In thyrortoxicosis, opthalmologia is due to :

Hypersensitivity to the sympathetic nerves.

Increased amount of retro-orbital fat.
Weakness of the inferior oblique , superior rectus muscle.
Atrophy of the optic nerve.

2. In acute appendicitis ,appendicular mass is :

a tumor obstructing the middle of the appendix.
an inflammatory location of the appendix.
a pus cavity surrounding the appendix.
a fecalith floating freely in the pelvis .

3. One of the following statements regarding wound healing is not true:

the inflammatory phase is necessary for healing.
during proliferative phase leucocytes cells predominate .
remolding of scars continues for life.
Vitamin C with ferrous needed for protein hydroxylation .

4. Which of the following is an indication for surgical excision in breast

disease :
complex cyst .
fibroadenoma less than 4cm.
fat necrosis .
fibroadenosis.

5. Regarding necrotizing fasciitis all are true except:

mortality rate is between 50%-70%.
it is caused by mixed an-aerobic flora .
haemolysis might complicate the disease.
clostridium perferinges is the pathogen . it is poly microbial mainly GAS

6. Which is not true regarding cancer colon :

the heredity type is the most common .
most of the carcinomas start by as a polyp.
there is a relative increase in right colon carcinoma.
stool for occult blood misses about 70% cancer colon.
7. Obstructive hernia is :
is rarely strangulated .
is associated with pain in the sciatic nerve.
is the most common in older women with cachexia .
is reducable when early diagnosed .
8. Overwhelming postsplenectomy sepsis is :
occurs 10-15 years after splenectomy.
is due to encapsulated bacteria .
is most common in elderly patients .
occurs most commonly after splenectomy for spherocytosis .

9. If a medullary thyroid carcinoma is suspected you ask for which of the

following :
serum thyroglobulin level.
serum calcium level .
serum calcitonin level.
serum alkaline phosphatase.

10. The best operative approach to choledochal cyst is :

Cytoduodenostomy.
cytojujnostomy.
roux-en-y cytojejunostomy .
cyst exicion and hepaticojejunostomy . roux-in-Y

11. The optimal managmement of traumatic duodenal hematoma is :

angiography and embolization.
laparotomy and evacuation .
laperotomy and gastrojejunostomy.
observation.

12. Disc lesion between L4-5 will lead to :

reduced knee jerk .
reduced ankle jerk .
weekness of foot dorsiflection.
reduced sesnsation of the small toe .
13. Metabolic acidosis is a complication of topical application of :
sodium mafenide.
 silver nitrate.
silver sulfadiazine.
betedine .

14. Appearance of a U wave on electro cardiogram occurs in :

hyperkalemia .
hypokalemia .
hypermagnesemia.
hypomagnesemia .

15. Peaked T-wave on electrocardoiogram is a feature of :

hypernatremia.
hyponatremia.
hyperkalemia.
hypokalemia.

16. Which of the following results of thyroid fine needle aspiration

indicates surgical treatment
A nodule that disappeared on aspiration.
Clumps of follicular cells.
Anaplastic thyroid cells.
Lymphoma.

17. The most important diagnostic test for a thyroid nodule is :

Ultrasound.
Radioactive isotope scan.
Thyroid function test.
Fine-needle aspiration.

18. Advantage of full thickness over split thickness skin graft is:
Less wound contraction.
Better take.
More resistance to infection.
Better sensory function.

19. With regard of tubular carcinoma is situe in a 43 year

premenopausal women , you should tell the patient which of the
 following ?
She needs simple mastectomy.
She must be placed on tamoxifen and chemotherapy .
She requires lumpectomy and radiotherapy.
She should just be observed closely.

20. A second degree burn is charectarized by which of the following ?

Coagulative necrosis extending to subcutaneous fat.
Erythema and bullae formation.
Pearly white appearance.
Anesthetic.

21. Which of the following factors has not shown to increase a woman's
risk for breast cancer:
Smoking .
Previous history of benign breast biopsies .
Atypia seen on pathology from previous breast biopsy .
First degree relative with history of breast cancer.
22. A 25 years old man noticed right gynacomastia since 5 years , he
should be adviced to have which of the following :
Mastectomy.
Observation .
Endocrine workup and subcutaneous mastectomy.
Needle biobsy of the breast.

23. The standard initial therapy for acute sigmoid volvulus is :

Laparotomy to reduce the volvulus.
Colonoscopy.
Rigid sigmoidoscopy.
Laparotomy and sigmoidectomy .

24. A 40 years old woman presents with abdominal pain flushing ,

diarrhea and wheezing , what is the most likely diagnosis ?
Appendiceal carcinoid .
Ileal carcinoid with liver metastasis.
Bronchial carcinoid.
Non of the above.
25. A 6 months old boy presents with an inguinal hernia , what is the
best treatment of choice
Observation .
Surgical repair when fully grown .
surgery of the affected side and exploration of the other side .
surgery of the affected side .

26. A 30 years male patient brought to ER after motor accident ,

becomes unconscious , CT scan is performed showed space
occupying lesion . what is the most likely diagnosis ?
Acute subdural hematoma.
Acute epidural hematoma.
Cerebral contusion .
Subarachnoid hemorrhage.

27. A non healing pyloric channel ulcer with elevated [Link]

712mg/dl is suggestive of :
Zollinger-Ellison syndrome
MEN-1.
MEN-2A .
MEN-2B.
28. A pseudocyst of the paccreate can be treated by :
Percutaneous drainage of the cyst .
Excision of pseudocyst .
Laparotomy and internal drainage of the cyst .
Distal pancreatectomy.

29. Whipples triad in insulinoma include all except

Hypoglycemic symptoms.
Blood glucose <50mg /dl during the symptomatic episodes .
Relief of symptoms by intravenous injection of glucose .
Fasting elevated blood insulin levels.

30. Which of the following is caused by contraceptive pills

Hepatic adenoma .
 Hepatoma.
Hepatic hamartoma.
Cholangiocarcinoma.

31. Auto infarction of the spleen is seen in :

Hereditary splerocytosis.
Feltys syndrome.
Sickle cell disease .
Thalassemia major.

32. One of the following is not true in ulcerative colitis

The colon and rectum are involved usually .
Inflammatory process involves all bowel layers. this is for crohns disease that is transmural
Inflammatory changes are confluent with no skip areas .
Carries higher risk of colorectal cancer than general population.

33. A 3 years old boy with undescended testicle at the pubic tubercle
level should be advised to do :
Observation until age of 5.
Orchiopexy as soon as possible .
Ultrasound guided biopsy of testicle .
Orcidectomy.

34. The most reliable means of preoperative nutritional assessment is :

A. Clinical history of weight loss. this is the best ( BMI )
B. Serum albumin level.‫ ؟؟؟؟؟‬this one indicagte chronic manutrition
C. Impired cell mediated immunity.
D. Triceps skin fold measurement .
35. Pyoderma gangrenosum is typically associated with :
Advanced colonic adenocarcinoma.
Rectal cacinoid .
Ulcerative colitis .
villous adenoma of the colon.

36. In contrast to a keloid , a hypertrophic scar:

Is more likely to be familial .
May subside spontaneously .
 May develop spontaneously .
Often extends beyond the limits of wound.

37. A 65 years old woman from a nursing home with a history of chronic
constipation , presented complaining of abdominal pain and
marked abdominal distention . what is the most likely diagnosis ?
Appendicitis .
Carcinoma of the colon .
Volvulus of the sigmoid colon.
Volvulus of the cecum.

38. Appendectomy wounds are classified as :

A. Clean .
B. Clean contaminated .
C. Contaminated .
D. Infected .

39. Regarding torsion of a testicular appendage which is true :

A. Occurs most commonly after puberty.
B. Involves the head of epididymis.
C. Involves the hydatid of morgagni.
D. Requires urgent surgery .

40. The most important measure to get a chronic venous ulcer to heal is
:
Daily dressing with ointment antibiotic.
Stop smoking .
Applay compression bandaging.
Surgery to excise the ulcer.

41. Which of true regarding chronic leg ulcer ?

A. 80%are due to venous insufficiency .
B. A biopsy is best done of the ulcer edge .
 C. Basal cell carcinoma is the commonest malignancy in the leg .
D. Arterial and venous ulcer are easily diagnosed .

42. Which of the following features is true of testicular cancer :

Is most common in elderly men .
Commonly metastasis to the inguinal nodes.
Is in sensitive to radiation therapy .
Arises most commonly from cells .

43. The febrile response after multiple trauma stems from which of the
following mediators?
A. IL 1.
B. IL 2.
C. IL 10.
D. IL -4.

44. The severity of hypovelemic shock has been found to correlate with
the
hematocrit .
pulmonary capillary wedge pressure.
lactic acid.
white blood count.
45. The drug of choice in malignant hyperthermia is :
A. calcium channel blockers.
B. isoflurane
C. ketamine.
D. dantrolene.

46. Monteggia fracture is :

fracture dislocation of the olecranon.
fracture of the coronid process .
fracture of the upper end of the ulna with dislocation of the head of radius.
fracture of the shafts of forearm bones.

47. galeazzi fracture is :

fracture of the lower end of the radius.
fracture of the shaft of the radius with dislocation of the inferior radio-ulnar joint.
 fracture of the lower end of the radius with anterior displacement
fracture separation of the lower radial epiphysis.
48. After a fall on the outstretched and pair fracture in the "anatomical
snuff-box" indicates which of the following bones ?
lunate.
scaphoid.
hamate.
trapezoid.

49. A 10 kg male sustained a 30% second degree burn , what is his

calculated fluid resuscitation?
A. 1200 cc in 24 h.
B. 2000 cc in 24 h .
C. 1500 cc in 24 h.
D. 2200 cc in 24 h.

50. A 50 years male 70 kg, sustained a 60% second degree burn what
are his fluid requirement in 24 hours:
18200 cc in 24 h.
8000 cc in 24 h.
9100 cc in 24 h.
10000 cc in 24 h.

51. Which of the following statement regarding varicose veins is

incorrect:
are associated with an increased risk of pulmonary embolism.
all are acquired during adulthood.
hemosedrin deposition causes pigmentation .
the saphenofemoral junction is initially affected.
they can be primary or secondary .

52. Only one of the following suggests that shock in an injured patient
may have a cause other than hypovolemia which one is this:
A. hypotension.
B. distended neck veins.
C. decreased skin temperature.
D. diminished pulse pressure.
 E. falling central venous pressure.

53. Compound fracture is:

a fracture of two bones.
a fracture of bone and nerve injury.
a fracture of bone with large vessel injury .
a bone fracture with liver injury .
a fracture with open skin or mucous membrane.
54. Regarding Hirschsprungs disease all true except:
it is caused by aganglionosis of a segment of the colon.
nerve fibers are absent in the segment affected.
babies affected fail to pass meconium.
it may be familial.
it commonly affects the recto sigmoid region .

55. Compartment syndrome is described by all the following except:

A. pain on passive movement .
B. decreased sensation of nerves .
C. tense swelling of the involved region .
D. diminished pulses in late stage.
E. increased capillary filling .

56. The following are true of tetanus except:

requires an anaerobic environment for germination of spores.
infection spreads along facial planes.
the causative organism has a characteristics drumstick appearance.
symptoms may start months after infection .
tetanus immune globulin is used for passive immunization.
57. Which of the following is not true regarding cerebrospinal fluid;
it is produced in the lateral,( vreutricles).
it enters the subarachnoid space through the foramina of luschica and
magendie.
it is reabsorbs mostly into the lymphatics. into brain venous sinuses
The normal ESF pressure is between 120-180 mm H2O.
it can be sampled from the cristerna magna.

58. If a patient presents to ER with an open sucking wound of the thorax

:
A. he should be turned to the side of the wound.
B. the wound should be sutured immediately .
C. the wound should be covered with Vaseline gauze and an occlusive
dressing.
D. he should be placed on positive pressure ventilator.

59. Hemorrhage from arterial injuries is best controlled in the ER by :

application of hemostat to bleeding vessels.
cautary .
direct pressure.
tourniquet application.

60. Afferent loop syndrome usually occurs after :

A. billroth II surgery.
B. billroth I surgery.
C. Anteroposterior rectal resection.
D. Hartman's procedure.