Final surgery exam-4th year medical students

1. Which of the following is not true about Pneumatosis intestinalis of small

bowel?
a) It is seen equaly and males and females
b) Most common location is subserosa in the jejunum
c) Operative Procedures are required in most of the cases
d) It is associated with COPD and immunodeficiency states

2. Which of the following is not true for ectopic pancreas

  a) stomach and duodenum are the most common site
  b) Ectopic pancreas appears as a submucosal irregular nodule in the wall
  c) Islet tissue is present in all the organs where ectopic pancreas is present.
  d) Ulceration, bleeding and obstruction are the most common symptoms

3. The most common cystic disease of the spleen is

a) Hydatic cyst of spleen
b) Pseudo cyst of the spleen
c) Columnar lined cyst of spleen
d) Cystic lymphangioma

4 ) True regarding splenic abscess are all except:

a) Majority of splenic abscess result from hematogenous spread from other sites
b) Both Gram positive and gram negative organisms are responsible for splenic
abscess
c) Splenomegaly is present in most of the patients.
d) 2/3rd of the splenic abscess are solitary in adults

5. Which of the following serum gastrin values is not indicative of    gastrinoma
              a) 5000pg/ml
              b)1000pg/ml
              c) 500pg/ml
              d) 100 pg/ml

6. Which does not predispose to  Carcinoma stomach?

a) Low fat and protein diet
b) Salted meat and fish
c) Low Nitrate consumption
d) HIgh Complex carbohydrate consumption

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7. Which of the following is not true about gastric lymphoma?
a) Stomach is the most common organ in the gi system which is involved in 
Lymphoma
b) Peak incidence of lymphomas is seen in 6th-7th decade
c) Endoscopy usually reveals gastritis like picture or gastric ulcer.
d) MALT lymphoma is the commonest variety.

8. Double bubble sign is seen in

a) Pyloric stenosis
b) Esophageal atresia
c) Duodenal Atresia
d) Ileal atresia

9. Most common cause of Budd Chiari syndrome in Asia is?

a) Polycythemia
b) IVC obstruction
c) Myeloproilferative disorders
d) Bechet’s disease

10. Which does not predispose to  Carcinoma stomach?

a) H. Pylori infection
b) Salted meat and fish
c) Low Nitrate consumption
d) High Complex carbohydrate consumption

11. Regarding the location of gastric ulcers the most common affected part of the
stomach is:
a) Lesser curvature
b) Antrum
c) Pyloric channel
d) Proximal stomach

12. A 59 year-old man, underwent partial gastrectomy with Billroth ll

reconstruction for intractable peptic ulcer disease which of the following
metabolic disturbances is not a potential consequences of this procedure:
a) Megaloblastic anemia
b) Iron deficiency anemia
c) Osteoporosis
d) Osteitis fibrosa cystica
e) Statorrhea

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13. A 20 year-old male is examined in ER following motor vehicle accident. His
Rt leg is injured as are his elbow and clavicle. Which of the following fractures or
dislocations is most likely to result in an associated vascular injury?
a) Knee dislocation
b) Closed posterior elbow dislocation
c) Midclavicular fracture
d) Supracondylar femur fracture
e) Tibial plateau fracture

14. A 53 year-old man presents with constipation and 10 kgrs loss of weight over
the course of 6 months. Colonoscopy revealed a fungating mass in the sigmoid
colon. Biopsy is consistent with adenocarcinoma. His metastatic workup is
negative. A CEA level is obtained and is fourfold greater than normal. Which of
the following is the appropriate use of this test?
a) As an indication for neoadjuvant therapy
b) As an indication for postop radiation therapy
c) As an indication for preoperative PET scanning
d) As an indication for a more aggressive sigmoid resection
e) As a baseline measurement prior to monitoring postoperatively for
recurrence.

15. How much bile is produced by liver /day?

a)  100-300 ml
b)   300-500 ml
c)   500-1000ml
d)   500-1200 ml

16. In which of the following conditions anti thyroid antibody may be elevated?
a) Hashimoto thyroiditis
b) Grave's disease
c) Multinodular goitre
d) All of the above

17. A 45 year-old man came to ER c/o fever, tachycardia, confusion and

vomiting. Investigations were done and reveals markedly elevated T3 and T4. He
is diagnosed as having a thyroid strom.
Which of the following is the most appropriate next step in the management of
this patient.
a) Urgent subtotal thyroidectomy
b) Urgent total thyroidectomy
c) Urgent hemodialysis
d) Administration of fluids, antithyroid drugs, B-blockers, iodine solution and
steroids.
e) Urgent radiation therapy to the neck

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18. Which of the following pathologies is thought to have no malignant potential?
a) Ulcerative colitis
b) Villous adenoma
c) Familial polyposis
d) Peutz-Jeghers syndrome
e) Crohn’s disease

19. The X-Ray showed at the Right is:

a. PTC (percutanoeus transhepatic cholangiography)

b. T-tube cholangiography

c. ERCP (Endoscopic retrograde cholangio pancreatgraphy)

d. Operative cholangiogram through cystic duct

20. The CT scan showed at the Right most probably is:

a. Hemangioma of the liver
b. Cystic lesions in the liver most probably hydatid cysts
c. Hepatoma
d. Cholangiocarcinoma

21. The cystic lesion in the floor of the mouth like the one in the
picture is:
a. Retention cyst
b. Hematoma
c. Ranula
d. Molar abscess

22. Mirizzi's syndrome: –

a. Multiple cystic dilatation of CBD, causing obstruction
b. Obstruction of biliary system due to malformation in the common bile duct
(CBD)
c. Large stones within the gallbladder may cause biliary obstruction by external
compression.

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 d. Obstruction of biliary system caused by Klatskin tumor

23. Most major bile duct injuries during llap cholecystectomy occur in patients
under which one of the following cirucumstances:
a. Acute cholecystitis
b. Gallstone pancreatitis
c. Choledocholithiasis
d. Elective cholecystectomy
e. Laparoscopic procedure converted to open

24. The picture at the Rt is:

a. Retracted lid
b. Exophtalmus
c. Ptosis
d. lid lag

25. complications of blood transfusion include all except:

a. urticaria
b. Hypokalemia
c. Hepatitis c
d. ARDS
e. Jaundice

26. parameters used to assess nutritional status include all except:

a. Serum albumin
b. Triceps skin fold thickness
c. white cell account
d. Hand grip strength
e. Chest wall circumference

27. Deep Venous thrombosis is best diagnosed by :

a. 121 fibrinogen
b. CT scan
c. Venogran
d. Physical examination
e. Doppler ultrasonography

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28. Which of the following polyps is considered premalignant :
a. adenomatous
b. hamartomatous
c. inflammatory
d. hyperplastic

29. Six months child presented with reducible inguinal hernia, the best choice for
him is:
a. admit to hospital urgently and operate on
b. advice his family to wait for possible disappearance of hernia at age of
year
c. wait until the age of year then have surgery
d. have an appointment for surgery as soon as possible

30. Paget’s disease of the breast presents usually by :

a. multiple lumps on the same side
b. single big lump in upper outer quadrant
c. scaly, itchy, erosive area around the nipple
d. milky discharge from both nipples

31. The commonest presentation of Meckel's diverticulum in an adult is:

a- Gastroitestinal bleeding
B- Gastrointestinal obstruction
C- Intussuception
D- Litter,s hernia
E- Diverticulitis

32. The following are Complications of shock:

a. Acute Respiratory failure
b. Acute myocardial infarction
c. Acute renal failure
d. All of the above
e. A&C only

33. The following are manifestations of hyperparathyroidism EXCPET:

A. Recurrent pancreatitis
B. Psychological disturbance
C. Renal stones
D. Gall stones

34. Complication of ERCP include

A. Perforation
B. Pancreatitis
C. Hemorrhage

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 D. All the Above
E. A&C only

35. Complication of Crohn’s disease are:

a.Intestinal obstruction
b. Fistula
c.Anal disease
d. All of the above
e. A&B only

36. Hashimoto’s thyroiditis :

A) is of viral origin
B) presents usually by nodular goiter
C) can be diagnosed by thyroid antibodies and fine needle aspiration of
thyroid
D) is often pre malignant
E) must be treated always by surgery

37. All of the following are signs of raised intracranial pressure

Except:
a) Headache.
b) Vomiting.
c) Papilledema.
d) Aphasia.
e) Bradycardia.

38. All the followings are Indications for central line insertion EXCPET:
A. Massive fluid replacement
B. Massive blood replacement ***
C. Measurement of central venous pressure
D. Prolonged Intervenes fluid therapy

39. Most common early complication of central venous line is:

a) Sepsis
b) Pneumothorax
c) Thoracic duct injury
d) Thrombosis

40. Small bowel obstruction often results in: (all correct except one)
a) Hyperkalaemia.
b) Metabolic alkalosis.
c) Oliguria.

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 d) Hypovolaemia.
e) Severe dehydration.

41. Regarding Acute pancreatitis typically all of the following are correct except
a) Is accompanied by hypocalcaemia.
b) Produces paralytic ileus.
c) Is associated with a pleural effusion.
d) Produces pyloric obstruction.
e) Upper abdominal pain and vomiting.

42. Painless haematuria is the leading presentation of :

a) Renal cell carcinoma.
b) Transitional cell carcinoma of the bladder .
c) Ureteric stone.
d) Pelvi-ureteric obstruction.
e) Ureterocele.

43. The thyroid tumor which may be associated with pheochromocytoma is:
a) Papillary carcinoma.
b) Medullary carcinoma.
c) Follicular carcinoma.
d) Anaplastic carcinoma.
e) Malignant lymphoma.

44. ) Patients with major burns:

a) Are in a negative nitrogen balance.
b) Have normal calorie requirements.
c) Do not generally become anaemic.
d) Are resistant to septicaemia.
e) All of the above.

45. Fiboadenomata of the breast:

a) Are commonest in early adult life.
b) Are indiscrete and difficult to distinguish.
c) Are usually painless.
d) Resolve without treatment.
e) A&C only.

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46. Colonic polyps: all of the following are correct except :
a) Are associated with colonic cancer.
b) May be hereditary.
c) Should not be removed if they are asymptomatic.
d) May be hyperplastic.
e) Are commonly adenomatous.

47. Lymphedema:
a. May be Congenital
b. Should be bilateral
c. May be pitting in early stage
d. A & C only
e. None of the above

48. In acute appendicitis appendicitis:

a. The risk of developing the illness is greatest in childhood

b. Mortality increases with age and is greatest in the elderly
c. Faecoliths are present in 75-80% of resected specimens
d. Appendicitis is a possible diagnosis in the absence of abdominal tenderness
e. all are true

49. About pyogenic liver abscess, all the following are TRUE Except:

a. the etiology is unexplained in the majority of patients.

b. the diagnosis is confirmed by aspiration for culture and sensitivity.
c. treatment consists with antibiotics and aspiration.
d. atypical clinical or radiological findings should raise the possibility of
a necrotic neoplasm.
e. the most common organism is Staphylococcus Aureus.

50. About hepatic adenomas, all the following are TRUE Except:
A-females are more affected than males.
B-incidence is increased by oral contraceptive pills.
C-spontaneous regression is well recognized.
D-usually they are asymptomatic and are discovered incidentally.
E-they can rupture and as many as 25% are identified after an acute episode of
hemorrhage.

51. which one of the following clinical signs or symptoms is not associated with
serum sodium concentrations below 125 mEq/L?
A.Headache
B.Hallucinations

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C.Bradycardia
D.Hypoventilation
E.Hyperthermia

52) the metabolic rate increases by what percentage for each 1ºC elevation
in body temperature?
a. 1%
b. 5%
c. 10%
d. 15%
e. 20%

53) Chronic adrenal insufficiency is characterized by which of the following?

a. Hypothermia
b.Hypertension
c.Hyperkalemia
d.Hypernatremia
e.Hyperglycemia

54. Regarding peritonitis which of the following statements is not true?

a. Primary peritonitis is commoner in children with nephrosis and
adults with cirrhosis than in patients without such conditions
b. Primary peritonitis is usually monomicrobial
c. Chemical peritonitis often precedes bacterial contamination
d. Multiple organisms are commonly cultured from peritoneal dialysis
catheters
e. Tuberculosis peritonitis has an insidious onset

55) Regarding metastatic cancer, which of the following statements is true?

a. Axillary lymph node dissection is essential for staging a sarcoma of
the breast
b. Melanoma tends to metastasize first to the lung, brain and gas
trointestinal tract
c. Bone is frequently the site of metastasis for cancer of the breast
and prostate
d. Primary brain cancers have a predilection for metastasis to the lung
e. None of the above

56) regarding acute supurative parotitis, which one of the following

statements is not true?
a. It usually occurs in elderly or debilitated patients
b. Dehydration is a major contributing factor
c. Immediate surgical drainage is mandatory

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 d. The numerous vertically oriented fascial septa of the parotid space
lead to multiloculated abscesses when infection
e. S. aureas is the most frequent causative organism
57) which of the following studies are useful for the diagnosis of a
pheochromocytoma?
a. Clonidine suppression test
b. 24-hr urine metanephrine levels
c. 24-hr urine vanillylmandelic acid levels
d. plasma catecholamine levels
e. none of the above

58) Cushing's disease is caused by which of the following?

a. Adrenal adenoma
b. Adrenal carcinoma
c. Pituitary adenoma
d. Ectopic ACTH production
e. none of the above

59) With Regard to primary gastric lymphoma, which of the following statements
is true?
a. G1 bleeding is the most common symptom
b. Mucosal biopsy can establish the diagnosis in nearly all cases
c. Primary therapy is surgical resection
d. Primary therapy irradiation
e. The long-term survival rate is equivalent to that for adenocarcinoma

60) which of the following statements regarding the pathogenesis of

appendicitis is false?
a. Luminal obstruction is always the cause of acute
appendicitis
b. Luminal obstruction leads to increased pressure and
distention of the appendix
c. Obstruction of venous outflow and then arterial inflow
results in gangrene
d. Obstruction of the lumen may occur from lymphoid
hyperplasia, inspissated stool, or a foreign body
e. Viral or bacterial infections can precede an episode of
appendicitis

61) In Budd-chiari syndrome portal hypertension results from?

a. Massive splenomegaly
b. Cavernous hemangioma of the liver

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 c. Hepatic vein obstruction
d. Arterial venous fistula
e. None of the above

62) laparoscopic cholecystectomy is most strongly contra indicated in?

a. pregnancy
b. prior upper abdominal surgery
c. known common bile duct stones
d. chronic obstructive pulmonary disease
e. gallbladder cancer

63) which of the following is the best indication for preoperative ERCP in a
patient with gallstones?
a. Obstructive jaundice
b. Gallstone pancreatitis
c. History of jaundice
d. Elevated alkaline phosphatase to twice normal
e. A 10 mm common bile duct seen on ultrasonography

64) For which of the following congenital hemolytic anemias is splenectomy

primarily indicated?
a. Thalassemia
b. Hereditary Spherocytosis
c. Pyruvate kinase deficiency
d. Glucose-6-phosphate dehydrogenase deficiency
e. Sickle cell anemia

65) Gastric acid secretion is stimulated by all of the following EXCEPT

A. acetylcholine
B. gastrin
C. secretin
D. antral distention
E. gastric intraluminal protein

66) .For patients receiving total parenteral nutrition (TPN) as their only source of
nutrition
A. mortality is a direct result from complications of TPN
B. fever should be treated with immediate removal of the intravenous
access
C. renal function and creatinine clearance remain stable
D. calculous and acalculous cholecystitis is a long-term risk
E. bone loss can be controlled with careful supplementation of vitamin D
and calcium

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 67) All the following statements about paraoesophageal hernia are true
except:
A. The herniated portion of the stomach may become
gangrenous.
B. Surgical repair generally is indicated
C. Heart burn is the usual chief complaint
D. It can be life threatening.

68) The most common complication in a patient with aneurysm of the

ascending thoracic aorta is
A. Aortic valve insufficiency.
B. Cardiac tamponade.
C. Distal dissection.
D. Superior vena cava obstruction

69) An 8-year-old boy has had recurrent painful swelling of a 2-cm mass in the
midline of his neck just inferior to the hyoid bone. Which of the following
statements best describes this lesion?

A.Ectopic thyroid is present in approximately half of cases

B.Surgical excision includes the pyramidal lobe of the thyroid
C.The structure originates at the foramen cecum
D.Fistula tracts drain laterally at the anterior border of the
sternocleidomastoid muscle
E. Simple excision may be accomplished with local anesthesia

70) Acute compartment syndrome is characterized by all of the following EXCEPT:

A. pain on stretching the muscles.

B. absent arterial pulsation’s.

C. the presence of paresthesia or anesthesia.

D. the presence of paresis or paralysis.

E. can result after revascularisation of an acutely ischemic limb

71) Factors important in the formation of gallstones include

a. cholesterol saturation of bile.

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 b. gallbladder dysmotility.
c. nucleating agents.
d. obesity.
e. All of the above

72) . Complications of untreated pancreatic pseudocysts include all of the

following EXCEPT:
a. gastrointestinal obstruction.
b. pancreatic necrosis.
c. free rupture.
d. abscess.
e. intracystic hemorrhage

73) .Clinical features of anal fissure include

a. sever pain
b. bleeding
c. sentinel skin tag
d. mucus disharge
e. All of the above

74) Which one of the following causes elevation in serum amylase

a. Perforated. duodenal ulcer
b. Rupture Ectopic pregnancy
c. Acute pancreatitis
d. All of the above
e. Only A&C

75) Primary varicose viens

a. due to congenital valve incompetence
b. due to competent perforators
c. has higher complication rate than the secondary varicose
d. usually lead to venous ulcer
e. none of the above

76) What is the most common organism isolated from bile and blood cultures in
patients with acute cholangitis?
A. Enterobacter species
B. Bacteroides species
C. Escherichia coli
D. Enterococcus species
E. Candida albiccins

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77) Von Willebrand’s disease:
A. is an autosomal dominant disorder
B. results in prolonged prothrombin time
C. is associated with normal bleeding time
D. is due to decreased hepatic synthesis of von Willebrand’s factor
E. is typically associated with joint bleeding
78) The circulating level of which cytokine can be used as an indicator in
response to surgical trauma:
A. Interleukin-1
B. Interleukin-2
C. Interleukin-6
D. interleukin-8
E. tumor necrosis factor

79) M.E a 34 year-old underwent left modified radical mastectomy because of

ductal carcinoma in the central retro areolar area. Pathology study result was:
infiltrating duct carcinoma. Tumor of 3.2 X 2 X 1.8 cm. in the retro areolar area.
The borders were free of tumor. There was 4 out of 18 lymph nodes with
metastasis. ES & PR receptors were negative and Her 2 was positive +3. Pre op
CT of the chest and abdomen were free as well as bone scan was with no
evidence of metastasis.
In which stage (TNM) you classified this tumor
a. T2 N1 Mx
b. T2 N2 M0
c. T3 N1 M0
d. T2 N3 M0

80) For the same patient in Question 79. Which protolo of treatment you advise:
a. Chemotherapy + Radiotherapy + Herceptin
b. Chemotherapy + Herceptin
c. Chemotherapy + Tamoxifen
d. Herceptin + Radiotherapy

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