Section 1:

A patient presents 1 month after a benign right breast biopsy with a lateral
subcutaneous cord felt just under the skin and causing pain. The etiology of this
condition is?
a. Fat necrosis
b. Thrombophlebitis
c. Superficial thrombophlebitis
d. Suture granuloma
A patient with rectal cancer and underwent APR. What type of stoma should be
created?
a. End colostomy
b. Loop colostomy
Most common site of loop colostomy:
a. Transverse colon
High trans-sphincteric fistula is best managed by:
a. Laying open fistula
b. Fistulectomy
c. Draining seton
Corkscrew sign in upper GI study indicates:
a. malrotation with mid-gut volvulus
Which of these is a diagnostic sign of midgut volvulus?
a. Abdominal distension
b. Spiral Sign Ultrasound
c. Double bubble sign on X-ray
Next step after total thyroidectomy of papillary thyroid cancer:
a. Thyroid suppression
A 70-year-old female patient presented to the clinic with a thyroid nodule and
hoarseness. She has a hard solitary nodule in the left side and left vocal cord
paralysis. What is the most likely diagnosis?
a. Papillary thyroid carcinoma
b. Follicular adenoma
Which of the following is considered adjunctive to primary survey in trauma
patients?
a. US
b. CT
Organ that is anterior to the mediastinum?
a. Ascending aorta
b. Descending aorta
c. Trachea
d. Esophagus
Patient had trauma and blood pressure is low:
Focused US of abdomen
Which of the following causes late dumping syndrome?
Excessive secretion of insulin
Which cell secretes pepsinogen:
Chief cells
Trypsinogen is released by:
Exocrine cells in acini
DM patient going for hernia repair:
Give antibiotics
In which surgery a healthy patient does not require antibiotics:
Inguinal hernia repair
Most common cause of lower GI bleeding in patient <40 or <50 years?
hemorrhoids
CT imaging is indicated in:
All children with renal trauma
The most common cause of ureteric injury is:
Iatrogenic
What is the percentage of blunt thoracic trauma needing thoracotomy?
10-15%
What is the most common systemic complication of acute pancreatitis?
Shock
Patient with blunt pelvic fracture. Resuscitated with IV fluid and hypotensive,
next step:
Pelvis wrapped with blood transfusion
Site of chest tube insertion:
5th ICS mid axillary line
In open pneumothorax, air is preferentially entering the exposed pleural cavity
through the wound when:
the opening is greater than 2/3 of the tracheal diameter
A 22-year-old was stabbed with 5cm long knife blade in the right chest he came
to the ER alert and wide awake he was complaining of shortness of breath his
right chest was hyper resonant and had no breath sounds. His BP 110/76 HR 86
with central vein pressure of 3 cm H2O what is your management?
a. Chest x ray and chest tube insertion
b. needle decompression
c. ringer’s Lactate
Which of the following is an indication for endoscopic repair of peptic ulcer?
a. Active pulsatile bleeding or non-bleeding visible vessel
(You MUST offer endoscopic repair)
b. Ulcer with a clean base or a flat pigmented spot
(You MUST NOT offer endoscopic repair)
Which of the following is true regarding clean contaminated wounds?
a. entering GI or urinary tract with no gross spillage
b. entering GI or urinary system with gross spillage
c. opening an old traumatic devitalized or abscess wound
In case of penetrating anterior urethral injury, which the next appropriate step:
a. small gauge catheter
b. Foley catheter
c. Supra pubic catheter
d. Surgical repair
An old male patient presented to the clinic with a urological problem. You
inserted a foley in him, which wasn’t smooth. You faced difficulty in inserting it;
the patient screamed of pain. Then there was blood at the meatus. What is the
likely diagnosis?
a. BPH
b. Anterior Urethral injury
MVA patient (child) complains from flank pain. During inserting a Foley, urine
stained with blood came out. Most likely:
A. Renal injury
B. Ureteric injury
C. Urethral injury
Which of the following is a feature of grade 3 renal trauma?
A. renal laceration less than 1 centimeter
B. intact collecting system
C. extravasation
D. expanding hematoma
What is the grade of renal trauma that involves parenchymal laceration without
involving the pelvicalyceal system?
A. Grade 2
B. Grade 3 (also choose if not involving pelvicalyceal system)
C. Grade 4
D. Grade 5
What is modality of choice for active bleeding in renal trauma in hemo-
dynamically stable patients?
A. Arterial embolization
B. Laparoscopic repair
C. Laparotomy
D. Conservative
Which one of the following is an indication of renal surgery following trauma?
A. Pulsatile perirenal hematoma
B. Perirenal hematoma
The most common cause of acute urinary retention is:
A. Normal Bladder Contraction
B. Increase Urethral Resistance
C. Increase bladder pressure
What is the best management for a bladder rupture with intraperitoneal
perforation?
A. Operative management and simple repair of the bladder
B. Operative management and urinary diversion
Female patient came with Left chest gunshot Low bp 90/70, High distended JVP
Normal breath sounds on both side and no tracheal deviation.
What is the best management for this patient?
A. IV fluid
B. Needle decompression
C. Pericardiocentesis
D. Chest tube
A Traumatic patient with shock, dilated neck vein and trachea in the midline
what's the diagnosis?
A. pneumothorax
B. Cardiac Tamponade
What is the next step in a patient diagnosed with tension pneumothorax after
needle thoracotomy?
A. Intubation
B. Chest tube
C. Observation
D. Chest radiograph
Which of the following is the most characteristic sign of acute extradural
Hematoma?
A. Depressed level of consciousness
B. Ipsilateral fixed pupil dilation
C. Contralateral pupil dilation
D. Projectile vomiting
Patient had blunt trauma. Despite no external bleeding, BP 80/40 and
bradycardia. The patient responded to IV lactated ringer but still has abdominal
pain and tenderness. What is the next step?
A. CT
B. FAST
Which of the following reasons for hemothorax is more to cease spontaneously?
A. Hilar vessels
B. Internal thoracic arteries
C. Intercostal vessels
D. Pulmonary parenchyma
a 40-year-old male had an MVA complaining of fracture chest pain. GCS 14/15
with paradoxical movement during inspiration. Trachea not deviated. VITALS:
BP 110/80. RR 30. PsO2 90% What is the likely diagnosis?
A. Flail Chest
B. Pneumothorax
C. Hemothorax
A 19 Y/O suffers an MVA. He is currently in the ER, on a chest tube for
hemothorax. Which of the following indicates the need for immediate thoracic
surgery?
A. Initial drainage of 500mL of blood
B. Initial drainage of 1000mL of blood
C. Initial drainage of 1500 mL of blood
18-year-old post MVA presented to ER unconscious, snoring, and in respiratory
distress. What’s the first thing to do?
A. Give IV fluid bolus
B. Jaw thrust
C. Needle decompression
15-year-old adolescent male suffers a road traffic accident and is ejected out of
the car. He presents with hypotension and cold extremities and is on/off
responsive to fluid resuscitation. What is the most likely injury to cause this
picture?
A. Pelvic fracture
B. Bleeding scalp injury
C. Deep seated, enclosed cerebral injury
A 30-year-old restrained driver was involved in a motor-vehicle crash. He is
hemodynamically stable and has a large seat belt sign on the abdomen. His
abdomen is tender to palpation. In this patient, one should be most concerned
about:
A. Liver and spleen injury
B. Duodenum and pancreas
C. Renal pedicle avulsion
D. Pelvic fracture
Which of the following is an accurate definition of flail chest?
A. unilateral multiple rib fractures with subcutaneous emphysema
B. Bilateral multiple rib fractures with subcutaneous emphysema
C. Unilateral multiple rib fractures with pneumothorax
D. Two adjacent bones are broken in at least two places
A traumatic patient presented to the ER hypotensive and in dyspnea. You did
bedside US that showed the right lung to be sliding and the left lung as non-
sliding. What is the diagnosis?
a. Pneumothorax
b. Tension pneumothorax
Which one is an early symptom of tension pneumothorax?
A. epistaxis
B. tracheal deviation (late sign)
C. Dilated veins
D. subcutaneous emphysema
Which of the following ribs fractures is associated with delayed or immediate
splenic hemorrhage?
A. right ribs 8-12
B. left ribs 6-11
Section 2:
What is the most common systemic complication of acute pancreatitis?
Shock
a 61-year-old male with chest pain relieved by calcium carbonate, ECG is
normal. Diagnosis is:
Gastroesophageal incompetence
Most common site for appendix and least common site: batch4
Retrocecal is the commonest, retroileal/post ileal is the least common
Most common malignancy in the appendix: batch4
Carcinoid tumor
Most common complication of appendicitis: batch4
Perforation
Site of angiodysplasia:
Right colon
An intraoperative finding suggests carcinoid tumor in appendix: batch4
a mass at the tip of appendix
What is the best definition of Richter’s hernia?
Involves part of the bowel wall
Case about pancreatitis. Assessment of severity is through?
CT index
Patient is 3-days post op, fever and high WBCs. What is the diagnosis:
UTI
Patient is 5-day post op, fever and high WBCs. What is the diagnosis:
Wound infection
A 70-year-old man undergoes upper GI surgery. On the fifth day post-op, he
develops fever and shortness of breath. What is your working diagnosis?
(Q was deleted)
A. Cardiac vs pulmonary cause
B. Intra-abdominal collection
C. DVT
D. Wound infection
45-year-old diabetic lady underwent simple repair of a paraumbilical that was
containing a sac of omentum hernia. Five days postoperatively, she presented
with redness, pain and discharge. In the surgical incision.
A. Usually occurs 8 to 10 days postoperatively
B. You can prevent it by giving prophylactic antibiotic up to 5 days postoperatively
C. Usually responds to local antibiotics
D. Clostridia related wound infection can occurs early as 25 hours post
In blunt pancreatic trauma, what is the most definitive method for detecting
pancreatic duct injuries:
A. CT scan
B. ERCP
Damage in acute pancreatitis is located in:
A. Exocrine cells
B. Endocrine cells
C. Pancreatic duct
CT sign of basal fracture with Dural tear:
A. Intracranial aerocele
B. Battle sign
C. Racoon eyes

The likeliest long-term complication of untreated DVT is?

A. PE (late)
B. Venous ulcer/ stasis ulcer
A patient develops cerebrospinal otorrhea. Which of the following findings is
present?
A. Perforated tympanic membrane “ruptured eardrum”
B. Fractured mastoid air cell
C. Fractured cribriform plate
D. Fractured ridge of petrosal temporal bone
Which of the following is a poor prognostic factor for patients with severe
traumatic brain injury?
A. GCS < or= 8
B. ICP > 30
C. Age > 50 years
What statement is appropriate regarding healing of arterial grafts:
A. They completely heal by 3 months
B. They completely heal by 1 year
C. Arterial synthetic grafts do not heal completely in humans
D. Polytetrafluoroethylene grafts heal completely, and Dacron grafts do not heal
Thromboembolism in a patient undergoing pelvic surgery could be caused by
which of the following vein?
A. Pelvic
B. Femoral
A patient is diagnosed with a femoral embolus. What is the most appropriate
treatment?
A. Heparin
B. Immediate embolectomy
A patient presents with a lower limb ulcer. He is known case of Type 2 diabetes
with a history of diabetic neuropathy. The ulcer developed 6 weeks ago and
became painful. A metal probe passed into the wound and reached the bone.
Lower limb pulses are weak. Patient is febrile.
The most appropriate next step in management is to:
A. Initiate IV antibiotics
B. Revascularize
C. Order an X-Ray
Which of the following is the diagnostic gold standard in critical limbs ischemia?
A. CT Angiography
B. Conventional angiography
C. Ultrasound
A 30 YO woman has safely delivered a healthy, term baby. She then develops a
painful swelling two days postpartum in the left lower limb. What is the most
appropriate imaging modality?
A. CT angiogram
B. Duplex Ultrasound
A patient underwent abdominal surgery 2 days ago. While being hospitalized, he
developed calf pain and chest pain/tightness in addition to being feverish.
What is the next step?
A. Order CT chest
B. Approach the patient with thorough history and physical examination
C. Drain the possible intra-abdominal abscess
80 years lady known diabetic, presented to the ED with symptoms strongly
related to acute lower limb ischemia (pale, pulseless, cold, paralyzed). Her HR is
160 irregularly irregular. BP 90/50. This patient most likely has.
A. Chronic limb ischemia
B. Acute on chronic limb ischemia
Which of the following is a hard sign for vascular injury?
A. Neurologic abnormality
B. Bruit over the artery by auscultation
C. Significant bleeding found on history
D. Proximity penetrating trauma
Which of the following is a soft sign of vascular injury?
A. Absent pulse
B. Normal ABI
C. Neurological deficit
D. Pulsatile expanding hematoma
Patient with symptomatic saphenofemoral junction incompetence. How to
manage?
A. Grade 3 stocking
B. Palma procedure
C. Valve surgery
D. Laser endo-venous therapy
A female patient presents to the clinic complaining of left leg pain. Pain is
relieved with walking, massage and leg elevation. P/E reveals an ulcer above the
left medial malleolus. What is the most likely diagnosis?
A. Deep venous insufficiency
B. Peripheral arterial disease
Case of an elderly, symptoms of venous insufficiency. Best investigation to order?
A. Venous duplex ultrasound
B. CT-Angio
What is the cause of primary varicose veins?
A. Weakness of vein wall and valvular incompetence
B. Deep venous obstruction
55-year-old female patient presented with an ulcer on the right medial malleolus.
Which of the following is true?
A. Superficial venous surgery reduces the risk of future ulceration
B. the best intervention is one layer bandage
C. apply 50 mmHg pressure on the ulcer
D. anticoagulation therapy is appropriate
Sclerotherapy is best used in which of the following?
A. Intradermal veins
B. Varicose with reflex
Which of the following is true regarding probe usage in ultrasound?
A. You use a linear probe for FAST
B. You use a linear probe for liver
C. You use an intracavitary probe for kidney
D. You use a curvilinear probe for the pelvis
What ultrasound artifact results from partial, or complete reflection or
absorption of sound waves?
A. Shadowing
B. Edge shadowing
C. Reverberation
At surgery for a right inguinal hernia, a 72-year-old man is found to have a
hernia sac that is not independent of the bowel wall. The cecum forms part of the
wall of the sac. Such a hernia is properly referred to as which of the following?
A. Incarcerated
B. Irreducible
C. Sliding
D. Richter’s
What is the most common vitamin deficiency that predisposes to developing
incisional hernias?
A. Vitamin A
B. Vitamin B
C. Vitamin C
40 YO female with LLQ pain and fever, diverticulitis is suspected with
tenderness. What is the ideal management for the case?
A. IV antibiotics and observation
B. CT drainage
C. percutaneous drainage
D. Surgery
What is the most common site of Meckel’s diverticulitis?
A. Distal ileum
B. Proximal ileum
C. Proximal jejunum
d. Distal jejunum
A patient is presenting with severe LLQ pain, fever, leukocytosis, and vomiting .
If the patient was diagnosed with an obstructing sigmoid diverticulitis, what is
the standard management of this patient?
A. Hartmann’s procedure
B. Resection and anastomosis
A patient who is morbidly obese with symptoms of appendicitis. You will do an
appendectomy. Which of these factors favors open vs laparoscopic procedure?
A. Older age
B. Morbid obesity
What is true about appendicitis in elderly:
A. Usually present late
B. Less likely to be perforated
C. Perforation mortality is 60%
D. Never present with obstruction symptoms
A 60-year-old female with history of cholecystitis 6 months. Now she has a 10mm
asymptomatic gallstone. what’s the appropriate management for her?
A. Cholecystectomy
B. ERCP
A male patient presents with yellow sclera (icterus), abdominal pain and fever.
He is previously known to your hospital as a case of cholelithiasis, supported by
ultrasound. You have already given fluid and antibiotics. What is the next step in
your management?
A. OR for cholecystectomy
B. ERCP for decompression
C. Insert tube for cholecystectomy
D. PTC for drainage
A 35yrs old male had mild acute biliary pancreatitis, which of the following is the
best timing for his laparoscopic cholecystectomy?
A. After ERCP
B. 48-72hrs after the symptoms improve
C. 4-6 weeks after resolution of symptoms
3-What is the most common renal colic pain characteristic?
A. Gradual onset
B. Very sudden onset
Conservative management for hemorrhoids?
A. Cold baths
B. Stool softeners
What is the appropriate initial investigation of occasional per rectal bleeding
consisting of one or two drops of blood?
A. PR exam and proctoscopy
B. Colonoscopy
Which is the most common non-local cause of per rectal bleeding among the
following?
A. Warfarin overdose
B. Von Willebrand disease
Which of the following is an accompanying ailment with bleeding per rectum?
a. Anal fistula
b. Sentinel pile with healed ulcer
A patient with initially difficulty in swallowing solids but eventually dysphagia
for liquids occurs. What is the most likely cause?
A. Barret’s esophagus
B. Adenocarcinoma of the esophagus
C. Esophageal varices
A 34-year-old overweight man came to your clinic complaining of chronic cough
which he has been taking medication for, the cough is worse at night and when
he lays down during the day, it is relieved by sitting down and drinking water.
What is the most likely complaint the pt has?
A. GERD
B. Barret esophagus
C. Side effect of medication
72-year-old obese male presented to the clinic due to undigested food
regurgitation, difficulty swallowing solid foods, and exacerbated symptoms of
heart burn that was controlled by omeprazole. He noticed significant weight loss
(4.5 kg). His previous BMI was 30 and is currently 29. He is a 35 pack year
smoker. Physical examination unremarkable. What is the next management?
A. Upper endoscopy
B. Esophageal manometry
C. CT
D. Barium Study
55-year-old obese male presented for follow up for acid reflux. He had a heart
burn for 8 years that was controlled on parantazol once daily. Ten weeks ago,
symptoms exacerbated and had nocturnal regurgitation; he increased it to twice
daily. Despite the increase in dose, he had minimal improvement of symptoms.
He confirmed that he takes it 30 minutes before meals. Physical examination and
Upper endoscopy were normal. What is the next best step in management?
A. Ambulatory pH impedance
B. Esophageal Manometry
C. Fundoplication
D. barium esophagus
Section 3:
A baby boy is passing urine and meconium from urethra. Exam shows flat
buttocks and absent anus. What is your management:
colostomy formation
The esophagus may cause upper GI bleeding if there is:
Portal hypertension
Most common imaging used in hematuria:
X-ray KUB
Pulsating swelling in right neck, most likely cause is:
carotid body tumor
Most common risk associated with carotid aneurysm:
Embolization of mural thrombus
A 67-year-old man presenting with low grade, low stage localized prostate
cancer. What is the best option to do for this patient?
A. Radical prostatectomy
B. hormonal therapy
C. Active surveillance
D. Radiotherapy
African American man age? Complaining of non-painful bleeding at the end of
micturition for one day and there are no other symptoms (No frequency, No
urgency...
What is the most likely diagnosis?
A. Urethral Cancer
B. Renal cancer
C. urethrocolith
a 25 years old soldier male incidentally discovered to have hematuria in a routine
dipstick without associated symptoms. What are the most common causes of this
microscopic hematuria in this patient?
A. Over consumption of berries and beets
B. Benign prostatic hyperplasia
C. Urinary calculi
D. Bladder carcinoma
The initial evaluation in a patient with hematuria is
A. Urine dipstick
B. Urine culture
C. US
D. CT
Surgical exploration is indicated in:
A. acute epididymitis
B. chronic epididymitis
C. Torsion of testicular appendege with blue dot
D. Testicular trauma
Which of the following is the earliest macroscopic feature of Crohn’s?
A. Cobblestoning
B. Crypt abscess
C. Fistula
D. Aphthous/ aphthoid ulcer
Which of these is the criteria used by anesthesiologists to determine ease of
intubation preoperatively?
A. Mallampati score
B. BONES
C. RODS
Which of the following Cephalosporins prolongs prothrombin time?
A. Ceftriaxone
B. Cefuroxime
C. Cefotetan
D. Cephalothin
Most common cause of post hepatic portal hypertension
A. Budd Chiari syndrome
B. Cirrhosis
C. Splenic thrombosis
D. Schistosomiasis
What is true regarding power doppler?
A. Shows blood flow and direction
B. Detects low flow
C. Examines flow velocity
D. Shows pulsed waveforms
55 presents with a 12 history of worsening central abdominal pain Which of
the following excludes pancreatitis
A. transferase
B. alpha 1 anti-trypsin
C. amylase
D. calcium
thoracic bile duct is found at the junction of
A. Left carotid artery and subclavian artery
B. Left internal jugular vein and subclavian vein
C. Right internal jugular vein and subclavian vein
20 years old girl came with classic presentation and finding of appendicitis of 4
hours. A presumptive diagnosis was made of early acute appendicitis What
you’re the next step?
A. Starvation+ iv therapy
B. Observation
C. Appendectomy next few hours
In abdominal penetrating trauma patients who are hemodynamically stable and
were managed conservatively. What is the most commonly missed injury?
A. spleen
B. diaphragm
C. small bowel
D. colon
a 25-year-old man fell down from his bicycle and hit a concrete wall on his left
side. An ultrasound examination showed free fluid in the abdomen. A CT scan
confirmed a grade III splenic injury. The most important contraindication for a
nonoperative management of the splenic injury is:
A. Hemodynamic instability
B. Active bleeding on CT scan
C. Need for multiple blood transfusion
D. Extensive associated injuries
A 7-year-old boy presents with a two-day history of a painful discrete 2cm mobile
lump in the right side of the neck, superiorly just anterior to the
sternocleidomastoid muscle. On examination his temperature is 38.2°C and he
has red and inflamed tonsils. What is the most likely diagnosis?
Reactive lymphadenitis
A 27-year-old man presents with a five-week history of intermittent swelling
under the mandible on the left side. This tends to be triggered by eating and is
painful. Examination confirms a smooth, soft, mobile swelling in the left
submandibular region with some thickening palpable on the floor of the mouth.
Which etiology is more likely?
Submandibular duct cyst