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Surgery Final > 2013 > Flashcards

2013 Flashcards

1
Q

Which of the following is used best to visualize atlantoaxial instability in RA patients? 2013
a. Atlantoaxial interval in flexion and extension
b. CT and measure the distance between joints
c. Atlatnodental x-ray on open mouth
d. MRI of C1-2

A

b. CT and measure the distance between joints

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2
Q

Terminal ileum affected and creeping fat

A

Crohn’s

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3
Q

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

A

a. Inflammatory breast cancer

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4
Q

A 23 year old male had a knee injury while playing football. He came to you with swelling in his knees. You performed full knee examination for him
Lachman: +ve
Anterior drawer: +ve
Varus stress: - ve
Valgus stress : +ve
McMurray test : +ve
What is the best treatment for his conditions? 2013
a. Open surgical repair of his medial meniscus and ACL
b. Arthroscopic repair of his medial meniscus and ACL
c. Open surgical repair of his medial meniscus, MCL, and ACL
d. Open surgical repair of his MCL and ACL

A

b. Arthroscopic repair of his medial meniscus and ACL
Unhappy triad case, the MCL is usually managed by physiotherapy

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5
Q

A 55 year old female came to the hospital for a left flank pain. US revealed a highly reflective mass. What is the most likely diagnosis? 2013
a. Papillary necrosis
b. Renal calculi
c. Angiomyolipoma
d. RCC

A

c. Angiomyolipoma

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6
Q

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

A

a. Application of pelvic wrap or binder

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7
Q

Which of the following injuries causes wallerian degeneration? 2013
a. Axonomesis
b. Neuropraxia
c. Neurotmesis

A

a. Axonomesis

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8
Q

A patient had cholecystectomy and during which his right hepatic artery was injured. He then was transfused with 2 L and well resuscitated. Later on, his urine output was 2.4 L and his blood urea level was increasing over 5 days even though he tried to increase his water intake. How would you manage him? 2013
a. Advice 8 L of fluid intake to remove urea
b. Adjust his fluid resuscitation according to his output
c. IV ammonium chloride
d. Make IV fluid 750 mL
e. IV KCL

A

b. Adjust his fluid resuscitation according to his output

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9
Q

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

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.

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10
Q

Which of the following is a urinary obstructive symptom? 2013
a. Dysuria
b. Hematuria
c. Hesitancy
d. Frequency

A

c. Hesitancy

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11
Q

An 18 year old female presented with a well circumscribed 2 cm mass in her breast. It was painless, rubbery, with discrete borders. It appears to be freely movable with the breast.
What is the most likely diagnosis?

A

Fibroadenoma

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12
Q

A 13-year-old boy was playing with his friends. He tried to throw the ball with his hand in a position of external rotation, complete abduction, and extension. If he had an injury in this position, which x-ray view would be the best to order? 2013
a. Axillary
b. AP
c. Scapular Y
d. Lateral

A

a. Axillary

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13
Q

A 26 year old male had a motorcycle accident. The doctor in the ER found blood on his urethral meatus. He also had a severe pelvic injury distending his abdomen. Physical examination revealed a dullness of the suprapubic area on percussion. What is most likely to be injured? 2013, 2010
a. Intraperitoneal bladder rupture
b. Penis crush injury
c. Membranous urethra injury

A

c. Membranous urethra injury

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14
Q

A patient who is a heavy smoker presented with shortness of breath five days after surgery. CXR and physical examination were unremarkable. His O2 saturation was 84% on room air. What is the likely diagnosis? 2013
a. Atelectasis
b. Aspiration pneumonia
c. COPD exacerbation
d. Congestive heart failure
e. Pulmonary Embolism

A

e. Pulmonary Embolism
Atelectasis and pneumonia are early complications and usually present with fever and CXR findings. COPD and heart failure are unlikely with a normal chest CXR. The only possible explanation is prolonged immobilization after surgery which predisposes the patient to DVT.
PE usually occurs with normal CXR. Desaturation, dyspnea, and chest pain may be the only findings.

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15
Q

A 56 years old lady twisted her ankle while climbing the stairs. She had ecchymosis and blisters around the injury. The X-ray showed a bimalleolar fracture. What is the most appropriate initial management? 2013
a. Cast
b. External fixation
c. K-wires
d. ORIF

A

b. External fixation

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16
Q

A clinical scenario describing that a pressure over the patient’s left lower quadrant causes pain in the right lower quadrant. What is the name of this sign?

A

Rovsing sign

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17
Q

A 22 year old male presented with anemia, endoscopy showed a gastric, small bowel and colon polyps in addition to dark pigmentation around his mouth. What is the diagnosis?
2017, 2013
a. Cronkhite-Canada syndrome
b. Familial adenomatous polyposis
c. Non-polyposis colonic cancer
d. Juvenile polyposis
e. Peutz-Jegher syndrome

A

e. Peutz-Jegher syndrome

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18
Q

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

A

b. Ultrasound of the kidney, ureter and urinary bladder

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19
Q

Which of the following is a cofactor in the hydroxylation of proline?

A

Vitamin C

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20
Q

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

A

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.

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21
Q

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

A

b. Administration of epinephrine

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22
Q

A patient had an episode of epigastric pain. He had severe retching but was unable to vomit. Passing a nasogastric tube has failed. What is the most likely diagnosis? 2013
a. Gastric outlet obstruction
b. Gastric volvulus
c. Gastritis
d. Perforated ulcer
e. SBO

A

b. Gastric volvulus

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23
Q

You are called to assess a 23-year old patient post hemi-thyroidectomy. She is developing respiratory distress. In addition, she has stridor and becoming more agitated. What should you do? 2015, 2013
a. Arrange for CT to check for collection.
b. Arrange for US to check for collection.
c. Treat with diphenhydramine and epinephrine.
d. Ventolin nebulizer and CXR.
e. Notify on-call team and anesthesia to evacuate hematoma and protect airway.

A

e. Notify on-call team and anesthesia to evacuate hematoma and protect airway.

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24
Q

What is meant by upper Gl bleeding?

A

a. Bleeding above the ligament of Treitz

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25
Q

An 8-year-old girl came to your hospital complaining of painless limping. Her x-ray showed fragmentation of the head of her femur. What is the likely diagnosis? 2013
a. Slipped Capital Femoral Epiphysis
b. Undiagnosed Developmental dysplasia of the hip
c. Limb length discrepancy
d. Legg-Calve-Perthes disease

A

d. Legg-Calve-Perthes disease

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26
Q

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? 2013
a. Testicular Torsion
b. Epididymo-orchitis
c. Torsion Of Testicular Appendage

A

a. Testicular Torsion

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27
Q

Diabetic man who had an ulcer and underwent surgery, his wound kept open till it closed spontaneously later. What is the type of closure? 2013
a. Primary delayed
b. Secondary delayed
c. Primary intention
d. Secondary intention
e. Tertiary intention

A

d. Secondary intention

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28
Q

A patient came to your hospital after a MVA. How to determine the energy of his injury? 2013
a. Mass and volume
b. Distance and density
c. Distance and velocity
d. Weight and gravity
e. Mass and velocity

A

e. Mass and velocity

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29
Q

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 cystoscopy revealed a 3-cm papillary mass. How should this lady be managed at this point? 2013
a. BCG
b. TURB
c. Systemic chemotherapy
d. Cystectomy and urinary diversion

A

b. TURB

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30
Q

Where are the chief cells found? 2016, 2013
a. Antrum
b. Body
c. Fundus
d. Incisura
e. Pylorus

A

b. Body
c. Fundus

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31
Q

A patient had symptoms of gastric outlet obstruction. He was diagnosed later with pyloric stenosis/atresia. How would you diagnose his condition on clinical examination? 2013
a. Auscultate LUQ
b. Palpate for peristalsis from LUQ to RUQ
c. Palpate for peristalsis from RUQ to LUQ
d. Percuss upper abdomen
e. Succussion Splash

A

b. Palpate for peristalsis from LUQ to RUQ
Succussion splash might be used for gastric outlet obstruction; however, peristalsis is more specific for pyloric stenosis

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32
Q

A 30 year old lactating woman develops a tender mass in her breast with an erythematous overlying skin. How should this patient be treated? 2013
a. Incision and drainage
b. Intravenous antibiotics.
c. Wide local excision

A

a. Incision and drainage

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33
Q

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

A

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.

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34
Q

How to differentiate between keloid and hypertrophic scar? 2013
a. Biopsy
b. Erythema
c. Height of the scar
d. Keloid goes beyond the scar border

A

d. Keloid goes beyond the scar border

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35
Q

In which of the following locations can you get an injury of the radial nerve? 2013
a. Midshaft of the humerus
b. Proximal third and midshaft of the humerus
c. Midshaft and distal third of the humerus
d. Head of the Humerus
e. Distal third of the Humerus

A

c. Midshaft and distal third of the humerus

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36
Q

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

A

d. CT scan of chest, abdomen and pelvis

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37
Q

Low PH / high co2 / normal hco3

A

respiratory acidosis

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38
Q

Which of the following is an early sign of xylocaine (lidocaine) toxicity? 2016, 2015, 2013, 2012
a. Cardiac arrhythmia
b. Perioral numbness
c. Seizures

A

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.

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39
Q

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

A

c. Thoracodorsal nerve

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40
Q

A 12 year old boy with extrahepatic fusiform dilatation of the biliary tree. What is the diagnosis? 2013
a. Biliary atresia
b. Choledochal cysts

A

b. Choledochal cysts

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41
Q

A young boy bumped into his friend and fractured his left arm. X-ray showed that he had a simple bone cyst in his arm. What is the most appropriate management? 2013
a. Functional brace
b. ORIF
c. External fixation

A

b. ORIF

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42
Q

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

A

b. Transitional zone

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43
Q

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

A

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

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44
Q

An 18-year-old boy presented with a constantly-growing mass in his right thigh. Further laboratory investigations and imaging established a diagnosis of osteosarcoma. What management plan would give the most local control and highest function? 2013
A) Radiotherapy of the lesion
B) Intralesional bone resection neoadjuvant chemotherapy and bone prosthesis
C) Knee amputation
D) Extra-articular bone resection, neoadjuvant chemotherapy and allograft bone
E) Above knee amputation

A

D) Extra-articular bone resection, neoadjuvant chemotherapy and allograft bone

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45
Q

What is the most common place for metastasis of osteosarcoma? 2013
a. Bone
b. Liver
c. Lung
d. Brain
e. Lymph nodes

A

c. Lung

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46
Q

What are the boundaries of Calot’s triangle? 2017, 2016, 2015, 2013
a. Cystic duct, common hepatic duct, inferior liver edge
b. Left hepatic duct, inferior liver edge and CBD
c. Right hepatic artery, cystic duct, and CBD

A

a. Cystic duct, common hepatic duct, inferior liver edge

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47
Q

A 16 years old sickler patient had severe bilateral hip pain. The x-ray showed that his right hip joint collapsed and left femur is necrotic. What is the best way of management? 2013
a. THR for both hips
b. Right THR and left decompression
c. Left THR and right decompression
d. Systemic steroids
e. Wait for hip replacement in the future

A

c. Left THR and right decompression

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48
Q

A female presented after MVA was hemodynamically stable, a 4 cm lesion was found incidentally on CT scan. What is the best management? 2013
a. Appointment for elective adrenalectomy
b. Biochemical tests to see adrenal function
c. Biopsy
d. PET scan
e. Reassurance since she is asymptomatic

A

b. Biochemical tests to see adrenal function

This is a case of adrenal incidentaloma. The goal is to know if it is functional and if it is malignant.
* Malignancy: can be diagnosed by CT findings based on size (90% of malignant masses are > 4 cm), density and borders.
* FNA biopsy CANNOT distinguish between benign mass and carcinoma.
* PET scan is useful for someone with a history of malignancy.
* Functionality by lab tests even if patient is asymptomatic.
B is the best answer

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49
Q

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

A

c. Fresh Frozen Plasma

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50
Q

A 33-year-old woman with a one day history of colicky central abdominal pain, vomiting, and obstipation. No past medical history is significant except for a laparotomy she had when she was a child. On examination, the bowel sounds were hyperactive. What’s the most likely cause of her symptoms? 2013
a. Paralytic ileus
b. Gallstone ileus
c. Crohn’s
d. Colorectal tumor
e. Adhesions

A

e. Adhesions

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51
Q

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 and body temperature 39 C. A KUB x-ray was immediately performed and showed a radiopaque shadow to the right 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? 2013
a. Observation
b. Administration of intravenous fluids
c. Insertion of a nephrostomy tube
d. Insertion of a double J stent

A

b. Administration of intravenous fluids

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52
Q

Which of the following would be the best method to diagnose prostate cancer? 2013, 2010
a. PSA only
b. CT scan
c. Transrectal ultrasound
d. PSA and transrectal ultrasound biopsy

A

d. PSA and transrectal ultrasound biopsy

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53
Q

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 is the mechanism that contributes to failure of his healing? 2013
a. Increased risk of infection
b. Hypoxemia and reduced angiogenesis
c. Glycation of protamine

A

b. Hypoxemia and reduced angiogenesis

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54
Q

A 56 years old obese female OA of her knees. She tried physiotherapy and taking NSAID, but that didn’t improve her condition. What would be the best intervention to alleviate her symptoms? 2013
a. Weight Loss
b. Physiotherapy
c. Steroids
d. Glyco Hyaline injections

A

a. Weight Loss

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55
Q

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

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.

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56
Q

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

a. Sacroiliac ligament

57
Q

An athlete had multiple anterior shoulder dislocations. Damage of which structure contributed to his repeated injury? 2013
a. Biceps tendon
b. Supraspinatus and Infraspinatus muscles
c. Anterior superior labrum
d. Coracoacromial ligament

A

c. Anterior superior labrum

58
Q

A patient with peptic ulcer disease, he had a proton pump inhibitor. What additional antibiotics would you prescribe for this patient? 2016, 2013
a. Amoxicillin & ciprofloxacin
b. Amoxicillin & clarithromycin
c. Amoxicillin & clindamycin
d. Metronidazole & ciprofloxacin
e. Metronidazole & clindamycin

A

b. Amoxicillin & clarithromycin

59
Q

What is the most common type of urinary stones? 2013
a. Calcium oxalate
b. Calcium phosphate
c. Uric acid

A

a. Calcium oxalate

60
Q

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

A

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

61
Q

Which of the following conditions increases the risk of developing clear renal cell carcinoma? 2013
a. Birt-Hogg-Dube syndrome
b. Von Hippel-Lindau disease
c. ADPKD
d. Papillary carcinoma
e. Tuberous sclerosis

A

b. Von Hippel-Lindau disease

62
Q

Adjuvant treatment after GIST (C-kit mutation). How will you treat it?

A

Imatinib
Note: imatinib is a tyrosine kinase inhibitor that is used as a chemotherapy for GIST.

63
Q

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

A

d. Tuberculous ileitis

64
Q

A patient with gallstones, during laparoscopic cholecystectomy the surgeon found a distended gallbladder, which when aspirated there was a clear fluid. What is the diagnosis? 2013
a. Mucocele of GB
b. Empyema of GB

A

a. Mucocele of GB

65
Q

Which of the following drugs are used initially to treat benign prostatic hyperplasia? 2013
a. Alpha blockers
b. Alpha agonists
c. Beta blockers
d. Beta agonist
e. Anticholinergic

A

a. Alpha blockers

66
Q

A 70 year old patient had surgery. After that, his vitals were as follows:
CO2: 62 SO2: 90% on room air
O2: 43? HCO3: 24
What is the most appropriate management at this point?

a. Ask him to take deep breath and cough
b. 40% O2 mask
c. Intubation & ventilatory assist
d. Lactate Ringer
e. Pain killers

A

c. Intubation & ventilatory assist

67
Q

An 18 year old male had a fracture while playing football. His fracture was grade 3C. What is the most appropriate management of this patient? 2013
a. Early antibiotics and debridement
b. Early antibiotics and tetanus toxoid
c. Vascular repair, early antibiotics, and debridement
d. External fixator
e. ORIF

A

c. Vascular repair, early antibiotics, and debridement

68
Q

What do carcinoid tumor cells arise from?

A

Enterochromaffin cells.
Also known as kulchitsky cells

69
Q

Type of hernia that’s superior to inguinal ligament and medial to inferior epigastric vessels? 2013

A

Direct inguinal

70
Q

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

a. External Branch of superior laryngeal nerve

71
Q

A healthy patient with right renal cell carcinoma (10 cm mass-Grade 3)? 2013
a. Radical Nephrectomy
b. Simple nephrectomy with ureterectomy
c. Partial nephrectomy

A

a. Radical Nephrectomy

72
Q

A patient had experienced cold limbs and tachycardia. His PCWP increased to 18 and his CO was 3 L/minute. What is this type of shock? 2013
a. Neurogenic
b. Anaphylactic
c. Hypovolemic
d. Cardiogenic

A

d. Cardiogenic

73
Q

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.
Although he is compliant to his medications, the symptoms won’t regress. 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? 2013
a. Transurethral resection of the prostate
b. Alpha adrenergic blockers
c. Alpha-5-reductase inhibitors
d. Silodosin
e. Lifestyle changes

A

a. Transurethral resection of the prostate

74
Q

Second postoperative day after a splenectomy, the patient developed hyperkalaemia (K=6.3). Recently started on an oral fluid diet. He is not complaining. His vital signs and ECG were normal. What is the next step in management? 2013
a. Insulin and dextrose
b. 500 ml of 5% dextrose
c. Nothing as he is asymptomatic
d. Spironolactone

A

a. Insulin and dextrose

75
Q

A 65 year old patient who is diabetic (glucose=21 mol/L) presented with perianal pain, you found out that he has cellulitis. You noticed an oozing ulcer with black edges. What is the most important step for management of this patient? 2013
a. Glucose level control
b. Broad spectrum antibiotics
c. CT to check for extended abscess
d. Immediate debridement

A

d. Immediate debridement
This patient most likely has Fournier gangrene (necrotizing fasciitis of perianal region), and diabetes is a major risk factor. Best initial diagnosis is with CT shows air in soft tissue).
Treatment with EARLY and aggressive surgical exploration and debridement together with broad-spectrum antibiotics.

76
Q

What is the best location for knee aspiration? 2013
a. Lateral to the lateral collateral ligament
b. Medial to the patellar tendon
c. Popliteal fossa
d. Posterior to medial collateral ligament

A

b. Medial to the patellar tendon

77
Q

Which of the following neurological deficits are found in Brown- Sequard syndrome?
A) Ipsilateral CST and ipsilateral spinothalamic tract
B) Ipsilateral CST, contralateral spinothalamic, contralateral gracile and cuneate fasciculi
C) Ipsilateral CST and ipsilateral gracile and cuneate fasciculi
D) Contralateral CST, contralateral spinothalamic tract

A

C) Ipsilateral CST and ipsilateral gracile and cuneate fasciculi

78
Q

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

A

a. It allows soft tissue swelling

79
Q

A 38-year-old woman complains of right upper abdominal heaviness for one year. She has been on oral contraceptives for 15 years. No nausea or vomiting, no weight loss and she has a good appetite. Ultrasound showed 2×2 cm mass on the right side of the liver. What is your diagnosis? 2013
a. Granuloma liver
b. Liver abscess
c. Liver cell adenoma
d. Liver metastasis
e. Hepatocellular carcinoma

A

c. Liver cell adenoma

80
Q

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

A

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

81
Q

An 18-year-old male patient was brought to the emergency room with flank pain and fever.
The patient’s heart rate was 120/min, and his blood pressure was 100/60. His body temperature was 38.5 Co. Ultrasound shows stenosis at the pelviureteric junction with a markedly disrupted hydronephrosis of the right kidney. The patient was rehydrated, and a urologist was consulted. What is the appropriate next step to manage this patient? 2013
a. Insertion of a nephrostomy tube
b. Radical nephrectomy
c. Open lithotomy
d. Ureteroscopy
e. Pyeloplasty

A

a. Insertion of a nephrostomy tube

82
Q

Which of the following predispose to gallstones? 2013
a. Increased cholesterol and stasis
b. Increased cholesterol and non-functional gallbladder

A

a. Increased cholesterol and stasis
(stasis occurs in patients of TPN or prolonged fasting)

83
Q

How many days does spermatogenesis take normally? 2013
a. 7-10
b. 20-30
c. 30-60
d. 60-70
e. 100-120

A

e. 100-120

84
Q

A 36 years old male weighing 60 Kg was malnourished. If you wanted to feed him parentally, what is the optimal TPN calorie intake? 2013
a. 1 cc/kg/d
b. 15 cc/kg/d
c. 30 cc/kg/a
d. 50 cc/kg/d
e. 100 cc/kg/d

A

c. 30 cc/kg/a

85
Q

A young boy was playing basketball. He heard a pop when prepared to jump. After that, he could not extend his knee and had ecchymosis. You palpated a gap superior to his patella.
What is the most likely injury? 2015, 2013
a. Patellar fracture.
b. Patellar tendon rupture.
c. Patellar superior dislocation.
d. Quadriceps tendon rupture.

A

d. Quadriceps tendon rupture.

86
Q

Following extubation and modified wide excision, a woman in her seventies developed the following vital signs:
Pulse high BP ~130/80 PO2 High
Respiratory rate <6. Ph 7.2 PCO2 Low
What is the likely diagnosis? 2013
a. Respiratory acidosis
b. Respiratory alkalosis
c. Mixed alkalosis and acidosis

A

-

87
Q

Which of the following is a feature of malignant rather than benign breast cancer? 2013
a. Changes size with the menstrual cycle
b. Freely movable
c. Tenderness
d. Tethering to the skin

A

d. Tethering to the skin

88
Q

Patient with ulcerative colitis for 16 years and now he is presenting with jaundice and pruritus. What could the patient have?

A

Sclerosing Cholangitis

89
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 cholangio-pancreatography

A

a. Cholecystectomy in the same admission when the pain resolves

90
Q

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

A

a. Carbamazepine

91
Q

What is found in both the inguinal canal and femoral canal?

A

Inguinal ligament

92
Q

A 45 year old male patient wanted to do bariatric surgery. What is the recommendation for the BMI knowing that he has diabetes mellitus? 2013
a. 30
b. 35
c. 40
d. 45

A

b. 35

93
Q

Which nerve supplies pectoralis minor muscle? 2017, 2016, 2013
a. Medial pectoral nerve
b. Lateral pectoral nerve
c. Long thoracic
d. Thoracodorsal nerve

A

a. Medial pectoral nerve

94
Q

A 56-year-old man with liver cirrhosis had bleeding varices which was controlled, he’s taken to the ICU to be monitored, after 2 days he was confused. What’s the management? 2013
a. Antibiotics
b. Halothane
c. Lactulose
d. Thiamine

A

c. Lactulose

95
Q

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

A

a. Incision and drainage and IV antibiotics

96
Q

Which of the following is needed for collagen formation in wound healing? 2013
a. Vitamin A
b. Vitamin B
c. Vitamin C
d. Vitamin D

A

c. Vitamin C

97
Q

A patient had a fracture in his humerus with intact neurological functions. After the ORIF, he experienced drop writs. What is the most probable cause? 2013
a. The nerve was accidentally cut by the surgeon
b. Traumatic injury to the nerve
c. Radial nerve apraxia
d. Compression of the nerve by the plates and screws

A

a. The nerve was accidentally cut by the surgeon

98
Q

Which of the following thyroid malignancies can be monitored through blood levels of calcitonin, which is a hormone that decreases calcium level in the body? 2013
a. Anaplastic thyroid carcinoma
b. Follicular thyroid carcinoma
c. Lymphoma
d. Medullary thyroid carcinoma
e. Papillary thyroid carcinoma

A

d. Medullary thyroid carcinoma

99
Q

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

a. 24 hour esophageal pH monitoring

100
Q

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 mg/mL. Biopsy showed that the lesion is poorly differentiated with a Gleason score of 8. Metastatic workup detects no metastasis. The patient was put on hormonal therapy. Which of the following represents the hormone levels in a patient on hormonal therapy? 2013
a. Low FSH, high LH, low testosterone
b. Low FSH, low LH, low testosterone
c. High FSH, Low LH, low testosterone
d. Low FSH, low LH, High testosterone

A

b. Low FSH, low LH, low testosterone

101
Q

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

A

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.

102
Q

What is the histological type of juvenile polyps? 2013
a. Adenomatous
b. Hamartomatous
c. Hyperplasia

A

b. Hamartomatous

103
Q

A 75-year-old female underwent oophorectomy for an ovarian mass. Pathological examination revealed metastatic gastric adenocarcinoma. What is the mode of spread in this case? 2013
a. Implantation
b. Hematogenous
c. Lymphatic extension
d. Trans-coelomic

A

d. Trans-coelomic
Krukenberg tumor is trans-coelomic spread.

104
Q

Female with constant right upper quadrant pain (high AST, ALT, ALP, amylase (1000), bilirubin, and total bilirubin). What is the diagnosis? 2013
a. Hepatitis A
b. Biliary pancreatitis
c. Gilbert

A

b. Biliary pancreatitis
Amylase 5x more than normal limit is highly specific for acute pancreatitis

105
Q

What forms the superior border of the ischiorectal fossa? 2017, 2013
a. Gluteus major
b. Obturator Internus
c. Levator Ani Complex

A

c. Levator Ani Complex

106
Q

Bleeding varices refractory to medical and endoscopic treatment. What is the next step of management?

A

Sengstaken-blakemore tube

107
Q

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.

A

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.

108
Q

Which of the following markers is elevated in hepatocellular carcinoma? 2016, 2013, 2012
a. AFP
b. B-HCG
C. CA19-9
d. CA25

A

a. AFP

109
Q

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

A

a. Kidney

110
Q

fatty acid deficiency question repeated

A

-

111
Q

A 65-year-old man who previously had voiding symptoms came with a 15-hour history of urinary retention. Physical examination showed a distended and percussible bladder. How should this patient be managed? 2013
a. Suprapubic catheter
b. CT without contrast
c. Immediate insertion of a Foley’s catheter
d. Crede maneuver

A

c. Immediate insertion of a Foley’s catheter

112
Q

An 83-year-old patient presented with 3 hours of generalized abdominal pain, (signs of peritonitis) tachycardia, tachypnoea. What is the next appropriate step after resuscitation? 2013
a. Erect CXR
b. Supine CXR
c. Abdominal CT with contrast

A

a. Erect CXR

113
Q

A 63-year-old male present with painless jaundice and pruritus. He reports to drink alcohol daily. Examination of his abdomen revealed a palpable non-tender gallbladder. What is the likely diagnosis? 2017, 2013
a. Alcoholic hepatitis
b. Gallstones
c. PBC
d. Pancreatic cancer

A

d. Pancreatic cancer

114
Q

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

A

a. Rubber band ligation

115
Q

Bird beak appearance on barium esophagogram. What is the most likely diagnosis?

A

Achalasia

116
Q

A man who underwent ERCP developed air under the diaphragm on CXR. What is the best next step? 2013
a. CT of abdomen
b. Endoscopy
C. Exploratory laparotomy
d. Serum amylase and lipase levels

A

C. Exploratory laparotomy

117
Q

A 62 years old male 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?
a. ileal neobladder
b. Ileal conduit

A

a. ileal neobladder

118
Q

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

119
Q

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

A

d. Thyroglossal duct cyst

120
Q

What is the main source of nutrition for small intestines? 2013
a. Glutamine
b. Glycine

A

a. Glutamine

121
Q

Which of the following is associated with the highest risk of transmission with needle stick injury? 2017, 2016, 2013, 2010
a. Epstien-Barr virus
b. Hepatitis A virus
C. Hepatitis B virus
d. Hepatitis C virus
e. HIV

A

C. Hepatitis B virus
CDC data from most common to least: HBV (6-30%), HCV (1-2%), HIV (0.3%)

122
Q

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

A

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.

123
Q

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

A

a. Cajal cells

124
Q

A patient had left mastectomy for removal of breast cancer. She later experienced ipsilateral hypoesthesia on her arm posterolaterally. Which nerve might be injured?
a. Axillary nerve
b. Intercostal brachial nerve
c. Long thoracic nerve
d. Thoracodorsal nerve

A

Axillary nerve

125
Q

A patient had xanthogranulomatous pyelonephritis. He experienced right flank pain and fever. A CT scan revealed a stone in his right kidney. What is the most likely organism? 2013
a. E. coli
b. Proteus
c. Klebsiella
d. Streptococcus

A

a. E. coli

126
Q

A patient has hyponatremia Na=122 and glucose=24. He received insulin that decreased his glucose level to 5.5. What is the impact of insulin on sodium levels? 2013
a. Sodium increases to normal without specific therapy
b. Sodium remains unchanged
c. Sodium increases transiently then returns to
d. Sodium decreases transiently

A

a. Sodium increases to normal without specific therapy

127
Q

Which of the following nutritional parameters has a half-life of 20 days? 2013
a. Albumin
b. Prealbumin
c. Transferrin
d. Creatinine
e. Retinal binding protein

A

a. Albumin

128
Q

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

A

a. Uric acid stones

129
Q

What is the normal compartment pressure in the leg? 2013
a. 0-15
b. 15-30
c. 30-35
d. 34-50

A

a. 0-15

130
Q

A patient had pain in his neck. He couldn’t flex his wrist, and experienced hypoesthesia in the dorsal of his thumb, index and middle fingers. Which of the following nerves could be compressed? 2013
a. C3-C5
b. C5-C6
c. C6-C7
d. C7-T1

A

c. C6-C7

131
Q

A 55-year-old man suffering from heartburn underwent gastroesophageal endoscopy evaluation. Pathological examination showed metaplastic esophageal lining. What is the most likely diagnosis? 2013
a. Acute esophagitis
b. Barrett esophagus
c. Epithelial dysplasia
d. Epithelial keratinization

A

b. Barrett esophagus

132
Q

Fibroblast in the proliferative phase of wound healing. 2013
a. Type 3 Collagen
b. Type 4 Collagen
c. Type 2 Collagen

A

a. Type 3 Collagen

133
Q

A patient who was on TPN is now changed to Ringer’s lactate. He developed tachycardia, sweating, and confusion. Which of the following nutrient abnormalities will be responsible? 2013
a. Hypokalemia
b. Hyponatremia
c. Hypoglycemia
d. Hypophosphatemia

A

c. Hypoglycemia

134
Q

A 43 years old female attempted suicide from the 4th floor. She came to the hospital with a calcaneal fracture. After suspecting an injury to the lumbar vertebra, an x-ray was done that showed lumbar fracture, what is the mechanism of this fracture? 2013
a. Flexion-distraction injury
b. Burst injury
c. Avulsion injury
d. Distension injury
e. Rotation dislocation injury

A

b. Burst injury

135
Q

When should antibiotics be given in a Clean contaminated surgery? 2013, 2010
a. 4 hours before skin incision
b. 8 hours before skin incision
c. Within 1 hr of skin incision
d. After skin incision

A

c. Within 1 hr of skin incision

136
Q

A surgeon noted a markedly dilated gallbladder and decided to aspirate-found clear thick fluid. What is the diagnosis?

A

Mucinous content, cholestasis

137
Q

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

A

c. Umbilical vein

138
Q

Duodenal ulcer bleeding, during surgery which artery …
….? 2013
a. Celiac artery
b. Gastroduodenal artery
c. Left gastroepiploic artery
d. Splenic artery
e. Superior mesenteric artery

A

b. Gastroduodenal artery

139
Q

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

A

a. Urethral stricture

Surgery Final (10 decks)

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