CSC1

Surgery Junior clerkship 2004/2005

Group A
MCQ part:
1. FNA can NOT differentiate between:
a. Folicular adenoma & carcinoma.
b.
c.
2. Female patient present with lump in the left lobe of the thyrioid. Hemithyroidectomy was
don’t, it shows follicular carcinoma infiltrating the capsule of the gland, the best treatment is:
a. Total thyroidectomy & I131 ablation therapy post operation.
b.
c.
3. patient present with midline lump which move during tongue protrusion:
a. thyroglossal cyst
b.
c.
d.

4. 40 years old female patient present with 2x3 lump in the inner upper quaduarnt of the right
breast. CXR had done showing mass in the upper part of the lung. FNA shows
adenocarcinoma of both lesions. The best treatment is:
a. Total mastectomy & Radiotherapy
b. Radical mastectomy and axillary lymph nodes clearance.
c. Local wide excision of the lump, axillary lymph nodes clearance.
d.
e.
5. 20 year old patient present with lump on outer upper quadrant which is painless, mobile, no
skin changes. The most likely diagnosis is:
a. Fiberoadenoma.
b.
c.

6. Patient present with bloody nipple discharged, painless breast. Most likely diagnosis is:
a. intraductal papilloma.
b.

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 c.
7. Female patient 34 years, in the 2nd trimester present with creamy yellowish discharge from the
nipple, most likely diagnosis is:
a. Galactocele.
b.
c.
8. Pateint involved in RTA, his eye are close, pupil dilated & not reactive to light. Not respond
to painful stimuli but his legs move in extension and produce non understandable sounds.
GCS is:
a. 3
b. 5
c. 7
d. 9
e. 11
9. ASA classification [anesthesia]:
10. Side effects of spinal anesthesia is
a. Intraoperative bleeding
b. Hypotension
c.
11. Patient fall on his center of his abdomen, brusies around the umbilicus. Most likely organ
injured is:
a. Small bowel
b.
c.
12. Patient sustained injury to LUQ, most likely injured organ is:
a. Liver
b.
c.
13. Patient in ICU, mean arterial pressure is 70 , CVP=0 and cardiac output= 2 liter/min. most
likely this patient suffer from:
a. Septic shock
b. Hypvolemic shock
c. Cardiac shock
d. Pulmonary shock
e. Neurogenic shock
14.
a. Urea/creatinine ratio 1:10
b. Urine osmolarity > plasma osmolarity
c. Urine sodium < 10 millequvilant
d.

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15. In acute cholecystitis:
a. Murphy's sign +ve
b.
16. Indication for bariatric operation (gastric bandage):
a. Patient 18 years old or more, BMI >40 , primary obesity, tried diet for >5 years
and failed, not alcoholic, not deprived, understand operation and no major risk
factor.
b.
c.
17. Patient present with appediceal mass, best treatment is:
a. NPO, IV antibiotic, analgesia, elective appendectomy after 8 weeks.
b.
c.
18. Best treatment of lymphadenoma tarda is:
a. Compression stocking
b.
c.
19. best intial investigation for AAA is:
a. angiography
b. AXR
c. U/S
d. CT
e. MRI
20. AAA:
a. Is benign disorder
b. Operate if more than 5.5 cm
c. Observe only
d. Repair if rupture.
e.
21. Dilated superficial vessels on medial sides of leg is best treated by
a. Sclerotherapy
b.
22. Patient present with pain in flank radiating to the groin, colicky in nature, urine analysis = 5
WBC. Best investigation is :
a. IVP
b.
23. To differentiate between bowel obstructive and paralytic ileus is:
a. Colicky abdominal pain
b. Distention
c. Vomiting

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 d. Constipation
e.
24. Regarding anal fissure, all true except:
a. 10% on posterior midline
b. 50% resolve with bulk laxative
c. Is almost always associated with anal fistula
d.

25. female patient presnt with bright fresh blood per rectum she suffered from constipatin for long
time, PR show no fleshy part protrudes and it is very painful that PR cant done. Most likely
diagnosis is
a. Anal fissure
b.
26. Patient present with bloody diarrhea recurrent and abdominal pain, barium follow through
show normal ileum. Most likely diagnosis is:
a. Ulcerative colitis
b. Chron's disease
c. Cancer colon
d.
e.
27. patient present with massive bleeding per rectum for the first time, barium enema show
normal colon. Most likely diagnosis is:
a. Diverticulosis
b. Angiodysplaisa
c.
28. Patient present of dysphagia for solid then food, examination show spondly love figers in thin
patient
a. Achalesia
b. Nutcraker " espphosititis"
c.
29. Patient with dysphagia & regurgitation, barium meal shows dialed esophagus:
a. Achalasia
b.
c.
30. All of the following are risk for gastric cancer except:
a. Atrophic gastritis
b. Chronic gastric ulcer
c. NSAID
d. Pernicious anemia

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 e.

31. Best treatment for non dilated visible vessels grade II is

a. Conservation & observation
b. Endoscopy diathermy
c. Ligation by endoscopy
d. Gastroectomy
e.
32. Egyptian patient present with esophageal varices, the most likely cause is:
a. Perisinosoidal hypertension
b. Portal vein thrombosis (due to schistomisis)
c.
d.
e.
33. patient from Indian sub-continual had mild diarrhea and then vague RUQ pain, most likely
diagnosis is
a. amoebic abscess
b.
c.
34. Bennet's fracture best treated by:
a. Percutanous pining and base & 1st metacarpal with carpal bone.
b. Open reduction and repair ligament.
c.
35. patient with central cord syndrome is cervical region:
a. severe weakness in hands and upper limb, sparing and lower limb
b. paralysis and lower limb with sparing the upper limb
c. both upper and lower limb paralysis
d.
e.
36. femoral neck hip fracture:
a. rare in women
b. most common in young women with high energy trauma
c. In Emarati young patient with high energy trauma.
d.
e.

37. AVN (avascular necrosis) of femoral hip:

a. Fracture of cervical (neck) hip
b.

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 c.
38. Most commonly need reduction in fracture distal radius if:
a. Intraarticular
b.
39. Most commonly dislocated carpal bone is:
a. Lunate
b. Hamate
c. Trapizuid
d.
e.
40. Giant cell tumor is:
a. Benign tumor but recurrent is 20-30% after excision
b.
41. osterosarcoma is distal femoral boneis best treated by:
a. distal femur and proximal tibia excision, artholosis and chemotherapy.
b.
c.
42. Patient with pelvic fracture, blood on urtheral meatus with high riding prostate. Most likely
cause is:
a. Urethral rupture
b.
43. in trans-urethral prostectomy, most life threatening condition is:
a. intraperitoneal rupture and prostate capsule
b. extraperitoneal and prostate capsule.
c.
d.
44. human body composed of :
a. Water
b. protein
c.
45. Patient involved in RTA and sustained injury to the medial of the left nipple, patient complain
of dyspnea, O/E neck vein are distended, most important next step in management is:
a. Chest tube
b. IV cannula on anterior of chest
c. IV fluid resuscitation
d. Pericardiocentesis.
e.
46. Neo-adjuvant therapy is:
a. Chemotherapy before operation to downstate the tumor, shrink it and make it
operable.

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 b.
c.
47. according to duke's classification, colon cancer which extends through sub mucosa +
muscularis proppria is class:
a. A
b. B
c. C
d. D
48. Patient present with weak urine stream and hesitancy for 6 month. Urine analysis shows 6
WBC/hpf. PR shows enlarged smooth prostate. Post voiding catherizaion shows residual
urine. The most likely diagnosis is:
a. BPH
b. Prostate cancer
c.
49. All of the following can be caused by chronic retention of urine except:
a. Cyctitis
b. Urethritis
c. Pylonephritis
d. Epidydimo-orchitis
e.
50. In shoulder anterior dislocation:
a. Axillary nerve is most commonly injured
b.
51. In supracondylar fracture
a. Vascular damage and compartment syndrome are suspected.
b.
c.
52. All of the following are advantages of internal fixation of femur except
a. Good alignment of the fracture
b. Sooner discharged of the patient to reduce complication of immobilization (DVT).
c. Patient will be more independent on others
d. Quick healing of fracture bones. (because of less blood supply).
e.
53. In pilonidal sinus, all of the following are true except:
a. Coccyigititis can be complication
b. Staph aurues is the usual causative organism.
c.
d.
54. female 22 years present with Epigastric pain radiating to the back, fever and chills, serum
amylase is 3500. U/S shows dilated CBD. Total bilirubin 3.1. most important next step is:

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 a. IV antibiotic, ERCP for extraction on impacted stone in CBD and evacuation of
bile system and elective cholesystecmoy.
b.
c.
55. A 50 years patient present with recurrent abdominal pain in Epigastric area, steotorrhea and
dyspepsia. Patient showed to be alcoholic. The most likely diagnosis:
a. Acute pancreatitis
b. Chronic pancreatitis
c. Peptic ulcer
d.
e.

56. A 60 year old male patient present with mass in RIF that is painless for 8 months. The
investigation of choice for definitive diagnosis is:
a. Barium enema
b. AXR
c. Barium meal
d. Colonscopy
e. Angiography
57. A 70 years old female patient with a history of atrial fibrillation present with sudden severe
continuous abdominal pain, pulse is irregular. Most likely diagnosis is:
a. Ischemic colitis
b. Acute pancreatis
c. Perforated DU
d.
e.
58. All of the following are post spleenoectomy complication except:
a. Pancreatis-splenic fitula
b. Left pleural effusion
c. Sub-pherenic abscess
d.
e.
59. Regarding scaphid fracture:
a. Avascular of the distal segment is common
b. Avascular of the proximal segment is common
c. Pain in snuff box at anterior wrist
d.
e.
60. In ischemic colitis, patient will be on:

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 a. Respiratiory alkalosis
b. Respiratory acidosis
c. Metabolic alkalosis
d. Metabolic acidosis
e.

61. In arterial injury, the limb can be rescued if:

a. Repaired within 6 hours
b.
62. In cholestatic jaundice, there is:
a. Pale stool with prusitis
b. Pale stool without prusitis
c. Dark stool with prusitis
d. Dark stool without prusitis
e. Prusitis only
63. The indicator that jaundice is due to obstruction is:
a. Presence of urine urobilinogen
b. Pale stool
c.
64. Tenesmus is:
a. Sensation of incomplete evacuation
b.
65. All of the following are some strategies in the treatment of GERD except:
a. Weight reduction
b. Elevate the head with sleeping
c. H2 blockers
d. Stop NSAID
e.
66. In Nissin fundoplication of stomach, the fundus of the stomach is wrapped around the lower
esophagus in an angle of :
a. 45
b. 90
c. 180
d. 270
e. 360
67. All of the following are signs of acute appendicitis except:
a. McBurnery's point tenderness
b. Psoas sign
c. Murphy's sign
d. Rovsing's sing

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 68. Patient 60 years old with jaundice for 6 month, with mild weakness and no pain. O/E
gallbladder is distended and palpable. The most likely diagnosis is:
a. Pancreatic Head cancer
b.
c.
69. A 6 year old boy discovered by school doctor to have absent right testes. He was referred to
urology clinic. The best management is:
a. Regular follow up
b. Orchodyctomy because of increased risk of cancer
c. Orchodepexy
d.

SAQ Part, PMP

Patient 18 years old male involved in RTA. He present with LUQ pain and contusion on the
LUQ. Generalized, guarding and rigidity. Pulse 130 /min PB 80/50.
1. The most likely explanation for patient symptoms and signs is:

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  Answer: ruptured spleen
2. List 8 procedures or management you will dot?








3. What are treatment options and what preventive measures you will take?
 Answer: Conservable, splenoraphy or splenoectomy
 Preventive: vaccination ; H.Influenza, S.pnemonia, N.menigitis. IV
antibiotics for 10 days "penicillin".

Patient presents with 5 cm lump in outer upper quadrant, mobile, no skin changes, no
axillary's lymph nodes palpable.
1. List 3 investigation tools you want to order?
 U/S
 Mammogram
 FNA
2. What classification according to TNM system?
 T2N0M0
3. What is the best treatment of choice?
 Answer:

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 4. List 3 investigation to check for metastasis?
 Answer:

Patient 60 years old presents with painless hematouria for 8 months

1. what investigation can help you in management diagnosis of the patient (6 measures or
management)?






2. In patient with massive hematouria, list 6 procedures or measures in dealing with such
cases?







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 3. List 2 differentiatial diagnosis?


4. Discuss treatment fo one of your differential diagnosis?



Patient 60 years old present with pain on calf muscles on exertion. Pain starts after 200-300
meter walk and relieve with rest. He is heavy smoker, obese and diagnosed with hypercholesterolemia.
1. What is the medical term for this condition?

2. List six points for conservation treatment?






3. In future, List 2 interventions that may help in treamtment of this patient (surgery)?



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 5

Patient presents with fracture of scaphoid bone to the ER.

1. Clinically, where can you elicit most of pain?

2. What you will write on X-ray form which will help viewing the fracture?


3. If you don’t see the fracture, how will you manage the patient? Why?



4. What is the ideal length for scaphoid fracture immobilization?


OSCE:

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Station 1:
 Dr Yosef, 2.5 min with Model, gloves and Gel.
 Do PR and describe your finding.
 Do not forget to say "I want to do proctoscope at the end".
Station 2:
 Proctoscope on the table, 2.5 min
 Answer the questions.
 What is this?
 List 3 disease in which you can use it?
Station 3:
 Chest tube on the table, 2.5 min.
 Answer the questions.
 What is this?
 Where can you insert it?
 List 2 indications for it use?
Station 4:
 Model, NG tube, Glove, KY gel, 2.5 min, Dr. Amer.
 Insert NG tube and describe what you are doing
 Don’t forget to say "I will give cup of water to the patient to swallow".
Station 5:
 Model, Foley catheter set, 2.5 min, Dr.Tareq.
 Insert catheter and describe what you are doing.
 Don’t forget before you start to check that everything is there and not missing.
Station 6:
 Model "upper limb", IV canulla, swab, gloves, tourniquet, Dr.Khalil. 2.5 min
 Insert IV line and describe what you are doing.
 Don’t forget to remove tourniquet at the end.
Station 7:
 Rest, 2.5 min.
Station 8:
 X-ray abdomen, 5 min.
 Answer the questions.
 What is the most important finding?
o Answer: air under diaphragm.
 What is most likely cause in Al Ain?
o Answer: Perforated DU.
 List 6 procedure or management you will do?
o

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 o
o
o
o
o
 What is the definitive treatment?
o
 List 3 risk factor that make prognosis worse?
o
o
o
Station 9:
 X-ray chest showing Tension Pnemothorax. 5 min
 Patient involved in RTA, dyspnea.
 What is most likely diagnosis?
o Answer: Tension Pnemothorax
 How you will be certain about your diagnosis clinically? Answer:
o Hyper-resonances chest L
o Less air entry to L lung
o Tracheal deviation to the Right.
 Should this X-ray to be taken? Why?
o No, patient may collapse and die from low venous return and compression on the
great vessels.
 What is your treatment?
o IV cannula on 2nd intercostal spac, midclavicular line and later chest tube when
patient become stable in the 5th intercostal space axillary line.
Station 10:
 X-ray of abdomen. 5 min
 What is your finding?
o Dilated colon
 What is most likely diagnosis?
o Large bowel obstruction.
 List 3 symptoms?
o Distension
o Constipation
o Colicky abdominal pain
o Vomiting
 List 2 signs:

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 o Distention
o High pitch tinkling bowel sounds "increase bowel sounds".
o Visible peristalsis
 What is the treatment?
o NPO
o NG tube
o Treat the cause
Station 11:
 X-ray of R arm. 5 min
 What is your finding?
o Oblique fracture of midhumerus
 What structure (nerve) most commonly injured?
o Radial nerve
 What presentation patient will have if that nerve is injured?
o Wrist drop and loss sensation over a coin area between thumb and index finger.
 For how long you will immobilize fracture?
o 6-8 weeks.

Station 12:
 Arterial tree examination, Dr abu zidan. 5 min
 Inspection:
o color, skin changes, hair less, ulcer over the pressure area (look carefully under
heels), scars muscle atrophy.
o Don’t forget to do Burger's test or just say.
 Papating
o Temperature
o Capillary refilling
o Pulse "compare"
o Compare both side
 Auscultation: For bruit
o Aorta "Epigastric area"
o Femoral
o Renal "costovertebral angel"
Station 13:
 Abdominal examination, Prof. braniki. 5 min
 Inspection

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  Palpation
o When doing superficial palpation, look at face of patients
o RIF is always the start pint of hepatosplenomegaly palpation.
o Learn properly how and where to balloting of kidneys.
 Percussion.
 Auscultation.
Station 14:
 Knee Examintion, Dr. Lensho. 5 min
 Diffusion test
 Anterior and posterior cruiate ligaments
 Medial and lateral menisci.
 Medial and lateral collateral ligaments
Station 15:
 Rest

Clinical Examination
30 min, each case 10 minutes
2 surgical cases and 1 orthopedic case.
Group 1
Prof. Safi; indirect inguinal hernia
Dr.Yosef; thyroid Nodule
Dr.Salah; Knee stiffness due to gun shot.
Group 2
Dr.Fawaz torab; Acute cholecystitis
Dr.Micheal; Indirect inguinal hernia
Dr.Carl lenso; RTA fracture, scapula and 3rd 4th 5th ribs
Group 3
Prof. Braniki; obstructive jaundice, cancer periampullary or indirect inguinal hernia.
Dr.Hashimi; Lymph nodes in Neck and supraclavical nodes
Prof. young; Tumor in shoulder
Group 4
Dr.Khalil; inguinal hernia
Dr. Abu Zidan; RTA abdominal trauma "spleen"
Dr.Levistsoki; Knee problem

 Take brief history 2.5 min

 Do brief physical exam "focused only" 2.5 min
 Discussion bed side
o Differential diagnosis

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o Investigation you want
o He will show you x-ray or lab result
o Treatment
o It rather testing knowledge rather than history or physical examination.

GOOD LUCK 

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