Surgery

Question 1

Battle’s sign

Answer 1

Ecchymosis behind the ear
Fracture the base of the skull

Question 2

Herniation syndrome

Answer 2

1- subfalcine herniation under the falx cerebri : compression the anterior cerebral artery

2- downward transtentorial : rupture of paramedian basilar artery ( duret hemorrhage
3- transtentorial uncal : the inner part of temporal lobe herniate through the gap
Ipsilateral mass lesions
- posterior cerebral artery
- ipsilateral CNIII : downward and out position and dilated pupil and ptosis
- ipsilateral hemiparesis
-brain stem hemorrhage (duret)
4 - cerebellar tonsillar into the foramen magnum: cardio respiration arrest

Question 3

Lowering the cranial blood pressure

Answer 3

1- hyperventilation reduces co2 levels which produce vasoconstriction in the brain
2- reduces metabolic demand by sedation
3 - increasing venous flow ( elevation of the head )
4- therapeutic lumber puncture

Question 4

Epileptic seizure and electrical burn
Massive uncoordinated muscle contraction

Answer 4

Posterior shoulder dislocation
Closed reduction

Question 5

Outstretched arm and axillary fullness and flattened deltoid

Answer 5

Anterior shoulder dislocation
Examines the axillary nerve ( weakness of abduction)

Question 6

Shoulder pain

Answer 6

1- rotator cuff impingement
2- rotator cuff tears
3- adhesive capsulitis

Question 7

Tendinopathy
Repetitive activity above shoulder height
The space between humeral head and acromion is reduced

Answer 7

Neer test shoulder internally rotated and forearm pronated

Question 8

Rotator cuff tears
Supra and infra spinatus
Weakness of abduction
Drop arm test

Answer 8

Unable to lower the arm
It will drop rapidly around mid adduction
Trt surgery

Question 9

Adhesive capsulitis
Frozen shoulder syndrome
Inflammation, fibrosis,

Answer 9

Shoulder stiffness
Dx : > 50% reduction in both passive and active ROM

Question 10

Colles fracture
An outstretched hand

Answer 10

Dinner fork deformity of the wrist
Compression of the median nerve

Question 11

Montegia fracture

Answer 11

Diaphyseal fracture of the proximal ulna with anterior dislocation of the radial head

Question 12

Monte giga fracture
Galeazei fracture

Answer 12

Monteggia ulnar fracture
Galeazei radial
Trt open reduction and internal fixation

Question 13

Buckle (torus) fracture
Forearm
Stable and incomplete fracture

Answer 13

X ray cortical bulge
Trt pain control and splint placement

Question 14

Greenstick fracture
Strong periosteum which limits the fracture line from extending through the width of the bone

Answer 14

Opposite side without a break in the cortex
Unstable fracture
Immobilisation casting

Question 15

Bilirubin stone
Pigmented radiopaque
Chlolesterol stone radiolucent

Answer 15

Pigmented :

Black : calcium bilirubin
Brown: infectious diseases

Question 16

Biliary sludge absence of cholecystokinin there is no contraction of gall bladder leads to biliary stasis

Answer 16

Prolonged fasting and rapid weight loss and prolonged use of total parental nutrition

Question 17

Post cholecystectomy syndrome
The same pain is persistent

Answer 17

Stone in the common bile duct or sphincter oddi dysfunction

Question 18

Sphincter of oddi dysfunction

Answer 18

Dilated common bile duct without visible stones
Manometry
Trt sphincterotomy

Question 19

Porcelain gallbladder chronic disease
Calcification and inflammation

Answer 19

Ct scan : calcified rim in the gall bladder with central bile filled dark area
Adeoncarinoma
Surgery

Question 20

Hernias

Answer 20

1- indirect hernia
2- direct hernia
3- femoral hernia
4- incisional hernia

Question 21

Groin hernias
- indirect
Direct
Femoral

Answer 21

1- indirect: male infants - patent processus vaginalis - protruding through deep linguinal ring
Lateral to inferior epigastric vessels

Question 22

Direct hernia

Answer 22

Older men - weakness of transversalis fascia
Protrude through hesselbach triangle
Travels medial to inferior epigastric vessels

Question 23

Femoral herniated

Answer 23

Woman- weakness of proximal femoral canal
Protruding through femoral ring
Travels inferior to inguinal ring

Question 24

Appendix

Answer 24

Psoas sign RLQ pain : retrocecal appendix
Obturator sign : RLQ pain with internal rotation pelvic appendix
Rovsing signs: appendix
Rectal tenderness: pelvic

Question 25

Postoperative fever

Answer 25

1- blood products given during or prior surgery( within a few hours) 2- acute fever (first week) nosocomial infection 3- subacute fever > 1 week : drug fever or clostridium difficile after long course of ANTIBIOTICS surgical site infection 4- delayed postoperative fever viral from blood products or infective endocarditis

Question 26

Fever and muscle rigidity soon after surgery under general anesthesia

Answer 26

Malignant hyperthermia ( halothen and succinylcholine ) Mutation in the gene which codes for ryanodine receptors- release high levels of Ca in the cytoplasm which activates ATP consumption- heat and muscle damage

Question 27

Painful swelling of parotid gland aggravated by chewing after surgery

Answer 27

Dehydrated post operative patients and elderly are prone to develop acute bacterial parotitis

Question 28

Tenderness that improves with elevation of the testes

Answer 28

Prehn sign epididymitis Pathogen from the urethral in a retrograde through ejaculatory duct to the ductus deferens Risk factors: age > 35 and bladder outlet obstruction Those who are under 35 from sex chlamydia

Question 29

Acute onset of back pain and profound hypertension

Answer 29

Should be evaluated for a presumptive diagnosis of ruptured abdominal aortic aneurysm

Question 30

Levofloxacin increases collagen degradation

Answer 30

Should be avoided in patients with a known aortic aneurysm

Question 31

Leriche syndrome

Answer 31

Arterial occlusion at the bifurcation of the aorta into the common iliac Trade of : bilateral hip thigh buttock claudication Absent femoral pulse Impotence always present with this condition أساسي للتشخيص يعني

Question 32

Chronic venous insufficiency

Answer 32

Varicose veins and skin discolouration or skin ulceration Erythrocytes extravasation causes hemosiderin deposition: stasis dermatitis

Question 33

Fever and abdominal pain or flank pain radiating to the groin

Answer 33

Psoas sign Psoas abccess

Question 34

Acute abdominal pain + lower intestinal bleeding

Answer 34

Ischemic colitis Repair of aneurysm of aorta

Question 35

Sudden back pain or flank with sudden hemp dynamic instability

Answer 35

Retro peritoneal hematoma Cardiac Catheterisation

Question 36

Lateral epicondylitis: tennis elbow Medial epicondylitis: golfers elbow

Answer 36

Overuse NSAIds

Question 37

Positive trendelebberg sign

Answer 37

Dropping of the contralateral hem pelvis below its normal horizontal level during monopedal stance

Question 38

Bursitis

Answer 38

1 pre patellar bursitis housemaid’s knee : due to staphylococcus. Aspiration of bursal fluid 2- pes anserinus pain syndrome ( anserine) anterior medial of the tibial plateau valgus test is negative to rule out the medial collateral ligaments 3- trochanteric bursitis : worsened with hip flexion Abduction aggravate the pain Hip range of motion is normal

Question 39

Young parents with thalamic hemorrhage and there is no risk factors

Answer 39

Look for urine toxicology screen Subcortical hemorrhage for cocaine

Question 40

Large irregular king stone with UTIs

Answer 40

Struvite mg amonium phosphate

Question 41

Pulmonic valve stenosis

Answer 41

Ejection click , crescendo - decrescendo murmur, over the second left of intercostal space widened s2

Question 42

Plural effusion with coronary artery bypass surgery

Answer 42

Small and early onset (1-2 days) No respiratory symptoms