arab board orthopedic exam june 2013

1-On which of the following does aldosterone exert its greatest effect? A. Glomerulus B. Proximal tubule C. Thin portion of the loop of Henle D. Thick portion of the loop of Henle E. Cortical collecting duct E 2-MEN 2A and MEN 2B syndromes are associated with germline mutations in: A. The p53 tumor suppressor gene. B. The H-ras gene. C. The N-myc gene. D. The RET proto-oncogene. Answer: D 3-A 28-year-old male was injured in a motorcycle accident in which he was not wearing a helmet. On admission to the emergency room he was in severe respiratory distress and hypotensive (blood pressure 80/40 mm. Hg), and appeared cyanotic. He was bleeding profusely from the nose and had an obviously open femur fracture with exposed bone. Breath sounds were decreased on the right side of the chest. The initial management priority should be: A. Control of hemorrhage with anterior and posterior nasal packing. B. Tube thoracostomy in the right hemithorax. C. Endotracheal intubation with in-line cervical traction. D. Obtain intravenous access and begin emergency type O blood transfusions. E. Obtain cross-table cervical spine film and chest film. Answer: C 4-. Which of the following variables best predicts prognosis for patients with a recent diagnosis of cutaneous melanoma and no clinical evidence of metastatic disease?

A. Breslow thickness. B. Clark's level. C. Ulceration. D. Gender. E. Celtic complexion. Answer: A 5-Biologic features of adult soft tissue sarcomas include the following except: A. Mutations of p53 in metastatic liposarcoma. B. A low (less than 1%) risk of metastasis for small, low-grade lesions. C. Recurrent disease in at least 33% of patients. D. Lymph node metastasis in less than 3% of patients. E. Mutations of p53 in Li-Fraumeni syndrome. A 6. A new marker that has possible utility in the management of patients with non– small-cell lung cancer (NSCLC) is: A. Calcitonin. B. Neuron-specific enolase. C. CYFRA 21-1. D. Glucagon. E. Chromogranin A. Answer: C 7-. The presence of which marker is a significant poor prognosis variable for patients with breast cancer: A. CEA. B. C-erb B-2. C. AFP. D. Human chorionic gonadotropin (hCG). E. RB-1. Answer: B 8-. A 45-year-old man with long-standing gastroesophageal reflux undergoes upper endoscopy that reveals patchy areas of epithelium resembling gastric mucosa extending 5 cm proximal to the esophagogastric junction. Biopsies are obtained. The pathologic report describes “Barrett’s epithelium”. Which of the following

processes does this finding represent? a. Cellular hyperplasia b. Cellular hypertrophy c. Metaplasia d. Carcinoma in situ Answer: c 9- Patients that have acquired immunodeficiency syndrome are at increased risk for which of the following neoplasms? a. Colorectal cancer b. Meningioma c. Kaposi’s sarcoma d. Hepatocellular carcinoma e. Esophageal carcinoma Answer: c 10- DNA viruses have been implicated as etiologic agents in several human tumors. Evidence for a causative role exists for which of the following neoplasms? a. Hodjkin lymphoma b. Testicular carcinoma c. Cervical carcinoma d. Osteogenci sarcoma e. Esophageal carcinoma Answer: c 11- Which of the following statements about surgical anatomy of the colon and rectum is/are correct? A. The cecum has the largest inner diameter of all segments of the colon (13 to 15 cm.). B The rectum is entirely an intraperitoneal organ. C The ileocolic, right colic, and middle colic arteries are branches from the superior mesenteric artery

C 12-. All are true about the dumping syndrome except: A. Symptoms can be controlled with a somatostatin analog. B. Diarrhea is always part of the dumping syndrome. C. Flushing and tachycardia are common features of the syndrome. D. Separating solids and liquids in the patient's oral intake alleviates some of the symptoms of the syndrome. E. Early postoperative dumping after vagotomy often resolves spontaneously. Answer: B 13-a 40 year old woman is admitted to the icu after retroperitoneal sarcoma resection on postoperative day 5 her platelet count dropped to 85000(baseline 325,000) . she has been receiving unfractional heparin for venous thromboembolism prophylaxis perioperatively. She has no evidence of clinical bleeding. All of the following are indicated except Oral warfarin Direct thrombin inhibitor Discontinuing all heparin Testing for heparin induced thrombocytopenia (HIT) antibodies Evaluation for venous thromboembolism A 14- which of the following is a common complication of roux-y gastric bypass (rygb)? Vitamin D deficiency Primary hyperparathyroidism Anemia due to lack of transferring

Symptomatic thiamine deficiency Hypocoagulable state A 15- when a patient with colonic pseudo-obstruction fails to improve after two doses of neostigmin, the next step should be Laparotomy and partial colectomy with anastomosis Percutaneous cecostomy Additional dose of neostigmin Erythromycin administration Colonscopic decompression E 16- Which of the following statements about laparoscopic surgical complications is not true? A. Damage to the common bile duct is most frequent B. Electrocautey equipment is the most common type of device causing injury C. Excessive pain is the most common indication for re-laparoscopy less than 48 hours D. Delayed re-laparoscopy significantly increases length of hospital stay E. Delayed identification of the injury is common B 17- a 45 year old man with a history of hepatitis C and cirrhosis presents for elective cholecystectomy for symptomatic gallstones. The single best predictor of perioperative mortality is

A. Ultrasound appearance of the gallbladder B. CT appearance of the liver C. Child-Pugh classification D. MELD score E. Hepatitis C viral load D 18- Negative pressure wound is associated with all of the following except A. Increased local blood flow B. Stimulation of granulation tissue C. Decreased tissue edema D. Decreased bacterial counts E. Increased rate of wound healing D 19- Which of the following has not been shown to decrease the incidence of ventilator-associated pneumonia(VAP)? A. Topical oral cholrhexidine B. Elevation of the head of the bed 30 degree C. Silver-coated endotracheal tubes D. Early tracheostomy E. Decreased sedative use D 20- which of the following is recommended to prevent nosocomial pneumonia in patients with flail chest associated with an underlying pulmonary contusion?

A. Mandatory mechanical ventilatory support B. Corticosteroids C. Epidural analgesia D. Antibiotics E. Immediate chest wall fixation C 21- which of the following statements about corticosteroid administration in septic shock is true? A. Intravenous corticosteroids should be administered simultaneously with initial fluid rescuscitation B. Hypoalbuminemia less than 2.5 g/dl decreases total cortisol levels C. Hydrocortisone less than 450mg/day is required to demonstrate optimal benefit D. Cosyntropin stimulation testing is accurate for evaluating adrenal insufficiency E. Dexamethasone is the preferred corticosteroid foe use of septic shock B 22- which of the following statements about thrombocytosis in trauma patients in the ICU is true? A. Does not increase the risk of venous thromboembolism B. Occurs in 50% C. Increases mortality D. Not associated with infection E. Normalizes in 3 to 5 days A

23- of the following the most appropriate feeding approach for patients with severe head injury would be A. Total parenteral nutrition (TPN) at day 3 B. Enteral feeding at day 3 C. TPN day 5 D. Enteral feeding at day 5 E. Peripheral caloric support at day 1 B 24- which of the following statements about posttraumatic renal failure (creatinine more than mg/dl) among patients in a level 1 trauma centre is true? A. Occurs in more than 5% of patients B. Has in hospital mortality of nearly 40% C. Dialysis required in 50% of cases D. Creatinine generally rises above 2 mg/dl within 48 hours E. Most surviving patients require posthospital dialysis B 25- which of the following statements about fetal death after a motor vehicle crash is true? A. Maternal acetabular fracture are not associated with increased fetal mortality B. Uterine rupture is the leading cause of fetal death C. Abruption placenta is the leading cause of fetal death D. Three point seatbelt use in the third trimester has no effect on fetal outcome E. Intra-uterine fetal death is rare after a motor vehicle crash in the first trimester

C 26- three years after renal transplant . a 65 year old patient with a newly diagnosed colon carcinoma. The patient receives monotherapy with sirolimus for immunosuppression. An elective colon resection is scheduled. This patient has an increased risk for A. Intraoperative bleeding B. Wound dehiscence C. Deep venous thrombosis D. Postoperative diabetes E. Adrenal deficiency B 27- which of the following statements about tunneled dialysis catheter is true? The right internal jugular vein is the preferred approach They are the preferred mode of dialysis in diabetics The tip of catheter should be in the right ventricle The risk of infection is lower than with a polytetrafluoroethylene (PTFE) graft Hemodialysis is more efficient than with an arteriovenous fistula A 28- renal transplant patients have an increased incidence of A. Adenocarcinoma of the uterus B. Nonmelanoma skin cancer C. Lobular breast cancer

D. Colonic carcinoid E. Lung cancer B 29- a 12 year old premenarched girl presents with a 2 week history of progressive abdominal pain and urinary retention. Placement of a urinary catheter yield 700 ml of clear urine. On examination, she is afebrile with normal vital signs. She has a palpable, mildy tender mass filling her pelvis and lower abdomen. The most likely diagnosis is A. Posterior urethral valves B. Imperforate hymen C. Appendiceal abscess D. Ovarian teratoma E. Urinary tract infection B 30- the single most important risk factor for noninfectious sternal dehiscence after median sternostomy is A. Hyperglycemia B. Hypertension C. Obesity D. Internal thoracic artery use E. Femal sex C 31-which of the following statements about massive hemoptysis is true?

A. Exanguination is the most common cause of mortality B. Pulmonary artery embolization is the most effective nonsurgical treatment option C. bronchial arteries are the most common source of bleeding D. rigid bronchoscopy is contraindicated E. CT is the initial diagnostic procedure of choice C 32- the most appropriate treatment for a patient with a 2 cm diffuse large B-cell lymphoma limited to the antrum of the stomach would be A. Total gastrectomy B. Radiotherapy followed by gastrectomy C. Systemic chemotherapy D. Distal gastrectomy E. Chemoradiation C 33- which of the following statements about medullary thyroid cancer (MTC) true? A. All forms are hereditary B. The most aggressive fowm is MEN2B C. Normal calcitonin levels excludes the diagnosis D. MEN2B is associated with mucosal neuromas, pheochromocytoma, parathyroid hyperplasia, and MTC E. MEN2A patients usually exhibit findings consistent with pheochromocytoma prior to MTC B

34- which of the following tumor markers is most closely associated with the diagnosi of gastrointestinal stromal tumor (GIST)? A. CEA B. CD117 C. HER/neu D. CA125 E. P53 B 35- pressure sores are best prevented by A. Routine use of air-flow mattresses B. Frequent re-positioning C. Aggressive nutritional support D. Infection control E. Drying powders to moist skin surfaces B 36- when performing a four-compartment fasciotomy for leg compartment syndrome the A. Femoral nerve can be easily injuried B. Soleus muscle is taken down off the tibia to decompress the deep compartment C. Anterior tibial artery can be easily injuried D. Procedure should not be performed until the pedal pulses are absent E. Skin should be loosely closed B

37- During cholecystectomy in a 67-year-old woman, there is severe bleeding from accidental injury to the hepatic artery. The patient requires transfusion of 2000 mL of blood. After the operation, 24-hour urine output varies between 1250 and 2700 mL/d. She was adequately hydrated, but BUN levels continue to rise 10-12 mg daily over a 5-day period. What is the main finding? (A) Progressive bleeding (B) High-output renal failure (C) Postcholecystectomy syndrome (D) Glomerulonephritis (E) Obstructive jaundice

B 38- Metabolic changes likely to occur include which of the following? (A) Hyperkalemia (B) Hyponatremia (C) Hypophosphatemia (D) Metabolic alkalosis (E) Hypomagnesemia

A 39- Management includes which of the following? (A) Restriction of fluids to 750 mL/d (B) 8 L of fluid daily to remove urea (C) Replacement of fluid loss plus insensible loss (D) 80 mEq potassium chloride (KC1) per 12 hour (E) Ammonium chloride IV

C

40- A 70-year-old woman has low cardiac output with increased PCWP and increased systemic vascular resistance. What should be the drug of choice? (A) Dopamine (B) Norepinephrine (C) Dobutamine (D) Epinephrine (E) Phenylephrine

C 41- A 60-year-old man had undergone exploratory laparotomy for perforated gastric ulcer with severe peritoneal contamination. Six hours after surgery, he is tachycardic, hypertensive, and has shallow respirations. Intubation and institution of ventilatory support is indicated in the presence of which of the following? (A) Respiratory rate of 23 breaths/min (B) PaC0 2 of 45 mm Hg (C) Pa0 2 of 55 mm Hg on room air (D) HR of 140 bpm (E) BP of 150/100 mm Hg

C 42- A 20-year-old man has undergone appendectomy for perforated appendicitis with generalized peritonitis. Seven days postoperatively, his temperature continues to spike to 103. 8°F despite antibiotic therapy with ampicillin, gentamicin, and metronidazole. A CT scan reveals a large pelvic abscess. Soon afterward, he has bleeding from the mouth and nose with increasing oozing from the surgical wound and all intravenous puncture sites. What is the most likely diagnosis? (A) Anaphylactoid reaction to intravenous dye (B) Disseminated intravascular coagulation (DIC)

(C) Antibiotic -induced coagulopathy (D) Liver failure (E) Congenital bleeding disorder

B 43- A 65-year-old male is resuscitated using hydroxyethyl starch (hetastarch). Which of the following is associated with the use of hetastarch ? (A) Thrombotic thrombocytopenia (B) Elevated levels of factor VIII (C) Elevation of serum creatinine (D) Hyperbilirubinemia (E) Hyperamylasemia

E 44- A 64-year-old assistant hair stylist undergoes a vaginal hysterectomy under spinal anesthesia. Bleeding occurs when an attempt is made to separate and exclude the right ureter from the operating field. After a short interval, respiratory arrest occurs and intubation must be instituted. What is the most likely cause of respiratory arrest during this procedure under spinal anesthesia? (A) Paralysis of the intercostal muscle (B) Paralysis of the diaphragm (phrenic nerves) (C) Centrally induced mechanism secondary to decreased cardiac output (D) Diffusion of anesthetic to the level of the pons (E) Diffusion of anesthetic to the level of the medulla C 45- A full term neonate is found to have a swollen right scrotom. Gentle persistent pressure easily reduces an air filled structure back into the abdomen. The condition recurs promptly as

the infant begins to cry. This (A) Mandates immediate surgical repair (B) Is the same defect as a communicating hydrocoele (C) Should have a tension-free mesh repair (D) Should prompt exploration of the left groin (E) Is generally irreducible in children

B 46- You are called to the emergency room to see a 5-year-old child who has been vomiting for two days. She is thin, pale, lethargic, and febrile to 102.4°F. She has a respiratory rate of 39 beats per minute (bpm) and a diffusely tender, rigid abdomen without localizing signs. You should (A) Order an abdominal/pelvic CT scan with oral contrast to clarify the diagnosis. (B) Realize that her omentum is likely to "wall off" and contain the infection. (C) Order a barium enema to rule out intussusception. (D) Start fluid resuscitation and observe on broad-spectrum IV antibiotics. (E) Take her immediately to the operating room for abdominal exploration.

E 47- You are called to see a 4-hour-old neonate in the well-baby nursery who has developed bilious vomiting after taking his first feeding. He was born at 39-week gestation, has not yet passed meconium and has an unremarkable examination. An upper gastrointestinal (GI) series would be the study of choice to rule out which of the following clinical conditions? (A) Ileal atresia (B) Meconium ileus (C) Duodenal web

(D) Malrotation (E) Tracheoesophageal fistula

E 48- A 3-year-old, recently adopted Romanian boy is referred after his initial pediatrician's assessment for an undescended testicle. On exam his left testicle is normal and in place. He has no evidence of hernias. However, his right hemiscrotum is empty and there is a testicule sized mass plapable at the pubic tubercle. The most appropriate next step is (A) Observation until age 5 (B) Right orchiopexy (C) Right orchiopexy and right inguinal hernia repair (D) Right orchiopexy and right testicle biopsy (E) An abdominal ultrasound

C 49- A 6-year-old girl presents with a left breast mass. Her mother first noticed it a day before and is very concerned because both the child's maternal grandmother and maternal aunt have had breast cancer. It is firm, smoothly circumscribed, and slightly eccentric under the left areola. The right breast is unremarkable. You suggest (A) Immediate excisional biopsy (B) A mammogram (C) Repeat examination in 1 month (D) Genetic testing for breast cancer (BRCA) 1 and 2 mutations (E) Sterotactic needle biopsy

C 50- A 4-year-old girl is referred to your office by the pediatrician for the finding of an abdominal mass on her 4-year-old well child visit. She had

been consistently in the seventy-fifth pecentile for height and weight and although she is still in the seventy-fifth pecentile for height she is only in the fortieth percentile for weight. She has been eating normally and having normal daily BMs. On examination you palpate an 8-cm right midabdominal mass. It is firm, nontender, and poorly mobile. The most likely diagnosis is (A) Constipation with a distended cecum (B) Wilms' tumor (C) Neuroblastoma (D) Lymphoma (E) Hempatoblastoma

C 51-A 12-year-old girl presents to the emergency department following a skiing crash in which the left side of her midtorso hit a tree. She pres-ents with left side lower chest and upper abdominal pain. She also complains of left shoulder pain. The most likely diagnosis is which of the following? (A) Rib fractures (B) Liver injury (C) Ruptured diaphragm (D) Splenic injury (E) Ruptured stomach

D 52- which is the best method to distinguish a Wilm's tumor from a neuroblastoma? (A) Shifting dullness (B) Physical examination of the abdomen (C) Catecholamine levels (D) Auscultation for bowel sounds (E) Cortisol administration

B 53- A newborn full-term baby boy with diagnosis of imperforate anus (Fig. 13-2) is also at risk to have a (A) Dextrocardia (B) Rib cage anomaly (C) Tracheoesophageal fistula (D) Ulnar skeletal deformity (E) Proximal limb malformation

C 54- The most common pathogen in neonatal sepsis is (A) Haemophilus influenzae (B) Pneumococcus (C) Klebsiella pneumoniae (D) Escherichia coli (E) Staphylococcus epidermidis

E 55- A patient in the surgical ICU is in septic shock after surgery for perforated diverticulitis. His temperature is 102. 3°F and his heart rate is 120 bpm. He is requiring dopamine for BP support. Which of the following drugs would be appropriate for use in this situation? (A) Recombinant activated protein C (B) Antitumor necrosis factor(TNF)antibody (C) Interleukin-1 (IL-1) receptor antagonist (D) Antiendotoxin antibody (E) Sodium nitroprusside

A

56-A 51-year-old man presents with recent onset of what appears to be a large left varicocele. He should be investigated for possible: (A) Infertility (B) Testicular tumor (C) Renal tumor (D) Portal hypertension (E) Torsion of the appendix testis

C 57- Elevated serum levels of alpha fetoprotein in a man is in which of the followings A. seminomatous germ cell tumor B. non seminomatous germ cell tumor C. leydind cell tumor D. sertoli cell tumor B 58- a patient with renal cell carcinoma with extension to the IVC is best treated with A. radiotherapy B. chemotherapy C. thrombolytic therapy D. nephrectomy and remove the site of metastasis E. nephrectomy and remove the site of metastasis with graft E 59- initial management of a patient with priapism includes A. bed rest, narcotics, and hydration

B. Administration of beta blockers C. Placement of an 18-g IV catheter into the corpus cavernosum D. Surgical exploration C 60- a patient with a complex pelvic fracture is scheduled for open reduction and fixation of the fracture in the operating room. He also has an extraperitoneal bladder injury with a contained area of extravasation. The best treatment for the bladder injury is A. Leaving foley catheter in place for 7-10 days B. Percutaneous drainage of the extravasation and foley catheter drainage of the bladder C. Transurethral repair of the bladder injury D. Open repair of the bladder injury D 61- paraphimosis refer to Inability to retract the foreskin Inability to reduce the foreskin after it has been retracted Infection of the foreskin Excessive length of foreskin B 62- the most common malignant tumor of the brain in children is A. Ganglioneuroma B. Neuroblastoma

C. Medulloblastoma D. Glioblastoma C 63- which of the following test is most sensitive in determining if the fluid is cerebrospinal fluid Glucose level Halo test Fluid serum LDH ratio Beta transferring D 64- clinical finding which can be seen in a patient who is brain dead include Minimally reactive pupil unilaterally No spontaneous breathing with a paco2 of 50 mmhg Minimal, unilateral decorticate posturing to painful stimulus Positive triple flexion reflex of the leg Extension position D 65- a 4 year old presents with a fracture of the femur (midshaft) with 20% of anterior angulation. Which of the following is the best treatment for this child ? Traction and bed rest Closed reduction and application of spica cast

Open reduction and external fixation Open reduction and intramedullary fixation B 66- which of following is associated with forced dorsiflexion of the foot? A. Fracture of the talus B. Fracture of the navicular C. Fracture of the cuneiform D. Fracture of the cuboid A 67- tear in the medial meniscus in a young athelete is best treated by A. Immobilization and anti –inflammatory agents B. Arthroscopic repair of meniscus C. Resection of the meniscus D. Resection of the meniscus and replacement with allograft B 68- which of the following statements is true concerning the effect of pneumoperitoneum on the circulatory system A. Cardiac output is significantly improved secondary to an attenuated stress response B. Cardiac output is always increased secondary to augmented venous return (increases preload) C. Pneumoperitoneum decreases the capillary wedge pressure D. Systemic absorption of co2 has no significant hemodynamic effects

E. Cardiac work is increased E 69- an 18 year old girl is transported to the emergency department after a fall from a tree. Survey reveals bilateral foot injuries with tenderness and crepitus over the heels. In addition to ordering chest, pelvis, C-spine, and calcaneal radiographs, evaluating physician should also examine and order radiograph of: A. The thoracic spine B. The maxilla C. Bilateral wrist D. The lumbosacral spine E. Bilateral elbows D 70- a 42 year male passenger is brought to the emergency department after being ejected during a motor vehicle rollover. In the trauma room he is hemodynamically stabilized after intubation. Among other injuries he is noted to have tense swelling of his right thigh. Radiographs confirm a midshaft femur fracture. This injury: A. has no systemic effect on the patient’s overall morbidity and mortality B. alone cannot cause enough bleeding to produce hemodynamic instability C. rarely leads to fat embolism and ARDS D. should be definitely stabilized in 24 hours D

71- a patient with a nonobstructing carcinoma of the sigmoid colon is being prepared for elective resection. Which of the following reduce the risk of postoperative infectious complicatios? A. A single preoperative parenteral dose of antibiotic effective against aerobes and anaerobes. B. Avoidance of oral antibiotics to prevent emergence of clostridium difficile C. Postoperative administration for 48 hours of parenteral antibiotics effective against aerobes and anaerobes D. Postoperative administration of parenteral antibiotics effective against aerobes and anaerobes until the patient’s intravenous lines and all other drains are removed E. Redosing of antibiotics in the operating room if the case lasts for more than 2 hours A 72- an elderly diabetic woman with chronic steroid-dependent bronchospasm has an ileocolectomy for a perforated cecum. She is taken to the ICU intubated and is maintained on broad-spectrum antibiotics, renal-dose dopamine, and a rapid steroid taper. On postoperative day 2 she develops a fever of 39.2C (102.5F), hypotension, lethargy, and laboratory values remarkable for hypoglycemia and hyperkalemia. Which of the following is the most likely explanation for her deterioration? a. Sepsis b. Hypovolemia c. Adrenal insufficiency d. Acute tubular necrosis e. Diabetic ketoacidosis

C 73- Signs and symptoms associated with early sepsis include a. Respiratory acidosis b. Decreased cardiac output c. Hypoglycemia d. Increased arteriovenous oxygen difference e. Cutaneous vasodilation E

74- a 65 year old man has an enterocutaneous fistula originating in the jejunum secondary to inflammatory bowel disease. Which of the following would be the most appropriate fluid for replacement of his enteric losses?

A. D.W

B. 3% normal saline C. Ringer lactate D. 0.9% sodium chloride E. 6% sodium bicarbonate solution C 75- a 23 year old man arrives in the ER after a motor vehicle collision . examination reveals an unstable pelvis and blood at the urethral meatus. Which of the following studies would most accurately identify a urethral injury? A. CT scan of the pelvis B. Intravenous pyelogram C. Stress cystogram D. Antegrade urethrogram E. Retrograde urethrogram E 76- 10- year-old boy develops right lower quadrant pain, nausea, vomiting, and a fever . you suspect appendicitis and plan for an emergent appendectomy. As you are preparing to transport him to the operating room, his parents mention that he jas hemophilia A. what should you administer for this condition? A. Vitamin K B. FFP C. Factor Viii D. Cryoprecipitate E. Factor Vii C 77- about lactated ringer’s solution which is true Composed of 130 meq Na Should not be given to patient with acidosis because of increases in serum lactic acid Should not be used in patients with liver injury A 78- a 40 year old man sustains a gunshot wound to the neck just above the clavicle. Initial systolic blood pressure in the emergency department is 70 mm hg and increases to 90 mm hg with fluids. The next step in management would be: left anterolateral thoracotomy Right anterolateral thoracotomy Median sternotomy Right supraclavicular and infraclavicular exploration Insertion of foley balloon into the bullet wound C 79- in a failed suicide attempt a depressed student severs her radial nerve at the wrist the expected disability is: loss of ability to extend the wrist loss of ability to flex the wrist wasting of the intrinsic muscles of the hand

sensory loss over the thenar pad and thumb web palmar insensitivity D 80- with regard to anatomy of esophagus which of the following is true the esophagus is 35 cm long the esophagus is divided into three segments there are five predictable areas of narrowing (1) the thyropharyngeus (2) the thoracic inlet (3) the left subclavian artery (4) the left bronchus and (5) the crossing of the thoracic duct the arterial blood is supplied by the splenic right gastric pulmonary and innominate arteries the pharyngoesophageal segment of the esophagus consists of the three constrictors and stylopharyngeus muscle B? 81- the gastroduodenal artery is a branch of : celiac trunk superior mesenteric left gastric artery common hepathic artery Right gastric artery D 82- which of the following statements describe the typical venous drainage of the adrenal gland Plexuses of small veins provides the major drainage of each gland A primary central vein provides the minor drainage of each gland Both glands drain into the inferior vena cava left adrenal gland drain to the left renal vein right adrenal gland drain to the right renal vein D 83- Which of the following is not a pathophysiological feature of thermal injury? increase capillary permeability due to the direct effect of heat and the liberation of vasoactive mediators increase pulmonary vascular resistance during the immediate postburn period elevated thyronine(T3) and thyroxine (T4) levels elevated (IL-6) level decreased immunoglobulin G (igG) level C 84- a 45 year old man weighing 70 kg sustains second and third degree burns to 5% of the TBSA with inhalation injury. Resuscitation is initiated according to the parkland formula. Which of the following best represents the initial intravenous fluid rate for this patient? 437.5 ml/hr 625 ml/hr 875 ml/hr

732 ml/hr 1000 ml/hr C 85- a young adult had partial hepatectomy for severe injury. During surgery, he was transfused with twelve units of packed red blood cells. In the recovery room, he was noted be bleeding from the surgical incision and IV puncture sites. The most likely cause of this bleeding is: Secondary to partial hepatectomy Unknown primary bleeding disorder Hypercalcemia Hypocalcemia Secondary to dilutional thrombocytopenia and deficiency of clotting factors E 86- the most Important aspect in treating DIC is A. B. C. D. E. C

Administer heparin Administer platelets Treat the underlying disease Achieve normal level of fibrinogen Transfuse with fresh frozen plasma and ryoprecipitate

87- meniscal tears usually result from which of the following circumstances? A. Hyperextension B. Flexion and rotation C. Simple hyperflexion D. Compression E. Femoral condylar fracture B 88- which of the following statements regarding compartment syndromes following orthopedic injuries is true? A. The first sign is loss of pulse in the extremity B. Passive flexion of the extremity proximal to the involved compartment will aggravate the pain C. Surgical decompression (fasciotomy) is necessary only as a last resort D. These syndromes are most commonly associated with supracondylar fracture of humerus and tibial shaft E. The syndrome is often painless D 89- complications of hypospadias include all of the following except A. Urethrocutaneous fistula B. Meatal stenosis C. Retrograde ejaculation D. Urethral diverticulum E. Residual penile curvature

C 90- the most significant prognostic factor for soft tissue sarcoma is A. Site B. Size C. Grade of malignancy D. Cell type E. Tissue origin C 91- stored blood is deficient in A. Factor ii B. Factor vii C. Factor viii D. Factor ix E. Factor xi C 92- Succinylcholine is contraindicated for: (a) patients with hepatitis (b) emergency intubation of burn victims (c) celiotomy 2 weeks after spinal cord injury (d) parotidectomy (e) thyroidectomy C 93- A patient with head injury opens his eyes and withdraws his arm to pain. He is making incomprehensible sounds. His Glasgow Coma Scale score is: (a) 3 (b) 4 (c) 8 (d) 6 (e) 5 C 94- During CO2 pneumoperitoneum: (a) the mean arterial pressure increases (b) the mean arterial pressure decreases (c) the systemic vascular resistance increases (d) the systemic vascular resistance decreases (e) the cardiac output increases C 95- Tissue loss almost always results from ligation of the: (a) popliteal artery (b) common femoral artery (c) superficial femoral artery (d) brachial artery (e) portal vein A 96- A middle-aged woman is admitted unconscious to the Emergency Department following a head injury in a car accident. There is bruising over the upper abdomen. Blood pressure is 80 mm Hg systolic, pulse 120/minute. What is the most important initial step in the management of this patient?

Immediate laparotomy Perform emergency burrholes X-ray (three views) of abdomen Diagnostic peritoneal lavage Check airway breathing and circulation

E 97- A 54-year-old man presents with extreme pain and swelling of the left middle finger. Four days earlier, he suffered a small puncture wound to the volar aspect of the finger at the level of the distal flexor crease. Passive extension of the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints severely aggravates his symptoms. Which one of the following is the most likely diagnosis? Mid-palmar space infection Septic tenosynovitis Cellulitis Septic arthritis distal interphalangeal (DIP) joint Pulp space infection

B 98- a patient has a blood pressure of 70/50 and serum lactate level of 30mg/100 ml his cardiac output is 1.9 l/min and his central venous pressure is 2 cmh2o the most likely diagnosis is A. Congestive heart failure B. Cardiac tamponade C. Pulmonary embolus D. Hypovolemic shock E. Septic shock D 99- after a major trauma all of the following hormones increase except A. Cortisol B. ACTH C. Glucagons D. Thyroxine E. Arginine vasopressin D 100- the best way to determine the effectiveness of pulmonary ventilation preoperatively is by

A. B. C. D. E. A?

Arterial blood gas analysis Serial spirometry PH determination Expired lung Pco2 Pulmonary dead space

101- The etiologic factor implicated in the development of pulmonary insufficiency following major nonthoracic trauma is a. Aspiration b. Atelectasis c. Fat embolism syndrome d. Fluid overload e. Pneumonia C 102. the most common bacterial infection in spleenectomized patient is A. streptococcus pneumonia B. staphylococcus C. H.influenza A 103. the phase that is resistant to radiation is A. G0 B. G1 C. G2 D. (S)phase E. (M) phase D 104. regarding wound healing except radiation promote wound healing 105. ventral bud of pancreas develop to form A. Unicinate process B. Superior part of head C. Neck D. Body A

106. which statement is true unicinate process pass behind 3rd portion of duodenum? 107. regarding C.difficile: indication of colectomy in patients not respond to medical therapy and develop toxic megacolon 108.according to brain abscess : forms are acute, subacute and chronic? 109.regarding brain metastasis : breast is the second most common cause 110. changes in patient with nasogastric tube is : metabolic alkalosis 111. facial fracture with diplopia is due to fracture of temporal bone maxilla zygomatic arch ethmoid C 112. Vitamin K deficiency the factors affected are : ii,vii,ix,x 113.patient develop a large solid neck hematoma postthyroidectomy is due to : failure of hemostasis 114. renal cell carcinoma prognosis depend on :Staging 115.IgA transferred by the process of pinocytosis transcytosis primary active transport secondary active transport

B 116.quadratus femoris supplied by: sacral plexus nerve 117.regarding compartment syndrome: most commonly occur after supracondylar fracture of humerus and tibial fracture 118.which of the following regarding cerebral edema caused by head injury is more accurate A. Cerebral edema caused by head injury is vasogenic and nontoxic in origin B. Steroids are useful for the treatment of head trauma C. Hypercapnia induces cerebral vasoconstriction and is useful for decreasing blood volume D. Within 2-3 days after injury maximal cerebral edema has already formed so further monitoring is unnecessary if the patient is clinically stable D 119. all are true regarding epidural analgesia except: it has sedative effect? 120.a surgeon open the suture postoperatively and remove it the cells found on it are:monocyte? 121. a patient has a fever and cough and night sweating not respond to antibiotics it found to have TB the cells responsible are : plasma cells 122. aneuploidy means: abnormal number of chromosomes 123. the characteristic of malignant cells is: invasion 124. Staphylococcus epidermidis:

a. is coagulase positive b. on microscopy are Gram positive cocci in chains c. are usually sensitive to penicillin d. grown in blood cultures are due to contamination and should be ignored e. are destroyed by povodine iodine E 125. The following are true about disinfectants that can be used effectively for skin: a. glutaraldehyde b. ethyl alcohol with povidone-iodine c. ethylene oxide d. chloramphenicol drops B 126. cefuroxime mechanism : inhibit cell wall synthesis 127.amekacin mechanism: inhibit ribosomal RNA 128. Bacteria spores: a. are sensitive to antibiotics b. allow the bacteria to multiple in adverse condition c. are usually formed by Gram-negative bacteria d. can be identified with Gram stains except. e. are killed by temperature of 1200 for 20 minutes. E 129. The following are true about Clostridium tetani: a. it is a Gram positive bacilli with terminal spore b. tetanus can occur weeks after the initial infection c. the symptoms of tetanus is produced by an exotoxin d. tetanus antitoxin is ineffective when the toxin enters the nervous tissue e. gas gangrene can result from Clostridium tetani infection E 130. The following are true about hepatitis B: a. it is a RNA virus

b. immunity can be acquired by vaccination with a live attenuated virus c. persistent presence of HBsAg increases the risk of acute liver disease d. the average incubation period is 30 days e. the presence of antibody to hepatitis B surface antigen is a reliable indicator of non-infectivity E 131.cytokeratin appears in melanoma 132. the best indicator to determine the condition of the patient and surgical intervention: history 133. alternate involuntary continuous rhythmic muscular contraction and relaxation in rapid succession is called A. Hypertonia B. Hypotonia C. Clonus C 134.platelet disorder will affect : A. bleeding time B. clotting time C. PT D. APTT A 135. correct about corticosteroids : bind to the cell membrane 136.according to parotid gland is true: it is bilobed deep and superficial and facial nerve pass between them? 137.patient prepared for liver transplantation what is the risk that will delay the operation : alcohol intake for 3 months 138.most risk factor of operation is :COPD 139.estrogen in females primarily produced by : granulose cells 140. confirm pulmonary embolism by V/Q scan 141. treatment of MRSA is: macrolids 142. not transmitted by blood transfusion A. Hepatitis A B. Hepatitis B C. Hepatitis C D. HIV E. Malaria A 143. a patient transfused with infected blood with hepatitis B, it will manifest : 6months or later 144. carcinoid hypertensive crisis best treated with : octreotide 145. hyperkalemia :wide QRS 146: best to be given in burn is: crystalloid 147. the best fluid to be given to the burn patient within 48 hours is :crystalloid 148. all rae true except : lumbar puncture is contraindicated in subarachnoid hemorrhage 149. inflammatory is : IL-10

150. confirm inhalation burn: carbonaceous sputum 151. In keloid: increase epidermoid growth factor 152:asbestos: increase thoracic mesothelioma 153: (pepsinogen) is released by the: chief cells 154: routin renal function test are: serum urea and serum creatinine 155:Which of the following statements regarding compartment syndromes following orthopedic injuries is true?

a. The first sign is usually loss of pulse in the extremity b. Passive flexion of the extremity proximal to the involved compartment will aggravate the pain c. Surgical decompression (fasciectomy) is necessary only as a last resort d. These syndromes are most commonly associated with supracondylar fractures of the humerus and tibial shaft e. The syndrome is often painless

D 156: a 6 year old boy is brought into the emergency …. Perths disease (Q446 pretest 13) 157: drug that should not be discontinued abruptly Cimetidine Clonidine Amiodarone Digoxin B 158: drug that not cause ototoxicity : A. Ethacrynic acid B. Gentamicin C. Frusemide D. Cefuroxime E. Streptomycin D 159: decrease risk of aspiration pneumonia by give metoclopromide 160: good wound healing in open wound : depend on vascularity of the edges 161: patient cant move peripheries after administration of drug: vasogenic shock? 162: most common site of pathologic fracture of femur iS subtrochanteric 163: regarding pethidine except A. Causes more myosis than morphine B. It metabolized to active substances with analgesic properties C. Has a longer duration than morphine D. Possesses atropine like activity E. Has some local anaesthetic activity C 164: In the fetal circulation:

a)The oxygen dissociation curve of fetal haemoglobin is shifted to the right compared with adult haemoglobin ensuring oxygen delivery to the fetus despite low oxygen partial pressures

b)It is the presence of the ductus arteriosus and large pulmonary vascular resistance which ensures most of the right ventricular output passes into the aorta c)The patency of the ductus arteriosus is maintained by high oxygen tensions d)The patency of the ductus arteriosus is maintained by the vasodilating effects of prostaglandin G2 e)2,3 DPG levels are higher in fetal haemoglobin compared with adult haemaglobin

B 165 sever gram negative infection tachycardia hypotension delirium 166: the strongest buffer system in the body is : renal 167: amino acid initiate salivary gland production: glutamate ? 168: fasciotomy most common injured superficial peroneal ? 169: post pancreatic cyst aspiration respiratory insufficiency due to : atelectasis 170: hydrocele : between visceral and peritoneal layers of tunica vaginalis 171 part of anatomical oral cavity soft palate posterior tongue anterior tongue retromolar trigone D? 172 : lidocaine can cause except A. Sedation B. convulsions C. slowed a-v conduction D. prolongation of cardiac action potential E. shortening of the refractory phase D