2018

Recalls

MRCS I.V.

September 2018
 MRCS I.V. Course

Sep 2018
1. A 70 old diabetic man presented with multiple profuse urination. He describes that every time he
finishes his toilet, he has the same desire to urinate with a large amount. What is the most likely
cause?
A. Cystitis
B. Detrusor overactivity
C. Bladder diverticulum
D. Underactive bladder
E. Bladder outlet obstruction

2. A 49 years old man reported that he neglected his desire to urinate due to stressful condition.
After the situation passed, he felt no desire to urinate. On examination, he has abdominal
tenderness and distension with an empty foley catheter. What is the most accepted cause?
A. Blocked catheter
B. Hypovolemia
C. Bladder diverticulum
D. Ureteric stone
E. Bladder rupture

3. A patient suffered sensory deficit over the anterior thigh with inability to extend the knee after
an open hernia repair. What is the affected nerve?
A. Obturator nerve
B. Sciatic nerve
C. Genitofemoral nerve
D. Femoral nerve
E. Ilioinguinal nerve

4. A 45-year-old man presents with fever and pain in his right loin and groin. A soft swelling was
noted in his femoral triangle. Diagnosis of a psoas abscess was made. Which of the following
statements is most accurate regarding psoas major?
A. It arises from the lateral borders of the bodies of T12 to L5
B. It extends the hip
C. It inserts into the greater trochanter of the femur
D. It is innervated from T12 and L1
E. It passes posterior to the capsule of the hip joint

5. A 42 years old man developed a painful scrotal swelling after vasectomy. The most probable
diagnosis is:
A. Spermatocele
B. Sperm granuloma
C. Hydrocele
D. Teratoma
E. Epidydimoorchitis

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6. A 6 years old child presented with his mother with a tender left hemiscrotum. On examination,
there is a blue dot over the upper pole of the left testis. What is the most likely cause?
A. Torsion testicular appendages
B. Hematocele
C. Torsion testis
D. Varicocele
E. None of the above
7. A 42 years old man noticed a testicular mass after history of trauma 3 weeks. He has enlarged
supraclavicular lymph node. What is the most likely diagnosis?
A. Teratoma
B. Seminoma
C. Lymphoma
D. Hydrocele
E. Sperm granuloma

8. A 7-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
9. A 12 years old overweight child presented with obvious limping and limited internal rotation. He
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

10. A 2 months old neonate was brought by his mother after a breech delivery. She is concerned
that there is a prominent skin crease on the left hip. 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
11. A 21 years old soldier presented with metatarsal pain. Xray revealed no bony abnormality. 2
weeks later, Xray revealed callus formation. What is the most likely cause?
A. March fracture
B. Freiburg disease
C. Morton’s neuroma
D. Osteoarthritis
E. None of the above

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12. 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

13. A 30 years old athlete sustained trauma to his right knee which became rigidly flexed at 30
degrees. Trials to flex or extend knee were unsuccessful and he mentioned that his knee gives
away. What is the most likely cause?
A. Anterior cruciate ligament injury
B. Loose body
C. Dislocated patella
D. Meniscal tear
E. Posterior cruciate ligament injury

14. A 32 years old athlete injured his left knee. There is a positive valgus stress test with minimal
knee effusion. What is the most likely diagnosis?
A. Anterior cruciate ligament injury
B. Lateral collateral ligament injury
C. Medial collateral ligament injury
D. Meniscal tear
E. Posterior cruciate ligament injury

15. A 33 years old man suffered an ankle injury. Xray was normal and surgeon suspects
ligamentous injury. What is the most appropriate investigation?
A. Repeat Xray
B. MRI
C. CT scan
D. Bone scan
E. Ultrasound

16. A man fell on his hand during a rugby game. Examination revealed a suspected intraarticular
fracture of elbow joint. What is the most appropriate investigation?
A. Repeat Xray
B. MRI
C. CT scan
D. Bone scan
E. Ultrasound

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17. A 41 years old female presented to ortho clinic complaining of pain in her left shoulder.
Examination revealed a painful arc between 60-120 degrees. What is the most likely cause?
A. Frozen shoulder
B. Anterior shoulder dislocation
C. Posterior shoulder dislocation
D. Supraspinatus tendinitis
E. Calcific tendinitis

18. A patient cannot elevate his arm above 90 degrees and cannot shrug his shoulders after a
posterior neck triangle maneuver. What the nerve affected?
A. Glossopharyngeal nerve
B. Vagus nerve
C. Long thoracic nerve
D. Axillary nerve
E. Accessory nerve

19. A patient underwent ORIF for a bimalleolar fracture, with a below knee cast. Then he
developed inability to dorsiflex his ankle and paranesthesia along the dorsum of the foot. What is
the affected nerve?
A. Common peroneal nerve
B. Sural nerve injury
C. Superficial peroneal nerve
D. Deep peroneal nerve
E. Sciatic nerve
20. A man sustained a deep laceration between Achille’s tendon and lateral malleolus. Which
structure may be injured?
A. Peroneus tertius muscle
B. Saphenous nerve
C. Superficial peroneal nerve
D. Tibialis posterior muscle
E. Peroneus longus muscle
21. A 53 years old female presented with loss of sensation over the lateral aspect of the leg after a
varicose vein surgery. What is the affected nerve?
A. Sural nerve
B. Saphenous nerve
C. Superficial peroneal nerve
D. Deep peroneal nerve
E. Tibial nerve
22. A man suffered a fracture neck of femur. ORIF was done through a posterior hip approach.
Postoperatively, he complained weakness in his left leg. What is the likely cause?
A. Tourniquet paralysis
B. Sciatic nerve injury
C. Femoral nerve injury
D. Compartmental syndrome
E. None of the above

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23. A 33 years old man suffered an anterior ankle laceration. On examination, there is loss of toes
dorsiflexion. Where do you expect an associated sensory loss?
A. Dorsum of the foot
B. 1st web space
C. Dorsum of the foot except 1st web space
D. Lateral aspect of the foot
E. Medial aspect of the foot

24. A 26-year-old man presents to the Emergency Department with extensive bleeding from his
arm after sustaining a glass injury. On examination there is a 7 cm transverse laceration across
the anterior aspect of his elbow. On exploring the cubital fossa, you would 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

25. Where is the level of ulnar nerve injury in a hand with complete clawing at little and ring,
interossei wasting and hypothesia of the little and ring fingers?
A. At the axilla
B. At the elbow
C. At the upper arm
D. At the wrist
E. Deep ulnar nerve injury

26. A patient has a weak grip; when she tries to hold a knife, her hand flexes with lost sensation
over badge area. What is the affected nerve?
A. Radial nerve
B. Median nerve
C. Ulnar nerve
D. Lateral cord
E. Posterior cord

27. A 24 years old female patient presented with a fixed flexed little and ring. He can flex it
normally but cannot extend it due to pain. What is the appropriate treatment?
A. Fasciotomy
B. Release trigger finger
C. Carpal tunnel release
D. NSAIDS
E. None of the above

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28. A 40 years old patient presented within 3 hours after suffering a closed subcapsular fracture.
The most appropriate treatment is:
A. Hemiarthroplasty
B. External fixation
C. Internal fixation
D. Casting
E. Total hip replacement

29. What is the anterior relation of femoral hernial neck?

A. Inguinal ligament
B. Pectineal ligament
C. Lacunar ligament
D. Femoral vein
E. Fascia Lata

30. A female patient presented with a dark black gangrene affecting her perineum with extension
of necrotic tissue to the groin. What is the causative organism?
A. Streptococcus pyogenes
B. Staphylococcus aureus
C. Mixed aerobe and anaerobe
D. Pseudomonas
E. MRSA

31. What is the relation of ulnar nerve to the ulnar artery in wrist?
A. Ulnar nerve is ulnar to ulnar artery
B. Ulnar artery is ulnar to the ulnar nerve
C. Ulnar nerve is radial to ulnar artery
D. Ulnar nerve is superficial to ulnar artery
E. None of the above
32. A patient presented with painful ankle joint after sudden trauma to his ankle. Squeezing his calf
does not produce plantar flexion. What is the test to be positive?
A. Retropulsion test
B. Thomas test
C. Simmonds Thompson test
D. Forment test
E. None of the above

33. A woman presented with a 24-hour history of colicky pain and bloody diarrhea after eating
barbecued chicken. What is the causative organism?
A. Campylobacter
B. Salmonella
C. Staphylococcus aureus
D. Clostridium perfringens
E. Streptococcus pyogenes

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34. What is the causative organism of septic arthritis in a patient with sickle cell disease?
A. Staphylococcus aureus
B. Streptococcus pyogenes
C. Pseudomonas
D. Salmonella
E. None of the above

35. A patient with Gouty arthritis undergone joint aspiration. What is the expected finding under
the microscope?
A. Needle shaped crystals and negative birefringence
B. Rhomboidal shaped crystals and negative birefringence
C. Needle shaped crystals and positive birefringence
D. Rhomboidal shaped crystals and positive birefringence
E. None of the above

36. What is the Least reliable sign of compartment syndrome?

A. Increasing pain out of proportion
B. Altered sensation
C. Increased compartment pressure
D. Pain on passive stretch
E. Loss of pedal pulses

37. A patient recently come from Bangladesh complains of abdominal pain and vomitting. He gives
no history of similar attacks. What is the most likely cause?
A. Typhoid fever
B. Hepatitis A
C. Campylobacter
D. Staphylococcus aureus
E. Clostridium perfringens

38. A 53 years old female presented with a painless dark black eschar affecting her hand. What is
the likely cause?
A. Streptococcus pyogenes
B. Anthrax
C. Campylobacter
D. Staphylococcus aureus
E. Clostridium perfringens

39. A patient presented with a wound with dirty odour and crepitation. What is empirical antibiotic
to be used till the result of swap appear?
A. Metronidazole
B. High dose penicillin
C. Low dose penicillin
D. Rifampicin
E. Tetracycline

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40. A nasal MRSA carrier patient came to the hospital for surgery. What is the most appropriate
treatment?
A. Mupirocin2%
B. Chlorhexidine gluconate
C. IV vancomycin
D. IV Teicoplanin
E. None of the above

41. A 23 years old man suffered a distal femoral Fracture during a sport injury. Which nerve is at
greatest risk?
A. Tibial nerve
B. Common peroneal nerve
C. Sciatic nerve
D. Superficial peroneal nerve
E. Sural nerve

42. A man suffered a complex tibial fracture during a car accident. There is a dirty overlying wound.
What is the definitive management?
A. Open reduction and internal fixation by nail
B. Open reduction and internal fixation by plate
C. Open reduction and external fixation
D. Closed reduction and cast
E. None of the above

43. A 42 years old weightlifter presented with unexplained loss of weight, pain in both lower limbs
and loss of ability to urinate. What is the most likely cause?
A. Metastatic lesion
B. Stress vertebral body fracture
C. Axial subluxation
D. Spondylolisthesis
E. None of the above

44. A 25 years old athlete sustained an ankle injury. Xray was normal before 2 months. He is now
presenting with persistent ankle pain. What is the appropriate next step?
A. X-ray
B. MRI
C. CT
D. Bone scan
E. None of the above
45. A 62 years old man is known to have a prostatic cancer. Investigations revealed a metastatic
vertebral lesion. What is the most appropriate management?
A. Radical prostatectomy
B. PCA
C. Radiotherapy
D. Watchful waiting
E. None of the above

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46. A man has trauma to his face affecting orbit with periorbital hematoma, subconjunctival
hemorrhage and epistaxis. What is the possible fracture site?
A. Nasal bone
B. Naso-ethmoidal
C. Maxillary
D. Maxilloorbital
E. None of the above

47. A 50-year-old women presents with a diffuse swelling in the region of her right parotid together
with facial pain. On examination she has a right sided facial nerve palsy what is the cause?
A. Pleomorphic adenoma
B. Adenoid cystic carcinoma
C. Sarcoid
D. Sjogren's syndrome
E. Sialolithiasis

48. 35 yrs. old female on the routine mamo has intermediate microcalcification and the mamo was
negative 3 years ago with no lymph node
A. Ductal carcinoma in situ
B. Lobular carcinoma in situ
C. Invasive duct carcinoma
D. Lobular carcinoma
E. Paget's disease

49. Female patient on warfarin and must make further investigation. What is the next step?
A. PET CT
B. Core Biopsy
C. MRI
D. Excisional biopsy
E. None of the above

50. A 29-year-old patient brought to ER after falling from the floor A patient nonresponsive to any
stimuli there is no eye opening what is his GCS?
A. 3
B. 0
C. 5
D. 6
E. 11

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51. A 33-year-old male is complaining of a headache and a sensation of pressure between the eyes
and pain in his teeth. On examination she is febrile ad he reported that he had had dental
extraction 5 days ago. What is the likely diagnosis?
A. Ethmoid sinus cancer
B. Maxillary sinus cancer
C. Nasal polyps
D. Ethmoidal sinusitis
E. Maxillary sinusitis

52. A 28 years old patient stabbed on right side posterior to axillary line, Xray showing
pneumothorax with fluid level. what is the best management?
A. Chest drains with suction
B. Needle Decompression
C. thoracentesis
D. Chest drain
E. None of the above

53. which of the following is a tumor marker of melanoma?

A. VMA
B. CA 15-3
C. S100
D. CEA
E. None of the above
54. Male patient 45-year-old presented with red Velvety like lesion in his tongue
What is the most likely diagnosis?
A. Leukoplakia
B. Erythroplakia
C. Squamous cell carcinoma
D. AIDS
E. None of the above
55. A 55-year-old female presented with Neck rubbery mass with axillary and inguinal masses what
is most likely diagnosis?
A. HIV
B. lymphoma
C. Leukemia
D. Squamous cell carcinoma
E. None of the above
56. A 24-year-old patient presented with trauma to the chest his CXR shown widening of the
mediastinum. what of the structure being rupture?
A. ascending aorta
B. descending aorta
C. arch of the aorta
D. esophageal rupture
E. SVC

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57. A 25-year-old male pedestrian is hit by a van on a busy road. He is brought to the Emergency
Department by ambulance. On examination he is dyspneic, and hypoxic despite administration of
high flow 100% oxygen. His blood pressure is 110/70 and pulse rate is 115 bpm. The right side of
his chest is hyper-resonant on percussion and has decreased breath sounds. The trachea is
deviated to the left. What is your management?
A. Needle in 5th intercostal space at the mid axillary line
B. Between Xiphoidal process and left sternocostal margin
C. Between Xiphoidal process and right sternocostal margin
D. 3rd intercostal space
E. None of the above

58. A 25-year-old man is admitted having been stabbed in the interior chest. On examination he is
alert and coherent. He has congested neck veins. His pulse is 140 beats/minute and his blood
pressure 90/60 mmHg. He has normal breath sounds. What is the most likely cause of his cardiac
arrest 15 minutes later?
A. Cardiac tamponade
B. Congestive cardiac failure
C. Hypovolemia
D. Tension pneumothorax
E. Ventricular arrhythmia

59. A 85-year-old man presents with a cough and hemoptysis. He has a modest smoking history of
15 pack years. He is found to have a tumor located in the right main bronchus, with no evidence
of metastatic disease his pathology showing keratin between flat cells. He decides to undergo
any treatment what is your diagnosis?
A. Adenocarcinoma
B. Small cell lung cancer
C. Large cell lung cancer
D. Squamous cell carcinoma
E. None of the above

60. A 45-year-old homeless man presents with a cough and weight loss over three months. On
examination his BMI (Body Mass Index) is 19 and he has reduced breath sounds in the right
upper zone. His chest X-ray shows a caveating lesion in the right upper lobe. He undergoes a
bronchoscopy and a bronchial biopsy. The biopsy shows featureless necrosis surrounded by
epithelioid macrophages and giant cells. Which of the following is the most likely diagnosis?
A. Actinomycosis
B. Bronchiectasis
C. Sarcoidosis
D. Squamous cell carcinoma
E. Tuberculosis

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61. A 55-year-old smoker patient presented with hemoptysis and mucous phlegm. pathological
examination of his phlegm showing squamous cell in his sputum what is the most likely
diagnosis?
A. Squamous cell carcinoma
B. Small cell carcinoma
C. Tuberculosis
D. reversible metaplasia
E. None of the above

62. A 55-year-old female presented with epigastric pain and vomiting with inability to leaning
forward his investigations reveled elevated amylase and lipase. what is the type of necrosis in
this condition?
A. Liquefactive
B. Fibrinoid
C. Fat
D. Gangrenous
E. Coagulative

63. A 23-year-old female presented with right iliac fossa pain his U/S showing acute appendicitis.
What is the most predominant cell after 24 hours?
A. Neutrophils
B. Basophils
C. Eosinophils
D. Macrophages
E. T lymphocytes

64. A female patient 45 years old referred to surgeon with solitary thyroid swelling of thyroid of
less the pathology of the nodule showing papillary thyroid carcinoma 2cm cm with no lymph
nodes enlarged what is your treatment?
A. total thyroidectomy with nodal clearance
B. total thyroidectomy
C. hemithyroidectomy
D. subtotal thyroidectomy
E. None of the above

65. Hassall s corpuscles present in which gland of the following?

A. Thyroid
B. Para thyroid gland
C. Thymus glad
D. Pituitary gland
E. Pancreas

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66. Young girl complaining from enlarged cervical lymph node. Diagnosed on Histopathology as
Medullary thyroid carcinoma. what is appropriate management?
A. total thyroidectomy with nodal clearance
B. total thyroidectomy only
C. hemithyroidectomy
D. subtotal thyroidectomy
E. None of the above

67. A tall thin, 25-year-old woman presents to the surgical clinic with a complaint of swelling in the
front of her neck for the last four months. On clinical examination she has a swelling in the left
lobe of the thyroid and multiple neuromas lesions within the oral cavity. Her blood pressure is
220/120 mmHg. Laboratory investigations show that he calcium and electrolytes are normal and
serum calcitonin and urinary VMA levels are elevated, which of the following is the most likely
cause of the hypertension?
A. Conn's syndrome
B. Cushing's disease
C. Essential hypertension
D. Pheochromocytoma
E. Renal artery stenosis

68. Female patient 50 years old has history of Hashimoto thyroiditis 8 years ago now she noticed
the gland rapidly enlarged and have difficulty of swallowing with pathology bland cells and CD 20
+ve phenotype what's your diagnosis?
A. Lymphoma
B. Medullary thyroid carcinoma
C. Follicular thyroid carcinoma
D. Papillary thyroid carcinoma
E. None of the above

69. A 40-year-old women presented with a mass on her forehead. On examination, she had a
fluctuant pulsatile mass on her head. Examination of her neck revealed a mass inferior to the
hyoid with a positive Berry's sign. What is the most likely underlying diagnosis?
A. Follicular thyroid cancer
B. Medullary thyroid cancer
C. Papillary thyroid cancer
D. Anaplastic thyroid cancer
E. Parathyroid gland cancer

70. A Chinese lady has conductive hearing loss, palatine ulcer and cervical lymphadenopathy, what
is the most likely diagnoses?
A. Nasopharyngeal carcinoma
B. Oropharyngeal carcinoma
C. TB
D. Infectious mononucleosis
E. Actinomycosis

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71. You review 42-year-old woman six weeks following a renal transplant for focal segmental
glomerulosclerosis. Following the procedure, she was discharged on a combination of tacrolimus,
mycophenolate, and prednisolone. She has now presented with a five-day history of feeling
generally unwell with anorexia, fatigue and arthralgia. On examination, she has a temperature of
37.9 and has widespread lymphadenopathy. What is the most likely diagnosis?
A. Hepatitis C
B. Coxsackie virus
C. HIV
D. Hepatitis B
E. Cytomegalovirus

72. A 64-year-old man presents to the clinic with right upper quadrant 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 tumour 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

73. A patient was diagnosed with papillary thyroid carcinoma thyroidectomy was done . what will
be his follow up plan after operation?
A. Calcitonin
B. Thyroglobulin
C. Alpha fetoprotein
D. CEA (carcinoembryonic antigen)
E. None of the above

74. A 65-year-old woman presents with a 2.5 cm diameter mass in the upper outer quadrant of the
left breast with associated axillary lymphadenopathy. A core biopsy is taken which confirms the
presence of carcinoma. Which of the following types of carcinoma is this most likely to be?
A. Invasive ductal carcinoma
B. Invasive lobular carcinoma
C. Medullary carcinoma
D. Mucinous carcinoma
E. Tubular carcinoma

75. A biopsy specimen using Prussian blue stain to detect which of the following martial ?
A. Amyloid
B. Sarcoid
C. IRON
D. Asteroid bodies
E. None of the above

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76. A female patient 45 years old referred to surgeon with solitary thyroid swelling of thyroid of
less the pathology of the nodule showing papillary thyroid carcinoma 2 cm with no lymph nodes
enlarged
A. total thyroidectomy with nodal clearance
B. total thyroidectomy only
C. hemithyroidectomy
D. subtotal thyroidectomy
E. None of the above

77. Young girl complaining from enlarged cervical lymph node. Diagnosed on Histopathology as
Medullary thyroid carcinoma. what is appropriate management?
A. total thyroidectomy with nodal clearance
B. total thyroidectomy only
C. hemithyroidectomy
D. subtotal thyroidectomy
E. none of the above
78. A thyroidectomy specimen from a 43-year-old lady shows a mass with prominent oxyphil cells
and scanty thyroid colloid and complaining from pulsatile mass in her skull what is your
diagnosis?
A. Follicular carcinoma
B. Anaplastic carcinoma
C. Medullary carcinoma
D. Papillary carcinoma
E. Lymphoma

79. A tall, thin, 25-year-old woman presents to the surgical clinic with a complaint of swelling in the
front of her neck for the last four months. On clinical examination she has a swelling in the left
lobe of the thyroid and multiple neuromas lesions within the oral cavity. Her blood pressure is
220/120 mmHg. Laboratory investigations show that he calcium and electrolytes are normal and
serum calcitonin and urinary VMA levels are elevated, which of the following is the most likely
cause of the hypertension?
A. Conn's syndrome
B. Cushing's disease
C. Essential hypertension
D. Pheochromocytoma
E. Renal artery stenosis

80. A 65-year-old woman presents with a 2.5 cm diameter mass in the upper outer quadrant of the
left breast with associated axillary lymphadenopathy. A core biopsy is taken which confirms the
presence of carcinoma. Which of the following types of carcinoma is this most likely to be?
A. Invasive ductal carcinoma
B. Invasive lobular carcinoma
C. Medullary carcinoma
D. Mucinous carcinoma
E. Tubular carcinoma
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81. Female patient had mammogram 2 years ago which was normal result , now mammogram
showed microcalcification, her examination and u/s revealed 2 cm mass in her right breast......??
A. Conservative surgery
B. Modified radical mastectomy
C. Radiotherapy
D. Chemotherapy
E. None of the above

82. 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

83. 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. 13
84. RTA patient admitted after observation then discharged by giving treatment. 10 days later
came with abdominal discomfort especially after eating, it became worse. What is the cause?
A. Diaphragm rupture
B. diaphragmatic hernia
C. curling ulcer
D. acute gastric dilatation
E. esophageal perforation

85. A 30 years old patient brought to ER with rib fracture patient is intubated, then becomes
hypotensive and hypoxic what is your diagnosis?
A. Tension pneumothorax
B. Hemothorax
C. Hemopericardium
D. Hemopneumothorax
E. None of the above
86. A patient came after RTA, his GCS was less than 10, after log rolling, he suddenly become
hypoxic and rapid decrease in po2 what is your explanation?
A. Respiratory center depression
B. Spinal cord injury
C. tracheal tube displacement
D. pneumothorax
E. large amount of hemorrhage

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87. A 27-year-old man is involved in a road traffic accident. He is seen in the emergency
department with chest pain. Clinical examination is essentially unremarkable, and he is
discharged. He subsequently is found dead at home. What is the most likely underlying injury?
A. Tracheobronchial tree injury
B. Traumatic aortic disruption
C. Cardiac laceration
D. Diaphragmatic rupture
E. Rupture of the esophagus

88. 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

89. A 45-year-old homeless man presents with a cough and weight loss over three months. On
examination his BMI (Body Mass Index) is 19 and he has reduced breath sounds in the right
upper zone. His chest X-ray shows a caveating lesion in the right upper lobe. He undergoes a
bronchoscopy and a bronchial biopsy. The biopsy shows featureless necrosis surrounded by
epithelioid macrophages and giant cells. Which of the following is the most likely diagnosis?
A. Actinomycosis
B. Bronchiectasis
C. Sarcoidosis
D. Squamous cell carcinoma
E. Tuberculosis

90. A 6 years old child brought with his mother with a groin swelling increase with playing and
decrease with laying down. What is the possible diagnosis?
A. Indirect inguinal hernia
B. Varicocele
C. Undescended testis
D. Ectopic testis
E. None of the above
91. In tempo mandibular joint dislocation, the patient has severe pain around the joint. what is the
affected nerve?
A. Auriculotemporal
B. Infra-alveolar
C. Great auricular
D. Great occipital
E. None of the above

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92. Patient with serum potassium 6. What should be immediate step?

A. IV fluid
B. Insulin and glucose infusion
C. B agonist
D. Pamidronate
E. IV ca gluconate

93. 30years-old alcoholic man presents with acute severe upper abdominal pain and vomiting. He is
admitted to the intensive therapy unit with a diagnosis of severe acute pancreatitis 48 hours
later he develops peripheral paresthesia and carpopedal spasms. The most likely underlying
metabolic abnormality is :
A. hypercalcemia
B. hyponatremia
C. hypocalcemia
D. hypokalemia
E. hypernatremia

94. A woman had a routine gynecological check. what is palpated anterior to the cervix on PV?
A. base of bladder
B. dome of bladder
C. ischiorectal fossa
D. puborectalis muscle
E. none of the above

95. A 28-year-old man presents with an ischiorectal abscess. Where is this abscess cavity 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

96. The maximum point of resistance while you put urinary catheter is:
A. Bulbar urethra
B. membranous urethra
C. preprostatic urethra
D. prostatic urethra
E. none of the above

97. The male pelvis differs from the female one by all of the following except:
A. the female pelvis is wider and shallower than male
B. the female inlet is rounded or oval in shape while male is apple in shape
C. suprapubic angle is acute while male is large
D. the bone is lighter in female than in male
E. coccyx is straight in female while in male is curves

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98. A patient is noticed that he is confused, agitated after TUR operation. Diagnosis is:
A. Hypercalcemia
B. Hyperkalemia
C. Hypocalcemia
D. Hypokalemia
E. Hyponatremia

99. 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

[Link] mass in a child appears during the day time and disappear during the night what is the
pathology?
A. Dartos muscle
B. Patent processes vaginalis
C. Testicular capsule
D. Tunica albuginea
E. Tunica vasculosa

101.A patient diagnosed that he has a herpes zoster complaining of pain in the tip of the nose.
Which of the following at the same Dermatome of tip of nose?
A. Ear pinna
B. angle of mouth
C. jaw angle
D. cornea
E. None of the above

[Link] relation of the kidney is:

A. psoas muscle
B. peritoneum
C. liver
D. hepatic flexure
E. gonadal vessels

[Link] relation of head of pancreas include:

A. pylorus of the stomach
B. common bile duct
C. portal vein
D. IVC
E. Aorta

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[Link] is come from Anterior gastric ulcer between the antrum and the body of stomach ,
what is the source of bleeding
A. short gastric
B. left gastroepiploic
C. right gastroepiploic
D. left gastric
E. none of the above
105. A 63-year-old man who smokes heavily presents with dyspepsia. He is tested and found to be
positive for helicobacter pylori infection. One evening he has an episode of hematemesis and
collapses. What is the most likely vessel to be responsible?
A. Portal vein
B. Superior mesenteric artery
C. Gastroduodenal artery
D. short gastric
E. None of the above

[Link] is the most part of the following is susceptible to colonic ischemia?

A. Right colon
B. Transverse colon
C. Rectosigmoid colon
D. left colon
E. splenic flexure

107.55 years old complained of a stroke affecting left lower extremity paralysis , what is the arterial
supply responsible for that paralysis
A. right anterior cerebral
B. left anterior cerebral
C. right middle cerebral
D. PICA.
E. anterior spinal artery

108.31 years old female suffered from dysarthria and wheelbarrow effect of tongue on one side.
which nerve is affected?
A. Lingual nerve
B. Hypoglossal nerve
C. Chorda tympani
D. Glossopharyngeal
E. Vagus
109.55 years old suffered from Vitamin deficiency and the patient is alcoholic and has
manifestations of Wernicke's ataxia with cardiomyopathy
A. thiamine deficiency
B. pellagra
C. folic acid
D. iron
E. vitamin B12

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[Link] deficiency causing night blindness is:

A. Vitamin A
B. Vitamin B12
C. Vitamin B2
D. Vitamin C
E. Vitamin D

[Link] hormone increases pancreatic secretion rich in bicarbonate

A. Secretin
B. CCK
C. Gastrin
D. Histamine
E. Serotonin

[Link]’s diverticulum in pharynx occur between:

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

[Link] with congenital anti thrombin 3 came to do an operation, what will you prescribe for
her postoperative
A. warfarin 6 month
B. warfarin for life
C. heparin for 6 months
D. heparin for life
E. None of the above

[Link] INR for warfarin is:

A. 1:2
B. 2:3
C. 3:4
D. 4:5
E. 5:6

[Link] disturbance that causes flat p wave and inverted T wave is:
A. Hypokalemia
B. Hyperkalemia
C. Hypocalcemia
D. Hypercalcemia
E. Hyponatremia

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[Link] wave is coinciding with Ventricular repolarization?

A. P wave
B. QRS wave
C. T wave
D. ST segment
E. None of the above

[Link] diuretic acts on Na/k channel in collecting duct and causes hyperkalemia
A. Furosemide
B. Thiazide
C. Mannitol
D. spironolactone
E. None of the above

[Link] clearance used to measure what?

A. GFR
B. RBF
C. Plasma blood flow
D. Tubular secretion
E. Tubular reabsorption

[Link] acts on which one of the following

A. ADH
B. angiotensin 1
C. angiotensin 2
D. Angiotensinogen
E. None of the above
[Link] causing metabolic acidosis is due to loss of what?
A. HCO3
B. HCL
C. K
D. Ca
E. Na
121. if you do DRE, what will you palpate 4 cm from anal verge posterolateral
A. ischiospinous ligament
B. puborectalis muscle
C. sacrotuberous ligament
D. seminal vesicles
E. bladder

[Link] complained from homonymous hemianopia, what is the most affected site in brain?
A. optic nerve
B. optic chiasma
C. Lateral geniculate body
D. temporal lobe
E. parietal lobe

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[Link] tempo mandibular joint dislocation, the patient has severe pain around the joint what is the
nerve?
A. Auriculotemporal
B. Infra-alveolar
C. Great auricular
D. Great occipital
E. None of the above

[Link] of mastoid process infection with pus can cause destruction of which of the following
A. inner ear
B. sigmoid sinus
C. occipital-mandibular
D. internal carotid artery
E. superior sagittal sinus

125.35 years old woman presented with recurrent peptic ulcer. She is on proton pump inhibitor and
previously perceived h pylori eradication treatment. Which of the following is likely to raise in
her venous blood?
A. CCK
B. Secretin
C. Gastrin
D. Histamine
E. Pancreozymin

[Link] in left pleuro-peritoneal membrane:

A. Morgagni hernia
B. Bochdalek hernia
C. Hiatus hernia
D. Ectopia cardia
E. None of the above

127.4 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. None of the above

128.1-day neonate presented by bilious vomiting and scaphoid abdomen

A. Esophageal atresia
B. CHPS
C. Duodenal atresia
D. HSD
E. Volvulus

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129.4-week girl presented by non-bilious vomiting and failure to thrive

A. Esophageal atresia
B. CHPS
C. Duodenal atresia
D. HSD
E. Volvulus

130.10 months boy is screaming with passing dark blood, sausage shaped abdominal mass in
examination with free DRE
A. Intussusception
B. Meckel's diverticulum
C. juvenile polyp
D. anal fissure
E. anal hemorrhoid

[Link] has vertebral mass can cause respiratory compromise on which level?
A. mandible
B. cricoid
C. thyroid
D. hyoid
E. odontoid

132.A patient with Malignant melanoma. what is the best prognostic factor
A. .5 mm Breslow thickness
B. Free margins
C. No lymph nodes involved
D. No distant spread
E. None of the above

133.A patient had a velvety red lesion in the mouth. Biopsy revealed keratin. What is the cause?
A. SCC
B. adenocarcinoma
C. Basal cell carcinoma
D. Keratoacanthoma
E. Seborrhic keratosis

[Link] coronary artery is a branch from?

A. Anterior of Ascending aorta
B. Arch of aorta
C. Posterior and left from ascending aorta
D. Posterior and right from ascending aorta
E. None of the above

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[Link] describing the sino-atrial node, which one of the following statements is correct?
A. it is part of the somatic nervous system
B. It is usually supplied by the left coronary artery
C. If lies in the wall of the left atrium
D. It lies in the wall of the right ventricle
E. It receives fibers derived from the vagus nerves

136.A 58-year-old man, admitted for inguinal hernia surgery, is found to have an enlarged heart
shadow on his chest radiograph. Which one of the/following statements is true of the right
ventricle?
A. Has a muscular wall that is normally thicker than that of the Left ventricle
B. Forms the apex of the heart
C. Forms the right border of the heart
D. Is directly related to the diaphragm
E. Gives rise to the aorta

137.A 32-year-old man presents to the acute surgical unit with acute pancreatitis. He suddenly
becomes dyspneic and his saturations are 89% on air. A CXR shows bilateral pulmonary
infiltrates. His CVP pressure is 16mmHg. What is the most likely diagnosis?
A. Pulmonary edema
B. Pneumococcal pneumonia
C. Staphylococcal pneumonia
D. Pneumocystis carinii
E. Adult respiratory distress syndrome

[Link] right rib fracture at the angle of t8 inward cause injury of?
A. Liver
B. rt lower lung
C. IVC
D. Pulmonary trunk
E. Hemiazygos vein

139.A 25-year-old man is admitted having been stabbed in the interior chest. On examination he is
alert and coherent. He has congested neck veins. His pulse is 140 beats/minute and his blood
pressure 90/60 mmHg. He has normal breath sounds. What is the most likely cause of his cardiac
arrest 15 minutes later?
A. Cardiac tamponade
B. Congestive cardiac failure
C. Hypovolemia
D. Tension pneumothorax
E. Ventricular arrhythmia

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[Link] scenario about esophageal varices, the anastomosis in lower esophagus is made
between which esophageal veins and …………
A. Left gastric vein
B. short gastric vein
C. Right gastric vein
D. Left gastroepiploic vein
E. Right gastroepiploic vein

[Link] are content of the posterior mediastinum except:

A. Descending aorta
B. Thoracic duct
C. Azygous vein
D. body of vertebrae
E. splanchnic nerves to heart

142.A case of burn in 70 kg patient with 50% surface area affection what is the fluid requirements
during the 24 hours?
A. 16 liters
B. 14 liters
C. 11 liters
D. 9 liters
E. 7 liters

143.72-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. PEG
144.A patient will do hemorrhoids and his HB is 9 he put in a list after 6 weeks how would you give
him supplement
A. blood transfusion
B. IV IRON
C. oral iron
D. vitamin B
E. folic acid

145.A child has got a Water burn (scald) covering whole dorsal forearm with erythema with blisters,
what is your management?
A. occlusive dressing
B. keep it open
C. split thickness skin graft
D. full thickness skin graft
E. flap

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[Link] 35 years old has blood pressure is 110/80 and ICP is 18, what is cerebral perfusion
pressure
A. 52
B. 72
C. 92
D. 112
E. 132

147. Center is stimulated in response to hypothermia?

A. Thalamus
B. hypothalamus
C. subthalamus
D. reticular formation
E. inferior olivary nucleus

[Link] compensatory measures in the body toward shock?

A. baroreceptor stimulation
B. sympathetic stimulation
C. adrenaline activation
D. parasympathetic inhibition
E. renin activation

149.A drug used in induction anesthesia in shock for a patient came in trauma
A. ketamine
B. thiopentone
C. propofol
D. etomidate
E. All of the above

[Link] has an inotropic effect through

A. alpha1
B. d1
C. d2
D. alpha2
E. beta1

[Link] anesthesia is given for biers block to a colle's fracture?

A. prilocaine
B. lidocaine
C. lidocaine with adrenaline
D. bupivacaine
E. xylocaine

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[Link] common side effect?

A. Cardiotoxicity
B. Hepatotoxicity
C. Malignant hyperthermia
D. Histamine release
E. Renal damage

[Link] agent for anesthesia?

A. Succinyl choline
B. Vecuronium
C. Atracium
D. Pancuronium
E. Neostigmine

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

A. RBC
B. Muscle cell
C. Hepatocyte
D. Fat cells
E. All of the above

[Link] is the cause of hemorrhagic pancreatitis?

A. Amylase
B. Lipase
C. trypsin
D. gastrin
E. glucagon

[Link] of the following is not considered a measure to enhance rapid recovery after a hip
surgery?
A. A carbohydrate rich solution 2 hours preoperatively
B. Preoperative anti emetic
C. No nasogastric tube
D. Limit IV fluids
E. Good analgesia

157.35 years old patient after eating canned food presented by flaccid paralysis and diagnosed as
botulinum toxin affection. What is the mode of action of botulin toxin
A. Block release of acetyl choline from its vesicles
B. Block nicotinic cholinergic receptors
C. Block muscarinic cholinergic receptors
D. close ca release from sarcoplasmic reticulum
E. none of the above

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[Link] of Vater opening in?

A. In the posteromedial part of Proximal jejunum
B. In the posteromedial part of Third part of duodenum
C. In the posteromedial part of 2nd part of duodenum
D. In the posteromedial part of First part of duodenum
E. None of the above

[Link] pa O2 and High Pa CO2 occur in :

A. Type 1 respiratory failure
B. Type 2 respiratory failure
C. Respiratory alkalosis
D. Metabolic acidosis
E. Metabolic alkalosis

[Link] incision for evacuation of an abscess and after healing scar overgrowth and a painful mass
rapidly growing and the Skin is immobile over lesion
A. epidermoid cyst
B. dermatofibroma
C. lipoma
D. dermoid cyst
E. pyogenic granuloma

[Link] has a gunshot to her back, which transect cord at Lt side presents with features
suggestive of a Brown-Sequard syndrome. The clinical findings will include which of the
following ?
A. Left sided weakness, left sided proprioception and vibration loss, right sided loss of pain
and temperature
B. Right sided weakness, right sided proprioception and vibration loss, left sided loss loss
of pain and temperature
C. Right sided weakness, right sided proprioception and vibration loss, right sided loss loss
of pain and temperature
D. Right sided weakness, left sided proprioception and vibration loss,right sided of loss of
pain and temperature
E. None of the above

[Link] parathyroid gland develops from?

A. 1st pharyngeal pouch
B. 2nd pharyngeal pouch
C. 3rd pharyngeal pouch
D. 4th pharyngeal pouch
E. 6th pharyngeal arch

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[Link] artery true is enters the foramen transversum at which level?

A. C3
B. C4
C. C5
D. C6
E. C7

164.A man complains of being thirsty and getting up in the middle of the night to go to the toilet.
His weight is 85.5 kg, height 1.65 in and blood pressure 167/94 mmHg. An oral glucose tolerance
test was performed and produced the following results: Fasting plasma glucose 11.3 mmol/L The
most likely diagnosis:
A. Diabetes insipidus
B. Diabetes mellitus
C. Impaired fasting blood sugar
D. sepsis
E. None of the above

[Link] higher control of autonomic nervous system is

A. thalamus
B. hypothalamus
C. subthalamus
D. cerebellum
E. medulla
166.A 37-year-old man presents with severe headache, photophobia and neck stiffness. Kernig's
sign is positive and a midline lumbar puncture is performed immediately to determine if a
cerebrospinal fluid (CSF) pathogen is involved. In performing this procedure, at which level we do
this procedure?
A. At iliac crest
B. At anterior iliac spine
C. Transpyloric plane
D. Subcostal plane
E. None of the above

[Link] epigastric vein drains in:

A. Internal iliac vein
B. External iliac vein
C. Superior mesenteric vein
D. Inferior mesenteric vein
E. None of the above
168.59 years old come with a spinal trauma and after neurological examination the physician said
that he has spasticity with hyperreflexia in his limb, what is the site of lesion
A. corticospinal tract lesion
B. lower motor neuron lesion
C. Cerebellar lesion
D. Basal ganglia lesion
E. Hypothalamus lesion

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169.A 33-year-old female attends the day unit for elective varicose vein surgery. She has previously
had recurrent pulmonary embolic events. After the procedure she is persistently bleeding. Her
APTT is 52 (increased).
A. Factor V Leiden
B. Protein C deficiency
C. Disseminated intravascular coagulation
D. Antiphospholipid
E. None of the above

170.34 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] girl with splenomegaly, jaundice and increase bilirubin level. What is the diagnosis?
A. Spherocytosis
B. Sickle cell anemia
C. Intermittent porphyria
D. ITP
E. none of the above

172.A 71-year-old lady trips over and falls landing on her left shin. She sustains a large pretibial
laceration of her leg, wound dirty and rugged flap edges
A. Immediate split thickness skin graft
B. Delayed split thickness skin graft
C. Primary closure
D. Delayed primary closure
E. Random free flap
173. 6 cm Laceration on the scalp with dirty edges, treatment:
A. Flap
B. primary closure
C. healing by secondary intention
D. simple suture
E. Delayed closure with sutures

[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. Frontonasal process
D. Palatine processes
E. None of the above

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[Link] is the embryological cause of vagino-rectal fistula?

A. Vittelointestinal tract
B. Urachus
C. Cloaca
D. Mesonephric duct
E. Metanephric duct

[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

177.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
178.A case of steatorrhea due to gastrinoma what is the cause?
A. decrease lipase
B. whipple disease
C. gluten sensitivity
D. decrease bile secretion
E. increase output of juice in the duodenum and stomach
179.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] lady day1 postoperative with hypotension and low sodium and high potassium
with long term steroids
A. Adrenal insufficiency
B. Cushing syndrome
C. Conn's disease
D. SIADH
E. Diabetes insipidus

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[Link] of Conserving water after hypovolemic shock

A. Dilation of afferent
B. Contraction of afferent
C. dilation of efferent
D. increase bowman's capsule permeability
E. None of the above

[Link] takes ibuprofen for longstanding osteoarthritis. Twenty-four hours after emergency
embolectomy his blood pressure is 90/60 mmHg and he pass very dark brown urine. A dipstick
shows myoglobin and traces of blood. His blood glucose is 15 mmol/L (normal-4.0-6.0), urea 12
mmol/L (normal 3.2-7.5) and creatinine 180 mmol/L (normal 35-110). What is the most likely
cause of his abnormal renal function?
A. Drug induced nephropathy
B. Hypovolemia
C. Methemoglobinemia
D. Rhabdomyolysis
E. Acute renal failure

183.A 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

[Link] used in operation to control blood loss and give bloodless field Is based on:
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

[Link] is structure open during herniorrhaphy

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

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186.35 years male presented by back pain and weakness of lower limbs due to central disc prolapse
with lower motor neuron lesion manifestation
A. cauda equina
B. syringomyelia
C. brown Sequard syndrome
D. posterior cord syndrome
E. anterior cord syndrome

[Link] operation of superficial parotidectomy, facial nerve injury occurred inside the operation
and postoperative the patient suffered from all except
A. unable to close his eye
B. loss of corneal reflex
C. unable to elevate his eyebrow
D. numbness of the cheek
E. drop the angle of the mouth

188.A Patient presented with fracture of the face involving maxilla and numbness over the cheek.
Which of the following nerve is most likely involved?
A. Mental
B. Infra-orbital
C. Superior alveolar
D. Auriculotemporal
E. Supratrochlear

189.A 30 years old patient brought to ER with history of RTA his Echo showing cardiac Tamponade
for which pericardiocentesis was done what is the proper site of insertion?
A. Between Xephoid process and left sternocostal margin
B. Between Xephoid process and right sternocostal margin
C. Safety triangle in the chest
D. 2nd intercostal space
E. None of the above

190.A Young male come to the ER with crushed limb, by examination is tachycardic on 120 b-min
with Bp 110-70. By examining the limb, you notice that both bones of the leg are crushed with
completely avulsed popliteal artery, nerves are completely crushed with massive tissue loss.
What is the best choice for the patient?
A. Wait the tissues to gain viability
B. Interposition saphenous graft for popliteal artery repair
C. Interposition synthetic graft for popliteal artery repair
D. Amputation
E. None of the above

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191.A 65-year-old male underwent a loop colostomy for emergency obstructing rectal tumor. He
came nowadays to do revision and anterior resection, what is the best investigation to discover
any leakage?
A. Barium enema
B. Unenhanced CT
C. Unenhanced MRI
D. Water Soluble contrast
E. Colonoscope
[Link] is the most common biliary complications after lap cholecystectomy?
A. Bile leak from cystic duct stump
B. Common bile duct injury
C. Hepatic duct injury
D. Cholangitis
E. Duodenal injury

[Link] patient 58 years old with diabetes and chronic AF and come with sudden loss left lower
limb pain, by examination he has no distal pulsation below knee, what is the most accepted
cause of ischemia?
A. Chronic thrombosis
B. Embolic cause
C. Peripheral hypoperfusion
D. Normal Sequalae in old age
E. None of the above

194.A 6-year-old-boy with deteriorating health needs a blood transfusion, the parents refused for
religious reasons. What will you do?
A. Consent by proxy
B. Cannot proceed
C. Proceed without consent
D. Apply for a judge to a court
E. None of the above

195.A 26-year-old patient with down’s syndrome in need for appendicectomy, patient understand
all aspects of Surgery, from whom you will obtain the consent?
A. Consent the patient
B. Consent the parents
C. Cannot proceed
D. Proceed without consent
E. None of the above
196.A 63 years old patient complaining from Calf claudication on walking a short distance, by
examination there is loss of tibial arteries pulses, what is the most likley arterial occlusion site?
A. External iliac artery
B. Common femoral artery
C. Superficial femoral artery
D. Popliteal artery
E. Anterior tibial artery

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[Link] patient 39-year-old presented with sudden chest pain and hematemesis which occurs
after aggressive vomiting. By examination he has subcutaneous crepitus sensation over the
upper chest, what is the most accepted diagnosis?
A. Mallory Weiss syndrome
B. Borehave syndrome
C. Rupture trachea
D. Rupture Zenker diverticulum
E. Rupture pulmonary plebs

198.A 72-year-old man presents with dysphagia. He is investigated and found to have an
adenocarcinoma of the distal esophagus. His staging investigations have revealed a solitary
metastatic lesion in the right lobe of his liver.
A. Oesophagectomy
B. Endoscopic sub mucosal dissection
C. Photodynamic therapy
D. Insertion of oesophageal stent
E. None of the above

199.A 67-year-old lady presents with jaundice and abdominal pain. Her investigations show a
dilated common bile duct, a carcinoma of the pancreatic head compressing the pancreatic duct.
Her liver contains bi-lobar metastasis.
A. Gastrojejunostomy
B. Pancreatoduodenectomy
C. Conservative management
D. MRI guided pancreatic stent
E. Endoscopic pancreatic stent

200.A 54y male Patient with recurrent fainting attacks that improve by taking sugar drink, CT
abdomen show a pancreatic lesion of 3 cm size what is the best laboratory finding?
A. High CEA
B. High CA 19-9
C. High c-peptide
D. High Glucose
E. None of the above

201.A 70-year-old male resented with intestinal obstruction and diagnosed as Malignant
obstruction of the right colon. Surgical resection done and the pathology report show that the
malignancy involves all the submucosa with no invasion of the muscularis propria and there are 2
nodes out of 24 is positive. PET scan showed that there is no Mets. What is the TNM
classification of the condition?
A. T1N0M0
B. T1N1M1
C. T1N1M0
D. T2N1Mo
E. T3N1M0

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202.A 78-year-old man presents with symptoms of headaches and deteriorating vision. He notices
that there is marked pain on the right hand side of his face when he combs his hair. What is the
most likely diagnosis?
A. Giant cell arteritis
B. Wegener’s granulomatosis
C. Polyarteritis nodosa
D. Takayasu's arteritis
E. Buerger’s disease

203.A case of gangrene of the toe, with absent distal pulsation on examination using Doppler USG
which type of wave do you expect to find?
A. monophasic with low flow velocity
B. triphasic doppler signal
C. biphasic with low velocity
D. monophasic with high velocity
E. biphasic with high velocity

204. right coronary artery is coming from:

A. post left part of ascending aorta above valve
B. post right part of ascending aorta above valve
C. anterior part of ascending aorta above valve
D. ascending aorta below valve
E. None of the above

205.A patient has anal incontinence after childbirth what is the best management step?
A. defecation defecography
B. anal manometry
C. colon transit time
D. CT with contrast
E. Colonoscope

[Link] of Rt cerebellar lesion include all of the following except

A. Ataxia
B. Intention tremors
C. Rigidity
D. Unsteady gait
E. Dysmetria

207. A 34 years old presented by abdominal pain after open cholecystectomy. What is proper
management
A. NSAID
B. Paracetamol
C. Epidural
D. Local lidocaine in the wound
E. None of the above

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208.A 55 years old presented by ulcer on lateral border of tongue with cervical lymphadenopathy,
what do you think about the cause?
A. Adenocarcinoma
B. Basal cell cancer
C. Squamous cell cancer
D. Melanoma
E. Kaposi sarcoma

209.A 55 years old patient presented later with asymmetric smile after an operation in the face.
which nerve is affected?
A. Trigeminal
B. Facial
C. Glossopharyngeal
D. Vagus
E. Hypoglossal

[Link] high /CO low /CVP high

A. septic shock
B. neurogenic shock
C. cardiogenic shock
D. hemorrhagic shock
E. None of the above

[Link] high /CO low /CVP low

A. septic shock
B. neurogenic shock
C. cardiogenic shock
D. hemorrhagic shock
E. None of the above

212.A patient developed extradural hematoma following a road traffic accident, on examination he
was found to have lateral squint and mydriasis, what nerve is most likely affected?
A. Abducens
B. Oculomotor
C. Optic
D. Facial
E. Trochlear

213.2 years old child presented with Arnold chiari syndrome due to cerebellar tonsil herniation and
associated syringomyelia with affection of which tract
A. Dorsal column
B. Spinothalamic tract
C. Corticospinal tract
D. Extrapyramidal tract
E. None of the above
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214.A patient has a pulsatile aneurysm related to a vessel at the level of greater trochanter. What is
that artery?
A. External iliac artery
B. common iliac artery
C. Inferior mesenteric artery
D. Femoral artery
E. Popliteal artery

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Notes

MRCS IV Recalls 40 MRCS I.V. Course