SurgiNotes 2022 - Questions 2010-2021

ELEMAM’s SurgiNotes 2022
[Questions 2010-2021]
‫بسم هللا الرحمن الرحيم‬
‫ الملف ده فيه امتحانات خاصه بالجزء األول للزمالة المرصية ف الجراحة العامة و تخصصتا‪.‬‬
‫ عباره عن ‪:3 Parts‬‬
‫‪Part A‬‬
‫• الجزء ده عباره عنه ‪ 12‬امتحان ‪( MCQ‬وىه كل االمتحانات المتاحة من ‪ 2010‬ل ‪:)2021‬‬
‫‪1. 2021 September - Paper (1) MCQ [Not Answered].‬‬
‫‪2. 2021 March - Paper (2) MCQ.‬‬
‫‪3. 2020 October - Paper (2) MCQ.‬‬
‫‪4. 2020 October - Paper (1) MCQ.‬‬
‫‪5. 2019 July - Paper (1) MCQ.‬‬
‫‪6. 2018 July - Paper (1) MCQ.‬‬
‫‪7. 2018 February - Paper (1) MCQ.‬‬
‫‪8. 2017 February - Paper (1) MCQ.‬‬
‫‪9. 2015 March - Paper (1) MCQ.‬‬
‫‪10.2014 March - Paper (1) MCQ.‬‬
‫‪11.2013 June - Paper (1) MCQ.‬‬
‫‪12.2010 January - Paper (1) MCQ.‬‬
‫• االمتحانات دي كلها مجابه من فايل د‪ O.A. /‬ما عدا االمتحان االول لسه اجاباته مش متوفرة‬
‫سني اىل فاتت بنسبه‬
‫بس الحمد هلل االمتحان لحسن الحظ متكرر منه كت ري من أسئلة ال ر‬
‫‪ %60‬تقريبا‪.‬‬
‫• فيه بعض األسئلة لألسف مش موجوده ف الورق األصل اىل ناقل منه االمتحانات وده ف‬
‫امتحاني بس الحمد هلل‪:‬‬
‫ر‬
‫‪1. 2021 September - Paper (1) MCQ:‬‬
‫‪a. 13 – 14 – 15 – 16 – 17.‬‬
‫‪2. 2018 July - Paper (1) MCQ:‬‬
‫‪a. 4 – 3 – 2 – 1.‬‬
‫‪b. 13 – 12 – 11 – 10 – 9.‬‬
‫‪c. 44 – 43 – 42 – 41 – 40.‬‬
‫‪d. 97 – 96 – 95 – 94 – 93.‬‬
‫• برده فيه بعض الكلمات ماكنتش واضحة او مش موجوده في بعض األسئلة بس الحمد هلل مش‬
‫كتير‪:‬‬
‫‪1. 2020 October - Paper (2) MCQ: 65.‬‬
‫‪2. 2018 July - Paper (1) MCQ: 90.‬‬
‫‪Part B‬‬
‫• الجزء ده عباره عنه ‪ 7‬امتحانات ‪( Written‬وىه كل االمتحانات المتاحة من ‪ 2010‬ل‬
‫‪:)2021‬‬
‫‪1. 2019 July - Paper (2) Written.‬‬
‫‪2. 2018 July - Paper (2) Written.‬‬
‫‪3. 2018 February - Paper (2) Written.‬‬
‫‪5. 2013 June - Paper (2) Written.‬‬
‫‪7. 2012 June - Paper (2) Written.‬‬
‫• االمتحان دي مش متجاوبة بس الموضع بسيط تقريبا كل المواضيع موجوده في كتاب الجراحة‬

‫بتاع القصر العيني في الجزء الى متحدد للجزء االول وفيه كمان بالي ليست موجوده على‬
‫اليوتيوب باسم ‪ Egyptian Fellowship - General Surgery‬على القناه الرسمية للزمالة‬
‫المصرية شارحه معظم المواضيع دي‪.‬‬
‫• فيه بعض الكلمات ماكنتش واضحة او مش موجوده في بعض األسئلة بس الحمد هلل في امتحان‬
‫واحد‪:‬‬
‫‪1. 2013 June - Paper (2) Written: 9 a – c – d.‬‬
‫‪Part C‬‬
‫• الجزء ده عباره عنه ‪ 3‬أجزاء ‪ MCQ‬ف ال ‪( Basic‬متكرر فيها أسئلة ر‬
‫كتي ف االمتحانات‬
‫المتاحة من ‪ 2010‬ل ‪:)2021‬‬
‫‪1. Surgical Anatomy MCQ.‬‬
‫‪2. Antibiotics Pharmacology MCQ.‬‬
‫‪3. Physiology MCQ.‬‬
‫‪.‬‬ ‫• فيه بعض األسئلة متكررة ف نفس الفايل سبتها لزياده التأكيد للناس اىل بتنس برسعه‬
‫غي‬
‫ ف النهاية انا جمعت االمتحانات واألسئلة دي بغرض ان احنا نساعد بعض ومش محتاج منكم ر‬
‫دعوه بظهر الغيب ولو حد ليه أي تعديل عل اجابه او أي حد قدر يوصل ل األسئلة او الكلمات اىل‬
‫ناقصه ما رييددش انه يقول عليها ‪......‬‬
‫بالتوفيق ان شاء هللا لينا كلنا ف االمتحان اىل جاي‬

PART A:
Previous Exams - MCQ [2010-2021]
ELEMAM’s SurgiNotes
ElEMAM’s SurgiNotes 2022
Egyptian Board Of General Surgery

1st Part Exam – Paper (1) MCQ
September 2021
1. A 34-year-old man is undergoing an emergency appendectomy. After the
appendectomy has been performed successfully, the patient undergoes an
exploratory laparoscopy. Which of the following anatomic features are the MOST
useful to distinguish the jejunum from the ileum?
a. Jejunum has thinner walls compared with the ileum.
b. Jejunum has less mesenteric fat compared with the ileum.
c. Jejunum has more numerous vascular arcades compared with the ileum.
d. Jejunum has more numerous lymphatic follicles beneath the mucosa
compared with the ileum.
e. Jejunum has fewer villi compared with the ileum.
2. A 48-year-old female complains of symptoms of carpal tunnel syndrome, for almost
a year. Which muscles MOST typically become weakened in this condition?
a. Dorsal interossei.
b. Lumbricals III and IV.
c. Thenar.
d. Palmar interossei.
e. Hypothenar.
3. A 34-year-old woman had partial thyroidectomy. Twenty-four hours
postoperatively it was noted that the patient frequently aspirates fluid into her
lungs. Upon examination it was determined that the area of the piriform recess
above the vocal fold of the larynx was anesthetized. Which of the following nerves
was MOST likely iatrogenically injured?
a. External branch of the superior pharyngeal.
b. Hypoglossal.
c. Internal branch of the superior laryngeal.
d. Lingual.
e. Recurrent laryngeal.
4. Which of the following is consistently the LARGEST artery to the stomach?
a. Left gastric artery.
b. Right gastric artery.
c. Left gastroepiploic artery.
d. Right gastroepiploic artery.
e. Short gastric vessels.
P a g e 1 | 25
5. The principal blood supply to the parathyroid glands is which of the following?
a. Superior thyroid arteries.
b. Inferior thyroid arteries.
c. Thyroid ima arteries.
d. Parathyroid arterial branches directly from the external carotid artery.
e. Vertebral artery.
6. A 73-year-old lady suffers a fracture at the surgical neck of the humerus. During
surgical correction, which of the following vessels lie posterior to the fracture?
a. Axillary artery.
b. Brachial artery.
c. Thoracoacromial artery.
d. Transverse scapular artery.
e. Posterior circumflex humeral artery.
7. The femoral canal is a point of weakness in the abdominal wall. Which of the
following statements is the MOST accurate regarding the anatomy of the
femoral canal?
a. The femoral artery forms the anterior border of the femoral canal.
b. The femoral vein forms the lateral border.
c. The inguinal ligament lies posterior to the canal.
d. The pectineal part of the inguinal ligament is anterior to the canal.
e. The pectineal ligament forms the medial border.
8. Which of the following is the MAIN blood supply to the breast?

a. Acromio-thoracic artery.
b. Intercostal arteries.
c. Internal thoracic artery.
d. Lateral thoracic artery.
e. Superior thoracic artery.
P a g e 2 | 25
9. A 74-year-old woman presents to the outpatient clinic with pelvic pain. A CT

scan reveals enlarged para-aortic lymph nodes. These are MOST likely to be
involved in secondary spread from a tumor in which of the following organs?
a. Cervix.
b. Ovary.
c. Uterus.
d. Vagina.
e. Vulva.
10.A 44-year-old man is admitted to the emergency department with excessive
vomiting and dehydration. Radiographic images demonstrate that part of the
bowel is being compressed between the abdominal aorta and the superior
mesenteric artery. Which of the following intestinal structures is MOST likely
being compressed?
a. Second part of duodenum.
b. Transverse colon.
c. Third part of duodenum.
d. First part of duodenum.
e. Jejunum.
11.A 6-year-old boy is admitted to the hospital with high fever and pain over the
parotid gland. A diagnosis of parotiditis (Mumps) is established. Which of the
following nerves is responsible for painful sensations at the region of the parotid
gland?
a. Facial.
b. Auriculotemporal.
c. Lesser petrosal.
d. Lingual.
e. Chorda tympani.
12.A 64-year-old woman is reviewed in the emergency department with an acute
right groin swelling, below and lateral to the pubic tubercle. Which of the
following forms the medial boundary of the ring through which this hernia is
protruding?
a. Conjoint tendon.
b. Inferior epigastric artery.
c. Inguinal ligament.
d. Lacunar ligament.
e. Pectineal ligament.
P a g e 3 | 25
P a g e 4 | 25
18.Which group of lymph nodes will be inflamed secondary to paronychia of the

big toe?
a. Deep inguinal lymph nodes.
b. External iliac lymph nodes.
c. Lateral group of superficial inguinal lymph nodes.
d. Medial group of superficial inguinal lymph nodes.
e. Vertical group of superficial inguinal lymph nodes.
19.Pain referred to the right side of the neck and extending laterally from the right
clavicle to the tip of the right shoulder is MOST likely due to involvement of:
a. Cervical cardiac nerves.
b. Posterior vagal trunk.
c. Right intercostal nerves.
d. Right phrenic nerve.
e. Right recurrent laryngeal nerve.
20.Which of the following nerves is MOST likely to be injured following fracture

shaft of the humerus?
a. Medial cord of the brachial plexus.
b. Median nerve.
c. Musculo-cutaneous nerve.
d. Radial nerve.
e. Ulnar nerve.
P a g e 5 | 25
21.During an operation for abdominal aortic aneurysm, the inferior mesenteric

artery was ligated, but still the vascularity of the descending colon was
preserved. From which of the following arteries came the blood supply of the
descending colon?
a. Ileocolic artery.
b. Left gastroepiploic artery.
c. Marginal artery.
d. Middle rectal.
e. Superior rectal.
22.A patient who had an injury to the right lateral side of the neck was unable to
raise his right shoulder. What is the injured nerve?
a. Accessory.
b. Dorsal scapular.
c. Greater occipital.
d. Thoracodorsal.
e. Transverse cutaneous nerve of the neck.
23.A 40-year-old male patient had a superficial parotidectomy operation. Post-

operatively he complained of numbness at the lobule of the ear. What was the
injured nerve?
a. Buccal branch of the facial nerve.
b. Cervical branch of the facial nerve.
c. Great auricular nerve.
d. Lesser occipital nerve.
e. Marginal mandibular nerve.
24.A 30-year-old male patient was subjected to a motor car accident and he had
only a fracture of the upper end of the fibula. At examination the patient had
sensory loss at the dorsum of the right foot. Which else may be found on clinical
examination of the patient?
a. Sensory loss at the middle side of the foot.
b. Sensory loss at the sole of the foot.
c. Weak dorsiflexion of the foot.
d. Weakness in flexion of the knee.
e. Weakness in planter flexion of the foot.
P a g e 6 | 25
25.A 20-year-old man presented with a stab injury to the anterior aspect of the
right wrist. On examination he was found to have a deep 2 cm long transverse
laceration at the front of the right wrist with loss of sensation in the ring and
little fingers. The patient was unable to abduct and adduct his fingers on the
affected side. Radial pulse was palpable. What was the MOST likely structure to
have been injured?
a. Anterior interosseous nerve.
b. Median nerve.
c. Musculocutaneous nerve.
d. Radial nerve.
e. Ulnar nerve.
26.A 30-year-old male had a stab wound at the front of the forearm. Examination
revealed loss of flexion of the distal pharynx of the thumb and the lateral 3
fingers. Which of the following was the injured nerve?
a. Ulnar nerve.
b. Posterior interosseous nerve.
c. Anterior interosseous nerve.
d. Radial nerve.
e. Musculocutaneous nerve.
27.A 42-year-old construction worker noted a swelling in the right submandibular

region. Biopsy reveals malignancy and surgical excision is advised. The patient is
informed that one of the risks of this operation is which of the following?
a. Horner syndrome.
b. Excessive sweating in the temporal region.
c. Deformity of the angle of the mouth.
d. Submandibular duct calculus.
e. Trismus.
28.A CT scan of a 63-year-old man reveals that the left renal vein is occluded as it
crosses the aorta. The occlusion is due to compression by an arterial aneurysm
anterior to the vein. What is the MOST likely location of this aneurysm?
a. Coeliac artery.
b. Inferior mesenteric artery.
c. Left colic artery.
d. Middle colic artery.
e. Superior mesenteric artery.
P a g e 7 | 25
29.A 24 year old female received a small-caliber bullet wound to the popliteal fossa.
The surgeons recognized that the bullet had severed the tibial nerve. Such an
injury would MOST likely result in which of the following?
a. Inability to extend the leg at the knee.
b. Foot drop.
c. A dorsiflexed and everted foot.
d. A plantar flexed and inverted foot.
e. Total inability to flex the leg at the knee joint.
30.An 80-year-old man presents with a prostatic malignancy. Imaging reveals a

sclerotic lesion in a thoracic vertebra. Which is the MOST likely vascular route
of metastatic spread?
a. Cremasteric vein.
b. Inferior mesenteric vein.
c. Internal iliac vein.
d. Testicular vein.
e. Vertebral veins.
31.A 25-year-old man is playing football when he complains of posterior thigh pain
whilst sprinting with the ball. On examination he has tenderness in the lower
lateral posterior thigh. He is unable to fully extend the knee due to pain. What
is the MOST likely injury?
a. Biceps femoris tear.
b. Gracilis tear.
c. Gastrocnemius tear.
d. Semimembranosus tear.
e. Semitendinosus tear.
32.A 35-year-old man presents to the emergency department following a sports

injury. He has gross deformity of his arm and X-rays reveal a supracondylar
fracture of the humerus. Examination also reveals some paresthesia over the
thenar eminence. Which nerve has been damaged with the fracture?
a. Axillary.
b. Median.
c. Musculocutaneous.
d. Radial.
e. Ulnar.
P a g e 8 | 25
33.A 65-year-old man presents with haematuria and right loin pain. Computerized
tomography demonstrates a right renal tumor and he undergoes a right radical
nephrectomy. The right testicular vein drains into which of the following?
a. Inferior mesenteric vein.
b. Inferior vena cava.
c. Right adrenal vein.
d. Right lumbar vein.
e. Right renal vein.
34.A 58-year-old male farmer was accidentally injured by a sharp tool. During
physical examination the doctor noted that the patient has foot drop, although
sensation was present over the dorsum of the foot and the skin of the posterior
calf. Which of the following nerve was injured?
a. Femoral nerve.
b. Sciatic nerve.
c. Superficial fibular (Peroneal) nerve.
d. Deep fibular (Peroneal) nerve.
e. Common fibular (Peroneal) nerve.
35.Which of the following cell types is essential for normal wound healing?
a. Erythrocytes.
b. Leukocytes.
c. Lymphocytes.
d. Monocytes
e. Platelets.
36.Which of the following can lower the serum potassium level?

a. Calcium gluconate.
b. Dextrose 25%.
c. Ringer's lactate.
d. Saline.
e. Sodium bicarbonate.
P a g e 9 | 25
37.Which of the following cells is responsible for the secretion of pepsinogen?

a. Chief cells.
b. Enterochromaffin cells.
c. Mucous cells.
d. Paneth cells.
e. Parietal cells.
38.The cervical esophagus receives its blood supply primarily from the:
a. Internal carotid artery.
b. Inferior thyroid artery.
c. Superior thyroid artery.
d. Inferior cervical artery.
e. Facial artery.
39.Which of the following is the MOST potent stimulus for ADH hormone
secretion?
a. Decreased plasma osmolarity.
b. Decreased plasma volume.
c. Hypothalamic releasing factor.
d. Increased plasma osmolarity.
e. Increased plasma volume.
40.Which of the following increases the tone of the lower esophageal sphincter?
a. Gastrin.
b. Secretin.
c. Cholecystokinin.
d. Caffeine.
e. Calcium channel blocker.
P a g e 10 | 25
41.A patient, who presented with severe diarrhea as a result of clostridium difficile,
develops a metabolic acidosis. This is MOST likely due to loss of which one of
the following ions in the diarrhea?
a. Cl-.
b. HCO3-.
c. K+.
d. NH4+.
e. ОН-.
42.Which of the following is an excitatory transmitter for small bowel motility?

a. Nitric oxide.
b. Vasoactive intestinal peptide.
c. Adenosine triphosphate.
d. Acetylcholine.
e. Catecholamines.
43.Primary malignant tumors of which of the following endocrine glands does NOT
present with hyperfunction?
a. Thyroid.
b. Parathyroid.
c. Endocrine pancreas.
d. Adrenal medulla.
e. Adrenal cortex.
44.A 26-year-old patient presents with abdominal pain, weight loss and
steatorrhea. He is found to have severe terminal ileal involvement. Which of the
following vitamins is the LEAST likely to be deficient?
a. Vitamin A.
b. Vitamin D.
c. Vitamin E.
d. Vitamin C.
e. Vitamin K.
P a g e 11 | 25
45.Which of the following cytokines has anti-inflammatory properties?

a. Granulocyte macrophage colony-stimulating factor.
b. IL-10.
c. IL-2.
d. IL-3.
e. Tumor necrosis factor.
46.Which of the following microscopic features MOST likely indicates that a

neoplasm is malignant?
a. Atypia.
b. Increased nuclear : cytoplasmic ratio.
c. Invasion
d. Necrosis.
e. Pleomorphism.
47.Which of the following can adverse effects of steroids on wound healing?

a. Copper.
b. Vitamin A.
c. Vitamin C.
d. Vitamin D.
e. Vitamin E.
48.A 45-year-old man with a long history of ulcerative colitis undergoes

colonoscopy. Biopsy shows that the mucosal architecture is abnormal. The
epithelial cells have enlarged hyperchromatic nuclei and there is failure of
maturation towards the surface. There is no evidence of invasion. Which of the
following pathological processes BEST fits this histological description?
a. Carcinoma.
b. Dysplasia.
c. Hyperplasia.
d. Hypertrophy.
e. Metaplasia.
P a g e 12 | 25
49.In the presence of acute inflammation, when an abscess has formed, which of
the following cell types is MOST likely to be primarily involved in phagocytic
activity?
a. Erythrocytes.
b. Lymphocytes.
c. Macrophages.
d. Mast cells.
e. Plasma cells.
50.Which of the following disturbances in associated with tumor lysis syndrome?

a. Hypocalcemia.
b. Hypouricemia.
c. Hypokalemia.
d. Hypomagnesemia.
e. Hypophosphatemia.
51.Which of the following is the MOST effective way in preventing surgical site
infection?
a. Antibiotic prophylaxis.
b. Bowel preparation.
c. Drains and irrigation.
d. Skin preparation.
e. Surgical technique.
52.Which of the following abnormalities indicate the possibility of

hyperaldosteronism?
a. Hyperkalaemia, hyponatremia, hypochloremia.
b. Hypokalaemia, hypernatremia, high pH.
c. Hypokalaemia, hypochloremia, high pH.
d. Hyperkalaemia, hypernatraemia, low pH.
e. Hyperkalemia, hyponatremia, hyperglycemia.
P a g e 13 | 25
53.The medial mammary artery supplying the medial aspect of the breast is a
tributary of the:
a. 2nd, 3rd and 4th intercostal arteries.
b. Internal mammary artery.
c. Thoracoacromial artery.
d. Posterior intercostal arteries.
e. Musculo-phrenic artery.
54.Which of the following is TRUE regarding the physiology of the thyroid gland?
a. Absorption of iodides occurs by passive diffusion.
b. Potassium perchlorate prevents the union between iodine and tyrosine.
c. T3 is four times more active than T4.
d. The half-life of thyroxine is 4 days.
e. The necessary intake of iodide is 50 ug/day.
55.Which of the following is the MAJOR stimulus for aldosterone secretion?

a. ACTH.
b. Angiotensin II.
c. Cortisol.
d. Hypernatraemia.
e. Hypokalaemia.

b. Dextrose 25%.
d. Saline.
P a g e 14 | 25
57.In compensating for respiratory alkalosis, the body excretes more:

a. Ammonium ions.
b. Bicarbonate ions.
c. Dihydrogen phosphate ions.
d. Carbonic acid.
e. Hydrogen ions.
58.Which of the following clinical situations can be associated with hypovolemic

hyponatremia?
a. Congestive heart failure.
b. SIADH (Syndrome of inappropriate ADH).
c. Cirrhosis.
d. Hyperglycemia.
e. Gastrointestinal losses.
59.Which of the following statements is TRUE about Cushing's disease?

a. ACTH may be high.
b. Blood sugar is low.
c. It is due to a pituitary adenoma in 10% of cases.
d. Serum Na is low.
e. Surgery is not successful in the treatment.
60.A 40-year-old male patient is complaining of persistent, headache, recurrent

attacks of palpitation, sweating and visual disturbances. Blood pressure of the
patient is 180/110 mmHg. Which of the following is MOST accurate in the
diagnosis of the problem?
a. 24-hour urinary catecholamines.
b. 24-hour urinary VMA.
c. CT scan of the abdomen.
d. Plasma aldosterone level.
e. Plasma metanephrine level.
P a g e 15 | 25
61.Which of the following tests will be helpful in the EARLY management of a

patient who had total thyroidectomy?
a. Antithyroglobulin antibody.
b. Serum calcium.
c. Serum iodine.
d. T4.
e. TSH.
62.What is the recommended treatment of acute adrenal insufficiency?

a. Normal saline, potassium and glucose.
b. Hypertonic saline and potassium.
c. Normal saline and potassium.
d. Intravenous mineralocorticoids.
e. Normal saline, glucose and intravenous glucocorticoids.
63.A patient who had adrenalectomy to remove a pheochromocytoma

demonstrates signs of confusion and complains of sweating and headache
several hours following his operation. His blood pressure is 130/65 mmHg, his
heart rate is 100 beats/min and his respiratory rate is 12 breaths/min. What is
the MOST likely cause of his symptoms?
a. Dehydration.
b. Postoperative bleeding.
c. Hypoglycemia.
d. Narcotic overdose.
e. Incomplete removal of the pheochromocytoma.
64.Preventing acute renal failure following crush injury:

a. Maintenance of an alkaline urine (pH >6) to prevent cast formation.
b. Maintenance of adequate urine output with mannitol.
c. Vigorous intravenous fluid replacement.
d. Administration of xanthine oxidase inhibitors to prevent hyperuricemia.
e. Emergent dialysis to remove myoglobin from the circulation.
P a g e 16 | 25
65.Which of the following is the MOST common cause of death in patients with
ovarian cancer?
a. Uremia.
b. Anemia.
c. Liver failure.
d. Bowel obstruction.
e. Respiratory failure.
66.Which of the following occurs in starvation?

a. Increase in plasma glucose.
b. Decrease in urinary nitrogen excretion.
c. Increase in plasma ketone bodies.
d. Increase in glucose utilization by the brain.
e. Metabolic alkalosis.
67.A 56-year-old lady presents with a pathological bone fracture, which of the
following is the likely primary source?
a. Thyroid.
b. Breast.
c. Kidney.
d. Endometrium.
e. Colon.
68.Central venous access lines are a minor procedure, but may associated with
many complications, the COMMONEST is:
a. Haematoma.
b. Air embolism.
c. Pneumothorax.
d. Arrhythmias.
e. Lost wire or catheter.
P a g e 17 | 25
69.Which of the following metabolic changes is MOST prominent during times of

physiologic stress?
a. Increase in growth hormone (GH) release.
b. Increase in TSH.
c. Increased levels of T4 and T3.
d. Initial insulin increases and then suppression.
e. Increase in cortisol excretion.
70.Which of the following is the BEST parameter for monitoring septic shock?
a. Central venous pressure (CVP).
b. Vasopressor requirement.
c. Urine output.
d. Serum lactate.
e. Mental status changes.
71.A 55-year-old male patient is receiving 150 mg of aspirin daily because he has
coronary artery disease. Which of the following tests will be affected in this
patient?
a. Bleeding time.
b. Coagulation time.
c. INR.
d. PTT.
e. Thrombin time.
72.A 40-year-old male patient had a car accident which led to fracture pelvis. The
patient received 4 litres of stored blood following which he had evidence of
generalized coagulopathy. Deficiency of which of the following factors is the
cause of the problem?
a. Fibrinogen.
b. II.
c. V, VIII.
d. XI.
e. XII.
P a g e 18 | 25
73.What is the MAIN mode of action of heparin?

a. It increases the level of protein C.
b. It is a cofactor of antithrombin III.
c. It prevents clot retraction.
d. It prevents platelets aggregation.
e. It prevents the synthesis of fibrinogen.
74.What is the principal mechanism of the antithrombotic action of administering

aspirin in low dose?
a. Induction of capillary vasodilatation.
b. Induction of endothelial cell prostacyclin production.
c. Induction of endothelial heparin production.
d. Inhibition of factor V production by the liver.
e. Inhibition of platelet production of thromboxane A2.
75.What does increased level of fibrin degradation products (FDP) in the blood
denote?
a. Diminished fibrinogen synthesis.
b. Diminished platelet count.
c. Diminished platelet function.
d. Disseminated intravascular coagulation (DIC).
e. Heparin overdose.
76.A cirrhotic patient with abnormal haemostatic studies requires an urgent

cholecystectomy. A transfusion of fresh frozen plasma is planned to minimize
the risk of bleeding. What is the optimal timing of this transfusion?
a. In the recovery room.
b. Intraoperatively.
c. On call to surgery.
d. The night before surgery.
e. Two days before surgery.
P a g e 19 | 25
77.A 22-year-old man is brought into the emergency department in profound shock
after a fall from the fourth floor of a building. After resuscitation, small bowel
resection and hepatic segmentectomy are performed at laparotomy. He
receives 15 unit of packed RBCs, 4 unit of fresh-frozen plasma and 8 L of Ringer’s
lactate. On closure, diffuse oozing of blood is noted. What is the MOST likely
cause?
a. Hepatic failure.
b. Hypersplenism.
c. Platelet deficiency.
d. Factor IX (Christmas factor) deficiency.
e. Congenital hypoprothrombinemia.
78.Which of the following substances is produced by the vascular endothelium and

inhibits platelets aggregation?
a. Thromboxane A2.
b. Prostacyclin.
c. Nitric oxide.
d. ADP.
e. Serotonin.
79.Which of the following types of shock is associated with high pulmonary wedge
pressure?
a. Hypovolemic shock.
b. Cardiogenic shock.
c. Early septic shock.
d. Late septic shock.
e. Neurogenic shock.
80.What is the mode of action of carbimazole?

a. It diminishes the blood supply of the thyroid gland.
b. It prevents the release of thyroid hormone from the gland.
c. It prevents the union between iodine and tyrosine.
d. It prevents transformation of iodides to iodine.
e. It prevents uptake of iodides by the thyroid gland.
P a g e 20 | 25
81.Which of the following is the MOST common sign of Cushing's syndrome?

a. Acne.
b. Hirsutism.
c. Hypertension.
d. Purple striae.
e. Truncal obesity.
82.Which of the following is the FIRST sign or symptom of hypocalcemia?

a. Shortened QT interval.
b. Trousseau sign.
c. Circumoral numbness.
d. Anxiety.
e. Laryngospasm.

84.A 70-year-old patient with diabetes and paraplegia is undergoing an elective

laparoscopic cholecystectomy after an episode of biliary pancreatitis. Shortly
after induction, blood pressure is normal, but ECG shows peaked P waves and a
widened QRS complex. The MOST likely diagnosis is:
a. Ketoacidosis.
b. Hyperkalemia.
c. Hypoglycemia.
d. Hypocalcemia.
e. Acute myocardial infarction.
P a g e 21 | 25
85.A 40 years old dark-skinned male had an excision of a parotid tumor that
resulted in an ugly scar. Which information applies to his condition?
a. Keloids contain an overabundance of fibroblasts.
b. A hypertrophic scar extends beyond the boundaries of the original
wound.
c. Improvement is usually seen with keloid excision followed by intralesional
steroid injection.
d. An incision placed perpendicular to the lines of natural skin tension will
result in the least obvious scar.
e. Hypertrophic scars occur most commonly on the lower extremities.
86.A 78-year-old woman with emphysema on oxygen mask has the following blood
gas results:
pH PO2 PaCO2 Bicarbonate Base excess
Finding: 7.28 70 mm Hg 48 mm Hg 36 mmol/L +5
What is the MOST likely interpretation?
a. Mixed respiratory and metabolic acidosis.
b. Partially compensated metabolic acidosis.
c. Partially compensated respiratory acidosis.
d. Uncompensated metabolic acidosis.
e. Uncompensated respiratory acidosis.
87.What is the MAIN brain's fuel during prolonged starvation?

a. Amino acid.
b. Glucose.
c. Ketones.
d. Lactose.
e. Short-chain fatty acid.
88.Which of the following hormones is primarily responsible for differentiation of

the breast ductal epithelium?
a. Estrogen.
b. Testosterone.
f. Progesterone.
c. Prolactin.
d. Gonadotrophic hormone.
P a g e 22 | 25
89.Marjolin's ulcer arises in areas exposed to:

a. External beam radiation.
b. Thermal injury.
f. Pressure.
c. Lymphedema.
d. Chronic irritation.
90.Shock following severe carbon monoxide poisoning is MOST commonly:

b. Neurogenic shock.
c. Cardiogenic shock.
d. Vasodilatory shock.
e. Anaphylactic shock.
91.Vasoconstriction is one of the initial physiologic responses to hypovolemic

shock. This is mediated by:
a. Activation of alpha-adrenergic receptors on the arterioles.
b. Down regulation of alpha-adrenergic receptors on the arterioles.
c. Activation of beta-adrenergic receptors on the arterioles.
d. release of angiotensin II hormone.
e. Down regulation of beta-adrenergic receptors on the arterioles.
92.Bleeding in patients with thrombasthenia is treated with:

a. Whole blood transfusion.
b. Factor V injection.
c. Factor VII injection.
d. Fresh frozen plasma transfusion
e. Platelet transfusion.
P a g e 23 | 25
93.Hemophilia C is caused by a deficiency of:

a. Factor VIII.
b. Factor IX.
c. Factor X.
d. Factor XI.
e. Factor VII.
94.An abnormal aPTT (Partial thromboplastin time) is associated with an

abnormality in which portion of the clotting mechanism?
a. Platelet aggregation.
b. Intrinsic pathway.
c. Extrinsic pathway.
d. Both intrinsic and extrinsic pathway.
e. Coagulation (Clot formation).
95.The primary lymphatic drainage of the midline of the upper lip is:
a. Submandibular nodes.
b. Submental nodes.
c. Intraparotid nodes.
d. Preauricular nodes.
e. Jugulo-omohyoid nodes.
96. Pancreas divisum occurs as a result of:

a. Pancreatitis.
b. Carcinoma of the pancreas.
c. Penetrating Trauma to the pancreas.
d. Blunt trauma to the pancreas.
e. Abnormal fusion of the pancreatic ducts.
P a g e 24 | 25
96.More than 80% of accessory spleens are found in the splenic hilum. What is the
second MOST common location for an accessory spleen?
a. The Lienorenal ligament.
b. The greater omentum.
c. The gastrocolic ligament.
d. The tail of the pancreas.
e. The splenocolic ligament.
98. Which of the following is the primary function of the spleen in human adults?
a. Production of red cells.
b. Production of white cells.
c. Destruction of platelets.
d. Storage of blood.
e. Host defense.
99.The inguinal ligament is a part of which abdominal wall muscle?

a. Transversalis.
b. Internal oblique.
c. External oblique.
d. Rectus abdominis.
e. Pyramidalis.
100. The MOST common position of the right recurrent laryngeal nerve is:
a. Anterior to the inferior thyroid artery.
b. Posterior to the inferior thyroid artery.
c. Between the branches of the inferior thyroid artery.
d. Transversely parallel to inferior thyroid artery.
e. Absent (Nonrecurrent) laryngeal nerve.
P a g e 25 | 25

March 2021
1. Which of the following statements is TRUE about Cushing's disease?
a. ACTH is high.
d. Serum Na is low.
2. A 40-year-old male patient is complaining of persistent headache, recurrent

a. 24 hour urinary catecholamines.
b. 24 hour urinary VMA.
3. What is the hormone that acts on the intestines to increase calcium absorption?
a. Calcitonin.
b. Corticotrophin releasing factor (CRF).
c. Pancreatic polypeptide.
d. Parathormone.
e. Thyroxine.
4. A 30-year-old female patient complains of fatigue, generalized bony aches and

depression. The patient gives a history of 2 previous operations for urinary
stones. Which of the following laboratory tests is MOST accurate in the
diagnosis?
a. 24 hours urinary calcium.
b. Ionizable serum calcium.
c. Parathormone hormone.
d. Plasma chloride.
e. Serum phosphate.
P a g e 1 | 25
5. Regarding the anatomy of the thyroid gland, which of the following TRUE?
a. In about 80% of persons, the recurrent laryngeal nerve traverses anterior
to the inferior thyroid artery.
b. The recurrent laryngeal nerve has an oblique course around the
subclavian artery on the left side.
c. The superior laryngeal nerve provides both sensory and motor function
to the larynx.
d. The thyroid gland is innervated only by parasympathetic fibers from the
vagus nerve.
e. Unilateral recurrent laryngeal nerve injury usually results in airway
compromise that necessitates tracheotomy.
6. Which of the following tests will be helpful in the EARLY management of a

patient who had total thyroidectomy?
a. Antithyroglobulin antibody.
b. Serum calcium.
c. Serum iodine.
d. T4.
e. TSH.
7. A 23-year-old woman undergoes total thyroidectomy for carcinoma of the

thyroid gland. On the second postoperative day, she begins to complain tingling
sensation in her hands. She appears quite anxious and later complains of muscle
cramps. What is initial therapy?
a. 10 mL of 10% magnesium sulfate intravenously.
b. 22-dihydrotachysterol orally.
c. Continuous infusion of calcium gluconate.
d. Oral calcium gluconate.
e. Oral vitamin D.
8. You have a patient who has pheochromocytoma and his blood pressure is
200/120 mmHg. You are preparing this patient for surgery. Which of the
following drugs should be used FIRST for the control of blood pressure?
a. Phenoxybenzamine.
b. Propranolol.
c. Nifedipine.
d. Atenolol.
e. Captopril.
P a g e 2 | 25
9. A 45-yearold female is found to have a 2-cm solid nodule in her right adrenal
gland at the time of an abdominal CT scan following an auto-accident. With
regard to the adrenal lesion, the patient is asymptomatic and the nodule is
found to be non-functional on evaluation. What is the recommended
management?
a. Extraperitoneal right adrenalectomy through either a flank of posterior
approach.
b. Suppression with 5 mg prednisone PO t.d.s.
c. Follow-up CT scan after 3 months.
d. Excision biopsy via laparoscopic approach.
e. Arterial embolization.

11.A 40-year-old female patient complains of tiredness, putting on weight,

intolerance to cold weather and hoarseness of voice. Investigations revealed
low levels of T3, T4 and TSH. What is the diagnosis?
a. Hashimoto's thyroiditis.
b. Previous thyroidectomy.
c. Pituitary hypothyroidism.
d. Primary hypothyroidism.
e. Hypothyroidisms following 131I intake.
12.A 50-year-old woman presents with lethargy, weight gain, cold intolerance and
loss of interest for the past six months. Which is the MOST appropriate initial
investigation?
a. Erythrocyte sedimentation rate estimation.
b. Radioactive isotope scan of thyroid.
c. Thyroid antibodies screen.
d. Thyroid stimulating hormone estimation.
e. Ultrasound scan of thyroid gland.
P a g e 3 | 25
13.A patient with chronic renal failure attends the emergency department
complaining of increasing confusion, muscle weakness, nausea, vomiting and
fatigue. The serum calcium level is 12.4 mg/dl. The FIRST step in management
of this patient should be:
a. Emergency parathyroidectomy.
b. Aggressive intravenous hydration.
c. Initiation of furosemide infusion.
d. Continuous calcitonin infusion.
e. Initiation of bisphosphonates.
14.What is the MOST common cause of primary adrenal insufficiency (Addison’s

disease)?
a. Tuberculosis.
b. Kaposi sarcoma.
c. Cytomegalovirus.
d. Lymphoma.
e. Autoimmune disorder.

heart rate is 100 beats/mm and his respiratory rate is 12 breaths/min. What is
a. Dehydration.
c. Hypoglycemia.
16.A 42-year-old woman is in the intensive care unit immediately following removal
of a left adrenal pheochromocytoma. Her blood pressure is 80/40 mmHg. The
MOST appropriate treatment of the patient's hypotension is:
a. Epinephrine.
b. IV bolus of lactated Ringer solution.
c. Methylprednisolone.
d. Phenoxybenzamine.
e. Phenylephrine.
P a g e 4 | 25
17.A 50-year-old woman scheduled for parathyroidectomy presents to the

emergency department with nausea, vomiting and altered mental status.
Laboratory analysis reveals serum calcium of 16 mg/dl. In addition to IV fluids,
the BEST medication to give immediately would be:
a. Calcitonin.
b. Furosemide.
c. Mithramycin.
d. Prednisone.
e. Zoledronic acid.
18.An otherwise healthy 52-years-old male is in the postoperative care unit, hours
after undergoing an uncomplicated left-sided laparoscopic adrenalectomy for a
0.5 cm cortisol-producing tumor when he is noted to have a heart rate of 82
beats per minute and blood pressure of 90/40 mmHg. After administration of 2
L of normal saline, the blood pressure is unchanged. The MOST critical next step
in management will be to:
a. Administer 100 mg IV hydrocortisone.
b. Begin a norepinephrine drip.
c. Check troponin levels.
d. Obtain a 12 lead EKG.
e. Obtain a portable chest x-ray.
19.A 15-year-old woman presents with acute back pain after minor fall.
Radiological examination reveals an osteoporotic crush fracture. What is the
expected laboratory finding?
a. Hypercalcaemia.
b. Hyperphosphataemia.
c. Hypokalaemia.
d. Hyponatraemia.
e. Normocalcaemia.
20.Calcitonin helps mediate calcium homeostasis by which of the following
actions?
a. Stimulates osteoblast-mediated bone formation and inhibits renal
resorption of calcium and phosphate.
b. Directly inhibits secretion of parathyroid hormone (PTH).
c. Inhibits intestinal absorption of calcium.
d. Stimulates hydroxylation of vitamin D.
e. Stimulates osteoclast-mediated bone resorption.
P a g e 5 | 25
21.In addition to determining blood glucose levels, the perioperative management

of a patient with diet-controlled diabetes mellitus should include which of the
following considerations?
a. Determination of glycosylated hemoglobin (HBA1c) level before surgery.
b. Subcutaneous administration of regular insulin for glucose levels above
140 mg%.
c. Metformin initiated 3 days prior surgery.
d. Intravenous (IV) insulin therapy 1 h prior to surgery.
e. Oral liquid carbohydrate initiated 3 h prior to surgery.
22.Which one of the following clinical scenarios is associated with hypercalcemia?

a. Fluid resuscitation for shock.
b. Rapid infusion of blood products.
c. Improper administration of phosphates.
d. Malignancy.
e. Acute pancreatitis.

b. Trousseau sign.
d. Anxiety.
e. Laryngospasm.
24.On workup, a patient is found to have elevated free cortisol and plasma ACTH
levels. Further testing reveals that both low- and high-dose dexamethasone
administration fail to suppress cortisol production. What is the MOST likely
diagnosis?
a. Bilateral adrenal hyperplasia.
b. Pituitary tumor.
c. Adrenal adenoma.
d. Ectopic ACTH-producing tumor.
e. Exogenous corticosteroids.
P a g e 6 | 25
25.Which of the following cancers is MOST common in organ transplant recipients?

a. Bronchogenic carcinoma.
b. Lung cancer.
c. Pancreatic cancer.
d. Prostatic cancer.
e. Skin cancer.
26.Antilymphocytic globulin is useful to treat:

a. Acute rejection.
b. Chronic rejection.
c. Graft-versus-host reaction (GVS).
d. Hyperacute rejection.
e. Immunosuppressive drug toxicity.
27. A 40-year-old male patient underwent a renal transplant from a cadaveric

donor. Immediately after finishing the vascular anastomosis, the kidney became
cyanotic and flaccid. Histological examination revealed deposition of
immunoglobulins and complement in the vessels walls. What is the
immunological background of the problem?
a. Donor cytotoxic T-lymphocytes directed against the host antigens.
b. Donor natural killer cells directed against host antigens.
c. Host natural killer cells against donor antigens.
d. Preformed donor antibodies against the host antigens.
e. Preformed host antibodies against the donor antigens.
28.Which of the following allogeneic grafts does NOT require immunosuppression?

a. Kidney.
b. Hearn.
c. Liver.
d. Bone marrow.
e. Cartilage.
P a g e 7 | 25
29.Which of the following is the MOST commonly used primary maintenance

immunosuppressive agent?
a. Tacrolimus (Prograf).
b. Azathioprine (Imuran).
c. Mycophenolate (CellCept).
d. Rapamycin (Sirolimus).
e. Pirfenidone.
30.Which of the following statements regarding rejection of solid organ transplants

is TRUE?
a. Hyper-acute rejection begins in the operating room with reperfusion of
the transplanted organ.
b. Liver transplants are especially susceptible to hyper-acute rejection.
c. Most immunosuppressive medications are used to prevent chronic
rejection.
d. The major cause of graft failure is acute rejection.
e. Chronic rejection is characterized histologically by lymphocyte
infiltration.
31.Which of the following is NOT an indication for liver transplant?

a. Cirrhosis complicated by ascites and esophageal varices.
b. Acute liver failure secondary to acetaminophen overdose.
c. NASH (Nonalcoholic steatohepatitis) complicated by hepatic
encephalopathy.
d. Hepatocellular carcinoma with underlying cirrhosis.
e. Hepatocellular carcinoma with biopsy-proven lymph node metastasis.
32.Which of the following statements about acute rejection is NOT TRUE?

a. It is T-cell mediated.
b. It is related to organ-host human leukocyte antigen disparity.
c. Treatment can save the grafted organ in 90% to 95% of cases.
d. It does not occur with living related donors.
e. It is associated with an increased risk of chronic rejection.
P a g e 8 | 25
33.Which of the following transplants is MOST susceptible to donor-recipient HLA

mismatches?
a. Skin.
b. Renal.
c. Liver.
d. Corneal.
e. Cardiac valves.
34.You review a 42-year-old woman six weeks following a renal transplant for focal
segmental glomerulosclerosis. Following the procedure she discharged on a
combination of tacrolimus, mycophenolate and prednisolone. She has now
presented with a five day history of feeling generally unwell with anorexia,
fatigue and arthralgia. On examination she has a temperature of 37.9 oC and has
widespread lymphadenopathy. What is the MOST likely diagnosis?
a. Hepatitis C.
b. Epstein-Barr virus.
c. HIV.
d. Hepatitis B.
e. Cytomegalovirus.
35.Five days after an uneventful cholecystectomy, an asymptomatic middle aged
woman, is found to have a serum sodium level of 120 mEq/L. What is the proper
management?
a. Administration of hypertonic saline solution.
b. Administration of Ringer's lactate solution.
c. Aggressive diuresis with furosemide.
d. Plasma ultra-filtration.
e. Restriction of free water.
36.A 28-year-old male was injured In a motorcycle accident. On admission he was
in severe respiratory distress and appeared cyanotic (With blood pressure of
80/40 mmHg). The patient was bleeding profusely from the nose and had an
obviously open femur fracture with exposed bone. Breath sounds were
decreased on the right side of the chest. What should be the initial
management?
a. Control of hemorrhage with anterior and posterior nasal packing.
b. Tube thoracostomy in the right hemithorax.
c. Endotracheal intubation with in-line cervical traction.
d. Obtain intravenous access and begin emergency blood transfusion.
e. Obtain cross-table cervical spine film and chest film.
P a g e 9 | 25
37.A 24-year-old woman has acute renal failure following postpartum hemorrhage.
Laboratory studies showed serum glucose 150 mg/dl; sodium 135 mEq/L;
potassium 6.5 mEq/L; chloride 105 mEq/L and bicarbonate 15 mEq/L. Which of
the following is recommended?
a. Decrease potassium chloride to 10 mEq/L.
b. Intravenous 0.9% sodium chloride.
c. 100 ml of 50% glucose water with 10 U insulin.
d. Intravenous calcitonin.
e. Intravenous magnesium sulfate.
38.Following an operation and extubation, a patient was restless. His arterial blood
gases revealed: pH 7.36; PaO2 65 mmHg; PaCO2 55 mmHg; PaCO3- 38 mmol/L.
The physiologic status can BEST be described as which of the following?
a. Respiratory alkalosis.
b. Respiratory acidosis.
c. Metabolic acidosis.
d. Metabolic alkalosis.
e. Combined respiratory and metabolic acidosis.
39.What is the predominant metabolic abnormality in patients with pyloric

obstruction?
b. Hyperchloremic alkalosis.
c. Salt-losing enteropathy.
d. Intrinsic renal disease.
e. Metabolic acidosis.
40.A primary tumor of which of these organs is the LEAST likely to metastasize to
bone:
a. Breast.
b. Colon.
c. Kidney.
d. Lung.
e. Prostate.
P a g e 10 | 25
41.A patient, who had gastrectomy 10 days ago developed massive pulmonary
embolism proved by CT angiography. What is the recommended treatment?
a. IV heparin.
b. Fibrinolytic agents.
c. Warfarin.
d. IV acetylsalicylic acid.
e. Corticosteroids.
42.A 28-year-old motorcyclist sustained multiple fractures and a multifragmented

fracture of his left femoral shaft. He underwent reamed intramedullary nailing
the next day. Twenty-four hours postoperatively, he became increasingly
confused and hypoxaemic. The MOST likely diagnosis is:
a. Fat embolism.
b. Hypovolemia.
c. Systemic sepsis.
d. Tension pneumothorax.
e. Unrecognized head injury.
43.A 39-year-old woman is making a slow but adequate recovery after sustaining a
40% surface area burn injury. On the sixth postoperative day she becomes
unwell. She vomits intermittently, has painless abdominal distension and starts
to hiccup. What is the MOST likely cause of these symptoms?
a. Acute gastric dilatation.
b. Acute intestinal obstruction.
c. Clostridium difficile infection.
d. Fecal impaction.
e. Systemic sepsis.
44.The arterial blood gases of a patient who had an operation for ruptured aortic
aneurysm are: pH 7.54, PO2 100 mmHg, PCO2 30 mmHg, HCO3- 30 mmol/L. What
is the acid-base disturbance?
a. Respiratory acidosis.
b. Respiratory alkalosis.
c. Metabolic alkalosis.
d. Combined respiratory and metabolic alkalosis.
e. Compensated respiratory acidosis.
P a g e 11 | 25
45.A 78-year-old man with history of coronary artery disease requests an elective
epigastric hernia repair. Which of the following is valid reason for delaying the
proposed surgery?
a. Coronary artery bypass surgery 3 months earlier.
b. A history of cigarette smoking.
c. Jugular venous distension.
d. Hypertension.
e. Hyperlipidemia.
46.A 50-year-old man presented with severe repeated vomiting as a result of

gastric outlet obstruction is admitted to the hospital. There is marked
dehydration, with urine output 20 ml/h and the hematocrit is 48%. Initial
treatment for this patient should include which of the following?
a. Administration of 10% dextrose (D10W) in one-third saline solution IV.
b. Antiemetics.
c. Ringer's lactate solution.
d. Hemodialysis to correct azotemia.
e. Saline fluid replacement with appropriate potassium administration.
pressure?
c. Early septic shock .
48.A COMMON drug that can trigger an episode of malignant hyperthermia:

a. Propofol.
b. Dantrolene.
c. Ketamine.
d. Succinylcholine.
e. Neostigmine.
P a g e 12 | 25
49.What is the CORRECT management of the commonest acid-base imbalance seen

in long standing or severe hemorrhagic shock?
a. Intravenous sodium bicarbonate.
b. Component blood therapy.
c. Increased fluid administration.
d. Vasopressors.
e. Hyperventilation adenoma.
50. A 65-year-old man undergoes trans-sphenoidal surgery for a pituitary macro-

adenoma. On the first postoperative day he is noted to be confused. The MOST
likely cause is:
a. Hyperkalemia.
b. Hyperuricemia.
c. Hypoglycemia.
d. Hyponatraemia.
e. Hypoxia.
51.A 38-year-old man in end-stage renal failure resulting from polycystic kidney
disease receives a cadaveric renal transplant. Good renal function is established
but four weeks later deteriorates, the serum creatinine rising by 25%. Which of
the following processes is MOST likely to be responsible for this deterioration?
a. B-cell mediated rejection.
b. Circulating immune complex disease.
c. IgG antibody mediated rejection.
d. Post-transplant lymphoproliferative disorder.
e. T-cell mediated rejection.
52.A 78-year-old woman with emphysema receiving 28% oxygen by mask has the
following blood gas results:
Normal: 7.35-7.45 90-110 35-45 22-26 -2 to +2
The MOST likely interpretation is:
P a g e 13 | 25
53.A 56-year-old motorcyclist presents to the emergency department after he had

involved in a road traffic accident. He is conscious and is maintaining his normal
airway and breathing. He is found to have an open right femoral fracture with
palpable distal pulses and normal sensation. Resuscitation is started. Urethral
catheterization drained 250 ml immediately but over the following 60 minutes
he drained only 10 ml. Which of the following is the MOST likely cause of his low
urine output?
a. Blocked catheter.
c. Hypovolemic shock.
d. Ruptured bladder.
e. Septic shock.
54.A 55-year-old man presents to the emergency department after collapsing. On
examination his pulse is 124 beats/minute, blood pressure is 60/30 mmHg,
respiratory rate is 30 breaths/minute and his peripheries are warm. What is the
MOST likely diagnosis for this patient?
a. Cardiac failure.
b. Hemorrhage.
c. Hypovolemia.
d. Pulmonary embolus.
e. Sepsis.
55.A 22-year-old man involved in a motor vehicle accident is found to have a
thoracic spine fracture (T6) and paraplegia. The patient is hypotensive with a
systolic BP of 70 mmHg, is bradycardiac with a pulse of 48 beats/min and is
breathing comfortably. Which of the following would the MOST appropriate
initial treatment?
a. Isotonic fluid administration.
b. Steroid administration within 24 hours of the injury.
c. Immediate intubation.
d. Alpha-agonist administration.
e. Immediate magnetic resonance imaging.
56.The pathogenesis of stress-related gastric mucosal injury is:
a. Elevated gastric acid levels.
b. Bile reflux.
c. Reduced gastric blood flow.
d. Helicobacter pylori infection.
e. Use of nonsteroidal anti-inflammatory drugs.
P a g e 14 | 25
57.A 55-year-old male patient has been receiving TPN for prolonged time and
developed hypomagnesaemia. Which of the following conditions clinically
resembles hypomagnesaemia?
a. Hypoglycemia.
b. Hypokalemia.
c. Hypophosphatemia.
d. Hypocalcemia.
e. Hyponatremia.
58.Which of the following are effects of epinephrine in response to injury?

a. It enhances the adherence of leukocytes to vascular endothelial
membranes.
b. It stimulates the release of aldosterone.
c. It inhibits the secretion of thyroid hormones.
d. It increases glucagon secretion.
e. It decreases lipolysis in adipose tissues.
59.A 21-year-ald man undergoes major abdominal surgery after a motor vehicle
collision. He has a cardiac arrest in the intensive care unit shortly after returning
from surgery. Select the MOST appropriate pharmacologic agent for the patient:
a. Epinephrine.
b. Norepinephrine.
c. Phenylephrine.
d. Dopamine.
e. Dobutamine.
c. Urine output.
d. Serum lactate.
P a g e 15 | 25
61.Which of the following is an important goal of therapy at 24 hours after the

onset of hypovolemic shock that may improve mortality?
a. Normalization of blood pressure and heart rate.
b. Normalization of urine output and base deficit.
c. Discontinuation of vasopressors and inotropes.
d. Ensuring the hematocrit is at least 30% (0.3).
e. Normalization of body and skin temperature.
62.Which of the following is TRUE about the catabolic response to trauma?

a. Intravenous hyperalimentation can prevent the catabolic response to
trauma.
b. Liver glycogen is the source of dextrose in the first week.
c. The catabolic response initiated by the thyroid hormones.
d. The catabolic response is the same regardless of the severity of trauma.
e. There is inevitable loss of muscle mass.
63.Effective management of gastric acid aspiration includes which of the following?

a. Suctioning and controlled ventilation with positive end-expiratory
pressure (PEEP).
b. Tracheal intubation and saline lavage of the lungs.
c. Prophylactic antibiotic therapy.
d. Prophylactic steroid therapy.
e. Diuresis.
64.The arterial blood gas results of a 40-year-old male patient who had an accident
one week ago are: pH 7.54; PO2 80 mmHg; PCO2 30 mmHg; PCO3- 18 mmol/L.
The MOST likely cause is:
a. Excessive vomiting.
b. Pulmonary embolism.
c. Diabetic ketoacidosis.
d. CVA.
e. Persistent diarrhea.
P a g e 16 | 25

physiologic stress?
b. Increase in TSH.
d. Initial insulin increase and then suppression.
66.Which of the following options is MOST appropriate for a type II diabetic patient
undergoing bilateral hernia repair as a day-case procedure under general
anesthesia?
a. Their usual diabetic medication should be omitted on the night before
surgery.
b. They should be prescribed an insulin/dextrose sliding scale starting at 6
a.m. on the day of surgery.
c. They should be placed first on the operating list whenever possible.
d. They should be kept nil by mouth at least 6 hours before the procedure.
e. They should receive long acting insulin at the night of the operation.
67.Regarding hypokalemia, which of the following statements is Not TRUE?

a. Potassium and hydrogen are exchanged for sodium in the renal tubule.
b. Respiratory acidosis is associated with increased renal potassium loss.
c. Metabolic acidosis is usually associated with hypokalemia.
d. Flattened T wave and a prolonged QT interval are associated with
hypokalemia.
e. Intravenous potassium administration should not exceed 40 to 60 mEq/h.
68.A 70-year-old man undergoes anterior resection for carcinoma of the rectum.
He is extubated in the operating room (OR). In the recovery room, he is found
to be restless with an HR of 136 bpm and a BP of 144/80 mmHg. ABG analysis
on room air reveals pH 7.24; PCO2 60 mmHg; PO2 54 mmHg; HCO3- 25 mEq/L
and SaO2 90%. Appropriate management for this patient should be which of the
following?
a. To administer 40% oxygen by mask.
b. Morphine, 2 mg IV.
c. C. Ringer's lactate 250 mL over 1 hour.
d. Intubation and ventilatory support.
e. Deep breathing and coughing.
P a g e 17 | 25
69. Clinical studies have shown that administration of lactated Ringer's solution to
patients with hypovolemic shock may:
a. A Increase serum lactate concentration.
b. Impair liver function.
c. Improve hemodynamics by alleviating the deficit in the interstitial fluid
compartment.
d. It increases metabolic acidosis.
e. Increase the need for blood transfusion.
70.Central venous access lines is a minor procedure, but may associated with many
complications, the COMMONEST is:
a. Haematoma.
b. Air embolism.
c. Pneumothorax.
d. Arrhythmias.
e. Lost wire or catheter.
71. The gold standard for diagnosing pulmonary embolism (PE) is:
a. CT pulmonary angiogram.
b. MRI.
c. Ventilation perfusion nuclear scan (VQ scan).
d. Duplex ultrasound.
e. ECG.
72.What is the MOST common tumor that metastasizes to the adrenal gland?
a. Breast cancer.
b. Bronchogenic cancer.
c. Melanoma.
d. Renal cell carcinoma.
e. Thyroid cancer.
P a g e 18 | 25
73.Which of the following the COMMONEST cause of metastatic hypercalcaemia?

a. Breast cancer.
b. Prostatic cancer.
c. Lung cancer.
d. Testicular tumors.
e. Thyroid malignancy.
74.Which of the following is LEAST likely to cause metastasis to the brain?

a. Prostate cancer.
b. Melanoma.
c. Small cell carcinoma of the lung.
d. Breast cancer.
e. Renal carcinoma.
75.A 40-year-old man presents to his doctor with a swelling in the neck of eight
weeks' duration. Clinical examination demonstrates that he has multiple
swellings in the neck, axillae and both inguinal regions. What is the MOST likely
diagnosis?
a. Acute lymphadenitis.
b. Cat-scratch disease.
c. Malignant lymphoma.
d. Metastatic carcinoma.
e. Reactive Lymphadenopathy.
76.Which of the following is NOT characteristic of poor differentiation?

a. Pleomorphism (Variability in the size and shape of cells).
b. Giant cells.
c. Decreased mitotic activity.
d. High nuclear : cytoplasmic ratio.
e. Clumped chromatin.
P a g e 19 | 25
77.Which of the following tumor marker-disease association is NOT CORRECT?

a. PSA and prostate cancer.
b. CEA and colon cancer.
c. CA 19-9 and pancreatic cancer.
d. AFP and breast cancer.
e. CA 125 and ovarian cancer.
78.A patient undergoing chemotherapy for acute leukemia develops bilateral

ureteric stones. What is the MOST likely composition of these stones?
a. Calcium oxalate.
b. Xanthine.
c. Cystine.
d. Triple phosphate.
e. Uric acid.
79.A 43-year-old woman is undergoing external beam radiation therapy for

invasive breast cancer. Biopsy of the tumor shows a relatively high mitotic index,
indicative of active growth. Which portion of the cell cycle in actively dividing
cells is MOST sensitive to ionizing radiation?
a. S phase.
b. M phase.
c. G1 phase.
d. G2 phase.
e. All phases are equally radiosensitive.
80. Which of the following malignancies is the COMMONEST to produce

metastases to the spine?
b. Breast cancer.
c. Prostatic cancer.
d. Renal cell carcinoma.
e. Colon cancer.
P a g e 20 | 25
81.In examining a biopsy of a primary tumor, the CLEAREST evidence of malignancy

is provided by:
a. Absence of a capsule.
b. Basophilia of the cytoplasm.
c. Invasion of surrounding structures.
d. Excess of mitoses.
e. Nuclear aberrations.
82.A 56-year-old lady presents with a pathological fracture of the proximal femur.
Which of the following primary sites is the MOST likely source of her disease?
a. Thyroid.
b. Breast.
c. Kidney.
d. Endometrium.
e. Colon.
83.Which of these option is the COMMON cause of death in patients with ovarian
cancer?
a. Uremia.
b. Anemia.
c. Liver failure.
d. Bowel obstruction.
e. Respiratory failure.
84.Which of the following genes is a protooncogene?

a. BRCA-I.
b. DCC.
c. RAS.
d. APC.
e. P53.
P a g e 21 | 25

86.The perioperative management of a patient whose diabetes has been controlled

by diet alone consists of blood glucose level determinations and which of the
following?
a. Continuation of diet and determination of serum glucose level before
surgery.
b. Subcutaneous administration of regular insulin.
c. Oral hypoglycemic agents discontinued 3 days before surgery.
d. Insulin infusion beginning one hr before surgery.
e. Increased oral carbohydrate intake to prevent ketosis.
87.What is the MOST deleterious effect of excessive glucose in the formula of

longstanding TPN?
a. Hyperglycemia.
b. Excessive diuresis.
c. Hepatic steatosis.
d. Hyponatremia.
e. Hypoglycemia.
88.Which of the following with regard to metabolism during fasting is TRUE?

a. The main source of fuel in short-term fasting (<5 days) is derived from
hepatic glycogen stores.
b. Norepinephrine, vasopressin, and angiotensin II promote the assembly of
glycogen chains during fasting.
c. In prolonged starvation, ketone bodies become the primary fuel source
for the brain
d. d Lipid stores in adipose tissue provide 40% of the caloric expenditure
during starvation.
e. Release of tree fatty acids is stimulated by an increase in serum insulin
levels.
P a g e 22 | 25
89.The gold standard for diagnosing pulmonary embolism (PE) is:

b. MRI.
c. Ventilation perfusion nuclear scan (VQ scan).
d. Duplex ultrasound.
e. ECG.
90.The chest X-ray of a 68-year-old intubated man in the surgical intensive care unit
reveals an infiltrate in his right lower lobe. Concurrent with this finding, the
patient has an elevated leukocyte count and increased endotracheal secretions.
Which of the following procedures would have been MOST effective in
preventing ventilator-associated pneumonia (VAP)?
a. Elevation of the head of bed above 30 degrees.
b. Initiation of ranitidine.
c. Replacement of nasogastric tube with nasoduodenal tube for post pyloric
enteral feeding.
d. Selective decontamination of the digestive tract.
e. Use of prophylactic topical antibiotics (Intratracheal or oral).
91.What is the single MOST important treatment measure in preventing acute

renal failure following crush injury?
a. Maintenance of an alkaline urine (pH> 6) to prevent cast formation.
b. Maintenance of adequate urine output with mannitol.
c. Vigorous intravenous fluid replacement.
d. Administration of xanthine oxidase inhibitors to prevent hyperuricemia.
e. Emergent dialysis to remove myoglobin from the circulation.
92.A 35-year-old male patient was subjected to a car accident and had multiple rib
fractures and fracture of the right shaft femur. The pulse is 120/min and the BP
is 90/60 mmHg. The patient is in severe agony. What is the MOST appropriate
parenteral analgesic for this patient?
a. Morphine.
b. Fentanyl.
c. Midazolam.
d. Paracetamol.
e. Propofol.
P a g e 23 | 25
93.Which site or venue is the area that is at GREATEST risk for surgical errors?
a. Operating room.
b. Surgical intensive care unit.
c. Hospital wards/floors.
d. Emergency department.
e. Ambulatory care sites.
94.An unconscious accident victim is hypotensive from intra-abdominal
hemorrhage and needs an emergency laparotomy. His identity is unknown and
therefore, no family is available. Which of the following should be done?
a. Nothing, it is illegal to operate on a patient without consent.
b. The surgeon should document the need for the surgery in the chart and
proceed.
c. Three doctors should document the need for the surgery in the chart and
the surgeon should then proceed.
d. A court order for surgery should be obtained prior to proceeding.
e. Inform local health authority and then proceed.
95.Surgical "Never Events" are errors in medical care that are clearly identifiable,
preventable and serious in their consequences for patients and that indicate a
real problem in the safety and credibility of a health care facility. Which surgical
error does NOT belong to this category?
a. Surgery performed on the wrong body part.
b. Surgery performed on the wrong patient.
c. Immediately postoperative death in an ASA class II patient.
d. Wrong surgical procedure performed on a patient.
e. A foreign body left in a patient after surgery.
96.Before skin incision "Time Out" is a phase of the surgical safety check list. What
is the CORRECT step that should be done at this phase?
a. The Checklist coordinator will verbally review with the patient his
identity.
b. The Checklist coordinator will verbally review with the patient that the
procedure and site are correct.
c. The Checklist coordinator will verbally review with the patient that
consent for surgery has been given.
d. The team will confirm that prophylactic antibiotics have been
administered within the previous 60 minutes.
e. The team will review together the operation that was performed,
completion of sponge and instrument counts.
P a g e 24 | 25
97.The nurse prepared a unit of blood to be transfused to a patient with lower

gastrointestinal bleeding. Just before transfusion she noticed that the blood unit
didn't belong to the patient and she sent it back to the blood bank and received
the right one. This situation is called:
a. Adverse event.
b. Near miss event.
c. Never event.
d. No harm event.
e. Sentinel event.
98.An 80-year-old woman with advanced Alzheimer's disease has been ill for 4 days
and is transferred from the nursing home with fever, hypotension and
abdominal swelling. Computed tomographic (CT) scan reveals a superior
mesenteric artery thrombosis, bowel ischemia and pneumatosis. She is acidotic
and in acute renal failure. Surgical intervention would necessitate resection of a
significant length of small and large bowel. Which of the following statements
about this patient's care is TRUE?
a. She is dying and palliative care is indicated.
b. The decision for further care should be left solely with the family.
c. Operation is the only chance for cure o the bowel ischemia and should be
performed.
d. Aggressive ICU resuscitation is warranted and operation should be
performed if the patient stabilizes.
e. Operation should be performed, but dialysis should not be contemplated.
99.Which of the following denotes the duty of the doctor to intervene on the
patient's behalf to increase comfort, health and well-being?
a. Nonmaleficence.
b. Autonomy.
c. Euthanasia.
d. Beneficence.
e. Justice.
100. Which of the following is NOT considered (As a never event)?
a. Wrong side surgery.
b. Venous thromboembolic disease.
c. Medication errors.
d. Unintentionally retained foreign materials.
e. Wrong patient.
P a g e 25 | 25

October 2020
a. Acromiothoracic artery.
2. A 40-year-old male patient had excision of a carotid body tumor. Which of the
following nerves is MOST liable to be injured?
a. Facial nerve.
b. Glossopharyngeal nerve.
c. Hypoglossal nerve.
d. Spinal accessory nerve.
e. Vagus nerve.
3. Intracapsular fractures of the neck of the femur are very liable to be followed
by avascular necrosis of the head of femur. From which arteries does the head
of femur receive its MAIN blood supply?
a. Artery of the ligament of the head of femur.
b. Deep external pudendal artery.
c. First perforator artery of the deep femoral.
d. Medial and lateral circumflex femoral arteries.
e. The superficial femoral artery.
4. Taste from the posterior one third of tongue is provided by which of the
following nerves?
a. Facial.
b. Glossopharyngeal.
c. Hypoglossal.
d. Lingual.
e. Vagus.
P a g e 1 | 25
5. Pain referred to the right side of the neck and extending laterally from the right
6. Which of the following nerves is MOST likely to be injured following fracture

b. Median nerve.
d. Radial nerve.
e. Ulnar nerve.
7. Which of the following will be present following injury of the long thoracic
nerve?
a. Depression of the shoulder.
b. Inability to abduct the shoulder.
c. Inability to extend the shoulder.
d. Loss of sensation at the medial side of the axilla.
e. Winging of the scapula.
8. During an operation for abdominal aortic aneurysm, the inferior mesenteric

artery was ligated, but still the vascularity of the descending colon was
preserved. From which of the following arteries came the blood supply of the
descending colon?
a. Ileocolic artery.
b. Left gastroepiploic artery.
c. Marginal artery.
d. Middle rectal.
e. Superior rectal.
P a g e 2 | 25
9. Which of the following is TRUE regarding the anatomy of the thyroid gland?
a. In about 80 % of persons, the recurrent laryngeal nerve traverses anterior
to the larynx.
vagus nerve.
10.A patient who had an injury to the right lateral side of the neck was unable to
raise his right shoulder. What is the injured nerve?
a. Accessory.
b. Dorsal scapular.
c. Greater occipital.
d. Thoracodorsal.
e. Transverse cutaneous nerve of the neck.
11.Which group of lymph nodes will be inflamed secondary to paronychia of the

big toe?
a. Deep inguinal lymph nodes.
b. External iliac lymph nodes.
c. Lateral group of superficial inguinal lymph nodes.
d. Medial group of superficial inguinal lymph nodes.
e. Vertical group of superficial inguinal lymph nodes.
12.A patient has severe hematemesis due to bleeding ulcer on the lesser curvature
of the stomach. During surgery which artery needs to be ligated to stop the
bleeding?
a. Gastroduodenal.
b. Left gastric.
c. Left gastroepiploic.
d. Right gastroepiploic.
e. Short gastric.
P a g e 3 | 25
13. A 40-year-old male patient had a superficial parotidectomy operation. Post

injured nerve?
c. Great auricular nerves.
14. A 30-year-old male patient was subjected to a motor car accident and he had only
a fracture of the upper end of the fibula. At examination the patient had sensory
loss at the dorsum of the right foot. Which else may be found on clinical
examination of the patient?
a. Sensory loss at the middle side of the foot.
b. Sensory loss at the stole of the foot.
c. Weakness in dorsiflexion of the foot.
d. Weakness in flexion of the knee.
e. Weakness in planter flexion of the foot.
15. A 25-year-old male patient is involved in a serious car accident. Examination reveals
that his right leg is shortened and internally rotated. The patient is unable to
dorsiflex or planter flex his foot. All sensations below the knee are lost apart from
the medial side of the leg and foot and upper back of the calf. Which of the
following is the MOST likely injured nerve?
a. Common peroneal nerve.
b. Tibial nerve.
c. Obturator nerve.
d. Sciatic nerve.
e. Femoral nerve.
16. A 20-year-old man presented with a stab injury to the anterior aspect of the right
wrist. On examination he was found to have a deep 2 cm long transverse laceration
at the front of the right wrist with loss of sensation in the ring and little fingers. The
patient was unable to abduct and adduct his fingers on the affected side. Radial
pulse was palpable. What was the MOST likely structure to have been injured?
b. Median nerve.
d. Radial nerve.
e. Ulnar nerve.
P a g e 4 | 25
17.A 19-year-old woman attends the emergency department after being shot in
the neck with an air-gun pellet. In the course of surgical exploration of the
posterior triangle, a nerve is injured. The patient is unable to shrug her left
shoulder or fully abduct her left arm. Which is the MOST likely structure to have
been injured?
a. Axillary nerve.
b. Dorsal scapular nerve.
c. Long thoracic nerve.
e. Suprascapular nerve.
18.Which of the following statement is TRUE regarding surgical excision of the right
submandibular salivary gland?
a. Injury to the lingual nerve would result in loss of sensations to the
posterior one third of the right side of the tongue.
b. Injury to the hypoglossal nerve would result in deviation of the tongue to
the right side on protrusion of the tongue.
c. The great auricular nerve is at a risk of injury.
d. Injury of the marginal mandibular branch of the facial nerve would result
in sensory loss at the angle of the mandible.
e. Injury to the cervical branch of the facial nerve would result in drooping
of the right angle of the mouth.
19.A 30-year-old male had a stab wound of the front of the forearm. Examination
revealed loss of flexion of the distal pharynx of the thumb and the lateral 3
fingers. Which of the following was the injured nerve?
a. Ulnar nerve.
b. Posterior interosseous nerve.
c. Anterior interosseous nerve.
d. Radial nerve.
e. Musculocutaneous nerve.
20.A 24-year-old woman presents to the outpatient clinic with pelvic pain. A CT
a. Cervix.
b. Ovary.
c. Uterus.
d. Vagina.
e. Vulva.
P a g e 5 | 25

protruding?
a. Conjoint tendon.
22.A 30-year-old motorcyclist suffers a closed fracture to the mid-shaft of the tibia.
Anterior compartment syndrome could cause loss of sensation:
a. In the first web space.
b. Over the dorsum of the foot.
c. Over the lateral edge of the foot.
d. Over the medial aspect of the hallux.
e. Over the medial malleolus.

a. Horner syndrome.
e. Trismus.
24.A 32-year-old man is brought to the emergency department following a fall. An

X-ray reveals that he has a fracture of the surgical neck of his humerus.
Neurological examination reveals paraesthesia over the upper lateral arm
(Overlying the deltoid muscle). Which nerve is MOST likely to have been
damaged?
a. Axillary.
b. Median.
d. Radial.
e. Ulnar.
P a g e 6 | 25
a. Coeliac artery.
26.A 27-year-old man is admitted to the emergency department after a car crash.
Physical examination reveals weakness in medial rotation and adduction of the
humerus. Which of the following nerves was MOST probably injured?
a. Thoracodorsal.
b. Axillary.
c. Dorsal scapular.
d. Spinal accessory.
e. Radial.
27.A 19-year-old man is brought to the emergency department after dislocating his
shoulder while playing football. Following treatment of the dislocation, he
cannot initiate abduction of his arm. An MRI of the shoulder shows a torn
muscle. Which muscle was MOST likely damaged by the injury?
a. Coracobrachialis.
b. Long head of the triceps.
c. Pectoralis minor.
d. Supraspinatus.
e. Teres major.
28.A 48-year-old female complains of symptoms of carpal tunnel syndrome, for

almost a year. Which muscles MOST typically become weakened in this
condition?
a. Dorsal interossei.
b. Lumbricals III and IV.
c. Thenar.
d. Palmar interossei.
e. Hypothenar.
P a g e 7 | 25
29.A 60-year-old-male male accidentally injured his wrist with a knife, partially
dividing the ulnar nerve. Which of the following actions would MOST likely be
lost as a result of this injury?
a. Flexion of the proximal interphalangeal joint of the fifth digit (Little
finger).
b. Extension of the thumb.
c. Adduction of the fifth digit.
d. Abduction of the thumb.
e. Opposition of the thumb.
30.A 43-year-old woman cannot hold a piece of paper between her thumb and the
lateral side of her index finger without flexing the distal joint of her thumb.
Weakness of which specific muscle causes this sign to appear?
a. Flexor pollicis longus.
b. Adductor pollicis.
c. Flexor digiti minimi.
d. Flexor carpi radialis.
e. Extensor indicis.
31.A 34-year-old man is undergoing an emergency laparotomy. Which of the

following anatomic features are the MOST useful to distinguish the jejunum
from the ileum?
32.What is the MAJOR source of protein in multi-trauma patients during the

catabolic phase?
a. Fat.
b. Kidney.
c. Liver.
d. Plasma protein.
e. Skeletal muscle.
P a g e 8 | 25
a. Erythrocytes.
b. Leukocytes.
c. Lymphocytes.
d. Monocytes.
e. Platelets.
34.A 50-year-old male patient is suffering from septic shock due to leaking
intestinal anastomosis. Which of the following is the BEST index for the severity
of shock?
a. Creatinine level.
b. Hb %.
c. Lactate level.
d. O₂ saturation of arterial blood.
e. Plasma sodium concentration.

a. ACTH.
b. Angiotensin II.
c. Cortisol.
d. Hypernatraemia.
e. Hypokalaemia.
P a g e 9 | 25

a. Chief cells.
c. Mucous cells.
d. Paneth cells.
e. Parietal cells.
38.A 60-year-old male patient is suffering from diabetic ketoacidosis. Which of the
following is the MOST important buffer base in the extracellular fluid?
a. Bicarbonate.
b. Hemoglobin.
c. Lactate.
d. Phosphate.
e. Plasma proteins.
39.The following acid-base data: pH: 7.2, PCO₂: 20 mmHg, HCO3-: 8 mmol/L, base
excess: -19 mmol/L, would be MOST consistent with:
a. Anxiety.
b. Lobar collapse of the lung.
c. Pyloric obstruction.
d. Septic shock.
e. Starvation.

a. Amino acid.
b. Glucose.
c. Ketones.
d. Lactose.
P a g e 10 | 25
41.A 63-year-old man undergoes a peripheral vascular procedure under general

anesthesia. A decrease in urine formation and excretion are noted. Decreased
urine flow under general anesthesia occurs because of which of the following?
a. Vasopressin.
b. Aldosterone suppression.
c. Depression of glucocorticoid.
d. Depression of thyroid function.
e. Specific effect of anesthesia on renal tubules.
42.Which of the following is a function of the parasympathetic system?

a. Increase the blood supply of the heart.
b. Increase the blood supply of skeletal muscles.
c. Increase in the heart rate.
d. Stimulation of glycogenolysis.
e. Increased motility of the gastrointestinal tract.
43.A 25-year-old man presents to the emergency department after being involved
in a road traffic accident. He is conscious, talking, has a blood pressure of 90/70
mmHg and a heart rate of 100 beats/minute. He has sustained a fractured pelvis
and femur. Which of the following is TRUE?
a. His total peripheral resistance is decreased.
b. The discharge rate of his carotid sinus nerves is increased.
c. There is a decrease in renin production.
d. There is an increase in angiotensin II.
e. There is an increase in renal sodium excretion.
44.Which of the following is CHARACTERISTIC of protein metabolism after trauma?

a. Decreased liver gluconeogenesis.
b. Inhibition of skeletal muscle breakdown by interleukin-1 and tumor
necrosis factor (INF, cachectin).
c. Decreased urinary nitrogen loss.
d. Hepatic synthesis of acute-phase reactants.
e. Decreased glutamine consumption by fibroblasts, lymphocytes and
intestinal epithelial cells .
P a g e 11 | 25
What is the MOST likely interpretation?

after induction, blood pressure is normal, but ECG shows peaked T waves and a
a. Ketoacidosis.
b. Hyperkalemia.
c. Hypoglycemia.
d. Hypocalcemia.
47.Which of the following statements regarding wound healing is TRUE?

a. Keloids contain an overabundance of fibroblasts.
b. A hypertrophic scar extends beyond the boundaries of the original
wound.
c. Improvement is usually seen with keloid excision followed by intralesional
steroid injection.
d. An incision placed perpendicular to the lines of natural skin tension will
result in the least obvious scar.
e. Hypertrophic scars occur most commonly on the lower extremities.

hyponatremia?
a. CHF.
b. Syndrome of inappropriate ADH secretion.
c. Cirrhosis.
d. Hyperglycemia.
P a g e 12 | 25
49.A 35-year-old man is admitted to the ICU following an emergency splenectomy

and nephrectomy for injuries sustained in a car accident. He received 12 units
of packed red blood cells intraoperatively. What electrolyte abnormality is
MOST likely to occur?
a. Hypokalaemia.
b. Hyperkalaemia.
c. Hypercalcemia.
d. Hypomagnesemia.
e. Hyperphosphatemia.
50.Which of the following is NOT an action of cortisol in a metabolically stressed

patient?
a. It stimulates release of insulin by the pancreas.
b. It induces the insulin resistance in muscles and adipose tissue.
c. It stimulates release of lactate from skeletal muscle.
d. It induces release of glycerol from adipose tissue.
e. It leads to immunosuppression.
51.Which one of the following is LEAST useful in the immediate treatment of

hyperkalemia?
a. Calcium salts.
b. Sodium bicarbonate.
c. Potassium-binding resins.
d. Glucose and insulin.
e. Hemodialysis.
52.A 40-year-old male patient was injured in the thigh and a bleeding point was
ligated by a silk suture. The patient got recurrent attacks of inflammation at the
site of the wound. The surgeon explored the wound and removed an
inflammatory mass around the silk suture. Which of the following cells will be
the predominant cell detected in this mass?
a. Basophils.
b. Eosinophils.
c. Lymphocyte.
d. Monocytes.
e. Neutrophils.
P a g e 13 | 25
53.Which of the following cells is an example of a permanent cell NOT capable of

division?
a. Acinar cells of the pancreas.
b. Colonic mucosal cells.
c. Erythrocytes.
d. Hepatocytes.
e. Osteocytes.
54.In patients with reflux esophagitis. What does the presence of columnar cells in
the esophageal mucosa represent?
a. Carcinoma in situ.
b. Carcinoma.
c. Dysplasia.
d. Hyperplasia.
e. Metaplasia.
55.Which of the following cytokines has anti-inflammatory properties?

a. Granulocyte macrophage colony-stimulating factor.
b. IL-10.
c. IL-2.
d. IL-3.
e. Tumor necrosis factor-α.

a. Atypia.
b. Increased nuclear cytoplasmic ratio.
c. Invasion.
d. Necrosis.
e. Pleomorphism.
P a g e 14 | 25
patient?
a. Bleeding time.
c. INR.
d. PTT.
e. Thrombin time.
58.A 30-year-old male patient was admitted to the casualty department due to a
car accident. The patient had fracture of the pelvis and the right femur and he
received 5 liters of blood following which he started to have bleeding from is
nose and mouth. What is the MAIN cause of this bleeding tendency?
a. Decrease in fibrinogen.
b. Decrease in prothrombin.
c. Decrease of calcium.
d. Increased fibrinolytic activity.
e. Platelet depletion.
59.A patient with a life threatening pulmonary embolus is receiving heparin. She
developed serious vaginal bleeding and a major retroperitoneal haematoma
after 5 days of heparin therapy. What is the recommended treatment?
a. Reverse heparin and evacuate the haematoma.
b. Reverse heparin by protamine sulphate and insert a vena caval filter.
c. Stop heparin and closely observe the patient.
d. Stop heparin, give fresh frozen plasma and start warfarin therapy.
e. Switch to low-dose heparin.
60.Which of the following is the MOST likely cause of increased prothrombin time?
a. Christmas disease.
b. Hemophilia.
c. Heparin therapy.
d. Von Willebrand’s disease.
e. Warfarin overdose.
P a g e 15 | 25

62.You were obliged to perform a cholecystectomy for a cirrhotic patient. During

surgery there was excessive bleeding. What would you order?
a. Fresh blood.
b. Fresh frozen plasma.
c. Fresh platelets.
d. IV vitamin K.
e. IV factor VIII.
63.You are planning to perform cholecystectomy for a female patient who is

receiving warfarin 5 mg daily because she had mitral valve replacement 4 years
ago. What is your pre-operative management?
a. Continue warfarin and give fresh frozen plasma intraoperatively.
b. Continue warfarin and give fresh platelets intraoperatively.
c. Continue warfarin and give IV vitamin K intraoperatively.
d. Stop warfarin and substitute it by heparin for 10 days preoperatively.
e. Stop warfarin and substitute it by heparin for 5 days preoperatively.
denote?
P a g e 16 | 25
65.A cirrhotic patient with abnormal hemostatic studies requires an urgent

66.A fully heparinized patient develops a condition requiring emergency surgery.

After stopping the heparin, what else should be done to prepare the patient?
a. 2 units of cryoprecipitates.
b. Administration of protamine sulphate 1 mg for every 100 units of heparin
most recently administered.
c. Immediate fresh frozen plasma.
d. Transfusion of 10 units of platelets.
e. Vitamin K intravenously.
67.A 5-year-old boy slipped and hurt his right knee while walking. He presents with
a tender, swollen, warm knee with significant hemarthrosis. His PT is 12
(Normal: 13 seconds), PTT is over 100 (Normal: 25 seconds), platelet count is
300,000/mm³ and bleeding time is normal. Initial management should consist
of which of the following?
a. Fresh-frozen plasma.
b. Aspiration of knee.
c. Factor VIII concentrate.
d. Passive exercise.
e. Long-leg cast.
68.Which of the following denotes a hemolytic transfusion reaction during

anesthesia?
a. Shaking chills and muscle spasms.
b. Fever and oliguria.
c. Hyperpyrexia and hypotension.
d. Tachycardia and cyanosis.
e. Bleeding and hypotension.
P a g e 17 | 25
69.A 50-year-old female patient has chronic renal failure and has been maintained
an chronic dialysis. The patient underwent cholecystectomy. Post-operatively
she had severe bleeding. What is the MOST likely cause for this bleeding?
a. Elevated PT.
b. Elevated PTT.
c. Low platelet count.
d. Decreased platelet aggregation.
e. Sepsis.
70.A 70-year-old female patient is receiving warfarin because she has AF and had
previous thrombosis. Which of the following statements regarding warfarin is
CORRECT?
a. The dose of warfarin is adjusted according to the partial thromboplastin
time.
b. Warfarin takes about 8 hours to exert its effects.
c. Warfarin acts by inhibiting factor XII.
d. If the patient is also taking aspirin, the dose of warfarin should be
reduced.
e. Protamine sulphate is the antidote to warfarin.
71.In the awake, non-anesthetized patient suspected of having a hemolytic post-

transfusion reaction, the MOST characteristic signs are:
a. Nausea and vomiting.
b. Fever and chills.
c. Oliguria and hemoglobinuria.
d. Cyanosis and dyspnea.
e. Tenderness of the renal angle.
72.On postoperative day 4 after a Whipple procedure, a patient develops

symptoms consistent with massive pulmonary embolism. Computed
tomography confirms a saddle embolus. After emergent lytic therapy with
urokinase, the patient is bleeding from the surgical site. Which of the following
options is the BEST choice to treat the bleeding?
a. Aminocaproic acid.
b. Cryoprecipitate.
c. Dextran.
d. Fresh frozen plasma.
e. Packed red blood cells.
P a g e 18 | 25
73.Regarding low molecular weight heparin, which of the following is TRUE?

a. Activity is effectively measured by activated partial thromboplastin time
(APTT).
b. Strongly binds to plasma proteins.
c. Has a longer plasma half-life than a standard heparin.
d. Has its effect reversed by an equivalent dose of protamine.
e. Has a normal plasma clearance in patients with renal failure.
74.Trauma patients sustaining what type of injury are at HIGHEST risk of venous
thromboembolism?
a. Head trauma.
b. Femur fracture.
c. Pelvic fracture.
d. Splenectomy.
e. Spinal cord injury.
75.Which of the following is the MOST effective way in preventing surgical site
infection?
76.Which of the following is TRUE regarding antibiotics?

a. Aminoglycosides may cause hepatotoxicity.
b. Ampicillin in effective against pseudomonas infections.
c. Cephalosporins are rarely used for prophylaxis.
d. Penicillins act by disrupting the peptidoglycan of the bacterial cell wall.
e. Vancomycin is the first choice for treatment of infections with staph.
aureus.
P a g e 19 | 25
77. A 45-year-old diabetic male patient complains of severe pain in the thigh.
Examination reveals spreading oedema, swelling and tenderness of the thigh. A
provisional diagnosis of necrotizing fasciitis is made. Which of the following is
MOST important in the treatment?
a. Antifungal agents.
b. Antitoxin.
c. Hyperbaric O₂.
d. Immunoglobulins.
e. Wide surgical debridement.
78. A patient with a non-obstructing carcinoma of the sigmoid colon being prepared
for elective resection. Which of the following reduces the risk of postoperative
infectious complications?
a. Avoidance of oral antibiotics to prevent emergence of Clostridium difficile.
b. Postoperative administration for 48 h of parenteral antibiotics effective
against aerobes and anaerobes.
c. Postoperative administration of parenteral antibiotics effective against
aerobes and anaerobes until the patient's intravenous lines and all other
drains are removed.
d. Redosing of antibiotics in the operating room if the case lasts for more than
2 hours of operating time.
e. Single preoperative parenteral dose of antibiotic effective against aerobes.
79. A 40-year-old male patient had renal transplantation and is receiving

immunosuppression. Few days following the operation the patient developed
persistent fever. Which of the following infectious microorganisms is currently the
MOST likely cause of this fever?
a. Candidiasis.
b. Coli sepsis.
c. Cytomegalovirus sepsis.
d. Pneumococcal sepsis.
e. Streptococci.
80. A 30-year-old female patient developed postoperative wound infection after a

thyroidectomy operation. What is the MOST likely causative organism?
a. Bacteroides
b. E. coli.
c. Proteus.
d. Staph. aureus.
e. Streptococci.
P a g e 20 | 25
81.Which of the following is the mode of action of ciprofloxacin?

a. Blockage of bacterial DNA replication.
b. Competitive inhibition of the enzyme dihydrofolate reductase.
c. Inhibition of bacterial wall synthesis.
d. Inhibition of protein synthesis by ribosomes.
e. Inhibition of translocation of peptides.
82.A 30-year-old woman sustained a puncture wound to the foot. The patient has
been on a therapeutic dose of steroids for the past 5 years for ulcerative colitis.
Her last tetanus toxoid booster was 8 years ago. What should the patient
receive?
a. Tetanus toxoid booster.
b. Human immunoglobulin, antibiotics with anaerobic coverage.
c. Tetanus toxoid plus human immunoglobulin.
d. Tetanus toxoid plus human immunoglobulin and antibiotics with aerobic
and anaerobic coverage.
e. Wide debridement of the wound.
83.Which of the following measures is MOST likely to reduce the risk of

postoperative wound infection with MRSA?
a. 5 days of broad spectrum prophylactic antibiotics.
b. Ensure that the patient showers with chlorhexidine wash prior to surgery.
c. A policy of staff handwashing between patients.
d. Screening patients for MRSA carriage prior to surgery.
e. Preoperative shaving the area of incision.
84.Treatment of wounds with negative pressure wound dressings (VAC dressings)

may result in all of the following EXCEPT:
a. Increased apoptosis.
b. Increased granulation tissue.
c. Improved microvascular blood flow to wound edges.
d. Removal of excess fluid and debris.
e. Lower bacterial counts.
P a g e 21 | 25
85.A 45-year-old woman undergoes an uneventful laparoscopic cholecystectomy

for which she receives one dose of cephalosporin. One week later, she returns
to the emergency room with fever, nausea and copious diarrhea and is
diagnosed with pseudomembranous colitis. Which one of the following
statements is CORRECT?
a. Surgical intervention is frequently required.
b. After appropriate antibiotic therapy, the relapse rate is less than 5%.
c. Tissue culture assay for Clostridium difficile toxin B is neither sensitive nor
specific; therefore diagnosis should be based on clinical findings.
d. If surgery is performed a left hemicolectomy is usually adequate to treat
pseudo membranous colitis.
e. Indications for surgical treatment include intractable disease, failure of
medical therapy, toxic megacolon and colonic perforation.
86.What is the oral antibiotic MOST likely to be effective against a pseudomonas

urinary tract infection?
a. Ciprofloxacin.
b. Trimethoprim-sulfamethoxazole.
c. Cephalexin.
d. Nitrofurantoin.
e. Amoxicillin.
87.Which of the following is TRUE regarding necrotizing fasciitis?

a. Skin manifestations may be totally absent.
b. It is commonly a single microbial infection.
c. The muscles are usually involved.
d. Broad spectrum antibiotics are the most essential measure of treatment.
e. It commonly occurs in previously healthy people.
88.Renal transplant patients have an increased incidence of:

a. Adenocarcinoma of the uterus.
b. Nonmelanoma skin cancer.
c. Lobular breast cancer.
d. Colonic carcinoid.
e. Lung cancer.
P a g e 22 | 25
89.Which of the following statements about the treatment of necrotizing fasciitis

is TRUE?
a. The tissue underlying necrosis is reflected by the extent of skin necrosis.
b. Intravenous immune globulin (IVIG) is the first line of therapy.
c. Penicillin provides sufficient antibiotic coverage.
d. Hyperbaric oxygen has been shown to improve survival.
e. Exploratory incisions over normal-appearing skin are effective in
determining the extent of the necrosis.
90.The clinical course of the majority of patients with HCV infection is characterized
by which one of the following?
a. Acute constitutional symptoms and jaundice.
b. Acute fulminant hepatic failure.
c. Development of chronic hepatitis.
d. Progression to cirrhosis.
e. Development of hepatocellular carcinoma .
91.A surgical resident sustains a needle stick with a hollow-bore needle
contaminated with the blood of a patient who is hepatitis B antigen positive.
The resident completed a series of three hepatitis B vaccines one-year ago, but
his antibody response was not checked. Which of the following statements BEST
describe management of this case?
a. Observation only is indicated since the source does not have active HBV
infection.
b. The resident needs a booster of hepatitis B vaccine.
c. The resident should receive HBIG immediately.
d. The resident should receive HBIG and a hepatitis B vaccine immediately.
e. The resident needs to be tested for anti-hepatitis B antibody immediately.
If the test insult is negative, proceed as in alternative D.
92.Which of the following statements about the usage of antibiotics for the
prevention of surgical site infection is NOT TRUE?
a. Antibiotics should be administered within 60 minutes of incision.
b. The therapeutic dose of the antibiotic should be administered
intravenously.
c. Adequate tissue concentrations should be maintained during operation
by re-dosing as necessary.
d. Antibiotics should be continued for 48 hours after operation.
e. Vancomycin is the agent of choice for patients from nursing homes
undergoing hip replacement.
P a g e 23 | 25
93.The EARLIEST manifestations of serious gram-negative infection may consist of

a triad of signs that includes:
a. Tachypnea, hypotension and an altered sensorium.
b. Tachypnea, hypotension and lactic acidosis.
c. Thrombocytopenia, hypotension and lactic acidosis.
d. Mild hyperventilation, respiratory alkalosis and an altered sensorium.
e. Tachycardia, hypotension and metabolic acidosis.
94.Postoperative wound infections after operations for head and neck cancer are
MOST frequently caused by:
a. Bacillus fragilis.
b. Escherichia coli.
c. Gram negative anaerobes.
d. Staphylococcus aureus.
e. Pseudomonas aeruginosa.
95.What is the MOST common bacterial organism present in the colon?

a. Bacteroides.
b. Clostridium difficile.
c. Escherichia coli.
d. Salmonella.
e. Streptococci.
96.After being struck by a moving truck, a 23-year-old woman undergoes a

splenectomy during diagnostic laparotomy. She leaves the hospital against
medical advice on postoperative day 4, after refusing vaccination. Infection with
which of the following organisms is MOST likely to result in her developing
sepsis?
a. Beta-hemolytic streptococcus.
b. Candida albicans.
c. Clostridium difficile.
d. Escherichia coli.
P a g e 24 | 25
97.Septic shock is characterized by:

a. Increased capillary permeability.
b. Vasoconstriction.
c. A low cardiac output.
d. A high systemic vascular resistance.
e. Bradycardia.
98.Following urinary tract infection associated with extraction of a stone, a 64-year-

old woman developed gram-negative septicemia. Which statement is TRUE for
gram-negative bacterial septicemia?
a. Pseudomonas is the most common organism isolated.
b. Many of the adverse changes can be accounted for the endotoxin release.
c. The cardiac index is low.
d. Central venous pressure (CVP) is high.
e. Endotoxin is mainly a long-chain peptide.
99.Which of the following is NOT characteristic of aminoglycosides?

a. Active against a broad spectrum of gram-negative aerobes and useful for
synergy against some gram-positive cocci.
b. Emergence of resistant bacterial stains.
c. Narrow margin between therapeutic and toxic blood levels.
d. Nephrotoxicity, ototoxicity and neuromuscular paralysis.
e. Excellent activity in abscesses in which gram negative organisms are
involved.
100. The MOST common source of bacteria in wound infection after groin hernia
repair is:
a. The patient skin.
b. The patient nasopharynx.
c. Operating room air.
d. Surgical instruments.
e. Gastrointestinal flora.
P a g e 25 | 25

October 2020
1. The arterial blood gas analysis of a patient was pH 7.5, P(CO2) 47 mmHg, HCO3-
35 mmol/L. This patient MOST likely is suffering from:
a. Chronic obstructive pulmonary disease.
b. Diabetic ketoacidosis.
c. Persistent diarrhea.
d. Profound vomiting.
e. Salicylate poisoning.
2. Five days after an uneventful cholecystectomy, an asymptomatic middle aged
management?
3. A 65-year-old diabetic woman with chronic steroid-dependent bronchospasm
had hemicolectomy for a perforated cecum. The patient was intubated and
maintained on broad-spectrum antibiotics, renal-dose dopamine and a rapid
steroid taper. On postoperative day 2, she developed a fever of 39.2 oC,
hypotension and lethargy. Laboratory investigations revealed hypoglycemia and
hyperkalemia. What is the MOST likely diagnosis of this acute event?
a. Adrenal insufficiency.
c. Hypovolemia.
d. Insulin overdose.
e. Sepsis.
4. What is the MOST common fluid disorder in the surgical patient?
a. Extracellular fluid deficit.
b. Hyperkalemia.
c. Hyponatremia.
d. metabolic acidosis.
P a g e 1 | 25
5. The osmolarity of the extracellular fluid space is determined primary by a

concentration of:
a. Bicarbonate.
b. Chloride ion.
c. Phosphate radicals.
d. Potassium ion.
e. Sodium ion.
6. Which of the following is a CHARACTERISTIC of neurogenic shock?

a. Cool moist skin.
b. Decreased blood volume.
c. Increased peripheral vascular resistance.
d. Increased cardiac output.
e. Bradycardia.
7. A 28-year-old male was injured in a motorcycle accident. On admission he was

in severe respiratory distress and appeared cyanotic (With blood pressure of
80/40 mmHg). The patient was bleeding profusely from the nose and bad an
obviously open femur fracture with exposed bone. Breath sounds were
decreased on the right side of the chest. What should be the initial
management?
a. Control of hemorrhage with anterior and posterior nasal packing.
b. Tube thoracostomy in the right hemithorax.
c. Endotracheal intubation with in-line cervical traction.
d. Obtain intravenous access and begin emergency blood transfusion.
e. Obtain cross-table cervical spine film and chest film.
8. What is the MOST common symptom after major pulmonary embolism?

a. Cough.
b. Dyspnea.
c. Hemoptysis.
d. Pleural pain.
e. Palpitation.
P a g e 2 | 25
9. Following an operation and extubation, a patient was restless. His arterial blood
gases revealed: pH 7.36; PaO2 65 mmHg; PaCO2 55 mmHg; HCO3- 36 mmol/L.
10.What is the predominant metabolic abnormality in patients with pyloric

obstruction?
b. Hyperchloremic alkalosis.
c. Salt-losing enteropathy.
d. Intrinsic renal disease.
e. Metabolic acidosis.
11.62-year-old man has a history of myocardial infarction. He undergoes

uneventful left hemicolectomy for carcinoma of the colon. In the recovery room,
he is hypotensive and is given a fluid bolus of 500 ml Ringer's lactate over 30
minutes. He is intubated and his neck veins are distended. His HR is 130 bpm,
his BP is 80/60 mmHg and his urine output is 20 ml over the last hour. What
should be the next step in his management?
a. Administration of Ringer's lactate 500 ml over 1 hour.
b. Administration of dopamine.
c. Insertion of a Swan-Ganz catheter.
d. Administration of lasix.
e. Extubation of the patient.
12.A 60-year-old male patient had a colectomy operation. Post-operatively the

patient had tachycardia, hypertension and shallow respiration. Which of the
following is an indication to intubate the patient?
a. PaCO2 of 45 mmHg.
b. Respiratory rate 25/min.
c. PO2 of 55 mmHg at room temperature.
d. Heart rate of 130/min.
e. High pulmonary capillary wedge pressure.
P a g e 3 | 25
13.Which of the following metabolic effects is present in shock?

a. Increase in sodium and water excretion.
b. Increase in renal perfusion.
c. Decrease in cortisol levels.
d. Hyperkalemia.
e. Hypoglycemia.
14.A 65 year old man is noted to have a blood pressure of 90/62 mmHg on the
evening after an uncomplicated small bowel resection for obstruction. His heart
rate is 110/mm, respiratory rate 24/mm and temperature 37.4 oC, urine output
is only 20 ml over 2 hours and oxygen saturation by pulse oximetry is 95%. His
pre-operative hemoglobin was 12.6 g/dl. Which of the following statements is
the MOST accurate regarding the patient?
a. Initial therapy should be intravenous crystalloid fluid bolus.
b. Intravenous furosemide (Lasix) should be administered.
c. This patient is most likely affected by anxiety and a mild anxiolytic and
careful observation should be initiated.
d. A hemoglobin level performed in the recovery room after surgery of 12.4
g/dl is good evidence against active hemorrhage.
e. Urgent CT abdomen is required.
15.A patient, who had gastrectomy 10 days ago developed massive pulmonary
a. IV heparin.
b. Fibrinolytic agent.
c. Warfarin.
e. Corticosteroids.
16.Which of the following is the COMMONEST cause of ARDS?

a. Sepsis syndrome.
b. Aspiration.
c. Acute pancreatitis.
d. DIC.
e. Fat embolism.
P a g e 4 | 25
17.A 70-year-old man with chronic obstructive pulmonary disease is admitted for
elective hemicolectomy. What is a preoperative arterial blood gas analysis likely
to show?
Arterial PCO2: Bicarbonate:
a. Decreased. Decreased.
b. Decreased. Increased.
c. Decreased. Normal.
d. Increased. Decreased.
e. Increased. Increased.
18.A 39-year-old woman making a slow but adequate recovery after sustaining a
40% surface area burn injury. on the sixth postoperative day she becomes
to hiccup. What is the MOST likely causes of these symptoms?
d. Fecal impaction.
e. Systemic sepsis.
19.A 60-year-old man had undergone exploratory laparotomy for perforated

gastric ulcer with severe peritoneal contamination. Six hours after surgery, he is
tachycardic, hypertensive and has shallow respirations. Intubation and
institution of ventilatory support in indicated in the presence of which of the
following?
a. Respiratory rate of 23 breaths/min.
b. PaCO2 of 45 mmHg.
c. PaO2 of 55 mmHg on room air.
d. Heart rate of 140 bpm.
e. BP of 100/70 mmHg.
20.Which of the following types of shock is associated with high pulmonary wodge
pressure?
P a g e 5 | 25

a. Propofol.
b. Dantrolene.
c. Ketamine.
d. Succinylcholine.
e. Neostigmine.
22.A middle-aged woman is brought to the emergency department following a

head injury in a car accident. The patient is unconscious and there is bruising
over the upper abdomen. Blood pressure is 80 mmHg systole, pulse
120/minutes. What is the MOST important initial step in the management of
this patient?
a. X-ray (Three views) of abdomen.
b. Immediate laparotomy.
c. Check airway, breathing and circulation.
d. Perform emergency burr holes.
e. Diagnostic peritoneal lavage.
23.Choose the TRUE statement about septic shock:

a. Gram positive organisms do not cause septic shock because they lack the
cell endotoxin.
b. Leucopenia is not a feature of septic shock.
c. The second most common source of gram-negative bacteremia is the
urinary tract.
d. Escherichia coli is the second most common organism identified in gram
negative bacteremia.
e. The toxic effects of gram-negative endotoxin appear to be the result of
abnormal activation of normal physiologic pathways.
24.The anion gap will increase with an increase in the plasma concentration of:
a. Sodium.
b. Potassium.
c. Chloride.
d. Bicarbonate.
e. Lactate.
P a g e 6 | 25
25. A 78-year-old woman with emphysema receiving 28% oxygen by mask has the
Normal: 7.35-7.45 90-110 35-45 22-26 -2 to +2
26. A 28-year-old motorcyclist is admitted following a road traffic accident, having
sustained bilateral femoral fractures and a ruptured spleen. Three days
postoperatively he is noted to be agitated, hypoxaemic and difficult to ventilation
with a BP of 120/80 mmHg, regular pulse of 88 a beats/minute and he is apyrexial.
A chest X-ray shows bilateral diffuse lung infiltrates. What is the MOST likely
underlying diagnosis?
a. Adult respiratory distress syndrome (ARDS).
b. Atelectasis.
c. Bronchopneumonia.
d. Pulmonary oedema.
e. Pulmonary thrombo-embolism.
27. A 22-year-old man involved in a motor vehicle accident is found to have a thoracic
spine fracture (T6) and paraplegia. The patient is hypotensive with a systolic BP of
70 mmHg, is bradycardiac with a pulse of 48 beats/min and is breathing
comfortably. Which of the following would the MOST appropriate initial
treatment?
28. Which of the following is TRUE regarding nosocomial pneumonia among intensive
care unit patients?
a. Has the same mortality rate as does community-acquired pneumonia.
b. Is the most common nosocomial infection.
c. Can be avoided by early tracheostomy.
d. Is directly related to the duration of intubation.
e. Can be prevented by early institution of prophylactic antibiotics.
P a g e 7 | 25
29.With regard to complications of blood transfusion, which of the following

statements is TRUE?
a. Febrile reactions are regarded rare.
b. Transfusions lasting more than 6 hours increase the risk of infection by
contaminated blood.
c. One hundred mL of intravenous air is well tolerated.
d. Gram positive organisms are the commonest contaminants of stored
blood.
e. Larval stage of hydatid disease can be transmitted by blood transfusion.
30.A 55-year-old male patient has been receiving TPN for prolonged time and
developed hypomagnesaemia which of the following conditions clinically
resembles hypomagnesaemia?
a. Hypoglycemia.
b. Hypokalemia.
d. Hypocalcemia.
e. Hyponatremia.

membranes.
e. It decreases lipolysis in adipose tissue.
32.The gold standard for diagnosing pulmonary embolism (PE) is:

b. MRI.
c. Ventilation perfusion nuclear scans (VQ scans).
d. Duplex ultrasound U/S.
e. ECG.
P a g e 8 | 25
c. Urine Output.
d. Serum lactate.

trauma.
c. The catabolic response is initiated by the thyroid hormones.
35.Which of the following statements regarding hypervolemia in postoperative

patients is TRUE?
a. Hypervolemia can be produced by the administration of isotonic salt
solutions in amounts that exceed the loss of volume.
b. Acute overexpansion of the ECF space is typically not well tolerated in
healthy individuals.
c. Excess administration of normal saline can result in metabolic
derangement, most commonly hyperchloremic metabolic alkalosis.
d. The most reliable sign of volume excess is peripheral edema.
e. Daily weight measurement in the postoperative period does not help
determine fluid status.
36.Which of the following substances has been shown to be useful as a measurable

marker of the response to injury?
a. Tumor necrosis factor-a (TNF-a).
b. Interleukin-2 (IL-2).
c. IL-6.
d. IL-10.
e. C-reactive protein (CRP).
P a g e 9 | 25
37.A 35-year-old woman presents to you after running her first marathon with
complaints of muscle aches. Which of the following is NOT an action of cortisol
in this metabolically stressed patient?
a. It stimulates release of insulin by the pancreas.
b. It induces insulin resistance in muscles and adipose tissue.
f. It stimulates release of lactate from skeletal muscle.
c. It induces release of glycerol from adipose tissue.
d. It leads to immunosuppression.

physiologic stress?
b. Increase in TSH.
d. Initial insulin increase and then suppression.
39.Which of the following statements relating to large volume blood loss in trauma
is INCORRECT?
a. Tranexamic acid reduces the incidence of rebleeding following surgery.
b. Hypocalcaemia may complicate resuscitation.
c. Colloids are preferred initially as they reduce the incidence of
coagulopathy.
d. When patients receive over 5 units of whole blood, mortality increases
when blood products greater than 3 weeks old are utilized.
e. In the battlefield setting a ratio of one unit fresh blood to one unit plasma
is often utilized.
40.Maintaining perioperative serum glucose levels between 80 and 110 mg/dl in

diabetic patients undergoing cardiac surgery may:
a. Have no effect on postoperative complications.
b. Increase the incidence of deep sternal wound infections.
c. Increase the incidence of hypoglycemia.
d. Promote osmotic diuresis.
e. Decrease in-hospital mortality.
P a g e 10 | 25
41.A 45-year-old male patient had renal transplantation operation. Thirty minutes
after the operation the urinary output markedly dropped. The blood pressure
of was 120/80 mmHg. Duplex scanning of the transplanted kidney revealed
patent renal vessels and normal pelvicalyceal system. Which of the following is
TRUE regarding the present problem?
a. It is less liable to occur in females who had repeated pregnancies.
b. It is more liable to occur in patients who receive liver transplantation.
c. Stimulated CD4 lymphocytes are mainly responsible for the problem.
d. The patient needs immediate removal of the transplanted kidney.
e. The problem can be corrected by increasing the dose of cyclosporine.
42.Which of the following cells is responsible for cell mediated immunity?

a. B-lymphocytes.
b. Dendritic cells.
c. Monocytes.
d. Natural killer cells.
e. T-lymphocytes.
43.A 40-year-old male patient underwent a renal transplant com a cadaveric donor.
Immediately after finishing the vascular anastomosis, the kidneys became
immunoglobulins and complement in the vessel walls. What is the
a. Donor cytotoxic T-lymphocytes directed against the front antigens.
44.Which of the following is a major DISADVANTAGE of living donor organ

transplantation?
a. Elective procedure.
b. Immediate graft function.
c. Improved graft survival.
d. Mortality and morbidity of donors.
e. Shorter hospital stay.
P a g e 11 | 25
45.Which of the following is COMMONEST vascular complication which may follow

hepatic living related donor transplantation?
a. Portal vein stenosis.
b. Hepatic artery thrombosis.
c. Hepatic artery stenosis.
d. Inferior vena cava thrombosis.
e. Hepatic vein stenosis.

a. Kidney.
b. Heart.
c. Liver.
d. Bone marrow.
e. Cartilage.
47.One week after receiving a cadaver renal allograft, the recipient remains oliguric
and dialysis dependent. Ultrasonography reveals a large perigraft fluid
collection. Appropriate next step in the management of this patient is:
a. Observation.
b. Aspiration of the perigraft fluid and installation of fibrosis inducing agent
to obliterate the dead space.
c. Aspiration of the perigraft fluid collection for chemical analysis.
d. CT of the abdomen.
e. Angiography for localization of the bleeding site.
48.A 37-year-old woman with end-stage renal disease had a cadaveric renal
transplant 18 months previously. She tolerated her transplantation well and has
been receiving a stable regiment of tacrolimus and corticosteroids with a
creatinine of 1.0 mg/dl. She now presents with fatigue, bone pain and
osteoporosis. Her serum calcium is 11.5 mg/dl. The next step in management
should be:
a. Subtotal parathyroidectomy.
b. An increase in corticosteroid dose.
c. Hydration and diuresis.
d. Calcitonin injections.
e. Phosphate binders.
P a g e 12 | 25


a. ACTH is high.
d. Serum Na is low.
51.A 40-year-old male patient is complaining of persistent, headache, recurrent

52.A 30-year-old pregnant female patient (First trimester) developed palpitations,

tremors, excessive sweating, nervousness and failure to gain weight. Which of
the following investigations is the MOST accurate to diagnose her condition?
a. Free thyroxine level.
b. Level of thyroid peroxidase enzyme.
c. Technetium scan.
d. Thyroglobulin level.
e. Total thyroid level.
P a g e 13 | 25

d. It prevents the transformation of iodides to iodine.
e. It prevents the uptake of iodides by the thyroid gland.
54.Which of the following is the MOST common sign of Cushing’s syndrome?

a. Acne.
b. Hirsutism.
c. Hypertension.
d. Purple striae.
e. Truncal obesity.
55.A 23-year-old woman undergoes total thyroidectomy for carcinoma of the

cramps. What is the initial therapy?
a. 10 ml of 10% magnesium sulfate intravenously.
e. Oral vitamin D.
56.What is the BEST screening test to evaluate a patient to diagnose Cushing’s

syndrome?
a. Fasting a.m. cortisol.
b. 24-hour urine cortisol.
c. Low-dose dexamethasone suppression test.
d. Serum adrenocorticotrophic hormones levels.
e. High-dose dexamethasone suppression test.
P a g e 14 | 25
57. Which of the following statements regarding adrenal cortical insufficiency is TRUE?
a. Treatment with exogenous steroids is usually ineffective.
b. It is commonly seen as a consequence of metastasis of distant tumors, such
as lungs or breast, to the adrenal glands.
c. Chronic adrenal insufficiency (Addison's disease) in the preoperative patient
should be recognized by constellation of findings, including the
hyperglycemia, hypernatremia and hypokalemia.
d. Death from untreated chronic adrenal insufficiency may occur within hours
of surgery.
e. The most common underlying cause today is infection with resistant
microorganisms.
58. A 55-year-old female patient who has metastatic breast cancer presents with
weakness, anorexia, malaise, constipation and back pain and lethargy. Laboratory
studies include a normal chest X-ray; serum albumin 3.2 mg/dl; serum calcium 14
mg/dl; serum phosphorus 2.6 mg/dl; serum chloride 108 mg/dl; BUN 32 mg/dl and
creatinine 2.0 mg/dl. What is the appropriate initial management?
a. Intravenous normal saline infusion.
b. Administration of thiazide diuretics.
c. Administration of intravenous phosphorus.
d. Use of mithramycin.
e. Neck exploration and parathyroidectomy.
59. You have a patient who has pheochromocytoma and his blood pressure 200/120
mmHg. You are preparing this patient for surgery. Which of the following drugs
should be used FIRST for the control of blood pressure?
b. Propranolol.
c. Nifedipine
d. Atenolol.
e. Captopril.
60. After undergoing a thyroidectomy operation. 42-year-old opera singer has no
change in speech, but she has difficulty in singing high-pitched voices. Which nerve
is MOST likely to be injured?
a. Recurrent laryngeal.
b. Internal laryngeal.
c. External laryngeal.
d. Pharyngeal branch of vagus.
e. Phrenic.
P a g e 15 | 25
61.50-year-old woman presents with lethargy, weight gain, cold intolerance and
investigation?
62.40-year-old man is admitted to the surgical day case unit for repair of his left
inguinal hernia. On examination he is noted to have diffuse skin tanning, spotty
pigmentation of the elbows, nipples and buttocks and pigmentation of the scar
from a previous right inguinal hernia repair. Three hours after the operation he
becomes severely hypotensive. What is the MOST likely cause?
a. ACTH deficiency.
b. Adrenal insufficiency.
c. Growth hormone deficiency.
d. Potassium deficiency.
e. Thyroxin deficiency.
63.A pregnant mother in her first trimester comes to her clinician office with a
diagnosis of primary hyperparathyroidism. What is the CORRECT management?
a. Parathyroidectomy during the second trimester.
b. Parathyroidectomy during the third trimester.
c. Prescribing a calcimimetic agent to help reduce hypercalcemia until after
delivery, when definitive surgery can be offered safely.
d. Close observation and parathyroidectomy following delivery.
e. Weekly injections of calcitonin until delivery, when definitive surgery can
be offered safely.
a. Dehydration.
c. Hypoglycemia.
P a g e 16 | 25
65.With regard to calcium homeostasis, which of the following statements is

FALSE?
a. ……
b. ……
c. ……
d. ……
e. ……
66.Calcitonin helps mediate calcium homeostasis by which of the following

actions?
a. Stimulates osteoblast mediated bone formation and inhibits the renal
resorption of calcium and phosphate.
b. Directly inhibits the secretion of parathyroid hormones (PTH).
c. Inhibits intestinal absorptions of calcium.
d. Simulates hydroxylation of vitamin D.
e. Stimulates osteoclast mediated bone resorption.
67.What is the MOST common cause of primary adrenal insufficiency (Addison

disease)?
a. Tuberculosis.
b. Kaposi sarcoma.
c. Cytomegalovirus.
d. Lymphoma.
a. Epinephrine.
e. Phenylephrine.
P a g e 17 | 25
69.A 75-year-old woman presents with acute back pain after a minor fall.
a. Hypercalcaemia.
b. Hyperphosphatemia.
c. Hypokalaemia.
d. Hyponatraemia.
e. Normocalcaemia.

a. Fluid resuscitation of shock.
d. Malignancy.

b. Trousseau sign.
d. Anxiety.
e. Laryngospasm.

P a g e 18 | 25
73.A complication that enteral and parenteral feeding have in COMMON is:
a. Increased incidence of sepsis.
b. Intestinal villous atrophy.
c. Elevated liver transaminases.
d. Hyperosmolar non-ketotic coma.
e. Diarrhea.
74.A 50-year-old male diabetic patient whose diabetes has been controlled by
regimen alone is going to have repair of an incisional hernia. What is your plan
of management?
a. Continuation of diet and determination of serum glucose level before
surgery.
b. Subcutaneous administration of regular insulin.
c. Oral hypoglycemic agents for 3 days atter surgery.
d. Insulin infusion beginning one for before surgery.
e. Increased oral carbohydrate intake to prevent ketosis.
75.Which of the following with regard to metabolism during fasting is TRUE?

a. The main source of fuel in short-term fasting (<5 days) is derived from
hepatic glycogen stores.
b. Norepinephrine, vasopressin and angiotensin II promotes the assembly of
glycogen during fasting.
c. In prolonged starvation, ketone bodies become the primary fuel for the
brain.
d. Lipid stores in adipose tissue provide 50% of the caloric expenditure
during starvation.
e. Release of fatty acids is stimulate by an increase in serum insulin levels.
76.Extracellular fluid has a:

a. Higher protein content than intracellular fluid.
b. Higher potassium content than intracellular fluid.
c. Higher sodium content than intracellular fluid.
d. Higher magnesium content than intracellular fluid.
e. Higher number of large organic molecules than intracellular fluid.
P a g e 19 | 25
77.A 35-year-old man is admitted to the ICU following a diagnosis of acute

pancreatitis. After initial resuscitation, the patient's condition improves and
enteral tube feedings are started through a postpyloric tube. Initial intolerance
to a tube feeding regimen requires the clinician to:
a. Immediately discontinue the tube feeding regimen and start total
parenteral nutrition (TPN).
b. Add water to feeding regimen to dilute the feedings for better tolerance.
c. Consider slowing the tube feeding regimen and progress to the goal rate
less aggressively.
d. Immediately change the tube feeding formula.
e. Increase the tube feeding rate per hour.
78.Hyperglycemia in a surgical patient receiving TPN may BEST be managed by:

a. Oral hypoglycemics.
b. Decreasing the dextrose load and doubling the amount of fat.
c. Adding regular insulin to the TPN.
d. Discontinuing TPN for 2 weeks and then trying to start TPN again.
e. Increasing the concentration of protein and carbohydrate calories and
decreasing that of lipids.
79.A 50-year-old man with small-bowel fistula has been receiving TPN for the
previous 3 weeks. He is scheduled for exploratory laparotomy and closure of
fistula. On the day of surgery, TPN is discontinued and intravenous infusion with
Ringer's lactate is started. An hour later, the patient was found to be anxious,
sweating and tachycardic. What is the MOST likely cause?
a. Anxiety.
b. Hypoglycemia.
c. Hypovolemia.
d. Unexplained hemorrhage.
e. Hyperglycemia.
80.In which of the following conditions is the enteral route appropriate for
nutrition?
a. Upper gastrointestinal bleed.
b. Complete small bowel obstruction.
c. Acute flare up of Crohn's disease.
d. Low output colonic fistula.
e. High output small bowel fistula.
P a g e 20 | 25
81.If a patient with pulmonary failure is receiving total parenteral nutrition.

Difficulty in weaning because of respiratory muscle weakness is MOST likely to
be associated with:
a. Hypocalcemia.
b. Hypochloremia.
c. Hyponatremia.
d. Hypomagnesemia.
e. Hypophosphatemia.
82.Which of the following conditions causes the GREATEST increase in energy

expenditure?
a. Pyloric obstruction from chronic duodenal ulcer.
b. Fractured femur.
c. Perforated diverticulitis of colon.
d. Thermal burns more than 30% total body surface area.
e. Right inguinal herniorrhaphy for incarcerated inguinal hernia.
83.A 75-year-old female presents with ductal carcinoma in situ for simple
mastectomy. She has marked muscle wasting on examination and admits to a
poor diet. Which of the following values is MOST predictive of postoperative
mortality?
a. Serum sodium.
b. Serum albumin.
c. Serum protein.
d. Serum creatinine.
e. Serum glucose.
84.A patient who presented with severe diarrhea as a result of clostridium difficile,
the following ions in the diarrhea?
a. Cl-.
b. HCO3-.
c. K+.
d. NH4+.
e. OH-.
P a g e 21 | 25
85.Bacterial pressure sores are BEST prevented by:

a. Routine use of air-flow mattresses.
b. Frequent re-positioning.
c. Aggressive nutritional support.
d. Infection control.
e. Drying powders to moist skin surfaces.
86.Which of the following statements is TRUE regarding beta-hemolytic

streptococci?
a. They produce a characteristic beta-lactamase.
b. They are one of the causes of necrotizing fasciitis.
c. They are the most common cause of infective endocarditis.
d. They are resistant to ampicillins.
e. They are part of the normal vaginal flora.
87.Which of the following statements regarding MRSA is TRUE?

a. The treatment of choice is clindamycin.
b. MRSA can only be found in the health care setting.
c. MRSA is more virulent than methicillin sensitive S. aureus.
d. Treatment of surgical patients with intranasal mupirocin decreases
wound infection rates with MRSA.
e. Hospitalized patients colonized with MRSA require contact isolation.
88.Which of the following statements regarding prevention of surgical site

infection is TRUE?
a. All hair should be removed by shaving from the operative site.
b. Smoking has no effect on postoperative surgical site infection.
c. Prophylactic antibiotics should be administered within 30 minutes of
incision.
d. Administration of 80% oxygen reduces surgical site infection in vascular
procedures.
e. Chlorhexidine containing skin preparations have a clear benefit in
reducing surgical site infection compared with povidone-iodine solutions.
P a g e 22 | 25
89.With regard to potassium, which of the following statements is NOT TRUE?

a. Normal dietary intake of potassium is 50 to 100 mEq/day.
b. In patients with normal renal function, most ingested potassium is
excreted in urine.
c. More than 90% of the potassium in the body is located in the extracellular
compartment.
d. Critical hyperkalemia (>6 mEq/L) is rarely encountered if renal function is
normal.
e. Administration of sodium bicarbonate shifts potassium from the
extracellular space (ECF) to the intracellular space (ICF).
90.Surgical safety check-list before induction of anesthesia includes all of the

following EXCEPT?
a. Does the patient have a known allergy?
b. Difficult airway or aspiration risk?
c. Risk of >500 ml blood loss (7 ml/kg in children)?
d. Is the site of surgery shaved?
e. Is the site marked?
91.A 77-year-old man is admitted for a radical prostatectomy. On postoperative

day 3 a productive cough and fever develop. A chest radiograph shows a right
lower lobe infiltrate. Which of the following is CORRECT regarding immune
function in older patients?
a. WBC counts increase significantly even with mild infections.
b. The T-cell response to new antigens is impaired.
c. Normal neutrophil counts decline with age.
d. Normal acute phase protein levels are decreased.
e. Normocytic anemia is uncommon in older patients.
92.Which site or venue is the area that is at GREATEST risk for surgical errors?
a. Operating room.
b. Surgical intensive care unit.
c. Hospital wards/floors.
d. Emergency department.
e. Ambulatory care sites.
P a g e 23 | 25

proceed.
94.The MOST common indication for surgery in the elderly is:

a. Obstructive vascular disease.
b. Thrombotic vascular disease.
c. Biliary tract disease.
d. Colorectal disease.
e. Pancreatic disease.

a. Adverse event.
b. Near miss event.
c. Never event.
d. No harm event.
e. Sentinel event.
96.World health organization established the surgical safety checklist in order to

maintain patient safety in the operating theatre. One of the measures that
eliminate wrong site surgery is to perform a time-out check. The timing of this
check is:
a. Before referral to the operating theatre.
b. Before induction of anesthesia.
c. Before skin incision.
d. Before removal of an important organ.
e. Before closure of the wound.
P a g e 24 | 25
97. An 80-year-old woman with advanced Alzheimer's disease has been ill for 4 days
and is transferred from the nursing home with fever, hypotension and abdominal
swelling. Computed tomographic (CT) scan reveals a superior mesenteric artery
thrombosis, bowel ischemia and pneumatosis. She is acidotic and in acute renal
failure. Surgical intervention would necessitate resection of a significant length of
small and large bowel. Which of the following statements about this patient's care
is TRUE?
a. She is dying and palliative care is indicated.
b. The decision for further care should be left solely with the family.
c. Operation is the only chance for cure o the bowel ischemia and should be
performed.
d. Aggressive ICU resuscitation is warranted and operation should be
performed if the patient stabilizes.
e. Operation should be performed, but dialysis should not be contemplated.
98. Duty to intervene on the patient's behalf to increase comfort, health and well-
being:
a. Non-maleficence.
b. Autonomy.
c. Euthanasia.
d. Beneficence.
e. Justice.
99. Which of the following statements regarding the role of collagen in wound healing
is TRUE?
a. Collagen synthesis in the initial phase of injury is the sole responsibility of
endothelial cells.
b. Net collagen content increases for up to 2 years after injury.
c. At 3 weeks after injury, more than 50% of the tensile strength of the wound
has been restored.
d. Tensile strength of the wound increases gradually for up to 2-years after
injury; however, it generally reaches a level of only about 80% of that of
uninjured tissue
e. Tensile strength is the force necessary to reopen a wound.
100. Respiratory alkalosis can occur as a result of:
a. Asphyxia.
b. Asthma.
c. Severe emphysema.
d. Hyperventilation.
e. Hypoventilation.
P a g e 25 | 25

July 2019
1. A 25-year-old man is playing football when he complains of posterior thigh pain
whilst sprinting with the ball. On examination he has tenderness in the lower lateral
posterior thigh. He is unable to fully extend the knee due to pain. What is the MOST
likely injury?
a. Biceps femoris tear.
b. Gracilis tear.
c. Gastrocnemius tear.
d. Semimembranosus tear.
e. Semitendinosus tear.
2. After undergoing a surgical procedure on the small (Short) saphenous vein, a
patient complains of pain and numbness on the lateral aspect of the foot. The
nerve MOST likely to be affected is the:
a. Deep peroneal.
b. Lateral plantar.
c. Saphenous.
d. Superficial peroneal.
e. Sural.
3. A 70-year-old woman undergoes a left mastectomy and axillary clearance. At a
follow-up appointment she was noted to have winging of the left scapula. Which
muscle has been paralyzed as a result of the dissection of the axilla?
a. Latissimus dorsi.
b. Pectoralis major.
c. Serratus anterior.
d. Teres major.
e. Trapezius.
4. A 27-year-old man is admitted to the emergency department after a car crash.
a. Thoracodorsal.
b. Axillary.
c. Dorsal scapular.
e. Radial.
P a g e 1 | 25

exploratory laparoscopy. Which of the following anatomic features are the
MOST useful to distinguish the jejunum from the ileum?
6. A 45-year-old woman is admitted to the emergency department with a

complaint of severe abdominal pain. CT scan and MRI examinations reveal a
tumor of the head of the pancreas involving the uncinate process. Which of the
following vessels is MOST likely to be occluded?
a. Common hepatic artery.
b. Cystic artery and vein.
c. Superior mesenteric artery.
d. Inferior mesenteric artery.
e. Portal vein.
7. Upon removal of a leg cast, a 15-year-old boy complains of numbness of the

dorsum of his right foot and inability to dorsiflex and evert his foot. Which is the
MOST probable site of the nerve compression that resulted in these symptoms?
a. Popliteal fossa.
b. Neck of the fibula.
c. Lateral compartment of the leg.
d. Anterior compartment of the leg.
e. Medial malleolus.
8. Which of the following statements is TRUE regarding the marginal mandibular

nerve?
a. Is a branch of the 5th cranial nerve.
b. Supplies motor function to the strap muscles.
c. May be associated with the submandibular gland.
d. Lies deep to the facial vein.
e. Is most often injured during dissection of the posterior triangle (level 5)
of the neck.
P a g e 2 | 25

a. Cervix.
b. Ovary.
c. Uterus.
d. Vagina.
e. Vulva.

protruding?
a. Conjoint tendon.
11.A 30-year-old motorcyclist suffers a closed fracture to the mid-shaft of the tibia.
12.An 82-year-old man has complete occlusion of his inferior mesenteric artery on
angiography but no symptoms or signs of colonic ischemia. Which of the
following arteries is the MOST likely additional source of blood supply to the
territory of the inferior mesenteric artery?
a. Left colic.
b. Left gastroepiploic.
c. Middle colic.
d. Splenic.
e. Superior rectal.
P a g e 3 | 25
13.In L5 nerve root compression from a herniated intervertebral disc, altered

cutaneous sensation is predominantly in the:
a. Dorsum of foot.
b. Heel of foot.
c. Medial border of foot.
d. Outer border of foot.
e. Sole of foot.
14.A 22-year-old man is admitted to the emergency department after falling from
his bicycle. Radiograph examination reveals a fracture of the tibia above ankle.
MRI and physical examination reveal the tibial nerve is severed on the posterior
aspect of tibia. Which of the following signs will MOST likely present during
physical examination?
a. Sensory loss of the dorsum of the foot.
b. Sensory loss on the sole of the foot.
c. Foot drop.
d. Paralysis of the extensor digitorum brevis.
e. Sensory loss of the entire foot.
15.Wound healing is relatively SLOWEST in which of the following?

a. Eyelid.
b. Lips.
c. Sternum.
d. Stomach.
a. c. Urinary bladder.
P a g e 4 | 25

b. Dextrose 25%.
d. Saline.
18.Which of the following is the MOST potent stimulus for contraction of the gall
bladder?
a. Acetylcholine.
b. Cholecystokinin.
c. Intravenous hyperalimentation.
d. Secretin.
e. Vagal stimulation.
a. Bicarbonate.
b. Hemoglobin.
c. Lactate.
d. Phosphate.
e. Plasma proteins.
20.Which of the following statements is CORRECT regarding potassium

homeostasis?
a. About 60% of the total body potassium is in the intracellular
compartment.
b. Aldosterone stimulates potassium reabsorption in the distal convoluted
tubules.
c. Hypokalaemia causes depression of the ST segment
d. In alkalosis there is usually hyperkalaemia.
e. Insulin causes potassium to leave the cell.
P a g e 5 | 25

22.During the second (Proliferative) phase of wound healing the predominant cells
in the wound site are fibroblasts. Cross linkage of collagen requires hydroxy-
proline and hydroxy-lysine residues, which requires a specific vitamin to be
available in sufficient quantities. Deficiency of which vitamin results in collagen
that is unstable?
a. Vitamin B2 (Riboflavin).
b. Vitamin B6 (Pyridoxine).
c. Vitamin C (Ascorbic acid).
d. Vitamin D (Cholecalciferol).
e. Vitamin E (Tocopherol).

widened QRS complex. The most likely diagnosis is:
a. Ketoacidosis.
b. Hyperkalemia.
c. Hypoglycemia.
d. Hypocalcemia.
to show?
Bicarbonate Arterial pCO2
Decreased Decreased A
Increased Decreased B
Normal Decreased С
Decreased Increased D
Increased Increased E
P a g e 6 | 25
25.Norepinephrine (Noradrenaline) causes an increase in the systemic vascular

resistance. In which condition is its use MOST appropriate?
a. Cardiogenic shock.
b. Hypovolemic shock.
c. Neurogenic shock.
d. Obstructive shock (e.g. Pulmonary embolism).
e. Septic shock.
26.Parathyroid hormone is important for regulation of calcium homeostasis. Which

of the following BEST describes the hormone?
a. Accelerates renal hydroxylation of vitamin D.
b. Directly accelerates calcium absorption from the intestine.
c. Is a steroid hormone.
d. Is secreted under the control of the anterior pituitary.
e. Increases plasma phosphate concentration in a normal adult.

hyponatremia?
a. Congestive heart failure.
b. SIADHI (Syndrome of inappropriate ADH).
c. Cirrhosis.
d. Hyperglycemia.
28.An 80-year-old man with a history of hypertension, controlled with thiazide

diuretics, undergoes transurethral resection of prostate under general
anesthetic. The surgery is prolonged and in the recovery room he complains of
nausea and a headache. He later becomes agitated and confused. Which of the
following is the MOST likely diagnosis?
a. Hypercalcaemia.
b. Hyperuricaemia.
c. Hypoglycaemia.
d. Hypokalaemia.
e. Hyponatraemia.
P a g e 7 | 25
29.A 50-year-old male patient was punctured in his foot by a very tiny piece of glass
which could not be removed. Three months later the patient presented by a
firm small nodule at the site of the puncture and this was excised. Which of the
following cells will be predominant on pathological examination of the removed
nodule?
a. Epithelioid cells.
b. Fibroblasts.
c. Lymphocytes.
d. Plasma cells.
e. Polymorphonuclear leucocytes.
30.In patients with reflux esophagitis, What does the presence of columnar cells in
b. Carcinoma.
c. Dysplasia.
d. Hyperplasia.
e. Metaplasia.
31.With regard to protein loss after injury, which of the following statements is
TRUE?
a. It can be prevented by total parenteral nutrition.
b. It occurs primarily from skeletal muscle.
c. It occurs primarily from the site of injury.
d. It results from significant decrease intake.
e. It results from impaired synthesis.
32.A 54-year-old man with a history of depression is brought to the emergency

department. He has taken an overdose of benzodiazepines and is found
unconscious, lying on his right upper limb. His right arm is swollen and mottled
in color, with an insensate and stiff hand. Analysis of his urine is MOST likely to
reveal increased levels of:
a. Haemoglobin.
b. Myoglobin.
c. Protein.
d. Red blood cells.
e. White blood cells.
P a g e 8 | 25
33.Which of the following statements regarding TNF is TRUE?

a. TNF-α is produced only by monocytes and macrophages.
b. Release of TNF is stimulated by exotoxins.
c. TNF enhances the anticoagulant activity of endothelial surfaces.
d. TNF is responsible for the cachexia associated with metastatic disease.
e. Glucocorticoids have essentially no effect on TNF-α expression.

a. Bacteroides.
d. Salmonella.
e. Streptococci.
35.Severe sepsis can be defined as:

a. Sepsis in association with refractory hypotension despite adequate fluid
resuscitation.
b. The systemic host response to invasive infection.
c. Sepsis in association with organ dysfunction.
d. The presence of micro-organisms invading normally sterile host tissues.
e. A clinical syndrome characterized by two or more of: tachycardia, tachypnea,
hyper- or hypothermia and leukocytosis or leucopenia.
36.Which of the following operations is a clean contaminated operation?

a. Colectomy for a prepared colon.
b. Drainage of a pericolic abscess.
c. Inguinal hemiectomy.
d. Perforated appendicitis.
b. Thyroidectomy.
P a g e 9 | 25
37.Which of the following is MOST important in the treatment of necrotizing

fasciitis?
b. Antitoxin.
c. Hyperbaric O2.
d. Immunoglobulins.
receive?
39.Treatment of wounds with negative-pressure wound dressings (VAC dressings)
may result in all of following EXCEPT:
a. Increased apoptosis.
b. Increased granulation tissue.
c. Improved microvascular blood flow to wound edges.
d. Removal of excess fluid and debris.
e. Lower bacterial counts.
40.A 45-year-old woman undergoes an uneventful laparoscopic cholecystectomy
for which she receives one dose of cephalosporin. One week later, she returns
to the emergency room with fever, nausea and copious diarrhea and is
subsequently diagnosed with pseudomembranous colitis. With respect to this
disease, which one of the following statements is CORRECT?
a. Surgical intervention is frequently required.
b. After appropriate antibiotic therapy, the relapse rate is less than 5%.
c. Tissue culture assay for Clostridium difficile toxin B is neither sensitive nor
specific; therefore diagnosis should be based on clinical findings.
d. If surgery is performed a left hemicolectomy is usually adequate to treat
pseudomembranous colitis.
e. Indications for surgical treatment include intractable disease failure of
medical therapy, toxic megacolon and colonic perforation.
P a g e 10 | 25
41.A non-immune surgical resident is stuck by a contaminated needle from a

hepatitis B surface antigen (HBsAg)-positive source. Which of the following is
the CORRECT initial treatment?
a. None because the patient does not have active hepatitis B virus (HBV)
infection and is immune to HBV.
b. Interferon.
c. Vaccination against HBV.
d. Hepatitis B immune globulin (HBIG).
e. Vaccination against HBV and administration of HBIG.
is TRUE?
a. The underlying tissue necrosis is reflected by the extent of skin necrosis.
b. Intravenous immunoglobulin is the first line of therapy.
e. Exploratory incisions over normal appearing skin are effective in
43.Which of the following statements regarding the risk for postsplenectomy sepsis
is TRUE?
a. The indication for splenectomy has no bearing on a patient's risk for
developing postsplenectomy sepsis.
b. Adult splenectomy patients have a greater likelihood of developing
postsplenectomy sepsis than do children or newborns who require a
splenectomy.
c. The risk for postsplenectomy sepsis is highest in the first year after
splenectomy, but asplenic patients' increased risk for developing sepsis
persists for approximately 10 years following splenectomy.
d. The risk of sepsis is increased in splenectomy patients due to impaired
cellular immunity.
e. The most common organism implicated in postsplenectomy sepsis is
Haemophilus influenzae.
c. Urine output.
d. Serum lactate.
P a g e 11 | 25
45.Which of the following which is the MOST effective way in preventing surgical
infection?
46.Which of the following is an EARLY manifestation of sepsis?

a. Cutaneous vasodilatation.
b. Decreased cardiac output.
c. Hypoglycaemia.
d. Increased arteriovenous O2 difference.
e. Respiratory acidosis.
47.A 37-year-old woman with end-stage renal disease had a cadaveric renal
transplant 18 months previously. She tolerated her transplantation well and has
been receiving a stable regiment of tacrolimus and corticosteroids with a
creatinine of 1.0 mg/dl. She now presents with fatigue, bone pain and
osteoporosis. Her serum calcium is 11.5 mg/dl. The next step in management
should be:
a. Subtotal parathyroidectomy.
b. An increase in corticosteroid dose.
c. Hydration and diuresis.
d. Calcitonin injections.
e. Phosphate binders.

P a g e 12 | 25

is TRUE?
a. Hyper-acute rejection begins in the operating room with reperfusion of
b. Liver transplants are especially susceptible to hyper-acute rejection.
rejection.
infiltration.
50.Which of the following is NOT an indication for liver transplant?

a. Cirrhosis complicated by ascites and esophageal varices.
b. Acute liver failure secondary to acetaminophen overdose.
c. NASH (Nonalcoholic steatohepatitis) complicated by hepatic
encephalopathy.
d. Hepatocellular carcinoma with underlying cirrhosis.
e. Hepatocellular carcinoma with biopsy-proven lymph node metastasis.
51.The arterial blood gas analysis of a patient was pH 7.5, P(CO2) 47 mmHg, HCO3-

woman is found to have a serum sodium level of 120 mEq/L. What is the proper
management?
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53.In the presence of acute blood loss, what is the initial mechanism to maintain
an adequate preload to the heart?
a. Development of tachycardia.
b. Hormonal effects of angiotensin.
c. Hormonal effects of rennin.
d. Increase in systemic vascular resistance.
e. Increased cortisol secretion.
54.Which of the following is a clinical feature of a major pulmonary embolism?

a. Bradycardia.
b. Collapsed neck veins.
c. Hemoptysis.
d. High fever.
e. Tachypnea.
55.Following an operation and extubation a patient was restless. His arterial blood
gases revealed: pH 7.36; PaO2 65 mmHg; PaCO2 55 mmHg; PaCO3- 30 mmol/L.
56.A 75-year-old woman who is in the ICU after undergoing colectomy is

hypotensive and tachycardic. Pulmonary capillary wedge pressure (PCWP) is
elevated to 18 mmHg, and cardiac output is 3 L/min. She is in shock BEST
described as which of the following?
b. Septic shock.
d. Anaphylactic shock.
P a g e 14 | 25

d. Hyperkalemia.
e. Hypoglycemia.
58.A 21-year-old man undergoes major abdominal surgery after a motor vehicle
collision. He has a cardiac arrest in the intensive care unit shortly after returning
from surgery. Select the MOST appropriate pharmacologic agent for the patient:
a. Epinephrine.
b. Norepinephrine.
c. Phenylephrine.
d. Dopamine.
e. Dobutamine.
59.Advantages of epidural analgesia include the following EXCEPT:

a. Earlier mobilization after surgery.
b. Earlier return of bowel function.
c. Shorter hospitalizations.
d. Increased stress response to surgery.
e. Excellent pain relief.
60.Which of the following is an important goal of therapy at 24 hours after the

onset of hypovolemic shock that may improve mortality?
a. Normalization of blood pressure and heart rate.
b. Normalization of urine output and base deficit.
c. Discontinuation of vasopressors and inotropes.
d. Ensuring the hematocrit is at least 30% (0.3).
e. Normalization of body and skin temperature.
P a g e 15 | 25

trauma.
patient?
a. Bleeding time.
c. INR.
d. PTT.
e. Thrombin time.
63.Which of the following is a CONTRAINDICATION to heparin therapy?

a. Closed head injury two weeks ago.
b. Heparin-induced thrombocytopenia.
c. Subclavian vein thrombosis.
d. Superior mesenteric artery embolism.
e. Third trimester of pregnancy.
64.Which of the following is the MOST likely cause of increased prothrombin time?
a. Christmas disease.
b. Hemophilia.
c. Heparin therapy.
d. Von Willebrand’s disease.
e. Warfarin overdose.
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b. It is a co-factor of antithrombin III.

67.Which of the following statement is TRUE concerning hemophilia A?

a. A positive family history for bleeding disorders is present in all patients.
b. Hemophilia A is inherited as a sex-linked recessive deficiency of factor VIII.
c. Laboratory tests reveal a prolongation of aPTT, prothrombin time (PT),
thrombin clotting time and platelet aggregation.
d. Minor bleeding cannot be controlled locally without the need for
replacement therapy.
e. Spontaneous bleeding is usual with factor VIII levels greater than 10% of
normal.
68.You were obliged to perform cholecystectomy for a cirrhotic patient. During

a. Fresh blood.
c. Fresh platelets.
d. IV vitamin K.
e. IV factor VIII.
P a g e 17 | 25
denote?

71.Which of the following is the BEST method of identifying the liability to bleeding
during a surgical procedure?
a. Platelet count.
b. A complete history and physical examination.
c. Bleeding time.
d. Lee-White clotting time.
e. Prothrombin time (PT).

anesthesia?
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73.A victim of blunt abdominal trauma requires a partial hepatectomy. He is rapidly

transfused with 8 units of appropriately cross-matched packed red blood cells
from the blood bank. He is noted in the recovery room to be bleeding from
intravenous puncture sites and the surgical incision. His coagulopathy is likely
due to thrombocytopenia and deficiencies of which clotting factors?
a. II only.
b. II and VII.
c. V and VII.
d. IX and X.
e. XI and XII.
74.Regarding low molecular weight heparin, which of the following is TRUE?

a. Activity is effectively measured by activated partial thromboplastin time
(APTT).
b. Strongly binds to plasma proteins.
c. Has a longer plasma half-life than a standard heparin.
d. Has its effect reversed by an equivalent dose of protamine.
e. Has a normal plasma clearance in patients with renal failure.
75.A 45-year-old woman with deep vein thrombosis is taking warfarin (Coumadin),
5 mg/d. Seven days after initiation of therapy, she has warfarin-induced skin
necrosis. Which of the following statements regarding this condition is TRUE?
a. It commonly occurs after warfarin therapy.
b. It usually involves the upper extremities.
c. It improves with an increase in the dose of Coumadin.
d. It improves with a decrease in the dose of Coumadin.
e. It requires cessation of Coumadin and infusion of heparin.
76.Which of the following is MOST likely to be a risk factor for the development of
carpal tunnel syndrome?
a. Addison's syndrome.
b. Diabetes insipidus.
c. Fibromyalgia.
d. Graves' disease.
e. Hypothyroidism.
P a g e 19 | 25
77.A 30-year-old female patient complains of fatigue, generalized bony aches and
diagnosis?
d. Plasma chloride.
e. Serum phosphate.

79.Which of the following is the MOST potent stimulus for aldosterone secretion?
a. ACTH.
b. Antidiuretic hormone.
c. Hyperkalaemia.
d. Hypernatraemia.
e. The rennin angiotensin system.
80.Which of the following abnormalities indicates the possibility of

hyperaldosteronism?
a. Hyperkalemia, hyponatremia, hypochloremia.
b. Hyperkalemia, hypernatremia, low pH.
c. Hyperkalemia, hyponatremia, hyperglycemia.
d. Hypokalemia, hypernatremia, high pH.
e. Hypokalemia, hypochloremia, high pH.
P a g e 20 | 25
81.Twelve hours after having undergone a subtotal thyroidectomy, a 30-year-old

woman develops agitation and difficulty in breathing. Examination reveals
tachycardia and anterior cervical swelling: the surgical dressing is dry. What is
the MOST appropriate treatment?
a. Insertion of an endotracheal tube.
b. Re-opening of the cervical wound at bed.
c. Determination of the serum calcium concentration.
d. Administration of morphine.
e. Administration of O2 by nasal catheters.
82.A 40-year-old woman had the anterior lobe of the pituitary removed because of
a tumor. Without postoperative supplements, which of the following could
occur?
a. Failure to produce adequate amounts of thyroxine.
b. Failure to produce parathyroid hormone in response to hypocalcaemia.
c. Failure to secrete catecholamines in response to stress.
d. Failure to secrete insulin in hyperglycaemia.
e. Inability to concentrate urine in response to water deprivation.
83.What is the MOST common cause of primary adrenal insufficiency (Addison’s

disease)?
a. Tuberculosis.
b. Kaposi sarcoma.
c. Cytomegalovirus.
d. Lymphoma.
84.Which of the following is the MOST common cause of goitrous hypothyroidism

in adults?
a. Graves' disease.
b. Riedel's thyroiditis.
c. Hashimoto's disease.
d. De Quervain's thyroiditis.
e. Lymphoma of the thyroid gland.
P a g e 21 | 25
85. Which of the following biochemical tests for the work-up of pheochromocytomas
has the HIGHEST sensitivity?
a. Urinary norepinephrine.
b. Urinary vanillylmandelic acid.
c. Urinary total metanephrine.
d. Plasma free metanephrines and normetanephrine.
e. Urinary epinephrine.
86. Regarding the anatomy of the thyroid gland, which of the following is TRUE?
a. In about 80% of persons, the recurrent laryngeal nerve traverses anterior to
the inferior thyroid artery.
b. The recurrent laryngeal nerve has an oblique course around the subclavian
artery on the left side.
c. The superior laryngeal nerve provides both sensory and motor function to
the larynx.
vagus nerve.
87. A 40-year-old male patient who had excision of pheochromocytoma demonstrates

signs of confusion and complains of sweating and headache several hours following
his operation. His blood pressure is 130/65 mmHg, heart rate is 85 beats/min and
respiratory rate is 12 breaths/min. What is the MOST likely cause of his symptoms?
a. Dehydration.
c. Hypoglycemia.
88. A 47-year-old male with Crohn's colitis maintained on 40 mg prednisone daily for
the past year presents for elective colectomy. The procedure was uncomplicated
and he was adequately resuscitated. In the post-anesthesia care unit (PACU), the
patient is noted to be febrile and hypotensive with mean arterial blood pleasure of
80/60 mmHg in the 50s. What is your next step in management?
a. IV dobutamine.
b. Hydrocortisone.
c. 1 unit of packed red blood cells.
d. Antibiotics.
e. Epinephrine.
P a g e 22 | 25

a. Fluid resuscitation from shock.
d. Malignancy.
90.What is the MOST deleterious effect of excessive glucose in the formula of

longstanding TPN?
a. Hyperglycemia.
d. Hyponatremia.
e. Hypoglycemia.
91.An adult male develops acute necrotizing pancreatitis after an endoscopic

retrograde cholangiopancreaticogram. The patient requires ventilatory support
and is in need of nutritional support. Which is the BEST route of providing
nutrition?
a. Parenteral nutrition through peripheral access.
b. Parenteral nutrition through central access.
c. Enteral nutrition through jejunal feeding tube.
d. Oral elemental supplementation.
e. Intra-gastric tube feeding.
92.A 50-year-old man with small-bowel fistula has been receiving TPN for the
previous 3 weeks. He is scheduled for exploratory laparotomy and closure of
fistula. On the morning of the day of surgery, TPN is discontinued and
intravenous infusion with Ringer's lactate is started. An hour later, the patient
is found to be anxious, sweating and tachycardic. What is the MOST likely cause?
a. Anxiety.
b. Hypoglycemia.
c. Hypovolemia.
d. Unexplained hemorrhage.
e. Hyperglycemia.
P a g e 23 | 25
93.A patient of serious car accident remains intubated and is without enteral
feeding for 3 days. Which of the following is the MAIN energy source during
critical illness/injury?
a. Skeletal muscle.
b. Liver.
c. Adipose tissue.
d. Kidney.
e. Gut.
94.Four days after undergoing hysterectomy, a 30-year-old woman develops

phlegmasia cerulea dolens over the right lower extremity. What is the MOST
appropriate treatment?
a. Bed rest and elevation.
b. Systemic heparinization.
c. Venous thrombectomy.
d. Prophylactic vena caval filter.
e. Local urokinase infusion.
95.A patient with multiple small bowel resections for Crohn's disease presents with
an acute flare. He is suspected of having functionally a short gut syndrome and
started on TPN. Refeeding syndrome is characterized by which of the following
electrolyte abnormalities?
a. Hyponatremia, hypokalemia and hypercalcemia.
b. Hyperphosphatemia, hypokalemia and hypocalcaemia.
c. Hypokalemia, hypomagnesemia and hypophosphatemia.
d. Hypokalemia, hyponatremia and hypomagnesemia.
e. Hyperkalemia, hypernatremia and hypercalcemia.
96.After 4 days of TPN, a patient above develops blood glucose levels greater than
300 mg/dl. Hyperglycemia in a surgical patient receiving TPN may BEST be
managed by:
a. Oral hypoglycemics.
b. Decreasing the dextrose load and doubling the amount of fat.
c. Adding regular insulin to the TPN.
d. Discontinuing TPN for 2 weeks and then trying to start TPN again.
e. Increasing the concentration of protein and carbohydrate calories and
decreasing that of lipids.
P a g e 24 | 25

proceed.
a. Adverse event.
b. Near miss event.
c. Never event.
d. No harm event.
e. Sentinel event.
99.World health organization established the surgical safety checklist in order to
maintain patient safety in the operating theatre. One of the measures that
check is:
d. Before removal of important organ.
100. A 12-year-odl child undergoes spinal fixation for severe scoliosis.
Postoperatively, the patient becomes hypotensive, tachycardic and oliguric and
hematocrit is 18%. The parents and child refuse all blood products. The next
step should be to:
a. Withhold all blood products.
b. Transfuse packed red blood cells.
c. Administer erythropoietin.
d. Transfuse human hemoglobin substitute (PolyHeme).
e. Obtain court decision for blood transfusion.
P a g e 25 | 25

July 2018
P a g e 1 | 25
5. A 27-year-old man is admitted to the emergency department after a car crash,

humerus. Which of the following nerve was MOST probably injured?
a. Thoracodorsal.
b. Axillary.
c. Dorsal scapular.
e. Radial.
6. A 32-year-old male is admitted to the emergency department with groin pain.
Examination reveals that the patient has an indirect inguinal hernia. Which of
the following nerves is compressed by the herniating structure in the inguinal
canal to give the patient pain?
a. Iliohypogastric.
b. Lateral femoral cutaneous.
c. Ilioinguinal.
d. Subcostal.
e. Pudendal.
7. A 44-year-old man is admitted to the emergency department with excessive
being compressed?
e. Jejunum.
exploratory laparoscopy. Which of the following anatomic features are the
MOST useful to distinguish the jejunum from the ileum?
P a g e 2 | 25
P a g e 3 | 25
14.The femoral canal to a point of weakness in the abdominal wall. Which of the
following statements is the MOST accurate regarding the anatomy of the
femoral canal?
a. The femoral artery forms the anterior border of the femoral canal.
b. The formal vein forms the lateral border.
c. The inguinal ligament lies posterior to the canal.
d. The pectineal pant of the inguinal ligament is anterior to the canal.
e. The pectineal ligament forms the medial border.
15.Which of the following is consistently the LARGEST artery in the anastomosis?

a. Left gastric artery.
b. Right gastric artery.
c. Left gastroepiploic artery.
d. Right gastroepiploic artery.
e. Short gastric vessels.

a. Eyelid.
b. Lips.
c. Sternum.
d. Stomach.
e. Urinary bladder.
P a g e 4 | 25
17.Which of the following stimulates glycogenesis?

a. Aldosterone.
b. Cortisol.
c. Glucagon.
d. Insulin.
e. Thyroxine.

b. Dextrose 25%.
d. Saline.
19.Which of the following is the MOST potent stimulus for ADH hormone
secretion?
a. Decreased plasma osmolality.
b. Decreased plasma volume.
c. Hypothalamic releasing factor.
d. Increased plasma osmolality.
e. Increased plasma volume.
bladder?
a. Acetylcholine.
b. Cholecystokinin.
d. Secretin.
e. Vagal stimulus.
P a g e 5 | 25
21.A 60-year old male patient is suffering from diabetic ketoacidosis. Which of the
following is the MOST powerful buffer base in the extracellular fluid?
a. Bicarbonate.
b. Haemoglobin.
c. Lactate.
d. Phosphate.
e. Plasma proteins.
22.The following acid-base data: pH: 7.2, PCO2: 20 mmHg, HCO3-: 8 mmol/L, Base
a. Anxiety.
d. Septic shock.
e. Starvation.
23.Which of the following is the MOST potent stimulus for aldosterone synthesis?
a. ACTH.
b. Antidiuretic hormone (ADH).
c. Hyperkalemia.
d. Hypernatraemia.
e. Renin angiotensin system.
24.The patient whose blood pH is 7.47, whose PCO2 is 31 mmHg in the arterial
blood and whose levels of bicarbonate ion in arterial blood is 23 mEq/L is in:
a. Compensated metabolic alkalosis.
b. Uncompensated respiratory acidosis.
c. Uncompensated respiratory alkalosis.
e. Uncompensated metabolic alkalosis.
P a g e 6 | 25
25.A 25-year old man presents to the emergency department after being involved
in a road traffic accident. He is conscious, talking, has a blood pressure of 90/70
mmHg and heart rate of 100 beats/minute. He has sustained a fracture pelvis
26.Which of the following is the MOST important stimulus for triggering the
endocrine response after injury?
a. Afferent nerve stimuli from the injured area.
b. Hypovolemia.
c. Tissue acidosis.
d. Local wound factors.
e. Temperature changes.
27.A 65-year-old man undergoes trans-sphenoidal surgery for a pituitary macro-

likely cause is:
a. Hyperkalemia.
b. Hyperuricemia.
c. Hypoglycemia.
d. Hyponatremia.
e. Hypoxia.
28.All of the following activate the sympathoadrenal and hypothalamic-pituitary

axis during stress or injury EXCEPT:
a. Pain.
b. Hypovolemia.
c. Acidosis.
d. Hypercapnia.
e. Acetylcholine.
P a g e 7 | 25
29.Which pancreatic islet cell type produces a hormonal peptide to stimulate

glycogenolysis and gluconeogenesis?
a. Alpha cell.
b. Beta cell.
c. Delta cell.
d. F cell.
e. PP cell.
30.Parathyroid hormone is important for regulation of calcium homeostasis, which

of the following BEST describes the hormone?
a. Accelerates renal hydroxylation of vitamin D.
b. Directly accelerates calcium absorption from the intestine.
c. Is a steroid hormone.
d. Is secreted under the control of the anterior pituitary.
e. Increases plasma phosphate concentration in a normal adult.
31.A patient who presented with severe diarrhea as a result of Clostridium difficile,
the following ions in the diarrhoea?
a. Cl-.
b. HCO3-.
c. K+.
d. NH4+.
e. OH-.
32.A 15-year-old female patient presented by enlargement of the upper deep

cervical lymph nodes which had been present for 4-months. The patient did not
respond to multiple courses of antibiotics. The temperature was 37.8 oC. The
lymph nodes were matted together and they were slightly tender. Which of the
following cells will be predominant on histopathological examination?
b. Fibroblasts.
c. Lymphocytes.
d. Plasma cells.
P a g e 8 | 25
b. Carcinoma.
c. Dysplasia.
d. Hyperplasia.
e. Metaplasia.
34.A patient who has hydatid cyst of the liver will have increased percentage of
which cells in his blood count:
a. Basophils.
b. Eosinophils.
c. Lymphocytes.
d. Monocytes.
e. Neutrophils.
TRUE?
d. It results from impaired synthesis.
e. It results from significant decrease intake.

a. Carcinoma.
b. Dysplasia.
c. Hyperplasia.
d. Hypertrophy.
e. Metaplasia.
P a g e 9 | 25
37.Which of the following is an anaerobic organism?

a. Bacteroides.
b. E. coli.
c. Klebsiella.
d. Pseudomonas aeruginosa.
e. Staphylococcus aureus.

b. Drainage of a peri-colic abscess.
c. Inguinal herniectomy.
e. Thyroidectomy.
39.A 45-year-old diabetic male patient complains of severe pain in the thigh.
b. Antitoxin.
c. Hyperbaric O2.
d. Immunoglobulins.
P a g e 10 | 25
P a g e 11 | 25
45.An 80-year-old woman who lives in a nursing home and who had just finished a
10-days course of antibiotics, has abdominal pain and profuse diarrhea. Her
stool is tested and comes back positive for Cl. difficile. What is the MOST
appropriate initial management?
a. Oral vancomycin.
b. Intravenous vancomycin.
c. Metronidazole.
d. Vancomycin enema.
e. Supportive treatment only.
46.Which of the following statement about the usage of antibiotics for the
a. Antibiotics should be administrated within 60 minutes of incision.
b. The therapeutic dose of the antibiotic should be administrated
intravenously.
e. Vancomycin is the agent of chronic for patients from nursing homes

a. Bacteroides.
d. Salmonella.
e. Streptococci.
48.After being struck by a moving truck, a 23-year-old woman undergoes

sepsis?
P a g e 12 | 25
49.Which of the following organisms is the MOST common pathogenic organism

causing transfusion sepsis?
a. Pseudomonas aeruginosa.
b. Staph. aureus.
c. Strept. pyogenes.
d. E. coli.
e. CI. Welchii.
50.Following urinary tract infection associated with extraction of a stone, a 64-year-

old woman developed gram-negative septicemia. Which statement is TRUE for
gram-negative bacterial septicemia?
a. Pseudomonas is the most common organism isolated.
b. Many of the adverse changes can be accounted for the endotoxin release.
c. The cardiac index is low.
d. Central venous pressure (CVP) is high.
e. Endotoxin is mainly a long-chain peptide.
51.A non-immune surgical resident is stuck by a contaminated needle from an

HBsAg-positive source. Which of the following is the CORRECT initial
management?
a. None, because the patient doesn’t have active HBV and is immune to
HBV.
b. Interferon.
c. Vaccination against HBV.
d. Hepatitis B immunoglobulin (HBIG).
e. Vaccination against HBV and administration of HBIG.
52.A 40-year-old male patient a renal transplant from a cadaveric donor.

Immediately after finishing the vascular anastomosis, the kidney became
P a g e 13 | 25
53.Three months after orthotopic liver transplantation for cirrhosis, a 42-year-old

man develops fever, diarrhea and crampy abdominal pain. Clostridium difficile
assay is negative. The diagnosis is BEST obtained by:
a. Stool for ova and parasites.
b. Peripheral blood smear.
c. Urinary antigen assay.
d. Liver biopsy.
e. Colonoscopy with mucosal biopsies.
54.Which of the following statements regarding TNF is TRUE?

a. TNF-α is produce only by monocytes and macrophages.
b. Release of TNF is stimulated by exotoxins.
c. TNF is an anabolic stimulant to the host that results in the deposition of
fat.
d. TNF is responsible for the cachexia associated with metastatic disease.
e. TNF expression increase in response to glucocorticoid exposure.
55.The STRONGEST independent risk factor for stress-related mucosal damage and
gastrointestinal bleeding in critically ill patients is:
a. Glucocorticoid administration.
b. Hypotension.
c. Mechanical ventilator support for 48 or more hours.
d. Organ transplantation.
e. Renal failure.
56.A 65-year-old diabetic woman with chronic steroid-dependent bronchospasm

had hemicolectomy for a perforated cecum. The patient was intubated and was
steroid taper. On postoperative day 2 she develop a fever of 39.2 °C (102.5 °F),
c. Hypovolemia.
e. Sepsis.
P a g e 14 | 25
57.A 40-year-old male patient developed convulsions 24 hours after having an

operation. His serum sodium is 120 mEq/L. Which of the following is the
appropriate management?
a. Administration of normal saline (0.9%).
b. Administration of hypertonic saline (3%).
c. Emergency hemodialysis.
d. Administration of vasopressin.
e. Administration of Lasix, 40 mg intravenously (IV).
58.A 68-year-old man has a history of myocardial infarction. He undergoes

a. Administration of Ringer's lactate, 500 mL over 1 hour.

d. Hyperkalemia.
e. Hypoglycemia.
60. A patient who had gastrectomy 10 days ago developed massive pulmonary
a. IV heparin.
b. Fibrinolytic agent.
c. Warfarin.
e. Corticosteroids.
P a g e 15 | 25

a. Sepsis syndrome.
b. Aspirin.
d. DIC.
e. Fat embolism.
to show?
Arterial PCO2 Bicarbonate.
a. Decreased Decreased.
b. Decreased Increased.
c. Decreased Normal.
d. Increased Decreased.
e. Increased Increased.
unwell. She vomits intermittently, has painless abdominal distention and starts
d. Faecal impaction.
e. Systemic sepsis.
64.A 78-year-old man with a history of coronary artery disease requests an elective
epigastric hernia repair. Which of the following is valid reason for delaying the
proposed surgery?
a. Coronary artery bypass surgery 3 months earlier.
b. A history of cigarette smoking.
c. Jugular venous distension.
d. Hypertension.
e. Hyperlipidemia.
P a g e 16 | 25
65.A 50-year-old man presented with severe repeated vomiting as a result of

gastric outlet obstruction is admitted to the hospital. There is marked
dehydration, with urine output 20 ml/h and the hematocrit is 48%. Initial
treatment for this patient should include which of the following?
b. Antiemetics.
c. Ringer's lactate solution.
pressure?

a. Propofol.
b. Dantrolene.
c. Ketamine.
d. Succinylcholine.
e. Neostigmine.
68.Which of the following techniques does NOT provide a definitive airway?

a. Cricothyroidotomy.
b. Tracheostomy.
c. Nasotracheal tube.
d. Laryngeal mask airway.
e. Endotracheal tube.
P a g e 17 | 25
a. Sodium.
b. Potassium.
c. Chloride.
d. Bicarbonate.
e. Lactate.
patient?
a. Bleeding time.
c. INR.
d. PIT.
e. Thrombin time.
received 5 liters of blood following which he started to have bleeding from nose
and mouth. What is the MAIN cause of this bleeding tendency?
P a g e 18 | 25

74.You were obliged to operate for a strangulated inguinal hernia in a patient who
was receiving 300 mg aspirin daily. During surgery there was excessive bleeding.
What would you advise?
a. Desmopressin.
b. Fresh blood.
c. Fresh frozen plasma.
d. Fresh platelets.
e. IV vitamin K.
75.What in the cause of the prolonged prothrombin time in patients with liver
cirrhosis?
a. Abnormal fibrinolysis.
b. Deficiency of protein S.
c. Factor VII deficiency.
d. Thrombocytopenia.
e. Von Willebrand's disease.
76.Low molecular weight heparin (LMWH) compared with unfractionated

intravenous heparin (UIH) for the treatment of pulmonary embolism is
associated with a:
a. Higher incidence of all-cause mortality
b. Higher incidence of recurrent symptomatic venous thromboembolism at
the end of treatment.
c. Higher incidence of recurrent symptomatic venous thromboembolism at
3 months.
d. Lower incidence of major bleeding complications.
e. Lower risk of heparin-induced thrombocytopenia.
P a g e 19 | 25
77.A cirrhotic patient with abnormal hemostatic studies requires an urgent

78.Which of the following mechanisms initiates the normal hemostatic

mechanism?
a. Fibrin formation.
b. Fibrin stabilization.
c. Fibrinolysis.
d. Platelet plug formation.
e. Vascular constriction.
79.What is the treatment of a hemophilic patient who had massive hemarthrosis

of the knee following a fall on his knee?
a. Penicillamine.
c. Transfusion of factor VIII to 10% of normal factor levels.
d. Platelet transfusion.
e. Exploration of joint.
80.After undergoing a transurethral resection of the prostate, a 65-year-old man

experiences excessive bleeding attributed to fibrinolysis. It is appropriate to
administer which of the following?
a. Heparin.
b. Warfarin (Coumadin).
c. Volume expanders and cryoprecipitate.
d. Aminocaproic acid (Amicar).
e. Fresh-frozen plasma and vitamin K.
P a g e 20 | 25
81.Which of the following denotes hemolytic transfusion reaction during

anesthesia?
a. Shaking chills and muscle spasm
82.A 50-year-old female patent has chronic renal failure and has been maintained
on chronic dialysis. The patient underwent cholecystectomy. Post-operatively
a. Elevated PT.
b. Elevated PTT.
e. Sepsis.
83.A mother mentions that her 8-year-old boy gets recurrent attacks of
hemarthrosis following a minimal trauma. Investigations revealed normal
platelet count and prothrombin time, but the partial thromboplastin time is
prolonged. Which of the following statements regarding this clinical condition is
TRUE?
a. There is an underlying liver problem.
b. The sisters of this boy are usually having the same problem.
c. The boy has had repeated episodes of epistaxis.
d. There is no family history in this condition.
e. Transfusion of factor VIII concentrate is helpful.
84.70-year-old female patient is receiving warfarin because she has AF and had
CORRECT?
time.
reduced.
P a g e 21 | 25
85.Which of the following is MOST likely to be a risk factor for the development of
carpal tunnel syndrome?
a. Addison's syndrome.
b. Diabetes insipidus.
c. Fibromyalgia.
d. Graves' disease.
e. Hypothyroidism.
86.Regarding the anatomy of the thyroid gland, which of the following is TRUE?
to the larynx.
vagus nerve.

88.What is the COMMONEST cause of thyrotoxicosis?

a. Autonomous nodule.
b. Graves' disease.
c. Iodine intake.
d. Subacute thyroiditis.
e. Toxic nodular goiter.
P a g e 22 | 25
89.What of the following is the MOST common sign of Cushing’s syndrome?

a. Acne.
b. Hirsutism.
c. Hypertension.
d. Purple striae.
e. Truncal obesity.
90.A 55-year-old female …… Grave’s disease and has been treated by propyl
thiouracil for 4 years. The patient developed mass enlargement of the thyroid
gland. What is the cause of this enlargement?
a. ……
b. ……
c. ……
d. ……
e. ……
91.Twelve hours after having undergone a subtotal thyroidectomy, a 30-year-old

92.A 55-year-old female patient who had metastatic breast cancer presents with
weakness, anorexia, malaise, constipation and back pain and lethargy.
Laboratory studies include a normal chest X-Ray; serum albumin 3.2 mg/dl;
serum calcium 14 mg/dl; serum phosphorus 2.6 mg/dl; serum chloride 108
mg/dl; BUN 32 mg/dl and creatinine 2.0 mg/dl. What is the appropriate initial
management?
P a g e 23 | 25
P a g e 24 | 25

a. Dehydration.
c. Hypoglycemia.

hemorrhage and needs an emergency laparotomy, his identity is unknown and
proceeds.
100. World health organization established the surgical safety checklist in order
to maintain patient safety in the operating theatre. One of the measures that
check is:
d. Before removal of important organ.
P a g e 25 | 25

February 2018
1. A 34-year-old man is seen in the emergency department with a fibular fracture
following a football match. On examination he is noted to have loss of foot eversion.
Which area of skin should be examined to confirm loss of the cutaneous distribution
of the affected nerve?
a. Along the lateral aspect of the foot.
b. Along the medial aspect of the foot.
c. Between the hallux and the second digit.
d. On the dorsal surface of the foot.
e. On the plantar surface of the foot.
2. Which of the following statement is TRUE regarding surgical excision of the right
submandibular salivary gland?
a. Injury to the lingual nerve would result in loss of sensations to the posterior
one third of the right side of the tongue.
b. Injury to the hypoglossal nerve would result in deviation of the tongue to the
right side on protrusion of the tongue.
c. The great auricular nerve is at a risk of injury.
d. Injury of the marginal mandibular branch of the facial nerve would result in
sensory loss at the angle of the mandible.
e. Injury to the cervical branch of the facial nerve would result in drooping of the
right angle of the mouth.
3. Which of the following is the sensory supply to the skin of the tip of the index finger?
a. Radial nerve only.
b. Radial and median nerves.
c. Median and ulnar nerves.
d. Ulnar nerve only.
e. Median nerve only.
4. Which of the following statements is TRUE regarding the marginal mandibular nerve?
a. Is a branch of the 5th cranial nerve.
b. Supplies motor function to the strap muscles.
c. May be associated with the submandibular gland.
d. Lies deep to the facial vein.
e. Is most often injured during dissection of the posterior triangle (Level 5) of the
neck.
P a g e 1 | 25

a. Cervix.
b. Ovary.
c. Uterus.
d. Vagina.
e. Vulva.
6. A 64-year-old woman is reviewed in the emergency department with an acute

protruding?
a. Conjoint tendon.
7. A 30-year-old motorcyclist suffers a closed fracture to the mid-shaft of the tibia.

8. An 82-year-old man has complete occlusion of his inferior mesenteric artery on

angiography but no symptoms or signs of colonic ischaemia. Which of the
a. Left colic.
c. Middle colic.
d. Splenic.
e. Superior rectal.
P a g e 2 | 25
9. A 62-year-old man develops abdominal pain after eating. An arteriogram reveals

absence of blood flow in the celiac artery. Collateral branches supply the
stomach through which of the following?
a. Intercostal arteries.
b. Right renal artery.
d. Inferior epigastric artery.
e. Left colic artery.
10.A 21-year-old man has been stabbed in the back of the knee, dividing the
popliteal artery and is undergoing repair via a posterior approach. Which of the
following structures is MOST likely to be encountered first when dissecting deep
from the skin incision?
a. Popliteal artery.
b. Popliteus muscle.
c. Popliteal vein.
d. Tibial nerve.
e. Soleus muscle.
11.An 80-year-old man presents with a prostatic malignancy. Imaging reveals a

d. Testicular vein.
e. Vertebral veins.
12.A 42-year-old woman presents to her doctor with shoulder pain. On

examination, shoulder abduction is weak and painful. Which muscle is likely to
be affected?
a. Infraspinatus.
b. Subscapularis.
c. Supraspinatus.
d. Teres major.
e. Teres minor.
P a g e 3 | 25
13.A 32-year-old man is brought to the emergency department following a fall. An

damaged?
a. Axillary.
b. Median.
d. Radial.
e. Ulnar.
14.While assessing an elderly woman with severe neck arthritis you note she has
weakness of finger abduction and adduction. This is MOST likely to be due to
compression of which spinal nerve root of the brachial plexus?
a. Fifth cervical.
b. Sixth cervical.
c. Seventh cervical.
d. Eighth cervical.
e. First thoracic.

a. Eyelid.
b. Lips.
c. Sternum.
d. Stomach.
e. Urinary bladder.

trauma.
P a g e 4 | 25

b. Dextrose 25%.
d. Saline.
18.Which of the following hormones exhibits a diurnal rhythm in its secretion?

a. ACTH.
b. Aldosterone.
c. Noradrenaline.
d. Parathyroid hormone.
e. Prolactin.

a. Chief cells.
c. Mucous cells.
d. Paneth cells.
e. Parietal cells.
a. Bicarbonate.
b. Haemoglobin.
c. Lactate.
d. Phosphate.
e. Plasma proteins.
P a g e 5 | 25
21.The following acid-base data: pH: 7.2, PCO2: 20 mmHg, HCO3-: 8 mmol/L, Base
a. Anxiety.
d. Septic shock.
e. Starvation.

a. Amino acid.
b. Glucose.
c. Ketones.
d. Lactose.
23.A 45-year-old female patient complains of reflux oesophagitis secondary to a

sliding hiatus hernia. Which of the following decreases the tone of the lower
esophageal sphincter?
a. Fatty meal.
b. Gastric alkalization.
c. Gastric distension.
d. Gastrin.
e. Proteins.

likely cause is:
a. Hyperkalaemia.
b. Hyperuricaemia.
c. Hypoglycaemia.
d. Hyponatraemia.
e. Hypoxia.
P a g e 6 | 25
25. Which of the following is TRUE regarding the release of tumor necrosis factor-α?
a. Can be effectively blocked by anti-TNF-a antibodies to halt systemic
inflammatory response syndrome (SIRS).
b. Does not have any beneficial effects in the early phases of the inflammatory
response.
c. Is primarily from leukocytes.
d. Promotes polymorphonuclear (PMN) cell adherence and further cytokines
release.
e. Is always deleterious.
26. A 21-year-old graduate student has a large hypertrophic scar on the lower part of
her face. The patient had sustained a laceration on her face 2 years previously after
injuring her face. Which of the following statements regarding scar revision is
TRUE?
a. Scar maturation refers to the change in size of the wound in the first 1 to 2
months.
b. Scar revision should have been performed in the first 3 months after injury
to minimize fibrosis.
c. Revision should be performed earlier in children than in adults.
d. It corrects undesirable pigmentation.
e. Scar revision should be delayed approximately 1 year to allow maturation.
27. A 25-year-old man presents to the emergency department after being involved in
a road traffic accident. He is conscious, talking, has a blood pressure of 90/70
mmHg and a heart rate of 100 beats/minute. He has sustained a fractured pelvis
28. Which one of the following findings is MOST likely to be present in a patient with
severe magnesium deficiency?
a. Respiratory depression.
b. Bradycardia.
c. Tetany.
d. Hypotension.
e. Loss of patellar reflex Hyperactive reflexes.
P a g e 7 | 25
29.Which of the following is often associated with early sepsis?

a. Normal acid-base balance.
b. Metabolic alkalosis.
d. Respiratory alkalosis.
30.A 50-year-old male patient was punctured in his foot by a very tiny piece of glass
which could not be removed. Three months later the patient presented by a
firm small nodule at the site of the puncture and this was excised. Which of the
following cells will be predominant on pathological examination of the removed
nodule?
b. Fibroblasts.
c. Lymphocytes.
d. Plasma cells.
31.What does the presence of cytokeratin on immunohistochemical staining points

to?
a. Carcinoma.
b. Ewing's sarcoma.
c. Hodgkin's lymphoma.
d. Melanoma.
e. Soft tissue sarcoma.

division?
c. Erythrocytes.
d. Hepatocytes.
e. Osteocytes.
P a g e 8 | 25
b. Carcinoma.
c. Dysplasia.
d. Hyperplasia.
e. Metaplasia.

a. Atypia.
c. Invasion.
d. Necrosis.
e. Pleomorphism.

a. Carcinoma.
b. Dysplasia.
c. Hyperplasia.
d. Hypertrophy.
e. Metaplasia.
activity?
a. Erythrocytes.
b. Lymphocytes.
c. Macrophages.
d. Mast cells.
e. Plasma cells.
P a g e 9 | 25
37.Which of the following is the MOST likely cause of pyrexia occurring 48 hours
after an abdominal operation?
a. Chest infection.
b. DVT.
c. Leaking intestinal anastomosis.
d. Pulmonary embolism.
e. Wound infection.

e. Vancomycin is the first choice for treatment of infections with Staph.
aureus.
b. Antitoxin.
c. Hyperbaric O2.
d. Immunoglobulins.
40.A 35-year-old female patient had an operation for perforated appendicitis.

Postoperatively the patient complained of fever and wound pain. There was
tenderness, redness and swelling at the site of the wound. Which of the
following organisms MOST likely to be responsible for this problem?
a. Clostridium botulinum.
b. Clostridium tetani.
e. Streptococcus pyogenes.
P a g e 10 | 25
41.40-year-old male patient had renal transplantation and is receiving

immunosuppression. Few days following the operation the patient develop
persistent fever. Which of the following infectious microorganisms is currently
the MOST likely cause of this fever?
a. Candidiasis.
b. Coli sepsis.
e. Streptococci.
42.A 30-year-old female patient developed postoperative wound infection after a

a. Bacteroides.
b. E. coli.
c. Proteus.
d. Staph. aureus.
e. Streptococci.
43.Which of the following is the mode of action of amikacin?

e. Inhibition of translocation of Peptides.
44.The use of prophylactic antibiotics has become commonplace. Which of the

following statement(s) is TRUE concerning the prophylactic use of antibiotics?
a. Prophylactic antibiotics should be administered for all surgical
procedures.
b. Continuing thee antibiotic into the postoperative period has led to
improved results in antibiotic prophylaxis.
c. The appropriate use of prophylactic antibiotics must include the initiation
of the agent prior to the surgical procedure.
d. The prophylactic administration of broad-spectrum agents (Third-
generation cephalosporins) has been shown to be particularly
advantageous.
e. The topical use of antimicrobial agents is of no advantage in the
prophylactic setting.
P a g e 11 | 25


a. Ciprofloxacin.
c. Cephalexin.
d. Nitrofurantoin.
e. Amoxicillin.
47.An obese 50-year-old man who has had a renal transplant undergoes left direct
hernia repair with mesh under local anesthesia. Medications include tacrolimus
(Prograf) and prednisone. A nasal swab is positive for methicillin-resistant
staphylococcus aureus (MRSA). Which of the following statements is TRUE?
a. His wound classification is clean.
b. He should receive oral antibiotics for 48 hours postoperatively.
c. His risk of surgical site infection is less than 1%.
d. Mesh is contraindicated in this patient.
e. The wound should be irrigated with vancomycin.
48.Compared with wet to dry dressing changes, negative pressure wound therapy
is associated with all of the following EXCEPT:
a. Increased local blood flow.
b. Stimulation of granulation tissue.
? Wrong Q.
c. Decreased tissue edema.
d. Decreased bacterial counts.
e. Increased rate of wound healing.
P a g e 12 | 25
49.A 70-year-old woman is admitted to hospital with a severe respiratory tract

infection. Five days later she develops diarrhoea. On flexible sigmoidoscopy
patchy raised yellow plaques are seen in the sigmoid colon. Which of the
following is the MOST likely causative organism?
a. Clostridium difficile.
c. Proteus mirabilis.
e. Streptococcus faecalis.
50.Which of the following is NOT characteristic of aminoglycosides?

a. Active against a broad spectrum of gram-negative aerobes and useful for
synergy against some gram-positive cocci.
b. Emergence of resistant bacterial strains.
c. Narrow margin between therapeutic and toxic blood levels
d. Nephrotoxicity, ototoxicity and neuromuscular paralysis.
e. Excellent activity in abscesses in which gram-negative organisms are
involved.
51.Which of the following cells is responsible for cellular mediated immunity?

a. B-lymphocytes.
b. Dendritic cells.
c. Monocytes.
d. d. Natural killer cells.
e. T-lymphocytes.

b. Lung cancer.
e. Skin cancer.
P a g e 13 | 25
53.A 40-year-old male patient underwent a renal transplant from a cadaveric

54.Three months after orthotopic liver transplantation for cirrhosis, a 42-year-old

man develops fever, diarrhea and crampy abdominal pain. Clostridium difficile
assay is negative. The diagnosis is BEST obtained by:
a. Stool for ova and parasites.
b. Peripheral blood smear.
c. Urinary antigen assay.
d. Liver biopsy.
e. Colonoscopy with mucosal biopsies.
55.Which of the following is COMMONEST vascular complication which may follow

hepatic living related donor transplantation?
a. Portal vein stenosis.
b. Hepatic artery thrombosis.
c. Hepatic artery stenosis.
d. Inferior vena cava thrombosis.
e. Hepatic vein stenosis.

is TRUE?
a. Hyperacute rejection begins in the operating room with reperfusion of
b. Liver transplants are especially susceptible to hyperacute rejection.
rejection.
infiltration.
P a g e 14 | 25

management?
58.A 65-year-old diabetic woman with chronic steroid-dependent bronchospasm

had hemicolectomy for a perforated cecum. The patient was intubated and was
steroid taper. On postoperative day 2 she develop a fever of 39.2 °C (102.5 °F),
c. Hypovolemia.
e. Sepsis.
59.Which of the following is a clinical feature of a major pulmonary embolism?

a. Bradycardia.
b. Collapsed neck veins.
c. Haemoptysis.
d. High fever.
e. Tachypnea.
Laboratory studies showed serum glucose, 150 mg/dL: sodium, 135 mEq/L:
potassium, 6.5 mEq/L: chloride, 105 mEq/L and bicarbonate, 15 mEq/L. Which
of the following is recommended?
P a g e 15 | 25
61.Following an operation and extubation a patient was restless. His arterial blood
gases revealed: pH 7.36: PaO2 65 mmHg: PaCO2 55 mmHg: PaCO3- 30 mmol/L.
62.A 68-year-old man has a history of myocardial infarction. He undergoes

a. Administration of Ringer's lactate 500 ml over 1 hour.

c. Decrease in Cortisol levels.
d. Hyperkalemia.
e. Hypoglycemia.
64.A 40-year-old man is confused and restless the second day after upper
abdominal surgery and repair of a hiatus hernia. What is the MOST probable
cause of his condition?
a. Pulmonary embolism.
b. Narcotic overdose.
c. Pulmonary atelectasis.
d. Electrolyte imbalance.
e. Starvation ketosis.
P a g e 16 | 25
to show?
institution of ventilatory support is indicated in the presence of which of the
following?
67.A seventy year-old man presents to the ER with several bone fractures and a
ruptured spleen after failing from a height. Which of the following BEST
represents his response to injury?
necrosis factor (TNF, cachectin).
d. Decreased glutamine consumption by fibroblasts, lymphocytes and
intestinal epithelial cells.
e. Hepatic synthesis of acute-phase reactants.
68.The arterial blood gases of a patient who had an operation for ruptured aortic
aneurysm are: pH 7.54, PO2 100 mmHg, PCO2 30 mmHg, HCO3- 30 mmol/L. What
is the acid base disturbance?
c. Metabolic alkalosis.
d. Combined respiratory and metabolic alkalosis.
e. Compensated respiratory acidosis.
P a g e 17 | 25
pressure?

a. Propofol.
b. Dantrolene.
c. Ketamine.
d. Succinylcholine.
e. Neostigmine.

a. Gram-positive organisms do not cause septic shock because they lack the
cell-wall endotoxin.
urinary tract.
d. Escherichia coli is the second most common organism identified in gram-
e. The toxic effects of gram-negative endotoxin appear to be the result of
the abnormal activation of normal physiologic pathways.

d. Vasopressors.
e. Hyperventilation.
P a g e 18 | 25
73. A 38-year-old man in end-stage renal failure resulting from polycystic kidney
but four weeks later deteriorates, the serum creatinine rising by 25%. Which of the
following processes is MOST likely to be responsible for this deterioration?
Normal: 7.35-7.45 90-110 35-45 22-26 -2 to +2
75. 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 correction of the
glucose concentration to 120 mg/dl with insulin, the serum sodium concentration
would:
a. Decrease significantly unless patient receive normal saline.
b. Decrease transiently but return to 122 mEq/L.
c. Remain essentially unchanged.
d. Increase to normal range without specific therapy.
e. Increase to hypernatremic level.
76. A 60-year-old man with a past history of angina undergoes an uncomplicated
operation for an inguinal hernia. Postoperatively he is found to be hypotensive,
tachycardic and has a raised jugular venous pressure. What is the MOST likely
underlying cause of his hypotension?
a. Reduced afterload.
b. Reduced parasympathetic tone.
c. Reduced preload.
d. Reduced stroke volume.
e. Reduced sympathetic tone.
P a g e 19 | 25

membranes.
78.A 55-year-old male patient is receiving 150 mg of aspirin daily because has
coronary artery disease. Which of the following tests will be affected this
patient?
a. Bleeding time.
c. INR.
d. PTT.
e. Thrombin time.


P a g e 20 | 25

a. Fresh blood.
c. Fresh platelets.
d. IV vitamin K.
e. IV factor VIII.
denote?
84.A 53-year-old woman has acute onset of right calf pain, swelling and tenderness.
Duplex scanning demonstrates acute deep venous thrombosis of the right
femoral-popliteal veins. Intravenous unfractionated heparin therapy is begun.
On postoperatively day 9, she has the acute onset of shortness of breath,
hypoxemia and chest pain. Computed tomographic (CT) angiography
demonstrates multiple, bilateral pulmonary emboli. In addition, her platelet
count has fallen to 50,000. What is the definitive management of this problem?
a. Administration of low molecular heparin and placing an inferior vena cava
filter.
b. Continuing unfractionated heparin and beginning of a direct thrombin
inhibitor (Argatroban).
c. Continuing unfractionated heparin and immediate platelet transfusion.
d. Discontinuing unfractionated heparin.
e. Discontinuing unfractionated heparin and beginning low molecular
weight heparin.
P a g e 21 | 25

86.Which of the following mechanisms initiates the normal haemostatic

mechanism?
c. Fibrinolysis.
87.After undergoing a transurethral resection of the prostate, a 65-year-old man

experiences excessive bleeding attributed to fibrinolysis. It is appropriate to
administer which of the following?
a. Heparin.
b. Warfarin (Coumadin).
c. Volume expanders and cryoprecipitate.
d. Aminocaproic acid (Amicar).
e. Fresh-frozen plasma and vitamin K.
a. Elevated PT.
b. Elevated PTT.
e. Sepsis.
P a g e 22 | 25
89. A 22-year-old man is brought into the emergency department in profound shock
after a fall from the fourth floor of a building. After resuscitation, small bowel
resection and hepatic segmentectomy are performed at laparotomy. He receives
15 units of packed RBCs, 4 units of fresh-frozen plasma and 8 L of Ringer's lactate.
On closure, diffuse oozing of blood is noted. What is the MOST likely cause?
a. Hepatic failure.
b. Hypersplenism.
90. A mother mentions that her 8-year-old boy gets recurrent attacks of hemarthrosis
following a minimal trauma. Investigations revealed normal platelet count and
prothrombin time, but the partial thromboplastin time is prolonged. Which of the
following statements regarding this clinical condition is TRUE?
c. The boy has had repeated episodes of epistaxis.
91. A 70-year-old female patient is receiving warfarin because she has AF and had
CORRECT?
time.
d. If the patient is also taking aspirin, the dose of warfarin should be reduced.
92. A 12-year-old boy with-known factor VIII deficiency has a painful, swollen,
immobile right knee. The clinician suspects hemarthrosis. Therapeutic options
include which of the following?
a. Immediate aspiration and compression dressings to prevent cartilage
necrosis.
b. Compression dressings and immobilization to prevent further bleeding.
c. Immediate aspiration after appropriate factor VIII replacement therapy.
d. Initial trial of factor VIII therapy, compression dressings, cold packs and rest
followed by active range-of-motion exercises.
e. Factor VIII replacement followed by arthrotomy.
P a g e 23 | 25
93.The MOST useful laboratory test to assess both risk of bleeding and response to
therapy in patients with uremia is:
a. Bleeding time.
b. Platelet count.
c. INR.
d. APTT.
e. Thrombin time.

a. ACTH is high.
d. Serum Na is low.
diagnosis?
d. Plasma chloride.
e. Serum phosphate.
96.A 33-year-old woman is scheduled for elective cholecystectomy. Preoperative

evaluation shows the presence of mild to moderate hypothyroidism. What is
the MOST appropriate policy for this patient?
a. Postpone surgery until an euthyroid state is achieved.
b. Proceed with surgery if severe clinical symptoms are not present.
c. Proceed with surgery while beginning treatment with L-thyroxin.
d. Proceed with surgery while beginning treatment with thion-amides.
e. Proceed with surgery with the knowledge that minor perioperative
complications could develop.
P a g e 24 | 25

cramps. What is initial therapy?
e. Oral vitamin D.
98.Twelve hours after having undergone a subtotal Thyroidectomy, a 30-year-old

99.You have a patient who has pheochromocytoma and his blood pressure is
200/120 mmHg. You are preparing this patient for surgery. Which of the
following drugs should be used FIRST for the control of blood pressure?
b. Propranolol.
c. Nifedipine.
d. Atenolol.
e. Captopril.
100. What is the recommended treatment of acute adrenal insufficiency?

P a g e 25 | 25

February 2017
1. Which of the following nerves passes beneath the inguinal ligament?
a. Saphenous nerve.
b. Genital branch of the genitofemoral nerve.
c. Iliohypogastric nerve.
d. Ilioinguinal nerve.
e. Lateral cutaneous nerve of the thigh.
2. A 30-year-old male received a blow to the front of his arm. Following that he
suffered from weakness in flexion and supination of the forearm. Which of the
following nerves is MOST likely to be injured?
a. Axillary.
b. Median.
d. Radial.
e. Ulnar.
3. Which of the following overlies the right suprarenal gland?

a. Aorta.
c. Right crus of the diaphragm.
d. Right hepatic vein.
e. Right renal artery.
4. A 40-year-old-male patient had a superficial parotidectomy operation. Post-

injured nerve?
c. Great auricular nerve.
P a g e 1 | 25
5. A 74-year-old woman present to the outpatient clinic with pelvic pain. A CT scan
reveals enlarged para-aortic lymph nodes. These are MOST likely to be involved
in secondary spread from a tumour in which of the following organs?
a. Cervical.
b. Ovary.
c. Uterus.
d. Vagina.
e. Vulva.

protruding?
a. Conjoint tendon.
c. Inguinal Ligament.
d. Lacunar Ligament.
e. Pectineal Ligament.
7. A 30-year-old motorcyclist suffers a closed fracture to the mid-shaft of the tibia.

8. A 32-year-old man is brought to the emergency department following a fall. An

damaged?
a. Axillary.
b. Median.
d. Radial.
e. Ulnar.
P a g e 2 | 25
9. A CT scan of the a 63-year-old man reveals that the left renal vein is occluded as
it crosses the aorta. The occlusion is due to compression by an arterial aneurism
anterior to the vein. What is the MOST likely location of aneurism?
a. Coeliac artery.
e. Superior mesenteric.
10.A 70-year-old woman undergoes a left mastectomy and axillary clearance. At a

follow-up appointment she was noted to have winging of left scapula. Which
muscle has been paralysed as a result of the dissection of the axilla?
d. Teres major.
e. Trapezius.
11.A 35-year-old woman is seen at the surgical clinic with a history of faecal
incontinence since the birth of her second child 18 months previously. The first
stage of labour had been prolonged and difficult. Physical examination reveals
a relatively lax anal sphincter. Which nerve is likely to have been damaged in
labour?
a. Genitofemoral nerve.
b. Lumbosacral trunk.
c. Obturator nerve.
d. Pelvic splanchnic nerve.
e. Pudendal nerve.
12.A 65-year-old man presents with hematuria and right lion pain. Computerized
tomography demonstrates a right renal tumour and he undergoes a right radical
d. Right lumber vein.
P a g e 3 | 25
13. A 19-year-old man is brought to the emergency department after dislocation his
shoulder while playing football. Following treatment of the dislocation. He cannot
initiate abduction of his arm. An MRI of the shoulder shows a torn muscle. Which
muscle was MOST likely damaged by the injury?
a. Coracobrachialis.
b. Long head of the triceps.
c. Pectoralis minor.
d. Supraspinatus.
e. Teres major.
14. A 32-years-old male patient is admitted to the emergency department with groin
pain. Examination reveals that the patient has an indirect inguinal hernia. Which of
the following nerves is compressed by the herniated structure In the inguinal canal
to give the patient pain?
a. Iliohypogastric.
b. Lateral femoral cutaneous.
c. Ilioinguinal.
d. Subcostal.
e. Pudendal.
15. A 44-year-old man is admitted to the emergency department with excessive
vomiting and dehydration. Radiographic images demonstrate that part of bowel is
being compressed between the abdominal aorta and the superior mesenteric
artery. Which of the following intestinal structures is MOST likely being
compressed?
a. second part of duodenum.
e. Jejunum.
16. A 34-year-old is undergoing an emergency appendectomy has been performed
successfully. The patient undergoes an exploratory laparoscopy. Which of the
following anatomic feature are the MOST useful to distinguish the jejunum form
the ilium?
a. Jejunum has thinner walls compared with the ilium.
b. Jejunum has less mesenteric fat compared with ileum.
compared with ileum.
P a g e 4 | 25
17.After a modified radical mastectomy, a 45-year-old woman reports weakness in

her arm. On examination, she has mild weakness when she internally rotates
and adducts her arm. This is MOST likely due to injury to which of the following
nerves?
a. Intercostal brachial.
b. Long thoracic.
c. Thoracodorsal.
d. Supraclavicular.
e. Medial pectoral.
a. Erythrocytes.
b. Leukocytes.
c. Lymphocytes.
d. Monocytes.
e. Platelets.
19.Wound healing is relatively SLOWEST in which of the following ?

a. Eyelid.
b. Lips.
c. Sternum.
d. Stomach.
e. Urinary bladder.

trauma.
c. the catabolic response is initiated by the thyroid hormones.
d. the catabolic response is the same regardless of the severity of trauma.
P a g e 5 | 25

b. Dextrose 25%.
d. Saline.
22.What is the site of maximum absorption of short chain fatty acids produced by
bacteria?
a. The caecum.
b. The colon.
c. The duodenum.
d. The ileum.
e. The jejunum.
bladder?
a. Acetylcholine.
b. Cholecystokinin.
d. secretin.
24.The following acid base data: pH: 7.2, PCO2: 20 mmHg, HCO3-: 8 mmol/L, base
excess: 19 mmol/L, would be MOST consistent with:
a. Anxiety.
d. Septic shock.
e. Starvation.
P a g e 6 | 25

a. Amino acid.
b. Glucose.
c. Ketones.
d. Lactose.
26.A 45-year-old female patent complains of reflux oesophagitis secondary to a

sliding hiatus hernia. Which of following decreases the tone of the lower
a. Fatty meal.
d. Gastrin.
e. Proteins.
27.A 21-year-old graduate student has a large hypertrophic scar on the lower part
of face. The patient has sustained a laceration on her face 2 years previously
after injuring her face. Which of the following statement regarding scar revision
is TRUE?
a. scar maturation refers to the change in size of the wound in the first 1 to
2 months.
b. Scar revision should have been performed in the first 3 months after
injury to minimize fibrosis.
c. Revision should be performed earlier in children than in adults.
d. It corrects undesirable pigmentation.
e. Scar revision should be delayed approximately 1 year to allow
maturation.

axes during stress or injury EXCEPT:
a. Pain.
b. Hypovolemia.
c. Acidosis.
d. Hypercapnia.
e. Acetylcholine.
P a g e 7 | 25
29.With regard to potassium which of the following statement is NOT TRUE?

excreted in urine.
c. More than 90% of potassium in the body is located in the extracellular
compartment.
normal.
extracellular space (ECF) to the intracellular space (ICS).
30.Which of the following is NOT a trigger of visceral pain?

a. Ischemia.
b. Traction.
c. Distention.
d. Heat.
e. Inflammation.

a. Alpha cell.
b. Beta cell.
c. Delta cell.
d. F cell.
e. PP cell.

resistance. In which condition, its use is MOST appropriate:
e. Septic shock.
P a g e 8 | 25
33.A 40-year-old man is brought to the emergency department following a road

traffic accident. The primary survey detects grade 3 shock as a result of pelvic
fracture. Which of the following pathophysiological mechanism is the FIRST to
be activated to maintain circulating blood volume?
a. Antidiuretic hormone secretion.
b. Atrial naturetic peptide.
c. Parasympathetic nervous system.
d. Renin-angiotensin system.
e. Sympathetic nervous system.
34.Which of the following is often associated with early sepsis?

a. Normal acid-base balance.
b. Metabolic alkalosis.
d. Respiratory alkalosis.
35.Which of the following is TRUE with regard to wound contraction?

a. It is the primary process affecting closure of a sutured or stapled surgical
wound.
b. Bacterial colonization significantly slows the process of contraction.
c. It may account for a maximum of 50% decrease in the size of a wound.
d. It is based on specialized fibroblasts that contain actin myofilaments.
e. The percentage reduction of wound size is increased with adherence of
skin to underlying tissue.
36.Histopathological examination of a cavitating apical lung mass from a 45-year-

old man show necrotic material surrounded by epithelioid cells and occasional
multinucleated giant cells. Acid fast bacilli are identified. Which cell type gives
rise to giant cells?
a. Basophil.
b. Eosinophil.
c. Lymphocyte.
d. Macrophage.
e. Neutrophil.
P a g e 9 | 25

a. Carcinoma.
b. Dysplasia.
c. Hyperplasia.
d. Hypertrophy.
e. Metaplasia.
38.With regard to the healing process which of the following statements is

CORRECT?
a. Collagen content reaches a maximum at approximately one week after
injury.
b. Monocytes are essential for normal wound healing.
c. Fibroblasts appear in the wound within 24 to 36 h after the injury.
d. The function of monocytes in wound healing is limited to phagocytosis of
bacteria and debris.
e. Early in wound healing type 1 collagen is predominant.
39.A 45-year-old man had a 22 year history of gastro-oesophageal reflux disease.

The lower third of his oesophagus was reddened and biopsies revealed
columnar epithelium. What was the process affecting the tissue?
a. Anaplasia.
b. Dysplasia.
c. Hyperplasia.
d. Hypertrophy.
e. Metaplasia.
40.Which of the following is an EARLY manifestation of sepsis?

a. Cutaneous vasodilatation.
b. Decreased cardiac output.
c. Hypoglycaemia.
P a g e 10 | 25
41. Bacteroides fragilis responds BEST to adequate doses of which of the following
antibiotics?
a. Cefoxitin.
b. Clindamycin.
c. Erythromycin.
d. Tazocin.
e. Tobramycin.
42. A 30-year-old male patient was involved in a car accident. He had severe lacerated
wound involving the gluteal and thigh regions with laceration of bulky muscles.
What is the MOST important measure in the management of this patient?
a. Hyperbaric O2.
b. Insertion of a drain.
c. Local antibiotics powder.
d. Removal of foreign and dead tissues.
e. Skin graft.
43. Which of the following cells will be involved in the chronic inflammatory reaction
which follows the introduction of foreign body?
a. Eosinophils.
b. Giant cells.
c. Mast cells.
d. Neutrophils.
e. Plasma cells.
44. A patient with a non-obstructing carcinoma of the colon is being prepared for
elective resection. Which of the following reduces the risk of postoperative
infectious complication?
a. Avoidance of oral antibiotics to prevent emergence of Clostridium difficile.
b. Postoperative administration for 48 h of parenteral antibiotics effective
against aerobes and anaerobes.
c. Postoperative administration of parenteral antibiotics effective against
aerobes and anaerobes until the patient's intravenous lines and all other
drains are removed.
d. Redosing of antibiotics in the operating room if the case lasts for more than
2 hours of operating time.
e. Single preoperative parenteral dose of antibiotic effective against aerobes.
P a g e 11 | 25
45.A 40-year-old male patient had renal transplantation and is receiving

a. Candidiasis.
b. Coli sepsis.
e. Streptococci.
46.What of the following is the MOST common serious infectious complication of

blood transfusion?
a. Acquired immunodeficiency syndrome.
b. Cytomegalovirus.
c. Malaria.
d. Virus A hepatitis.
e. Virus C hepatitis.
47.Which of the following has the GREATEST influence for impaired healing of a
wound?
a. Anaemia.
b. Diabetes mellitus.
c. Intake of corticosteroids.
d. Local wound infection.
e. Malnutrition.
48.What is the COMMONEST organism to cause infections following splenectomy?

a. Haemophilus influenza.
c. Neisseria meningitides.
e. Streptococcus pneumonia.
P a g e 12 | 25
49.Which of the following statement is TRUE regarding beta-hemolytic

streptococci?
a. They produce a characteristic beta-lactamase.
b. They are one of the causes of necrotizing fasciitis.
c. They are the most common cause of infective endocarditis.
d. They are resistant to ampicillins.
e. They are part of normal vaginal flora.

a. Ciprofloxacin.
c. Cephalexin.
d. Nitrofurantoin.
e. Amoxicillin.
51.Regarding necrotizing fasciitis:

a. Skin manifestations may be totally absent.

is TRUE?
e. Exploratory incisions over normal appearing skin are effective in
P a g e 13 | 25
53.Which of the following is the mechanism of action of aminoglycosides?

a. Impairment of bacterial DNA synthesis.
b. Inhibition of cell wall synthesis.
c. Disruption of ribosomal protein synthesis.
d. Disruption of cell wall cation homeostasis.
e. Disruption of the cytoplasmic membrane.
54.The clinical course of majority of patients with HCV infection is characterized by

which one of the following?
e. Development of hepatocellular carcinoma.
10-days course of antibiotics. Has abdominal pain and profuse diarrhea. Her
stool is tested and comes back positive for Cl. difficile. What is the MOST
appropriate initial management?
a. Oral vancomycin.
c. Metronidazole.
d. Vancomycin enemas.
56.Which of the following statement about the usage of antibiotics for the
a. Antibiotics should be administrated within 60 minutes of incision.
b. The therapeutic dose of the antibiotic should be administrated
intravenously.
e. Vancomycin is the agent of chronic for patients from nursing homes
P a g e 14 | 25

a. Tachypnea, hypotension and altered sensorium.
c. Thrombocytopenia, Hypotension and lactic acidosis.

of the following organisms is MOST likely to result in her developing sepsis?
59.Sever sepsis is differentiated from sepsis by:

a. A history of premorbid conditions such as diabetes.
b. Positive blood cultures for bacteria and fungus.
c. Acute organ failure such as renal insufficiency.
d. Prolonged arterial hypotension.
e. Temperature more than 38.5 °C.

a. B-lymphocytes.
b. Dendritic cells.
c. Monocytes.
e. T-lymphocytes.
P a g e 15 | 25
61. What is the MOST common cause of death 2-years after heart transplantation?
a. Accelerated graft arteriosclerosis.
b. Arrhythmia.
c. Cardiomyopathy.
d. Infection.
e. Malignancy.
62.Following organ transplantation, the rejection reaction that is caused by the

presence of preformed antibodies in the recipient is referred as:
a. Accelerated.
b. Acute.
c. Chronic.
d. Hyperacute.
e. Intermediate.
63.Which of the following is a MAJOR disadvantage of living donor organ

transplantation?
a. Elective procedure.
b. Immediate graft function.
c. Improved graft survival.
d. Mortality and morbidity of donors.
e. Shorter hospital stay.

immunoglobulins and complement in vessels walls. What is the immunological
background of the problem?
P a g e 16 | 25
65.The arterial blood gas of a patient was pH 7.5, PCO2 47 mmHg, HCO3- 35 mmol/L.
This patient MOST likely is suffering from:

management?
67.What is the MOST common fluid disorder in the surgical patient?

b. Hyperkalemia.
c. Hyponatremia.
d. Metabolic acidosis.
68.What is the MOST common symptom after major pulmonary embolism?

a. Cough.
b. Dyspnea.
c. Hemoptysis.
d. Pleural pain.
e. Palpitation.
P a g e 17 | 25
Laboratory studies showed serum glucose 150 mg/dl, sodium 135mEq/L,
potassium 6.5 mEq/L, chloride 105 mEq/L and bicarbonate 15 mEq/L. Which of
the following is recommended?
70.A 40-year-old male patient developed convulsions 24 hours after having an

operation. His serum sodium is 120 mEq/L. Which of the following is the
appropriate management?
a. Administration of normal saline (0.9%).
b. Administration of hypertonic saline (3%).
c. Emergency hemodialysis.
d. Administration of vasopressor.
e. Administration of Lasix 40 mg intravenously (IV).
71.A 50-year-old man presented with sever repeated vomiting as a result of gastric
outlet obstruction is admitted to the hospital. There is marked dehydration,
with urine output 20 ml/h and the hematocrit is 48%. Initial treatment for this
patient should include which of the following?
b. Antiemetics.
c. Ringer's Lactate solutions.
72.Which of the following types of shock is high pulmonary wedge pressure?

P a g e 18 | 25

b. Tracheostomy.
74.What is the CORRECT management of commonest acid-base imbalance seen in

long standing or sever hemorrhagic shock?
d. Vasopressors.
a. Sodium.
b. Potassium.
c. Chloride.
d. Bicarbonate.
e. Lactate.

likely cause is:
a. Hyperkalemia.
b. Hyperuricaemia.
c. Hypoglycemia.
d. Hyponatremia.
e. Hypoxia.
P a g e 19 | 25
77.A man suffers a brachial injury. On examination, he has a Horner's syndrome in

association with upper limb paralysis. The Horner's syndrome suggests
involvement of which nerve roots?
a. C2 & C3.
b. C4 & C5.
c. C6 & C7.
d. C8 & T1.
e. T2 & T3.
a. Reverse heparin and evacuate the hematoma.
c. stop heparin and closely observe the patient.
d. stop heparin, give fresh frozen plasma and start warfarin therapy.

a. It Increase the level of protein C.

a. Fresh blood.
c. Fresh platelets.
d. IV vitamin K.
e. IV factor VIII.
P a g e 20 | 25
denote?
a. Diminished fibrin synthesis.
82.Low molecular weight heparin (LMWH) compared with unfractionated

intravenous heparin (UFH) for the treatment of pulmonary embolism is
associated with a:
a. Higher incidence of all-cause mortality.
b. Higher incidence of recurrent symptomatic venous thromboembolism at
the end of treatment.
c. Higher incidence of recurrent symptomatic venous thromboembolism at
3 months.
d. Lower incidence of major bleeding complications.
e. Lower risk of heparin-induced thrombocytopenia.

84.Which of the following mechanisms initiates the normal hemostatic

mechanism?
c. Fibrinolysis.
P a g e 21 | 25
85.A patient who received 8 units of blood during an operation developed diffuse
oozing of blood at the site of the wound. Which of the following tests will be
helpful for the diagnosis of the etiology of this ooze?
a. Platelet count.
b. Bone marrow biopsy.
c. Liver-spleen scan.
d. Factor VIII assay.
e. Smear for Howell-Jolly bodies.
86.A 5-year-old boy slipped and hurted his right knee while walking. He presents
with a tender, swollen, warm knee with significant hemarthrosis. His PT is 12
(Normal, 13 second), PTT is over 100 (Normal, 25 second), platelet count is
300,000/uL and bleeding time is normal. Initial management should consist of
which of the following?
a. Fresh frozen plasma.
e. Long-leg cast.
anesthesia?
a. Shaking, chills and muscle spasms.
d. Tachycardia.
88.A 22-year-old man is brought into the emergency department in profound shock
after a full from the fourth floor of a building. After resuscitation, small bowel
resection and hepatic segmentectomy are performed at laparotomy. He
receives 15 units of packed RBCs, 4 Units of fresh-frozen plasma and 8 L of
Ringer's lactate. On closure, diffuse oozing of blood is noted. What is the MOST
likely cause?
a. Hepatic failure.
b. Hypersplenism.
P a g e 22 | 25

a. ACTH is high.
d. Serum Na is low.
90.A 40-year-old male patient is complaining of persistent headache, recurrent

c. T scan of abdomen.
91.What is the MOST common cause of the thyrotoxicosis?

a. Autonomous nodules.
b. Grave's disease.
c. Iodine intake.
a. ACTH.
c. Hyperkalemia.
d. Hypernatremia.
e. The renin angiotensin system.
P a g e 23 | 25
93.Which of the following is the COMMON sign of Cushing's syndrome?

a. Acne.
b. Hirsutism.
c. Hypertension.
d. Purple striae.
e. Truncal obesity.
94.You have a patient who has pheochromocytoma and his blood pressure is
200/120 mmHg. You are preparing this patient for surgery. What is the following
drugs should be FIRST for the control of blood pressure?
b. Propranolol.
c. Nifedipine.
d. Atenolol.
e. Captopril.

e. Normal saline, glucose and Intravenous mineralocorticoids.
96.Which of the following is NOT present in primary hyperparathyroidism?

a. Hypercalcemia.
b. Hyperchloremia.
d. Low bicarbonate levels.
e. Increased pH.
P a g e 24 | 25
97.A 40-year-old women had the anterior lobe of the pituitary removed because of
a tumour. Without postoperative supplements, which of the following could
occur?
b. Failure to produce parathyroid hormone in response to hypocalcemia.
98.A 30-year-old primigravida complains of headaches, restlessness, sweeting and

tachycardia. She is 18 week pregnant and her blood pressure is 200/120 mmHg.
Appropriate workup might include:
a. Exploratory laparotomy.
b. Mesenteric angiography.
c. Head CT scan.
d. Abdominal CT scan.
e. Abdominal ultrasound.
99.A 50-year-old woman present with lethargy, weight gain, cold intolerance and
investigation?
100. A 48-year-old woman with breast cancer diagnosis five years ago is admitted
with a two week history of back pain, nausea, fatigue and constipation. Her
serum calcium is 14 mg/dl. Which of the following is the CORRECT first line
treatment for this patient?
a. Bisphosphonate infusion.
b. Calcitonin infusion.
c. Dextrose/insulin infusion.
d. Forced diuresis with furosemide.
e. Intravenous fluids.
P a g e 25 | 25

March 2015
1. A 30-year-old male patient had a road traffic accident. Examination revealed loss of
contour of the shoulder and the arm was held in an adducted position. The patient could
not move his shoulder. Which of the following nerves was MOST likely injured in this
patient?
a. Axillary (Circumflex).
b. Median.
d. Radial.
e. Ulnar.
2. Which of the following nerves is liable to be injured during opening of the inguinal canal
in herniorrhaphy operation?
a. Iliohypogastric nerve.
b. Obturator nerve.
c. Lateral femoral cutaneous nerve.
e. Pudendal nerve.
3. A 25-year-old male patient is involved in a serious car accident. Examination reveals that
his right leg is shortened and internally rotated. The patient is unable to dorsiflex or
planter flex his foot. All sensations below the knee are lost apart from the medial side of
the leg and foot and upper back of the calf. Which of the following is the MOST likely
injured nerve?
b. Tibial nerve.
c. Obturator nerve.
d. Sciatic nerve.
e. Femoral nerve.
4. A 40-year-old male patient was stabbed in the right gluteal region. The wound was
sutured in the casualty department and the patient discharged. The patient noted that
his gait was not proper. Exam revealed a waddling gait and Trendelenburg’s test was
positive. What was the injured nerve?
a. Superior gluteal nerve.
b. Nerve to quadratus femoris.
c. Inferior gluteal nerve.
d. Nerve to obturator externus.
e. Obturator nerve.
P a g e 1 | 25
5. A 65-year-old man presents with haematuria and left loin pain. Computerized
tomography confirms a left renal tumour. The normal left renal hilum lies at
which vertebral level?
a. T11.
b. T12.
c. L1.
d. L2.
e. L3.

involved in secondary spread from a tumour in which of the following organs?
a. Cervix.
b. Ovary.
c. Uterus.
d. Vagina.
e. Vulva.

protruding?
a. Conjoint tendon.

angiography but no symptoms or signs of colonic ischaemia. Which of the
a. Left colic.
c. Middle colic.
d. Splenic.
e. Superior rectal.
P a g e 2 | 25
9. An 80-year-old man presents with a prostatic malignancy. Imaging reveals a

d. Testicular vein.
e. Vertebral veins.
10.Which of the following statements regarding splenic anatomy is TRUE?

a. The splenic ligaments are all avascular.
b. The tail of the pancreas is often contained in the splenorenal ligament.
c. The average weight of the adult spleen is 300 g.
d. The first branches of the splenic artery are the short gastric arteries.
e. Accessory spleens are most commonly found in the greater omentum.
a. Coeliac artery.

d. Teres major.
e. Trapezius.
P a g e 3 | 25
13.A 44-year-old man is admitted to the emergency department with excessive

being compressed?
e. Jejunum.
14.A 22-year-old man is admitted to the emergency department after falling from
his bicycle. Radiograph examination reveals a fracture of the tibia above ankle.
MRI and physical examination reveal the tibial nerve is severed on the posterior
aspect of tibia. Which of the following signs will MOST likely present during
physical examination?
a. Sensory loss of the dorsum of the foot.
b. Sensory loss on the sole of the foot.
c. Foot drop.
d. Paralysis of the extensor digitorum brevis.
e. Sensory loss of the entire foot.
15.Which of the following is the MAIN action of secretin?

a. It augments the action of cholecystokinin.
b. It inhibits acid secretion by the stomach.
c. It stimulates the production of enzyme rich pancreatic juice.
d. It stimulates the production of alkaline pancreatic juice.
e. It stimulates the secretion of bile.
16.Which of the following statements is correct regarding potassium homeostasis?

a. About 60% of the total body potassium is in the intracellular
compartment.
b. Aldosterone stimulates potassium reabsorption in the distal convoluted
tubules.
c. Hypokalaemia causes depression of the ST segment.
d. In alkalosis there is usually hyperkalaemia.
e. Insulin causes potassium to leave the cell.
P a g e 4 | 25

a. Amino acid.
b. Glucose.
c. Ketones.
d. Lactose.

a. Fatty meal.
d. Gastrin.
e. Proteins.
19.Which of the following is TRUE about epinephrine?

a. It decreases lipolysis in adipose tissues.
b. It decreases lipolysis in the liver.
c. It decreases the secretion of thyroid hormone.
e. It increases insulin release.
20.The majority of the blood volume at rest is contained within the:

a. Arterial system.
b. Capillary bed.
c. Portal circulation.
d. Pulmonary circulation.
e. Venous system.
P a g e 5 | 25
21.The hypothalamus contains cells which are sensitive to:

a. Partial pressure of oxygen.
b. Arterial blood pressure.
c. Hydrogen ions concentration.
d. Thyroid-stimulating hormone concentration.
e. Plasma volume.
22.In compensating for respiratory alkalosis, the body excretes MORE:

a. Ammonium ions.
d. Carbonic acid.
e. Hydrogen ions.
23.A fit 30-year-old man donates 500 ml of blood. Which one of the following is the
MOST likely physiological change?
a. A fall in blood pressure.
b. Activation of renin-angiotensin system.
c. Reduced urine output.
d. Sweating.
e. Tachypnoea.
24.Which of the following gastrointestinal secretions has the HIGHEST bicarbonate

level?
a. Gastric.
b. Pancreatic.
c. Colonic.
d. Ileal.
e. Saliva.
P a g e 6 | 25
25. During the second (Proliferative) phase of wound healing the predominant cells in
the wound site are fibroblasts. This cell is of mesenchymal origin and produces the
matrix and collagen needed to strengthen the scar. Cross linkage of collagen
requires hydroxy-proline and hydroxy-lysine residues, which requires a specific
vitamin to be available in sufficient quantities. Deficiency of which vitamin results
in collagen that is unstable?
a. Vitamin B2 (Riboflavin).
b. Vitamin B6 (Pyridoxine).
c. Vitamin C (Ascorbic acid).
d. Vitamin D (Cholecalciferol).
e. Vitamin E (Tocopherol).
27. A 70-year-old patient with diabetes and paraplegia is undergoing an elective
laparoscopic cholecystectomy after an episode of biliary pancreatitis. Shortly after
induction, blood pressure is normal, but ECG shows peaked P waves and a widened
QRS complex. The MOST likely diagnosis is:
a. Ketoacidosis.
b. Hyperkalemia.
c. Hypoglycemia.
d. Hypocalcemia.
28. A 70-year-old man with chronic obstructive pulmonary disease is admitted for
elective hemicolectomy. What is a preoperative arterial blood gas analysis likely to
show?
P a g e 7 | 25
29.Which of the following is TRUE regarding the release of tumour necrosis factor-
α?
a. Can be effectively blocked by anti-TNF- α, antibodies to halt systemic
inflammatory response syndrome (SIRS).
b. Does not have any beneficial effects in the early phases of the
inflammatory response.
c. Is primarily from leukocytes.
d. Promotes polymorphonuclear (PMN) cell adherence and further
cytokines release.
e. Is always deleterious.
30.Which one of the following is LEAST useful in the immediate treatment of

hyperkalemia?
a. Calcium salts.
b. Sodium bicarbonate.
c. Potassium-binding resins.
d. Glucose and insulin.
e. Hemodialysis.

a. Alpha cell.
b. Beta cell.
c. Delta cell.
d. F cell.
e. PP cell.
32.A 15-year-old female patient presented by enlargement of the upper deep

cervical lymph nodes which had been present for 4-months. The patient did not
respond-to-multiple courses of antibiotics. The temperature was 37.8 oC. The
lymph nodes were matted together and they were slightly tender. Which of the
following cells will be predominant on histopathological examination?
b. Fibroblasts.
c. Lymphocytes.
d. Plasma cells.
P a g e 8 | 25

division?
c. Erythrocytes.
d. Hepatocytes.
e. Osteocytes.
34.Which of the following phases of cell cycle is MOST resistant to

chemotherapeutic therapy?
a. G0.
b. S.
c. G1.
d. M
e. G2.
35.A 45-year-old woman is admitted with a chronic cough and weight loss. On
examination, crepitations are heard over the apex of the right lung. A chest X-
ray reveals cavitation in the right apex. What is a lung biopsy MOST likely to
show?
a. Abundant plasma cells.
b. Aggregates of activated macrophages.
c. Eosinophils.
d. Mast cells.
e. Neutrophilic infiltrates with abscess formation.

CORRECT?
injury.
e. Early in wound healing, type I collagen is predominant.
P a g e 9 | 25
activity?
a. Erythrocytes.
b. Lymphocytes.
c. Macrophages.
d. Mast cells.
e. Plasma cells.
38.A 45-year-old man had a 12-year history of gastro-oesophageal reflux disease.

The lower third of his oesophagus was reddened and biopsies revealed
columnar epithelium. What was the process affecting the tissue?
a. Anaplasia.
b. Dysplasia.
c. Hyperplasia.
d. Hypertrophy.
e. Metaplasia.
a. Chest infection.
b. DVT.
e. Wound infection.
40.Which of the following organism is FAMOUS for production of the enzyme

penicillinase and resists penicillin therapy?
a. Bacteroides.
b. Hemolytic streptococci.
c. Klebsiella.
P a g e 10 | 25

e. Vancomycin is the first choice for treatment of infections with Staph.
aureus.

b. Drainage of a pericolic abscess.
c. Inguinal herniectomy.
e. Thyroidectomy.
b. Antitoxin.
c. Hyperbaric O2.
d. Immunoglobulins.
44.The effectiveness of prophylactic antibiotics in surgery is MOSTLY related to the:

a. Continuation of antibiotics for 24 hours after surgery.
b. Timing of initial administration.
c. Use of bactericidal agents.
d. Use of broad-spectrum agents.
e. Use of two synergistic antibiotics.
P a g e 11 | 25

a. Candidiasis.
b. Coli sepsis.
e. Streptococci.

a. Bacteroides.
b. E. coli.
c. Proteus.
d. Staph. aureus.
e. Streptococci.

48.What of the following is the MOST common serious infectious complication of

blood transfusion?
b. Cytomegalovirus.
c. Malaria.
P a g e 12 | 25
49.Which of the following organisms produces an endotoxin?

a. Clostridium botulinum.
b. Clostridium tetani.
c. E. coli.
d. Pneumococci.
receive?
51.Which of the following groups of antibiotics will be effective against methicillin

resistant staph organisms (MRSA)?
a. Third generation cephalosporins.
b. Macrolides.
c. Fluroquinolones.
d. Glycopeptides.
e. Ampicillin + Clavulanic acid.
10-day course of antibiotics has abdominal pain and profuse diarrhea. Her stool
is tested and comes back positive for Cl. difficile. What is the MOST appropriate
initial management?
a. Oral vancomycin.
c. Metronidazole.
d. Vancomycin enemas.
P a g e 13 | 25

a. B-lymphocytes.
b. Dendritic cells.
c. Monocytes.
e. T-lymphocytes.
54.A 64-year-old man underwent transplantation, which was complicated by graft-

versus-host reaction. He had undergone a transplantation of which of the
following?
a. Kidney.
b. Skin.
c. Bone marrow.
d. Cornea.
e. Liver.

56.Which of the following is the MOST commonly used-primary maintenance

immunosuppressive agent?
a. Tacrolimus (Prograf).
b. Azathioprine (Imuran)
c. Mycophenolate (CellCept).
d. Rapamycin (Sirolimus).
e. Corticosteroids.
P a g e 14 | 25
57.A patient is reported to have a potassium level of 7.3 mEq/L. What is the FIRST
diagnostic or therapeutic maneuver for this patient?
a. An ECG and administration of 1 g of 10% calcium gluconate.
b. An ECG and infusion of 45 mEq/L NaHCO3.
c. An ECG and infusion of glucose and insulin intravenously.
d. Kayexalate enema.
e. Transfer to an intensive care unit for careful cardiac monitoring.

management?

a. Cough.
b. Dyspnea.
c. Hemoptysis.
d. Pleural pain.
e. Palpitation.
P a g e 15 | 25
61.A 45-year-old male with a known history of alcoholism is admitted with acute
pancreatitis. His serum calcium is 7 mg/dl. Management is based upon which of
the following?
a. One-fourth of calcium in scrum is ionized.
b. Alkalosis increases the ionized calcium component.
c. Hypocalcemia may cause polyuria and polydipsia.
d. Determination of serum albumin is necessary for proper determination of
serum calcium level.
e. 20% of serum calcium is bound to citrates.
62.A 75-year-old woman who is in the ICU after undergoing colectomy is

hypotensive and tachycardic. Pulmonary capillary wedge pressure (PCWP) is
elevated to 18 mmHg and cardiac output is 3 L/min. She is in shock BEST
b. Septic shock.
d. Anaphylactic shock.

d. Hyperkalemia.
e. Hypoglycemia.
64.Features of adult respiratory distress syndrome (ARDS) include all the following
EXCEPT:
a. Increased lung compliance.
b. Diffuse pulmonary infiltrates on chest X ray.
c. Increase alveolar arterial oxygen gradient.
d. Diuretics may help in recovery of these patients.
e. Artificial ventilation when required must be based on pressure based
ventilation.
P a g e 16 | 25

a. Sepsis syndrome.
b. Aspiration.
d. DIC.
e. Fat embolism.
d. Faecal impaction.
e. Systemic sepsis.

following?
P a g e 17 | 25
pressure?

b. Tracheostomy.
71.Dopamine is a frequently used drug in critically ill patients because:

a. At high doses it increases splanchnic flow.
b. At high doses it increases coronary flow.
c. At low doses it decreases heart rate.
d. At low doses it lowers peripheral resistance.
e. It inhibits catecholamine release.
72.A 28-year-old motorcyclist is admitted following a road traffic accident, having

postoperatively he is noted to be agitated, hypoxaemic and difficult to ventilate.
His observations show a blood pressure of 120/80 mmHg, regular pulse of 88
beats/minute and he is apyrexial. A chest X-ray shows bilateral diffuse lung
infiltrates. What is the MOST likely underlying diagnosis?
b. Atelectasis.
P a g e 18 | 25
73.A 56-year-old motorcyclist presents to the emergency department after being

involved in a road traffic accident. He is conscious and is maintaining his own
airway and breathing. He is found to have an open right femoral fracture with
palpable distal pulses and normal sensation. Resuscitation is started. Urethral
catheterization drained 250 ml immediately but over the following 60 minutes
he drained only 10 ml. Which of the following is the MOST likely cause of his low
urine output?
a. Blocked catheter.
d. Ruptured bladder.
e. Septic shock.
patient?
a. Bleeding time.
c. INR.
d. PTT.
e. Thrombin time.

a. A Closed head injury two weeks ago.
received 5 liters of blood following which he started to have bleeding from his
P a g e 19 | 25
77.Which of the following is associated with a defect of the platelet function?

a. Epistaxis.
b. Hemarthrosis.
c. Normal bleeding time.
d. Prolonged prothrombin time.
e. Soft tissue hemorrhages.

a. Desmopressin.
b. Fresh blood.
d. Fresh platelets.
e. IV vitamin K.

receiving warfarin 5 mg/daily because she had mitral valve replacement 4 years
d. Stop warfarin and substitute it by heparin for 10 days preoperatively
P a g e 20 | 25
81.A victim of blunt abdominal trauma requires a partial hepatectomy. He is rapidly

transfused with 8 units of appropriately cross-matched banked blood. He is
noted in the recovery room to be bleeding from intravenous puncture sites and
the surgical incision. Which of the following is responsible for the patients
coagulopathy?
a. II and VII.
b. II only.
c. IX and X.
d. V and VIII.
e. XI and XII.

83.A 5-year-old boy slipped and hurt his right knee while walking. He presents with
a tender, swollen, warm knee with significant hemarthrosis. His PT is 12
(Normal, 13 seconds), PTT is over 100 (Normal, 25 seconds), platelet count is
300,000/mm3 and bleeding time is normal. Initial management should consist
e. Long-leg cast.

anesthesia?
P a g e 21 | 25
a. Elevated PT.
b. Elevated PTT.
e. Sepsis.
86.A 70-year-old female patient is receiving warfarin because she has AF and had
CORRECT?
time.
reduced.
e. Protamine sulphate is the antidote to warfarin

88.A 40-year-old-male-patient is complaining of persistent headache, recurrent

P a g e 22 | 25
89.A 30-year-old pregnant female patient (First trimester) developed palpitation

c. Technetium scan.
e. Total thyroxine level.
90.What is the hormone that acts on the intestines to increase calcium absorption?
a. Calcitonin.
d. Parathormone.
e. Thyroxine.
diagnosis?
c. Total serum calcium .
d. Plasma chloride.
e. Serum phosphate.

P a g e 23 | 25
93.What is the COMMONEST cause of thyrotoxicosis?

a. Autonomous nodule.
b. Graves' disease.
c. Iodine intake.

95.A 30-year-old primigravida complains of headaches, restlessness, sweating and

tachycardia. She is 18 week pregnant and her blood pressure is 200/120 mmHg.
Appropriate workup might include:
a. Exploratory laparotomy.
b. Mesenteric angiography.
c. Head CT scan.
d. Abdominal CT scan.
e. Abdominal ultrasonogram.
96.A 53-year-old man with renal failure presents with nausea, headache and
pruritus. Blood tests show a serum calcium of 13 mg/dl (Normal 9-10.5 mg/dl).
Which of the following is the MOST likely diagnosis?
a. Hypoparathyroidism.
b. Primary hyperparathyroidism.
c. Pseudohypoparathyroidism.
d. Secondary hyperparathyroidism.
e. Tertiary hyperparathyroidism.
P a g e 24 | 25

a. Dehydration.
c. Hypoglycemia.
a. Epinephrine.
e. Phenylephrine.
99.On postoperative day 3, after undergoing an exploratory laparotomy, distal
pancreatectomy, splenectomy and fixation of a left femur fracture after a motor
vehicle collision, a 46-year-old man is found to be lethargic, confused and
vomiting. His blood pressure is 90/40 mmHg, serum glucose is 45 mg/dl, serum
sodium is 121 mEq/L, serum potassium is 5.3 mEq/L, hemoglobin 11.2 mg/dL.
Which of the following is the MOST likely cause accounting for his condition?
a. Acute adrenal insufficiency.
b. Internal bleeding.
c. Pituitary infarction.
e. Volume overload with lactated Ringer solution.
100. A 75-year-old woman presents with acute back pain after a minor fall.
a. Hypercalcaemia.
b. Hyperphosphataemia.
c. Hypokalaemia.
d. Hyponatraemia.
e. Normocalcaemia.
P a g e 25 | 25

March 2014
a. Acromiothoracic artery.
2. Taste from the posterior one third of tongue is provided by which of the
following nerves?
a. Facial.
b. Glossopharyngeal.
c. Hypoglossal.
d. Lingual.
e. Vagus.
3. Which of the following nerves is MOST likely to be injured following fracture

b. Median nerve.
d. Radial nerve.
e. Ulnar nerve.
4. What is the site of drainage of the inferior thyroid veins?

a. External jugular vein.
b. Innominate vein.
c. Internal jugular vein.
d. Subclavian vein.
e. Vertebral vein.
P a g e 1 | 25
5. Which of the following nerves is liable to be injured during opening of the

inguinal canal in herniorrhaphy operation?
b. Obturator nerve.
e. Pudendal nerve.
6. A 25-year-old male patient is involved in a serious car accident. Examination
reveals that his right leg is shortened and internally rotated. The patient is
unable to dorsiflex or plantarflex his foot. All sensations below the knee are lost
apart from the medial side of the leg and foot and upper back of the calf. Which
of the following is the MOST likely injured nerve?
b. Tibial nerve.
c. Obturator nerve.
d. Sciatic nerve.
e. Femoral nerve.
7. A 20-year-old man presented to the emergency department with a stab injury
to the anterior aspect of the right wrist. On examination he was found to have
a deep 2-сm long transverse laceration at the front of the right wrist with loss
of sensation in the ring and little fingers. The patient was unable to abduct and
adduct his fingers on the affected side. Radial pulse was palpable. What was the
MOST likely structure to have been injured?
b. Median nerve.
d. Radial nerve.
e. Ulnar nerve.
8. During the surgical repair of a perforated duodenal ulcer in a 47-year-old male
patient, the gastroduodenal artery is ligated. A branch of which of the following
arteries will continue to supply blood to the pancreas in this patient?
a. Inferior mesenteric.
b. Left gastric.
c. Right gastric.
d. Proper hepatic.
e. Superior mesenteric.
P a g e 2 | 25
9. A 19-year-old woman attends the emergency department after being shot in

the neck with an air-gun pellet. In the course of surgical exploration of the
posterior triangle, a nerve is injured. The patient is unable to shrug her left
shoulder or fully abduct her left arm. Which is the MOST likely structure to have
been injured?
a. Axillary nerve.
b. Dorsal scapular nerve.
c. Long thoracic nerve.
e. Suprascapular nerve.
10.A 34-year-old man is seen in the emergency department with a fibular fracture
following a football match. On examination he is noted to have loss of foot
eversion. Which area of skin should be examined to confirm loss of the
cutaneous distribution of the affected nerve?
a. Along the lateral aspect of the foot.
b. Along the medial aspect of the foot.
c. Between the hallux and the second digit.
d. On the dorsal surface of the foot.
e. On the plantar surface of the foot.
11.Which of the following is the sensory supply to the skin of the tip of the index
finger?
a. Radial nerve only.
b. Radial and median nerves.
c. Median and ulnar nerves.
d. Ulnar nerve only.
e. Median nerve only.
12.Which one of the following structures provides the GREATEST support for the
liver?
a. The falciform ligament.
b. The coronary ligament.
c. The ligamentum teres.
d. The hepatic veins joining the inferior vena cava.
e. The ligamentum venosum.
P a g e 3 | 25
13.A 65-year-old man presents with haematuria and right loin pain. Computerized
tomography demonstrates a right renal tumour and he undergoes a right radical
d. Right lumbar vein.
14.A 62-year-old man is admitted to the emergency department due to retention
of urine. Physical examination reveals prostatic hypertrophy. After several
unsuccessful attempts to catheterize the penile urethra, the urologist orders
drainage of the urinary bladder by the least invasive procedure, avoiding entry
into the peritoneal cavity or the injury of any major vessels or organs. Which of
the following spaces needs to be traversed by the needle to reach the bladder?
a. Ischioanal fossa.
b. Perineal body.
c. Retropubic space (Of Retzius).
d. Superficial perineal cleft.
e. Deep perineal pouch.
15.A 20-year-old male while walking slipped on the wet pavement and injured his
right arm. Radiographic images showed a midshaft fracture of the humerus.
Which pair of structures was MOST likely injured at the fracture site?
a. Median nerve and brachial artery.
b. Axillary nerve and posterior humeral circumflex artery.
c. Radial nerve and deep brachial artery.
d. Suprascapular nerve and artery.
e. Long thoracic nerve and lateral thoracic artery.
16.A 29-year-old female is examined in the emergency department after falling
from her balcony. Radiographic examination reveals that she has suffered a
broken clavicle, with associated internal bleeding. Which of the following
vessels is MOST likely to be injured in clavicular fractures?
a. Subclavian artery.
b. Cephalic vein.
c. Lateral thoracic artery.
d. Subclavian vein.
e. Internal thoracic artery.
P a g e 4 | 25
17.Which of the following tests will be affected after intake of non-steroidal anti-
inflammatory drugs?
a. Bleeding time.
c. INR.
d. PTT.
e. Thrombin time.

c. C. Increase in the heart rate.
19.A 48-year-old woman presents to the emergency department with persistent

diarrhea. On examination, she is apyrexial and has an irregularly irregular pulse
of 140 beats/minute. The MOST likely cause of the abnormal cardiac rhythms is:
a. Hypernatraemia.
b. Hypokalaemia.
c. Hypovolaemia.
d. Myocardial ischaemia.
e. Sepsis.
20.Stress related hyperglycemia is thought to be due to increased release of all of

the following EXCEPT:
a. Glucocorticoids.
b. Growth hormone.
c. Thyroid-stimulating hormone (TSH).
d. Glucagon.
e. Epinephrine.
P a g e 5 | 25

axes during stress or injury EXCEPT:
a. Pain.
b. Hypovolemia.
c. Acidosis.
d. Hypercapnia.
e. Acetylcholine.

membranes.
23.With regard to potassium, which of the following statements is NOT TRUE?

excreted in urine.
c. More than 90% of the potassium in the body is located in the extracellular
compartment.
normal.
extracellular space (ECF) to the intracellular space (ICP).

resistance. In which condition, its use is MOST appropriate:
e. Septic shock.
P a g e 6 | 25
25.A 60-year-old woman had a total pancreatectomy three months ago. She now
complains of offensive, foul smelling stools that are difficult to flush. Lack of
which enzyme is responsible?
a. Amylase.
b. Cholecystokinin.
c. Lipase.
d. Secretin.
e. Trypsin.
26.Respiratory alkalosis can occur as a result of:

a. Asphyxia.
b. Asthma.
c. Severe emphysema.
d. Hyperventilation.
e. Hypoventilation.
27.Anti-diuretic hormone (ADH) is secreted in response to shock and remains

elevated for approximately 1 week. Which of the following is seen as a result of
this increased level of ADH?
a. Decreased water permeability in the distal tubules.
b. Increased sodium loss in the distal tubules.
c. Mesenteric vasoconstriction.
d. Mesenteric vasodilatation.
e. Increased hepatic glycolysis.
28.Pancreatic acini secrete enzyme that play an important role in the digestion of
proteins. What is the MOST potent stimulant of pancreatic acinar cells?
a. Acetylcholine.
b. Cholecystokinin (CCK).
c. Peptide.
d. Secretin.
e. Trypsinogen.
P a g e 7 | 25

a. ACTH.
b. Angiotensin II.
c. Cortisol.
d. Hypernatraemia.
e. Hypokalaemia.

a. Chief cells.
c. Mucous cells.
d. Paneth cells.
e. Parietal cells.
bladder?
a. Acetylcholine.
b. Cholecystokinin.
d. Secretin.

a. Fatty meal.
b. Gastric alkalinization.
d. Gastrin.
e. Proteins.
P a g e 8 | 25
33.A 40-year-old male patient was injured in the thigh and a bleeding point was
ligated by a silk suture. The patient got recurrent attacks of inflammation at the
site of the wound. The surgeon explored the wound and removed an
inflammatory reaction mass around the silk suture. Which of the following cells
will be the predominant cell detected in this mass?
a. Basophils.
b. Eosinophils.
c. Lymphocyte.
d. Macrophages.
e. Neutrophils.

division?
c. Erythrocytes.
d. Hepatocytes.
e. Osteocytes.

a. Atypia.
c. Invasion.
d. Necrosis.
e. Pleomorphism.
36.Which of the following can minimize effects of steroids on wound healing?

a. Copper.
b. Vitamin A.
c. Vitamin C.
d. Vitamin D.
e. Vitamin E.
P a g e 9 | 25
37.A 45-year-ol woman is admitted with a chronic cough and weight loss. On
examination, crepitations are heard over the apex of the right lung. A chest X-
ray reveals cavitation in the right apex. What is a lung biopsy MOST likely to
show?
a. Abundant plasma cells.
b. Aggregates of activated macrophages.
c. Eosinophils.
d. Mast cells.
e. Neutrophilic infiltrates with abscess formation.

a. Bacteroides.
b. E. coli.
c. Klebsiella.

a. Candidiasis.
b. E. coli.
c. Cytomegalovirus.
d. Pneumococci.
e. Streptococci.

c. C Inhibition of bacterial wall synthesis.
P a g e 10 | 25
41.Which of the following organisms is the COMMONEST to cause urinary tract

infection following catheterization?
b. E. coli.
c. Pseudomonas aeruginosa.
d. Staph. aureus.
e. Strept. pneumonia.
42.Which of the following has the GREATEST influence for impaired healing of a
wound?
a. Anaemia.
b. Diabetes mellitus.
c. Intake of corticosteroids.
d. Local wound infection.
e. Malnutrition.
receive?
44.The clinical course of the majority of patients with HCV infection is characterized
by which one of the following?
e. Development of hepatocellular carcinoma.
P a g e 11 | 25

is TRUE?
e. Exploratory incisions over normal-appearing skin are effective in
46.Which of the following statements about the usage of antibiotics for the
a. Antibiotics should be administered within 60 minutes of incision.
b. The therapeutic dose of the antibiotic should be administered
intravenously.
e. Vancomycin is the agent of choice for patients from nursing homes

a. Tachypnea, hypotension and an altered sensorium.
c. Thrombocytopenia, hypotension and lactic acidosis
48.A 24-year-old HIV positive man presents to the emergency room with acute
onset pain and redness in his scrotum, penis and perineum. Upon examination,
you feel crepitus over the erythematous area described, which emits a foul-
smelling grey discharge. What is the MOST appropriate management for this
patient's illness?
a. Apply topical polymycin ointment.
b. Give hydrocortisone infusion.
c. Initiate highly active antiretroviral treatment.
d. Initiate penicillin G infusion.
e. Surgical debridement of affected tissue.
P a g e 12 | 25

sepsis?
50.Severe sepsis is differentiated from sepsis by:

a. A history of premorbid conditions such as diabetes.
b. Positive blood culture for bacteria and fungus.
c. Acute organ failure such as renal insufficiency.
d. Prolonged arterial hypotension.
e. Temperature more than 38.5 °C.
51.Septic shock is characterized by:

a. Increased capillary permeability.
b. Vasoconstriction
c. A low cardiac output.
d. A high systemic vascular resistance.
e. Bradycardia.
52.A blue-green discharge from an ulcer indicates infection with:

a. Candida albicans.
b. Haemophilus influenza.
c. Pseudomonas pyocyaneus.
e. Streptococcus viridans.
P a g e 13 | 25

a. Bacteroides.
b. E. coli.
c. Proteus.
d. Staph. aureus.
e. Streptococci.
54.Which of the following is the mode of action of ciprofloxacin?

e. Inhibition of translocation of Peptides.

56.A 45-year-old male patient had renal transplantation operation. Thirty minutes
after the operation the urinary output markedly dropped. The blood pressure
of was 120/80 mmHg. Duplex scanning of the transplanted kidney revealed
patent renal vessels and normal pelvicalyceal system. Which of the following is
TRUE regarding the present problem?
a. It is less liable to occur in females who had repeated pregnancies.
b. It is more liable to occur in patients who receive liver transplantation.
c. Stimulated CD4 lymphocytes are mainly responsible for the problem.
d. The patient needs immediate removal of the transplanted kidney.
e. The problem can be corrected by increasing the dose of cyclosporin.
P a g e 14 | 25
57.Which of the following is a potential sequela of cytomegalic virus infection?

a. Cholecystitis.
b. Intra-abdominal abscess.
c. Pancreatitis.
d. Parotitis.
e. Pyelonephritis.

b. Colon cancer.
e. Skin cancer.
59.What is the single MOST important factor in determining whether to perform a

transplant between a specific donor and recipient?
a. ABO blood types of the donor and recipient.
b. Closeness of relationship between the donor and recipient.
c. HLA types of the donor and recipient.
d. Mixed lymphocyte culture assays of the donor and recipient.
e. Peripheral T-cell count of the recipient.

cyanotic and flaccid. Histological examination revealed depositions of
P a g e 15 | 25
61.A patient is reported to have a potassium level of 7.3 mEq/L. What is the FIRST
diagnostic or therapeutic maneuver for this patient?
a. An ECG and administration of 1 g of 10% calcium gluconate.
b. An ECG-and infusion of 45 mEq/L NaHCO3.
c. An ECG and infusion of glucose and insulin intravenously.
d. Kayexalate enema.
e. Transfer to an intensive care unit for careful cardiac monitoring.
63.Five days after uneventful cholecystectomy, asymptomatic middle aged

management?
b. by Administration of Ringer's lactate solution.
64.What is the MOST common fluid disorder in the surgical patient?

b. Hyperkalemia.
c. Hyponatremia.
d. Metabolic acidosis.
P a g e 16 | 25
65.The osmolarity of the extracellular fluid space is determined primary by the

concentration of:
a. Bicarbonate.
b. Chloride ions.
d. Potassium ions.
e. Sodium ions.
66.In the presence of acute blood loss, what is the initial mechanism to maintain
an adequate preload to the heart?
a. Development of tachycardia.
b. Hormonal effects of angiotensin.
c. Hormonal effects of rennin.
d. Increase in systemic vascular resistance.
e. Increased cortisol secretion.
67.Which of the following is characteristic of neurogenic shock?

a. Cool moist skin.
e. Bradycardia.

a. Cough.
b. Dyspnea.
c. Hemoptysis.
d. Pleural pain.
e. Palpitation.
P a g e 17 | 25
69.A 60-year-old male patient had a colectomy operation. Post-operatively the

patient had tachycardia, hypertension and shallow respiration. Which of the
following is an indication to intubate the patient?
a. PaCO2 of 45 mmHg.
b. Respiratory rate 25/min.
c. PO2 of 55 mmHg at room temperature.
d. Heart rate of 130/min.
e. High pulmonary capillary wedge pressure.

a. Sepsis syndrome.
b. Aspiration.
d. DIC.
e. Fat embolism.
71.Which of the following characterizes protein metabolism during trauma?

necrosis factor (TNF; cachectin).
d. Hepatic synthesis of acute-phase reactants.
e. Decreased glutamine consumption by fibroblasts, lymphocytes and
intestinal epithelial cells.

d. Vasopressors.
P a g e 18 | 25
73. A 38-year-old man in end-stage renal failure resulting from polycystic kidney disease
receives a cadaveric renal transplant. Good renal function is established but four
weeks later deteriorates, the serum creatinine rising by 25%. Which of the following
processes is MOST likely to be responsible for this deterioration?
Finding: 7.28 70 mmHg 48 mmHg 36 mmol/L +5
Normal: 7.35-7.45 90-110 35-45 22-26 -2 to +2
postoperatively he is noted to be agitated, hypoxaemic and difficult to ventilate. His
observations show a blood pressure of 120/80 mmHg, regular pulse of 88
beats/minute and he is apyrexial. A chest X-ray shows bilateral diffuse lung infiltrates.
What is the MOST likely underlying diagnosis?
b. Atelectasis.
spine fracture (T6) and paraplegia. The patient is hypotensive with systolic BP of 70
mmHg, is bradycardiac with a pulse of 48 beats/min and is breathing comfortably.
Which of the following would the MOST appropriate initial treatment?
P a g e 19 | 25
77.What is the primary source of calories during prolonged starvation (>5 days
fasting)?
a. Skeletal muscle proteins.
b. Body stored fat.
c. Liver glycogen.
d. Ketone bodies.
e. Muscle glycogen.

b. Tracheostomy.

P a g e 20 | 25
received 5 liters of blood following which he started to have bleeding from is



a. Fresh blood.
c. Fresh platelets.
d. IV vitamin K.
e. IV factor VIII.
P a g e 21 | 25

d. Transfusion of 10 units of platelet.
86.A 5-year-old boy slipped and hurted his right knee while walking. He presents
with a tender, swollen, warm knee with significant hemarthrosis. His PT is 12
(Normal, 13 seconds), PTT is over 100 (Normal, 25 seconds), platelet count is
300,000/mm3 and bleeding time is normal. Initial management should consist
e. Long-leg cast.
a. Elevated PT.
b. Elevated PTT.
e. Sepsis.
TRUE?
c. he boy has had repeated episodes of epistaxis.
P a g e 22 | 25

a. Calcitonin.
d. Parathormone.
e. Thyroxine.
diagnosis?
c. Total serum calcium.
d. Plasma chloride.
e. Serum phosphate.

hyperaldosteronism?
P a g e 23 | 25

thyroid gland. On the second postoperative day, she begins to complain of
tingling sensation in her hands. She appears quite anxious and later complains
of muscle cramps. What is initial therapy?
a. 10 mL of 10% magnesium sulfate intravenously.
c. Intravenous infusion of calcium gluconate.
e. Oral vitamin D.
94.A 55-year-old female patient who has metastatic breast cancer presents with
weakness, anorexia, malaise, constipation and back pain and lethargy.
Laboratory studies include a normal chest X-ray; serum albumin 3.2 mg/dl;
serum calcium 14 mg/dl; serum phosphorus 2.6 mg/dl; serum chloride 108
mg/dl; BUN 32 mg/dl and creatinine 2.0 mg/dl. What is the appropriate initial
management?

96.A 45-year-old woman is found to be hypertensive. Further blood testing reveals

serum sodium 145 mmol/L, serum potassium 2.8 mmol/L, serum bicarbonate
30 mmol/L. The MOST likely cause for her symptoms is over secretion of which
of the following?
a. ACTH.
b. Adrenaline.
c. Aldosterone.
d. Cortisol.
e. Norepinephrine (Noradrenaline).
P a g e 24 | 25
97. Which of the following which is the MOST effective way in preventing surgical
infection?

postoperatively he is noted to be agitated, hypoxaemic and difficult to ventilate.
His observations show a blood pressure of 120/80 mmHg, regular pulse of 88
beats/minute and he is apyrexial. A chest X-ray shows bilateral diffuse lung
infiltrates. What is the MOST likely underlying diagnosis?
b. Atelectasis.
spine fracture (T6) and paraplegia. The patient is hypotensive with a systolic BP of
70 mmHg, is bradycardiac with a pulse of 48 beats/min and is breathing
comfortably. Which of the following would the MOST appropriate initial
treatment?
100. A 26 -year-old man with history of chronic duodenal presents with repeated
vomiting for 2 days. Insertion of Foley’s catheter in yields 130 ml of concentrated
urine. Serum electrolytes showed sodium 128 mEq/L, potassium 2.9 mEq/L and
chloride 64 mEq/L. Blood pH is 7.53 The MOST appropriate initial management is:
a. 5% dextrose in 0.45 normal saline.
b. 0.45 normal saline plus potassium chloride 60 mEq/L.
c. Lactated Ringer's solution plus potassium chloride 60 mEq/L.
d. Ammonium chloride to correct blood pH.
e. IV furosemide (Lasix) to correct urine output.
P a g e 25 | 25

June 2013
1. A 30-year-old male patient had a road traffic accident. Examination revealed loss
of contour of the shoulder and the arm was held in an adducted position. The
patient could not move his shoulder. Which of the following nerves was MOST
likely injured in this patient?
a. Axillary (Circumflex).
b. Median.
d. Radial.
e. Ulnar.
2. A 42-year-old woman presents to her doctor with shoulder pain. On examination,
shoulder abduction is weak and painful. Which muscle is likely to be affected?
a. Infraspinatus.
b. Subscapularis.
c. Supraspinatus.
d. Teres major
e. Teres minor.
3. A 32-year-old man is brought to the emergency department following a fall. An X-
ray reveals that he has a fracture of the surgical neck of his humerus. Neurological
examination reveals paraesthesia over the upper lateral arm (Overlying the deltoid
muscle). Which nerve is MOST likely to have been damaged?
a. Axillary.
b. Media.
d. Radial.
e. Ulnar.
4. While assessing an elderly woman with severe neck arthritis you note she has
weakness of finger abduction and adduction. This is MOST likely to be due to
compression of which spinal nerve root of the brachial plexus?
a. Fifth cervical.
b. Sixth cervical.
c. Seventh cervical.
d. Eighth cervical.
e. First thoracic.
P a g e 1 | 25
5. Which one of the following muscles is an extensor of the hip?

a. Adductor longus.
b. Gracilis.
c. Iliopsoas.
d. Pectineus.
e. Semitendinosus.
6. In L5 nerve root compression from a herniated intervertebral disc, altered

cutaneous sensation is predominantly in the:
a. Dorsum of foot.
b. Heel of foot.
c. Medial border of foot.
d. Outer border of foot.
e. Sole of foot.
7. A 47-year-old woman undergoes a modified radical mastectomy for a T2N2

infiltrating ductal carcinoma. She arrives at her first postoperative visit
complaining of hypoesthesia of the upper posteromedial aspect of the
ipsilateral arm. What might explain this finding?
a. Lymphatic fibrosis.
b. Medial pectoral pedicle injury.
c. Second intercostal brachial cutaneous nerve injury.
d. Axillary vein thrombosis.
e. Thoraco-dorsal pedicle injury.
8. Which of the following nerves is liable to be injured during opening of the

inguinal canal in herniorrhaphy operation?
b. Obturator nerve.
e. Pudendal nerve.
P a g e 2 | 25

angiography but no symptoms or signs of colonic ischemia. Which of the
a. Left colic.
c. Middle colic.
d. Splenic.
e. Superior rectal.

d. Teres major.
e. Trapezius.

a. Horner syndrome.
e. Trismus.
12.After undergoing a surgical procedure on the small (Short) saphenous vein, a

patient complains of pain and numbness on the lateral aspect of the foot. The
nerve MOST likely to be affected is the:
a. Deep peroneal (Fibular).
b. Lateral plantar.
c. Saphenous.
d. Superficial peroneal (Fibular).
e. Sural.
P a g e 3 | 25
13.A 35-year-old woman is seen at the surgical clinic with a history of faecal
incontinence since the birth of her second child 18 months previously. The first
stage of labour had been prolonged and difficult. Physical examination reveals
a relatively lax anal sphincter. Which nerve is likely to have been damaged in
labour?
a. Genitofemoral nerve.
b. Lumbosacral trunk.
c. Obturator nerve.
d. Pelvic splanchnic nerve.
e. Pudendal nerve.
14.A 27-year-old man is admitted to the emergency department after a car crash.
a. Thoracodorsal.
b. Axillary.
c. Dorsal scapular.
e. Radial.
15.A 5-year-old male entered the emergency department with a complaint of
severe abdominal pain. During physical examination it is observed that his
cremasteric reflex is absent. Which of the following nerves is responsible for the
efferent limb of the cremasteric reflex?
a. Ilioinguinal.
b. Iliohypogastric.
c. Genitofemoral.
d. Pudendal.
e. Ventral ramus of T12.
16.A 45-year-old woman is admitted to the emergency department with a
complaint of severe abdominal pain. CT scan and MRI examinations reveal a
tumor of the head of the pancreas involving the uncinate process. Which of the
following vessels is MOST likely to be occluded?
a. Common hepatic artery.
b. Cystic artery and vein.
d. Inferior mesenteric artery.
e. Portal vein.
P a g e 4 | 25
17.Upon removal of a leg cast, a 15-year-old boy complains of numbness of the

dorsum of his right foot and inability to dorsiflex and evert his foot. Which is the
MOST probable site of the nerve compression that resulted in these symptoms?
a. Popliteal fossa.
b. Neck of the fibula.
c. Lateral compartment of the leg.
d. Anterior compartment of the leg.
e. Medial malleolus.
18.A 42-year-old male fell from a height. Radiographic examination reveals fracture
of the proximal femur. Which of the following arteries supplies the proximal part
of the femur?
a. Deep circumflex iliac.
b. Acetabular branch of obturator.
c. Lateral circumflex femoral.
d. A branch of profunda femoris.
e. Medial circumflex femoral.
19.Which of the following is TRUE regarding the secretory functions of the

pancreas?
a. Secretin releases fluid rich in enzymes.
b. Secretin releases fluid rich mainly in electrolytes and bicarbonate.
c. Cholecystokinin releases fluid, predominantly rich in electrolytes and
bicarbonate.
d. All pancreatic enzymes are secreted in an inactive form.
e. The pancreas produces proteolytic enzymes only.
20.A 63-year-old man undergoes a peripheral vascular procedure under general

anesthesia. A decrease in urine formation and excretion is noted. Decreased
urine flow under general anesthesia occurs because of which of the following?
a. Vasopressin.
b. Aldosterone suppression.
c. Depression of glucocorticoid.
d. Depression of thyroid function.
e. Specific effect of anesthesia on renal tubules.
P a g e 5 | 25
21.In compensating for respiratory alkalosis, the body excretes more:

a. Ammonium ions.
d. Carbonic acid.
e. Hydrogen ions.
22.A 50-year-old female patient complains of thirst, polyuria and dehydrated

tongue due to uncontrolled diabetes mellitus. What is the cause of metabolic
acidosis in this patient?
a. High glucose levels depress the respiratory center in the medulla.
b. Glucose is an acidic substance.
c. Glucose is osmotically active and for every water molecule retained, a
hydrogen ion is also retained.
d. Most diabetics have chronic diarrhea, which leads to excessive loss of
bicarbonate ions.
e. Increased rate of lipolysis and ketogenesis.
23.A patient whose blood pH is 7.47, whose PCO2 is 31 mmHg in arterial blood and
whose levels of bicarbonate ion in arterial blood are 23 mEq/liter is in:
a. Compensated metabolic alkalosis.
b. Uncompensated respiratory acidosis.
c. Uncompensated respiratory alkalosis.
e. Uncompensated metabolic alkalosis.
24.What is the MOST serious physiological abnormality in acute renal failure?

a. Fluid overload.
b. ↑ Creatinine.
c. ↑ Urea.
d. Acidosis.
e. Raised blood urea N2.
P a g e 6 | 25

26.A fit 30-year-old man donates 500 ml of blood. Which one of the following is the
MOST likely physiological change?
a. A fall in blood pressure.
b. Activation of renin-angiotensin system.
c. Reduced urine output.
d. Sweating.
e. Tachypnoea.

likely cause is:
a. Hyperkalemia.
b. Hyperuricaemia.
c. Hypoglycaemia.
d. Hyponatraemia.
e. Hypoxia.
Finding: 7.28 70 mmHg 48 mmHg 36 mmol/L +5
P a g e 7 | 25
29.A 40-year-old woman had the anterior lobe of the pituitary removed because of
a tumour. Without postoperative supplements, which of the following could
occur?
b. Failure to produce parathyroid hormone in response to hypocalcaemia.

a. Ketoacidosis.
b. Hyperkalemia.
c. Hypoglycemia.
d. Hypocalcemia.
31.A 48-year-old woman presents to the emergency department with persistent

diarrhea. On examination, she is apyrexial and has an irregularly irregular pulse
of 140 beats/minute. The MOST likely cause of the abnormal cardiac rhythms is:
a. Hypernatraemia.
b. Hypokalaemia.
c. Hypovolaemia.
d. Myocardial ischaemia.
e. Sepsis.
to show?
Arterial pCO2 Bicarbonate
a Decrease Decreased
b Decreased Increased
c Decreased Normal
d Increased Decreased
e Increased Increased
P a g e 8 | 25

division?
c. Erythrocytes.
d. Hepatocytes.
e. Osteocytes.
b. Carcinoma.
c. Dysplasia.
d. Hyperplasia.
e. Metaplasia.
35.Which of the following cells are COMMONLY found in tissues undergoing

chronic inflammation?
a. Eosinophils.
b. Lymphocytes.
c. Mast cells.
d. Platelets.
TRUE?
d. It results from impaired synthesis.
e. It results from significant decrease intake.
P a g e 9 | 25
37.Which of the following can decrease the adverse effects of steroids on wound
healing?
a. Copper.
b. Vitamin A.
c. Vitamin C.
d. Vitamin D.
e. Vitamin E.
38.Histopathological examination of a cavitating apical lung mass from a 45-year-

old man shows necrotic material surrounded by epithelioid cells and occasional
multinucleated giant cells. Acid fast bacilli are identified. Which cell type gives
rise to the giant cells?
a. Basophil.
b. Eosinophil.
c. Lymphocyte.
d. Macrophage.
e. Neutrophil.

CORRECT?
injury.
e. Early in wound healing, type I collagen is predominant.

a. Candidiasis.
b. Coli sepsis.
e. Streptococci.
P a g e 10 | 25

a. Bacteroides.
b. E. coli.
c. Proteus.
d. Staph. aureus.
e. Streptococci.

43.Which of the following organisms is the COMMONEST to cause urinary tract

infection following catheterization?
b. E. coli.
c. Pseudomonas aeruginosa.
d. Staph. aureus.
e. Strept. pneumonia.
44.Which is the initial management of antibiotic associated diarrhea?

a. Amoxycillin.
b. Discontinuing the causative antimicrobial.
c. Metronidazole.
d. Oral erythromycin.
e. Vancomycin.
P a g e 11 | 25
45.The use of prophylactic antibiotics has become commonplace. Which of the

following statement(s) is TRUE concerning the prophylactic use of antibiotics?
a. Prophylactic antibiotics should be administered for all surgical
procedures.
b. Continuing thee antibiotic into the postoperative period has led to
improved results in antibiotic prophylaxis.
c. The appropriate use of prophylactic antibiotics must include the initiation
of the agent prior to the surgical procedure.
d. The prophylactic administration of broad-spectrum agents (Third-
generation cephalosporins) has been shown to be particularly
advantageous.
e. The topical use of antimicrobial agents is of no advantage in the
prophylactic setting.
46.Which of the following is the MOST common serious infectious complication of

blood transfusion?
b. Cytomegalovirus.
c. Malaria.
47.What is the COMMONEST organism to cause infections following splenectomy?

a. Haemophilus influenza.
c. Neisseria meningitidis.
e. Streptococcus pneumonia.

a. B-lymphocytes.
b. Dendritic cells.
c. Monocytes.
e. T-lymphocytes.
P a g e 12 | 25
49.The MAIN mode of action of cyclosporine is interference of:

a. Antibody production by plasma cells.
b. Cytotoxic T-cell function.
c. Identification of antigen.
d. Interleukin-2 production.
e. Macrophage.

b. Renal cell carcinoma.
e. Skin cancer.
51.Pathogenic mechanisms involved in tuberculosis can be primarily attributed to

which of the following?
a. Cell-mediated hypersensitivity.
b. Clogging of alveoli by large numbers of acid-fast mycobacteria.
c. Humoral immunity
d. Specific cell adhesion sites.
e. Toxic production by the mycobacteria.

a. Kidney.
b. Heart.
c. Liver.
d. Bone marrow.
e. Cartilage.
P a g e 13 | 25

management?
b. by Administration of Ringer's lactate solution.
d. dl Plasma ultra-filtration.
54.What is the MOST common fluid or electrolyte disorder in the surgical patient?
b. Hyperkalemia.
c. Hyponatremia.
d. Metabolic: acidosis.
55.The osmolarity of the extracellular fluid space is determined primary by the

concentration of:
a. Bicarbonate.
b. Chloride ion.
d. Potassium ions.
e. Sodium ion.
56.Which of the following is CHARACTERISTIC of neurogenic shock?

a. Cool moist skin.
e. Bradycardia.
P a g e 14 | 25

a. Cough.
b. Dyspnea.
c. Hemoptysis.
d. Pleural pain.
e. Palpitation.
Laboratory studies showed serum glucose, 150 mg/dl; sodium, 135 mEq/L;
potassium, 6.5 mEq/L; chloride, 105 mEq/L and bicarbonate, 15 mEq/L. Which
of the following is recommended?
a. Decrease potassium chloride to 10 mEq/day.
59.A 55-year-old man sustains numerous injuries involving the abdomen and lower
extremities. During the intra- and postoperative periods, he is resuscitated with
10 L of Ringer's lactate and 2 U of packed red blood cells (RBC). After initial
improvement, he has severe dyspnea on the second postoperative day. The
MOST useful initial diagnostic test is which of the following?
a. Electrocardiogram.
b. Analysis of arterial blood gases.
c. Insertion of a central venous line.
d. Ventilation-perfusion scan.
e. Computed tomography (CT) scan of abdomen.

d. Hyperkalemia.
e. Hypoglycemia.
P a g e 15 | 25

a. Sepsis syndrome.
b. Aspiration.
d. DIC.
e. Fat embolism.
62.A 5-year-old man had undergone exploratory laparotomy for perforated gastric
ulcer with severe peritoneal contamination. Six hours after surgery, he is
following?
63.What is the primary source of calories during acute starvation (< 5 days fasting)?
a. Skeletal muscle proteins.
b. Body stored fat.
c. Liver glycogen.
d. Ketone bodies.
e. Muscle glycogen.
pressure?
P a g e 16 | 25

a. Propofol.
b. Dantrolene.
c. Ketamine.
d. Succinylcholine.
e. Neostigmine.

b. Tracheostomy.

a. Gram-positive organisms do not cause septic shock because they lack the
cell-wall endotoxin.
urinary tract.
d. Escherichia coli is the second most common organism identified in gram-
e. Gram-negative endotoxemia appears to be the result of the abnormal
activation of normal physiologic pathways.
68.A 38-year-old man in end-stage renal failure resulting from polycystic kidney
but four weeks later deteriorates, the serum creatinine rising by 25%. Which of
the following processes is MOST likely to be responsible for this deterioration?
P a g e 17 | 25
69.A 55 year-old male patient is receiving 150 mg of aspirin daily because he has
patient?
a. Bleeding time.
c. INR.
d. PTT.
e. Thrombin time.
70.A 30 year-old male patient was admitted to the casualty department due to a
received 5 liters of blood following which he started to have bleeding from his

P a g e 18 | 25

a. Desmopressin.
b. Fresh blood.
d. Fresh platelets.
e. IV vitamin K.

d. Stop warfarin and substitute it by heparin for 10 days preoperatively.
76.Which of the following is TRUE regarding a male patient who has haemophilia?
a. He has frequent attacks of spontaneous mucocutaneous bleeding.
b. His sisters are affected as well.
c. The partial thromboplastin time is normal.
d. The prothrombin time is prolonged.
P a g e 19 | 25


e. e Vitamin K intravenously.
79.Which of the following mechanisms initiates the normal haemostatic

mechanism?
c. Fibrinolysis.
80.You are planning to perform colectomy for a 55-year-old male patient who had
a previous CABG operation and is receiving 150 mg of aspirin daily. What will be
your policy?
a. Continue aspirin and administer fresh frozen plasma intraoepratively.
b. Continue aspirin and administer fresh platelets intraoperatively.
c. Stop aspirin for 5 days preoperatively and substitute it by warfarin.
d. Stop aspirin for 10 days preoperatively and substitute it by subcutaneous
heparin.
e. Stop aspirin for 3 days preoperatively.
P a g e 20 | 25
81.Which of the following is the BEST method of identifying the liability to bleeding
during a surgical procedure?
a. Platelet count.
b. A complete history and physical examination.
c. Bleeding time.
d. Lee-White clotting time.
e. Prothrombin time (PT).
82.What is the treatment of a hemophilic patient who had massive hemarthrosis

of the knee following a fall on his knee?
a. Penicillamine.
c. Transfusion of factor VIII to 10% of normal factor levels.
d. Platelet transfusion.
e. Exploration of joint.
83.Which of the following denotes a haemolytic transfusion reaction during

anesthesia?
84.A 50-year-old female patient bas chronic renal failure and has been maintained
a. Elevated PT.
b. Elevated PTT.
e. Sepsis.
P a g e 21 | 25
85.70-year-old female patient is receiving warfarin because she has AF and had
CORRECT?
time.
reduced.
TRUE?
c. The Loy has had repeated episodes of epistaxis.
87.A 40-year-old male patient is complaining of persistent headache, recurrent
88.A 30-year-old pregnant female patient (First trimester) developed palpitation,
c. Technetium scan.
e. Total thyroxine level.
P a g e 22 | 25
a. Calcitonin.
d. Parathormone.
e. Thyroxine.
90.Regarding the anatomy of the thyroid gland, which of the following is TRUE?
to the larynx.
vagus nerve.
a. ACTH.
c. Hyperkalaemia.
d. Hypernatraemia.
e. The rennin angiotensin system.

hyperaldosteronism?
P a g e 23 | 25

thyroid gland. On the second postoperative day, she begins to complain of
tingling sensation in her hands. She appears quite anxious and later complains
of muscle cramps. What is initial therapy?
e. Oral vitamin D.

95.A 50-year-old woman presents with lethargy, weight gain, cold intolerance and
investigation?
96.A 48-year-old woman with breast cancer diagnosed five years ago is admitted
with a two week history of back pain, nausea, fatigue and constipation. Her
serum calcium is 14 mg/dl. Which of the following is the CORRECT first line
treatment for this patient?
a. Bisphosphonate infusion.
b. Calcitonin infusion.
c. Dextrose/insulin infusion.
d. Forced diuresis with furosemide.
e. Intravenous fluids.
P a g e 24 | 25
97.Which of the following which is the MOST effective way in preventing surgical
infection?
a. Chest infection.
b. DVT.
e. Wound infection.

a. Bacteroides.
b. E. coli.
c. Klebsiella.
100. A patient came with weakness in extension of hand and pronation. On

examination there is no wasting of hand muscles. Flexion of the wrist is normal,
biceps and triceps are normal. No brachioradialis jerk. Where is the lesion?
a. Median nerve.
b. Radial nerve.
c. Ulnar nerve.
d. Musculocutaneous nerve.
e. Nerve to anterior interosseous.
P a g e 25 | 25

January 2010
1. Which of the following muscles is NOT supplied by the femoral nerve?
a. Sartorius.
b. Rectus femoris.
c. Gracilis.
d. Pectineus.
e. Vastus lateralis.
2. Which of the following is NOT a branch of the femoral artery?

a. Deep external pudendal artery.
b. Superficial circumflex-femoral artery.
c. Deep circumflex femoral artery.
d. Superficial epigastric artery.
e. Superficial external pudendal artery.
3. Which of the following is NOT a branch of the axillary artery?

a. Lateral thoracic artery.
b. Thoraco-acromial artery.
c. Suprascapular artery.
d. Anterior circumflex humeral artery.
e. Subscapular artery.
4. Which of the following is NOT TRUE about the adductor canal?

a. It starts at the apex of the femoral triangle.
b. The roof is formed by the deep fascia.
c. It contains the femoral artery, vein and nerve.
d. It terminates at the adductor hiatus.
e. The floor is foined by the adductor longus and magnus.
P a g e 1 | 25
5. The venous drainage of the caudate lobe of the liver is to:

a. The left hepatic vein.
b. The portal vein.
c. The right hepatic vein.
d. The inferior vena cava.
e. The middle hepatic vein.
6. Which of the following is NOT present in ulnar nerve injury at the wrist?
a. Atrophy of the interossei.
b. Inability to adduct the thumb.
c. Loss of sensation over the medial 1/3 of the dorsum of the hand.
d. Partial claw hand.
e. Inability to abduct the fingers.
7. Which of the following is NOT present in sciatic nerve injury?

a. Loss of sensation of the sole of the foot.
b. Inability to dorsiflex the ankle.
c. Loss of sensation of the medial side of the foot.
d. Inability to abduct the foot.
e. Trophic ulcers of the sole of the foot.
8. Which of the following is WRONG about the scalenus anterior muscle?

a. It arises from the anterior tubercles of C3-C7 vertebrae.
b. It is inserted into the scalene tubercle of the first rib.
c. It is crossed by the vagus nerve.
d. The subclavian vein passes in front of the muscle.
e. The subclavian artery passes posterior to the muscle.
P a g e 2 | 25
9. Which of the following is NOT TRUE about latissimus dorsi muscle?

a. It is inserted into the floor of the bicipital groove of the humerus.
b. The nerve supply is derived from the posterior cord of the brachial plexus.
c. The arterial supply is derived from the second part of the axillary artery.
d. It is an adductor and medial rotator of the upper limb.
e. It takes origin from the lumbar fascia.
10.All the following regarding the femoral canal are CORRECT EXPECT:
a. The femoral sheath invests the femoral vessels and the femoral branch of
the genitofemoral nerve.
b. The femoral nerve courses down lateral to the femoral artery outside the
femoral sheath.
c. The femoral hernia descends down within the femoral sheath.
d. The femoral canal is a fatty cushion between the femoral artery and vein.
e. The pectineus muscle lies behind the femoral sheath.
11.Which of the following muscles is NOT supplied by the obturator nerve?

a. Gracilis.
b. Adductor longus.
c. Adductor brevis.
d. Pectineus.
e. Adductor magnus.
12.Which of the following is NOT present in femoral nerve injury?

a. Loss of sensations over the medial side of the foot.
b. Loss of the knee jerk reflex.
c. Loss of the cremasteric reflex.
d. Loss of sensations over the anterior aspect of the thigh.
e. Atrophy of the sartorius muscle.
P a g e 3 | 25
13.Which of the following is NOT supplied by the trigeminal nerve?

a. The muscles of mastication.
b. The buccinator muscle.
c. The temporomandibular joint.
d. The conjunctiva.
e. The mucous membrane of the maxillary air sinus.
14.Which of the following nerves is NOT derived from the cervical plexus?
a. Auriculotemporal nerve.
b. Great auricular nerve.
c. Transverse cervical nerve.
d. Supraclavicular nerves.
e. Phrenic nerve.
15.Which of the following is FALSE regarding the flexor retinaculum at the wrist?
a. Attached to the scaphoid and trapezium laterally and to the pisiform and
hamate medially.
b. Gives attachments to the thenar and hypothenar eminences muscles.
c. The median nerve enters the palm beneath its midpoint.
d. Ulnar nerve and artery run deep to it medially.
e. Gives an insertion to the palmaris longus muscle.
16.Regarding the inguinal canal all the following statements are TRUE EXCEPT:
a. The internal ring lies midway between the symphysis pubis and anterior
superior iliac spine.
b. The internal ring lies lateral to the inferior epigastric vessels.
c. The external oblique aponeurosis forms the anterior boundary.
d. The inguinal ligament forms the inferior boundary.
e. The conjoint tendon forms the lateral part of the posterior wall.
P a g e 4 | 25
17.Taste from the posterior one third of tongue is provided by which of the
following nerves?
a. Glossopharyngeal.
b. Facial.
c. Lingual.
d. Vagus.
e. Hypoglossal.
18.All the following are branches of the internal iliac artery EXCEPT:
a. Superior gluteal artery.
b. Inferior vesical artery.
c. Superior rectal artery.
d. Inferior rectal artery.
e. Uterine artery.
19.Which of the following structures does NOT pass through the aortic opening of
the diaphragm?
a. Azygos vein.
b. Thoracic duct.
c. The right phrenic nerve.
d. The aorta.
e. Lymph vessels from the thorax.
20.Which of the following nerves is MOST liable to be injured in fracture of the

surgical neck of the humerus?
a. Median nerve.
b. Ulnar.
c. Circumflex nerve.
d. Radial nerve.
e. Nerve to latissimus dorsi muscle.
P a g e 5 | 25
21.Which of the following is NOT TRUE about the femoral ring?

a. It is bounded anteriorly by the inguinal ligament.
b. It is bounded posteriorly by the pectineal ligament.
c. It is bounded medially by the lacunar ligament.
d. It is bounded laterally by the femoral artery.
e. It contains the lymph node of Cloquet.
22.Which of the following is NOT TRUE about the parotid gland?

a. The capsule is formed from the investing layer of cervical fascia.
b. The secretory supply is by the auriculotemporal nerve.
c. The external carotid artery transverses the gland.
d. Branches of the facial nerve are deep to the retromandibular vein.
e. Lymph nodes may be within the gland.
23.Which of the following does NOT pass in the adductor (Hunter's) canal?
a. Femoral artery.
b. Saphenous nerve.
c. Nerve to vastus medialis.
d. Obturator nerve.
e. Femoral vein.
24.Which of the following is NOT TRUE about the anatomy of the ureter?
a. It crosses the bifurcation of the common iliac artery.
b. It passes superficial to the uterine artery.
c. The ductus deferens crosses superficial to the ureter near its termination.
d. It receives blood supply from the renal, aortic and vesical arteries.
e. It is supplied by sympathetic autonomic nerves T11-L1.
P a g e 6 | 25
25.Which of the following is TRUE about the ilioinguinal nerve?

a. It supplies the cremasteric muscle.
b. It supplies the lower part of the rectus abdominis muscle.
c. It supplies the skin on the inner side of the upper part of the thigh.
d. It represents the collateral branch of the second lumbar nerve.
e. In the inguinal canal it has posterior to the spermatic cord.
26.Which of the following is NOT present in injury of the common peroneal nerve?
a. Loss of eversion of the foot.
b. Loss of extension of the foot.
c. Loss of sensations at the sides of the third toe.
d. Loss of sensations at the lateral aspect of the leg.
e. Loss of planter flexion of the foot.
27.Which of the following is NOT a structure of the spermatic cord?

a. Testicular artery.
b. Testicular veins.
c. Genital branch of the genitor-femoral nerve.
e. Sympathetic fibres from the aortic sympathetic plexus.
28.Which of the following is NOT TRUE about the inguinal canal?

a. The inferior wall is reinforced in its medial part by the lacunar ligament.
b. The anterior wall is reinforced in its lateral third by the fibres of the
internal oblique muscle.
c. The superior wall is formed by the lowest arching fibres of the internal
oblique and transverses abdominis.
d. The deep inguinal ring is lateral to the inferior epigastric vessels.
e. The iliohypogastric nerve runs superficial to the spermatic cord.
P a g e 7 | 25
29.Which of the following tests will be affected after intake of non-steroidal anti-
inflammatory drugs?
a. Coagulation time.
b. PTT.
c. INR.
d. Bleeding time.
e. Thrombin time.
30.Which of the following statements is NOT CORRECT about hypokalemia?

a. It may occur in Conn's syndrome.
b. It presents by malaise and muscle weakness.
c. It may occur in an Addisonian crisis.
d. It may lead to paralytic ileus.
e. ECG shows elevation of the ST segment.
31.Which of the following is NOT TRUE about neurogenic shock?

a. It may follow spinal fractures.
b. There is tachycardia.
c. The extremities are warm.
d. There is bradycardia and hypotension.
e. Vasopressors may be useful.
32.Which of the following statements is NOT TRUE about haemophilia?

a. It is an X-linked disorder.
b. It may lead to recurrent hemarthrosis.
c. Prothrombin time is increased.
d. It may give rise to severe abdominal pain.
e. It is safe to operate on a hemophilic patient if the concentration of the
specific factor is 30%.
P a g e 8 | 25
33.All the following are complications of massive blood transfusion EXCEPT:

a. Hypothermia.
b. Hypocalcemia.
c. Hypokalaemia.
d. Acidosis.
e. DIC.
34.Regarding hyperkalemia all are TRUE EXCEPT:

a. Is mostly the result of renal failure.
b. Is common with massive tissue destruction.
c. Muscle rigidity is a manifestation of severe hyperkalemia.
d. Causes a peaked T-wave on the electrocardiogram.
e. Urgent treatment is by Ca gluconate and Na bicarbonate.
35.The MAJOR source of protein for multi-trauma patients during the catabolic
phase is:
a. Plasma protein.
b. Fat.
c. Liver.
d. Skeletal muscle.
e. Kidney.
a. Leukocytes.
b. Monocytes.
c. Platelets.
d. Erythrocytes.
e. Lymphocytes.
P a g e 9 | 25
37.Which of the following is the MOST sensitive liver function:

a. Prothrombin time and concentration.
b. Partial thromboplastin time.
c. Level of fibrinogen.
d. Coagulation time.
e. AST.
38.Low molecular weight heparin produces its effects due to inhibition of which
factor?
a. IIa.
b. IXa.
c. Xa.
d. XI.
e. XII.
39.The following statements are CORRECT EXCEPT:

a. Hypoproteinaemia impairs wound healing.
b. Immobilization of the wounded part helps wound healing.
c. Corticosteroid intake impairs wound healing.
d. The intake of cancer chemotherapy agents delays wound healing.
e. Irradiation of a wound promotes healing.
40.Which of the following statements is NOT TRUE about potassium?

a. Plasma level is raised in metabolic acidosis.
b. The plasma level is a reliable index of total body potassium.
c. Plasma potassium represents 0.4% of total body potassium.
d. In Conn's syndrome there is hypokalemia.
e. Calcium infusion can be used for the treatment of hyperkalaemia.
P a g e 10 | 25
41.Which of the following statements is NOT TRUE about secretin?

a. It is secreted mainly in the duodenum.
b. The main stimulus for secretion is the presence of acid in the duodenum.
c. It stimulates the secretion of thick enzyme rich pancreatic juice.
d. It decreases gastric acid section.
e. It stimulates gall bladder contraction.
42.Intravenous infusion of epinephrine will cause all the following EXCEPT:

a. Tachycardia.
b. Hyperglycaemia.
c. Bronchodilatation.
d. Increased splanchnic blood flow.
e. Decreased bowel mobility.
43.Which of the following stimulates glycogenesis?

a. Cortisol.
b. Insulin.
c. Glucagon.
d. Aldosterone.
e. Thyroxine.
44.Which of the following is the BEST index for the severity of shock?
a. Hb%.
b. Creatinine level.
c. Lactate level.
d. O2 saturation of arterial blood.
e. Plasma sodium concentration.
P a g e 11 | 25
45.Which of the following is NOT associated with acute response to injury?

a. Increased plasma cortisol.
b. Raised plasma fatty acids.
c. Increased glucagon level.
d. Reduced liver glycogen.
e. Reduced aldosterone level.
46.Which of the following does NOT cause increased gastrin release from the
pyloric antrum?
a. Antral distension.
b. Vagal stimulation
c. Products of protein digestion.
d. Antral acidity.
e. Antral alkalinity.
47.Which of the following is NOT a cause of hypokalemia?

a. Pyloric obstruction.
b. Alkalosis.
d. Villous papilloma of the colon.
e. The use of carbonic anhydrase inhibitors.
48.Which of the following is NOT TRUE about hypokalemia?

a. It may be present in paralytic ileus.
b. It may be present after insulin therapy.
c. The reflexes are decreased.
d. ECG shows a wide QRS complex.
e. It is present in alkalosis.
P a g e 12 | 25
49.Which of the following is NOT TRUE about enteral nutrition?

a. It may lead to diarrhea.
b. There is a risk of gastric reflux and pulmonary complications.
c. It is not suitable for long-term nutrition.
d. It is superior to parenteral nutrition.
e. It may cause abdominal colic.
50.Which of the following is NOT CORRECT about the catabolic response to

trauma?
a. Main source of glucose is the liver glycogen.
b. There is loss of the muscle mass.
c. Intravenous hyperalimentation diminishes but cannot prevent the
catabolic response.
d. It is related to the severity of the trauma.
e. The response is initiated by catecholamines.
51.Which of the following is NOT TRUE about the physiology of the thyroid gland?
a. Thyroxine is mainly bound to thyroid binding globulin.
b. T3 is 3-4 times more active than T4.
c. Cells of thyroid follicles have prominent endoplasmic reticulum.
d. The half-life of thyroxine is about four days.
e. Thiouracil blocks the binding of iodine to tyrosine.
52.The MOST important difference between interstitial fluid and plasma is the:
a. Osmolarity.
b. Potassium concentration.
c. Sodium concentration.
d. Concentration of proteins.
e. Chloride concentration.
P a g e 13 | 25

a. Angiotensin II.
b. ACTH.
c. Hypokalaemia.
d. Hypernatraemia.
e. Cortisol.
54.The effects of glucocorticoid hormones include all the following EXCEPT:

a. Increased hepatic glycogen synthesis.
b. Decreased glucose uptake by the adipose tissue.
c. Increased hepatic gluconeogenesis.
d. Decreased protein synthesis in the skeletal muscles.
e. Decreased glucose uptake by the skeletal muscles.
55.In a healthy adult man weighing 70 Kg:

a. The body water content is 75%.
b. The plasma volume is approximately 5 litres.
c. Approximately 1.5 litres of water are lost daily from the lungs.
d. The intracellular fluid volume is approximately two-thirds of the total
body water.
e. The daily potassium requirement is approximately 3.5-5 mmol/Kg.
56.During prolonged starvation the brain's MAIN fuel is:

a. Lactose.
b. Amino acid.
c. Glucose.
d. Short-chain fatty acid.
e. Ketones.
P a g e 14 | 25
57.Which of the following statements is NOT TRUE about DVT?

a. The clinical picture is not accurate in the diagnosis.
b. The incidence of DVT following hip surgery is about 10%.
c. Duplex scanning is highly accurate in the diagnosis.
d. Malignancy is an important predisposing factor.
e. Venography is not commonly performed for the diagnosis nowadays.
58.Which of the following is NOT TRUE in DIC?

a. It may occur in septic shock.
b. Fibrinogen level is low.
c. FDP are elevated.
d. PT and PTT are elevated.
e. There is elevated platelet count.

b. Third trimester of pregnancy.
c. Heparin-induced thrombocytopenia.
d. Subclavian vein thrombosis.
e. Superior mesenteric artery embolism.
60.All the following may lead to DIC EXCEPT:

a. Accidental hemorrhage.
b. Burn.
c. Metastatic carcinoma of the prostate.
d. Von Willebrand's disease.
e. Incompatible blood transfusion.
P a g e 15 | 25
61.The FIRST important event in hemostasis following severe tissue injury is:
a. Blood coagulation.
b. Formation of a platelet plug.
c. Vascular spasm.
d. Formation of thromboplastin.
e. Formation of prothrombin activator.
62.Which of the following is associated with a defect of the platelet function?

a. Epistaxis.
b. Haemorthrosis.
c. Soft tissue hemorrhages.
d. Normal bleeding time.
e. Prolonged prothrombin time.
63.Which of the following is NOT TRUE regarding warfarin?

a. They inhibit the synthesis of biologically active forms of coagulation
factors II, VII, IX and X.
b. They exert their action after 2-3 days.
c. The dose is controlled by the partial thromboplastin time.
d. The dose needs to be reduced if there is concomitant intake of aspirin.
e. Vitamin K is the antidote to warfarin.
64.Which of the following is NOT transmitted through blood transfusion?

a. Malaria.
b. Hepatitis C.
c. Human immunodeficiency virus.
d. Cytomegalovirus.
e. Clostridium difficile.
P a g e 16 | 25
65.You were obligated to perform cholecystectomy for a cirrhotic patient. During

a. Fresh blood.
b. Fresh platelets.
c. IV vitamin K.
d. Fresh frozen plasma.
e. IV factor.
a. Fresh blood.
c. Desmopressin.
d. IV vitamin K.
e. Fresh platelets.

a. Stop warfarin and substitute it by heparin for 3 days preoperatively.
b. Stop warfarin and substitute it by heparin for 10 days preoperatively.
c. Continue warfarin and give fresh frozen plasma intraoperatively.
d. Continue warfarin and give IV vitamin K intraoperatively.
e. Continue warfarin and give fresh platelets intraoperatively.
68.Which of the following statements is NOT CORRECT about tumour necrosis

factor (TNF-alpha)?
a. It is released mainly from macrophages.
b. It can cause multiple organs failure.
c. High concentration is present in cases of septic shock.
d. It is one of the interferons.
e. It cause anorexia, tachycardia and fever.
P a g e 17 | 25
69.Multisystem failure in septic shock is caused by the following EXCEPT:

a. Release of chemical mediators (Cytokines) by macrophages.
b. Damage of vascular endothelium.
c. Defective oxygen delivery to the cells.
d. Marked anemia.
e. Dysfunction of intestinal mucosa allows more bacteria to enter the blood
stream.
70.Which of the following is WRONG about hyperacute rejection?

a. It is due to the presence of preformed antibodies.
b. It occurs within hours of transplantation.
c. It can be treated by corticosteroids.
d. It is best treated by removal of the graft.
e. Cyclosporin A did not reduce its incidence.
71.Regarding necrotizing fasciitis:

a. Skin may show hemorrhagic bullae.
72.Which of the following leucocytes will be involved in the development of a stitch

granuloma?
a. Basophils.
b. Eosinophils.
c. Monocytes.
d. Neutrophils.
e. Lymphocyte.
P a g e 18 | 25
73.Which of the following statements regarding wound healing is NOT TRUE?

a. A dehisced wound that is re-sutured gains strength faster than primary
wound.
b. Wounds heal faster at 39°C than at 37 °C.
c. Wound healing is accelerated in a low tissue oxygen environment.
d. Synthesis of new collagen is blocked in ascorbic acid deficiency.
e. Wound healing will not occur normally in the absence of monocytes.
74.The following measures are important contributing factors in controlling

bacterial wound contamination in the operating room EXCEPT:
a. Appropriately timed preoperative antibiotic prophylaxis.
b. Scrubbing, gowning and gloving.
c. Surgical site hair shaving in the evening prior to operation.
d. Antimicrobial skin preparation.
e. Refined and aseptic techniques.
75.All of the following statements regarding the use of systemic prophylactic

antibiotics are true EXCEPT:
a. The goal is to attain high tissue level at time of incision.
b. Should be as broad-spectrum as possible in most cases.
c. Are usually given as a single dose.
d. They are not effective if given 3 hours after making the incision.
e. Are not effective in reducing postoperative respiratory infections.
76.Which of the following is NOT TRUE about systemic inflammatory response

(SIRS)?
a. It may be caused by peritonitis, burns and acute pancreatitis.
b. The white leucocytic count may be reduced below 4000.
c. There is metabolic acidosis.
d. The temp may drop to 36 °C.
e. There is reduced output of catecholamines.
P a g e 19 | 25
77.Which of the following is an EARLY manifestation of sepsis:

a. Decreased cardiac output.
b. Hypoglycaemia.
c. Cutaneous vasodilatation.
a. Wound infection.
b. DVT.
c. Chest infection.
e. Leaking intestinal anastomosis.
79.Which of the following is NOT TRUE about gas gangrene?

a. It is mainly caused by Cl. Welchii.
b. There is usually crepitus and color changes in the affected area.
c. The main effects are due to bacterial endotoxin.
d. Anti-gas gangrene serum is no more used in the treatment.
e. Debridement of the affected tissues is vital in the treatment.
80.One of the following is an anaerobic organism:

a. Staphylococcus aureus.
b. E. coli.
c. Klebsiella.
e. Bacteroides.
P a g e 20 | 25
81.The organism that is FAMOUS for production of the enzyme penicillinase and
resists penicillin therapy is:
a. Staphylococcus aureus.
b. Haemolytic streptococci.
c. Klebsiella.
e. Bacteroides.
82.The MAIN source of staphylococci in the body is:

a. The urinary tract.
b. The stomach, duodenum and upper jejunum.
c. The colon.
d. The nasal cavity and skin.
e. None of the above.
83.Which of the following is NOT CORRECT about erysipelas?

a. Caused by methicillin resistant staph. aureus (MRSA).
b. Sensitive to penicillin.
c. Infectious.
d. Spreading infection with no pus formation.
e. Rose pink skin patches with vesicles at the edge.
84.In pseudomembranous enterocolitis the causing organism is:

a. Clostridium perfringens.
b. Clostridium septicum.
d. Clostridium tetani.
e. Clostridium oedematiens.
P a g e 21 | 25

a. Penicillins act by disrupting the peptidoglycan of the bacterial cell wall.
c. Vancomycin is the first choice for treatment of infections with staph.
aureus.
d. Aminoglycosides may cause hepatotoxicity.
e. Cephalosporins are rarely used for prophylaxis.
86.What is MOST important in the management of a lacerated contaminated

wound?
a. Removal of foreign and dead tissues.
b. Local antibiotics powder.
c. Insertion of a drain.
d. Skin graft.
e. Hyperbaric O2.
87.Clavulanic acid is given in combination with amoxicillin in order to:

a. Reduce the risk of allergic reactions.
b. Prolong amoxicillin half-life.
c. Reduce the severity of diarrhea.
d. Extend amoxicillin antibacterial spectrum.
e. Protect against gastric acidity.
88.The aminoglycoside MOST likely to remain a useful therapeutic agent in the

event of gentamicin resistance is:
a. Streptomycin.
b. Amikacin.
c. Neomycin.
d. Tobramycin.
e. Kanamycin
P a g e 22 | 25
89.The MOST frequent serious complication of treatment with gentamycin is:

a. Serum sickness.
b. Kidney damage.
c. Reactivation of tuberculosis.
d. Blood dyscrasias.
e. Intravascular thrombosis.
90.The effectiveness of prophylactic antibiotics in surgery is MOSTLY related to the:

a. Use of broad-spectrum agents.
b. Continuation of antibiotics for 24 hours after surgery.
c. Timing of initial administration.
d. Use of two synergistic antibiotics.
e. Use of bactericidal agents.
91.The MOST deleterious effect of excessive glucose in the formula of longstanding

TPN is:
a. Hyperglycemia.
d. Hyponatremia.
e. Hypoglycemia.
92.Arterial blood gas analysis revealed a pH 7.6, P(O2) 85 mmHg, P(CO2) 46 mmHg
and HCO3- 44 mmol/L. This denotes:
a. Metabolic acidosis.
c. Respiratory acidosis.
e. Combined respiratory and metabolic alkalosis.
P a g e 23 | 25
93.The BEST initial therapy for major pulmonary embolism is:

a. Aspirin.
b. Heparin.
c. Warfarin.
d. A fibrinolytic agent.
e. Corticosteroids.
94.Arterial blood gas values of a patient are:

pH 7.36.
PO2 45 mmHg.
PCO2 60 mmHg.
HCO3- 34 mmol/L.
Base excess 5 mmol/L.
These values are consistent with:
a. Acute morphine overdosage.
b. Sepsis.
d. Lobar atelectasis.
e. Severe chronic obstructive airway disease.
95.Which of the following is an appropriate definition of the shock state?

a. Low blood pressure to maintain normal metabolic and nutritional
functions.
b. Low cardiac output to maintain metabolic and nutritional functions.
c. Shock index greater than 0.9 to maintain metabolic and nutritional
functions.
d. Inadequate tissue perfusion to maintain normal metabolic and nutritional
functions.
e. Abnormal vascular resistance to maintain normal metabolic and
nutritional functions.
96.Which of the following biochemical changes is NOT seen in shocked patients?

a. Hyperglycemia.
b. Negative nitrogen balance.
c. Hyperlacticacidemia.
e. Hyperkalemia.
P a g e 24 | 25
97.Among the physiologic responses to acute injury one is TRUE:

a. Increased secretion of insulin.
b. Increased secretion of thyroxine.
c. Decreased secretion of vasopressin (ADH).
d. Decreased secretion of glucagon.
e. Decreased secretion of aldosterone.
98.A 20-year-old woman has the following arterial blood results: pH= 7.49, PCO2=
47 mmHg, HCO3-= 35 mmol/L, oxygen saturation= 98% on air. Her plasma
potassium concentration is 2.5 mmol. The physiologic status can BEST be
a. There is a respiratory alkalosis.
b. There is a metabolic alkalosis.
c. Her urine is likely to be acidic.
d. Pulmonary embolism is a likely diagnosis.
e. There is respiratory acidosis.
99.The LEAST safe artery to insert an arterial line into is the:

a. Radial.
b. Ulnar.
c. Brachial.
d. Axillary.
e. Femoral.
100. Which of the following is MOST accurate in the diagnosis of pulmonary

embolism?
a. ECG.
b. Chest X-ray.
c. D dimmer test.
d. CT angiography.
e. Ventilation perfusion lung scan.
P a g e 25 | 25
PART B:
Previous Exams - Written [2010-2021]

1st Part Exam – Paper (2) Written
July 2019
1.
A. What is the blood supply and lymphatic drainage of the breast? (6 marks)
B. What is the origin, insertion, blood supply and nerve supply of the rectus
abdominis muscle? Give one example of surgical significance of this
muscle. (6 marks)
2. Explain how can a young fit person lose about 1.5 liters of blood, yet the vital
signs are stable. (14 marks)
3. Give an explanation for the following:

a. Patients with liver cirrhosis may have a disturbance of the hemostatic
mechanism. (3 marks)
b. Patients with ARDS have persistent hypoxia. (3 marks)
c. Patients with chronic renal failure may develop secondary
hyperparathyroidism. (3 marks)
d. Prophylactic antibiotics should be given about one hour before surgery.
(3 marks)
4. A 65-year-old fit male patient had a colectomy operation for colonic cancer. The
patient was doing fine in the postoperative period, but on the 7th postoperative
day the patient collapsed while going to the toilet. The pulse was 110/min and
BP was 90/60 mm Hg. The respiratory rate was 24/minute.
a. What is the most likely diagnosis? (1 mark)
b. Mention one differential diagnosis. (1 mark)
c. What investigations you would like to do. (4 marks)
d. What is the treatment? (8 marks)
5.
A. What is the definition of surgical site infection (SSI)? (2 marks)
B. Classify wounds regarding their liability to SSI. (4 marks)
C. Discuss the treatment of necrotizing fasciitis. (6 marks)
Page 1|2
6. A 30-year-old female patient who delivered 4 weeks ago is complaining of

severe pain in the left lower limb. Examination reveals a temperature of 37 °C.
Local examination reveals swelling and tenderness in the left leg and thigh.
b. Describe the necessary investigations and explain the possible findings.
(3 marks)
c. What is the plan of treatment? (6 marks)
d. Explain two complications which may complicate the present problem.
(2 marks)
7. A 50-year-old female patient complains of right hypochondrial pain and

obstructive jaundice. Examination reveals a pulse of 120/min, BP 90/60 and a
temperature of 39 °C. There is tenderness and rigidity in the right hypochondric
area.
b. Describe the necessary investigations. (4 marks)
c. What is the plan of treatment? (7 marks)
8.
A. A 50-year-old female patient is diagnosed as having right
pheochromocytoma. The pulse is 120/min and BP is 190/110 mm Hg. You
are planning to operate on the patient.
a. How are you going to prepare this patient for the operation?
(2 marks)
b. Explain 3 complications specific to this operation which may occur
during the operation or in the postoperative period. Discuss how are
going to treat these complications. (5 marks)
B. A 55-year-old female patient has chronic renal failure and she is on
regular renal dialysis. For the last year the patient has been complaining
of generalized bony aches and pruritis. Investigation revealed blood urea
of 50 mg/dl and creatinine of 2 mg/dl, serum calcium 10 mg/dl, serum
phosphates 7 mg/dl, and a high parathormone level.
b. Explain the management. (4 marks)
Page 2|2

July 2018
1. In your answer sheet, write the name of structures marked by the letters (1-12).
(12 marks)
Page 1|3
2. A 20-year-old male was subjected to a car accident which led to fractures of his
right femur and tibia. Exam revel a conscious patient with a pulse of 80/min and
BP 120/80 mmHg. Explain how the patient had normal vital signs in spite of his
major injuries. (14 marks)
3. A 50-year-old diabetic female patient gives a one week history of abdominal

pain which started in umbilical area and later localized in the right iliac fossa.
Generally, the patient was drowsy, dyspneic with a pulse of 130/min and BP
90/60 mmHg and local exam revealed tenderness and guarding in the lower
abdomen.
a. What is the most likely diagnosis? (1 marks)
b. Explain 4 valuable investigations? (2 marks)
c. Discuss your plan of treatment. (9 marks)
4.
A. Mention 5 indications for liver and for renal transplantation. (5 marks)
B. Mention 3 immunosuppressive drugs and enumerate their side effects.
(7 marks)
5.
A. Discuss the clinical picture and treatment of incompatible blood
transfusion. (6 marks)
B. What is meant by massive blood transfusion? (1 marks)
C. What are the complications of massive blood transfusion? (5 marks)
6.
A. For each of the following drugs explain the mode of action and the
antidote in case of overdosage:
a. Heparin. (2 marks)
b. Warfarin. (2 marks)
c. Streptokinase (2 marks)
d. Aspirin. (2 marks)
B. What is meant by consumption coagulopathy? Mention 5 etiologies for
the problem. (6 marks)
Page 2|3
7.
A. Mention 5 indications and 5 contraindications for total parenteral
nutrition (TPN). (5 marks)
B. What is catheter related fever and what is the treatment? (7 marks)
8. Give an explanation for the following: (3 marks for each)

a. Enteral nutrition is preferable to TPN whenever possible.
b. Measuring the serum lactate level is a good index to the severity of shock.
c. Tension pneumothorax is a surgical emergency.
d. Patients with chronic renal failure may develop secondary
hyperparathyroidism.
Page 3|3

February 2018
1. Explain the origin, insertion, nerve supply, blood supply and 2 examples of
surgical significance of the following muscles:
a. Latissimus dorsi muscle. (6 marks)
b. Sternomastoid muscle. (6 marks)
2.
A. Explain the factors which affect wound healing. (10 marks)
B. Choose a suitable suture material for the following procedures:

a. Intestinal anastomosis. (0.5 mark)
b. Closure of an abdominal wound. (0.5 mark)
c. Sternotomy. (0.5 mark)
d. Nerve repair. (0.5 mark)
3.
A. Discuss the factors which affect calcium metabolism. (8 marks)
B. Mention the laboratory findings in primary hyperparathyroidism.
(3 marks)
C. Mention 6 causes for Hypercalcaemia. (3 marks)
4. Explain the underlying mechanisms which lead to abnormal haemostasis in the

following problems.
a. Haemophilia A. (2 marks)
b. Immune thrombocytic purpura. (2 marks)
c. Liver cirrhosis. (6 marks)
d. Consumption coagulopathy. (2 marks)
e. Massive blood transfusion. (2 marks)
Page 1|2
5. Give an explanation for the following:

a. Enteral nutrition is preferable whenever possible. (3 marks)
b. Prophylactic antibiotics should be given before the start and of operation.
(3 marks)
c. Patients with chronic renal failure may develop secondary
hyperparathyroidism. (3 marks)
d. Patients with breast cancer may develop metastases longtime after the
treatment of a primary tumor. (3 marks)
6.
B. Classily wounds regarding to their liability to SSI. (6 marks)
C. You are planning to perform colectomy for colonic cancer, explain the
procedures you are going to do to minimize SSI? (4 marks)
7. A 60-year-old diabetic male patient complains of progressive pain and swelling

of the perineal area. Exam reveals a pulse of 120/min, BP 110/70 mmHg and a
temperature of 39 °C. Local examination reveals swelling, tenderness, warmth
and a crepitus overlying the scrotum.
b. Explain the factors which predispose to the occurrence of this problem.
(4 marks)
c. Discuss the treatment. (7 marks)
8.
A. What is meant by screening programmes for cancer? (2 marks)
B. What are the pre-requisites of a good screening programme? (4 marks)
C. Mention 4 problems which are suitable for screening programmes.
(3 marks)
D. What is the definition of the following terms:
a. Metaplasia. (1 mark)
b. Dysplasia. (1 mark)
c. Carcinoma in situ. (1 mark)
Page 2|2

February 2017
1. Discuss the origin, insertion, blood supply and nerve supply of each of the
following. Give an example of surgical significance of each.
a. Pectoralis major muscle. (6 marks)
b. Sternomastoid muscle. (6 marks)
2.
A. Discuss the factors which affect wound healing. (8 marks)
B. Classify Suture materials. Mention 2 types for each one of your
classification. (6 marks)
3.
A. Mention 3 causes for each of the following: (8 marks)
b. Metabolic acidosis.
c. Respiratory alkalosis.
B. In a table form mention the arterial blood gases (PH, PO2, PCO2 & HCO3-)
of each one of them. (6 marks)
4. A 45 year old women had endoscopic retrograde cholangiography (ERC) and

insertion of a stent because she had calcular obstructive jaundice. Next day the
patient developed fever and rigors. Pulse was 120/min. BP 90/60 mmHg,
temperature 39 °C.
a. What is the most likely diagnosis. (1 mark)
b. Mention 2 investigations. (2 marks)
5. A 55-year-old male is receiving 5 mg warfarin daily because he had previous

mitral valve replacement. The patient is scheduled to have colectomy for
carcinoma of colon. Discuss your plan for preoperative management of this
patient regarding his haemostatic problem. (12 marks)
Page 1|2
6. Give an example for the following:

a. Patients suffering from liver cirrhosis have haemostatic disorders.
(4 marks)
b. Enteral nutrition is preferable to intravenous nutrition whenever
possible. (4 marks)
c. screening mammography is recommended for women above the age of
50 years. (4 marks)
7. A 25 year old female patient complains of palpitation. Excessive sweating, loss

of weight and insomnia. Examination reveals a pulse of 120/min and tremors in
outstretched hands.
b. Mention 3 valuable investigations. (2 marks)
c. Explain 3 lines of treatment mentioning the advantages and
disadvantages of each. (9 marks)
8. A 50- years old diabetic male patient had a scratch of the left thigh. Over the
next 2-dayes the patient started to complain of fever. Pain and swelling of the
thigh as shown in the figure. Pulse was 120/min and temperature 38.5 °C.
b. Mention 3 valuable investigations. (2 marks)
Page 2|2

June 2013
1.
A. Describe the origin, insertion, blood supply, nerve supply and action of
the latissimus dorsi muscle. (10 marks)
B. Describe an example of a surgical procedure using this muscle. (2 marks)
2. Discuss the complications of blood transfusion. (12 marks)
3. Explain the etiology, pathophysiology, clinical picture and treatment of septic

shock. (12 marks)
4. Mention 10 risk factors for deep vein thrombosis. (5 marks)
5. Explain prophylaxis against post-operative venous thromboembolism. (9 marks)
6. Give an explanation for the following: (2 marks each)

a. Enteral nutrition is preferable over parenteral nutrition whenever
possible.
b. Patients with hyperparathyroidism have hypercalcaemia.
c. It is essential to perform chest x-ray before starting infusion in a CVP line.
d. Patients with breast cancer may develop a metastases long time after
treatment.
e. Patients with adult respiratory distress syndrome (ARDS) have severe
hypoxia.
Page 1|2
7. 50-year-old patient is receiving 4 mg warfarin daily because she mitral valve

replacement. You are planning to perform colectomy for the patient because
she had carcinoma of the sigmoid colon. Describe the plan of management
concerning the haemostatic mechanism. (12 marks)
8. Describe the clinical picture of primary hyperparathyroidism. (13 marks)
9. The following are clinical scenarios for 5 clinical cases. Read the scenarios the
answer in your answer sheet. (3 marks each)
a. A 20-year old restrained driver with tachycardia, hypotension and a
……abdomen after collision with another car.
b. A 70-year old male with urine retention due to prostate hyperplasia
undergoes a difficult catheterization. He develops fever, chills, loin pain
and hypertension.
c. A 17-year old male victim of a motor vehicle crash has bradycardia,
……tension and complains that he cannot move or feel his lower limbs.
d. A 65-year old male is brought to the ICU complaining of chest pain and
dyspnoea. He is diaphoretic, hypotensive and has crepitations in the ……of
both lungs.
e. A hydatid cyst of the liver ruptures during surgery. The patient becomes
hypotensive.
Page 2|2

February 2013
1.
A. Discuss the origin, Insertion, nerve and blood supply of the rectus
abdominis muscle. (8 marks)
B. Discuss two examples of surgical significance related to the muscle.
(4 marks)
2.
A. Discuss the stages of wound healing. (4 marks)
B. What are the factors which affect wound healing? (8 marks)
3.
A. Mention 5 cases for metabolic acidosis. (5 marks)
B. Write an arterial blood gas report indicative of metabolic acidosis.
(2 marks)
C. What is the treatment? (5 marks)
4. Explain how a young fit man may lose up to 1.5 L of blood and yet his vital signs
are stable. (14 marks)
5.
A. Mention 5 causes for disseminated intravascular coagulation. (5 marks)
B. Mention the results of haemostatic tests. (3 marks)
C. What is the treatment? (4 marks)
6.
A. Mention 5 indications for total parenteral nutrition (TPN). (5 marks)
B. Discuss the complications of TPN. (7 marks)
7.
B. Classify wounds regarding their liability to SSI. (6 marks)
C. Discuss the clinical picture and treatment of necrotizing fasciitis. (6 marks)
8. Discuss the clinical picture, investigations and treatment of pulmonary
embolism. (12 marks)
Page 1|1

June 2012
1. Explain the origin, insertion, nerve supply and blood supply of the pectoralis
major muscle. Mention 2 examples of the surgical significant of this muscle.
(12 marks)
2. Discuss the relations, blood supply and lymphatic drainage of the right kidney.
(12 marks)
3. Explain how a young fit man may lose 1.5 L of blood, yet he is vitally stable.
(14 marks)
4.
A. Discuss the stages of wound healing. (6 marks)
B. Discuss the factors which affect wound healing. (8 marks)
5. A 50-year-old female patient who had mitral valve replacement is receiving

warfarin 5 mg/day. You are planning to perform colectomy for cancer colon.
How are going to manage the patient regarding the haemostatic mechanism?
(12 marks)
6. Discuss the etiopathology, clinical picture and treatment of septic shock.

(12 marks)
7. Mention 5 indications for renal transplantation. Mention 3 immunosuppressive

drugs and enumerate their side effects. (12 marks)
8. Explain the requirements of a useful screening programme for cancer. Discuss 3

screening programmes for cancer. (12 marks)
Page 1|1
PART C:
Basic - MCQ

Surgical Anatomy MCQ
1. Which of the following muscles is NOT supplied by the femoral nerve?
a. Sartorius.
b. Rectus femoris.
c. Gracilis.
d. Pectineus.
e. Vastus lateralis.
2. Which of the following is NOT a branch of the femoral artery?

b. Superficial circumflex femoral artery.
c. Deep circumflex femoral artery.
d. Superficial epigastric artery.
e. Superficial external pudendal artery.
3. Which of the following is NOT a branch of the axillary artery?

a. Lateral thoracic artery.
b. Thoraco-acromial artery.
d. Anterior circumflex humeral artery.
e. Subscapular artery.
4. Which of the following is NOT TRUE about the adductor canal?

a. It starts at the apex of the femoral triangle.
b. The roof is formed by the deep fascia.
c. It contains the femoral artery, vein and nerve.
d. It terminates at the adductor hiatus.
e. The floor is formed by the adductor longus and magnus.
5. The venous drainage of the caudate lobe of the liver is to:

a. The left hepatic vein.
b. The portal vein.
c. The right hepatic vein.
d. The inferior vena cava.
e. The middle hepatic vein.
P a g e 1 | 22
6. All the following are supplied by the glossopharyngeal nerve EXCEPT:

a. Stylopharyngeus muscle.
b. The parotid gland.
c. The mucous membrane of the middle ear.
d. Styloglossus muscle.
e. The carotid body.
7. Which of the following is NOT present in Erb-Duchenne paralysis?

a. Adduction of the arm.
b. Extension of the forearm.
c. Supination of the forearm.
d. The palm is facing backwards.
e. Sensory loss over the outer side of the arm.
8. Which of the following is NOT present in ulnar nerve injury at the wrist?
a. Atrophy of the interossei.
b. Inability to adduct the thumb.
c. Loss of sensation over the medial 1/3 of the dorsum of the hand.
d. Partial claw hand.
e. Inability to abduct the fingers.
9. Which of the following is NOT present in sciatic nerve injury?

a. Loss of sensation of the sole of the foot.
b. Inability to dorsiflex the ankle.
c. Loss of sensation of the medial side of the foot.
d. Inability to abduct the foot.
e. Trophic ulcers of the sole of the foot.
10.The MAIN blood supply to the breast is from:

a. Superior thoracic artery.
b. Lateral thoracic artery.
d. Acromiothoracic artery.
e. Intercostal arteries.
P a g e 2 | 22
11.Which of the following muscles does NOT belong to the rotator cuff?
a. Supraspinatus.
b. Subscapularis.
c. Teres major.
d. Teres minor.
e. Infraspinatus.
12.Which of the following is NOT present following injury of the radial nerve in the
arm?
a. Wrist drop.
b. Inability to extend the metacarpophalangeal joints.
c. Sensor loss at the radial side of the dorsum of the hand.
d. Inability to extend the forearm.
e. Wasting of muscles at the back of forearm.
13.Which of the following is WRONG about the scalenus anterior muscle?

a. It arises from the anterior tubercles of C3-C7 vertebrae.
b. It is inserted into the scalene tubercle of the first rib.
c. It is crossed by the vagus nerve.
d. The subclavian vein passes in front of the muscle.
e. The subclavian artery passes posterior to the muscle.
14.Which of the following is NOT TRUE about latissimus dorsi muscle?

a. It is inserted into the floor of the bicipital groove of the humerus.
b. The nerve supply is derived from the posterior cord of the brachial plexus.
c. The arterial supply is derived from the second part of the axillary artery.
d. It is an adductor and medial rotator of the upper limb.
e. It takes origin from the lumbar fascia.
15.Which of the following is NOT TRUE about the submandibular salivary gland?
a. The duct arises from the deep part of the gland.
b. The deep part lies between the mylohyoid and the digastric muscle.
c. It is related to the hypoglossal nerve.
d. The mandibular branch of the facial nerve may be injured during
submandibular sialoadenectomy.
e. It is more frequently affected by calculi than the parotid gland.
P a g e 3 | 22
16.Which of the following nerves is MOST frequently injured during excision of

carotid body tumor?
a. Facial nerve.
b. Hypoglossal nerve.
c. Spinal accessory nerve.
d. Glossopharyngeal nerve.
e. Vagus nerve.
17.Which of the following is CORRECT regarding the veins of the neck?

a. The anterior jugular veins course downwards between the sternohyoid
and the sternothyroid muscles.
b. The external jugular vein runs superficial to the sternocleidomastoid
muscle throughout its length.
c. The internal jugular vein receives all the venous drainage of the thyroid.
d. All neck veins are equipped with bicuspid valves like those of the lower
limbs.
e. The external jugular veins drains in the root of the neck into the internal
jugular vein.
18.All the following regarding the anatomy of the salivary glands are CORRECT
EXCEPT:
a. The parotid gland is mainly serous.
b. The submandibular gland is mainly mucous.
c. The minor salivary glands are found in all the oral mucosa including the
hard palate.
d. The secretory fibers reach the parotid through the auriculotemporal
nerve.
e. The submandibular duct courses anteriorly below the lingual nerve.
19.All the following regarding the femoral canal are CORRECT EXPECT:
a. The femoral sheath invests the femoral vessels and the femoral branch of
the genitofemoral nerve.
b. The femoral nerve courses down lateral to the femoral artery outside the
femoral sheath.
c. The femoral hernia descends down within the femoral sheath.
d. The femoral canal is a fatty cushion between the femoral artery and vein.
e. The pectineus muscle lies behind the femoral sheath.
P a g e 4 | 22
20.The long thoracic nerve arises from:

a. The medial cord of the brachial plexus.
b. The lower trunk of the brachial plexus.
c. The posterior cord of the brachial plexus.
d. The roots of the brachial plexus.
e. The upper trunk of the brachial plexus.
21.Which of the following muscles is NOT supplied by the obturator nerve?
a. Gracilis.
b. Adductor longus.
c. Adductor brevis.
d. Pectineus.
e. Adductor magnus.
22.The blood supply of the head of femur arises mainly from:
b. Medial and lateral circumflex femoral arteries.
c. Artery of the ligament of the head of femur.
d. First perforator artery of the deep femoral.
e. The superficial femoral artery.
23.Which of the following complications may follow post-rectopexy performed for
rectal prolapse?
a. Impotence.
b. Urinary incontinence.
c. Retention of urine.
d. Loss of ejaculation.
e. Fecal incontinence.
24.The greater sciatic foramen transmits the following structures EXCEPT:
a. Superior gluteal vessels.
b. Posterior cutaneous nerve of the thigh.
c. Pyriformis muscle.
d. Obturator internus tendon.
e. Inferior gluteal vessels.
25.Which of the following is the motor supply to the external urethral sphincter?
a. Parasympathetic supply from S2-S4.
b. Sympathetic supply from the hypogastric plexus.
c. Inferior rectal nerve.
d. Perineal branch of the pudendal nerve.
e. Presacral nerve.
P a g e 5 | 22
26.The carpal tunnel contains all the following structures EXCEPT:

a. Flexor digitorum superficialis tendon.
b. Median nerve.
c. Flexor policis longus tendon.
d. Ulnar nerve.
e. Flexor carpi radialis tendon.
27.One of the following muscles is NOT involved in full abduction of the upper limb:
a. Deltoid.
b. Infraspinatus.
d. Teres major.
e. Trapezius.
28.The deep perineal pouch contains all the following structures EXCEPT:
a. The membranous urethra.
b. Sphincter urethra.
c. Bulbourethral glands.
d. Internal pudendal vessels.
e. Superficial transverse perineal muscles.
29.Which of the following is NOT present in femoral nerve injury?

a. Loss of sensations over the medial side of the foot.
b. Loss of the knee jerk reflex.
c. Loss of the cremasteric reflex.
d. Loss of sensations over the anterior aspect of the thigh.
e. Atrophy of the sartorius muscle.
30.Which of the following is NOT supplied by the subclavian artery?

a. Pericardium.
b. Parathyroid glands.
c. Cerebellum.
d. Submandibular salivary glands.
e. Pectoralis major muscle.
P a g e 6 | 22
31.Which of the following is NOT supplied by the trigeminal nerve?

a. The muscles of mastication.
b. The buccinator muscle.
c. The temporomandibular joint.
d. The conjunctiva.
e. The mucous membrane of the maxillary air sinus.
32.Which of the following is NOT CORRECT regarding the ischiorectal fossae?

a. The medial wall is formed by levator ani and the external.
b. The two fossae communicated across the midline.
c. The base is formed by skin.
d. It contains the inferior rectal nerve and internal.
e. Pudendal vessels.
33.All the following statements about the femoral triangle are CORRECT EXCEPT:
a. The lateral border is formed by the medial border of the sartorius.
b. The medial border is formed by the lateral border of adductor longus.
c. The floor is formed by iliacus, psoas and pectineus and adductor longus.
d. The profunda femoris vessels are among the contents.
e. The femoral branch of the genitofemoral nerve lies in the roof of the
triangle.
34.Which nerve is responsible for causing pain in the ear during acute tonsillitis?
a. Facial.
b. Lingual.
c. Glossopharyngeal.
d. Lesser palatine.
e. Hypoglossal.
35.Which of the following is NOT TRUE about the thoracic duct?

a. It starts at the level of L1 vertebra.
b. It lies on the right side of the descending thoracic aorta.
c. It crosses the midline at the level of T7 vertebra.
d. It arches over the left subclavian artery.
e. It drains into the left innominate vein.
P a g e 7 | 22
36.Which of the following is NOT TRUE about the psoas major muscle?
a. It originates in part from the last thoracic vertebra.
b. It is supplied from the femoral nerve.
c. It is inserted into the lesser trochanter.
d. It is a flexor to the hip joint.
e. The genitofemoral nerve is anterior to it.
37.Which of the following nerves is NOT derived from the cervical plexus?
a. Auriculotemporal nerve.
b. Greater auricular nerve.
c. Transverse cervical nerve.
d. Supraclavicular nerves.
e. Phrenic nerve.
38.All the following regarding the submental triangle are CORRECT EXCEPT:
a. It is bound by the anterior bellies of the digastric muscle and the hyoid
bone.
b. The mylohyoid muscle constitutes its floor.
c. Lymph nodes constitutes its major anatomical content.
d. The sublingual salivary glands are amongst its contents.
e. Thyroglossal duct cyst can be found at its base.
39.All the following regarding the sternocleidomastoid are CORRECT EXCEPT:

a. It is partially innervated by the cervical plexus.
b. It covers most of the cervical lymph nodes.
c. The cutaneous branches of the cervical plexus emerge from behind the
midpoint of its posterior border.
d. It forms the posterior boundary of the carotid triangle.
e. The cutaneous orifice of a branchial fistula lies at the junction of the upper
and middle thirds of its anterior border.
40.All the following vessels have valves EXCEPT:

a. The deep veins of the lower limbs.
b. The superficial veins of the upper limb.
c. The portal vein.
d. The superficial abdominal veins.
e. The thoracic duct.
P a g e 8 | 22
41.Regarding the anatomy of the spleen which of the following is CORRECT:

a. The splenic artery is a branch of the superior mesenteric artery.
b. The splenic vein runs just above the superior border of the pancreas.
c. The splenic artery and vein reach the spleen through the gastrosplenic
ligament.
d. The splenic artery gives origin to the left gastroepiploic artery.
e. The lienorenal ligament contains the short gastric vessels.
42.Which of the following is FALSE regarding the flexor retinaculum at the wrist?
a. Attached to the scaphoid and trapezium laterally and to the pisiform and
hamate medially.
b. Gives attachments to the thenar and hypothenar eminences muscles.
c. The median nerve enters the palm beneath its midpoint.
d. Ulnar nerve and artery run deep to it medially.
e. Gives an insertion to the palmaris longus muscle.
43.Regarding the inguinal canal all the following statements are TRUE EXCEPT:
a. The internal ring lies midway between the symphysis pubis and anterior
superior iliac spine.
b. The internal ring lies lateral to the inferior epigastric vessels.
c. The external oblique aponeurosis forms the anterior boundary.
d. The inguinal ligament forms the inferior boundary.
e. The conjoint tendon forms the lateral part of the posterior wall.
44.Taste from the posterior one third of tongue is provided by which of the
following nerves?
a. Glossopharyngeal.
b. Facial.
c. Lingual.
d. Vagus.
e. Hypoglossal.
45.Pain referred to the right side of the neck and extending laterally from the right
P a g e 9 | 22
46.Which is CORRECT about scalenus anterior muscle?

a. It has no role in respiration.
b. It separates subclavian vein from the subclavian artery and brachial
plexus.
c. It is inserted in the second rib.
d. It is pierced by the phrenic nerve.
e. Suprascapular artery is posterior to it.
47.A complete division of the right oculomotor nerve (III) would result in all of the
following signs EXCEPT:
a. Ptosis.
b. Diplopia.
c. Convergent squint.
d. Dilated pupil on the right side.
e. Loss of a consensual papillary reflex when the left eye is examined.
48.All of the following muscles are involved in abduction of the hip joint EXCEPT:
a. Gluteus medius.
b. Gluteus minimus.
c. Sartorius.
d. Quadratus femoris.
e. Tensor fasciae latae.
49.All of the following structures would drain through the thoracic duct EXCEPT:
a. Left arm and thorax.
b. Left face and neck.
c. Left side of abdomen.
d. Right face and neck.
e. Right side of abdomen.
50.Which of the following nerves provides the afferent limb of the sneezing reflex?
a. Ophthalmic division of the trigeminal nerve.
b. Maxillary division of the trigeminal nerve.
c. Mandibular division of the trigeminal nerve.
d. Glossopharyngeal nerve.
e. Vagus nerve.
P a g e 10 | 22
51.Which of the following nerves may be injured during an episiotomy?

a. Pudendal nerve.
b. Inferior gluteal nerve.
c. Superior gluteal nerve.
d. Ventral rami of S3 and S4.
e. Inferior hypogastric nerve.
52.All the following are branches of the internal iliac artery EXCEPT:
a. Superior gluteal artery.
b. Inferior vesical artery.
c. Superior rectal artery.
d. Inferior rectal artery.
e. Uterine artery.
53.Which of the following structures does NOT pass through the aortic opening of
the diaphragm?
a. Azygos vein.
b. Thoracic duct.
c. The right phrenic nerve.
d. The aorta.
e. Lymph vessels from the thorax.
54.Which of the following nerves is MOST likely to be injured following fracture

a. Median nerve.
b. Musculocutaneous nerve.
c. Radial nerve.
d. Ulnar nerve.
e. Medial cord of the brachial plexus.
55.Which of the following nerves is MOST liable to be injured in fracture of the

surgical neck of the humerus?
a. Median nerve.
b. Ulnar.
c. Circumflex nerve.
d. Radial nerve.
e. Nerve to latissimus dorsi muscle.
P a g e 11 | 22
56.Which of the following is NOT a branch of the internal mammary artery?

a. Anterior intercostals arteries.
b. Pericardiophrenic artery.
c. Perforating arteries.
d. Inferior epigastric artery.
e. Musculophrenic.
57.All the following arteries supply the ureter EXCEPT:

a. Renal artery.
b. Abdominal aorta.
c. External iliac artery.
d. Testicular artery.
e. Inferior vesical artery.
58.Branches of the facial nerve supply all the following EXCEPT:

a. Orbicularis oculi muscle.
b. Buccinator muscle.
c. Anterior belly of the digastric muscle.
d. Taste sensations to the anterior two thirds of the tongue.
e. Stapedius muscle.
59.Which of the following is NOT a branch of the vagus nerve?

a. Recurrent laryngeal nerve.
b. Pharyngeal plexus.
c. Superior laryngeal nerve.
d. Cardiac branches.
e. Tonsillar branch.
60.Which of the following muscles is NOT supplied by the hypoglossal nerve?

a. Styloglossus.
b. Genioglossus.
c. Hyoglossus.
d. Palatoglossus.
e. Thyrohyoid.
P a g e 12 | 22
61.Which of the following is NOT a branch of the internal pudendal artery?

a. Dorsal artery of the penis.
b. Artery of the bulb of the penis.
c. Perineal branches.
d. Middle rectal artery.
e. Deep artery of the penis.
62.Which of the following is NOT TRUE about the femoral nerve?

a. It is derived from the posterior divisions of L2-4.
b. It supplies sensations to the medial side of the foot.
c. The nerve to vastus medialis runs in the adductor canal.
d. It has no branches above the inguinal ligament.
e. It is not contained within the femoral sheath.
63.Which of the following is NOT TRUE about the popliteal fossa?

a. It is bounded superolaterally by the biceps femoris.
b. The popliteus muscle forms a part of its floor.
c. The popliteal artery is deeper the popliteal vein.
d. The posterior cutaneous nerve of thigh lies in its roof.
e. It contains the superficial peroneal nerve.
64.Which of the following is NOT CORRECT about the vagus nerve?

a. It contains motor fibers which originate from the nucleus ambiguus.
b. It contributes to the pharyngeal plexus.
c. The superior laryngeal nerve arises from the inferior ganglion.
d. It arises from the medulla between the inferior olive and the middle
cerebellar peduncle.
e. It supplies the stylopharyngeus muscle.
65.Which of the following muscles is a lateral rotator to the hip joint?

a. Iliacus.
b. Psoas major.
c. Quadratus femoris.
d. Adductor longus.
e. Pectineus.
P a g e 13 | 22
66.Which of the following is NOT TRUE about the epiploic foramen?

a. The superior border is formed by the quadrate lobe.
b. The posterior border is formed by the I.V.C.
c. The anterior border is formed by the free margin of the lesser omentum.
d. It opens into the lesser sac to the left.
e. The inferior border is formed by the first part of the duodenum.
67.Which of the following is NOT TRUE about the femoral ring?

a. It is bounded anteriorly by the inguinal ligament.
b. It is bounded posteriorly by the pectineal ligament.
c. It is bounded medially by the lacunar ligament.
d. It is bounded laterally by the femoral artery.
e. It contains the lymph node of Cloquet.
68.Which of the following is NOT TRUE about the parotid gland?

a. The capsule is formed from the investing layer of cervical fascia.
b. The secretory supply is by the auriculotemporal nerve.
c. The external carotid artery transverses the gland.
d. Branches of the facial nerve are deep to the retromandibular vein.
e. Lymph nodes may be within the gland.
69.Which of the following is NOT TRUE about the trigeminal nerve?

a. It supplies sensory nerves to the entire face.
b. It supplies secretory fibers to the parotid gland.
c. It supplies sensory fibers to the nose.
d. It supplies motor films to the muscles of mastication.
e. It supplies secretory fibers to the submandibular salivary gland.
70.Which of the following will be present following injury of the long thoracic
nerve?
a. Depression of the shoulder.
b. Inability to extend the shoulder.
c. Winging of the scapula.
d. Inability to abduct the shoulder.
e. Loss of sensation at the medial side of the axilla.
P a g e 14 | 22
71.Which of the following nerves is MOST likely to be injured following fracture of

the medial epicondyle of the humerus?
a. The ulnar nerve.
b. The radial nerve.
c. The median nerve.
d. The musculocutaneous nerve.
e. Posterior interosseous nerve.
72.Which of the following is NOT TRUE about the esophagus?
a. It is partially supplied by the recurrent laryngeal nerve.
b. It is crossed by the right main bronchus.
c. It lies anterior to the descending thoracic aorta.
d. There is constriction at the level of C6.
e. It receives arterial supply from the descending aorta.
73.Which of the following statements is TRUE regarding the anatomy of the neck?
a. The anterior jugular veins are deep to the investing layer of deep fascia.
b. The investing layer of deep fascia splits to enclose the strap muscles.
c. The recurrent laryngeal nerve enters the larynx deep to the inferior
border of the cricopharyngeus muscle.
d. The internal laryngeal nerve may be damaged during ligation of the
superior thyroid vessels.
e. The inferior thyroid veins drain into the subclavian veins.
74.Which of the following statements is CORRECT regarding the left recurrent
laryngeal nerve?
a. It hooks around the arch of the aorta anterior to the attachment of the
ligamentum arteriosum.
b. It supplies the left cricothyroid muscle.
c. It supplies the left inferior constrictor muscle.
d. It supplies sensation to the whole laryngeal mucosa on the left side.
e. It contains motor fibers derived from the spinal root of the left accessory
nerve.
75.The thoracic duct drains lymph from all the following EXCEPT:
a. The left lower limb.
b. The colon.
c. The right arm.
d. The kidneys.
e. The left side of the head.
P a g e 15 | 22
76.Which of the following muscle does NOT belong to the rotator cuff?
a. Subscapularis.
b. Teres minor.
c. Supraspinatus.
d. Infraspinatus.
e. Teres major.
77.Which of the following structures passes into the quadrangular space of the
shoulder?
a. Anterior circumflex humeral artery.
b. Radial nerve.
c. Posterior circumflex humeral artery.
d. Circumflex scapular artery.
e. Thoracodorsal nerve.
78.Which muscle is likely to be injured if a posterior episiotomy is cut too far?

a. Ischiocavernosus muscle.
b. External urethral sphincter.
c. Puborectalis muscle.
d. External anal sphincter.
e. Iliococcygeus.
79.Impotence following abdominoperineal resection is due to injury of:

a. Pelvic splanchnic nerves.
b. Perineal nerve.
c. Presacral nerve.
d. Inferior rectal nerve.
e. Pudendal nerve.
80.Ligation of which of the following arteries is MOST likely to affect the blood
supply of the pancreas?
a. Inferior phrenic.
b. Superior mesenteric.
d. Inferior mesenteric.
e. Right colic.
P a g e 16 | 22
81.Which of the following does NOT pass in the adductor (Hunter's) canal?
a. Femoral artery.
b. Saphenous nerve.
c. Nerve to vastus medialis.
d. Obturator nerve.
e. Femoral vein.
82.Which of the following nerves emerges at the medial margin of the psoas major
muscle?
a. Ilioinguinal.
b. Femoral.
c. Genitofemoral.
d. Obturator.
e. Iliohypogastric.
83.The esophageal opening of the diaphragm is formed by:

a. The left crus of the diaphragm.
b. The central tendon of the diaphragm.
c. The sternal fibers of the diaphragm.
d. The right crus of the diaphragm.
e. The costal fibers of the diaphragm.
84.A possible complication of stripping of the long saphenous vein is loss of

sensation at:
a. The sole of the foot.
b. The medial side of the foot.
c. The lateral side of the leg.
d. The lateral side of the foot.
e. The medial side of the thigh.
85.Which of the following vessels does NOT participate in the blood supply of the
hip joint?
a. Medical circumflex femoral.
b. Superior gluteal.
c. Lateral circumflex femoral.
d. Obturator.
e. Pudendal.
P a g e 17 | 22
86.Which of following is NOT present in injury of the sciatic nerve?

a. Loss of planter flexion of the foot.
b. Loss of sensations of the sole of the foot.
c. Loss of dorsiflexion of the foot.
d. Loss of flexion of the knee.
e. Loss of eversion of the foot.
87.Following an appendicectomy a patient developed paraesthesia at the pubic

area. What is the injured nerve?
a. Ilioinguinal.
b. Genitofemoral.
c. Iliohypogastric.
d. Lateral cutaneous nerve of the thigh.
e. Medial cutaneous nerve of the thigh.
88.Following an appendicectomy the patient developed a direct inguinal hernia.

What is the injured nerve?
a. Iliohypogastric.
b. Genital branch of genitofemoral.
c. Medial cutaneous nerve of the thigh.
d. Ilioinguinal.
e. Subcostal.
89.If the inferior mesenteric artery is occluded, which artery will supply the
descending colon?
a. Superior rectal.
b. Middle rectal.
c. Marginal artery.
d. Left gastroepiploic.
e. Ileocolic.
90.Ligation of which of the following arteries is MOST likely to affect the blood
supply of the pancreas?
a. Inferior phrenic.
b. Superior mesenteric.
d. Inferior mesenteric.
e. Right colic.
P a g e 18 | 22
91.Which of the following is NOT a branch of the facial artery?

a. Tonsillar.
b. Inferior labial.
c. Angular.
d. Submental
e. Sublingual.
92.Which of the following is NOT TRUE about the phrenic nerve?

a. It is derived from C3,4,5.
b. It crosses the scalenus medius muscle from the lateral to the medial side.
c. It contains motor and sensory fibers.
d. It supplies the pericardium and the pleura.
e. In the neck the left phrenic nerve is crossed by the thoracic duct.
93.The laryngeal mucosa below the vocal cords is supplied by:

a. The internal laryngeal nerve.
b. The recurrent laryngeal nerve.
c. The external laryngeal nerve.
d. The pharyngeal plexus.
e. The glossopharyngeal nerve.
94.Which of the following is NOT TRUE regarding the pterygoid venous plexus?
a. It is situated between the temporalis and lateral pterygoid muscles.
b. It communicates with the anterior facial vein.
c. It drains into the external jugular vein.
d. It communicates with the cavernous sinus.
e. It receives the middle meningeal vein.
95.The carotid sheath contains all the following EXCEPT:

a. The common carotid artery.
b. The internal jugular vein.
c. The vagus nerve.
d. The sympathetic trunk.
e. The common carotid artery.
P a g e 19 | 22
96.The MAIN blood supply of the upper end of the esophagus is:
a. Inferior thyroid artery.
b. Transverse cervical artery.
d. Aorta.
e. Left bronchial artery.
97.Which structure is related to the right sternoclavicular joint posteriorly?

a. Subclavian artery.
b. Transverse cervical artery.
c. Bifurcation of the innominate artery.
d. Esophagus.
e. Common carotid artery.
98.Which of the following is NOT TRUE about the anatomy of the ureter?
a. It crosses the bifurcation of the common iliac artery.
b. It passes superficial to the uterine artery.
c. The ductus deferens crosses superficial to the ureter near its termination.
d. It receives blood supply from the renal, aortic and vesical arteries.
e. It is supplied by sympathetic autonomic nerves T11-L1.
99.Which of the following statements about the urethra is NOT CORRECT?

a. The prostatic urethra is the widest part
b. The spongy urethra is supplied by the internal pudendal artery.
c. Lymphatic drainage is mainly to the internal iliac lymph nodes.
d. The membranous urethra is surrounded by the internal urethral
sphincter.
e. The ejaculatory duct open into the prostatic urethra.
100. Which of the following nerves is responsible for motor innervation of the
constrictor muscles?
a. The vagus nerve.
b. The glossopharyngeal nerve.
c. The accessory nerve.
d. The sympathetic trunk.
e. The hypoglossal nerve.
P a g e 20 | 22
101. Which of the following muscles is NOT supplied by the oculomotor nerve?
a. Levator palpebrae superioris.
b. Superior oblique.
c. Medial rectus.
d. Inferior oblique.
e. Superior rectus.
102. Which of the following is NOT TRUE as regard the pudendal nerve?
a. It arises from S2,3,4.
b. The leaves the pelvis through the greater sciatic foreman.
c. It runs along alcohol's canal.
d. It is a purely sensory nerve.
e. It gives off the inferior rectal nerve.
103. Which of the following is NOT present in the ischiorectal fossa?

a. Internal pudendal vessels.
b. Inferior rectal vessels.
c. Inferior rectal nerve.
d. Internal anal sphincter.
e. Inferior rectal nerve.
104. Which of the following is NOT TRUE regarding the cavernous sinus?
a. The right and left sinuses are connected together.
b. It drains into the inferior petrosal sinus.
c. It receives blood from the superior and inferior ophthalmic veins.
d. Infection of the central area of the face may cause cavernous sinus
thrombosis.
e. It contains the mandibular nerve.
105. All the following are branches of the maxillary artery EXCEPT:
a. Middle meningeal artery.
b. Accessory meningeal artery.
c. Deep temporal arteries.
d. Inferior alveolar artery.
e. Ascending palatine.
P a g e 21 | 22
106. Which of the following muscles is NOT supplied by the mandibular nerve?
a. Lateral pterygoid.
b. Temporalis.
c. Posterior belly of digastric.
d. Stylohyoid.
e. Mylohyoid.
107. Which of the following muscles is NOT supplied by the vagus nerve?
a. Laryngeal muscles.
b. Pharyngeal constrictors.
c. Palatoglossus.
d. Genioglossus.
e. Palatopharyngeus.
108. Injury of the hypoglossal nerve causes all the following EXCEPT:
a. Atrophy of the same side of the tongue.
b. Deviation of the tongue to the same side of the lesion.
c. Paralysis of all the muscles of the tongue.
d. ……
e. ……
P a g e 22 | 22

Antibiotics Pharmacology MCQ
1. All of the following are TRUE regarding penicillins EXCEPT:
a. Most penicillins only cross the blood brain barrier when the meninges are
inflamed.
b. Penicillins don’t require dosage adjustment in renal failure.
c. Penicillins inhibit cross linkage of peptidoglycans in the cell wall.
d. Piperacillin is a penicillin active against pseudomonas.
e. Only about 5 to 10% of people with a past history of penicillin allergy have
a reaction on re exposure.
2. Ciprofloxacin:
a. Is a defluorinated analogue of nalidixic acid.
b. Inhibits topoisomerases 2 and 3.
c. Has no gram positive cover.
d. Has a bioavailability of 30%.
e. May cause an arthropathy.
3. Resistance to B lactams:
a. Can be due to an efflux pump.
b. Is most commonly due to modification of the target PBPs.
c. Does not involve penetration of drug to target PBPs.
d. Infers resistance only to penicillin.
e. Can involve up to 5 different B lactamases.
4. Macrolides:
a. Have enhanced activity at acidic pH.
b. Have little activity against legionella.
c. Have half-lives which increase in patients with anuria.
d. Induce cytochrome p450 enzymes.
e. Are contraindicated in neonates.
5. Flucloxacillin:
a. Is ineffective against streptococci.
b. Is active against enterococci and anaerobes.
c. Blocks transpeptidation and inhibits peptidoglycan synthesis.
d. Is poorly absorbed orally.
e. Has excellent penetration into CNS and prostate.
Page 1|8
6. All of the following inhibit nucleic acid synthesis EXCEPT:

a. Norfloxacillin.
b. Chloramphenicol.
c. Trimethoprim.
d. Rifampicin.
e. Sulfasalazine.
7. Which of the following is a second generation cephalosporin?

a. Cefaclor.
b. Ceftazidime.
c. Cephalexin.
d. Cefotaxime.
e. Cephalothin.
8. Regarding the pharmacokinetics of the tetracyclines:

a. Tetracyclines are 40 to 80 % bound by serum proteins.
b. Absorption is enhanced by coadministration of antacids.
c. Tetracyclines cross the blood brain barrier easily.
d. Doxycycline is excreted predominantly by the kidney.
e. Demeclocycline is a short acting tetracycline drug.
9. All of the following are recognized adverse effects of isoniazid EXCEPT:

a. Hepatitis.
b. Peripheral neuropathy.
c. Retrobulbar neuritis.
d. Decreased phenytoin metabolism – increased phenytoin blood
levels/toxicity.
e. CNS toxicity.
10.Vancomycin:
a. 90% of vancomycin is excreted by glomerular filtration.
b. Inhibits protein synthesis in bacteria.
c. Is bactericidal against gram negative bacilli.
d. Is well absorbed from the GIT.
e. One adverse reaction to infusions of vancomycin is the “Blue man”
syndrome.
Page 2|8
11.Regarding mechanisms of antiviral drug action:

a. Blockage of viral uncoating is caused by rifampicin.
b. Zidovudine is a protease inhibitor.
c. Amantadine blocks viral DNA packaging and assembly.
d. Indinavir is a reverse transcriptase inhibitor.
e. Acyclovir inhibits viral DNA synthesis.
12.Regarding toxicity of antibiotics:

a. Enamel dysplasia is common with aminoglycosides.
b. Gray baby syndrome occurs with rifampicin use.
c. Haemolytic anemias can occur with sulphonamides use.
d. Nephritis is the most common adverse reaction with isoniazid.
e. Disulfiram like reaction can occur with macrolides.
13.Chloramphenicol:
a. Does not penetrate the blood brain barrier.
b. Must be administered parenterally.
c. Can be safely used in premature infants.
d. Can cause depression of bone marrow function.
e. Can cause discoloration of developing teeth when given to children.
14.Spironolactone:
a. Has a steroid structure.
b. Is a partial agonist.
c. Promotes sodium retention.
d. Increases potassium loss.
e. Is a loop diuretic.
15.Which of the following drugs cause diuresis by the mechanisms indicated?

a. Ethanol – by preventing the reabsorption of sodium from renal tubular
fluid.
b. Digoxin – by inhibiting release of ADH.
c. Dopamine – by inhibiting active transport of chloride over the entire
length of the descending limb of the loop of Henle.
d. Frusemide – by inhibiting carbonic anhydrase.
e. Chlorothiazide – by inhibiting active sodium transport in the ascending
limb of the loop of Henle.
Page 3|8
16.All of the following antibiotics bind to the 50S subunit of the ribosome thereby
inhibiting protein synthesis EXCEPT:
a. Chloramphenicol.
b. Erythromycin.
c. Linezolid.
d. Doxycycline.
e. Clindamycin.
17.Pharmacokinetics of doxycycline:
a. 20% bound by serum proteins.
b. 60-70% absorption after oral administration.
c. Absorption is impaired by divalent cations, Al3+ and antacids.
d. Widely distributed especially into the CSF.
e. Is eliminated via renal mechanisms.
18.Which of the following inhibits DNA gyrase?

a. Penicillin.
b. Trimethoprim.
c. Chloramphenicol.
d. Ciprofloxacin.
e. Gentamicin.
19.Resistance to penicillin and other β lactams is due to:

a. Modification of target PBPs.
b. Impaired penetration of drug to target PBPs.
c. Presence of an efflux pump.
d. Inactivation of antibiotics by β lactamase.
e. All of the above.
20.All of the following are recognized adverse effects of isoniazid EXCEPT:

a. Hepatitis.
b. Peripheral neuropathy.
c. Retrobulbar neuritis.
d. ↓ Phenytoin metabolism → ↑ Phenytoin blood levels and toxicity.
e. CNS toxicity.
Page 4|8
21.Regarding fluoroquinolones:
a. Ciprofloxacin is ineffective in the treatment of gonococcus.
b. Norfloxacin and Ciprofloxacin are predominantly faecally excreted.
c. Norfloxacin and Ciprofloxacin have long half-lives (12 hours).
d. They have poor oral bioavailability.
e. May damage growing cartilage in children less than 18 years of age.
22.Vancomycin:
a. Is never orally administered as it is poorly absorbed from the GIT.
b. Binds to the 30S unit on the ribosome and inhibits protein synthesis.
c. 60% of vancomycin is excreted by glomerular filtration.
d. Parenteral vancomycin is commonly used for treatment of infections
caused by methicillin susceptible staphylococci.
e. Adverse reactions to vancomycin are encountered in about 10% of
patients.
23.Regarding the “Azole” group of antifungals:
a. Fluconazole has low water solubility.
b. Ketoconazole may be given IV/PO.
c. Itraconazole undergoes renal elimination.
d. Clotrimazole is the treatment of choice for systemic candidiasis given
orally.
e. They work by reduction of ergosterol synthesis by inhibition of fungal
cytochrome P450 enzymes.
24.The fluoroquinolones:
a. May be administered to patients with severe campylobacter infection.
b. Work by inhibiting dihydrofolate reductase.
c. Have little effect against gram positive organisms.
d. Are heavily metabolized in the liver.
e. Are safe to give to breast feeding mothers.
25.Clindamycin:
a. Inhibits bacterial cell wall synthesis.
b. Is often used for prophylaxis of endocarditis in patients with valvular
disease who are undergoing dental procedures.
c. Penetrates through BBB into CSF well.
d. Works well against enterococci and gram negative aerobic organisms.
e. Is 10% protein bound.
Page 5|8
26.Which of the following is a second generation cephalosporin?

a. Ceftazidime.
b. Cephalothin.
c. Cefotaxime.
d. Cefaclor.
e. Cephalexin.
27.The cephalosporin with the HIGHEST activity against gram positive cocci is:
a. Cefaclor.
b. Cephalothin.
c. Cefuroxime.
d. Cefepime.
e. Cefotaxime.
28.Regarding the penicillins:

a. Penicillin ix excreted into breast milk to levels 3-15% of those present in
the serum.
b. Absorption of Amoxil is impaired by food.
c. Benzathine penicillin is given PO.
d. Penicillins are 90% excreted by glomerular filtration.
e. Dosage of nafcillin should be adjusted in the presence of renal failure.
29.Rifampicin:
a. Inhibits hepatic microsomal enzymes.
b. Inhibits DNA synthesis.
c. Is bactericidal for mycobacteria.
d. Is not appreciably protein bound.
e. Is predominantly excreted unchanged in the urine.
30.Regarding resistance to antibiotics:

a. Penicillinases cannot inactivate cephalosporins.
b. Macrolides can be inactivated by transferases.
c. Mutation of aminoglycoside binding site is its main mechanism of
resistance.
d. Tetracycline resistance is a marker for multidrug resistance.
e. Resistance to antibiotics is rarely plasmid encoded.
Page 6|8
31.Concerning toxicity of antibiotics:

a. Enamel dysplasia is common with aminoglycosides.
b. Grey Baby Syndrome occurs with rifampicin use.
c. A disulfiram like reaction can occur with macrolides.
d. Haemolytic anemias can occur with sulphonamides use.
e. Nephritis is the most common adverse reaction with isoniazid.
32.Which of the following is considered to be bacteriostatic?

a. Penicillin.
b. Chloramphenicol.
c. Ciprofloxacin.
d. Cefoxitin.
e. Tobramycin.
33.Half-life of amphotericin B is:

a. 2 seconds.
b. 20 minutes.
c. 2 hours.
d. 2 weeks.
e. 2 months.
34.Regarding antiseptic agents, all of the following are TRUE EXCEPT:

a. Sodium hypochlorite is an effective antiseptic for intact skin.
b. Potassium permanganase is an effective bactericidal agent.
c. Formaldehyde may be used to disinfect instruments.
d. Chlorhexidine is active against gram positive cocci.
e. Ethanol is an effective skin antiseptic because it denatures microbial
proteins.
35.Ciprofloxacin:
a. Is a defluorinated analogue of nalidixic acid.
b. Inhibits topoisomerases 2 and 3.
c. Has no gram positive cover.
d. Has bioavailability of 30%.
e. May cause an arthropathy.
Page 7|8
36.Flucloxacillin:
a. Is ineffective against streptococci.
b. Is active against enterococci and anaerobes.
c. Blocks transpeptidation and inhibits peptidoglycan synthesis.
d. Is poorly absorbed orally.
e. Has excellent penetration into CNS and prostate.
37.Aminoglycosides:
a. Have a β lactam ring.
b. Can produce neuromuscular blockade.
c. Are DNA gyrase inhibitors.
d. Normally reach high CSF concentrations.
e. Have good oral absorption but high first pass metabolism.
38.Ribosomal resistance occurs with:

a. Sulphonamides.
b. Penicillin.
c. Fluoroquinolones.
d. Macrolides.
e. Trimethoprim.
39.Regarding antivirals:
a. Delvindine is a nucleoside reverse transcriptase inhibitor (NRTI).
b. Zidovudine (AZT) is a non-nucleoside reverse transcriptase inhibitor
(NNRTI).
c. NRTIs activate HIV-1 reverse transcriptase.
d. Abacavir is a protease inhibitor.
e. NRTIs require intracytoplasmic activation to the triphosphate form.
40.All of the following are TRUE regarding metronidazole EXCEPT:

a. It is used to treat giardia.
b. It causes a metallic taste in the mouth.
c. It inhibits alcohol dehydrogenase.
d. It is used to treat gardnerella.
e. It is useful against trichomonas vaginalis.
Page 8|8

Physiology MCQ
1. Regarding equilibrium potential (Mammalian spinal motor neurons):
a. The resting membrane potential is – 70 mV – identical to that of ECF.
b. Equilibrium potential of potassium is +90 mV.
c. Increases in external sodium concentrations decrease the resting
membrane potential.
d. Equilibrium potential of sodium is –60 mV.
e. Na+-K+ ATPase pumps 2 sodium out of cell for every 3 potassium it pumps
in.
2. Regarding body composition:
a. 18% body weight is protein/related substances.
b. 15% body weight is interstitial fluid.
c. 60% body weight is water.
d. 5% body weight is plasma.
e. All of the above are true.
3. Regarding buffers in the body:
a. Initial correction of pH disturbance is achieved by the kidneys.
b. The phosphate buffer system is the predominant buffer in the blood.
c. Bones contribute to buffering by taking up bicarbonate.
d. Hb is an important buffer in the blood.
4. The size of the action potential is decreased by:
a. Decreased extracellular calcium.
b. Increased external sodium.
c. Decreased internal sodium.
d. Decreased internal potassium.
e. Increased internal potassium.
5. Regarding body fluid compartments:
a. About 2/3 TBW is extracellular.
b. ECF/intracellular fluid volume ratio is larger in infants than in adults.
c. Plasma volume in a 70 kg male is approximately 5 litres.
d. A 30 year old male has 40% water as a percentage of body weight.
e. Transcellular fluid has a greater volume than intracellular fluids.
Page 1|3
6. Fick’s law of diffusion is dependent on all EXCEPT:

a. The posture of the subject.
b. The solubility of the gas.
c. Thickness of membrane barrier.
d. Molecular weight of the gas.
e. Area of the membrane.
7. Regarding movement across cell membranes:

a. Exocytosis requires sodium and energy.
b. Insulin reuptake is by receptor mediated endocytosis.
c. Thyroid hormones decrease the activity of the Na+-K+ ATPase.
d. Active transport of sodium is rarely coupled with other substances.
e. Na+-K+ ATPase has a 1:1 coupling ratio.
8. In regard to pH:
a. pH of a solution is the log to base 10 of the reciprocal hydrogen ion
concentration.
b. Is the negative log of the concentration of hydrogen ions.
c. For each pH unit less than 7, the concentration of hydrogen ion is
increased 10 fold.
d. A pH of 7 is equal to a hydrogen ion concentration of 10-7 mmol/L.
9. Regarding heterotrimeric G proteins:

a. GDP is bound to the B subunit.
b. They are not serpentine receptors.
c. The delta unit separates from the other subunits to bring about the
biological effect.
d. The intrinsic GTPase activity of the alpha subunit converts GTP to GDP.
e. They span the membrane seven times.
10.Which of the following is CORRECT?

a. Chloride concentration in interstitial fluid is greater than in the plasma.
b. Potassium concentration in interstitial fluid is greater than that in
intracellular fluid.
c. Sodium concentration in intracellular fluid is greater than in plasma.
d. Protein concentration in plasma is greater than in intracellular fluid.
e. Bicarbonate concentration in intracellular fluid is greater than in
interstitial fluid.
Page 2|3
11.Regarding basic physiological measures all of the following are TRUE EXCEPT:
a. Osmolarity is the number of osmoles/liter of solution.
b. pH is the log to base 10 of the reciprocal of hydrogen ion concentration.
c. Carbon has a molecular mass of 12 Dalton.
d. Osmolarity is measured by freezing point depression.
e. One equivalent of sodium is 23 g/L.
12.With regards to cell membrane potential:

a. The Donnan effect relies on non-diffusible ions.
b. The exterior of the cell is negative with respect to the interior.
c. The membrane potential tends to push chloride out of the cell.
d. It can be derived by measuring the chloride concentration and using the
Nernst equation.
e. Potassium leaks out against its concentration gradient.
13.Regarding the comparison of ECF with CSF, all of the following are TRUE EXCEPT:
a. CSF has less protein.
b. CSF has lower osmolality.
c. CSF has lower pH.
d. CSF has more bicarbonate.
e. CSF has lower specific gravity.
14.Which of the following does NOT act via an intracellular receptor?

a. Cortisol.
b. Thyroxine.
c. ANP.
d. Aldosterone.
e. Retinoic acid.
15. Regarding functional morphology of the cell:

a. Tay Sachs disease is a cell membrane disorder.
b. Actin is the most abundant protein in mammalian cells.
c. Peroxisomes are 5 um in diameter.
d. The assembly of microtubules in the cell cytoskeleton is facilitated by
cold.
e. Myosin 1 is present in skeletal muscle.
Page 3|3

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ELEMAM’s SurgiNotes 2022

‫• االمتحان دي مش متجاوبة بس الموضع بسيط تقريبا كل المواضيع موجوده في كتاب الجراحة‬

‫بالتوفيق ان شاء هللا لينا كلنا ف االمتحان اىل جاي‬

Egyptian Board Of General Surgery

8. Which of the following is the MAIN blood supply to the breast?

9. A 74-year-old woman presents to the outpatient clinic with pelvic pain. A CT

18.Which group of lymph nodes will be inflamed secondary to paronychia of the

20.Which of the following nerves is MOST likely to be injured following fracture

21.During an operation for abdominal aortic aneurysm, the inferior mesenteric

23.A 40-year-old male patient had a superficial parotidectomy operation. Post-

27.A 42-year-old construction worker noted a swelling in the right submandibular

30.An 80-year-old man presents with a prostatic malignancy. Imaging reveals a

32.A 35-year-old man presents to the emergency department following a sports

36.Which of the following can lower the serum potassium level?

37.Which of the following cells is responsible for the secretion of pepsinogen?

42.Which of the following is an excitatory transmitter for small bowel motility?

45.Which of the following cytokines has anti-inflammatory properties?

46.Which of the following microscopic features MOST likely indicates that a

47.Which of the following can adverse effects of steroids on wound healing?

48.A 45-year-old man with a long history of ulcerative colitis undergoes

50.Which of the following disturbances in associated with tumor lysis syndrome?

52.Which of the following abnormalities indicate the possibility of

55.Which of the following is the MAJOR stimulus for aldosterone secretion?

56.Which of the following can lower the serum potassium level?

57.In compensating for respiratory alkalosis, the body excretes more:

58.Which of the following clinical situations can be associated with hypovolemic

59.Which of the following statements is TRUE about Cushing's disease?

60.A 40-year-old male patient is complaining of persistent, headache, recurrent

61.Which of the following tests will be helpful in the EARLY management of a

62.What is the recommended treatment of acute adrenal insufficiency?

63.A patient who had adrenalectomy to remove a pheochromocytoma

64.Preventing acute renal failure following crush injury:

66.Which of the following occurs in starvation?

69.Which of the following metabolic changes is MOST prominent during times of

73.What is the MAIN mode of action of heparin?

74.What is the principal mechanism of the antithrombotic action of administering

76.A cirrhotic patient with abnormal haemostatic studies requires an urgent

78.Which of the following substances is produced by the vascular endothelium and

80.What is the mode of action of carbimazole?

81.Which of the following is the MOST common sign of Cushing's syndrome?

82.Which of the following is the FIRST sign or symptom of hypocalcemia?

83.Which of the following occurs in starvation?

84.A 70-year-old patient with diabetes and paraplegia is undergoing an elective

87.What is the MAIN brain's fuel during prolonged starvation?

88.Which of the following hormones is primarily responsible for differentiation of

89.Marjolin's ulcer arises in areas exposed to:

90.Shock following severe carbon monoxide poisoning is MOST commonly:

91.Vasoconstriction is one of the initial physiologic responses to hypovolemic

92.Bleeding in patients with thrombasthenia is treated with:

93.Hemophilia C is caused by a deficiency of:

94.An abnormal aPTT (Partial thromboplastin time) is associated with an

96. Pancreas divisum occurs as a result of:

99.The inguinal ligament is a part of which abdominal wall muscle?

Egyptian Board Of General Surgery

2. A 40-year-old male patient is complaining of persistent headache, recurrent

4. A 30-year-old female patient complains of fatigue, generalized bony aches and

6. Which of the following tests will be helpful in the EARLY management of a

7. A 23-year-old woman undergoes total thyroidectomy for carcinoma of the

10.What is the recommended treatment of acute adrenal insufficiency?

11.A 40-year-old female patient complains of tiredness, putting on weight,