2020

Recalls

Sep 2020 MRCS I.V.

 MRCS I.V. Course

Sep 2020
1. A patient developed severe watery diarrhea while he is in at ICU after a surgery for IBD,
colonoscopy was done and revealed a yellowish plaque affecting the colon. What is the causative
organism?
A. Streptococcus Bovis
B. Streptococcus Pyrogens
Tx oral metro
C. Staphylococcus aureus
D. Clostridium deficile Dx: Psudomembranous colitis If severe than vanco orally
E. Campylobacter No response to medical tx then sub total collectomy

2. A male patient in Africa presented with a swollen scrotum associated with chyluria. There is no
other symptoms. What is the most likely cause?
A. Schistosoma
B. [Link]
C. Staphylococcus aureus
D. Wuchereria Bancrofti
E. Bacteroides

3. A 49-year-old Egyptian man on holiday in the United Kingdom presents with haematuria. He
gives a history of bladder irritative symptoms for seven months. He has lived in a rural
community for his whole life. What is the possible diagnosis?
A. Cystitis cystica
B. Interstitial cystitis
C. Multiple superficial transitional cell carcinomas
D. Muscle invasive transitional cell bladder cancer
E. Squamous cell carcinoma of the bladder

4. A man developed severe gangrene and color change affecting perineum with extension of
necrotic tissue to the groin. Which bacteria causing this condition?
A. Staphylococcus aureus
B. E coli
C. Mixed aerobe and anaerobe Fourniere gangrene
D. Streptococcus pyogenes Bacteroides, Ecoli

E. Clostridium perfringens

5. A 45 years old man came with a 24-hours history of severe knee pain, cannot move the leg in any
direction, he is apyrexial, WBC count normal, what is the most definitive investigations to know
the cause:
A. Arthroscopy
B. knee aspiration
C. ESR
D. Xray
E. USG

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6. A middle-aged man was involved in a motorboat accident, he sustained a separation of lumbar

spine from sacral spine, with associated lumbar nerve root injury. Which of the following
movements will be affected?
A. Hip flexion
B. Knee extension
C. foot inversion
D. Planter flexion S1 nerve root injury
E. Hip adduction

7. A 25 years old athlete came with a single rib fracture. He is in pain, but he is vitally stable. What
is the most appropriate management?
A. Chest drain
B. Admission, observation and analgesia
C. Analgesia and discharge
D. Infiltration of wound with 5% bupivacaine
E. None of the above

8. A 59 years old COPD patient came with a rib fracture. X-ray was done with no hemo or
pneumothorax detected, but the patient is in pain. What is the most appropriate management?
A. Chest drain
B. Admission, observation and analgesia
C. Analgesia and discharge
D. Infiltration of wound with 5% bupivacaine
E. None of the above

9. A 34 years old patient presented after chest trauma. The trauma affected the ribs from 5th to
10th which were fractured. The patient is cyanosed and tachycardic. What is the most
appropriate management?
A. Chest drain
B. Admission, observation and analgesia
C. Analgesia and discharge
D. Infiltration of wound with 5% bupivacaine
E. None of the above

10. A 33 years old man presented with shoulder pain. On passive shoulder abduction, he is unable
to maintain his shoulder abducted. Which of the following is the most accurate diagnosis?
A. Supraspinatus tendinitis
B. Rotator cuff tear
C. Volkman ischemic contracture
D. Frozen shoulder
E. None of the above

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11. A 53 years old female patient presented with a winged scapula after breast surgery. What is the
affected muscle?
A. Serratus anterior
B. Latissmus dorsi
C. Petctoralis major
D. Teres minor
E. Teres major

12. A 60-year-old man complains of aching, heaviness numbness and tingling in his thighs and legs.
These symptoms are precipitated by standing or by walking for 10 minutes. They are relieved by
sitting down. He has noticed that walking downhill is more troublesome than going uphill. What
is the most likely cause?
A. Occlusion of an external iliac artery
B. Occlusion of both common iliac arteries
C. Osteoarthritis of the hip
D. Saddle embolus
E. Spinal stenosis

13. A 32 years old man suffered numbness over the inferomedial aspect of the leg just below the
knee. Which nerve is affected?
A. Sural nerve
B. Femoral nerve
C. Infrapatellar nerve
D. Tibial nerve
E. Superficial peroneal nerve

14. A woman sustained needle brick to her thigh. Several days later she noticed red streaks around
site of the brick. What is the most likely cause of this condition?
A. Streptococcus viridians
B. Streptococcus Pyrogens Dx: Lymphangitis
C. Staphylococcus aureus
D. Streptococcus pneumonia
E. None of the above

15. A 42 years old female presented with an ankle pain. Clenching the calf muscles does not
produce plantar flexion. What is the most likely cause?
A. Ruptured soleus muscle
B. Ruptured gastrocnemius muscle
C. Rupture tendoachile’s Simmonds Thompson Test
D. Ankle fracture
E. Anterior talofibular ligament injury

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16. A patient undergone colectomy for a colon cancer. Post operatively he was admitted to ICU and
ventilated. Several days later his chest Xray showed bilateral patches of pneumonia. What is the
causative organism of this case?
A. Streptococcus pneumonia
B. Staphylococcus aureus
C. Pseudomonas.
D. E coli
E. Hemophilus Influenza

17. A slightly overweight 13-year-old boy presents with a three-week history of right hip pain and
limping. On examination the hip moves into external rotation when flexed. Which of the
following is the most likely diagnosis?
A. Developmental dysplasia (congenital dislocation) of hip
B. Juvenile rheumatoid arthritis
C. Perthes disease
D. Slipped upper femoral epiphysis
E. Traumatic dislocation of the hip

18. A 70 years old female after total hip replacement for osteoporotic joint. The removed head of
femur was examined. What would you expect regarding pathological changes in the specimen?
A. Normal mineralization and reduced bone density Normal mineral osteoporosis
B. Reduced mineralization and reduced bone density Low mineralization osteomalacia

C. Normal mineralization and normal bone density

D. Increased mineralization and increased bone density
E. None of the above

19. A man presented with right leg fracture. Onion peel appearance revealed in x-ray. what is your
diagnosis?
A. Osteosarcoma
B. Osteoblastoma
C. Multiple myeloma
D. Ewing sarcoma
E. Osteoclastoma

20. A 6-year-old baby was brought by his mother after she noticed that he has evident limping with
pain in his left hip. She denies any history of trauma. What is the most accurate diagnosis?
A. Perthes disease
B. Slipped upper femoral epiphysis
C. Developmental dysplasia of the hip
D. Septic arthritis
E. Osteoarthritis

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21. A patient developed ptosis and loss of sensation over the medial side of the arm after a
shoulder injury. What is the responsible nerve root?
A. C6
B. C7
C. C8
D. C5
E. T1

22. A 54 years old man was admitted for a cholecystectomy. Investigations revealed that he is a
MRSA nasal carrier. What is the most appropriate treatment?
A. IV teicoplanin
B. Oral vancomycin
C. Mupirocin spray
D. IV vancomycin
E. None of the above

23. A 24 years old man suffered an injury to his upper limb. On examination, his ring and little
fingers are partially flexed with intact sensation over the dorsal aspect of these fingers. What is
the most accepted lesion?
A. Ulnar nerve at the wrist
B. Ulnar nerve at the elbow
C. Ulnar nerve in the forearm
D. Median nerve
E. Radial nerve

24. A 20 years old man with history of a pinned midtarsal fracture 7 years ago is now presenting
with tarsal pain at the site of fracture. Xray would likely show:
A. Osteoarthritis
B. Rheumatoid arthritis
C. Malunion
D. Nonunion
E. Avascular necrosis

25. A patient has tibial shaft fracture, which was managed conservatively. Now he shows signs of
compartment syndrome. The Least reliable sign of compartment syndrome:
A. Loss of sensation
B. Absent distal pulse.
C. Pain on passive movement.
D. Tense swollen leg
E. None of the above

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26. What is the dermatomal supply to the elbow, lateral forearm and thumb?
A. C6
B. C8
C. T2
D. T1
E. C5

27. During Posterior approach to the distal femur. Which nerve is at risk?
A. Common peroneal nerve
B. Sciatic nerve
C. Tibial nerve
D. Femoral nerve
E. None of the above

28. A 23 years old patient was admitted after falling on his outstretched hand. His examination
revealed that he has lost sensation over the index and middle finger. What is the most accepted
cause of this injury?
A. Hook of hamate fracture
B. Distal radial fracture
C. lunate dislocation.
D. Scaphoid fracture
E. Montagea fracture

29. Treatment of 1cm ureteric stone with no hydronephrosis:

A. ESWL
B. PCN
C. Percutaneous nephrolithotomy
D. Medical treatment
E. Ureteroscopy

30. A 26 years old man presents to the ED with extensive bleeding from his arm after sustaining a
glass injury. On examination there’s a 7 cm transverse laceration across the anterior aspect of his
elbow. On exploring the cubital fossa, you expect the brachial artery to be:
A. Anterior to the median nerve.
B. Lateral to the biceps tendon
C. Lateral to the median nerve.
D. Medial to the median nerve.
E. Superficial to the bicipital aponeurosis.

31. What is the normal epithelial lining of the urinary bladder?

A. Stratified Squamous epithelium non keratinized
B. Columnar epithelium with goblet cell
C. Columnar epithelium without goblet cell
D. Transitional epithelium
E. Stratified Squamous epithelium keratinized

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32. A 38 years old man sustained a tibial fracture for which he undergone closed reduction and
casting. Several hours later, he developed severe pain and numbness in his leg. What is the most
appropriate management?
A. Analgesia and follow up
B. Assess pulsation
C. Compartmental pressure management
D. 4 compartment decompression
E. None of the above

33. A surgeon made an incision from below the clavicle to the deltopectoral groove. Which of the
following structures will not be encountered?
A. Medial cord of brachial plexus
B. Axillary vein
C. Thoracoacromial artery
D. Pectoralis minor insertion
E. Pectoralis major

34. A surgeon noticed an artery branching at the superior aspect of pyriformis. What is that artery?
A. Pudendal artery
B. Superior gluteal artery
C. Inferior
D. Superficial epigastric artery
E. None of the above

35. A 54 years old man undergone hip replacement for fractured neck femur. During follow up, the
man walks with the Trendelenburg gait. what is the most likely cause?
A. Sciatic nerve injury
B. femoral nerve injury
C. Superior gluteal nerve injury
D. Gluteus maximus muscle paralysis
E. Inferior gluteal nerve injury

36. A 49-year-old Egyptian man on holiday in the United Kingdom presents with haematuria. He
gives a history of bladder irritative symptoms for seven months. He has lived in a rural
community for his whole life. What is the causative organism?
A. Fasciola
B. Schistosoma mansoni
C. Schistosoma hematobium
D. Ascaris
E. Hepatitis A

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37. A 23 years old athlete sustained multiple twisting knee injuries during a game. 24 hours later,
his knee is swollen and painful with restricted movements of the joint. MRI would show:
A. Meniscal tear
B. Medial collateral ligament injury
C. Lateral collateral ligament injury
D. Anterior cruciate ligament injury
E. Posterior cruciate ligament injury

38. A 23 years old Patient underwent ORIF for a bimalleolar fracture. Below knee cast was applied.
The patient then developed inability to dorsiflex his ankle and paranesthesia along the dorsum of
the foot. Which nerve injury would be the cause of this case?
A. Common peroneal nerve injury
B. Sural nerve injury
C. Superficial peroneal n injury
D. Deep peroneal nerve injury
E. Tibial nerve injury

39. A child has Pruritis ani, stool analysis showed ova and cysts in stool. What is the most
appropriate treatment option?
A. Metronidazole
B. Mebendazole
C. Estradiol
D. Tinidazole
E. None of the above

40. A female patient presented with sharp pain over the dorsum of the foot radiating to the toes.
On examination, there is tender swelling in the cleft between 3rd and 4th metatarsal bones.
What is the most likely cause?
A. March fracture
B. Freiburg disease
C. Morton’s neuroma
D. Osteoarthritis
E. None of the above

41. A 25-year-old female with a displaced fracture to her tibia and fibula about 2 c.m from the
ankle joint, what is the best management to be done?
A. External fixation
B. Cast from groin to foot
C. Intramedullary nailing
D. Fixation with plates
E. None of the above

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42. A 56-year-old man with chronic emphysema is on the high dependency unit (HDU), ten days
after anterior resection. He has developed acute shortness of breath' and hypotension): Which of
the following landmarks would be the most appropriate to use to obtain a femoral arterial blood
gas sample?
A. A point midway between the anterior superior iliac spine and the pubic tubercle
B. A point midway between the anterior superior iliac spine and the pubic symphysis
C. A point midway between the greater trochanter and the pubic symphysis
D. A point 1 cm inferior and 4 cm lateral to the pubic tubercle
E. A point 2 cm lateral to the midway point between the anterior superior iliac spine and
pubic symphysis

43. A 28 years old man developed loss of sensation below the knee after a posterior hip dislocation.
This is associated with weak movements of the leg. What is the most likely cause?
A. Tourniquet palsy.
B. Sciatic nerve injury.
C. Compartment syndrome.
D. Femoral nerve injury.
E. None of the above

44. A 70-year-old man presents to his General Practitioner with back pain that has been worsening
over the last six weeks. He also complains of slow urinary flow. Digital rectal examination reveals
an irregular hard prostate. Prostate specific antigen is 300 ng/ml (normal <4). What should the
first line of treatment be:
A. Bladder neck incision
B. Hormonal manipulation
C. Radical prostatectomy
D. Transurethral resection of prostate
E. Watchful waiting

45. A patient developed sensory deficit over the anterior thigh with inability to extend the knee
after surgical hernia repair. What is the nerve injured?
A. Obturator nerve
B. Lateral cutaneous nerve of the thigh
C. Femoral nerve
D. Femoral branch of genitofemoral nerve
E. Sciatic nerve

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46. A man developed acute scrotum after trauma with edematous tender left hemiscrotum. On
examination there’s a tender testis which is higher than the other one. The most likely underlying
cause is:
A. Testicular torsion
B. Testicular hematocele
C. Hydrocele
D. Teratoma
E. Spermatocele

47. A 50-year-old woman sustains a displaced distal radial fracture. This is manipulated under
anaesthetic and treated in a cast for six weeks. After three months she returns to the fracture
clinic with painful and limited pronation and supination. which of the following is the most
diagnoses?
A. Complex regional pain syndrome Type 1 (reflex sympathetic dystrophy)
B. Malunion
C. Non-union
D. Posterior interosseous nerve palsy
E. Radial nerve compression

48. A 62 years old man developed hematuria and weight loss over the last 2 months. Abdominal
U/S showed a 10 cm mass in the right kidney. What is the most appropriate investigation?
A. MRI
B. Biopsy
C. CT scan
D. Ascending urethrogram
E. None of the above

49. A 35 years old man noticed a painful swelling above the testis after vasectomy. What is the
most likely underlying diagnosis?
A. Teratoma
B. Hematoma
C. Hydrocele
D. Spermatocele
E. Sperm granuloma

50. Which of the following infections is associated with staghorn stones?

A. Pseudomonas
B. [Link]
C. Acinitobacter
D. Staphylococcus aureus
E. Proteus

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51. Most common organism for osteomyelitis is:

A. Streptococcus pneumonia
B. Staphylococcus aureus
C. Pseudomonas
D. Salmonella
E. H. influenza

52. A 36-year-old butcher injures his left index finger with a knife, suffering a deep laceration on
the palmar aspect of the middle phalanx. On examination he’s unable to flex DIP, which tendon is
likely to have been injured?
A. Flexor carpi facialis
B. Flexor carpi radialis
C. Flexor digitorum profundus
D. Flexor digitorum superficialis
E. Flexor indicis

53. A 52 years old man suffered an open fracture of tibia. What is the best management?
A. External fixation
B. Cast from groin to foot
C. Intramedullary nailing
D. Fixation with plates
E. None of the above

54. A 53 years old female presented with pain after completing her hand work as a typist. She
reported dropping of objects from her hand. What is the most appropriate treatment?
A. Steroids
B. Physiotherapy
C. Carpal tunnel release
D. Analgesia
E. None of the above

55. A 35-year-old man falls and sustains a fracture to the middle third of his clavicle. Which vessel is
at greatest risk of injury?
A. Subclavian vein
B. Subclavian artery
C. External carotid artery
D. Internal carotid artery
E. Vertebral artery

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56. A 63 years old diabetic patient presented with late onset painless urine retention following a
total hip replacement surgery. What is the most likely cause of this condition?
A. Underactive bladder
B. Stone
C. Urethral stenosis
D. Bladder neck inactivity
E. None of the above

57. A 50 years old male with dysuria and tender swollen testicle. He is feverish with rising TLC.
What is the diagnosis?
A. Testicular torsion
B. Testicular hematocele
C. Epididymitis
D. Teratoma
E. Spermatocele

58. A woman suffered an arm injury. On examination, she is unable to catch the knife as her hand
flexes. There is loss of sensation over the badge area. What is the likely cause?
A. Radial nerve
B. Axillary nerve
C. Posterior cord injury
D. Medial cord injury
E. None of the above

59. What is the best investigation for supracondylar fracture?

A. CT
B. MRI
C. X ray
D. Bone scan
E. None of the above

60. Nerve supply of dorsal interosseous muscles is:

A. Ulnar nerve
B. Radial nerve
C. Median nerve
D. Anterior interosseus nerve
E. None of the above

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61. Young patient with breast lump in lateral upper quadrant, mammogram found a
microcalcifications. What is the most possible diagnosis?
A. Duct ectasia
B. Duct papilloma
C. Fibrocystic disease
D. Duct carcinoma insitu
E. None of the above

62. A 62-year-old woman presents to her General Practitioner with a two-week history of backpain.
She has lost 8 cm in height over the last five years Investigations reveal Findings Normal Adjusted
(corrected) Calcium 2.78 mmol/L (2.15-2.55) mmol/L Phosphate 0.84 mmol/L( 0.8-1.4 )Estimated
GFR 0.96ml/minute(normal) More than 90 PTH 8.9 pmol/L 0.95-5.7 Which of the following is the
most likely cause?
A. Hypoparathyroidism
B. Primary hyperparathyroidism
C. Pseudo hypoparathyroidism
D. Secondary hyperparathyroidism
E. Tertiary hyperparathyroidism

63. 9-year-old female presented with smooth fluctuant mass showing halo sign in mammography
aspiration was done there is no blood, no fluid refilling what is your management?
A. discharge no follow-up required
B. surgical excision
C. true cut biopsy
D. FANC
E. None of the above

64. A 55-year-old Male Patient presented with general fatigue and weight loss. With positive Benz
jones protein in urine and passing and lytic bone lesion in Xray what is your diagnosis?
A. Amyloidosis
B. Multiple myeloma
C. Lymphoma
D. Ostomalecia
E. None of the above

65. What is the Reason to give steroid to brain tumor before surgery?

A. Decrease peri tumor edema

B. Decrease tumor vascularity
C. Decrease tumor size
D. Treatment of papilledema
E. Noe of the above

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66. A 60-year-old lady presented with creamy nipple discharge. What is your possible diagnosis?
A. Duct ectasia
B. Breast cancer
C. Ductal papilloma
D. Fibroadenoma
E. None of the above

67. What is the Type of amyloid in Renal failure?

A. AL
B. AA
C. β-amyloid
D. Transthyretin
E. Globulin

68. A 5-year-old boy presents with recurrent episodes of sinusitis. The casualty staff are surprised
to find his liver lying in the left upper quadrant of the abdomen. What is the underlying
diagnosis?
A. Von Recklinghausen's disease
B. Li Fraumeni syndrome
C. Pierre Robin syndrome
D. Kartagener's syndrome
E. MEN I

69. 52 years old fell from stairs, his wife believes he lost consciousness for 15 seconds only, he feels
totally recovered now, what to do?
A. Admit and observe
B. Immediate CT
C. CT after 1 Hour
D. CT after 2 hours
E. Discharge and advise on warning sings

70. Multiple myeloma can cause which type of amyloidosis?

A. AL
B. AA
C. β-amyloid
D. Transthyretin
E. Globulin

71. Which virus is associated with Kaposi's sarcoma?

A. Human herpes virus 8
B. Human papillomavirus 16
C. Human T-lymphotropic virus 1
D. Epstein-Barr virus
E. Human papillomavirus 18

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72. Man presenting with head injury showing deterioration in GCS which becomes 3 with unilateral
unreactive pupil?
A. tentorial Herniating
B. hydrocephalus
C. papilledema
D. Subarachnoid hemorrhage
E. None of the above

73. 60-year-old man brought to E/R complaining of trouble with speech and inability to form long
sentences what is the artery responsible for this condition?
A. ACA
B. MCA
C. PICA
D. PCA
E. NONE of the above

74. A 79-year-old woman with hypochromic microcytic anemia and axillary and inguinal
lymphadenopathy what is your diagnosis?
A. Bronchial cancer
B. Non-Hodgkin lymphoma
C. Hodgkin lymphoma
D. Gastric cancer
E. None of the above

75. A 50 year old Patient came to ER assessment of consciousness level was done according to GCS
patient can localizes pain, open eye to pain and sounds what the GCS?
A. 9
B. 7
C. 12
D. 11
E. None of the above

76. A 35-yr-old lady presented with bloody nipple discharge. What is your possible diagnosis?
A. Duct ectasia
B. Breast cancer
C. Ductal papilloma
D. Fibroadenoma
E. None of the above

77. Pt. had experience of abdominal pain and diarrhea and vomiting his investigations revealed
hyperparathyroidism what is the next investigation should be done
A. Thyroid
B. Pituitary To investigate MEN1
C. Adrenals
D. Kidney
E. None of the above

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78. A 21-year-oid man has been hit by a cricket ball on the side of the head. Initially he has a
Glasgow coma score (GCS) of 1EJE4, V5, M6). Four hours after arrival in hospital, while on the
observation ward, his GCS drops to 7(E1, V2, M4). His left pupil dilates, and he begins to
demonstrate extensor posturing of the limbs. What are the most likely changes to his vital signs
since injury? Dx: Cushing
Blood pressure Heart rate

A Decreased Decreased

B Decreased Increased

C Decreased Normal

D Increased Decreased

E Increased Increased

79. A 66-year-old female presented with Thyroid mass Rapidly growing and has stridor with change
in her voice what is your possible diagnosis?
A. follicular Carcinoma
B. Papillary carcinoma
C. Anaplastic carcinoma
D. Medullary carcinoma
E. None of the above

80. A 55 year old female presented with Thyroid mass and she also complaining from pulsating
mass in her forehead what is your possible diagnosis ?
A. follicular Carcinoma
B. Papillary carcinoma
C. Anaplastic carcinoma
D. Medullary carcinoma
E. None of the above

81. A 24-year-old woman presents with a swelling in the thyroid gland. She also has enlarged lymph
nodes in the left anterior triangle of the neck. Which of the following is the most likely diagnosis?
A. Anaplastic carcinoma
B. Follicular adenoma
C. Follicular carcinoma
D. Medullary carcinoma
E. Papillary carcinoma

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82. An 8-year-old boy presents with a lump in his neck. On examination, he is found to have a lump
in the midline of the neck immediately below the hyoid which moves on tongue protrusion.
What is the most likely diagnosis?
A. Benign lymphadenopathy
B. Malignant lymphadenopathy
C. Thyroglossal cyst
D. Branchial cyst
E. Dermoid cyst

83. A 19- year-old man fell down a flight of stairs. On presentation to the Emergency Department
his Glasgow Coma Score (GCS) was 14/15 with no local neurological signs. An hour later he
Vomited, and his GCS deteriorated to 10. He developed a fixed and dilated left pupil. Which of
the following is likely to seen on the scan?
A. Left-sided acute subdural hematoma
B. Left-sided extradural hematoma
C. Left-sided midbrain hematoma
D. Right-sided acute subdural hematoma
E. Right-sided extradural hematoma

84. A 25-year-old lady presents with a swelling located at the anterior border of the
sternocleidomastoid muscle. The swelling is intermittent and on examination it is soft and
fluctuant. What is the most likely diagnosis?
A. Thyroglossal cyst
B. Branchial cyst
C. Carotid body tumor
D. Infection with Bartonella
E. Dental abscess

85. Esophageal biopsy shows the columnar epithelium containing goblet cells what is the type of
changes occur in cell?
A. aplasia
B. atrophy
C. hyperplasia
D. hypertrophy
E. metaplasia

86. A 20-year-old lady presents with a lump in the upper outer aspect of her right breast. On
examination, she has a firm mobile mass in the upper outer quadrant of her right breast. What is
the most likely underlying disease process?
A. Atypical ductal hyperplasia
B. Breast cyst
C. Duct ectasia
D. Fibroadenoma
E. Fat necrosis

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87. Pt with cervical lymphadenopathy underwent excisional biopsy showed non necrotizing
granuloma with giant cell and fibrosis what is your possible diagnosis?
A. Sarcoidosis
B. TB
C. Lymphoma
D. Leprosy
E. Fungal infection

88. A 49-year-old female is due to undergo a renal transplant. Apart from ABO compatibility which
of the following is most important in matching donor and recipient organs?
A. HLA-DR
B. Rhesus
C. HLA- A
D. HLA-B
E. HLA-C

89. 60-year-old man presents with a short history of pain in the right cheek and right upper teeth
Maxillary sinus infection is diagnosed. This sinus is particularly prone to infection because of?
A. absence of Celia on the epithelium lining the sinus
B. closeness of the sinus to the nasal cavity
C. poor blood supply
D. Position of the sinus ostium high on the medial wall
E. relationship of the front teeth to the floor of the sinus

90. A 33-year-old female presented with depression and her investigations reveled, low TSH and
increased Ca and she was on antacid what is your possible diagnosis of this condition?
A. milk alkali syndrome
B. vit d toxicity
C. hyperthyroidism
D. Hyperparathyroidism
E. Sarcoidosis

91. Pt with liver biopsy, showing birefringence apple green with Congo red stain, what is your
diagnosis of this condition?
A. Abnormal deposition of copper
B. Amyloidosis
C. Hemochromatosis
D. Hemosiderin deposition
E. None of the above

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92. What is the defective gene in a patient with breast cancer ?

A. P53
B. BRCA I
C. APC
D. SIS
E. None one the above

93. discomfort. He has never attended the hospital previously and is usually well. He has just
retired from full time employment as a machinist in a PVC factory. CT scanning shows a large
irregular tumor in the right lobe of his liver. Which of the following lesions is the most likely?
A. Liposarcoma
B. Angiosarcoma
C. Hamartoma
D. Hydatid liver disease
E. Benign angioma

94. A 4-year-old is brought to the general practitioner by her mother. She has been distressed with
ear pain for the past 14 hours. She is constantly touching and pulling at her ear. Whilst she is sat
in the waiting room her mother notices a discharge of foul-smelling fluid from the ear, following
which the pain resolves
A. Acoustic neuroma
B. Preauricular sinus
C. Acute suppurative otitis media
D. Cholesteatoma
E. Otitis externa

95. A previously fit young man is admitted after a road traffic accident. He is satisfactorily
intubated because of a head injury. He has a Glasgow coma score of 8 (E2, V4, M4) There are no
other external injuries and initial cardiorespiratory stability is achieved during the primary
survey. He suddenly becomes hypoxic after log- rolling to examine the back. What is the most
likely cause of his deterioration?
A. Cardiac tamponade
B. Ongoing major hemorrhage
C. Spinal injury
D. Tension pneumothorax
E. Tracheal tube displacement

96. 32 years old female presented with thyroid nodule and hyperthyroidism followed by
hypothyroidism in her thyroid function what is the most distinctive investigation to reach
diagnosis?
A. FNAC
B. Antibodies
C. MRI
D. Repeat thyroid function
E. None of the above

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97. A 35-year-old women complained from sustained tibial fracture, her underwent IMN, few hours
later he started to have calf pain, you suspected the patient might be having compartment
syndrome, which of the following is the first management?
A. Analgesia with morphine
B. Four compartment decompression
C. Serial examination and follow up
D. Intercompartmental pressure measurement
E. 5-Nerve block

98. A 35-year-old male presented with severe chest pain, he is tall and slim with history of inguinal
hernia repair when he was 2 years old. His father died sudden at age of 47 years old with sudden
chest pain. What is the most accepted diagnosis?
A. Anginal pain
B. Pleural effusion
C. Aortic dissection
D. Lung abscess
E. Esophageal rupture

99. You have collected a data of 87 child’s urea and create levels before anesthesia to study the
effect of anesthesia on dehydration. You matched them with the normal levels. What is the
statistical test to use?
A. Paired T test
B. Un paired T test
C. Mann Whitney
D. Chi-square

100.A 25-year-old female patient presented to the ER with sudden onset Abdominal and Bp 90-60
with 110 pulse rates. By examination she has tenderness all over the abdomen especially right
iliac fossa. She confirms that she has no history of abdominal pain or similar condition. what is
the most accepted diagnosis?
A. Acute appendicitis
B. Rupture ectopic pregnancy Haemorrhagic shock from ruptured ectopic
C. Salpingitis
D. Perforated duodenal ulcer.
E. PID

101.A 37-Female presented with ulcer on the medial malleolus with painless skin changes around
ankle. With a history of varicose vein repair. Her ABI is normal. What is the most accepted cause
of this ulcer?
A. Infected eczema
B. Venous ulcer
C. Ischemic ulcer
D. Malignant ulcer
E. Neuropathic ulcer

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[Link] is the scientific bases of application of tourniquet that used in operations to control blood
loss and give bloodless field?
A. after exsanguination Inflation of cuff above diastolic
B. Inflation of cuff above mean before exsanguination.
C. Inflation of cuff above mean before exsanguination.
D. Inflation of cuff above systolic before exsanguination
E. Inflation of cuff above systolic after exsanguination

103.A 20-year-old man presents with a 24-hour history of sever anal pain and fever, with a history
of one month of perianal discharge and diagnosed a perianal fistula. On examination he has a
peri anal abscess. What is the best treatment?
A. Fistulotomy
B. Incision and drainage of the abscess
C. Seton wire application
D. Multistage fistula repair
E. Lateral sphincterotomy

[Link] notice a nurse was practicing a minor procedure in the ward which lacks evidence or any
reference what will you do?
A. Risk assessment
B. Medical Audit
C. Report to GMC
D. Health and safety
E. Incident report

105.A 26-week gestation suspected to have a perforated viscus what is the most accurate
investigation to diagnose the case?
A. Chest x-rays erect.
B. Abdominal US
C. CT abdomen
D. MRI abdomen
E. Cross table lateral Abdominal X-ray

[Link] ‘s the best long-term management for post-phlebitis syndrome?

A. Heparin
B. Long life warfarin
C. Lower limb stocking bandage
F. Vitamin C
D. Antibiotics
[Link] are conducting a cross sectional study measuring BP in certain population, what is the type
of the data that you will obtain?
A. Ordinal
B. Nominal
C. Continuous
D. Discrete
E. E. None of the above

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108.A 35 female patient underwent lap cholecystectomy and discharged to home in a good general
condition, one month later she return unremitting jaundice, pale stool and dark urine. What is
the most accepted diagnosis?
A. Cystic duct leak
B. CBD injury
C. Missed CBD stone
D. Cancer pancreas
E. HCC

109.A 43-year-old lady underwent lap cholecystectomy, and presented post-operative with colicky
abdominal pain and jaundice so she procced for ERCP after this maneuver she is feverish and
jaundice with severe abdominal pain in the right upper quadrant, what is the most likely
diagnosis?
A. Pancreatitis
B. Cholangitis charcot triad: Fever pain jaundice
C. Missed stone.
D. Perforated Duodenal ulcer
E. Liver abscess

110.A 50-year-old male presented with a dry gangrene of fifth toe, investigation done and revealed
a long segment occlusion in the superficial femoral artery with only one patent runoff in the
posterior tibial artery. What is the most appropriate management for this situation?
A. Amputation of 5th toe
B. Below knee amputation
C. Midfoot amputation
D. Femoro-distal bypass
E. Angiography with insertion of stent

111.A 55-year-old man presents with a history of progressive dysphagia over the past 4 weeks. For
the past 5 years he had regularly attended his general practitioner with symptoms of dyspepsia
and reflux. What is the most accepted cause for dysphagia?
A. Benign esophageal stricture
B. Carcinoma of the esophagus
C. Achalasia
D. Hiatus hernia
E. Esophageal reflux

112.A known case of Ca Head of pancreases presented by jaundice painless unremitting jaundice,
PET scan of the body showed a liver Mets. what is the best intervention?
A. Cholecystectomy
B. ERCP and Stent Palliative care for stage 4
C. Hepaticojejunostomy
D. Whipple’s operation
E. Gastrojejunostomy

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113.A case of intermittent claudication in the calf muscles with loss of pulse below knee only, where
is the most probable site of the arterial lesion?
A. SFA occlusion at the adductor canal
B. CFA before origin of profunda artery
C. External iliac artery
D. Anterior tibial artery
E. Internal iliac artery

[Link] 8 months screaming child was brought by his mother who described that he passed a red
jelly stool this morning. What is the most likely underlying diagnosis?
A. Intussusception
B. Meckel diverticulum
C. Necrotizing enterocolitis
D. Juvenile polyp
E. anal fissure
115.A man done hyperhidrosis operation. On examination, he has a ptosis and miosis. Which nerve
roots you suggest involvement of?
A. C2 & C3 roots
B. C4 & C5 roots
C. C6 & C7 roots
D. C8 & T1 roots
E. T2 & T3 roots
[Link] acts on which one of the following
A. angiotensin 1
B. angiotensin 2
C. Angiotensinogen
D. ADH
E. Aldosterone
117.A 65 year old man is admitted with a two week history of vomiting investigations confirm a
benign pyloric stenosis. What of this finding match with this patient?
K+ Na+ PH

A 2.6 mmol/L 148 mmol/L 7.1

B 3.4 mmol/L 156 mmol/L 7.48

C 3.2 mmol/L 118 mmol/L 7.47

D 6.0 mmol/L 120 mmol/L 7.1

E 2.8 mmol/L 128 mmol/L 7.2

Normal 3.5-4.9 137-144 7.3 : 7.4

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118.45 years old patient with severe head injury 14 days ago. He is now has slow recovery, what
type of feeding this patient will you need?
A. TPN
B. Nasogastric tube
C. Feeding jejunostomy
D. Enteral with special formula
E. Oral intake

[Link] of the following serves as the axis of gut rotation during development?
A. aorta
B. Superior mesenteric artery
C. Inferior mesenteric artery
D. Umbilical vessels
E. Vitelline artery

[Link] epigastric vein drains in?

A. Internal iliac vein
B. External iliac vein
C. Superior mesenteric vein
D. Inferior mesenteric vein
E. Femoral vein

121.A patient will do hernial repair and his Hemoglobin is 9 he put in a list after 6 weeks how would
you give him supplement
A. blood transfusion
B. plasma transfusion
C. IV iron
D. oral iron
E. folic acid

122.50-year-old patient for elective hernia repair as the day case, he is diabetic type 1 and has
autonomic neuropathy, what is the main problem as a day case in this patient?
A. Reduced pulse rate variability
B. Increase urine output
C. Bleeding
D. Ischemia of the heart
E. None of the above

[Link] free fluid will collect in the lowest part of the peritoneal cavity. At operation with
the patient supine, in which of the following will the fluid collect first?
A. Hepatorenal pouch
B. Left anterior subphrenic space
C. Lesser sac
D. Right paracolic gutter
E. Right anterior subphrenic space

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[Link] of following investigations is most accurate for measuring the renal plasma flow?
A. Creatinine clearance
B. Glucose Clarence
C. Inulin Clarence
D. Para-amino-hippuric acid
E. Urea clearance

125.A 12-year-old child was admitted to the Emergency Department having inhaled a peanut.
Where will the peanut most likely to have lodged?
A. Left lower lobe bronchus
B. left upper lobe bronchus
C. Right lower lobe bronchus
D. Right middle lobe bronchus
E. Right upper lobe bronchus

[Link] presented by tachycardia and hypertension which of the following hormone decrease
with warming
A. TSH
B. ACTH
C. ADH
D. Cortisol
E. Catecholamine

[Link] scenario about tooth extraction and the patient develop lower lip numbness, what the
nerve affected?
A. Lingual nerve
B. Inferior alveolar
C. Marginal mandibular branch of facial nerve
D. Facial nerve
E. Hypoglossal nerve

128.A 32-years old man presents with a painful torticollis there is no past medical history and his
only complaint is that he has been feeling rather tired over the last 4 nights. On examination, he
has large rubbery mass in the lateral aspect of his neck as well as a few smaller masses along his
internal jugular vein. You correctly assume that the muscular neck spasm and the large mass are
connected. The most likely cause of his torticollis is due to pressure on?
A. Ansa cervicalis
B. Cervical plexus branch
C. Cranial accessory nerve
D. Spinal accessory nerve
E. Vagus nerve

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[Link] with serum potassium 6.5. What should be immediate step?

A. I.V. fluid
B. Insulin and glucose infusion
C. B agonist
D. Pamidronate
E. i.v. ca gluconate

130.A female presented by 20% burn over her chest, for which she underwent graft treatment, 10
days later she came with sweeping discharge from the graft edges, fever and chest pain, what
medication you will give?
A. Flucloxacillin
B. Cephalosporin
C. Cephalosporin and Metronidazole
D. Ampicillin
E. None of the above

[Link] injured his tip of index finger, what is the best type of anesthesia to be used in ring
block?
A. Lidocaine
B. Lidocaine with adrenaline
C. Bupivacaine
D. Bupivacaine with adrenaline
E. Prilocaine

[Link] cell is dependent on Cori cycle for energy:

A. RBC
B. Muscle cell
C. Hepatocyte
D. Fat cells
E. Nerve cells

[Link] is firstly treated by

A. Iv saline chloride .9%
B. IV ca chelating
C. K supplementation
D. Pamidronate
E. Zoledronate

[Link] of these I.V fluid have the highest sodium content

A. Saline glucose fluid
B. Normal saline
C. Hartman solution
D. Glucose 5%
E. None of the above

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[Link] Cerebral perfusion pressure if Blood pressure =110/80 and ICP =18.
A. 72
B. 82
C. 90
D. 102
E. 115

[Link] 82-year-old man has complete occlusion of his inferior mesenteric artery on angiography
but no symptoms or signs of colonic ischemia. Which of the following arteries is the most likely
additional source of blood supply to the territory of the inferior mesenteric artery?
A. Left colic
B. Left gastroepiploic
C. Middle colic
D. Splenic
E. Superior rectal

[Link] are content of the posterior mediastinum except:

A. Descending aorta
B. Vagus nerve
C. Thoracic duct
D. Azygous vein
E. Vertebral body

[Link] fetal circulation, how will the blood passes from rt atrium to left atrium?
A. Through ductus venosus
B. Through ductus arteriosus
C. Through foramen ovale
D. Through pulmonary VSD
E. None of the above

139.A Child with kwashiorkor developed hepatomegaly. What is the deposit in liver?
A. Sarcoid
B. Melanin
C. Lipofuscin
D. Amyloid
E. fat

140.A child with patent ductus arteriosus and left sternum murmur heard on his chest, what about
this anomaly?
A. Shunt from right atrium
B. Shunt to pulmonary artery
C. Shunt to aorta
D. Shunt to left atrium
E. None of the above

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[Link] clamping the umbilical cord what will not give oxygenated blood to the embryo any more
A. Ductus venosus
B. Umbilical artery
C. Ductus arteriosus
D. Pulmonary artery
E. Pulmonary vein

[Link] elderly patient with an Ulcer painless on his face and his biopsy show flat cells with keratin ,
what is your diagnosis?
A. SCC
B. Keratoacanthoma
C. Herpes labialis
D. BCC
E. Metastatic

143.4 Month child with failure to thrive with recurrent chest infection and dyspnea increase with
lying flat in the night and awake him from sleep
A. TOF
B. Congenital diaphragmatic hernia
C. Asthma
D. GERD
E. Intestinal atresia

[Link] is the major duodenal papillae open?

A. In the anteromedial part of Third part of duodenum
B. In the posteromedial part of Third part of duodenum
C. In the posteromedial part of 2nd part of duodenum
D. In the anteromedial part of 2nd part of duodenum
E. In the posteromedial part of First part of duodenum

[Link] vitamin supports collagen or important in wound healing?

A. vitamin A
B. vitamin E
C. vitamin B6
D. vitamin C
E. vitamin K

[Link] neuropathy in alcoholic patient is due to deficiency of which vitamin

A. Thiamine
B. Pellagra
C. folic acid
D. iron
E. vitamin B12

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[Link] K is required for normal blood clotting. Which one of the following statements is
true about the effects and availability of vitamin K?
A. Affects platelet function
B. Cause bleeding if taken in excess
C. Is provided only by fresh food
D. Is depleted by oral broad-spectrum antibiotics
E. Vitamin K absorption is affected by gastric resection

148.A 34 years old patient was in operation with tourniquet. after release of tourniquet, what is
the substance released causing VD?
A. Noradrenaline
B. Vasopressin
C. Histamine
D. Serotonin
E. Adrenaline

149.A 7 years old boy presents with abdominal pain with attack of bloody stool and diagnosed as
Meckel diverticulum, which of the following ectopic mucosa mostly found in Meckel
A. pancreatic
B. ileal
C. gastric
D. duodenal
E. none of the above

[Link] female pelvis is characterized by which of the following:

A. the female pelvis is deeper and narrow
B. the female inlet is apple in shape
C. pubic arch is wide
D. the bone is heavy
E. coccyx is pointed inward

[Link] patient has microcytic hypochromic anemia due to iron deficiency and taken for
endoscopy, what is the site of biopsy will you take?
A. Esophagus
B. Gastric
C. Duodenum
D. Jejunum
E. Colon

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152.1-day neonate with history of polyhydramnios intrauterine and after birth, fluid coming from
mouth with dyspnea and cyanosis
A. congenital esophageal atresia with tracheoesophageal fistula.
B. congenital diaphragmatic hernia
C. duodenal atresia
D. Hirschsprung
E. None of the above

153.A 28-year-old man presents with an ischiorectal abscess. Where is this abscess cavity likely to
be sited?
A. Above the levator ani
B. Between external and internal anal sphincter
C. Lateral to the obturator internus
D. Medial to the internal anal sphincter
E. Medial to the pudendal canal

[Link] colectomy heel pressure sore with skin necrosis, what is management?
A. debridement and delayed primary closure
B. compression
C. Elevation
D. STSG
E. Conservative dressing

[Link] is true about SA node anatomy and physiology

A. Main conducting system of the heart
B. present in the wall of left atrium
C. has somatic nerve supply
D. has vagal nerve supply
E. none of the above

[Link] with TIA, he underwent left carotid endarterectomy and immediately post procedure he
developed dysarthria and tongue deviation to the left.
What is the most likely diagnosis?

A. Another TIA
B. Hypoglossal nerve neuropraxia
C. Middle cerebral artery occlusion
D. Anterior cerebral artery occlusion
E. None of the above

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[Link] of skull in which glossopharyngeal nerve pass

A. Foramen ovale
B. Foramen rotundum
C. Jugular foramen
D. Foramen lacerum
E. Hypoglossal canal

[Link] had a brain tumor, supplied by a very large middle meningeal artery, which foramen was
enlarged or dilated?
A. Foramen of ovale
B. Foramen rotundum
C. Foramen spinosum
D. Foramen lacerum
E. Jugular foramen

159.2 years old girl with burn over whole dorsum of forearm with blister and erythema, what is the
appropriate management?
A. Occlusive dressing
B. Split thickness graft
C. escharotomy
D. Leave uncovered
E. fasciotomy

160.18 years girl with cystic swelling fluctuating at anterior border of sternomastoid border
A. Thyroglossal cyst
B. cystic hygroma
C. Branchial cyst
D. congenital epidermoid
E. acquired epidermoid

[Link] cases of Unilateral cleft lip there is failure of fusion of?

A. Maxillary process and medial nasal process
B. Maxillary process and lateral nasal process
C. Palatine processes
D. Maxillary processes
E. None of the above

162.A 18 years old man after he ate canned food, he feels flaccid paralysis and diagnosed as
botulinum toxin , in which does this toxin act on?
A. Acetylcholine
B. Adrenaline
C. GABA
D. Glutamate
E. Serotonin

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163.A surgeon is carrying out an elective splenectomy for congenital spherocytosis. Which structure
will be divided in order to mobilize the spleen from the posterior abdominal wall?
A. Gastrosplenic ligament
B. Lesser omentum
C. Lienorenal ligament
D. Phrenicocolic ligament
E. Short gastric vessels

164.a patent came with keloid scar after old trauma, what is Keloid scar best management
A. intralesional steroids
B. re-excision
C. laser therapy
D. oral corticosteroids
E. none of the above

165.A woman with increased TSH+ lower limit T4 , what is your diagnosis?
A. primary hypothyroidism
B. primary hyperthyroidism
C. Secondary hyperthyroidism
D. Secondary hypothyroidism
E. sick euthyroid

[Link] person and doing hip surgery . Which of the following is not considered a measure
to enhance rapid recovery ?
A. oral carbohydrate 2 hours preoperatively
B. weight reduction before surgery
C. anti-emetic
D. diazepam
E. Epidural analgesia

[Link] skin graft

A. xenograft
B. Isograft
C. Autograft
D. Allograft
E. None of the above

168.a 28-year-old primigravida presents in the Emergency Department with history of sudden chest
pain Her father died at 42 years of age of a heart attack She is strikingly tall and slim. On
examination there are no abnormal physical signs other than a tachycardia of 90 beats minute in
keeping with her anxiety.
A. Acute massive pulmonary embolism
B. Aortic dissection
C. Myocardial infarction
D. Puerperal sepsis
E. Pulmonary infarction

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[Link] going through junction of linea semilunaris and costal margin on right side, which
structure will be injured?
A. GB
B. Liver
C. Right kidney
D. Cecum
E. Spleen

170.72-year-old man is due to undergo an esophagectomy for malignancy. His BMI is 17.5. What is
the best feeding regime immediately following surgery?
A. Total parenteral nutrition.
B. Feeding jejunostomy.
C. Feeding duodenostomy.
D. Liquid diet orally.
E. Soft solids orally.

[Link] baby girl passed meconium via vagina and after examination show lower vaginal what
is embryological origin?
A. Vittelointestinal tract
B. Urachus
C. Improper division of Cloacal septum
D. Mesonephric duct
E. Metanephric duct

[Link] a patient with Cleft palate, it represents defect in the embryological fusion of what
structures?
A. Frontonasal
B. Maxillary
C. palatal processes
D. lateral nasal
E. medial nasal

173.5o years old woman presented by 3 cm solitary swelling in her right lobe of the thyroid gland
A. Excisional biopsy with 2 mm safety margin
B. Excisional biopsy with 2 cm safety margin
C. Incisional biopsy
D. FNAB
E. True cut biopsy

174.A 68 years old man presented with an inguinal hernia. During repair it was found to be direct
hernia. Which of the following statements is correct regarding direct hernia?
A. inferior epigastric artery forms the lateral border
B. inferior epigastric artery forms the medial border
C. iliac artery forms the lateral border
D. iliac artery forms the medial border
E. none of the above

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[Link] is structure open during herniorrhaphy after skin and fascia

A. external oblique Aponeurosis
B. internal oblique muscle
C. conjoint tendon
D. fascia transversalis
E. peritoneum

176.A surgeon makes a Pfannenstiel incision for access to the pelvic organs. He incises the
abdominal wall down to and through the rectus sheath. He retracts the rectus abdominis
muscles laterally from the midline to expose the:
A. linea alba
B. peritoneum
C. posterior rectus sheath
D. transversalis fascia
E. transversus abdominis muscle

177.65 years old man presented with an inguinoscrotal swelling in the right groin which is non
tender. A cough impulse is elicited, at operation, an indirect inguinal hernia is repaired. The
cremasteric muscle is derived from which of the following
A. External oblique aponeurosis
B. Internal oblique muscle
C. Rectus abdominal muscle
D. Rectus sheath
E. Transversalis fascia

178.A 19-year-old man was assaulted and sustained injuries to the right side of his head. After two
weeks he notices dial his right eye is dry and it could not produce tears. from which ganglion is
post synaptic fibers arise to supply lacrimal gland?
A. Geniculate ganglion
B. Inferior ganglion of the vagus nerve
C. Otic ganglion
D. Pterygopalatine ganglion
E. Superior cervical ganglion

[Link] is the nerve supply for the 2nd brachial arch?

A. Mandibular of trigeminal
B. Facial
C. Glossopharyngeal
D. Superior laryngeal
E. Vagus

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[Link] diverticulum in pharynx occur between?

A. Between sup and middle constrictors
B. Between middle and inf constrictor
C. Between thyropharyngeal and cricopharyngeal muscle
D. Between false and true vocal cords
E. None of the above

[Link] relation of kidney includes which of the following?

A. Adrenal
B. Psoas muscle
C. Liver
D. Hepatic flexure
E. Pylorus

182.1cm BCC on the nose of woman removed up to mucosa level and ala cartilage
A. full thickness graft
B. split thickness graft
C. local flap
D. heal by secondary intention
E. none of the above

[Link] thyroidectomy patient with low voice, what's nerve injury?

A. Superior laryngeal unilateral
B. Recurrent laryngeal unilateral
C. Glossopharyngeal nerve
D. Accessory
E. Phrenic nerve

184.A man with prostatism, On PR, posterolateral ridge on palpation. What structure?
A. Sacrospinous ligament
B. Puborectalis muscle
C. Ischiorectal fossa
D. Obturator internus muscle
E. None of the above

[Link] is the structure that felt in PV examination anteriorly at level of cervix?

A. Dome of bladder
B. base of bladder
C. puborectalis
D. ischiorectal fossa
E. none of the above

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186.A 50-year-old woman presents with a history of fecal incontinence over the past few year She
had a prolonged and difficult first stage of labor 20 years previously. Physical examination reveals
a relatively lax anal sphincter. Which nerve is likely to have been damaged in labor?
A. Autonomic nerves to the rectum
B. Genitofemoral nerve
C. Lumbosacral trunk
D. Obturator nerve
E. Pudendal nerve

187.A 42-year-old multiparous woman is admitted to the Emergency Department due to pelvic
discomfort. The duty gynecologist diagnoses uterine prolapse. Which anatomical structure gives
significant direct support to the uterus?
A. Cervical ligaments
B. broad ligament
C. Round ligaments
D. Transverse perineal Muscles
E. None of the above

[Link] of the tricuspid valve occurs at the onset of which phase of the cardiac cycle?
A. Isovolumic relaxation
B. Rapid filling
C. Reduced filling
D. Rapid and reduced ejection
E. Isovolumic contraction

[Link] of epithelium of the urinary bladder

A. Transitional epithelium
B. Non stratified Squamous epithelium
C. Columnar epithelium
D. Cuboidal epithelium
E. Stratified squamous epithelium

190.31 years old presented by ureteric colic referred to inguinal region. Why this pain referred to
inguinal region according to dermatomal supply?
A. T8 – T 10
B. T10
C. T11 - L1
D. L2 – L 5
E. S2 – S5

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[Link] happen in septic shock

COP SVR HR
High Low High
Low Low Low
Low High Low
Low High High
Normal Normal Normal

192.34 years old pregnant woman develop swollen leg. her mother and her maternal aunt have the
same problem during pregnancies. Which of the following test will be positive in the blood?
A. Antinuclear antibodies
B. Antiphospholipid antibodies
C. Anti-thyroglobulin antibodies
D. Antimitochondrial antibodies
E. None of the above

[Link] Hemophilia, which factor is likely to be affected?

A. V
B. VIII
C. X
D. VII
E. IX

[Link] pleural space is negative with respect to atmospheric pressure, except for which of the
following:
A. During valsalva maneuver
B. During Muller maneuver
C. During expiration
D. During inspiration
E. None of the above

[Link] inguinal hernial repair, we found transverse nerve when we open the external oblique
muscle during repair
A. Genital of Genitofemoral nerve
B. Femoral of genitofemoral nerve
C. Ilioinguinal nerve
D. Femoral nerve
E. Obturator nerve

[Link] is the metabolic effect of insulin?

A. increase glycogen synthesis in muscle
B. increase potassium in blood
C. increase glycolysis in liver
D. increase Na in the blood
E. none of the above

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[Link] of cones medullaris termination in 1 month Child?

A. L1- L2
B. L2-L3
C. L4-L5
D. S1- S2
E. S2 – S3

198.A woman is in the recovery room receives 15L oxygen by mask Blood Gas Shows PH (7.3) , pO2
(11) , pCo2 (7): which receptor is most likely to be stimulated by this blood gas picture
A. Adrenergic receptors
B. Baroreceptors
C. Chemoreceptors
D. J receptors
E. Lung stretch-receptors

[Link] of middle cardiac vein in which site?

A. Anterior interventricular groove
B. Posterior interventricular groove
C. Right atrioventricular groove
D. Left atrioventricular groove
E. At margin of right ventricle

200.A patient undergone splenectomy after trauma. During operation the surgeon was due to ligate
the splenic artery. What is the structure most likely to be injured during this step?
A. Tail of pancreas
B. Fundus of stomach
C. Pancreatic duct
D. Phrenico-colic ligament
E. Small intestine

201.A 72-year-old man has just undergone an emergency repair for a ruptured abdominal aortic
aneurysm. Preoperatively he was taking aspirin, clopidogrel and warfarin. Intra operatively he
received 5000 units of unfractionated heparin prior to application of the aortic cross clamp. His
blood results on admission to the critical care unit are as follows: ull blood count: Hb 8 g/dl,
Platelets 40 * 109/l and WBC 7.1 * 109/l His fibrin degradation products are measured and found
to be markedly elevated. Which of the following accounts for these results?
A. Anastomotic leak
B. Disseminated intravascular coagulation
C. Heparin induced thrombocytopenia
D. Adverse effect of warfarin
E. Dearranged platelet function as the drug not stopped

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202.A 56-year-oId man presents with headache and vomiting with deterioration over the last two
weeks. On examination he has papilledema. A CT scan shows a space occupying lesion in the
right parietal lobe. He develops a sudden homonymous hemianopia. Which past of the visual
system to be affected?
A. Lens
B. Optic Chiasm
C. Optic radiation
D. Retina
E. Second cranial nerve

203.A 2-year-old child is referred because of an impalpable testis in the left scrotum. Which of the
following positions describes an ectopic testis?
A. At the deep inguinal ring
B. At the base of the penis
C. At the superficial inguinal ring
D. In the inguinal canal.
E. in the upper part of the scrotum

[Link] is not reliable to measure oxygen on low tissue perfusion

A. Pulse oximeter
B. ABG
C. Capillary wedge pressure
D. Swan Ganz catheter
E. None of the above

[Link] is the mechanism of action of Local lidocaine?

A. sodium channel block
B. sodium channel opening
C. k channel block
D. k channel open
E. none of the above

206.28-year-old primigravida presents in the Emergency Department with history of sharp pleuritic
chest pain Her father died at 67 years of age of stomach cancer. She coughed up Some blood at
morning.
A. Acute massive pulmonary embolism
B. Aortic dissection
C. Myocardial infarction
D. Panic attack
E. Pulmonary infarction

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207.26-year-old primigravida presents in the Emergency Department extremely breathless

complaining of tightness in her chest. She is Cyanosed and the neck veins are distended Her 62-
year-old father has recently died of myocardial infarction.
A. Acute massive pulmonary embolism
B. Aortic dissection
C. Myocardial infarction
D. Panic attack
E. Pulmonary infarction

[Link] single respiratory test parameter (FEVJ Forced expiratory volume in one second; FVC -
Forced vital capacity) is the best prediction for morbidity and mortality after surgery?
A. A. Confronted flow volume loop
B. FEV1 < 1L
C. FEV1/FVC > 90%.
D. tidal volume = 1500
E. increased residual volume

[Link] INR to patient on warfarin with superficial femoral superficial femoral thrombosis
A. 1 – 2
B. 2 – 3
C. 3 – 4
D. 4 – 5
E. 5 – 6

[Link] in RTA, complained of LL pain and lower abdominal pain, blood pressure 85/60, heart rate
110 and conscious and talking GCS not mentioned, what is the initial management?
A. massive hemorrhagic protocol
B. morphine for pain
C. tracheal intubation
D. platelet transfusion
E. O blood transfusion

[Link] colored fluctuant swelling below the tongue due to Sublingual gland
A. Branchial cyst
B. Thyroglossal cyst
C. Epidermoid cyst
D. Ranula
E. Submandibular abscess

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212.A 68-year-old farmer presents with a skin lesion on his forehead. It has been present for the
past 6 months and has grown slightly in size during that time. On examination he has an
ulcerated lesion with pearly white raised edges that measures 2cm in diameter.
A. Squamous cell carcinoma
B. Bowens disease
C. Actinic keratosis
D. Keratoacanthoma
E. Basal cell carcinoma

213.54 years old presented by nocturia and thirst. The physician asked him to do FBF and PPG – FBG
was 5 then post prandial 2 hours was 7, what is your diagnosis?
A. Normoglycemia
B. impaired glucose tolerance test
C. DM
D. DI
E. None of the above

[Link] pulmonary embolism despite of heparin use

A. LMWH
B. LMWH and stocking
C. vena cava filter
D. warfarin for life
E. warfarin for 6 months

[Link] is true about Vertebral artery course?

A. closely related to vagus
B. enter skull through foramen ovale
C. pass through C6 transverse foramina
D. pass through C7 transverse foramina
E. none of the above

216.10 y old child with persistent bloody diarrhea. Failure to thrive and anemia
Diagnosis
A. AV malformation
B. Carcinoma of colon
C. Hurspuring disease
D. IBD
E. Juvenile polyp

[Link] athlete patient came with single rib fracture, has pain and was stable?
A. Oral analgesic
B. Admission, observation and analgesia
C. Infiltration of wound with .5% bupivacaine
D. chest drain insertion at 5th intercostal space
E. None of the above

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[Link] patient elderly with chronic bronchitis came with rib fracture, x-ray done with no
hemothorax or pneumothorax, but the patient is in pain
A. Oral analgesic
B. Admission, observation and analgesia
C. Infiltration of wound with .5% bupivacaine
D. chest drain insertion at 5th intercostal space
E. none of the above

[Link] postoperative period of thyroidectomy, the patient has symptoms of perioral tingling and
twitches
A. hypocalcemia
B. hypokalemia
C. hyponatremia
D. hypercalcemia
E. hyperkalemia

[Link] infusion of Saline 0.9% will produce?

A. Hyperchloremic metabolic acidosis
B. Hyperchloremic metabolic alkalosis
C. Hyperchloremic respiratory acidosis
D. Hyperchloremic respiratory alkalosis
E. Hypochloremic metabolic alkalosis

221.53 years old presented by crushing chest pain at rest. He was hypertensive and heavy smoker,
blood pressure 145/9 and pulse 135. What is the principal cause for decrease coronary blood
flow:
A. Decreased diastolic interval Changes in heart rate (that increases cardiac
work) restrict coronary
B. Decreased systolic time inflow because rate increases occur primarily
at the expense of the diastolic interval.
C. Increase diastolic time
D. Increase systolic time
E. None of the above

222.A 21-year-old map comes into the Emergency Department with a severe headache and neck
stiffness of recent onset. You suspect acute meningitis and decide immediately to treat with
antibiotics and perform a lumbar puncture. After your third attempt to obtain for cerebrospinal
fluid (CSF) you notice that the fluid obtained is stained red. However, during the collection of CSF
into three containers it is noted that the final bottle is now cleared of any blood. Which
anatomical structure is the most likely to be responsible for this bleeding?
A. Anterior spinal artery
B. Epidural artery
C. Subarachnoid vein
D. Veins within the erector spinae muscles
E. Vertebral venous plexus

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[Link] with bilateral femoral and inguinal swelling or lymphadenopathy and spotting blood in
her underwar, what is the asking source of metastasis
A. cervix
B. vulva
C. body of the uterus
D. ovarian tumor
E. none of the above

224.-Pain management of patient with renal cancer and has left humorous mets and pain
A. Paracetamol
B. Radiation
C. Non-steroids
D. Morphine
E. Nerve bock

225.55 years old male smoker and alcoholic with painful bleeding ulcer from lateral side of tongue,
what is your diagnosis?
A. Aphthous ulcer
B. Squamous cell carcinoma
C. Benign ulcer
D. leukoplakia
E. none of the above

[Link] increase renal perfusion in hypovolemia by which of the following?

A. increase efferent diameter
B. decrease efferent diameter
C. increase afferent diameter
D. decrease afferent diameter
E. increase permeability

[Link] response to hypothermia

A. peripheral vasoconstriction
B. decrease sweating
C. shivering
D. hypothalamus regulation
E. none of the above
228.A person has fracture sternum, which structures mostly to be damaged?
A. Left atrium
B. Left lobe of the liver
C. Left ventricle
D. Right atrium
E. Right ventricle

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[Link] is the Anterior relation of head of pancreas?

A. Bile duct
B. hepatic artery
C. second part of duodenum
D. Right kidney
E. pylorus of stomach

230.11 years child with sudden acute testicular pain and left one is higher than the right one, what
is the diagnosis?
A. testicular torsion
B. hydrocele
C. orchitis
D. incarcerated hernia
E. none of the above

[Link] patients fall when she was upstairs presented by open triangular flap on the shin of tibia
7 cm long and 5 cm wide but could not approximated
A. Immediate split thickness skin graft
B. Delayed split thickness skin graft
C. Primary closure
D. Delayed primary closure
E. Random free flap

[Link] surface gastric ulcer between the antrum and the body of stomach develops massive
bleeding, what is the most accepted artery to be affected?
A. short gastric a
B. right gastroepiploic a
C. left gastric a
D. gastroduodenal artery
E. none of the above

[Link] pleural space is negative with respect to atmospheric pressure, except for which of the
following:
A. During a Valsalva maneuver
B. During Muller maneuver
C. During expiration
D. During inspiration
E. During forced inspiration

[Link] varices means increase in pressure in which vessels

A. Short gastric
B. Left gastric
C. Left gastroepiploic
D. Right gastric
E. Right gastroepiploic

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[Link] patient hypertensive and his parameters show hyperkalemia and hyponatremia which of
these drugs give this picture
A. Beta agonist
B. Angiotensin 2 blocker
C. alpha blocker
D. B blocker
E. none of the above

[Link] "fight or flight", response produces a release of epinephrine (adrenaline). What is the
primary metabolic effect of epinephrine?
A. Alanine shunt activation
B. Cortisol release
C. Glycolysis
D. Tachycardia
E. Vasoconstriction

237.34 years old female presented by calcular gall bladder with tenderness on right
hypochondrium. the site of cholecystitis tenderness is the meeting point between
A. Right linea semilunaris and midaxillary line
B. costal margin and midaxillary line
C. Right linea semilunaris and costal margin
D. linea alba and costal margin
E. none of the above

[Link] cyst present in the neck between which muscles

A. cricothyroid and thyroglossus
B. thyropharyngeus and thyroglossus
C. omohyoid and sternomastoid
D. sternothyroid and sternohyoid
E. none of the above

239.51 years old Patient with crohn disease and made an urgent operation and removing 50 cm
from ileum inside the operation, what do you think the nutrition given postoperative
A. Start oral
B. start oral with special formula
C. nasogastric tube
D. TPN with peripheral line
E. TPN at home

240.T wave inversion in lead 3 in unstable hypoxic patient after 3 day from hip replacement surgery
A. acute myocardial infarction
B. acute massive PE
C. cardiogenic shock
D. hypovolemic shock
E. none of the above

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241.76 years old male had hemiarthroplasty, he receive enoxaparin and antibiotic , after 7 days he
came hypotensive 85/65 and tachycardia 120 with pleural chest pain with deep inhalation
A. thromboembolism
B. fat embolism
C. lobar pneumonia
D. tension pneumothorax
E. none of the above

[Link] 2 diabetes millets how to control perioperative

A. variable timing of insulin
B. fixed timing of blood sugar monitored regularly
C. blood sugar monitored by patient
D. place on insulin timing scale
E. none of the above

[Link] contraindication to contrast study

A. allergy to iodinated contrast
B. GFR 40
C. dehydration
D. sepsis
E. none of the above

[Link] runner after long marathon presented by generalized muscle weakness and pain and
anormal color urine and has low urine volume
A. acute kidney injury
B. specific gravity less than 1.005
C. creatinine kinase more than 300
D. serum myoglobin normal
E. none of the above

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Notes

MRCS IV Recalls 47 MRCS I.V. Course