MULUNGUSHI UNIVERSITY

SCHOOL OF MEDICINE AND HEALTH SCIENCES

END OF SURGERY CLINICAL PLACEMENT THEORY TEST

PAPER ONE

There are 50 multiple choice questions in this paper of the single best answer type.
You are required to answer all the questions
You are required to write your answers on the answer sheets provided.
Time allowed is 1 hour 30 minutes.

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1. Which one of the following statements is FALSE about electrical burns?

A. They may present with insignificant entry wound while causing severe
arrhythmias on the heart and may even cause death.
B. 11KV electricity lines are classified under high voltage and are lethal.
C. It is common for the person to have anterograde amnesia or confusion.
D. Lightning injuries can be difficult to diagnose if the person presents
without witnesses, is unable to relate the details of his or her injury, or is
found dead in a field, mountain side, or street.
E. Lightning injuries always lead to death.

2. Burn wounds can be Scald burn injuries which can be caused by liquids,
grease, or steam. Which one of the following is false about burns?

A. Liquid scalds can be further divided into spill and immersion liquefactive
necrosis.
B. Fire burn injuries can be divided into flash and flame burns.
C. The mechanism of burn injury can be used as a predictor of outcome.
D. Patients with flame burns and electrical burn injuries often require
hospitalization.
E. In contrast, most patients with burns caused either by contact with hot
surfaces or sun exposure are managed as outpatients

3. Regarding hernias choose the correct statement

A. Bockdaleck’s hernia is an internal hernia
B. Reducible hernia is strangulated
C. Strangulation can happen without obstruction
D. A litters hernia contains appendix a content
E. A sliding hernia has a sac separate from the contents

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4. A 23-year-old male presents to the emergency department after a
cooking accident. He was carrying hot oil in a frying pan from the stove
to the sink while wearing shorts when he slipped and spilled some oil
on his left leg. The medial aspect of his calf has a 3x8 cm area that is
mottled pink-and-white and is not blistered.

What is the most likely classification of his burn wound?

A. Deep partial thickness
B. Superficial partial
C. Full thickness
D. Partial thickness
E. Superficial thickness
5. With regard to the vermiform appendix:
A. It is most often situated in a pelvic position
B. It receives blood via the right colic branch of the superior mesenteric
artery
C. It lies at McBurney’s point (halfway between the anterior superior iliac
spine and umbilicus)
D. It is unimportant in humans
E. It is a retroperitoneal structure
6. Which of the following types of ulcers is associated with major burns?
A. Cushing ulcer – due to increased ICP after head injury
B. Curling ulcer- gastric ulcer associated with major burns
C. Marjolin ulcer – skin cancer as a result of major burns,
D. Venous ulcer
E. Arterial ulcer

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7. A 22-year-old man is brought into the emergency department following
a road traffic accident. He sustained an open fracture of the right tibia
and fibula. His HR is 110 bpm, blood pressure (BP) 108/85, respiratory
rate (RR) 28, urine output is 30 mL in the last hour. Which class of
haemorrhagic shock does he fall into?
A. Class I
B. Class II
C. Class III
D. Class IV
E. Class V
8. A mother notices that her newborn baby boy is drooling excessively; on
feeding him, he swallows normally, but moments later starts to cough
and appears to choke on the milk, which is brought up through his nose.
Which of the following is the most likely diagnosis?
A. Oesophageal atresia 86% present with distal tracheoesophageal fistula
B. Duodenal atresia
C. Small bowel atresia
D. Gastric outlet obstruction
E. Congenital diaphragmatic hernia
9. A newborn presents with profuse bilious vomiting at birth with fullness
in the epigastric region. AXR shows the ‘double bubble’ sign. Which of
the following pathologies is this associated with?
A. Oesophageal atresia
B. Congenital intestinal obstruction
C. Gastric outlet obstruction
D. Duodenal atresia
E. Meconium ileus

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10.Concerning pulse oximetry:
A. It measures arterial O2 partial pressure
B. Readings are inaccurate in the presence of carbon monoxide
C. It gives a good indication of ventilation
D. Readings are usually reliable despite poor peripheral perfusion
E. It usually uses three wavelengths of light
11.A 25-year-old female was involved in a road traffic accident and
suffered a significant head injury. She is being monitored in the
neurosurgical intensive care unit (ICU). Her BP is 100/70 and she has a
HR) of 80 bpm. Her current intracranial pressure (ICP) is 10 mmHg.
Which of the following is her cerebral perfusion pressure?
A. 70 mmHg CPP= MAP- ICP
B. 170 mmHg
C. 90 mmHg
D. 180 mmHg
E. 40 mmHg
12.A 37-year-old male was admitted with a perforated duodenal ulcer. At
laparotomy he was found to have a perforation at the posterior part of
the first part of the duodenum. Which of the following anatomical
structures lies just posterior to this?
A. Splenic vein
B. Inferior vena cava
C. Gastroduodenal artery
D. Coronary vein
E. Superior mesenteric vein

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13. A 35-year-old woman fell from the roof of her house. Paramedics on
arrival report that she is opening her eyes to speech, moves in response
to painful stimuli by withdrawing her arms and is using inappropriate
words. Her vital signs are stable. What is her current Glasgow Coma
Scale (GCS)?
A. 4
B. 10
C. 9
D. 7
E. 3
14.As part of her triple assessment, a 55-year-old woman undergoes a
fine-needle aspiration (FNA) of a breast lump. The cytology comes back
as ‘C3’. Which one of the following best describes C3?
A. Insufficient (non-diagnostic) sample
B. Breast cancer
C. Equivocal
D. Suspected breast cancer
E. Benign
15. A 48-year-old woman undergoes a triple assessment for a left upper
outer quadrant breast lump. The results of the clinical assessment show
the lump to be 4.5 cm in diameter, with mobile lymph nodes on the
same side and no evidence of distant metastases.
Which of the following is her TNM classification?
A. T1N3M0
B. T2N2M0
C. T3N1M0
D. T2N3M1
E. T2N1M0

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16.Which one of the following is not a chemical mediator of inflammation?
A. Histamine
B. Prostaglandins
C. Interleukins
D. 5-Hydroxytryptamine( serotonin)
E. Telomerase
17. Gas gangrene is most commonly caused by which of the following
organisms?
A. Staphylococcus aureus
B. Streptococcus pyogenes
C. Clostridium tetani
D. Clostridium perfringens
E. MycobacteriaQW
18.A 15-year-old boy of African origin presents with splenomegaly and
jaundice. He is complaining of abdominal pain and his bilirubin is
100 μmol/L. Select the likely diagnosis.
A. Biliary colic
B. Prehepatic jaundice
C. Hepatocellular jaundice
D. Gallstone in common bile duct
E. Sclerosing cholangitis
19.A 3-day-old girl with cystic fibrosis has a palpable mass in the right
lower quadrant. A plain abdominal X-ray reveals dilated small bowel
loops. Select the appropriate diagnosis.
A. Volvulus
B. Intussusception
C. Meconium ileus
D. Hirschsprung’s disease
E. Meckel’s diverticulum

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20. A 39-year-old woman was a pedestrian hit by a car while crossing the
road. She complains of chest and abdominal pains. On examination, her
GCS score is 14/15 (E4, V4, M6). Her vital observations are as follows:
BP 86/32 mmHg; pulse 145/min. She has bruising and tenderness over
her lower left 9th and 10th ribs. She has rebound tenderness and
guarding over the left upper quadrant of her abdomen. Her chest X-ray
demonstrates left rib fractures affecting ribs 8–10. Select the likely
diagnosis.
A. Tension pneumothorax
B. Cardiac tamponade
C. Flail segment
D. Ruptured spleen
E. Haemothorax
21. A 44-year-old man is involved in a road traffic accident. He was the
driver of a delivery truck, travelling at 50 miles/h, and was hit from the
side. On arrival at A&E he is unstable. His vital observations are as
follows: BP 90/32 mmHg; pulse 160/min; respirator rate
45 breaths/min. On examination, his neck veins are engorged and
distended. His trachea is central with quiet heart sounds. Select the
likely diagnosis.
A. Tension pneumothorax
B. Cardiac tamponade = becks triad
C. Flail segment
D. Ruptured spleen
E. Haemothorax

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22. A 72-year-old woman presents with an ulcer over the anteromedial
aspect of the lower limb. It is flat, with edges sloping towards the
centre, and has seropurulent discharge. She does not recall any trauma.
She has suffered ‘for years’ with an aching pain over the leg due to her
varicose veins. Over the last 2 months she has noted that this area is
now brown in colour.
Select the likely diagnosis.
A. Chronic obliterative arterial disease
B. Venous ulcer
C. Traumatic ulcer
D. Rheumatoid arthritis
E. Squamous cell carcinoma
23. Muscles power of Grade 4 is:

A. Only a flicker of movement

B. Movement against gravity
C. No movement
D. Movement against resistant
E. Movement with gravity eliminated

24. Fourth step in fracture healing is:

A. Remodelling 5
B. Consolidation 4
C. Inflammation 2
D. Haematoma 1
E. Callus formation 3

25. Following are early local complications of fractures except:

A. Vascular injury
B. Nerve injury
C. Compartment syndrome
D. Avascular necrosis
E. Fracture blisters
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26. The most common cause of compartment syndrome:
A. Fracture
B. Post ischemic swelling
C. Superficial injury of muscles
D. Operative trauma
E. All of the above

27. In dislocation of joints, reduction should be done:

A. Immediately
B. After 6 hours
C. After 8 hours
D. After 12 hours
E. After 24 hours

28. Fractures of which bones may be associated with visceral injuries:

A. Femur
B. Tibia
C. Humerus
D. Pelvic
E. Radius

29. Second stage of acute haematogenous osteomyelitis:

A. Suppuration 2
B. Inflammation 1
C. Bone necrosis 3
D. Resolution 5
E. Reactive new bone formation 4

30. In which bone is haematogenous osteomyelitis common in children:

A. Radius
B. Pelvic
C. Femur

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D. Clavicle
E. Vertebra

31. Acute septic arthritis is associated with all except:

A. May be caused by a penetrating wound
B. May be caused by an open fracture involving a joint
C. May be due to blood borne infection
D. Tends to end with the formation of a fibrous ankyloses
E. Pathological dislocation of joint

32. Tuberculosis of the spine is thought to originate from:

A. By extension from the para vertebral structures
B. In the cancellous vertebral body
C. In ligamentous structures
D. In the nucleus pulposus
E. In the annulus fibroses

33. About Claudication which of the following statements are

true?
A. Intermittent claudication may be present at rest.
B. Intermittent claudication is commonly relieved by getting out
of bed.
C. Intermittent claudication is most commonly felt in the calf.
D. Intermittent claudication distance is usually inconsistent on a
day-to-day basis for a given patient.
E. Intermittent claudication is thought to be due to nerve
compression in the leg muscle compartments.

34. About Investigations the following statements are true

except?

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 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.
35. Gangrene; which of the following is not a cause?
A. Buerger’s disease -
B. Infection
C. Intra-arterial drug injection
D. Frostbite
E. Deep vein thrombosis insufficiency.
36. Indications of amputation include all the following except:
A. Fixed color changes
B. Absent pulsation
C. Tense calf with non-contractile muscle
D. Bulging anterior leg compartment insensate to pain
E. Non- bleeding limb to incisions
37.About embolism, all the following are true except:
A. Young age
B. No collaterals
C. Trophic changes
D. The source of emboli may be undetectable
E. D-dimers are positive if its thrombo-embolic

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38.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.
39. Which of the following is not a predisposing factor for a hernia?
A. Chronic obstructive pulmonary disease
B. Obesity
C. Ureteric stones
D. Pregnancy
E. Peritoneal dialysis.
40.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 female patients.
D. An operation is only occasionally required.
E. The node of Cloquet is a content of the femoral sheath.
41. Best treatment for testicular torsion is:
A. Resuscitation.
B. Early operation to untwist and pexy the affected testis.
C. Orchiopexy for other testis.
D. All of the above in sequence.
E. A and B are correct.
42.In epididymo-orchitis, which of the following is false?
A. The causes are chlamydia and gonococci as sexually transmitted
infections.

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 B. The initial symptoms are those of urinary tract infection (UTI).
C. In mumps 18 per cent of men may develop the condition.
D. It is a common postoperative complication after prostatectomy.
E. Treatment is doxycycline for chlamydia or a broad-spectrum
antibiotic.
43. The commonest presentation of gall stones is:
A. Asymptomatic
B. Biliary colic
C. Charcot’s triad
D. Jaundice
E. Reynaud’s pentad
44.A 64-year-old woman complains of gait imbalance, headache and
deterioration of mental status over the past several months. Her vision
is normal. A CT scan reveals hydrocephalus, but the lumbar puncture
pressure is unexpectedly low. What does she have?
A. Meningitis
B. Normal-pressure hydrocephalus
C. Sigmoid sinus thrombosis
D. Echinococcus
E. Glioblastoma multiforme
45.The following type of stone is radiolucent in (KUB) films:
A. Calcium stones.
B. Urate stones.
C. Cyteine stones. Ass wi fanconi
D. Oxalate stones. Most common
E. Magnesium-ammonium-sulphate form staghorn= proteus
46.As regard complications of prostate cancer:
A. Most common site for distant metastasis is vertebral column.
B. Urine retention is a late complication.

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 C. Most common sexual complication after prostatectomy is retrograde
ejaculation.
D. All of the above.
E. B and A are correct
47. 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
48. Which of the following statements regarding benign breast disease is
true?
A. Nipple retraction always indicates an underlying malignancy.
B. Staphylococcus aureus is the most common cause for non-lactational mastitis.
C. Fibroadenomas should always be offered excision, as they are associated with a
high risk of malignancy.
D. The histology of phyllodes tumour may be benign, intermediate or malignant.
E. Blood-stained nipple discharge is usually due to a breast carcinoma.

49. Which one of the following statements about carcinoma of the breast
is false?
A. Hormone replacement therapy (HRT) increases the risk of breast cancer.
B. Inflammatory breast cancer is not caused by infection in the breast.
C. Medullary carcinoma in the breast is associated with a poor prognosis.
D. Van Nuy’s scoring system is used to decide further management after local
excision in patients with ductal carcinoma in situ (DCIS).
E. Oestrogen receptor positive tumours are treated with tamoxifen or aromatase
inhibitors.

50. Which one of the following statements with regards to carcinoma of

the breast is true?

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A. Paget’s disease of the breast is usually associated with an underlying invasive
carcinoma.
B. The survival outcome following breast conserving treatment and mastectomy
are not equal.
C. Positive resected margins are not a significant predictor of recurrence after
breast-conserving surgery.
D. Sentinel lymph node biopsy should not be offered in clinically node-negative
axilla.
E. The pectoralis minor and major muscles are removed in Patey’s mastectomy.

The end

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