DEPARTMENT MCQS

1.GENERAL
BREAST P2
THYROID P5
GENERAL (PART 2) P9
VASCULAR P19
SALIVARY & SKIN P27
PLASTIC P33
2.GIT
Esophagus & stomach P50
BILIARY & PERITONEUM P55
LIVER & SPLEEN P57
pancreas & appendix P61
INTESTINE P67
Anal canal, review subjects & pediatrics P80
HERNIA & TESTIS P85
 GENERAL
BREAST
361. After intraductal papilloma, unilateral bloody nipple discharge from
one duct orifice is most commonly caused by which of the following
pathologic
conditions? page 396 edition 2017
A. Paget's disease of the nipple.
B. Intraductal carcinoma.
C. Inflammatory carcinoma.
D. Subareolar mastitis.

362. Which of the following conditions is associated with increased risk of

breast cancer? page 399 edition 2017
A. Fibrocystic mastopathy.
B. Severe hyperplasia.
C. Atypical hyperplasia.
D. Papillomatosis.

363. Which of the following are the most important and clinically useful risk
factors for breast cancer? page 399 edition 2017
A. Fibrocystic disease, age, and gender.
B. Cysts, family history in immediate relatives, and gender.
C. Age, gender, and family history in immediate relatives.
D. Obesity, nulliparity, and alcohol use.

366. Which of the following breast lesions are noninvasive malignancies?

Page 400 edition 2017
A. Intraductal carcinoma of the comedo type.
B. Tubular carcinoma and mucinous carcinoma.
C. Infiltrating ductal carcinoma and lobular carcinoma.
D. Medullary carcinoma, including atypical medullary lesions
367. Which of the following treatments should never be recommended to a
patient with purely intraductal carcinoma? page 407 edition 2017
A. Modified radical mastectomy.
B. Lumpectomy to clear surgical margins, followed by observation.
C. Incisional biopsy with an involved margin, followed by radiation.
D. Excisional biopsy to clear margins, followed by radiation

368. The proper treatment for lobular carcinoma in situ (LCIS) includes which
of the following components? 403 page edition 2017
A. Close follow-up.
B. Radiation after excision.
C. Mirror-image biopsy of the opposite breast.
D. Mastectomy and regional node dissection

369. A 21-year-old woman presents with an asymptomatic breast mass.

Which of the following statement(s) is/are true concerning her diagnosis
and treatment? page 405edition 2017
A. Mammography will play an important role in diagnosing the lesion
B. Ultrasonography is often useful in the differential diagnosis of this lesion
C. The mass should always be excised
D. The lesion should be considered pre-malignant

371. Which of the following statement(s) is/are associated with

gynecomastia? page 411 edition 2017
A. If the disease is unilateral, it is unlikely drug-related
B. The standard surgical treatment is subcutaneous mastectomy
C. The presence of gynecomastia is often associated with the subsequent development of
breast cancer
D. A formal endocrine evaluation is indicated in most patients with gynecomastia

21.The most common breast mass in the female is : 392

A. breast carcinoma
B. duct papilloma
C. fibroadenoma
D. breast cyst
22.Pathological difference between the 2 types of fibroadenosis is / are :
A. fatty element .
B. fibrous element.
C. glandular elements .
D. All of the above.

23.The organism responsible for breast abscess is : 391

A. staph.aurus
B. E.Coli
C. streptococci
D. pneumococci

24.Management of lactational breast abscess is / are : 391

A. incision& drainage .
B. Anti inflammatory.
C. Antibiotics.
D. All of the above.

25.Management of chronic breast abscess is / are : 393

A. excision .
B. Anti inflammatory .
C. antibiotics.
D. All of the above .

26.Nipple discharge may be : 396

A. Milky
B. bloody
C. creamy
D. all of the above

27.Management of ANDI : 395

A. Surgical
B. hormonal
C. medical
D. Non of the above

28.congenital breast diseases include : 390

A. polythelia
B. athelia
C. polymastia
D. All of the above

29.breast cysts include : 395

A. lymphatic cyst
B. blood cyst
C. galactocele
D. all of the above

30.Screening breast program test is : 407

A. Mammography
B. Biopsy
C. MRI
D. All of the above

THYROID
1.regarding thyroid gland which statement is true?
a. Is supplied by the branch of internal carotid artery
b..The isthmus lies in front of the 2 nd to 5th tracheal ring
c.Moves with deglutition because its connected to the hyoid bone
d.Is developed from a diverticulam from the floor of the mouth
answer =d

2- medullary carcinoma of thyroid arises from ?

a- parafollicular cells
b- cells lining the acini
c- capsule of thyroid
d- stroma of the gland
answer=a

3-characteristic eye sign in Grave’s ?

a- exopthalmos
b- ptosis
c- optic neuropathy
d- myopathy
answer : a

4- pick out the correct statements .

a- the external laryngeal nerve runs close to the superior thyroid artery .
b- the recurrent laryngeal nerve runs close to the middle thyroid vein .
c- the external laryngeal nerve runs close to the inferior thyroid artery .
d- the recurrent laryngeal nerve runs close to the superior thyroid artery .
answer : a

5- a post-thyroidectomy patient develops signs and symptoms of tetany. The

management is ?
a- I.V calcium gluconate
b- Bicarbonate
c- Calcitonin
d- Vitamin D
Answer : a .

6- all of the following are early life threatening complications of thyroid operation
except ?
a- tracheomalacia and collapse of larynx
b- wound hematoma with compression of the trachea
c- hypocalcemia
d- thyroid storm
answer : c .

7- treatment of choice for medullary carcinoma of thyroid is ?

a- total thyroidectomy
b- partial thyroidectomy
c- iodine 131 ablation
d- hemithyroidectomy
answer : a

8- in toxic goiter pregnancy patient which is true?

a- thiouracil is contraindicated
b- surgery is contraindicated
c- radioiodine is contraindicated
d- none
answer: c

9- thyrocervical trunk arises from which artery ?

a-Aorta
b-Right carotid
c- subclavian artery
d-brachiocephalic vein
answer=c

10-least malignant thyroid cancer ?

a- papillary
f- medullary
g- anaplastic
h- follicular
answer =a

539. treatment of FNAC of 1cm solitary thyroid nodule that yielded the f cell
tumor?
A. total thyroidectomy
B. hemithyroidectomy of the affected lobe
C. palliative radiotherapy
D. total thyroidectomy with modified radical neck dissection

540. a patient diagmosed as having MEN 2A having thyroid nodules,

elevated
metanephrines , hypercalcemia and an adrenal mass?Whats the initial
surgical
treatment ?
A. parathyroidectomy
B. total thyroidectomy
C. adrenalectomy
D. follow up

541. treatmrnt of a 3 cm follicular tyroid carcinoma with palpable cervical

lymphadenopathy?
A. total thuroidectomy
B. hemithyroidectomy of the affected lobe
C. total thyroidectomy with modified radical neck dissection
D. total thyroidetomy and central lymph nodes dissection

542. which of the following is not true for Hashimoto thyroiditis?

A. being an autoimmune disorder caused by CD4 cells with specificity to thyroid antigens
B. common clinical presentation as hypothyroidism
C. surgery is a must for cure
D. can progress to lymphoma

543. the treatment of choice wathin’s tumor of the salivary glands ?

A. enucleation
B. surgical excision
C. external radiation
D. palliative therapy

544. regarding head and neck tumors, the following are true except
A. persistent unilateral otalgia may denote an underlying occult malignancy
B. recent hoarsness may be an alarming sign and needs evaluation
C. a recently discovered lump mandates incisional biopsy as a first step in evaluation
D. multiple lumps shall raise suspicion to lymphoma and hence CT neck,chest and
abdomen is
needed

545. Regardingludwig’sangina,all are true except

A. infection of cellular tissues around submandibular salivary glands
B. it’s treated mainly medically with antibiotics with a minimal role of surgical
intervention
C. it’s a life threateming condition that spreads tapidely
D. it can be predisposed by dental infection

546. the best modality to biopsy a suspicios lymph node is

A. FNAC
B. true cut biopsy
C. incisional biopsy
D. excisional biopsy

547. the most sensitive and commonly used method to localize a

parathyroid
adenoma is
A. technetium 99m sestamibi scan
B. neck US
C. CT
D. PET CT scan

548. surgical exploration for primary hyperparathyroidism revealed

enlargement
of the four glands ,whats the most appropriate action?
A. closure of the wound and ollow up the patient
B. total(4 gland) parathyroidectomy and life long calcium supplements
C. excision of the largest gland
D. subtotal (3 1l2 glands) parathyroidectomy

GENERAL
206. All of the following are tests of primary haemostasis except:
A. Platelets count.
B. Bone marrow aspiration.
C?
C. Prothrombin time.
D. Bleeding time.
(B), page 50, Ninth edition

207. Laboratory findings in DIC are all of the following except:

A. Prolonged PT and PTT.
B. High level of fibrinogen.
C. Thrombocytopenia.
D. Raised level of fibrin degradation products.
(B), page 47, Ninth edition
208. A patient with spinal shock may have all of the following except:
A. Hypotension.
B. Tachycardia.
C. Warm dry skin.
D. Sensory loss in both lower limbs.
(B), page 60, Ninth edition

209. Patients with septic shock may have:

A. Bradycardia
B. Hypertension.
C. Polyuria.
D. Cold clammy skin
(D), page 64, Ninth edition

210. Patients with septic shock may have:

A. Low PO2
B. Low PCO2 Except
C. Low HCO3 .
D. High pH.
(D), page 63, Ninth edition

211. Patients in hypovolaemic shock have all of the following except:

A. Flushed.
B. Hypotension.
C. Tachycardia.
D. Oliguria.
(A), page 54, Ninth edition

213. In endocrinal shock due to Addison’s crisis, patients may have all of the
following except:
A. Hypernatraemia.
B. Tachycardia.
C. hypercalaemia
D. Hypotension.
(A), page 384, Ninth edition

214. Management of shock due to Addison’s crisis is all of the following except:
A. Essentially prophylactic.
B. IV hydrocortisone.
C. Saline infusion.
D. Blood Transfusion.
(D), page 384, Ninth edition

215. In haemophilia, all of the following are true except:

A. Caused by deficiency of factor VIII or X.
B. Patients are liable to recurrent haemarthrosis.
C. NSAIDs and aspirin must be avoided.
D. Patients must receive infusion of factor concentrate before any surgery.
(A), page 45, Ninth edition

111. Hypokalemia:
A. Can cause paralytic ileus.
B. May cause muscle paralysis.
C. May cause cardiovascular events early on ECG.
D. Is often the result of renal and gastrointestinal losses?
E. Is never seen in drowning.

278. A trauma victim is hypotensive. Any of the following can be the cause,
except:
A. Extradural hematoma
B. Lacerations of the spleen
C. Pelvic fracture
D. Liver Lacerations.
E. Bilateral fracture of the femur shafts.
295. The oral cavity commensals do not cause harm to the oral cavity due to all of the
followings except :
A. Regular desquamation of the oral mucosa.
B. Rapid replacement of surface cells.
C. Weakness of these commensals.
D. Saliva that washes the oral cavity continuously.
E. The mild antibiotic activity of saliva.
The answer is C
Page 275 the introduction paragraph (7th edition)

296. Which of the followings is considered a predisposing factor of stomatitis? :

A. Anemia.
B. Vitamin B2 deficiency.
C. Immunodeficiency.
D. Autoimmune diseases.
E. All of the above.
The answer is E
Page 275 Predisposing factors (7th edition)

297. Which of these drugs is used for treatment of monilial stomatitis? :

A. Clindamycin.
B. Ampicillin.
C. Metronidazole.
D. Amphotericin-B lozenges.
E. Amoxicillin.
The answer is D
Page 275 Monilial stomatitis (7th edition)

298. Aphthous stomatitis is characterized by:

A. Painless small nodular swelling.
B. Painful ulcers that heal normally within 10 – 14 days.
C. Small vesicles due to Herpes simplex infection.
D. Fungal infection due to prolonged usage of antibiotics.
E. Non of the above.
The answer is B
Page 275 stomatitis (7th edition)

299. Which of the followings is incorrect regarding Ranula:

A. It is a retention cyst arising from a sublingual salivary gland.
B. The wall is composed of a thin fibrous capsule lined by macrophages.
C. It forms an opaque bluish cystic swelling.
D. It shows prominent blood vessels running over its surface.
E. Marsupilisation is the treatment of choice.
The answer is D
Page 275 Ranula (7th edition)

300. Which of the followings is not a congenital cause of macroglossia:

A. Acromegaly.
B. Cavernous haemangioma.
C. Congenital A-V fistula.
D. Lymphangioma.
E. Neurofibromatosis.
The answer is A
Page 276 Macroglossia (7th edition)

301. All the followings are precancerous lesions of the tongue except:300
A. Syphilis.
B. Candida fungus infection.
C. Dental ulcer.
D. Leukoplakia.
E. Erythroplakia.

302. Regarding the TNM staging system of tongue carcinoma, all of the followings are
correct except:302
A. T0 is referred to carcinoma in situ.
B. T4 means involvement of the tongue base.
C. N0 states for no lymph node metastasis.
D. N2 means ipsilateral or contralateral lymph nodes < 6 cm.
E. M1 is distant metastasis.

303. Which of the following modalities is a treatment of the tongue cancer? :302
A. Surgical excision with safety margin.
B. Radiotherapy.
C. Adjuvant chemotherapy.
D. a & b only.
E. a, b & c.

335. Which is false about Dupuytren's contracture? 222

A. There is contracture of the flexor tendons of the thumb and index finger
B. There is contracture of the palmar fascia
C. The palmar fascia is thickened
D. May be associated with liver cirrhosis

309.Adamantinoma of the mandible commonly complicated by all of the following

EXCEPT
A. Pathological fracture of the mandible.
B. Ulceration and infection.
C. Recurrence after inappropriate surgery.
D. Turns into carcinoma from epithelial cells.
344. In cases affected by alveolar abscess: 305
A. No risk of spread to cavernous sinus.
B. It is usually caused by blood borne route.
C. Can be complicated by spread to maxillary antrum.
D. It is a self-limited infection.

348. Regarding carcinoma of the maxilla: 311

A. Blood borne metastasis is rare.
B. Females are affected more than males.
C. Usually presented before adulthood.
D. Lymphtic spread commonly to supraclvicular lymph nodes.

349. Regarding management of carcinoma of the maxilla: 312

A. Radiotherapy is recommended in cases with bone invasion.
B. Radical block neck dissection is indicated only if cervical lymph nodes are involved.
C. Combination of radiotherapy and surgery is not recommended in advanced cases.
D. In absence of lymph node involvement, prophylactic cervical lymph node dissection
should be done.

383. In the management of pulp space infection page 235 edition 2017
A. Rapid drainage without waiting for fluctuation
B. Do not perform surgical drainage until pointing of an abscess is seen
C. Oral antibiotics are enough
D. Topical antibiotics are enough

385. Simple ganglions: page 240 edition 2017

A. Are commonly found on the flexor surface of the wrist
B. Simple aspiration provides definitive treatment
C. If left for many years that may turn malignant
D. Recurrence is common even after surgical excision

386. Long flexor tendons of the hand page 231 edition 2017
A. Flexor digitorumsuperficialis tendon is inserted at the base of the proximal phalanx
B. Flexor digitorumprofundus tendon splits into two parts near its insertion
C. Flexor digitorumprofundus is responsible for flexion of the distal interphalangeal joint
D. Flexor digitorumsuperficialis is partly supplied by the ulnar nerve
387. Ulnar nerve in the hand supplies all the following muscles except (page 254 edition
2017)
A. Hypothenar muscles
B. Interossei
C. Adductor pollicis
D. 1st and 2ndlumbricals

388. Median nerve in the hand supplies page 252 edition 2017
A. Sensation to the little finger
B. Opponenspollicis
C. All the lumbrical muscles
D. Adductor pollicis longus

389. Carpal tunnel syndrome Page 221 edition 2017

A. Caused by entrapment of the median nerve at the cubital fossa
B. Caused by entrapment of the median nerve under the flexor retinaculum
C. Caused by entrapment of the ulnar nerve at Guyon’s canal
D. Caused by entrapment of the ulnar nerve between the heads of flexor carpi ulnaris
muscle

390. Ingrowing nails page 236 edition 2017

A. More commonly affects finger nails than toe nails
B. Conservative treatment has no role in its management
C. Surgery involves excision of the entire nail from its bed
D. Caused by incorrect trimming of nails

391. Flexor digitorumprofundus muscle page 231 edition 2017

A. Is inserted at the base of the distal phalanx
B. Is inserted at the base of the middle phalanx
C. Is supplied entirely by the median nerve
D. Is supplied entirely by the ulnar nerve

392. A 65 years old woman, presented with a nodule in the tongue for the last 6
months. On examination it was found to be 1cm of size, situated on the anterior 2/3 on
the left side of tongue. It was ptovisionally diagnosed as malignancy, which group of
lymph nodes would be involved first? Page 301 edition 2017
A. Left inferior deep cervical
B. Right inferior deep cervical
C. Left superior deep cervical
D. Right superior deep cervical
E. Submental

393. Patient Unable to taste sugar in the anterior part of the tongue which nerve is
involved? Page 247 edition 2017
A. Vagus Nerve
B. Accessory Nerve
C. Maxillary Nerve
D. Glossopharyngeal nerve
E. Facial Nerve

394. Tongue Deviation to the right side on protrusion, which of the following nerve is
involved?
A. Vagus Nerve
B. Right Hypoglossal Nerve
C. Left hypoglossal Nerve
D. Lingual
E. Glossopharyngeal

395. Which of the following Nerves passes through foramen Ovale

A. Abducent
B. Trochlear
C. Occulomotor
D. Mandibular
E. Maxillary

396. Facial Paralysis and loss of sensation of anterior 2/3 of the tongue at which level of
facial nerve is damaged. Page 247 edition 2017
A. Facial Nerve Nucleus
B. Parotid Gland
C. Styloid Foramen
D. Internal Acoustic Meatus
E. Facial Canal

397. On protrusion, Tongue deviates, Which nerve is involved?

A. Facial Nerve
B. Hypoglossal Nerve
C. Abducent Nerve
D. Facial colliculus
E. Trigeminal Nerve

518. Causes of hyperkalemia

A. Inadequate intake
B. Hyperaldosterinism
C. Diarrhoea
D. Renal failure

519. Causes of hypokalemia

A. Blood transfusion
B. Diarrhoea
C. Hyperglycemia
D. Renal failure

520. Which of the following is a symptom of hypokalemia

A. Ileus
B. Paralysis
C. Cardiac arrest
D. All of the above

521. Which of the following is a cause for respiratory acidosis

A. Narcotics
B. Renal failure
C. Severe diarrhoea
D. Ketoacidosis

522. All of the following are crystalloids except

A. Lactated Ringer’s
B. Albumin 5%
C. 0.9 % Sodium chloride
D. Glucose 5 %

523. Causes of poor wound healing are all of the following except:
A. Old age
B. Smoking
C. Salicylates therapy
D. Steroids therapy

524. which of the following is a character of a hypertrophic scar

A. Respect wound margins
B. More common in dark race
C. Regression is rare
D. Neck and chest are common sites

525. Which of the following syndromes is associated with poor wound healing
A. Ehlers-Danlos Syndrome
B. Down Syndrome
C. MEN syndrome
D. All of the above

526. All of the following are causes for metabolic acidosis except
A. Loss of bicarbonate
B. Narcotics
C. GI losses
D. Renal failure

527. Which of the following is one of the ECG changes in hyperkalemia

A. Narrow QRS complex
B. Flattened P wave
C. Shortened PR interval
D. Atrial fibrillation

528. Which of the following are advantages of minimal access surgery ?

A. Decrease in wound size
B. Decreased postoperative pain
C. Shorter operating time
D. Improved vision
E. Reduced operting theatre costs

529. Which of the following are limitations of minimal access surgery ?

A. Technically more demanding
B. Loss of tactile feedback
C. Extraction of large specimens Except
D. Poor vision
E. Difficulty with hemostasis

570. Which of the following statements about the coagulation cascade is/are
true?
A. The intrinsic pathway of coagulation is the predominant pathway in vivo for
hemostasis and coagulation.
B. The intrinsic pathway beginning with the activation of factor XII is the
predominant in vivo mechanism for activation of the coagulation cascade.
C. Deficiencies of factor VIII and IX cause highly significant coagulation
abnormalities.
D. Deficiencies of factor XII cause severe clinical bleeding syndromes.

VASCULAR & LYMPH

41. Regions where atherosclerotic lesions are Iikely to occur include
all of the following EXCEPT the: 161
A. infrarenal aorta
B. superficial femoral artery
C. Proximal internal carotid artery
D. supraceliac aorta
E. Proximal coronary arteries

42. Characteristics of arterial claudication include all of the following

EXCEPT 161
A. it causes profound fatigue in the leg, hip, and thigh
B. it is regularly produced by exercise
C. it is relieved by rest in several minutes
D. it occurs after sitting for long periods of time
E. extremity pulses are diminished

43. All of the following complications may com monly follow lower
extremity angiography ExCEPT
A. renal failure
B. dehydration
C. arterial occlusion
D. pseudoaneurysm formation
E. intracerebral hemorrhage
44. Foot ulcers secondary to arterial insufficiency are successfully
treated by all of the following techniques EXCEPT
A. debridement of devitalized tissue
B. elevation of the affected extremity
C. antibiotic administration
D. bed rest
E. avoidance of pressure on the heel

45. Aortoiliac vascular reconstruction is indicated by all of the

following clinical presentations ExCEPT
A. impotence related to bilateral internal iliac artery occlusion
B. rest pain in the foot
C. complete occlusion of the external iliac artery
D. gangrene of the toes
E. emboli in the leg originating from the distal aorta

46. The commonest cause of death following arterial reconstruction

of the lower extremity is
A. graft infection
B. cerebrovascular accident
C. myocardial infarction
D. systemic sepsis secondary to skin necrosis
E. none of the above

47. True statements concerning acute arterial occlusion include all of

the following ExCEPT 151
A. it is usually caused by emboli that originate it is a cardiac source
B. it results in severe pain
C. it requires immediate heparinization
D. a fasciotomy is always required following res-toration of blood flow
E. catheter embolectomy is the most commonly used surgical procedure

48. A 65-year-old woman with a long history of atrial fibrillation

presents to the emergency room with a history of sudden onset of
severe abdominal pain. Following the onset of pain, she vomited once
and had a large bowel movement. No flatus has been passed since that
time. Physical examination reveals a mildly distended abdomen, which
is diffusely tender, although peritoneal signs are ab- sent. Ten years
ago, she underwent an abdominal hysterectomy. The most likely
diagnosis in this patient would be 626
A. acute cholecystitis
B. perforated duodenal ulcer
C. acute diverticulitis
D. acute embolic mesenteric ischemia
E. small bowel obstruction secondary to adhesions

49. Characteristics of a patient with renovascular hypertension

include all of the following EXCEPT
A. sudden onset of severe hypertension in a patient younger than 35
B. inability to control blood pressure despite multiple drug therapy
C. sudden worsening of hypertension in a patient who had been well
controlled
D. presence of flank bruits
E. elevated white blood cell count in the urine

50. All of the following statements concerning abdominal aortic

aneurysm are true EXCEPT 177
A. most abdominal aortic aneurysms are caused by atherosclerosis
B. most abdominal aortic aneurysms begin just above the level of the renal
arteries
C. abdominal aortic aneurysms are most frequently discovered on physical
examination
D. a CT scan gives details about the relationship of the aneurysm to renal and
visceral vessels and demonstrates accompanying venous anomalies
angiography should be carried

1) An obese patient develops acute oedematous lower limb following a Pelvic

surgery. Deep vein thrombosis is suspected . The most useful investigation in this
case would be
a) Doppler imaging
b) Fibrinogen uptake
c) Venography
d) Plethysmography

2) Which of these is not a risk factor for thromboembolism –

a)Myocardial infarction
b)Hypertension
c)Estrogen therapy
d)Superficial thrombophlebitis

3) Most common cause of death in patients with Burger’s disease is

a) Gangrena
b) Pulmonary embolism
c) Myocardial infarction
d) Carcinoma lung
4) Which of the following best responds to sympathectomy
a) Burger’s disease
b) Hyperhydrosis
c) Raynaud’s disease
d) Acrocyanosis

5) Most common cause of aneurysm of abdominal aorta is

a) Trauma
b) Atherosclerosis
c) Syphilis
d) Cystic medial necrosis

6) The most common complication of an aortic aneurysm size 8 cm is

a) Rupture
b) Intramural thrombosis
c) Embolism
d) Calcification

7) White leg is due to

a)Femoral vein thrombosis and lymphatic obstruction
b)Deep femoral vein thrombosis
c)Lymphatic obstruction only
d)None of the above

8) All of the following are seen in deep vein thrombosis except –

a) Pain
b) Discolouration
c) Swelling
d) Claudication

9) The following is the commonest site for venous ulcer-

a)Instep of foot
b)Lower 1/3 leg and ankle
c)Lower 2/3 of leg
d)middle 1/3 of leg

10) The most important perforator of the Lower limb is between

a)Long saphenous and posterior tibial vein
b)Short saphenous and posterior tibial vein
c)Short saphenous and popliteal vein
d)Long saphenous and femoral vein

11) Best method for diagnosis of Deep vein thromvosis is –

a)Doppler examination
b)Plethysmography
c)Contrast phlebography
d)1131 Fibrinogen studies

12) Commonest complication varicose vein stripping is

a) Thrombo embolism
b) Hemorrhage
c) Ecchymosis
d) Infection

13) Investigation of choice for diagnosis of deep vein thrombosis

a) Venogram
b) Doppler
c) Isotope scan
d) Homans sign

14) Pulsating varicose vein in ayoung adult is due to

a)Arteriovenous fistula (
b)Sapheno femoral incompetence
c)Deep vein thrombosis
d)Abdominal tumour

15) Which is not used in treatment of Superficial venous thrombosis

a)Immediate anticoagulation
b)Rest and elevation
c)Analgesics
d)Treat assosiated malignancy

16) Most common complication of varicose vein stripping is

a) Infection
b) Haemorrhage
c) Ecchymosis
d) Thrombo embolism

17) An operated case of varicose veins has a recurrence rate of

a) About 10%
b) About 25%
c) About 50%
d) Over 60%

18) What is acceptable in the management of femoral vein thrombosis

a)Bed rest and spiral elastic bandages
b)A venogram
c)Thrombectomy
d)Embolectomy
e)A mobin udin umbrella inserted into the vein

19) Operations for varicose veins are best accomplished by – (

a)Stripping
b)Multiple subcutaneos ligatures
c)Subfascial ligatures
d)Division and ligation at the superficial venous system

20) A 60-years old male has been operated for carcinoma of caecum and right
hemicolectomy has been done. On the fourth post – oprative day, the patient
develops fever and pain in the legs. The most important clinical entity one should
look for is –
a)Urinary tract infection
b)Intravenous line infection
c)Chest infection
d)Deep vein thrombosis

21) All of following may be predisposing factors for deep vein thrombosis except
a) Oral contrceptives
b) Nephrotic syndrome
c) Sickle cell anemia
d) Thrombocytosis

22) Which of the following test is used to detect perforator incompetence in

varicose-
a) Trendelenberg test
b) Fegan’s test- (localise)
c) Morissey’s test
d) Homan’s test

Which ONE of the following statements is correct? Leg ulceration is most

commonly caused by...
• A.Trauma
• B.Chronic venous insufficiency
• C.Bacterial infections
• D.Vasculitis
• E.Peripheral artery occlusive disease

430. Which of the following is a hard sign of arterial injury:

A. Absent pulse
B. Pallor
C. Active bleeding
D. All of the above

431. Branham sign for AV shunt means:

A. Increased blood pressure with compression of arterial inflow
B. Decreased blood pressure with compression of arterial inflow
C. Increased heart rate with compression of arterial inflow
D. Decreased heart rate with compression of arterial inflow

432. All of the following are complication of AV shunt creation except:

A. Steal syndrome
B. Venous hypertension
C. Renal osteodystrophy
D. Hyperdynamic heart failure

433. Which of the following is a complication of popliteal vein injury:

A. Superficial thrombophlebitis
B. Primary varicose veins
C. Deep venous thrombosis
D. None of the above

434. Inadverent intra-arterial drug injection can cause acute limb

ischemia by:
A. Subintimal drug injection
B. Distal micro-particle embolization
C. Intimal damage by irritant drug
D. All of the above

435. Complications following repair of delayed arterial injury include all

of the following except:
A. Compartment syndrome
B. Hyponatremia
C. Myoglobinuria
D. Hyperkalemia

436. Possible surgical findings for arterial injuries with supra-condylar

fracture humerus are:
A. Arterial spasm
B. Contusion thrombosis
C. Arterial transection
D. All of the above

437. Which of the following is a surgical option to treat arterial contusion

thrombosis injury:
A. Localized endarterctomy
B. Saphenous vein interposition graft
C. Patch angioplasty
D. All of the above

438. Clinical sequaele for vascular injury following shot gun to femoral
triangle include all of the following except:
A. Lymphorrehea
B. Lost adduction of the thigh
C. Pulseless limb
D. Arterio-venous fistula

232. Malignant cell in Hodgkin's lymphoma is:

A. Lymphocytes
B. Histocytes
C. Reed Sternberg cell
D. Reticulum cells

233. Chronic lymphedema predispose to all except:

A. Lymphangiosarcoma
B. Marjolin’s ulcer
C. Recurrent infections
D. Thickening of the skin

234. The most common form of lymphedema is:

A. Congenital lymphedema
B. Lymphedema precox
C. Lymphedema tarda
D. Secondary lymphedema

235. The most effective therapy for lymphedema is

A. Compression therapy
B. Surgical excision of the involved area
C. Surgical by pass of the obstructed lymphatics
D. Combined excision of the affected areas withby pass of the obstructed
lymphatics

236. Cocket&Dodd's operation is for

A. Sapheno femoral flush ligation
B. Subfascial ligation
C. DVT
D. Diabetic foot infection

237. Which is true regarding Trendlenburg operation

A. Stripping of the great saphenous vein
B. Flush ligation of the great saphenous vein
C. Flush ligation of the short saphenous vein
D. Ligations of the perforators

238. Gold standard diagnostic test in varicose veins is:

A. Photoplethysmography
B. Duplex imaging
C. U/S
D. Radio-labeled fibrinogen study

239. Injection sclerotherapy for VV is by using:

A. Phenol
B. Absolute alcohol
C. 70% alcohol
D. Ethanolamine oleate

240. The most important perforator of the lower limb is between:

A. Long saphenous & posterior tibial vein
B. Long saphenous& femoral vein
C. Short saphenous & posterior tibial vein
D. Short saphenous & popliteal vein

241. Which is true regarding venous ulcers?

A. Constitutes about 40% of chronic leg ulcers
B. Topical antibiotics should be used
C. Surgery is the treatment of choice
D. Compression is the first line of ttt
 SALIVARY & SKIN
385. Simple ganglions: page 240 edition 2017
A. Are commonly found on the flexor surface of the wrist
B. Simple aspiration provides definitive treatment
C. If left for many years that may turn malignant
D. Recurrence is common even after surgical excision

398. The Parotid Duct opens at the Level of ? page 313 edition 2017
A. Mandibular second molar
B. Mandibular second premolar
C. Upper second incisor
D. Upper second Molar
E. Upper second premolar

399. Which of the following is not true about Stenson Duct? Page 313 edition
2017
A. It arises from the deep lobe of parotid gland
B. It runs over masseter muscle
C. Opens opposite to the second molar tooth
D. It pierces buccinators muscle
E. It arises from the superior lobe of parotid gland

401. Due to multiple salivary calculi (stones) in the submandibular duct, the
submandibular
gland of a 45-year-old individual was surgically removed. What major artery directly
related to
the gland was of special concern to the surgeon? P291 Seventh edition
A. lingual
B. superior thyroid
C. facial
D. ascending pharyngeal
E. maxillary

• Which of the following bursae is adventitious bursa?

A. The prepatellar bursa
B. The olecranon bursa
C. The infrapatellar bursa
D. The bunion
• the treatment of choice warthin’s tumor of the salivary glands ?
A. enucleation
B. surgical excision
C. external radiation
D. palliative therapy

• Regarding ludwig’s angina,all are true except

A. infection of cellular tissues around submandibular salivary glands
B. it’s treated mainly medically with antibiotics with a minimal role of surgical
intervention
C. it’s a life threateming condition that spreads tapidely
D. it can be predisposed by dental infection

1. All major salivary glands arise from

a.Ectoderm
b.Endoderm
c.Mesoderm
d.All three embryonal tissue

2. Benign tumors of superfical lobe of parotid gland takes a very long time to project
outwards because
a.The external surface of the parotid gland is covered by tough parotid fascia
b.Slow rate of tumor growth
c.The styloid process stops the progression of tumor
d. Ramus of the mandible stops tumor progression

3. During sleep salivary secretion is maintained by

a.Sublingual gland only
b.Submandibular gland only
c.Parotid gland only
d.Submandibular and sublingual salivary glands

4. Acini of parotid glands are formed by

a.Mucinous cells
b.Serous cells
c.Seromucinous cells
d.Cloudy cells

5. The parotid gland is divided into superficial and deep portions by:
a.Cartilagenous portion of external auditory canal
b.Facial nerve branches
c.Mandible
d.Internal maxillary artery
6. Sublingual salivary gland is situated
a.Under the palatopharyngeous muscle
b.Posterior to the mylohyoid muscle
c.Below the mylohyoid muscle
d.Above the mylohyoid

7. Technitium pertechnetate scans are useful in the diagnosis of

a.Monomorphic adenoma
b.Warthin's tumor
c.Sialadinitis
d.Pleomorphic adenoma

8. The antibiotic that is actively secreted in the saliva is

a.Streptomycin
b.Clindamycin
c.Cefixime
d.Ampicillin

9. During sleep the parotid gland is known to secrete about

a.75% of basal salivary secretion
b.100% of basal salivary secretion
c.Parotid secretion ceases during sleep
d.50% of basal salivary secretion

10. Multiple cystic lesions inside both the parotid glands in a patient should alert the
clinician for a possible diagnosis of
a.Measles infection
b.Mumps
c.HIV infection
d.Malignancy

11. Warthin's tumor is commonly seen in

a.Submandibular salivary gland
b.Accessory salivary gland
c.Sublingual salivary gland
d.Parotid gland

12. Parotid duct is known as

a.Finely's duct
b.Stenson's duct
c.Wharton's duct
d.Stylle's duct

13. In parotid surgeries the most reliable way of identifying the facial nerve is
a.By tracing it from the mastoid cavity
b.By removing the styloid process
c.Searching at the tympanomastoid sulcus
d.By using the tragal pointer

14. In Bulimia parotid glands are

a.Shrunken in size
b.Nodular
c.Enlarged
d.Cystic in nature

15. Perineural invasion is common in

a.Acinous cell carcinoma
b.Adenoid cystic carcinoma
c.Pleomorphic adenoma
d.Mucoepidermoid carcinoma

16. Calcium content of saliva is low in

a.Submandibular salivary gland secretions
b.Parotid secretions
c.Accessory salivary gland secretions
d.Sublingual salivary gland secretions

17. Submandibular salivary gland swelling is differentiated from submandibular

lymphadenitis clinically by
a.Bidigital palpation
b.Presence of transillumination in submandibular salivary gland
c.Movement during swallowing
d.Palpation from behind the patient

18. Parotid calculi are diagnosed by

a.Xray skull lateral view
b.CT scan
c.Plain radiograph of parotid gland
d.Plain radiograph occlusal view

19. Sialolithiasis is common in

a.Sublingual salivary gland
b.Submandibular salivary gland
c.Accessory salivary gland
d.Parotid gland

20. Superfical parotidectomy is contraindicated in patients with sialectasis because

a.There is high risk of infection
b.There is a high risk of fistula formation
c.There is risk of facial palsy
d.There is high risk of dry mouth

21. Daily average volume of saliva produced in a human being is

a. 3 - 5 litres
b. 3 - 4 litres
c. 8 - 10 litres
d. 1 - 1.5 litres

22. In submandibular salivary gland surgery, the branch of facial nerve at risk is
a.Lower zygomatic nerve
b.Upper zygomatic nerve
c.Marginal mandibular nerve
d.Buccal nerve

23. In patients with diabetes mellitus the parotid gland is

a.Shrunken
b.Cystic in nature
c.Fibrosed
d.Enlarged

24. Chemical stimulation maximises the secretion of

a.Accessory salivary gland
b.Sublingual gland
c.Parotid gland
d.Submandibular gland

25. Parotid gland secretions constitute about

a.1/5 th of salivary secretion
b.90% of salivary secretion
c.3/4 th of salivary secretion
d.100% of salivary secretion

26. Parotid gland is a

a.Mucoserous salivary gland
b.Serous salivary gland
c.Protenaceous salivary gland
d.Mucinous salivary gland

27. Salivary fistula is commonly originates from

a.Sublingual salivary glands
b.Submandibular salivary glands
c.Accessory salivary glands
d.Parotid glands
28. The first salivary gland to develop is
a.Submandibular salivary gland
b.Accessory salivary glands
c.Sublingual salivary gland
d.Parotid gland

29. Parotid gland swellings are very painful because

a.The parotid gland is closely related to the external auditory canal
b.The parotid glands suppurate easily
c.There is no outer layer of fascia covering the parotid gland
d.The outer layer (parotid fascia) is inelastic and firm

30. Anesthesia over parotid gland area is caused by injury to

a.Buccal nerve
b.Orbital nerve
c.Greater auricular nerve
d.Marginal mandibular nerve

31. The parotid has constant relationship with

a.Upper zygomatic nerve
b.Marginal mandibular nerve
c. Lower zygomatic nerve
d.Buccal branch of facial nerve

32. Adenoid cystic carcinoma is known to commonly involve

a.Parotid gland
b.Minor salivary glands
c.Submandibular salivary gland
d.Sublingual salivary gland

33. Submandibular salivary gland is separated into superficial and deep portions by
a.Buccinator muscle
b.Mylohyoid muscle
c.Digastric muscle
d.Sternomastoid muscle

34. Tumors arising from deep lobe of parotid gland extending across the
parapharyngeal space is covered on their anterior aspect by
a.Stretched out fibers of middle constrictor muscle
b.Stretched out fibers of lateral pterygoid muscle
c.Stretched out fibers of medial pterygoid muscle
d.Stretched out fibers of superior constrictor muscles

35. Sialadenosis commonly involves

a.Accessory salivary gland
b.Submandibular gland
c.Parotid gland
d.Sublingual gland

36. Oncocytoma almost exclusively occurs in

a.Parotid salivary gland
b.Sublingual salivary gland
c.Submandibular salivary gland
d.Accessory salivary gland

37. In superficial parotidectomy

a.Only a part of superfical lobe is removed
b.The superfical lobe is removed completely
c.The deep lobe is removed completely
d.The whole of superfical lobe and part of deep lobe of the gland is removed

38. Warthin's tumor is known to develop from

a.Acinar cells
b.Myoepithelial cells
c.Lymphoid tissue within parotid gland
d.Basal cells

39. Food stimulates secretion of

a.Sublingual salivary gland
b.Parotid gland
c.Accessory salivary glands
d.Submandibular salivary gland

40. Carbohydrate-protein substances corresponding to the blood group antigens are

not secreted by
a.Accessory salivary glands
b.Sublingual salivary glands
c.Submandibular salivary glands
d.Parotid glands

PLASTIC
1) Which of the following applies to branchial cysts?
a) They usually present in the neonatal period.
b) They present in the midline of the neck.
c) Infection of the cyst leads to an increase in size, facilitating surgical
excision.
d) They are found at the junction of the upper and middle third of
 the sternomastoid muscle.

2) Branchial cyst is best differentiated from cold abscess by:

a) Fluctuant
b) Contains cholesterol crystal
c) Trans-illumination
d) Contain Sulphur granules

3) Regarding cystic hygroma the following is true:

a) Exclusively occur in the neck
b) Occur since birth or early infancy
c) Does not trans-illuminate
d) Completely compressible

4) In thoracic outlet syndrome the following is true, except:

a) Affection of the upper trunk of brachial plexus is the most common
b) Arterial involvement might lead to aneurysm formation and distal ischemia
c) More common in females
d) May be associated with Raynaud's phenomenon especially on Exposure to
cold weather

5) Which of the following is true of a cystic hygroma?

a) They present during puberty.
b) They are brilliantly translucent.
c) They are firm on palpation.
d) Cosmetic concern is the only indication for treatment.
e) They undergo a predictable growth pattern

6) · A thyroglossal duct cyst is a remnant of which structure?

a) The thyro cervical trunk.
b) The cervical sinus.
c) The track of the thymus through the neck into the mediastinum.
d) The fourth branchial pouch.
e) The track of the thyroid from the tongue base to the neck

7) Ludwig's angina describes which condition?

a) Submandibular swelling with inflammatory edema of floor of mouth
b) Spreading cellulitis of the lower neck with dark discoloration in patches
related to necrosis.
c) Gingivo stomatitis.
d) Retrosternal chest pain related to swallowing.
e) Cellulitis secondary to zoster lesions in the cervical dermatom
8) Which of the following is WRONG for cystic hygroma?
a) It is a type of cavernous haemangioma.
b) It can be the earliest swelling of the neck that appears in life.
c) It can obstruct labour.
d) It is brilliantly translucent

9) A 33-year-old female noted a discharge from a sinus in overlying skin below

right angle of the mandible. She recalls previous episodes of fullness
&
mild
pain in this region over the past several years. What is the most likely cause?
a) Thyroglossal duct cyst. d) Myeloma.
b) Branchial cyst. e) Trauma to theneck
c) Teratoma.

10) A 9-year-old boy complains of a swelling on the left side of his neck in the
supraclavicular region. The swelling is translucent; a diagnosis of cystic
hygroma is established. What is true of cystic hygroma?
a) It arises from sweat glands in the neck.
b) It is usuallyan anterior midline structure.
c) It may occur in the mediastinum.
d) Its lesions are usually easy to enucleate.
e) It is premalignant

11) The classic complete neck dissection for palpable adenopathy in the posterior
triangle of the neck includes removal of which of the following?
a) The transverse process,C2-C4 d) The trapezius.
b) The spinal accessory nerve. e) The vagus.
c) Both thyroid lobes.

12) Cystic hygromas are the product of:

a) Failure of lymphatic sacs to develop connections with the rest of the
lymphatic system
b) Hypoplasia of drainage channels connecting the lymphatic systems of
extremities to the main primordial lymphatic system of the torso.
c) Neoplastic growth of normal lymphatic structures.
d) Inflammation of lymphatic ducts in the neck

13) In children, the most common malignant tumor of the neck is:
a) Lymphoma. d) Angioblastoma.
b) Neuroblastoma. e) Rhabdomyosarcoma
c) Thyroid carcinoma.

14) The complications of tracheostomy include the following, except:

a) Surgical emphysema b) Secondary
 haemorrhage e) Tracheal fistula
c) Tracheomalacia.
d)Laryngeal stenosis

15) In radical block dissection of malignant cervical glands, the following structures
are preserved except the:
a) Carotid arteries
b) Internal jugular vein.
c) Vagus, phrenic and hypoglossal nerves.
d) Sympathetic trunk.
e) Scalene muscles

16) Radical block dissection, it is necessary to preserve the:

a) Sternomastoid muscle
b) Submandibular salivary gland.
c) Jugular vein.
d) Carotid arteries.
e) Omohyoid muscle
17) Concerning carotid body tumor, true statements do not include that it:
a) Arises at the carotid bifurcation.
b) Occurs in middle life.
c) Presents as a hard nodular swelling (potato tumor).
d) Grows slowly but may become malignant.
.e) Is always symptomless.

18) The following statements about scalene syndrome are correct except that it:
a) Results from compression of the lower trunk of the brachial
plexus and the subclavian artery in the scalene triangle
b) Is particularly common in females.
c) May be associated with a cervical rib.
d) May not be associated with any abnormalities in the plain X-ray.
·.e) There are usually neural, arterial and venous symptoms
◘ Comment: Venous manifestations are rare in the form of DVT

19) The most frequent symptom of the scalene syndrome is:

a) Pain along the ulnar nerve distribution
b) Parasthesia over the medial border of the forearm and hand.
c) Weakness and atrophy of the small muscles of the hand.
· d) Claudication with exercise.
e) Gangrene of the digits.

20) Among the following statements about branchial cyst, it is untrue that it:
a) Is a congenital cyst presenting at birth
 b) Forms a globular swelling below the angle of the jaw.
c) Is opaque on transillumination.
d) Is lined with squamous epithelium.
e) Contains mucoid fluid rich in cholesterol crystals

21) Among the following statements about congenital branchial fistula, the following
incorrect one is that it:
a) Commonly results from rupture of a branchial cyst.
b) Usually opens externally at the lower third of the anterior border of the
Sternomastoid muscle.
c) May be bilateral.
d) Discharges clear mucoid fluid.
e) Requires removal of the whole track by the "step-ladder" operation

22) Adson's test for the scalene syndrome is positive when:

a) Pallor of the hand is noted.
b) The radial pulse disappears.
c) Numbness and tingling of the fingers occur.
d) All of the above.
e) None of the above

23) True statements about Ludwig's angina do not include that it:
a) Is a virulent cellulitis of the floor of the mouth.
b) Usually results from infection with staphylococci.
c) Causes marked swelling in the submandibular region with severe
edema of the tongue.
d) May cause suffocation.
e) May require urgent operation

24) Which one among the following statements about cystic hygroma is
untrue?
a) Affects infants and young children
b) Occurs chiefly in the neck, AXILLA AND groin.
c) Presents as a large soft fluctuant translucent swelling.
d) Is localized to the subcutaneous tissues.
e) Spontaneous cure is recorded in rare cases

25) Regarding brachial cysts, which of the following is true?

a) Usually appears in old age.
b) It protrudes from the posterior border of the sternomastoid.
c) The swelling is fixed.
d)I It is related to the upper third of the sternomastoid.
t
e) It can be treated by CT guided aspiration.
26) Which of these swellings is in the posterior triangle of the neck?
a) Submental lymph node d) Carotid body tumor
b) Pharyngeal pouch e) Thyroglossal cyst
c) Laryngocele

27) Regarding tracheostomy the following are true, except

a) Indicated if prolonged mechanical ventilation is required
b)I is the ideal airway in upper air way obstruction during emergency
t
sitting
c) The tracheal is opened longitudinally
d) If using a cuffed tracheostomy tube might lead to T.O.F if prolonged

28) Regarding thoracic outlet syndrome, select the right answer:

a) The lower trunk of the brachial plexus is the main structure to be
compressed.
b) More commonly the subclavian artery is compressed causing
upper limb ischemia.
c) There is tingling and numbness in the lateral aspect of the hand and
forearm.
d) Examination always reveals a palpable cervical rib.
e) Surgery is never required.

29) Which of the following muscles contributes to the muscular triangle of

the neck?
a) Posterior belly of c) inferior belly of omohyoid
digastric d) Superior belly of omohyoid
b) Trapezium

30) Which of the following muscle will need to be divided in cases of

pharyngeal diverticulum?
a) Cricothyroid
b) Cricopharyngeus
c) Middle constrictor
d) Thyro pharyngeus

31) A40-year old male came complaining of a neck swelling of 10 months.

On examination, it was in the carotid triangle, 5 cm in size, pulsating,
with a lobulated surface, moves from side to side but not vertically, and
pulsations were transmitted. The best management is:
a) Thyroid scan
b) Ciprofloxacin 750 mg twice daily for 5days.
c) Trans-arterial embolization.
d) Excision.
32) An 18-year-old patient was brought by his mother complaining of a
swellingin the neck. On examination the swelling was protruding from
beneath the anterior border of the upper third of the sternomastoid, it
was 4 cm in diameter, smooth, mobile and fluctuant. Aspiration revealed
cholesterol crystals. The best management is;
a) Division of the sternomastoid
b) Ultrasound-guided percutaneous aspiration
c) Incision and drainage
d) Excision

33) Which of the following swellings will be present in the midline of the
neck?
a) Carotid body tumor
b) Lower deep cervical lymph nodes
c) Cystic hygroma
d) Submental lymph nodes

34) Which of these conditions is associated with loss of laryngeal click?

a) Pharyngeal diverticulum
b) Post-cricoid carcinoma·
c) Supraglottic laryngeal carcinoma
d) Pancoast tumor

35) The inferior belly of omohyoid is present in this triangle:

a) Carotid c) Posterior
b) Digastric d) Muscular

36) About carotid body tumor, all the following are true except :
a) Chemodectoma
b) Presents by mass in carotid triangle
c) Mass is pulsatile
d) Majority are benign
e) Biopsy needed

37) Baby was born with Lt Posterior Triangle swelling, the swelling is
subcutaneous, partially compressed and translucent, clinical diagnosis is:
a) Sternomastoid tumor. d) Dermoid cyst.
b) Branchial cyst. e) Cystic hygroma.
c) Hemangioma

38) About branchial cyst and fistula, all are true except:
a) Is observed in neonates.
b) Is partially covered by sternomastoid muscle. Main DD to branchial
cyst is cold abscess.
 c) Contains cholesterol crystals.
d) Before excision.
39) About thoracic outlet syndrome, all the following are true, except:
a) In all cases cervical rib present.
b) Commonest manifestation caused by compression on lower trunk of
brachial plexus.
c) May be hypoesthesia of medial side of forearm.
d) One cause of Reynaud's phenomenon
e) There may be chronic heaviness and edema of upper limb.

40) A65-year female complains from regurgitation of undigested food, few

hours after meals, she also has progressive difficulty in swallowing and
swelling in the left side of the neck what is your diagnosis:
a) Achalasia of the cardia
b) Diffuse esophagus spasm
c) Pharyngeal pouch
d) Foreign body ingestion

41) Which the following muscles share in the boundaries of the posterior
triangle?
a) Anterior belly of digastric
b) Posterior belly of digastric
c) Inferior belly of omohyoid
d) Trapezius

42) An18-year-old girl came complaining of a neck sinus. She had a swelling at the
same site that became painful and red then ruptured spontaneously 2 years ago
leaving this opening. On examination there was a crescentic opening in the
midline of the neck a little towards the Lt Side. The best management is:
a)Injection with ethanolamine oleate.
b) Antibiotics.
c) Excision up to the base of the tongue.
d) Excision up to pharynx

43) All of the following statements are correct, except:

a) The branchial cyst usually appears after the age of 20years
b) The branchial fistula is never congenital
c) The cyst is susceptible to infection because its wall is surrounded by
lymphatic tissue
d) Branchial cyst appears in the carotid triangle

44) A Cirsoid aneurysm is:

a) An abnormal aortic aneurysm.
 b) Is named after Sir William Cirsoid.
c) A femoral aneurysm.
d) An arteriovenous fistula
e) An abscess

45) Regarding simple ganglion, select the right answer:

a) It is a cyst that contains clear serous fluid.
b) Results from protrusion of synovial membrane.
c) It is usually soft in consistency.
d) Only treatment is by aspiration.
e) Has no relation to tendons

46) Concerning basal-cell carcinoma, the false statement is that they are:
a) Much less common than Squamous-cell carcinoma
b) Very rare in oriental and black races
c) Particularly common in tropical regions
d) Characterized histologically by dark-staining solid masses of cells arising from
the
basal layer of the epidermis
e) Commonest on the exposed skin of blonde subjects and outdoor workers

47) Sebaceous cyst is characterized by the following except that it:

a) Is due to obstruction of a sebaceous gland.
b) Is lined by stratified Squamous epithelium.
c) Contains a yellow greasy material known as sebum.
d) May occur on the palms and soles.
e) Is always anchored to the overlying skin at the punctum of the obstructed
gland.

48) Which of the following descriptions of ulcer edges denote malignancy?

a) Sloping.
b) Overhanging.
c) Everted
d) Punched out
e) Rolled

49) Which of the followings is not a type of malignant melanoma?

a) Superficial spreading.
 b) Nodular.
c) Giant congenital pigmented naevus
d) Lentigo malignant
e) Acral lentiginous

50) Which of the following statements are false?

a) The vast majority of malignant melanoma form in pre-existing naevi.
b) Change in color, shape, size and surface in a naevus should be looked upon with
suspicion.
c) Incision biopsy should be done in all suspicious lesions.
d) Superficial spreading melanoma is the most common type.
e) Exposure to ultraviolet rays is a major cause of malignant melanoma

51) A farmer presented with a 2 cm firm rounded reddish nodule with a central crust
that enlarged rapidly over the past few weeks:
a) Basal cell carcinoma.
b) Squamous cell carcinoma.
c) Keratoacanthoma.
d) Melanoma

52) Broder's grading of malignant tumors depends on:

a) The degree of spread of tumor in the lymphatics.
b) The degree of differentiation shown by component cells as viewed through the
microscope.
c) A clinical grading for carcinoma of the breast.
d) An operative grading for carcinoma of the colon

53) In melanoma, which of the following factors is most predictive of the patient's long-
term prognosis?
a) Circumference of lesion.
b) Darkness of lesion.
c) Depth of lesion.
d) Sharpness of border between lesion and adjacent skin

54) Regarding basal cell carcinoma, select the correct answer:

a) Most of the lesions occur in the face below a line drawn from the lobule of the ear
to the angle of the mouth.
 b) The lesion usually starts as a small nodule covered by thin epidermis.
c) It is usually radioresistant
d) The prognosis after surgery is usually poor.
e) Excision of draining lymph nodes is necessary

55) A 45-year-old male developed an ulcerative nodule lesion of 1.5 cm near the right
ala of the nodes for 6 months duration, your diagnosis is:
a) Squamous cell carcinoma.
b) Actinic keratosis
c) Sebaceous cyst.
d) basal cell carcinoma

56) In malignant Melanoma, all are true, except:

a) Is associated with ultraviolet radiation
b) Albinism and Xerodermia pigmentosa are predisposing factors
c) Occurs more commonly western world
d) Huntchinson’s melanotic freckle is the benign premalignant

57) Regarding basal cell carcinoma, the following is true:

a) It may show flat ulcer (leveled with skin)
b) Metastasize to regional L.N.
c) May present with satellite deposits
d) Best treated with tropical 5-FU.

58) Which of the following statements is WRONG regarding skin squamous cell
carcinoma?
a) Xerodermia pigmentosa is one of the predisposing factors.
b) Microscopic appearance is characterized by the presence of cell nests
c) Blood spread is early.
d) Surgery is indicated for a Marjolin’s ulcer.
e) It has everted edges.

59) The most common precancerous lesion in the skin is:

a) Xerodermia pigmentosa.
b) Seborrhoeic keratosis.
c) Actinic (senile) keratosis.
d) Chronic radiodermatitis.
e) Bowen's disease.
60) Regarding hemangiomas, select the right answer:
a) Strawberry angioma is a cavernous hemangioma.
b) Strawberry angioma usually disappears spontaneously.
c) Port wine stain is usually raised above the skin surface.
d) Port wine stain is easily treated by surgical excision.
e) It is not a hamartoma.

61) Regarding sebaceous cyst, select the right answer:

a) Are usually rapidly growing.
b) Commonly seen before adolescence.
c) Common in the scrotum.
d) Malignant transformation causes Cock's peculiar tumor.
e) Infection is rare.

62) Regarding types of dermoid cysts, select the right answer:

a) Sequestration-external angular dermoid.
b) Inclusion-after surgical operations.
c) Tubulodermoid-finger dermoids.
d) Implantation-ovarian dermoids.
e) Never contains aberrant tissue.

63) Which of the following lipomas is usually harmless?

a) Submucous lipoma of the intestine
b) Extradural lipoma.
c) Parosteal.
d) Retroperitoneal
e) Subcutaneous.

64) Which statement is incorrect concerning rodent ulcer:

a) Is a basal-cell carcinoma.
b) Has a red granular floor and rolled-in beaded edge.
c) May be pigmented.
d) May spread to regional lymph nodes.
e) Is best treated by surgical excision.
65) The treatment of melanoma includes the following, except:
a) Wide surgical excision.
b) Block dissection of the regional lymph nodes.
c) Radiotherapy.
d) Chemotherapy.
e) Immunotherapy

66) Which of the following statement about glomus tumor is incorrect?

a) Arises from the arteriovenous shunts of the distal extremities.
b) Occurs most often under a finger nail.
c) Consists of blood vessels, nerve fibrils, smooth and epithelioid cells
d) Is entirely painless.
e) Appears as a minute purple spot under the nail

67) Which statement about sebaceous adenoma is untrue?

a) May arise from a sebaceous gland or cyst.
b) Occurs most often on the face and scalp.
c) Resembles basal cell carcinoma histologically.
d) Forms a firm lobulated pink tumor with a narrow base.
e) Never shows signs of malignancy.
Comment: The answer is E: A sebaceous adenoma may show signs of local malignancy,
such as vascularity, rapid growth, ulceration and recurrence after excision. It is often
regarded as a sebaceous carcinoma and is treated by radical local excision as in rodent
ulcer.

68) Keloids are characterized by the following, except:

a) Consist of dense overgrowth of scar tissue.
b) Develop after wounds, burns and vaccination marks.
c) Are particularly common in Negroes and pregnant females.
d) Occur most often on the face, neck and front of the chest.
e) May turn malignant.

69) Malignant melanoma is characterized by the following, except:

a) Rarely arises from hair-bearing naevi.
 b) Frequently arises from junctional naevi.
c) Is rare in the black races.
d) Is radiosensitive.

70) The prognosis of patients with melanoma depends on:

a) Depth of invasion.
b) Clinical stage of the disease.
c) Location of the tumor.
d) All of the above.
e) None of the above
71) The following is a common site for sebaceous cyst, except:
a) Face
b) Neck
c) Scrotum
d) Sole of the foot

72) Dermoid cysts occurring in the fingers are:

a) Sequestration
b) Inclusion
c) Teratomatous
d) Implantation

73) The BEST management of a hemangioma affecting the whole ear in an infant is:
a) Reassurance and follow up
b) Laser photocoagulation
c) Embolization
d) Surgical excision

74) A 25-year female presented with a 1-cm pigmented lesion of the shoulder region.
The definitive diagnosis should be established by:
a) Aspiration biopsy.
b) Incision biopsy.
c) Exfoliative cytology.
d) Excisional biopsy.
e) Frozen-section biopsy.

75) A 63-year-old male presented to you with a 7 mm ulcer in the center of the lower
lip. On examination, the ulcer had a hard base not fixed to the mandible, with elevated
edges. The submental lymph node was felt hard in consistency. A biopsy showed
malignant cells with formation of cell nests. Neck MRI showed no other lymph node
affection. The best management is:
a) V-shaped excision alone.
b) V-shaped excision with suprahyoid block neck dissection.
c) V-shaped excision with bilateral complete block neck dissection.
d) Intra-arterial chemotherapy.

76) Which of the following lipomas can turn malignant?

a) Submucous lipoma.
b) Parosteal lipoma
c) Intermuscular lipoma.
d) Retroperitoneal lipoma.

77) your brother had a long-standing sebaceous cyst on his back. He complained to you
at it had recently enlarged and become painful. On examination it was reddish in color,
surrounded by an area of erythema. The best management is:
a) Squeeze out the contents.
b) Incision and drainage.
c) Excision of the sebaceous cyst.
d) YAG laser.

78) This type of melanoma can occur beneath the nail bed and has a bad prognosis:
a) Superficial spreading
b) Nodular
c) Lentigo maligna
d) Acral lentiginous

79) A 23-year-old female presented to you with a painful swelling in the left axilla of 4
days duration following removal of axillary hair. She has no fever, but the pain is
throbbing. On examination, the swelling is reddish, 2*3 cm bulging around 1 cm and
the center of the swelling is softer than the edges. The best management in this case
would be:
a) Ultrasound imaging
 b) Amoxicillin-clavulanic acid
c) Incision and drainage
d) Excision and delayed primary suture.

80) A 62-year-old fair lady presented to you with a 1 cm hard nodule fixed to nasal
cartilage. A biopsy done revealed the cells arranged in nest, the outer layer giving a
palisade arrangement and inner layers are polyhedral with large basophilic nuclei
with minimal mitosis and no attempt at keratinization. The best management is:
a) Surgery
b) Radiotherapy
c) UF (fluorouracil) ointment
d) Cryotherapy

81) You were consulted on a 72-year-old bedridden lady who had a 5 cm bed sore on
the sacral region with necrotic floor. The best management is:
a) Use betadine occlusive dressing
b) Use semi-occlusive dressing like hydrocolloid sheets.
c) Use osmotic agents like honey
d) Regular debridement followed by closure.

82) A father brought his 6 months old child with a 1 cm reddish patch on his right
cheek. After interrogation he said it appeared shortly after birth but is growing slowly.
The best management in this case is:
a) Reassurance
b) Steroid injection
c) Pulsed dye laser
d) Excision

83) The most common skin tumor found in the nasolabial fold is :
a) Basal cell carcinoma
b) Squamous cell carcinoma
c) Melanoma
d) Kaposi's sarcoma

84) An infected sebaceous cyst is primarily treated by:

a) Excision with surrounding rim of healthy tissue
b) Simple excision
 c) Enucleation
d) Incision and drainage
85) Which of these tumors is associated with skin pigmentations:
a) Solitary neurofibroma
b) Generalized neurofibromatosis
c) Acoustic neuroma
d) Ganglion neuroma

86) Which of the following lipomas can kill the patient even if it remains benign?
a) Subfascial
b) Submucous
c) Intermuscular
d) Intra-articular

87) The edge of squamous cell carcinoma ulcer is:

a) Everted
b) Inverted
c) Rolled in
d) Undermined

88) Regarding basal cell carcinoma:

a) It may show raised everted edge
b) Metastasize to regional LND
c) May present with satellite deposits
d) Surgery is a line of TTT

89) Sun exposure predispose to this type of neoplasia:

a) Melanoma
b) Breast cancer
c) Hodgkin's lymphoma
d) Nasopharyngeal carcinoma

90) Which of the following is a precancerous skin lesion?

a) Port wine stain
b) Squamous or senile keratosis
c) Lentigo nevus
d) Rodent ulcer
91) A mother brought her 4 months old child with a 1.5 cm reddish patch on his right
cheek that appeared shortly after birth and in increasing gradually in size. The best
management is:
a) Reassurance
b) Corticosteroid injection
c) Nd-YAG laser
d) Excision

92) A 52-year-old male came complaining of a painless slowly enlarging mass in the
right thigh. On examination there was a firm 20x15 cm affecting the front of the thigh
with normal overlying skin. The best management is:
a) Reassurance and follow-up
b) Fine needle biopsy
c) Incision and drainage
d) Excision

93) You saw your aunt who had a 5mm mobile ulcerated mass on the left nasolabial
fold with a beaded rolled in edge. there were no palpable ipsilateral submandibular
nodes, you should:
a) Check for cathepsen-D
b) Do a PET -CT scan
c) Send her to the radiotherapist
d) Excise the lesion with 5mm safety margin
94) Punctum is present in:
a) Sebaceous cyst
b) Lipoma
c) Fibroma
d) Melanoma

95) Strawberry nevus is a type of:

a) Involutional hemangioma
b) Non involutional hemangiomas
c) Fibroadenoma
d) Histocytoma
 GIT
Esophagus & stomach
410. Which of the following statements about esophageal anatomy is correct?
P.412-413, Seventh
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 fibro-areolar 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 para-esophageal lymph nodes.

412. Which of the following statements about achalasia is correct? P.416,

Seventh edition
A. In most cases, the cause is a parasitic infestation by Trypanosomacruzi.
B. Chest pain and regurgitation are the usual symptoms.
C. Distal-third esophageal adenocarcinomas may occur in as many as 20% of
patients within 10 years of diagnosis.
D. Manometry demonstrates failure of LES relaxation on swallowing and
absent or weak simultaneous contractions in the esophageal body after swallowing.
E. Endoscopic botulinum toxin injection of the LES, pneumatic dilatation, and
esophagomyotomy provide highly effective curative therapy for achalasia.

413. Which of the following statements about diffuse esophageal spasm is true?
P.418, Seventh edition
A. Chest pain due to esophageal spasm is easily differentiated from angina
pectoris of cardiac origin.
B. Bouts of esophageal obstruction and regurgitation of food are characteristic.
C. During manometric assessment, unless the patient is having pain there may
be no detectable multiphasic, high-amplitude, simultaneous esophageal
contractions.
D. The treatment of choice is a long esophagomyotomy from the aortic arch to
the esophagogastric junction.

415. The following statements about the influence of diet and lifestyle on lower
esophageal sphincter (LES) function are true except one. Identify the incorrect
statement. P.419, Seventh edition
A. A high-protein diet increases LES pressure.
B. A fat meal results in sustained decrease in LES pressure.
C. Chocolate ingestion causes a decrease in LES pressure.
D. Peppermint produces a transient decrease in LES values.
E. Cigarette smoking produces no significant changes in LES pressures.

416. Long-term surveillance is required after diagnosis of Barret's oesophagus

because there is a marked correlation between this condition and P.422, Seventh
edition
A. Oesophageal adenocarcinoma
B. Adenocarcinoma of gastric cardia
C. Squamous cell carcinoma of oesophagus
D. Squamous cell carcinoma of gastric cardia

417. Heartburn is quite harmless if relieved with antacids. It should be

investigated if accompanied with P.422, Seventh edition
A. Loss of weight
B. Dysphagia
C. Haematemesis
D. Any of the above

418. Which of the following is a goal of treatment for patients with GERD?
P.419, P.420 Seventh edition
A. Healing of erosive lesions, if present
B. Symptom control
C. Avoidance of complications, e.g. strictures
D. All of the above

452. Esophageal Atresia cases that FAIL will require this surgery when the baby
grows up
A. Colon bypass
B. Coronary bypass
C. Cranial bypass
458. Congenital Hypertrophic Pyloric Stenosis (CHPS) occurs at which age
A. At birth
B. After 2-3 weeks from birth
C. After 2-3 years from birth

459. Congenital Hypertrophic Pyloric Stenosis (CHPS) surgery is

A. Pyloromytomy
B. Appendectomy
C. Thoracotomy

464. Which of the following conditions are precancerous?

A. Pharyngeal (Zenker’s) diverticulum
B. Achalasia
C. Corrosive stricture
D. Barrett’s oesophagus
E. all of the above

465. One of the curative operations for carcinoma of the oesophagus is called
A. Whipple’s operation
B. Anderson–Hynes operation
C. Heller’s operation
D. Ivor–Lewis operation
E. Hartmann’s operation

466. Which of the following are importantin the causation of gastric cancer?
A. H. pylori infection
B. Gastric atrophy
C. Pernicious anaemia
D. Previous gastric surgery
E. Smoking.
F. all of the above

467. Which of the following statements regarding clinical features of gastric

cancer are true?
A. Anaemia can be a presenting symptom.
B. Troiser’s sign refers to a palpable ‘Virchow’s node’ in the right
supraclavicular fossa.
C. This is a rare cause of GOO(gastric outlet obstruction).
D. Trousseau’s sign is diagnostic.

468. Which of the following are associated with the molecular pathology of
gastric cancer?
A. Mutation or loss of heterozygosity in
B. APC gene
C. Mutation in gene coding for beta-catenin
D. Mutations in gene coding for E-cadherin
E. Inactivation of p53
F. all of the above

469. Which of the following are true with regard to spread of gastric cancer?
A. Tumour reaching the serosa usually indicates incurability.
B. Blood-borne metastases commonly occur in the absence of lymph node
spread.
C. Krukenberg’stumours are always associated with other areas of
transcoelomic spread.
D. Sister Joseph’s nodule is diagnostic of gastric cancer.
E. The lymphatic vessels related to thecardia have no relation to the
oesophageallymphatics.

470. Which of the following areunequivocal evidence of incurability in gastric

cancer?
A. Involvement of distant peritoneum
B. N3 nodal disease
C. Involvement of adjacent organs
D. Gastric outlet obstruction.

471. Which of the following are true regarding the treatment of gastric cancer?
A. D1 resection is superior to a D2 resection.
B. The 5-year survival in the UK is between 50 and 75 per cent.
C. There is a definite role for neoadjuvantchemotherapy.
D. Radiotherapy to the gastric bed is a useful adjunct.

472. All the following investigations may be needed to stage gastric

adenocarcinoma except one:
A. Staging CT
B. Laparoscopy
C. Bone scan
D. EUS
E. Exploratory laparotomy

473. All the following are the risk factors for gastric cancer except one:
A. Helicobacter pylori infection
B. Atrophic gastritis ????? ALL
C. Pernicious anaemia
D. Alcohol abuse
IS TRUE
E. Smoking

BILIARY & PERITONEUM

246. A 35-year-old female patient had a laparoscopic cholecystectomy.
Postoperatively she developed persistent (300 ml) bile leakage via the drain for 7
days. ERCP revealed slipping of clips which were applied over the cystic duct.
What is the recommended treatment?
A. ERCP and stenting.
B. Laparoscopic application of clips to the cystic duct.
C. Meticulous observation.
D. Percutaneous aspiration.
E. Urgent surgery to ligate the cystic duct.
(A)

249. A 40-year-old female patient was subjected to laparoscopic

cholecystectomy. While the umbilical trocar was introduced, major bleeding
occurred and the patient was shocked. What of the following vessels was most
probably injured?
A. Aorta.
B. Inferior vena cava.
C. Left common iliac artery.
D. Right common iliac artery.
E. Right common iliac vein.
(A)

250. Which of the following is the most appropriate initial test for the evaluation
of obstructive jaundice?
A. CT scanning.
B. ERCP.
C. HIDA scanning.
D. PTC.
E. Ultrasound imaging
(E)

253. An 85-year-old man has 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 small-bowel obstruction suggests a
diagnosis of gallstone ileus.
B. An enterotomy should be distal to the site of obstruction and the stone
should be removed.
C. Gallstone ileus is more common in the young adults.
D. Cholecystectomy should be performed during exploration.
E. Small-bowel obstruction usually occurs in the distal jejunum.
Answer in A
Page 407,

259. 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. Patient 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.
The answer is C
Page 405 Choledocal cyst (6th edition)
Page 416 Risk Factors (6th edition)408 Gall stone ileus (6th edition)

265. Following recovery in the hospital from a fracture of the femur, a 70-yearold
female patient develops RUQ abdominal pain and fever. She has tenderness in
the right subcostal region. There is evidence of progressive sepsis and
hemodynamic instability The WBC count is 24,000. A bedside sonogram confirms
the presence of acalculous cholecystitis. What should treatment involve?
A. Intravenous antibiotics alone
B. ERCP
C. Percutaneous drainage of the gallbladder
D. Urgent cholecystectomy
E. Elective cholecystectomy after 3 months
The answer is D
Page 411 Acute non calcular cholecystitis (6th edition)

279. Regarding diagnostic peritoneal lavage after blunt abdominal trauma, all
are true except;
A. It is good in diagnosing intestinal injuries.
B. It is good in diagnosing renal injuries.
C. It is good in diagnosing intra-peritoneal bleeding.
D. There is no need for it in shocked who has abdominal tenderness and
rigidity.
E. It could be replaced by FAST scan or CT scan.
The answer is B
Page 588 Pathology (6th edition)

280. Regarding traumatic rupture of the diaphragm, all the following statements
are true except:
A. It mainly affects left side.
B. Plain chest X-ray can be diagnostic.
C. It is very easy to diagnose.
D. It is likely to be associated with abdominal and thoracic injuries
E. The only treatment is surgical repair
The answer is C
Page 390 Diaphragmatic injuries (7th edition)

LIVER & SPLEEN

196. The spleen contacts all of the following organs EXCEPT:
A. Jejunum
B. Kidney
C. Left colic flexure
D. Tail of the pancreas
E. Stomach

197. Which of the following is NOT in contact with the spleen?

A. Colon
B. Diaphragm
C. Duodenum
D. Pancreas
E. Stomach

199. Most common splenic cyst is?

A. Dermoid cyst
B. Hydatid cyst
C. Pseudocyst
D. Lymphangioma
Page (581)

200. What is the name of the ligament that related to the spleen and prevents its
enlargement vertically downwards :
A. Colicphrenic
B. Coliccolic
C. Phrenicocolic
D. phreniccolon

205. The most suitable treatment of large splenic abscess is :

A. Antibiotics only
B. Antibiotic and percutaneous drainage
C. Antibiotic and partial splenectomy
D. Antibiotics and splenectomy
(B)

247. A 35-year-old female patient presented by dull aching pain in the right
hypochondrium. CT scan revealed a well-defined cyst in the right lobe of the liver.
Immunological tests excluded the presence of hydatid disease. What is the most
appropriate treatment for this patient?
A. Aspiration and injection of absolute alcohol.
B. Hepatic artery embolization.
C. Limited hepatic resection.
D. Marsupilisation.
E. Observation.

262. A 43-year-old female patient had an abdominal CT scan which showed a 4-cm
lesion in the periphery of the left lobe of the liver. The lesion enhances on the arterial
phase of the CT scan and has a central scar. Which of the following is the
recommended treatment of
this lesion?
A. Wedge resection of the lesion
B. Formal left hepatectomy
C. Intra- arterial embolization of the lesion
D. Radiofrequency ablation of the liver lesion
E. Stop the intake of oral contraceptive.
The answer is E
Page 396 FNH (6th edition)

274. A 25-years old man presents following blunt abdominal trauma, CT scan shows
splenic lacerations. His HR is 110, RR 23 and mildly anxious. What percentage of his
blood
volume do you estimate he has lost?
A. <15%
B. 15-30%
C. 30-35%
D. 35-40%
E. >40%
The answer is B
Page 34 Class II haemorrhage (7th edition)

1. A 16 years old female patient with pigment gall bladder stone may
be subjected to have :
A. Hereditary spherocytosis
B. Sickle cell anemia
C. Thalassemia major
D. Elliptocytosis
E. Hereditary haemolytic anemia

2. All of the following are features of ITP except :

A. Capillary fragility
B. Prolonged bleeding time
C. Diminished platelets count
D. Absence of megakaryocytes from bone marrow

3. Hypersplenism is associated with all of the following EXCEPT :

A. Portal hypertension
B. Lymphoma
C. Splenic abscess
D. Gaucher’s disease

586. Which of the following statements about pyogenic abscess of the liver are true?
A,C
A. The right lobe is more commonly involved than the left lobe.
B. Appendicitis with perforation and abscess is the most common underlying cause of
hepatic abscess.
C. Mortality is largely determined by the underlying disease.
D. Mortality from hepatic abscess is currently greater than 40%.

587. Which of the following statements most accurately describes the current therapy
for pyogenic hepatic abscess?
A. Antibiotics alone are adequate for the treatment of most cases.
B. All patients require open surgical drainage for optimal management.
C. Optimal treatment involves treatment of not only the abscess but the underlying
source as well.
D. Percutaneous drainage is more successful for multiple lesions than for solitary ones.

588. Which of the following statements characterize amebic abscess?

A. Mortality is higher than that for similarly located pyogenic abscesses.
B. The diagnosis of amebic abscess may be based on serologic tests and resolution of
symptoms.
C. In contrast to pyogenic abscess, the treatment of amebic abscess is primarily
medical.
D. Patients with amebic abscess tend to be older than those with pyogenic abscess.

589. Which of the following statement(s) is/are 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.

590. Which of the following statement(s) about malignant neoplasms of the liver is/are
true? ALL IS TRUE
A. Hepatocellular carcinoma is probably the number 1 cause of death from cancers
worldwide.
B. The most common resectable hepatic malignant neoplasm in the United States is
colorectal
metastasis.
C. Hepatoma has at least one variant that has a much more benign course than
hepatomas in general.
D. Hepatomas are generally slower growing than was formerly believed.

591. Which of the following statement(s) is/are true about bile duct cancers?
A. If resected, proximal lesions are usually curable.
B. The more proximal the lesion, the more likely is resection to be curative.
C. Radiation clearly prolongs survival.
D. Transplantation is usually successful if the lesion seems confined to the liver.
E. None of the above is true.

592. Echinococcosis liver disease caused by Echinococcusgranulosus: A,B,C

A. Is not a neoplasm.
B. Is endemic to parts of Europe, but not the United States.
C. Is usually curable by resection.
D. Is more deadly than in its Echinococcusmultilocularis form.

593. Which of the following statements about hemobilia are true?

A. Tumors are the most common cause.
B. The primary treatment of severe hemobilia is an operation.
C. Percutaneous cholangiographichemobilia is usually minor.
D. Ultrasonography usually reveals a specific diagnosis.

594
. Ligation of all of the following arteries usually causes significant
exc hepatic enzyme abnormalities
ept:

A. Ligation of the right hepatic artery.

B. Ligation of the left hepatic artery.
C. Ligation of the hepatic artery distal to the gastroduodenal branch.
D. Ligation of the hepatic artery proximal to the gastroduodenal artery.

595. Which of the following is the most common acid-base disturbance in patients with
cirrhosis and portal hypertension?
A. Metabolic acidosis.
B. Respiratory alkalosis.
C. Metabolic alkalosis.
D. Respiratory acidosis.

597. 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. Esophagogastricdevascularization (Sugiura procedure).
D. Side-to-side portacaval shunt.
E. End-to-side portacaval shunt.

pancreas & appendix

1. For which of the following patients would non operative therapy of appendicitis be
appropriate: 687 ninth edition
A. A pregnant woman in the third trimester.
B. 35-year-old patient with subsiding symptoms and a right lower quadrant mass.
C. An elderly patient with concomitant cardiac disease.
D. A 20 year old woman with crohn's disease.

2. With regard to the location of the appendix which of the following is/are true: 681
A. The base of the appendix can always be found at the confluence of the cecaltaenia.
B. In the majority of cases, the tip of the appendix found in the pelvis.
C. The appendix is often retrocecal and extraperitoneal.
D. The position of the tip of the appendix in appendicitis does not determine the symptoms
of the patient.

3. The function of the appendix which of the following is/are true:

A. It is a vestigial organ with no known function.
B. It is a component of the secretory immune system. May be B
C. Its immunological function protects against cancer.
D. The infantile appendix is the sole source of lymphocytes.

4. Regarding clinical picture of appendicitis: 683

A. Typical history of vague abdominal pain followed by periumbilical pain and later right
lower quadrant pain.
B. Nausea and vomiting usually precede the pain.
C. Haematuria and pyuria are quite common.
D. Most patients present with constipation.

5. In acute appendicitis :
A. Normal total and differential white blood cell count excludes the diagnosis of
appendicitis.
B. The presence of white and red blood cells in urine is not compatible with the diagnosis
of appendicitis.
C. The degree of abnormality in the total and differential WBC count is correlated to the
degree of appendiceal abnormality.
D. Symptoms of appendicitis and finding of anemia sould raise suspicion of cecal cancer.

6. Appendicitis in children, which of the following statements is/are true?

A. It is more uncommon than in adults because of the relatively larger diameter of the
appendiceal lumen.
B. It is often associated with higher fever and more vomiting than in adults.
C. When rupture occurs, a localized periappendiceal abscess results more often than in
adults.
D. All of the above.
7. A 26-year-old woman presents to the emergency room at the midpoint of her
menstrual cycle right lower quadrant abdominal pain and tenderness, fever to 39C,
mild diarrhea, and vomiting. The WBC count is 12,500/mm, which of the following is
the most likely diagnosis? 684
A. Acute appendicitis.
B. Ruptured Graafian follicle.
C. Acute gastroenteritis.
D. Pelvic inflammatory disease.
E. Crohn's disease.

8. During evaluation of male patient with right lower quadrant abdominal pain,
which of
the following should be included in differential diagnosis? 685
A. Acute mesenteric adenitis.
B. Gastroenteritis.
C. Diverticulitis.
D. Intussusceptions.
E. All of the above.

9. A patient suspected of having appendicitis underwent exploration. Crohn's disease

was
found. Which of the following are true? 623
A. All grossly involved bowel, including appendix, should be resected.
B. An inflamed appendix, cecum, and terminal ileum should be resected.
C. Perforated bowel and advanced crohn's disease with obstruction should be resected.
D. All of the above.

10. Rovsing's sign: 684

A. Pain in the right lower quadrant when pressure is applied in the left lower quadrant.
B. Pain on extension of the right thigh with patient lying on the left side.
C. Increased pain caused by cough.
D. Pain with passive rotation of the flexed right hip.

11.With regard to the clinical course of appendicitis, which of the following

statements is/are true? 683
A. The typical history is one of vague abdominal pain, followed by periumbilical pain and,
later, right lower quadrant pain.
B. Nausea and vomiting usually precede the pain
C. Gross hematuria and pyuria are quite common
D. Most patients present with obstipation

12.Which of the Following is the most common neoplasm of the appendix? 689
A. Adenocarcinoma
B. Carcinoid
C. Malignant mucocele
D. Lymphoma
E. Lymphosarcoma.

13.The most common presentation of appendiceal adenocarcinoma is: 689

A. Palpable abdominal mass
B. Acute appendicitis
C. Ascites
D. Incidental finding during unrelated surgery
E. Chronic anemia

15.All of the following are true regarding acute appendicitis EXCEPT: 683
A. The luminal capacity of the appendix is 0.1 mL
B. The initial periumbilical pain is due to stimulation of the visceral afferent nerve fibres
C. Hyperperistalsis is a feature of early appendicitis
D. Chronic appendicitis does not occur
E. Children younger than 5 years have a higher perforation rate

16.Which of the following is the most reliable in confirming the diagnosis of acute
appendicitis ?
A. Classic history of initial periumbilical pain shifting to the right iliac fossa
B. Localized tenderness at McBurney point
C. Rebound tenderness
D. Presence of obturator sign
E. Rovsing sign

17.The appediceal artery is a branch of the : 681

A. Right colic artery
B. Middle colic artery
C. Left colic artery
D. Ileocolic artery
E. Hypogastric artery
18.While palpating at McBurrney’spoint , you are pressing against ? B
A. The tip of the appendix
B. The base of the appendix
C. The ascending colon
D. None of the above

19.All of the following are in favor of laparoscopic appendectomy whencompared

open
appendectomy except: 692
A. Less pain
B. Better exploration of the abdomen
C. Less cost
D. higher learning curve

20.The commonest position of the appendix is: 681

A. retrocecal
B. pelvic
C. retro-ileal
D. paracecal

243. Which of the following statements regarding surgical treatment of pancreatic

cancer is true?
A. Involvement of the superior mesenteric artery is not a contraindication to Whipple
operation.
B. Preoperative biliary stenting is associated with improved survival.
C. Pylorus preserving operation is better than Whipple operation from the nutritional
point of view.
D. The 5-year survival of Whipple operation for carcinoma of the head of pancreas is
around 40%.
E. Total pancreatectomy is associated with improved survival.
(C)

244. Which of the following is true regarding pancreatic pseudocyst?

A. Early surgical interference is indicated to avoid complications.
B. It leads to persistent elevation of the serum amylase following acute pancreatitis.
C. The commonest presentation is obstructive jaundice.
D. The cyst wall is lined by columnar epithelium.
E. There is a low incidence of spontaneous resolution on conservative treatment.
(B) amylase may be only elevated in aspirate from cyst, page 567, Ninth edition
256. A 30-year-old male is admitted with frequent episodes of hypoglycemia.
Biochemical
investigations confirmed an insulinoma. Localization studies were carried out. A CT
scan
and magnetic resonance imaging (MRI) of the abdomen failed to reveal a tumor in
the
pancreas. An endoscopic ultrasound, however, localized a 2-cm insulinoma in the tail
of the
pancreas. What should be the next step in the management of this patient?
A. Somataostatin receptor scintigraphy (SRS) to confirm the insulinoma.
B. Exploratory laparotomy and total pancreatectomy.
C. Distal pancreatectomy.
D. Whipple pancreaticoduodenectomy.
E. Enucleation of the tumour.
The answer in C
Page 434 Insulinoma treatment (6th edition)

257. A 25-year-old female presents with episodes of bizarre behaviour, memory lapse,
and unconsciousness. She also demonstrated previously episodes of extreme hunger,
sweating, and tachycardia. During one of these episodes, her blood sugar was tested
and
was found to be 40 mg/dL. Which of the following would most appropriately indicate
the
diagnosis?
A. Demonstration of insulin antibodies in blood
B. Abnormal glucagon level
C. CT of the pancreas showing a mass
D. Hypoglycemia during a symptomatic episode with relief of symptoms by
intravenous
glucose
E. Decreased circulating C peptide in the blood
The answer is D
Page 433 the Whipple triad (6th edition)

267. Which of the following investigations is most accurate in the localization of

gastrinoma?
A. Angiography
B. CT scan of the abdomen
C. MRI scan
D. Radionuclide octreotide scan
E. Abdominal ultrasound
D is the answer (P 434)
287. A patient attends the Outpatient Clinic following a recent admission with acute
pancreatitis. He reports intermittent upper abdominal pain and vomiting. On
examination
there is a large non-tender mass in the epigastrium. What is your diagnosis?
A. Pancreatic abscess
B. Pancreatic necrosis
C. Pancreatic pseudocyst
D. Cancer of head of pancreas
E. Chronic pancreatitis
The answer is C
Page 427 Pancreatic Pseudocysts (6th edition)

290. Which is the single best enzyme for diagnosing acute pancreatitis?
A. Lipase
B. Serum amylase
C. Amylase isoenzymes
D. Renal clearance of amylase
E. Alkaline phosphatase
A

291. Which is true about plain x- ray in acute pancreatitis?

A. "Sentinel loop"
B. Generalized ileus with air-fluid levels
C. "Colon cutoff sign"
D. Duodenal distention with air-fluid levels
E. All of the above
The answer is E
Page 426 Investigations (6th edition)

294. Most common cause of chronic pancreatitis

A. Gallstone
B. Alcoholism
C. Tropical pancreatitis
D. Severe protein-calorie malnutrition
E. A and B
The answer is E
Page 428 Aetiology (6th edition)

INTESTINE
8. During evaluation of male patient with right lower quadrant abdominal
pain, which of the following should be included in differential diagnosis? 685
A. Acute mesenteric adenitis.
B. Gastroenteritis.
C. Diverticulitis.
D. Intussusceptions.
E. All of the above.

9. A patient suspected of having appendicitis underwent exploration. Crohn's

disease was found. Which of the following are true? 623
A. All grossly involved bowel, including appendix, should be resected.
B. An inflamed appendix, cecum, and terminal ileum should be resected.
C. Perforated bowel and advanced crohn's disease with obstruction should be
resected.
D. All of the above.

51. What are the cardinal signs of obstruction syndrome? 486

A. Abdominal pain and cramping
B. Nausea, vomiting
C. Unable to pass stool or gas
D. Abdominal guarding.
E. Abdominal fullness, gaseous, distention

52. History and physical examination permit the diagnosis of intestinal

obstruction in most cases. Which of the following are important for the clinical
diagnosis of small bowel obstruction? 486
A. Crampy abdominal pain.
B. Fever.
C. Vomiting.
D. Abdominal distention.
E. Leukocyte count above 12,000.
F. Abdominal tenderness.

53. Which of the following statement(s) is/are true concerning the

pathophysiology of small bowel obstruction? 485
A. Most of gas seen on plane abdominal radiographs is produced by gas forming
microorganisms.
B. Elevation of luminal pressure contributes to fluid accumulation in the small
bowel in closed loop but not open loop small bowel obstructions.
C. Intestinal blood flow initially increases to the bowel wall in early bowel
obstruction.
D. In the face of obstruction, myoelectrical activity of the bowel is consistently
increased.

54. The lamina propria between the intestinal epithelium and the muscularis
mucosae contains: 485
A. Blood and lymph vessels.
B. Undifferentiated epithelial cells.
C. Nerve fibers.
D. Enterochromaffin cells.
E. Macrophages.
F. Connective tissue.

55. Regarding small bowel obstruction 486,487

A. most often due to an obstructed hernia.
B. Causes colicky abdominal pain and vomiting.
C. Abdominal distension is seen in all patients.
D. All cases can be managed conservatively for the first 24 hours.
E. Rarely requires aggressive fluid resuscitation.

56. Regarding strangulated small intestine obstruction: 486

A. Pain that is not relieved by nasogastric tube
B. Abdominal meteorism is central.
C. Vomiting are early and abundants.
D. Infectious syndrome is right away important
E. Douglass pouch is pain on rectal palpation.

57. A mechanism of strangulation in acute bowel obstruction is suspected

when: 486
A. Continuous pain.
C. Air-fluid noises.
D. Hiccups.

58. Occlusion in strangulation of the small intestine: 486

1: The pain syndrome begins abruptly.
2: The central abdominal bloating.
3: Vomiting is early and abundant.
4: The infectious syndrome is important from the outset.
5: The cul de sac (uterorectal or vesicorectal pouch) is painful at rectal
examination.

59. During the paralytic ileus, all signs those are common except one, which
one? 491
A. Abdominal distension,
B. Iincreased-fluid noises on auscultation,
C. Abdominal pain discrete
D. Radiological small bowel distention and colon
E. Low fluid levels .

62. Before a bowel obstruction which (s) is (are) on (the) item (s) for a small
bowel obstruction due to strangulation? 551
A - The gradual onset of pain.
B - The existence of an abdominal scar.
C - No matter the digital rectal examination.
D - The permanent nature of the pain.
E - The absence of fluid levels on radiographs of the abdomen without reparation.

64. Obstruction due to strangulation of small bowel clamp (frange, adhesion) is

characterized by: 551,487,486
A - A sudden onset.
B - Severe pain.
C - Vomiting late.
D - Images with air-fluid folds haustraux on radiographs of the abdomen without
preparation.
E - Images air-fluid level which shows the folding of the small intestine.

65. A mechanism of obstruction in acute bowel obstruction is suggested by:

486
A - Curl peristaltic.
B - Silence has abdominal auscultation.
C - Asymmetry of bloating.
D - Emptiness of the rectum to the touch.
E - Conservation of the general condition.

66. The small bowel obstruction by strangulation is characterized by:

551,486,487
A - Start brutal.
B - Important abdominal distension.
C - Strong intensity of abdominal colic.
D - Earliness vomiting.
E - Air-fluid level higher than wide.

68. The location in the small intestine to acute intestinal obstruction by

strangulation is suspected in: 486
A - Central bloat peri-umbilical.
B - Presence of peristaltic waves.
C - Asymmetrical arrangement of bloat.
D - Precocity and abundance vomiting.
E - Abdominal contracture.

69. In paralytic ileus, all the signs that are common but one. Which one? 491
A - Abdominal distension.
B - Increase in noise-fluid for the inspection.
C - Abdominal pain discreet.
D - Radiological small bowel distention and bowel.
E - Low fluid levels.

71. One definition is the following gallstone ileus. Which one? 407
A - A choledochal gravel gallstones. (empierrement)
B - A peritonitis by gallbladder perforation.
C - Inflammatory bowel obstruction in contact with acute cholecystitis.
D - A small bowel obstruction by migration of gallstones.
E - None of the above is correct.

72. For a mechanism of strangulation during an acute intestinal obstruction is

retained: 486
A - Existence of peristaltic waves.
B - Silence abdominal auscultation.
C - Early progressive.
D - Presence of an abdominal scar.
E - Pain with digital rectal examination.

73. Concerning the adhesion volvulus of the small intestine: 490

A - The flange (s) may take (s) be congenital.
B - In case of single flange, it sits constantly at the foot of the vuvolus loop.
C - The direction of twist of the handle is either clockwise or counter-clockwise.
D - The expansion only affects intestinal bowel volvulus upstream of and respects
the vuvolus loop.
E - The maximum anatomical lesions seat at the foot of the vuvolus loop.

74. A mechanism of obstruction in acute bowel obstruction is suggested by:

486
A - Curl peristaltic.
B - Silence has abdominal auscultation.
C - Asymmetry of bloating.
D - Emptiness of the rectum to the touch.
E - Conservation of the condition.

76. On the occasion of an acute intestinal obstruction which of the following

proposals, the one you remember? 486
A - Pneumoperitoneum.
B - Air-fluid level higher than wide.
C - Bulky abdominal distension.
D - Abdominal contracture.
E - None of these.

77. What are the signs accompanying occlusion by volvulus of the small
intestine? 490
A - Sudden onset.
B – Bloat immobile.
C - Minor abdominal pain.
D - Auscultation Abdominal silent.
E - Early vomiting.

78. In acute intestinal obstruction due to strangulation of the small intestine

recent physical exam may find: 486
A - A central bloating.
B - Peristaltic waves.
C - An abdominal scar.
D - A periumbilical contracture.
E - Air-fluid noises on auscultation.

79. In strangulation obstruction of the small intestine, bloating is: 551, 486
A. Sudden onset.
B. Central.
C. Noise with air-fluid on auscultation.
D. Animated peristaltic waves.
E. Sound on percussion.

80. A bloat of obstruction in acute bowel obstruction is suspected when: 551,

486
A. Peristaltic undulations.
B. Abdominal silence.
C. Asymmetry of bloat.
D. Conservation condition.

81. One of the following sign is characteristic of an occlusion of the sigmoid

volvulus. Which? 490
A - Fever Early.
B - Bloat oblique.
C - Blood on rectal examination.
D - All of distension of the colon in the abdomen with preparation.
E - Liquid Levels colic. Colonic fluid level

82. Occlusion of the sigmoid colon cancer is characterized by: 481,482

A. Gradual onset.
B. Significant (important) abdominal bloating.
C. Intensive abdominal colic.
D. A large number of air fluid levels.
E. Air fluid levels higher than wide.

83. Bloat of the pelvic colon volvulus: 481,482

1. Has an asymmetrical layout.
2. Was tympanic to percussion.
3. Accompanied by peristaltic waves.
4. Accompanied by abdominal contraction.
5. Accompanied by removal of abdominal skin reflexes

84. One of the following is characteristic of a sigmoid volvulus: 490,491

A. Fever early.
B. Bloat oblique.
C. Distension of the colon together with the ASP.
D. Colonic fluid level.
85. Occlusion of the sigmoid colon cancer is characterized by: 490,491
A- Beginning progressive.
B- Abdominal distension important.
C- Strong intensity of abdominal colic.
D- A large number of air-fluid level.
E- Air-fluid levels higher than wide.

86. The distension of the pelvic colon volvulus: 490,491

A - A an asymmetrical arrangement.
B - Is tympanic to percussion.
C - Comes with peristaltic waves.
D - Accompanied by abdominal contraction.
E - Comes with removal of abdominal cutaneous reflexes.

87. Among the various claims about the cecal volvulus include one (s) is (are)
true (s): 490
A - There may be secondary to an absence of apposition of the cecum.
B - He was a frequent early clinical brutal.
C - Vomiting is often hemorrhagic.
D - The cessation of materials and gas net.
E - The pain is often intense.

88. The occlusion of the sigmoid colon cancer is characterized by: 481
A - Early progressive.
B - Abdominal distension important.
C - High intensity of abdominal colic.
D - A large number of air-fluid level.
E - The air-fluid level higher than wide.

89. The bloating of pelvic colon volvulus: 490

A - In an asymmetrical arrangement.
B - Is tympanic to percussion.
C - Comes with peristaltic waves.
D - is accompanied by abdominal contraction.
E - Comes with removal of abdominal cutaneous reflexes.

93. Occlusion by neoplastic stenosis of the hinge rectosigmoid: 485

A. a mode is usually faster.
B. accompanied by vomiting early.
C. has a total silence on auscultation abdominal.
D. causes bloating in part (part in a flatulence).
E. may be preceded by rectal hemorrhage.

94. Of the following characters, which ones can not (usually) apply to the
sigmoid volvulus? 490
A. Sudden onset.
B. Early vomiting.
C. Central bloat.
D. Many fluid levels.
E. Endoscopic treatment.

96. In an occlusion of the left colon obstruction: 485

A. vomiting are early and abundant.
B. bloat is peripheric.
C. the peristaltic waves are numerous.
D. air-fluid sounds on auscultation are evident.
E. images radiological air-fluid are higher than wide

97. Quote the 2 causes of obstruction small intestine by obstruction of the

bowels: 485
A. Volvulus
B. Bilary ileus
C. Tumors blocking the intestines
D. Electrolyte imbalances.

98. Quote the 3 causes of intestinal obstruction by strangulation of the bowels:

486
A. Postoperative adhesions.
B. Obstruction intestine by mesenteric tumor.
C. Volvulus (twisted intestine).
D. Foreign bodies (ingested materials that obstruct the intestines).
E. Hernias (strangulated hernia).

99. Complete mechanical small bowel obstruction can cause dehydration by:
486
A. Interfering with oral intake of water.
B. Inducing vomiting.
C. Decreasing intestinal absorption of water.
D. Causing secretion of water into the intestinal lumen.
E. Causing edema of the intestinal wall.

100. A 45-year-old man with a history of previous right hemicolectomy for colon
cancer presents with colicky abdominal pain which has become constant over the
last few hours. He has marked abdominal distension and has had only minimal
vomiting of a feculent material. His abdomen is diffusely tender. Abdominal x-ray
shows multiple air fluid levels with dilatation of some loops to greater than 3 cm
in diameter. The most likely diagnosis is: 486
A. Proximal small bowel obstruction.
B. Distal small bowel obstruction.
C. Acute appendicitis.
D. Closed-loop small bowel obstruction.

153. In case of intussusception in infants, a sign is virtually pathognomonic.

Which?
A- Rectal bleeding
B- Paroxysmal abdominal pain
C- Emptiness of the right iliac fossa
D- Palpation of an intussusception
E- association pain, rectal bleeding
(page 642-643)

154. Regarding trans-valvular ileo-ileocolic intussusception: what are the true

statements?
A- It was born on the colon
B- It is usually idiopathic
C- It is often resistant to radiation treatment
D- Appendix is driven in trans-valve with the flange
E- It can be caused by a Mekel diverticulum
(page 642-643)

155. Which of the following statement(s) is/are true concerning

Intussusception?
A. A form of intestinal obstruction caused by the prolapse of a part of the
intestine into the adjoining intestinal lumen.
B. Intussusception involves a telescoping of one portion of the intestine into
another, which results in decreased blood supply of the involved segment.
C. Intussusception is the sliding of one part of the intestine into another.
D. Intussusception is a term derived from the Latin intus (within) and suscipere (to
receive). One segment of the bowel (intussusceptum) invaginates into another
(intussuscipiens) just distal to it, leading to obstruction. The bowel may simply
telescope on itself (non-pathological lead point), or some pathology may be the
focus of the invagination (pathological lead point).
E. Intussusception is defined as the telescoping of one segment of bowel into the
immediately distal segment of bowel.
(page 642-643)

156. Claw sign seen in?

A. Intusseption.
B. Volvulus.
C. Adhesion.
D. Impacted feces
(page 642-643)

157. The acute intussusception:

A. Is observed mainly between 2 and 6 years
B. The absence of rectal bleeding diagnosis eliminates
C. A barium enema diagnosis eliminates normal
D. The strand of intussusception can descend into the left colon
(page 642-643)

162. Cases of intussusception:

A. Nasopharyngeal infection
B. Meckel diverticulum
C. Intestinal lymphoma
D. Thrombocytopenic purpura
E. HSP
(page 642-643)

169. What (s) is (are) among the following radiological signs, that (those) which
reflect a gallstone ileus:
A - Ascending clear subdiaphragmatic gas.
B - Images-fluid of the small intestine.
C - Pneumobilie (pneumobilia).
D - Enlargement of the paracolic gutters.
E - Image parietography gaseous small bowel loops.
170. One definition is the following gallstone ileus. Which one?
A - A choledochal gravel gallstones. (empierrement)
B - A gallbladder perforation peritonitis.
C - Inflammatory bowel obstruction in contact with acute cholecystitis.
D - A small bowel obstruction by migration of gallstones.
E - None of the above is correct.

171. The gallstone ileus may be due to a fistula:

A - Cholecysto-colic.
B - Cholecysto-duodenal.
C - Choleysto-choledochal.
D - choledocho-choledochal.
E - Hepatico tube.

172. Indicate the exact proposal regarding gallstone ileus:

A. It comes with a pneumoperitoneum.
B. it is accompanied by a pneumobilia.
C. It produced an array of small bowel obstruction due to strangulation.
D. it is accompanied by jaundice.
E. it complicates anmicrolithiasis.

282. All the following regarding Rectal prolapse are true except:
A. It is one of the causes of the obstructed defecation syndrome.
B. It can be associated with excessive straining.
C. It is most common among elderly women.
D. It can be treated with perineal or abdominal surgical approaches.
E. Its treatment is only surgical.
The answer is E
Page 493 Treatment (6th edition)

283. To see the complete rectal prolapse, The best position to put the patient is:
A. Squatting position.
B. Supine position.
C. Lithotomy position.
D. Knee-elbow position.
E. Prone position.
The answer is A Page 492 signs (6th edition)
325. Duodenal obstruction is associated with the following except :640
A. Bilious vomiting
B. Mild abdominal distention.
C. Double bubble sign in abdominal x ray.
D. Marked abdominal distention.

326. Intussusception may be associated with the following except :673

A. Red currant jelly stools.
B. Abdominal mass.
C. Colicky pain.
D. Metabolic alkalosis.

Incidence of maligenant transformation in FAP is..page 630 edition 2017

A. 100%
B. 20%
C. 30%

374. Maligenancy of Right colon may present by..page 633 edition 2017.
A. anemia
B. weakness
C. weight loss
D. all of the above

375. cancer of the colon is characterized by the following except that it : page
633 edition 2017
A. Has ahigh incidence in western countries
B. Is commonest in the pelvic colon
C. often develops on top of aprecancerous lesion
D. may present acutely by massive colonic hemorrhage
E. causes arise in the carcinoembryonic antigen in the serum

376. which statement among the following is untrue about cancer of the right
colon? page 633 edition 2017
A. is commonest in the ceum
B. rarely presents with intestinal obstruction
C. May present with anemia of obsecure origin
D. Is rarely palpable on abdominal examiation
E. Is best treated by extended right colectomy
378. Carcioma of the left colon differs from the right colon in the following exept
.....page 633 edition 2017
A. Is usually stenosing scirrhous lesion
B. Frequently presents with intestinal obstruction
C. Rarely causes diarrhea
D. Is usually impalpable on abdominal exaamination
E. Carries abetter prognosis of radical resection

379. The site of the colonic maligenancy is more common in .....page 631 edition
2017
A. caecum
B. transfer colon
C. segmoid and rectal cancer

381. Staging of rectal carcinoma by ....page 634 edition 2017

A. MRI rectum and anal canal
B. Endorectal ultrasound
C. 1&2

Anal canal, review subjects &

pediatrics
155. Which of the following statement(s) is/are true concerning
Intussusception?
A. A form of intestinal obstruction caused by the prolapse of a part of the
intestine into the adjoining intestinal lumen.
B. Intussusception involves a telescoping of one portion of the intestine into
another, which results in decreased blood supply of the involved segment.
C. Intussusception is the sliding of one part of the intestine into another.
D. Intussusception is a term derived from the Latin intus (within) and suscipere (to
receive). One segment of the bowel (intussusceptum) invaginates into another
(intussuscipiens) just distal to it, leading to obstruction. The bowel may simply
telescope on itself (non-pathological lead point), or some pathology may be the
focus of the invagination (pathological lead point).
E. Intussusception is defined as the telescoping of one segment of bowel into the
immediately distal segment of bowel.
(page 642-643)

156. Claw sign seen in?

A. Intusseption.
B. Volvulus.
C. Adhesion.
D. Impacted feces
(page 642-643)

157. The acute intussusception:

A. Is observed mainly between 2 and 6 years
B. The absence of rectal bleeding diagnosis eliminates
C. A barium enema diagnosis eliminates normal
D. The strand of intussusception can descend into the left colon
(page 642-643)

162. Cases of intussusception:

A. Nasopharyngeal infection
B. Meckel diverticulum
C. Intestinal lymphoma
Most probably All of the above
D. Thrombocytopenic purpura
E. HSP
(page 642-643)

164. How (s) review (s) may be appealed to explore first-line acute abdominal
pain in children?
A - Small bowel transit,
B - Chest x-ray,
C - CT abdominal
D - Abdominopelvic ultrasound,
E – GI Barium.
(page 642-643)

166. Complete Rx of intussception indicates?

A. Free passage of barium in the small intestine.
B. Passage of faceus and flatus along with barium.
C. Improvement of clinical condition.
D. Claw sign.
(page 642-643)

183. in hirshsprung disease what is correct

A. may present in neonate
B. has no complications after surgery
C. has no genetic association
Page (668-669)

184. All of the following are presentations of hirshsprung disease except

A. enterocolitis
B. neonatal obstruction
C. nonbilious vomiting.
Page (668-669)

185. all of the following investigations in hirshsprung disease except

A. anorectalmanometry
B. Rectal biobsy
C. Barium enema
D. abdominal sonar
Page (668-669)

325. Duodenal obstruction is associated with the following except :640

A. Bilious vomiting
B. Mild abdominal distention.
C. Double bubble sign in abdominal x ray.
D. Marked abdominal distention.

326. Intussusception may be associated with the following except :673

A. Red currant jelly stools.
B. Abdominal mass.
C. Colicky pain.
D. Metabolic alkalosis.

327. The initial management of high imperforate anus in male newborn is : 672
A. Colostomy.
B. Anoplasty.
C. Intestinal resection and anastomosis.
D. Non of the above.

328. The initial management of Low imperforate anus in male newborn is :672
A. Colostomy.
B. Anoplasty.
C. Intestinal resection and anastomosis .
D. None of the above

330. The following anomalies can be found in the male newborn with high
anorectal malformation 670
A. Bucket handle anomaly.
B. Rectovesical fistula.
C. Anal stenosis.
D. Anocutaneous fistula.

331. Hirschsprung's disease is associated with the following except : 667

A. Delayed passage of meconium .
B. No ganglion cells in rectal biopsy.
C. Chronic constipation
D. Olive like epigastric mass.

333. The definitive management of Hirshsprung's disease is : 668

A. Laxative
B. Contrast enema
C. Resection of the aganglionic bowel .
D. Non of the above .

334. Neglected cases of intussusception can be managed by the following except

: 673
A. Resuscitation
B. Pneumatic reduction
C. Abdominal exploration
D. Non of the above .

422. All are symptom of anal fissures except: P.635, 636, Seventh edition
A. pain
B. bleeding
C. constipation
D. infected discharge

423. Treatment option of 3rd degree piles include all except: P.640, 641,
Seventh edition
A. band ligation
B. HAL
C. PPH
D. Harmonic and ligasure heamorrhoidectomy

424. Etiology of piles include all except: P.637, 638, Seventh edition
A. straining
B. weak msenchyme
C. Genitic
D. prolonged recumbancy in bed

425. Complications of piles include all except: P.641 Seventh edition

A. Heamorrhage
B. anemia
C. strangulation
D. intestinal obstruction

426. Types of fistula include all except: P.644 Seventh edition

A. intersphinctric
B. intrasphinctric
C. trans sphincteric
D. supra sphincteric

427. Aseesment of anal incontinence by all Except: P.646 Seventh edition

A. clinical
B. ano recal manometry
C. defecography
D. cut abdominal pelvis

428. All can cause painful anal condition except: P.635, 636, Seventh edition
A. anal fissure
B. prolapsed piles
C. carcinoma of the anus
D. anal fistulas

449. Esophageal Atresia has many types, which is the COMMONEST P.608
Seventh edition
A. Esophageal Atresia without Tracheo-esophageal Fistula
B. Esophageal Atresia with Tracheo-esophageal Fistula
C. Tracheo-esophageal Fistula without Esophageal Atresia

355. Which of the following congenital abnormalities are correctly defined?

A. Omphalocele represents a defect in the abdominal wall lateral to the
umbilical cord.
B. The herniated viscera associated with omphaloceles are usually covered
with a membranous sac.
C. An umbilical polyp is a small excrescence of omphalomesenteric duct
mucosa that is retained in the umbilicus.
D. Meckel's diverticulum results when the intestinal end of the
omphalomesenteric duct persists and represents a true diverticulum

528. Which of the following are advantages of minimal access surgery ?

A. Decrease in wound size
B. Decreased postoperative pain
C. Shorter operating time
D. Improved vision
E. Reduced operting theatre costs

529. Which of the following are limitations of minimal access surgery ?

A. Technically more demanding
B. Loss of tactile feedback
C. Extraction of large specimens
D. Poor vision Except D
E. Difficulty with hemostasis

HERNIA & TESTIS

72. For a mechanism of strangulation during an acute intestinal obstruction is
retained: 486
A - Existence of peristaltic waves.
B - Silence abdominal auscultation.
C - Early progressive.
D - Presence of an abdominal scar.
E - Pain with digital rectal examination.

356. The following statement(s) is/are true concerning the indications for
treatment of an inguinal hernia.page741- edition 2017
A. Most adult hernias will remain stable in size, therefore delay seldom affects
the technical aspects of a surgical repair
B. There is a direct correlation between the length of time that a hernia is
present and the risk of major complications
C. The morbidity and mortality associated with emergent operation due to
hernia complications is significantly greater than for elective repair of the
identical hernia
D. A truss maintains a hernia in the reduced state, therefore, minimizing the
risk of incarceration and strangulation

358. In advising a patient preoperatively of potential complications of operative

treatment of an inguinal hernia, which of the following statement(s) is/are true?
( A, C &D )
A. Severe symptoms due to sensory nerve entrapment or injury can occur
B. The most common vascular structure injured during the course of a groin
hernia repair is the femoral artery
C. Recurrent hernia after primary groin repair should occur in less than 10% of
cases
D. Wound infection increases the risk of recurrent hernia

359. Which of the statement(s) is/are true concerning laparoscopic hernia

repair? A, B & C
A. General anesthesia is required
B. Either an abdominal or preperitoneal approach is possible
C. The use of prosthetic mesh is required in all variations
D. Long-term results suggest that the laparoscopic approach is equal to
traditional repairs

360. The following statement(s) is/are true concerning incarceration of an

inguinal hernia.page 741- edition 2017 B&C
A. All incarcerated hernias are surgical emergencies and require prompt
surgical intervention
B. Attempt at reduction of an incarcerated symptomatic hernia is generally
considered safe
C. Vigorous attempts at reduction of an incarcerated hernia may result in
reduction en masse with continued entrapment and possible progression to
obstruction or strangulation
D. Incarcerated hernias frequently cause both small and large bowel
obstruction

439. What is the TREATMENT of Inguinal Hernia P.683 Seventh edition

A. Herniotomy
B. Appendectomy
C. Colectomy

440. Every Hernia has a

A. Sac
B. may be false sac
C. may be double sac

441. Hernias occur in P.671 Seventh edition

A. Anywhere
B. Anatomical positions in the body
C. intracranial

442. Complications for Inguinal Hernia include P.673 Seventh edition

A. Strangulation
B. Stretching
C. Stenting

443. The Age for Repair of Inguinal Hernia P.685 Seventh edition
A. After 1 year
B. Any Age
C. After 25 years

444. The Inguinal Hernia occurs in P.687 Seventh edition

A. Inguinal Canal
B. stenson Canal
C. Birth Canal

445. Umbilical Hernia complications include P.689 Seventh edition

A. Strangulation
B. None, it never complicates
C. Infection

446. Orchipexy for the Testis is performed in P.777 Seventh edition

A. Undescended Testis
B. Retractile Testis
C. Absent Testis

447. Complications of Undescended Testis include P.777 Seventh edition

A. Sterility
B. Bleeding
C. Infection

448. Hydrocele Surgery is same surgery as P.790 Seventh edition

A. Inguinal Hernia
B. Hypospadias
C. Hydrocephalus

351. The most common hernia in females is:

A. Femoral hernia.
B. Spigelian inguinal hernia.
C. Inguinal hernia.
D. Obturator hernia.
E. Umbilical hernia.

354. 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 transabdominalpreperitoneal (TAPP) and totally
extraperitoneal approach (TEPA) repairs are based on the preperitoneal repairs of
Cheattle, Henry, Nyhus, and Stoppa.
356. The following statement(s) is/are true concerning the indications for
treatment of an inguinal hernia. B & C
A. Most adult hernias will remain stable in size, therefore delay seldom affects
the technical aspects of a surgical repair
B. There is a direct correlation between the length of time that a hernia is
present and the risk of major complications
C. The morbidity and mortality associated with emergent operation due to
hernia complications is significantly greater than for elective repair of the
identical hernia
D. A truss maintains a hernia in the reduced state, therefore, minimizing the
risk of incarceration and strangulation

357. Which of the following statement(s) is/are true concerning the diagnosis
and management of epigastric hernias?
A. A large peritoneal sac containing abdominal viscera is common
B. At the time of surgical repair, a careful search for other defects should be
performed
C. Recurrent epigastric hernias after simple closure is uncommon
D. Patients with symptoms of a painful midline abdominal mass frequently will
contain incarcerated small bowel