Sohag University
Sohag faculty of medicine
4/5/2016
Surgery department
Time allowed: 3 hours
M.S.C General Surgery
Paper II


I- Discuss :- (20 marks)
Management of small intestinal tumours.

II- Write short account on:- (10 marks for each)
1- Aetiology and management of flail chest.
2- Clinical features, diagnosis and treatment of gastroesophageal
reflux disease (GERD).
3- Pott's disease.
4- Management of bile leak after biliary tract surgery.
5- Differential diagnosis of unilateral swollen limb.
6- Strategies of management of splenic trauma.

III- A 60- year- old male complains of left loin pain for 2 months, he is
hypertensive, diabetic and heavy smoker. Positive findings are:
BP= 160/100 mmHg. Urine analysis shows RBCs count of 35/ HPF. U/S
shows solid central mass in left kidney with no pelvicalyceal dilatation.
1) What is the most likely diagnosis? (5 marks)
2) What is the importance of genital examination in this patient? (5
marks)

IV- Choose the best single answer (10 marks):-
1. The appropriate surgical treatment for suspected carcinoma of the testis is:
A. Transscrotal percutaneous biopsy.
B. Transscrotal open biopsy.
C. Repeated examinations.
D. Inguinal exploration, control of the spermatic cord, biopsy, and radical orchectomy if tumor
is confirmed.


2. A 28-year-old white male presents with asymptomatic testicular enlargement. Which of
the following statement is true concerning his diagnosis and management?
A. Tumor markers, b-fetoprotein (AFP) and human chorionic gonadotropin (HCG) will both be
of value in the patient regardless of his ultimate tissue type
B. Orchiectomy should be performed via scrotal approach
C. The diagnosis of seminoma should be followed by postoperative radiation therapy
D. With current adjuvant chemotherapy regimens, retroperitoneal lymphadenectomy is no
longer indicated for non-seminomatous testicular tumors


3. hurthle cells are seen in ?
A. hashimoto's thyroiditis
B. follicular cell carcinoma
C. hurthle cell thyroid adenoma
D. all the above


4. C cells populate which part of the lateral lobe of the thyroid ?
A. upper one-third of the lateral lobe of thyroid
B. middle one-third of the lateral lobe of thyroid
C. lower one-third of the lateral lobe of the thyroid
D. distributed equally all over the lateral lobe of the thyroid


5. MEN 2A and MEN 2B syndromes are associated with germline mutations in:
A. The p53 tumor suppressor gene.
B. The H-ras gene.
C. The N-myc gene.
D. The RET proto-oncogene

.
6. Which is the most appropriate form of biopsy for a major salivary gland tumour?
a) Open surgical biopsy to allow histology.
b) Salivary washings.
c) Frozen section during formal excision.
d) Fine-needle aspiration cytology.
e) Biopsy is contraindicated.


7. Which of the following is true regarding sick euthyroid syndrome?
a) It can be present as high T3 and T4
b) TSH may be high
c) TSH is usually suppressed
d) Thyroid replacement is favoured


8. Which of the following is true regarding Cushing's disease?
a) Patients with Cushing's disease are at increased risk of hospital-acquired infections.
b) Patients do not require prophylactic anticoagulation.
c) Following surgical removal of unilateral adrenal adenomata, cortisol supplementation is not
necessary.
d) Nelson's syndrome is a cause of Cushing's disease.
e) Cushing's-associated medical conditions need not be treated medically preoperatively.


9. “CYSTIC HYGROMA” is:
a)Lymphangiectasia.
b)Cavernous haemangioma.
c)Sebaceous cyst.
d)Dermoid cyst.
e)Haemangioma.


10. Which of the following is not true for ectopic pancreas:
a) stomach and duodenum are the most common site
b) Ectopic pancreas appears as a submucosal irregular nodule in the wall
c) Islet tissue is present in all the organs where ectopic pancreas is present
d) Ulceration, bleeding and obstruction are the most common symptoms