1.

With regard to total body water, all of the following are true except:

A. 50 to 70% of total body weight is water.

B. In general the percentage of total body weight that is water is higher in males
than in females.
C. Lean individuals have a greater proportion of water (relative to body weight)
than do obese individuals.
D. The percentage of total body weight that is water increases with age.
E. Body water is divided into extracellular (i.e. intravascular and interstitial) and
intracellular functional compartments.

2. With regards to the distribution and composition of the body fluid

compartments, which of the following statement is incorrect:

A. The majority of intracellular water is in skeletal muscle.

B. The major intracellular cation is sodium.
C. The major intracellular anions are the proteins and phosphates.
D. The major extracellular cation is sodium.
E. The major extracellular anions are chloride and bicarbonates.

3. With regard to respiratory acidosis and alkalosis, all of the following

are true except:

A. Respiratory acidosis is associated with an increased denominator of the

Henderson- Hasselbalch ratio that is due to CO2 retention, resulting in a ratio
of less than 20:1.
B. Respiratory alkalosis is associated with a decreased denominator that is due to
a loss of CO2, resulting in a ratio of greater than 20:1.
C. Compensation for respiratory acidosis is primarily renal.
D. Compensation for respiratory alkalosis is primarily pulmonary.

4. With regard to risk factors for breast cancer, one of the following is
true:

A. Incidence does not appear to be age related among those older than age 35
years.
B. Family history is not a major predictor of risk for developing breast cancer.
C. Late first pregnancy increases the risk.
D. Diet and weight have no association with breast cancer risk.
 5. Which of the following thyroid adenomas may in rare instances
behave in a malignant manner:

A. Colloid adenoma.
B. Embryonal adenoma.
C. Fetal adenoma.
D. Hurthle cell adenoma.

6. With regard to the technique of needle aspiration biopsy of the

thyroid, one is true:
A. It is generally contraindicated because of the extremely vascular nature of
the thyroid gland.
B. False positive results are rare.
C. False negative results occur less often than false positive results.
D. There is a 3% risk that cancer cell will implant.
E. Benign versus malignant follicular neoplasm are fairly easily differentiated.

7. With regard to vitamin D physiology, one is true:

A. The major non-dietary source of vitamin D is hepatic synthesis.
B. Hydroxylation of vitamin D3 results in a loss of metabolic activity.
C. Vitamin D decreases intestinal absorption of dietary calcium.
D. Vitamin D has a direct effect on bone resulting in ossification of the bone.
E. Increased level of PTH inhibits the hydroxylation of 25-
hydroxycholiecalciferol in the kidneys.

8. Which of the following is the most important mechanism for

maintaining competence of the gastroeosophageal junction:

A. Intact vagus nerve.

B. Diaphragmatic crural pinch.
C. Angle of the esophageal entry into the stomach.
D. Orientation of muscle fibers of the esophageal sphincter.
E. Intraabdominal segment of the esophagus.

9. With regard to Para esophageal hiatal hernia, all of the following are
true except:

A. Symptomatic gastroeosophageal reflux is the most common complication.

B. Often there is an associated sliding hernia.
C. Large asymptomatic hernia necessitate repair.
D. Surgical treatment usually involves an antireflux procedure.
E. Pain is common.
10. One of the following is true regarding perforated duodenal ulcer:

A. Can be ruled out if pneumoperitoneum is demonstrated.

B. Can be treated non-operatively.
C. Requires a definitive anti ulcer procedure at the time of the operation.
D. Most commonly occur with posterior ulcers.
E. Is a contraindication to parietal cell vagotomy because of the risk of
mediastinal contamination.

General
1.D 2.B 3.D 4.C 5.D 6.B 7.D 8.E 9.A
10.B
1. All the following structures lie in the transpyloric plane except:

A. The neck of the pancreas.

B. The left kidney.
C. The fundus of the gallbladder.
D. Duodenojejunal junction.
E. The celiac trunk.

2. All of the following muscles have attachment to the costal cartilage

except:

A. Pectoralis major.
B. Diaphragm.
C. External oblique.
D. Transversus abdominis.

3. Regarding the sternal angle (angle of Louis) all true except:

A. Marks the demarcation between the superior and inferior mediastinum.

B. Marks the level of the top of the arch of the Aorta.
C. Marks the level of the second costal cartilage.
D. Marks the level where the azygous vein drains into the superior vena cava.
E. Corresponds to the level of intervertebral disc between 4th and 5th thoracic
vertebrae.

4. All of the following veins drain into the left brachiocephalic vein
except:
A. Vertebral.
B. Thymic.
C. Internal thoracic.
D. Left supreme intercostal vein.
E. Superior thyroid.
5. During exercise, all true except:

A. Pulmonary ventilation increases up to a maximum of 10- fold.

B. The depth of ventilation increases before the rate.
C. Oxygen debt can occur up to a maximum of 20 liters.
D. The total peripheral resistance falls.
E. Energy is derived from the local glycogen store rather than from extra
muscular carbohydrate.

6. On ascent to high altitude, all true except:

A. There is increased erythropoieten secretion.
B. Mountain sickness is mainly caused by cerebral edema.
C. The cardiac output is reduced.
D. The oxygen dissociation curve is shifted to the right.
E. Pulmonary edema can occur in the unacclimatized individual.

7. Regarding thyroxin, all true except:

A. Acts via cyclic adenosine monophosphate.
B. Can bind to albumin.
C. Has a half-life of about 7 days.
D. Is mainly metabolized by muscle and liver.

8. All of the following are true regarding absorption in the G.I. tract
except:
A. Active absorption of calcium occurs mainly in the duodenum.
B. Glucose and galactose compete for the same carrier system.
C. Protein may be absorbed as di and tri peptides.
D. Bile acids are predominantly absorbed in the terminal ileum.

9. All of the following are true regarding bile, except:

A. Its electrolyte basis is an alkaline solution resembling that of the pancreatic
juice.
B. The main primary bile acids are colic acid and deoxycolic acid.
C. It is concentrated in the gall bladder.
D. Bile salts entering the colon when the terminal ileum is resected prevent sodium
and water reabsorption.
10. Regarding calcium, all true except:
A. Total plasma levels are about 2.5mmol/L (10microgram/dl).
B. Is actively absorbed in the intestine.
C. Given intravenously as gluconate.
D. Is useful in the management of hypokalemia.
E. Levels are raised in blood taken from a standing subject.

1.E 2.C 3.B 4.E 5.A 6.C 7.A 8.D 9.B

10.D
1. Alveolar ventilation(V) & perfusion(Q) are;
A. Evenly distributed through out the lung
B. Segmental & cannot be measured
C. Inversely related through out the lungs
D. Highest in the bases while V/Q is low
E. Low in the apices & in the bases

2. If arterial pCO2 has markedly increased(pCO2 70 torr) one should

A.Rapidly decrease pCO2 to 40 torr.
B. Rapidly hyperventilate the patient
C.Decrease pCO2 slowly (1 torr.per minute)
D.Infuse a pressure agent
E.Increase concentration of O2.

3. The main objective of therapy in ARDS is

A.Increase the number of functioning alveoli
B. Increase PaO2 to more than 70 torr.
C. Increase pulmonary compliance
D. To maintain an open airway
E.To decrease the work of breathing

4.Which of the following is characteristic of Barrett’s ulcer?

A.Benign histology

B. Location at the leading edge of the squamocolumnar junction

C. Occurrence in 30% 0f patients with Barrett’s esophagus

D. Presentation with cervical dysphagia

E.Responsiveness to H2 blockers
 5. All the following are characteristics of the thoracic duct EXCEPT:
A. It takes its origin in the abdomen
B. It enters the chest through the esophageal hiatus
C. In the neck, it is located behind the carotid sheet & jugular vein
D.It contains many valves to protect it against blood flow
E.Injury to the duct below T5 usually results into a right sided chylothorax
.
6. Regarding the right main bronchus, all the following are true EXCEPT:
A. It is longer & wider than the left
B. It extends from the carina down to the origin of middle lobe bronchus
C. Its structure is identical to trachea
D. The right upper lobe bronchus leaves the main bronchus outside the hilum
E. It is more vertical than the left

7. The diagnosis of neurogenic thoracic outlet syndrome is usually established by:

A. Cervical spine Xray.

B. History & physical examination
C. Nerve conduction studies
D. Digital plethysmography
E. Adson’s test

8. Causes of metabolic acidosis include all the following EXCEPT:

A. Diabetes millets
B. Vomiting
C. Starvation
D. Renal failure
E. Small bowel fistula

9. All the following components or qualities of stored whole blood tend to

decrease over time EXCEPT:

A. Red blood cell viability

B. Potassium concentration
C. pH
D. Platelet activity
E. O2 carrying capacity
 10.Clinical features of Plummer-Vinson (Paterson-Killey) syndrome include all

the following EXEPT:

A. Atrophic oral mucosa

B. Subacute combined degeneration of the cord
C. Koilonychia
D. Anemia
E.Dysphagia

11. Which of the following is most useful for determining the need for surgery in

a patient with a pharyngeal diverticulum (Zenker’s)?

A. Clinical history & esophagogram

B. Flexible fiber-optic esophagoscopy
C. Manometry of the upper esophageal sphincter
D. Measured thickness of the cricopharyngeus sphincter on the esophagogram
E.24-hour distal esophageal pH monitoring

12. The procedure responsible for the largest number of esophageal perforations

is:

A. Esophageal bouginage
B. Esophageal sclerotherapy
C. Flexible esophagoscopy
D. Insertion of naso-gastric tube
E.Pneumatic dilatation

13. Each of the following steps is appropriate in the initial management of patients

with acute corrosive injury to the esophagus, EXCEPT:

A. Administration of antibiotics
B. Administration of emetic agents
C. Cricothyroidotomy or tracheostomy
D. Fiberoptic laryngoscopy
E. Placement of large bore intravenous cannula
 14. The primary pathophysiologic effect of a pericardial effusion that produces

tamponade is:

A. Cardiac irritability
B. Impairment of left ventricular filling
C. Impairment of right ventricular filling
D. Production of pulmonary edema
E. Shift of the superior & inferior vena cava

15. Each of the following statement regarding the anatomy and function of the

phrenic nerve is correct EXCEPT:

A. An accessory phrenic nerve commonly occurs in the neck but is rare in the thorax.
B. Diaphragmatic pacing requires intact lower motor neurons of the phrenic nerves
and viable cell bodies of C3, C4, and C5.
C. The left phrenic nerve passes anterior to the scalenus anterior muscle.
D. The phrenic nerve is the sole motor nerve supply to the diaphragm.
E. The phrenic nerve supplies sensory fibers only to the superior surface of the
diaphragm.

16. The commonest tumor of trachea is:

A. Squamous cell carcinoma

B. Adenocarcinoma
C. Adenoid cystic carcinoma (cylendroma)
D. Carcinoid tumor
E. Oat cell carcinoma

17. The bronchial mucosa is composed of all the following EXEPT:

A. Pseudostratified epithelium
B. Basal cells
C. Goblet cells
D. Adeno-cystic cells
E. Cilia
18. Spinal cord injury at the level of C2, results IN:

A. Transient apnea
B. Permanent apnea
C. Loss of breathing automaticity(Ordine curse)
D. Cheyne-Stokes respiration
E. Kussmaul respiration

19.Hoarseness secondary to bronchogenic carcinoma is usually due to extension of

the tumor in to which structure?

A. Vocal cord
B. Superior laryngeal nerve
C. Left recurrent laryngeal nerve
D. Right vagus nerve
E. Larynx

1 --- D
2 --- C
3 --- A
4 --- A
5 --- B
6 --- A
7 --- B
8 --- B
9 --- B
10 – B
11 –A
12 ---C
13 ---B
14 --- C
15 --- E
16 --- C
17 --- D
18 --- C
19 --- C
 1. Generalized edema results from all of the following disorders EXCEPT
A. Systemic hypertension.
B. Congestive heart failure.
C. Cirrhosis.
D. Nephrotic syndrome.
E. Hyperaldosteronism. (A)

2. Disorders that predispose to thrombosis include all of the following

EXCEPT:
A. Pancreatic carcinoma.
B. Pregnancy.
C. Vitamin K deficiency.
D. Sickle cell anemia.
E. Severe burns
(C)

3. The feature most important in differentiating a malignant from benign

tumor IS:
A. Lack of encapsulation.
B. High mitotic rate.
C. Presence of necrosis.
D. Presence of metastases.
E. Nuclear pleomorphism (anaplasia)

(D)

4. In inflammatory response, neutrophils release molecules that have all

of the following effects EXCEPT:
A. Chemotaxis of monocytes.
B. Chemotaxis of lymphocytes.
C. Degranulation of mast cells.
D. Increase vascular permeability independent of histamine
release.
E. Connective tissue digestive.

(B)
 5. All of the following tumors are malignant EXCEPT:
A. Glomus tumor.
B. Ewing’s sarcoma.
C. Wilms’ tumor.
D. Seminoma.
E. Histocytosis X.
(A)

6. Malignancies that commonly occur in children younger than 5 years of

age include all of the following EXCEPT:
A. Leukemia.
B. Wilms’ tumor.
C. Retinoblastoma.
D. Rhabdomyosarcoma.
E.Osteosarcoma. (E)

7. All the following statements about vitamin A are true EXCEPT:

A. Deficiency causes blindness.
B. Liver disease causes deficiency.
C. Toxicity causes liver disease.
D. Deficiency causes squamous metaplasia in glandular
epithelium.
E. Toxicity is associated with increase infections.
(B)
8. Which of the following statements about vitamin K deficiency is
TRUE:
A. Deficiency causes defects in both the intrinsic and extrinsic
coagulation pathways.
B. Deficiency produces defects in platelets function.
C. Deficiency is associated with strict vegetarian diet.
D. Interstitial bacteria produce enough vitamin K to prevent
deficiency under normal conditions.
E. Deficiency develops less frequently in breast fed infants
than in bottle fed infants.
(A)
 9. All of the following commonly contribute to postoperative atelectasis
after uncomplicated abdominal surgery EXCEPT:
A. Adult respiratory distress syndrome.
B. Diaphragmatic elevation.
C. Voluntary suppression of coughing.
D. Excessive bronchial secretion.
E. Limitation of respiratory movements.
(A)

10. diffuse alveolar damage (adult respiratory distress syndrome) is the

major pattern of pulmonary damage produced by all of the following
EXCEPT:
A. Oxygen toxicity.
B. Narcotic overdose.
C. Septic shock.
D. Cardiopulmonary bypass surgery.
E. Pneumothorax. (E)

11. All of the following statements about disseminated intravascular

coagulation are true EXCEPT:
A. the disorder is characterized by widespread thrombosis.
B. The disorder is characterized by widespread of
hemorrhage
C. It most often present as a primary (idiopathic condition)
D. The brain is the organ most often involved
E. The disorder is associated with mucin-secretion
adenocarcinoma
(C)
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1. Which one of the following statements about duodenal atresia and stenosis in the
newborn is not true:

a. prenatal detection of duodenal atresia has remained constant over the past three
decades.
b. a mucosal web with a normal muscular wall is the most common duodenal
abnormality.
c. the double-bubble sign on plain films is the classic x-Ray finding.
d. downs syndrome is identified in up to 25%of infants.
e. cardiac abnormalities are commonly associated with duodenal atresia.

(a)

2. Jaundice in jejunal atresia:

a. Occur in 85% of cases.

b. More common in ileal atresia than in jejunal atresia.
c. Mainly due to unconjugated fraction of bilirubin.
d. Occur in less than 5%.
e. More common in males than females.
©

3. Which of the following statements about hypertrophic pyloric stenosis in the

newborn is not true?

a. There is familial predisposition.

B. Hypochloremia and hypokalemia may be present.
c. The pylorus can frequently be palpated on physical examination.
d. Emesis on feeding is common in the early postoperative period.
e. It is best diagnosed by an upper gastrointestinal study.

(e)
4. For pediatric patients with appendicitis, which of the following statements is
not true:

a. The rate of misdiagnosis is highest in children under 3 years old.

b. Computed tomographic (CT) scanning is less accurate in children than adults.
c. CT scan is used to rule out peri-appendiceal abscess.
d. Urinary sepsis is the most common misdiagnosis.
e. WBC count does not effectively differentiate perforated from nonperforated
appendicitis.

(d)

5. Eight hours after an infant exhibits excessive drooling and mild respiratory
distress. An abdominal radiograph shows complete lack of air in the
gastrointestinal tract. Which is the most likely diagnosis?

a. Hirschsprung”s disease.
b. Tracheoesophageal fistula H type.
c. Pyloric atresia.
d. Choanal atresia.
e. Esophageal atresia without Tracheoesophageal fistula

(E)