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1. The best operative approach to choledochal cyst is: a. b. c. d. cystoduodenostomy. Cystojejunectomy. Roux-en-y cystojejunostomy. Cyst excision and hepaticojejunostomy. 2. A young female proved to have sclerosing cholangitis, she gives a long history of diarrhea, she is likely to suffer from which of the following? a. Celiac disease. b. Liver cirrhosis. c. Crohnr's disease. d. Ulcerative colitis. e. Pernicious anemia. 3. Portal pressure is considered elevated when it is above which of the following? a. b. c. d. e. 0.5 mm hg. 1.5 mm hg. 12 mm hg. 40 mm hg. 100 mm hg. 4. The most common benign hepatic lesion is: a. b. c. d. e. heamangioma adenoma focal nodular hyperplasia hamartoma. Lipoma. 5. An absolute contraindication to treat conserving surgery for breast cancer is a. b. c. d. e. large tumor tumor of high grade early pregnancy retroareolar tumor. Clinical axillary nodes 6. Doing pringle maneuver to control bleeding from the liver you compress which of the followings: a. b. c. d. e. portal vein, hepatic vein, hepatic artery Portal vein, hepatic artery, cystic artery. Portal vein and hepatic artery. Portal vein, hepatic artery, CBD. Cystic artery, cystic duct, CBD. 7. A woman with longstanding rheumatoid arthritis has neutropenia on routine lab, and splenomegaly is noted on physical examination which is the most likely diagnosis a. b. c. d. e. Thalassemia Hereditary spherocytosis. Sickle cell disease. Idiopathic autoimmune hemolytic anemia. Felty's syndrome. 8. After mastectomy winging of the scapula results from injury to: a. b. c. d. e. The medial pectoral nerve. The lateral pectoral nerve. The long thoracic nerve. The thoracodorsal nerve. The intercostobrachial nerve. 9. Metabolic acidosis is a complication of the topical application of : a. b. c. d. e. Sodium mafenide. Silver nitrate. Silver sulfadiazine. Betadine. Bactiracin. 10. The adverse effect of steroids on wound healing can be reversed with : a. b. c. d. e. Vitamin C. Vitamin A. Copper. Vitamin D. Vitamin E. 11. Volkman's contracture is a complication of: a. b. c. d. e. Humeral head fracture. Femoral neck fracture. Posterior dislocation of the knee. Supracondylar humeral fracture. Colle's fracture 12. During prolonged starvation, the brain's main fuel is: a. b. c. d. Glucose. Amino acids. Ketones. Short chain fatty acids. 13. The diagnosis of inflammatory breast cancer is confirmed by: a. b. c. d. e. Mammography. FNA. Ultrasound. Skin biopsy. MRI. 14. Male breast cancer is associated with a. b. c. d. BRCA- 1 gene. BRCA- 2 gene. APC gene. P 53 gene. 15. Pleomorphic parotid adenoma: a. b. c. d. e. Requires core biopsy before resection. Is adequately treated by enucleation. Commonly undergoes malignant transformation. Commonly results in fascial palsy. Is the most common parotid neoplasm. 16. An early feature of lidocaine toxicity is a. b. c. d. arrythmia. Muscle twitching. Respiratory depression. Hypotension. 17. A patient with abdominal wall desmoids tumor should be screened for: a. b. c. d. e. Lung cancer. Colon polyps. Breast cancer. Medullary thyroid carcinoma. Pancreatic cancer. 18. Which of the following is an inhibitor of wound contraction: a. b. c. d. glucocorticoids. Penicillamine. Colchicine. Aspirin. 19. Hand infection caused by a human bite is due to: a. b. c. d. e. Staphylococcus aureus. Clostridium difficile. Herpes simplex. eikenella corroelens. candida species. 20.The protein loss of equivalent to 100g of nitrogen is a. 75gm protein. b. c. d. e. 150gm protein. 375 gm protein. 525 gm protein. 625 gm protein. 21. Elevation of urinary 5-hydroxyindole acetic acid is diagnostic of : a. b. c. d. e. pheochromocytoma. Cushing disease. Carcinoid syndrome. Aldosteronoma. Nephroblastoma. 22. The most common cause of large bowel obstruction is: a. b. c. d. e. Colorectal cancer. Crohn's colitis. Diverticulosis. Adhesion. Volvulus. 23. Nutritional markers include the following except a. b. c. d. e. sikin fold thickness. Mid arm muscle circumference. Total leucocyte count. Serum albumin. Skin allergy tests. 24. Which is incorrect regarding carcinoid tumor of the appendix: a. b. c. d. e. Most are asymptomic. Tumors less than 2cm require no further therapy other than appendectomy. It is always malignant. Carcinoid syndrome arises when hepatic metastasis have occurred. Synchronous carcinoid tumor in the distal ileum may be present. 25. In ulcerative colitis all are true except: a. b. c. d. e. The rectum is almost always involved. The serosa is usually normal. Entercutaneous or intestinal fistulae are common. After 10 years carries some risk of malignancy. Acute mucosal inflammation and crypt abscesses are typical. 26. The hall mark of multiple endocrine neoplasia type 2 syndrome is: a. b. c. d. e. Hyperparathyroidism. Pheocromocytoma. Medullary thyroid carcinoma. Pituitary adenoma. Neural ganglionas. 27. During a trauma primary survey the following should be identified except: a. b. c. d. e. Airway obstruction. Tension pnemothorax Myocardial contusion. Blood pressure and pulse rate. Neurological 28. In grade I hypovolaemia which is correct: a. b. c. d. e. Tachycardia is a reliable clinical sign. Occurs when more than 40% of the blood is lost. A fall in pulse pressure is observed. Urine output is markedly reduced. Capillary return is delayed. 29. In hirschsprung's disease which is false: a. Is due to absent ganglion in aurbach's plexus. b. In most cases the recto-sigmoid is involved. c. In most cases patients present with delayed passage of meconium in the first 24 hours. d. Nerve fibers are absent in the affected part. e. On barium enema the segment has a cone- shap. 30. Which is true regarding obstructive jaundice? a. b. c. d. e. Urinary conjugated bilirubin is decreased. Urinary urobilinogen is decreased or absent. Serum indirect bilirubin is increased. Serum alkaline phosphate is decreased. Fecal stercobilinogen is increased. 31. Regarding mickle's diverticulum are true except: a. b. c. d. e. Occurs in about 2%of the population. Will be found on the mesenteric border. Is a true diverticulum. Can cause intestinal obstruction. Can cause brisk gastrointestinal bleed. 32. During surgical excision of the submandibular gland which is incorrect: a. b. c. d. e. The marginal mandibular nerve runs deep to the myelohyoid. Both the fascial vein and artery may need to be divided. The lingual nerve should be preserved. The hypoglossal nerve should be preserved. The skin incision should be placed 4cm below lower border of the mandible. 33. Regarding the sensory dermatom which is false: a. C3 and C4 supply the tip of the shoulder. b. L1 supplies the umbilicus. c. L4-L5 supply the sole of the foot. d. Sacreal nerve supply the perianal skin. e. The sensory nerve to the face is the trigeminal. 34. Which is false in perthe's disease: a. b. c. d. e. Usually presents before 10 years of age. Is due to avascular necrosis of the distal femoral epiphysis. Is more common in boys. Plain x-ray shows the capital femoral epiphysis to be smaller, denser, flatter. May require subtrochanteric osteotomy. 35. Which is false regarding the common bile duct: a. b. c. d. e. Lies in the free edge of lesser omentum. Lies anterior to the portal vein. Lies to the left of the hepatic artery. May open into the duodenum independent of the pancreatic duct. Lies anterior to the first part of the duodenum. 36. Which is true about the esophagus: a. b. c. d. e. 1s 40 cm in length. In the thorax passes behind the left main bronchus. Is lined by columnar epithelium in the upper 2/3. Drains all of it's blood into the azygos. Is lined by transitional epithelium in the lower 1/3. 37. Physical examination and ultrasound are suggestive of appendicular mass, which is not true: a. b. c. d. e. it should be treated conservatively. Patient should undergo urgent appendectomy. It may progress into an absess. Appendicular mass is an inflammatory process. Interval appendectomy should be done 2-3 months later. 38. A patient with electrical burn of the leg complain of pain in passive movement of the foot, the pedal pulses are diminished. The next step is: a. b. c. d. escharotomy. femoral angiogram. leg elevation and intravenous heparin. fasciotomy. 39. In repair of a femoral hernia, the structure most vulnerable to major injury lies: a. b. c. d. medially. Laterally. Anteriorly. Posterioly. e. Superficially. 40. After a major motor accident trauma , patient admitted to the ICU starts to be bleed massively from the stomach probably due to : a. b. c. d. e. gastric ulcer. Duodenal ulcer. Hiatal hernia. Mallory-weiss tear Errosive gastritis 1-A patient with non-metastatic gestational trophoblastic disease can be treated with weekly intramuscular injections of which of the following agents ? A.Cyclophosphamide B.Carboplatinum C.VP-16 (etoposide) D.Actinomycin D E. Methotrexate 2-The most likely karyotype of patient with a complete mole would be ? A. 46, XX B. 46, XY C. Diandric triploidy D. Triploidy with two haploid sets of maternal origin E. Aneuploidy 3-Prophylactic "oophorectomy" in patient with BRCA 1 mutations implies or results in the following ? A. Reduces the risk of breast cancer B. Necessitates removal of fallopian tubes C. Peritoneal cytologies should be done at the time of prophylactic oophrectomy D. Patients can still develop intra-abdominal papillary serious cancers as a result of primary peritoneal cancers E. All of the above 4-The most common sign and symptom of uterine rupture is ? A. Abdominal pain B. Loss of contractions C. Recession of the fetal presenting part D. Fetal heart rate changes E. He,orrhage 5-The potential causes for fetal tachycardia include all of the following except ? A. Fetal behavioral state B. Chorioamnoinitis C. Meternal fever D. Maternal ingestion of methamphetimine E. Maternal beta blocker drug 6-You are managing a 24 year old G1 PO at 40 5/7 weeks EGA in labor. She has progressed to 6 cm cervical dilation and the electronic fetal heart rate (FHR) tracing has been reassuring. There is a sudden and sustained fetal bradycardia. All of the following are plausible causes for the FHR pattern except ? A. Uterine rupture B. Cord prolapse C. Placental abruption D. Meconium aspiration E. Amniotic fluid embolism 7-Which of the following amplitude range in fetal heart rate (FHR) monitoring defines minimal variabilty ? A. Undetectable B. > undetectable - < 5 beats per minutes (bpm) C. 6-25 bpm D. >25 bpm 8-Intrapartum asphyxia accounts for what percent of cerebral palsy ? A. <10 B. 10-20 C. 21-30 D. 31-40 E. 80-90 9-You deliver a depressed fetus whose skin is noted to be meconium stained. When did meconium passage most likely occur in utero ? A. <3 hours B. 3-6 hours C. 12-18 hours D. 24 hours E. 48 hours 10-The non reassuring fetal heart rate (FHR) pattern of ischemia is characterized by all of the following except ? A. Initial FHR reactivity with subsequent non-reactivity B. Prolonged fetal tachycardia C. Abrupt and sudden profound bradycardia D. Substantial rise in baseline FHR E. Repetitive FHR decelerations 11-All of the following are adverse pregnancy outcomes associated with maternal hypothyroidism except ? A. Impairment in fetal intellectual development B. Placental abruption C. Preeclampsia D. Preterm delivery E. Gestational diabetes mellitus 12-Which of the following laboratory tests is the most useful to diagnose hyperthyroidism in pregnancy ? A. Thyroid Stimulating Hormone (TSH) B. Thyroid Binding Globulin (TBG) C. Total T4 D. Free T4 E. T3 13-All of the following are physiologic changes in the thyroid function tests during pregnancy except ? A. Decreased Thyroid Stimulating Hormone (TSH in the first trimester) B. Increased Total T4 C. Increased Thyroid Binding Globulin (TBG) D. No change in the free T4 E. Increased Thyroid Stimulating Hormone (TSH) in the second and third trimester 14-The advantages of a prophylactic oophorectomy at the time of hysterectomy for benign reasons include all of the following except ? A. Lowers the incidence of ovarian cancer B. Lowers the risk of coronary artery disease C. Lowers the risk of subsequent surgery for ovarian pathology D. Accommodates patients request 15-What is the least likely effective treatment for a patient with Stress Urinary Incontinence (SUI) without a cystocele ? A. Anterior colporraphy B. Burch retropubic urethropexy C. Tension free vaginal tape (TVT) D. Transobturator tape (TOT) E. Pubovaginal sling with autologous fascia 16-Dysfunctional Uterine Bleeding (DUB) is defined as abnormal uterine bleeding? A. Secondary to hormonal dysfunction B. Caused by cancer C. In a patient with von Willebrand's disease D. With no organic cause E. Caused by an endometrial polyp 17-Relative contraindications for the use of combination hormonal contraception include ? A. History of thrombophlebitis B. Diabetes with vascular involvement C. Hypertriglyceridemia D. migraine with aura E. Smoking over age 35 years 18-Which of the following are true in regards to uterine sarcomas? A. Although saecomas account for only 3% of uterine cancers, they often have a poor prognosis B. Leiomyosarcomas usually arise de novo from the uterine smooth muscle, rather than from a preexisting fibroid C. Rapid enlargement of a presumed fibroid uterus is a potential sign of a leiomyosarcoma D. There is no offical staging system for uterine sarcomas, but it is customary to use the FIGO system for endometrial cancers E. All of the above are true 19-The most frequent complication after radical hysterectomy is: A. Ureterovaginal fistulization B. Vesicvaginal fistula C. Postoperative bladder dysfunction D. Bowel obstruction E. Enterovaginal fistulas 20-A 19-year-old primigravid woman at 42 weeks' gestation comes the labor and delivery ward for induction of labor. Her prenatal course was uncomplicated. Examination shows her cervix to be long, thick, closed, and posterior. The fetal heart rate is in the 140s and reactive. The fetus is vertex on ultrasound. Prostaglandin (PGE2) gel is placed intravaginally. One hour later, the patient begins having contractions lasting longer than 2 minutes. The fetal heart rate falls to the 70s. Which of the following is the most appropriate next step in management? A. Administer general anesthesia B. Administer terbutaline C. Perform amnioinfusion D. Start oxytocin E. Perform cesarean delivery 21- A 27-year-old woman, gravida 2, para 2, comes to the physician to have her staples removed after an elective repeat cesarean delivery. Her pregnancy course was uncomplicated. She states that she is doing well except that since the delivery she has noticed some episodes of sadness and tearfulness. She is eating and sleeping normally and has no strange thoughts or thoughts of hurting herself or others. Physical examination is within normal limits for a patient who is status post cesarean delivery. Which of the following is the most likely diagnosis? A. Maternity blues B. Postpartum depression C. Postpartum mania D. Postpartum psychosis E. Poststerilization depression 22-A 22-year-old primigravid woman comes to the labor and delivery ward at term with regular, painful contractions. Her prenatal course was unremarkable. She has a past medical history significant for mitral valve prolapse with regurgitation demonstrated on echocardiography. She takes no medications and has no allergies to medications. Examination shows that her cervix is 4 centimeters dilated and the fetus is in vertex presentation. The fetal heart rate is reassuring. Which of the following is the most appropriate management of this patient? A. Administer intravenous antibiotics throughout labor. B. Administer intravenous antibiotics 30 minutes prior to the delivery. C. Administer intravenous antibiotics after the cord is clamped. D. Administer intravenous antibiotics six hours after the delivery. E. Antibiotic prophylaxis is not necessary 23-A 26-year-old primigravid woman at 42 weeks' gestation comes to the labor and delivery ward for induction of labor. The prenatal course was significant for a positive group B Streptococcus culture performed at 35 weeks. Antenatal testing over the past 2 weeks has been unremarkable. The patient is started on lactated Ringer's IV solution. Sterile vaginal examination shows that the patient's cervix is long, thick, and closed. Prostaglandin (PGE2) gel is placed into the vagina, and electronic fetal heart rate monitoring is continued. In approximately 60 minutes, the fetal heart rate falls to the 90s, as the tocodynamometer shows the uterus to be contracting every 1 minute with essentially no rest in between contractions. Which of the following was most likely the cause of the uterine hyperstimulation? A. Infection B. IV fluids C. Postdates pregnancy D. Prostaglandin (PGE2) gel E. Vaginal examination 24-A 16-year-old female comes to the physician because of an increased vaginal discharge. She developed this symptom 2 days ago. She also complains of dysuria. She is sexually active with one partner and uses condoms intermittently. Examination reveals some erythema of the cervix but is otherwise unremarkable. A urine culture is sent which comes back negative. Sexually transmitted disease testing is performed and the patient is found to have gonorrhea. While treating this patient's gonorrhea infection, treatment must also be given for which of the following? A. Bacterial vaginosis B. Chlamydia C. Herpes D. Syphilis E. Trichomoniasis 25-A 27-year-old primigravid woman at 39 weeks' gestation comes to the labor and delivery ward with a gush of fluid and regular contractions. Examination shows that she is grossly ruptured, contracting every 2 minutes, and that her cervix is dilated to 4 cm. The fetal heart rate tracing is in the 140s and reactive. She is admitted to labor and delivery, and over the following 4 hours she progresses to 9 cm dilation. Over the past hour, the fetal heart rate has increased from a baseline of 140 to a baseline of 160. Furthermore, moderate to severe variable decelerations are seen with each contraction. The fetal heart rate does not respond to scalp stimulation. The decision is made to proceed with cesarean delivery. Which of the following is the reason for the cesarean delivery and the preoperative diagnosis? A. Fetal acidemia B. Fetal distress C. Fetal hypoxic encephalopathy D. Low neonatal APGAR scores E. Non-reassuring fetal heart rate tracing 26-A 29-year-old woman, gravida 2, para 1, at 38 weeks' gestation comes to the labor and delivery ward with frequent painful contractions. Her prenatal course was significant for a urine culture that showed 100,000 colony-forming units/milliliter of Group-B streptococci and asthma, for which she uses an albuterol inhaler. Examination shows that she is contracting every 2 minutes and her cervix is 5 centimeters dilated and 100% effaced. Which of the following medications should this patient be treated with during labor and delivery? A. Betamethasone B. Folic acid C. Magnesium sulfate D. Oxytocin E. Penicillin 27-The most common cause of postpartum haemorrhage is: A. retained tissue B. cervical tear C. atony D. coagulopathy 28-Active management of third stage of labour include all the fallowing except: A. syntocinon 10iu IM at delivery of anterior shoulder B. early clamp and cut of cord C. cotrolled cord traction D. bimanual uterine massage 29-Following prolonged second stage of labour, your primigravid patient at 42 weeks gestation finally delivers the fetal head, but the anterior shoulder does not release with a normal amount of downward traction. The statement that most accurately is associated with this complication is: A. History of shoulder dystocia in a previous pregnancy does not confer any greater risk of the complication in this pregnancy. B. It is important to stop and suction the newborn before attempting to deliver the anterior shoulder in cases where this complication is anticipated. C. After delivery of the fetal head, pH can be expected to drop by 0.04 per minute due to cord compression. D. Shoulder dystocia rarely occurs in normal birthweight infants. E. Routine induction of labour for macrosomia has been proven to improve perinatal outcomes. 30. Which of the following examples is NOT a risk factor for ectopic pregnancy: A. Prior tubal surgery B. Obesity C. Prior ectopic pregnancy D. Prior tubal infection/PID combination 31.While hypertension and proteinuria are diagnostic for pre-eclampsia, other non-diagnostic findings worth evaluating include: A. Rapid weight gain B. Family history of pre-eclampsia or eclampsia C. Maternal age greater than 40 D. Deep tendon reflexes E. All of the above 32. withe preferred agent of choice for Group B Strep prophylaxis is: A. Ampicillin 2gm load intravenously, followed by 1gm every 4 hours. B. Clindamycin 900mg intravenously every 8 hours. C. Penicillin G 5 million units intravenously, then 2.5 million units every 4 hours. D. Erthromycin 500 mg intravenously every 6 hours. 33. which of the following conditions should a vaginal trial of labour be considered: A. Vasa previa B. Placenta previa C. Uterine rupture D. Abruption 34. Dysfunctional labour is: A. More common in parous women B. Defined as protracted or arrested labour C. Requiring early hospitalization D. Normal 35. Which of the following would NOT be a treatment for a non-reassuring FHR pattern: A. Initiate oxytocin B. Acoustic or scalp stimulation C. Amnioinfusion D. Plan immediate delivery 1- In previously fit adults, the most common organism causing osteomyelitis is: A. B. C. D. Staph. Aureus Strep. Pneumonia Psudomonus Gonococcus 2- With plain radiography, we expect to see characteristic changes denoting acute osteomyelitis within: A. B. C. D. 2 days One week 2 weeks One month 3- Sequestrum means: A. B. C. D. newly formed bone dead bone infected bone tumorous bone 4- One of the following is correct in managing acute osteomyelitis: A. B. C. D. antibiotic treatment should be initiated before culture results are available we should avoid splintage to keep affected limb freely mobile we should encourage patient to walk on the affected site to enhance circulation analgesia is not recommended in these patients 5- In acute osteomyelitis, we expect to see all of the following except: A. B. C. D. raised ESR raised WBC redness and hotness at the infected region profound pus discharge from the affected bone 6- You were on charge in the emergency room when you suspected septic arthritis in a child, all of the following steps should be considered except one, it is to: A. B. C. D. admit patient to the hospital ask for CBC, ESR and CRP discharge the patient home ask for X-ray of the affected joint 7- A compound fracture means that a fracture : A. B. C. D. has breached bone is composed of many pieces is forming an angle has healed well 8- When a fracture occurs after weakness in bone structure or lytic lesion, it is called: A. B. C. D. comminuted compound pathological stress 9- Greenstick fractures occur in: A. B. C. D. 10A. B. C. D. elderly athletes army recruits Children Regarding fractures, one of the following statements is false: all fractures of limbs should be splinted to ensure healing all fractures of vertebrae are associated with neurological deficit fractures around joints may result in decreased joint motion in general, lower limb fractures heal faster than upper limb ones 1. Which of the following mechanisms is primarily responsible for initiating early development of the kidney? A. B. C. D. E. Differentiation of the pronephros Interaction between the mesonephric ducts and metanephros Intraction between the ureteric bud and the mesonephros Interaction between the paramesonephric ducts and metanephros Interaction between the ureteric bud and metanephros 2. Which of the following is a recognised function of Mullerian Inhibitory Substance (MIS)? A. B. C. D. E. Causes regression of the mesonephric ducts Causes regression of the paramesonephric ducts Converts testosterone to dihydrotestosterone Stimulates the second phase of testicular descent None of the above 3. Klinefelter’s syndrome is most commonly associated with which of the following karyotypes? A. B. C. D. E. 46XY 47XYY 45Y 47XXY 45X 4. Affects fertility A. varicocele B. spermatocele C. both D. non 5. A 6 month old male infant has made a full recovery following a non-specific febrile illness which proved to be a urinary infection. Ultrasound demonstrates bilateral upper tract dilatation. The most appropriate next investigation? A. Intravenous urogram (IVU) B. Micturating cystourethrogram (MCUG) C. Indirect MAG3 isotope cystogram D. Direct MAG3 isotope cystogram E. MRI 1. Stye, all true except A. B. C. D. is acute inflammation of lash follicle of the eyelid should be treated with warm compressor should be excised soon caused mainly by staphylococci 2. Causes of proptosis, all true except A. B. C. D. orbital tumor thyroid disease preseptal cellulitis capillary haemangioma 3. Corneal dendritic ulcer, all true except A. B. C. D. caused by Herpes simplex may has geographic ulcer oral Zovirax is not indicated should be treated with topical Zovirax and Steroids 4. Signs of proliferative diabetic retinopathy, all true except A. B. C. D. vitreous hemorrhage NVE (new vessel elsewhere) cotton wool spot preretinal haemorrhage 5. Regarding amblyopia, all true except A. B. C. D. the most common causes is strabismus is better if discovered early in life can be bilateral strabismus amblyopia is usually treated by surgery 1. Nerves which supply the pinna include all EXCEPT: A. B. C. D. Greater auricular Auriculotemporal Glosspharyngeal Lesser occipital 2. An adult with acute pain in the ear and blood-filled vesicles on the tympanic membrane and deep of the meatus, the diagnosis is: A. Malignant otitis externa B. Myringitis bullosa C. Herpes zoster oticus D. Otomycosis 3. Presence of nystagmus when person looks straight ahead is called: A. B. C. D. 1st degree nystagmus 2nd degree nystagmus 3rd degree nystagmus Gaze nystagmus 4. Tympanic membrane is normal in all except: A. B. C. D. Méniére's disease Otosclerosis Eustachian tube blockage Presbycusis 5. Ototoxic drug where sensorneural hearing loss can be reserved by stopping the drugs is : A. B. C. D. Gentamicin Furosemide Amikacine Neomycin