1.

Which of the following anatomic features of the biliary system are important considerations in operative
cholangiography?
A. The left hepatic duct comes off farther anterior than the right one.
B. At the confluence there may be more than just a right and a left hepatic duct.
C. Dissection of the triangle of Calot is more important than cholangiography in preventing bile duct injury.
D. Segments V, VII, or VIII sometimes join the biliary system below the confluence.
E. All of the above are correct.
2. Which of the following statements characterize amebic abscess?
A. Mortality is higher than that for similarly located pyogenic abscesses.
B. The diagnosis of amebic abscess may be based on serologic tests and resolution of symptoms.
C. In contrast to pyogenic abscess, the treatment of amebic abscess is primarily surgical.
D. Patients with amebic abscess tend to be older than those with pyogenic abscess.
3. Which of the following statement(s) is/are true about benign lesions of the liver?
A. Adenomas are true neoplasms with a predisposition for complications and should usually be resected.
B. Focal nodular hyperplasia (FNH) is a neoplasm related to birth control pills (BCPs) and usually requires
resection.
C. Hemangiomas are the most common benign lesions of the liver that come to the surgeon's attention.
D. Nodular regenerative hyperplasia does not usually accompany cirrhosis.
4. Which of the following statements about hemobilia are true?
A. Tumors are the most common cause.
B. The primary treatment of severe hemobilia is an operation.
C. Percutaneous cholangiographic hemobilia is usually minor.
D. Ultrasonography usually reveals a specific diagnosis.
5. Ligation of all of the following arteries usually causes significant hepatic enzyme abnormalities except:
A. Ligation of the right hepatic artery.
B. Ligation of the left hepatic artery.
C. Ligation of the hepatic artery distal to the gastroduodenal branch.
D. Ligation of the hepatic artery proximal to the gastroduodenal artery

6. Which of the following is the most common acid-base disturbance in patients with cirrhosis and portal
hypertension?
C. Metabolic alkalosis.
7. Cytokines are endogenous signals that stimulate:
A. Septic shock
B. The central nervous system to initiate fever.
C. The production of acute-phase proteins.
D. Hypoferremia.
E. All of the above are correct.
1

8. Which of the following statements about maxillofacial trauma is/are false?

A. Asphyxia due to upper airway obstruction is the major cause of death from facial injuries.
B. The mandible is the most common site of facial fracture.
C. The Le Fort II fracture includes a horizontal fracture of the maxilla along with nasal bone fracture.
D. Loss of upward gaze may indicate either an orbital floor or orbital roof fracture.

9. 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.

10. Regarding the diagnosis and treatment of cardiac tamponade, which of the following statements is/are
true?
A. Accumulation of greater than 250 ml. of blood in the pericardial sac is necessary to impair cardiac output.
B. Beck's classic triad of signs of cardiac tamponade include distended neck veins, pulsus paradoxicus, and
hypotension.
C. Approximately 15% of needle pericardiocenteses give a false-negative result.
D. Cardiopulmonary bypass is required to repair most penetrating cardiac injuries.

11.Which of the following statement(s) is true concerning the diagnosis of a peripheral vascular injury?
A. The presence of a Doppler signal over an artery in an extremity essentially rules out an arterial injury
B. Doppler examination is a valuable tool in the diagnosis of venous injuries
C. A gunshot wound in the proximity of a major vessel is an absolute indication for arteriography
D. Both the sensitivity and specificity of arteriography of the injured extremity approaches 100%

12. An 18-year-old male suffers a gunshot wound to the abdomen, resulting in multiple injuries to the small
bowel and colon. Which of the following statement(s) is/are true concerning this patients perioperative
management?
A. A multi-agent antibiotic regimen is indicated
B. Antibiotics should be continued postoperatively for at least 7 days
C. Laparotomy, as a diagnostic test for postoperative sepsis, should be considered
D. The incidence of postoperative wound or intraabdominal infection would be increased in association with a
colon injury

13. A 75-year-old man is involved in a motor vehicle accident. Which of the following statement(s) is/are true
concerning this patients injury and management?
A. Acceptable vital sign parameters are similar across all age groups
B. Hypertonic solutions should not be used for resuscitation due to concerns for fluid overload
C. The patient would be more prone to a subdural hematoma than a younger patient
D. There is no role for inotropic agents in the management of this patient

14. Valid points in the management of burns on special areas include:

A. The large majority of genital burns are best managed by immediate excision and autografting
B. All digits with deep dermal and full-thickness burns should be immobilized with six weeks of axial Kirschner
wire fixation
C. Deep thermal burns of the central face are best managed with immediate excision and autografting
D. Burns of the external ear are commonly complicated by acute suppurative chondritis if topical mafenide
acetate is not applied

15. Which of the following statements regarding unusual hernias is incorrect?

A. An obturator hernia may produce nerve compression diagnosed by a positive Howship-Romberg sign.
B. Grynfeltt's hernia appears through the superior lumbar triangle, whereas Petit's hernia occurs through the
inferior lumbar triangle.
C. Sciatic hernias usually present with a painful groin mass below the inguinal ligament.
D. Littre's hernia is defined by a Meckel's diverticulum presenting as the sole component of the hernia sac.
E. Richter's hernia involves the antimesenteric surface of the intestine within the hernia sac and may present with
partial intestinal obstruction.

16. The following statement(s) is/are true concerning umbilical hernias in adults.
A. Most umbilical hernias in adults are the result of a congenital defect carried into adulthood
B. A paraumbilical hernia typically occurs in multiparous females
C. The presence of ascites is a contraindication to elective umbilical hernia repair.
D. Incarceration is uncommon with umbilical hernias

17. Which of the following statements about esophageal anatomy is correct?

A. The esophagus has a poor blood supply, which is segmental in distribution and accounts for the high
incidence of anastomotic leakage.
B. The esophageal serosa consists of a thin layer of fibroareolar tissue.
C. The esophagus has two distinct muscle layers, an outer, longitudinal one and an inner, circular one, which are
striated in the upper third and smooth in the distal two thirds.
D. Injury to the recurrent laryngeal nerve results in vocal cord dysfunction but does not affect swallowing.
E. The lymphatic drainage of the esophagus is relatively sparse, localized primarily to adjacent paraesophageal
lymph nodes.

18. Which of the following is most reliable for confirming the occurrence of a significant esophageal caustic
injury?
A. History of the event.
B. Physical examination of the patient.
C. Barium esophagraphy.
D. Endoscopy.
19. Numerous epidemiologic associations have been made between (1) environmental and dietary factors and
(2) the incidence of gastric cancer, including all except:
A. Dietary nitrites.
B. Dietary salt.
C. Helicobacter pylori infection.
D. Dietary ascorbic acid.
20. Complete mechanical small bowel obstruction can cause dehydration by:
A. Interfering with oral intake of water.
B. Inducing vomiting.
C. Decreasing intestinal absorption of water.
D. Causing secretion of water into the intestinal lumen.
E. All of the above
21. Meckel's diverticulum most commonly presents as:
A. Gastrointestinal bleeding.
B. Obstruction.
C. Diverticulitis.
D. Intermittent abdominal pain.
22. A 45-year-old man with a history of previous right hemicolectomy for colon cancer presents with colicky
abdominal pain which has become constant over the last few hours. He has marked abdominal distension and
has had only minimal vomiting of a feculent material. His abdomen is diffusely tender. Abdominal x-ray
shows multiple air fluid levels with dilatation of some loops to greater than 3 cm in diameter. The most likely
diagnosis is:
A. Proximal small bowel obstruction
B. Distal small bowel obstruction
C. Acute appendicitis
D. Closed-loop small bowel obstruction
23. Which of the following statement(s) is true concerning laboratory tests which might be obtained in the
patient discussed above?
A. The presence of a white blood cell count > 15,000 would be highly suggestive of a closed-loop obstruction
B. Metabolic acidosis mandates emergency exploration
C. An elevation of BUN would suggest underlying renal dysfunction
D. There is no rapidly available test to distinguish tissue necrosis from simple bowel obstruction

24. Recurrence after operation for Crohn's disease:

A. Occurs after operations for ileal Crohn's but not colonic Crohn's.
B. Is usually found just proximal to an enteric anastomosis.
C. Rarely requires reoperation.
D. Occurs in 1% of patients at risk per year during the first 10 years after the operation.
E. Is prevented by maintenance therapy with corticosteroids.
25. The most common indication for surgery secondary to acute diverticulitis is:
A. Abscess.

26. Many patients with ulcerative colitis are operated upon electively with total abdominal colectomy, rectal
mucosectomy, formation of a small intestinal reservoir, and ileoanal anastomosis. The most common
postoperative complication after this operation is which of the following?
B. Small bowel obstruction
27. A 30-year-old male two years postoperative after total abdominal colectomy with ileoanal anastomosis
reports a sudden increase in stool frequency, nocturnal leakage, and low-grade fevers. Physical examination is
unremarkable . Flexible endoscopic examination of the small intestinal pouch reveals a friable erythematous
mucosa .Biopsies of the mucosa are obtained. While awaiting biopsy results, which of the following is the most
appropriate empiric therapy?
C. Oral metronidazole
28. Useful methods for detection of splenic injury, in descending order of sensitivity, are:
A. Magnetic resonance imaging (MRI)
B. CT.
C. Ultrasonography.
D. Isotope scan.
29. Which of the following comments does not describe hypersplenism?
A. It may occur without underlying disease identification.
B. It may be secondary to many hematologic illnesses.
C. It is associated with work hypertrophy from immune response.
D. It requires evaluation of the myeloproliferation.
E. It is associated with antibodies against platelets.

30.You are consulted regarding a 50-year old male with Laennecs cirrhosis, portal hypertension and
hypersplenism. He has no history of gastrointestinal bleeding. You would recommend which of the following?
D. Observation

31. Which of the following statements about the differential diagnosis of hypercalcemia is correct.
A. Malignant tumors typically cause hypercalcemia by ectopic production of parathyroid hormone (PTH).
B. The diagnosis of primary hyperparathyroidism is supported by these serum levels: calcium, 10.8 mg. per dl.;
chloride, 104 mmol. per liter; bicarbonate 21 mmol. per liter; phosphorus, 2.4 mg. per dl.; elevated parathyroid
hormone.
C. Familial hypocalciuric hypercalcemia is distinguished from primary hyperparathyroidism by parathyroid
imaging.
D. Although serum albumin binds calcium, the measured total calcium value is usually unaffected in patients
with severe hypoproteinemia.
E. Thiazide diuretics are a good treatment for hypercalcemia and can be given to patients with apparent
hypercalcemia of malignancy.
32. The parathyroid glands:
A. Develop from the second and third pharyngeal pouches, along with the palatine tonsil and the thymus.
B. Migrate caudally in the neck in normal development but can be found anywhere from the pharyngeal mucosa
to the deep mediastinum.
C. Secrete PTH and calcitonin to manage calcium homeostasis.
D. Usually number four, but frequently number only two or three.
E. Contain enzymes that catalyze the conversion of 25(OH) vitamin D 3 to 1,25(OH) 2 vitamin D 3.
33. Which of the following breast lesions are noninvasive malignancies?
A. Intraductal carcinoma of the comedo type.
B. Tubular carcinoma and mucinous carcinoma.
C. Infiltrating ductal carcinoma and lobular carcinoma.
D. Medullary carcinoma, including atypical medullary lesions.
34. A 45-year-old woman presents with a weeping eczematoid lesion of her nippl E. Which of the following
statement(s) is/are true concerning her diagnosis and management?
A. Treatment is with warm compresses and oral antibiotics
B. Biopsy of the nipple revealing malignant cells within the milk ducts is invariably associated with an
underlying invasive carcinoma
C. The appropriate treatment is mastectomy
D. The lesion always represents a high-risk disease with a significant risk of subsequent metastatic disease
35. The effect of high positive end-expiratory pressures (PEEP) on cardiac output is:
A. None.
B. Increased cardiac output.
C. Decreased cardiac output because of increased afterload to the left ventricle.
D. Decreased cardiac output because of decreased effective preload to the left ventricle.
36. The diagnosis of myasthenia gravis can be confirmed most reliably using:
D. Single-fiber EMG.

37. In an infant with suspected PDA, which of the following would be the optimal method of confirming the
diagnosis?
D. Two-dimensional echocardiography with continuous-wave and color-flow Doppler echocardiography.
38. A 5-year-old girl is found on routine examination to have a pulmonic flow murmur, fixed splitting of P2
and a right ventricular lift. The following is/are true:
A. Cardiac catheterization is indicated if the chest film shows cardiomegaly
B. Radiology report of scimitar syndrome findings on the chest film would indicate need for an arteriogram
C. If the catheterization report is ostium secondum defect, at least one pulmonary vein drains anomalously
D. Measured pulmonary vascular resistance of 14 Woods units/m2 with an ASD mandates early repair
E. An ASD with Qp/Qs of 1.8 can be observed until symptoms occur
39. The single most important indication for emergency pulmonary embolectomy is:
C. The presence of persistent and intractable hypotension.
40. A 67-year-old man with acute popliteal arterial embolism has a negative cardiac echo for source of the
thrombus. The following is/are true:
A. Most likely non-cardiac source is a thoracic aortic aneurysm
B. Embolism is more common from femoral than popliteal arterial aneurysms
C. Emboli from popliteal aneurysms are often clinically silent
D. Embolism is rare from subclavian artery aneurysms
41. Which of the following statements about allograft rejection are true?
A. In the absence of immunosuppression, the time and intensity of rejection of transplants between unrelated
donors and recipients is highly variable.
B. Allograft rejection may be mediated by antibodies or by cells.
C. Allograft rejection is thought to be caused by Th2 cells.
D. Acute cellular rejection is the major cause for loss of clinical organ transplants.
E. An individual with tolerance is unable to reject an allograft.
42. Which of the following are contraindications to lung transplantation?
A. Age 65 years or older.
B. Current corticosteroid therapy.
C. History of thoracotomy.
D. Ventilator-dependent respiratory failure.

43. Familial hypercholesterolemia has been proposed as a disease to be treated by gene therapy. The
molecular basis of familial hypercholesterolemia is which of the following?
A. Absence of hepatic low density lipoprotein receptors
B. Overproduction of high density lipoprotein
C. Absence of lipoprotein lipase
D. Overproduction of hepatic ornithine transcarbamylase
7

44. The pentalogy of Cantrell includes all of the following except:

A. Epigastric omphalocele.
B. Sternal cleft.
C. Intracardiac defect.
D. Pericardial cyst.
E. Ectopia cordis.

45. Patients with Wilms tumors most frequently present with which of the following?
E. A unifocal, unilateral lesion

46. Renal adenocarcinomas:

A. Are of transitional cell origin.
B. Usually are associated with anemia.
C. Are difficult to diagnose.
D. Are extremely radiosensitive.
E. Frequently are signaled by gross hematuria.

47. A 55-year-old male presents with severe flank pain radiating to the groin associated with nausea and
vomiting. Urinalysis reveals hematuria .A plain abdominal film reveals a radiopaque 5 mm stone in the area
of the ureterovesical junction. Which of the following statement(s) is/are true concerning this patients
diagnosis and management?
A. A likely stone composition for this patient would be uric acid
B. The stone will likely pass spontaneously with the aid of increased hydration
C. Stone analysis is of relatively little importance
D. Patients with a calcium oxalate stone and a normal serum calcium level should undergo further extensive
metabolic evaluation

48. The most common physical findings in a patient with median nerve compression at the wrist (carpal
tunnel syndrome) are:
A. Diminished two-point discrimination and dryness of the index and long fingers.
B. Atrophy of the abductor pollicis brevis and opponens pollicis.
C. A positive percussion test at the wrist and a positive wrist flexion test producing paresthesias at the thumb,
index, and long fingers.
D. A weak grip in addition to hand cramping and difficulty writing.

49. Isolated flexor digitorum superficialis tendon function is determined by assessing:

A. Flexion of the metacarpophalangeal joint.
B. Flexion of the proximal interphalangeal joint with the adjacent digits held in extension.
C. Flexion of the distal interphalangeal joint.
D. Flexion of the proximal interphalangeal joint.
8

50. Which of the following statements are true?

A. The Hoffmann-Tinel sign localizes the level of a nerve injury.
B. Causalgia is a term used to denote the etiology of pain.
C. Secondary repair of a lacerated nerve 3 to 8 weeks after injury has several advantages.
D. A surgeon who finds at delayed (3 to 8 weeks) exploration that a clinically nonfunctioning nerve is in
continuity should resect the injured portion of the nerve and suture together the ends.
E. If a nerve is found to be disrupted at delayed (3 to 8 weeks) exploration, the surgeon should find the two ends
of the nerve and suture them together.
51. What is the critical difference between frame-based and frameless stereotactic procedures?
A. The use of digitized imaging studies such as CT and MRI.
B. The use of rendered three-dimensional images and a three-dimensional digitizer.
C. Rigid fixation of the patient's head to the operating room table.
D. The presence of a lesion in the brain on digitized imaging studies.
E. The absence of a lesion in the brain on digitized imaging studies.
52. The following are absorbable sutures
A. Catgut
B. Silk
C. Polyamide (Nylon)
D. Polyglyconate (Maxon)
E. Polyglactin (Vicryl)
53. During surgery on the submandibular gland
A. An incision on the lower border of the mandible is safe
B. The submandibular gland is seen to wrap around the posterior border of mylohyoid
C. The facial artery and vein are divided as they course through the deep part of the gland
D. The hypoglossal nerve is seen to loop under the submandibular duct
E. Damage to the lingual nerve will cause loss of sensation to the posterior third of the tongue
54. Regarding pancreatic carcinoma false
A. 90% are ductal adenocarcinomas
B. Less than 20% occur in the head of the gland
C. The usual presentation is with pain, weight loss and obstructive jaundice
D. Ultrasound has a sensitivity of 80-90% in the detection of the tumour
E. Less than 20% of patients are suitable for curative surgery
55. Regarding the management of major trauma
A. Deaths follow a trimodal distribution
B. X-rays after the primary survey should be of AP Cervical spine, chest and pelvis
C. Cardiac tamponade is characterised by raised BP, low JVP and muffled heart sounds
D. Assessment of uncomplicated limb fractures should occur during the primary survey
E. Deterioration of the casualty during the primary survey should lead to the secondary survey

56. Regarding appendicitis

A. The risk of developing the illness is greatest in childhood
B. Mortality decreases with age .
C. 20% of appendices are extraperitoneal in a retrocaecal position
D. Faecoliths are present in 75-80% of resected specimens
E. Appendicitis is a possible diagnosis in the absence of abdominal tenderness
57. Regarding stones in the gallbladder
A. Cholesterol stones are the least common
B. Pigment stones are due increased excretion of polymerised conjugated bilirubin
C. Are not a risk factor for the development of gallbladder carcinoma
D. 90% of gallstones are radio-opaque
E. A mucocele of the gallbladder is caused by a stone impacted in Hartmann's pouch
58. Stones in the common bile duct the false is
A. Are found in 30% of patients undergoing cholecystectomy (Without pre-op ERCP)
B. Can present with Charcot's Triad
C. Are suggested by an bile duct diameter >8mm on ultrasound
D. ERCP, sphincterotomy and balloon clearance is now the treatment of choice
E. If removed by exploration of the common bile duct the T-tube can be removed after 3 days
59. Regarding crystalloid solutions the false is
A. Normal saline contains 154 mmol sodium and 154 mmol of chloride
B. 3 litres of dextrose saline in a day will provide 90 mmol of sodium
C. 2 grams of potassium chloride is equal to 57 mmol of the salt
D. Hartmann's solution contains calcium and bicarbonate
E. The daily maintenance potassium requirement of a 40 Kg woman is about 40 mmol
60. Solitary thyroid nodules the false is
A. Are more prevalent in women
B. In the adult population less than 10% are malignant
C. Less than 20% of scintigraphically cold nodules are malignant
D. The risk of a hot module being malignant is negligible
E. Should be surgically removed in all patients
61. Regarding abdominal wall hernias the false is
A. Almost 100,000 hernia operations are performed annually in the United Kingdom
B. Over 60% of inguinal hernias are indirect
C. In women inguinal hernias are as common as femoral hernias
D. The mortality assocaited with strangulation is over 10%
E. The mortality has reduced dramatically over the past 30 years

10

62. The femoral canal the false is

A. Lies medial to the femoral vein
B. Has the inguinal ligament as its anterior border
C. Has the lacunar ligament as its lateral border
D. Has the pectineal ligament as its posterior border
E. Contains the lymph node of Cloquet
63. Intermittent claudication the false is
A. Affects less than 1% of men over the age of 50 years
B. At 5 years 10% of claudicants will have progressed to an amputation
C. At 5 years 20% of claudicants will have died from ischaemic heart disease
D. Is usually associated with an ankle / brachial pressure index (ABPI) 0.3- 0.7
E. Is associated with a fall in the ABPI on exercise with delayed recovery
64. The pathology of ulcerative colitis the false is
A. Shows full thickness inflammation
B. The rectum is almost always involved
C. 10% patients have terminal ileal disease
D. Enterocutaneous or intestinal fistulae are less common
E. The serosa is usually normal
65. Regarding benign breast disease the false is
A. Cyclical mastalgia is the commonest reason for referral to the breast clinic
B. Fibroadenomas are derived from the breast lobule
C. Lactational breast abscesses are usually due to Staph aureus
D. Duct ectasia is less common in smokers
E. Atypical lobular hyperplasia is associated with an increased risk of breast cancer
66. Regarding anal fissures the false is
A. 10% occur in the posterior midline
B. Multiple fissures suggest a diagnosis of tuberculosis or Crohn's Disease
C. 50% of acute fissures heal with the use of a bulking agent
D. Sphincterotomy has a success rate of over 90%
E. Sphincterotomy is associated with minor faecal incontinence in over 15% of patients
67. Fibroadenomas the false is
A. Are benign monoclonal neoplasms
B. Most commonly present in late adolescence or the early 20s
C. Should be diagnosed by triple assessment
D. At least 30% reduce in size over a 2 year period
E. Can be safely managed conservatively

11

68. Warfarin the false is

A. Reduces the concentration of vitamin A dependent clotting factors
B. Has a half life of about 36 hours
C. Crosses the placenta and should be avoided in pregnancy
D. Doses should be reduced in liver disease
E. An INR of between 2.0 and 3.0 is appropriate in the treatment of DVT
69. Heparin the false is
A. Is a heterogeneous mixture of sulphated polysaccharides
B. Potentiates the actions of antithrombin III
C. Has a half life of 12 hours
D. Can be reversed by protamine sulphate
E. Can induce an idiosyncratic thrombocytopenia
70. The following cause hypercalcaemia except
A. Sarcoidosis
B. Primary hyperparathyroidism
C. Acute pancreatitis
D. Metastatic bronchial carcinoma
E. Milk-Alkali syndrome
71. Regarding oesophageal cancer the false is
A. Squamous carcinomas predominate in the upper 2/3 of the oesophagus
B. Overall 5 year survival is greater than 50%
C. Tylosis genetically predisposes to the disease
D. 15% of adenocarcinomas are associated with Barrett's oesophagus
E. For palliation an Atkinson tube can be inserted endoscopically
72. Infantile hypertrophic pyloric stenosis the false is
A. Occurs with a male : female ratio of 4:1.
B. Sons of affected mothers have a 20% risk of developing the lesion
C. Invariably presents between three and four weeks of age
D. Typically presents with nonbilious vomiting
E. Surgical treatment is by Heller's Cardiomyotomy
73. Oesophageal atresia the false is
A. Is often associated with a distal trachea-oesophageal fistula
B. Polyhydramnios is often present late in pregnancy
C. 50% have other associated congenital abnormalities
D. Contrast X-ray studies are necessary to confirm the diagnosis
E. Post-operatively over 30% develop oesophageal strictures

12

74. The following are features of Fallot's Tetralogy except

A. An atrial septal defect
B. Pulmonary stenosis
C. Right ventricular hypertrophy
D. A right to left cardiac shunt
E. Cyanotic attacks during feeding and crying
75. The functions of a tracheostomy are to except
A. Bypass an upper airway obstruction
B. Reduce the anatomical dead space
C. Increase airway resistance
D. Protect against aspiration
E. Allow frequent airway suction
76. Medullary carcinoma of the thyroid the false is
A. Is a tumour of the parafollicular C cells
B. Produce thyroxine as the principle hormone
C. 90% of cases are sporadic
D. Can occur as part of the MEN type II syndrome
E. Total thyroidectomy is the surgical treatment of choice
77. The following are features of thyrotoxicosis except
A. Weight gain
B. Palpitations
C. Proximal myopathy
D. Increased skin pigmentation
E. Pretibial myxoedema
78. Regarding abdominal aortic aneurysms the false is
A. They commonly remain symptomless until they rupture
B. The risk of rupture increases with aortic diameter
C. Elective repair should have a 30-day mortality of less than 5%
D. Emergency repair has a 30-day mortality of less than 10%
E. The benefits of surgery for small (4.0-5.5 cm) is unproven
79. In patients with carotid artery disease
A. A bruit is a reliable sign of the degree of stenosis
B. Atheroma is most commonly seen in the external carotid artery
C. An embolic event often results in an ipsilateral hemiplegia
D. Prophylactic aspirin reduces the risk of a stroke
E. Surgery is of proven benefit in those with asymptomatic stenoses

13

80. Hepatocellular carcinoma the false is

A. Has a high incidence in East Africa and South-east Asia
B. Its worldwide incidence parallels the prevalence of Hepatitis B
C. Mycotoxins (e.g. aflatoxin) are an important aetiological factor
D. Over 80% of tumours are surgically resectable
E. Liver transplantation offers the only chance of cure in those with irresectable disease
81. Serum alpha fetoprotein the false is
A. Is increased in testicular tumours
B. In testicular tumours is produced by trophoblastic elements
C. Is increased in over 70% patients with hepatocellular carcinoma
D. In patients with hepatocellular carcinoma levels correlate well with size of the tumour
E. In patients with hepatocellular carcinoma levels fall following resection of the tumour
82. Regarding testicular tumours
A. They are the commonest malignancy in young men
B. Peak incidence for teratomas is seen at the age of 25 years
C. Seminomas are radiosensitive
D. Over 75% of Stage I teratomas are cured by surgery alone
E. Chemotherapy rarely produces a cure in those with metastatic disease
83. In patients with ascites the false is
A. A exudate has a protein content of greater than 30 g per litre
B. Both malignancy and infection result in a transudate
C. Ovarian carcinoma is the commonest malignant cause of ascites
D. Cirrhosis results in marked sodium retention
E. Tumour cells increase the permeability of the peritoneum
84. Regarding opiate analgesia the false is
A. Patient controlled analgesia (PCA) is more effective than intermittent parenteral dosing
B. The total opiate dose is usually reduced with a PCA
C. Fentanyl is more lipid soluble than morphine
D. Epidural morphine can result in late respiratory depression
E. Epidural and parenteral morphine can be safely administered together
85. Intussusception the false is
A. Is most common in children from 6 to 12 years
B. Presents with colicky abdominal pain, rectal bleeding and an abdominal mass
C. 10% present with diarrhoea and vomiting suggestive of gastroenteritis
D. If no shock or peritonitis hydrostatic reduction can be attempted
E. A Meckel's diverticulum can induce an intussusception

14

86. Hirschsprung's disease the false is

A. Is due to absent ganglion cells in Auerbach's plexus
B. 10% cases have involvement of the recto-sigmoid segment
C. 80% cases present with delayed passage of meconium in the first 24 hours after birth
D. The affected segment of bowel appears as cone-shaped contracted zone on barium enema
E. On rectal biopsy there increased acetylcholinesterase containing cells in the muscularis
87. Laparoscopic cholecystectomy the false is
A. Is usually performed using a four port technique
B. The Veress needle is an 'open' technique for inducing the pneumoperitoneum
C. A supraumbilical abdominal scar is a contraindication to laparoscopic cholecystectomy
D. Dissection of Calot's triangle should be performed before the cystic duct is clipped
E. Most series report a conversion rate of less than 5%
88. In obstructive jaundice the false is
A. Urinary conjugated bilirubin is increased
B. Serum unconjugated bilirubin is increased
C. Urinary urobilinogen is reduced
D. Serum conjugated bilirubin is increased
E. Faecal stercobilinogen is reduced
89. Regarding the anatomy of the inguinal canal the false is
A. The internal ring lies midway between the symphysis pubis and anterior superior iliac spine
B. The internal ring lies medial to the inferior epigastric vessels
C. The external oblique aponeurosis forms the anterior boundary
D. The inguinal ligament forms the inferior boundary
E. The conjoint tendon forms the medial part of the posterior wall
90. Papillary carcinoma of the thyroid the false is
A. Can be reliably diagnosed using fine needle aspiration cytology
B. Is almost always unifocal
C. Histologically displays Psammoma bodies
D. Typically spread to the cervical lymph nodes
E. Requires a total thyroidectomy for large tumours
91. Regarding bladder tumours the false is
A. 90% are squamous carcinomas
B. Painless haematuria is the commonest presentation
C. Cigarette smoking is an important aetiological factor
D. 80% of tumours are superficial (i.e no muscle invasion)
E. Superficial tumours are often well controlled by transurethral resection

15

92. Regarding ureteric calculi the false is

A. Are most often composed of calcium oxalate or phosphate
B. Most stones of those less than 5 mm in diameter pass spontaneously
C. Extracorporeal lithotripsy is useful for stones in the upper third of the ureter
D. About 30% of patients require open surgery to remove the stone
E. An obstructed ureter in the presence of infection is a surgical emergency
93. Regarding bladder calculi the false is
A. The incidence has fallen markedly in this country since the late 19th century
B. They may be totally asymptomatic
C. They are more prevalent in patients with chronic urinary sepsis
D. They are associated with squamous metaplasia of the bladder mucosa
E. They increase the risk of transitional cell carcinoma
94. Ectopic pregnancy the false is
A. Occurs in about 1% of pregnancies
B. The risk is increased in those with a history or pelvic inflammatory disease
C. Usually presents between 2 and 4 months of gestation
D. Patients usually have a positive pregnancy test
E. if shocked early laparotomy is essential
95. Tetanus the false is
A. Is due to an infection with a gram-positive spore forming rod
B. The organism produces a powerful endotoxin
C. The toxin prevents the release of inhibitory neurotransmitter
D. Clostridium tetani is sensitive to penicillin
96. Regarding pathological terms
A. Hypertrophy is an increase in tissue size due to increased cell number
B. Hyperplasia is an increase in tissue size due to an increase in cell size
C. Atrophy is an increase in tissue size to disuse
D. Metaplasia is a change form one abnormal tissue type to another
E. A hamartoma is a developmental abnormality
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

E
B
A
C
D
C
E
B
C
C
D
D
C
D
C

16
17
18
19
20
21
22
23
24
25
26
27
28
29
30

B
C
D
D
E
A
B
D
B
A
B
C
B
E
D

31
32
33
34
35
36
37
38
39
40
41
42
43
44
45

B
B
A
C
D
D
D
B
C
C
B
D
A
D
E

46
47
48
49
50
51
52
53
54
55
56
57
58
59
60

E
B
C
B
C

B
A+D+E

B
B
A
B
E
E
C
E

16

61
62
63
64
65
66
67
68
69
70
71
72
73
74
75

E
C
A
A
D
A
A
A
C
C
B
E
D
A
C

76
77
78
79
80
81
82
83
84
85
86
87
88
89
90

B
A
E
D
D
B
E
B
E
A
B
B
B
B
B

91
92
93
94
95
96

A
D
E
C
B
E