Paper 1 MCQ

1) Collar stud abscess is defined as

a. Abscess making fistula
b. Superficial trickling of pus through deep fascia from a deep cavity
c. Epithelialising track of deep abscess
d. Postoperative abscess after hematoma
e. Abscess due to foreign body
2) In SIRS, two or more of the following criteria is met except:
a. Temperature ≥38°C(100.4°F) or ≤36 C (96.8°F)
b. Heart rate≥90beatsperminute
c. Respiratory rate≥12 breaths per minute or
d. PaCO2 ≤32 mmHg or the need for mechanical ventilation
e. White blood cell count ≥12,000/μL or ≤ 4000/μL or ≥10% band forms
3) A patient undergoing elective cholecystectomy will need:
a. No perioperative antibiotics
b. Single shot of broad spectrum IV antibiotics within one hour before
skin incision
c. Single shot of broad spectrum IV antibiotics within first 30 minutes before
skin incision
d. Short term antibiotic regimen for 48 hours
e. Three days of broad spectrum antibiotic as the bile is not sterile
4) The principles of hand infections treatment include which of the following?
a. Long term antibiotic should be continued until infection completely
subsides
b. Pus is diagnosed when hand swelling shows evident cross fluctuation
c. Active hand movement is permitted after complete healing of the hand
incision
d. In the acute stage , the hand should be placed in the position of best
function
e. Hand abscess drainage should be under local anasethia
5) Kanavel’s sign is:
a. Swelling above flexor retinaculum
b. Flexion of the thumb when the radial bursae is infected
c. Flexion of the finger in the compound palmar ganglion
d. Tenderness over an infected ulnar bursae between the transverse
palmar creases
6) The main clinical difference between cellulitis and erysipelas is that:
a. Cellulitis is mainly affecting diabetic patients
b. Erysipelas is mainly affecting children
c. Cellulitis is associated skin edema and pallor
d. Absence of lymphangitis in erysipelas
e. Raised well demarcated edge in erysipelas
7) In case of seroma that develops after hernioplasty, which is wrong:
a. By observation, most of them will resolve without intervention
b. Treatment includes repetitive sterile aspiration and pigtail catheter under US
guidance
c. When persistent beyond 8 weeks or longer, injection of sclerosant substance
 d. Open drainage is preferred than closed drainage
e. Could be complicated by abscess formation

8) A 25 years old male patient presented with multiple organ injuries in a severe
trauma accident. He underwent multiple operations and received 3 units of packed
RBCs during surgery. During blood transfusion of the 4 th unit in the ward, he
suddenly complained of marked chest tightness and loin pains. His conjunctiva
became yellow. The proper management:
a. Take the patient to the OR to correct his condition
b. Stop transfusion, resuscitate, and give IV mannitol drip
c. Resuscitate and give antibiotic
d. Revise the blood bank, resuscitate and give FFP
e. Stop transfusion, resuscitate and give low-molecular weight heparin
9) Dermoid cyst is different from sebaceous cyst in that:
a. It is lined by columnar epithelium
b. It has a punctum
c. It occurs only at lines of skin fusion
d. It may contain hairs and teeth
10) The true statement concerning the treatment of hypokalemia
a. IV potassium is preferable to oral potassium
b. Potassium should not be infused before urine output is established
c. IV potassium is given on sodium bicarbonate solution
d. Rate of infusion pump should not exceed 10mEq/hour in ICU
11) Hypertrophic scar differs from keloid in that
a. It is raised above the skin surface
b. It has high rate of recurrence after excision
c. It never extends beyond the limits of original wound
d. It is treated by intralesional injection of steroids
e. It is related to wound infection
12) Superior vena cava obstruction (SVCO) as an oncological emergency is treated by:
a. SVC stenting used for tumors not sensitive for chemotherapy or
radiotherapy
b. Urgent surgical bypass operation
c. Hormonal therapy to shrink the tumor
d. Medical treatment only is not enough
13) Complications of spinal anasethia include all of the following except:
a. Headache
b. Urinary retention
c. Meningitis
d. Hypertension
e. Subdural hematoma
14) The basic categories of anasethic drugs are the following except:
a. Intravascular induction agents to provide rapid smooth induction of
hypnosis
b. Gases and volatile liquids that are given by inhalation to maintain
anasethia
c. Analgesics (morphine, pethidine and NSAID)
d. Muscle relaxants and their antagonists
e. Oxygen inhalation via endotracheal tube
15) In chronic liver disease, the precautions during general anasethia should be:
a. Use N2O
b. Increase doses of opiod
c. Use long acting muscle relaxants
d. Ventilation should be controlled (to avoid hypoxia and to maintain
normal PaCO2)
16) A known patient of AF presented to the emergency department with acute RT LL
ischemia. He had no history of claudication. On examination, the affected limb is
pulseless starting from common femoral artery, with loss of light touch. Calf
muscles are tender but lax, motor functions are preserved.
a. Angiography followed by femoral embolectomy
b. Urgent femoral embolectomy under local anasethia
c. Urgent aortofemoral bypass operation under general anasethia
d. Anticoagulant therapy alone is the treatment of choice
17) In local examination for diagnosing arterial injury, the less specific (equivocal)
sign (soft sign) for arterial injury is:
a. External arterial bleeding
b. Loss of distal pulses
c. Small or moderate sized hematoma that isn’t pulsating and not
expanding
d. Manifestations of acute ischemia(6 Ps)
e. A palpable thrill of an audible bruit heard with stethoscope at or distal to
area of injury
18) A 45 years old male, smoker, non diabetic presented complaiming of continuous
right foot pain of 4 weeks duration. On examination, the big toe showed an ulcer
which was very tender on touch, pedal pulses were absent on both sides. The
patient is having:
a. Acute reversible ischemia
b. Acute irreversible ischemia
c. Chronic ischemia of claudication stage
d. Critical limb ischemia
19) You were called to assess the arterial circulation of bed ridden patient with
congestive heart failure who developed an heal ulcer. You couldn’t feel the pedal
pulse. Your next step is?
a. Evaluate doppler signals using bedside pocket doppler
b. Ask for arterial duplex to detect stenosis or occlusion along the arterial
tree
c. Ask for CT angiography to accurately define the arterial tree
d. Ask for MR arteriography as it is less invasive
20) A 63 years old patient with the past history of lower limb claudications presented
with acute progressive pain of his right lower limb and inability to walk for two
days. On examination, the right foot and leg are cold, the foot showed fixed
cyanosis with loss of sensation. Calf muscles are turgid and paralysed. Pedal
pulses are absent on both sides. This patient has :
a. Reversible acute arterial thrombosis
b. Reversible acute arterial embolism
c. Irreversible acute arterial thrombosis
d. Irreversible acute arterial embolism
21) Secondary VV are characterized by:
a. It is usually bilateral
b. Venous angiography is the investigation of choice
c. Chronic venous ulcer is a common complication
d. Most effective treatment is stripping of long saphenous vein
22) A 55 years old male with an accidently discovered 4 cm infrarenal andominal
aortic aneurysm not extending into the iliac arteries is best managed by:
a. Assurance and serial follow up
b. Surgical repair with a dacron tube graft
c. Surgical repair with a bifurcated dacron graft
d. Endovascular aneurysm repair with a tube stent graft
e. Endovascular aneurysm repair with a bifurcated stent graft
23) All of the following can explain why some patients with the lower limbs peripheral
arterial disease may have no claudications except:
a. They don’t walk far enough to claudicate
b. The collateral circulation has developed to deliever enough blood top the
lower limb muscles
c. The arterial stenosis isn’t hemodynamically significant to cause symptoms
d. The patient is taking vasodilators
24) Finding a venous ulcer in a patient with chronic venous disease means that the
patient has
a. Incompetent valves of long saphenous veins
b. Saphena varix
c. Incompetent ankle perforators
d. Associated LL chronic ischemia
25) Prevention of DVT for risky patients undergoing major surgery include all of the
following except
a. Ambulation after 48 hours of operation
b. Active leg exercises while in bed
c. Graduated compression elastic stockings
d. Intermittent pneumatic compression devices
e. Heparin subcutaneously peroperatively for 5-7 days
26) The investigation of choice in suspected testicular torsion
a. Tecnitium scan
b. Scrotal duplex
c. Scrotal ultrasound
d. CT scan
e. MRI
27) Renal cell carcinoma stage T3b means that the tumour includes
a. The kidney only
b. The kidney and its gerota fascia
c. The kidney within gerota fascia and venous extension to IVC below
diaphragm
d. The kidney , its gerota’s fascia and ipsilateral suprarenal gland
e. The kidney , its gerota’s fascia and nearby organs
28) In male infertility, testicular biopsy is indicated in
a. Oligospermia to differentiate obstructive from non obstructive causes
b. Teratospermia to differentiate the cause of increase abnormal forms
c. Asthenospermia to differentiate the cause of decrease sperm motility
d. Azoospermia to differentiate obstructive from non obstructive
causes
29) The most common cause of pediatric obstructive uropathy is
a. Pelvi-ureteric junction obstruction
b. Uretero-vesical junction obstruction
c. Posterior urethral valve
d. Ureterocele
e. Calculi
30) Absolute indications of surgical intervention in benign prostatic hyperplasia
(BPH) include:
a. Moderate symptoms (moderate IPSS score)
b. Recurrent UTI
c. Recurrent attacks of acute retention
d. Hematuria
e. Stone bladder
31) Branchial cleft remenants most often presents with which of the following clinical
problems:
a. Airway obstruction
b. Heamorrhage
c. Malignant degeneration
d. Pain
e. Lateral neck swelling or discharge
32) The sure diagnosis of hirshsprung disease is made by
a. History of delayed passage of meconium
b. Rectal biopsy
c. Barium enema
d. Digital rectal examination
33) Contraindication of pneumatic reduction in infant suspected to have
intussusception include the following
a. Repetitive attacks of colics
b. Passage of red currant jelly stools
c. Air under diaphragm in abdominal x ray
d. Palpable sausage shaped mass
34) Which of the following statments is true of infants with gastrochisis?
a. The defect in the anterior abdominal wall is just lateral to the
umbilicus
b. The contents are included in a peritoneal sac
c. There is a high incidence of associated anomalies
d. Liver usually herniates in the defect
e. It is associated with chromosomal syndromes
35) Anal atresia may occur as part of the following g group of anomalies except:
a. Vertebral body segmentation defect
b. Congenital inguinal hernia
c. Cardiovascular (PDA, VSD)
d. Trachea-esophygeal fistula
e. Unilateral renal agenesis
f. Limb anomaly (radial ray hypoplasia)
36) Blood spread of skin malignancies is commonly found with
a. Basal cell carcinoma
b. Squamous cell carcinoma
c. Malignant melanoma
d. Keratoacanthoma
37) Rhomboid flap is a type of
a. Local flap
b. Regional flap
c. Z plasty
d. Free flap
38) During fetal development, a cleft lip results when the maxillary process fails to
fuse normally with which of the following process(es):
a. Lateral nasal
b. Frontonasal
c. Medial nasal
d. Mandibular
e. All of the above
39) Fracture maxilla is characterized by all of the following except:
a. Eye ecchymosis
b. Elongated midface
c. Retruded midface
d. Malocclusion
e. Ocular dystopia
40) In replantation of an amputated finger, the following(s) should be considered:
a. Don’t clamp bleeding vessel
b. Don’t ligate any vessel
c. Don’t perfuse any vessel
d. Finger can survive upto 30 hours cold ischemia
e. All of the above
41) Indication for interference in hemangiomas is
a. In hidden areas and deep lesions
b. Lesions in the field of the vision
c. Infected lesions
d. Slowly growing lesions
42) A patient develops cyanosis and edema of the toes following closes manipulation
and casting for fractures of both bones of leg. The main line of treatment will be:
a. Give anticoagulant
b. Elevation of the limb
c. Change to below knee cast
d. Splitting the cast
e. Application of ice packs with intravenous antibiotics administration
43) The last step in fracture healing is
a. Hematoma formation
b. Consolidation
c. Bone remodeling
d. Callus formatiomn
e. Bone demineralization
44) Commonest malignant tumour in bone is
a. Osteosarcoma
b. Aneurysmal bone cyst
c. Giant cell tumour
d. Metastasis
e. Multiple myeloma
45) Open oblique fracture of tibia with severe soft tissue injury is best managed by
a. Open reduction and internal fixation with plate and screws
b. Locked intramedullary nailing
c. Patellar weight bearing cast
d. External fixator
e. Above knee cast
46) Enchondroma
a. of high malignant potential if solitary
b. mainly affecting long bones especially, the femur and tibia
c. mainly presenting with pain that responds well to salicylates
d. typically protruding beyond the cortex in plain X ray
e. treated by curettage or excision with bone graft
47) The following is true regarding sudeck’s atrophy
a. This is a form of reflex parasympathetic dystrophy
b. Decrease blood flow to paraarticular areas
c. There are severe burning pain and swelling of the hand due to muscle
hypertrophy
d. Osteoporosis of carpal and metacarpal bones
e. Treated by parasympathectomy
48) Bimalleolar and trimalleolar pott’s fracture of the ankle are treated by:
a. Below knee plaster cast for 6 weeks
b. Above knee plaster cast for 6 weeks
c. External fixation
d. Open reduction and fixation of the fractured malleoli and posterior margin
by tension wires
e. Open reduction and fixation of the fractured malleoli and posterior
margin by screws
49) For early diagnosis of acute hematogenous osteomyelitis we used:
a. Plain X-ray
b. Bone scan
c. MRI
d. U/S
e. Aspiration of pus from subcutaneous space
50) Treatment of congenital dislocation of the hip (CDH) of a baby up to 6 or 9
months is:
a. Conservative
b. Pavlik hareness
c. Closed reduction under GA, followed by hip spicca
d. Open reduction with femoral or pelvic osteotomy
e. Open reduction without femoral or pelvic osteotomy
51) In ankle sprain, surgery is indicated in:
a. Mild ankle sprain
b. Sprain with pain, swelling, ecchymosis
c. Sprain with focal tenderness and swelling over involved ligament
d. Severe sprain of distal talofibular ligament that widens the ankle
mortis
52) Shoulder impengiment and rotator cuff tears are diagnosed by:
a. Hawkin’s impengiment test
b. Neer impengiment test
c. Painful arc sign
d. Empty can test
e. All of the above
53) The first radiological investigation for cerebrovascular stroke patients is:
a. CT scan
b. MRI brain
c. Cerebral amgiography
d. Electroencephalogram (EEG)
e. Non of the above
54) Wrist drop occurs with injury of which nerve:
a. Axillary nerve
b. Ulnar nerve
c. Median nerve
d. Radial nerve
55) Congenital hydrocephalus is most commonly caused by which one of the
following maternal infections:
a. Rubella
b. Toxoplasmosis
c. Influenza
d. HIV
e. Group B streptococci
56) Management of brain abscess should not include:
a. Lumbar puncture with culture and sensitivity
b. Gadolinium enhancement for MRI
c. Aspiration
d. Excision
e. Corticosteroids
57) Fractures of the base of the skull of the middle cranial fossa is characterized by:
a. CSF rhinorrhea
b. Brain matter may escape into the nose or pharynx
c. Escape of CSF and blood from the ear (otorrhea)
d. Extravasation of blood producing an boggy swelling or discoloration at the
nape of the neck
58) Extradural hematoma is diagnosed (characterized by)
a. CT revealed that the hematoma is concavoconvex (crescentric)
b. CT revealed that the hematoma is biconvex (lenticular)
c. Persistent loss of consciousness with no lucid interval
d. Commonly bilateral and extensive
59) In patients who present with a penetrating chest injury, injury to the heart is most
likely when the following physical sign(s) is/are present:
a. Hypotension
b. Distended neck veins
c. Decreased heart sounds
d. Widening of mediastinum in plain x ray chest
e. All of the above
60) Treatment of acute empyema when the fluid collects rapidly of if pus becomes
thick is:
a. Repeated aspiration with antibiotics according to culture and sensitivity
b. Closed drainage through an intercoastal chest tube
c. Open drainage by rib resection
d. Decortication