‫‪Surgery‬‬

‫‪final exam‬‬

‫فريق إحسان األكاديمي‬

‫لجنة الطب البشري‬
‫رؤية تنير دروب تميزكم‬
‫‪1‬‬
 Surgery-Ihsan batch-summer of 2018

*Dr Sohail Bakkar questions:

1) Best prognosis of melanoma :
A. Lentigo
B. Desmoplastic
C. Nodular
D. Superficial spreading
Answer: A

2) Which of the following has most malignant potential:

A. junctional nevus
B. intradermal nevus
C. blue nevus
Answer: A

3) Which type of cancer is not reported after Sistrunk’s procedure:

A. Papillary thyroid carcinoma
B. Sequamous cell carcinoma
C. Medullary thyroid carcinoma
D. Anaplastic
E. Follicular
Answer: C

4) Which is not a histological feature used to diagnose PTC

A. nuclear crowding
B. nuclear groove
C. intranucleatid cytoplasmic inclusion
D. papillary architecture
Answer: D

2
5) One of the following has the majority risk for breast cancer:
A. Mother with breast cancer
B. Null parity
C. Age > 55
D. Biopsy done shows carcinoma in situ
Answer: C (most probably)

6) Melanoma with 3 mm thick what is the safe excision margin for this:
A. 1 cm
B. 2 cm
C. 3 cm
D. 4 cm
Answer: B

7) One of the following does not cause Mets:

A. SCC
B. BCC
C. Adenocarcinoma
Answer: B

8) Which of the following is incorrectly matched :

A. Median portion of thyroid - foramen cecum
B. Superior parathyroid - 4th pharyngeal pouch
C. Lateral portion of thyroid - 3th pouch
D. C cells - neural crests
E . Obliteration of the thyroglossal duct - tenth week of gestation
Answer: C

9) According to Bethesda diagnostic category which is not true:

A. Type 1 – repeat FNA with US guidance
B. Type 2 rapid growth – surgical removal
C. Type 3 – repeat FNA
D. Type 4 – Surgical lobotomy
E. Type 5 – Thyroidectomy
Answer: B

3
10) One of the following is incorrectly matched:
A. Hasimotos thyroiditis - anaplastic ca
B. Medullary ca - MEN 1
C. Paplliary ca - radiation
D. Follicular - iodine deficiency
E. Follicular ca - MNG
Answer: B

11) What is the most common nerve injured during parotid surgery :
A. Facial nerve
B great auricular nerve
C. Auricular temporal nerve
Answer: B

12) Breast lump with overlying skin ulceration, which FNAC stage:
A. C1
B. C2
C. C3
D. C4
E. C5
Answer: E

13) Most common cause of bloody nipple discharge:

A. intraductal paplioma
B. Duct ectasia
C. Duct hyperplasia
Answer: A

14) Mismatch regarding best management:

A. Pregnant + Graves - medically
B. Toxic adenoma - radioiodine ablation
C. C. Toxic adenoma- lobectomy
Answer: B

4
 15) Pt. With Ca:11, PTH:600, your next step?
A. Total parathyrodectomy
B. Targeted parathyrodectomy
Answer: B

16) Indications for surgery except:

A. conns syndrome
B. pheochromocytoma
C. Adrenal incidenteloma
D. bilateral adrenal hyperplasia
Answer: D

*Dr.khaled al omar questions:

from this file: https://www.dropbox.com/s/8d0jeaxyw1ol6y4/pediatric-
surgery.pdf?dl=0
17) In neonates with congenital diaphragmatic hernia, which of the following
statements is true?
A. The defect is more common on the right side.
B. Survival is significantly improved by administration of pulmonary vasodilators.
C. An oxygen index of 20 is an indication for extracorporeal membrane
oxygenation (ECMO).
D. Oligohydramnios is a frequent occurrence.
E. Mortality is the result of pulmonary hypoplasia.
Answer: E
18) In neonates with necrotizing enterocolitis, which of the following findings is an
indication of significant bowel ischemia?
A. Increased gastric residuals.
B. Septic shock.
C. Cardiac failure due to a patent ductus arteriosus.
D. Elevated platelet count.
E. Erythema of the abdominal wall.
Answer: E

5
19) The treatment of choice for neonates with uncomplicated meconium ileus is:
A. Observation.
B. Emergency laparotomy, bowel resection, and Bishop-Koop enterostomy.
C. Intravenous hydration and a gastrograffin enema.
D. Emergency laparotomy, bowel resection, and anastomosis.
E. Sweat chloride test and pancreatic enzyme therapy.
Answer: C

20) In infants with duodenal atresia all the following statements are true except:
A. There is an increased incidence of Down syndrome.
B. Duodenal atresia can be detected by prenatal ultrasound examination.
C. It may occur in infants with situs inversus, malrotation, annular pancreas, and
anterior portal vein.
D. It is best treated by gastroenterostomy.
E. There is a high incidence of associated cardiac defects.
Answer: D

21) A 2.8-kg. Neonate with excessive salivation develops respiratory distress.

Attempts to pass an orogastric catheter fail because the catheter coils in the back of
the throat. A chest film is obtained and shows right upper lobe atelectasis and a
gasless abdomen. The most likely diagnosis is:
A. Proximal esophageal atresia without a fistula.
B. Proximal esophageal atresia with a distal tracheoesophageal (TE) fistula.
C. “H-type” TE fistula.
D. Esophageal atresia with both proximal and distal TE fistula.
E. Congenital esophageal stricture.
Answer: A

22) Patients with Wilms’ tumors most frequently present with which of the
following? A.Bilateral metachronous lesions
B.Bilateral synchronous lesions
C.An extrarenal primary
D.A multicentric primary lesion
E.A unifocal, unilateral lesion

6
 Answer: E
*Questions from slide topics:

23) A patient with hepatic encephalopathy that was caused by alcoholic cirrhosis. what
is the acid Base disturbance noticed in this patient :
A. Normal anion gap metabolic acidosis
B. Respiratory acidosis
C. Anion gap metabolic acidosis
D. Respiratory alkalosis
E. Metabolic alkalosis
Answer: E

24) What is the most organism to cause sepsis for a pt who just had a splenectomy ?
A. group b strep
B. B. E.coli
C. pseadomonus
D. c.difficile
Answer: A

25) Branchial cyst origin :

A. first branchial cleft
B. second branchial cleft
C. third branchial cleft
D. first branchial arch
E.second branchial arch
Answer: B

26) According to primary survey , which of the following is considered a circularity

hazard , need immediate management :
A. unstable pelvic fracture
B. 40% pneumothorax
C. pericardial effusion
D. femur artery injury
Answer: B

7
27) According to acute appendicitis , which of the following is not true :
Answer: rectal exam has no diagnostic role

28) Differentiate btw ileitis and acute appendicitis :

A. the time between the acute and subacute symptoms
B. presence of diarrhea
Answer: B

29) Most common inguinal hernia in female is:

Answer: indirect

30) Pt during surgery received 20,000 heparin , then after surgery he had severe
bleeding , the best initial management is :
A. IV platelet
B. iv protamine sulfate
Answer : B

31) In wound healing , which of the following is true :

A. the first response is inflammatory
B. vasoconstriction mediated by histamine and pgi
C. macrophages appear after 24 hour
D. main function of neutrophils is scar formation ( or contracture )
E. none of the above
Answer: E (most probably)

32) Surgical wound sealing occur after :

A. 24 hours
B. 48 hours
C. 36 hours
D. 3 days
E. 1 week
Answer : B (most probably)

8
33) Which of the following in breast cancer has the best prognosis :
A. HR + / HER +
B. HR +/ HER -
C. HER+/ HR -
D. Triple negative
Answer: B

34) All of the following not visceral pain :

A. distention
B. retraction
C. heat
Answer: C

35) 26 year old had a burn involving the right upper limb circumferentially, bilateral
lower limb and perineum. what is the TBAS :
A.28
B. 40
C. 46
D.76
Answer: C

36) RTA patient’s systolic blood pressure was less than 90 with 80 heart rate what is
the likely type of shock in this patient :
A. cardiogenic shock
B. Hypovolemic shock
C. Neurogenic shock
D. anapylactic shock
E. septic shock
Answer: C

37) What is the most common nerve injured during submandibular surgery:
A. Lingual nerve
B. Ansa cervicalis
C. Mandibular branch
Answer : C

9
38) Ligation of which artery would stop bleeding from gastric ulcer:
A. right gastric
B. gastroepoploic
C. left inferior pancreaticoduodenal
D. gastroseodenal
Answer: D

39) One of the following is correct :

A. Patient with BRAC 1 has 40% risk to developing ovarian cancer **
B. BRAC 1 associated with male breast ca
C.BRAC 1 mutation associated with 90% of breast ca
Answer: A
(info: BRCA 2 is associated with male breast cancer)

40) Patient did (big %) resection of the small intestine. Later on when u/s was done
and he was on TPN, it showed biliary stones. What could be the cause for this
patient:
A. Decrease cholecystokinin secretion due to loss of internal stimulation
B. Low cholesterol estrafication.
C. Increase total cholesterol level in serum
D. Something related to bile acids due to liver dysfunction
Answer: A

41) Which of the following is incorrect regarding keloid over hypertrophic scar:
A. Keloid extends beyond the boundary of the original tissue injury
B. Excision with intraregional steroids
C. More in dark skinned people
D. Spontaneous regression is common
E. Keloid and hypertrophic scar are synonymous
Answer: D (according to dr.sohail although E is also incorrect)

42) Which of the following is incorrect regarding patient with mitral stenosis:
A. Left chamber hypertrophy

10
 B. Right chamber hypertrophy
C. Left atrial enlargement
D - hemosidrin pigmentaintion
E- chronic lung congestion
Answer: A

43) Which of the following are true according to chylothorax:

A. cholesterol to triglycerides ratio > 1
B. triglycerides level 20
C. 50% associated with congenital disorder
Answer: A

44) Parathyroid hormone related protein seen in:

Answer: small cell carcinoma

45) Insulinoma location :

A. 90% in the head
B. evenly distributed along the pancreas
C. 10% in the tail
D. 50 % in the body
Answer: B

46) Hypercalcemia associated with malignancy caused by?

A. PTH
B. hyper parathyroid
C. PTH related peptide
D. Calcitonin
Answer: C

47) Which of the following is the least dx : ( ca 12 , pth 500 , albumin 4 )

A. parathyroid hyperplasia
B. 4 glands disease
C. parathyroid adenoma

11
 D. MEN 3 (2b)
E. parathyroid ca
Answer: E (most probably)

48) The most common injured nerve in fasciotomy:

A. Sural
B. Common perineal
C. Ant tibial
D. Saphenous
E. Superficial peroneal
Answer: D (most probably)

49) True about Hypovolemic shock :

Answer: venous pressure is low

50) True about multiple gastric ulcers resistant to ppi :

A. Presents with whipple tirade
B. Most common in tail of pancreas
C. Causes hypoglycemia
D. Associated with MEN2
E. It’s almost sporadic
Answer: E (most probably)

51) 40y pt with melanoma has had one month hx of abdominal pain, vomiting and
nausea, what’s your ddx?
A. Adenocarcinoma
B. Volvulus
C. Obstruction
D. Intussuption
E. Diverticulitis
Answer: A

52) Pt with RUQ pain was found to have gas inside the GB... What is the ttt?
A. Clidamycin

12
 B. Amoxicillin
C. piperacillin/tazobactam

53) Which of the following is the most useful diagnostic test for H,pylori?
A. urease breathing test
B. stool antigen
C. Urease endoscopic biopsy
D. Histological endoscopic biopsy
E. all have equal results
Answer: C

54) A pt noticed a left mass in the left thigh with a 5 cm diameter. what is the
management:
A. Fna
B. Excisional biopsy
C . Insicional biopsy
D. Wide excision with 2 cm safe mar
E. MRI

55) Which of the following is not indication for surgery in pneumothorax?

A. First time contra lateral pneumothorax
B. Second time ipsilateral pneumothorax
C. Spontaneous hemothorax
D. Failure of the lung to re-expand after 48 hr
E. Professions risk
Answer: D (most probably)

56) Pt. With HIV came to the clinic with scrotal mass, non erythematous, and bad
odor, what’s your management?!
A. antivral agent
B. ampicillen
C. excision of the mass

57) Fournier gangrene ttt:

Answer: debridement of the area

13
58) All cause hyperca++ except?
Answer: Acute pancreatitis

59) The best x-ray to show Pnemoperotinum is:

A. Ct
B. Lateral decubitus
C. Pa chest xray
D. Erect and supine abd xray
Answer: D

60) Best way to identify a bleeder preop:

A. Platelet count
B. Bleeding time
C. Ptt

61) About HCC which is incorrect?

A. hepatic adenoma has a risk for HCC
B. most common in Africa
C. alpha fetoprotein is tumor marker for it's fibrolamelar
D. most common primary malignant hepatic tumor
E. hepatitis B without cirrhosis can cause HCC
Answer: E

62) Incorrect about post operative bleeding?

A. delayed bleeding POD#1
B. can result from dislodgement of clot or emboli ....
C. may be significant and cause re-exploration
D. can be due to infection .....

63) True about gastrinoma:

A. It is usually sporadic
B. It is found mostly in the tail of the pancreas

64) Mask is protective for:

A. patient only

14
B. doctor only
C. both
D. should not be used
E. none of the above
Answer: A (that’s how dr.sohail answered it!)
65) Most stable stitch used in surgery:
A. cat gut
B. nylon
C. Vicryl
Answer: C

66)Advantages of full thickness over split thickness skin graft:

A. larger surface
B. less infection
C. superficial skin matches
D. less blood supply
E. Less contracture
Answer: E
67) Marjulin's ulcer:
A. External irradiation beam
B. Thermal injury
C. Pressure
D. Non of the above
Answer: B (most probably)

68) Which of the following is not correctly matched:

A. Acute colic referred to the right sub scapular area
B. Ruptured spleen referred to the left shoulder
C. Pancreatitis referred to the back
D. Uterine pathology to the suprapubic area
E. Upper rectum to the lower back
Answer: D (most probably)

15
69) Patient presented with right inguinal mass and when histopathology examined for
the lymph nodes in that area you find they are involved. From which organ they
likely came from:
A. Dome of the bladder
B. Upper portion of the rectum
C. Upper portion of the testis
D.
E. Anal canal orifice
Answer: E
70) In fluid recitation which is correct:
A. prbc more than five combined with calcium
B. pt with hypovolemic shock , given crystalloids and prbc to increase oxygen
carrying capacity and intravascular volume
C.
D.
(there was a lot of questions about fluid and blood transfusion so you should study
the topic)

71) Not a complication of massive blood transfusion :

A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
Answer: C

72) Humerus head was dislocated, what is the nerve injured :

A. Median nerve
B. Radial nerve
C. Axillary nerve
D. Ulnar nerve
E. Supraclavicular nerve
Answer: C
16
73) Patient presented with streaks of blood during defecation ... laceration presented
distal to dentate line in the midline what is the best initial management:
A. Internal lateral sphinctertomy
B .Laxative (bisacodyl)
C. Observation
D. Stool softeners
Answer: B (most probably but some answered D)

74) Patient with dysphasia after endoscopy there's a high grade dysplasia with barret
esophagus .what’s the next step?
A. Observation
B. Esophagectomy
C. PPI
D. Anti-reflux surgery

75) Q about cytokines:

A. mediate inflammation
B. CNS stimulation of fever
C. produce large number of acute-phase proteins
76) The characteristic changes that follow a major operation or moderate to severe
injury do not include the following:
A. Hypermetabolism
B. Fever
C. Tachypnea
D. Hyperphagia
E. Negative nitrogen balance
Answer: D
*Questions from a website:
https://medcosmossurgery.blogspot.com/search/label/MCQ%20%3A%20
General%20Surgery
77) Graft between patient and unrelated \Genetically non identical member from the
same species is:
A. allograft

17
B. autograft
C. synograft
D. xongraft
Answer: A

78) Which of the following statements about extracellular fluid are true?
A. The total extracellular fluid volume represents 40% of the body weight.
B. The plasma volume constitutes one fourth of the total extracellular fluid volume.
C. Potassium is the principal cation in extracellular fluid.
D. The protein content of the plasma produces a lower concentration of cations than
in the interstitial fluid.
E. The interstitial fluid equilibrates slowly with the other body compartments.
Answer: B

79) Which of the following statements are true of a patient with hyperglycemia and
hyponatremia?
A. The sodium concentration must be corrected by 5 mEq. per 100 mg. per 100 ml.
elevation in blood glucose.
B. With normal renal function, this patient is likely to be volume overloaded.
C. Proper fluid therapy would be unlikely to include potassium administration.
D. Insulin administration will increase the potassium content of cells.
E. Early in treatment adequate urine output is a reliable measure of adequate volume
resuscitation.
Answer: D

80) Which of the following are not determinants of a postoperative cardiac

complication?
A. Myocardial infarct 4 months previously.
B. Clinical evidence of congestive heart failure in a patient with 8.5 gm. per dl.
hemoglobin.
C. Premature atrial or ventricular contractions on electrocardiogram.

18
D. A harsh aortic systolic murmur.
E. Age over 70 years.
Answer: B
81) In patients receiving massive blood transfusion for acute blood loss, which of the
following is/are correct?
A. Packed red blood cells and crystalloid solution should be infused to restore
oxygen-carrying capacity and intravascular volume.
B. Two units of FFP should be given with every 5 units of packed red blood cells in
most cases.
C. A “six pack” of platelets should be administered with every 10 units of packed red
blood cells in most cases.
D. One to two ampules of sodium bicarbonate should be administered with every 5
units of packed red blood cells to avoid acidosis.
E. One ampule of calcium chloride should be administered with every 5 units of
packed red blood cells to avoid hypocalcemia.
Answer: A

82) Which of the following statements about allograft rejection are true?
A. In the absence of immunosuppression, the time and intensity of rejection of
transplants between unrelated donors and recipients is highly variable.
B. Allograft rejection may be mediated by antibodies or by cells.
C. Allograft rejection is thought to be caused by Th2 cells.
D. Acute cellular rejection is the major cause for loss of clinical organ transplants.
E. An individual with “tolerance” is unable to reject an allograft.
Answer: B

83) Which of the following statements about posttransplantation malignancy is

correct?
A. Certain immunosuppressive agents increase the incidence of malignancy in
transplant recipients, whereas others do not.
B. Those malignancies most commonly seen in the general population (breast, colon)
are substantially more common in transplant recipients.
C. Lymphoproliferative states and B-cell lymphomas are associated with Epstein-

19
Barr virus.
D. None of the above.
Answer: C

84) The following statement(s) is/are true concerning umbilical hernias in adults.

a. Most umbilical hernias in adults are the result of a congenital defect carried into
adulthood
b. A paraumbilical hernia typically occurs in multiparous females
c. The presence of ascites is a contraindication to elective umbilical hernia repair.
d. Incarceration is uncommon with umbilical hernias
Answer: b

85) Which of the following statement(s) is/are true concerning traumatic pericardial
tamponade?

a. The condition only develops in cases of penetrating trauma

b. Beck’s triad, consisting of muffled heart sounds, decreased pulse pressure, and
jugular venous distention can be seen in most patients
c. Two-dimensional echocardiography has replaced diagnostic pericardiocentesis in
most hemodynamically stable patients
d. The majority of patients with a small injury to a single chamber of the heart
arriving with vital signs at the hospital will die of their injuries
Answer: c

86) 41. Meckel's diverticulitis most often occurs in the:

A. Proximal jejunum.
B. Distal jejunum.
C. Proximal ileum.
D. Distal ileum.
Answer:D

20
87) Which of the following statements is not true concerning the various types of
shock?
A. Traumatic shock is more commonly associated with subsequent organ injury and
multiorgan failure syndrome than hemorrhagic shock
B. Cardiogenic shock can be of either an intrinsic or compressive nature
C. Hypodynamic septic shock is associated with a decreased mortality risk when
compared with hyperdynamic septic shock
D. Hypoadrenal shock usually responds quickly to resuscitation
E. Neurogenic shock occurs with the absence of sympathetic activity
Answer: C
88) Scar formation is part of the normal healing process following injury. Which of
the following tissues has the ability to heal without scar formation?
a. Liver
b. Skin
c. Bone
d. Muscle
Answer: c

21