1. Topic: Traumatic Posterior Shoulder Dislocation

Correct Answer: B. Attitude of arm in internal rotation

Explanation: In a traumatic posterior shoulder dislocation, the affected arm typically assumes an internal rotation position. This is because the posterior dislocation causes the humeral head to move backward, leading to the arm being held close to the body with internal rotation.

2. Topic: Dislocation Erecta of the Shoulder

Correct Answer: B. Lower

Explanation: Dislocation erecta of the shoulder refers to a rare type of dislocation where the humeral head is displaced inferiorly or downward, causing the arm to be held in an extended position. This results in an unusual presentation where the arm is held in a position that appears as if it is standing upright, hence the term “erecta.”

3. Topic: Carpal Tunnel Syndrome

Correct Answer: C. A paralysis of the opposition of the thumb

Explanation: Carpal tunnel syndrome affects the median nerve, which controls the muscles responsible for the opposition of the thumb. This results in difficulty performing tasks that require thumb opposition, such as pinching or grasping.

4. Topic: Acute Osteomyelitis in Children

Correct Answer: D. Acute osteomyelitis in children is generally localized to the diaphyseal region of the bone

Explanation: Acute osteomyelitis in children typically affects the metaphyseal region of long bones, especially near the knee, rather than the diaphyseal region. This is because the metaphysis has a rich blood supply, making it more susceptible to hematogenous infection.

5. Topic: Open Fracture Classification

Correct Answer: C. The loss of substance of the soft parts prevents any closure

Explanation: In the context of open fractures, Stage III is characterized by severe soft tissue injury where the loss of substance prevents any potential for closure of the wound. This indicates a more severe injury with extensive tissue damage.

6. Topic: Synovial Fluid in Acute Gout

Correct Answer: D. Cloudy liquid with 10,000 cells per mm³ and very birefringent microcrystals

Explanation: During an acute gout attack, synovial fluid is typically cloudy and has a high cell count, often around 10,000 cells/mm³. The presence of very birefringent (needle-shaped) microcrystals, which are characteristic of monosodium urate crystals, confirms gout.

7. Topic: Total Nerve Section

Correct Answer: B. Neurotmesis

Explanation: Neurotmesis refers to a complete transection or total section of a nerve, where both the nerve fibers and the surrounding connective tissue are disrupted. This results in a total loss of function and requires surgical intervention for possible repair.

8. Topic: Posterior Shoulder Dislocation

Correct Answer: B. Impossibility of external rotation of the arm

Explanation: In posterior shoulder dislocation, the most suggestive clinical sign is the inability to externally rotate the arm. This occurs because the shoulder joint’s normal range of motion is restricted by the dislocated position.

9. Topic: Femoral Diaphysis Fracture

Correct Answer: B. BA ECB

Explanation: A fracture of the femoral diaphysis commonly causes external rotation of the lower limb (B) due to muscle contractions. It may also lead to hemorrhagic shock (C) due to substantial bleeding and can be complicated by fat embolism (E). However, it does not typically present with an arch deformity of the thigh (A) or sciatic paralysis (D) before treatment. Sciatic paralysis is less common and usually occurs with more severe injury or complications.

10. Topic: Isolated Functional Colopathy

Correct Answer: B. Weight loss

Explanation: Isolated functional colopathy, or functional gastrointestinal disorders, commonly present with symptoms like abdominal pain (A), constipation (C), diarrhea (D), and postprandial bloating (E). Weight loss (B) is not typically associated with functional colopathy and suggests a more serious underlying condition that requires further investigation.

11. Topic: Evolution of a Subphrenic Abscess from Duodenal Ulcer Perforation

Correct Answer: B. BA BCD

Explanation: During the evolution of a subphrenic abscess resulting from duodenal ulcer perforation, you may observe: Fever (A) Subocclusive state (B) Vomiting (C) Localized defense (D) Pain on digital rectal examination (E) is not typically associated with subphrenic abscesses, as the abscess is generally not palpable or associated with rectal symptoms.

12. Topic: Major Ischemic Risk Associated with Fracture

Correct Answer: C. AC BDE

Explanation: Rupture of the following arteries associated with a fracture focus creates a significant ischemic risk: The external iliac artery (A) The common femoral artery (C) The superficial femoral artery (D) The popliteal artery (E). The lower axillary artery (B) is not typically associated with major ischemic risk in the context of fractures. Thus, the correct combination is AC BDE.

13. Topic: Septic Arthritis

Correct Answer: A. Osteophytes

Explanation: Septic arthritis typically presents with signs like articular pinching (B), mirror geodes (C), subchondral demineralization (D), and thickening of the soft tissues (E). These findings are associated with joint infection and inflammation. Osteophytes (A), however, are associated with osteoarthritis rather than septic arthritis. Hence, osteophytes are not a feature of septic arthritis, making this the correct answer.

14. Topic: Prioritization of Surgical Interventions in Trauma

Correct Answer: C. Extra dural hematoma

Explanation: An extra dural hematoma (C) is a life-threatening condition that can cause rapid deterioration due to increased intracranial pressure. Immediate surgical intervention is crucial to prevent brain damage or death. While other injuries such as stomach wounds (A), open leg fractures (B), rupture of the urethra (D), and fractures of the acetabulum (E) are serious, they do not typically pose an immediate threat to life like an extra dural hematoma does. Therefore, the extra dural hematoma should be prioritized for surgical intervention.

15. Topic: Fractures of the Upper Extremity of the Radius in Children

Correct Answer: D. They can accompany a dislocation of the elbow

Explanation: Fractures of the upper extremity of the radius in children, such as those involving the radial head, can indeed be associated with dislocations of the elbow (D). This combination often results from significant trauma to the elbow. While these fractures are common (A) and may involve the radial head or neck (B), and could potentially be associated with radial nerve injuries (C), they do not necessarily require surgical treatment (E) unless there are complications or significant displacement. Therefore, the ability to accompany an elbow dislocation is a key characteristic.

16. Topic: Ankylosis

Correct Answer: B. Bone fusion between two articular surfaces

Explanation: Ankylosis specifically refers to the fusion of bone between two articular surfaces, resulting in immobility at the joint (B). This is different from morning stiffness (A) or decreased range of motion (C), which are symptoms rather than definitions. While ankylosis leads to a complete loss of movement at the joint (D), its defining feature is the actual fusion of the bones. Stiffness at the end of the day (E) is not related to the definition of ankylosis.

17. Topic: Crural Nerve Paralysis

Correct Answer: B. The crural nerve passes under the crural arch medial to the femoral vein

Explanation: The crural nerve (femoral nerve) does not pass under the crural arch medial to the femoral vein; it actually passes lateral to the femoral vein (B). The nerve originates from the lumbar roots L2, L3, and L4 (A), divides into branches within the femoral triangle (C), and is involved in the patellar reflex arc (D). Hematoma of the psoas muscle can indeed affect the crural nerve (E).

18. Topic: Lumbosciatica with S1 Topography

Correct Answer: B. The ankle reflex is diminished or abolished

Explanation: In a lumbosciatica disc with S1 involvement, the most characteristic finding is a diminished or abolished ankle reflex (B). This is due to the involvement of the S1 nerve root which is responsible for the ankle reflex. Hypoesthesia in S1 typically affects the lateral aspect of the foot, not the dorsal surface of the big toe (A). Walking on heels is more challenging with L5 nerve root involvement (C). Radiological narrowing of the L5-S1 disc is not always present (D), and an electromyogram may show abnormalities but is not constantly disturbed (E).

19. Topic: Elective Hernia Repair in the Context of Cardiovascular History

Correct Answer: C. Jugular venous distension

Explanation: Jugular venous distension (C) is a sign of right-sided heart failure or fluid overload and indicates potential cardiovascular instability, which could complicate surgery. This would be a valid reason to delay elective hernia repair. Recent coronary artery bypass surgery (A) is a concern but may not be an immediate reason to delay unless there are specific complications. A history of smoking (B), hypertension (D), and hyperlipidemia (E) are risk factors but are not immediate contraindications for delaying surgery in this context.

20. Topic: Post-Celiotomy Intestinal Motility

Correct Answer: B. To the stomach in 24 hours, the small intestine in 4 hours, and the colon in 3 days

Explanation: Normal intestinal motility typically resumes in the following order after celiotomy: the small intestine usually recovers within 4 hours, the stomach within 24 hours, and the colon generally returns to normal function within 3 days. This timeline reflects the typical postoperative recovery pattern. Immediate resumption (E) and longer durations (C) are less common and do not align with typical postoperative recovery.

21. Topic: Preoperative Characteristics and Postoperative Ischemia

Correct Answer: C. Dyspnea on exertion

Explanation: Dyspnea on exertion indicates underlying cardiac or pulmonary issues that may increase the risk of postoperative ischemia. Other preoperative characteristics such as angina pectoris (A) or frequent premature ventricular contractions (B) are significant but less directly indicative of immediate postoperative ischemia risk. Tricuspid insufficiency (D) and age over 60 (E) may be relevant but are not as direct indicators of the risk as dyspnea on exertion.

22. Topic: Blood Transfusion and Clotting

Correct Answer: D. Transfusion through Ringer’s lactate solution

Explanation:
Clotting of transfused blood is typically associated with the use of incompatible blood types, such as ABO or Rh incompatibility (A and C), but Ringer’s lactate solution (D) can cause clotting due to its calcium content, which can activate coagulation. Minor blood group incompatibility (B) is less likely to cause immediate clotting issues. Transfusion through 5% glucose and water (E) does not generally lead to clotting.

23. Topic: Wound Healing

Correct Answer: E. Rather in wound healing, type 1 collagen is predominant

Explanation: In wound healing, type 1 collagen is the predominant type, especially in the later stages of healing, as it provides strength and structural support. Collagen content generally increases over several weeks, not just one week (A). Monocytes play a broader role in wound healing beyond just phagocytosis, including modulating inflammation and tissue repair (B and D). Fibroblasts appear somewhat later, typically after 48-72 hours (C).

24. Topic: Wound Contraction

Correct Answer: D. It is based on specialized fibroblasts which contain actin myofilaments

Explanation: Wound contraction is a key process in wound healing, primarily driven by specialized fibroblasts called myofibroblasts, which contain actin myofilaments that help pull the edges of the wound together (D). This process is not the primary mechanism in sutured or stapled wounds, as they primarily heal through primary intention (A). Bacterial colonization can indeed hinder the healing process, but it is not a defining factor for contraction (B). Contraction typically contributes less than 50% to the total wound size reduction (C). The reduction percentage or skin adhesion details mentioned are not standard or relevant measures for contraction (E).

25. Topic: Management of Thigh Injury with Compartment Syndrome

Correct Answer: B. Immediate exploration and repair

Explanation: In a case of thigh injury with paresthesias, weak pulses, and inability to move the foot, there is a high suspicion of vascular injury and possible compartment syndrome (B). Immediate exploration and repair are crucial to address potential vascular damage and prevent complications such as limb ischemia. Angiography (A) can be useful for diagnostic purposes but is not the immediate intervention required. Anterior compartment fasciotomy (C) is indicated if compartment syndrome is confirmed, but the priority is to explore and repair the injury first. Observation (D) and local exploration (E) are inadequate for addressing the potential severity of the injury and its complications.

26. Topic: Postoperative Mortality After Heart Transplantation

Correct Answer: C. Accelerated graft arteriosclerosis

Explanation: After the first year post-heart transplantation, accelerated graft arteriosclerosis becomes the most common cause of death (C). This condition involves progressive narrowing and hardening of the transplanted heart’s arteries, leading to graft failure. While infections (A), arrhythmias (B), acute rejection episodes (D), and cancer (E) are significant concerns, their prevalence in causing death decreases after the initial postoperative period. Accelerated graft arteriosclerosis emerges as the leading cause due to its chronic and progressive nature, impacting long-term survival.

27. Topic: Major Histocompatibility Complex (MHC) Proteins

Correct Answer: D. MHC class 1 proteins act as major targets for antibody-mediated allograft rejection and are detected by cross-match techniques

Explanation: MHC class 1 proteins are indeed major targets for antibody-mediated allograft rejection and are detected by cross-match techniques (D). These proteins are present on almost all nucleated cells and are crucial for presenting endogenous antigens to cytotoxic T cells. MHC class 2 proteins, in contrast, are primarily expressed by antigen-presenting cells (B). They are encoded by different loci (e.g., HLA-DP, HLA-DQ, HLA-DR) and are involved in presenting exogenous antigens to helper T cells (E). The other statements are incorrect as MHC class 1 proteins are not restricted to mononuclear cells (A), MHC class 2 proteins are not encoded by the HLA locus mentioned (C), and MHC class 2 proteins are not the main targets of cross-match techniques (D).

28. Topic: Treatment of Chronic Ulcer

Correct Answer: C. Billroth 1 type partial gastrectomy

Explanation:
When a gastric ulcer does not improve with standard medical treatment such as H2 blockers and antacids, and especially if there is no improvement after 6 weeks, surgical intervention may be necessary. Billroth 1 type partial gastrectomy is a procedure that involves removing part of the stomach and is suitable for ulcers that are resistant to medical therapy (C). Local excision of the ulcer (B) is generally not sufficient as it doesn’t address potential underlying issues. Resuming the trial medical treatment (A) is not appropriate if the ulcer remains unchanged after adequate treatment. Vagotomy with pyloroplasty (E) or without (D) might be considered, but these are generally part of a more complex surgical approach, often used when ulcer is complicated or recurrent despite other interventions.

29. Topic: Effects of Colon Resection

Correct Answer: B. Patients who undergo major colon resections experience little change in their bowel habits following the operation

Explanation: After major colon resections, patients generally adapt well, experiencing minimal long-term changes in bowel habits due to compensatory mechanisms of the remaining bowel (B). The net absorption of water by the rectum (A) is not well established, and the right colon actually plays a more significant role in water and electrolyte absorption compared to the left colon (C, D). The role of the ileocecal valve in fluid homeostasis is not as prominent as once thought (E).

30. Topic: Diagnosis of Severe Upper Left Side Pain

Correct Answer: E. Rupture of the spleen

Explanation: The patient’s presentation, including severe upper left side pain, pallor, elevated pulse, tense and rigid abdomen without peristalsis, suggests rupture of the spleen (E). This condition can follow trauma or infection, leading to internal bleeding and abdominal rigidity. Acute pyelonephritis (A) and Fitz Hugh Curtis Syndrome (B) usually have different pain locations and symptoms. Perforated peptic ulcer (C) and peritonitis (D) are possible but less likely given the history and clinical findings.

31. Topic: Midline Neck Swelling in Newborn

Correct Answer: C. Cystic hygroma

Explanation: A large midline neck swelling in a newborn that transilluminates is most likely a cystic hygroma (C). Cystic hygromas are congenital lymphatic malformations that are typically filled with lymphatic fluid and show transillumination. A branchial cyst (A) is usually lateral and not typically transilluminated. Cervical adenopathy (B) and goiter (D) do not commonly present with transillumination. A thyroglossal cyst (E) is midline but usually does not transilluminate and is less common with a significant swelling involving the tongue.

32. Topic: Characteristics of Venous Ulcers

Correct Answer: B. They are usually found on the inner side of the leg

Explanation:
Venous ulcers typically occur on the inner side of the leg, particularly around the medial malleolus (B). They are often painful (A), and compression therapy, such as with compression stockings, is a key part of treatment (C). Venous ulcers do not usually require hospitalization (D) and are more common than arterial ulcers (E).

33. Topic: Management of Acute Dyspnea Post-Trauma

Correct Answer: C. Decompress the right pleural space

Explanation: In the context of acute dyspnea after a car accident with markedly reduced breath sounds on one side, the most immediate concern is a possible tension pneumothorax or pleural effusion, which requires urgent decompression (C). While a chest X-ray (A) can help diagnose the issue, it should not delay treatment. Arterial blood gas analysis (B), pericardiocentesis (D), and intravenous fluids (E) may be important later but are not the immediate priorities if the clinical picture suggests a pleural space issue.

34. Topic: Acute Increase in Intracranial Pressure

Correct Answer: A. Respiratory irregularities

Explanation: An acute increase in intracranial pressure often leads to respiratory irregularities (A) due to pressure on the brainstem, which controls breathing. Lower blood pressure (B) can occur but is less directly indicative than respiratory changes. Tachycardia (C) is not a primary sign of increased intracranial pressure; instead, it may occur in other conditions. Retinal hemorrhage (D) and compression of the fifth cranial nerve (E) are not as directly associated with acute intracranial pressure increases.

35. Topic: Obstructive Jaundice in Chronic Pancreatitis

Correct Answer: D. Narrowing of the bile duct

Explanation: In patients with chronic pancreatitis, narrowing of the bile duct (D) is a common cause of obstructive jaundice due to inflammation and fibrosis affecting the bile duct. Pseudocyst formation (A), gallstones (B), and pancreatic head tumors (C) can also cause obstructive jaundice but are less common in this context. Cholangiocarcinoma (E) is a potential cause but is less directly related to chronic pancreatitis compared to bile duct narrowing.

36. Topic: Malignancy with Specific Symptoms

Correct Answer: A. Gastric carcinoma

Explanation: The symptoms described—difficulty swallowing, vomiting, weight loss, melaena, supraclavicular lymphadenopathy, and a hyperpigmented velvety patch (aurora)—are indicative of gastric carcinoma (A). This condition often presents with systemic symptoms and associated signs like the Virchow’s node (supraclavicular lymphadenopathy) and Leser-Trélat sign (hyperpigmented patch). While esophageal (C) and pancreatic (D) carcinomas can also present with dysphagia and weight loss, the specific combination of symptoms, including melaena and cutaneous findings, strongly points to gastric carcinoma.

37. Topic: Sliding Inguinal Hernia

Correct Answer: D. Can lead to intestinal damage if not diagnosed

Explanation: A sliding inguinal hernia, where the hernia sac includes a portion of the abdominal wall structures, such as the bladder or colon, can indeed lead to intestinal damage if not identified and managed properly (D). The risk of intestinal damage arises because of the potential for incarceration or strangulation of the involved organs. While sliding inguinal hernias can sometimes be challenging to diagnose pre-operatively (A), they can have serious consequences, making early detection and appropriate surgical intervention crucial.

38. Topic: Bacterial Septicemia in Splenectomized Patients

Correct Answer: D. Pneumococcus

Explanation: Splenectomized patients are particularly vulnerable to severe infections due to the loss of their spleen’s role in filtering pathogens and producing antibodies. Pneumococcus (D) is especially threatening in these individuals as it can cause severe pneumococcal infections, which are more common and more serious in the absence of a functioning spleen. While Staphylococcus aureus (A), Colibacillus (B), Salmonella (C), and Listeria (E) can also cause infections, pneumococcus is the most notably dangerous due to its propensity to cause rapid and severe illness in this high-risk population.

39. Topic: Upper Gastrointestinal Bleeding

Correct Answer: D. Diagnostic endoscopy is best done within the first 24 hours

Explanation: In cases of upper gastrointestinal bleeding, performing diagnostic endoscopy within the first 24 hours (D) is crucial for identifying the source of bleeding and providing timely intervention. This early endoscopy improves the chances of visualizing and managing the bleeding point effectively. The bleeding point is typically located above the ligament of Treitz (A), and while angiodysplastic lesions (B) are a cause, they are not the most common. Hematemesis (C) is not always present; patients may have melena or occult bleeding. Selective mesenteric angiography (E) is more often used for cases where endoscopy is not successful or in hemodynamically unstable patients.

40. Topic: Long-term Complications of Gastrectomy

Correct Answer: E. Vitamin B12 deficiency

Explanation: Vitamin B12 deficiency (E) is actually a recognized long-term complication of total or partial gastrectomy, as the absorption of this vitamin is impaired following surgery. This is due to the removal of parts of the stomach, which reduces intrinsic factor production essential for Vitamin B12 absorption. Gastric cancer (A) is a potential long-term risk, particularly if residual gastric tissue is present. Obstruction (B) can occur due to adhesions or other changes in anatomy post-surgery. Folate deficiency (C) and iron deficiency (D) are also common due to changes in digestive and absorptive processes.

41. Topic: Urinary Incontinence

Correct Answer: C. It can be helped with drug treatment

Explanation: Drug treatment can be effective in managing urinary incontinence, particularly in cases of urge incontinence or overactive bladder. For the patient described, who experiences difficulty affording diapers and has a history of urinary leakage and smoker’s cough, pharmacological interventions could provide relief. Pelvic floor weakness (B) is a common cause of urinary incontinence, but it is not the only factor, and treatment often starts with conservative measures such as pelvic floor exercises before considering surgery. Most women with urinary incontinence do not seek medical care (A), and bladder instability (D) can be present even with small, frequent, and urgent urination. Surgical intervention (E) is usually considered after other treatments fail, not as an immediate solution.

42. Topic: Esophageal Symptoms and Diagnosis

Correct Answer: B. Investigation by barium swallow is indicated

Explanation: Given the patient’s difficulty swallowing both solids and liquids, weight loss, and the presence of back tarry stools (indicating possible gastrointestinal bleeding), a barium swallow study is an appropriate initial diagnostic tool to evaluate esophageal pathology. This test helps visualize structural abnormalities and motility issues. The prognosis (A) would be uncertain without further diagnostic clarification. The patient’s symptoms are more indicative of structural or obstructive issues rather than ulcerative peptic disease (C) or achalasia (D). Barium swallow is crucial for determining the underlying cause, such as esophageal cancer or strictures, rather than assuming other diagnoses or outcomes (E).

43. Topic: Leriche Syndrome (Atherosclerotic Occlusive Disease of the Abdominal Aortic Bifurcation)

Correct Answer: A. Claudication of the buttock and thigh

Explanation: Leriche syndrome, which involves occlusion at the level of the abdominal aortic bifurcation, typically presents with claudication of the buttocks and thighs due to impaired blood flow to these regions during physical activity. Symptoms like causalgia (B) are less characteristic for this condition. Retrograde ejaculation (C) and gangrene of the toes (D) are not directly associated with Leriche syndrome but may relate to more distal vascular issues. Redness dependent on the feet (E) is also not a typical feature of this syndrome. The primary symptom is claudication in the buttocks and thighs due to reduced arterial flow.

44. Topic: Management of Renal Stones

Correct Answer: A. Conservative treatment including hydration and analgesics will not give a satisfactory result

Explanation: For a stone of 1.5 cm in diameter, conservative treatment alone (hydration and analgesics) is often insufficient due to the size of the stone, which may not pass spontaneously. Serial radiography (B) is used to monitor stone progress but is not always necessary unless complications arise. Urinalysis (C) frequently shows microhematuria but is not diagnostic on its own. While acute episodes are managed, recurrence is common without addressing underlying causes (D). High blood urea and serum creatinine (E) might be present due to obstructive uropathy but are not directly related to the effectiveness of initial conservative treatment.

45. Topic: Management of Urethral Rupture in Pelvic Fractures

Correct Answer: E. Immediate placement of a suprapubic cystostomy probe

Explanation: In cases of pelvic fracture with urethral rupture, especially when the rupture is located above the urogenital diaphragm, immediate placement of a suprapubic cystostomy (E) is necessary to divert urine and prevent further injury to the urethra. This approach avoids complications that may arise from attempting to place a Foley catheter through the urethra (B) in the presence of a rupture. Immediate surgical reconstruction (C) is usually not done at the initial stage due to the need for patient stabilization. Percutaneous nephrostomy (A) is not the first choice for managing urethral injuries. Exploration of the pelvis (D) may be necessary but is secondary to managing the urethral injury.

46. Topic: Brain Contusions

Correct Answer: B. They can occur on the opposite side of the point of cranial impact

Explanation: Brain contusions often occur on the opposite side of the impact, known as a “coup-contrecoup” injury (B). This phenomenon happens due to the brain’s motion within the skull. Contusions are more commonly seen in the frontal and temporal lobes rather than the occipital lobes (A). They are typically accompanied by parenchymal bleeding (C) and can be exacerbated by anticoagulants (D). Anticonvulsant drugs (E) are used to manage seizures that might occur post-contusion, making them relevant in early management.

47. Topic: Acute Abdominal Pain

Correct Answer: B. Acute mesenteric ischemia

Explanation: Acute mesenteric ischemia (B) is a condition where blood flow to the intestines is critically reduced, leading to potential bowel necrosis. This situation requires immediate surgical intervention to restore blood flow and prevent extensive damage. In contrast, acute pancreatitis (A), acute diverticulitis (C), acute cholecystitis (D), and acute Crohn’s disease (E) can often be managed initially with conservative treatments or less urgent surgical approaches depending on the severity and response to medical management.

48. Topic: Neck Mass Diagnosis

Correct Answer: A. Branchial cyst

Explanation: A branchial cyst (A) typically presents as a mass located along the anterior border of the sternocleidomastoid muscle, which is consistent with the description. These cysts are remnants of the branchial apparatus and are often found in this area. Cervical adenopathy (B), goiter (C), submandibular adenopathy (D), and thyroglossal cyst (E) have different common locations and characteristics that do not match the typical presentation of a branchial cyst.

49. Topic: Ascitic Fluid Infection

Correct Answer: C. Presence of a germ in culture

Explanation: The presence of a germ in culture (C) is definitive for confirming an infection in ascitic fluid. This is the most specific indicator as it directly identifies the causative pathogen. Elevated protein levels (A), neutrophil count (B), high amylase levels (D), and low pH (E) can indicate infection or other abnormalities but are not as definitive as a positive culture.

50. Topic: Zenker’s Diverticulum

Correct Answer: B. Located at the level of the crico-pharyngeal space

Explanation: Zenker’s diverticulum (B) is typically located at the level of the crico-pharyngeal space, specifically in the area where the pharynx meets the esophagus, just above the cricopharyngeal muscle. It is not generally associated with gastroesophageal reflux (A) nor commonly seen in young adults (E). It does not have a high risk of cancerous degeneration (C) and is not related to adenopathies (D).