‫بسم هللا الرحمن الرحيم‬

General Surgery – 6th Year

April 26th, 2018
1- The most abundant collagen in wound healing is:
a. Type I
b. Type II
c. Type III
d. Type IV
e. Type V
Answer:

2- Which of the following is correct about Krebs cycle?

a. Pyruvate and oxaloacetate gives citrate
b. It can function anaerobically
Answer: A

3- Which of the following is the caloric needs for an infant?

a. 110 kcal/kg/day
b. 70 kcal/kg/day
c. 90 kcal/kg/day
d. 50 kcal/ kg/day
Answer: A

4- Which of the following is correct about the anatomy of the esophagus?

a. Recurrent laryngeal nerve injury cause hoarseness of voice but not dysphagia
b. Upper 1/3 of the esophagus has striated muscle and lower 2/3 had smooth muscles
Answer:

5- Orchidopexy causes?
a. Increase fertility
b. Decrease cancer
c. None of the above
Answer:

6- Which of the following is correct about undescended testes?

a. Laparoscopy is used if the testis is not palpable

7- Which of the following is the most common site of hernia in children?

a. Boys, right side
b. Boys, left side
c. Girls, right side
d. Girls, left side
e. None of the above
Answer: A
8- A 55-year-old patient presented with left lower abdominal pain, and he was treated with
antibiotics. 2 weeks later he presented with recurrent UTIs and pneumaturia, which of the
following is the underlying diagnosis?
a. Diverticular disease
b. Fistula in ano
c. Crohns disease
Answer: A

9- A patient presented with a burn of 22% TBSA, which of the following you should consider?
a. Tetanus booster
b. Tetanus toxoid
c. Topical antibiotics
Answer:
10-

11- P
a
t
i
ent presented to the ER, her eyes respond when you put pressure on her forehead, she speaks
incomprehensible sounds and has flexion withdrawal from pain, her GCS is?
a. 7
b. 8
c. 9
d. 10
e. 11
Answer: B

12- A patient who sustained a head injury presents to the ED with a BP of 80/60, what is the goal
of his systolic BP?
a. 80
b. 90
c. 100
d. 110
e. 120
Answer:

13- A patient presents with LUQ pain, after a motor vehicle accident, his BP is 80/50, what is the
next step in management?
a. Laparotomy
b. CT scan
c. Abdominal X-ray
Answer: A
14- Neonates with NEC may demonstrate all of the following findings on abdominal films except:
a. Pneumatosis intestinalis.
b. Portal vein air.
c. Pneumoperitoneum.
d. Colovesical fistula.
e. Fixed and thickened bowel loops.
Answer: D

15- Which is incorrect about NEC?

a. Always requires surgery

16- Which of the following is correct about congenital pyloric stenosis?

a. Bilious vomiting
b. Presents from 6-12 months of age
c. Associated with metabolic alkalosis
Answer: C

17- Most common type of skin cancer is?

a. Superficial spreading
b. Nodular
c. Lentigo maligna
Answer: A

18- A newborn infant develops coughing, choking and cyanosis with his first feeding. He is noted
to have excessive drooling. What are the important associated anomalies that must be
screened for prior to surgical intervention?
a. Right-sided aortic arch
b. Hydrocephalus
c. Genitourinary obstruction
d. Congenital heart disease
Answer: C

19- There is an emerging consensus that the surgical repair for congenital diaphragmatic hernia is
best done:
a. Emergently at the bedside, eliminating the risks of transporting an unstable neonate
b. While on extracorporeal membrane oxygenation
c. When the infant is potentially extubatable
d. Within the first 48 to 72 hours of life
Answer: C

20- A 3-week old infant has a barium upper gastrointestinal series to evaluate vomiting. The
duodenojejunal flexure is found to be to the right of the midline as well as more caudal and
 anterior than a normal ligament of Treitz. The child is seen to reflux barium spontaneously to
the level of the mid-thoracic esophagus. You would recommend which of the following?
a. Barium enema
b. Emergency laparotomy
c. A trial of H2, blockade and cisapride therapy
d. Upper gastrointestinal endoscopy
e. Overnight pH probe analysis
Answer: B

21- A 1500-gram, 30-week gestation neonate is fed at 2 weeks of age. He develops abdominal
distention, bilious vomiting and guaiac-positive stool. A plain film of the abdomen
demonstrates pneumatosis intestinalis. Which of the following related statements are true?
a. An emergency barium upper GI series should be done to rule out malrotation
b. The child should have a nasogastric tube placed, broad spectrum intravenous antibiotics
begun, and sequential abdominal films obtained.
c. The likelihood of intestinal perforation is more than 50%
Answer: B

22- Patients with Wilms’ tumors most frequently present with which of the following?
a. Bilateral metachronous lesions
b. Bilateral synchronous lesions
c. An extrarenal primary
d. A multicentric primary lesion
e. A unifocal, unilateral lesion
Answer: E

23- Answer: C

24-
25-
26-
A
n
s
w
e
r
 :B

27- Gastroschisis defect is located:

a. On the right of the umbilicus

28- A physician is conducting a case control study on osteoporosis, which of the following is
correct about case control studies when compared to cohort?
a. Provides more information about different outcomes
b. Good for studying rare risk factors
c. Good for establishing the incidence rate
Answer: A

29- A 70-year-old male patient is evaluated for knee pain, and was found to have a 1.5 popliteal
aneurysm, what is the appropriate management?
a. Aspirin
b. Clopidogrel
c. Aspiring + Clopidogrel
d. Surgery
Answer:

30- A patient with atrial fibrillation, currently on digoxin, presented with right arm pain. On
examination there is decrease pulses, what is the next step in management?
a. Doppler U/S
b. Embolectomy
c. Heparin
Answer:

31- Which of the following is incorrect about appendicitis?

a. Somatic pain is unilateral and carried by A fibers
b. Visceral pain is bilateral and carried by C fibers
c. CT scan is used in children and women to effectively diagnose appendicitis
Answer: C

32- Which of the following is incorrect about appendicitis?

a. Visceral pain causes localized peritonitis
33- A patient from a rural area, presented with RUQ pain, and was found to have multiple cysts in
her liver. She underwent surgery, where she became hemodynamically unstable and passed
away. Which of the following is her cause of death?
a. Anaphylaxis

34- A patient presented with anaphylaxis, with low BP. What is the management?
a. IM epinephrine

35- All of the following criteria are used in Irie/glascow criteria for pancreatitis except?
a. Amylase
b. Albumin
c. Calcium
Answer: A

36- An increase in the volume of any one of the three components (brain, blood, CSF) must be at
the expense of the other two beyond the autoregulation. This principle is called?
a. Monro hypothesis
b. Monro Kellie doctrine
Answer: B

37- A patient was diagnosed with cecal cancer, which of the following would use to follow up?
a. CEA
b. CA19-9
c. CA125
Answer: A

38- Which of the following is not an indication for fibroadenoma resection?

a. Age >35
b. Positive family history of breast cancer
c. Patients desire
d. Size > 3 cm
e. Other answer
Answer: E

39- Which of the following is not a risk factors for breast cancer?
a. Smoking
b. Low bone density
c. Family history of breast cancer
Answer: B

40- Which of the following is not true about crush syndrome?

a. Also called rhabdomyolysis
b. Hypercalcemia is present
 c. Hyperkalemia, hyperuricemia, and renal failure are present
d. There is associated motor and sensory loss
Answer: B

41- Management of incidental duodenal ulcer?

a. Biopsy
b. Antibiotics
Answer: B

42- Which of the following is incorrect about H.pylori?

a. Never present in normal population

43- Previous question was repeated twice

a. Never present in normal population

44- A patient presented with intestinal obstruction, there was a mass found at the ileocecal valve
which has 85% cholesterol component, which of the following is consistent with the
diagnosis?
a. Air in biliary tree (this is gallstone ileus)

45- Which of the following is more common in Crohns rather than ulcerative?
a. Gallstones
b. Erythema nodosum
Answer: A

46- Which of the following is correct about anal fissure?

a. Occurs laterally
b. Occurs with diarrhea
c. I don’t remember the rest of the answers
Answer:

47- Which of the following is correct about dumping syndrome?

a. Can be treated with somatostatin analogs
b. Flushing and tachycardia can occur
c. Always present with diarrhea
d. After vagotomy, there could be diarrhea (not sure of this option)
Answer:

48- Which is correct about the anatomy of the inguinal canal?

a. The upper border is made up from the internal oblique and the transversalis fascia
b. The lower border is made from the external oblique aponeurosis
c. It is oblique in infants
d. The upper border is made up from only the external oblique aponeurosis
 Answer:

49- A patient has lost 800 cc of blood, what classification of hemorrhagic shock is this?
a. I
b. II
c. III
d. IV
Answer: B

50- Which of the following is a characteristic of femoral nerve injury?

a. Loss of knee reflex
b. Loss of knee flexion
c. Loss of hip abduction
d. Loss of hip adduction
Answer: A

51- The most common ovarian tumor in children is?

a. Teratoma
b. Dysgerminoma
c. Germ cell tumor
d. Epithelial tumor
Answer:

52- A patient presented with hemothorax, a decision was made to insert a chest tube. Where
would you insert the chest tube?
a. Anterior to mid axillary line, 5th intercostal space

53- All of the following are causes of malabsorption except?

a. H pylori
b. Mesenteric ischemia
c. Crohns disease
d. Celiac disease
Answer:

54- Which of the following is true about MALToma?

a. Strongly associated with H.pylori
b. Low grade tumors require surgical resection
Answer: A

55- Which of the following is true about breast cancer?

a. Black patients have worse prognosis than white patients
b. Breast edema occur only due to cooper’s ligament invasion
 Answer:

56- Which of the following is True about breast cancer?

a. Stage for stage, males have worse prognosis than females
b. Don’t remember rest of the options

57-

58- W
h
i
c
h
of the following is not a risk factor for atherosclerosis?
a. Hypertension
b. Smoking
c. HRT
Answer:

59- Which of the following is correct about hyperventilation?

a. Can occur in response to cerebral injury
b. Lowers PH
c. Increase PCO2
d. Lowers O2
Answer:

60- A 6-month-old child presented to the ED, his parents say that he fell from the chair while he
was sitting. On examination there is a boggy mass on his skull, but remainder of examination
is unremarkable. What is the best next step in management?
a. Head CT
b. Discharge and follow up in the clinic
c. Discharge and report to the police and child protective services
d. Confront the patients that you are suspecting child abuse
Answer:

61- Which of the following is correct about colonic tumors?

a. It is difficult to treat
b. We only use chemotherapy if there is metastasis
c. If there is an invasion to the muscularis, it carries a worse prognosis
Answer:
62- All the following are used in managing a patient with gastric outlet obstruction who presented
with vomiting, except?
a. NG tube
b. IV hydration and electrolytes replacement
c. Endoscopy and biopsy
d. PPIs
Answer:

63- Which of the following is correct about obstructive jaundice?

a. Indicates a stone in the common bile duct
b. Urine is dark due to conjugated bilirubin
c. Stool is pale due to decreased stercoblin
d. There is low LDH
Answer:

64- Which of the following is not in Charcot’s triad/ Reynolds pentad?

a. Palpable gallbladder

65- Which is true about bile?

a. Contains phospholipid

66- A 30-year-old patient presented with dysphagia of 2 years duration, she also lost weight
during this period, what is the initial step for management?
a. Barium swallow
b. Endoscopy
c. PH manometry
Answer:

67- Which of the following is incorrect about GERD?

a. The LES pressure is low
b. The UES pressure is high
c. There is more functional impairment if there is a longitudinal columnar epithelium
Answer:

68- A patient on TPN, presented with acalculous cholecystitis. What is the mechanism?
a. Loss of enteral stimulation of CCK

69- Which of the following carry a worse prognosis in neuroblastoma?

a. Age <1
b. Age >13
c. Absence of N-Myc amplification
Answer:
70- Which is true about the anatomy of the heart?
a. The ascending aorta is completely encased with the pericardium
b. The pulmonary artery is anterior to the aorta
c. I don’t remember the rest
Answer: ?

71- Which of the following is a criterion for brain stem death?

a. GCS of 3
b. No spontaneous ventilation
c. No response to epinephrine
Answer: B

72-

73- W
h
i
c
h

is true about colon cancer?

a. Sporadic is more common than familial

74- Duodenal atresia is associated with which of the following?

a. Trisomy 21

75- Which of the followings statements regarding an infant with meconium ileus are true?
a. There is a high probability that he will have cystic fibrosis

76- How to diagnose Hirschsprung’s disease is?

a. Rectal biopsy

77- Which of the following cause dilated toxic megacolon?

a. Crohns disease
b. Hirschsprung disease
Answer:

78-
79-

80- Which is the most common cause of bloody nipple discharge?

a. Intraductal papilloma

81- Which of the following is correct about undescended testes?

a. Associated with malignancy

82- Specifically, the question was about squamous cell carcinoma of the lung.

83- Which of the following is correct about extradural hematoma?

a. Does not cross sutural margins

84- Patient came to the ER following RTA, he can’t feel anything from the nipple down, the spinal
injury is at what level?
a. T4
b. T5
c. T6
d. T7
Answer: A

85- In a specific population, they found out that moldy grains induce P53 mutations, this increases
the risk of which of the following cancers?
a. Liver cancer

86- Which of the following is present more extracellularly than intracellularly?

a. Sodium
b. Potassium
c. Magnesium
d. ATP
e. AMP
 Answer: A

87- Which of the following is false in diverticulosis?

a. Most commonly in sigmoid colon
b. It is false diverticula
c. Contains 2 ectopic tissues
Answer: C

88- Which of the following is wrong about appendicitis?

a. Alvarado is not typically done to establish the diagnosis
b. Psoas sign is elicited with hip flexion
Answer:

89- A 70-year-old patient presented with recurrent episodes of transient vision loss, his pulse is 90
and regular. What is the next step in management?
a. Doppler Ultrasound of the carotids
b. Echocardiography
c. ECG
Answer: A

90- What is true about compartment syndrome?

a. Passive flexion of the leg elicits pain
b. Rarely requires surgery
Answer: A

91- Which of the following differentiates crohns from ulcerative colitis on sigmoidoscopy?
a. Presence of granuloma

92- GFR in a newborn compared to adult is?

a. 60% more
b. 30% more
c. 30% less
d. 60% less
e. The same as an adult
Answer: