Surgery Multiple Choice Questions

Exam 1: Year unknown

1.

Varicose veins of the lower limbs

a. May require ligation of the femoral vain
b. May be made worse by pregnancy
c. May be injected with 3% phenol in almond oil
d. Predispose to deep venous thrombosis
e. Usually cause ulcers in the toes

2.

Occlusive disease of the aortic bifurcation causes:

a. Bilateral calf claudication
b. Buttock claudication
c. Bleeding per rectum
d. Priapism

3.

Malignant tumors of the testis:

a. Most commonly occur before the age of 40
b. Are usually radio resistant
c. Abdominal scan is of value in staging tumour
d. A patient with metastases is incurable

4.

Crohns disease:
a. Is found more frequently in small than in large intestine
b. Is usually cured by surgery
c. Granuloma rarely found on histological examination
d. Mucosal rather than transmural involvement usual

5.

In Ulcerative Colitis
a. The rectum is almost always involved
b. Pseudopolyps are premalignant lesions
c. Mucosal rather than transmural involvement usual
d. Less association with malignancy than Crohns disease

6.

In fibrocystic disease of the breast

a. Pain is often cyclical
b. Symptoms usually get worse after the premenopause
c. Green discharge from nipples suggests cancer
d. Often associated with subsequent breast cancer

7.

Pancreatic pseudocysts
a. Are developmental in origin
b. Usually arise in the lesser peritoneal sac
c. May be effectively treated by internal drainage
d. Occur following pancreatic abscess

8.

Acute protrusion of L4/L5 or L5/S1 intervertebral disc

a. Is usually associated with lumbar scoloisis
b. Causes reduction in straight leg raising
c. Commonly causes loss of knee tendon reflex
d. May be associated with sensory change at the lateral border of the foot

9.

The following are features of Horners syndrome

a. Unilateral exophthalmos
b. Atrophy of the muscles of the hand
c. Meiosis
d. Loss of sweating on one side of the face

10.

Fracture sites that are known to be slow in healing and often lead to non-union
a. Proximal humerus
b. Pertrochanteric fracture of the femur
c. Intrascapular fracture of the femur
d. Junction of middle and distal third of the tibia

11.

Acute intestinal obstruction

a. Is most commonly due to strangulated femoral hernia
b. Generally involves the small intestine
c. Pain and vomiting are usually early presenting symptoms
d. Supine abdominal X-ray may show air/fluid levels

12.

Acute cholecystitis
a. Is always related to the presence of gallstones
b. Is sometimes associated with jaundice
c. Ultrasound is more useful than oral cholecystogram during an acute attack
d. May be treated by cholecystectomy within the first week.

DANIELLE
EXAM 2:
Final Medical SY 6000 Surgery exam, Summer 2004
1.
Fluid and electrolyte balance:
a. Insulin and glucose infusion may be used to treat hyperkalemia> 6.5 mg/L
b. Short gut Syndrome does not predispose to carcinoma
c. Patients on IV fluids require 1 mmol/kg body weight of potassium per day
d. Hyponatremia should be corrected by large volumes of hypertonic saline
e. Vomiting due to gastric outlet obstruction causes hypochloremia,
hypokalemia and metabolic alkalosis
2.

Regarding sinuses and fistulae

a. High output fistulae are characterized by loss of intestinal fluid in excess
of 200 mL/24 hours
b. Pilonidal sinus is premalignant
c. An example of a congenital fistula is a thyroglossal fistula
d. Inefficient or non-dependent drainage is one of the factors leading to
persistence of a sinus
e. A chronic subareolar abscess can lead to a mammary fistula

3.

Regarding thyroid and parathyroid neoplasms

a. Follicular carcinoma of thyroid primarily spreads through lymphatics
b. Parathyroid adenoma is the most likely cause of primary
hyperparathyroidism
c. Huerthle cell carcinoma is a variant of papillary carcinoma of the thyroid
d. Phaeochromocytoma is detected by measuring urinary 5-HIAA levels
e. Superior laryngeal nerve supplies cricothyroid muscle

4.

Regarding lesions of the breast

a. A breast lesion is >5 cm in dimension
b. Tamoxifen should be prescribed for life to patients with breast cancer
c. Axillary lymph node involvement is a weak predictor of outcome
d. Comedo DCIS is associated with lower recurrence rate
e. Breast cancer metastasizes to lung more commonly than bone

5.

Abdominal Aortic Aneurysms (AAA)

a. Surgery is recommended for patients with AAA size > 6 cms
b. 90% arise below renal arteries
c. Ischemia of the colon is a peri-operative risk
d. Mortality rate of ruptured AAA is 25%
e. Blue toe syndrome occurs in association with AAA

6.

T/F:
a. Carotid atheromatous disease is the commonest cause of strokes in the
western world
b. Varicose veins are treated by femoral-popliteal bypass graft
c. Chest pain is relieved by elevation of the foot
d. Diabetic patient presenting with an ischemic foot may have an Ankle
Brachial Pressure Index of 0.8
e. Cervical rib may present with wasting of the thenar muscles

7.

Regarding colorectal cancer

a. hereditary non-polyposis colorectal cancer is autosomal dominant
b. Colorectal cancers develop before 40 years of age in familial adenomatous
polyposis (FAP)
c. Polyps in Peutz Jeghers Syndrome are hyperplastic
d. The Familial Adenomatous Polyposis gene is on the short arm of
chromosome 5.
e. Hereditary nonpolyposis colorectal cancer accounts for 5% of colorectal
cancer cases.

8.

Hernias
a. Direct inguinal hernias pass through the internal ring
b. A femoral hernia is the most common hernia in females
c. Testicular atrophy may occur after inguinal hernia repair
d. Inguinal hernias in children are treated by herniorraphy
e. Open appendicectomy is associated with an increased incidence of right
sided indirect inguinal hernia

9.

Pancreatitis
a. Cholelithiasis is the commonest cause
b. Cullens sign is associated with bruising in flanks
c. Steroids are not associated with acute pancreatitis
d. The treatment of sterile necrotizing pancreatitis in necrosectomy
e. A pseudocyst should be drained within 2 weeks of the acute attack

10.

Gallstones
a. Ascending cholangitis requires emergency decompression of the Common
Bile Duct
b. Choledochal cysts are associated with malignancy
c. The five year survival rate of adenocarcinoma of gallbladder is less than
5%
d. Magnetic Resonance Cholangiography gives an accurate picture of the
biliary tree
e. Gallstones can be dissolved by chenodoxycholic acid

11.

Diverticular disease
a. Bleeding from diverticular disease is characteristically plum colored
b. The treatment of diverticular disease is oral steroids
c. May arise in the rectum
d. Is best treated with a low residue diet
e. May present with Urinary Tract Infection

12.

Orthopedics
a. Smiths fracture results in volar angulation of the radius
b. A fractured neck of femur results in external rotation of the lower limb
c. The radial nerve is often injured in fracture of the neck of humerus
d. Bennetts fracture involves distal end of radius
e. Supracondylar fracture of humerus may cause vascular complications

13.

Trauma/Cardiothoracic
a. In the initial management of the injured patient, control of hemorrhage
should be the priority
b. Right diaphragmatic rupture is more common than left
c. Fracture of left lower ribs may be associated with ruptured spleen
d. A flail chest is commonly associated with Acquired Respiratory Distress
Syndrome
e. Tension pneumothorax is diagnosed on chest X-ray

14.

Urology
a. In suspected torsion of the testis, ultrasound may be of value
b. Unilateral orchidopexy is the treatment of choice for torsion of the testis
c. Varicocele is more common on the right side
d. Varicocele is associated with oligospermia
e. Uric acid calculi are the most common types of renal calculi

15.

Pleomorphic salivary adenoma

a. Presents as a slowly growing painless lump
b. Can present with facial nerve weakness
c. Treatment includes radiotherapy
d. Sentinel lymph node mapping is recommended
e. The minimum operation is a superficial parotidectomy

16.

Melanoma
a. Ulceration of the primary lesion is associated with worsening of prognosis
b. A brisk tumor infiltrating lymphocyte response is associated with worse
prognosis
c. Clarks level III implies invasion of the reticular dermis
d. Suspicious lesions should be evaluated by initial incision biopsy

e. Sentinel lymph node mapping should be considered for lesions of

intermediate depth (1-4 mm)
17.

Nerve injuries/Hand
a. Flexor tendons require at least 6 weeks of immobilization for adequate
healing and strength
b. A compound fracture of metacarpal, sustained while punching an
opponent in teeth, should be treated with antibiotics
c. Tinels sign is useful in monitoring progress following nerve repair
d. Ulnar nerve entrapment is more common at elbow than wrist
e. Normal sensation over the thenar eminence is consistent with carpal tunnel
syndrome

18.

In head injury patients

a. Patients with acute subdural hematoma present with a lucid interval
b. The lowest Glasgow Coma score possible is 3
c. Skull fracture is a risk factor for extradural hematoma
d. In a patient with decreased level of consciousness, skull X-ray is the
investigation of choice
e. Normal intracranial pressure ranges between 10-30 mm Hg

19.

Delayed recovery of consciousness following general anesthesia may be caused

by
a. Intra-operative hypoxia
b. Carbon dioxide narcosis
c. Opioid premedication
d. Residual neuromuscular blockade
e. Hyperventilation
20. Factors which increase the likelihood of aspiration of gastric content at the
induction of anaethesia
a. Increasing age
b. Anxiety
c. Chronic Obstructive Pulmonary Disease
d. Major Trauma
e. Pregnancy

EXAM 3
Final Medical Surgical MCQ March, 1999
1.
The following associations are true:
a. Galen (AD 131-200)
:
A Greek
b. Andreas Vesalius (1514-1564) :
De Humanis Corporis Fabrica
c. Benjamin Alcock (1849)
:
Professor of Anatomy, Cork
d. Ignaz Semmelweiss (1818-1865) :
Postpuerpal sepsis
e. Abraham Colles (1773-1843) :
Orthopedic Surgeon, Cork
2.

Regarding Hypertrophic pyloric stenosis

a.
There is a predominance of males 4:1 (M:F)
b.
Stenosis occurs 4-6 weeks after birth
c.
Characteristically presents with blood stained projectile vomiting
d.
0.45% saline solution is the resuscitation fluid of choice
e.
Hypokalemic hypochloremic metabolic acidosis chracterises the
metabolic disturbance

3.

Patients presenting with acute pancreatitis

a.
Hyperparathyroidism may be the underlying aetiology
b.
Onset of acute pancreatitis is associated with tetracycline therapy
c.
A normal serum amylase occurs in up to 30% of cases
d.
Characteristically have associated steatorrhea
e.
60% of cases have detectable choledocholithiasis

4.

Regarding melanoma
a.
Juvenile melanoma (Spitz naevus) is a benign condition
b.
Breslow staging of <0.75mm has predicted 5 year survival of 95-100%
c.
Acral lentiginous melanoma is the rarest form of melanoma
d.
Overall males have a better prognosis
e.
Locoregional radiotherapy confers a significant survival benefit

5.

Risk factors for the development of colorectal carcinoma include:

a.
Chronic ulcerative colitis
b.
Peutz-Jeghers syndrome
c.
Gardners syndrome
d.
Juvenile polyps
e.
Previous cholecystectomy

6.

The natural history of colonic polyps

a.
The majority are premalignant
b.
Overall villous adenomatous polyps have a poorer prognosis than
tubular polyps
c.
There is a higher incidence of rectosigmoid lesions than ascending
colonic lesions
d.
85% of adenomatous polyps are tubular in nature
e.
Hereditary polyposis coli is associated with duodenal and gastric
polyps

7.

Features of Charcots triad and Reynolds pentad include

a.
Right upper quadrant pain
b.
A palpable gall bladder
c.
Pyrexia
d.
Rigors
e.
Shock

8.

In Inflammatory bowel disease secondary to Crohns Disease

a.
The rectum is usually involved
b.
Granuloma formation is characteristic
c.
There is a male predominance (M:F of 2:1)
d.
Restorative proctocolectomy potentially offers surgical cure for the
disease
e.
Fistula tract formation is more suggestive of ulcerative colitis

9.

Toxic megacolon
a.
Is unique to ulcerative colitis
b.
Colonic perforation carries mortality of 50%
c.
Is best treated with high dose corticosteroids for at least 72 hours
d.
A gastrograffin enema may be diagnostic
e.
Occurs in 10% IBD patients

10.

Regarding herniae
a.
The most common hernia in females in femoral
b.
Femoral herniae are classically located below and medial to the pubic
tubercle
c.
Herniorrhaphy invariably necessitates herniotomy
d.
Inguinal hernia nearly always are congenital in origin
e.
An indirect inguinal hernia will protrude through Hasselbachs triangle

11.

The following are features of hyperparathyroidism

a.
Osteoporosis
b.
Polydipsia and polyuria
c.
A technetium-99m sestamibi isotope scan would be unhelpful
d.
Primary hyperparathyroidism is secondary to adenoma in >90% cases
e.
A positive Chvosteks sign is evident in 30% of cases

12.

Recognized abdominal surgical incisions include

a.
A Kochers incision
b.
A Commando incision
c.
A Battles incision
d.
A Gridiron incision
e.
A Mercedes Benz incision

13.

Thyroid neoplasia exhibits the following features

a.
Follicular thyroid carcinoma is the most common type
b.
When associated with MEN IIa, are medullary in origin
c.
Papillary thyroid carcinoma is often multifocal
d.
Hematogenous spread is a feature of follicular thyroid carcinoma
e.
Thyroid lymphoma is strongly associated with Hashimotos Disease

14.

In patients with gastro-oesophageal reflux disease (GORD)

a.
The treatment is largely medical
b.
A hiatus hernia is found in over 70% cases
c.
The Belsey Mark IV procedure alleviates the symptoms
d.
A Nissen Fundoplication is the operation of choice
e.
The use of the Demeester scoring system is appropriate

15.

The following conditions are premalignant for oesophageal neoplasia

a.
Tylosis
b.
Plummer-Vinson Syndrome
c.
Barrets oesophagus
d.
Achalasia
e.
Scleroderma

16.

Regarding intestinal obstruction necessitating inpatient management

a.
Large bowel obstruction is most commonly caused by neoplasia
b.
Small bowel obstruction is most commonly caused by incarcerated
herniae
c.
Ogilvies syndrome is a reflection of an underlying mechanical
obstruction
d.
A caecal volvulus is more common than a sigmoid volvulus
e.
A birds beak deformity on barium enema is characteristic of a
sigmoid volvulus

17.

The following occur in Leriche syndrome

a.
Clubbing
b.
Claudication
c.
Lower extremity muscle wasting
d.
Impotence
e.
Paradoxically high ankle brachial indiced (ABIs)

18.

In the management of burns:

a.
A splenectomy is indicated in Class I and II splenic injuries
b.
Kehrs sign may be found in patients with splenic injury
c.
An 80kg male with 20% burn surface area will require over 6L fluid in
the first 24 hours of resuscitation.
d.
A liter of Hartmanns solution contains 130 mmol sodium
e.
A Hartmanns solution is a crystalloid isotonic solution

19.

The following are true:

a.
Volar angulation is a feature of the Smiths fracture
b.
A Bennett fracture is an intrarticular fracture
c.
A Colles fracture results in radial deviation
d.
A dinner fork deformity is characteristically found in Colles fracture
e.
The Lachman manoeuvre is useful in anterior shoulder dislocation

20.

Criteria for the diagnosis of the Systemic Inflammatory Response Syndrome

(SIRS) include
a.
A wcc < 4/mm3
b.
A temperature greater than 380C or rectal temperature <360C
c.
A heart rate greater than 90 bpm
d.
One positive blood culture
e.
The presence of >10% immature bands forms on a full blood count

CARMEL
EXAM 4 : Unknown year, unknown college
First two questions missing
3.

Trauma
a. Pneumothorax can be temporarily treated by inserting a 16 gauge cannula in
the second intercostal space of the same side
b. Fracture of the posterior cranial fossa is associated with Battles sign
c. Ultrasound is the gold standard in the diagnosis of rupture of the thoracic
aorta
d. A flail chest is associated with pericardial effusion
e. Coronary air embolisation is an unusual consequence of injury to the lung
parenchyma

4.

Pharyngeal pouch
a. It is a pulsion diverticulum arising from Killians dehiscence
b. It appears as a swelling in the anterior triangle of the neck
c. Presents as halitosis, regurgitation of food and dysphagia
d. Is a congenital diverticulum
e. Arises withing the superior pharyngeal constrictor muscle

5.

Carcinoma of the breast

a. LCIS is more common than DCIS
b. T2 lesions measure >5 cm in size
c. Inflammatory breast cancer presents as erythema, warmth and edema of the
involved breast
d. Follow up of breast cancer involves measuring serum levels of Ca 19-9
e. Treatment of locally advanced breast cancer is mastectomy

6.

Nipple discharge
a. Bloody nipple discharge is due to fibrocystic disease
b. Serous discharge is due to duct papilloma in about of cases
c. Chromophobe adenoma is a microadenoma
d. Phenothiazines cause serous discharge
e. Treatment of bloody nipple discharge is microdochotomy

7.

Thyroid gland
a. Graves disease is common in females
b. Subacute (DeQuervains) thyroiditis is an autoimmune disease
c. Papillary carcinoma, secondary to radiation, is multifocal
d. Men IIA comprises medullary carcinoma, phaeochromocytoma(s) and
parathyroid hyperplasia
e. Medullary carcinoma is treated by total thyroidectomy and central neck
dissection

8.

Regarding chronic peptic ulcers

a. Type I ulcers occurs along the lesser curvature of the stomach
b. Type III ulcers occur at or just proximal to the pylorus
c. Peptic ulcers that bleed erode the right gastric artery
d. Gastrojujenocolic fistula occurs after gastrectomy and Billroth II anastomosis
e. Post gastrectomy cancer is associated

9.

Crohns Disease
a. Is predominantly a transmural disease
b. Characteristic microscopic lesions are noncaseating granulomas
c. Bloody diarrhea is the most frequent presentation
d. Peri-anal disease is an infrequent presentation
e. Toxic dilatation of the colon is a common finding

10.

Carcinoid tumour
a. The most common location of a carcinoid tumour is the terminal ileum
b. Appendiceal carcinoids frequently metastasise
c. Urinary 5-HIAA is the most reliable test to confirm the diagnosis of carcinoid
tumour
d. Octreotide can successfully control the symptoms of diarrhea and flushing
e. 5-HIAA is a metabolite of tyrosine

11.

Appendicitis
a. The commonest location of the appendix is in the pelvis
b. Psoas sign is elicited by flexion of the right hip
c. Is associated with a fecolith in 90% cases
d. Laparoscopic appendicectomy has been shown to be superior to open
appendicectomy for acute appendicitis
e. Rovsigns sign is elicited by pressing in the left iliac fossa causing pain in the
right iliac fossa

12.

Colorectal cancer
a. Adenomatous polyps account for more than 90% colorectal cancers
b. High fibre diet, calcium and selenium have a cytoprotective effect
c. Colonic cancer is part of Lynch II Syndrome
d. FAP is inherited as an autosomal recessive pattern
e. HPNCC is autosomal dominant

13.

Cholelithiasis
a. Biliary colic occurs only with stones in the common bile duct
b. Merrizis syndrome is associated with cholestatic jaundice
c. Charcots triad includes jaundice, rigors and palpable gallbladder
d. Chenodeoxycholic and ursodeoxycholic acid are used for dissolution of
cholesterol stones

14.

e. For symptomatic cholelithiasis laparoscopic cholecystectomy is the operation of

choice
Pancreatitis
a. Foxs sign is discoloration of groins
b. Alcohol is an aetiological factor for the development of acute pancreatitis
c. A Ransons criteria of 7-8 is associated with mortality of 50%
d. Steatorrhea is associated with acute pancreatitis
e. A chain of lake appearance is pathognomonic of chronic pancreatitis

15.

Vascular
a. The mortality rate of ruptured AAA isa 40%
b. Ultrasound can reliably meaure the size and site of AAA
c. Ruptured AAA may present as pain in the renal angle
d. Surgery is recommended for patients with AAA > 6cm diameter
e. Spinal cord ischemia is an infrequent complication

16.

Peripheral vascular disease

a. Normal ankle-brachial ratio is <0.75
b. Thromboendarterectomy is the operation of choice for aortoiliac occlusive
disease
c. Rest pain is relieved by elevation of the foot
d. Impotence is a common phenomenon associated with occlusive disease of the
distal aorta and iliac vessels
e. Sympathectomy provides good symptomatic relief of rest pain

17.

Paediatric surgery
a. Hirschprungs disease is caused by absence of ganglion cells in the Auerbachs
plexus
b. High imperforate anus is treated by colostomy followed by sacroperineal or
abdominosacral pull through of the proximal colon
c. Congenital hypertrophic pyloric stenosis is common in female infants
d. Meckels Diverticulum is best diagnosed by 99m Technetium scan
e. Idiopathic intussussception occurs in a 6 to 9 month old infant

18.

Orthopedics
a. Colles fracture results a fall on an outstretched hand with the wrist in flexion
b. Fractured ribs invariably cause a pneumothorax
c. The leg is externally rotated in fracture of neck of femur
d. Fracture of the humeral shaft may cause injury to the radial nerve
e. Fat embolism following multiple fractures is associated with petichial skin rash

19.

Urology
a. The majority of bladder tumours are squamous cell carcinomas
b. Renal cell carcinoma is always treated with adjuvant chemotherapy
c. The most common urinary calculi are triple phosphate stones
d. Testicular tumours commonly metastasize to the groin lymph nodes

e. Fracture of the bony pelvis leads to injury to the membranous urethra

20.

Skin cancer
a. Kaposis Sarcoma is a tumour of vascular endothelial origin
b. Xeroderma Pigmentosa is an autosomal recessive disease
c. Sunlight exposure is the principle cause of basal cell carcinoma and squamous
cell carcinoma
d. Superficial spreading melanoma has the worst prognosis
e. Squamous cell carcinoma is not sensitive to radiotherapy

DAVID RYAN
EXAM 5: Unknown year, UCC.
1. Regarding Gastric Surgery
a. Early postprandial dumping is due to hypoglycemia
b. Recurrent ulcers after treatment of duodenal ulcer are secondary to excessive acid
production
c. Patients may develop a diamorphic blood picture
d. Blind loop syndrome is common in antecolic anastomosis
Cant read e
2. Gastrointestinal polyposis syndrome
a. Hereditary nonpolyposis colorectal cancer is autosomal dominant
b. Colorectal cancers develop before 40 years of age in familial adenomatous
polyposis (FAP)
c. Polyps in Peutz-Jeghers Syndrome are hyperplastic
d. Turcotts syndrome is gastrointestinal polyps with CNS tumors
e. Hereditary nonpolyposis colorectal cancer accounts for <5% of cases
3. Salivary glands
a. Pleomorphic adenoma is the most common benign tumour of the submandibular
gland
b. Mikulics Syndrome refers to the bilateral enlargement of lacrimal and salivary
glands
c. Sialothiasis is almost exclusively a problem of the submandibular gland
d. Incisional biopsy is performed in all salivary gland tumours
e. Lingual nerve can be damaged in surgery on submandibular gland
4. Hernias
a. Direct inguinal hernias pass through internal ring
b. A femoral hernia is the most common hernia in females
c. Testicular atrophy may occur after inguinal hernia repair
d. Inguinal hernias in children are treated by hernoraphy
e. Littres hernia contains Meckels diverticulum
5. Abdominal Aortic Aneurysms
a. Surgery is recommended for patients with AAA size > 6 cms
b. 90% arise below renal arteries
c. Ischemia of colon is common
d. Mortality rate of ruptured AAA is 25%
e. Blue toe syndrome occurs in association with AAA

6. Vascular
a. Carotid atheromatous disease is the commonest cause of strokes in the western
world
b. Varicose veins are treated by femoral-popliteal bypass graft
c. Rest pain is relieved by elevation of the foot
d. Normal ABI is greater than 0.90
e. Cervical rib may present with wasting of thenar muscles
7. Orthopedics
a. Smiths fracture results in volar angulation of the radius
b. A fractured neck of femur results in lateral rotation of the lower limbs
c. The radial nerve is injured in fracture of neck and humerus
d. Bennetts fracture involves distal end of radius
e. Supracondylar fracture may cause vascular complications
8. Fluid and electrolyte balance
a. Insulin and glucose infusion may be used to treat hyperkalemia >6.5 mg/L
b. Short gut syndrome doesnt predispose to carcinoma
c. Patients on IV fluids require 1mmol/kg body potassium per day
d. Hyponatremia should be corrected by large volumes of hypertonic saline
e. Adult burns victims require 2L fluid in 24 hours
9. Regarding sinuses and fistulas
a. High output fistulas are characterized by loss of intestinal fluid in excess of 200
mL/24 hours
b. Pilonidal sinus is premalignant
c. An example of congenital fistula is thyroglossal fistula
d. Inefficient on nondependent drainage is one of the factors leading to persistence
of a sinus
e. A chronic subareolar abscess leads to a mammillary fistula
10. Carcinoma of the breast
a. T3 breast lesion is >5 cm in dimension
b. Tamoxifen should be prescribed for life to patients with breast cancer
c. Axillary lymph node involvement is a weak predictor of outcome
d. Comedo DCIS is associated with low recurrence rate
e. Breast cancer rarely metastasizes to bone
11. Pancreatitis
a. Cholelithiasis is the commonest cause
b. Cullens sign is associated with bruising in flanks
c. Steroids are not associated with acute pancreatitis
d. The treatment of sterile necrotizing pancreatitis is always surgery
e. A pseudocyst should be drained within 2 weeks of the acute attack

12. Gallstones
a. Ascending cholangitis requires emergency decompression of the CBD
b. Choledochal cysts are associated with malignancy
c. The five year survival rate of adenocarcinoma of GB is less than 5%
d. Magnetic resonance cholangiogram gives accurate picture of biliary tree
e. Gallstones can be dissolved by ursodeoxycholic acid
13. Meckles diverticulum
a. Is found in 2% of the population
b. Is a true diverticulum
c. Contains ectopic tissue in 50% cases
d. Is a remnant of vitello-intestinal duct
e. May mimic as acute appendicitis
14. Trauma
a. In the initial management of the injured patient, control of hemorrhage should be
the priority
b. Right diaphragmatic rupture is more common than left
c. Fracture of left lower ribs may be associated with rupture of the spleen
d. A flail chest is commonly associated with ARDS
e. Liver or splenic injuries always require operative intervention
15. Thoracic/Neurosurgery
a. A chest drain is usually inserted in the 4th/5th intercostal space in the mid-axillary
line
b. Thorascopic sympathectomy is the treatment of hyperhydrosis of the feet
c. CT scan of the brain is indicated in depressed skull fracture
d. A GCS < 8 is an indication for endotracheal intubation
e. Tension pneumothorax is diagnosed on chest X-ray
16. Endocrine
a. Follicular carcinoma of thyroid primarily spreads through lymphatics
b. Parathyroid adenoma is the most likely cause of hyperparathyroidism
c. Hurtle cell carcinoma is a variant of papillary carcinoma of the thyroid
d. Phaeochromocytoma is associated with MEN IIa
e. Superior laryngeal nerve supplies cricothyroid muscle
17. Paediatrics
a. Hydrocele in a child <1 year old necessitates surgery
b. Pyloric stenosis presents within 10-12 weeks of life
c. Mesenteric adenitis is an uncommon cause of abdominal pain in children
d. An undescended testes may be found in the hilum of the spleen
e. Children with pyloric stenosis have hypokalemic, hyperchloremic acidosis

18. Evidence based medicine

a. Occult blood testing is a proven screening modality for colorectal carcinoma
b. Endoscopic ultrasound accurately assess rectal tumour presentation
c. Laparoscopic appendicectomy has revolutionized the treatment of acute
appendicitis
d. Sentinel lymph node biopsy is not yet a standard form of treatment for breast
carcinoma world-wide
e. Immunotherapy using interferon-alpha is of benefit in Stage III malignant
melanoma
19. The following are associated with malignancy
a. Acanthosis nigricans
b. Thrombophlebitis migrans
c. Ganglions
d. Fourniers Gangrene
e. Keratoacanthoma
20. Diverticular disease
a. The most common cause of bleeding per rectum is diverticular disease
b. The treatment of diverticular disease is oral steroids
c. Is a premalignant condition
d. Is best treated with a low residue diet
e. Surgery is indicated in more than 50% of patients with diverticular disease

EXAM 6: Unknown year, unknown location

Questions 1-6 missing
7. Carcinoma of the lung is:
a. Commonest cancer in our community
b. A tumour with 20% cure rate
c. Associated with better prognosis if oat cell in type
d. Characterised by rising incidence in females
e. Most commonly developed from alveolar epithelium
8. Brachial embolism
a. Has more favorable prognosis than popliteal aneurysm
b May be operated upon under local anesthesia
c. Is associated with mitral stenosis
d. Always leads to gangrene is not removed
e. Embelectomy should be associated with fibrinolytic therapy
9. Oophrectomy for breast cancer
a. Has now been abandones as a form of therapy
b. Is best done by irradiation of ovaries
c. Has been replaced by chemotherapy
d. May reveal ovarian metastases
e. Should be followed by estrogen therapy if done at menopause
10. In varicose veins:
a. Communicating veins penetrate the deep fascia
b. The aim of sclerosant therapy is to thrombose the veins
c. More commonly involve the left lower limb
d. Lateral leg is commoner site ulceration
e. May be familial
11. In a contaminated traumatic wound:
a. Local antibiotics are very helpful
b. Tetanus toxoid provides 100% against tetanus
c. Gas in tissues is pathognonomic of gas gangrene
d. Following debridement the wound should be closed by sutures
e. Tetanus antitoxin if indicated is preferable to human immune globulin
12. The following with tuberculous cervical adenopathy
a. Coronary involvement is usual
b. Cavitation is always present
c. The bacillus is usually of bovine origin
d. The prognosis is good
e. Antituberculous drugs are usually indicated

13. If a patient is cyanosed following tracheostomy with a cuffed tube, suspect

a. Laryngeal edema
b. Intubation of right bronchus
c. Mucus blocking tube
d. Mucus blocking bronchi
e. Displacement of tube
14. Tracheal shift to the left may be caused by
a. Right pneumothorax
b. Nodular goiter
c. Collapse of right lung
d. Left sided emphysema
e. Right pneumonectomy
15. A patient has pain over lower internal end of radius, extension and abduction of
thumb
a. This is due to a fractured lunate
b. May be caused by DeQuervains disease
c. May be due to Kohlers disease
d. May be treated by steroid injection
e. Often results from unaccustomed use hand
16. Patients with secondary thyrotoxicosis
a. Should never be treated with radioiodine
b. Tend to develop recurrent laryngeal nerve palsy
c. Have thyroid antibodies in their blood
d. Usually have a diffusely enlarge goiter
e. Generally are in the 20-40 age group
17. Circumcision is indicated in:
a. Ammenincal dermatitis
b. Non-retractile prepuce at one year
c. Prophylaxis of carcinoma of penis
d. Phimosis
e. Paraphimosis
18. In carcinoma of larynx
a. Hoarseness is a late symptom
b. Peak incidence is from 20-40 years
c. There is an association with cigarette smoking
d. There is association with occupation
e. Distant metastases occur early

19. Shoulder dislocation

a. Occurs from direct violence
b. Is not associated with any fracture
c. Commonly damages the axillary artery
d. If adequately immobilized following reduction recurrent dislocation is
prevented
e. Should be X-rayed before reduction
20. The following anaesthesic agents are inflammable
a. Nitrous oxide
b. Chloroform
c. Ether
d. Oxygen
e. Trichloroethylene
21. Ingested foreign bodies are likely to be arrested
a. At crico-pharyngeus
b. At thoracic inlet
c. At aortic arch
d. At diaphragm
e. In stomach
22. Cancer of oesophagus
a. Is associated with duodenal ulceration
b. Presents with chest pain
c. Is always a squamous cell carcinoma
d. Has a bad prognosis
e. Frequently presents with heartburn
23. Carcinoma of the stomach
a. Has a good prognosis
b. Often presents with anorexia
c. May be associated with previous gastric surgery
d. Has rarely spread to lymph glands at time of prognosis
e. Is always diagnosed by barium meal
24. Infantile pyloric stenosis
a. Presents with vomiting from birth
b. Frequently results in acidosis
c. Is readily diagnosed clinically
d. Is usually cured by surgery
e. Is associated with subsequent duodenal ulceration

25. The gastric antrum

a. Secretes acid
b. Is responsible for secretion of gastrin
c. Is responsible for production of intrinsic factor
d. Is important in the mechanism of gastric emptying
e. Is denervated by truncal vagotomy
26. Meckels diverticulum
a. Arises from the foregut
b. May cause massive gastrointestinal bleeding
c. Is associated with carcinoma of the small bowel
d. May cause intussusception
e. Is an acquired lesion
27. Crohns disease
a. Is predominantly a mucosal disease
b. Always requires surgery
c. Is associated with the development of fistulae
d. Often involves the perianal region
e. Rarely recurs following adequate surgical management
28. The terminal ileum is responsible for the absorption of:
a. Vitamin B12
b. Vitamin C
c. Bile acids
d. Fat
e. Iron
29. Ulcerative colitis:
a. Occurs predominantly in those over 50
b. Usually involves rectum
c. May be precipitated by stress
d. May result in colonic cancer
e. Always responds to steroids
30. Diverticular disease
a. Involves predominantly the sigmoid colon
b. Is pre-cancerous
c. May result in massive bleeding per rectum
d. Responds to low residue diet
e. Is more common in elderly

31. Large bowel cancers

a. Is the most common cause of large bowel obstruction
b. Is the most common cause of vesico-intestinal fistula
c. Most commonly occurs is recto-sigmoid
d. Rarely develops from colonic polyps
e. Has a bad prognosis
32. Chronic perianal disease may be secondary to:
a. colonic diverticular disease
b. Gastrointestinal tuberculosis
c. Polyposis coli
d. Carcinoma of recto-sigmoid
e. Crohns disease
33. In obstructive jaundice
a. Serum alkaline phosphatase is normal
b. Oral cholecystogram is of value
c. The gallbladder is palpable
d. There is splenomegaly
e. Vitamin K absorption is impaired
34. Nephroblastomas:
a. is radio-sensitive
b. Requires early surgery
c. Responds to chemotherapy
d. Has a good prognosis over the age of ten
e. Usually metastasizes to bone
35. Benign prostatic hyperplasia may result in:
a. Acute epididymo-orchitis
b. Bladder stone
c. Hematuria
d. Bladder diverticulum
e. Testicular atrophy