Surgery Core Final 2019 Exam Paper PDF

‫‪Surgery‬‬ ‫‪- Core batch, 2019‬‬ ‫‪- 4th year final exam, 28/5/2023‬‬ ‫‪ -‬جمع االمتحان‪:‬‬ ‫سميات‬ ‫آية ر‬ ‫ ‬ ‫اشقي‬...

‫‪Surgery‬‬ ‫‪- Core batch, 2019‬‬ ‫‪- 4th year final exam, 28/5/2023‬‬ ‫‪ -‬جمع االمتحان‪:‬‬ ‫سميات‬ ‫آية ر‬ ‫ ‬ ‫اشقي‬ ‫ر‬ ‫عبد هللا أبو‬ ‫ ‬ ‫محمد النجار‬ ‫ ‬ ‫محمد شناعة‬ ‫ ‬ ‫‪Page | 1‬‬ 1. Hormones secreted from Islets of langerhans: A. Glucagon, insulin, somatostatin, pancreatic polypeptide B. Glucagon, insulin, somatostatin, secretin C. All of the above Answer: A 2. Most common benign pancreatic cancer: A. Serous cystadenoma B. Mucinous cystadenoma C. Mature teratoma D. Intraductal mucinous papillary adenoma Answer: A 3. Correct about liver cyst associated with polycystic liver disease: A. Best treatment is laparoscopic fenestration of cysts B. Usually symptomatic C. Hormonal therapy can aid in treatment D. Autosomal recessive E. LFTs are always abnormal Answer: A 4. 6 year old child after RTA, SBP:90, HR:140, RR: 36, lethargic, withdraws in response to painful stimuli. best cannulation site? A. Interosseous route B. Superficial veins in upper arm C. Venous cutdown on medial veins of the ankle D. Peripheral cannulation by femoral vein E. Internal jugular venous line Answer: A? 5. Female skater fallen several weeks presented with painful hard lump with skin retraction in the left breast: A. Fat necrosis B. Breast abscess C. Cancer D. Hematoma E. Sclerosing adenosis Answer: A 6. Most common site of atherosclerosis in lower limb: A. Superficial femoral B. Popliteal C. Profunda femoral D. Common femoral artery Answer: A 7. All of the following lie in parotid gland except? A. Facial nerve B. Hypoglossal nerve C. External carotid artery D. Lymph nodes E. Retromandibular vein Answer: B Page | 2 8. Correct about portal vein anatomy: A. In hepatoduodenal ligament, the portal vein runs posterior to bile duct and cystic artery. B. Portal vein normal pressure 10-12 mmHg C. Portal vein = splenic vein + IMV D. Portal vein has 2 valves. E. One- third of blood to the liver comes through portal vein Answer: A 9. Correct about neoplasm of vasoactive intestinal peptides (VIPoma): A. Watery diarrhea, hypokalemia, achlorhydria B. Watery diarrhea, hyperkalemia, gallstones C. Watery diarrhea, Necrolytic rash, hyperkalemia D. Watery diarrhea, Necrolytic rash, hypokalemia Answer: A 10. What kind of examination potentially confers the highest radiation dose? A. MRI B. U/S C. Intravenous pyelogram D. A nuclear medicine examination E. X-ray fluoroscopy Answer: E 11. Which of the following is diagnostic of a thyroid swelling? A. Moves with swallowing. B. Presence of dilated neck veins C. Fixity to underlying structures. D. Presence in midline of neck E. Moves in protrusion of the tongue. Answer: A 12. A pre-term neonate undergoing emergency surgery generally A. Increased fibrinolytic activity B. Requires platelet transfusion C. Requires IM vitamin K injection if not given at birth D. Have normal coagulation profile E. Has adequate coagulation factors passed from the placenta of the mother Answer: C 13. Conservative management rather than reconstructive arterial surgery is generally recommended for patients with which of the following? A. Toe gangrene B. Claudication C. Ischemic ulceration D. Ischemic neuropathy E. Nocturnal foot pain Answer: B Page | 3 14. A 45-year-old woman complains of pain in her left breast of 2 weeks duration. On examination she has tender string-like band with overlying prominent veins. The most likely diagnosis is: A. Fibrocystic disease B. Paget’s disease C. Duct ectasia D. Fat necrosis E. Mondor’s disease Answer: E 15. Which of the following is most urgent in the initial management of caustic ingestion in children? A. Chest radiograph B. Urgent surgery C. Maintain airway and oxygenation D. Induce vomiting E. Upper GI endoscopy Answer: C 16. When renal impairment is demonstrated in a patient, the first therapeutic intervention Should be to: A. Begin a mannitol infusion. B. Begin a low dose dopamine C. Restore adequate circulating blood volume. D. Administer a cardiac inotropic agent. E. Administer a loop diuretic. Answer: C 17. Hypospadias: A. Maybe associated with chordee and hooded prepuce B. Is a benign condition no need for treatment C. Usually part of syndrome Answer: A 18. A woman presents with a 10 kg weight loss and is also complaining of nausea and vomiting. Her blood pressure is 90/60 when sitting, whereas it is 70/50 when standing. She also has skin hyperpigmentation. Her labs reveal metabolic acidosis, hyponatremia, and hyperkalemia. What is the most likely diagnosis? A. Addison’s disease B. Sheehan syndrome C. Empty sella syndrome D. Craniopharyngioma Answer: A 19. A 61-year-old lady undergoes (Lumpectomy) for 0.3 cm tumor. ER/PR are positive, while HER-2 is negative. Sentinel Lymph node is negative. Which of the following is the next step in therapy? A. Axillary resection B. A radical mastectomy C. Combined chemotherapy with AC regimen D. Observation E. Radiotherapy for the affected breast Answer: E Page | 4 20. A 56-year-old lady undergoes (Lumpectomy) for 0.4 cm tumor. Sentinel Lymph node is negative. Which of the following is the next step in therapy? A. Axillary resection B. A radical mastectomy C. Combined chemotherapy D. Observation E. Radiotherapy for the affected breast Answer: E 21. The likely cause of hematuria in a 68-year man is: A. BPH B. UTI C. Glomerulonephritis D. Bladder tumors E. Kidney stones Answer: A 22. All of the following are associated with higher risk for breast cancer in premenopausal woman except: A. Obesity B. Smoking C. Early menarche D. Family history E. Radiation Answer: A 23. Which statement concerning testicular torsion is true? A. Most common during the neonatal period B. Contralateral orchidopexy is not recommended at the time of scrotal exploration C. Intravaginal torsion rarely occurs in adolescents D. The twisted testis is viable if operated upon within 48 hours E. Torsion of the appendix testis mimics testicular torsion Answer: E 24. The commonest indication for surgery in multinodular goiter is? A. Dysphagia B. Dyspnea C. Cosmetic D. Nerve compression and voice changes E. Malignancy suspicion Answer: C or E? 25. A 44-year-old woman is seen by her physician for nipple discharge. Blood tests and imaging are performed. Which of the following results should be more investigated? A. Ultrasound of nipple showing duct ectasia B. Ultrasound with fibrocystic changes and 2-mm cyst C. Ductogram with no filling defects or abnormalities D. Prolactin levels of 100 ng/ml Answer: D Page | 5 26. Which of the following statement is TRUE regarding varicocele? A. They result in lower testicular temperature B. It may affect sperm motility and sperm count C. They should always be repaired when identified D. They should be looked for with the patient supine E. They usually result in infertility Answer: B 27. 70% of prostate abscess is caused by: A. Escherichia coli B. Staph epidermis C. P. auruginosa D. Strep fecalis E. Neisseria gonorrhea F. Gonococcus Answer: A 28. All correct in varicocele examination EXCEPT? A. Examine patient in supine position B. Patient privacy C. Warm your hands D. Explain the exam to patient E. Start by inspection Answer: A 29. Which is correct about carcinoma of pancreas: A. The head of pancreas is the most common site. B. Hyperamylasemia is diagnostic. C. It is associated with good prognosis. D. It metastasizes to inguinal lymph nodes. E. All patients present with obstructive jaundice. Answer: A 30. Not a risk factor of gastric cancer: A. HBV B. Smoking C. Obesity D. Nitrosamine E. Poor fruit and vegetables intake Answer: A 31. Urographic demonstration of longitudinal folds in the renal pelvis & ureter in children is typical of: A. Hypoplasia of the kidney. B. Venous varicosities around the ureter. C. Congenital valves in the ureter. D. Early sign of hydronephrosis. E. Vesico-ureteric reflux. Answer: E Page | 6 32. One of the following is wrong about splenic rupture A. It usually associated with left lower rib fracture B. It can be associated left hemidiaphragm rupture C. It cause left upper quadrant pain and can be felt in the left shoulder D. Ultrasound in useful E. Splenotraphy (splenorrhaphy) should be prompted in children Answer: D 33. Wrong statement about heart: A. Aortic and mitral have two leaflets B. Blood comes from left atrium to LV C. Rheumatic heart disease is a cause of valvular dysfunction D. Diseases include stenosis and regurgitation Answer: A 34. A 38-year-old man comes to the emergency department with severe abdominal pain and vomiting. The pain radiates to his back and improves by bending forward. Physical examination shows tenderness over the epigastrium and decreased bowel sounds. The patient is admitted to the hospital and treated with intravenous fluids and pain medication, but his condition fails to improve. An abdominal CT scan reveals diffuse pancreatic enlargement with areas of necrosis. The inappropriate activation of which of the following most likely initiated this patient's condition? A. Amylase B. Chymotrypsinogen C. Lipase D. Proelastase E. Trypsinogen Answer: E 35. A 50-year-old man complains of disabling claudication if right leg. The angiogram shows a right common iliac artery stenosis (95%). What is your management? A. Angioplasty with stent-placement B. Aortofemoral bypass C. Iliofemoral bypass D. Axillofemoral bypass E. Femorofemoral bypass Answer: A, C or E? 36. Wrong about Ranson criteria initially: A. Calcium < 1.9 mmol/L B. Glucose > 11.1 mmol/L C. LDH > 400 IU D. AST > 250 IU E. WBC > 16000/mm3 Answer: A 37. Most common shock in pediatric: A. Hypovolemic B. Septic C. Obstructive D. Cardiogenic Answer: A (may be B) Page | 7 38. Not a complication of gallstone: A. Portal vein thrombosis B. Acute cholangitis C. Pancreatitis D. Chronic Cholecystitis Answer: A 39. The most common etiology of gallbladder disease in the pediatric population is: A. Congenital abnormality of the biliary tract B. Concurrent haematological disorder C. Primary cholelithiasis D. Prolonged total parenteral nutrition (TPN) use E. History of ileal resection. Answer: C 40. Not a complication of appendectomy A. Pelvic abscess B. Cecal volvulus C. Wound infection D. Incisional hernia E. Intestinal obstruction by adhesions Answer: B 41. Most common non-gonococcal cause of urethritis A. Chlamydia Trachomatous B. Mycoplasma genitalium C. Ureaplasma urealyticum D. Herpes simplex virus Answer: A 42. In the newborn with anorectal malformation, radiological studies of the location of the rectum ideally must be done: A. After 48 hours of life B. During the first 6 hours of life C. From 12 to 18 hours of life D. From 6 to 12 hours of life E. After 18 hours of life Answer: A 43. Wrong about shock A. Cold clammy extremities are seen in hypovolemic shock B. Warm extremities are seen in distributive shock C. Shock + bradycardia always mean neurogenic until proven otherwise D. Hypotension + tachycardia = decompensated shock E. Hypovolemic is the most common Answer: C or D? Page | 8 44. Presentation of internal piles: A. Bleeding after defection B. Prolapse C. Pruritus D. Tenesmus Answer: A 45. A 2-year-old female complains of painless rectal bleeding. She passes soft stool once a day. She is hemodynamically stable. Which is the initial investigation would be helpful to reveal her condition? A. Tech 99 B. Colonoscopy C. All of the above Answer: A 46. Sign of acute pancreatitis A. Cullen sign B. Trousseau's sign C. Kehr sign D. Boas sign E. Murphey sign Answer: B (I think Cullen in hemorrhagic) 47. Severity of acute pancreatitis correlate with levels of the following, except A. Calcium B. Transaminase C. Amylase D. White blood cell count E. Glucose Answer: C 48. A 48-year-old male is admitted to the hospital with severe epigastric abdominal pain and vomiting after an episode of binge-drinking. Four weeks later, he is found to have a palpable upper abdominal mass and a cystic lesion is visualized on computed tomography scanning the inner walls of the lesion are most likely lined with: A. Glycogen-rich cuboidal epithelium B. Columnar mucinous epithelium C. Atypical cells forming papillary projections D. Fibrous and granulation tissue E. Endothelial cells Answer: D 49. The best screening approach for detecting early hepatocellular carcinoma in patients with chronic viral hepatitis is? A. Alpha-fetoprotein B. CA 125 C. CA 19-9 D. Carcinoembryonic antigen E. Alpha-fetoprotein with US Answer: E (doctor said in lecture) Page | 9 50. Most common cancer in renal transplant patients A. Gastric cancer B. Breast cancer C. Squamous cell carcinoma of the skin D. Pancreatic cancer E. Transplant lymphoproliferative disorder Answer: C 51. The most helpful test in diagnosing thyroid malignancy is: A. Laryngoscopy B. Thyroid function tests C. Ultrasound of thyroid D. Isotopic scan of thyroid E. FNA cytology Answer: E 52. What is wrong: A. Lymphatic dissemination is more common in follicular than papillary thyroid carcinoma B. Hurthle’s cell is a variant of follicular thyroid carcinoma C. Papillary thyroid carcinoma is non-capsulated Answer: A 53. Wrong about CABG: A. For managing atherosclerotic coronary artery patients B. Graft usually uses arteries or veins from the same person C. Smoking does not increase risk of coronary artery disease Answer: C 54. Most common cause of acute urinary retention in male? A. BPH B. Urethral strictures C. Prostatic abscess D. Carcinoma of the prostate E. Chronic prostatitis Answer: A 55. Not complication of reperfusion injury? A. Lactic acidosis B. Rhabdomyolysis C. ARD's D. Cardiac arrhythmia E. Absent distal pulses Answer: E 56. Which kind of stones is associated more frequently with pyelonephritis? A. Calcium oxalate B. Uric acid C. Cysteine D. Struvite E. Matrix stones Answer: D Page | 10 57. Wrong statement about visceral aneurysms:: A. Most aneurysm is symptomatic B. Most common visceral aneurysm is splenic C. Risk of rupture of splenic aneurysm increases in pregnancy Answer: A 58. Acute mesenteric ischemia. All true except: A. Pneumatosis & gas in Mesenteric vein B. Patients present with hematochezia C. Sever pain with soft & lax abdomen D. It usually affects elderly and cardiac patients. E. Mesenteric angiogram has no role in the diagnosis and treatment. Answer: E 59. One of the following is wrong about appendicitis: A. Profuse vomiting B. Rovsing sign maybe positive C. The pain may start periumbilically D. Leukocytosis E. Anorexia is common Answer: A 60. Rearding risk stratification for DVT (Wells score) , choose the wrong answer: A. Order d-dimer if wells < 2 B. Unprovoked DVT needs shorter anticoagu lation compared to provoked C. Wells > or = 2 indicate likely DVT D. Wells score of 2 means 40٪‫؜‬chance of DVT E. Diagnosis of DVT by duplex ultrasound Answer: B 61. One hour after infusion of 500 ml 0.9 NaCl, how much of it remains in the intravascular volume? A. 375 ml (75%) B. 50 ml (10%) C. 500 ml (100%) D. 250 ml (50%) E. 125 ml (25%) Answer: E 62. One of the following is a second most important risk of breast cancer: A. Age B. Gender C. BRCA 1 D. Family history Answer: A 63. Radiocontrast most likely to result in acute renal failure in : A. DM B. Compromised renal function C. Dehydration Answer: A or B? Page | 11 64. An elderly complains of recurrent episodes of an Amaurosis fugax. It’s attributable to micro embolization of which of the following? Oath A. Retinal artery B. Superficial temporal artery C. Facial artery D. Occipital artery Answer: A 65. Regarding perforated duodenal ulcer, the following are correct except: A. The patient present with severe upper abdominal pain which decreases after few hours B. Most common in second part of duodenum C. Plain x-ray abdomen may show gas under the diaphragm D. Bacterial peritonitis usually develops after more than six hours E. Treatment is usually surgical Answer: B 66. Patient admitted for hemorrhagic stroke developed DVT, next step? A. Warfarin B. IVC filter C. Thrombolytics D. Thrombectomy E. LMWH F. Observation Answer: B 67. Regarding carotid body tumors, which statement is true? A. They are usually treated by embolization B. They most frequently present as painless neck mass C. They frequently manifest with a stroke D. FNA is needed for diagnosis E. They are derived from endothelial cells Answer: B 68. Contraindication for nasotracheal tube except: A. Battle B. Raccoon eyes C. Epistaxis D. CSF leak from nose E. CSF leak from ears Answer: C 69. The glomerular filtration rate is best determined using substance which is? A. Neither secreted nor reabsorbed by the tubule. B. Sugar. C. Secreted by the proximal tubule. D. Reabsorbed by the proximal tubule. E. Secreted and reabsorbed Answer: A Page | 12 70. Which of the following statements regarding total body water is false? A. In males, approximately 60% of total body weight is water B. The percentage of total body water decreases with age C. Majority of body water is contained within interstitial fluid compartment D. Percentage of total body weight water is higher in males than females E. Percentage of total body weight water is higher in lean muscular than obese people. Answer: C 71. Urea is not ideal marker for determining the GFR because? A. Fractional excretion of urea varies according to the state of hydration. B. Urea is secreted by the anionic transporter of proximal tubule. C. Large molecule not freely filtered by glomerulus D. Urea is secreted by the cationic transporter of proximal tubule. Answer: A? 72. Wrong about Diabetic Foot Ulcer: A. Claudication is not common duo to sensory neuropathy B. Sensory neuropathy is the commonest neuropathy C. 85% of major amputation is associated with previous ulcer D. The risk of a person with diabetes undergoing a lower extremity amputation is estimated to be 23 times that of a person without diabetes. E. ABPI is conclusive on DUF Answer: E 73. True about hepatic adenoma: A. Can differentiate between FNH by early washout in the arterial phase on CT B. Adenoma complicated by bleeding is best treated by surgery C. A 5.5 cm adenoma is indicated for surgery even if asymptomatic D. More common in men E. Include Kupffer cells in its tissue proliferation Answer: C 74. A 12-year- old female has undergone appendectomy for appendicitis that is perforated with pus in the abdomen. Her parents ask you about the long term complications. What is the correct? A. She is at increased risk of endometriosis B. She is at increased risk of ovarian torsion C. She is at increased risk of infertility D. She is at increased risk of adhesive intestinal obstruction E. All of the above Answer: D or E 75. All of the following are true regarding diverticulosis, except A. Happens in raw along the tinea coli muscles. B. Rectum is spread. C. Sigmoid colon is the most common site D. Are considered true diverticula as their wall contain three layers E. Meckel’s is usually multiple Answer: E Page | 13 76. All of the following statements are true regarding the mesenteric circulation, except: A. Superior and inferior mesenteric veins unite to form the portal vein. B. Inferior mesenteric artery supplies the colon from the mid transverse region down to the rectum. C. Superior mesenteric artery supplies all the small bowel from the ligament of Treitz. D. Splenic flexure is well vascularized. E. Inferior mesenteric vein also takes part in the formation of the portal vein Answer: D 77. Regarding diverticular disease of the colon, all the following are true EXCEPT: A. Do not occur in the rectum B. Diverticular pain is usually increased after eating C. Stool is typically of small hard pieces or constipation alternating with diarrhea D. Presents with symptoms similar to appendicitis but occurs on the left side in elderly individuals with diverticulitis. E. Pain is relieved by passing stool or flatus Answer: B 78. Wrong about lymphedema ? A. In lipoedema, the foot is not involved, leading to inverse shouldering at the ankle. B. Lymphedema praecox is common in women and unilateral C. Lymphedema tarda is related to obesity D. Lymphedema congenital is more common in males and bilateral E. Secondary lymphedema from malignancy starts distal to proximal Answer: E 79. Best imaging modality for renal stones? A. CT enhanced B. CT non enhanced C. KUB D. MRI Answer: B 80. One of the following about acute Ischemia is wrong A. Embolus occurs proximal to thrombosis B. Patients with thrombosis are new to vascular service C. Patient with embolus need prompt intervention D. History of cardiac conditions used to differentiate between thrombus and embolus Answer: A or B? Page | 14 81. One of the following is false about diffuse gastric adenocarcinoma A. Poor prognosis B. Familial gastric cancer C. Less common in patients with inherited gastric cancer syndrome D. Poorly differentiated E. It more common in young, females, low frequency population Answer: C 82. All of the following indicate vulnerable arterial plaque except : A. Hyperechoic lesion with acoustic shadow. B. Lipid rich plaque C. Irregular marginated ulcerated plaque D. Hemorrhage inside it E. Crescendo TIA Answer: A? 83. IBDs, what’s true: A. Extra intestinal manifestations is indicative for surgery in Crohn’s disease B. The best treatment of UC is total proctocolectomy and ileal pouch Answer: B 84. Most common source of pyogenic lever abscess: A. Septic emboli from portal vein B. Biliary C. Direct extension from a contiguous source of infection D. Arterial Answer: A 85. 10 kg child with Hemothorax, when you insert a chest tube immediately drained 300ml, next step: A. Prepare the patient for Surgery B. Clamp the chest tube C. Put another chest tube in the contralateral side D. Put another chest tube in the ipsilateral side E. Intubation Answer: A 86. One is wrong about SOFA score? A. Tachycardia is part of qSOFA triad B. It is an assessment for 6 organ systems C. It stands for sequential organ failure assessment score D. It can be used for sepsis Answer: A 87. A 23-year-old man is hospitalized with acute pancreatitis that resolves rapidly on fasting. He has suffered 2 similar episodes during the past 2 years. A gallbladder ultrasound obtained during a previous episode was normal. The patient has no other medical problems and takes no medications. He does not consume alcohol. Which of the following tests should be considered during the workup of this patient? A. Serum ceruloplasmin B. Serum cholesterol C. Serum ferritin D. Serum triglycerides Answer: D Page | 15 88. 65 year old male suffers from sever right upper quadrant pain for 12 hours radiating to the back. Ultrasound was done. It revealed gallbladder thickening and cholelithiasis. CBD diameter was more than 12 mm. It was afebrile. The labs: elevated AST, ALT, direct bilirubin and ALP. what is your management? A. Admit to hospital + IV fluid + IV antibiotic +ERCP B. Admit to hospital + IV fluid + IV antibiotic + laparoscopic cholecystectomy C. Give him an appointment for liver biopsy for chronic hepatitis screening D. Send home and schedule for elective laparoscopic cholecystectomy E. Pain management and send to home Answer: A 89. Which of the following can have liver transplantation? A. Single 6.5 cm mass in segment 4 with no lymph node involvement B. 1 tumor