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Fluid And Electrolyte

1. The effective osmotic pressure between the plasma and interstitial


fluid compartments is primarily controlled by:
a)
b)
c)
d)
e)

Bicarbonate.
Chloride ion.
Potassium ion.
Protein.
Sodium ion.

2. Symptoms and signs of extracellular fluid volume deficit


include all of the following except:
a)
b)
c)
d)
e)

Anorexia.
Apathy.
Decreased body temperature.
High pulse pressure.
Orthostatic hypotension.

3. The osmolarity of the extracellular fluid space is determined


primarily by the concentration of:
a)
b)
c)
d)
e)

Bicarbonate
Chloride ion
Phosphate radicals
Sodium ion
Sulfate radicals

4. The osmolarity of the extracellular fluid space is determined


primarily by the concentration of:
f)
g)
h)
i)
j)

Bicarbonate
Chloride ion
Phosphate radicals
Sodium ion
Sulfate radicals

5. Potassium deficiency should be suspected:


a)
b)
c)
d)
e)

In cases of paralytic ileus.


When the patient's reflexes are exaggerated.
If there is a decrease in height and peaking of the T waves of an ECG.
In alkalotic states.
In intestinal obstruction.

6. The sodium ion:


a) Is the principal regulator of the intracellular volume.
b) Is the major ionic component of the intracellular fluid volume.
c) Is present in greater concentration in intracellular fluid than
extracellular fluid.
d) Is excreted in larger amounts than normal in the early postoperative
period.
e) C&D only
7. Acute post traumatic renal failure:
a)
b)
c)
d)
e)

May be due to hypovolaemia and poor tissue perfusion.


Is particularly associated with crush injuries.
May be due to kidney damage following tubular obstruction.
Should initially be treated by fluid restriction.
Should be treated initially by fluid restriction.

8. Intravenous parenteral feeding:


a) Should deliver at least 2500 calories/day to an adult.
b) Should deliver at least 10g of nitrogen (i.e. 66g of protein)/day to an
adult.
c) Can be effectively achieved with isotonic solutions.
d) Is with complications with present day solutions and methods of
administration.
e) Can be given by central intravenous infusion line(CVL)

9. Intravenous parenteral feeding:


f) Should deliver at least 2500 calories/day to an adult.
g) Should deliver at least 10g of nitrogen (i.e. 66g of protein)/day to an
adult.
h) Can be effectively achieved with isotonic solutions.
i) Is with complications with present day solutions and methods of
administration.
j) Can be given by central intravenous infusion line(CVL)

Acute Abdomen
10. Acute abdominal pain which is (all correct except one)
a) Colicky in nature indicates obstruction of hollow viscus.
b) In right upper quadrant increased by inspiration is typical
of cholecystitis
c) Continuous is typical of inflammation
d) Maximal in the right loin is typical with duodenal ulcer.
e) Maximal in epigastrium and related to meal is typical of
gastric problem.
11. Faeculent vomiting:
a)
b)
c)
d)
e)

Is commonly seen after upper gastrointestinal tract.


Indicates large bowel obstruction.
Indicates bacterial proliteration in the upper intestinal.
Suggests a gastro-colic fistula.
Suggests small bowel fistula

12. Perforated duodenal ulcers: (all correct except one)


a)
b)
c)
d)

Occur most frequently in female


Are usually preceded by an dxacerbation of ulcer symptoms.
Are usually accompanied by a leucocytosis.
Produce abdominal tenderness which is most marked in the
epigastrium.
e) May cause septicemia.
13. A perforated duodenal ulcer:
a) Usually lies on the anterior or superior surface of the
duodenum.
b) Usually presents with the acute onset of severe back pain.
c) Produces radiological evidence of free gas in the peritoneum
in over 90 percent of the patients.
d) Is usually treated by vagotomy and pyloroplasty
e) Is usually treated conservatively.

14. Appendicitis is:


a)
b)
c)
d)
e)

More common in females


Distributed evenly thoughout the world's population
More likely to occur if the appendix is in the retrocaecal position.
Commonly the result of appendicular obstruction.
B&C only.

15. Patients with early appendicitis:


a)
b)
c)
d)
e)

Usually present with central abdominal pain.


Rarely present with anorexia.
Have usually vomited many time.
Usually complain of similar attacks of pain in the previous few weeks.
B&C only.

16. Obstruction of the lumen of the appendix may lead to: (all correct
except one)
a)
b)
c)
d)
e)

Mucosal ulceration
Gangrenous appendicitis.
A perforated appendix.
Intussusception of the appendix.
Acute appendicitis.

17. In the differential diagnosis of appendicitis in an infant it is


important to consider: (all correct except one)
a)
b)
c)
d)
e)

Ileo-ileal instussusception.
Basal pneumonia.
Henoch-schoenlein purpura.
Torsion of an ovarian cyst.
Gastroenteritis.

18. Acute non-specific mesenteric lymphadenitis: (all correct except one)


a)
b)
c)
d)

Is commonest between 5 and 12 years of age.


Is usually associated with an upper respiratory tract infection.
Is usually associated with cervical lymphadenopathy
Is characterized by enlarged mesenteric lymph nodes which are
infected by gram-negative organisms.
e) Is one of the differential diagnosis of acute appendicitis.
19. The level of intestinal obstruction can be determined by:
(all correct except one)
a) Questioning the patient.
b) Examining the patient.
c) Radiological examination of the patient.
d) Repeated measurements of the patient's girth.
e) Upper & lower contrast studies.
Acute small bowel obstruction: (all correct except one) .20
a) Is commonly caused by postoperative adhesions.
b) Accompanied by the signs of peritonitis, suggests bowel strangulation.
c) Is often associated with a raised serum amylase.
d) Generally produces abdominal distension within 2 to 3 hours of onset.
Can be diagnosed by history and clinical examination
21. Strangulation of the bowel: (all correct except one)
a)
b)
c)
d)
e)

commonly complicates closed loop obstruction.


Is difficult to distinguish from simple intestinal obstruction. *
Is accompanied by bleeding into the affected bowel.
Frequently causes peritonitis.
Is characterized by severe abdominal pain.

22. Large bowel obstruction:


a)
b)
c)
d)
e)

Is most commonly caused by colonic cancer *


Has its maximum incidence before the age of 50.
Frequently presents with nausea and vomiting.
Usually heralds its onset with constant suprapubic pain.
Frequently treated conservatively.

23. Acute pancreatitis typically: (all correct except one)


a)
b)
c)
d)
e)

Is accompanied by hypercalcaemia.
Produces paralytic ileus.
Is associated with a pleural effusion.
Produces pyloric stenosis. *
Upper abdominal pain and vomiting.

24. Patients with acute colonic deveticulitis:


a)
b)
c)
d)
e)

Often give a history of recent lower abdominal colic. *


Often present with pyrexia.
Can be frequently diagnosed on sigmoidoscopic appearances.
Frequently develop faecal peritonitis.
All the above.

25. Acute pancreatitis: (all correct except one)


a) Often simulates a perforated peptic ulcer in its presentation.
b) Often presents with the signs of hypovolaemia.
c) Can readily be distinguished from other causes of acute abdominal
pain by the presence of a raised serum amylase. *
d) Frequently has a raised concentration of urinary amylase.
e) Most commonly caused as a complication of GB stones.
26. Childhood intussusception: (all correct except one)
a) Usually presents during the first year of life.
b) Is frequently ileocolic.
c) Can usually be diagnosed without x-ray examination of the abdomen.
d) Rarely requires surgical treatment. *
e) Can be diagnosed by abdominal US.
27. Neonatal duodenal obstruction:
a) May be associated with down's syndrome. *
b) Is more frequently found in premature infants.
c) Typically presents with gross abdominal distension.
d) Usually presents with vomiting of non-bile stained fluid
e) B&C only.

28. acute superior mesenteric artery occlusion: (all correct except one)
a) Characteristically presents with sudden pain and tenderness of
increasing intensity.
b) Is frequently accompanied by overt or occult blood loss in the stools.
c) Frequently produces peritonitis.
d) Can usually be diagnosed on plain abdominal x-rays. *
e) Can be diagnosed by mesenteric artery ongiography.

29. Biliary colic typically:


a)
b)
c)
d)
e)

Occurs 3 to 4 hours after meals.


Lasts 5 to 20 minutes.
Radiates from the upper abdomen to the right subscapular region. *
Is made better by deep inspiration.
B&C only.

Polytrauma
30.Regarding tension pneumothorax, the first step in the
management is:
a) Obtaining a stat chest x-ray.
b) Cricothyroidectomy
c) Passin on endotracheal tube
d) Starting oxygen by a valve-mask device
e) Chest decompression needle.
31.Regarding the management of polytrauma:
A) Death follow a trimodal distribution.
B) X-ray after primary survey should be AP cervical spine, chest
and pelvis.
C) Cardiac tamponade is characterized by raised B.p, a low JUP.
D) Assessment of uncomplicated limb fractures should occur
during the primary survey.
E) A and B only. *

32. Blunt injuries to the abdomen (all are correct except)


a) May cause shock
b) May cause peritonitis
c) May cause acute gastroduodenal ulceration
d) May treated conservativly
e) Rarely need urgent laparatomy *

33.Injuries to the urethra (all are correct except one)


a) Are more common in male.
b) Are often caused by road traffic accidents.
c) Are easily diagnosed on intra venous pyelography. *
d) Require urgent surgical treatment.
e) Diagnosed by antegrade urethragraphy.

34.Car seat belts when properly adjusted


a) Prevent injuries to abdominal organs.
b) May cause small bowel injuries. *
c) Do not reduce the incidence of head injuries of passengers
involving in RTA.
d) Protect the cervical spine during sudden acceleration .
e) A & D only

35. In head trauma patient after control of air way , the first
diagnostic study
a)
b)
c)
d)
e)

X-rays of the skull.


CT scan of the head.
X-rays of cervical spine *
Carotid angiography.
Lumber puncture.

10

Burns
36. Estimation of the area of a burn: ( all correct except one)
a)
b)
c)
d)

Is of very little clinical significance. *


Provides important prognostic information.
Is an important factor in the estimation of the fluid required.
Can be based on a formula which states that the adult trunk is 36 per
cent of the whole body surface area.
e) Should be recorded in each chart of burned patient.
37. Patients with major burns:
a)
b)
c)
d)
e)

Are in a negative nitrogen balance. *


Have normal calorie requirements.
Do not generally become anaemic.
Are resistant to septicaemia.
All of the above.

38. Scalds:
a)
b)
c)
d)
e)

Are more frequent in children. *


Commonly cause full thickness skin loss.
Should be skin grafted within 48 hours of the injury.
Need routine antibiotic treatment.
All of the above.

39. Major burns are sometimes complicated by: (all correct


except one)
a)
b)
c)
d)
e)

Acute gastric and duodenal ulcers.


Paralytic ileus.
Cerebral oedema.
Mesenteric thrombosis. *
Septicemia.

11

Shock and blood transfusion


40.In all forms of shock there is:
a) An impairment of cellular oxygenation. *
b) A decreased cardiac output.
c) An increased effective circulating fluid volume.
d) A low central venous pressure (CVP).
e) An increased pulse rate.
41.The metabolic acidosis of shock can be effectively treated by:
f) Warming the patient.
g) Administering ammonia chloride.
h) Artificial ventilation.
i) Restoring normal tissue perfusion. *
42. Nacl intravenous infusion. siptic shock is associated with a
hypodynamic cardiovascular state: ( all correct except one)
j) if preceded by existing hypovolaemia.
k) In generalized peritonitis.
l) When there is a gram-positive bacteraemia. *
m) In elderly patients.
n) In late gram negative septicemia.
43. In cardiogenic shock:
o) The central venous pressure is low. *
p) The difference in the arteriovenous oxygen tension is increased.
q) The haematocrit is raised.
r) The blood pressure is unaffected.
s) C&D only.
44. A blood transfusion reaction: (all correct except one)
t) May be due to incompatibility of the recipient serum and donor
cells.
u) Is manifest by thrombophlebitis of the infusion site. *
v) Occurs within the first 30 minutes of transfusion.
w) May produce renal damage.
x) May produce anaphylactic shock.
45. Massive blood transfusions may be complicated by:
y) Hyperkalaemia.
z) Hypocalcaemia.
aa)Coagulopathy.
bb)
Leucopenia. *
cc)DIC.
12

Fractures
And
Dislocations
46. In a healing fracture: (All correct except one)
A.
B.
C.
D.
E.

The haematoma is initially invaded by osteoblasts. *


The tissue formed by the invading osteoblasts is termed osteoid.
Calcium salts are laid down in the osteoid tissue.
The final stage of repair is the remodelling of the callus.
The callus formation is related to the amount of stress at fracture side.

47. Non-union is often seen in:


A.
B.
C.
D.
E.

Fractures of the 4th metatarsal.


Fractures of the neck of the femur. *
Fractures of the condyle of the mandible.
Colles fractures.
Oblique fracture line of femur.

48. In a colles fracture the distal radial fragment:


A.
B.
C.
D.
E.

Is dorsally angulated on the proximal radius. *


Is usually torn from the intra-articular triangular disc.
Is deviated to the ulnar side.
Is rarely impacted.
Is ventrally displaced.

13

Skin And Breast


49. A malignant melanoma:
A.
B.
C.
D.
E.

Frequently arises from hair-bearing naevi.


Frequently arises from junctional naevi. *
Has a worse prognosis when it areses on the leg.
Should be suspected in any big pigmented lesion.
Non of the above is correct.

50. Squamous cancer of the lip:


A.
B.
C.
D.

Is most common in early adult life.


Is more common in fair skinned subjects. *
Metastasises readily by the blood stream.
Is preferably treated by radiotherapy once lymph node deposits are
present.
E. All of the above are correct.
51- Basal cell carcinomas:
A.
B.
C.
D.
E.

Usually metastasise to regional lymph nodes.


Are less common than squamous cell carcinomas.
Are characterised histologically by epithelial pearls.
Are particularly common in oriental races.
Non of the above is correct. *

52- Fiboadenomata of the breast:


A. Are commonest in early adult life.
B. Are indiscrete and difficult to distinguish.
C. Are usually painless.
D. Resolve without treatment.
E. A&C only. *
53 Pagets disease of the nipple:
A.
B.
C.
D.
E.

Usually presents as abilateral eczema of the nipple.


Is always related to an underlying breast cancer. *
Indicates incurable breast cancer.
Has non-specific histological characteristics.
A&C only.
14

Extrahepatic Biliary System


54- Gallstones: (all correct except one)
A. Have an incidence which increases with age.
B. Are more frequent in females.
C. Usually contain a predominance of cholesterol.
D. Are formed in bile which is supersaturated with bile acids. *
E. Are formed in bile which is supersaturated with cholesterol.
56- stones in the common bile duct:
A.
B.
C.
D.
E.

Are present in nearly 50 per cent of cases of cholecystitis.


Often give rise to jaundice, fever and biliary colic. *
Are usually accompanied by progressive jaundice.
Are usually associated with a distended gallbladder.
A&D only.
Colon, Rectum And Anus

57- Ulcerative colitis:


A. Is more common in female than males.
B. Appears most commonly between the ages of 20 and 30.
C. Usually presents with abdominal discomfort and diarrhoea.
D. Can usually be diagnosed on sigmoidoscopic examination.
E. All of the above correct. *
58- Diverticular disease of the colon:
A. Often presents with lower abdominal pain.
B. May present with severe rectal haemorrhage.
C. May present with peritonitis.
D. All of the above are correct. *
59- Colonic polyps: (all correct except one)
A. Are associated with colonic cancer.
B. May be hereditary.
C. Should not be removed if they are asymptomatic. *
D. May be hyperplastic.
E. Are commonly adenomatous.

15

Thyroid,Parathyroid
60- Signs and symptoms of hyperthytoidism include:
(All correct except one)
A.
B.
C.
D.
E.

Decreased sweating. *
An irregular pulse rate.
Cardiac failure.
Diplopia.
Loss of weight.

61- a multinodular (adenomatous) goitre:


A.
B.
C.
D.

Is more common in those patients having a deficient iodine intake.


Is usually preceded by a diffuse goitre in early adult life
Is rarely a precancerous condition.
Is effectively treated in early stage with thyroid hormones to prevent
further adenomatous changes.
E. All of the above. *
62- Hashimotos desease:
A. Is often associated with increased levels of cerculating thyroid
antibodies.
B. Is characterised by lymphocytic infiltration and fibrosis of the thyroid
gland.
C. Is usually treated by sub-total thyroidectomy.
D. Should be treated by anti-thyroid drugs.
E. A&B only. *
63- The surgical treatment of thyroid cancer:
A. Should be by total thyroidectomy in the potentially curable patient.
B. Should include block dissection of the neighbouring lymph nodes
whether or not they appear to contain tumour.
C. Is most successful in the papilary type of cancer.
D. Should be preceded by a therapeutic dose of iodin 131.
E. A& C only. *
16

64- The earliest symptoms of hyperparathyroidism include:


A.
B.
C.
D.
E.

Diarrhoea.
Polydipsia and polyuria. *
Unexplained weight gain.
Mucle spasm
C&D only.

65- Phaeochromocytomata:
A.
B.
C.
D.
E.

Are tumours of the spinal nerve roots.


Are frequently multiple. *
Characteristically present with a yellow skin discolouration.
Can be effectively managed by long term medical therapy.
C&D only.

66- In cushings syndrome:


A.
B.
C.
D.
E.

There is usually an increased deposition of fat over the face and trunk.
Hypotension ans hypokalaemia are frequently present.
There is an increased production of adrenal hormones.
The cause is most frequently an adrenal tumour.
A&C only. *

17

Surgical Infection

67- Streptococcal infections:


A.
B.
C.
D.
E.

Are characterised by abscess formation.


Rarely produce lymphadenitis.
Do not produce baceraemia.
Can produce a gangrenous skin infection. *
All of the above.

68- A pelvic abscess:


A. Lies extrapeitoneally.
B. May be a complication of abdominal surgery. *
C. Rarely presents with diarrhoea.
D. Should be treated with antibiotics alone.
E. A&C only
69-Heavily contaminated and dirty wounds:
A.
B.
C.
D.
E.

Require surgical toilet and delayed closure.


Require the administration of systemic antibiotics.
Can usually be treated by wound toilet and primary closure.
Should be totally excised.
A&B only. *

70- Inguinal herniae:


A. In children are usually of the direct type.
B. Of the indirect type are congenital in origin. *
C. Will regress spontaneously in children.
D. In young adults are most commonly of the direct type.
E. C&D only.
71- Strangulated contents of hernial sacs:
A. Are always accompanied by intestinal obstruction.
B. Are more common in direct than indirect inguinal herniae.
C. Are usually reducible.
D. Produce local pain and tenderness. *
E. All of the above
18

72- Incisional herniae are related to:


(All correct except one)
A. Wound infections.
B. Anaemia and malnutrition. *
C. Obesity.
D. The use of absorbable suture materials.
E. To the technique of wound closure.
73- True statements concerning a femoral hernia include which of the
following?
A.
B.
C.
D.
E.

It is common in male.
It is usually results from a defect in lateral part of transversalis fascia.
It is common in children.
It is less common in female.
It may be confused with inguinal lymphadenopathy. *

19

Vascular Systems
74- Acute arterial occlusion:
A. Should be treated conservatively if the site of the occlusion is above
the inguinal ligament.
B. Demands the urgent use of vasodilator drugs.
C. Of a limb is usually painless due to the anoxic damage produced in
the peripheral nerves.
D. May produce irreversible muscle necrosis after 6 hours. *
E. B&C only.
75- Common sites for atheromatous arterial aneurysms are:
A.
B.
C.
D.
E.

The femoral artery.


The middle cerebral artery.
The abdominal aorta.
Intrarenal.
A&C only *

76-The long saphenous vein:


A.
B.
C.
D.
E.

Arises on the medial aspect of the sole of the foot.


Passes 1cm in front of the medial malleolus. *
Passes in front the knee joint.
Enters the femoral sheath by piercing the fascia lata.
Related to the sural nerve

78- In deep venous thrombosis of the lower limb:


A.
B.
C.
D.
E.

One of the most common sites of origin is the short saphenous vein.
One of the common sites of origin is in the iliofemoral segment. *
The diagnosis can usually be made by clinical examination.
Tender swollen thrombosed veins are usually palpable.
Usually associated with varicose vein.

20

Neurosurgery
79- In head injuries the causes of a rising intracranial pressure: (all
correct except one)
A.
B.
C.
D.
E.

Intracerebral haemorrhage.
Cerebral oedema.
Rhinorrhoea. *
Meningitis.
Extradural hemorrhage.

80- Birth injuries involving the fifth and sixth cervicaal nerve roots of
the brachial plexus:
A. Are known as klumpkes palsy.
B. Are rarely followed by full recovery.
C. Are characterised by the arm being held in the pronated and internally
rotated position. *
D. Show weakness and wasting of the small muscles of the hand.
E. Non of the above correct.
81- Following a peripheral nerve injury:
A.
B.
C.
D.
E.

Loss of axon continuity is described as neuropraxia.


Due to gunshot wounds primary nerve repair is desirable.
Delayed suture is best performed one week after the injury.
Delayed suture is best performed three months after the injury.
None of the above is correct. *

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