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MRCS Mageed Sheet > MRCS Recalls April 2017 > Flashcards

MRCS Recalls April 2017 Flashcards

1
Q
  1. A man developed numbness over the lateral aspect of the forearm. This occurred after an axillary injury. Which nerve root is responsible?
    A. T1
    B. C5
    C. C6
    D. C7
    E. C8
A

C. C6

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2
Q
  1. A 12-year-old boy is brought to hospital with a deformed thigh after being struck on that side by a motor vehicle. What is the type of fracture?
    A. Greenstick
    B. Oblique
    C. Spiral
    D. Transverse
    E. Comminuted
A

D. Transverse

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3
Q
  1. A 70-year-old woman, who suffers from multiple metastatic bony lesions sustains a fracture through the metastatic lesion in her humerus after reaching out for a bus as it was pulling away from the bus stop. What is the type of fracture?
    A. Greenstick
    B. Oblique
    C. Spiral
    D. Transverse
    E. Comminuted
A

B. Oblique

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4
Q
  1. A 24-year-old man suffers severe pain just above the ankle after suffering a twisting injury whilst playing football. What is the type of fracture?
    A. Greenstick
    B. Oblique
    C. Spiral
    D. Transverse
    E. Comminuted
A

C. Spiral

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5
Q
  1. A 6- year-old boy complains of pain in the lower forearm after falling on the outstretched hand whist roller blading. There is slight swelling and little deformity of the lower forearm.
    What is the type of fracture?
    A. Greenstick
    B. Oblique
    C. Spiral
    D. Transverse
    E. Comminuted
A

A. Greenstick

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6
Q
  1. After varicose vein surgery, a patient developed numbness over the medial aspect of foot which nerve is damaged?
    A. Saphenous nerve
    B. Sural nerve
    C. Superficial peroneal nerve
    D. Deep peroneal nerve
    E. None of the above
A

A. Saphenous nerve

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7
Q
  1. What is the relation of ulnar nerve to the ulnar artery in wrist? A. Ulnar nerve is ulnar to ulnar artery
    B. Ulnar artery is ulnar to the ulnar nerve
    C. Ulnar nerve is radial to ulnar artery
    D. Ulnar nerve is superficial to ulnar artery
    E. None of the above
A

A. Ulnar nerve is ulnar to ulnar artery

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8
Q
  1. A 49 years old man reported that he neglected his desire to urinate due to a stressful condition. After the situation passed, he felt no desire to urinate. On examination, he has abdominal tenderness and distension with an empty foley catheter. What is the most accepted cause?
    A. Blocked catheter
    B. Hypovolemia
    C. Bladder diverticulum
    D. Ureteric stone
    E. Bladder rupture
A

E. Bladder rupture

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9
Q
  1. Root of transmission of MRSA infection is:
    A. Contact
    B. Feco-oral
    C. Droplet.
    D. Sexually transmitted
    E. None of the above
A

A. Contact

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10
Q
  1. A patient undergone herniotomy a day case surgery. Postoperatively, he developed diarrhea. 2 other patients in the same ward had the same manifestations. Clostridium difficile was found to be causative organism. What is possible mode of transmission of the Clostridium difficile toxin?
    A. Endogenous
    B. Feco-oral
    C. nosocomial
    D. respiratory
    E. Contact
A

B. Feco-oral

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11
Q
  1. A child known with sickle cell anemia experienced hip pain with high grade fever and TLC of 16 and ESR up to 66. What is the most likely underlying organism?
    A. Staphylococcus aureus
    B. Streptococcus pneumonia
    C. Salmonella
    D. Neisseria meningitis
    E. None of the above
A

C. Salmonella

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12
Q
  1. A patient suffered an injury to his thumb finger while gardening. He is now complaining of a fluctuant swelling in the palp space of his thumb. What is the causative organism?
    A. Streptococcus pyogenes
    B. Klebsiella
    C. Staphylococcus aureus
    D. Pseudomonas
    E. MRSA
A

C. Staphylococcus aureus

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13
Q
  1. What is the organism that causes superficial clean wound infection ?
    A. Streptococcus pyogenes
    B. Klebsiella
    C. Staphylococcus aureus
    D. Pseudomonas
    E. MRSA
A

C. Staphylococcus aureus

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14
Q
  1. A surgeon is making an incision from a point below to the middle third of the clavicle to the delto-pectoral groove. Which of the following structures is least likely to be injured ?
    A. Shoulder joint capsule
    B. Pectoralis major muscle
    C. Cephalic vein
    D. Thoracoacromial artery
    E. None of the above
A

A. Shoulder joint capsule

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15
Q
  1. Posterior border of Anatomical snuffbox is made by :
    A. Extensor pollicis brevis
    B. Abductor pollicis longus
    C. Adductor pollicis brevis
    D. Extensor pollicis longus
    E. Adductor longus
A

D. Extensor pollicis longus

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16
Q
  1. Action of psoas muscle includes:
    A. Hip flexion
    B. Hip extension
    C. Knee flexion
    D. Knee extension
    E. Hip abduction
A

A. Hip flexion

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17
Q
  1. A 55-year-old man complains of long-standing pain in the lumbar region on heavy physical activity. He is very stiff in the morning and the pain is worse at the end of the day. Anti- inflammatory medication provides moderate relief of his symptoms. Examination reveals restriction of his movements in the spine with pain on extension of the spine. There are no clinical signs in the legs. Which of the following is the most likely diagnosis?
    A. Central prolapsed lumbar disc
    B. Disc infection
    C. Facet joint arthrosis
    D. Malignant vertebral lesion
    E. Posterolateral disc prolapse
A

C. Facet joint arthrosis

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18
Q
  1. A 35 years old man, just returned from Bangladesh, presented with bloody diarrhea and lower abdominal pain. Mucosa appeared severely distorted on sigmoidoscopy. What is the most likely cause?
    A. Entamoeba histolytica
    B. Ulcerative colitis
    C. Campylobacter
    D. Hepatitis A
    E. Enterobius vermicularis
A

A. Entamoeba histolytica

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19
Q
  1. A patient had a 24-hour duration colicky pain and bloody diarrhea after eating barbecued chicken. Which organism causes this condition?
    A. Staph aureus
    B. E coli
    C. Campylobacter
    D. S. pyogenes
    E. None of the above
A

C. Campylobacter

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20
Q
  1. Which of the following muscle is a hip extensor?
    A. Pyriformis
    B. Semitendinosus
    C. Sartorius
    D. Gluteus Medius
    E. Obturator internus
A

B. Semitendinosus

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21
Q
  1. What forms the medial wall of the femoral canal ?
    A. Femoral nerve
    B. Lacunar ligament
    C. Inguinal ligament
    D. Femoral vein
    E. Pectineal ligament
A

B. Lacunar ligament

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22
Q
  1. What is the least reliable sign of compartment syndrome?
    A. Pain out of proportion
    B. Absent pulse
    C. Tense muscles
    D. Paresthesia
    E. None of the above
A

B. Absent pulse

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23
Q
  1. A woman underwent short saphenous vein striping for varicose veins & developed numbness at the lateral aspect of the foot. What nerve has been injured?
    A. Common peroneal
    B. Tibial
    C. Sural
    D. Saphenous nerve
    E. Deep peroneal nerve
A

C. Sural

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24
Q
  1. A 32-year-old man falls from a height with his legs apart, landing heavily astride an iron bar. On examination there is extensive bruising in the anterior perineum and scrotum, extending onto the anterior abdominal wall. What is the diagnosis?
    A. The bladder is ruptured
    B. The bulbar part of the urethra is ruptured
    C. The membranous urethra is ruptured
    D. The prostatic urethra is ruptured
    E. None of the above
A

B. The bulbar part of the urethra is ruptured

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25
Q
  1. A 20-year-old rugby player falls to the ground with severe pain in his right knee after being tackled. When seen a week later at the orthopaedic clinic, he is found to have an effusion in his right knee, persistent tenderness 2.5 cm above the joint line on the medial side and on testing sideways tilting with the knee at 30 degree of flexion, increased lateral angulation is noted compared with the unaffected side. What is the diagnosis?
    A. Anterior cruciate ligament
    B. Lateral collateral ligament
    C. Lateral meniscus
    D. Medial collateral ligament
    E. Medial meniscus
A

D. Medial collateral ligament

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26
Q
  1. A 30-year-old man injures his right knee, causing a painful swelling in that area, during a road traffic accident. Radiographs show no bony injury. A fortnight later he notices difficulty in walking downhill. At the orthopaedic clinic, he is found to have a small effusion in the knee joint and when both knees are flexed to 90 and are viewed from the side, the upper part of the right tibia is seen to be posteriorly displaced compared with the left tibia. What is the likely diagnosis?
    A. Posterior cruciate ligament
    B. Lateral collateral ligament
    C. Lateral meniscus
    D. Medial collateral ligament
    E. Medial meniscus
A

A. Posterior cruciate ligament

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27
Q
  1. A 7-year-old baby was brought by his mother after she noticed that he has evident limping with pain in his left hip. She denies any history of trauma. What is the most accurate diagnosis?
    A. Perthes disease
    B. Slipped upper femoral epiphysis
    C. Developmental dysplasia of the hip
    D. Septic arthritis
    E. Osteoarthritis
A

A. Perthes disease

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28
Q
  1. A 59 years old male golfer develops stiffness and pain in his first metatarsophalangeal joint. A plain X-ray shows that there are subchondral cysts and reduced joint space. What is the most likely diagnosis?
    A. Enchondroma
    B. Gout
    C. Osteoarthritis
    D. Rheumatoid arthritis
    E. Septic arthritis
A

C. Osteoarthritis

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29
Q
  1. A 53 years old patient underwent operation for IBD which was complicated by wound infection. Several days later, he developed diarrhea with crampy abdominal pain. What is the most likely cause?
    A. Staphylococcus aureus
    B. Bacteroides
    C. Clostridium perfringens
    D. Clostridium Deficile
    E. None of the above
A

D. Clostridium Deficile

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30
Q
  1. A 29 years old man presented with severe right iliac fossa pain and fever. CT scan showed a perforated appendix. What is the most likely causative organism?
    A. Staphylococcus aureus
    B. Bacteroides
    C. Clostridium perfringens
    D. Clostridium Deficile
    E. E. coli
A

E. E. coli

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31
Q
  1. A 53 years old female was injured in her hand by a thorn during gardening. 2 days later, the wound became erythematous with creeping red streaks around it. What is the most likely cause?
    A. Staphylococcus aureus
    B. E.coli
    C. Streptococcus pyogenes
    D. Bacteroides
    E. Anthrax
A

C. Streptococcus pyogenes

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32
Q
  1. A 54 years old man presented with painless hematuria. U/S revealed a renal mass. What is the best next step?
    A. MRI
    B. PET CT
    C. CT scan
    D. Renal biopsy
    E. None of the above
A

C. CT scan

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33
Q
  1. A 2 months old neonate was noticed to have a dorsal slit on his penis. This deformity is often associated with:
    A. polycystic kidney
    B. undescended testis
    C. bladder exstrophy
    D. horseshoe kidney
    E. none of the above
A

C. bladder exstrophy

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34
Q
  1. Which nerve is at risk during medial approach to the ankle?
    A. Saphenous nerve
    B. Sural nerve
    C. Tibial nerve
    D. Common peroneal (fibular) nerve
    E. None of the above
A

A. Saphenous nerve

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35
Q
  1. Which nerve is at risk during posterior approach to the distal femur?
    A. Saphenous nerve
    B. Sciatic nerve
    C. Tibial nerve
    D. Common peroneal (fibular) nerve
    E. None of the above
A

C. Tibial nerve

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36
Q
  1. During hip arthroplasty, the surgeon noticed an artery running on the superior border of pyriformis muscle. What is that artery?
    A. Inferior gluteal artery
    B. Pudendal artery
    C. Internal iliac artery
    D. Superior gluteal artery
    E. External iliac artery
A

D. Superior gluteal artery

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37
Q
  1. A 24 years old female presented with a persistent thigh pain. Xray revealed a shaft of femur mass with onion peel appearance. What is the most likely diagnosis?
    A. Ewing sarcoma
    B. Osteosarcoma
    C. Giant cell tumor
    D. Multiple myeloma
    E. Paget’s disease
A

A. Ewing sarcoma

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38
Q
  1. In order to expose the right axillary artery, a transverse incision is typically made below the clavicle from a point just lateral to the sternal end of the clavicle to the deltopectoral groove. Which of the following structure would be encountered in the dissection down to the vessel?
    A. Lateral thoracic artery
    B. Phrenic nerve
    C. Suprascapular artery
    D. Thoracic duct
    E. Thoracoacromial artery.
A

E. Thoracoacromial artery.

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39
Q
  1. During recovery from varicose veins surgery, a 35 years old woman complains of weakness of dorsiflexion of the ankle. Physical examination reveals absent sensation over the dorsum of the foot. Which of the following nerves is most likely injured?
    A. Common peroneal nerve
    B. Deep peroneal nerve
    C. Saphenous nerve
    D. Superficial peroneal nerve
    E. Sural nerve
A

A. Common peroneal nerve

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40
Q
  1. A 54 years old heavy smoker presented with frank hematuria. CT showed a bladder mass without diverticulae. Pathology of the mass would probably show:
    A. Squamous cell carcinoma
    B. Transitional cell carcinoma
    C. Renal cell carcinoma
    D. Nephrobastoma
    E. None of the above
A

B. Transitional cell carcinoma

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41
Q
  1. A 49-year-old Egyptian man on holiday in the United Kingdom presents with haematuria. He gives a history of bladder irritative symptoms for seven months. He has lived in a rural community for his whole life. What is the possible diagnosis?
    A. Squamous cell carcinoma
    B. Transitional cell carcinoma
    C. Renal cell carcinoma
    D. Nephrobastoma
    E. None of the above
A

A. Squamous cell carcinoma

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42
Q
  1. A 75-year-old woman presents with acute back pain after a minor fall. Radiological examination reveals an osteoporotic crush fracture. Which of the following is the most likely electrolyte finding?
    A. Hypercalcaemia
    B. Hyperphosphataemia
    C. Hypocalcaemia
    D. Hyponatraemia
    E. Normocalcaemia
A

E. Normocalcaemia

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43
Q
  1. What is the course of median nerve related to brachial artery in the arm down to the elbow?
    A. Anterior then medial then lateral
    B. Lateral then medial then anterior
    C. Lateral then anterior then medial
    D. Posterior then medial
    E. None of the above
A

C. Lateral then anterior then medial

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44
Q
  1. An X-ray failed to show scaphoid fracture in a 25 years old athlete after 5 days of injury. What is the best next investigation?
    A. MRI
    B. CT scan
    C. Bone scan
    D. Repeat Xray
    E. None of the above
A

B. CT scan

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45
Q
  1. A 55 years old man presented with history of weight loss and hematuria. His GP ordered a CBC which showed hemoglobin level of 18.8. What is the most likely underlying diagnosis?
    A. Squamous cell carcinoma of the kidney
    B. Renal cell carcinoma of the kidney
    C. Transitional cell carcinoma of the bladder
    D. Schistosomiasis
    E. Recurrent cystitis.
A

B. Renal cell carcinoma of the kidney

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46
Q
  1. A child known with sickle cell anemia experienced hip pain with high grade fever and TLC of 16 and ESR up to 66. What is the most likely underlying organism?
    A. Staphylococcus aureus
    B. Streptococcus pneumonia
    C. Salmonella
    D. Neisseria meningitis
    E. None of the above
A

C. Salmonella

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47
Q
  1. Pneumonia in ventilated patients is mainly caused by:
    A. Staphylococcus aureus
    B. Streptococcus pneumonia
    C. Salmonella
    D. Neisseria meningitis
    E. Pseudomonas
A

E. Pseudomonas

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48
Q
  1. A 45-year-old man is involved in a car accident. On admission he is in hypovolaemic shock, and radiographs show a displaced anterior pelvic fracture. On rectal examination, the prostate gland cannot be felt in its usual position. What is the possible diagnosis?
    A. The bladder is ruptured
    B. The bulbar part of the urethra is ruptured
    C. The membranous urethra is ruptured
    D. The prostatic urethra is ruptured
    E. None of the above
A

C. The membranous urethra is ruptured

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49
Q
  1. A 32-year-old man falls from a height with his legs apart, landing heavily astride an iron bar. On examination there is extensive bruising in the anterior perineum and scrotum, extending onto the anterior abdominal wall. What is the possible diagnosis?
    A. The bladder is ruptured
    B. The bulbar part of the urethra is ruptured
    C. The membranous urethra is ruptured
    D. The prostatic urethra is ruptured
    E. None of the above
A

B. The bulbar part of the urethra is ruptured

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50
Q
  1. A man suffered a wrist injury in a fight. On examination he has lost sensation over the palmar aspect of the lateral 3 and half fingers with a weak hand grip. What is the most likely cause?
    A. Ulnar nerve injury
    B. Radial nerve injury
    C. Anterior interosseus nerve injury
    D. Posterior interosseus nerve injury
    E. Median nerve injury
A

E. Median nerve injury

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51
Q
  1. A 45-year-old woman feels a sudden pain in her left leg and feels as if she has been hit in the back of the ankle as she starts to cross the road before she falls. Which of the following is the most appropriate clinical lest?
    A. An impingement sign
    B. Apley’s grinding test
    C. Phalen’s manoeuvre
    D. Simmonds’ squeeze test
    E. Thomas test
A

D. Simmonds’ squeeze test

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52
Q
  1. A 5 years old child presented with pruritis ani with eggs and cysts at anal verge. What is the most appropriate treatment?
    A. Mebendazole
    B. metronidazole
    C. Tinidazole
    D. Bithionol
    E. None of the above
A

A. Mebendazole

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53
Q
  1. A 52-year-old man is found to have multiple myeloma. What skull X-ray appearances would be characteristic?
    A. Diffuse thickening of the calvarium
    B. Hair on end appearance.
    C. Multiple fractures
    D. Multiple osteolytic lesions
    E. Multiple osteosclerotic lesions
A

D. Multiple osteolytic lesions

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54
Q
  1. A 52 years old man presented with joint pain lasting for 7 months. He was diagnosed with Gouty arthritis. Aspiration of the joint would probably show:
    A. Rhomboidal shaped negative brifrengence crystals
    B. Needle shaped negative brifrengence crystals
    C. Rhomboidal shaped positive brifrengence crystals
    D. Needle shaped positive brifrengence crystals
    E. None of the above
A

B. Needle shaped negative brifrengence crystals

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55
Q
  1. A 45-year-old man presents with fever and pain in his right loin and groin. A soft swelling was noted in his femoral triangle. Diagnosis of a psoas abscess was made. Which of the following statements is most accurate regarding psoas major?
    A. It arises from the lateral borders of the bodies of T12 to L5
    B. It extends the hip
    C. It inserts into the greater trochanter of the femur
    D. It is innervated from T12 and L1
    E. It passes posterior to the capsule of the hip joint
A

A. It arises from the lateral borders of the bodies of T12 to L5

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56
Q
  1. A 24-year-old man with a history of Crohn’s disease presents with generalized bone pains and tenderness in his thighs. He also has increasing muscle weakness, increasing difficulty in walking and a change of gait. Serum calcium and phosphate levels are low but alkaline phosphatase and parathyroid hormone levels are elevated. A bone biopsy shows increase in non-mineralised osteoid. What is the most likely diagnosis?
    A. Osteitis fibrosa cystica
    B. Osteomalacia
    C. Osteoporosis
    D. Paget disease of the bone
    E. Multiple myeloma
A

B. Osteomalacia

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57
Q
  1. Which of the following muscle is a hip extensor?
    A. Pyriformis
    B. Obturator internus
    C. Sartorius
    D. Gluteus Medius
    E. Semitendinosus
A

E. Semitendinosus

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58
Q
  1. Which organism causes diverticular abscess in adults?
    A. Staphylococcus aureus
    B. Streptococcus pyogenes
    C. E.coli
    D. Neisseria meningitis
    E. Pseudomonas
A

C. E.coli

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59
Q
  1. What is the spinal root for big toe dorsiflexion?
    A. L4
    B. L5
    C. S1
    D. S2
    E. L3
A

B. L5

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60
Q
  1. A 9-year-old female presented with smooth fluctuant mass showing halo sign in mammography aspiration was done there is no blood, no fluid refilling what is your management?
    A. discharge no follow-up required
    B. surgical excision
    C. true cut biopsy
    D. FANC
    E. None of the above
A

A. discharge no follow-up required

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61
Q
  1. A 50 year old Patient came to ER assessment of consciousness level was done according to GCS patient can localizes pain, open eye to pain and sounds what the GCS ?
    A. 9
    B. 7
    C. 12
    D. 11
    E. None of the above
A

A. 9

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62
Q
  1. A female patient 45 years old referred to surgeon with solitary thyroid swelling. The pathology of the nodule shows papillary thyroid carcinoma 0.5 cm with no lymph nodes enlarged. What is the appropriate management?
    A. total thyroidectomy with nodal clearance
    B. total thyroidectomy only
    C. hemithyroidectomy
    D. subtotal thyroidectomy
    E. None of the above
A

C. hemithyroidectomy

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63
Q
  1. Pt. had experience of abdominal pain and diarrhea and vomiting his investigations revealed hyperparathyroidism what is the next investigation should be done
    A. Thyroid
    B. Pituitary
    C. Adrenals
    D. Kidney
    E. None of the above
A

B. Pituitary

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64
Q
  1. A 20-years old man presents with abdominal pain and shock. He is found to have hemoperitoneum Due to a ruptured spleen. He denies any history of trauma what is the most likely predisposing cause of his splenic rupture?
    A. Epstein Barr virus infection
    B. Human immunodeficiency virus (HIV) infection
    C. Measles virus infection
    D. Mumps virus infection
    E. Varicella zoster virus infection
A

A. Epstein Barr virus infection

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65
Q
  1. A 24-year-old patient presented with trauma to the chest his CXR shown widening of the mediastinum. what of the structure being rupture?
    A. ascending aorta
    B. descending aorta
    C. arch of the aorta
    D. esophageal rupture
    E. SVC
A

B. descending aorta

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66
Q
  1. Hassall s corpuscles present in which gland of the following?
    A. Thyroid
    B. Para thyroid gland
    C. Thymus glad
    D. Pituitary gland
    E. Pancreas
A

C. Thymus glad

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67
Q
  1. A biopsy specimen using Prussian blue stain to detect which of the following martial ?
    A. IRON
    B. Amyloid
    C. Sarcoid
    D. Asteroid bodies
    E. None of the above
A

A. IRON

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68
Q
  1. An 85-year-old man presents with a cough and hemoptysis. He has a modest smoking history of 15 pack years. He is found to have a tumor located in the right main bronchus, with no evidence of metastatic disease. He decides to undergo any treatment and he remains well for what is your diagnosis?
    A. Adenocarcinoma
    B. Small cell lung cancer
    C. Large cell lung cancer
    D. Squamous cell carcinoma
    E. None of the above
A

D. Squamous cell carcinoma

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69
Q
  1. A 70-year-old man with carcinoma of the bronchus presents with blurring of vision, headaches and nausea, particularly in the morning. Which of the following is the most appropriate treatment?
    A. Carbamazepine
    B. Dexamethasone
    C. Morphine elixir
    D. Paracetamol
    E. Radiotherapy
A

B. Dexamethasone

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70
Q
  1. A previously fit 21-year-old man collapses while running a marathon Resuscitation is unsuccessful. post-mortem examination shows an intracranial hemorrhage. What is the most likely site of the A hemorrhage?
    A. Extradural
    B. Intracerebral
    C. Intraventricular
    D. Subarachnoid
    E. Subdural
A

D. Subarachnoid

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71
Q
  1. A 68-year-old woman presents with a two-month history of intermittent, bloodstained nipple discharge from her right breast. There is no significant-past history. Clinical examination confirms presence of a bloodstained nipple discharge but shows no palpable abnormality. A mammogram id ultrasound scan are normal. What is the most appropriate next step in management?
    A. Clinical follow-up in three months
    B. Ductogram
    C. Reassure patient and discharge
    D. Surgical excision of affected duct
    E. Tamoxifen
A

D. Surgical excision of affected duct

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72
Q
  1. A 53-year-old woman who complains of paroxysmal headaches associated with palpitation and sweating. is found to have a mass in the right lobe of her thyroid. she has a family history of thyroid cancer. which of the following is the most likely diagnosis?
    A. Anaplastic carcinoma
    B. Follicular carcinoma
    C. Medullary carcinoma
    D. Papillary carcinoma
    E. Squamous carcinoma
A

C. Medullary carcinoma

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73
Q
  1. After eating peanuts, patient developed significant wheezing and dyspnea. Which of the following cells are responsible for these symptoms?
    A. Neutrophils
    B. Basophils
    C. Eosinophils
    D. Macrophages
    E. T lymphocytes
A

B. Basophils

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74
Q
  1. A 55-year-old female presented with symptoms of Psychosis and dry mouth her investigations reveled, low TSH and increased Ca. She was on warfarin and antacid medication what is your possible diagnosis of this condition?
    A. Milk alkali syndrome
    B. Vit D toxicity
    C. Hyperthyroidism
    D. Hyperparathyroidism
    E. None of the above
A

A. Milk alkali syndrome

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75
Q
  1. A 62-year old woman presents with a firm “irregular mass in-the upper outer quadrant of the right breast. This is shown to be malignant on mammography and fine needle aspiration- cytology. She is treated with wide local excision and axillary clearance. Which of the following histopathological findings would imply a better prognosis.?
    A. Absence of HER2 amplification
    B. Bloom and Richardson Grade III
    C. More than three positive axillary nodes
    D. Presence of lymph vascular invasion
    E. Presence of estrogen receptors
A

E. Presence of estrogen receptors

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76
Q
  1. Tuberculin test is considered which type of hypersensitivity?
    A. T cell mediated
    B. Cytotoxic type
    C. Type 1 hypersensitivity
    D. Immune complex type
    E. Type 5 hypersensitivity
A

A. T cell mediated

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77
Q
    • From which of the following cell types do giant cells most commonly originate?
      A. Neutrophils
      B. Myofibroblasts
      C. Fibroblasts
      D. Macrophages
      E. Goblet cells
A

D. Macrophages

78
Q
  1. A 45-year-old man complains of increasing headaches, associated with nausea and vomiting, especially in the morning, he has no focal neurological signs but ophthalmic examination demonstrates bilateral papilledema. Which of the following is the most likely diagnosis?
    A. Acoustic neuroma
    B. Chronic subdural hemorrhage C. Frontal lobe glioma
    D. Intracerebral hemorrhage
    E. Subarachnoid hemorrhage
A

C. Frontal lobe glioma

79
Q
  1. A 5-year-old boy presents to the clinic with short stature suggestive of achondroplasia. What is the genetic basis of this condition?
    A. X linked defect
    B. Y linked defect
    C. YY linked defect
    D. Autosomal dominant defect
    E. Autosomal recessive defect
A

D. Autosomal dominant defect

80
Q
    1. A woman presented with a swelling in her thyroid gland developed #femur facture without trauma. What is your possible diagnosis?
      A. Papillary carcinoma
      B. Follicular carcinoma
      C. Anaplastic carcinoma
      D. Medullary carcinoma
      E. None of the above
A

B. Follicular carcinoma

81
Q
  1. What is the defective gene in a patient with breast cancer ?
    A. P53
    B. BRACAI
    C. APC
    D. SIS
    E. None one the above
A

B. BRACAI

82
Q
  1. What is marker for colorectal cancer ?
    A. CA 27-29
    B. CA 15-3
    C. CEA
    D. CA 125
    E. None of the above
A

C. CEA

83
Q
  1. A 34-year-old lady presents with a long-standing offensive discharge from the ear and on examination is noted to have a reduction in her hearing of 40 decibels compared to the opposite side. What is the most probable diagnosis?
    A. Acoustic neuroma
    B. Preauricular sinus
    C. Acute suppurative otitis media D. Cholesteatoma
    E. Otitis externa
A

D. Cholesteatoma

84
Q
  1. A 45- female come to your clinic presented with Bloody discharge from single duct in her right breast. What is the most probable diagnosis?
    A. intraductal papilloma
    B. plasma cell mastitis
    C. breast cyst
    D. breast cancer
    E. None of the above
A

A. intraductal papilloma

85
Q
  1. A 66-year-old woman with a crusty lesion on the areola on examination there is No underlying breast mass. What is your possible diagnosis?
    A. Paget’s disease of the nipple
    B. Breast cancer
    C. intraductal papilloma
    D. plasma cell mastitis
    E. breast cyst
A

A. Paget’s disease of the nipple

86
Q
  1. which type of audit will you use when you want to evaluate the increasing number of deaths after certain procedure?
    A. Process Audit
    B. Outcome Audit
    C. Standard audit
    D. Financial Audit
    E. None of the above
A

B. Outcome Audit

87
Q
  1. which type of audit will you use when you want to determine if doctors follow the local guidelines policies or not?
    A. Outcome Audit
    B. Process Audit
    C. Standard audit
    D. Financial Audit
    E. None of the above
A

C. Standard audit

88
Q
  1. What is the best investigation in cases of Boerhaave syndrome?
    A. Upper GI Endoscope
    B. Barium Swallow
    C. Chest X ray
    D. CT Chest
    E. MRI
A

D. CT Chest

89
Q
  1. Which of the following is not considered as a predisposing factor to cancer colon?
    A. Crohn’s disease
    B. Alcohol
    C. Smoking
    D. Diverticular disease
    E. Genetic causes
A

D. Diverticular disease

90
Q
  1. A 25-year-old man presents with constipation after taking opiate analgesics for back pain. Which of the following is the most likely description of his rectal bleed?
    A. Bright red, associated with severe perianal pain
    B. Bright red, short lasting episodes of profuse bleeding
    C. Dark red. associated with profuse watery stools
    D. Dark red. mixed in with bowel motions
    E. Dark red. profuse bleeding associated with strong smell
A

A. Bright red, associated with severe perianal pain

91
Q
  1. A 62-year-old man presents with a painful, pale right lower limb. He underwent right femoro- popliteal (below knee) bypass 18 months ago using in-situ vein. On duplex examination the graft is blocked. What is the most likely histological feature of the graft?
    A. Aneurysmal dilatation
    B. Atheromatous plaques
    C. Neointimal hyperplasia
    D. Smooth muscle hyperplasia
    E. Chronic thrombosis
A

C. Neointimal hyperplasia

92
Q
  1. A study comparing fluid requirements in burn patient, study participants are classified to males and female groups, most patient had small values and other some has larger values. Which test to apply?
    A. Paired T test
    B. Unpaired T test
    C. Mann Whitney U test
    D. Chi-square
    E. P value
A

C. Mann Whitney U test

93
Q
  1. A 55-year-old man who had undergone a total colectomy 30 years previously for familial adenomatous polyposis presents with a three-week history of painless jaundice with the passage of pale stools and dark urine, anorexia, weight loss and vomiting. What is the most accepted diagnosis?
    A. Carcinoma of the duodenum
    B. Gastric carcinoma
    C. Hepatitis C
    D. Hepatocellular carcinoma
    E. Primary biliary cirrhosis
A

A. Carcinoma of the duodenum

94
Q
  1. What is the most common Cause of abdominal aortic anueyrsm?
    A. Hypertension
    B. Fungal infection
    C. Marfan’s syndrome
    D. Arthrosclerosis
    E. Congenital defect
A

D. Arthrosclerosis

95
Q
  1. A 27-year-old has had pancolitis for the last five years. Which one of these complications is the least likely to develop?
    A. Arthritis
    B. Cholangitis
    C. Iritis
    D. Polyarteritis
    E. None of the above
A

D. Polyarteritis

96
Q
  1. Which of the following medications may be used in cases of carcinoid?
    A. Dexamethasone
    B. B-blocker
    C. Anti-histaminic
    D. Octreotide
    E. carbimazole
A

D. Octreotide

97
Q
  1. A 35-year-old man notices that he is becoming dizzy when he plays squash, in addition he has also developed cramping pain in his arm. When you discuss with the patient about his history, he alleged that he enters in repeated attacks of fainting after aggressive jobs with the same limb. What is the most appropriate first investigation?
    A. Chest X-ray
    B. CT-brain
    C. Venous duplex of the neck
    D. Arterial duplex of the aortic arch and it is branches
    E. CT Angiogram of the aortic arch and it is branches
A

D. Arterial duplex of the aortic arch and it is branches

98
Q
  1. A 21-year-old map comes into the Emergency Department with a severe headache and neck stiffness of recent onset. You suspect acute meningitis and decide immediately to treat with antibiotics and perform a lumbar puncture. After your third attempt to obtain for cerebrospinal fluid (CSF) you notice that the fluid obtained is stained red. However, during the collection of CSF into three containers it is noted that the final bottle is now cleared of any blood. Which anatomical structure is the most likely to be responsible for this bleeding?
    A. Anterior spinal artery
    B. Epidural artery
    C. Subarachnoid vein
    D. Veins within the erector spinae muscles
    E. Vertebral venous plexus
A

E. Vertebral venous plexus

99
Q
  1. A 32-year-old woman has a pigmented lesion excised from her left calf. The histopathological diagnosis is melanoma in situ, which is completely excised with a 1 cm margin. What is the next most appropriate management?
    A. Education about skin self-examination and discharge from follow up
    B. Elective inguinal lymph node dissection
    C. Re excision with 2 cm margin
    D. Re excision with 3 cm margin
    E. Removal of any other pigmented
A

A. Education about skin self-examination and discharge from follow up

100
Q
  1. Patient with congenital antithrombin3 came to do and operation, what will you prescribe for her postoperative
    A. warfarin 6 month
    B. warfarin for life
    C. heparin for 6 months
    D. heparin for life
    E. LMWH for life
A

B. warfarin for life

101
Q
  1. Recurrent pulmonary embolism despite of heparin use
    A. LMWH
    B. LMWH and stocking
    C. Warfarin
    D. Warfarin and stocking
    E. vena cava filter
A

E. vena cava filter

102
Q
  1. Which of the following can used as a surface landmark for external jugular vein?
    A. Lobule of the ear to the Sternoclavicular joint
    B. Mastoid to the Sternoclavicular joint
    C. Styloid process to the Sternoclavicular joint
    D. Anterior Border of sternocleidomastoid
    E. The angle of mandible to the middle 3rd of clavicle
A

E. The angle of mandible to the middle 3rd of clavicle

103
Q
  1. Patient in anxiety, there some physiological changes in his body as releasing adrenaline , from which adrenalin is secreted?
    A. Adrenal cortex
    B. Adrenal medulla
    C. Presynaptic sympathetic ganglia
    D. Sympathetic nerve ending
    E. Parasympathetic nerve ending
A

B. Adrenal medulla

104
Q
  1. Damage of dorsal root ganglia cause loss of
    A. Sensory
    B. Motor
    C. Parasympathetic affection
    D. Sympathetic affection
    E. None of the above
A

A. Sensory

105
Q
  1. Ejection systolic murmur with pulmonary edema
    A. Aortic regurge
    B. aortic calcification
    C. mitral regurge
    D. mitral stenosis
    E. None of the above
A

B. aortic calcification

106
Q
  1. Site of action of benzfluthiazide on the nephron
    A. proximal convoluted tubule
    B. Distal convoluted tubules
    C. Ascending loop of Henle
    D. Descending loop of Henle
    E. Collecting tubules
A

B. Distal convoluted tubules

107
Q
  1. Site of action of furosemide
    A. proximal convoluted tubule
    B. Distal convoluted tubules
    C. Ascending loop of Henle
    D. Descending loop of Henle
    E. Collecting tubules
A

C. Ascending loop of Henle

108
Q
  1. What is the Lymphatic drainage of the testis?
    A. Para-aortic LN
    B. Superficial inguinal L.N
    C. Deep inguinal L.N
    D. Superficial inguinal
    E. Internal iliac
A

A. Para-aortic LN

109
Q
  1. What is lymphatic drainage of Scrotal ulcer?
    A. Horizontal Superficial inguinal
    B. Lumbar
    C. paraaortic
    D. transverse Superficial inguinal
    E. Internal iliac
A

D. transverse Superficial inguinal

110
Q
  1. Lymph drainage of prostate?
    A. Ext iliac LN
    B. Paraaortic L.N
    C. Inguinal L.N
    D. Internal iliac L.N
    E. None of the above
A

D. Internal iliac L.N

111
Q
  1. Left Renal vein compressed by aneurysm of which one of the following arteries?
    A. SMA
    B. IMA
    C. Aorta
    D. Splenic artery
    E. Celiac trunk
A

A. SMA

112
Q
  1. Inferior mesenteric vein drains into
    A. IVC
    B. Superior mesenteric vein
    C. Splenic vein
    D. Portal vein direct
    E. Renal vein
A

C. Splenic vein

113
Q
  1. What is most relevant anterior relation of right suprarenal gland?
    A. IVC
    B. SVC
    C. SMA
    D. IMA
    E. Celiac
A

A. IVC

114
Q
  1. Patient start weaning in ICU, what is the best option to help weaning?
    A. CPAP
    B. tracheotomy
    C. SIMV
    D. Cricothyroid membrane
A

B. tracheotomy

115
Q
  1. A 45-year-old man undergoes an upper gastrointestinal endoscopy for a benign oesophageal stricture. This is dilated and he suffers an iatrogenic perforation at the site. His imaging shows a small contained leak and a small amount of surgical emphysema. What is the most appropriate nutritional option?
    A. Nil by mouth and intravenous fluids alone
    B. Intravenous fluids and sips orally
    C. Total parenteral nutrition
    D. Nasogastric feeding
    E. PEG tube feeding
A

C. Total parenteral nutrition

116
Q
  1. 72-year-old man is due to undergo staged esophagectomy for malignancy. His BMI is 17.5.
    What is the best feeding regime immediately following surgery?
    A. Total parenteral nutrition.
    B. Feeding jejunostomy.
    C. Feeding duodenostomy.
    D. Liquid diet orally.
    E. Soft solids orally.
A

B. Feeding jejunostomy.

117
Q

118.1-day neonate presented by bilious vomiting and scaphoid abdomen
A. Esophageal atresia
B. CHPS
C. Duodenal atresia
D. HSD
E. Volvulus

A

C. Duodenal atresia

118
Q

119.9 month child with Rt upper quadrant mass , empty rectum and repeated vomiting?
A. Volvulus
B. pyloric stenosis
C. duodenal atresia
D. intussusception
E. none of the above

A

D. intussusception

119
Q

120.A child presented in the neonatal period by abdominal distention and he has family history of cystic fibrosis?
A. Duodenal atresia
B. Meconium ileus
C. Hirschsprung
D. Malrotation
E. None of the above

A

B. Meconium ileus

120
Q
  1. There was child vomiting with distended abdomen and meconium plug was removed after 3 days by suppository
    A. Hirschsprung
    B. Duodenal atresia
    C. Ileal atresia
    D. Malrotation
    E. None of the above
A

A. Hirschsprung

121
Q
  1. Pigmentation and clinical picture like Addison disease Na low and k high what is the hormone check
    A. ACTH
    B. TSH
    C. Aldosterone
    D. ADH
    E. FSH
A

A. ACTH

122
Q

123.A 72-year-old man has just undergone an emergency repair for a ruptured abdominal aortic aneurysm. Preoperatively he was taking aspirin, clopidogrel and warfarin. Intra operatively he received 5000 units of unfractionated heparin prior to application of the aortic cross clamp. His blood results on admission to the critical care unit are as follows:
Full blood count: Hb 8 g/dl, Platelets 40 * 109/l and WBC 7.1 * 109/l
His fibrin degradation products are measured and found to be markedly elevated. Which of the following accounts for these results?
A. Anastomotic leak
B. Disseminated intravascular coagulation
C. Heparin induced thrombocytopenia
D. Adverse effect of warfarin
E. Adverse effects of antiplatelet agents

A

B. Disseminated intravascular coagulation

123
Q

124.Lack of which factor affect intrinsic pathway
A. IX a
B. VII
C. VI
D. X
E. VIII

A

A. IX a

124
Q

125.15x9 cm lesion deep fascia, what is the next step
A. excisional biopsy
B. incisional biopsy
C. punch biopsy
D. core biopsy
E. none of the above

A

D. core biopsy

125
Q

126.A 63 years old man had undergone liver transplant. On staining of the resected liver, it turned blue. What is the underlying pathology?
A. Hemochromatosis
B. Cirrhosis
C. Hepatocellular carcinoma
D. Wilson disease
E. Amyloidosis

A

A. Hemochromatosis

126
Q

127.30 years old female presented by pigmented mole 1 cm in diameter on her back that has enlarged and bleeds easily over the last two months
A. Excisional biopsy with 2 mm safety margin
B. Excisional biopsy with 2 cm safety margin
C. Incisional biopsy
D. FNAB
E. Core biopsy

A

A. Excisional biopsy with 2 mm safety margin

127
Q

128.After extensive burn, patient presented with painless abdominal distension associated with hiccup and vomiting?
A. Curling ulcer
B. acute gastric dilatation
C. sepsis
D. intestinal obstruction
E. none of the above

A

B. acute gastric dilatation

128
Q

129.A man, who has undergone emergency major abdominal surgery two-days previously. is noted to be confused. He has been on furosemide for mild heart failure. The plasma sodium is 122 mmol Inspection of the fluid chart shows that he has been written-up for IL, four-hourly intravenous 5% glucose infusions, what is the most likely cause for the hyponatremia ?
A. An ACTH response to surgery B. Excessive saline free IVF
C. Osmotic effect of hyperglycemia induced by glucose infusions
D. Syndrome of inappropriate antidiuretic hormone
E. Use of loop diuretic in the long term

A

B. Excessive saline free IVF

129
Q

130.Patient presented by tachycardia and hypertension which of the following hormone decrease with hyperthermia
A. TSH
B. ACTH
C. ADH
D. Cortisol
E. Catecholamine

A

A. TSH

130
Q

131.54 years old presented by nocturia and thirst. The physician asked him to do FBF and PPG – FBG was 5 then post prandial 2 hours was 7, what is your diagnosis?
A. Normoglycemia
B. impaired glucose tolerance test
C. DM
D. DI
E. None of the above

A

A. Normoglycemia

131
Q
  1. What will you give to pregnant lady with megaloblastic or macrocytic anemia?
    A. B12
    B. Folate
    C. Iron oral
    D. Iron IV
    E. None of the above
A

B. Folate

132
Q
  1. What about gastric acid secretion reduced by?
    A. Prostaglandin E2
    B. ADP
    C. Histamine
    D. Gastrin
    E. Serotonin
A

A. Prostaglandin E2

133
Q
  1. which is the precursor of isoprenaline, that stimulates Bl-receptors on the heart and stimulates alpha l-receptors at high dose ?
    A. Dopamine
    B. Dobutamine
    C. Noradrenaline
    D. Adrenaline
    E. None of the above
A

A. Dopamine

134
Q
  1. Following mastoidectomy, a patient complains of impaired taste sensation what is the nerve-injured?
    A. chorda tympani nerve
    B. greater petrosal
    C. lingual nerve
    D. glossopharyngeal
    E. vagus
A

A. chorda tympani nerve

135
Q
  1. What is the muscled derived from the 2nd brachial arch?
    A. Mandibular of trigeminal
    B. Facial
    C. Glossopharyngeal
    D. Superior laryngeal
    E. Recurrent laryngeal
A

B. Facial

136
Q
  1. Defect in left pleuro-peritoneal membrane:
    A. Morgagni hernia
    B. Bochdalek hernia
    C. Hiatus hernia
    D. Ectopia cardia
    E. None of the above
A

B. Bochdalek hernia

137
Q
  1. Hypothermia ECG features.
    A. Prominent J wave
    B. U wave
    C. Delta wave
    D. Short QT interval
    E. None of the above
A

A. Prominent J wave

138
Q
  1. Teratology of Fallot is characterized by which one of the following malformations?
    A. Aortic Stenosis
    B. Atrial septal defects
    C. Hypertrophy of left ventricle D. Pulmonary stenosis
    E. Transposition of great vessels
A

D. Pulmonary stenosis

139
Q

140.60% burn case with bilateral leg edema. Most common Cause?
A. Hypoalbuminemia
B. Sepsis
C. Heart failure
D. DVT
E. Cellulitis

A

A. Hypoalbuminemia

140
Q

141.A 66-year-old woman with known tumor of her spine has started to retain urine and is experiencing decreased anal and rectal tone. The tumor is pressing directly on the conus medullaris. At which one of the following vertebral levels is the tumor most likely to be located?
A. T9/T10
B. T11/T12
C. L1/L2
D. L3/C4
E. L5/S1

A

C. L1/L2

141
Q

142.A 42-year-old multiparous woman is admitted to the Emergency Department due to pelvic discomfort. The duty gynecologist diagnoses uterine prolapse. Which anatomical structure gives significant direct support to the uterus?
A. Cervical ligaments
B. broad ligament
C. Round ligaments
D. Ovarian ligament
E. Transverse perineal Muscles

A

E. Transverse perineal Muscles

142
Q

143.A surgeon makes a Pfannenstiel incision for access to the pelvic organs. He incises the abdominal wall down to and through the rectus sheath. He retracts the rectus abdominis muscles laterally from the midline to expose the:
A. linea alba
B. peritoneum
C. posterior rectus sheath
D. transversalis fascia
E. transversus abdominis muscle

A

D. transversalis fascia

143
Q

144.Man prepared for exploration surgery. what is the layer where the upper midline incision was done?
A. linea alba
B. linea semilunaris
C. fascia transversalis
D. external oblique muscle
E. internal olique muscle

A

A. linea alba

144
Q

145.65 years old man presented with an inguinoscrotal swelling in the right groin which is non tender. A cough impulse is elicited, at operation; an indirect inguinal hernia is repaired. The cremasteric muscle is derived from which of the following
A. External oblique aponeurosis
B. Internal oblique muscle
C. Rectus abdominal muscle
D. Rectus sheath
E. Transversalis fascia

A

B. Internal oblique muscle

145
Q

146.65 years old man presented with hydrocele, what do you think the dartos muscle is derived from which of the following
A. External oblique aponeurosis
B. Internal oblique muscle
C. Subfacial layer
D. Rectus sheath
E. Transversalis fascia

A

C. Subfacial layer

146
Q

147.31 years old suffering from keloid scar after old trauma, what do you think the best management?
A. excision
B. excision with safety margin
C. steroids oral
D. Intra lesion steroid
E. Laser therapy

A

D. Intra lesion steroid

147
Q

148.A hypertensive patient taking ramipril for controlling blood pressure, which of the following causing constriction of efferent arteriole
A. Angiotensin 2
B. Angiotensin 1
C. Renin
D. Angiotensinogen
E. Nitric oxide

A

A. Angiotensin 2

148
Q

149.56 years old woman ventilated after one day of aortic aneurism surgery. Her pulmonary wedge pressure is 19 mmHg – normal 8: 12 mmHg – and she has bilateral obvious lung opacities on the
-ray. What is your diagnosis
A. ARDS
B. Lobar pneumonia
C. Aspiration pneumonia
D. Pulmonary edema secondary to heart failure
E. Pulmonary embolism

A

D. Pulmonary edema secondary to heart failure

149
Q
  1. Cushing cause which abnormality
    A. Hyperkalemia
    B. Hypokalemia
    C. Hypocalcemia
    D. Hypercalcemia
    E. Hyponatremia
A

B. Hypokalemia

150
Q
  1. Metabolic acidosis associated with which abnormality
    A. Hyperkalemia
    B. Hypokalemia
    C. Hypocalcemia
    D. Hypercalcemia
    E. Hyponatremia
A

A. Hyperkalemia

151
Q
  1. Widened QRS and flat p
    A. Hypercalcemia
    B. Hyperkalemia
    C. Hypocalcemia
    D. Hypokalemia
    E. Hyponatremia
A

B. Hyperkalemia

152
Q
  1. Twenty – four hours after a routine aortic valve replacement for a heavily calcified valve the patient’s heart rate abruptly falls to 40 beats/minute. the systolic pressure was 140 mmHg and become 110 mmHg and right atrial pressure was 7 mmHg and become 15 mmHg. which of the following is the most likely diagnosis?
    A. Atrial fibrillation
    B. Cardiac tamponade
    C. Digoxin toxicity
    D. Heart block
    E. Left ventricular failure
A

D. Heart block

153
Q

154.A 25-year-old man is admitted having been stabbed in the interior chest. On examination he is alert and coherent. He has congested neck veins. His pulse is 140 beats/minute and his blood pressure 90/60 mmHg. He has normal breath sounds. What is the most likely cause of his cardiac arrest 15 minutes later?
A. Cardiac tamponade
B. Congestive cardiac failure
C. Hypovolemia
D. Tension pneumothorax
E. Ventricular arrhythmia

A

A. Cardiac tamponade

154
Q
  1. Abdominal free fluid will collect in the lowest part of the peritoneal cavity. At operation with the patient supine, in which of the following will the fluid collect first?
    A. Hepatorenal pouch
    B. Left anterior subphrenic space
    C. Lesser sac
    D. Right paracolic gutter
    E. Right anterior subphrenic space
A

A. Hepatorenal pouch

155
Q
  1. Closure of the tricuspid valve occurs at the onset of which phase of the cardiac cycle?
    A. Isovolumic relaxation
    B. Rapid and reduced filling
    C. Rapid and reduced ejection D. Isovolumetric contraction
    E. None of the above
A

D. Isovolumetric contraction

156
Q

157.A 25-year-old male pedestrian is involved in a road traffic accident. He sustains multiple injuries and is admitted to the intensive care unit, intubated and ventilated. Over the week he develops adult respiratory distress syndrome. What is the main reason for hypoxemia in this condition?
A. Increased lung compliance
B. Reduced diffusion
C. Reduced surfactant
D. Reduced elastase
E. Left to right shunt

A

B. Reduced diffusion

157
Q

158.A 53-year-old man complains of ‘crushing’ chest pain at rest He has chronic hypertension and is a heavy smoker. His pulse rate is 138 beats/minute and blood pressure 140/90 mmHg. What is the principal cause underlying his reduced coronary artery blood flow?
A. Decreased cardiac muscle wall tension
B. Decreased coronary oxygen extraction
C. Decreased diastolic interval
D. Decreased systolic interval
E. Decreased vagal tone

A

C. Decreased diastolic interval

158
Q

159.A young man took a maximal inspiration then exhaling maximally. This is measured by spirometry. What does this represent?
A. Vital capacity
B. Functional residual capacity
C. Total lung capacity
D. Inspiratory reserve volume
E. None of the above

A

A. Vital capacity

159
Q

160.In a patient with Cleft palate, it represents defect in the embryological fusion of what structures?
A. Frontonasal
B. Maxillary
C. palatal shelves
D. lateral nasal
E. medial nasal

A

C. palatal shelves

160
Q

.A 32-year-old woman has a pigmented lesion excised from her left calf. The histopathological diagnosis is melanoma in situ, which is completely excised with a 1 cm margin. What is the next most appropriate management?
A. Education about skin self-examination and discharge from follow up
B. Elective inguinal lymph node dissection
C. Re excision with 2 cm margin
D. Removal of any other pigmented
E. None of the above

A

A. Education about skin self-examination and discharge from follow up

161
Q

162.Scenario of mastoid process infection which spread to brain with pus discharge can cause destruction of which of the following?
A. Inner ear
B. Sigmoid sinus
C. Occipital sinus
D. internal carotid artery
E. superior sagittal sinus

A

B. Sigmoid sinus

162
Q

163.A 22-year man is shot in the back, in the lumbar region. He has increased tone and hyperreflexia of his right leg. He cannot feel his left leg.
A. Tabes dorsalis
B. Subacute degeneration of the cord
C. Brown-Sequard syndrome
D. Syringomyelia
E. Epidural hematoma

A

C. Brown-Sequard syndrome

163
Q

164.A 68-year-old man presents to the plastics team with severe burns to his hands. He is not distressed by the burns. He has bilateral charcot joints. On examination there is loss of pain and temperature sensation of the upper limbs.
A. Transverse myelitis
B. Subacute degeneration of the cord
C. Brown-Sequard syndrome
D. Syringomyelia
E. Epidural hematoma

A

D. Syringomyelia

164
Q

165.A 60-yearold man presents to the-Emergency Department with epistaxis. The source 0f the bleeding is identified as Little’s area and resolves with direct cautery. Which vessel is most likely responsible for the bleeding?
A. Anterior ethmoidal artery
B. Infraorbital artery
C. Middle meningeal artery
D. Sphenopalatine artery
E. supratrochlear artery

A

D. Sphenopalatine artery

165
Q
  1. What makes the anterior wall of the heart?
    A. Mostly made of right ventricle
    B. Mostly made for left ventricle
    C. Mostly made of right atrium
    D. Mostly made of left atrium
    E. None of the above
A

A. Mostly made of right ventricle

166
Q
  1. Rt Coronary artery:
    A. arise from posterior surface of aorta above valve
    B. arise from anterior surface of aorta above valve
    C. lei in posterior Interventricular groove
    D. arise inferior from sinus in the aorta
    E. none of the above
A

B. arise from anterior surface of aorta above valve

167
Q
  1. Depolarizing agent for anesthesia?
    A. Succinyl choline
    B. Vecuronium
    C. Atracium
    D. Neostegmine
    E. Pancuronium
A

A. Succinyl choline

168
Q
  1. Child with Cervical sinus anterior to sternomastoid, from what branchial cleft?
    A. 1st
    B. 2nd
    C. 3rd
    D. 4th
    E. 5th
A

B. 2nd

169
Q

170.A 60-year-old man undergoes cystectomy for a bladder carcinoma. During surgery, the ureters are identified. On which region of the bladder do the ureters pierce the bladder wall?
A. Anterior surface
B. Apex
C. Lateral surfaces
D. Neck
E. Base

A

E. Base

170
Q
  1. Recurrent pulmonary embolism despite of heparin use
    A. Warfarin for 6 months
    B. Warfarin for life
    C. LMWH
    D. LMWH and stocking
    E. vena cava filter
A

E. vena cava filter

171
Q
  1. Patient with congenital antithrombin3 came to do and operation, what will u prescribe for her postoperative
    A. warfarin 6 month
    B. warfarin for life
    C. heparin for 6 months
    D. heparin for life
    E. None of the above
A

B. warfarin for life

172
Q
  1. Nerve lesion in hernia operation cause paresthesia at top of scrotum and base of penis, what is the most accepted nerve to be injured?
    A. genitofemoral nerve
    B. ilioinguinal nerve
    C. obturator nerve
    D. Femoral nerve
    E. Saitic nerve
A

B. ilioinguinal nerve

173
Q
  1. After the nurse cut the umbilical cord which of the following will not contain oxygenated blood any more
    A. Ductus arteriosus
    B. ductus venosus
    C. portal vein
    D. umbilical artery
    E. hepatic artery
A

B. ductus venosus

174
Q
  1. Addison cause which abnormality
    A. Hyperkalemia
    B. Hypokalemia
    C. Hypocalcemia
    D. Hypercalcemia
    E. Hypernatremia
A

A. Hyperkalemia

175
Q
  1. Patient on inotropes for treatment of shock, Noradrenaline was given what is the most indication of it?
    A. Neurogenic shock
    B. Anaphylactic shock
    C. Septic Shock
    D. Hypovolemic shock
    E. Obstructive shock
A

C. Septic Shock

176
Q
  1. Preganglionic neurotransmitter
    A. Acetylcholine
    B. Noradrenaline
    C. Adrenaline
    D. Dopamine
    E. None of the above
A

A. Acetylcholine

177
Q
  1. Resting potential of skeletal muscles maintained by
    A. Na
    B. K
    C. Ca
    D. Cl
    E. None of the above
A

B. K

178
Q

179.55 years old male presented by ulcer deep to it swelling contain keratinized skin , calcium and bone What is the pathology:
A. BCC
B. SCC
C. Melanoma
D. Kaposi sarcoma
E. None of the above

A

B. SCC

179
Q
  1. Premature baby with inguinal tender swelling
    A. direct hernia
    B. indirect hernia
    C. femoral
    D. testis torsion
    E. inguinal lymphadenitis
A

B. indirect hernia

180
Q
  1. ST elevation in lead II, III, avF A. Inferior MI
    B. Anterior MI
    C. Septal MI
    D. Lateral MI
    E. None of the above
A

A. Inferior MI

181
Q

182.A severe COPD patient receiving high flow oxygen became drowsy.
A. acute respiratory failure
B. chronic respiratory failure
C. respiratory alkalosis
D. metabolic acidosis
E. metabolic alkalosis

A

A. acute respiratory failure

182
Q
  1. patient presented with knee pain and operated in his left knee after 24 hour he develop chest pain and hemoptysis shortness of breathing what underline hematological predispose to his presentation?
    A. Anemia
    B. Thrombocytosis
    C. Thrombocytopenia
    D. Neutrophilia
    E. Lymphocytosis
A

B. Thrombocytosis

183
Q
  1. Most common site of obstruction in hydrocephalus?
    A. Foramen magnum
    B. Foramen of Monro
    C. Foramen of magende
    D. Foramen of luska
    E. Cerebral Aqueduct
A

E. Cerebral Aqueduct

184
Q

185.A 12-year-old child was admitted to the Emergency Department having inhaled a peanut. Where will the peanut most likely to have lodged?
A. Left lower lobe bronchus
B. left upper lobe bronchus
C. Right lower lobe bronchus
D. Right middle lobe bronchus
E. Right upper lobe bronchus

A

C. Right lower lobe bronchus

185
Q
  1. The pleural space is negative with respect to atmospheric pressure, except for which of the following:
    A. During a Valsalva maneuver
    B. During Muller maneuver
    C. During expiration
    D. During inspiration
    E. None of the above
A

A. During a Valsalva maneuver

186
Q
  1. COPD patient with peritonitis and ABG show metabolic acidosis due to
    A. Peritonitis
    B. COPD
    C. Smoking
    D. Heart failure
    E. None of the above
A

A. Peritonitis

187
Q
  1. Which part of ECG represents atrial depolarization?
    A. P wave
    B. QRS wave
    C. T wave
    D. J wave
    E. None of the above
A

A. P wave

188
Q
  1. Within the posterior triangle, which nerve is at risk of damage during surgery?
    A. Auricular branch of the facial
    B. Glossopharyngeal
    C. Phrenic
    D. Recurrent laryngeal
    E. Spinal accessory
A

E. Spinal accessory

189
Q

190.A 60-yr-old man with a history of angina undergoes an uncomplicated operation, for an inguinal hernia. Postoperatively he is found to be hypotensive, tachycardic, and has a raised jugular venous pressure. What is the most likely Underlying cause of his hypotension?
A. Reduced afterload
B. Reduced parasympathetic
C. Reduced preload
D. Reduced stroke volume
E. Reduced sympathetic tone

A

D. Reduced stroke volume

190
Q

191.35 years old man with Crohn’s disease then have watery diarrhea, what is the electrolyte disturbance?
A. Hypokalemia
B. Hyperkalemia
C. Metabolic alkalosis
D. Hypercalcemia
E. Hypernatremia

A

A. Hypokalemia

191
Q
  1. A patient cannot make a 90 degree angle between thumb and palm is a result of which nerve injury?
    A. Ulnar nerve
    B. Posterior interosseus nerve
    C. Median nerve
    D. Anterior interosseus nerve
    E. None of the above
A

B. Posterior interosseus nerve

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