2018

Recalls

January 2018 MRCS I.V.

 MRCS I.V. Course

Jan 2018
1. Numbness of the lower lips, which nerve involved?
A. Buccal
B. Mental
C. Superior alveolar
D. Lingual
E. None of the above

2. A Diabetic man on metformin or 11 years, presented to emergency unit with hyperglycemia and
drowsiness. What is the cause of lactic acidosis ?
A. Metformin
B. Aspirin
C. Alcohol
D. Frusemide
E. None of the above

3. A patient with Malignant melanoma. what is the best prognostic factor ?

A. .5 mm Breslow thickness
B. Free margins
C. No lymph nodes involved
D. No distant spread
E. None of the above

4. Patient is found to have extreme hypothermia. Which of the following be best management for
rewarming the patient?
A. Intraperitoneal fluid infusion
B. Rectal Warm water
C. Bladder warm water
D. Warm iv fluids
E. None of the above

5. External spermatic fascia of the cord is derived from which structure?

A. External oblique aponeurosis
B. Internal oblique muscle
C. Transversus abdominus
D. Fascia transversalis
E. Peritoneum

6. During cholecystectomy, pt. develops extreme bradycardia. Past history of heart transplant
present. Which drug to give?
A. Atropine
B. Glycopyrrolate
C. Ephedrine
D. Isopretrenol
E. None of the above

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7. What is the anesthesia for Colle's fracture?

A. Lidocaine
B. Bupivacaine
C. Xylocaine
D. Bier block
E. None of the above

8. What is the local anesthesia used in biers block?

A. Lidocaine
B. Bupivacaine
C. Xylocaine
D. Prilocaine
E. None of the above

9. Patient injured his tip of index finger, what is the best type of anesthesia to be used in ring block
or thumb injury
A. Lidocaine
B. Lidocaine with adrenaline
C. Bupivacaine
D. Bupivacaine with adrenaline
E. None of the above

10. Neonate with cyanotic heart disease. What is the diagnosis?

A. VSD
B. ASD
C. PDA
D. TGA
E. None of the above

11. which of following investigations is most accurate for measuring the GFR?
A. Creatinine clearance
B. Glucose Clarence
C. Inulin Clarence
D. PAH
E. Urea clearance

12. Which of the following is the 1st branch of internal carotid as soon as it leaves the cavernous
sinus?
A. Ophthalmic Artery
B. ACA
C. MCA
D. Anterior choroidal
E. Posterior communicating

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13. 60% burn case with bilateral leg edema. Cause?

A. Hypovolemia
B. DVT
C. Hypoalbuminemia
D. Sepsis
E. Circumferential burn

14. Hypercalcemia is firstly treated by

A. IV saline chloride .9%
B. IV ca chelating
C. K supplementation
D. Pamidronate
E. Zoledronate

15. A mother found meconium at in front of nappy:

A. Patent urachus
B. Patent vitello intestinal duct
C. Meckel diverticulum
D. Patent processes vaginalis
E. None of the above

16. Which of the following serves as the axis of gut rotation during development?
A. Celiac trunk
B. Superior mesenteric artery
C. Inferior mesenteric artery
D. Umbilical vessels
E. None of the above

17. Patient removed from burnt house. In what scenario patient needs intubation?
A. Resp rate of 35
B. pH 7.2
C. Sweating, confusion and anxious
D. Pco2 5.7
E. None of the above

18. Patient with serum potassium 6. What should be immediate step?

A. I.V. fluid
B. Insulin and glucose infusion
C. B agonist
D. Pamidronate
E. IV ca gluconate

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19. Which is true about FFP?

A. It is leuco-depleted
B. can't use them after 24 hours out of fridge
C. should be cross matched
D. urticaria is not one of its complication
E. All of the above

20. Which of the following requires immediate renal replacement?

A. K+ 6.5 mmol/L
B. PH acidotic
C. Increase creatinine
D. Increase BUN
E. None of the above

21. Sigmoid colon bleeding planned for angioembolization. Which vessel should the interventionist
enter to stop bleed?
A. Right colic
B. Left colic
C. Middle Colic
D. Rectal middle artery
E. Iliocolic

22. Action on which of the following receptor is responsible for the depressant action in an old man
who underwent laparotomy and is on Morphine, RR is 6/min?
A. Mu receptor
B. Delta
C. Dopamine
D. Serotonin
E. None of the above

23. Which of the following muscles is responsible for quiet respiration?

A. Diaphragm
B. Intercostals
C. Scalene
D. Serratus anterior
E. Abdominal wall muscles

24. After excision of submandibular gland , there is deviation of tongue is noted. What is the nerve
injured during operation?
A. Marginal mandibular
B. Hypoglossal
C. Lingual
D. Glossopharyngeal
E. Spinal accessory

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25. General sensation lateral tongue by which nerve?

A. Lingual
B. Glossopharyngeal
C. Vagus
D. Chorda tympani
E. Hypoglossal

26. A 53 years old woman with hypothyroidism and microcytic anemia (MCV was low. Which of the
following is the patient at highest risk of during perioperative period?
A. Decreased cardiac contractility
B. High cholesterol
C. Decrease motility of GIT
D. Cold intolerance
E. Menstrual irregularity

27. Female patient suffered from atrophic gastritis. Which of the following antibodies will be
found?
A. Antibody to parietal cells
B. Antibody to peptic cell
C. Antibody to enteroendocrine cells
D. Antibodies to mucous cell
E. None of the above

28. Post-operative patient who is recently getting restless. Urine output chat is tabulated hourly as
80 ml / 80ml/ 80 ml /0ml/ 0ml/ 0ml in last 5 hours. what is the cause?
A. Blocked Catheter
B. Hypovolemic shock
C. Acute tubular necrosis
D. Stress condition
E. None of the above

29. Over infusion 3.5 L of NS to shock patient, which of the following is the potential result ?
A. hyperchloremic acidosis
B. hyperchloremic alkalosis
C. hyperchloremic alkalosis
D. hyperchloremic alkalosis
E. None of the above

30. During splenectomy, short gastric arteries ligated. which structure at risk of direct damage?
A. Fundus of the stomach
B. lesser curvature of stomach
C. Tail of pancreas
D. Left kidney
E. Left supra renal

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31. Which of the following is not in immediate relation of 3rd part of duodenum?
A. Right kidney
B. Right ureter
C. Right Psoas
D. IVC
E. Aorta

32. Which of the following makes the posterior wall of inguinal canal?
A. Conjoint tendon
B. Internal oblique muscle
C. Transversus abdominus
D. External oblique muscle
E. None of the above

33. Which of the structures listed is the reason that testis descends to scrotum?
A. Gubernaculum
B. Processes vaginalis
C. Tunica vaginalis
D. Spermatic cord
E. None of the above

34. Scrotal ulcer LN drainage is:

A. Deep inguinal
B. Lumbar paraaortic
C. Superficial inguinal
D. Internal iliac
E. None of the above

35. Female cervix lesion LN drainage is:

A. Deep inguinal
B. Lumbar paraaortic
C. Superficial inguinal
D. Internal iliac
E. None of the above

36. Anal canal lesion drains into:

A. Deep inguinal
B. Lumbar paraaortic
C. Superficial inguinal
D. Internal iliac
E. None of the above

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37. Prior to Episiotomy, which nerve is blocked?

A. internal pudendal nerve
B. obturator nerve
C. ilioinguinal nerve
D. Genitofemoral nerve
E. Lumbosacral trunk

38. Which of the following changes is expected after cholecystectomy?

A. Decreased secretion of bile salts
B. Reduced hepatic circulation of bile salts
C. Increased production of bile acids
D. Elevated bile salt secretion
E. None of the above

39. A 33 years old male presented with a tender swollen testis with black dot in the upper pole of
his scrotum. What is the most likely diagnosis?
A. Torsion of testicular cord
B. Hydrocele
C. Hematocele
D. Torsion of testicular hydatid
E. Teratoma

40. What is the main treatment of Anaphylaxis

A. IM adrenaline
B. Anti-allergic medication
C. Oxygen
D. IV antihistaminic
E. IV cortisol

41. chylothorax after thoracotomy and esophagectomy. Where in the course is the Thoracic duct
injured?
A. Before it entered subclavian in neck
B. At pleural reflection in superior mediastinum
C. During its course from diaphragm before it reached superior mediastinum
D. At the entry un the junction between internal jugular and subclavian
E. None of the above

42. A neonate with audible bowel sound in left chest. What is the congenital defect?
A. Failure to closure of pleuroperitoneal membrane
B. Failure of closure of septum transversum
C. Wide opening of the esophagus
D. Failure of separation of foregut and trachea-esophageal tube
E. None of the above

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43. Coin ingested and seen on x-ray somewhere, where will you find it Lodged?
A. At thyroid level
B. At hyoid level
C. at cricopharyngeal level
D. At heart level
E. At the carina

44. Mechanism behind pale offensive stool in Obstructive jaundice

A. decreased enterohepatic circulation
B. increase conjugated bilirubin in the blood
C. decrease conjugated bilirubin in the blood
D. decrease hepatic secretion of bile
E. none of the above

45. Which of the following intervention will decrease raised ICPP with immediate effect but short
duration?
A. Hyperventilation
B. Hypoventilation
C. Mannitol
D. Head position low than the body
E. None of the above

46. Long scenario on Pancreatitis. Which of the following is the mediator of auto digestion?
A. Trypsin
B. Lipase
C. Amylase
D. Fecal elastase
E. Gastrin

47. A man complains of being thirsty and getting up in the middle of the night to go to the toilet.
His weight is 85.5 kg, height 1.65 in and blood pressure 167/94 mmHg. An oral glucose tolerance
test was performed and produced the following results: Fasting plasma glucose 11.3 mmol/L The
most likely diagnosis:
A. Diabetes insipidus
B. Diabetes mellitus
C. Impaired fasting blood sugar
D. sepsis
E. None of the above

48. A 58-year-old woman presented to the Emergency Department with a large fluctuant swelling
the site of a recent insect bite. She is anxious, tachycardic, and pyrexial. An ECG shows critical
fibrillation. She is noted to have a goiter. The swelling at the site of the bite requires surgical
drainage. Which of the following classes of drug would be most appropriate as part of her
preoperative preparation for surgery?
A. Alpha-2 adrenoceptor agonist
B. Alpha-1 adrenoceptor agonist

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C. Alpha adrenoceptor blocker

D. Beta adrenoceptor agonist
E. Beta adrenoceptor blocker

49. Male patient 63 years old with sudden loss of consciousness and monoplagia affection his right
upper limb and Broca's Aphasia, Which Artery is mostly affected?
A. left anterior cerebral
B. left middle cerebral
C. Right anterior cerebral
D. Left anterior cerebral
E. Right PCA

50. Male patient 65 years old with sudden affection of gait, disequilibrium and nystagmus
A. PICA Syndrome
B. AICA syndrome
C. Anterior cerebral artery affection
D. Middle cerebral artery affection
E. PCA affection

51. A young guy with Midgut volvulus underwent resection and has 30cm of gut left. What is the
option of nutrition for this patient
A. TPN
B. Can be fed orally
C. Feeding jejunostomy
D. PEG
E. Nasogastric tube

52. Redo operation for esophageal cancer. What is the option of nutrition for this patient
A. TPN
B. Can be fed orally
C. Feeding jejunostomy
D. PEG
E. Nasogastric tube

53. After right hemicolectomy. What is the option of nutrition for this patient
A. TPN
B. Can be fed orally
C. Feeding jejunostomy
D. PEG
E. Nasogastric tube

54. A confusing scenario of patient developing sudden urinary retention and lower limb paresis.
Which artery?
A. Anterior spinal
B. Artery of Adamchweick
C. Lumbar artery
D. Posterior spinal artery

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E. Vertebral artery

55. A 37-year-old man presents with severe headache, photophobia and neck stiffness. Kernig's
sign is positive and a midline lumbar puncture is performed immediately to determine if a
cerebrospinal fluid (CSF) pathogen is involved. In performing this procedure, which is the last of
the following structures to be pierced by the lumbar puncture needle?
A. Arachnoid mater
B. Dura mater
C. Interspinous ligament
D. Posterior longitudinal ligament
E. Anterior longitudinal ligament

56. 55 years old are came to your clinic with lateral squint after head and neck operation, which
other features may you find in this patient?
A. Mydriasis
B. Exophthalmos
C. Pale skin
D. Nystagmus
E. None of the above

57. 55 years old came to your clinic after hyperhidrosis operation and he is diagnosed as Horner
syndrome. Which site may be affected?
A. Anterior horn of spinal cord
B. Posterior horn of spinal cord
C. Dorsal root ganglia
D. Lateral horn of spinal cord
E. None of the above

58. A 65-year-old man, remains, on the high dependency unit following a gastrectomy three days
previously. His urine output: has averaged 80ml/hour for the last 24 hours. He has one dry
abdominal drain arid no nasogastric losses: His urea and electrolytes are normal He is to stay nil
by mouth for a further 24 hours. Which of the following fluid regimes is most appropriate to his
electrolyte and water requirements over the next 24 hours?
A. 1 L of 0.9 % saline plus 1.5 L. of 4 % dextrose/0.18 % saline
B. 1 L of 0.9 % saline plus 1.5 L of 5 % dextrose
C. 1 L of 0.9 % saline plus 1.5 L of Hartmann's solution
D. 2 L of 0.9% saline
E. 2 L of 4 % dextrose/0,18 % saline

59. Which is true regarding left coronary?

A. It runs behind pulmonary trunk
B. It runs in anterior interventricular groove
C. It comes out of aorta just below the valves
D. It is branch of aortic arch
E. All of the above

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60. A clinical scenario that you need to do a tracheostomy. Which of the listed structures have the
least chance to get injured in this procedure?
A. Ascending pharyngeal artery
B. Recurrent laryngeal nerve
C. Anterior jugular artery
D. Thyroid isthmus
E. None of the above
61. Mechanism of action of heparin includes:
A. V/ VIII/ X inhibition
B. X inhibition
C. antithrombin 3 inhibition
D. thrombin inhibition
E. All of the above

62. Urachus, the remnant will be seen as:

A. median umbilical ligament
B. medial umbilical ligament
C. lateral umbilical ligament
D. ligament teres
E. ligament venosus

63. A 53-year-old man presents with a nodule on his chin. He is concerned because it has grown
extremely rapidly over the course of the preceding week. On examination he has a swollen, red,
dome shaped lesion with a central defect that contains a keratinous type material.
A. Squamous cell carcinoma
B. Bowens disease
C. Actinic keratosis
D. Basal cell carcinoma
E. Keratoacanthoma
64. A 70-year-old lady presents with skin lesions that she describes as unsightly. On examination
she has raised lesions with a greasy surface located over her trunk. Apart from having a greasy
surface the lesions also seem to have scattered keratin plugs located within them.
A. Seborrheic keratosis
B. Keratoacanthoma
C. Squamous cell cancer
D. Basal cell cancer
E. None of the above

65. A 68-year-old farmer presents with a skin lesion on his ear pinna. It has been present for the
past 6 months and has grown slightly in size during that time. On examination he has an
ulcerated lesion with pearly white raised edges that measures 2cm in diameter.
A. Squamous cell carcinoma
B. Bowens disease
C. Actinic keratosis
D. Keratoacanthoma
E. Basal cell carcinoma

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66. A 21-year-old lady presents with a nodule on the posterior aspect of her right calf. It has been
present at the site for the past 6 months and occurred at the site of a previous insect bite.
Although the nodule appears small, on palpation it appears to be nearly twice the size it appears
on examination. The overlying skin is faintly pigmented.
A. Dermatofibroma
B. Malignant melanoma
C. Pyogenic granuloma
D. Decrum disease
E. None of the above

67. Bluish lesion of toe and inguinal lymphadenopathy?

A. Melanoma
B. SCC
C. BCC
D. Ischemia
E. Cellulitis

68. A man develops septicemia following surgery for perforated acute appendicitis He is
hypotensive. Arterial blood gases reveal: PH= (7.26) PaCo2= (7.2KPA) Pa02= (75 kPa).
Bicarbonate= (17 mmol/L) What is the most likely explanation for these readings ?
A. Compensated metabolic acidosis
B. Compensated respiratory acidosis
C. Mixed metabolic and respiratory acidosis
D. Uncompensated metabolic acidosis
E. Uncompensated respiratory acidosis

69. A woman with emphysema receiving 28% oxygen by mask has the following blood gas results
PH= (7.28) /p02= (6.2) /pCo2= (8) Bicarbonate= (36) Base Excess= (+5) The most likely
interpretation is:
A. Metabolic acidosis
B. Metabolic alkaosis
C. Mixed respiratory and metabolic acidosis
D. Partially compensated metabolic acidosis
E. Partially compensated respiratory acidosis

70. Trauma to head and vertex is depressed. Which structure may be damaged?
A. Superior sagittal sinus
B. Inferior sagittal sinus
C. Transverse sinus
D. Sagittal sinus
E. Confluence of sinus

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71. The child presented by bluish cystic lesion below the tongue and described as Ranula. Which
gland does it originate from?
A. sublingual gland
B. submandibular gland
C. dermoid cyst
D. thyroglossal cyst
E. none of the above

72. child swallow a coin come with difficulty breathing Xray show coin at the gastro-osepgheal
junction and how far is this from the incisors.
A. 22 cm
B. 25 cm
C. 27 cm
D. 30 cm
E. 40 cm
73. An ICU patient on Intermittent positive pressure ventilator for collapsed lung what is the effect
of this type of ventilation ?
A. Increase stroke volume
B. Reduce venous return
C. Increase afterload
D. Increase cardiac contractility
E. None of the above

74. A man has continuous ooze from wound for 2 days after a femoropopliteal bypass. He was on
aspirin and clopidogrel till 48 hours before operation. Why do you think is the bleed?
A. Side effects of Aspirin and clopidogrel
B. Anastomotic disruption at the proximal site
C. Loose suture in the skin
D. No hemostasis in the operation
E. None of the above

75. 70 years old man attended a respiratory clinic due to complaint of longstanding breathlessness.
His spirometry revealed an FEV1 of 1.8L and FVC of 2.1L. Which of the following are most likely
cause?
A. Fibrosing alveolitis
B. Asthma
C. Bronchiectasis
D. COPD
E. Emphysema
76. A young girl with dyspnea. FEV 1. 2 / FVC 3.6 then some treatment is given, what is the
diagnosis?
A. Asthma
B. fibrosing alveolitis
C. lung collapse
D. fibrosis
E. Asbestosis

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77. The patient presented of infection of dangerous area of the face lead to cavernous sinus
thrombosis. which of these nerves are affected?
A. Abducent
B. Facial
C. Cochlear nerve
D. Glossopharyngeal nerve
E. Mandibular branch of trigeminal

78. Doctor unable to pass NG to the stomach in 1-day neonate after fluid coming from mouth after
birth and made an x-ray which show air in stomach:
A. congenital esophageal atresia with tracheoesophageal fistula.
B. congenital diaphragmatic hernia
C. duodenal atresia
D. Hirschsprung
E. None of the above

79. A 58 years old man has noticed a testicular swelling that is painless on palpation. His father died
of testicular cancer. What is the tumor marker for testicular teratoma?
A. AFP
B. CEA
C. CA125
D. Alkaline phosphatase
E. S100

80. A patient is being admitted for scheduled elective surgery. He has been found to have nasal
MRSA positive. What is the most appropriate treatment line?
A. Mupirocin ointment for 5 days
B. Chlorhexidine body wash
C. IV vancomycin
D. Oral vancomycin
E. IV teicoplanin

81. A patient is shifted to a ward after laparotomy. Blood culture is positive for Gram +ve cocci. He
is asymptomatic. But another patient in the ward has MRSA infection. What is the most
appropriate treatment line?
A. Mupirocin ointment for 5 days
B. Chlorhexidine body wash
C. IV vancomycin
D. Oral vancomycin
E. IV penicillin

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82. A 23 years old female noticed a groin swelling. On ultrasound, a femoral Hernia was diagnosed.
Intraoperatively, what is behind the neck of the hernia sac?
A. Inguinal ligament
B. Lacunar ligament
C. Pectineal ligament
D. Femoral vein
E. None of the abov

83. A 58 years old female complained of a nodule of 3 cm size in the extensor surface of elbow.
Biopsy was taken and showed necrobiotic granulomatous inflammation. What is the most
appropriate diagnosis?
A. Rheumatoid nodule
B. Erythema nodosum
C. Kaposi sarcoma
D. Basal cell carcinoma
E. SCC

84. A 23 years old male presented with a badly infected wound with crepitus on the anterior aspect
of the thigh. What is the expected causative organism?
A. Clostridium perfringens
B. Clostridium deficile
C. Staphylococcus aureus
D. E.coli
E. Streptococcus pyogenes

85. A 58 years old female presented with a rose-pink rash around cellulitic wound with eschars
which was also indurated. What is the expected causative organism?
A. Staphylococcus aureus
B. Streptococcus pyogenes
C. Anthrax
D. Clostridium perfringens
E. E.coli

86. A 23 years old female presented with a painful swelling over the dorsal aspect of her 3rd
metatarsal bone. What is the pathophysiology of Morton’s neuroma?
A. Nerve trauma and regeneration
B. Nerve inflammation with fibrosis
C. Fibrosis of perineural tissue
D. Nerve ischemia
E. None of the above

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87. A 22 years old athlete fell during a football game fracturing his right leg. A complex tibial
fracture was shown on Xray. Intramedullary nailing was done after open reduction. 7 hours later,
he developed dyspnea, breathlessness and chest pain. What is the most likely diagnosis?
A. ARDS
B. Pneumonia
C. Fat embolism
D. Coronary artery syndrome
E. Myocardial infarction

88. What investigation is best for a patient thought to have labral tear of acetabulum?
A. CT
B. 3 view xray
C. MRI
D. Compression ultrasound
E. None of the above

89. A 58 years old man presented with a long history of dysuria, weak stream and hesitation. On PR
a smooth swelling was palpated in the prostate. What is the underlying pathology of this lesion?
A. Hypertrophy
B. Hyperplasia
C. Dysplasia
D. Neoplasia
E. Atrophy

90. A 23 years old athlete had a fracture Shaft of femur in a rugby game which was reduced, and
implant placed. At the end of operation, you note that the lower leg seems pale with reduced
pulse. What is the best next step in management?
A. Reexplore the wound
B. Embolization
C. Angiography
D. Compartment release
E. Compression ultrasound

91. A 25 years old footballer described that he cannot extend his left knee after a trauma to his leg
in a match. What is the most likely cause?
A. Lateral meniscus tear
B. Anterior cruciate tear
C. Loose body
D. Posterior cruciate tear
E. Medial meniscus tear

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92. A 65 years old man described that he cannot extend his left knee. There is no history of
preceding trauma. What is the most likely cause?
A. Lateral meniscus tear
B. Meniscal cyst
C. Loose body
D. Posterior cruciate tear
E. Medial meniscus tear

93. On a physical examination, a 28 years old man was found unable to lift his thumb from table
while palm facing upwards. What is the expected nerve lesion causing this deformity?
A. Radial nerve
B. Posterior interosseous nerve
C. Median nerve
D. Anterior interosseous nerve
E. Ulnar nerve

94. A 54 years old female presented with loss of sensation over the medial aspect of her leg after a
varicose vein surgery. Which nerve is the most likely responsible?
A. Deep peroneal nerve
B. Sural nerve
C. Saphenous nerve
D. Superficial peroneal nerve
E. Tibial nerve

95. A 42 years old man described loss of sensation in the1st web space of the left foot. Which nerve
is the most likely responsible?
A. Deep peroneal nerve
B. Sural nerve
C. Saphenous nerve
D. Superficial peroneal nerve
E. Tibial nerve

96. A young guy with testicular pain which is eased with elevation of the testis. He is systemically
unwell with fever reaching 39 degrees. What is the most likely causative organism?
A. Staphylococcus aureus
B. Streptococcus pyogenes
C. Anthrax
D. Chlamydia
E. Clostridium perfringens

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97. A 25 years old athlete came with a single rib fracture. He is in pain, but he is vitally stable. What
is the most appropriate management?
A. Chest drain
B. Admission, observation and analgesia
C. Analgesia and discharge
D. Infiltration of wound with 5% bupivacaine
E. None of the above
98. A 59 years old COPD patient came with a rib fracture. X-ray was done with no hemo or
pneumothorax detected, but the patient is in pain. What is the most appropriate management?
A. Chest drain
B. Admission, observation and analgesia
C. Analgesia and discharge
D. Infiltration of wound with 5% bupivacaine
E. None of the above

99. A 34 years old patient presented after chest trauma. The trauma affected the ribs from 5th to
10th which were fractured. The patient is cyanosed and tachycardic. What is the most
appropriate management?
A. Chest drain
B. Surgical repair
C. Analgesia and discharge
D. Infiltration of wound with 5% bupivacaine
E. None of the above

100.A 23 years old athlete had the lateral side of his ankle injured in an inversion trauma. Which
two ligaments are the most liable for injury?
A. Deltoid ligament and Calcaneocuboid ligament
B. Calcaneocuboid ligament and Talocalcaneal ligament
C. Talocalcaneal ligament and deltoid ligament
D. Anterior and posterior talofibular ligament
E. Anterior talofibular ligament and Calcaneofibular ligament ligament

101.Cuboid bone has following joint relations in its distal part:

A. Fourth and fifth metatarsal bones
B. Medial cuneiform and navicular
C. 1st and 2nd metatarsal
D. Talus bone
E. 3rd metatarsal bone
102.What is the relation of extensor indices to extensor digitorum in index finger?
A. Medial
B. Lateral
C. Posterior
D. Anterior
E. None of the above

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103.A 70 years old man with prostatic cancer, has bony metastasis to shaft of femur and is
asymptomatic. What is the most appropriate mode of treatment?
A. Radiotherapy
B. Morphine
C. PCM
D. Further investigation
E. Watchful waiting

104.A 12 years old child presented with a-four-hour history of testicular pain after bicycle riding.
Examination shows a tender scrotum. What is the most appropriate treatment?
A. Testicular doppler
B. Explore immediately
C. Call urologist
D. Medical treatment
E. Aspiration

105.A 33 years old male presented with a tender swollen testis with black dot in the upper pole of
his scrotum. What is the most likely diagnosis?
A. Torsion of testicular cord
B. Hydrocele
C. Hematocele
D. Torsion of testicular hydatid
E. Teratoma
106.A 44 years old man presented with a slowly growing painful lateral swelling in his left knee. He
reported no history of trauma. What is the most likely underlying cause?
A. Meniscal tear
B. Loose body
C. Meniscal cyst
D. Patellar fracture
E. Lateral cruciate tear

107.A 2 years old child was brought by his mother with ova and cysts in his stool associated with
bloody diarrhea. What is the most appropriate line of treatment?
A. metronidazole
B. tinidazole
C. Mebendazole
D. Bithionol
E. None of the above
108.A newborn was brought by his anxious mother with a lesion in his back. She reported that it is
present since his birth 8 days ago. On examination, a sac containing CSF and spinal cord matter
was protruding from his back. What is the underlying pathology?
A. Meningocele
B. Meningomyelocele
C. Spina bifida
D. Spinal canal stenosis
E. None of the above

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109.A 58 years old female complained of pain in her legs on walking which gets better by walking
uphill and pushing trolley. What is the underlying cause of this pain?
A. Meningocele
B. Vertebral disc prolapse
C. Spinal stenosis
D. Spondylolisthesis
E. None of the above

110.A 53 years old Egyptian presented with hematuria and dysuria. He was subsequently diagnosed
as having Schistosomiasis. What is the pathological cellular change associated with
Schistosomiasis?
A. Columnar dysplasia with goblet cells
B. Transitional cell neoplasia
C. Squamous metaplasia of transitional cells
D. Granulomatous metaplasia
E. None of the above

111.A 52 years old man suffered a pelvic fracture on a road accident. He is now unable to pass urine
with a tender full bladder on ultrasound. Where is the site of injury?
A. Membranous urethra
B. Bulbar urethra
C. Bladder rupture
D. Prostatic urethra
E. None of the above

112.Scaphoid bone receives its blood supply from:

A. its medial end
B. its proximal end
C. its distal end
D. its lateral end
E. None of the above

113.A 7 days neonate brought by his mother with an abnormal skin crease in his left groin. What is
the most likely cause?
A. Developmental hip dysplasia
B. Slipped upper femoral epiphysis
C. Perth’s disease
D. Stress fracture
E. None of the above
114.A 23 years old footballer has injured his left knee during a match. Xray revealed a displaced
patellar fracture. What is the most appropriate management?
A. Wire binding
B. Excision of quadriceps tendon
C. Boot cast
D. Nailing
E. None of the above

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115.After one week of injuring his arm. Which process is undergoing?

A. Angiogenesis
B. Hemostasis
C. Inflammation
D. Wound contraction
E. Remodeling

116.A 23-year-old man presents to the surgical clinic with an inguinal hernia. On examination he has
a small direct hernia. However, you also notice that he has pigmented spots around his mouth,
on his palms and soles. In his history he underwent a reduction of an intussusception aged 12
years. Which of the following lesions is most likely to be identified if a colonoscopy were
performed?
A. Hamartomas
B. Tubulovillous adenoma
C. Colorectal cancer
D. Crohns disease
E. Hyperplastic polyp

117.A 45-year-old homeless man presents with a cough and weight loss over three months. On
examination his BMI (Body Mass Index) is 19 and he has reduced breath sounds in the right
upper zone. His chest X-ray shows a caveating lesion in the right upper lobe. He undergoes a
bronchoscopy and a bronchial biopsy. The biopsy shows featureless necrosis surrounded cells in
the periphery. Which cell responsible for this condition?
A. Neutrophils
B. Macrophages
C. Basophils
D. Mast cells
E. Eosinophils

118. What is the Type of amyloid in Renal failure patient?

A. AL
B. AA
C. β-amyloid
D. Transthyretin
E. Globulin

119.An injury to orbit of eye due to direct hit by a squash ball. Now presents with diplopia. Visual
acuity Normal. X-ray orbit anatomy is normal. Best next investigation?
A. MRI
B. 3D CT
C. X-ray skull
D. U/S
E. None of the above

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120.A Case of pneumonia in a 3 years post renal transplant patient not responding to antibiotics.
Which organism is responsible about this condition?
A. EBV
B. CMV
C. H.Influenzae
D. Herpes zoster virus
E. T.B

121.Renal transplant patient described complaining from recurrent abdominal pain with bone pain
and he mentioned that he had had multiple fractures in the last period his investigations showing
High calcium, low phosphate, high alkaline phosphate. What is the diagnosis?
A. Tertiary hyperparathyroidism
B. Secondary hyperparathyroidism
C. Primary hyperparathyroidism
D. Increase vitamin D
E. None of the above

122.A 50-year-old man presented with progressive cough, dyspnea and weight loss starts to
complain and his investigations reveled Hyponatremia which histological type of lung cancer in
this patient?
A. Small cell carcinoma
B. Adenocarcinoma of the lung
C. Squamous cell carcinoma
D. Lung lymphoma
E. Adenosquamous carcinoma of the lung

123.A 60-year-old man brought to E/R complaining of trouble with speech and inability to form long
sentences what is the artery responsible for this condition?
A. ACA
B. MCA
C. PICA
D. PCA
E. None of the above

124.Male patient 55 years old presented to ER with slurred speech with termers and inability to
perform rapid alternating movement after examination of his eye there was nystagmus in his
both eyes what is your diagnosis?
A. PICA syndrome
B. ACA syndrome
C. MCA syndrome
D. Medullary syndrome
E. None of the above

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125.A 5-year-old child came to your clinic presented with swelling in his neck, his examination
revealed thyroglossal cyst. Why is it important to excise thyroglossal cyst?
A. Deglutition problem
B. infection
C. cancer
D. Fistula
E. None of the above

126.A 66-year-old female with 2-week history of stridor, dysphagia hoarseness of voice. On
examination thyroid swelling with lymph node +ve. FNAC shows spindle cells
A. Anaplastic thyroid carcinoma
B. Medullary thyroid carcinoma
C. Papillary thyroid carcinoma
D. Follicular thyroid carcinoma
E. Lymphoma

127.A 60-year-old man presents with a one-month history of headache, confusion and recent onset
of right sided hemiparesis. A CT scan demonstrates a 4 cm >- 4 cm lesion with central necrosis in
the left frontal lobe. It is seen extending across the midline along the corpus callosum. There is
extensive edema around the lesion. Which of the following is the most likely diagnosis of this
lesion?
A. Central neurocytoma
B. Ependymoma
C. Glioblastoma multiform
D. Meningioma
E. Oligodendroglioma

128.A Young girl came complaining from enlarged cervical lymph node. Diagnosed on
Histopathology as Medullary thyroid carcinoma. What is appropriate management?
A. total thyroidectomy with nodal clearance
B. total thyroidectomy only
C. hemithyroidectomy
D. subtotal thyroidectomy
E. None of the above

129.A 68-year-old female who has never smoked presents with a mass at the periphery of her right
lung. What is your diagnosis?
A. Adenocarcinoma
B. Small cell lung cancer
C. Large cell lung cancer
D. Squamous cell carcinoma
E. None of the above

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130.A 65year old Female with Breast Ca which is ER –ve . PR –ve but Her2 neu + ve with positive
3/15 L.N. what postop regime you give as adjuvant?
A. Tamoxifen
B. Tamoxifen and ECF regime
C. Herceptin and ECF regime
D. Herceptin only
E. None of the above

131.When you want to detect the ability of a screening test to detect the proportion of test positive
patients in relation to all other patients, what is the test that you will use?
A. Sensitivity
B. Specificity
C. Number needed to treat
D. Odds ratio
E. chi square

132.A 23-year-old athlete had a fracture Shaft of femur in a rugby game which was reduced, and
implant placed. At the end of operation, you note that the lower leg seems pale with reduced
pulse. What is the best next step in management?
A. Reexplore the wound
B. Embolization
C. Angiography
D. Compartment release
E. Compression ultrasound

133.Routine checkup of colonoscopy, colonoscopy Can't pass beyond hepatic flexure. What
investigation shall follow?
A. CT Colonography
B. US
C. Re use colonoscope
D. MRI Abdomen
E. Tumor markers

134.Which of the following changes occur after cholecystectomy?

A. Increase rate of bile follow after meals
B. Decreased rate of bile flow after meals
C. Change bile composition
D. Liver cell failure
E. None of the above

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135.A 35-year-old man notices that he is becoming dizzy when he plays squash, in addition he has
also developed cramping pain in his arm. When you discuss with the patient about his history, he
alleged that he enters in repeated attacks of fainting after aggressive jobs with the same limb.
What is the most appropriate first investigation?
A. Chest X-ray
B. CT-brain
C. Venous duplex of the neck
D. Arterial duplex of the aortic arch and it is branches
E. CT Angiogram of the aortic arch and it is branches

136.A 74 years old man presented to the ER with sigmoid perforation and fecal peritonitis the BP is
90-60 and pulse is 120. What is the best Surgical option?
A. Ileostomy
B. Hartman’s procedure
C. Diverting ileostomy with descending –rectal anastomosis
D. Ileoanal anastomosis and diverting colostomy
E. Cecostomy

137.Male patient complains from abdominal aneurysm measuring 4.7 cm what Is the best action?
A. Open surgical repair
B. EVAR
C. CT angiography
D. Follow up with serial ultrasound
E. No thing to do

138.A 35-year-old male complaining from dysphagia, by examination there is no weight loss or
palpable masses in the abdomen. The patient has history of esophagectomy and anastomosis. A
barium study showed a stenotic segment of 3 cm in the middle part of the esophagus. What is
the best intervention?
A. Surgical resection
B. balloon dilatation
C. Botulinum injection
D. Medical treatment
E. No intervention needed

139.A 43-lady presented by jaundice, she diagnosed as primary biliary cirrhosis. Which is the
antibody you can test positive?
A. ANA
B. ANCA
C. Alkaline phosphatase
D. antimitochondrial antibodies
E. CEA

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140. What is the best investigatory tool to detect air under diaphragm?
A. CT without contrast
B. US
C. CT colonography
D. MRI
E. Chest Abdomen X-Ray Erect

141.Female patient 40 years old has swelling painful leg and diagnosed as DVT, what is the best
initial investigation?
A. Duplex on the venous system
B. Compression ultrasound
C. Plethysmography
D. Venography
E. Superficial US

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Notes

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