PMC Surgical Exam

Feb\2018

By
Dr. Shams Hammouri
Dr. Mohamed Sowad
 PMC Exam 2\2018

1. A man presented with a right sided non tender mass in the thyroid gland, all
of the following are true except:
1- Ultrasound of the thyroid is the initial test
2- Cold nodule on thyroid scan is diagnostic of cancer
3- FNA biopsy is the investigation of choice
4- The man should undergo right hemithyroidectomy if the FNA showed
follicular neoplasm
5- Lymph node scan is a must if the FNA came positive fo papillary carcinoma

2. A young female presented with signs of thyrotoxicosis including palpitations,

tremors, and exophthalmos. Regarding iodine uptake the following is correct:
1- Increase uptake in localized follicle of thyroid scan
2- Increase uptake in multiple pattern in thyroid scan
3- Increase uptake in all thyroid gland
4- No increase in uptake
5- Decrease uptake in thyroid gland

3. In MEN type I which of the following is the most common:

1- Pituitary adenoma
2- Primary hyperparathyroidism
3- Pheochromocytoma
4- Pancreatic insulinoma
4. Regarding hydatic cyst, all of the following are true except:
1- Treatment is metronidazole
2- Liver is the most common site of infection
3- Has characteristically 3 layer cyst
4- Human is accidental host
5- Can be diagnosed by serologic and radiologic study

5. A woman presented with sudden onset of abdominal pain, her history is

remarkable for a previous surgery 3 years ago, and AF to which she is treated with
anticoagulant. On examination a tender mass was found above the umbilicus, the
mass persist with contraction of abdominal wall muscles. The most likely cause
of her pain is:
1- Thrombocytopenia
2- Bleeding from Sup. Epigastric artery
3- Bleeding from inf. Epigastric artery
4- Occult trauma
5- Intraabdominal abscess

6. Regarding Sister Mary Joseph in abdominal cancer, one is true:

1- Gastric cancer with left supraclavicular lymph node metastasis
2- Left subclavian lymph node metastasis
3- Umbilical nodules associated with carcinomatosis
4- Bleeding in the abdominal cavity

7. Regarding femoral hernia:

1- Most common hernia in females
2- Lateral to the femoral vessels
3- Cooper’s ligament forms the anterior boundary of femoral canal
4- Treatment involves suturing cooper’s ligament to iliopubic ligament
5- Bassini’s repair is an appropriate method for treatment
8. A newborn presented with frothy cough, dyspnea with feeding, difficulty
passing the NG tube. Chest x-ray showed coiled tube in the chest with air in the
stomach. The most likely diagnosis of this condition is:
1- Trachio-esophageal fistula
2- Diaphragmatic hernia
3- Hirschbrung disease
4- Duodenal atresia

9. A 2 months old infant with Down syndrome was brought with parents
complaining that he has gradual abdominal distention, associated with
intermittent biliary vomiting. He had history of delayed passage of meconium.
The parents state that he has been unduly constipated. The most likely diagnosis
would be:
1- Intestinal atresia
2- Biliary atresia
3- Volvulus and malrotation
4- Diaphragmatic hernia
5- Necrotizing enterocolitis

10. A 63 years old man the second day after right hemicolectomy had a fever of
39°C, associated with dyspnea. On P\E there was limitation of his right chest
movement together with decreased air entry on the right side. The most likely
cause is:
1- Subphrenic abscess
2- Atelectasis
3- Myocardial infection
4- Pyelonephritis
11 .Drug associated with hypernatremia in a patient:
1- Loop diuretics
2- Calcium channel blocker
3- Aspirin
4- Digoxin
5- NSAIDs

12. A 60 years old man had a surgery. All of the following are used as prophylaxis
for DVT except:
1- Enoxaparin
2- elastic stockings
3- Sequential compressive device
4- Warfarin
5- Clopidogrel

13. The best treatment of primary gastric lymphoma (non MALT lymphoma):
1- Surgery
2- Chemotherapy
3- Surgery followed by radiotherapy
4- Chemotherapy followed by surgery
5- Radiotherapy

14. Regarding retroperitoneal fibrosis:

1- More common in women
2- Treatment is by radiotherapy
3- IVP is the investigation of choice
4- Causes medial deviation of the ureters
15. Regarding retroperitoneal sarcoma only one is true:
1- Fibrosarcoma is the most common variant
2- Lymph node metastasis is common
3- Treatment is by enucleation
4- Prognosis is mainly affected by grade of tumor

16. Regarding the gallbladder:

1- In case of cholelithiasis, CCK causes bladder pain that wanes and wax
2- Glucagon helps emptying the bladder
3- Bladder contraction is inhibited by vegal stimulation
4- Passively absorb sodium and chloride

17. A 75 years old female presented with progressive abdominal pain and
obstipation, she had no history of previous surgery. Abdominal film showed
dilated bowel loops with air fluid levels with air in the biliary tree. The most
appropriate management for her condition would be:
1- Small bowel enterotomy with stone extraction and cholecystectomy and
excision of the fistula
2- Small bower enterotomy with stone extraction
3- Aggressive fluid and I.V antibiotics
4- Cholecystectomy alone
5- Excision of the fistula alone

18. Decreased urinary urobilinogen may be associated with:

1- Hemolytic disease
2- Biliary obstruction
3- Hepatitis C infection
4- Gilbert syndome
 19. A man presented with sudden onset of severe abdominal pain associated
with nausea and vomiting, the pain seems to radiate to the back (penetrating).
His serum amylase level was 2000 U/L. The most common cause for his
presentation:
1- Alcohol and biliary stones
2- Increased serum triglyceride
3- High serum calcium
4- High Blood Pressure

20. Most common benign endocrine pancreatic tumor:

1- Insulinoma
2- Glucagonoma
3- VIPoma
4- Gastrinoma

21. Best method for diagnosis of pancreatic gastrinoma:

1- CT scan
2- MRI
3- Angiography
4- Octreotide scan
5- Abdominal US

22. Regarding limb ischemia:

1- Calf pain during rest is manifestation of severe limb ischemia
2- To relief rest pain best way is elevation of the leg over pillows
3- Paralysis may be a presenting symptom of an acute ischemic leg
4- Absent pulse is manifestation of critical limb ischemia
5- Claudication has a variable distance with each time
23. Reynaud’s phenomena:
1- Primary Reynaud’s typically causes digital gangrene
2- SLE is a common cause of primary Reynaud’s
3- Primary Reynaud’s may be associated with vibratory machinery
4- Sympathectomy is effective for treatment

24. The type of urinary incontinence associated with Benign Prostatic Hyperplasia
is best defined as:
1- Urge incontinence
2- Stress incontinence
3- Overflow incontinence
4- Detrusor muscle instability

25. Regarding hypovolemic shock:

1- Pulse pressure is increased in grade 1 shock
2- Pulse pressure is increased in grade 2 shock
3- Pulse pressure is decrease in grade 2 shock
4- Pulse pressure is normal in grade 1 shock
5- Pulse pressure is decreased in grade 1 shock

26. A 65 years old man presented with right groin swelling for the past 6 months.
On examination inguinal hernia was diagnosed. The hernia is reducible with
gentle pressure. Otherwise examination is normal. Choose the best answer:
1- The risk of strangulation is increased without surgery
2- Should be treated with emergency laparotomy
3- If surgery is not performed intractable pain is the result
4- Laparoscopic surgery is the treatment of choice
27. The most common cause of transfusion related death is:
1- Acute transfusion lung injury
2- Fluid overload
3- Iatrogenic hepatitis C infection
4- Bacterial infection of the platelets
5- Technical cause of ABO incompatibility

28. Regarding gastric ulcer, one is true:

1- Type 1 ulcer is associated with hypersecretion of gastric acid
2- Type 2 ulcer is the most common type
3- Type 3 ulcer is associated with hyposecretion of gastric acid
4- Type 4 ulcers are close to gastroesophageal junction
5- Type 2 ulcer is prepyloric

29. Warthin’s tumor, one is true:

1- Adenolymphoma of the parotid gland
2- Mixed tumor of the parotid gland
3- Malignant condition
4- None of the above

30. In Glasgow Coma Scale:

1- The maximum score is 12
2- The minimum score is 0
3- Eye opening in response to verbal command is 2
4- A score of 10 means the patient is oriented
5- A score of 6 means patient is in coma
31. A 25 years old man fell from a tree and had LOC, when he arrived to the ER he
was awake and alert, GCS was 15. On examination he had multiple lacerations on
the temporal area of his skull. His GCS after one hour was 12 and started to drop
within few hours. The most likely diagnosis is:
1- Extradural hemorrhage
2- Subdural hemorrhage
3- Cerebral contusion
4- Subarachnoid hemorrhage

32. The main source of energy in acute starving diet (5 days of starvation):
1- Fat
2- Ketone bodies
3- Glycogen
4- Muscles
5- Amino acids

33. About arcuate line, choose the best answer:

1- Below this line external oblique doesn’t share in anterior rectus sheath
2- Is lies just above the umbilicus
3- Below this line posterior rectus sheath is thin
4- Below this line rectus abdominis lies on the fascia transversalis

34. A 45 years old woman presented with swelling in her right arm for 6 months,
it was diagnosed as desmoid tumor. Of the following which is the best statement:
1- The condition is highly malignant
2- The tumor is characterized by rapid enlargement
3- She should have a colonoscopy
4-
35. With familial adenomatous polyposis, choose one answer:
1- Occurs in the late adult life
2- Is screened for by Occult blood in stool
3- Associated with osteomas and dermoid cyst in Gardener’s syndrome
4- Is due to mutation in chromosome 12
5- Inherited as autosomal recessive disorder

36. Of the following intestinal polyps, which is the least likely to become
malignant:
1- Tubulous polyp
2- Tubule-villous polyp
3- Hamartoma associated with Peutz-Jegher’s syndrome
4- Villous polyp
5- Hyperplastic intestinal polyp

37. The surgical risk with obese patient include:

1- Myocardial infarction
2- DVT/ Thromboembolism
3- Pain control
4- Aspiration
5- Pressure sores

38. Which of the following is not an associated surgical risk with a jaundiced
patient:
1- Clotting disorders
2- Hepato-renal syndrome
3- Infection
4- Poor wound healing
5- Myocardial Infarctioin
39. In a patient diagnosed with hemothorax, what best describes massive
hemothorax:
1- 500 cc of blood in the chest cavity
2- 750 cc of blood in chest cavity
3- 1000 cc of blood in chest cavity
4- 1500 cc accumulation bilaterally
5- More than 1500 cc in the chest cavity

40.
1-
2-
3-
4-
5-

41. Ruptured Graafian follicle will release:

1- Primary oocyte
2- Primary oocyte with first polar body
3- Secondary oocyte
4- Secondary oocyte with first polar body

42. About chlamydial infection, all the following are true except one:
1- The most common sexually transmitted disease
2- Can cause pelvic inflammatory disease
3- Sensitive to metronidazole
4- Can cause pneumonia in infants
5- Most infections tend to be silent
43. A 45 years old woman presented to the clinic complaining of post coital
bleeding. She states that it is similar to menstruation. The most common cause
for her condition is:
1- Cervical polyp
2- Cervical ectopy
3- Cervical cancer
4- Nabothian cyst of the cervix

44. The most direct drive, medical or socioeconomic to use of contraception:

1- Increase socioeconomic class
2- Control of population growth
3- Decrease maternal morbidity
4- Decrease sexually transmitted diseases
5- Decrease fetal abnormalities

45. The most common cause of polyhydramnios is:

1- Multiple gestation
2- Duodenal atresia
3- Gestational diabetes
4- Idiopathic

46. All of the following are possible causes for preterm delivery except:
1- Urinary tract infections (UTI)
2- Pregnancy eating dates
3- Post-maturity
4- Hypertensive disease
47. A young girl in early pregnancy presented with a painless mass on the left
breast. On examination, a palpable non tender 2 cm mass was felt in the left
breast. The most appropriate next step:
1- Ultrasound of the breast
2- Needle aspiration of the mass
3- Mammography
4- Incisional biopsy
5- Hot compresses

48. A 45 years old woman presented to the clinic with a uterine leiomyoma
diagnosed with pelvic examination, the next step would be:
1- Myomectomy
2- Hysterectomy
3- Pelvic ultrasound
4- Endometrial biopsy

49. A young girl was diagnosed with a malignant ovarian tumor. The origin of
most common ovarian tumors in her age group is:
1- Epithelial
2- Sex cord
3- Germ cell
4- Mixed origin

50. A 27 years old female presented with increased weight and hirsutism, with
multiple cysts in the ovary. The most likely diagnosis:
1- Polycystic ovary
2- Ashermann’s syndrome
3- Sheehan’s syndrome
4- Pituitary adenoma
51. Polycystic ovary syndrome is usually associated with increased level of:
1- LH
2- FSH
3- Prolactin
4- Growth hormone

52. Secondary amenorrhea may be associated with all the following except:
1- Polycystic ovary
2- Ashermann’s syndrome
3- Androgen insensitivity syndrome
4- Pituitary adenoma

53. Prognosis of ovarian cancer is mostly dependent on:

1- Presence of sex hormone receptors
2- Body mass index (BMI)
3- Histological grade of the tumor
4- Tumor stage

54. Mature cystic teratoma (Dermoid tumor), choose one answer:

1- Is always malignant
2- Contents are most often immature
3- Presence of hair is characteristic
4- Mature teeth is present in 70% of the cases
5- Mature teratoma of the ovary acts like that of the testis
55. The relation of longitudinal axis of the fetus to the longitudinal axis of the
mother best describes:
1- Position
2- Lie
3- Station
4- Presenting part

56. The stage of labor that begins with fully dilated cervix and ends with delivery
of the fetus is called:
1- First stage of labor
2- Second stage of labor
3- Third stage of labor
4- Forth stage of labor

57. Causes of postpartum hemorrhage do not include:

1- Multiparity
2- Hemophilia A
3- Active management of third stage of labor
4- Placental abruption

58. Spasmodic dysmenorrhea, all are true except :

1- Caused by vaginal infection
2- Can be a presenting symptom in endometriosis
3- Means painful menstruation
4- More with ovulatory cycles
5- First line in management is NSAIDs
59. About CA 125, the false statement is:
1- Specific for ovarian tumor
2- Can be raised in pelvic endometriosis
3- Can be used for screening of ovarian cancer
4- Raised by epithelial tumors

60. The drug of choice for hypertension with pregnancy is:

1- Labetalol
2- Methyl dopa
3- ACEI
4- Calcium channel blockers

61. Regarding DVT in pregnancy, one is true:

1- More common in the left leg
2- More with blood group O
3- More in primigravida
4- No treatment is needed
5- Warfarin can be given for prophylaxis

62. The most affected organ in Mayer–Rokitansky–Küster–Hauser syndrome is:

1- Vaginal atresia
2- Absent fallopian tubes
3- Absent ovary
4- Atrophic breast
63. About dexamethasone in pregnancy:
1- Can be given anytime between 25 and 34 weeks
2- Decreases incidence of neonatal respiratory distress syndrome
3- Given in multiple courses
4- Decrease neonatal morbidity and mortality
5- Decrease incidence of intracranial hemorrhage

64. An abnormal biophysical profile indicates:

1- Increased risk of fetal death in the next gestational week
2- High risk of preterm labor
3- Meconium aspiration syndrome
4-
5-

65. Postpartum puerperal sepsis can be caused by all of the following except:
1- Beta hemolytic strept. Group A
2- Staph Aureus
3- Clostridium Wilchii
4- E.Coli
5- H. Influenza

66. Of the following, the drug absolutely contraindicated with breast feeding:
1- Warfarin
2- Aspirin
3- Lithium
4- Aspirin
5- Penicillin
67. Androgen insensitivity syndrome is characterized by:
1- Atrophic breast
2- Genetically XX 46
3- Has normal female level of testosteron
4- Has no uterus

68. Approximately what percentage of spontaneous 1ST trimester abortions

show chromosomal abnormalities:
1. 1%
2. 10%
3. 25%
4. 50%
5. 75%

69. Interstitial ectopic pregnancy:

1- Extrauterine
2- Rarely passes 4 weeks
3- Can’t be diagnosed unless ruptured
4- More dangerous than ampullary
5- Requires hysterectomy

70. The vaccine that is not contraindicated in pregnancy is:

1- Rubella
2- Robeola (Measles)
3- Polio
4- Mumps
71. Kegel exercises are used to:
1- Increase strength of abdominal wall muscles
2- Improve the position of the bladder neck and the urethra
3- Increase intraabdominal pressure
4-
5-

72. Oxygen is delivered to the fetus by:

1- Simple diffusion
2- Facilitated diffusion
3- Endocytosis
4- Active transport

73. All of the following hormones are glycoproteins except:

1- BHCG
2- FSH
3- LH
4- GH
5- HPL

74. Oligohydramnios can be caused by:

1- Unilateral renal agenesis
2- Duodenal atresia
3- Posterior urethral valve
4- Esophageal fistula
5- Diaphragmatic hernia
75. All of the following are inherited as X-linked conditions except:
1- Hemophilia A
2- Fragile X syndrome
3- Duchenne Muscle dystrophy
4- Diabetes insipidus
5- Cystic fibrosis

76. Signs of proliferative diabetic retinopathy, all true except

1- vitreous hemorrhage
2- NVE (new vessel elsewhere)
3- cotton wool spot
4- preretinal haemorrhage

77. All of the following are true except, choose one answer:
1- Artery occlusion can cause sudden loss of vision
2- Temporal fibers at the level of the chiasm crosses to the opposite side
3- Occipital lesions can cause homonymous hemianopia
4- Optic nerve damage can cause central field defect

78. All are true with retinal examination using an ophthalmoscope except:
1- The macula is the posterior pole and responsible for fine vision
2- The optic disc is the part of the optic nerve visible at the retina
3- The artery is usually thicker than the vein
4- There’s high condensation of cones in the fovea
79. All of the following are present in Horner syndrome except:
1- Ptosis
2- Myosis
3- Anhydrosis
4- Exophthalmos

80. Giant cell arteritis, one is correct:

1- Blindness is usually mild
2- Mostly bilateral
3- Affects people above 60 years of age
4- There is always histological changes in temporal artery biopsy

81. Presence of nystagmus when person looks straight ahead is called:

1- 1st degree nystagmus
2- 2nd degree nystagmus
3- 3rd degree nystagmus
4- Gaze nystagmus

82. Tympanic membrane is normal in all except:

1- Méniére's disease
2- Otosclerosis
3- Eustachian tube blockage
4- Presbycusis

83. All are true about malignant otitis externa except:

1- Can result in nerve palsy
2- Associated with severe ear pain and purulent discharge
3- Caused by Staph. Aureus
4- Can erode deep into the bone
84. All of the following are correct in secretory otitis media except:
1- Conductive hearing loss
2- Abnormal tympanic membrane mobility
3- Normal conduction on bone audiogram
4- Normal x-ray mastoid bone

85. 2 years old infant presented with high fever and buffy upper and lower
eyelids, what is the most likely diagnosis:
1- Maxillary sinusitis
2- Frontal sinusitis
3- Ethmoid sinusitis
4- Pansinusitis

86. The most common cause of painless hematuria:

1- Renal cell carcinoma
2- Urinary bladder carcinoma
3- UTI
4- Urinary stone

87. Urinary stones may be associated with the following infectious agents except:
1- Pseudomonas
2- Klebsiella
3- Proteus
4- E. Coli
5- Enterococcus
88. Renal colic is caused by:
1- Obstruction of the ureter
2- Traction on renal capsule
3- Presence of stone
4- Dull aching pain

89. In testicular torsion, the false statement is:

1- Similar pain me be caused by torsion, acute epididymitis
2- Pain may originate in suprapubic region
3- Cremasteric reflex is usually preserved
4- In case of doubt surgical exploration is a must

90. Undescended testes must be descended by:

1- 1 year
2- 2 years
3- 3 years
4- Age of puberty

91. The type of bone healing associated with intramedullary nail is:
1- Primary
2- Secondary
3- Extra-cortical healing
4- Harvesting
92. Primary bone healing occurs in which of the following internal fixation
methods:
1- Locked intramedullary mail
2- Unlocked intramedullary nail
3- External fixation
4- wire
5- Plate fixation

93. A young man presented to ER after sustaining a deep knife injury to the gluteal
region, his gate was waddling with the hip falling to one side with each step. The
most likely injured nerve is:
1- Superior Gluteal nerve
2- Inferior Gluteal nerve
3- Nerve to Obturator Interna
4- Obturator Narve
5- Femoral Nerve

94. In the shoulder, the nerve that passer through the quadrangular space in the
posterior shoulder gives supply to the following muscle:
1- Deltoid
2- Supraspinatus
3- Subscapularis
4- Infraspinatus
5- Teres major

95. The first stage of bone healing is:

1- Inflammation\ Hematoma formation
2- Angiogenesis
3- Bone remodeling
4- Bone refining
96. In the forearm, radial pulse can be felt immediately lateral to which muscle:
1- Abductor Pollicis Longus
2- Extensor Pollicis Longus
3- Flexor carpi Radialis
4- Palmaris Longus
5- Flexor Digitorum Profunda

97. In case of tennis elbow (lateral epicondylitis), the injury is at site of the origin
of the following muscle:
1- Extensor carpi radialis brevis
2- Brachioradialis
3- Triceps muscle
4- Brachialis

98. A man presented to the clinic complaining of decreased sensation in the tip
of his little finger, this is due to injury of the following nerve:
1- Median nerve
2- Cutaneous nerve
3- Ulnar nerve
4- Radial nerve

99. Of the following, what is the least likely to affect bone healing:
1- Infection
2- Vitamin D deficiency
3- 2 month of steroid use
4- Use of bisphosphonate for treatment of osteoporosis
5- Non steroidal anti-inflammatory drugs (NSAIDs)
100. Gout is diagnosed by the presence of skin lesions with non perfringens Tophi,
or the presence of:
1- High serum alkaline phosphatase
2- High serum uric acid
3- The presence of calcium pyrophosphate crystals
4- Monosodium urate crystals
5- High urinary calcium

Dr. Sun