1. Amongst the following signs which one can be considered as being almost pathognomonic of evolved chronic pancreatitis?
2. In the list below, which one of is incompatible with the diagnosis on intra-epithelial carcinoma of the cervix?
3. In the observation of a patient with a fracture of the vault of the skull associated with a brief loss of consciousness, the following point to an extradural hematoma except one. Which one?
4. Among the following cancers, which one has an increase in incidence due to the inhalation of asbestos fibres?
5. Among the following propositions which one is false concerning pseudoarthrosis after a fracture of the neck of the femur?
6. A surgical operation is indicated for a prostatic adenoma when.
7. Among the following complications of chronic pancreatitis which one is false?
8. Among the following clinical signs, one not a component of a complete acute ischaemic syndrome of a limb observed in the first six hours. Which one?
9. Patients who have had a splenectomy are at risk of severe bacterial septicaemia. Among the following bacteria, which one particularly threatens these subjects?
10. In case of cancer of the head of the pancreas, the following signs can be observed except one. Which one?
11. The following surgical diseases constitute differential diagnoses of intestinal obstruction except one. indicate the one that is false
12. Intestinal obstruction of the elderly leads to the suspicion of the following aetiologies except one. Which one?
13. Among the following statements, which one relates to common bile duct stones:
15. In patient with upper gastro-intestinal bleeding
16. a 16-year-old man presents with blue right arm with absent radial pulse and painful passive finger extension after a supracondylar fracture of the humerus . He has:
17. A 70-year-old woman complains of right sided pleuritic chest pain 10 days after a fractured neck of the femur.
18. A 65-year-old woman falls on an out-stretched arm shows weakness of wrist extensors. She has:
19. A 35-year-old woman present after a fall on an outstretched arm. Her radiograph shows a nondisplaced transverse fracture of the right humeurs
20. A 24-year man presents with a swollen painful hand after falling over playing squash. His radiograph reveals a scaphoid fracture.
21. A 65-year-old woman requires treatment for a fractured neck of femur
22. Which of the following statements concerning fluid and electrolyte balance are correct?
23. A deteriorating level of consciousness in the accident department an hour after serious head injury
24. A 28-year-old man presents with recurrent Crohn’s disease. He has previously had multiple small bowel resections and has 50 cm of small intestine left. One this occasions he has admitted with an enterocutaneous fistula. Witch of the following options would provide the most suitable nutritional support?24. A 28-year-old man presents with recurrent Crohn’s disease. He has previously had multiple small bowel resections and has 50 cm of small intestine left. One this occasions he has admitted with an enterocutaneous fistula. Witch of the following options would provide the most suitable nutritional support?
25. Which of the following statements relates to the peptic ulcer disease?
26. Necrotizing pancreatitis
27. Which of the following is the most common cause of obstructive jaundice in-patient with chronic pancreatitis
28. Concerning cholangiocarcinoma, which of the following if false?
29. A 30-year-old cyclist wearing no helmet was hit by a car travelling at 29m/h; he was taken to the local emergency department. On examination he was confused, localizing to pain and eye, opening to speech. Which of the following is correct?
30. A 48-year-old diabetic patient has been admitted with diabetic ketoacidosis (DKA). On examination there is an erythematous boggy area on the left foot over a small ulcer which is the likely cause of the DKA. What is the management after resuscitating the patient?
31. Venous thromboembolism prophylaxis is not required in:
33. Which one of the following is not a recognized long-term complication of partial gastrectomy?
34. The anatomical site of the neck of a femoral hernia is the
35. A 45-year-old patient in shock complaining of sudden-onset generalized upper abdominal pain. Radiating to the right iliac fossa and the tip of his right shoulder. He reports one episode of vomiting but none since. He has no past medical problem. On examination his abdomen is rigid and bowel sound are absent the diagnosis is:
36. A 45-year-old man present to the emergency department with a history of coffee-ground vomiting. He also reports that 2 days his stool has appeared darker than usual. Which of the following gives the most sensitive guide to the severity of his gastrointestinal haemorrhage?
38. Postoperative atelectasis is more common in:
39. The following statements concern cardiogenic shock:
40. The following features are in keeping with a postoperative opiate overdose
41. Which of the following is a contra-indication to major elective surgery requiring general anaesthesia:
42. Barrett’s oesophagus is:
43. In Paget’s disease of the breast
44. Which of the following is a classical feature of a perforated peptic ulcer
45. Which of the following statement is true concerning gastric carcinoma:
46. Strangulating small bowel obstruction is less common in:
47. In small bowel mesenteric ischaemia:
48. Direct inguinal hernias
49. A sliding type inguinal hernia:
50. Which of the following features is characteristics of venous ulcers?
OBSTETRICS / GYNAECOLOGY
Instructions: Questions 51-75 : Choose the best single answer from the different propositions provided for each question.
51. The exact sequence of the development of the embryo is as follows:
52. During the cephalic delivery, the normal sequence of the evolution of delivery is
53. The most common method of confirming premature membranes rupture in our hospital is by
54. The complication of B-mimetic drugs includes one of these symptoms
55. Approximately what percentage of spontaneous first trimester abortion shows chromosomal abnormalities?
56. The commonest organism causing Urinary tract infection in pregnant women is:
57. A 59-year-old postmenopausal woman presents a month’s history of per vaginal bleeding. On speculum examination, the cervix appears normal and there is no vaginal discharge. What is the single most appropriate diagnostic test?
58. A 24-year-old woman reports she has missed the first pill her second pill pack. She had unprotected sexual intercourse (UPSI) 2 days ago. What is the single most appropriate management?
59. A 29-year-old woman with a family issue of breast cancer in her mother at age 35 would like to be screened for breast carcinoma. What is the single most appropriate management?
60. A patient experiences dystocia (difficult and prolonged labour) with a breech baby. Weighs 3.5kg but does not move his right arm. What is the single most likely diagnosis?
61. A 52-year-old married woman presents with bleeding per vagina. She reached menopause at 48. Nothing abnormal is discovered on examination of the cervical os. What is the single next most appropriate investigations?
62. A 45-year-old woman reported a green discharge from her right nipple. She is concerned. One exam, there are no lumps and on axillary lymph and adenopathy. There is redness and tenderness around the nipple. What is the single most likely diagnosis?
63. A 30-year-old woman with pregnancy of 30 weeks is involved in a road traffic accident. What is the single precaution to take with this woman during the initial assessment?
64. A 55-year-old woman post vaginal hysterectomy only complains of constant urine dribbling. What is the single most likely diagnosis?
65. A 34-year-old woman with pregnancy of 11 weeks would like to be screened for down’s syndrome baby. She is adamant she wants testing now and does not want to wait. What is the single most appropriate screening test?
66. A 15-year-old school girl complains of dysmenorrhea and she has a regular cycle. What is the single most appropriate management?
67. A 40-year-old woman with a child cystic fibrosis would like antenatal testing to ensure her second child is not affected. What is the single next most appropriate investigation?
68. A 40-year-old woman has an antenatal serum triple marker test. The alpha foeto-protien and estradiol level are low but the hCG is twice normal. What is the single most likely potential diagnosis?
69. A 30-year-old woman’s smear test comes back positive for severe dyskaryosis. What is the most appropriate management?
70. A 40-year-old woman’s smear test came back positive for CIN II. What is the single most appropriate management?
71. A 46-year-old woman informs you that her mother was diagnosed with ovarian cancer at age 55. She is concerned as she now smokes, drinks and is HRT (hormone replacement therapy). What is the single most appropriate management?
72. A 45-year-old woman reports nipple changes. On examination, there are scaly, erythematous plaques on and around the inverted nipple. On squeezing the nipple. A serosanguinolent discharge appears. What is the single most likely diagnosis?
73. A 25-year-old woman would like to know the mode of action of the mini-pill. What is the single best answer?
74. A 40-year-old woman with 34 weeks pregnancy is noted to have an incident BP of 160/100mmhg on an antenatal review. She denies blurring vision. There is no proteinuria and no signs of peripheral oedema. Blood tests are normal. What is the single most appropriate management?
75. A 40-year-old woman is brought in emergency with shock and profuse vaginal bleeding she had delivered her baby at home. On examination a low transverse scar is noted. What is the single most likely diagnosis?
76. A 6-week pregnancy woman present with right-sided pelvic pain. She has hqs not had a scan for this pregnancy. There is no per vaginal bleeding. She presents to casualty at 2 a with a BP of 100mmHg and pulse of 80/minute. What is the single most appropriate management
77. A 30-year-old woman complain of 7 months of amenorrhoea, facial hair and acne. She has put on 2kg in the past month. What is the single most likely diagnosis?
78. Two hours later, she is noted to have significant post-partum haemorrhage
79. Following a spontaneous vaginal delivery, a 22-year-old woman continues to bleed in spite of the use of oxytocin. The uterus appears to contract well but then relaxes with increased bleeding. What is the single most likely diagnosis?
80. A 27-year-old woman whose last period was 8 weeks ago presents with heavy vaginal bleeding and left lower quadrant pain. Serum β-HCG is slightly elevated vaginal examination shows a closed cervical os. What is the most probable single diagnosis?
81. A 14-year-old adolescent with normal sexual development complains of amenorrhoea for 5months. Her first menses were 10 months ago, since which she has had three menses. What is the single most likely diagnosis?
82. A 28-year-old woman on combined oral contraceptive pills present with a 3-month history of post coital and intermenstrual bleeding. Speculum examination shows an everted ulcerated cervix. An endocervical smear is normal.
83. A 59-year-old obese woman present with post-menopausal bleeding. She had regular periods until 3 years ago. General and speculum examination reveals no abnormality. Vaginal ultrasound shows endometrial thickening. What is the single most likely diagnosis?
84. A 27-year-old young woman with a history of pelvic infection and 8-week amenorrhea presents with left iliac fossa pain. She also reports a small abundance of liquid and brown vaginal discharge. What is the single most likely diagnosis?
85. A 17-year-old high school student presents 1 week before her exams having missed her period in addition to recurrent colicky abdominal pain and diarrhoea. General examination is normal as are blood tests. Pregnancy test is negative. What is the single most likely diagnosis?
86. A 34-year-old woman presents with a 2-year history of gradually worsening painless menorrhagia. On examination, she is pale and has an enlarged bulky uterus.
87. A 32-year-old woman who is 19 weeks pregnant presents with severe nausea, vomiting and heavy vaginal bleeding. On examination the uterus is large for date. What single most likely diagnosis?
88. A 23-year-old woman presents with pelvic pain fever and vaginal discharge. On examination there is marked lower and adnexal tenderness. There is cervical motion tenderness. What is the most probable single diagnosis?
89. A 37-year-old para 3+2 who is 34 weeks pregnant presents with painless fresh vaginal bleeding of about 150cc in volume. What is the single most likely diagnosis?
90. A 37-year-old woman presents with secondary amenorrhoea, palpitation and weight loss of 5kg despite a good appetite. Pregnancy test is negative. What is the single most probable diagnosis?
91. A 26-year-old woman with amenorrhoea for 7weeks, vaginal spotting and mild right lower quadrant pain. Her periods have always been irregular. On examination, the uterus is of normal size and the right lower quadrant is tender. Her β-HCG level the day before was 110mIU/ml.
92. Investigating a young female with dysuria, vaginal discharge and pelvic pain:
93. A 23-year-old nulligravida stopped her oral contraceptive pills to conceive. She had a menstrual flow after the last pack of contraceptive pills, then was is amenorrhoea for 7 months. She otherwise fit and healthy.
94. A 60-year-old woman presents with a lump in the lower inner quadrant of the right breast. On examination axillary lymphadenopathy is palpable. Mammography showed a 2.3cm mass with microcalcification. What is the single most probable diagnosis?
95. A 32-year-old primiparous woman is fully dilated for 4 hours and has been pushing for 1.5 hours. The foetal head is in occipito-posterior position 4cm below the ischial spine
96. A 34-year-old obese multiparous woman presents in early labour. On examination the presenting part has not engaged the pelvic outlet.
97. A 37-year-old woman presents with a 3 months history of meno-metrorrhagia. She has been on oral contraceptive pills
98. A 27-year-old primiparous woman is admitted to hospital 1 hour after rupture of her membranes. She is 39 weeks pregnant but the baby is small gestational age
99. A 32-year-old multiparous woman is fully dilated for 1 hour and the CTG shows variable decelerations.
100. A 23-year-old airhostess with a history of migraine consult her general practitioner asking for contraception for at least 1 year. Her partner refuses to use condoms
