1. Carcinoma of the breast
a. Regional lymph node involvement is a bad prognostic factor
b. Ductal carcinoma is the most common type of malignant tumor
c. Local radiotherapy is indicated after wide local excision
d. CEA scanning is used to localize sentinel lymph nodes
e. Fine needle aspiration cytology is not a reliable test in diagnosing breast
cancer
2. Cholelithiasis
a. Gall-stones can be dissolved with bile salts therapy
b. Is a common cause of carcinoma of the gall-bladder
c. Acalculous cholecystitis is an auto-immune disease
d. Ascending cholangitis required emergency decompression of the
common bile duct
e. Alkaline phosphatase is not raised in obstructive jaundice
3. Fractures
a. 1.5-2 litres of blood can be lost in a fracture of the femur
b. Bennett’s fracture involves the proximal end of the radius
c. The junction of the body at C7 and T1 should be visualized in every
suspected cervical trauma
d. Fractured ribs invariably cause pneumothorax
e. The leg is externally rotated in fractured neck of femur
4. Abdominal aortic aneurysm (AAA)
a. Ultrasound can reliably measure the size and site of AAA
b. The risk of rupture is greater than 50% in a year if the size of the AAA is
greater than 6 cm
c. Renal failure is not a common complication of ruptured AAA repair
d. The mortality rate of ruptured AAA is 30%
e. AAA does not cause micro-embolisation
5. Fluid and electrolyte balance
a. Crystaloids should be used for resuscitation in hypovolemia
b. Short gut syndrome does not predispose to renal calculi
c. The value of 110 meq/L of sodium in plasma is within normal limits
d. A urine output of 0.1 mL/kg/hour in an adult patient is satisfactory
e. Insulin and glucose infusion may be used to treat hyperkalemia of 6.5
mEg/L
6. Hernias
a. Irreducible hernias in children are treated by herniorraphy
b. Incisional hernias are more common after transverse than midline
incisions
c. Testicular atrophy may occur after inguinal hernia repair
d. Strangulation is more common in indirect than direct inguinal hernia
e. A Spigelian hernia is readily diagnosed with a herniogram
7. Paediatrics
a. 95% of umbilical hernias in children younger than 5 years do not need
surgery
b. Pyloric stenosis commonly occurs between ages of 5-10
c. An undescended testicle may be found in the hilum of the spleen
d. Recurrence of intusussception is common in the first few days after
reduction
e. Mesenteric adenitis is an uncommon cause of abdominal pain in
children
8. Salivary glands
a. Pleomorphic adenoma is the commonest benign tumour of the parotid
gland
b. Incisional biopsy is performed in all salivary gland tumours
c. Frey’s syndrome is common after submandibular gland surgery
d. Lymphomas do occur in the parotid gland because embryologically the
gland grows enclosing the lymphatic tissue in it
e. The lingual nerve can be damaged in surgery on the submandibular
gland
9. Trauma
a. A flail chest is commonly associated with ARDS
b. U/S is gold standard in diagnosis of ruptured thoracic aorta
c. Liver is the solid organ most often injured in blunt abdominal trauma
d. Right diaphragmatic rupture is more common than left
e. Esophageal rupture in the neck is diagnosed by Gastrograffin swallow
in more than 90% of cases
10. Pancreatitis
a. Raised CRP is a specific test in diagnosis of acute pancreatitis
b. U/S examination would show a stone in the lower end of the CBD in
>80% of cases
c. A pseudocyst should be drained within 2 weeks of acute attack
d. The treatment of sterile necrotizing pancreatitis is always surgery
e. Pancreatitis can be reliably diagnosed in a patient if serum amylase is
more than 1000 units per liter.
11. Anemia
a. Cecal carcinoma commonly presents with microcytic hypochromic
anemia
b. Resection of the terminal ileum may cause megaloblastic anemia
c. Total gastrectomy is not associated with Vitamin B12 deficiency
d. The cause of anemia in chronic disease is multi-factorial
e. Mastectomy is a major cause of iron deficiency anemia in surgical
practice
12. Nutrition
a. Parenteral nutrition is superior to enteral nutrition
b. Parenteral nutrition can cause derangements in liver function tests
c. In a septic patient, the brain uses fat as its energy source
d. TNF may be responsible for protein catabolism in a very sick patient
e. Parenteral nutrition is usually indicated in a healthy patient undergoing
major abdominal surgery
13. Gastrointestinal
a. A pressure of 100 mmHg is needed in the esophageal balloon of
Minnesota tube to control bleeding from esophageal varices
b. Mallory-Weiss syndrome is associated with vomiting
c. Bleeding from a duodenal ulcer is usually from the gastro-duodenal
artery
d. An unstable patient, despite adequate fluid resuscitation, requires
emergency surgical intervention
e. A high output enterocutaneous fistula is defined as a fistula with output
of 100-200 mL in 24 hours
14. Oesophagus
a. Plummer Vinson syndrome predisposes to esophageal cancer
b. Failure of relaxation of the esophageal sphincter is characteristic of
achalasia
c. 90% of hiatus hernias are associated with reflux esophagitis
d. Severe dyspepsia in reflux disease is an indication for surgery
e. The overall 5 year survival rate of carcinoma of the esophagus is more
than 80%
15. Endocrine
a. Cervical lymph nodes are usually involved at the time of diagnosis of
medullary carcinoma of the thyroid
b. Phaeochromocytoma is associated with renal artery stenosis
c. Parathyroid adenoma is the most likely cause of hyperparathyroidism
d. Total thyroidectomy is indicated in follicular carcinoma of the thyroid
gland
e. Recurrent laryngeal nerve is damaged in >15% of cases in thyroid
surgery
16. Diverticular disease
a. The most common cause of major bleeding per rectum is diverticular
disease of the colon
b. Surgery is indicated in more than 50% of patients with diverticular
disease
c. Diverticulitis is never associated with pseudopolyps
d. Diverticular disease is associated with severe perianal disease
17. Skin
a. SCC is resistant to radiotherapy
b. BCC metastasizes in 15-20% cases
c. Prognosis of nodular type of malignant melanoma is worse than
superficial spreading
d. Depth of skin involvement in melanoma may predict the state of distant
metastases
e. Melanoma is more common in the white population of Australia and
New Zealand as compared to their European counterparts
18. Vascular
a. Rest pain in peripheral vascular disease is an indication for surgical
intervention
b. Necrotic changes in the diabetic foot are never worse than perceived on
inspection
c. Short vascular stenotic segment in iliac vessels are not amenable to
angioplasty
d. The most common cause of TIAs and stroke in carotid disease is
complete occlusion of the carotid vessel
e. Varicose ulcers are treated by femoral popliteal bypass graft procedure
19. Colorectal carcinoma
a. More than 90% of colorectal cancer arises from adenomatous polyps
b. Chemotherapy is administered as an adjuvant therapy for Duke A
carcinoma
c. Liver metastases in colorectal cancer cannot be treated surgically
d. Colorectal cancer is one of the commonest cancers in the western world
e. Colonoscopy is a reliable diagnostic tool in expert hand in 95% of cases
for colorectal cancer
20. Urology, Thoracic and Neurosurgery
a. The most common tumour of the bladder is adenocarcinoma
b. 90% of renal stones are radiolucent
c. A thoracostomy tube is usually inserted in the fourth or fifth intercostal
space in the mid-axillary line for the treatment of pneumothorax
d. Thoracoscopic sympathectomy is a treatment of hyperhydrosis of the feet
e. CT scan of brain is indicated in depressed skull fracture
21. In primary hyperparathyroidism
a. Most patients present with urinary tract calculi
b. Serum calcium is always higher than normal
c. PTH is usually within normal limits
d. Chloride:Phosphate ratio is higher than normal
22. Which of the following suggests that a thyroid swelling is malignant
a. Thyrotoxicosis
b. Hoarseness
c. Palpable lymph nodes
d. Increased radioiodine uptake
23. The following are recognized complications of Crohn’s disease
a. Iritis
b. Ascending cholangitis
c. Sclerosing cholangitis
24. First degree haemorrhoids
a. Are commonly diagnosed by digital examination
b. Frequently present with bleeding
c. May be treated by rubber band ligation
25. Postoperative agitation is associated with
a. Sedation
b. Hypoxemia
c. Cardiac arrhythmias
d. Urinary retention
26. A right carotid bruit may often be found in patients with
a. Amaurosis fugax
b. Right sided stroke
c. Left eye blindness
d. Ischaemic heart disease
27. A Meckel’s diverticulum of the small intestine
a. Is situated 60 cm from the jejuno-ileal junction
b. Contains all coats of the intestinal wall
c. May be associated with fibrous band connecting it to the umbilicus
d. Always contains ectopic gastric mucosa
28. Rupture of the spleen
a. Always occurs with rib fracture
b. May occur with ruptured diaphragm
c. May occur with ruptured kidney
d. Conservative treatment in children
e. Is associated with shoulder tip pain
29. Ulcerative colitis
a. Always confined to large bowel
b. Always involves rectum
c. Fistula is common
30. Carcinoma of the rectum
a. May present with inguinal lymphadenopathy
b. Always treated by abdominal resection
c. Has 5 year survival rate of 25%
d. Responds to chemotherapy
31. Carcinoma of esophagus
a. Adenocarcinoma in lower one third
b. 5 year survival rate is 45%
32. Melanoma
a. Always from pre-existing naevus
b. May be non-pigmented
c. May have a halo
d. Commonly occurs in children less than 12 years
e. Spreads by lymphatics and not blood
33. lood transfusion
a. Stored at 4 degrees C
b. Stored at 0 degrees C
c. Contains factor V and VIII
d. Contains platelets
e. Best given within 7 days
34. Acute osteomyelitis
a. Is caused by Staph aureus
b. Treated by penicillin
c. Xray changes present after 2 weeks
d. Sequestration present
e. May cause septic arthritis
f. Caused by Strep
g. Responds to cloxacillin
h. Requires urgent blood culture
i. Early surgery rarely needed
35. TB lymphadenitis
a. Not common in persons > 60
b. Decreasing in Ireland
c. Involves Reed-Sternberg cells
d. Rubbery and discrete
e. May cause chronic sinus
36. Chronic fistula persist
a. If foreign body present
b. If streptococcus in wound
c. If TB in wound
d. If obstruction further down
e. If lined by epithelium
37. Bladder diverticulum
a. Usually congenital
b. Associated with obstruction
c. Associated with infection
d. Contains mucous membrane
e. Never seen on cystoscopy
38. Chronic pancreatitis may be a result of:
a. Gallstones
b. Alcohol
c. ERCP
d. Trauma
39. Perforation of a duodenal ulcer
a. Always gas under diaphragm
b. Insidious onset
c. Rolling around the bed
d. Shoulder tip pain
e. Uncommonly get back pain
40. Extradural haemorrhage
a. Usually arterial
b. Often venous
c. Needs immediate surgery
d. Comes on insidiously
e. Always associated with fracture of the skull
41. Intussusseption in children
a. Assumed with mass in LIF
b. Should never do a barium enema
c. Surgery is always required
d. Commonest at 1-2 months
e. Examination may be normal
42. Hiatus hernia
a. Usually treated medically in children
b. Usually treated by surgery in adults
c. Achalasia at junction of upper 2/3 and lower 1/3
43. Plummer-Vinson syndrome
a. First demonstrated by Patterson and Kelly
b. Assume with esophageal web
c. Is premalignant
d. Causes dysphagia
e. Occurs in middle-aged men
44. Ganglion
a. May be painful
b. May be painless
c. Must be excised
d. May become malignant
e. May become recurrent
45. Duct papilloma
a. Commonest age 35-50
b. Bloody discharge
c. May feel a lump
46. Varicocele
a. Common on the left side
b. Associated with oligospermia
c. Like a bag of worms when lying down
d. Treated by tight underpants
e. May be painful
47. Molluscum sebaceum
a. Is a sebaceous cyst
b. Is Bowen’s disease
c. Is an epithelioma
d. Is a keratoacanthoma
e. May heal spontaneously
48. Tetanus
a. Is an endotoxin
b. Spreads to CNS via NN (what is NN??)
c. Spasm  respiratory arrest
d. Active immunity confirmed by increase in IgE
e. Children more than 1 year immunized
49. Chronic fissure in ano
a. Is painful
b. Involves squamous epithelium
c. Involved columnar epithelium
d. Treated by total sphincterotomy
e. Treated by partial internal sphincterotomy
50. K+ depletion
a. Associated with villous papilloma
b. Associated with nasogastric suction
c. Occurs 24 hours post-op due to increased output
d. Treated freely by IV potassium with no danger
e. Causes muscle cramps
51. In grown toe nail
a. Should be cut conversely
b. Corners should be cut back
c. Needs patients cooperation
d. Koilonychia is common
52. History
a. Hippocrates described inflammation
b. Pasteur was a professor of medicine
c. Halsted and rubber gloves
d. Mendel was a geneticist
e. Christmas disease was first described at Christmas time
53. Boy, 10 days post-op from appendicectomy and febrile with pus from wound
a. Requires a laparotomy
b. Requires NG suction and IV fluid
c. Needs local dressing only
d. Requires strict bed rest
e. Requires antibiotics
54. Fracture of the neck of femur
a. Prostheses it the treatment of choice
b. Mobilization without surgery
c. Bed rest
d. Plating
e. None of the above
55. Fracture of the clavicle
a. May be diagnosed clinically
b. Usually caused by direct trauma to shoulder
c. Delayed union common
d. Often causes damage to brachial plexus
56. Carbuncle
a. Caused by strep
b. Multilobulated
c. Treated with gentamycin
d. Exquisitely tender
e. Associated with DM
57. The following are anaerobes
a. Proteus
b. Staph aureus
c. Clostridium perfringens
d. Clostridium difficile
e. Bacteroides
58. Removal of sutures
a. Face, head and neck
b. Hands
c. Palm
d. Rest of upper limb
e. Trunk
f. Lower limb
g. Scalp
h. Feet
3 days
5 days
8 days
7-10 days
7-10 days
10-14 days
5 days
10-14 days
59. History
a. Harvey described circumcision in 1616
b. Microscope was not invented until 1590
c. Fleming discovered streptomycin
d. Rhesus factor discovered 1935
60. Dukes staging of colon Ca
a. B Associated with lymph nodes
b. A survival 100%
c. Staging done pre-op
d. Staging done post-op
e. C survival 50%
61. Increased intraluminal pressure with
a. Esophageal diverticulum
b. Bladder diverticulum
c. Pharyngeal diverticulum
d. Meckel’s diverticulum
e. Diverticular disease
62. Boy, 7 days post-op, gets fever. Likely causes include
a. Atelectasis
b. UTI
c. Wound abscess
d. Pelvic abscess
e. Anaerobic abscess
63. Strep pyogenes
a. Causes carbuncle
b. Causes erysipelas
c. Commonest cause of wound infection today
d. Produces enzyme destroying cloxacillin
64. Perthes disease
a. Commonest in teens
b. Involves acetabulum
c. Involves femoral head
d. Treatment by surgery usually
65. Internal fixation needed for
a. Fracture of neck of femur
b. Colles fracture
c. Pott’s fracture
d. Fracture of shaft of femur
66. Haemoptysis caused by
a. Pulmonary embolus
b. Coarctation of aorta
c. Carcinoma of lung
d. Mitral stenosis
67. Regarding cysts
a. True cysts are lined by squamous epithelium
b. External angular dermoid is an example of congenital cyst
c. Spermatocele is an acquired cyst
d. A hydrocele is a retention cyst
e. Implantation dermoid cysts are common in fingers of women who sew
68. Wound dehiscence
a. Is commoner in midline vertical incisions
b. Patients who are hypoproteinemic/malnourished are at a higher risk
c. Occurs within 2-3 days postoperatively
d. The issue of serosanguinous fluid from the wound is an ominous sign
e. Tension sutures should be left for 5-7 days
69. History
a. Lister introduced aseptic surgery in 1867
b. Simpson introduced chloroform as an anaesthetic drug in 1847
c. ABO blood groups discovered 1935
d. Hippocrates lived and worked in Alexandria
e. Harvey described circulation of the blood in 1628
70. Metabolic response to trauma includes
a. Antidiuresis for 16-24 hours
b. Fever
c. Rise in serum sodium concentration
d. Renal retention of potassium
e. Leucocytosis
71. Carcinoma of anterior 2/3 of tongue
a. Metastasizes first to deep cervical nodes
b. Metastasizes first to submandibular nodes
c. Is rare in males
d. Is an adenocarcinoma
e. Can be treated by ionizing radiation
72. Is an intracapsular fracture of the femur, the characteristic findings are:
a. External rotation of LL
b. Internal rotation of LL
c. Knee flexion
d. Ecchymosis of thigh
e. Shortening
73. Virulence of Strep pyogenes is tested by
a. Antibiotic sensitivity
b. Ability to form
c. Ability to hemolyse blood
d. Phenotyping
e. Ability to form fibrinolysins
74. The following are correctly paired:
a. Hypokalemia and acidosis
b. Carcinoma of gallbladder and cirrhosis of liver
c. Gallstones and abnormal liver bile
d. Thrombophlebitis and cerebral embolism
e. Heparin and treatment of DIC
75. Non-union is common in fractures of the
a. Humeral shaft
b. Waist of scaphoid
c. Neck of femur
d. Head of radius
e. Shaft of femur
76. Extra-dural haemorrage may
a. Occur spontaneously
b. Run a chronic course
c. Involve middle meningeal artery
d. Result from indirect injury
e. Cause rapid death
77. Acute osteomyelitis
a. Is usually streptococcal
b. Involves epiphysis
c. May cause septic arthritis
d. Is always secondary to trauma
e. Is always sensitive to penicillin G
78. In an adult fracture of the shaft of femur, adequate treatment
a. Allows traction
b. Plaster of paris
c. Intramedullary nail
d. Skeletal traction in Thomas splint
e. Early mobilization with none of the above
79. In bronchial carcinoma, surgical exploration is contraindicated if
a. There is lobar collapse
b. There is recurrent laryngeal nerve paralysis
c. Axillary glands are palpable
d. There is pulmonary osteo-arthropathy
e. There is Horner’s syndrome