0

QUALIFICATION
MATERIAL PART III
Qualification material is first of in its kind & prepared by qualifying
batch of 2013 named “THE 300++” in order to make easy for qualifying
students to prepare themselves. The materials are in 3 parts with part I
being WHAT TO READ OUTLINE GUIDE FOR QUALIFICATION EXAM 2013,
part II being QUALIFICATION EXAM 2013 FOLDER with all lecture notes
collected & compiled and part III being THIS MATERIAL.A lot of medical
students from the batch are involved in the preparation of the material
starting from giving ideas, suggestions, comments, material collection,
scanning, editing, publishing and many more. And I think it is worth to
THANK them all. But again I want to thank & I AM ETERNALY HAPPY for
all of you involved at least asking the progress of our work.

AGAIN THE SAYING IS “WE CAN DO MORE……”

TEMESGEN BEYENE, REPRESENTATIVE.

 1

WHAT TO READ OUTLINE GUIDE FOR QUALIFICATION EXAM 2013

I thought it has been a long time since we have started our clinical years when the awaited
qualification is looming. With that in mind I have tried to collect & compile what to read guide for our
qualification exam just to cover almost all topics.

Within this outline guide you will have:

 All lecture topic outlines

 All seminar topics of clinical year including C1 & C2
 All tutorial topics
 Bedside topics covered
 Possible short case topics

And finally I want to thank all of you for your support with material provision & all the suggestions
with your valuable comments.

NB: This material may not be all inclusive….It is just an overview….

If this makes you happy I will be happy!

Temesgen Beyene

Your representative……..
 2

1. Internal medicine

Lecture outline;

 Thyphus, thyphoid & relapsing fever

 CNS infections
 Sexually transmitted diseases
 HIV/AIDS
 Lesihmaniasis
 Malaria
 Filariasis and trypanosomiasis
 Schistosomiasis
 Intestinal parasites
 Bronchial asthma
 Pneumonia
 Pulmonary tuberculosis
 Chronic obstructive lung disease
 Pulmonary manifestation of HIV infection
 Pulmonary neoplasm
 Congestive heart failure
 Valvular Heart diseases
 Cardiomyopathy
 Pericarditis, myocarditis
 Infective endocarditis
 Hypertension
 Peptic ulcer disease
 Malabsorption
 Diseases of large bowel
 Acute hepatitis
 Chronic hepatitis
 Cirrhosis and complications
 Fluid and electrolytes
 Acid –Base disorders
 Glomerulonephritis
 Nephritic syndrome
 Acute renal failure
 Chronic renal failure
 Urinary tract infections
 Dizziness and disturbance of consciousness
 Extra pyramidal disorders
 Neurological manifestation of HIV/AIDs
 Circulatory disturbance of the brain
 Seizure disorders
 Diseases of the spinal cord
 Neuropathy, myopathy
 Anemia
 Myeloproliferative disorders
 Acute leukemia
 Lymphoproliferative disorders
 Malignant lymphomas
 Clinical approach to normal and abnormal hemostasis
 3

 Diabetes mellitus
 Disease of the thyroid
 Disease of the adrenal
 Disease of the pituitary
 Parathyroid, metabolic bone diseases
 Clinical application of radionuclide
 In-vitro application of radionuclide and radioimmunoassay
 Immunology-rheumatology

Year IV seminar topics;

 Pulmonary edema
 DKA
 AKI
 AFI
 Shock
 Seizure & Coma
 Acute GI bleeding
 Hemostasis
 Acute mgt of Asthma
 TB-HIV

Common bedside topics to be covered;

 Respiratory(TB,Pneumonia)
 Cardiovascular
o Rheumatic heart disaesae
o Ischemic heart disease,MI
o CHF
 CNS(stroke, spinal cord disease)
 Abdomen ;CLD
 Immunology; HIV + complications
 Neoplasms
o Lymphoma
o Leukemia + complications
o Myeloma
 Hematology; Anemia(aplastic, megaloblastic)
 Endocrinology; DM type I & II
 Renal; nephrotic syndrome

2. Pediatrics & child health

Lecture outline;

 Introduction to pediatrics & child health

 Childhood paralytic syndromes
 Meningitis beyond neonatal age
 Childhood seizure disorders
 Extrauterine adaptation of the newborn
 Problems of prematurity &LBW infants
 Breast feeding
 4

 Complementary feeding
 Respiratory distress in newborn
 Perinatal asphyxia
 Perinatal infections
 SAM
 Vit A deficiency
 Vit D def/rickets
 Acquired heart disease I/Rheumatic fever
 Acquired heart disease II/infective endocarditis
 Disorders of thyroid gland
 Disorders of adrenal gland
 Diabetes mellitus
 Acute diarrheal disease
 Congenital heart disease I/cyanotic
 Congenital heart disease II/acyanotic
 Immunization
 Vaccine preventable diseases
 TB intra thoracic/pulmonary
 TB extra thoracic/extra pulmonary
 Pneumonia
 URTI/pharyngitis & its complications otitis media
 ALTB/epiglottitis
 Childhood anemia
 Childhood leukemia’s
 Childhood lymphomas
 Solid tumors in children
 Pediatrics HIV AIDS
 Collagen vascular disease
 UTI
 Nephrotic syndrome
 AGN

Year III seminar topics;

 Hx taking & P/E in newborn & children

 Normal growth development
 Neonatal thermoregulation
 Neonatal jaundice
 Approach to comatose child
 Bleeding disorders
 Hemolytic anemia
 Common pediatric procedures
 Failure to thrive
 Calcium & phosphorus metabolism/rickets
 Cardiorespiratory adaptation at birth
 Pathophysiology of severe malnutrition
 Chromosomal diseases I
 Chromosomal diseases II
 HIV AIDS
 5

 Poisoning
 Malaria
 Respiratory distress in infants & children
 Pathophysiology of CHF
 Fluid & electrolyte hemostasis
 Pathophysiology of ARF

Year IV seminars/tutorials by seniors

 IMNCI
 Growth monitoring
 Rational use of Abx
 Prescription writing
 Shock
 Approach to child in coma
 Poisoning
 Respiratory emergency
 Mgt of acutely convulsing child
 Mgt of common newborn problems
 Mgt of child in CHF
 Mgt of HIV infection
 ETAT

Common beside topics to be covered;

 Meningitis
 Prematurity, LBW, respiratory distress in newborn, PNA, neonatal sepsis, neonatal
jaundice, KMC, etc
 SAM, Vit A def, rickets
 CHF, rheumatic fever, infective endocarditis
 Diabetes mellitus, DKA
 Diarrhea
 Congenital heart disease
 TB, tuberculoma
 Pneumonia
 Childhood anemia
 Childhood lymphoma
 Solid tumors in children like wilms & abdominal mass
 HIV AIDS & complications
 UTI
 Nephrotic syndrome, nephritic syndrome
 AGN/PSAGN
 URTI
 Burn
 Orthopedics like osteomyelitis
 Pediatric surgery like appendicitis, intestinal obstruction

3. Surgery

Lecture outline; may be detailed…..

 6

 Key topics in general surgery

o Nutrition in surgery
o Wound healing
o Fluid & electrolyte imbalance
o Hemostasis & transfusion therapy
o Influence of co-existing disease
o Basics of oncology
o Pre-Op asst & post-op care
o Surgery & HIV-AIDS
o Anesthesia & critical care
 Trauma & resuscitation
o Skin & soft tissue tumors
o Salivary glands & neck swellings
 Neck swellings
 Salivary gland disorders
o Thyroid, parathyroid & adrenal disease
 Evaluation of thyroid disorders
 Hypo & hyper thyroidism
 Thyroiditis
 Thyroid nodules & thyroid neoplasms
 Complications of thyroid surgery
o Parathyroid; hyperparathyroidism
o Adrenal; adrenal cortex & medullary tumors
o Breast disease
 Hx, presentations & triple asst of breast disorders
 Non-malignant breast conditions
 Nipple discharge
 Breast infections
 Gynecomastia
 Malignant breast disease
 Principles of breast surgery
o Esophageal disorders
 Hiatus hernia & GERD including esophageal strictures
 Work up of a patient with dysphagia including esophageal Ca &
 Functional disorders of esophagus
 Esophageal trauma
o Stomach disorders
 PUD
 Gastric Ca & primary gastric lymphoma
 Benign gastric tumors
 Post-gastrectomy syndromes
 Upper GI hemorrhage
o Small bowel disorders
 Small bowel obstruction
 Neoplasms
 Crohns disease
 Mesenteric ischemia
o Colonic, rectal & anal disorders
 7

 Appendicitis
 Large intestinal obstruction
 Volvulus
 Diverticular disease
 Lower GI hemorrhage
 IBD
 Haemorrhoids
 Perianal abscess
 Anal fissure
 Colorectal Ca
o Surgical diseases of liver
 Liver tumors
 Hepatic abscess
 Hepatic cyst including hydatid cyst disease
o Biliary surgery
 Acute cholecystitis & ascending cholangitis
 Acalculous choecystitis
 Sclerosing cholangitis
 Biliary tree tumors & carcinoma of gall bladder
 Bile duct injuries
o Pancreas
 Acute pancreatitis & chronic pancreatitis
 Pancreatic Ca
o Hernia
 Inguinal hernias, femoral, internal, abd wall hernias
o Acute abdomen
o Arterial disease
 Atherosclerosis & non-atherosclerotic disase
 Acute & chronic lower limb ischemia
 Abdominal aortic anerysum
 Arterial aneurysmal disease
o Venous & lymphatic disease
 Varicose veins
 DVT
 Key topics in cardiothoracic surgery
o Bronchogenic Ca
o Infectious; emphysema,abscess, brnchioectasis, TB
o Chest trauma & resuscitation
o Mediastinal masses
 Key topics in neurosurgery
o GCS & mini neurological exam
o Mgt of patient with head & spinal injury
 Key topics in orthopedics surgery
o General principles of bone pathophysiology
o Orthopedic trauma
o Fractures
 Classification
 Healing
 8

 Clinical features
 Radiological investigations
 Principles of mgt
 Complications
o Compartment syndrome
o Dislocations
o Infection
o Pediatric orthopedics
o Orthopedic tumors
 Key topics in pediatrics surgery
o pediatrics fluids, nutrition & resuscitation
o pediatrics tumors
o congenital neonatal surgical problems
o intussusception & meckels diverticulum
o aspirated or ingested foreign body
 key topics in plastic surgery
o wound healing
o skin grafting & flaps
o Burns
 asst of %BSA & depth
 resuscitation of burn victim
 key topics in urology
o urinary tract investigations
o renal Ca, bladder Ca, prostate Ca, testicular Ca
o BPH
o Testicular torsion
o Scrotal masses
o UTI including genital tract infection
o Calculi disease
o Urinary tract trauma
o Ureteric obstruction/reflux
o Hematuria
o Hydronephrosis

Year III seminar topics

 Abdominal trauma
 Acute abdomen
 ARF in surgical patient
 Anesthesia
 Bleeding disorders
 Burn
 Chest trauma
 Fluid & electrolyte balance
 Genitourinary trauma
 Head injury
 Intestinal obstruction
 9

 Perianal surgical conditions

 Pre & Post op care
 Rational use of ABx
 Shock
 Surgical infections
 Upper GI bleeding
 wound

Year IV seminar topics;

 Causes & mgt of UGI bleeding

 Principles of mgt of patients with Multiple injury
 Sepsis, septic shock & hypovolemic shock
 Causes & mgt of Hematuria
 Mgt of acute abdomen
 Head injury & its mgt
 Mgt Burn
 Fluid electrolyte &acid base mgt of surgical patients
 Common post op complications & their mgt
 Obstructive jaundice & its mgt
 Approach to patient with breast lamp
 Peritonitis & intra-abdominal abcess

Bedsides to be covered

 PUD with special emphasis to GOO

 Gastric carcinoma
 Cholelithiasis, gall bladder stone diseases
 Obstructive jaundice; with emphasis to choledocholithiasis & pancreatic head tumors
 Breast masses with emphasis to breast Ca
 Goiter; including thyroid ca,benign endemic goiter & toxic goiter
 BOO with emphasis to BPH; prostatic Ca & urethral stricture
 Hematuria; with emphasis to renal & bladder tumors
 Urinary tract stone diseases
 Intra-abdominal masses
 Large intestinal obstruction with emphasis to sigmoid volvulus & colonic Ca
 Small bowel obstruction
 Dysphagia; with emphasis to esophageal ca & achalasia cardia
 Neck masses other than goiter
 Groin hernias, scrotal swellings ,testicular masses & varicose veins
 Acute abdomen with emphasis to acute appendicitis & intestinal obstruction
 Perianal abscess
 Chest injury & abdominal injury
 Head injury & burn injury
 Orthopedic trauma
 Benign & malignant bone tumors
 Specific upper & lower rib fractures
 Evaluation of patient with an orthopedic trauma
 10

Short cases commonly encountered;

 Colostomy
 T-tube
 NG-tube
 Abdominal mass
 Catheterization/bladder
 Chest tube,X-ray
 Goiter
 Neck mass of common neck triangles
 Tracheostomy
 Hernias
 Testicular mass
 Breast mass
 Surgical incision/dressing
 Burn
 Orthopedics like POP,traction,osteomyelitie,etc
 Head injury for GCS
 Varicose veins
 DVT
 Wound ,surgical infection
 Post op cases

4. Obstetrics & Gynecology

Lecture outline;

 Menstrual cycle, fertilization and implantation

 Physiological changes in pregnancy
 ANC principles organization and practices
 Physiology and mechanism of normal labor
 Partographic control of labor and detection of fetal distress
 Abnormal labor
 Induction and augmentation
 CPD, obstructed labor, uterine rupture
 Analgesia and anesthesia in obstetric practice
 Multiple pregnancy
 Breech presentation and its management
 IUGR and Rh-iso immunization
 Drugs and medications in pregnancy
 Instrumental deliveries
 Caesarian section and VBAC
 Abortion and post abortion care
 Techniques of termination of pregnancy
 Ectopic pregnancy
 The puerperium normal and abnormal
 Breast care and breast feeding
 Family planning
 Anemia in pregnancy
 Diabetes and pregnancy
 11

 Overview of medical disorders in pregnancy

 Antepartum hemorrhage
 Postpartum hemorrhage
 Hypertensive disorders in pregnancy
 Abnormal uterine bleeding
 Overview of reproductive health, maternal and perinatal mortality and morbidity
 Amenorrhea and dysmenorrhea
 Endometriosis and infertility
 Preterm labour and PROM
 HIV/AIDS in obstetrics and gynecology
 STD, PID and Genital tuberculosis
 Menopause
 CIN and invasive Ca of cervix
 Malignant conditions of the uterine corpus
 Uterine myoma
 Ovarian tumors
 Gestational trophoblastic diseases
 Urinary incontinence
 Common minor gynecologic operative procedures
 Malignant conditions of the vulva and vagina
 Uterovaginal prolapse

Year III seminar topics;

 Hypertension in pregnancy
 Bleeding in early pregnancy (abortion, ectopic, GTD)
 HIV in obstetrics and Gyn, PMTCT
 Big for date uterus
 Operative deliveries
o Cesarean section
o Breech
o Vaccum/Forceps
o Destructive deliveries
 Drugs and medication in pregnancy
 Obstructed labour
o Diagnosis and management
o Ruptured uterus
o VVF
 AUB/DUB
 Analgesia/anesthesia in obs/Gyn

Year III tutorial topics;

 History taking in obs/gyn

 12

 Physical examination in obstetrics and gynecology

 Diagnosis of pregnancy and minor disorders
 Management of the 3rd stage of labor
 Neonatal care and resuscitation
 Ante partum hemorrhage
 PID/STI
 Post term pregnancy
 Malpresentations and malposition’s
 Contraception/family planning, emergency contraception

Year IV seminar topics;

 Hormonal contraceptives and IUCD

 PMTCT
 Management of labor and the partograph
 Obstetrics anesthesia and analgesia
 Syndrome management of STD and Mx of PID
Year IV tutorial topics;

 Harmful traditional practices in obstetrics and gynecology

 Ante partum fetal surveillance
 Intra partum fetal surveillance and fetal distress
 Evaluation of female urinary incontinence
 Approach to the patient with vaginal discharge
 Approach to the patient with chronic pelvic pain
Bedside topics;

 Ovarian tumors
 Cervical cancer
 Abortion and PAC
 Abnormal vaginal discharge
 Fetal surveillance and monitoring
 Cord prolapse
 Post-partum hemorrhage
 Preeclampsia and eclampsia
 Medical disorders in pregnancy
 Puerperal sepsis
 Caesarean section
 Obstructed labour and uterine rupture
 Drugs in obstetrics
 Obstetrics maneuvers
 Acute abdomen in gyne and obs
 Instruments in gynecology (MVA, D&C, speculums)
 Family planning methods (discussion and demonstration)
 Abdominal pelvic mass
 Pelvic relaxation
 13

Common instruments;

 Forceps
 Vaccum extraction
 IPAS with MVA & cannula
 IUD insertion
 Family planning instruments, pills
 Speculum
 Fetal skull
 Pelvic asst & diameters
 Leopold exam
 GA,EDD calculation
 Partograph
 Placenta
 Tenaculum, uterine sound, trocher forceps
 Destructive delivery set
 STD pictures
5. Public health

5.1. Epidemiology

 General principles of epidemiology

o Definition of epidemiology
o Scope of epidemiology
o Primary uses of epidemiology
o Casual predisposing factors for disease
o Concepts in infectious disease epidemiology & mechanisms of disease transmission
o Levels of diseases prevention
o Levels of disease occurrence
 Investigating an outbreak
o Reasons for investigating an outbreak
o Steps in an outbreak investigations
 Diagnostic & screening tests in epidemiology
 Epidemiologic surveillance
 Epidemiological studies
o Categories of epidemiologic studies
 Descriptive epidemiologic studies
 Analytic epidemiologic studies
 Description of the occurrence of disease in the human population
 Analytical epidemiological studies
o Observational studies
o Experimental/intervention studies
 Potential error in epidemiological studies
o Error/Random error vs systematic error/bias
o Confounding effect
o Validity/internal & external
o Data quality
 14

 Validity
 Reliability
 Measurements in epidemiology
o Measures of disease occurrence
o Measures of association
 Substantive epidemiology
o Public health importance of disease
o The distribution, determinants,& mechanisms of stated disease to the human host
o Current screening & diagnostic provisions to identify apparently healthy individuals &
sick people
o The available strategies to prevent & control the diseases
 Levels of disease prevention

5.2. Biostatistics

Chapter 1. Introduction Statistics.

1.1. Definitions of terms.

1.2. Types of data
1.3. Scales of Measurement
1.4. Sources of data.
1.5. Methods of data collection
Chapter 2. Methods of data Presentation

2.1. Tables.
2.2. Visual Displays
2.2.1. Bar chart
2.2.2. PIE chart
2.2.3. Histogram
2.2.4. Box and Whisker Plot
2.2.5. Line graph
Chapter 3. Measures of Central Tendency (Location) and Measures of Dispersion
3.1. Measures of Central Tendency

3.1.1. Arithmetic Mean

3.1.2. Median
3.1.3. Mode
3.2. Measures of Dispersion

3.2.1. Range (R)

3.2.2. Interquartile range (IQR
3.2.3. Variance (2, S2
3.2.4. Standard deviation (, S)
3.2.5. Coefficient of variation (CV)
Chapter 4. Probability and Probability Distributions

4.1. Categories of Probability

 15

4.2. Properties of Probability

4.3. Basic Probability Rules
4.4. Probability Distributions
Chapter 5. Sampling and Sampling distribution

5.1. Definition
5.2. Sampling Methods
5.2.1. Probability sampling methods
5.2.2. Non-probability sampling methods
Chapter 7. Estimation of population parameters

 Parameter and Statistic

 Point estimate
 Confidence interval
Chapter 8. Hypothesis Testing

 Null and Alternative hypotheses

 Type I and Type II errors
 The P-Value
Chapter 9. Determining Sample Size

Chapter 10. Statistical Methods for Categorical variables

 Chi-square
 Odds ratio
Chapter 11. Introduction demography and hospital statistics

5.3. Research methodology

1. Introduction

2. Types of research

3. Components of a research proposal

4. Research questions and problem statement

5. Literature search and review

6. Formulating research hypothesis

7. Formulation of research

8. Study designs

9. Quantitative and qualitative research methods

10. Sample size calculation

 16

11. Overview of sampling methods

12.Types of variables

13. Data collection techniques

14. Designing research questionnaire

15. Bias in data collection

16. Data management and analysis

17. Health research ethics

18. Scientific report writing

19. Dissemination of research findings

5.4. Environmental health

Part I: Introduction to human ecology;

1. Introduction to the course

2. Environment and environmental health concepts
3. Water pollution and its control
4. Ambient air pollution and its control
5. Indoor air pollution and its control
6. Population, environment and development: I
7. Population, environment and development: II
8. Global environmental health problem: I
9. Global environmental health problem: II
10. Principles of pollution and its control
11. Irrigation and water development
12. Public health important vectors and their control
13. Site and location: Altitude, climate and health
14. Site and location: Altitude, climate and health
15. Sociological environment (Health and culture)
16. Sociological environment (Health and culture) Part II: Environmental health & sanitation
17. Introduction and definitions
18. Provision of safe and adequate water supply I
19. Provision of safe and adequate water supply II
20. Provision of safe and adequate water supply III
21. Housing and health I
22. Housing and health II
23. Principles of occupational health/hygiene I
24. Principles of occupational health/hygiene II
25. Solid waste management I
26. Solid waste management II
27. Medical waste management
 17

28. Human waste management I

29. Human waste management II
30. Human waste management III
31. Food hygiene and protection I
32. Food hygiene protection II

5.5. Reproductive health;

 Introduction to MCH/RH

o Definitions, concepts and principles of MCH/RH

o Reasons for MCH/RH services
o Historical development of MCH/RH
o Gender Vs Sex in relation to MCH/RH
 Women’s health problems and status

o Unintended pregnancy and unsafe abortion

o Problems related to Pregnancy and childbirth
o Harmful Traditional Practice and Cultures, customs & practices to MCH
o Violence Against Women
o HIV/AIDS & STIS
o Cancers of Reproductive organs
o Malnutrition
 Maternal health services
- Antenatal Care
- Delivery services
- Postnatal care
- Family planning
 Common problems in children
- ARI
- Diarrhoeal disease
- Vaccine preventable diseases
- Malaria
- Malnutrition
 Health service components for children
- Well-baby clinic
o Growth monitoring o Screening
o Immunization
 i

- Sick baby clinic

 Providing Family Planning services
 Provision of comprehensive abortion
care
 Adolescent Reproductive health
 Prevention and control of
STIs/HIV/AIDS
 2

5.6. Health education;

 Introduction to health behavior

 Understanding human behavior
 Behavioural Communication process
 Education and educational methods
 Behavioural models
 Evaluation of behavioural change
 Resistance to change
 An overview of qualitative research methods

5.7. Health management;

Lecture topics

 Introduction to COMH 501 Management functions Demeke

 Management functions Management Skills Demeke
 Historical development and current Ethiopian health care system Awoke
 Health Logistics management Getnet
 Concepts of supply and demand for health care &Health care financing Ababi
 Economic evaluation of health care programs(Health economics) Ababi
 Human resource management Melesse
Seminar topics;

 The concept of health and its determinants(Group one)

 Ethiopian health policy (Group two)
 General profile of HSDP (Group three)
 Health extension programme overview(Group four)
 Principles of public health (Group five)
 Concepts of primary health care (Group six)
 Team work and team building (Group seven)
 Health management information system(Group eight)

Individual assignment topics;

 overview of Ethiopian health policies

 overview of HSDP
 Health Extension program and its implementation in Ethiopia
 overview of health care financing (please communicate to Ato Alemayehu for supporting
materials)
 over view HMIS and its implementation in Ethiopia

Nutrition
 3

Lecture topics

Introduction Dr.Solomon

 Human nutrition
 Public health nutrition
 Nutrition and development
 Causes of malnutrition
 Nutrition through and Life stages

Nutritional asst Dr.Jemal

 Methods of nutritional assessment

 The present nutrition situation
 Nutritional surveillance

Nutritional problems of public health importance Dr.Jemal

 Protein-energy malnutrition – Dr Bilal

 Vitamin A deficiency
 Iron deficiency anemia
 Iodine deficiency disorders
 Zinc deficiency

Nutrition interventions Dr.Solomon

 Essential nutrition actions

 Emergency Nutrition Interventions
 Ethiopian National Nutrition strategy

That is all & wish you best luck on your qualification exam!!!

Temesgen Beyene

Qualifying Batch representative of 2013

4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
 56

Addis Ababa University Faculty of Medicine

Department of Surgery

Written EXAMINATION

FOR
Final YEAR MEDICAL Students

October 18, 2004

INSTRUCTIONS

1. The examination consists of 100 questions of which most are multiple choice type with
one best response type. There are few true and false and matching type questions.
 57

2. Answer all questions on the question paper itself.

3. Write your names on each page of the question paper.

4. Time allowed is 3 hours.

Best Wishes!

1. Risk factors for cholelithiasis include all except:-

A. Female sex
B. Maturity onset diabetes
C. Obesity
D. Age greater than 40 year
E. Hot climate
2. One of the following statement is not true

A. About 80 % of gall stones are mixed stones

B. Cholesterol stones can be silent for many years.
 58

C. Infection is the most important factor in causation of mixed stone.

D. Gall stone colic is a commonly associated with vomiting
E. Gall stone ileus is a commonly encountered complication of gallstone diease
3. A 60-year female patient presented with a sudden on set of right upper quadrant pain accompanied
by rigor, fever and vomiting. On examination the patient was in agony with blood pressure of 100/60
mm Hg, pulse rate of 96 beats per minute. She had mild icterus of the sclera and right upper quadrant
tenderness. The most likely diagnosis of this case would be :-

A. Acute Cholecystitis
B. Acute Pancreatitis
C. Ascending cholangitis
D. Perforated peptic ulcer disease
E. Intestinal obstruction
4. In the above patient the following investigation could be of some help except:-

A. Ultrasonography
B. Plain abdominal x-ray in erect position
C. Total WBC count
D. Oral cholecystography
E. Liver function test
5. One of the following statement is not true regarding obstructive Jaundice.

A. Patient with obstructive jaundice secondary to carcinoma are older compared to those due
to stone.
B. Presence of pain is suggestive of stone obstruction rather than tumour.
C. Gall bladder is never palpable in stone disease.
D. Abdominal ultrasound is the most useful means of investigation for obstructive jaundice
E. Absence of clay colored stool may not deny the diagnosis of obstructive jaundice.
6. Absolute indication for exploration of the common bile duct (CBD) includes all except :-

A. Ultrasound proved stones in the CBD

B. CBD dilated more than 1.2 cm in size
C. Palpable stones in the CBD
D. Multiple small stones in the gall bladder
E. Intra operative cholangiography revealing filling defect.
7. Regarding anorectal abscess:-

A. It results from pyogenic infection of anal glands

B. E.Coli is the most frequent causative organism.
C. Blood borne infection is unlikely mechanism
D. A,B and C
E. A&B only
8. Which one of the following statement is true about fistula in ano?

A. Even though multiple openings are seen in the perianal skin, the internal opening is always
single
B. It usually results from inflammatory bowel disease.
C. Dentate line is the land mark to delineate between high and low fistula.
 59

D. Broad spectrum antibiotics are the treatment option in most cases.

E. Surgical treatment is effective in all cases of fistula in ano.
9. Haemorrhoids:-

A. Can cause chronic anemia

B. Can not be felt by digital rectal examination unless they are thrombosed
C. Do not always deserve surgery
D. None of the above
E. All of the above.
10.A 40 years old male patient presented with perianal pain during and after defecation . He also has
noticed streak of fresh blood along with passage of hard stool. This patient is most likely suffering from:-

A. Thrombosed internal haemorrhoids

B. Fissure in ano
C. Sub mucous abscess
D. Proctitis
E. Perianal abscess
11. All are complications of urinary tract infections except:-

A. Acute renal failure

B. Septicemia
C. Hydronephrosis
D. Interstitial necrosis
E. Stone formation
12. ______is not an indication for urgent surgical intervention in ureteric calculi

A. Ureteric obstruction in solitary kidney

B. Bilateral complete obstruction
C. Unremitting bouts of colic
D. Infection above the impacted stone
E. Perforation
13. An absolute indication for renal exploration following road traffic accident is:

A. Subcapsular hematoma detected on serial ultrasonography

B. History of haematuria
C. Loin tenderness
D. Flank bruising
E. Hypovolemic shock
14. The following are etiological factors incriminated in transitional cell carcinomas except:-

A. Stone diseases
B. Balkan nephropathy
C. Smoking
D. Occupational disease
E. Phenacetin abuse
15. The aim of renal stone treatment is:-

A. To remove stones
 60

B. To relieve infection
C. To preserve renal function
D. To prevent recurrence
E. All of the above.
16. Sterile pyuria is diagnostic of

A. Stone disease
B. Genitourinary tuberculosis
C. Urothelial neoplasm
D. Prostitis
E. All of the above.

17.Which of the following statements is not true about urinary stone

A) Urate stones form in alkaline urine

B) Struvite stones are composed of magnesium, ammonium and phosphates
C) Some cases of calcium oxalate stones can be prevented by oral calcium supplementation
D) All of the above
E) None of the above
18. The following statements regarding urinary stones are correct except

A) Most staghorn calculi are asymptomatic

B) To prevent recurrence, fluid intake should be increased in all patients irrespective of the
stone type
C) Stone analysis and systematic metabolic evaluation is essential for effective prevention of
recurrence
D) Treatment depends on the site, size and effect of the stone on the kidneys
E) None of the above
19. The following statements are correct about Adenocarcinoma of the kidney except

A) It is more common in men

B) Surgical removal is the main stay of treatment
C) Haematuria is the most common symptom
D) The tumor has a tendency to grow in to the renal vein and inferior vena cava
E) None of the above
20. What is the most specific method of diagnosing bladder carcinoma

A) Ultrasonography
B) Intravenous urography
C) Urethrocystography
D) Urethrocystoscopy
E) Computerized tomography scan
21. In prostatic carcinoma

A) T3 tumour is best treated by radical prostatectomy

B) PSA value of 10nmol/L is diagnostic of advanced prostatic cancer
 61

C) Osteolytic metastasis are not common unlike other tumors

D) Transrectal ultrasound is accurate method for staging the local disease
E) There is no place for transrectal biopsy
22. All of the following statements are correct about testicular neoplasms except

A) Over 95% of them are malignant

B) Teratomas occur in a younger age groups compared to seminomas

C) The diagnosis has to be confirmed by trans scrotal open biopsy before orchidectomy

D) None of the above

E) All of the above

23.A 21 year -old man who was involved in an automobile accident is brought to the emergency room.
On admission, his blood pressure is 80/60, respirations are purely diaphragmatic, and he has a right-
sided Horner's syndrome. Cervical spine X-rays showed a C4 on C5 fracture dislocation but C7 is not
visualized. Which of the following statements about management of this patient is correct?

A. repeat cervical spine films are not necessary as there is very little likelihood of fracture at
another level.
B. vasopressor agents have to be administered immediately to raise the blood pressure
C. attention must be given to maintaining an adequate airway
D. administration of manitol is unnecessary
E. the nature of the cervical injury is a contraindication to the use of traction as part of
therapy.
24. All the following statements regarding the Glasgow Coma scale are true except

A. it serves as a scale to assess severity of head trauma

B. a high score correlates with a high mortality
C. it measures eye opening
D. it measures motor response
E. it measures verbal response
25. Increased intracranial pressure is characterized by the following clinical findings except

A. Respiratory irregularities
B. Increased blood pressure
C. bradycardia
D. decreased auditory acuity
E. none of the above
26. Lower limb up going plantar response on neurological examination is

A. Lower motor neuron lesion

B. Upper motor neuron lesion

C. CNS lesion
 62

D. Peripheral nerve lesion

27.A jaw reflex is a function of :-

A. V cranial nerve

B. III cranial nerve

C. VII cranial nerve

D. None of the above

28. Fracture dislocation of Lumbar I results in all of the following except:-

A. Paralysis of the lower limbs

B. Bowel and bladder function loss

C. No autonomic dysfunction

D. All of the above

29. The best modality of treatment for acute subdural hematoma(SDH)

A. Burr hole and evacuation

B. Craniectomy and evacuation

C. Trephination and evacuation of hematoma

D. Craniotomy and evacuation of hematoma

30. Which of the following statements is true concerning soft tissue injuries in the trauma patient?

A. palpable pulses rule out arterial injury

B. Fasciotomies are frequently required in conjunction with vascular repair
C. Stab wounds or missile tracts near major vessels can be closed if there is no sign of major
arterial or venous hemorrhage
D. Exposed nerves can be left open, as granulation tissue will readily cover them
E. Attached bones should be removed in order to speed healing
31. All the following statements regarding carcinoma of the lip are true except

A. It is most frequently a squamous cell carcinoma

B. It occurs most frequently in the lower lip
C. It is radio resistant
D. It is usually low grade and well differentiated
E. It metastasizes via lymphatic
32. Axillary burns in children with subsequent tissue loss is best treated by

A. Skin heterograft
 63

B. Tanner mesh-expanded skin graft

C. Excision of scar and sheet graft

D. Z-plasty

E. All of the above

33. parotid Tumors under age of 15

A. Should be removed because of high malignant potential

B. Should be removed because they are usually vascular origin
C. Should be removed because of in ability to tell which are malignant and which are benign
D. All of the above
E. None of the above
34. Water evaporation from burn surfaces is most extensive with
A. First degree burns
B. Second degree burns
C. Third degree burns
D. All the above
E. None of the above
35. Wound contraction is caused by which of the following mechanism?

A. Collagen formation
B. Myo fibroblasts
C. Elastic fibers
D. Ground substance
E. Granulation tissue
36. After performing a tangential excision of a burn eschar, the wound should be covered with

A. Nothing
B. Fine mesh gauze
C. Topical antibiotics
D. Split thickness skin graft
E. Full thickness skin graft
37. Contracture is the most serious complication of burn healing in

A. Hand
B. Neck
C. Axilla
D. Eyelid
E. All of the above
38. Spontaneous oesophageal perforation

A. Occurs in non alcoholic males

B. Follows severe vomiting or retching after an alcoholic binge
C. Occur typically in the thoracic esophagus just above the hiatus
D. Usually causes haematemesis as well
E. Has a high mortality if it is treated initially by operation
 64

39. Complications of foreign bodies in the esophagus include

A. Medistinitis and empyema thoraces

B. Hemorrhage
C. Trachea-oesophageal fistula
D. Oesophageal stricture
E. All the above.
40. In the investigation of achalasia of the cardia:

A. A barium swallow shows presence of gas in the fundus of the stomach

B. A barium swallow shows strong, irregular uncoordinated peristalsis
C. At oesophagoscopy, the oesophagus contains food debris and is dilated and the instrument is
passed through the cardia with difficulty
D. At manometry the waves of the pharyngo-oesophagus sphincter are abnormal
E. At manometry, the pressure at the oesophagus-gastric junction is usually higher than normal
and does not fall to the normal level on swallowing

41. Co-arctation of the aorta

A. Is a localized deformity of the aortic intima

B. Is more commonly per-ductal
C. If preductal is asymptomatic in infancy
D. If preductal is asymptomatic in infancy
E. If post-ductal, occurs at the level of the ligamentum arteriosus or post-distal to the left of
subclavian artery
42. Contra-indications to surgery in co-arctation of the aorta include:

A. Bacterial endocarditis

B. Heart failure in an infant

C.Severe hypertension

D.Age over 16-years

E.Presence of septal defects

43. In the care of the chest bottle and tubes

A. The bottle may be below or at the level of the chest

B. The chest tube must be soft to prevent pressure necrosis of the drainage wound
C. Before the water seal bottle is moved or changed the chest tube must not be clamped
 65

D. Oscillation within the chest tube does not necessarily indicate patency of tube
E. Removal of the tube is delayed until the lung is fully expanded or fluid drainage is less than
50ml in 24 hours
44. Atlectasis after thoracotomy

A. Is the commonest complication of lobectomy

B. Is due to excessive production of bronchial secretions
C. Causes contra lateral mediastinal shift
D. Is always associated with pyrexia, dyspnoea, tachycardia and cyanosis
E. Is treated by immediate Bronchoscopy and aspiration of the secretion
45. Recurrent spontaneous pneumothorax is best treated by:-

A. Observation
B. Insertion of a wide-bore intercostal catheter connected to an underwater seal
C. Chemical pleurodesis
D. Parietal Pleurectomy
E. Thoracotomy
46. Which of the following organisms may be found in empyema?

A. Streptococcus
B. Staphylococcus
C. Esch. Coli
D. H.Influenza
E. All of the above
47. In chronic empyema

A. The ribs on the affected side are crowded and the hemidiaphram depressed
B. The mediastinum is shifted to the contra lateral side
C. A tumour may not be the cause
D. Aspiration of the pleural cavity and instillation of antibiotics should be tried
E. Decortication is the operation of choice if the lung is healthy
48. The commonest site for bronchiectasis is:-

A. Right upper lobe

B. Right middle lobe
C. Right lower lobe
D. Left upper lobe
E. Left lower lobe

49. In the prognosis of lung cancer:-

A. The overall 5-year survival is about 16%

B. The 5-year survival when the tumour is completely resected is 45%
C. The mean survival of inoperable cases is 6-8 months
D. Survival is improved by radiotherapy and cytotoxic therapy
E. Small (oat) cell carcinoma has a better prognosis than squamous cell carcinoma
50. Which is the first and most important activator of HYPERGLYCEMIA in trauma and surgery?
 66

A. Cortisone
B. Epinephrine
C. Glucagone
D. Testosterone
E. Insulin
51. In which of the following is the metabolic response the highest?

A. Gastrectomy for Cancer

B. Bilateral femur fractures
C. 50% Burn
D. Appendiceal peritonitis
E. Small Bowel obstruction
52. What is True and False in the ANABOLIC PHASE of trauma and surgery

A. Nitrogen balanse is negative

B. Weight gain
C. Insulin production increasing
D. Cortisole in plasma raised
53.The following is often seen in the legs with traumatic arteriovenous fistulas

A. Varices
B. Ulceration
C. Pulsating mass with systolic bruit.
D. Gangrene
E. Edema
54. Varices of the legs are caused by the following in most cases.

A. Incompetence of valves of the saphenous veins.

B. Incompetence of valves of communicating veins
C. Deep vein thrombosis
D. A - V fistulas
E. Venous stasis in the pelvis.
55. Lymph edema of the leg is often followed by

A. Ulceration
B. Gangrene
C. Pachyderma (Elephantiasis)
D. Loss of sensation
E. Severe pain
56. Which of the following clinical features are seen in primary Thyrotoxicosis only.

A. Hypertension
B. Exophtalmos
C. Tremor
D. Weight loss
E. Irritability
57. Match the following clinical features seen in Adrenal conditions listed under A-D, to relevant
changes in laboratory values listed under 1-4.
 67

A. Osteoporosis
B. Female hirsutism
C. Muscle weakness
D. Hypertension

1. Hypokalemia

2. Hypercortisolism

3. VMA /urine

4. 17-ketosteroids

58. What is the most serious complication in multinodular goiter?

A. Thyrotoxicosis

B. Cancer

C. Airway Obstruction

D. Venous Stasis in the neck

E. Unsightliness

59. What are true and false answers in follicular cancer of the thyroid?

----------A. Metastasis mainly to local lymphnode

----------B. The common type of carcinoma in multinodular goiter

----------C. Is invasive

----------D. Has better prognosis than papillary cancer of the thyroid

----------E. Common in young adults

60. Among Ethiopians the most common peptic ulcer complication requiring urgent surgical intervention
is

A) Bleeding duodenal ulcer

B) Perforated duodenal ulcer
C) Bleeding gastric ulcer
D) Perforated gastric ulcer
E) Complete gastric outlet obstruction
61. In correcting a severe dehydration of a patient with gastric outlet obstruction you start resuscitation
with
A. Normal saline
B. 5% Dextrose in water
 68

C. Ringer’s lactate
D. 1/3 saline solution
E. Dextrose in saline solution
62. A 30 year old smoker was operated for perforated duodenal ulcer. The interval between the onset
of severe abdominal pain and surgical intervention was about two days. The choice of intervention in
this patient should be

A. Repair of perforation and peritoneal lavage

B. Repair of perforation, peritoneal lavage, truncal vagotomy and gastrojejunostomy
C. Partial gastrectomy, Billroth I anastomosis and peritoneal lavage
D. Peritoneal lavage and postoperative suctioning via a nasogastric tube
E. None of the above
63. The above patient died a week later. The most likely cause of death in this patient is

A. Nutritional depletion and electrolyte imbalance

B. Thromboembolism
C. Myocardial Infarction
D. Massive bleeding from a kissing ulcer
E. Sepsis
64. Bowel preparation before resection of a colonic tumor includes all except

A. Enema
B. Laxatives
C. Low residue diet
D. Antibiotics
E. Anal dilatation
65. The most common presentation of colonic tumor as an emergency is

A. Obstruction
B. Massive bleeding
C. Perforation
D. Fistulous communication
E. Pericolic abscess
66. Important clues of an anastomotic leak following a hemicolectomy for a colonic tumor includes all
except

A. Fever
B. Abdominal distention
C. Tachycardia
D. Absent bowel sounds
E. Air under the diaphragm detected on X-ray
67. Post operative complications in a nutritionally depleted patient includes all except

A. Wound dehiscence
B. Wound infection
C. Pulmonary infection
D. Prolonged paralytic ileus
E. Bleeding disorder even in the absence of hepatobiliary pathology
 69

68. Which of the following is not a means to assess nutritional status in a surgical patient

A. History
B. Anthropometric measurements
C. Biochemical measurements
D. Immunologic measurements
E. None of the above
69. The 5 year survival for Dukes’ B colorectal carcinoma is

A. Less than 10%

B. About 20%
C. About 40%
D. About 60%
E. Greater than 90 %
70. Which of the following statements is not true about intussusception

A. Most are well nourished and other wise healthy children

B. The clinical presentation include sudden onset of abdominal pain characterized by episodic
screaming and drawing the legs up
C. The appearance of blood in stool is common
D. Lead point is found in majority of the patients
71. Ultrasound examination will be helpful on the management of the following pediatrics problems
except

A. Intussusception
B. Appendicitis
C. Criptorchidism
D. Hirschsprung's disease
72. Which of the following entities always requires surgical correction during in fancy

A. Imperforate anus
B. Hypo plastic left colon
C. Meconium plug syndrome
D. Meconium ileus
73. A 3 week-old infant, here to fore apparently healthy, exhibits sudden onset of bilious
vomiting.Which of the following is the most likely diagnosis

A. Pyloric stenosis
B. Tracheoesophageal fistula, H.type
C. Hirschisprungs disease
D. Duodenal atresia
E. Malrotation of midgut
74. Eight hour after birth an infant exhibits excessive drooling and mild respiratory distress an
abdominal x-ray showed complete absence of air in the GI tract which is the most likely diagnosis

A. Pyloric atresia
B. Tracheoesophagesl fistula,H.type
C. Esophageal atresia without tracheoesophageal fistula
 70

D. Esophageal atresia with distal tracheoesophageal fistula

75. In undescended testis (True or False)

A. -------Orchidopexy reduces the risk of malignancy

B. -------Improves spermatogenesis if done early
C. -------Hormonal treatment with HCG has encouraging result
D. -------Orchidopexy reduces the risk of trauma
76. In a child with acute scrotum

A. Hydrocele is the common cause

B. Epididymo-orchitis is the usual cause
C. Testicular torsion should be the working diagnosis
D. Conservative treatment should be considered
77. Which of the following are contraindications to attempt barium enema reduction of an
intussusception in a child

A. Pneumo peritoneum
B. ''current jelly'' stool
C. Recurrence after hydrostatic reduction
D. Patient age over 5 years
78. In the management of massive upper GI bleeding

A. Detailed history is mandatory

B. Physical examination should be rapid and systematic

C. Endoscopic identification of the source of bleeding is a top priority

D. Cross matching and blood transfusion should be the initial treatment

E. All of the above

79. An absolute indication for an urgent or emergent surgical intervention in upper GI hemorrhage is

A. Unstable vital signs.

B. A large gastric or duodenal ulcer
C. A large bleeding vessel
D. Shortage of whole blood for transfusion
E. All of the above
80. A False statement is

A. Mallory-Weiss tear usually stops without specific treatment

B. Surgical treatment of erosive gastritis has a 50% mortality rate
C. The mortality rate from variceal bleeding approximates 50%
D. In a patient with haematochezia, lower GI endoscopy should precede the UGI
endoscopy
E. The overall mortality rate from UGIH is about 25%
81. Regarding breast cancer, an Incorrect statement is
 71

A. Incidence rates are on the decline

B. Lobular carcinoma in situ is a premalignant condition
C. Axillary nodal status is the single most important prognostic factor
D. Tumor size directly correlates with survival
E. Tumor grade directly correlates with survival

82. In the management of breast cancer, a wrong statement is

A.
Approximately 50% of locally advanced disease has concurrent systemic metastases
ER+ /PR+ tumors have a longer disease-free survival
B.
C.
No woman can be reassured that she is cured
D.
Local treatment can influence outcome if micrometastasis is absent at the time of
diagnosis
E. None of the above.
83. Concerning treatment options for breast cancer

A. Mastectomy is curative for ductal carcinoma in situ

B. Post mastectomy radiation therapy is indicated if resection margin is positive

C. The response to hormonal manipulation is better for node positive postmenopausal

women

D. The response to chemotherapy is better for pre menopausal node positive women

E. All of the above

84. Gastric cancer, a false statement includes

A. Gastric cancer is highly lethal cancer world wide

B. Adenocarcinoma accounts for 95% of cancers
C. The incidence of gastric cancer is on the rise
D. Gastric cancer most frequently involves the pyloric antrum
E. All of the above
85. Pancreatic cancer

A. The incidence is on the increase

B. Jaundice is invariably present
C. Epigastric mass is usually an early feature
D. Diagnosis is not difficult
E. All of the above
 72

86. Pancreatitis, a false statement includes

A. In up to 40% of chronic pancreatitis calcifications are evident.

B. About 50% of pseudo cysts resolve spontaneously

C. Nearly 75% is associated with biliary disease or alcohol abuse

D. About 90% of chronic pancreatitis is alcohol-related

E. Chronic pancreatitis is a self-limited disease

87. Acute ischemia of the foot is commonly expected in all of the following conditions except

A.Compartment syndrome

B.Valvular heart disease

C.Supracondylar femur fracture

D.Bullet injury to the popliteal fossa

E.None of the above

88. Skeletal tuberculosis is commonly seen in

A.Spine

B.Hip

C.Knee

D.Shoulder

E.Wrist

89. Choose the incorrect statement about shoulder dislocation

A. Recurrent dislocation is common

B. Commonly the head of the humerus is situated anterior to the gleinoid fossa

C. Injury to the axillary nerve can occur

D. None of the above

 73

90. Which statment is false concerning fracture of the patella

A.Direct trauma leads to comminuted fracture

B.Indirect trauma leads to transverse fracture

C.Quadriceps muscle is responsible for the indirect fracture

D.Undisplaced fracture can be treated conservatively

E.None of the above

91. Which statment is false about colles fracture

A.The distal fracture moves medially

B.It is extension fracture

C.The ulnar styloid can be avulsed

D.The distal fragment moves posteriorly

E.All are correct

92. Pelvic fractue can lead to the following complications except

A. Liver laceration with hemoperitoneum

B. Rupture of the urinary bladder

C. Rupture of the rectum

D. Hemorrahgic shock

E. Pulmonary embolism

93. The best treatment of a closed displaced radioulnar shaft fracture in an adult is

A.traction through distal radius

B.Closed reduction and circular pop with the cast split

C.External fixation

D.Internal fixation

E.Closed reduction and circular pop without splitting the cast

94. Osteogenic sarcoma

 74

A.Is a bone tumour more frequently seen in old age

B.Most frequently affects the ribs vertebrae and pelvis

C.Gives rise to cystic lesions of the involved bone on x-ray

D.Arises in the metaphyseal end of long bones

E.All of the above

95. Which one of the following electrolytes should not at all be given for a patient in shock and oliguria

A.Calcium

B.Potassium

C.Sodium

D.Chiloride

E.Bicarbonate

96. The following changes are expected in a patient with sever vomiting due to gastric out let
obstruction, except

A. Hyponatremia

B. Hypochloremia

C. Hypokalemia

D. Alkalosis

E. Acidosis

97. Regarding potassium administration, all are true except

A. It should not be given in the early postoperative hours

B.Preferrably the patient should be on continuous ECG monitor

C.It can be given through iv injection

D. The iv fluid with added potassium should be properly labeled and run slowly

E. None
 75

98. Likely differential diagnosis in a young woman with appendicitis includes all except

A.Meckels Diverticulitis

B.Ruptured ectopic pregnancy

C.Torsion of the ovarian cyst

D.Acute Salpingitis

E.None of the above

99. Which of the following statement is not true about sigmoid volvulus

A.Usually it produces extreme abdominal distension

B.It is more common in the cities than the rural areas

B.Radiography shows inverted U appearance

C.If not gangrenous upto 90% can be treated non -operatively

D.None of the above

100. All of the following statements are characteristics of strangulation of the bowel except

A. It commonly complicates closed loop obstruction

B. It is difficult to distinguish it from simple intestinal obstruction

C. It is accompanied by bleeding into the affected bowel

D. It frequently causes peritonitis

E. It may result in gram negative septicemia

THE END!!

Good Luck
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150