2006 Surgery Final 6th Year

2006 – Surgery Final (Sub specialties) – 6th THORACIC SURGERY: 1) Patient presents with a typical presentation of Mysthenic disease, a CT chest was done and a mediastinal mass was found, what do you this is the diagnosis? a. Thymoma 2) There is a patient arriving to the ER after a RTA, with complaints of difficulty breathing, on examination his hemodynamics are stable, and he has tachypnea, with deviation of the trachea to the right and absent breathing sounds and dullness on percussion and on the left with normal finding on the right side, which of the following of the likely cause? a. Cardiac Tamponade b. Massive Heamothorax c. Tension Pneumothorax d. Flail Chest e. 3) A patient comes to u after a motorcycle accident. On physical examination his vitals are HR:110, BP: 80/57 ad has labored breathing. His Glascow Coma Scale was 8. O/E: tachypnea, with deviation of the trachea to the right and absent breathing sounds and dullness on percussion and on the left with normal finding on the right side, which of the following of the likely cause? a. Cardiac Tamponade b. Massive Heamothorax c. Tension Pneumothorax d. Flail Chest e. 4) For the previous case, what is the initial management? a. Pericardio-centesis b. Chest tube in the second intercostal space c. Immediate needle thoracostomy d. Endotracheal intubation e. 100% oxygen by mask 5) There is a 3rd patient arriving to the ER after a RTA, with complaints of difficulty breathing, on examination he is in shock (BP 90/70), his heart rate was around 130, and he had dilated neck veins, and he has tachypnea, with deviation of the trachea to the right and absent breathing sounds and dullness on percussion and on the left with normal finding on the right side, which of the following of the likely cause? a. Cardiac Tamponade b. Massive Heamothorax c. Tension Pneumothorax d. Flail Chest e.

6) Which of the following is a hypertonic solution? a. 5% Dextrose b. Mannitol c. 0.9% NS d. Human tonic albumin e. 7) This patient has a chest X-ray which revealed multiple lesions in the lung fields measuring 1-2 cm, which of the following of the most likely diagnosis: a. Secondary lesion metastatic lesions b. 8) A middle age worker who presented with difficulty breathing and has a large bloody effusion, which of the following is the likely cause? a. Malignant mesothelioma b. 9) A patient with a known case of mesothelioma, on history, exposure to which of the following agents is a possible cause of this disease? a. Asbestos b. 10) the immediate management Of open Chest wounds is: a. placing a Chest tube in second ICS midclavicular line b. chest tube in 4th or 5th ICS mid axillary line c. chest needle in the 2nd ICS midclavicular line d. occlusive dressing 11) A patient known to be a smoker of 40 pack years comes to with a history suggestive of lung cancer and is diagnosed with squamous cell carcinoma of a bronchus complicated with distal pneumonia. CT showed no mediastinal or chest lymphadenopathy. What is the next step you would do? a. bone scan to detect silent mets b. combined radio and chemotherapy c. endobronchial laser surgery d. thoracotomy and surgical excision e. lobectomy 12) A patient known to be a smoker of 40 pack years comes to with a history suggestive of lung cancer and is diagnosed with squamous cell carcinoma of the right upper lober. CT showed no mediastinal or chest lymphadenopathy. What is the next step you would do? a. Bone scan to detect silent mets b. Combined radio and chemotherapy c. Endobronchial laser surgery d. Right pneumonectomy e. Right upper lobectomy 13) A young man comes to u with a history of recurrent spontaneous pneumothorax. How would you manage?

a. chest tube insertion b. giving medications c. video assisted thoracoscopy 14) A 57 years old nonsmoker woman presents with a peripheral lesion on the x-ray. What is the most likely diagnosis?? a. hamartoma b. adenocarcinoma c. squamous cell carcinoma d. small cell carcinoma e. oat cell carcinoma 15) A middle aged lady with night sweats, fever, and neck swellings and sustained rise in JVP up to the age of the mandible, which of the following is a possible reason? a. Blockage of the superior vena cava b. 16) Which of the following is a contraindication for bronchoscopy? a. Presence of malignant cells in the pleural effusion 17)

ENT: 18) Presentation with an offensive muco-purulent ear discharge, what is the most likely cause? a. Choleastatoma b. Secretory otitis media c. 19) Which of the following is NOT a systemic cause of epistaxis? a. Rhematic fever b. Coagulopathies c. Liver disease d. Nasopharyngeal angiofibroma 20) Another epistaxis 21) All of the following is an indication of tonsillectomy EXCEPT? a. b. Parotid swelling 22) Which of the following is NOT an indication for adenoidectomy? a. Snoring b. headache c. unilateral hypertrophied Tonsil d. quinsy e. OSAS 23) Which of the following is NOT a disease of the salivary glands? a. Goiter 24) Which one of the following is not part of the paranasal sinuses?

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a. Sphenopalatine b. Maxiallary c. Sphenoid d. Frontal e. Ethmoidal Which one of the following is not part of the paranasal sinuses? a. Some weird name of a sinus (NOT PARANASAL) b. Maxiallary c. Sphenoid d. Frontal e. Ethmoidal Which of the following muscles is supplied by the facial nerve (CN VII) a. Platysma b. Temporalis c. Ptregoid d. Anterior belly of digastric muscle e. Strap muscles External ear irrigation is indicated in all of the following EXCEPT? a. external otistis media b. ear wax c. metal foreign body removal d. animate foreign body removal e. cholesteotoma All of the following create a predisposition to secretory otitis media EXCPET? a. Recurrent upper respiratory Tract infections b. Ciliary immotility disease c. Eustachian tube dysfunction d. Hypertrophied adenoids e. Foreign body in the external ear All of the following are causes of stridor EXCEPT? a. acute laryngitis b. acute epiglotitis c. laryngeal cancer d. unilateral vocal cord paralysis e. bilateral vocal cord paralysis What is the most vital function of the larynx? a. sound production b. serving as an air passage c. preventing choking Which of the following is NOT a cause of hoarse voice? a. Some weird syndrome b.

32) On examination of the oronasal cavity, which of the following structures cannot be seen? a. Adenoids b. Tonsils c. Soft pallet d. Hard pallet e. Tongue 33) Which of the following is the unit for sound a. KHz b. MHz c. Hz d. HzDb e. dB 34) Why is acute laryngitis a serious condition in young children? a. Presence of immature reflexes of the larynx predispose to laryngeal spasms b. 35)

Neurosurgery: 36) Which of the following is the most common cause of spontaneous SAH? a. Aneurysm b. coagulopathy c. AV malformation d. hypertension e. trauma 37) Which of the following is the most common cause of SAH? a. Aneurysm b. coagulopathy c. AV malformation d. hypertension e. trauma 38) Which of the following would cause 3rd nerve palsy? a. Internal Carotid Aneurysm (cavernous sinus) b. basilar aneurysm c. Cerebellopontine tumor d. meningeoma 39) Uncal herniation is likely to cause which of the following? a. Ipsilateral dilatation of the pupil b. 40) Which of the following is an indication for need of surgical intervention after epidural hemorrhage? a. fixed dilated pupils

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b. fluctuating blood pressure readings c. deterioration in level of consciousness d. GCS 15/15 e. patient presenting within 72 hours Which of the following supplies the basal ganglia of the brain? a. Laticunostraital branches b. ACA c. MCA d. PCA e. AComm.A epidural hemorrhage is associated with: a. brain contusion b. brain tumor c. subarachnoid hemorrhage A middle aged patient comes to the emergency with sudden onset occipital headache. CT is negative. What would you do next?! a. Lumbar puncture b. MRI c. CT angiogram d. cerebral angiography e. do nothing and send him home Which of the following is the most common presentation of patients with SAH? a. Headache Patient has presented with an active prolactinoma, which of the following is an appropriate management? a. Bromocriptine b. Surgical excision c. Radiotherapy d. Chemotherapy e. Which of the following is the most sensitive test in suspected cases of SAH? a. CT scan b. MRI c. angiogram d. LP e. US Which of the following is the most important step managing a patient who arrived to your ER with history of head trauma? a. Following the ATLS algorithm Which of the following would be a presentation of a patient with thoracic lumbar disc herniation? a. Urinary retention

b. Cauda equine syndrome c. Quadriplegia d. Hemiplegia e. Back pain 49) Patient presents to you with weakness of the lower limbs associated with urinary retention, which of the following is the closest diagnosis? a. Cauda equine syndrome b. Prolapse at the level of D4-D5 c. 50) Patient presents with suspected cauda equine syndrome, which of the following is true? a. Patient need to be managed quickly b. Patient presents with urinary frequency 51) Which is the most likely complication of SAH after 48 hours? a. Re-bleed b. vasospasm 52)

Plastic Surgery: 53) In the case of suspected inhalational injury, which of the following is the most appropriate next step if management? a. Head elevation b. Intubation and 100% O2 c. 54) Which of the following is a good promoter for skin graft success? a. Recipient site with a good capillary bed b. 55) Which of the following causes wound contraction after skin graft? a. Infection b. Epithelialization tissue from the recipient site 56) Which of the following cells secretes collagen during healing? a. Fibroblasts b. Macrophages c. Lymphocytes d. Red blood cells e. platelets 57) All of the following affect wound healing success EXCEPT: a. Types of sutures used b. Infections c. Jaundice d. 58) Which of the following is not a criteria for cleft surgery

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a. Age >10 weeks b. WBCs 10 pounds d. Hb >10 e. Cleft size >10mm Why is it necessary for a patient with cleft palate to be seen by an ENT specialist before undergoing a surgery? a. Recurrent otitis media due to Eustachian tube dysfunction b. Why should a cleft defect be operated on before the age of 2 years? a. To prevent articulation problems b. To prevent recurrent otitis media c. What is the ideal time for repairing a facial wound?! a. 6 hours b. 12 hours c. 24 hours d. 48 hours e. 72 hours The proliferative phase of wound healing starts within: a. 1 day b. 2 days c. 4 days d. 1 week e. 2 weeks A patient comes to you with extensive loss of skin and muscle and the tibial bone apparent with disturbed periosteum. How do you reconstruct this defect?! a. approximation and closure of skin even with insufficient skin b. debridement and skin grafting c. free or pedicled flap d. dressing the defect e. IV antibiotics A patient comes to the emergency with a third degree burn involving his arm and is circumferential. To avoid compartment syndrome in his case what should u do in immediately?! a. escharotomy b. amputation c. vasodilators which of these is the commonest non-bacterial opportunistic organism commonly isolated In burn patients: a. MRSA b. aspergellosis c. fusamides

d. phycomytes e. candida 66) A patient comes to you with 12 hours old laceration wound and some skin loss. How would you manage? a. IV antibiotics b. Tetanus vaccine c. cover the wound and let it heal by itself (dressing) d. delayed primary closure with skin graft

67) A teenager male with gynecomastia, what is the best management at this stage? a. Observation 68) Which of the following is NOT true about third degree burns? a. Dilated veins b. painless 69) Which of the following is true about 1st degree burns? a. Heals within 7-10 days b. painless 70) When is the best time to operate on repair of a cleft palate? a. 9-12 months b. 3-6 months c. 1-2 years d. 5-7 years e. 1st month 71) Which of the following is NOT true about cleft lip? a. Is always associated with cleft palate 72)

ANESTHESIA: 73) Which of the following is an appropriate management of post-operative nausea and vomiting? a. Ondansetrone b. 74) Which of the following anesthetic agents has the fastest recovery? a. Propofol b. Ketamine c. Medazolam d. Sodium Thiopental e. Esmolol 75) Patient is to undergo an operation in a prone position, which of the following would be the most appropriate technique for securing the airways? a. LMA (laryngeal mask airway) b. ETT c. Laryngeal airway intubation

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d. Oxygen mask e. Nasal airway. Which of the following vasopressors would be the first line of management of shock? a. Dubutamine b. ADH c. Noradrenaline d. Adrenaline e. When 35% of blood is lost during a surgery which of the following is true? a. CVP will decrease b. Which of the following is true about the use of lidocaine in local anesthesia? a. Simultaneous use of adrenaline will not affect the dose used b. Accidental vascular injection is always accompanied with toxicity c. CNS signs of toxicity occur before the onset of cardiac symptoms d. A 55 years old lady is about to undergo an elective surgery, she has hypertension controlled well on medications since 5 years, what is her ASA score? a. I b. II c. III d. IV e. V An ASA score of III relates to which of the following patients? a. A patient in his late 60s who has long term severe comorbid conditions creating a limitation to his activity all are IV induction anesthetic agent except: a. Propofol b. Ketamine c. Medazolam d. Sodium Thiopental e. Esmolol

82) Which of the following is a depolarizing muscle relaxant? a. suchcenylcholine b. misocurium

83) Which of the following is an early sign of septic shock syndrome? a. Cardiac output is usually normal or high b. 84) Hypothermia can be caused by all of the following except? a. Venodilation b. Hypothyroidisim

c. Shock d. Mostuirising air in the ventilation machine e. 85) Which of the following is the first thing in the assessment of a comatose patient? a. MRI b. Looking for injection sites 86) Which of the following is true regarding pain control and management in the elderly? a. They have decreased reflexes b. Not sure 87) Which of the following doesn’t occur with rhematic fever? a. Ataxia b.

Opthalmology: 88) All of the following are causes of sudden painless loss of vision except: A. Central retinal artery occlusion B. Optic atrophy C. Optic neuritis D. Retinal detachment E. Central retinal vein occlusion 89) Flashes of light before the eyes (photopsia) is a feature of the following conditions except: A. Impending retinal detachment B. Vitreous traction of the retina C. Retinitis D. Migraine E. Central retinal artery occlusion 90) Mono-ocular diplopia is seen in the following condition A. Incipient cataract B. Paralytic squint C. Myasthenia gravis D. Thyroid disorders E. Blow out fracture of the floor of the orbit 91) Snellen’s chart is used to test: A. Vision B. Refraction C. Presbyopia D. Color blindness E. Intraocular pressure 92) Shallow anterior chamber is seen in all except: A. Old age B. Primary open angle glaucoma

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C. Hypermetropia D. Angle – closure glaucoma E. Intumescent (swollen cataractous) lens Subconjuctival hemorrhage can occur in all conditions except: A. Passive venous congestion B. Pertusis C. Trauma D. High Intraocular pressure E. Viral conjunctivitis Blue sclera is seen in : A. Alkaptonuria B. Osteogenesis imperfect C. Lowe’s syndrome D. Uveitis E. Glaucoma Earliest symptom in corneal ulcer is : A. Loss of sensation B. Diminished vision C. Photophobia D. Pain E. Loss of vision The commonest type of cataract in adults is : A. Nuclear cataract B. Cortical cataract C. Morgagnian cataract D. Posterior subcapsular cataract E. Mature cataract Causes of early onset of cataract are all except: A. Diabetes mellitus B. Smoking C. Trauma D. Recurrent episodes of diarrhea E. Steroids The most common symptom of Primary open glaucoma A. Headache B. Eye pain C. Tearing D. No symptoms E. Decreased vision Commonest cause of vitreous hemorrhage is : A. Diabetes B. Hypertension

C. Age D. Lens extraction E. Trauma 100) In case of chemical injury to the eye , the first line of management should be: A. Start intensive topical steroid B. Referral to ophthalmologist urgently C. Copious irrigation of the eye with water D. Patch the eye E. Check the vision and eye pressure 101) Primary retinal detachment is seen in : A. Diabetes B. High myopia C. Malignant melanoma D. Hyperopia E. Primary open angle glaucoma 102) The commonest symptom of retinal detachment is A. Sudden loss of vision B. Sudden field defect C. Floater D. Flashes of light E. Eye pain 103) Conjugate fixation reflex is established by the age of : A. 3 weeks B. 6 weeks C. 3 months D. 6 months E. 12 months 104) Hirschberg test is used to detect : A. Squint B. Field defect C. Glaucoma D. Optic atrophy E. Visual acuity 105)