Surgery Final Exam

4th Year
20/05/13
O.o

MCQs:
1- Hemobilia
a. iatrogenic
b. occurs in the abdominal wall
2- Cleft palate is best operated in:
a. 10 months
b. 6 months
c. 16 months
d. 10 weeks
e. 16 weeks
3- Which of the following approaches is considered standard care for most
Wilms tumor patients in the United States today?
a. Adriamycin and vincristine therapy followed by surgical resection
b. Needle biopsy followed by either chemotherapy or resection
depending upon the histology
c. Primary surgical resection followed by chemotherapy
d. Radiation therapy if judged unresectable on CT or MRI imaging
4- Polyhydramnios is frequently observed in all of the following conditions
except:
a. Esophageal atresia.
b. Duodenal atresia.
c. Pyloric atresia.
d. Hirschsprung's disease.
e. Congenital diaphragmatic hernia

5- All about Hirschsprung's disease is true except:

a. Male : Female ratio is 4:1
b. Aganglionic
c. Associated with Downs Syndrome
d. Diagnosed by a biopsy that shows decrease in the acetylcholine
esterase
e. .
6- Which of the following about breast is true:
a. Mastalgia is the most common complaint in breast cancer
b. BSE has 85% accuracy rate
c. Firm, round, mobile mass in a young women may be cancer
d.
e. All of the above
7- A 45 years woman with bloody discharge from the nipple . Next step :
a. Ultrasound
b. Mammogram
c. MRI
d. Ductography
e. .
8- The treatment of choice for neonates with uncomplicated meconium ileus:
a. Observation.
b. Emergency laparotomy, bowel resection, and Bishop-Koop
enterostomy.
c. Intravenous hydration and a gastrograffin enema.
d. Emergency laparotomy, bowel resection, and anastomosis. Sweat
chloride test and pancreatic enzyme therapy.
9- Which of the following hematomas must be drained ASAP:
a. Neck hematoma
b. Pelvic hematoma
c. Perineal hematoma
d. Sciatic hematoma
e. Axillary hematoma

10- A patient with pancreatitis, not improving, you suspect necrotic

pancreatitis, what is the best to diagnose:
a. Ultrasound
b. MRI
c. Contrast CT scan
d. CT guided percoutaneous biopsy
e. ..
11- 19 year old female, with cyclic breast pain and 1.5 cm nodularity on the
UOQ of both breasts .. the next step is :
a. Observation
b. Ultrasound
c. Mammogram
d. MRI
e. ..
12- A patient with DCIS ( I guess 1.5 cm )without surrounding tissue invasion,
best treatment is:
a. Lumpectomy with radiotherapy
b. Mastectomy
c. Mastectomy with lymph node biopsy
d. Radical mastectomy
e. Sth. to do with lumpectomy !
13- The best indicator for prognosis of breast cancer is:
a. Age
b. Size
c. Lymph node
d. .
e. .
14- All of the following in the proliferative stage except:
a. Granulation tissue
b. Vasoconstriction
c. .

15- Which of the following is present in the early septic shock:

a. Decrease in the cardiac output
b. Vasodilation
c. Aretial venous difference increase
d. .
e. .
16- All of the following is true about unusual hernia, except:
a. Littres hernia in mickels diverticulum
b. Petit is inferior lumbar hernia, while grynfeltts is superior lumbar
hernia
c. Sciatic hernia is painful and below the inguinal ligament and lateral
to the pubic tubercle
d. Richters hernia anti-mesentric wall strangulation without
obstruction
e.
17- Most complain of anal fissure is:
a. Bleeding
b. Itching
c. Painful defecation
d.
e.
18- Most common cause of LGI bleeding in the adults:
a. Anal fissure
b. Diverticulosis
c. Hemorrhoids
d. .
e. .
19- The first symptom of strangulated hernia is:
a. Shock
b. Vomiting
c. Intestinal obstruction

d. Pain
e. ..
20- In neonates with necrotizing enterocolitis, which of the following findings
is an indication of significant bowel ischemia:
a. Increased gastric residuals.
b. Septic shock.
c. Cardiac failure due to a patent ductus arteriosus.
d. Elevated platelet count.
e. Erythema of the abdominal wall
21- Patient with head trauma, eyes open, words incomprehensible, localizes
pain.. GCS is ? 11
22- Which of the following is associated with burn:
a. Pseudomonas infection
b. A lower limb burn in a child is 18%
c. .
d. ..
e.
23- What is the treatment in pseudomembranous colitis:
a. Penicillin G
b. Penicillin V
c. Vancomycin
d.
e.
24- The best prophylaxis to prevent OPSI after splenectomy:
a. IV immunoglobulin
b. Vaccination
c. Antibiotic !
d. .
e. .
25- Conservative therapy after splenic injury is indicated in all of the
following, except:
a. Hemodynamic stability
b. Low transfusion volume

c. No peritonitis
d. Shattered spleen
e.
26- All of the following about early dumping syndrome is correct, except:
a. Tachycardia and sweating
b. Diarrhea is always present
c. Somatostatin may help
d. After antrectomy
e. May be due to vagal inhibition and may goes spontaneously
27- A man with antrectomy after minutes of eating he develops sweating,
tachycardia, and diarrhea .. the most appropriate cause is:
a. Early dumping syndrome
b. Bile reflux gastritis
c. Late dumping syndrome
d.
e.
28- The definitive management of sclerosing cholangitis is :
a. Liver transplantation
b. Roux en Y choledochojejunostomy
c.
d.
e. .
29- All of the following about cholangitis is correct, except:
a. Charcots triad is always present
b. Choledocholithiasis is the most common cause
c. Bile bacteria is present
d. There has to be obstruction and infection
e. ..
30- The management of choice in tension pneumothorax is:
a. Needle decompression
b. Tracheal intubation
c. Chest drain
d.
e.

31- A patient with a history of esophageal varices, presents with massive

episode of hematemesis the first step in management is:
a. Clear the mouth from the blood and remove any clots
b. Blood transfusion
c. Endoscopy
d. Urgent surgery
e. ..
32- A 24- year old man came to the E & A department after gun shot in the
upper quadrant . What is the first step in management :
a. Airway maintenance
b. Blood transfusion
c. Surgery
d. .
e. ..
33- Concerning AAA, the following is TRUE:
a. Smoking is the strongest predisposing factor.
b. Suprarenal AAA is the commonest type that accounts more than
95%.
c. Rupture is highr in males.
d. Diameter more than 3 cm is an indication for elective repair.
e. EVAR has higher mortality rates than open repair.
34- A 75 year old overweight ,smoker person with pain in his legs after walking
half a kilometer,which is relieved immediately by rest,ABI is 0.8,the most
appropriate management is:
a. IV heparin
b. Fogarty catheter thrombectomy.
c. Conservative management.
d. Sympathectomy.
e. PTA
35- All of the following is true concerning varicose ulcer, except: they are
premalignant.

36- Which of the following is associated with Crohns disease:

a. Medical therapy for the strictures
b. Mucus goblet cells depletion
c. Cancer risk is more common than UC
d. It almost always involves the rectum
e. None of the above
37- A 63 year old man, presents with pallor, fatigability, Anemia he has
positive occult blood stool . After investigations he has colon cancer
where is it found most likely?
a. Right colon
b. Left colon
c. Sigmoid
d. Rectum
e.
38- Forrest classification F 1/a :
a. Spurting arterial bleeding
b. Oozing bleeding
c. Visible vessel on the base of ulcer
d. Coagulum(clot) in the ulcer
e. Coffee ground ulcer base
39- What is true concerning inguinal hernia:
a. Inferior epigastric vessels are located medially to the deep ring
40- The medial wall of the femoral hernia is:
a. Lacunar ligament
41- Wound healing will be impaired in all of the following, except:
a. Older Age
b. Controlled DM
c. Remote infection
d. Malnutrition
e.

42- Simple appendectomy is:

a. Dirty
b. Contaminated
c. Clean
d. Clean/contaminated
e. ..
43- 70 kg male with 30% BSA burn, how mush fluid should be given in the first
8 hrs:
a. 4.2 L
b. 2.3 L
c. .
d. ..
e. ..
44- About body fluids, which is true :
a. Female and obese has more fluid
b. Muscles have less fluid
c. With age, body fluid decreases
d. There is wild variability among individuals
e. .
45- A patient with hypoglycemia and hyponatremia . Which is true:
a. Insulin will increase the potassium amount in the cells
46- About follicular carcinoma of the thyroid, which is correct:
a. Multi focal
b. Spread to lymph nodes
c. Has increased iodine concentration
d. .
e.
47- All of the following about anal fissure is true, except:
a. Most commonly lateral
b. Chronic fissure develops sentinel pile

c. Lateral fissure may be due to cancer

d. Managed by lateral internal sphinecterotomy
e. ..
48- All about hemorrhoids are correct except:
a. It occurs only in the external hemorrhoidal vein
b. May be caused by colon cancer
c. May be caused in pregnancy
d. It may cause incontinence
e. .
49- Most important factor in developing atelectasis post operatively is :
a. High abdominal surgery
b. Inadequate physiotherapy
c. Infection
d. Bad control of pain
e.
50- Doesn't require DVT prophylaxis? 21 yo undergoing day time surgery at
daily care.
51- LMWH works by inhibiting:
a. Xa
52- A 15-year-old female presents with RUQ abdominal pain. Workup reveals
a choledochal cyst. Which of the following statements is TRUE?
a. Choledochal cysts are more common in men.
b. Laparoscopic cholecystectomy is the recommended treatment.
c. Patients with a choledochal cyst have an increased risk of
cholangiocarcinoma.
d. All patients with a choledochal cyst have abdominal pain, a RUQ
mass, and jaundice.
e. The etiology is infectious

53- All of the following is true about paraesophageal hiatus hernia, except: !!!
a. 5% of the hiatal hernias
b. May be associated with reflux
c. Asymptomatic pt. doesnt need surgery
d.
e.
54- All of the following is present in the acute stage of severe trauma or
moderate to severe surgery, except:
a. Hypermetabolism
b. Negative nitrogen balance
c. Hyperphagia
d. .
e. .
55- A female patient presents with a mass below the inguinal ligament (history
of femoral hernia) . What is the best investigation:
a. CT scan
b. Ultrasound
c. Herniography
d. MRI
e. Biopsy
56- A pt. with perforated appendectomy .. after 7 days he develops redness,
swelling, tender in the area of the wound, what is the treatment:
a. Topical AB
b. Systemic AB
c. Topical & Systemic AB
d. Surgical incision and drainage
e. ..
57- About corrosive injuries to the esophagus, what is true:
a. Acidic injury is more severe than alkaline
b. Alkaline injury is more severe than acidic
c. .

58- After gastrectomy, what should you replace parenterally:

a. Vitamin B 12
59- Which of the following isnt a recognized management in ZE syndrome:
a. Antrectomy
b. Gastrectomy
c. Highly selective vagotomy
d. Vagotomy with antrectomy
e. PPI
60- All of the following is true about inguinal hernia, except:
a. Less common in preterm infant
b. 10% bilaterally
c. 10-20% will develop in the contra-lateral side
d.
e.
61- A pt. with abdominal penetrating trauma .. His ph = 7.25 , pCO2 = 25 ,
HCO3- = 15 .. what does he has :
a. Metabolic acidosis with respiratory compensation
b. Non compensatory metabolic acidosis with respiratory alkalosis
c. ..
d.
e. None of the above
62- 3-day infant presented with bilious vomiting and abdominal distention ..
what is the most likely cause:
a. Duodenal atresia
b. Malrotation
c. Jejuna valvulus
d. ..
e. ..

63- 8-month boy with lethargy, abdominal distension and rectal bleeding with
jelly-like stools, what is true:
a. Appendicitis is suspected
b. Needs urgent surgery
c. Dont do surgery before 2 days colonoscopy
d. Barium enema is diagnostic and therapeutic
64- A colon polyp that is well-differentiated adenocarcinoma .. reaches the
muscularis but no further extension, what is the appropriate management:
a. Colonectomy
b. Segmental excision
c. Polypectomy
d. .
e.
65- All true about Mallory Wiess body, except:
a. Mostly massive and needs emergent surgery
66- What is true about the esophagus:
a. Barrets esophagous has 40 fold increase in developing
adenocarcinoma
67- Multi tract producing pus is present in :
a. Furuncle
b. Carbuncle
c. .
d. ..
e.
68- Micro calcification in the lower part of the breat is due to :
a. Fat necrosis
b. Atypical hyperplasia
c.
d. .
e.

69- Obstructing Sigmoid colon cancer with competent ilio-cecal valve, rupture
occurs most commonly in :
a. Hepatic flexure
b. Splenic fexure
c. Liver
d. Cecum
e. .
70- A pt. with fatigue .. have accidental mass in his adrenal gland . Whats
next:
a. Surgery
b. CT scan
c. Ultrasound
d. Biochemical tests
e. .
71- All of the following have malignant potential, except:
a. Duct ectasia
b. DCIS
c. Atypical hyperplasia
d.
e.
72- A man with penetrating neck injury .. the first step in management:
a. Airway maintenance
73- Not in Ranson Criteriae :
a. Lipase
74- All true about ultrasound of the thyroid, except:
a. Solid vs. cyst
b. Malignant vs. benign
c. The size of the nodule
d. The lymph nodes
e.

75- Pt. with diverticulitis .. the investigation is :

a. Barium enema
b. Colonoscope
c. CT scan
d. ..
e. .
76- What is true about diverticulosis:
a. Most commonly in the sigmoid due to increase lumen
b. True diverticulum
c. Most of pt. need surgery
d. .
e. .
77- Which of the following is a complication of anterectomy, except:
a. Early dumping syndrome
b. Late dumping syndrome
c. Bile gastritis
d. Steatosis
e. .
78- Most common complication of thyroglossal cyst:
a. Malignancy
b. Hyperthyroidism
c. Infection
d.
e. ..
79- All is true about MOF, except:
a. Sepsis is the most common cause in surgical patients
b. Hepatic insufficiency occurs early
c. Increase the mortality with the number of involved organs
d. .
e. .

80- AF with acute upper limb ischemia, what should you do:
a. Embolectomy
b. Heparin
c. ECG
d.
e.
81- The most important factor in preventing (or treating) Enterocutanous
fistula is:
a. Nutrition
b. Prevent abscess
c. Wound care
d. .
e. .
82- About colon polyp . What is true:
a. FAP will develop colon cancer 100% if unresected
83- All true about gastric cancer except:
a. Familial type is autosomal recessive
84- All true about Gastroschisis, except:
a. Associated with other anomalies
85- All true about hyperparathyroidism, except:
a. Most of the patients develop renal stones ( mostly asymptomatic !)
b. 85% of the cases due to parathyroid adenoma
c. You should suspect parathyroid cancer when the Ca in more than
12 mmol/L and parathyroid hormone is increased
d. Recurrent is when it happen again after 6 months
e. The sestamibi Dye is best detecting ectopic parathyroid tissue
86- As regards Buergers disease, all are true except:
a. Exclusively in males.
b. Exclusively in smokers.

c. At earlier age than atherosclerosis.

d. Excellent distal run off on angiogram.
e. Affects veins as well.
87- Which is true about scrotal swelling:
a. Hydrocele may be inguino-scrotal
b. Transillumination in cancer
c. Sth about testicular appendix
d.
e.
88- Male with lesion in the lower lip for 4 months no lymph node:
a. Basal cell carcinoma
b. Squamous cell carcinoma
c. Herpes simplex virus
d.
89- The most common cause of fatal transfusion reaction:
a. Allergic reaction
b. Anaphylactic reaction
c. Clerk error
d. .
e. .
90- All of the following are risk factors for HCC, except:
a. Hepatitis B
b. Hepatitis C
c. Aphlatoxin
d. OCP
e. Smoking
91- Which of the following is true regarding liver lesions:
a. Adenoma is a true neoplasm and must be resected
b. Hemangioma is the most common lesion in the liver
c. FNH mostly presents as multiple nodules

d. FNH have increased rate of rupturing

e.
92- A 45-year old man underwent UGI endoscopy; he developed sudden
shortness of breath .. on examination there was crepitus sensation in the
neck, what should you do:
a. Observation only
b. Tracheal intubation
c. .
d.
e.
93- Most serious organisms after splenectomy:
a. Viral
b. Enteric bacteria
c. Encapsulated bacteria
d. ..
e. ..
94- A 24 year old male had trauma (RTA) . He is conscious but have
craniofascial fracture .. after 4 hours, he has vomiting confusion the
diagnosis is:
a. Acute epidural hematoma
b. Acute subdural hematoma
c.
d. .
e. .
95- Most common cause of urgent surgery in PUD:
a. Perforation
b. Obstruction
c. Bleeding
d.
e.

96- About preoperative .. all true except:

a. 24-hr ECG is useless to assess arrhythmias
97- What is the best management in a carcinoid tumor in the appendix:
a. Right hemicolectomoy if there is +ve lymph node or local invasion
b. RT hemicolectomy all the time
c. Only appendectomy always
d. Chemotherapy
e.

Static :
2 X-rays >>>>> one in erect position and the other in plain position
Melanoma vs. Basal cell carcinoma
4 Surgical instruments
Omphalocele vs. Gastroschisis
Ascites with obstructive jaundice
Hemorrhoid

.......