Dashboard / My courses / SOM 3101 / Year Three Progressive Test - Today Friday 29th September 2023

/ Year 3 Undergraduate Progressive Test

St art ed on Friday, 29 September 2023, 10:45 AM

St at e Finished
Complet ed on Friday, 29 September 2023, 12:09 PM
T ime t aken 1 hour 23 mins

Question 1

Complete

Marked out of 1.00

Healing by second intention is characterized by all the following EXCEPT

a.
Abundant granulation tissue

b. Wound contraction

c.
More common complications

d. Longer duration of healing

e.
Thin scar
Question 2

Complete

Marked out of 1.00

Among those causes of dysphagia, which one is unlikely to be located in the Oesophagus?

a. Achalasia

b. Zenker’s diverticulum

c. Rings/Webs

d.
Neoplasm

e. Idiopathic aperistalsis

Question 3

Complete

Marked out of 1.00

All are true about hormone levels in response to stress except:

a. Increased Insulin- like growth factor- 1

b.
Increased glucagon

c. Increased ACTH

d. Increased catecholamines
Question 4

Complete

Marked out of 1.00

Complications of urine retention include

a. Haematuria

b. Acute kidney failure

c. Shock

d.
bladder rupture

e. Extravasation of urine

Question 5

Complete

Marked out of 1.00

Chilaiditi’s sign refers to

a. Presence of Chyle in the common bile duct.

b.
Presence of bowel loops (colonic) above the liver and below the right hemidiaphragm.

c. Presence of saint’s triad and pus in the gall bladder.

d. Porcelain gall bladder.

Question 6

Complete

Marked out of 1.00

The following is the most common risk factor for bile duct injury globally

a. Laparoscopic biliary surgery

b. Abdominal trauma

c. All the above.

d.
Open biliary surgery

Question 7

Complete

Marked out of 1.00

Which statement is incorrect?

a.
If the hyponatremia is known to be less than 48 hours in duration it can be corrected quickly

b. Hyperlipidemia can cause an artificially low na+

c.
In chronic hyponatremia, the Na+ should not be raised by more than 0.5mmol/l/hr

d. Central pontine myelinolysis is caused when hypernatremia is corrected too quickly

e. If the Na+ level is raised too quickly in a patient with chronic hyponatremia it causes an increase in ICP
Question 8

Complete

Marked out of 1.00

When an elderly patient presents to you with features of long- standing and severe dysphagia associated with fatigue; your main concern
will be:

a. To ensure that he has a higher hemoglobin level so that he can undergo esophagogastretomy since he may lose a lot of blood
during surgery.

b.
To assess any state of dehydration, glycemia, and electronic imbalance

c. To first perform a barrow swallow to be sure of the anatomical location of the dysphagia

d. To prescribe urgently for him smooth muscle relaxants that might him to swallow.

e. To prescribe an oesophagoscopy so that you can detect lesions and possible biopsy from lesions seen to have a proper diagnosis

Question 9

Complete

Marked out of 1.00

The following are complications of acute pancreatitis except

a.
None of the above.

b. Acute respiratory distress syndrome

c.
Pancreatic pseudocyst

d. Pleural effusion
Question 10

Complete

Marked out of 1.00

Proinflammatory cytokines involved in surgical stress response causing pyrexia by acting on the hypothalamus include the following
except:

a. TNF- alpha

b.
IL- 8

c. IL- 3

d.
IL- 1

e. IL- 6
Question 11

Complete

Marked out of 1.00

Looking at this barium swallow X- ray below showing irregular filling defects; which one is most likely to be the diagnosis:

a. Esophageal carcinoma

b.
Sliding hernia

c. Achalasia

d.
Zenker’s’ diverticuloma

e. Esophageal stricture from caustic injury

Question 12

Complete

Marked out of 1.00

Your post- op patient has a Foley catheter however in the past 2 hours there’s been 10mLs of urine collected. What should you do?

a. Have the patient sit in a high Fowler’s position

b. Irrigate the Foley catheter with 30mls of normal saline

c. Notify the physician and continue to closely monitor the output

d.
Decrease the IV fluid rate

Question 13

Complete

Marked out of 1.00

The following guidelines prevent surgical site infections except:

a.
Perioperative antibiotics given intra- operatively

b. Using films on the skin

c.
Improving patient’s natural defence mechanisms like early mobilization and nutritional status improvement.

d. Theatre sterility rules

e. Preoperative skin preparation

Question 14

Complete

Marked out of 1.00

Which of the following hernias can occur through a defect in the transverse abdominal muscle?

a. Spigelian hernia

b. Umbilical

c. Incisional (midline)

d.
Epigastric

e. Obturator

Question 15

Complete

Marked out of 1.00

A 50- year- old woman presents to the emergency room with acute onset severe epigastric pain. No vomiting. This is the second episode in
as many months. She had bariatric surgery 2 years ago. What is the most likely diagnosis?

a. Acute pancreatitis

b. Acute Gastroduodenitis.

c.
Acute Cholecystitis

d. Obstructed Petersen’s hernia.

Question 16

Complete

Marked out of 1.00

In a patient with strangulated inguinal hernia, there is

a. Richter’s hernia

b. Impediment of flow of bowel content

c. Compromised blood supply to hernia contents

d.
None of the above

Question 17

Complete

Marked out of 1.00

The ebb phase is characterized by all except:

a.
Lactic acidosis

b. Reduced cardiac output

c.
Increased basal metabolic rate

d. Hypothermia

e. Hypovolemia
Question 18

Complete

Marked out of 1.00

Acute retention of urine is

a. Failure to void of acute onset

b. Painful failure to void

c. Not a surgical emergency

d.
Painful failure to void with relief on bladder evacuation

e. Failure to void for less than 30 days duration

Question 19

Complete

Marked out of 1.00

What is the most common type of shock encountered in surgical practice:

a. Distributive shock

b.
Endocrine shock

c. Cardiogenic shock

d. Hypovolemic shock
Question 20

Complete

Marked out of 1.00

Which of the following is not a differential diagnosis of right iliac fossa pain

a. Appendicular mass

b. Irritable bowel syndrome.

c. Psoas abscess

d.
Diverticulitis

e. Typhoid ileal perforation

Question 21

Complete

Marked out of 1.00

A 70- year- old grandfather presents to the surgical outpatients' clinic with deep worsening jaundice over the last three months. On
examination, he is wasted and has extensive scratch marks. What is the most likely diagnosis?

a. Klatskin tumor

b. Gastric Antral carcinoma

c.
Cholelithiasis

d. None of the above.

Question 22

Complete

Marked out of 1.00

Modern guidelines on fasting before surgery allow intake of clear fluids up to

a. 8hrs before surgery

b. 2 hours before surgery

c. 6hours before surgery

d.
4 hours before surgery

Question 23

Complete

Marked out of 1.00

Calot’s triangle is defined by

a.
The cystic duct, CBD, and Splenic artery

b. The CBD and superior border of the pancreas and the splenic hilum

c.
The confluence of the CBD, right and left hepatic ducts.

d. None of the above.

Question 24

Complete

Marked out of 1.00

Which of the following physical signs is associated with the correct definition suggestive of acute appendicitis?

a. Dunphy sign: pain in the RLQ with palpation on the left

b.
Iliopsoas sign: pain on internal rotation of the right hip

c. Mortar's sign: pain at the McBurney's point

d.
Obturator sign: pain with extension of the leg

e. Rovsing sign: pain in the RLQ on palpation of the left lower quadrant

Question 25

Complete

Marked out of 1.00

Wound contraction is mediated by

a. Myofibroblasts

b.
Collagen

c. Epithelial tissue

d. Elastin

e.
Keratin
Question 26

Complete

Marked out of 1.00

The type of hernia that occurs primarily in elderly malnourished women and is associated with neuralgia

a. Lumbar

b. Obturator

c. Femoral

d.
Inguinal

e. Umbilical

Question 27

Complete

Marked out of 1.00

Which of the following is not a cause of an abdominal wall hernia?

a. Heavy weight lifting

b.
Marfanoid syndrome

c. High parity

d. Diabetes mellitus

e. Lathyrism
Question 28

Complete

Marked out of 1.00

The following differentiates surgical from non- surgical jaundice

a. Pruritis affecting only the upper limbs

b. Progressively deepening jaundice

c. Steatorrhea that improves with time

d.
None of the above.

Question 29

Complete

Marked out of 1.00

Presentation of acute retention is characterized by

a.
Intermittency

b. hesitancy

c.
All the above

d. Weak stream

e. Straining to void
Question 30

Complete

Marked out of 1.00

Skin grafting is a form of

a. Quaternary intention healing

b. Secondary intention healing

c. Tertiary intention healing

d.
Primary intension healing

Question 31

Complete

Marked out of 1.00

The most precise diagnostic screening procedure for differentiating a benign from a malignant thyroid nodule is?

a.
Thyroid scan

b. FNAC

c.
Thyroid core biopsy

d. Thyroid ultrasound scan

e. Thyroid function test

Question 32

Complete

Marked out of 1.00

Removal of stitches of uncomplicated wounds on the trunk is after

a. 3 – 4 weeks

b. 7 – 10 days

c. 10 - 14 days

d.
14 – 21 days

e. 5 – 7 days

Question 33

Complete

Marked out of 1.00

The following are modifiers of the metabolic response to injury except:

a. Immobilization

b.
Minimal period of starvation

c. Epidural analgesia

d. Minima access techniques

Question 34

Complete

Marked out of 1.00

A 43- year male patient known hypertensive with a 5- year history of dysphagia. Foods, especially solids but occasionally liquids, are sticking
at the level of his upper sternum with every meal. He is usually able to get the food down with repeated swallows or by drinking water.
More recently, he has noticed the spontaneous regurgitation of clear, foamy liquid and undigested food into his mouth, especially when
bending over after dinner. His wife has noted that he coughs at night and has lost about 5 kg.

Additional complaints include episodes of chest "seizures," characterized as a squeezing pain without radiation, that can occur at any time
of day. These episodes last for several minutes to 1 hour and are unrelated to physical activity or meals. Drinking cold water sometimes
helps alleviate the pain. The patient denies heartburn or odynophagia. He traveled to Kampala one month before the onset of the
dysphagia. His past medical history is unremarkable, but he does have a smoking history of 20 packs per year. His physical examination is
unremarkable.

Which treatment option could be the least appropriate for this patient?

a. Modified Heller’s myotomy

b. Nissen Fundoplication

c. Botulinum toxic injection

d. Esophageal resection (esophagectomy)

e.
Dilatation with pneumatic or balloon dilators
Question 35

Complete

Marked out of 1.00

During swallowing the:

a. Rima glottis opens.

b. The gag reflex is suspended.

c. The auditory tube opens.

d.
The cricopharyngeal muscle contracts.

e. Soft palate propels the bolus down

Question 36

Complete

Marked out of 1.00

Regarding Gallstone disease

a. The best initial investigation is an abdominal ultrasound scan.

b.
Always requires a cholecystectomy

c. A plain abdominal X- ray can identify stones in 80% of cases.

d. It’s asymptomatic in only 10% of cases

Question 37

Complete

Marked out of 1.00

Wound healing is described as a process of four phases. Which of the following is incorrect?

a. Proliferative or repair phase

b. Haemostasis phase

c. Remodeling phase

d.
Inflammatory phase

e. Epithelial cell migration phase

Question 38

Complete

Marked out of 1.00

Consider the following statements regarding abdominal incisions, which one is the most correct

a. Midline incisions tend to be associated with more post- operative pain

b.
Transverse incisions tend to be associated with less respiratory complications

c. Midline incisions tend to be associated with better cosmetic outcomes

d. Transverse incisions tend to be associated with better cosmetic outcomes

Question 39

Complete

Marked out of 1.00

A 40- year- old Makerere University administrator is admitted to the emergency room with colicky right upper quadrant pain, nausea,
anorexia, and on and on- and- off fevers. The pain radiates to the right iliac fossa and the right shoulder blade posteriorly. Your supervising
consultant thinks the above patient could be having symptoms secondary to gallstone disease. Which of the below is a risk factor for
Gallstone disease?

a. Sedentary lifestyle.

b. Cholecystokinin deficiency

c.
All of the above.

d. Excessive alcohol consumption

Question 40

Complete

Marked out of 1.00

Which is incorrect with regards to the fluid and its content?

a. Hartman’s- 5 mmol K+/L

b.
D5W- 50gm glucose/L

c. Normal Saline – 150mmol Na+/L

d. Hartman’s – 131mmol Na+/L

e. Hartman’s –131mmolCl- /L
Question 41

Complete

Marked out of 1.00

The following features characterize Saint’s Triad except

a. Fever

b. Jaundice

c. Right upper quadrant pain

d.
Vomiting

Question 42

Complete

Marked out of 1.00

Patients with chronic retention of urine

a.
are admitted for antibiotic coverage

b. Need daily fluid balance charting

c.
are in pain on presentation

d. are discharged immediately

Question 43

Complete

Marked out of 1.00

Food is prevented from entering the larynx during the pharyngeal phase of swallowing by

a. Constriction of the laryngeal entrance

b. Downward movement of the larynx.

c. Posterior movement of the epiglottis

d.
Increase in respiratory rate.

e. Upward movement of the epiglottis.

Question 44

Complete

Marked out of 1.00

The most common type of collagen required in the proliferation phase of wound healing is

a. Collagen type X

b.
Collagen type IV

c. Collagen type III

d. Collagen type II

e. Collagen type I
Question 45

Complete

Marked out of 1.00

What is the obligate requirement of glucose during starvation to sustain cerebral energy metabolism?

a. 150g

b. 200g

c. 100g

d.
50g

Question 46

Complete

Marked out of 1.00

Which of the following is the most common cause of acute pancreatitis in Uganda?

a.
Scorpion stings

b. Aflatoxins and other food poisons

c.
Hypertriglyceridemia

d. None of the above.

Question 47

Complete

Marked out of 1.00

Regarding the surgical anatomy of the liver

a. It is divided into seven segments

b. Half of its blood supply is from the portal vein.

c. The portal triad consists of the hepatic artery, common bile duct, and the portal vein.

d.
Resection of 50% of the liver is fatal.

Question 48

Complete

Marked out of 1.00

As the Doctor attending to the above patient, what is the most appropriate investigation following resuscitation?

a.
Serum electrolytes and liver function tests

b. Plain abdominal X- ray.

c.
Abdominal Ultrasound scan

d. Non- contrasted CT abdomen and pelvis

Question 49

Complete

Marked out of 1.00

Which statement is incorrect about blood products?

a. FFP must be ABO compatible

b. 50 units of platelets should raise the platelet count by 5

c. a bag of FFP contains 180 ml

d.
A bag of packed cells is 300 ml

e. Platelets must be ABO compatible

Question 50

Complete

Marked out of 1.00

A 43- year male patient known hypertensive with a 5- year history of dysphagia. Foods, especially solids but occasionally liquids, are sticking
at the level of his upper sternum with every meal. He is usually able to get the food down with repeated swallows or by drinking water.
More recently, he has noticed the spontaneous regurgitation of clear, foamy liquid and undigested food into his mouth, especially when
bending over after dinner. His wife has noted that he coughs at night and has lost about 5 kg.

Additional complaints include episodes of chest "seizures," characterized as a squeezing pain without radiation, that can occur at any time
of day. These episodes last for several minutes to 1 hour and are unrelated to physical activity or meals. Drinking cold water sometimes
helps alleviate the pain. The patient denies heartburn or odynophagia. He travelled to Kampala one month before the onset of the
dysphagia. His past medical history is unremarkable, but he does have a smoking history of 20 packs per year. His physical examination is
unremarkable.
Reading from the above clinical case; which diagnosis is less likely to be listed in your differentials?

a. Esophageal stricture from caustic injury

b. Zenkers’ diverticuloma

c. Epilepsy with neuropathy of cranial nerves 9 and 10

d. Achalasia

e. Esophageal carcinoma
Question 51

Complete

Marked out of 1.00

You are the 3rd year undergraduate student responsible for caring for a patient assigned to you following surgery. What is your highest
priority?

a.

b.
Assessing for haemorrhage

c. Maintaining a patent airway

d.
Managing the patient’s pain

e. Assessing the vitals every 15 minutes

Question 52

Complete

Marked out of 1.00

The first sign of wound healing is

a. Granulation tissue

b. Localized edema

c.
Leukocytic infiltration

d. Epithelialization

e.
Dilatation of capillaries
Question 53

Complete

Marked out of 1.00

Which of the following is not included as a risk factor for increased risk of wound infection?

a. Poor perfusion

b. Malnutrition

c. All are included

d.
Poor surgical technique

e. Colonization and translocation in GIT

Question 54

Complete

Marked out of 1.00

A surgical site infection can occur up to how many days after the operative period?

a. 40 days

b.
60 days

c. 90 days

d. 30 days
Question 55

Complete

Marked out of 1.00

Which of the following is not a symptom of hypokalaemia?

a. Muscle weakness

b. Constipation

c. Seizures

d.
Ileus

e. Paralysis

Question 56

Complete

Marked out of 1.00

What plays a key role in the inflammatory phase of wound healing in the skin?

a. Collagen

b.
Fibroblasts

c. Lymphocytes

d. Platelets

e. Macrophages
Question 57

Complete

Marked out of 1.00

Which of the following is not a cause of hypercalcemia?

a. tuberculosis

b. Postprandial measurement

c. Renal failure

d.
lung Ca

e. Hypomagnesemia

Question 58

Complete

Marked out of 1.00

While taking your history regarding the onset of the dysphagia, which pathology/diagnosis is unlikely for an onset beyond 6 weeks:

a. Achalasia

b.
Carcinoma

c. Foreign body

d. Benign stricture

e. Zenker’s diverticulum
Question 59

Complete

Marked out of 1.00

The following are the radiological features of small bowel obstruction except:

a. Staircase arrangement of air- fluid levels

b. Presence of valvulae conniventes/plicae circulares

c. Paucity of colonic gas

d.
Presence of haustral folds

e. Centrally distributed air- fluid levels.

Question 60

Complete

Marked out of 1.00

What is needed for collagen synthesis?

a. Vitamin C

b.
Iron supplements

c. Protein

d. Carbohydrates

e. All of the above

Question 61

Complete

Marked out of 1.00

A 70- year- old grandfather presents to the surgical outpatients' clinic with deep worsening jaundice over the last three months. On
examination, he is wasted and has extensive scratch marks. What is your preferred initial investigation for the above patient?

a. Contrasted CT scan of abdomen and pelvis.

b.
Serum electrolytes and liver function tests

c. Abdominal Ultrasound scan

d.
Magnetic Resonance Cholangiopancreatography (MRCP)

Question 62

Complete

Marked out of 1.00

Busoga hernias or Gill- Ogilvie hernias are,

a. Direct inguinal hernias

b. Indirect inguinal hernias

c. Internal hernias

d.
Femoral hernias

e. Lumbar hernias
Question 63

Complete

Marked out of 1.00

A 43- year male patient known hypertensive with a 5- year history of dysphagia. Foods, especially solids but occasionally liquids, are sticking
at the level of his upper sternum with every meal. He is usually able to get the food down with repeated swallows or by drinking water.
More recently, he has noticed the spontaneous regurgitation of clear, foamy liquid and undigested food into his mouth, especially when
bending over after dinner. His wife has noted that he coughs at night and has lost about 5 kg.

Additional complaints include episodes of chest "seizures," characterized as a squeezing pain without radiation, that can occur at any time
of day. These episodes last for several minutes to 1 hour and are unrelated to physical activity or meals. Drinking cold water sometimes
helps alleviate the pain. The patient denies heartburn or odynophagia. He traveled to Kampala one month before the onset of the
dysphagia. His past medical history is unremarkable, but he does have a smoking history of 20 packs per year. His physical examination is
unremarkable.

Which diagnosis is less likely to be listed in your differentials?

a. Esophageal stricture from caustic injury

b. Esophageal carcinoma

c. Epilepsy with neuropathy of cranial nerves 9 and 10

d. Zenkers’ diverticuloma

e. Achalasia

Question 64

Complete

Marked out of 1.00

The preoperative preparation of a deeply jaundiced patient awaiting a Whipple's procedure involves all the following except

a.
Discuss the prognosis of the primary disease and procedure with the patient and their family.

b. Vitamin K injections for 1 week.

c. Adequate preoperative fluid rehydration.

d.
None of the above.
Question 65

Complete

Marked out of 1.00

In acute retention of Urine

a. Urine volume is not important

b. Urine volume is 700mls

c. urine volume is 1L

d.
Urine is opalescent

e. Urine volume is 300- 500mls

Question 66

Complete

Marked out of 1.00

Surgical site infection

a. Antibiotic prophylaxis is best administered at the time of skin incision

b.
Betadine antiseptic retains its antimicrobial properties longer than chlorhexidine- based preparations

c. Has been proven to be increased by using electrocautery to make skin incisions.

d. Reduced rates are seen when using perioperative patient warming

e. Affects 15% of clean wounds

Question 67

Complete

Marked out of 1.00

As part of the physiological response to injury, all about growth hormones are true except:

a. It has a direct lipolytic effect

b. It has proinflammatory properties

c. T has anti- inflammatory properties

d.
It has insulin- antagonizing effect

Question 68

Complete

Marked out of 1.00

Which of the following factors is the most important influence on the genesis of surgical site infections?

a.
Age of patient

b. Glove puncture in the course of surgery

c.
Bacterial content of the wound at the end of the operation

d. Preoperative showering for the patient

e. whether suture material is absorbable or not.

Question 69

Complete

Marked out of 1.00

A 29- year- old woman presents with RLQ pain, fever, and leukocytosis. Before imaging studies, the Alvarado score is used to determine the
patient's likelihood of having appendicitis. All of the following variables make up the Alvarado score EXCEPT:

a. Left shift of neutrophils

b. A right shift of neutrophils

c. Fever

d.
RLQ pain

e. Anorexia

Question 70

Complete

Marked out of 1.00

Gallstone ileus refers to

a.
Gallstones lodged in the common bile duct

b. Paralytic ileus that occurs due to acalculous cholecystitis.

c.
Paralytic ileus arising from calculous cholecystitis.

d. Gallstone (s) lodged in terminal ileum causing bowel obstruction.

Question 71

Complete

Marked out of 1.00

The physical aetiological factors of retention of urine can be

a. a and d

b. Prostate disease

c. DM

d.
Parkinson’s disease

e. Rectocele

Question 72

Complete

Marked out of 1.00

A painful fluctuant collection of blood is

a. Haematoma

b.
Seroma

c. Abrasion

d. Ecchymosis

e. Abscess
Question 73

Complete

Marked out of 1.00

You are caring for a post- op patient. On evaluating the patient, which signs are indicative of infection?

a. White cell count above 14,000 cells/mL

b. Rectal temperatures above 39 degrees Celcius

c. Redness, warm and tender incision

d.
Presence of an indwelling catheter

Question 74

Complete

Marked out of 1.00

Metabolic stress response to surgery and trauma includes all except:

a.
Catabolism

b. Anabolism

c.
Anorexia

d. Immobility
Question 75

Complete

Marked out of 1.00

You admit a patient to the postanaesthetic care unit with a blood pressure of 130/90 and a pulse of 68 beats per minute. After 30
minutes, the patient's blood pressure is 120/65, and the pulse is 100. You document the patient's skin as cold, moist, and pale. What is the
patient showing signs of?

a. Sepsis

b.
Malignant hypothermia

c. Hypovolemic shock

d. Hypothermia

e. Neurogenic shock

Question 76

Complete

Marked out of 1.00

Healing of wounds by first intention requires all of the following EXCEPT

a.
More common complications

b. Abundant granulation tissue

c.
Longer duration of healing

d. Wound contraction

e.
Thin scar
Question 77

Complete

Marked out of 1.00

Which is not a potential complication of a massive blood transfusion?

a. Hypernatremia

b. Hyperkalaemia

c. Hypothermia

d.
Hypercalcemia

e. Coagulopathy

Question 78

Complete

Marked out of 1.00

Which of the following statements is true regarding cancer of the thyroid gland?

a. I123 is not effective in papillary carcinoma

b.
Follicular carcinoma predominantly spreads to the chest

c. Papillary carcinoma is the most common

d. Medullary carcinoma produces thyroglobulin

e. Anaplastic is the most indolent type.

Question 79

Complete

Marked out of 1.00

The initial management of the patient with an obstructed hernia is, the doctor will need to,

a. Do an ultrasound scan

b. Pass NG tube

c. Give a proton pump inhibitor

d.
Initiate antibiotic treatment

e. Do a plain abdominal X- ray

Question 80

Complete

Marked out of 1.00

The ebb phase begins at the time of injury and lasts for approximately:

a. 48- 72 hours

b.
<24 hours

c. 72- 96 hours

d. 24- 48 hours
Question 81

Complete

Marked out of 1.00

A 13- year- old girl is referred to a breast surgeon for breast asymmetry secondary to a rapidly growing right breast mass. Physical
examination reveals an 8cm central right breast mass. She underwent menarche at 12. Her mother was diagnosed with breast cancer at
the age of 41. What is the most appropriate next step?

a. Patient reassurance and mother that this is normal breast development

b.
Prophylactic mastectomy due to high- risk

c. Core biopsy

d. Mammogram

e. Incisional biopsy

Question 82

Complete

Marked out of 1.00

Congenital hernias are commonly

a.
Umbilical

b. Inguinal

c.
Femoral

d. Epigastric

e.
Diaphragmatic
Question 83

Complete

Marked out of 1.00

The normal anion gap is

a. <30

b. <7

c. <22

d.
<12

e. <18

Question 84

Complete

Marked out of 1.00

Which of the following statements is true regarding the thyroid gland?

a. Subtotal thyroidectomy is the most appropriate treatment for hyperthyroidism

b.
Patients with Grave’s disease have high TSH levels

c. The majority of solitary nodules are benign

d. Chvostek’s sign can result from significant goiter

e. Prophylactic total thyroidectomy should be considered in children with MEN II syndrome

Question 85

Complete

Marked out of 1.00

Which statement is unlikely to be through regarding the oropharyngeal dysphagia?

a. Drooling, dysarthria, hoarseness, and other neurological symptoms may be seen.

b. Results from neuromuscular dysfunction that affects swallowing, and causes choking, nasal regurgitation, or tracheal aspiration.

c. Occurs typically due to difficulty initiating a swallow and is generally due to structural, anatomic, or neuromuscular abnormalities.

d.
This may be due to pathology in the pharyngeal phase where the patient develops a cough while swallowing.

e. It is due to pathology in the esophageal phase which may be specified by food getting stuck in the pathway.

Question 86

Complete

Marked out of 1.00

Regarding T- Tube in the management of surgical jaundice

a. Placed in the management of ampullary cancer

b.
Usually placed in the common bile duct (CBD).

c. None of the above.

d. Must be removed within 14 days after placement.

Question 87

Complete

Marked out of 1.00

A 40- year- old Makerere University administrator is admitted to the emergency room with colicky right upper quadrant pain, nausea,
anorexia, and on and on- and- off fevers. The pain radiates to the right iliac fossa and the right shoulder blade posteriorly. What is the most
likely diagnosis?

a. Valentino syndrome

b.
Acute pyelonephritis

c. Acute appendicitis

d. Acute Cholecystitis.

Question 88

Complete

Marked out of 1.00

The following are likely complications of Gallstone disease

a. All the above.

b.
Intestinal obstruction

c. Mirizzi syndrome

d.
Cholangitis
Question 89

Complete

Marked out of 1.00

A 40- year- old female had a laparoscopic cholecystectomy 6 weeks ago. She returns to the clinic with persistent watery diarrhoea since
her surgery. She reports no other symptoms. What is your likely diagnosis?

a. Pancreatic cholera.

b.
Post- cholecystectomy syndrome.

c. Persistent food poisoning

d.
Clostridium deficile infection

Question 90

Complete

Marked out of 1.00

All the following factors determine whether a wound will become infected except:

a. Vascularity and health of tissues being invaded.

b. Presence of dead or foreign tissue

c. Absence of antibiotics during the decisive period.

d.
Host defence

e. Virulence and inoculum of infective agent

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