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1.

A 35-year-old male is struck on the lateral aspect of his right knee by the bumper of a car travelling at
low velocity. On examination he is unable to dorsiflex the ankle, evert the foot and extend the toes. There is
loss of sensation of the dorsum of the foot. He is most likely to have damaged which structure?
A. Common peroneal nerve
B. Deep peroneal nerve
C. Saphenous nerve

2. Which one of the following suggest a diagnosis of Hirschsprung's disease?


A. A contrast-study showing dilatation of the aganglionic bowel segment.
B. Early presentation with vomiting.
C. neonatal large bowel obstruction.
D. Presentation after 1 year of age
E. Red current jelly stools.

3. A 46-year-old man presents after penetrating injuries to his arm and forearm. He is unable to extend his
fingers. There is no sensory disturbance and there is no vascular injury. Which nerve has been damaged?
A. anterior interosseous nerve
B. median nerve
C. posterior interosseous nerve
D. radial nerve
E. ulna nerve

4. Which of the following regarding the anatomy of the heart is true?


A. The aortic valve is tricuspid
B. The ascending aorta is entirely outside the pericardial sac
C. The left atrial appendage is identified readily by transthoracic echocardiography.
D. The pulmonary trunk lies anterior to the ascending aorta
E. The right atrium is posterior to the left atrium.

5. Which of the following is not within the carpal tunnel?


A. median nerve
B. flexor digitorum profundus
C. flexor digitorum superficialis
D. flexor pollicis longus?
E. abductor pollicis longus

6. A 48-year-old woman with chronic pancreatitis due to gallstones is noted to have a macrocytic anemia
What is the most likely cause of the anemia?
A. Bone marrow dysfunction
B. Folate deficiency
C. Hyposplenism
D. Hypothyroidism
E. Vitamin B12 deficiency
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7. Which of the following organs is in direct contact with the anterior surface of the left kidney, without
being separated from it by visceral peritoneum?
A. Duodenum
B. Jejunum
C. Pancreas
D. Spleen
E. Stomach
8. A 5-year-old boy presents to Accident and Emergency complaining of acute pain over his upper tibia He
is febrile and he refuses to move his leg. A diagnosis of osteomyelitis is suspected The likely infecting
organism is?
A. Clostridium difficile
B. Haemophilus influenzae
C. Pseudomonas
D. Salmonella
E. Staphylococcus aureus
9. Which is the principle root inervation for the small muscles of the hand?
A. C5
B. C6
C. C7
D. C8
E. T1
10. Which of the following is true concerning Scaphoid fractures?
A. Rarely occur in young adults
B. when complicated by avascular necrosis the proximal pole is usually affected
C. should be treated by bone grafting and internal fixation even if undisplaced
11. A 17-year-old girl underwent emergency splenectomy after a domestic accident. Which one of the
following organisms is most likely to cause life-threatening infection in the future?
A. Actinomycosis
B. Haemophilus influenzae
C. Pseudomonas aeruginosa
D. Staphylococcus aureus
E. Streptococcus pneumonia

12. Which vertebral level and corresponding structure is correct?


A. C4 and bifurcation of the carotid artery
B. T2 and manubriosternal joint
C. T10 and opening for vena cava in diaphragm
D. T12 and oesophageal opening in the diaphragm
E. T8 and aortic opening in the diaphragm

13. Which of the following statements is true of Compartment syndrome:


A. Only occurs following fractures.
B. Loss of distal pulse is an early sign.
C. The presence of pain is unhelpful in diagnosis.
D. Passive stretch of affected muscles exacerbates pain.
14. The axillary nerve passes directly inferior to which muscle as it leaves the axilla?
A. Long head of triceps
B. Long head of biceps
C. Pectoralis major
D. Subscapularis
E. Teres minor
15. Which of the following is not a branch of the pudendal nerve?
A. Perineal nerve
B. Dorsal nerve of the penis.
C. Inferior rectal nerve
D. Genitofemoral nerve
E. Posterior scrotal nerve
16. A patient presents with a history of low back pain and sciatica The pain radiates to the little toe, the
ankle reflex is absent and the patient has difficulty in everting the foot. Which nerve root is likely to be
trapped
A. L3
B. L4
C. L5
D. S1
E. S2
17. The commonest clinical manifestation of primary hyperparathyroidism is:
A. Renal stone disease
B. Bone disease
C. Peptic ulceration
D. Constipation
E. Polyuria
18. Which of the following structures accompany the median nerve in the carpal tunnel?
A. Flexor carpi ulnaris.
B. Flexor digitorum profundis.
C. The ulnar artery.
D. All of the above
E. None of the above
19. Which of the following is a branch of the LATERAL CORD of the brachial plexus?
A. Suprascapular nerve
B. Lower subscapular nerve
C. Medial pectoral nerve
D. Musculo-cutaneous nerve
E. Upper subscapular nerve
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20. Which of the following vertebrae has the most prominent spinous process?
A. T1.
B. T2.
C. C7.
D. T11.
21. The ulnar nerve all are true except :
A. innervates the first dorsal interosseus muscle
B. originates from the laterall cord of the brachial plexus
C. has no branches above the elbow
D. innervates the medial half of the flexor digitorum profundus
E. innervates the adductor pollicis muscle
22. A 9 month old boy presents with an acute scrotal swelling. The following diagnoses are likely:
A. Epididymitis
B. Orchitis
C. Torsion of the testicular appendage
D. Irreducible inguinal hernia
E. Acute idiopathic scrotal oedema
23. Congenital pyloric stenosis:
A. Presents in the first few daies after birth.
B. Can cause hyperchloraemic alkalosis.
C. Is inherited as an autosomal recessive
D. Typically presents with bile stained vomiting after feeds
E. Is often diagnosed by feeling a mass in the right hypochondrium.
24. If torsion of the testicle is suspected, surgical exploration:
A. Should be immediate and include the asymptomatic side
25. Meckel's diverticulum all are true except :
A. Can present with chronic anaemia
B. Is present in 2% of the population.
C. Can be diagnosed by hydrogen breath test.
D. May contain ectopic pancreatic tissue
E. May be implicated in Littre's hernia

26. Which of the following statements is true of upper limb nerve injuries?
A. Injury to the median nerve results in a wrist drop
B. Injury to the radial nerve results in loss of sensation over the palmar aspect of the index finger
C. Injury to the median nerve results in loss of sensation in the anatomical snuffbox
D. Injury to the ulnar nerve results in a claw hand
E. Injury to the ulnar nerve results in loss of sensation over the thumb

27. Concerning the inguinal canal:


A. It transmits the ilio-inguinal nerve
B. The deep inguinal ring lies below the mid-point of inguinal ligament
C. The superficial inguinal ring overlies the pubic tubercle
D. Laterally , the anterior wall is made up of the external oblique aponeurosis
E. Laterally, the posterior wall is formed by the conjoint tendon
28. In chest trauma, urgent cardiothoracic surgical referral is necessary for all except:
A. Continuing massive air leak following insertion of chest drain
B. Cardiac tamponade
C. Disruption of the great vessels
D. Severe pulmonary contusion
E. Continuing haemorrhage following insertion of chest drain
29. A raised titre of anti-HBs in the bloodallare true except :
A. signifies previous hepatitis B infection
B. is produced after hepatitis B vaccination
C. indicates immunity to hepatitis infection
D. indicates active hepatitis B infection
30. The following statements regarding intravenous solutions is correct:
A. Normal saline contains 180mmol/l of sodium
B. Ringer's lactate solutions is designed for intracellular fluid replacement
C. Sodium bicarbonate 8.4% is a hyperosmolar solution
D. Normal saline with added potassium is appropriate therapy to correct a respiratory alkalosis
31. The following is true of the blood supply of the rectum all are true except:
A. The principle blood supply is derived from the inferior rectal artery
B. The median sacral vessels contribute to the blood supply
C. As the inferior mesenteric artery crosses the pelvic brim it becomes known as the superior rectal artery
D. The internal venous rectal plexus is continuous with the vascular cushions of the anal canal
E. The superior rectal vein drains to the portal system
32. Which of the following concerning the Femoral sheath is false:
A. Contains the femoral artery
B. Contains lymph nodes
C. Contains the femoral canal
D. Contains femoral nerve
33. The following is true of the spleen:
A. Is the largest lymphoid organ in the body
B. Lies obliquely between the seventh and tenth rib
C. The lower pole extends beyond the mid-axillary line
D. Is usually palpable when normal
E. Usually measures 16cm in maximum length when healthy

34. A knife stabbed horizontally through the fourth intercostals space to the right of the sternum is likely
to damage the:
A. Right brachiocephalic veinB. Hemiazygos vein
C. Descending aorta
D. Right pulmonary artery
E. Thoracic duct
35. Breast cancer risk is increased in association with the following factors except:
A. Nulliparity
B. Immediately after pregnancy
C. Early menarche
D. Early age at first pregnancy
E. Late menopause
36. The Appendix all true except:
A. Is typically less than 10 cm in length in the adult.
B. Is located in the retrocaecal recess.
C. Macburneys point, lies 2/3 laterally from a line from umbilicus to the anterior superior iliac spine
D. The longitudinal coat of the appendix is derived from the three bands of taenia coli.
E. Is supplied by branches of the inferior mesenteric artery
37. In tension pneumothorax the following signs are present except:
A. Hypoxia
B. Hyper resonance to percussion on the affected side
C. Tracheal deviation to the ipsilateral side
D. Distended neck veins
E. Tachycardia
38. The following are encountered during inguinal hernia repair :
A. Scarpas' fascia
B. Colle's fascia
C. Ilioinguinal nerve
D. Cremaster muscle
E. Genitofemoral nerve
39. Which of the following variables best predicts prognosis for patients with a recent diagnosis of
cutaneous melanoma and no clinical evidence of metastatic disease?
A. Breslow thickness
40. The intravenous fluid that a 60 kg., 30-year-old woman with an 80% burn should be given in the first
24 hours following burn injury is:
A. 19.2 liters of 5% glucose in lactated Ringer's.
B. 14.4 liters of lactated Ringer's.

41. All venous sinuses of the dura mater ultimately drain into :
A. Internal jugular vein
42. The tendon of biceps bronchii muscle inserted into the
A. Radial tuberosity
43. the saphenous nerve is terminal branch of the :
A. Ilioinguinal nerve
B. Femoral nerve
C. Genitofemoral nerve
D. Superior glutial nerve
E. popliteal nerve
44. All the following origenat on the scapula except
A. Trapezius
B. Teres major
C. Deltoid
D. Brachio-radialis
E. Coraco-brachialis
45. Total number of human vertebra is:
A. 33 vertebras.
46. Foot droop is usually associated with paralysis of the:
A. Common peroneal
47. The following pass through the aortic hiatus of the diaphragm
A. Aorta
B. Azygos vein
C. Thoracic duct
D. All of the above
E. Non of the above
48. At birth the umbilical vein become the:
A. Round ligament of the liver
49. Arrangement of structures at hilum of the right kidney as following from anterior to posterior:
A. Vein ,artery , ureter
50. Shock can best be defined as:
A. Hypotension.
B. Hypo perfusion of tissues.
C. Hypoxemia
D. All of the above
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51. All of the following are true about neurogenic shock except:
A. there is a decrease in systemic vascular resistance and an increase in venous capacitance
B. tachycardia or bradycardia may be observed, along with hypotension.
C. the use of an alpha agonist such as phenylephrine is the mainstay of treatment.
D. Severe head injury, spinal cord injury, and high spinal anesthesia may all cause neurogenic shock.
52. All of the following may be useful in the treatment of cardiogenic shock except:
A. Dobutamine
B. Sodium nitroprusside
C. Pneumatic antishock garment.
D. Intra-aortic balloon pump.
53. All of the following statements about hemorrhagic shock are true except:
A. Following hemorrhagic shock, there is an initial interstitial fluid volume contraction.
B. Dopamine, or a similar inotropic agent, should be given immediately for resuscitation from hemorrhagic
shock, to increase cardiac output and improve oxygen delivery to hypoperfused tissues.
C. The use of colloid solutions or hypertonic saline solutions is indicated for treatment of hemorrhagic shock.
D. In hemorrhagic shock, a narrowed pulse pressure is commonly seen before a fall in systolic blood pressure
54. Which of the following statements about head injury and concomitant hyponatremia is true?
A. There are no primary alterations in cardiovascular signs.
B. Signs of increased intracranial pressure may be masked by the hyponatremia
C. Oliguric renal failure is an unlikely complication.
D. Rapid correction of the hyponatremia may prevent central pontine injury.
E. This patient is best treated by restriction of water intake
55. Which of the following statements about extracellular fluid is true?
A. The total extracellular fluid volume represents 40% of the body weight.
B. The plasma volume constitutes 20%of the total extracellular fluid volume
C. Potassium is the principal cation in extracellular fluid
D. The protein content of the plasma produces a lower concentration of cations than in the interstitial fluid
E. The interstitial fluid equilibrates slowly with the other body compartments.
56. Which of the following statements is true of a patient with hyperglycemia and hyponatremia?
A. Insulin administration will increase the potassium content of cells.
B. The sodium concentration must be corrected by 5 mEq. per 100 mg. per 100 ml. elevation in blood
glucose
C. With normal renal function, this patient is likely to be volume overloaded
D. Proper fluid therapy would be unlikely to include potassium administration.
57. Which of the following is not associated with increased likelihood of infection after major elective
surgery?
A. Age over 70 years.
B. Chronic malnutrition.
C. Controlled diabetes mellitus.
D. Long-term steroid use
E. Infection at a remote body site
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58. The transfusion of fresh frozen plasma (FFP) is indicated for which of the following reasons?
A. For the correction of abnormal PT secondary to warfarin therapy, vitamin K deficiency, or liver disease
B. Volume replacement.
C. As a nutritional supplement.
D. Treatment of prolonged bleeding time

59. In patients receiving massive blood transfusion for acute blood loss, which of the following is correct?
A. Packed red blood cells and crystalloid solution should be infused to restore oxygen-carrying capacity and
intravascular volume
B. Two units of FFP should be given with every 5 units of packed red blood cells in most cases.
C. A six pack of platelets should be administered with every 10 units of packed red blood cells in most
cases.
D. One to two ampules of sodium bicarbonate should be administered with every 5 units of packed red blood
cells to avoid acidosis.

60. Hemostasis and the cessation of bleeding require which of the following processes?
A. Adherence of platelets to exposed subendothelial glycoproteins and collagen with subsequent aggregation
of platelets and formation of a hemostatic plug.
B. Interaction of tissue factor with factor VII circulating in the plasma
C. The production of thrombin via the coagulation cascade with conversion of fibrinogen to fibrin.
D. Cross-linking of fibrin by factor XIII.
E. All of the above
61. Advantages of epidural analgesia include:
A. Earlier mobilization after surgery.
B. Earlier return of bowel function.
C. Shorter hospitalizations.
D. Decreased stress response to surgery.
E. All of the above
62. Factors that decrease collagen synthesis include all of the following except:
A. Protein depletion.
B. Infection.
C. Anemia
D. Advanced age
E. Hypoxia
63. Which of the following statement is true concerning excessive scarring processes?
A. Keloids occur randomly regardless of gender or race
B. Hypertrophic scars and keloid are histologically different
C. Keloids tend to develop early and hypertrophic scars late after the surgical injury
D. Simple reexcision and closure of a hypertrophic scar can be useful in certain situations such as a wound
closed by secondary intention

64. Which of the following statement is true concerning the vascular response to injury?
A. Vasoconstriction is an early event in the response to injury
B. Vasodilatation is a detrimental response to injury with normal body processes working to avoid this
process
C. Vascular permeability is maintained to prevent further cellular injury
D. Histamine, prostaglandin E2 (PGE2) and prostacyclin (PGI2) are important mediators of local
vasoconstriction
65. All are true ligamentous attachments of liver except
A. Falciform ligament
B. Coronary Ligaments
C. Hepatoduodenal ligaments
D. Glisson's capsul
66. The appropriate surgical treatment for suspected carcinoma of the testis is:
A. Inguinal exploration, control of the spermatic cord, biopsy, and radical orchectomy if tumor is confirmed
67. Nasotracheal intubation all true except :
A. Is preferred for the unconscious patient without cervical spine injury.
B. Is preferred for patients with suspected cervical spine injury.
C. Maximizes neck manipulation.
D. Is contraindicated in the patient who is breathing spontaneously.
68. The radiographic findings indicating a torn thoracic aorta include all except :
A. Widened mediastinum.
B. Presence of an apical pleural cap.
C. Tracheal deviation to the right.
D. right hem thorax.
69. Which of the following steps is not a part of the primary survey in a trauma patient?
A. Insuring adequate ventilatory support
B. Measurement of blood pressure and pulse
C. Neurologic evaluation with the Glasgow Coma Scale
D. Examination of the cervical spine
70. Which of the following statement(s) is/are true concerning the Advanced Trauma Life Support (ATLS)
classification system of hemorrhagic shock?
A. Class I shock is equivalent to voluntary blood donation
B. In Class II shock there will be evidence of change in vital signs with tachycardia, tachypnea and a
significant decrease in systolic blood pressure
C. Class IV hemorrhage can usually be managed by simple administration of crystalloid solution
D. Class III hemorrhage involves loss of over 40% of blood volume loss and can be classified as lifethreatening

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71. The clinical picture of gallstone ileus includes all except ?


A. Air in the biliary tree
B. Small bowel obstruction.
C. A stone at the site of obstruction.
D. Acholic stools.
E. Associated bouts of cholangitis.

72. The evaluation of a comatose patient with a head injury begins with:
A. Establishment of an airway.
73. Which of the following signs does Horner's syndrome include?
A. Ptosis.
B. Facial hyperhidrosis.
C. Exophthalmos.
D. Mydriasis.
74. The goals of proper fracture reduction include all except?
A. Providing patient comfort and analgesia
B. Allowing for restoration of length of the extremity.
C. Correcting angular deformity and rotation.
D. Enabling immediate motion of all fractured extremities.
75. The neurovascular structure most commonly injured as a result of an anterior dislocation of the
shoulder is the:
A. Musculocutaneous nerve
B. Axillary nerve
C. Axillary artery.
D. Median nerve
76. The radial nerve is at greatest risk for injury with which fracture?
A. Fracture of the surgical neck of the humerus.
B. Fracture of the shaft of the humerus.
C. Supracondylar fracture of the humerus.
77. The most consistent sign of a fracture of the carpal scaphoid is:
A. Wrist pain during attempted push-ups.
B. Diffuse swelling on the dorsum of the wrist.
C. Localized tenderness in the anatomic snuffbox.
D. Wrist popping on movement.
78. Hematogenous osteomyelitis most frequently affects:
A. The diaphysis of long bones.
B. The epiphysis.
C. The metaphysis of long bones.
D. Flat bones.
E. Cuboidal bones.
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79. The most common hernia in females is:


A. Femoral hernia
B. Direct inguinal hernia
C. Indirect inguinal hernia
80. Which of the following most often initiates the development of acute appendicitis?
A. A viral infection.
B. Acute gastroenteritis.
C. Obstruction of the appendiceal lumen.
81. The most helpful diagnostic radiographic procedure in small bowel obstruction is:
A. CT of the abdomen.
B. Contrast study of the intestine
C. Supine and erect x-rays of the abdomen.
D. Ultrasonography of the abdomen.
82. Which of the following treatments should never be recommended to a patient with purely intraductal
carcinoma?
A. Modified radical mastectomy.
B. Lumpectomy to clear surgical margins, followed by observation.
C. Incisional biopsy with an involved margin, followed by radiation.
D. Excisional biopsy to clear margins, followed by radiation.
83. In role of nine extent of burn if entire trunk is burned it will be equal to:
A. 9% body surface area
B. 18% body surface area
C. 36% body surface area
D. 27% body surface area
84. Which of the following does not describe intermittent claudication?
A. Is elicited by reproducible amount of exercise
B. Abates promptly with rest.
C. Is often worse at night.
D. May be an indication for bypass surgery.
85. Which of the following statements are true?
A. Patients with critical limb ischemia have paralysis and paresthesias.
B. All arterial injuries are associated with absence of a palpable pulse
C. Preoperative arteriography is required to diagnose an arterial injury.
D. The presence of Doppler signals indicates that an arterial injury has not occurred
E. In all patients with multiple trauma, arterial injuries should be repaired before other injuries are addressed
86. A patient with acute urinary tract infection (UTI) usually presents with:
A. Chills and fever.
B. Flank pain.
C. Nausea and vomiting.
D. Painful urination.
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87. The most precise diagnostic screening procedure for differentiating benign thyroid nodules from
malignant ones
A. Fine-needle-aspiration biopsy (FNAB).

88. Hyperthyroidism can be caused by all of the following except:


A. Graves' disease
B. Plummer's disease
C. Struma ovarii.
D. Hashimoto's disease
E. Medullary carcinoma of the thyroid

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