2011

Question 1

A 27-year-old man reports a history of bleeding per rectum that he noticed recently upon defecation. Proctoscopy reveals the presence of grade I hemorrhoids. What is the appropriate treatment option for this patient? 2013, 2011
a. Rubber band ligation
b. Hemorrhoidectomy

Answer 1

a. Rubber band ligation

Question 2

19.A 45-year-old woman presents to the casualty with periumbilical pain and vomiting. An abdominal radiograph shows dilated bowel loops establishing a diagnosis of small bowel obstruction. She says that she underwent a laparotomy for another condition 15 years back.
The patient is now stable. What is the likely cause of this patient’s presentation? 2011
a. Gallstone ileus
b. Inflammatory bowel disease
c. Postoperative adhesions

Answer 2

c. Postoperative adhesions

Question 3

13.A 61-year-old lady has an eight-month history of weight loss and vague abdominal pain. Her family noticed she has been looking pale as well. Laboratory investigations reveal the presence of iron deficiency anemia. What is the appropriate next step? 2013, 2011
a. Colonoscopy
b. Abdominal x-ray
c. Barium enema

Answer 3

a. Colonoscopy
Notes: Chronic blood loss leading to iron deficiency anemia in males and postmenopausal females is always due to bleeding from the gastrointestinal tract. These population groups should undergo thorough investigation of the upper and lower gastrointestinal tracts endoscopically at the same session to exclude cancer.

Question 4

A 19-year-old male patient presents with a few hours history of right lower quadrant pain as well as nausea and vomiting. After examining the patient, a diagnosis of appendicitis was established. Soon after, the patient developed diffuse abdominal pain and fever. He looked dehydrated as well. What is the best next step in the management of this patient? 2011
a. Administration of IV fluids and antibiotics
b. Immediate appendectomy
c. Perform a CT scan

Answer 4

a. Administration of IV fluids and antibiotics
Notes: A case of appendicitis complicated by perforation. Stabilizing the patient is a priority.

Question 5

While performing a cholecystectomy, the surgeon elaborates on the boundaries of the triangle of Calot in order to safely remove the gallbladder without injuring the surrounding structures. Which of the following structures passes through the triangle of Calot?
a. Cystic artery
b. Cystic duct
c. Right hepatic artery
d. Left hepatic artery

Answer 5

a. Cystic artery
Note: The triangle of Calot is bounded by the common hepatic duct medially, the cystic duct laterally and the liver edge superiorly according to the modern definition. The cystic artery and Calot’s lymph node being the contents.

Question 6

39.Following thyroidectomy, an elderly female patient started to complain of perioral numbness. How should this patient be properly managed?

Answer 6

a. Administration of IV calcium gluconate
Note: Transient hypocalcemia may occur 24 to 48 hours after total or near-total thyroidectomy. The pathophysiology behind it is thought to be related to transient ischemia of the parathyroid glands. Permanent hypoparathyroidism is uncommon.

Question 7

Which of the following is a risk factor for developmental dysplasia of the hip? 2011
a. Family history
b. Polyhydramnios
c. Male gender

Answer 7

a. Family history

Question 8

16.A 36-year-old male had a motor vehicle accident. The patient’s blood pressure was 90/70 mmHg, and heart rate was 130 /mins. An unstable pelvis was present on physical examination with overlying ecchymosis. The patient was immediately resuscitated with 4 packs of PRBCs but did not stabilize. What would be an appropriate step at this point? 2013,
2011
a. Application of pelvic wrap or binder
b. Resuscitation with more blood
c. Arterial embolization
d. Exploratory laparotomy

Answer 8

a. Application of pelvic wrap or binder

Question 9

16.A 52-year-old lady was brought to the casualty complaining of colicky umbilical pain and vomiting. She could not pass stools during the day before. An abdominal x-ray confirms a diagnosis of small bowel obstruction. While in the ward, the physician notices that her abdomen is becoming distended, erythematous and tender to palpation. She had a fever as well. What is the most appropriate next step in this patient’s management? 2011
a. Surgical exploration
b. Start her on antibiotics and observe

Answer 9

a. Surgical exploration
Note: In a patient with bowel obstruction, the presence of abdominal tenderness, fever, tachycardia or leukocytosis indicates subsequent ischemia and strangulation that necessitate immediate explorative laparotomy.

Question 10

24.A 68-year-old man was brought to the emergency room with severe right upper quadrant pain and fever. On physical examination, scleral icterus was present. Abdominal ultrasound showed a dilated common bile duct of 9 cm. The patient was immediately resuscitated with fluids, and antibiotics were given. The patient is now stable. What is the appropriate next step of management? 2011
a. Endoscopic retrograde pancreatocholangiography to decompress the common bile duct
b. Observe the patient since he is stable

Answer 10

a. Endoscopic retrograde pancreatocholangiography to decompress the common bile duct

Question 11

10.What type of kidney stones is radiolucent and is treated by alkalization of urine? 2013, 2011
a. Uric acid stones
b. Cystine stones
c. Calcium oxalate stones
d. Magnesium-ammonium-phosphate stones

Answer 11

a. Uric acid stones

Question 12

10.A 53 year old lady underwent a modified radical mastectomy to treat her breast cancer.
After the procedure, she was noticed to have a protruding scapula and difficulty abducting her arm. Which nerve has been likely injured? 2016, 2011, 2010
a. Axillary nerve
b. Lateral pectoral nerve
c. Long thoracic nerve

Answer 12

c. Long thoracic nerve

Question 13

33.What is the treatment of choice for medullary thyroid carcinoma? 2011
a. Total thyroidectomy and central neck node dissection
b. Hemithyroidectomy and central neck node dissection
c. Chemoradiation

Answer 13

a. Total thyroidectomy and central neck node dissection

Question 14

38.A 53-year-old female presents with a history of flank pain she has been having for weeks.
Further investigations revealed bilateral kidney stones. She did recall spontaneously passing small stones while urinating during the past year. What is the proper next step in diagnosing this patient? 2011
a. Check calcium, phosphate and parathyroid hormone levels
b. Perform a nuclear scan

Answer 14

a. Check calcium, phosphate and parathyroid hormone levels

Question 15

17.Which gene is initially mutated in colorectal carcinoma? 2012, 2011
a. APC gene
b. RAS gene
c. P53 gene

Answer 15

a. APC gene

Question 16

10.A 68-year-old male patient was admitted to the ward for a terminal illness. He has been in the hospital for weeks. While checking on the patient, the nurse noticed a bed sore in the sacral area. What could be done to prevent bed sores?

Answer 16

a. Repositioning the patient

Question 17

What is the gold standard modality for the diagnosis of osteomyelitis? 2012, 2011
a. MRI
b. Bone scan
c. CT scan
d. Radiography

Answer 17

a. MRI

Question 18

A young patient presents with hematuria. Microscopic examination showed dysmorphic red blood cells and casts. What is the source of hematuria in this patient? 2013, 2011
a. Kidney
b. Ureter
c. Urinary bladder
d. Prostate
e. Urethra

Answer 18

a. Kidney

Question 19

24.A 55-year-old man was brought to the casualty with sudden onset of severe abdominal pain.
The patient is on NSAIDs for his back pain. On physical examination, the abdomen was diffusely tender. A plain chest radiograph shows pneumoperitoneum. How should this patient be managed? 2011
a. Conservatively with fluid and electrolyte replacement
b. Immediate laparotomy

Answer 19

b. Immediate laparotomy
Note: Sudden onset of abdominal pain in a patient on NSAIDs raises the suspicion of a perforated peptic ulcer that is further confirmed by an erect chest x-ray. Immediate laparotomy and omental patch should ensue.

Question 20

19.A 38-year-old man presents to the casualty with hematemesis. He said that shortly before that, he forcefully vomited after binging on alcohol last night. Upper endoscopy shows a longitudinal mucosal slit at the gastroesophageal junction. What is the diagnosis? 2011
a. Mallory-Weiss tear
b. Boerhaave syndrome
c. Reflux esophagitis

Answer 20

a. Mallory-Weiss tear

Question 21

26.A 68-year-old male patient develops acalcular cholecystitis after a long stay in the ICU. Given his unstable condition, how should this patient be managed? 2011
a. Percutaneous cholecystostomy
b. Laparoscopic cholecystectomy
c. Perform an ERCP

Answer 21

a. Percutaneous cholecystostomy

Question 22

What forms the portal vein? 2017, 2011, 2010
a. Splenic vein and Inferior Mesenteric vein
b. Superior Mesenteric vein and Splenic vein
c. Superior Mesenteric vein and Inferior Mesenteric vein

Answer 22

b. Superior Mesenteric vein and Splenic vein

Question 23

Which of the following nerve injuries has the best prognosis? 2011
a. Neuropraxia
b. Neurotmesis
c. Axonotmesis

Answer 23

a. Neuropraxia

Question 24

21.A 65-year-old lady presents with swelling in her groin area. On physical examination, the swelling was located inferior and lateral to the pubic tubercle and was irreducible. What is the likely diagnosis? 2011
a. Femoral hernia
b. Direct inguinal hernia
c. Indirect inguinal hernia
d. Obturator hernia

Answer 24

a. Femoral hernia

Question 25

A young male patient was brought to the casualty with a lower limb fracture. A splint was applied until further management was decided. What is an advantage of applying a splint over a cast? 2016, 2013, 2011
a. It allows soft tissue swelling
b. Minimizes the need for surgical intervention
c. It gives better stabilization
d. Facilitates healing
e. Decreases the risk of infection

Answer 25

a. It allows soft tissue swelling

Question 26

34.Which of the following is true regarding the lymphatic drainage of the breast? 2011
a. Lateral side of the breast drains into the supraclavicular lymph nodes
b. Medial and lateral sides of the breast drain into both the parasternal and axillary lymph nodes
c. Medial side of the breast drains into the parasternal lymph nodes
d. The nipple-areolar complex drains into the parasternal lymph nodes

Answer 26

c. Medial side of the breast drains into the parasternal lymph nodes

Question 27

15.A 23-year-old man was brought to the emergency department after he was involved in a car accident. He was short of breath and had distended neck veins. The right of his chest was hyperresonant with absent breath sounds. What is the appropriate management of this patient? 2011
a. Needle insertion in the right 2nd intercostal space midclavicular line
b. Needle insertion in the right 4th intercostal space midclavicular line

Answer 27

a. Needle insertion in the right 2nd intercostal space midclavicular line

Question 28

A 15-year-old girl presented to the casualty with a fracture in her upper arm. An immediate x-ray was taken and showed an oblique fracture of the distal humerus. Which nerve is likely to have been injured in association with this fracture? 2011
a. Radial nerve
b. Ulnar nerve
c. Median nerve
d. Musculocutaneous nerve
e. Axillary nerve

Answer 28

a. Radial nerve

Question 29

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)

Answer 29

e. Slipped Capital Femoral Epiphysis Disease (SCFE)

Question 30

45.A 56-year-old lady has recently undergone thyroidectomy. While in the ward, the nurse notices that the patient is short of breath. The doctor on- call notices a neck swelling as well. How should this patient be immediately managed?
a. Evacuation of the hematoma
b. Perform a neck CT scan
c. Tracheostomized the patient

Answer 30

a. Evacuation of the hematoma
Note: If the patient is in respiratory distress, and neck hematoma is suspected, the surgical wound should be opened and the hematoma evacuated immediately at the bedside.

Question 31

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

Answer 31

b. Check her prolactin level
Bilateral milky nipple discharge highly suggests galactorrhea. Diagnosed by serum prolactin and CT/MRI of pituitary gland

Question 32

Which muscle maintains the anorectal angle and anal continence? 2012, 2011
a. Coccygeus
b. Obturator internus
c. Puborectalis

Answer 32

c. Puborectalis

Question 33

A 69-year-old man was recently diagnosed with prostatic carcinoma after detecting a prostatic nodule on rectal examination. The patient’s PSA level was found to be 14 ng/mL.
Biopsy showed that the lesion is poorly- differentiated with a Gleason score of 8. Metastatic workup detects no metastasis. The patient was decided to undergo medical castration.
Which of the following represents the hormone levels in a patient on medical castration?
2011
a. Low FSH, low LH, low testosterone
b. High FSH, high LH, low testosterone

Answer 33

a. Low FSH, low LH, low testosterone
Note: Drugs used in medical or chemical castration include GRH agonists which desensitize the anterior pituitary to the effects of GRH and hence, result in decreased secretion of FSH and LH, and in turn decreased testosterone.

Question 34

38.A 58-year-old woman has been recently diagnosed with breast cancer. The patient states that she has a family history of breast cancer. Her mother died of the disease and her sister has it as well. What is the most important risk factor this woman has and predisposed her to develop breast cancer? 2011
a. Advanced age
b. Family history

Answer 34

a. Advanced age
Note: Age is the most significant risk factor for breast cancer. Given her presentation at this age, her disease is more likely due to advanced age than to her family history of breast cancer.

Question 35

41.A 31-year-old woman was found to have a thyroid nodule on physical examination. The nodule was non tender and moved with swallowing. What is the appropriate next step in the management of this nodule? 2011
a. Fine needle aspiration
b. Thyroid scan

Answer 35

a. Fine needle aspiration
Note: Despite the fact that management of thyroid nodules should start with thyroid function tests, thyroid scan, diagnostic ultrasound then FNA, the vignette and answers provided do not follow that algorithm. Thyroid scans are generally not recommended in the initial workup of a thyroid nodule, and FNA, on the other hand, has emerged as the most important step in the diagnostic evaluation of thyroid nodules.

Question 36

21.What is the management of periampullary cancer? 2011
a. Resection of the pancreatic head
b. Whipple’s procedure

Answer 36

b. Whipple’s procedure

Question 37

22.A 43-year-old man recently developed a swelling in his groin. He says that it used to disappear upon lying down. The mass was located above the inguinal ligament. On physical examination, the physician couldn’t reduce the mass, and the overlying skin was tender to palpation and erythematous. The patient was tachycardic as well. What is the appropriate next step in this setting? 2011
a. Operative exploration
b. Elective repair

Answer 37

a. Operative exploration

Question 38

Which radiological finding indicates pelvic instability? 2017, 2016, 2011
a. Symphysis diastasis 5 mm
b. Sacroiliac impaction
c. Sacroiliac diastasis 1cm
d. Fracture of superior pubic rami
e. Fracture of inferior pubic ram

Answer 38

c. Sacroiliac diastasis 1cm

Question 39

42.After undergoing thyroidectomy, a 42-year-old lady was found to have difficulty breathing with stridor. Her oxygen saturation in room air was 94%. There was no blood found in her wound. What would be the immediate management for this patient? 2011, 2010
a. Endotracheal intubation
b. Tracheostomy

Answer 39

a. Endotracheal intubation
Note: Bilateral vocal cord paralysis due to bilateral recurrent laryngeal nerve injury is a devastating complication that manifests in the immediate postoperative period with airway obstruction, biphasic stridor or respiratory distress. Endotracheal intubation is initially attempted; should that fail, urgent tracheostomy follows. Emergency tracheotomy may be required, but if possible, first perform endotracheal intubation.

Question 40

14.A 63-year-old man presents with rectal carcinoma that was found to be of stage T3N1. How should this patient be treated?

Answer 40

Neoadjuvant chemoradiotherapy
Note: T3 and T4 lesions are treated by neoadjuvant chemoradiation which may significantly down-stage the tumor and hence, improve resectability and potentially preserve the sphincter. Presence of nodal metastasis requires treatment with neoadiuvant chemoradiation regardless of T stage, followed by adjuvant chemotherapy.

Question 41

Which of the following structures forms the lateral wall of the femoral canal? 2015, 2011
a. Femoral vein
b. Femoral artery
c. Femoral nerve
d. Lacunar ligament

Answer 41

a. Femoral vein

Question 42

What could be a cause of priapism in a patient from the East Mediterranean region? 2011,
2010
a. Sickle cell disease
b. Hemophilia
c. Peripheral vascular disease

Answer 42

a. Sickle cell disease

Question 43

A 24-year-old man was playing football when he suddenly developed severe knee pain and difficulty bearing weight. Whenever he tries to walk on his knee, clicking is heard. On physical examination, the right knee was swollen and tender. Mcmurray test was positive as well. What is the diagnosis? 2011
a. Medial meniscus tear
b. Anterior cruciate ligament tear
c. Posterior cruciate ligament tear
d. Lateral collateral ligament tear
e. Medial collateral ligament tear

Answer 43

a. Medial meniscus tear

Question 44

11.A 66-year-old man is needed to be on long term urinary catheterization, but the physician is concerned about recurrent urinary tract infections. What could be done to prevent this complication? 2011
a. Change the catheter every week
b. Prophylactic antibiotics

Answer 44

a. Change the catheter every week

Question 45

A 33-year-old lady with a history of SLE on prednisolone and immunosuppressive medication. She complains of bilateral groin pain for the past six months. She says she cannot bear weight on them which has limited her movement dramatically. What is most likely the diagnosis? 2016, 2011
a. Lupus reactive arthritis
b. Osteoarthritis
c. Avascular necrosis
d. Gout
e. Osteoporosis secondary to steroids

Answer 45

c. Avascular necrosis

Note: Hip pain in a patient on steroids is avascular necrosis until proven otherwise.

Question 46

What forms the wall of pancreatic pseudocyst? 2017, 2011
a. Columnar
b. Epithelial tissue
c. Granulation tissue
d. Squamous cell

Answer 46

c. Granulation tissue

Question 47

A 28-year-old man who has multiple partners and recurrent history of sexually transmitted infections presents this time with dysuria and whitish-yellow discharge from his meatus. He also had a tender erythematous testis. The physician prescribes him antibiotics. The patient wants to know about the long-term complications of having these infections? 2013, 2011
a. Urethral stricture
b. Erectile dysfunction or infertility
c. Testicular cancer

Answer 47

a. Urethral stricture

Question 48

43.A 41-year-old lady presents with hirsutism, hypertension and central obesity. Abdominal
MRI revealed the presence of a 7 cm suprarenal mass. What is the likely diagnosis? 2011
a. Adrenocortical carcinoma
b. Cushing disease

Answer 48

a. Adrenocortical carcinoma
Note: Cushing disease is due to ACTH-producing pituitary tumor rather than an adrenal tumor. A functioning carcinoma of the adrenal cortex is the likely diagnosis.

Question 49

A young patient complains of abdominal pain. He says that any movement could exacerbate his pain while lying flat and still alleviates it. What is this patient likely to have? 2011
a. Peritonitis
b. Ureteric colic
c. Small bowel obstruction

Answer 49

a. Peritonitis

Question 50

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

Answer 50

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.

Question 51

A 57-year-old male smoker with a history of diabetes mellitus had a recent fracture in his lower limb which he was treated for. Follow-up x-rays show inability of the fracture to heal despite appropriate management. What type of fracture nonunion does this patient have?
2016, 2013, 2011
a. Atrophic non-union
b. Hypertrophic non-union
c. Oligotrophic non-union

Answer 51

a. Atrophic non-union
Note: Atrophic non-union occurs in states of decreased blood supply to the bone, resulting in no callus formation and inability of the fracture to heal. Factors like smoking and diabetes promote this reduction in blood supply.

Question 52

23.A 43-year-old man presents to the hospital with an episode of hematemesis. Upper endoscopy revealed the presence of a bleeding peptic ulcer. The patient was resuscitated and is now stable. Following investigations showed that the patient was positive for Helicobacter pylori. What is the treatment option available for this patient? 2011, 2010
a. Proton pump inhibitors and antibiotics against H. pylori
b. Proton pump inhibitors and H2 receptor antagonists

Answer 52

a. Proton pump inhibitors and antibiotics against H. pylori

Question 53

A 32-year-old woman complained of difficulty swallowing. She says that she regurgitates undigested food she ate a couple of days back. Esophageal manometry showed a hypertensive lower esophageal sphincter which fails to relax and peristalsis of the esophageal body. What is the diagnosis? 2015, 2011
a. Achalasia
b. Diffuse Esophageal Spasm
c. Gastroesophageal reflux disease

Answer 53

a. Achalasia

Question 54

Which of the following is a tumor marker for pancreatic cancer? 2015, 2011
a. CEA
b. CA 19-9
c. Ca-125
d. Alpha fetoprotein

Answer 54

b. CA 19-9

Question 55

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

Answer 55

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.

Question 56

17.What are the most common causes of pancreatitis? 2011
a. Gallstones and alcohol
b. Drug-induced
c. Scorpion bite
d. Autoimmune

Answer 56

a. Gallstones and alcohol

Question 57

22.Which of the following spine injuries is associated with seat belt trauma? 2011
a. Flexion-distraction injury
b. Burst injury
c. Compression injury

Answer 57

a. Flexion-distraction injury

Question 58

17.A 32-year-old otherwise healthy female reports vague abdominal pain and a sense of heaviness in the right side of her abdomen. She is on oral contraceptive pills. An abdominal CT showed a hypodense lesion in the left lobe of the liver. What is the likely diagnosis? 2011
a. Hepatic adenoma
b. Metastasis

Answer 58

a. Hepatic adenoma

Question 59

A 56-year-old man who has a known history of hypertension, diabetes mellitus, coronary heart disease and epilepsy takes the following drugs: alpha blockers, carbamazepine, metformin and atenolol. He comes to the urology clinic with a complaint of erectile dysfunction. Which of the drugs he takes is likely to have caused his erectile dysfunction?
2013, 2011, 2010
a. Carbamazepine
b. Atenolol
c. Alpha blockers
d. Metformin

Answer 59

a. Carbamazepine

Question 60

21.A 41-year-old man with a long term history of lower back pain wakes up in the morning with weakness in his lower limbs. He also complains of numbness and paresthesia in the perianal area. He noticed his urine dribbling as well which progressed to incontinence. What could be the underlying mechanism of this patient’s presentation? 2011
a. Large disc herniation
b. Disc prolapse at level L1

Answer 60

a. Large disc herniation

Question 61

37.Which of the following thyroid malignancies can be monitored through blood? 2011
a. Anaplastic thyroid carcinoma
b. Follicular thyroid carcinoma
c. Lymphoma
d. Medullary thyroid carcinoma
e. Papillary thyroid carcinoma

Answer 61

d. Medullary thyroid carcinoma
Note: Calcitonin and carcinoembryonic antigen levels are important tumor markers for medullary thyroid carcinoma and correlate strongly with the extent of disease.

Question 62

A 47-year-old diabetic male complains of severe swelling in the perianal area. Physical examination of the perianal region reveals erythema and swelling that is tender too. How should this patient be managed?
a. Incision and drainage and IV antibiotics
b. IV antibiotics
c. Aspiration

Answer 62

a. Incision and drainage and IV antibiotics

Question 63

Which of the following drugs are used to treat benign prostatic hyperplasia? 2011
a. Alpha blockers
b. Alpha agonists
c. Beta blockers

Answer 63

a. Alpha blockers

Question 64

A 42-year-old woman is brought to the emergency room after a head trauma. Her ABG profile was as follows: pH 7.32, bicarbonate 28, PCO2 78. What is the likely diagnosis? 2011
a. Uncompensated respiratory acidosis
b. Compensated respiratory acidosis
c. Uncompensated metabolic acidosis
d. Compensated metabolic acidosis

Answer 64

a. Uncompensated respiratory acidosis

Question 65

27.A 36-year-old woman comes to the OPD with a complaint of intermittent right upper quadrant pain that lasts for a few hours per episode. She does not have a fever. She says that her pain is precipitated by fatty foods. What is the appropriate next investigation? 2011
a. Abdominal ultrasound
b. CT scan
c. HIDA scan

Answer 65

a. Abdominal ultrasound

Question 66

Which of the following is true with regards to secondary bone healing? 2011
a. It occurs via endochondral ossification
b. Direct osteonal bridging is present on histology
c. It needs an absolute stable condition
d. No callus is visible

Answer 66

a. It occurs via endochondral ossification

Question 67

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

Answer 67

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.

Question 68

20.A 54-year-old man reports a history of severe periumbilical pain that is colicky in nature. It started this morning and was associated with nausea and vomiting. Bowel sounds were hyperactive on physical examination. An abdominal radiograph shows a dilated small bowel with prominent folds. A nasogastric tube was inserted, and fluid deficit was corrected. What is the next step in the management of this patient? 2011
a. Arrange for colonoscopy
b. Perform a CT scan with contrast
c. Perform barium enteroclysis
d. Take the patient to the operation theater

Answer 68

b. Perform a CT scan with contrast
Note: Abdominal CT scan with contrast is an essential part of the workup of mechanical small bowel obstruction. It helps in identifying the transition point, etiology, whether the obstruction is partial or complete as well as predicting ischemic complications.

Question 69

17.A 31-year-old gentleman presents acutely with hematemesis. The patient looked dehydrated and was immediately resuscitated into a stable condition. What should be done at this point? 2011
a. Upper endoscopy
b. Perfume a barium swallow
c. Arrange for discharge

Answer 69

a. Upper endoscopy

Question 70

25.A 68-year-old man presents with a recent onset of severe abdominal pain and distention. A plain abdominal radiograph shows a sigmoid volvulus. What is the appropriate next step in the management of this patient? 2011
a. Sigmoidoscopy and decompression
b. Water soluble enema and decompression
c. Immediate sigmoidectomy

Answer 70

a. Sigmoidoscopy and decompression

Question 71

At what rate does an injured neuronal axon regenerate? 2011
a. 1 mm/day
b. 0.1 mm/day
c. 0.1 mm/week
d. 1mm/week
e. 10 mm/week

Answer 71

a. 1 mm/day

Question 72

24.A 57-year-old lady was found to have colon cancer in the region of the hepatic flexure. How should this patient be managed? 2011
a. Extended right hemicolectomy
b. Total colectomy
c. Right hemicolectomy

Answer 72

a. Extended right hemicolectomy

Question 73

A child with septic arthritis, the doctor noticed that his trunk shifts over the hip quickly and shifts back to the opposite side due to pain in his lower limb. What type of gait is described here? 2016, 2011
a. Antalgic gait
b. Waddling gait
c. Shuffling gait
d. Trendelenburg gait

Answer 73

a. Antalgic gait

Question 74

25.A 48-year-old lady presents to the emergency room with an episode of hematemesis. She was immediately resuscitated and an upper endoscopy was conducted. Endoscopy showed a bleeding ulcer. Resuscitation and therapeutic endoscopic attempts failed to stabilize the patient who was still in shock. What is the appropriate next step in managing this patient?
2011
a. Excision of the ulcer
b. Suture ligation of the bleeding ulcer

Answer 74

b. Suture ligation of the bleeding ulcer

Question 75

A 58-year-old lady presents with a recent history of painless hematuria. She has been a heavy smoker for the past 20 years. A CT urography shows a filling defect in the posterior wall of the urinary bladder, and urine cytology yielded malignant transitional cells establishing a diagnosis of bladder cancer. How should this lady be managed at this point?
2011
a. TURB
b. Cystectomy and urinary diversion

Answer 75

a. TURB
Note: The gold standard for confirming the diagnosis of bladder carcinoma is cystoscopy and biopsy to determine the presence of muscular invasion and hence, plan treatment. In this lady, TURB should be performed for two purposes: 1. Therapeutic to reset the tumor.
2. Diagnostic to check for invasion. Cystectomy might eventually follow if muscle is invaded.

Question 76

A 51-year-old man comes to the urology clinic with a complaint of erectile dysfunction. He has a known history of diabetes mellitus, hypertension and coronary artery disease. Which of the following tests would not be performed to investigate this patient’s erectile dysfunction? 2011
a. Urine free cortisol
b. Lipid profile
c. Prolactin level
d. FSH, LH and testosterone levels

Answer 76

a. Urine free cortisol

Question 77

23.Following an operative hernia repair, a middle-aged patient develops loss of sensation on the medial aspect of his left scrotum. Which of the following nerves is likely to have been injured? 2011
a. Genital branch of the genitofemoral nerve
b. lioinguinal nerve
c. Lateral cutaneous nerve of the thigh
d. Iliohypogastric nerve

Answer 77

a. Genital branch of the genitofemoral nerve

Question 78

20.A 47-year-old lady presents to the emergency room with severe left flank pain, nausea and vomiting and fever. On measuring her vital signs, heart rate was 118/min, blood pressure was 85/57 mmHg and body temperature was 38.7 Co. A KUB x-ray was immediately performed and showed a radiopaque shadow to the left of L3 vertebra, which is likely to be a ureteric stone. Ultrasound shows a dilated renal pelvis and calyces. What should immediately be done as part of this patient’s management plan? 2011
a. Administration of intravenous fluids
b. Insertion of a nephrostomy tube
c. Insertion of a double J stent

Answer 78

a. Administration of intravenous fluids
Note: Rehydration of a hemodynamically unstable patient is a priority.

Question 79

What is the embryological origin of the falciform ligament? 2017, 2013, 2012, 2011
a. Ductus venous
b. Umbilical artery
c. Umbilical vein
d. Urachus

Answer 79

c. Umbilical vein

Question 80

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

Answer 80

a. Testicular torsion

Question 81

A 71-year-old woman presents with abdominal pain and vomiting. Plain radiograph of the abdomen shows dilated bowel loops, calcification in the right lower quadrant and air in the biliary tract. What is the likely diagnosis? 2017, 2011
a. Acute appendicitis
b. Gallstone ileus

Answer 81

b. Gallstone ileus

Question 82

28.Following mastectomy, a middle-aged female has a difficulty adducing and internally rotating her arm, and there’s no winging of the scapula. Which nerve is injured? 2013, 2011
a. Axillary nerve
b. Long thoracic nerve
c. Thoracodorsal nerve

Answer 82

c. Thoracodorsal nerve

Question 83

Which of the following structures forms the floor of the inguinal canal? 2016, 2011
a. Inguinal ligament
b. Transversalis fascia
c. External oblique aponeurosis
d. Conjoint tendon
e. Femoral vein

Answer 83

a. Inguinal ligament

Question 84

22.Which of the following depicts a correct sequence of the steps done at the emergency room to manage an open fracture?

Answer 84

Intravenous antibiotics for 72 hours -> debridement and irrigation -> external fixation

Question 85

17.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

Answer 85

a. Cholecystectomy in the same admission when the pain resolves

Question 86

37.A 21-year-old woman complains of a mass in her breast that is causing her discomfort. On physical examination, the mass was mobile and rubbery in consistency. What is the likely diagnosis in this patient?

Answer 86

Fibroadenoma

Question 87

10.A 38-year-old man was brought to the casualty with severe left knee pain and difficulty bearing weight. On examination of his knee, it was erythematous and very tender. Range of movement was limited due to pain. Synovial fluid analysis showed gram-negative diplococci.
What is the appropriate management plan for this patient? 2011
a. Arthrotomy, irrigation and intravenous antibiotics
b. Oral antibiotics and physiotherapy

Answer 87

a. Arthrotomy, irrigation and intravenous antibiotics

Question 88

21.A 42-year-old woman has obstructive jaundice. Soon after, she complains of pruritus. What is causing this patient’s pruritus? 2011
a. Bile salts
b. Bile salts and histamine
c. Bilirubin

Answer 88

a. Bile salts

Question 89

12.A 76-year-old woman who fell off her wheelchair sustained a displaced fracture of her femoral neck. What would be a proper option to manage her condition? 2011
a. Hip hemiarthroplasty
b. Femur traction for 8 weeks
c. No need for surgical treatment because she is bound to her wheelchair

Answer 89

a. Hip hemiarthroplasty

Question 90

16.A 63-year-old male patient with a long-standing history of benign prostatic hyperplasia complains of hesitancy and straining during urination that are affecting his quality of life.
Occasionally, he cannot pass urine whatsoever. In addition, he has been having recurrent urinary tract infections. Laboratory investigation showed a serum creatinine level of 187 umol/L and BUN level of 15 mol/L. What is the optimal treatment option for this patient at this stage? 2011
a. Transurethral resection of the prostate (TURP)
b. Alpha adrenergic blockers
c. Alpha-5-reductase inhibitors
d. Lifestyle changes

Answer 90

a. Transurethral resection of the prostate (TURP)
Note: Absolute indications for BPH surgery are: refractory urinary retention, recurrent UTIs, recurrent hematuria refractory to medical treatment, renal insufficiency and bladder stones.

Question 91

Which of the following statements correctly describes overflow incontinence? 2011
a. Inability to control urination in a patient with bladder outlet obstruction
b. Inability to control urination with increases in intra-abdominal pressure

Answer 91

a. Inability to control urination in a patient with bladder outlet obstruction
Note: Bladder outlet or neck obstruction, as one cause of overflow incontinence, results in the accumulation of urine in the bladder and eventually, an increase in the intravesical pressure which will later exceed urethral pressure resulting in involuntary leakage of urine or overflow incontinence.

Question 92

18.A 61-year-old patient has a recent history of obstructive jaundice. On physical examination, a palpable non-tender mass was detected in the right upper quadrant. The patient is a heavy smoker for 30 years. What is the likely diagnosis? 2011
a. Pancreatic adenocarcinoma
b. Chronic pancreatitis
c. Choledocolithiasis

Answer 92

a. Pancreatic adenocarcinoma

Question 93

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

Answer 93

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.

Question 94

Which of the following conditions increases the risk of developing renal cell carcinoma?
2011, 2010
a. Von Hippel-Lindau disease
b. Birt-Hogg-Dubé Syndrome

Answer 94

a. Von Hippel-Lindau disease

Question 95

Which of the following is an indication for surgical fixation of a clavicular fracture? 2011
a. Neurovascular injury
b. Angulated fracture

Answer 95

a. Neurovascular injury

Question 96

13. Which of the following fibers mediates initial wound healing?
    a. Collagen I
    b. Collagen Il
    c. Collagen III
    d. Collagen IV

Answer 96

c. Collagen III

Question 97

12.For which age group is ultrasound used to diagnose developmental dysplasia of the hip?
2011
a. Newborns till 3 months
b. Three to six months
c. Six months to two years

Answer 97

b. Three to six months
Note: Ultrasonography is best used to confirm the diagnosis from six weeks to six months of age. However, it results in high false positives when used for screening early on.

Question 98

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

Answer 98

a. Palpation of the left lower quadrant elicits pain in the right lower quadrant

Question 99

10.A 26-year-old man reports severe thigh pain especially at night. A plain radiograph reveals the presence of a benign tumor in the upper third of the femoral shaft. What is likely to be seen in this setting? 2011
a. Geographic border of the lesion
b. Florid periosteal reaction
c. Wide transitional zone
d. Codman’s triangle
e. Moth-eaten appearance of the lesion

Answer 99

a. Geographic border of the lesion
Note: Description of a lesion to have a geographic border gives the impression that the tumor is well-defined, which supports the diagnosis of being benign. Other markers of benignity are the presence of a narrow transitional zone and the absence of periosteal reaction.

Question 100

36.What is the mode of inheritance of the BRCA1 gene? 2011, 2010
a. Autosomal dominant
b. Autosomal recessive
c. X-linked dominant
d. X-linked recessive

Answer 100

a. Autosomal dominant

Question 101

15.A 45-year-old female complains of inability to control her urination while coughing, sneezing or lifting heavy objects. What is the likely diagnosis? 2011, 2010
a. Stress incontinence
b. Urge incontinence
c. Mixed incontinence

Answer 101

a. Stress incontinence

Question 102

A 34-year-old man presented with severe flank pain and decreased urine output but is allergic to iodine. How should this patient be initially investigated? 2013, 2011, 2010
a. Retrograde urethrogram
b. Ultrasound of the kidney, ureter and urinary bladder
c. CT scan with contrast

Answer 102

b. Ultrasound of the kidney, ureter and urinary bladder

Question 103

11.A patient was allergic to penicillin. Which antibiotics should be administered instead before his surgery?

Answer 103

Ciprofloxacin and metronidazole (flagyl)

Question 104

A 72-year-old man after hip replacement surgery presented with abdominal pain, bloating, nausea and vomiting. He was diagnosed with Ogilvie’s syndrome (Acute Colonic Pseudo-Obstruction ACPO). Which of the following drugs is used for treatment?

Answer 104

Neostigmine

Question 105

Which of the following has the highest malignant potential? 2011, 2010
a. Adenomatous polyp
b. Inflammatory polyp
c. Hamartomatous polyp
d. Hyperplastic polyp

Answer 105

a. Adenomatous polyp

Question 106

Which region of the prostate is involved in benign prostatic hyperplasia? 2013, 2011
a. Peripheral zone
b. Transitional zone
c. Central zone

Answer 106

b. Transitional zone

Question 107

22.A 58-year-old man with a long term history of cirrhosis due to hepatitis C infection presents with an abdominal mass in the right upper quadrant which was found to be in the liver.
What is this lesion most likely to be? 2011
a. Liver abscess
b. Hepatic adenoma
c. Hydatid cyst
d. Hepatocellular carcinoma

Answer 107

d. Hepatocellular carcinoma

Question 108

25.A 45-year-old woman with a long-standing history of ulcerative colitis presents with jaundice. What could be the underlying cause of her presentation?

Answer 108

Sclerosing cholangitis
Note: Primary sclerosing cholangitis is present in 1% to 5% of those with inflammatory bowel disease, and approximately 75% of patients with PSC have or will ultimately develop
BD, namely ulcerative colitis.

Question 109

A 57-year-old man complains of chronic heartburn. Upper endoscopy shows longitudinal tongues of metaplastic mucosa extending up the esophageal wall. What is the diagnosis? 2011
a. Barrett esophagus
b. Eosinophilic esophagitis
c. Esophageal web

Answer 109

a. Barrett esophagus

Question 110

34.A 49-year-old lady has a history of weight loss, bulging eyes and diffuse neck swelling. She was scheduled to undergo surgery for her goiter. Which of the following complications would be prevented by proper preoperative preparation? 2011
a. Hemorrhage
b. Hypocalcemia
c. Recurrent laryngeal nerve injury
d. Thyrotoxic crisis (thyroid storm)

Answer 110

d. Thyrotoxic crisis (thyroid storm)
Note: Thyroidectomy should be performed only in patients who have been previously rendered euthyroid via antithyroid medications. Thyrotoxic crisis can complicate surgery in an unprepared patient.

Question 111

Which electrolyte is higher in pancreatic secretions compared to plasma? 2016, 2011
a. Sodium
b. Bicarbonate
c. Potassium
d. Magnesium

Answer 111

b. Bicarbonate

Question 112

35.What is the most common cause of primary hyperparathyroidism? 2011
a. Parathyroid adenoma
b. Parathyroid hyperplasia
c. Parathyroid carcinoma

Answer 112

a. Parathyroid adenoma

Question 113

39.A 30-year-old lactating woman develops a tender mass in her breast with an erythematous overlying skin. How should this patient be treated? 2011
a. Incision and drainage and antibiotics
b. Intravenous antibiotics only
c. Wide local excision

Answer 113

a. Incision and drainage and antibiotics

Question 114

Which of the following medical terms describes sperm of low quantity and abnormal forms?
2015, 2013, 2011
a. Oligoteratospermia.
b. Oligoasthenospermia.
c. Asthenoteratospermia.
d. Oligospermia
e. Teratospermia.

Answer 114

a. Oligoteratospermia.
Note: Oligospermia implies decreased sperm count; azoospermia means absent sperm in the semen; teratospermia describes abnormal morphology; while asthenospermia refers to abnormal motility.

Question 115

A 53-year-old man presents with a history of painless hematuria. Cystoscopy and biopsy confirm a diagnosis of muscle-invading bladder carcinoma. The patient has decided to undergo radical cystectomy and desires to have a continent urinary diversion. Which of the following surgical options represents a continent urinary diversion? 2011
a. Neobladder
b. Ileal conduit

Answer 115

a. Neobladder
Note: With an ileal conduit, or incontinence urinary diversion, the ureters drain freely into a part of the ileum which drains into an ostomy bag. The patient has no control over micturition. With a neobladder, or continent urinary diversion, a small part of the bowel is made into a pouch which mimics the storage function of the bladder. The process of urination resembles the normal one.

Question 116

A 43-year-old man had an irregular swelling just below the left auricular area. It was non-tender and firm in consistency. The patient had a facial droop on the left side when smiling and couldn’t purse his lips. What is the likely diagnosis? 2011
a. Benign pleomorphic adenoma
b. Parotid carcinoma

Answer 116

b. Parotid carcinoma
Note: Involvement of the seventh cranial nerve in patients with parotid swelling should raise the suspicion of malignancy. The swelling being irregular in shape is another keyword.

Question 117

35.A 25-year-old woman develops a lesion in her breast that is painful in nature. The overlying skin is erythematous. The patient reports a history of breastfeeding recently. How would this patient be investigated? 2011
a. Breast ultrasound
b. Mammogram
c. Skin punch biopsy

Answer 117

a. Breast ultrasound

Question 118

A 25-year-old man has a history of varicoceles in the right scrotum. Upon lying flat, the dilated veins do not disappear. Which of the following structures is likely to be obstructed?
2013, 2011, 2010
a. Inferior vena cava
b. External iliac artery
c. Internal iliac artery
d. Right renal artery

Answer 118

a. Inferior vena cava
Left-sided varicoceles are more common due to the indirect drainage of the left gonadal vein into the IC via the left renal vein. Right-sided varicoceles, on the other hand, should raise the suspicion of a retroperitoneal mass compressing the IVC and hence, predisposing to varicoceles

Question 119

18.A 65-year-old man who is a case of benign prostatic hyperplasia presents with a 15 hour history of urinary retention. Physical examination showed a distended and percussible bladder. How should this patient be managed?

Answer 119

Immediate insertion of a Foley’s catheter

Question 120

What are the cells of origin in gastrointestinal stromal tumors? 2013, 2011, 2010
a. Cajal cells
b. Kutchinsky cells
c. Paneth cells

Answer 120

a. Cajal cells

Question 121

36.A 28-year-old female presents with fatigue and heat intolerance. She recalls having a common cold a week back. On physical examination, the thyroid was enlarged and tender, and the overlying skin was erythematous. Her ESR was found to be high. What is the likely diagnosis? 2011
a. Autoimmune thyroiditis
b. Graves disease
c. Subacute thyroiditis
d. Thyroglossal duct cyst

Answer 121

c. Subacute thyroiditis

Question 122

A 36-year-old man was brought to the casualty after a traumatic accident. In the emergency room, the patient’s blood started to ooze profusely from his wounds and sites of IV cannulation. What is the likely diagnosis? 2017, 2011
a. Catheter-related infection
b. Disseminated intravascular coagulation
c. Transfusion reaction

Answer 122

b. Disseminated intravascular coagulation

Question 123

Which of the following tests is not used to investigate benign prostatic hyperplasia? 2011
a. Urine cytology
b. Uroflowmetry
c. Bladder ultrasound
d. PSA level

Answer 123

a. Urine cytology

Question 124

12.A 57-year-old man who has a history of coronary artery disease, diabetes mellitus and hypertension is scheduled for a hernia repair. What medication should be stopped days before the surgery? 2011
a. Aspirin
b. Beta blocker
c. Insulin
d. Nitrates

Answer 124

a. Aspirin

Question 125

17.On the second day after his operation, a young patient developed fever and mild hypoxia.
What could be the likely cause of this patient’s presentation? 2011
a. Aspiration pneumonitis
b. Atelectasis due to inadequate analgesia
c. Wound infection

Answer 125

b. Atelectasis due to inadequate analgesia
Note: Postoperative fever on the first two days is likely due to atelectasis rather than a wound infection which occurs more commonly after the second day. The presence of hypoxia supports the likely cause.

Question 126

14.Which of the following would be a definitive treatment option for a young female with stress incontinence? 2011
a. Vaginal sling surgery
b. Botulinum toxin injection

Answer 126

a. Vaginal sling surgery

Question 127

A 31-year-old male athlete presents to the orthopedic clinic with foot pain that increases on walking. Foot x-ray shows a transverse fracture in the fifth metatarsal with cortical thickening. What is this patient likely to have?

Answer 127

Metatarsal stress fracture

Question 128

23.Which of the following is the most important step in the management of a patient with lower back pain? 2011
a. Neurological exam
b. MRI
c. CT scan

Answer 128

a. Neurological exam
Note: As surprising as it sounds, neurological examination is superior to imaging modalities, including MRI, when deciding a treatment plan for a patient with lower back pain. The presence of progressive neurological dysfunction, which is determined by examination, is an indication for surgical intervention as opposed to the classic treatment with pain killers and physiotherapy. Moreover, lower limb weakness or paralysis, perineal paresthesia and sphincter dysfunction detected on physical exam are signs of an underlying cauda equina, which warrants urgent surgical decompression. MRI is not even indicated in most patients with lower back pain aside from certain conditions.

Question 129

A 6-month-old baby was brought by his parents to the urology clinic to get circumcised. On physical examination of the baby, the urethral meatus was on the ventral aspect of his penis. The parents are so willing to have their child circumcised. What advice would be recommended for the parents regarding their child’s circumcision? 2013, 2011, 2010
a. Circumcision is contraindicated in hypospadias
b. They should wait when their son is older
c. It should be performed immediately

Answer 129

a. Circumcision is contraindicated in hypospadias
Hypospadias are an absolute contraindication for circumcision which should be deferred as the foreskin may be utilized in the correction.

Question 130

18.A patient with carcinoid syndrome presented with wheezing, flushing, and diarrhea. What organ should the carcinoid tumor invade for carcinoid syndrome to occur? 2013, 2011, 2010
a. Colon
b. Liver
c. Rectum

Answer 130

b. Liver
Note: Hormones released by the tumor are metabolized by the liver and produce no symptoms; however, if hepatic metastases are present, hormones will drain into the systemic circulation without metabolism causing diarrhea, flushing and other symptoms of carcinoid syndrome.

Question 131

What statement accurately describes Monteggia fracture? 2011
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 131

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

Question 132

44.A 58-year-old man undergoes total thyroidectomy for a thyroid malignancy. Which of the following is used as an adjuvant treatment? 2011
a. Radioiodine ablation
b. Only observation

Answer 132

a. Radioiodine ablation
Note: Ablative therapy is needed after total thyroidectomy in high-risk patients. It aims to destroy any remaining thyroid tissue and any occult microscopic cancer cells.

Question 133

40.A 33-year-old female patient was found to have a hot thyroid nodule. Thyroid function tests showed a high T4 and low TSH. What is the best treatment option for this patient? 2011
a. Hemithyroidectomy
b. Nodule excision
c. Radioactive iodine
d. Total thyroidectomy

Answer 133

b. Nodule excision

Question 134

21.An 18-year-old male patient was brought to the emergency room with flank pain and fever.
The patient’s heart rate was 112/min, and his blood pressure was 97/62 mmHg. His body temperature was 38.5 Co. Ultrasound shows stenosis of the pelviureteric junction with a dilated calyceal system. The patient was rehydrated, and a urologist was consulted. What is the appropriate next step to manage this patient? 2011
a. Insertion of a nephrostomy tube
b. Radical nephrectomy
c. Pyeloplasty

Answer 134

?

Question 135

15.A 42-year-old man had recently undergone a choledochojejunostomy. Few days later, he developed abdominal pain and fever. The drainage bag contained a greenish discharge.
What is the underlying cause of this patient’s presentation? 2011, 2010
a. Abscess
b. Anastomotic leak
c. Ascending cholangitis
d. Digested blood

Answer 135

b. Anastomotic leak

Question 136

20.A 54-year-old man with a history of alcoholic cirrhosis was admitted for decompensation.
The surgeon asks one of the residents about the components of the Child-Pugh classification used to predict the prognosis of patients with cirrhosis. The resident mentions ascites, encephalopathy and serum albumin. What are the other two indicators? 2011
a. Serum bilirubin and INR
b. AST and ALT
c. Alkaline phosphatase and gamma glutamyl transferase

Answer 136

a. Serum bilirubin and INR

Question 137

29.A 47 year old woman develops erythema and induration of her left breast. She was started on a course of antibiotics which turned out to be ineffective. A skin biopsy was taken and showed invasion of the dermal lymphatics by malignant cells. What is the likely diagnosis?
2013, 2011
a. Inflammatory breast cancer
b. Mastitis.
c. Paget disease of the nipple

Answer 137

a. Inflammatory breast cancer

Question 138

12.A 35-year-old female has a history of right lower quadrant pain for a couple of days.
Abdominal x-ray shows calcification in the right lower quadrant in the region of the terminal ileum. Chest x-ray, on the other hand, shows fibrocavitating lesions in the lung apices. What does this patient have? 2013, 2011
a. Acute appendicitis
b. Gallstone ileus
c. Mesenteric lymphadenitis
d. Tuberculous ileitis

Answer 138

d. Tuberculous ileitis

Question 139

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

Answer 139

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.

Question 140

What is the most common type of bladder carcinoma? 2011
a. Transitional cell carcinoma
b. Squamous cell carcinoma
c. Adenocarcinoma

Answer 140

a. Transitional cell carcinoma

Question 141

10.Following a penicillin injection, a middle-aged patient develops an anaphylactic reaction. He was having difficulty breathing and developed a rash all over his body. How should this patient be immediately managed? 2013, 2011
a. Administer high-dose oral steroids.
b. Administration of epinephrine
c. Start antihistamines

Answer 141

b. Administration of epinephrine

Question 142

18.A 51-year-old patient with a history of cirrhosis was brought to the emergency room with an episode of hematemesis. He was immediately resuscitated, and IV somatostatin and epinephrine were administered. Despite the measures taken and increasing the dose of epinephrine, the patient continued to bleed. What should be done next in this setting? 2011
a. Insert of a Sengstaken-Blakemore tube
b. Perform transjugular intrahepatic portosystemic shunt
c. Administer beta blockers to reduce the portal venous pressure

Answer 142

a. Insert of a Sengstaken-Blakemore tube
Notes: Sengstaken-Blakemore tube can be used as a temporary measure to manage refractory variceal bleeding. It acts by tamponading the bleeding veins until a more definitive plan is carried out.

Question 143

11.An 18-year-old boy presented with a constantly-growing mass in his upper arm. Further laboratory investigations and imaging established a diagnosis of osteosarcoma. What would be an appropriate treatment plan for this patient’s condition? 2011
a. Neoadjuvant chemotherapy, tumor resection and bone prosthesis
b. Upper limb amputation
c. Radiotherapy

Answer 143

a. Neoadjuvant chemotherapy, tumor resection and bone prosthesis

Question 144

A 41-year-old gentleman presents with scrotal swelling that he had for a few weeks. The urologist did a testicular ultrasound which revealed the presence of a testicular tumor. The doctor scheduled the patient for inguinal orchiectomy to treat his condition. Which of the following measures should be conducted prior to the surgery? 2013, 2011
a. Trans-scrotal biopsy
b. Sperm Banking
c. Radiotherapy
d. CT scan of chest, abdomen and pelvis
e. Chemotherapy

Answer 144

d. CT scan of chest, abdomen and pelvis

Question 145

A 26-year-old man was brought to the casualty after a motorcycle accident. Complete evaluation of the patient was performed, and blood was noted at the urethral meatus.
Which of the following measures should be done before inserting a Foley catheter?

Answer 145

Perform a retrograde urethrogram then insert a suprapubic catheter if urethral injury is documented
Note: All patients with suspected urethral injury should undergo retrograde urethrography.
Never insert a cystoscope or a catheter before RUG is performed in such patients

Question 146

27.A young man who is on androgenic steroids develops bilateral tender masses in his breasts.
What is the likely diagnosis? 2013, 2011
a. Breast abscess
b. Breast cancer
c. Gynecomastia

Answer 146

c. Gynecomastia
Note: The use of anabolic steroids inhibits endogenous production of testosterone resulting in estrogen predominance and induction of breast proliferation.

Question 147

What is a correct sequence of steps done on a trauma patient according to the ATLS protocol? 2011
a. Primary survey -> hemodynamic resuscitation -> secondary survey -> tertiary survey
b. Primary survey -> secondary survey -> hemodynamic resuscitation -> tertiary survey
c. Primary survey -> secondary survey -> tertiary survey - resuscitation

Answer 147

a. Primary survey -> hemodynamic resuscitation -> secondary survey -> tertiary survey