Low pitch sound after thyroidectomy is usually attributed to malfunction of:

A. Omohyoid muscle.
B. Sternohyoid muscle.
C. Cricothyroid muscle.
D. Thyrohyoid muscle.
E. Sternothyroid muscle.
ANSWER: C

Serum calcium level is usually elevated in all of the followings except:

A. Primary hyperparathyroidism.
B. Secondary hyperparathyroidism.
C. Tertiary hyperparathyroidism.
D. Hyperparathyroidism due to ectopic adenoma.
E. Vitamin D intoxication.
ANSWER: B

Unilateral bloody nipple discharge from one duct orifice is most commonly caused
by:

A. Paget's disease of the nipple.

B. Carcinoma in situ.
C. Inflammatory carcinoma.
D. Subareolar mastitis.
E. Intraductal papilloma.
ANSWER: E

Which of the following has the highest risk for Colo-rectal carcinoma?
A. Ulcerative colitis.
B. Crohn’s disease.
C. Familial polyposis coli.
D. Diverticulosis.
E. Juvenile polyps.
ANSWER: C

A 35 years old male patient developed large amount of fresh bleeding per rectum 10
days post hemorrhoidectomy. The most probable cause for his bleeding is
A. Sloughing of a vessel wall.
B. Uncontrolled bleeding missed at the time of surgery.
C. Clot dislodgment.
D. Injury by defecation.
E. Vasodilation.
ANSWER: A

Neoplastic cells have the ability to spread. One of the following is true:
A. Lymph node metastases permeate the sinusoids of the node and later spread
throughout the subcapsular space
B. Carcinoma in situ has no detectable invasion beyond the basement membrane
C. Lymphatic involvement is common with sarcomas
D. The metastatic process of malignancy is highly efficient, as once they shed into
the bloodstream, they produce metastasis almost always
E. Epithelial neoplasm spread only through hematogenous route
ANSWER: B

A 47-year-old woman presents to the emergency room after a motor vehicle accident,
mildly lethargic and confused, with normal airway and vitals. She complains of a
headache, and has a frontal scalp hematoma. After stabilizing her cervical spine
and doing primary survey, she becomes more lethargic, moving only to pain. Which of
the following is the most likely to be present?
A. Subdural hematoma
B. Extradural hematoma
C. Cerebral contusion
D. Intracerebral hematoma
E. Diffuse axonal injury
ANSWER: B

If you want to review a reference paper addressing the best method of management
yielding the best outcome, which of the following has the best level of evidence?
A. A well-powered double-blinded randomized controlled trial
B. A case-series
C. A retrospective series of more than 1000 patients
D. Meta-analysis of retrospective series
E. A case-report
ANSWER: A

All of the following are gases used to provide pneumoperitoneum in laparoscopic

surgery except?
A. Methane
B. Carbon dioxide
C. Helium
D. Nitrous oxide
E. Argon.
ANSWER: A

In which region of the GI tract is the longitudinal muscle of the muscularis

arranged into distinct longitudinal bundles?
A. Duodenum
B. Jejunum
C. Ileum
D. Colon
E. Stomach
ANSWER: D

All of the following conditions are associated with low cardiac output except
A. Anaphylactic shock.
B. Cardiac tamponade.
C. Tension pneumothorax.
D. Massive pulmonary embolism.
E. Air embolism.
ANSWER: A

All the following statements are true regarding allergic blood transfusion
reactions except
A. They are caused by donor antigens or antibodies.
B. They are more commonly occur with transfusion of packed red blood cells.
C. They are usually mild.
D. Usually treated by antihistamines.
E. Epinephrine is occasionally needed in the management of the reaction.
ANSWER: B

All the following are true about refeeding syndrome except

A. It occurs more with patients on parenteral nutrition than patients on enteral
formulas.
B. It results mainly from decreased levels of some electrolytes.
C. It results in multiorgan failure.
D. It is prevented by increasing calorie intake slowly and regular administration
of minerals and vitamins.
E. It is treated by stopping proteins in the given formula.
ANSWER: E
In considering a donor for living related liver transplantation, one of the
following is a contra indication from the donor stand point.
A. Replaced or accessory right or left hepatic artery
B. Active Non-Alcoholic Steatohepatitis (NASH) with fibrosis
C. Atherosclerosis of the aorta
D. Two right bile ducts
E. Dual right hepatic vein
ANSWER: B

A 43-year-old man was transported to the emergency department after a high voltage
electrical injury at work. After intubation, resuscitation and exposure, you notice
a significant burn in his right upper extremity and his feet. In regards to his
electrical burn, all of the following are true except:
A. Admission under cardiac monitoring due to high risk for arrhythmias
B. Electrical burn necrosis may extend beyond the burn entry site in his extremity
C. Repeated debridement and fasciotomy may be necessary
D. Allowing necrotic tissue to spontaneously separate on its own prior to
debridement is preferable, as the extent of necrosis may be extensive
E. Main vessel thrombosis and potential need for amputation is a risk in extremity
electrical burns
ANSWER: D

While performing a laparoscopic appendectomy in a thin female patient, the

consultant surgeon notices a prominent peristalsing structure crossing the right
external iliac artery, traversing to the medial part of the pelvis. This tube-like
structure represents:
A. Right round ligament
B. Right ureter
C. Right broad ligament
D. Right gonadal vessel
E. Hypogastric plexus
ANSWER: B

A patient with an open wound inquires about the best option to provide the best
aesthetic (cosmetic) result. Which of the following gives the best cosmetic result?
A. Nothing can be done
B. Applying a vacuum dressing will almost result in a scar-less wound
C. Frequent dressings
D. Placement of silver dressing
E. Delayed primary closure
ANSWER: E

What is the most likely initial symptom to occur as a result of local anesthetic
toxicity?
A. Seizures
B. Restlessness
C. Slurred speech
D. Coma
E. Muscle weakness
ANSWER: B

A 55-year-old man with Crohn’s disease had undergone resection of small bowel and
anastomosis. Ten days later, he is found to have bilious drainage of 1 L/d from the
drains. He is started on total parenteral nutrition (TPN). Four days later, his
arterial blood gases (ABGs) are pH, 7.25; PO2, 98 mm Hg; and PCO2, 40 mm Hg. His
anion gap is 10. The most likely cause is which of the following?
A. Diabetic ketoacidosis
B. Renal failure
C. Hypovolemic shock
D. Small-bowel fistula
E. Uncompensated metabolic alkalosis
ANSWER: D

After undergoing a transurethral resection of the prostate, a 65-year-old man

experiences excessive bleeding attributed to fibrinolysis. It is appropriate to
administer which of the following?
A. Heparin
B. Warfarin (Coumadin)
C. Volume expanders and cryoprecipitate
D. Aminocaproic acid (Amicar)
E. Fresh-frozen plasma and vitamin K
ANSWER: D

A 70-year-old woman has low cardiac output with increased pulmonary capillary wedge
pressure (PCWP) and increased systemic vascular resistance. What should be the drug
of choice?
A. Dopamine
B. Norepinephrine
C. Dobutamine
D. Epinephrine
E. Phenylephrine
ANSWER: C

Which of the following is not a limitation of minimal access surgery?

A. Technically more demanding
B. Loss of tactile feedback
C. Extraction of large specimens
D. Poor vision
E. Difficulty with hemostasis.
ANSER: D

Which of the following is not a complication associated with pneumoperitoneum?

A. Hyperthermia
B. Acidosis
C. Cardiac arrhythmias
D. Gas embolism
E. Reduced cardiac return
ANSWER: A

All the following statements about the anatomy of the esophagus are true except
A. The narrowest point of esophagus is at the level of cricopharyngeal muscle
B. The Meissner plexus is located in the submucosa
C. The Auerbach plexus is located between the muscle layers of the esophagus
D. The esophagus lacks the serosal layer
E. The outer longitudinal muscle layer is an extension of the crichopharyngeus
muscle
ANSWER: E

All the following statements regarding the blood supply of the stomach are true
except
A. The left gastroepiploic artery commonly arises from splenic artery
B. Ligation of the left gastric artery can result in acute left sided hepatic
ischemia
C. The stomach is well protected from ischemia because of rich collateral
circulation
D. The short gastric arteries provide significant blood supply to the body of the
stomach
E. The gastroepiploic artery usually originates from the gastroduodenal artery
ANSWER: D

Which of the following sutures is natural?

A. Silk.
B. Polyglycolic.
C. Polydioxanone.
D. Polyproline.
E. Polyglactin.
ANSWER: A

Braided sutures
A. Are non-absorbable.
B. Are natural.
C. Have better knotting.
D. Have stronger memory.
E. Carries less risk of infection
ANSWER: C

Which of the following is true about hemophilia A?

A. Is factor VIII deficiency.
B. Inherited as autosomal dominant.
C. Males and females are equally affected.
D. Fresh frozen plasma is the treatment of choice.
E. The platelet function is impaired in patients with hemophilia.
ANSWER: A

All the following are risk factors for surgical site infection except
A. Obesity.
B. Female gender.
C. Uremia.
D. Obesity.
E. Jaundice.
Answer: B

All the following are true about cellulitis except

A. It is a non-suppurative infection.
B. It is well localized.
C. Commonly caused by beta hemolytic streptococci.
D. Fever is common.
E. Blood cultures are usually negative.
ANSWER: B

Which of the following antibiotics is most effective against Clostridia difficile?

A. Imipenem.
B. Metronidazole.
C. Vancomycin.
D. Ciprofloxacin.
E. Ceftazidime.
ANSWER: C

With regard to bipolar and monopolar devices, which of the following is true?
A. Both use direct current (DC).
B. Both uses alternating current (AC).
C. Bipolar uses AC, while monopolar uses DC.
D. Bipolar uses DC, while monopolar uses AC.
E. Neither requires an electrosurgical unit.
ANSWER: B
Which of the following sites for central venous catheter placement is associated
with the lowest rate of catheter-associated blood stream infections?
A. Internal jugular vein
B. Subclavian vein
C. Femoral vein
D. Both A and B are equivalent
E. All sites are equivalent if sterile technique is maintained
ANSWER: B

All the following are causes of wide anion gap metabolic acidosis except
A. Lactic acidosis.
B. Ketoacidosis.
C. Pancreatic fistula.
D. Alcohol toxicity.
E. Salicylic acid overdose.
ANSWER: C

Autologous intraoperative blood donation can be an option in which of the following

conditions?
A. Aortocoronary bypass.
B. Mastectomy and breast reconstruction for breast cancer.
C. Sigmoid resection for volvulus.
D. Surgery for abdominal abscess.
E. Liver transplant for cirrhosis and small hepatocellular carcinoma.
ANSWER: A

Cryoprecipitate is stored at
A. 2 to 6 degrees C.
B. -2 to -6 degrees C.
C. Room temperature.
D. -30 degrees C.
E. -70 degrees C.
ANSWER: D

All commonly develop as consequences of reperfusion syndrome except

A. Hyperkalemia.
B. Myocardial suppression.
C. Vasoconstriction.
D. Acute lung injury.
E. Acute renal injury.
ANSWER: C

Early after a skin cut wound, all the following occur at the site of injury except
A. Vasodilation.
B. Platelets aggregation.
C. Infiltration by macrophages and polymorphonuclear cells.
D. Release of serotonin.
E. Swelling of the injury site.
ANSWER: A

All the following are true regarding necrotizing soft tissue infections except
A. They are usually polymicrobial.
B. Beta hemolytic streptococci are usually part of the causative microbes.
C. Clostridia perfrengens causes gas gangrene.
D. Pain is usually out-of-proportion to physical signs.
E. Treatment is high dose of a wide spectrum antibiotic changed according to
culture result when ready.
ANSWER: E
A 40-year-old lady presented with 2cm left breast mass in the retro-areolar region
proved by a true-cut biopsy to be invasive ductal carcinoma. Metastatic work up was
free. You discussed the condition with her and offered mastectomy with sentinel
axillary LN sampling. She refused to do any breast surgery. What should you do?
A. Insist on your plan.
B. Discuss the matter with her family.
C. Refer her to another surgeon.
D. Discuss with her other treatment options although not as effective as surgery.
E. Inform the police that she refuses treatment.
ANSWER: D

Complications of trans-arterial angiography include all the following except

A. Renal impairment.
B. Deep vein thrombosis.
C. Arterial dissection.
D. Hematoma.
E. Distal embolism.
ANSWER: B

All the following is true about the abdominal wall anatomy except
A. The rectus abdominus muscles lie between the anterior and posterior rectus
sheets all the way from xiphoid to symphysis pubis.
B. The internal oblique muscle lies between the external oblique and the
transversus abdominis.
C. The transversalis fascia lies under the transversus abdominis muscle.
D. The latissimus dorsi lies posterior to the external oblique muscle.
E. The linea semilunaris lies at the lateral border of the rectus abdominis.
ANSWER: A

Richter’s hernia defined as

A. An inguinal hernia that contains ovary.
B. An inguinal hernia that contains appendix.
C. An irreducible hernia.
D. A hernia that involve only part of the bowel wall.
E. A posterior lumber hernia.
ANSWER: D

All the following about the inguinal anatomy are true except
A. The deep inguinal ring is a defect in the transversalis fascia.
B. The deep inguinal ring lies midway between the symphysis pubis and the anterior
superior iliac spine.
C. The inferior epigastric vessels lie just medial to the deep inguinal ring.
D. The external oblique aponeurosis forms the anterior wall of the inguinal canal.
E. The inguinal ligament constitutes the floor of the inguinal canal.
ANSWER: B

Which of the following is a contraindication for a day-case surgery?

A. A patient over the age of 60 years.
B. A surgery that should be done under general anesthesia.
C. A patient on warfarin.
D. A hypertensive patient.
E. A laparoscopic surgery.
ANSWER: C

A 20-year-old male underwent surgery for hemorrhoids, which kind of postoperative

analgesia you prefer to give him in the first 3 days?
A. Paracetamol.
B. Nonsteroidal anti-inflammatory.
C. Local lidocaine gel.
D. Carbamazepine.
E. Diazepam.
ANSWER: B

All the following are true about thyroid neoplasms except

A. Follicular neoplasms are unifocal.
B. Papillary cancers carries an excellent prognosis.
C. Papillary cancer metastasize commonly to cervical lymph nodes.
D. Lymph node metastasis in papillary thyroid cancer is the main determinant of
prognosis.
E. Medullary cancer commonly metastasizes to lymph nodes.
ANSWER: D

Which of the following is a proven advantage of gastro-intestinal staplers?

A. Less infectious complications.
B. Less bleeding.
C. Shortens surgery time.
D. Less anastomotic leak.
E. Less cost.
ANSWER: C

All the followings contribute to gastroesophageal reflux except

A. Presence of Hiatal hernia
B. Cigarette smoking
C. High protein diet
D. Obesity
E. Abnormal esophageal motility
ANSWER: C

All the following statements regarding gastrointestinal tract diverticular disease

are true except
A. Most colonic diverticula are false diverticula
B. Meckel's diverticulum is a pulsion type diverticulum
C. The most common way of presentation in children with symptomatic Meckel's
diverticulum is Gastrointestinal bleeding
D. False diverticula are usually acquired
E. Sigmoid colon is the most affected site
ANSWER: B