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Multiple Choice : Part 1

Surgery

Surgery
Results
24 of 100 questions answered correctly

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1. Question

Regarding carcinoma developing in patients with ulcerative colitis, all are correct EXCEPT;

Incidence increases with the duration of the disease

Age at onset determines frequency of cancer

Neoplasia arises from pseudopolyps

Growths are multiple, flat and infiltrating

Prognosis is poor

Correct

2. Question

A 35-year-old gentleman presented with a history of progressive, bilateral hearing loss for two years.
There was no history of head trauma, otorrhoea, otalgia, or the use of ototoxic medications. The
otoscopic findings were normal on the right, while on the left he had a pink, vascular area
posteroinferiorly in the tympanic cavity. The Rinne’s test was negative bilaterally, while the Weber’s
test lateralised to the left ear. Impedance tympanometry is likely to demonstrate the following curve.

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 Type E

Type B

Type C

Type Ad

Type As

Incorrect

3. Question

A 22-year-old motorcyclist slips while speeding and develops major chest injury with dyspnea. He is
rushed to the emergency room. The immediately life threatening chest injury in this case would be:

Diaphragmatic rupture

Blunt cardiac injury

Tension pneumothorax

Pulmonary contusion

Tracheobronchial rupture

Correct

4. Question

A ‘cherry red spot’ on fundoscopic exam is pathognomonic of which ocular emergency;

Temporal arteritis

Optic neuritis

Retrobulbar haemorrhage

Central retinal artery occlusion

Retinal detachment

Incorrect

5. Question

As the amount of total body fat increases, what happens to total body water composition?

Increases

Decreases

Unchanged

Depends on patient age

Depends on how much they drink

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 Incorrect

6. Question

Early septic shock is characterized by all of the following EXCEPT

Hypermetabolism

High cardiac output

Low systemic vascular resistance (SVR)

Positive blood culture more than 90% of the time

Warm extremities

Incorrect

7. Question

A Monteggia fracture dislocation of the forearm

Is the combination of a fracture of the distal ulna with a dislocation of the radial head

Is not seen in children

Can usually be treated conservatively in adults

Is the combination of a fracture of the proximal ulna with a dislocation of the radial head

Is the combination of​fracture of the distal radius with a dislocation of the distal radio-ulna joint

Incorrect

8. Question

During vessel wall injury, the initial step in clot formation is __________?

Local mast cell release of adenosine diphosphate

Fibrin polymerization

Plasminogen activation

Platelet adherence to subendothelial collagen

Vitamin K adhering to the factors

Incorrect

9. Question

Which of the following is NOT a feature of familial hypercholesterolaemia?

Xanthelasma

Xanthomata involving Achilles tendon

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 Corneal arcus

Premature coronary arterydisease

Eruptive xanthomatoma

Incorrect

10. Question

Typical examination features of a torn meniscus include all of the following with the exception of:

joint line tenderness

an effusion

positive Lachman’s test

a locked knee

positive McMurray’s test

Incorrect

11. Question

A 35-year-old gentleman presented with a history of progressive, bilateral hearing loss for two years.
There was no history of head trauma, otorrhoea, otalgia, or the use of ototoxic medications. The
otoscopic findings were normal on the right, while on the left he had a pink, vascular area postero-
inferiorly in the tympanic cavity. The Rinne’s test was negative bilaterally, while the Weber’s test
lateralised to the left ear. The most likely diagnosis is;

Glomus tumour

Otosclerosis

False-negative Rinne's test

Chronic mucoid otitis media

Chronic suppurative otitis media

Correct

12. Question

Sequential application and removal of tourniquets to the lower limb is a technique that is used to
detect and confirm the diagnosis of which condition?

Duplex Doppler Ultrasound

Sapheno-femoral Incompetence

Angiography

Thalassemia Syndrome

Magnetic Resonance Imaging

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 Incorrect

13. Question

Typical radiographic features of osteoarthritis involves all the following EXCEPT;

sub- chondral cysts

sub-chondral sclerosis

joint space narrowing

periarticular osteopenia

osteophyte formation

Incorrect

14. Question

Which of the following urinary calculi is radiolucent?

Calcium oxalate

Uric acid

Cystine stones

Triple phosphate stones

Mixed stones

Correct

15. Question

A patient presents with a 3 cm tumour with ER, PR positive and HER negative receptors has the best
prognosis After a detailed consultation the patient opts for surgical treatment as the first approach to
her management. Which of the following is the best option?

Neoadjuvant chemotherapy followed by wide local excision without radiotherapy

Breast conserving surgery with adjuvant radiotherapy and evaluation of the axillary lymph
nodes

Simple mastectomy with radiotherapy

Breast-conserving surgery with chemotherapy, evaluation of the axillary lymph nodes, but
without radiotherapy

A radical mastectomy with radiotherapy and chemotherapy

Incorrect

16. Question

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 A 25-year-old university student undergoes total thyroidectomy for papillary thyroid cancer. During
the operation, the inferior thyroid artery is ligated. The nerve intimately related to this artery is:

Internal laryngeal nerve

External laryngeal nerve

Superior laryngeal nerve

Recurrent laryngeal nerve

Non-recurrent laryngeal nerve

Incorrect

17. Question

When taking a history of a patient with vomiting and abdominal pain, the key aspect is;

Duration of pain

Abdominal scars after a previous laparotomy

Nature of pain

History of smoking

History of diabetes

Incorrect

18. Question

Which of the following is not a typical radiographic feature of a slipped upper femoral epiphysis?

widening of the physis (growth plate)

decreased height of the epiphysis

the epiphysis is tilted towards the back

a line along the superior neck misses the epiphysis

a broadened femoral neck

Incorrect

19. Question

Which of the following is NOT diagnostic of diabetes mellitus?

Random glucose of 16.1mmol/L in a patient with polyuria, polydipsia and weight loss

HbA1c 7.0% and fasting glucose 7.2 mmol/L

Random glucose of 13.2 mmol/L in an asymptomatic patient

Glucose values of 7.1 mmol/L in the fasting state and 11.5 mmol/l 2 hours after having a drink
containing 75 g glucose.

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 HbA1c of 6.8% and glucose 2 hours after 75 g glucose of 12.2 mmol/L

Incorrect

20. Question

A 36 year old woman presents with a 3 day history of a painless swelling in her left calf. She had
been on the oral contraceptive pill for the past 6 months. Prior to that she has experienced 4
spontaneous abortions and had given up trying for pregnancy. Recently she had been seen by her
GP with a facial rash and joint pains. Her mother as well as a maternal uncle and two aunts who had
a history of recurrent thrombosis. She had also recently been in hospital following a vehicular
accident in which she sustained a fracture to her left femur. As a child she had been admitted to
hospital with rheumatic fever. On examination she was noted to have a painless swollen left calf. Her
pulse rate was 100 beats per minute and irregular. A malar rash is noted on her face. She also has a
murmur a mitral stenosis. A Doppler ultrasound reveals a deep vein thrombosis of her left popliteal
vein. Which of the following is NOT likely to be a contributing factor to her DVT?

Systemic lupus erythematosus with antiphospholipid syndrome

A familial thrombophilic disorder

Oral contraceptive pill use

Her mitralstenosis and atrial fibrillation

Her immobilization from her recent hospitalization

Incorrect

21. Question

A 30-year-old male patient was admitted after being severely beaten by a known assailant. He has
periorbital discoloration, and drainage from the ear and nose. He responds to command by
incomprehensible speech, withdraws from pain but does not open his eyes. Which of the following is
the appropriate Glasgow coma score for him?

13

11

Incorrect

22. Question

A 25-year-old female presents with a nodule in the left lobe of the thyroid that she discovered
accidently one moth prior to her visit. The nodule is not producing any symptoms and is 2 cm in
diameter. In the past, she had a brief exposure of radiation, 300R, to her face for treatment of acne.
If a total thyroidectomy is performed, possible postoperative complications include all EXCEPT;

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 Hypocalcemia

Hypercalcemia

Hoarseness

Airway obstruction

Hemorrhage

Incorrect

23. Question

Prophylactic antibiotics given for surgery should be administered within how long prior to incision?

0-1 hours

1-2 hours

2-3 hours

4-5 hours

10-12 hours

Incorrect

24. Question

A fourteen year old obese boy presented with a three week history of right knee pain and a limp, with
no history of trauma. The MOST LIKELY diagnosis would be?

osteochondritis dissecans of the knee

Osgood-Schlatter’s disease

osteosarcoma of the distal femur

slipped upper femoral epiphysis

patellar tendonitis

Incorrect

25. Question

A 60-year old patient presents to hospital passing bright red blood per rectum. A colonoscopy
reveals three 2 cm diameter pedunculated polyps that are removed during the procedure. Which of
the following is most likely?

Hyperplastic polyps have strong malignant potential and may grow to a large size

Tubular adenomas are the most infrequent neoplastic polyps with a strong malignant potential

Polyps associated with APC gene abnormality are common in hereditary non-polyposis
carcinoma

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 Villous adenomas have a greater malignant potential than tubular adenomas

Multiple villous adenomas, usually more than 100, associated with MMR (Mismatch repair)
genes are found in FAP syndrome

Correct

26. Question

A twenty five year old man was involved in a motor vehicle accident and is found to have an
internally rotated adducted and flexed hip. What is most likely diagnosis?

A fracture of the neck of the femur

A fracture of the posterior acetabulum

A posterior dislocation of the hip joint

A fracture of the sub-trochanteric femur

A fracture of the greater trochanter

Incorrect

27. Question

A 55-year-old woman presents with a 4 months history of concerning epigastric burning and
bloating with indigestion after meals. This was associated with occasional bouts of nausea and mild
weight loss since the onset of her symptoms. Which of the following statements about this patient is
true?

Acute Pancreatitis needs to be excluded

A pancreatic mass is a possible cause that would be best demonstrated with an

abdominal CT Scan

Cholelithiasis is not a common underlying cause for her symptoms.

Gastro-oesophageal reflux disease would be reliably excluded using a barium meal.

If a barium meal demonstrates a gastric ulcer, a course of anti-ulcer and H. pylori treatment is
adequate

Incorrect

28. Question

What is the most common cause of large bowel obstruction?

Carcinoma

Diverticular disease

Incarcerated Hernia

Surgical adhesions

Volvulus

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 Incorrect

29. Question

Which of the following is not a utilized prosthesis for heart valve replacement in humans?

Aortic Root Homograft

Tilting Disc Mechanical valve

Porcine xenograft

Ovine pulmonary root xenograft

Bileaflet mechanical valve

Correct

30. Question

In a patient with obstructive jaundice secondary to choledocholithiasis which set of biochemical

results would you expect;

Predominantly direct hyperbilirubinaemia with a low akaline phosphatase

Predominantly indirect hyperbilirubinaemia with a low alakline phosphatase

Predominantly direct hyperbilirubinaemia with a high alkaline phosphatase

Predominantly indirect hyperbilirubinaemia with a high alkaline phosphatase

Normal bilirubin and normal alkaline phosphatase

Incorrect

31. Question

A 20-year-old man receives multiple blood transfusions for abdominal gunshot wound. He complains
of numbness around his mouth and displays carpopedal spasm and a positive Chvostek sign. The
treatment required is:

Intravenous bicarbonate

Intravenous potassium

Intravenous calcium

Intravenous digoxin

Intravenous parathormone

Incorrect

32. Question

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 A 21-year-old male presents to the emergency room in acute urinary retention. He has a past history
of a sexually transmitted infection that was untreated. He admits to worsening difficulty voiding prior
to presentation. The likely cause of his urinary retention is:

Benign prostatic hyperplasia

Prostate cancer

Ureteric calculi

Urethral stricture

Diabetes mellitus

Incorrect

33. Question

Persistent Cerebro-Spinal Fluid rhinorrhea is seen in:

High cervical fractures

Hydrocephalus

Nasal bone fractures

Brain tumours

Fractures of the base of the cranium

Incorrect

34. Question

Wheezing, diarrhoea, and vomiting are characteristic features of this syndrome, often associated
with the several species of mushrooms that cause these symptoms by which mechanism?

Salicylism

cholinergic crisis

serotonin syndrome

sedative/hypnotic

anticholinergic

Correct

35. Question

A 60-year-old man presents with a history of coughing up small amounts of blood-tinged sputum.
He has a 30 pack-year smoking history. Appropriate intervention would include:

Flexible bronchoscopy

Endoscopy

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 Rigid bronchoscopy

Pleurodesis

Fundoscopy

Correct

36. Question

Indication for emergency room thoracotomy does not include:

Intra-abdominal hemorrhage requiring aortic cross-clamping

A history of blunt chest trauma in a patient brought to the ER with no vital signs

The need to perform internal cardiac massage

Penetrating cardiac injury with massive blood loss and shock

Acute pericardial tamponade unresponsive to closed cardiac massage

Incorrect

37. Question

Surgical management for Crohn’s disease includes all of the following except:

Ileostomy

Colostomy

Fistulectomy

Ileocolostomy

Ileoanal pouch

Incorrect

38. Question

The club foot deformity has the following features except:

association with congenital torticolis

hindfoot valgus

forefoot adductus

tight tendoAchilles

equinus deformity

Correct

39. Question

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 Screening for prostate cancer utilizes:

Urinalysis

Prostate specific antigen (PSA)

Transrectal ultrasound

Abdominal ultrasound

Acid phosphatase

Correct

40. Question

Toxicity from antipsychotics, such as Haldol, may produce a syndrome characterised by flushed
skin, tachycardia, delirium and hyperthermia and dry skin is an example of;

Salicylism

cholinergic crisis

serotonin syndrome

sedative/hypnotic

anticholinergic

Incorrect

41. Question

A 26-year-old obese male presents with a 3-month history of right-sided nasal obstruction, right
sided hearing loss and aural fullness, bloodstained postnasal discharge and right-sided cervical
lymphadenopathy Assessment of the extent of this disorder is best established by;

Post nasal space x-rays

CT scan

Angiogram

Anterior rhinoscopy

pneumatic otoscopy

Correct

42. Question

A twenty-seven-year-old HIV positive man presented with pain and swelling of the right clavicle. The
most likely organism responsible for the osteomyelitis would be?

Staph aureus

Proteus sp.

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 Candida albicans

Haemophilus influenza

Pseudomonas sp.

Incorrect

43. Question

A 28-year-old lady presents with a painless 3 cm. swelling in the neck. Thyroid function tests show
that she is hyperthyroid, and a thyroid scan shows increased uptake. Which of the following
statements is correct?

If a fine needle aspiration shows follicular cells surgery will not be necessary

A carcinoma of the thyroid gland does not occur in patients who have a hyper-functioning
nodule

Papillary carcinomas spread by the haematogenous route and result in distant bone
metastases.

Medullary carcinoma of the thyroid is likely in this patient because of her age

The presence of Psammoma bodies is common in papillary thyroid neoplasms.

Incorrect

44. Question

A 68-year-old woman fell at home while descending stairs. On examination she has shortening and
external rotation of the right lower limb. X-rays show a subcapital fracture of the right femoral neck.
What additional investigations are required for the preparation of the patient for surgery?

A bone scan

An MRI

Electrocardiogram

Computerized tomographic scan

A 68-year-old woman fell at home while descending stairs. On examination she has shortening
and external rotation of the right lower limb. X-rays show a subcapital fracture of the right femoral
neck. What additional investigations are required for the preparation of the patient for surgery? A
bone scan An MRI Electrocardiogram Computerized tomographic scan A scanogram

Incorrect

45. Question

Medical management of Benign prostatic hyperplasia (BPH) usually includes this class of drug:

Alpha (α)agonists

Alpha (α) blockers

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 Beta (ß) blockers

Anti-cholinergics

Oestrogens

Incorrect

46. Question

A 60-year old man presents with pain the right upper quadrant, a smooth, round mass in the region
with fever and chills. No jaundice is present and an ultrasound shows a large stone lodged in
Hartmann’s Pouch with a distended gallbladder with a thickened wall. What is the most likely
diagnosis?

Ascending cholangitis with Charcot’s triad

Obstructive Jaundice

Stone in Common bile duct

Mucocele

Empyema

Incorrect

47. Question

A 68-year-old road-worker is admitted to the ward with abdominal distension for five days, no bowel
action for two days and failure to pass flatus over the previous 24 hours. Concerning his
investigations, he should

get an urgent barium enema

be discharged with an outpatient appointment for a follow up barium enema

have a rigid sigmoidoscope followed by CT scan

have sigmoidoscopy followed by a barium enema

get an erect chest radiograph

Incorrect

48. Question

The following are features of a plaster of Paris cast EXCEPT;

chemically it is hemi-hydrated calcium carbonate

it undergoes an exothermic reaction in setting

it may cause the compartment syndrome

it is radio-opaque on x-ray

it is easier to remove than a fiberglass cast

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 Incorrect

49. Question

With regards to Monteggia fractures the following are true​except:

Loss of pronation and supination is a complication

Occurs most commonly in adults

It is defined by a fracture of the radius and a dislocation of the distal radio-ulna joint

Surgical treatment is usually indicated

A radial dislocation is often missed

Correct

50. Question

A 31-year-old lady developed severe RUQ abdominal pain associated with nausea and several
episodes of vomiting after having a fried chicken sandwich.

Acute cholecystitis

Biliary Colic

Ascending cholangitis

Acute pancreatitis

Liver abscess

Correct

51. Question

Which of the following is not an established cause of a non-union?

nerve injury

soft tissue interposition

excess movement at the fracture site

too little movement at the fracture site

poor blood supply

Correct

52. Question

A thin 68-year-old woman with a history of heavy cigarette use who presents with a painful ulcer on
the lateral aspect of the left foot, including the left 5th toe, is likely suffering from:

Venous stasis ulcer

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 CEAP 6 venous insufficiency

Arterial ulcer

Sickle Cell Anemia

Compression Therapy

Correct

53. Question

A 25-year old male patient is brought to the accident and emergency unit after sustaining blunt
abdominal trauma after a motor vehicle accident. Initial evaluation reveals that he has a fractured
pelvis bruising to the right flank and blood at the meatus. After bolus fluid infusion he complains of
abdominal discomfort and inability to pass urine. What is the best line of management?

Foley catheter insertion followed by and intravenous urogram

Foley catheterization using a catheter introducer

A contrast enhanced computed tomography (CT) scan of the abdomen and pelvis

A transrectal ultrasound

A retrograde cysto-urethrogram

Incorrect

54. Question

An 80-year old diabetic lady with cardiac disease presents with a gangrenous foot to the heel
almost. She is in extreme pain and her white cell count is high and rising further daily. What is the
next best step?

Femoro-distal bypass using reversed saphenous vein

Amputation

Intravenous antibiotics only

Digital Subtraction Angiogram

ABPI

Incorrect

55. Question

A 68-year-old woman fell at home while descending stairs. On examination she has shortening and
external rotation of the right lower limb. X-rays show a subcapital fracture of the right femoral neck.
What is the best surgical procedure for this fracture?

Hemiarthroplasty

Arthrodesis

Dynamic hip screw

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 Compression screws

locked nailing

Correct

56. Question

After having ERCP she developed epigastric pain with nausea and vomiting. What is the likely
diagnosis?

Acute cholecystitis

Biliary Colic

Ascending cholangitis

Acute pancreatitis

Liver abscess

Incorrect

57. Question

Which of the following is a feature of preseptal cellulitis?

Pain when moving eyes

Proptosis

Decreased visual acuity

Redness and swelling of the eyelid

Abnormal pupillary response

Incorrect

58. Question

A 75-year old woman with no significant medical history presents to the emergency department with
a sudden onset of severe generalised abdominal pain, and left shoulder tip pain preceded by eight
episodes of vomiting. Physical examination reveals moderate abdominal distension, with diffuse
tenderness and guarding. Bowel sounds are diminished. What is the most likely diagnosis in this
patient?

Necrotizing pancreatitis

Acute cholecystitis

Acute oesophageal perforation

Adhesive small bowel obstruction

Mallory Weis syndrome

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 Incorrect

59. Question

A 35-year-old gentleman presented with a history of progressive, bilateral hearing loss for two years.
There was no history of head trauma, otorrhoea, otalgia, or the use of ototoxic medications. The
otoscopic findings were normal on the right, while on the left he had a pink, vascular area
posteroinferiorly in the tympanic cavity. The Rinne’s test was negative bilaterally, while the Weber’s
test lateralised to the left ear. Which of the following is not recommended in the treatment of this
condition?

Hearing aid

Sodium fluoride therapy

Stapedectomy

Grommet insertion

Stapedotomy

Incorrect

60. Question

A 41-year-old male sustains a crush injury to the pelvis. He is noted to have blood at the urethral
meatus. Which of the following is true?

He should have a urethral catheter inserted immediately.

A retrograde urethrogram should be requested

A nephrostomy tube should be inserted

An external condom catheter should be applied

A intravenous pyelogram (IVU) should be requested

Incorrect

61. Question

A 25 year old footballer’s knee gives way on the pitch with acute swelling and pain noted. What is
the most appropriate step in diagnosis?

Do emergency CT scan

Standard x-rays plus a skyline view

MRI

Do a bone scan on an urgent basis

Ultrasound to look for a joint effusion or meniscal tear.

Incorrect

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 62. Question

A twenty-year-old man fell on the outstretched right hand and sustained an injury to the wrist.
Examination revealed tenderness in the snuff box and radiographs showed no fractures. The most
appropriate treatment would be:

a bone scan

an MRI scan

a back slab and repeat x-rays in two weeks’ time

a complete scaphoid plaster

repeat radiographs with different views

Incorrect

63. Question

Which procedure is appropriate for emergency surgery for lower gastrointestinal bleeding in a 80-
year-old man?

Right hemicolectomy

Left hemicolectomy

Sigmoid colectomy

Panproctocolectomy

Total colectomy

Correct

64. Question

What volume of fluid is required in the initial 24 hours for a 80kg male with 20% first degree burns
and 30% second degree burns?

24L

2L

6L

20L

12L

Correct

65. Question

A fifty two year old woman presented with pain in the knees with ascending and descending stairs.
She also has pain with kneeling, squatting and experiences difficulty getting out of a car as a result
of knee pain. What is the most likely diagnosis?

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 a torn meniscus

a torn anterior cruciate ligament

loose bodies within the knee

patello-femoral arthritis

tibio-femoral arthritis

Incorrect

66. Question

Which of the following tests is used to distinguish whether hyperinsulinemia is exogenous or

endogenous?

Pro-insulin

Pre-pro-insulin

C peptide

Insulin

Betahydroxybutyrate

Correct

67. Question

Which statement(s) regarding pituitary hormones is NOT TRUE?

Surgical excision of large growth-hormone producing adenoma is the treatment of choice

The hypothalamus control prolactin secretion primarily by secreting a stimulatory

substance

Men and non-gravid women have similar prolactin levels

The primary manifestations of Sheehan’s syndrome are amenorrhea and hypothyroidism

Typically, one specific cell type in the anterior pituitary usually secretes one specific hormone

Incorrect

69. Question

The full developed picture of traumatic (hypovolemic) shock is characterized by all of the following
EXCEPT;

Oliguria

Peripheral vasoconstriction

Increased blood viscosity

Mental dullness

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 Bradycardia

Incorrect

70. Question

A 20-year old gentleman fell into a dirty drain and injured his left leg. He presents with an extremely
swollen limb, with good pulses. The skin looks necrotic and there is crepitus with gas confirmed on
radiographs. A Gram-stain shows gram-positive rods. What is the best course of action?

Femoro-distal bypass using reversed saphenous vein

Amputation

Intravenous antibiotics only

Digital Subtraction Angiogram

Incorrect

71. Question

A 40 year-old pat70 kg patient is brought to the accident and emergency unit immediately after
suffering partial thickness burns to the entire surface of the anterior chest and abdomen and the
complete surfaces of both upper limbs. Fluid resuscitation is started with Ringer’s solution. The initial
resuscitation rate of fluid administration should be approximately

300 ml per hour

700 ml per hour

1000 ml per hour

1200 ml per hour

1500 ml per hour

Incorrect

72. Question

In the third trimester of pregnancy, a twenty seven years old woman presented with the carpal tunnel
syndrome. The treatment of choice should be;

diuretics

splints

surgical decompression

steroid injection

nonsteroidal anti-inflammatory drugs

Incorrect

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 73. Question

All the following predispose to diabetic wound infections EXCEPT:

Charcot foot

Automonoic neuropathy

Retinopathy

HBA1C of 4%

Smoking

Correct

74. Question

A twelve year old avid ballet dancer presents with anterior knee pain. Radiographs done showed
fragmentation of the tibial tubercle. What is the most likely diagnosis?

Osgood-Schlatter’s disease

patellar tendonitis

fracture of the proximal tibia

prepatellar bursitis

Chondromalacia patellae

Correct

75. Question

A 40-year old obese female, para 4 is admitted with a history of right upper quadrant pain, vomiting
and nausea. She is icteric with a high fever, chills and rigors and looks unwell. What is the most likely
diagnosis that may be life-threatening?

Diverticultits

Mirizzi’s syndrome

Ascending cholangitis with Charcot’s triad

Obstructive Jaundice

Incorrect

76. Question

Which of the following is NOT used in the treatment of Achalasia?

Left thoracotomy and Heller's cardiomyotomy

Endoscopic balloon dilatation

Botulinum toxin injection

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 Laparoscopic Heller's myotomy

Endoscopic mucosal ablation

Incorrect

77. Question

When comparing Ulcerative colitis (UC) with Crohn’s disease all of the following are true EXCEPT?

Crohn's is a transmural disease and UC involves the submucosa

Crohn's has skip lesions

Granulomas are characteristic of Crohn's.

Ulcerative colitis involves the rectum.

Ulcerative colitis is associated with fistula formation

Incorrect

78. Question

A 50-year old woman developed an enterocutaneous fistula following a laparotomy for adhesive
bowel obstruction. The fistula output has been ranging from 100-200 mls/day. What route of nutrition
would be appropriate in this patient?

Total parenteral nutrition

Oral intake

Nasogastric feeding

Nasojejunal feeding

Jejunostomy feeding

Incorrect

79. Question

The following are true of fractures of the femur in an adult EXCEPT;

they are usually treated in a plaster

they may lead to hypovolemic shock

they take approximately 3-6 months to heal

they are usually treated by an intra-medullary rod

they may lead to the fat embolism syndrome

Incorrect

80. Question

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 A neonate was admitted to the nursery because of a diagnosis of presumed sepsis. Blood cultures
grew a gram-negative organism. What would be the most likely cause?

Haemophilus influenza

Pseudomonas sp

E.coli

Group B Strep.

Neisseria gonorrhoea

Correct

81. Question

75-year old man with a history of smoking since age 18 complains of a sudden onset of severe pain
in the left calf. Examination reveals weak femoral pulses and absent popliteal and pedal pulses. A
left-sided lower abdominal bruit is also heard. Despite a period of observation his condition
continues to deteriorate. What is the best choice for the treatment of this patient?

A below-knee amputation

A fasciotomy

A left femoro-poplitial bypass using long saphenous vein

A Fogarty embolectomy

An aortobifemoral bypass graft

Incorrect

82. Question

Which of the following statements is true?

A BRCA1-associated breast tumour with negative ER, PR receptors has a good prognosis

A 3 cm tumour with negative ER, PR, HER receptors has the best prognosis

a. A 3 cm tumour with ER, PR positive and HER negative receptors has the best prognosis

A grade III tumour of whatever size will have a better prognosis than a grade I tumour of the
same size

A tumour with absent axillary nodes will have the best prognosis regardless of tumour size,
receptor status or grade

Incorrect

83. Question

Stoffers or Stauffers syndrome is paraneoplastic syndrome of renal cell cancer. It is manifested by;

Hypertension

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 Hypercalcemia

Liver dysfunction

Polycythemia

Pulmonary dysfunction

Incorrect

84. Question

ABO blood group compatibility is usually required for transplantation of all of the following EXCEPT
the;

Heart

Kidney

Liver

Cornea

Pancreas

Incorrect

85. Question

A 50-year-old university professor with cardiac failure presents to the emergency room with a 7-day
history of right upper quadrant pain and fever. Examination reveals temperature 39 Celcius, right
upper quadrant tenderness and guarding. Murphy’s sign is positive. WBC – 18 x 109 /L. Ultrasound
shows a distended, thick-walled gall bladder with echogenic material. The most appropriate
management is:

Conservative management with NPO and analgesia

Emergency cholecystectomy

Cholecystectomy on the next available list

ERCP

Percutaneous cholecystostomy tube placement

Incorrect

86. Question

A 30-year-old male patient was admitted after being severely beaten by a known assailant. He has
periorbital discoloration and drainage from the ear and nose. He responds to command by
incomprehensible speech, withdraws from pain but does not open his eyes. Which of the following
management decisions is not appropriate for the patient above?

urethral catheterization

arterial blood gases analysis

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 prophylactic antibiotic therapy

book patient for emergency neurosurgery

decompression of the stomach via a nasogastric tube

Incorrect

87. Question

17 year old football player sustained a posterior dislocation of his left knee. Before the knee was
reduced, he did not have palpable left foot pedal pulses. After the knee was reduced, his pedal
pulses returned. The left ankle brachial index (ABI) performed after relocation of the knee was 0.6.
The right (uninjured extremity) ABI was 1.2. In addition to complete history and physical, venous
insufficiency would be best diagnosed using which of the following?

Regular x-rays

Duplex ultrasound and/or venogram

CT with contrast

MRI

CT without contrast

Incorrect

88. Question

A 55-year-old lady noticed dark urine, pale stools and yellowing of her eyes. An ultrasound revealed
gallstones and a dilated CBD. She likely has?

Empyema gallbladder

Chronic Cholecystitis

Choledocholithiasis

ERCP

L. MRCP

Incorrect

89. Question

A 57 year old man with no previously known chronic illnesses is admitted with a non
ST Segment elevated myocardial infarction. He was not on any medication prior to admission. Which
if the following is NOT likely to form part of his therapeutic regimen at the time of discharge?

Ramipril

Bisoprolol

Prazosin

Simvastatin

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 Clopidogrel

Correct

90. Question

Which of the following is NOT a complication of acute pancreatitis?

Pseudocyst

Chronic pancreatitis

Deep venous thrombosis

Acute respiratory distress syndrome

Renal failure

Incorrect

91. Question

A 25 -year-old male patient presents with right loin to groin pain over the last four hours, hematuria
and burning on passing urine. On examination he is found to have right loin tenderness but a soft,
non-tender abdomen.
The likely cause of this scenario is:

Acute appendicitis

Meckel’s diverticulitis

Torsion of the right testis

Right ureteric calculus

A right psoas abscess.

Incorrect

92. Question

A 62 year old hypertensive man is referred to the medical outpatients clinic from the Accident and
Emergency department. He gives a history of a retrosternal chest pain brought on by climbing stairs
and usually relieved by rest although of late he has been finding that the pain lingers on long after
the precipitating physical activity has ended. He wants to know if there is any medication that is
likely to give him quicker relief from his pain. You tell him that the drug most likely to achieve this is:

Isosorbide mononitrate

Glyceryl trinitrate

Isosorbide dinitrate

Carvediolol

Low dose Aspirin

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 Incorrect

93. Question

Which one of the following is the most preferred route to perform cerebral angiography?

Transfemoral route

Transaxillary route

Direct carotid puncture

Transbrachial route

None of the above

Incorrect

94. Question

With regards to Sciatica from an acute prolapsed intervertebral disc;

Most commonly occurs in the over 40 age group

Is most common in men

Is usually caused by a twisting injury to the spine

The L3 nerve root is most commonly involved

Urgent spinal decompression is the treatment of choice

Incorrect

95. Question

Which of the following is true of the NYHA II classification of dyspnea:

Limitation of performance of normal activities

Capable of ordinary physical activity

Absence of symptoms at rest

PACO2 raised at rest

PAO2 decreased on FiO2 < 0.5

Correct

96. Question

The most sensitive imaging modality for diagnosis of ureteric stones in a patient with acute colic is:

X-ray KUB region

Ultrasonogram

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 Non-contrast CT scan of the abdomen

Contrast enhanced CT scan of the abdomen

MRI of abdomen

Incorrect

97. Question

A 65-year old diabetic patient with a long history of a chronic leg ulcer presents with a 6-hour history
of marked inflammation of the right foot. During examination the patient is noted to be sweating with
hypotension, tachycardia, and tachypnoea. A brown serous discharge is noted from the foot and
examination reveals crepitus and the presence of blebs extending above the knee joint. What is the
most likely diagnosis?

Diabetic cellulitis

Clostridial cellulitis

Chronic osteomyelitis with draining sinuses

Gram-positive septicaemia

Toxic shock syndrome

Incorrect

98. Question

A woman presents with acute pain in the left lower limb. The limb is cool. Pulses are palpable.
Diagnosis can be confirmed, definitively, by what investigation?

Duplex Doppler Ultrasound

Sapheno-femoral Incompetence

Angiography

Thalassemia Syndrome

Magnetic Resonance Imaging

Incorrect

99. Question

In a patient with an acute deep vein thrombosis (DVT) typical clinical findings are;

There are no typical findings, they are all unreliable

Absence of pedal pulses

Immobility of the ankle

Significant swelling

Muscle atrophy

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 Incorrect

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