1. The roof of the ischiorectal fossa is formed by:
A. Levator ani muscle B. Deep transverse perineal muscle C. External anal sphincter D. Obturator internus muscle E. Waldeyer's fascia
A. Levator ani muscle
2. Fistula-in-ano often accompanies which one of the following disorders:
A. Diverticulitis B. Crohn's disease of the colon C. Ulcerative colitis D. Carcinoma of the rectum E. Bacillary dysentery
B. Crohn's disease of the colon
3. Five days following appendicectomy for an acutely inflamed appendix an 18 year old man develops a pyrexia of 38.5C. The most likely cause of the pyrexia is:
A. Lobar pneumonia B. Wound infection C. Pelvic abscess D. Multiple pulmonary emboli E. Portal pyaemia
B. Wound infection
4. The operative mortality of coronary artery bypass approximates 10% in which of the following situations?
A. Elective operation B. Revision of failed coronary bypass surgery C. Emergency coronary artery bypass D. Severely impaired left ventricular function E. None of the above
E. None of the above
5. Which of the following is pathognomonic of primary carcinoma of the breast:
A. Oedema of the skin over a breast mass B. Nipple retraction C. A very hard mass in the breast D. Enlarged nodes in the axilla E. None of the above
E. None of the above
6. In the examination of the breast, which one of the following statements is incorrect:
A. Tenderness suggests an inflammatory or fibroadenotic lesion B. Inversion of the nipple is always pathological C. Multiple nodules suggest fibroadenosis D. Fat necrosis may produce tethering of a hard lump to the skin E. A hard, painless, irregular nodule is probably cancer
B. Inversion of the nipple is always pathological
7. All but one of the following statements about female breast carcinoma are correct. The exception is:
A. In Australian females the risk of developing the disease at some time during life is approximately 11% B. Radiotherapy after mastectomy does not improve the five-year survival C. Needle biopsy is contra-indicated because it promotes metastasis D. Radioisotope bone scanning will detect more bony metastases than radiographic skeletal survey E. Ten-year survival figures are more meaningful than five-year survival data in comparison of results of treatment, as there is a significant fall-off between five and ten years
C. Needle biopsy is contra-indicated because it promotes metastasis
8. Which of the following has had the greatest rise in mortality rates over the past 40 years:
A. Gastric carcinoma B. Pancreatic carcinoma C. Colorectal carcinoma D. Lung carcinoma E. Leukaemia
D. Lung carcinoma
9. Brain metastasis is most frequently due to which one of the following cancers:
A. Rectum B. Lung C. Thyroid D. Breast E. Stomach
B. Lung
10. The incidence of bony metastases is lowest in which of the following neoplasms:
A. Breast carcinoma B. Hepatoma C. Lung carcinoma D. Prostatic carcinoma E. Renal carcinoma
B. Hepatoma
11. Following open heart surgery, a patient develops chest pain, fever, tachycardia, and a pericardial friction rub. Which of the following statements is/are true regarding this situation?
A. This picture usually is accompanied by pleural effusion and evidence of congestive heart failure B. The most likely diagnosis is pulmonary embolism C. Usually there will be an associated leukocytosis or eosinophilia D. Primary treatment should include antibiotics E. The patient likely will respond well to anti-inflammatory agents
E. The patient likely will respond well to anti-inflammatory agents
12. Each of the following measures is commonly used in the treatment of chest injuries except:
A. Tracheostomy B. Epidural analgesia C. Open reduction of fractured ribs D. Intercostal nerve block E. Intermittent positive pressure respiration
C. Open reduction of fractured ribs
13. On a micro chest X-ray survey film a round opacity of 3 cm in diameter was seen peripherally in the left lower lung field. The patient, a male, was a non-smoker. Seven years previously a 'black mole' had been excised from the posterior aspect of the calf. No malignant cells were seen on repeated examination of the sputum. Investigations did not reveal any evidence of disease elsewhere. What treatment would you recommend:
A. A course of antibiotics B. Intravenous nitrogen mustard C. Reassurance of the patient D. X-irradiation of the lung E. Pulmonary lobectomy
E. Pulmonary lobectomy
14. Spontaneous pneumothorax has resulted in 50% collapse of the right lung. Select the correct primary treatment:
A. Observe for spontaneous absorption of air from pleural space B. Aspirate the air by means of needle and syringe C. Thoracotomy D. Empty the pleural space by intercostal tube drainage E. Tracheostomy
D. Empty the pleural space by intercostal tube drainage
15. On routine chest X-rays, a large antero-superior mediastinal mass was noted in a young man who complained of weight loss, fever and night sweats. Which one of the following would be the most likely diagnosis:
A. Reticulum cell sarcoma B. Tuberculosis C. Sarcoidosis D. Hodgkin's disease E. Carcinoma of the lung
D. Hodgkin's disease
16. A 49 year old school teacher states that for five weeks he has had a boring pain in the right part of his neck and shoulder going down the medial aspect of his right arm. The pain was initially intermittent but for the past two weeks has been constant. He has smoked about 20 cigarettes a day for 30 years. Physical examination discloses a miotic right pupil and a mild right ptosis. Chest X-ray shows an opacity at the apex of the right lung field. The most likely diagnosis is:
A. Tuberculosis B. Carcinoma C. Sarcoidosis D. Histoplasmosis E. Klebsiella pneumonia
B. Carcinoma
17. A 50 year old sheep farmer who smokes 40 cigarettes per day presents with a cavitated lesion in the lingular segment of the lung. The Casoni test is negative. The most likely diagnosis is:
A. Ruptured hydatid cyst B. Cavitated pulmonary tuberculosis C. Non-specific lung abscess D. Carcinoma of the lung E. Solitary aspergilloma
D. Carcinoma of the lung
18. Contraindications to coronary artery bypass include:
A. Refractory congestive heart failure B. Severely depressed left ventricular ejection fraction (less than 0.20) C. Age over 70 years D. Angiographic inability to visualize a patent distal vessel E. Acute myocardial infarction
A. Refractory congestive heart failure
19. Thymic tumours are often associated with:
A. Agammaglobulinaemia B. Rhabdomyosarcomas C. Lymphosarcomas D. Myasthenia gravis E. Myeloblastic leukaemia
D. Myasthenia gravis
20. Radical surgery is recommended for familial adenomatous polyposis because:
A. Polyps are frequently associated with colitis B. Polyps cause chronic blood loss and anaemia C. Large bowel obstruction may supervene D. Malignant change is common E. Intussusception occurs frequently
D. Malignant change is common
21. The chief problem in the management of Hirschsprung's disease is:
A. Anomalous blood supply of colon B. Danger of perforation of thin bowel wall C. Finding level where ganglion cells are present D. Dividing the extensive adhesions E. Faecal contamination of peritoneal cavity
C. Finding level where ganglion cells are present
22. Cancer of colon occurs most frequently in the:
A. Caecum B. Hepatic flexure C. Transverse colon D. Descending colon E. Sigmoid colon
E. Sigmoid colon
23. Parathyroid adenoma should be suspected in which of the following circumstances:
A. Alterations in blood calcium and phosphorus levels B. Kidney stones C. Bony changes seen on X-ray films D. Recurrent abdominal pain E. All of the above
E. All of the above
24. The most common cause of mitral insufficiency is:
A. Bacterial endocarditis B. Rheumatic fever C. Mitral valve prolapse D. Papillary muscle dysfunction B. Rupture of chordae tendineae
B. Rheumatic fever
25. In attempting to define the origin of a mass arising from the left upper quadrant, the presence of resonance anterior to the mass favours a lesion of the:
A. Left kidney B. Spleen C. Liver D. Splenic flexure of colon E. Carcinoma of the stomach
A. Left kidney
26. A patient presents with a history of vomiting and oliguria. Serum electrolytes are: Na+ 120 mM, K+ 3 mM, Cl- 50 mM, HCO3- 40 mM. The biochemical disorder is characteristic of which one of the following:
A. Renal tubular acidosis B. Ureterosigmoidostomy C. Pyloric stenosis D. Chronic renal failure E. Diarrhoea
C. Pyloric stenosis
27. Which of the following best describes the average daily requirement of potassium in a normal adult:
A. 80 m.mol B. 4 m.mol C. 10 m.mol D. 150 m.mol E. 40 m.mol
A. 80 m.mol
28. An 11 year old child has had several recent major bleeds from gastro-oesophageal varices. There is a history of neonatal umbilical sepsis and liver function is good. Which of the following operations would be most appropriate:
A. Trans-oesophageal banding of varices B. Gastric transection C. Splenectomy D. Portacaval shunt E. Spleno-renal anastomosis
A. Trans-oesophageal banding of varices
29. Mallory-Weiss syndrome may be caused by:
A. Vomiting during alcoholic episode B. Severe coughing spell C. Grand mal epileptic seizure D. Heavy lifting E. Any of the above
E. Any of the above
30. Which of the following situations is most likely to occur after a large pulmonary embolism:
A. High pulmonary venous pressure with pulmonary oedema B. High right ventricular pressure, with raised systemic venous pressure C. High left atrial pressure, with functional mitral valve incompetence D. Low systemic arterial and venous pressures E. Low right atrial and central venous pressures
B. High right ventricular pressure, with raised systemic venous pressure
31. Which one of the following statements about femoral hernia is true:
A. Femoral herniae are more common in women than inguinal herniae B. Femoral herniae are more common in women than in men C. Femoral herniae are usually bilateral D. Femoral herniae rarely strangulate E. Femoral herniae frequently occur in children
B. Femoral herniae are more common in women than in men
32. Which of the following statements about cervical ribs is the most correct:
A. They are the commonest cause of subclavian vein thrombosis B. They are a common cause of Raynaud’s disease C. They represent an extension of the transverse process of C8 D. The C8/T1 trunk of the brachial plexus passes immediately below the rib. E. They are usually incidental radiological findings
E. They are usually incidental radiological findings
33. In which of the following does the viscus by definition form part of the wall of the hernial sac:
A. Richter's hernia B. Indirect inguinal hernia C. Sliding hernia D. Spigelian hernia E. Direct inguinal hernia
C. Sliding hernia
34. In approximately what percentage of patients is a strangulated femoral hernia painful:
A. More than 95% B. 75% C. 50%' D. 25% E. Less than 5%
A. More than 95%
35. Which one of the following herniae would be most likely to strangulate
A. Indirect inguinal B. Direct inguinal C. Femoral D. Incisional E. Para-umbilical
C. Femoral
36. Regeneration after partial removal is most complete in the:
A. Spleen B. Kidney C. Liver D. Intestine E. Adrenal
C. Liver
37. What is an epulis:
A. An ingrowing toe nail B. Granuloma of gingival tissues C. A malignant jaw tumour D. Skin tumour E. A sweat gland tumour
B. Granuloma of gingival tissues
38. A 56 year old man is seen complaining of a 'sore' on the vermilion border of his lower lip that has been progressively enlarging over the past six months. On examination the lesion measures 1 cm in diameter and is a firm nodule with superficial ulceration and crusting. The most likely diagnosis is:
A. Basal cell carcinoma B. Malignant melanoma C. Squamous cell carcinoma D. Leukoplakia E. Solar keratosis
C. Squamous cell carcinoma
39. All the following cardiac anomalies are corrected surgically with cardiopulmonary bypass techniques EXCEPT:
A. Fallot’s tetralogy B. Patent ductus arteriosus C. Ventricular septal defect D. Transposition of the great vessels E. Truncus arteriosus
B. Patent ductus arteriosus
40. An enlarged submental lymph node would suggest malignancy of:
A. The posterior third of the tongue B. The lower lip C. The thyroid gland D. The upper lip E. The nasopharynx
B. The lower lip
41. Leakage of clear fluid from the anterior nares after a head injury is associated with fracture of:
A. Nasal bones B. Maxilla C. Cribriform plate of ethmoid D. Basisphenoid E. Temporal bone
C. Cribriform plate of ethmoid
42. When testing for injury to the ulnar nerve at the elbow which of the following signs is not compatible with complete division of the nerve:
A. Ulnar deviation of the hand B. Hyperextension of the metacarpophalangeal joints of the ring and little fingers C. Loss of adduction of the ring and little fingers D. Loss of sensation in the ring and little fingers E. Atrophy of the hypothenar eminence
A. Ulnar deviation of the hand
43. Which of the following fractured facial bones is most commonly associated with a trigeminal nerve deficit:
A. Zygoma B. Ethmoid C. Maxilla D. Mandible E. Nasal
C. Maxilla
44. The majority of patients with metastatic carcinoma to the brain present with:
A. Cerebellar signs B. Cerebral symptoms C. Hydrocephalus D. Motor loss E. Sensory loss
B. Cerebral symptoms
45. A patient has sustained a deep laceration above the elbow. He is unable to extend the proximal interphalangeal joints of the 4th and 5th digit and has anaesthesia of the dorsal aspect of his index finger. Which of the following nerves has been injured:
A. Median nerve B. Ulnar nerve C. Radial nerve D. Musculo-cutaneous nerve E. Combination of A and B
C. Radial nerve
46. A 72 year old man has just finished a five course dinner when he is suddenly seized by a violent coughing spell accompanied by vomiting. He becomes blue and collapses. On admission to hospital he is noted to be shocked, cyanosed and anxious. There is subcutaneous emphysema palpable in the neck area and dullness at the left base. The most likely diagnosis is:
A. Myocardial infarction B. Pulmonary embolus C. Tension pneumothorax D. Dissecting aneurysm E. Ruptured oesophagus
E. Ruptured oesophagus
47. Benign oesophageal stricture may be caused by all but one of the following. The exception is:
A. Gastro-oesophageal reflux B. Perforation C. Ingestion of strong acids D. Ingestion of strong alkalis E. Prolonged ingestion of alcohol
E. Prolonged ingestion of alcohol
48. What essential investigation should be carried out following discharge from hospital on a 38-year-old male who is initially admitted to hospital with an anterior myocardial infarct:
A. Serial ECGs B. Holter monitoring C. Thallium scanning D. Coronary angiography E. Stress test with ECG monitoring
D. Coronary angiography
49. The Mallory-Weiss syndrome presents with haematemesis and/or melaena due to bleeding from which one of the following:
A. Oesophageal varices B. Acute erosions due to ingestion of analgesica C. Angiomatous malformations D. Lower oesophageal mucosal tear E. Hereditary telangiectasia
D. Lower oesophageal mucosal tear
50. A 59 year old widow with a long history of indigestion and heartburn complains of painful dysphagia which is worse for solid food and was first experienced three months ago. Barium swallow shows narrowing of the lower oesophagus and a hiatus hernia. The next step in management should be:
A. Antacids, 'Gaviscon', soft diet and elevation of the head of the bed B. Oesophagoscopy with biopsy C. Oesophageal dilatation by bougies D. Oesophago-gastrectomy E. Fundoplication
B. Oesophagoscopy with biopsy
51. Each of the following conditions is associated with Paget's disease of bone except:
A. Deafness B. Bone sarcoma C. Heart failure D. Acute pancreatitis E. Pathological fracture
D. Acute pancreatitis
52. Which of the following is not associated with acute pancreatitis
A. Hyperparathyroidism B. Alcoholic excess C. Cholelithiasis D. Mumps E. Gastric carcinoma
E. Gastric carcinoma
53. In a jaundiced patient, which one of the following signs would suggest a diagnosis of carcinoma of the head of pancreas
A. Smooth rounded mass moving on respiration in the right upper quadrant B. Shifting dullness C. Palpable supraclavicular lymph nodes D. Tenderness in the costovertebral angle E. Gastric succussion splash
A. Smooth rounded mass moving on respiration in the right upper quadrant
54. Which one of the following is not associated with pancreatitis:
A. Gall stones B. Alcohol C. Mumps D. Hypercalcaemia E. Myasthenia gravis
E. Myasthenia gravis
55. Which of the following diseases is associated with meconium ileus:
A. Congenital pyloric stenosis B. Bile duct atresia C. Cystic fibrosis D. Ileal atresia E. Hirschsprung's disease
C. Cystic fibrosis
56. In the newborn baby, excess amniotic fluid, salivation, choking attacks, recurrent cyanosis and regurgitation of feeds should suggest:
A. Fibrocystic disease of the pancreas B. Hypertrophic pyloric stenosis C. Hirschsprung's disease D. Duodenal atresia E. Oesophageal atresia
E. Oesophageal atresia
57. In which of the following diseases should the whole length of the ureter be removed together with the kidney
A. Renal cell carcinoma tumour of the kidney B. Wilm's tumour of the kidney C. Papillary tumour of the renal pelvis D. Polycystic kidney E. Staghorn calculus
C. Papillary tumour of the renal pelvis
58. After the initial treatment of papilloma of the bladder which is the essential feature of continuing management:
A. Watching for haematuria B. Radiotherapy C. Urinary cytology D. Repeated cystoscopies E. Periodic intravenous pyelograms
D. Repeated cystoscopies
59. The following statements about testicular seminoma are correct except:
A. Occurs most frequently in the third and fourth decades B. Has a better prognosis than teratoma of the testis C. Cryptorchid has a greater risk of malignancy D. Secondary masses are painless E. Superficial inguinal nodes are a common site of metastatic spread
E. Superficial inguinal nodes are a common site of metastatic spread
60. Which of the following is not a characteristic of oxalate urinary calculus:
A. It is covered with sharp projections B. It may be black C. It is radio-opaque D. It is associated with envelope-shaped crystals E. It is frequently secondary to infection
E. It is frequently secondary to infection
61. Which one of the following conditions is associated with renal calculi:
A. Thyroid adenoma B. Parathyroid adenoma C. Pancreatic adenoma D. Pituitary adenoma E. Adrenal adenoma
B. Parathyroid adenoma
62. The most common site of ectopic testis is:
A. Perineal B. Pelvic C. Femoral (in Scarpa's triangle) D. Inguinal E. Penile
D. Inguinal
63. Which of the following observations is the most reliable index of adequate resuscitation of a severely burned patient:
A. Haemoglobin B. Haematocrit C. Rate of production of urine D. Specific gravity of urine E. Blood pressure
C. Rate of production of urine
64. The most sensitive index of fluid retention is:
A. Jugular venous pressure B. Urinary output C. Increase in body weight D. Pitting oedema E. Appearance of the tongue
C. Increase in body weight
65. A 70 year old man is pale and sweating with a thin, rapid pulse after a large haematemesis. Which one of the following methods would you prefer to monitor the rate of blood volume replacement in such post-haemorrhagic shock:
A. Haematocrit B. Blood volume C. Central venous pressure measurement D. Extracellular fluid volume measurement E. Plasma electrolyte measurement
C. Central venous pressure measurement
66. In the hour following a deceleration accident associated with rupture of the descending thoracic aorta what percentage of patients will reach hospital still alive:
A. 100% of cases B. 80% of cases C. 50% of cases D. 30% of cases E. 10% of cases
C. 50% of cases
67. Recurrent painful enlargement of the submandibular gland is most frequently caused by:
A. Actinomycosis B. Pleomorphic salivary adenoma C. Metastatic disease D. Submandibular calculus E. Mumps
D. Submandibular calculus
68. The most effective treatment for a recurrent basal cell carcinoma is:
A. Excision B. Topical 5-fluorouracil C. Superficial radiation D. Liquid nitrogen E. CO2 snow
A. Excision
69. A longstanding ulcer on the lower third of the leg was described as having a floor covered with grey adherent slough. The edges were heaped up, bled easily on contact and were not undermined. No haematologic or bowel abnormality was detected. The spleen was not palpable. The aetiology of this ulcer is likely to be:
A. Arterial insufficiency B. Trauma C. Venous insufficiency D. Neoplastic E. Tuberculosis
D. Neoplastic
70. A cyst has been growing slowly in the subcutaneous tissue of the forehead at the outer border of the eyebrow. It is:
A. Branchial cyst B. Lipoma C. Lacrimal gland neoplasm D. Cystic hygroma E. Dermoid cyst
E. Dermoid cyst
71. In the first six to eight hours after injury if the systolic blood pressure is less than 100 mm.Hg, the pulse rate is over 100 per minute and there are cold extremities and pallor of the face, which of the following do you suspect:
A. Hypothermia B. Blood loss C. Circulating bacterial toxins D. Adrenal failure E. Inadequate analgesia
B. Blood loss
72. Steatorrhoea can occur in all of the following conditions except:
A. Gastrocolic fistula B. Small intestinal stricture C. Diverticular disease of the colon D. Vagotomy and pyloroplasty E. Crohn's disease
C. Diverticular disease of the colon
73. Which one of the following features suggests that a small gut obstruction is strangulating:
A. Profuse vomiting B. Marked abdominal tenderness C. Absolute constipation D. Progressive distension E. Multiple fluid levels on plain X-ray of the abdomen
B. Marked abdominal tenderness
74. The following are indications for splenectomy except:
A. Traumatic rupture B. Splenorenal shunt C. Idiopathic thrombocytopaenic purpura D. Non-thrombocytopaenic purpura E. Congenital haemolytic anaemia
D. Non-thrombocytopaenic purpura
75. Which one of the following is associated with thyroid disease
A. Ptosis B. Lid lag C. Nystagmus D. Dendritic ulcer E. Internal ophthalmoplegia
B. Lid lag
76. Hyperthyroidism complicated by high output cardiac failure in the 30th week of pregnancy should be treated first with:
A. 131.I B. Propylthiouracil C. Propranolol D. Surgical extirpation of two-thirds or more of the thyroid gland E. Caesarean section
C. Propranolol
77. After what surgical procedure is the following clinical picture occasionally observed: numbness of hands, general weakness, blurred vision, carpopedal spasm, Chvostek's sign:
A. Blalock-Taussig procedure B. Hypophysectomy C. Thyroidectomy D. Nephrectomy E. Removal brachial cleft cyst
C. Thyroidectomy
78. Which of the following lesions can usually be distinguished easily from cancer of the thyroid on the basis of physical examination:
A. De Quervain's thyroiditis (granulomatous thyroiditis) B. Follicular adenoma of the thyroid C. Hashimoto's thyroiditis (struma lymphomatosa) D. Riedel's struma E. None of the above
E. None of the above
79. Carcinoma of the posterior third of the tongue may present with all but one of the following. The exception is:
A. Earache B. Frontal headache C. Bad taste in the mouth D. Difficulty in swallowing E. Enlarged cervical lymph nodes
B. Frontal headache
80. A 59 year old clerk is referred by his dentist with a painless ulcer on the dorsum of the tongue present for two months. The most appropriate course will be:
A. Serological tests for syphilis B. Biopsy C. Swab for culture and sensitivities D. Course of penicillin for seven days E. Regular observation of the lesion for any change
B. Biopsy
81. The best treatment for localised renal cell carcinoma (hypernephroma) in the adult is:
A. Radical nephrectomy B. Chemotherapy C. Radiation therapy D. Close observation E. Renal arteriography every six months
A. Radical nephrectomy
82. Which of the following conditions is not likely to occur as part of a post-gastrectomy syndrome:
A. Diarrhoea B. Post-prandial hypotension C. Osteoporosis D. Loss of weight E. Tenesmus
E. Tenesmus
83. Which of the following is not consistent with a diagnosis of superficial femoral artery occlusion:
A. Rest pain B. Gangrene of the great toe C. Claudication in the thigh D. Calf claudication at 50 metres E. Improvement in claudication distance during period of observation
C. Claudication in the thigh
84. Each of the following is a sign of severe arterial insufficiency in a limb except:
A. Shiny atrophic skin B. Brown skin pigmentation C. Pallor on elevation of the limb D. Rubor on depression of the limb E. Venous filling time of longer than 20 seconds
B. Brown skin pigmentation
85. Systemic emboli with mitral stenosis:
A. Are unlikely in absence of exertional dyspnoea B. Are not related in frequency to the presence of atrial fibrillation C. Are most commonly renal D. Most commonly involve an extremity E. Rarely occur in asymptomatic patients
D. Most commonly involve an extremity
86. An active woman of 57 years presents with an ulcer just above the left medial malleolus. The ulcer followed minor trauma three weeks ago and is close to the site of another ulcer she had two years earlier. Examination reveals normal arterial pulses. The initial management most likely to result in early healing is:
A. Left lumbar sympathectomy B. Biopsy of the ulcer C. Culture of the discharge and administration of the appropriate antibiotic D. Local dressing together with an elastic bandage applied to the left foot and leg E. Rest in bed with elevation of the left leg
E. Rest in bed with elevation of the left leg
87. All but one of the following reduce the incidence of post-operative deep vein thrombosis. The exception is:
A. Post-operative physiotherapy for the legs B. Subcutaneous low-dose heparin C. Intravenous low molecular weight dextran D. Pre, per and post-operative compression bandaging of the legs E. Intermittent per-operative pneumatic calf compression
C. Intravenous low molecular weight dextran
88. A decrease in the radius of a blood vessel by one-half will decrease the flow through the vessel to:
A. One-thirty-second B. One-sixteenth C. One-eighth D. One-fourth E. One-half
B. One-sixteenth
89. Indications for medical therapy of patients with dissecting thoracic aortic aneurysm include:
A. Stable disease presenting more than two weeks after the onset of symptoms B. Failure of opacification of the false lumen on initial angiography C. Inabilty to identify the site of origin on angiography D. Localised saccular enlargement E. Renal artery compromise
A. Stable disease presenting more than two weeks after the onset of symptoms
90. All the following statements regarding atelectasis are true EXCEPT:
A. A chest X-ray is required to confirm the diagnosis before treatment B. It occurs more commonly after upper than lower abdominal operations C. It may be caused by either bronchial obstruction or hypoventilation D. It usually becomes manifest in the first 24 hours after operation E. There is often associated fever and relative bradycardia
A. A chest X-ray is required to confirm the diagnosis before treatment
91. A patient has a gunshot wound in which a bullet has entered the left sixth intercostal space anteriorly and exited straight posteriorly. He is not hypotensive and has no signs of peritoneal irritation. The MOST SUITABLE management is:
A. Admission to the hospital for close observation B. Local exploration of both wounds and if penetration into the peritoneal cavity cannot be proved, admission to the hospital for observation C. Peritoneal lavage and if this proves positive, exploratory laparotomy D. Injection of radiopaque material into the anterior wound and if dye enters the peritoneal cavity, exploratory laparotomy E. Exploratory laparoscopy/laparotomy
E. Exploratory laparoscopy/laparotomy
92. When dealing with contaminated traumatic wounds the MOST IMPORTANT factor for avoiding infection is:
A. Delayed closure of the wound B. Antibiotic therapy C. Adequate debridement D. Administration of tetanus toxoid E. Use of absorbable buried suture material
C. Adequate debridement
93. Significant intra-abdominal trauma is MOST RELIABLY diagnosed by:
A. Raised serum amylase B. Raised white blood cell count C. Peritoneal lavage positive for pink fluid D. Abdominal tenderness and guarding E. Absent bowel sounds
C. Peritoneal lavage positive for pink fluid
94. Which of the following statements is FALSE:
A. Thrombosed external haemorrhoids are acutely painful B. Lesions lying at the dentate line will cause anal pain C. Lesions lying above the dentate line are usually associated with severe pain D. Lesions lying below the dentate line are usually painful E. Pain is not a prominent symptom with uncomplicated internal haemorrhoids
C. Lesions lying above the dentate line are usually associated with severe pain
95. Pancreatic pseudocysts:
A. Usually are caused by pancreatic cancer B. Require immediate surgical intervention C. Are best managed by excision D. Are best managed by internal drainage E. Frequently become pancreatic abscesses
D. Are best managed by internal drainage
96. Ranson's criteria relate to:
A. Carcinoma of the pancreas B. The severity of acute diverticulitis C. Chronic pancreatic disease and malabsorption D. The prognosis in patients with acute pancreatitis E. The outcome of active thyroid crises
D. The prognosis in patients with acute pancreatitis
97. A 50 year old man notes episodes of postprandial upper abdominal pain for the past two months. Four days ago he had pain and the onset of jaundice. There is mild upper abdominal and right upper quadrant tenderness. Temperature 38oC. Lab: WBC 13,000; bilirubin 84 mmol/l; AST normal; alkaline phosphatase 220 (normal up to 85). The most likely diagnosis is:
A. Ascending cholangitis B. Obstructive jaundice due to carcinoma head of pancreas C. Intrahepatic cholestasis due to alcoholic hepatitis D. Advanced cirrhosis with impending liver failure E. Hepatitis
A. Ascending cholangitis
98. Ultrasound is a good method of demonstrating gallstones because:
A. Solids cannot transmit sound B. Solids absorb sound and prevent it from being transmitted on to the tissues beyond C. Acoustic impedance is equal to the speed of sound multiplied by density. D. It can exclude the presence of stones in the common bile duct E. The fluid in the gallbladder casts an acoustic shadow which highlights the stone
C. Acoustic impedance is equal to the speed of sound multiplied by density.
99. A bloody discharge from the nipple is most frequently caused by which of the following lesions:
A. Chronic cystic mastitis B. Intraductal papilloma C. Adenofibroma D. Cystosarcoma phyllodes E. Carcinoma of the breast
B. Intraductal papilloma
100. Which side effect may be expected in a patient receiving curative radiotherapy for prostate cancer:
A. Proctitis B. Nausea and vomiting C. Headaches D. Severe skin inflammation E. Swollen legs
A. Proctitis
101. Operations for varicose veins are best accomplished by:
A. Stripping, high saphenous vein ligation and stab avulsions. B. Multiple subcutaneous ligatures C. Subfascial ligatures D. Division and ligation at the sites of a bad leak from the deep to the superficial venous system E. Injecting sclerosants throughout
A. Stripping, high saphenous vein ligation and stab avulsions.
102. What is the treatment of choice for a pleomorphic adenoma of the parotid:
A. Surgical removal with surrounding normal parotid and preservation of facial nerve B. Total parotidectomy with sacrifice of the facial nerve and cable grafting C. Cryosurgical destruction of the tumour D. External beam radiotherapy E. Enucleation and radiotherapy
A. Surgical removal with surrounding normal parotid and preservation of facial nerve
103. Splenectomy in trauma:
A. Is rarely avoidable if the spleen is injured B. Has the same risk of pneumococcal sepsis as seen in Hodgkin's disease C. Should be followed by pneumococcal vaccination D. Has a low mortality because the spleen is usually the only site of injury E. Is more common after penetrating trauma than blunt trauma
C. Should be followed by pneumococcal vaccination
104. Ten days after a splenectomy for blunt abdominal trauma, a 23 year old man complains of upper abdominal and lower chest pain exacerbated by deep breathing. He is anorectic but ambulatory and otherwise making satisfactory progress. On physical examination, his temperature is 39.2oC (100oF) rectally and he has decreased breath sounds at the left lung base. His abdominal wound appears to be healing well, bowel sounds are active and there are no peritoneal signs. Rectal examination is negative. The white blood cell count is 12,500/mm3 with a shift to the left. Chest X-rays show platelike atelectasis of the left lung field. Abdominal X-rays show a nonspecific gas pattern in the bowel and an air fluid level in the left upper quadrant. Serum amylase is 150 Somogyi units per 100 mL (normal: 60 to 180).
The most likely diagnosis is: A. Incisional pain B. Subphrenic abscess C. Subfascial wound infection D. Pancreatitis E. Pulmonary embolism
B. Subphrenic abscess
105. All of the following EXCEPT ONE are signs of a strangulated hernia:
A. Tense B. Irreducible C. Absent cough impulse D. Tenderness E. Fluctuance
E. Fluctuance
106. A 26 year old man presents with a three week history of pain and a swelling in the left side of his scrotum. Which of the following is the most correct:
A. If the swelling is within the scrotum and separate from the testis, it is probably a hydrocele B. If the swelling transilluminates then malignancy can be excluded C. If the examiner cannot get his hand above the swelling then the patient probably has an inguinoscrotal hernia D. The patient may have a twisted hydatid of Morgagni (appendix of the testis) which is swelling at the lower pole of the testes E. Tuberculous epididymo-orchitis is a common cause of such a swelling
C. If the examiner cannot get his hand above the swelling then the patient probably has an inguinoscrotal hernia
107. A clinically well 43 year old woman presents with a history of having seen blood in her urine seven days previously. The recommended management of this patient is:
A. Reassurance B. Microurine culture and sensitivity, voided urinary cytology and ultrasound examination C. Ultrasound examination of the urinary tract, cystourethroscopy and urethroscopy D. Microurine culture and sensitivity, urinary cytology, intravenous urogram (pyelogram) and cystoscopy E. Microurine culture and sensitivity, urinary cytology, computed tomography scan of abdomen and pelvis
D. Microurine culture and sensitivity, urinary cytology, intravenous urogram (pyelogram) and cystoscopy
108. Which of the following constitute the most likely differential diagnosis of an upper urinary tract filling defect:
A. Urinary infection, radiolucent stone, blood clot, renal cyst B. Urothelial tumour, radiolucent stone, sloughed papilla, blood clot C. Radiolucent stone, renal cyst, blood clot,, sloughed papilla D. Radiolucent stone, foreign body, urothelial tumour, angiomyolipoma E. Radiolucent, stone, foreign body, TB, urothelial tumour
B. Urothelial tumour, radiolucent stone, sloughed papilla, blood clot
109. Death from trauma typically occurs:
A. Either immediately at the scene of the accident, or later in Casualty at the Trauma Centre B. Within seconds to minutes of the injury, within one to two hours of the injury or several days to weeks after the injury, in three definable peaks C. As a result of disruption of the brain, heart or major vessels D. Through delay in transfer of patients from outlaying hospitals to major trauma centres E. Because in-line immobilization of the neck was not maintained properly during transfer
B. Within seconds to minutes of the injury, within one to two hours of the injury or several days to weeks after the injury, in three definable peaks
110. A 57 year old woman with weight loss and an obstructing carcinoma of the oesophagus is given total parenteral nutrition while she is receiving preoperative irradiation. Three days later the patient is lethargic and her behaviour strange. Her urine output has increased to 3000 ml/24 hours. Which of the following would be most useful in determining the nature of this patient's problem:
A. Measurement of serum electrolytes B. Lumbar puncture C. Determination of the urine/serum creatinine ratio D. Liver function tests E. Measurement of blood glucose
E. Measurement of blood glucose
111. Which of the following can produce an irregular mass in the breast:
1. Mammary duct ectasia 2. Fat necrosis 3. Breast abscess 4. Carcinoma of the breast
A. IF 1, 2 AND 3 ARE CORRECT B. IF 1 AND 3 ARE CORRECT C. IF 2 AND 4 ARE CORRECT D. IF ONLY 4 IS CORRECT E. IF ALL ARE CORRECT
