2012 Flashcards
(146 cards)
1
Q
A 65-year old smoker presented with anorexia, fatigue, and vomiting. UGI Endoscopy revealed an ulcerative lesion of the incisura. Where is the incisura located? 2012
a. Body
b. Fundus
C. Greater Curvature
d. Gastrocolic ligament
e. Lesser Curvature
A
e. Lesser Curvature
2
Q
How would you resuscitate a patient in shock? 2012
a. Standardized size lumen Femoral Central Line
b. Bilateral 16g Peripheral Cannula
c. Bilateral 22g Peripheral Cannula
d. Unilateral 16g Peripheral Cannula
e. Unilateral 22g Peripheral Cannula
A
b. Bilateral 16g Peripheral Cannula
3
Q
What is an indication for proctocolectomy in UC patients?
A
Toxic megacolon
4
Q
Which of the following structures has venous drainage to both the portal vein and IVC? 2012
a. Stomach
b. Duodenum
c. leum
d. Rectum
A
d. Rectum
5
Q
A stone in the ureteropelvic junction of 10 mm in size. How will you treat it? 2012
a. PCNL
b. Ureteroscopy
c. ESWL
A
c. ESWL
*For upper ureteric stones > 5 mm we start with ESWL and if failed -> flexible Ureteroscopy + laser. Maybe the question had info to help exclude one of them; like mentioning rigid ureteroscopy, which is used for lower ureteric stones. ESWL is contraindicated in pregnancy, if the patient is on anticoagulation, active UTI, acute urinary obstruction.
6
Q
A 27-year-old female in her late first trimester was diagnosed with acute bacterial cystitis on routine U/A. What is the most appropriate treatment? 2017, 2012
a. Nitrofurantoin for 3 days
b. Trimethoprim for 5 days
c. Cephalosporin for 7 days
d. Cefazolin for 7 days
e. Ciprofloxacin for 7 days
f. Levofloxacin for 7 days
A
a. Nitrofurantoin for 3 days
7
Q
13.A 74-year old male complains of LLQ pain. Physical examination revealed localized tenderness. No peritonitis. Abdominal x-ray was normal. WBC count was 16×10°. What is the investigation? 2012
a. Barium enema
b. Abdominal ultrasound
C. Abdominal CT
d. Colonoscopy
e. Laparoscopy
A
C. Abdominal CT
8
Q
A 29-year-old woman presents with a recent history of obstructive jaundice and abdominal pain. She was found to have a high level of conjugated bilirubin and an INR of 1.8. Dilated common bile duct was detected on abdominal ultrasound. What would be the cause of her elevated INR? 2012
a. Chronic liver dysfunction
b. Vitamin K deficiency
A
b. Vitamin K deficiency
9
Q
A 27 year old female patient with biliary pancreatitis. What would be the definitive treatment for her condition? 2013, 2012, 2011
a. Cholecystectomy in the same admission when the pain resolves
b. Cholecystectomy when the amylase becomes normal
c. Endoscopic retrograde cholangiopancreaticography
A
a. Cholecystectomy in the same admission when the pain resolves
10
Q
13.A hypertensive man post TURP. His creatinine is 5000 and is euvolemic. What do you give him? 2012
a. ACEI
b. CCB
c. Diuretics
A
c. Diuretics
11
Q
28.A 40-year old female came with positive nuclear imaging of a hot nodule on the right thyroid lobe. What’s the next step? 2012
a. Radioactive iodine
b. Resection of the nodule with negative 1-cm margins
c. Right hemithyroidectomy
d. Total Thyroidectomy
A
b. Resection of the nodule with negative 1-cm margins
12
Q
32.In patients with BRCA1 gene mutation, which of the following has proven to be effective to prevent the risk of breast cancer? 2012
a. Close follow up
b. Prophylactic bilateral mastectomies
c. Radiation Therapy
d. Tamoxifen
e. Yearly MRI
A
b. Prophylactic bilateral mastectomies
13
Q
27.Which brachial arch gives rise to superior parathyroid glands? 2012
a. I
b. Il
c. Ill
d. IV
e. V
A
d. IV
14
Q
Sign and symptoms and labs of septic arthritis with normal x-ray. What is the appropriate next step in management along with IV antibiotics?
a. Open total debridement
b. Arthroscopic aspiration
A
b. Arthroscopic aspiration
*Must do aggressive arthroscopic aspiration and irrigation or open debridement if tools are not available
15
Q
A 50-year old lady known to have gallstones came with Epigastric pain radiating to the back. On P/E, tve sign of peritonitis, Serum amylase was 650. Which of the following indicate a poor prognostic factor? 2012
a. Arterial PO2 = 7
b. Pyrexia= 38.5 Celcius
c. WBC count= 10 X 109
d. Age > 50
e. Serum Amylase > 650
A
a. Arterial PO2 = 7
(Ranson’s criteria)
16
Q
31.A patient with a history of breast cancer that was resected now presented with back pain.
She is diagnosed with a compression fracture. What imaging technique will you perform next? 2012, 2010
a. Bone scan
b. No further imaging is needed
A
a. Bone scan
17
Q
Bloody nipple discharge. What is the least likely diagnosis? 2012
a. Breast cyst
b. Ductal carcinoma
A
a. Breast cyst
18
Q
A 30 year old woman with 5 days Post Laparoscopic Cholecystectomy was discharged and came back to the hospital complaining of fever and RUQ pain. Bilirubin and Liver Enzymes were NORMAL. What is the most appropriate next step? 2012
a. Abdominal
b. U/S
c. HIDA Scan
d. ERCP
e. MRCP
A
(People argued between HIDA scan and U/S because of possibility of an Abscess - Also this question is part of the 5-Ws of post-op fever)
This is a case of post-cholecystectomy syndrome. First thing to do is LFTs and US. If it showed fluid collection or stones or pancreatitis, you treat accordingly. And if there’s a leak, we would do HIDA.
19
Q
12.The major blood source of the liver comes from: 2013, 2012
a. Common Hepatic Artery
b. Cystic Artery
c. Left Hepatic Artery
d. Portal Vein
e. Right Hepatic Artery
A
d. Portal Vein
20
Q
23.An elderly patient known to have AFib had an episode of acute mesenteric ischemia after surgery. What is the most likely origin of the embolism/thrombus? 2012
a. Heart
b. Calves
c. Upper extremity
A
a. Heart
21
Q
A 2-months year old child with developmental dysplasia of the hip (DDH), what’s the management?
A
Pelvic harness
22
Q
21.A patient post-thyroidectomy, four hours later developed perioral numbness, confusion, and prolonged QT interval in the ECG, what is the next step in management? 2012
a. Order blood count, BUN, and corrected calcium
b. Give oral calcium
c. Give IV calcium Gluconate
A
c. Give IV calcium Gluconate
23
Q
Parkinon’s patient, has dysuria and turbid urine. Which of the following is he likely to have? 2012
a. Cysteine
b. Uric acid stone
c. Magnesium ammonium phosphate
A
c. Magnesium ammonium phosphate
24
Q
A female patient with recurrent UTI and on chronic laxatives for constipation, what kind of stone do you think she has? 2012
a. Calcium oxalate
b. Uric acid
c. Cysteine
d. Magnesium ammonium phosphate
A
d. Magnesium ammonium phosphate
25
13.What will you give the patient in the previous question? 2012
a. ACE inhibitor
b. Adrenaline
c. Beta blockers
d. Promethazine
(The nurse called you because a patient who took penicillin now has swollen lips and cannot breathe.)
b. Adrenaline
26
How long do you stop aspirin for before an elective hernioplasty? 2012
a. 1-4 hours
b. 1 day
c. 3 days
d. 5 days
e. 7 days
e. 7 days
*The life cycle of platelets ranges from 7-10 davs
27
Patient came with an acute onset of RLQ pain. The patient said that the pain started as umbilical pain followed by nausea and vomiting then RLQ pain. The patient was diagnosed with appendicitis. Blood samples were taken from the patient. What is the first step in taking blood samples from the patient according to protocol? 2012
a. Clean patient's hand
b. Wear gloves
c. Identify the patient info and reason for blood sampling
d. Place tourniquet
c. Identify the patient info and reason for blood sampling
28
A young male who has a 2.5 cm renal stone with negative urine culture. What is the next step of management?
ESWL
29
A 13-year old obese boy with hypothyroidism presents with hip pain and limping. Which is the likely diagnosis?
-
30
What is the most common symptom of testicular cancer? 2012
a. Metastasis
b. Asymptomatic mass
c. Painful swelling
b. Asymptomatic mass
31
Patient presented in the ward with Erythema and tenderness at the surgical site 2 days after he had a knee surgery. How do you treat this patient?
Antibiotics with Arthroscopy
32
A young man presents to the surgery clinic with a history of chronic anal fissure. What is the treatment option available for this patient? 2013, 2012, 2011
a. GTN ointment
b. Fissurectomy
a. GTN ointment
Note: Chronic anal fissures should be initially treated with topical pharmacologic agents, e.g., calcium channel blockers or nitrates. Patients who fail to respond to conservative or medical therapy can be referred to surgery.
33
11.Bleeding varices refractory to medical and endoscopic treatment. What is the next step of management?
Sengstaken-blakemore tube
34
13.You were called by the ICU to assess a 43 year old male 2 hours after inserting an internal jugular vein catheter after uncomplicated partial liver surgery. He has a history of myocardial infarction and bronchial asthma. The patient appears to be short of breath and is unwell. Vital signs are HR 120, BP 95/50, T 37.2, O, sat. 87%. What is the diagnosis or cause?
2012, 2010
a. Atelectasis
b. Aspiration pneumonia
c. Myocardial infarction
d. Pneumothorax
e. Pulmonary embolism
d. Pneumothorax
*Common after inserting a central line, that's why you might order a CXR
35
A 50 year old diabetic presented with a history of BPH he did not pass urine for the last 12 hours. What is the condition called?
Acute urinary retention
36
Patient was involved in a car accident and presented with bleeding. He is known to be on warfarin. What can we give to counteract the effect of warfarin immediately? 2013, 2012
a. Cryoprecipitate
b. Factor 7
c. Fresh Frozen Plasma
d. Platelets
c. Fresh Frozen Plasma
Acute bleeding = stop warfarin + give FFP
Supratherapeutic IN without bleeding = stop warfarin + give vit K (reduces IN with 1-2
days)
37
22.Which of the following causes upper Gl bleeding in a major traumatic brain injury? 2012
a. AV malformation
b. Curling Ulcer
c. Cushing's Ulcer
d. Dieulafoy Ulcer
c. Cushing's Ulcer
38
Which mutation is in patients with no family history of colon polyps or cancer? 2012
a. APC
b. Kras
c. P53
d. MLH1
a. APC
39
A young male with recurrent swelling in the submandibular area (painful?) during an oral examination of his current presentation found a tender mass in the floor of the mouth. What is the best next step to investigate? 2012
a. CT neck
b. Neck ultrasound
c. Ultrasound guided needle aspiration
d. X-ray of the mandible
d. X-ray of the mandible
The likely diagnosis is sialolithiasis which can be easily visualized on an x-ray of the mandible. This might be correct since they're asking about the 'next' test.
40
What is an absolute indication for internal fixation of the shaft of the humerus? 2012
a. Segmental injury
b. Fracture angulated more than 20°
c. Brachial artery injury
d. Radial nerve injury
e. Comminuted
a. Segmental injury
(Indications for ORIF: failure to reduce fracture, bilateral humeral fractures, segmental fracture, open fracture + secondary radial nerve injury, extension to the joint, delayed union malunion non-union)
(If Radial nerve injury is primary, it's treated conservatively)
41
A young obese boy with a history of hypothyroidism reports a history of severe hip pain that is causing him to limp as he is unable to bear weight. On flexion of the hip there's a forced external rotation. What is the likely diagnosis? 2016, 2012, 2011, 2010
a. Juvenile osteoarthritis
b. Development Dysplasia of the Hip (DDH)
c. Limb Length Discrepancy (LLD)
d. Legg-Calve-Perthes Disease (LCPD)
e. Slipped Capital Femoral Epiphysis Disease (SCFE)
e. Slipped Capital Femoral Epiphysis Disease (SCFE)
42
A patient with a horseshoe kidney. What prevents the kidney from rising further upwards during the embryology process? 2012
a. Superior mesenteric artery
b. Inferior mesenteric artery
b. Inferior mesenteric artery
43
What is the most common type of bladder cancer? 2012
a. Secondary metastasis
b. Sarcomatous carcinoma
a. Secondary metastasis
44
Colon Cancer Metastasis to the liver occurs by which route of spread? 2012
a. Direct Extension
b. Portal Circulation
c. Lymphogenous
d. Hematogenous
b. Portal Circulation
45
A male patient underwent a surgery for rectal adenocarcinoma. He now presents with abdominal distention and pain (maybe fever too). White cell count was high, CT showed a 12x10 mass in the right iliac fossa around the drain. It is serosanguinous. How to elicit the diagnosis? 2012
a. Drain creatinine
b. Drain bilirubin
c. Repeat CT
d. Colonoscopy
a. Drain creatinine
(diagnostic approach to rule out ureteral injury with urine leak)
46
A 13-year old patient fell off his bike and presented with arm pain. X-ray showed an ill-defined region with a poor transitional zone. What's the next step?
Neoadjuvant Therapy and Tumor Resection
47
18.A young patient with Crohn's disease developed severe pain which was diagnosed to be caused by ileus stenosis. What's the next step of management? 2012
a. Intensive course of corticosteroids
b. Humira
c. Surgery
d. Continue the same treatment and follow up
c. Surgery
48
A 24-year-old female diagnosed with breast cancer; her genetic testing revealed BRCA1 mutation. What other type of cancer is it commonly associated with? 2017, 2012
a. Ovarian
b. Parathyroid
c. Prostate
a. Ovarian
49
A boy came with symptoms of testicular torsion of 4 hours duration. You want to take him for surgical exploration but his father is worried and thinks you might have the wrong diagnosis. What do you do? 2012
a. Urgent Ultrasound
b. Urgent Nuclear scan
c. Convince the father that this is an urgent procedure
a. Urgent Ultrasound
*Nuclear scan will take a long time; we consulted urologists about this question (bc of the father issue)
50
10.If the same patient needs an emergency surgery, what can we give to stop the effects of aspirin? 2012
a. Cryoprecipitate
b. Factor 7
c. Fresh Frozen Plasma
d. Platelets
e. Prothrombin concentrate
d. Platelets
51
A 30 year old female came with a 2 month history of tremor that prevented her from doing her job properly, she is a typist. she had weight loss around 7 kg. neck examination of thyroid was normal. what could be the cause? 2012
a. Grave's
b. Toxic adenoma
c. Toxic multinodular goiter
b. Toxic adenoma
52
A 40-year old patient came to the clinic with dysuria and frequency. He denied having hematuria, or throat infection. Previous Medical history showed Well-Controlled Glucose levels and that he had straddle injury 10 years ago while riding a horse. What is the diagnosis? 2012
a. Urethral injury
b. Diabetic Neuropathy
a. Urethral injury
Note: Neuropathy is a microvascular complication that can be prevented with glucose controlled
53
A 2-month-old male child with suspected DDH. He is the first born, and the mother had a normal delivery. What is the most appropriate test? 2012
a. U/S
b. Ortolani and Barlow test
a. U/S
54
A 34-year-old male came to the clinic following hernia repair 5 weeks ago. He complains of ipsilateral small testes. What can explain his symptoms?
Injury to testicular artery
*It should be injury to the pampiniform plexus of veins not injury to the testicular artery.
Ischemic orchitis happens more commonly due to thrombosis of the venous plexus causing eventual blood flow reduction, arterial injury is a much less common cause. It's a tricky question
55
Fistula involving the internal sphincter muscle. How do you manage? 2012
a. Seton placement
b. Lateral sphincter dissection
a. Seton placement
56
14.Where does the volvulus mostly occur? 2012
a. Cecum
b. Ileocecal valve
c. Sigmoid
d. Stomach
c. Sigmoid
57
Patient present with foot drop. Which nerve is affected?
Common Peroneal Nerve
58
A 35-year-old man has a history of chronic lower back pain that sometimes shoots along his left lower limb. He is a labor worker and once after lifting a few heavy boxes, he suddenly developed a markedly severe back pain associated with lower limb weakness. Spine MRI showed disc prolapse at L5-S1 level. What is expected to be found on neurological examination of the lower limb? 2012, 2011
a. Loss of plantar flexion and an absent ankle reflex
b. Loss of great toe extension and an absent ankle reflex
c. Loss of knee extension and absent jerk reflex
a. Loss of plantar flexion and an absent ankle reflex
Note: A prolapsed disc affects the nerve root below it. In this vignette, S1 spinal root is compressed leading to loss of the neurological functions it mediates, i.e. plantar flexion and ankle reflex.
59
30.A patient with retrosternal goiter causing difficulty breathing and the patient is undergoing an operation to remove it. Which of the following is the least important test to be done? 2012
a. СТ
b. FNA
c. Laryngoscopy
d. Spirometry and PFT
e. US
d. Spirometry and PFT
*FNA should be done to rule out malignant transformation which will change the entire treatment plan.
60
A patient admitted for gallstone pancreatitis. A few hours later, he became hypotensive and tachycardic. ABG: low O2, low PH , normal CO2. Xray showed bilateral lung infiltrate
a. Acute respiratory distress
b. pancreatic pseudocyst
c. necrotizing pancreatitis
d. DIC
Acute respiratory distress
61
Numbness in the anterior part of the scrotum and pubis. Which nerve is affected? 2012
a. lioinguinal
b. Genitofemoral
b. Genitofemoral
62
A patient with hypoxia and difficulty breathing post-abdominoplasty. What do you do next? 2012
a. Administer thrombolytic
b. Spirometry and chest physio
-
63
A 45-year-old female presented with right upper quadrant pain, leukocytosis, nausea and vomiting. Ultrasound showed acute cholecystitis.What is the next step?
Cholecystectomy
64
Which of the following markers is elevated in hepatocellular carcinoma? 2016, 2013, 2012
a. AFP
b. B-HCG
C. CA19-9
d. CA25
a. AFP
65
12.The nurse called you because a patient who took penicillin now has swollen lips and cannot breathe. What is the mechanism behind this? 2012
a. Antibody mediated hypersensitivity
b. Cell-mediated hypersensitivity
c. IgE-mediated hypersensitivity
d. IgM-mediated hypersensitivity
c. IgE-mediated hypersensitivity
66
A 35-year old patient k/c/o Ulcerative Colitis. Which of the following is an indication of total proctocolectomy? 2012
a. IDA
b. Sclerosing Cholangitis
c. Occasional Bouts of Diarrhea
d. Toxic Megacolon
b. Sclerosing Cholangitis
67
16.Two days after the cholecystectomy, the patient developed fever and RUQ pain, normal liver enzymes and bilirubin, what is the next step? 2012
a. Abdominal ultrasound
b. ERCP
c. HIDA
d. PTC
a. Abdominal ultrasound
*A HIDA scan can help me diagnose a leak, but 'next step' should be abdominal ultrasound to check if there is a collection; in my opinion.
68
A 40 year old IV-drug user presented with a 2-weeks history of thigh pain and limping. P/E showed tenderness in the midshaft of femur with no masses or swellings. He had occasional fever and night sweats. Recent lab investigations showed high WBCs, high ESR, and high
CRP. Which of the following will confirm the diagnosis? 2012
a. Bone Scan (Triple-Phase)
b. CT
c. MRI
d. U/S
e. X-rays of the femur
Note: Not sure what's the answer in MSD (Week 27 - Orthopedics) Surgery Seminar says it confirms diagnosis 24-48 hrs after the onset but i also think X-ray could be right. (Please check)
69
21.A patient presented with hematemesis and has a long history of consuming alcohol. What is the diagnosis? 2012
a. Esophageal varices
b. Ulcer
b. Ulcer
(Mallory weis tear wasn't in the options)
*Most common cause of upper Gl bleeding even in ethanol consumers. It depends on the patient's presentation, if he's chronic liver disease and painless hematemesis it's most likely varices
70
A patient presented with numbness on the medial side of the thigh. Which nerve is involved?
Ilioinguinal nerve
71
A young patient with Cohn's underwent ileocecal resection. After the procedure, he was doing well and gained weight. He presented a few weeks later with diarrhea without pain or fever. What is the most likely cause of his diarrhea? 2012
a. Short bowel syndrome
72
12.What is the most common complication of prostate biopsy guided transrectal US? 2012
a. Hematuria
b. Sepsis
c. Bleeding per rectum
a. Hematuria
73
Which muscle maintains the anorectal angle and anal continence? 2012, 2011
a. Coccygeus
b. Obturator internus
c. Puborectalis
c. Puborectalis
74
A man with a kidney stone detected on KUB. How to confirm?
СТ KUB
75
23.A 61-year-old woman develops whitish discharge from both of her breasts. Physical examination of the breast is otherwise normal. What is the appropriate next step in investigating this patient? 2013, 2012, 2011
a. Bilateral ductogram
b. Check her prolactin level
c. LH and FSH ratio
d. Order a breast ultrasound
b. Check her prolactin level
Bilateral milky nipple discharge highly suggests galactorrhea. Diagnosed by serum prolactin and CT/MRI of pituitary gland
76
A 50-year-old male presented with left lower quadrant pain, constipation, and bleeding per rectum. He also had signs of infection. What is the next step in management? 2016, 2012
a. Barium enema
b. CT abdomen
c. Colonoscopy
b. CT abdomen
The scenario is suggestive of diverticulitis
77
A 12-year old boy fell off his bike on his outstretched hand and felt pain. On inspection, there was swelling on his right forearm. Imaging showed discontinuity (fracture) of one cortex whereas the other cortex is intact of the distal radial bone. What is the fracture called? 2012
a. Greenstick Fracture
b. Buckle fracture
a. Greenstick Fracture
78
A 40 year old with tibial fracture and above knee cast. She is experiencing knee pain for four hours and swelling. What do you do? 2012
a. remove cast
b. below knee cast
c. fasciotomy of all compartments
d. measure intracompartmental pressure
a. remove cast
79
10.A 45 y/o male patient presented with anal discharge. What is the treatment of intersphincteric fistula?
Stent placement
80
Which of the following is an early sign of xylocaine (lidocaine) toxicity? 2016, 2015, 2013,
2012
a. Cardiac arrhythmia
b. Perioral numbness
c. Seizures
b. Perioral numbness
Lidocaine is a class I antiarrhythmic drug, its toxicity can cause both cardiac and CNS manifestations, but CNS is by far the most common. However, early symptoms of its toxicity are circumoral numbness, tongue paresthesia, and dizziness. Sensory complaints may include tinnitus and blurred vision. Excitatory signs, such as restlessness, agitation, nervousness, or paranoia, may progress to muscle twitches and seizures.
81
A patient with UPJ narrowing, what is the best imaging method? 2012
a. Plain KUB
b. CT
c. Retrogram
d. Ultrasound
d. Ultrasound
*screen by US, diagnose by DMSA diuretic renal scan to quantify renal function and define extent of obstruction
82
Lady with rebound tenderness and rigidity. Her WBCs are high. What is the best next step?
Erect chest x-ray
83
Where does this pain originate from if it is retrosternal and radiates to the sides of the chest and is aggravated by leaning forward? 2012
a. Esophagus
b. Heart
c. Pancreas
d. Stomach
a. Esophagus
84
What is the most common cause of a fistula between the bladder and uterus? 2012
a. Radiation
b. Obstructed prolonged labor
c. Cesarean section
d. Direct trauma
b. Obstructed prolonged labor
*Worldwide, it's obstructed prolonged labor. In developed countries, it's gynecologic surgery, particularly hysterectomy.
85
What is found in both the inguinal canal and femoral canal?
Inguinal ligament
86
Posterior duodenal ulcer bleeding. Which artery is involved? 2012
a. Celiac artery
b. Gastroduodenal
c. Right Gastroepiploic artery
d. Splenic artery
b. Gastroduodenal
87
What treats Bilharzia?
Anti-protozoan drugs
88
14.Post op patient with SOB. X-ray showed bilateral filling defects. ABG showed low P02 and normal CO2. What is your diagnosis?
Respiratory failure type 1
89
Which ligament provides the most stability to the pelvic bone? 2013, 2012
a. Sacroiliac ligament
b. Sacrotuberous ligament
c. Sacrospinous ligament
d. pubic symphysis
a. Sacroiliac ligament
90
What is meant by upper Gl bleeding?
Bleeding above the ligament of Treitz
91
A 44-year-old man was immediately taken to the hospital after being in a car accident. On measuring his vital signs, his blood pressure was 88/64 mmH, and heart rate was 52/mins. What type of shock does this trauma patient have? 2012, 2011
a. Neurogenic shock
b. Hypovolemic shock
c. Cardiogenic shock
d. Septic shock
e. Anaphylactic shock
a. Neurogenic shock
Note: Trauma patients with spinal cord injury are prone to develop a state of shock due to the interruption of sympathetic outflow below the site of the lesion, a phenomenon called neurogenic shock. This leads to vasodilation, hypotension and bradycardia; the latter is due to the unopposed vagal output.
92
A 70 year old male with yellowish discoloration of the sclera and tea colored urine for 3 days. He denies pain. He reports smoking 3 packs of cigarettes for the past 45 years. What diagnostic test would be used? 2012
a. CT
b. MRI
c. U/S
d. ERCP
e. Endoscopy
a. CT
Note: the diagnosis is pancreatic cancer of the head >> causing obstructive jaundice (not sure)
93
A 30-years old male came to the hospital with a history of extramarital relationship presenting with fever and an erythematous, tender testicle. What is the diagnosis?
Epididymo-orchitis
94
16.Patient with staghorn stone but minimal calyceal dilation, how to treat it? 2012
a. PCNL
b. ESWL
c. ureteroscopy
d. Open ureterolithotomy
a. PCNL
*Small staghorn stones that don't change the anatomy of the kidney can be removed by PCNL
95
A 64-year-old man was admitted to the ward for pneumonia. Intravenous ampicillin was administered. Few days later, he presents with abdominal pain and diarrhea. Colonoscopy shows pseudomembranes. How should this patient be treated? 2012, 2011
a. Oral metronidazole
b. IV vancomycin
c. IV metronidazole
a. Oral metronidazole
Notes: Oral treatment with antimicrobial agents is the preferred mode of management of pseudomembranous colitis, with metronidazole being the preferred first line of treatment.
Reliable parenteral treatment does not exist.
96
A patient with acute pancreatitis. What is NOT associated with poor prognosis?
High amylase level
97
What is the most common histological type of bladder cancer? 2012
a. Squamous
b. Adenocarcinoma
c. Small cell carcinoma
a. Squamous
(transitional cell carcinoma wasn't in the options)
98
What is the most common complication of Meckel's diverticulum in adults? 2016, 2012
a. Ulceration
b. Bleeding
c. Perforation
d. Small Bowel Obstruction
d. Small Bowel Obstruction
99
A 25-year-old male presented with a mass in the midline of his neck. The mass moved with swallowing and also upon protrusion of the tongue. What is the most likely diagnosis? 2016, 2014, 2013, 2012
a. Branchial cleft cyst
b. Follicular nodule
c. Lipoma
d. Thyroglossal duct cyst
d. Thyroglossal duct cyst
100
A 30 year old female came to the family physician complaining of recurrent retrosternal chest pain associated with a bitter taste in her mouth. It increases after eating food and lying supine. Examination was completely normal. What test would confirm your suspicion of the above symptoms? 2013, 2012
a. 24 hour esophageal pH monitoring
b. Barium swallow
c. CT-Scan
a. 24 hour esophageal pH monitoring
101
What is the definition of nocturia? 2017, 2012
a. waking up at night to void where each micturition is preceded and followed by sleep
b. the total volume of urine passed between the time the individual goes to bed with the intention of sleeping and the time of waking with the intention of rising.
a. waking up at night to void where each micturition is preceded and followed by sleep
102
16.A 72 year old lady had a stroke. She is unable to see in the right lower quadrant of both visual fields, what is affected? 2012
a. Optic chiasm
b. Left parietal lobe
c. Right temporal lobe
d. Right optic radiation
b. Left parietal lobe
103
What electrolyte abnormality is associated with prolonged QT interval? 2012
a. Hypocalcemia
b. Hypermagnesemia
c. Hypokalemia
d. Hypomagnesemia
a. Hypocalcemia
104
A patient with 10 mm lower ureteric stone (with typical symptoms) and radiopaque stone seen on x-ray. What's your next step? 2012
СТ
105
A young man was involved in a car accident, there was a fracture of L4/L5 (not sure of the level but it was somewhere around L5) and the vertebral canal was completely occupied by a piece of the fracture, what do you expect to see when examining the patient? 2012
a. Babinski sign
b. Hyper-reflexia
c. Spinal shock
d. Urinary incontinence
d. Urinary incontinence
* The presentation would be of cauda equina, the most likely answer would be urinary incontinence (it's ideally retention, but overflow incontinence might follow later).
106
Which gene is initially mutated in colorectal carcinoma? 2012, 2011
a. APC gene
b. RAS gene
c. P53 gene
a. APC gene
107
15.Post op elderly patient not passing motion or flatus. He is otherwise ok with no fever. What is the mechanism of the underlying problem?
Hypokalemia
108
A 14-year-old patient was brought by his parents to the casualty presenting with severe left scrotal pain and swelling. The left scrotum was erythematous and very tender to palpation.
The left testis was high-riding, and the cremasteric reflex was absent on the left side. What is the diagnosis? 2012, 2011
a. Testicular torsion
b. Epididymo-orchitis
c. Torsion of testicular appendage
a. Testicular torsion
109
A 20 year old female patient presented with a 4 cm papillary thyroid tumor in the right lobe. How to manage? 2012, 2010
a. Total thyroidectomy
110
How would you manage this patient? (Patient with 10 mm lower ureteric stone (with typical symptoms) and radio-opaque stone seen on xray.)
a. Ureteroscopy and lithotomy
b. Conservative
a. Ureteroscopy and lithotomy
111
How do you manage a diabetic with retrograde ejaculation? 2012
a. Beta blockers
b. Alpha blockers
c. Alpha agonist
d. Not treated medically
c. Alpha agonist
* It is treated with TCA, Antihistamines, and Alpha-agonists
112
What best describes a total thyroidectomy wound? 2012, 2010
a. Clean-contaminated
b. Clean Wound
b. Clean Wound
113
A 56 years old diabetic male had symptoms of hesitancy, urgency, and dribbling of urine. His father has a history of BPH, and his uncle had prostate cancer. Ten years ago, he had a pelvic straddle injury. Now he presents with symptoms of urinary retention and his diabetes is controlled. What is the cause of his symptoms ? 2012
a. Prostate cancer
b. BPH
c. His symptoms are the result of his diabetes
d. Urethral stricture
d. Urethral stricture
114
A patient underwent an operation involving the surgeon cutting the gluteus minimus and maximus leading to unpainful limping. What is the gait called?
Trendelenberg gait
115
A 34-year-old female in a motorcycle accident, laparotomy and splenectomy was done.
What should be given to her before discharge? 2017, 2016, 2014, 2012
a. Meningococcal, H. influenza, pneumococcal
b. Pneumococcal and tetanus
c. Varicella zoster, meningococcal and tetanus
d. Meningococcal and hepatitis B
e. Tetanus only
a. Meningococcal, H. influenza, pneumococcal
116
A 21-year-old male patient has a recent onset of right iliac fossa pain, fever as well as nausea and vomiting. He says that the pain started around the umbilicus then shifted to his right lower quadrant. On physical examination, there was rebound tenderness in the right iliac fossa and a positive Roving sign. The patient had a temperature of 38.5 Co. What is the Rovsing sign?
a. Palpation of the left lower quadrant elicits pain in the right lower quadrant
b. Palpation of the right lower quadrant elicits pain in the left lower quadrant
c. Palpation of the left lower quadrant elicits pain in the suprapubic region
a. Palpation of the left lower quadrant elicits pain in the right lower quadrant
117
What is the embryological origin of the falciform ligament? 2017, 2013, 2012, 2011
a. Ductus venous
b. Umbilical artery
c. Umbilical vein
d. Urachus
c. Umbilical vein
118
A 38 year old female with RUQ pain, tenderness, elevated ALP, AST, ALT, GGT. She has a cystic lesion in the right (or left?) lobe. What is it? 2012
a. Liver abscess
b. Liver adenoma
c. HCC
a. Liver abscess
119
10.One complication of transurethral resection of the prostate is post- TURP syndrome. Which electrolyte abnormality is the hallmark of this complication?
a. Hyponatremia
b. Hypernatremia
c. Hypokalemia
d. Hyperkalemia
a. Hyponatremia
Note: Post-TURP syndrome is caused by absorption of a large volume of the hypotonic irrigation solution through the perforated venous sinusoids, leading to a hypervolemic hyponatremic state, and eventually confusion, nausea and vomiting, hypertension, and bradycardia.
120
Patient with a history of BPH and progressive reduction of urea last week couldn't pass urine for the last 12 hours. What is this called? 2012
a. Anuria
b. Oliguria
c. Acute retention
d. Chronic retention
c. Acute retention
121
13.Bird beak appearance on barium esophagogram. What is the most likely diagnosis?
Achalasia
122
A 45-year-old woman had a MVA. Her GCS score was 14/15, HR was 126 and BP 80/60 mmHg, O2 was 83% on oxygen mask, trachea was deviated with hyperresonant chest and decreased air entry in right chest. Tender abdomen with guarding and unstable pelvis. What is the most appropriate next step in management?
a. Needle tracheostomy
b. Chest tube
c. Needle thoracostomy
d. Intubation
e. Pelvic wrap
c. Needle thoracostomy
123
What is the substance that improves idiopathic male fertility/What is the most critical component of the sperm in spermatogenesis? 2012
a. Zinc
b. Copper
c. Magnesium
d. Calcium
e. Iron
a. Zinc
124
A 60 year old diabetic male complaining of waking up 4 times in the night to urinate, with burning sensation with some mild hematuria sometimes. He has never had these symptoms before. What is the appropriate next step?
Urinalysis and urine culture
125
21.A patient was involved in a car crash. He is in tachycardia and hypotension. GCS less than 8.
FAST was negative. What's the appropriate next step? 2012
a. Pelvic packing
b. Pelvic binder
c. Fluid resuscitation
b. Pelvic binder
126
Patient is a K/C/O Hepatitis C came with a U/S image of a focal lesion in the right lobe of the liver. He underwent a percutaneous liver biopsy and went home after that waiting for the lab results. However, before the lab results came out, the patient came to the emergency room with RUQ pain, jaundice, Hb level <7.7, and +ve fecal occult. What is the explanation? 2012
a. Hepatocellular carcinoma
b. Hemobilia
b. Hemobilia
127
Patient with a BMI of 35. What can decrease her risk of kidney stones? 2012
a. Bariatric surgery
b. Restrict Ca
c. Restrict Na
d. Restrict protein
e. Increase Ca
c. Restrict Na
Calcium restriction can aggravate the condition
128
Accident, seat belt mark was found, cervical spine is affected, name the injury:
Flexion distraction
129
A football player who heard a sudden pop while running, followed by immediate swelling and knee locking. On examination, the Lachman test was positive, the McMurray test was positive, but the posterior drawer test was negative. What is the diagnosis?
ACL and meniscus injury
130
11.A patient experienced a rectal/ anal mass that prolapses only during defecation but returns spontaneously afterwards. What is it? 2012
a. Grade I hemorrhoids
b. Grade II hemorrhoids
c. Grade Ill hemorrhoids
d. Grade IV hemorrhoids
b. Grade II hemorrhoids
131
Which nerve is most at risk of injury while ligating the superior pedicle during thyroidectomy? 2013, 2012
a. External Branch of superior laryngeal nerve
b. Internal Branch of superior laryngeal nerve
c. Recurrent laryngeal nerve
d. Vagal nerve
a. External Branch of superior laryngeal nerve
132
What is the advantage of synthetic mesh in the repair of inguinal hernia? 2017, 2014, 2012
a. Reduces Infection
b. Reduces Recurrence
c. Reduces operative time
d. Reduces risk of scrotal hematoma
b. Reduces Recurrence
133
A patient with a forearm injury after falling on an outstretched hand resulting in a fracture of the junction of the distal third of the radius with associated subluxation or dislocation of the distal radioulnar joint. What’s the fracture?
Galeazzi's Fracture
134
15.A lady presents with episodes of constipation and diarrhea. She had abdominal bloating.
Fecal occult blood, hematological, and biochemical tests were negative. What is her diagnosis?
a. Celiac
b. Crohn's
c. IBS
d. Ulcerative Colitis
c. IBS
135
15.Which is the mechanism of action of LMWH?
Against factor 10a
136
A young man was involved in a car accident, there was fracture of L4/L5 and the vertebral canal was completely occupied by a piece of the fracture. He was unable to move both legs on examination: loss of reflex, hypotonia. What's the condition? 2012
a. Anterior Cord
b. Brown Sequard
c. Spinal Shock
d. Neurogenic Shock
c. Spinal Shock
(neurogenic shock: no hints for hemodynamic instability)
137
What is the gold standard modality for the diagnosis of osteomyelitis? 2012, 2011
a. MRI
b. Bone scan
c. CT scan
d. Radiography
a. MRI
138
What antibiotics are prescribed for a pregnant woman with asymptomatic cystitis? 2012
a. Ciprofloxacin for 7 days
b. Levofloxacin for 5 days
c. Trimethoprim for 3 davs
d. Amoxicillin
e. Nitrofurantoin for 7 days
e. Nitrofurantoin for 7 days
139
How do you treat the previous patient? (50 year old diabetic presented with a history of BPH, he did not pass urine for the last 12 hours.)
Insert foley's catheter immediately
140
How do you treat the previous patient? (A 30-years old male came to the hospital with a history of extramarital relationship presenting with fever and an erythematous, tender testicle.)
Give Antibiotics
141
A 37 year old female with a 24 hour history of RUQ pain, positive murphy sign, and fever. The US showed acute acalculous cholecystitis. What is the next management?
Cholecystectomy
142
Gallbladder was found to be too distended when doing a lap chole. The surgeon decided to aspirate it and clear fluid came out. Why?
Complete obstruction with resorption of bile
143
Case of 3X4 cm cystic lesion in the right lobe in a 40-year old lady with increased ALP, ALT, AST. What is the most probable diagnosis? 2012
a. Hydatid Cyst
b. HCC
a. Hydatid Cyst
144
patient with uncomplicated diverticulitis on antibiotics and IV fluids. What can be done after 6 weeks? 2012
a. Colonoscopy
145
10.What do carcinoid tumor cells arise from?
Enterochromaffin cells.
Also known as kulchitsky cells
146
What are the left and right lobes of the liver defined by? 2017, 2012
a. Calot's triangle
b. Cantle line
c. Hepatic artery
d. Portal vein
b. Cantle line
