Dr. M. Salah exam.

11/22
Breast
1)Female ptn has breast mass 7cm in upper outer quadrant infiltrating chest wall, she desires breast conserving surgery
Which is the management plan for her
*Chemo radio
*Chemo then WLE
*Radio then WLE
*Chemo radio then WLE
2) 57 female, menarche 14, 2 children, OCP for 17 years, her mother had Br cancer the, the most risk factor for har to get cancer breast is
*family history
*Age
*OCP
*Parity

3) 40 y. o. female with firm mobile breast mass, with clinically axillary LN, which is the next step in dx
*mammogram
*CT chest
*FNAC
*MRI
4) Lactating female with subareolar hard mass with throbbing pain 4 days & leucocytosis, what is the management
*Reassure
* Incision and drainage
* Percutaneous aspiration
*Antibiotics

5) Which of the following is considered early cancer breast

*stage 1
*stage2
*stage 3
*stage4

Thyroid
6) Ptn hx of toxic nodular goiter was on antithyroid drugs but on & off not presented by palpitations and tachycardia .,, his TSH 0.2,, his management
*Total thyroidectomy
*Near total thyroidectomy
*Antithyroid drugs
7) Ptn presented by thyroglossal cyst, how to be sure it does not contain thyroid ectopic tissue
*radionuclide scan
*TSH
*neck us
*FNAC

8) Patient presented by hard lateral neck mass about 2 cm with loin pain, the probable diagnosis
*PTH carcinoma
*PTH adenoma
*Malign. thyroid nodule

Hernia
9) Ptn with tender inguinal mass with anorexia and vomiting, his management
*Lap hernia
*Open hernia
*Lockwood
10) Ptn presented by tender umbilical mass wit fever, redness, by examination. audible int sounds, the dx is (with pic)
*Strangulated omentum
*Strangulated hernia with loops
*Obstructed hernia with loops

11) What is the diagnosis of the lesion in the pic (umbilical mass with discoloration, I think it is umb hernia)
*Ventral hernia
*Paraumbilical hernia
*Spigelian hernia
*Inguinal hernia

12) Ptn with midline incisional hernia with defect 5 cm, repair done by suturing the mesh in the defect, what is the name
*Sub lay
*On lay
*Interlay
*Outlay
13) Ptn did lap chole 10 months ago, presented by epigastric mass 2x2 cm, tender, no impulse, 5cm below xiphoid since 2 months, what to do
*US
*CT
*Aspiration

Fluids
14) Ptn has hx vomiting for 2 weeks, laps ↓K, NA, CL, alkalosis, with concentrated urine, what to give
*dextrose
*Hartmann’s
* Bolus saline + K
* Bolus saline till improve UOP then add k
15) What is the dose of maintenance fluids in child after 20 kg
*4ml/kg/h
*2ml/kg/h
*1ml/kg/h
16) Child did ileostomy and now has ileostomy diarrhoea, the proper fluid to give
*Ringer
*Saline
*Hartmann’s

Trauma
17) Ptn RTA presented pulse 120 bl/pr 80/40 received 2l fluids then pl.br 70/40, abd distended + CT showing splenic laceration, ptn for
*DPL
*Lap exploration
*Laparotomy

18) Ptn RTA pulse 120, BP 110/60, abd mild pain rt hypochondrial, CT showing large liver laceration, what to do
*Discharge
*Admit and close observe
*Exploration

19) Ptn RTA presented by severe bleeding per nose, DCL, o2 90, FAST +ve, chest x ray query haemothorax, the next step
*Exploration
* Stop epistaxis
*Chest tube
*Intubation

20) ptn RTA presented to ER with noisy breathing, and hemothorax, what to do first
*Chest tube
*Assessment of airway

Burn
21) Ptn 17 years with pic burn all rt upper limb, what percentage
*9%
*18%
*4.5%
Oesophagus
22) Ptn complaining of recurrent severe chest pain (pic of barium swallow), diagnosis
*Diffuse esophageal spasm
*Achalasia
* Oesophageal cancer

23) Ptn history of achalasia, what comp be alert to

* Chest infection
* Dysphagia
* Wt loss

24) Old age ptn, long hx GORD, and recently dysphagia, diet in LAST MONTHS with loss of wait,, recently has post prandial cough ,, what is the most
alarming sign
*Post prandial cough
*Dysphagia
* Wt. loss
25) Alcoholic ptn, had nausea and vomiting 4 hours ago, presented tachycardic, dyspneic, decreased air sounds in lt side chest, with epigastric pain, dx
mostly
*Rupture oesophagus
*Pneumothorax
*Rupture trachea
*Mallory Weiss s
26) Child accidently drank caustic lye, has redness of lips, mouth and pharynx, what is proper
* Enteral feeding
*Early Oesophagoscopy
*Feeding jejunostomy
*Antibiotics

Stomach
27) H pylori ass with any type of gastritis
*A
*B
*C

28) Ptn with hx peptic ulcer, presented dehydrated with vomiting and by examination succussion splash ,, 1st step in management
*NGT
*Exploration
*CT
29) Ptn 75 alcoholic, smoker, hx anorexia, nausea, vomiting and wt loss, by examination succussion splash with distended abdomen ,, dx mostly
*GOO
*Duodenal cancer
*Pancreatitis

30) Which of the following if infiltrated is considered early gastric carcinoma

*Mucosa and submucosa
*Muscularis mucosa
*Serosa
31) Ptn hx gastrectomy and reconstruction, 2 hours after eating, fainting, improvs by feeding
*Late dumping
*Early dumping
*Leakage
32) Ptn hx ca stomach, resection done by roux en y reconstruction, 4th day started oral, abd pain
, upper series show leakage from duodenal stump, management
*Reexploration
* Endoscopy
*Drainage
*Somatostatin
33) Ptn hx ca stomach, resection done with roux en y reconstruction, 4th day started oral, abd lax, drain showed 150 cm serous fluid, mostly leakage
*duodenal stump
*esophagojejunostomy
*jejunojejunostomy
34) The most common used drugs for peptic disease
*long term PPI
*H pylori eradication
*H2 blockers
*Antacids and prokinetics
35) Ptn presented by massive haematemesis, BP 90/40, Hb ↓, management
*Endoscopy & cauterisation
* Explore, duodenotomy and oversewing of bleeder
36) Ptn presented by mild abd pain (all labs and vitals normal ) attached x-ray erect show air under diaphragm , what to do
*Discharge
*Admit and follow up
*Exploration
*Fluids and antibiotics

Small intestine
37) a patient with a pic. of intra operative shows intussception, what is maximin pressure of pneumatic reduction
*80
*100
*120
*200
38) Ptn presented by persistent vomiting and abd distension since 24 hours , admitted for 2 days under conservative ttt and did not improve , surgical hx
of appendectomy (x-ray showing small int obstruction ) , the next step is
*Exploration
*Small int series
*Follow up
*CT

39) Pathophysiology of Crohn’s disease

*Mural thickening of intestine
* Coagulative inflammation
*Granulomatous.
40) Female ptn pain, history of Crohn’s disease, presented by Rt iliac pain and fever, management
*Steroids
*Antibiotics
*Azathioprine

Liver
41) Ptn hx travel to Mexico, has hepatic collection, aspiration chocolate like collection, for diagnosis
*Serology amebiasis
*Serology Echinococcus
42) Neonate presented by jaundice, us biliary atresia, best time for management
*8weeks
*12weeks
*16 weeks
43) Biliary injury bismuth 4 , not remember Q

Pancreas
44) Ptn presented by CT with pancreatic head lesion 3 cm with multiple projections in dilatations in main and minor pancreatic ducts, mangment
*Distal pancreatectomy
*Total pancreatectomy
*Pancreaticoduodenectomy
45) Ptn presented by vague epigastric mass, best for dx
*CT
*US
*MRCP
*Upper series
46) Most common presentation of chronic pancreatitis
*Pain
*Jaundice
47) Ptn in ICU with infected necrotizing pancreatitis, best management
*Antibiotics
*CT guided drainage
*necrosectomy
48) Ptn in ICU with severe pancreatitis, many lab results and vitals
*SIRS
49) Ptn in Icu severe pancreatitis become anxious and aggressive,
*ARDS
50) Most common site of glucagonoma
*Head of pancreas
*Tail
*Neck
*Body
51) Ptn post necrosectomy, frothy discharge in drains, ptn afebrile, pathophysiology due to
*Decreased vascular resistance
*Increased cop
52) Pathophysiology of calculous pancreatitis
*Bile reflux in pancreatic duct
*Activation of proenzymes

Biliary and GB
53) Many questions regarding Ac cholecystitis, Ch cholecystitis, Ascending cholangitis
54) 50 ys ptn with rt hypochondrial pain, diabetic, leukocytosis, fever, us showed calcular cholecystitis with dilated CBD (laps show ↑bilirubin but mainly
indirect) what is the management
*Lap chole
*Open chole
*ERCP
55) Ptn rt hypochondrial pain, fever, jaundice (labs ↑ BIL, ALT, ALP, amylase) diagnosis is
*Acute calcular cholecystitis
*Cholangitis
*Acute pancreatitis

56) Picture intraoperative lap chole, most indicative of chronicity

*Thick wall gall bladder
*Haemorrhagic wall
*Adhesions
57) ERCP showing filling defect, ttt
*Lithotripsy
*Stone extraction by ERCP

Appendix
58) Perforated appendix, how many days Abs
*1-2
*3-5
*5-7
Colon
59) Ptn 35 ys, Ct showing ileocecal junction on lt side with mesenteric whirl, with pelvic free fluid, diagnosis
*Caecal volvulus
*Malrotation
*Band
60) The previous ptn management
*Exploratory laparotomy
*Laparoscopic untwisting
*NGT
*Rectal tube
61) Ptn homosexual, has anal pain, ulceration mostly
*Anal cancer
*Rectal cancer
*Fissure
62) Male 50 with rectal cancer, his father had rectal cancer, the responsible gene is
*Proto-oncogene
*Oncogene
*Tumour suppressor gene
63) Female with cx rectum and no family hx, the responsible gene
*APC
*K –ras
*Don’t remember others
64) Ptn with rectal cancer, 5 cm from anal verge, suspected mesorectal invasion, but MRI excluded any lymphadenopathy, best for him
*Low Ant resection
*APR
*Chemoradiotherapy
65) Ptn with bleeding per rectum, proctoscopy bulging mucosa at three sited , with spontaneous retraction upon removal of the proctoscope , management
*Stool softener and bulk forming diet
*Haemorrhoidectomy
*Sclerotherapy

66) Previous ptn, piles any degree??

*1st
*2nd
*3rd
*4th
67) MRI showing abscess within the levator plate, no external or int opening, but MRI showing track descending 3 cm till midline at 6 o’clock ,, mostly
diagnosis
*Pelvirectal fistula
*Subcutaneous fistula
*Submucous fistula
*Low perianal fistula
68) Ptn ca rectum, CT could net detect if LN involvement or not, what to do
*Endorectal US
*Barium enema

69) Ptn post haemorrhoidectomy 3 weeks incontinence, how detect structural abnormality
*Endoanal us
*Barium enema
*Defecogram

Endocrine
70) Ptn with polydipsia, polyuria, and many labs, dx
*hyper corticosteroids
*hyperadrenalism

Skin & soft tissue

71) Pic showing arm melanoma, what indicates wider radical resection
*Positive LNs
*More thickness of the lesion
*Wider lesion
*Age

paediatric
72) Neonate, drooling, Ryle not passing, x-ray no abdominal air, diagnosis
*Oesoph atresia with distal fistula
*Oesoph atresia without fistula
*laryngeal atresia
73) Child has low back mass discharging caseous material, on pr discharge increase
*Pilonidal sinus
*Postanal dermoid
*Sacrococcygeal teratoma

74) Gastroschisis mostly associated with

*Intestinal atresia

Urology
75) Ptn with rectovaginal fistula, diagnosis by
*CT
*Barium enema
*Cystoscopy
76) Ptn hx Prostatism, fainted, syncopal attack, presented by suprapubic pain , first to do
*Urethral catheter
*Suprapubic
*Urgent TURP
*Antibiotics

Ethics
77)Ptn old age with dementia, diagnosed advanced breast cancer, family don’t want to tell her
*Tell her
*Don’t tell her
*Ask why they don’t want to tell her
*tell social workers
78)Ptn in ICU, need amputation, family refuses as he may want to die in one piece not pieces
*Proceed to operation
*Don’t amputate
*Refer to court
* Ask another surgeon opinion
79) Junior doing appendectomy, discovered caecal mass
*Try to remove
*Call the senior and wait
*Tell the relatives it is unresectable
80) During appendectomy, found ovarian cyst
*Remove
*Don’t remove
*Take consent from family
81) Ptn post-operative during travel, alarm found metal towel, how to prevent
* Sharps and metal counting
*Time out
*Sign out
82) Surgeon did lt nephrectomy instead of Rt nephrectomy, best to prevent
*WHO checklist

83) Name of the event in previous question

*sentinel event
*near miss
84) How to prevent wrong side surgery
*senior resident marking the ptn
*nurse doing timeout
*booking system

Others
85) Pic of cachectic ptn, most diagnostic sign of chronic dehydration (‫المريض جلد على عضم‬
*Sunken eyes
*Atrophied ms
*Clear subcutaneous veins
*Bony prominence

86) Alcoholic ptn present by severe epistatic pain (normal all laps & vitals) what is the diagnosis
*Acute pancreatitis
*Perforated du
*Acid peptic disease
*AC cholecystitis
87) Ptn presented by fr femur, what is the contraindication of neuraxial anasthesia
*sarcoidosis
*malignant hyperthermia
*anticoagulation
88) Ptn presented by ac abdomen, exploration, 1ry enteral repair, after 4 days opening one stitch, gush of large amount of small intestinal content, what is
the management
*Enteral feeding
*Re exploration
*IV hyperalimentation
*Reassure
89) From the following which could suggest ptn has SIRS
*peripheral temp > 38.5
* WBC < 4000
90) Ptn for calculation GCS
91-95) Questions for diagnosis of SIRS, Sepsis, severe sepsis, Septic shock
96) Ptn post appendectomy presented by erythematous wound, removal one stitch serous discharge for
*Follow up
*Regular dressing
*Opening all wound
97) Ptn dm erythema rt foot till thigh with crepitations, for
*Antibiotics
* Amputation
*Debridement
98) Pt with hotness and erythema rt leg, for
*Reassure
*Antibiotics
*Debridement
99) Ptn with hugely prolapsed ileostomy, with edema of part of it and starting of ischemic patch, management *refashioning
*Emergent refashioning
*Discharge home
*Elective closure of ileostomy

100) Which of the following in the most emergent

*Tracheobronchial injury
*Haemothorax
*Tension pneumothorax
*Aortic rupture
101) Ptn with mediastinal mass, CT showing upper lung lesion, which most proper
*Cervical mediastinoscopy
*Open lung biopsy
102) Ptn with stab and diaphragmatic injury, lap repair done, 3 hours postop ptn tachycardic, dyspneic, stressed, best investigation
*Chest x-ray
*ECG
*ABG
103) Icu ptn, developed subarachnoid hge, most electrolyte disturbance
*hypernatremic
104) Pic of ptn diabetic, hx amputation of middle toe with delayed healing, duplex intact dorsalis pedis pulse, intact femoral with 3 cm constriction in
distal part of it, best for ptn
*Femero- femoral bypass
*Femero-popliteal bypass
*Profundoplasty
*Femero-tibial bypass
105) Patient get postoperative blood clot as the surgeon did not prescribe anticoagulant
*Error of commission
*Error of omission
*Drug error
106) Ptn with varicosities presented by bleeding from vessel beside medial malleolus, 1st management for him
*Tourniquet
*Tight bandage
*Urgent stripping
*Ligation of offending vessel
107) What is the following is a contraindication for surgical cricothyroidotomy
*Laryngeal edema from burn
*Fracture of larynx
*Unstable fracture mandible