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Zagazig UniversityFaculty of MedicineDepartment of General Surgery Exam for HO: 29.10.2007 1. A 25-year-old woman is diagnosed with acute appendicitis at the beginning of the third trimester of her pregnancy is best managed by:A. Delaying surgery B. Emergency surgery C. waiting for 4 weeks D. Waiting for 6 weeks. 2. A 26-year-old man with a comminuted closed fracture of the femur shaft undergoes intramedullary nail fixation. Two days postoperatively, he develops a pyrexia, shortness of breath and a tachycardia.A. Cardiogenic shock B. Fat embolismC. Hypovolemic shock D. Thromboembolism 3. A 60-year-old lady presents to the A&E with a temperature of 37.60 C and vomiting of 48 hours duration. On examination, a localized swelling below and lateral to the right pubic tubercle is noticed. The swelling is tender and irreducible with no cough impulse. The diagnosis is most probably:A. Psoas abscess. B. Femoral aneurysmC. Strangulated femoral hernia D. Saphena varix 4. A 59-year-old woman with a history of rheumatoid arthritis treated with NSAID's gold and steroid, present with 4 ours of acute abdominal pain. This was made worse by the ambulance ride. The most specific investigation is:A. Erect chest x-ray B. CT abdomenC. CBC D. Gastroscopy 5. A 77-year-old woman presents with abdominal pain and jaundice. Ultrasound reveals stones in the common bile duct. She is unfit for operation. The best approach for this patient is:A. Emergency cholecystectomy B. Elective cholecystectomyC. ERCP D. Lithotripsy. 6. A 12-year-old boy is brought to the Emergency Department with a 3-day history of right iliac fossa pain. There is a palpable mass with localized tenderness. Temperature and pain respond to intravenous antibiotics. Treatment is by:A. Urgent operation within 12-24 hours. B. Wait 2 weeks and operate.C. Wait 6 months and operate. D. Wait 6 weeks and operate. 7. The suture material for use in vascular anastomosis in the leg is:A. 0" vicryl B. 2'0' silkC. 6'0' Prolene D. 2'0' Prolene 8. A 43-year-old housemaid complains of severe upper right epigastric quadrant (RUQ) pain 2 hours after eating a meal of chips and fried chicken. The pain radiates to her back and makes her nauseated. There is no other systemic symptom. The most probable diagnosis is:A. Acute pancreatitis B. Acute cholecystitisC. Biliary colic D. Perforated peptic ulcer. 9. A 21-year-old motorcyclist presents with multiple injuries following RTA. Clinical examination reveals a critically ischemic right lower leg. The right dorsalis pedis pulse is weak. The right calf is tense and swollen. The intracompartmental pressure was 55 mmHg (high). Angiography shows no discontinuity of the arterial tree. The treatment of choice for this patient is:A. Femorodistal bypass. B. femoropopliteal bypassC. Percutaneous balloon angiography D. Fasciotomy. 10. A 45-year-old woman presents with varicose veins and swollen leg. Duplex confirms a DVT. The treatment of choice is:A. Compression and warfarin. B. Elevation and NSAID'sC. IV Heparin D. Varicose vein surgery11. An 80-year-old lady with arterial fibrillation has a 4-day history of abdominal pain and some bleeding per rectum. The most likely diagnosis is:A. Cecal Carcinoma B. Mesenteric ischemiaC. Intussusception D. Crohns's disease 12. A 40-year-old man with a history of sudden onset abdominal pain and vomiting has increased serum amylase. He has no previous history of pancreatitis. The most likely diagnosis is:A. Biliary obstruction B. Acute pancreatitisC. Cancer head of pancreas D. Pancreatic pseudocyst. 13. The most appropriate tumor marker for colorectal carcinoma Is:A. Acid phosphatase B. α-frtoproteinC. Carcinoembryonic antigen D. β-hCG 14. A28-year-old IV drug abuser presents with a mildly tender pulsatile swelling over his right femoral triangle. He gives a history of considerable bleeding from the wound before the swelling developed. He is apyrxial and systemically well. The most likely diagnosis is:A. Psoas abscess B. Saphena varixC. Strangulated femoral hernia D. False aneurysm of femoral artery. 15. A 62-year-old woman is admitted with vomiting, colicky abdominal pain and a distended abdomen. She has previously undergone multiple gynecological operations. The most likely specific diagnostic investigation is: A. CT Abdomen B. Mesenteric angiographyC. Erect abdominal X-ray D. CBC 16. A 70-yeaar-old man presents with epigastric pain, jaundice, rigors and fever. The most appropriate diagnosis is:A. Acute cholangitis B. Hepatitis CC. Chronic pancreatitis D. Hepatocellular carcinoma 17. A patient has distended neck veins, having stabbed lateral to the trachea. Examination reveals decreased breath sounds, hyperresonant lung field and tracheal deviation. The most likely diagnosis is:A. Cardiac tamponade B. HemothoraxC. Tension pneumothorax D. Pulmonary embolism 18. A 43-year-old lady presented to the emergency department with an 8-week history of epigastric discomfort, she had a pyrexia 380C and a WBC 15X109/L. There was associated nausea but no vomiting or features of generalized peritonitis. There was some indication of increased pain on ingestion of fatty foods. A. Biliary colic B. PancreatitisC. Gastritis D. Cholecystitis 19. A2-year-old lady presents with a 3-week history of bright red rectal bleeding associated with pain on defecation. Her symptoms started post-partum. The most likely diagnosis is:A. Anal carcinoma B. Anal fissureC. Hemorrhoids D. Colonic polyp 20. A 10-year-old boy had n appendectomy for perforated gangrenous appendicitis 3 days ago, with uneventful postoperative recovery. He now returns to the Emergency Department with further lower abdominal pain and swinging pyrexia of 30C. The wound is clean but there is tenderness on digital examination. The most likely diagnosis is:A. Respiratory tract infection B. Deep-vein thrombosisC. Pelvic Abscess D. Urinary tract infection GOOD LUCK Answers can be found on the web site: www.abdellatif. 8m.net
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