1

Vascular
1. About Claudication which of the following statements are true?

a. Intermittent claudication may be present at rest.

b. Intermittent claudication is commonly relieved by getting out of bed.
c. Intermittent claudication is most commonly felt in the calf.
d. Intermittent claudication distance is usually inconsistent on a day-to-day basis for a
given patient.
e. Intermittent claudication is thought to be due to nerve compression in the leg muscle
compartments.

2. About Investigations the following statements are true except?

a. Doppler ultrasound works on the basis of a frequency shift when sound waves hit
moving red blood cells.
b. ABPI means ‘ankle brachial pulsatility index.
c. An ABPI of greater than 0.9 is probably normal.
d. Duplex scans are a combination of wave form analysis and B-mode ultrasound.
e. Carotid surgery is often performed on the basis of duplex scans without further imaging.

3. Drugs which of the following drugs have been shown to improve claudication?

a. Beta-blockers
b. Aspirin
c. Oxpentifylline
d. Simvastatin
e. Prostacyclin.

4. Gangrene; which of the following is not a cause?

a. Buerger’s disease
b. Infection
c. Intra-arterial drug injection
d. Frostbite
e. Deep vein thrombosis insufficiency.

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5. About amputation, which of the following are not an indication for major
amputation?

a. Clostridium infection of the lower leg.

b. Severe trauma
c. Neurofibroma
d. Knee flexion contracture
e. Severe rest pain without gangrene.

6. In acute ischaemia pain is more prominent in:

a. At the site of obstruction
b. Most proximal part of the limb
c. Most peripheral part of the limb
d. All of the above

7. Indications of amputation include all the following except:

a. Fixed color changes
b. Absent pulsation
c. Tense calf
d. Bulging anterior leg compartment

8. about embolism, all the following are true except:

a. Young age
b. No collaterals
c. Trophic changes
d. The source of emboli may be undetectable

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9. The most urgent aspect in treatment of arterial embolism is:

a. Digitalis
b. Heparin
c. Morphine
d. Diuretics

10. The action of heparin in arterial embolism is to:

a. Deal with cardiac problem
b. Prevent propagation of thrombosis
c. Prevent further embolization
d. All of the above

11. In a traumatized patient showing signs of fracture and acute ischemic:

a. Urgent repair of the affected vessel
b. Urgent ligation of the affected vessels
c. Reduction of the fracture and waiting for return of pulse is the I st step
d. None of the above

12. Arterial embolism may result from:

a. Atherosclerosis
b. Bone fracture
c. Parasites
d. All of the above

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13. The most common cause of fat embolism is:

a. Weight gain
b. Weight loss
c. Bone fracture
d. None of the above

14. The most common site of arterial embolism

a. Common carotid artery
b. Brachial artery
c. Femoral artery
d. Popliteal artery

15. About acute arterial thrombosis all the following ore true except:
a. Old age
b. History of chronic ischemia
c. No collateral
d. There may be history of diarrhea

16. Sure signs of arterial injury include all the following except:
a. Signs of ischemia
b. Evidence of adjacent nerve injury
c. Pulsating hematoma
d. Palpable thrill at the site of injury

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17. In trauma causing arterial spasm treatment may include:

a. Pointing the artery with papaverine
b. Excision and grafting
c. Dilatation by Fogarty catheter
d. All of the above

18. Management of complete arterial rear may include all the following except
a. Dissection of the artery
b. Cut the minor bronchus
c. Suturing in transverse suture line
d. Saphenous grafting

19. About crush syndrome there will be

a. Alkaline urine
b. Small % of patient develops acute renal failure
c. Small % of the developed renal failure will need dialysis
d. Hypovolemic shock

20. Which of the following regarding varicose veins are true?

a. Varicose veins may cause venousclaudication.

b. Varicose veins may be associated with the fOXC2 gene.
c. The prevalence of varicose veins is twice as common in women than in men.
d. Right leg varicose veins are more common than left leg varicose veins.
e. Handheld Doppler provides an accurate assessment of saphenopopliteal
competence.

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21. Which of the following statements regarding lymphoedema are true?

a. Primary lymphoedema occurs in more than 5 per cent or the population.

b. Early treatment is usually successful.
c. Early treatment includes surgical drainage.
d. Fluid is relatively low in protein in lymphoedema.
e. Lymphoedema often involves the muscle compartments.

22 . Which of the following is not a risk factor for lymphoedema?

a. Limb surgery (e.g. varicose vein operation)

b. Obesity
c. Family history
d. A Baker’s cyst
e. Air travel.

23. A 55-year-old woman gives a history of tiredness, aching, and a feeling of heaviness in the
left lower leg for the past 3 months. These symptoms are relieved by leg elevation. She is also
awakened frequently by calf and foot cramping, which is relieved by leg elevation, walking, or
massage. On physical examination there are superficial varicosities, non pitting edema, and a
slightly painful, 2 cm. diameter superficial ulcer 5 cm. above and behind the left medial malleolus.
What is the most appropriate diagnosis?

a. Isolated symptomatic varicose veins.

b. Superficial lymphatic obstruction.
c. Deep venous insufficiency.
d. Arterial insufficiency.
e. Incompetent perforating veins.

24. The best treatment plan for the patient described in the preceding question should
include:

a. Varicose vein ligation and stripping as soon as possible.

b. Ulcer debridement, vein stripping, and skin grafting.
c. Ligation of the medial perforating veins.
d. Transposition of saphenous vein valve.
e. Leg elevation, external support, and ambulation without standing.

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25. In patients who develop a documented episode of deep venous thrombosis (DVT) the most
significant long-term sequale is:

a. Claudication.
b. Recurrent foot infection s.
c. Development of stasis ulcer.
d. Pulmonary embolization.
e. Diminished arterial perfusion.

26. A 28-year-old woman developed a painful thrombosis of a superficial varix in the left
upper calf 2 days previously. After spending the 2 days in bed with her leg elevated, she felt
better and the tenderness resolved; however, when out of bed she developed a twinge of
right-sided chest pain when walking and a feeling of heaviness in the calf. Which treatment is
most appropriate?

a. Check for leg swelling, tenderness, and Homan's sign, and obtain a Doppler ultrasound study.
b. Begin antibiotics for a probable secondary bacterial infection.
c. Order emergency venography, and if it is abnormal, begin heparin administration.
d. Begin ambulation and discontinue bed rest that probably caused muscle pain by hyperextension of the
knee.
e. If there is no pain on dorsiflexion of the left foot reassure her, since a negative Homan's sign precludes the
diagnosis of DVT.

27. In a 55-year-old grocery store cashier with an 8-month history of leg edema increasing over the
course of a work day, associated with moderate to severe lower leg bursting pain, the most
appropriate investigative study or studies are:

a. Doppler duplex ultrasound.

b. Brodie-Trendelenburg test.
c. Ascending and descending phlebography.
d. Measurement of ambulatory and resting foot venous pressure.
e. Venous reflux plethysmography.

28. In an otherwise healthy male with previously normal pulmonary and cardiac function,
how much of the pulmonary vascular bed must usually be occluded to produce an unstable
cardiovascular state (shock)?

a. 10%.
b. 20%.
c. 40%.
d. More than 50%.

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29. Lytic therapy in pulmonary embolism:

a. Should precede anticoagulation.

b. Can be considered for all patients.
c. Can be considered for hemodynamically unstable patients.
d. Is indicated for the majority of patients with documented pulmonary embolism.

30. The single most important indication for emergency pulmonary embolectomy is:

a. The likelihood of another episode of embolism.

b. The inability to determine whether the problem is acute pulmonary embolism or
acute myocardial infarction.
c. The presence of persistent and in tractable hypotension.
d. Pulmonary emphysema.

31. In prevention of the fat emboli syndrome the primary therapy can be
accomplished by which of the following?

a. Systemic anticoagulation achieving a partial thromboplastin time greater than 50

seconds.
b. Intravenous administration of alcohol.
c. Prophylactic administration of methyl prednisolone.
d. Maintaining a serum albumin value greater than 3 gm. per 100 ml. in the days
immediately following injury.

32. Significant tachypnea and hypoxia follow development of fat emboli

syndrome, and the goal of ventilatory support should be:

a. Keeping the respiratory rate below 30.

b. Preventing respiratory alkalosis.
c. Reversing pulmonary shunting using positive end-expiratory pressure.
d. Maintaining an adequate total volume.

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33. Which of the following statements correctly characterizes the healing of

prosthetic arterial grafts in humans?

a. Complete healing occurs within 3 months of graft implantation.

b. Complete healing occurs within 1 year of graft implantation.
c. Prosthetic grafts do not heal completely in humans.
d. Polytetrafluoroethylene (PTFE) grafts heal completely whereas Dacron grafts do
not.
e. Dacron grafts heal completely but PTFE grafts do not.

34. Which of the following con firms the diagnosis of transection of the descending
thoracic aorta?

a. Widened mediastinum.
b. Fractured first rib.
c. Left pleural effusion.
d. Positive aortogram.
e. All of the above.

35. When complications occur after operating on a descending thoracic aorta,

perhaps the most devastating is:

a. Recurrent nerve injury.

b. Bleeding with hemothorax.
c. Paraplegia.
d. Renal insufficiency.

36. The most common risk associated with carotid artery aneurysm is:

a. Thrombosis of the aneurysm.

b. Embolization of mural thrombus.
c. Rupture of the aneurysm.
d. Compression of the hypopharynx.

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37. The cause of subclavian arterial aneurysms is most often:

a. Sepsis.
b. A congenital defect.
c. Atherosclerosis.
d. Fibromuscular dysplasia.

38. Of the visceral aneurysms, which is the most common?

a. Celiac.
b. Superior mesenteric.
c. Hepatic.
d. Splenic.

39. Aneurysms of the renal artery are most common:

a. At its origin from the aorta.

b. In the main renal artery or the bifurcation in to th e primary branches.
c. Within the kidney.

40. An aortic abdominal aneurysm was first successfully resected by:

a. Matas.
b. Linton.
c. Dubost.
d. Non e of the above.

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41. Evaluation of the natural history of abdominal aortic aneurysms in patients

who are followed without any surgical procedure indicates that:

a. Approximately 20% are alive at the end of 5 years.

b. Seventy-five per cent of patients succumb by the end of the first year.
c. Aortic rupture is quite common in this group, occurring in more than half by the
second year.
d. None of the above.

42. The appropriate treatment in most situations of an aortic abdominal graft that
has become infected is:

a. Intravenous antibiotics and observation for future complication s.

b. Catheter drainage at the site of infection.
c. Replacement of the infected graft with another prosthetic graft.
d. Excision of the entire graft and insertion of ax illobifemoral grafts.

43. In a patient with an abdominal aortic aneurysm and a history of several previous
abdominal procedures for release of dense peritoneal adhesions causing episodes
of intestinal obstruction, consideration should be given to which one of the
following at operation?

a. Cardiopulmonary bypass.
b. An incision from the xiphoid process to the symphysis pubis.
c. Incision in the left flan k with a retroperitoneal approach.
d. An axillobifemoral graft.

44. The incidence of inflammatory aortic abdominal aneurysms with dense periaortic
adhesions and possible involvement of adjacent structures such as the duodenum,
renal vein, and ureter is approximately:

a. 2%.
b. 10%.
c. 25%.

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45. Carotid artery occlusive disease most often produces transient ischemic
attacks or stroke by which of the following mechanisms?

a. Reduction of flow to the affected area of the brain through stenotic or occluded
vessels.
b. Embolization of atheromatous debris and/or clot with occlusion of intracranial
branches of the carotid artery.
c. Thrombosis and propagation of the clot into the intracranial branches.
d. All of the above are equally common.

46. Which of the following does not describe intermittent claudication?

a. Is elicited by reproducible amount of exercise.

b. Abates promptly with rest.
c. Is often worse at night.
d. May be an indication for bypass surgery.

47. In terms of long-term graft patency, the best results in the femoral tibial bypass
position have been achieved with:

a. A modified human umbilical cord graft.

b. Polytetrafluoroethylene (PTFE [Gore-Tex]).
c. Saphenous vein allograft.
d. Segments of greater and lesser saphenous and cephalic veins spliced together.

48. Which of the following statements about femoral popliteal bypass grafting is/are
true?

a. Lon g-term graft surveillance by duplex scanning has no effect on graft patency
rates.
b. Graft failure and amputation occur in half the patients within 5 years.
c. If grafting is successful, long-term mortality is improved.
d. Patency rates of 80% to 90% at 1 year currently are expected.

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49. Which of the following statements about percutaneous renal artery transluminal angioplasty
(PRTA) are true?

a. Patients with renovascular hypertension are usually cured after successful PRTA.
b. Patients with renovascular hypertension due to atherosclerosis are more likely to benefit
from PRTA than those in whom it is due to fibromuscular dysplasia.
c. PRTA of ostial atherosclerotic lesions is more successful than PRTA of nonostial lesions.
d. PRTA is associated with a higher morbidity and mortality than angioplasty for peripheral
vascular disease.

50. Which of the following statements are true?

a. All arterial injuries are associated with absence of a palpable pulse.

b. Preoperative arteriography is required to diagnose an arterial injury.
c. The presence of Doppler signals indicates that an arterial in jury has not occurred.
d. Patients with critical limb ischemia have paralysis and paresthesia.
e. In all patients with multiple trauma, arterial in juries should be repaired before other injuries
are addressed.

51. A patient presents with a gunshot wound of the mid-neck. Although drunk, he exhibits no
lateralizing neurologic signs. After control of his airway is achieved, he is taken directly to the
operating room for control of hemorrhage. The common carotid artery has a 2-cm. destroyed
segment. There is also a major esophageal injury. The best treatment for this carotid injury is:

a. Vein graft replacement of the common carotid artery.

b. Ligation of the common carotid artery.
c. Ligation of the common carotid artery proximally with a subclavian carotid bypass.
d. Ligation of the common carotid artery with sympathectomy.
e. Prosthetic graft replacement of the common carotid artery.

52. A 35-year-old man involved in a motor vehicle accident presents with a knee
dislocation that is easily reduced. Radiography of the knee shows no fracture. Which of the
following statements about h is treatment are true?

a. If he has normal pulses he can be discharged.

b. If he has normal pulses he requires either close observation or arteriography.
c. If he has absent distal pulses and severe ischemia he should undergo arteriography in the
radiology suite.
d. A popliteal vein injury is best treated with ligation.
e. A popliteal artery injury should be repaired with the ipsilateral saphenous vein if available.

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53. A 24-year-old man is involved in an industrial accident in which he sustains a

crushed pelvis. Diagnostic peritoneal lavage is positive. At exploration, a large pelvic
hematoma is found. What is the best treatment?

a. Explore all the major arteries and veins of the pelvis and surgically control the
bleeding if possible.
b. Do not explore the pelvic hematoma. Close the abdomen and apply a MAST suit.
c. Do not explore the pelvic hematoma. Apply a pelvic fixator and send the patient
to radiology f or possible embolization of bleeding pelvic vessels.
d. Use sustained hypotensive anesthesia to try to control bleeding.
e. Open the pelvic hematoma and apply laparotomy pads with topical hemostatic
agents.

54. Which of the following statements about acute arterial occlusion today is/are not
true?

a. Most arterial emboli originate in the heart as a result of underlying cardiac

disease.
b. It can be treated under local anesthesia.
c. It is usually due to atherosclerotic disease.
d. Surgical treatment can usually be avoided if the lesion is diagnosed early.

55. Which of the following statements about lytic agents is/are true?

a. They were first introduced well after the advent of balloon embolectomy.
b. Streptokinase is nonantigenic.
c. Systemic use is the most effective means of delivery.
d. The interval to reperfusion limits their utility in the treatment of advanced
ischemia.

56. Which of the following is not an indication for postoperative heparinization ?

a. Suspected venous thrombosis.

b. Risk of embolism following acute myocardial infarction.
c. Advanced ischemia secondary to acute embolic occlusion.
d. Dissolution of residual thrombus after balloon thromboembolectomy.

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57. Which of the following is/are not true of the embolectomy catheter technique?

a. The balloon should be inflated by the same person who withdraws the catheter.
b. Distal exploration should be carried out in all major branches of the affected
extremity.
c. The balloon is designed to dilate as it traverses areas of luminal narrowing.
d. Removal of adherent thrombus requires alternate catheter-based therapy in
addition to balloon exploration.

58. Which of the following is the least reliable indicator of successful thrombectomy?

a. Vigorous back-bleeding after removal of thrombotic material.

b. Arteriographically demonstrated patency of all runoff vessels.
c. Normal distal pulses.
d. Return of normal skin color and temperature.

59. A 21-year-old woman presents with digital color changes in response to cold
stimulation. Physical examination and laboratory data, including an autoimmune
disease screen, are normal. She should be advised that:

a. Her condition is characteristic of vasospastic Raynaud's syndrome and, while

she may be at a slightly higher risk for developing a connective tissue disease in
the future, there is no evidence of one currently.
b. Her problem with her fingers will get progressively worse and she will eventually
lose fingers.
c. She has scleroderma, which will manifest itself at a later date.
d. Her problem is “all in her head.”

60. Obstructive Raynaud's syndrome can be differentiated from vasospastic Raynaud's

syndrome by the:

a. Ice water test.

b. Digital hypothermic challenge test.
c. Antinuclear antibody levels.
d. Digital blood pressure measurement.

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61. The most dangerous DVT which requires the longest period of treatment:

a. Calf vein DVT

b. Femoral vein DVT
c. Ileofemoral DVT
d. All of the above

62. Which of the following statements about upper extremity edema is/are true?

a. Lymphedema is more common than venous edema.

b. Signs and symptoms of venous obstruction include edema, distention of
superficial veins, tightness, aching, cyanosis and pain.
c. Distal venous obstructions are more likely than proximal venous obstructions to
cause symptoms in the upper extremity.
d. All patients with symptomatic upper extremity venous thrombosis should receive
fibrinolytic therapy.

63. Which of the following statements about chronic mesenteric ischemia due to
atherosclerosis is/are correct?

a. Postprandial pain in these patients is due to gastric hyperacidity and in most

cases is relieved with H 2 blockers.
b. Men are more often affected than women.
c. Mesenteric endarterectomy is the surgical treatment of choice, since long-term
patency rates are superior to mesenteric bypass.
d. Arteriography is no longer necessary in these cases since noninvasive
diagnosis can be established using duplex ultrasound scanning.
e. Surgical treatment is indicated to prevent intestinal infarction in symptomatic
patients.

64. Which of the following statements about angiotensin II is correct?

a. It is a decapeptide.
b. It is an enzyme found in high concentration in the pulmonary circulation.
c. It is a direct vasoconstrictor and stimulates aldosterone production.
d. It is a vasoconstrictor and inhibits aldosterone secretion.

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65. Which of the following statements about atherosclerotic obstruction of the renal arteries
is true?

a. Lesions are usually short.

b. These lesions are usually found in the distal renal arteries, particularly just beyond
branch points.
c. Ostial lesions are best treated with balloon angioplasty.
d. Lesion s of this type are the second most common cause of renal artery stenosis.

66. Which of the following statements about the treatment of renal artery stenosis is/are true?

a. Though a significant cause of hypertension, renal artery stenosis seldom results in loss
of renal function.
b. In patients with medically controlled renovascular hypertension there is no need to
consider revascularization.
c. Balloon angioplasty is more effective in patients with atherosclerotic disease as
compared with those with fibromuscular disease.
d. In patients with severe atherosclerosis of the aorta, bypass from the splenic or hepatic
arteries should be considered.

67. All but one of the following statements is true. Which is not true?

a. Successful clinical repair of injured veins had been affected by the turn of the twentieth
century.
b. Initial large experience in managing injured vein s came from the battlefields of
twentieth-century wars.
c. More than 50% of repaired injured veins thrombose.
d. Phlebography is useful in evaluating variable venous anatomy.
e. Repeated phlebography following attempted venous repair is useful in determining the
success rate.

68. Concerning in-vivo regulation of the anticoagulated state by endothelium, the following
is/are true:

a. Heparin-ATIII inactivates only thrombin

b. Thrombomodulin serves only to bind thrombin
c. Production of von Willebrand factor (VWF) inactivates platelets
d. Endothelial cells can secrete tissue factor

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69. Ten years after irradiation of the neck for a tonsillar carcinoma, a 59-year-old
woman is found to have symptomatic carotid artery disease. Arteriogram shows a 70%
irregular stenotic lesion. The following is/are true:

a. Replacement of the artery should be planned due to radiation induced arterial injury
b. The pathology is most likely to be an inflammatory reaction with endothelial
sloughing and thrombosis
c. If atherosclerotic disease is found, the plaque will be no different than nonirradiated
plaques
d. The patient should be managed medically because of the radiation arterial in jury

70. A 23-year-old woman with fever, myalgia and anorexia presents with hypertension
and a cool, ischemic left arm. Angiography shows multiple stenoses of the subclavian and
renal arteries. The following is/are true:

a. Coronary angiography is indicated with high likelihood of finding coronary disease

b. Endarterectomy of the lesions would be preferred to transluminal angioplasty
c. The presentation is more suggestive of Behcet’s disease than Takayasu arteritis
d. Preferred management consists of corticosteroids

71. Concerning the fibrinolytic system the following is/are true:

a. Plasminogen is an a-globulin
b. Fibrin but not fibrinogen is lysed by plasmin
c. The main inhibitor of plasmin is a2-macroglobulin
d. TAP is activated during fibrin bonding to plasminogen

72. An 82-year-old man with a long history of coronary and peripheral vascular disease
presents with an acutely ischemic right lower extremity. The following is/are true:

a. The first step in management should be an arteriogram

b. If intractable congestive heart failure is present, non-operative treatment with
heparin would be appropriate
c. If prolonged ischemia has occurred, reperfusion should be accompanied by sodium
bicarbonate
d. Regardless of the period of ischemia, fasciotomy should be based on the findings
postoperative

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73. Two days following coronary angiography and angioplasty, a 47-year-old male diabetic
develops painful blue toes on both feet. The following is/are true:

a. It is very unlikely that there is any connection between the catheterization and the
extremity problem
b. The appropriate treatment is vasodilators and an antiplatelet agent
c. If both superficial femoral arteries are obstructed, the most likely etiology is in-situ
microvascular thrombosis
d. If renal failure or pancreatitis develops, the outlook for long term survival is very poor

74. A 70-year-old man presents with sudden pain and ischemic changes in his left leg.
An arterial embolus is suspected. The following is/are true:

a. The most likely source of an arterial embolus is from intracardiac thrombus on a

previous MI
b. If atrial fibrillation (AF) is present, it is known that chronic AF is less likely to produce
embolism than paroxysmalAF
c. Currently, the most common cause of AF is ischemic rather than rheumatic heart
disease
d. Aspirin is more effective than Coumadin in AF for reducing risk of stroke and
cardiovascular mortality

75. 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

76. Which of the following is/are appropriate candidates for exercise testing?

a. The patient with symptoms of intermittent claudication but normal resting ankle
brachial indices
b. The patient with rest pain, non healing ulcers or gangrene
c. If the resting ankle pressure is below 30–40 mmHg
d. The patient with blue toe syndrome and readily palpable pedal pulses

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77. Which of the following statements is/are true regarding the use of duplex
scanning as a means to follow and monitor bypass grafts?

a. Duplex scanning is accurate and cost effective

b. A localized increase in systolic velocity greater than 2 5% compared to adjacent
segments in the graft identifies a diameter reduction of at least 50%
c. Peak systolic velocities should be less than 40 cm/sec throughout the graft
d. Arterial venous fistulas associated with in situ bypass grafts are difficult to detect
with a duplex scanner

78. Which of the following is/are true with respect to hypertension?

a. There is a threshold effect of blood pressure on the risk of cardiovascular

complications
b. The risk of hypertension is essentially con fined to stroke
c. Common antihypertensive regimens may have adverse effects on a patient’s lipid
profile
d. Aggressive blood pressure reduction in patients with ischemic heart disease may
increase mortality and morbidity

79. Which of the following is/are true regarding treatment of diabetes?

a. Strict control with insulin but not oral hypoglycemic agents markedly reduces
the incidence of cardiovascular complications in diabetic persons
b. Vascular complications are directly proportion al to the degree of glycemic
control
c. The effects of diabetes are most marked in individuals with other risk factors
d. The impact of diabetes and cardiovascular risk is relatively uniform

80. Pressure in superficial veins of the leg during standing:

a. 60 mmHg
b. 70 mmHg
c. 80 mmHg
d. 90 mmHg

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81. Superficial thrombophelbitis may complicate:

a. Varicose veins
b. Trauma
c. Abscess
d. All of the above

82. About thrombophlebitis migrans:

a. It resolves spontaneously and reappear in another area
b. It is common with Burger's disease
c. It is common with visceral malignancy
d. All of the above

83. About phlegmasia cerulae dolens all the following ore true except:
a. There is massive iliofemoral DVT
b. Severe congestion and cyanosis of lower limb
c. Treated by anticoagulants
d. May lead to venous gangrene

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Neurosurgery
1. A 43-year-old man experiences lower back pain after lifting a heavy object off the
ground. The following morning, he notices that the pain has begun to radiate down the
posterolateral aspect of the right leg and across the top of the foot to the big toe. The pain
is severe, electric in quality, associated with paresthesia over the same distribution, and
made worse by coughing. On examination, it is found that he has an area of diminished
sensation to pinprick over the dorsum of the right foot and mild weakness in his right
extensor hallucis longus muscle. The deep tendon reflexes are all intact. What is the most
likely diagnosis?
(A) Lumbar spinal fracture with compression of the caudaequina
(B) Herniated lumbar disk on the right at the level of L4–L5
(C) Herniated lumbar disk on the left at the level of L4–L5
(D) Herniated lumbar disk on the right at the level of S1–S2
(E) Intermittent claudication

2. A 48-year-old woman has a lower back pain and hypoesthesia in the left S1 dermatomal
distribution (left calf and lateral left foot). What is the most likely cause?
(A) A lesion at the right L4–L5 interspace
(B) Pathology where the nerve exits the spinal canal immediately above the pedicle of S3
vertebra
(C) A herniated nucleus pulposus
(D) Compression by the L5 lamina
(E) A lesion outside the vertebral column

3. A 35-year-old secretary complains of severe pain in the neck that radiates down the
right arm. The pain is electric in quality and affects specifically the radial aspect of the right
forearm and the thumb. She also describes numbness and paresthesia over the same
distribution. On physical examination, she is found to have an area of diminished
sensation to pinprick over the right wrist and thumb. The right biceps tendon reflex is
diminished, but there is no loss of muscle strength. She has right C5–C6 disk compression
and radiculopathy affecting which of the following?
(A) The right C4 root
(B) The right C4 mixed spinal nerve
(C) The right C4 anterior primary rami
(D) The right C6 root
(E) The right C6 spinal ganglion

4. A 57-year-old woman presents to the emergency department with new-onset seizures.

She was witnessed by her husband to have a generalized seizure lasting approximately 1
minute. She has smoked 1 pack of cigarettes a day for over 40 years. In the past 3 months,
she has lost 25 lb in weight. On examination, she appears thin and nervous but findings on
her neurologic examination are otherwise essentially within normal limits. Plain
radiographs of the chest obtained in the emergency department show a 4-cm nodule in
the upper lobe of her right lung. To exclude cerebral metastasis as a cause of her seizure,
what should the next test requested be?
(A) An electroencephalogram (EEG)
(B) A CT scan of the brain with intravenous contrast
(C) Aspinaltap to measure opening pressureand obtain CSF for cytology
(D) An MRI of the brain with intravenous contrast
(E) Doppler ultrasound
1 2 3 4
B C D D
 164

5. A 64-year-old man presents with headache and left-sided upper extremity

weakness. The MRI findings suggest that this is a glioblastomamultiforme. This is
because the tumor exhibits which of the following?
(A) It is regular in shape.
(B) It is well demarcated from surrounding brain tissue.
(C) It shows a ring pattern of enhancement with intravenous contrast and has a
nonenhancing necrotic center.
(D) It shows an absence of surrounding white-matter edema.
(E) It arises from the carotid body

6. A 63-year-old woman presents for workup to determine the reason for a gradual
hearing loss over approximately 5 years and intermittent tinnitus over the last
several months. Findings on physical and neurologic examination are
entirely within normal limits, except for the presence of sensorineural hearing loss
in the left ear. She has no cranial nerve deficits. An MRI of the brain with
gadolinium reveals the presence of an extra-axial tumor in the region
of the left cerebella-pontine angle. What is the most likely diagnosis?
(A) Epidermoid tumor (cholesteatoma)
(B) Glioblastomamultiforme
(C) Meningioma
(D) Acoustic neuroma
(E) Glomus tumor

7. In the management of a 64-year-old woman struck by a car, mannitol is given to

do which of the following?
(A) Increase CSF formation
(B) Increase the respiratory rate
(C) Increase the pulse rate
(D) Replace extensive fluid loss
(E) Lower raised ICP
8. Following a sudden impact in an accident, the 34-year-old race car driver
becomes unconscious and is admitted to the hospital. A CT scan is performed, and
a right space-occupying lesion is noted (Fig. 11–1). What is the most likely
diagnosis?
(A) Corpus callosum injury
(B) Pituitary apoplexia
(C) Acute subdural hematoma
(D) Acute epidural hematoma
(E) Chronic subdural hematoma

5 6 7 8
c D E C
 165

9. A 64-year-old woman complains of gait imbalance, headache and deterioration

of mental status over the past several months. Her vision is normal. A CT scan
reveals hydrocephalus, but the lumbar puncture pressure is unexpectedly low.
What does she have?
(A) Meningitis
(B) Normal-pressure hydrocephalus
(C) Sigmoid sinus thrombosis
(D) Echinococcus
(E) Glioblastoma multiforme

10. A 23-year-old woman complains of progressive loss of vision and papilledema.

Investigations show normal findings on CT scan. A lumbar puncture shows marked
elevation of pressure. What is the most likely diagnosis?
(A) Pseudotumorcerebri
(B) Corpus cavernous thrombosis
(C) Cavernous sinus thrombosis
(D) Retinoblastoma
(E) Chordoma

11. During her eighth month of pregnancy, a 29-year-old woman is noted to have
hydramnios. Further testing shows anencephalus. In this case hydramnios is
caused by which of the following?
(A) Impairment of the fetus’s swallowing mechanism
(B) Tumor of the fetus’s brain
(C) A secretory peptide from the placenta
(D) Excess antidiuretic hormone (ADH) from the fetus
(E) Renal agenesis

12. A 28-year-old man presents with a history of chronic headache. The headache
is intermittent, severe, poorly localized, and most often present when he arises in
the morning. He suffered a severe blow to the head and sustained a skull fracture
at the age of 15. Findings on his physical and neurologic examinations are within
normal limits. An MRI of the brain with gadolinium reveals the presence of a large,
nonenhancing extra-axial cyst in the region of
the right temporal tip. This most likely represents which of the following?
(A) An arachnoid cyst
(B) A cystic astrocytoma
(C) Rathke’s cleft cyst
(D) A Dandy-Walker cyst (failure of proper formation of the foramina of Lushka
and Magendie)
(E) Polycystic disease

9 10 11 12
B A A A
 166

13. A 15-year-old boy complains of right-sided weakness and gait impairment. ACT
scan shows a large, nonenhancing cyst in the posterior cranial fossa, with an
enhancing tumor nodule in the left cerebellum. What is the most likely diagnosis?
(A) An arachnoid cyst
(B) A cystic astrocytoma
(C) Rathke’s cleft cyst
(D) Glioblastomamultiforme
(E) A large sebaceous cyst ans:B

14. A 43-year-old man is treated with pyridostigmine for facial, ocular, and
pharyngeal weakness due to myasthenia gravis. Which statement is true of
pyridostigmine?
(A) It is unrelated to neostigmine.
(B) It has far more side effects than neostigmine.
(C) Pyridostigmine and neostigmine reverse depolarizing neuromuscular blockade.
(D) It causes greater muscarinic effect than neostigmine.
(E) It is an anticholinesterase agentans:E

15. A 17-year-old male presents with 3-month history of headache, weight gain,
decreased concentration, polyuria, and polydypsia. His headaches are mostly in
morning and involvesthe frontal region. On examination he was found to have
bitemporal visual field defect and no facial hair. MRI scan revealed a suprasellar
partially calcified cystic lesion with displacement of optic chiasm. The most likely
pathology is:
(A) Giant aneurysm of carotid artery
(B) Pituitary macroadenoma
(C) Glioblastomamultiforme
(D) Craniopharyngioma
(E) Testicular metastasisans:d

16. He underwent a craniotomy for resection of his lesion. Twelve hours

postoperatively, he developed diuresis of over 500 mL/h. The diagnosis of (DI) was
entertained. What laboratory findings are most consistent with the clinical
impression?
(A) Urine specific gravity of over 1010
(B) Serum sodium of less than 135
(C) Decreased both serum and urine osmoloaity
(D) Increased serum osmolality and decreased urine osmolality
(E) Increased both serum and urine osmolalities

13 14 15 16
B E D D
 167

17. A 45-year-old woman was brought to emergency department for sudden onset
of severe headache associated with photophobia, nausea, and transient loss of
consciousness. On examination, she is awake and alert with normal cranial nerve
function. She also exhibits normal muscle strength and sensation.Her past medical
history is significant for sickle cell disease (SCD) and hypertension. CT scan confirms
the diagnosis of SAH without any intraparenchymal abnormality.
What is the least likely cause of SAH?
(A) Aneurysmal bleed
(B) Sickle cell angiopathy
(C) Arteriovenous malformation (AVM)
(D) Hemorrhagic meningioma
(E) Blood dyscrasia

18. What is the most definitive diagnostic test in this condition?

(A) CT angiography
(B) Magnetic resonance angiography (MRA)
(C) Cerebral angiogram
(D) MR spectroscopy
(E) Positron emission tomography (PET) Scan

19. What is the most likely complication of angiography in this patient?

(A) Cerebral stroke
(B) Aneurysmal rupture
(C) Increased intracranial pressure
(D) Vascular wall damage
(E) Sickle cell crisis

17 18 19
D C E
 173

Cardiothtoracic
l. About etiology of pneumothorax:
a- Spontaneous pneumothorax is always secondary to lung disease
b- Accidental pneumothorax needs a penetrating injury
c- Mechanical ventilation can result in pneumothorax
d- Central venous line insertion is not a reported cause

2. All of the following ore radiological features of pneumothorax

except:
a- Lung collapse on some side
b- Jet black opacity on some side
c- Shift of cardiac shadow to some side
d- Flat diaphragm on some side

3. The main line of treatment in closed pneumothorax without

mediastinal shift is:
a- Chest tube
b- Mechanical ventilation
c- Needle aspiration
d- Conservative treatment

4. The following aid(s) in diagnosis of open pneumothorax

a- Cyanosis
b- Congested non-pulsating neck veins
c- Harsh whistling sound following trauma
d- All of the above

1. C

2. C

3. D

4. D
 174

5. For treatment of pneumothorax intercostals tube is inserted in

a- 5th space of parasternal line
b- 2nd space of parasternal line
c- 2nd space of midclavicular line
d- Any of the above

6. Circulatory failure in open pneumothorax is due to the following

except:
a- Mediastinal flutter
b- Exaggerated negativity of intrathoracic pressure
c- Associated great vessel injury
d- Diminished cardiac function due to respiration failure

7. All of the following are differential diagnoses for sudden chest pain
without shock except:
a- Tension pneumothorax
b- Massive pulmonary embolism
c- Massive myocardial infarction
d- Flail chest

8. The most life threatening chest wall lesion is:

a- Emphysema
b- Tension pneumothorax
c- Flail chest
d- Hemothorax

5. C

6 B
7 D

8 B
 175

9. All ore causes of hemothorax except:

a- Trauma
b- Bronchogenic carcinoma
c- Rupture of emphysematous bullae
d- Anticoagulant therapy
e- Hemophilia

10. About treatment of hemothorax all are correct except:

a- there is no need to decorticate of all
b- Resuscitation and stabilization of general condition has the priority
c- Encysted hemothorax is on indication of thoracotomy
d- Fibrinolysis may prevent clotting giving chance to conservation

11. As regards pathology of hemothorax all are correct except:

a- Blood always coagulates completely
b- Blood is defibrinatned by continuous diaphragmatic motion
c- Hemothorax con result in large hydrothorax by transudation
d- lt can be complicated by fibrothorax or emphysema

12. In flail chest limitation of movement of flail part is done to:

a- Decrease risk of injury to intercostals structure
b- Prevent paradoxical movement and pendulum respiration
c- Prevent mediastinal flutter
d- Decreases pain
e- All of the above

9 C
l0 A
11 A
12 E
 176

13. The following organisms cause a sever type of empyema

complicated by dense adhesions:
a- Staph
b- Streptococci
c- Pneumococci
d- E.Coli

14. All of the following ore indications of open surgical drainage of pus
in acute empyema except:
a- thick pus
b- Rapid recollection of pus
c- Streptococcal empyema
d- Extensive conditions

15. As regards Empyema necessitans all are correct except:

a- ls an encysted empyema
b- Gives expansible impulse on cough
c- Can perforate skin leading to skin sinus
d- is a subcutaneous abscess communicated with empyemic pleura

16. The following ore signs of chronic empyema except:

a- Paroxysmal fever and chills
b- Flattening of diaphragm
c- Sinus in chest wall discharging pus
d- Scoliosis

13 C
14 C
15 A
16 b
 177

17. All of the following ore complications of chronic empyema except:

a- Empyema necessitans
b- Amyloidosis
c- Mesothelioma
d- Toxic arthritis

18. The following factor(s) predispose to chronic empyema:

a- Pulmonary tuberculosis
b- DM
c- Inadequate drainage
d- Bronchogenic carcinoma
e- All of the above

19. About bronchogenic carcinoma all are correct except:

a. Common in old smoker moles
b. Con present by any chest symptom
c. Usually inoperable of diagnosis
d. 5 year old survival rate is 60%

20. During the insertion of a subclavian catheter for hyperelimentation

in a patient with Crohn's disease the patient become dyspneic with a
respiratory role of 32/min, pulse rate of l20/min. and drop of the B.P.
to 80/60. The appropriate immediate action is:
a. Chest X-ray,
b. Lung scan.
c. lntubation ond mechanical ventilation.
d. Chest tube.
e. Vasopressors.

17 C
18 E
19 D
20 D
 178

21. The treatment of choice in flail chest is:

a. Tracheotomy.
b. lntercostal nerve block.
c. Adhesive strapping.
d. Elevation of broken ribs with towel clips.
e. Positive pressure ventilation.

22. Open chest wounds are characterized by the following except that
they:
a. May cause "pendulum respiration".
b. May produce "mediastinal flutter.
c. May be associated with abdominal injuries.
d. Need immediate sealing of the wound.
e. Always require thoracotomy for definitive treatment.

23. Which of the following statements about traumatic haemothorax is

untrue?
a. May absorb spontaneously.
b. May be associated with signs of internal hemorrhage.
c. Cannot be diagnosed radiologically with less than 500 ml of blood.
d. Should be treated by repeated needle aspirations.
e. May require decortications of both lung and pleura.

24. The following statements about spontaneous pneumothorax are

true except that it :
A. May occur in the absence of any pulmonary lesion.
B. is readily diagnosed clinically.
C. Usually resolves spontaneously.
D. May require intercostal catheter drainage.
E .Usually requires exploratory thoracotomy.

21 E
22 E
23 A
24 E
 179

25. ln a case of pleural effusion. The following statements are correct

except that:
a. The diagnosis can be made with as little as 100 ml of fluid.
b. The trachea may be displaced to the opposite side.
c. Aspiration of blood-stained fluid is highly suspicious of bronchogenic
carcinoma.
d. Open biopsy of the pleura is necessary.
e. Rapid aspiration of the fluid is not advisable.

26. Pleural fluid with the appearance of "anchovy sauce” pus is

characteristic of:
a. E. coli.
b. Staph. aureus.
c. Echinococcus.
d. Entomeba histolytica.
e. Hemothorax.

27. The primary treatment of Tuberculous empyema is:

a. Systemic chemotherapy.
b. Aspiration.
c. Closed tube drainage.
d. Open drainage.

25 A
26 D
27 A
 227

PLASTIC SURGERY
1.Themain advantage of Lund and Browder charts over rule of nines is:
a- lt is easier
b- More accuroteto regarding sex of patient
c- More accuroteregarding age of patient
d- All of the above

2. About 3rd degree (full thickness) burn:

a- Completely painless
b- No graft is needed
c- Healing occurs from skin appendages
d- Usually dry, white or block

3.ln the rule of nines:

a- Front of trunk = 27%
b- Head and neck = 18%
c- Each lower limb = I8%
d- All of the above

4.About management of burns:

a- Biological dressing decreases all complications of burn
b- Parkland's formula is a good rule for fluid replacement
c- Occlusive dressing is easier to perform
d- Exposure method is suitable for face and buttocks
e- All of the above

1 2 3 4
C D C E
 228

5.About healing intentions:

a. Ulcers heal by first intention
b. Second intention gives better cosmoses than first
c. First intention occurs on clean cut edges without gaps or tissue loss
d. All of the above

6. All of the followings are factors affecting wound healing:

a. Age of the patient
b. General condition
c. Corticosteroid
d. Type of wound and type of closure
e. All of the above.

7.The most common site for the following diseases is correctly matched except:
a- Keloids :face, neck and skin over sternum
b- Hypertrophic scars :extensor surfaces
c- Hemangiomas:head and neck
d- Basal cell carcinoma:face

8. Langenbeek's repair:
a- lsa method of grafting in burns
b- lsa method of repair after surgical excision of Sq.C.C.
c- lsa method of repair of cleft lip
d- lsa method of repair of cleft palate

5 6 7 8
C E B D
 229

9.About cleft upper lip all ore correct except:

a- Median is the most common
b- Lateral is due to non-fusion of median nasal process (future frenulum) with
maxillary process
c- Lateral is more common on left side
d- Best time for repair is the earliest possible time (3 months)
e- Repair is mainly for cosmetic purposes

10.About cleft palate all are correct except:

a- Usually associated with other congenital anomalies
b- May range from cleft uvulaup to tripartite deformity
c- Causes nasal regurgitation, nasal deformity
d- Best time for repair ls 5 years old

11.The following are subtypes of capillary hemangioma except:

a- Strawberry hemongioma
b- Portwinehemongioma
c- Cirsoid aneurism
d- Salmon Patch

12.A subtype of capillary hemangiomaraised above skin surface:

a- Strawberry hemangioma
b- Portwinehemangioma
c- Salmon patch
d- None ofthe above

9 10 11 12
A D C A
 230

13. First-intention healing of clean incised wounds is characterized by the following

except:
a. An inflammatory reaction during the first few days.
b. Epithelialization within 48 hours.
c. Fibroblastic proliferation and capillary budding during the next week.
d. Region of normal tensile strength within 4 weeks.
e.Production of thin linear scar.

14.Woundhealing is not impaired by

a. Anemia.
b. Hypoproteinemia.
c. Ascorbic acid deficiency.
d. Cortisone administration.
e. lmmunosuppressivetherapy.

15.Metabolicchanges after burning are due to the following except :

a. The endocrine responses to injury.
b. Local fluid loss into the burnt area.
c. Reduced heat loss.
d. lncreased insensible water loss.
e. Bacterialinfection.

16.Themostfrequent gostrointestinalcomplication of an extensive burn is :

a. Acute gastritis.
b. Acute dilatation of the stomach.
c. Curling's ulcer.
d. Paralytic ileus.
e. Diarrhea

13 14 15 16
D A C B
 231

17.The most useful measure in preventing renal shut-down in post burn

patients is:
a. Monitoring an hourly urine output between 30 and 50 ml.
b. Alkalinization of the urine.
c. Mannitoladministration.
d. Administration of colloids.
e. Blood transfusion.

18. Which statement is incorrect concerning electrical burns ?

a. Usually have asmall surface area.
b. Are always superficial.
c. Are often associated with massive muscle necrosis.
d. Moy cause reddish discoloration of the urine.
e. Are best treated by immediate excision and grafting.

19.Keloids ore characterized by the following, except:

a. Consist of dense overgrowth of scar tissue.
b. Develop after wounds, burns and vaccination marks.
c. Are particularly common in negroes and pregnant females.
d. Occur most often on the face. neckand front of the chest.
e. May turn malignant.

20. A paraplegic bed-ridden patient developed a large deep bed-sore over his
sacrum. The best regimen is by wide excision and :
a. Local applications.
b. Thierschgrafting.
c. Wolfe-grafting.
d. Localskin flops.
e. Myocutaneousflap.

17 18 19 20
A B E E
 232

21.lnunilateral hare-lip, the following statements are true except that it:
a. Affects the upper lip only.
b. Moy be partial or complete.
c. ls due to failure to fusion between the maxillary process with the fronto-nasal
process and the maxillary process of the opposite side.
d. lsalways associated with nasaldeformity.
e. Produces no serious speech defects.

22. Concerning complete cleft palate, the untrue statement is that it :

a. ls due to failure fusion of the palatal shelves of the maxillary processes with each
otherand with the frontonasal process.
b. ls often associated with cleft-lip and broadening of the face.
c. lnterferes with nutrtionand speech.
d. Predisposes to upper respiratory tract infections.
e. Requires surgical repair after the second year of life.

23.The most frequent fracture of the face involves the:

a. Zygoma.
b. Maxilla.
c. Orbitalfloor.
d. Nasal bones.
e. Mandible.

24. A 6 year old boy has a 2 cm lesion on Right cheek. The lesion has been
enhancing since birth. On Auscultation lesion is pulsatile, it has a thrill and it has a
harsh sound on auscultation. It has multiple feeding arteries. The best treatment
option for this lesion would be

a) External beam radiotherapy

b) Ligation of the feeding arteries
c) LASER therapy
d) Embolisation followed by surgery

21 22 23 24
E E E D
 233

25. Which of the following is not true about keloids?

a) Keloid is excessive scar formation within and outside the boundaries of skin incision
b) Recurence rate of keloid after excision is 10-20%
c) Exact cause of keloid formation is not known but fibroblast dysfunction is commonly
attributed
d) Adjunctive treatment besides surgery gives the best results

26. Which of the following is true about Langer's line of the skin?

a) These are in the direction of muscle fibres.

b) These are perpendicular to the long axis of underlying muscle fibres
c) Most favourable incision is circular over an exposed area
d) Most favorable incision is a rhomboid shaped one over an exposed area

27. The repair of cleft lip should be done at which age

a) 1 month
b) 3 months
c) 6 months
d) 1 year

28.Fastest promoter of epithelisation in wound healing occurs with

a) Tight approximation of wound edges

b) Occlusive dressing
c) Leaving the wound open
d) Steroid Application

25 26 27 28
B B B B