Professional Documents
Culture Documents
MCQ General Surgery Book
MCQ General Surgery Book
MCQ General Surgery Book
-1-
1- General Principles of surgery :
• Wound healing and management
• Acutely injured patient
• Acute hemorrhage, blood transfusion and blood substitutes
• Hemostasis
• Shock
• Surgical infections, Cellulitis, Tetanus, Gas gangrene
• Surgical nutrition in Surgical patients
• Principles of organ Transplantation
• Principles of Laparoscopy
• Priciples of oncology
2- Burnand principles of plastic surgery:
• Types of burns and its complications
• Skin graft and flaps
• Cleft lip, Cleft palate
• Hemangioma and vascular malformation
3- Skin and soft tissue:
• Dermoid cyst , seabceous cyst, lipoma
• Skin tumors ( BCC and SCC )
• Melanoma
• Soft tissue Sarcoma
4- Vascular surgery:
• Acute and chronic limb ischemia
• Arterial aneurysm
• Varicose veins and chronic venous insufficiency
• DVT, Postphlebitic leg, Leg ulcers
• Lymphedema, Differential diagnosis of swollen limbs
5- Head and neck:
• Thyroid swelling including cancer
• Salivary glands, Anatomy, Sialadenitis, Parotid tumors
• Differential diagnosis of Jew swellings
• Differential Diagnosis of neck swelling (Medline and Lateral
• Cancer tongue and cancer lip
• Cleft lip and palate
• Cervical rib
6- Breast:
• Anatomy, embryology and congenital anomalies of the breast.
• Benign breast diseases , mastalgia , nipple discharge
• Breast cancer
7- Oesophagus:
• Esophagus: GERD and motility disorder
-2-
• Cancer esophagus and Dysphagia
8- Stomach and duodenum :
• Anatomy and congenital anomalies of the stomach
• Peptic ulcer disease and complications
• Cancer stomach.
9- Liver and portal vein, spleen:
• Segmental anatomy of the liver
• Cysts, abscesses and tumors of the liver
• Portal hypertension
• Upper gastrointestinal bleeding
• Splenomegaly
10- Biliary system :
• Gall stones, Cholecystitis
• Obstructive jaundice
11- Pancreas:
• Acute pancreatitis, Pancreatic tumors
12- Small and large intestine :
• Small Intestinal obstruction
• Inflammatory bowel disease
• Diverticular disease of the colon
• Colonic obstruction and Cancer colon
13- Vermiform Appendix :
• D.D of acut abdomen
14- Rectum and anal canal :
• Imperforate anus
• Anatomy, Anal fissure, Hemorrhoids, Rectalprolapse,
• Cancer rectum
• Anatomy, Anaorectal suppuration, Anal fistula
• Bleeding per rectum
15- Perineum, omentum and mesentery:
16- Hernia:
• Anatomy and surgical importance.
• Inguinal hernia.
• Femoral
• ventral hernias, Incisional hernia, recurrent hernia, burst abdomen.
17- Scrotum:
• Varicocele and hydrocele.
• Diseases of testis and epididymis.
• D.D of inguina-scrotal swelling
18- Pediatric surgery:
19- Surgical instruments and tubes:
-3-
20- X-rays:
21- Jars and surgical pathology:
22- Basic surgical skills (models) :
• Rectal examination
• Wound care and stitch
• Uretheral catheterization
• Nasogastric tube
• Examination of trauma patient
• Vascular acess
23- Cardiothoracic surgery:
• Bronchogenic carcinoma
• Mediastinum and Chest Tube
• Chest trauma
• Suppurative lung diseases
• I.H.D
• Valvular heart diseases
• Cong-H.D
• Mediastinum
• Diaphragm
24- Neurosurgery:
• Introduction and CNS examination
• Congenital CNS anomalies
• Head injuries
• Subarachniod hemorrhage and neurovascular diseases
• Brain tumours
• Spinal tumours
• Spinal fracture
• Peripheral nerve injuries
25- Urology:
• Urological Case taking
• Congenital anomalies
• Hematuria
• Hydronephrosis
• Stones
• urinary tract trauma
• Urinary tract infections
• Renal tumors
• Bladder cancer
• BPH, prostate cancer
• Anuria / Retention
• Testicular tumors
-4-
• Erectile dysfunction and Infertility
• Renal transplantation
26- Orthopedic surgery:
• General principles of fractures and dislocations
• Congenital orthopedic disorders and birth injuries
• Shoulder and upper limb fractures
• Pelvis and lower limb fractures
• Osteomyelitis and arthritis
• Bone tumors
27- Anaesthesia and intensive care :
• Preoperative assessment and premedication
• General anaesthesia (inhalational), (intravenous)
• Complications of GA
• Regional anaesthesia part
• Basic life support
28- Trauma
29- Head and neck
30- Oral cavity
31- ENT
32- EYE
33- Soft tissue
34- Gynae and obstatric
35- Lymphoma and LN
36- GIT
37- Psychiatry
38- Others
-5-
1- General Principles of surgery
3. The most common site for the following diseases is correctly matched except:
a- Keloids: face, neck and skin over sternum
b- Hypertrophic scars: extensor surfaces
c- Hemangiomas: head and neck
d- Basal cell carcinoma: face
Correct answer: B
-6-
6 . Surgical wound of gastrojejunostomy is an example for -
A. Clean wound
B. Clean contaminated
C. Contaminated wound
D. Dirty wound
Correct answer: B
-7-
Acutely injured patient
1. All but one of the following statements is true. Which is not true?
a. Successful clinical repair of injured veins had been affected by the turn of the
twentieth century.
b. Initial large experience in managing injured vein s came from the battlefields of
twentieth-century wars.
c. More than 50% of repaired injured veins thrombose.
d. Phlebography is useful in evaluating variable venous anatomy.
e. Repeated phlebography following attempted venous repair is useful in determining
the success rate.
Correct answer: C
-8-
6. A middle-aged worker reported with multiple injuries and fractures was found
to be in hypovolemic shock. He was resuscitated with IV fluids. Best indicator to
monitor his status of fluid requirement is:
A. Blood pressure and pulse rate
B. Skin turgor and dry tongue
C. State of consciousness
D. Central venous pressure recording
Correct answer: D
4. The best guide for the required blood transfusion ln hemorrhagic shock ls :
a) Arterial B.P.
b) Pulse rate.
c) Hematocrits.
d) Central venous pressure (CVP)
e) Urine output per minute.
Correct answer: D
-9-
Correct answer: C
8. The best guide for the required blood transfusion ln hemorrhagic shock ls :
a. Arterial B.P.
b. Pulse rate.
c. hematocrit.
d. Central venous pressure (CVP)
e. Urine output per minute.
Correct answer: D
- 10 -
D. ligation of the bleeding vessel
Correct answer: C
15 . Transfusion of one unit of factor VIII concentrate will raise the level by
A. 1%
B. 2%
C. 10%
D. 25%
Correct answer: B
Hemostasis
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Shock
- 12 -
Correct answer: C
11. A comatosed patient who has sustained multiple closed injures is admitted
with severe hypotension. The hypotension is most probably due to :
a. Intracranial hematoma.
b. Cerebral-concussion.
c. Internal hemorrhage.
d. Neurogenic shock.
e. Cardiogenic shock.
Correct answer: C
- 13 -
13 . The recommended fluid for initial fluid challenge in a trauma victim in shock
is -
A. 5% dextrose
B. 10% dextrose
C. Dextrose normal saline
D. Hartman's solution
Correct answer: D
- 14 -
19 . A patient with multiple injuries, ribs, abdomen, spine. Has bradycardia and
hypotension - which type of shock is this?
A. Anaphylactic
B. Neurogenic
C. Hypovolemic and neurogenic
D. Hypovolemic and septic
Correct answer: C
3. About Ludwig’s angina, all the following statements are true, except:
a. This is tuberculous infection of the deep neck spaces
b. Diabetics are more prone to develop this condition
c. It causes laryngeal oedema
d. Oedema of the floor of mouth pushes the tongue upwards
e. Urgent incision and drainage is needed
Correct answer: A
- 15 -
5. Which of the following is not a priority vaccine for the first year of life
A. Hib (Haemophiles influenzae type b )
B. Hepatitis B
C. DPT (diphtheria, whooping tetanus )
Correct answer: B
11 . A 40yrs male presents with abrupt onset pain, weakness, loss of contour of
shoulder and muscle wasting on 5th day of tetanus toxoid immunization. Possible
cause is
A. Radial nerve entrapment
B. Hysterical
C. Thoracic outlet syndrome
D. Brachial plexus neuritis
Correct answer: D
- 16 -
12 . In case of missile injury which one is most important:
A. Immunization and nerve repair
B. Fixation of fractures and tetanus immunization
C. Debridement and cleaning
D. Immediate skin suturing
Correct answer: C
18. Sickness benefit in Employees' State Insurance (ESI) is for how many days
A. 51
B. 61
C. 91
D. 71
Correct answer: C
- 17 -
19. The drug of choice for type 2 lepra reaction is
A .Clofazimine
B. Chloroquin
C. Thalidomide
D. Steroids
Correct answer: C
20. Which of the following is most efficiently transmitted by needle stick injury
A. HIV
B. Hepatitis B
C. Hepatitis C
D. CMV
Correct answer: B
- 18 -
Surgical nutrition in Surgical patients
2. Which of the following will not lead to decrease in cell mediated immunity
A. protein energy malnutrition
B. zinc deficiency
C. selenium deficiency
D. iron deficiency
Correct answer C
- 19 -
7. All are components of Primary Health Care except
A. providing essential drugs
B. supplementary nutrition
C. treatment of locally endemic diseases and minor ailments
D. prevention of locally endemic diseases
Correct answer B
- 20 -
13 . 29yrs- old man, met an accident with a car and has been in 'deep coma' for
the last 15 days. Which of the following is the most suitable route for the
administration of protein and calories?
A. Nasogastric tube feeding
B. Central venous hyperalimentation
C. Jejunostomy tube feeding
D. Gastrostomy tube feeding
Correct answer: C
- 21 -
5 . The advantage of Bladder drainage over Enteric drainage after Pancreatic
Transplantation is better monitoring of
A. Amylase levels
B. HBA1C levels
C. Electrolyte levels
D. Glucose levels
Correct answer: A
Principles of Laparoscopies
Priciples of oncology
- 22 -
3- A 75-year-old man with lung cancer was admitted to the hospital with
worsening dyspnea. He complains of progressive dyspnea for 2 months. On
physical examination, he has distended jugular veins, plethoric face, venous
collaterals on his chest wall, and distant heart sounds. What is the most likely
diagnosis?
A. Pericardial tamponade
B. Constrictive pericarditis
C. Congestive heart failure
D. Superior vena cava (SVC) syndrome
Correct answers: D
4- A 42-year-old man with a medical history significant for lung cancer is brought
to an emergency room for altered mental status. His family reports altered mental
status for 3 days. He has been lethargic and difficult to arouse. On examination,
he has orthostatic blood pressure and dry mucous membranes. Laboratory
evaluation reveals Ca 14.5 mg/dl and Cr 2.0 mg/dl. Which of the following is the
most appropriate initial management for this patient?
A. 0.9% saline bolus
B. Furosemide
C. Pamidronate
D. 0.45% saline bolus
Correct answers: A
7. The untrue statement about desmoid tumors of the abdominal wall is that they :
a) Arise from the rectus muscle or its sheath.
b) Occur most often in multiparous women.
c) Are locally invasive.
d) May give rise to metastasis.
e) Should be treated by wide local excision.
Correct answer: D
- 23 -
8. The untrue statement about desmoid tumors of the abdominal wall is that they
:
a. Arise from the rectus muscle or its sheath.
b. Occur most often in multiparous women.
c. Are locally invasive.
d. May give rise to metastasis.
e. Should be treated by wide local excision.
Correct answer: D
13 . Which of the following is the most common malignant tumor of adult males
in India?
A. Cola-rectal carcinoma
B. Lung cancer
C. Oropharyngeal carcinoma
D. Gastric carcinoma
Correct answer: C
- 24 -
2- Burn and Principles of plastic surgery
4. What percentage of a 1-year-old child is burnt if their anterior torso and all of R
arm are burnt?
a) 10%
b) 15%
c) 24%
d) 32%
e) 49%
Correct answer: C
- 25 -
6. Which is false about a lightening strike?
a) the patient should not be handled as they are charged and dangerous
b) flashover is potentially life saving
c) the likelihood of long-term impairment after recovery is low
d) being stuck directly is more dangerous than side flash and step voltage
e) if caught in a lightening strike you should keep your feet together and crouch down
Correct answer: A
11. Above which level will the patient be tetraplegic rather than paraplegic?
a. C7
b. C8
c. T1
d. T2
e. T3
Correct answer: C
- 26 -
12. Which is incorrect of spinal cord syndromes?
a. Central cord syndrome has greater power loss of lower extremities than upper.
b. Central cord syndrome occurs with hyperextension injuries often with patients with
pre-existing cervical canal stenosis.
c. Anterior cord syndrome is characterized by paraplegia and loss of pain and
temperature sensation, with intact position sense, vibration.
d. Brown-Sequard syndrome results from hemi section of the cord.
e. Central cord syndrome and anterior cord syndrome are thought to result from
compromised anterior spinal artery blood supply.
Correct answer: A
15. Burns involving head face and trunk constitutes how much percentage
A. 45%
B. 55%
C. 60%
D. 65%
Correct answer A
- 27 -
17. Parkland formula for burns is for
A. Ringer lactate
B. glucose saline
C. Normal saline
Correct answer: A
22 . A patient suffered from 3rd degree burn of right upper limb, 2nd degree burns of
right lower limb and 1st degree of burn of whole of the back. Total percentage of burn
will be
A. 27 %
B. 36 %
C. 45 %
D. 54 %
Correct answer: A
- 28 -
24 . A young man weighing 65 kg was admitted to the hospital with severe burns in a
severe catabolic state. An individual in this state requires 40 kcal per kg body weight
per day and 2 gms of protein/kg body weight/day. This young man was given a solution
containing 20% glucose and 4.25% protein. If 3000 ml of solution is infused per day:
A. The patient would not be getting sufficient protein
B. The calories supplied would be inadequate
C. Both protein and calories would be adequate
D. Too much protein is being infused
Correct answer: C
25 . A 16 years girl sustains a steam burn measuring 6 by 7 inches over the ulnar aspect
of her right forearm. Blisters develop over the entire area of the burn wound, and by the
time the patient is seen 6 hour after the injury, some of the blisters have ruptured
spontaneously. In addition to debridement of the necrotic epithelium, all therapeutic
regiments might be considered appropriate for him Except:
A. Application of mafenide acetate cream, but no daily washes or dressing
B. Heterograft application with sutures to secure it in place and daily washes, but no
dressing
C. Application of silver sulfadiazine and daily washes, but no dressing
D. Application of polyvinyl pyrrolidone foam, daily washes and a light occlusive
dressing changed daily
Correct answer: B
- 29 -
30 . Sun burns are -
A. First degree burns
B. Second degree burns
C. Third degree burns
D. Could be any of the above
Correct answer: A
31 . The best guide to adequate tissue perfusion in the fluid management of a patient
with burns, is to ensure a minimum hourly urine output of -
A. 10-30 ml
B. 30-50 ml
C. 50-70 ml
D. 70-100 ml
Correct answer: B
- 30 -
35. The main advantage of Lund and Browder charts over rule of nines is:
a- It is easier
b- More accurate to regarding sex of patient
c- More accurate regarding age of patient
d- All of the above
Correct answer: C
39. Which of the following is true about Langer's line of the skin?
a) These are in the direction of muscle fibers.
b) These are perpendicular to the long axis of underlying muscle fibers
c) Most favorable incision is circular over an exposed area
d) Most favorable incision is a rhomboid shaped one over an exposed area
Correct answer: B
- 31 -
42 . The malignancy in burns are:
A. Marjolins ulcer
B. Desmoid tumor
C. Basal cell ca
D. Squamous cell ca
Correct answer: A
- 32 -
e. Diarrhea
Correct answer: B
49. The most useful measure in preventing renal shut-down in post burn patients is:
a. Monitoring an hourly urine output between 30 and 50 ml.
b. Alkalinization of the urine.
c. Mannitol administration.
d. Administration of colloids.
e. Blood transfusion.
Correct answer: A
52. A paraplegic bed-ridden patient developed a large deep bed-sore over his sacrum.
The best regimen is by wide excision and:
a. Local applications.
b. Thiersch grafting.
c. Wolfe-grafting.
d. Local skin flops.
e. Myocutaneous flap.
Correct answer: E
53.ln unilateral hare-lip, the following statements are true except that it:
a. Affects the upper lip only.
b. May be partial or complete.
c. ls due to failure to fusion between the maxillary process with the frontal-nasal
process and the maxillary process of the opposite side.
d. ls always associated with nasal deformity.
e. Produces no serious speech defects.
Correct answer: E
54. Concerning complete cleft palate, the untrue statement is that it:
a. ls due to failure fusion of the palatal shelves of the maxillary processes with each
other and with the frontonasal process.
b. ls often associated with cleft-lip and broadening of the face.
c. interferes with nutrition and speech.
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d. Predisposes to upper respiratory tract infections.
e. Requires surgical repair after the second year of life.
Correct answer: E
55. A 6-year-old boy has a 2 cm lesion on Right cheek. The lesion has been enhancing
since birth. On Auscultation lesion is pulsatile, it has a thrill, and it has a harsh sound
on auscultation. It has multiple feeding arteries. The best treatment option for this lesion
would be
a) External beam radiotherapy
b) Ligation of the feeding arteries
c) LASER therapy
d) Embolization followed by surgery
Correct answer: D
- 35 -
Cleft lip, Cleft palate
1. Langenbeek's repair:
a- ls method of grafting in burns
b- ls method of repair after surgical excision of Sq.C.C.
c- ls method of repair of cleft lip
d- ls method of repair of cleft palate
Correct answer: D
4. Langenbeek’s repair:
a. Is a method of grafting in burns
b. Is a method of repair after surgical excision of SCC
c. Is a method of repair of cleft lip
d. Is a method of repair of cleft palate
Correct answer : D
- 36 -
7 . The following are true of cleft lip except
A. It can be diagnosed inutero
B. Most of the cleft lip babies do not feed well
C. Most of them are associated with cleft palate
D. Surgery is usually performed before 6 months of age
Correct answer: B
- 37 -
Hemangioma and vascular malformation
1. A29-year-old female swimmer develops a pigmented lesion on the right thigh. With
reference to a pigmented lesion, there is an increased risk of developing melanoma if it
is identified with which of the following?
(A) Hutchinson freckle (lentigomaligna)
(B) Freckle involving basal layer of skin
(C) Congenital nevocellular nevi
(D) Hemangioma
(E) Tophi
Correct answer: C
- 38 -
3- Skin and soft tissue
3. All of the following statements are true as regard benign breast disease, except
A Benign breast disease is the most common cause of breast problems.
B Lipoma is a common condition of the breast.
C Traumatic fat necrosis can be mistaken for a carcinoma.
D 30 per cent of breast cysts recur after aspiration.
Correct answer: B
- 39 -
6- All the following can be considered as complication of lipoma is a patient
except:
a) Myxomatous transformation.
b) Sarcomatous transformation.
c) Infection, suppuration and discharge.
d) Calcification especially is axilla, groin and buttocks
Correct answer : C
9- Attachment to the skin by fibrous tissues (= Dimpling and slippery edge), are
characters of:
a) Rodent ulcer.
b) Aneurysm.
c) Lipoma.
d) Sebaceous cyst.
Correct answer: C
12- The following are example of swelling move in only direction except:
a) Ganglion.
b) Neurofibroma.
c) Lipoma.
d) Aneurysm.
Correct answer: C
- 40 -
13- Spot diagnosis to differentiated lipoma and sebaceous cyst is:
a) Consistency.
b) Attachment to deep muscle.
c) Slippery edge of the lipoma and the punctum of the sebaceous cyst.
d) Compressibility.
Correct answer: C
2. A 67-year-old business executive and tennis player has a basal cell carcinoma
removed from the right cheek. What is TRUE of basal cell carcinoma (Fig. 2–3)?
(A) It may show a flat ulcer.
(B) It may metastasize to lymph nodes.
(C) It may metastasize to remote skin areas.
(D) It is found exclusively in the head and neck.
(E) It is best treated by topical 5-FU
Correct answer: A
- 41 -
3. List the layers of skin from the most superficial to the deepest layer adjacent to
the dermis (a) basal layer, (b) granular layer, (c) prickle layer, and (d) stratum
corneum.
(A) a b c d
(B) d b a c
(C) d c b a
(D) c a b d
(E) c a d b
Correct answer: C
4. A completely excised skin lesion of the face proved to be a basal cell carcinoma.
The further management of the case should be :
a. Lymph node dissection.
b. Radiotherapy.
c. Chemotherapy.
d. Regular follow up.
e. Reassurance of the patient.
Correct answer: D
5. A 35-year-old White male previously diagnosed with basal cell nevus syndrome
(Gorlin’s syndrome) presents with a new lesion for treatment. Apart from mulitple
basal cell lesions other features of this disorder may include:
(A) The disorder is genetically determined and transmitted as an autosomal dominant.
(B) Rib abnormalities such as splayed or bifid ribs.
(C) Skin ribs on the palms and soles.
(D) A benign clinical course before puberty.
(E) Normal mental development.
Correct answer: E
6. The following are (is) correctly matched about origin of skin tumors:
a- Squamous cell carcinoma: epidermis
b- Basal cell carcinoma: Basal areas or appendages
c- Melanoma: melanocytes
d- All of the above
Correct answer: D
- 42 -
9. All of the following are signs of epitheliomatous transformation in basal cell
carcinoma except:
a- Rapid growth
b- lnvasion of basement membrane
c- Everted edges
d- Hard fixed LNs
Correct answer: B
10. A case presented by chronic ulcer resistant for healing, the following support
your diagnosis as basal cell carcinoma except:
a. Male sex
b. 50 years age
c. Face as primary site
d. The surgeon decision to conserve
Correct answer: D
11. A completely excised skin lesion of the face proved to be basal cell carcinoma.
The further management of the case should be:
a. Lymph node dissection.
b. Radiotherapy.
c. Chemotherapy.
d. Regular follow up.
e. Reassurance of the patient
Correct answer: D
12. Concerning basal-cell carcinomas, the false statement is that they are :
a. Much less common than squamous cell carcinomas.
b. Very rare in oriental and block races
c. Particularly common in tropical regions.
d. Characterized histologically by dork-staining solid mosses of cells arising from the
basal layer of the epidermis.
e. Commonest on the exposed skin of blonde subjects and outdoor workers
Correct answer: A
14. A skin lesion which is ulcerated with rolled, smooth, pearly borders is most
likely:
a.Melanoma
b.Basal cell carcinoma
c.Seborrheic keratosis
d.Squamous cell carcinoma
Correct answer: B
- 43 -
15. Which of the following is NOT a pre-malignant (or does not have malignant
potential) skin condition/ lesion?
a. Actinic keratosis
b. Nevus sebaceous
c. Dysplastic nevus
d. Seborrheic keratosis
Correct answer: D
16. Which of the following skin lesions is NOT associated with sun exposure?
a. Actinic keratosis
b. Basal cell carcinoma
c. Seborrheic keratosis
d. Melanoma
Correct answer: D
17. This type of skin lesion is elevated, brown, and has a “stuck on” appearance:
a. Actinic keratosis
b. Basal cell carcinoma
c. Xanthoma
d. Seborrheic keratosis
e. Verruca
Correct answer: D
- 44 -
21. The following are true of the skin lesions EXCEPT:
a.Actinic keratosis is completely benign with no malignant potential
b.Nodular ulcerative variant is a type of basal cell carcinoma
c.Squamous cell carcinoma occurs in primarily sun exposed area of skin
d.Basal cell carcinoma has a 95% cure rate if lesion is less than 2 cm in diameter
Correct answer:A
23. The following are (is) incorrectly matched about behavior of skin tumors:
a- Malignant melanoma: locally malignant tumor
b- Squamous cell carcinoma: malignant tumor
c- Basal cell carcinoma: locally malignant tumor
d- Hemangioma: Hamartoma
e- Nevi: benign tumor
Correct answer: A
24. The most common site for the following diseases is correctly matched except:
a- Keloids: face, neck and skin over sternum
b- Hypertrophic scars: extensor surfaces
c- Hemangiomas: head and neck
d- Basal cell carcinoma: face
Correct answer: B
- 45 -
27 . Characteristic of basal cell carcinoma is -
A. Keratin pearls
B. Foam cells
C. Nuclear palisading
D. Psammoma bodies
Correct answer: C
29 . A 48 year old sports photographer has noticed a small nodule over the upper
lip from four months. The nodule is pearly white with central necrosis,
telangiectasia. The most likely diagnosis would be -
A. Atypical melanoma
B. Kaposi’s sarcoma
C. Basal cell carcinoma
D. Squamous cell carcinoma
Correct answer: C
30 . MOHs micrographic excision for basal cell carcinoma is used for all the
following except -
A. Recurrent tumor
B. Tumor less than 2 cm in diameter
C. Tumors with aggressive histology
D. Tumors with perineural invasion
Correct answer: B
31 . A rodent ulcer
A. Is a squamous cell carcinoma
B. Is a basal cell carcinoma
C. Is a venous ulcer
D. Contains epithelial pearls
Correct answer: B
- 46 -
33 . A patient presents with a small fast-growing lesion on the upper extremity
and comments that it has been present for past 2 weeks. The lesion most likely
represents -
A. Squamous cell cancer
B. Keratoacanthoma
C. Basal cell cancer
D. Junctional nevus
Correct answer: B
34. A 75-year-old farmer complained of a scaly, plaque like skin lesion on his
forearm with recent development of ulceration. Biopsy reveals invasive squamous
carcinomas within actinic keratosis negative examination of axillary nodes.
Definitive treatment is:
(A) Local wound care until the ulcer heals; then wide excision and repair
(B) Excision of the lesion with frozen section determined free margins and repair
(C) Wide excision; split-thickness skin graft and axillary node dissection
(D) Wide excision; split-thickness graft and radiation therapy
(E) Wide excision; split-thickness graft and Chemotherapy
Correct answer: B
- 47 -
Correct answer: A
42- What is the commonest type of ulcers can appear at the neck:
a) Tuberculous ulcer.
b) Rodent ulcer.
c) Basal cell carcinoma.
d) Epithelioma .
Correct answer: A
44- The most important predisposing factor of the rodent ulcer is:
a) Continuous friction.
b) Exposure to sunlight.
c) Hairy areas of the body.
d) Drugs.
Correct answer: B
- 48 -
Correct answer: C
47- Which of the following is accurate regarding risk factors for skin cancer?
A- Genetic predisposition and family history are more important risk factors for the
development of melanoma than are exposure to sunlight and radiation
B- Cutaneous squamous cell carcinoma (cSCC) related to immunosuppression
typically has a less aggressive course, with a lower rate of local recurrence,
metastasis, and death
C- Ultraviolet A (UV-A) radiation plays a greater role in the development of BCC
than does ultraviolet B (UV-B) radiation
28%
D- The presence of freckling and benign nevi indicate an increased risk for skin
cancer, with the number of nevi more important than the size in terms of melanoma
risk.
Correct answer : D
48- Which of the following is accurate about the types of cutaneous malignant
melanoma?
A- The most common type of head and neck melanoma is nodular.
B- Mucosal melanomas mostly arise in the nasal cavity and are associated with a poor
prognosis and recurrence after treatment.
C- Lentigo maligna (LM) is regarded as the most invasive form of melanoma.
D- Desmoplastic melanomas (DMs) are rarely associated with LM lesions, typically
appear on the extremities, are mildly infiltrative, and rarely recur
Correct answer : B
49- Which of the following is accurate regarding the clinical presentation and
physical examination of patients with nonmelanoma skin cancers?
A- Lip SCC is more common on the upper lip than on the lower lip
B- Nodular BCC is the most common type and usually presents with telangiectasis
C- The cornea is the most common location for conjunctival SCCs
D- Morphea form BCC is typically associated with ulceration, bleeding, and crusting
Correct answer : B
- 49 -
Melanoma
- 50 -
7. Risk factors for malignant transformation in naevi include the following
except:
a- Microscopic: junctional type
b- Macroscopic: lentigo
c- Incomplete removal
d- Chronic irritation
Correct answer: B
- 51 -
13.Which of the following is TRUE about melanoma?
a.The most common skin cancer
b.The most common benign skin cancer
c.The most common cause of death from skin cancer
d.The most common skin cancer among Asians
Correct answer: C
14. A 65-year-old male presents to clinic with a small skin lesion (0.5 cm) on his
chest which is very suspicious for melanoma. Which of the following is the most
appropriate option for this patient?
a.Conservative treatment
b.Excisional biopsy with wide margins
c.Immediate chemotherapy and radiotherapy
d.Immediate CT scan
e.None of the above
Correct answer: B
16. A man has a suspected melanoma excised from his back. It appears to be less
than 1 mm deep. The smallest margin to plan for excision is:
a.5 cm
b.2 cm
c.1 cm
d.6 cm
e.2 mm
Correct answer: C
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18. A 40-year-old woman arrives at her family doctor’s office with concern about
a black, bleeding lesion on her left lower leg. She states that it has become enlarged
over the past several months and more irregular in appearance. Which of the
following is FALSE about melanoma?
a.Excision is the primary management
b.Nodular melanoma is the most common
c.Ulceration is a negative prognostic factor
d.Family history is a risk factor
e.The most common site on males is the back
Correct answer: B
19. A tumour descending into the reticular dermis, but not invading the
subcutaneous tissue, would be classified as:
a.Clarks level I
b.Clarks level III
c.Clarks level V
d.Clarks level IV
Correct answer: D
21.Which nevus would you most likely remove due to its increased malignant
potential?
a.Compound
b.Intradermal
c.Junctional
d.Large pigmented
e.None of the above
Correct answer: D
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24 . Worst prognosis in melanoma is seen in subtype
A. Superficial spreading
B. Nodular melanoma
C. Lentigo maligna melanoma
D. Amelanotic melanoma
Correct answer: B
27 . Biopsy from a mole on the left foot shows cytologic atypia of melanocytes
and diffuse epidermal infiltration by anaplastic cells, which are also present in
the papillary and reticular dermis. The most possible diagnosis is:
A. Dysplastic nevus
B. Melanoma, clark level III
C. Melanoma, clark level IV
D. Congenital melanocytic nevus
Correct answer: C
28 . All of the following statements about malignant melanoma are true except:
A. Acral lentiginous melanoma carrier a good prognosis
B. Prognosis is better in female than in male
C. Most common type is superficial spreading melanoma
D. Stage IIA shows satellite deposits
Correct answer: A
- 54 -
31 . Deep vein thombosis occur most commonly after -
A. Total hip replacement
B. Gastrectomy
C. Prostatic operation
D. Brain surgery
Correct answer: A
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6 . Which one of the following soft tissue sarcomas frequently metastasizes to
lymph nodes?
A. Osteosarcoma.
B. Fibrosarcoma.
C. Alveolar soft part sarcoma.
D. Embryonal Rhabdomyosarcoma.
Correct answer: D
7 . All of the following soft tissue sarcoma have a propensity for lymphatic spread
except -
A. Neurofibrosarcoma
B. Synovial sarcoma
C. Rhabdomyosarcoma
D. Epitheloid sarcoma
Correct answer: A
8. A 12-year old has been referred to you following complete resection with clean
margins of a high-grade malignant peripheral nerve sheath tumor of the shoulder
region. The tumor measured approximately 3.5 cm in greatest dimension. A CT
scan of the chest and a bone scan were within normal limits. The patient does not
have evidence of NF1. Which of the following approaches would you recommend?
A. Chemotherapy with doxorubicin and ifosfamide
B. Radiotherapy
C. Chemotherapy with doxorubicin and ifosfamide plus radiotherapy
D. Observation
Correct answer is D.
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11.You are taking care of a 4-year old with a Stage 3, Group III embryonal
rhabdomyosarcoma of the bladder. After 12 weeks of therapy with vincristine,
dactinomycin, and cyclophosphamide (VAC), you obtain an MRI and the
radiologist tells you that the tumor has not changed in size. Which of the following
treatment approaches should you recommend?
A. Continue with the current chemotherapy regimen, which also calls for local
radiotherapy to begin shortly
B. Change to an alternate chemotherapy regimen and reassess in another 12 weeks
C. Proceed to extensive surgery followed by an alternate chemotherapy regimen
D. Change to an alternate chemotherapy regimen and initiate local radiotherapy
E. Biopsy the mass and base further decisions on the viability of the tumor
Correct answer is A.
12.You are seeing a 16-year old with a newly diagnosed grade 3 epithelioid
sarcoma of the right forearm. After the biopsy, you obtain an MRI of the forearm
that shows the mass to be > 5 cm in size. Your staging evaluations should include
which of the following?
A. Chest CT, bone scan
B. Chest CT, bone scan, bone marrow aspirate/biopsy
C. Chest CT, bone scan, lymph node biopsy
D. Bone scan, bone marrow aspirate/biopsy
E. Chest CT, lymph node biopsy
Correct answer is C.
13.A mass on the left arm of a 14-year old girl has been biopsied. The pathologist
tells you that the immunostaining for desmin is positive but wants to do an
additional immunostaining to confirm the diagnosis. Which of the following stains
would be most helpful to establish the diagnosis?
A. CD99
B. vimentin
C. synaptophysin
D. keratin
E. myogenin
Correct answer is E.
14. A mass on the left arm of a 14-year-old girl has been biopsied. The
pathologist tells you that the immunostaining for desmin is positive but wants
to do an additional immunostaining to confirm the diagnosis. Which of the
following stains would be most helpful to establish the diagnosis?
A. CD99
B. Vimentin
C. Synaptophysin
D. Keratin
E. Myogenin
Correct answer is E
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15. A 3-month-old presents with paraspinal infantile fibrosarcoma. Molecular
studies show the presence of a characteristic chromosomal translocation. Based
on cytogenetic analysis, this tumor seems to share a genetic origin with which
of the following tumors?
A. Mesoblastic nephroma
B. Aggressive fibromatosis (Desmoid tumor)
C. Infantile hemangiopericytoma
D. Inflammatory myofibroblastic tumor
E. Malignant rhabdoid tumor
Correct answer is A
16. You are taking care of a 4-year-old with a stage 3, group III embryonal
rhabdomyosarcoma of the bladder. After 12 weeks of therapy with vincristine,
dactinomycin, and cyclophosphamide (VAC), you obtain an MRI and the
radiologist tells you that the tumor has not changed in size. Which of the
following treatment approaches should you recommend?
A. Continue with the current chemotherapy regimen, which also calls for local
radiotherapy to begin shortly.
B. Change to an alternate chemotherapy regimen and reassess in another 12 weeks.
C. Proceed to extensive surgery followed by an alternate chemotherapy regimen.
D. Change to an alternate chemotherapy regimen and initiate local radiotherapy.
E. Biopsy the mass and base further decisions on the viability of the tumor.
Correct answer is A
17. You are seeing a 16-year-old with a newly diagnosed grade 3 epithelioid
sarcoma of the right forearm. After the biopsy, you obtain an MRI of the
forearm that shows the mass to be >5 cm in size. Staging evaluations ideally
include which of the following?
A. Chest CT scan
B. Chest CT scan, bone marrow aspirate/biopsy
C. Chest CT scan, MRI of the regional lymph node bed
D. Chest CT scan, abdominal CT scan
Correct answer is C
18. You are treating a patient with localized osteosarcoma of the distal femur
with methotrexate, doxorubicin, and cisplatin (MAP) chemotherapy. At week
10 of treatment the patient undergoes complete resection of the tumor.
Pathology demonstrates 40% necrosis. Which of the following represents the
most appropriate further therapy?
A. Ifosfamide and etoposide (IE)
B. MAP + ifosfamide and etoposide (MAPIE)
C. Gemcitabine docetaxel
D. MAP
E. Sorafenib
Correct answer is D
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19. You are discussing prognosis with the mother of a patient with stage 3,
group III rhabdomyosarcoma. Which of the following is the most unfavorable
primary site?
A. Extremity
B. Prostate
C. Infratemporal fossa
D. Neck
E. Biliary tree
Correct answer is A
20. A 12-year-old has been referred to you following complete resection with
clean margins of a high-grade malignant peripheral nerve sheath tumor of the
shoulder region. The tumor measured approximately 4 cm in greatest
dimension. A CT scan of the chest and a bone scan were within normal limits.
The patient does not have evidence of NF1. Which of the following treatment
approaches would you recommend?
A. Chemotherapy with doxorubicin and ifosfamide
B. Radiotherapy
C. Chemotherapy with doxorubicin and ifosfamide plus radiotherapy
D. Observation
Correct answer is D
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23. A patient with a 12-cm pelvic mass, a biopsy reveal high-grade
undifferentiated sarcoma.. Which of the following treatment approaches do you
recommend?
A. Upfront chemotherapy followed by either resection and/or radiotherapy, followed
by further chemotherapy
B. Upfront resection to avoid radiotherapy followed by chemotherapy
C. Resection alone
D. Radiotherapy alone
Correct answer is A
25. Biopsy of a bone tumor reveals small round blue cells. Immunostains show
that the tumor is CD99 positive. RT PCR did not identify the t(11;22)(q24;q12).
The pathologist asks you about the clinical and radiographic features of the
case. You state that the patient is an 11-year-old Caucasian girl and that the
tumor arises in the diaphysis of the femur and shows an onion-skin pattern on
imaging. You and the pathologist decide to do which of the following?
A. Initiate treatment for small round cell osteosarcoma
B. Repeat the biopsy
C. Do FISH using FLI1 break-apart probes
D. Do RT PCR for the t(1;13)(p36;q14)
E. Do FISH using EWS break-apart probes
Correct answer: E
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4- Vascular surgery
2. About Investigations of limb ischemia the following statements are true except?
a. Doppler ultrasound works on the basis of a frequency shift when sound waves hit
moving red blood cells.
b. ABPI means ‘ankle brachial pulsatility index.
c. An ABPI of greater than 0.9 is probably normal.
d. Duplex scans are a combination of wave form analysis and B-mode ultrasound.
e. Carotid surgery is often performed on the basis of duplex scans without further
imaging.
Correct answer: B
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5. About amputation, which of the following is not an indication for major
amputation?
a. Clostridium infection of the lower leg.
b. Severe trauma
c. Neurofibroma
d. Knee flexion contracture
e. Severe rest pain without gangrene.
Correct answer: C
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12. Arterial embolism may result from:
a. Atherosclerosis
b. Bone fracture
c. Parasites
d. All of the above
Answer: D
15. About acute arterial thrombosis all the following are true except:
a. Old age
b. History of chronic ischemia
c. No collateral
d. There may be history of diarrhea
Answer: C
16. Sure signs of arterial injury include all the following except:
a. Signs of ischemia
b. Evidence of adjacent nerve injury
c. Pulsating hematoma
d. Palpable thrill at the site of injury
Answer: B
18. Management of complete arterial tear may include all the following except
a. Dissection of the artery
b. Cut the minor branches
c. Suturing in transverse suture line
d. Saphenous grafting
Answer: C
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19. A 28-year-old woman developed a painful thrombosis of a superficial varix in
the left upper calf 2 days previously. After spending the 2 days in bed with her leg
elevated, she felt better and the tenderness resolved; however, when out of bed she
developed a twinge of right-sided chest pain when walking and a feeling of
heaviness in the calf. Which treatment is most appropriate?
a. Check for leg swelling, tenderness, and Homan's sign, and obtain a Doppler
ultrasound study.
b. Begin antibiotics for a probable secondary bacterial infection.
c. Order emergency venography, and if it is abnormal, begin heparin administration.
d. Begin ambulation and discontinue bed rest that probably caused muscle pain by
hyperextension of the knee.
e. If there is no pain on dorsiflexion of the left foot reassure her, since a negative
Homan's sign precludes the diagnosis of DVT.
Answer: C
20. In a 55-year-old grocery store cashier with an 8-month history of leg edema
increasing over the course of a workday, associated with moderate to severe lower
leg bursting pain, the most appropriate investigative study or studies are:
a. Doppler duplex ultrasound.
b. Brodie-Trendelenburg test.
c. Ascending and descending phlebography.
d. Measurement of ambulatory and resting foot venous pressure.
e. Venous reflux plethysmography.
Answer: A
22. The single most important indication for emergency pulmonary embolectomy
is:
a. The likelihood of another episode of embolism.
b. The inability to determine whether the problem is acute pulmonary embolism or
acute myocardial infarction.
c. The presence of persistent and in tractable hypotension.
d. Pulmonary emphysema.
Answer: C
23. In prevention of the fat emboli syndrome the primary therapy can be
accomplished by which of the following?
a. Systemic anticoagulation achieving a partial thromboplastin time greater than 50
seconds.
b. Intravenous administration of alcohol.
c. Prophylactic administration of methyl prednisolone.
d. Maintaining a serum albumin value greater than 3 gm. per 100 ml. in the days
immediately following injury.
Answer: D
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24. Significant tachypnea and hypoxia follow development of fat emboli
syndrome, and the goal of ventilatory support should be:
a. Keeping the respiratory rate below 30.
b. Preventing respiratory alkalosis.
c. Reversing pulmonary shunting using positive end-expiratory pressure.
d. Maintaining an adequate total volume.
Answer: C
25. Carotid artery occlusive disease most often produces transient ischemic
attacks or stroke by which of the following mechanisms?
a. Reduction of flow to the affected area of the brain through stenotic or occluded
vessels.
b. Embolization of atheromatous debris and/or clot with occlusion of intracranial
branches of the carotid artery.
c. Thrombosis and propagation of the clot into the intracranial branches.
d. All of the above are equally common.
Answer: B
27. In terms of long-term graft patency, the best results in the femoral tibial
bypass position have been achieved with:
a. A modified human umbilical cord graft.
b. Polytetrafluoroethylene (PTFE [Gore-Tex]).
c. Saphenous vein allograft.
d. Segments of greater and lesser saphenous and cephalic veins spliced together.
Answer: D
28. Which of the following statements about femoral popliteal bypass grafting is
true?
a. Long-term graft surveillance by duplex scanning has no effect on graft patency
rates.
b. Graft failure and amputation occur in half the patients within 5 years.
c. If grafting is successful, long-term mortality is improved.
d. Patency rates of 80% to 90% at 1 year currently are expected.
Answer: D
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d. PRTA is associated with a higher morbidity and mortality than angioplasty for
peripheral vascular disease.
Answer: D
31. A patient presents with a gunshot wound of the mid-neck. Although drunk, he
exhibits no lateralizing neurologic signs. After control of his airway is achieved, he
is taken directly to the operating room for control of hemorrhage. The common
carotid artery has a 2-cm. destroyed segment. There is also a major esophageal
injury. The best treatment for this carotid injury is:
a. Vein graft replacement of the common carotid artery.
b. Ligation of the common carotid artery.
c. Ligation of the common carotid artery proximally with a subclavian carotid bypass.
d. Ligation of the common carotid artery with sympathectomy.
e. Prosthetic graft replacement of the common carotid artery.
Answer: A
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34. Which of the following statements about acute arterial occlusion today is not
true?
a. Most arterial emboli originate in the heart as a result of underlying cardiac disease.
b. It can be treated under local anesthesia.
c. It is usually due to atherosclerotic disease.
d. Surgical treatment can usually be avoided if the lesion is diagnosed early.
Answer: D
37. Which of the following is not true of the embolectomy catheter technique?
a. The balloon should be inflated by the same person who withdraws the catheter.
b. Distal exploration should be carried out in all major branches of the affected
extremity.
c. The balloon is designed to dilate as it traverses areas of luminal narrowing.
d. Removal of adherent thrombus requires alternate catheter-based therapy in addition
to balloon exploration.
Answer: C
39. A 21-year-old woman presents with digital color changes in response to cold
stimulation. Physical examination and laboratory data, including an autoimmune
disease screen, are normal. She should be advised that:
a. Her condition is characteristic of vasospastic Raynaud's syndrome and, while she
may be at a slightly higher risk for developing a connective tissue disease in the future,
there is no evidence of one currently.
b. Her problem with her fingers will get progressively worse and she will eventually
lose fingers.
c. She has scleroderma, which will manifest itself at a later date.
d. Her problem is “all in her head.”
Answer: A
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40. Obstructive Raynaud's syndrome can be differentiated from vasospastic
Raynaud's syndrome by the:
a. Ice water test.
b. Digital hypothermic challenge test.
c. Antinuclear antibody levels.
d. Digital blood pressure measurement.
Answer: D
41. Which of the following statements about chronic mesenteric ischemia due to
atherosclerosis is correct?
a. Postprandial pain in these patients is due to gastric hyperacidity and in most cases is
relieved with H 2 blockers.
b. Men are more often affected than women.
c. Mesenteric endarterectomy is the surgical treatment of choice, since long-term
patency rates are superior to mesenteric bypass.
d. Arteriography is no longer necessary in these cases since noninvasive
diagnosis can be established using duplex ultrasound scanning.
e. Surgical treatment is indicated to prevent intestinal infarction in symptomatic
patients.
Answer: E
44. Which of the following statements about the treatment of renal artery stenosis
is true?
a. Though a significant cause of hypertension, renal artery stenosis seldom results in
loss of renal function.
b. In patients with medically controlled renovascular hypertension there is no need to
consider revascularization.
c. Balloon angioplasty is more effective in patients with atherosclerotic disease as
compared with those with fibromuscular disease.
d. In patients with severe atherosclerosis of the aorta, bypass from the splenic or
hepatic arteries should be considered.
Answer: D
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45. Concerning in-vivo regulation of the anticoagulated state by endothelium, the
following is true:
a. Heparin-ATIII inactivates only thrombin
b. Thrombomodulin serves only to bind thrombin
c. Production of von Willebrand factor (VWF) inactivates platelets
d. Endothelial cells can secrete tissue factor
Answer: D
46. Ten years after irradiation of the neck for a tonsillar carcinoma, a 59-
year-old woman is found to have symptomatic carotid artery disease.
Arteriogram shows a 70% irregular stenotic lesion. The following is true:
a. Replacement of the artery should be planned due to radiation induced arterial injury
b. The pathology is most likely to be an inflammatory reaction with endothelial
sloughing and thrombosis
c. If atherosclerotic disease is found, the plaque will be no different than nonirradiated
plaques
d. The patient should be managed medically because of the radiation arterial in jury
Answer: C
47. A 23-year-old woman with fever, myalgia and anorexia presents with
hypertension and a cool, ischemic left arm. Angiography shows multiple stenoses
of the subclavian and renal arteries. The following is true:
a. Coronary angiography is indicated with high likelihood of finding coronary disease
b. Endarterectomy of the lesions would be preferred to transluminal angioplasty
c. The presentation is more suggestive of Behcet’s disease than Takayasu arteritis
d. Preferred management consists of corticosteroids
Answer: D
50. Two days following coronary angiography and angioplasty, a 47-year-old male
diabetic develops painful blue toes on both feet. The following is true:
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a. It is very unlikely that there is any connection between the catheterization and the
extremity problem
b. The appropriate treatment is vasodilators and an antiplatelet agent
c. If both superficial femoral arteries are obstructed, the most likely etiology is in-situ
microvascular thrombosis
d. If renal failure or pancreatitis develops, the outlook for long term survival is very
poor
Answer: D
51. A 70-year-old man presents with sudden pain and ischemic changes in
his left leg. An arterial embolus is suspected. The following is true:
a. The most likely source of an arterial embolus is from intracardiac thrombus on a
previous MI
b. If atrial fibrillation (AF) is present, it is known that chronic AF is less likely to
produce embolism than paroxysmal AF
c. Currently, the most common cause of AF is ischemic rather than rheumatic heart
disease
d. Aspirin is more effective than Coumadin in AF for reducing risk of stroke and
cardiovascular mortality
Answer: C
53. Which of the following statements is true regarding the use of duplex
scanning as a means to follow and monitor bypass grafts?
a. Duplex scanning is accurate and cost effective
b. A localized increase in systolic velocity greater than 2 5% compared to adjacent
segments in the graft identifies a diameter reduction of at least 50%
c. Peak systolic velocities should be less than 40 cm/sec throughout the graft
d. Arterial venous fistulas associated with in situ bypass grafts are difficult to detect
with a duplex scanner
Answer: A
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55. Which of the following is true regarding treatment of diabetes?
a. Strict control with insulin but not oral hypoglycemic agents markedly reduces
the incidence of cardiovascular complications in diabetic persons
b. Vascular complications are directly proportion al to the degree of glycemic control
c. The effects of diabetes are most marked in individuals with other risk factors
d. The impact of diabetes and cardiovascular risk is relatively uniform
Answer: C
59. About phlegmasia cerulae dolens all the following are true except:
a. There is massive iliofemoral DVT
b. Severe congestion and cyanosis of lower limb
c. Treated by anticoagulants
d. May lead to venous gangrene
Answer: C
60. Interruption of Inferior Vena cava is not indicated in
A.multiple septic emboli
B.multiple small peripheral emboli
C.when anticoagulation is contraindicated
D.Ileo femoral thrombosis
Correct answer C
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62 . Which of the following statements regarding arteriovenous fistulae is true?
A. Blood volume is decreased
B. Cardiac output is decreased
C. Heart rate is decreased
D. Peripheral vascular resistance is decreased
Correct answer: D
65. Following resection of the left colon, a 67- year-old obese woman develops left-
sided leg edema due to deep-vein thrombosis. She is placed on anticoagulants, but
after 2 weeks of warfarin (Coumadin), she develops a pulmonary embolus with
slight hypoxemia. What should the next step in management involve?
(A) Increasing the dose of anticoagulants
(B) Discontinuing anticoagulants
(C) Use of an inferior vena cava (IVC) filter
(D) CT scan of the leg and abdomen
(E) Femoral vein ligation
Correct answer: C
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68 . The most common cause of peripheral limb ischemia is -
A. Trauma
B. Altherosclerosis
C. Buerger's disease
D. Takayasty's disease
Correct answer: B
Arterial aneurysm
1. The most common risk associated with carotid artery aneurysm is:
a. Thrombosis of the aneurysm.
b. Embolization of mural thrombus.
c. Rupture of the aneurysm.
d. Compression of the hypopharynx.
Answer: B
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5. An aortic abdominal aneurysm was first successfully resected by:
a. Matas.
b. Linton.
c. Dubost.
d. None of the above.
Answer: C
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11 . Peripheral aneurysm most commonly located at -
A. Femoral artery
B. Popliteal artery
C. Brachial artery
D. Axillary artery
Correct answer: B
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17. A 67-year-old man with acute popliteal arterial embolism has a negative
cardiac echo for source of the thrombus. The following is true:
a. Most likely non -cardiac source is a thoracic aortic aneurysm
b. Embolism is more common from femoral than popliteal arterial aneurysms
c. Emboli from popliteal aneurysms are often clinically silent
d. Embolism is rare from subclavian artery aneurysms
Answer: C
20. Which of the following confirms the diagnosis of transection of the descending
thoracic aorta?
a. Widened mediastinum.
b. Fractured first rib.
c. Left pleural effusion.
d. Positive aortogram.
e. All of the above.
Answer: D
22. The appropriate treatment in most situations of an aortic abdominal graft that
has become infected is:
a. Intravenous antibiotics and observation for future complications.
b. Catheter drainage at the site of infection.
c. Replacement of the infected graft with another prosthetic graft.
d. Excision of the entire graft and insertion of ax illobifemoral grafts.
Answer: D
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Varicose veins and chronic venous insufficiency
3. The best treatment plan for the patient described in the preceding question
should include:
a. Varicose vein ligation and stripping as soon as possible.
b. Ulcer debridement, vein stripping, and skin grafting.
c. Ligation of the medial perforating veins.
d. Transposition of saphenous vein valve.
e. Leg elevation, external support, and ambulation without standing.
Answer: E
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6 . Surgery in varicose veins in NOT attempted in presence of -
A. Deep vein thrombosis
B. Multiple incompetent perforators
C. Varicose veins with leg ulcer
D. All of the above
Correct answer: A
9 . A pt presented with pulsating varicose veins of the lower limb. Most probable
diagnosis is:
A. Klippel Trenaunay syndrome
B. Tricuspid regurgitation
C. DVT
D. Right ventricular failure
Correct answer: A
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12 . A 55yrs male presents with varicose vein with saphena-femoral incompetence
and normal perforator management is:
A. Saphena-femoral flush ligation
B. saphenofemoral flush ligation with striping
C. endovascular striping
D. Sclera-therapy
Correct answer: B
1 . Which of the following is the best way of preventing development of deep vein
thrombosis(DVT) in post operative period ?
A. Physiotherapy
B. Early ambulation
C. Low dose aspirin
D. Prophylactic heparin
Correct answer: D
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5. In patients who develop a documented episode of deep venous thrombosis (DVT)
the most significant long-term sequala is:
a. Claudication.
b. Recurrent foot infections.
c. Development of stasis ulcer.
d. Pulmonary embolization.
e. Diminished arterial perfusion.
Answer: C
6. The most dangerous DVT which requires the longest period of treatment:
a. Calf vein DVT
b. Femoral vein DVT
c. Ileofemoral DVT
d. All of the above
Answer: C
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3. Second stage of lymphedema includes:
a) Soft tissue
b) Reversible swelling
c) Can be infected
d) 3-5 cm differences between limbs
Correct answer : D
8. When you examine a male patient with lymphedema, you discover pitting
edema, and it’s reversible with elevation. From your point of view, which stage of
lymph is?
a) Stage I
b) Stage II
c) Stage III
d) Stage IV
Correct answer : A
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Correct answer : D
12.Deep abdominal breathing exercises before and after exercise is effective for:
a) Stimulate lymph flow
b) Improve ROM
c) Increase lymph volume
d) Prevent infection
Correct answer : A
16. Which of the following statements about upper extremity edema is true?
a. Lymphedema is more common than venous edema.
b. Signs and symptoms of venous obstruction include edema, distention of superficial
veins, tightness, aching, cyanosis and pain.
c. Distal venous obstructions are more likely than proximal venous obstructions to
cause symptoms in the upper extremity.
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d. All patients with symptomatic upper extremity venous thrombosis should receive
fibrinolytic therapy.
Answer: B
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5- Head and neck
2 . Which of the following would be the best treatment for a 2 cm thyroid module
in a 45yrs man with FNAC revealing it to be a papillary CA?
A. Total thyroidectomy with left sided modified neck dissection
B. Hemithyroidectomy
C. Hemithyroidectomy with modified neck dissection
D. Near total thyroidectomy with radiotherapy
Correct answer: A
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6 . Which of the following is the commonest tumour of thyroid -
A. Anaplastic carcinoma
B. Follicular carcinoma
C. Papillary carcinoma
D. Medullary carcinoma
Correct answer: C
8 . In an accident there was rupture of the pituitary stalk. This would lead to all
of the following except:
A. Hyperprolactinemia
B. Diabetes Insipidus
C. Hypothyroidism
D. Diabetes Mellitus
Correct answer: D
9 . A 38 year woman had recurrent episodes of headache and sweating. Her mother
had renal calculi and died of thyroid cancer. Physical observations revealed a
thyroid nodule and ipsilateral enlarged cervical lymph nodes. Surgeon should
order the woman before performing thyroid surgery:
A. Estimation of hydroxy indole acetic acid in urine
B. Thyroid scan
C. Estimation of TSH, and TRH levels in serum
D. Estimation of urinary metanephrines, VMA and catecholamines
Correct answer: D
10 . Which of the following would be the best treatment for a 2 cm thyroid nodule
in a 50 year old man with FNAC revealing it to be a papillary carcinoma?
A. Subtotal thyroidectomy with modified neck dissection
B. Hemithyroidectomy
C. Hemithyroidectomy with modified neck dissection
D. Near total thyroidectomy with modified neck dissection
Correct answer: D
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12 . In prolactinoma most common symptom other than galactorrhea is ?
A. Bitemporal hemianopia
B. Amenorrhea
C. Thyroid dysfunction
D. Headache
Correct answer: B
14 . A 20 year old girl with 9 months history of neck and swelling with thyrotoxic
symptoms.On investigation increased T4 and decreased TSH with palpable 2 cm
nodule was found.Next investigation will be -
A. Thyroid scan
B. USG
C. CT scan
D. Radioactive iodine uptake
Correct answer: A
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18 . Parathyroid adenoma most commonly involves which of the following sites:
A. Thyroid substance
B. Superior parathyroid lobe
C. Inferior parathyroid lobe
D. In the mediastinum
Correct answer: C
23 . A 27 years lady presents with a palpable thyroid nodule, and needle biopsy
demonstrates amyloid in the stroma of the lesion. A cervical lymph node is
palpable on the same side as the lesion. The best treatment should be
A. Removal of the involved lobe, the isthmus, a portion of the opposite lobe, and he
enlarged lymph node
B. Removal of the involved node, the isthmus, and the enlarged lymph node.
C. Total thyroidectomy and irradiation of the cervical lymph nodes
D. Total thyroidectomy and modified neck dissection on the side of the enlarged
lymph node
Correct answer: D
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24 . Cervical lymphadenopathy is seen most commonly in which variety of thyroid
carcinoma?
A. Papillary carcinoma
B. Follicular carcinoma
C. Anaplastic carcinoma
D. Medullary carcinoma
Correct answer: A
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30 . MEN-II is seen with the following type of thyroid carcinoma:
A. Medullary
B. Papillary
C. Follicular
D. Anaplastic
Correct answer: A
32 . A 70 years woman presents with post myocardial infraction after 6 weeks with
mild CHF. There was past H/O neck surgery for parathyroid adenoma 5 years
ago. ECG shows slow atrial fibrillation. Serum Ca+2 13.0mg/L and urinary
Ca+2 is 300mg/24h.On examination their is small mass in the para tracheal
position behind the right clavicle. Appropriate management is-
A. Observation and repeat serum Ca+2 in two months
B. Ultrasound - guided alcohol injection of the mass
C. Repeat neck surgery
D. Treatment with technetium-99
Correct answer: B
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36 . Treatment of Medullary carcinoma thyroid -
A. Radiotherapy and Chemotherapy
B. Surgery and Radiotherapy
C. Radioiodine ablation
D. Surgery only
Correct answer: D
- 90 -
Correct answer: B
- 91 -
49 . For solitary thyroid nodule. The treatment of choice is -
A. Radical thyroidectomy
B. Hemithyroidectomy
C. Total thyroidectomy
D. subtotal thyroidectomy
Correct answer: B
50 . A patient operated for thyroid surgery for a thyroid swelling later in the
evening developed difficulty in breathing. There was swelling in the neck. The
immediate management would be:
A. Epinephrine injection
B. Tracheostomy
C. IV calcium glucanate
D. Open the wound sutures in the ward
Correct answer: D
55 . All of the following are true about Lymphoma of the thyroid except:
A. More common in females
B. Slow growing
C. Clinically confused with undifferentiated tumors
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D. May present with respiratory distress and dysphagia
Correct answer: B
57 . The most appropriate operation for a solitary nodule in one lobe of thyroid is
A. Hemithyroidectomy
B. Lobectomy
C. Partial lobectectomy with 1 cm margin around nodule
D. Nodule removal
Correct answer: A
58 . Patient presents with neck swelling and respiratory distress few hours after a
thyroidectomy .Next management would be:
A. Wait and watch
B. Oxygen by mask
C. Open immediately
D. Tracheostomy
Correct answer: C
60 . A 50 year old male is suffering from severe dyspnea after thyroid surgery-
the treatment of choice is -
A. Tracheostomy
B. Open in operative site
C. Wait and watch
D. Cricothyroidotomy
Correct answer: B
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62 . Which of the bellow is true?
A. Excess calcium intake can lead to hyperthyroidism
B. Goitre more than 5% of population is endemic goitre
C. Colloid goitre mostly presents as hyperthyroidism
D. Thyroid storm, the clinical features are primarily due to increased thyroxine
Correct answer: B
67 . A 45 year old patient presents with thyroid swelling and lymph node in neck,
on aspiration amyloid material was found, management is:
A. Total thyroidectomy with neck dissection
B. Hemithyroidectomy
C. Hemithyroidectomy with neck dissection
D. Total thyroidectomy with neck irradiation
Correct answer: A
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68 . In a patient presenting with a swelling of the thyroid, the radionuclide scan
showed a cold nodule and the ultrasound showed a non cystic solid mass. The
management of this patient would be:
A. Lobectomy
B. Hemithyroidectomy
C. Eltroxin
D. Radio Iodine therapy
Correct answer: B
70 . After thyroidectomy, patient developed stridor within 2 hrs. All are likely
cause of stridor except:
A. Hypocalcemia
B. Recurrent laryngeal nerve palsy
C. Larynogomalacia
D. Wound hematoma
Correct answer: A
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74 . Which thyroid malignancy can present with diarrhea?
A. Papillary carcinoma
B. Follicular carcinoma
C. Medullary carcinoma
D. Hurthle cell carcinoma
Correct answer: C
77 . Hashimoto's disease is -
A. An autoimmune thyroiditis
B. A granulomatous thyroiditis
C. Focal thyroiditis
D. A parathyroid tumor
Correct answer: A
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80 . A young patient has a midline, tender swelling in neck occurring after an
attack of score throat. The diagnosis is -
A. Acute thyroiditis
B. Thyroglossal cyst
C. Subacute thyroiditis
D. Toxic goiter
Correct answer: A
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87 . A patient presents with respiratory distress and neck swelling few hours
after thyroid surgery. The next immediate management would be:
A. Open stiches immediately
B. Wait and watch
C. Tracheostomy
D. Oxygen by mask
Correct answer: A
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Correct answer: C
99 . Which of the following will not lead to respiratory distress after Thyroid
Surgery
A. Laryngomalacia
B. Bilateral recurrent laryngeal nerve injury
C. Hypocalcemia
D. None of the above
Correct answer: D
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100 . For a 21 years lady, needle biopsy of solitary thyroid nodule with palpable
cervical lymph nodes on the same sides demonstrates amyloid in stroma of
lesion. Possible diagnosis is
A. Thyroid adenoma
B. Multi nodular goitre
C. Medullary carcinoma thyroid
D. Follicular carcinoma thyroid
Correct answer: C
101 . In patients with papillary carcinoma of thyroid, the following factors are
associated with poor prognosis EXCEPT -
A. Age more than 40 years
B. Size more than 3 cms
C. Female gender
D. Tall cell variant
Correct answer: C
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106 . One of the following is not correct in papillary carcinoma of thyroid -
A. Always unifocal
B. Can be reliably diagnosed using fine needle aspiration cytology
C. requires a total thyroidectomy for large tumours
D. Typically spreads to the cervical lymph nodes
Correct answer: A
107 . A 26 years old woman presents with a palpable thyroid nodule, and needle
biopsy demonstrates amyloid in the stroma of lesion. A cervical lymph node is
palpable on the involved side as the lesion, the preferred treatment should be
A. Removal of the enlarged node, the isthmus, and the enlarged lymph node.
B. Removal of the involved lobe, the isthmus portion of the opposite lobe, and the
enlarged lymph node.
C. Total thyroidectomy and modified neck dissection on the side of the enlarged
lymph node.
D. Total thyroidectomy and irradiation of the cervical lymph nodes.
Correct answer: C
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D. Surgery for thyrotoxicosis
Correct answer: C
116 . A 45 year old male presents with 4 x 4 cm, mobile right solitary thyroid
nodule of 5 months duration. The patient is euthyroid. The following statements
about his management are true except -
A. Cold nodule on thyroid scan is diagnostic of malignancy
B. FNAC is the investigation of choice
C. The patient should undergo hemithyroidectomy if FNAC report is inconclusive
D. Indirect laryngoscopy should be done in the preoperative period to asses mobility
of vocal cords
Correct answer: A
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119. As regard to T3:
a) Less concentration thon circulating T4.
b) More potent thon T4.
c) Mostly bound to TBG.
d) All of the above.
Correct answer: D
120.The correct sequence of events for the metabolism of iodine and synthesis
thyroid hormone is: E
a) Trapping, organification, coupling, release,oxidation.
b) Oxidation, trapping, coupling, organification, release.
c) Coupling, organification, trapping, oxidation, release.
d) Trapping, coupling, oxidation. release, organification.
e) Trapping., oxidation, organification, coupling. release
Correct answer:
123. the following statements regarding TSH measuring are true except:
a) lt is increased after total thyroidectomy.
b) Normal TSH is about 5 micro units/liter.
c) lt is the most sensitive test for mild cases.
d) All of the above
Correct answer: B
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Correct answer: C
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Correct answer: C
134. Which of the following treatment schedule for diffuse toxic goiter is True:
a) Over 45 years: radioactive iodine.
b) Under 45 years: with large goiter: surgery.
c) Under 45 years: with small goiter: antithyroid drugs.
d) None of the above.
e) All of the above.
Correct answer: E
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139. The following type of thyroiditis mimics malignancy:
a) Hashimoto thyroiditis.
b) Riedle thyroiditis.
c) De Queryoin's thyroiditis.
d) All of the above.
Correct answer: B
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145. In thyroid carcinoma, mediastinal node involvement is o feature of which
type:
a) Follicular.
b) Anaplastic.
c) Papillary.
d) Medullary.
Correct answer: D
149. A 17 year old girl presented with o 2.5 cm nodule in the right lobe of the
thyroid gland and enlarged three cervical LNs confirmed by US. FNA cytology
revealed malignant cells with vesicular nuclei, the most probable diagnosis is:
a) Lymphoma
b) b. Anaplastic carcinoma
c) Follicular carcinoma
d) Papillary carcinoma
e) Medullary carcinoma
Correct answer: D
150. A 3A-year old female presents for evolution of a palpable thyroid nodule
Tc99 scan demonstrated a single cold nodule it may be the following EXCEPT:
a) Carcinoma
b) Non-functioning adenoma
c) Thyroid cyst
d) Colloid nodule
e) Autonomous nodule
Correct answer: E
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151. The most frequent variety of thyroid cancer is:
a) Follicular carcinoma
b) Papillary carcinoma
c) Anaplastic carcinoma
d) Medullary carcinoma
Correct answer: B
156. ln physiological goiter the following statements are true except that it:
a) Affects males more often thon females.
b) Presents as fullness of the neck (Venus neck).
c) ls characterized by uniform smooth enlargement with fleshy or firm consistency.
d) Moy be associated with toxic or pressure symptoms.
e) Usually resolves spontaneously.
Correct answer: D
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157. The best routine management for multinodular goitre is by:
a) Hemithyroidectomy.
b) Partial thyroidectomy.
c) Bilateral wedge resection.
d) Subtotal thyroidectomy.
e) Thyroxin administration.
Correct answer: D
158. Among the following statements about retrosternal goiter, the false one is
that it:
a) Usually arises in aberrant intra-thoracic thyroid tissue.
b) is particularly common in males.
c) Moy present with symptoms of mediastinal compression (syndrome).
d) is often associated with palpable enlargement of the thyroid.
e) is best removed through a cervical incision.
Correct answer: A
160. voice fatigue after thyroidectomy is due to injury to which of the following
nerves ? :
a) Superior laryngeal.
b) External laryngeal.
c) internal laryngeal.
d) Recurrent laryngeal.
e) Vagus.
Correct answer: B
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e) Rodioiodine.
Correct answer: B
165. True statements about papillary carcinoma of the thyroid do not include
that it :
a) Often affects adolescents.
b) ls a slow-growing tumor.
c) May be hormone-dependent.
d) Metastasize early by the blood stream.
e) ls rodioresistant.
Correct answer: D
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d) Familial hyperparathyroidism.
e) Ectopic production of parathormone.
Correct answer: A
170- All the following are True about the thyroglossal cyst EXCEPT:
a) Painless swelling.
b) Cystic in consistency.
c) Moves up and Down with swallowing but not with protrusion of the tongue.
d) If infected, can form a thyroglossal fistula.
Correct answer: C
173- The simple nodular goiter can be complicated by one of the following
EXCEPT:
a) 2ry thyrotoxicosis.
b) Haemorrhage.
c) Turn malignant in 30% of cases
d) Stridor.
Correct answer: D
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175- All are features of Grave's disease EXCEPT:
a) Affects mainly elderly males more than females.
b) Shows clinical picture of hyperthyroidism.
c) Thyroid profile has a "low" TSH value.
d) Can be accompanied by exophthalmos.
Correct answer: A
177- As differentiation between primary and 2ry toxic goiter all are true
EXECPT:
a) The 2ry is more common in elderly.
b) The 2ry appears with gradual onset.
c) the 2ry is presented by diffuse enlargement of the gland.
d) Nervous manifestation, metabolic disorders and eye signs are more prominent in
the 1ry form.
Correct answer:C
179- Pre-operative preparation for the patient include all of the following
EXECPT:
a) CBC, coagulation profile, liver and kidney profile.
b) CXR and indirect laryngoscopy.
c) Thyroid profile and neck ultrasound.
d) Recurrent laryngeal nerve conduction.
Correct answer: D
180- Regarding the recurrent laryngeal nerve, all are true EXECPT:
a) If injured bilaterally, completely, the patient will be aphonic.
b) Stridor will occur in unilateral complete injury.
c) Can be injured during devascularization of the inferior lobe.
d) Can be non-recurrent only on the right side.
Correct answer:B
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Correct answer: A
183- The following is not one of the characters of the malignant thyroid cyst:
a) Its aspirate is haemorrhagic.
b) Cytology shows malignant cells.
c) Rapid re-accumulation after aspiration.
d) The cyst will be completely disappeared after aspiration.
Correct answer: D
184- Malignant goiter, if painful the pain will be referred to the ear through:
a) Phrenic nerve.
b) Sympathetic plexus.
c) Bronchial plexus.
d) Arnold's nerve ( branch of vagus nerve)
Correct answer:D
186- In a case of goiter, the following may be cause of un-equal pulse during
examination:
a) Diffuse goiter.
b) Cancer thyroid.
c) Retrosternal goiter.
d) Hashimoto's disease.
Correct answer:C
187- Hard goiter can be felt during examination of the gland in the following
cases:
a) Malignancy.
b) Calcified simple nodular goiter.
c) Riedle's thyroiditis.
d) Tense thyroid cyst.
Correct answer: A
188-All of the following are causes of dullness over the manubrium stain
EXECPT:
a) Ectopic thyroid.
b) Pneumothorax.
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c) Pre-tracheal lymph nodes.
d) Retrosternal goiter.
Correct answer: B
4. Parotid gland is the most common salivary gland affected by the following
pathologies except:
a. Acute bacterial sialadenitis.
b. Salivary stones. ,
c. Pleomorphic adenoma.
d. Adenolymphoma (Warthin'stumor)
e. Mumps.
Correct answer : B
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e. May require excision of the affected gland.
Correct answer : A
9. Which structure marks the posterior boundary of the submandibular duct which
can safely be accessed via an intra oral approach?
a. The third molar tooth
b.The body of the submandibular duct
c. The lingual nerve
d. The posterior edge of the mylohyoid
e. The marginal mandibular nerve.
Correct answer : C
10. Which structure attaches the deep lobe of the submandibular gland to the lingual
nerve?
a. The hypoglossal nerve
b.The submandibular ganglion
c. The deep cervical fascia
d. The tendon of digastric
e.The mylohyoid.
Correct answer : B
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c. 40 per cent
d. 50 per cent
e. 60 per cent.
Correct answer : D
15. Which of the following structures does not lie in the parotid gland?
a. The facial nerve
b. Terminal branches of the external carotid
c. The glossopharyngeal nerve
d. The retromandibular vein
e. Lymph nodes.
Correct answer : C
18. Which of the following landmarks is used to locate the facial nerve trunk?
a. The insertion of sternomastoid
b. The greater horn of the hyoid
c. The superior-most portion of the cartilaginous ear canal
d. The insertion of digastric
e. The insertion of masseter.
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Correct answer : D
20. Which of the following branches of the facial nerve can be divided without the
need for immediate cable graft repair?
a. Temporal
b. Oribtal
c. Zygomatic
d. Buccal
e. Cervical.
Correct answer : D
24. About submandibular salivary stones, all the following statements are true, except:
a.The majority are radia-opaque
b.A stone can be detected by CT scan
c.A stone may present by a submandibular swelling that increases in size by eating
d.A submandibular salivary swelling can be rolled over the angle of the mandible
e.A stone in the gland is treated by submandibular sialadenectomy
Correct answer : D
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25. About pleomorphic adenoma of the parotid gland, all the following statements are
true, except:
a.It has epithelial and mesenchymal components
b.The tumour is painless
c.It has an incomplete capsule
d.The tumour is usually present deep to the facial nerve
e. It may turn malignant
Correct answer : D
26. About adenolymphoma, all the following statements are true, except:
a.The tumour is related to smoking
b.It may be bilateral
c.It has epithelial and lymphoid components
e.The tumour is cystic
e.Facial nerve palsy is characteristic of this tumour
Correct answer : E
29. All of the following is correct about salivary glands’ stones except….:
a) Neck US may be a useful investigation.
b) 90% of them are radiopaque.
c) In bidigital examination, they are better felt from inside.
d) Pain may refer to tongue or teeth.
Correct answer : A
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c) Submaxillary
d) Minor salivary gland
Correct answer : B
- 119 -
Correct answer : A
- 120 -
45. Which is the most appropriate form of biopsy for a major salivary gland
tumour?
a. Open surgical biopsy to allow histology
b. Salivary washings
c. Frozen section during formal excision
d. Fine-needle aspiration cytology (FNAC)
e. Biopsy is contraindicated.
Correct answer: D
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51.All of the following is true about salivary glands’ tumors except:
a) 80% of them occur in parotid gland.
b) 80% of parotid gland tumors are benign.
c) 80% of parotid gland tumors occur in the deep lobe.
d) 80% of benign parotid tumors are pleomorphic adenomas.
Correct answer: C
56. Which of the following salivary gland tumors shows perineural spread
A.Warthin's tumor
B. Adenoid cystic carcinoma
C. Carcinoma in pleomorphic adenoma
D. Mucoepidermoid carcinoma
Correct answer B
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58 . Which of the following is most common neoplasm of salivary gland :
A. Pleomorphic adenoma
B. Adenocystic Carcinoma
C. Mucoepidermoid
D. Mixed tumour
Correct answer: A
- 123 -
65 . Which of the following is the most common tumor of the salivary gland?
A. Acinic cell tumor
B. Pleomorphic adenoma
C. Mucoepidermoid tumor
D. Warthin's tumor
Correct answer: B
70 . A Warthin's tumour is -
A. An adenolymphoma of parotid gland
B. A pleomorphic adenoma of parotid
C. A carcinoma of the parotid
D. A carcinoma of sunmandibular salivary gland
Correct answer: A
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72 . Surgery for Ranula involves -
A. Incision and drainage
B. Excision of cyst
C. Excision of affected sublingual salivary gland
D. Excision of cyst and affected sublingual salivary gland
Correct answer: D
73 . A Warthin's tumour is
A. An adenolymphoma of parotid gland
B. A pleomorphic adenoma of the parotid
C. A carcinoma of the parotid
D. A carcinoma of submandibular salivary gland
Correct answer: A
75 . Sialosis refers to -
A. Bilateral parotitis
B. Sjogren's syndrome
C. Noninflammatory parotid enlargement
D. Bilateral salivary duct ectasia
Correct answer: C
78-Ranula is a:
a) Cystic swelling in the floor of the month
b) Forked uvula
c) Sublingual thyroid
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d) Thyroglossal cyst
Correct answer : A
81. Which statement most accurately describes the anatomy of the sublingual glands?
a. They drain through the sublingual duct which opens into the floor of mouth.
b. They drain either directly on to the floor of mouth or into the submandibular duct.
c. They consist of two lobes separated by the mylohyoid muscle.
d. They are embedded in the intrinsic muscles of the ventral surface of the tongue.
e. They lie in the space between the mandible and the two bellies of digastric.
Correct answer : B
1. Correct statements about dentigerous cyst include the following except that it:
a. Occurs in children and adolscents in relation to a missing tooth.
b. is more common in the upper than in the lower jaw.
c. Presents as a globular swelling expanding the jaw.
d. Is lined with squamous epithelium.
Correct answer : B
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2.Correct statements about dentigerous cyst include the following except
that it:
a. Occurs in children and adolscents in relation to a missing tooth.
b. is more common in the upper than in the lower jaw.
c. Presents as a globular swelling expanding the jaw.
d. is lined with squamous epithelium.
Correct answer: B
4 . A 82 years patient presents with a midline tumor of the lower jaw, involving the
alveolar margin. He is edentulous. Treatment of choice is:
A. Commando operation
B. Hemimandibulectomy
C. Marginal mandibulectomy
D. Segmental mandiblectomy
Correct answer: D
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e. Mandible.
Correct answer: E
14 . In which of the following head and neck cancers, is lymph node metastasis least
common -
A. Buccal mucosa
B. Tongue
C. Lower alveolus
D. Hard palate
Correct answer: D
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15 . All are true about carcinoma palate, except -
A. Slow growing
B. Bilateral lymphatic spread
C. Adenocarcinoma
D. Presents in pain
Correct answer: D
1.A 24 years old female presented with a neck swelling on the left side, on clinical
examination it was located in the carotid triangle deep to the sternomastoid muscle
,mobile from side to side ,it was transopaque on transillumination, Aspiration revealed
mucoid fluid rich in cholesterol crystals, your provisional diagnosis is………..:
a) Cervical lymph node level III.
b) Carotid body tumor.
c) Cystic hygroma.
d) Branchial cyst.
Correct answer : D
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2 . A central midline neck swelling is noted in a 4year old girl posted for
tonsillectomy.The swelling is, painless, mobile and cystic, just below the hyoid
bone of size 2 X 1.1 X 1 cm. U/S showed a thick walled cystic lesion. Management
would include -
A. Percutaneous aspiration
B. Chest X-ray
C. Surgical removal
D. Antiboitics
Correct answer: C
3. Midline cystic swelling in the neck, moves up anddown with deglutition and with
protrusion of the tongue:
a) Thyroid cancer.
b) Branchial cyst.
c) Ranula.
d) Thyroglossal cyst.
Correct answer : D
3. All the followings are predisposing factors for cancer tongue except:
a- Cigarette smoking
b- Spicy food
c- Septic tooth
d- Sjogren syndrome
e- Syphilis
Correct answer : D
4. In unilateral hare-lip the following statements are true except that it:
a. Affects the upper lip only.
b. May be partial or complete.
c. Is due to failure to fusion between the maxillary process with the frontonasal process
and the maxillary process of the opposite side.
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d. Is always associated with nasal deformity.
e. Produces no serious speech defects.
Correct answer : E
8. The anterior 2/3 of the tongue receives common sensation through ………nerve:
a) Glossopharyngeal.
b) Chorda tympani of facial.
c) Lingual.
d) Hypoglossal.
Correct answer : C
9. A 62-year-old alcoholic presents with an indurated ulcer, 1.5 cm in length, in the left
lateral aspect of her tongue (not fixed to the alveolar ridge). There are no clinically
abnormal glands palpable in the neck, and a biopsy of the tongue lesion reveals
squamous cell carcinoma. What should she undergo?
(A) Chemotherapy
(B) Local excision of the ulcer
(C) Wide excision and left prophylactic neck dissection
(D) Antibiotic therapy and should be encouraged to stop smoking
(E) Wide excision of ulcer and radiotherapy
Correct answer : C
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10. A 59-year-old woman has discomfort in the posterior part of her tongue. Abiopsy
confirms that the lesion is a carcinoma. What is true in carcinoma of the posterior
third of the tongue?
(A) Lymphoid tissue is absent.
(B) Lymph gland spread is often encountered.
(C) There is an excellent prognosis.
(D) The tissue is well differentiated.
(E) The recurrent laryngeal nerve is infiltrated.
Correct answer : B
11-A 5-year-old girl presents with difficulty breathing. On examination, of the oral
cavity a 3-cm mass is found in the midline on the posterior aspect of the tongue. The
most likely diagnosis is:
(A) Lingual tonsil
(B) Lingual thyroid
(C) Foreign body stuck to the tongue
(D) Dermoid
(E) Angioneurotic edema
Correct answer : B
13. All the followings are predisposing factors for cancer tongue except:
a- Cigarette smoking
b- Spicy food
c- Septic tooth
d- Sjogren syndrome
Correct answer: D
14. A 59-year-old woman has discomfort in theposterior part of her tongue. Abiopsy
confirms that the lesion is a carcinoma. What is true incarcinoma of the posterior
third of the tongue?
(A) Lymphoid tissue is absent.
(B) Lymph gland spread is often encountered.
(C) There is an excellent prognosis.
(D) The tissue is well differentiated.
(E) The recurrent laryngeal nerve isinfiltrated.
Correct answer: B
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Correct answer: D
16.A 5-year-old girl presents with difficulty breathing. On examination, of the oral
cavity a3-cm mass is found in the midline on the posterior aspect of the tongue. The
most likelydiagnosis is:
(A) Lingual tonsil
(B) Lingual thyroid
(C) Foreign body stuck to the tongue
(D) Dermoid
(E) Angioneuroticedema
Correct answer: B
17. Carcinoma of the tongue infiltrating the mandible is best treated by:
a. Radiotherapy of both primary and regional gland.
b. Twa-stage excision of primary and regional glands.
c. on block excision of primary and whole lymphatic area (Commando operation).
d. Radiotherapy for primary followed by radical neck dissection.
e. Excision of primary and radiotherapy to cervical lymph nodes.
Correct answer: C
18 . A patient has carcinoma of tongue in the right lateral aspect with lymph node of 4
cm size in level 3 on the left side of neck, what is the stage ?
A. N1
B. N0
C. N3
D. N2
Correct answer: D
19 . A patient presented with a 1 X 1.5 cms growth on the lateral border of the
tongue.The treatment indicated would be
A. Laser ablation
B. Interstitial brachytherapy
C. External beam radiotherapy
D. Chemotherapy
Correct answer: B
20 . A patient with Ca Tongue is found to have lymph nodes in the lower neck.The the
treatment of choice for the lymph nodes is:
A. Lower cervical neck dissection
B. Suprahyoid neck dissection
C. Tele radiotherapy
D. Radical neck dissection
Correct answer: D
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22 . Abbe-Estlander Flap is used for:
A. Eyelid
B. Ears
C. Lip
D. Tongue
Correct answer: C
24 . Which of the following is the commonest site of oral cancer among Indian
population?
A. Floor of mouth
B. Tongue
C. Lip
D. Alveobuccal complex
Correct answer: D
Cervical rib
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4 . Allen's test is useful in evaluating which of the following?
A. Presence of cervical rib
B. Thoracic outlet compression
C. Digital blood flow
D. Integrity of palmar arch
Correct answer: D
6- Breast
1. After undergoing modified radical mastectomy for cancer of the right breast, a
52-year-old female teacher becomes aware that the medial end of her scapula
becomes prominent in protraction movements at the shoulder. She also complains
of some weakness in complete abduction of the same shoulder. What nerve was
injured?
(A) Long thoracic
(B) Thoracodorsal
(C) Ulnar
(D) Intercostobrachial
Correct answer: A
2. The following statements about lymphatic drainage of the breast are all true,
except
a. Lymph from medial half of the breast may drain in internal mammary nodes.
b. From anywhere in the breast lymphatics drain mostly to axillary nodes
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c. Division of axillary nodes into levels I, II and III depends upon the anatomical
relationship with the pectoralis minor.
d. Level one axillary nodes is the highest in the axilla.
e. The sentinel node is the earliest axillary node to be involved with cancer spread.
Correct answer: D
3. The axillary lymph nodes are divided into three levels I,II, III by
a. The axillary artery
b. The axillary vein
c. The pectoralis minor
d. The clavicle
e. The nerve to latissimus dorsi
Correct answer: C
4. How many lactiferous ducts drain into the nipple of the mature female breast
a. 5-10
b. 15-20
c. 25-30
d. 35-40
Correct answer: B
1- A blood stained discharge from the nipple indicates which of the bellow:
A. Fibroadenoma.
B. Breast abscess.
C. Fat Necrosis of Breast.
D. Duct Papilloma.
Correct answer: D
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3 . A blood stained discharge from the nipple indicates:
A. Breast abscess
B. Fibroadenoma
C. Duct papilloma
D. Fat necrosis of breast
Correct answer: C
4 . A women noticed mass in her left breast with bloody discharge. Histopathology
revealed duct ectasia. Treatment is -
A. Lobectomy
B. Hadfield operation
C. Simple mastectomy
D. Microdochotomy
Correct answer: B
8 . A 14 years old healthy girl of normal height and weight for age, complains that
her right breast has developed twice the size of her left breast since the onset of
puberty at the age of 12 Both breasts have a similar consistency on palpation with
normal nipples areolae. The most likely cause for these findings is:
A. Cystosarcoma phyllodes
B. Virginal hypertrophy
C. Fibrocystic disease
D. Early state of carcinoma
Correct answer: B
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C. Local wide excision
D. Chemotherapy
Correct answer: B
15 . A 25 year old female complains of discharge of blood from a single duct in her
breast.The most appropriate treatment is :
A. Microdochectomy
B. Radical excision
C. Biopsy to rule out carcinoma
D. Radical mastectomy
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Correct answer: A
19. An 18-year-old presents with a well circumscribed 2-cm mass in her right
breast. The mass is painless and has a rubbery consistency and discrete borders.
It appears to move freely through the breast tissue. What is the likeliest diagnosis?
(A) Carcinoma
(B) Cyst
(C) Fibroadenoma
(D) Cystosarcomaphyllodes
(E) Intramammary lymph node
Correct answer: C
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(E) Fat necrosis
Correct answer: A
23. The following statements about post-mastectomy arm edema, all are true,
except
a. Is always transient
b. Adding radiotherapy to the axilla after clearance of lymph nodes increases the risk
of edema
c. Rough dissection of the axillary vein at surgery is one of the causes
d. Insertion of an IV line in the ipsilateral upper limb is a predisposing factor
e. May be caused by recurrence in the axilla.
Correct answer: A
24. The following statements about post-mastectomy arm edema, all are true,
except
a. Is always transient
b. Adding radiotherapy to the axilla after clearance of lymph nodes increases the risk
of edema
c. Rough dissection of the axillary vein at surgery is one of the causes
d. Insertion of an IV line in the ipsilateral upper limb is a predisposing factor
e. May be caused by recurrence in the axilla.
Correct answer: A
25. About acute lactational breast abscess, one statement only is true
a. Is commonly multilocular
b. Weaning the baby is mandatory
c. Aspiration pus by a wide bore needle is superior to incisional drainage as it avoids
injury to lactiferous ducts
d. Mammography is indicated if an abscess in suspected
e. Treatment is essentially conservative by antibiotics
Correct answer: A
26. The following about fibrocystic breast are all true, except
a. May be asymptomatic
b. May cause nipple retraction
c. Is a cause of breast pain
d. Produces breast nodularity
e. May cause discharge per nipple
Correct answer: C
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27. During pregnancy, alveolar epithelium develops in the breast which is
responsible after delivery for the production of milk. Which portion of alveolar
epithelial cell is responsible for production of the fat present in human milk
a. Endoplasmic reticulum
b. Mitochondria
c. Cell membrane
d. Cytoplasm
Correct answer:D
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33. In the ANDI (aberrations of normal development and involution)
classification, a 2 cm fibroadenoma is considered
a. Normal
b. A disorder
c. A disease
d. A premalignant disease
Correct answer: B
36. Massive swellings of the breast include all the following except:
a- Cystosarcomaphylloides
b- Atrophic scirrhous carcinoma.
c- Diffuse hypertrophy.
d- Giant fibroadenoma.
Correct answer: B
37. The most useful investigation for breast with prosthesis is:
a. Mammography.
b. US.
c. FNAB.
d. MRI.
e. Hormonal receptors.
Correct answer : D
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Correct answer : D
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Correct answer : B
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53. breast cyst all true except
a.commonest is galactocele
b.malignancy is suspected if the cyst is tense
c. malignancy is suspected if the lump doesnot totally disappear after complete
aspiration
d. multiplicity of cyst raise suspiscion of malignancy
e.cyst excision is necessary in most cases
Correct answer : D
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59. Most common site of actinomycosis:
a. GlT.
b. Head and neck.
c. Breast.
d. Lungs.
Correct answer: B
60 . Mondor's disease is
A. Thrombophlebitis of the Superficial veins of Breast
B. Carcinoma of the breast
C. Premalignant condition of the breast
D. Filariasis of the breast
Correct answer: A
Breast cancer
1 . Which the following tumor may occur in the residual breast or overlying skin
following wide local excision and radiotherapy for mammary carcinoma?
A. Basal cell carcinoma
B. Angiosarcoma
C. Leiomyosarcoma
D. Squamous cell carcinoma
Correct answer: B
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Correct answer: C
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C. Surface is convex
D. Capsulated
Correct answer: D
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B. Pelvis
C. Femur
D. Lumbar vertebra
Correct answer: D
20 . A 44 years female presents with a hard and mobile lump in the breast.Next
investigation is:
A. Mammography
B. Excision biopsy
C. FNAC
D. USG
Correct answer: C
22 . 35 year old female with painful breast lump in a breast feeding woman.
Investigation of choice is -
A. Mammography
B. US
C. MRI
D. CT
Correct answer: B
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Correct answer: A
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B. Ataxia Telangiectasia
C. BRCA 1
D. BRCA 2
Correct answer: B
35 . The risk factor for increased incidence relapse in stage I, carcinoma breast
includes all except:
A. Aneuploidy
B. Decreased Her-2 / neu oncogene
C. -ve estrogne / progesterone receptor status
D. High 's' phase
Correct answer: B
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37 . Sentinel lymph node biopsy is useful in case of:
A. Breast carcinoma
B. Prostrate ca
C. Thyroid ca
D. Colon carcinoma
Correct answer: A
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D. All of the above
Correct answer: A
48 . Use of tamoxifen in carcinoma of breast patients does not lead to the following
side effects
A. Thromboembolic events
B. Endometrial Carcinoma
C. Cataract
D. Cancer in opposite breast
Correct answer: D
49 . Histological variety of Breast carcinoma with breast prognosis is ?
A. Medullary
B. Colloid
C. Lobular
D. Tubular
Correct answer: D
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50 . Ca breast Stage T4b involves all except -
A. Nipple retraction
B. Skin ulcer over the swelling
C. Dermal edema
D. Satellite nodule
Correct answer: A
52 . Nodule in upper outer segment of breast with cyclical pain, the most likely
diagnosis is:
A. Phylloides tumor
B. Fibroadenoma
C. Fibrocystic disease of breast
D. None
Correct answer: C
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Correct answer: D
60 . A female patient present with a hard mobile lump in her right. breast. Which
investigation would be most helpful in making on diagnosis:
A. FNAC
B. Needle biopsy
C. Excision biopsy
D. Mammography
Correct answer: C
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C. Pectoralis major myocutoneous flap
D. Transversus rectus abdominus free flap
Correct answer: C
64 . Which of the following is the next investigation for painful breast lump in a
lactating woman?
A. USG
B. Mammography
C. X-ray
D. MRI
Correct answer: A
67. One of the following statements as regard investigations for breast cancer is
true
A Fifty per cent of breast cancers are missed by population-based mammographic
screening.
B Ultrasound can also be used as a screening tool.
C Magnetic resonance imaging (MRI) can be a useful imaging tool.
D Fine-needle aspiration cytology (FNAC) and core biopsy are equally useful
diagnostically.
Correct answer: C
68. Which of the following conditions have an increased risk of breast carcinoma
A Breast cyst
B Duct ectasia
C Atypical ductal or lobular hyperplasia
D Fibroadenoma.
Correct answer: C
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70. In the treatment of breast cancer, which of the following statements are false?
A There is a higher rate of local recurrence after conservative surgery and radiotherapy.
B After mastectomy, radiotherapy to the chest wall is not indicated.
C Sentinel lymph node biopsy should be done in clinically node-negative disease.
D Besides treating the patient, the role of axillary surgery is to stage the patient
accurately.
Correct answer: B
71. A 35-year-old premenopausal woman whose mother had breast cancer comes
into your office and has been told that she has fibrocystic breasts. On examination
she has multiple areas of thickening but no discrete mass. Of the following
diagnostic tests, which should be performed?
(A) Re-examination in 6 months
(B) Bilateral breast ultrasound
(C) Thermography
(D) Bilateral breast magnetic resonance imaging (MRI) with gadolinium
(E) Spot compression views if an area of discrete asymmetry or concerning
calcifications is seen
Correct answer: D
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75. Hematogenous spread of breast cancer may produce any of the following,
except:
a. Brain metastases.
b. Fracture of the spine
c. Pleural effusion
d. Jaundice
e. Hypocalcemia
Correct answer:E
76. Concerning sampling of a breast lump, all the following statement are true,
except
a. The most accurate is excisional biopsy
b. Fine need aspiration cytology does not require general anaethesia
c. Fine need aspiration cytology shows tissue architecture.
d. Frozen section biopsy is sometimes inconclusive.
e. Trucut biopsy obtains a core of tissue.
Correct answer: C
79. For Modified radical mastectomy, all the following are true, except
a. The areola and nipple are removed
b. The whole breast tissue is removed
c. Block dissection of axillary nodes requires excision of axillary vein
d. Nerve to serratus anterior should be spared
e. The pectoralis major is spared.
Correct answer: C
80. When screening females for breast carcinoma, what if the most significant risk
a. Three previous breast biopsies in premenopausal females.
b. More than 2 first degree relatives with ovarian or breast carcinoma
c. Hyperplasia in breast biopsy
d. None of the above.
Correct answer: B
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81. What is the hereditary factor percentage in female breast cancers
a. 20.30%
b. 45-50%
c. 6-10%
d. 75-80%
e. None of the above.
Correct answer: C
84. Which of the following conditions increases a woman’s risk of breast cancer
a. Sclerosing adenosis
b. Fibroadenoma
c. Atypical lobular hyperplasia
d. Intraductal papilloma
Correct answer: C
85. A 35 year old woman with BRAC-1 gene mutation seeks your advice about her
known increased risk of breast cancer. You should recommend
a. Mammograms and physical examination every 6 months until she is 50, then
bilateral prophylactic mastectomy
b. Mammograms and physical examination every 6 months + tamoxifen
c. Prophylactic bilateral mastectomy and if she has completed childbearing,
prophylactic bilateral oophorectomy.
d. None of the above.
Correct answer: C
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87. All the following are recognized side effects of radiotherapy except:
a- Local burn.
b- Pulmonary fibrosis.
c- End arteritis.
d- None of the above.
Correct answer: D
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94. In curable breast cancer in premenopausal females may be treated by
the following except:
a- Local mastectomy
b- Radiotherapy
c- Estrogen administration
d- Chemotherapy
e- Tamoxifen
Correct answer: C
96. Risk factors of cancer breast include all the following except:
a- Mutation in suppressor genes (BRCA l, Il).
b- Early menarche.
c- Carcinoma in situ.
d- Prolonged lactation.
e- White races.
Correct answer : D
97. Increased occurrence of cancer breast in upper loteral quadrant is due to:
a- increased oestrogen receptors.
b- increased breast mass.
c- Both of the above.
d- None of the above.
Correct answer : D
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d- Patient aged 50 years
Correct answer : C
102. a women has 3 cm breast mass non palpable LNs and no clinical evidence of
distant metastasis, which is true?
a. stage II breast cancer
b.grade I breast cancer
c. pathological evidence of cancer is necessary
d. consider fibroadenoma and give treatment
e.excision of the mass only is enough
Correct answer : C
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107- An 82-year-old woman with a history of breast cancer presents to clinic with
complaints of headache for the past 2 weeks. She describes daily retra-orbital
headaches that are worse in the morning. In addition, she notes severe nausea and
vomiting. MRI of the brain reveals multiple metastatic lesions. Which of the
following is the most appropriate initial management for this patient?
1. Biopsy the lesions
2. Surgical resection
3. Dexamethasone
4. Repeat MRI in 6 months
Correct answers: (3)
7- Oesophagus
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3 . Boerhaave syndrome is ?
A. Spontaneous Rupture of esophagus
B. Traumatic Rupture of esophagus
C. Tracheo esophageal fistula
D. Foreign body Esophagus
Correct answer: A
7 . A 40 year old female patient presents with dysphagia to both liquids and
solids and regurgitation for 3 months. The dysphagia was non progressive. What
is the most likely diagnosis?
A. Lower esophagus mucosal ring
B. Carcinoma of the esophagus
C. Reflux esophagitis with esophageal stricture
D. Achalasia cardia
Correct answer: D
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10 . Non progressive contraction of Esophagus are:
A. Secondary
B. Primary
C. Quaternary
D. Tertiary
Correct answer: D
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Correct answer: B
18. A known HIV positive patient complains of severe odynophagia. He avoids eating
and drinking because of the intense pain, and he has lost a significant amount of
weight. Which of the following is TRUE?
(A) Esophagectomy is the treatment of choice.
(B) Cancer is the only condition that can explain these findings.
(C) UGI series is not useful.
(D) Candida is the most common cause of infectious esophagitis.
(E) Esophageal candidiasis is almost certain if the patient has oral thrush.
Correct answer: D
19. A 54-year-old man presents with a massive UGI bleed. After resuscitation,
endoscopy is performed. No esophageal varices, gastritis, or gastric ulcers are seen.
After copious irrigation, a pinpoint lesion is seen near the GE junction.
What can be said about this lesion?
(A) It is a carcinoid.
(B) It is related to alcohol use.
(C) It is exclusively a mucosal lesion.
(D) Surgery if first-line therapy.
(E) Bleeding is from a submucosal vessel
Correct answer: E
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Correct answer: C
22. A patient has been diagnosed with achalasia. He refused surgery initially, preferring
to try nonoperative therapy. He tried life style modification, calcium channel blockers,
botulin toxin injection, and endoscopic pneumatic dilatation. None of the treatments
alleviated his symptoms. What are his surgical options?
(A) Esophagectomy
(B) Surgical esophagomyotomy proximal to the LES
(C) Modified Heller myotomy and partial fundoplication
(D) Repeat pneumatic dilation using pressures of loops
(E) Nissen fundoplication
Correct answer: C
23. A 50-year-old man presents to the emergency department with chest pain. The
patient is evaluated for a myocardiac infarction. The workup is negative. On further
questioning, his symptoms include dysphagia (with both liquids and solids). Which of
the following is TRUE?
(A) A barium swallow will always show a corkscrew esophagus.
(B) Manometry shows simultaneous high-amplitude contractions.
(C) Initial evaluation should exclude coronary artery disease.
(D) A pulsion diverticulum may be present.
Correct answer: A
24. A 79-year-old retired opera singer presents with dysphagia, which has become
progressively worse during the last 5 years. He states that he is sometimes aware of a
lump on the left side of his neck and that he hears gurgling sounds during swallowing.
He sometimes regurgitates food during eating. What is the likely diagnosis?
(A) Carcinoma of the esophagus
(B) Foreign body in the esophagus
(C) Plummer-Vinson (Kelly-Patterson) syndrome
(D) Zenker’s (pharyngoesophageal) diverticulum
(E) Scleroderma
Correct answer: D
25. A symptomatic patient has a barium swallow that reveals a 3-cm Zenker’s
diverticulum. The next step in management is?
(A) H2 blockers
(B) Anticholinergic drugs
(C) Elemental diet
(D) Bougienage
(E) Surgery (cricopharyngealmyotomy and diverticulectomy)
Correct answer: E
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27 . All of the following statements about Zenker's diverticulum are true Except:
A. False diverticulum
B. Out pouching of the anterior pharyngeal wall,just above the cricopharyngeus
muscle
C. Acquired diverticulum
D. Lateral X-rays on Barium swallow are often diagnostic
Correct answer: B
30. A30-year-old psychiatric patient has a barium swallow after removal of a foreign
body to rule out a small perforation of the esophagus. No perforation is seen, but an
epiphrenic diverticulum is visualized. An epiphrenic diverticulum may be associated
with which of the following?
(A) Duodenal ulcer
(B) Gastric ulcer
(C) Cancer of the tongue
(D) Cancer of the lung
(E) Hiatal hernia
Correct answer: E
27. A 53-year-old moderately obese woman presents with heartburn aggravated mainly
by eating and lying down in the horizontal position. Her symptoms are suggestive of
gastroesophangeal reflux disease (GERD). Which of the following statements is
TRUE?
(A) It is best diagnosed by an anteroposterior (AP) and lateral film of the chest.
(B) It may be alleviated by certain drugs, especially theophylline, diazepam, and
calcium channel blockers.
(C) It is not relieved by cessation of smoking.
(D) If it is associated with dysphagia, it suggests a stricture or motility disorder.
(E) It should be immediately treated with Surgery
Correct answer: D
28. A 64-year-old man has symptoms of reflux esophagitis for 20 years. The barium
study shown (Fig. 5–2) demonstrates a sliding hiatal hernia. Which is TRUE in sliding
hiatal hernia?
(A) A hernia sac is absent.
(B) The cardiais displaced into the posterior mediatstinum.
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(C) Reflux esophagitis always occur.
(D) A stricture does not develop.
(E) Surgery should always be avoided.
Correct answer: B
29. A 45-year-old man presents with a long history of heartburn, especially at night. He
uses three pillows to sleep and has medicated himself with a variety of antacids over
the past 15 years. Recently he has been complaining of dysphagia that he localized to
the precordial area. Which is the most likely diagnosis?
(A) Adenocarcinoma of the esophagus
(B) Angina pectoris
(C) Benign peptic stricture of the esophagus
(D) Achalasia of the esophagus
(E) Lower esophageal ring (Schatzki’s ring)
Correct answer: C
30. A 60-year-old man presents with excruciating chest pain. The pain follows an
episode of violent vomiting that occurred after a heavy meal. Subcutaneous emphysema
was noted in the neck. X-rays shows air in the mediastinum and neck, and a fluid level
in the left pleural cavity. What is the most likely diagnosis?
(A) Perforated duodenal ulcer
(B) Spontaneous rupture of the esophagus
(C) Spontaneous pneumothorax
(D) Inferior wall myocardial infarction
(E) Dissecting aortic aneurysm
Correct answer: B
31. A 45-year-old pilot has retrosternal burning; especially when he eats and lies down
to go to sleep. He has self-medicated himself with over the counter heartburn
medications. Upper endoscopy reveals an erythematous and inflamed distal esophagus.
In severe reflux esophagitis, the resting pressure of the LES is decreased. This may be
physiologically increased by which of the following?
(A) Pregnancy
(B) Glucagon
(C) Gastrin
(D) Secretin
(E) Glucagon
Correct answer: C
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33 . All of the following operations are done for gastro esophageal reflux disease
except -
A. Heller's cardiomyotomy
B. Belsey operation
C. Nissen fundoplication
D. Hill procedure
Correct answer: A
2 . Upper GI endoscopy and biopsy from lower esophagus in a 48 years old lady
with chronic heart burn shows presence of columnar epithelium with goblet cells.
The feature is most likely consistent with:
A. Dysplasia
B. Hyperplasia
C. Carcinoma in - situ
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D. Metaplasia
Correct answer: D
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Correct answer: B
14 . Which of the following is the most common site for squamous cell ca
esophagus ?
A. Middle third
B. Upper third
C. Gastra-esophageal junction
D. Lower third
Correct answer: A
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Correct answer: C
- 173 -
C. Barret' s esophagus
D. All of the above
Correct answer: D
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30. A46-year-old man has a long history of heartburn (GERD). His barium study
shows an irregular, ulcerated area in the lower third of his esophagus. There is marked
mucosal disruption and overhanging edges. What is the most likely diagnosis?
(A) Sliding hiatal hernia with GERD
(B) Paraesophageal hernia
(C) Benign esophageal stricture
(D) Squamous carcinoma of the esophagus
(E) Adenocarcinoma arising in a Barrett’s Esophagus
Correct answer: E
31. A 46-year-old man present with dysphagia of recent onset. His esophogram shows
a lesion in the lower third of his esophagus. Biopsy of the lesion shows
adenocarcinoma. His general medical condition is excellent, and his metastatic
workup is negative. What should his management involve?
(A) Chemotherapy
(B) Radiation therapy
(C) Insertion of a stent to improve swallowing
(D) Surgical resection of the esophagus
(E) Combination of chemotherapy and radiation therapy
Correct answer: D
2. A 64-year-old woman with arthritis is a chronic NSAID user. She develops severe
epigastric pain and undergoes an upper endoscopy. She is told that she has an ulcer
adjacent to the pylorus. Which of the following is TRUE about the pylorus?
(A) It cannot be palpated at laparotomy.
(B) It is not covered completely by omentum.
(C) It is a distinct anatomic entity that can be distinguished during laparotomy.
(D) It is a true physiologic sphincter.
(E) It is a site where cancer is rarely found
Correct answer: C
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Peptic ulcer disease and complications
3 . What is probable diagnosis of a patient with spinal POP cast presenting with
bilious vomiting:
A. Acute dilation of stomach
B. Duodenal obstruction
C. Peritonitis
D. Acute pancreatitis
Correct answer: B
8 . The following have strong casual associated with H. pylori infection except -
A. Chronic gastritis
B. Peptic ulcer disease
C. Gastric carcinoma
D. Gastric adenoma
Correct answer: D
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Correct answer: B
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20 . Which of the following management procedures of acute upper
gastrointestinal bleed should possibly be avoided:
A. Intravenous vasopressin
B. Intravenous beta-blockers
C. Endoscopic sclerotherapy
D. Balloon tamponade
Correct answer: B
22. A 44-year-old woman is scheduled for gastric surgery. She has no comorbid disease.
The anesthesiologist has difficulty inserting the orotracheal tube. In between intubation
attempts he uses an ambu-bag to oxygenate the patient. The patient’s abdomen gets
distended and tympany is noted in the left upper quadrant. Suddenly the patient
becomes hypotensive. Which of the following can cause a vosogvagal response during
anesthesia?
(A) The gastric remnant following a distal gastrectomy
(B) Corrosive gastritis
(C) Pernicious anemia
(D) Gastric volvulus
(E) Acute gastric dilatation
Correct answer: E
24. A50-year-old man is involved in a major motor vehicle collision and suffers
multiple traumas. He is admitted to the intensive care unit. After 2 days of hospital
admission he bleeds massively from the stomach. What is the probable cause?
(A) Gastric ulcer
(B) Duodenal ulcer
(C) Hiatal hernia
(D) Mallory-Weiss tear
(E) Erosive gastritis
Correct answer: E
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25. A 65-year-old lawyer has an elective colon resection. On postoperative day number
five, the patient develops fever, leukocytosis, and increasing abdominal pain and
distension. An anastomotic leak is suspected. During the preparation for a CAT scan,
fresh blood and coffee grounds are seen in the nasogastric tube.
Acute stress gastritis is best diagnosed by?
(A) CAT scan
(B) UGI series
(C) Angiogram
(D) Capsule endoscopy
(E) Upper endoscopy
Correct answer: E
26. A73-year-old woman is admitted to the hospital with a mild UGI hemorrhage that
stopped spontaneously. She did not require transfusion. She had ingested large
amounts of aspirin in the past 4 months to relieve the pain caused by severe
rheumatoid arthritis. Endoscopy confirms the presence of a duodenal ulcer. A biopsy
is done. What is the next step in the management of a duodenal ulcer associated with a
positive biopsy for H. pylori?
(A) H2 blockers
(B) Bipolar electrocautery of the ulcer
(C) Triple therapy
(D) Photocoagulation
(E) Elective surgery
Correct answer: C
27. A52-year-old artist develops epigastric pain that is relieved by antacids. She also
complains that her stool has changed color and is black and tarry. What is the most
important cause of the entity presenting above other than H. pylori?
(A) Submucosal islet cells
(B) Hyperglycemia
(C) Diet
(D) Acid secretion
(E) Acute erosive gastritis
Correct answer: D
28. An elderly patient delayed seeking medical attention for his early satiety and
weight loss because he attributed these changes to aging. When he underwent upper
endoscopy a large mass was seen in the stomach. Which statement is TRUE regarding
gastric carcinoma?
(A) During resection, it is safe to leave cancer at the cut edges.
(B) The incidence is increased in patients with gastric ulcer disease.
(C) Draining lymph nodes should not be removed.
(D) It is caused by diverticulitis.
(E) It is associated with hyperchlorhydria.
Correct answer: B
29. A 45-year-old man complains of burning epigastric pain that wakes him up at
night. The pain is relieved by eating or using over-the counter antacids and H2
blockers. Diagnosis is best confirmed by which of the following?
(A) Urea breath test
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(B) Serum gastrin levels
(C) Barium meal examination
(D) Upper endoscopy
(E) Upper endoscopy and biopsy
Correct answer: E
30. A44-year-old dentist was admitted to the hospital with a 1-day history of
hematemesis caused by a recurrent duodenal ulcer. He has shown considerable
improvement following operative treatment by a truncal vagotomy and pyloroplasty,
10 years prior to this incident. Which is TRUE of truncal vagotomy?
(A) It is performed exclusively via the thorax.
(B) It can be performed in the neck.
(C) If complete, it will result in increased acid secretion.
(D) It requires a gastric drainage procedure
(E) It has been abandoned as a method to treat ulcer disease
Correct answer: D
31. A42-year-old executive has refractory chronic duodenal ulcer disease. His
physician has suggested several surgical options. The patient has chosen a parietal
(highly selective) vagotomy instead of a truncal vagotomy and antrectomy because?
(A) It results in a lower incidence of ulcer recurrence.
(B) It benefits patients with antral ulcers the most.
(C) It reduces acid secretion to a greater extent.
(D) The complication rate is lower.
(E) It includes removal of the ulcer.
Correct answer: D
32. A63-year-old woman is admitted to the hospital with severe abdominal pain of 3-
hour duration. Abdominal examination reveals board-like rigidity, guarding, and
rebound tenderness. Her blood pressure is 90/50 mm Hg, pluse 110 bpm (beats per
minute), and respiratory rate is 30 breaths per minute. After a thorough history and
physical, and initiation of fluid resuscitation, what diagnostic study should be
performed?
(A) Supine abdominal x-rays
(B) Upright chest x-ray
(C) Gastrograffin swallow
(D) Computerized axial tomography (CAT) scan of the abdomen
(E) Abdominal sonogram
Correct answer: B
33. A frail elderly patient is found to have an anterior perforation of a duodenal ulcer.
He has a recent history of nonsteroidal anti-inflammatory drug (NSAID) use and no
previous history of peptic ulcer disease. A large amount of bilious fluid is found in the
abdomen. What should be the next step?
(A) Lavage of the peritoneal cavity alone
(B) Lavage and omental patch closure of the ulcer
(C) Total gastrectomy
(D) Lavage, vagotomy, and gastroenterostomy
(E) Laser of the ulcer
Correct answer: B
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34. Three months after recovery from an operation to treat peptic ulcer disease, a
patient complains that she has difficulty eating a large meal. A 99m Tc-labeled
chicken scintigraphy test confirms a marked delay in gastric emptying. A delay in
gastric emptying may be due to which of the following?
(A) Zollinger-Ellison syndrome (ZES)
(B) Steatorrhea
(C) Massive small-bowel resection
(D) Previous vagotomy
(E) Hiatal hernia
Correct answer: D
35. A64-year-old supermarket manager had an elective operation for duodenal ulcer
disease. He has not returned to work because he has diarrhea with more than 20 bowel
movements per day. Medication has been ineffective. The exact details of his
operation cannot be ascertained. What operation was most likely performed?
(A) Antrectomy and Billroth I anastomosis
(B) Gastric surgery combined with choleystectomy
(C) Truncal vagotomy
(D) Highly selective vagotomy
(E) Selective vagotomy
Correct answer: C
36. A40-year-old man has had recurrent symptoms suggestive of peptic ulcer disease
for 4 years. Endoscopy reveals an ulcer located on the greater curvature of the
stomach. A mucosal biopsy reveals Helicobacter. pylori. What is TRUE
About H. pylori?
(A) Active organisms can be discerned by serology.
(B) It is protective against gastric carcinoma.
(C) It is associated with chronic gastritis.
(D) It causes gastric ulcer but not duodenal ulcer.
(E) It can be detected by the urea breath test in <60% of cases.
Correct answer: C
37. A 63-year-old man has an upper gastrointestinal (UGI) study as part of his workup
for abdominal pain. The only abnormal finding was in the antrum, where the mucosa
prolapsed into the duodenum. There were no abnormal findings on endoscopy. What
should he do?
(A) Sleep with his head elevated.
(B) Be placed on an H2 antagonist.
(C) Undergo surgical resection of the antrum.
(D) Be observed and treated for pain accordingly.
(E) Have laser treatment of the antral mucosa.
Correct answer: D
38. A63-year-old man underwent gastric resection for severe peptic ulcer disease. He
had complete relief of his symptoms but developed “dumping syndrome.” This patient
is most likely to complain of which of the following?
(A) Gastric intussusception
(B) Repeated vomiting
(C) Severe diarrhea
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(D) Severe vasomotor symptoms after eating
(E) Intestinal obstruction
Correct answer: D
39. A 65-year-old man was admitted to the hospital for severe bilious vomiting
following gastric surgery. This occurs in which circumstance?
(A) Following ingestion of gaseous fluids
(B) Spontaneously
(C) Following ingestion of fatty foods
(D) Following ingestion of bulky meals
(E) In the evening
Correct answer: B
40. A 64-year-old man has had intermittent abdominal pain as a result of duodenal
ulcer disease for the past 6 years. Symptoms recurred 6 weeks before admission. He is
most likely to belong to which group?
(A) A and secretor (blood group antigen in body fluid)
(B) B and Lewis antigen
(C) AB
(D) O and nonsecretor
(E) O and secretor
Correct answer: D
41. A64-year-old man was evaluated for moderate protein deficiency. He underwent a
gastrectomy 20 years earlier. He is more likely to show which of the following?
(A) Porphyria
(B) Hemosiderosis
(C) Aplastic anemia
(D) Hemolytic anemia
(E) Iron deficiency anemia
Correct answer: E
42. A68-year-old woman has been diagnosed with a benign ulcer on the greater
curvature of her stomach, 5 cm proximal to the antrum. After 3 months of standard
medical therapy, she continues to have guaiac positive stool, anemia, and abdominal
pain with failure of the ulcer to heal. Biopsies of the gastric ulcer have not identified a
malignancy. The next step in management is which of the following?
(A) Treatment of the anemia and repeat all studies in 6 weeks
(B) Endoscopy and bipolar electrocautery or laser photocoagulation of the gastric
ulcer
(C) Admission of the patient for total parenteral nutrition (TPN), treatment of anemia,
and endoscopic therapy
(D) Surgical intervention, including partial gastric resection
(E) Surgical intervention, including total Gastrectomy
Correct answer: D
43. Over the past 6 months, a 60-year-old woman with long standing duodenal ulcer
disease has been complaining of anorexia, nausea, weight loss and repeated vomiting.
She recognizes undigested food in the vomitus. Examination and workup reveal
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dehydration, hypokalemia, and hypochloremic alkalosis. What is the most likely
diagnosis?
(A) Carcinoma of the fundus
(B) Penetrating ulcer
(C) Pyloric obstruction due to cicatricial stenosis of the lumen of the duodenum
(D) ZES (Zollinger Ellison Syndrome)
(E) Anorexia nervosa
Correct answer: C
44. A 50-year-old woman presents with duodenal ulcer disease and high basal acid
secretory outputs. Secretin stimulated serum gastrin levels are in excess of 1000
pg/mL. She has a long history of ulcer disease that has not responded to intense
medical therapy. What is the most likely diagnosis?
(A) Hyperparathyroidism
(B) Pernicious anemia
(C) Renal failure
(D) ZES
(E) Multiple endocrine neoplasia
Correct answer: D
45. A50-year-old man presents with vague gastric complaints. Findings on physical
examination are unremarkable. The serum albumin level is markedly reduced (1.8
g/100 mL). A barium study of the stomach shows massive gastric folds within the
proximal stomach. These findings are confirmed by endoscopy. What is the correct
diagnosis?
(A) Hypertrophic pyloric stenosis
(B) Gallstone ileus
(C) Mallory-Weiss tear
(D) Hypertrophic gastritis
(E) Crohn’s disease
Correct answer: D
46. A 2-cm ulcer on the greater curvature of the stomach is diagnosed in a 70-year-old
woman by a barium study. Gastric analysis to maximal acid stimulation shows
achlorhydria. What is the next step in management?
(A) Antacids, H2 blockers, and repeat barium study in 6 to 8 weeks
(B) Proton pump inhibitor (PPI) (e.g., omeprazole) and repeat barium study in 6 to 8
weeks
(C) Prostoglandin E (misoprostol) and repeat barium study in 6 to 8 weeks
(D) Immediate elective surgery
(E) Upper endoscopy with multiple biopsies (at least 8 or 9) for the ulcer
Correct answer: E
47. A55-year-old school bus driver was diagnosed 3 months ago with an antral ulcer.
He was treated for H. pylori and continues to take a PPI. Repeat endoscopy
demonstrates that the ulcer has not healed. What is the next treatment option?
(A) Treatment with H2 blockers
(B) Vagotomy alone without additional surgery
(C) Endoscopy and laser treatment of the ulcer
(D) Distal gastrectomy with gastroduodenal anastomosis (Billroth I)
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(E) Elevating the head of the bed when asleep
Correct answer: D
48. A 55-year-old man complains of anorexia, weight loss, and fatigue. AUGI study
demonstrates an ulcerated lesion at the incisura. Where is the incisura?
(A) Cardia
(B) Fundus
(C) Greater curvature
(D) Lesser curvature
(E) Gastrocolic ligament
Correct answer: D
49. A 64-year-old woman presents with severe upper abdominal pain and retching of
1-day duration. Attempts to pass a nasogastric tube are unsuccessful. X-rays show an
air-fluid level in the left side of the chest in the posterior mediastinum. An
incarcerated paraesophageal hernia and gastric volvulus is diagnosed. What is the next
step in management?
(A) Insertion of a weighted bougie to untwist the volvulus
(B) Elevation of the head of the bed
(C) Placing the patient in the Trendelenburg position with the head of the bed lowered
(D) Laparotomy and vagotomy
(E) Surgery, reduction of the gastric volvulus, and repair of the hernia
Correct answer: E
50. A 48-year-old man undergoes surgery for a chronic duodenal ulcer. The procedure
is a truncal vagotomy and which of the following?
(A) Gastroenterostomy
(B) Removal of the duodenum
(C) Closure of the esophageal hiatus
(D) Incidental appendectomy
(E) No further procedure
Correct answer: A
51. A healthy 75-year-old man bleeds from a duodenal ulcer. Medical management
and endoscopic measures fail to stop the bleeding. What is the next step in
management?
(A) Continued transfusion of 8 U of blood
(B) Administration of norepinephrine
(C) Oversewing of the bleeding point
(D) Oversewing of the bleeding point, vagotomy and pyloroplasty
(E) Hepatic artery ligation
Correct answer: D
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Cancer stomach
2 . Which of the following is the most common cause of gastric outlet obstruction
in India?
A. Cancer of stomach
B. Tuberculosis
C. Peptic ulcer disease
D. Duodenal lymphoma
Correct answer: A
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7 . A 60 year old male diagnosed to have carcinoma stomach. CT scan of abdomen
showed a mass measuring 4 X 4 cm in the antrum with involvement of celiac nodes
and right gastric nodes. Management of choice is:
A. Total gastrectomy
B. Subtotal gastrectomy
C. Palliative
D. Chemotherapy
Correct answer: B
9 . In which of the following, Sister Mary Joseph nodule is most commonly seen?
A. Stomach cancer
B. Ovarian cancer
C. Pancreatic cancer
D. Colon cancer
Correct answer: A
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14 . All of the following are indications for surgery in gastric lymphomas except
A. Bleeding
B. Perforation
C. Residual disease following chemotherapy
D. Intractable pain
Correct answer: D
19 . For inoperable gastric neoplasms involving the cardia, the best palliation is
by -
A. Intubation
B. Exclusion
C. Presternal bypass
D. Gastroenterostomy
Correct answer: A
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21 . Investigation of choice for liver metastasis in gastric carcinoma is ?
A. US
B. CT
C. MRI
D. HIDA scan
Correct answer: B
22 . All of the following are indications for surgery in gastric lymphoma except -
A. Bleeding
B. Perforation
C. Residual disease following chemotherapy
D. Intractable pain
Correct answer: D
26. A 60-year-old man has been having vague symptoms of upper abdominal
discomfort, early satiety, and fatigue. He is referred to a gastroenterologist, who
performs an upper endoscopy. Although a discrete mass is not visualized, the stomach
looks abnormal. It does not distend easily with insufflation. A biopsy shows signet ring
cells. Which of the following is TRUE?
(A) Signet ring cells are typically found in intestinal type gastric adenocarcinoma.
(B) Signet ring cell cancer is the most common type of gastric cancer.
(C) “Leather bottle stomach” is a term used to describe a nondistensible stomach
infiltrated by cancer.
(D) The gross appearance of the stomach always shows classic findings of linitus
plastica.
(E) Linitus plastica has an excellent prognosis.
Correct answer: C
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27. A 26-year-old man is diagnosed with adenocarcinoma of the stomach. He wants to
know what could have caused him to develop this condition. He does an internet search.
Which of the following is a risk factor for developing gastric cancer?
(A) Exposure to ionizing radiation
(B) Blood group B
(C) A diet high in fiber
(D) H. pylori infection
(E) North American descent
Correct answer: D
28. A 30-year-old executive learns that he has a duodenal ulcer. His gastroenterologist
prescribes and outlines medical therapy. The patient worries that if medical therapy
fails he may need surgery. Which of the following is the best indication for elective
surgical therapy for duodenal ulcer disease?
(A) An episode of melena
(B) Repeated episodes of pain
(C) Pyloric outlet obstruction due to scar formation from an ulcer
(D) Frequent recurrences of ulcer disease
(E) Referral of pain to the back, suggestive of pancreatic penetration
Correct answer: C
29. A 36-year-old man presents with weight loss and a large palpable tumor in the
upper abdomen. Endoscopy reveals an intact gastric mucosa without signs of
carcinoma. Multiple biopsies show normal gastric mucosa. A UGI study shows a
mass in the stomach. At surgery, a 3-kg mass is removed. It is necessary to remove
the left side of the transverse colon. What is the most likely diagnosis?
(A) Gastric cancer
(B) Gastrointestinal stromal tumor (GIST)
(C) Choledochoduodenal fistula
(D) Eosinophilic gastroenteritis
(E) Linitis plastica
Correct answer: B
30. A 74-year-old man presents with anorexia and self-limited hematemesis. During
endoscopy a mass is discovered and a biopsy is done. A hematopathologist diagnoses
non-Hodgkin’s lymphoma. What is the recommended therapy?
(A) Chemotherapy alone
(B) Immunotherapy
(C) Radiation and chemotherapy
(D) Surgery, radiation, and chemotherapy
(E) Surgery alone
Correct answer: C
31. A63-year-old woman is admitted to the hospital with a UGI bleeding that subsides
spontaneously within a short time after admission. A barium study shows a gastric
ulceration that is described by the radiologist as having a “doughnut sign.” What is the
most likely diagnosis?
(A) Lipoma
(B) Gastric ulcer
(C) Ectopic pancreas
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(D) GIST
(E) Carcinoma
Correct answer: D
36 . Which of the following is the Gold standard test for recurrent gastrointestinal
stromal tumor ?
A. USG
B. PET CT
C. MRI
D. MIBG
Correct answer: B
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9- Liver and portal vein, spleen:
1. Following an emergency operation for hepatic and splenic trauma, the surgeon
inserts a finger into the foramen of Winslow in an attempt to stop the bleeding. Which
is TRUE of the hepatic artery?
(A) It is called the common hepatic artery at this level.
(B) It is medial to the common bile duct and anterior to the portal vein.
(C) It is posterior to the portal vein.
(D) It is posterior to the inferior vena cava.
(E) It forms the superior margin of the epiploic foramen.
Correct answer: B
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6 . True about fibrolamellar carcinoma of the liver,except:
A. Better prognosis than HCC
B. More common in females
C. Occur in younger individuals
D. AFP levels always greater than >1000
Correct answer: D
7 . In orthotropic liver transplantation, which is the best way to get bile drainage in
donor liver?
A. Donor bile duct with jejunum of recipient
B. External drainage for few days followed by choledochojejunostomy
C. Donor bile duct with recipient bile duct or Roux en Y choledochojejunostomy
D. Donor bile duct with duodenum of recipient
Correct answer: C
1. The most common cause of pyogenic liver abscess in children today is which
of the following?
a. Perforated appendicitis
b. Blunt liver injury
c. Immunocompromised host
d. Percutaneous liver biopsy
e. Omphalitis
Correct answer: c
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D. Hepatitis B serology positive
Correct answer: C
5. A 55-year-old man has had previous hemicolectomy for a carcinoma of the right
colon. At this time, 3 years after the primary resection, a CT scan shows a solitary
lesion in the right lobe of the liver. What is the next step in management?
(A) Laser cauterization
(B) Radiotherapy
(C) Hepatic artery catheterization and local chemotherapy
(D) Symptomatic treatment with analgesics, because the colon disease is now stage IV
(E) Exploratory laparotomy and resection of the tumor.
Correct answer: E
7 . Surgeon excises a portion of liver to the left of the attachment of the falciform
ligament. Which of the following segments may be resected?
A. Segment 1 and 4b
B. Segment 1a and 4
C. Segment 1 and 3
D. Segment 2 and 3
Correct answer: D
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11. Mortality from rupture liver is about:
a. 5%.
b. 20%.
c. 4O%.
d. 50%.
Correct answer: B
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18. Stage Ill of hepatic bilharziasis means:
a. Hepatomegaly.
b. Hepatosplenomegaly.
c. Splenomegaly with shrunken liver.
d. None of the above.
Correct answer: C
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Correct answer: D
25. Which of the following statements(s) is/are true about benign lesions of the
liver:
a. Adenomas are true neoplasms with o predisposition for complications
and should usually be resected.
b. Focal nodular hyperplasia (FNH) is a neoplasm related to oral
contraceptive pills and usually requires resection.
c. Hemangiomas are the most common benign lesions of the liver that
come to the surgeon's attention.
d. Nodular regenerative hyperplasia does not usually accompany cirrhosis.
Correct answer: A
26. Rupture of on amoebic liver abscess occurs most often into the:
a. Peritoneal cavity.
b. Pleural cavity.
c. Pericardial cavity.
d. Duodenum.
e. Colon.
Correct answer:B
28. The most appropriate treatment for amoebic Iiver abscess is by:
a. Emetine hydrochloride.
b. Metronidazole.
c. Aspiration.
d. Open drainage.
e. Excision.
Correct answer:.B
30. Which of the following procedures is associated with least risk of hepatic
encephalopathy:
a. Mesocaval shunt .
b. Proximol splenorenal shunt.
c. Distal splenorenol shunt' (Warren shunt).
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d. Side to side portocaval shunt.
Correct answer: C
31. A small cirrhotic liver with grossly enlarged caudate lobe demands
exclusion of:
a. Portal vein thrombosis.
b. Budd-Chiari syndrome.
c. Hepatoma .
d. Primary sclerosing cholangitis
Correct answer: B
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Portal hypertension
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7 . Which of the following statements is not true regarding chylous ascites
A. Can be seen in abdominal lymphoma
B. Can occur following abdominal surgery
C. Low fat diet is useful in controlling chylous ascites
D. Ascitic fluid contains no lymphocytes
Correct answer: D
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Splenomegaly
4. Which of the following is the best initial screening test for thrombocytapenia
A.bleeding time
B.clotting time
C.platelet count
Correct answer A
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5. A 12-year-old boy who underwent a previous splenectomy for thalassemia
presents to the emergency room with fever, chills, and septic shock. The parents
give a history of seemingly minor sore throat, which started only a few hours
previously. The child is hypotensive and appears moribund. A diagnosis of
overwhelming post splenectomy infection (OPSI) is made.
Which of the following statements about OPSIis TRUE?
(A) The condition is more common in children.
(B) The condition is more common after splenectomy for trauma.
(C) Prophylactic antibiotics have not been shown to improve outcome in children.
(D) Prophylactic vaccination against Enterococcus should be performed.
(E) The condition is very common after splenectomy.
Correct answer A.
8. As the functional anatomy of the spleen is divided into red pulp, white
pulp, and marginal zone, what function is incorporated into the anatomy of
the cortical zone that relates to infection control?
A. Filtration of red cells, encapsulated bacteria, and other foreign material.
B. Red pulp for formation of red cells.
C. White pulp for its role in formation of granulocytes.
D. Gray areas, so formed because of the production of platelets.
E. Fibrous trabeculae.
Correct answer: A
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10. Useful methods for detection of splenic in jury, in descending order of
sensitivity, are:
A. Diagnostic peritoneal lavage.
B. CT.
C. Ultrasonography.
D. Isotope scan.
E. Magnetic resonance imaging (MRI).
Correct answer: B
11. The following comments about immune thrombocytopenic purpura (ITP) are
accurate:
A. Platelet count is low.
B. Circulating antiplatelet factor is present.
C. Antiplatelet factor is immunoglobulin G (IgG) antibody.
D. Purpura is directed against a platelet-associated antigen.
E. May be fatal.
F. All of the above.
Correct answer: A
12. ITP:
A. Is most common in men in their 20s.
B. Is frequently cured in adults by corticosteroid administration.
C. Usually requires splenectomy in children.
D. Is most common in the sixth decade of life.
E. Is in remission in more than 80% of patients with splenectomy.
Correct answer: E
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D. It requires evaluation of the myelo proliferation.
E. It is associated with antibodies against platelets.
Correct answer: E
18. Which of the following statements about lymphatic capillaries are true?
A. These vessels have delicate tricuspid valves every 2 to 3 mm.
B. Lymphatic capillaries are more permeable than blood capillaries.
C. Lymphatic capillaries are less permeable than blood capillaries.
D. Lymphatic capillaries contain gaps large enough to admit particles as large as
lymphocytes.
Correct answer: C,D
19. Which of the following forces do not promote the formation of interstitial
fluid?
A. Increased venous pressure.
B. Constrictive pericarditis.
C. Hypernatremia.
D. Hypoproteinemia.
Correct answer: C
20. The two primary causes of death from sickle cell disease in the first decade of
life are which of the following?
a. Sepsis
b. Splenic sequestration crisis
c. Acute chest syndrome
d. Heart failure
Correct answer: a, b
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21. The best therapy for a patient with thrombotic thrombocytopenic purpura is
which of the following:
a. Plasmapheresis
b. Corticosteroids
c. Splenectomy
d. Intravenous immune globulin
Correct answer: a
22. Which of the following statements regarding post splenectomy sepsis are
true, except?
a. The incidence in children is generally reported as less than 5%
b. Hemophilus influenzae, Streptococcus pneumoniae and Neisseria meningitidis
are the most common causative organisms.
c. Auto transplantation techniques eliminate this risk
d. The mortality rate is now approximately 50%
e. The incidence in adults in approximately 1%
Correct answer: c.
23. A 50-year old male with Laennec’s cirrhosis, portal hypertension and
hypersplenism. He has no history of gastrointestinal bleeding. You would
recommend which of the following?
a. Splenectomy
b. Prophylactic sclerotherapy for esophageal varices
c. Portosystemic shunt
d. Observation
Correct answer: d
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26. A 40-year old woman with chronic immune thrombocytopenic purpura
(ITP) is refractory to corticosteroids. The approximate likelihood she will
benefit from a splenectomy is approximately which of the following?
a. Less than 2 0%
b. 40%
c. 60%
d. 80%
Correct answer: c
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9. With intraoperative T-tube cholangiography, incidence of missed stones is:
a-0%
b- 5%
c- 20%
d- 30%
Correct answer: E
14. Which of the following statements(s) about gallstone ileus is/are not true?
a- The condition is seen most frequently in women older than 70.
b- Concomitant with the bowel obstruction, air is seen in the biliary tree.
c- The usual fistula underlying the problem is between the gallbladder and the
ileum.
d- When possible, relief of small bowel obstruction should be accompanied by
definitive repair of the fistula since there is of significant incidence of
Recurrence if the fistula is left in place.
e- Ultrasound studies may be of help in identifying gallstone of the
obstructing agent.
Correct answer: C
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15. Gas in the biliary system in a plain X-ray is diagnostic of
a. Choledochoduodenal fistula
b. intestinal obstruction
c. Emphysematous Cholecystitis
d. Viral hepatitis
e. A and C
Correct answer: E
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Correct answer: B
24. Which of the following lesions are believed to be associated with the
development of carcinoma of the gallbladder?
a- Cholecystoenteric fistula.
b- A calcified gallbladder.
c- Adenoma of the gallbladder.
d- Xanthogranulomatous cholecystitis.
e- All of the above.
Correct answer: E
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29 . True statement about gall stones are All/Except:
A. Lithogenic bile is required for stone formation
B. May be associated with carcinoma gall bladder
C. Associated with diabetes mellitus
D. More common in males between 30-40 years of age
Correct answer: D
33 . All of the following are predisposing factors for gallstone formation except:
A. Vagotomy
B. Jejunal resection
C. Ileal resection
D. Right hemicolectomy
Correct answer: D
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C. Cholestyramine therapy
D. Vagal stimulation
Correct answer: D
42 . Mirizzi's syndrome is ?
A. Gall bladder stone compressing hepatic duct
B. Gall bladder carcinoma invading IVC
C. Gall bladder stone causing cholecystitis
D. Pancreatic carcinoma
Correct answer: A
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B. Anaplastic carcinoma
C. Sq. cell carcinoma
D. Transitional cell ca
Correct answer: A
44 . A 72 years male patient presented with history of chest pain and was
diagnosed to have coronary artery disease. During routine evaluation, an
ultrasound of the abdomen showed presence of gallbladder stones. There was no
past history of biliary colic or jaundice. The best treatment advice for this
patient for his gallbladder stones is
A. Laparoscopic cholecystectomy
B. Open cholecystectomy
C. ERCP and removal of gallbladder stones
D. No surgery for gallbladder stones
Correct answer: D
45 . A 69 years old male patient having coronary artery disease was found to
have gall bladder stones while undergoing a routine ultrasound of the abdomen.
There was no history of biliary colic or jaundice at any time. What is the best
treatment advice for such a patient for his gallbladder stones?
A. Open cholecystectomy
B. Laparoscopic cholecystectomy
C. No surgery for gallbladder stones
D. ERCP and removal of gallbladder stones
Correct answer: C
48 . Which of the bellow is associated with fish consumption and also cause ca
gallbladder ?
A. Anglostronglyoidosis cantonensis
B. H. dimunata
C. Clonorchis sinensis
D. Gnathisomia
Correct answer: C
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49 . Survival in unresectable Gall Bladder CA is?
A. 1year.
B. 12-24 months
C. 4-6 months
D. 8-10 months
Correct answer: C
53 . Most common site for impaction of gall stones in gall stone ileus is:
A. IIst part of duodenum
B. Ist part of duodenum
C. Colon
D. Terminal ileum
Correct answer: D
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55 . Regarding primary sclerosing cholangitis, all of the following are true
EXCEPT -
A. Ultrasound examination is often normal
B. ERCP is the preferred approach
C. Cholangiographic appearance may mimic diffuse form of cholangiocarcinoma
D. Affects only intrahepatic ducts
Correct answer: D
Obstructive jaundice
2- The gold standard for the definitive diagnosis of the extrahepatic biliary
atresia is:
A. Peroperative cholangiography
B. Hepatobiliary scintigraphy
C. Alkaline phosphate level
D. Liver biopsy
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Correct answer: A
9 . All of the following are required for visualization of gall bladder in an oral
cholecystogram except:
A. Ability to absorb water
B. Functioning hepatocytes
C. Motor mechanism of gall bladder
D. Patency of cystic duct
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Correct answer: C
14 . 5 days after CBD surgery there is a small leak. What will be the best The
treatment -
A. Ultrasound guided aspiration
B. ERCP and stenting
C. Re-exploration and hepatojejunostomy
D. Re-exploration and primary repair
Correct answer: B
15 . The procedure of choice for elective removal of CBD stones for most patients
is -
A. Open choledocholithotomy
B. Endoscopic choledocholithotomy
C. Laparoscopic choledocholithotomy
D. Percutaneous choledocholithotomy
Correct answer: C
16 . Small gall bladder with dilated intrahepatic biliary channels found in:
A. GB stone
B. CBD stone
C. Carcinoma head of pancreas
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D. GB cancer
Correct answer: B
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23 . The treatment of choice for an 8 mm retained common bile duct (CBD) stone
is -
A. Laparoscopic CBD exploration
B. Percutaneous stone extraction
C. Endoscopic stone extraction
D. Extracorporeal shock wave lithotripsy
Correct answer: C
11- Pancreas;
7. The following are complications of acute pancreatitis. The most common cause of
death is:
a. Neurogenic shock.
b. Multiorgan failure.
c. Tetany.
d. Pancreatic abscess and septicemia.
Correct answer: B
10. As regards surgical drainage of pseudo pancreatic cyst all are correct except:
a. lndicated in all cases.
b. lndicated in infection.
c. lndicated if the cyst >6cm or persistent >5weeks.
d. Done by cystojejunostomy or more common cystogastrostomy.
Correct answer: A
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d. All are true.
Correct answer: D
13-The most important investigation for the extent of cancer pancreas is:
a. ERCP.
b. US.
c. CT.
d. Barium meal.
Correct answer: C
17. Which of the following statements about Pancreatic Carcinoma is not true
A. Hereditary Pancreatitis significantly increases the risk
B. Mutation in P53 gene is associated in 75% of cases
C. Five years survival after curative pancreaticoduodenectomy is 15 - 20%
D. Median survival in locally advanced (stage III) disease is 3-6 months
Correct answer: D
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18. A 42-year-old man who consumed more than 3 bottles of vodka weekly over
the past 20 years is admitted with upper abdominal pain radiating to the back,
nausea, and vomiting. Serum amylase and lipase are elevated, and a diagnosis of
pancreatitis is made. In determining his prognosis, which of the following factors
would cause the greatest concern?
(A) Hypercalcemia (Ca>12 mg/dL)
(B) Age over 40 years
(C) Hypoxemia
(D) Hyperamylasemia (>600 U)
(E) Elevated lipase.
Correct answer: C
20- A 40-year-old alcoholic male is admitted with severe epigastric pain radiating
to the back. Serum amylase level is reported as normal, but serum lipase is
elevated. The serum is noted to be milky in appearance. A diagnosis of
pancreatitis is made. The serum amylase is normal because
(A) The patient has chronic renal failure.
(B) The patient has hyperlipidemia.
(C) The patient has alcoholic cirrhosis.
(D) The patient has alcoholic hepatitis.
(E) The diagnosis of pancreatitis is incorrect.
Correct answer: B
21- A 52-year-old woman is admitted to the hospital with abdominal pain. She
reports that she drinks alcohol only at social occasions. The amylase is elevated
to 340 U. Which following x-ray finding would support a diagnosis of idiopathic
pancreatitis?
(A) Hepatic lesion on CT scan
(B) Choledocholithiasis on ultrasound
(C) Anterior displacement of the stomach on barium upper GI series
(D) Large loop of colon in the RUQ
(E) Irregular cutoff of the CBD on cholangiogram
Correct answer: C
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22- A 40-year-old man with a history of alcohol consumption of 25-year duration
is admitted with a history of a 6-lb weight loss and upper abdominal pain of 3-
weeks duration. Examination reveals fullness in the epigastrium. His
temperatureis 99F, and his WBC count is 10,000.
Which is the most likely diagnosis?
(A) Pancreatic pseudocyst
(B) Subhepatic abscess
(C) Biliary pancreatitis
(D) Cirrhosis
(E) Splenic vein thrombosis
Correct answer: A.
23- A 48-year-old woman is admitted with acute cholecystitis. The bilirubin level
is elevated, as are the serum and urinary amylase levels. Which radiologic sign
indicates biliary obstruction in pancreatitis?
(A) Pancreatic intraductal calcification
(B) Smooth narrowing of the distal CBD
(C) Stomach displaced anteriorly
(D) Calcified gallstone
(E) Air in the biliary tree
Correct answer: B.
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26- A 40-year-old woman with severe chronic pancreatitis is scheduled to
undergo an operation, because other forms of treatment have failed. The
ultrasound shows no evidence of pseudocyst formation or cholelithiasis and
endoscopic retrograde cholangiopancreatogram (ERCP) demonstrates dilated
pancreatic ducts with multiple stricture formation. Which operations suitable to
treat this condition?
(A) Pancreaticojejunostomy (Puestow procedure)
(B) Gastrojejunostomy
(C) Cholecystectomy
(D) Splenectomy
(E) Subtotal pancreatectomy
Correct answer: A.
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30- Insulinoma is most commonly located in which part of the pancreas:
A. Head
B. Body
C. Tail
D. Equally distributed
Correct answer: D
- 225 -
D. Presents as epigastric mass
Correct answer: B
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43 . Whipples triad is seen in -
A. Insulinoma
B. Somatostatinoma
C. Glucagonoma
D. CA pancreas
Correct answer: A
47 . All of the following statements about Pseudopancreatic cysts are true except:
A. Serum amylase levels are increased
B. Presents as an epigastric mass
C. Percutaneous aspiration is treatment of choice
D. Cystojejunostomy is treatment of choice
Correct answer: C
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D. Resection of diverticulum with a short segment of ileum and anastomosis
Correct answer B
7. A 55-year-old woman presents with vague RLQ abdominal pain. A palpable mass
is noted on abdominal examination. The mass is painless, well defined, mobile, and
nonpulsatile. What is the most likely diagnosis?
(A) A mesenteric cyst
(B) Appendix mass
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(C) Perforated tuba-ovarian abscess
(D) Cholecystitis
(E) Meckel’s diverticulum
Correct answer: A
8. A 68-year-old man presents with crampy abdominal pain and distention with
vomiting. Findings on physical examination are positive for healed abdominal scars.
X-rays reveal multiple gas fluid levels. The WBC count is 12,000. What is the most
likely diagnosis?
(A) Small-bowel intestinal obstruction due to adhesions
(B) Hernia
(C) Appendicitis
(D) Inflammatory bowel disease
(E) Gallstones and ascites
Correct answer: A
11- ln children and adolescents, the commonest cause of intestinal obstruction is:
a. Bonds and adhesions.
b. lntussusception.
c. Strangulated hernia.
d. Neoplasm.
e. Benign stricture.
Correct answer: C
14- A 40-year-old female presented with colicky abdominal pain, vomiting and
constipation of 48 hours duration. She gave a history of previous laparotomy and
examination revealed abdominal distension with loud bowel sounds. The most
probable diagnosis is:
a. Adhesive intestinal obstruction.
b. Gall-stone ileus.
c. internal hernia.
d. Paralytic ileus.
e. Mesenteric vascular occlusion.
Correct answer: A
16 . A female patient presents with pigmentation of the lips and oral mucosa and
intestinal polyps. Her sister also gives the same history. Most probable diagnosis is:
A. Carcinoid tumor
B. Melanoma
C. Villous adenoma
D. Peutz-Jegher syndrome
Correct answer: D
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Inflammatory bowel disease
2 . A 40 year old male patient presented with mild abdominal pain, mild
constipation with a feeling of incomplete evacuation and mucus in stools for the
past 4 years. On examination, tenderness is present in left iliac fossa. The most
likely diagnosis is -
A. Ulcerative colitis
B. Diverticular disease of the colon
C. Irritable bowel syndrome
D. Ca colon
Correct answer: C
4. Compared with Crohn's disease Ulcerative colitis does not have more
A.Malignant change
B.Fistula formation
C.Bleeding per rectum
D.Cholangio carcinoma
Correct answer B
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Diverticular disease of the colon
1- The following statements about diverticular disease of the colon are true except that
it :
a. increases in incidence with advancing age.
b. Does not involve the rectum.
c. ls essentially due to o high-residue diet.
d. Moy be asymptomatic.
e. Moy cause massive rectal bleeding.
Correct answer: C
1- All of the following are true about Familial adenomatosis polyposis (FAP),
except-
A. Polyps develop in late adulthood
B. Epidermal cysts and osteomas may occur
C. Autosomal recessive inheritance
D. Screening done by sigmoidoscopy
Correct answer: C
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4. The X-ray finding which helps to distinguish Hirschsprung's disease from
congenital megacolon is
A.Delayed evacuation of barium
B.Air fluid levels
C.Presence of a transition zone
D.Dilated bowel loops
Correct answer C
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11. Possible sites for pilonidal sinus include the following except:
a. Anal cleft.
b. Axilla.
c. Umbilicus.
d. None of the above.
Correct answer: D
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18. An elderly male with history of habitual constipation presented because of
progressive abdominal distension with diarrhea and tenesmus. He should be
suspected lo suffer from:
a. Carcinoma of the rectum
b. None-specific ulcerative colitis
c. Amoebic colitis
d. Crohn's diseose
e. Proctocolitis
Correct answer: A
20. Concerning internal piles, the following statements are correct except that
they:
a. Are due to varicosity of the internal hemorrhoidal plexus.
b. May consist of mother or daughter piles.
c. Present clinically by bleeding and prolapse.
d. Are usually associated with severe pain.
e. May resolve under conservative treatment in the early stages.
Correct answer: D
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Correct answer: A
- 236 -
30. Which of the following statements regarding anal warts is false?
a. They are associated with HPV infection.
b. The incidence has decreased over the last three decades.
c. Acetic acid is helpful in diagnosis.
d. Treatment options include 25 per cent podophyllin and surgical excision
Correct answer: B
31. The risk factors for anal squamous cell carcinoma (SCC) include the
following except:
a. Human papillomavirus (HPV) infection
b. HIV infection
c. Renal transplant
d. Other genital cancers
e. Rectal cancer.
Correct answer: E
33- Correct statements about Hirschsprung's disease include the following except
that it
a. ls due to congenital absence of ganglion cells from the rectum and port
of the colon.
b. Presents with constipation since birth.
c. ls characterized by o tight empty rectum on rectal examination.
d. Rarely needs rectal biopsy for definitive diagnosis.
e. Always requires surgical treatment.
Correct answer: D
35- Which statement among the following is untrue about cancer of right colon ?
a. ls commonest in the coecum.
b. Rarely presents with intestinal obstruction.
c. Moy present with anemia of obscure origin.
d. ls rarely palpable on abdominal examination.
e. ls best treated by extended right colectomy.
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Correct answer: D
36- Carcinoma of the left colon differs from that of the right colon in the following
except that it:
a. ls usually a stenosing scirrhous lesion.
b. Frequently presents with intestinal obstruction.
c. Rarely causes diarrhea.
d. ls usually impalpable on abdominal examination.
e. Carriers a better prognosis after radical resection.
Correct answer: C
38- The best screening investigation for cancer of the colon in the general
population is:
a. Abdominal ultrasound.
b. Barium enema.
c. Stool occult blood test.
d. Carcinoembryonic antigen (CEA) assay.
e. Colonoscopy.
Correct answer: C
39- Concerning infantile intussusception the following statements are true except
that it:
a. Usually occurs during the first year of life.
b. Causes recurrent attacks of severe colicky abdominal pain.
c. ls characterized by the passage of "red-current jelly" stool.
d. Can be diagnosed without radiological examination.
e. Always requires urgent operation.
Correct answer: E
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41- Complications of congenital megacolon include the following except:
a- Failure to thrive
b- Bad chest
c- Cancer colon
d- Obstructive enterocolitis.
Correct answer: C
46-Which of the following statements regarding the risk of cancer in the context
of ulcerative colitis is/are correct?
a- After 10 years of active disease, the risk of cancer approximates 20%
to 30%
- 239 -
b- After 10 years of active disease, the risk of cancer approximates 27" to
3%
c- The risk of colon cancer in ulcerative colitis is identical to controls
d- After 20 years of disease activity, the risk of colon cancer
approximates 80%
Correct answer: B
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52- The most common site for cancer colon is:
a- Coecum
b- Ascending colon
c- Transverse colon
d- Descending colon
e- Sigmoid and rectum
Correct answer: E
54- What has been found to be an acceptable screening technique for detecting
recurrent colon cancer:
a- Screening sigmoidoscopy.
b- Screening the stool for occult blood.
c- Stool cytology.
d- Measurement of carcinoembryonic antigen (CEA) levels.
e- Colonoscopy.
Correct answer: D
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57. A 25-year-old male develops diarrhea and colicky abdominal pain. Ulcertive
colitis is diagnosed on colonoscopy. Which of the following findings is consistent
with the diagnosis?
(A) The rectum is not involved.
(B) The disease is confluent, there are no skip areas in the colon and the rectum is
involved.
(C) The full thickness of the bowel wall is involved.
(D) Microscopic examination of the mucosa reveals normal cells without evidence of
dysplasia.
(E) The incidence of colorectal cancer is equal to that of the general population
Correct answer: B
58. A 35-year-old man has known ulcerative colitis. Which of the following is an
indication for total proctocolectomy?
(A) Occasional bouts of colic and diarrhea
(B) Sclerosing cholangitis
(C) Toxic megacolon
(D) Arthritis.
(E) Iron deficiency anemia
Correct answer: C
59.A 55-year-old man presents with left lower quadrant (LLQ) abdominal pain of
2-day duration, associated with constipation. On physical examination, he has
tenderness localized to the LLQ with fullness in that area leukocyte count is 22,000
and temperature is 101.5°F. Which would be the best diagnostic study to evaluate
this man?
(A) Diagnostic laparoscopy
(B) Barium enema
(C) Plain abdominal roentgenogram
(D) Computed tomography (CT) of the abdomen/pelvis with orally (PO) and
intravenous (IV) contrast
(E) Colonoscopy
Correct answer: D
60.A patients CT scan reveals diverticulitis confined to the sigmoid colon. There is
no associated pericolic abscess. What is best course of treatment?
(A) Bowel rest, nasogastric suction, IV fluids, and broad spectrum antibiotics
(B) Urgent surgical resection
(C) Steroids
(D) Diverting colostomy
(E) Ileostomy
Correct answer: A
61. The standard initial therapy for acute sigmoid volvulus is:
(A) Laparotomy to reduce the volvulus and replace the sigmoid colon to its normal
position
(B) IV neostigmine
(C) Colonoscopy
(D) Ileostomy
(E) Rigid sigmoidoscopy
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Correct answer: E
62. A 30-year-old male is diagnosed with Peutz- Jeghers syndrome. What findings are
consistent with the diagnosis?
(A) Adenomas
(B) Hamartomas
(C) Adenomatous polyps
(D) Villoglandular polyps
(E) Villotubular polyps
Correct answer: B
63. A 12-year-old boy complains of pain in the lower abdomen (mainly on the right
side). Symptoms commenced 12 hours before admission. He had noted anorexia
during this period. Examination revealed tenderness in the right iliac fossa, which was
maximal 1 cm below Mc Burney’s point. In appendicitis, where does the pain
frequently commence?
(A) In the right iliac fossa and remains there
(B) In the back and moves to the right iliac fossa
(C) In the rectal region and moves to the right iliac fossa
(D) In the umbilical region and then moves to the right iliac fossa
(E) In the right flank
Correct answer: D
65. A 29-year-old woman presents to her physician’s office with pain in the right iliac
fossa. Examination reveals tenderness in this region. Her last menstrual cycle was 2
weeks previously and findings on gynecologic examination and leukocyte count are
normal. A provisional diagnosis of acute appendicitis is made. She should be
informed that operations to treat this condition reveal acute appendicitis in what
percentage of cases?
(A) A small percentage of cases
(B) 50–89% of cases
(C) 90–99% of cases
(D) More than 99% of cases
(E) No reliable statistics are available
Correct answer: C
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66. A 28-year-old man is admitted to the emergency department complaining of pain
in the umbilical region that moves to the right iliac fossa. Which is a corroborative
sign of acute appendicitis?
(A) Referred pain in the right side with pressure on the left (Rovsing) sign
(B) Increase of pain with testicular elevation
(C) Relief of pain in lower abdomen with extension of thigh
(D) Relief of pain in lower abdomen with internal rotation of right thigh
(E) Hyperanesthesia in the right lower abdomen
Correct answer: A
67. A 54-year-old man with diarrhea is found to have ulcerative colitis. Colectomy
should be advised in patients with ulcerative colitis who have symptoms that persist
for more than which of the following?
(A) 1 month
(B) 6 months
(C) 1–5 years
(D) 10–20 years
(E) More than 25 years
Correct answer: D
68. A 48-year-old woman develops colon cancer. She is known to have a long history
of ulcerative colitis. In ulcerative colitis, which of the following is a characteristic of
colon cancer?
(A) Occurs less frequently than in the rest of the population.
(B) Is more likely to occur when the disease is confined to the left colon.
(C) Occurs equally in the right and left side.
(D) Has a synchronous carcinoma in 4–5% of cases.
(E) Has an excellent prognosis because of physician awareness
Correct answer: C
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Correct answer: C
71. A43-year-old man is seen in his physician’s office for severe pain in the perineum.
Examination reveals exquisite tenderness in the area to the right side of the anal verge
due to a perianal abscess. Rectal examination is refused. What should be the next step
in management?
(A) Drainage of the abscess in the office under local anesthesia.
(B) Excision of the vertical fold of Morgagni.
(C) Drainage under general anesthesia and immediate colonoscopy.
(D) CT scan of the abdomen.
(E) Insertion of a rectal tube.
Correct answer: A
72.A 64-year-old man undergoes CEA surveillance for cancer, because his brother
and father both had colon cancer. What information should he be provided?
(A) CEA is highly sensitive for diagnosis.
(B) If CEA is elevated preoperatively, it implies unresectable disease.
(C) Increases in CEA after resection may indicate tumor recurrence.
(D) CEA is highly specific for the presence of colon cancer.
(E) CEA is present in normal adult colonic mucosa
Correct answer: C
73. A 70-year-old man presents with pallor and breathlessness on exertion. He does
not complain of abdominal pain. He has microcytic, hypochromic anemia. What is the
most probable cause?
(A) Diverticulosis of the colon
(B) Peptic ulcer disease
(C) Crohn’s disease
(D) Ulcerative colitis
(E) Carcinoma of the right colon
Correct answer: E
74. A 25-year-old man has recurrent, indolent fistula in Ano. He also complains of
weight loss, recurrent attacks of diarrhea with blood mixed in the stool, and tenesmus.
Proctoscopy revealed a healthy, normal-appearing rectum. What is the most likely
diagnosis?
(A) Crohn’s colitis
(B) Ulcerative colitis
(C) Amoebic colitis
(D) Ischemic colitis
(E) Colitis associated with acquired immunodeficiency syndrome (AIDS)
Correct answer: A
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(D) Volvulus of the cecum
(E) Small-bowel obstruction
Correct answer: C
76. A 40-year-old man with a long history of bloody diarrhea presents with increased
abdominal pain, vomiting, and fever. On examination, he is found to be dehydrated
and shows tachycardia and hypotension. The abdomen is markedly tender with
guarding and rigidity. What is the most likely cause?
(A) Toxic megacolon in ulcerative colitis
(B) Small-bowel perforation from regional enteritis
(C) Perforated carcinoma of the sigmoid colon
(D) Volvulus of the sigmoid colon
(E) Acute perforated diverticulitis
Correct answer: A
77. A 55-year-old woman presents with pain in the LLQ of the abdomen and fever of
102°F. On examination, she is found to be dehydrated and has tenderness in the LLQ.
A CT scan shows a mass in the LLQ involving the sigmoid colon. There is a minimal
amount of free fluid and no free air. What should the initial treatment of this patient
include?
(A) IV fluids, penicillin, and steroids
(B) IV fluids, cefoxitin, and nasogastric drainage
(C) IV fluids, blood transfusion, and laparotomy
(D) Immediate laparotomy
(E) Bowel preparation followed by Laparotomy
Correct answer: B
79. A 64-year-old man has a benign lesion of the colon. He is informed that the lesion
does not predispose to colon cancer. What is the lesion he has?
(A) Ulcerative colitis
(B) Villous adenoma
(C) Hyperplastic polyp
(D) Adenoma in familial polyposis
(E) Colon mucosa in a patient with colon Carcinoma
Correct answer: C
80- The least common site for cancer in the alimentary tract is:
a. Pharynx.
b. Esophagus.
c. Stomach.
- 246 -
d. Small bowel.
e. Colon and rectum.
Correct answer: D
81- The following is/are risk factors for volvulus of pelvic colon except:
a. Old age.
b. Chronic constipation.
c. Short sigmoid.
d. Adhesions.
Correct answer: C
85 . 60 year old male with CA descending colon presents with acute intestinal
obstruction. In emergency department the treatment choice is -
A. Defunctioning colostomy
B. Hartman's procedure
C. Total colectomy
D. Lt hemicolectomy
Correct answer: B
- 247 -
87 . Carcinoma right colon is most commonly of which type -
A. Stenosing
B. Ulcerative
C. Tubular
D. Fungating
Correct answer: D
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94 . Based on Epidemiological studies, which of the following has been found to
be most protective against Carcinoma Colon:
A. Low selenium diet
B. Low protein diet
C. High fiber diet
D. Low fat diet
Correct answer: C
98 . A 25 years male, on tour, presents with bright red painless bleed since 7 days
and abdominal pain. External and per rectal examinations are normal. As
attending general practioner, your next step is-
A. Refer to surgeon for sigmoidoscopy
B. Refer to gastroenterologist for colonoscopy
C. Proctoscopy
D. Do a barium enema
Correct answer: C
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100 . True statements about congenital megacolon include all of the following
except:
A. Loud borborygmi
B. Dilatation and hyper trophy of pelvic colon
C. Large stool
D. Symptoms appear within 3 days following birth
Correct answer: D
106 . Which of the following carries the least risk of Colonic malignancy ?
A. Familial adenomatous polyposis
B. Gardner's syndrome
C. Villous adenoma
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D. Peutz-Jegher's syndrome
Correct answer: D
109 . A patient suffered bullet injury to left side of the colon and presented in the
causality department after 12 hour. What will be the m/n(management):
A. Proximal defunctioning colostomy
B. Primary closure
C. Proximal colostomy and bringing out the distal end as mucus fistula
D. Resection and primary anastomosis
Correct answer: C
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113 . In which case immunoguided surgery is done -
A. CA colon
B. CA pancreas
C. CA jejunum
D. CA anal canal
Correct answer: A
118 .Most commonly associated with high risk for carcinoma colon is ?
A. Peutz-Jegher syndrome
B. Juvenile Familial Polyposis
C. Familial Adenomatous Polyposis
D. Lynch syndrome
Correct answer: C
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120 . A three year old male child presents with history of constipation and
abdominal distension for the last two years. The plain radiograph of abdomen
reveals fecal matter containing distended bowel loops. A barium enema study done
subsequently shows a transition zone at the recta-sigmoid junction with reversal
of recta-sigmoid ratio. The most probable diagnosis is:
A. Anal atresia
B. Malrotation of the gut
C. Hirschsprung's disease
D. Congenital megacolon
Correct answer: C
121 . An elderly male presents with alteration of bowel habits, features of intestinal
obstruction along with hematochezia. Probable diagnosis is:
A. Tuberculosis
B. Diverticulosis
C. Ulcerative colitis
D. Colon carcinoma
Correct answer: D
124 . Which screening test for colon cancer is proven effective in RCT ?
A. Colonoscopy
B. Flexible Sigmoidoscopy
C. Occult blood in stool
D. Upper GI endoscopy
Correct answer: A
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126 . A 50 years female has not passed stools for the last 14 days. X-ray shows no
air fluid levels. Possible diagnosis is:
A. Aganglionosis of the colon
B. Paralytic ileus
C. Duodenal obstruction
D. Intestinal pseuda-obstruction
Correct answer: D
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133 . Following genetic counselling in a family for Familial polyposis coli(FPC)
next screening test is -
A. Occult blood in stools
B. APC gene
C. Flexible sigmoidoscopy
D. Colonoscopy
Correct answer: B
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140. Prolonged intake of refined foods leads to which of the following carcinoma
A.stomach
B.gall bladder
C.colon
D.pancreas
Correct answer C
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4 . All are true about appendix except:
A. Most malignancies are adenocarcinoma
B. Carcinoid is found in 0.5% cases of excised patients
C. Pseudomyxoma peritonei occurs following rupture of mucocele of appendix
D. Hot flush, diarrhea, and bronchospasm may occur
Correct answer: A
6 . Which of the following organisms produces signs and symptoms that mimic
acute appendicitis ?
A. Enteropathic E. coli
B. Enterobius vermicularis
C. Trichomonas hominis
D. Yersinia enetrocolitica
Correct answer: B
Imperforate anus
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2. Most common cause of death in imperforate anus is:
a. Toxemia.
b. Peritonitis.
c. Electrolyte imbalance.
d. Associated anomalies.
Correct answer: D
4. Lateral sphincterotomy:
a. ls better than posterior sphincterotomy.
b. ls usually curative.
c. Must be combined with fissurectomy in chronic fissures.
d. All of the above.
Correct answer: D
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6. Which of the following statements regarding anal fissure is false
a. It is most common in the posterior wall.
b. The common finding is a hypotonic anal sphincter.
c. Operation can be avoided in about 50 per cent of patients by the use of local agents
like glyceryl trinitrate (GTN) or Diltiazem.
d. The most important complication after lateral internal sphincterotomy is
incontinence, which may affect up to 30 per cent of patients.
Correct answer: C
9 . Which of the following is ideal for the treatment with injection of sclerosing
agents?
A. Internal hemorrhoids
B. External hemorrhoids
C. Strangulated hemorrhoids
D. Prolapsed hemorrhoids
Correct answer: A
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12- Which of the following is accurate about the treatment of internal
hemorrhoids by grade?
A- Surgery is often recommended as a first-line treatment for grade I internal
hemorrhoids.
B- Stapled hemorrhoid surgery is typically the initial treatment for grade II or II
internal hemorrhoids.
C- Significantly symptomatic grade III and grade IV hemorrhoids are best treated
with surgical hemorrhoidectomy.
D- Surgical consultation is typically unnecessary in grade IV internal hemorrhoids,
because in-office procedures are still the recommended choice.
Correct answer: C
14. Prolapsing piles that reduces spontaneously at the end of the act is of
which degree:
a. First degree.
b. 2nd degree.
c. 3rd degree.
d. 4th degree.
Correct answer: B
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18 . A thrombosed external hemorrhoid(or perianal hematoma) is -
A. Painless, with graduate onset
B. The 5 day, painful , self curing lesion
C. Part of internal hemorrhoids
D. A sentinel pile
Correct answer: B
19- The following statements about partial rectal prolapse are true except that it:
a. Consists of a double layer of mucous membrane.
b. ls commonest in elderly people.
c. ls often associated with poor sphincter tone.
d. ls rarely associated with hemorrhoids.
e. ls best treated by ligature-excision of prolapsing mucosa.
Correct answer: D
20-Which of the following statement(s) about complete rectal prolapse is/are true:
a- Rectal prolapse results from intussusception of the rectum and
rectosigmoid.
b- The disorder is more common in men thon in women.
c- Continence nearly always is recovered after correction of the prolapse.
d- All of the above ore true.
Correct answer: A
21- Sigmoid volvulus has been associated with each of the following except:
a. Chronic constipation and laxative abuse.
b. Chronic rectal prolapse.
c. Chronic traumatic paralysis.
d. Medical management of Parkinson's disease.
Correct answer: B
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24 . A 32 years patient presents with complete rectal prolapse, which of the
following procedure is associated with lowest risk of recurrence:
A. Thiersh Procedure
B. Delorme's Procedure
C. Altemier's Procedure
D. Abdominal Rectopexy
Correct answer: D
27. Which of the following is most accurate about the etiology and epidemiology
of hemorrhoids?
A-External hemorrhoids occur more commonly among older adults (>65 years) than
among young and middle-aged adults
B- Internal hemorrhoids often cause cutaneous pain because they are innervated by
cutaneous nerves.
C- Hemorrhoids have a male-to-female predilection of nearly 4:1.
D- Recognized risk factors associated with the development of hemorrhoids include
lack of erect posture, spinal cord injury, and episiotomy
Correct answer: D
28- Which of the following is an indication for complete colon evaluation in the
setting of symptomatic hemorrhoids and rectal bleeding, according to guidelines
from the American Society of Colon and Rectal Surgeons?
A- Age 45 years if no complete examination done within the past 5 years
B- Age 10 years older than the age of a single, first-degree relative with
adenocarcinoma diagnosed at younger than 50 years.
C- Age 10 years younger than the age of two first-degree relatives with colorectal
cancer.
D- Age older than 50 years, regardless of other factors, including negative fecal
immunochemical testing (FIT).
Correct answer: C
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29- Which of the following is most accurate about the workup of hemorrhoids?
A- Anoscopy is indicated for viewing internal hemorrhoids and should include use of
a side-viewing anoscope.
B- Proctoscopy is typically preferred to anoscopy as an initial investigation in patients
with suspected internal hemorrhoids.
C- Routine histologic examination of hemorrhoidal tissue is mandatory for diagnosis.
D- Anemia due to hemorrhoidal bleeding occurs in nearly half of all patients and
helps confirm diagnosis.
Correct answer: A
Cancer rectum
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4 . In lateral anal sphincterotomy, the following sphincter is divided -
A. Subcutaneous part of external sphincter
B. Deep part of external sphincter
C. Internal sphincter
D. Puborectalis sphincter
Correct answer: C
5 .The best acceptable operation for a rectal carcinoma at 5cm from the anal
verge is:
A. Abdominal perineal resection
B. Anterior resection
C. Local resection
D. Posterior resection
Correct answer: A
1. What is the management of a low, straight, 2cm long peri anal fistula.
A. Fistulectomy
B. Seton repair
C. Proximal colostomy
D. Anal dilatation
Correct answer A
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2 . A Toddler has few drops of blood coming out of rectum.Probable diagnosis is
A. Juvenile Rectal Polyp
B. Adenoid Polyposis Coli
C. Rectal Ulcer
D. Piles
Correct answer: A
1 . A patient gives chronic history of Diarrhea and blood in stool presents with
multiple fistulae in the perineum and multiple strictures in small intestine. The
diagnosis is-
A. Crohn's disease
B. Radiation enteritis
C. Ulcerative Colitis
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D. Ischemic bowel disease
Correct answer: A
2 . All of the following statements about Necrotizing fascitis are true, except
A. Most commonly caused by Group A beta hemolytic streptococci
B. Infection of fascia and subcutaneous tissue
C. Surgical debridement is Mandatory
D. Most common site is perineum followed by trunk and extremities
Correct answer: D
3 . Locate the renal stone with pain radiating to medial side of thigh and
perineum due to slipping of stone in males
A. At pelvic brim
B. Intramural opening of ureter
C. Junction of ureter and renal pelvis
D. At crossing of gonadal vessels and ureter
Correct answer: A
5 . Content of epiplocele is ?
A. Omentum
B. Intestine
C. Colon
D. Urinary bladder
Correct answer: A
6. A 79-year-old man has had abdominal pain for 4 days. An operation is performed,
and a gangrenous appendix is removed. The stump is inverted. Why does acute
appendicitis in elderly patients and in children have a worse prognosis?
(A) The appendix is retrocecal.
(B) The appendix is in the preileal position.
(C) The appendix is in the pelvic position.
(D) The omentum and peritoneal cavity appear to be less efficient in localizing the
disease in these age groups.
(E) The appendix is longer in these age groups
Correct answer: D
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8. All of the following conditions are derived from the primitive embryonic
foregut except:
A. Bronchogenic cyst.
B. Cystic adenomatoid malformation.
C. Gastric duplication.
D. Mesenteric cyst.
E. Pulmonary sequestration.
Correct answer: D
16- Hernia
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2. Which of the following statements about the causes of inguinal hernia is correct?
A. Excessive hydroxyproline has been demonstrated in the aponeuroses of hernia
patients.
B. Obliteration of the processes vaginalis is a contributing factor for the development
of an indirect inguinal hernia.
C. Physical activity and athletics have been shown to have a protective effect toward
the development of inguinal hernias.
D. Elevated levels of circulating serum elastalytic activity have been demonstrated in
patients with direct herniation who smoke.
E. The majority of inguinal hernias are acquired.
Correct answer: D
3. The following statements about the repair of inguinal hernias are true except:
A. The conjoined tendon is sutured to Cooper's ligament in the Bassini hernia repair.
B. The McVay repair is a suitable option for the repair of femoral hernias.
C. The Shouldice repair involves a multilayer, imbricated repair of the floor of the
inguinal canal.
D. The Lichtenstein repair is accomplished by prosthetic mesh repair of the inguinal
canal floor in a tension-free manner.
E. The laparoscopic transabdominal preperitoneal (TAPP) and totally extraperitoneal
approach (TEPA) repairs are based on the preperitoneal repairs of Cheattle, Henry,
Nyhus, and Stoppa.
Correct answer: A
4. Which of the following statements concerning the abdominal wall layers are
correct?
A. Scarpa's fascia affords little strength in wound closure.
B. The internal abdominal oblique muscles have fibers that continue into the scrotum
as cremasteric muscles.
C. The transversalis fascia is the most important layer of the abdominal wall in
preventing hernias.
D. The lymphatics of the abdominal wall drain into the ipsilateral axillary lymph
nodes above the umbilicus and into the ipsilateral superficial inguinal lymph nodes
below the umbilicus.
Correct answer: ABCD
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6. The following statement(s) is/are true concerning the indications for treatment of an
inguinal hernia.
a. Most adult hernias will remain stable in size, therefore, delay seldom affects the
technical aspects of a surgical repair
b. There is a direct correlation between the length of time that a hernia is present and
the risk of major complications
c. The morbidity and mortality associated with emergent operation due to hernia
complications is significantly greater than for elective repair of the identical hernia
d. A truss maintains a hernia in the reduced state, therefore, minimizing the risk of
incarceration and strangulation
Correct answer: b, c
7. Which of the following statement(s) is/are true concerning the diagnosis and
management of epigastric hernias?
a. A large peritoneal sac containing abdominal viscera is common
b. At the time of surgical repair, a careful search for other defects should be
performed
c. Recurrent epigastric hernias after simple closure is uncommon
d. Patients with symptoms of a painful midline abdominal mass frequently will
contain incarcerated small bowel
Correct answer: b
10. Which of the statement(s) is/are true concerning laparoscopic hernia repair?
a. General anesthesia is required
b. Either an abdominal or preperitoneal approach is possible
c. The use of prosthetic mesh is required in all variations
d. Long-term results suggest that the laparoscopic approach is equal or better than
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traditional repairs
Correct answer: a, b, c
11. Which of the following statement(s) is/are true concerning repair of inguinal
hernias?
a. The Bassini repair approximates the transversus abdominis aponeurosis and
transversalis fascia and the shelving edge of the inguinal ligament.
b. The Bassini repair is an adequate repair for a femoral hernia
c. A relaxing incision is important for repairs of direct and large indirect inguinal
hernias to prevent excessive tension in the closure
d. An advantage to the use of prosthetic material is the mesh incites formation of scar
tissue to further increase tensile strength provided by the mesh alone
Correct answer: a, c, d
12. The following statement(s) is/are true concerning the epidemiology of inguinal
hernias.
a. Inguinal hernias occur with a male-ta-female ratio of about 7:1
b. Femoral and umbilical hernias are more common in women, with a female-ta-male
ratio of 4:1
c. The frequency of inguinal hernias increases with age
d. Almost all umbilical hernias occur in the pediatric age group
Correct answer: a, c
13. The following statement(s) is/are true concerning umbilical hernias in adults.
a. Most umbilical hernias in adults are the result of a congenital defect carried into
adulthood
b. A paraumbilical hernia typically occurs in multiparous females
c. The presence of ascites is a contraindication to elective umbilical hernia repair.
d. Incarceration is uncommon with umbilical hernias
Correct answer: b
14. The following statement(s) is/are true concerning the anterior abdominal wall
musculature.
a. The lateral musculature of the abdominal wall consists of three muscle layers.
These are, from external to internal, the external oblique, the transversus abdominis,
and the internal oblique muscles
b. The transversalis fascia lies on the deep side of the transversus muscle and extends
to form an essentially complete fascial envelope of the abdominal cavity
c. Above the semicircular line, the internal oblique aponeurosis splits into posterior
and anterior laminae
d. The rectus abdominis muscles originate on the ribs superiorly and on the pubis
inferiorly and are clearly distinct throughout their entire length
Correct answer: b, c
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c. Vigorous attempts at reduction of an incarcerated hernia may result in reduction en
masse with continued entrapment and possible progression to obstruction or
strangulation
d. Incarcerated hernias frequently cause both small and large bowel obstruction
Correct answer: b, c
16. A careful history is necessary in all patients being considered for inguinal hernia
repair. Symptoms which deserve investigation and appropriate treatment prior to
proceeding with inguinal hernia repair include:
a. Chronic cough
b. Urinary hesitancy and straining
c. Change in bowel habit
d. A specific episode of muscular straining with associated discomfort
Correct answer: a, b, c
17. The following statement(s) is/are true concerning abdominal incisional hernias.
a. Large incisional hernias are associated with a high recurrence rate when closed
primarily
b. A large potential space remains anterior to the abdominal wall closure in most
patients indicating a need for postoperative wound drainage
c. The use of prosthetic mesh can often be avoided by employing relaxing incisions in
the anterior fascia parallel to the midline
d. Incisional hernias are frequently associated with a tissue deficit either due to
chronic retraction and scarring or the result of tissue necrosis from either infection or
tension at the initial closure
Correct answer: a, b, c, d
18. Which of the following structures are derived from the external oblique muscle
and its aponeurosis?
a. The inguinal or Poupart’s ligament
b. The lacunar ligament
c. The superficial inguinal ring
d. The conjoined tendon
Correct answer: a, b, c
19. A number of special circumstances exist in the repair of inguinal hernias. The
following statement(s) is/are correct.
a. Simultaneous repair of bilateral direct inguinal hernias can be performed with no
significant increased risk of recurrence
b. The preperitoneal approach may be appropriate for repair of a multiple recurrent
hernia
c. A femoral hernia repair can best be accomplished using a Bassini or Shouldice
repair
d. Management of an incarcerated inguinal hernia with obstruction is best approached
via laparotomy incision
Correct answer: b
20. Which of the following statements about acute salpingitis are true?
A. The disease rarely occurs after menopause.
B. Gonococcal infection is most common.
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C. There is minimal cervical tenderness to palpation.
D. Vaginal discharge occurs rarely.
Correct answer: AB
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27. Which of the following is not true in relation to strangulated hernias?
a. They present with local and then generalized abdominal pain and vomiting.
b. A normal hernia can strangulate at any time.
c. This is more common in femoral hernia.
d. They can be reliably excluded in irreducible hernias on clinical examination.
e. They require urgent surgery.
Correct answer: D
28. Regarding the anatomy of the inguinal canal, which of the following are true?
a. In infants the internal and external rings are almost superimposed.
b. The inferior epigastric vessels lie posterior and lateral to the internal ring.
c. The inguinal canal is about 10 cm long and is directed downwards, medially and
forwards.
d. The internal ring is a U-shaped opening in the external oblique aponeurosis 1.25 cm
above the mid-inguinal point.
Correct answer: A
29. Which of the following are true about a sliding inguinal hernia?
a. It is common in men.
b. It should be suspected clinically in small hernias confined to the inguinal canal.
c. It is more common in the young patient.
d. It is impossible to control with a truss, and hence an operation is indicated.
Correct answer: D
30. Which of the following statement regarding a femoral hernia are true?
a. The femoral canal occupies the most lateral component of the femoral sheath.
b. It can be easily controlled by truss.
c. Strangulation is the initial presentation in 40 per cent of patients.
d. An operation is only occasionally required.
Correct answer: D
31. Which of the following statements are true regarding umbilical hernia?
a. Men are affected more frequently than women.
b. Irreducibility is common due to omental adhesions.
c. Mayo’s operation involves mesh repair of the hernia.
d. Infantile umbilical hernias need immediate surgery.
Correct answer: C
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e. Orchidopexy reduces the chances of developing a testicular tumour.
Correct answer: E
36- The following are True about the inguinal canal EXCEPT:
a. It is a 4 cm tunnel in the lower abdominal muscles.
b. It contains spermatic cord in males and Round ligament in female.
c. The floor is formed by the inguinal ligament and the roof is formed by conjoint
tendon.
d. Boundaries include external oblique muscle posterior and fascia transversalis
anteriorly.
Correct answer: D
37- Following organs can be found within the hernia sac EXCEPT:
a) Colon.
b) Ovary.
c) Urinary Bladder.
d) Prostate.
Correct answer: D
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c) Portion of the Urinary Bladder in the sac.
d) Omentum in the sac
Correct answer: B
41- All the following are True when the sac content in omentum EXCEPT:
a) Doughy in consistency.
b) Gives No gurgling sensation.
c) Dull on percussion.
d) Reduced by difficulty in Beginning.
Correct answer: D
43- Injury of the ilia-inguinal nerve during hernia repair can cause:
a) Direct hernia due to paralysis of conjoint tendon.
b) Loss of erectile function.
c) Numbness of the scrotum and medial aspect of the upper thigh.
d) Testicular dragging pain.
Correct answer: C
46- All of the following is True about the clinical picture of the oblique hernia
EXCEPT:
a) The swelling increase in size with cough.
b) Giving gurgling sensation during reduction
c) Can reach the scrotum.
d) Direction of the reduction is "backward"
Correct answer: D
47- About the internal ring test, all are true EXCEPT:
a) Can differentiate between indirect, direct and femoral hernia.
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b) Not usually done.
c) Oblique hernia does not come out except after thumb release.
d) The test starts by asking the patient to reduce hernia.
Correct answer: A
50- Regarding the direct hernia, all the following are true EXCEPT:
a) Neck of the sac is Medical to the inferior epigastric a.
b) The sac is within the cord including its contents.
c) Usually accuse in elderly and > 50 % is bilateral.
d) Un-commonly complicated.
Correct answer: B
54- The most common type of hernia liable for strangulation is:
a) Incisional.
b) Para-umbilical.
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c) Femoral.
d) Direct.
Correct answer: C
55- The commonest hernia type that can be seen strangulated is:
a) Incisional
b) Inguinal.
c) Para-umbilical.
d) Femoral.
Correct answer: B
56- The pathological sequence of the strangulated hernia includes all of the following
except:
a) Impeded venous return.
b) Intestinal Obstruction.
c) Impaired arterial blood flow.
d) Gangrene.
Correct answer: B
57- During the hernial repair, all the following are "wrong" except:
a. Viable intestine is returned back to the abdomen.
b. The omentum never to be excised.
c. The mesh should be applied to cover the cord.
d. Herniorrhaphy should be performed with good tension.
Correct answer: A
58- The ONLY cause of lost expansile impulses on cough during hernia examination
is:
a) Irreducible hernia.
b) Obstructed hernia.
c) Strangulated hernia.
d) Retrosternal goiter.
Correct answer: C
59- The synthetic material used in herniopalsty is:
a) Prolene mesh
b) Vicryl mesh
c) Double faced mesh
d) Silk mesh
Correct answer: A
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61. Which of the following are more common in multiparous women?
a. Indirect inguinal hernia
b. Lumbar hernia
c. Umbilical
d. Direct inguinal hernia
Correct answer: C
64. Regarding the anatomy of the inguinal canal, which of the following are true?
a. In infants the internal and external rings are almost superimposed.
b. The inferior epigastric vessels lie posterior and lateral to the internal ring.
c. The inguinal canal is about 10 cm long and is directed downwards, medially and
forwards.
d. The internal ring is a U-shaped opening in the external oblique aponeurosis 1.25 cm
above the mid-inguinal point.
Correct answer: A
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b. Men are affected more frequently than women.
c. Mayo’s operation involves mesh repair of the hernia.
d. Infantile umbilical hernias need immediate surgery.
Correct answer: A
Inguinal hernia.
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3 . False regarding Bochdalek hernia is -
A. Spleen and kidney can herniate
B. Occurs posterolateral
C. Always occurs on right side
D. Hernia may or may not have sac
Correct answer: C
4. Inter parietal hernia at the level of arcuate line and lateral border of rectus is called
A. Spigelian hernia
B. Lumbar hernia
C. Richter's hernia
D. Epigastric hernia
Correct answer: A
8 . A patient operated for direct inguinal hernia developed anethesia at the root of the
penis and adjacent part of the scrotum the nerve likely to be injured is:
A. Genital br. of genitofemoral nerve (supply dartos muscle)
B. Femoral br. of genitofemoral nerve
C. Iliohypogastric nerve
D. Ilioinguinal nerve
Correct answer: D
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10 . All should be done in a case of strangulated inguinal hernia except:
A. Abdominal x-ray
B. IV fluids for resuscitation
C. Needle aspiration for diagnosis
D. Immediate surgery
Correct answer: C
12. During repair of indirect inguinal hernia, while releasing the constriction at the deep
inguinal ring,the surgeon takes care not to damage one of the following structures
A. Flax inguinalis (conjoint tendon)
B. Interfoveolar ligament
C. Inferior epigastric artery
D. Spermatic cord
Correct answer: C
13 . The person whose work on the radical cure of hernia immortalized his name was -
A. William Halsted
B. Eduardo Bassini
C. Kocher
D. Koontz
Correct answer: B
Femoral
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C. 7th day
D. 9th day
Correct answer: C
17- Scrotum
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6-The main disadvantage of palomo operation is:
a. Testicular artery injury.
b. High recurrence.
c. Hernia formation.
d. lnjury to vas.
Correct answer: B
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Correct answer: D
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3. Which of the following statements is/are true of infants with gastroschisis?
A. It is associated with malrotation.
B. There is a high incidence of associated anomalies.
C. There is prolonged adynamic ileus following repair.
D. It is complicated by intestinal atresia in 10% to 12% of cases.
E. It is associated with chromosomal syndromes.
Correct answer: ACD
5. Which of the following statements are true regarding the premature neonate?
A. A 15% to 20% right-ta-left shunt occurs across the foramen ovale and patent
ductus arteriosus.
B. Surfactant levels are normal after 30 weeks' gestation.
C. Fluid requirements are higher than in a full-term baby.
D. Rectal temperature is the best indicator of core body temperature.
E. They are more at risk for infection than the full-term infant.
Correct answer: ACE
7. The treatment of choice for neonates with uncomplicated meconium ileus is:
A. Observation.
B. Emergency laparotomy, bowel resection, and Bishop-Koop enterostomy.
C. Intravenous hydration and a gastrograffin enema.
D. Emergency laparotomy, bowel resection, and anastomosis.
E. Sweat chloride test and pancreatic enzyme therapy.
Correct answer: C
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E. Ectopia cordis.
Correct answer: D
9. In infants with duodenal atresia all the following statements are true except:
A. There is an increased incidence of Down syndrome.
B. Duodenal atresia can be detected by prenatal ultrasound examination.
C. It may occur in infants with situs inversus, malrotation, annular pancreas, and
anterior portal vein.
D. It is best treated by gastroenterostomy.
E. There is a high incidence of associated cardiac defects.
Correct answer: D
10. The initial treatment of choice for a 2.5-kg. infant with a 20.0-cm. long
proximal jejunal atresia and 8.0 cm. of distal ileum is:
A. Laparotomy, nasogastric suction, proximal dilatation to lengthen the atretic
jejunum, total parenteral nutrition, and delayed anastomosis.
B. Laparotomy and proximal end-jejunostomy.
C. Laparotomy and immediate small bowel transplantation.
D. Laparotomy and double-barrel enterostomy (jejunum and ileum), with refeeding of
jejunal contents into distal ileum and delayed anastomosis.
E. Laparotomy, tapering jejunoplasty, and end-ta-oblique jejunoileal anastomosis.
Correct answer: E
12. Neonates with NEC may demonstrate all of the following findings on
abdominal films except:
A. Pneumatosis intestinalis.
B. Portal vein air.
C. Pneumoperitoneum.
D. Colovesical fistula.
E. Fixed and thickened bowel loops.
Correct answer: D
13. The most common type of congenital diaphragmatic hernia is caused by:
A. A defect in the central tendon.
B. Eventration of the diaphragm in the fetus.
C. A defect through the space of Larrey.
D. An abnormally wide esophageal hiatus.
E. A defect through the pleuroperitoneal fold.
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Correct answer: E
16. For a 22-kg infant, the maintenance daily fluid requirement is approximately
which of the following?
a. 1100 ml
b. 1250 ml
c. 1550 ml
d. 1700 ml
e. 1850 ml
Correct answer: c
18. A term infant 48 hours of age suddenly develops hypoxemia, irritability, and
glucose and temperature instability. Which of the following statements are true?
a. Empiric antibiotic coverage for b-hemolytic Streptococci and Escherichia coli
should be initiated
b. An intravenous infusion of prostaglandin E1 should be initiated immediately
c. Exogenous surfactant should be given immediately
d. The mortality rate for this child is approximately 50%
Correct answer: a, d
19. Which of the following statements about pulmonary surfactant are true?
a. Endogenous surfactant deficiency is the key physiologic problem in preterm infants
with the infant respiratory distress syndrome
b. Surfactant function can be restored to normal using aerosolized
phosphatidylcholine administration
c. Exogenous surfactant replacement has been shown to reduce mortality in preterm
infants with the infant respiratory distress syndrome
d. Surfactant is produced by Type I alveolar epithelial cells
Correct answer: a, c
20. Which of the following statements regarding premature infants are true?
a. Complications of prematurity account for approximately 85% of fetal deaths
b. Prematurity is defined by the World Health Organization as birth prior to 35 weeks
gestation
c. Infants with intrauterine growth retardation have physiologic problems which are
more dependent on the birth weight than the gestational age
d. Preterm infants are at increased risk for hypocalcemia and hypoglycemia when
compared to term infants
Correct answer: a, d
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21. Other than the history and physical exam, which of the following tests is
considered an essential feature of the preoperative evaluation of a patient with a
suspected thyroglossal duct cyst?
a. Cervical ultrasound
b. Thyroid scan
c. Serum T3 and T4 levels
d. Needle aspiration
e. None of the above
Correct answer: e
23. Branchial cleft remnants most often present with which of the following
clinical problems?
a. Infection
b. Airway obstruction
c. Hemorrhage
d. Malignant degeneration
e. Pain
Correct answer: a
24. Proximity to which of the following structures places it at risk during surgical
excision of a second branchial cleft remnant?
a. Internal carotid artery
b. External carotid artery
c. Hypoglossal nerve
d. All of the above
e. None of the above
Correct answer: d
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physiologic consequence of pulmonary hypoplasia
d. Survival rates of 75% are reported in several contemporary series
e. Congenital heart disease is present in approximately 20% of these infants
Correct answer: b, d, e
28. Infants with a double aortic arch most commonly present with which of the
following problems?
a. Dysphagia
b. High output cardiac failure related to a patent ductus arteriosus
c. Positional hyperemia and edema of the right upper extremity
d. Symptomatic tracheal compression
Correct answer: d
29. Which of the following is most common after primary esophagostomy for
esophageal atresia with a distal tracheoesophageal fistula?
a. Anastomotic leak
b. Esophageal stricture
c. Recurrent tracheoesophageal fistula
d. Gastroesophageal reflux
e. Tracheomalacia requiring aortopexy
Correct answer: d
30. Which of the following is the most common primary lung tumor in infants
and children?
a. Pulmonary blastoma
b. Squamous cell carcinoma
c. Endobronchial carcinoid
d. Leiomyoma
e. Metastatic osteogenic sarcoma
Correct answer: c
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32. The definitive evaluation of a child with a suspected congenital cystic
abnormality of the tracheobronchial tree is best done using which of the
following?
a. Rigid bronchoscopy
b. Computerized tomography or magnetic resonance imaging
c. Chest x-ray
d. Angiography
e. Barium esophagogram
Correct answer: b
33. A newborn infant develops coughing, choking and cyanosis with his first
feeding. He is noted to have excessive drooling. What are the important
associated anomalies that must be screened for prior to surgical intervention?
a. Right-sided aortic arch
b. Hydrocephalus
c. Genitourinary obstruction
d. Congenital heart disease
Correct answer: c
34. Which of the following ventilation strategies is the best initial approach for a
neonate with a left congenital diaphragmatic hernia and the following post
ductal arterial blood gases: PaO2 50 mm Hg, PaCO2 60 mm Hg, pH 7.35?
a. High-frequency jet ventilation
b. Permissive hypercapnia with convential pressure controlled ventilation
c. Extracorporeal membrane oxygenation (ECMO)
d. Induced respiratory alkalosis
e. Inhaled nitric oxide with conventional volume controlled ventilation
Correct answer: b
35. There is an emerging consensus that the surgical repair for congenital
diaphragmatic hernia is best done:
a. Emergently at the bedside, eliminating the risks of transporting an unstable neonate
b. While on extracorporeal membrane oxygenation
c. When the infant is potentially extubatable
d. Within the first 48 to 72 hours of life
Correct answer: c
36. Meckel’s diverticulum may present with which of the following signs or
symptoms?
a. Hemorrhage
b. Intussusception
c. Volvulus
d. Patent omphalomesenteric duct
e. Right lower quadrant peritoneal findings
Correct answer: a, b, c, d, e
37. A 3-week old infant has a barium upper gastrointestinal series to evaluate
vomiting. The duodenojejunal flexure is found to be to the right of the midline as
well as more caudal and anterior than a normal ligament of Treitz. The child is
seen to reflux barium spontaneously to the level of the mid-thoracic esophagus.
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You would recommend which of the following?
a. Barium enema
b. Emergency laparotomy
c. A trial of H2, blockade and cisapride therapy
d. Upper gastrointestinal endoscopy
e. Overnight pH probe analysis
Correct answer: b
38. Which of the following statements regarding duodenal atresia are true?
a. 20% to 40% of these infants have Trisomy 21
b. When associated with an annular pancreas, division of the pancreas at the site of
obstruction is curative
c. Bilious vomiting is typical because the obstruction is usually distal to the ampulla
of Vater
d. Reconstruction is best achieved with Roux-en-Y duodenojejunostomy
Correct answer: a, c
41. Which of the following’s statements regarding an infant with meconium ileus
are true?
a. The probability is 100% that he will have cystic fibrosis
b. Nonoperative therapy resolves this problem in approximately twa-thirds of patients
c. The average life expectancy is approximately 26 to 28 years for this infant at
present
d. The finding illustrated below on plain film is an absolute operative indication
Correct answer: a, b, c, d
42. You are asked to recommend therapy for an asymptomatic 2 year old who
swallowed a small alkaline watch battery 4 hours Aga. A plain film shows the
intact battery in the intestine beyond the stomach. The best course of therapy is?
a. Immediate laparotomy, enterotomy and removal of the battery
b. Enteroscopy with extraction
c. Laparoscopy with ultrasound localization and extraction
d. Cathartics and a follow-up plain film in 48 hours if the child remains asymptomatic
Correct answer: d
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44. Of the following, which is the most likely cause of hemodynamically
significant lower gastrointestinal bleeding in a 6-month-old male child?
a. Meckel diverticulum
b. Henoch-Schonlein purpura
c. Intussusception
d. Crohn’s colitis
e. Hemolytic uremic syndrome
Correct answer: a, c
45. Which of the followings statement regarding Hirschprung’s disease are true?
a. Suction rectal biopsy is virtually always diagnostic if the specimen includes
submucosa
b. Hirschprung’s disease is the result of a sex linked dominant gene
c. The endorectal pullthrough is demonstrably superior to other forms of surgical
construction
d. Ninety percent or more of patients have an excellent or good functional result
following reconstructive surgery
e. The important cause of mortality in contemporary practice is enterocolitis
Correct answer: a, d, e
46. The operative procedure of choice for managing the most common type of
choledochal cyst is which of the following?
a. Cyst gastrostomy
b. Cyst jejunostomy
c. Excision with Roux-en-Y hepaticojejunostomy
d. Transduodenal marsupialization
e. Endoscopic sphincterotomy
Correct answer: c
49. The most common cause of acute pancreatitis in childhood is which of the
following?
a. Pancreas divisum
b. Cholelithiasis
c. Trauma
d. Valproic acid
e. Annular pancreas
Correct answer: c
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Correct answer: B
52 . A 21 years old patient attended a party the previous night and gives the
following symptoms. pain in abdomen radiating to back, pulse 100/min, BP
100/76 . temp 39 degree C and vomiting before coming Most probable dx is:
A. Acute appendicitis
B. Acute cholecystitis
C. Acute diverticulitis
D. Acute pancreatitis
Correct answer: D
57 . All of the following can be used to predict severe acute pancreatitis except -
A. Glassow score33
B. APACHE II39
C. CT severity36
D. C-reactive protein < 100
Correct answer: D
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C. Pseuda-cyst occurs in the first week after the attack
D. Abdominal pain is uncommon
Correct answer: A
61 . Which of the following does not correct with severity of acute pancreatitis -
A. Serum Glucose
B. Serum amylase
C. Serum calcium
D. AST
Correct answer: B
62 .Factors that produce acute pancreatitis include all of the following except -
A. Alcohol
B. Hypercalcemia of parathyroid origin
C. Gall stones
D. Hemochromatosis
Correct answer: D
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51. Which of the following are typical causes of neonatal intestinal obstruction?
a. Intussusception
b. Meconium ileus
c. Hirschsprung’s disease
d. Meckel’s diverticulum
e. Incarcerated hernia
Correct answer: b, c, e
53. At what age is surgical orchiopexy recommended for a child with a unilateral
undescended testis?
a. Promptly upon discovery, regardless of age
b. 1 year
c. 5 to 6 years
d. Any time prior to puberty
Correct answer: b
55. The medical indications for circumcision include which of the following?
a. Infants with a history of urinary tract infection
b. Hypospadias
c. Phimosis
d. Enuresis
e. Vesicoureteral reflux
Correct answer: a, c, e
57. Which of the following are considered low risk features for neuroblastoma
patients?
a. Age less than one year
b. Stage 2A and 2B disease (International Staging Criteria)
c. Stage 4S disease (International Staging Criteria)
d. Neuron specific enolase plasma level less than 100 ng/ml
e. None of the above
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Correct answer: a, b, c, d
58. A one month old female infant is brought to you for evaluation of afriable
polypoid mass prolapsing through the vaginal introitus. Your presumptive
diagnosis is which of the following?
a. Ectopic ureterocele
b. Rectal prolapse
c. Congenital adrenal hyperplasia with ambiguous genitalia
d. Embryonal rhabdomyosarcoma
Correct answer: d
59. Which of the following approaches is considered standard care for most
Wilms’ tumor patients today?
a. Adriamycin and vincristine therapy followed by surgical resection
b. Needle biopsy followed by either chemotherapy or resection depending upon the
histology
c. Primary surgical resection followed by chemotherapy
d. Radiation therapy if judged unresectable on CT or MRI imaging
Correct answer: c
61. Patients with Wilms’ tumors most frequently present with which of the
following?
a. Bilateral metachronous lesions
b. Bilateral synchronous lesions
c. An extrarenal primary
d. A multicentric primary lesion
e. A unifocal, unilateral lesion
Correct answer: e
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64. Which of the following statements regarding renal tumors of childhood and
adolescence are true?
a. Clear cell sarcoma is presently considered a variant of Wilms’ tumor with a poor
prognosis
b. Clear cell sarcoma of the kidney has a high rate of metastasis to bone
c. Rhabdoid tumors may arise in the kidney, mediastinum or brain
d. Childhood rhabdoid tumors of the kidney carry an excellent prognosis
Correct answer: b, c
65. Which of the following syndromes are associated with the development of
Wilms’ tumor?
a. Beckwith-Wiedemann Syndrome (hemi-hypertrophy, macroglossia, aniridia)
b. Neurofibromatosis
c. Denys-Drash syndrome (pseudo hermaphroditism, glomerulopathy)
d. Gonadal dysgenesis
e. Hemolytic uremic syndrome
Correct answer: a, b, c, d
66. In meconium aspiration syndrome all of the following are true except .
A.There is always respiratory distress
B. Steroids are not useful
C. Extracorporeal membrane oxygenation (ECMO) may be useful
Correct answer A
68. At what age a child is able to state correctly his name and sex .
A.24months
B.36months
C.30months
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D.42months
Correct answer A?
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79 . 4 years old female child with bone mets and abdominal mass - seen in -
A. Neuroblastoma
B. Wilms tumour
C. Dysgerminoma ovary
D. Burkitt's
Correct answer: A
80 . A new born girl not passed meconium for 48 hours, has abdominal
distension and vomiting. Initial investigation of choice would be -
A. Genotyping for cystic fibrosis
B. Manometry
C. Serum trypsin immunoblot
D. Lower GI contrast study
Correct answer: D
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(b) Are more common on the right than the left
(c) Are rarely associated with other congenital anomalies
(d) Present with respiratory distress in the neonatal period
(e) Neonates usually require sedation, ventilation and intestinal decompression prior
to surgery
Correct answer: a , d , e are true .
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B. Choledochal cyst
C. ileal atresia
D. Pyloric stenosis
Correct answer: D
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98 . In pyloric stenosis, which one occurs:
A. Hypokalemic metabolic acidosis
B. Hyperchloremic metabolic acidosis
C. Hyperkalemic metabolic alkalosis
D. None
Correct answer: D
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acetylcholinesterase in the aganglionic segment
(e) Early treatment may involve rectal irrigation or an emergency colostomy
Correct answer: a , b , e are true .
105. Which of the following statements about Hirschsprung's disease is/are true?
A. There are no ganglion cells seen in Auerbach's plexus.
B. There is an increased incidence of Down syndrome.
C. It is more common in girls.
D. It may be associated with enterocolitis.
E. It may involve the small intestine.
Correct answer: ABDE
106. Which of the following statements is/are true of infants with gastroschisis?
A. It is associated with malrotation.
B. There is a high incidence of associated anomalies.
C. There is prolonged adynamic ileus following repair.
D. It is complicated by intestinal atresia in 10% to 12% of cases.
E. It is associated with chromosomal syndromes.
Correct answer: ACD
108. Which of the following statements are true regarding the premature
neonate?
A 15% to 20% right-ta-left shunt occurs across the foramen oval and patent ductus
arteriosus.
B. Surfactant levels are normal after 30 weeks' gestation.
C. Fluid requirements are higher than in a full-term baby.
D. Rectal temperature is the best indicator of core body temperature.
E. They are more at risk for infection than the full-term infant.
Correct answer: ACE
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110. A male infant weighing 3 kg is born via spontaneous vaginal delivery at 37
weeks gestation. His Apgar score is 6/9 at 1 and 5 minutes. The patient is in no
apparent distress. Physical examination reveals no anus. What is the most
appropriate initial step in this patient’s management?
(A) Colostomy
(B) Continued observation for 24 hours
(C) Intubation and mechanical ventilation
(D) Magnetic resonance imaging (MRI) of the abdomen and pelvis
(E) Posterior sagittal anorectoplasty
Correct answers : (B)
ii. The patient undergoes pyloromyotomy. During the procedure, a deep mucosal
injury is noted at the distal aspect of the incision. How should this patient’s mucosal
injury be managed?
(A) Closure of the mucosal defect with the myotomy intact
(B) Closure of the mucosal and muscular defects with repeat myotomy at a later date
(C) Closure of the mucosal and muscular defects with repeat myotomy on another
side of the pylorus
(D) Wide local drainage and antibiotics
(E) Wide local drainage, antibiotics, and 10 to 14 days of postpyloric tube feeding
correct answers: C
112. A previously healthy 5-year-old girl presents to the ED with her parents
with a temperature of 100.8°F (38.2°C) and a 2-day history of decreased appetite
and persistent vague abdominal pain with tenderness in the mid-abdomen and
right lower quadrant. Her parents report that she has had no appetite and felt
nauseous but has not vomited. Laboratory results are unremarkable except for a
white blood cell count of 16,000 cells/mL (normal, 4500– 11,000 cells/mL).
Ultrasound of the abdomen and pelvis is inconclusive, and the patient is admitted
to the hospital for observation. Eighteen hours into her hospital stay, she passes
copious amounts of bloody stool. She remains hemodynamically stable with
normal vital signs and no change in her abdominal pain. What is this patient’s
most likely diagnosis?
A) Appendicitis
(B) Colonic arteriovenous malformation
(C) Colonic diverticulitis
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(D) Gastric stress ulcer
(E) Meckel’s diverticulitis
correct answers: E
114. A 1-day-old male infant has been intolerant of oral feeds and is vomiting.
The vomitus sometimes appears bile-colored. On examination, the patient’s
abdomen is mildly distended and somewhat tympanitic but is nontender to
palpation. A radiograph is performed in the following figure. What is this
patient’s most likely diagnosis?
(A) Annular pancreas
(B) Duodenal atresia
(C) Intestinal malrotation
(D) Jejunoileal atresia
(E) Pyloric stenosis
correct answers : B
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20- X-rays
5. The most common neurologic abnormality that occurs with head injury is -
A. Hemiplegia
B. Ocular verve palsy
C. Altered consciousness
D. Convulsions
Correct answer: C
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21- Jars and surgical pathology
Rectal examination
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Uretheral catheterization
3 . Chronic urethral obstruction due to benign prostatic hypertrophy can lead to the
following change in the kidney parenchyma -
A. Hyperplasia
B. Hypertrophy
C. Atrophy
D. Dysplasia
Correct answer: C
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7 . All are true about bulbar urethral rupture, except -
A. Perineal hematoma
B. Floating prostate on per rectal examination
C. Collecting of urine in perineum
D. Bleeding per urethra
Correct answer: B
8 . Which of the following is the most common site of urethral carcinoma in men?
A. Prostatic urethra
B. Fossa Navicularis
C. Bulb membranous urethra
D. Penile urethra
Correct answer: C
Nasogastric tube
Vascular acess
Bronchogenic carcinoma
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Correct answer: D
8. A 60-year-old man with known squamous cell cancer of the lung presents to the
clinic for a follow-up appointment with complaints of dyspnea on exertion. The
patient has completed 3 cycles of cisplatin and gemcitabine. Surveillance
computed tomography (CT) scan of the thorax performed 2 days prior indicates a
stable 2-cm right lower lung lesion, a stable 1-cm right mediastinal lymph node,
and a new moderate-sized right pleural effusion. The patient subsequently
undergoes a right thoracentesis, which yields an exudative effusion with cytology
positive for squamous cells. Which of the following is the patient’s current stage
of disease?
A) Stage IIA
(B) Stage IIB
(C) Stage IIIB
(D) Stage IV
Correct answer: C
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10. A 13-year-old was referred to you with a chest mass. Following biopsy of
the mass the pathologist tells you that this is a small round blue cell tumor and
that immunostains are positive for neuron-specific enolase, synaptophysin, and
vimentin. Which of the following findings is most likely present in the tumor cells?
A. t(2;13)(q35;q14)
B. t(11;22)(q24;q12)
C. Ring chromosome
D. N-MYC amplification
E. t(X;18)(p11;q11)
Correct answer is B.
11. A 13-year-old was referred to you with a chest mass. Following biopsy of
the mass, the pathologist tells you that this is a small round blue cell tumor and
that immunostains are positive for neuron-specific enolase, synaptophysin, and
vimentin. Which of the following findings is most likely present in the tumor cells?
A. t(2;13)(q35;q14)
B. t(11;22)(q24;q12)
C. Ring chromosome
D. N-MYC amplification
E. t(X;18)(p11;q11)
Correct answer is B
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4 . Chest drain insertion is safest when performed -
A. In the apex of the chest for pneumothorax
B. In the base of the chest for hemothorax
C. In the 'triangle of safety' on the anterolateral chest wall
D. With the smallest bore chest tube available
Correct answer: C
5 . Most common site for putting chest drain in case of pleural effusion
A. 2nd intercostal space midclavicular line
B. 7th intercostal space midaxillary line
C. 5th I.C. space mid clavicular line
D. 5th I.C. space just lateral to vertebral column
Correct answer: B
Chest trauma
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5. Open chest wounds are characterized by the following except that they:
a. May cause "pendulum respiration".
b. May produce "mediastinal flutter.
c. May be associated with abdominal injuries.
d. Need immediate sealing of the wound.
e. Always require thoracotomy for definitive treatment.
Correct answer: E
6 . A man presented with fractures of 4th to 10th ribs and respiratory distress after
a Road Traffic Accident (RTA). He is diagnosed to have flail chest and a Pa O2 of
<60%, management is:
A. Tracheostomy
B. IPPV with oral intubation
C. Fixation of ribs
D. Strapping of chest
Correct answer: B
7 . A 50 year old smoker male presents with pain along the left arm and ptosis.
His chest radiograph shows a soft tissue opacity at the left lung apex with
destruction of adjacent ribs. The picture is suggestive of:
A. Adenocarcinoma lung
B. Bronchial carcinoid
C. Pancoast tumour
D. Bronchoalveolar carcinoma
Correct answer: C
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11. As regards pathology of hemothorax all are correct except:
a- Blood always coagulates completely
b- Blood is defibrinated by continuous diaphragmatic motion
c- Hemothorax can result in large hydrothorax by transudation
d- lt can be complicated by fibrothorax or emphysema
Correct answer: A
15. The main line of treatment in closed pneumothorax without mediastinal shift
is:
a- Chest tube
b- Mechanical ventilation
c- Needle aspiration
d- Conservative treatment
Correct answer: D
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18. Circulatory failure in open pneumothorax is due to the following except:
a- Mediastinal flutter
b- Exaggerated negativity of intrathoracic pressure
c- Associated great vessel injury
d- Diminished cardiac function due to respiration failure
Correct answer: B
19. All of the following are differential diagnoses for sudden chest pain without
shock except:
a- Tension pneumothorax
b- Massive pulmonary embolism
c- Massive myocardial infarction
d- Flail chest
Correct answer: D
21. The following statements about spontaneous pneumothorax are true except
that it :
A. May occur in the absence of any pulmonary lesion.
B. is readily diagnosed clinically.
C. Usually resolves spontaneously.
D. May require intercostal catheter drainage.
E .Usually requires exploratory thoracotomy.
Correct answer: E
23. What is the largest size hemothorax that an injury to an intercostals artery can
cause?
a) Negligible-50ml
b) Small= 200ml
c) Moderate=600ml
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d) Large = 1200ml
e) Massive=>1600ml
Correct answer: E
26.Which part of the heart is most often damaged in blunt cardiac trauma?
a) RV
b) LV
c) RA
d) RV
e) Interventricular septum
Correct answer: A
27.What percentage of pts with blunt trauma to the aorta who survive to hospital
will be dead within 24 hours if left untreated?
a) 10%
b) 20%
c) 30%
d) 40%
e) 50%
Correct answer: E
28.What is the next step if you see a stable patient with a good mechanism of injury
for traumatic aortic dissection and a widdenend mediastinum on CXR?
a) MRI
b) OT
c) Spiral CT
d) Aortography
e) TOE
Correct answer: B
29.Which sign on CXR is most specific and sensitive for traumatic aortic
dissection?
a) widened mediastinum
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b) oesophageal deviation of >2cm to right at level of T4
c) obscuration of the aortic knob
d) small left hemothorax
e) depression of the R main bronchus >40 degrees below horizontal
Correct answer: A
30. Radiopaque shadow seen immediately after trauma to the chest could be due
to
A.pulmonary embolism
B.pulmonary contusion
C.hemothorax
D.pneumonia
Correct answer C
2. All of the following ore indications of open surgical drainage of pus in acute
empyema except:
a- thick pus
b- Rapid recollection of pus
c- Streptococcal empyema
d- Extensive conditions
Correct answer: C
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5. All of the following ore complications of chronic empyema except:
a- Empyema necessitans
b- Amyloidosis
c- Mesothelioma
d- Toxic arthritis
Correct answer: C
7. ln a case of pleural effusion. The following statements are correct except that:
a. The diagnosis can be made with as little as 100 ml of fluid.
b. The trachea may be displaced to the opposite side.
c. Aspiration of blood-stained fluid is highly suspicious of bronchogenic carcinoma.
d. Open biopsy of the pleura is necessary.
e. Rapid aspiration of the fluid is not advisable.
Correct answer: A
8. Pleural fluid with the appearance of "anchovy sauce” pus is characteristic of:
a. E. coli.
b. Staph. aureus.
c. Echinococcus.
d. Entamoeba histolytica.
e. Hemothorax.
Correct answer: D
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Ischemic Heart Disease
Cong-Heart Diseases
Diaphragm
- 320 -
C. Left side more common
D. Associated with pneumothorax
Correct answer: C
24- Neurosurgery
1.Which cranial nerve does not travel through the orbital foramen?
a) 2
b) 3
c) 4
d) 5
e) 6
Correct answer: C
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4. In the surveillance for Acute Flaccid Paralysis, the age group that is included
is below
A. 5years
B. 12years
C. 8years
D. 16years
Correct answer B?
8 . A person has been brought in casualty with history of road accident. He had
lost consciousness transiently and then gained consciousness but again become
unconscious. Most likely, he is having brain hemorrhage of -
A. Intracerebral
B. Sub arachnoid
C. Sub Dural
D. Extra Dural
Correct answer: D
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C. CSF leak
D. Increased size of head
Correct answer: C
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17 . A 45 years RTA patient with 'Inappropriate speech' evaluated by the
'Glasgow Coma Scale' will have a verbal score of:
A. 3
B. 4
C. 1
D. 2
Correct answer: A
21. A 43-year-old man experiences lower back pain after lifting a heavy object off the
ground. The following morning, he notices that the pain has begun to radiate down the
posterolateral aspect of the right leg and across the top of the foot to the big toe. The
pain is severe, electric in quality, associated with paresthesia over the same distribution,
and made worse by coughing. On examination, it is found that he has an area of
diminished sensation to pinprick over the dorsum of the right foot and mild weakness
in his right extensor hallucis longus muscle. The deep tendon reflexes are all intact.
What is the most likely diagnosis?
(A) Lumbar spinal fracture with compression of the caudaequina
(B) Herniated lumbar disk on the right at the level of L4–L5
(C) Herniated lumbar disk on the left at the level of L4–L5
(D) Herniated lumbar disk on the right at the level of S1–S2
(E) Intermittent claudication
Correct answer: B
22. A 48-year-old woman has a lower back pain and hypoesthesia in the left S1
dermatomal distribution (left calf and lateral left foot). What is the most likely cause?
(A) A lesion at the right L4–L5 interspace
(B) Pathology where the nerve exits the spinal canal immediately above the pedicle of
S3 vertebra
(C) A herniated nucleus pulposus
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(D) Compression by the L5 lamina
(E) A lesion outside the vertebral column
Correct answer: C
23. A 35-year-old secretary complains of severe pain in the neck that radiates down the
right arm. The pain is electric in quality and affects specifically the radial aspect of the
right forearm and the thumb. She also describes numbness and paresthesia over the
same distribution. On physical examination, she is found to have an area of diminished
sensation to pinprick over the right wrist and thumb. The right biceps tendon reflex is
diminished, but there is no loss of muscle strength. She has right C5–C6 disk
compression and radiculopathy affecting which of the following?
(A) The right C4 root
(B) The right C4 mixed spinal nerve
(C) The right C4 anterior primary rami
(D) The right C6 root
(E) The right C6 spinal ganglion
Correct answer: D
25. A 64-year-old man presents with headache and left-sided upper extremity weakness.
The MRI findings suggest that this is a glioblastoma multiform. This is because the
tumor exhibits which of the following?
(A) It is regular in shape.
(B) It is well demarcated from surrounding brain tissue.
(C) It shows a ring pattern of enhancement with intravenous contrast and has a
nonenhancing necrotic center.
(D) It shows an absence of surrounding white-matter edema.
(E) It arises from the carotid body
Correct answer: C
26. A 63-year-old woman presents for workup to determine the reason for a gradual
hearing loss over approximately 5 years and intermittent tinnitus over the last several
months. Findings on physical and neurologic examination are entirely within normal
limits, except for the presence of sensorineural hearing loss in the left ear. She has no
cranial nerve deficits. An MRI of the brain with gadolinium reveals the presence of an
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extra-axial tumor in the region of the left cerebella-pontine angle. What is the most
likely diagnosis?
(A) Epidermoid tumor (cholesteatoma)
(B) Glioblastoma multiforme
(C) Meningioma
(D) Acoustic neuroma
(E) Glomus tumor
Correct answer: D
28. Following a sudden impact in an accident, the 34-year-old race car driver becomes
unconscious and is admitted to the hospital. A CT scan is performed, and a right space-
occupying lesion is noted (Fig. 11–1). What is the most likely diagnosis?
(A) Corpus callosum injury
(B) Pituitary apoplexies
(C) Acute subdural hematoma
(D) Acute epidural hematoma
(E) Chronic subdural hematoma
Correct answer: C
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31. During her eighth month of pregnancy, a 29-year-old woman is noted to have
hydramnios. Further testing shows anencephalous. In this case hydramnios is caused by
which of the following?
(A) Impairment of the fetus’s swallowing mechanism
(B) Tumor of the fetus’s brain
(C) A secretory peptide from the placenta
(D) Excess antidiuretic hormone (ADH) from the fetus
(E) Renal agenesis
Correct answer: A
32. A 28-year-old man presents with a history of chronic headache. The headache is
intermittent, severe, poorly localized, and most often present when he arises in the
morning. He suffered a severe blow to the head and sustained a skull fracture at the age
of 15. Findings on his physical and neurologic examinations are within normal limits.
An MRI of the brain with gadolinium reveals the presence of a large, nonenhancing
extra-axial cyst in the region of the right temporal tip. This most likely represents which
of the following?
(A) An arachnoid cyst
(B) A cystic astrocytoma
(C) Rathke’s cleft cyst
(D) A Dandy-Walker cyst (failure of proper formation of the foramina of Lushka and
Magendie)
(E) Polycystic disease
Correct answer: A
33. A 15-year-old boy complains of right-sided weakness and gait impairment. ACT
scan shows a large, nonenhancing cyst in the posterior cranial fossa, with an enhancing
tumor nodule in the left cerebellum. What is the most likely diagnosis?
(A) An arachnoid cyst
(B) A cystic astrocytoma
(C) Rathke’s cleft cyst
(D) Glioblastomamultiforme
(E) A large sebaceous cyst
Correct answer: B
34. A 43-year-old man is treated with pyridostigmine for facial, ocular, and pharyngeal
weakness due to myasthenia gravis. Which statement is true of pyridostigmine?
(A) It is unrelated to neostigmine.
(B) It has far more side effects than neostigmine.
(C) Pyridostigmine and neostigmine reverse depolarizing neuromuscular blockade.
(D) It causes greater muscarinic effect than neostigmine.
(E) It is an anticholinesterase agent
Correct answer: E
35. A 17-year-old male presents with 3-month history of headache, weight gain,
decreased concentration, polyuria, and polydipsia. His headaches are mostly in morning
and involves the frontal region. On examination he was found to have bitemporal visual
field defect and no facial hair. MRI scan revealed a suprasellar partially calcified cystic
lesion with displacement of optic chiasm. The most likely pathology is:
(A) Giant aneurysm of carotid artery
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(B) Pituitary macroadenoma
(C) Glioblastoma multiforme
(D) Craniopharyngioma
(E) Testicular metastasis
Correct answer: D
37. A 45-year-old woman was brought to emergency department for sudden onset of
severe headache associated with photophobia, nausea, and transient loss of
consciousness. On examination, she is awake and alert with normal cranial nerve
function. She also exhibits normal muscle strength and sensation. Her past medical
history is significant for sickle cell disease (SCD) and hypertension. CT scan confirms
the diagnosis of SAH without any intraparenchymal abnormality. What is the least
likely cause of SAH?
(A) Aneurysmal bleed
(B) Sickle cell angiopathy
(C) Arteriovenous malformation (AVM)
(D) Hemorrhagic meningioma
(E) Blood dyscrasia
Correct answer: D
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Congenital CNS anomalies
1 . A newborn with meningomyelocele has been posted for surgery. By which of the
following, the defect should be immediately covered-
A. Tincture Benzoin Gauze
B. Methylene Blue Gauze
C. Normal Saline Gauze
D. Povidone Iodine Gauze
Correct answer: C
Head injuries
2.Which facial view x ray is the best for examining the orbits and midface?
a) OPG
b) Waters or occipitomental
c) Caldwell or PA view
d) Submental vertex
e) Towne
Correct answer: B
4.What is the name of the fracture that is clinically detected by tugging on the
maxilla/hard palate causing the nose to move.
a) le fort 5
b) le fort 4
c) le fort 3
d) le fort 2
e) le fort 1
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Correct answer: D
5 . Clinical feature of fracture of Zygomatic bone include all of the following except:
A. Bleeding
B. C.S.F. rhinorrhea
C. Diplopia
D. Trismus
Correct answer: B
10. Watery discharge from the ear occurs in all of the following EXCEPT:
a. Cerebra-spinal otorrhea.
b. Parotid fistula.
c. Acute otitis media.
d. Endolymphatic sac surgery.
Correct answer: C
11. In lesion of facial nerve at vertical part below the nerve of stapedius"
there is:
a. Loss of taste.
b. Impairment of salivation.
c. Impairment of lacrimation.
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d. Hyperacusis.
Correct answer: A
13. In lesion of the facial nerve at the geniculate ganglion, there is:
a. Loss of taste.
b. Impairment of salivation.
c. Impairment of lacrimation.
d. Hyperacusis.
e. All of the above.
Correct answer: E
18. The cause of Bell's palsy may be one of the following EXCEPT:
a. Vascular ischemia.
b. Virus infection.
c. Bacterial infection.
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d. Auto immune.
Correct answer: A; B and D.
22. The most accurate diagnostic test to detect degeneration of the facial nerve:
a. Nerve excitability test.
b. Electromyography.
c. Electroneurography.
d. Stapedial reflex.
Correct answer: C.
24 . After 4 weeks of Head trauma, patient presents with features of irritability and
altered sensorium. Commonest cause will be:
A. Chronic subdural hematoma
B. Extradural hematoma
C. Intraparenchymal bleed
D. Electrolyte imbalance
Correct answer: A
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Subarachniod hemorrhage and neurovascular diseases
Brain tumours
Spinal tumours
Spinal fracture
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2. Sphenoid wing dysplasia is seen in
A.Von Hippel Lindau's disease
B.Neurofibromatosis
C.Sturge Weber syndrome
D.Bournville's disease
Correct answer B
25- Urology:
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C. acute pyelonephritis
D. sickle cell disease
Correct answer B
7 . A 62 year old male was found to have a solid renal tumor on CT scan which
had invaded the renal vein and inferior vena cava. All are true except:
A. Pre-op biopsy is not indicated
B. IVC invasion means inoperable condition
C. Pre-op radiotherapy or chemotherapy is not done
D. Chest x-ray is done to rule out pulmonary metastasis
Correct answer: B
8 . A patient presented with renal cell carcinoma invading IVC and the renal
vein. False statement is:
A. Preop biopsy is not necessary
B. IVC involvement indicates inoperability
C. Pre op radiotherapy is not essential
D. Chest x-ray should be done to rule out pulmonary metastasis
Correct answer: B
10 . Renal collar which surrounds the aorta has its two limbs split by:
A. Left renal vein
B. Left renal artery
C. Isthmus of horseshoe kidney
D. All of the above
Correct answer: A
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B. Pheochromocytoma
C. Adrenocortical carcinoma
D. Hypernephroma
Correct answer: C
- 336 -
18 . Renal Calculi associated with proteus infection
A. Triple Phosphate
B. Uric Acid
C. Xanthine
D. Calcium Oxalate
Correct answer: A
20 . Which of the following is the most important prognostic indicator for Renal
cell carcinoma?
A. Size
B. Pathological staging
C. Nuclear grade
D. Histological type
Correct answer: B
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D. Acute adrenal insufficiency usually is secondary to exogenous glucocorticoid
administration.
Correct answer: C
26 . In 'Three glass Test' shreds are present in 1st glass only.The most probable
diagnosis should be ?
A. Urethritis
B. Cystitis
C. Prostatitis
D. Renal pathology
Correct answer: A
28 . Triad of Renal colic, swelling in loin which disappears after passing urine is
called
A. Kocher's triad
B. Saint's triad
C. Diestel’s crisis
D. Charcot's triad
Correct answer: C
29 . Nephroureterectomy is indicated in ?
A. Renal carcinoma
B. Chronic pyelonephritis
C. Polycystic kidney disease
D. Transitional carcinoma of the pelvis extending till ureter
Correct answer: D
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31 . All of the following are associated with renal cell carcinoma, except:
A. Amyloidosis
B. Polycythemia
C. Hypertension
D. Cushing's syndrome
Correct answer: D
32 . Which drug is not a part of the Triple Therapy immunosuppression for post-
renal transplant patients?
A. Azathioprine
B. Cyclosporine
C. Prednisolone
D. FK 506
Correct answer: D
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38 . Commonest symptom of CA urinary bladder is -
A. Increase frequency
B. Hematuria
C. Lower abdominal pain
D. Perineal pain
Correct answer: B
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45. The common malignant tumor of renal pelvis and ureter is:
a. Squamous carcinoma
b. Adenocarcinoma
c. Transitional cell carcinoma
d. Papillary carcinoma
Correct answer : C
46 . Investigation of choice in case of 50 years old patient with low back pain and
urinary retention:
A. Acid phosphatase
B. Alkaline phosphatase
C. Ultrasound abdomen
D. Electrophoresis
Correct answer: A
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d. Cystoscope of bladder carcinoma shows pseudo tubercle, sandy patches and
ulceration.
Correct answer: C
54. Solitary cyst of the kidney may contain the following except:
a. Clear fluid.
b. Cholesterol crystals.
c. May contain altered blood.
d. Pyogenic material if infected.
Correct answer: B
58. The formation of middle lobe in BPH arises from which zone:
a. Transitional zone
b. Central zone
c. Peripheral zone
d. None of the above
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Correct answer : B
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65. Treatment of rupture bladder includes the following except:
a. Resuscitation.
b. Watertight repair without drain.
c. Urethral catheter for 2 weeks.
d. 2ry survey and treatment of associated injuries.
Correct answer : B
71. The triad of signs of rupture urethra includes the following except:
a. Perineal hematoma
b. Bleeding per urethra
c. Retention of urine
d. Bleeding per rectum
Correct answer : D
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72. Male 25 years old arrived at the hospital in severe shock after a road traffic
accident. Abdominal examination revealed tenderness and rigidity in the loin
and fullness in the suprapubic region. He failed to pass any urine. He should be
suspected lo have:
a. Rupture of the spleen
b. Rupture of the left kidney
c. Retroperitoneal hematoma
d. Extraperitoneal rupture of the bladder
e. lntrapelvic rupture of the urethra
Correct answer : B
77. All of the following findings give sure diagnosis of renal TB except:
a. Acid fast, alcohol fast bacilli on ZN stain.
b. Sterile pyuria.
c. +ve culture on Lowenstein medium.
d. +ve culture on BancTec medium.
Correct answer : B
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78. About urinary bilharziasis:
a. Most common organism is Schistosoma mansoni.
b. May lead to transitional cell carcinoma.
c. Characteristic sandy patches on macroscopic exam.
d. Nonspecific histopathological pattern may be seen.
Correct answer : C
84. The following statements about pyonephrosis are correct except that it
a. Is a chronic retention of infected urine in the kidney
b. Usually results from ca-incident infection and obstruction as in renal calculi and
pyelonephritis
c. ls characterized by dilatation of the pelvicalyceal system with extensive excavation
of the parenchyma
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d. Presents with pain, swelling, fever and pyuria
e. ls best treated by primary nephrectomy
Correct answer : E
90. All of the following are predisposing factors to Ca oxalate stone except:
a. Hyperparathyroidism.
b. increase consumption of mongo, tomato and milk.
c. Bone secondaries.
d. Giant tumor lysis.
e. Prolonged recumbency.
Correct answer : D
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91. The most symptomatic urinary stone is:
a. Oxalate.
b. Urate.
c. Phosphate.
d. Cysteine.
Correct answer : A
97. Renal calculus formation has been shown to be related to all of the following
except:
a. Vitamin D metabolism.
b. Urea splitting bacteria.
c. Immobilization.
d. Stenosis of ureteropelvic junction.
e. Malabsorption.
Correct answer : E
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98. A ureteric stone needs surgical removal when:
a. Enlarging
b. Obstructing
c. Too large to pass
d. Causing urinary infection
e. All of the above
Correct answer : E
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104. Risk factors of transitional cell carcinoma include all of the following
except:
a. Smoking.
b. Cyclophosphamide.
c. Pelvic irradiation.
d. Exposure to benzidine.
e. Exposure to schistosomiasis.
Correct answer : E
105. All of the following primary sites metastasize classically with osteolytic
lesion except:
a. Kidney.
b. Prostate.
c. Bladder.
d. Breast.
e. Lung.
Correct answer : B
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d. Pulmonary metastasis.
e. Polycythemia.
Correct answer : A
112. Radiological findings of benign hypertrophy of the prostate include all of the
following except:
a. Filling defect at base of the bladder.
b. Diverticula of the bladder.
c. Uretheral dilatation.
d. Ureteral dilatation.
Correct answer : D
115. The following statements concerning hypernephroma are true except that it:
a. Is a carcinoma arising from renal tubular cells
b. Commonly arises in one pole of the kidney
c. Usually manifests itself by recurrent renal hematuria
d. Never causes pain
e. May form a palpable moss
Correct answer : D
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Congenital anomalies
4. In ectopia vesica:
a. absent anterior abdominal wall.
b. Absent anterior bladder wall.
c. Associated late rupture of cloacal membrane.
d. All of the above.
Correct answer: D
Hematuria
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2 . Terminal hematuria is most commonly caused by
A. Renal calculus
B. Ureteric calculus
C. Bladder calculus
D. Urethral calculus
Correct answer: C
5 . A 60 year old smoker came with the history of painless gross hematuria for
one day. The investigation of choice would be -
A. USB KUB
B. Urine for malignant cytology
C. Urine routine and microscopy
D. Plain X-ray KUB
Correct answer: B
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8 . A 67-year-old man presented with initially after a single episode of gross
painless hematuria. An excretory urogram demonstrated a 1.5 mm round filling
defect in the right lower renal infundibulum. The best study to obtain next is -
A. Urinary cytology
B. Cystoscopy
C. Ultrasonography
D. Retrograde pyelography
Correct answer: C
9 . A patient presents with hematuria of several days and dysmorphic RBC casts
in urine. The site of origin is:
A. Kidney
B. Ureter
C. Bladder
D. Urethra
Correct answer: A
10 . A 30 year old male presents with pain on the right flank and hematuria. A
CECT abdomen reveals a large 8X8 cm sized solid mass in the right kidney and
3x3 cm solid mass occupying the upper pole of left kidney. The most appropriate
surgical treatment for this patient is:
A. Bilateral radical nephrectomy
B. Right radical nephrectomy and biopsy of the mass from opposite kidney
C. Right radical nephrectomy and left partial nephrectomy
D. Right radical nephrectomy only
Correct answer: C
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D. Retrograde pyelography
Correct answer: C
14 . A 23 year old male who is otherwise normal complains of mild pain in his right
iliac fossa in a waveform pattern which increases during the night and he becomes
exhausted and is admitted in the hospital. On examination there is mild hematuria.
Urine examination levels plenty of RBC's 50 WBCs/hpf. Urine pH is 5.5. Most
likely diagnosis is -
A. Ca-Urinary bladder
B. Glomerulonephritis
C. Cystitis
D. Ureteral calculus
Correct answer: D
15. A 60-year-old male presenting with painless hematuria gives a history of two
similar attacks during the last six months. He had no pain, dysuria or frequency
and examination revealed no abnormality. He should be suspected to be
suffering from:
a. Polycystic kidney
b. Renal calculus
c. Carcinoma of the bladder
d. Hypernephroma
e. Senile enlargement of the prostate
Correct answer : D
Hydronephrosis
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mg/dl and urea level were 180 mmol/1. Which should be the immediate
treatment
A. 'J' stent drainage
B. Hemodialysis
C. Ureteroscopic removal of stones
D. Lithotripsy
Correct answer: A
3 . A 63 years male with poor stream of urine, post void residual urine is 400 ml,
bilateral hydronephrosis and prostate weighing 75 g. His Ur- 118 and Cr- 3.4.
The next steps of management is-
A. CT to rule out ca
B. MRI pelvis
C. Catheterize with Foley catheter
D. b/l PC Nephrostomies
Correct answer: C
4. An infant is noted to have a left flank mass shortly after birth and an
ultrasound examination demonstrates left hydronephrosis. The most common
cause of this finding is which of the following?
a. Neonatal Wilm’s tumor
b. Congenital ureteropelvic junction obstruction
c. Multicyclic dysplastic kidney
d. Vesicoureteral reflux
Correct answer: b
5 . A patient presents with pain and tenderness in left iliac fossa. USG shows a 3
cm stone in the renal pelvis without any hydronephrosis. Most appropriate
management is -
A. PCNL
B. ESWL
C. Diuretics
D. Medical dissolution therapy with potassium citrate
Correct answer: A
Stones
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C. common in infected urine
D. usually seen in acidic urine
Correct answer: D
- 357 -
D. Medium range (2-5 MHz) pulsed wave are used
Correct answer: A
2 . What will be the next investigation to be done in a case of a 2 year old female
child with 1st episode of UTI -
A. Abdominal Ultrasound
B. DMSA scan
C. 6 monthly urine culture
D. Nothing actively needed
Correct answer: A
5 . A 9 year boy presented with abdominal pain and recurrent UTI, IVP reveals
duplication of left ureter. The most likely site of ectopic opening would be:
A. Seminal vesicle
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B. Vas-deference
C. Prostatic urethra
D. Ejaculatory duct
Correct answer: C
Renal tumors
Bladder cancer
3 . Commonest cause of periumbilical pain after 30 min.of TURP done under spinal
anesthesia with Bupivacaine
A. Meteorism
B. Perforation of bladder
C. Recovery from bupivacaine anesthesia
D. Mesentery artery ischemia
Correct answer: B
4 . A 55years male with positive family history of prostate cancer has come to you for a
screening test.The most sensitive screening test is -
A. PSA
B. DRE (digital rectal examination)
C. Endorectal Coil MRI with T1W and T2 W images
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D. DRE +PSA
Correct answer: D
5 . All of the following can be seen after transurethral resection of prostate except:
A. Congestive cardiac failure
B. Transient blindness
C. Convulsion
D. Hypernatremia
Correct answer: D
6 . 60 years patient with fever, dysuria, PSA 8.5 ng/ml on DRE prostate is n tender, diffuse
back pain - next line of management is -
A. Emergency TURP
B. Repeat PSA
C. Admit and antibiotics
D. TRUS guided biopsy
Correct answer: C
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Anuria / Retention
Testicular tumors
2 . After sexual intercourse, a person develops pain in the left testes that does not
get relieved on elevation of scrotum. Possible diagnosis is:
A. Torsion testis
B. Epididymo-orchitis
C. Tumor testes
D. Fourniers gangrene
Correct answer: A
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Correct answer: B
6 . All of the following clinicopathologic features are seen more often in seminomas
as compared to non-seminomatous germ cell tumors of the testis except -
A. Tumors remain localized to testis for long time
B. They are radiosensitive
C. They metastasize predominantly by lymphatics
D. They are often associated with raised levels of serum AFP and HCG
Correct answer: D
8 . A 28-year-old man presents with a single descended testis and a 6 cm solid mass
seen by CT. The most likely diagnosis is -
A. Metastatic prostate cancer
B. Teratoma
C. Hyperplastic cryptorchid testis
D. Seminoma
Correct answer: B
9 . A 40-year-old men is suffering from fever and pain in scrotum which is not
relieved by elevation of test is 3 days before had sexual contact with a young
female:
A. Testicular tumour
B. Acute epididymitis
C. Torsion of testis
D. Acute orchitis
Correct answer: C
10 . Which of the following age is the best time for surgery of undescended testis?
A. 6 months of age
B. Just after birth
C. 24 months of age
D. 12 months of age
Correct answer: D
11 . All of the following are predisposing factors for torsion of testis except:
A. Long pedicle
B. Long mesorchium
C. Inversion of testis
D. Varicocele
Correct answer: D
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B. Orchidopexy reduces the risk of malignancy
C. Cryptorchidism is a risk factor for testicular tumor
D. Seminoma is the most common tumor
Correct answer: B
14 . Following statements are true about germ cell tumors of testis except
A. They constitute 90-95% of all primary testicular tumors
B. Seminoma is the most common tumor developing in the pts with cryptorchid testis
C. Alpha-feto protein is markedly raised in all germ cell tumors
D. High inguinal orchidectomy is the initial surgical procedure
Correct answer: C
16 . A patient presented with a hard swelling in his right testis.All are true
statements except:
A. Trans-scrotal biopsy is needed
B. Inguinal exploration is done
C. High inguinal exploration should be done
D. Scrotal U/S is done
Correct answer: A
17 . A 12 year old boy experiences sudden severe pain in the right testis. On
palpation there is exquisite tenderness. The most likely diagnosis -
A. Spontaneous hemorrhage
B. Torsion
C. Strangulated hernia
D. Epidydimitis
Correct answer: B
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19 . A 16 year old boy presents with acute onset pain in the left testis.The following
statements about his management is true except -
A. The patient should be prescribed antibiotics and asked to come after a week
B. Color flow Doppler will be very useful in diagnosis
C. Scrotal exploration should be done without delay if doppler is not available
D. If left testis is not viable on exploration, patient should undergo left Orchidectomy
and right orchidopexy
Correct answer: A
- 364 -
Correct answer: B
- 365 -
33- Best time for orchiopexy is:
a. At l st day of life.
b. 6-l5 months.
c. At 5 years.
d. At puberty.
Correct answer: B
35- Concerning undescended testis, the following statements ore true except that
it:
a . Affects about 1% of all males
b. is commoner on the right than on the left side
c. is bilateral in about 20% of cases
d. May be intra-abdominal or extra-abdominal
e. is rarely associated with inguinal hernia
Correct answer: E
36. The following statements about ectopic testis ore true except that it:
a. is probably due to rupture of the scrotal tail of the gubernaculum
b. May lie in the groin or pubic region.
c. Does not develop normally.
d. Has normal long spermatic cord.
e. Can be easily replaced in the scrotum.
Correct answer: C
- 366 -
Correct answer: A
- 367 -
d. Sertoli cell tumors are benign and orchidectomy is curative.
Correct answer: C
50. The hazards of incomplete descent of testis include all the following except:
a. Sterility in bilateral cases
b. Trauma
c. Torsion
d. Increased liability to malignant change in later life
e. Epididymo-orchitis.
Correct answer: E
51. Which of the following statements are true with regard to testicular torsion?
a. The typical symptom is sudden agonizing pain in the scrotum.
b. It is most common above 25 years of age.
c. Inversion of the testis and a transverse lie are not a cause.
d. Doppler ultrasound (US) scan should be done to confirm the diagnosis.
e. The emergency operation of fixation of the testis to the tunica albuginea with non-
absorbable sutures should be done on both sides.
Correct answer: E
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53. In testicular tumours, which of the following statements is false?
a. A scrotal lump that is inseparable from the testis is likely to be a tumour.
b. Lymphatic spread is usually to the paraaortic lymph nodes.
c. Teratomas occur in the third decade and seminomas in the fourth decade.
d. Seminomas usually spread via the lymphatics.
Correct answer: D
54. Which of the following statements is false with regard to the management of
testicular tumours?
a. Tumour markers are measured, and a chest X-ray carried out.
b. Initial surgical treatment is orchidectomy through the groin.
c. Staging is done by CT scan and MRI.
d. Seminomas are radiosensitive.
e. Secondaries from teratoma are always treated by surgery.
Correct answer: D
56.A 16-year old adolescent presents with a left sided scrotal mass. Ultrasound
shows a paratesticular mass. Which of the following is the most appropriate
surgical approach?
A. Tran scrotal orchidectomy and resection of the entire spermatic cord
B. Inguinal orchidectomy and resection of the entire spermatic cord
C. Open biopsy of the mass through an inguinal incision followed by inguinal
orchidectomy and resection of the entire spermatic cord after biopsy
D. Open biopsy of the mass through a Tran scrotal approach followed by Tran scrotal
orchiectomy and resection of the entire spermatic cord
Correct answer is B.
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Erectile dysfunction and Infertility
Renal transplantation
2 . A 45 years male with a single Kidney presents with a solitary exophytic mass of
4cm localized at its lower pole. The best recommended management option is-
A. Radical Nephrectomy with dialysis
B. Radical Nephrectomy with immediate Renal Transplantation
C. Partial Nephrectomy
D. Radical Nephrectomy
Correct answer: C
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26- Orthopedic surgery:
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c. Closure of skin wounds is always indicated.
d. All bluish non contracting non bleeding muscles should be excised.
Correct answer: C
9. Delayed union:
a. May be caused by infection.
b. Systemic steroids may cause delayed union.
c. ls diagnosed when there is non-union after 1.5 times of the expected time for union.
d. ls treated by treatment of the cause + rigid fixation.
e. All of the above.
Correct answer : E
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13. The most common site of fracture clavicle is:
a. Middle third.
b. Medial end.
c. Between middle and lateral thirds.
d. Between middle and medial thirds.
Correct answer : C
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20. Most common hand infection is:
a. Distal pulp space infection (felon).
b. Paronychia.
c. Ulnar bursitis.
d. Thenar space infection.
Correct answer: B
2. Features seen on a child’s cervical spine X Ray that are different from an
adult’s include all of the following EXCEPT
A Anterior pseudo subluxation C2 on C3 can be normal until 8 years
B Increased depth of anterior soft tissue space
C Predental space (C1) up to 5mm
D Prominent lordosis
Correct answer : D
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Shoulder and upper limb fractures
- 375 -
7. Regarding forearm fractures which is FALSE?
A All Galeazzi fracture-dislocations require surgery
B All Monteggia fracture-dislocations require ORIF
C Radial head fractures with up to 200 tilts can be managed conservatively
D Smith’s fracture is managed with below elbow plaster with wrist in pronation and
full dorsiflexion
Answe: D
8. Radial head fractures are commonly associated with all of the following
EXCEPT
A Lateral collateral ligament injury
B Medial collateral ligament injury
C Coronoid fracture
D Olecranon fracture
Correct answer : A
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13. In regard to elbow dislocation, which of the following is FALSE?
A It is associated with significant soft tissue injury and resultant instability.
B It is one of the three most common large joint dislocations – the others being
glenohumeral and patellofemoral
C Patients typically present with their arm held in near full extension
D The commonest associated neurovascular injury is to the Ulnar nerve.
Correct answer : C
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Pelvis and lower limb fractures
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D When followed up 20 years later; most patients are pain free and active
Answer: A
12. What is the key event required for a Triplane Ankle Fracture to Occur?
A Inversion Injury
B Ossification of Epiphysis
C Axial Loading Injury
D Partial Fusion of Growth Plate
Answer: D
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13. Which of the following is TRUE?
A Most tibial plateau fractures involve the medial plateau
B A Segond fracture suggests PCL disruption and anterolateral rotator instability
C The younger the age of onset of Perthes disease, the better the prognosis
D The more proximal the scaphoid fracture, the lower the incidence of
avascular necrosis
Answer: C
15. Which of the following is CORRECT when treating neck of femur fractures?
A Alignment maintained by pre operative skin traction helps post operative mobility
B Indwelling urinary catheters are not associated with post operative infection
C Antibiotics at time of anaesthetic induction reduce post operative infection rates
D Patients do not need nursing on pressure mattresses in the pre operative
period where surgery is conducted within 24 hrs
Answer: C
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19. In knee injuries which of the following is TRUE?
A A common triad of injuries is ACL/MCL and medial meniscus.
B Proximal tib-fib dislocation occurs with a twisting force to the extended knee.
C Tears of the patellar tendon need repair due to the high stress of quadriceps
contraction.
D 60% of adolescents with a knee hemarthrosis on x-ray will have an
osteochondral fracture.
Correct answer : D
20. Which of the following statement regarding femoral neck fractures is TRUE?
A They are more common in men
B Intracapsular fractures are more common than extracapsular fractures
C Displaced fractures should be treated with skin traction in the ED
D Intermittent catheterization is preferable to indwelling catheters
Correct answer : D
21. In the child with Slipped Upper Femoral Epiphysis (SUFE), which statement
is FALSE?
A SUFE is a Salter Harris type fracture.
B Bilateral SUFE in a child under 10 years of age is more likely to be associated with
endocrine / metabolic disorders.
C The ‘Klein line’ is helpful in diagnosing SUFE
D A ‘Frog leg’ plain XR view of the hips is a helpful investigation to diagnose SUFE
Correct answer : D
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Osteomyelitis and arthritis
Bone tumors
- 382 -
removed which demonstrates involvement with tumor. No other disease is found
on staging evaluation. What is stage and group of this patient’s tumor?
a. Stage 1, Group I
b. Stage 1, Group II
c. Stage 1, Group III
d. Stage 2, Group I
e. Stage 2, Group II
Correct answer: C
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7. The peak incidence of Ewing’s sarcoma occurs during which decade?
1. First
2. Second
3. Third
4. Sixth
Correct answer: 2
9. A 11 – years – old Caucasian girl with tumor arises in the diaphysis of the
femur and X – ray shows an onion-skin pattern. Biopsy of a bone tumor reveals
small round blue cells. Immunostains show that the tumor is CD99 positive. You
and the pathologist decide to do which of the following?
A. Initiate treatment for small round cell osteosarcoma
B. Repeat the biopsy
C. Do FISH using FLI1 break-apart probes
D. Do RT PCR for the t(1;13)(p36;q14)
E. Do FISH using EWS break-apart probes
Correct answer is E.
10. A 7-year old girl is receiving chemotherapy for a stage 3, group III
rhabdomyosarcoma of the extremity. After her second course of chemotherapy
she is admitted to the hospital with right upper quadrant pain, jaundice,
abdominal distension, and weight gain. Which of the following is the most
appropriate next step in the evaluation/treatment of this patient?
A. Echocardiogram
B. Nutrition consult
C. Doppler study of the liver
D. Serum hepatitis screen
E. Urinalysis
Correct answer is C.
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C. If a regional lymph node is enlarged on imaging and physical examination and is
removed but does not show rhabdomyosarcoma, then the patient has stage 3, Group
I rhabdomyosarcoma
D. If a regional lymph node is enlarged on imaging and physical examination and is
removed but does not show rhabdomyosarcoma, then the patient has stage 2, Group
I rhabdomyosarcoma
E. If a regional lymph node is enlarged on imaging and physical examination and is
removed and shows rhabdomyosarcoma, then the patient has stage 3, Group III
rhabdomyosarcoma
Correct answer is C.
15. You are caring for a new patient with a large localized Ewing sarcoma of
the soft tissues of the arm. The surgeon believes that the tumor can be resected
without amputation but asks whether you can give some chemotherapy to
shrink the tumor before surgery. Which of the following would you tell the
surgeon?
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A. If the tumor can be resected without amputation, then the best time to do the resection
is before any chemotherapy in order to improve the prognosis
B. You agree with waiting to do the resection until week 12 of therapy and will begin
chemotherapy; you recognize that radiotherapy will not be necessary if the tumor is
completely resected at week 12 of therapy
C. You agree with waiting to do the resection until week 12 of therapy and will begin
chemotherapy; you recognize that radiotherapy will be necessary even if the tumor
is completely resected at week 12 of therapy
D. If the tumor can be resected without amputation, then the best time to do the resection
is before any chemotherapy; you recognize that this is the only way to avoid
radiotherapy
Correct answer is B.
16. You are reviewing the MRI of a patient with a tumor of the distal femur.
The radiologist tells you that the tumor is on the surface of the bone and does
not invade the medullary cavity. The radiologist suspects osteosarcoma. The
MRI suggests which of the following?
A. This is not an osteosarcoma based on this pattern.
B. This is a low grade osteosarcoma that can be treated with resection alone.
C. This is a high grade osteosarcoma that can be treated with resection alone.
D. This is an osteosarcoma and all osteosarcomas require chemotherapy.
Correct answer is B
18. You treated a patient for a localized Ewing sarcoma of the chest wall on the
right side at the age of 7 with cycles of vincristine, doxorubicin, and
cyclophosphamide (VDC) alternating with cycles of etoposide and ifosfamide
(IE) and radiotherapy. At age 16 he presents with an osteosarcoma of the right
scapula. Which of the following best explains why the osteosarcoma developed?
A. This is most likely secondary to previous treatment with an alkylating agent.
B. This is most likely secondary to previous treatment with a topoisomerase II inhibitor.
C. This is most likely secondary to radiotherapy.
D. This is most likely secondary to a germline mutation in a tumor suppressor gene.
E. This is most likely secondary to previous treatment with anthracycline.
Correct answer is C
19. You are caring for a new patient with a large localized Ewing sarcoma of
the soft tissues of the arm. The surgeon believes that the tumor can be resected
without amputation but asks whether you can give some chemotherapy to
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shrink the tumor before surgery. Which of the following would you tell the
surgeon?
A. If the tumor can be resected without amputation, then the best time to do the resection
is before any chemotherapy to improve the prognosis.
B. You agree with waiting to do the resection until week 12 of therapy and will begin
chemotherapy; you recognize that radiotherapy will not be necessary if the tumor is
completely resected at week 12 of therapy.
C. You agree with waiting to do the resection until week 12 of therapy and will begin
chemotherapy; you recognize that radiotherapy will be necessary even if the tumor
is completely resected at week 12 of therapy.
D. If the tumor can be resected without amputation, then the best time to do the resection
is before any chemotherapy; you recognize that this is the only way to avoid
radiotherapy.
Correct answer is B
20. A surgeon refers a patient to you with osteosarcoma of the distal femur. He
has already completed what appears to be an appropriate and uncomplicated
limb-sparing surgical resection. You complete a staging evaluation that shows
no evidence for metastases. The patient’s family has learned that most patients
receive some chemotherapy before surgery, and they wonder whether their
child should have received chemotherapy before surgery. You indicate that the
surgeon should have referred the patient to you before surgery and that
A. You will treat the patient with high-dose methotrexate, doxorubicin, and cisplatin
(MAP) chemotherapy and the outcome will not be adversely affected by the early
surgery.
B. The patient’s prognosis is now definitely worse because you will not be able to
optimize the chemotherapy regimen based on the response to chemotherapy.
C. You could have administered preoperative chemotherapy, which would have
changed the surgical approach dramatically.
D. You will now have to treat the patient with an intensified chemotherapy regimen that
was designed for patients with unresectable/metastatic osteosarcoma.
E. You will treat the patient with MAP chemotherapy and optimize local control by
using radiotherapy so that the outcome should not be affected.
Correct answer is A
21. A 10-year-old presents with a localized Ewing sarcoma of the ilium. Which
of the following best describes prognostic features for this patient?
A. A pelvic primary site is the single most unfavorable prognostic feature for Ewing
sarcoma.
B. Prognosis for this patient depends primarily on whether surgery or radiotherapy is
used as local therapy.
C. Prognosis for this patient has improved with the addition of ifosfamide and etoposide
to vincristine, doxorubicin, and cyclophosphamide.
D. This patient’s age represents a more important negative prognostic factor than the
primary site.
Correct answer is C
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Others
1. What is the BMI (body mass index) of a male with weight 45kg and height
1.5m
A.19
B.20
C.21
D.18
Correct answer: B
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D. Hyponatremia
Correct answer: D
4 . A patient underwent prostatic surgery and during surgery glycine was used
for bladder irrigation. Which abnormality will give vomiting and clouding of
consciousness on 3rd postop day:
A. Hypomagnesemia
B. Hypokalemia
C. Hyponatremia
D. Hypercalcemia
Correct answer: C
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4. Thiopentone sodium has a short duration of action because
A. it is rapidly metabolized
B. it is rapidly redistributed
Correct answer B
Regional anaesthesia
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Basic life support
28- TRAUMA
1.Which investigation of the abdomen in trauma is described by: rapid, sensitive, not
specific, not examine retroperitoneum, repeatable, non invasive?
a) physical examination
b) CT
c) FAST (Focused assessment with sonography in trauma)
d) DPL (Diagnostic peritoneal lavage)
e) Plain x- ray
Correct answer: C
6 . Which of the following is done to expose the coeliac axis, left renal artery, superior
mesenteric artery and abdominal aorta in a case of trauma?
A. Cranial visceral rotation
B. Caudal visceral rotation
C. Left medial visceral rotation
D. Right medial visceral rotation
Correct answer: C
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Correct answer: A
12 . After trauma, a patient presents with a drop of blood at the tip of urinary meatus;
He complains of inability to pass urine. Next step of management should be:
A. Catheterize, drain bladder, and remove the catheter thereafter
B. Catheterize, drain bladder, and retain the catheter thereafter
C. IVP should be done
D. MCU should be done
Correct answer: B
13 . In order to expose the coeliac axis, left renal artery, superior mesenteric artery
and blood abdominal aorta in a case of trauma, which of the following is performed -
A. Cranial visceral rotation
B. Caudal visceral rotation
C. Left medial visceral rotation
D. Right medial visceral rotation
Correct answer: C
14 . A patient died after a blunt trauma to chest most common cause of death in blunt
trauma to chest is -
A. Oesophageal rupture
B. Tracheo bronchial rupture
C. Pulmonary laceration
D. Pneumothorax
Correct answer: B
18 . What should be the approach for doing laparotomy in blunt trauma abdomen?
A. Always midline incision
B. Depends on organ injured
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C. Depends upon type of injury
D. Always transverse
Correct answer: A
22 . A 35 years man with blunt abdominal trauma with h/o pelvic fracture has presented
to ER. He has passed only few drops of blood per meatus and no urine in the past 8
hours. His bladder is palpable per abdomen. The correct diagnosis is-
A. Urethral injury
B. Anuria due to hemorrhagic shock
C. Bladder rupture
D. Ureteral rupture leading to extravasation of urine in retroperitoneum
Correct answer: A
24 . A patient is brought to the hospital with history of RTA 8 hours back. A few drops
of blood were noted at the external urethral meatus. He has not passed urine and his
bladder is palpable per abdomen. What is the probable diagnosis?
A. Ureteral injury with extravasations of urine in the retro peritoneum
B. Urethral injury
C. Rupture bladder
D. Anuria due to hypovolemia
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Correct answer: B
25 . A patient was brought to the hospital with a history of RTA eight hours back.A few
drops of blood is noted at the external urethral meatus.He has not passed urine and his
bladder is palpable per abdomen. The probable diagnosis is -
A. Urethral injury with extravasation of urine in the retroperitoneum
B. Anuria due to hypovolemia
C. Urethral injury
D. Rupture bladder
Correct answer: C
26 . Which among the following is best method to assess intake of fluid in Polytrauma
patient
A. Urine output
B. CVP
C. Pulse
D. BP
Correct answer: A
28 . Trauma and Injury Severity Score (TRISS) includes which of the bellow:
A. RTS+ISS+Age
B. GCS+BP+RR
C. RTS+GCS+BP
D. RTS+ISS+GCS
Correct answer: A
30 . A 25 years male complains of upper abdominal and lower chest pain exacerbated
by deep breathing, ten days after a splenectomy for blunt abdominal trauma. He is
anorectic but ambulatory and otherwise making satisfactory progress. On physical
examination, his temperature is 38.2 degree C(108 degree C) reptilian he has decreased
breath sounds at the left lung base. His abdominal wound appears to be healing well,
bowel sound are active and there are no peritoneal sings. Rectal examination is
negative. The W.B.C count is 12,500mm3 with a shift to left. Chest X-rays show
platelike atelectasis of the left lung field. Abdominal X-rays show a nonspecific gas
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pattern in the bowel and an air-fluid level in the left upper quadrant. Serum amylase is
150 Somogyi units dl(normal 60 to 80).most Possible diagnosis is
A. Pulmonary embolism
B. Subfascial wound infection
C. Subphrenic abscess
D. Pancreatitis
Correct answer: C
34 . After trauma to neck causing fracture of cervical spine what will be the first step:
A. Immobilization
B. Intubation
C. Maintenance of airway
D. X-ray cervical spine
Correct answer: A
36 . All of the following can be done in a case of pelvic fracture with pelvic
hematoma and had not passed urine since trauma except:
A. Pass indwelling urethral catheter
B. IV fluid infusion
C. IV pylography
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D. Digital per rectal examination
Correct answer: A
37 . Which of the following is the best parameter to assess fluid intake in a poly-
trauma patient
A. Urine output
B. BP
C. Pulse
D. Pulse oximetry
Correct answer: A
41 . A 23 years male falls on the ground when he is struck in the right temple by a
baseball. While being driven to the hospital, he lapses into coma. He is unresponsive
with the dilated right pupil when he reaches the emergency department. Which of the
following is the most important step in initial management ?
A. X-ray of the skull and cervical spine
B. Doppler ultrasound examination of the neck
C. Craniotomy
D. CT scan of the head
Correct answer: C
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43 . In hand injuries the first structure to be repaired is
A. Bone
B. Skin
C. Tendon
D. Verve
Correct answer: B
1- Which one among the following statements about cystic hygroma is untrue?
a. Affects infants and young children.
b. Occurs chiefly in the neck, axilla and groin.
c. Presents as a large soft fluctuating translucent swelling.
d. is localized to the subcutaneous tissues.
e. May rupture subcutaneously with spontaneous cure.
Correct answer : D
2. Among the following statements about branchial fistula, the incorrect one is that it
a. Commonly results from rupture of a branchial cyst.
b. Usually at the lower third of the anterior border of the sternomastoid muscle.
c. is often bilateral.
d. Discharges clear mucoid fluid.
e. Requires removal of the whole track by the "step-ladder' operation.
Correct answer : C
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5. The commonest swellings in the carotid triangle are:
a.Thyroid nodules
b. Lymphadenopathy
c. Carotid body tumour
d.Branchial cyst
e.Lipoma
Correct answer : B
6. About cold abscess of the neck, all the following statements are true, except:
a.It is usually caused by caseation of tuberculous lymphadenitis
b. The abscess may have two components, one superficial, and one deep to the deep fascia
c.The condition is mildly painful with low-grade fever
d. Anti-tuberculous treatment is an essential part of treatment
e. Drainage is achieved by incision
Correct answer : E
10. All of the following is true about ameloblastoma (previously called adamantinoma)
except………….:
a) It is located near symphysis menti usually.
b) It originates from Mallasez cells.
c) It grows both in horizontal and vertical rami.
d) It has equal lobulations.
Correct answer : A
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11-A43-year-old teacher underwent left parotidectomy. Upon awakening from
surgery, paralysis of the left lower lip was observed. This complication was most likely
due to injury to which of the following:
(A) Parotid duct
(B) Facial nerve - temporal branch
(C) Facial nerve – marginal mandibular branch
(D) Facial nerve - main trunk
(E) Platysma muscle
Correct answer : C
12. A9-year-old boy complains of a swelling on the left side of his neck in the
supraclavicular region. The swelling is translucent; a diagnosis of cystic hygroma is
established. What is true of cystic hygroma?
(A) It arises from sweat glands in the neck.
(B) It is usually an anterior midline structure.
(C) It may occur in the mediastinum.
(D) Its lesions are usually easy to enucleate.
(E) It is premalignant.
Correct answer : C
14-A 58-year-old woman undergoes excision biopsy of a tumor in the left posterior
triangle of her neck. Histology suggests that this is a metastatic cancer. What is the
most likely site of the primary tumor?
(A) Ovary
(B) Adrenal gland
(C) Kidney
(D) Piriform fossa
(E) Stomach
Correct answer : D
15-The classic complete neck dissection for palpable adenopathy in the posterior
triangle of the neck includes removal of which of the following?
(A) The transverse process, C2–C4
(B) The spinal accessory nerve
(C) Both thyroid lobes
(D) The trapezius
(E) The vagus
Correct answer : B
16. A 40-year-old woman is suspected of having a carotid body tumor. Which one of
the following is most characteristic of such a tumor?
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(A) They secrete catecholamines.
(B) They are more common at sea level.
(C) They arise from structures that respond to changes in blood volume.
(D) They arise from the structures that respond to changes in PO2.
(E) They are usually highly malignant.
Correct answer : D
18. What is the most common site for foreign bodies in the head and neck?
(A) Eye
(B) Ear
(C) Nose
(D) Throat
(E) Esophagus
Correct answer : B
19-A 33-year-old female noted a discharge from a sinus in the overlying skin below the
right angle of the mandible. She recalls previous episodes of fullness and mild pain in
this region over the past several years. What is the most likely cause?
(A) Thyroglossal duct cyst
(B) Branchial cyst
(C) Teratoma
(D) Myeloma
(E) Trauma to the neck
Correct answer : B
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22-regarding the pharyngeal pouch which statement is incorrect
a) It protrudes through killian 's dehiscence
b) It usually turns to the left side of the neck
c) It may be visible in the neck
d) It is twice as common in males as in females
Correct answer : D
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29 . True about Branchial cyst is -
A. Mostly arises from 2nd branchial system
B. Cysts are more common than sinuses
C. Sinus should always be operated
D. Causes dysphagia and hoarseness
Correct answer: A
- 403 -
36- Treatment of Ludwig angina includes
a) Amoxicillin plus metronidazole
b) Decompression of both submandibular triangles
c) Tracheostomy
d) All of the above
Correct answer : D
- 404 -
43- All of the following are true regarding cystic hygroma except -
A. May be present at birth
B. Brilliantly trans illuminant
C. Increases in size on coughing
D. Sclerotherapy may be beneficial
Correct answer: D
44- Which of the following is not a landmark for facial nerve during parotid surgery?
A. Inferior belly of omohyoid
B. Digastric muscle
C. Retrograde dissection of distal branch.
D. Tragal pointer
Correct answer: A
49. A patinet is diagnosed to have malignant metstasis in right upper deep cervical
lymph nodes. There are no symptoms to indicate the site of the primary .The possible
primary lesion may be any of the following, except
a. Nasopharyngeal carcinoma
b. Carcinoma of maxillary antrum
c. Papillary carcinoma of thyroid
d. Carcinoma of pyriform fossa of hypopharynx
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e. Laryngeal carcinoma
Correct answer: E
52. A 58-year-old woman undergoes excision biopsy of a tumor in the left posterior
triangleof her neck. Histology suggests that this is a metastatic cancer. What is the
most likely site of the primary tumor?
(A) Ovary
(B) Adrenal gland
(C) Kidney
(D) Piriform fossa
(E) Stomach
Correct answer: D
53.The classic complete neck dissection for palpable adenopathy in the posterior
triangle ofthe neck includes removal of which of the following?
(A) The transverse process, C2–C4
(B) The spinal accessory nerve
(C) Both thyroid lobes
(D) The trapezius
(E) The vagus
Correct answer: B
54. A 40-year-old woman is suspected of having a carotid body tumor. Which one of
the following is most characteristic of such a tumor?
(A) They secrete catecholamines.
(B) They are more common at sea level.
(C) They arise from structures that respond to changes in blood volume.
(D) They arise from the structures that respond to changes in PO2.
(E) They are usually highly malignant.
Correct answer: D
- 406 -
(C) Injury to the recurrent laryngeal nerve
(D) Injury to the superior laryngeal nerve
(E) Scar tissue extending to the vocal cords
Correct answer: C
- 407 -
62. Thyroglossal cyst may occasionally give rise to which carcinoma ?
a- papillary
b- anaplastic
c- medullary
d- follicular
Correct answer: A
67. Which of the following gene defects is associated with development of the
medullary carcinoma of the thyroid ?
a- RET proto oncogene
b- FAP gene
c- RB gene
d- BRCA 1 gene
Correct answer: A
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69. RET gene is located on which chromosome ?
a- 5th chromosome.
b-13chromosome.
c-10thchromosome.
d.17 chromosome.
Correct answer: C
71. Psammoma bodies are seen in all of the following conditions except ?
a- serous cystadenoma of ovary
b- papillary carcinoma of thyroid
c- meningioma
d- mucinouscystadenoma of ovary
Correct answer: D
74. a patient presented with headache and flushing . he has a family history of his
relative having died of a thyroid tumor. The investigation that would be required for
this patient will be ?
a- chest x-ray
b- measurement of 5-HIAA
c- measurement of catecholamine
d- intravenous pyelography
Correct answer: C
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76. Mutated p53 gene is formed in most of ?
a- anaplastic carcinomas
b- PCT
c- MCT
d- FCT
Correct answer: A
77. The most precise diagnostic screening procedure for differentiating benign thyroid
nodules from malignant ones is:
A. Thyroid ultrasonography.
B. Thyroid scant scan.
C. Fine-needle-aspiration biopsy (FNAB).
D. Thyroid hormone suppression.
Correct answer: C
78. The preferred operation for initial management of a thyroid nodule that is
considered suspicious for malignancy by FNAB is:
A. Excision.
B. Partial lobectomy.
C. Total lobectomy and isthmectomy.
D. Total thyroidectomy.
Correct answer: C
80. All of the following are components of the MEN type 2B syndrome except:
A. Multiple neuromas on the lips, tongue, and oral mucosa.
B. Hyperparathyroidism.
C. MTC.
D. Pheochromocytoma.
Correct answer: B
81. MEN 2A and MEN 2B syndromes are associated with germline mutations in:
A. The p53 tumor suppressor gene.
B. The H-ras gene.
C. The N-myc gene.
D. The RET prota-oncogene.
Correct answer: D
82. Radioactive iodine is effective treatment for metastatic lung disease for which of
the following thyroid neoplasms?
a. Hürthle cell carcinoma
b. Papillary carcinoma
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c. Follicular carcinoma
d. B+C
e. Medullary carcinoma
f. Anaplastic carcinoma
Correct answer: D
83. A 45-year-old woman has a solitary, nonfunctioning thyroid nodule and fine
needle cytology is non-diagnostic. Which of the following is the initial surgical
procedure of choice?
a. Total extracapsular thyroidectomy
b. Subtotal thyroid lobectomy and resection of the isthmus
c. Total extracapsular thyroid lobectomy, resection of the isthmus, and modified
unilateral neck dissection
d. Total extracapsular thyroid lobectomy and resection of the isthmus
Correct answer: D
84. Which of the following statements regarding medullary carcinoma of the thyroid
are true?
a. Approximately 75% of all cases are hereditary
b. The overall 10-year survival rate is less than 10%
c. Medullary carcinoma of the thyroid is associated with both multiple endocrine
neoplasia IIa (MEN IIa) and multiple endocrine neoplasia IIb (MEN IIb) syndromes
d. Prophylactic total thyroidectomy is recommended for MEN IIa and MEN IIb
patients after the age of 10 years
Correct answer: C
85. A 50-year-old male has undergone an ipsilateral thyroid lobectomy and isthmus
resection for what appeared on frozen section to be a benign nodular lesion 2.0 cm in
diameter. 72 hours later the final pathology returns and the diagnosis is a high-grade
angioinvasive follicular carcinoma. What do you recommend?
a. 99mTc bone scan to rule out occult bone metastases
b. Ipsilateral radical neck dissection
c. Total thyroidectomy
d.Observation with sequential 131I scans every 3 months
Correct answer: C
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c. Hypercalcemia causing mental status changes
d. Atrophy of Type II muscle fibers
e. Osteitisfibrosacystica
Correct answer: E
91 . A 5-year-old patient has a midline neck mass that moves with swallowing and is
located just the hyoid. The mass is most likely to be a -
A. Branchial cleft cyst
B. Cystic hygroma
C. Teratoma
D. Thyroglossal duct cyst
Correct answer: D
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94 .Cystic hygroma in the neck -
A. Develops from sequestration of jugular lymph channels
B. Is lined by stratified epithelium
C. Is nontransilluminant
D. Is lined by columnar epithelium
Correct answer: A
97 . In post radical neck dissection shoulder syndrome, are all seen except -
A. Shoulder drooping
B. Normal electromyographic finding
C. Restricted range of movement
D. Pain
Correct answer: B
98 . Prineural invasion in head and neck cancer is most commonly seen in-
A. Adenoid cystic carcinoma.
B. Adenocarcinoma.
C. Squamous cell carcinoma.
D. Basal Cell Adenoma.
Correct answer: A
99-Laryngocele is common to
a) Trumpet blowers
b) Glass blowers
c) Patient of chronic cough
d) All of the above
Correct answer : D
- 413 -
101-of the 800 lymph node of the body lymph nodes in the neck is aroud
a) 100
b) 200
c) 300
d) 400
Correct answer : C
102-in radical neck dissection all the following are removed except
a) Accessory nerve
b) Internal jugular vein
c) Carotid artery
d) Submandibular gland
e) Sternomastoid muscle
Correct answer : C
103-cystic hygroma is a
a) Haemangioma
b) Sebaceous gland tumour
c) Meningioma
d) Lymphangioma
Correct answer : D
- 414 -
30- ORAL CAVITY
1. A T2 malignant tumor of the oral cavity near the mandible is best treated
with .
A.Radiotherapy
B.Chemotherapy
C.Surgery
D.Laser ablation
Correct answer C
31- ENT
1.Bezold's abscess is seen at
A.petrous tip
B.Mastoid tip
C.digastric triangle
D.subdurally
Correct answer B
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D.bleeding is present
Correct answer B
9. For Grommet tube insertion in serous otitis media, the incision on tympanic
membrane is made on
A.anteroinferior quadrant
B.anterosuperior quadrant
C.posterosuperior quadrant
D.posteroinferior quadrant
Correct answer A
- 416 -
10. What is the symptom of a person with unilateral abductor paralysis
A.dyspnea on exertion
B.transient hoarseness
C.husky voice
D.inspiratory stridor
Correct answer B
32- EYE
- 417 -
D.Hydroxy amphetamine
Correct answer D
6. Steroid may be used in the treatment of which of the following type of herpes
keratitis
A. Superficial punctate keratitis
B. Dendritic ulcer
C. Geographic ulcer
D. Disciform keratitis
Correct answer D
7. Which of the following is the cause of blindness in partial retinal branch vein
occlusion
A. Cystoid macular edema
B. Macular hemorrhage
C. Vitreous hemorrhage
Correct answer A
- 418 -
D. developmental cataract
Correct answer C
1. A43-year-old window cleaner fell off a scaffold. He sustained an open wound on the
right leg. Debridement was carried out in the emergency department, and the edges of
the wound were left open. The wound measures 4 cm x 6 cm. What is TRUE of wound
contraction?
(A) It occurs within 12 hours of injury.
(B) It is more prominent over the tibia than gluteal region.
(C) It is accelerated if wound is excised 3 days after injury.
(D) It accounts for excessive fibrous tissue formation and fixation of tissue around a
joint.
(E) It is experimentally less affected by excision of tissue from center of wound rather
than at the periphery.
Correct answer: E
- 419 -
2. Which factor is least likely to inhibit wound contraction?
(A) Radiation
(B) Cytolytic drug
(C) Transformation growth factor b
(D) Full-thickness skin graft
(E) External splints
Correct answer: E
4. A12-year-old boy has multiple skin lesions that are diagnosed as von
Recklinghausen’s syndrome (NF 1). What is TRUE of this condition?
(A) It does not show other malignant lesions.
(B) It is autosomal recessive.
(C) It is associated with optic nerve gliomas.
(D) It is characterized by AV malformation.
(E) It is associated with dermoid
Correct answer: C
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8. Sebaceous cyst is characterized by the following except that it:
a. ls due to obstruction of a sebaceous gland.
b. ls lined by stratified squamous epithelium.
c. Contains yellow poultices greasy material known as sebum.
d. Moy occur on the palms and soles
e. ls always anchored to the overlying skin at punctum of the obstructed gland.
Correct answer: d
9. The untrue statement about desmoid tumors of the abdominal wall is that they
:
a. Arise from the rectus muscle or its sheath.
b. Occur most often in multiparous women.
c. Are locally invasive.
d. May give rise to metastasis.
e. Should be treated by wide local excision
Correct answer: D
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15. Scabies in children differs from that in adults in that it affects
A. webspace
B. face
C. genitalia
D. axilla
Correct answer: B
16. A smear from a genital lesion shows Donovan bodies. The diagnosis is
A. Lymphogranuloma venereal
B. Chancroid
C. Granuloma inguinal
Correct answer C
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22 . A keratin horns
A. Arises from sebaceous cyst
B. Is a papilloma with excess keratin formation
C. Is due to matting of hair
D. Is congenital
Correct answer: A
26 . A patient comes with rectal carcinoma situated 6 cm above dentate line with
no nodal metastasis The treatment of choice will be -
A. Ant resection
B. APR
C. Radiotherapy
D. Hartman's procedure
Correct answer: A
27. A12-year-old boy has multiple skin lesions that are diagnosed as von
Recklinghausen’s syndrome (NF-1). What is TRUE of this condition?
(A) It does not show other malignant lesions.
(B) It is autosomal recessive.
(C) It is associated with optic nerve gliomas.
(D) It is characterized by atrioventricular (AV) malformation.
(E) It is associated with dermoid
Correct answer: C
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28 . Most common tumor to produce metastasis to cervical lymph nodes
A. Glottic Ca
B. Nasopharyngeal carcinoma
C. Ca Base of tongue
D. Ca lip
Correct answer: B
32 . Which of the following causes second degree upper cervical lymph node
metastasis:
A. Nasopharyngeal carcinoma
B. Breast carcinoma
C. Lung carcinoma
D. Thyroid carcinoma
Correct answer: A
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C. Trichomonas
D. Candida
Correct answer A
2. A pregnant women presents with a placenta praevia of a major degree. The foetus is
malformed. Which of the following will be the best line on management
A. cesarian section
B. oxytocin drip
C. rupture of membranes
D. instillation of PG E2
Correct answer A
8. A pregnant woman with Mitral stenosis is most likely to undergo failure in which
period
A.16wks
B.24wks
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C.20wks
D.28wks
Correct answer D
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Correct answer A
20. If a patient comes with complaints of post dated pregnancy what is the first thing
that you will do
A. USG
B. NST
C. Review the menstrual history once more
D. X-ray abdomen
Correct answer C
22. A 25-year-old woman is noted to have a solid and cystic right ovarian mass
measuring 10 cm on ultrasound. Which of the following is the most likely histologic
subtype?
A. Serous
B. Mucinous
C. Brenner
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D. Teratoma
E. Fibroma
Correct answer: D
25. Which of the following is NOT a risk factor for cervical cancer?
a. Multiple sexual partners
b. Condom usage
c. HPV infection
d. HIV infection
e. Smoking
Correct answer: B
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29. A 4-year-old girl is noted to have breast enlargement and vaginal bleeding. On
physical examination, she is noted to have a 9-cm pelvic mass. Which of the
following is the most likely etiology?
A. Cystic teratoma
B. Dysgerminoma
C. Endodermal sinus tumor
D. Granulosa cell tumor
E. Mucinous tumor
Correct answer: D
(2) Follicular lymphomas in childhood differ from adult-onset disease in all except:
1. Bcl-6 expression
2. Prognosis
3. Treatment
4. Pathogenesis
Correct answer: 1
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(5) Most common site of myoepithelial carcinoma is-
1. Submandibular salivary gland
2. Parotid gland
3. Sartorius muscle
4. Breast
Correct answer: 2
(8) Which one of the following is the characteristic radiological feature of myoepithelial
carcinoma
1. Low T1 and low T2 signal intensity and indistinct margin on MRI scan
2. Low T1 but high T2 signal intensity with distinct margin on MRI scan
3. Low T1 and low T2 signal intensity and distinct margin on MRI scan
4. Low T1 but high T2 signal intensity with indistinct margin on MRI scan
Correct answer: 1
(9) What criterion is customarily used to define mediastinal lymph nodes visualized by
computed tomography (CT) as being pathologic?
1. >1 cm on short axis
2. >1 cm on long axis
3. 2.5 cm on short axis
4. >2.5 cm on long axis
Correct answer: 1
(10) In patients with NSCLC, what proportion of patients with enlarged nodes on CT have no
evidence of neoplastic disease at surgical exploration of the mediastinum?
1. 5%
2. 15%
3. 30%
4. 45%
Correct answer: 3
(11) Which of the following most accurately characterizes the value of magnetic resonance
imaging (MRI) in comparison with CT in evaluation of mediastinal lymph nodes?
1. More sensitive
2. More specific
3. Less effective
4. Similar outcomes
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Correct answer: 4
(12) A 50 year old man presented with 3 month history of right sided cervical lymphnode
enlargements.The best investigation to establish the diagnosis in this case would be:
A. Tuberaulin test
B. Lymph-node biopsy
C. FNAC
D. X-ray
Correct answer: B
36- GIT
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5-The following are radiologic finding ln TB enteritis:
a- Sterlin's sign is characteristic of ulcerative type
b- Hypertrophic type always show distortion and elevation of coecum
c- Hypertrophic type always show narrow ileum
d- None of the above
Correct answer: D
7-True statements about chronic duodenal ulcers do not lnclude that they:
a- Are never malignant.
b- Occur equally in both sexes.
c- Produce epigastric pain several hours after eating.
d- Hove a periodic clinical course.
e- May heal under medical treatment.
Correct answer: B
10- Among the following statements about Crohn's disease, lt is untrue that it :
a. ls commonest in the third decode.
b. Always involves the terminal ileum,
c. ls a segmental granulomatous lesion affecting all coots of the bowel
and the related mesentery.
d. May be associated with skip areas and anorectal lesions.
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e. Should be managed medically whenever possible.
Correct answer: B
12- The least common site for cancer in the alimentary tract is:
a. Pharynx.
b. Esophagus.
c. Stomach.
d. Small bowel.
e. Colon and rectum.
Correct answer: D
16- As regard hydrostatic barium reduction of intussusception all are correct except:
a. Should be tried in all cases.
b. Successful in about half of cases.
c. Success is proved by filling of terminal ileum.
d. May be complicated by perforation.
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Correct answer: A
19- The most common cause of death in low intestinal obstruction is:
a. Toxemia.
b. Dehydration.
c. Electrolyte imbalance.
d. Generalized peritonitis.
Correct answer: A
21- The following types of intestinal obstruction may present without absolute
constipation except:
a. Early cases of high intestinal obstruction
b. Gall stone ileus.
c. Mesenteric vascular occlusion.
d. Paralytic ileus.
e. Richter's hernia.
Correct answer: D
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23- The following are recognized causes of paralytic ileus. The most common is:
a. Diabetic ketoacidosis.
b. Drugs.
c. Peritoneal irritation.
d. Postoperative.
e. Spinal injury.
Correct answer: D
25- The most common injured artery in mesenteric vascular occlusion is:
a. Celiac artery.
b. Gastroduodenal artery.
c. Superior mesenteric artery.
d. inferior mesenteric artery.
Correct answer: C
26- In children and adolescents, the commonest cause of intestinal obstruction is:
a. Adhesions
b. lntussusception
c. Strangulated hernias
d. Neoplasm
e. Paralytic ileus
Correct answer: C
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29- Example of third space sequestration is:
a. Burn
b. Fracture hematoma
c. Small bowel obstruction
d. All of the above
Correct answer: D
30- A 20-year-old man swallowed two open safety pins. X-rays show pins in the small
intestine, the most appropriate management of this point is:
a. lV antibiotics
b. 250 ml magnesium citrate orally
c. lmmediate surgery
d. Serial abdominal exam and x-rays if required
Correct answer: D
34 . In case of choledochal cyst, bile diversion into the small intestine is not done
because of the risk of:
A. Malignancy
B. Pancreatitis
C. Recurrent Cholangitis
D. Gall stones
Correct answer: C
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37- PSYCHIATRY
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280 Others
38- Others
9 . In the acronym 'SWELLING' used for the history and examination of a lump
or swelling, the letter 'N' stands for -
A. Nodes
B. Noise (Thrill/bruit)
C. Numbness
D. Neurological effects
Correct answer: B
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14 . Which of the following is the most common site of cholangiocarcinoma?
A. Hilum
B. Distal biliary duct
C. Multifocal
D. Intrahepatic duct
Correct answer: A
15 . In the Forrest classification for bleeding peptic ulcer with a visible vessel it is
classified as -
A. FI
B. FI Ia
C. FII b
D. FII
Correct answer: B
17 . In a patient with diffusive liver disease, platelet count of less than 50000, the
procedure of choice for liver biopsy is -
A. Plugged liver biopsy
B. Laparoscopic liver biopsy
C. Trans jugular liver biopsy
D. Laparotomy and wedge biopsy
Correct answer: C
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20 . True about Warthin's tumor is ?
A. Pleomorphic adenoma
B. Cystadenoma lymphomatous
C. Most common parotid tumor
D. Malignant tumor
Correct answer: B
21 . A 35 years male patient presented with left sided abdominal pain to the
emergency room 6 hours after an RTA. He was hemodynamically stable and
FAST positive. Contrast Enhanced CT(CECT)scan showed grade III splenic
laceration. The most appropriate management is-
A. Splenorrhaphy
B. Splenectomy
C. Conservative Management
D. Splenic Artery Embolization
Correct answer: D
22 . In carcinoma cheek what is the best drug for single drug chemotherapy -
A. Vincristine
B. Cyclophosphamide
C. Cisplatin
D. Daunorubicin
Correct answer: C
23 . A 16 years male patient with ITP has a platelet count of 50,000 and is being
planned for splenectomy. The best time for platelet infusion in this patient is-
A. At the time of skin incision
B. 2 hours before surgery
C. Immediately after removal of spleen
D. After ligating the splenic artery
Correct answer: D
26 . Treatment of choice for squamous cell carcinoma of anus below dentate line
is ?
A. Chemotherapy
B. Wide local excision
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C. Sphincter sparing surgery
D. Monoclonal antibodies
Correct answer: B
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B. Metabolic acidosis with paradoxical alkaluria
C. Metabolic alkalosis with paradoxical bicarbonaturia
D. Metabolic acidosis with paradoxical bicarbonaturia
Correct answer: A
34 . Critical limb ischemia occurs when the ankle-brachial index falls to below -
A. 0.3
B. 0.5
C. 0.9
D. 1.0
Correct answer: A
36 . Ganglion is ?
A. Collection of neurons in CNS
B. Collection of neurons outside CNS
C. Collection of dendrites
D. Any collection of neurons
Correct answer: B
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C. Direct contact
D. Lymphatic spread
Correct answer: B
41 . After 30% loss of blood volume in road traffic accident. What next m/n is to
be given:
A. IV fluid only
B. IV fluid with cardiac stimulant
C. Dopamine
D. Vasopressor drug
Correct answer: A
42 . 50-year-old male with positive family history of prostate cancer has come to
you for a screening test. The most sensitive screening test to pick up prostate
cancer is:
A. DRE
B. PSA
C. DRE+PSA
D. Endorectal Coil MRI with T1W and T2W images
Correct answer: C
43 . 15 years old girl, regular swimmer presents with sudden onset of pain in
abdomen, abdominal distension and fever of 39 degree C and obliteration of the
liver dullness. Most probable diagnosis is:
A. Ruptured typhoid ulcer
B. Primary bacterial peritonitis
C. Ruptured ectopic pregnancy
D. UTI with PID
Correct answer: A
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C. Idiopathic pancreatitis
D. Post operative pancreatitis
Correct answer: A
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53 . In which of the following patients, thyrotoxicosis should not be suspected -
A. Patients with unexplained weight loss
B. Patients with unexplained diarrhea
C. Patients with distal muscle weakness
D. Patients with paroxysmal atrial tachycardia
Correct answer: C
55 . A chronic Alcoholic present with abdominal pain radiating to the back that
responds to analgesics. At evaluation the pancreatic duct was found to be dilated
and stones were noted in the tail of pancreas. The most appropriate management
is:
A. Percutaneous removal of stone
B. Medical management
C. Pancreatic Tail Resection
D. Pancreatico Jejunostomy
Correct answer: B
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C. Payers patch hypertrophy
D. Mekell’s diverticulum
Correct answer: C
62 . A patient presential with local gigantism of the leg and increased pulsations
of the lower limb veins. Most probable diagnosis is:
A. Tumor
B. AV fistula
C. Varicose veins
D. Incompetence of the saphenofemoral junction
Correct answer: B
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66 . Which of the following is resistant to lithotripsy?
A. Triple phosphate stone
B. Calcium oxalate
C. Uric acid stone
D. Cystine stone
Correct answer: D
71 . A patient comes with stage III non seminomatous testicular tumor the
treatment of choice is
A. Radiotherapy
B. Chemotherapy
C. Hormonal therapy
D. Surgery
Correct answer: B
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73 . Treatment of duodenal atresia is ?
A. Roux- en-y procedure
B. Duodenoduodenostomy
C. Duodenojejunostomy
D. Duodenal canalization
Correct answer: B
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80 . A decubitus ulcer is
A. A venous ulcer
B. An ulcer in the region of the elbow
C. A pressure sores
D. An ulcer of the tongue
Correct answer: C
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87 . Stain used to diagnose premalignant lesion of lip is ?
A. Crystal violet
B. H and E
C. Toluidine blue
D. Giemsa
Correct answer: C
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Correct answer: C
96 . Occupations at risk for bladder cancer include all of the following EXCEPT
A. X-ray technicians
B. Textile workers
C. Petrol workers
D. Painters
Correct answer: A
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100 . Commonest site of a rodent ulcer is
A. Limbs
B. Face
C. Abdomen
D. Trunk
Correct answer: B
103 . Which of the following is the gold standard test for insulinoma?
A. C-peptide levels
B. Low glucose levels < 30 mg/dL
C. 72 hr fasting test
D. Plasma insulin levels
Correct answer: C
105 . All of the following are features of Zollinger Ellison syndrome except -
A. Intractable peptic ulcers
B. Severe diarrhea
C. Beta cell tumours of the pancreas
D. Very high acid output
Correct answer: C
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107 . All of the following are used in pneumatosis cystoids intestinalis except -
A. High flow oxygen
B. Albendazole
C. Metronidazole
D. Sulphasalazine
Correct answer: B
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114 . 66 years previously healthy man is admitted to a hospital because of a closed
head injury and ruptured spleen following a roadside automobile accident. During
the first 4 days of hospitalization, following laparotomy and splenectomy, he
receives 5% dextrose 0.5% normal saline solution at a rate of 125mL/h. Recorded
daily fluid outputs include 450 to 600mL of nasogastric drainage and 700 to 1000
mL of urine. The patient is somnolent but easily aroused until the morning of the
5th hospital day, when he noted to be in deep coma. By the after-noon, he begins
having seizures. The following laboratory data are obtained: Serum
electrolytes(meq L):Na+128:K+1.8;Cl-94;HCO3-19.Serum osmolality : 260m
Osm/L; Urine electrolytes (meq/L):Na+61;K+18.Which of the following about
diagnosis or treatment of this patient's is true:
A. Secondary to metabolic acidosis their is hypokalemia
B. Emergency carotid arteriogram to be done
C. IV infusion of 20ml of 50% MgSO4 given for 4 hrs.
D. A small quantity of hypertonic saline to be given
Correct answer: D
115 . DTPA scan of hypertensive young lady is normal, USG shows small kidney
on left side. Next investigation will be:
A. CT Scan abdomen
B. Retrograde pyelogram
C. Digital subtraction angiography
D. DMSA
Correct answer: C
116 . Which is not elevated in a child presenting with jaundice, icterus, pruritus
and clay colored stools -
A. Gamma glutamyl transpeptidase
B. Alkaline phosphatase
C. 5'-nucleosidase
D. Glutamate dehydrogenase
Correct answer: D
118 . Which among the following is not a feature of peripheral arterial occlusion?
A. Shock
B. Pallor
C. Pain
D. Pulselessness
Correct answer: A
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119 . Following tumour may regress spontaneously except
A. Malignant melanoma
B. Retinoblastoma
C. Choriocarcinoma
D. Osteosarcoma
Correct answer: D
123 . For differentiating Inguinal hernia and femoral hernia the landmark will
be -
A. Pubic symphysis
B. Femoral artery
C. Inferior epigastric vessel
D. Pubic tubercle
Correct answer: D
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Correct answer: A
129 . A 60 year diabetic and hypertensive male with second grade prostatism
admitted for prostatectomy developed myocardial infarction. Treatment now
would be:
A. Terazocin
B. Finasteride
C. Diethyl stilbestrol
D. Finasteride and terazocin
Correct answer: A
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132 . Most common site for abscess after laparotomy is:
A. Pelvic
B. Subphrenic
C. Subhepatic
D. Paracolic
Correct answer: A
137 . A 8 years child presents with an expansile swelling on medial side of the
nose. Possible diagnosis is:
A. Meningocele
B. Teratoma
C. Lipoma
D. Dermoid cyst
Correct answer: A
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139 . How do you get an ideal scar ?
A. Achieve quiet, secondary healing
B. Ensure tight closure of the skin
C. Give antibiotics
D. Minimize tension
Correct answer: D
143. A child presents with raised ICT, on CT, scan a lesion is seen around
foramen of Monroe and multiple periventricular calcific foci. What is the
probable diagnosis ?
A. Central Neurocytoma
B. Ependymoma
C. Subependymal Giant cell Astrocytoma
D. Ganglioglioma
Correct answer: C
144 . 7 - years girl who has non-pitting edema of recent onset affecting her right
leg but no other symptoms is refer for evaluation. Which of the following is true
about her?
A. A lymphangiogram will show hypoplasia of the lymphatics
B. Prophylactic antibodies are indicated
C. A variety of operations will ultimately lead to a normal appearance of the limb
D. Elastic stocking and diuretics will lead to a normal appearance of the limb
Correct answer: A
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D. Inner lower quadrant of buttock
Correct answer: C
146 . The length of the feeding tube to be inserted for transpyloric feeding is
measured from the tip of:
A. Nose to the umbilicus
B. Ear lobe to the umbilicus
C. Nose to the knee joint
D. Ear lobe to the knee joint
Correct answer: B
148 . Which of the following is the treatment for achalasia associated with high
rate of recurrence?
A. Open surgical myotomy
B. Botullin toxin
C. Pneumatic dilatation
D. Laproscopic myotomy
Correct answer: B
149 . A 60-year-old smoker came with a history of painless gross hematuria for
one day. Most logical investigation would be
A. Urine routine
B. Plain X-ray KUB
C. USG KUB
D. Urine microscopy for malignant cytology
Correct answer: D
150 . A 50 years old woman presented with history of recurrent episodes of right
upper abdominal pain for the last one year. She presented to casualty with history
of jaundice and fever for 4 days. On examination, the patient appeared toxic and
had a blood pressure of 90/60 mmHg. She was started on intravenous antibiotics.
Ultrasound of the abdomen showed presence of stones in the common bile duct.
What would be the best treatment option for her?
A. ERCP and bile duct stone extraction
B. Laparoscopic cholecystectomy
C. Open surgery and bile duct stone extraction
D. Lithotripsy
Correct answer: A
151 . Smoking may be associated with all of the following cancer's Except:
A. Ca Nasopharynx
B. Ca Larynx
C. Ca Esophagus
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D. Ca Bladder
Correct answer: A
154 . A 30 year old male patient presents with sudden onset swelling and pain over
the right hemiscrotum. On examination the scrotum is reddened and tender.
Which of the following statement about the affecting condition is not true?
A. If torsion confirmed, treat with antibiotics and analgesics, and perform corrective
surgery immediately
B. If torsion confirmed, treat with antibiotics and analgesics, and perform corrective
surgery after 14 days
C. Probable diagnosis is torsion
D. The right testis is likely to ride high in the scrotal compartment.
Correct answer: B
157 . All the following statements are true regarding Malignant Parotid Gland
Tumors except -
A. Painful
B. Presents with skin Ulceration
C. Cervical Lymphadenopathy present
D. Facial nerve involvement
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Correct answer: B
158 . What will be the diagnosis of 45 years old male with history of chronic
smoking and pain in lower limb due to blockage of femoral artery -
A. Thromboangitis obliterans
B. Atherosclerosis
C. Embolism
D. Arteritis
Correct answer: B
160 . A 27 years patient with head injury opens eyes to painful stimulus, uses
inappropriate words, and localizes pain. His GCS score is-
A. 10
B. 8
C. 14
D. 12
Correct answer: A
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D. Cannot be used for reconstruction after excision of ORA cancer
Correct answer: A
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Correct answer: C
175 . All hernias involving bowel that reach the stage of vascular compromise, do
cause symptom signs of intestinal obstruction, except -
A. Sciatic hernia
B. Littre's hernia
C. Cloquet's hernia
D. Serafini's hernia
Correct answer: B
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178 . All of the following are true of congenital cystic kidneys EXCEPT
A. It is transmitted as an autosomal dominant trait
B. It manifests clinically at a young age
C. The lungs may also be affected
D. Unilateral swelling may be palpable
Correct answer: B
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185 . Emergency Thoracotomy is done in
A. Cardiac tamponade
B. Massive pneumothorax
C. Clotted hemothorax
D. Haemorrhage of more than 200 ml/hr for more than three hours
Correct answer: D
187 . When PCNL is done through 11th intercostals space, one may expect
A. Damage to colon
B. Remnants fragments
C. Hydrothorax
D. Hematuria
Correct answer: C
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Correct answer: D
195 . Which of the following is the treatment of choice for squamous cell anal
cancer?
A. Laser fulguration
B. Abdominoperineal resection
C. Platinum-based chemotherapy
D. Chemoradiotherapy
Correct answer: D
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D. Loose areolar tissue
Correct answer: D
202 . 25 years old patient presented with mass in rt iliac fossa. Which after
laparotomy was found to be carcinoid of 2.5 cm in diameter. What will be the
next step in management?
A. Segmental resection
B. Appendicectomy
C. Rt. hemicolectomy
D. Do yearly 5 HIAA assay
Correct answer: C
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D. Blood borne metastasis are often seen
Correct answer: C
211 . A 33 years patient suddenly experienced pain radiating along the medial
border of the dorsum of foot. Which nerve is most likely to be accidently ligated-
?
A. Saphenous nerve
B. Sural nerve
C. Genicular nerve
D. Deep peroneal nerve
Correct answer: A
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212 . The following are true about Hepatocellular carcinoma except:
A. It has a high incidence in East Africa and South-east Asia
B. Its worldwide incidence parallels the prevalence of Hepatitis B
C. Over 80% of tumours are surgically resectable
D. Liver transplantation offers the only chance of cure in those with irresectable
disease
Correct answer: C
213 . Which one is not the bad prognostic sign for pancreatitis?
A. TLC >16000
B. Calcium less than 8 mmol/L
C. Glucose > 200 mg%
D. Prothrombin >2 times the control
Correct answer: D
216 . Which of the following is the most common cysts of the spleen?
A. Pseudo cyst
B. Lymphangioma
C. Hydatid cyst
D. Dermatoid cyst
Correct answer: C
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219 . Dysphagia Iusoria is due to:
A. Ca larynx
B. Esophageal web
C. Esophageal diverticulum
D. Compression by aberrant blood vessel
Correct answer: D
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Correct answer: B
227 . The most appropriate site for pluri sentesis done by inserting a needle in an
adult is:
A. 7th intercostal space in mid axillary's bone
B. 5th intercostals space in midclavicular line
C. 10th intercostal space adjacent to the vertebral column
D. 2nd intercostals space adjacent to the sternum
Correct answer: A
228 . A 60 year old man presented with dysphagia. After 4 months he improved
without any treatment. Investigation of choice in this case-
A. Upper GI endoscopy
B. CT scan
C. Manometric examination
D. Barium swallow
Correct answer: D
230 . Resection of 90% of the ileum and jejunum causes all the following except
A. Hypogastrinemia
B. Steatorrhea
C. Anemia
D. Extracellular volume depletion
Correct answer: A
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232 . The least painful surgical approach to the heart and lungs is -
A. Median sternotomy
B. Posterolateral thoracotomy
C. Anterolateral thoracotomy
D. Transverse sternal splitting thoracotomy
Correct answer: A
233 . All of the following statements regarding bronchial cysts are true except:
A. Are commonly infected
B. Multilocular
C. Seen in mediastinum
D. 50-70% occur in lung
Correct answer: B
234 . Foreign body aspiration in supine position causes which of the following
parts of the lung commonly to be affected:
A. Apical left lobe
B. Apical lobe of right lung
C. Apical part of the lower lobe
D. Posterobasal segment of left lung
Correct answer: C
235 . A lady had Meningioma with inflammatory edematous lesion. She has
planned for surgery. Junior resident's mistake in writing pre-op notes is -
A. Stop Steroids
B. Wash head with shampoo
C. Antibiotic Sensitivity
D. Continue antiepileptics
Correct answer: A
236 . Which of the following is the most common site of Morgagni hernia?
A. Left anterior
B. Left posterior
C. Right anterior
D. Right posterior
Correct answer: C
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Correct answer: A
241 . After rupture of middle meningeal artery bleeding occurs in which region -
A. Subdural bleed
B. Extradural bleed
C. Intracerebral bleed
D. Subarachnoid bleed
Correct answer: B
242 . 60 years woman, has a left femoral venous thrombosis during a pregnancy
30 year ago. The left greater saphenous vein had been stripped at age 21 She now
presents with a large non healing ulceration over the medical left calf, which has
continuously progressed despite bedrest, elevation, and use of a support stocking.
Descending phlebography of the left leg demonstrates a patent deep venous
system, with free flow of dye from the groin to foot. The first profunda femoris
valve is competent. Which of the following is appropriate management?
A. Ligated iliofemoral venous thrombectomy with creation of the temporary
arteriovenous fistula
B. Subfascial ligation of perforating veins in the left calf
C. Division of the superficial femoral vein in the groin and transposition of its distal
end onto the profunda femoris vein below the level of the competent profunda valve
D. Saphenous venous crossover graft with anastomosis of the end of the right
saphenous vein onto the side of competent femoral vein
Correct answer: C
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244 . In BPH most common lobe involved is
A. Lateral
B. Posterior
C. Median
D. Anterior
Correct answer: C
248 . A male baby with vigorous feeding and immediate vomiting at 2 months of
age. Most possible diagnosis is -
A. Brain tumor
B. Congenital hypertrophic pyloric stenosis
C. Paralytic ileus
D. Hirschsprung's disease
Correct answer: B
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250 . Most common tumor of parotid gland is -
A. Squamous cell carcinoma
B. Pleomorphic adenoma
C. Adenolymphoma
D. None of the above
Correct answer: B
252 . Which of the following is the preferred treatment modality for annual
pancreas
A. Whipple's operation
B. Duodena-jejunostomy
C. Gastro-jejunostomy
D. Jejuna-cystostomy
Correct answer: B
253 . A 50 years old male patient, an alcoholic and smoker presents with a 3 hour
history of severe retrosternal chest pain and increasing shortness of breath. He
started having this pain while eating, which was constant and radiated to the back
and interscapular region. He was a known hypertensive. On examination, he was
cold and clammy with a heart rate of 130/min, and a BP of 80/40 mmHg. JVP was
normal. All peripheral pulses were present and equal. Breath sounds were
decreased at the left lung base and chest x-ray showed left pleural effusion. What
is the most likely diagnosis?
A. Acute aortic dissection
B. Acute myocardial infarction
C. Rupture of the esophagus
D. Acute pulmonary embolism
Correct answer: A
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278 . Which of the following microscopic features is typical of Paget's disease -
A. Presence of large vacuolated cells
B. Epidermal hypertrophy
C. Subdermal round cell infiltration
D. All of the above
Correct answer: A
279 . Which malignancy of parotid gland spreads through the neural sheath
A. Adenoid cystic carcinoma
B. Adenocarcinoma
C. Pleomorphic adenoma with malignant change
D. Sarcoma
Correct answer: A
281 . Minimum nitrogen required for an adult with dynamic tissue turnover to
maintain a positive nitrogen balance is -
A. 3.5-4.5 g
B. 5.5-6.6 g
C. 7.5-8.5 g
D. 9.5-10.5 g
Correct answer: B
283 . In Video assisted thoracoscopic surgery for better vision the space in the
operative field is created by:
A. Self retaining retractor
B. CO2 insufflations
C. Collapse of ipsilateral lung
D. Rib spacing
Correct answer: C
- 477 -
285 . Chronic paronychia is caused by
A. Mycobacterium tuberculosis
B. Improper treatment of acute paronychia
C. Fungal infection
D. Repeated trauma
Correct answer: C
286 . A 25 year old boy reports 36 hours following a RTA with splenic injury-
100/60 mm Hg and pulse-180/minute. Investigations show splenic lower pole
laceration with hemoperitoneum. The patient is resuscitated with blood
transfusion and adequate fluid to the extend BP-120/80 mm Hg and pulse-
80/minute. Next step in management would be:
A. Splenorraphy
B. Lower pole excision
C. Splenectomy
D. Observation with close monitoring and no surgery until further deterioration
Correct answer: D
- 478 -
291 . Increase in resting metabolic expenditure is seen maximally following
A. Selective surgery
B. Multiple fractures
C. Peritonitis
D. Burns
Correct answer: A
292 . Line of surgical division of the liver into left and right lobes is:
A. Gall bladder fossa to IVC
B. Gall bladder fossa to the bare area
C. IVC to falciform ligament
D. Falciform ligament to diaphragm
Correct answer: A
295 . A 58 years has h/o IHD and atherosclerosis. He presents with abdominal
pain and maroon stools: Possible diagnosis is:
A. Acute mesenteric ischemia
B. Acute intestinal obstruction
C. Appendicitis
D. Peritonitis
Correct answer: A
- 479 -
298 . A surgeon exercises a portion of liver to the left of the attachment of the
falciform ligament. The segments that have been resected are:
A. Segment 1 and 4b
B. Segment 1a and 4
C. Segment 1 and 3
D. Segment 2 and 3
Correct answer: D
302 . A 50 year old man known to have diabetes, presents with, poor urinary
stream, hesitancy, difficulty in micturition and failure to void completely. What
is the diagnosis?
A. BPH
B. Autonomic neuropathy
C. UTI
D. Atonic bladder
Correct answer: B
304 . A patient was operated for colonic carcinoma and later a solitary nodule
was found in the liver. Treatment of choice is:
A. Chemotherapy
B. Conservative treatment
- 480 -
C. Surgery
D. Radiation
Correct answer: C
305 . All of the following are true regarding stones in the common bile duct,
except-
A. ERCP, sphincterotomy and balloon clearance is now the standard treatment
B. When removed by exploration of the common bile ducts the T-tube can be
removed after 3 days
C. Can present with charcot's triad
D. Are suggested by a bile duct diameter > 6 mm of ultrasound
Correct answer: B
- 481 -
612 . While packing catgut suture, Preservative is-
A. Glutaraldehyde
B. Hydrogen peroxide
C. Isopropyl alcohol
D. Colloidal iodine
Correct answer: C
311. At the time of TURP, surgeon take care to dissect above the verumontanum
to prevent injury to:
A. Prostatic Utricle
B. Trigone of bladder
C. External Urethral Sphincter
D. Urethral crest
Correct answer: C
313 . All of the following are indications for thoracotomy in blunt chest injury
except -
A. Initial drainage of 350 ml blood from the intercostal drain
B. Continuous bleeding of >200 ml / hour for 3 hours from intercostal drain
C. Continuous brisk bleeding of > 100 ml / 15 minutes from intercostal drain
D. Rupture of diaphragm
Correct answer: A
314 . What is the cell of origin of primary lymphoma of the GI tract associated
with celiac disease?
A. B cell
B. T cell
C. Histiocyte
D. Dendritic cell
Correct answer: B
316. A patient has small, oval multiple ulcers in oral cavity with red
erythematous margins. The diagnosis is -
A. Carcinoma
B. Aphthous ulcer
- 482 -
C. Tubercular ulcer
D. Syphilitic ulcer
Correct answer: B
319 . All are to be done in case of 20 years old female coming to causality with
right iliac fossa pain, with local guarding and tenderness, except:
A. IV glucose
B. Pethidine 100 mg.I.M.
C. Nill orally
D. None
Correct answer: D
321 . Common sites for Cushing ulcers include all of the following except:
A. Ist part of duodenum
B. Distal duodenum
C. Esophagus
D. Stomach
Correct answer: B
- 483 -
C. Volvulus
D. Wilm's tumor
Correct answer: B
643 . In the immediate post operative period the common cause of respiratory
insufficiency could be because of the following, except
A. Residual effect of muscle relaxant
B. Overdose of narcotic analgesic
C. Mild Hypovolemia
D. Myocardial infarction
Correct answer: C
328 . Which of the following procedure is done prior to surgery for carcinoma
rectum:
A. Rigid proctoscopy
B. MRI
C. Rectal endosonographic
D. Barium enema examination
Correct answer: C
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329 . All of the following are true regarding Warthin’s tumour except:
A. More common in females
B. Commonly involve the parotid glands
C. They arise from the epithelial and the lymphoid cells
D. 10% are bilateral
Correct answer: A
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335 . Post-Dural puncture headache is typically:
A. A result of leakage of blood into the epidural space
B. Worse when lying down than in sitting position
C. Bifrontal or occipital
D. Seen within 4 hours of dural puncture
Correct answer: C
341 . Poland's syndrome of the congenital absence of the sternal head of the
pestoralis major muscle is associated with -
A. Mastalgia
B. Amazia
C. Polymazia
D. Gynecomastia
Correct answer: B
- 486 -
342 . In abdominal surgery lambert sutures refer to -
A. Single layer suturing
B. Sero muscular sutures
C. All coat intestinal suturing
D. Skin suturing
Correct answer: B
343 . A lady presented with VVF due to prolong labour one year back, on
examination ectopic opening is found on the interuretric bar close to the opening
of right ureter, Treatment of choice is:
A. Transvaginal repair of VVF
B. Transvesical VVF repair
C. Transperitoneal trans vesical fistula repair with reimplantation of right ureter
D. All of the above
Correct answer: C
346 . All the following are true about Meckel's diverticulum except
A. Bleeding
B. Intussusception
C. Arises at the mesenteric border
D. Located 60 cm from the cecal valve
Correct answer: C
347 . A 55 year male, working as a hotel cook, has four dependent family
members. He has been diagnosed with an early-stage squamous cell cancer of
anal canal. He has more than 60% chances of cure. Which of the following is the
best treatment option?
A. Combined surgery and radiotherapy
B. Abdomino-perineal resection
C. Chemotherapy alone
D. Combined chemotherapy and radiotherapy
Correct answer: D
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348 . Which of the following malignant disease of children has the best
prognosis?
A. Wilm's tumor
B. Neuroblastoma
C. Rhabdomyosarcoma
D. Primitive neuroectodermal tumor
Correct answer: A
352 . Which of the following Abdominal structure will be responsible for sharp
pain while doing Abdominal surgery:
A. Parietal peritoneum
B. Liver parenchyma
C. Small intestine
D. Colon
Correct answer: A
- 488 -
355 . In case of Ca lung which among the following will be C/I for surgical
resection:
A. Malignant pleural effusion
B. Hilar lymphadenopathy
C. Consolidation of one lobe
D. Involvement of visceral pleura
Correct answer: A
357 . All about radiological evaluation of a patient with Cushing's syndrome are
true except-
A. MRI of the adrenals may distinguish adrenal adenoma from carcinoma
B. Adrenal CT scan distinguished adrenal cortical hyperplasia from an adrenal tumor
C. MRI of the sella turcica will identify a pituitary cause for Cushing's syndrome
D. Petrosal sinus sampling is the best way to distinguish a pituitary tumor from an
ectopic ACTH producing tumor
Correct answer: C
358. 65-year-old men presents with Abdominal pain and distension of abdomen.
His stools were maroon colored, and he gives a past history of cerebrovascular
accident and myocardial infarction. What will be the probable diagnosis?
A. Ulcerative colitis
B. Acute mesenteric ischemia
C. Irritable bowel syndrome
D. Chron's disease
Correct answer: B
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361 . Treatment of choice of Warthin’s tumour is:
A. Radiotherapy
B. Chemotherapy
C. Superficial parotidectomy
D. Excision
Correct answer: C
365 . The preferred initial treatment for carcinoma of the anal canal is -
A. Abdominoperineal resection
B. Abdominoperineal resection followed by radiotherapy
C. Radiotherapy alone
D. Chemoradiation
Correct answer: D
- 490 -
368. A new born presented with bloated abdomen shortly after birth with
passing of less meconium. A full-thickness biopsy of the rectum was carried out.
Rectal biopsy findings is most likely to be present-
A. Thickened muscularis propria.
B. Lack of ganglion cells.
C. Fibrosis of submucosa.
D. Hyalinization of the muscular coat.
Correct answer: B
370. A 30 year male patient presented with left sided abdominal pain to the
emergency room, 6 hours after an RTA. He was hemodynamically stable and
FAST positive. Contrast Enhanced CT(CECT)scan showed grade III splenic
laceration. The most appropriate treatment is-
A. Splenic Artery Embolization
B. Conservative Management
C. Splenectomy
D. Splenorrhaphy
Correct answer: B
372 . Sitaram a 40-year-old man, met with an accident and comes to emergency
department with engorged neck veins, pallor, rapid pulse and chest pain.
Diagnosis is:
A. Pulmonary Laceration
B. Cardiac tamponade
C. Hemothorax
D. Splenic rupture
Correct answer: B
373 . A 50 year old male Raju present with occasional dysphagia for solids,
regurgitation of food and foul smelling breath. Probable diagnosis is-
A. Achalasia cardia
B. Zenkers diverticulum
C. CA esophagus
D. Diabetic gastroparesis
Correct answer: B
- 491 -
374 . Features of dequervan's disease are A/E
A. Tends to regress spontaneously
B. Painful and associated with enlargements of thyroid
C. Autoimmune in etiology
D. Increase ESR
Correct answer: C
- 492 -
Correct answer: C
386. Least chances of complication like dumping syndromes, and diarrhea is seen
in:
A. Highly selective vagotomy
B. Truncal vagotomy and Gastrojejunostomy
C. Antrectomy with truncal vagotomy
D. Vagotomy with pyloroplasty
Correct answer: A
- 493 -
D. Posterior fossa cyst
Correct answer: C
389 . Tumor marker for primary hepatocellular carcinoma are all except -
A. Alpha 2 macro globin
B. Alpha feto protein
C. Neurotension
D. PIVKA-2
Correct answer: A
391 . Which is not elevated in a child presenting with jaundice, icterus, pruritus
and clay-colored stools.
A. 5' - nucleotidase
B. Glutamate dehydrogenase
C. Gamma glutamyl transpeptidase
D. Alkaline phosphatase
Correct answer: B
- 494 -
394 . After cholecystectomy tensile strength of incision is improved by -
A. Granulation tissue formation
B. Cross linking of protocollagen
C. Macrophage invasion
D. Replacement of type iii collagen
Correct answer: B
396 . Which of the following is C/I for Bag and mask ventilation?
A. Septicemia
B. Tracheoesophageal fistula
C. Meconium aspiration
D. Diaphragmatic hernia
Correct answer: D
397 . Which of the following is the most common cause of acute mesenteric
ischemia ?
A. Venous thrombosis
B. Arterial thrombosis
C. Non occlusive disease
D. Embolism
Correct answer: D
- 495 -
401 . Margolin’s ulcer is characterized by all EXCEPT
A. Development in a scar
B. Slow growth
C. Painless nature
D. Spreads to lymph nodes
Correct answer: D
402 . 40 years old male, chronic smoker presents with claudication and a medial
leg ulcer. For the past one month he is having rest pain. Which of the following
procedures would not relieve his rest pain:
A. Lumber Sympathectomy
B. Omentoplasty
C. Conservative Amputation
D. Femoropopliteal bypass
Correct answer: D
407 . Which is not a preferred site for planning vascular access for maintenance
hemodialysis?
A. Radio cephalic AV fistula
B. Saphenofemoral fistula
C. Nondominant extremity
- 496 -
D. Upper limb
Correct answer: B
413 . All of the following are features of frontal lobe abscess, except -
A. Personality change
B. Urinary incontinence
C. Anosmia
D. Memory is intact
Correct answer: D
- 497 -
Correct answer: A
415 . At the time of reconstruction of an amputated limb, the first step is-
A. Venous repair
B. Arterial repair
C. Nerve anastomoses
D. Fixation of the bone
Correct answer: D
420 . A 35 year male with stab injury to anterior abdomen presents with a tag of
omentum protruding through the abdominal wall near the umbilicus. On
evaluation he is hemodynamically stable and shows no signs of peritonitis. Initial
management of patient should be-
A. Local Wound Exploration and Suturing
B. CECT Abdomen
C. FAST
D. Exploratory Laparotomy
Correct answer: B
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421 . For Ca of Anal canal which one is the treatment of choice -
A. Radiotherapy + APR
B. Only radiotherapy
C. Chemoradiation
D. Radiotherapy + chemotherapy
Correct answer: C
422 . Surgery for undescended testes should be done before which of the
following age?
A. 12 months
B. 6 months
C. 36 months
D. 24 months
Correct answer: A
425 . A-75 year-old frail elderly man underwent TURP. The biopsy revealed
adenocarcinoma. What is the next line of management
A. Radiotherapy
B. Surgery followed by Hormonal replacement therapy
C. Constructive treatment
D. Surgery followed by radiotherapy
Correct answer: C
427 . Sheela, a middle-aged diabetic female presented with flank pain and fever.
On U/S the kidney was irregular and showed fat density lesion with calculi. The
diagnosis is most probably:
A. TB kidney
B. Xanthogranulomatous kidney
- 499 -
C. Chronic pyelonephritis
D. Renal abscess
Correct answer: B
429 . A 63 years male patient of coronary artery disease was on Aspirin for 2
years. He now complains of black stools. Abdominal examination is normal. The
most likely diagnosis is-
A. Esophageal varices
B. Duodenal ulcer
C. Ileocecal TB
D. Ca colon
Correct answer: B
430 . Regular drinking of which of the following fruit juices can prevent UTI -
A. Raspberry
B. Grape
C. Cranberry
D. Orange
Correct answer: C
431 . Disparity of the bowel ends during end to end anastomosis is corrected by -
A. Cheatle's manoeuvre
B. Connell suture
C. Lembert suture
D. Czerny technique
Correct answer: A
432 . Which of the following is the diagnostic method of choice for Hirschsprung
disease?
A. Contrast enema
B. MRI
C. Rectal Biopsy
D. Manometry
Correct answer: C
433 . A 6 years boy presents with recurrent abdominal pain and bilious vomiting.
Condition was diagnosed by barium follow through. Surgery was done, - mesenteric
widening, appendicectomy, cutting the Ladd's band. The diagnosis is-
A. Mal rotation
B. Recurrent Caecal volvulus
C. Stricture TB
D. Recurrent appendicitis
Correct answer: A
- 500 -
434 . All are true regarding Kaposi sarcoma except one -
A. Predominant in male
B. Multicentric origin
C. Chemotherapy is treatment of choice
D. Occurs in AIDS patient only
Correct answer: D
836 . A 70-year-old patient with thigh and calf claudication, and ulcers of lower
extremity, treatment of choice
A. Streptokinase
B. Thrombolysis
C. Aorto femoral bypass
D. Embolectomy
Correct answer: C
- 501 -
440 . A case of spontaneous pneumothorax comes to you what will be earliest the
treatment of choice -
A. IPPV
B. Needle aspiration
C. ICD
D. Wait and watch
Correct answer: B
446 . A 21 days male baby presenting with vomiting and failure to thrive is found
to have pyloric stenosis. The next step of management is-
A. Fluid resuscitation may be delayed
B. It is emergency so do pyloromyotomy immediately
- 502 -
C. Cardiopulmonary resuscitation
D. Correction of electrolyte disturbances
Correct answer: D
447 . A 65 years male was diagnosed as carcinoma right lung. On CECT chest
there was a tumor of 5x5 cm in upper lobe and another 2x2 cm size tumor nodule
in middle lobe. Which of the following is the primary modality of treatment ?
A. Chemotherapy
B. Radiotherapy
C. Supportive treatment
D. Surgery
Correct answer: D
- 503 -
453 . In a survey, many children are examined and were found to have urogenital
abnormalities. Which congenital anomaly is associated with increased risk of
bladder carcinoma ?
A. Bladder exstrophy
B. Medullary sponge kidney
C. Double ureter
D. Unilateral renal agenesis
Correct answer: A
455 . Which of the following causes least irritation of the peritoneal cavity:
A. Blood
B. Bile
C. Pancreatic enzyme
D. Gastric enzyme
Correct answer: A
456 . All of the following drugs are used in treatment of Hirsutism except -
A. Cyproterone acetate
B. Spironolactone
C. Flutamide
D. Mifepristone
Correct answer: D
- 504 -
Correct answer: A
461 . Apart from Escherichia coli, which of the bellow is the most common
organism implicated in acute suppurative bacterial peritonitis?
A. Pepto streptococcus
B. Pseudomonas aeruginosa
C. Bacteroides
D. Klebsiella
Correct answer: C
462 . Which among the following parotid tumor spreads through neural sheath -
A. Mixed parotid tumor
B. Adenocystic Ca
C. Sq. cell Ca
D. Oxyphilic lymphoma
Correct answer: B
465 . A 23 year male with azoospermia found to have normal FSH and
testosterone levels and normal size testes. Possible cause is -
A. Undescended testis
B. Klinefelter’s syndrome
C. Vas obstruction
D. Kalman syndrome
Correct answer: C
- 505 -
D. Non - small cell CA lung
Correct answer: D
- 506 -
C. Congenital renal defect
D. Obstructive uropathy
Correct answer: B
476 . A 17 years old girl presents with history of generalized abdominal pain,
fever, recurrent vomiting. On examination, she has a temperature of 103 degree
F, Right Iliac fossa tenderness; and WBC are 19600/mm3:
A. Ruptured Ectopic Pregnancy
B. Intussusception
C. Ruptured Appendicular Abscess
D. Twisted ovarian cyst
Correct answer: C
479 . Who said these words 'To study phenomenon of disease without books is to
sail an uncharted sea, while to study without patients is not to go to sea at all '
A. Hamilton Bailey
B. Sir Robert Hutchison
C. Sir William Osler
- 507 -
D. JB Murphy
Correct answer: C
480 . Which of the following will give Medusa head colony on x-ray:
A. Hook worm infestation
B. Round worm infestation
C. Tenia solium infestation
D. a + b
Correct answer: B
- 508 -
D. Obstructed hernia
Correct answer: B
487 . After RTA a young male present with non pulsatile retroperitoneal
hematoma. On table IVU was done. Right kidney not visualized. Left kidney
showed immediate excretion of dye. What is the next step in management -?
A. Nephrectomy
B. Open Gerota's facia and explore proximal renal vessels
C. Performed Retrograde pyelography
D. Perform on table angiography
Correct answer: D
- 509 -
493 . Urine gets collected in which place in case of extra peritoneal rupture of
bladder -
A. Groin
B. Below urogenital diaphragm
C. Above urogenital diaphragm
D. Perineal space
Correct answer: C
- 510 -
500 . Most common site of anorectal abscess is ?
A. Perianal
B. Ischiorectal
C. Pelvirectal
D. Intersphincetric
Correct answer: A
502 . Which of the following is the best prognostic factor for head injury?
A. Mode of injury
B. CT findings
C. Glasgow coma scale
D. Age
Correct answer: C
503 . The peak flow rate which indicates the degree of bladder obstruction
should be -
A. Less than 100 ml/sec
B. Less than 50 ml/sec
C. Less than 25 ml/sec
D. Less than 15 ml/sec
Correct answer: D
- 511 -
507 . In Richter's hernia the sac contains -
A. Greater omentum
B. Caecum
C. Part of the small gut wall
D. Spleen
Correct answer: C
508. The treatment of choice for symptomatic, retained common bile duct stones,
is:
A. Immediate surgery
B. Conservative treatment with antibiotics
C. Endoscopic sphincterotomy
D. Medical dissolution of the stones
Correct answer: C
511 . Most common post operative complications of ileo anal pouch anastomosis
in ulcerative colitis is -
A. Pouchitis
B. Pelvic abscess
C. Small bowel obstruction
D. Perianal complication
Correct answer: A
- 512 -
D. Watchful observation
Correct answer: B
517 . Following are the complaints of a patient with history of ischemic heart
disease, acute abdominal pain, tenderness, distension of abdomen, absent blow
sound, maroon colored blood in stool. Diagnosis is -
A. Mesenteric ischemia
B. Colon carcinoma
C. Ulcerative colitis
D. Crohn's disease
Correct answer: A
518 . Which of the following is the most preferred approach for pituitary
surgery?
A. Trans ethmoidal
B. Transcranial
C. Transcallosal
D. Trans-sphenoidal
Correct answer: D
519 . The treatment of choice for adult hypertrophic pyloric stenosis is:
A. Pyloromyotomy
B. Pyloroplasty
C. Billionth’s I anastomosis
D. Gastrectomy
Correct answer: B
- 513 -
520 . Clay colored stools are seen in
A. Hemolytic jaundice
B. Hepatic jaundice
C. Obstructive jaundice
D. Amoebic hepatitis
Correct answer: C
523 . Immediate surgery is not done in one of the following types of intestinal
obstruction:
A. Postoperative adhesion
B. Volvulus
C. Strangulated inguinal hernia
D. Paralytic ileus following appendicular perforation
Correct answer: A
- 514 -
527. Chronic Burrowing ulcer is caused by -
A. Streptococcus viridans
B. Streptococcus pyogenes
C. Microaerophilic streptococci
D. Pepto streptococcus
Correct answer: C
532 . 32-year-old female, from rural background presented with a h/o chronic
tobacco chewing since 14 year of age. Now she has difficulty in opening her
mouth. On oral examination, no ulcers are seen. Most probable diagnosis is:
A. Submucous oral fibrosis
B. Carcinoma of buccal mucosa
C. TM joint arthritis
D. Trigeminal nerve paralysis
Correct answer: A
- 515 -
Correct answer: D
536 . A 45 year old gentleman has undergone truncal vagotomy and pyloroplasty
for bleeding duodenal ulcer seven years ago. Now he was intractable recurrent
symptoms of peptic ulcer. All of the following suggest the diagnosis of Zollinger
Ellison syndrome, except -
A. Ulcers in proximal jejunum and lower end of esophagus
B. Serum gastrin value of 200 pg/ml with secretin stimulation
C. Basal acid output of 15 meq/hour
D. Serum gastrin value of 500 pg/ml
Correct answer: B
537 . The operative wound after surgery for gangrenous, perforated appendicitis
is best managed by -
A. Primary suture
B. Delayed primary closure
C. Healing by secondary intention
D. Antibiotic lavage
Correct answer: B
- 516 -
540 . All are middle mediastinal masses except:
A. Ganglioneuroma
B. Aortic aneurysm
C. Bronchogenic cyst
D. Pleuro - pericardial cyst
Correct answer: A
541 . Duodenal blow out following Billroth gastrectomy most commonly occurs
on which day -
A. 2rd day
B. 4th day
C. 6th day
D. 12th day
Correct answer: B
- 517 -
D. Chlorine sensitive metabolic acidosis
Correct answer: A
- 518 -
C. Adenomatous polyp
D. All
Correct answer: B
557 . Which of the following is the treatment of choice for the management of
carcinoma of the anal canal?
A. Primary radiotherapy
B. Abdominoperineal resection
C. Neoadjuvant chemotherapy and local excision
D. Combined radio and chemotherapy
Correct answer: D
- 519 -
560 . Antral obstruction with vomiting is not characterized by -
A. Hypokalemia
B. Hypochloremia
C. Acidosis
D. Hyponatremia
Correct answer: C
563 . A new born child has not passed meconium for 48 hrs. What is the
diagnostic procedure of choice?
A. Contrast enema
B. USG
C. MRI
D. CT
Correct answer: A
566 . A 6-week neonate presented with undescended tests on the right side and
normal testes on left side. The treatment of choice would be:
A. 5 year age before going to school
B. Puberty
C. Orchiopexy at 2 years
- 520 -
D. Immediately
Correct answer: C
570 . 70 years old male presents with a h/o lower GI bleed for last 6 months.
Sigmoidoscopic examination shows a mass, of 4 cm about 3.5 cm above the anal
verge. The treatment of choice is:
A. Colostomy
B. Anterior resection
C. Abdominoperineal resection
D. Defunctioning anastomosis
Correct answer: C
571 . Which of the following is the most common cause of death in Crohn's
disease?
A. Electrolyte disturbance
B. Malignancy
C. Sepsis
D. Thromboembolic complication
Correct answer: B
- 521 -
573 . After laparotomy most common site of collection and abscess formation-in
intra-abdominal cavity.
A. Pelvic
B. Subhepatic
C. Subphrenic
D. Paracolic
Correct answer: A
578 . A 70-year-old man comes to casualty with urinary retention and back pain.
Which investigation should be performed:
A. Serum acid phosphatase
B. Serum Calcium
C. Serum alkaline phosphatase
D. Serum electrophoresis
Correct answer: A
579 . Which of the following is the most important prognostic factor for
colorectal CA ?
A. Age of patient
B. Lymph node status
C. Site of lesion
- 522 -
D. Tumour size and characteristics
Correct answer: B
581 . A sequestrum is
A. A piece of dead soft tissue
B. A dead tooth
C. A piece of dead bone
D. A piece of dead skin
Correct answer: C
- 523 -
C. Carcinoma of esophagus
D. Plummer Vinson syndrome
Correct answer: A
592 . A newborn baby presents with absent anal orifice and meconuria. What is
the most appropriate management?
A. Posterior Sagittal Anorectoplasty
B. Perineal V-Y plasty
C. Transverse colostomy
D. Conservative
Correct answer: C
- 524 -
593 . Pancreatic pseudocyst most commonly occurs after
A. Trauma
B. Pancreatitis
C. Pancreatic surgery
D. Pancreatic malignancy
Correct answer: B
594 . A female noted an abdominal mass in left. side of her 6 month old child.
Which showed calcification near the left kidney. What will be the cause:
A. Leukemia
B. Neuroblastoma
C. Renal cell carcinoma
D. Lymphoma
Correct answer: B
597 . Head injury patient, eye opening is seen with painful stimulus, localizes the
pain and there is inappropriate verbal response. What would be the score on
GCS-
A. 9
B. 8
C. 11
D. 10
Correct answer: D
- 525 -
Correct answer: C
- 526 -
D. Wait and watch
Correct answer: D
- 527 -
613. Limb salvage can be done in all except -
A. Nerve injury
B. Vascular injury
C. Bone injury
D. Muscle injury
Correct answer: B
615 . A 50-year-old man, known to have diabetes, presents with poor urinary
stream, increased frequency of micturition and hesitancy. What is the most likely
diagnosis?
A. BPH
B. Autonomic neuropathy
C. UTI
D. Atonic bladder
Correct answer: A
617 . A patient comes with stony hard, painless lymph node in left
supraclavicular fossa. A biopsy report states Sq cell Carcinoma. What is the
diagnosis:
A. Stomach carcinoma
B. Breast carcinoma
C. Lung carcinoma
D. Pancreas carcinoma
Correct answer: C
618 . A 45 years patient presents with recurrent duodenal ulcer of 2.5 cm size;
procedure of choice is-
A. Highly selective vagotomy
B. Laparoscopic vagotomy and gastrojejunostomy
C. Truncal vagotomy and antrectomy
D. Truncal vagotomy and gastrojejunostomy
Correct answer: C
- 528 -
619 . Most common site of rhabdomyosarcoma is ?
A. Orbit
B. Nasopharynx
C. Extremities
D. Hypopharynx
Correct answer: A
- 529 -
D. Lower GI scopy is contraindicated in sigmoid volvulus
Correct answer: D
628 . On mammogram all of the following are the features of a malignant tumor
except:
A. Spiculation
B. Microcalcification
C. Macrocalcification
D. Irregular mass
Correct answer: C
629. All of the following are true regarding solitary rectal ulcer except:
A. Mostly involve midline in posterior wall
B. History of per rectal examination in 50%
C. 20% multiple
D. Causes rectal prolapse
Correct answer: A
- 530 -
D. Diaphragmatic hernia
Correct answer: C
635 . Extravasated urine following rupture of bulbar urethra collects in all the
following regions except -
A. Penis
B. Scrotum
C. Inguinal canal
D. Beneath the superficial fascia m the abdominal wall
Correct answer: C
638 . A 45 year old male having a long history of cigarette smoking presents with
gangrene of left foot. An amputation of the left foot was done. Representative
sections from the specimen revealed presence of arterial thrombus with
neutrophilic infiltrate in the arterial wall. The inflammation also extended into
the neighboring veins and nerves. The most probable diagnosis is -
A. Hypersensitivity angitis
B. Thrmoboangitis obliterans
C. Takayasu arteritis
- 531 -
D. Giant cell arteritis
Correct answer: B
642 . A patient with BHP underwent TURP under spinal anesthesia. An hour
later he developed altered sensorium, nausea, and vomiting. The cause is:
A. Water intoxication
B. Rupture bladder
C. Hypernatremia
D. Bupivacaine overdose
Correct answer: A
- 532 -
645. Kehr's sign seen in splenic rupture is -
A. Pain over left shoulder
B. Pain over right scapula
C. Periumbilical pain
D. Pain over renal angle
Correct answer: A
- 533 -
652. Which is not an indication of radiotherapy in Pleomorphic adenoma of
parotid?
A. 2nd histologically benign recurrence
B. Involvement of deep lobe
C. Malignant transformation
D. Microscopically positive margins
Correct answer: A
- 534 -
Correct answer: C
659 . Immediate management of a patient with Multiple fracture and Fluid loss
includes the infusion of
A. Blood
B. Dextran
C. Normal saline
D. Ringer lactate
Correct answer: D
663 .Treatment of carcinoma penis involving proximal shaft without lymph node
involvement:
A. Palliative chemotherapy
B. Radiotherapy
C. Total penectomy with block dissection of ilioinguinal lymph node
D. Total penectomy with bilateral sentinel node biopsy
Correct answer: C
665 .The most common cause of delayed urinary tract obstructive symptoms after
TURP is-
A. Stricture of the bulb of urethra
B. Bladder neck stenosis
- 535 -
C. Stricture of the Navicular fossa
D. Stricture of the membranous urethra
Correct answer: B
671 .Which of the following is the most common cause of unilateral parotid
swelling in an adult?
A. Pleomorphic adenoma
B. Warthin’s tumor
C. Hemangioma
D. Adenocarcinoma
Correct answer: A
- 536 -
C. Hydronephrosis
D. Pain in abdomen
Correct answer: B
676 .A boil is
A. Any abscess of the skin
B. Same as a carbuncle
C. An acute infection of a hair follicle
D. The same as a pyogenic granuloma
Correct answer: C
679 .All of the following are features of exstrophy of the bladder except:
A. Cloacal membrane is present
B. Epispadias
C. Umbilical and inguinal hernia
- 537 -
D. Posterior bladder wall protrudes through the defects
Correct answer: A
- 538 -
D. Peri vesical space
Correct answer: D
692 . A 50 years old male presents with a hard scrotal swelling. All of the following
can be done except:
A. Testicular biopsy
B. Chest x-ray
C. Inguinal exploration
D. CT abdomen
Correct answer: A
- 539 -
D. Marginal mandibular nerve injury
Correct answer: A
697 . You have seen a patient in emergency, and you are suspecting a strangulated
indirect inguinal hernia; the first thing you will do:
A. Straight X-ray of abdomen
B. Prepare the patient for emergency operation
C. Aspirate to confirm
D. Give immediate IV antibiotics
Correct answer: B
- 540 -
D. Surgical removal is the treatment of choice
Correct answer: A
706 .In the TNM staging of lung cancer N2 nodes includes all of the following
EXCEPT -
A. Paratracheal nodes
B. Subcarinal nodes
C. Nodes in the inferior pulmonary ligaments
D. Interlobar nodes
Correct answer: D
- 541 -
D. Cysto - jejunostomy is the treatment of choice
Correct answer: D
710 . All of the following are synonyms for Renal cell carcinoma except -
A. Adenocarcinoma of kidney
B. Hypernephroma
C. Grawitz tumor
D. Transitional cell tumor of the kidney
Correct answer: D
714 .After blunt injury in abdomen, patient was hemodynamically stable, the next
investigation is-
A. Barium Swallow
B. X-ray abdomen
C. DPL
- 542 -
D. FAST
Correct answer: D
719 . A young patient presents with history of dysphagia more to liquid than solids.
The first investigation you will do is:
A. Barium Swallow
B. Esophagoscopy
C. Ultrasound of the chest
D. C.T. scan of the chest
Correct answer: A
720 .Raised gastrin level without associated increase acid secretion is seen in -
A. Carcinoma stomach
B. Gastrinoma
C. Pernicious anemia
D. G cell hyperplasia
Correct answer: C
- 543 -
721 .In which of the following, Double Bubble sign is seen?
A. Duodenal atresia
B. Pyloric stenosis
C. Esophageal atresia
D. Ileal atresia
Correct answer: A
723. Composition of which of the following intravenous fluids has the closest
resemblance to plasma?
A. Isotonic saline
B. 1/5 isotonic saline
C. 4.3% dextrose
D. Ringer's lactate
Correct answer: D
725 . In a case of accidental injury of the external femoral vein with intact femoral
artery next step in management would be:
A. Repair of the vein with end-ta-end anastomosis
B. Ligation of both ends
C. Ligation of only the proximal end
D. Ligation of the vein as well as the artery
Correct answer: A
727 . A 55 year old diabetic patient presented with impotence with history of
failure to get erection after papaverine intracavernous injection. Colour doppler
shows no abnormality of arteries but shows mild venous run-off, Treatment of
choice here would be:
A. Penile prosthetic implants
B. Intracavernous injection of papaverine
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C. Psychotherapy
D. Vacuum constriction device
Correct answer: D
733 . A male executive, 50-year age is seen in casualty with hypotension and
hematemesis. There is previous history suggestive of alcohol intake of 100 ml.
daily. The blood loss is around 2 liters. Most probable diagnosis is:
A. Gastritis
B. Duodenal ulcer
C. Mallory-Weiss tear
D. Esophageal varices
Correct answer: B
- 545 -
734 . Which is MOST COMMON site for iatrogenic oesophageal performation -
A. Abdominal portion
B. Cervical portion
C. Above arch of aorta
D. Below arch of aorta
Correct answer: B
- 546 -
741 . All of the following are seen in persisting vomiting except:
A. Hypokalemia
B. Decreased K+ in urine
C. Elevated pH of blood
D. Metabolic alkalosis
Correct answer: B
- 547 -
748 . Triad of haemobilia includes all, except -
A. Pain
B. Fever
C. G.I. bleeding
D. Jaundice
Correct answer: B
753 . One side of kidney is normal, other side kidney is contracted kidney with
scar, what is the most probable diagnosis ?
A. Chronic pyelonephritis
B. Polycystic kidney
C. Renal artery stenosis
D. Tuberculosis of kidney
Correct answer: A
- 548 -
755 . All except one is removal in Whipple's operation -
A. Duodenum
B. Head of pancreas
C. Portal vein
D. Common bile duct
Correct answer: C
759 . Following modalities can be used for in situ ablation of liver secondaries,
except:
A. Alcohol
B. Radia-frequency
C. Ultrasonic waves
D. Cryotherapy
Correct answer: C
760 . A 38 year lady presents with fever for 3 weeks. On examination she is
observed to have Splenomegaly. Ultrasonography reveals a hypoechoic shadow in
spleen near the hilum. Gram negative bacilli are isolated on blood culture. The
most Possible causative organism is-
A. Toxoplasmosis
B. Cytomegalovirus
C. Lymphoma virus
D. Salmonella
Correct answer: D
- 549 -
761 . All of the following are modalities of therapy for hepatocellular carcinoma
except -
A. Radiofrequency ablation
B. Trans arterial catheter embolization
C. Percutaneous acetic acid
D. Nd Yag laser ablation
Correct answer: D
762 . Odynophagia is -
A. Throat pain
B. Pain on swallowing
C. Heartburn
D. Painless dysphagia
Correct answer: B
- 550 -
762 . Most Imp. technical consideration at the time of doing below knee
amputation is:
A. Post. flap should be longer than the anterior flap
B. Stump should be long
C. Stump should be short
D. Ant flap should be longer than post flap
Correct answer: A
763 . Cells from the neural crest are involved in all except
A. Hirschsprung's disease
B. Neuroblastoma
C. Primitive neuroectodermal tumour
D. Wilm's tumor
Correct answer: D
- 551 -
Correct answer: D
- 552 -
D. Prolapse
Correct answer: C
779 . All are false except one in case of hypertrophic pyloric stenosis
A. Symptomatic within one week
B. Lump is always clinically palpable
C. The treatment of choice is Finney's pyloroplasty
D. Ultrasonography is diagnostic test
Correct answer: D
780 . Rupture of urethra above the deep perineal pouch causes urine retention in
which of the following region?
A. Scrotum
B. Medial aspect of thigh
C. Anterior abdominal wall
D. True pelvis only
Correct answer: D
781 . Preferred incision for abdominal exploration in Blunt injury abdomen is:
A. Always Midline incision
B. Depending upon the organ
C. Transverse incision
D. Paramedian
Correct answer: A
- 553 -
782 . Verrucous carcinoma of buccal mucosa is usually a -
A. High grade malignancy
B. Associated with early lymph noses
C. Deep invasive malignancy
D. Densely Keratinized
Correct answer: D
783 . Which of the following is the pre-malignant condition with the highest
probability of progression to malignancy?
A. Leucoplakia
B. Erythroplakia
C. Dysplasia
D. Hyperplasia
Correct answer: B
787 . Most common cause of gangrene of foot of 30 years old farmer who is a
chronic smoker:
A. Raynaud's disease
B. Myocardial infarction
C. Atherosclerosis
D. Thromboangitis obliterans
Correct answer: D
- 554 -
D. Distension of Abdomen
Correct answer: C
790 . A 68 years woman, on her third day of hospitalization, who is being treated
with antibiotics for acute cholecystitis develops increased pain and tenderness in
the right upper quadrant with a palpable mass. Her temperature rises to 40 degree
C (104 degree F) her blood pressure falls to 80/60mmHg. Hematemesis, melena
and petechiae are noted. Laboratory studies reveal thrombocytopenia, prolonged
prothrombin time, and a decreased fibrinogen level. The most important step in
the correction of this patient's coagulopathy is:
A. Administration of e-Aminocaproic acid
B. Administration of fresh frozen plasma
C. Exploratory laparotomy
D. Administration of heparin
Correct answer: C
- 555 -
795 . True about Acute Epididymitis is
A. Associated with urinary infection
B. Painless
C. Scrotum size is reduced
D. Clinically does not mimic torsion of testes
Correct answer: A
796 . Which one of the following is used as preservative for packing catgut suture?
A. Isopropyl alcohol
B. Colloidal iodine
C. Glutaraldehyde
D. Hydrogen peroxide
Correct answer: A
797 . A 40 years old female presented with a progressively increasing lump in the
parotid region. On oral examinations, the tonsil was pushed medially. Biopsy
showed it to be pleomorphic adenoma. The appropriate treatment is:
A. Superficial parotidectomy
B. Lumpectomy
C. Conservative total parotidectomy
D. Enucleation
Correct answer: C
800 . What is the reason for following set of symptoms after prostatic Sx-
Restlessness, vomiting and change in sensorium-?
A. Electrolyte imbalance
B. Bladder neck obstruction
C. Acute pyelonephritis
D. Ureter stenosis
Correct answer: A
- 556 -
Correct answer: A
806 . In a blast injury, which of the following organ is least vulnerable to the blast
wave?
A. G.I. tract
B. Lungs
C. Liver
D. Ear drum
Correct answer: C
- 557 -
C. Contaminated wound
D. Dirty wound
Correct answer: B
814 . Ligation of which nerve will lead to parasthesia and pain on the dorsum of
foot during venesections of great saphenous vein
A. Sural nerve
B. Geniculate
C. Saphenous nerve
D. Deep peroneal nerve
Correct answer: C
- 558 -
C. At 6-10 years
D. At 1-2 years
Correct answer: B
816 . A 60 year old male presents with hematuria at onset of micturition-cause is:
A. Urethral stone
B. Bladder tumor
C. Ureteric stone
D. Prostatitis
Correct answer: A
818 . One of the following will always present with Bilious vomiting
A. Pyloric stenosis
B. Esophageal atresia
C. Atresia of the 3rd part of the duodenum
D. Malrotation of the gut
Correct answer: C
- 559 -
D. Vitelline duct
Correct answer: D
823 . A 34 year old patient is brought to the emergency as a case of head injury,
following a head on collision road traffic accident. His BP is 90/60 mmHg.
Tachycardia is presents. Most possible diagnosis is:
A. Intracranial hemorrhage
B. Intraabdominal bleed
C. EDH
D. SDH
Correct answer: B
825 . Which of the following is not a complication of surgery for thoracic outlet
syndrome -
A. Brachial plexus injury
B. Pneumothorax
C. Long thoracic nerve injury
D. Lymphocutaneous fistula
Correct answer: D
- 560 -
829 . Zollinger-Ellison syndrome is characterized by all of the following except
A. Post bulbar ulcer
B. Recurrent duodenal ulcer
C. Severe diarrhea
D. Massive HCL in response to histamine injection
Correct answer: D
830 . A 55 years male presents with h/o abdominal pain. He is found to have a
fusiform dilatation of the descending aorta. Possible cause is-
A. Atherosclerosis
B. Trauma
C. Syphilitic aortitis
D. Right ventricular failure
Correct answer: A
831. In case of carcinoid tumor which site is having least potential for malignancy
A. Lung
B. Stomach
C. Small Intestine
D. Appendix
Correct answer: A
833 . A patient with ITP has a platelet count of 50,000 and is being planned for
splenectomy. What is the best time for platelet infusion in this patient?
A. At the time of skin incision
B. 2 hours before surgery
C. Immediately after removal of spleen
D. After ligating the splenic artery
Correct answer: D
- 561 -
836 . 'Spider leg' appearance of calyces on intravenous urography is seen in
A. Congenital cystic kidneys
B. Hypernephroma
C. Horse shoe kidney
D. Hydronephrosis
Correct answer: A
837 . A 12 year old female swimmer comes with history of abdominal pain clinical
examination reveals rigidity, guarding and generalized tenderness over abdomen
with masking of liver dullness. What is Diagnosis:
A. Primary peritonitis
B. Intussusception
C. Enteric perforation
D. Biliary tree obstruction with peritonitis
Correct answer: C
- 562 -
Correct answer: C
844 . All of the following are known predisposing factors for cholangiocarcinoma
except:
A. Ulcerative colitis
B. Primary sclerosing cholangitis
C. CBD stones
D. Clonorchis sinensis
Correct answer: C
- 563 -
D. Highly selective vagotomy
Correct answer: D
853 . A 65 years male has foul breath; He regurgitates food that is eaten 2 days
ago: Possible diagnosis is:
A. Scleroderma
B. Achalasia cardia
C. Zenkers diverticulum
D. Meckel’s diverticulum
Correct answer: C
- 564 -
C. Hiatus hernia
D. Diverticulosis of colon
Correct answer: A
858 . The most common site of enlargement of the lymph nodes in Hodgkin's
lymphoma is
A. Mediastinal
B. Axillary
C. Cervical
D. Abdominal
Correct answer: C
860 . A man with blunt injury abdomen after road side accident has a blood
pressure of 100/80 mm Hg and a pulse rate of 120 bpm. Airway has been
established and respiration has been stabilized. Next best step in management is.
A. Blood for cross matching and IV fluids
B. Immediate Blood Transfusion
C. Rush the patient to the OT
D. Ventilate the patient
Correct answer: A
- 565 -
863 . The treatment of cholecysto enteric fistula following ulceration of gallstones
through the gall bladder into the duodenum -
A. Excision of track and closure of fistula
B. Diverted the bile of another anastomosis
C. Cholecystectomy and primary repair of the bowel
D. Radical excision of all related structures and reconstruction
Correct answer: C
865 . Which of the following is not included in Ranson's score for acute
pancreatitis ?
A. Age
B. WBC count
C. Blood glucose
D. Serum amylase
Correct answer: D
868 . All of the following about benign prostatic hypertrophy (BPH) are true
EXCEPT -
A. Decreased force and caliber of urinary stream is the presenting feature
B. Increased prostate specific antigen level (PSA) is one of the diagnostic features
C. Dynamic uroflowmetry is one of the diagnostic modalities
D. Incidence is age related
Correct answer: B
- 566 -
D. Chromosome 17
Correct answer: D
872 . All of the following statements about Gynecomastia are true except:
A. Subcutaneous mastectomy is the initial treatment of choice
B. Seen in liver disease
C. There may be estrogen/testosterone imbalance
D. Can be drug induced.
Correct answer: A
875 . After removal of the parotid gland, patient is having sweating on cheeks
while eating. In this complication seen after parotidectomy, the auriculotemporal
nerve which contains parasympathetic secretomotor fibers to parotid gland is
fused with which nerve ?
A. Greater petrosal nerve
B. Facial nerve
C. Great auricular nerve
D. Buccal nerve
Correct answer: C
- 567 -
876 . Due to decelerations, aorta can be ruptured at place where it is fixed except -
A. At ligament arteriosum
B. Behind the esophagus
C. Behind the crura of diaphragm
D. Aortic valve
Correct answer: B
878 . Acalculous cholecystitis can be seen in all of the following conditions except -
A. Enteric fever
B. Dengue hemorrhagic fever
C. Leptospirosis
D. Malaria
Correct answer: D
879 . USG shows diffuse wall thickening of gall bladder with hyperechoic nodules
at neck and comet tail artifacts. The most possible diagnosis will be:
A. Xanthogranulomatous cholecystitis
B. Cholesterol crystals
C. Adenomyomas
D. Adenocarcinoma of gall bladder
Correct answer: C
- 568 -
883 . Which of the following is not associated with left sided portal hypertension?
A. Secondary to pancreatic inflammation
B. Normal superior mesenteric and portal venous pressure
C. Easily reversed by splenectomy
D. Isolated esophageal varices present
Correct answer: D
888 . Claudication is -
A. Pain at rest
B. Pain relieved by rest
C. Pain at first step
D. Pain not relived by rest
Correct answer: B
- 569 -
890 . Type III category of basal fracture of skull are -
A. Those that run in the coronal plane from lateral end of one petrous through sella
turcica to lateral end of contralateral petrous ridge
B. Run from side to side in the coronal plane but do not pass through the Sella turcica
C. RUn from to the contralateral back passing through the sella turcica
D. Run from front to back involving all cranial fossa and sella turcica
Correct answer: B
894 . Allens test for integrity of palmar arch tests which of the following ?
A. Radial artery
B. Ulnar artery
C. Both
D. None
Correct answer: C
- 570 -
897 . Which is not a premalignant condition?
A. Bowen's disease
B. Leukoplakia
C. Acanthosis nigricans
D. Solar keratosis
Correct answer: C
899 . Bowel can get strangulated in all of the following space except:
A. Rectouterine pouch
B. Ileocolic recess
C. Para duodenal recess
D. Omental bursa
Correct answer: A
902 . A 45 year male patient has a surgical cause of obstructive jaundice. USG
can tell A/E-
A. Peritoneal deposits
B. Level of obstruction
C. Ascites
D. Gall bladder stones
Correct answer: A
- 571 -
904 . In case of clearing airway one of the following is not included -
A. Neck tilt
B. Mouth gag
C. Chin lift
D. Head lift
Correct answer: D
905 . Minimum nitrogen required for an adult with dynamic tissue turnover to
maintain a positive nitrogen balance is -
A. 3.5-4.5 g
B. 5.5-6.6 g
C. 7.5-8.5 g
D. 9.5-10.5 g
Correct answer: B
907 . An adult patient with leg pain gangrene of toe. His ankle to brachial
arterial arterial pressure ratio would be less than?
A. 1
B. 0.3
C. 0.5
D. 0.8
Correct answer: B
- 572 -
Correct answer: A
911 . Risk factors for malignant change in any asymptomatic patient with a gall
bladder polyp on USG include A/E-
A. Rapid increase in size of polyp
B. Age > 60 yr.
C. Associated Gall stones
D. Size of polyp > 5mm
Correct answer: D
914 . What will be the diagnosis of the child pulsatile swelling on medial side of the
nose -
A. Teratoma
B. Meningocele
C. Dermoid cyst
D. Carcinoma of ethmoid bone
Correct answer: B
916 . Which of the following is the most common cause of acquired arteriovenous
fistula?
A. Blunt trauma
B. Penetrating trauma
C. Bacterial infection
D. Fungal infection
Correct answer: B
917 . All the following statements about Pancreatic Carcinoma is true, except-
A. Hereditary Pancreatitis significantly increases the risk
B. Mutation in P53 gene is associated in 75% of cases
- 573 -
C. Five year survival after curative pancreaticoduodenectomy is 15-20%
D. Median survival in locality advanced (stage III) disease is 3-6 months
Correct answer: D
920 . The following statements are true about Pyrone’s disease except
A. Patient presents with complaints of painful erection
B. Condition affects adolescent males
C. The condition can be associated with Dupuytren's contracture of the tendon of the
D. Spontaneous regression occurs in 50% of the cases
Correct answer: B
922 . Which of the following may present as pulsatile swelling on medial side of
nose:
A. Meningoencephalocele
B. Dermoid cyst
C. Cystic hygroma
D. Supra orbital artery aneurysm
Correct answer: A
- 574 -
924 . Commonest presentation of Hodgkin's lymphoma is
A. Fever
B. Leukocytosis
C. Painless enlargement of lymph node
D. Pruritis
Correct answer: C
925 . A man comes to emergency with stab injury to left flank. He has stable vitals.
What would be the next step in management -?
A. Laparotomy
B. Laparoscopy
C. CECT
D. Diagnostic peritoneal lavage
Correct answer: C
928 . A patient presents with Abdominal pain, Jaundice and Malena. The diagnosis
is:
A. Carcinoma gall bladder
B. Acute pancreatitis
C. Haemobilia
D. Acute cholangitis
Correct answer: C
- 575 -
931 . In current scenario which is the most common cause of septicemia?
A. Gram negative bacteria
B. Gram positive bacteria
C. Fungus
D. Parasite
Correct answer: A
933 . The 3 years old boy presents with poor urinary stream. Most likely cause is:
A. Stricture urethra
B. Neurogenic bladder
C. Urethral calculus
D. Posterior urethral valve
Correct answer: D
935 . Biochemical changes associated with urinary diversion include all of the
following EXCEPT
A. Hypokalemia
B. Uremia
C. Acidosis
D. Hypochloremia
Correct answer: D
- 576 -
Correct answer: A
941 . A 55 years lady presents with 2 year history of recurrent abdominal pain
with radiation to her back. Pain is severe in intensity and refractory to simple
analgesics. USG and Contrast Enhanced CT scan (CECT)confirmed the diagnosis
and showed a dilated pancreatic duct. The likely recommended surgical procedure
is-
A. Whipple's Procedure
B. Longitudinal Pancreatico jejunostomy
C. Vagotomy with Antrectomy
D. Vagotomy with Gastrojejunostomy
Correct answer: B
- 577 -
944 . Most common infection after splenectomy is -
A. Anaerobic
B. Staphylococcal
C. Streptococcal
D. Pneumococcal
Correct answer: D
949 . A patient has acute abdominal pain with blood and mucus in stool with
palpable mass per abdomen is due ta-
A. Meckel’s diverticulum
B. Volvulus
C. Intussusception
D. Hypertrophic pyloric stenosis
Correct answer: C
- 578 -
951 . One is not the feature of obstructive jaundice -
A. Pruritis
B. Elevated level of S. bilirubin
C. Raised alkaline phosphatase
D. Raised Urinary urobilinogen
Correct answer: D
952 . Meconium ileus is usually associated with all of the following EXCEPT
A. Absence of air-fluid levels in X-ray
B. High sodium chloride concentration in sweat
C. Grossly distended large intestine
D. Surgically treated by Bishop-Koop operation
Correct answer: C
956 . Which of these does not change or remains same throughout life:
A. Salmon patch
B. Strawberry angiomas
C. Portwine stain
D. Capillary hemangioma
Correct answer: C
- 579 -
958 . True regarding mesothelioma, except-
A. Histopathology shows biphasic pattern
B. Occurs in late middle age
C. Bilaterally symmetrical
D. Associated with asbestos exposure
Correct answer: C
959- Which of the following statements are true and which are false?
1 . The surface area of the peritoneal membrane is nearly equal to that of the skin.
Correct answer T
2 . The parietal peritoneum is poorly innervated.
Correct answer F
3. The peritoneum has the capacity to absorb large volumes of fluid.
Correct answer T
4. The peritoneum has the ability to produce fibrinolytic activity.
Correct answer T
5. When injured, the peritoneum produces an inflammatory exudate.
Correct answer T
6. Peritonitis in perforated duodenal ulcer is initially sterile.
Correct answer T
7. Immunocompromised patients may present with opportunistic peritoneal infection.
Correct answer T
8. Bacteroides are sensitive to penicillin.
Correct answer F
9. In perforated duodenal ulcer there may be signs of peritonitis in the right iliac fossa.
Correct answer T
10. Children can localise infection effectively.
Correct answer F
11. The tumour marker of HCC is alpha fetoprotein.
Correct answer T
12. The blood supply of HCC is the hepatic artery rather than the portal vein.
Correct answer T
13. Venous drainage of the testis is systemic haematogenous spread of testicular cancer goes
to the lungs rather than the liver.
Correct answer T
14. In Glasgow coma scale, Eye opening scale is 1 to 4, Best verbal response scale is to 5.
- 580 -
Best motor response scale is 1 to 6. Thus, the lowest scale is 3, while the highest scale (fully
conscious is 15).
Correct answer T
15. The oesophagus is 30 cm long.
Correct answer F
16. The oesophagus has three natural constrictions.
Correct answer T
17. It is lined throughout by columnar epithelium.
Correct answer F
18. The lower oesophageal sphincter (LOS) is a zone of high pressure.
Correct answer T
19. The pressure at the LOS is 50 mmHg.
Correct answer F
20. Difficulty on swallowing (dysphagia) is a cardinal symptom of oesophageal carcinoma.
Correct answer T
21. Retrosternal pain on swallowing (odynophagia) is always of cardiac origin.
Correct answer F
22. Heartburn is a common symptom of gastro-oesophageal reflux disease (GORD).
Correct answer T
23. Dysphagia in the oral or pharyngeal (voluntary) phase, when patients say they cannot
swallow, is usually from neurological or muscular diseases.
Correct answer T
24. Regurgitation and reflux are the same and are caused by obstruction to the esophagus.
Correct answer F
25. Barium swallow is the investigation of choice in GORD.
Correct answer F
26. Flexible oesophago - gastroduodenoscopy (OGD) is the initial investigation of choice in
suspected carcinoma.
Correct answer T
27. Endosonography (EUS) should be carried out when a carcinoma is seen in the esophagus.
Correct answer T
28. Oesophageal manometry should be done when motility disorder is suspected.
Correct answer T
29. 24 h pH recording is an accurate method of evaluating GORD.
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Correct answer T
30. In a suspected foreign body (FB) in the oesophagus, water-soluble contrast examination
should be carried out.
Correct answer F
31. When a food bolus is stuck in the oesophagus, always suspect an underlying disease.
Correct answer T
32. Most iatrogenic perforations of the oesophagus can be treated conservatively.
Correct answer T
33. Most spontaneous perforations of the oesophagus (Boerhaave’s syndrome) require an
operation.
Correct answer T
34. In Mallory–Weiss syndrome the tear is usually in the lower end of the oesophagus.
Correct answer F
35. Pharyngeal (Zenker’s) diverticulum is precancerous for esophagus.
Correct answer T
36. GORD is precancerous for esophagus.
Correct answer T
37. Achalasia is precancerous for esophagus.
Correct answer T
38. Corrosive stricture is precancerous for esophagus.
Correct answer T
39. Barrett’s oesophagus is precancerous for esophagus.
Correct answer T
40. Whipple’s operation is a curative operation for carcinoma of the oesophagus.
Correct answer F
41. Anderson–Hynes operation Is a curative operation for carcinoma of the oesophagus.
Correct answer F
42. Heller’s operation Is a curative operation for carcinoma of the oesophagus.
Correct answer F
43. Ivor–Lewis operation Is a curative operation for carcinoma of the oesophagus.
Correct answer T
44. Hartmann’s operation Is a curative operation for carcinoma of the oesophagus .
Correct answer F
45. The right gastric artery is a branch of the coeliac artery.
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Correct answer F
46. Vagal fibers to the stomach are afferent.
Correct answer F
47. The parietal cells are in the body of the stomach and are the acid-secreting cells.
Correct answer T
48. The venous drainage of the stomach ends in the inferior vena cava (IVC).
Correct answer F
49.The chief cells secrete pepsinogen.
Correct answer T
50. Gastric acid is a predisposing factors for gastric ulcer.
Correct answer F
51. H. pylori infection is a predisposing factor for gastric ulcer.
Correct answer T
52. NSAIDs is a predisposing factor for gastric ulcer.
Correct answer T
53. Smoking is a predisposing factor for gastric ulcer.
Correct answer T
54. High socioeconomic groups. is a predisposing factors for gastric ulcer.
Correct answer F
55. From the clinical features of peptic ulcers: The pain never radiates to the back and this
differentiates this from biliary colic.
Correct answer F
56. From the clinical features of peptic ulcers: Vomiting is a notable feature.
Correct answer F
57. From the clinical features of peptic ulcers: Bleeding is rare.
Correct answer F
58. From clinical features of peptic ulcers: They may cause gastric outlet obstruction.
Correct answer T
59. From the clinical features of peptic ulcers: Weight loss is a typical symptom.
Correct answer F
60. H. pylori infection is important in the causation of gastric cancer?
Correct answer T
61. Gastric atrophy is important in the causation of gastric cancer?
Correct answer T
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62. Pernicious anemia is important in the causation of gastric cancer?
Correct answer T
63. Previous gastric surgery is important in the causation of gastric cancer?
Correct answer T
64. Smoking. is important in the causation of gastric cancer?
Correct answer T
65. The clinical features of gastric cancer may be non-specific in the early stages.
Correct answer T
66. Anaemia can be a presenting symptom of gastric cancer.
Correct answer T
67. Troiser’s sign refers to a palpable ‘Virchow’s node’ in the right supraclavicular fossa.
Correct answer F
68. Gastric cancer is a rare cause of GOA.
Correct answer F
69. Trousseau’s sign is diagnostic of gastric cancer.
Correct answer F
70. Mutation or loss of heterozygosity in APC gene is associated with the molecular
pathology of gastric cancer?
Correct answer T
71. Mutation in gene coding for beta-catenin is associated with the molecular pathology of
gastric cancer?
Correct answer T
72. Mutations in gene coding for E-cadherin is associated with the molecular pathology of
gastric cancer?
Correct answer T
73. Inactivation of p53 is associated with the molecular pathology of gastric cancer?
Correct answer T
74. Microsatellite instability. is associated with molecular pathology of gastric cancer?
Correct answer T
75. Gastric cancer reaching the serosa usually indicates incurability.
Correct answer T
76. In gastric cancer blood-borne metastases commonly occur in the absence of lymph node
spread.
Correct answer F
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77. In gastric cancer Krukenberg’s tumors are always associated with other areas of trans
coelomic spread.
Correct answer F
78. In gastric cancer Sister Joseph’s nodule is diagnostic of gastric cancer.
Correct answer F
79. In gastric cancer The lymphatic vessels related to the cardia have no relation to the
oesophageal lymphatics.
Correct answer F
80. Hematogenous metastases is an unequivocal evidence of incurability in gastric cancer.
Correct answer T
81. Involvement of distant peritoneum is an unequivocal evidence of incurability in gastric
cancer.
Correct answer T
82. N3 nodal disease is an unequivocal evidence of incurability in gastric cancer.
Correct answer F
83. Involvement of adjacent organs is an unequivocal evidence of incurability in gastric
cancer
Correct answer F
84. Gastric outlet obstruction is an unequivocal evidence of incurability in gastric cancer.
Correct answer F
85. D1 resection is superior to a D2 resection in the treatment of gastric cancer.
Correct answer F
86. The 5-year survival of gastric cancer in the UK is between 50 and 75 per cent.
Correct answer F
87. In the treatment of gastric cancer there is a definite role for neoadjuvant chemotherapy.
Correct answer T
88. Gastrointestinal continuity is established after total gastrectomy by a Roux loop.
Correct answer T
89. In the treatment of gastric cancer Radiotherapy to the gastric bed is a useful adjunct.
Correct answer F
90. The liver is fixed in its place by peritoneal reflections called ligaments.
Correct answer T
91. The major part of the blood supply of the liver is derived from the hepatic artery.
Correct answer F
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92. The portal vein lies posterior to the hepatic vein and common bile duct.
Correct answer T
93. The bile duct, portal vein and hepatic artery are contained in the lesser omentum.
Correct answer T
94. The portal vein is formed by the union of the superior mesenteric and left gastric veins.
Correct answer F
95. The left hepatic duct has a longer extrahepatic course than the right.
Correct answer T
96. The major venous drainage is by three veins – right, middle and left hepatic veins
draining directly into the inferior vena cava (IVC).
Correct answer T
97. All the three major veins join the IVC within the liver parenchyma.
Correct answer F
98. The functional lobes of the liver are divided by the falciform ligament.
Correct answer F
99. The liver is divided into eight functional segments – I to IV in the left hemi-liver and V–
VIII in the right hemi-liver.
Correct answer T
100. The spleen lies in front of the left 10th, 11th and 12th ribs.
Correct answer F
101. The splenic artery arises from the coeliac axis.
Correct answer T
102. The inferior mesenteric vein empties into the splenic vein.
Correct answer T
103. The tail of the pancreas lies in the lienorenal ligament.
Correct answer T
104. The inner surface of the spleen has two impressions – gastric and colic.
Correct answer F
105. Partial splenectomy can result in splenic regeneration.
Correct answer T
106. During splenectomy the tail of the pancreas can be damaged.
Correct answer T
107. A gastric or pancreatic fistula can occur as a post-splenectomy complication.
Correct answer T
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108. In a left hemicolectomy the spleen can be in danger.
Correct answer T
109. The risk of opportunist post-splenectomy infection (OPSI) is greatest after the first 6
months of splenectomy.
Correct answer F
110. Splenuli are present in approximately 10–30 per cent of the population.
Correct answer T
111. Splenic artery aneurysm can occur as a complication of acute pancreatitis.
Correct answer T
112. Plain abdominal X-ray is the ideal imaging modality.
Correct answer F
113. A massively enlarged spleen is prone to infarction.
Correct answer T
114. The splenic hilum is a common site for the development of a pseudocyst of the pancreas.
Correct answer T
115. Patients with asymptomatic gallstones should routinely be advised to have a
cholecystectomy.
Correct answer F
116. Ninety per cent of patients with acute cholecystitis respond to conservative treatment.
Correct answer T
117. Antibiotics are not required in the management of acute cholecystitis in the absence of
jaundice.
Correct answer F
118. Urgent laparoscopic cholecystectomy in a patient with acute cholecystitis is associated
with a five times greater conversion rate compared with elective surgery.
Correct answer T
119. Acalculous cholecystitis has a mild clinical course.
Correct answer F
120. The incidence of symptomatic bile duct stones varies from 5 to 8 per cent.
Correct answer T
121. Charcot’s triad consists of pain, stones and jaundice.
Correct answer F
122. Primary sclerosing cholangitis (PSC) is associated with hypergammaglobulinemia and
elevated smooth muscle antibodies.
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Correct answer T
123. Clonorchiasis can predispose to bile duct carcinoma.
Correct answer T
124. Bismuth type 3 biliary stricture is a hilar stricture.
Correct answer T
125. Gall bladder carcinoma is a rare disease.
Correct answer T
126. The majority of Gall bladder carcinoma are adenocarcinomas.
Correct answer T
127. In Gall bladder carcinoma the CA19–9 is elevated in 80 per cent of the cases.
Correct answer T
128. In Gall bladder carcinoma A palpable mass is an early sign.
Correct answer F
129. Prognosis of Gall bladder carcinoma is generally good.
Correct answer F
130. The pancreas weighs 200 g.
Correct answer F
131. The uncinate process lies behind the superior mesenteric vessels.
Correct answer T
132. The vast majority of pancreatic tissue is composed of exocrine acinar tissue.
Correct answer T
133. Of the endocrine cells, 75 per cent are B cells, 20 per cent are A cells and the remainder
are D cells.
Correct answer T
134. The accessory pancreatic duct drains the head and uncinate process.
Correct answer T
135. Ultrasonography (US) is the initial investigation of choice in the jaundiced patient.
Correct answer T
136. When doing a computed tomography (CT) scan, initially an unenhanced scan must be
done followed by a scan after intravenous contrast injection (CECT).
Correct answer T
137. While doing a magnetic resonance cholangiopancreatography (MRCP), intravenous
secretin injection helps to determine any obstruction to the pancreatic duct.
Correct answer T
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138. An increase in serum amylase is diagnostic of acute pancreatitis.
Correct answer F
139. Endoscopic retrograde cholangiopancreatography (ERCP) should always be preceded
by a plain radiograph.
Correct answer T
140. Pancreatic injury is common following blunt abdominal trauma.
Correct answer F
141. Pancreatic injury is often accompanied by damage to the liver, spleen and duodenum.
Correct answer T
142. The serum amylase is raised in most cases of pancreatic injury.
Correct answer T
143. In Pancreatic injury A CECT scan will delineate the damage.
Correct answer T
144. In doubtful cases of Pancreatic injury, urgent ERCP is helpful.
Correct answer T
145. All patients with pancreatic trauma should undergo an exploratory laparotomy.
Correct answer F
146. Pancreatic duct disruption requires surgical exploration.
Correct answer T
147. Severe injury to the duodenum and the head of the pancreas requires a
pancreatoduodenectomy.
Correct answer T
148. After conservative management for pancreatic injury, duct stricture and pseudocyst may
occur as complications.
Correct answer T
149. During splenectomy, iatrogenic injury to the pancreatic tail can occur.
Correct answer T
150. Acute pancreatitis accounts for 3 per cent of hospital admissions in the UK for
abdominal pain.
Correct answer T
151. Acute pancreatitis is classified into mild and severe.
Correct answer T
152. 80 per cent of Acute pancreatitis are mild acute pancreatitis, with a mortality rate of 1
per cent.
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Correct answer T
153. 20 per cent of acute pancreatitis are severe acute pancreatitis, with a mortality of 20–50
per cent.
Correct answer T
154. In all cases of acute pancreatitis, there is a marked rise in serum amylase.
Correct answer F
155. The small bowel is approximately 10 meters long.
Correct answer F
156. The colon is approximately 3 meters long.
Correct answer F
157. The most fixed part of the small bowel is the duodenum.
Correct answer T
158. The jejunum is wider, thicker and more vascular than the ileum.
Correct answer T
159. Peyer’s patches are contained in the ileum.
Correct answer T
160. Duodenal diverticulum may result from a long-standing duodenal ulcer.
Correct answer T
161. Jejunal diverticula may give rise to malabsorption problems.
Correct answer T
162. A Meckel’s diverticulum can cause severe lower gastrointestinal haemorrhage.
Correct answer T
163. A suspected Meckel’s diverticulum is best imaged by a barium meal and follow
through.
Correct answer F
164. Pain originating in a Meckel’s diverticulum is located around the umbilicus.
Correct answer T
165. In the Western world, 60 per cent of the population over the age of 60 have diverticular
disease of colon.
Correct answer T
166. A low-fibre diet causes Diverticular disease of colon.
Correct answer T
167. Diverticular disease of colon consist of mucosa, muscle and serosa.
Correct answer F
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168. Diverticular disease of colon with perforation have a 10 times higher mortality than
those with an inflammatory mass.
Correct answer T
169. In diverticular disease of colon Sepsis is the principal cause of morbidity.
Correct answer T
170. From the complication of diverticular disease of the colon : Paracolic abscess.
Correct answer T
171. From the complication of diverticular disease of the colon : Fistulae.
Correct answer T
172. From the complication of diverticular disease of the colon : Lower gastrointestinal
haemorrhage.
Correct answer T
173. From the complication of diverticular disease of the colon : Carcinoma.
Correct answer F
174. From the complication of diverticular disease of the colon : Stricture.
Correct answer T
175. In complicated diverticular disease : Urinary symptoms may be the predominant
presentation at times.
Correct answer T
176. In complicated diverticular disease : Profuse colonic haemorrhage may occur in 17 per
cent.
Correct answer T
177. In complicated diverticular disease: Fistulae occur in 5 per cent of cases.
Correct answer T
178. In complicated diverticular disease: The commonest fistula is coloenteric.
Correct answer F
179. In acute diverticulitis, CT scan is the ‘gold standard’ for imaging.
Correct answer T
180. In the surgical treatment of diverticular disease: Colonoscopy must be carried out in all
elective cases.
Correct answer T
181. In the surgical treatment of diverticular disease : Barium enema is essential prior to
elective operation.
Correct answer T
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182. In the surgical treatment of diverticular disease : Primary resection and end-ta-end
anastomosis mustt be carried out in all cases.
Correct answer F
183. In the surgical treatment of diverticular disease : Hartmann’s operation is the procedure
of choice in perforated diverticulitis.
Correct answer T
184. In the surgical treatment of diverticular disease with vesicocolic fistula, a one-stage
operation can usually be done.
Correct answer T
185. In 95 per cent of cases of ulcerative colitis, the disease starts in the rectum and
spreadsproximally.
Correct answer T
186. Ulcerative colitis is a diffuse disease affecting all the layers of the large bowel.
Correct answer F
187. In ulcerative colitis Granulomas are a typical microscopic feature.
Correct answer F
188. The transverse colon is affected in toxic megacolon.
Correct answer T
189. Patients with ulcerative colitis may present as an emergency with fulminating colitis in
5–10 per cent.
Correct answer T
190. Complication of ulcerative colitis include: Carcinoma.
Correct answer T
191. Complication of ulcerative colitis include: Primary sclerosing cholangitis.
Correct answer T
192. Complication of ulcerative colitis include: Internal fistulae.
Correct answer F
193. Complication of ulcerative colitis include: Ankylosing spondylitis.
Correct answer T
194. Complication of ulcerative colitis include: Perforation.
Correct answer T
195. Barium enema finding in UC: Loss of haustrations.
Correct answer T
196. Barium enema finding in UC: Narrow contracted colon.
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Correct answer T
197. Barium enema finding in UC: Increase in the presacral space.
Correct answer T
198. Barium enema finding in UC: Cobble stone appearance.
Correct answer F
199. Barium enema finding in UC: Backwash ileitis.
Correct answer T
200. The indications for surgery in UC: Severe fulminating disease not responding to
vigorous medical treatment.
Correct answer T
201. The indications for surgery in UC: Severe dysplastic change or cancer on biopsy.
Correct answer T
202. The indications for surgery in UC: Non-compliance of medical treatment.
Correct answer F
203. The indications for surgery in UC: Chronic steroid-dependent disease requiring large
doses.
Correct answer T
204. The indications for surgery in UC: Extraintestinal disease.
Correct answer T
205. Regarding surgery in UC: In the emergency situation, total abdominal colectomy and
ileostomy should be the procedure of choice.
Correct answer T
206. Regarding surgery in UC: Proctocolectomy and ileostomy are associated with the
lowest complication rate.
Correct answer T
207. Regarding surgery in UC: Restorative proctocolectomy with an ileoanal pouch should
be considered in all patients.
Correct answer T
208. Regarding surgery in UC: Colectomy with ileorectal anastomosis is the most favored
procedure.
Correct answer F
209. Regarding surgery in UC: Ileostomy with a continent intraabdominal pouch is not often
done.
Correct answer T
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210. About Crohn’s disease (CD):The ileum is affected in 60 per cent of cases.
Correct answer T
211. About Crohn’s disease (CD): It affects the entire thickness of the bowel.
Correct answer T
212. About Crohn’s disease (CD): Non-caseating granulomas are found in only 60 per cent
of patients.
Correct answer T
213. About Crohn’s disease (CD): One in 10 patients have a first-degree relative with the
disease.
Correct answer T
214. About Crohn’s disease (CD): A patient can be cured of CD once the diseased small or
large bowel is removed.
Correct answer F
215. About imaging in Crohn’s disease (CD): Small-bowel enema is the imaging of choice
in small-bowel disease.
Correct answer T
216. About imaging in Crohn’s disease (CD): Barium enema and colonoscopy should be
done for large-bowel disease.
Correct answer T
217. About imaging in Crohn’s disease (CD): MRI is the ‘gold standard’ for perianal fistulae.
Correct answer T
218. About imaging in Crohn’s disease (CD): CT scan is used for suspected intraabdominal
abscess and internal fistulae.
Correct answer T
219. About inflammatory bowel disease (UC and CD) : Patients must be managed jointly by
the physician and surgeon.
Correct answer T
220. About inflammatory bowel disease (UC and CD) : Surgery, when indicated, must be as
radical as possible.
Correct answer F
221. About inflammatory bowel disease (UC and CD) : Patients must be given a good trial
of optimum medical treatment prior to surgery.
Correct answer T
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222. About inflammatory bowel disease (UC and CD) : There is more chance of a cure after
surgery in UC than in CD.
Correct answer T
223. About inflammatory bowel disease (UC and CD) : In emergency presentation, patients
must be vigorously resuscitated prior to operation and managed in the ITU postoperatively.
Correct answer T
224. In Familial Adenomatous Polyposis: 20 per cent of FAP arise as a result of new
mutations in the adenomatous polyposis coli (APC) gene.
Correct answer T
225. In Familial Adenomatous Polyposis: Large-bowel cancer occurs 15–20 years after the
onset of the disease.
Correct answer T
226. In Familial Adenomatous Polyposis: On surveillance, if there are no polyps by the age
of 30 years, FAP is unlikely.
Correct answer T
227. In Familial Adenomatous Polyposis: Polyps do not develop anywhere else other than
the colon.
Correct answer F
228. In Familial Adenomatous Polyposis: Colectomy with ileorectal anastomosis may result
in rectal cancer later.
Correct answer T
229. Right colonic cancers present with features of anemia.
Correct answer T
230. Left colonic cancers present with rectal bleeding and obstructive symptoms.
Correct answer T
231. In Colon cancer: Even for an experienced colonoscopies, the failure rate to visualize
the caecum is 10 per cent.
Correct answer T
232. In Colon cancer: Intravenous urography (IVU) should be routinely done.
Correct answer F
233. Synchronous colon cancers occur in 5 per cent.
Correct answer T
234. In large bowel cancer: Thorough preoperative assessment and staging should be done
with colonoscopy, US and spiral CT.
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Correct answer T
235. In large bowel cancer: Resection is not done if the patient has liver metastases.
Correct answer F
236. In large bowel cancer: If, at operation, hepatic metastases are found, biopsy should be
done.
Correct answer F
237. In large bowel cancer: Hepatic resection for metastases should be considered as a staged
procedure.
Correct answer T
238. In large bowel cancer: Over 95 per cent of colonic carcinomas can be resected.
Correct answer T
239. Causes of adynamic intestinal obstruction include: Paralytic ileus.
Correct answer T
240. Causes of adynamic intestinal obstruction include: Hernia.
Correct answer F
241. Causes of adynamic intestinal obstruction include: Mesenteric vascular obstruction.
Correct answer T
242. Causes of adynamic intestinal obstruction include: Pseudo-obstruction.
Correct answer T
243. Causes of adynamic intestinal obstruction include: Adhesions.
Correct answer F
244. Increased postoperative adhesions occurs with: Ischemic areas.
Correct answer T
245. Increased postoperative adhesions occurs with: Good surgical technique.
Correct answer F
246. Increased postoperative adhesions occurs with: Foreign material.
Correct answer T
247. Increased postoperative adhesions occurs with: Covering anastomosis and raw areas.
Correct answer F
248. Increased postoperative adhesions occurs with: Crohn’s disease.
Correct answer T
249. Regarding intussusception: It is most common in children with a peak incidence
between 5 and 10 months of age.
Correct answer T
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250. Regarding intussusception: About 10 per cent of infantile intussusceptions are
idiopathic.
Correct answer F
251. Regarding intussusception: It causes obstruction but not strangulation.
Correct answer F
252. Regarding intussusception: Meckel’s diverticulum can be a cause in older children.
Correct answer T
253. About sigmoid volvulus: This is the most common site of volvulus in adults.
Correct answer T
254. About sigmoid volvulus: The predisposing factors include constipation, long pelvic
mesocolon and narrow attachment of the mesocolon.
Correct answer T
255. About sigmoid volvulus: The rotation is usually in a clockwise direction.
Correct answer F
256. About sigmoid volvulus: Flatus tube decompression is associated with a low rate of
recurrence.
Correct answer F
257. About sigmoid volvulus: There is no role for emergency surgery.
Correct answer F
258. Muscles of the leg are enclosed in a tight sleeve that is formed of the deep fascia.
Fascial septa divide these muscles into two compartments.
Correct answer F
259. Rigid fixation of a fracture is needed for healing of an arterial repair, otherwise it will
be disrupted or contused and thrombosed.
Correct answer T
260. This patient is suspected to have injury of the bulbous urethra. If the patient voids,
urine will spread in the subcutaneous tissues, deep to the membranous part of the superficial
fascia.
Correct answer T
261. The most important factor that affects wound healing is vascularity of its edges.
Correct answer T
262. A hernia must be repaired with absorbable material, so as to resist stresses for life.
Correct answer F
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263. Delayed primary closure of the skin means skin closure when pus stops to drain from
the wound.
Correct answer F
264. Incised wounds treatment is by hemostasis and leaving the wound open to drain.
Correct answer F
265. The extent of tissue damage by a missile depended upon its weight.
Correct answer T
266. The extent of tissue damage by a missile is proportionate to its velocity.
Correct answer T
267. Stab wound usually fracture bones and thus add to tissue damage.
Correct answer F
268. Stab wounds are inflicted by knives and may injure viscera.
Correct answer T
269. In the presence of contamination, delayed primary closure of an incised wound reduces
the possibility of infection.
Correct answer T
270. In healing by secondary intention wound contraction and granulation tissue does not
play major roles.
Correct answer F
271. Shoch with bradycardia is Hypovolemic shock.
Correct answer F
272. Disseminated intravascular coagulation (DIC) is a complication of shock particularly
the hypovolemic type.
Correct answer F
273. Metabolic acidosis is commonly seen in cases of shock though the pH is normal a low
bicarbonate level indicates metabolic acidosis
Correct answer T
274. Adult respiratory distress syndrome (ARDS) is one example of the multiple organ
failure syndrome which occurs with shock.
Correct answer T
275. Shock particularly the septic type, major burns, and severe pancreatitis can all trigger
the release of cytokines that lead to systemic inflammatory response syndrome (SIRS) the
to multiple organ failure (MOF).
Correct answer T
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276. Renal failure that is caused by shock is irreversible.
Correct answer F
277. In cardiogenic shock, the neck veins are collapsed.
Correct answer F
278. Treatment of cyclic mastalgia can be avoidance of breast support.
Correct answer F
279. A Fibroadenoma is a mixed epithelial and mesenchymal benign tumour. The peak age
of appearance is late teens and early twenties.
Correct answer T
280. Regarding breast cysts, Multiplicity of cysts raises suspicion of malignancy.
Correct answer F
281. The commonest histological type of breast cancer is Ductal carcinoma in situ.
Correct answer F
282. In breast cancer, T stands for tumour size. A tumour between 2-5 cm is T2.
Correct answer T
283. Mammography indicated for regular screening of women who are at high-risk of
development of breast cancer.
Correct answer F
284. Breast cancer is better for tumors in the medial half than the lateral one of the breast
Correct answer F
285. Paget’s disease of the nipple is lobular carcinoma arising at the opening of a lactiferous
duct on the nipple.
Correct answer F
286. In a young female patient, a Lanz incision is preferred as this is more in keeping with
langer's lines.
Correct answer T
287. A Kocher's incision is a subcostal incision used for open cholecystectomy.
Correct answer T
288. A Collar incision is made for submandibular gland excision and block dissection.
Correct answer F
289. Esophageal carcinoma is commoner in smokers, in people with increased alcohol
intake oesophageal strictures or certain dietary deficiencies.
Correct answer T
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290. A pharyngeal pouch occurs in a weakness in the superior constrictor muscle. It is also
known as killian's dehiscence.
Correct answer F
291. Achalasia is Treated by injection of botulinum toxin.
Correct answer T
292. In venous type ulcer the duplex show good arterial flow, so compression bandaging
would be suitable treatment.
Correct answer T
293. In an arterial ulcer with stigmata of chronic arterial insufficiency, Revascularization
should be attempted, either endovascularly or surgically.
Correct answer T
294. Inter-sphincteric abscesses can be incised, drained, and laid open. Trans-sphincteric
abscesses are usually laid open to reduce the risk of incontinence following damage to both
internal and external sphincter mechanisms in this case seton drainage.
Correct answer T
295. Sub-phrenic abscess is a known complication of diverticular disease, usually occurring
approximately 1-3 days following the initial episode.
Correct answer F
296. Amylase of 1000 Somogyi U/dl is characteristic of acute pancreatitis.
Correct answer T
297. Epstein-Barr virus is associated with Burkitt's lymphoma in the presence of malarial
infection.
Correct answer T
298. Aspergillus flavus releases aflatoxin which occur as a dietary contaminant and are
associated with hepatocellular regeneration.
Correct answer F
299. Primary hydrocele is most common at young age.
Correct answer F.
300. Fournier's gangrene is necrotizing fasciitis of the scrotum.
Correct answer T.
301. This man has a Glasgow coma scale (GCS) of 3. He is unable to protect his own
airway; securing the airway is therefore paramount.
Correct answer T
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302. Hyperplasia is increased tissue or organ size due to increased cell size in response to
increased functional demand.
Correct answer F
303. Atrophy is the decrease in size of an organ or tissue by reduction in cell size and /or
reduction in cell numbers.
Correct answer T
304. Agenesis is failure of development of an organ or structure. This differs from atresia
which is failure of development of a lumen in a normally tubular structure.
Correct answer T
305. Transitional cell carcinomas of the renal pelvis resemble those affecting the bladder
but are much less common they tend to invade the renal parenchyma and have a tendency to
distal spread.
Correct answer T
306. hemorrhagic SHOCK class 1 is loss of 0-15% of circulating volume; there are no
obvious changes apart from the patient perhaps feeling uncomfortable and restless.
Correct answer T
307. Painless jaundice together with a history of weight loss is strongly suggestive of a
malignancy.
Correct answer T
308. Sharing of needles among intravenous drug misusers is a serious risk factor for
hepatitis B and C both of which predispose to the development of hepatocellular cancer in
later years Alpha-fetoprotein is a marker for this cancer although it is also raised in
hepatoma.
Correct answer T
309. Cola-colic intussusception typically presents as in this case and the tumor acts as the
apex. Half of all adult intussusceptions are due to carcinoma.
Correct answer T
310. Hyperparathyroidism presents with the symptoms of hypocalcemia including
paraesthesia, cramps, tetany, circum-oral tingling, and convulsions.
Correct answer F
311. Secondary hyperparathyroidism is caused by chronic renal failure in response to a low
calcium level, and is characterized by a low serum and a raised PTH level.
Correct answer T
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312. A recent general anesthetic and opioid-based analgesia causing constipation are two
factors which predispose to developing urinary retention post-operatively.
Correct answer T
313. Umbilical hernias in young children should be treated surgically.
Correct answer F
314. Laparoscopic repair of inguinal hernias is recommended for the management of
bilateral inguinal hernias unless there are any contraindications present.
Correct answer T
315. Squamous cell carcinoma is most common in sun-exposed areas frequently bleeds and
is characterized by an undermined edge.
Correct answer T
316. Squamous cell characterized by a rolled pearly edge. It does not tend to bleed as often
as melanoma.
Correct answer F
317. Full-thickness skin grafting can be used on exposed tendon, but is not good for exposed
bone or cartilage.
Correct answer T
318. Local flaps provide their own blood supply and can transfer skin, fascia, muscle, and
bone.
Correct answer T
319. Free flaps can not provides their own blood supply, and can be used with local flap.
Correct answer F
320. Hemorrhoidal bleeding is painless and not mixed with stools it is bright red as its origin
from the arteriovenous cushions of the anal canal.
Correct answer T
321. Rubber band ligation is most useful in stopping bleeding from first- and second-degree
hemorrhoids for third degree hemorrhoids, band ligation is enough to control the prolapse.
Correct answer F
322. Hemorrhoidectomy causes considerable postoperative pain. This may result in reflex
retention of urine, rather than incontinence.
Correct answer T
323. Fecal incontinence can occur if the whole anal sphincter mechanism is divided Anal
stenosis may follow hemorrhoidectomy if the surgeon leaves intact muco-cutaneous bridges
between the raw areas.
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Correct answer F
324. The majority of abscesses start as infection of an anal gland. These glands are present
in the intersphincteric space and have their ducts open at the dentate line.
Correct answer T
325. Anal fistulotomy or fistulectomy wounds should be sutured.
Correct answer F
326. Surgery for a high fistula requires division of the entire anal sphincter mechanism and
would produce incontinence if done in one stage.
Correct answer T
327. The majority of anal canal cancers are of the squamous carcinoma type.
Correct answer T
328. The caudate lobe is segment I. it lies between the porta hepatic and the inferior vena
cava (IVC) posteriorly.
Correct answer T
329. The enzyme alkaline phosphatase is elevated in cases of bill stasis and with bone
diseases particularly bone resorption and destruction.
Correct answer T
330. Being a retroperitoneal organ an isolated injury of the kidney is likely to stop bleeding
spontaneously because of the tamponade effect of the posterior peritoneum on the
hematoma.
Correct answer T
331. The main danger of liver injury is bleeding However bleeding can stop spontaneously.
Correct answer F
332. Acute appendicitis always causes a liver abscess if it happens infection gets to the liver
through lymphatics.
Correct answer F
333. An amoebic liver abscess characteristically contains clear fluid.
Correct answer F
334. The normal portal pressure is 8-12cm water.
Correct answer T
335. Schistosomiasis carries a worse prognosis than post-hepatitis cirrhosis.
Correct answer F
336. Viral hepatitis A resolves spontaneously without ill effects. One the hand types B and
C can cause liver cirrhosis and predispose to the development of hepatocellular carcinoma.
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Correct answer T
337. Hemangiomas of the liver are common findings on imaging studies (CT or
ultrasound)that are done for other indications.
Correct answer T
338. carcinoembryonic antigen is elevated in patients with GIT and breast cancer.
Correct answer T
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