena cava
e. Ureter

95- Strangulated hernia all the following are true except,

Select one:
a. The hernia becomes irreducible
b. Risk of strangulation is highest in hernias which have a small neck of rigid tissue.
c. All of them
d. There is intermittent pain
e. Usually tender with local redness
 96- All of the following are salivary gland tumors, except:

Select one:
a. mucoepidermoid carcinoma
b. Warthin’s tumor
c. adenolymphoma
d. Dermatofibrosarcomaprotuberans
e. pleomorphic adenoma

97- A patient was found to have 630ml of bile in the drain s/p laparoscopic
cholecystectomy. The most appropriate step to do next, is:

Select one:
a. Total parenteral nutrition
b. Abdominal US
c. Endoscopic retrograde cholangiopancreatography (ERCP)
d. Percutaneous transhepatic cholangiography
e. Abdominal CT

98- All of the following are true about spigelian hernia EXCEPT:

Select one:
a. A palpable bulge on examination is uncommon
b. They occur through the aponeurotic layer between the rectus abdominis and semilunar line
c. A computed tomography scan is useful to establish the diagnosis
d. They tend to be small
e. The risk of incarceration is low

99- A 28-year-old motorcyclist sustained multiple fractures and a multifragmented

fracture of his left femoral shaft. He underwent reamed intramedullary nailing the next
day. Twenty-four hours postoperatively, he became increasingly confused and
hypoxaemic. The most likely diagnosis is:

Select one:
a. Systemic sepsis
b. Tension pneumothorax
c. Fat embolism
d. Unrecognised head injury
e. Hypovolaemia

100- The most common complication of splenectomy is

Select one:
a. Subphrenic abscess
b. Pancreatic Fistula
c. Lt. Basal atelectasis
d. Wound infection
e. Gastric dilatation

101- Advantages of early surgery in burns include all the following except

Select one:
a. Improved nitrogen balance
b. Better healing is obtained by the elimination of the necrotic tissue,
c. Decrease in the anabolic phase of muscular metabolism by early movement
d. Reduction in the risk of sepsis
e. Shortening of the period of hospitalization