Sohag University
Sohag faculty of medicine
28/4/2012
Surgery department
Time allowed: 3 hours
MD in general surgery
Paper II

A)Discuss the following question:-
-Obstructive defecation syndrome.
(25 marks)
B) Write brief account on the following questions:-
1-Update management of lymphedema.
(15 marks)
2-Monoclonal antibodies.
(15 marks)
3-Update management of hand injuries.
(15 marks)
4-Bone softening diseases.
(15 marks).

 

1.What is the most important predictor of clinical progression in BPH
A. Gland size
B. Symptom severity
C. PSA
D. Age
E. High post-void residual


2. A patient with acute urinary tract infection (UTI) usually presents with:
A. Chills and fever.
B. Flank pain.
C. Nausea and vomiting.
D. 5 to 10 white blood cells per high-power field (hpf) in the uncentrifuged urine specimen.
E. Painful urination.


3. Renal adenocarcinomas:
A. Are of transitional cell origin.
B. Usually are associated with anemia.
C. Are difficult to diagnose.
D. Are extremely radiosensitive.
E. Frequently are signaled by gross hematuria.


4. Stress urinary incontinence:
A. Is principally a disease of young females.
B. Occurs only in males.
C. Is associated with urinary frequency and urgency.
D. May be corrected by surgically increasing the volume of the bladder.
E. Is a disease of aging produced by shortening of the urethra.


5. Which of the following is true of blunt renal trauma?
A. Blunt renal trauma and penetrating renal injuries are managed similarly.
B. Blunt renal trauma with urinary extravasation always requires surgical exploration.
C. Blunt renal trauma must be evaluated by contrast studies using either IVP or CT.
D. Blunt renal trauma requires exploration only when the patient exhibits hemodynamic
instability.
E. Any kidney fractured by blunt renal trauma must be explored.


6. Carcinoma of the bladder:
A. Is primarily of squamous cell origin.
B. Is preferentially treated by radiation.
C. May be treated conservatively by use of intravesical agents even if it invades the bladder
muscle.
D. May mimic an acute UTI with irritability and hematuria.
E. Is preferentially treated by partial cystectomy.
7. 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.


8. 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


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


10. 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


11. 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.


12. Which of the following is true concerning islet cell neoplasms of the pancreas in
patients with MEN type 1?
A. Islet cell neoplasms in patients with MEN 1 are characteristically multicentric.
B. The most common islet cell neoplasm in patients with MEN 1 is gastrinoma.
C. Islet cell neoplasms in patients with MEN 1 may be malignant.
D. All of the above.


13. Prolactinomas of the pituitary:
A. Most often produce dysfunctional uterine bleeding in women.
B. Most commonly produce infertility in men.
C. When asymptomatic, are best treated surgically early in the microadenoma stage.
D. May enlarge during pregnancy, requiring treatment with bromocriptine or surgery.
E. Commonly occur in patients with MEN 2.


14. Adrenocortical carcinoma:
A. May be suspected in a patient with rapidly progressive Cushing's syndrome and virilizing
features or in asymptomatic patients with adrenal tumors larger than 6 cm on CT.
B. Most often is diagnosed early in its course when disease is confined to the adrenal gland.
C. Is differentiated from benign adrenocortical adenoma by tumor necrosis, hemorrhage, and
cellular features of large hyperchromatic nuclei and more than 20 mitoses per high-power
field.
D. Should be resected only if disease is localized to the adrenal gland; otherwise treatment
with mitotane is indicated.


15.While awaiting surgery on a HMO waiting list, a 50-year-old female with primary
hyperparathyroidism is admitted to the hospital with oliguria, confusion, nausea and
vomiting, muscle weakness and a serum calcium of 13.5 mg/dL. Of the treatment
options below, which one is the most appropriate?
A. Administer 1 gm of hydrocortisone STAT
B. Begin an IV EDTA (chelating agent) infusion STAT
C. Administer IV Mithramycin and calcitonin concurrently and proceed to ICU for cardiac
monitoring
D. Begin a normal saline infusion at 2X maintenance volume followed by 1mg/kg
furosemide IV
E. None of the above