2019

Recalls

September 2019 MRCS I.V.

 MRCS I.V. Course

Sep 2019
1. A Child with kwashiorkor developed hepatomegaly. What is the deposit in liver?
A. Sarcoid
B. Melanin
C. Lipofuscin
D. Amyloid
E. None of the above

2. Patient had left iliac fossa pain and rectal bleeding. He was subsequently diagnosed with
sigmoid cancer. A decision was taken to embolize the responsible vessel. At which level does it
branch from aorta?
A. L1
B. L3
C. L5
D. L4
E. S1
3. TM joint is considered:
A. synovial bicondylar hinge joint
B. synovial ball and socket
C. synovial plane s
D. synovial pivot joint
E. none of the above

4. A 71-year-old lady trips over and falls landing on her left shin. She sustains a large pretibial
laceration of her leg leaving a dirty wound with rugged flap edges. What is the appropriate
wound management?
A. Immediate split thickness skin graft
B. Delayed split thickness skin graft
C. Primary closure
D. Delayed primary closure
E. Randomized free flap

5. leg burn with deep wound ulcer 7 X 9 cm with tibia exposed. What is the best management?
A. secondary intention
B. simple suture
C. immediate split thickness graft
D. delayed split thickness graft
E. flap
6. Caucasian girl with splenomegaly, jaundice and increase bilirubin level
A. Spherocytosis
B. Sickle cell anemia
C. Intermittent porphyria
D. G6PD
E. Hemophilia

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7. child with hydrocele, fluid accumulates in which layer

A. tunica vaginalis
B. tunica albuginea
C. superficial inguinal pouch
D. deep inguinal ring
E. none of the above

8. Recurrent pulmonary embolism despite of heparin use

A. LMWH
B. LMWH and stocking
C. Stocking
D. vena cava filter
E. None of the above

9. Bluish colored fluctuant swelling under tongue:

A. Ranula due to sublingual gland
B. small salivary gland tumor
C. submandibular gland tumor
D. thyroglossal cyst
E. branchial cyst

10. Weak sensation of lateral aspect of tongue after molar surgery.

A. Lingual n.
B. Glossopharyngeal nerve
C. Chorda tympani of facial nerve
D. Hypoglossal nerve
E. None of the above

11. What is the Cerebral perfusion pressure calculation if the BP 110/80 and ICP18.
A. 72
B. 86
C. 92.
D. 96
E. None of the above

12. The following cells depends on Cori cycle for 02 completely.

A. Hepatocyte
B. Erythrocyte
C. Muscle cell
D. Cardiac muscle
E. None above the above

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 MRCS I.V. Course

13. A patient had a dirty scalp laceration with no other skin loss. Management is:
A. wound excision and primary closure
B. simple suture
C. wound debridement with secondary intention healing
D. flap
E. none of the above

14. A man develops septicemia following surgery for perforated acute appendicitis He is
hypotensive. Arterial blood gases reveal: PH= (7.26) PaCo2= (7.2KPA) Pa02= (75 kPa).
Bicarbonate= (17 mmol/L) What is the most likely explanation for these readings ?
A. Compensated metabolic acidosis
B. Compensated respiratory acidosis
C. Mixed metabolic and respiratory acidosis
D. Uncompensated metabolic acidosis
E. Uncompensated respiratory acidosis

15. Hypercalcemia is firstly treated by

A. Iv saline chloride .9%
B. IV ca chelating
C. K supplementation
D. Pamidronate
E. Zoledronate

16. A case of suspected PE, what is the best investigation.

A. CTPA
B. VQ perfusion scan
C. Xray
D. ECG
E. D-Dimer

17. A 3 years child presented by hydrocele. Processes vaginalis comes from what structure
A. Peritoneum
B. Fascia transversalis
C. Internal oblique muscle
D. Cremasteric muscle
E. External oblique muscle

18. Which structure is opened during herniorrhaphy?

A. external oblique Aponeurosis
B. internal oblique muscle
C. conjoint tendon
D. fascia transversalis
E. peritoneum.

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19. Anterior relation of head of pancreas

A. Pylorus of stomach.
B. CBD
C. Portal vein
D. Aorta
E. IVC

20. Right testicular vein drains into:

A. IVC
B. Rt renal vein
C. Right suprarenal
D. Right iiac vein
E. None of the above

21. Torticollis which nerve responsible for muscle which causing this Or Nerve supply of
sternocleidomastoid muscle?
A. Glossopharyngeal
B. Trigeminal
C. Vagus nerve
D. Spinal accessory nerve.
E. None of the above

22. What is the parasympathetic ganglion that supply the lacrimal gland?
A. geniculate ganglion
B. Pterygopalatine ganglion
C. Otic ganglion
D. Submandibular ganglion
E. None of the above

23. A man with prostatism, On PR, posterolateral ridge on palpation. What structure?
A. Sacrospinous ligament
B. Puborectalis muscle
C. Ischiorectal fossa
D. Obturator internus muscle
E. None of the above

24. On PV examination, you feel something in front at the level of Cervix

A. base of bladder
B. dome of bladder
C. Rectum
D. Uterus
E. None of the above

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25. A man with BP 200/100 and potassium 2.1. What you expect to be found in his investigation?
A. High aldosterone
B. high cortisol
C. low ACTH
D. High urinary catecholamines.
E. High calcitonin level

26. A man with RTA had 10/15 GCS and also taken unit blood transfusion now has low platelet,
normal APTT, low fibrinogen and high PT? What is the diagnosis?
A. DIC
B. Deficiency of anti-thrombin III
C. Thrombin deficiency
D. Factor 5 leyden
E. None of the above

27. A man underwent esophagogastrostomy for cancer esophagus. Post-operative period he lost
significant weight . what should you do?
A. TPN
B. Nasogastric tube feeding
C. Intraoperative jejunostomy
D. Gastrostomy
E. None of the above

28. A patient with cervical lymphadenopathy was investigated and FNAC suggested squamous Cell
carcinoma. Clinical examination and upper tract endoscopy were normal. What should be the
next line of investigation?
A. CT
B. MRI
C. FDG Pet CT (PET CT scan)
D. MRI of whole body
E. Radio-isotope investigation

29. What is the parasympathetic ganglion that supply the lacrimal gland?
A. geniculate ganglion
B. Pterygopalatine ganglion
C. Otic ganglion
D. Submandibular ganglion
E. Satellite ganglion

30. A young boy with sudden mildly tender swelling in dorsum of wrist
A. ganglion cyst
B. lipoma
C. aneurism
D. neurofibroma
E. sebaceous cyst

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31. A woman noticed blood spot in the pants with revealed inguinal lymph nodes. what is the
Origin?
A. Vulva
B. Cervix
C. Body of Uterus
D. Fundus of uterus
E. None of the above

32. ECG changes in pulmonary embolism

A. ST elevation in V1V2V3
B. Wide QRS
C. Inverted T in V1V2V3
D. Hyperacute T wave
E. Left ventricular hypertrophy

33. Level of lumbar cistern CSF fluid?

A. L1
B. L2
C. S1
D. S2
E. T12

34. RTA patient admitted after observation then discharged by giving treatment. 10 days later
came with abdominal discomfort especially after eating, it became worse. What is the cause?
A. Diaphragm rupture
B. diaphragmatic hernia
C. curling ulcer
D. acute gastric dilatation
E. esophageal perforation

35. Recurrent DVT despite of heparin. What is the best prophylaxis?

A. LMWH
B. LMWH and stocking
C. Vena cava filter
D. Warfarin long term
E. None of the above

36. Patient with IV fluid having warming device attached during surgery which hormone secretion
decrease?
A. TSH
B. ACTH
C. ADH
D. Cortisol
E. Catecholamine

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37. The "fight or flight", response produces a release of epinephrine (adrenaline). What is the
primary metabolic effect of epinephrine?
A. Alanine shunt activation
B. Cortisol release
C. Glycolysis
D. Tachycardia
E. Vasoconstriction

38. All are true about Bell's palsy except:

A. Dropping of the eye lid
B. Dryness of the eye
C. Dropping of the mouth
D. Pain in the ear
E. Numbness of cheek

39. 4 Month child with failure to thrive with recurrent chest infection and dyspnea increase with
lying flat in the night and awake him from sleep
A. TOF
B. Congenital diaphragmatic hernia
C. Asthma
D. GERD
E. None of the above

40. 1-day neonate presented by bilious vomiting and scaphoid abdomen

A. Esophageal atresia
B. CHPS
C. Duodenal atresia
D. HSD
E. Volvulus

41. Position of CBD papilla opening in duodenum in ERCP?

A. anterior & medial,
B. anterior & lateral
C. posterior and medial
D. posterior & lateral
E. none of the above

42. A patient with ureteric colic, pain radiates into loin to groin-Why? Which dermatome?
A. T11 to L1
B. T12
C. L2
D. L2-3-4
E. S2-3-4

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43. What is not included in enhanced post op program:

A. Carbohydrate drink 2 hours before.
B. Intra operative antiemetics.
C. Preoperative diazepam
D. Early postoperative ambulation
E. Early removal of drains

44. In obstetric surgery, Pfannenstiel's incision was made. which structure is divided?
A. Rectus abdominis
B. arcuate ligament
C. external oblique
D. posterior rectus sheath
E. none of the above

45. Irritability, muscle twitching in postoperative period of thyroidectomy

A. hypocalcemia
B. hypokalemia
C. hyponatremia
D. hypercalcemia
E. hyperkalemia

46. A child with distended abdomen, pain, vomiting, groin swelling...

A. Indirect Inguinal hernia
B. Direct inguinal hernia
C. Hydrocele
D. Undescended testis
E. None of the above

47. Deep inguinal ring found in:

A. Fascia transversalis
B. Internal oblique muscle
C. Cremasteric muscle
D. External oblique muscle
E. None of the above

48. Action on which of the following receptor is responsible for the depressant action in an old
man who underwent laparotomy and is on Morphine with RR of 6/min?
A. Mu receptor
B. Delta
C. Dopamine
D. Serotonin
E. None of the above

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49. A patient with bee sting suddenly developed shock. Which first?
A. IM adrenaline
B. IV hydrocortisone
C. IV antihistamine
D. Prednisolone
E. IV fluids

50. A 42-year-old multiparous woman is admitted to the Emergency Department due to pelvic
discomfort. The duty gynecologist diagnoses uterine prolapse. Which anatomical structure
gives significant direct support to the uterus?
A. Cervical ligaments
B. broad ligament
C. Round ligaments
D. Transverse perineal Muscles
E. None of the above

51. Origin of Rt Coronary artery from:

A. anterior aspect of ascending aorta above valve
B. right posterior aspect of ascending aorta above valve
C. inferiorly below cusp of aortic valve
D. aortic arch
E. none of the above

52. A girl had mastoid abscess. Spread of infection to

A. sagittal sinus
B. sigmoid sinus
C. superior sagittal sinus
D. internal ear
E. none of the above

53. Patient with HB 9gm%. plan for surgery after 6wk what is preferred?
A. blood transfusion
B. IV iron
C. oral iron
D. Folic acid
E. none of the above

54. Closure of the tricuspid valve occurs at the onset of which phase of the cardiac cycle?
A. Isovolumic relaxation
B. Rapid and reduced filling
C. Rapid and reduced ejection
D. Isovolumetric contraction
E. None of the above

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55. A 26-year-old man is admitted to the Emergency Department with multiple peripheral
fractures. He is clinically shocked. Which is the structure responsible for the first hemostatic
response to a fall in systemic arterial blood pressure?
A. Adenohypophysis
B. Baroreceptor
C. Chemoreceptor
D. Renin
E. Neurohypophysis

56. Gastrin release is increased by:

A. Adrenaline
B. Glucagon
C. Calcitonin
D. Acetylcholine
E. None of the above

57. A previously healthy young male wakes up in the morning with sudden SOB with fall in spo2
low BP ,tachycardia and absent breath sounds on the left side what is the probable diagnosis
A. spontaneous pneumothorax
B. Pneumonia
C. Pleural effusion
D. Hemopneumothorax
E. pericardial effusion

58. A man with left loin colicky pain. Imaging show stone impaction at the Vesicoureteral junction
Where it is visible?
A. Ischia tuberosity
B. Ischial spine
C. Sacroiliac joint
D. L2-5 transverse process
E. None of the above

59. Male patient admitted in ICU after RTA. He was intubated as his GCS 7 with admission,
monitor showing rapid decrease in po2 after leg movement what is the cause of this condition
A. Pneumothorax
B. Spinal cord injury
C. Slipped endotracheal tube
D. Respiratory center depression
E. Cardiac tamponade

60. Facial injury cause numbness in cheek and upper 3 teeth. Which nerve is affected?
A. Supratrochlear
B. Supraorbital
C. Infratrochlear
D. Infraorbital
E. None of the above

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61. Unique features of axis vertebrae.

A. bifid spinous process
B. carotid tubercle(C6)
C. no transverse process
D. no spinous process
E. none of the above

62. what is true about the ureter?

A. Ureter passes below aortic bifurcation
B. Ureter passes above uterine artery
C. Ureter is medial to gonadal vessels
D. Ureter is lateral to gonadal vessels
E. All of the above

63. 55 years old male will go for total knee arthroplasty and you need a Tourniquet application to
have a bloodless field to which level you will adjust the Tourniquet pressure?
A. Above the mean arterial pressure
B. Above systolic blood pressure
C. Equal to the mean arterial pressure
D. Above diastolic arterial pressure
E. None of the above

64. Which type of lymphoma is associated with coeliac disease?

A. T-cell lymphoma
B. B- cell Lymphoma
C. Burkitt's lymphoma
D. Mantle cell lymphoma
E. None of the above

65. Which statement relating to the peri operative management of patients with diabetes mellitus
is false?
A. They should be placed first on the operating list
B. An intravenous sliding scale should be used in all cases
C. Potassium supplementation is likely to be required in diabetics on a sliding scale
D. Electrolyte abnormalities are more common after major visceral resections
E. None of the above

66. A female 30 years old, developed pain between 3rd and 4th toes with no history of trauma. It is
elicited by vertical compression on metatarsal heads. What is the most likely diagnosis?
A. Stress fracture
B. Freiburg disease
C. Morton neuroma
D. Osteoarthritis
E. None of the above

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67. A patient developed acromioclavicular joint dislocation after trauma during rugby game. Xray
showed no fracture. What is the expected ligamentous injury?
A. Coracoacromial ligament injury
B. Coracoclavicular ligament injury
C. Deltoid ligament injury
D. Ligamentum teres injury
E. None of the above

68. What is the causative organism of septic arthritis in patients with sickle cell anemia?
A. Staph. Aureus
B. Strept. pyrogens
C. Salmonella
D. Neisseria
E. Pseudomonas

69. Which dermatome that supplies thumb and index fingers?

A. C6
B. C8
C. T1
D. C5
E. C7

70. A 36 years old heavy lifter

complained of back pain radiating to
his leg. MRI was ordered and result is
as shown in the picture. What is the
level of lesion?
A. L3-4
B. L4-5
C. L5-S1
D. L2-3
E. S1-1

71. A 53 years old female complained of

stitches and pain in her hands
especially at rest. Histology of the
lesion would probably show:
A. Needle shaped crystals
B. Rhomboidal crystals
C. Granulomatous necrobiosis
D. Apple green perfringens
E. Asteroid bodies

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72. A 56 years old male presented with painless hematuria, back pain with Xray showing multiple
osteolytic lesions in vertebrae alongside with Lung lesions. What is the most likely cause?
A. Small cell lung cancer
B. Prostatic cancer
C. Renal cell carcinoma
D. Neuroblastoma
E. Adenocarcinoma of the lung

73. A 45 years old man complained of pain in his knee. His lab investigation revealed Ca of 8.6 and
uric acid of 26 (N: 3.5-7). Histology of the knee aspirate would probably show:
A. Needle shaped crystals
B. Rhomboidal crystals
C. Granulomatous necrobiosis
D. Apple green perfringens
E. Asteroid bodies

74. A 53 years old man is due to undergo Cholecystectomy. His swap revealed that he is a nasal
carrier of MRSA. What is the most appropriate treatment?
A. Chlorhexidine Daily bath
B. IV vancomycin
C. Mupirocin nasal spray
D. IV rifampicin
E. Oral teicoplanin

75. A 12 years old boy was brought by his mother with a sudden onset scrotal pain, visible black
spot above testes. What is the most appropriate diagnosis?
A. Testicular torsion
B. Hematocele
C. Morgagni cyst torsion
D. Epidydimoorchitis
E. Varicocele

76. A patient is undergoing an inguinal hernia repair. Postoperatively, the patient has weakness in
his leg with lost extension of knee. Which nerve is affected?
A. Ilioinguinal nerve
B. Genitofemoral nerve
C. Femoral nerve
D. Obturator nerve
E. Sciatic nerve

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77. A 6 years old child presented with short left leg associated with knee pain for the last 3
months. What is the most likely diagnosis?
A. Perthes disease
B. Slipped femoral cap
C. Developmental dysplasia of the hip
D. Septic arthritis
E. Osteogenesis imperfecta

78. A 13-year-old obese child is brought by his mother with limited internal rotation. External
rotation to limb causes pain. What is the most likely diagnosis?
A. Perthes disease
B. Slipped femoral capitulum
C. Developmental dysplasia of the hip
D. Septic arthritis
E. Osteogenesis imperfecta

79. A 32 years old man sustained an elbow trauma during his work. His examination revealed
severe pain on extremes of pronation and supination. What is the most likely injured nerve?
A. Radial nerve
B. Anterior interosseus nerve
C. Posterior interosseus nerve
D. Median nerve
E. Ulnar nerve

80. A 35 years old male undergone open reduction and internal fixation for a complex tibial
fracture. Postoperatively, he became dyspneic, tachycardic with skin rash. What is the most
likely diagnosis?
A. Fat embolism
B. Pulmonary embolism
C. ARDS
D. Pulmonary infarction
E. Pneumonia

81. A 56-year-old man with chronic emphysema is on the high dependency unit (HDU), ten days
after anterior resection. He has developed acute shortness of breath' and hypotension): Which
of the following landmarks would be the most appropriate to use to obtain a femoral arterial
blood gas sample?
A. A point midway between the anterior superior iliac spine and the pubic tubercle
B. A point midway between the anterior superior iliac-spine and the pubic symphysis
C. A point midway between the greater trochanter and the pubic symphysis
D. A point 1 cm inferior and 4 cm lateral to the pubic tubercle
E. A point 2 cm lateral to the midway point between the anterior superior iliac spine and
pubic symphysis

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82. A 41 years old man was playing football when he felt sudden pain in the calf, he could not
continue the game. Squeezing on calf muscles produced no planter flexion. What is the most
likely diagnosis?
A. Biceps muscle rupture
B. Posterior cruciate ligament injury
C. Achilles tendon rupture
D. Gastrocnemius tear
E. Ruptured baker cyst.

83. A 32 years old man was playing football when he fell on his knee. The joint got swollen with
pain, so he was prescribed rest for 4 weeks. After 4 weeks of rest he returned to play again. He
felt the same pain and the joint got swollen. What is the most likely diagnosis?

A. Medial meniscus tear

B. Anterior cruciate ligament injury
C. Medial collateral ligament injury
D. Posterior cruciate ligament injury
E. Loose body ligament injury

84. What is the most accurate relation of median nerve with brachial artery in the arm?
A. Medial to it
B. Medial then anterior then lateral
C. Lateral then anterior then medial
D. Posterior to it
E. Deep to it

85. A man presented after painting of ceiling with shoulder pain. The pain is mainly during
movements of shoulder between 60-120 degrees. What is most likely diagnosis?
A. Subacromial bursitis
B. Supraspinatus tendinitis
C. Frozen shoulder
D. Shoulder dislocation
E. None of the above.

86. A 35 years old female with pruritus ani. Sellotape examination shows egg in stool. What is the
most likely causative organism?
A. Enterovirus vermicularis
B. Ascariasis
C. Entamoeba histolytica
D. Giardia lambia
E. Cryptosporidium

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87. During a pelvic surgery, A nerve was injured emerging from the lateral aspect of psoas major
causing lost sensation over the lateral aspect of the thigh. What is the corresponding nerve
root of the affected nerve?
A. L1-2
B. L2-4
C. L2-3
D. L3-4
E. L1-3

88. A 32 years old woman presented with perianal itching. Stool analysis showed cyst and worms.
What is the most appropriate treatment?
A. Mebendazole
B. Tinidazole
C. Metronidazole
D. Bithionol
E. None of the above

89. A middle age man with sub capital femoral neck fracture with minimal displacement. What is
the most appropriate management?
A. Internal fixation with nail
B. Internal fixation with plate
C. External fixation
D. Closed reduction and cast
E. Total hip replacement

90. A 32 years old man suffered RTA. On examination, there is a grossly open dirty comminuted
fracture of tibia. What is the most appropriate management?
A. Wound debridement and immediate external fixation
B. Wound debridement and internal fixation
C. Wound debridement and delayed external fixation
D. Closed reduction and cast

91. A 53 years old patient was admitted to ICU and received antibiotics. He subsequently
developed severe diarrhea with crampy abdominal pain. What is the appropriate treatment?
A. Oral vancomycin
B. Oral metronidazole
C. IV metronidazole
D. Oral mebendazole
E. None of the above
92. A patient suffered a trauma to his thigh leaving a dirty wound with lacerations. Several days
later the wound becomes infected with crepitations. Which Organism?
A. Clostridium deficile
B. Staphylococcus aureus
C. Streptococcus pyogenes
D. Clostridium perfringens
E. Bacillus anthracis

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93. A patient undergone perianal surgery in a Lloyd Davis position. After operation, She
complained foot drop which subsequently improved. What is the most likely cause?
A. Neuropraxia of common peroneal nerve.
B. Neuropraxia of tibial nerve.
C. Neurotmesis of common peroneal nerve.
D. Neurotmesis of tibial nerve.
E. Axonotmesis of common peroneal nerve

94. After varicose vein surgery, lateral part of foot became numb in a 40 years old female. What is
the most likely affected nerve?
A. Saphenous nerve
B. Tibial nerve
C. Sural nerve
D. Lateral cutaneous nerve of the thigh
E. None of the above
95. A 32 years old female came to clinic with a gradual onset swelling at the lateral aspect of knee.
She reports no history of trauma or family history. What is the most likely cause?
A. Meniscal cyst
B. Loose body
C. Medial meniscus tear
D. Chondromalacia patellae
E. Lateral collateral ligament injury

96. A 53 years old farmer presented with blood tinged dark spot with eschar on his hand dorsum
after injury. He is feverish and severely toxic. What is the most likely causative organism?
A. Streptococcus pyogenes
B. Bacillus Anthracis
C. Staphylococcus aureus
D. Clostridium perfringens
E. Bacteroides
97. A 32 years old man reported tingling sensation over the lateral 2/3 of the palm with weak hand
flexion. What is the most accepted causative trauma?
A. Scaphoid fracture
B. Hamate dislocation
C. Lunate dislocation
D. Distal radial fracture
E. None of the above

98. A 20-year-old male, with history of trauma to his groin 6 weeks ago, now presented with
irregular hard testicular swelling with fluid around it. The swelling trans-illuminated. He has
enlarged left supraclavicular lymph node. What is the most likely diagnosis?
A. Hydrocele
B. Hematoma
C. Teratoma
D. Torsion testis
E. Seminoma

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99. A 22-year-old female patient presented with bloody nipple discharge with no palpable masses
in the breast. What is the most probable diagnosis?
A. Intraductal papilloma
B. Duct ectasia
C. Fibro adenosis
D. Breast cancer
E. Paget disease
100. A 45-year-old lady with persistent creamy discharge from breast. What is the diagnosis?
A. Intraductal papilloma
B. Duct ectasia
C. Fibro adenosis
D. Breast cancer
E. Paget disease

101. A 53 years old Lady noticed an anterior neck swelling. She has a pulsatile mass located in her
forehead. What is the most likely cause?
A. Lymphoma
B. Medullary thyroid cancer
C. Follicular thyroid carcinoma
D. Papillary thyroid carcinoma
E. Thyroglossal cyst

102. A 53 years old man taking carbimazole for hyperthyroidism suddenly developed agitation,
tachycardia and elevated blood pressure upon emotional stress. What is the likely cause?
A. Carbimazole overdose
B. Hypothyroidism
C. Hyperthyroidism
D. Thyrotoxic crisis
E. None of the above

103. Female patient has Mediastinal mass biopsy taken from the mass which showing- Hassall
corpuscles what the most probably diagnosis?
A. Lymphoma
B. Follicular carcinoma
C. Schwannoma
D. thymoma
E. none of the above
104. During parathyroidectomy, the surgeon wants to identify the parathyroid gland, Frozen
section was done. What is the best answer describing the Frozen section??
A. Put the specimen on paraffin
B. But stain firstly then put the specimen
C. Using labeled fluorescence
D. Put cells on slide then stain with hematoxylin and eosin
E. Put the specimen in formaldehyde

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105. A young woman presented with breast cyst aspirated was done until become dry and
cytology showing NAD what is your management
A. Discharge No follow up.
B. culture of aspirated fluid
C. excision of cyst
D. benzidine test
E. take biopsy

106. A young woman with 2 cm size right thyroid swelling. Biopsy was taken and showing
papillary carcinoma with no metastasis. What is the best Treatment for this case?
A. Right hemithyroidectomy.
B. Subtotal thyroidectomy.
C. Total thyroidectomy
D. Total thyroidectomy with lymph node clearance
E. Radioactive iodine

107. A pregnant woman 6 weeks with presented with palpitation, heat intolerance and swelling in
her neck what is the best treatment for here ?
A. Propranolol
B. Thyroidectomy
C. Propylthiouracil
D. Carbimazole
E. Radioactive iodine
108. A 33-year-old lady presented with thyroid swelling in her neck and high calcitonin what is
your possible diagnosis?
A. medullary carcinoma
B. follicular carcinoma
C. papillary carcinoma
D. lymphoma
E. anaplastic carcinoma
109. A 33-year-old female patient has forearm wound. what is the most important component in
2nd phase healing?
A. Vitamin A
B. Vitamin B12
C. Hyaluronidase enzyme
D. Vitamin D
E. Vitamin C
110. A 23-year-old patient present to E/R department with Head trauma after examination he has
depressed fracture. What is your management?
A. Refer to neurosurgery
B. CT head within 2 hours
C. CT head within 8 hours
D. MRI brain
E. None of the above

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A
111. An 28 years old patient stabbed on right side posterior to axillary line, x ray showing
pneumothorax with fluid level. what is the best management?
A. Chest drain with suction
B. Needle Decompression
C. thoracentesis
D. Chest drain without suction
E. None of the above
112. A 53 years old woman presented with cervical LN, on examination, supraclavicular, axillary
and inguinal LN all enlarged. What is your possible Diagnosis?
A. Lymphoma
B. TB
C. Cancer breast
D. Adenocarcinoma in the lung
E. None of the above
113. A 16-year-old child presented headache and discharge from medial canthus of left eye what
is your possible diagnosis?
A. Ethmoidal sinusitis
B. Maxillary sinusitis
C. Carcinoma in ethmoid sinus
D. Carcinoma in maxillary sinus
E. One of the above

114. A man with Ca prostate. His mother and sister have Cancer breast, father healthy, what is
the genetic association of this condition?
A. P53
B. K-Ras
C. BRCA1 and 2
D. MYC
E. Sis

115. A 40-year-old man presented to hospital after RTA. His GCS was 10 and his C.T showing
crescent shaped lesion. What is the cause of this condition?
A. Chronic subdural hematoma
B. Subarachnoid hemorrhage
C. Intra ventricular hemorrhage
D. Brain concussion
E. acute subdural hematoma
116. A Man hits his head against door, then loses consciousness for 15 sec. Examined, found to be
ok. Management?
A. Discharge home with instructions on head injury,
B. Call neurosurgeon
C. Hospitalize only if old age
D. Brain CT
E. None of the above

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117. A female patient presented with thyroid swelling after examination her BP was 200/100
mmHg what is your Diagnosis?-
A. MEN IIA
B. Pheochromocytoma
C. Graves diseases
D. Medullary thyroid carcinoma
E. MEN IIB

118. A 55-year-old woman with increased TSH with Normal T4 and low T3 what is your Diagnosis?
A. primary hypothyroidism
B. Grave's disease
C. Secondary hypothyroidism
D. Sick euothyroid
E. Hyperthyroidism

119. woman with increased TSH with Normal T4 . what is your diagnosis?
A. primary hypothyroidism
B. Grave's disease
C. Secondary hypothyroidism
D. Subclinical hypothyroidism
E. None of the above

120. Female patient has a 3cm mass in her breast what is the Best biopsy method for this mass?
A. FNAC
B. Incisional biopsy
C. Excisional biopsy
D. Punch biopsy
E. Core biopsy

121. A 23-year-old female presented with solitary thyroid nodule what is the Best way to biopsy for
thyroid?
A. FNAC
B. Incisional biopsy
C. Excisional biopsy
D. Punch biopsy
E. Core biopsy

122. Male patient has in his investigations Urinary Bence Jones proteins (24h urine sample) what is
the most probably diagnosis?
A. Osteoblastoma
B. Myelofibrosis
C. Lymphoma
D. Leukemia
E. Multiple Myeloma

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123. A man has cervical, inguinal and axillary lymph node enlargement his pathology showing
Hodgkin lymphoma. Which cell in Lymphoma originate?
A. B cells
B. T cells
C. NK cells
D. Eosinophils
E. Neutrophils

124. A man has a wound in his leg What is the early response after injury
A. mast cells migration
B. eosinophils accumulation
C. cytokines release
D. N Killer cell release
E. Neutrophils

125. Which of the following is considered a positive test in cases of DVT?

A. Homan test
B. Hallux extension test
C. Babinski sign
D. Painful calf muscle on inversion or version
E. None of the above

126. DVT prophylaxis for patient with IHD and peripheral vascular disease:
A. Stocking
B. Unfractionated heparin 1000-unit hourly
C. LMWH
D. Stocking and LMWH
E. LMWH with pneumatic compression

127. DVT prophylaxis regarding patient with antithrombin 3 deficiency?

A. warfarin lifelong,
B. warfarin 3 or 6 months
C. IVC filter
D. LMWH
E. Stocking

128. A 46-year-old lady underwent Lap Cholecystectomy for chronic calcular cholecystitis, 1 months
later she presented by progressive unremitting jaundice with pale stool, dark urine what is the
most probable diagnosis?
A. Bile duct injury
B. Collection on the surgical bed of the gallbladder
C. Residual CBD stone
D. Acute pancreatitis
E. None of the above

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129. You are conducting a cross sectional study measuring BP in certain population, what is the type
of the data that you will obtain?
A. Ordinal
B. Nominal
C. Continuous
D. Discrete
E. None of the above

130. Male Patient 54 years has no past medical history complained from severe abdominal pain and
sudden shocked, he is diagnosed as ruptured abdominal aortic aneurysm, what is the best
action?
A. CT abdomen with contrast
B. Urgent laparotomy
C. Duplex ultrasound
D. Best supportive care without intervention
E. None of the above

131. Female patient 45 years old complained from ischemic manifestation in her lower limb with
distal gangrene in the toes, theses event occurs following AAA repair, what is the most
common cause of the gangrene?
A. Arterial embolism
B. Atherosclerosis
C. Propagated Thrombus
D. Foreign body aneurysm
E. Vasospasm following surgery

132. A case of gangrene of the toe, with absent distal pulsation on examination using Doppler USG
which type of wave do you expect to find?
A. monophasic with low flow velocity
B. triphasic doppler signal
C. biphasic with low velocity
D. monophasic with high velocity
E. biphasic with high velocity

133. Elderly patient is diagnosed as having abdominal aortic aneurysm, which is considered the
most common cause of this condition?
A. Atherosclerosis
B. Marfan’s syndrome
C. Thrombosis
D. Autoimmune disease
E. None of the above

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134. A case of intermittent claudication in the calf muscles with loss of pulse below knee only,
where is the most probable site of the arterial lesion?
A. SFA occlusion at the adductor canal
B. CFA before origin of profunda artery
C. External iliac artery
D. Anterior tibial artery
E. Internal iliac artery

135. An alcoholic man admitted with severe chest pain and hematemesis that occurs after vigorous
attack of vomiting. By examination he has crepitations in the anterior chest wall. What is the
most probable diagnosis?
A. Complete esophageal rupture
B. Mallory Weiss tear
C. Pneumothorax
D. Fracture ribs
E. None of the above

136. A patient presented with calf pain on walking 50 meter. Diagnosed as Claudication. Block of
which level is responsible?
A. Superficial femoral
B. popliteal
C. deep femoral
D. external iliac
E. profunda femoris

137. Male patient with left iliac fossa pain for the past 6 wks. with increased frequency of
defecation with attacks of fresh rectal bleeding. No significant weight loss. What is the likely
diagnosis?
A. Cancer sigmoid colon
B. IBD
C. Diverticulitis
D. Irritable bowel disorder
E. None of the above

138. A 56 patient after colorectal surgery. What investigation is done to rule out anastomotic leak.
A. CT with contrast
B. MRI
C. Barium Enema
D. water soluble double contrast enema
E. Colonoscopy

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139. A 10 years boy presented in RTA obviously internal hemorrhage mostly due to rupture spleen
and he is hemodynamically unstable, and you decide to procced for surgery, From whom you
will obtain your consent?
A. Consent the patient him self
B. Consent the parents
C. Proceed without consent
D. Two consultant consent
E. Apply to the court

140. A 27-year-old has had pancolitis for the last five years. Which one of these complications is the
least likely to develop?
A. Arthritis
B. Cholangitis
C. Iritis
D. Polyarteritis
E. Toxic megacolon

141. A 26-year-old patient with down’s syndrome, in need for appendicectomy, patient understand
all aspects of Surgery?
A. Consent the patient
B. Consent the parents
C. Cannot proceed
D. Proceed without consent
E. Apply to court

142. A 22-year-old male with motorcycle injury he is unstable, unconscious, and needs urgent
surgical operation, from whom you take the consent?
A. Consent the patient
B. Consent the parents
C. Cannot proceed
D. Proceed without consent
E. Apply for a judge to a court

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