surgery

Question 1

The most common malignant primary bone tumor is:

a. Osteosarcoma

b. Ewing cell tumour

c. Giant cell tumour

d. Osteoid osteoma

e. chondrosarcoma

Question 2

A 30-year-old male sustained road traffic accident resulting in pelvic fracture. What is the most reliable
sign indicating complete urethral disruption:

a. Blood at external meatus

b. Failure to pass a catheter

c. Inability to void

d. Perineal haematoma

e. A high ballottable prostate

Question 3

A 50 yrs old female presented with a 1 week history of yellow discoloration of the sclera and epigastric
pain, blood test showed total serum bilirubin of 7 mg/dl, direct 6 mg/dl and indirect 1 mg/dl. The next
investigation would be

Choose one answer.

a. Liver biopsy

b. Hepatitis serology.

c. Ultrasound abdomen

d. CT scan abdomen

e. ERCP and stone extraction

Question 4

In a patient with portal hypertension?

a. Liver transplantation has no role in patient with cirrhosis

b. Endoscopic banding or sclerotherapy is the treatment of choice for variceal bleeding.

c. Commonest cause in Sudan is hepatitis C virus.

d. Portal vein thrombosis is the commonest cause in pediatrics

e. Propanolol can be used as primary prophylaxis against variceal bleeding.

Question 5

Acute appendicitis is commonly associated with.

a. Anorexia

b. Vomiting.

c. White cells count more than 20000

d. Diarrhoea

e. Hyperpyrexia(temperature more than 38)

In superficial skin graft, we make holes in the graft

Choose one answer.

a. For Expansion of the graft.

b. To avoid infection.

c. Easy surgery.

d. For good blood supply.

e. For drainage.

Question 7

Regarding gall stones:

Choose one answer.

a. Most people with gallstones are asymptomatic.

 b. Gallstone ileus occurs when a gallstone travels through the bile duct into the small bowel and
causes an obstruction.

c. Mirizzi's syndrome is caused by a stone in the common bile duct

d. Approximately 90% of gallstones are visible on plain abdominal x-ray.

e. CT is the imaging modality of choice in diagnosing gallstones.

Question 8

Marks: 1

Immediate management of tension pneumothorax is?

Choose one answer.p;

a. Chest tube in the 6 th intercostals space mid axillary line .

b. Chest X-ray.

c. Insertion of needle at 2nd intercostals space mid clavicular line.

d. Chest CT Scan.

e. Thoracotomy.

Question 9

Marks: 1

The following paediatric tumor is congenital:

Choose one answer.

a. Neuroblastoma

b. Sacrococcygeal teratoma

c. Nephroblastoma

d. Pheochromocytoma

e. Intestinal lymphoma.

Question 10

Marks: 1

A lady of 70 years old with history of intermittent claudication presented with sever pain at the LL for
half hour, the diagnosis most probably is:
Choose one answer.

a. D.V.T

b. Varicose vein.

c. Chronic limb ischemia.

d. Diabetic septic foot.

e. Acute on chronic limb ischemia.

Marks: 1

The most common hernia in a female is.

Choose one answer.

a. Femoral hernia

b. Obturator hernia.

c. Indirect inguinal hernia.

d. Direct inguinal hernia.

e. Umblical hernia.

Question 12

Marks: 1

24- years –old man is brought into the emergency room after having a motor- cycle accident. He has a
scalp wound that is bleeding profusely. His eyes open only after his name is loudly called; however, he is
confused when asked about the details of the accident. He obeys commands in all extremities. In this
case, the Glasgow com scale(G C s) score is

Choose one answer.

a. 14.

b. 13

c. 12

d. 11

e. 15.

Question 13
Marks: 1

An elderly diabetic patient who has acute cholecystitis is found to have a serum sodium level of 122
meq/l and blood glucose of 600 mg/dl after correcting the glucose concentration to 100 mg/dl with insulin
the serum sodium concentration would

Choose one answer.

a. Increase to the normal range without specific therapy.

b. Remain essentially unchanged.

c. Decrease significantly unless the patient also received 3 percent saline

d. Increase to a hypernatremic level because of glucose-induced dieresis.

e. Decrease transiently but return to approximately 122 meq/L without specific therapy.

Question 14

Marks: 1

Skin graft is indicated in patient with:

Choose one answer.

a. malignancy.

b. Exposed bone.

c. Deep burn.

d. Superficial burn.

e. Wound with granulation tissue.

Question 15

Marks: 1

Tennis elbow represents:

Choose one answer.

a. Lateral epicondylitis

b. Adhesive capsulitis

c. Medial epicondylitis

d. Stress fracture
 e. Tenosynovitis

The most important feature of compartment syndrome is:

Choose one answer.

a. Pallor

b. Palpable pulse.

c. Pain

d. Parathesia

e. Paralysis

Question 17

Marks: 1

The commonest type of hernia in children is:

Choose one answer.

a. Direct inguinal hernia.

b. Incisional hernia

c. Oblique inguinal hernia.

d. Femoral hernia.

e. Umbilical hernia .

Question 18

Marks: 1

Which type of ulcer typically occur in ventilated ICU patient.

Choose one answer.

a. Marjolin ulcer.

b. Cushing ulcer.

c. Stress ulcer.

d. Curling ulcer.
 e. Venous ulcer.

Question 19

Marks: 1

The most commonly used imaging method for diagnosis of acute cholecystitis is.

Choose one answer.

a. Ultrasound of the abdomen.

b. Oral cholecystogram.

c. CT of the abdomen.

d. MRI of the abdomen.

e. Radionuclide scan of the gallblader.

Question 20

Marks: 1k.

The osmolarity of the extracellular fluid space is determined primarily by the concentration of

Choose one answer.

a. Phosphate radicals

b. Bicarbonate

c. Sulfate radicals

d. Chloride ion

e. .Sodium ion

Ureteric obstruction:

Choose one answer.

a. Is associated with hematuria.

b. Is usually associated with infection behind the obstruction

c. Usually requires open surgical relief of the obstruction.

d. Is commonly caused by a urinary tract calculus.

 e. Is associated with deterioration of renal function and rising blood urea and creatinine values.

Question 22

Marks: 1

35 years old man is admitted after having an accident in the machinery, his airway was intact. PR 119
pbm , BP 130/105 and RR 25/mint. In what stage of shock this patient?

Choose one answer.

a. Class I.

b. Class III.

c. Class II

d. Impossible to say from given information.

e. Class IV.

Question 23

Marks: 1

Typical clinical presentation for most Renal Cell Carcinoma cases is:

Choose one answer.

a. gross haematuria

b. Microscopic haematuria

c. Incidental finding

d. Loin pain

e. Loin mass

Question 24

Marks: 1

Avascular necrosis of the femoral head is a complication of:

Choose one answer.

a. Subtrochanteric fractures.

b. Exteracapsular hip fractures.

c. Femoral shaft fractures.

 d. Intracapsular hip fractures

e. Hip dislocation.

Question 25

Marks: 1

Correct statements about insensible water loss in humans include.

Choose one answer.

a. Insensible water loss through the skin is in the form of sweat.

b. Insensible water loss through an unhumidified tracheotomy tube may exceed one liter per day

c. Insensible water loss drops to near zero when intake is sharply curtailed.

d. Insensible water loss is caused by vomiting

e. Insensible water loss occurs through skin and feces

The most common type of shoulder dislocation is:

Choose one answer.
a. - Medial
b. Superior
c. Inferior
d. Posterior
e. Anterior
Question 27
Marks: 1
The most important symptoms, those deserve investigations and appropriate mangement before hernial
repair are.
Choose one answer.
a. Groin swelling and suprapubic pain.
b. Constipation and backache.
c. Recent cough and chest pain
d. Urinary hesitency and straining.
e. Crampy abdominal pain and dyspepsia .
Question 28
Marks: 1
Meckles diverticulum often occur in.
Choose one answer.
a. Proximal ileum.
b. Distal ileum.
 c. Second part of the duodenum.
d. Distal jejunum.
e. Proximal jejunum.
Question 29
Marks: 1
The most commonly injured nerve following humerus shaft fractures is
Choose one answer.
a. Radial nerve.
b. Anterior interosseous nerve.
c. Ulnar nerve.
d. Posterior interosseous nerve.
e. Median nerve.
Question 30
Marks: 1
Which of the following factors decrease the intracranial pressure (I C P)
Choose one answer.
a. Movement.
b. Complete bed rest.
c. Pain.
d. Fever.
e. Valsalva.
Esophageal atresia :
Choose one answer.
a. Is best diagnosed by contrast study
b. The commonest type is pouch atresia without fistula
c. Is associated with bulging of the left hemi-thorax & scaphoid abdomen
d. Majority have lower pouch Trachea-esophageal a tresia
e. IS associated with oligohydramnios
Question 32
Marks: 1
The most common type of headache is
Choose one answer.
a. Cluster.
b. Post concussive.
c. Migraine
d. Due to temporal arteritis.
e. Tension.
Question 33
Marks: 1
Pleomorphic adenoma of the parotid gland is best treated with
Choose one answer.
a. Simple enucleation
b. Radical parotidectomy
c. Radiotherapy
d. Superficial parotidectomy
e. Local extra-capsular excision
Question 34
Marks: 1
Beck’s triad used to diagnose?
Choose one answer.
a. Haemothorax.
b. Traumatic rupture of the aorta.
c. Tension pneumothorax.
d. Cardiac tamponade.
e. Pleural effusion.
Question 35
Marks: 1
A 28 years fit male,with a history of reducible swelling ,develop abdominal pain ,distension and
vomiting.The most probable cause is.
Choose one answer.
a. Adhesive intestinal obstruction.
b. Faecal impaction.
c. Pseud-obstruction of the colon.
d. Sigmoid volvulus.
e. Obstructed inguinal hernia.

The commonest complication of undescended testicle is :

Choose one answer.
a. Strangulated inguinal hernia
b. Testicular trauma
c. Decrease chance of fertility
d. High incidence of malignancy
e. Testicular torsion
Question 37
Marks: 1
In a 21 yrs woman, the most important Indication for surgery in thyroid enlargement is?
Choose one answer.
a. Failure of medical treatment.
b. Physiological goiter.
c. Suspicion of malignancy.
 d. Cosmosis.
e. Multinodular goiter.
Question 38
Marks: 1
Visceral abdominal pain is typically.
Choose one answer.
a. Mediated via spinal nerves.
b. Well localized.
c. Sharp and precise.
d. Easy to control.
e. Vague,perceived in the midline.
Question 39
Marks: 1
The first choice for diagnosis of a suspected deep vein thrombosis of the lower limb is:
Choose one answer.
a. Radioactive labled fibrinogen uptake
b. Real time Doppler imaging
c. Isotope injection with gamma scanning
d. Plethysmography
e. Contrast sonography
Question 40
Marks: 1
A forty year old lady complains of right sided bloody nipple discharge the most likely diagnosis is :
Choose one answer.
a. Duct – ectasia.
b. Fibrocystic disease of the breast.
c. Intraductal papilloma .
d. Mastitis.
e. Ductal carcinoma.

A 63 year old man presented with lower urinary tract symptoms (LUTS) , lower back pain and a PSA of
20 ng/ml. What is your next course of action:

Choose one answer.

a. Magnetic Resonance imaging

b. Transrectal Ultrasound guided prostatic biopsy

c. Digital rectal examination

d. Start hormonal therapy

e. Treat with Finasteride

Question 42

Marks: 1

The most important indication of thoracotomy in haemothorax is?

Choose one answer.

a. Drainage of 500ml of blood immediately through chest tube.

b. Severe respiratory distress.

c. 200ml of blood in one hour.

d. Oxygen saturation less than 60%.

e. Drainage of 1 liter or more through chest tube immediately.

Question 43

Marks: 1

The commonest premalignant condition predisposings to adenocarcinoma of the oesophagus is

Choose one answer.

a. Caustic stricture.

b. Barret,s oesophagus.

c. Plummer-Vinson syndrome.

d. Radiation oesophagitis.

e. Achalsia of the cardia.

Question 44

Marks: 1

A 45 years old woman is brought into the urgent care center after being involved in motor vechicle
accident while driving home with her husband.Her husband was ejected from the car by the force of the
impact and did not survive.On initial exam her eyes open to pain ,and she utters only sounds she localizes
pain on the right arm ,withdraws on the left side and the right leg is not examined due to the possibility of
a fracture. the Glasgow Coma Scale (G C s) of this case is

Choose one answer.

a. 7

b. 10.

c. 11.

d. 8

e. 9
Question 45

Marks: 1

In a patient with acute renal failure, the LEAST urgent reason for dialysis is

Choose one answer.

a. SEVERE ACIDOSIS

b. BUN <100ML/DL

c. HYPERKALEMIA

d. UREMIC PERICARDITIS

e. UREMIC ENCEPHALOPATHY.

A 50 years old man broad to the E/R after road traffic accident he sustained deep laceration on his Rt foot
and Rt leg. O/E: - the wound is found to contain sand and mud, muscles at wound site were black in
colour . The best to do is?

Choose one answer.

a. Do above knee amputation.

b. Debridement of the wound and graft it.

c. Irrigate the wound with warm saline, cover it with gauze and give the patient antibiotic.

d. Debridement of the wound and closure with 2/0 nylon.

e. Debridement of the wound, apply dressing and leave it open

Question 47

Marks: 1

The most common fluid disorder in the surgical patient is

Choose one answer.

a. C.Hyponatremia

b. B.Hyperkalemia

c. E.Metabolic alkalosis

d. D.Metabolic acidosis
 e. Extracellular fluid volume deficit

Question 48

Marks: 1

A 75-year-old lady presented to the casualty with left lower quadrant abdominal pain, lasting for 10
hours. She is known to have chronic constipation. On examination; looked ill, pulse rate 100 b/m, blood
pressure 90/60, temperature 39C and there was tenderness with guarding in the left iliac fossa. Erect plain
abdominal X-ray showed free gas under the diaphragm. This patient most probably has:

Choose one answer.

a. Perforation of colonic diverticulum

b. Torsion left ovarian cyst

c. Perforated duodenal ulcer

d. Perforated appendicitis

e. Crohn’s disease

Question 49

Marks: 1

In 78 years old male,sudden massive rectal bleeding is most likely due to.

Choose one answer.

a. Diverticular disease.

b. Ulcerative colitis.

c. Bleeding tendency.

d. Acute anal fissure.

e. Juvenile rectal polyp.

Question 50

Marks: 1

In preparing a patient with hyperthyroidism for surgery it’s important to?

Choose one answer.

a. Do direct laryngoscope.

b. Prepare 2 unit of blood.

 c. Told him about complication.

d. Bring him to euthyroid status.

e. Keep him fasting for 1 day.

Which organism, is more concern to Urologist , in causing complicated UTI:

Choose one answer.

a. Chlamydia trachomatis

b. Proteus Mirabilis

c. Streptococcus faecalis

d. Echerichia coli

e. Staph Epidermidis

Question 52

Marks: 1

A 35-year-old smoker is involved in a house fire and receives a 45% total surface area burn. One half of
the burned surface appears to be third degree. On the third post-burn day, the patient is noted to have
bloody drainage from a NG tube and a decrease of 5% in his hematocrit. Appropriate management should
include which of the following:

Choose one answer.

a. Blood transfusion with PPI (Proton Pump Inhibitor) infusion.

b. Immediate selective arteriography to diagnose and treat presumed stress ulceration

c. Urgent upper gastrointestinal contrast study to delineate site of bleeding

d. Urgent intravenous infusion of vasopressin

e. Urgent OGD (esophagogastroduodenoscopy)

Question 53

Marks: 1

A 25 yrs old man stabbed on Rt side of his chest .On arrival he was haemodynamically unstable with
reduced air entry on the Rt side. O2 saturation on room air was 90% chest X-ray showed haemothorax on
the affected site. The most appropriate management is?
Choose one answer.

a. Thoracotomy.

b. Prescription of antibiotics.

c. Intubation with mechanical ventilation.

d. Insertion of chest tube

e. Observation.

Question 54

Marks: 1

You are called urgently to see an 80 years man who is six days following anterior resection of rectal
cancer because, he saw gush of pink fluid come from his laparotomy incision. O/E: - you noticed loop of
small intestine coming out from his wound. Following initial resuscitation the next best step is to?

Choose one answer.

a. Return the patient to theater for deep tension sutures.

b. Call for senior help.

c. Apply vacuum assisted closure therapy.

d. Administration of I V cephalosporin.

e. Cover the small bowel with sterile saline soaked gauze

Question 55

Marks: 1

A neonate presented with delayed passage of meconium for more than 48 hours most likely due to:

Choose one answer.

a. Pyloric stenosis

b. Meconium ileus

c. Hirsch sprung’s disease

d. Jejuno-ileal atresia

e. Annular panereas
The most dominant risk factor for breast cancer is:

Choose one answer.

a. Aging.

b. Working during night shifts.

c. Past history of benign breast surgery .

d. Smoking.

e. Alcohol abuse .

Question 57

Marks: 1

A middle third clavicle fracture in a child is best treated by:

Choose one answer.

a. Plate and screws

b. K wires

c. Brace

d. Arm sling

e. Plaster of Paris

Question 58

Marks: 1

Contraindication of surgery in varicose vein is:

Choose one answer.

a. Eczema.

b. D.V.T.

c. Renal mass.

d. Trauma.

e. Valve incompetence.

Question 59
Marks: 1

A patient with no oral intake is being maintained by intravenous 0.45 percent saline solution over a period
of time the initial result will be a transfer of

Choose one answer.

a. Water from the extracellular to the intracellular space

b. Sodium ion from the extracellular to the intracellular space

c. Sodium ion from the intraocular to the extra cellular space

d. Potassium ion from the intracellular to extracellular space

e. Water from the intracellular to the extracellular space

Question 60

Marks: 1

A fifty year old lady presents with left sided breast lump which is attached to skin and chest wall with
palpable ipsilateral axillary lymph nodes , the first line of treatment is:

Choose one answer.

a. quadrent-ectomy plus axillary clearance.

b. Mastectomy plus axillary clearance .

c. Immune-therapy.

d. Hormonal therapy.

e. Chemo-therapy.

Good luck all of you