Surgery class 2024 cycle 1:

1. 1 month old with hypertrophic pyloric stenosis presented with projectile

vomiting, what are the findings expected?
- loss of appetite
- ⁠olive like mass in the epigastrum
- ⁠bile stained vomit

2. 8 month old with intermittent screaming and vomiting, and mass in the RUQ,
what is the daignosis?
- intusscusption
- ⁠volvulus
- ⁠malrotation
- ⁠hirschprung

3. . Left elbow fixed by internal nail causing Claw hand, Nerve involved? Ulnar
nerve

4. . Scaphoid fracture like past exam

5. . Child with nursemaid fracture past exam

6. 70 years old male with inability to urinate for 6 hours, there is history of
drippling,What youll find in examination?

-Suprapubic mass
-Normal size prostate
-Huge semnioma

7. Cluster) X ray of kidney stones picture.

Most likely type of stone?
Best Initial treatment?
A stone cant be seen in CT?

8. Patient asls surgen to take the decision ?

Theraputic priviledge
9. All the follewing characters of malignant hyperthermia exept ?
-fever
-increase o2 consum
-hyperlalemia
-flaccid paralysis
-myoglobinuria

10. Pic of air under diaphragm ?

Complicated peptic ulcer

11. Pic of hand lymphoaginitis

12. Best antibiotics for cellulitis ?

Pincillin + coxacilin

13. Malignant hyperthermia all correct, except:

Flaccid paralysis

14. Opioid over dose antidote?

Naloxane

15. -patient complianing of mild RUQ pain…. Can’t remember in( and there is
huge palpable mass felted ?
Mucocele

16. 5- patient came with painful swelling below and lateral to pubic tuburcle
dx ?
Strangulated femoral hernia (i think)

17. Young, male, h/o abdominal pain in RIF, since 4 days, went to the ER and
received antibiotics but came again with the same pain. O/E : palpable
tender mass in RIF CT attached .. what it ur management ?
- aspiration of the collection
- emergent laparotomy
- IV hydration and antibiotics and observe

*EXTENDED*
18. 1)Young, male, MVA, right sided chest pain, Xray attached (showed
pneumothorax) ,what is ur diagnosis
- right tension pneumothorax
- ⁠cardiac temponade
- ⁠flail chest
2- what finding you expect to see ?
- distended neck veins
- ⁠increase tactile frematus on the right side
- ⁠dullness on the right side
- ⁠absent breath sound bilaterally
3- what is ur management?
- large bore needle @ 4th ICS
- ⁠thoracotomy
- ⁠strap the chest and … ( something related to flail chest management)

19. Elderly, female, history of laparotomy for splenic reupture, present with
vomiting, colicky abdominal pain, constipation. X ray attached
1- what is ur diagnosis?
- adhesive LBO
- ⁠mechanical SBO
- ⁠..
2- what finding you expect initially ?
- exaggerated bowel sound
- ⁠visible peristalsis
3- Which of the following is not done while managing this patient ?
- emergent laparotomy / surgery

*EXTENDED*
20. Match electrolyte disturbance with the clinical picture

1- patient with pyloric stenosis & vomiting ?

2- ECG pic with tented T wave ?
Patient with acute pancreatitis ?
3- patient with constipation and normal K, still not improving ?

21. 35 years old male presented with hand infx diagnosed with cellulitis,
which Abx will use?
Pencillin + Cloxacillin
Erythromycin + metronedazole
Erthromycine + Cloxacillin
Metronedazole + cephalosporin
22. 70 y/o male presented to A/E with 6 hours history of urinary retention, he
have 7 months history of weak stream, dripping, nocturia.
1- large seminoma on examination of scrotum
2- normal prostate on DRE
3- suprapubic mass
4- bilateral uretric stones on imaging

23. Extended Match

1. Patient with paralytic ileus post-op with ECG of hyperkalemia (T waves)
2. ⁠Patient with acute pancreatitis which is most likely
3. ⁠Patient with post-op paralytic ileus with normal K+
4. ⁠Patient with DM and ESRD post-op bleeding from wound after a couple of
days
5. ⁠Patient with pyloric stenosis what is the acid-base disturbance?

Options: hypocalcemia, hypercalcemia, hypokalemia, hyperkalemia,

hypomagnesemia, hypermagnesemia, respiratory acidosis, normal anion gap
metabolic acidosis, hyperuricemia, hyperamylasemia, lactic acidosis

24. Patient with pinpoint tenderness in the nail, sensitive to touch and temp
and nail deformity ?
1- glomus tumor
2- giant cell tumor
3- gangilion cyst
4- Neuroliomyoma

25. Elderly, female, lesion near the eye ( ulcer ) , what is true ?
1- hard fixed pre auricular LN on examination
2- can be treated by immunotherapy
3- histology shows marjolin squamous ulcer
4- radical surgical excision

26. obese, female, had a surgery for femoro-iliac something, now she
developed hypoxia, PE is suspected .. which test is confirmatory ?
1- spiral chest CT
2- calf tenderness on palpation
3- venography of LL
4- ECG
Cluster with 2 attached pictures, one of a lady hanging her leg outside the bed
and the other is this:
27. elderly woman k/c/o diabetes and HTN presented to your clinic with
Lower leg pain that started several months ago and it is increasing with time,
now the pain is not relieved unless she keeps her leg in the position shown in
the pic.
Q1: what is the most probable diagnosis?
1- critical limb ischemia with wet gangrene
2- chronic ischemia with rest pain
3- Acute limb ischemia
Q2: What is the study shown in the picture ?
1- CT Angio
2- peripheral conventional angio?
Q3: in the pic one of the pt foot was covered with dressing. The question was..
which type of dressing you expect to found when you remove the dressing?
1- ischemic
2- neuropathic
3- venous
4- pressure

28. Question about “Chinese liver fluke”which parasite? ( there is a pic of the
parasite)
Mosquitoes
Bat bites
Fish
Dog
Contaminated vegetables

29. ‫ ﻣﺎ ﺣﺼﻠﺖ ﺻﻮرة ﺗﺸﺒﮭﮭﺎ ﺑﺲ ﯾﻌﻨﻲ‬ulcer ‫ ﻓﻲ‬lower back the question: 85 bed ridden
with all risk factors and they ask what type
-diabetic ulcer
-pressure ulcer

30. 27, male, with right scrotal heaviness, non transilluminating mass on
examination, CT attached .. what’s the best treatment ?
1- send him home with best palliative care
2- patient can benefit from total body irradiation
3- antibiotics

31. Elderly, male, slowly increasing swelling of right scrotum, left scrotum
normal, + transillumination test, ur hands can go above it .. what is the
management?
1- apiration of the collection
2- emergency surgery
3- ..

32. 35, female, smoker, breast pain, not related to menses, o/e foul smelling
discharge from an opening near the nipple .. diagnosis ?
1- eczema of the nipple
2- periductal mastitis
3- paget disease
4- ductal papilloma

33. Female, presents with hard breast lump, biopsy showed grade 3 ductal
carcinoma, 2 hard axillary LN, no distant mets, pictures of the surgery were
attached. She was given chemo after surgery
1- What type of surgery is done ?
- nipple and skin sparing mastectomy
- radical mastectomy
- subcutaneous mastectomy

2- what is the rationale behind giving chemo ?

- for the malignant axillay LN
- ⁠kill and residual mico-metastasis

34. Succession splash is a sign of ?

- gastric outlet obstruction
- ⁠..
- ⁠..

35. Patient diagnosed with rectal Ca, 20 cm from the anus .. what is the best
treatment ?
1- Neoadjuvant chemo then abdominoperineal resection
2- Neoadjuvant chemo then anterior resection
3-..

36. CT of bladder cancer he was smoker?

What is the cause? Smoking cigarettes
What is the type? TCC

37. most common cause of recation of blood transfusion?

Human error
Un.. circulating antibodies
Expired blood
Infected blood ? ( not sure )
38. 34 teacher with (picture of medial hyperpigmentation )what of the
following not complication ?
Cold temperature
Ulcer
Itching

39. Patient with difficulty swallowing solids the liquids .. barium pic attached
(esophageal cancer), what treatment will benefit the patient?
- chemo
- ⁠myotomy
- ⁠PPI
-

40. Not indication for admissions to burn unit?

A. 25% TBSA partial thickness burn
B. 13% TBSA partial thickness burn in 3 years old boy
C. High voltage electrical burn
D. 18% TBSA superficial burn in adult
E. Inhalational injury

41. zenker diverticulum pic the question was what is true about it ?
Soft neck mass with gurling on palpation
Congenital origin

42. 40 y/o male known case of ulcerative colitis presented with severe
abdominal pain, in examination he is ill looking and his abdomen is
distended, u did x-ray (attached) What is the diagnosis?
1- fecal impaction and secondary megacolon
2- sigmoid volvulus
3- mechanical small bowel obstruction
4- toxic megacolon with loss of haustration
43. Senario of patient with benign prostatic hyperplasia present with urinary
retention what is the physical sign you will see :
Suprapubic mass

Cluster:
44. Female, presents with hard breast lump, biopsy showed grade 3 ductal
carcinoma, 2 hard axillary LN, Her receptor overexpression, estrogen and
progesterone positive. no distant mets, Grading and staging was done, stage
3 breast cancer. pictures of the surgery were attached. She was given chemo
after surgery
1- What type of surgery is done ?
- nipple and skin sparing mastectomy
- radical mastectomy
- subcutaneous mastectomy

2- what is the rationale behind giving chemo while there is no evidence of

distant metastasis ?
- for the malignant axillay LN
- ⁠kill and residual mico-metastasis
3- what is the good prognostic factor in her case?
1- Her 2 over expression
2- Estrogen positive
3- presentation at young age
4- the type of surgery done
5- the grade of the tumor

Cluster
45. Tumor in the rectum, space between it and the anus 20cm, there is no
evidence of metastasis. Mild elevation of CEA
1- what is the best treatment option?
1- best palliative
2- neoadjuvent radio/chemo with local excision of the tumor
3- Total abdominoperineal resection
4- neoadjuvant chemo/radio with anterior dissection of the rectum
2- what is the role of CEA measurement ?
1- for grading
2- to confirm the diagnosis
3- for the prognosis
4- for future follow- up after treatment
I3- which monoclonal antibody is useful in colorectal adenocarcinoma?
1- Avastin
2- Herceptin
3- 5-FU
4- ?
5-?

Cluster:
46. Picture of branchial cyst
Scenario:
18 years old female presented to your clinic with neck mass, on examination
you found the mass deep to the upper 1/3 of sternocliedomastoid.
Q1: what is the diagnosis ?
Q2: how to manage?
1- resect under GA
2- observe because self limiting disease
Q3: what is the origin?
1- congenital
2- inflammatory
3- anaplastic

47. Picture of healed ulcer on the medial side of the leg. All of the following
findings are expected *EXCEPT*:
1- ulcer
2- itching
3- hyperpigmentation
4- dilated veins in the calf and thigh
5- cold periphery

48. Patient presented with bilateral buttocks claudication and new onset of
impotence,The ischemia is on which level?
1- aorto-iliac
2- femoral-popliteal
3- popliteal- tibial
4- femoral-tibial
4-iliac-femoral

49. Patient presented with burns,10% superficial -like sun burn- and 20%
partial thickness burn, his weight is 75kg,How much is the amount of the
fluid you’re going to administer in the the 1st 8 hours ?
50. Cluster about grave disease ?
1-Diagnosis ?
2-Elevation TSI
3-what is associated: diploipia / lymph nodes enlargement/ dry skin / slurred
speech

51. 60 years old Patient with past medical history of hypertension and
ischemic heart disease presented with inguinoscrotal swelling, what is your
next step?
1- reassure him and send him home
2- explain for him that no need to do operation due to his past medical
background
3- fix with ? I don’t remember
4- book him for surgery

52. 70 years old patient presented with right scrotal swelling, you can go
above the swelling but you can’t distinguish the right testes from the
swelling, attached picture showed +ve transllumination. What you will do
next ?
1- evacuate the swelling with needle aspiration
2- scrotal US
I don’t remember the remaining options

53. 30 years old male patient drinks a lot of alcohol and with history of chronic
recurrent abdominal pain, this is his x-ray, what is the diagnosis?
1- perforation
2-Gastritis 3- PUD
4-chronic pancreatitis