Surgery Multiple Choice Questions

1. Fluid and electrolyte balance: a. Insulin and glucose infusion may be used to treat hyperkalemia> 6.5 mg/L b. Short gut Syndrome does not predispose to carcinoma c. Patients on IV fluids require 1 mmol/kg body weight of potassium per day d. Hyponatremia should be corrected by large volumes of hypertonic saline e. Vomiting due to gastric outlet obstruction causes hypochloremia, hypokalemia and metabolic alkalosis

2. Regarding sinuses and fistulae a. High output fistulae are characterized by loss of intestinal fluid in excess of 200 mL/24 hours b. Pilonidal sinus is premalignant c. An example of a congenital fistula is a thyroglossal fistula – d. Inefficient or non-dependent drainage is one of the factors leading to persistence of a sinus – e. A chronic subareolar abscess can lead to a mammary fistula –

3. Regarding thyroid and parathyroid neoplasms a. Follicular carcinoma of thyroid primarily spreads through lymphatics – b. Parathyroid adenoma is the most likely cause of primary hyperparathyroidism c. Hürthle cell carcinoma is a variant of papillary carcinoma of the thyroid – d. Phaeochromocytoma is detected by measuring urinary 5-HIAA levels – e. Superior laryngeal nerve supplies cricothyroid muscle – TRUE

4. Regarding lesions of the breast a. A breast lesion is >5 cm in dimension - b. Tamoxifen should be prescribed for life to patients with breast cancer – c. Axillary lymph node involvement is a weak predictor of outcome – d. Comedo DCIS is associated with lower recurrence rate – e. Breast cancer metastasizes to lung more commonly than bone -

5. Abdominal Aortic Aneurysms (AAA) a. Surgery is recommended for patients with AAA size > 6 cms – b. 90% arise below renal arteries – c. Ischemia of the colon is a peri-operative risk – d. Mortality rate of ruptured AAA is 25% - e. Blue toe syndrome occurs in association with AAA -

6. T/F: a. Carotid atheromatous disease is the commonest cause of strokes in the western world – b. Varicose veins are treated by femoral-popliteal bypass graft – c. Chest pain is relieved by elevation of the foot – d. Diabetic patient presenting with an ischemic foot may have an Ankle Brachial Pressure Index of 0.8 – e. Cervical rib may present with wasting of the thenar muscles –

7. Regarding colorectal cancer a. Hereditary non-polyposis colorectal cancer is autosomal dominant – b. Colorectal cancers develop before 40 years of age in familial adenomatous polyposis (FAP) – c. Polyps in Peutz Jeghers Syndrome are hyperplastic – d. The Familial Adenomatous Polyposis gene is on the short arm of chromosome 5 – e. Hereditary nonpolyposis colorectal cancer accounts for 5% of colorectal cancer cases. -

8. Hernias a. Direct inguinal hernias pass through the internal ring – b. A femoral hernia is the most common hernia in females – c. Testicular atrophy may occur after inguinal hernia repair – d. Inguinal hernias in children are treated by herniorraphy – e. Open appendicectomy is associated with an increased incidence of right sided indirect inguinal hernia –

9. Pancreatitis a. Cholelithiasis is the commonest cause – b. Cullen’s sign is associated with bruising in flanks – b. Steroids are not associated with acute pancreatitis – d. The treatment of sterile necrotizing pancreatitis in necrosectomy – e. A pseudocyst should be drained within 2 weeks of the acute attack –

10. Gallstones a. Ascending cholangitis requires emergency decompression of the Common Bile Duct - b. Choledochal cysts are associated with malignancy – c. The five year survival rate of adenocarcinoma of gallbladder is less than 5% - d. Magnetic Resonance Cholangiography gives an accurate picture of the biliary tree – e. Gallstones can be dissolved by chenodoxycholic acid –

11. Diverticular disease a. Bleeding from diverticular disease is characteristically plum colored – b. The treatment of diverticular disease is oral steroids – c. May arise in the rectum - c. Is best treated with a low residue diet – d. May present with Urinary Tract Infection – 12. Orthopaedics a. Smith’s fracture results in volar angulation of the radius – b. A fractured neck of femur results in external rotation of the lower limb – c. The radial nerve is often injured in fracture of the neck of humerus – d. Bennett’s fracture involves distal end of radius – e. Supracondylar fracture of humerus may cause vascular complications –

13. Trauma/Cardiothoracic a. In the initial management of the injured patient, control of hemorrhage should be the priority – b. Right diaphragmatic rupture is more common than left – c. Fracture of left lower ribs may be associated with ruptured spleen d. A flail chest is commonly associated with Acquired Respiratory Distress Syndrome e. Tension pneumothorax is diagnosed on chest X-ray

14. Urology a. In suspected torsion of the testis, ultrasound may be of value – b. Unilateral orchidopexy is the treatment of choice for torsion of the testis – c. Varicocele is more common on the right side - d. Varicocele is associated with oligospermia – e. Uric acid calculi are the most common types of renal calculi –

15. Pleomorphic salivary adenoma a. Presents as a slowly growing painless lump – b. Can present with facial nerve weakness – c. Treatment includes radiotherapy – d. Sentinel lymph node mapping is recommended – e. The minimum operation is a superficial parotidectomy –

16. Melanoma a. Ulceration of the primary lesion is associated with worsening of prognosis – b. A brisk tumour infiltrating lymphocyte response is associated with worse prognosis - c. Clark’s level III implies invasion of the reticular dermis – d. Suspicious lesions should be evaluated by initial incisional biopsy – e. Sentinel lymph node mapping should be considered for lesions of intermediate depth (1-4 mm) –

17. Nerve injuries/Hand a. Flexor tendons require at least 6 weeks of immobilization for adequate healing and strength - b. A compound fracture of metacarpal, sustained while punching an opponent in teeth, should be treated with antibiotics – c. Tinel’s sign is useful in monitoring progress following nerve repair – d. Ulnar nerve entrapment is more common at elbow than wrist – e. Normal sensation over the thenar eminence is consistent with carpal tunnel syndrome –

18. In head injury patients a. Patients with acute subdural hematoma present with a lucid interval – b. The lowest Glasgow Coma score possible is 3 – c. Skull fracture is a risk factor for extradural hematoma – d. In a patient with decreased level of consciousness, skull X-ray is the investigation of choice – e. Normal intracranial pressure ranges between 10-30 mmHg –

19. Delayed recovery of consciousness following general anesthesia may be caused by a. Intra-operative hypoxia - b. Carbon dioxide narcosis - c. Opioid premedication - d. Residual neuromuscular blockade - e. Hyperventilation -

20. Factors which increase the likelihood of aspiration of gastric content at the induction of anaethesia a. Increasing age - b. Anxiety - c. Chronic Obstructive Pulmonary Disease - d. Major Trauma – e. Pregnancy - EXAM 3 Final Medical Surgical MCQ March, 1999 The following associations are true: a. Galen (AD 131-200) : A Greek b. Andreas Vesalius (1514-1564) :De Humanis Corporis Fabrica; c. Benjamin Alcock (1849) : Professor of Anatomy, Cork d. Ignaz Semmelweiss (1818-1865) : Postpuerpal sepsis e. Abraham Colles (1773-1843) : Orthopedic Surgeon, Cork

1. Regarding Hypertrophic pyloric stenosis a. There is a predominance of males 4:1 (M:F) b. Stenosis occurs 4-6 weeks after birth c. Characteristically presents with blood stained projectile vomiting d. 0.45% saline solution is the resuscitation fluid of choice e. Hypokalemic hypochloremic metabolic acidosis chracterises the metabolic disturbance

2. Patients presenting with acute pancreatitis a. Hyperparathyroidism may be the underlying aetiology b. Onset of acute pancreatitis is associated with tetracycline therapy c. A normal serum amylase occurs in up to 30% of cases d. Characteristically have associated steatorrhea e. 60% of cases have detectable choledocholithiasis

3. Regarding melanoma a. Juvenile melanoma (Spitz naevus) is a benign condition b. Breslow staging of <0.75mm has predicted 5 year survival of 95-100% c. Acral lentiginous melanoma is the rarest form of melanoma d. Overall males have a better prognosis e. Locoregional radiotherapy confers a significant survival benefit

4. Risk factors for the development of colorectal carcinoma include: a. Chronic ulcerative colitis b. Peutz-Jeghers syndrome c. Gardners syndrome d. Juvenile polyps e. Previous cholecystectomy

5. The natural history of colonic polyps a. The majority are premalignant b. Overall villous adenomatous polyps have a poorer prognosis than tubular polyps c. There is a higher incidence of rectosigmoid lesions than ascending colonic lesions d. 85% of adenomatous polyps are tubular in nature e. Hereditary polyposis coli is associated with duodenal and gastric polyps

6. Features of Charcots triad and Reynolds pentad include a. Right upper quadrant pain b. A palpable gall bladder c. Pyrexia d. Rigors e. Shock

8. In Inflammatory bowel disease secondary to Crohns Disease a. The rectum is usually involved b. Granuloma formation is characteristic c. There is a male predominance (M:F of 2:1) d. Restorative proctocolectomy potentially offers surgical cure for the disease e. Fistula tract formation is more suggestive of ulcerative colitis

9. Toxic megacolon a. Is unique to ulcerative colitis b. Colonic perforation carries mortality of 50% c. Is best treated with high dose corticosteroids for at least 72 hours d. A gastrograffin enema may be diagnostic e. Occurs in 10% IBD patients

10. Regarding herniae a. The most common hernia in females in femoral b. Femoral herniae are classically located below and medial to the pubic tubercle c. Herniorrhaphy invariably necessitates herniotomy d. Inguinal hernia nearly always are congenital in origin e. An indirect inguinal hernia will protrude through Hasselbachs triangle

11. The following are features of hyperparathyroidism a. Osteoporosis b. Polydipsia and polyuria c. A technetium-99m sestamibi isotope scan would be unhelpful d. Primary hyperparathyroidism is secondary to adenoma in >90% cases e. A positive Chvosteks sign is evident in 30% of cases

12. Recognized abdominal surgical incisions include a. A Kochers incision b. A Commando incision c. A Battles incision d. A Gridiron incision e. A Mercedes Benz incision

13. Thyroid neoplasia exhibits the following features a. Follicular thyroid carcinoma is the most common type b. When associated with MEN IIa, are medullary in origin c. Papillary thyroid carcinoma is often multifocal d. Hematogenous spread is a feature of follicular thyroid carcinoma e. Thyroid lymphoma is strongly associated with Hashimoto’s Disease

14. In patients with gastro-oesophageal reflux disease (GORD) a. The treatment is largely medical b. A hiatus hernia is found in over 70% cases c. The Belsey Mark IV procedure alleviates the symptoms d. A Nissen Fundoplication is the operation of choice e. The use of the Demeester scoring system is appropriate

15. The following conditions are premalignant for oesophageal neoplasia a. Tylosis b. Plummer-Vinson Syndrome c. Barret’s oesophagus d. Achalasia e. Scleroderma

16. Regarding intestinal obstruction necessitating inpatient management a. Large bowel obstruction is most commonly caused by neoplasia b. Small bowel obstruction is most commonly caused by incarcerated herniae c. Ogilvies syndrome is a reflection of an underlying mechanical obstruction d. A caecal volvulus is more common than a sigmoid volvulus e. A bird’s beak deformity on barium enema is characteristic of a sigmoid volvulus

17. The following occur in Leriche syndrome; a. Clubbing b. Claudication c. Lower extremity muscle wasting d. Impotence e. Paradoxically high ankle brachial indiced (ABIs)

18. In the management of burns: a. A splenectomy is indicated in Class I and II splenic injuries b. Kehrs sign may be found in patients with splenic injury c. An 80kg male with 20% burn surface area will require over 6L fluid in the first 24 hours of resuscitation. d. A liter of Hartmanns solution contains 130 mmol sodium e. A Hartmanns solution is a crystalloid isotonic solution

19. The following are true: a. Volar angulation is a feature of the Smiths fracture b. A Bennett fracture is an intrarticular fracture c. A Colles fracture results in radial deviation d. A dinner fork deformity is characteristically found in Colles fracture e. The Lachman manoeuvre is useful in anterior shoulder dislocation 20. Criteria for the diagnosis of the Systemic Inflammatory Response Syndrome (SIRS) include a. A wcc < 4/mm3 b. A temperature greater than 380C or rectal temperature <360C c. A heart rate greater than 90 bpm d. One positive blood culture e. The presence of >10% immature bands forms on a full blood count EXAM 4 : Unknown year, unknown college First two questions missing

3. Trauma a. Pneumothorax can be temporarily treated by inserting a 16 gauge cannula in the second intercostals space of the same side b. Fracture of the posterior cranial fossa is associated with Battle ’s sign c. Ultrasound is the gold standard in the diagnosis of rupture of the thoracic aorta d. A flail chest is associated with pericardial effusion e. Coronary air embolisation is an unusual consequence of injury to the lung parenchyma

4. Pharyngeal pouch a. It is a pulsion diverticulum arising from Killians dehiscence b. It appears as a swelling in the anterior triangle of the neck c. Presents as halitosis, regurgitation of food and dysphagia d. Is a congenital diverticulum e. Arises withing the superior pharyngeal constrictor muscle

5. Carcinoma of the breast a. LCIS is more common than DCIS b. T2 lesions measure >5 cm in size c. Inflammatory breast cancer presents as erythema, warmth and edema of the involved breast d. Follow up of breast cancer involves measuring serum levels of Ca 19-9 e. Treatment of locally advanced breast cancer is mastectomy

6. Nipple discharge a. Bloody nipple discharge is due to fibrocystic disease b. Serous discharge is due to duct papilloma in about ¾ of cases c. Chromophobe adenoma is a microadenoma d. Phenothiazines cause serous discharge e. Treatment of bloody nipple discharge is microdochotomy

7. Thyroid gland a. Graves disease is common in females b. Subacute (DeQuervains) thyroiditis is an autoimmune disease c. Papillary carcinoma, secondary to radiation, is multifocal d. Men IIA comprises medullary carcinoma, phaeochromocytoma(s) and parathyroid hyperplasia e. Medullary carcinoma is treated by total thyroidectomy and central neck dissection

8. Regarding chronic peptic ulcers a. Type I ulcers occurs along the lesser curvature of the stomach b. Type III ulcers occur at or just proximal to the pylorus c. Peptic ulcers that bleed erode the right gastric artery d. Gastrojujenocolic fistula occurs after gastrectomy and Billroth II anastomosis e. Post gastrectomy cancer is associated

9. Crohn’s Disease a. Is predominantly a transmural disease b. Characteristic microscopic lesions are noncaseating granulomas c. Bloody diarrhea is the most frequent presentation d. Peri-anal disease is an infrequent presentation e. Toxic dilatation of the colon is a common finding 10. Carcinoid tumour a. The most common location of a carcinoid tumour is the terminal ileum b. Appendiceal carcinoids frequently metastasise c. Urinary 5-HIAA is the most reliable test to confirm the diagnosis of carcinoid tumour d. Octreotide can successfully control the symptoms of diarrhea and flushing e. 5-HIAA is a metabolite of tyrosine

11. Appendicitis a. The commonest location of the appendix is in the pelvis b. Psoas sign is elicited by flexion of the right hip c. Is associated with a fecolith in 90% cases d. Laparoscopic appendicectomy has been shown to be superior to open appendicectomy for acute appendicitis e. Rovsigns sign is elicited by pressing in the left iliac fossa causing pain in the right iliac fossa

12. Colorectal cancer a. Adenomatous polyps account for more than 90% colorectal cancers b. High fibre diet, calcium and selenium have a cytoprotective effect c. Colonic cancer is part of Lynch II Syndrome d. FAP is inherited as an autosomal recessive pattern e. HPNCC is autosomal dominant

13. Cholelithiasis a. Biliary colic occurs only with stones in the common bile duct b. Merrizi’s syndrome is associated with cholestatic jaundice c. Charcot’s triad includes jaundice, rigors and palpable gallbladder d. Chenodeoxycholic and ursodeoxycholic acid are used for dissolution of cholesterol stones e. For symptomatic cholelithiasis laparoscopic cholecystectomy is the operation of choice

14. Pancreatitis a. Foxs sign is discoloration of groins b. Alcohol is an aetiological factor for the development of acute pancreatitis c. A Ransons criteria of 7-8 is associated with mortality of 50% d. Steatorrhea is associated with acute pancreatitis e. A chain of lake appearance is pathognomonic of chronic pancreatitis

15. Vascular a. The mortality rate of ruptured AAA is 40% b. Ultrasound can reliably meaure the size and site of AAA c. Ruptured AAA may present as pain in the renal angle d. Surgery is recommended for patients with AAA > 6cm diameter e. Spinal cord ischemia is an infrequent complication

16. Peripheral vascular disease a. Normal ankle-brachial ratio is <0.75 b. Thromboendarterectomy is the operation of choice for aortoiliac occlusive disease c. Rest pain is relieved by elevation of the foot d. Impotence is a common phenomenon associated with occlusive disease of the distal aorta and iliac vessels e. Sympathectomy provides good symptomatic relief of rest pain

17. Paediatric surgery a. Hirschprungs disease is caused by absence of ganglion cells in the Auerbachs plexus b. High imperforate anus is treated by colostomy followed by sacroperineal or abdominosacral pull through of the proximal colon c. Congenital hypertrophic pyloric stenosis is common in female infants d. Meckels Diverticulum is best diagnosed by 99m Technetium scan e. Idiopathic intussussception occurs in a 6 to 9 month old infant

18. Orthopedics a. Colles fracture results a fall on an outstretched hand with the wrist in flexion b. Fractured ribs invariably cause a pneumothorax c. The leg is externally rotated in fracture of neck of femur d. Fracture of the humeral shaft may cause injury to the radial nerve e. Fat embolism following multiple fractures is associated with petichial skin rash

19. Urology a. The majority of bladder tumours are squamous cell carcinomas b. Renal cell carcinoma is always treated with adjuvant chemotherapy c. The most common urinary calculi are triple phosphate stones d. Testicular tumours commonly metastasize to the groin lymph nodes e. Fracture of the bony pelvis leads to injury to the membranous urethra

20. Skin cancer b. Kaposis Sarcoma is a tumour of vascular endothelial origin c. Xeroderma Pigmentosa is an autosomal recessive disease d. Sunlight exposure is the principle cause of basal cell carcinoma and squamous cell carcinoma e. Superficial spreading melanoma has the worst prognosis f. Squamous cell carcinoma is not sensitive to radiotherapy 2. Gastrointestinal polyposis syndrome a. Hereditary nonpolyposis colorectal cancer is autosomal dominant b. Colorectal cancers develop before 40 years of age in familial adenomatous polyposis (FAP) c. Polyps in Peutz-Jeghers Syndrome are hyperplastic d. Turcotts syndrome is gastrointestinal polyps with CNS tumors e. Hereditary nonpolyposis colorectal cancer accounts for <5% of cases

3. Salivary glands a. Pleomorphic adenoma is the most common benign tumour of the submandibular gland b. Mikulic’s Syndrome refers to the bilateral enlargement of lacrimal and salivary glands c. Sialothiasis is almost exclusively a problem of the submandibular gland d. Incisional biopsy is performed in all salivary gland tumours e. Lingual nerve can be damaged in surgery on submandibular gland

4. Hernias a. Direct inguinal hernias pass through internal ring b. A femoral hernia is the most common hernia in females c. Testicular atrophy may occur after inguinal hernia repair d. Inguinal hernias in children are treated by hernioraphy e. Littres hernia contains Meckel’s diverticulum

5. Abdominal Aortic Aneurysms a. Surgery is recommended for patients with AAA size > 6 cms b. 90% arise below renal arteries c. Ischemia of colon is common d. Mortality rate of ruptured AAA is 25% e. Blue toe syndrome occurs in association with AAA

6. Vascular a. Carotid atheromatous disease is the commonest cause of strokes in the western world b. Varicose veins are treated by femoral-popliteal bypass graft c. Rest pain is relieved by elevation of the foot d. Normal ABI is greater than 0.90 e. Cervical rib may present with wasting of thenar muscles

7. Orthopedics a. Smith’s fracture results in volar angulation of the radius b. A fractured neck of femur results in lateral rotation of the lower limbs c. The radial nerve is injured in fracture of neck and humerus d. Bennett’s fracture involves distal end of radius e. Supracondylar fracture may cause vascular complications

8. Fluid and electrolyte balance a. Insulin and glucose infusion may be used to treat hyperkalemia >6.5 mg/L b. Short gut syndrome doesn’t predispose to carcinoma c. Patients on IV fluids require 1mmol/kg body potassium per day d. Hyponatremia should be corrected by large volumes of hypertonic saline e. Adult burns victims require 2L fluid in 24 hours

9. Regarding sinuses and fistulas a. High output fistulas are characterized by loss of intestinal fluid in excess of 200 mL/24 hours b. Pilonidal sinus is premalignant c. An example of congenital fistula is thyroglossal cyst d. Inefficient or nondependent drainage is one of the factors leading to persistence of an abscess e. A chronic subareolar abscess leads to a mamillary fistula

10. Carcinoma of the breast a. T3 breast lesion is >5 cm in dimension b. Tamoxifen should be prescribed for life to patients with breast cancer c. Axillary lymph node involvement is a weak predictor of outcome d. Comedo DCIS is associated with low recurrence rate e. Breast cancer rarely metastasizes to bone

11. Pancreatitis a. Cholelithiasis is the commonest cause b. Cullen’s sign is associated with bruising in flanks c. Steroids are not associated with acute pancreatitis d. The treatment of sterile necrotizing pancreatitis is always surgery e. A pseudocyst should be drained within 2 weeks of the acute attack

12. Gallstones a. Ascending cholangitis requires emergency decompression of the CBD b. Choledochal cysts are associated with malignancy c. The five year survival rate of adenocarcinoma of GB is less than 5% d. Magnetic resonance cholangiogram gives accurate picture of biliary tree e. Gallstones can be dissolved by ursodeoxycholic acid

13 a. Is found in 2% of the population b. Is a “true” diverticulum? c. Contains ectopic tissue in 50% cases d. Is a remnant of vitello-intestinal duct? e. May mimic as acute appendicitis

14. Trauma a. In the initial management of the injured patient, control of hemorrhage should be the priority b. Right diaphragmatic rupture is more common than left c. Fracture of left lower ribs may be associated with rupture of the spleen d. A flail chest is commonly associated with ARDS e. Liver or splenic injuries always require operative intervention 15. Thoracic/Neurosurgery a. A chest drain is usually inserted in the 4th/5th intercostal space in the mid-axillary line b. Thorascopic sympathectomy is the treatment of hyperhydrosis of the hands c. CT scan of the brain is indicated in depressed skull fracture d. A GCS < 8 is an indication for endotracheal intubation e. Tension pneumothorax is diagnosed on chest X-ray

16. Endocrine a. Follicular carcinoma of thyroid primarily spreads through lymphatics b. Parathyroid adenoma is the most likely cause of hyperparathyroidism c. Hurtle cell carcinoma is a variant of papillary carcinoma of the thyroid d. Phaeochromocytoma is associated with MEN IIa e. Superior laryngeal nerve supplies cricothyroid muscle

17. Paediatrics a. Hydrocele in a child <1 year old necessitates surgery b. Pyloric stenosis presents within 10-12 weeks of life c. Mesenteric adenitis is an uncommon cause of abdominal pain in children d. An undescended testes may be found in the hilum of the spleen e. Children with pyloric stenosis have hypokalemic, hyperchloremic acidosis

18. Evidence based medicine a. Occult blood testing is a proven screening modality for colorectal carcinoma b. Endoscopic ultrasound accurately assess rectal tumour presentation c. Laparoscopic appendicectomy has revolutionized the treatment of acute appendicitis d. Sentinel lymph node biopsy is not yet a standard form of treatment for breast carcinoma world-wide e. Immunotherapy using interferon-alpha is of benefit in Stage III malignant melanoma

19. The following are associated with malignancy a. Acanthosis nigricans b. Thrombophlebitis migrans c. Ganglions d. Fourniers Gangrene e. Keratoacanthoma

20. Diverticular disease a. The most common cause of bleeding per rectum is diverticular disease b. The treatment of diverticular disease is oral steroids c. Is a premalignant condition d. Is best treated with a low residue diet e. Surgery is indicated in more than 50% of patients with diverticular disease 7. Carcinoma of the lung is:

a. Commonest cancer in our community b. A tumour with 20% cure rate. c. Associated with better prognosis if oat cell in type d. Characterised by rising incidence in females e. Most commonly developed from alveolar epithelium

8. Brachial embolism a. Has more favorable prognosis than popliteal aneurysm b May be operated upon under local anesthesia c. Is associated with mitral stenosis d. Always leads to gangrene is not removed e. Embolectomy should be associated with fibrinolytic therapy 9. Oophrectomy for breast cancer a. Has now been abandoned as a form of therapy b. Is best done by irradiation of ovaries c. Has been replaced by d. May reveal ovarian metastases e. Should be followed by estrogen therapy if done at menopause

10. In varicose veins: a. Communicating veins penetrate the deep fascia b. The aim of sclerosant therapy is to thrombose the veins c. More commonly involve the left lower limb d. Lateral leg is commoner site ulceration e. May be familial

11. In a contaminated traumatic wound: a. Local antibiotics are very helpful b. Tetanus toxoid provides 100% against tetanus c. Gas in tissues is pathognonomic of gas d. Following debridement the wound should be closed by sutures e. Tetanus antitoxin if indicated is preferable to human immune globulin

13. If a patient is cyanosed following tracheostomy with a cuffed tube, suspect a. Laryngeal edema b. Intubation of right bronchus c. Mucus blocking tube d. Mucus blocking bronchi e. Displacement of tube

14. Tracheal shift to the left may be caused by a. Right pneumothorax b. Nodular goiter c. Collapse of right lung d. Left sided emphysema e. Right pneumonectomy

15. A patient has pain over lower internal end of radius, extension and abduction of thumb a. This is due to a fractured lunate b. May be caused by DeQuervain’s disease c. May be due to Kohler’s disease d. May be treated by steroid injection e. Often results from unaccustomed use hand

16. Patients with secondary thyrotoxicosis a. Should never be treated with radioiodine b. Tend to develop recurrent laryngeal nerve palsy ? c. Have thyroid antibodies in their blood d. Usually have a diffusely enlarge goiter e. Generally are in the 20-40 age group

17. Circumcision is indicated in: a. Ammoniacal dermatitis b. Non-retractile prepuce at one year c. Prophylaxis of carcinoma of penis d. Phimosis e. Paraphimosis

18. In carcinoma of larynx a. Hoarseness is a late symptom b. Peak incidence is from 20-40 years c. There is an association with cigarette smoking d. There is association with occupation e. Distant metastases occur early

19. Shoulder dislocation a. Occurs from direct violence b. Is not associated with any fracture c. Commonly damages the axillary artery d. If adequately immobilized following reduction recurrent dislocation is prevented e. Should be X-rayed before reduction 21. Ingested foreign bodies are likely to be arrested a. At crico-pharyngeus b. At thoracic inlet c. At aortic arch d. At diaphragm e. In stomach

22. Cancer of oesophagus a. Is associated with duodenal ulceration b. Presents with chest pain c. Is always a squamous cell carcinoma d. Has a bad prognosis e. Frequently presents with heartburn

23. Carcinoma of the stomach a. Has a good prognosis b. Often presents with anorexia c. May be associated with previous gastric surgery d. Has rarely spread to lymph glands at time of prognosis e. Is always diagnosed by barium meal

24. Infantile pyloric stenosis a. Presents with vomiting from birth b. Frequently results in acidosis c. Is readily diagnosed clinically d. Is usually cured by surgery e. Is associated with subsequent duodenal ulceration

25. The gastric antrum a. Secretes acid b. Is responsible for secretion of gastrin c. Is responsible for production of intrinsic factor d. Is important in the mechanism of gastric emptying e. Is denervated by truncal vagotomy

26. Meckel’s diverticulum a. Arises from the foregut b. May cause massive gastrointestinal bleeding c. Is associated with carcinoma of the small bowel d. May cause intussusception e. Is an acquired lesion

27. Crohn’s disease a. Is predominantly a mucosal disease b. Always requires surgery c. Is associated with the development of fistulae d. Often involves the perianal region e. Rarely recurs following adequate surgical management

28. The terminal ileum is responsible for the absorption of: a. Vitamin B12 b. Vitamin C c. Bile acids d. Fat e. Iron

29. Ulcerative colitis: a. Occurs predominantly in those over 50 b. Usually involves rectum c. May be precipitated by stress d. May result in colonic cancer e. Always responds to steroids

30. Diverticular disease a. Involves predominantly the sigmoid colon b. Is pre-cancerous c. May result in massive bleeding per rectum d. Responds to low residue diet e. Is more common in elderly

31. Large bowel cancers a. Is the most common cause of large bowel obstruction b. Is the most common cause of vesico-intestinal fistula c. Most commonly occurs is recto-sigmoid d. Rarely develops from colonic polyps e. Has a bad prognosis

32. Chronic perianal disease may be secondary to: a. colonic diverticular disease b. Gastrointestinal tuberculosis c. Polyposis coli d. Carcinoma of recto-sigmoid e. Crohn’s disease

33. In obstructive jaundice a. Serum alkaline phosphatase is normal b. Oral cholecystogram is of value c. The gallbladder is palpable d. There is splenomegaly e. Vitamin K absorption is impaired

34. Nephroblastomas: a. is radio-sensitive b. Requires early surgery c. Responds to chemotherapy d. Has a good prognosis over the age of ten e. Usually metastasizes to bone 35. Benign prostatic hyperplasia may result in: a. Acute epididymo-orchitis b. Bladder stone c. Hematuria d. Bladder diverticulum e. Testicular atrophy