2015 - 7th

Question 1

Mechanism of action of Silodosin?
a. Phosphodiesterase inhibitor
b. Alpha blocker

Answer 1

b. Alpha blocker

Question 2

A patient presented to the ER after abdominal aortic aneurysm (AAA) surgery with fever and new heart murmur. It was found the she has (name of bacteria?). Sensitivity chart showed resistance to vancomycin. What will you give her?
a. Azathioprine
b. Ciprofloxacin
c. Gentamycin
d. Linezolid

Answer 2

d. Linezolid

Question 3

A 20-year-old diabetic and heavy smoker presented with sustained tibial lower third fracture. What type of non-union this patient will have?
a. Hypertrophic
b. Atrophic
c. Oligotrophic

Answer 3

b. Atrophic

Question 4

A male patient had open pelvic fracture. Post-operatively, he developed numbness in the anterior scrotum and anterior pubis. Which nerve was affected?
a. Femoral
b. Obturator
c. Ilioinguinal
d. Genital branch of genitofemoral
e. Ilio-hypogastric

Answer 4

d. Genital branch of genitofemoral

Question 5

A patient presented with shock. He had multiple injuries, including a simple pneumothorax, pelvis fracture, etc. What is the cause of his shock?
a. Cardiac arrhythmia
b. Anaphylaxis
c. Bleeding

Answer 5

c. Bleeding

Question 6

A patient presented to the ER after a street fight. He punched a man in his face and now has a laceration extending the width of his dorsal aspect of the hand over his metacarpophalangeal joints (We assumed it was from hitting the teeth of the other man). Which of the following pathogens will you cover in his antibiotic regimen?
a. Pasteurella multocida
b. Streptococcus bovis
c. Eikenella echinococcus

Answer 6

c. Eikenella echinococcus (A common pathogen acquired from human bites)

Question 7

Patient has a BMI of 35. He developed cola-colored urine after a long urological procedure/surgery. His creatinine kinase levels were high. No other information was provided. What is the likely diagnosis?

Answer 7

Rhabdomyolysis

Question 8

An 80-year-old male, with restrictive lung disease, requires urethral catheterization. His physician wants to give him chronic prophylaxis to UTI. Which drug will worsen his respiratory condition?
a. Ciprofloxacin
b. Nitrofurantoin
c. Amoxicillin
d. Cefuroxime
e. Trimethoprim/sulfamethoxazole

Answer 8

b. Nitrofurantoin

Question 9

Which of the following is true regarding the healing process of bridging plate use for diaphyseal fracture (extra-articular stabilization)?
a. Provides stable environment (very rigid stabilization)
b. Primary bone healing
c. No callus
d. Endochondral ossification

Answer 9

d. Endochondral ossification

Question 10

A 60-year-old female was skiing. She suddenly had dislocated fracture of femoral neck. What is the best way of management?
a. Hemiarthroplasty
b. Total hip replacement

Answer 10

. Total hip replacement (the patient is active from the scenario)

Question 11

A 55-year-old patient presented with moderate lower urinary tract symptoms, mainly nocturia and frequency more than 8 times. What is the most appropriate next step in management?
a. Urine cytology
b. Frequency volume chart
c. Urodynamics
d. Oral desmopressin
e. Oral alpha-blocker drug

Answer 11

e. Oral alpha-blocker drug (moderate symptoms of BPH is an indication to start treatment medically. Urodynamics are optional)

Question 12

A patient has presented with right limb swelling after radical mastectomy and radiotherapy. What test to confirm your diagnosis?
a. Magnetic resonance imaging
b. Ultrasound
c. CT
d. Lympho-schintigraphy

Answer 12

d. Lympho-schintigraphy

Question 13

A young patient fell from 7-meter height. His x-ray showed bilateral fracture of the calcaneus. What other associated injuries might this patient present with?
a. Vertical shear of the pelvis and lumbar spine fracture
b. Vertical shear of the pelvis and lumbar and cervical spine fracture
c. Fracture of the talus, vertical shear of the pelvis, lumbar spine fracture, femoral fracture

Answer 13

a. Vertical shear of the pelvis and lumbar spine fracture

Question 14

A patient presented with neck pain and headache post trauma. On examination, you found ptosis, miosis and anhidrosis. How would you confirm the diagnosis?
a. Neck CT scan
b. Chest x-ray
c. MRI

Answer 14

a. Neck CT scan
Answer: a (carotid dissection)

Question 15

Young male came in with left testicular mass. It was excised from inguinal showing 3-cm germ
cell tumor. What will we follow up to check for metastasis or surveillance?
a. Paraaortic
b. Aortocaval
c. Pelvic
d. Inguinal
e. Para-caval

Answer 15

a. Paraaortic

Question 16

A 16-year-old was presented with a left neck mass. Cytology was done and showed medullary thyroid carcinoma. His calcium levels are normal. The boy is adopted so no family history is available. What is the best next step in management?
a. Order cortisol level
b. Order MRI
c. Upper and lower endoscopy
d. Serum metanephrines
e. Order thyroglobulin level

Answer 16

d. Serum metanephrines (Check for MEN2a)

Question 17

A patient had neck mass. It is shown to be thyroid cancer and its type is B cell lymphoma. What is the treatment?
a. Total thyroidectomy
b. Total thyroidectomy with central node dissection
c. Chemoradiation
d. Radiation

Answer 17

c. Chemoradiation

Question 18

Which zone of the prostate is affected by prostatic adenocarcinoma?
a. Transitional
b. Peripheral
c. Periurethral

Answer 18

b. Peripheral

Question 19

A 55-year-old gentleman underwent an elective inguinal hernia repair and spinal anesthesia. Six hours post-operatively, he experienced difficulty in urination and sensation of incomplete urination. On examination, the bladder was percussible and distended. The amount of residual urine was 200 ml and post-void residual volume was 150 ml. What is the best management?
a. Wait until he voids
b. Insert Foley’s catheter
c. Insert suprapubic catheter

Answer 19

b. Insert Foley’s catheter

Question 20

A 1-year-old child underwent inguinal hernia repair. On the morning after the surgery, he developed fever, watery diarrhea and patchy redness over the lower abdomen and pelvis. There was peau d’orange changes above the incision. He also had pain out of proportion to touch.
What is the most likely diagnosis?
A) Polymicrobial necrotizing fasciitis
B) Allergic reaction to antiseptic
C) Abdominal compartment syndrome
D) Missed bowel injury

Answer 20

A) Polymicrobial necrotizing fasciitis

Question 21

A 43-year-old female had thyroid lobectomy for solitary thyroid nodule 6 months ago. Her thyroid function tests showed hypothyroidism and she was started on thyroxine. Which drug may affect thyroxine levels and higher dose may be needed?
a. Phenytoin
b. Metronidazole
c. Phenelzine
d. Cimetidine
e. Morphine

Answer 21

a. Phenytoin

Question 22

A 58-year-old lady diagnosed with muscle invasive bladder cancer is undergoing radical cystectomy and neobladder reconstruction using the terminal ileum. On the next follow-up, she looked pale and was found to have megaloblastic anemia. What is the most likely reason of her anemia?
a. Infection
b. Renal impairment
c. Medication toxicity
d. Vitamin B12 deficiency
e. Folate deficiency

Answer 22

d. Vitamin B12 deficiency

Question 23

Which of the following is a contraindication to c-collar?
a. Stable spinous process fracture 4
b. Stable spinous process fracture 5
c. Atlantoaxial dissociation
d. Soft tissue injury and neck muscle spasms

Answer 23

c. Atlantoaxial dissociation

Question 24

What is the treatment of stage I osteosarcoma?

Answer 24

Resection of the tumor with chemotherapy

Question 25

A patient with neurogenic bladder presented with a bladder stone around 5 cm. What is the management? a. Transurethral cystolitholapaxy b. Percutaneous cystolitholapaxy

Answer 25

b. Percutaneous cystolitholapaxy

Question 26

What does azoospermia mean? a. Zero sperm b. Sperm <1 million c. Reduced sperm motility

Answer 26

a. Zero sperm

Question 27

A patient had a bleeding issue and his labs showed prolonged prothrombin time (PT). He was on warfarin. Which of the following factors are involved? a. II, VII, IX, X b. X, XI, XII, XII c. II, V, VI, VII

Answer 27

a. II, VII, IX, X

Question 28

A 65-year-old man complaining of new onset acute urinary retention necessitating evacuating with urethral catheter. He has been on warfarin for one month after undergoing coronary stenting. Digital rectal examination revealed large prostate with no nodules and good anal tone. His creatinine level was normal. Abdominal US showed normal sized kidneys, thickened wall of the bladder with multiple diverticula and a prostate size of 100 g. What would be your next best step after inserting foley’s catheter? a. Transurethral resection of prostate (TURP) b. Give Tamsulosin and observe c. Suprapubic proctectomy d. Laser prostatectomy

Answer 28

b. Give Tamsulosin and observe

Question 29

A 38-year-old male, a known case of diabetes mellitus type 2, has 2 cm kidney stone. Urine culture was done 3 days ago and it was negative. PCNL was arranged, and pus was aspirated. Which of the following is the next step? a. Irrigate pus and continue PCNL b. Abort and do ESWL c. Abort procedure and keep nephrostomy d. Convert to ureteroscopy e. Convert to open nephrectomy

Answer 29

c. Abort procedure and keep nephrostomy

Question 30

A patient had shoulder dislocation. The humerus is displaced medially to glenoid. Which nerve will likely to be injured? a. Axillary nerve b. Radial nerve

Answer 30

a. Axillary nerve

Question 31

A patient with Parkinson disease has recurrent urinary tract infections. What is the most common type of stones in these patients? a. Struvite b. Cystine c. Calcium oxalate d. Ammonium oxalate

Answer 31

a. Struvite

Question 32

A patient with disc herniation at L2-L3 level. What would you expect on physical examination? a. Weakness of hip flexion and absent knee reflex b. Weakness of knee flexion and absent achilles reflex c. Weakness of knee extension and absent knee reflex

Answer 32

c. Weakness of knee extension and absent knee reflex

Question 33

A patient had anterior dislocation of the hip joint. Which nerve is likely to be injured? a. Femoral b. Obturator c. Ilioinguinal d. Sciatic e. Peroneal

Answer 33

a. Femoral

Question 34

What is the most common cause of infertility in a 43-year-old gentleman?

Answer 34

Varicocele

Question 35

A marathon runner had unilateral foot pain. His x-ray was done and showed transverse fracture line with cortical thickening (hyperlucent). What is the diagnosis? a. Stress fracture b. AVN

Answer 35

a. Stress fracture

Question 36

Which of the following is a risk factor for increased mortality in necrotizing fasciitis? a. Delay in surgical debridement b. Age c. Diabetes

Answer 36

a. Delay in surgical debridement

Question 37

A patient presented with an abnormality in his scar as a post-operative complication. He had abnormal growth of tissue, but it was respecting the edges of the wound. What is the appropriate treatment option? a. Excision b. Intra-lesional steroids c. UV therapy

Answer 37

b. Intra-lesional steroids

Question 38

48. Young female athlete with clavicular fracture. Which of the following is an absolute indication for fixation? a. Bone fragments 1 cm overlap b. Being diabetic c. Young active athlete d. Tenting of the skin e. Fracture of the contralateral humerus

Answer 38

Most likely e (bilateral fractures)

Question 39

A 33-year-old lay with history of SLE on prednisolone and immunosuppressive medication. She complains of bilateral groin pain for the past 6 months. What is the most likely the diagnosis? a. Lupus reactive arthritis b. Osteoarthritis c. Avascular necrosis (AVN) d. Gout e. Osteoporosis secondary to steroids

Answer 39

c. Avascular necrosis (AVN)

Question 40

What statement accurately describes Monteggia fracture? a. Fracture of the proximal ulna with proximal radioulnar joint dislocation b. Fracture of the distal ulna with distal radioulnar joint dislocation c. Fracture of the proximal radius with proximal radioulnar joint dislocation

Answer 40

a. Fracture of the proximal ulna with proximal radioulnar joint dislocation

Question 41

A straightforward question about Toxic epidermal necrosis (TEN). A scenario was given (blisters and large areas of peeling skin), and the question was about the diagnosis itself.

Answer 41

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