1st General Surgery Selection Exam, March 2004 (89/110)

Good luck Doctor!

1. Most important complication of transfusion of blood product

ABO incompatibility
a)
Haemostatic breakdown
b)
Hepatitis
c)
HIV
d)
Hepatitis
e)
2. Differential diagnosis of keratocanthoma
Basal Cell Carcinoma
a)
Melanoma
b)
Squamus Cell carcinoma
c)
d)
e)

3. Most important diagnostic study for imperforate anus

Barium Enema
a)
Ultrasound
b)
Plain x-ray with inverted baby
c)
d)
e)

4. Vit-K dependant factors

Factors II, IV, IX, X
a)
Factors II, IV, X, XI
b)
Factors I, II, X, IX
c)
Factors III, II, VII, X
d)
Factors V, VII, II, XII1
e)
5. GCS score indicating severe head trauma
<4
a)
6
b)
8
c)
13
d)
11
e)
6. Burn wound which is dark in color and painless
First degree
a)
Second degree
b)
Third degree
c)
Fourth degree
d)
Fifth degree
e)
7. In acute pancreatitis, 50% mortality is labeled with how many Ranson
Criteria?
1-2
a)
4-5
b)
5-6
c)
>7
d)
e)

8. Presentation of a patient with nuerogenic shock

a)
b)
c)
d)
e)

Hypotension, bradycardia, warm hands

Hypotension, tachycardia, warm hands
Hypotesion, tachycardia, cool and clammy hands
Hypertension, tachycardia, cool hands
Hypertension, Tachycardia, warm hands

9. Neurogenic shock can occur in

Hemorrhage
a)
Hypovolemia
b)
Transaction of the spinal cord
c)
Toxemia
d)
Sepsis
e)
10.The most common type of shoulder dislocation is
Anterior
a)
Posterior
b)
Inferior
c)
Superior
d)
Lateral
e)
11.In Regards to Scaphiod fractures, there is necrosis due to
There is dislocation fracture
a)
The blood supply is distal to proximal
b)
Tendons cause tension on the fractured fragments
c)
d)
e)

12.Young female presented to the ER, she has been involved in MVA, she
sustained tibial and femur fractures. Was stabilized and admitted. Then
developed sudden respirator distress, she is most likely suffering from
Fat Embolism
a)
b)
c)
d)
e)

13.Female patient suffered from femur trochanter fracture. Admitted to

hospital. 2 weeks later she complains of leg pain and swelling, on
examination the leg is swollen and calf is tender. The most important
complication that may arise in this situation is
Fat Embolism
a)
Pulmonary embolism
b)
c)
d)
e)

14.Aspirin in low doses acts by inhibition of

Thromboxine A2
a)
Clotting factor production in the liver
b)
c)
d)
e)

15.Aspirin prophylaxis post thrombotic myocardial infarction acts to

Inhibit platelet aggregation on collagen
a)
Inhibit platelet adhesion
b)

c)
d)

e)
16.Warferrin (Mechanism of action)
Inhibition of clotting factors
a)
Decrease vit-K absorption by the gut
b)
c)
d)

e)
17.Metastatic osteosclerotic bones on plan x-ray. Primary most likely to be
in
Prostate
a)
Urinary Bladder
b)
Lung
c)
Liver
d)
e)

18.Correct statement regarding the three phases of wound healing

Inflammation, epitheliazation, contracture
a)
Inflammation, fibroplasias, contracture
b)
Fibroplasia, epitheliazaion, contrature
c)
d)
e)

19.In wound healing, maximal amount of collagen occurs at

10 days
a)
21 days
b)
6 months
c)
< 1 week
d)
e)

20.In wound healing, which of the following is important to harden the

healing
Tensile
a)
Elastin
b)
Collagen
c)
d)
e)

21.Post inguinal hernia repair complication of testicular atrophy is due to

Repair of pantaloon hernia
a)
Too tight repair of internal inguinal ring
b)
c)
d)
e)

22.Major blood supply of the testis

Hypogastric artery
a)
Internal spermatic arteries
b)

c)
d)

External spermatic arteries

Pudendal arteries

e)

23.19-year-old female who is lethargic, pale and in shock, has cervical

tenderness and right pelvic mass on PV exam. Most likely diagnosis
Ovarian cyst torsion
a)
Ruptured ectopic pregnancy
b)
Perforated appendicitis with abscess
c)
d)
e)

24.Villous adenoma of the rectum

Anterior perineal resection
a)
Local excision
b)
Radiotherapy
c)
Observation with serial sigmoidooscopy
d)
e)

25.KUB was done, incidentally a gallstone was found. Your next step should
be
Lap cholecystectomy
a)
Arrange for ERCP
b)
Ultrasound
c)
Schedual for laparotomy cholecystectomy
d)
Observation
e)
26.Male patient with duodenal ulcer has been having chronic vommeting
for two weeks. What metabolic disterbance will he have?
Hypochloremic, hypokalemic metabolic acidosis
a)
Hyporchloremic, hyperkalemic metabolic acidosis
b)
Hypochloremic, hypokalemic metabolic alkalosis
c)
d)
e)

27.Duedenal ucer surgery with least risk of recurrance is

High selective vagotomy
a)
Vagotomy and pyloroplasty
b)
Vagotomy and antrectomy
c)
d)
e)

28.Best long term management of Achalesia is

Nifidipine
a)
Nitrates
b)
Hellers myotomy
c)
Funduplication
d)
e)

29.Symptoms of thyrotoxicosis
Obesity
a)
Atrial fibrillation
b)

c)
d)

Low energy level

Loss of hair at the lateral part of the eyebrows

e)

30.A women underwent uneventful vaginal delivery. 2 weeks later

developed breast periareolar pian, erythema. Likely causative organism
is
Colistredia
a)
Streptococci
b)
Staph aurues
c)
Heamophilus influenza
d)
e)

31.Major cause of cellulites is

Colistredia
a)
Streptococci
b)
Staph aurues
c)
Heamophilus influenza
d)
e)

32.Psuedomembrenous colitis, causative microorganism

Colistredia
a)
Coliforms
b)
Staph aurues
c)
d)
e)

33.Nipple Discharge
Likely to be benign if spontenous
a)
Likely to be malignant if bloody and unilateral
b)
If ductogram is normal, no need for further evaluation
c)
d)
e)

34.Most common Thyroid cancer is

Pappilary
a)
Folicular
b)
Anaplastic
c)
Medullary
d)
Adenocarcinoma
e)
35.Thyroid cancer that secretes calcitonin
Medullary
a)
Follicular
b)
Anaplastic
c)
Pappilary
d)
Mucodermoid
e)
36.Most common finding of contamintion on indewelling hyperalemtation
subclavian catheter in an immunocompremised patient on broad
spectrum antibiotic is
Pnuemocyctic carnii pnuemoniea
a)
Psuedomonas argenosa
b)
Candida albicans
c)

d)
e)

Staph aurues
Streptococci pyogens

37.The most cost-effective and quick investigation for breast lump is

FNA
a)
Mammogram
b)
Radio isotope scan
c)
Exesional biopsy
d)
Lumpectomy
e)
38.Epidemiologically, Fibroadenoma is commonest in
Second/Third decade of life
a)
Above 50 years
b)
c)
d)
e)

39.The best definision of pseudocyst

Complication of pancreatitis
a)
Lack of epithelial cell lining
b)
Mostly congenital
c)
d)
e)

40.Post modified radical mastectomy the patient may have winging of the
scapula due to injury of the nerve inervating
Teres major
a)
Teres minor
b)
Pectoralis major
c)
Subscapularis
d)
Latismus dorsi
e)
41.63 year old man who is healthy, is schedualed to undergo elective
inguinal hernia repair. Antibiotic coverage should be
Single IV dose 1 hour pre op
a)
IV dose pre op surgery and for 24hrs post op
b)
IV dose 24hrs pre op before and 24hrs after post op
c)
IV dose 48hrs pre op and 48hrs post opHemostatic breakdown
d)
e)

42.Old lady with mitral regurgetationdue to mitral valve prolapse to

undergo cystogram for UTI, Recommended antibiotic therapy for
protection against endocarditis
PO erythromycin
a)
PO Amoxacillin
b)
IV Ampicillin + Gentamycin
c)
NO antibiotic
d)
e)

43.Most common type of choledocal cyst

Intrahepatic diffuse
a)
Extrahepatic saccular
b)
c)
d)
e)

44.Most reliable sign in acute appendicitis is

Localized RLQ tenderness
a)
Psoas sign
b)
Rovings sign
c)
PR tenderness
d)
e)

45.Pathophysiology of acute appendicitis

Closed loop obstruction
a)
Edema
b)
Infarction of the appendix
c)
Ulceration of the mucosa
d)
Infection
e)
46.Most common cause of spontenous pnuemothorax
Rupture of bleb
a)
b)
c)
d)
e)

47.Lung Abscess
Always excised
a)
Mostly due to aspiration
b)
Rarely reqiures antibiotics if well drianed
c)
d)
e)

48.In tension pnuemothorax, immediate treatment

IVF
a)
Needle aspiration to drain the pnuemothorax
b)
c)
d)
e)

49.Hyperkalemia = 7.3 mEq/L, what is the first step in diagnosing and

treating this condition
IV insulin and glucose with EKG monitoring
a)
IV sodium bicarbonate with EKG monitoring
b)
IV 1g 10%calcium gluconate with EKG monitoring
c)
Shift to ICU for proper observation and treatment
d)
e)

50.Maximum amount
10 mEq/L
a)
20 mEq/L
b)
40 mEq/L
c)
60 mEq/L
d)
80 mEq/L
e)

of Potassium that can be administered in IVF is

with EKG monitoring
with EKG monitoring
with EKG monitoring
with EKG monitoring
with EKG monitoring

51.Superior vena caval obstruction syndrome mostly occurs with

Right upper lobe brochogenic carcinoma
a)

b)
c)

Thymoma
Lymphoma

d)
e)

52.Felon is
a)
b)
c)

Inflamation of the extesor tendons in the hand

Inflamation of the flexor tendons in the hand
Infection in a closed area in the pulp of distal finger

d)
e)

53.(a funny word??) is a special kind of cellulites caused by

Ecoli
a)
Colistredia
b)
Staph aurues
c)
Strepto pyogens
d)
Heamophilis influenzea
e)
54.Anterior mediastinal mass, most common cause
Lymphoma
a)
Thymoma
b)
c)
d)
e)

55.25 year old man, cause of mass ??

HL
a)
NHL
b)
c)
d)
e)

56.Overwhelming Sepsis of Splenectomy will be mostly seen in

Young boy <4 years old when spelenectomy was done sepsis occurs
a)
within 2 years
Woman undergone splenectomy for ITP
b)
Middle aged man post trauma undergone splenectomy
c)
Old age man post trauma undergone splenectomy
d)
Young man post trauma undergone splenectomy
e)

57.Which rare tumor of the small bowel required Mickels Diverticulum to

occure
Carcinoids
a)
Gastric adenoma
b)
Liemyosarcoma
c)
Malegnant melanoma
d)
e)

58.Carbuncle
Infection of the hair follicle
a)
b)

c)
d)
e)

59.Regarding spherocytosis
Myelodysplasia
a)
Gallstone
b)
Recurrent generalized abdominal pain
c)
d)
e)

60.What is the only contraindication to diagnostic peritoneal lavage DPL or

CT in the evaluation of blunt abdominal
Severe head injury
a)
Retro peritoneal hematoma
b)
Preganat patient
c)
Impressing need to go for explaratory laparatomy
d)
Unstable patient
e)
61.The disadvantage of DPL vs. CT in the evaluation of blunt abdominal
trauma
CT is faster
a)
Cant evaluate retroperitoneal injuries
b)
Cant be done in head trauma
c)
d)
e)

62.Which organ is least likely to be infracted due to thromboembolism

Brain
a)
Liver
b)
Kidney
c)
Heart
d)
Spleen
e)
63.In acute pancreatitis, blood and fliud runs along falciform ligament to
umbilical region, this is
Caput Meduesa
a)
Cullens sign
b)
Turners sign
c)
Chevosteks sign
d)
e)

64.Patinet was involved in MVA, wearing a seatbelt, has abdominal

echemosis on the skin, the injured viscera is likely to be
Liver
a)
Spleen
b)
Kidney
c)
Urinery bladder
d)
Pancrease
e)
65.Indication to transfuse packed RBC
Hct < 25%
a)
Hct < 35%
b)
Loss of 500ml of blood, stable patient
c)

d)
e)

Loss of more than 500ml of blood, unstable patient

Hgb < 10%

66.Regrading banked blood

Hct similar to normal blood
a)
Hyperkalemic
b)
Alkalotic
c)
d)
e)

67.The best method to transfuse Fibrenogen

Cryppercipitate
a)
FFP
b)
Whole blood
c)
d)
e)

68.Which does not effect wound healing

Prednisolone
a)
Azathioprene
b)
Cyclosporine
c)
Radiation
d)
e)

69.Which UT stone is radiolucent

Uric Acid
a)
Oxalate
b)
c)
d)
e)

70.How much fliud should be aspirated to abolish the clinical symptoms

cardiac tamponade
15-30cc
a)
50cc
b)
100cc
c)
150cc
d)
200cc
e)

71.Most common salivery gland tumor is in

Subclavian
a)
Parotid
b)
Sublingular
c)
Submandibular
d)
e)

72.Most common site for mixed tumor

Parotid
a)
b)
c)
d)
e)

73.Important cell for wound healing

Basophils
a)
Macrophage
b)
Nuetrophils
c)
Esonophils
d)
e)

74.What nerve is commonly injured in humorous fractures?

Radila
a)
Ulnar
b)
Median
c)
Musculocutanous
d)
e)

75.Cholecystitis may arise from

TPN
a)
Over hydration
b)
Low fatty diet
c)
d)
e)

76.Which method of nuetrition has most complications

Jujenostomy tube
a)
Gastrostomy tube
b)
NGT
c)
Nasoduedenal tube
d)
Nasojujenal tube
e)
77.Most common indication for renal transplant
End srage glumeru-pyelonephritis
a)
TB
b)
c)
d)
e)

78.Death from hypothermia, due to

Respiratory compremise
a)
Coagulopathy
b)
Renal Failure
c)
Arrythemia
d)
e)

79.Best indicator for fliud therapy in hypotension is

Increase BP
a)
Decrease in HR
b)
Increase in Hct
c)
Increase in urine output
d)
e)

80.Treatment for arteriovenous fistula

Ligation of artery proximal to fistula
a)

b)
c)
d)

Ligation of vien distal to fistula

Exsion of fistla and reconstruction of the vessles
Medial therapy only

e)

81.What percent of lymph node cancer has no primaries

1%
a)
3%
b)
5%
c)
10%
d)
25%
e)
82.Septic shock mortality rate
5%
a)
10%
b)
12%
c)
25%
d)
30%
e)
83.Female presents with a groin mass, mostlikely to be
Epigastric hernia
a)
Femoral hernia
b)
Ingiunal hernia
c)
Incesional hernia
d)
e)

84.Respiratory distress in flial chest is due to

Assosiated pnuemothorax
a)
Assosiated hemothorax
b)
Paradoxical respiratory movement
c)
Pain due to movement of fractured ribs
d)
e)

85.Patinet was treated at ER for UL fracture, was put in plaster of paris. 4

hours later he returned complaing of finger pain, on examintion his
fingers are tender, sweollen and cyanosed, Your treatment should be
Prompt removal of cast near the fingers
a)
Prompt removal of whole
b)
c)
d)
e)

86.Which of the following is useful to monitor levo thyroxine therapy

T3
a)
T4
b)
TSH
c)
Immunoglobulins
d)
e)

87.Which of the following investigations is most useful to decide for thyroid

surgery
FNA cytology
a)
Ultrasound
b)
Nuclear scan
c)
TSH
d)
e)

88.What is the best diagnostic test to evaluate GERD

Ba swallow
a)
Plain x-ray
b)
Upper GI endoscopy
c)
Demonstrating PH < 4 for hours
d)
e)

89.Regarding IBD
UC effects the ileum
a)
Microscopic examination of CD shows transmural pathology
b)
Only CD has higher risk of malignancy
c)
d)
e)