23.6.

2020 / ‫ المرحلة الخامسة‬/ ‫إمتحان الجراحة التكميلي‬

Q1/ Choose the most appropriate answer:
Which of the following statements regarding hand infections is TRUE?
a. The relatively avascular environment of the synovial sheaths makes them
resistant to infections. F
b. All of hands infections have a mixed flora. F
c. The organisms most commonly isolated from hand infections are
penicillinase producing staphylococci. T
d. A common organism isolated in a human bite injury to the hand is E. coli.
F
e. Treatment of human bites includes aggressive wound cleaning and
antibiotics therapy before suturing. F

Which of the following statements regarding burn depth is TRUE?

a. First-degree burns are characterised by erythema, pain and blistering of the
skin.
b. Second-degree burns involve the epidermis of the skin only.
c. Third-degree burns are characterised by erythema, pain, bullae and
moisture from fluid extravasation.
d. Third-degree burns blanch to the touch.
e. Fourth-degree burns involve muscle or bone.

A 33-year-old women involved in a house fire sustains burns to bilateral lower

extremities, anterior torso, genital area, and her entire left arm. Approximately
what percentage of TBSA is burned?
a. 64% → (18+18+18+1+9=64%)
b. 54%
c. 36%
d. 72%
e. 43%
A 45-year-old man weighting 70 kg sustains second and third degree burns to
50% of the TBSA with inhalation injury. Resuscitation is initiated according to
the parkland formula. Which of the following best represents the initial
intravenous fluid rate for this patient?
a. 625 ml/hr
b. 437.5 ml/hr
c. 732 ml/hr
d. 875 ml/hr (4*50%*70kg=14,000mL → 1/2 in 1st 8 hrs. → 7000ml\8hrs.)
 e. 1000 ml/hr

Which of the following statements regarding the blood supply of the skin graft is
true?
a. The process of capillary ingrowth begins approximately 48 hr. after
grafting, with generalised blood flow established by the fifth and sixth day
postgraft day.
b. Before imbibition, inosculation or capillary alignment is essential for graft
survival.
c. The active uptake of nutrients and serum by the skin graft is a process
called imbibition.
d. Capillary buds from recipient bed vessels have been shown to form
anastomoses with graft vessels and to invade the graft directly.
e. None of above.

Which of the following recipient beds is unlikely to support a spilt thickness skin
graft???????
a. Muscle without overlying fascia (Excellent support)
b. Tendon without paratenon (unlikely to support)
c. Nerve without perineurium (unlikely to support)
d. Bone without periosteum (unlikely to support)
e. Subcutaneous tissue with organized clot (unlikely to support)

Which of the following statements regarding the use of splitthickness and

full-thickness skin grafts is true?
a. A split-thickness skin graft undergoes approximately 10%
shrinkage of its surface area immediately after harvesting.
b. A full-thickness skin graft undergoes approximately 10% shrinkage
of its surface area immediately after harvesting.
c. Secondary contraction is more likely to occur after adequate
healing of a full-thickness skin graft than a split-thickness skin
graft.
d. Sensation does not return to areas that have undergone skin
grafting.
e. Skin grafts may be exposed to moderate amounts of sunlight
without changing pigmentation.

Basal and squamous cell carcinoma 9

Keloid and hypertophic scar 10 ….. Rush pp 521
A 29-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 (lentigo maligna)
b. Freckle involving basal layer of skin
c. Congenital nevocellular nevi
d. Hemangioma
e. Tophi
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According to Hunt and Hess grading scale. A subarachnoid haemorrhage patient
with deep coma, decerebrate rigidity and moribund appearance is classified as:
a. Grade I
b. Grade II
c. Grade III
d. Grade IV
e. Grade V

Most common primary brain tumours are:

a. Gliomas
b. Acoustic neuromas
c. Meningiomas
d. Metastatic tumours
e. None of above.

Arterio-venous malformations are most commonly in the distribution of:

a. Vertebral artery
b. Basilar artery
c. Anterior cerebral artery
d. Middle cerebral artery
e. Posterior cerebral artery
The most common cause of non-traumatic subarachnoid haemorrhage is:
a. Infection
b. Hypertension
c. Tumours
d. Aneurysm → 80% of aetiology is Berry Aneurysm.
e. Arteriovenous malformations
Regarding meningiomas, which of the following statements is NOT true:
a. They are more common in male → 74% of patients are females.
b. They are usually a slowly growing tumour.
c. Olfactory groove meningiomas can present as anosmia and headache.
d. Brain CT scan may show calcifications with the tumour.
e. It is rare for benign meningiomas to be malignant.

The most common aetiology of aneurysm is:

a. Congenital
b. Idiopathic
c. Mycotic (infection)
d. Traumatic
e. Arteriosclerotic

Regarding common clinical features of cord lesions, which of the following

statements is NOT true:
a. Spastic weakness
b. Extensor plantar response.
c. Loss or depression of tendon reflexes.
d. Sensory impairment below the level of the lesion which can affect
different modalities in different degree.
e. All of the above.

Regarding spinal injuries management, which of the following statements is

NOT true:
a. Care of skin and bladder is essential.
b. Spinal stability is a key factor in the management.
c. Rehabilitation is an important part of treatment plan. Main efforts should
be directed toward repairing the cut spinal cord surgically.
d. All of the above.

The following are the treatment options available for management of the patient
with head injury. Which of the following does NOT have an effect on reducing
intracranial pressure?
a. Corticosteroids
 b. Mannitol
c. Furosemide
d. Hyperventilation
e. Barbiturates

Cancers arising in the following organs commonly metastasized to the brain

except:
a. Skin
b. Lung
c. Bowel
d. Kidney
e. Endometrium
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Parapneumonic pleural effusion should be drained if the pH less than:
a. 7.0
b. 7.1
c. 7.2
d. 7.3
e. 7.4
The most common presenting symptoms of acute arterial occlusion is:
a. Pain
b. Pallor
c. Pulseless
d. Paresthesia
e. Paralysis
Which of the following statements is true?
a. Pyogenic lung abscess occurs most frequently in the lower lobe of left
lung. F
b. Anaerobic bacteria are commonly present in Pyogenic lung abscess.
c. Aminoglycoside is the treatment of choice for lung abscess. F
d. Operation is usually required for to eradicate a pyogenic lung abscess. F
e. All of the above.
All of the followings are acceptable operative approaches to management of
thoracic outlet syndrome except:
a. Scalenectomy.
b. Excision of a cervical rib.
c. Thoracoplasty.
d. First rib resection.
 e. Division of anomalous fibromuscular bands.

A 24-year-old male has new onset of chest pain. Chest films demonstrate a large
anterosuperior mass. Appropriate evaluation should include:
a. Measurement of serum alpha-fetoprotein and beta–human chorionic
gonadotropin.
b. Bone scan
c. A barium swallows.
d. A myelogram.
e. Chest U/S.
With regards to acute arterial occlusion, which of the following is FALSE?
a. 90% of emboli are of cardiac origin.
b. Irreversible changes begin to occur within 4-6 hours after acute arterial
occlusion
c. Heparinization should be administered immediately, except if the patient
is proceeding urgently to theatre.
d. Thrombotic arterial occlusion is often associated with other signs of
peripheral vascular disease.
What can cause a closed pneumothorax?
a. Blunt trauma
b. Gun shot
c. Bite wound
d. Thoracentesis
e. All of the above.
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Difficult intubation is associated with the following except:
a. Short neck
b. Dental abscess
c. Limited mouth opening
d. Limited neck movement
e. Mallampati Grade 1
The intravenous anesthetic, which produces dissociative Anaesthesia:
a. Ketamine
b. Thiopentone
c. Halothane
d. Midazolam
e. Neostigmine
According to ASA classification, recent myocardial infarction classified as:
a. ASA-I
b. ASA-II
c. ASA-III
d. ASA-IV
e. ASA-V
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When does the bony lesion of osteomyelitis appears on X-ray?
a. 2 hours.
b. 24 hours.
c. 1 week.
d. 2 weeks.
e. 3 weeks.
Aspirated synovial fluid in septic arthritis will have:
a. Clear color
b. Milk-like fluid
c. High viscosity
d. Markedly increase polymorphnucleic (PMN) leukocytes.
e. None of the above.
Which is NOT a metaphyseal tumor?
a. Giant cell tumor. T
b. Osteosarcoma. T
c. Chondrosarcoma. T
d. Aneurysmal bone cyst. T
e. None of the above
Most common bone to fracture in the body is:
a. Clavicle
b. Humerus
c. Femur
d. Tibia
e. Talus
First sign of compartment syndrome is:
a. Pain on stretch
b. Loss of movement
c. Tingling
 d. Loss of pulse
e. Paralysis

Commonest fracture in elderly with fall on outstretched hand (FOOSH) is:

a. Colle’s fracture
b. Smith fracture
c. Galeazzi fracture
d. Monteggia fracture
e. Bennets fracture
Return of Bulbocavernosus reflex in spinal shock:
a. Sign of recovery form spinal shock. (Typically occurs)??????
b. Partial lesion of spinal cord
c. Complete transection of spinal cord
d. Incomplete transection of spinal cord
e. None of the above.
The commonest cause of limp in a child of seven years is:
a. CDH
b. T.B. hip
c. Coxa vara
d. Perthe’s disease
e. Slipped upper femoral epiphysis
Provocative test for detecting C.D.H.
a. Cozen test
b. Peterson test
c. Barlow test
d. Von-rosen test
e. Perkin’s test
The ideal treatment of bilateral idiopathic clubfoot in a newborn is:
a. Manipulation by mother
b. Manipulation and dennis-brown splint
c. Manipulation and casts. (Ponseti method)
d. Surgical release.
e. None of the above
Which is NOT a principle of compound fracture treatment?
a. Immediate wound closure
b. Wide skin excision
c. Wound debridement
d. Aggressive antibiotics cover
 e. All of above

The most preferred treatment of fracture of neck of femur in a young person is:
a. Closed reduction and internal fixation
b. Conservative treatment
c. Hemiarthroplasty
d. Total hip treatment
e. All the above
The normal bone replaced by fibrous tissue with flecks of osteoid in:
a. Fibrous dysplasia (FD)
b. Fibrous cortical defect
c. Osteochondroma
d. Osteosarcoma
e. Osteoclastoma
Shepherded crock deformity is characteristic of:
a. Rarefaction and sclerosis
b. Osteoclastoma
c. Fibrous dysplasia (FD)
d. None of above
X-ray features in osteosarcoma showing:
a. Soap bubble appearance (Giant-cell tumor)
b. Sessile lesion (broader base)
c. Onion peel appearance (Ewing sarcoma)
d. None of above (Lytic or sclerotic lesions)
Ewing tumor is a malignant tumour of:
a. Osteocyte
b. Osteoblast
c. Enchondroma
d. Fibrous dysplasia
e. Fibrous cortical defect
f. Osteomyelitis
Benz jones protein in urine may refer to:
a. Bone marrow
b. Fibroblast
c. Chondrosarcoma
d. Osteomyelitis
 e. Vascular endothelium of bone marrow
Tennis elbow is the term used to:
a. Ulnar nerve neuritis
b. Myositis ossificans of supinator muscle
c. Olecranon bursitis
d. A fractured head of radius
e. Over use of the extensor muscles of the forearm attach to lateral
epicondyle of the humerus. (lateral epicondylitis)
OA of elbow showing:
a. Muscle atrophy
b. Paresthesia
c. Loss of radial bow
d. Narrowing of joint space
e. Widening of joint space
Gunstock deformity occurs after:
a. Malunited supracondylar fracture
b. Medial epicondyle fracture
c. Lateral condyle fracture
d. Coronoid process
e. Distal radius fracture
In shoulder dislocation, the humeral head usually dislocates primarily in which
of the following directions:
a. Superiorly
b. Inferiorly
c. Anteriorly (95% of cases)
d. Posteriorly
e. Laterally
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Q2\ What are the aims of the treatment of clubfoot? and how the
correction can be achieved?
Q3\ Mention the stages and management of brain abscess.
Four stages are:
1. stage I: early cerebritis (day 1 to day 3) characterized by necrotic tissue,
local inflammatory response, marked edema This stage there is no
demarcation between the lesion and surrounding brain.
2. stage two (late cerebritis)(day 4-10): characterized by : pus , maximum
edema.
3. stage three (early encapsulation)(day10—13) Capsule limits spread of
infection Capsule develops slowly in medial wall of abscess?
4. Stage four: late capsule stage ( day 14 and on ).
Management includes:
A. Antibiotic therapy : Antibiotic is mandatory and should given and depends
on C/S beside Empirical treatment depend on the etiology as
1. Sinusitis : ( penicillin + metronidazole )
2. Otitis : ( penicillin + metronidazole + 3rd generation cephalosporin)
3. Metastatic abscess :(metronidazole + 3rd generation cephalosporin)
4. Post traumatic abscess (vancomycin)
B. Aspiration : has advantages of Confirm diagnosis, Remove of purulent
material, Provide environment for antibiotics to work and Provide
immediate relief of Increased ICP.
C. Excision of brain abscess has advantages of Traumatic abscess ( contain
foreign body and bone fragment), Fungal abscess and Gas containing
abscess.