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MCQ 2 PROFESSIONAL 3 2012/2013

1. Complications of blood transfusion include

a. Citrate toxicity T (anticoagulant used à hypocalcemia, hypomagnesium (binding)
à myocardial depression or coagulopathy)
c. Hemophillia F
d. Hepatitis A F (Hepatitis B and C, HIV, CMV, EBV)
e. Immunisation sensitization T (RH isoimmunization and incompatibility)

2. Match the following diseases and their tumour markers

a. testicular Ca - beta HCG T (choriocarcinoma)
b. colorectal ca - CEA T
c. prostate cancer - ??? (tapi bukan PSA la) F (must be PSA)
d. papillary thyroid ca - thyroglobulin T (papillary and follicular)
e. medullary thyroid ca - calcitonin T (associated with lymphadenopathy)

3. Gastric ca inoperable
a. invaded omentum F (invades omentum is T4, not stage 4) (inoperable depends
on the stage: stage 4 and recurrent)
b. N4 invasion F (no N4 in gastric ca, only till N3b)
c. Peritoneal seeding T (associated with poor prognosis and treated with palliative
d. involve submucosa F (invade submucosa; stage II maximum)
e. multiple metastasis to liver T (stage 4 inoperable; palliative)

4. Local management of gangrenous foot

a. daily foot bath F (risk of infection)
b. heating by heating pads F (further injury)
c. cooling by ice F
d. minor surgical toilet T
e. avoidance of pressure T (prevent blister and ulcers)

6. Venous thrombosis associated with

a) major orthopaedic surgery T (transient)
b) anti thrombin III deficiency T (inherited)
c) inhabitants in the equatorial countries F (khatulistiwa)
d) visceral neoplasm T (acquired)
e) polycythemia vera T
7. Hydrocele
a) is translucent T (usually bilateral and impalpable testis)
b) contains fluid that clots spontaneously F – serous fluid from visceral layer of tunica
c) communicate with peritoneal cavity T – in congenital (via patent processus vaginalis)
d) is complicated by metaplasia F – atrophy of testis; rupture; hematocele; infection;
hernia of sac
e) is associated with hernia – T hernia of hydrocele sac

9. Precancerous lesion of penis

a. penile leukoplakia T growth of keratin on skin/ mucus membrane; tendency to
become SCC
b. urethritis F
c. balanitis xerotica T- inflammatory condition of skin that affects the foreskin and the
glans / penile lichen sclerosus
d. chronic penile papilloma F
e. paraphimosis F(foreskin trapped behind glans penis)

10. Complications of TURP include

A. Hypernatremia F - hyponatremia
B. Bacteremia T
C. Bladder neck contracture T due to fibrosis
D. Retrograde ejaculation T
E. Urethral stricture T

11. Regarding bladder calculi

A. increase frequency of urination at night T – asymptomatic, suprapubic pain, dysuria,
intermittency, frequency, hesistancy, nocturia, and urinary retention
B. pain is felt at the tip of penis T – Other common signs- terminal gross hematuria,
sudden termination of voiding with some degree of associated pain referred to the tip of
penis, scrotum, perineum, back or hip
C. hematuria occur at the beginning of micturition F – terminal gross hematuria
D. 90% of the stone is radiopaque F – less calcium stones; 50% uric acid
E. can be treated with vesico-lithotripsy. T – perform endoscopically

12. Boundaries of inguinal canal

A. transverse abdominis muscle anteriorly F – roof
B. psoas muscle posteriorly F – transversalis fascia and conjoint tendon
C. rectus abdominis muscle superiorly F – aponeurosis and transversalis fascia
D. inguinal ligament inferiorly T – lacunar ligament ; iliopubic tract
E. ileopectineal ligament medially F

13. Umbilical discharge is associated with

Causes of umbilical discharge : Patent Urachus, Post laproscopic surgery umbilical discharge, Umbilical hernia with ulceration,
Umblical abscess, Vitelline umbilical sinus, Recurrent folliculitis, Advanced Ca GB, Pilonidal sinus

a) umbilical abscess T - pus

b) pilonidal sinus T – itching and discharge
c) adenoma F
d) patent urachus T - fibrous remnant of the allantois, a canal that drains the urinary
bladder of the fetus that joins and runs within the umbilical cord (most common) - urine
e) merkel's diverticulum F - vestigial remnant of the omphalomesenteric duct à umbilical

14. Regarding anal fistula

A) The internal opening of high type is above the dentate line T (high type is above
B) Perianal discharge is a presentation T – in chronic conditions
C) Antibiotic is a mainstay of treatment F (fistulostomy)
D) It is treated by ligation of inter-sphincteric fistula tract T
E) Diabetes Mellitus is a risk factor F

15. Anal incontinence causes:

· Congenital abnormalities such as spina bifida and myelomeningocele
· Anal surgery
· Medical conditions (diabetes mellitus, stroke, spinal cord trauma, and degenerative disorders of the
nervous system)
· Vaginal delivery
· Pudendal nerve injury

B.hyperthyroidism F – cause diarrhea
C.pudendal nerve neuropathy T – alcock canal (entrapment)
D.acute anal fissure F
E.proctalgia fugax F - severe, intermittent episodes of rectal pain that are self-limited.

16. Clinical features of acute appendicitis include

A) pain around umbilicus T
B) vomiting T
C) guarding & rigidity at RIF T
D) macroscopic hematuria F microscopic hematuria in pelvic appendicitis
E) +ve rovsing sign T

18. Effect of splenectomy

A) howell jolly bodies in peripheral blood T - histopathological findings of basophilic
nuclear remnants (clusters of DNA) in circulating erythrocytes
B) hyperthrophy of other splenunculi T
C) eosinophilia F
D) neutropenia F - neutrophilia
E) immunodeficiency T – asplenia is a form

19. Complication of intestinal anastomosis include (surgical procedure to establish

communication between 2 formerly distant portions of the intestine)
A : haemorhage T
B : stenosis T stricture
C : intussusception F
D : diverticulum F
E : atresia F -Prolonged functional ileus; leak; infection (Medscape)

20. Regarding esophageal variceal

A-restricted to esophagus T – lower part of oesophagus
B-demostrate by portography F – resectability of hepatic lesion
C-demostate by OGDS T
D-tx by sclerosing injection T
E-related to liver cirrhosis T

21. Common bile duct stone are excreted by means of

a. cholecystectomy Tif no facilities of ercp, do laparoscopic cholecystectomy with cbd exp.
c.sphincterotomy T
d.exploration of common bile duct T
e.choledochoscopy TSuccessful stone extraction with the choledochoscope can be achieved in 75% to 95% of
the cases with a morbidity less than 5%. Using this technique, the surgeon can improve the cost benefit of bile duct

22. Papillary carcinoma of thyroid

A. more in men F (young female, chinese)
B. slow growing T
C. is TSH sensitive F
D. takes up iodine T
E. arise from parafollicular cell F (follicular cells)
23. Hemangioma of liver common in female and congenital
A-most common benign tumor T (8-10%)
B- asymptomatic T
C-diagnosed by FNAC F (avoid biopsy – it can cause rupture)
D-non compressible F (compressible)
E-complicated by haemorrhage T (haemorrhage if trauma)

24. Stage 3 breast cancer is characterized by

A. Tumor size of 2 cm F (>5cm)
B. Fixed ipsilateral axillary nodes T
C. Presence of distant metastasize F (stage 4)
D. Adherence of tumor to underlying muscle T
E. palpable ipsilateral supraclavicular lymph nodes T

25.Regarding liver abscess

A. E.histolytica is a causative organism T(amoebic)
B. Right hypochondriac pain is a common presentation T(capsular stretch)
C. Jaundice is a late symptom T (common in pyogenic)
D. Ruptures is one of its complication T (amoebic)
E. open drainage is one of the treatment choice T if more than 3cm open if rupture,
multiloculation, other pathology (biliary)

26. Causes of lower GI bleeding

A. Angiodysplasia T (colon or rectum)
B. Polyps T (colon or rectum)
C .Thrombosed piles F
D. Anal fissures T
E. Colon cancer T (PR bleeding + change in bowel habit + colicky abdominal pain =
colorectal CA until proven otherwise)

27. Obstructive jaundice is caused by

A. Periampullary Ca T
B. pseudocyst pancreas T (pseudocyst majority arise from body and tail) (choledochal
cyst can cause obstructive jaundice)
C. Stone in Common Bile Duct T
D. stone in cystic duct F
E. Stricture of Common Bile duct T

28. Causes of acute urinary retention

A. Retroverted gravid uterus F
B. Ureteric calculi F
C. Meatal stenosis F
D. Post hemorrhoidectomy T (swelling in the tissue or spasm of pelvic muscles)
E. Hysteria F (research found out AUR is not related to Hysteria)

29. Flail chest injury

A. Fracture of several adjacent ribs at 2 parts T
B. Causes paradoxical chest movement T
C. Causes left to right shunt F (right to left shunt??)
D. Endotrachial intubation needed for severe cases T
E. Indication for thoracotomy F (needle decompression=needle thoracostomy, indicated
in tension pneumothorax) (thoracostomy for massive hemothorax then thoracotomy)

30. Ruptured of spleen

A Abdominal distension T
B. Ladder appearance in X ray F (ladder appearance for small bowel obstruction)
C. Boas sign F (Boas sign is hyperaesthesia below the right scapula can be a symptom
in acute cholecystitis)
D. Deep breathing F (more pain on deep breathing)
E. Guarding T

31. Symptoms that related to carcinoma of sigmoid colon

A. Abdominal pain T
B. Per rectal blood T
C. Alternating bowel habit T
D. Repeated vomiting F
E. Tenesmus F (only lesion in the lower two third of rectum perceived as fecal mass
causing an unpleasant sensation of incomplete defecation)

33. Incisional hernia is related to

A. Infection T (post-op wound infection)
B. Anemia and malnutrition T poor healing
C. Post ileus T (obese patient tend to have ileus and pneumonia which increase risk of
incisional hernia)
D. Using non-absorbable sutures F (use of absorbable suture has higher risk of
incisional hernia)
E. Failure of techniques T

34. Long saphenous varicose veins

A. Cause DVT T
B. Cause femoral embolism F (femoral embolism= femoral artery occlusion)
C. Tredelenburg test positive T
D. Vein more marked at medial malleolus T
E. Due to incompetent of saphenofemoral valve T

35. Hirschsprung disease

A. Occurs in young adult F (usually present soon after birth, but can present in later
B. Proximal bowel is dilated T
C. The treatment of choice -- Duhamel procedure T
D. Associated with submucosal fibrosis F

36. Regarding sexual transmitted diseases

A The most causative bacteria is Chlamydia trachomatis T
B Genital herpes present with painless vesicles and ulcers F (painful)
C Chlamydia infection is treated with doxycycline T
D Human papilloma virus is associated with cervical cancer T
E infertility is a complication T

39. Regarding menopause

A. Universal median age is 56 years old F (universal: 51.4, Malaysia: 50.7)
B. Premature menopause is defined as menopause before the age of 40 years old T
(Premature menopause: ovarian failure that occurs before age 40. a/w smoking, living
at high altitude or poor nutritional status)
C. Follicular Stimulating Hormone estimates degree of ovarian reserve T (The most
commonly used test to assess this ovarian reserve is the day 3 FSH test)
D. Hot flushes is a common symptoms T
E. Osteoporosis is a long term complication T (other long term complications include
IHD, Alzheimer)

40. Regarding Polycystic Ovarian Syndrome

A. Hirsutism is one of the criteria T
B. Associated with increase insulin T
C. Obesity is a feature T
D. Cervical Ca is cx F (chronic anovulation à endometrial ca)
E. Clomiphene is first line ovulation induction agent T

41. Ectopic pregnancy

A. Commonest site is at corneal end T (tubal)
B. PID increase risk T
C. Tip shoulder pain suggest intraperitoneal blood collection T
D. positive cervical excitation T
E. Methotrexate is treatment for ruptured ectopic pregnancy F (surgery)

42. Regarding recurrent miscarriage

A. Defined as 2 or more miscarriage its succession F (>3)
B. Antiphospholipid antibodies is a cause T (karyotype abnormalities, uterine
abnormalities, hormonal changes, lupus anticoagulant, anticardiolipin)
C. Parental karyotyping is one of the investigations T (60% of recurrent miscarriage is
due to this)
D. Uterine abnormalities is diagnosed by hysterosalpingography F (two-dimensional
ultrasound scanning and/or hysterosalpingography can be used as an initial screening
test. Combined hysteroscopy and laparoscopy and possibly three-dimensional
ultrasound scanning should be used for definitive diagnosis; RCOG 2011)
E. Treat bacterial vaginosis reduce fetal loss T (treatment of bacterial vaginosis early in
the second trimester with oral clindamycin significantly reduces the incidence of second-
trimester miscarriage and preterm birth in the general population; RCOG 2011)

43. Regarding menorrhagia

A.Define as blood more than 60mL per day F (> 80mL per cycle or more than 1 week)
B.Von willebrand disease is a cause T (fibroid, adenomyosis, malignancy, bleeding
disorder, cervical ectropion, iucd, infection, drug)
C.Flooding suggest excessive bleeding T
D.Endometrial biopsy is indicated in woman more than 40 years old T (increased risk of
endometrial ca and hyperplasia)
E.MIRENA intrauterine system reduce blood loss T (levonorgestrel-releasing
intrauterine system which acts as a iucd and to treat menorrhagia as well)

44. Regarding endometriosis

A. Retrograde menstruation causes pelvic endometriosis T
B. Dyschezia is a presenting symptom T (pain on defecation) (dysmenorrhea, heavy or
irregular bleeding, pelvic pain, back pain, dyspareunia, dyschezia, dysuria, pain during
C. Peritoneal endometriosis is visualized by ultrasound F (TVS good for chocolate cyst,
laparoscopic surgery to view remain the most sensitive mode showing a powderburn
D. It causes chronic pelvic pain T
E. It regresses after menopause T (but can recur if on HRT)

45. Regarding gestational trophoblastic disease

A. It is prevalent of the extreme of reproductive age T (<20, >40)
B. Severe vomiting is a feature T (hyperemesis gravidarum)
C. Ultrasonography feature of snowstorm appearance is a characteristic of partial mole
F (snowstorm in complete mole)
D. COCP used immediately after suction and curettage F (Women with GTD should be
advised to use barrier methods of contraception until hCG levels revert to normal. Once
hCG level have normalised, the combined oral contraceptive pill may be used. There is
no evidence as to whether single-agent progestogens have any effect on GTN. If oral
contraception has been started before the diagnosis of GTD was made, the woman can
be advised to remain on oral contraception but she should be advised that there is a
potential but low increased risk of developing GTN. Intrauterine contraceptive devices
should not be used until hCG levels are normal to reduce the risk of uterine perforation,
RCOG 2010)
E. Beta hCG is checked after each pregnancy to exclude recurrence T (and checked
weekly and in 6 months after in reference range)

46. Regarding ovarian cancer

a. Late presentation is common T (mostly asymptomatic, so detect late)
b. It is associates with BRCA 1 gene T
c. CA-125 is an effective marker for screening F (it's not specific but is used in
screening together with TVS)
d. Dysgerminoma can be treated with radiotherapy T (radiosensitive)
e. Granulosa cell tumor causes postmenopausal bleeding T (excessive oestrogen

47. Regarding cervical intraepithelial neoplasia (CIN)

A. It is a premalignant condition of the cervix T
B. Chlamydia infection is a cause F (HPV)
C. It is a histological diagnosis T
D. Immunocompromised patient are at increased risk T (Sex at a young age, Multiple
sexual partners, Promiscuous male partners, History of sexually transmitted diseases,
E. Large loop excision of transformation zone is the treatment of CIN III T (local ablative
or excisional measures such as cryosurgery, laser ablation, and loop excision with
lifelong surveillance)

49. Regarding lactation

A. Prolactin stimulates milk ejection F (milk formation and secretion)
B. Oxytocin stimulates milk secretion F
C. Immunoglobulin A found in breast milk T
D. COCP suppresses lactation T
E. Exclusive breastfeed delay return menses T (6 weeks if no BF à 12 weeks in
exclusive BF)
50. Primary postpartum hemorrhage
A. Defined by blood loss more than 1500ml within 24 hours F (> 500mL within 24 hours)
B. Is a major cause of maternal death T
C. Multiple pregnancy is a risk T
D. Use of oxytocin in 3rd stage reduce the incidence T
E. Rush balloon is a treatment T

51. Regarding Instrumental Delivery

A. It can be performed when cervical dilatation has achieved 9cm F (full dilatation,
except 2nd twin)
B. Indicated in obstructed labour F
C. Perform when abdominal fetal head is 0/5 T
D. Forceps delivery may cause cephalohematoma T (more in ventouse)
E. Vacuum Delivery has higher failure rate than forceps T

52. Regarding normal physiological changes in pregnancy

A. Normal weight gain is 15-20kg F (11.5-16kg in normal Bmi mother)
B. Increment of uterus weight from 50g to 1000g T
C. Decrease in red cell mass F
D. Decrease in total peripheral resistance T (vasoD)
E. Delayed gastric emptying T (decrease in gastric motility)

53. Regarding Pre eclampsia

A. More common in multiparous women F (muti with different partners)
B. Due to incomplete trophoblastic invasion of spiral arterioles T
C. Epigastric pain is a feature T
D. HELLP syndrome is a complication T
E. It resolves with delivery T

54 Regarding gestational diabetes mellitus

A. Previous stillbirth is a risk factor T
B. Diagnosed with random blood sugar F (MOGTT)
C. UTI is common T
D. Is treated with metformin F
E. Is a risk factor for having type 2 DM in future T

56. Regarding IDA in pregnancy

Anemia define <10g/dl F(10.5-rcog, who-11)
A. MCV increase F (hypochromic microcytic anaemia)
B. Serum feritin reduced T
C. Oral iron therapy will increase Hb 1g/week F
D. Increased risk for PPH T

57. Regarding preterm delivery

A. Within 24-37 weeks T
B. Bacterial vaginosis is a risk factor T
C. Fetal fibronectin is used to predict preterm delivery T
D. Steroid use increase the risk of infection F
E. Bed rest is an effective treatment F

58. Polyhydramnios associated with

B. IUGR F (oligohydramnios)
C. Immunosuppression F
D. Amniocentesis on 15 weeks F (oligohydramnios)
E. Fetal neural tube defect T

59. Regarding placenta preavia

A. Higher risk in multiple pregnancies T
B. Painless haemorrhage is a common presentation T
C. Diagnosed at 32 weeks T (after 28 weeks) 28 to34 wks
D. Vaginal examination is contraindicated T
E. Postpartum haemorrhage is a complication T

60. Regarding CTG

A. A normal baseline fetal heart rate is between 110-160 bpm T
B. Variable deceleration is a normal response that occur when compression of fetal
head F
C. Late decelerations are suggest of fetal hypoxia T
D. It is used increase rate for obstetric intervention
E. Non-assuring CTG is an indication for fetal scalp sampling F (fetal scalp sampling in

61. Regarding IUGR

A. Associated with pre eclamsia T
B. Associated with chromosomal abnormality T
C. Single sympysiofundal height is reliable F
D. Associated with oligohydramnios T
E. Severe IUGR delivered via LSCS T

65. Regarding mechanism of labour

A. Fetal head descent in OP position. F
B. Internal rotation occur at the level of ischial spines T
C. Internal rotation happen due to resistance from pelvic floor muscles T
D. Restitution occur when fetal head realign with shoulder T
E. External rotation turns the fetal head’s occiput facing maternal’s left thigh F

66. Regarding labour

A. In active phase, average cervical dilatation rate in nulliparous is 1cm/hr T
B. 2nd stage last from full dilatation to delivery of fetus T
C. 3rd stage end with separation of placenta T
D. Normal 3rd stage is 30min T
E. Active management 3rd stage decrease PPH T

69. Regarding hepatitis B

a. DNA (incomplete question)
b. Elevated trasaminase T
c. Incubation periods 2 weeks F (The incubation period of the hepatitis B virus is 75
days on average, but can vary from 30 to 180 days; WHO 2015)
d. Spread by parenteral T
e. vaccination given to baby with high risk T (-people who inject drugs or have a
partner who injects drugs
-people who change their sexual partners frequently
-men who have sex with men
-babies born to infected mothers
-close family and sexual partners of someone with hepatitis B
-anyone who receives regular blood transfusions or blood products
-people with any form of liver disease
-people with chronic kidney disease
-people travelling to high-risk countries
-male and female sex workers
-people who work somewhere that places them at risk of contact with blood or body
fluids, such as nurses, prison staff, doctors, dentists and laboratory staff
-families adopting or fostering children from high-risk countries)

70. Episiotomy
A. Allow widening birth canal T
B. Mediolateral episiotomy practice in Malaysia T
C. Midline episiotomy less bleed compare to mediolateral episiotomy T
D. Done on crowning T
E. Must be performed for instrumental delivery F (not necessarily. “In the absence of
robust evidence to support routine use of episiotomy in operative vaginal delivery,
restrictive use of episiotomy, using the operator’s individual judgement, is supported”;
RCOG 2011)

71. Regarding spinal stenosis

A. Relieve by stooping position T
B. Majority need surgery F (first line is oral medications, physical therapy, and
corticosteroid injections)
C. Clinical symptoms minimal F
D. Pain refer to gluteal region T
E. Claudication is a hallmark T

72. Regarding peripheral nerve of upper limb

A. Clavicle fracture caused axillary nerve injury F
B. Carpal tunnel syndrome cause pointing finger F (numbness and tingling in radial 3
half digits)
C. Ulnar nerve neuritis caused by chronic cubitus valgus deformity T
D. Ulnar tunnel syndrome cause ulnar paradox F(ulnar nerve compressed at wrist)
E. Wrist drop due to tourniquet palsy T (Limb paralysis is also referred to as nerve paralysis or
tourniquet paralysis syndrome. When this occurs, all motor nerves distal to the cuff are affected, resulting
in a temporary or permanent inability to move the extremity. The radial nerve is the most common nerve
affected. Symptoms of tourniquet paralysis are: motor paralysis and loss of the sense of touch, pressure,
and proprioceptive responses)

73. Asymmetrical elbow triangle occur in

A. Fracture of proximal ulnar F
B. Elbow dislocation T
C. Lateral humeral condyle fracture T
D. Radial head fracture F
E. Olecranon fracture T

74. A fall from height causes

A. Calcaneal # T
B. Pylon # T (fracture of distal tibia involving articulating surface of ankle joint)
C. Tibial plateau # T
D. Neck of femur # T
E. Sacroiliac joint diasthesis F

75. Radiograph features of tuberculous arthritis

A. Marginal osseous erosion T (phemister’s triad- juxtaarticular osteoporosis,
peripheral osseous erosion, gradual narrowing of joint space)
B. Perseveration of joint space F (loss of joint space)
C. Periarticular osteoporosis T
D. Bony ankylosis F (fibrous ankylosis)
E. Calcification F

77. Features of osteogenesis imperfect in radiograph

a.increase radio-opacity F
b.shepherd crook deformity T
c.thin cortices T
d.thick growth plate F
e.multiple lytic lesion F

79. Regarding rheumatoid arthritis,

a. primarily affects articular cartilage T
b. associated with HLA-DR4 T
c. commonly affects women T
d. distal interphalangeal joint is commonest affected F (Proximal IPJ)
e. extra-articular involvement in 10-30% of cases T

80) Regarding congenital hip dislocation

A) common in girl than boy T
b) extended breech predisposed to DDH T
C) delayed in walking in neglected case ??
d) left more common than right side T
E) generalized ligament laxity predisposed to it T

81. Regarding assessment of difficult airway

a. mallampati II is at moderate risk F (moderate: Mallampati III ; Severe: Mallampati IV)
b. a history of rheumatoid arthritis pose significant risk F
c. receding mandible preclude difficult airway T
d. limited neck flexion is at high risk T
e. Down syndrome patient predispose to obstructed airway T

82. 80 kg man perioperative management

A. Daily fluid requirement is 4 litter fluid F
B. Urine output 40ml per hour T
C. Fluid maintenance 120ml/hour T

83. Analgesics available in suppository form

a. Lignocaine T
b. Paracetamol T

c. Morphine T
d. Diclofenac T
e. Fentanyl F (IV)

84. Preventive measures in ICU

A. Give pressure stocking for deep vein thrombosis T
B. Give Paracetamol for hyperthermia T
C. Give Antibiotic for infection prophylaxis T
D. Give H2 blocker for gatric stress ulcer T
E. Elevate head for pneumonia T

85. Kisselbach plexus blood supply

a.superior labile artery T
b.greater palatine artery T
c.anterior ethmoid artery T
d.sphenopalatine artery T
e.posterior ethmoid artery F

86. Ludwig angina

A. Is an infection at retropharyngeal space F
B. Is secondary to infected lower molar tooth T
C. Cause elevation of floor of mouth T
D. Present with interscapular pain F
Is diagnosed based on cervical radiography F