Wound healing

1. About healing intentions:

a. First intention occurs on clean cut edges without gaps or tissue loss.

b. A big Ulcer usually heals by first intention. a

C. Second intention gives better cosmoses than first.

d. All the above.

2. The following is incorrect regarding factors affecting wound healing:

a. Edema of the tissues delay healing.

b. Children shows delayed wound healing.

C. Type of wound and type of closure. b

d. State of tissues vascularity.

3. As regards keloid the wrong statement is:

a) Dense overgrowth of scar tissue beyond the original scar.

b) May turn malignant.

c) Are particularly common in black races. b

d) High recurrence rate after removal.

4. Factors affecting wound healing include all the following are:

a) Anti-inflammatory drugs

b) Heparin

c) Chemotherapy. e

d) Radiotherapy

e) salicilates

5. the following is late complication of wound healing:

a) Burst abdomen

b) Hematoma d

c) Wound infection

d) Hypertrophic scar
6. In wound healing, all true except:

a) Healing by secondary intention is liable for infection

b) Healing by primary intention used when there is minimal tissue loss c

c) Urogenital wound is considered heavily contaminated wound

d) Wound healing starts with inflammatory phase

7. Which of the following measures is NOT useful in reducing surgical wound infection?

a. Reducing operative time

b. Increasing hospital stay to detect more infections

c. Using antiseptic skin preparation b

d. Improving nutritional status

8. About healing by secondary intention, which is the wrong statement?

a. Granulation tissue fills the gap before epithelium covers the raw area
b. It is a relatively slow process c
c. It ultimately produces a neat scar
d. Wound infection leads to healing by secondary intention

9. Wound healing is LEAST impaired by which of the following?

a. Hypoproteinemia.
b. Alcohol consumption. b
c. Smoking.
d. Cortisone administration.

10. The clean-contaminated wound characteristic indicates which of the following?

a. Entry of intestinal or urinary tract without significant spillage

b. Gross spillage from intestinal tract a

c. Drainage of an abscess

d. No entry of intestinal tract

 11. Which of the following statements about the process of wound healing is true?

a. The remodelling phase involves fibroblast activity and production of collagen and ground substance.
b. The white cells stick to the damaged endothelium and release cytokines.
c. The proliferative phase lasts from 3 days to 3 weeks following the injury. c
d. The inflammatory phase begins 2–3 days after the injury.

12. A 51-year-old woman underwent an abdominal surgery 6 days ago. She had been recovering well. On
morning rounds, you notice a large amount of serosanguinous drainage on her gown. The most likely
diagnosis is:

a. Wound dehiscence a
b. Ascites
c. Leak at the duodenal stump
d. Wound infection

Hemorrhage & Shock

1. As regards septic shock:

a) The commonest organism responsible is gram negative bacilli a

b) metabolic alkalosis is common sequlae

C) Pco2 is essentially high

d) The presence of low temperature in septic shock is of bad prognosis

2. Septic shock:

a) Commonly caused by staph aureus

b) Massive antibiotics is the mainstay of treatment.

c) Intravenous infusion and Adrenocortical steroids is life saving

d) Drainage of septic collections gives the best response d

3. The following condition usually does not lead to a shock state:

a) Penicillin injection.

b) Severe pain.

c) Peritonitis.

d) 1o % 2nd degree burn d

4. Secondary hemorrhage is usually due to:

a) Trauma

b) Slipped ligature

c) Infection c

d)) All of the above

5. The most urgent measure in the management of a severely injured patient in the reception room is:

a) Control of active bleeding.

b) Taking blood sample for grouping and cross matching8

c) Establishing an intravenous line.

d) Securing clear airway and adequate pulmonary ventilation. d

6. A comatosed patient who has multiple closed injures is admitted with severe

persistent hypotension. The hypotension is most probably due to:

a) lntracranial hematoma.

b) Cerebral-concussion.

c) Internal hemorrhage. c

d) Neurogenic shock.

7. Which of the followings is the best guide for blood transfusion in hemorrhagic shock is:

a) Arterial B.P.

b) Pulse rate.

c) Haematocrit. d

d) Central venous pressure (CVP)

8. The wrong statement regarding the characters of Venous bleeding include:

a) Dark red

b) Steady and copious flow.

C) Blood loss in the form of oozing c

d) Easier control than arterial bleeding

9. The most effective treatment of anaphylactic shock is:

a. Intra-venous adrenaline.

b. Intra-venous corticosteroids.

C. Intra-venous antibiotics a

d. Blood transfusion.

10. As regards shock:

a) In Neurogenic shock heart rate rise in line with the drop in blood pressure.

b) Central venous catheters are suitable for volume overload resuscitation insevere shock state.

c) Patient in irreversible hypovolemic shock usually does not respond adequately to fluid and inotropic therapy. c

d) High arterial PH is an indicator for severe tissues hypoxia.

11. A man is brought to the hospital after a motor car accident hit him on the right side. He is presented with severe
dyspnea, the incorrect statement is:

a) Neck should be immobilized immediately.

b) Pneumothorax should be expected. d

c) Pulse of 90/ min. with systolic blood pressure of 120 mmHg excludes the presence of internal hemorrhage.

d) The presence of fracture femur should be repaired first before the vascular injury if associated in the same limb.

12. A 32-year-old man comes to the emergency department with a history of vomiting large amounts of
blood. Which of the following is the most important first step in management of this patient?

a. Inserting a nasogastric tube

b. Obtaining a history and performing a physical examination
c. Fluid resuscitation c
d. Performing upper gastrointestinal endoscopy

13. A patient with history of recent bleeding, has a pulse of 110/ min, respiratory rate of 25/min, and a
urine output of 22 ml/hr. The best way to resuscitate the patient is by:

a. No fluids are necessary

b. Blood transfusion only
c. Lactated Ringer's solution till urgent blood transfusion is available d
d. Lactated Ringer's solution only
14. A 32-year-old man comes to the emergency department with a history of vomiting large amounts of
blood. Which of the following is the most important first step in management of this patient?

a. Inserting a nasogastric tube

b. Obtaining a history and performing a physical examination
c. Fluid resuscitation c
d. Performing upper gastrointestinal endoscopy

15. About early management of polytrauma victims, which of the following is the wrong statement?

a. A neck collar should be postponed until cervical spine fracture is proved

b. Full history and examination are part of the secondary survey
c. Arrest of external bleeding takes priority over splinting of fractures a
d. Exclusion of ventilation problems like tension pneumothorax is part of early management

16. Which of the following statements regarding the immediate management of a polytraumatized patient
is true?

a. The physical signs of a tension pneumothorax are difficult to pick up in the resuscitation room and so it must be
diagnosed by an immediate chest X-ray.
b. Airway management should be accompanied by cervical spine control. a
c. ABC (airway, breathing, circulation) is the secondary survey.
d. When the patient enters the resuscitation room the first priority is to listen to a detailed history about the mode
of injury

Electrolyte imbalance

1. Major causes of metabolic acidosis include which of the following?

a. Diabetic ketoacidosis (buildup of ketones)

b. Drugs and substances such as acetazolamide, alcohol, aspirin, and iron d
c. Lactic acidosis (buildup of lactic acid as occurs in shock)
d. All are correct

2. With respiratory alkalosis, usually the only treatment needed is:

a. Mechanical ventilation

b. None of the above

c. Slowing down the rate of breathing c

d. Increase rate of respiration

3. Metabolic acidosis causes the following electrolyte disturbance:

a. None of the above

d
b. Hypomagnesaemia and hypophosphatemia

c. Hypokalemia and hypochloremia

d. Hyperkalemia and increase free serum calcium

4. Electrolytes are ionized molecules important to:

a. All statements given are correct

b. Balance pH and acid base level in our body and Regulate the function of the neuromuscular, endocrine, and
excretory systems.
c. Regulate the passage of fluid between and within cell a
d. Regulate the function of the neuromuscular, endocrine, and excretory systems.
e. Balance pH and acid base level in our body

5. As regards hypokalemia, the following is not present:

a) It is common finding in gastro- intestinal fistula.

b) It is common complication in persistent diarrhea or vomiting. d

c) Arrythmia are common.

d) Thirst is earliest symptom.

Infection

1. As regards these forms of infection:

a) A furuncle is staph infection of hair follicle

b) Cellulitis has a well demarcated and elevated edge. a

c) The common site for carbuncle is anterior abdominal wall

d) Wound infection is common to occur after 2 to 3 weeks

2. All of the following statements about erysipelas are true EXCEPT:

a. It is caused by methicillin resistant staph aureus

b. It is red with well demarcated edge a
c. It is sensitive to penicillin
d. It is a spreading infection with no pus formation
3. Which of the following statements regarding abscesses is true?

a. Staphylococcus aureus is the most common causative organisms.

b. Most abscesses are associated with no or low grade fever. a
c. Subcutaneous abscess do not present with throbbing pain.

d. The main treatment of an abscess is observation

4. The main line of treatment of an acute pyogenic abscess is:

a. None of the above

b. Intravenous antibiotics
c. Topical antibiotic ointment d
d. Incision and drainage of the abscess

5. Which of the following is the wrong statement regarding cellulitis?

a. Fever and leukocytosis are usually absent

b. This is non-suppurative invasive infection of tissues.

c
c. It is commonly caused by Streptococci

d. It is poorly localized and tends to spread

6. As regards tetanus:

a) It can follow either major or even minor traumas

b) The main pathology is due to spread of the organisms through the peripheral nerves

c) The pathogenesis depends on the presence of anaerobic condition c

d) After trauma the vaccine administration can abort the attack

7. In gas gangrene:

a) It is caused by aerobic, gram +ve bacilli

b) Any forms of trauma can result in this type of infection

c) Blisters with gas bubbles are essential findings c

d) Vaccination can prevent the infection

8. In Gas gangrene:

a) The causative organisms is Gram-positive, rod-shaped bacilli

b) The organism produces neurotoxins that affects the peripheral nerves c

c) The tissues show blisters and gas bubbles near the infected area

d) Prophylactic gas gangrene vaccine can prevent the infection

9. Which of the following statements regarding clostridial wound infections is true?

a. Clostridia are Gram-positive anaerobic spore-bearing cocci.

b. Necrotic and foreign material in devitalized wounds increase risk. b
c. They do not necessitate antibiotics for treatment.
d. The spores are rarely found in soil and manure.

10. A 68-year-old woman underwent an amputation of her right leg following severe crush injury. Three
days postoperatively she has fever and tachycardia and looks toxic. The amputation site looks red and
brawny with the limb swollen with crepitus in the intermuscular planes. Which is the most likely diagnosis?

a. Abscess
b. Cellulitis
c. Bacteremia d
d. Gas gangrene

Hand infection

1. The most common form of hand infection is:

a) Pulp space infection.

b) Paronychia.

c) Ulnar bursitis. b

d) Thenar space infection.

2. In pulp space infection:

a) It is infection of distal volar space

b) It may occur on top of mid-palmar space infection

c) If thrombosis occurs in the digital artery, necrosiss of the epiphysis commonly occurs d

d) If surgery indicated the preferred incision lateral one

3. As regards hand infection:

a) The commonest organism is streptococci

b) Early drainage is mandatory in pulp space infection

C) Palmar incision is better than lateral incision for drainage of pulp space b

d) In tenosynovitis of the finger there is extension deformity.

4. Regarding hand infections:

a. Web space infection is the most common form.

b. tenosynovitis of a finger considered a surgical emergency.

C. Tenosynovitis of the ring finger can spread to the index finger. c

d. Incision and drainage must be waited until fluctuation is established.

5. Essential findings in tenosynovitis of the index finger are:

a) Localized swelling

b) Painful flexion of the index finger c

c) Tenderness

d) All of the above

6. As regards ulnar bursitis

a) There is flexion of the medial 4 fingers

b) It produce edema of the dorsum of the hand a

c) The little finger is markedly swollen

d) Incision is done over the antero-medial aspect of the fifth metacarpalbone

Burn

1. As regards zone of stasis in burnt area:

a) It is the inner most zone of burnt area

b) It shows increased blood flow d

c) It shows local cell damage

d) Proper resuscitation improves this area

2. Indications of skin graft in burns:
a) First degree burns

b) All cases of second degree burns c

c) Deep burns of the hand.

d) All of the above.

3. Male patient body weight 70 Kg, presented with superficial burns involving both upper limbs and back of
the chest wall, the wrong statement about this case is:
a) The patient considered major degree of burns

b) The volume of fluids needed for the management is about 7.5 litres/day.

c) The local management rarely involves the use of skin grafts. c

d) The burnt areas are usually sensitive

4- Minor burns are:

a) Less than 15% in children

b) Less than 15% in adults b

C) Is always superficial

D) Is always deep

5. One of the followings is not included in third degree burn:

a) Usually caused by long exposure to burn agent

b) It means burn of whole epidermis and dermis

c) The burnt area is usually painless a

(a) Healing usually by epithelialization.

6.The incorrect as regarding rule of nines in burn assessment is:

a. Front of trunk > 18% a

b. Head and neck 9 %

C. Each lower limb 18%

d. Both upper limbs 18%

 face & oral cavity

1. In a case with complete cleft lip:

a) Columella is displaced to the normal side

b) Nasal tip is deviated towards the non-cleft side

c) Muscle fibers of the orbicularis oris are often intact c

d) Nasal ala on the side of the cleft is displaced

2. The repair of cleft lip should be done at which age?

a. 1 month

b. 3-6 months b

C. 12 months

d. 18 months

3. In cleft palate

a) The patient has cosmetic disfigurement

b) It caused by failure of fusion between the maxillary and mandibular processes

c) Surgery entail closure of the defect with sutures c

d) Management is essential before 6 months age

4. Concerning unilateral cleft lip, the following statements are true EXCEPT:

a. It may be partial or complete.

b. It produces no speech defects
c. It is due to failure to fusion between the maxillary process with the fronto-nasal process and the maxillary c
process of the opposite side.
d. It is usually associated with nasal deformity.

5. Concerning complete cleft palate, the wrong statement is:

a. It predisposes to upper respiratory tract infections.

b. It interferes with nutrition and speech.
c. It is due to failure fusion of the palatal shelves of the maxillary processes with each other and with the d
frontonasal process.
d. It requires surgical repair after the second year of life.
6. Which of the following statements regarding orofacial clefts is true?

a. Disfigurement in cleft lip is not a big concern

b. Cleft palate rarely requires surgical repair.

c
c. Failure of fusion of the 2 maxillary processes with the frontonasal process results in cleft palate.

d. Cleft lip is always associated with other congenital anomalies.

Tongue

1. The following is not a predisposing factor for cancer tongue:

a) Smoking

b) Chronic superficial glossitis

c) T.B. ulcer c

d) Dental ulcer

2. In carcinoma of the anterior2/3 thirds of the tongue the wrong statement is:

a) Spread to cervical lymph nodes on both sides

b) Cause dysphagia

c) Usually inoperable c

d) Surgical treatment is the first choice.

3. As regards posterior third cancer tongue:

a) It is usualy presented late

b) It has a better prognosis than anterior tumors

c) Excision with safety margin is highly indicated d

d) Radiotherapy is the main line of treatment

4. As regards cancer posterior 1/3 of tongue, the wrong statement is:

a) Has good prognosis as it is early diagnosed

b) Spread by blood is common. a

c) The type is squamous cell carcinoma.

d) It may present as an ulcer with everted edge.

5. Distant metastases from carinoma of tongue by blood stream is more likely when the carcinoma involves:
a. Anterior third
b. Lateral margin
c. Posterior third c
d. Middle third

6. Old male has malignant ulcer in the tip of the tongue, in which neck region the lymph nodes metastasis
could be detected?
a) Carotid triangle

b) Submandibular region

c) Muscular triangle d

d) Submental triangle

7. Patient aged 66 years, presented with ulcer in tip of the his tongue with hard base

for 2 months duration 1cm x 1 cm investigation revealed malignancy

a) The expected pathology expected to be adenocarcinoma d

b) If lymph nodes are involved, they are the submandibular L.N.

c) The edge is typically raised inverted and indurated

d) The treatment is typically hemi-glossectomy

8. Which of the followings can be presented with ulcer with hard base in the inner part of the lower lip:

a) Ulcerating melanoma

b) Epithelioma

c) Rodent ulcer b

d) Any of the above

9. Squamous cell carcinoma is not the predominant malignant lesion in which of the following?
a. Lip

b. Anterior two-thirds of the tongue

C. Submandibular gland b

d. Esophagus
10. Which of the followings is incorrect regarding Ranula:
a) It is a retention cyst arising from a sublingual salivary gland.

b) The wall is composed of a thin fibrous capsule lined by macrophage

C) It forms an opaque bluish cystic swelling. c

d) It shows prominent blood vessels running over its surface.

e) Marsupialization is the treatment of choice.

11. What is the most common malignancy encountered in the oropharynx and tongue?

a. Non-Hodgkin’s lymphoma
b. Adenoid cystic carcinoma
c. Squamous cell carcinoma c
d. Adenocarcinoma

Salivary

1. Acute bacterial sialo-adenitis most commonly affects:

a) Parotid gland

b) Submandibular gland a

c) Sublingual gland

d) All are equal

2. Acute parotid abcess:

a) Infection route through the duct is the commonest route

b) Anerobes is commonly involved organisms

c) Aspiration commonly relieves the condition a

d) Parotidectomy is the needed procedure in big abcess

3. As regards salivary stones:

a) Mostly present in the parotid gland

b) Mostly are radio-opaque b

c) Duet stones usually needs removal of the affected gland

d) C.T. SCAN is basic investigation needed to reach the diagnosis

4. Concerning salivary stones, the wrong statement is:

a) Commonly the gland stone can`t be felt clinically

b) Mostly are radio-opaque,

c) Treatment of single stone in the duct is essentially gland removal. c

d) Less commonly affect parotid gland.

5. Concerning pleomorphic adenoma, which of following statements is incorrect?

a) It has pseudo-capsule.

b) Satellite nodules may co-exist.

c) it may present as rapidly growing salivary swelling just below the lobule of the ear. c

d) Inereased incidence of recurrence after enucleation.

6. Adenolymphoma is common in:

a) Parotid gland

b) Submandibular gland a

c) Sublingual salivary glands

d) All of the above.

7. Warthin's tumor refers to:

a) Pleomorphic adenoma

b) Adenoid cystic carcinoma d

c) Mucoepidermoid tumour

d) Adenolymphoma

8. Wartin's tumor, the wrong statement is:

a) It commonly affects parotid gland.

b) Isotope scan revealed cold nodule. b

c) Exclusively affects males.

d) Facial nerve is rare to be affected.

9. In parotid carcinoma:

a) It commonly affects superficial lobe

b) The tumor is soft in consistency a

c) Facial nerve is commonly intact

d) Superficial parotidectomy is the treatment of choice in most cases.

10. Commando's operation is indicated in which of the followings:

a) Cancer tongue

b) Malignant melanoma d

c) Squamous cell carcinoma with lymph nodes metastasis

d) Cancer parotid

11. Female patient presented with swelling associated with severe pain in-front of the ear of

4 days duration. O/E there is pitting edema of the skin overlying and the swelling is

filing the gap between the mastoid process and angle of the mandible. Which of the

following statements is incorrect?

a) Fine needle aspiration cytology has no role as regards diagnosis. c

b) Mouth examination usually reveals edema related to the upper molars.

c) Superficial parotidectomy is essentially needed with failed medical treatment.

d) Incision and drainage procedure is the usual treatment.

12. A 64-year-old man presents with a firm swelling of his left parotid. There is no apparent facial nerve
weakness and the mass seems mobile overlying sternomastoid muscle. What is most probable diagnosis?

a. Pleomorphic adenoma a
b. Lymphoma
c. Sialoadenitis
d. Mucoepidermoid carcinoma

13. Which of the following is NOT a feature of salivary malignancy?

a. Invasion of the overlying skin

b. Cervical lymph node enlargement d
c. Rapid enlargement
d. Soft consistency
14. Which of the following bacteria is the most common cause of bacterial parotitis?

a. Pseudomonas aeruginosa
b. Streptococcus pyogenes
c. Hemophilus Influenzae d
d. Staphylococcus aureus

Anatomy

1. The following structure is present inside the parotid gland:

a) Posterior facial vein

b) Internal carotid artery a

c) Vagus nerve

d) Facial artery

2. The parotid duct:

a) Opens opposite 1st molar tooth.

b) Opens in the floor of the mouth. d

c) Drains against gravity.

d) None of the above.

3. A submental dermoid cyst is anatomically bounded by one of the followings:

a) 2 Anterior bellies of 2 digastric muscles

b) Ramus of the mandible and posterior belly of digastric a

C) anterior and Posterior bellies of digastric muscles

d) a and b

4. Atumor arising from the submandibular gland is in the triangle bounded by

a) 2 anterior bellies of 2 digastric muscles and mandible

b) 2 bellies of same digastric muscle and mandible

C) 2 bellies of same digastric muscle and anterior border of sternomastoid. b

d) Anterior belly of digastric, midline and sternomastoid muscle

5. Old male has malignant ulcer in the tip of the tongue, in which neck region the lymph nodes metastasis
could be detected?

a) Carotid triangle

b) Submandibular region

c) Muscular triangle d

d) Submental triangle

6. Anatomically, swelling related to the parotid gland

a) It can fill the gap between mastoid process and angle of the mandible.

b) It may extend in front and below auricle of the ear. d

c) Contraction of the masseter muscle make the swelling prominent.

d) All the above.

7. Which of the following is not a branch of the facial nerve?

a. Temporal

b. Zygomatic

C. Oribtal. c

d. Cervical.

8. the following structure is not related to submandibular salivary gland:

a) Hypoglossal nerve.

b) Facial artery.

c) Lingual nerve. d

d) Chorda tympani nerve.

9. The following structure is present inside the parotid gland:

a. Facial artery
b. Internal carotid artery d
c. Vagus nerve
d. Posterior facial vein