Awn 6th Year Surgery Final Exam 2019
** 100 Questions in 120 minutes.
1) The most common indication of sebaceous cyst surgery is :-
A) Infection
B) malignancy
C) cosmetic disfigurement
ANSWER: C) Cosmetic
2) Thrombophlebitis migrans (Migratory Thrombophlebitis) is seen in:
A) Pancreatic CA
B) Gastric CA
C) Colon CA
D) lung CA
E) breast CA
Answer: A) Pancreatic CA
3) One of the following is not a complication of acute pancreatitis:
A) Acute renal failure
B) Hypertension
C) Acute respiratory distress syndrome
D) Pancreatic infection
Answer: B) Hypertension
4) Most common cause of mechanical intestinal obstruction in elderly:
A) Adhesions
B) Cancer
C) Diverticulitis
Answer: A) Adhesions
5) All of the following cause hypergastrenemia except:
A) Hypocalcemia
B) Zollinger Ellison Syndrome
C) Short gut syndrome
D) Renal failure
E) Retained Antrum of the stomach
Answer: A) Hypocalcemia
6) 69 years old male patient came complaining of hematuria. What is the most
common cause of his presentation:
A) Bladder cancer
B) BPH
C) Stones
Answer: B) BPH
7) Which tumor is not spread by hematogenous route :-
A) skin cancer
B) breast cancer
C) gastric cancer
D) Liver cancer
Answer: ?
8) All of the following are reliable indicators of tissue perfusion except:
A) arterial serum lactate
B) venous serum lactate
C) blood pressure
D) venous oxygen saturation
E) base deficit
Answer: C) Blood pressure
9) The most common presentation for multinodular colloid goitre is:
A) clinically toxic nodule
B) difficulty swallowing
C) difficulty breathing
D) cosmetic
Answer: D) Cosmetic
10) Which of the following is not seen in axillary fossa :-
A) long thoracic nerve
B) thoracodorsal nerve
C) musculocutaneous nerves of the hand
D) Apical lymph node
E) Axillary Vein
Answer:
11) All of the following cause paralytic ileus except:
A) retroperitoneal hemorrhage
B) uremia
C) bacterial peritonitis
D) tetanus
E) Tricyclic Antidepressants
Answer: D) Tetanus
12) Regardin GI symptoms, which is true :
A) tenesmus is associated with rectal lesion
B) diarrhea means no cancer
C) small caliber stool means obstructing tumor
D) dark blood per rectum means upper GI bleeding
Answer: A
13) All of the following are risk factors for esophageal cancer except :-
A) male
B) alcohol
C) barrets esophagus
D) Anemia
E) obesity
Answer: D) Anemia
14) Skin graft is:
A) allograft
B) isograft
C) autograft
D) xenograft
E) none of the above
Answer: C) Autograft
15) Which is not a risk for gastric cancer:
A) chronic atrophic gastritis
B) pernicious anemia
C) achlohydria
D) MEN 1
Answer: D) MEN 1
16) The most common cause of obstructive jaundice in chronic pancreatitis
patient is:
A) gallstones
B) cholangiocarcinoma
C) pancreatic head tumor
D) bile duct stenosis
E) Pancreatic pseudocyst formation
Answer:
15) A 45-year-old man with persistent cough is noted to have a suspicious
lesion on CXR. The physician orders a CT scan. Which one of the following
describes the main purpose of CT imaging for a patient with a suspicious lung
mass?
A. Determine if the mass is infectious in origin
B. Differentiate between primary and metastatic disease
C. Discern between exudative pleural effusion and transudative effusion
D. Determine the anatomic location of the mass
E. Differentiate between malignant and benign lesions
Answer: D
16) The Four points of probe placement in Focused Abdominal sonogram for
trauma FAST are:
A) Epigastrium, Right hypochondrium, Left lower chest, hypogastrium
B) Epigastrium, right and left hypochondria, right iliac fossa
C) Epigastrium, right and left lumbar regions, hypogastrium
D) hypogastrium, right and left lumbar regions, right lower chest
Answer: A)
17) Which imaging can't be ordered in a tumor obstructing the colon:
A) CT with IV contrast
B) CT with oral contrast
C) barium enema
D) water soluble contrast
Answer: C) barium enema?
18) The most common source of femoral artery thrombosis is:
A) atheroma
B) femoral aneurysm
C) abdominal mass
D) raynaud phenomenon
Answer: A) Atheroma
19) Newborn was admitted to NICU because of respiratory distress and he was
on ventilator, you noted right inguinal hernia, which is the best to do:
A) do surgery immediately while patient on ventilator
B) do surgery at age of 2 years if hernia still present
C) wait until patient is off ventilator and ready for discharge then do surgery
Answer: C
20) Which is not risk factor for gallbladder stone:
A) pregnancy
B) smoking
C) fatty diet
D) contraceptive pills
E) crohn's disease
Answer: ?
21) 70% of prostate abscess is caused by:
A) E.coli
B) gonococcus
Answer: A
22) All of the following about intermittent claudication are true except:
A) Bursting pain in calf
B) Pain relieved by rest
C) Indication of coronary artery disease
D) Pain in group of muscles
E) It’s Predictable and reproducible
Answer: A
23) All of the following are measures to decrease wound infection except:
A) shaving of the skin of wound area the night before surgery
B) decreaee pre-operative hospital stay
Answer: A
24) Components of Cardio-Pulmonary Bypass machine except:
A) Heparin injector
B) Oxygenator
C) reservoir
D) pump
Answer: A
25) Which is wrong about critical limb ischemia:
A) pain increase at night
B) patient hang his leg from the bed to decrease pain
C) critical limb ischemia has a malignant course
D) pain is in the calf muscle
E) pain and tissue loss are the main symptoms
Answer: D
26) A question about collagen and phases of wound healing, which is the true
statement:
Answer: Collagen causes tensile strength of wound of 80% of uninjured skin after
3 months
27) Which is wrong about the inflammatory phase of wound healing:
A) vasoconstriction occurs followed by vasodilation
B) activation of complement system, and c4 is the most important
C) monocytes must present for proper wound healing
Answer: B
28) Which is the most consistent with left side tension pneumothorax:
A) hypotension, diminished breathing sounds on left side, lung opacification
in the left side in CXR, right sided tracheal deviation
B) right sided tracheal deviation, diminished breathing sounds on the left
side
Answer: B
29) Most reliable Sign of hernial strangulation
A) Rebound tenderness
B) Exaggerated bowel sounds
C) Abdominal distention
Answer: A
30) Which of the following is the most common hernia in females
a. Direct inguinal hernia
b. Indirect inguinal hernia
c. Femoral hernia
d. Epigastric hernia
Answer: b
31) All wrong about testicular torsion except one true:
A) Insidious onset with unilateral scrotal pain
B) Intra-vaginal torsion most common in neonates
C) Happens usually in neonates and after puberty
Answer: C
32) Which does not occur when starting Cardio-Pulmonary Bypass :
A) decrease in platelets
B) increase in interstitial fluid
C) activating of complement system
Answer:
33) The most common cause of upper limb lymphedema:
A) post radiation
B) filariasis
C) axillary clearance after breast cancer surgery
Answer: C
34) 28 YO female complaining of right lower abdominal pain for 3mo ,
occasionally fever , diarrhea 3 to 4 times per daywith mucus but no blood , +
eye symptoms, abdominal exam reveal local tenderness in RLQ most likely dx
A) chronic appendicitis
B) crohn's disease
C) Ulcerative colitis
D) IBS
Answer: B
35) 4 weeks old baby previously healthy, presented with billious vomiting of 6
hours ( other informations), which is the best imaging test to order :
A) abdoimnal ultrasound
B) CT scan
C) MRI
D) Upper GI series
Answer: A?
36) Which is wrong about appendicitis:
A) pain usually precedes vomiting
B) anorexia usually presents
C) High grade fever
Answer: C
37) Regarding carcinoid tumors in the appendix which is ture:
A) carcinoid tumors mostly located at the base of appendix
B) If regional lymph nodes are positive we do right hemicolectomy
C) 30% of pt present with carcinoid syndrome
D) 50% of carcinoid tumors are multiple
Answer: B
38) Regarding neurogenic mediastinal tumors, which is wrong:
A) they are usually asymptomatic
B) located in upper parts of posterior mediastinum
C) they are mostly malignant
D) occurs in children
E) most common tumor of posterior mediastinum
Answer: C
39) Trauma patient presented with low blood pressure and tachycardia, and
was found to have splenic rupture in lower pole. He was resuscitated and after
2 hours he had normal blood pressure and normal heart rate. Which of the
following is the best to do :
A) observe the patient with careful monitoring
B) ultrasound every 2 hours
C) laparotomy for exploration with total splenectomy
D) abdominal exploration with partial splenectomy
Answer:
40) Which of the following is associated with Inferior Vena Cava obstruction?
A) Caput medusa
B) Hemorrhoids
C) Esophageal varices
D) Gastric varices
E) Prominent thoraco-epigastric vein
Answer: E?
41) Longitudinal fold in renal pelvis and ureter in children seen in:
a. vesicoureteral reflux .
b. hydronephrosis.
Answer: a
42) Prophylactic Abs are given in case of clean contaminated surgical wound?
A) 1 hour pre-operative
B) within 1 hour postoperative
C) 3 days prior to surgery
D) Night before the surgery
Answer: A
43) Which can't be the cause of wound infection after hernia surgery:
A) staph aureus
B) coliform bacili
C) streptococcus hemolyticus
D) pseudomonas
E) strep fecalis
Answer: D?
44) Risk factors of pilonidal sinus except ?
A) Obesity
B) Poor personal hygiene
C) Family hx
D) Male gender
E) Professional driver
Answer:
45) Presentation of anal fistula:
Answer: Nodule with Pus discharge
46) Location of anal fissure in men mostly:
A) Posteriar mildine perianal skin
B) Upper part of anal canal posterior
C) Lower part of anal canal posterior
Answer: A
47) What is the treatment of suspicious malignany in FNA of thyroid:
A) total thyroidectomy
B) subtotal thyroidectomy
Answer: A
48) Which is wrong about volvulus:
A) if detortion is not successful we think of strangulation
B) after successful detortion 10% of patient may have volvulus another time
C) Contrast enema for volvulus shows a ccc bird beak sign
Answer: B
49) 3 years old child who developed bleeding per rectum 1 day ago presented
to the ER with HB 7.. No history of fever or Abdomenal pain.. Which test has
the highest diagnostic value for his condition:
A) Abdominal CT
B) Technetium-99m pertechnetate scintigraphy
C) stool culture
Answer: B
50) Not a hypocalcemia symptom:
A) Oily skin
B) Congestive heart failure
C) Perioral numbness
D) Muscle spasms
Answer:
51) True about electrolytes:
Answer: Hyperkalemia can be managed by insulin & glucose
52) A question about short bowel syndrome, which statement is worng:
A) total resection of jejunum will not cause nutritional sequelae
B) massive resection of the bowel will cause gastric hyposecretion and
increase in pH
C) up to 70% of bowel can be removed if terminal ileum and ileocecal valve
to be left functional
Answer:
53) Young male with natal cleft presented with swelling and redness in sacrum ,
Wts DX ?
A) Pilonidal sinus
B) Perianal abcess
C) Sacral tumor
D) Warts
Answer:
54) Highest radiation dose:
A) nuclear imaging
B) X ray fluroscopy
C) Intravenous pylogram
D)US
E)MRI
Answer:
55) Most radio-sensitive testicular cancer:
A) Seminoma
B) Teratoma
C) Interstitial cell tumor
D) Choriocarcinoma
Answer: A
56) Most common cause of death in blunt chest trauma
A) Pulmonary contusion
B) Tracheo-Bronchial injury
Answer:
57) One of the following statements is true regarding anatomy of the neck:
A) External carotid artery has 8 branches
B) External carotid artery lies anterior to the Internal carotid artery
Answer:
58) A question about Phyllodes Tumor, which is wrong:
Answer: as other sarcomas, it highly metastasizes via blood
59) All are components of revised trauma score except:
A) Pulse rate
B) Respiratory rate
C) Blood pressure
D) Glasgow coma scale
Answer: A
60) Most common complication after gynecomastia repair is:
A) Wound infection
B) Nipple retraction
C) Under resection
D) Hematoma
E) breast asymmetry
Answer:
61) VACTRL is associated with which one of the following:
A) Liver anomalies
B) Ear deformities
C) Tracheo-esophageal fistula
Answer: C
62) The most common cause of non-gonococcal urethritis:
Answer: + chlamydia
63) False about burns:
A) 3rd degree heals by skin graft
B) massive burn cause generalized capillary leakage
C) partial thickness heals by epithelialization?
D) Superficial burns cause significant fluid loss
E) full thickness burn around joints causes contractures
Answer: D
64) Which of the following is considered as high risk for malignancy in solitary
pulmonary nodule?
A. Calcification
B. Speculated border on CT
C. history of TB
D) doubling in size in less than 30 days
Answer: B
65) What is the risk of recurrence using enucleation in Pleomorphic adenoma of
the parotid:
A) 25%
B) 10%
C) 2%
D) 1%|
E) 5%
Answer: A
66) Correct about Enteral feeding:
A) preserve gastric mucosa
B) more risk of infection than TPN
C) Used for head trauma patients
Answer: A
67) About Branchial cyst, what’s wrong
A) originate from second cleft
B) presentation at age 15 yrs
C) can open to skin forming a fistula
D) a choice about the site
E) Clear fluid that brilliantly transilluminates
Answer: E
68) 50 years old male known to have Aortic stenosis has experienced Angina
pectoris and single episode of syncope recently.. Which of the following
statements is correct:
A. His new symptoms has nothing to do with his condition
B. The patient is not candidate for surgery because he hasn't developed
heart failure yet
C. Percutaneous balloon valvuloplasty can be considered for this patient
D. Trans-valvular pressure more the 50 mmHg is an indication for surgery
Answer:
69) Regarding Thyroid nodule, Which of the following clinical features is not in
favour of malignancy:
A. Lymph nodes involvement
B. Dominant solitary nodule
C. Rapidly growing
D. Dysphagia
E. Frequent and loose bowel motions
Answer: E
70) A question about acute emphysematous cholecystitis, which is wrong:
A) more common in male
B) more in diabetics
C) cause gallbladder gangrene
D) causative pathogens include E. Coli, clostridium perfringens, Bacteroides
fragilis
E) associated with gallstones in 90% of cases
Answer: E
71) A question about carotid endarterectomy, which is correct:
A) 10 year survival rate must be calculated before surgery
B) Perioperative risk of stroke in asymptomatic is <3% , symptomatic is <6%
Answer: B
72) A question about acute presentation of Foreign Body aspiration, What do
we see On x ray?
A) Atelectasis
B) Hyperinflation of the affected side
C) Foreign body itself
D) Pneumonia
Answer: B
73) Wrong statement regarding hypovolemic shock:
A. Class III associated with 30-40% blood loss
B. Class IV patient is lethargic
C. Class I no hemodynamic changes except for decrease in pulse pressure
D. Class III, IV are treated by blood transfusion
Answer: C
74) Question asked about the wrong statement:
Answer: Beck's triad consist of muffled heart sounds, JVD and tachycardia
75) Q about two stage venous cannulation in heart surgery, which is wrong:
A) can be used in most cardiac surgeries
B) bi-caval cannulation must be used in right side surgery
C) ensures complete emptying of the right ventricle
Answer: I think something else
76) Wrong statement regarding neurogenic shock
A. Warm well perfused skin
B. Vasopressors are absolutely contraindicated
C. Can be caused by gastric dilation
Answer: B
77) A question about flail chest, what’s the true?
A) The mortality due to directly flail injury itself
B) majority of patients will not need mechanical ventilation
C) mechanical ventilation improve the mortality
D) PCA is superior to epidural anesthesia
Answer: C?
78) Elderly patient with history of alternating bowel habit, then constipation
became the dominant symptom which is associated with narrowing of the stool
which is coated with blood.. You suspected that the patient has Colorectal
cancer.. What is the most probable site of the tumor?
A. Cecum
B. Right colon
C. Transverse colon
D. Left colon
E. Rectum
Answer: D
79) Predisposes to urinary stone
a) Bacillus typhosus
b) S. faecalis
c) P. vulgaris & P. aeuroginosa
d) M. tuberculosis
e) E. coli
Answer: C
80) Wrong statement about valves:
Answer: Tissue valve has less risk for destruction than mechanical valve
81) All of the following are true about cryptorchidism except
a) Hormonal therapy may be used in the treatment
b) The most common ectopic position is suprapubic area
c) Orchiectomy may be necessary in some cases
d) It should be treated in most cases
e) Incidence = 1% at age of 1 year
Answer: B?
82) Which statement concerning testicular torsion is true?
A. Most common during the neonatal period
B. Contralateral orchidopexy is not recommended at the time of scrotal
exploration
C. Intravaginal torsion rarely occurs in adolescents
D. The twisted testis is viable if operated upon within 48 hours
E. Torsion of the appendix testis mimics testicular torsion
Answer:
83) Regarding clostridial myonecrosis, all of the following statements are true
except
a. It may occur as a post-operative complication of above the knee
amputations
b. Wound debridement is the initial line of treatment
c. The organism is strictly anaerobic
d. It has significant toxemic symptoms
e. Administration of toxoid could be helpful in its management
Answer: e
84) False about hepatic tumor:
a. adenoma may transform to malignancy
b. hemangioma of 10 cm size is an indication of resection
Answer: b
85) All are Risk factors of inguinal hernia in pediatrics except ?
A) CF
B) Female gender
C) Connective tissue disorders
Answer: B?
86) The following surgical operations are considered clean and do not require
prophylactic antibiotics except
a. Stripping a varicose saphenous vein
b. Excision of subcutaneous lipoma
c. Herniotomy in a two years old boy
d. Excision of breast fibroadenoma in a healthy female
e. Repair of paraumbilical hernia using a mesh
Answer: e
