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Sample Multiple choice

questions
Single best answers.
Write down the single best
answer to each question

1
Which one of the following factors does not
have an adverse effect on wound healing
1. Vitamins C deficiency
2. hyperbilirubinaemia
3. systemic corticosteroid administration
4. exposure to ultraviolet light
5. hypo albuminaemia

2
A 25-year-old, otherwise healthy man undergoes an
appendectomy with primary closure of the wound for a
perforated appendix. No antibiotics are administered.
Should this patient develop an intra-abdominal abscess
which one of the following organisms would most likely
be responsible?
1.
2.
3.
4.
5.

Escherichia coli
Bacteroides
Streptococcus faecalis
Proteus
Serratia marcescens

3
A 35-year-old builder is brought into the AETC after
a fall from a ladder. His breathing is laboured and
he is cyanotic. No breath sounds can be heard in
the right lung field, which is resonant to percussion.
The most appropriate first step in his management
is
1.
2.
3.
4.
5.

Cricothyroidotomy
obtaining an urgent chest x-ray
passing an oral endotracheal tube
starting intravenous IV fluids
Insertion of a chest drain

4
An 18-year-old boy is admitted to the AETC. He was a passenger
in a pickup which overturned. He is in a coma (Glasgow coma
score 7). His pulse is barely palpable at a rate of 140 bpm , his
blood pressure is 60/0. Breathing is rapid and shallow, with air
entry over both lung fields. His abdomen is moderately
distended with no audible peristalsis. There are closed fractures
of the right forearm and left lower leg. After rapid intravenous
administration of 2 L of Ringers lactate solution through IV
cannulas in both arms his pulse is 130 and blood pressure 70/0.
The next immediate step should be to
1.
2.
3.
4.
5.

Obtain cross lateral x-rays of the cervical spine.


Obtain head and abdominal CT scans
obtain supine and lateral decubitus x-rays of the abdomen
obtained an arch aortagram
explore the abdomen

6
The most common, earliest,
presenting symptom of acute arterial
occlusion is
1.
2.
3.
4.

pain
pallor
Paralysis
paraesthesia

5. pulselessness

7
The most common symptom after
major pulmonary embolism is
1.
2.
3.
4.
5.

cough
dyspnoea
fear of death
haemoptysis
pleuritic pain

8
Valves involved in the act of swallowing
include all the following structures
except which:
1.
2.
3.
4.
5.

cricopharyngeus
epiglottis
lower oesophageal sphincter
soft palate
tongue

9
In a patient who has undergone a total
gastrectomy the secretion of which
one of the following is not affected
1.
2.
3.
4.
5.

bicarbonate
hydrochloric acid
intrinsic factor
lipase
pepsinogens

10
Fat absorption occurs primarily in the
1.
2.
3.
4.
5.

stomach
first part of the duodenum
third part of the duodenum
jejunum
ileum

11

A 55-year-old postmenopausal woman has had intermittent


flushing of her face, upper body and hands for the last
eight months. Approximately 3 months ago she began to
develop cramping abdominal pain followed by sudden
onset of watery, non-bloody diarrhoea stool. Physical
examination now reveals the following vital signs:
temperature, normal; pulse one 110 bpm; blood pressure,
130/80 mmHg; and respiratory rate, 18 breaths per
minute. Telangiectasis this is noted on the cheeks and
nose and forehead. Rectal examination yields FOB positive
stools. Extremities show mild peripheral oedema. Which of
the following tests would be most helpful in reaching a
diagnosis in this case?
1.
2.
3.
4.

Intravenous pyelography
Barium enema
chest x-ray
quantitative determination of the urinary vanillyl-mandelic acid
(VMA) excretion

12
On barium enema examination a 55-year-old woman is
noted to have a 2.5 cm benign appearing polyp in the
sigmoid colon. Excision attempted during flexible
sigmoidoscopy is incomplete but yields several portions of
adenomatous issue that do not appear histologically to be
malignant. The most appropriate plan for this woman
would be
1. sigmoid colectomy
2. sigmoid colostomy and polypectomy
3. segmental resection of the polyp with excision of the 3 cm margin of
colon
4. periodic barium enema examination to assess the growth of the
polyp remnant
5. repeated sigmoidoscopy sessions to complete removal of the polyp

13
In a patient with acute pancreatitis the following
findings detected within 48 hours of admission
all indicate a poor prognosis except which one
1. arterial PO2 of less than 60 mmHg (normal 95-100
mmHg)
2. changing blood urea nitrogen from 20 mg/dL to 30
mg/dL (normal
3. changing haematocrit from 42 to 30%
4. leucocyte count 25,000/mm3 (normal > 5000/mm3)
5. serum amylase 3500 units per litre (normal <250
U/L)

14
Findings in a patient with sickle cell
disease may include all of the
following except which one
1.
2.
3.
4.
5.

ankle ulcerations
episodes of acute abdominal pain
increased levels of haemoglobin Hb-A
Jaundice
joint pain

5
A 30-year-old female patient presents with a 2 cm
mass below her right ear lobe. She has been aware of
the mass for four years. Physical examination reveals
a firm, non-tender movable mass and intact facial
nerve function; cervical lymph nodes are not palpable.
The most likely diagnosis is
1.
2.
3.
4.
5.

papillary cystadenoma lymphomatosum (Warthins Tumour)


low-grade mucoepidermoid carcinoma
Benign mixed tumour (pleomorphic adenoma)
Malignant mixed tumour
acinar cell adenocarcinoma

15
The spermatic cord is inadvertently
divided during a difficult hernia repair;
which one of the following is not affected?
1.
2.
3.
4.
5.

autonomic nerve fibres


genital nerve
lymphatics
testicular artery
vas deferens

16
A 24-year-old gardener is struck in the right temple
by a falling branch. While being driven to hospital
he becomes unconscious. When he reaches the
AETC he is unresponsive (GCS 3/15) with a dilated
right pupil. The most appropriate step after initial
resuscitation in his immediate management is ...
1.
2.
3.
4.
5.

x-rays of the skull and cervical spine


Doppler ultrasound examination of the neck
Craniotomy
CT scan of the head
Angiography

17
A 25-year-old man is seen in the emergency
department after he struck his head against the
windshield in a road traffic accident. He opens his
eyes and withdraws his arm during painful stimulation
of his hand. He responds verbally to questions with
inappropriate words. His Glasgow coma Scale score is
1.
2.
3.
4.
5.

6
9
12
15
not obtainable from this data

18
Which one of the following statements is
not correct about testicular torsion
1. it is more common before puberty
2. a diagnostic isotope scan should precede
operation
3. it can be confused with acute epididymitis
4. the testicle is usually found high in the
scrotum
5. if operation on one testicle is required a bilateral
orchidopexy should be done

19
Which one of the following statements about
testicular cancer is not correct
1. diagnosis should be established by
percutaneous biopsy of the testicular mass
2. seminomas are the most common cellular type
3. seminomas are extremely radio sensitive
4. teratocarcinomas are more common in younger
men
5. teratocarcinomas should be evaluated by pelvic
CT

20
In the presence of septic arthritis involving
the hip joint, the patient tends to hold hip
in
1.
2.
3.
4.
5.

Abduction and external rotation


Adduction and internal rotation
Abduction, extension and internal rotation
Abduction, flexion and external rotation
Adduction, flexion and internal rotation

21
Intertrochanteric fractures of the
femur in elderly patients are best
managed by
1. skeletal traction with balanced
suspension
2. transcutaneous pin fixation
3. open reduction and internal fixation
4. prosthetic femoral head replacement
5. total hip replacement

22
A supracondylar fracture in a child should be
treated by
1. manipulation, reduction and immobilisation of the
arm at 90 with slight pronation
2. manipulation, reduction and immobilisation of the
arm in a forced flexion position with plaster splints
3. immediate open reduction in fixation with screws
4. application of Bucks traction to the wrist
5. use of overhead pulley traction to reduce the
fracture

23
The symptoms of thyrotoxicosis are
controlled most rapidly by the
administration of which one of the
following
1.
2.
3.
4.
5.

levothyroxine sodium
potassium iodide
propranolol
propyl thiouracil
radioactive iodine

24
A double bubble on an air contrast
upper gastrointestinal series in an
infant is characteristic of
1.
2.
3.
4.
5.

duodenal atresia
jejunal atresia
meconium ileus
midgut volvulus
pyloric stenosis

25
Concerning Hirschsprungs disease in children: which
one of the following statements is not correct?
1. an absence of ganglion cells in a dilated segment of the
colon is the underlying problem
2. constipation is a classic symptom and almost always
begins in the early days of life
3. faecal incontinence is unusual in older affected children
4. rectal examination of affected patients usually reveals an
empty rectal ampulla
5. temporary colostomy prior to definitive surgical correction
is frequently the treatment of choice