crash mcq 1.pptx

REVISION MCQS
MEDTUTORS PER EXCELLENCE
QUESTION BANK 1

1. USING A PLASTIC SOLUSET INFUSION SET, THE
MAINTENANCE DOSE FOR A 4.8KG INFANT IS?
• A. 15dpm
• B. 20dpm
• C. 25dpm
• D. 30dpm

2. ALL ARE COMPLICATIONS OF BLOOD TRANSFUSION
EXCEPT?
A. Malaria
B. Iron overload
C. Hypokalemia
D. brucellosis

3. ALL THE FOLLOWING INFLUENCES WOUND
HEALING EXCEPT?
a. Diabetic mellitus
b. Vit c deficiency
c. Connective tissue disorders
d. immobilisation

4. GASES IN SIMPLE INTESTINAL OBSTRUCTION
a. Are absorbed by blood
b. Consists of nitrogen, oxygen, CO2 and methane
c. Can pass through the obstruction distally
d. None of the above

5. CRITERIA FOR BLOOD DONORS INCLUDES
a. No major operation in the last 6 months
b. No pregnancy within the last 12 months
c. No blood donation in the past 6 months
d. No clinical malaria in the past 12 months

6. IN PATIENTS WITH BLOOD GROUP AB
a. Has no anti-A and anti-B in his serum
b. has anti-A and anti-B
c. Has antibody A alone
d. Has antibody B alone

7. THE FOLLOWING FACTORS POSITIVELY AFFECTS WOUND
HEALING?
a. Immobilisation
b. Scurvy
c. Poor blood supply
d. Surgical site infection

8. WHICH OF THE FOLLOWING ABOUT BLOOD TRANSFUSION
IS FALSE?
a. 1 unit of concentrate raises platelet count by 5-10 x 10^9/L
b. Patients can pre-donate blood up to 3 weeks before surgery for autologous transfusion
c. Intra-operative blood salvage is contra-indicated in tumour resection.
d. Cryo precipitate is indicated in factor VIII deficiency

9. WHICH OF THE FOLLOWING IS A COMPLICATION
OF MASSIVE BLOOD TRANSFUSION?
a. Hypokalemia
b. Hypocalcemia
c. Hypercalcemia
d. Thrombosis

10. THE LOWEST PERCENTAGE OF BODY WATER IS LOCATED IN
WHAT COMPARTMENT?
a. Intracellular
b. Extracellular
c. Blood plasma
d. interstitial

11. TOTAL BODY WATER DEPENDS ON
a. Age
b. Sex
c. Obesity

12. MAJOR SOURCE OF WATER LOSS FROM THE BODY IS
a. Sweat
b. Urine
c. Feces
d. Insensible loss (lungs and skin)

13. NOT A CAUSES OF BOO IN A 40YR OLD MAN
a. Urethral stricture
b. Calculi
c. Posterior urethral valve
d. Neurogenic bladder

14. COMMONEST CAUSE OF INTESTINAL OBSTRUCTION
a. Tumors
b. Inflammation
c. Adhesions
d. Intraluminal

15. Concerning superficial partial thickness burns
a. Painful
b. Pink and wet
c. No blisters
d. Heals within 2-3 weeks

16. Concerning degree of burn injury, a deep burn will result
from contact with for
a. 2 minutes @ 50 degrees
b. 20 seconds @ 65 degrees
c. 2 seconds @ 50 degrees

17. Renal changes in burns except
a. Oliguria
b. Anuria
c. Increased GFR
d. Renal failure

18. Acute complications of burns
a. Loss of body parts
b. loss of function
c. Upper GI bleeding
d. psychological problems

19. Regarding phases of wound healing
a. Platelets release multiple chemokines which helps stabilize the wound
b. The proliferation phase is the first part of granulation tissue formation
c. The maturation phase is the first phase of wound healing
d. Wound reaches maximal strength at 6 months

20. Complications of wound healing
a. Marjolin ulcers
b. Hyperpigmentation
c. Weak scars
d. synchronicity

21. Heavily contaminated and dirty wounds
a. Require surgical toileting and primary closure
b. Require surgical toileting and delayed closure
c. Should totally be excised
d. Require administration of steroids

22. Patient with major burns
a. Do not generally become anemic
b. Have normal calorie requirement
c. Increased production of acute phase reactant by the liver
d. Are resistant to septicemia

23. Partial thickness burns
a. Usually doesn’t heal without skin grafting
b. Rarely ever causes physiological derangement of the patient
c. May deteriorate into full thickness skin loss
d. Heals within 7 days in the absence of infection

24. Electrolyte imbalance in intestinal obstruction
a. Hypokalemia
b. Hyponatremia
c. Alkalosis
d. hypervolemia

25. Major cause of death in intestinal obstruction due to
strangulation is
a. Loss of water and electrolyte
b. Renal failure
c. Shock
d. peritonitis

26. The amount of potassium in full strength darrows is
A . 38mmol/L
B. 37mmol/L
C. 36mmol/L
D. 35mmol/L
E. 34mmol/L

27. Extracellular compartment account for
A. 60% body weight
B. 40% body weight
C. 15% body weight
D. 35% body weight
E. 20% body weight

28. Total body water is higher in males due to
A. Increase body fat
B. Have more bone density
C. They have more weight
D. Have more muscle mass
E. Have more insensible loss

29. Hyponatremia is treated with
A. Normal saline
B. Hypertonic saline
C. Ringer’s lactate
D. Darrow’s solution
E. Hartman’s solution

30. Symptoms of hypokalemia include;
A. Hyper-reflexia
B. Slurred speech
C. Anuria
D. Increased bowel motily
E. Hyperventilation

31. ECG changes in Hypokalemia
A. Shortened QT interval
B. Prominent U wave
C. Elevated ST segment
D. Absent T wave
E. Tall tented T wave

32. ECG changes in Hyperkalemia
A. Shortened QT interval
B. Prominent U wave
C. Elevated ST segment
D. Absent T wave
E. Tall tented T wave

33.Hypomagnesemia causes
A. Hyperreflexia
B. Hyporeflexia
C. Hypotension
D. Hypertension
E. Hypoglycemia

34. Gastric outlet obstruction is characterised by
A. Hypochloremia
B . Metabolic acidosis
C . Hypophosphatemia
D . Hypercalcemia
E . Hyponatremia

35. Hypocalcemia
A. Is defined by serum calcium 2.1mEq/L
B. Is associated with hypoparathyroidism
C. Causes tented T waves
D. Causes generalised atony
E. Results from osteoblastic activities

36.Concerning burns
• A. Zone of coagulation is reversible
• B. superficial partial thickness burns heal by the 5th -6th week
• C. Deep partial thickness has poor capillary refill
• D. Full thickness has large blisters that easily ruptures
• E. In adult exposed to hot water, deep burns occur from contact of 1min at 50ᵒ

37. PATHOPHYSIOLOGY OF BURNS
• A. There is initial vasoconstriction due to catecholomines
• B. there is prostaglandin release and increase GFR
• C. Cushing ulcers occur due to release of acute phase proteins
• D. Restlessness is due to Oedema
• E There is decrease fragility of RBC

38. BURNS
• A. There increase nitrogen loss and reduce oxygen consumption
• B. There is increase TNF and reduced IL1
• C. There is increase nor-adrenaline output
• D. Diabetic does not occur
• E. in supra-glottic burns, complete obstruction may occur within 30min

39. In Wallaces rule of 9 in adult
• A. Neck is 9%
• B. upper limb is 18%
• C. The back is 9%
• D. The palm is 1%
• E. Applies only in adults

40. Fluid resuscitation in burns
• A. adults with >15% and children > 10% requires fluid resuscitation
• B. colloid can be use after estimation of requirement using parkland’s formula.
• C. Maintenance is added to parkland’s land formula in adult
• D. 50% of the fluid is given in the first hour of presentation

41. Muir and Barclay
• A. 4 rations of fluid is given
• B. 1ration is given in the 1st 8 hours
• C. 1 ration is given in the 1st 12 hours
• D. 2nd ration is given in the 2nd 16 hours
• E. the 3rd ration is given in 3rd 8hours

42. A 17-year-old female presents after a motor vehicle crash and is in hemorrhagic shock. A
massive transfusion protocol is triggered. What is the optimal ratio in damage control
resuscitation?
• A. 2 plasma:1 platelet:1 red blood cell
• B. 1 plasma:1 platelet:1 red blood cell
• C. 1 plasma:1 platelet:3 red blood cells
• D. 2 plasma:1 cryoprecipitate:1 red blood cell
• E. 1 plasma:1 cryoprecipitate:1 red blood cell

43. A 29-year-old female is the driver of an automobile involved in a high-speed motor
vehicle crash. She is 30 weeks pregnant. She complains of abdominal pain but does not
have peritoneal signs. Her HR is 105 beats/min, and blood pressure is 108/66 mmHg. Which
of the following statements is true regarding trauma in a pregnant patient?
• A. Less than 5% of all pregnancies are affected by trauma.
• B. The uterus is protected by the bony pelvis until the beginning of the second trimester.
• C. A woman of 25 weeks’ gestation will have a palpable fundal height at approximately the
level of the umbilicus.
• D. Blood volume during pregnancy increases by approximately30%.
• E. Hypotensive patients should be placed in the right lateral position.

44. A 32-year-old male presents after being assaulted by a bat to his head, face, and torso. He
opens his eyes to sternal rub, localizes to pain, and is only making groaning sounds. What is
this patient’s GCS?
• A. 7
• B. 8
• C. 9
• D. 10
• E. 11

45. The patient in the previous scenario now only has extensor posturing. What is the next
best step in management?
• A. CT scan of the head
• B. Continue to perform primary and secondary surveys
• C. Bolus of hypertonic saline
• D. Elevation of the head of the bed 30 degrees
• E. Endotracheal intubation

46. A CT of the head is obtained demonstrating a 3-cm right sided subdural hematoma with a
1-cm midline shift. The patient is taken to the operating room, and the hematoma is
evacuated. Postoperatively, he is admitted to the intensive care unit (ICU), intubated, and
sedated with an ICP monitor in place. Which of the following treatment measures can be
used to maintain adequate cerebral perfusion pressure (CPP)?
• A. Hyperventilation to a PaCO2 of 25 mmHg
• B. Mannitol, 1 g/kg IV
• C. Hydrocortisone, 100 mg IV every 8 h for 3 days
• D. Strict blood pressure control to a systolic range of 90 to 100 mmHg
• E. Reverse Trendelenburg positioning of the bed at all times

47. The most common histologic type of melanoma is:
• A. Superficial spreading
• B. Nodular
• C. Lentigo maligna
• D. Acral lentiginous
• E. Desmoplastic

48.Which statement correctly describes increased risk for the development of malignant
melanoma?
• A. Melanoma accounts for 50% of all skin cancer diagnoses but accounts for 10% of deaths
due to skin cancer.
• B. Populations that reside at further distances from the equator have a higher incidence of
melanoma.
• C. An adult patient with greater than 50 clinically normal appearing nevi is at an increased risk
for melanoma.
• D. The p16/CDKN2A tumor suppressor gene, located on chromosome 9, is implicated in 40%
of cases of familial melanoma.
• E. A genetic component has been implicated in the pathogenesis of melanoma, with nearly
25% of all patients diagnosed with melanoma reporting a positive family history

49. Choose the correct statement regarding basal cell carcinoma.
• A. It originates from the deep dermal appendages.
• B. Intermittent intense exposure to UV light is a greater risk factor than exposure at a low
dose per episode of a similar total dose.
• C. Fifty percent of basal cell carcinoma occurs on the head and neck of an individual.
• D. The risk for a second basal cell carcinoma is lower for men with index tumors on the trunk.
• E. Most common type is superficial basal cell carcinoma

50. Which of the following is the most significant prognostic factor for patients with node-
positive (stage III) melanoma?
• A. Nodal size
• B. Number of involved lymph nodes
• C. Tumor thickness
• D. Tumor ulceration
• E. Patient gender

51 . Which of the following statements about the management of inguinal hernias in infants
and children is true?
• A. Repair should be delayed until a child reaches school age since most inguinal hernia
defects close spontaneously.
• B. Repair usually requires a Bassini procedure.
• C. The distal sac should be removed to prevent the formation of a secondary hydrocele.
• D. Contralateral inguinal exploration is indicated routinely because of the high risk for
bilaterality.
• E. Intubation of the clinically apparent hernia sac with a laparoscope is one method of
examining the contralateral side.

52. Which of the following statements is true regarding femoral hernias?
• A. Femoral hernias should not be repaired through an infrainguinal approach.
• B. If an incarcerated femoral hernia cannot be reduced intraoperatively, the insertion of the
inguinal ligament can be cut from the pubic tubercle to allow more space.
• C. Femoral hernias are more common than inguinal hernias in females.
• D. A laparoscopic repair is an inappropriate choice for a femoral hernia repair.
• E. Incarcerated femoral hernias can be observed and managed on an elective basis

53. Which of the following developments has not led to a decrease in recurrence rates after a
groin hernia repair?
• A. Modifications of the Bassini repair
• B. Routine use of prosthetic material
• C. Widespread acceptance of the “tension-free” concept
• D. Use of the preperitoneal space for hernia repair
• E. Use of laparoscopy in hernia repair

54. A morbidly obese man is in the ICU 12 h after a separationof- components hernia repair
for a large hernia with loss of abdominal domain. He is intubated and sedated. The nurse
calls you to the bedside because of worsening abdominal distension. Which of the following
is not a sign of developing an abdominal compartment syndrome?
• A. Increasing peak airway pressures
• B. Decreasing urine output
• C. Increasing tidal volumes
• D. Increasing bladder pressures
• E. Decreased central venous pressure (CVP)

55. Which of the following urologic complications does not occur with hernia repair?
• A. Ischemic orchitis
• B. Transection of the vas deferens
• C. Prostatitis
• D. Testicular atrophy
• E. Ovarian torsion within the hernia sac

56. The following are correct concerning preoperative care except
A. It include history taking and physical examination
B. Medical conditions are optimised
C. Anticipates and plan for perioperative problems
D. Informed consent is involved
E. Does not require communication

57. Which of the following statements concerning preoperative investigations is false.
A. Chest x-ray must be done in a 30 year old man presenting with acute appendicitis
B. Ventricular ejection fraction of less than 35 percent indicate high risk of cardiac complications
C. BMI < 15 is associated with significant mortality
D. ECG is usually require in patient above 40 years
E. HIV testing require patient consent

58. A 40- year woman is to have partial
gastrectomy for a simple gastric ulcer. Answer
question 3-5
3. The history should include the following except
A. Previous operation and anaesthesia experience
B. Drug therapy
C. Previous dysentery and urinary difficulty
D. Social habit regarding alcohol and tobacco
E. Concurrent disease

59. The operation should be postponed if she has:
A. Cold
B. Diabetes for which she has been receiving treatment
C. A history of asthma
D. A history of DVT
E. A hemoglobin of 10g/dl

60. Clinical examination does not reveal any abnormality. The investigation that MUST be
done include:
A. Chest x-ray
B. Blood urea and electrolytes
C. ECG
D. Liver function test
E. Prothrombine, bleeding and clotting times

61. Obesity predispose to the following except
A. Airway obstruction
B. Respiratory infection
C. Wound infection
D. Urinary tract infection
E. Deep venous thrombosis

62. Which of the following is not a problem associated with surgery in the obese.
A. Myocardial infarction
B. Aspiration
C. Deep vein thrombosis (DVT)/ embolism
D. Pressure sore
E. Pain control

63. The following are problems associated with surgery in the jaundice patient except?
A. Clotting disorder
B. Hepatorenal syndrome
C. Infection
D. Poor wound healing
E. Myocardial infarction

64. The following are surgical risk in a diabetic patient except
A. Infection
B. Myocardial infarction
C. Pressure sore
D. Poor wound healing
E. Pain control

65. Which of the following is not a risk factor DVT
A. Young age
B. Pregnancy
C. Smoking
D. Trauma
E. Malignancy

66. In a patient with typhoid perforation, which one of the following may cause cardiac arrest
or affect reversal of muscle relaxation after operation if it is not corrected before operation?
A. Hyponatremia
B. Hypochloremia
C. Hypokalemia
D. Dehydration
E. Anaemia

67. According to the clssification of the American society of
anaesthesiology, the grade of a patient;
A. With gastric outlet obstruction is 4
B. With a haemoglobin of about 10g/dl but with no symtoms of
breathlessness is 3
C. With respiratory obstruction from a foreign body is 2
D. With SS or SC disease is 3
E. Who is moribund an and is not expected to live 24hours with or
without surgery is 6

68. In the anaesthetize SS or SC patient
A. Oxygen should be given as 50% if Hb is <8g/dl
B. Transfusion trigger can be 8g/dl
C. Intravenous infusion is not always necessary
D. It is not essential to replace blood as it is lost
E. Transfused blood should be as fresh as possible

69. Cardia arrest during operation may be caused by:
A. Decrease realease of catecholamines and hypoxia from asphyxia
B. Hemorrhage
C. Hyponatremia
D. fluid overload
E. hyperventilation

70. Which of the following observation is not mandatory after an upper abdominal
operation.
A. Respiratory rate
B. Pulse rate and BP chart
C. Central venous pressure
D. Four-hourly temperture
E. Intake-output chart

71. Which of the drugs is used in management of cardiac arrest
A. Digoxin
B. Magnesium sulphate
C. Adrenaline
D. Sodium citrate
E. Potassium chloride

72. Which of the drugs is not used in management of cardiac arrest.
A. isoprenaline
B. Calcium chloride
C. Sodium bicarbonate
D. Propranolol
E. Amiodarone

73. Postoperative convulsion could be due to
A. Pyrexia
B. Hypotension
C. Water overload
D. Hypocalcemia
E. All of the above

74. Clinical features of deep venous thrombosis
A. Is more common in the right limb
B. Occurs commonly in the profunda femoris vein
C. Is symptom- free in about two-third of patient
D. Swell is the always the first sign
E. In most cases gives a positive Homan’s sign

75. Atelectasis
A. Is a common post operative complications following lower abdominal surgery
B. Usually occurs 5-7 days after operation
C. Is commonly caused by hyperventilation
D. Can be prevented by prophylactic antibiotic therapy
E. predisposes to bronchopneumonia

76. Concerning total body water (TBW)
A. Extracellular fluid is more in neonates
B. Extracellular fluid is 40% of body weight
C. More in the obese individuals
D. Interstitial space is 15 %
E. The intravascular space is 15%

77. Concerning the distribution of ions in fluid compartment
A. The predominant intracellular anion is chloride
B. The predominant intracellular anion is phosphate
C. The predominant intracllular cation is sodium
D. The predominant intracllular cation is potassium
E. The predominant extracellular cation is potassium

78. Concerning composition of intravenous fluid
A. One litre of 5% dextros water has 100g of glucose
B. Ringers lactate contains 154mmol of sodium per litre
C. Paediatric saline contains 43g of glucose in 500ml of water
D. Normal saline contains 130mmol of sodium in one litre
E. Half strength darrows contain 18mmol of potassium in one litre

79. Concerning intravenous fluid administration
A. Ringers lactate is more physiologic and is the fluid of choice for gastric outlet obstruction
B. 5% dextros is fliud of choice in resuscitating shock in paediatrics age group
C. Darrows solution is used in hypokalemia
D. 3% saline is use for correcting hyponatremia
E. 2 liters is the total daily requirement in an adult

80. Fluid and electrolyte balance in the tropics
A. Insensible loss is 1500ml in 24hours
B. Urine is 1500ml n 24hours
C. Sodium loss in the urine is 150mmol in 24hours
D. Potassium loss in faeces is 5mmol
E. Endogenous water production is 500ml in 24hours

81. The 24 hour Maintenance fluid in an adult in the tropics contains
A. 1 liter of normal saline
B. 1 liter 5% dextrose
C. 2g of potassium chloride
D. 2 liters of ringers lactate
E. 1 liter of full strength darrows

82. Cause of chronic dehydration
A. High output enterocutenous fistula
B. Persistent diarrhea
C. Peritonitis
D. Intestinal obstruction
E. Gastric outlet obstruction

83. Fluid and electrolyte abnormality in typhoid perforation
A. Hypernatermia
B. Hypochloremia
C. Hyperkalemia
D. Hypokalemia
E. Hypomagnesemia

84. Which is not a fluid and electrolyte problems in GOO
A. Hypochloremia
B. Hyponatremia
C. Hypokalemia
D. Metabolic alkalosis
E. Metabolic acidosis

85. Hypokalemia
A. Is serium potassium < 2.5mmol/L
B. Is cause by diuretic therapy
C. Increases peristalsis
D. Causea muscles spasm
E. Has shortened QT interval

86.Hyperkalemia
A. Serum potassium > 4mmol/L
B. Has ectopic beats on ECG
C. Has prominent U wave
D. Limb ischemia is a cause
E. Has prolonged QT interval

87. Hyponatremia
A. Causes seizures
B. Corrected with ringers lactate
C. Insulin is added to its treatment
D. TURP is not a cause
E. Causes diuresis

88.
A. trousseau’s sign tests for hypercalcemia
B. trousseau’s sign tests for hypocalcemia
C. Trosier’s sign tests for hypercalcemia
D. Trosier’s sign tests for hypocalcemia
E. Chvostek’s sign test for hypercalcemia

89. Not a precaution for potassium correction
A. Patient most be making adequate urine
B. Potassium chloride is not given in bolus
C. Should be under ECG monitoring
D. Not more than 20mmol/hour
E. Not more than 150mmol in 24hours

90.Which is not a form of distributive shock
A. Neurogenic shock
B. Septic shock
C. Anaphylactic shoch
D. Autonomic effect of Spinal shock
E. Obstructive shock

91. In all forms of shock:
A. There is effective tissue perfusion.
B. The blood volume is reduced
C. There is cellular hypoxia.
D. Cardiac function is impaired
E. There is vasoconstriction in the microcirculation

92. The microcirculation consists of:
A. The capillaries
B. The arterioles and capillaries
C. The venules and capillaries
D. An anteriole, venule and the interposed capillaries.
E. The venules

93. Which of the following is true of the circulation?
A. Each heart beat propels 70-90ml of blood at a pressure of about 120mmHg.
B. About 30% of the blood is contained in the micro-circulation
C. About 20% of the blood is in the main arteries
D. Only about one-halve of the capillaries are normally open at any one time
E. The average adult has 100ml of blood per kg/body weight.

94. The following are vasodilators except:
A. Histamine.
B. Bradykinin.
C. Kallidin.
D. epinephrine.
E. Local products of metabolism.

95. As a result of cellular hypoxia:
A. Anaerobic glycolysis of a mol of glucose produces 5 ATP units.
B. Potassium with chloride and water enters the cell.
C. Acid phosphatase leaves the cell
D. The lipoprotein membranes of the lysosomes break down.
E. Hydrogen released from glucose combines with oxygen to form water

96. In neurogenic shock:
A. The arterioles and venules of the muscles are constricted and those of the skin dilated
B. The cause may be pain or fright.
C. Feeling of cold is experienced.
D. The pulse is rapid and the blood pressure low
E. The patient is laid flat with the head high

97. In septic shock:
A. The WBC shows leucopaenia after initial leucocytosis
B. There is thrombocytosis
C. Blood culture is invariably positive for bacteria
D. The count of the RBC is low or normal.

98. Multiple Organ Dysfunction Syndrome is probably due to the following except
A. Activation of Coagulation pathways.
B. Tissue factor
C. Depletionof anti-oxidants.
D. DIC.
E. Metabolic alkalosis

• 99. Persistence of the following in the serum predicts Multiple Organ Dysfunction
Syndrome
A. TNF-α
B. IL - 1
C. IL - 4
D. IL - 8.
E. IL - 10

100. In systemic inflammatory response syndrome (SIRS), there must be two or more of the
following:
A. Temperature > 38˚C or< 36˚C.
B. Heart rate > 100 beats/min
C. Respiratory rate > 25/min or PaCo2 < 32mmHg
D. WBC > 12,000 mm3 or < 3,000 mm3

101. The initial measure used in the treatment of anaphylactic shock:
A. Adrenaline
B. Antihistamine
C. Hydrocortisone.
D. Aminophylline.
E. Intravenous fluid.

102. Which of the following is TYPICAL of neurogenic shock (vasovagal syndrome)?
A. Sweating
B. Hypotension
C. Pallor
D. Bradycardia.
E. Loss of consciousness

103. In the treatment of septic shock:
A. Blood is needed urgently
B. Corticosteroids, given in massive doses, have been shown to inhibit the production of
arachidonic acid derivatives by complement-activated PMN.
C. Antibiotics are not particularly beneficial as the organisms are already dead
D. Digitalis is not required.
E. Fluid therapy is of secondary importance , and may be dispensed with

104. Causes of shock lung (ARDS) include except:
A. Direct effect of shock on the lung
B. Direct injury of the lung
C. Excessive fluid administration
D. Oxygen toxicity
E. Fat embolism and thrombo-embolism.

105. “Irreversible” shock maybe due to except:
A. Inadequate fluid replacement.
B. Continued blood loss.
C. Metabolic alkalosis
D. Undetected organ injury.
E. Multiple use of antibiotics.

106. The central venous pressure is a function of except.
A. Venous blood flow.
B. The tone of the main veins.
C. Distensibility and contractility of the right atrium and ventricle.
D. The intrathoracic pressure.
E. Contractility of the left ventricle

107. A blood donor should:
A. Be between 18-65 years and over 46 kg in weight.
B. Have a haemoglobin of over 14.5g/dl
C. Not have had malaria in the past three months
D. Being free from hypertension, massive splenomegaly or hepatomegaly is not important.
E. Not have had an operation within the last 4 months

108. Cryorecipitate is rich in:
A. Factor III
B. Factor VI
C. Factor VII
D. Factor VIII.
E. Factor IX

109. In blood stored for 14 days:
A. About 50% per cent of the red cells survive 24 h. after transfusion.
B. The plasma concentration of potassium is about 14 mmol/l
C. The ionized calcium is about 1 mmol/l
D. There is little or no activity of Factor V or Factor VIII.
E. The pH is 7.0

110. Sensation of heat and pain along the vein being used for blood transfusion soon after
transfusion has begun is suggestive of:
A. Haemolytic reaction
B. Allergic reaction
C. Thrombophlebitis
D. Simple febrile reaction
E. Bacterial contamination

111. A patient who is having blood transfusion for the first time complains of fullness in the
head, dyspnoea, constricting pain in the chest and fever. The most likely clinical diagnosis is:
A. Simple febrile reaction
B. Allergic reaction
C. Haemolytic reaction. T
D. Septicaemia
E. Septic shock

112. Wound Healing in our patients is essentially a process of:
A. Resolution
B. Partial regeneration
C. Repair.
D. Contraction
E. Involution

113. Collagen is made up principally of which of the following amino acids?
A. Methionine and cystine
B. Glycine and glutamic acid
C. Proline and lysine
D. Hydroxyproline and lysine
E. Hydroxylysine and hydroxyproline.

114. Surgical revision of a scar should not be advised in less than:
A. 3 months
B. 4 months
C. 5 months
D. 6 months.
E. 7 months

115. In deep partial thickness burns destruction of the following occur:
A. arterioles .
B. The hair follicles and sebaceous glands.
C. Sweat glands
D. Red cells
E. Capillaries

116. The electrolyte composition of oedema fluid in burns:
A. Has a higher sodium concentration than plasma
B. Has a lower potassium concentration than plasma
C. Has a higher bicarbonate concentration than plasma
D. Has a lower chloride concentration than plasma
E. Is the same as that of plasma

117. Which of the following statements about preoperative fasting are true?
A. Clear fluids are allowed up to 2 hours before surgery.
B. Cow and formula milk are allowed up to 3 hours before surgery.
C. Pain, opiates and trauma increase gastric emptying time.
D. Hiatus hernias increase the risk of aspiration.
E. Routine medication can be given within 2 hours of surgery.

118. Which of the following drugs will cause derangement of a standard coagulation screen?
A. Low-molecular-weight heparin
B. Unfractionated heparin
C. Clopidogrel
D. Warfarin
E. Aspirin

119. Which of the following factors increases the likelihood of difficulty obtaining and
securing the airway under anaesthesia?
A. Obesity
B. Dentures
C. Reduced neck movement
D. Mallampati grade 1 and 2
E . Previous radiotherapy to the neck

120. Which of the following statements are true?
A. Bilious secretions have electrolyte contents similar to normal serum.
B. Gastric outlet obstruction can cause hypochloraemic metabolic alkalosis.
C. An infusion of 5% dextrose provide an electrolyte content similar to plasma.
D. Albumin infusions are helpful when the haematocrit is < 30%.
E. A normal adult requires 50 mmol/day of potassium.

A. Normally bowel motility is significantly lower in the ileum than in the jejunum.
B. Resection of 50% of the proximal jejunum causes fluid, electrolyte and nutritional
imbalances.
C. Short bowel syndrome occurs when > 200 cm of short bowel is resected with a colectomy.
D. Patients with a jejunostomy must be encouraged to drink plain water to overcome losses.
E. Renal stones may occur in short bowel syndrome.

A. Total parenteral nutrition (TPN) should be offered to malnourished who have an
inappropriate or disrupted gastrointestinal tract
B. TPN is best delivered via a dedicated central venous catheter.
C. Patients on TPN have lower hospital length of stay when compared to enteral nutrition.
D. A weight gain of more than 3 kg per day suggests fluid retention.
E. Abnormalities in liver function tests are common with TPN usage

123. Which of the following answers regarding deep vein thrombosis (DVT) are true?
A. All types of surgical procedure increase the risk of DVT equally.
B. DVTs are more likely in patients with malignancy.
C. With preventative treatment, DVTs are rare in the postoperative period.
D. DVTs are simple to diagnose.
E. Epidural and spinal anaesthesia are protective against lower limb DVTs.

124. Which of the following answers regarding hypotension are false?
A. Hypotension is only important if urine output drops below 30mL/hour.
B. Hypotension associated with epidural use is always due to sympathetic blockade.
C. Mean arterial pressure is equal to cardiac output multiplied by systemic vascular resistance.
D. Mean arterial pressure above 60 mmHg is adequate.
E. Bleeding always causes a fall in blood pressure.

125. Which of the following answers regarding postoperative bleeding are true?
A. Postoperative bleeding can be difficult to diagnose.
B. Postoperative bleeding is not significant unless Hb drops below 8g/dL.
C. Patients should be resuscitated with warmed fluids where possible.
D. Postoperative bleeding is only significant if losses are over 1 L.
E. Patients should have a valid group and save prior to major surgery

126. Which of the following statements are true in the pathophysiology of shock?
A. In shock, cells switch from aerobic to anaerobic metabolism.
B. The product of anaerobic respiration is carbon dioxide, resulting in respiratory acidosis.
C. Hypoxia and acidosis generate oxygen free radicals and cytokine release.
D. Renal ischaemia leads to decreased glomerular filtration (GFR), thus activating the renin-
aldosterone angiotensin system (RAAS).
E. Once shock has been treated and circulation restored, the physiological disturbances return
to normal.

127. The following statements are true except:
A. Haemorrhage with hypovolaemic shock results in a state of coagulopathy.
B. Haemoglobin level is an accurate indicator of the degree of haemorrhage.
C. The acid-base disturbance is metabolic acidosis.
D. Permissive hypotension is a strategy to be followed until haemorrhage is controlled.
E. Haemorrhagic shock can be classified into three groups – mild, moderate and severe.

A. Blood group ’O’ is regarded as universal donor.
B. Blood group ’AB’ is regarded as universal recipient.
C. The vast majority of the population is Rhesus negative.
D. In coagulopathy packed red blood cells should be transfused.
E. Fresh frozen plasma (FFP) has a shelf life of 2 years.

129. The following statements are true except:
A .The inflammatory phase of wound healing lasts for 5 to 7 days.
B. Platelet-rich blood clot and dilated vessels are typical of the inflammatory phase.
C. Fibroblastic activity is the main feature of the proliferative phase.
D. In a tendon injury, fibrous adhesion between the tendon and its sheath is an important
mechanism of healing.
E. In a fractured bone cortical structure and medullary cavity are restored in the remodelling
phase.

A. The aim in treatment of a wound is to reduce the inflammatory and proliferative responses.
B. The mechanism of wounding influences the healing of a wound.
C. There is no role for tests for hepatitis and HIV when managing wounds.
D. Primary repair of all damaged structures should be attempted in all wounds.
E. Healing by tertiary intention should be the choice in certain situations.

131. A fit 30-year-old woman while gardening suddenly became very short of breath, had
intense itching with rash and complained of a painful red spot on her arm. She has been
brought to the A&E department and is hypotensive, hypoxic with warm peripheries.The
diagnosis is
A. Cardiogenic shock
B. Anaphlactic shock
C. Hypovolaemic shock
D. Mismatched blood transfusion
E . Neurogenic shock

132. Which of the following statements regarding burns in children
A. The majority are electrical or chemical.
B. Scalds are the most common type.
C. Hot water thermostat setting at 60.C helps to improve safety in homes.
D. Intravenous (IV) resuscitation in children is not required for burns up to 10% total body
surface area (TBSA).
E. Non-accidental injury is common in children’s burns

133. Regarding burn injury in adults in, which of the following statements are true?
A. Electrical and chemical burns are common.
B. Scalds at home are more common than flame burns.
C. Alcohol problems are rare in relation to burn injury.
D. Effective care requires multidisciplinary input.
E. Intravenous fluids are required for burns of 15% TBSA or more.

134. Which of the following statements regarding burns in children
A. The majority are electrical or chemical.
B. Scalds are the most common type.
C. Hot water thermostat setting at 60.C helps to improve safety in homes.
D. Intravenous (IV) resuscitation in children is not required for burns up to 10% total body
surface area (TBSA).
E. Non-accidental injury is common in children’s burns

135. Regarding burn injury in adults in, which of the following statements are true?
A. Electrical and chemical burns are common.
B. Scalds at home are more common than flame burns.
C. Alcohol problems are rare in relation to burn injury.
D. Effective care requires multidisciplinary input.
E. Intravenous fluids are required for burns of 15% TBSA or more.

136. Which of the following statements are true regarding epidermal burns?
A. Epidurmal burns are classified as superficial burns.
B. Epidurmal burns are red in colour.
C. Epidurmal burns are painless.
D. Epidurmal burns are associated with a normal capillary refill time.
E. Epidurmal burns heal by primary intention.

137. The criteria for transfer of a patient with burns to a specialised burns unitinclude the
following:
A. Partial- and full-thickness burns ≥10% of the total body surface area in patients≤10 years or
≥50 years of age.
B. Full-thickness burns involving the genitalia.
C. Full-thickness burns ≥5% body surface area in any age group.
D. Chemical injury.
E. Inhalation burn.

138. Which of the following statements regarding respiratory problems in burns are true?
A. Burn injury to the lungs can be fatal.
B. Injury can be due to inhalation of hot or poisonous gases.
C. Burn injury is more common in the supraglottic than in the lower airway.
D. Haemoglobin combines with carbon monoxide less easily than with oxygen.
E. Hydrogen cyanide interferes with mitochondrial respiration.

139. Which of the following statements regarding smoke inhalation are true?
A. Inhaled smoke particles can cause a cause a chemical alveolitis and subsequent increased
gaseous exchange.
B. Inhaled smoke particles may be suspected with a specific situation in an enclosed space.
C. Early elective intubation is contraindicated.
D. Symptoms can take 24 hours or up to 5days to develop.
E. The result of carbon monoxide poisoning is a metabolic alkalosis

140. Which of the following statements are true regarding carbon monoxide poisoning?
A. Carboxyhaemoglobin dissociates less readily than oxyhaemoglobin.
B. The fall in PaO2 is directly proportional to a rise in carboxyhaemoglobin levels.
C. The PaO2 levels are always reduced.
D. Carbon monoxide binds with the intracellular cytochrome system and produces abnormal
cellular function.
E. Carboxyhaemoglobin levels of ≥20% is manifested by ataxia and convulsions.

141. Which of the following statements are true in relation to burns and total body surface
area (TBSA)?
A. Epidermal destruction can occur when a surface temperature of 70.C is applied for 1 second.
B. A child’s head comprises a smaller percentage of TBSA than that of an adult.
C. According to the Lund and Browder chart, an adult with burns involving both sides of one
upper limb, as well as the hand, equates to about 15% TBSA burn.
D. The ‘rule of nines’ is widely used in the burns unit to estimate burn size in a 10-year-old
child.
E. In small burns the patient’s whole hand is 1% of TBSA and is a useful guide to assess a burn.

142. Which of the following statements regarding burn depth are true?
A. The depth of a burn together with percentage of TBSA and smoke inhalation are key
parameters in the assessment and management of a burn.
B. Alkalis, including cement, usually result in superficial burns.
C. Fat burns are deeper than electrical contact burns.
D. Capillary filling is not present in superficial burns.
E. Deep dermal burns take a maximum of two weeks to heal without surgery.

143. Which of the following statements regarding the consequences of burns are true?
A. As a result of a burn, complement causes degranulation of mast cells and,
subsequently,neutrophils.
B. Mast cells do not release primarycytokines.
C. As a result of a burn, an increase in vascular permeability occurs.
D. Following a burn, water only moves from the intravascular to extravascular space.
E. In burns affecting >15% TBSA in an adult, fluid loss results in shock and the volume lost as
fluids is directly proportional to the area of burn.

A. The simplest and most commonly used crystalloid is Ringer’s lactate.
B. Hypertonic saline produces an excess of intracellular water shifting to the extracellular space
C. Human albumin solution is a colloid that reduces protein leak out of cells, thereby helping to
reduce oedema.
D. The Parkland formula is the most widely used formula in the United Kingdom and calculates
the fluid replacement in the first 24 hours.
E. Using the Parkland formula, the fluid requirement in the first 24 hours for a man of 70 kg
with an 18% TBSA burn is about 2,800 mL.

A. Inguinal hernia is more common in men than in women.
B. Femoral hernia is more common than inguinal hernia in women.
C. Femoral hernia is felt below and medial to the pubic tubercle.
D. The risk of bowel strangulation is greatest in femoral hernia, less in indirect inguinal hernia
and least in direct inguinal hernia.
E. A ‘sliding’ inguinal hernia can pass either medial or lateral to the inferior epigastric vessels.

146. Which of the following conditions is usually present with hyperthyroidism?
A Graves’ disease.
B. Toxic nodule.
C. Thyroid malignancy.
D. De Quervain’s thyroiditis.
E. Toxic multinodular goitre.

147. What are the manifestations of thyrotoxicosis?
A. Irritability.
B. Hair loss.
C. Muscle weakness and wasting.
D. Hyperkinesias.
E. Heart failure.

148. Which of the following are associated with Graves’ disease?
A. Pretibial myxoedema.
B. Exposure keratitis.
C. Optic neuropathy.
D. Chemosis.
E. Lymphoid hyperplasia.

149. Which of the following are true regarding medical therapy for thyrotoxicosis?
A. Propranolol and nadolol reduce free T3 (fT3) and free T4 (fT4) levels.
B. Antithyroid drugs most often cure thyrotoxicosis due to a toxic nodule.
C. Carbimazole can be safely given in pregnancy and lactation.
D. Agranulocytosis is an uncommon problem with antithyroid drugs.
E. Patients with ophthalmopathy respond best to medical management.

150. Surgery is the preferred option of treatment in which of the following cases of
thyrotoxicosis?
A. A diffuse toxic goitre.
B. Severe manifestations of Graves’ ophthalmopathy.
C .Pregnant mothers not adequately controlled with medications.
D. Relapse of Graves’.
E. Presence of local compressive symptoms.

151. Which of the following are indications for radioiodine treatment?
A. Relapsed Graves’ disease.
B. Thyrotoxicosis in young children.
C. Multinodular goitre.
D. Severe ophthalmopathy.
E. Pregnancy and lactation.

152. Which of the following statements regarding thyroid neoplasms are true?
A. Papillary carcinoma is the most common.
B. Men and women are equally affected.
C. Thyroid cancer is most common after the age of 70 years.
D. Medullary carcinoma originates from the C-cells.
E. Anaplastic carcinoma is the least common.

153. Which of these following statements are true?
A. Nipple retraction always indicates an underlying malignancy.
B. Staphylococcus aureus is the most common cause for lactational mastitis.
C. Fibroadenomas should always be offered excision, as they are associated with a high risk of
malignancy.
D. The histology of phyllodes tumour may be benign, intermediate or malignant.
E. Blood-stained nipple discharge is usually due to a breast carcinoma.

A. Consent should be obtained by the person doing the operation.
B. The written communication should always be in English.
C. Consent is necessary before physical examination of a patient.
D. Every possible hazard, however remote the possibility, should be explained in detail.
E. Legally, a signed consent from a patient is proof that valid consent has been properly
obtained.

155. For consent to be valid, which of the following statements are true?
A. The patient must be competent to give it.
B. The patient must not be coerced into decision making.
C. The patient must be given sufficient information.
D. If competence is severely compromised, the patient's carer should assume responsibility.
E. If a patient has a legally valid advanced directive refusing treatment, the decision must be
honoured.

A. The surgeon is always obliged to provide life-sustaining treatment.
B. A decision to withhold treatment should be taken along with another senior clinician and
recorded in detail.
C. In palliation for pain in advanced malignancy, a potential lethal dose of analgesia is
appropriate.
D. Confidentiality is absolute.
E. All research activity must be externally validated.

157. Which of the following does not increases the
• risk of myocardial ischaemia?
• A Tachycardia
• B Hypertension
• C Pain
• D Anaemia
• E Beta blockers

158. Which of the following statements about the management of high-risk patients is true?
A All patients undergoing major surgery should be started on beta blockers on the day of
surgery.
B Long-term beta blockers can be safely withheld on the day of surgery.
C The oesophageal Doppler accurately measures cardiac output.
D Better fluid management can reduce postoperative ileus after abdominal surgery.
E late return to enteric feeding is associated with reduced hospital stay.

158. Regarding preoperative management of patients with severe respiratory disease, which of
the following statement is true?
A. A course of antibiotics should always be given in patients with chronic sputum production.
B. Stopping smoking prior to surgery is of little benefit.
C. Regional anaesthesia should be considered where possible. @
D. A course of steroids prior to surgery Is not necessary in patients with chronic obstructive
airway diseases.
E. Preoperative physiotherapy has no role

160. Which of the following statements is true?
• A, Serum albumin is a measure of nutritional status.
• B, Unintentional weight loss of > 20% in the preceding 6 months is indicative of a poor
outcome.
• C, Body mass index (BMI) is a better indicator than weight in critically ill patients.
• D, Anthropometry is an indirect measure of energy and protein stores.
• E, A Malnutrition universal screening tool (MUST) score of 3 suggests a high risk of
malnutrition.

A Bilious secretions does not have electrolyte contents similar to normal serum.
B Gastric outlet obstruction can cause hypochloraemic metabolic alkalosis.
C An infusion of 5% dextrose provide an electrolyte content similar to plasma.
D, Albumin infusions are helpful when the haematocrit is < 30%.
E, A normal adult requires 90 mmol/day of potassium.

A, Normally bowel motility is significantly higher in the ileum than in the jejunum.
B, Resection of 50% of the proximal jejunum causes fluid, electrolyte and nutritional
imbalances.
C, Short bowel syndrome occurs when >200 cm of short bowel is resected with a colectomy.
D, Patients with a jejunostomy must be encouraged to drink plain water to overcome losses.
E, bladder stones may occur in short bowel syndrome.

163. Which of the following answer regarding deep vein thrombosis (DVT) is true?
A, All types of surgical procedure increase the risk of DVT equally.
B, DVTs are more likely in patients with malignancy@.
C, With preventative treatment, DVTs are rare in the postoperative period.
D, DVTs are simple to diagnose.
E, Epidural and spinal anaesthesia are a cause of lower limb DVTs

164. Which of the following answers regarding hypotension is true?
A, Hypotension is only important if urine output drops below 30mL/hour.
B, Hypotension associated with epidural use is always due to sympathetic blockade.
C, Mean arterial pressure is equal to cardiac output multiplied by systemic vascular resistance.
D, Mean arterial pressure above 60 mmHg is adequate.
E, Bleeding always causes a fall in blood pressure.

165. Which of the following answers regarding postoperative bleeding is true?
A, Postoperative bleeding can be difficult to diagnose.
B, Postoperative bleeding is not significant unless Hb drops below 8g/dL.
C, Patients should be resuscitated with cold fluids where possible.
D, Postoperative bleeding is only significant if losses are over 1 L.
E, Patients don’t need blood saved prior to major surgery

166. Which of the following answers regarding postoperative nausea and vomiting is true?
A, Patients need anti-emetics routinely in the perioperative period to prevent N&V.
B, N&V is more frequent in thin patients.
C, Vomiting may cause the patient to aspirate.
D, inadequate pain relief with multimodal analgesia helps to prevent N&V.
E, The risk of N&V does not vary with the procedure performed

167. In relation to blunt injuries, which of the following statements is false?
A, The mechanisms are direct or indirect.
B, In indirect injury, associated injuries may be present and should be sought.
C, In chest injuries damage to abdominal organs is rare.
D, Overt injury should lead the clinician to look for a covert injury as well.
E, Proper exposure is essential so as not to miss other injuries.

168. Which of the following is NOT a direct result of raised ICP?
A, Reduced perfusion pressure.
B, Headache, vomiting and reduced conscious level.
C, Tonsillar herniation.
D, Loss of cerebral autoregulation.
E, Displacement of CSF and venous blood from the cranium.

169. Which of the following statements regarding respiratory problems in burns is true?
A, Burn injury to the lungs can be fatal.
B, Injury can never be due to inhalation of hot or poisonous gases.
C, Burn injury is more common in the supraglottic than in the lower airway.
D, Haemoglobin combines with carbon monoxide less easily than with oxygen.
E, Hydrogen cyanide does not interferes with mitochondrial respiration.

A, Copious water lavage is the best first-aid measure for phosphorus burns.
B, Elemental sodium burns should be treated by water lavage.
C, Damage from alkalis is usually less than with acids.
D, The onset of pain may be delayed in alkali burns.
E, Local radiation burns causing ulceration need excision and split-skin graft repair

171. The following statements is true regarding chemical burns:
A, Acid burns require longer irrigation than alkali burns.
B, Dry powder should be brushed away before irrigation with water.
C, Neutralising agents should be the first line of treatment in cement burns.
D, Hydrofluoric acid burns are associated with hypercalcaemia.
E, Systemic sodium chloride may be required in the treatment of burns due to hydrofluoric
acid.

172. Which of the following statements is false?
A, The depth of a burn can be assessed initially from the temperature and nature of the
causative agent and time of application.
B, Electric contact burns are almost certainly full-thickness.
C, Superficial partial-thickness burns involve destruction of the whole dermis.
D, Sensation is totally absent in a full thickness burn.
E, Tangential shaving may be a useful diagnostic and management tool in partial-thickness
burns.

A, Oral fluids containing no salt are essential when given as fluid replacement in burns.
B, Fluids required can be calculated from a standard formula.
C, Hyponatraemia can be avoided in oral fluid management by rehydrating with a solution such
as Dioralite.
D, Urine output gives a major clue as to adequacy of fluid replacement.
E, Three types of fluid are commonly used for IV fluid replacement in burns: Ringer’s lactate,
hypertonic saline and colloids.

174. Which of the following statement regarding wound healing is false?
A, Wound healing can proceed in the absence of polymorphonuclear leucocytes.
B, Monocytes are essential for wound healing.
C, Collagen is formed by two polypeptide chains.
D, Type IV collagen is seen predominantly in the basement membrane.
E, The normal ratio of Type I to Type III collagen in the skin is approximately 4:1

175. Which of the following statements regarding keloid scars are true?
A, Keloid scars are predisposed by wound haematoma and infection.
B, Keloid scars extend beyond the margins of the original scar.
C, Keloid scars are less common in children and young adults.
D, Keloid scars usually develop within weeks of initial injury.
E, Keloid scars are characterised by decreased collagen synthesis

A, The surface of the skin is an important biological layer for homeostasis.
B, The epidermis regenerates from deeper follicular elements.
C, Epidermal keratinocytes cannot be cultured and thus are of no value in wound management.
D, The depth of skin varies in different parts of the body.
E, In the absence of skin, a wound heals by secondary intention with fibrosis and contracture.

177. Regarding anatomy of the shoulder, which of the
following is not a muscle of the rotator cuff?
A, Infraspinatus
B, Subscapularis
C, Supraspinatus
D, Teres major
E, Teres minor

178. Which of the following conditions is not usually present
with hyperthyroidism?
A, Graves’ disease.
B, Toxic nodule.
C, Thyroid malignancy.
D, De Quervain’s thyroiditis.
E, Toxic multinodular goitre.

179. Which is not the manifestations of thyrotoxicosis?
A, Irritability.
B, Hair gain.
C, Muscle weakness and wasting.
D, Hyperkinesias.
E, Heart failure.

180. Which of the following is not associated with Graves’
disease?
A, Pretibial myxoedema.
B, Exposure keratitis.
C, Optic neuropathy.
D, Osmosis.
E, Lymphoid hyperplasia

181. Which of the following are true regarding medical
therapy for thyrotoxicosis?
A, Propranolol and nadolol reduce free T3 (fT3) and free T4 (fT4) levels.
B, Antithyroid drugs most often cure thyrotoxicosis due to a toxic nodule.
C, Carbimazole can be safely given in pregnancy and lactation.
D, Agranulocytosis is an uncommon problem with antithyroid drugs.
E, Patients with ophthalmopathy respond best to medical management

182. Which of these following statements is true?
A. Nipple retraction always indicates an underlying malignancy.
B. Staphylococcus aureus is the most common cause for lactational mastitis.
C. Fibroadenomas should always be offered excision, as they are associated with a high risk of
malignancy.
D. The histology of phyllodes tumour is always malignant.
E. Blood-stained nipple discharge is usually due to a breast carcinoma

A, Wet gangrene occurs when there is infection.
B, Neuropathy is an important factor in diabetic gangrene.
C, Frostbite is gangrene caused by cold injury to the vessel wall.
D, Bedsore is a type of gangrene.
E, Amputation of the affected limb should be done in all cases.

A. Inguinal hernia is more common in men than in women.
B. Femoral hernia is more common than inguinal hernia in women.
C. Femoral hernia is felt below and medial to the pubic tubercle.
D. The risk of bowel strangulation is less in femoral hernia, lesser in indirect inguinal hernia and
least in direct inguinal hernia.
E. A ‘sliding’ inguinal hernia can pass either medial or lateral to the inferior epigastric vessels.

A. The condition occurs equally in children and adults.
B. Intussusception in all age groups is ileocolic.
C. All cases of intussusception will require an operation.
D. In children the abdomen is initially distended.
E. US of abdomen has a high diagnostic sensitivity in children

186. Clinical features of intestinal obstruction, which
of the following statements is false?
A. Vomiting is early and distension minimal in high small bowel obstruction.
B. The vomitus is faeculent in distal small bowel obstruction.
C. The more distal the obstruction in the small bowel, the greater is the abdominal distension.
D. Absolute constipation is present in all cases.
E. The administration of enemas can result in misleading findings

187. In intestinal obstruction, the following statement
is true except:
A. Continuous severe pain is suggestive of strangulation.
B. Tenderness over the right iliac fossa is a sinister sign.
C. Fever indicates strangulation.
D. Secondary polycythaemia might be a feature of dehydration.
E. Normal bowel sounds excludes intestinal obstruction.

188. In Haemorrhoids, which of the following
statement is false?
A. Haemorrhoids are symptomatic anal cushions.
B. Traditionally, four degrees are recognised.
C. Conservative treatment should be the first line of management.
D. Urgent surgery is justified in certain complications.
E. Operation is always indicated

189. Haematuria, the following statements are true
except:
A. Microscopic haematuria is not always abnormal.
B. Haematuria at the start of urinary stream indicates a cause in the lower urinary tract.
C. Haematuria where the urine is uniformly mixed with the urine points to a cause in the upper
urinary tract.
D. Terminal haematuria is caused by bladder irritation or infection.
E. Painful haematuria may indicates a malignant pathology.

190. The hazards of incomplete descent of testis are
the following except:
A. Impaired fertility
B. Hernia
C. Torsion
D. Increased liability to malignant change in later life
E. Epididymo-orchitis

191. Acute appendicitis
A. Is rare in children under 2years
B. Is not a common disease
C. Always resolve spontaneously
D. Obstruction of the lumen rarely leads to the disease
E. All of the above

192. In acute abdomen posisitve Murphy’s sign
suggest
A. Acute cholecystitis
B. Acute appendicitis
C. Acute pancreatitis
D. Acute diverticulitis
E. Acute hepatitis

193. Acute abdomen
A. It does not require immediate surgical intervention
B. Abdominal angina is not a cause
C. Herpe’s zoster is the number one cause
D. Red current jelly stool is a symptom of intussusception
E. Inflammatory conditions usually cause colicky pain

194. In Inguinal canal the inferior epigastric artery
forms
A. The lateral wall of the Hesselbech’s triangle
B. The medial wall of the Hesselbach’s triangle
C. The content of the Hesselbech’s triangle
D. The weakest part of the canal
E. All of the above

195. Bladder stones, Which of the following statements are
true?
A. Men are more often affected than women.
B. An oxalate calculus develops in sterile urine.
C. A cystine calculus is radio-opaque.
D. Treatment is crushing with an optical lithotrite in all cases.
E. In men with stones and outflow obstruction from enlarged prostate, both can be dealt with
at the same time.

196. Pain of urological origin, Which of the following statements is false?
A. Pain of renal origin is a deep-seated sickening ache and ‘bursting’ in nature.
B. Pain from a ureteric stone is colicky and radiates to the groin, scrotum, or labium.
C. Pain from the urinary bladder is a suprapubic discomfort.
D. Perineal pain is a penetrating ache and can be referred to the rectum.
E. Large, slow-growing, space-occupying lesions produce a constant ache.

197. Regarding spinal physical examination, which of the
following nerve roots is associated with an absent ankle jerk
reflex?
A. L4
B. L5
C. S1
D. S2
E. S3

198. Which of the following is not an indication for a
tracheostomy?
A. Upper airway obstruction.
B. Potential upper airway obstruction
C. Pneumothorax.
D. Prolonged artificial ventilation.
E. Protection of the lower airway.

199. Potassium: which of these is true?
A. is the major intracellular cation.
B. concentrations are decreased in acute tubular necrosis.
C. depletion occurs in Addison's disease.
D. is excreted preferentially to hydrogen ions in gastric outlet obstruction.
E. gain occurs in high enterocutaneous fistulae

200. Lumbar puncture: which is correct
A. is useful in the diagnosis of subarachnoid haemorrhage.
B. involves the insertion of a fine needle into the subdural space.
C. should be performed with the patient in the prone position.
D. may have fatal consequences if performed in communicating hydrocephalus.
E. is not part of the septic work-up in an infant with unexplained pyrexia.

201. Chest drain insertion: which of the following is
true.
A. does not require observation of a full aseptic technique
B. is unnecessary in spontaneous pneumothoraces of less than 50%
C is associated with more complications when performed under direct vision with blunt
dissection down to the parietal pleura
D is not indicated in malignant pleural effusions
E should be in the intercostal space at the upper border of the rib

202. Increased intracranial pressure, if unrelieved, may
typically be associated with these except:
A. tachycardia
B. hypertension
C. apnoea
D. transtentorial herniation
E. foraminal herniation

203. Urinary retention: which of these is true
A. is invariably associated with suprapubic pain
B. Affects only men
C. occurring in young females is usually not associated with any significant underlying
pathology
D. may result in renal dysfunction
E. due to urethral stricture is best managed by insertion of a transurethral catheter

204. Clinical stigmata of chronic liver disease includes
all except:
A. spider naevi
B. koilonychia
C. finger clubbing
D. caput Medusa
E. peripheral oedema

205. The following statements are true:
A in obstructive jaundice there are high circulating levels of conjugated bilirubin and
bilirubin in the urine.
B. in haemolytic jaundice there are high circulating levels of conjugated bilirubin and no
bilirubin in the urine
C in obstructive jaundice there is excess urobilinogen in the urine which renders it dark in
colour.
D in obstructive jaundice the serum alkaline phosphatase decreases
E in hepatocellular jaundice there is no rise in the serum alkaline phosphatase

206. In acute appendicitis: which of these is false
A obstruction of the lumen is the initiating event.
B the indigenous bacterial flora are typical of the large bowel.
C a faecolith is present in more than 10% of cases.
D if untreated will invariably progress to necrosis and
perforation.
E prophylactic antibiotics should be administered to reduce the risk postoperative wound
infection.

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