101. Topic: Traumatic Posterior Shoulder Dislocation

Correct Answer: B. Attitude of arm in internal rotation

Explanation: In traumatic posterior shoulder dislocation, the fundamental clinical sign is the attitude of the arm in internal rotation (B). This occurs because the humeral head displaces posteriorly and internally rotates. The arm may also appear adducted and internally rotated but internal rotation is the more specific clinical sign. Option A (attitude of arms in adduction) is not specific enough as it does not address the characteristic internal rotation seen in posterior dislocations. Option C (attitude of arm in external rotation) is incorrect as the arm typically shows internal rotation. Option D (shoulder stump deformity) is not a recognized clinical sign for posterior dislocation. Therefore, the correct and fundamental clinical sign for traumatic posterior shoulder dislocation is the attitude of the arm in internal rotation.

102. Topic: Complications of Poteau-Colles Fracture (Colles’ Fracture)

Correct Answer: C. A pseudarthrosis

Explanation: A pseudarthrosis, which refers to a non-union or failure of bone healing resulting in a false joint formation, is almost never encountered after a Poteau-Colles (Colles’) fracture (C). Colles’ fractures typically heal well with appropriate treatment, and the risk of non-union is low. Option A (late rupture of the extensor pollicis longus tendon) can occur due to the proximity of the fracture site to the tendons of the wrist extensors. Option B (severe algodystrophy), also known as complex regional pain syndrome, can sometimes develop after Colles’ fracture. Option D (carpal tunnel syndrome) can occur due to swelling or scarring around the median nerve at the wrist. Option E (limited and painful pronosupination) can result from stiffness or malunion of the fracture. Therefore, the complication that is almost never encountered after a Poteau-Colles fracture is a pseudarthrosis (C).

103. Topic: Urinary Complications in Pelvic Fractures

Correct Answer: D. Fractures of the obturator frame

Explanation: Among pelvic fractures, fractures of the obturator foramen (D) are associated with the most frequent urinary complications. Fractures involving the obturator foramen can potentially injure the nearby structures such as the bladder or urethra, leading to urinary complications. Option A (fractures of the iliac spines) and option C (fractures of the iliac wing) typically do not involve structures directly associated with urinary complications. Option B (fractures of the acetabulum) may involve the hip joint but are less likely to cause urinary complications compared to obturator fractures. Therefore, the correct answer regarding the pelvic fractures causing the most frequent urinary complications is D, fractures of the obturator frame.

104. Topic: Traumatic Injuries of the Anterior Cruciate Ligament (ACL)

Correct Answer: C. They always cause instability of the knee

Explanation: Traumatic injuries of the anterior cruciate ligament (ACL) can present with various characteristics: They can be isolated, meaning they may occur without involvement of other knee structures. They can be partial, affecting only a portion (bundle) of the ligament. They can be associated with a lesion of the internal meniscus due to the anatomical proximity and mechanism of injury. They can relate to the condylar insertion of the ligament, where it attaches to the femur. Option C (They always cause instability of the knee) is incorrect because not all ACL injuries lead to knee instability. While instability is a common symptom, the severity and presence of instability vary among individuals and types of injuries. Some partial tears or low-grade injuries may not cause significant instability. Therefore, the correct answer, as it relates to the exception among the statements about traumatic injuries of the ACL, is C. associated with a bi-malleolar fracture is necrosis of the astragalus (Option D).

105. Topic: Complications of Bi-malleolar Fracture

Correct Answer: D. Necrosis of the astragalus

Explanation: A bi-malleolar fracture involves fractures of both the lateral and medial malleoli of the ankle. Complications that can occur include bad callus of the instep (A), tibio-tarsal osteoarthritis (B), pseudarthrosis of the medial malleolus (C), and algodystrophic syndrome (E). However, necrosis of the astragalus (D) is not a typical complication associated with bi-malleolar fractures. This condition usually involves vascular compromise or avascular necrosis of the talus bone, which is not directly related to a bi-malleolar fracture pattern. Therefore, option D is the correct answer as it does not align with typical complications following this type of ankle fracture

106. Topic: Circumflex Nerve Palsy

Correct Answer: C. Bacterial colonization

Explanation: Circumflex nerve palsy, specifically affecting the axillary nerve (a branch of the circumflex nerve), is most commonly associated with an antero-internal dislocation of the shoulder (Option C). This type of shoulder dislocation can stretch or compress the axillary nerve, leading to weakness or paralysis of the deltoid and teres minor muscles supplied by this nerve. Option A (a fracture of the clavicle) and Option B (an acromioclavicular dislocation) typically do not involve the axillary nerve directly. Option D (a fracture of the greater tuberosity) can affect the shoulder joint but is less likely to cause axillary nerve injury compared to an antero-internal shoulder dislocation. Therefore, the traumatic injury most often responsible for circumflex nerve palsy is an antero-internal dislocation of the shoulder (Option C).

107. Topic: Factors Promoting Esophageal Cancer

Correct Answer: C. An antero-internal dislocation of the shoulder

Explanation: Several factors are known to promote the development of esophageal cancer: Peptic esophagitis: Chronic inflammation of the esophagus due to acid reflux. Caustic esophageal sclerosis: Scarring of the esophagus due to ingestion of corrosive substances. Sideropenic dysphagia: Difficulty swallowing due to iron deficiency anemia. Alcohol and tobacco poisoning: Consumption of alcohol and tobacco products, known carcinogens for the esophagus. Option C (aerophageal esophageal mycosis) refers to fungal infections of the esophagus, which are not typically associated with an increased risk of esophageal cancer. While chronic irritation and inflammation from fungal infections can potentially contribute to esophageal pathology, they are not recognized as direct promoters of esophageal cancer compared to the other listed factors. Therefore, the correct answer regarding factors promoting esophageal cancer is C, as aerophageal esophageal mycosis is not typically linked to an increased risk of esophageal cancer.

108. Topic: Diagnosis of Gastric Ulcer Perforation

Correct Answer: C. Aerophageal esophageal mycosis

Explanation: In a patient suspected of gastric ulcer perforation, several complementary examinations can be considered to aid in diagnosis: A. An x-ray of the abdomen without standing frontal preparation can reveal signs of free air under the diaphragm, indicative of perforation. B. An x-ray of the abdomen without preparation lying in profile can also show signs of pneumoperitoneum. D. An opaque transit to water-soluble contrast can demonstrate leakage of contrast material into the peritoneal cavity. E. A puncture and washing of the abdomen (peritoneal lavage) can provide diagnostic fluid for analysis and cultures. Option C (an esophagogastroduodenal fibroscopy, also known as an upper gastrointestinal endoscopy) is contraindicated in the acute setting of gastric ulcer perforation. Performing endoscopy can worsen the perforation, leading to further leakage of gastric contents into the peritoneal cavity and exacerbating peritonitis. Therefore, the correct answer, as it relates to contraindicated examinations in the context of gastric ulcer perforation, is C.

109. Topic: Gastric Ulcer Perforation

Correct Answer: C. An esophagogastroduodenal fibroscopy

Explanation: In the evaluation of gastric ulcer perforation, various complementary examinations can be employed. An x-ray of the abdomen without standing frontal preparation (A) or without preparation lying in profile (B) can provide valuable diagnostic information, such as signs of free air under the diaphragm indicating perforation. An opaque transit study with water-soluble contrast (D) can help visualize the site and extent of the perforation. Puncture and washing of the abdomen (E) may be necessary for diagnostic purposes in certain cases. However, esophagogastroduodenal fibroscopy (C) is contraindicated in the acute setting of suspected gastric ulcer perforation due to the risk of exacerbating the perforation or spreading contamination in the peritoneal cavity.

110. Topic: Lesions Predisposing to Stomach Cancer

Correct Answer: D. A poly gastric adenoma

Explanation: Poly gastric adenomas are known precursors to stomach cancer. These adenomas can undergo dysplastic changes over time, potentially progressing to gastric carcinoma. Option A, duodenal ulcers, and option B, drug gastritis, do not typically predispose to stomach cancer. Duodenal ulcers are more associated with duodenal or gastric lymphoma, while drug gastritis usually resolves upon cessation of the offending drug. Option C, gastric angiomas, are benign vascular lesions that do not predispose to malignancy. Option E, “All the answers below,” is incorrect because not all listed lesions are known to predispose to stomach cancer; only poly gastric adenomas have a significant association. Therefore, option D is correct as it correctly identifies a lesion that predisposes to stomach cancer, distinguishing it from the other options provided.

111. Topic: Complications of Appendicitis

Correct Answer: E. All of the above

Explanation: Appendicitis, if not treated promptly, can lead to various complications. A wall abscess (A) may form due to localized infection. Evisceration (B), where abdominal contents protrude through the incision site, can occur in severe cases. A cecal fistula (C) may develop, leading to abnormal connections between the cecum and adjacent structures. Disembowelment (D), though a severe term, can metaphorically describe the protrusion of bowel loops or severe complications in extreme cases of untreated appendicitis. Therefore, all options (A, B, C, D) can potentially complicate appendicitis, making answer E correct.

112. Topic: Colonic Diverticulosis

Correct Answer: A. It sits more often on the right colon than on the left colon

Explanation: Colonic diverticulosis typically occurs more frequently in the left colon, particularly the sigmoid colon, rather than the right colon. The condition is often asymptomatic (B), though it can lead to complications such as stercoral peritonitis (C) from perforation, colonic stenosis (D) from chronic inflammation, and pneumaturia (E) due to fistula formation between the colon and bladder. Therefore, the statement that diverticulosis is more common in the right colon is incorrect, making A the correct answer.

113. Topic: Gallstone Ileus

Correct Answer: B. Cholecysto-duodenal fistula

Explanation: Gallstone ileus is a rare complication of cholelithiasis where a large gallstone passes through a fistula between the gallbladder and the duodenum, causing mechanical obstruction in the intestine. The most common fistula involved in gallstone ileus is the cholecysto-duodenal fistula (B), where the gallstone can pass into the duodenum. Other types of fistulas mentioned (A, C, D, E) are less commonly associated with gallstone ileus. Therefore, option B is correct because it represents the typical anatomical pathway for gallstones to cause ileus.

114. Topic: Sigmoid Volvulus

Correct Answer: B. An oblique meteorism

Explanation: Sigmoid volvulus is a condition where the sigmoid colon twists upon itself, causing obstruction. The term “oblique meteorism” refers to the characteristic appearance of distension in the abdomen, which is typically oblique or asymmetrical. This is due to the torsion of the sigmoid colon, which leads to accumulation of gas and fluid in the affected segment. The other options: An early fever: Fever is not typically associated with sigmoid volvulus unless there is ischemia or perforation. Blood on digital rectal examination: This can occur in many conditions affecting the rectum and colon, not specific to sigmoid volvulus. A distension of the entire colonic framework in the abdomen: This is a general description of colonic distension, not specific to sigmoid volvulus. Air levels in the colon: Air-fluid levels can be seen in many types of intestinal obstruction, not specific to sigmoid volvulus. Therefore, option B is correct as it describes the specific appearance of abdominal distension seen in sigmoid volvulus

115. Topic: Sigmoid Volvulus

Correct Answer: C. Minor abdominal pain

Explanation: Sigmoid volvulus is characterized by the twisting of the sigmoid colon around itself, leading to bowel obstruction. The signs associated with sigmoid volvulus include an abrupt onset of symptoms (A), an immobile abdominal distension or meteorism (B), silent or decreased bowel sounds on abdominal auscultation (D), and early vomiting (E) due to the obstruction. However, minor abdominal pain (C) is not typically associated with sigmoid volvulus. Instead, patients usually experience severe abdominal pain due to the bowel obstruction and ischemia caused by the volvulus. Therefore, the correct answer is C.

116. Topic: Crural Hernia

Correct Answer: C. It is most often associated with an ipsilateral inguinal hernia

Explanation: Crural hernias, also known as femoral hernias, are a type of hernia that protrudes through the femoral canal below the inguinal ligament. Here’s why statement C is incorrect: Crural hernias are typically acquired hernias that occur due to weakness or enlargement of the femoral ring, allowing abdominal contents to protrude into the femoral canal (correct). B. Crural hernias are more common in women, especially elderly women, but they can occur in both sexes (correct). C. Unlike inguinal hernias, crural hernias are not commonly associated with ipsilateral inguinal hernias. Inguinal hernias occur through a different anatomical pathway (incorrect). D. Crural hernias can indeed occur after previous hernia repairs on the same side, similar to other types of hernias (correct). E. In women, crural hernias are more common than in men, making them one of the most common types of hernias in women (correct). Therefore, the correct answer is C. Crural hernias are not typically associated with ipsilateral inguinal hernias.

117. Topic: Cancer of the tail of the pancreas

Correct Answer: B. A tumor of the left hypochondrium

Explanation: Cancer of the tail of the pancreas often presents with a tumor in the left hypochondrium due to the location of the tail of the pancreas. This area corresponds to the left upper quadrant of the abdomen. Other symptoms associated with pancreatic tail tumors may include vague abdominal pain, weight loss, and occasionally jaundice if the tumor involves the common bile duct. However, digestive hemorrhage (A), an umbilical tumor (C), and flying epigastric pain (D) are not typical presentations of cancer of the tail of the pancreas, making them incorrect options. Therefore, the correct answer is B, as it aligns with the anatomical location and typical presentation of pancreatic tail cancers.

118. Topic: Surgical Treatment in Chronic Pancreatitis

Correct Answer: E. None of the above

Explanation: Surgical treatment for chronic pancreatitis in adults is not solely based on the presence of specific radiological findings or imaging features alone. Instead, the decision for surgery is multifactorial and depends on the patient’s symptoms, disease severity, response to medical management, and the presence of complications such as intractable pain, ductal obstruction, or pseudocysts that do not respond to conservative measures. Therefore, options A, B, C, and D, which suggest various radiological findings or imaging modalities, do not dictate the necessity for surgical intervention in chronic pancreatitis. Hence, the correct answer is E, indicating that none of the listed observations alone mandate surgical treatment.

119. Topic: Traumatic Hemoperitoneum due to Splenic Rupture

Correct Answer: D. All answers above

Explanation: In cases of traumatic hemoperitoneum due to spleen rupture, several clinical signs can typically be observed: Dullness of the flanks (due to blood in the peritoneal cavity). Pain on rectal examination (due to irritation of the peritoneum). Radiation of pain to the left shoulder (Kehr’s sign, due to irritation of the diaphragm and phrenic nerve from blood in the peritoneal cavity). These signs collectively indicate the presence of hemoperitoneum secondary to splenic injury. Therefore, the correct answer is D, as all the listed signs are commonly observed in such cases.

120. Topic: Renal Parenchymal Tumors

Correct Answer: E. Simple kidney cyst

Explanation: The most common renal parenchymal tumor is a simple kidney cyst. Simple kidney cysts are benign fluid-filled sacs that can develop in the kidneys, often as a result of age-related changes. They are typically asymptomatic and discovered incidentally during imaging studies for other conditions. Unlike other options listed: Renal adenoma: These are benign tumors of the kidney, less common than simple kidney cysts. Adenocarcinoma: This refers to malignant tumors of the kidney, such as renal cell carcinoma, which are less common than simple cysts. Angioma: This is a vascular tumor of the kidney, also less common than simple kidney cysts. Angiomyolipoma: A benign tumor composed of blood vessels, smooth muscle cells, and fat cells, which is less common than simple cysts. Therefore, simple kidney cysts are the correct answer as they are the most common renal parenchymal tumors encountered clinically.

121. Topic: Bladder Cancer Severity Factors

Correct Answer: C. The depth of penetration into the bladder wall

Explanation: The severity of bladder cancer is primarily determined by the depth of penetration of the tumor into the bladder wall. This factor correlates directly with the stage of the cancer and its potential for metastasis. The deeper the tumor invades into the bladder wall, the more advanced and potentially aggressive the cancer is considered. The importance of hematuria: While hematuria (blood in the urine) is a common symptom of bladder cancer, its presence alone does not indicate the severity or stage of the cancer. The size and number of tumors: While these factors contribute to the staging of bladder cancer, they do not independently determine severity. The existence of ureteral dilation above the tumor: This suggests obstruction and potential spread of the tumor, but it is not the primary determinant of severity. The age of the patient: Age can influence prognosis and treatment decisions but does not directly correlate with the severity of bladder cancer. Therefore, the correct answer is C because the depth of tumor penetration into the bladder wall is a critical factor in determining the severity and stage of bladder cancer.

122. Topic: Benign Prostatic Hyperplasia (BPH) Obstructive Symptoms

Correct Answer: E. The decrease in the strength of the urinary stream

Explanation: In benign prostatic hyperplasia (BPH), the prostate gland enlarges, causing compression of the urethra and leading to obstructive urinary symptoms. One of the hallmark symptoms of obstructive syndrome in BPH is a decrease in the strength of the urinary stream. This occurs because the enlarged prostate obstructs the flow of urine through the urethra, resulting in a weaker stream. Late urinary drops: This can occur due to incomplete emptying of the bladder after urination, but it is not specific to obstructive symptoms. Nocturia: Nocturia, or waking up at night to urinate, can occur due to increased urine production or reduced bladder capacity but is not directly related to obstructive symptoms. Pollakiuria: Pollakiuria refers to frequent urination, which can occur in various urinary conditions but is not specific to obstructive symptoms. Urinary burns: This term typically refers to dysuria, which can occur due to inflammation or infection of the urinary tract, rather than directly related to obstructive symptoms. Therefore, the correct answer is E because a decrease in the strength of the urinary stream is a characteristic obstructive symptom in men with benign prostatic hyperplasia.

123. Topic: Prostate Adenocarcinoma

Correct Answer: D. Thrombocytopenic purpura

Explanation: Prostate adenocarcinoma can present with several symptoms related to urinary and reproductive functions. Hemospermia (A), initial hematuria (B), and terminal hematuria (E) are all potential symptoms that may occur due to the involvement of the prostate gland. Anuria (C), though rare, can occur in advanced cases where the cancer obstructs the urinary tract. Thrombocytopenic purpura (D), however, is not typically associated with prostate adenocarcinoma. This condition involves a decrease in platelet count leading to bleeding and bruising due to impaired clotting, which is not a common manifestation of prostate cancer. Therefore, option D is the correct answer as it does not fit the typical symptom profile of prostate adenocarcinoma.

124. Topic: Diagnosis of Testicular Cancer

Correct Answer: D. Surgical exploration via the inguinal route

Explanation: When faced with a sensitive testicular mass suspected to be testicular cancer, the most appropriate method to confirm the diagnosis is surgical exploration via the inguinal route (option D). This approach allows for direct visualization and biopsy of the testicular mass, which is crucial for histopathological diagnosis. Scrotal ultrasound (option A) is useful for initial evaluation and characterization of testicular masses but is not definitive for diagnosing cancer without biopsy confirmation. Testicular biopsy (option B) may be considered in some cases, but it carries a risk of seeding cancer cells along the biopsy tract and is not typically recommended as a primary diagnostic tool. The dosage of ACEs (option C) and hospitalization for heparin infusion and local care (option E) are not relevant for the diagnosis of testicular cancer. Therefore, option D, surgical exploration via the inguinal route, is the correct answer for making a positive diagnosis of testicular cancer.

125. Topic: Subrenal Aortic Aneurysm Complications

Correct Answer: B. A dissection of the celiac trunk

Explanation: Subrenal aortic aneurysms can lead to several complications. These include digestive hemorrhage (A), as the aneurysm may affect nearby blood vessels or organs, and rupture in the inferior vena cava (C), which can occur if the aneurysm expands and breaks through the vessel wall. Left ureteral compression (D) is possible due to the aneurysm’s proximity to the ureters, causing urinary symptoms, and vertebral erosion (E) can happen as the aneurysm erodes adjacent vertebral bodies. However, a dissection of the celiac trunk (B) is not typically associated with subrenal aortic aneurysms, making this the incorrect statement. The celiac trunk is located higher up in the abdominal aorta, and dissections involving it are generally related to aneurysms in the suprarenal or thoracic aorta rather than subrenal ones.

126. Topic: Antero-internal Dislocation of the Shoulder

Correct Answer: B. The branchio-thoracic bruise

Explanation: Antero-internal dislocation of the shoulder is characterized by several signs. The branchio-thoracic bruise (B) is a key indicator, suggesting injury or bruising around the shoulder and upper arm area. Other signs include irreducible abduction (A), indicating difficulty or inability to move the arm away from the body, and filling of the delto-pectoral groove (E), which can indicate displacement of the shoulder joint. The subacromial void (C) and external ax kick (D) are not typically associated with antero-internal shoulder dislocation.

127. Topic: Poteau-Colles Fracture Characteristics

Correct Answer: E. Paresthesias in the territory of the median nerve

Explanation: The Poteau-Colles fracture, commonly known as a Colles’ fracture, is a distal radius fracture typically presenting with specific clinical signs. A wrist deformity (A) is often evident due to the displacement of the fracture. The ascent of the radial styloid (B) occurs as the radial fragment displaces dorsally and proximally. Internal projection of the ulnar styloid (C) can be seen due to the radial deviation of the hand. A supra-articular dorsal pain point (D) is common, reflecting the site of fracture and soft tissue injury. However, paresthesias in the territory of the median nerve (E) are not a typical feature of this fracture. While median nerve injury can occur, it is not a defining characteristic of a Poteau-Colles fracture, making this the incorrect statement. The primary clinical features focus on the anatomical deformities and localized pain rather than nerve symptoms.

128. Topic: Recognizing Collateral Nerve Section in Finger Wounds

Correct Answer: C. Loss of sensibility of a hemipulp

Explanation: A section of the collateral nerve in a finger wound is most accurately identified by the loss of sensibility in a hemipulp (C). This is because the collateral nerves provide sensory innervation to the sides of the finger pulp, and their injury results in a distinct sensory deficit. A cool fingertip (A) might indicate vascular compromise rather than nerve damage. Lack of mobility in finger flexion (B) and loss of active extension of the 2nd and 3rd phalanx (D) suggest tendon or muscle injury rather than nerve damage. Pulpal hyperesthesia (E) would indicate increased sensitivity, which is inconsistent with nerve section. Thus, the loss of sensibility in a hemipulp is the most direct sign of collateral nerve injury.

129. Topic: Disadvantages of Surgical Treatment for Open Leg Fractures

Correct Answer: B. Delayed consolidation

Explanation: Surgical treatment of an open leg fracture is associated with the disadvantage of delayed consolidation (B). This refers to the extended time required for the bone to heal and unite properly, which can be prolonged due to factors like the severity of the injury, the need for precise surgical alignment, and potential complications from the surgery itself. The need for repeated radiographic checks (A), risk of stiffness (C), and thromboembolic risk (D) are considerations in both surgical and orthopedic treatments, but delayed consolidation specifically highlights a potential drawback of surgical intervention, making it the correct and most relevant disadvantage in this context.

130. Topic: Diagnosis of Medial Meniscal Tear of the Knee

Correct Answer: B. Functional instability

Explanation: The diagnosis of a medial meniscal tear is primarily guided by symptoms such as pain and its specific location (A), quadriceps amyotrophy (C), the standard radiological appearance (D), and knee blocking (E). These factors are direct indicators of a meniscal tear. Functional instability (B), however, is not specific to medial meniscal tears and can be associated with various other knee pathologies, making it the incorrect statement. The focus in diagnosing meniscal tears is on localized symptoms and specific diagnostic tests rather than general knee instability.

131. Topic: Sprain of the External Lateral Ligament of the Ankle

Correct Answer: D. Forced inversion of the foot

Explanation: A sprain of the external lateral ligament of the ankle typically occurs due to a mechanism of forced inversion of the foot (D). This movement stretches and potentially tears the lateral ligaments, which are not designed to handle extreme inward rolling. Other mechanisms, such as forced eversion (A), forced abduction of the rear foot (B), forced equine (C), and forced ankle slope (E), do not commonly cause injury to the external lateral ligament, making them incorrect in this context. The emphasis in diagnosing this type of sprain is on the inversion mechanism.

132. Topic: Complications of Severe L4 Fracture

Correct Answer: C. An abolition of a patellar reflex

Explanation: A severe L4 fracture can directly affect the L4 nerve root, leading to the abolition of the patellar reflex (C), as the L2-L4 spinal nerves mediate this reflex. Other complications such as involvement of the terminal cone with bladder disorders (A), hematomyelia (B), and cauda equina syndrome (D) are not typically associated specifically with an L4 fracture. The focus for diagnosing this complication revolves around the direct neurological impact on the L4 level.

133. Topic: Esophageal Cancer Dysphagia

Correct Answer: B. It first marked for solid food

Explanation: Dysphagia in esophageal cancer is typically first noticeable with solid foods (B) because the growing tumor narrows the esophageal lumen, making it difficult for solid substances to pass through. As the cancer progresses, dysphagia may eventually affect the ability to swallow liquids as well. Other signs such as evidence of mediastinal extension (A), dysphagia appearing at the onset of tumor growth (C), and capricious evolution (D) are not characteristic of the initial presentation of dysphagia in esophageal cancer. The initial symptom being difficulty with solid food is a key indicator in diagnosing esophageal cancer.

134. Topic: Mechanism of Gastric Ulcers

Correct Answer: C. Decreased mucosal barrier resistance and/or wall fragility

Explanation: The predominant factor in the mechanism of gastric ulcers is decreased mucosal barrier resistance and/or wall fragility (C). This makes the gastric lining more susceptible to damage from stomach acid and pepsin. While acid hypersecretion of vagal origin (A) and due to excessive gastrin secretion (B) can contribute to ulcer formation, they are more commonly associated with duodenal ulcers. An increase in the number of parietal cells (D) and gastric atrophy (E) are less directly related to the primary mechanism of gastric ulcer development. The focus is on the integrity and defense mechanisms of the gastric mucosa rather than just the levels of acid production.

135. Topic: Treatment of Peptic Ulcer Disease in Zollinger-Ellison Syndrome

Correct Answer: C. Gastrectomy

Explanation: In Zollinger-Ellison syndrome, which is characterized by gastrin-secreting tumors leading to severe peptic ulcer disease, the recommended treatment is gastrectomy (C). This surgical procedure involves removing the stomach to control excessive acid production effectively. Supra-selective vagotomy (A) and truncal vagotomy with antrectomy (B) are less effective because they do not address the root cause, which is the gastrin-secreting tumor. Total gastrectomy (D) is often too extensive and may not be necessary. Upper pole gastrectomy (E) is not relevant in this context. The primary goal is to eliminate the source of excessive acid production, which is best achieved with a gastrectomy.

136. Topic: Appendiceal Plastron

Correct Answer: E. Requires emergency surgery

Explanation: Appendiceal plastron refers to a localized form of peritonitis around the appendix, typically caused by the agglutination of intestinal loops and omentum. The characteristics of appendiceal plastron include the formation of a mass in the right iliac fossa (D) and it is often treated effectively with antibiotics (C). However, unlike acute appendicitis which often requires emergency surgery, appendiceal plastron (E) does not typically mandate immediate surgical intervention. Instead, it can often be managed initially with antibiotics and then followed by elective surgery after the acute inflammation has subsided. Therefore, E is the incorrect statement in this context.

137. Topic: Appendiceal Peritonitis

Correct Answer: D. All answers

Explanation: Appendiceal peritonitis refers to the inflammation and infection of the peritoneum surrounding the appendix, typically due to a perforated appendicitis. The management of appendiceal peritonitis involves several key interventions: Emergency surgical intervention: Prompt surgical removal of the inflamed appendix is usually necessary to prevent further complications such as abscess formation or generalized peritonitis. Pus sampling for bacteriological purposes: During surgery, pus or intra-abdominal fluid sampling for bacteriological analysis helps guide appropriate antibiotic therapy. Peritoneal toilet: Thorough washing and cleansing of the peritoneal cavity (peritoneal toilet) are essential to remove infectious debris and reduce the risk of ongoing infection. Therefore, all of the options (A, B, and C) are essential components of the management of appendiceal peritonitis, making option D the correct answer.

138. Topic: Cecal Volvulus

Correct Answer: C. Vomiting is often hemorrhagic

Explanation: Cecal volvulus is a condition where the cecum twists on its mesentery, leading to obstruction of the bowel. The correct statement among the options provided is: Vomiting is often hemorrhagic. Cecal volvulus typically presents with the following features: A. It may be secondary to lack of attachment of the cecum: True. Cecal volvulus can occur due to a congenital anomaly where the cecum lacks proper fixation. B. It frequently has a sudden clinical onset: True. Cecal volvulus often presents acutely with severe abdominal pain and symptoms of bowel obstruction. D. The stopping of materials and gases is clear: True. Bowel sounds are absent or reduced due to the obstruction, leading to a lack of peristalsis. E. The pain is often intense: True. Patients with cecal volvulus typically experience severe abdominal pain due to bowel distension and ischemia. Option C is incorrect because vomiting in cecal volvulus is typically non-hemorrhagic, consisting of bile-stained fluid or undigested food contents due to the proximal obstruction. Hemorrhagic vomiting is more characteristic of conditions such as upper gastrointestinal bleeding or Mallory-Weiss syndrome, not cecal volvulus. Therefore, the correct answer is C.

139. Topic: Acute Generalized Peritonitis of Appendicular Origin

Correct Answer: E. The existence of the defense of the right hypochondrium

Explanation: Acute generalized peritonitis due to appendicular origin typically presents with specific clinical features. These include a history of painful crises in the right iliac region (A), pain on rectal examination (B) due to local inflammation affecting adjacent structures, fever at the onset (C) as a sign of systemic response to infection, and the initial signs beginning at the level of the right iliac fossa (D), where the appendix is anatomically located. Defense of the right hypochondrium (E) suggests involvement of structures not typically affected by appendicitis and is therefore not consistent with appendicular peritonitis. Defense of the right hypochondrium could indicate involvement of the liver or gallbladder, which are not typically related to appendicitis.

140. Topic: Douglas Cul-de-sac Abscess

Correct Answer: E. All answers

Explanation: Douglas cul-de-sac abscess, also known as a pelvic abscess, can manifest with several characteristic features: It can follow appendicular peritonitis: Douglas cul-de-sac abscess can develop as a complication of various intra-abdominal infections, including appendicular peritonitis. It is accompanied by oscillating fever: Pelvic abscesses often present with fluctuating or oscillating fever due to ongoing infection and inflammation. It is the rectal examination which often allows its diagnosis: Examination of the rectum can reveal tenderness, swelling, or fluctuance, suggesting the presence of a pelvic abscess. It may be accompanied by dysuria in humans: Depending on the size and location of the abscess, adjacent structures such as the bladder or ureters can be affected, leading to symptoms like dysuria. Therefore, all of the statements (A, B, C, and D) are true regarding Douglas cul-de-sac abscess, making answer E correct.

141. Topic: Complications of Untreated Intra-funicular External Oblique Inguinal Hernia

Correct Answer: D. Thrombosis of the ipsilateral iliac artery

Explanation: Untreated intra-funicular external oblique inguinal hernia can lead to several complications. Necrosis of a small loop (A), chronic irreducibility (B), necrosis of an epiploic fringe (C), and bowel obstruction (E) are all potential complications due to hernia incarceration and strangulation. However, thrombosis of the ipsilateral iliac artery (D) is not a recognized complication directly linked to untreated inguinal hernia. This complication involves a separate vascular issue that is not typically associated with hernia pathology.

142. Topic: External Oblique Inguinal Hernia

Correct Answer: B. Not found in the old man

Explanation: External oblique inguinal hernia is a common type of inguinal hernia. It typically occurs due to weakness in the abdominal wall, which may be congenital (A). The diagnosis is primarily clinical, often involving physical examination findings (C). This type of hernia carries a risk of strangulation (D), which is a serious complication necessitating urgent surgical intervention (E). However, it can occur in individuals of any age, including older adults, making option B incorrect.

143. Topic: Advanced Chronic Pancreatitis

Correct Answer: C. Presence of calcifications in the pancreatic area visible on X-ray without preparation of the abdomen

Explanation: Advanced chronic pancreatitis often manifests with calcifications in the pancreatic area, which are visible on X-ray without the need for specific preparation (C). These calcifications are considered almost pathognomonic due to their characteristic appearance in imaging studies. Steatorrhea (A) and diffuse increase in pancreatic parenchymal density on CT scan (B) are supportive but less specific findings. Dilatation of the Wirsung canal on ultrasound (D) and short stenosis of the main bile duct (E) are associated with pancreatic ductal abnormalities but are not as indicative of advanced chronic pancreatitis as calcifications seen on X-ray.

144. Topic: Subcapsular Hematoma of the Spleen

Correct Answer: D. All answers

Explanation: To confirm the diagnosis of a subcapsular hematoma of the spleen following abdominal contusion, multiple imaging modalities can be used: An ultrasound (A) is often the initial imaging modality of choice due to its non-invasiveness and ability to visualize splenic injuries. Celiac arteriography (B) may be considered if there is suspicion of active bleeding or vascular injury. A CT scan (C) provides detailed imaging of the spleen and surrounding structures, offering valuable information about the extent and nature of the hematoma. Therefore, all of the options (A, B, and C) are appropriate for confirming the diagnosis of a subcapsular hematoma of the spleen, making option D the correct answer. 

145. Topic: Renal Colic

Correct Answer: A. Pain in the hypochondrium with ascending irradiation

Explanation: Renal colic typically presents with severe, intermittent flank pain that radiates to the groin. The correct symptoms associated with renal colic include: Hematuria (B): Blood in the urine due to irritation of the urinary tract by the passing stone. Increase in size of painful kidney (C): Swelling and enlargement of the kidney affected by obstruction or inflammation. Extravasation of contrast medium on urography (D): Leakage of contrast material outside the normal urinary tract anatomy, indicative of ureteral injury or obstruction. Pollakiuria (E): Increased frequency of urination, often seen in response to irritation from the stone passing through the ureter. Pain in the hypochondrium with ascending irradiation (A) is not typically associated with renal colic. Instead, renal colic pain is usually localized to the flank and radiates to the groin or lower abdomen. Therefore, option A is the incorrect answer in the context of signs associated with renal colic.

146. Topic: Pain related to distention of the ureter

Correct Answer: A. In bladder cancers, hematuria

Explanation: Pain related to distention of the ureter typically radiates to the groin and external genitalia. In bladder cancers, hematuria is a common accompanying sign due to the presence of blood in the urine, which can occur as a result of the tumor’s infiltrative nature affecting the bladder lining.

147. Topic: Sexual Disorders After Prostate Adenectomy

Correct Answer: A. Loss of libido

Explanation: After prostate adenectomy (prostatectomy), loss of libido (A) is a common sexual disorder due to changes in hormone levels and nerve damage. Erectile dysfunction (B) and anejaculation (C) are also frequent. Retrograde ejaculation (D) occurs when semen enters the bladder instead of exiting through the urethra. Premature ejaculation (E) involves early ejaculation rather than the loss of libido typically seen post-prostatectomy.

148. Topic: Diagnosis of Prostate Cancer

Correct Answer: C. Prostate biopsy

Explanation: Prostate cancer diagnosis primarily relies on prostate biopsy (C), where tissue samples are collected and examined for cancerous cells. Acid phosphatase levels (A) were previously used but are less specific and sensitive compared to biopsy. Intravenous urography (B) is used to assess kidney function and anatomy but not for prostate cancer diagnosis. Carcinoembryonic antigen (D) is more relevant in other cancers, not prostate. Prostate ultrasound (E) aids in visualizing the prostate but does not provide definitive cancer diagnosis like biopsy does.

149. Topic: Testicular Cancer

Correct Answer: C. Gynecomastia

Explanation: Testicular cancer typically presents with symptoms such as acute intrascrotal pain (A), palpable mass or swelling (B), and in some cases, signs like varicocele (D) or intra-scrotal heaviness (E). Gynecomastia (C), however, is not associated with testicular cancer but rather with hormonal imbalances or conditions affecting breast tissue enlargement unrelated to testicular cancer.

150. Topic: Abdominal Aortic Aneurysm

Correct Answer: B. A throbbing abdominal mass

Explanation: Abdominal aortic aneurysm (AAA) is characterized by a throbbing abdominal mass (B), which is a pathognomonic sign due to the pulsatile nature of the aneurysm. Other symptoms such as abdominal systolic murmur (A), systolic expansion of the mass (C), aortic compression pain (D), and intermittent claudication (E) of the lower limbs may also be associated with AAA but are not pathognomonic.