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Arab Board Orthopedic Exam June 2013
Arab Board Orthopedic Exam June 2013
A. Glomerulus
B. Proximal tubule
2-MEN 2A and MEN 2B syndromes are associated with germline mutations in:
A. The p53 tumor suppressor gene.
B. The H-ras gene.
C. The N-myc gene.
D. The RET proto-oncogene.
Answer: D
3-A 28-year-old male was injured in a motorcycle accident in which he was not
wearing a helmet. On admission to the emergency room he was in severe
respiratory distress and hypotensive (blood pressure 80/40 mm. Hg), and appeared
cyanotic. He was bleeding profusely from the nose and had an obviously open
femur fracture with exposed bone. Breath sounds were decreased on the right side
of the chest. The initial management priority should be:
A. Control of hemorrhage with anterior and posterior nasal packing.
B. Tube thoracostomy in the right hemithorax.
C. Endotracheal intubation with in-line cervical traction.
D. Obtain intravenous access and begin emergency type O blood transfusions.
E. Obtain cross-table cervical spine film and chest film.
Answer: C
4-. Which of the following variables best predicts prognosis for patients with a
recent diagnosis of cutaneous melanoma and no clinical evidence of metastatic
disease?
A. Breslow thickness.
B. Clark's level.
C. Ulceration.
D. Gender.
E. Celtic complexion.
Answer: A
5-Biologic features of adult soft tissue sarcomas include the following except:
A. Mutations of p53 in metastatic liposarcoma.
B. A low (less than 1%) risk of metastasis for small, low-grade lesions.
C. Recurrent disease in at least 33% of patients.
D. Lymph node metastasis in less than 3% of patients.
E. Mutations of p53 in Li-Fraumeni syndrome.
A
6. A new marker that has possible utility in the management of patients with non–
small-cell lung cancer (NSCLC) is:
A. Calcitonin.
B. Neuron-specific enolase.
C. CYFRA 21-1.
D. Glucagon.
E. Chromogranin A.
Answer: C
7-. The presence of which marker is a significant poor prognosis variable for patients
with breast cancer:
A. CEA.
B. C-erb B-2.
C. AFP.
D. Human chorionic gonadotropin (hCG).
E. RB-1.
Answer: B
8-. A 45-year-old man with long-standing gastroesophageal reflux undergoes upper
endoscopy that reveals patchy areas of epithelium resembling gastric mucosa
extending 5 cm proximal to the esophagogastric junction. Biopsies are obtained.
The pathologic report describes “Barrett’s epithelium”. Which of the following
processes does this finding represent?
a. Cellular hyperplasia
b. Cellular hypertrophy
c. Metaplasia
d. Carcinoma in situ
Answer: c
9- Patients that have acquired immunodeficiency syndrome are at increased risk for
which of the following neoplasms?
a. Colorectal cancer
b. Meningioma
c. Kaposi’s sarcoma
d. Hepatocellular carcinoma
e. Esophageal carcinoma
Answer: c
10- DNA viruses have been implicated as etiologic agents in several human tumors.
Evidence for a causative role exists for which of the following neoplasms?
a. Hodjkin lymphoma
b. Testicular carcinoma
c. Cervical carcinoma
d. Osteogenci sarcoma
e. Esophageal carcinoma
Answer: c
11- Which of the following statements about surgical anatomy of the colon and
rectum is/are correct?
A. The cecum has the largest inner diameter of all segments of the colon (13 to 15
cm.).
B The rectum is entirely an intraperitoneal organ.
C The ileocolic, right colic, and middle colic arteries are branches from the superior
mesenteric artery
C
Oral warfarin
Vitamin D deficiency
Primary hyperparathyroidism
Hypocoagulable state
15- when a patient with colonic pseudo-obstruction fails to improve after two doses
of neostigmin, the next step should be
Percutaneous cecostomy
Erythromycin administration
Colonscopic decompression
C. Excessive pain is the most common indication for re-laparoscopy less than 48 hours
17- a 45 year old man with a history of hepatitis C and cirrhosis presents for elective
cholecystectomy for symptomatic gallstones. The single best predictor of
perioperative mortality is
A. Ultrasound appearance of the gallbladder
B. CT appearance of the liver
C. Child-Pugh classification
D. MELD score
18- Negative pressure wound is associated with all of the following except
19- Which of the following has not been shown to decrease the incidence of
ventilator-associated pneumonia(VAP)?
D. Early tracheostomy
C. Epidural analgesia
D. Antibiotics
C. Increases mortality
E. Normalizes in 3 to 5 days
A
23- of the following the most appropriate feeding approach for patients with severe
head injury would be
C. TPN day 5
24- which of the following statements about posttraumatic renal failure (creatinine
more than mg/dl) among patients in a level 1 trauma centre is true?
25- which of the following statements about fetal death after a motor vehicle crash
is true?
A. Maternal acetabular fracture are not associated with increased fetal mortality
B. Uterine rupture is the leading cause of fetal death
D. Three point seatbelt use in the third trimester has no effect on fetal outcome
E. Intra-uterine fetal death is rare after a motor vehicle crash in the first trimester
C
26- three years after renal transplant . a 65 year old patient with a newly diagnosed
colon carcinoma. The patient receives monotherapy with sirolimus for
immunosuppression. An elective colon resection is scheduled. This patient has an
increased risk for
A. Intraoperative bleeding
B. Wound dehiscence
D. Postoperative diabetes
E. Adrenal deficiency
27- which of the following statements about tunneled dialysis catheter is true?
E. Lung cancer
29- a 12 year old premenarched girl presents with a 2 week history of progressive
abdominal pain and urinary retention. Placement of a urinary catheter yield 700 ml
of clear urine. On examination, she is afebrile with normal vital signs. She has a
palpable, mildy tender mass filling her pelvis and lower abdomen. The most likely
diagnosis is
C. Appendiceal abscess
D. Ovarian teratoma
30- the single most important risk factor for noninfectious sternal dehiscence after
median sternostomy is
A. Hyperglycemia
B. Hypertension
C. Obesity
E. Femal sex
32- the most appropriate treatment for a patient with a 2 cm diffuse large B-cell
lymphoma limited to the antrum of the stomach would be
A. Total gastrectomy
B. Radiotherapy followed by gastrectomy
C. Systemic chemotherapy
D. Distal gastrectomy
E. Chemoradiation
33- which of the following statements about medullary thyroid cancer (MTC) true?
B
34- which of the following tumor markers is most closely associated with the
diagnosi of gastrointestinal stromal tumor (GIST)?
A. CEA
B. CD117
C. HER/neu
D. CA125
E. P53
D. Infection control
D. Procedure should not be performed until the pedal pulses are absent
B
37- During cholecystectomy in a 67-year-old woman,
there is severe bleeding from accidental injury to the
hepatic artery. The patient requires transfusion of
2000 mL of blood. After the operation, 24-hour urine
output varies between 1250 and 2700 mL/d. She was
adequately hydrated, but BUN levels continue to rise
10-12 mg daily over a 5-day period.
(D) Glomerulonephritis
(A) Hyperkalemia
(B) Hyponatremia
(C) Hypophosphatemia
(E) Hypomagnesemia
C
40- A 70-year-old woman has low cardiac output
with increased PCWP and increased systemic
vascular resistance. What should be the drug of
choice?
(A) Dopamine
(B) Norepinephrine
(C) Dobutamine
(D) Epinephrine
(E) Phenylephrine
(B) PaC0 2 of 45 mm Hg
(E) BP of 150/100 mm Hg
(D) Hyperbilirubinemia
(E) Hyperamylasemia
(B) A mammogram
(C) Neuroblastoma
(D) Lymphoma
(E) Hempatoblastoma
51-A 12-year-old girl presents to the emergency department following a skiing crash
in which the left side of her midtorso hit a tree. She pres-ents with left side lower
chest and upper abdominal pain. She also complains of left shoulder pain. The most
likely diagnosis is which of the following?
(A) Dextrocardia
(B) Pneumococcus
A
56-A 51-year-old man presents with recent onset of what appears to be a large left
varicocele. He should be investigated for possible:
(A) Infertility
57- Elevated serum levels of alpha fetoprotein in a man is in which of the followings
58- a patient with renal cell carcinoma with extension to the IVC is best treated with
A. radiotherapy
B. chemotherapy
C. thrombolytic therapy
D. Surgical exploration
60- a patient with a complex pelvic fracture is scheduled for open reduction and
fixation of the fracture in the operating room. He also has an extraperitoneal
bladder injury with a contained area of extravasation. The best treatment for the
bladder injury is
A. Ganglioneuroma
B. Neuroblastoma
C. Medulloblastoma
D. Glioblastoma
63- which of the following test is most sensitive in determining if the fluid is
cerebrospinal fluid
Glucose level
Halo test
Beta transferring
64- clinical finding which can be seen in a patient who is brain dead include
Extension position
65- a 4 year old presents with a fracture of the femur (midshaft) with 20% of
anterior angulation. Which of the following is the best treatment for this child ?
69- an 18 year old girl is transported to the emergency department after a fall
from a tree. Survey reveals bilateral foot injuries with tenderness and crepitus
over the heels. In addition to ordering chest, pelvis, C-spine, and calcaneal
radiographs, evaluating physician should also examine and order radiograph of:
C. Bilateral wrist
E. Bilateral elbows
D
71- a patient with a nonobstructing carcinoma of the sigmoid colon is
being prepared for elective resection. Which of the following reduce the
risk of postoperative infectious complicatios?
74- a 65 year old man has an enterocutaneous fistula originating in the jejunum secondary to
inflammatory bowel disease. Which of the following would be the most appropriate fluid for
replacement of his enteric losses?
A. D.W
B. 3% normal saline
C. Ringer lactate
D. 0.9% sodium chloride
E. 6% sodium bicarbonate solution
C
75- a 23 year old man arrives in the ER after a motor vehicle collision .
examination reveals an unstable pelvis and blood at the urethral meatus.
Which of the following studies would most accurately identify a urethral
injury?
A. CT scan of the pelvis
B. Intravenous pyelogram
C. Stress cystogram
D. Antegrade urethrogram
E. Retrograde urethrogram
E
76- 10- year-old boy develops right lower quadrant pain, nausea,
vomiting, and a fever . you suspect appendicitis and plan for an emergent
appendectomy. As you are preparing to transport him to the operating
room, his parents mention that he jas hemophilia A. what should you
administer for this condition?
A. Vitamin K
B. FFP
C. Factor Viii
D. Cryoprecipitate
E. Factor Vii
C
78- a 40 year old man sustains a gunshot wound to the neck just above the
clavicle. Initial systolic blood pressure in the emergency department is 70
mm hg and increases to 90 mm hg with fluids. The next step in management
would be:
left anterolateral thoracotomy
Right anterolateral thoracotomy
Median sternotomy
Right supraclavicular and infraclavicular exploration
Insertion of foley balloon into the bullet wound
C
79- in a failed suicide attempt a depressed student severs her radial nerve at
the wrist the expected disability is:
loss of ability to extend the wrist
loss of ability to flex the wrist
wasting of the intrinsic muscles of the hand
sensory loss over the thenar pad and thumb web
palmar insensitivity
D
82- which of the following statements describe the typical venous drainage of
the adrenal gland
Plexuses of small veins provides the major drainage of each gland
A primary central vein provides the minor drainage of each gland
Both glands drain into the inferior vena cava
left adrenal gland drain to the left renal vein
right adrenal gland drain to the right renal vein
D
83- Which of the following is not a pathophysiological feature of thermal
injury?
increase capillary permeability due to the direct effect of heat and the
liberation of vasoactive mediators
increase pulmonary vascular resistance during the immediate postburn
period
elevated thyronine(T3) and thyroxine (T4) levels
elevated (IL-6) level
decreased immunoglobulin G (igG) level
C
84- a 45 year old man weighing 70 kg sustains second and third degree
burns to 5% of the TBSA with inhalation injury. Resuscitation is initiated
according to the parkland formula. Which of the following best represents
the initial intravenous fluid rate for this patient?
437.5 ml/hr
625 ml/hr
875 ml/hr
732 ml/hr
1000 ml/hr
C
85- a young adult had partial hepatectomy for severe injury. During
surgery, he was transfused with twelve units of packed red blood cells. In
the recovery room, he was noted be bleeding from the surgical incision
and IV puncture sites.
The most likely cause of this bleeding is:
Secondary to partial hepatectomy
Unknown primary bleeding disorder
Hypercalcemia
Hypocalcemia
Secondary to dilutional thrombocytopenia and deficiency of clotting
factors
E
86- the most Important aspect in treating DIC is
A. Administer heparin
B. Administer platelets
C. Treat the underlying disease
D. Achieve normal level of fibrinogen
E. Transfuse with fresh frozen plasma and ryoprecipitate
C
87- meniscal tears usually result from which of the following circumstances?
A. Hyperextension
B. Flexion and rotation
C. Simple hyperflexion
D. Compression
E. Femoral condylar fracture
B
88- which of the following statements regarding compartment syndromes
following orthopedic injuries is true?
A. The first sign is loss of pulse in the extremity
B. Passive flexion of the extremity proximal to the involved
compartment will aggravate the pain
C. Surgical decompression (fasciotomy) is necessary only as a last
resort
D. These syndromes are most commonly associated with
supracondylar fracture of humerus and tibial shaft
E. The syndrome is often painless
D
93- A patient with head injury opens his eyes and withdraws
his arm to pain. He is making incomprehensible
sounds. His Glasgow Coma Scale score is:
(a) 3
(b) 4
(c) 8
(d) 6
(e) 5
C
94- During CO2 pneumoperitoneum:
(a) the mean arterial pressure increases
(b) the mean arterial pressure decreases
(c) the systemic vascular resistance increases
(d) the systemic vascular resistance decreases
(e) the cardiac output increases
C
95- Tissue loss almost always results from ligation of
the:
(a) popliteal artery
(b) common femoral artery
(c) superficial femoral artery
(d) brachial artery
(e) portal vein
A
97- A 54-year-old man presents with extreme pain and swelling of the left middle finger.
Four days earlier, he suffered a small puncture wound to the volar aspect of the finger at
the level of the distal flexor crease. Passive extension of the proximal interphalangeal
(PIP) and distal interphalangeal (DIP) joints severely aggravates his symptoms. Which one
of the following is the most likely diagnosis?
Septic tenosynovitis
Cellulitis
98- a patient has a blood pressure of 70/50 and serum lactate level of 30mg/100 ml
his cardiac output is 1.9 l/min and his central venous pressure is 2 cmh2o the most
likely diagnosis is
A. Congestive heart failure
B. Cardiac tamponade
C. Pulmonary embolus
D. Hypovolemic shock
E. Septic shock
D
99- after a major trauma all of the following hormones increase except
A. Cortisol
B. ACTH
C. Glucagons
D. Thyroxine
E. Arginine vasopressin
D